1
|
Manconi M, van der Gaag LC, Mangili F, Garbazza C, Riccardi S, Cajochen C, Mondini S, Furia F, Zambrelli E, Baiardi S, Giordano A, Rizzo N, Fonti C, Viora E, D'Agostino A, Cicolin A, Cirignotta F, Aquilino D, Barassi A, Del Giudice R, Fior G, Gambini O, Giordano B, Martini A, Serrati C, Stefanelli R, Scarone S, Canevini M, Fanti V, Stein HC, Marconi AM, Raimondo E, Viglietta E, Santoro R, Simonazzi G, Bianconcini A, Meani F, Piazza N, Filippakos F, Gyr T. Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study. Sleep Med 2024; 113:41-48. [PMID: 37984016 DOI: 10.1016/j.sleep.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women. METHODS multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum. RESULTS 439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI. CONCLUSIONS The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management.
Collapse
Affiliation(s)
- Mauro Manconi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University of Bern, Bern, Switzerland.
| | - Linda C van der Gaag
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Francesca Mangili
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Susanna Mondini
- UOC NEUROMET IRCCS Institute of Neurological Sciences Bologna, Italy
| | - Francesca Furia
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Simone Baiardi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandra Giordano
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Nicola Rizzo
- Division of Obstetrics and Prenatal Medicine, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Fonti
- IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elsa Viora
- Prenatal Ecography Unit, AOU Città Della Salute e Della Scienza, Dipartimento di Ostetricia e Ginecologia, Torino, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | | | - Daniele Aquilino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandra Barassi
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Renata Del Giudice
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giulia Fior
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Barbara Giordano
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alma Martini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Chiara Serrati
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Rossana Stefanelli
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Silvio Scarone
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mariapaola Canevini
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Valentina Fanti
- Department of Health Sciences, Università Degli Studi di Milano, Italy
| | | | - Anna Maria Marconi
- Department of Health Sciences, Università Degli Studi di Milano, Italy; Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Erica Raimondo
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Emanuela Viglietta
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Rossella Santoro
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinical Neurologica NeuroMet, Ospedale S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy
| | - Giuliana Simonazzi
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Alessandra Bianconcini
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Francesco Meani
- Centro di Senologia Della Svizzera Italiana, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Nicoletta Piazza
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Filippos Filippakos
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Thomas Gyr
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| |
Collapse
|
2
|
Mondini S, Gislon G, Zucali M, Sandrucci A, Tamburini A, Bava L. Risk factors of high somatic cell count and differential somatic cells in early lactation associated with selective dry cow therapy. Animal 2023; 17:100982. [PMID: 37797494 DOI: 10.1016/j.animal.2023.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
The routine use of intramammary antimicrobial products in all dairy cows at the beginning of the dry period is no longer allowed in European Union (EU) countries due to the new Regulation (EU) 2019/6 to reduce antimicrobial resistance. This study investigated the application of a selective dry cow therapy scheme and the risk factors of high individual milk somatic cell count (SCC) and individual neutrophil count in early lactation, as a response to the application of a selective dry cow therapy (SDCT) protocol. The study was carried out on three commercial farms, and a total of 243 lactating cows were monitored at the end of lactation and at the beginning of the next one, 91 of which were dried off without the use of antimicrobials (NoT) based on milk SCC, differential somatic cell count (DSCC), and the response of Vetscan DC-Q milk analyser, using a secret algorithm. The remaining 152 cows received antimicrobials (T). After calving, similar means were observed between the two treatment groups for SCC (4.8 vs 4.9 log10 cells/ml for T and NoT, respectively, P = 0.5) and total milk leucocyte count (TLC) (5 vs 5.1 log10 cells/ml for T and NoT, respectively, P = 0.7) in milk. However, the use of antimicrobials led to a lower DSCC (58 vs 64% for T and NoT, respectively, P = 0.01) and lower percentage of neutrophils (59 vs 64% for T and NoT, respectively, P = 0.05), although the levels of DSCC and percentage of neutrophils in cows dried off without antimicrobials remained lower than the risk threshold suggested by the international literature. A logistic regression was computed after the application of selective dry cow therapy to identify risk factors of high milk SCC (≥100 000 cells/mL) at the beginning of lactation. Increased milk SCC after calving was related to high SCC at the end of lactation and abandonment of antimicrobial therapy at dry-off. Moreover, the length of the dry period, milk protein content, and flank cleanliness in the last test day before dry-off were other factors in the logistic regression. Neutrophil counts at the beginning of the next lactation were affected by the same factors that influenced SCC, together with milk production, TLC, and macrophages on the last test day. The results obtained in these studied farms showed that selective dry cow therapy may be applied without adversely affecting the next lactation.
Collapse
Affiliation(s)
- S Mondini
- Department of Agricultural and Environmental Sciences, University of Milan, via Celoria 2, 20133 Milan, Italy
| | - G Gislon
- Department of Agricultural and Environmental Sciences, University of Milan, via Celoria 2, 20133 Milan, Italy
| | - M Zucali
- Department of Agricultural and Environmental Sciences, University of Milan, via Celoria 2, 20133 Milan, Italy
| | - A Sandrucci
- Department of Agricultural and Environmental Sciences, University of Milan, via Celoria 2, 20133 Milan, Italy
| | - A Tamburini
- Department of Agricultural and Environmental Sciences, University of Milan, via Celoria 2, 20133 Milan, Italy.
| | - L Bava
- Department of Agricultural and Environmental Sciences, University of Milan, via Celoria 2, 20133 Milan, Italy
| |
Collapse
|
3
|
Pensato U, Amore G, Muccioli L, Sammali S, Rondelli F, Rinaldi R, D'Angelo R, Nicodemo M, Mondini S, Sambati L, Asioli GM, Rossi S, Santoro R, Cretella L, Ferrari S, Spinardi L, Faccioli L, Fanti S, Paccagnella A, Pierucci E, Casadei B, Pellegrini C, Zinzani PL, Bonafè M, Cortelli P, Bonifazi F, Guarino M. CAR t-cell therapy in BOlogNa-NEUrotoxicity TReatment and Assessment in Lymphoma (CARBON-NEUTRAL): proposed protocol and results from an Italian study. J Neurol 2023; 270:2659-2673. [PMID: 36869888 DOI: 10.1007/s00415-023-11595-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To investigate neurotoxicity clinical and instrumental features, incidence, risk factors, and early and long-term prognosis in lymphoma patients who received CAR T-cell therapy. METHODS In this prospective study, consecutive refractory B-cell non-Hodgkin lymphoma patients who received CAR T-cell therapy were included. Patients were comprehensively evaluated (neurological examination, EEG, brain MRI, and neuropsychological test) before and after (two and twelve months) CAR T-cells. From the day of CAR T-cells infusion, patients underwent daily neurological examinations to monitor the development of neurotoxicity. RESULTS Forty-six patients were included in the study. The median age was 56.5 years, and 13 (28%) were females. Seventeen patients (37%) developed neurotoxicity, characterized by encephalopathy frequently associated with language disturbances (65%) and frontal lobe dysfunction (65%). EEG and brain FDG-PET findings also supported a predominant frontal lobe involvement. The median time at onset and duration were five and eight days, respectively. Baseline EEG abnormalities predicted ICANS development in the multivariable analysis (OR 4.771; CI 1.081-21.048; p = 0.039). Notably, CRS was invariably present before or concomitant with neurotoxicity, and all patients who exhibited severe CRS (grade ≥ 3) developed neurotoxicity. Serum inflammatory markers were significantly higher in patients who developed neurotoxicity. A complete neurological resolution following corticosteroids and anti-cytokines monoclonal antibodies was reached in all patients treated, except for one patient developing a fatal fulminant cerebral edema. All surviving patients completed the 1-year follow-up, and no long-term neurotoxicity was observed. CONCLUSIONS In the first prospective Italian real-life study, we presented novel clinical and investigative insights into ICANS diagnosis, predictive factors, and prognosis.
Collapse
Affiliation(s)
- Umberto Pensato
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
- Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giulia Amore
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | - Lorenzo Muccioli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | - Susanna Sammali
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | - Francesca Rondelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Rita Rinaldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Roberto D'Angelo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Marianna Nicodemo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Luisa Sambati
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Gian Maria Asioli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Simone Rossi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Rossella Santoro
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Lucia Cretella
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Susy Ferrari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | - Luca Spinardi
- Diagnostic and Interventional Neuroradiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Faccioli
- Diagnostic and Interventional Neuroradiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Paccagnella
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisabetta Pierucci
- Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Cinzia Pellegrini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Massimiliano Bonafè
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pietro Cortelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia
| | | | - Maria Guarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italia, Sant'Orsola Hospital, Via Giuseppe Massarenti 9, Bologna, Italia.
| |
Collapse
|
4
|
Loddo G, La Fauci G, Vignatelli L, Zenesini C, Cilea R, Mignani F, Cecere A, Mondini S, Baldelli L, Bisulli F, Licchetta L, Mostacci B, Guaraldi P, Giannini G, Tinuper P, Provini F. The Arousal Disorders Questionnaire: a new and effective screening tool. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
5
|
Garbazza C, Hackethal S, Migliore E, D'Agostino A, Serrati C, Fanti V, Riccardi S, Baiardi S, Cicolin A, Borgwardt S, Mondini S, Cirignotta F, Cajochen C, Manconi M. Influence of chronotype on the incidence and severity of perinatal depression in the "Life-ON" study. J Affect Disord 2022; 317:245-255. [PMID: 36055526 DOI: 10.1016/j.jad.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/10/2022] [Accepted: 08/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perinatal depression (PND) is a severe complication of pregnancy, but there are no established risk factors predicting the disease. Evening chronotype has been associated with unhealthy lifestyle habits and adverse outcomes during pregnancy. In this study, we aimed to clarify whether chronotype can predict symptoms and/or occurrence of PND. METHODS Two hundred ninety-nine women were followed-up from the first trimester of pregnancy until 6 months postpartum. Chronotype was assessed at baseline using the MEQ, while mood was repeatedly assessed by depression rating scales (EPDS, HDRS, MADRS). The influence of time and chronotype on EPDS, HDRS and MADRS, was estimated by constructing multilevel linear mixed regression models. A Cox proportional-hazard regression model was built to evaluate the association between chronotype and incidence of depression. RESULTS Chronotype modulated PND symptom severity depending on time of assessment, with evening chronotypes having a higher risk for developing PND symptoms, as assessed by EPDS, at postpartum visits V4 (5-12 days) and V5 (19-26 days). These also had less healthy lifestyle habits and were more likely to suffer from gestational diabetes mellitus and undergo cesarean delivery as compared to other chronotypes. LIMITATIONS Only a minority of women were classified as evening chronotypes. The long follow-up phase of the study led to missing data. CONCLUSIONS Pregnant evening chronotypes show unhealthy lifestyle habits and sociodemographic characteristics commonly associated with a higher risk for PND. They also have a higher risk of developing PND symptoms in the first month after delivery. Chronotype should therefore be routinely assessed during pregnancy to identify women potentially at risk for developing PND.
