Pharmacologic Treatment of Sleep Disorders in Pregnancy

McLafferty, Laura P.; Spada, Meredith; Gopalan, Priya

doi:10.1016/j.jsmc.2018.02.004

Cited by 17 publications

(6 citation statements)

References 81 publications

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“… 98 This report suggested that based on the available literature, perceived risks of narcolepsy medications might be overestimated, 98 however current studies indicate the potential of teratogenicity of certain therapies and treatment of narcolepsy during pregnancy should consider all potential risks and benefits and should include informed collaboration between patient, sleep doctor and obstetrician. 99 , 100 Challenges for women with narcolepsy who choose to go without medication during pregnancy and lactation are likely to include compromised safety to both mother and fetus/infant as well as increased work absences and potential for unemployment for working women due to poor symptom control. 101 Simply anticipating these challenges could make embarking on family life a difficult consideration for young adult women with narcolepsy and may, in part, explain the increased age at first pregnancy for NT1 women and increased likelihood for single-pregnancy discovered in recent retrospective cohort and case–control studies.…”

Section: Challenges and Prospects For Specific Populations With Narcomentioning

confidence: 99%

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

Barker¹,

Flygare²,

Paruthi³

et al. 2020

NSS

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Narcolepsy is a neurological disorder of the sleep-wake cycle characterized by excessive daytime sleepiness (EDS), cataplexy, nighttime sleep disturbances, and REM-sleep-related phenomena (sleep paralysis, hallucinations) that intrude into wakefulness. Dysfunction of the hypocretin/orexin system has been implicated as the underlying cause of narcolepsy with cataplexy. In most people with narcolepsy, symptom onset occurs between the ages of 10 and 35 years, but because the disorder is underrecognized and testing is complex, delays in diagnosis and treatment are common. Narcolepsy is treated with a combination of lifestyle modifications and medications that promote wakefulness and suppress cataplexy. Treatments are often effective in improving daytime functioning for individuals with narcolepsy, but side effects and/or lack of efficacy can result in suboptimal management of symptoms and, in many cases, significant residual impairment. Additionally, the psychosocial ramifications of narcolepsy are often neglected. Recently two new pharmacologic treatment options, solriamfetol and pitolisant, have been approved for adults, and the indication for sodium oxybate in narcolepsy has been expanded to include children. In recent years, there has been an uptick in patient-centered research, and promising new diagnostic and therapeutic options are in development. This paper summarizes current and prospective pharmacological therapies for treating both EDS and cataplexy, discusses concerns specific to children and reproductive-age women with narcolepsy, and reviews the negative impact of health-related stigma and efforts to address narcolepsy stigma.

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Section: Challenges and Prospects For Specific Populations With Narcomentioning

confidence: 99%

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

Barker¹,

Flygare²,

Paruthi³

et al. 2020

NSS

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“…In addition to being affected by the circadian system, pregnancy appears to influence the circadian regulation of behaviors, as pregnant women often report and are treated for sleep disturbances (reviewed in Lee, 1998; Sahota et al, 2003; McLafferty et al, 2018). Indeed, such daily disturbances have been detected in women of all ages, parities, races/ethnicities, and income levels and across all months of pregnancy (Mindell et al, 2015; Reid et al, 2017).…”

mentioning

confidence: 99%

Pregnancy Induces an Earlier Chronotype in Both Mice and Women

et al. 2019

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Daily rhythms generated by endogenous circadian mechanisms and synchronized to the light-dark cycle have been implicated in the timing of birth in a wide variety of species. Although chronodisruption (e.g., shift work or clock gene mutations) is associated with poor reproductive outcomes, little is known about circadian timing during pregnancy. This study tested whether daily rhythms change during full-term pregnancies in mice and women. We compared running wheel activity continuously in both nonpregnant ( n = 14) and pregnant ( n = 13) 12- to 24-week-old C57BL/6NJ mice. We also monitored wrist actigraphy in women ( N = 39) for 2 weeks before conception and then throughout pregnancy and measured daily times of sleep onset. We found that on the third day of pregnancy, mice shift their activity to an earlier time compared with nonpregnant dams. Their time of daily activity onset was maximally advanced by almost 4 h around day 7 of pregnancy and then shifted back to the nonpregnant state approximately 1 week before delivery. Mice also showed reduced levels of locomotor activity during their last week of pregnancy. Similarly, in women, the timing of sleep onset was earlier during the first and second trimesters (gestational weeks 4-13 and 14-27) than before pregnancy and returned to the prepregnant state during the third trimester (weeks 28 until delivery). Women also showed reduced levels of locomotor activity throughout pregnancy. These results indicate that pregnancy induces changes in daily rhythms, altering both time of onset and amount of activity. These changes are conserved between mice and women.

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“…Iron and folate metabolism: during pregnancy, the level of serum iron, ferritin, and folate diminishes, possibly due to their dilutions in a larger blood volume, given the demand by the fetus. Genetics: there is a hypothesis suggesting that pregnancy may cause initiation of symptoms in women who are genetically predisposed to developing RLS [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

“…In order to treat RLS, in mild cases, typically nonpharmacological methods such as stretching the legs before sleep and use of elastic socks when accompanied by varicose veins are suggested [14][15][16][17][18]. If RLS symptoms are mild or trivial, changes in the lifestyle such as regular exercise may be beneficial.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of Restless Legs Syndrome/Willis-ekbom disease (RLS/WED) in the third trimester of pregnancy: a systematic review

et al. 2020

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Background: RLS is known as one of the most common movement disorders during pregnancy, which is most aggravated in the third trimester of pregnancy and can affect up to one-third of pregnant women. This study intends to determine the total prevalence of RLS in the third trimester of pregnancy through a systematic review. Methods: The present study was conducted via meta-analysis method up to 2019. The papers related to the subject of interest were obtained through searching in SID, MagIran, IranDoc, Scopus, Embase, Web of Science (ISI), PubMed, Science Direct, and Google Scholar databases. Heterogeneity of the studies was examined via I 2 index, and the data were analyzed in Comprehensive meta-analysis software. Results: In investigating 10 papers capturing 2431 subjects within the age range of 25-39 years, the total prevalence of RLS in the third trimester of pregnancy based on meta-analysis was obtained as 22.9% (95% CI: 14.7-33.8%). Further, as the sample size increased, the RLS prevalence diminished, while with increase in years, this prevalence increased, where this difference was statistically significant (P < 0.05). Conclusion: Prevalence of RLS in the third trimester of pregnancy is high, healthcare policymakers should organize educational classes to improve the life dimensions among this group of pregnant women.

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Pharmacologic Treatment of Sleep Disorders in Pregnancy

Cited by 17 publications

References 81 publications

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

<p>Living with Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns</p>

Pregnancy Induces an Earlier Chronotype in Both Mice and Women

The prevalence of Restless Legs Syndrome/Willis-ekbom disease (RLS/WED) in the third trimester of pregnancy: a systematic review

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