Sleep Disorders: From Clinical Research to Daily Practice

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (1 April 2023) | Viewed by 12252

Special Issue Editors


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Guest Editor
Department of Surgery and Medical-Surgical Specialties, University of Catania, I-95125 Catania, Italy
Interests: cerebrovascular diseases; dementia; sleep disorders; non-invasive brain stimulation; neurosonology
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Guest Editor
Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
Interests: neurology; sleep medicine; movement disorders

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Guest Editor
Department of Biomedical and Biotechnological Sciences, University of Catania, 09124 Catania, Italy
Interests: translational applications of transcranial magnetic stimulation; neurosonology.

Special Issue Information

Dear Colleagues,

Recently, there has been significant progress in the understanding of the pathophysiology underlying some sleep disorders, such as restless legs syndrome (RLS) and REM sleep behaviour disorder (RBD), especially their electrophysiological basis and the possibility to non-invasively neuromodulate them.

Gaining novel insights into the complex interactions between central and peripheral neural circuits in the generation of symptoms of RLS is mandatory for a better diagnostic refinement. Further insight is provided by the effectiveness of some non-pharmacological tools, such as transcranial magnetic stimulation, transcranial direct current stimulation, and transcutaneous direct spinal stimulation, thereby extending the therapeutic arsenal. Regarding RBD, new methods that specifically explore and possibly measure other alterations beyond the brainstem are relevant to determine whether a prodromic neurodegenerative disorder underlies this condition occurring even at the stage of isolated RBD.

In this Special Issue, we focus on the neurophysiological correlates of sensory-motor network involved in RLS and the cortical–brainstem connections implicated in RBD in order to provide new translational insights into their pathophysiological mechanisms and to guide new pharmacological and non-pharmacological treatments.

Dr. Giuseppe Lanza
Dr. Michela Figorilli
Dr. Francesco Fisicaro
Guest Editors

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Keywords

  • sleep medicine
  • sleep disorders
  • restless legs syndrome
  • REM sleep behaviour disorder
  • sensory-motor network
  • neurodegeneration
  • non-invasive brain stimulation
  • transcranial magnetic stimulation
  • transcranial direct-current stimulation
  • transcutaneous direct spinal stimulation
  • clinical neurophysiology
  • neural plasticity
  • neurotransmission
  • neuropsychiatry
  • neuropharmacology
  • translational neuroscience

Published Papers (6 papers)

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Editorial

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4 pages, 208 KiB  
Editorial
Special Issue “Sleep Disorders: From Clinical Research to Daily Practice”
by Francesco Fisicaro, Giuseppe Lanza and Michela Figorilli
J. Clin. Med. 2023, 12(16), 5271; https://doi.org/10.3390/jcm12165271 - 13 Aug 2023
Cited by 1 | Viewed by 818
Abstract
Healthy sleep is indissolubly linked to both physical and mental health, as pointed out by evidence showing the negative impact of poor sleep on neurological, psychiatric, cardiovascular, respiratory, metabolic, and immune systems, among others [...] Full article
(This article belongs to the Special Issue Sleep Disorders: From Clinical Research to Daily Practice)

