Actigraphic Analysis of Treatment Response
Sleep DisordersCircadian Rhythm2 moreThe study examines and illustrates the utility of utilizing actigraphic measurements to assess treatment response.
Effect of Ropinirole on Spinal Cord Reflexes and Restless Legs Syndrome
Restless Legs SyndromeThis study will examine the effects of the drug Ropinirole on spinal cord reflexes and on symptoms of restless legs syndrome (RLS). Patients with RLS have uncomfortable sensations in the legs, usually in the evening or early part of the night. Most patients also have periodic involuntary leg movements. The condition tends to worsen over time, resulting in severe discomfort and sleep disturbances. Ropinirole affects chemical messengers thought to be involved in spinal cord function and in modulating RLS symptoms. Healthy normal volunteers and patients with RLS between 18 and 80 years of age may be eligible for this study. Patients must have mild to moderate RLS and periodic limb movements. All candidates will be screened with a medical history, physical and neurological evaluations, electromyogram (see below), polysomnogram (see below), electrocardiogram (ECG), and blood and urine tests. They may also have magnetic resonance imaging (MRI) or computerized tomography (CT) scans and a chest x-ray. Participants must stop taking all medications prohibited by the study for at least 1 week before the study starts and throughout its duration. The study will last approximately 2 to 3 weeks for healthy volunteers and 7 to 8 weeks for patients. Participants will undergo the following baseline evaluations: electroencephalography (EEG), a measure of brain wave activity; polysomnography (PSG), an overnight sleep study; electromyography (EMG), a measure of muscle activity; and spinal flexor reflex studies (spinal cord responses to electrical stimulation). For these studies, several electrodes are attached to the scalp or to the legs and arms using a cream that helps conduct brain signals through the cables to be recorded. The nervous system activity can be assessed at rest or after stimulation with an electric current. For EMG, a small needle is inserted into a few muscles and the subject is asked to relax or to contract the muscles. The electrical activity of the muscle cells is recorded and analyzed by a computer. Spinal flexor reflex studies usually involve stimulating the nerves in the legs with very brief electric currents of mild to moderate intensity. Flexor reflex studies will be done early in the night while the subject is awake and also during sleep. Brain, muscle and breathing activities will be monitored continuously during sleep. A suggested immobilization test (SIT) will be done around 10 p.m. During the test, the subject sits still for about 1 hour, while the leg muscle activity is recorded using special electronic devices attached to the skin. At the end of the test, volunteers will be asked questions about symptoms they may have experienced during the test, and patients will be asked questions about their RLS symptoms during the test. After the baseline tests, participants will be randomly assigned to take either Ropinirole tablets or a placebo (a look-alike inactive substance) daily for 5 weeks. They will be admitted to the NIH Clinical Center for 3 to 4 nights at the end of the second week and for 2 nights at the end of the study to repeat the baseline tests described above. Volunteers will take Ropinirole or placebo daily for 1 week. They will be admitted to the Clinical Center for 3 to 4 days at the beginning and then at the end of the study for repeat testing. Medical examinations, ECGs and blood tests will be done at various times during the study for safety monitoring. Patients' blood pressure will be monitored weekly. Small amounts of blood will be drawn up to three times each day for routine studies, research and drug levels. Throughout the study volunteers will complete questionnaires for evaluation of possible RLS symptoms, and patients will have their symptoms assessed using a RLS Severity Rating Scale. Two weeks after the study ends, participants will be interviewed by telephone about any adverse experiences.
Does Emergence Time Relate With Emergence Agitation in Pediatric Patients?
Emergence AgitationPost Operative Behavioral ChangesEmergence agitation (EA) is one of the unpleasant symptoms after general anesthesia. The patient can be irritable, uncooperate, cry, moan and combative behaviors. Sometimes the patient may need to be thrashed to prevent physical harm. The mechanism of EA is still unknown. EA is usually self limiting within 45 to 60 minutes after wake up from anesthesia. The incidence of EA is much higher in pediatric group when compared with adult. In some centre the incidence of EA can be up to 67 % depends on anesthesia technique, race, and child's temperament. Kain et al, reported that the patient who had marked EA tended to have post operative maladaptive behaviors. These maladaptive behaviors such as insomnia, eating disturbance, aggressive behavior and even developmental regression can be happen until one year after anesthesia. From the previous study, reported that fast emergence was associated with a high incidence of agitation. This prospective observation study is conducted to determine that emergence time has any effect on EA or not. The authors use process electroencephalogram (entropy) to monitor emergence time which defined as the time which state entropy level over sixty to eighty. Meanwhile, we will evaluate the emergence time by the conventional method which used the time from ceasing anesthesia to the time of eye opening by normal voice stimuli. The primary outcome of this study is the correlation between emergence time (both from Process EEG and clinical presentation) and incidence of emergence agitation. Two secondary outcomes will be measured. Firstly, the correlation between emergence time and postoperative behavioral changes. Secondly, the relationship between entropy monitoring and clinical symptoms.