Collapse
Affiliation(s)
- Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Centre for Chronobiology, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.
| | - Sandra Hackethal
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Enrica Migliore
- Clinical Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy; Cancer Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Chiara Serrati
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valentina Fanti
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Simone Baiardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostics, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Susanna Mondini
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Christian Cajochen
- Centre for Chronobiology, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| |
Collapse
|
6
|
Mainieri G, Loddo G, Castelnovo A, Balella G, Cilea R, Mondini S, Manconi M, Provini F. EEG Activation Does Not Differ in Simple and Complex Episodes of Disorders of Arousal: A Spectral Analysis Study. Nat Sci Sleep 2022; 14:1097-1111. [PMID: 35698590 PMCID: PMC9188335 DOI: 10.2147/nss.s360120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Disorders of arousal (DoA) are characterized by incomplete awakening from NREM sleep, with the admixture of both deep sleep and wake EEG activity. Previous observations suggested that changes in EEG activity could be detected in the seconds preceding DoA episodes. The aims of this work were to characterize the topography of EEG spectral changes prior to DoA episodes and to investigate whether or not behavioral complexity could be predicted by changes in EEG immediately preceding behavioral onsets. PATIENTS AND METHODS We collected 103 consecutive video-polysomnographic recordings of 53 DoA adult patients and classified all episodes as simple, rising and complex arousal movements. For each episode, a 5-second window preceding its motor onset ("pre-event") and a 60-second window from 2 to 3 minutes before the episodes ("baseline") were compared. Subsequently, a between-group comparison was performed for the pre-event of simpler versus the more complex episodes. RESULTS Spectral analysis over 325 DoA episodes showed an absolute significant increase prior to DoA episodes in all frequency bands excluding sigma, which displayed the opposite effect. In normalized maps, the increase was relatively higher over the central/anterior areas for both slow and fast frequency bands. No significant differences emerged from the comparison between simpler and more complex episodes. CONCLUSION Taken together, these results show that deep sleep and wake-like EEG rhythms coexist over overlapping areas before DoA episodes, suggesting an alteration of local sleep mechanisms. Episodes of different complexity are preceded by a similar EEG activation, implying that they possibly share a similar pathophysiology.
Collapse
Affiliation(s)
- Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, Bologna, Italy
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Giulia Balella
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Rosalia Cilea
- Neurology Unit, "Morgagni-Pierantoni" Hospital, AUSL Romagna, Forlì, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| |
Collapse
|
7
|
Loddo G, Fragiacomo F, Mainieri G, Mondini S, Buzzi G, Calandra-Buonaura G, Provini F. Disorders of arousal in 4 older men: evidence from clinical practice. J Clin Sleep Med 2022; 18:129-136. [PMID: 34180806 PMCID: PMC8807889 DOI: 10.5664/jcsm.9516] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To describe clinical and video-polysomnographic features of disorders of arousal (DoA) in older adults. METHODS Four consecutive male patients with nocturnal motor behaviors underwent a clinical interview, neurologic examination, laboratory tests, brain magnetic resonance imaging, and nocturnal in-laboratory or 24- to 48-hour home video polysomnography. The patients repeated an evaluation after 6 months of follow-up, including a 48-hour home video polysomnography in 2 patients. RESULTS The patients were aged 65-72 years, and 1 patient has Parkinson disease. Sleep-related behavioral episodes had begun from 12-55 years before our observation. Three patients presented with a positive family history for DoA. Sleep motor episodes were described as suddenly raising the head or trunk, sitting in bed, screaming, speaking, gesturing, and sleepwalking (in 1 patient). When questioned, all patients seemed confused, rarely reporting any dream-like content. We recorded 25 DoA episodes of different intensity and complexity arising from nonrapid eye movement sleep. The semiology of the episodes was similar to that described in younger patients, consisting of sleep terrors and confusional arousals. All patients presented with physiological rapid eye movement sleep muscle atonia. Medication therapy reduced the frequency of the episodes in 2/4 patients. CONCLUSIONS DoA may begin in adulthood and persist or arise in older adults, sometimes causing sleep-related injuries. Motor patterns of DoA in older adults are similar to those of younger patients. A combined clinical examination and video polysomnography recording are crucial in establishing a definitive diagnosis of nocturnal motor behavior in all older adults and especially in those affected by neurodegenerative diseases. CITATION Loddo G, Fragiacomo F, Mainieri G, et al. Disorders of arousal in 4 older men: evidence from clinical practice. J Clin Sleep Med. 2022;18(1):129-136.
Collapse
Affiliation(s)
| | - Federica Fragiacomo
- U.O. Neurologia, Ospedale Castelfranco Veneto, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Greta Mainieri
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Giovanna Calandra-Buonaura
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy,Address correspondence to: Federica Provini, MD, PhD, IRCCS, Institute of Neurological Sciences of Bologna, Bellaria Hospital, Via Altura, 3, 40139 Bologna, Italy; Tel: ++ 39 051 4966829;
| |
Collapse
|
8
|
Loddo G, La Fauci G, Vignatelli L, Zenesini C, Cilea R, Mignani F, Cecere A, Mondini S, Baldelli L, Bisulli F, Licchetta L, Mostacci B, Guaraldi P, Giannini G, Tinuper P, Provini F. The Arousal Disorders Questionnaire: a new and effective screening tool for confusional arousals, Sleepwalking and Sleep Terrors in epilepsy and sleep disorders units. Sleep Med 2021; 80:279-285. [PMID: 33610075 DOI: 10.1016/j.sleep.2021.01.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arousal Disorders (DoA) include Confusional Arousals, Sleepwalking and Sleep Terrors. DoA diagnosis is mainly clinical but no validated questionnaires exist for DoA screening according to the criteria of the International Classification of Sleep Disorders, Third Edition. Recently our group proposed the Arousal Disorders Questionnaire (ADQ) as a new diagnostic tool for DoA diagnosis. The objective of this study was to evaluate the diagnostic accuracy of the ADQ in a sleep and epilepsy center. METHODS One interviewer blinded to clinical and video-polysomnographic (VPSG) data administered the ADQ to 150 patients consecutively admitted to our Sleep and Epilepsy Centers for a follow-up visit. The final diagnosis, according to VPSG recordings of at least one major episode, classified patients either with DoA (DoA group) or with other sleep-related motor behaviors confounding for DoA (nDoA group). RESULTS 47 patients (31%) composed the DoA group; 56 patients with REM sleep behavior disorder, 39 with sleep-hypermotor epilepsy, six with night eating syndrome, and two with drug-induced DoA composed the nDoA group. The ADQ had a sensitivity of 72% (95% CI: 60-82) and a specificity of 96% (95% CI: 89-98) for DoA diagnosis; excluding the items regarding consciousness and episode recall, sensitivity was 83% (95% CI: 71-90) and specificity 93% (95% CI: 86-97). CONCLUSIONS The ADQ showed good accuracy in screening patients with DoA in a sleep and epilepsy center setting. Diagnostic criteria related to cognition and episode recall reduced ADQ sensitivity, therefore a better definition of these criteria is required, especially in adults.
Collapse
Affiliation(s)
- Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giusy La Fauci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rosalia Cilea
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Mignani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Annagrazia Cecere
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Laura Licchetta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| |
Collapse
|
9
|
Loddo G, Baldassarri L, Zenesini C, Licchetta L, Bisulli F, Cirignotta F, Mondini S, Tinuper P, Provini F. Seizures with paroxysmal arousals in sleep‐related hypermotor epilepsy (SHE): Dissecting epilepsy from NREM parasomnias. Epilepsia 2020; 61:2194-2202. [DOI: 10.1111/epi.16659] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - Lorenzo Baldassarri
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italia
| | - Laura Licchetta
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italia
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italia
| | - Fabio Cirignotta
- Department of Head, Neck and Sensory System Neurology Unit Sant' Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Susanna Mondini
- Department of Head, Neck and Sensory System Neurology Unit Sant' Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italia
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italia
| |
Collapse
|
10
|
Baiardi S, Mondini S. Inside the clinical evaluation of sleepiness: subjective and objective tools. Sleep Breath 2019; 24:369-377. [PMID: 31144154 DOI: 10.1007/s11325-019-01866-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To critically review the available tools for evaluating excessive daytime sleepiness (EDS) in clinical practice. METHODS Objective tests and subjective scales were divided into three groups in accordance with the different dimensions of sleepiness they measure, namely physiological, manifest, and introspective. Strengths, weaknesses, and limitations of each test have been analysed and discussed along with the available recommendations for their use in clinical practice. RESULTS The majority of the tests developed for sleepiness evaluation do not have practical usefulness outside the research setting. The suboptimal correlation between different tests mainly depends on the different dimensions of sleepiness they analyse. Most importantly in-laboratory tests poorly correlate with sleepiness in real-life situations and, to date, none is able to predict the risk of injuries related to EDS, especially on an individual level. CONCLUSIONS There exists not the one best test to assess EDS, however, clinicians can choose a more specific test to address a specific diagnostic challenge on the individual level. The development of novel performance tests with low cost and easy to administer is advisable for both screening purposes and fitness for duty evaluations in populations at high risk of EDS-related injuries, for example professional drivers.