Research

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13 pages, 290 KiB  
Article
Sleep-Disordered Breathing in Acute Stroke: A Single-Center, Prospective, Longitudinal Study
by Panagiotis Plomaritis, Aikaterini Theodorou, Konstantinos Lourentzos, Maria-Ioanna Stefanou, Lina Palaiodimou, Georgia Papagiannopoulou, Vasiliki Kotsali-Peteinelli, Marianna Bregianni, Georgios P. Paraskevas, Georgios Tsivgoulis and Anastasios Bonakis
J. Clin. Med. 2023, 12(3), 986; https://doi.org/10.3390/jcm12030986 - 27 Jan 2023
Cited by 5 | Viewed by 1421
Abstract
Background: Sleep-disordered breathing (SDB) is common among acute stroke patients. We sought to investigate the prevalence, severity and type of SDB in consecutive acute stroke patients. Moreover, we aimed to identify independent predictors of SDB in the acute stroke setting and investigate potential [...] Read more.
Background: Sleep-disordered breathing (SDB) is common among acute stroke patients. We sought to investigate the prevalence, severity and type of SDB in consecutive acute stroke patients. Moreover, we aimed to identify independent predictors of SDB in the acute stroke setting and investigate potential associations between SDB and functional outcomes at three months. Methods: We prospectively studied consecutive acute stroke patients, who underwent overnight polysomnography within 72 h from symptom onset. Demographics, clinical and imaging characteristics were documented. Daytime sleepiness preceding the stroke, stroke severity on admission and functional outcome at three months were evaluated using the Epworth-Sleepiness Scale (ESS), National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), respectively. SDB was documented using standard polysomnography criteria. Results: A total of 130 consecutive acute stroke patients were prospectively evaluated [110 with ischemic stroke and 20 with intracerebral hemorrhage, mean age 60.5 ± 10.9 years, 77% men, median NIHSS score on admission: 3 (IQR: 2–17)]. The rate of SDB detection on polysomnography recordings was 79% (95% CI: 71–86). Three variables were independently associated with the likelihood of SDB detection in multivariable analyses adjusting for potential confounders: age (OR per 10-year-increase: 2.318, 95% CI: 1.327–4.391, p = 0.005), male sex (OR: 7.901, 95% CI: 2.349–30.855, p = 0.001) and abnormal ESS-score (OR: 6.064, 95% CI: 1.560–32.283, p = 0.017). Among patients with SDB, congestive heart failure was independently associated with the likelihood of central apnea detection (OR: 18.295, 95% CI: 4.464–19.105, p < 0.001). Among all patients, increasing NIHSS score on admission (OR: 0.817, 95% CI: 0.737-0.891, p < 0.001) and Apnea–Hypopnea Index (OR: 0.979, 95% CI: 0.962–0.996, p = 0.020) emerged as independent predictors of excellent functional outcome at 3 months (mRS-scores 0–1). Conclusion: The high prevalence and severity of SDB in acute stroke patients and its negative impact on functional outcome indicate the importance of polysomnography implementation in everyday clinical practice of acute stroke work-up and management. Full article
(This article belongs to the Special Issue Sleep Disorders: From Clinical Research to Daily Practice)
11 pages, 1477 KiB  
Article
Central Symptoms of Insomnia in Relation to Depression and COVID-19 Anxiety in General Population: A Network Analysis
by Eun Jung Cha, Hong Jun Jeon and Seockhoon Chung
J. Clin. Med. 2022, 11(12), 3416; https://doi.org/10.3390/jcm11123416 - 14 Jun 2022
Cited by 7 | Viewed by 2313
Abstract
Background: Insomnia is prevalent among the general population, and studies have shown an increase in insomnia symptoms during the novel coronavirus (COVID-19) pandemic. Despite numerous studies of insomnia, few studies have investigated insomnia symptoms in detail. In this study, we used network analysis [...] Read more.
Background: Insomnia is prevalent among the general population, and studies have shown an increase in insomnia symptoms during the novel coronavirus (COVID-19) pandemic. Despite numerous studies of insomnia, few studies have investigated insomnia symptoms in detail. In this study, we used network analysis to investigate interactions between insomnia symptoms in the general population. Furthermore, given the effect of COVID-19 on mental health, we also investigated how anxiety response to COVID-19 and depression related to insomnia symptoms. Methods: Data from 785 non-infected participants were used. The Insomnia Severity Index (ISI), Stress and Anxiety to Viral Epidemics—6 Scale (SAVE-6), and Patient Health Questionnaire—9 (PHQ-9) were used to measure insomnia symptoms, anxiety response to COVID-19, and depression, respectively. Network analysis was performed using R Studio. Centrality indices and edge weights were obtained, and each index was evaluated using bootstrapping methods. Results: The network revealed ISI7 (worry about current sleep pattern) to be the most central insomnia symptom. ISI7 was strongly connected to SAVE-6 total score, and ISI2 (difficulty staying asleep) was strongly connected to PHQ-9 total score. Conclusion: High centrality of ISI7 supports the role of dysfunctional cognitions in etiological models of insomnia and thus the cognitive behavioral therapy for insomnia. The relationship between ISI7 and SAVE-6 is explained by transposition of worry and fear of contracting COVID-19 to worry about sleep patterns. The link between ISI2 and PHQ-9 necessitate further investigations of whether specific symptoms of insomnia are more associated with depression. Full article
(This article belongs to the Special Issue Sleep Disorders: From Clinical Research to Daily Practice)
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7 pages, 241 KiB  
Article
Patients with a Higher Number of Periodic Limb Movements Have Higher Nocturnal Blood Pressure
by Klaudia Krzyzaniak, Eemil Partinen, Markku Partinen and Mariusz Sieminski
J. Clin. Med. 2022, 11(10), 2829; https://doi.org/10.3390/jcm11102829 - 17 May 2022
Cited by 3 | Viewed by 1257
Abstract
There is growing evidence that periodic limb movements in sleep (PLMS) may lead to increased blood pressure (BP) values during the night. The aim of this study was to assess if patients with disordered sleep and an increased number of PLMS have higher [...] Read more.
There is growing evidence that periodic limb movements in sleep (PLMS) may lead to increased blood pressure (BP) values during the night. The aim of this study was to assess if patients with disordered sleep and an increased number of PLMS have higher BP values at night. We analyzed 100 polysomnographic (PSG) recordings of patients with disordered sleep, with the exclusion of sleep-related breathing disorders. Patients also registered beat-to-beat blood pressure during PSG. We compared the BP of patients with an increased number of PLMS (more than 5 PLMS per hour of sleep) during the night (examined group, n = 50) to the BP of patients with a PLMS number within the normal range (up to 5 PLMS per hour of sleep) (control group, n = 50). Patients from the examined group had significantly higher values of systolic BP during the night (119.7 mmHg vs. 113.3 mmHg, p = 0.04), sleep (119.0 mmHg vs. 113.3 mmHg, p = 0.04), and wake (122.5 mmHg vs. 117.2 mmHg, p = 0.04) periods and of diastolic BP during the night (75.5 mmHg vs. 70.6 mmHg, p = 0.04) and wake (77.6 mmHg vs. 71.5 mmHg, p = 0.01) periods. Our results suggest a relationship between the number of PLMS during the night and the values of nocturnal blood pressure. It is possible that their treatment could lower nocturnal BP in patients with sleep disorders, therefore improving their vascular risk profile. Full article
(This article belongs to the Special Issue Sleep Disorders: From Clinical Research to Daily Practice)
14 pages, 356 KiB  
Article
Reduced Intracortical Facilitation to TMS in Both Isolated REM Sleep Behavior Disorder (RBD) and Early Parkinson’s Disease with RBD
by Giuseppe Lanza, Filomena Irene Ilaria Cosentino, Bartolo Lanuzza, Mariangela Tripodi, Debora Aricò, Michela Figorilli, Monica Puligheddu, Francesco Fisicaro, Rita Bella, Raffaele Ferri and Manuela Pennisi
J. Clin. Med. 2022, 11(9), 2291; https://doi.org/10.3390/jcm11092291 - 20 Apr 2022
Cited by 9 | Viewed by 2332
Abstract
Background: a reduced intracortical facilitation (ICF), a transcranial magnetic stimulation (TMS) measure largely mediated by glutamatergic neurotransmission, was observed in subjects affected by isolated REM sleep behavior disorder (iRBD). However, direct comparison between iRBD and Parkinson’s disease (PD) with RBD is currently lacking. [...] Read more.
Background: a reduced intracortical facilitation (ICF), a transcranial magnetic stimulation (TMS) measure largely mediated by glutamatergic neurotransmission, was observed in subjects affected by isolated REM sleep behavior disorder (iRBD). However, direct comparison between iRBD and Parkinson’s disease (PD) with RBD is currently lacking. Methods: resting motor threshold, contralateral cortical silent period, amplitude and latency of motor evoked potentials, short-interval intracortical inhibition, and intracortical facilitation (ICF) were recorded from 15 drug-naïve iRBD patients, 15 drug-naïve PD with RBD patients, and 15 healthy participants from the right First Dorsal Interosseous muscle. REM sleep atonia index (RAI), Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Epworth Sleepiness Scale (ESS) were assessed. Results: Groups were similar for sex, age, education, and patients for RBD duration and RAI. Neurological examination, MMSE, ESS, and GDS were normal in iRBD patients and controls; ESS scored worse in PD patients, but with no difference between groups at post hoc analysis. Compared to controls, both patient groups exhibited a significantly decreased ICF, without difference between them. Conclusions: iRBD and PD with RBD shared a reduced ICF, thus suggesting the involvement of glutamatergic transmission both in subjects at risk for degeneration and in those with an overt α-synucleinopathy. Full article
(This article belongs to the Special Issue Sleep Disorders: From Clinical Research to Daily Practice)

