Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance.

Sleep has a critical role in promoting health. Research over the past decade has documented that sleep disturbance has a powerful influence on the risk of infectious disease, the occurrence and progression of several major medical illnesses including cardiovascular disease and cancer, and the incidence of depression. Increasingly, the field has focused on identifying the biological mechanisms underlying these effects. This review highlights the impact of sleep on adaptive and innate immunity, with consideration of the dynamics of sleep disturbance, sleep restriction, and insomnia on (a) antiviral immune responses with consequences for vaccine responses and infectious disease risk and (b) proinflammatory immune responses with implications for cardiovascular disease, cancer, and depression. This review also discusses the neuroendocrine and autonomic neural underpinnings linking sleep disturbance and immunity and the reciprocal links between sleep and inflammatory biology. Finally, interventions are discussed as effective strategies to improve sleep, and potential opportunities are identified to promote sleep health for therapeutic control of chronic infectious, inflammatory, and neuropsychiatric diseases.

Why Sleep Is Important for Health: A Psychoneuroimmunology Perspective

Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder.

With the WHO in China

Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies to prospective outcomes, and lack of comprehensive adjustments for confounders make interpretation of the literature difficult. We reviewed prospective studies with total mortality or a composite cardiovascular end point as an outcome in relation to the level and the circadian profile of systolic BP. We analyzed studies in hypertensive patients (n=23 856) separately from those in individuals randomly recruited from populations (n=9641). We pooled summary statistics and individual subject data, respectively. In both patients and populations, in analyses in which nighttime BP was additionally adjusted for daytime BP and vice versa, nighttime BP was a stronger predictor than daytime BP. With adjustment for the 24-hour BP, both the night-to-day BP ratio and dipping status remained significant predictors of outcome but added little prognostic value over and beyond the 24-hour BP level. In the absence of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation of ambulatory BP recording need to be updated.

Predictive Role of the Nighttime Blood Pressure

Objectives: To assess heart rate (HR) and blood pressure (BP) changes associated with periodic leg movements during sleep (PLMS) with or without EEG signs of arousal in subjects with primary restless legs syndrome (RLS). Methods: Ten patients with RLS (4 women, aged 47.3 ± 13.5 years) underwent one night of polysomnography along with noninvasive beat-to-beat BP monitoring. Ten PLMS with microarousals (PLMS-MA) and 10 PLMS without microarousals (PLMS-noMA) were analyzed in each subject. Systolic and diastolic BP (SBP, DBP) were measured within a 25-beat temporal window comprising 10 beats before and 15 beats after onset of each movement. PLMS-related BP changes were assessed by repeated measures one-way analysis of variance. BP changes associated with PLMS-MA and PLMS-noMA were compared by paired t -tests. Pearson correlation coefficients were used to assess the relationship between cardiovascular changes and clinical and polysomnographic variables. Results: BP increased significantly in association with all PLMS (on average, SBP 22 mm Hg, DBP 11 mm Hg). BP changes associated with PLMS-MA were greater vs those associated with PLMS-noMA ( p Conclusions: Periodic leg movements–related repetitive nocturnal blood pressure fluctuations could contribute to the risk of cardiovascular diseases in patients with restless legs syndrome, especially in the elderly.

Nocturnal blood pressure changes in patients with restless legs syndrome

INSOMNIA REFERS TO THE SUBJECTIVE EXPERIENCE OF NON RESTORATIVE SLEEP DUE TO DIFFICULTY FALLING ASLEEP, DIFFICULTY MAINTAINING SLEEP or early awakening.1,2 Insomnia is the most common sleep complaint in the general population, with a variable prevalence ranging from 2% to 48%, a broad range which reflects the variable definition of insomnia, different modalities of investigation, and the population under study.2,3 Indeed, insomnia may appear in association with another medical or psychiatric disorder (comorbid insomnia), or as an independent condition as primary insomnia.3 Hallmarks of primary insomnia are the subjective experience of difficulty initiating and maintaining sleep, accompanied by distress or impairment in daytime function; the repetitive (as opposed to sporadic) recurrence of a poor sleep night;4 and duration of ≥ 1 month (according to DSM-IV definition)5, whereas ≥ 6 months duration is required to fulfill diagnostic criteria for chronic insomnia.1–3

The pathophysiological mechanisms of primary insomnia remain elusive. Psychophysiological factors such as stress, anxiety, and autonomic hyperarousal are significant components of this condition6 and would appear to be implicated in its genesis and perpetuation. Polysomnography often fails to detect traditional criteria of poor sleep in insomniacs.2 However, studies assessing quantitative electroencephalographic (EEG) spectral analysis have shown that, even in the presence of an apparently normal sleep architecture during polysomnography, these subjects have a decrease in EEG activity in the low frequencies (0.5-3.5 Hz) and an increased activity in high frequencies (14-45 Hz) during NREM sleep,7–9 suggesting hyperactivity of the central nervous system during their sleep. Finally, studies using positron emission tomography assessing metabolic activity during NREM sleep have documented that insomniacs, compared to good sleepers, have higher metabolic activity in the ascending reticular activating system, along with areas pertaining to the emotion regulation and cognitive systems.10 These data suggest that the interaction of the systems regulating arousal, emotions, and cognitive function is part of the neurobiology of insomnia and support the concept that poor sleep is a symptom of a primary disorder of the arousal system. Indeed, as part of the arousal response, nocturnal plasma catecholamine concentration11 and low frequency components of heart rate variability have been reported to be higher in insomniacs than good sleepers.12