Collapse
Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Via Altura 1/8, 40139, Bologna, Italy.
| | - Susanna Mondini
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| |
Collapse
|
11
|
Baldini T, Loddo G, Sessagesimi E, Mignani F, Cirignotta F, Mondini S, Licchetta L, Bisulli F, Tinuper P, Provini F. Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain. Front Neurol 2019; 10:526. [PMID: 31164861 PMCID: PMC6534078 DOI: 10.3389/fneur.2019.00526] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Disorders of Arousal (DoA) are NREM parasomnias that have been typically regarded as self-limited childhood manifestations. It is now clear that DoA can persist in adults, often presenting with distinctive characteristics. So far, few studies have described the clinical course and characteristics of DoA in adulthood, therefore a large part of their semiology is ignored. The aim of this study is to describe the clinical manifestations of DoA in an adult population and to provide a pathophysiological interpretation of their features. Methods: We screened our database for all 1,600 adult (≥15 years) patients with sleep-related motor behaviors between 1995 and 2016. We identified 45 patients with typical DoA episodes, of whom a complete history, neurological examination and diagnostic video-polysomnography (VPSG) were available. All patients provided a detailed description of their episodes (with particular regards to semiology, frequency, and association with stressful life events) in different life periods. VPSG recordings were reviewed and DoA episodes were identified and assigned to three different categories according to their complexity. Results: Our population was composed of 45 adult patients ranging between 15 and 76 years. Sleepwalking was reported by 86% of patients, possibly associated with complex interactions with the environment and violent behaviors in 53% of cases; distressing mental contents were reported by 64%. Recall of the episodes was reported in 77% of patients. Non-restorative sleep was reported in 46% of patients. Stress was a potential episode trigger in 80% of patients. VPSG recordings documented 334 DoA episodes. According to our classification of motor patterns, 282 episodes (84%) were Simple Arousal Movements (SAMs), 34 (10%) Rapid Arousal Movements (RAMs) and 18 (5%) Complex Arousal Movements (CAMs). Discussion: Our study confirms that DoA in adulthood present with distinctive characteristics, such as non-restorative sleep, violence and complex, or bizarre behaviors. Alternative classifications of DoA based on motor patterns could be useful to characterize DoA episodes in adults, as different motor patterns often coexist in the same individual and minor episodes are more common but generally underreported by patients. Prospective studies are needed for a definitive characterization of DoA in adulthood throughout the life course.
Collapse
Affiliation(s)
- Tommaso Baldini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elisa Sessagesimi
- Radiology Unit, Experimental, Diagnostic and Specialty Medicine, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Francesco Mignani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Cirignotta
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Susanna Mondini
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Laura Licchetta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| |
Collapse
|
12
|
Loddo G, Sessagesimi E, Mignani F, Cirignotta F, Mondini S, Licchetta L, Bisulli F, Tinuper P, Provini F. Specific motor patterns of arousal disorders in adults: a video-polysomnographic analysis of 184 episodes. Sleep Med 2018; 41:102-109. [DOI: 10.1016/j.sleep.2017.08.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/27/2022]
|
13
|
Baiardi S, La Morgia C, Sciamanna L, Gerosa A, Cirignotta F, Mondini S. Is the Epworth Sleepiness Scale a useful tool for screening excessive daytime sleepiness in commercial drivers? Accid Anal Prev 2018; 110:187-189. [PMID: 29074223 DOI: 10.1016/j.aap.2017.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
The significant social and economic impact of excessive daytime sleepiness makes sleep evaluation a primary medical need in commercial drivers. However, the best screening tool is still matter of debate. In our cohort of 221 commercial drivers, only ten (4.5%) had Epworth Sleepiness Scale scores indicative of excessive daytime sleepiness. These findings and the lack of concordance in estimating excessive daytime sleepiness among commercial drivers in previous studies using the same psychometric measure indicate that the Epworth Sleepiness Scale is not a reliable tool. This may be due to the low internal consistency of the scale in non-clinical samples and the possible intentional underscoring of sleepiness due to a perceived threat of driver's license suspension. Moreover, the reliability of the Epworth Sleepiness Scale results may be strongly influenced by the administration setting. The clinical application of inexpensive less time-consuming new tools like performance tests should be considered for the objective evaluation of excessive daytime sleepiness in commercial drivers.
Collapse
Affiliation(s)
- Simone Baiardi
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Chiara La Morgia
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lucia Sciamanna
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Gerosa
- Mountain Workplace Prevention and Safety Unit, Local Health Trust, Bologna, Italy
| | - Fabio Cirignotta
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Susanna Mondini
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| |
Collapse
|
14
|
Baiardi S, Mondini S, Baldi Antognini A, Santoro A, Cirignotta F. Survival of Dialysis Patients with Restless Legs Syndrome: A 15-Year Follow-Up Study. Am J Nephrol 2017; 46:224-230. [PMID: 28869939 DOI: 10.1159/000479938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Restless legs syndrome, also known as Willis/Ekbom disease (RLS/WED), is a sleep-related, sensorimotor disorder with a high prevalence among end-stage renal disease (ESRD) patients undergoing haemodialysis (HD) (about 15-40%). Whether RLS/WED in uremic patients influences cardiovascular morbidity and mortality remains a matter of controversy. The aim of this study was to evaluate the relationship of RLS/WED and mortality in a population of chronically dialyzed patients. METHOD In 1996, we studied 128 patients with ESRD undergoing HD; 47 subjects (36.7%) complained RLS/WED symptoms. Fifteen years later we evaluated the mortality of this population. No clinical follow-up examination of the uremic population was made. The Kaplan-Maier curves in dialysis patients with or without RLS/WED (control group matched for age) were constructed for all-cause mortality and compared using log-rank test. RESULTS The Kaplan-Maier curves disclosed a lower mortality rate in the uremic patients with RLS/WED than in those without RLS/WED (p = 0.04). In our analysis, the mortality rate was not influenced by RLS/WED severity (p = 0.11) or gender (p = 0.15). No difference among the causes of death was found in the 2 groups. CONCLUSIONS Our study suggests that mortality in ESRD patients is not influenced by concomitant RLS/WED. After a 15-year follow-up, survival rates in our cohort were significantly longer in uremic subjects with RLS/WED than in those without RLS/WED. Finally, we found no relationship between RLS/WED severity and mortality.
Collapse
Affiliation(s)
- Simone Baiardi
- Neurology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, Bologna, Italy
| | | | | | | | | |
Collapse
|
15
|
Gobbi R, Baiardi S, Mondini S, Cerritelli L, Piccin O, Scaramuzzino G, Milano F, Melotti MR, Mordini F, Pirodda A, Cirignotta F, Sorrenti G. Technique and Preliminary Analysis of Drug-Induced Sleep Endoscopy With Online Polygraphic Cardiorespiratory Monitoring in Patients With Obstructive Sleep Apnea Syndrome. JAMA Otolaryngol Head Neck Surg 2017; 143:459-465. [PMID: 28253389 DOI: 10.1001/jamaoto.2016.3964] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Drug-induced sleep endoscopy is a diagnostic technique that allows dynamic evaluation of the upper airway during artificial sleep. The lack of a standardized procedure and the difficulties associated with direct visual detection of obstructive events result in poor intraobserver and interobserver reliability, especially when otolaryngology surgeons not experienced in the technique are involved. Objectives To describe a drug-induced sleep endoscopy technique implemented with simultaneous polygraphic monitoring of cardiorespiratory parameters (DISE-PG) in patients with a diagnosis of obstructive sleep apnea syndrome and discuss the technique's possible advantages compared with the standard procedure. Design, Setting, and Participants This prospective cohort study included 50 consecutive patients with obstructive sleep apnea syndrome who underwent DISE-PG from March 1, 2013, to June 30, 2014. A standard protocol was adopted, and all the procedures were carried out in an operation room by an experienced otolaryngology surgeon under the supervision of an anesthesiologist. Endoscopic and polygraphic obstructive respiratory events were analyzed offline in a double-blind setting and randomized order. Main Outcomes and Measures The feasibility and safety of the DISE-PG technique, as well as its sensitivity in detecting respiratory events compared with that of the standard drug-induced sleep endoscopy procedure. Results All 50 patients (43 men and 7 women; mean [SD] age, 51.1 [12.1] years) underwent DISE-PG without technical problems or patient difficulties regarding the procedure. As expected, polygraphic scoring was more sensitive than endoscopic scoring in identifying obstructive events (mean [SD] total events, 13.3 [6.8] vs 5.3 [3.6]; mean [SD] difference, 8.8 [5.6]; 95% CI, 7.3 to 10.4; Cohen d, -1.5). This difference was most pronounced in patients with a higher apnea-hypopnea index (AHI) at baseline (mean [SD] difference for AHI >30, 27.1% [31.0%]; 95% CI, -36.2% to 90.4%; Cohen d, 0.2; for AH I >40, 76.0% [35.5%]; 95% CI, 4.6% to 147.4%; Cohen d, 0.5; for AHI >50, 92.2% [37.2%]; 95% CI, 17.3% to 167.1%; Cohen d, 0.6) and a high percentage of hypopneas (≥75% of all obstructive events) at baseline (mean [SD] difference, 20.2% [5.4%]; 95% CI, 9.2% to 31.3%; Cohen d, 1.1). No other anthropomorphic or polygraphic features at baseline were associated with the differences between the DISE-PG and baseline home sleep apnea test. Conclusions and Relevance The DISE-PG technique is feasible, safe, and more sensitive at detecting an obstructed breathing pattern than is drug-induced sleep endoscopy alone. The DISE-PG technique could be helpful for accurate comprehension of upper airway obstructive dynamics (ie, degree of obstruction and multilevel pattern) and a nonobstructive breathing pattern (ie, central apneas).