Effects of Lidocaine Infusion on Quality of Recovery and Agitation After Functional Endoscopic Sinus...
Chronic Polypous RhinosinusitisThe essential anesthesia requirements for FESS include airway management, considerations for facilitating surgical access, provision of a clear and still surgical field for precision surgery, assuring quick and non-stimulating emergence from anesthesia, and fast-tracking patients for discharge. Postoperative agitation, although short-lived, is potentially harmful to both patients and recovery room staff, it has a potential for self-injury by removing intravenous catheters, tubing, oxygen masks and nasal packs. Furthermore, very agitated patients can pose an immediate danger to operating theatre staff.
Anesthetic Depth and the Incidence of Emergence Agitation in Children Undergoing Strabismus Surgery...
StrabismusThis study evaluates the association between the depth of general anesthesia and the occurrence of emergence agitation (EA). The investigators hypothesized that optimal level of anesthetic depth could decrease the incidence of EA in children undergoing strabismus surgery compared to the deep level of anesthetic depth.
Sleep Quality in Pregnancy and Its Impact on Pregnancy Outcomes
Obstructive Sleep ApneaPregnancy Induced Hypertension4 moreHypothesis:Sleep Disorders are very common during pregnancy but the their exact role in causation of pregnancy related disorders is yet to be determined. OSA can complicate pregnancy given the risk factors of weight gain, upper displacement of the diaphragm, and hormonal-induced hyperaemia of the nasopharyngeal passages. SDB confers the risk of hypertensive disorders of pregnancy and is associated with adverse maternal and foetal outcomes. The study would involve pregnant females which would be prospectively followed in pregnancy and post partum to know the prevalence of sleep disorders in pregnancy. Diagnosis of sleep disorders would be confirmed by overnight polysomnography and ambulatory blood pressure monitoring. Pregnancy outcomes, both maternal and fetal would be recorded and its relation with sleep disorders in pregnancy would be analysed.
Effect on RLS Symptom Severity After Switching to Neupro® in Patients Who Previously Experienced...
Restless Legs SyndromeThe objective is to assess the effect of Neupro® on the severity of Restless Leg Syndrome (RLS) symptoms and augmentation in patients with augmentation associated with previous oral dopaminergic therapy. In addition, the change in treatment regimen used when switching to Neupro® will be evaluated.
Sleep Disorders Managed and Assessed Rapidly in Transient Ischemic Attack (TIA) and In Early Stroke...
StrokeIschemic Attack4 moreThe aim of the investigators was to determine whether the immediate management of any detected sleep disorders can improve outcomes in patients who have had a transient ischemic attack (TIA) or minor stroke. This group of patients is at high risk for having a recurrent stroke or TIA, and the investigators would like to investigate new ways of preventing potentially avoidable events. The treatment of sleep disorders immediately after a stroke or TIA may prove to be a novel method of avoiding future strokes and improving outcomes.
Non-interventional Observational Study of Pramipexole in Restless Legs Syndrome: Impact on Quality...
Restless Legs SyndromeIn this German non-interventional observational study 1980 patients diagnosed with Restless Legs Syndrome (RLS) will be investigated by 990 General Practitioners across all federal states in Germany. Both moderate to severe RLS patients, with or without previous RLS treatment, suffering from RLS symptoms like a desire to move the extremities usually associated with some discomfort, motor restlessness and worsening of symptoms at rest with at least temporary relief by activity, worsening of symptoms later in the day or at night, are eligible for this study, if it is planned to initiate therapy with pramipexole or to add pramipexole to a previously given, insufficient therapy. Three visits are planned to be documented in this PMS study, one baseline visit, visit two after the end of pramipexole titration and visit three after 12 weeks of treatment. Evaluations and visits are to be carried out and documented only if part of routine medical practice. The main goal of observational studies is to determine how pramipexole treatment works when applied in actual practice and thus maximise external validity. In actual practice patients who have been excluded in the clinical registration trials of PPX in moderate to severe primary RLS (i.e. those with certain disease histories, co-morbidities and/or demographic characteristics) will be treated with PPX. Thus in addition during this observational study information on the efficacy and safety of PPX in those patients will be obtained. The objectives of this PMS study are: To evaluate the treatment effect of pramipexole on RLS severity and general improvement as measured by IRLS and CGI-I. To evaluate quality of life of RLS patients as measured by the Restless Legs Syndrome Quality of Life questionnaire (RLS-QoL). To evaluate the safety profile of PPX in a natural study population.
Sifrol (Pramipexole) Onset of Action and Impact: a 12-weeks Observational Study in Patients With...
Restless Legs SyndromeThe objectives of the Post Market Surveillance (PMS) study are to evaluate the treatment effect of pramipexole on Restless Legs Syndrome (RLS) severity as measured by International Restless Legs Rating Scale and Global Clinical Impression - Improvement, to evaluate the time to reaching maintenance dose of pramipexole