RESUMEN
BACKGROUND: Data regarding the epidemiology of secondary pulmonary hypertension are scanty. OBJECTIVES: To describe the spectrum and relative incidence of background diseases in patients with significant secondary PHT. METHODS: We identified 671 patients with systolic pulmonary artery pressure of 45 mm Hg or more from the database of the echocardiographic laboratory. Their background diseases were recorded and classified into three subgroups: cardiac, pulmonary and pulmonary vascular disease without pulmonary parenchymal disease. Age at the first echocardiographic study, gender and systolic PAP values were recorded. Data between the three subgroups were compared. RESULTS: The mean age of the patients was 65 +/- 15 years, mean systolic PAP 61 +/- 14 mm Hg and female:male ratio 1.21:1. At the time of diagnosis 85% of the patients were older than 50. PHT was secondary to cardiac disease in 579 patients (86.3%), to PVD without PPD in 54 patients (8%) and to PPD in only 38 patients (5.7%). Mean age and mean systolic PAP did not differ significantly among the three subgroups. There was a significantly higher female:male ratio in patients with PVD without PPD compared with cardiac or pulmonary diseases (1.7:1 vs. 1.2:1 and 1.7 vs. 0.8:1 respectively, P < 0.05). CONCLUSIONS: The majority of patients with significant PHT are elderly with heart disease. PVD without PPD and chronic PPD are a relatively uncommon cause of significant PHT. Since the diagnosis of PHT is of clinical significance and sometimes merits different therapeutic interventions, we recommend screening by Doppler echocardiography for patients with high risk background diseases.
Asunto(s)
Hipertensión Pulmonar/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ecocardiografía , Femenino , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Humanos , Hipertensión Pulmonar/diagnóstico , Enfermedades Pulmonares/complicaciones , Enfermedades Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Ultrasonografía DopplerRESUMEN
In a study of how physicians evaluate patient compliance, practitioner judgments were compared to the self-reports of 138 adult patients receiving treatment for pulmonary diseases at an outpatient clinic. The research found no significant relationship between physician evaluations of compliance and accounts given by the same patients. The conclusions of physicians regarding patient compliance proved to be influenced by their views on the seriousness of the condition and the effectiveness of treatments, but patient reports were different. Physicians clearly have difficulties in appraising the compliance behavior of their patients.
Asunto(s)
Cooperación del Paciente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Juicio , Masculino , Persona de Mediana Edad , MédicosRESUMEN
Pulmonary lymphangioleiomyomatosis (PLAM) is rare progressive, fatal interstitial lung disease, considered to be sex hormones related. We report a follow-up, after 19 years, in a patient with PLAM without intervention. Despite excessive oestrogen production during four pregnancies there was only mild deterioration of her respiratory disease. Patients with good functional reserve should be followed-up closely before deciding on hormonal ablative treatment.
Asunto(s)
Estrógenos/fisiología , Neoplasias Pulmonares/fisiopatología , Linfangioleiomiomatosis/fisiopatología , Embarazo/fisiología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Linfangioleiomiomatosis/diagnóstico , Linfangioleiomiomatosis/terapia , Persona de Mediana Edad , Pruebas de Función Respiratoria , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: This study was carried out to establish a reliable bank of information on the spectral characteristics of chest wall breath sounds from healthy men and women, both non-smokers and smokers. METHODS: Chest wall breath sounds from 272 men and 81 women were measured using contact acoustic sensors, amplifiers, and fast Fourier transform (FFT) based spectral analysis software. Inspiratory and expiratory sounds were picked up at three standard locations on the chest wall during breathing at flows of 1-2 l/s and analysed breath by breath in real time. RESULTS: The amplitude spectrum of normal chest wall breath sounds has two linear parts in the log-log plane--low and high frequency segments--that are best characterised by their corresponding regression lines. Four parameters are needed and are sufficient for complete quantitative representation of each of the spectra: the slopes of the two regression lines plus the amplitude and frequency coordinates of their intersection. The range of slopes of the high frequency lines was -12.7 to -15.2 dB/oct during inspiration and -13.4 to -20.3 dB/oct during expiration. The frequency at which this line crossed the zero dB level--that is, the amplitude resolution threshold of the system--was designated as the maximal frequency (Fmax) which varied from 736 to 999 Hz during inspiration and from 426 to 796 Hz during expiration with higher values in women than in men. The mean (SD) regression coefficient of the high frequency line was 0.89 (0.05). CONCLUSIONS: These data define the boundaries of normal chest wall breath sounds and may be used as reference for comparison with abnormal sounds.
