Insomnia, sleep fragmentation and excessive daytime sleepiness are common in Parkinson's disease (PD) and may contribute to the reduction of cognition and alertness in those patients. Melatonin has been shown to improve sleep in several conditions. In experimental models of PD, melatonin can ameliorate motor symptoms. To evaluate the effect of melatonin on sleep and motor dysfuntion in PD, we studied 18 patients (Hoehn & Yahr I to III) from a PD clinic. Prior to treatment, motor dysfunction was assessed by UPDRS II, III and IV. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) and daytime somnolence by the Epworth Sleepiness Scale (ESS). Full polysomnography (PSG) was performed in all subjects. Patients were then randomized to receive melatonin (3mg) or placebo one hour before bedtime for four weeks. All measures were repeated at the end of treatment. On initial assessment, 14 patients (70%) showed poor quality sleep (PSQI > 6) and eight (40%) excessive daytime sleepiness (ESS > 10). Increased sleep latency (50%), REM sleep without atonia (66%), and reduced sleep efficiency (72%) were found on PSG. Eight patients had an apnea/ hipopnea index greater than 15 but no severe oxygen desaturation was observed. Sleep fragmentation tended to be more severe in patients on lower doses of levodopa (p = 0.07). Although melatonin significantly improved subjective quality of sleep (p = 0.03) as evaluated by the PSQI index, PSG abnormalities were not changed. Motor dysfunction was not improved by the use of melatonin. Undetected differences in motor scores and PSG findings may have been due to a small sample size and a type II error.

OBJECTIVE -To investigate the presence of restless legs syndrome (RLS) and the quality of sleep in a population of type 2 diabetic patients.RESEARCH DESIGN AND METHODS -The study population was composed of 100 consecutive patients regularly attending a diabetes clinic at the University Hospital of the Federal University of Ceará. The subjects' quality of sleep was assessed by the Pittsburgh Sleep Quality Index, and excessive daytime sleepiness (EDS) was measured by the Epworth Sleepiness Scale. The RLS was diagnosed using the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Other relevant clinical and laboratory parameters were obtained by interview and chart review.RESULTS -RLS was found in 27% of patients. Poor sleep quality was present in 45% of cases and was associated with age (P ϭ 0.04), peripheral neuropathy (P ϭ 0.001), and RLS (P ϭ 0.000). EDS was found in 26% of patients. Logistic regression analysis revealed an association between RLS and peripheral neuropathy (odds ratio 12.85 [95% CI 2.83-58.40], P ϭ 0.001).CONCLUSIONS -RLS is common in type 2 diabetic patients and can be a major cause of sleep disruption in these patients. Diabetes Care 28:2633-2636, 2005 Diabetes is a lifelong disease of increasing incidence in the Western world and is frequently comorbid with other disorders such as retinopathy, peripheral neuropathy, and nephropathy (1,2). Most patients develop diabetes after age 40 years, and, although much progress has been made in therapy, the majority of diabetic patients continue to die from macrovascular complications (i.e., cardiovascular disease) (3).Recently it has become clear that sleep disturbances (e.g., chronic insomnia, sleep apnea) have a major impact on health and quality of life; this adverse impact can usually be reversed by adequate diagnosis and treatment (4). Neuropathy may also contribute to the significant reduction in quality of life for patients (5).These problems are frequently overlooked on routine medical interviews; furthermore, in some cases, short-term disturbances of sleep may evolve into chronic conditions (6). The indiscriminate use of sleeping pills may further disrupt the sleep-wake cycle and contribute to stress in patients with sleep disorders (7). In type 2 diabetes, sleep disturbances are believed to be common (8) and have been attributed to impaired glucose metabolism and general physical distress (9).Restless legs syndrome (RLS) is a common neurological condition characterized by unpleasant sensations deep inside the legs that occur at rest, especially at bedtime (10,11). The paresthesias are accompanied by an irresistible urge to move the limbs, with movement temporarily relieving the symptoms (12,13). RLS patients experience discomfort and complain of disturbances in initiating and maintaining sleep, sleepiness, and lessrefreshing sleep (14). The intensity of sensory and motor symptoms can vary throughout a patient's lifetime but generally tends to increase with advancing age. RLS has been reported in association ...

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