CPAP a Help for Migraine Sufferers?

Add migraine headaches to the list of ailments helped by CPAP. New research presented at the recent annual meeting of the European Neurological Society (ENS), showed that CPAP treatment can decrease the frequency, intensity, and duration of migraine attacks. Medication use and lost days from work also went down.

In results presented at the 23rd ENS meeting in Barcelona, Hildegard Hidalgo, MD, from the Department of Neurology at Kamillus-Klinik in Asbach, Germany, said that 25% of patients with OSA also have migraines, and that the frequency of OSA in patients with migraine is similar to that in the general population.

According to a conference wrapup in the website Medscape, the researchers screened 314 potential participants with OSA. Inclusion criteria were an apnea-hypopnea index (AHI) greater than 15 or greater than 5 with clinical symptoms (excessive daytime sleepiness, nonrefreshing sleep, sleep fragmentation, nocturia, decreased concentration, memory loss, or morning headaches), and a diagnosis of migraine according to International Classification of Headache Disorders, second edition, criteria.

Additional inclusion criteria were being free of migraine prophylactic medications, oxygen therapy, or other central nervous system medications, and not having any other neurologic or psychiatric disorders. In-hospital video polysomnography was performed.

Compared with baseline, polysomnography showed significant improvements at 1 year in AHI, mean duration of sleep-related breathing disorders, oxygen desaturation index (all P < .001), arousal index (P < .002), slow wave sleep (P = .031), and other measures. CPAP therapy significantly reduced migraine measures and disease burden.

Source: European Neurological Society and Medscape

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Better Brains Through CPAP!

The list of CPAP benefits seems to grow, and the latest research from Europe only adds to the evidence. Specifically, researchers at the University Vita-Salute San Raffaele in Milan, Italy, found that CPAP correlates with improvement in brain white matter deficits seen in patients with OSA.

The findings suggest that the brain damage seen in these patients is reversible. Using fractional anisotropy (FA) and mean diffusivity (MD) on magnetic resonance diffusion tensor imaging, researchers studied 17 men with severe OSA (age 30 to 55 years) with a mean body mass index of 32.24 ± 4.35 kg/m2 before and after CPAP therapy.

“Our study showed significant FA and MD differences in the brain of OSA subjects before treatment,” said Luigi Ferini-Strambi, MD, associate professor in the Sleep Disorders Center at the University Vita-Salute San Raffaele. After 12 months of treatment, increase in FA and MD demonstrating nonpermanent damage in OSA patients and improvement in the tests for short-term memory and executive functions were seen.”

In previous studies, Ferini-Strambi showed that compared with controls, untreated patients with OSA had decreases in gray matter volume in the left posterior parietal cortex, the right superior frontal gyrus, and the left entorhinal cortex. There was significant negative correlation between gray matter volume and cognitive performance.

Researchers also found some small clusters increase in gray matter volume after treatment compared with pretreatment values, but no region showed a significant gray matter volume increase after use of a statistical threshold corrected for multiple comparisons.

Source: European Neurological Society

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Eliminating Insomnia-Like Side Effects of RLS

Occasionally dismissed even by sleep specialists, the problem of restless leg syndrome (RLS) is gaining attention in recent months thanks to a new study from Johns Hopkins University School of Medicine. In the small study headed by Richard P. Allen, PhD, associate professor of neurology at Hopkins, MRI was used to shed light on RLS.

According to a report in Neurology, the MRI found glutamate—a neurotransmitter involved in arousal—in abnormally high levels in people with RLS. The more glutamate the researchers found in the brains of those with RLS, the worse their sleep.

If confirmed, the study’s results may change the way RLS is treated, Allen says, potentially erasing the sleepless nights (insomnia) that are the worst side effect of the condition.

“We may have solved the mystery of why getting rid of patients’ urge to move their legs doesn’t improve their sleep,” says Allen in an ION Publications recap. “We may have been looking at the wrong thing all along, or we may find that both dopamine and glutamate pathways play a role in RLS.”

For the study, Allen and his colleagues examined MRI images and recorded glutamate activity in the thalamus, the part of the brain involved with the regulation of consciousness, sleep and alertness. They looked at images of 28 people with RLS and 20 people without. As more is understood about the neurobiology, findings may not only apply to RLS, Allen says, but also to some forms of insomnia.


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Sleep Mechanism Identified that enables the Brain to Consolidate Emotional Memory

A new study from Sleep researchers at University of California campuses in Riverside and San Diego has identified the sleep mechanism that enables the brain to consolidate emotional memory, and the study results indicate a broader role for sleep in the processing of emotional stimuli with differing effects based on arousal and valence, and raises the possibility that sleep spindles causally facilitate emotional memory consolidation.

The study — “Pharmacologically Increasing Sleep Spindles Enhances Recognition for Negative and High-arousal Memories” is published in the Journal of Cognitive Neuroscience.