Asunto(s)
Ruidos Respiratorios/fisiología , Adulto , Computadores , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Factores Sexuales , Fumar , EspirometríaRESUMEN
Sleep-wake cycles of 27 residents from the 800-bed Rambam hospital, which serves the northern part of Israel, were investigated by wrist-worn actigraphs. Fifteen subjects (aged 30.6 +/- 4.6) worked in wards with a "heavy" workload, and 12 (aged 35 +/- 2.6) in wards with a "light" load. There were significant differences among the residents in sleep duration. Residents working in the emergency room had the shortest sleep periods, and those working in "light" wards had the longest. There was no significant increase in sleep duration the day after the night "on call." Sleep duration was significantly negatively correlated with the number of new admissions, and with the subjective daily assessment of work load. It is concluded that residents working in wards with a heavy load suffer from chronic partial sleep deprivation, which should be taken into consideration in residents' work regulation.
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Internado y Residencia , Sueño , Carga de Trabajo , Adulto , Femenino , Humanos , Masculino , Factores de Tiempo , Tolerancia al Trabajo ProgramadoRESUMEN
During 1976-1988 we diagnosed sleep apnea syndrome (SAS) in 1,620 adult men and women monitored in the Technion sleep laboratories. Their age at the time of diagnosis ranged between 21 and 79 years. Fifty-seven patients (53 men and 4 women) had died by 1990, 53% due to respiratory-cardiovascular causes. The observed/expected (O/E) mortality rates, calculated for men only, revealed excess mortality of patients under 70 years old. Excess mortality was significant in the fourth and fifth decades (3.33, p < 0.002; 3.23, p < 0.0002, respectively). In patients older than 70 O/E was 0.33 (p < 0.0007). Hierarchical multivariate analysis with four fixed variables [age, body mass index (BMI), hypertension and apnea index] and four additional variables added manually one at a time (heart disease, lung disease, diabetes, apnea duration) was used to determine the predictors of death from all causes, cardiopulmonary causes and from myocardial infarction (MI). All four major variables were found to be significant predictors of mortality from all causes, in addition to lung disease and heart disease. Only age and BMI were significant predictors of cardiopulmonary deaths in addition to lung disease. Age, BMI and hypertension predicted MI deaths in addition to lung disease. These results were interpreted to suggest that SAS affects death indirectly, most probably by being a risk factor for hypertension.
Asunto(s)
Síndromes de la Apnea del Sueño/mortalidad , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , Enfermedades Cardiovasculares/complicaciones , Electroencefalografía , Femenino , Humanos , Hipertensión/complicaciones , Enfermedades Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/complicaciones , Insuficiencia Respiratoria/complicaciones , Factores de Riesgo , Factores Sexuales , Síndromes de la Apnea del Sueño/complicacionesRESUMEN
A new clinical indication for GnRH-a treatment seems to exist in addition to the many indications known so far. The successful treatment of cyclic severe attacks of bronchial asthma during ovulation and the menstrual periods with a GnRH-a is described. A 45-year-old woman with long-standing bronchial asthma was hospitalized because of severe bronchial asthma and status asthmaticus 11 times during the 5 months before her referral. The hospitalizations were either during the ovulatory or menstrual period, and in two of them they were so grave to require artificial ventilation through an endotracheal tube. To induce pituitary-ovarian desensitization and amenorrhea, the patient was put on monthly injections of depot GnRH-a, which she has been receiving for the last 20 months. Subjective improvement was accompanied by a significant improvement in spirometric indices, by lack of hospitalizations, and decrease in glucocorticoid daily dosage. Although a trial of sequential add-back HRT was unsupportable because of respiratory aggravation, low-dose continuous HRT was tolerated by the patient. In light of the dramatic subjective and objective improvement in association with the GnRH-a treatment, we conclude that this new application deserves further experience.
