Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls. Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of “periodicity,” i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires. Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients. Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

The recording of slow pupillary oscillations in complete darkness is a promising approach for objective evaluation of daytime sleepiness at the physiological level. The aim of the present study was to analyze the magnitude of between- and within-subject variation of the pupillary unrest index (PUI) in a sample of healthy individuals.

Background: Studies on effects of radio frequency-electromagnetic fields (RF-EMF) on the macrostructure of sleep so far yielded inconsistent results. This study investigated whether possible effects of RF-EMF exposure differ between individuals.Objective: In a double-blind, randomized, sham-controlled cross-over study possible effects of electromagnetic fields emitted by pulsed Global System for Mobile Communications (GSM) 900 and Wideband Code-Division Multiple Access (WCDMA)/Universal Mobile Telecommunications System (WCDMA/UMTS) devices on sleep were analysed.Methods: Thirty healthy young men (range 18-30 years) were exposed three times per exposure condition while their sleep was recorded. Sleep was evaluated according to the American Academy of Sleep Medicine standard and eight basic sleep variables were considered.Results: Data analyses at the individual level indicate that RF-EMF effects are observed in 90% of the individuals and that all sleep variables are affected in at least four subjects. While sleep of participants was affected in various numbers, combinations of sleep variables and in different directions, showing improvements but also deteriorations, the only consistent finding was an increase of stage R sleep under GSM 900 MHz exposure (9 of 30 subjects) as well as under WCDMA/UMTS exposure (10 of 30 subjects).Conclusions: The results underline that sleep of individuals can be affected differently. The observations found here may indicate an underlying thermal mechanism of RF-EMF on human REM sleep. Nevertheless, the effect of an increase in stage R sleep in one third of the individuals does not necessarily indicate a disturbance of sleep. (C) 2015 Elsevier Inc. All rights reserved.

Background: TETRA (terrestrial trunked radio) is a digital radio communication standard, which has been implemented in several European countries and is used by public executives, transportation services, and by private companies. Studies on possible impacts on the users' health considering different exposure conditions are missing.Objectives: To investigate possible acute effects of electromagnetic fields (EMF) of two different levels of TETRA hand-held transmitter signals on cognitive function and well-being in healthy young males.Methods: In the present double-blind cross-over study possible effects of short-term (2.5 h) EMF exposure of handset-like signals of TETRA (385 MHz) were studied in 30 healthy male participants (mean +/- SD: 25.4 +/- 2.6 years). Individuals were tested on nine study days, on which they were exposed to three different exposure conditions (Sham, TETRA 1.5 W/kg and TETRA 6.0 W/kg) in a randomly assigned and balanced order. Participants were tested in the afternoon at a fixed timeframe.Results: Attention remained unchanged in two out of three tasks. In the working memory significant changes were observed in two out of four subtasks. Significant results were found in 5 out of 35 tested parameters, four of them led to an improvement in performance. Mood, well-being and subjective somatic complaints were not affected by TETRA exposure.Conclusions: The results of the present study do not indicate a negative impact of a short-term EMF-effect of TETRA on cognitive function and well-being in healthy young men. (C) 2015 Elsevier Inc. All rights reserved.

Background: Studies have shown that exposure to radiofrequency electromagnetic fields (RF-EMF) in the mobile communication frequency range may induce physiological modifications of both spontaneous as well as event-related human electroencephalogram. So far, there are very few peer-reviewed studies on effects of Terrestrial Trunked Radio (TETRA), which is a digital radio communication standard used by security authorities and organizations in several European countries, on the central nervous system.Objectives: To analyze the impact of simulated TETRA handset signals at 385 MHz on slow cortical potentials (SCPs).Methods: 30 young healthy males (25.2 +/- 2.7 years) were exposed in a double-blind, counterbalanced, cross-over design to one of three exposure levels (TETRA with 10 g averaged peak spatial SAR: 1.5 W/kg, 6.0 W/kg and sham). Exposure was conducted with a body worn antenna (especially designed for this study), positioned at the left side of the head. Subjects had 9 test sessions (three per exposure condition) in which three SCPs were assessed: SCP related to a clock monitoring task (CMT), Contingent negative variation (CNV) and Bereitschaftspotential (BP).Results: Neither behavioral measures nor the electrophysiological activity was significantly affected by exposure in the three investigated SCP paradigms. Independent of exposure, significant amplitude differences between scalp regions could be observed for the CMT-related SCP and for the CNV.Conclusions: The present results reveal no evidence of RF-EMF exposure-dependent brain activity modifications investigated at the behavioral and the physiological level. (C) 2015 Elsevier Inc. All rights reserved.

Background Sleep disturbance is a common characteristic of patients with post-traumatic stress disorder (PTSD). Besides the clinical descriptions of nightmares and insomnia, periodic limb movements (PLMs) are reported to co-occur in PTSD. Although the causal relationship between sleep disturbance and PTSD is not fully understood, sleep disturbance is an independent risk factor for the development and reactivation of PTSD. In contrast, the link between PTSD and REM sleep behaviour disorder (RBD) is less clear. Method A case report is presented to illustrate differential diagnosis and time course of sleep disturbance in the context of PTSD. Result A 63-year-old man who had been successfully treated for PTSD but who suffered the re-occurrence of disturbed sleep due to RBD and PLM, which was misdiagnosed as reactivation of PTSD. Conclusions RBD can mimic PTSD-related nightmares. Accurate diagnosis of sleep disturbance in PTSD is relevant for treatment and prognostic evaluation.

Results of studies on the possible effects of electromagnetic fields emitted by mobile phones on cognitive functions are contradictory, therefore, possible effects of long-term (7 h 15 min) electromagnetic field (EMF) exposure to handset-like signals of Global System for Mobile Communications (GSM) 900 and Wideband Code-Division Multiple Access (WCDMA) on attention and working memory were studied. The sample comprised 30 healthy male subjects (mean ± SD: 25.3 ± 2.6 years), who were tested on nine study days in which they were exposed to three exposure conditions (sham, GSM 900 and WCDMA) in a randomly assigned and balanced order. All tests were presented twice (morning and afternoon) on each study day within a fixed timeframe. Univariate comparisons revealed significant changes when subjects were exposed to GSM 900 compared to sham, only in the vigilance test. In the WCDMA exposure condition, one parameter in the vigilance and one in the test on divided attention were altered compared to sham. Performance in the selective attention test and the n-back task was not affected by GSM 900 or WCDMA exposure. Time-of-day effects were evident for the tests on divided and selective attention, as well as for working memory. After correction for multiple testing, only time-of-day effects remained significant in two tests, resulting in faster reactions in the afternoon trials. The results of the present study do not provide any evidence of an EMF effect on human cognition, but they underline the necessity to control for time of day.

Readers are encouraged to submit interesting and challenging clinical cases, accompanied by examples from sleep studies, images, sleep logs, actigraphy, and videos. The cases should be derived from real clinical encounters and illustrate a diagnostic or therapeutic dilemma. The general format is as follows, not to exceed 1000 words in total: