BACKGROUND: To investigate the sleep disorders related to chronic insomnia and compare the characteristics of each group. METHODS: We registered 191 patients (female 56.0%, age 61.7 years) who have complained about symptoms of insomnia for more than three months and assessed sleep disorders related chronic insomnia by analyzing their polysomnography (PSG) parameters, demographics, and questionnaires (Insomnia Severity Index, Beck Depression Inventory, Pittsburg Sleep Quality Index, and Epworth Sleepiness Scale, and World Health Organization Quality of Life Assessment Instrument abbreviated version). RESULTS: Patients were categorized into groups of primary insomnia (PI, 51.8%, n=99), comorbid insomnia with obstructive sleep apnea (CIO, 38.7%, n=74), and comorbid insomnia with periodic limb movement disorder (CIP, 9.4%, n=18). CIO was older and more obese than PI and CIP. The proportion of males was the highest in CIO. Arousal index of PSG was higher in CIO and CIP than in PI. Other parameters and the results of questionnaires were not different among groups. CONCLUSIONS: About a half of patients with chronic insomnia symptoms (48.2%) had considerable sleep disorders associated with insomnia. Our study suggests that the PSG as well as history taking and demographics are necessary to clarify the relevant conditions of chronic insomnia disorder for appropriate treatment.
Arousal ; Demography ; Depression ; Humans ; Male ; Nocturnal Myoclonus Syndrome ; Polysomnography ; Quality of Life ; Sleep Apnea, Obstructive ; Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders ; World Health Organization

OBJECTIVES: Periodic limb movement disorder (PLMD) has been debated with regard to its clinical significance and diagnostic criteria. The current diagnostic criterion for PLMD in adults has been changed from periodic limb movement index (PLMI) > 5/ hour to PLMI > 15/hour by the International Classification of Sleep Disorders (ICSD). In this study, we aimed to investigate the changes in polysomnographic sleep variables according to PLMI and to determine the relevance of the diagnostic criterion for PLMD. METHODS: Out of 4195 subjects who underwent standard polysomnography, we selected 666 subjects (370 males and 296 females, aged 47.1 ± 14.8) who were older than 17 years and were not diagnosed with primary insomnia, sleep apnea, narcolepsy, or REM sleep behavior disorder. Subjects were divided into three groups according to PLMI severity: group 1 (PLMI ≤ 5), group 2 (5 < PLMI ≤ 15), and group 3 (PLMI > 15). Demographic and polysomnographic sleep variables and Epworth sleepiness scale (ESS) were compared among the three groups. RESULTS: There were significant differences among the three groups in age and gender. Sleep efficiency (SE) and stage 3 sleep percentage in group 1 were significantly higher than those in groups 2 and 3. The wake after sleep onset (WASO) score in group 1 was significantly lower than those in groups 2 and 3. However, there were no significant differences in SE, stage 3 sleep percentage, or WASO between groups 2 and 3. Sleep latency (SL) in group 1 was significantly lower than that in group 3, but there was no difference in SL between group 2 and group 3. ESS score in group 1 was significantly higher than that in group 3, but there was no difference between group 2 and group 3. Partial correlation analysis adjusted by age showed that PLMI was significantly related to SE and WASO. CONCLUSION: This study suggests that PLMI influences polysomnographic sleep variables. In addition, we found the individuals who did not have PLMD but had PLMI > 5 were not different in polysomnographic sleep variables from the individuals who had PLMD according to the current criterion. These results raise questions about the relevance of the current diagnostic criterion of PLMD.
Adult ; Classification ; Extremities* ; Female ; Humans ; Male ; Narcolepsy ; Nocturnal Myoclonus Syndrome ; Polysomnography ; REM Sleep Behavior Disorder ; Sleep Apnea Syndromes ; Sleep Initiation and Maintenance Disorders ; Sleep Wake Disorders

