Figures and tables from this article:
Fig. 1. During NREM sleep, abnormal thalamocortical structures may be unable to generate sufficient slow oscillations to drive the reactivation of hippocampal memory traces. These same structures may also be unable to facilitate normal spindle activity, preventing efficient declarative memory consolidation due to an absence in cortical plastic changes. Decreases in spindle activity lead to failure in inhibiting sensory information from reaching the neocortex. Thus, the individual is awakened and kept awake by sensory information, consequently experiencing disturbed NREM sleep.View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.prs.rt('data_end');Sunday, June 3, 2012
Does abnormal non-rapid eye movement sleep impair declarative memory consolidation? Disturbed thalamic functions in sleep and memory processing
a Yeshiva University: Ferkauf Graduate School of Psychology, Rousso Building, 1165 Morris Park Avenue, Bronx, NY 10461, United Statesb Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, University of Kiel, GermanyReceived 10 July 2010. Revised 30 July 2011. Accepted 1 August 2011. Available online 1 September 2011.View full text Non-rapid eye movement (NREM) sleep has recently garnered support for its role in consolidating hippocampus-based declarative memories in humans. We provide a brief review of the latest research on NREM sleep activity and its association with declarative memory consolidation. Utilizing empirical findings from sleep studies on schizophrenia, Alzheimer’s disease, and fibromyalgia, we argue that a significant reduction of slow-wave sleep and sleep spindle activity contribute to the development of deficits in declarative memory consolidation along with concomitant sleep disturbances commonly experienced in the aforementioned disorders. A tentative model is introduced to describe the mediating role of the thalamocortical network in disruptions of both declarative memory consolidation and NREM sleep. The hope is to stimulate new research in further investigating the intimate link between these two very important functions.prs.rt("abs_end");NREM sleep; Sleep spindles; Slow-wave sleep; Declarative memory consolidation; Hippocampus; Thalamocortical network; Schizophrenia; Alzheimer’s disease; Fibromyalgia syndrome
Sleep in attention-deficit/hyperactivity disorder in children and adults: Past, present, and future
Sun Young Rosalia Yoona, b, 
, 
, , Umesh Jainb, e, , Colin Shapiroa, c, d, f, a Institute of Medical Sciences, University of Toronto, Canadab Child, Youth and Family Service, Centre for Addiction and Mental Health, 352-250 College Street, Toronto, ON, M5T 1R8, Canadac Division of Patient Based Clinical Research, Toronto Western Research Institute, Canadad Youthdale Child and Adolescent Sleep Centre, CanadaReceived 5 April 2011. Revised 1 July 2011. Accepted 5 July 2011. Available online 26 October 2011.View full text The understanding that sleep can give rise to, or exacerbate symptoms of attention-deficit/hyperactivity disorder (ADHD), and that good sleep hygiene improves attention and concentration tasks has sparked interest in the investigation of possible etiological relationships between sleep disorders and ADHD.Studies indicate that 30% of children and 60–80% of adults with ADHD have symptoms of sleep disorders such as daytime sleepiness, insomnia, delayed sleep phase syndrome, fractured sleep, restless legs syndrome, and sleep disordered breathing. The range and diversity of findings by different researchers have posed challenges in establishing whether sleep disturbances are intrinsic to ADHD or whether disturbances occur due to co-morbid sleep disorders. As a result, understanding of the nature of the relationship between sleep disturbances/disorders and ADHD remains unclear.In this review, we present a comprehensive and critical account of the research that has been carried out to investigate the association between sleep and ADHD, as well as discuss mechanisms that have been proposed to account for the elusive relationship between sleep disturbances, sleep disorders, and ADHD.prs.rt("abs_end");Sleep architecture; Sleep disturbances; Sleep disordered breathing; Restless legs; Periodic limb movements; ADHD; Circadian cycle
