SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science IV. Sleep Disorders – Parasomnias
behaviors and/or vigorous sleep talk were under control, however, this
tendency has not been well investigated. We developed a questionnaire
for evaluating dream frequency and intensity by RBD patients and their
behaviors by family members to see whether it could be used as a tool
for evaluating treatment efficacy even in a patient who lives alone.
Methods: Consecutive 28 patients (man 24/ woman 4, age:67.2±7.1
years) with idiopathic RBD (iRBD) who came to our clinic from October
2005 to December 2009 were studied. RBD severity index (RBDSI),
which is composed of four questions about frequency and intensity of
the dreams for patients (RBDSI-A) and six questions about observed
behaviors for his/her bed partner or family members (RBDSI-B), were
performed twice or more, mostly before and after treatment by clonazepam.
Seven patients were excluded from the analysis who responded
the questionnaire only once.
Results: RBDSI-A decreased from 10.9±3.1 (range 4-16) to 7.3±2.8
(range 3-15) and RBDSI-B decreased from 14.2±4.1 (range 7-21) to
7.9±4.9 (range 0-18), and RBDSI-A and B scores are significantly correlated.
Clonazepam was effective, which was clearly shown by decrease
in RBDSI-A and RBDSI-B. There were five patients with no medication
in whom both RBDSI-A and RBDSI-B decreased as time went by.
Conclusion: RBDSI could be used to assess the efficacy of drug treatment
in most of the patients, and it could also be applicable for evaluating
the natural course. RBDSI-A seems to reflect severity of iRBD to
some extent, therefore, it could be a workable tool to evaluate nocturnal
behaviors of iRBD patients who have no observer.
0571
SLEEP-RELATED EATING DISORDER AND OBSTRUCTIVE
SLEEP APNEA
Atwal P, Weinstein M, Feuerman M
Sleep Medicine, Winthrop University Hospital, Garden City, NY, USA
Introduction: Sleep-related eating disorder (SRED), consisting of recurrent
episodes of eating following arousal from nighttime sleep, is frequently
associated with other sleep disorders in particular parasomnias.
A strong association with obstructive sleep apnea (OSA) has not been
reported in patients with SRED and it is unclear whether OSA is a cause
or consequence of SRED. We present a retrospective review of 39 cases
of SRED with specific attention towards the prevalence of OSA.
Methods: Retrospective review of records of patients, diagnosed with
SRED at Winthrop University Hospital from April 2005 to December
2010, detailing demographic, clinical and polysomnographic characteristics.
Results: 39 patients(54% females / 46% males) with age ranging 21-
75 years(mean: 48.1+/-15.0) with BMI 21.5-50.8(mean31.1+/-6.4) diagnosed
with SRED, described variable symptoms including nocturnal
eating(100%), snoring(77%), EDS(74.36%), sleepwalking(46.15%),
sleep talking(25.64%), insomnia(81.6%). All patients with insomnia(100%)
reported difficulty in maintenance of sleep(95% CI 89-100).
Nocturnal eating episodes were described as occurring 2-3 times/week
with 70.97% endorsing eating “high calorie/high carb” foods. 2 patients
acknowledged eating raw bacon/frozen food and one described history
of almost causing a fire while trying to cook at night. 37.14% of patients
reported full recall, 11.43% no recall, and 51.43% variable recall.
Morning anorexia was reported in 15.79% of patients. Mood disorders
were noted in 47.37% of patients (72.2% depression, 38.8% anxiety disorder
and 22.2% bipolar disorder). Salient polysomnographic features
included median sleep latency of 23.0 minutes, sleep efficiency of 32-96
%( mean: 76.8+/- 14.0), % REM sleep 1.2- 25 %( mean: 14).OSAS was
noted in 73.53% (95% CI 56.9%-85.4%), with Apnea Hypopnea Index
(AHI) ranging from 0.3-96.6 (median: 10.1).
Conclusion: There is a high prevalence of OSA in patients with SRED.
