Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0021
E. Golden, M. Tippmann-Peikert
This chapter describes a patient with narcolepsy type 1, a disorder of central hypersomnolence. His history, clinical evaluation, study results, treatment, and clinical course are detailed. The disorder is then reviewed, highlighting its classic clinical features—hypersomnia, cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations, and disturbed sleep—and its underlying pathophysiology. The differential diagnosis is discussed, and recommendations for clinical evaluation are provided with official diagnostic criteria from the International Classification of Sleep Disorders, 3rd edition. Pharmacologic and nonpharmacologic treatment options are then addressed, along with their respective benefits and side-effect profiles.
{"title":"Napping the Day Away","authors":"E. Golden, M. Tippmann-Peikert","doi":"10.1093/MED/9780190671099.003.0021","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0021","url":null,"abstract":"This chapter describes a patient with narcolepsy type 1, a disorder of central hypersomnolence. His history, clinical evaluation, study results, treatment, and clinical course are detailed. The disorder is then reviewed, highlighting its classic clinical features—hypersomnia, cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations, and disturbed sleep—and its underlying pathophysiology. The differential diagnosis is discussed, and recommendations for clinical evaluation are provided with official diagnostic criteria from the International Classification of Sleep Disorders, 3rd edition. Pharmacologic and nonpharmacologic treatment options are then addressed, along with their respective benefits and side-effect profiles.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82657105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0019
A. Kominsky, T. Waters
This chapter discusses the role of neuromodulation in the treatment of obstructive sleep apnea (OSA). Various forms of hypoglossal nerve stimulation (HNS) have been researched, and one commercially available form of stimulation was approved for treatment of moderate to severe OSA by the U.S. Food and Drug Administration in 2014. Because of the novelty of this treatment and subgroup responsiveness, inclusion and exclusion criteria have been developed. The treatment is reserved for select patients who have been deemed to fail or are intolerant of positive airway pressure therapy. The nature of the therapy requires multidisciplinary care from both otolaryngology and sleep medicine specialists. Of the available outcome data, the therapy is effective at not only reducing the severity of OSA but also improving patient-reported outcomes of daytime sleepiness and quality of life.
{"title":"Stimulation Ultimately Prevails","authors":"A. Kominsky, T. Waters","doi":"10.1093/MED/9780190671099.003.0019","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0019","url":null,"abstract":"This chapter discusses the role of neuromodulation in the treatment of obstructive sleep apnea (OSA). Various forms of hypoglossal nerve stimulation (HNS) have been researched, and one commercially available form of stimulation was approved for treatment of moderate to severe OSA by the U.S. Food and Drug Administration in 2014. Because of the novelty of this treatment and subgroup responsiveness, inclusion and exclusion criteria have been developed. The treatment is reserved for select patients who have been deemed to fail or are intolerant of positive airway pressure therapy. The nature of the therapy requires multidisciplinary care from both otolaryngology and sleep medicine specialists. Of the available outcome data, the therapy is effective at not only reducing the severity of OSA but also improving patient-reported outcomes of daytime sleepiness and quality of life.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"177 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79925682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0040
E. Blasberg, T. Kraai, M. Grigg-Damberger
An infant with severe congenital laryngomalacia presented with inspiratory stridor when feeding, crying, or supine, relieved by prone or upright repositioning. Suprasternal retractions, hypoxemia, feeding difficulties, and failure to thrive prompted admission to the pediatric intensive care unit. Symptoms of sleep disordered breathing contributed to the severity of her laryngomalacia. Overnight polysomnography confirmed severe obstructive sleep apnea and sleep-related hypoxemia. The patient underwent supraglottoplasty with resolution of the wake hypoxemia but with residual stridor and apnea. Revision supraglottoplasty led to remission of the stridor and obstructive sleep apnea but emergence of central sleep apnea. This case discusses the clinical features, diagnostic evaluation, and management of congenital laryngomalacia. Supraglottoplasty, reserved for infants with moderate or severe laryngomalacia, is the treatment of choice. Obstructive sleep apnea improves but usually does not fully remit after supraglottoplasty. Central sleep apnea is not uncommon in infants with laryngomalacia and may reflect immature or abnormal brainstem nuclei regulating regulation of respiration during sleep.