ADHD = Attention-deficit/hyperactivity disorder, ADHD-C = ADHD of the combined subtype, ADHD-H/I = ADHD of the hyperactive/impulsive subtype, ADHD-I = ADHD of the inattentive subtype, BD = bipolar disorder, CD = conduct disorder, DEP = major depressive episode, C(P/T)RS-R:S = Conner’s (parent/teacher) rating scale-revised: short forms, GAD = generalized anxiety disorder, IQ = intelligence quotient, LD = learning disability, MPH = methylphenidate, OCD = obsessive compulsive disorder, ODD = oppositional defiant disorder, PTSD = post-traumatic stress disorder, SAD = separation anxiety disorder, SD = standard deviation.View Within ArticleTable 2. Studies of sleep disturbances in children with ADHD with objective methods.AHI = Apnea hypopnea index, BD = bipolar disorder, CD = conduct disorder, DEX = dextro-amphetamine, DLMO = dim light melatonin onset, GAD = generalized anxiety disorder, LD = learning disability, MD = major depression, MPH = methylphenidate, MSLT = multiple sleep latency test, ODD = oppositional defiant disorder, PLMI = periodic limb movement index, RDI = respiratory disturbance index, REM = rapid eye movement, S1 = stage 1 sleep, SAD = separation anxiety disorder, SDB = sleep disordered breathing, SE = sleep efficiency, SOL = sleep onset latency, SOT = sleep onset time,TSP = total sleep period.View Within ArticleTable 3. Studies of sleep disturbances in adults with ADHD with subjective methods.ADHD = attention-deficit/hyperactivity disorder, ADHD-C = ADHD of the combined subtype, ADHD-H/I = ADHD of the hyperactive/impulsive subtype, ADHD-I = ADHD of the inattentive subtype, ASRS = adult self report scale, CSM = composite scale of morningness, EDS = excessive daytime sleepiness, ESS - Epworth sleepiness scale, IH = idiopathic hypersomnia, GAD = generalized anxiety disorder, MDD = major depressive disorder, MPH = methylphenidate, OCD = obsessive compulsive disorder, PTSD = post-traumatic stress disorder.View Within ArticleTable 4. Studies of sleep disturbances in adults with ADHD with objective methods.DEX = dextro-amphetamine, BRD = brief recurrent depression, MDD = major depressive disorder, MPH = methylphenidate, PSG = polysomnography, REM = rapid eye movement, SE = sleep efficiency, SOL = sleep onset latency.View Within ArticleCopyright © 2011 Elsevier Ltd. Published by Elsevier Ltd. All rights reserved.prs.rt('data_end');
, , , Umesh Jainb, e, , Colin Shapiroa, c, d, f, a Institute of Medical Sciences, University of Toronto, Canadab Child, Youth and Family Service, Centre for Addiction and Mental Health, 352-250 College Street, Toronto, ON, M5T 1R8, Canadac Division of Patient Based Clinical Research, Toronto Western Research Institute, Canadad Youthdale Child and Adolescent Sleep Centre, CanadaReceived 5 April 2011. Revised 1 July 2011. Accepted 5 July 2011. Available online 26 October 2011.View full text The understanding that sleep can give rise to, or exacerbate symptoms of attention-deficit/hyperactivity disorder (ADHD), and that good sleep hygiene improves attention and concentration tasks has sparked interest in the investigation of possible etiological relationships between sleep disorders and ADHD.Studies indicate that 30% of children and 60–80% of adults with ADHD have symptoms of sleep disorders such as daytime sleepiness, insomnia, delayed sleep phase syndrome, fractured sleep, restless legs syndrome, and sleep disordered breathing. The range and diversity of findings by different researchers have posed challenges in establishing whether sleep disturbances are intrinsic to ADHD or whether disturbances occur due to co-morbid sleep disorders. As a result, understanding of the nature of the relationship between sleep disturbances/disorders and ADHD remains unclear.In this review, we present a comprehensive and critical account of the research that has been carried out to investigate the association between sleep and ADHD, as well as discuss mechanisms that have been proposed to account for the elusive relationship between sleep disturbances, sleep disorders, and ADHD.prs.rt("abs_end");Sleep architecture; Sleep disturbances; Sleep disordered breathing; Restless legs; Periodic limb movements; ADHD; Circadian cycleFigures and tables from this article:
Table 1. Studies of sleep disturbances in children with ADHD with subjective methods.ADHD = Attention-deficit/hyperactivity disorder, ADHD-C = ADHD of the combined subtype, ADHD-H/I = ADHD of the hyperactive/impulsive subtype, ADHD-I = ADHD of the inattentive subtype, BD = bipolar disorder, CD = conduct disorder, DEP = major depressive episode, C(P/T)RS-R:S = Conner’s (parent/teacher) rating scale-revised: short forms, GAD = generalized anxiety disorder, IQ = intelligence quotient, LD = learning disability, MPH = methylphenidate, OCD = obsessive compulsive disorder, ODD = oppositional defiant disorder, PTSD = post-traumatic stress disorder, SAD = separation anxiety disorder, SD = standard deviation.View Within ArticleTable 2. Studies of sleep disturbances in children with ADHD with objective methods.AHI = Apnea hypopnea index, BD = bipolar disorder, CD = conduct disorder, DEX = dextro-amphetamine, DLMO = dim light melatonin onset, GAD = generalized anxiety disorder, LD = learning disability, MD = major depression, MPH = methylphenidate, MSLT = multiple sleep latency test, ODD = oppositional defiant disorder, PLMI = periodic limb movement index, RDI = respiratory disturbance index, REM = rapid eye movement, S1 = stage 1 sleep, SAD = separation anxiety disorder, SDB = sleep disordered breathing, SE = sleep efficiency, SOL = sleep onset latency, SOT = sleep onset time,TSP = total sleep period.View Within ArticleTable 3. Studies of sleep disturbances in adults with ADHD with subjective methods.ADHD = attention-deficit/hyperactivity disorder, ADHD-C = ADHD of the combined subtype, ADHD-H/I = ADHD of the hyperactive/impulsive subtype, ADHD-I = ADHD of the inattentive subtype, ASRS = adult self report scale, CSM = composite scale of morningness, EDS = excessive daytime sleepiness, ESS - Epworth sleepiness scale, IH = idiopathic hypersomnia, GAD = generalized anxiety disorder, MDD = major depressive disorder, MPH = methylphenidate, OCD = obsessive compulsive disorder, PTSD = post-traumatic stress disorder.View Within ArticleTable 4. Studies of sleep disturbances in adults with ADHD with objective methods.DEX = dextro-amphetamine, BRD = brief recurrent depression, MDD = major depressive disorder, MPH = methylphenidate, PSG = polysomnography, REM = rapid eye movement, SE = sleep efficiency, SOL = sleep onset latency.View Within ArticleCopyright © 2011 Elsevier Ltd. Published by Elsevier Ltd. All rights reserved.prs.rt('data_end');
Epidemiology of restless legs syndrome: A synthesis of the literature
a Stanford Sleep Epidemiology Research Center, Stanford University, School of Medicine, 3430 West Bayshore Road, Palo Alto, CA 94303, United Statesb Stanford University, School of Medicine, Stanford, CA 94305, United Statesc Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, United StatesReceived 12 January 2011. Revised 8 May 2011. Accepted 9 May 2011. Available online 26 July 2011.View full text Restless legs syndrome (RLS) has gained considerable attention in the recent years: nearly 50 community-based studies have been published in the last decade around the world. The development of strict diagnostic criteria in 1995 and their revision in 2003 helped to stimulate research interest on this syndrome. In community-based surveys, RLS has been studied as: 1) a symptom only, 2) a set of symptoms meeting minimal diagnostic criteria of the international restless legs syndrome study group (IRLSSG), 3) meeting minimal criteria accompanied with a specific frequency and/or severity, and 4) a differential diagnosis. In the first case, prevalence estimates in the general adult population ranged from 9.4% to 15%. In the second case, prevalence ranged from 3.9% to 14.3%. When frequency/severity is added, prevalence ranged from 2.2% to 7.9% and when differential diagnosis is applied prevalence estimates are between 1.9% and 4.6%. In all instances, RLS prevalence is higher in women than in men. It also increases with age in European and North American countries but not in Asian countries. Symptoms of anxiety and depression have been consistently associated with RLS. Overall, individuals with RLS have a poorer health than non-RLS but evidence for specific disease associations is mixed. Future epidemiological studies should focus on systematically adding frequency and severity in the definition of the syndrome in order to minimize the inclusion of cases mimicking RLS.prs.rt("abs_end");Epidemiology; Restless legs syndrome; Community; Primary Care; Mental disorders; IllnessRLS, Restless legs syndrome; IRLSSG, International Restless Legs Syndrome Study Group; DIS, Difficulty initiating sleep; DMS, Difficulty maintaining sleep; NRS, non-restorative sleep; ESS, Epworth Sleepiness ScaleECA = Epidemiologic Catchment Area; HPFS = Health Professionals Follow-up Study; ICSD = International classification of sleep disorders; IRLSSG = International restless legs syndrome study group; M = Men; NHANES = National Health and Nutrition Examination Survey; NHS II = Nurses' Health Study II; NIH = National Institutes of Health; RLS = Restless legs syndrome; t/mo = times per month; t/wk = times per week; unkn = unknown; W = Women.View Within ArticleTable 2. Prevalence for restless legs syndrome or symptoms in clinical settings.View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.prs.rt('data_end');