Collapse
Affiliation(s)
- Riccardo Gobbi
- Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Baiardi
- Neurology Unit, Department of Head, Neck and Sensory System, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy3Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Susanna Mondini
- Neurology Unit, Department of Head, Neck and Sensory System, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Cerritelli
- Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ottavio Piccin
- Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Maria Rita Melotti
- Anesthesia and Intensive Care Unit, Department of Surgical and Anesthesiological Sciences, University of Bologna, Bologna, Italy
| | - Francesco Mordini
- Anesthesia and Intensive Care Unit, Department of Surgical and Anesthesiological Sciences, University of Bologna, Bologna, Italy
| | - Antonio Pirodda
- Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Cirignotta
- Neurology Unit, Department of Head, Neck and Sensory System, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy3Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Sorrenti
- Department of Head, Neck and Sensory System, Otorhinolaryngolologic Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
16
|
Baiardi S, Sciamanna L, Mondini S, Gentili C, Signorelli R, Trentin L, Cirignotta F. 0664 VIDEO MONITORING DURING MAINTENANCE OF WAKEFULNESS TEST: MAY THE BEHAVIOURAL ANALYSIS BE AN ADDITIONAL TOOL FOR RESULTS INTERPRETATION? Sleep 2017. [DOI: 10.1093/sleepj/zsx050.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Baiardi S, Cirignotta F, Cicolin A, Garbazza C, D’Agostino A, Gambini O, Giordano A, Canevini M, Zambrelli E, Marconi AM, Mondini S, Borgwardt S, Cajochen C, Rizzo N, Manconi M. Chronobiology, sleep-related risk factors and light therapy in perinatal depression: the "Life-ON" project. BMC Psychiatry 2016; 16:374. [PMID: 27814712 PMCID: PMC5225570 DOI: 10.1186/s12888-016-1086-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/21/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Perinatal depression (PND) has an overall estimated prevalence of roughly 12 %. Untreated PND has significant negative consequences not only on the health of the mothers, but also on the physical, emotional and cognitive development of their children. No certain risk factors are known to predict PND and no completely safe drug treatments are available during pregnancy and breastfeeding. Sleep and depression are strongly related to each other because of a solid reciprocal causal relationship. Bright light therapy (BLT) is a well-tested and safe treatment, effective in both depression and circadian/sleep disorders. METHODS In a 3-year longitudinal, observational, multicentre study, about 500 women will be recruited and followed-up from early pregnancy (10-15 gestational week) until 12 months after delivery. The primary aim of the present study is to systematically explore and characterize risk factors for PND by prospective sleep assessment (using wrist actigraphy, polysomnography and various sleep questionnaires) and bloodbased analysis of potential markers during the perinatal period (Life-ON study). Secondary aims are to explore the relationship between specific genetic polymorphisms and PND (substudy Life-ON1), to investigate the effectiveness of BLT in treating PND (substudy Life-ON2) and to test whether a short term trial of BLT during pregnancy can prevent PND (substudy Life-ON3). DISCUSSION The characterization of specific predictive and risk factors for PND may substantially contribute to improve preventive medical and social strategies for the affected women. The study results are expected to promote a better understanding of the relationship between sleep disorders and the development of PND and to confirm, in a large sample of women, the safety and efficacy of BLT both in prevention and treatment of PND. TRIAL REGISTRATION ClinicalTrials.gov NCT02664467 . Registered 13 January 2016.
Collapse
Affiliation(s)
- Simone Baiardi
- Department of Head, Neck and Sensory System, Neurology Unit, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Cirignotta
- Department of Head, Neck and Sensory System, Neurology Unit, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, Neuroscience Department, AOU Città della Salute e della Scienza - Molinette, Università di Torino, Torino, Italy
| | - Corrado Garbazza
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland ,Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland ,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Armando D’Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Orsola Gambini
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Giordano
- Sleep Medicine Center, Neuroscience Department, AOU Città della Salute e della Scienza - Molinette, Università di Torino, Torino, Italy
| | | | | | - Anna Maria Marconi
- Department of Obstetrics and Gynaecology, DMSD San Paolo, University of Milan, Milan, Italy
| | - Susanna Mondini
- Department of Head, Neck and Sensory System, Neurology Unit, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefan Borgwardt
- Division of Neuropsychiatry and Brain Imaging, Department of Psychiatry (UPK), Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland ,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Nicola Rizzo
- Department of Obstetrics and Gynecology, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland.
| |
Collapse
|
18
|
Sorrenti G, Piccin O, Mondini S, Ceroni AR. One-phase management of severe obstructive sleep apnea: Tongue base reduction with hyoepiglottoplasty plus uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 2016; 135:906-10. [PMID: 17141082 DOI: 10.1016/j.otohns.2006.06.1253] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 06/15/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: To describe the results of a 1 phase surgical procedure for the treatment of severe obstructive sleep apnea (OSA) attributable to tongue base obstruction. STUDY DESIGN AND SETTING: A retrospective nonrandomized study at S Orsola Malpighi University Hospital of Bologna, Italy. METHODS: Ten male patients affected by severe OSA (mean apnea/hypopnea index [AHI] of 54.7), underwent uvulopalatopharyngoplasty (UPPP) associated with tongue base reduction and hyoepiglottoplasty (TBRHE). The indications to this surgical procedure were based on the presence of hyolingual abnormalities and absence of craniofacial deficiencies determined by preoperative assessment. RESULTS: Mean AHI decreased from 54.7 + 11.5 to 9.4 + 5.4 whereas the mean low SaO2 value went from 77% + 6.2 to 90.7% + 3 and the time of sleep with SaO2 < 90% improved from 53% + 17.2 to 7.3% + 8. The overall success rate was 100%. CONCLUSIONS AND SIGNIFICANCE: TBRHE is an effective and safe treatment in patients with severe OSA attributable to tongue base obstruction and in absence of craniofacial deficiencies.
Collapse
Affiliation(s)
- Giovanni Sorrenti
- ENT Department, S Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | | | | | | |
Collapse
|
19
|
Guarino M, Rondelli F, Favaretto E, Stracciari A, Filippini M, Rinaldi R, Zele I, Sartori M, Faggioli G, Mondini S, Donti A, Strocchi E, Degli Esposti D, Muscari A, Veronesi M, D'Addato S, Spinardi L, Faccioli L, Pastore Trossello M, Cirignotta F. Short- and Long-Term Stroke Risk after Urgent Management of Transient Ischaemic Attack: The Bologna TIA Clinical Pathway. Eur Neurol 2015; 74:1-7. [PMID: 26044401 DOI: 10.1159/000430810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rapid management can reduce the short stroke risk after transient ischaemic attack (TIA), but the long-term effect is still little known. We evaluated 3-year vascular outcomes in patients with TIA after urgent care. METHODS We prospectively enrolled all consecutive patients with TIA diagnosed by a vascular neurologist and referred to our emergency department (ED). Expedited assessment and best secondary prevention was within 24 h. Endpoints were stroke within 90 days, and stroke, myocardial infarction, and vascular death at 12, 24 and 36 months. RESULTS Between August 2010 and July 2013, we evaluated 686 patients with suspected TIA; 433 (63%) patients had confirmed TIA. Stroke at 90 days was 2.07% (95% confidence interval (CI), 1.1-3.9) compared with the ABCD2-predicted risk of 9.1%. The long-term stroke risk was 2.6% (95% CI, 1.1-4.2), 3.7% (95% CI, 1.6-5.9) and 4.4% (95% CI, 1.9-6.8) at 12, 24 and 36 months, respectively. The composite outcome of stroke, myocardial infarction, and vascular death was 3.5% (95% CI, 1.7-5.1), 4.9% (95% CI, 2.5-7.4), and 5.6% (95% CI, 2.8-8.3) at 12, 24, and 36 months, respectively. CONCLUSIONS TIA expedited management driven by vascular neurologists was associated with a marked reduction in the expected early stroke risk and low long-term risk of stroke and other vascular events.
Collapse
Affiliation(s)
- Maria Guarino
- Neurology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Vangelista A, Frascà GM, Mondini S, Bonomini V. Idiopathic IgA mesangial nephropathy: immunohistological features. Contrib Nephrol 2015; 40:167-73. [PMID: 6388997 DOI: 10.1159/000409745] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
21
|
Baiardi S, La Morgia C, Mondini S, Cirignotta F. A restless abdomen and propriospinal myoclonus like at sleep onset: an unusual overlap syndrome. BMJ Case Rep 2015; 2015:bcr-2014-206679. [PMID: 25820108 DOI: 10.1136/bcr-2014-206679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report for the first time the association between restless abdomen, a phenotypic variant of restless legs syndrome in which symptoms are limited to the abdomen, and propriospinal myoclonus at sleep onset causing severe insomnia. The treatment with a low-dosage of dopaminergic drug (pramipexole) induced the immediate disappearance of both symptoms, which was documented by video-polysomnography.
