Objective: To further explore the effects of sodium oxybate (SXB) administration on nocturnal sleep in narcolepsy patients during a double-blind, placebo-controlled, parallel group study conducted with 228 adult patients with narcolepsy/cataplexy in the United States, Canada, and Europe. Method: Patients were withdrawn from antidepressants and sedative/hypnotics, and then randomized to receive 4.5, 6, or 9 g SXB or placebo nightly for 8 weeks. Patients receiving 6 and 9 g/night doses were titrated to their final dose in weekly 1.5 g increments, while patients receiving placebo were randomized to undergo a similar mock dose titration. The use of stimulant therapy continued unchanged. Changes in sleep architecture were measured using centrally scored nocturnal polysomnograms. Daily diaries were used to record changes in narcolepsy symptoms and adverse events. Results: Following 8 weeks of SXB treatment, study patients demonstrated significant dose-related increases in the duration of stage 3 and 4 sleep, reaching a median increase of 52.5 minutes in patients receiving 9 g nightly. Compared to placebo-treated patients, delta power was significantly increased in all dose groups. Stage 1 sleep and the frequency of nocturnal awakenings were each significantly decreased at the 6 and 9 g/night doses. The changes in nocturnal sleep coincided with significant decreases in the severity and frequency of narcolepsy symptoms. Conclusions: The nightly administration of SXB to narcolepsy patients significantly impacts measures of slow wave sleep, wake after sleep onset, awakenings, total sleep time, and stage 1 sleep in a dose-related manner. The frequency and severity of narcolepsy symptoms decreased with treatment. Citation: Black J; Pardi D; Hornfeldt CS; Inhaber N. The nightly use of sodium oxybate is associated with a reduction in nocturnal sleep disruption: a double-blind, placebo-controlled study in patients with narcolepsy. J Clin Sleep Med 2010;6(6):596-602.
Black, Jed; Pardi, Daniel; Hornfeldt, Carl S.; Inhaber, Neil
ObjectivePrevious studies have suggested that sleep disturbance may be the “hallmark of posttraumatic stress disorder,” although several investigations have failed to find evidence for sleep disruption. The purpose of this study was to determine whether intense averse stimulation during early development, in the form of physical and\\/or sexual abuse, led to disruption of sleep and nocturnal activity.
CAROL A. GLOD; MARTIN H. TEICHER; CAROL R. HARTMAN; THOMAS HARAKAL
Subjective and objective sleep disturbance was studied in children with nocturnal asthma. Relations between such disturbance and daytime psychological function were also explored, including possible changes in learning and behaviour associated with improvements in nocturnal asthma and sleep. Assessments included home polysomnography, parental questionnaires concerning sleep disturbance, behaviour, and mood and cognitive testing. Compared with matched controls, children with asthma had significantly more disturbed sleep, tended to have more psychological problems, and they performed less well on some tests of memory and concentration. In general, improvement of nocturnal asthma symptoms by changes in treatment was followed by improvement in sleep and psychological function in subsequent weeks. The effects of asthma on sleep and the possible psychological consequences are important aspects of overall care.??
Stores, G; Ellis, A; Wiggs, L; Crawford, C; Thomson, A
Background: Nocturnal reflux is important in the pathogenesis of esophagitis. The relationship between reflux and sleep is\\u000a poorly understood, although data support both paradigms of nocturnal reflux causing arousal and nocturnal arousal allowing\\u000a reflux. Furthermore, the effect of fundoplication on sleep is unknown. Methods: Seven volunteers and 11 patients with gastroesophageal\\u000a reflux disease (GERD) and nocturnal symptoms were studied with
J. A. Cohen; A. Arain; P. A. Harris; D. W. Byrne; M. D. Holzman; K. W. Sharp; W. O. Richards
Objectives: The purpose of this study was to assess nocturnal sleep latencies among narcoleptics.Methods: Thirteen narcoleptics and matched sleepy and alert controls participated in this study. Subjects were awakened three times on each of two experimental nights. The latencies to sleep and rapid eye movement sleep were evaluated at the beginning of the night and following each experimental awakening.Results: The
K. Nykamp; L. Rosenthal; T. Helmus; R. Gerhardstein; R. Day; T. Roehrs; M. L. Syron; T. Roth
The present experiments in 10 healthy men compared auditory evoked potentials (AEPs) and heart rate (HR) indicators of stimulus processing during early and late phases of nocturnal stage 2 sleep. Definition of early and late sleep relied on endocrine pituitary-adrenal secretory activity which is known to be inhibited during early nocturnal sleep but sharply increases during late sleep. AEPs and HR responses were recorded to trains of 10 tone pips (1000 Hz; interstimulus interval 15 s; intertrain interval > 3 min). On one night, tone pips were presented in the first part of sleep, on the other night tone presentation took place in the second part, with the order of conditions balanced across subjects. Amplitudes of N150 and N550 components of the AEP, and of acceleratory and deceleratory HR responses, were higher during the first than second part of nocturnal sleep (P < 0.05). Moreover, habituation of P240 and N550 amplitudes was slower during the first than second part of sleep (P < 0.05). In supplementary experiments, AEP and HR responses to the same stimuli did not differ between the first and second part of the night when subjects were waking during stimulation. Results indicate a reduced inhibitory control over cortical stimulus processing during early nocturnal sleep. This diminished inhibition of cortical processing together with other concomitant changes during early sleep (such as the enhanced inhibition of pituitary-adrenal secretion) may reflect a coordinated regulatory function of sleep possibly mediated by hippocampal mechanisms. PMID:8862114
Plihal, W; Weaver, S; Mölle, M; Fehm, H L; Born, J
Effective sleep/wake schedules for space operations must balance severe time constraints with allocating sufficient time for sleep in order to sustain high levels of neurobehavioral performance. Developing such schedules requires knowledge about the relationship between scheduled "time in bed" (TIB) and actual physiological sleep obtained. A ground-based laboratory study in N=93 healthy adult subjects was conducted to investigate physiological sleep obtained in a range of restricted sleep schedules. Eighteen different conditions with restricted nocturnal anchor sleep, with and without diurnal naps, were examined in a response surface mapping paradigm. Sleep efficiency was found to be a function of total TIB per 24 h regardless of how the sleep was divided among nocturnal anchor sleep and diurnal nap sleep periods. The amounts of sleep stages 1+2 and REM showed more complex relationships with the durations of the anchor and nap sleep periods, while slow-wave sleep was essentially preserved among the different conditions of the experiment. The results of the study indicated that when sleep was chronically restricted, sleep duration was largely unaffected by whether the sleep was placed nocturnally or split between nocturnal anchor sleep periods and daytime naps. Having thus assessed that split-sleep schedules are feasible in terms of obtaining physiological sleep, further research will reveal whether these schedules and the associated variations in the distribution of sleep stages may be advantageous in mitigating neurobehavioral performance impairment in the face of limited time for sleep.
Mollicone, Daniel J.; Van Dongen, Hans P. A.; Dinges, David F.
Parasomnias are sleep-related abnormal behaviors. They are frequent and overlooked causes of nocturnal disruptive behavior in the elderly, especially when patients are cognitively impaired. Confusion and violence can result in sleep disruption, injuries for the patients or their bed partners, caregivers distress, and they can be a motive for institutionalization. Parasomnias include the NonREM sleep disorders of arousal (sleepwalking, sleep terrors, confusional arousals and sleep-related eating disorder), the REM sleep behavior disorder (RBD) and more rarely the parasomnia overlap syndrome, which associates both NREM and REM parasomnias. Patients with NREM sleep parasomnias are confused, eyes open, with a glazed look during their nocturnal behaviors, and they have a post-episode amnesia. They shout and bolt from the bed (night terrors), look about in a confused manner, walk and speak (sleepwalking), and eat peculiar or inedible food (sleep-related eating disorders). These behaviors, which are frequent in young adults, may be triggered by short-half live hypnotics in elderly. During the parasomnia, the brain is partially awake (enough to perform complex motor and verbal action), and partially asleep (without conscious awareness or responsibility). RBD is characterized by a loss of the normal muscle atonia that accompanies REM sleep. Patients have excessive motor activity such as punching, kicking, or crying out in association with dream content. RBD are frequent in Parkinson's disease and dementia with Lewy bodies and may precede the cognitive or motor symptoms of these diseases by 5 to 10 years. RBD can also be promoted by antidepressants. When combined with thorough clinical interviews, the video-polysomnography is a powerful tool, especially for discriminating the parasomnia from nocturnal frontal lobe epilepsy, sleep apneas and periodic leg movements. Ensuring safety and withdrawing deleterious treatments are useful in patients with violent activities, potential injurious or bothersome to other household members. Clonazepam and melatonin (3-12 mg) are highly effective for treating RBD. PMID:20525541
Leu-Semenescu, Smaranda; Arnulf, Isabelle
Assessed sleep patterns, sleep disruptions, and sleepiness of second-, fourth-, and sixth-graders. Found that older children had more delayed sleep onset times and increased reported daytime sleepiness than younger; girls spent more time in sleep than boys and had increased percentage of motionless sleep; and 18 percent of children had fragmented…
Sadeh, Avi; Raviv, Amiram; Gruber, Reut
... insomnia. Sleep Problems as a Risk Factor for Suicide As noted above, sleep problems are associated with ... disorders, both of which are risk factors for suicide (Wong & Brower, 2012). Overarousal, marked by agitation and ...
Study Objectives: To assess if sleep patterns and sleepiness are compromised in children with nocturnal enuresis (NE), in comparison with normal control subjects, and to evaluate the role of enuresis-related events during sleep. Design: Assessment of natural sleep patterns at home in a sample of children referred to enuresis clinics and controls. Setting: Children's homes. Participants: Thirty-two children (19 boys and 13 girls aged 5.1 to 9.1 years) who suffer from primary NE and 94 healthy control subjects (49 boys and 45 girls aged 5 to 8.58 years). Interventions: N/A. Measurements and Results: Sleep measures were derived from 3 to 5 nights of actigraphy and daily logs. Additional information on events related to enuresis and daytime sleepiness was collected using daily reports. Children with NE slept significantly worse than did the control subjects. Their compromised sleep patterns were reflected in a higher number of actigraphic nighttime awakenings, the reduced percentages of motionless sleep, the higher number of reported nighttime awakening, and the increased sleep latency. Children with NE also reported higher levels of sleepiness in the morning and in the evening. Conclusions: Compared with the sleep of control subjects, the natural sleep of children with NE is significantly more fragmented, and the children with NE experience higher levels of daytime sleepiness. This phenomenology is associated with bedwetting episodes and attempts to keep the child dry during the night. These findings may suggest that children with NE suffer from sleep fragmentation, which may explain their higher arousal threshold. These findings have clinical implications for enuresis management. Citation: Cohen-Zrubavel V; Kushnir B; Kushnir J; Sadeh A. Sleep and sleepiness in children with nocturnal enuresis. SLEEP 2011;34(2):191-194.
Cohen-Zrubavel, Vered; Kushnir, Baruch; Kushnir, Jonathan; Sadeh, Avi
Simultaneous overnight oesophageal pH and manometric and sleep electroencephalographic recordings were performed in eight healthy subjects, aged 20-38 years, to test the hypothesis that the frequency of primary, swallow related contractions decreases progressively with deeper sleep stages whereas the frequency of secondary contractions remains constant throughout the night. During the nocturnal period (2300 to 0700), periods of oesophageal motor quiescence were interspersed by clusters of contractions detected 5 and 15 cm above the lower oesophageal sphincter. Primary contractions decreased in frequency from 1.42/min (median) during arousal periods to 0.22/min during stage 1 sleep, 0.05/min during stages 2 to 4 combined, and 0.03/min during rapid eye movement (REM) sleep. Secondary contractions were also most frequent during arousal periods (0.51/min) and they, too, decreased in frequency during stage 1 (0.35/min) and stages 2 to 4 combined (0.08/min). During REM sleep, however, the frequency of secondary contractions increased (0.50/min) to levels noted during arousal and stage 1 sleep. Compared with primary contractions, secondary contractions had a lower amplitude (51.9 hPa v 76.0 hPa; p = 0.0078) and a shorter duration (3.08 v 4.06 s; p = 0.0078). The results of this study suggest that there is no intrinsic oesophageal motor activity in the absence of a stimulatory input from the central nervous system and that the increased number of secondary contractions during REM sleep may be a result of an REM related increase in autonomic nervous system activity although a temporary decrease of efferent inhibitory influences cannot be ruled out. Nocturnal contraction clusters comprise both primary contractions during arousals and stage 1 sleep and secondary contractions during REM sleep.
Castiglione, F; Emde, C; Armstrong, D; Schneider, C; Bauerfeind, P; Stacher, G; Blum, A L
Summary. The nocturnal sleep of three 1-Methyl, 4-phenyl, 1,2,3,6-tetrahydropyridine (MPTP) treated monkeys (one non-motor disabled\\u000a and two severely motor disabled), while held in a primate chair was regis-tered using a reversible system for head fixation\\u000a and chronic recordings. Two electroencephalogram (EEG) channels, one electrooculogram (EOG) and one electromyogram (EMG) channel\\u000a were monitored constantly and tape recorded during eight nights for
H. Almirall; I. Pigarev; M. D. de la Calzada; M. Pigareva; M. T. Herrero; T. Sagales
Rationale: Sleep-disordered breathing recurrent intermittent hypoxia and sympathetic nervous system activity surges provide the milieu for cardiac arrhythmia development. Objective: We postulate that the prevalence of nocturnal cardiac arrhythmias is higher among subjects with than without sleep-disordered breathing. Methods: The prevalence of arrhythmias was compared in two samples of participants from the Sleep Heart Health Study frequency-matched on age, sex, race/ethnicity, and body mass index: (1) 228 subjects with sleep-disordered breathing (respiratory disturbance index ? 30) and (2) 338 subjects without sleep-disordered breathing (respiratory disturbance index < 5). Results: Atrial fibrillation, nonsustained ventricular tachycardia, and complex ventricular ectopy (nonsustained ventricular tachycardia or bigeminy or trigeminy or quadrigeminy) were more common in subjects with sleep-disordered breathing compared with those without sleep-disordered breathing: 4.8 versus 0.9% (p = 0.003) for atrial fibrillation; 5.3 versus 1.2% (p = 0.004) for nonsustained ventricular tachycardia; 25.0 versus 14.5% (p = 0.002) for complex ventricular ectopy. Compared with those without sleep-disordered breathing and adjusting for age, sex, body mass index, and prevalent coronary heart disease, individuals with sleep-disordered breathing had four times the odds of atrial fibrillation (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.03–15.74), three times the odds of nonsustained ventricular tachycardia (OR, 3.40; 95% CI, 1.03–11.20), and almost twice the odds of complex ventricular ectopy (OR, 1.74; 95% CI, 1.11–2.74). A significant relation was also observed between sleep-disordered breathing and ventricular ectopic beats/h (p < 0.0003) considered as a continuous outcome. Conclusions: Individuals with severe sleep-disordered breathing have two- to fourfold higher odds of complex arrhythmias than those without sleep-disordered breathing even after adjustment for potential confounders.
Mehra, Reena; Benjamin, Emelia J.; Shahar, Eyal; Gottlieb, Daniel J.; Nawabit, Rawan; Kirchner, H. Lester; Sahadevan, Jayakumar; Redline, Susan
Nocturnal eating disorder (NED) is a rare syndrome that includes disorders of both eating and sleeping. It is characterized by awakening in the middle of the night, getting out of bed, and consuming large quantities of food quickly and uncontrollably, then returning to sleep. This may occur several times during the night. Some patients are fully conscious during their nocturnal eating, while some indicate total amnesia. The etiology of NED is still unclear, as research findings are contradictory. Those suffering from NED exhibit various levels of anxiety and depression, and many lead stressful life-styles. Familial conflict, loneliness and personal crises are commonly found. Recently, a connection has been discovered between NED and unclear self-definition, faulty interpersonal communication, and low frustration threshold. Several authors link it to sleepwalking, leg movements during sleep, and sleep apnea. Treatment is still unclear and there have been trials of pharmacotherapy, psychotherapy, or a combination of both. However, pharmacological treatment has generally been found to be the most effective, although each case must be considered individually. In 1998, 7 women referred to our Eating Disorders Clinic, 5% of all referrals, were subsequently diagnosed as suffering from NED. Of these, 3 suffered from concurrent binge-eating disorder and 4 also from bulimia nervosa. 2 case studies representative of NED are presented. PMID:10883092
Tzischinski, O; Lazer, Y
Objectives To estimate the prevalence and characteristics of frequent nocturnal sweating in obstructive sleep apnoea (OSA) patients compared with the general population and evaluate the possible changes with positive airway pressure (PAP) treatment. Nocturnal sweating can be very bothersome to the patient and bed partner. Design Case–control and longitudinal cohort study. Setting Landspitali—The National University Hospital, Iceland. Participants The Icelandic Sleep Apnea Cohort consisted of 822 untreated patients with OSA, referred for treatment with PAP. Of these, 700 patients were also assessed at a 2-year follow-up. The control group consisted of 703 randomly selected subjects from the general population. Intervention PAP therapy in the OSA cohort. Main outcome measures Subjective reporting of nocturnal sweating on a frequency scale of 1–5: (1) never or very seldom, (2) less than once a week, (3) once to twice a week, (4) 3–5 times a week and (5) every night or almost every night. Full PAP treatment was defined objectively as the use for ?4?h/day and ?5?days/week. Results Frequent nocturnal sweating (?3× a week) was reported by 30.6% of male and 33.3% of female OSA patients compared with 9.3% of men and 12.4% of women in the general population (p<0.001). This difference remained significant after adjustment for demographic factors. Nocturnal sweating was related to younger age, cardiovascular disease, hypertension, sleepiness and insomnia symptoms. The prevalence of frequent nocturnal sweating decreased with full PAP treatment (from 33.2% to 11.5%, p<0.003 compared with the change in non-users). Conclusions The prevalence of frequent nocturnal sweating was threefold higher in untreated OSA patients than in the general population and decreased to general population levels with successful PAP therapy. Practitioners should consider the possibility of OSA in their patients who complain of nocturnal sweating.
Arnardottir, Erna Sif; Janson, Christer; Bjornsdottir, Erla; Benediktsdottir, Bryndis; Juliusson, Sigurdur; Kuna, Samuel T; Pack, Allan I; Gislason, Thorarinn
Objective To describe nocturnal asthma symptoms among urban children with asthma and assess the burden of sleep difficulties between children with varying levels of nocturnal symptoms. Methods We analyzed baseline data from 287 urban children with persistent asthma (ages 4–10) enrolled in the School-Based Asthma Therapy trial; Rochester, NY. Caregivers reported on nocturnal asthma symptoms (# nights/2 weeks with wheezing or coughing), parent quality of life (Juniper’s PACQLQ), and sleep quality using the validated Children’s Sleep Habits Questionnaire. We used bivariate and multivariate statistics to compare nocturnal asthma symptoms with sleep quality/quantity and quality of life. Results Most children (mean age 7.5yrs) were Black (62%); 74% had Medicaid. Forty-one percent of children had intermittent nocturnal asthma symptoms, 23% mild persistent, and 36% moderate to severe. Children’s average total sleep quality score was 51 (range 33–99) which is above the clinically significant cut-off of 41, indicating pervasive sleep disturbances among this population. Sleep scores were worse for children with more nocturnal asthma symptoms compared to those with milder symptoms on total score, as well as several subscales including night wakings, parasomnias, and sleep disordered breathing (all p<.03). Parents of children with more nocturnal asthma symptoms reported their child having fewer nights with enough sleep in the past week (p=.018) and worse parent quality of life (p<.001). Conclusions Nocturnal asthma symptoms are prevalent in this population, and are associated with poor sleep quality and worse parent quality of life. These findings have potential implications for understanding the disease burden of pediatric asthma.
Fagnano, Maria; Bayer, Alison L.; Isensee, Carrie A.; Hernandez, Telva; Halterman, Jill S.
Background A substantial increase in transportation of goods on railway may be hindered by public fear of increased vibration and noise leading to annoyance and sleep disturbance. As the majority of freight trains run during night time, the impact upon sleep is expected to be the most serious adverse effect. The impact of nocturnal vibration on sleep is an area currently lacking in knowledge. We experimentally investigated sleep disturbance with the aim to ascertain the impact of increasing vibration amplitude. Methodology/Principal Findings The impacts of various amplitudes of horizontal vibrations on sleep disturbance and heart rate were investigated in a laboratory study. Cardiac accelerations were assessed using a combination of polysomnography and ECG recordings. Sleep was assessed subjectively using questionnaires. Twelve young, healthy subjects slept for six nights in the sleep laboratory, with one habituation night, one control night and four nights with a variation of vibration exposures whilst maintaining the same noise exposure. With increasing vibration amplitude, we found a decrease in latency and increase in amplitude of heart rate as well as a reduction in sleep quality and increase in sleep disturbance. Conclusions/Significance We concluded that nocturnal vibration has a negative impact on sleep and that the impact increases with greater vibration amplitude. Sleep disturbance has short- and long-term health consequences. Therefore, it is necessary to define levels that protect residents against sleep disruptive vibrations that may arise from night time railway freight traffic.
Smith, Michael G.; Croy, Ilona; Ogren, Mikael; Persson Waye, Kerstin
Numerous medical disorders, including obstructive sleep apnea, may cause nocturnal diaphoresis. Previous work has associated severe obstructive sleep apnea with nocturnal diaphoresis. This case report is of import as our patient with severe nocturnal diaphoresis manifested only mild sleep apnea, and, for years, his nocturnal diaphoresis was ascribed to other causes, i.e., first prostate cancer and then follicular B-cell lymphoma. Additionally, it was the nocturnal diaphoresis and not more common symptoms of obstructive sleep apnea, such as snoring, that led to the definitive diagnosis of his sleep apnea and then to treatment with a gratifying resolution of his onerous symptom. Citation: Vorona RD; Szklo-Coxe M; Fleming M; Ware JC. Nocturnal diaphoresis secondary to mild obstructive sleep apnea in a patient with a history of two malignancies. J Clin Sleep Med 2013;9(7):717-719.
Vorona, Robert Daniel; Szklo-Coxe, Mariana; Fleming, Mark; Ware, J. Catesby
Study Objectives: To examine nighttime sleep patterns of persons with dementia showing nocturnal agitation behaviors and to determine whether restless legs syndrome (RLS), periodic limb movements in sleep (PLMS), and obstructive sleep apnea (OSA) are associated with nocturnal agitation behaviors. Design: Cross-sectional. Setting: General community. Participants: 59 participants with geriatrician-diagnosed dementia. Participants ages ranged from 66 to 88 years (mean age 79.1; SD 6.0). Mean Mini Mental State Examination (MMSE) score was 20.1 (SD 6.6). MMSE was used to measure baseline cognitive function and not for the diagnosis of dementia. Interventions: None. Measurements and Results: Sleep was measured by 2 nights of in-home, attended, portable polysomnography (PSG). Nocturnal agitation was measured over 3 additional nights using the Cohen-Mansfield Agitation Inventory modified for direct observations. Two experts independently and via consensus identified probable RLS. Total sleep time in participants was 5.6 h (SD 1.8 h). Mean periodic limb movements in sleep index (PLMI) was 15.29, and a high percentage (49%) had moderate to severe obstructive sleep apnea. Probable RLS was present in 24% of participants. Those with more severe cognitive impairment had longer sleep latency. Severe cognitive impairment, low apnea hypopnea index (AHI), and probable RLS were associated with nocturnal agitation behaviors (R2 = 0.35, F3,55 = 9.40, P < 0.001). Conclusions: It appears that probable RLS is associated with nocturnal agitation behaviors in persons with dementia, while OSA and PLMS are not. Further investigation is warranted to determine if treatment of RLS impacts nocturnal agitation behaviors in persons with dementia. Citation: Rose KM; Beck C; Tsai PF; Liem PH; Davila DG; Kleban M; Gooneratne NS; Kalra G; Richards KC. Sleep disturbances and nocturnal agitation behaviors in older adults with dementia. SLEEP 2011;34(6):779-786.
Rose, Karen M.; Beck, Cornelia; Tsai, Pao-Feng; Liem, Pham H.; Davila, David G.; Kleban, Morton; Gooneratne, Nalaka S.; Kalra, Gurpreet; Richards, Kathy Culpepper
In this study, the marmoset monkey model was validated using nocturnal electroencephalogram measurements for evaluating effects on sleep quality. In order to test whether the proposed sleep inducing drugs affect the quality of sleep and/or disrupt the nor...
B. M. Bouwman I. H. Philippens M. J. Jongsma R. A. Vanwersch R. W. Busker
Study Objective: Objective physiologic data on sleep and nocturnal breathing at initial exposure and during acclimatization to high altitude are scant. We tested the hypothesis that acute exposure to high altitude induces quantitative and qualitative changes in sleep and that these changes are partially reversed with acclimatization. Design: Prospective observation. Setting: One night in a sleep laboratory at 490 meters, the first and the third night in a mountain hut at 4559 meters. Participants: Sixteen healthy mountaineers. Intervention: Altitude exposure. Measurements: Polysomnography, questionnaire evaluation of sleep and acute mountain sickness. Results: Compared to 490 m, median nocturnal oxygen saturation decreased during the 1st night at 4559 m from 96% to 67%, minute ventilation increased from 4.4 to 6.3 L/min, and the apnea-hypopnea index increased from 0.1 to 60.9/h; correspondingly, sleep efficiency decreased from 93% to 69%, and slow wave sleep from 18% to 6% (P < 0.05, all instances). During the 3rd night at 4559 m, oxygen saturation was 71%, slow wave sleep 11% (P < 0.05 vs. 1st night, both instances) and the apnea/hypopnea index was 86.5/h (P = NS vs. 1st night). Symptoms of AMS and of disturbed sleep were significantly reduced in the morning after the 3rd vs. the 1st night at 4559 m. Conclusions: In healthy mountaineers ascending rapidly to high altitude, sleep quality is initially impaired but improves with acclimatization in association with improved oxygen saturation, while periodic breathing persists. Therefore, high altitude sleep disturbances seem to be related predominantly to hypoxemia rather than to periodic breathing. Citation: Nussbaumer-Ochsner Y; Ursprung J; Siebenmann C; Maggiorini M; Bloch KE. Effect of short-term acclimatization to high altitude on sleep and nocturnal breathing. SLEEP 2012;35(3):419-423.
Nussbaumer-Ochsner, Yvonne; Ursprung, Justyna; Siebenmann, Christoph; Maggiorini, Marco; Bloch, Konrad E.
Air leaking through the mouth has been reported in kyphoscoliotic patients receiving nasal ventilation via volume-limited ventilators. This study accessed the frequency of occurrence and effect on sleep quality of air leaking through the mouth during nocturnal nasal ventilation in patients with chest wall and neuromuscular disease using pressure-limited ventilation. Overnight and daytime polysomnography was performed in six stable experienced users of nocturnal nasal noninvasive positive-pressure ventilation (NPPV) who had chronic respiratory failure due to neuromuscular disease or chest wall deformity. All patients used the BiPAP S/T-D ventilatory support system (Respironics, Inc., Murrysville, PA). Measures included sleep scoring, leak quantitation, diaphragm and submental electromyograms (EMGs), and tidal and leak volumes. All patients had air leaking through the mouth for the majority of sleep. Sleep quality was diminished because of poor sleep efficiency and reduced percentages of slow-wave and rapid eye movement (REM) sleep. Air leaking through the mouth was associated with frequent arousals during stages 1 and 2 and REM sleep that contributed to sleep fragmentation, but arousals were infrequent during slow-wave sleep. Despite prevalent leaking, oxygenation was well maintained in all but one patient. Patients used a-combination of passive and active mechanisms to control air leaking. Although nasal ventilation improves nocturnal hypoventilation and symptoms in patients with restrictive thoracic disorders, air leaking through the mouth is very common during use. The leaking is associated with frequent arousals during lighter stages of sleep that interfere with progression to deeper stages, compromising sleep quality. Portable pressure-limited ventilators compensate for leaks, maintaining ventilation and oxygenation, but further studies are needed to determine which interfaces and ventilator techniques best control air leaking and optimize sleep quality. PMID:9322272
Meyer, T J; Pressman, M R; Benditt, J; McCool, F D; Millman, R P; Natarajan, R; Hill, N S
Despite the substantial advances in the understanding of pain mechanisms and management, postoperative pain relief remains an important health care issue. Surgical patients also frequently report postoperative sleep complaints. Major sleep alterations in the postoperative period include sleep fragmentation, reduced total sleep time, and loss of time spent in slow wave and rapid eye movement sleep. Clinical and experimental studies show that sleep disturbances may exacerbate pain, whereas pain and opioid treatments disturb sleep. Surgical stress appears to be a major contributor to both sleep disruptions and altered pain perception. However, pain and the use of opioid analgesics could worsen sleep alterations, whereas sleep disruptions may contribute to intensify pain. Nevertheless, little is known about the relationship between postoperative sleep and pain. Although the sleep-pain interaction has been addressed from both ends, this review focuses on the impact of sleep disruptions on pain perception. A better understanding of the effect of postoperative sleep disruptions on pain perception would help in selecting patients at risk for more severe pain and may facilitate the development of more effective and safer pain management programs. PMID:24074687
Chouchou, Florian; Khoury, Samar; Chauny, Jean-Marc; Denis, Ronald; Lavigne, Gilles J
Relationships between common lifestyle practices important to sleep hygiene (e.g., smoking cigarettes, drinking alcohol, ingesting caffeine, exercising, bedtimes, getting-up times) and nocturnal sleep have not been documented for women with insomnia in their home environments. This community-based sample of 121 women, ages 40 to 55 years, included 92 women who had experienced insomnia for at least 3 months and 29womenwith
Rita E. Cheek; Joan L. Shaver; Martha J. Lentz
Sleep and circadian rhythm disruption are frequently observed in patients with psychiatric disorders and neurodegenerative disease. The abnormal sleep that is experienced by these patients is largely assumed to be the product of medication or some other influence that is not well defined. However, normal brain function and the generation of sleep are linked by common neurotransmitter systems and regulatory
Katharina Wulff; Silvia Gatti; Joseph G. Wettstein; Russell G. Foster
Twenty-five children, age range 2 to 14 years (mean age=7), were referred to the Stanford University Sleep Disorders Clinic for various clinical symptoms, including excessive daytime somnolence, heavy nocturnal snoring, and abnormal daytime behavior. All children (10 girls and 15 boys) were polygraphically monitored during sleep. No sleep apnea syndrome or oxygen desaturation was revealed. However, each child presented significant
Ch. Guilleminault; R. Winkle; R. Korobkin; B. Simmons
"Muscle activity in the legs (MAL)" is an extension of the classification, nocturnal myoclonus, to include all phasic muscle activity in the legs during sleep, irrespective of the repetitiveness, periodicity, or minimum duration of the muscle events. This report examined the number of MAL events and, especially, MAL events associated with arousals (MAL arousals) and awakenings (MAL awakenings) in the clinical records of 9 narcoleptics, 42 obstructive sleep apnea (OSA) patients, and 12 nocturnal myoclonus patients. The mean MAL arousals/hr for narcoleptics, OSA patients, and nocturnal myoclonus patients were 20.5, 3.0, and 12.9, respectively; the mean MAL awakenings/hr were 2.5, 0.2, and 1.3, respectively. Both the narcoleptics and nocturnal myoclonus patients had significantly more MAL arousals/hr and MAL awakenings/hr of sleep than OSA patients. Nonetheless, 62% of the OSA patients had greater than or equal to 1 MAL arousal/hr. Narcoleptics had significantly more MAL awakenings/hr than nocturnal myoclonus patients; narcoleptics also had more MAL arousals/hr of sleep than nocturnal myoclonus patients, but this difference was not significant. Most, 89%, of the narcoleptics, 22% of the OSA patients, and 100% of the nocturnal myoclonus patients had greater than or equal to 5 MAL arousals/hr of sleep. These findings suggest that there may be a relationship between the pathogenesis of MAL, narcolepsy, and OSA. PMID:3791645
Hartman, P G; Scrima, L
Recent research provides evidence for an interaction between sleep and the activation of the hypothalamic–pituitary–adrenal (HPA)-axis, but detailed studies in patients are still missing. We investigated hourly evening and nocturnal plasma cortisol secretion and sleep in seven male patients with severe chronic primary insomnia and age- and gender-matched controls. Evening and nocturnal cortisol levels were significantly increased in patients. Evening
Andrea Rodenbeck; Gerald Huether; Eckart Rüther; Göran Hajak
Nocturia, waking up at night to void, is a highly prevalent disorder in the elderly, with a profound impact on life expectancy,\\u000a health, and quality of life (QoL). Elderly persons with nocturia are troubled by sleep impairment because of involuntary awakenings,\\u000a increased nightmares, and a general feeling of insufficient and non-restorative sleep. Consequently, their daytime performance\\u000a is impaired and they
Study Objectives: Recent studies have suggested that nonrestorative sleep (NRS) symptoms may be distinct from nocturnal insomnia symptoms (NIS). However, there is limited information on the demographic, medical, and biologic correlates of NRS independent from NIS in the general population. This report presents the sociodemographic correlates, patterns of comorbidity with other sleep and physical disorders, C-reactive protein (CRP) levels, and general productivity associated with NIS and NRS in a nationally representative sample of US adults. Design: National Health and Nutrition Examination Survey (NHANES). Setting: The 2005-2008 surveys of the general population in the United States. Participants: There were 10,908 individuals (20 years or older) Interventions: N/A. Measurements and Results: Respondents were classified by the presence or absence of NIS and NRS. Compared with those without insomnia symptoms, respondents with NIS were older and had lower family income and educational levels than those with NRS. In addition, there was a significant association between NIS and cardiovascular disease, whereas NRS was associated with other primary sleep disorders (including habitual snoring, sleep apnea, and restless legs syndrome), respiratory diseases (emphysema and chronic bronchitis), thyroid disease, and cancer as well as increased CRP levels. In addition, the study participants with NRS only reported poorer scores on the Functional Outcomes of Sleep Questionnaire (FOSQ) than those without insomnia symptoms or those with NIS only. Conclusions: These findings suggest that there are substantial differences between NIS and NRS in terms of sociodemographic factors, comorbidity with other sleep and physical disorders, increased CRP level, and functional impairment. An inflammatory response might play a unique role in the pathogenesis of NRS. Citation: Zhang J; Lamers F; Hickie IB; He JP; Feig E; Merikangas KR. Differentiating nonrestorative sleep from nocturnal insomnia symptoms: demographic, clinical, inflammatory, and functional correlates. SLEEP 2013;36(5):671-679.
Zhang, Jihui; Lamers, Femke; Hickie, Ian B.; He, Jian-Ping; Feig, Emily; Merikangas, Kathleen R.
Study Objectives: Upper airway sensory deficit has been reported to be associated with snoring or obstructive sleep apnea. There are limited data on the correlation between disease severity and upper airway sensation. In this study, we investigated the relationship between clinical parameters and standardized palatal sensory threshold (SPST) using Semmes Weinstein monofilaments. Methods: We recruited 40 snorers and 19 control subjects. Palatal sensory threshold was measured in all study subjects, using Semmes Weinstein monofilaments. Standardized palatal sensory threshold was determined by subtraction of hard palate sensation from uvular sensation. All subjects with snoring underwent a modified Muller maneuver during wakefulness before polysomnography. Results: SPST was higher in snorers than in control subjects, but did not differ according to the severity of obstructive sleep apnea. Patients with higher SPST (? 0.45 g/mm2) were older and had more severe hypoxemia indices: lower nadir oxyhemoglobin saturation (SpO2) and higher percentage of sleep time at < 90% SpO2. Adjusted for age, sex, neck circumference, and body mass index, SPST was correlated with the apnea-hypopnea index and hypoxemia indices. With a cutoff value ? 0.45 g/mm2, the sensitivity of SPST for nocturnal hypoxemia (nadir SpO2, < 80%) was 81.3%. Patients with higher SPST (? 0.45 g/mm2) showed more airway occlusion in modified Muller maneuver, than those with lower values. Conclusions: The SPST measured using Semmes Weinstein monofilaments reflects nocturnal hypoxemia and airway occlusion. This test provides a potential tissue marker of the severity of hypoxemia in patients who snore. Citation: Kim SW; Park HW; Won SJ; Jeon SY; Jin HR; Lee SJ; Chang DY; Kim DW. Palatal sensory threshold reflects nocturnal hypoxemia and airway occlusion in snorers and obstructive sleep apnea patients. J Clin Sleep Med 2013;9(11):1179-1186.
Kim, Sang-Wook; Park, Hyun Woo; Won, Sung Jun; Jeon, Sea-Yuong; Jin, Hong Ryul; Lee, So-Jin; Chang, Dong-Yeop; Kim, Dae Woo
The present study aimed to assess the cephalometric features in children with sleep-disordered breathing (SDB). The subjects were 70 children (34 boys and 36 girls, mean age 7.3, SD 1.72, range 4.2-11.9 years) with habitual snoring and symptoms of obstructive sleep disorder for more than 6 months. On the basis of overnight polygraphic findings, the subjects were further divided into subgroups of 26 children with diagnosed obstructive sleep apnoea (OSA), 17 with signs of upper airway resistance syndrome (UARS), and 27 with snoring. A control group of 70 non-obstructed children matched for age and gender was selected. Lateral skull radiographs were taken and cephalograms were traced and measured. The differences between the matched groups were studied using t-test for paired samples. Differences between the subgroups were studied using analysis of variance followed by Duncan's multiple comparison method. Children with SDB were characterized by an increased antero-posterior jaw relationship (P = 0.001), increased mandibular inclination in relation to the palatal line (P = 0.01), increased total (P = 0.019) and lower (P = 0.005) anterior face heights, a longer (P = 0.018) and thicker (P = 0.002) soft palate, smaller airway diameters at multiple levels of the naso- and oropharynx, larger oropharyngeal airway diameter at the level of the base of the tongue (P = 0.011), lower hyoid bone position (P = 0.000), and larger craniocervical angles (NSL-CVT, P = 0.014; NSL-OPT, P = 0.023) when compared with the non-obstructed controls. When divided into subgroups according to the severity of the disorder, OSA children deviated significantly from the control children especially in the oropharyngeal variables. Children with UARS and snoring also deviated from the controls, but the obstructed subgroups were not confidently distinguishable from each other by cephalometric measurements. Logistic regression analysis indicated that UARS and OSA were associated with decreased pharyngeal diameters at the levels of the adenoids (PNS-ad1) and tip of the uvula (u1-u2), an increased diameter at the level of the base of the tongue (rl1-rl2), a thicker soft palate, and anteriorly positioned maxilla in relation to the cranial base. Lateral cephalogram may thus reveal important predictors for SDB in children. Attention should be paid to pharyngeal measurements. Systematic orthodontic evaluation of SDB children is needed because of the effects of obstructed sleep on the developing craniofacial skeleton. PMID:20305055
Pirilä-Parkkinen, Kirsi; Löppönen, Heikki; Nieminen, Peter; Tolonen, Uolevi; Pirttiniemi, Pertti
We examined effects of very low doses of melatonin (0.1-10 mg, orally) or placebo, administered at 1145 h, on sleep latency and duration, mood, performance, oral temperature, and changes in serum melatonin levels in 20 healthy male volunteers. A repeated-measure double-blind Latin square design was used. Subjects completed a battery of tests designed to assess mood and performance between 0930 and 1730 h. The sedative-like effects of melatonin were assessed by a simple sleep test: at 1330 h subjects were asked to hold a positive pressure switch in each hand and to relax with eyes closed while reclining in a quiet darkened room. Latency and duration of switch release, indicators of sleep, were measured. Areas under the time-melatonin concentration curve varied in proportion to the different melatonin doses ingested, and the 0.1- and 0.3-mg doses generated peak serum melatonin levels that were within the normal range of nocturnal melatonin levels in untreated people. All melatonin doses tested significantly increased sleep duration, as well as self-reported sleepiness and fatigue, relative to placebo. Moreover, all of the doses significantly decreased sleep-onset latency, oral temperature, and the number of correct responses on the Wilkinson auditory vigilance task. These data indicate that orally administered melatonin can be a highly potent hypnotic agent; they also suggest that the physiological increase in serum melatonin levels, which occurs around 2100 h daily, may constitute a signal initiating normal sleep onset.
Dollins, A. B.; Zhdanova, I. V.; Wurtman, R. J.; Lynch, H. J.; Deng, M. H.
This study compared sleep in patients with Conduct Disorder/Oppositional Defiant Disorder (CD/ODD) and normative children and evaluated the associations between sleep and behavioral symptoms in patients. Participants were 30 patients, aged 7 to 12 years, with diagnoses of CD/ODD and their age and gender matched controls. Patients with CD/ODD and their parents reported significantly more sleep problems than did the control children and their parents (p values < 0.01). By actigraphy, CD/ODD children with comorbid ADHD slept significantly less than did the patients with CD/ODD alone and the controls. In patients, low sleep amount and efficiency associated with increased amount of parent-reported externalizing symptoms (r = -0.72, 0.66, p values < 0.001). Results highlight the need of evaluating sleep in children with CD/ODD. Improving their sleep may ease their symptoms. PMID:24180372
Aronen, Eeva T; Lampenius, Tuulikki; Fontell, Tuija; Simola, Petteri
In the current study, sleep actigraphy and parent-report measures were used to investigate differences in sleeping behavior among four groups of 3- to 7-year-olds (N = 79): children in regular foster care (n = 15); children receiving a therapeutic intervention in foster care (n = 17); low income community children (n = 18); and upper middle income…
Tininenko, Jennifer R.; Fisher, Philip A.; Bruce, Jacqueline; Pears, Katherine C.
