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David T Plante, Laurel A Finn, Erika W Hagen, Emmanuel Mignot, Paul E Peppard
BACKGROUND: Hypersomnolence is common in depression, however longitudinal associations of excessive daytime sleepiness (EDS), long habitual sleep duration, and objective sleep propensity with depressive symptomatology are not well established. METHODS: Data from adults participating in the Wisconsin Sleep Cohort Study who had multiple assessments at 4-year intervals were utilized in analyses. Conditional (intrasubject) logistic regression estimated the likelihood of development of depression and three primary hypersomnolence measures: subjective EDS [Epworth Sleepiness Scale (ESS) >10], habitual sleep duration ≥9h/day, and increased physiological sleep propensity [multiple sleep latency test (MSLT) mean sleep latency <8min]...
October 3, 2016: Journal of Affective Disorders
Lynn M Trotti
The transition from sleep to wake is marked by sleep inertia, a distinct state that is measurably different from wakefulness and manifests as performance impairments and sleepiness. Although the precise substrate of sleep inertia is unknown, electroencephalographic, evoked potential, and neuroimaging studies suggest the persistence of some features of sleep beyond the point of awakening. Forced desynchrony studies have demonstrated that sleep inertia impacts cognition differently than do homeostatic and circadian drives and that sleep inertia is most intense during awakenings from the biological night...
September 4, 2016: Sleep Medicine Reviews
K V Vinod, R Kaaviya, Bhaumik Arpita
Artery of Percheron (AOP) occlusion is a rare cause of ischemic stroke characterized by bilateral paramedian thalamic infarcts, with or without mesencephalic infarction. Clinically it presents with mental state disturbances, hypersomnolence, aphasia/dysarthria, amnesia and ocular movement disorders, including vertical gaze palsy. Here, we report a case of cardioembolic AOP infarction in a 37-year-old woman with rheumatic mitral valvular stenosis. This case is being reported to highlight the interesting clinical and neuroimaging features of this rare condition, and the differential diagnosis of AOP infarction on imaging have been discussed...
July 2016: Annals of Neurosciences
Madhu Nagappa, Parayil Sankaran Bindu, Shwetha Chiplunkar, Periasamy Govindaraj, Gayathri Narayanappa, Ayyappan Krishnan, M M Srinivas Bharath, Aarthi Swaminathan, Jitender Saini, Hanumanthapura R Arvinda, Sanjib Sinha, Pavagada S Mathuranath, Arun B Taly
Deficiency of gamma-amino-butyrate aminotransferase (ABAT) is a rare inherited disorder. A six-month-old girl presented with hyper-somnolence, hyperkinetic movements of distal extremities during wakefulness, hypotonia, bi-pyramidal signs, and impaired response to sound and visual stimuli. Brain MRI at five months showed restricted diffusion along the internal capsule and genu of corpus callosum. A follow up MRI at 18months, showed hyperintensities in brainstem, external and internal capsule, 'trilaminated' appearance of posterior limb of internal capsule and dysmyelination of sub-cortical white matter...
September 2, 2016: Brain & Development
Lynn Marie Trotti, Prabhjyot Saini, Catherine Koola, Vincent LaBarbera, Donald L Bliwise, David B Rye
STUDY OBJECTIVES: Patients with central disorders of hypersomnolence sometimes do not achieve satisfactory symptom control with currently available wake-promoting medications. Based on the finding that the cerebrospinal fluid from some patients with hypersomnolence demonstrates potentiation of gamma-aminobutyric acid (GABA)-A receptors in excess of that of controls, a finding that reverses with flumazenil, we initiated prescribing compounded flumazenil to carefully selected, treatment-refractory hypersomnolent patients...
August 22, 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Frédéric Roche
No abstract text is available yet for this article.
July 2016: Sleep Medicine
Lucie Barateau, Régis Lopez, Yves Dauvilliers
Narcolepsy type 1 (NT1) and type 2 (NT2) are two rare neurological diseases, classified as central disorders of hypersomnolence. The pathophysiology of NT1 is well known; it is caused by the selective destruction of hypocretin (Hcrt) neurons, by a highly suspected autoimmune process. On the contrary, little is known about NT2 etiology, sharing with NT1 somnolence and signs of dysregulation of rapid eye movement (REM) sleep, but not cataplexy. Management strategies are rather codified, at least in adults, with a lifelong treatment required in NT1, whereas no pharmacological study focused only on NT2 patients, with sometimes spontaneous improvement or disappearance of their symptoms...
