Sleep Disorders Manual

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Sleep disorders manual

Introduction

Using the term disorder as a phenomenon for loss of health is a complex proposal, since it exceeds the biomedical perspective, which mainly uses the term disease. The concept of disorder includes the vision of the individual in the face of the alteration of the state of health, this term is used in the mainly evolutionary conditions, with unclear etiology, manifestations that may be cause or consequence and experiences of attention in a particular sociocultural context.

When talking about movement disorders during sleep, we face a complex diagnostic challenge, since, despite being common nosological entities, their manifestations are not usually aware and therefore are not the cause of consultation. This happens with the most common movement disorders: Bruxism, in which the cause of consultation is usually diurnal effects such as headache, mood symptoms, alterations in obvious behavior in the pediatric population, the feeling of a non -repairing dream, sensitivity Dental or frequently they are a fortuitous finding in medical or dental consultation, such as the presence of dental wear and lingual indentation. It is the fourth partner who realizes the grinding or castañeo of the teeth. The approach requires the search for biological and psychological factors. The treatment should not be reduced to the use of occlusal guards.

Developing

In restless legs syndrome (SPI), it has a multifactorial etiology, although it is characterized by an unpleasant and deep sensation in the extremities, which increases with rest and partially or completely improvement with movement and present a clear circadian pattern. Typical manifestations are not the cause of consultation, given that chronicity causes the development of strategies, which allows it to deal with parstesthesia, which implies a sub diagnosis. So it is necessary to apply standardized and validated scales for our population intentionally to show symptoms associated with SPI. 

It is sleep fragmentation, the effects during vigil, cardiovascular, mood, cognitive comorbidities and adverse effects of inadequate therapeutic alternatives, the true reason for consultation, its approach must consider the association with specific physiological conditions such as pregnancy and pathophysiological as uremia, as well as comorbidity with other movement disorders, psychiatric disorders or other sleep disorders.

The periodic movement disorder of the extremities (TMPE) and its high presence associated with restless legs syndrome, must make suspect its coexistence, given that the last to find out is usually the one who suffers from them. These stereotypical, spasmodic and periodic movements vary from mild and imperceptible in most cases to complex movements to which it is essential to study through polysomnographic record. The appropriate quantification of movements is indispensable, the current technology allows to enrich sleep studies with video-electroencephalography and facilitate differential diagnosis.

The advance in the study of pathophysiology has evidenced the genetic importance in iron regulation and has allowed phenotypic research in animal models. Obviously the deficiency of the iron concentrations contained in the nigra substance in the cellular bodies of dopaminergic neurons that are projected to the striatum, a crucial area for the modulation of the movement. However, patients usually present iron values ​​within the limits of normality outside the brain, which implies a complication for the supplementary prescription of said element and its monitoring. 

Which has forced to investigate the cause of specific iron decrease at the central level. In animal models it has been evidenced that the lack of physical activity could be involved in the alteration of iron concentrations. These findings propose that sedentary life could be intimately linked as an environmental factor in the expression of movement disorders. It should be noted that iron deficiency evidence opens a range of diagnostic possibilities that need to be correlated with the clinic and complementary studies.

In image studies with functional magnetic resonance, structural alterations in the somatosensory cortex at the level of the bilateral postcentral turn and the posterior calluses have evidence NMOR and its fragmentation.

With respect to the treatment of both SPI-TMPE, the change of lifestyle with the incorporation of sleep hygiene measures, are the first and most important step, from an early age. Pharmacological treatment could divide it between non-dimérgic vs. Dopaminergic (dopaminergic agonists). The therapeutic plan should consider the supplementary iron administration given the evidence in clinical trials, however, it must be based on a comprehensive evaluation and the exhaustive search for the origin of the insensitive losses of hematic material. Exacerbant factors can be the administration of other drugs such as antidepressants or antihistamines.

The reasons for the search for other therapeutic alternatives are the fault to treatment and the need to increase dose and increase adverse effects, as well as the risk of dependence (benzodiazepines and opiates). It should be noted that the last pharmacological treatment option is opiates. Non -pharmacological treatments are still without conclusive data, it is the case of complementary therapies with phytopharmaceuticals such as the melissa officinalis L, millenary as acupuncture or more recent such as transcranial magnetic stimulation.

Bibliography

  • Gugini la, San Martin As, Cademartori MG, Boscato N, Correa MB, Goettems ML. Interventions to reduces Bruxism in Children and Adolescents: A Systematic Scoping Review and Critical Reflection. Eur J Pediat. 2020 Feb; 179 (2): 177-189. DOI: 10.1007/S00431-019-03549-8. EPUB 2019 DEC 19.
  • Guo H, Wang T, Niu X, Wang H, Yang W, Qiu J, Yang L. The Risk Factors Related to Bruxism in Children: A Systematic Review and Meta-Analysis. Arch Oral Biol. 2018 Feb; 86: 18-34. DOI: 10.1016/J.Archoralbio.2017.eleven.004. EPUB 2017 Nov 11.
  • Mansukhani MP, Covesin N, Somers VK. Neurological Sleep Disorders and Blood Pressure: Current Evidence. Hypertension. 2019 Oct; 74 (4): 726-732. DOI: 10.1161/Hypertensionaha.119.13456. EPUB 2019 SEP 3.

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