The Experts below are selected from a list of 13530 Experts worldwide ranked by ideXlab platform
Charles F Reynolds - One of the best experts on this subject based on the ideXlab platform.
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adaptation of problem solving therapy for primary care to prevent late life depression in goa india the dil intervention
Global Health Action, 2019Co-Authors: Amit Dias, Fredric Azariah, Miriam Sequeira, Revathi N Krishna, Jennifer Q Morse, Alex S Cohen, Pim Cuijpers, Stewart J Anderson, Vikram Patel, Charles F ReynoldsAbstract:ABSTRACTBackground: Depression in late life is a major, yet unrecognized public health problem in low- and middle-income countries (LMICs). The dearth of specialist resources, together with the lim...
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late life mental health education for workforce development brain versus heart
American Journal of Geriatric Psychiatry, 2012Co-Authors: Jules Rosen, Emily Stiehl, Vikas Mittal, Debra Fox, John G Hennon, Dilip V Jeste, Charles F ReynoldsAbstract:Purpose There is a shortage of mental health professionals to care for a growing geriatric population. Though not mutually exclusive, clinical and didactic educational experiences promote cognition, whereas affective knowledge (attitude) is promoted through nonclinical exposure to seniors. This study evaluates the relative impact of cognition and attitude on career interests among healthcare students. Methods We developed 13 interactive, video documentary "lessons" on late-life mental health presenting didactic material along with stories of actual patients and families. Four of these lessons were viewed at 1-week intervals by 42 students from medical school and graduate programs of social work, psychology, and nursing. Knowledge, attitudes, and inclinations toward working with seniors were assessed. Results Both cognition and attitudes toward seniors improved. Linear regression shows that change in attitude, not cognition, predicts interest in working with seniors. Conclusion Educational experiences that promote affective learning may enhance interest in geriatric careers among healthcare students.
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late life mental health education for workforce development brain versus heart
Social Science Research Network, 2012Co-Authors: Jules Rosen, Emily Stiehl, Vikas Mittal, Debra Fox, John G Hennon, Dilip V Jeste, Charles F ReynoldsAbstract:There is a shortage of mental health professionals to care for a growing geriatric population. Though not mutually exclusive, clinical and didactic educational experiences promote cognition, whereas affective knowledge (attitude) is promoted through nonclinical exposure to seniors. This study evaluates the relative impact of cognition and attitude on career interests among healthcare students.
Anne B Newman - One of the best experts on this subject based on the ideXlab platform.
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arterial stiffness and risk of overall heart failure heart failure with preserved ejection fraction and heart failure with reduced ejection fraction the health abc study health aging and body composition
Hypertension, 2017Co-Authors: Ambarish Pandey, Anne B Newman, Hassan Khan, Edward G Lakatta, Daniel E Forman, Javed Butler, Jarett D BerryAbstract:Higher arterial stiffness is associated with increased risk of atherosclerotic events. However, its contribution toward risk of heart failure (HF) and its subtypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), independent of other risk factors is not well established. In this study, we included Health ABC study (Health, Aging, and Body Composition) participants without prevalent HF who had arterial stiffness measured as carotid-femoral pulse wave velocity (cf-PWV) at baseline (n=2290). Adjusted Cox-proportional hazards models were constructed to determine the association between continuous and data-derived categorical measures (tertiles) of cf-PWV and incidence of HF and its subtypes (HFpEF [ejection fraction >45%] and HFrEF [ejection fraction ≤45%]). We observed 390 HF events (162 HFpEF and 145 HFrEF events) over 11.4 years of follow-up. In adjusted analysis, higher cf-PWV was associated with greater risk of HF after adjustment for age, sex, ethnicity, mean arterial pressure, and heart rate (hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref] =1.35 [1.05-1.73]). However, this association was not significant after additional adjustment for other cardiovascular risk factors (hazard ratio [95% confidence interval], 1.14 [0.88-1.47]). cf-PWV velocity was also not associated with risk of HFpEF and HFrEF after adjustment for potential confounders (most adjusted hazard ratio [95% confidence interval] for cf-PWV tertile 3 versus tertile 1 [ref]: HFpEF, 1.06 [0.72-1.56]; HFrEF, 1.28 [0.83-1.97]). In conclusion, arterial stiffness, as measured by cf-PWV, is not independently associated with risk of HF or its subtypes after adjustment for traditional cardiovascular risk factors.