Collapse
Affiliation(s)
- Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Neurology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, Italy
| | - Chiara La Morgia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Neurology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, Italy
| | - Susanna Mondini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Neurology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, Italy
| | - Fabio Cirignotta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Neurology Unit, S. Orsola-Malpighi Hospital, AOU Bologna, Italy
| |
Collapse
|
22
|
Giganti F, Guidi S, Aboudan S, Baiardi S, Mondini S, Cirignotta F, Salzarulo P. Sleep-readiness signals in insomniacs and good sleepers. J Health Psychol 2014; 21:661-8. [PMID: 24913008 DOI: 10.1177/1359105314535124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sleep is preceded by physiological and behavioural events that inform the subject that it is time to sleep. Our hypothesis is that insomniacs do not adequately recognize such signals, thus missing the best time to go to bed. Eighty-seven chronic insomniac participants and 76 age-matched good sleeper controls were recruited. Semi-structured interviews focused on three aspects of nocturnal sleep: features, habitual activities and signals that they usually rely on in order to decide their readiness to sleep. The results showed that insomniacs relied more than good sleepers on external signals (time) than on bodily ones to decide to go to sleep.
Collapse
Affiliation(s)
- Fiorenza Giganti
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Sara Guidi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Samir Aboudan
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| | - Simone Baiardi
- AOU of Bologna, S.Orsola- Malpighi Hospital, Bologna, Italy
| | | | | | - Piero Salzarulo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Italy
| |
Collapse
|
23
|
Pizza F, Contardi S, Baiardi S, Mondini S, Cirignotta F. On the road for a single and reliable objective assessment of sleepiness. Sleep 2012; 35:1323. [PMID: 23024429 DOI: 10.5665/sleep.2104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
24
|
Mondini S, Ferretti AM, Puglisi A, Ponti A. Pebbles and PebbleJuggler: software for accurate, unbiased, and fast measurement and analysis of nanoparticle morphology from transmission electron microscopy (TEM) micrographs. Nanoscale 2012; 4:5356-72. [PMID: 22814937 DOI: 10.1039/c2nr31276j] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Pebbles is a user-friendly software program which implements an accurate, unbiased, and fast method to measure the morphology of a population of nanoparticles (NPs) from TEM micrographs. The morphological parameters of the projected NP shape are obtained by fitting intensity models to the TEM micrograph. Pebbles can be used either in automatic mode, where both fitting and validation are reliably carried out with minimal human intervention, and in manual mode, where the user has full control on the fitting and validation steps. Accuracy in diameter measurement has been shown to be ≲1%. When operated in automatic mode, Pebbles can be very fast. The effective speed of 1 NP s⁻¹ has been achieved in favorable cases (packed monolayer of NPs). Since Pebbles is based on a local modeling procedure, it successfully treats cases such as low contrast NPs, NPs with significant diffraction scattering, and inhomogeneous background which often make conventional thresholding procedures fail. Pebbles is accompanied by PebbleJuggler, a software program for the statistical analysis of the sets of best-fit NP models created by Pebbles. Effort has been devoted to make Pebbles and PebbleJuggler the most user-friendly and the least user-tedious we could. Pebbles and PebbleJuggler are available at http://pebbles.istm.cnr.it.
Collapse
Affiliation(s)
- S Mondini
- Laboratorio di Nanotecnologie, Istituto di Scienze e Tecnologie Molecolari, Consiglio Nazionale delle Ricerche, Via G. Fantoli 16/15, 20138 Milano, Italy
| | | | | | | |
Collapse
|
25
|
Pizza F, Contardi S, Mondini S, Cirignotta F. Impact of sleep deprivation and obstructive sleep apnea syndrome on daytime vigilance and driving performance: a laboratory perspective. G Ital Med Lav Ergon 2012; 34:375-377. [PMID: 23405666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION To study the impact of sleepiness, a well-established cause of car accidents, on driving ability, we designed a 30-min monotonous simulated driving task. MATERIALS AND METHODS Our simulated driving task encompasses both primary vehicle control (standard deviation of lane position, crash occurrence) and secondary tasks (type and reaction times to divided attention tasks). Driving simulator data were correlated to subjective (state/trait) and objective (MSLT/MWT) sleepiness measures in healthy subjects undergoing sleep deprivation (SD) and in obstructive sleep apnea (OSAS) patients. RESULTS SD induced severe sleepiness during nighttime, when state sleepiness increased while primary vehicle control ability worsened. After SD, driving ability decreased and was inversely correlated to subjective and objective sleepiness at MSLT. OSAS patients driving ability was well correlated to objective sleepiness, with inverse correlation to sleep propensity at the MSLT and even more strict relation with the ability to maintain wakefulness at the MWT. CONCLUSIONS Sleepiness worsens driving ability in healthy subjects after SD and in OSAS patients. Driving ability correlates with subjective and objective sleepiness measures, in particular to the ability to maintain wakefulness.
Collapse
Affiliation(s)
- F Pizza
- IRCCS Istituto delle Scienze Neurologiche/Dipartimento di Scienze Neurologiche, Università di Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy.
| | | | | | | |
Collapse
|
26
|
Garbarino S, Bonanni E, Ingravallo F, Mondini S, Plazzi G, Sanna A. [Guidelines for the fitness to drive assessment in people with obstructive sleep apnoea syndrome (OSAS) and narcolepsy]. G Ital Med Lav Ergon 2011; 33:199-202. [PMID: 23393835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Given the prevalence of sleep disorders and sleep deprivation in modern societies, and the correlation between sleepiness and work and driving accidents, the excessive daytime sleepiness is an important issue. Although many studies showed that patients with untreated Obstructive sleep apnoea syndrome (OSAS) and narcolepsy have an higher risk for driving accidents, neither the European Community regulation nor the Italian law of the driving licence mention restrictions for these disorders. In 2010 the scientific association COMLAS (Association of legal medicine professionals of the Italian National Health Service) published the Guidelines for the examination by the Local Medical Commissions. The author presented the guidelines to assess the fitness to drive of people with OSAS or narcolepsy. The proposed criteria, set up in collaboration with the Commission "Sleepiness, Safety and Transportation" of the Italian Association of Sleep Medicine (AIMS), can be considered among the most advanced internationally.
Collapse
Affiliation(s)
- S Garbarino
- Commissione Sonnolenza, Sicurezza e Trasporti AIMS (Associazione Italiana Medicina del Sonno)
| | | | | | | | | | | |
Collapse
|
27
|
Pizza F, Contardi S, Mondini S, Cirignotta F. Simulated driving performance coupled with driver behaviour can predict the risk of sleepiness-related car accidents. Thorax 2010; 66:725-6. [DOI: 10.1136/thx.2010.140988] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Pizza F, Contardi S, Antognini AB, Zagoraiou M, Borrotti M, Mostacci B, Mondini S, Cirignotta F. Sleep quality and motor vehicle crashes in adolescents. J Clin Sleep Med 2010; 6:41-45. [PMID: 20191936 PMCID: PMC2823274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
STUDY OBJECTIVES Sleep-related complaints are common in adolescents, but their impact on the rate of motor vehicle crashes accidents is poorly known. We studied subjective sleep quality, driving habits, and self-reported car crashes in high-school adolescents. METHODS Self-administered questionnaires (with items exploring driving habits) were distributed to 339 students who had a driver's license and attended 1 of 7 high schools in Bologna, Italy. Statistical analysis were performed to describe lifestyle habits, sleep quality, sleepiness, and their relationship with the binary dependent variable (presence or absence of car crashes) to identify the factors significantly affecting the probability of car crashes in a multivariate binary logistic regression model. RESULTS Nineteen percent of the sample reported bad sleep, 64% complained of daytime sleepiness, and 40% reported sleepiness while driving. Eighty students (24%), 76% of which were males, reported that they had already crashed at least once, and 15% considered sleepiness to have been the main cause of their crash. As compared with adolescents who had not had a crash, those who had at least 1 previous crash reported that they more frequently used to drive (79% vs 62%), drove at night (25% vs 9%), drove while sleepy (56% vs 35%), had bad sleep (29% vs 16%), and used stimulants such as caffeinated soft drinks (32% vs 19%), tobacco (54% vs 27%), and drugs (21% vs 7%). The logistic procedure established a significant predictive role of male sex (p < 0.0001; odds ratio = 3.3), tobacco use (p < 0.0001; odds ratio = 3.2), sleepiness while driving (p = 0.010; odds ratio = 2.1), and bad sleep (p = 0.047; odds ratio = 1.9) for the crash risk. CONCLUSIONS Our results confirm the high prevalence of sleep-related complaints among adolescents and highlight their independent role on self-reported crash risk.
Collapse
Affiliation(s)
- Fabio Pizza
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - Sara Contardi
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | | | - Maroussa Zagoraiou
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Borrotti
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Barbara Mostacci
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - Susanna Mondini
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Cirignotta
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
29
|
Pizza F, Contardi S, Antognini AB, Zagoraiou M, Borrotti M, Mostacci B, Mondini S, Cirignotta F. Sleep Quality and Motor Vehicle Crashes in Adolescents. J Clin Sleep Med 2010. [DOI: 10.5664/jcsm.27708] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fabio Pizza
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - Sara Contardi
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | | | - Maroussa Zagoraiou
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Borrotti
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Barbara Mostacci
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| | - Susanna Mondini
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Cirignotta
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Neurological Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
30
|
Pizza F, Contardi S, Mondini S, Trentin L, Cirignotta F. Daytime sleepiness and driving performance in patients with obstructive sleep apnea: comparison of the MSLT, the MWT, and a simulated driving task. Sleep 2009; 32:382-91. [PMID: 19294958 DOI: 10.1093/sleep/32.3.382] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To test the reliability of a driving-simulation test for the objective measurement of daytime alertness compared with the Multiple Sleep Latency Test (MSLT) and with the Maintenance of Wakefulness Test (MWT), and to test the ability to drive safely, in comparison with on-road history, in the clinical setting of untreated severe obstructive sleep apnea. DESIGN N/A. SETTING Sleep laboratory. PATIENTS OR PARTICIPANTS Twenty-four patients with severe obstructive sleep apnea and reported daytime sleepiness varying in severity (as measured by the Epworth Sleepiness Scale). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Patients underwent MSLT and MWT coupled with 4 sessions of driving-simulation test on 2 different days randomly distributed 1 week apart. Simulated-driving performance (in terms of lane-position variability and crash occurrence) was correlated with sleep latency on the MSLT and more significantly on the MWT, showing a predictive validity toward the detection of sleepy versus alert patients with obstructive sleep apnea. In addition, patients reporting excessive daytime sleepiness or a history of car crashes showed poorer performances on the driving simulator. CONCLUSIONS A simulated driving test is a suitable tool for objective measurement of daytime alertness in patients with obstructive sleep apnea. Further studies are needed to clarify the association between simulated-driving performance and on-road crash risk of patients with sleep disordered breathing.