Asunto(s)
Asma/tratamiento farmacológico , Asma/fisiopatología , Hormona Liberadora de Gonadotropina/análogos & derivados , Ciclo Menstrual , Pamoato de Triptorelina/uso terapéutico , Femenino , Volumen Espiratorio Forzado , Humanos , Persona de Mediana EdadRESUMEN
Lung sounds (LS) analysis is a potential source of additional objective, noninvasive and quantitative information on the status of the pulmonary system. We have examined the hypothesis that the addition of lung sounds analysis to spirometry increases the sensitivity of objective population screening, as compared to the use of spirometry alone. Questionnaires, spirometry and lung sounds were obtained in 493 active workers. Lung sounds analysis consisted of the averaged power spectra of breath sounds, measured separately during inspiration and expiration at four standard locations over the trachea and the chest-wall. Of the 493 subjects, 91 had an obstructive lung disease, including 27 with chronic bronchitis identified by a history of prolonged cough and sputum production but with normal spirometry. Twelve additional workers had a restrictive lung disease. Abnormal spirometric results were found in 74 of the patients. Abnormal lung sounds analyses were found in 54 patients, including 14 of the chronic bronchitis cases, so that the overall sensitivity of objective screening tests increased from 71% to 87% by combining the two tests. Thirty three of the subjects considered normal by evaluation of their questionnaire and spirometry had abnormal lung sounds. Of the twenty four who were re-evaluated 12-18 months after the first tests, three had developed a lung or heart disease. We conclude that the combination of spirometry and lung sounds analysis significantly increased the sensitivity of detection of pulmonary diseases by objective tests, and provided an early sign of lung disease that was not detected by spirometry alone.
Asunto(s)
Enfermedades Pulmonares Obstructivas/diagnóstico , Pruebas de Función Respiratoria/métodos , Ruidos Respiratorios/fisiología , Espirometría , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Encuestas y CuestionariosRESUMEN
Transbronchial biopsy (TBB) has been considered to be inadequate for the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). We describe herein two patients with interstitial pulmonary disease in whom the diagnosis of BOOP was achieved by TBB. The two patients presented with progressive dyspnea, cough, tachypnea, and fine end-inspiratory crackles. The radiologic findings disclosed patchy alveolar infiltrates. Pulmonary function tests showed a restrictive pattern and decreased diffusing capacity. The pathologic findings disclosed bronchioles, alveolar ducts, and alveoli infiltrated with mononuclear cells. The lumina were obliterated with fibroblasts and loose granulation tissue. Corticosteroid treatment resulted in significant improvement. Transbronchial biopsy should be considered as a useful diagnostic tool for BOOP.
Asunto(s)
Biopsia , Bronquiolitis Obliterante/diagnóstico , Pulmón/patología , Neumonía/diagnóstico , Adolescente , Anciano , Bronquiolitis Obliterante/complicaciones , Femenino , Humanos , Neumonía/complicacionesRESUMEN
OBJECTIVE: To define the basis for the conflicting reports on the prognosis of lung cancer in young adults. DESIGN: Retrospective review of lung cancer patients between 1977 and 1988. SETTING: Medical centers in Chicago (Northwestern Memorial Hospital), northern Israel (Rambam Medical Center), and northern Italy (S. Anna and U. of Pavia Hospitals). PATIENTS: Patients were < or = 45 years of age with a diagnosis of primary lung cancer identified from tumor registry records, pathology reports, and hospital charts, plus a sample of patients > 45 years of age. MEASUREMENTS AND MAIN RESULTS: In Chicago, younger patients had a higher incidence of chest pain, fever, and neurologic symptoms at presentation than the older patients, and fewer were asymptomatic. They also had more lower lobe lesions on chest roentgenogram, a higher incidence of adenocarcinoma, more advanced disease, an increased likelihood of receiving chemotherapy, and reduced survival (p < 0.03). The poorer prognosis was due to more advanced disease at presentation. In Israel, younger patients more frequently presented with stage I disease than the older patients and they had a higher incidence of adenocarcinoma, an increased likelihood of receiving treatment especially surgery, and better survival (p < 0.02). There were no differences between the two age groups for symptoms, symptom duration, and chest roentgenogram findings. Compared with the younger patients in Chicago and Israel, those from northern Italy had more squamous cell cancers and fewer adenocarcinomas, more commonly presented with stage I or II disease, received radiation therapy less frequently, and were given supportive care more often. Survival was low and comparable to that reported from Chicago. CONCLUSION: Differences exist in the clinical characteristics, pathologic findings, and prognosis of younger and older patients with lung cancer from the same region and of younger patients from different regions. The difference in prognosis is related in part to the stage of disease at presentation and the ability to undergo resectional surgery.
