Parkinsonova nemoc (PN) je velmi častým progresivním onemocněním a řízení motorového vozidla je náročná a komplexní činnost, která vyžaduje souhru kognitivních a psychomotorických funkcí, správné plánování, dobrou paměť, pozornost a koordinaci oko‐ruka‐noha. Rozhodnutí o nezpůsobilosti řídit motorové vozidlo má pro pacienta zásadní význam, mějme ale na paměti i bezpečnost silničního provozu. Pacienti s PN mají vyšší výskyt kognitivních poruch a na řízení se rovněž podílí postižení hybnosti. Dalším problémem je výskyt nadměrné denní spavosti, která může být potencována medikací. Měli bychom se cíleně na denní spavost ptát. V současnosti neexistují jednotná právní kritéria, kterými bychom se mohli řídit.
Parkinson's disease (PD) is a very common progressive disease and driving is a demanding and complex activity that requires the interplay of cognitive and psychomotor functions, good planning, memory, attention and eye-hand-foot coordination. The decision to be unable to drive is of paramount importance to the patient, but we must also keep road safety in mind. Patients with PD have a higher incidence of cognitive impairment and impaired mobility is also involved in driving problems. In addition, the incidence of excessive daytime sleepiness, which can be potentiated by medication, is a problem. Daytime sleepiness should be specifically asked about. At present, there are no uniform legal criteria to follow.
- MeSH
- hluboká mozková stimulace metody MeSH
- lidé MeSH
- nežádoucí účinky léčiv MeSH
- Parkinsonova nemoc * farmakoterapie komplikace MeSH
- poruchy nadměrné spavosti diagnóza etiologie terapie MeSH
- posuzování zdravotní způsobilosti MeSH
- řízení motorových vozidel psychologie zákonodárství a právo MeSH
- Check Tag
- lidé MeSH
- MeSH
- dítě MeSH
- dospělí MeSH
- idiopatická hypersomnie diagnóza farmakoterapie MeSH
- kataplexie diagnóza farmakoterapie MeSH
- lidé MeSH
- narkolepsie diagnóza farmakoterapie MeSH
- polysomnografie metody MeSH
- poruchy nadměrné spavosti * diagnóza etiologie klasifikace MeSH
- spánková latence fyziologie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Excessive daytime sleepiness (EDS) is a frequent and disabling symptom of Parkinson's disease (PD) without approved treatment. THN102 is a novel combination drug of modafinil and low-dose flecainide. OBJECTIVE: The aim of this study is to evaluate the safety and efficacy of THN102 in PD patients with EDS. METHODS: The method involved a randomized, double-blind, placebo-controlled, crossover trial testing two doses of THN102 (200 mg/d modafinil with 2 mg/d [200/2] or 18 mg/d flecainide [200/18]) versus placebo; 75 patients were exposed to treatment. The primary endpoint was safety. The primary efficacy outcome was the change in Epworth Sleepiness Scale (ESS) score. RESULTS: Both doses of THN102 were well tolerated. ESS significantly improved with THN102 200/2 (least square means vs. placebo [95% confidence interval, CI]: -1.4 [-2.49; -0.31], P = 0.012) but did not change significantly with the 200/18 dosage. CONCLUSIONS: THN102 was well tolerated and showed a signal of efficacy at the 200/2 dose, supporting further development for the treatment of EDS in PD. © 2021 International Parkinson and Movement Disorder Society.
- MeSH
- dvojitá slepá metoda MeSH
- fixní kombinace léků MeSH
- flekainid * škodlivé účinky MeSH
- lidé MeSH
- modafinil * škodlivé účinky MeSH
- Parkinsonova nemoc * farmakoterapie MeSH
- poruchy nadměrné spavosti * etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
OBJECTIVE: The aim of the study was to discover the interrelation between the severity of gastroesophageal reflux disease (GERD) symptoms, acid exposure time (AET), excessive daytime sleepiness (EDS) and the level of active blood plasma ghrelin in the patients with undifferentiated connective tissue disease (UCTD). PATIENTS AND METHODS: Materials and methods: The study included 120 patients with GERD. All the patients were divided in two groups: Group I - GERD was not accompanied by the signs of connective tissue disease (n=45) and Group II - GERD developed on the background of UCTD syndrome (n=75). Daily transnasal pH monitoring was performed to determine the nature of pathological refluxes. EDS was detected by The Epworth Sleepiness Scale. Active ghrelin in blood plasma samples was determined by ELISA. RESULTS: Results: 80% of the patients of Group II and 35.48% of Group I suffered from EDS (p<0.05). The mean daily AET index was 5.48±0.4% in Group II and 6±0.2% in Group I, in the night hours mostly when patients were in the upright position. This phenomenon contributed to a deterioration of sleep quality and the appearance of EDS and was supported by a connection between AET and EDS (r=+0.827 for Group I and r=+0.768 for Group II). The mean De Meester index was higher in the patients of Group II (23.01±2.24 in Group I vs 31.08±2.4 in Group II; p<0.05). CONCLUSION: Conclusions: GERD manifestations are strongly related to the level to AET and intensity of EDS. The EDS symptoms depend on circulating ghrelin level.
