No abstract
The aim of the study was to assess sleep-wake habits and disorders and excessive daytime sleepiness (EDS) in an unselected outpatient epilepsy population. Sleep-wake habits and presence of sleep disorders were assessed by means of a clinical interview and a standard questionnaire in 100 consecutive patients with epilepsy and 90 controls. The questionnaire includes three validated instruments: the Epworth Sleepiness Scale (ESS) for EDS, SA-SDQ for sleep apnea (SA), and the Ullanlinna Narcolepsy Scale (UNS) for narcolepsy. Sleep complaints were reported by 30% of epilepsy patients compared to 10% of controls (p=0.001). The average total sleep time was similar in both groups. Insufficient sleep times were suspected in 24% of patients and 33% of controls. Sleep maintenance insomnia was more frequent in epilepsy patients (52% vs. 38%, p=0.06), whereas nightmares (6% vs. 16%, p=0.04) and bruxism (10% vs. 19%, p=0.07) were more frequent in controls. Sleep onset insomnia (34% vs. 28%), EDS (ESS >or=10, 19% vs. 14%), SA (9% vs. 3%), restless legs symptoms (RL-symptoms, 18% vs. 12%) and most parasomnias were similarly frequent in both groups. In a stepwise logistic regression model loud snoring and RL-symptoms were found to be the only independent predictors of EDS in epilepsy patients. In conclusion, sleep-wake habits and the frequency of most sleep disorders are similar in non-selected epilepsy patients as compared to controls. In epilepsy patients, EDS was predicted by a history of loud snoring and RL-symptoms but not by SA or epilepsy-related variables (including type of epilepsy, frequency of seizures, and number of antiepileptic drugs).
Objective: Because of known significant seasonal fluctuations of iodine concentration in cow's milk (ICM) in Switzerland (winter=summer (w=s) ICM ratio averages 5.6), we looked for seasonal variations and familial aspects in urinary iodine and sodium concentrations (UIC, UNaC). Design: Prospective sequential cohort investigation. Setting: University hospital. Subjects: Thirteen children (six girls, seven boys) aged 3 -10 y and their parents (n ¼ 9) aged 30 -47 y. Interventions: The volunteers collected 1729 spot urine samples (5.1996 -5.1998). UIC data from winter (UIC w : DecemberFebruary) and summer seasons (UIC s : July -September) were compared with UNaC and average milk consumption. Iodine intakes from milk and salt were modelized. Results: Highest seasonal fluctuations of UIC were found in six pre-school children (w=s UIC group average ¼ 1.56, significant), followed by seven school children (w=s UIC group average ¼ 1.24, N.S.); none existed in adults. UIC=UNaC showed corresponding seasonal fluctuations in children, but not in adults. Winter milk was an important iodine source for children, as proven indirectly by similar seasonal fluctuations of ICM, UIC, UIC=UNaC and an important part within UIC due to milk. Conclusions: Contribution to UIC from milk intake during winter was high in children (40 -50%) and lower in adults (about 20%). Compared with children, dietary habits of adults are more complex and their iodine supply depends mainly on iodized salt and not on milk, so the effect of seasonal ICM variations on UIC is less marked. Because of significant seasonal UIC fluctuations in consumers of fresh milk products in Switzerland, results of future UIC studies conducted during summer and winter seasons should be compared cautiously, especially in young children. Furthermore, consumption of milk is to be promoted, since, besides calcium and vitamins, it is an essential source of iodine. UNaC determination should be included in epidemiologic studies if the dietary source of iodine is questioned. Sponsorship: This work was supported by grants from the University Hospital in Bern, the Swiss Federal Office of Public Health, the 'Swiss National Foundation for Scientific Research' (32-49424.96), the 'Fondation Genevoise de Bienfaisance V Rossi di Montelera', the 'Schweizerische Lebensversicherungs-und Rentenanstalt' and the 'Schüpbach Foundation of the University of Bern'. European Journal of Clinical Nutrition (2003) 57, 636 -646. doi:10.1038=sj.ejcn.1601590 Keywords: iodine; season; milk; child; diet; salt *Correspondence: C Als, Division of Clinical Chemistry, Inselspital, University of Bern, CH-3010 Bern, Switzerland. E-mail: claudine.als@insel.ch Guarantors: C Als, B Zimmerli and M Haldimann. Contributors: CA had the initial idea, wrote and coordinated the project over several years. CA and BZ wrote the manuscript. MH and BZ did the calculations and the statistical evaluations. MH did the analyses of urinary iodine in his laboratory. All contributors helped in planning the study, evaluating the results a...
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