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Biomedical subjects

J Montplaisir

Publications and source records attributed to J Montplaisir.

At least 37 records · Page 2Linked to original sources
PubMed2001

Restless Legs Syndrome: scoring criteria for leg movements recorded during the suggested immobilization test.

Objective: To evaluate the characteristics of leg movements experienced by patients with the restless legs syndrome (RLS) during wakefulness using the suggested immobilization test (SIT).Methods: Forty patients with primary RLS who showed an index of leg movements greater than 40 during the SIT were selected for these analyses.Results: In general, Coleman's criteria for scoring PLMS were appropriate for scoring leg movements during the SIT. However, a substantial number of leg movements lasted between 5 and 10 s, exceeding Coleman's maximum duration criterion. The other criteria used to score PLMS (i.e. movements separated by 4-90 s and occurring in series of four consecutive movements) allowed detection of more than 90% of all leg movements recorded during the SIT. The distribution of inter-movement intervals (IMI) suggests that a great majority of leg movements recorded during the SIT are periodic, with a modal value of IMI between 11-12 s.Conclusion: Considering that leg movements recorded during the SIT last longer than those occurring during sleep, we recommend using a duration criterion of 0.5-10 s for scoring the former. We also recommend using the same periodicity criteria for the SIT as those used for scoring PLMS.

Journal Article↗
PubMed2001

Development of sleep patterns in early adolescence.

This study examines the developmental changes of sleep patterns as a function of gender and puberty and assesses the prevalence of sleep habits and sleep disturbances in early adolescence. It also investigates the relationship between sleep patterns, sleep habits and difficulty falling asleep and nocturnal awakenings. The present analyses are based on results available for 588 boys and 558 girls for whom mothers completed questions concerning demographics and sleep at annual intervals when their child was aged 10--13 years. The results indicated that nocturnal sleep times decreased, bedtimes were delayed and differences between weekend and school day sleep schedules progressively increased with age. Gender and puberty were both associated with the timing of sleep on weekends. Girls presented longer weekend time in bed (TIB) and later weekend wake time than boys. Similarly, subjects with higher pubertal status showed longer weekend TIB and later weekend wake time than subjects with lower pubertal status. Difficulty falling asleep was associated with later weekend wake time and with sleeping with a night light. In conclusion, the gender differences commonly reported in adolescents' sleep patterns are most likely explained by girls' higher pubertal status. This study emphasizes the link between puberty and a putative physiological need for more sleep, in presence of a general reduction of sleep times during adolescence. From age 10--13 years, the delay and lengthening of the sleep period on weekends in comparison to schooldays is associated with difficulty falling asleep.

Adolescent↗
PubMed2001

Age-related modifications of NREM sleep EEG: from childhood to middle age.

This study investigated the modifications in non-rapid eye movement (NREM) sleep electroencephalogram (EEG) power in 54 subjects, from children to middle-aged adults. Spectral analyses were performed on 5 h of NREM sleep. A marked decrease of absolute slow-wave activity (SWA) was observed with increasing age; children had significantly more SWA than adolescents, young and middle-aged adults. The decline of SWA across the night seems to level off with increasing age, suggesting an age-related attenuation of homeostatic sleep pressure. Absolute theta power was higher for children compared with the other three groups, and adolescents had more theta power than young and middle-aged adults. In comparison to young and middle-aged adults, alpha power was higher for children and adolescents. Children and adolescents had more sigma power than middle-aged adults. Absolute beta power was higher for children than for the other age groups. Therefore, the major alterations of NREM sleep EEG occurring between childhood and middle age are not restricted to SWA, but encompassed the theta, alpha, sigma and beta frequency bands.

