Neurological Diseases May Be Preceded by Sleep Disorder

Parkinson’s disease, multiple system atrophy, and dementia may have preclinical symptoms, such as idiopathic REM sleep behavior disorder (RBD), lasting for decades in some cases according to new research published online July 28 in the journal Neurology.
Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disorder characterized by loss of normal voluntary muscle atonia (sleep paralysis) during REM sleep. During REM sleep, which is the deepest part of the sleep cycle, the body is “disconnected” from the brain, leaving the body unable to move. Patients with RBD have REM sleep with excessive movements, some that may be potentially injurious or disruptive such as punching, shouting, getting out of bed, or flailing arm movements. It is estimated that 0.5% of the general population has RBD.
Daniel O. Claassen MD of the Mayo Clinic College of Medicine analyzed data from 27 patients with a history of RBD that preceded the onset of Parkinson’s disease, Parkinson’s dementia, multiple system atrophy, or dementia with Lewy bodies by at least 15 years. The vast majority of the participants (24) were male.
Read: Vitamin D May Reduce Parkinson's Risk
The patients' mean age at onset of the sleep disorder was 49 and at onset of neurologic symptoms was 72 (overall median onset of 25 years). At the latest follow up, 63% of the patients had progressed to dementia. The long preclinical phase has important implications for the development of therapies that may slow or halt the progression, say the authors of the study.
Parkinson’s disease belongs to a group of conditions called motor system disorders, with the primary symptoms being trembling in hands, arms, legs, or face; rigidity or stiffness of the limbs and trunk; bradykinesia (slowness of movement); and postural instability or impaired balance and coordination. It usually affects people over the age of 50. At present, there is no cure for Parkinson’s disease.
Dementia can also result from the brain changes that occur in Parkinson’s. The prevalence of dementia in Parkinson’s disease ranges from 20-40%. Patients may also have Alzheimer’s disease and cerebrovascular disease as co-morbid conditions.
Another common type of progressive dementia is Dementia with Lewy bodies (DLB). The central feature of DLB is progressive cognitive decline, combined with pronounced fluctuations in alertness and attention, recurrent visual hallucinations, and parkinsonian motor symptoms. Patients may also suffer from depression. Like both Alzheimer’s and Parkinson’s dementias, there is no cure.

Snoring Men Transform Into Sleeping Beauties After Surgery

Millions of men who suffer from sleep apnea may sacrifice a good night's sleep because they don't know where to get treatment, don't realize relief is available, or are too embarrassed to get help. However, comfort may be as close as their local plastic surgeon's office. Plastic surgeons at the forefront of identifying and treating sleep apnea will discuss the latest surgical advances today at the American Society of Plastic Surgeons (ASPS) and American Society of Maxillofacial Surgeons (ASMS) Plastic Surgery 2007 conference in Baltimore.
"Men over the age of 40 are the most common sufferers of sleep apnea due to their heavier build and shorter necks; however, women, children and overweight people are not immune," said Stephen Schendel, MD, ASPS Member Surgeon and lecture presenter. "Many men are extremely embarrassed to get help for sleep apnea even though it can lead to serious health issues."
Sleep apnea is a temporary inability to breathe during sleep, which can occur dozens; sometimes hundreds of times per night. Although someone may not be aware they have the condition, it can significantly disrupt their quality of sleep. According to the National Institutes of Health, sleep apnea is as common as adult diabetes and affects more than 12 million Americans.
"Left untreated, sleep apnea can cause high blood pressure and other heart disease, memory problems, mood swings, impotency and headaches," said Andrew Wexler, MD, ASMS president. "The condition can also lead to serious work injuries and car accidents because sufferers are drowsy and fall asleep."
Sleep apnea can occur when soft tissues of the nose and mouth relax -- which may restrict air flow. Plastic surgeons open the airway by removing excess tissue in the nose. The tongue is also shortened and pulled forward preventing it from slipping into the throat while sleeping. The disorder is also seen in patients with less pronounced facial features, such as a small chin, because they often have smaller airways. Plastic surgeons move the upper and lower jaws forward, creating a larger airway for these patients. Being overweight can also restrict the airway; however, the best treatment for these patients is weight loss.
Non-surgical options may not be as effective or as long-term as surgery. The most common non-surgical treatment is a Continuous Positive Airway Pressure (CPAP) machine, which some equate to sleeping with a scuba mask on, can often fall off during the night and forces the user to sleep on his back. Radiotherapy is another option that has moderate success; however, it may be only appropriate for people with minor conditions and requires multiple treatments.
"Treating sleep apnea is one of the less talked about ways plastic surgeons are helping to restore health and proper function to patients," said Richard D'Amico, MD, ASPS president. "After all, quality sleep is an integral part of how we function properly."