Andrea Dunai

Periodic limb movements in sleep are associated with stroke and cardiovascular risk factors in patients with renal failure

Periodic limb movements in sleep (PLMS) is prevalent among dialysed patients and is associated with increased risk of mortality. Our study aimed to determine the prevalence of this disease in a sample of transplanted and waiting‐list haemodialysed patients. One hundred transplanted and 50 waiting‐list patients underwent polysomnography. Moderate and severe diseases were defined as periodic limb movements in sleep index (PLMSI) higher than 15 and 25 events h−1, respectively. The 10‐year coronary heart disease risk was estimated for all patients using the Framingham Score. Moreover, the 10‐year estimated risk of stroke was calculated according to the modified version of the Framingham Stroke Risk Profile. PLMS was present in 27% of the transplanted and 42% of the waiting‐list group (P = 0.094); the proportion of severe disease was twice as high in waiting‐list versus transplanted patients (32 versus 16%, P = 0.024). Patients with severe disease had a higher 10‐year estimated risk of stroke in the transplanted group [10 (7–17) versus 5 (4–10); P = 0.002] and a higher 10‐year coronary heart disease risk in both the transplanted [18 (8–22) versus 7 (4–14); P = 0.002], and the waiting‐list groups [11 (5–18) versus 4 (1–9); P = 0.032]. In multivariable linear regression models the PLMSI was associated independently with the Framingham cardiovascular and cerebrovascular scores after adjusting for important covariables. Higher PLMSI is an independent predictor of higher cardiovascular and cerebrovascular risk score in patients with chronic kidney disease. Severe PLMS is less frequent in kidney transplant recipients compared to waiting‐list dialysis patients.

Sleep apnea is associated with cardiovascular risk factors among kidney transplant patients.

BACKGROUND AND OBJECTIVES We assessed the prevalence of obstructive sleep apnea (OSA) and its clinical correlates in a large sample of patients who received a kidney transplant (Tx). We also compared the prevalence of the disorder between dialysis patients who were on the waiting list for a Tx (WL) and Tx patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a cross-sectional study of 100 Tx and 50 WL patients who underwent one-night polysomnography (SLeep disorders Evaluation in Patients after kidney Transplantation [SLEPT] Study). Sociodemographic information and data about medication, comorbidity, and laboratory parameters were collected. RESULTS The prevalence of mild (apnea-hypopnea index [AHI] > or =5/h and <15/h), moderate (AHI > or =15/h and <30/h), and severe OSA (AHI > or =30/h) was 18, 11, and 14% in the Tx group and 28, 16, and 10% in the WL group, respectively. The AHI was significantly correlated with age (rho = 0.34), body mass index (rho = 0.45), neck circumference (rho = 0.4), abdominal circumference (rho = 0.51), and hemoglobin (rho = 0.24) in the Tx group. The proportion of Tx patients who were treated with three or more antihypertensive drugs was significantly higher in the OSA group (56 versus 31%; P = 0.022). Despite taking significantly more antihypertensive drugs, the average systolic BP was still higher in patients with versus without OSA (147 +/- 21 versus 139 +/- 18 mmHg; P = 0.059). CONCLUSIONS The prevalence of OSA is similar in Tx and WL patients and it may contribute to presence of hypertension in patients who receive a Tx.

Association between lunar phase and sleep characteristics.

OBJECTIVES Popular belief holds that the lunar cycle affects human physiology, behavior, and health, including sleep. To date, only a few and conflicting analyses have been published about the association between lunar phases and sleep. Our aim was to analyze the relationship between lunar phases and sleep characteristics. METHODS In this retrospective, cross-sectional analysis, data from 319 patients who had been referred for sleep study were included. Individuals with apnea-hypopnea index ≥ 15/h were excluded. Socio-demographic parameters were recorded. All participants underwent one-night standard polysomnography. Associations between lunar cycle (new moon, full moon and alternate moon) and sleep parameters were examined in unadjusted and adjusted models. RESULTS Fifty-seven percent of patients were males. Mean age for men was 45 ± 14 years and 51 ± 12 years for women. In total, 224 persons had their sleep study done during alternate moon, 47 during full moon, and 48 during new moon. Full moon was associated with lower sleep efficiency [median (%) (IQR): new moon 82 (18), full moon 74 (19), alternate moon 82 (15); P < 0.001], less deep sleep [median (%) (IQR): new moon 9 (9), full moon 6 (4), alternate moon 11 (9); P < 0.001], and increased REM latency [median (min) (IQR): new moon 98 (74), full moon 137 (152), alternate moon 97 (76); P < 0.001], even after adjustment for several covariables. CONCLUSION The results are consistent with a recent report and the widely held belief that sleep characteristics may be associated with the full moon.