{"title":"Our Baby Can’t Eat, Can’t Breathe, and Can’t Sleep!","authors":"E. Blasberg, T. Kraai, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0040","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0040","url":null,"abstract":"An infant with severe congenital laryngomalacia presented with inspiratory stridor when feeding, crying, or supine, relieved by prone or upright repositioning. Suprasternal retractions, hypoxemia, feeding difficulties, and failure to thrive prompted admission to the pediatric intensive care unit. Symptoms of sleep disordered breathing contributed to the severity of her laryngomalacia. Overnight polysomnography confirmed severe obstructive sleep apnea and sleep-related hypoxemia. The patient underwent supraglottoplasty with resolution of the wake hypoxemia but with residual stridor and apnea. Revision supraglottoplasty led to remission of the stridor and obstructive sleep apnea but emergence of central sleep apnea. This case discusses the clinical features, diagnostic evaluation, and management of congenital laryngomalacia. Supraglottoplasty, reserved for infants with moderate or severe laryngomalacia, is the treatment of choice. Obstructive sleep apnea improves but usually does not fully remit after supraglottoplasty. Central sleep apnea is not uncommon in infants with laryngomalacia and may reflect immature or abnormal brainstem nuclei regulating regulation of respiration during sleep.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76517466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0029
N. Jaimchariyatam, L. Aboussouan
Charcot-Marie-Tooth disease (CMT) is the most common hereditary motor and sensory polyneuropathy. Patients with CMT are prone to develop vocal cord palsy, diaphragmatic dysfunction, sleep disorders, and hypoventilation. Sleep disorders in CMT result mainly from comorbid sleep disordered breathing (SDB), including obstructive sleep apnea and sleep-related hypoventilation, and restless leg syndrome. Diaphragmatic dysfunction and pharyngeal neuropathy are the main pathogenetic mechanisms of SDB in patients with CMT. Similar to others, the diagnosis and treatment of SDB in patients with CMT are mainly based on polysomnography and nocturnal noninvasive ventilation, respectively.
{"title":"There Was a Crooked Man Who Could Not Breathe Day or Night","authors":"N. Jaimchariyatam, L. Aboussouan","doi":"10.1093/MED/9780190671099.003.0029","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0029","url":null,"abstract":"Charcot-Marie-Tooth disease (CMT) is the most common hereditary motor and sensory polyneuropathy. Patients with CMT are prone to develop vocal cord palsy, diaphragmatic dysfunction, sleep disorders, and hypoventilation. Sleep disorders in CMT result mainly from comorbid sleep disordered breathing (SDB), including obstructive sleep apnea and sleep-related hypoventilation, and restless leg syndrome. Diaphragmatic dysfunction and pharyngeal neuropathy are the main pathogenetic mechanisms of SDB in patients with CMT. Similar to others, the diagnosis and treatment of SDB in patients with CMT are mainly based on polysomnography and nocturnal noninvasive ventilation, respectively.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73739520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0048
K. Ashton, C. L. Thompson
A two-time breast cancer survivor is troubled by worry of her cancer returning; along with poor sleep hygiene and lack of routine schedule, this leads to insomnia. After a negative polysomnogram, she is evaluated by a psychologist trained in sleep and integrated into the breast cancer clinic. Cognitive-behavioral therapy for insomnia is recommended. Insomnia is common among breast cancer patients and survivors and is likely due to a combination of factors, including anxiety over prognosis and treatment side effects, which are sometimes long-lasting. Treatment of insomnia in these patients has been shown to improve their quality of life. Short sleep duration and circadian rhythm disturbances are associated with cancer development, progression, and prognosis.
{"title":"Did Cancer Kill My Sleep?","authors":"K. Ashton, C. L. Thompson","doi":"10.1093/MED/9780190671099.003.0048","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0048","url":null,"abstract":"A two-time breast cancer survivor is troubled by worry of her cancer returning; along with poor sleep hygiene and lack of routine schedule, this leads to insomnia. After a negative polysomnogram, she is evaluated by a psychologist trained in sleep and integrated into the breast cancer clinic. Cognitive-behavioral therapy for insomnia is recommended. Insomnia is common among breast cancer patients and survivors and is likely due to a combination of factors, including anxiety over prognosis and treatment side effects, which are sometimes long-lasting. Treatment of insomnia in these patients has been shown to improve their quality of life. Short sleep duration and circadian rhythm disturbances are associated with cancer development, progression, and prognosis.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81062397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0038
F. Ashraf, A. Yarahmadi, A. Zeft, N. Foldvary-Schaefer
Sleep disorder symptoms are rarely part of the clinical spectrum of paraneoplastic central nervous system disease. Ma1 and Ma2 antibodies involving mesencephalic and diencephalic structures, including the hypothalamus, can result in destruction of hypocretin neurons, leading to narcolepsy type 1 (formerly narcolepsy with cataplexy). This chapter presents a young man with testicular carcinoma and a devastating clinical syndrome of limbic encephalitis, supranuclear palsy, and narcolepsy with cataplexy in the setting of Ma1 and Ma2 paraneoplastic antibodies. Early treatment with removal of the underlying tumor and immunotherapy after several years resulted in a meaningful neurologic recovery. Paraneoplastic disorders should be considered in patients presenting with a subacute onset of narcolepsy in the setting of encephalitis and/or multifocal neurologic deficits.
