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Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
In order to be classified as having periodic limb movement disorder (PLMD), there must be a clinical sleep disturbance or complaints of daytime fatigue. There are three criteria for PLMD diagnosis: Demonstration of PLMs on polysomnography.Elevated PLM index (> 15 for adults and > 5 for children is recommended), though emphasis is placed on clinical context rather than absolute numbers.Clinical sleep disturbance or daytime fatigue/sleepiness must be present.
Introduction to polysomnography
Published in Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam, Clinical Atlas of Polysomnography, 2018
Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam
At times, these physiological functions get disrupted and give rise to different disease states. This disturbance may be limited to either state of consciousness, that is, wakefulness or sleep, or at times, may be seen during both stages. For example, exercise-induced cardiac ischemia may remain limited to the state of wakefulness. On the other hand, some pathological processes are seen only during sleep. These conditions may, (i) interfere with the initiation or maintenance of sleep, for example, insomnia; (ii) lead to abnormality in one of the physiological functions during sleep, for example, sleep apnea, sleep-related laryngospasm; (iii) be associated with movements during sleep, for example, restless legs syndrome/periodic limb movement disorder, sleep seizure, night terrors, and REM sleep behavior disorder; (iv) lead to excessive sleepiness, for example, narcolepsy, idiopathic hypersomnia, and Kleine-Levine syndrome. Lastly, some pathologies are present during wakefulness but further deteriorate during sleep, for example, non-apnic hypoxemia during sleep in COPD patients. The latter two entities that are seen during sleep interfere with the normal sleep process, and in such a situation, it is termed as sleep disorder.
Long-term discharge planning in traumatic brain injury rehabilitation
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
Mark J. Ashley, Susan M. Ashley
Sleep disturbance is a relatively common complication following TBI. Sleep disturbance can be manifest in three primary problems (although a multitude of problems can be encountered): 1) sleep apnea/hypopnea, 2) periodic limb movement disorder (PLMD), and 3) hypersomnolence (excessive daytime sleepiness). Interruption of sleep is a fairly common complaint following TBI and may be related to routine, diet, psychological issues, or sleep hygiene. Education should be provided regarding each of these impacts to the injured person and his or her caregivers as they may be most easily addressed. More complicated issues, such as sleep apnea/hypopnea, PLMD, and hypersomnolence, will require medical interventions. It is beyond the scope of this chapter to thoroughly review sleep disorders. Rather, the intent is to review some of the more common issues that may be encountered following TBI.
The Impact of Cognitive-Behavioral Interventions on Sleep Disturbance in Depressed and Anxious Community-dwelling Older Adults: A Systematic Review
Published in Behavioral Sleep Medicine, 2022
Future research should consider undertaking a comprehensive and objective assessment of sleep. Each of the studies in the review use self-report measures of sleep, which have low-to-moderate agreement with objective sleep measures, especially in older adulthood (Hughes et al., 2018; Unruh et al., 2008). Furthermore, composite scores of sleep disturbance are primarily utilized across the described research, potentially masking treatment effects on specific sleep features, given the multifaceted nature of sleep in old age (Roepke & Ancoli-Israel, 2010). This is particularly relevant as psychiatric diagnoses, such as GAD, have been associated with differences in specific subcomponents of sleep (e.g., lowered sleep quality and greater daytime dysfunction; Ramsawh et al., 2009) which may be more important to target and measure when assessing the outcome of a CBT intervention. Finally, none of the studies completed a detailed clinical sleep assessment, to establish any functional or sleep impairments (e.g., sleep disordered breathing, periodic limb movement disorder) which are common in older adults (Neikrug & Ancoli-Israel, 2010) and could influence sleep quality and limit the effectiveness of treatment. Future research is required, with the primary aim of investigating the effects of CBT intervention on sleep disturbance in late-life mental health, incorporating a comprehensive sleep assessment.
Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management
Published in Postgraduate Medicine, 2021
Russell Rosenberg, Paula K. Schweitzer, Joerg Steier, Jean-Louis Pepin
EDS is also associated with other sleep disorders that can co-occur with OSA. Insomnia is commonly comorbid with OSA, occurring in 39–55% of patients [69,70]. Narcolepsy, which can occur with (type 1) or without (type 2) cataplexy, idiopathic hypersomnia, and Kleine-Levin syndrome are central disorders of hypersomnolence where the primary complaint is EDS. The presence of cataplexy can help distinguish narcolepsy type 1 from other hypersomnolence disorders, whereas idiopathic hypersomnia and Kleine-Levin syndrome can be identified by consistent or episodes of long sleep times, respectively. Circadian rhythm sleep-wake disorders are characterized by misalignment between one’s biological clock and desired/required sleep-wake schedule (e.g. shift work, jet lag); wakefulness during the biological nighttime can lead to EDS. Finally, restless legs syndrome and periodic limb movement disorder, characterized by an urge to move the legs during rest/inactivity and frequent limb movements during sleep, respectively, can cause sleep disturbance-induced EDS [62].
How does one choose the correct pharmacotherapy for a pediatric patient with restless legs syndrome and periodic limb movement disorder?: Expert Guidance
Published in Expert Opinion on Pharmacotherapy, 2019
Thomas J. Dye, Neepa Gurbani, Narong Simakajornboon
Epidemiological studies have shown that restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are common in children and adolescents with an estimated prevalence of 2–4% [1,2]. The etiology of RLS and PLMD is not well understood. However, genetic factors, dopaminergic dysfunction, and iron deficiency have been proposed to play a role in the pathogenesis of RLS and PLMD [1]. In addition, other neurochemical systems including glutamate and opioid may be involved in the pathophysiology of RLS and PLMD. The diagnosis of RLS and PLMD is challenging, especially among young children, as they may not be able to describe specific RLS symptoms or these symptoms may not appear until later. Children often have non-specific symptoms such as restless sleep, insomnia, and daytime fatigue or sleepiness. The International RLS Study Group (IRLSSG) has developed specific diagnostic criteria for RLS and PLMD in children [3]. In addition to the five essential adult RLS criteria, several specific features should be considered in making a diagnosis of RLS in children. These features include language and cognitive development as related to ability to describe RLS symptoms, the effect of RLS on behavior and educational domain, and the close link between RLS and PLMD in children. Furthermore, certain clinical features including a periodic limb movement (PLM) index of more than 5/hr, a family history of RLS or PLMD among the first degree relatives, and a family history of PLMS (PLM index >5/hr) can be used to support the diagnosis of RLS in children.