Obstructive Sleep Apnea and Heart Rate Variability in Male Patients with Metabolic Syndrome: Cross-Sectional Study

BACKGROUND Obstructive sleep apnea (OSA) is often accompanied by the metabolic syndrome. Because both conditions are associated with depressed heart rate variability (HRV) separately, our aim was to study whether co-morbid OSA is associated with more reduced HRV in male patients with the metabolic syndrome. METHODS In this cross-sectional study, 35 men (age, 57±11 years) with the metabolic syndrome (according to International Diabetes Federation criteria) were included. OSA severity was defined by the apnea-hypopnea index (AHI). HRV was assessed by 24-hr ambulatory electrocardiographic monitoring. Standard deviation of all normal-to-normal RR intervals (SDNN), the high frequency power (HFP), and the ratio of low- to high-frequency power (LF/HF) were measured. RESULTS There were 14, 6, and 8 cases of severe (AHI ≥30/hr), moderate (15/hr≤AHI <30/hr), and mild (5/hr ≤AHI <15/hr) OSA, respectively. Seven patients had no OSA. Patients with mild-moderate or severe OSA had reduced SDNN and HFP values compared to those without OSA. Increasing OSA severity was associated significantly with lower daytime LF/HF ratio [standardized β regression coefficient (β)=-0.362, P=0.043] and higher night/day LF/HF ratio (β=0.377, P=0.023) after controlling for age, duration of diabetes, and severity of metabolic syndrome. CONCLUSIONS Co-morbid OSA is associated with decreased overall HRV, parasympathetic loss, and impaired diurnal pattern of sympathovagal balance that may further increase the cardiovascular vulnerability of male patients with the metabolic syndrome. The role of the HRV analysis in the risk assessment of these patients warrants further studies.

Obstructive sleep apnea in women

The prevalence of sleep disturbances and their symptomatic manifestations may be different in men and women. Women with obstructive sleep apnea are less likely to be diagnosed with sleep apnea compared to men, probably due to atypical symptoms such as morning headaches, symptoms of depression and daytime fatigue. There is a great importance of diagnosis and treatment of sleep disorders regarding quality of life, co-morbidity and mortality in both genders.A különböző alvászavarok prevalenciája és klinikai-tüneti megnyilvánulása eltérő lehet a férfi ak és a nők körében. Az utóbbi évek kutatásai hívták fel a fi gyelmet az obstruktív alvási apnoe gyakori előfordulására nők körében is, mivel a férfi akkal ellentétben, főként az atípusos tünetek miatt (mint a reggeli fejfájás, depresszióra jellemző tünetek, nappali fáradtság) az esetek nagy részében nem diagnosztizálják ezt a betegséget. Mindkét nemnél nagy jelentősége van az alvászavarok korai felismerésének és kezelésének, az életminőség, társbetegségek és a mortalitás szempontjából. Orv. Hetil., 2014, 155(52), 2067–2073.