{"title":"All Fall Down","authors":"F. Ashraf, A. Yarahmadi, A. Zeft, N. Foldvary-Schaefer","doi":"10.1093/MED/9780190671099.003.0038","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0038","url":null,"abstract":"Sleep disorder symptoms are rarely part of the clinical spectrum of paraneoplastic central nervous system disease. Ma1 and Ma2 antibodies involving mesencephalic and diencephalic structures, including the hypothalamus, can result in destruction of hypocretin neurons, leading to narcolepsy type 1 (formerly narcolepsy with cataplexy). This chapter presents a young man with testicular carcinoma and a devastating clinical syndrome of limbic encephalitis, supranuclear palsy, and narcolepsy with cataplexy in the setting of Ma1 and Ma2 paraneoplastic antibodies. Early treatment with removal of the underlying tumor and immunotherapy after several years resulted in a meaningful neurologic recovery. Paraneoplastic disorders should be considered in patients presenting with a subacute onset of narcolepsy in the setting of encephalitis and/or multifocal neurologic deficits.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80219186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0050
R. Vanek, N. Kempke
Shift work and long work hours, such as 12-hour shifts, can disturb sleep and circadian rhythms. Shift work disorder is a circadian rhythm disorder in which excessive sleepiness and/or insomnia due to work schedule occur. There is a circadian misalignment between the timing of the sleep/wake schedule and the circadian pressures for sleep and wakefulness. Between 10% and 38% of nightshift and rotating shift workers experience shift work disorder. There can be interruptions during sleep caused by light, noise, and social obligations when sleep occurs at unusual times, resulting in a short sleep duration/inadequate sleep and poor sleep quality. Sleep logs provide valuable information. To improve the quantity and quality of sleep, the sleep environment and timing of light exposure need to be optimized, and limiting interruptions during sleep is recommended. Wake-promoting agents such as armodafinil prior to work may be needed for fatigue management. Validated tools can aid in diagnosis, and there may be an underutilization of sleep specialists in these patients.
{"title":"She Works Hard for Her Sleep","authors":"R. Vanek, N. Kempke","doi":"10.1093/MED/9780190671099.003.0050","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0050","url":null,"abstract":"Shift work and long work hours, such as 12-hour shifts, can disturb sleep and circadian rhythms. Shift work disorder is a circadian rhythm disorder in which excessive sleepiness and/or insomnia due to work schedule occur. There is a circadian misalignment between the timing of the sleep/wake schedule and the circadian pressures for sleep and wakefulness. Between 10% and 38% of nightshift and rotating shift workers experience shift work disorder. There can be interruptions during sleep caused by light, noise, and social obligations when sleep occurs at unusual times, resulting in a short sleep duration/inadequate sleep and poor sleep quality. Sleep logs provide valuable information. To improve the quantity and quality of sleep, the sleep environment and timing of light exposure need to be optimized, and limiting interruptions during sleep is recommended. Wake-promoting agents such as armodafinil prior to work may be needed for fatigue management. Validated tools can aid in diagnosis, and there may be an underutilization of sleep specialists in these patients.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"118 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80225723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0020
Carlos L. Rodriguez, B. Tousi
Rapid-eye-movement sleep behavior disorder (RBD) is a parasomnia that is closely associated with neurodegenerative disorders. RBD is usually caused by neurodegeneration within the brainstem that disables the system responsible for immobilizing skeletal muscles during REM sleep and thus permits motor neurons to activate these muscles during dreaming. The underlying source of the brainstem neurodegeneration spreads over time to other central nervous system regions until it has sufficiently evolved to permit clinical recognition of the underlying neurodegenerative disorder. Longitudinal follow-up of patients with RBD has demonstrated that most patients subsequently develop some neurodegenerative disorder years later, particularly the synucleinopathies. We review the relationship between RBD and dementia with Lewy bodies, which is one of the synucleinopathies. The management of RBD is reviewed with discussion of the relevant considerations in patients with dementia with Lewy bodies.