Marital conflict was examined as a predictor of the quality and quantity of sleep in a sample of healthy 8 to 9 year-olds. Parents and children reported on marital conflict, the quantity and quality of children's sleep were examined through an actigraph worn for 7 consecutive nights, and child sleepiness was derived from child and mother reports.…
El-Sheikh, Mona; Buckhalt, Joseph, A.; Mize, Jacquelyn; Acebo, Christine
In the current study, sleep actigraphy and parent-report measures were used to investigate differences in sleeping behavior among four groups of 3- to 7-year-olds (N = 79): children in regular foster care (n = 15); children receiving a therapeutic intervention in foster care (n = 17); low income community children (n = 18); and upper middle income community children (n = 29). The children in therapeutic foster care exhibited longer sleep latency and increased variability of sleep duration than the upper middle income community children. In addition, there was indication of a treatment effect: the therapeutic foster care children slept longer than the regular foster care and low income community children and had earlier bedtimes, fell asleep earlier, and spent more time in bed than the regular foster care children. The results are discussed in terms of the effectiveness of early intervention for enhancing sleep in foster children.
Tininenko, Jennifer R.; Fisher, Philip A.; Bruce, Jacqueline; Pears, Katherine C.
To examine the physiological role of melatonin in sleep, nocturnal melatonin secretion was suppressed using 100 mg oral atenolol in two studies. In Study 1, nocturnal sleep was recorded in 8 young men over 4 nights. Subjects received atenolol on one of the last 2 nights and showed significantly increased total wake time (TWT) and wakefulness after sleep onset (WASO), as well as decreased REM sleep and slow-wave sleep (SWS). When melatonin (total 5 mg) was given after atenolol on the other night, the changes in TWT, WASO, REM, and SWS were reversed. In Study 2, sleep onset latencies (SOL) and core temperature (Tc) of 10 young men were measured for 3 nonconsecutive nights. In a cross-over design, atenolol given on one night significantly suppressed urinary 6-sulphatoxymelatonin (6s-aMT) production and increased hourly measures of Tc and SOL relative to baseline night values. Oral melatonin (3 mg), administered after atenolol, reversed the changes in Tc and SOL. These results suggest that endogenous melatonin may assist in the maintenance of normal sleep architecture (Study 1) and also increase nocturnal sleep propensity by hypothermic effects (Study 2). PMID:9177549
Van Den Heuvel, C J; Reid, K J; Dawson, D
Objectives: Sleep interruption is often reported by women with hot flashes and night sweats (or vasomotor symptoms, VMS). Although women report that VMS awaken them, polysomnography (PSG) studies have not consistently supported this contention. Design: We mimicked menopause using a gonadotropin-releasing hormone agonist (GnRHa) to investigate whether VMS increase awakenings and wake after sleep onset (WASO). VMS, serum estradiol, and at-home PSGs (two pretreatment, two posttreatment) were measured before and after 4 weeks on GnRHa. Regression models were used to determine the effect of increasing VMS frequency on awakenings and WASO, as measured objectively and subjectively. Participants: Twenty-nine healthy women (mean 27.3 y). Setting: Academic medical center. Interventions: Depot GnRHa (leuprolide 3.75-mg). Results: Serum estradiol was rapidly and uniformly suppressed on GnRHa. Persistent VMS were reported by 69% of women. The number of nighttime VMS correlated directly with the degree of sleep disturbance. Each additional reported nighttime VMS was associated with a 62% increase from baseline in PSG-measured WASO (P = 0.007), a 3% increase in awakenings (P = 0.05), and 6% increase in %N1 sleep (P = 0.02). Nighttime VMS were also associated with increased perceived WASO (312%; P = 0.02), awakenings (16%; P = 0.007), Insomnia Severity Index (P = 0.03), and Pittsburgh Sleep Quality Index (P = 0.03) scores, and decreased perceived sleep efficiency (P = 0.01). Objectively recorded nighttime VMS correlated with PSG-measured WASO (rs = 0.45, P = 0.02). Conclusions: This menopause model demonstrates that nighttime vasomotor symptoms correlate with increased sleep fragmentation. These findings are consistent with a specific contribution of vasomotor symptoms to polysomnography-measured sleep interruption suggesting that nighttime vasomotor symptoms interrupt sleep in the setting of menopause. Citation: Joffe H; Crawford S; Economou N; Kim S; Regan S; Hall JE; White D. A gonadotropin-releasing hormone agonist model demonstrates that nocturnal hot flashes interrupt objective sleep. SLEEP 2013;36(12):1977-1985.
Joffe, Hadine; Crawford, Sybil; Economou, Nicole; Kim, Semmie; Regan, Susan; Hall, Janet E.; White, David
We evaluated the effects of sleep disruption on the mealtime behavior of a young boy with developmental disabilities. Results showed that bite acceptance was less likely to persist during meals following disrupted sleep, but only when escape extinction was not implemented. Findings are discussed in terms of establishing operations and the effects of sleep disruption on the assessment and treatment of feeding problems.
Dolezal, Danielle N; Cooper-Brown, Linda J; Wacker, David P
Circadian phase resetting is sensitive to visual short wavelengths (450-480 nm). Selectively filtering this range of wavelengths may reduce circadian misalignment and sleep impairment during irregular light-dark schedules associated with shiftwork. We examined the effects of filtering short wavelengths (<480 nm) during night shifts on sleep and performance in nine nurses (five females and four males; mean age ± SD: 31.3 ± 4.6 yrs). Participants were randomized to receive filtered light (intervention) or standard indoor light (baseline) on night shifts. Nighttime sleep after two night shifts and daytime sleep in between two night shifts was assessed by polysomnography (PSG). In addition, salivary melatonin levels and alertness were assessed every 2 h on the first night shift of each study period and on the middle night of a run of three night shifts in each study period. Sleep and performance under baseline and intervention conditions were compared with daytime performance on the seventh day shift, and nighttime sleep following the seventh daytime shift (comparator). On the baseline night PSG, total sleep time (TST) (p < 0.01) and sleep efficiency (p = 0.01) were significantly decreased and intervening wake times (wake after sleep onset [WASO]) (p = 0.04) were significantly increased in relation to the comparator night sleep. In contrast, under intervention, TST was increased by a mean of 40 min compared with baseline, WASO was reduced and sleep efficiency was increased to levels similar to the comparator night. Daytime sleep was significantly impaired under both baseline and intervention conditions. Salivary melatonin levels were significantly higher on the first (p < 0.05) and middle (p < 0.01) night shifts under intervention compared with baseline. Subjective sleepiness increased throughout the night under both conditions (p < 0.01). However, reaction time and throughput on vigilance tests were similar to daytime performance under intervention but impaired under baseline on the first night shift. By the middle night shift, the difference in performance was no longer significant between day shift and either of the two night shift conditions, suggesting some adaptation to the night shift had occurred under baseline conditions. These results suggest that both daytime and nighttime sleep are adversely affected in rotating-shift workers and that filtering short wavelengths may be an approach to reduce sleep disruption and improve performance in rotating-shift workers. PMID:23834705
Rahman, Shadab A; Shapiro, Colin M; Wang, Flora; Ainlay, Hailey; Kazmi, Syeda; Brown, Theodore J; Casper, Robert F
Sleep and circadian rhythm disruption (SCRD) is a common feature in many neuropsychiatric diseases including schizophrenia, bipolar disorder and depression. Although the precise mechanisms remain unclear, recent evidence suggests that this comorbidity is not simply a product of medication or an absence of social routine, but instead reflects commonly affected underlying pathways and mechanisms. For example, several genes intimately involved in the generation and regulation of circadian rhythms and sleep have been linked to psychiatric illness. Further, several genes linked to mental illness have recently been shown to also play a role in normal sleep and circadian behaviour. Here we describe some of the emerging common mechanisms that link circadian rhythms, sleep and SCRD in severe mental illnesses. A deeper understanding of these links will provide not only a greater understanding of disease mechanisms, but also holds the promise of novel avenues for therapeutic intervention. PMID:23618559
Jagannath, Aarti; Peirson, Stuart N; Foster, Russell G
Circadian organization of the mammalian transcriptome is achieved by rhythmic recruitment of key modifiers of chromatin structure and transcriptional and translational processes. These rhythmic processes, together with posttranslational modification, constitute circadian oscillators in the brain and peripheral tissues, which drive rhythms in physiology and behavior, including the sleep–wake cycle. In humans, sleep is normally timed to occur during the biological night, when body temperature is low and melatonin is synthesized. Desynchrony of sleep–wake timing and other circadian rhythms, such as occurs in shift work and jet lag, is associated with disruption of rhythmicity in physiology and endocrinology. However, to what extent mistimed sleep affects the molecular regulators of circadian rhythmicity remains to be established. Here, we show that mistimed sleep leads to a reduction of rhythmic transcripts in the human blood transcriptome from 6.4% at baseline to 1.0% during forced desynchrony of sleep and centrally driven circadian rhythms. Transcripts affected are key regulators of gene expression, including those associated with chromatin modification (methylases and acetylases), transcription (RNA polymerase II), translation (ribosomal proteins, initiation, and elongation factors), temperature-regulated transcription (cold inducible RNA-binding proteins), and core clock genes including CLOCK and ARNTL (BMAL1). We also estimated the separate contribution of sleep and circadian rhythmicity and found that the sleep–wake cycle coordinates the timing of transcription and translation in particular. The data show that mistimed sleep affects molecular processes at the core of circadian rhythm generation and imply that appropriate timing of sleep contributes significantly to the overall temporal organization of the human transcriptome.
Archer, Simon N.; Laing, Emma E.; Moller-Levet, Carla S.; van der Veen, Daan R.; Bucca, Giselda; Lazar, Alpar S.; Santhi, Nayantara; Slak, Ana; Kabiljo, Renata; von Schantz, Malcolm; Smith, Colin P.; Dijk, Derk-Jan
Circadian organization of the mammalian transcriptome is achieved by rhythmic recruitment of key modifiers of chromatin structure and transcriptional and translational processes. These rhythmic processes, together with posttranslational modification, constitute circadian oscillators in the brain and peripheral tissues, which drive rhythms in physiology and behavior, including the sleep-wake cycle. In humans, sleep is normally timed to occur during the biological night, when body temperature is low and melatonin is synthesized. Desynchrony of sleep-wake timing and other circadian rhythms, such as occurs in shift work and jet lag, is associated with disruption of rhythmicity in physiology and endocrinology. However, to what extent mistimed sleep affects the molecular regulators of circadian rhythmicity remains to be established. Here, we show that mistimed sleep leads to a reduction of rhythmic transcripts in the human blood transcriptome from 6.4% at baseline to 1.0% during forced desynchrony of sleep and centrally driven circadian rhythms. Transcripts affected are key regulators of gene expression, including those associated with chromatin modification (methylases and acetylases), transcription (RNA polymerase II), translation (ribosomal proteins, initiation, and elongation factors), temperature-regulated transcription (cold inducible RNA-binding proteins), and core clock genes including CLOCK and ARNTL (BMAL1). We also estimated the separate contribution of sleep and circadian rhythmicity and found that the sleep-wake cycle coordinates the timing of transcription and translation in particular. The data show that mistimed sleep affects molecular processes at the core of circadian rhythm generation and imply that appropriate timing of sleep contributes significantly to the overall temporal organization of the human transcriptome. PMID:24449876
Archer, Simon N; Laing, Emma E; Möller-Levet, Carla S; van der Veen, Daan R; Bucca, Giselda; Lazar, Alpar S; Santhi, Nayantara; Slak, Ana; Kabiljo, Renata; von Schantz, Malcolm; Smith, Colin P; Dijk, Derk-Jan
We studied how forced-air warming, conventionally used to control body temperature during and after anaesthesia, affected the nocturnal rectal temperatures and sleep composition of young men and women. Seven healthy women who were taking oral or injection contraceptives, and six healthy men spent 3 nights in a controlled environment: an adaptation night followed by 2 nights when they slept under either a down duvet (baseline) or a quilt perfused with warm air (hot). Repeated analysis of variance (ANOVA) revealed significant gender differences in the body temperature responses. On the baseline night, despite sleeping under the same conditions, the women did not show a nocturnal drop in body temperature as shown by the men. Forced-air warming increased body temperature to a similar extent in the men and the women, and resulted in enhanced hyperthermia in the women, and blunted the drop in body temperature in the men, compared to their baseline nights. The significant increases in body temperature had no consequences, however, for the subjective sleep quality of either the men or women, and only minor consequences for objective sleep composition. Both men and women had increased amounts of Stage 2 sleep on the hot night (P < 0.04). In addition, the women had reduced rapid eye movement (REM) sleep when compared to their baseline night (P < 0.04). Our results confirm that in a passive thermal environment, women who are taking oral or injection contraceptives have higher nocturnal body temperatures than men. Also, as sleep architecture was minimally affected by the increases in body temperature of between 0.2 and 0.3 degree C on the hot night in the men and women, and subjective sleep quality was unaffected, our results question the existence of a tight association between sleep and body temperature. PMID:9785272
Baker, F C; Selsick, H; Driver, H S; Taylor, S R; Mitchell, D
Epidemiological studies link short sleep and circadian disruption with risk of metabolic syndrome and diabetes. We tested the hypotheses that prolonged sleep restriction with concurrent circadian disruption, as can occur with shift work, impairs glucose regulation and metabolism. Healthy adults spent >5 weeks in controlled laboratory conditions including: sleep extension (baseline), 3-week sleep restriction (5.6 h sleep/24 h) combined with circadian disruption (recurring 28-h ‘days’), and 9-day recovery sleep with circadian re-entrainment. Prolonged sleep restriction with concurrent circadian disruption significantly decreased resting metabolic rate, and increased postprandial plasma via inadequate pancreatic beta cell responsivity; these normalized with 9 days of recovery sleep and stable circadian reentrainment. Thus, in humans, prolonged sleep restriction with concurrent circadian disruption alters metabolism and could increase risk of obesity and diabetes.
