Sleep Medicine Center Kempenhaeghe

Heeze, Netherlands

Sleep Medicine Center Kempenhaeghe

Heeze, Netherlands

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Sherif E.,University of Zürich | Valko P.O.,University of Zürich | Overeem S.,Sleep Medicine Center Kempenhaeghe | Overeem S.,Radboud University Nijmegen | Baumann C.R.,University of Zürich
Parkinsonism and Related Disorders | Year: 2014

Sleep benefit in Parkinson's disease is characterized by restoration of mobility upon awakening from sleep and prior to drug intake. With this study, we aimed at assessing clinical and nocturnal sleep correlates of this phenomenon. We recorded motor and non-motor symptoms in 131 Parkinson patients with and without sleep benefit, as assessed by questionnaires. Polysomnography recordings were performed in 60 of these patients. Thirty-nine Parkinson patients (30%) reported sleep benefit. Motor symptoms, measures of sleepiness, fatigue, depression, anxiety, sleep-wake disorders, and dopaminergic treatment were not associated with sleep benefit, and most polysomnography measures were similar between both groups. However, Parkinson patients with sleep benefit had shorter total sleep times and longer sleep latencies at nocturnal polysomnography. The link between the occurrence of sleep benefit and shorter nocturnal sleep in Parkinson's disease remains unclear. © 2013 Elsevier Ltd.


van Gilst M.M.,Donders Institute for Brain | Bloem B.R.,Donders Institute for Brain | Overeem S.,Donders Institute for Brain | Overeem S.,Sleep Medicine Center Kempenhaeghe
BMC Neurology | Year: 2015

Background: Parkinson's disease (PD) patients may experience 'sleep benefit' (SB): a temporarily improved mobility upon awakening. SB has mainly been studied retrospectively using questionnaires, but it remains unclear whether it is associated with actual changes in motor functioning. Methods: We performed a prospective study on sleep-related changes in motor functioning, using a PD symptom diary during 7 days in 240 randomly selected PD patients (140 men; 66.8 ± 9.6 years; disease duration 9.3 ± 6.2 years). Afterwards, patients received a questionnaire on the possible subjective experience of SB. Results: Using the PD symptom diary, a positive change in motor function was observed after 267 nights (17.8%) and after 138 daytime naps (23.4%). Based on these results, 75 patients (32%) were classified as having SB. In response to the subsequent questionnaire, 73 patients (31%) reported SB. Interestingly, the groups with SB according to either the diary or the questionnaire overlapped only partially: outcomes were congruent in 63% of subjects (both negative 49%, both positive 14%). In both the diary and questionnaire, patients with SB showed a longer disease duration and longer medication use. According to the questionnaire, there was a trend towards a shorter sleep duration and lower sleep efficiency in the SB group. The mean change in motor function after sleep as assessed using the diary was higher in patients reporting subjective SB. Conclusion: We show that the subjective experience of SB in PD is not always related to an actual increase in reported motor function after sleep. Defining SB using either a symptom diary or a questionnaire on subjective experience, results in only partly overlapping groups. These data suggest that SB may be a more heterogeneous phenomenon than previously thought and that subjective experience of symptom severity is not necessarily related to actual motor function. © van Gilst et al.; licensee BioMed Central.


Louter M.,Radboud University Nijmegen | Louter M.,Sleep Medicine Center Kempenhaeghe | Munneke M.,Radboud University Nijmegen | Bloem B.R.,Radboud University Nijmegen | And 2 more authors.
Journal of the American Geriatrics Society | Year: 2012

OBJECTIVES: To study the relationship between nocturnal hypokinesia and sleep quality in Parkinson's disease (PD). DESIGN: Questionnaire study using intergroup analysis. SETTING: Parkinson Centre Nijmegen, a tertiary university referral center. PARTICIPANTS: Two hundred forty individuals with Parkinson's disease. MEASUREMENTS: Clinical and demographic data were obtained. Nocturnal hypokinesia was assessed using Question 35 of the Parkinson's Disease Quality of Life Questionnaire and rated on a 5-point Likert scale (1 = all of the time to 5 = never). The Pittsburgh Sleep Quality Index (PSQI) was used to quantify sleep quality, higher scores indicating poorer sleep quality. RESULTS: One hundred thirty-five of 240 participants had difficulties turning over in bed. Mean PSQI scores were significantly higher in participants with nocturnal hypokinesia (7.7 ± 4.1) than in those without (6.1 ± 3.4, P = .001). A regression model correcting for age, disease duration, and Hoehn and Yahr stage showed a significant influence of nocturnal hypokinesia on sleep quality (coefficient of determination = 0.042, standardized-beta = 0.163, P = .03). There was a linear relationship between frequency of nocturnal hypokinesia and sleep quality. CONCLUSION: This is the first study that documents that nocturnal hypokinesia negatively affects sleep quality in PD. Nocturnal hypokinesia therefore merits therapeutic attention, including optimal nighttime dopaminergic treatment and education about turning strategies in bed. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.


