Stephany Fulda

Ente Ospedaliero Cantonale · Neurocenter of Southern Switzerland / Sleep Medicine Unit

Treatment with mirtazapine, a widely prescribed antidepressant, has been linked to weight gain and dyslipidemia. Whether dyslipidemia occurs secondary to increased appetite due to antidepressant treatment, or due to direct pharmacological effects of mirtazapine is unknown. The aim of this analysis is to complement our previously published results o...

Introduction Treatment with mirtazapine, a widely prescribed antidepressant, has been linked to weight gain and dyslipidemia. Whether dyslipidemia occurs secondary to increased appetite due to antidepressant treatment, or due to direct pharmacological effects of mirtazapine is unknown. Methods The aim of this analysis is to complement our previousl...

Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterized by an urge to move the limbs with a circadian pattern (occurring in the evening/at night), more prominent at rest, and relieved with movements. RLS is one of the most prevalent sleep disorders, occurring in 5-10% of the European population. Thomas Willis first descri...

We introduce a new periodicity detection algorithm for binary time series of event onsets, the Gaussian Mixture Periodicity Detection Algorithm (GMPDA). The algorithm approaches the periodicity detection problem to infer the parameters of a generative model. We specified two models - the Clock and Random Walk - which describe two different periodic...

Frequent nightly arousals typical for sleep disorders cause daytime fatigue and present health risks. As such arousals are often short, partial, or occur locally within the brain, reliable characterization in rodent models of sleep disorders and in human patients is challenging. We found that the EEG spectral composition of non-rapid-eye-movement s...

Periodic leg movements during sleep (PLMS) are a frequent finding in nocturnal sleep registrations that include tibialis anterior electromyographic signals. Different PLMS scoring rules exist and can have a major impact on PLMS frequency, which tends to be underappreciated. There is no consistent evidence that frequent PLMS are a causal risk factor...

This systematic review and meta-analysis evaluated the diagnostic accuracy of screening instruments for restless legs syndrome (RLS) and reports sensitivity, specificity, positive (PPV) and negative predictive values (NPV). Searches for primary studies were conducted in electronic databases. Of the 1541 citations identified, 52 were included in the...

Chronic pain patients frequently suffer from sleep disturbances. Improvement of sleep quality alleviates pain, but neurophysiological mechanisms underlying sleep disturbances require clarification to advance therapeutic strategies. Chronic pain causes high-frequency electrical activity in pain-processing cortical areas that could disrupt the normal...

Study objectives To investigate (1) the effect of different scoring rules on leg movement (LM) classification in patients with obstructive sleep apnea (OSA), (2) determinants of respiratory event related leg movements (rLM), and (3) to relate LM parameters to clinical outcomes. Methods (1) LM classification was compared between the WASM 2006 and t...

Study Objectives The present study aimed at assessing the temporal non-rapid eye movement (NREM) EEG arousal distribution within and across sleep cycles and its modifications with aging and nighttime transportation noise exposure, factors that typically increase the incidence of EEG arousals. Methods Twenty-six young (19–33 years, 12 women) and 16...

BACKGROUND. Weight gain and metabolic changes during treatment with antidepressant drugs have emerged as an important concern, particularly in long-term treatment. It is still a matter of ongoing debate whether weight gain and metabolic perturbations with antidepressant use are the consequence of increased appetite and weight gain, respectively, or...

Purpose of Review Overview of recent development in the diagnosis and treatment of the periodic limb movement disorder (PLMD). Recent Findings The last years have seen several changes concerning PLMD diagnosis, detailed in the third edition of the International Classification of Sleep Disorders (ICSD-3) in 2014 as well as in periodic limb movement...

As a diagnostic term, central disorders of hypersomnolence refer to a group of sleep disorders that have excessive daytime sleepiness as their primary complaint. Daytime sleepiness can be either chronic or recurrent. Central disorders of hypersomnolence include narcolepsy type 1 and type 2, idiopathic hypersomnia, and hypersomnia due to a medical c...