Periodic limb movements during sleep (PLMS) are frequently observed in the general population, although such movements may be associated with a variety of medical and neurological disorders. Human T-lymphotropic virus type I-associated myelopathy (HAM) is a rare progressive disease in which abnormalities are rarely observed on spinal images. We present the case of a 55-year-old woman with PLMS who was later diag-nosed with HAM. The current case indicates that HAM can be considered a possible cause of PLMS.
Extremities* ; Female ; Human T-lymphotropic virus 1 ; Humans* ; Middle Aged ; Nervous System Diseases ; Nocturnal Myoclonus Syndrome ; Spinal Cord Diseases*

INTRODUCTIONChronic insomnia is associated with many physical and psychiatric illnesses, and its underlying aetiology needs to be identified in order to achieve safe and effective treatment. Obstructive sleep apnoea (OSA) and periodic limb movement disorder (PLMD) are common primary sleep disorders that can lead to chronic insomnia. Patients with these conditions are evaluated using polysomnography (PSG).

METHODSThe PSG records of 106 patients with chronic insomnia who presented to a multidisciplinary sleep clinic in Singapore over a five-year period were reviewed. To examine the utility of PSG in the evaluation of chronic insomnia, the clinical diagnoses of the patients before and after the sleep studies were compared.

RESULTSAmong the 106 patients, 69 (65.4%) were suspected to have primary sleep disorders based on clinical history and examination alone. Following PSG evaluation, 42.5% and 4.7% of the study population were diagnosed with OSA and PLMD, respectively. OSA was found in 35.9% of the 39 patients who had underlying psychiatric conditions.

CONCLUSIONThis study illustrates that many patients with chronic insomnia have underlying primary sleep disorders. It also highlights the danger of attributing chronic insomnia in psychiatric patients to their illness, without giving due consideration to other possible aetiologies. Clinicians should maintain a high index of suspicion for the presence of other aetiologies, and make timely and targeted referrals for sleep studies where appropriate.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Medical Records ; Middle Aged ; Nocturnal Myoclonus Syndrome ; diagnosis ; Polysomnography ; methods ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Sleep Apnea, Obstructive ; diagnosis ; Sleep Initiation and Maintenance Disorders ; therapy ; Sleep Wake Disorders ; diagnosis ; Treatment Outcome ; Young Adult

OBJECTIVES: The aim of this study is to evaluate the polysomnographic characteristics and prescription status of restless legs syndrome (RLS) patients in naturalistic setting. METHODS: We reviewed medical record of the patients over 18 years olds who (i) satisfied the clinical RLS diagnostic criteria and (ii) had the polysomnography and got treatment related thereto. As a baseline, we evaluated the four diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG) and the International Restless Legs Scale (IRLS) of the subjects. Then the polysomnography and the suggested immobilization test (SIT) were conducted and, after one month of pharmacotherapy using dopamine agonist, the IRLS was evaluated again. RESULTS: A total of 211 subjects participated in this analysis and 94 (44.5%) of them were male and the other 117 (55.5%) were female and the average age of the 211 subjects was 46.9+/-14.2. Out of such 211 subjects, 136 subjects (64.5%) also had the obstructive sleep apnea (OSA), and 53 subjects (25.1%) also had the periodic limb movement disorder (PLMD). 185 subjects (87.7%) out of the 211 subjects had some other sleep disorders except RLS. The results of the polysomnography were as follows : 78.0% of sleep efficiency, 86.8 min of wake after sleep onset, and 3.4% of N3. More specifically, 12.4/h of the average apnea hypopnea index, 14.8/h of the periodic limb movement during sleep (PLMS), 41.2/h of the periodic limb movement during wake during SIT and 21.6/h of total arousal index during sleep. Out of the total subjects, 149 (70.6%) of them took the ropinirole and 47 (22.3%) of them took the pramipexole, and the average dosage of ropinirole was 0.9mg(dosage range 0.125-5 mg) while the average dosage of pramipexole was 0.5 mg (dosage range 0.125-4 mg). The dosage of the ropinirole showed a significant positive correlation with the age (r=0.25, p=0.002) and also with the IRLS (r=0.23, p=0.038). The IRLS at the baseline was 24.9 while the same was decreased down to 13.4 after one month. CONCLUSIONS: Analyzing the result of this study, a majority of clinical RLS subjects demonstrated comorbidity with some other sleep disorder such as the OSA or PLMD. 25.1% of the subjects showed a PLMD, which was less than in previous researches and the average PLMS was not very high as 14.8/h. The dosage of dopamine agonist taken was often a bit more than the amount recommended in Korea. A prospective research using a large scale controlled subjects will be necessary with respect to this topic.
Apnea ; Arousal ; Benzothiazoles ; Comorbidity ; Dopamine Agonists ; Extremities ; Female ; Humans ; Immobilization ; Indoles ; Isothiocyanates ; Korea ; Male ; Medical Records ; Nocturnal Myoclonus Syndrome ; Polysomnography ; Prescriptions ; Restless Legs Syndrome ; Sleep Apnea, Obstructive ; Sleep Wake Disorders