Dhondt K.,Pediatric Sleep Center | Dhondt K.,Ghent University | Verloo P.,Ghent University | Verhelst H.,Ghent University | And 3 more authors.
Pediatrics | Year: 2013

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare and complex pediatric syndrome, essentially caused by dysfunction of 3 vital systems regulating endocrine, respiratory, and autonomic nervous system functioning. The clinical spectrum of ROHHAD is broad, but sleep/ wake disorders have received relatively little attention so far, although the central hypothalamic dysfunction would make the occurrence of sleep symptoms likely. In this case report, we expand the phenotype of ROHHAD with a number of striking sleep symptoms that together can be classified as a secondary form of narcolepsy. We present a 7-year-old girl with ROHHAD who displayed the classic features of narcolepsy with cataplexy: excessive daytime sleepiness with daytime naps, visual hallucinations, and partial cataplexy reflected in intermittent loss of facial muscle tone. Nocturnal polysomnography revealed sleep fragmentation and a sleep-onset REM period characteristic for narcolepsy. The diagnosis was confirmed by showing an absence of hypocretin-1 in the cerebrospinal fluid. We discuss potential pathophysiological implications as well as symptomatic treatment options. Copyright © 2013 by the American Academy of Pediatrics.


van de Laar M.,Sleep Medicine Center Kempenhaeghe | Verbeek I.,Sleep Medicine Center Kempenhaeghe | Pevernagie D.,Sleep Medicine Center Kempenhaeghe | Pevernagie D.,Ghent University | And 4 more authors.
Sleep Medicine Reviews | Year: 2010

Insomnia is a highly prevalent sleep disorder, known to affect psychological well-being and quality of life. While perpetuating factors have received much attention, the role of predisposing factors has not been studied in much detail. The susceptibility to develop insomnia may be linked to the presence of certain personality features. Here, we review studies that assessed this particular aspect of insomnia. Due to various methodological issues, definitive conclusions cannot be drawn as of yet, and several conflicting findings remain. However, there is a common trend indicating that insomniacs display more signs of 'neuroticism', 'internalization', anxious concerns and traits associated with perfectionism. These factors may play varying roles depending on the specific subdiagnosis of insomnia. In addition, certain personality traits may be related to the response to (cognitive) behavioral treatment. For instance, insomniacs reporting less 'guardedness' and have a higher score on the MMPI 'hypomania' scale show less improvement through psychological treatment. The specific role of personality traits in the etiology of insomnia is not yet clear, because of a lack of longitudinal data. Personality factors may play a causal role in the development of insomnia, but may also be a consequence of the sleep problem and the associated daytime dysfunction. Future longitudinal studies should not view personality as a single predisposing factor, but assess it as a part of a larger group of interacting psychological and physiological factors involved in the predisposition to and perpetuation of chronic insomnia. © 2009 Elsevier Ltd. All rights reserved.


Vaessen T.J.A.,VieCuri Medical Center | Vaessen T.J.A.,University of Tilburg | Overeem S.,Sleep Medicine Center Kempenhaeghe | Overeem S.,Radboud University Nijmegen | Sitskoorn M.M.,University of Tilburg
Sleep Medicine Reviews | Year: 2015

Obstructive sleep apnea (OSA) is associated with impairments in cognitive functioning. Although cognitive complaints are related to quality of life, work productivity and health care expenditures, most research and all reviews have focused exclusively on objective cognitive functioning so far. In this systematic review, we assessed the available literature on subjective measures of cognition in adult OSA patients. Concentration complaints were consistently found to be more severe in untreated OSA patients as compared to primary snorers and healthy controls. The same seems to be true for memory and executive function problems, but firm conclusions cannot be made as of yet, due to methodological limitations of the available studies. Cognitive complaints appear to be at least partially related to subjective sleepiness. Importantly, they are not necessarily a sign of objective cognitive impairment. Additional research is needed to explore the relation between cognitive complaints, sleepiness and mood problems using validated and norm-referenced questionnaires for cognitive complaints. In addition, the impact of continuous positive airway pressure (CPAP) treatment on cognitive complaints in OSA warrants further study. © 2014 Elsevier Ltd.


Donjacour C.E.H.M.,Leiden University | Aziz N.A.,Leiden University | Roelfsema F.,Leiden University | Frolich M.,Leiden University | And 4 more authors.
American Journal of Physiology - Endocrinology and Metabolism | Year: 2011

