Clayton Sleep Institute

Abstract Introduction Tonic motor activation (TOMAC) is a noninvasive medical device therapy that has been shown to reduce symptoms of refractory restless legs syndrome (RLS). Here, we evaluated the effects of TOMAC on subjective sleep quality. Methods One hundred and thirty-three adults with primary moderate-severe refractory RLS were 1:1 randomized to TOMAC or sham control for 4 weeks. Participants were instructed to self-administer a 30-minute TOMAC session bilaterally over the head of the fibula to electrically stimulate the peroneal nerve whenever RLS symptoms presented. Sleep quality was assessed through prespecified analysis of changes to Medical Outcomes Study Sleep Scale (MOS-Sleep) Sleep Problems Index I (MOS-I) and II (MOS-II) scores from baseline to Week 4. Post hoc t-tests were conducted on each MOS-Sleep item included in the MOS-I or MOS-II. Results MOS-I score changed by -11.8 points (48.5 to 36.7) for TOMAC and -2.8 points for sham (44.5 to 41.7), a difference of -9.0 points (p< 0.001). MOS-II score changed by -13.7 points (52.5 to 38.9) for TOMAC and -4.0 points for sham (48.3 to 44.3), a difference of -9.7 points (p< 0.001), which exceeds the proposed minimal clinically important difference (MCID) of 6 points. Post hoc analysis demonstrated statistically significant reductions in trouble falling asleep (item #7; -34.0% for TOMAC vs. -5.8% for sham; p< 0.01) and trouble staying awake during the day (item #9; -33.6% for TOMAC vs. -2.1% for sham; p< 0.05), which exceeded the standard MCID threshold of 30% relative to baseline. Conclusion For adults with refractory RLS, TOMAC improved subjective sleep quality, sleep latency, and daytime somnolence relative to sham control. Each of these improvements represented clinically important improvements. These data demonstrate that TOMAC can provide meaningful improvements to sleep quality and daytime functioning for patients with refractory RLS. Support (if any) Funding was provided by Noctrix Health, Inc.

Electrocardiographic (ECG) measurements are commonly used to diagnose left ventricular (LV) hypertrophy in men, yet the validity of this practice has seldom been appraised in American-style football (ASF) athletes. PURPOSE: Evaluate the accuracy of five commonly used ECG criteria for LV hypertrophy – Murphy (AJC, 1984), Sokolow (AHJ, 1949), Gruber (Arch Intern Med, 1943), Cornell (Casale, JACC, 1985), and Cornell voltage-duration product (C-VDP) (Malloy, JACC, 1992) – to predict echocardiographically (ECHO) measured LV mass (LVM) in ASF athletes. METHODS: Resting12-lead ECG and ECHO procedures were performed on 62 collegiate ASF players first entering an NCAA Football Bowl Subdivision university; age=18±1 yr., ht=186±7 cm, wt=99.9±22.6 kg, BMI=28.6±5.0 kg·m2, and BSA=2.23±0.26 m2. Regression was used to predict ECHO-derived LVM and LVM/BSA from the five ECG criteria, and from the ECG criteria with BMI (+BMI) added to the model. RESULTS: Table (*p<0.01 for regression)Table: No title available.None of the ECG criteria alone were predictive of LVM or LVM/BSA in ASF athletes. Adding BMI to the regression significantly improved the predictive accuracy for LVM but not for LVM/BSA. CONCLUSION: ECG criteria alone are not useful in diagnosing LVH in ASF athletes. Our results suggest that adding demographic measures to the predictive model may improve diagnostic accuracy. Thus, new algorithms for evaluating LVM and LVH in ASF athletes should be explored using demographic, body habitus, cardiovascular, and other ECG criteria.

Abstract The fully symmetrical cubature rules developed and presented are at present the most economically available for numerical integration over the unit cube of complete polynomial functions up to and including nineteenth order. Conventional Gaussian triple product integration formulae, by comparison, require more than twice as many integration points and weights.