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prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure the sleep heart health study
Circulation, 2010Co-Authors: Daniel J Gottlieb, Susan Redline, Anne B Newman, Helaine E Resnick, Stuart F Quan, George T Oconnor, Gayane Yenokyan, Naresh M Punjabi, Elisa K TongAbstract:Background— Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women. Methods and Results— A total of 1927 men and 2495 women ≥40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men ≤70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of...
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inflammatory markers and incident heart failure risk in older adults the health abc health aging and body composition study
Journal of the American College of Cardiology, 2010Co-Authors: Andreas P Kalogeropoulos, Anne B Newman, Vasiliki V Georgiopoulou, Bruce M Psaty, Nicolas Rodondi, Andrew L Smith, David G Harrison, Udo Hoffmann, Douglas C Bauer, Stephen B KritchevskyAbstract:Inflammatory markers, including interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP), are elevated in patients with heart failure (HF) and are associated with outcomes regardless of etiology (1–6). Inflammatory markers are also elevated in individuals with asymptomatic left ventricular systolic and diastolic dysfunction (7–9), and experimental studies have suggested that IL-6 and TNF-α are associated with left ventricular remodeling, fetal gene expression, myocyte hypertrophy, and myocyte apoptosis (10). These observations raise the possibility that inflammation may be related to a heightened risk for HF, and previous studies have indeed suggested such an association (11–13). However, the number of incident HF events in these studies was small precluding an opportunity to assess for possible differential association across major demographic groups and adequately control for important predictors of HF including incident coronary events. Finally, the incremental value of inflammatory markers for HF risk determination was not assessed in these studies. We recently developed and validated a prediction model for incident HF in the elderly, the Health ABC HF model (14), based on nine routinely available variables including age, history of coronary heart disease (CHD), smoking, systolic blood pressure, heart rate, and serum concentrations of fasting glucose, creatinine, and albumin. Most of these risk factors have been associated with inflammation. For example, the association of inflammation with CHD and subclinical atherosclerosis is well documented (15,16), as is the association between inflammation and diabetes mellitus (17). Systemic low-grade inflammation has been reported in smokers (18). Both inflammation and oxidative stress have been correlated with chronic kidney disease (19). Similar associations have been reported for hypertension and hypoalbuminemia (20,21). Thus, beyond the direct effects on myocardial cells, inflammation may also drive HF risk through the creation of a biologic milieu that predisposes individuals to HF. In this study, we assessed the association between baseline levels of inflammatory markers and risk for HF among the elderly participants of the Health, Aging, and Body Composition (Health ABC) Study in the total cohort and in predefined subgroups of interest, as well as the possible incremental value of these markers for incident HF prediction. In addition, we assessed the impact of multiple inflammatory marker elevation and the incremental value of serial biomarker measurements for incident HF prediction.
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polysomnographic and health related quality of life correlates of restless legs syndrome in the sleep heart health study
Sleep, 2009Co-Authors: John W Winkelman, Susan Redline, Carol M Baldwin, Anne B Newman, Helaine E Resnick, Daniel J GottliebAbstract:IT IS NOT CLEAR WHETHER RESTLESS LEGS SYNDROME (RLS) SHOULD BE CONSIDERED A SLEEP DISORDER. ON THE ONE HAND, RLS IS USUALLY DESCRIBED as a sensorimotor neurological disorder, and in fact there are no sleep related symptoms in the established diagnostic criteria for RLS.1 However, sleep disturbance is the primary clinical morbidity of RLS,2 and it may also mediate other important secondary features of the disorder such as reduced quality of life,3 depressive symptoms,4 and cardiovascular disease (CVD).5 Further, the diagnostic criteria for RLS are based on the International Classification of Sleep Disorders nosology.6 Confusion regarding the role of sleep disturbance in RLS may contribute to the lack of objective data regarding the sleep of such individuals in community settings. Historically, data describing the sleep of patients with RLS comes from either self-report in population-based studies or polysomnographic (PSG) studies of clinically referred patients. In a multinational study which recruited subjects from primary care providers' offices, Hening et al2 