Study Objectives To (i) replicate the recently described distribution of respiratory event associated leg movements (rLM) in subjects with mild to moderate obstructive sleep apnea syndrome (OSAS), (ii) explore global and local factors associated with the presence of rLM, and (iii) investigate differences related to OSAS severity and periodic leg mo...

This chapter reviews the available studies that investigated the effect of pharmacological treatment on cognitive functioning in WillisEkbom Disease/restless legs syndrome (WED/RLS). These studies included acute, single-night treatments with levodopa, clonazepam, ropinirole, and gabapetin and prolonged treatment with pramipexole, gabapentin enacarb...

Introduction Sleep disturbances are prevalent in Attention Deficit Hyperactivity Disorder (ADHD). The hypothesis that the typical daytime hyperactivity observed in these patients may correspond to an increased motor activity during the night, thus causing sleep disruption, has been studied in children, but rarely in adults. Here we present a first...

Objective: Current standard guidelines for scoring periodic leg movements (PLM) define the start and end of a movement but fail to explicitly specify the movement morphology necessary to classify an EMG event as a PLM, rather than some other muscle event. This is currently left to the expert visual scorer to determine. This study aimed to define t...

This report presents the results of the work by a joint task force of the International and European Restless Legs Syndrome Study Groups and World Association of Sleep Medicine that revised and updated the current standards for recording and scoring leg movements (LM) in polysomnographic recordings (PSG). First, the background of the decisions made...

Periodic leg movements during sleep (PLMS) are the most important objective finding in restless legs syndrome (RLS). During the last decade, PLMS have been very important for the assessment and comprehension of their pathophysiological correlates, which have been paralleled by the emergence of new computer-assisted and data-driven rules for their i...

Study objectives: Periodic limb movements of sleep (PLMS) occur within a subject as a series with a remarkably stable period defined by the inter-movement interval (IMI). Sometimes a non-PLMS movement occurs intervening between two PLMS. PLMS scoring rules specify totally ignoring these intervening leg movements (iLM). This implicitly assumes an i...

Currently, 2 sets of similar rules for recording and scoring leg movement (LM) exist, including periodic LM during sleep (PLMS) and periodic LM during wakefulness. The former were published in 2006 by a task force of the International Restless Legs Syndrome Study Group, and the second in 2007 by the American Academy of Sleep Medicine. This article...

Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB manage...

Objective The aim of this study was to analyze statistically the number of single leg movements (LMs) forming bilateral LMs during sleep, along with their combined duration, to eventually provide evidence-based data for the adjustment of the current scoring rules defining bilateral LMs. Methods Polysomnographic recordings of 111 untreated patients...

Objective: To evaluate the diagnostic accuracy of the standard periodic leg movement during sleep (PLMS) index, a recently introduced alternative one, and the periodicity index (PI) for restless legs syndrome (RLS). Subjects and methods: A total of 107 patients with RLS were retrospectively identified and included (47 males and 60 females, mean...

Objective: There is no broad screening instrument that can comprehensively assess parasomnias and sleep-related movement disorders listed in the International Classification of Sleep Disorders. The aim of this study was to develop the Japanese version of the Munich Parasomnia Screening (MUPS), a screening instrument for parasomnias and nocturnal b...

Objectives: The aim of this study was to describe and analyze the association between bilateral leg movements (LMs) during sleep in subjects with restless legs syndrome (RLS), in order to eventually support or challenge the current scoring rules defining bilateral LMs. Subjects and methods: Polysomnographic recordings of 100 untreated patients w...

Periodic leg movements during sleep (PLMS) are a highly active research topic and accumulating recent evidence has led to reevaluation of key aspects on the role of PLMS in restless legs syndrome (RLS). This article summarizes the recent developments in 3 areas: the relationship of PLMS to cortical arousals in patients with RLS, the differential ef...

Objective To evaluate an alternative index for periodic leg movements during sleep (PLMS) and wakefulness (PLMW) expected to be similar to the standard index when leg movement activity is genuinely periodic, but significantly lower when periodicity is low. Subjects and methods One-hundred-and-seven subjects with restless legs syndrome (RLS) were r...

