{
  "abstract": "Objective To present a single-subject study of sleep patterns experienced by an adult with Gilles de la Tourette Syndrome (GTS) over a fifteen-night study window.Methods A twenty-four-year-old male patient with a well-established diagnosis of GTS was referred to a tertiary-care neuropsychiatry outpatient clinic in relation to his vocalization. The vocalization consisted of a throat clearing utterance which occurred in bouts of either three or four and became progressively louder until the sequence ended. The intervention involved the patient using Sleep Cycle (a mobile application that relies on an accelerometer to monitor movements) which documents sleep stage patterns and detects and analyses sounds. The primary objective was to examine whether the vocalization occurs predominantly during certain sleep stages and how the vocalization is affected by sleep length and quality.Results The following main results are reported:[x] Vocalization Onset Time and Sleep Stage Pearson’s correlation coefficient was −0.807 (p < 0.001), indicating a significant linear relationship where deeper sleep stages are associated with reduced vocalization onset. Similarly, Spearman’s rho yielded a coefficient of −0.796 (p < 0.001), confirming a strong monotonic relationship. The results demonstrate that as the patient transitions between sleep stage, the timing and frequency of his vocalization significantly decreases.[x] Vocalization Onset Time and Sleep Quality Pearson’s correlation coefficient (r =0.221) indicated a weak positive linear relationship, suggesting that higher sleep quality might be associated with slightly later vocalization onset time. Similarly, Spearman’s Rho (ρ =0.216) showed a weak positive monotonic relationship between the two variables. However, neither correlation was statistically significant, with p-values of 0.429 and 0.440 for Pearson and Spearman, respectively.[x] Vocalization Onset Time and Time Asleep Pearson’s correlation coefficient (r =0.459) and Spearman’s Rho (ρ =0.497) both indicated a moderate positive relationship, suggesting that longer sleep duration is associated with a later onset of vocalization. While the findings hint at a potential association between increased sleep duration and delayed vocalization onset, the results were not of statistically significance (p =0.085 for Pearson and p =0.060 for Spearman).Conclusion The waxing and waning phenomena observed in GTS, high prevalence rate of psychiatric comorbidities, and various confounders can prevent methodologically precise studies being conducted. Future research could (i) aim to confirm these relationships and explore mechanisms underlying the observed effects and (ii) utilise more precise sleep measurement instruments with larger samples to clarify the relationship between tic onset and sleep patterns.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK",
        "University College London – Institute of Neurology, Queen Square, London, WC1N 3BG, UK"
      ],
      "name": "Dipesh Patel"
    },
    {
      "affiliations": [
        "Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK",
        "University College London – Institute of Neurology, Queen Square, London, WC1N 3BG, UK"
      ],
      "name": "Himanshu Tyagi"
    }
  ],
  "title": "#8168 Sleep patterns in Gilles de la Tourette syndrome: a case illustration",
  "uid": "f147cd8a-b206-513d-95f9-9023af68f598"
}