Hypocretin deficiency causes narcolepsy and may affect neuroendocrine systems and body composition. Additionally, growth hormone (GH) alterations my influence weight in narcolepsy. Symptoms can be treated effectively with sodium oxybate (SXB; γ-hydroxybutyrate) in many patients. This study compared growth hormone secretion in patients and matched controls and established the effect of SXB administration on GH and sleep in both groups. Eight male hypocretin- deficient patients with narcolepsy and cataplexy and eight controls matched for sex, age, BMI, waist-to-hip ratio, and fat percentage were enrolled. Blood was sampled before and on the 5th day of SXB administration. SXB was taken two times 3 g/night for 5 consecutive nights. Both groups underwent 24-h blood sampling at 10-min intervals for measurement of GH concentrations. The GH concentration time series were analyzed with AutoDecon and approximate entropy (ApEn). Basal and pulsatile GH secretion, pulse regularity, and frequency, as well as ApEn values, were similar in patients and controls. Administration of SXB caused a significant increase in total 24-h GH secretion rate in narcolepsy patients, but not in controls. After SXB, slow-wave sleep (SWS) and, importantly, the crosscorrelation between GH levels and SWS more than doubled in both groups. In conclusion, SXB leads to a consistent increase in nocturnal GH secretion and strengthens the temporal relation between GH secretion and SWS. These data suggest that SXB may alter somatotropic tone in addition to its consolidating effect on nighttime sleep in narcolepsy. This could explain the suggested nonsleep effects of SXB, including body weight reduction. © 2011 the American Physiological Society.


van Gilst M.M.,Donders Institute for Brain | Bloem B.R.,Donders Institute for Brain | Overeem S.,Donders Institute for Brain | Overeem S.,Sleep Medicine Center Kempenhaeghe
Parkinsonism and Related Disorders | Year: 2013

Sleep disorders are common among patients with Parkinson's disease (PD). However, there are also reports of PD patients experiencing a beneficial effect of sleep. Upon awaking in the morning some patients experience good mobility, as if they are in an "on" state induced by medication, contrary to what would be expected after a night without medication. This intriguing phenomenon is known as sleep benefit. Here, we review the available research on sleep benefit in PD, describing its prevalence, clinical effects and determinants. We also discuss the possible mechanisms underlying sleep benefit, and the potential clinical applicability. Finally, we propose a new definition of sleep benefit to allow for improved standardization and homogeneity in future research. Important research targets include the development of objective measures of sleep benefit, as a basis for obtaining a better understanding of sleep benefit, its underlying mechanisms and its potential therapeutic application. © 2013 Elsevier Ltd.


Overeem S.,Radboud University Nijmegen | Overeem S.,Sleep Medicine Center Kempenhaeghe | van Nues S.J.,Leiden University | van der Zande W.L.,Leiden University | And 3 more authors.
Sleep Medicine | Year: 2011

Background: Narcolepsy is often not recognized or accurately diagnosed. This may be due to the fact that cataplexy, a core symptom which is virtually 100% specific, can-in practice-only be diagnosed based on the patient's history. However, the current definition of cataplexy is not very precise and the common distinction between " typical" and " atypical" cataplexy is not well codified. Methods: We aimed to provide a detailed description of the phenotypic variability of cataplexy. We included 109 patients with a definite history of cataplexy and a proven hypocretin-1 deficiency. The questionnaire contained 37 items to broadly cover the clinical aspects of cataplexy, including triggers, pattern and duration of muscle weakness, associated aspects such as sensory phenomena, and limitations in daily life due to cataplexy. Results: " Laughing" only listed in place 11th of most frequent triggers. " Laughing excitedly" was much more potent, showing that a certain intensity of the emotion is important for a " cataplectogenic" effect. Anger was the highest ranking " non-humorous" trigger, followed by " unexpectedly meeting someone well known." About 60% of patients also had spontaneous cataplectic attacks. Forty-five percent of patients experienced both partial and complete attacks and 30% only partial cataplexy. Fifteen percent of complete attacks were reported to last longer than 2. min. An abrupt return of muscle function was an important feature. The jaw and the face were most often involved in partial attacks, even more than the knee or the leg. Conclusions: Cataplexy presents with a large phenotypical diversity, so the current " typical" versus " atypical" distinction may be difficult to hold. We propose that grading cataplexy with different levels of diagnostic confidence may be more useful. © 2010 Elsevier B.V.


Droogleever Fortuyn H.A.,Radboud University Nijmegen | Mulders P.C.,Radboud University Nijmegen | Renier W.O.,Radboud University Nijmegen | Buitelaar J.K.,Radboud University Nijmegen | And 2 more authors.
Sleep Medicine | Year: 2011

Gélineau originally described narcolepsy as a disease with an organic cause. However, the disorder had undeniable emotional triggers and psychiatric-like expressions, and soon a psychiatric etiology of narcolepsy became a seriously considered option. In fact, the psychiatric view dominated scientific thinking for a long time, not necessarily to the benefit of patients. When hypocretin (orexin) defects were proven to be the cause of narcolepsy Gélineau's original disease model was shown to be right. However, the psychiatric symptoms of the disease were not forgotten afterwards, but gained a different significance: as psychiatric expressions of a brain disease. These symptoms, such as anxiety and eating disorders, can be highly debilitating and warrant clinical attention. Here, we describe the role of psychiatry in the history of narcolepsy, showing their evolving association. © 2011 Elsevier B.V.

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