found that 88% of the 551 subjects identified as RLS sufferers by screening questionnaire (symptoms ≥ twice per week, which when present were associated with at least moderate distress) reported sleep disturbance attributed to their RLS. On nights in which RLS was present, 68% of RLS sufferers reported taking > 30 min to fall asleep, and 60% reported waking ≥ 3 times per night. In a recent PSG study of clinically referred patients Hornyak et al7 demonstrated that sleep latency was substantially longer in those with RLS (41.6 min) than in age- and gender-matched controls (25.4 min). Additional evidence of poor sleep in RLS patients included shorter total sleep time, lower sleep efficiency, higher arousal index, more stage shifts, longer REM latency, and abnormalities in the percentage of stages 1, 2, and REM sleep. Health-related quality of life (HR-QOL) is reduced in both physical and mental domains among patients with RLS.3,8,9 In one random-digit dialing study of 158 subjects with at least moderate RLS, HR-QOL was 1.2 standard deviations (SD) below the norm in physical domains and was 0.6 SD below the norm in mental/emotional health domains, even after controlling for age, gender, and disease comorbidity.9 Both were greater than QoL deficits observed in type 2 diabetes.9 In an effort to understand the genesis of RLS morbidity, the same group previously demonstrated that sleep disturbance, rather than the primary symptoms of RLS (urge to move, etc.) mediated the effects of RLS symptoms on the primary outcomes, emotional distress, and daytime alertness.3 Population-based studies may provide estimates of RLS morbidity in samples that include individuals with a wider spectrum of disease than are available in clinically referred samples, however no study to date has examined PSG-derived sleep data in a community-based sample with RLS. Similarly, no study has examined the relationship between RLS severity, as measured by PSG data, and QoL. We report the associations of PSG-derived sleep data in community dwelling individuals in relation to varying frequency and severity of RLS.
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diabetes and sleep disturbances findings from the sleep heart health study
Diabetes Care, 2003Co-Authors: Helaine E Resnick, Susan Redline, Anne B Newman, Barbara V Howard, Eyal Shahar, Adele Kaplan M Gilpin, Robert E Walter, Gordon A Ewy, Naresh M PunjabiAbstract:OBJECTIVE —To test the hypothesis that diabetes is independently associated with sleep-disordered breathing (SDB), and in particular that diabetes is associated with sleep abnormalities of a central, rather than obstructive, nature. RESEARCH DESIGN AND METHODS —Using baseline data from the Sleep Heart Health Study (SHHS), we related diabetes to 1 ) the respiratory disturbance index (RDI; number of apneas plus hypopneas per h of sleep); 2 ) obstructive apnea index (OAI; ≥3 apneas/h of sleep associated with obstruction of the upper airway); 3 ) percent of sleep time 2 saturation; 4 ) central apnea index (CAI; ≥3 apneas [without respiratory effort]/h sleep); 5 ) occurrence of a periodic breathing (Cheyne Stokes) pattern; and 6 ) sleep stages. Initial analyses excluding persons with prevalent cardiovascular disease (CVD) were repeated including these participants. RESULTS —Of the 5,874 participants included in this report, 692 (11.8%) reported diabetes or were taking oral hypoglycemic medications or insulin and 1,002 had prevalent CVD. Among the 4,872 persons without CVD, 470 (9.6%) had diabetes. Diabetic participants had worse CVD risk factor profiles than their nondiabetic counterparts, including higher BMI, waist and neck circumferences, triglycerides, higher prevalence of hypertension, and lower HDL cholesterol ( P 2 saturation, CAI, and periodic breathing ( P P CONCLUSIONS —These data suggest that diabetes is associated with periodic breathing, a respiratory abnormality associated with abnormalities in the central control of ventilation. Some sleep disturbances may result from diabetes through the deleterious effects of diabetes on central control of respiration. The high prevalence of SDB in diabetes, although largely explained by obesity and other confounders, suggests the presence of a potentially treatable risk factor for CVD in the diabetic population.
Stuart F Quan - One of the best experts on this subject based on the ideXlab platform.
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prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure the sleep heart health study
Circulation, 2010Co-Authors: Daniel J Gottlieb, Susan Redline, Anne B Newman, Helaine E Resnick, Stuart F Quan, George T Oconnor, Gayane Yenokyan, Naresh M Punjabi, Elisa K TongAbstract:Background— Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women. Methods and Results— A total of 1927 men and 2495 women ≥40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men ≤70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of...