Several studies reported decreased quality of life and sleep as well as increased rates of depression for patients with pituitary adenomas. Our aim was to explore to what extent differences in depression and sleep quality contribute to differences in quality of life between patients with pituitary adenomas and controls. Cross-sectional case-control...

To analyze statistically the association between periodic leg movements during sleep (PLMS) and arousals, in order to eventually support or challenge the current scoring rules and to further understand their reciprocal influence. Sleep research center. Twenty untreated consecutive patients with restless legs syndrome (RLS) (13 women and 7 males, me...

Study objectives: Current sleep scoring rules exclude leg movements that occur near respiratory events from being scored as periodic leg movements during sleep (PLMS) but differ in whether they exclude leg movements occurring at the end (WASM/ IRLSSG) or during a respiratory event (AASM). The aim of the present study was to describe the distributi...

Background Dopamine agonists (DAs) represent the first-line treatment in restless legs syndrome (RLS); however, in the long term, a substantial proportion of patients will develop augmentation, which is a severe drug-related exacerbation of symptoms and the main reason for late DA withdrawal. Polysomnographic features and mechanisms underlining aug...

Both restless legs syndrome ([RLS], also known as Willis-Ekbom Disease [WED]) and depression are common during pregnancy. However, no prior studies have assessed if pregnant women with RLS have an elevated risk of depression during and/or after pregnancy. 1,428 women who were pregnant in gestational week 16-17 were asked to participate in a longitu...

Background: Regulation of sleep and sleep-related breathing resides in different brain structures. Vascular lesions can be expected to differ in their consequences on sleep depending on stroke topography. However, studies addressing the differences in sleep and sleep-related breathing depending on stroke topography are scarce. The aim of the prese...

Sleep-related movement disorders (SRMD) encompass a group of relatively simple, stereotyped movements or monophasic movement disorders, such as periodic limb movement disorder (PLMD), sleep-related leg cramps, sleep-related bruxism, and sleep-related rhythmic movement disorder, that disturb sleep (American Academy of Sleep Medicine (2005) The Inter...

The restless legs syndrome (RLS) also known as Willis-Ekbom disease (WED) is one of the most frequent neurological sleep disorders. Epidemiological studies have shown consistently that it is more frequent in females than in males with male-to-female ratios mostly in the range of 1:1.5-1:2.0 in adult populations. One of the main candidates involved...

Introduction Current sleep scoring rules exclude leg movements that occur near respiratory events from the scoring of periodic leg movements during sleep. While the AASM rules exclude leg movements that occur during a period of 0.5 s preceding to 0.5 s following an apnea or hypopnea, the WASM/IRLSSG rules consider only leg movements during 0.5 s be...

Introduction Dopamine agonists represent the first- line treatment in restless legs syndrome (RLS), however in the long term, a substantial portion of patients will develop augmentation, which is a severe drug-related exacerbation of symptoms and the main reason of late therapy withdrawal. The mechanism underlining augmentation is unknown and no gu...

Daytime sleepiness (DS) is associated with poor health, impaired physical functioning, as well as somatic and psychiatric morbidity. The impact of DS on functional outcome in the elderly is unknown. We investigated whether observed daytime sleepiness in geriatric patients with moderate to severe functional impairment was associated with functional...

In the elderly population, daytime sleepiness (DS) is a burden that affects quality of life, cognitive and physical functioning as well as health status and morbidity. The measurement of DS in older subjects continues to be a challenge, as there are only few elderly-specific assessment tools available. Therefore, we compared the newly developed Ess...

One of the essential features of rapid eye movement (REM) sleep behavior disorder is REM sleep without atonia seen during nocturnal polysomnographic recordings. In this paper we provide an overview about the varied scoring criteria proposed for visual analysis of loss of atonia during REM sleep. The automatic quantification of loss of atonia overco...