- MeSH
- gastroezofageální reflux * komplikace MeSH
- ghrelin MeSH
- lidé MeSH
- nediferencované onemocnění pojivové tkáně * MeSH
- poruchy nadměrné spavosti * etiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Obstrukční spánková apnoe je nejběžnější poruchou dýchání ve spánku s vysokou prevalencí, která je spojena s nárůstem obezity. Primární terapií u většiny pacientů, zejména pak u pacientů se středně těžkou až těžkou obstrukční spánkovou apnoí, je přetlak v dýchacích cestách (positive airway pressure, PAP). Compliance k PAP však není ani zdaleka ideální a pro optimalizaci péče je nezbytný individualizovaný léčebný přístup.
Obstructive sleep apnea is the most common respiratory sleep disorder, with a high prevalence that is linked to the increase in obesity. The primary therapy for most patients, especially those with moderate to severe obstructive sleep apnea, is positive airway pressure (PAP). However, compliance with PAP is far from perfect. An individualized treatment approach that emphasizes chronic disease management that improves sleep-related health outcomes is necessary to optimize care.
- MeSH
- hypertenze etiologie MeSH
- lidé MeSH
- mandibulotomie MeSH
- obstrukční spánková apnoe * chirurgie diagnóza terapie MeSH
- osteotomie horní čelisti MeSH
- polysomnografie MeSH
- poruchy nadměrné spavosti etiologie terapie MeSH
- transkutánní elektrická neurostimulace MeSH
- trvalý přetlak v dýchacích cestách MeSH
- žaludeční bypass MeSH
- Check Tag
- lidé MeSH
The review deals with idiopathic hypersomnia, focusing mostly on the research findings about the presence, onset and severity of excessive daytime sleepiness and depressive symptoms in patients with idiopathic hypersomnia.
- MeSH
- chronoterapie metody MeSH
- hypnotika a sedativa aplikace a dávkování terapeutické užití MeSH
- lidé MeSH
- noční děsy diagnóza etiologie terapie MeSH
- polysomnografie metody MeSH
- poruchy iniciace a udržování spánku diagnóza etiologie terapie MeSH
- poruchy nadměrné spavosti diagnóza etiologie terapie MeSH
- poruchy spánku a bdění * diagnóza etiologie terapie MeSH
- psychoterapie metody MeSH
- somnambulismus diagnóza etiologie terapie MeSH
- spánková hygiena MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Kleine-Levin syndrome (KLS) is a rare disorder characterized by severe episodic hypersomnia, with cognitive impairment accompanied by apathy or disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas during episodes. Familial occurrence is increased, and risk is associated with reports of a difficult birth. We conducted a worldwide case-control genome-wide association study in 673 KLS cases collected over 14 y, and ethnically matched 15,341 control individuals. We found a strong genome-wide significant association (rs71947865, Odds Ratio [OR] = 1.48, P = 8.6 × 10-9) within the 3'region of TRANK1 gene locus, previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with rs71947865 variant had significantly increased reports of a difficult birth. As perinatal outcomes have dramatically improved over the last 40 y, we further stratified our sample by birth years and found that recent cases had a significantly reduced rs71947865 association. While the rs71947865 association did not replicate in the entire follow-up sample of 171 KLS cases, rs71947865 was significantly associated with KLS in the subset follow-up sample of 59 KLS cases who reported birth difficulties (OR = 1.54, P = 0.01). Genetic liability of KLS as explained by polygenic risk scores was increased (pseudo R2 = 0.15; P < 2.0 × 10-22 at P = 0.5 threshold) in the follow-up sample. Pathway analysis of genetic associations identified enrichment of circadian regulation pathway genes in KLS cases. Our results suggest links between KLS, circadian regulation, and bipolar disorder, and indicate that the TRANK1 polymorphisms in conjunction with reported birth difficulties may predispose to KLS.