Other

Jump to: Editorial, Research

8 pages, 802 KiB  
Protocol
Effects of Transcranial Direct Current Stimulation on Sleep in Athletes: A Protocol of a Randomized Controlled Trial
by Mohammad Etoom, Mohammad Alwardat, Alia Alghwiri, Francesco Lena and Andrea Romigi
J. Clin. Med. 2022, 11(19), 5883; https://doi.org/10.3390/jcm11195883 - 5 Oct 2022
Cited by 5 | Viewed by 3032
Abstract
Background: Sleep disturbances are common among athletes. There is recently a growing interest in improving sleep quality by using noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS). We hypothesized that bilateral dorsolateral prefrontal cortex anodal tDCS could improve sleep in [...] Read more.
Background: Sleep disturbances are common among athletes. There is recently a growing interest in improving sleep quality by using noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS). We hypothesized that bilateral dorsolateral prefrontal cortex anodal tDCS could improve sleep in different sports athletes. A randomized controlled trial is to be conducted to test this hypothesis. Methods: Eighty-four athletes are selected based on specific eligibility criteria and randomly allocated to the intervention or control group. Each participant will receive a 20-min session of bilateral anodal tDCS with an intensity of 1.5 mA (0.057 mA/cm2) in density 3 times a week for 2 weeks. The tDCS current will be delivered only for 30 seconds in the control group. This study’s outcome is a set of subjective and objective sleep parameters. Conclusion: This study assessed the effect of a novel tDCS protocol represented by bilateral anodal stimulation and may result in important advances in sleep management among athletes. Because of the high incidence and impact of athletes’ poor sleep quality, it is particularly important to explore effective interventions. Trial Registration: ClinicalTrials.gov: NCT05318352. Full article
(This article belongs to the Special Issue Sleep Disorders: From Clinical Research to Daily Practice)
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