Treatment of OSAS may reduce the number of arousals triggering nocturnal
eating episodes and improve SRED. Further studies are needed to
confirm this hypothesis.
0572
REM SLEEP BEHAVIOR DISORDER SCREENING
QUESTIONNAIRE IN PARKINSONIAN SYNDROMES:
VIDEOPOLYSOMNOGRAPHIC CHECK
Provini F, Alessandria M, Calandra-Buonaura G, Guaraldi P,
Scaglione C, Martinelli P, Montagna P, Cortelli P
Department of Neurological Sciences, University of Bologna, Bologna,
Italy
Introduction: Videopolysomnography (VPSG) is required by the International
Classification of Sleep Disorders to establish a diagnosis
of REM sleep behaviour disorder (RBD). VPSG is time and resource
consuming in routine clinical practice. In 2004, we developed an RBD
screening questionnaire, structured in three sections to evaluate nocturnal
sleep quality, RBD and other movement disorders during sleep.
The questionnaire explores details of RBD semeiology (vocalisations,
motor behaviour, consciousness and dreaming, dream contents upon
awakening) and episode frequency. The aim of this study was to verify
the reliability of the questionnaire by means of VPSG in patients with a
parkinsonian syndrome at onset (≤3 year history).
Methods: We recruited 24 consecutive patients (13 men; 11 women;
mean age 59±12 years; disease duration: 19±10 months). The screening
questionnaire was administered to patients and, when possible, to their
bed partner. All patients underwent VPSG, including EEG, EOG, chin
and limb EMG muscles. Sleep stages and the tonic and phasic components
of REM sleep were scored according to the American Academy of
Sleep Medicine (AASM) criteria.
Results: The questionnaire was positive in four patients, and at least one
of RBD episode was recorded during VPSG. VPSG in one patient, who
reported only one episode of RBD during his life, disclosed excessive
amounts of sustained or intermittent elevation of submental EMG tone
and excessive phasic submental or limb EMG twitching during REM
sleep, but no RBD episodes were recorded. No RBD episode was recorded
in the 19 patients with negative questionnaire.
Conclusion: Although our cohort was small, this study suggests that our
RBD questionnaire is reliable in the diagnosis of RBD in parkinsonian
syndrome at onset. The use of a semistructured questionnaire does not
replace VPSG, but may help sleep specialists suspect RBD.
0573
NOCTURNAL PERIODIC AND NON-PERIODIC LIMB
MOVEMENTS IN CHILDREN WITH PARASOMNIAS
Heshmati A, Perry GV, Goldman RR, Robert B
Children’s Mercy Hospital and Clinics, Kansas City, MO, USA
Introduction: Sleep terrors and sleepwalking are two common childhood
parasomnias, which occur in deep non-rapid eye movement sleep.
Despite widespread prevalence of these disorders, and the recognition
that they may arise from incomplete arousal, their pathophysiology is
not well understood. We studied the occurrence of obstructive sleep apnea
(OSA), periodic Leg movement (PLM), and non-periodic leg movement
in patients with parasomnias. Our hypothesis is that nocturnal limb
movements can trigger abrupt and incomplete EEG arousals and parasomnias.
Methods: A retrospective review of 1507 consecutive polysomnograms,
performed in Children’s Mercy Hospital Sleep Diagnostic Unit
from October 2007 to November 2010.
Results: One hundred and one patients with parasomnia identified by
history underwent polysomnography. The mean age for this group of
patients with parasomnias was 6.02 years ± 3.71 (ranged 10 months to
17 years). Of these 101 patients, 34 patients (33.6%) had OSA, and 15
patients (14.8%) had PLM disorder (PLM index>5). Twelve of these 14
patients had one or more episodes of confusional arousals documented
on the night of sleep study. In 9 (8.9%) of 14, the confusional arousal
was preceded by leg movements.
SLEEP, Volume 34, Abstract Supplement, 2011
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