- MeSH
- bipolární porucha etiologie MeSH
- cytokiny genetika MeSH
- genetická predispozice k nemoci MeSH
- genetická variace * MeSH
- genetické asociační studie MeSH
- hodnocení rizik MeSH
- Kleineho-Levinův syndrom komplikace epidemiologie genetika MeSH
- komplikace porodu epidemiologie etiologie MeSH
- lidé MeSH
- náchylnost k nemoci * MeSH
- odds ratio MeSH
- polymorfismus genetický MeSH
- poruchy nadměrné spavosti etiologie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
INTRODUCTION: Idiopathic hypersomnia (IH) is a rare orphan disease characterized by excessive daytime sleepiness, frequently accompanied by prolonged nocturnal sleep and difficulties awakening, termed sleep inertia or sleep drunkenness. Severe sleepiness usually causes a greater handicap than manifestations of narcolepsy. METHODS: Forty-three IH patients (17 male, mean age 42.8 ± SD 12.2 years, range 20-67), diagnosed in the past 20 years according to ICSD-2 or ICSD-3 criteria were invited for clinical examination to evaluate the course, manifestations and severity of the disease, as well as clinical comorbidities. The patients completed a set of questionnaires scoring sleepiness, sleep inertia, fatigue, depression, anxiety, circadian preference, and quality of life. RESULTS: IH patients were divided according to the duration of nocturnal sleep at the time of their diagnosis into two cohorts: (1) with normal sleep duration (n = 25, 58.1%) and (2) with long sleep duration (n = 18, 41.9%). The mean duration of ad libitum sleep per 22 h in the second cohort was 732.0 ± 115.4 min (range 603-1100), and women markedly prevailed (n = 14, 77.8%). Age at disease onset was younger in the group with long sleep duration (21.2 ± 11.4 years versus 28.1 ± 13.6 years, p = 0.028), their MSLT latency was longer (7.2 ± 3.7 min versus 5.1 ± 1.7 min, p = 0.005), a history of sleep inertia prevailed (p = 0.005), and daily naps were mostly non-refreshing (p = 0.014). Additionally, questionnaires in the group with long sleep duration showed more severe sleep inertia (p = 0.007), fatigue (p = 0.004), and a tendency towards evening chronotype (p = 0.001). CONCLUSIONS: IH patients with long sleep duration differ clinically as well as by objective measures at the time of diagnosis and in long-term follow up from IH patients without long 24-h sleep time. In our opinion they represent an independent clinical entity to be considered in the revised ICSD-3 criteria.
- MeSH
- dospělí MeSH
- idiopatická hypersomnie * diagnóza MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- narkolepsie * MeSH
- polysomnografie MeSH
- poruchy nadměrné spavosti * diagnóza epidemiologie etiologie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Nadměrná spavost (hypersomnolence) je relativně běžným stavem po spánkové deprivaci a také frekventovaným příznakem provázejícím řadu neurologických, psychiatrických a interních onemocnění, infekcí a traumat. Výskyt nadměrné spavosti u neurodegenerativních chorob, iktu, jakož i úrazů, tumorů a vybraných infekcí CNS představuje spolu s centrálními hypersomnolencemi významný klinický problém v neurologii. Zvýšený výskyt hypersomnolence je pozorován rovněž u psychiatrických diagnóz. S ohledem na dopady spavosti na kvalitu života a sociální fungování je problematika nadměrné spavosti nadále předmětem intenzivního výzkumu.
Excessive sleepiness (hypersomnolence) is a relatively common occurrence following sleep deprivation and, similarly, a prevalent symptom accompanying a number of neurological, psychiatric and other medical disorders, infections and traumas. The presence of excessive sleepiness in neurodegenerative diseases, vascular cerebral accidents, as well as CNS injuries, tumours and infections, and the existence of central disorders of hypersomnolence represent a significant clinical challenge in neurology. Increased prevalence of hypersomnolence has also been observed in mental disorders. Considering the impact of hypersomnolence on social functioning and the quality of life, excessive sleepiness is currently subject to intense clinical research.
