DM1 entails frequent EDS but with different phenotypes and distinct mechanisms involved. The high prevalence of daytime sleepiness and severe sleep apnoeas found in this study supports the routine use of clinical sleep interviews, PSG and MSLT in DM1, and emphasises the need for more randomised trials of psychostimulants.

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BackgroundObstructive sleep apnea (OSA) is becoming increasingly prevalent in North America and has been described in association with specific chronic diseases, particularly cardiovascular diseases. In primary care, where the prevalence of co-occurring chronic conditions is very high, the potential association with OSA is unknown. The purpose of this study was to explore the association between OSA and 1) the presence and severity of multimorbidity (multiple co-occurring chronic conditions), and 2) subcategories of multimorbidity.MethodsA cluster sampling technique was used to recruit 120 patients presenting with OSA of various severities from the records of a sleep laboratory in 2008. Severity of OSA was based on the results of the polysomnography. Patients invited to participate received a mail questionnaire including questions on sociodemographic characteristics and the Disease Burden Morbidity Assessment (DBMA). They also consented to give access to their medical records. The DBMA was used to provide an overall multimorbidity score and sub-score of diseases affecting various systems.ResultsBivariate analysis did not demonstrate an association between OSA and multimorbidity (r = 0.117; p = 0.205). However, severe OSA was associated with multimorbidity (adjusted odds ratio = 7.33 [1.67-32.23], p = 0.05). OSA was moderately correlated with vascular (r = 0.26, p = 0.01) and metabolic syndrome (r = 0.26, p = 0.01) multimorbidity sub-scores.ConclusionsThis study showed that severe OSA is associated with severe multimorbidity and sub-scores of multimorbidity. These results do not allow any causal inference. More research is required to confirm these associations. However, primary care providers should be aware of these potential associations and investigate OSA when deemed appropriate.

Temporal interictal rhythmic delta activity or TIRDA was found in 45 of the 127 recordings of patients with complex partial epilepsy (CPE) referred for both awake and sleep E E C TIRDA was more abundant during drowsiness and light sleep; it occurred more characteristically as trains of 50-100 ^.v sinusoidal or saw-toothed l-4Hz activity, recorded predominantly from anterior temporal regions. When occurring bilaterally and independently, TIRDA varied from side to side. TIRDA is often found in association with anterior temporal spikes or sharp waves (TS) particularly during sleep, as observed in 43 out of 45 EEGs. TIRDA can nevertheless occur as an isolated abnormality, as noted in two sleep and 12 awake study recordings. Because of its high specificity and positive predictive value over a large range of prevalence, TIRDA should be singled out as an accurate interictal indicator of CPE. In patients with isolated TIRDA, the cost of prolonged EEG recording during sleep for the purpose of activating TS has to be weighed against the yield of eventually confirming the obvious. RESUME: TIRDA ou activite rythmique temporale inter-critique dans le diagnostic de I'epilepsie partielle complexe: sensibilite, specificite et valeur predictive Chez 35 % des malades adresses pour investigation d'une epilepsie partielle complexe, l'electroencephalogramme a revele en temporal une activite delta rythmique inter-critique (TIRDA). Plus abondant durant somnolence et sommeil leger, le TIRDA se presente plus classiquement sous forme de train d'ondes de 1 a 4Hz, d'une amplitude allant de 50 a 100 |J.v. Lorsque bilateral, le TIRDA survient de facon asynchrone et avec une morphologie distincte de chaque cote. Souvent associe a des pointes temporales anterieures (TS), le TIRDA peut se retrouver n6anmoins de facon isolee. A cause de sa tres grande specificite et de sa valeur predictive elevee pour un large spectre de prevalence, le TIRDA merite d'etre retenu comme un indicateur intercritique pathognomonique de I'epilepsie partielle complexe. Les inconvenients d'un enregistrement prolonge pendant le sommeil, a la recherche de la pointe temporale classique, meritent d'etre souspeses lorsque le TIRDA represente la seule anomalie recueillie lors d'un electroencephalogramme initial.

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