Figures and tables from this article:
Fig. 1. Changes in RLS prevalence rates in North America and Europe general population according to used definitions. *Prevalence rates for differential diagnosis came from primary care samples. Prevalence estimates are based on samples including participants from 18 to =65 years.View Within ArticleFig. 2. a. Prevalence of RLS in men – North America and Europe. Included 12 studies that had provided prevalence by age groups for men. These studies are based on minimal IRLSSG criteria. A total of 23,282 men aged =18 are included in the scatter plot. b. Prevalence of RLS in men – Asia. Included 5 studies that had provided prevalence by age groups for men. These studies are based on minimal IRLSSG criteria. A total of 8081 men aged =18 are included in the scatter plot. c. Prevalence of RLS in women – North America and Europe. Included 12 studies that had provided prevalence by age groups for women. These studies are based on minimal IRLSSG criteria. A total of 26,150 women aged =18 are included in the scatter plot. d. Prevalence of RLS in women – Asia. Included 6 studies that had provided prevalence by age groups for women. These studies are based on minimal IRLSSG criteria. A total of 11,253 women aged =18 are included in the scatter plot.View Within ArticleTable 1. Prevalence for restless leg syndrome or symptoms in the general population.ECA = Epidemiologic Catchment Area; HPFS = Health Professionals Follow-up Study; ICSD = International classification of sleep disorders; IRLSSG = International restless legs syndrome study group; M = Men; NHANES = National Health and Nutrition Examination Survey; NHS II = Nurses' Health Study II; NIH = National Institutes of Health; RLS = Restless legs syndrome; t/mo = times per month; t/wk = times per week; unkn = unknown; W = Women.View Within ArticleTable 2. Prevalence for restless legs syndrome or symptoms in clinical settings.View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.prs.rt('data_end');
Saturday, June 2, 2012
Are sleep education programs successful? The case for improved and consistent research efforts
University of South Australia, Centre for Sleep Research, PO Box 2471, Adelaide SA 5000, AustraliaReceived 3 June 2011. Revised 2 August 2011. Accepted 2 August 2011. Available online 20 November 2011.View full text Sleep duration and quality are associated with a range of neuropsychological and psychosocial outcomes in children and adolescents but community awareness of this is low. A small body of literature on sleep education programs in children and adolescents delivered through school-based programs is attempting to address this. A review of the literature found only 8 studies and 4 pilot studies in abstract form. This paper presents these sleep education programs and evaluates their effectiveness. In general, findings suggest that when sleep knowledge was measured it was increased in most programs. However this did not necessarily equate to sleep behaviour change such as increased sleep duration or improved sleep hygiene. Reasons for this are discussed and may include motivation and readiness to change, salience to the individual, delivery, content, time allocation, or methodological underpinnings. This paper attempts to understand this and assess how best to improve future sleep education programs from a theoretical perspective. Specifically, it considers the theory of planned behaviour which may assist in ensuring maximum efficacy for the current and future development of sleep education programs.prs.rt("abs_end");Sleep education; Motivation; Sleep duration; Sleep hygiene; Paediatric sleep; Adolescent sleepAll items scored 0 or 1, except “description of principal confounders”, which scored 0, 1, or 2.View Within ArticleTable 2. General characteristics of school sleep education programs.* ACES = Australian centre for education in sleep, RCT = randomised controlled trial, STEPS = sleep treatment and education program for students.View Within ArticleTable 3. Summary of measures, design and results.ACES = Australian centre for education in sleep, DST = delayed sleep timing, PSQI = Pittsburgh sleep quality index, RCT = randomised controlled trial, STEPS = sleep treatment and education program for students.View Within ArticleTable 4. Quality of studies (not including abstracts).View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.prs.rt('data_end');
