Abstracts / Sleep Medicine 14S (2013) e18–e92
out the RBD-Single question, the RBD Screening Questionnaire (RBDSQ) and the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease’s (QUIP). Results: Probable RBD was found in 99/220 (45%, 59 M) patients.One or more ICDs or related behaviors were found in 60/99 (60.6%) patients with PD-pRBD and in 46/121 (38.0%) PD-noRBD (p = 0.001). PD-pRBD showed a higher QUIP score (1.5 ± 1.7 vs.0.8 ± 1.3; p = 0.009) and a higher number of ICD and related behaviors symptoms (1.5 ± 1.7 vs.0.9 ± 1.3; p = 0.001) compared to PD-noRBD. Furthermore, a signiﬁcant positive correlation between RBDSQ and QUIP scores was observed in the whole group (R = 0.269; p < 0.001). The frequencies of ICD symptoms in patients with PD-pRBD compared to PD-noRBD were as follows: compulsive gambling (9.1% vs.3.3%; p = 0.07), compulsive sexual behaviors (11.1%vs.6.6%; p = 0.23) compulsive shopping (14.4% vs.4.1%, p = 0.008) compulsive eating (18.2% vs.14.0%, p = 0.39), hobbyism (24.2% vs.13.2, p = 0.03), punding (19.2% vs.10.7%, p = 0.09), walkabout (6.1% vs.7.4%, p = 0.67), dopamine dysregulation syndrome (18.2% vs.5.0%, p = 0.002). A logistic regression model accounting for Center (Clermont-Ferrand/Turin), sex, age, PD duration, PD severity (H&Y score) and Levo-Dopa Equivalent Daily Dose, indicated that PD- pRBD have a twofold risk to develop any ICDs (RR: 2.1 (C.I. 1.31–3.60); p = 0.003) and a threefold risk to develop compulsive shopping (RR: 3.15 (1.11–8.9); p = 0.03 and Dopamine Dysregulation syndrome (RR: 3.15 (1.23–8.079; p = 0.017) compared to PD patients without RBD. Conclusion: This study showed for the ﬁrst time that RBD is associated to an increased risk to develop ICD symptoms in PD, even after controlling for age, severity, duration of PD and dopaminergic treatment. Further studies are warranted to clarify the mechanism underlying this association. Acknowledgements: Authors are in debt with neuropsychologist Dr. Tiphaine Vidal and neurologists Drs. Ana-Raquel Marques, Bérangère Debilly, Philippe Derost, Miguel Ulla and Nicolas Vitello for their contribution in collecting clinical data and with biostatistician Bruno Pereira for helping in statistical analysis. http://dx.doi.org/10.1016/j.sleep.2013.11.037
How should we deal with the possible development into lewy body diseases from idiopathic REM sleep behavior disorder in the real world clinical practice? N. Tachibana, K. Taniguchi, T. Oguri, H. Sugiyama, T. Hamano Department of Neurology and Center for Sleep-related Disorders, Kansai Electric Power Hospital, Japan
Introduction: It has been well established that apparent idiopathic REM sleep behavior disorder (iRBD) evolves mostly into Lewy body diseases (LBD) (Parkinson’s disease (PD) and dementia with Lewy bodies ). Therefore, in clinical practice we have to keep a watch on its early signs and symptoms as well as to treat REM sleep related behaviors. This study describes our experience in following up iRBD patients in the daily clinical setting, some of whom actually developed additional neurological and psychiatric signs and symptoms. Materials and methods: We retrospectively reviewed the sleep clinic records of consecutive 30 polysomnographically conﬁrmed iRBD patients who made the ﬁrst consultation in the four year time period from December 2005. Four patients who were lost within one year after the ﬁrst consultation were excluded. 26 patients (21 men and 5 women, 67.3} 5.9 years of age at the ﬁrst clinic visit) were analyzed whose follow-up duration was 4.6}1.6 years (range 1– 7.5 years).