Previous reports on the lesions causing stroke-related periodic limb movement in sleep (PLMS) have involved subcortical structures such as the basal ganglia/corona radiata or pons. We report a case of an 81-year-old female patient who presented with bilateral, right-side-predominant PLMS that developed after a left cortical infarction. The right-side PLMS may be attributable to the loss of cortical inhibition following a pyramidal tract lesion, while the left-side PLMS may be caused by activation of the contralateral motor cortex due to dysfunction of interhemispheric inhibition.
Aged, 80 and over ; Anterior Cerebral Artery ; Cerebral Infarction ; Extremities ; Female ; Humans ; Infarction ; Infarction, Anterior Cerebral Artery ; Motor Cortex ; Nocturnal Myoclonus Syndrome ; Pons ; Pyramidal Tracts

Actigraphy is a method for measuring activity with computerized wristwatch like devices. During the several decades, technological advances have improved the availability of these devices, with miniaturizing their size and increasing memory capacities and detection sensitivity. Compared with polysomnography, the gold standard for evaluation of sleep, actigraphy has unique advantages which are less expensive, noninvasive, less limited in time of recording, and more conductive to repeated measures. Now, actigraphy is used increasingly in clinical practice and research for sleep and other circadian rhythm abnormalities. This paper includes the basic technology and algorithms of actigraphy, reliability and validity issues, and general consideration for applications. Also it reviews the current literatures regarding use of actigraphy in sleep disorders including insomnia, obstructive sleep apnea, and periodic limb movement disorder and other psychiatric disorders related to alteration of circadian rhythm.
Actigraphy ; Circadian Rhythm ; Memory ; Nocturnal Myoclonus Syndrome ; Polysomnography ; Reproducibility of Results ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: We review the sleep problems of the alcohol dependence patients. Especially we are interested in the prevalence, the severity of symptoms, anxiety, depression, and sleep quality of restless legs syndrome (RLS) in the alcohol dependence patients. METHODS: We recruit 86 alcohol dependence patients who were admitted from October 6th, 2008 to October 17th, 2008. We interviewed each patient and evaluated sleep questionnaires such as the Sleep Disorder Questionnaire (SDQ), the Pittsburgh Sleep Quality Index (PSQI) and the International Restless Legs Syndrome Study Group (IRLSSG) rating scale. The presence of RLS and its severity were assessed using the IRLSSG diagnostic criteria and the IRLSSG severity scale, respectively. Depression and anxiety were evaluated by the Beck Depression Inventory (BDI) and the Beck anxiety inventory (BAI). RESULTS: Of all 86 patients, 59 patients have insomnia, 33 patients have RLS, 30 patients have Periodic limb movement disorder (PLMD), 29 patients have nightmare. RLS patients have more high score in the BAI (21.70+/-10.36 vs 14.67+/-11.98), and their sleep quality was poor in the PSQI (11.09+/-4.08 vs 7.92+/-3.91) than non-RLS patients. CONCLUSION: This study shows that alcohol dependence patients show many sleep problems such as insomnia and RLS. So we should notice that the sleep problems of alcohol dependence patients are important in clinical approach and treatment.