{"title":"Lost in a Dream","authors":"Carlos L. Rodriguez, B. Tousi","doi":"10.1093/MED/9780190671099.003.0020","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0020","url":null,"abstract":"Rapid-eye-movement sleep behavior disorder (RBD) is a parasomnia that is closely associated with neurodegenerative disorders. RBD is usually caused by neurodegeneration within the brainstem that disables the system responsible for immobilizing skeletal muscles during REM sleep and thus permits motor neurons to activate these muscles during dreaming. The underlying source of the brainstem neurodegeneration spreads over time to other central nervous system regions until it has sufficiently evolved to permit clinical recognition of the underlying neurodegenerative disorder. Longitudinal follow-up of patients with RBD has demonstrated that most patients subsequently develop some neurodegenerative disorder years later, particularly the synucleinopathies. We review the relationship between RBD and dementia with Lewy bodies, which is one of the synucleinopathies. The management of RBD is reviewed with discussion of the relevant considerations in patients with dementia with Lewy bodies.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90617878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0049
F. Royce, V. Shah
This chapter examines the interplay between obesity and the selection of treatment for severe sleep obstructed breathing in children and adolescents. It reviews the physiology of obstructive sleep apnea and hypoventilation, as well as the importance of partial-pressure carbon dioxide monitoring in evaluating sleep disordered breathing in obese children. It discusses the effectiveness, adherence, and clinical outcomes of various treatment options for pediatric obstructive sleep apnea/hypoventilation, including adenotonsillectomy, positive airway pressure (PAP) therapy, and weight loss. It also reviews current literature on newer-generation, autotitrating PAP devices and their role in pediatric obstructive sleep apnea. Finally, it discusses the role of oxygen therapy in the management of pediatric obstructive sleep apnea.
{"title":"Bilevel PAP Transforms a Teen’s Life","authors":"F. Royce, V. Shah","doi":"10.1093/MED/9780190671099.003.0049","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0049","url":null,"abstract":"This chapter examines the interplay between obesity and the selection of treatment for severe sleep obstructed breathing in children and adolescents. It reviews the physiology of obstructive sleep apnea and hypoventilation, as well as the importance of partial-pressure carbon dioxide monitoring in evaluating sleep disordered breathing in obese children. It discusses the effectiveness, adherence, and clinical outcomes of various treatment options for pediatric obstructive sleep apnea/hypoventilation, including adenotonsillectomy, positive airway pressure (PAP) therapy, and weight loss. It also reviews current literature on newer-generation, autotitrating PAP devices and their role in pediatric obstructive sleep apnea. Finally, it discusses the role of oxygen therapy in the management of pediatric obstructive sleep apnea.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79616815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0030
L. Lim
This case report illustrates an example of restless legs syndrome (RLS) with a positive family history and several secondary and exacerbating factors (including iron and vitamin B12 deficiency). RLS is a common yet often overlooked condition for which effective treatment is available. Symptoms can be triggered or exacerbated by common medications such as over-the-counter antihistamines, caffeine, and antidepressant medication. Secondary causes for RLS, including iron deficiency, should be excluded and treated. RLS can be inheritable. Childhood-onset symptoms and the presence of a first-degree relative with symptoms of RLS are suggestive of familial RLS. Symptoms of RLS are effectively managed by correction of secondary causes and medications, including dopamine agonists and certain anticonvulsants.
{"title":"What a Pain! My Childhood Leg Cramps Are Back","authors":"L. Lim","doi":"10.1093/MED/9780190671099.003.0030","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0030","url":null,"abstract":"This case report illustrates an example of restless legs syndrome (RLS) with a positive family history and several secondary and exacerbating factors (including iron and vitamin B12 deficiency). RLS is a common yet often overlooked condition for which effective treatment is available. Symptoms can be triggered or exacerbated by common medications such as over-the-counter antihistamines, caffeine, and antidepressant medication. Secondary causes for RLS, including iron deficiency, should be excluded and treated. RLS can be inheritable. Childhood-onset symptoms and the presence of a first-degree relative with symptoms of RLS are suggestive of familial RLS. Symptoms of RLS are effectively managed by correction of secondary causes and medications, including dopamine agonists and certain anticonvulsants.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86010581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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