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the sleep heart health study design rationale and methods
Sleep, 1997Co-Authors: Stuart F Quan, Susan Redline, Barbara V Howard, Conrad Iber, James P Kiley, Javier F Nieto, George T Oconnor, David M Rapoport, John A RobbinsAbstract:The Sleep Heart Health Study (SHHS) is a prospective cohort study designed to investigate obstructive sleep apnea (OSA) and other sleep-disordered breathing (SDB) as risk factors for the development of cardiovascular disease. The study is designed to enroll 6,600 adult participants aged 40 years and older who will undergo a home polysomnogram to assess the presence of OSA and other SDB. Participants in SHHS have been recruited from cohort studies in progress. Therefore, SHHS adds the assessment of OSA to the protocols of these studies and will use already collected data on the principal risk factors for cardiovascular disease as well as follow-up and outcome information pertaining to cardiovascular disease. Parent cohort studies and recruitment targets for these cohorts are the following: Atherosclerosis Risk in Communities Study (1,750 participants), Cardiovascular Health Study (1,350 participants), Framingham Heart Study (1,000 participants), Strong Heart Study (600 participants), New York Hypertension Cohorts (1,000 participants), and Tucson Epidemiologic Study of Airways Obstructive Diseases and the Health and Environment Study (900 participants). As part of the parent study follow-up procedures, participants will be surveyed at periodic intervals for the incidence and recurrence of cardiovascular disease events. The study provides sufficient statistical power for assessing OSA and other SDB as risk factors for major cardiovascular events, including myocardial infarction and stroke.
Susan Redline - One of the best experts on this subject based on the ideXlab platform.
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prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure the sleep heart health study
Circulation, 2010Co-Authors: Daniel J Gottlieb, Susan Redline, Anne B Newman, Helaine E Resnick, Stuart F Quan, George T Oconnor, Gayane Yenokyan, Naresh M Punjabi, Elisa K TongAbstract:Background— Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women. Methods and Results— A total of 1927 men and 2495 women ≥40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men ≤70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of...
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polysomnographic and health related quality of life correlates of restless legs syndrome in the sleep heart health study
Sleep, 2009Co-Authors: John W Winkelman, Susan Redline, Carol M Baldwin, Anne B Newman, Helaine E Resnick, Daniel J GottliebAbstract:IT IS NOT CLEAR WHETHER RESTLESS LEGS SYNDROME (RLS) SHOULD BE CONSIDERED A SLEEP DISORDER. ON THE ONE HAND, RLS IS USUALLY DESCRIBED as a sensorimotor neurological disorder, and in fact there are no sleep related symptoms in the established diagnostic criteria for RLS.1 However, sleep disturbance is the primary clinical morbidity of RLS,2 and it may also mediate other important secondary features of the disorder such as reduced quality of life,3 depressive symptoms,4 and cardiovascular disease (CVD).5 Further, the diagnostic criteria for RLS are based on the International Classification of Sleep Disorders nosology.6 Confusion regarding the role of sleep disturbance in RLS may contribute to the lack of objective data regarding the sleep of such individuals in community settings. Historically, data describing the sleep of patients with RLS comes from either self-report in population-based studies or polysomnographic (PSG) studies of clinically referred patients. In a multinational study which recruited subjects from primary care providers' offices, Hening et al2 found that 88% of the 551 subjects identified as RLS sufferers by screening questionnaire (symptoms ≥ twice per week, which when present were associated with at least moderate distress) reported sleep disturbance attributed to their RLS. On nights in which RLS was present, 68% of RLS sufferers reported taking > 30 min to fall asleep, and 60% reported waking ≥ 3 times per night. In a recent PSG study of clinically referred patients Hornyak et al7 demonstrated that sleep latency was substantially longer in those with RLS (41.6 min) than in age- and gender-matched controls (25.4 min). Additional evidence of poor sleep in RLS patients included shorter total sleep time, lower sleep efficiency, higher arousal index, more stage shifts, longer REM latency, and abnormalities in the percentage of stages 1, 2, and REM sleep. Health-related quality of life (HR-QOL) is reduced in both physical and mental domains among patients with RLS.3,8,9 In one random-digit dialing study of 158 subjects with at least moderate RLS, HR-QOL was 1.2 standard deviations (SD) below the norm in physical domains and was 0.6 SD below the norm in mental/emotional health domains, even after controlling for age, gender, and disease comorbidity.9 Both were greater than QoL deficits observed in type 2 diabetes.9 In an effort to understand the genesis of RLS morbidity, the same group previously demonstrated that sleep disturbance, rather than the primary symptoms of RLS (urge to move, etc.) mediated the effects of RLS symptoms on the primary outcomes, emotional distress, and daytime alertness.3 Population-based studies may provide estimates of RLS morbidity in samples that include individuals with a wider spectrum of disease than are available in clinically referred samples, however no study to date has examined PSG-derived sleep data in a community-based sample with RLS. Similarly, no study has examined the relationship between RLS severity, as measured by PSG data, and QoL. We report the associations of PSG-derived sleep data in community dwelling individuals in relation to varying frequency and severity of RLS.