Alcoholism ; Anxiety ; Depression ; Dreams ; Humans ; Nocturnal Myoclonus Syndrome ; Prevalence ; Surveys and Questionnaires ; Restless Legs Syndrome ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Sleep disturbances are very common in the patients with Parkinson's disease (PD) and several sleep disorders are known to have pathological associations with PD, such as REM sleep behavior disorder (RBD), restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). The authors conducted this study to find clinical characteristics and impact of sleep disorders in the patients with PD. METHODS: A total of 97 patients with PD (41 males, age 61.0+/-9.3 years, Hoehn and Yahr stage 1-4) were recruited. We interviewed bed partners of parkinsonian patients for sleep disorders with structured questionnaires and compared interview results with the clinical characteristics of Parkinson's disease and the results of cognitive function tests. RESULTS: RLS (24.7%), RBD (19.6%), sleep apnea (15.5%) and PLMD (13.4%) were frequently reported by bed partners of the patients. PLMD, RBD and apnea were significantly increased in male patients. Parkinsonian characteristics of the patients (dose of L-dopa, predominant motor symptom, duration of symptom and treatment, use of dopamine agonist, Hoehn and Yahr stage, and severity of motor symptoms) were not related with sleep disorders and daytime sleepiness, but the bed partners reported decreased arousal and increased daytime sleepiness in the patients with sleep disorders. The cognitive profiles of the patients showed impaired memory function in the sleepy patients. CONCLUSIONS: We could not find the correlations between sleep disorders and the clinical characteristics of PD. But, sleep disorders were prevalent in PD patients and caused daytime sleepiness and cognitive dysfunctions.
Apnea ; Arousal ; Cognition ; Dopamine Agonists ; Humans ; Levodopa ; Male ; Memory ; Nocturnal Myoclonus Syndrome ; Parkinson Disease ; Surveys and Questionnaires ; REM Sleep Behavior Disorder ; Restless Legs Syndrome ; Sleep Apnea Syndromes ; Sleep Wake Disorders

Excessive daytime sleepiness (EDS) is a prevalent complaint among patients in psychiatric and medical care. Patients with EDS have often been misdiagnosed with depression due to their complaints of lack of energy and poor concentration. Also, they have even been diagnosed erroneously with a psychotic disorder in case of coexistence with hypnagogic hallucination. EDS can seriously affect the person's quality of life by causing decreased academic achievement or work performance, low self esteem, and social withdrawal. EDS is also frequently associated with various medical and psychiatric conditions, and often fatal traffic or on-the-job accidents. The causes of EDS range from insufficient sleep to central nervous system-originated hypersomnia. The conditions that can lead to EDS include circadian rhythm disorders, primary disorders of alertness such as narcolepsy, sleep-related breathing disorders such as obstructive sleep apnea syndrome, sleep-related movement disorders such as periodic limb movement disorder and restless legs syndrome, chronic medical conditions such as cancer, and medications causing sleepiness. Treatment options should be tailored according to the underlying condition and include sufficient sleep time, light therapy, sleep scheduling, wakefulness-promoting medications, or mechanical airway managements such as nasal continuous positive airway pressure (CPAP).
Achievement ; Chronobiology Disorders ; Continuous Positive Airway Pressure ; Depression ; Diagnosis, Differential ; Disorders of Excessive Somnolence ; Hallucinations ; Humans ; Movement Disorders ; Narcolepsy ; Nocturnal Myoclonus Syndrome ; Phototherapy ; Psychotic Disorders ; Quality of Life ; Respiration ; Restless Legs Syndrome ; Self Concept ; Sleep Apnea, Obstructive