Insomnia significantly impairs daytime function and predisposes to major depression.1,3 There is also an emerging epidemiological evidence linking insomnia to higher cardiovascular morbidity and mortality.13–17 However, at present, no studies have assessed the effects of insomnia on cardiovascular function, and to our knowledge, no data exist on nighttime BP, which has been shown to be relevant in assessing cardiovascular risk in recent large studies.18,19 Blood pressure physiologically decreases during sleep,20 a reduction commonly called dipping. Studies indicated that day-to-night and nighttime regulation of BP appear to be tightly coupled with autonomic changes occurring during the wake-sleep cycle.21,22 This suggests that BP should be particularly sensitive to disturbances occurring during sleep, especially in the presence of hyperactivation of the sympathetic nervous system, such as that which may occur in insomniacs.

In the present study we investigated the 24-hour profile of arterial BP in subjects with chronic primary insomnia and tested the hypothesis that these subjects have higher nighttime BP and an attenuation of nocturnal BP dipping compared to good sleepers. We also assessed the relationship existing between nighttime BP and polysomnographic measures of poor sleep and EEG power spectra in the β frequencies.

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Nighttime Blood Pressure in Normotensive Subjects With Chronic Insomnia: Implications for Cardiovascular Risk

Study Objectives: Several studies have demonstrated a positive correlation between periodic leg movements during sleep (PLMS) and age in healthy subjects. However, little is known about periodic leg movements during wakefulness (PLMW) in this population. Although the definitions of PLMS and PLMW specify a typical intermovement interval of 20 to 40 seconds, scoring criteria allow an intermovement interval of 4 to 90 seconds. The aim of the present study was to look at the prevalence and interval distribution of PLMS and PLMW in relationship with age in a population of healthy subjects. Design: Periodic leg movements were recorded during 1 night. Setting: Sleep laboratory, Hopital du Sacre-Coeur de Montreal. Participants: Sixty-seven healthy subjects aged between 5 and 76 years (32 F, 35 M). Interventions: N/A Measurements and Results: The presence of PLMS was rare before the age of 40, but then the index increased dramatically. PLMW index was higher in younger subjects compared with middle-aged subjects. Interval histograms of PLMS did not revealed a clear peak in younger subjects. With advancing age, PLMS interval histograms show a peak around 15 to 35 seconds, which is not observed in younger subjects. On the other hand, despite high indexes, PLMW interval histograms do not show a clear peak for any age group. Conclusion: These results illustrate that interval evaluation is an important feature of the calculation of periodic movements to discriminate spontaneous motor activity from PLMS or PLMW.

/pdf/plms-and-plmw-in-healthy-subjects-as-a-function-of-age-3pfvt582s3.pdf

PLMS and PLMW in healthy subjects as a function of age: prevalence and interval distribution.

Blood pressure changes associated with periodic leg movements during sleep in healthy subjects

This study aimed to evaluate changes in sleep during the COVID-19 outbreak, and used data-driven approaches to identify distinct profiles of changes in sleep-related behaviours. Demographic, behavioural and psychological factors associated with sleep changes were also investigated. An online population survey assessing sleep and mental health was distributed between 3 April and 24 June 2020. Retrospective questions were used to estimate temporal changes from before to during the outbreak. In 5,525 Canadian respondents (67.1% females, 16-95 years old: Mean ± SDâ=â55.6 ± 16.3 years), wake-up times were significantly delayed relative to pre-outbreak estimates (p < .001, I· p 2  = 0.04). Occurrences of clinically meaningful sleep difficulties significantly increased from 36.0% before the outbreak to 50.5% during the outbreak (all p < .001, g ≥ 0.27). Three subgroups with distinct profiles of changes in sleep behaviours were identified: "Reduced Time in Bed", "Delayed Sleep" and "Extended Time in Bed". The "Reduced Time in Bed" and "Delayed Sleep" subgroups had more adverse sleep outcomes and psychological changes during the outbreak. The emergence of new sleep difficulties was independently associated with female sex, chronic illnesses, being employed, family responsibilities, earlier wake-up times, higher stress levels, as well as heavier alcohol use and television exposure. The heterogeneity of sleep changes in response to the pandemic highlights the need for tailored interventions to address sleep problems.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jsr.13231

Marie-Hélène Pennestri

Papers

Nocturnal blood pressure changes in patients with restless legs syndrome

Nighttime Blood Pressure in Normotensive Subjects With Chronic Insomnia: Implications for Cardiovascular Risk

PLMS and PLMW in healthy subjects as a function of age: prevalence and interval distribution.

Blood pressure changes associated with periodic leg movements during sleep in healthy subjects

Profiles of sleep changes during the COVID-19 pandemic: Demographic, behavioural and psychological factors.