Study Objectives: Recent evidence suggests that certain antidepressants are associated with an increase of periodic leg movements (PLMS) that may disturb sleep. So far, this has been shown in patients clinically treated for depression and in cross-sectional studies for various substances, but not mirtazapine. It is unclear whether antidepressants i...

There is a growing interest in sleep disorders in multiple sclerosis (MS) due to their high frequency and possible relationship to fatigue, a hallmark symptom in MS. Among them, insomnia and restless legs syndrome (RLS) are the most common ones. RLS is a sleep-related motor disorder characterized by a strong urge to move associated with uncomfortab...

Background: The number of periodic leg movements during sleep (PLMS index) shows high night-to-night variability, requiring multiple nights for its reliable estimation. It is currently not known if this is also the case for the degree of periodicity of leg movements, quantified by the Periodicity index. Objective: To compare night-to-night varia...

Introduction Leg movements (LMs) during sleep are frequent in patients with obstructive sleep apnea syndrome (OSAS). Current giudelines distinguish LMs associated with respiratory events from periodic leg movements (PLM), excluding the former when assessing PLM. The aim of the current study was to describe the time structure of global LMs, the rela...

Introduction Renal failure is often associated with severe RLS. First line treatment for RLS are non-ergot derivate dopamine-agonists but augmentation is one of the most frequent cause of discontinuation of long-term treatment in RLS. Herein we describe the management of a very severe case of augmentation in a case of RLS secondary to renal failure...

Impaired glucose tolerance is observed in depressed patients, and patients suffering from depression have an increased risk to develop diabetes mellitus. In depressed and diabetic patients, studies have shown both a beneficial effect of antidepressants on glucose homeostasis and the opposite. This review aims to structure the conflicting data and f...

The purpose of this study was to characterize the nature of the relation between periodic leg movements during sleep (PLMS) and cortical arousals to contribute to the debate on the clinical significance and treatment of PLMS. A prospective, placebo-controlled, single-blind, parallel group study was carried out including 46 drug-naive patients with...

To compare REM sleep chin EMG quantitative features between Parkinson's disease (PD) patients with or without REM sleep behavior disorder (RBD). Twenty-seven consecutive PD patients (mean age 67.9 years) and 19 normal controls (mean age 67.5 years) were enrolled. Detailed clinical, laboratory, and polysomnographic studies were obtained in all parti...

Obesity is a common feature of narcolepsy. In addition, an increased occurrence of non-insulin dependent diabetes has been reported. So far, it is not known whether glucose metabolism in narcolepsy is disturbed due to, or independently of obesity. Case-control study. Sleep medicine clinic at a research institute. We studied 17 patients with narcole...

Background: There is limited data on safety aspects of hormonal treatment in transsexual patients and clinical trials are lacking. Results: Compared to age-matched control groups, we did not observe a higher prevalence of lifetime cardiovascular, endocrine or tumoural comorbidities. FMT showed a lower prevalence of endocrine diseases (FMT to female...

REM sleep behavior disorder (RBD) is a parasomnia characterized by dream-enacting behavior and loss of muscle atonia during REM sleep. Idiopathic RBD occurs in the absence of any neurological disease or other possible cause, is male-predominant and its clinical course is generally chronic progressive. Secondary RBD may be related to neurodegenerati...

Previous studies exploring cognitive functioning in RLS have either relied on medication free subjects sampled within a clinical context or on subjects with RLS symptoms identified within population samples. However, in contrast to clinical samples, population studies so far have not excluded the use of antidepressants, hypnotics, or RLS relevant m...

Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom's 1945 seminal series of clinical cases with the disease. He, h...

In humans, rapid eye movements (REM) density during REM sleep plays a prominent role in psychiatric diseases. Especially in depression, an increased REM density is a vulnerability marker for depression. In clinical practice and research measurement of REM density is highly standardized. In basic animal research, almost no tools are available to obt...

The current definition of rapid eye movement (REM) sleep without atonia has no quantitative character, and cut-off values above which the level of electromyographic tone can be considered to be 'excessive' are unclear. The aim of this study was to analyse the characteristics of chin electromyographic amplitude by means of an automatic approach in a...