Buxton, Orfeu M.; Cain, Sean W.; O'Connor, Shawn P.; Porter, James H.; Duffy, Jeanne F.; Wang, Wei; Czeisler, Charles A.; Shea, Steven A.
Nocturnal enuresis is a very common pediatric problem which often has strong genetic roots. In the vast majority of children it resolves spontaneously, with time, therefore research and treatment of bedwetting cannot carry any risk to the child. The research on the etiology of bedwetting has been focused on sleep disturbances, nocturnal urine production and functional bladder capacity. So far
Uri S. Alon
Nocturnal pulse oximetry (NPO) has demonstrated to be a powerful tool to help in obstructive sleep apnoea (OSA) detection. However, additional analysis is needed to use NPO alone as an alternative to nocturnal polysomnography (NPSG), which is the gold standard for a definitive diagnosis. In the present study, we exhaustively analysed a database of blood oxygen saturation (SpO(2)) recordings (80 OSA-negative and 160 OSA-positive) to obtain further knowledge on the usefulness of NPO. Population set was randomly divided into training and test sets. A feature extraction stage was carried out: 16 features (time and frequency statistics and spectral and nonlinear features) were computed. A genetic algorithm (GA) approach was applied in the feature selection stage. Our methodology achieved 87.5% accuracy (90.6% sensitivity and 81.3% specificity) in the test set using a logistic regression (LR) classifier with a reduced number of complementary features (3 time domain statistics, 1 frequency domain statistic, 1 conventional spectral feature and 1 nonlinear feature) automatically selected by means of GAs. Our results improved diagnostic performance achieved with conventional oximetric indexes commonly used by physicians. We concluded that GAs could be an effective and robust tool to search for essential oximetric features that could enhance NPO in the context of OSA diagnosis. PMID:22154238
Álvarez, Daniel; Hornero, Roberto; Marcos, J Víctor; Del Campo, Félix
Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings. PMID:19836694
Charuvastra, Anthony; Cloitre, Marylene
I. SUMMARY Sleep disordered breathing (SDB) is now well recognized in children with neuromuscular diseases (NMD) and may lead to significant morbidity and increased mortality. Predisposing factors to SDB in children with NMD include reduced ventilatory responses, reduced activity of respiratory muscles during sleep and poor lung mechanics due to the underlying neuro-muscular disorder. SDB may present long before signs of respiratory failure emerge. When untreated, SDB may contribute to significant cardiovascular morbidities, neuro-cognitive deficits and premature death. One of the problems in detecting SDB in patients with NMD is the lack of correlation between lung function testing and daytime gas exchange. Polysomnography is the preferred method to evaluate for SDB in children with NMD. When the diagnosis of SDB is confirmed, treatment by non-invasive ventilation (NIV) is usually recommended. However, other modalities of mechanical ventilation do exist and may be indicated in combination with or without other supportive measures.
Arens, Raanan; Muzumdar, Hiren
Changes of Sleep Architecture, Spectral Composition of Sleep EEG, the Nocturnal Secretion of Cortisol, ACTH, GH, Prolactin, Melatonin, Ghrelin, and Leptin, and the DEX-CRH Test in Depressed Patients during Treatment with Mirtazapine
The noradrenergic and specific serotoninergic antidepressant mirtazapine improves sleep, modulates hormone secretion including blunting of hypothalamic–pituitary–adrenocortical (HPA) activity, and may prompt increased appetite and weight gain. The simultaneous investigation of sleep electroencephalogram (EEG) and hormone secretion during antidepressive treatment helps to further elucidate these effects. We examined sleep EEG (for later conventional and quantitative analyses) and the nocturnal concentrations of
Dagmar A Schmid; Adam Wichniak; Manfred Uhr; Marcus Ising; Hans Brunner; Katja Held; Jutta C Weikel; Annette Sonntag; Axel Steiger
The effects of cannabis extracts on nocturnal sleep, early- morning performance, memory, and sleepiness were studied in 8 healthy volunteers (4 males, 4 females; 21 to 34 years). The study was double-blind and placebo-controlled with a 4-way crossover design. The 4 treatments were placebo, 15 mg D-9-tetrahydrocan- nabinol (THC), 5 mg THC combined with 5 mg cannabidiol (CBD), and 15
Anthony N. Nicholson; Claire Turner; Barbara M. Stone; Philip J. Robson
Study Objectives A pilot study to examine the effects of intermittent nocturnal hypoxia on sleep, respiration and cognition in healthy adult humans. Methods Participants were eight healthy, non-smoking subjects (four male, four female), mean age of 26.4 ± 5.2 years, and BMI 22.3 ± 2.6 Kg/m2, exposed to nine hours of intermittent hypoxia between the hours of 10 P.M. and 7 A.M. for 28 consecutive nights. At a simulated altitude of 13,000 feet (FIO2 0.13), intermittent hypoxia was achieved by administering nasal nitrogen, alternating with brief (approximately five seconds) boluses of nasal oxygen. Pre and post exposure assessments included polysomnography, attention (20-minute Psychomotor Vigilance Test), working memory (10-minute verbal 2 and 3-back), Multiple Sleep Latency Test, and the Rey Auditory Verbal Learning Test. Obstructive and non-obstructive respiratory events were scored. Results Overall sleep quality showed worsening trends but no statistically significant change following exposure. There was no difference after hypoxia in sleepiness, encoding, attention or working memory. Hyperoxic central apneas and post-hyperoxic respiratory instability were noted as special features of disturbed respiratory control induced by intermittent nocturnal hypoxia. Conclusions In this model, exposure to nocturnal intermittent hypoxia for 4-weeks caused no significant deficits in subjective or objective alertness, vigilance, or working memory.
Weiss, Matthew D.; Tamisier, Renaud; Boucher, Judith; Lynch, Mekkin; Gilmartin, Geoffrey; Weiss, J. Woodrow; Thomas, Robert Joseph
The effects of cannabis extracts on nocturnal sleep, early-morning performance, memory, and sleepiness were studied in 8 healthy volunteers (4 males, 4 females; 21 to 34 years). The study was double-blind and placebo-controlled with a 4-way crossover design. The 4 treatments were placebo, 15 mg Delta-9-tetrahydrocannabinol (THC), 5 mg THC combined with 5 mg cannabidiol (CBD), and 15 mg THC combined with 15 mg CBD. These were formulated in 50:50 ethanol to propylene glycol and administered using an oromucosal spray during a 30-minute period from 10 pm. The electroencephalogram was recorded during the sleep period (11 pm to 7 am). Performance, sleep latency, and subjective assessments of sleepiness and mood were measured from 8:30 am (10 hours after drug administration). There were no effects of 15 mg THC on nocturnal sleep. With the concomitant administration of the drugs (5 mg THC and 5 mg CBD to 15 mg THC and 15 mg CBD), there was a decrease in stage 3 sleep, and with the higher dose combination, wakefulness was increased. The next day, with 15 mg THC, memory was impaired, sleep latency was reduced, and the subjects reported increased sleepiness and changes in mood. With the lower dose combination, reaction time was faster on the digit recall task, and with the higher dose combination, subjects reported increased sleepiness and changes in mood. Fifteen milligrams THC would appear to be sedative, while 15 mg CBD appears to have alerting properties as it increased awake activity during sleep and counteracted the residual sedative activity of 15 mg THC. PMID:15118485
Nicholson, Anthony N; Turner, Claire; Stone, Barbara M; Robson, Philip J
We evaluated the effects of sleep disruption on the mealtime behavior of a young boy with developmental disabilities. Results showed that bite acceptance was less likely to persist during meals following disrupted sleep, but only when escape extinction was not implemented. Findings are discussed in terms of establishing operations and the effects…
Reed, Gregory K.; Dolezal, Danielle N.; Cooper-Brown, Linda J.; Wacker, David P.
Several movement disorders may occur during nocturnal rest disrupting sleep. A part of these complaints is characterized by relatively simple, non-purposeful and usually stereotyped movements. The last version of the International Classification of Sleep Disorders includes these clinical conditions (i.e. restless legs syndrome, periodic limb movement disorder, sleep-related leg cramps, sleep-related bruxism and sleep-related rhythmic movement disorder) under the category entitled sleep-related movement disorders. Moreover, apparently physiological movements (e.g. alternating leg muscle activation and excessive hypnic fragmentary myoclonus) can show a high frequency and severity impairing sleep quality. Clinical and, in specific cases, neurophysiological assessments are required to detect the presence of nocturnal movement complaints. Patients reporting poor sleep due to these abnormal movements should undergo non-pharmacological or pharmacological treatments. PMID:22203333
Merlino, Giovanni; Gigli, Gian Luigi
Melatonin and serotonin rhythms, which exhibit a close association with the endogenous circadian component of sleep, are attenuated with increasing age. This decrease seems to be linked to sleep alterations in the elderly. Chrononutrition is a field of chronobiology that establishes the principle of consuming foodstuffs at times of the day when they are more useful for health, improving, therefore, biorhythms and physical performance. Our aim was to analyze whether the consumption of cereals enriched with tryptophan, the precursor of both serotonin and melatonin, may help in the reconsolidation of the sleep/wake cycle and counteract depression and anxiety in 35 middle-aged/elderly (aged 55-75 year) volunteers in a simple blind assay. Data were collected for 3 weeks according to the following schedule: The control week participants consumed standard cereals (22.5 mg tryptophan in 30 g cereals per dose) at breakfast and dinner; for the treatment week, cereals enriched with a higher dose of tryptophan (60 mg tryptophan in 30 g cereals per dose) were eaten at both breakfast and dinner; the posttreatment week volunteers consumed their usual diet. Each participant wore a wrist actimeter that logged activity during the whole experiment. Urine was collected to analyze melatonin and serotonin urinary metabolites and to measure total antioxidant capacity. The consumption of cereals containing the higher dose in tryptophan increased sleep efficiency, actual sleep time, immobile time, and decreased total nocturnal activity, sleep fragmentation index, and sleep latency. Urinary 6-sulfatoxymelatonin, 5-hydroxyindoleacetic acid levels, and urinary total antioxidant capacity also increased respectively after tryptophan-enriched cereal ingestion as well as improving anxiety and depression symptoms. Cereals enriched with tryptophan may be useful as a chrononutrition tool for alterations in the sleep/wake cycle due to age. PMID:22622709
Bravo, R; Matito, S; Cubero, J; Paredes, S D; Franco, L; Rivero, M; Rodríguez, A B; Barriga, C
Study Objectives: Newcomers at high altitude (> 3,000 m) experience periodic breathing, sleep disturbances, and impaired cognitive performance. Whether similar adverse effects occur at lower elevations is uncertain, although numerous lowlanders travel to moderate altitude for professional or recreational activities. We evaluated the hypothesis that nocturnal breathing, sleep, and cognitive performance of lowlanders are impaired at moderate altitude. Design: Randomized crossover trial. Setting: University hospital at 490 m, Swiss mountain villages at 1,630 m and 2,590 m. Participants: Fifty-one healthy men, median (quartiles) age 24 y (20-28 y), living below 800 m. Interventions: Studies at Zurich (490 m) and during 4 consecutive days at 1,630 m and 2,590 m, respectively, 2 days each. The order of altitude exposure was randomized. Polysomnography, psychomotor vigilance tests (PVT), the number back test, several other tests of cognitive performance, and questionnaires were evaluated. Measurements and Results: The median (quartiles) apnea-hypopnea index at 490 m was 4.6/h (2.3; 7.9), values at 1,630 and 2,590 m, day 1 and 2, respectively, were 7.0/h (4.1; 12.6), 5.4/h (3.5; 10.5), 13.1/h (6.7; 32.1), and 8.0/h (4.4; 23.1); corresponding values of mean nocturnal oxygen saturation were 96% (95; 96), 94% (93; 95), 94% (93; 95), 90% (89; 91), 91% (90; 92), P < 0.05 versus 490 m, all instances. Slow wave sleep on the first night at 2,590 m was 21% (18; 25) versus 24% (20; 27) at 490 m (P < 0.05). Psychomotor vigilance and various other measures of cognitive performance did not change significantly. Conclusions: Healthy men acutely exposed during 4 days to hypoxemia at 1,630 m and 2,590 m reveal a considerable amount of periodic breathing and sleep disturbances. However, no significant effects on psychomotor reaction speed or cognitive performance were observed. Clinical Trials Registration: Clinicaltrials.gov: NCT01130948. Citation: Latshang TD; Lo Cascio CM; Stöwhas AC; Grimm M; Stadelmann K; Tesler N; Achermann P; Huber R; Kohler M; Bloch KE. Are nocturnal breathing, sleep, and cognitive performance impaired at moderate altitude (1,630-2,590 m)? SLEEP 2013;36(12):1969-1976.
Latshang, Tsogyal D.; Lo Cascio, Christian M.; Stowhas, Anne-Christin; Grimm, Mirjam; Stadelmann, Katrin; Tesler, Noemi; Achermann, Peter; Huber, Reto; Kohler, Malcolm; Bloch, Konrad E.