Collapse
Affiliation(s)
- Fabio Pizza
- Unit of Neurology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | | | | | | |
Collapse
|
31
|
La Morgia C, Parchi P, Capellari S, Lodi R, Tonon C, Rinaldi R, Mondini S, Cirignotta F. 'Agrypnia excitata' in a case of sporadic Creutzfeldt-Jakob disease VV2. J Neurol Neurosurg Psychiatry 2009; 80:244-6. [PMID: 19151026 DOI: 10.1136/jnnp.2008.149344] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
32
|
Mostacci B, Ferlisi M, Baldi Antognini A, Sama C, Morelli C, Mondini S, Cirignotta F. Sleep disturbance and daytime sleepiness in patients with cirrhosis: a case control study. Neurol Sci 2008; 29:237-40. [PMID: 18810597 DOI: 10.1007/s10072-008-0973-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 07/01/2008] [Indexed: 01/03/2023]
Abstract
Sleep disturbance and excessive daytime sleepiness have been reported in patients with hepatic cirrhosis. The objective of this study was to evaluate daytime somnolence and sleep complaints in a group of 178 patients with cirrhosis compared to a control group. Sleep features and excessive daytime sleepiness were evaluated by the Basic Nordic Sleep Questionnaire (BNSQ) and the Epworth Sleepiness Scale (ESS). We collected clinical and laboratory data, neurological assessment and EEG recordings in cirrhotic patients. Patients with cirrhosis complained of more daytime sleepiness (p<0.005), sleeping badly at least three times a week (p<0.005), difficulties falling asleep (p<0.01) and frequent nocturnal awakening (p<0.005) than controls. We found a poor correlation between sleep disorders and clinical or laboratory parameters. Our results confirm previous literature reports suggesting a high prevalence of sleep disturbance in patients with cirrhosis. Insomnia and daytime sleepiness are the main complaints. Sleep disorders are probably a multifactorial phenomenon.
Collapse
|
33
|
Pizza F, Contardi S, Ferlisi M, Mondini S, Cirignotta F. Daytime driving simulation performance and sleepiness in obstructive sleep apnoea patients. Accid Anal Prev 2008; 40:602-609. [PMID: 18329412 DOI: 10.1016/j.aap.2007.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 08/23/2007] [Accepted: 08/28/2007] [Indexed: 05/26/2023]
Abstract
BACKGROUND Sleepiness related car accidents are common in obstructive sleep apnoea syndrome (OSAS) patients. The objective measurements of sleepiness used in clinical setting quantify the tendency to fall asleep in quiet situations that are completely different from driving. METHODS We studied 30 OSAS patients with subjective (subjective sleepiness scales) and objective (multiple sleep latency test, MSLT) sleepiness measurements, associated with driving simulation test (DST), previously validated in young healthy subjects. The results of subjective and objective sleepiness tests were compared with simulated driving performance in order to evaluate the suitability of our DST for measuring alertness. RESULTS Subjective and objective sleepiness measurements were significantly correlated with driving performance on the simulator. The most significant correlates of sleepiness were the measures of the primary vehicle control task on the simulator: lane position variability and crash data. The comparison of DST and MSLT results suggested our driving simulated approach could be used to evaluate daytime sleepiness in the clinical setting of OSAS patients. CONCLUSIONS Our DST is a suitable objective tool to detect sleepiness in OSAS patients, and could be useful in the clinical setting of sleep medicine and research.
Collapse
Affiliation(s)
- Fabio Pizza
- Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
| | | | | | | | | |
Collapse
|
34
|
Terzano MG, Cirignotta F, Mondini S, Ferini-Strambi L, Parrino L. Studio Morfeo 2: survey on the management of insomnia by Italian general practitioners. Sleep Med 2006; 7:599-606. [PMID: 16815749 DOI: 10.1016/j.sleep.2006.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 02/01/2006] [Accepted: 02/01/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE To carry out an observational epidemiological survey (Studio Morfeo 2) in order to define the management procedures of insomnia in a large Italian population presenting directly to the general practitioner (GP). PATIENTS AND METHODS Each GP recruited five insomniac subjects in the course of 1 week or 5 consecutive office days over a period of 2 weeks. On each office day, a brief questionnaire (Q1) including five questions investigating insomnia symptoms and current use of treatment was administered to the first 10 patients who referred to the GP office for reasons associated with their own health. The first patient of each day classified as insomniac underwent a second investigation based on a more detailed questionnaire (Q2) including demographic variables, socio-economic status, general medical conditions, severity, duration and clinical features of insomnia, daytime dysfunction, sleep satisfaction and therapeutic management. RESULTS In a primary care setting, insomnia symptoms are often persistent (>1 year), recurrent (>1/week) and accompanied by daytime consequences. Two out of three patients with insomnia symptoms are dissatisfied with their sleep. In most cases, insomnia symptoms are underrated both by the patients, who cover the problem or reject treatment, and by the GP, who limits intervention on the sleep disorder (scarcely modifying ongoing therapy both in responders and in non-responders). In responders, treatment was confirmed in 91% of cases and discontinued in only 2%. When there was no improvement, or if insomnia symptoms became worse (non-responders), treatment was nevertheless continued in 74.5% of cases, either maintaining the same ineffective dose, increasing the dose, or adding another drug or a non-pharmacological procedure. Regardless of specific medication, the Italian GP privileges the pharmacological approach, which is fourfold more frequent than non-pharmacological therapy (78.6 versus 18.2%). Non-benzodiazepine hypnotic drugs are mostly prescribed when the GP decides to apply medication in previously untreated patients with insomnia symptoms. Self-administration is not unusual among the patients with insomnia symptoms and is more common among non-responders. CONCLUSIONS Italian GPs tend to confirm the ongoing therapy and avoid re-evaluation of the treatment regimen. Limited use of non-pharmacological treatment in the Italian primary care setting is in line with this conservative approach of the GPs who tend to be problem-solvers rather than problem-seekers.
Collapse
Affiliation(s)
- Mario Giovanni Terzano
- Department of Neuroscience, Sleep Disorders Center, University of Parma, Via Gramsci, 14, 43100 Parma, Italy.
| | | | | | | | | |
Collapse
|
35
|
Ferretti A, Giampiccolo P, Redolfi S, Mondini S, Cirignotta F, Cavalli A, Tantucci C. Upper airway dynamics during negative expiratory pressure in apneic and non-apneic awake snorers. Respir Res 2006; 7:54. [PMID: 16573817 PMCID: PMC1508150 DOI: 10.1186/1465-9921-7-54] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 03/30/2006] [Indexed: 11/13/2022] Open
Abstract
Background The ability of negative expiratory pressure (NEP) technique to differentiate between awake snorers with and without obstructive sleep apnea-hypopnea (OSAH) was investigated. Methods Forty-eight subjects with sleep disordered breathing (SDB) and 7 healthy subjects, as non-snorer controls, underwent the NEP application of -5 and -7 cmH2O in the seated and supine position during wakefulness, after performing a sleep study. The upper airway collapsibility was assessed by computing the volume exhaled during the first 0.5 sec. (V,NEP0.5) and 1 sec. (V,NEP1) following the NEP start. Results Patients with severe (AHI ≥ 30) (n = 19) and mild-to-moderate (AHI <30 and >5) (n = 15) OSAH had lower V,NEP0.5 (340 ± 88 ml) as compared to snorers (AHI ≤ 5) (n = 14) (427 ± 101 ml; p < 0.01) and controls (n = 7) (492 ± 69 ml; p < 0.001) in the supine position with NEP -5 cmH2O. Less significant differences among the different groups were observed for V,NEP0.5 in the seated position with NEP -5 cmH2O and in both positions with NEP -7 cmH2O (only OSAH patients vs controls, p < 0.001). Similar results were obtained for V,NEP1 in either position by using both NEP -5 cmH2O and -7 cmH2O. In spite of this, a substantial overlapping of V,NEP0.5 and V,NEP1 between snorers and OSAH patients did not allow to identify a reliable diagnostic cut-off level. An inverse correlation with AHI was found for V,NEP0.5 in the supine position with NEP -5 cmH2O (rs = -0.46, p < 0.05) in severe OSAH patients. Conclusion The awake OSAH patients exhibit values of V,NEP0.5 and V,NEP1 lesser than those of awake snorers. The NEP technique, however, appears to have a limited usefulness as clinical tool for routine screening of the OSAH patients during wakefulness.
