Factors associated with injury in REM sleep behavior disorder.

Objective: As factors associated with injury in rapid eye movement (REM) sleep behavior disorder (RBD) remain largely unknown, we aimed to identify such factors.

Methods: We surveyed consecutive idiopathic (iRBD) or symptomatic RBD patients seen between 2008 and 2010 regarding RBD-related injuries. Associations between injuries and clinical variables were determined with odds ratios (OR) and multiple logistic regression analyses.

The role of nocturnal polysomnography in assessing children with Chiari type I malformation.

Objective: To evaluate nocturnal polysomnogram findings in children with suspected symptomatic Chiari type I malformation, correlate them with clinical and magnetic resonance imaging data and to determine if this information has value in clinical decision making process.

Methods: A retrospective review identified 24 children with type I Chiari malformation, presumed symptomatic who had undergone neurological assessment, cranial magnetic resonance imaging and nocturnal polysomnography. Perimedullary subarachnoid space effacement on the magnetic resonance studies and the magnitude of cerebellar tonsillar descent in relation to the McRae line were correlated with frequency of obstructive or central sleep apnea, number of cortical arousals and evidence of impaired vocal mobility on laryngoscopy.

Restless legs syndrome and daytime sleepiness are prominent in myotonic dystrophy type 2.

Objectives: Although sleep disturbances are common in myotonic dystrophy type 1 (DM1), sleep disturbances in myotonic dystrophy type 2 (DM2) have not been well-characterized. We aimed to determine the frequency of sleep disturbances in DM2.

Methods: We conducted a case-control study of 54 genetically confirmed DM2 subjects and 104 medical controls without DM1 or DM2, and surveyed common sleep disturbances, including symptoms of probable restless legs syndrome (RLS), excessive daytime sleepiness (EDS), sleep quality, fatigue, obstructive sleep apnea (OSA), probable REM sleep behavior disorder (pRBD), and pain.

Treatment outcomes in REM sleep behavior disorder.

Objective: REM sleep behavior disorder (RBD) is usually characterized by potentially injurious dream enactment behaviors (DEB). RBD treatment aims to reduce DEBs and prevent injury, but outcomes require further elucidation. We surveyed RBD patients to describe longitudinal treatment outcomes with melatonin and clonazepam.

Maxillomandibular advancement in the management of obstructive sleep apnea.

Maxillomandibular advancement (MMA) is a surgical option for obstructive sleep apnea (OSA). MMA involves forward-fixing the maxilla and mandible approximately 10  mm via Le Fort I maxillary and sagittal split mandibular osteotomies. We retrospectively reviewed outcomes from 24 consecutive OSA patients who underwent MMA at our institution.

Characteristics of REM sleep behavior disorder in childhood.

Study Objective: To describe our experience regarding the clinical and polysomnographic features of REM sleep behavior disorder (RBD) in childhood.

Methods: This was a retrospective chart review of children and adolescents with RBD and REM sleep without atonia. Demographics, and clinical and polysomnographic information were tabulated.

Light exposure among adolescents with delayed sleep phase disorder: a prospective cohort study.

The objective of this study was to compare light exposure and sleep parameters between adolescents with delayed sleep phase disorder (DSPD; n=16, 15.3±1.8 yrs) and unaffected controls (n=22, 13.

Nocturnal moaning and groaning-catathrenia or nocturnal vocalizations.

Purpose: Descriptions of nocturnal vocalizations, including catathrenia, are few. We undertook a study at our center on patients diagnosed with catathrenia, to evaluate the characteristic features of these events and their response to continuous positive airway pressure (CPAP) treatment.

Methods: Retrospective study of patients with a diagnosis of catathrenia who had an overnight polysomnogram (PSG) and available synchronized audio video recordings (to confirm the presence of moaning and groaning), at our center between January 2007 and May 2010.

Idiopathic hypersomnia: clinical features and response to treatment.

Objective: A recent American Academy of Sleep Medicine publication identified a need for research regarding idiopathic hypersomnia. We describe various clinical and polysomnographic features of patients with idiopathic hypersomnia, with an emphasis on response to pharmacotherapy.