Sleep impairments are comorbid with a variety of neurological and psychiatric disorders including depression, epilepsy, and alcohol abuse. Despite the prevalence of these disorders, the cellular mechanisms underlying the interaction between sleep disruption and behavior remain poorly understood. In this study, the impact of chronic sleep loss on sleep homeostasis was examined in C57BL/6J mice following 3 d of sleep restriction. The electroencephalographic power of slow-wave activity (SWA; 0.5-4 Hz) in nonrapid eye movement (NREM) sleep and adenosine tone were measured during and after sleep restriction, and following subsequent acute sleep deprivation. During the first day of sleep restriction, SWA and adenosine tone increased, indicating a homeostatic response to sleep loss. On subsequent days, SWA declined, and this was accompanied by a corresponding reduction in adenosine tone caused by a loss of one source of extracellular adenosine. Furthermore, the response to acute sleep deprivation (6 h) was significantly attenuated in sleep-restricted mice. These effects were long-lasting with reduced SWA and adenosine tone persisting for at least 2 weeks. To investigate the behavioral consequences of chronic sleep restriction, sensitivity to the motor-impairing effects of alcohol was also examined. Sleep-restricted mice were significantly less sensitive to alcohol when tested 24 h after sleep restriction, an effect that persisted for 4 weeks. Intracerebroventricular infusion of an adenosine A1 receptor antagonist produced a similar decrease in sensitivity to alcohol. These results suggest that chronic sleep restriction induces a sustained impairment in adenosine-regulated sleep homeostasis and consequentially impacts the response to alcohol. PMID:24478367
Clasadonte, Jerome; McIver, Sally R; Schmitt, Luke I; Halassa, Michael M; Haydon, Philip G
The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fatigue due to sleep disruption is a condition that could lead to operational errors, potentially resulting in loss of mission or crew. Pharmacological consumables are mitigation strategies used to manage the risks associated with sleep deficits. The likelihood of medical intervention due to sleep disruption was estimated with a well validated sleep model and a Monte Carlo computer simulation in an effort to optimize the quantity of consumables. METHODS: The key components of the model are the mission parameter program, the calculation of sleep intensity and the diagnosis and decision module. The mission parameter program was used to create simulated daily sleep/wake schedules for an ISS increment. The hypothetical schedules included critical events such as dockings and extravehicular activities and included actual sleep time and sleep quality. The schedules were used as inputs to the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model (IBR Inc., Baltimore MD), which calculated sleep intensity. Sleep data from an ISS study was used to relate calculated sleep intensity to the probability of sleep medication use, using a generalized linear model for binomial regression. A human yes/no decision process using a binomial random number was also factored into sleep medication use probability. RESULTS: These probability calculations were repeated 5000 times resulting in an estimate of the most likely amount of sleep aids used during an ISS mission and a 95% confidence interval. CONCLUSIONS: These results were transferred to the parent IMM for further weighting and integration with other medical conditions, to help inform operational decisions. This model is a potential planning tool for ensuring adequate sleep during sleep disrupted periods of a mission.
Lewandowski, Beth; Brooker, John; Mallis, Melissa; Hursh, Steve; Caldwell, Lynn; Myers, Jerry
Successful memory consolidation during sleep depends on healthy slow-wave and rapid eye movement sleep, and on successful transition across sleep stages. In post-traumatic stress disorder, sleep is disrupted and memory is impaired, but relations between these two variables in the psychiatric condition remain unexplored. We examined whether disrupted sleep, and consequent disrupted memory consolidation, is a mechanism underlying declarative memory deficits in post-traumatic stress disorder. We recruited three matched groups of participants: post-traumatic stress disorder (n = 16); trauma-exposed non-post-traumatic stress disorder (n = 15); and healthy control (n = 14). They completed memory tasks before and after 8 h of sleep. We measured sleep variables using sleep-adapted electroencephalography. Post-traumatic stress disorder-diagnosed participants experienced significantly less sleep efficiency and rapid eye movement sleep percentage, and experienced more awakenings and wake percentage in the second half of the night than did participants in the other two groups. After sleep, post-traumatic stress disorder-diagnosed participants retained significantly less information on a declarative memory task than controls. Rapid eye movement percentage, wake percentage and sleep efficiency correlated with retention of information over the night. Furthermore, lower rapid eye movement percentage predicted poorer retention in post-traumatic stress disorder-diagnosed individuals. Our results suggest that declarative memory consolidation is disrupted during sleep in post-traumatic stress disorder. These data are consistent with theories suggesting that sleep benefits memory consolidation via predictable neurobiological mechanisms, and that rapid eye movement disruption is more than a symptom of post-traumatic stress disorder. PMID:24467663
Lipinska, Malgorzata; Timol, Ridwana; Kaminer, Debra; Thomas, Kevin G F
Sleep disruption is an emergent military health issue, but remarkably little is known of its prevalence or comorbidities in the combat zone. This study was designed to quantify the prevalence and mental health correlates of sleep disruption among military personnel serving within a ground combat zone during Operation Enduring Freedom. This was a large, cross-sectional survey of active duty and reserve U.S. Navy personnel (N = 3,175). Self-reported sleep measures included total hours of sleep per day, total hours of sleep required to feel well-rested, difficulty falling asleep, and difficulty staying asleep. The survey also measured mental health symptoms, including post-traumatic stress symptoms, anxiety, and depression. Participants reported an average of 5.9 hours of sleep per day despite requiring on average 6.8 hours to feel well rested. More than half (56%) were classified as sleep deficient, and 67% reported 6 or fewer hours of sleep per day. Adjusted for covariates, individuals endorsing sleep disruption were at substantially elevated risk of meeting criteria for post-traumatic stress disorder, generalized anxiety disorder, and major depressive disorder. This study documents the prevalence of sleep disruption in a very large and difficult-to-access sample of military members serving in a combat zone, and details robust associations with mental health. PMID:25003859
Taylor, Marcus K; Hilton, Susan M; Campbell, Justin S; Beckerley, Shiloh E; Shobe, Katharine K; Drummond, Sean P A
Often practically healthy persons present complaints about the disturbance of sleep. Thus, at interrogation of 1122 healthy persons it was ascertained that 5% of them complain of sleeplessness, 12% complain about an insufficient amount of sleep and 34% wa...
V. S. Rotenberg
ObjectivePulse wave attenuation, which occurs in association with obstructive sleep apnea (OSA), is sympathetically mediated. We compared the effect of Doxazosin (DO, a peripheral ?-receptor inhibitor) and Enalapril (EN, an ACE inhibitor) on digital vasoconstriction and nocturnal blood pressure (BP) in hypertensive OSA patients.
Ding Zou; Ludger Grote; Derek N. Eder; Jakub Radlinski; Jan Hedner
The high prevalence of sleep disorders, particularly obstructive sleep apnea, is well established in children with Down syndrome. However, only a few studies have focused on older children and young adults in this population. Given the presence of sleep disorders and the early emergence of Alzheimer's disease, more work is needed to examine the relationship between sleep and cognition in Down syndrome. Twenty-nine adolescents and young adults with Down syndrome participated in the present study. Parents reported on their sleep difficulties using a well-validated measure of sleep problems in intellectual disabilities. Based on theoretical models linking obstructive sleep apnea to prefrontal cortex dysfunction, we tested components of executive functions that have been shown to be impaired in previous studies of Down syndrome. First, results indicate that participants with Down syndrome with higher body mass index also had increased caregiver reports of sleep apnea symptoms. Individuals with high ratings of sleep disruption also showed greater difficulties with executive function. These results suggest that sleep disruption may place this set of functions at risk in young adults. Future work should examine if this risk may result in earlier onset of dementia or steeper decline with Alzheimer's disease. Further, additional studies are needed to investigate the effect of exercise interventions and weight reduction on sleep disorders in this population. PMID:23584183
Chen, C-C J J; Spanò, G; Edgin, J O
Aim. To investigate the association between sleep quality and duration with lipid and glycaemic control in Caucasian subjects with type 2 diabetes. Methods. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) in 114 type 2 diabetes (T2DM) subjects. Comparisons were made between subjects with different sleep quality and sleep duration. Hierarchical multiple regression analyses were used to determine contributors to metabolic parameters. Results. Subjects with poor sleep quality (PQ; PSQI ? 6) had higher systolic blood pressure, glycated haemoglobin, urine albumin : creatinine ratio (UAC), total cholesterol (TC), and triglycerides (TG) (P < 0.05 for all) compared to those with good sleep quality (GQ; PSQI ? 5). Long sleep duration (LSD) subjects had higher TC and short sleep duration (SSD) subjects had higher TG compared to those with medium sleep duration. Sleep duration and PSQI score were independent predictors of TC and low-density lipoprotein cholesterol (LDL), contributing to 14.0% and 6.1% of the total variance, respectively. Conclusions. In this Caucasian T2DM population, PQ is associated with adverse cardiovascular risk markers, and long and short sleep disruptions have an independent negative impact on lipids. Sleep assessment should be included as part of a diabetes clinic review.
Wan Mahmood, Wan Aizad; Draman Yusoff, Mohd Shazli; Behan, Lucy Ann; Di Perna, Andrea; McDermott, John; Sreenan, Seamus
Insomnia is not a normal part of aging, but nighttime sleep in older adults is often disrupted, leading to excessive daytime sleepiness and other physical, psychological, and cognitive changes that affect overall health. Even so, clinicians often pay little attention to sleep in this population. The sleep of older adults tends to be less deep than that of younger people, and coexisting conditions and treatment effects can more easily disrupt sleep. This article reviews the current literature on sleep disruption in older adults and suggests ways that nurses can apply the information in intervening to improve sleep in their older patients. PMID:17443076
Cole, Catherine; Richards, Kathy
Objective: To assess whether awakenings from sleep and sleep duration in Post Traumatic Stress Disorder (PTSD) were related to demography, posttraumatic or depressive symptoms, subjective sleep quality, and daytime sleepiness. Methods: Sample consisted of 23 veterans with lifetime PTSD and current sleep disturbance not due to apnea or other diagnosable conditions. Data collection included demography, two weeks of actigraphy, Beck Depression Inventory, Posttraumatic Checklist, Clinical Assessment of Posttraumatic Symptoms, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Results: The study revealed that awakenings increased with younger age. Variability in awakenings also increased with younger age (p = 0.002). More awakenings were associated with shorter sleep duration. Conclusions: These paradoxical observations regarding younger age and more awakening may be related to increased sleep symptoms early in the course and then gradual waning of posttraumatic symptoms over time, since awakenings tend to increase with age in normals (rather than decrease, as we observed).
S. Khawaja, Imran; M. Hashmi, Ali; Westermeyer, Joseph; Thuras, Paul; Hurwitz, Thomas
Background: A study of the pattern of Sleep\\/Wake disturbance in frontotemporal dementia (FTD). Methods: Sleep diaries and prolonged actigraphy were used to re- cord the activity, sleep and wake of 13 patients with a clinical diagnosis of FTD. These were compared with diaries and actigraphy from normal age\\/sex matched controls and also to a population with probable Alzheimers disease (AD).
K. N. Anderson; C. Hatfield; C. Kipps; M. Hastings; J. R. Hodges
Sleep disturbances are common problems affecting the quality life of Parkinson's disease (PD) patients and are often underestimated. The causes of sleep disturbances are multifactorial and include nocturnal motor disturbances, nocturia, depressive symptoms, and medication use. Comorbidity of PD with sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, or circadian cycle disruption also results in impaired sleep. In addition, the involvement of serotoninergic, noradrenergic, and cholinergic neurons in the brainstem as a disease-related change contributes to impaired sleep structures. Excessive daytime sleepiness is not only secondary to nocturnal disturbances or dopaminergic medication but may also be due to independent mechanisms related to impairments in ascending arousal system and the orexin system. Notably, several recent lines of evidence suggest a strong link between rapid eye movement sleep behavior disorder and the risk of neurodegenerative diseases such as PD. In the present paper, we review the current literature concerning sleep disorders in PD. PMID:21876839
Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Iwanami, Masaoki; Hirata, Koichi
Problem: Children scheduled for adenotonsillectomy frequently also have reversible disruptive behavior disorders (DBD). We examined whether preoperative scores on a sleep questionnaire could assist in predicting postoperative improvement of both polysomnographic variables and disruptive behavior disorders.Methods: Sixty children, (mean age, 8.3 years) were studied. Behavior assessment, a sleep questionnaire, and nocturnal polysomnography were completed shortly before and 1 year after
Susan L. Garetz; Robert A. Weatherly; James E. Dillon; Donna J. Champine; Deborah L. Ruzicka; Kenneth E. Guire; Elise K. Hodges; Ronald D. hervin
SUMMARY Background A young adult female presented with syncope and periodic weakness. A 12-lead electrocardiogram showed frequent premature ventricular contractions and prolonged QU interval. Repetitive runs of nonsustained ventricular tachycardia were recorded at night. Investigations Electromyography, muscle biopsy, MRI, echocardiography, exercise stress testing using Bruce protocol with microvolt T-wave alternans testing, 24 h Holter monitoring, electrophysiological testing and examination of the effects of sleep and sleep stage on the patient's ventricular arrhythmias. Diagnosis Type 1 Andersen–Tawil syndrome, (also known as type 7 long QT syndrome). Severe ventricular arrhythmia was observed, predominantly during rapid eye movement sleep. We speculate that the autonomic instability present during rapid eye movement sleep precipitates increasing vulnerability to sleep-related ventricular tachycardia. Management ?-blocker therapy alone, subsequently combined with mexiletine treatment.
Garcia-Touchard, Arturo; Somers, Virend K; Kara, Tomas; Nykodym, Jiri; Shamsuzzaman, Abu; Lanfranchi, Paola; Ackerman, Michael J
Study Objectives: Neonatal maternal separation (NMS) disrupts development of cardiorespiratory regulation. Adult male rats previously subjected to NMS are hypertensive and show a hypoxic ventilatory response greater than that of controls. These results have been obtained in awake or anesthetised animals, and the consequences of NMS on respiratory control during normal sleep are unknown. This study tested the following hypotheses: NMS augments respiratory variability across sleep-wake states, and NMS-related enhancement of the hypoxic ventilatory response occurs during sleep. Methods: Two groups of adult rats were used: controls (no treatment) and rats subjected to NMS. Ventilatory activity, coefficient of variation, and hypoxic ventilatory response were compared between groups and across sleep-wake states. Subjects: Male Sprague Dawley rats—NMS: n = 11; controls: n = 10. Pups subjected to NMS were isolated from their mother for 3 hours per day from postnatal days 3 to 12. Controls were undisturbed. Measurements and results: At adulthood, sleep-wake states were monitored by telemetry, and ventilatory activity was measured using whole-body plethysmography. Sleep and breathing were measured for 2.5 hours (in the morning) while the rats were breathing room air. Data were analysed in 20-second epochs. Rats were then exposed to a brief (90-sec) hypoxic episode (nadir = 12% O2) to measure the hypoxic ventilatory response. The coefficient of variability for tidal volume and breathing frequency decreased during sleep but remained more elevated in NMS rats than in controls. During non-rapid eye movement sleep, the breathing-frequency response to hypoxia of NMS rats was significantly greater than that of controls. Conclusion: Neonatal maternal seperation results in persistent disruption of respiratory control during sleep. Citation: Kinkead R; Montandon G; Bairam A; Lajeunesse Y; Horner R. Neonatal maternal separation disrupts regulation of sleep and breathing in adult male rats. SLEEP 2009;32(12):1611-1620.