Collapse
Affiliation(s)
- A Ferretti
- Division of Pneumology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - S Redolfi
- Respiratory Medicine Unit, Department of Internal Medicine, University of Brescia, Italy
| | - S Mondini
- Neurology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - F Cirignotta
- Neurology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - A Cavalli
- Division of Pneumology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - C Tantucci
- Respiratory Medicine Unit, Department of Internal Medicine, University of Brescia, Italy
| |
Collapse
|
36
|
La Morgia C, Mondini S, Guarino M, Bonifazi F, Cirignotta F. Busulfan neurotoxicity and EEG abnormalities: a case report. Neurol Sci 2004; 25:95-7. [PMID: 15221628 DOI: 10.1007/s10072-004-0237-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2003] [Accepted: 03/04/2004] [Indexed: 11/26/2022]
Abstract
A 21-year-old woman with acute lymphoblastic leukemia underwent bone marrow transplantation (BMT). The conditioning regimen consisted of an association of busulfan (BU) and cyclophosphamide (Cy). The day after starting BU, she suffered a generalized tonic-clonic seizure. Electroencephalography (EEG) performed the day after the seizure showed diffuse polyspikes and spike-and-wave discharges. EEG on the following days showed persistent abnormalities (slowing of background activity intermixed with diffuse slow waves and isolated delta and theta bursts). These abnormalities persisted for about 20 days with complete normalization one month after the seizure. We suggest that BU is implicated in these abnormalities and emphasize the importance of EEG recording before and after bone marrow transplantation to disclose BU neurotoxicity.
Collapse
Affiliation(s)
- C La Morgia
- Neurology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, I-40138 Bologna, Italy.
| | | | | | | | | |
Collapse
|
37
|
Sorrenti G, Piccin O, Scaramuzzino G, Mondini S, Cirignotta F, Ceroni AR. Tongue base reduction with hyoepiglottoplasty for the treatment of severe OSA. Acta Otorhinolaryngol Ital 2004; 24:204-10. [PMID: 15688905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Surgical treatment for retro-lingual obstruction in patients suffering from obstructive sleep apnea syndrome remains a problem for which there is no simple solution. The techniques most in use (tongue suspension, genioglossal advancement with hyoid suspension) are effective primarily as stabilization methods modifying neither tongue position, nor volume and only produce appreciable results when performed on non-overweight patients with respiratory disturbance index <40. For patients suffering from severe obstructive sleep apnoea syndrome in whom the most obvious morphological alteration is the presence of hypo-pharyngeal obstruction due to tongue base hypertrophy, who are overweight or suffering from moderate obesity, a surgical procedure aimed at reducing tongue volume and at repositioning the hyoid bone, even if invasive, leads to a favourable outcome. Herein, personal experience is described in a group of 8 patients presenting severe obstructive sleep apnoea syndrome incompatible with normal quality of life and normal life expectancy (mean respiratory disturbance index = 55.1) who underwent surgical resection of the tongue base with hyoepiglottoplasty. This technique, first described by Chabolle, differs radically from others inasmuch as it guarantees enlargement of the hypo-pharyngeal lumen and remodelling of the hyolingual complex. Using a suprahyoid cervical approach, it is possible to effect ample reduction of the tongue base with amplification of the hypo-pharyngeal airway without inducing problems as far as concerns either swallowing or speech.
Collapse
Affiliation(s)
- G Sorrenti
- Department of Surgical Science and Reanimation, "S Orsola-Malpighi" Hospital, Italy.
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
Sleepiness and driving is a dangerous combination that causes thousands of crashes each year resulting in injury and death. In the last few years, driving simulators have been used to study the performance decrements associated with drowsiness. We correlated performances of a driving simulation task in healthy volunteers in different alertness conditions with objective (MSLT: Multiple Sleep Latency Test) and subjective (SSS: Stanford Sleepiness Scale; VAS: Visual Analogue Scale) sleepiness measurements. The subjects were tested on two days, after a normal night of sleep and after a night of complete sleep deprivation. The study consists of four sessions of MSLT, each one followed by subjective measurements of sleepiness and by a 30 min driving simulation task with a monotonous driving scenario. The parameters that correlate most highly with MSLT are the standard deviation of lane position, the mean RT, crash frequency and exceeding the speed limit frequency. The monotonous driving simulation we adopted showed strong correlations with MSLT and subjective sleepiness scales in healthy subjects and is suitable to evaluate excessive daytime sleepiness in patients.
Collapse
Affiliation(s)
- Fabio Pizza
- Sleep Center, Unit of Neurology, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
| | | | | | | | | |
Collapse
|
39
|
Villa MP, Brunetti L, Bruni O, Cirignotta F, Cozza P, Donzelli G, Ferini Strambi L, Levrini L, Mondini S, Nespoli L, Nosetti L, Pagani J, Zucconi M. [Guidelines for the diagnosis of childhood obstructive sleep apnea syndrome]. Minerva Pediatr 2004; 56:239-53. [PMID: 15252374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- M P Villa
- Gruppo di Studio interdisciplinare disturbi respiratori nel sonno, Società Italiana di Pediatria, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Driving Simulators reproduce situations that require tracking and visual searching, the main features of real driving. This study measured the reliability of a monotonous driving scenario to detect the circadian variations of alertness in healthy subjects. Five men and five women underwent a monotonous 30 min driving simulation task every 2 h. Before each driving task subjects completed the Stanford Sleepiness Scale (SSS) and the Visual Analogue Scale (VAS) to correlate the subjective measurements of sleepiness to the objective data of the simulator. Driving performances deteriorated or improved according to the circadian variation of alertness. The scenario is suitable to detect the consequences of sleepiness related to the circadian variations of alertness. The standard deviation of lane position, comparing the differences among the 10 min blocks in each task is the parameter most significant for the evaluation of sleepiness.
Collapse
Affiliation(s)
- Sara Contardi
- Sleep Center, Unit of Neurology, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
| | | | | | | | | |
Collapse
|
41
|
Lucchi E, Minicuci N, Magnifico F, Mondini S, Calza A, Avanzi S, Villani D, Bellelli G, Trabucchi M. A QUALITATIVE ANALYSIS OF THE MINI MENTAL STATE EXAMINATION ON ALZHEIMER’S DISEASE PATIENTS TREATED WITH CHOLINESTERASE INHIBITORS. Arch Gerontol Geriatr 2004:253-63. [PMID: 15207422 DOI: 10.1016/j.archger.2004.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The improvement in cognitive performances due to cholinesterase inhibitors (ChEls) is not homogeneous among Alzheimer's disease (AD) subjects. Aim of this study is to evaluate whether a specific pattern of change in mini mental state examination (MMSE) could be observed in AD subjects after 9-month treatment with ChEls. From September 2000 to September 2002, 99 subjects enrolled in the CRONOS project. They have never been previously treated with ChEls. All of them completed both the 3- and the 9-month follow-up. The multidimensional assessment included MMSE, activity of daily living (ADL), instrumental activity of daily living (IADL), somatic health status, according to design of the CRONOSproject. The MMSE was analyzed both as a total score and disaggregated in 11 items. All subjects were divided in 2 groups according to the degree of change in MMSE total score from baseline to the 9th month. Subjects with a change </= -1 were defined as non-responders(NR), whereas those with a change >0 as responders (R). At start, no statistically significant differences were found between the 2 groups. MMSE score was significantly higher in the R group both at 3 (p < 0.0001) and 9 months (p < 0.0001), while functional status (ADL and IADL) was significantly lower in NR group at 9 months (p = 0.025; p =0.018, respectively). In MMSE qualitative analysis of 3-month, NR significantly worsened in temporal (p </= 0.05) and spatial orientation (p </= 0.001), and in delayed recall items (p </= 0.0005) in comparison to their counterpart. At 9-month the differences between the 2 groups were observed also for registration (p < 0.001), attention (p </= 0.0005), obeying oral commands (p < 0.0005), reading and obeying commands (p </= 0.0005), writing a sentence (p </= 0.0005) and copying a design (p </= 0.05). In a multivariate regression model, after adjustment for demographic (age, education, gender) and clinical factors (duration of disease), only the change at 3 months in 5 MMSE items (temporal and spatial orientation,delayed recall, obeying an oral command and reading and obeying command) is associated with global cognitive change observed at 9 months. Data suggest that the change in cognitive performances of AD subjects treated with ChEls involves few and specific MMSE items at 3-month, while it tend to generalize to almost all the others at 9-month treatment.
Collapse
Affiliation(s)
- E Lucchi
- Alzheimer's Evaluation Unit, Ancelle della Caritá Hospital, I-26100 Cremona, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Anterior spinal artery (ASA) syndrome results in motor palsy and dissociated sensory loss below the level of the lesion, accompanied by bladder dysfunction. When the cervical spine is involved, breathing disorders may be observed. OBJECTIVE To describe the polysomnographic findings in a patient with cervical ASA syndrome complicated by a sleep breathing disorder. SETTING Unit of neurology at a sleep center. Patient A 30-year-old man had an ischemic lesion that affected the anterior cervical spinal cord (C2-C6) bilaterally because of an ASA thrombosis. He developed ASA syndrome associated with respiratory impairment during sleep. RESULTS The polysomnographic study during sleep showed a severe sleep disruption caused by continuous central apneas that appeared immediately after falling asleep. Treatment by intermittent positive pressure ventilation normalized the respiratory pattern and sleep architecture. CONCLUSIONS The sleep breathing pattern was compatible with central alveolar hypoventilation due to automatic breathing control failure caused by a lesion of the reticulospinal pathway, which normally activates ventilatory muscles during sleep. This autonomic sleep breathing impairment resembles that found as a complication in patients who undergo spinothalamic tract cervical cordotomy for intractable pain. This surgical complication is known as the Ondine curse.