Adolescent↗
PubMed2001

Daytime sleepiness and EEG spectral analysis in apneic patients before and after treatment with continuous positive airway pressure.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent apneas during sleep, resulting in repetitive hypoxemic episodes and interruptions of the normal sleep pattern. A previous study showed EEG slowing (ie, a higher ratio of delta + theta frequencies to alpha + beta frequencies on EEG) during rapid eye movement (REM) sleep and wakefulness in untreated OSAS patients. STUDY AND OBJECTIVES: To determine whether EEG slowing is reversible with continuous positive air pressure (CPAP) treatment and to verify whether the persistence of excessive daytime sleepiness (EDS) is correlated with residual slowing of the EEG. PATIENTS: Ten healthy subjects (9 men and 1 woman) and 14 patients with moderate-to-severe OSAS (13 men and 1 woman) were studied before and after 6 months of treatment with CPAP. RESULTS: Untreated OSAS patients showed EEG slowing in frontal and central cortical regions during both wakefulness and during REM sleep compared to healthy control subjects. This EEG slowing was found to be independent of time spent with arterial oxygen saturation < 90%, severity of OSAS, or mean sleep latency as determined by the multiple sleep latency test. CPAP treatment was found to correct the EEG slowing for both REM sleep and wakefulness. Daytime sleepiness also greatly improved with treatment, but some degree of somnolence remained. CONCLUSION: CPAP treatment was found to correct the EEG slowing that was observed in untreated OSAS patients. Persistent EDS may be related to persistent obesity after CPAP treatment.

Adult↗
PubMed2001

Slow-wave activity in sleep apnea patients before and after continuous positive airway pressure treatment: contribution to daytime sleepiness.

STUDY OBJECTIVES: To estimate the course of slow-wave activity (SWA), its amount during the night, and its correlation with daytime sleepiness in sleep apnea syndrome (SAS) patients. This study also verified whether continuous positive airway pressure (CPAP) treatment also restores a normal pattern of SWA in severe SAS patients. PARTICIPANTS: Ten patients with a diagnosis of severe SAS who showed a good clinical response to CPAP after approximately 9 months of treatment were included in this study. These patients were matched for sex and age with 10 control subjects. DESIGN: All subjects underwent 1 night of polysomnography (PSG), followed by the multiple sleep latency test (MSLT) the next day. For the SAS patients only, the same procedure was repeated after 9 +/- 0.7 months of CPAP treatment. In addition to traditional scoring of sleep stages, apneas, hypopneas, and microarousals, the SWA, defined as the power in the 0.75- to 4.5-Hz frequency band, was evaluated. RESULTS: A positive correlation between SWA of the first cycle and the MSLT (r = 0.56; p = 0.045) was found before treatment. Moreover, SAS patients significantly increased their mean SWA after CPAP treatment in the first (p = 0.024) and second (p = 0.002) sleep cycles and restored a more physiologic decay of SWA across the night. CONCLUSIONS: These results suggest that daytime sleepiness in SAS patients may be the result of a lack of SWA during the first part of the night, and show that CPAP restores a more physiologic pattern of SWA across the night.

Adult↗
PubMed2000

Development of disturbing dreams during adolescence and their relation to anxiety symptoms.

STUDY OBJECTIVES: This work assesses the prevalence and development of disturbing dreams among adolescents and the association of these dreams with anxiety. DESIGN: Sex differences in prevalence were analyzed with chi-square analyses. Changes over time were assessed with Wilcoxon tests and cross-tabulation tables. Associations with anxiety and DSM-III-R symptoms were assessed with ANOVA designs. SETTING: N/A. PARTICIPANTS: A total of 610 boys and girls rated their recall of disturbing and normal dreams at both 13 and 16 years of age. Subgroups of subjects were evaluated for anxiety symptoms at age 13 and for DSM-III-R symptoms of separation anxiety (SA), overanxious disorder (OD) and generalized anxiety disorder (GAD) at age 16. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The recall of disturbing dreams was more prevalent for girls than for boys at both ages, and increased over time for girls while it decreased for boys. The recall of normal dreams was also more prevalent for girls at both ages, but this difference could not fully account for the difference in recall of disturbing dreams. Normal dream recall increased from age 13 to 16 for both sexes. The frequent occurrence of disturbing dreams was associated with anxiety at age 13 and with GAD, SA and OD symptoms at age 16 for both sexes. Evidence of more numerous OD symptoms for girls with frequent disturbing dreams suggests that this form of anxiety may partially account for the observed sex difference in disturbing dream prevalence. CONCLUSIONS: The findings highlight a prevalence of disturbing dreams that is especially marked for adolescent girls. Unlike previous cross-sectional studies, which have found the same sex difference, this longitudinal design also calls attention to within-subjects changes in disturbing dream recall. The results also confirm that the frequent recall of disturbing dreams is associated with pathological symptoms of trait anxiety-apparently even as young as 13 years of age. Further study of disturbing dreams may contribute to understanding of associated pathophysiological factors which, too, vary by sex (e.g., PTSD, insomnia, depression).

