BRIEF SUMMARYCurrent Knowledge/Study Rationale: Sleep disordered breathing (SDB) is known to be common in patients with underlying cardiovascular disease. We hypothesized that diagnosing and initiating treatment for SDB in hospitalized cardiac patients would improve the overall management of their underlying cardiac condition. Study Impact: Our study identifi es a model of care that can increase the diagnosis and treatment of SDB in hospitalized cardiac patients. Finding a reduced 30-day cardiac readmission rate in CPAP adherent patients is important for both improving patient care and hospital fi nances.

Objectives Over 40% of individuals with Parkinson’s disease (PD) have rapid eye movement sleep behavior disorder (RBD). This is associated with excessive sustained (tonic) or intermittent (phasic) muscle activity instead of the muscle atonia normally seen during REM sleep. We examined characteristics of manually-quantitated surface EMG activity in PD to ascertain whether the extent of muscle activity during REM sleep is associated with specific clinical features and measures of disease severity. Methods In a convenience sample of outpatients with idiopathic PD, REM sleep behavior disorder was diagnosed based on clinical history and polysomnogram, and severity was measured using the RBD sleep questionnaire. Surface EMG activity in the mentalis, extensor muscle group of the forearms, and anterior tibialis was manually quantitated. Percentage of REM time with excessive tonic or phasic muscle activity was calculated and compared across PD and RBD characteristics. Results Among 65 patients, 31 had confirmed RBD. In univariate analyses, higher amounts of surface EMG activity were associated with longer PD disease duration (srho = 0.34; p = 0.006) and greater disease severity (p < 0.001). In a multivariate regression model, surface EMG activity was significantly associated with RBD severity (p < 0.001) after adjustment for age, PD disease duration, PD severity and co-morbid sleep abnormalities. Conclusion Surface EMG activity during REM sleep was associated with severity of both PD and RBD. This measure may be useful as a PD biomarker and, if confirmed, may aid in determining which PD patients warrant treatment for their dream enactment to reduce risk of injury.

No abstract

Restless legs syndrome (RLS) is a disorder characterized by an urge to move the lower limbs primarily at night. The urge is present at rest and is relieved by movement. However, in some cases the presentation is not straight forward and the diagnosis relies on a variety of supportive data rather than the formal diagnostic criteria alone. The present case is a representative example of this with atypical symptoms involving the urge to only move the toes rather than the legs. It highlights further unique features of RLS in that the patient's symptoms were exacerbated by lithium and associated with nocturnal eating syndrome.