Collapse
Affiliation(s)
- Mauro Manconi
- Units of Neurology, St Orsola-Malpighi Hospital, Bologna, Italy
| | | | | | | | | | | |
Collapse
|
43
|
Sorrenti G, Piccin O, Latini G, Scaramuzzino G, Mondini S, Rinaldi Ceroni A. Tongue base suspension technique in obstructive sleep apnea: personal experience. Acta Otorhinolaryngol Ital 2003; 23:274-80. [PMID: 15046416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Tongue suspension with Kit Repose is a surgical mini-invasive end-oral technique used in treatment of rear tongue obstruction. The base of the tongue is anchored with a non-reabsorbable suture, held in place with a titanium screw, to the mandible in correspondence to the geni apophysis of the mandible: this loop should prevent the tongue, during sleep, from dropping backwards, favoured also by gravity and hypotonicity of the genioglossus muscle. Aim of this report is to focus on the results of our experience in 15 patients presenting obstructive sleep apnea submitted to uvulopalatopharyngoplasty associated with tongue suspension, using the Kit Response bone screw system (Influent Inc., San Francisco, CA, USA). Mean age of patients was 50.5 years (range 36-66), with mean RDI (apnoea/hypopnea index) of 44.47 (range 23-63) and mean body mass index of 28.27 (range 22.6-34.4). Scrupulous clinical evaluation, including endoscopy and cephalometry, revealed a pharyngeal obstruction both retro palatal and retro lingual. Clinical and polysonnographic examinations were carried out 4-6 months after surgery. Patients were considered responders if the RDI had decreased by 50% and below 20, with disappearance of subjective symptoms (snoring, daytime sleepiness). Polysonnographic examination showed, overall, good results with mean reduction of RDI from 44.5 to 24.2 (45% reduction); albeit, only 6 cases could be considered surgically successful; 4 cases (26.6%) showed improvement whereas the remaining 5 (33.4%) failed to present any significant change in RDI. Even if the technique was, indeed, mini-invasive, rapidly performed and lacked significant complications, the results were not, in our opinion, encouraging, bearing in mind the high cost of the kit and limited stability of the results over time. Better results can be obtained by advancement of the genioglossus associated with hyoid suspension, whereas, of the mini-invasive techniques, promising outcomes would appear feasible with reduction of volume at the base of the tongue, using radiofrequency.
Collapse
Affiliation(s)
- G Sorrenti
- Department of Surgical Science and Reanimation, Otorhinolaryngology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
The objective of this study was to seek evidence of the particular sensitivity of proper name retrieval and to check the usefulness of proper names as diagnostic material in the early stages of Alzheimer's disease (AD). Whether a generalized naming deficit is an early symptom of AD it is not yet clear. Previous studies suggest that proper names might be the category of names that is indeed more sensitive to AD. Seventy AD patients (subdivided into "very mild", "mild" and "moderate") and 47 control subjects participated in the study. The performances in two short distinct tests requiring proper name retrieval (Naming People on Definition and Naming Faces), one test of common name retrieval, short (MMSE, 3MS) and long (MODA) batteries for the detection of dementia were compared. Proper name retrieval tests were shown to be more sensitive to early AD than any other tests and batteries that failed to distinguish "very mild" AD from controls. These findings suggest that proper name retrieval tasks might be profitably included in diagnostic tools for the early diagnosis of AD.
Collapse
Affiliation(s)
- C Semenza
- Department of Psychology, University of Trieste, Italy
| | | | | | | | | |
Collapse
|
45
|
Cirignotta F, Mondini S, Santoro A, Ferrari G, Gerardi R, Buzzi G. Reliability of a questionnaire screening restless legs syndrome in patients on chronic dialysis. Am J Kidney Dis 2002; 40:302-6. [PMID: 12148102 DOI: 10.1053/ajkd.2002.34508] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the reliability of a self-administered questionnaire on leg discomfort and restlessness as a screening tool for restless legs syndrome (RLS) in a population of chronically dialyzed patients. METHODS One hundred twenty-seven patients on chronic hemodialysis therapy filled in a self-administered questionnaire including 4 diagnostic questions for RLS and 12 subsequent questions on clinical characteristics of leg discomfort. Two neurologists trained in sleep medicine blinded to questionnaire answers evaluated all patients and diagnosed RLS according to criteria of the International Restless Legs Syndrome Study Group. We compared questionnaire results in terms of RLS diagnosis with direct patient evaluation performed by neurologists used as a gold standard. RESULTS The questionnaire showed a low sensitivity and specificity and did not prove reliable for screening for RLS in uremic patients. False-positive results seem to be caused by the presence of other leg symptoms and neurological objective signs suggesting peripheral neuropathy; false-negative results may be caused by the moderate severity of leg discomfort and its poor appraisal. CONCLUSION Our study suggests caution in evaluating results of questionnaires to screen for RLS in patients with chronic renal insufficiency on dialysis therapy.
Collapse
Affiliation(s)
- Fabio Cirignotta
- Neurology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
46
|
Luzzatti C, Mondini S, Semenza C. Lexical representation and processing of morphologically complex words: evidence from the reading performance of an Italian agrammatic patient. Brain Lang 2001; 79:345-359. [PMID: 11781047 DOI: 10.1006/brln.2001.2475] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The study of patients with acquired language disorders has provided crucial evidence for contemporary theories on mental lexical representation. This is particularly true for the representation of morphologically complex words. In this paper we analyzed the performance of a patient (M.B.) affected by agrammatism and dyslexia. M.B. was required to read aloud simple and morphologically complex words. The patient's pattern of errors was interpreted as the result of a predominant use of the lexical routine (phonological dyslexia). Three reading tasks were developed which allowed us to test M.B.'s ability to read morphologically complex words (reading of regular and irregular plurals; reading of high- and low-frequency singular and plural nouns; reading of evaluative suffixes). Errors were determined by frequency effect rather than by type of suffix (i.e., inflectional or derivational). High-frequency morphologically complex items seemed to meet stored representations, thus avoiding the parsing procedures that are required for less frequent items. These results are in keeping with dual route models of lexical representation of morphologically complex words.
Collapse
Affiliation(s)
- C Luzzatti
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.
| | | | | |
Collapse
|
47
|
Abstract
The presence of executive deficits has been sought at a stage of Alzheimer's disease where currently used neuropsychological batteries could not yet distinguish Alzheimer's patients from normal age- and education-matched controls. This study shows that, at this early stage, those patients that 6 months later are found to show clear signs of Alzheimer's had been significantly worse than normal controls in an executive function task adapted from the Brown-Peterson procedure.
Collapse
Affiliation(s)
- T M Sgaramella
- Divisione di Neurologia, Ospedale Civile di Vicenza, Trieste, Italy
| | | | | | | | | | | |
Collapse
|
48
|
Cirignotta F, Mondini S, Gerardi R, Mostacci B, Sancisi E. Unreliability of Automatic Scoring of MESAM 4 in Assessing Patients With Complicated Obstructive Sleep Apnea Syndrome. Chest 2001; 119:1387-92. [PMID: 11348943 DOI: 10.1378/chest.119.5.1387] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Portable devices are used for unattended recording of patients with suspected obstructive sleep apnea syndrome (OSAS). The MESAM 4 (MAP; Martinsried, Germany) is a computerized ambulatory polysomnographic system that records four parameters: breathing noise, heart rate, arterial oxygen saturation (SaO(2)), and body position. DESIGN AND METHOD We evaluated the reliability of the oxygen desaturation index (ODI) automatically calculated by the MESAM 4 device in evaluating patients with "complicated" OSAS. These patients present SaO(2) drops due to apneas associated with a fall in baseline SaO(2) during sleep, as occurs in the "overlap syndrome." Ten patients with complicated OSAS underwent nocturnal MESAM 4 recordings, and we compared the visual and automatic scorings of the ODI. RESULTS The ODI obtained with visual scoring was significantly higher than ODI automatically calculated by the MESAM 4 in all patients. In some patients, this difference was so significant that it could bias clinical judgment of OSAS severity. We demonstrated that the system did not identify those desaturation events that were superimposed on a fall in baseline SaO(2). The error depends on the algorithm by which the device recognizes the desaturation events and calculates the baseline SaO(2). CONCLUSION Automatic analysis of MESAM 4 recordings may be misleading in evaluating OSAS patients who have a fall in baseline SaO(2) during sleep. In this case, visual scoring performed by a trained polysomnographer is recommended.
Collapse
Affiliation(s)
- F Cirignotta
- Sleep Medicine Unit, Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | | | | | | | | |
Collapse
|
49
|
Cirignotta F, Manconi M, Mondini S, Buzzi G, Ambrosetto P. Wernicke-korsakoff encephalopathy and polyneuropathy after gastroplasty for morbid obesity: report of a case. Arch Neurol 2000; 57:1356-9. [PMID: 10987905 DOI: 10.1001/archneur.57.9.1356] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Gastric partitioning is a surgical procedure for the treatment of morbid obesity that may engender neurological complications, such as Wernicke encephalopathy and polyneuropathy. SETTING A specialist hospital. PATIENT A 36-year-old woman developed Wernicke-Korsakoff encephalopathy and polyneuropathy 3 months after gastroplasty for morbid obesity. A magnetic resonance scan documented the diagnosis, and a clear improvement occurred after parenteral thiamine treatment. In our patient and in previously described cases of the literature, postsurgical vomiting is a constant finding that seems to be the precipitating factor of neurological complications of gastric partitioning. CONCLUSION Persistent vomiting after gastroplasty for morbid obesity should be considered an alarming symptom to treat immediately with appropriate measures.
Collapse
Affiliation(s)
- F Cirignotta
- Department of Neurology, S. Orsola-Malpighi Hospital, via Albertoni 15, 40138 Bologna, Italy
| | | | | | | | | |
Collapse
|
50
|
Semenza C, Borgo F, Mondini S, Pasini M, Sgaramella T. Proper names in the early stages of Alzheimer's disease. Brain Cogn 2000; 43:384-7. [PMID: 10857731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A short proper name retrieval test was found to discriminate between unselected subjects and age- and education- matched patients affected by Alzheimer's type dementia at a stage where the Mini-Mental State Examination could not detect a difference between these groups. The proper name retrieval task also compared favorably with the 3MS, a more sensitive, modified version of the MMSE. These findings suggest that proper name retrieval could be used to an advantage and become a routine component of short batteries for the early detection of Alzheimer's disease.
Collapse
Affiliation(s)
- C Semenza
- Department of Psychology, University of Trieste, Italy
| | | | | | | | | |
Collapse
|