Adolescent↗
PubMed2000

Dynamics of slow-wave activity during the NREM sleep of sleepwalkers and control subjects.

STUDY OBJECTIVE: To compare the number and distribution of awakenings from slow-wave sleep (SWS) and both the power and dynamics of EEG slow-wave activity (SWA) in sleepwalkers and controls. Somnambulism is considered to be a disorder of arousal from NREM sleep and related to anomalous SWS and SWA. Power spectral analyses have never been used to quantify patients' SWA across sleep cycles. DESIGN: N/A SETTING: N/A PATIENTS: A polysomnographic study was performed on 15 adult sleepwalkers and 15 age- and sex-matched controls. INTERVENTIONS: N/A MEASUREMENTS & RESULTS: Sleepwalkers had a significantly greater number of awakenings from SWS than did control subjects. Controls showed a greater decrease in SWA across NREM cycles. Sleepwalkers had a significantly lower level of SWA during the first NREM period, where most awakenings take place. CONCLUSION: Sleepwalkers appear to suffer from an abnormality in the neural mechanisms responsible for the regulation of SWS.

Adolescent↗
PubMed2000

Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery.

Numerous studies have assessed a wide range of cognitive deficits associated with obstructive sleep apnea syndrome (OSAS). The comparison of these various results, however, is hampered by the fact that different studies employ different neuropsychological tests, even when assessing the same function. The aim of this paper is to present a standardized neuropsychological test battery for the evaluation of OSAS patients. Following a description of the general characteristics of OSAS, we review the main cognitive functions reported as being impaired in OSAS patients. These include general intellectual functioning, attentional functioning, memory and learning abilities, executive functions, and motor performance. Based on this review, we propose a test battery designed to cover these cognitive processes while taking into account the time constraints present in most research and clinical centers. In addition to providing a comprehensive neuropsychological evaluation of OSAS patients, the proposed test battery should facilitate the comparison of results from different laboratories.

Adolescent↗
PubMed2000

Arm restlessness in patients with restless legs syndrome.

Restless legs syndrome (RLS) is a neurologic disorder characterized principally by leg paresthesia and motor restlessness. Several clinical reports indicated that many patients with RLS also have arm paresthesia and restlessness. In the present study, the incidence of arm restlessness was assessed by questionnaire in 230 patients diagnosed with idiopathic RLS. Arm restlessness was reported by 48.7% of the patients. Patients with and without arm restlessness were compared with regard to clinical and polysomnographic parameters. No between-group differences were found for age at onset of RLS, duration of illness, gender, presence of a family history of RLS, sleep latency, total sleep time, sleep efficiency, and periodic leg movements index during sleep. However, arm restlessness was more frequent in patients with severe RLS. Interestingly, the polysomnographic data failed to differentiate the patients with arm restlessness from those without arm restlessness, except for sleep efficiency, which tended to be lower in patients with arm restlessness. In conclusion, the results of the present study are in agreement with clinical observations that a large proportion of patients with RLS have arm restlessness.

Adult↗
PubMed2000

Sleep in right hemispherectomized patients: evidence of electrophysiological compensation.

OBJECTIVES: The goal of this study is to provide a better understanding of the role of the cortex in sleep's macro- and microstructure modulation. METHODS: Sleep architecture and phasic events were investigated in 4 patients having undergone right functional or anatomical hemispherectomy and 8 control subjects. Between-groups differences were assessed using the Wilcoxon-Mann-Whitney test. RESULTS: Findings provide evidence for overall similarity between patients' and control subjects' left hemispheric sleep architecture. In addition, results clearly indicate that it is possible to detect electrical activity over the operated side of a hemispherectomized patient's brain, even when resection of the hemi-cortex has been complete. Finally, findings provide evidence for similar left and right hemispheric relative spectral activities and for an increase in fast activity bands over the intact hemisphere in anatomical hemispherectomized patients. CONCLUSIONS: This study provides evidence that right hemispherectomy does not produce significant sleep architecture alterations as recorded over the intact hemisphere. In addition, residual activity detected over the operated side in anatomical hemispherectomized patients is interpreted as resulting from volume conduction originating from generators located in the intact hemisphere. Finally, there is strong evidence for electrophysiological compensation in the intact hemisphere following complete resection of the contralateral hemi-cortex.