Figures and tables from this article:
Fig. 1. Representation of an integrated model of behaviour change (Adapted from Ajzen50).View Within ArticleTable 1. Downs and Black (1998)28 criteria used in the methodological quality evaluation of the reviewed studies.All items scored 0 or 1, except “description of principal confounders”, which scored 0, 1, or 2.View Within ArticleTable 2. General characteristics of school sleep education programs.* ACES = Australian centre for education in sleep, RCT = randomised controlled trial, STEPS = sleep treatment and education program for students.View Within ArticleTable 3. Summary of measures, design and results.ACES = Australian centre for education in sleep, DST = delayed sleep timing, PSQI = Pittsburgh sleep quality index, RCT = randomised controlled trial, STEPS = sleep treatment and education program for students.View Within ArticleTable 4. Quality of studies (not including abstracts).View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.prs.rt('data_end');
Restless legs syndrome – Theoretical roles of inflammatory and immune mechanisms
Theories for restless legs syndrome (RLS) pathogenesis include iron deficiency, dopamine dysregulation and peripheral neuropathy. Increased prevalence of small intestinal bacterial overgrowth (SIBO) in controlled studies in RLS and case reports of post-infectious RLS suggest potential roles for inflammation and immunological alterations.A literature search for all conditions associated with RLS was performed. These included secondary RLS disorders and factors that may exacerbate RLS. All of these conditions were reviewed with respect to potential pathogenesis including reports of iron deficiency, neuropathy, SIBO, inflammation and immune changes. A condition was defined as highly-associated if there was a prevalence study that utilized an appropriate control group. Small case reports were recorded but not included as definite RLS-associated conditions.Fifty four diseases, syndromes and conditions have been reported to cause and/or exacerbate RLS. Of these, 38 have been reported to have a higher prevalence than age-matched controls, 9 have adequate sized reports and have general acceptance as RLS-associated conditions and 7 have been reported in case report form. Overall, 42 of the 47 RLS-associated conditions (89%) have also been associated with inflammatory and/or immune changes. In addition, 43% have been associated with peripheral iron deficiency, 40% with peripheral neuropathy and 32% with SIBO. Most of the remaining conditions have yet to be studied for these factors.The fact that 95% of the 38 highly-associated RLS conditions are also associated with inflammatory/immune changes suggests the possibility that RLS may be mediated or affected through these mechanisms. Inflammation can be responsible for iron deficiency and hypothetically could cause central nervous system iron deficiency-induced RLS. Alternatively, an immune reaction to gastrointestinal bacteria or other antigens may hypothetically cause RLS by a direct immunological attack on the central or peripheral nervous system.Additional abbreviations: ADHD: attention-deficit/hyperactivity disorder; COPD: chronic obstructive pulmonary disease; NS: not studied.View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.
Fig. 1. Potential interplay of pathologic factors in secondary RLS. Abbreviations: RLS: restless legs syndrome; Inflam & Immune: inflammation and/or altered immunity; SIBO: small intestinal bacterial overgrowth; Neuropathy: peripheral neuropathy.
View Within ArticleFig. 2. [26], [55], [56] and [125] of hepcidin synthesis in the setting of inflammation and theoretical consequences for developing CNS iron deficiency and subsequent RLS. Hepcidin is the main hormone involved in regulation of iron levels and has been shown to be produced by the liver in humans and in the brain in animal models. Increased hepcidin levels lead to iron deficiency. Interleukin-6 is the main cytokine that can increase hepcidin levels. Lipopolysaccharides which are breakdown products of gram negative bacteria stimulate hepcidin synthesis. Hypoxia also stimulates hepcidin synthesis. Hepcidin binds to ferroportin on human choroid plexus cells and decrease availability of iron for the CNS. Not shown – Bacteria may also utilize iron and cause iron deficiency.57 Abbreviations: LPS: lipopolysaccharides.
