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Original Article Polysomnographic Findings into Sleep Disorders in Essential Tremor and Essential Tremor Plus: A Comparison with Healthy Controls
Ravi Prakash Singh1, Mythirayee S1, Doniparthi Venkata Seshagiri1, Gulshan Kumar2, Rohan Mohale1, Pramod Kumar Pal1, Bindu M Kutty2, Jitender Saini3, Nitish L Kamble1, Vikram Holla1, Ravi Yadav1corresp_icon

DOI: https://doi.org/10.14802/jmd.24191 [Accepted]
Published online: October 28, 2024
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1Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
2Centre for Consciousness Studies, Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
3Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
Corresponding author:  Ravi Yadav,
Email: docravi20@yahoo.com
Received: 13 September 2024   • Revised: 17 October 2024   • Accepted: 27 October 2024

Objective
To explore sleep patterns in individuals with Essential Tremor (ET) and Essential Tremor Plus (ET-Plus), compared to healthy controls, and assess differences between ET and ET-Plus, given the lack of established polysomnography (PSG) data on these groups and the potential for sleep disturbances to serve as clinical markers.
Methods
We conducted a prospective cross-sectional study at NIMHANS, Bengaluru, from November 2021 to August 2023 on 45 patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using TETRAS and FTMTRS, and sleep symptoms with ESS, PSQI, Mayo Sleep Questionnaire, RLS-Q, BQ, GAD-7 and PHQ-9. All cases and controls underwent overnight video PSG. Sleep scoring was manually done by a technically adequate sleep researcher and the first author following AASM (2022) guidelines with data analysed using R studio.
Results
ET patients exhibited younger onset age (30.8 ± 16.7 years) compared to ET-Plus patients (46.8 ± 11.1 years). ET-Plus had higher TETRAS and FTMRS scores (P < 0.001) than ET. Both ET and ET-Plus patients exhibited poorer sleep quality, excessive daytime sleepiness, REM sleep behavior disorder (RBD), and Restless Legs Syndrome (RLS) symptoms compared to controls. PSG findings supported these clinical observations, showing elevated Apnea-Hypopnea Index (AHI), reduced Total Sleep Time (TST), prolonged REM latency, decreased sleep efficiency, increased N1 stage duration, and reduced N2/N3 durations and percentages in patients versus controls.
Conclusion
The study highlights significant sleep architecture abnormalities in both ET and ET-Plus patients as compared to healthy controls, with no differences between the ET groups.

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