October 2016: Current Treatment Options in Neurology
Joseph Andrew Berkowski, Anita Valanju Shelgikar
Central disorders of hypersomnolence are rare conditions with a poorly understood pathophysiology, making the identification and management challenging for sleep clinicians. Clinical history is essential for ruling out secondary causes of hypersomnolence and distinguishing among diagnoses. Current diagnostic criteria rely heavily on the polysomnogram and multiple sleep latency test. The current focus of treatment of hypersomnolence is on drugs that promote alertness. Additionally, in the case of narcolepsy type 1, medication management addresses control of cataplexy, the hallmark symptom of this disorder...
September 2016: Sleep Medicine Clinics
Maurice M Ohayon, Yves Dauvilliers, Cristina Milesi
Excessive sleepiness or hypersomnolence is currently defined by two main symptoms: 1) the excessive amount of sleep, defined as a prolonged period of main sleep or the presence of naps; and 2) poor quality of awakening. Excessive sleepiness was reported by 27.8%. The presence of recurrent periods of irresistible sleep in the same day was found in 13.2%, recurrent naps in the same day in 1.9%, non-restorative sleep despite a nighttime sleep of more than 9 hours (0.7%), as well as a sleep drunkenness (4.4%). Adding criteria for duration and frequency (minimum of 3 times per week and duration of at least 3 months), having social or professional impairment and psychological distress, and after excluding significant associated comorbidities, the prevalence fall to 1...
June 2016: La Revue du Praticien
Brian J Murray
Excessive daytime sleepiness (EDS) is a common problem that is important to recognize and address. Initial steps in management are generally straightforward and only the most advanced cases would require referral to a subspecialist. Of particular concern is that of driving safety. There is a broad differential diagnosis for conditions contributing to EDS but a few common conditions account for the majority of clinical presentations. Subjective self-reporting will often lead to identification of potential problems, but this is often unreliable...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Lori Ani Panossian, Alon Y Avidan
Sleep disorders are common in neurology practice, but are often undiagnosed and untreated. Specific patient cohorts, such as older adults, patients residing in nursing homes, and patients with underlying chronic neurologic and psychiatric disorders, are at particular risk. If these sleep problems are not properly evaluated and managed the patient may experience exacerbation of the underlying neurologic disorder. This article highlights some of the key sleep disorders relevant to practicing neurologists, emphasizing hypersomnolence, insomnia, and sleep-related movement disorders in the setting of neurologic disorders to enhance the tools available for evaluation, and discusses management strategies...
August 2016: Neurologic Clinics
Raffaele Ferri, Fabio Pizza, Stefano Vandi, Martina Iloti, Giuseppe Plazzi
OBJECTIVE: To analyze the complexity of the nocturnal sleep stage sequence in central disorders of hypersomnolence (CDH), with the hypothesis that narcolepsy type 1 (NT1) might exhibit distinctive sleep stage sequence organization and complexity. METHODS: Seventy-nine NT1 patients, 22 narcolepsy type 2 (NT2), 22 idiopathic hypersomnia (IH), and 52 patients with subjective hypersomnolence (sHS) were recruited and their nocturnal sleep was polysomnographically recorded and scored...
August 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Yves Dauvilliers, Elisa Evangelista, Regis Lopez, Lucie Barateau, Isabelle Jaussent, Thierry Cens, Matthieu Rousset, Pierre Charnet
OBJECTIVE: The pathophysiology of idiopathic hypersomnia (IH) remains unclear. Recently, cerebrospinal fluid (CSF)-induced enhancement of γ-aminobutyric acid (GABA)-A receptor activity was found in patients with IH compared to controls. METHODS: Fifteen unrelated patients (2 males and 13 females) affected with typical IH, 12 patients (9 males and 3 females) with narcolepsy type 1, and 15 controls (9 males and 6 females) with unspecified hypersomnolence (n = 7) and miscellaneous neurological conditions (n = 8) were included...
August 2016: Annals of Neurology
Radostina Vlaeva Cherneva, Zheina Vlaeva Cherneva, Ognian Borisov Georgiev, Daniela Stoichkova Petrova, Julia Ivanova Petrova
BACKGROUND: Oxidative stress and inflammation are assumed as the main pathological triggers for vascular damage in hypersomnolent obstructive sleep apnoea (OSA) patients, whereas their exact role in less symptomatic population is currently unknown. AIM: To determine whether oxidative stress (urinary 8-isoprostane concentration) and inflammation (plasma resistin levels) are associated with vascular damage in non-hypersomnolent (Epworth Sleep Score <11) OSA patients...