Adolescent↗
PubMed2000

Homeostatic sleep regulation in patients with idiopathic hypersomnia.

OBJECTIVE: To determine whether the spectral activity during sleep of patients with idiopathic hypersomnia (IH) differs from that of healthy subjects. METHODS: Spectral analysis of the electroencephalogram (EEG) was performed in 10 patients with IH and in 10 age-matched control subjects. We compared the time course of absolute power for slow wave activity (SWA: 0.75-4.5 Hz), and for theta, alpha, sigma and beta bands for the first 4 non-rapid-eye movement (NREM) episodes. RESULTS: Compared to controls, IH patients had less SWA across the night although the exponential decay was preserved. The fall in SWA was statistically significant for the first two NREM episodes only. The lower power of SWA was related to lower amounts of stages 3 and 4 of NREM sleep during the sleep episodes. No correlation was found between SWA during the night and the mean sleep latency on the multiple sleep latency test (MSLT). CONCLUSIONS: These results showed that, in IH patients, the homeostatic sleep regulatory mechanisms are preserved but the sleep pressure, indicated by SWA, is lower.

Adolescent↗
PubMed2000

Pramipexole in the treatment of restless legs syndrome: a follow-up study.

The restless legs syndrome (RLS) is a condition characterized by unpleasant limb sensations occurring at rest and associated with an irresistible urge to move. Several treatments are used to treat RLS including benzodiazepines, opioids, dopaminergic agents, clonidine and anticonvulsant drugs such as carbamazepine and gabapentine. Dopaminergic agents are now considered the treatment of choice for RLS. Levodopa is effective in treating RLS; however, several patients treated with levodopa at bedtime developed morning or late afternoon restlessness. Recently, more attention has been paid to dopamine receptor agonists. Ergoline derivatives, bromocriptine and pergolide were found effective, but require concomitant administration of domperidone, a peripheral dopamine antagonist. In a recent study, we studied the efficacy and innocuity of pramipexole, a new dopamine agonist with a higher affinity for the D3 receptor subtype of the D2 family, in a double-blind, placebo-controlled, randomized trial. Pramipexole had major effects on RLS symptoms without severe side-effects. The present study aimed to assess the long-term efficacy of pramipexole. Seven patients were treated with the drug for a mean follow-up duration of 7.8 months. Treatment was started at a dosage of 0.25 mg, and progressively increased until the optimal therapeutic effect was obtained. Home questionnaires were completed for 7 consecutive days, after one month and after a mean of 7.8 months of treatment with pramipexole, assessing leg restlessness during the daytime, in the evening, at bedtime and during the night. There was no evidence of a decrease in the therapeutic effect of pramipexole in these patients, even 7.8 months after the initiation of treatment. The optimal dosage was 0.25 mg for one patient, 0.5 mg for five patients and 0.75 mg for one patient. While there was a progressive increase in severity of leg restlessness from daytime to nighttime before treatment, a suppression of leg restlessness was observed throughout the 24 h with a single dose of pramipexole at bedtime. The remarkable efficacy of pramipexole raises the possibility that the D3 receptors of the mesolimbic system may be more specifically involved in the physiopathology of RLS.

Adult↗
PubMed2000

Periodic arm movements in patients with the restless legs syndrome.

A high proportion of patients with restless legs syndrome (RLS) also complain of arm paresthesia but the presence of periodic arm movements (PAM) has never been documented in a sleep laboratory in these patients. We investigated the prevalence of PAM during nocturnal sleep and awakenings in 22 RLS patients. Fifteen patients had a PAM index >5 movements per hour during wakefulness and among them only 3 had a PAM index >5 during sleep. Twenty patients had a periodic leg movement (PLM) index >5 during wakefulness and 17 had a PLM index >5 during sleep. In 42.8% of cases, PAM showed temporal relationship with PLM during wakefulness. These results show that PAM is frequent in RLS and suggest that the basic neurological dysfunction responsible for RLS is probably not located exclusively at the level of the lumbar spinal cord but involves neuronal systems located at upper levels.

Adult↗
PubMed2000

Development of parasomnias from childhood to early adolescence.