Asunto(s)
Carcinoma Broncogénico/epidemiología , Carcinoma Broncogénico/patología , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/patología , Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Adulto , Factores de Edad , Carcinoma Broncogénico/terapia , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Chicago/epidemiología , Terapia Combinada , Femenino , Humanos , Israel/epidemiología , Italia/epidemiología , Pulmón/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Factores Sexuales , Fumar/epidemiología , Tasa de SupervivenciaRESUMEN
Pulmonary Siderosis results from inhalation of iron dust or fumes. It falls into the group of pneumoconioses in which the pulmonary reaction is minimal despite a heavy dust load. Since fibrosis is not caused by inhalation of iron dust, the clinical course is benign and pulmonary function tests and blood gases are within normal limits. We report the first case of sideropneumoconiosis from Israel, in a 39-year-old iron welder. Since this condition is still not recognized as an occupational disease in Israel, the aim of this presentation is to bring it to appropriate medical attention.
Asunto(s)
Hierro , Exposición Profesional/efectos adversos , Siderosis/etiología , Soldadura , Adulto , Polvo/efectos adversos , Humanos , Israel , MasculinoRESUMEN
Nonspecific pleuritis, i.e., inflammation of the visceral pleura, is recognized by the presence of pleural strands on the routine posteroanterior chest radiograph. The computed tomograph counterparts of these strands are seen as interlobular septal intrusions and lenticular or wedge-shaped subpleural opacities. The pleural reaction is nonspecific and may be found with asbestos exposure, traumatic hemorrhagic effusions, pulmonary embolism, viral pleurisy, malignant pleural effusions, and lupus or rheumatoid effusions. The asbestos-related pleural changes may be found alone or in association with parietal pleural plaque formation or with asbestotic lung fibrosis.
Asunto(s)
Amianto/efectos adversos , Enfermedades Profesionales/diagnóstico por imagen , Pleuresia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Humanos , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Pleuresia/etiologíaRESUMEN
38 patients with sleep apnea syndrome treated with uvulopalato-pharyngoplasty were interviewed 23 +/- 10.8 months after the operation (mean age 48.0 +/- 8.6 years, range 28-65). 22 were also studied in the sleep laboratory 10 +/- 10.7 months after operation. 3 months after operation 94% reported improvement in snoring and 77% improvement in excessive daytime sleepiness. 1 and 2 years after the operation snoring had decreased to 74% and 65%, respectively, and excessive sleepiness to 65%, for both periods. There was a decrease of at least 50% in the number of apneic periods per hour of sleep in 68%. Side-effects consisted of nasal regurgitation and vocal changes. Only age was of predictive value: the younger the patient the better the response.