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diabetes and sleep disturbances findings from the sleep heart health study
Diabetes Care, 2003Co-Authors: Helaine E Resnick, Susan Redline, Anne B Newman, Barbara V Howard, Eyal Shahar, Adele Kaplan M Gilpin, Robert E Walter, Gordon A Ewy, Naresh M PunjabiAbstract:OBJECTIVE —To test the hypothesis that diabetes is independently associated with sleep-disordered breathing (SDB), and in particular that diabetes is associated with sleep abnormalities of a central, rather than obstructive, nature. RESEARCH DESIGN AND METHODS —Using baseline data from the Sleep Heart Health Study (SHHS), we related diabetes to 1 ) the respiratory disturbance index (RDI; number of apneas plus hypopneas per h of sleep); 2 ) obstructive apnea index (OAI; ≥3 apneas/h of sleep associated with obstruction of the upper airway); 3 ) percent of sleep time 2 saturation; 4 ) central apnea index (CAI; ≥3 apneas [without respiratory effort]/h sleep); 5 ) occurrence of a periodic breathing (Cheyne Stokes) pattern; and 6 ) sleep stages. Initial analyses excluding persons with prevalent cardiovascular disease (CVD) were repeated including these participants. RESULTS —Of the 5,874 participants included in this report, 692 (11.8%) reported diabetes or were taking oral hypoglycemic medications or insulin and 1,002 had prevalent CVD. Among the 4,872 persons without CVD, 470 (9.6%) had diabetes. Diabetic participants had worse CVD risk factor profiles than their nondiabetic counterparts, including higher BMI, waist and neck circumferences, triglycerides, higher prevalence of hypertension, and lower HDL cholesterol ( P 2 saturation, CAI, and periodic breathing ( P P CONCLUSIONS —These data suggest that diabetes is associated with periodic breathing, a respiratory abnormality associated with abnormalities in the central control of ventilation. Some sleep disturbances may result from diabetes through the deleterious effects of diabetes on central control of respiration. The high prevalence of SDB in diabetes, although largely explained by obesity and other confounders, suggests the presence of a potentially treatable risk factor for CVD in the diabetic population.
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the sleep heart health study design rationale and methods
Sleep, 1997Co-Authors: Stuart F Quan, Susan Redline, Barbara V Howard, Conrad Iber, James P Kiley, Javier F Nieto, George T Oconnor, David M Rapoport, John A RobbinsAbstract:The Sleep Heart Health Study (SHHS) is a prospective cohort study designed to investigate obstructive sleep apnea (OSA) and other sleep-disordered breathing (SDB) as risk factors for the development of cardiovascular disease. The study is designed to enroll 6,600 adult participants aged 40 years and older who will undergo a home polysomnogram to assess the presence of OSA and other SDB. Participants in SHHS have been recruited from cohort studies in progress. Therefore, SHHS adds the assessment of OSA to the protocols of these studies and will use already collected data on the principal risk factors for cardiovascular disease as well as follow-up and outcome information pertaining to cardiovascular disease. Parent cohort studies and recruitment targets for these cohorts are the following: Atherosclerosis Risk in Communities Study (1,750 participants), Cardiovascular Health Study (1,350 participants), Framingham Heart Study (1,000 participants), Strong Heart Study (600 participants), New York Hypertension Cohorts (1,000 participants), and Tucson Epidemiologic Study of Airways Obstructive Diseases and the Health and Environment Study (900 participants). As part of the parent study follow-up procedures, participants will be surveyed at periodic intervals for the incidence and recurrence of cardiovascular disease events. The study provides sufficient statistical power for assessing OSA and other SDB as risk factors for major cardiovascular events, including myocardial infarction and stroke.