View Within ArticleTable 1. Iron deficiency, small intestinal bacterial overgrowth (SIBO), inflammation and/or immunological alterations and peripheral neuropathy in conditions associated with restless legs syndrome (RLS). References are categorized as either: a controlled study (CS); an observational case series (OS); a laboratory study (LS) which uses defined assays but does not have a control group; or a review article (RA). Highly-associated conditions are defined as RLS conditions shown to have a statistically higher prevalence than controls. This table does not include seven single case reports associated with RLS (see result section).
Additional abbreviations: ADHD: attention-deficit/hyperactivity disorder; COPD: chronic obstructive pulmonary disease; NS: not studied.View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.
When gender matters: Restless legs syndrome. Report of the “RLS and woman” workshop endorsed by the European RLS Study Group
Mauro Manconia, , , Jan Ulfbergb, Klaus Bergerc, Imad Ghorayebd, Jan Wesströme, Stephany Fuldaf, Richard P. Alleng, Thomas Pollmächerf, ha Sleep and Epilepsy Center, Neurocenter (EOC) of Southern Switzerland, Civic Hospital, Lugano, Via Tesserete 46, 6900 Lugano, Switzerlandb Department of Medicine, Uppsala University, Uppsala, Swedenc Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germanyd Clinical Neurophysiology Department, Centre Hospitalier et Universitaire de Bordeaux, Bordeaux cedex, Francee Center for Clinical Research Dalarna, Department of Women's and Children's Health, Uppsala University, Swedenf Max Planck Institute of Psychiatry, Munich, Germanyg Center of Mental Health, Klinikum Ingolstadt, Ingolstadt, Germanyh Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USAReceived 13 May 2011. Revised 30 August 2011. Accepted 30 August 2011. Available online 9 November 2011.View full text Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom's 1945 seminal series of clinical cases with the disease. He, however, reported this gender difference mainly for those with more severe symptoms. Since then numerous studies have reported that women are affected by RLS about twice as often as males for mild as well as moderate to severe RLS. The present review focuses on RLS in females from the perspectives of both epidemiology and pathophysiology. RLS will generally become worse or might appear for the first time during pregnancy. Parity increases the risk of RLS later in life suggesting that pregnancy is a specific behavioral risk factor for developing RLS. Some evidence suggests that dysfunction in iron metabolism and high estrogen levels might contribute to RLS during pregnancy. But, menopause does not lower the incidence of RLS nor does hormone replacement therapy lead to an increase, suggesting a quite complex uncertain role of hormones in the pathophysiology of RLS. Therefore, further, preferably longitudinal studies are needed to unravel the factors causing RLS in women. These studies should include genetic, clinical and polysomnographic variables, as well as hormonal measures and variables assessing iron metabolism.prs.rt("abs_end");Restless legs syndrome; Gender; Female; Sleep; Insomnia; Pregnancy; Estrogens; Menopause; Quality of lifeView Within ArticleTable 2. Epidemiological studies published in literature on RLS prevalence that included an assessment on the quality of life.Abbreviations: EQ-5D VAS, visual analogue scale score for the EQ-5D, a quality of life questionnaire developed by the EuroQoL Group; HRQoL, health related quality of life; MCS, mental component score of the SF-36; RLS, restless legs syndrome; PCS, physical component score of the SF-36; SF-36, SF-12, short form health survey.View Within ArticleTable 3. Studies exploring the role of estrogens in RLS.Abbreviations: AC, active controlled; CO, crossover; DB, double blind; HRT, hormone replacement therapy; IQR, interquartile range; PC, placebo controlled; PG, parallel group; PLM, periodic leg movements; R, randomized; SD, standard deviation.View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.prs.rt('data_end');