Asunto(s)
Paladar Blando/cirugía , Faringe/cirugía , Síndromes de la Apnea del Sueño/cirugía , Úvula/cirugía , Adulto , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
Death rates from a number of diseases linked epidemiologically to tobacco use continue to rise despite major reductions in per capita tobacco consumption, despite reductions in the total number of smokers, and despite very significant reductions in "tar", in other tumorigens and in essentially all classes of potential toxins in smoke delivered to the consumer. One concern is that smokers consume low delivery cigarettes differently and in a potentially more hazardous way than higher delivery cigarettes. The effect of nicotine reduction in cigarettes on human smoking behavior was studied in 102 human subjects by quantifiable determinants of tobacco-smoking behavior. This study indicates that reduction in nicotine delivery results in some accommodation in smoking behavior to titrate nicotine needs. In addition, smokers appear to adjust their smoking behavior as a function of taste preference, and this adjustment is as strong as the accommodation for nicotine. The theoretical application of these observations to the development of successful smoking cessation strategies is reviewed.
Asunto(s)
Conducta , Nicotina/sangre , Prevención del Hábito de Fumar , Fumar/sangre , Administración por Inhalación , Adulto , Carboxihemoglobina/metabolismo , Femenino , Humanos , Masculino , Monitoreo Fisiológico , Nicotina/administración & dosificación , Factores Sexuales , Fumar/psicología , Volumen de Ventilación Pulmonar/fisiologíaRESUMEN
A case is presented where a young man who was treated for Hodgkin's disease presented with a new pulmonary infiltrate. The infiltrate was diagnosed as recurrent Hodgkin's disease by means of endobronchial brush cytology via fiberoptic bronchoscopy.
Asunto(s)
Bronquios/patología , Enfermedad de Hodgkin/patología , Neoplasias Pulmonares/patología , Adulto , Biopsia/métodos , Broncoscopía/métodos , Humanos , MasculinoRESUMEN
The inhalation of platelet activating factor (PAF) produces bronchoconstriction in normal and asthmatic subjects. To identify the mechanism by which PAF-induced bronchoconstriction occurs in humans, bronchoprovocation testing was performed in 7 subjects (3 normal, 4 with mild asthma) after pretreatment with phosphate-buffered saline (PBS), atropine, chlorpheniramine, or indomethacin. We determined the nebulizer concentration of PAF which reduced specific airway conductance (SGaw) 35% (PC35 SGaw) and the slope of the PAF dose-response curve. Atropine produced baseline bronchodilatation (SGaw increased 50%), while chlorpheniramine and indomethacin had no effect on baseline pulmonary function. Atropine increased airway responsiveness to PAF: the PC35 SGaw decreased 40% (p less than 0.05) and the slope of the PAF dose-response curve increased 86% (p less than 0.05). In contrast, chlorpheniramine inhibited the airway response to PAF: the PC35 SGaw increased 87% (p less than 0.05), while the slope of the PAF dose-response curve decreased an insignificant 37%. Indomethacin did not affect either measurement. Chlorpheniramine also prevented the PAF-induced facial flushing and feeling of warmth; atropine and indomethacin did not. These results suggest that PAF-induced bronchoconstriction in humans is mediated at least in part by histamine release, not by cholinergic or cyclooxygenase-dependent mechanisms. Other indirect effects, such as the release of sulfidopeptide leukotrienes, or a direct effect on airway smooth muscle may also contribute to PAF-induced bronchoconstriction. Why atropine heightened the airway response to PAF is unclear.