Results: We found out that we had informed the possibility of future development in other neurodegenerative diseases in 24 patients (92.3%) after they completed diagnostic polysomnography and other investigations to rule out comorbid neurological diseases when they were discharged from hospital. However, the way of transmission was modiﬁed for each patient and mostly about PD, which later caused some confusion in the patients who developed psychiatric rather than motor symptoms. Two patients were not informed about this possibility because they were full of anxiety at that time. 16 out of 26 patients (61.5%) always came to the clinic alone and their RBD severity under treatment did not differ from that of the remaining 10 patients who were accompanied by their family members. Solo visit generally did not interfere with our comprehension of the actual state of RBD by the use of questionnaire for RBD severity index, nor with the assessment of motor function, but gradual intermittent intrusion of visual hallucination was difﬁcult to be perceived until family members came up. 18 out of 26 patients (69.2%) continued to pay a regular visit (once per 1–3 months) up to the present (June 2013), and what symptoms and signs appeared to them chronologically will be presented in the other paper of our group. Conclusion: In respect of development into LBD from iRBD, what we should focus on includes close communication with the patients as well as family members. It should be warranted to seek for good predictors for the future LBD in tandem with developing educational materials addressing this issue. Acknowledgements: We thank Kei-Ichi Marumoto and Yoko Uozumi for their technical support for performing PSG. http://dx.doi.org/10.1016/j.sleep.2013.11.038
sleep deprivation correlations with risk behaviors in adolescents: results from a portuguese national survey T. Paiva 1, T. Gaspar 2, M. Gaspar Matos 3 1 CENC, Sleep Medicine Center, Medical Faculty of Lisbon, Portugal 2 Instituto de Psicologia e Ciências da Educação, Universidade Lusiada, Portugal 3 Faculdade de Motricidade Humana, Portugal
Introduction: Adolescents sleep shows marked variation in duration and variability (Carskadon, 1982, Dahl e Lewin, 2002, Fredriksen et al., 2004); this is caused by the speciﬁc maturation period of adolescence and by external factors, among which the increasing school demands, high tech gadgets, the need of social interactions and health related factors must be accounted for. Furthermore, due to speciﬁc maturation characteristics the adolescent brain remains more vulnerable to impulsive behaviors in sex, food and sleep habits (Arain et al. 2013). Objectives To evaluate the impact of sleep deprivation (SD) upon current risk behaviors of adolescents, namely those involving reduced impulsive control. Materials and methods: The Portuguese survey reported in this study is a component of the Health Behaviour in School-Aged Children (HBSC) study (Currie, Roberts, & Morgan, 2004; Matos et al., 2006). This survey is based on a self-completed questionnaire to be administered in schools by teachers. The Portuguese HBSC survey included pupils in the 8th and 10th grades (high school); the mean age was 14.91 years (SD = 1.255, min 12.5, max 19.0). The National sample consisted of 3476 students from randomly chosen Portuguese schools, representing those school grades in the entire country, as geographically stratiﬁed by Education Regional Divisions. The school response rate was 89.9%. The gender and grade distribution were as follows: 53.8 % (n = 1869) were girls; in terms of school grade they were distributed as follows: 45.9% (n = 1594) attending
Abstracts / Sleep Medicine 14S (2013) e18–e92
the 8th grade, 54.1% (n = 1882) the 10th grade. This study used a Health Behaviour in School-Aged Children (HBSC 2010) questionnaire and inquired about: (1) gender and age; (2) socio demographics and self-reported BMI; (3) Family environment (social level, instruction level and employment of father and mother); (4) Sleep duration during the week and weekends, sleep deprivation; (5) Overnight dating in friends; (6) Risk behaviours: bullying, use of weapons, non-suicidal self harm, alcohol and drugs. Results: In what concerns risk behaviours it is clear from table 6 that their prevalence is relatively high in what concerns chronic use of alcoholic beverages (13.6%) and getting drunk (8.0%), use of soft drugs (11.4%) and drugs themselves (7.3%). All these behaviours are more prevalent in the sleep deprived adolescents with high signiﬁcance levels (v2 = 60.047; p = .000; v2 = 62.116; p = .000; v2 = 42.053; p = .000; v2 = 25.878; p = .000; respectively). In what concerns social behaviors dating with friends, which implies returning home during the morning at 6 or 8 am., is also quite frequent routinely done by students during every weekend or even more (25.3%). The prevalence signiﬁcantly increases in SD adolescents (v2 = 43.363; p = .000). Aggressive behaviors such as carrying weapons to school (6.7%) or being involved in ﬁghts (19.6) are also relatively frequent and the prevalence increases in SD adolescents (v2 = 14.484; p = .006 and v2 = 14.331; p = .006, respectively) Auto aggression, namely self cutting, had a prevalence of 15.5%, and is also signiﬁcantly associated with SD (v2 = 11.055; p = .026). Suffering (9.8%) or being involved in provocations or bullying (12.2%) are not so frequent and are also not related with SD. Conclusion: Most risk behaviors are strongly correlated with SD, namely consumption of alcohol and drugs, aggressive and violent behaviors and self cutting. No correlation was found with bullying and provocative behaviour. The impact of SD upon emotional and impulsive control in adolescents and young adults requires proper and detailed evaluation. Acknowledgements: Aventura Social team regarding data collection and Ministry of health (grant).