OBJECTIVES: This study examines the prevalence and developmental changes of parasomnias and assesses gender differences, relationships between parasomnias, and associations with anxiety and family adversity using data collected during the course of a longitudinal study of a representative sample of children from Québec. METHOD: The present analyses are based on results available for 664 boys and 689 girls for whom mothers have completed questions concerning demographics, parasomnias, and anxiety level. For the prevalence and developmental aspects of parasomnias, prospective data were collected at annual intervals from 11 to 13 years old and retrospective data for the period between ages 3 and 10 years were collected when the children were 10 years old. RESULTS: Somniloquy, leg restlessness, and sleep bruxism are the most frequent parasomnias. More girls were afflicted with leg restlessness, while enuresis and somniloquy were more common in boys. High anxiety scores were found in children suffering from night terrors, somniloquy, leg restlessness, sleep bruxism, and body rocking. Parasomnias were unrelated to the index of family adversity. CONCLUSIONS: Although sleepwalking, night terrors, enuresis, and body rocking dramatically decreased during childhood, somniloquy, leg restlessness, and sleep bruxism were still highly prevalent at age 13 years, paralleling results found in adults. Sleepwalking, night terrors, and somniloquy are conditions often found together. The only robust gender difference was for enuresis. High anxiety scores in parasomnias are reported for the first time in a large, controlled study. Sociodemographic variables do not seem to play a major role in the occurrence of parasomnias.

Adolescent↗
PubMed1999

Restless legs syndrome improved by pramipexole: a double-blind randomized trial.

BACKGROUND: Restless legs syndrome (RLS) is characterized by leg paresthesia associated with an irresistible urge to move. Currently used dopaminergic agents, such as levodopa, pergolide, and bromocriptine, offer incomplete control of sensory and motor symptoms and induce severe side effects. OBJECTIVE: To assess the safety and efficacy of pramipexole, a full D3-receptor agonist, in the treatment of RLS. METHODS: Ten RLS patients were studied before and after two 1-month treatments (placebo and pramipexole) administered in a double-blind crossover fashion. The severity of sensory and motor manifestations was assessed by 1 week of home questionnaires and 2 consecutive nights of sleep laboratory recordings. The indexes of periodic leg movement during sleep (PLMS) and during wakefulness (PLMW) were used as primary outcome variables. RESULTS: Pramipexole dramatically reduced the PLMS index to normal values (Wilcoxon, p = 0.005). The PLMW index was also significantly reduced (Wilcoxon, p = 0.007). Pramipexole also alleviated leg discomfort at bedtime and during the night as measured by the home questionnaires. CONCLUSIONS: Pramipexole is the most potent therapeutic agent ever tested for RLS. Measures of both sensory and motor functions returned to normal values after treatment. Moreover, these results further support the hypothesis that D3 receptors play a major role in the physiopathology of this condition.

Adult↗
PubMed1999

EEG and cardiac activation during periodic leg movements in sleep: support for a hierarchy of arousal responses.

OBJECTIVE: To investigate other physiologic changes that occur with periodic leg movements during sleep (PLMS) that might be considered to be more sensitive indices of sleep fragmentation. BACKGROUND: Although PLMS are associated with recurrent microarousals (MA), the frequency of PLMS with MA does not correlate with objective daytime sleepiness. It is postulated that the lack of correlation results from the low sensitivity of the standard criteria used to score MA. METHODS: Ten drug-free patients with a polygraphic and clinical diagnosis of restless legs syndrome (RLS) and PLMS were examined. The EEG correlates of PLMS were analyzed by visual scoring and spectral analysis during PLMS that ended in a visible microarousal (PLMS with MA) or not (PLMS without MA). The R-R interval in the EKG signal was also examined. RESULTS: A total of 34% of PLMS were associated with MA lasting >3 seconds, and 3% of PLMS were associated with MA lasting <3 seconds. Although PLMS with MA were associated with an increase in alpha activity, for PLMS without MA a significant increase in delta and theta activity was present. Both types of PLMS induced a shortening of the R-R interval; this was particularly more marked for PLMS with MA. CONCLUSIONS: First, visual scoring of MA that include a duration of less than 3 seconds has little effect on the detection of PLMS with MA. Second, EEG activation and tachycardia are present during both types of PLMS. Third, a hierarchy in the arousal response is present-going from autonomic activation to bursts of delta activity to alpha activity to a full awakening.

Analysis of Variance↗