Read Abstract Here

In the study the researchers experimentally increase non-REM sleep features, sleep spindle density, and SWS, with pharmacological interventions using Zolpidem (ambien) and sodium oxybate (xyrem) during daytime naps. The researchers also use a full spread of emotional stimuli to test all levels of valence and arousal and found that increasing sleep spindle density increases memory discrimination (da) for highly arousing and negative stimuli without altering measures of bias (ca).

Using two commonly prescribed sleep aids — zolpidem and sodium oxybate (Xyrem) the studys authors Mednick, Kaestner and Wixted were able to tease apart the effects of sleep spindles and rapid eye movement (REM) sleep on the recall of emotional memories. They determined that sleep spindles, not REM, affect emotional memory.

The researchers gave zolpidem, sodium oxybate (Xyrem) and a placebo to 28 men and women between the ages of 18 and 39 who were normal sleepers, allowing several days between doses to allow the pharmaceuticals to leave their bodies. The participants viewed standardized images known to elicit positive and negative responses for one second before and after taking supervised naps. They recalled more images that had negative or highly arousing content after taking zolpidem, a finding that also suggests that the brain may favor consolidation of negative memories.

The study may have even broader implications, the researchers said. Clinical guidelines of the U.S. Department of Veterans Affairs and Department of Defense recommend against the routine use of benzodiazepines to treat PTSD, although their use increased among men and women with PTSD between 2003 and 2010. The effects of benzodiazepines on sleep are similar to those of zolpidem. The U.S. Air Force uses zolpidem as one of the prescribed “no-go pills” to help flight crews calm down after taking stimulants to stay awake during long missions, the researchers noted in the study.

“In light of the present results, it would be worthwhile to investigate whether the administration of benzodiazepine-like drugs may be increasing the retention of highly arousing and negative memories, which would have a countertherapeutic effect,” they wrote. “Further research on the relationship between hypnotics and emotional mood disorders would seem to be in order.”

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Men with RLS have increased Risk of Mortality: New Study

Restless Legs Syndrome, is a neurological disorder characterized by an irresistible urge to move one’s body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso and head. Moving the affected body part modulates the sensations, providing temporary relief.

A study published in Neurology titled “Prospective Study of Restless Legs Syndrome and Mortality Among Men” looked into the possibility of increased mortality risk in men with restless legs syndrome.

Read Abstract Here

“This was a prospective cohort study of 18,425 US men free of diabetes, arthritis, and renal failure in the Health Professionals Follow-up Study (HPFS). In 2002, RLS was assessed using a set of standardized questions. Deaths were identified from state vital statistics records, the National Death Index, family reports, and the postal system.

Seven hundred subjects were diagnosed with RLS. The mortality rate in this segment was 25 percent compared to just 15 percent for those without RLS discovered after a follow-up after eight years.

The proponents led by Dr. Xiang Gao from the Brigham and Women’s Hospital located in Boston found out that men with RLS are 39 percent more likely to die earlier compared to those without RLS. The proponents noted that the statistics was still significant even after adjustments and after taking into consideration other health concerns of the subjects.

The study concluded that the higher mortality linked with RLS is independent of some known risk factors and frequently tied to immunologic disorders, metabolic disease, nutritional problems, respiratory disease, and endocrine disease.


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Beyond Trucking: ATS Addresses Sleepy Driving in the Non Commercial World

The threat of sleepy drivers at the helm of multi-ton commercial trucks is a problem that multiple agencies, private and public, continue to address with vigor. With the release of new clinical practice guidelines, the American Thoracic Society (ATS) is recognizing that non-commercial drivers also pose a significant risk.

The guidelines on sleep apnea, sleepiness, and driving risk for non-professional drivers are an update of a 1994 ATS statement on this topic. The full guidelines appear in the June 1, 2013 American Journal of Respiratory and Critical Care Medicine.

“Up to 20 percent of crashes that occur on monotonous roads can be attributed to sleepiness, and the most common medical cause of excessive daytime sleepiness is obstructive sleep apnea (OSA),” said Kingman P. Strohl, MD, director of the Center for Sleep Disorders Research at Case Western Reserve University and chair of the committee that drafted the guidelines. “With these new guidelines, we aimed to provide healthcare practitioners with a framework for the assessment and management of sleepy driving in the evaluation of OSA.”

Recommendations include:

• All patients undergoing initial evaluation for suspected or confirmed OSA should be asked about daytime sleepiness and recent unintended motor vehicle crashes or near misses attributable to sleepiness, fatigue, or inattention. Patients with these characteristics are considered high-risk drivers, and should be warned about the potential risk of driving until effective therapy is initiated.

• Additional information that should be elicited during initial evaluation for suspected or confirmed OSA includes the clinical severity of the OSA and treatment that the patient has received, including behavioral interventions. Adherence and response to therapy should be assessed at subsequent visits. Drowsy driving risk should be reassessed at subsequent visits if it was initially increased.

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