(4–9 h/d) compared to the lowest quartile of TV watching time (0– 2 h/d) spent longer time in bed at night (ppÂ=0.22 [95%CI 0.17, 0.27]), slept for shorter hours (ppÂ = 0.18 [ 0.24, 0.12]), and had lower sleep efﬁciency (OR = 0.54[0.48, 0.61]). They also reported higher prevalence of difﬁculty in getting to sleep (OR = 2.05[1.83, 2.30]), waking up during the night (OR = 1.54 [1.36,1.73]) or in early morning (OR = 1.61[1.43,1.81]) and trouble getting back to sleep. These associations remained after further adjustment for age, sex, social class, education, smoking, alcohol intake, hypnotic drug use, depression, Body Mass Index and physical activity (p < 0.001). The adjusted ORs associated with long TV viewing time for higher sleep efﬁciency (>= 80%) and difﬁculty falling asleep were 0.70 (0.59–0.84) and 1.78 (1.50–2.11), respectively. The above associations seemed stronger among those who were most physically active, though the interaction was not signiﬁcant. Physical activity was not associated with the sleep measures. Conclusion: TV viewing is associated with impaired sleep quality. Further longitudinal study is needed to examine the direction of the relationship. Acknowledgements: EPIC-Norfolk study was supported by the Medical Research Council, UK(G9502233, G0300128) and Cancer Research, UK (C865/A2883).
Introduction: Growing evidence supports the theory that memory decline in neurodegenerative disorders may be related to problems with slow wave sleep and spindle functioning, both of which have also been shown to play a role in declarative memory consolidation. Patients with sleep disordered breathing exhibit poor sleep quality along with various levels of cognitive deﬁcits. The aim of this study was to test the hypothesis that patients with obstructive sleep apnea exhibit only practice-related learning on a declarative memory task and lack the normal learning beneﬁt that occurs during sleep. Materials and methods: A total of 50 participants (mean age 39.1 years) were included, 28 of which were healthy controls and 22 were newly diagnosed with obstructive sleep apnea. All subjects underwent a baseline screening PSG evaluation, which also served as adaptation night. They subsequently underwent an overnight testing session, which included computer sessions of the Psychomotor Vigilance Task (PVT) and the Verbal paired- associates task (VPA) in the evening followed by a full night PSG and repeat PVT and VPA sessions in the morning. Results: Both group showed similar learning of the VPA in the evening. However the healthy control group showed signiﬁcantly higher morning scores (83.3% vs. 73.9%, p = 0.001) along with more overnight improvement on the VPA task compared to the OSA patients (13.6% vs. 5.9%. p = 0.002) There was a signiﬁcant difference in time spent in N3 sleep between the two groups during the test night (11.9% vs. 4.4%, p = 0.001), which was not observed during the adaptation night. Morning retention on the VPA correlated with the amount of slow wave sleep (p = 0.04). PVT baseline average reaction time at night and the average
Increased TV viewing time is associated with less sleep and more sleep difﬁculties in a large population-based cohort Y. Leng, N. Wainwright, R. Luben, P. Surtees, K. Khaw, C. Brayne University of Cambridge, UK
Introduction: TV watching before bedtime is often discouraged in sleep recommendations. However, there has been limited epidemiological evidence on how TV viewing time might inﬂuence different aspects of sleep, especially among the older population. We aim to explore the cross-sectional relation between TV viewing time and sleep in an ageing British population. Materials and methods: Data were drawn from the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study. During 2006–2007, 5475 men and women reported daily TV viewing time and at least one of the sleep measures: time spent in bed, sleep duration, difﬁculty getting to sleep at night, waking up during night or in early morning and trouble getting back to sleep. Sleep efﬁciency was deﬁned as the ratio of sleep duration and time in bed. Participants were categorized into four physical activity levels based on a physical activity questionnaire during the same period. Results: On average, participants spent 8.63 h (standard deviation [SD] = 0.85) in bed and slept for 6.93 h (SD = 1.10) per night. 47% of the participants reported difﬁculty getting to sleep, and more than 65% reported the other two difﬁculties. Those in the highest quartile
The effect of obstructive sleep apnea on declarative memory consolidation M. Guo 1, M. Igue 1, A. Malhotra 2, R. Stickgold 3, I. Djonlagic 1 1 Brigham and Women’s Hospital, Harvard Medical School, United States 2 Division of Pulmonary and Critical Care Medicine, University of California San Diego, United States 3 Beth Israel Deaconess Medical Center, Harvard medical School, United States