, , Jan Ulfbergb, Klaus Bergerc, Imad Ghorayebd, Jan Wesströme, Stephany Fuldaf, Richard P. Alleng, Thomas Pollmächerf, ha Sleep and Epilepsy Center, Neurocenter (EOC) of Southern Switzerland, Civic Hospital, Lugano, Via Tesserete 46, 6900 Lugano, Switzerlandb Department of Medicine, Uppsala University, Uppsala, Swedenc Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germanyd Clinical Neurophysiology Department, Centre Hospitalier et Universitaire de Bordeaux, Bordeaux cedex, Francee Center for Clinical Research Dalarna, Department of Women's and Children's Health, Uppsala University, Swedenf Max Planck Institute of Psychiatry, Munich, Germanyg Center of Mental Health, Klinikum Ingolstadt, Ingolstadt, Germanyh Department of Neurology, Johns Hopkins University, Bayview Medical Center, Baltimore, MD, USAReceived 13 May 2011. Revised 30 August 2011. Accepted 30 August 2011. Available online 9 November 2011.View full text Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom's 1945 seminal series of clinical cases with the disease. He, however, reported this gender difference mainly for those with more severe symptoms. Since then numerous studies have reported that women are affected by RLS about twice as often as males for mild as well as moderate to severe RLS. The present review focuses on RLS in females from the perspectives of both epidemiology and pathophysiology. RLS will generally become worse or might appear for the first time during pregnancy. Parity increases the risk of RLS later in life suggesting that pregnancy is a specific behavioral risk factor for developing RLS. Some evidence suggests that dysfunction in iron metabolism and high estrogen levels might contribute to RLS during pregnancy. But, menopause does not lower the incidence of RLS nor does hormone replacement therapy lead to an increase, suggesting a quite complex uncertain role of hormones in the pathophysiology of RLS. Therefore, further, preferably longitudinal studies are needed to unravel the factors causing RLS in women. These studies should include genetic, clinical and polysomnographic variables, as well as hormonal measures and variables assessing iron metabolism.prs.rt("abs_end");Restless legs syndrome; Gender; Female; Sleep; Insomnia; Pregnancy; Estrogens; Menopause; Quality of lifeFigures and tables from this article:
Fig. 1. Epidemiological results on RLS and pregnancy. Histograms show the prevalence trend of RLS in a group of 606 women surveyed at the end of pregnancy. In the period before pregnancy, 60 women already experienced RLS symptoms in their life (in a non pregnancy period) and were classified as “pre-existing RLS”. The remaining 546 women had never experienced RLS symptoms before and were classified as “healthy”. During the first assessed pregnancy (2nd histogram) 101 women, out of the 546 “healthy” ones, developed a transient RLS form strictly related to the pregnancy and were classified as “pregnancy-related RLS”. All these 101 women with a new form of pregnancy-related RLS form, except 6 women, recovered after delivery (3rd histogram). Fifty nine of the same pregnancy-related RLS group suffered again RLS symptoms during a further following pregnancy. After a mean follow up of 7 years, 25 out of the 101 women who experienced the symptoms during the first pregnancy (pregnancy-related RLS group) developed a chronic apparently idiopathic RLS form even out of pregnancy. Elaborated data from the study of Cesnik et al.37View Within ArticleFig. 2. Prevalence of RLS among women in two age groups and according to number of children born in the German general practioner study.43View Within ArticleFig. 3. Median serum ferritin by age for major USA gender and population groups.View Within ArticleFig. 4. Prevalence of clinically significant RLS by gender and age from large European and United States population-based samples. (Slightly modified from Allen et al).21View Within ArticleTable 1. Studies on the prevalence of RLS performed in random samples of the general population of different countries, using the IRLSSG criteria to assess the diagnosis.View Within ArticleTable 2. Epidemiological studies published in literature on RLS prevalence that included an assessment on the quality of life.Abbreviations: EQ-5D VAS, visual analogue scale score for the EQ-5D, a quality of life questionnaire developed by the EuroQoL Group; HRQoL, health related quality of life; MCS, mental component score of the SF-36; RLS, restless legs syndrome; PCS, physical component score of the SF-36; SF-36, SF-12, short form health survey.View Within ArticleTable 3. Studies exploring the role of estrogens in RLS.Abbreviations: AC, active controlled; CO, crossover; DB, double blind; HRT, hormone replacement therapy; IQR, interquartile range; PC, placebo controlled; PG, parallel group; PLM, periodic leg movements; R, randomized; SD, standard deviation.View Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.prs.rt('data_end');
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