Asunto(s)
Bronquios/fisiología , Factor de Activación Plaquetaria/farmacología , Adolescente , Adulto , Asma/fisiopatología , Atropina/farmacología , Bronquios/efectos de los fármacos , Bronquios/fisiopatología , Pruebas de Provocación Bronquial , Clorfeniramina/farmacología , Relación Dosis-Respuesta a Droga , Humanos , Indometacina/farmacología , Pruebas de Función RespiratoriaRESUMEN
Platelet-activating factor (PAF) is an inflammatory mediator that causes bronchial smooth muscle contraction in vitro and in vivo in experimental animals. To characterize the effect of PAF on human airways, 6 normal subjects and 6 subjects with mild asthma inhaled PAF using a standard bronchoprovocation protocol and nebulizer concentrations ranging from 0.1 to 1000 micrograms/ml. Aerosolized PAF produced bronchoconstriction in 5 of 6 normal and 3 of 6 asthmatic subjects as defined by at least a 35% decrease in specific airway conductance (SGaw). However, in these same subjects, flow rates measured at 30% of vital capacity from a partial forced expiratory maneuver (V30P) did not decrease at least 30% nor did the FEV1 decrease by 20%. The 8 PAF responders were 5 to 836 times more sensitive to PAF than to methacholine when SGaw was used to assess the airway response. The relative airway sensitivity of the PAF nonresponders could not be assessed. Normal and asthmatic subjects could not be differentiated by their airway response to PAF, and there were no clinical features that differentiated PAF responders from nonresponders. The maximal airway response to PAF occurred within 2 to 3 min and lasted 15 to 45 min. There were no late reactions. Both normal (p less than 0.01) and asthmatic (p less than 0.05) subjects exhibited tachyphylaxis to PAF. Finally, PAF sensitized the airways of all normal subjects to methacholine, including the one PAF nonresponder (p less than 0.02), but it did not sensitize the airways of the asthmatic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Resistencia de las Vías Respiratorias , Asma/fisiopatología , Bronquios/fisiopatología , Factor de Activación Plaquetaria/fisiología , Adolescente , Adulto , Aerosoles , Resistencia de las Vías Respiratorias/efectos de los fármacos , Pruebas de Provocación Bronquial , Femenino , Flujo Espiratorio Forzado , Volumen Espiratorio Forzado , Humanos , Masculino , Cloruro de Metacolina , Compuestos de Metacolina/farmacología , Factor de Activación Plaquetaria/farmacología , TaquifilaxisRESUMEN
Exposure to asbestos is an important public health hazard in all industrialized societies. Although the pulmonary manifestations of prolonged asbestos fiber exposure are well known, there is considerable disagreement over specific clinical features and employment policies. Three of these controversies are the following: a) Can lung cancer be ascribed to asbestos exposure in subjects who lack evidence of asbestosis? b) Is there any clinical significance to benign asbestos pleural changes? c) Is it advisable to change jobs when evidence of asbestosis or benign pleural changes develop? The purpose of this presentation is to help develop a suitable public policy for Israel. Such a policy would have clinical importance as well as economic, legal, and social consequences for the individual and society as a whole.
Asunto(s)
Amianto/efectos adversos , Enfermedades Pulmonares/etiología , Asbestosis/etiología , Calcinosis/etiología , Fibrosis/etiología , Humanos , Israel , Neoplasias Pulmonares/etiología , Enfermedades Profesionales/etiología , Enfermedades Pleurales/etiología , Derrame Pleural/etiología , Política PúblicaRESUMEN
In the last 2 years we have systematically treated 31 sleep apnea patients with 25-50 mg imipramine HCl given 30 min before bedtime. Imipramine treatment was attempted for nonoverweight patients with negative ear, nose and throat (ENT) findings and for patients who had not responded to weight reduction or ENT surgery (in all patients the apneas were not considered life threatening). Thirteen of the 31 (41.9%) patients, of whom 9 had central apnea, reported subjective improvement in diurnal and nocturnal symptoms within 10-15 days from the initiation of treatment. Sleep laboratory recordings conducted 1-5 months after the beginning of treatment revealed a significant decrease in the total number of apneas from 242 +/- 156 to 142.8 +/- 120.1 (p less than 0.01) in these patients. We concluded that treatment with imipramine may benefit selected sleep apnea patients particularly of the central type.
Asunto(s)
Imipramina/uso terapéutico , Síndromes de la Apnea del Sueño/tratamiento farmacológico , Adulto , Peso Corporal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Protriptilina/uso terapéuticoRESUMEN
Periodic leg movements in sleep were diagnosed in 8 patients with insomnia and in 12 patients with hypersomnia. Polysomnography did not reveal any difference in the number of leg movements in these groups, the mean duration of a leg movement, or the number of activity epochs. Those with insomnia, however, had a shorter intermovement interval than those with hypersomnia, with more leg movements in each activity epoch. Treatment with 0.5 to 2 mg clonazepam improved subjective complaints and decreased the number of leg movements without affecting the intermovement interval or movement duration.