June 3, 2016: Clinical Physiology and Functional Imaging
Xue Ming, Varsha Radhakrishnan, Lilia Kang, Keith Pecor
BACKGROUND: The effects of gender, headaches, and their interaction on sleep health (sleep duration, sleep onset and continuity, and indications of hypersomnolence) have not been well studied. MATERIALS AND METHODS: For American adolescents, we contrasted sleep health variables between males (n = 378) and females (n = 372) and between individuals with chronic headaches (n = 102 females and 60 males) and without chronic headaches (n = 270 females and 318 males) using data from surveys...
September 2016: Journal of Women's Health
Lucie Barateau, Régis Lopez, Yves Dauvilliers
Narcolepsy type 1 and narcolepsy type 2 are central disorders of hypersomnolence. Narcolepsy type 1 is characterized by excessive daytime sleepiness and cataplexy and is associated with hypocretin-1 deficiency. On the other hand, in narcolepsy type 2, cerebrospinal fluid hypocretin-1 levels are normal and cataplexy absent. Despite major advances in our understanding of narcolepsy mechanisms, its current management is only symptomatic. Treatment options may vary from a single drug that targets several symptoms, or multiple medications that each treats a specific symptom...
May 2016: CNS Drugs
Emily Mostofi, Wouter I Schievink, Valerie L Sim
Frontotemporal brain sagging syndrome is a dementia associated with hypersomnolence, personality changes, and features of intracranial hypotension on magnetic resonance imaging. The literature is sparse with respect to treatment options; many patients simply worsen. We present a case in which this syndrome responded to lumbar dural reduction surgery. Postoperative magnetic resonance imaging indicated normalization of brain sagging and lumbar intrathecal pressure. Although no evidence of cerebrospinal leak was found, extremely thin dura was noted intraoperatively, suggesting that a thin and incompetent dura could result in this low-pressure syndrome...
July 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
William G Mantyh, R Robert Auger, Timothy I Morgenthaler, Michael H Silber, Wendy R Moore
STUDY OBJECTIVES: Narcolepsy and idiopathic hypersomnia are commonly treated by sleep specialists and encountered by other medical providers. Although pharmacotherapy with modafinil and traditional stimulants is considered the mainstay of treatment, physicians are often uncomfortable with their prescription because of concerns regarding misuse. The goal of this study was to assess the frequency of stimulant misuse in this population. METHODS: A retrospective cohort study was performed evaluating patients 18 years and older diagnosed with narcolepsy with and without cataplexy and idiopathic hypersomnia with and without long sleep between 2003-2008...
2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Jing Yu Wang, Fang Han, Song X Dong, Jing Li, Pei An, Xiao Zhe Zhang, Yuan Chang, Long Zhao, Xue Li Zhang, Ya Nan Liu, Han Yan, Qing Hua Li, Yan Hu, Chang Jun Lv, Zhan Cheng Gao, Kingman P Strohl
STUDY OBJECTIVES: Kleine-Levin syndrome (KLS) is a rare disorder of relapsing sleepiness. The hypothesis was that the syndrome is related to a change in the vigilance peptide orexin A. METHODS: From 2002 to 2013, 57 patients with relapsing hypersomnolence were clinically assessed in a referral academic center in Beijing, China, and 44 (28 males and 16 females; mean age 18.3 ± 8.9 y (mean ± standard deviation, range 9-57 y) were determined to have clinical and behavioral criteria consistent with KLS...
2016: Sleep
Juan F Masa, Jaime Corral, Auxiliadora Romero, Candela Caballero, Joaquin Terán-Santos, Maria L Alonso-Álvarez, Teresa Gomez-Garcia, Mónica González, Soledad López-Martín, Pilar De Lucas, José M Marin, Sergi Marti, Trinidad Díaz-Cambriles, Eusebi Chiner, Miguel Merchan, Carlos Egea, Ana Obeso, Babak Mokhlesi
BACKGROUND: Obesity hypoventilation syndrome (OHS) is associated with a high burden of cardiovascular morbidity (CVM) and mortality. The majority of patients with OHS have concomitant OSA, but there is a paucity of data on the association between CVM and OSA severity in patients with OHS. The objective of our study was to assess the association between CVM and OSA severity in a large cohort of patients with OHS. METHODS: In a cross-sectional analysis, we examined the association between OSA severity based on tertiles of oxygen desaturation index (ODI) and CVM in 302 patients with OHS...
July 2016: Chest
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