Methods: A retrospective review of our database initially identified 997 patients, utilizing "idiopathic hypersomnia", "hypersomnia NOS", and "primary hypersomnia" as keywords.

Impulse control disorders with the use of dopaminergic agents in restless legs syndrome: a case-control study.

Study Objectives: To determine the frequency of impulse control disorders (ICDs) with the use of dopaminergic agents in restless legs syndrome (RLS).

Design: Prospective case-control study using a screening questionnaire for ICDs, followed by phone interview to confirm diagnoses for those meeting preset scoring thresholds on the questionnaire.

Setting: Academic, comprehensive sleep medicine center.

Idiopathic rapid-eye-movement sleep disorder: associations with antidepressants, psychiatric diagnoses, and other factors, in relation to age of onset.

Background: A retrospective, case-control chart review was performed to examine the relationship between the age of onset of idiopathic RBD and secondary associations.

Methods: Forty-eight idiopathic RBD patients were divided into early-onset and late-onset groups, compared to each other, and to their respective non-RBD controls.

Results: There were more females in the early-onset group as compared to their older counterparts (45% vs.

Cataplexy Emotional Trigger Questionnaire (CETQ)--a brief patient screen to identify cataplexy in patients with narcolepsy.

Study Objectives: This pilot study explored the sensitivity and specificity of a brief survey to determine the presence of cataplexy. We hypothesized that the brief questionnaire could provide a quick, sensitive, and specific screening tool to identify those patients with cataplexy, which would result in more timely referrals for further diagnostic testing.

Design: The pilot study utilized a brief questionnaire that was developed by including 5 questions that were found to be strong positive predictors of cataplexy from a previous 51-item cataplexy questionnaire.

Risks of high-dose stimulants in the treatment of disorders of excessive somnolence: a case-control study.

Study Objectives: To ascertain complications associated with high-dose stimulant therapy in patients with narcolepsy or idiopathic hypersomnia.

Design: Case-control, retrospective chart review.

Setting: Sleep center in an academic hospital.

Analysis of hypocretin (orexin) antibodies in patients with narcolepsy.

Study Objectives: We tested the hypothesis that patients with narcolepsy have serum antibodies specific for preprohypocretin and its derivatives.

Design: We tested sera from strictly diagnosed HLA DQB1*0602-positive narcoleptic patients with cataplexy for evidence of autoantibodies against human preprohypocretin, hypocretin 1 and 2, N-terminal leader and C-terminal peptides of preprohypocretin using enzyme-linked immunosorbent assays (ELISA). These results were compared to samples from nonnarcoleptic psychiatric and sleep apnea controls.

Studies of humoral immunity to preprohypocretin in human leukocyte antigen DQB1*0602-positive narcoleptic subjects with cataplexy.

Background: Canine models for narcolepsy have mutations of the hypocretin receptor 2 gene, and preprohypocretin knockout murine lines exhibit narcoleptic-like behaviors. Human narcolepsy with cataplexy is associated with human leukocyte antigen DQB1*0602 and reduced hypocretin levels in cerebrospinal fluid, suggesting an autoimmune diathesis. We tested the hypothesis that DQB1*0602-positive narcoleptic subjects with cataplexy have immunoglobulin (Ig)G reactive to human preprohypocretin and its cleavage products.

Characterizing the emotions that trigger cataplexy.

Cataplexy is an intriguing example of how emotions can trigger muscle weakness by activating neural pathways. When associated with excessive daytime sleepiness, cataplexy is considered pathognomonic of narcolepsy. A questionnaire was administered to 55 patients with narcolepsy-cataplexy and 47 comparison subjects with obstructive sleep apnea.

A putative link between childhood narcolepsy and obesity.

Background And Purpose: While there have been anecdotal observations of binge eating in childhood-onset narcolepsy, the possible relationship between increased weight gain and childhood-onset narcolepsy has not been evaluated.

Patients And Methods: A retrospective, case-control design was used to compare the body mass index (BMI) of 31 narcolepsy children at the time of diagnosis with that of healthy, age- and gender-matched controls.

Results: The median BMI in the narcolepsy subjects was 22.