Sleep disorders major

Restless-legs syndrome occurs in 5% to 15% of the population, making it a common sleep disorder.11,12 The prevalence of RLS increases with age and in various medical conditions such as end-stage renal disease (ESRD), pregnancy, and iron deficiency.13 RLS appears to be more common in women than in men and has a genetic link. The majority of RLS patients (63% to 92%) report a positive family history.14... 

The etiology of enuresis is poorly understood, but there is a clear genetic link. The incidence in children from families in whom there are no members with enuresis, where one parent had enuresis as a child, and where both parents had enuresis as children are 14%, 44%, and 77%, respectively. Loci for enuresis have been located on chromosomes 12,13, and 22. Sleep disorders are not considered major contributors with the exception of sleep apnea. Enuresis occurs in all sleep stages in proportion to the time spent in each stage. However, a small proportion of individuals are not aroused from sleep by bladder distention and have uninhibited bladder contractions preceding enuresis. 

Melatonin receptor agonists and their relevance for the treatment of sleep disorders and major depression have been previously reviewed in Ann. Rep. Med. Chem., volume 39 [29]. Since then, ramelteon has been approved, representing an important milestone for the proof of concept of this target, and has opened new possibilities for research. 

The International Classification of Sleep Disorders lists 88 types, with insomnia the most prominent symptom for many of these (17). Chronic insomnia is the most common sleep problem for which patients consult practitioners (18) and usually reflects psychological/ behavioral disturbances ( 19). Differences in treatment recommendations support the distinction between DSM-IV and the International Classification for Sleep Disorders ( 20). The DSM-IV divides primary disorders into two major groups the dyssomnias (in which the predominant disturbance is the amount, quality, or timing of sleep) and the parasomnias (in which the predominant disturbance is an abnormal event occurring during sleep) (7). 

The three most common types of depression are major depression, dysthymia, and bipolar disorder. Major depression, which may occur once but usually occurs several times in a person s life, will interfere with the ability to work, eat, sleep, study, and take pleasure in formerly enjoyed activities. Dysthymia is less severe than major depression but will interfere with feeling good and functioning well. Bipolar disorder (formerly called manic-depression) can be more serious than the other forms of depression. In this illness the person s mood swings from symptoms of depression to extreme excitement with over-activity and feelings of elation. This type of depression can progress to serious mental illness if not treated. 

Sleep disorders are common, and are generally underdiagnosed. The two major complaints related to sleep are insomnia ( I can t sleep ) and excessive daytime sleepiness (EDS, I can t stay awake ). EDS is a relatively nonspecific symptom. It can be the end result of any factor that causes sleep disruption, and it can be caused by primary or intrinsic sleep disorders. Insomnia of any cause can result in sleep deprivation and subsequent EDS. The most common cause of EDS in the general population is self-imposed sleep deprivation, or insufficient sleep syndrome. By contrast, the most common causes of EDS seen in a sleep center are primary (intrinsic) disorders of EDS. The American Academy of Sleep Medicine (AASM, formerly the American Sleep Disorders Association) classification of sleep disorders includes over 80 diagnoses that are associated with EDS, but the majority of patients evaluated at sleep centers have sleep apnea, narcolepsy, idiopathic hypersomnia, or periodic limb movements of sleep. 

Abnormal sleep-onset REM periods, which occur within 15 min of sleep onset, are of major importance in the diagnosis of narcolepsy. Other causes of sleep-onset REM periods, such as sleep deprivation or other sleep disorders (e.g., obstructive sleep apnea), must be excluded (28). 

III. Major Sleep Disorders, Arousals, and Consequent Sleep Deprivation... 

Many studies looked at traffic accidents among patients suffering from sleep disorders. It is worth noting that these studies, for the vast majority, used cohorts of patients and had very little or no connections with police forces. It is therefore very hard to get information on the nature of the accident (sleep-related) or even the degree of responsibility of the driver. 

Obviously, sleep disorders are a major cause of traffic accidents because of their prevalence but also because of their danger (high-risk ratio of death and injury). If OS AS is a well-covered field, other diseases such as narcolepsy and hypersomnias are not as frequently investigated. This could be explained by the low prevalence and therefore the limited public-health impact of accidents generated by these patients. We strongly believe that research must be conducted in this field to provide better information on the driving aptitude of these patients. 

There are two major diagnostic manuals that provide classification systems for sleep disorders and define criteria for insomnia conditions the DSM-IV and the ICSD. Both manuals employ different terminology to label insomnia conditions, and present varying ways to define insomnia. 

Both prescription and non-prescription medications for pediatric sleep problems are commonly recommended and used by both health care practitioners and parents in the United States and in Europe [1, 12-15], However, several studies suggest that in clinical practice these medications may not always be used appropriately, or for indications that are warranted [16, 17]. Health care providers are also hampered by the lack of information related to the safety, efficacy and tolerability of various classes of medications. The commonly used medications in various pediatric sleep disorders are discussed below. It is important to emphasize that the majority of these medications have not undergone controlled studies or systematic review to document their efficacy in pediatric sleep disorders. Furthermore, it should be noted that, by and large, these medications are most appropriately used in conjunction with established behavioral sleep strategies [1, 18, 19]. 

Secondary insomnia is the most frequent form of insomnia. The determinants of secondary insomnia can be grouped into the following categories (1) mental disorders (2) neurological diseases (3) medical conditions and (4) abuse of drug-or medication-induced sleep disorder [15]. A list of major factors is included as Tab. 1. 

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