Kinkead, Richard; Montandon, Gaspard; Bairam, Aida; Lajeunesse, Yves; Horner, Richard
Both chronic pain and sleep problems are common for children with intellectual and developmental disabilities (IDD). Although one study has revealed a relationship between having a medical condition and sleep problems in this population, the role of pain was not examined independently. Thus, the goal of this study was to clarify the specific role of pain in children's sleep problems. Caregivers of 123 children with IDD (67 male; mean age = 10 years, 7 months (SD = 49.7 months)) completed the Children's Sleep Habits Questionnaire (CHSQ) and provided information about children's pain, function and demographic characteristics. Children were grouped as having: No Pain (86), Treated Pain (21), or Untreated Pain (16). A Multivariate Analysis of Variance (MANOVA) indicated children who had pain had significantly more sleep problems overall (F(16, 222) = 2.2, p = .005), and more Night Wakings (F(2, 118) = 3.1, p = .05), Parasomnias (F(2, 118) = 5.0, p = .009) and Sleep Disordered Breathing (F(2, 118) = 5.1, p = .008) in particular. The pattern of sleep problems varied due to whether the child was taking pain medication. Children with pain also had significantly shorter typical sleep duration (F(2, 112) = 3.5, p = 0.035). The presence of sleep problems did not vary due to functional level or whether children were taking sleep medications. However, parents of children who were taking sleep medications reported that both Bedtime Resistance (F(1, 121) = 5.7, p = .019) and Sleep Duration (F(1, 121) = 6.0, p = .016) were more problematic for them. This data indicates pain disrupts sleep in children with IDD even when it is being managed pharmacologically, suggesting pain treatment may not be effective. These results suggest that pain should be considered during evaluation and management of sleep problems in children with IDD. PMID:21664797
Breau, Lynn M; Camfield, Carol S
Background Obstructive sleep apnoea (OSA) is the most common form of sleep-disordered breathing and a known risk factor for cardiovascular disease. We hypothesised that in patients with OSA the characteristics of nocturnal pulse rate (PR) are associated with changes in blood pressure and daytime sleepiness, following commencement of continuous positive airway pressure (CPAP) therapy. Methods Pulse oximetry data, demographics, daytime sleepiness and blood pressure were recorded at baseline and at one year follow up. Patients with OSA were grouped according to positive and negative changes in the PR (?PR) response during the first night of pulse oximetry before commencement of CPAP. Results A total of 115 patients (58 with OSA and 57 matched subjects without OSA) were identified and included in the analysis. The scale of improvement in daytime sleepiness could be predicted by a negative or positive ?PR, as recorded in the initial screening pulse oximetry [?ESS –5.8 (5.1) vs. –0.8 (7.2) points, P<0.05]. A negative correlation was observed between mean nocturnal PR and changes in systolic blood pressure (SBP) after one year of CPAP treatment (r=–0.42, P<0.05). Conclusions Mean nocturnal PR prior to CPAP initiation was associated with changes in SBP at one year follow up. A descending nocturnal PR in patients with OSA, prior to CPAP initiation, might help to identify a symptomatic response from long term CPAP treatment.
Drakatos, Panagis; Kosky, Christopher; Williams, Adrian; Hart, Nicholas; Rossi, Gian Paolo; Steier, Joerg
Study Objectives: To describe the rate, distribution and correlates of periodic limb movements in sleep (PLMS) in children with sickle cell disease (SCD). Design: Prospective, cross-sectional. Setting: Hospital-based sleep laboratory. Participants: Sixty-four children aged 2–18 years with SCD, hemoglobin SS-type who had an overnight polysomnogram and a parent-completed Pediatric Sleep Questionnaire. Mean age was 8.4 years (SD 4.8); 50% were male. Interventions: N/A Measurements and Results: The mean PLMS index was 3.7 (6.6) and ranged from 0 to 31.8, with 23.4% of the sample having PLMS ? 5/h. Sleep efficiency was decreased (P = 0.03), and the total arousal index (P = 0.003) and PLMS arousal index (P < 0.001) were increased in children with PLMS ? 5/h compared to those with PLMS < 5/h. PLMS were most frequent in NREM stage 2 sleep and during the fourth hour of sleep. Inter-movement interval duration peaked at 25–30 s. “Growing pains worst in bed” or “restlessness of the legs”, suggesting restless legs syndrome (RLS), were reported in 12.5% of the total sample and were more common in children with elevated PLMS. A PLMS score for identifying elevated PLMS in children, based on items from the Pediatric Sleep Questionnaire, did not significantly predict PLMS ? 5/h. Conclusions: Elevated PLMS are common in children with SCD and are associated with sleep disruption and symptoms of RLS. Future research into the time structure of PLMS, their causes and consequences, and development of a disease-specific sleep disorders screening questionnaire, is needed in children with SCD. Citation: Rogers VE; Marcus CL; Jawad AF; Smith-Whitley K; Ohene-Frempong K; Bowdre C; Allen J; Arens R; Mason TBA. Periodic limb movements and disrupted sleep in children with sickle cell disease. SLEEP 2011;34(7):899-908.
Rogers, Valerie E.; Marcus, Carole L.; Jawad, Abbas F.; Smith-Whitley, Kim; Ohene-Frempong, Kwaku; Bowdre, Cheryl; Allen, Julian; Arens, Raanan; Mason, Thornton B. A.
The term "nocturnal paroxysmal dystonia" has been used to describe patients who display paroxysmal episodes of dystonic-dyskinetic movements arising during nonrapid eye movement sleep, in particular stages 2-3 (Lugaresi E, Cirignotta F. Hypnogenic paroxysmal dystonia: epileptic seizure or a new syndrome. Sleep 1981;4: 129-138). The pathogenesis of these attacks has remained controversial. We describe a patient with posttraumatic paroxysmal nocturnal hemidystonia. Acetazolamide led to improvement. PMID:8139612
Biary, N; Singh, B; Bahou, Y; al Deeb, S M; Sharif, H
Daytime sleepiness is not only a clinical and research problem, it can have consequences in operational settings. Sleepiness and alertness are generally viewed as reciprocal and have been viewed as a function of the circadian cycle and of prior sleep and ...
L. C. Johnson C. L. Spinweber S. A. Gomez L. T. Matteson
BACKGROUND: Although considerable progress has been made in the treatment of chronic kidney disease, compromised quality of life continues to be a significant problem for patients receiving hemodialysis (HD). However, in spite of the high prevalence of sleep complaints and disorders in this population, the relationship between these problems and quality of life remains to be well characterized. Thus, we
Kathy P Parker; Nancy G Kutner; Donald L Bliwise; James L Bailey; David B Rye
This study focuses on analysis of the relationship between changes in blood oxygen saturation (SaO(2)) and heart rate (HR) recordings from nocturnal pulse oximetry (NPO) in patients suspected of suffering from obstructive sleep apnoea (OSA) syndrome. Two different analyses were developed: a classical frequency analysis based on the magnitude squared coherence (MSC) and a nonlinear analysis by means of a recently developed measure of synchrony, the cross-approximate entropy (cross-ApEn). A data set of 187 subjects was studied. We found significantly higher correlation and synchrony between oximetry signals from OSA positive patients compared with OSA negative subjects. We assessed the diagnostic ability to detect OSA syndrome of both the classical and nonlinear approaches by means of receiver operating characteristic (ROC) analyses with tenfold cross-validation. The nonlinear measure of synchrony significantly improved the results obtained with classical MSC: 69.2% sensitivity, 90.9% specificity and 78.1% accuracy were reached with MSC, whereas 83.7% sensitivity, 84.3% specificity and 84.0% accuracy were obtained with cross-ApEn. Our results suggest that the use of nonlinear measures of synchrony could provide essential information from oximetry signals, which cannot be obtained with classical spectral analysis. PMID:19696463
Alvarez, D; Hornero, R; Abásolo, D; del Campo, F; Zamarrón, C; López, M
Study Objectives: Vigilance is affected by induced and spontaneous skin temperature fluctuations. Whereas sleep deprivation strongly affects vigilance, no previous study examined in detail its effect on human skin temperature fluctuations and their association with vigilance. Design: In a repeated-measures constant routine design, skin temperatures were assessed continuously from 14 locations while performance was assessed using a reaction time task, including eyes-open video monitoring, performed five times a day for 2 days, after a normal sleep or sleep deprivation night. Setting: Participants were seated in a dimly lit, temperature-controlled laboratory. Patients or Participants: Eight healthy young adults (five males, age 22.0 ± 1.8 yr (mean ± standard deviation)). Intervention: One night of sleep deprivation. Measurements and Results: Mixed-effect regression models were used to evaluate the effect of sleep deprivation on skin temperature gradients of the upper (ear-mastoid), middle (hand-arm), and lower (foot-leg) body, and on the association between fluctuations in performance and in temperature gradients. Sleep deprivation induced a marked dissociation of thermoregulatory skin temperature gradients, indicative of attenuated heat loss from the hands co-occurring with enhanced heat loss from the feet. Sleep deprivation moreover attenuated the association between fluctuations in performance and temperature gradients; the association was best preserved for the upper body gradient. Conclusions: Sleep deprivation disrupts coordination of fluctuations in thermoregulatory skin temperature gradients. The dissociation of middle and lower body temperature gradients may therefore be evaluated as a marker for sleep debt, and the upper body gradient as a possible aid in vigilance assessment when sleep debt is unknown. Importantly, our findings suggest that sleep deprivation affects the coordination between skin blood flow fluctuations and the baroreceptor-mediated cardiovascular regulation that prevents venous pooling of blood in the lower limbs when there is the orthostatic challenge of an upright posture. Citation: Romeijn N; Verweij IM; Koeleman A; Mooij A; Steimke R; Vikkala J; van der Werg Y; Van Someren EJW. Cold hands, warm feet: sleep deprivation disrupts thermoregulation and its association with vigilance. SLEEP 2012;35(12):1673-1683.
Romeijn, Nico; Verweij, Ilse M.; Koeleman, Anne; Mooij, Anne; Steimke, Rosa; Virkkala, Jussi; van der Werf, Ysbrand; Van Someren, Eus J.W.
Objective: Chronic snoring that does not adhere to the criteria for a diagnosis of obstructive sleep apnea syndrome may be associated with learning and behavioral problems. We investigated the sleep structure of chronic snorers who had an apnea-hypopnea index of less than 1 event per hour and analyzed the cyclic alternating pattern. Methods:…
Lopes, M. Cecilia; Guilleminault, Christian
The usual differential diagnoses of nocturnal events in children include parasomnias, nocturnal seizures, nocturnal reflux (Sandifer syndrome), hypnic jerks, periodic limb movements of sleep, and sleep disordered breathing. We report a previously healthy young girl who presented to the sleep clinic for evaluation of nocturnal events which were diagnosed as medically refractory nocturnal seizures. It was not until a syncopal event occurred in the daytime, which prompted referral for cardiac evaluation, the diagnosis of idiopathic pulmonary arterial hyper-tension (IPAH) was made. Sleep physicians should consider IPAH in the differential diagnosis of nocturnal events in children. Citation: Izzo A; McSweeney J; Kulik T; Khatwa U; Kothare SV. “Nocturnal seizures” in idiopathic pulmonary arterial hypertension. J Clin Sleep Med 2013;9(10):1091-1092.
Izzo, Anthony; McSweeney, Julia; Kulik, Thomas; Khatwa, Umakanth; Kothare, Sanjeev V.
Human and animal studies demonstrate that short sleep or poor sleep quality, e.g. in night shift workers, promote the development of obesity and diabetes. Effects of sleep disruption on glucose homeostasis and liver physiology are well documented. However, changes in adipokine levels after sleep disruption suggest that adipocytes might be another important peripheral target of sleep. Circadian clocks regulate metabolic homeostasis and clock disruption can result in obesity and the metabolic syndrome. The finding that sleep and clock disruption have very similar metabolic effects prompted us to ask whether the circadian clock machinery may mediate the metabolic consequences of sleep disruption. To test this we analyzed energy homeostasis and adipocyte transcriptome regulation in a mouse model of shift work, in which we prevented mice from sleeping during the first six hours of their normal inactive phase for five consecutive days (timed sleep restriction--TSR). We compared the effects of TSR between wild-type and Per1/2 double mutant mice with the prediction that the absence of a circadian clock in Per1/2 mutants would result in a blunted metabolic response to TSR. In wild-types, TSR induces significant transcriptional reprogramming of white adipose tissue, suggestive of increased lipogenesis, together with increased secretion of the adipokine leptin and increased food intake, hallmarks of obesity and associated leptin resistance. Some of these changes persist for at least one week after the end of TSR, indicating that even short episodes of sleep disruption can induce prolonged physiological impairments. In contrast, Per1/2 deficient mice show blunted effects of TSR on food intake, leptin levels and adipose transcription. We conclude that the absence of a functional clock in Per1/2 double mutants protects these mice from TSR-induced metabolic reprogramming, suggesting a role of the circadian timing system in regulating the physiological effects of sleep disruption. PMID:23285241
Husse, Jana; Hintze, Sophie Charlotte; Eichele, Gregor; Lehnert, Hendrik; Oster, Henrik
Human and animal studies demonstrate that short sleep or poor sleep quality, e.g. in night shift workers, promote the development of obesity and diabetes. Effects of sleep disruption on glucose homeostasis and liver physiology are well documented. However, changes in adipokine levels after sleep disruption suggest that adipocytes might be another important peripheral target of sleep. Circadian clocks regulate metabolic homeostasis and clock disruption can result in obesity and the metabolic syndrome. The finding that sleep and clock disruption have very similar metabolic effects prompted us to ask whether the circadian clock machinery may mediate the metabolic consequences of sleep disruption. To test this we analyzed energy homeostasis and adipocyte transcriptome regulation in a mouse model of shift work, in which we prevented mice from sleeping during the first six hours of their normal inactive phase for five consecutive days (timed sleep restriction – TSR). We compared the effects of TSR between wild-type and Per1/2 double mutant mice with the prediction that the absence of a circadian clock in Per1/2 mutants would result in a blunted metabolic response to TSR. In wild-types, TSR induces significant transcriptional reprogramming of white adipose tissue, suggestive of increased lipogenesis, together with increased secretion of the adipokine leptin and increased food intake, hallmarks of obesity and associated leptin resistance. Some of these changes persist for at least one week after the end of TSR, indicating that even short episodes of sleep disruption can induce prolonged physiological impairments. In contrast, Per1/2 deficient mice show blunted effects of TSR on food intake, leptin levels and adipose transcription. We conclude that the absence of a functional clock in Per1/2 double mutants protects these mice from TSR-induced metabolic reprogramming, suggesting a role of the circadian timing system in regulating the physiological effects of sleep disruption.
