Narcolepsy with intermediate cerebrospinal level of hypocretin-1

Study objectives To describe the phenotype of narcolepsy with intermediate cerebrospinal hypocretin-1 levels (CSF hcrt-1). Methods From 1600 consecutive patients with narcolepsy from Bologna and Montpellier sleep centers we selected patients with intermediate CSF hcrt-1 levels (110-200 pg/ml). Clinical, neurophysiological and biological data were contrasted for the presence of cataplexy, HLA-DQB1*06:02, and median CSF hcrt-1 levels (149.34 pg/mL). Results Forty-five (55% males, aged 35 ± 17 years) patients (2.8% of all cases) were included. Thirty-three (73%) were HLA-DQB1*06:02, 29 (64%) reported cataplexy (21, 72.4% with typical features), and 5 (11%) had presumed secondary etiology. Cataplexy was associated with other core narcolepsy symptoms, increased sleep onset REM periods, and nocturnal sleep disruption. Cataplexy and irrepressible daytime sleep were more frequent in HLA DQB1*06:02 positive patients. Lower CSF hcrt-1 levels were associated with hallucinations. Conclusion Narcolepsy with intermediate CSF hcrt-1 level is a rare condition with heterogeneous phenotype. HLA DQB1*06:02 and lower CSF hcrt-1 were associated with typical narcolepsy features, calling for future research to distinguish incomplete from secondary narcolepsy forms.

Schlaf‘, Kindlein, schlaf‘: Schlafverhalten von Säuglingen unter Propranolol-Therapie

Sleep problems are frequently reported in infants treated with propranolol for infantile hemangiomas, possibly serving as a marker for a negative impact on central nervous system function. In this cohort study, we objectively investigate the sleep behavior of infants with infantile hemangiomas on propranolol compared to a healthy, untreated control group. Sleep of propranolol-treated infants and controls was investigated using ankle actigraphy and a 24-h diary for 7–10 days at ages 3 and 6 months. The main outcome measures were the Number of Nighttime Awakenings and Sleep Efficiency. The main secondary outcome measures included 24-hour Total Sleep, daytime sleep behavior, and parent-rated infant sleep quality and behavioral development based on the Brief Infant Sleep Questionnaire (BISQ) and the age-appropriate Ages-and-Stages Questionnaire (ASQ), respectively. Fifty-four term-born infants were included in each cohort. No group difference in any investigated parameter was seen at age 3 months. At age 6 months, the propranolol group exhibited a decrease in Sleep Efficiency and a trend towards an increased Number of Nighttime Awakenings compared to the control group. Treated infants at 6 months also had shorter daytime waking periods. 24-hour Total Sleep was unaffected by propranolol. No negative impact of propranolol on subjective sleep quality and behavioral development was noted. <b>Conclusion:</b> Propranolol exerts a measurable yet mild impact on objectively assessed infants’ sleep measures. Behavioral developmental scores were unaffected. Our results support propranolol as first-line therapy for complicated infantile hemangiomas. <b>What is Known:</b> •Sleep disorders are frequently reported in infants with infantile hemangiomas treated with propranolol and often lead to treatment discontinuation. • Investigations of the sleep pattern in this patient group using objective measures are lacking. <b>What is New:</b> • The sleep pattern of propranolol-treated infants is assessed using actigraphy and a 24-h sleep diary and compared to healthy, untreated controls. • Propranolol leads to a decreased sleep efficiency at night and an increased demand of daytime sleep, yet effects are mild overall.

A REVIEW ON BASTI CHIKITSA IN PRAMEHA: A CRITICAL ANALYSIS

Prameha is a Tridoshaja Vyadhi with Kapha predominance. It is a lifestyle disorder and Charaka explains it as a Santarpana Janya Vyadhi, caused due to overindulgence in heavy and richly nutritious food, daytime sleep, lack of exercise, other sedentary habits and not doing seasonal purification. All these etiological factors are responsible for the formation of Vitiated Meda and Kleda (deliquesce) i.e. Abhishyanda. The disease is mainly characterized by Prabhuta and Avila Mutrata. Prameha can be correlated with Diabetes Mellitus. Diabetes mellitus is a metabolic disorder of multiple aetiology, characterized by an increase in plasma blood glucose resulting from defects in insulin secretion, insulin action, or both. Globally, an estimated 463 million adults are living with Diabetes. Diabetes Currently affects more than 62 million people which is more than 7.1% of India’s adult population. As Prameha is a Santarpana Janya Vyadhi, Apatarpana is the main line of treatment. Charaka explains various Shodhana procedures in Prameha and contraindicates Basti in it, as it will increase the progress of the disease. But still, Acharyas explain various Basti Karmas for Prameha. Hence here is an attempt to critically analyse Basti Karma as a line of treatment in Prameha.