Az obstruktív alvási apnoe jelentősége nők körében | Obstructive sleep apnea in women

The prevalence of sleep disturbances and their symptomatic manifestations may be different in men and women. Women with obstructive sleep apnea are less likely to be diagnosed with sleep apnea compared to men, probably due to atypical symptoms such as morning headaches, symptoms of depression and daytime fatigue. There is a great importance of diagnosis and treatment of sleep disorders regarding quality of life, co-morbidity and mortality in both genders.A különböző alvászavarok prevalenciája és klinikai-tüneti megnyilvánulása eltérő lehet a férfi ak és a nők körében. Az utóbbi évek kutatásai hívták fel a fi gyelmet az obstruktív alvási apnoe gyakori előfordulására nők körében is, mivel a férfi akkal ellentétben, főként az atípusos tünetek miatt (mint a reggeli fejfájás, depresszióra jellemző tünetek, nappali fáradtság) az esetek nagy részében nem diagnosztizálják ezt a betegséget. Mindkét nemnél nagy jelentősége van az alvászavarok korai felismerésének és kezelésének, az életminőség, társbetegségek és a mortalitás szempontjából. Orv. Hetil., 2014, 155(52), 2067–2073.

Cardio- and cerebrovascular risk is associated with decreased slow wave sleep in patients with chronic kidney disease

WCN 2013 No: 1259 Topic: 36 — Other Topic Cardioand cerebrovascular risk is associated with decreased slow wave sleep in patients with chronic kidney disease A.V. Lindner, K. Ronai, K. Fornadi, A.S. Lazar, M.E. Czira, A. Dunai, R. Zoller, O. Veber, A. Szentkiralyi, Z. Kiss, E. Toronyi, M.Z. Molnar, I. Mucsi, M. Novak. Department of Neurology, Semmelweis University, Budapest, Hungary; Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary; Amgen Hungary Limited, Semmelweis University, Budapest, Hungary; Dept. of Transplantation and Surgery, Semmelweis University, Budapest, Hungary; Division of Nephrology, University of Toronto, Toronto, ON, Canada; Los Angeles Biomedical Research Institute at Harbor, UCLA, Torrance, CA, USA; Institute of Pathophysiology, Semmelweis University, Budapest, Hungary; Division of Nephrology, McGill University, Montreal, QC, Canada; Dept. of Psychiatry, University of Toronto, Toronto, ON, Canada Background: Previous studies reported that sleep fragmentation and decreased slow wave sleep related to certain cardiovascular risk factors e.g. cholesterol levels, obesity in general population. Objective: Our study aims to analyze association between cardioand cerebrovascular risk and slow wave sleep in patients with chronic kidney disease. Patients and methods: 100 kidney transplanted and 50 wait-listed hemodialyzed patients underwent polysomnography. The ten-year coronary heart disease risk was estimated for all patients using the Framingham Score. Moreover, the ten-year estimated risk of stroke was calculated according to the modified version of the Framingham Stroke Risk Profile. In multivariate linear regression models logarithmic transformed Framingham scores were used for estimating association between slow wave sleep and cardiocerebrovascular risk. Results: Mean age was 51 ± 13 yrs, ratio of males was 56% in the population. Slow wave sleep was reverse related to cardiovascular and stroke risk (Spearmans rho: 0.259, p = 0.003; −0.209, p = 0.011). In multivariate linear regression models the lower ratio of slow wave sleep was independently associated with the logarithmic transformed Framingham cardiovascular (beta =−0.211; 95% CI: −0.45 to −007) and cerebrovascular scores (beta =−0.155; 95% CI: −0.033–0.0) after adjusting for important co-variables (apnea–hypopnea index, serum albumin and hemoglobin levels, type of renal replacement, Charlson comorbidity index, sleep efficiency). Conclusion: Decreased slow wave sleep was found to be an independent predictor of higher cardioand cerebrovascular risk score in patients with chronic kidney disease. doi:10.1016/j.jns.2013.07.2299 Abstract — WCN 2013 No: 673 Topic: 36 — Other Topic Is transient global amnesia (TGA) hereditary? WCN 2013 No: 673 Topic: 36 — Other Topic Is transient global amnesia (TGA) hereditary? M.M. Dupuis, F. Evrard, S. De Bruijn, J. Segers-van Rijn, F. Dupuis, P. Jacquerye, G. Picard, O. Ghysens, K. Dahan, C. Verellen. Clinique St Pierre, Ottignies, Belgium; Neurology, Hagaziekenhuis, Den Haag, The Netherlands; Institut de Pathologie et de Genetique,