Daytime sleepiness is highly prevalent in the elderly and has a negative impact on perceived health, quality of life, functional status, risk of falling, and even mortality. In the aging Western society, there is an increasing need to recognize and assess daytime sleepiness in elderly people. However, the evaluation of daytime sleepiness in this po...

A growing body of data from genetic, immunological and clinical studies indicates an involvement of the immune system in the pathophysiology of schizophrenia and suggests that the modulation of the cytokine system by antipsychotics may be one cause for the improvement of psychotic symptoms. However, the influence of the typical antipsychotics chlor...

We investigated the antidepressants imipramine, desipramine, mirtazapine, citaloprame regarding their effect on cytokine production. Therefore we stimulated whole blood cultures using phytohaemagglutinin (PHA), toxic shock syndrome toxin-1 TSST-1, a monoclonal antibody against the surface antigen CD-3 (OKT3) combined with the protein CD40 and as st...

Zusammenfassung Wir untersuchten die Antidepressiva Imipramin, Desipramin, Mirtazapin und Citalopram bezüglich ihrer Wirkung auf die Zytokinproduktion. Dafür stimulierten wir Vollblut von zehn gesunden Probandinnen in vitro mit den Immunmodulatoren Phytohämagglutinin (PHA) und Toxic-Shock-Syndrom-Toxin-1 (TSST-1) sowie mit einem monoklonalen Antikö...

Sleep disorders are frequently associated with impaired performance although the type and extent of cognitive deficits varies widely between different types of sleep disorders. Treatment is expected to ameliorate these deficits. However, cognitive functioning and its change with treatment depend on numerous factors. In this chapter we discuss metho...

A growing body of data indicates that an activation of proinflammatory cytokines such as interferon-gamma (IFN-gamma) is involved in the pathophysiology of depression and that the suppression of pro-inflammatory cytokine production by antidepressants may lead to an improvement of depressive symptoms. However, the influence of the serotonin and nora...

Restless legs syndrome (RLS) is a frequent sleep-related movement disorder with disturbed sleep and quality of life. RLS patients complain about increased daytime sleepiness, but there are only few and inconsistent reports about cognitive functioning in this group. We compared cognitive performance of 23 unmedicated RLS patients to that of 23 healt...

Regulatory T cells (Tregs, CD4(+)CD25(hi)) are specialized in steering the immune response and cytokine release to maintain tolerance to self-antigens. As cytokines such as interleukin (IL)-1β, IL-6 and interferon (IFN)-α have been shown to be involved in the pathophysiology of depression and cytokine levels have been shown to change during success...

The polypeptide leptin exerts a multitude of regulatory functions. It has been implicated in the pathophysiology of inflammatory, metabolic and psychiatric disorders and has been found to be differentially expressed in men and women. Although a clear increase of leptin levels with age has been repeatedly observed in men, the association of leptin l...

Objectives: Our aim was to assess sleep characteristics in patients with Cushing's disease (CD) and non-functioning pituitary adenomas (NFPA). Methods: We assessed patients with CD and with NFPA treated at our outpatient units. Subjective sleep was assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness with the Epworth Slee...

Objectives: Increased body weight is a common feature of narcolepsy. In addition, an increased occurrence of non-insulin dependent diabetes has been reported. So far, it is not known whether glucose metabolism in narcolepsy is disturbed due to, or independently of obesity. Methods: We studied 17 patients with narcolepsy/cataplexy and 17 healthy con...

Restless legs syndrome (RLS) is a frequent sleep-related movement disorder with disturbed sleep and quality of life. RLS patients complain about increased daytime sleepiness, but there are only few and inconsistent reports about cognitive functioning in this group. We compared cognitive performance of 23 unmedicated RLS patients to that of 23 healt...

Introduction Many antidepressants have a pronounced effect on sleep EEG, and this effect can often be observed after the very first administration [1] (see also Chapter 18 in this volume). In general, the effects of antidepressants on sleep occur distinctly earlier than the effects on mood, which may take two to four weeks to develop [2]. These rap...