Daniel J Gottlieb - One of the best experts on this subject based on the ideXlab platform.
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prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure the sleep heart health study
Circulation, 2010Co-Authors: Daniel J Gottlieb, Susan Redline, Anne B Newman, Helaine E Resnick, Stuart F Quan, George T Oconnor, Gayane Yenokyan, Naresh M Punjabi, Elisa K TongAbstract:Background— Clinic-based observational studies in men have reported that obstructive sleep apnea is associated with an increased incidence of coronary heart disease. The objective of this study was to assess the relation of obstructive sleep apnea to incident coronary heart disease and heart failure in a general community sample of adult men and women. Methods and Results— A total of 1927 men and 2495 women ≥40 years of age and free of coronary heart disease and heart failure at the time of baseline polysomnography were followed up for a median of 8.7 years in this prospective longitudinal epidemiological study. After adjustment for multiple risk factors, obstructive sleep apnea was a significant predictor of incident coronary heart disease (myocardial infarction, revascularization procedure, or coronary heart disease death) only in men ≤70 years of age (adjusted hazard ratio 1.10 [95% confidence interval 1.00 to 1.21] per 10-unit increase in apnea-hypopnea index [AHI]) but not in older men or in women of...
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polysomnographic and health related quality of life correlates of restless legs syndrome in the sleep heart health study
Sleep, 2009Co-Authors: John W Winkelman, Susan Redline, Carol M Baldwin, Anne B Newman, Helaine E Resnick, Daniel J GottliebAbstract:IT IS NOT CLEAR WHETHER RESTLESS LEGS SYNDROME (RLS) SHOULD BE CONSIDERED A SLEEP DISORDER. ON THE ONE HAND, RLS IS USUALLY DESCRIBED as a sensorimotor neurological disorder, and in fact there are no sleep related symptoms in the established diagnostic criteria for RLS.1 However, sleep disturbance is the primary clinical morbidity of RLS,2 and it may also mediate other important secondary features of the disorder such as reduced quality of life,3 depressive symptoms,4 and cardiovascular disease (CVD).5 Further, the diagnostic criteria for RLS are based on the International Classification of Sleep Disorders nosology.6 Confusion regarding the role of sleep disturbance in RLS may contribute to the lack of objective data regarding the sleep of such individuals in community settings. Historically, data describing the sleep of patients with RLS comes from either self-report in population-based studies or polysomnographic (PSG) studies of clinically referred patients. In a multinational study which recruited subjects from primary care providers' offices, Hening et al2 found that 88% of the 551 subjects identified as RLS sufferers by screening questionnaire (symptoms ≥ twice per week, which when present were associated with at least moderate distress) reported sleep disturbance attributed to their RLS. On nights in which RLS was present, 68% of RLS sufferers reported taking > 30 min to fall asleep, and 60% reported waking ≥ 3 times per night. In a recent PSG study of clinically referred patients Hornyak et al7 demonstrated that sleep latency was substantially longer in those with RLS (41.6 min) than in age- and gender-matched controls (25.4 min). Additional evidence of poor sleep in RLS patients included shorter total sleep time, lower sleep efficiency, higher arousal index, more stage shifts, longer REM latency, and abnormalities in the percentage of stages 1, 2, and REM sleep. Health-related quality of life (HR-QOL) is reduced in both physical and mental domains among patients with RLS.3,8,9 In one random-digit dialing study of 158 subjects with at least moderate RLS, HR-QOL was 1.2 standard deviations (SD) below the norm in physical domains and was 0.6 SD below the norm in mental/emotional health domains, even after controlling for age, gender, and disease comorbidity.9 Both were greater than QoL deficits observed in type 2 diabetes.9 In an effort to understand the genesis of RLS morbidity, the same group previously demonstrated that sleep disturbance, rather than the primary symptoms of RLS (urge to move, etc.) mediated the effects of RLS symptoms on the primary outcomes, emotional distress, and daytime alertness.3 Population-based studies may provide estimates of RLS morbidity in samples that include individuals with a wider spectrum of disease than are available in clinically referred samples, however no study to date has examined PSG-derived sleep data in a community-based sample with RLS. Similarly, no study has examined the relationship between RLS severity, as measured by PSG data, and QoL. We report the associations of PSG-derived sleep data in community dwelling individuals in relation to varying frequency and severity of RLS.