Upper-lower limb and breathing exercise program for improving sleep quality and psychological status in multiple sclerosis: a pilot randomized controlled trial

Purpose: To examine the feasibility and possible effect of an 8-week exercise program on sleep quality, insomnia and psychological distress in individuals with multiple sclerosis (MS). Methods: Twenty-four individuals with MS were recruited into a controlled pre-post feasibility study and divided into 2 groups: exercise (n = 13; Expanded Disability Status Scale (EDSS): 1.0–7.5) and a related control group with no exercise (n = 11; EDSS: 1.0–7.0). The exercise group performed combined upper limb, lower limb and breathing exercises in a controlled group (2d/week, 60 min/session) for 8 weeks. Participants were administered measures to evaluate sleep quality (Pittsburgh Sleep Quality Index, PSQI), insomnia severity (Insomnia Severity Index, ISI), psychological distress (Clinical Outcomes in Routine Evaluation–Outcome Measure, CORE-OM) and additionally impact of fatigue (Modified Fatigue Impact Scale, MFIS) after 8-weeks. Results: Insomnia severity measured with ISI (F(1;22)=5.95, p = 0.023, η p 2 = 0.213, 90% CI = 0.02–0.42) and psychological distress measured with the CORE-OM (F(1;22)=4.82, p = 0.039, η p 2 = 0.179, 90% CI = 0.01–0.40) showed statistically significant group-by-time interaction. Sleep quality measured with the PSQI showed statistically significant group-by-time interaction only in an aspect of daytime sleep dysfunction (F(1;22)=5.33, p = 0.031, η p 2 = 0.195, 90% CI = 0.01–0.40). The fatigue impact measured with the MFIS showed statistically significant group-by-time interaction in physical (F(1;22)=6.80, p = 0.016, η p 2 = 0.236, 90% CI = 0.02–0.44) and cognitive aspects (F(1;22)=9.12, p = 0.006, η p 2 = 0.293, 90% CI = 0.05–0.49), and total score (F(1;22)=11.29, p = 0.003, η p 2 = 0.339, 90% CI = 0.08–0.52). Conclusions: Our 8-week program reduced insomnia severity, psychological distress and some aspects of fatigue (physical; cognitive; total), and improved sleep quality in an aspect of daytime sleep dysfunction in a small group of individuals with MS. Good feasibility and significant positive changes from baseline warrant further exploratory work.

Sleep during infancy, inhibitory control and working memory in toddlers: findings from the FinnBrain cohort study

Background Sleep difficulties are associated with impaired executive functions (EFs) in school-aged children. However, much less is known about how sleep during infancy relates to EF in infants and toddlers. The aim of this study was to investigate whether parent-reported sleep patterns at 6 and 12 months were associated with their inhibitory control (IC) and working memory (WM) performances at 30 months. Methods This study included children whose parents filled in a sleep questionnaire at 6 or 12 months and who participated in the development assessment at 30 months (initial available sample at 30 months; N = 472). The final sample comprised (a) 359 infants with IC task and sleep questionnaire at 6 months and 322 toddlers at 12 months and (b) 364 infants with WM task and sleep questionnaire at 6 months and 327 toddlers at 12 months. Nighttime, daytime and total sleep duration, frequency of night awakenings, time awake at night, and proportion of daytime sleep were assessed at 6 and 12 months using the Brief Infant Sleep Questionnaire. IC at 30 months was measured using a modified version of the Snack Delay task, and WM was measured at 30 months using the Spin the Pots task. Further, children were divided into three groups (i.e., “poor sleepers”, “intermediate sleepers”, and “good sleepers”) based on percentile cut-offs (i.e., <10th, 10th–90th and > 90th percentiles) to obtain a comprehensive understanding of the direction and nature of the associations between sleep and EF in early childhood. Results Our results showed an inverted U-shaped association between proportion of daytime sleep at 12 months and IC at 30 months, indicating that average proportions of daytime sleep were longitudinally associated with better IC performance. Furthermore, a linear relation between time awake at night at 12 months and WM at 30 months was found, with more time awake at night associating with worse WM. Conclusions Our findings support the hypothesis that sleep disruption in early childhood is associated with the development of later EF and suggest that various sleep difficulties at 12 months distinctively affect WM and IC in toddlers, possibly in a nonlinear manner.

299 Limited Time for Sleep in Night Shift Workers is associated with Risk of Insomnia and Shift Work Disorder

Introduction Sleep deficiency is a severe problem faced by night shift workers. Approximately one-third of night workers report insomnia during daytime sleep and excessive sleepiness during nighttime work; when severe, these symptoms characterize shift work disorder (SWD). Difficulty sustaining 7 to 9 hours of sleep during the daytime is partly due to a circadian drive for wakefulness. Not much is known, however, about how non-work activities contribute to the inability to obtain recovery sleep. We sought to explore how much time night workers are able to allocate for daytime sleep, and how this relates to insomnia-like symptoms and the likelihood of developing SWD. Methods Night shift workers (n=452, 19–69 years old, 54% men) from various occupations who worked at least four night shifts per month completed an online survey. This included questions related to shift duration, hours per workday of non-optional non-work activities, self-rated sleep need, the Insomnia Severity Index (ISI) and a validated 4-item SWD screening questionnaire. For each participant, we calculated the duration of work plus non-optional activities and compared the remaining available time for sleep to their self-described sleep need. Non-parametric Chi-square analyses and Pearson correlations were conducted. Results On average, shift duration was 8.9±1.6 hours, non-optional activities were 3.6±2.9 hours, and sleep need was 7.6±1.6 hours, leaving 15% of shift workers with insufficient free time to obtain the amount of sleep they needed. The percentage of workers at high risk for SWD was significantly greater among those who did not have enough free time for sleep compared to those whose schedules allowed sufficient sleep time (72% vs. 42%; χ2=20.2, p&lt;0.0001). We also found that shift workers with insufficient free time for sleep reported higher insomnia severity (r2=-0.20, p&lt;0.0001). Conclusion About 15% of night workers have non-optional activities outside work that limit their time to obtain sufficient sleep, and this contributes to greater insomnia-like symptoms and increased risk for SWD. Future research should focus on understanding what these non-optional activities are and whether they differ between night and day workers. These insights will enable personalized countermeasures to maximize the sleep and health of shift workers. Support (if any) Supported by US NIH grant R01-AG044416.