Salvatore Smirne

Prevalence and Patterns of Problematic Sleep Among Older Adolescents

OBJECTIVE Despite many constraints on time schedules among teenagers, epidemiological data on sleep complaints in adolescence remain limited and are nonexistent for sleep disorders. This study provides additional data on sleep habits and DSM-IV sleep disorders in late adolescence. METHOD A representative sample of 1,125 adolescents aged 15 to 18 years was interviewed by telephone using the Sleep-EVAL system. These adolescents came from 4 European countries: France, Great Britain, Germany, and Italy. Information was collected about sociodemographic characteristics, sleep/wake schedule, sleep habits, and sleep disorders and was compared with information from 2,169 young adults (19-24 years of age). RESULTS Compared with young adults, adolescents presented with a distinct sleep/wake schedule: they went to sleep earlier, they woke up later, and they slept longer than young adults did. On weekends and days off, they also slept more than young adults did. However, the prevalence rates of sleep symptoms and sleep disorders were comparable in both groups. Approximately 25% reported insomnia symptoms and approximately 4% had a DSM-IV insomnia disorder. Fewer than 0.5% had a circadian rhythm disorder. CONCLUSIONS Prevalence of insomnia disorders is lower in the adolescent population than in middle-aged or elderly adults. However, a rate of 4% in this young population is important given their young age and the consequences for daytime functioning.

Prevalence of narcolepsy symptomatology and diagnosis in the European general population

Objective: To determine the prevalence of narcolepsy in the general population of five European countries (target population 205,890,882 inhabitants). Methods: Overall, 18,980 randomly selected subjects were interviewed (participation rate 80.4%). These subjects were representative of the general population of the UK, Germany, Italy, Portugal, and Spain. They were interviewed by telephone using the Sleep-EVAL expert system, which provided narcolepsy diagnosis according to the International Classification of Sleep Disorders (ICSD). Results: Excessive daytime sleepiness was reported by 15% of the sample, with a higher prevalence in the UK and Germany. Napping two times or more in the same day was reported by 1.6% of the sample, with a significantly higher rate in Germany. Cataplexy (episodes of loss of muscle function related to a strong emotion), a cardinal symptom of narcolepsy, was found in 1.6% of the sample. An ICSD narcolepsy diagnosis was found in 0.047% of the sample: The narcolepsy was severe for 0.026% of the sample and moderate in 0.021%. Conclusion: This is the first epidemiologic study that estimates the prevalence of narcolepsy in the general population of these five European countries. The disorder affects 47 individuals/100,000 inhabitants.

How age and daytime activities are related to insomnia in the general population: Consequences for older people

OBJECTIVES: To determine the role of activity status and social life satisfaction on the report of insomnia symptoms and sleeping habits.

Prevalence and consequences of insomnia disorders in the general population of Italy.

OBJECTIVES To assess the prevalence of insomnia disorders using DSM-IV classification, and the consequences of insomnia in the Italian general population. METHODS A representative sample of the Italian general population composed of 3970 individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system (participation rate: 89.4%). Participants were interviewed about their sleep habits and sleep disorders. DSM-IV classification was used by Sleep-EVAL to determine the sleep disorder diagnosis. RESULTS Insomnia symptoms were reported by 27.6% of the sample. Sleep dissatisfaction was found in 10.1% and insomnia disorder diagnoses in 7% of the sample. The use of sleep-enhancing medication was reported by 5.7% of the sample. Most of these subjects were using anxiolytics. Dissatisfaction with sleep was associated with daytime sleepiness. Middle-aged drivers dissatisfied with their sleep were three times more likely to have had a road accident in the previous year compared to other drivers. However, fewer than 30% of subjects dissatisfied with their sleep or with an insomnia disorder diagnosis had consulted a physician about their sleep problem. CONCLUSIONS As in other European and non-European countries, insomnia is widespread in Italy. The consequences are important. Appropriate recognition and treatment of insomnia should be part of an educational program for general practitioners everywhere.

Nocturnal sleep study in multiple sclerosis: Correlations with clinical and brain magnetic resonance imaging findings

It has been suggested that sleep disturbances in multiple sclerosis (MS) may be related to periodic leg movements (PLM) during sleep, but to date polysomnographic studies were conducted only on small and unselected patient groups. Aim of this study was to evaluate 8-hour polysomnography in MS patients and to correlate sleep results with clinical and brain magnetic resonance imaging (MRI) data. Twenty-five clinically definite MS patients, without mood disorders and drug-free, entered the study. The patients were compared to 25 age- and sex-matched subjects. MS patients had significantly reduced sleep efficiency and experienced more awakenings during sleep. No difference was found in sleep architecture parameters between MS patients and controls. PLM was found in 9 patients (36%) and 2 controls (8%; p = 0.02). Of the six patients who complained of insomnia two had PLM and 2 others presented with PLM and central sleep apnea. In patients with PLM greater MRI lesion loads were detected in the infratentorial regions, particularly in cerebellum and brainstem. Larger studies in neurological diseases that produce focal lesions in these brain areas could provide useful information on the PLM pathogenesis.

Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems

Abstract Although the interaction between sleep and pain is generating considerable interest (NIH Technology Assessment Panel, 1996), it is still unknown if chronic pain is the cause or effect of poor sleep. To further this understanding, subjects free of pain and sleep problems need to be studied in order to assess their response to pain during sleep, defined as a behavioral and a physiological state in which sensory processing is altered. (For example, while auditory perception remains active, other sensory inputs are facilitated, attenuated, or suppressed (Velluti, 1997)). The present study provides data on polygraphic responses to cool (24°C), warm (37°C), and heat pain (>46°C) stimuli applied to shoulder skin during different sleep stages: the lighter sleep stage 2, the deep stages 3&4, and REM sleep. Based on evidence from eight subjects, we found that nociceptive heat stimulation evokes a moderate level of cortical arousal during sleep. Specifically, in comparison to the response induced by a warm 37°C non‐nociceptive control stimulation, the percentage of cortical arousal responses to heat pain stimuli (>46°C) was statistically greater in the lighter sleep stage 2 (48.3%) than in the deeper stages 3&4 (27.9%). A nocifensive behavioral‐motor response was associated with only 2.5% of the 351 heat pain stimuli. Two other markers of sleep quality–sleep stage shift and awakening–were not influenced by the thermal stimuli. None of the subjects demonstrated any burns in the morning following the thermal stimulations applied during sleep. We conclude that the processing of nociceptive inputs is attenuated across sleep stages.

Effects of a MAO-B Inhibitor in the Treatment of Alzheimer Disease

119 patients were enrolled in a double-blind randomized parallel study versus placebo carried out to assess both the efficacy and tolerability of L-deprenyl (10 mg/day) for treatment of patients with organic mental disorders of the Alzheimer type (DAT). The treatments were given for 3 months, starting after a run-in period of 15 days to evaluate efficacy. A complete neuropsychological battery was administered monthly after the start of treatment whereas tolerability was assessed by checking, recording and classifying all the unfavorable experiences occurring. According to the results, L-deprenyl would seem to be a useful and reliable tool for the treatment of DAT patients in an attempt to improve their cognitive functions and reduce behavioral alterations, without frequent or severe side effects.

Prevalence and pathologic associations of sleep paralysis in the general population

Background: Previous epidemiologic data on sleep paralysis (SP) came from small specific samples. The true prevalence and associated factors of SP in the general population remain unknown. Method:— A representative sample of the noninstitutionalized general population of Germany and Italy age ≥15 years (n = 8,085) was surveyed by telephone using the Sleep-EVAL questionnaire and the Sleep Questionnaire of Alertness and Wakefulness. Results: Overall, 6.2% (5.7 to 6.7%) of the sample (n = 494) had experienced at least one SP episode in their lifetime. At the time of the interview, severe SP (at least one episode per week) occurred in 0.8% of the sample, moderate SP (at least one episode per month) in 1.4%, and mild SP (less than one episode per month) in 4.0%. Significant predictive variables of SP were anxiolytic medication, automatic behavior, bipolar disorders, physical disease, hypnopompic hallucinations, nonrestorative sleep, and nocturnal leg cramps. Conclusions: SP is less common in the general population than was previously reported. This study indicates that the disorder is often associated with a mental disorder. Users of anxiolytic medication were nearly five times as likely to report SP, even after we controlled for possible effects of mental and sleep disorders.

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy: Electroclinical Picture

Summary: Purpose: Nocturnal frontal lobe epilepsy is a disorder that is difficult to diagnose because its clinical presentation is often limited to motor behavior during sleep. For this reason, a misleading diagnosis of benign nocturnal parasomnias might be possible. Recently, an inherited form of nocturnal frontal lobe epilepsy was described in some families. The aim of our work was to describe the electroclinical pattern of a sample of familial cases with this syndrome.

Lidocaine test in neuralgia

&NA; Ten patients with organic nerve injury causing chronic neuropathic pain were tested for the effects of intravenous lidocaine versus saline upon psychophysical somatosensory variables. The variables assessed were the subjective magnitude of pain, area of mechanical hyperalgesia and presence and magnitude of thermal heat/cold hyperalgesia. The study methods applied to evaluate these conditions were the conventional testing of somatosensory submodalities with area mapping and the subjective magnitude estimation of spontaneous pain. It was found that spontaneous pain and mechanical hyperalgesia were consistently improved, transiently, by intravenous administration of lidocaine in all 10 patients; areas of hyperalgesia which extended beyond the territory of the nerve also improved transiently. Spontaneous pain and mechanical hyperalgesia, but not hypoesthesia, were transiently improved by injection of saline in only 1 of the 10 patients. This outcome is probably due to a placebo effect. This improvement is in keeping with the inhibition of anomalous neural impulses which can be generated anywhere along the sensory channels responsible for generating spontaneous pain and hyperalgesia. Thus, intravenous lidocaine is proposed as a diagnostic aid in the examination of patients complaining of complex sensory disorders associated with nerve injury. The transient pain relief may allow a fuller identification of the area of sensory loss.