Eichele, Gregor; Lehnert, Hendrik; Oster, Henrik
Rationale: In adult rats, bilateral ablation of pre-Bötzinger complex (preBötC) neurokinin 1–expressing (NK1R) neurons leads to a progressive and irreversible disruption in breathing pattern, initially during sleep, eventually resulting in an ataxic breathing pattern during wakefulness. Objectives: Here we determine whether ablation of fewer preBötC NK1R neurons leads to a persistent pattern of disordered breathing during sleep but not during wakefulness. Methods: Adult male Sprague-Dawley rats (n = 12) were instrumented to record diaphragmatic, abdominal, and neck EMG, and EEG. Fourteen days later, a second surgery was performed to stereotaxically microinject into the preBötC on one side the toxin saporin conjugated to substance P (SP-SAP), which selectively ablates NK1R neurons. Measurements and Main Results: Postinjection, rats were monitored within a plethysmograph until they were killed (Days 21–51). At Days 6–9 post–unilateral SP-SAP injection, respiratory pattern during sleep, particularly REM sleep, became increasingly disordered, characterized by an increase in frequency of central sleep apnea and hypopneas (36.8 ± 7.4 episodes/h of REM vs. 6 ± 2.0 episodes/h in preinjection controls; P < 0.05), whereas breathing during resting wakefulness remained stable. Unlike bilateral SP-SAP–injected rats, an ataxic breathing pattern did not develop during wakefulness. Rats that were monitored up to 51 days post–SP-SAP injection continued to have sleep-disordered breathing; breathing during wakefulness remained relatively stable. Histologic analysis of the ventrolateral medulla confirmed that NK1R neurons within the preBötC on the injected but not on the contralateral side of the medulla were ablated. Conclusions: Gradual loss of preBötC NK1R neurons may be an underlying factor of sleep-disordered breathing, in particular of central sleep apnea.
McKay, Leanne C.; Feldman, Jack L.
Nocturnal deterioration of lung function frequently occurs in asthma patients. It results in sleep depravation and impaired\\u000a quality of life but is also associated with increased morbidity and mortality. Several mechanisms such as endogenous circadian\\u000a rhythm disturbances, concomitant disorders, behavioral and environmental factors have been implicated in the pathophysiology\\u000a of nocturnal asthma symptoms. Appropriately used, currently available asthma medications, including
Krzysztof Kowal; Lawrence Du Buske
During ISS and shuttle missions, difficulties with sleep affect more than half of all US crews. Mitigation strategies to help astronauts cope with the challenges of disrupted sleep patterns can negatively impact both mission planning and vehicle design. The methods for addressing known detrimental impacts for some mission scenarios may have a substantial impact on vehicle specific consumable mass or volume or on the mission timeline. As part of the Integrated Medical Model (IMM) task, NASA Glenn Research Center is leading the development of a Monte Carlo based forecasting tool designed to determine the consumables required to address risks related to sleep disruption. The model currently focuses on the International Space Station and uses an algorithm that assembles representative mission schedules and feeds this into a well validated model that predicts relative levels of performance, and need for sleep (SAFTE Model, IBR Inc). Correlation of the resulting output to self-diagnosed needs for hypnotics, stimulants, and other pharmaceutical countermeasures, allows prediction of pharmaceutical use and the uncertainty of the specified prediction. This paper outlines a conceptual model for determining a rate of pharmaceutical utilization that can be used in the IMM model for comparison and optimization of mitigation methods with respect to all other significant medical needs and interventions.
Myers, Jerry G.; Lewandowski, Beth E.; Brooker, John E.; Hurst, S. R.; Mallis, Melissa M.; Caldwell, J. Lynn
In human African trypanosomiasis (sleeping sickness), sleep and wake episodes are sporadically distributed throughout the day and the night. To determine whether these sleep disturbances affect the 24-h hormone profiles and the normal relationships between hormone pulsatility and sleep stages, poly-graphic sleep recordings and concomitant hormone profiles were obtained in 6 African patients with sleeping sickness and in 5 healthy
G. Brandenberger; A. Buguet; K. Spiegel; A. Stanghellini; G. Muanga; P. Bogui; M. Dumas
Nighttime food intake is associated with weight gain and higher HbA1c levels. We experienced night eaters who have no memory of their nocturnal eating in the morning. In this study, the curious night eating behavior was designated as "unremembered nocturnal eating syndrome (UNES)". We screened 1,169 patients with diabetes for sleep quality and abnormal eating behavior at night using the Pittsburgh Sleep Quality Index questionnaire with an additional question regarding UNES. When abnormal nocturnal eating behavior was noted, detailed clinical information was extracted from interviews with the patients. We identified 9 patients who experienced UNES. They had a higher BMI compared with subjects who reported no such episodes. Among them, 6 patients who consumed food at night without memory 2-5 times per month or more had significantly higher HbA1c levels. Continuous glucose monitoring in a patient with type 1 diabetes revealed an abrupt elevation of glucose levels from midnight when some foods were consumed. Eight of the 9 patients were taking benzodiazepine and/or non-benzodiazepine hypnotic agents when they experienced the episodes. The prevalence of UNES was 0.8% in all subjects and 4% in those taking hypnotic drugs. The ratio of hypnotic drug use in subjects with UNES was significantly higher than for individuals without UNES (89% vs. 17%, p<0.0001). Although UNES seems to be etiologically heterogeneous, hypnotics-induced parasomnia and/or anterograde amnesia may be associated with the behavior. UNES is not rare in diabetic patients on hypnotic medicine and may be a hidden cause of unexpected morning hyperglycemia. PMID:23774071
Yamada, Kentaro; Nakayama, Hitomi; Kato, Tomoko; Tajiri, Yuji; Sato, Shuichi; Hirao, Saori; Oshige, Tamami; Hara, Kento; Iwata, Shinpei; Kato, Naoka; Sasaki, Yuko; Hasuo, Rika; Yoshinobu, Satoko; Mitsuzaki, Kenshi; Kato, Tamotsu; Hashinaga, Toshihiko; Muraishi, Kazuhisa; Ohki, Tsuyoshi; Kaku, Hiroh
Sleep disruption appears not only to reflect a symptom of posttraumatic stress disorder (PTSD), but also a unique vulnerability for its development and maintenance. Studies examining the impact of psychosocial treatments for PTSD on sleep symptoms are few and no studies to date of which we are aware have examined this question in samples with co-occurring substance use disorders. The current study is a secondary analysis of a large clinical trial comparing 2 psychological treatments for co-occurring PTSD and substance use disorders. Women (N = 353) completed measures of PTSD at baseline, end of treatment, and 3-, 6-, and 12-month follow-ups. Results indicated that the prevalence of insomnia, but not nightmares, decreased during treatment, and that 63.8% of participants reported at least 1 clinical-level sleep symptom at the end of treatment. Improvement in sleep symptoms during treatment was associated with better overall PTSD outcomes over time, ?(2) (1) = 33.81, p < .001. These results extend the existing literature to suggest that residual sleep disruption following PTSD treatment is common in women with co-occurring PTSD and substance use disorders. Research on the benefits of adding sleep-specific intervention for those with residual sleep disruption in this population may be a promising future direction. PMID:24473926
McHugh, R Kathryn; Hu, Mei-Chen; Campbell, Aimee N C; Hilario, E Yvette; Weiss, Roger D; Hien, Denise A
Atopic diseases, such as asthma and allergic rhinitis, are common conditions that can influence sleep and subsequent daytime functioning. Children and patients with allergic conditions from ethnic minority groups might be particularly vulnerable to poor sleep and compromised daytime functioning because of the prevalence of these illnesses in these groups and the high level of morbidity. Research over the past 10 years has shed light on the pathophysiologic mechanisms (eg, inflammatory mediators) involved in many atopic diseases that can underlie sleep disruptions as a consequence of the presence of nocturnal symptoms. Associations between nocturnal symptoms and sleep and poorer quality of life as a result of missed sleep have been demonstrated across studies. Patients with severe illness and poor control appear to bear the most burden in terms of sleep impairment. Sleep-disordered breathing is also more common in patients with allergic diseases. Upper and lower airway resistance can increase the risk for sleep-disordered breathing events. In patients with allergic rhinitis, nasal congestion is a risk factor for apnea and snoring. Finally, consistent and appropriate use of medications can minimize nocturnal asthma or allergic symptoms that might disrupt sleep. Despite these advances, there is much room for improvement in this area. A summary of the sleep and allergic disease literature is reviewed, with methodological, conceptual, and clinical suggestions presented for future research.
Koinis-Mitchell, Daphne; Craig, Timothy; Esteban, Cynthia A.; Klein, Robert B.
Atopic diseases, such as asthma and allergic rhinitis, are common conditions that can influence sleep and subsequent daytime functioning. Children and patients with allergic conditions from ethnic minority groups might be particularly vulnerable to poor sleep and compromised daytime functioning because of the prevalence of these illnesses in these groups and the high level of morbidity. Research over the past 10 years has shed light on the pathophysiologic mechanisms (eg, inflammatory mediators) involved in many atopic diseases that can underlie sleep disruptions as a consequence of the presence of nocturnal symptoms. Associations between nocturnal symptoms and sleep and poorer quality of life as a result of missed sleep have been demonstrated across studies. Patients with severe illness and poor control appear to bear the most burden in terms of sleep impairment. Sleep-disordered breathing is also more common in patients with allergic diseases. Upper and lower airway resistance can increase the risk for sleep-disordered breathing events. In patients with allergic rhinitis, nasal congestion is a risk factor for apnea and snoring. Finally, consistent and appropriate use of medications can minimize nocturnal asthma or allergic symptoms that might disrupt sleep. Despite these advances, there is much room for improvement in this area. A summary of the sleep and allergic disease literature is reviewed, with methodological, conceptual, and clinical suggestions presented for future research. PMID:22867694
Koinis-Mitchell, Daphne; Craig, Timothy; Esteban, Cynthia A; Klein, Robert B
Light is being used as a pre-launch countermeasure to circadian and sleep disruption in astronauts. The effect of light on the circadian system is readily monitored by measurement of plasma melatonin. Our group has established an action spectrum for human melatonin regulation and determined the region of 446-477 nm to be the most potent for suppressing plasma melatonin. The aim of this study was to compare the efficacy of 460 and 555 nm for suppressing melatonin using a within-subjects design. Subjects (N=12) were exposed to equal photon densities (7.18 x 10(12) photons/cm2/s) at 460 and 555 nm. Melatonin suppression was significantly stronger at 460 nm (p<0.02). An extension to the action spectrum showed that 420 nm light at 16 and 32 microW/cm2 significantly suppressed melatonin (p<0.04 and p<0.002). These studies will help optimize lighting countermeasures to circadian and sleep disruption during spaceflight. PMID:15838948
Fucci, Robert L; Gardner, James; Hanifin, John P; Jasser, Samar; Byrne, Brenda; Gerner, Edward; Rollag, Mark; Brainard, George C
Exposure to a 5060-Hz electromagnetic field can decrease the nocturnal production of melatonin in rodents. Melatonin is considered to be a marker of circadian rhythms, and abnormalities in its secretion are associated with clinical disorders, including fatigue, sleep disruption, mood swings, impaired performance, and depression, which are consequences of desynchronisation. Interestingly, some epidemiological studies have been reported finding most of
Brahim Selmaoui; Jacques Lambrozo; Yvan Touitou
The intimate relationship between sleep and epilepsy has long been recognized, yet our understanding of the relationship is incomplete. In this article we address four key issues in this area. First, we consider the reciprocal interaction between sleep and epilepsy. Sleep state clearly influences seizure onset, particularly in certain epilepsy syndromes. The converse is also true; epilepsy may disrupt sleep, either directly through seizures and epileptiform activity, or indirectly through medication-related effects. Unraveling the influences of sleep stage, epilepsy syndrome, and drug effects is challenging, and the current state of knowledge is reviewed. Secondly, accurate diagnosis of sleep-related epilepsy can be difficult, particularly the distinction of nocturnal frontal lobe epilepsy (NFLE) from arousal parasomnias. The challenges in this area, along with work from the authors, are discussed. Thirdly, we will explore the putative relationship between obstructive sleep apnea (OSA) and epilepsy, including the effect of OSA on quality of life; this will lead us to a brief exploration of the effects of OSA on neuroendocrine function. Finally, we will review the evidence surrounding the role of sleep in sudden unexpected death in epilepsy (SUDEP). PMID:23465654
Derry, Christopher P; Duncan, Susan
Various experimental studies on sleep are described. The following areas are discussed: (1) effect of altered day length on sleep, (2) effect of a partial loss of sleep on subsequent nocturnal sleep; (3) effect of rigid control over sleep-wake-up times; (4) sleep and wakefulness in a time-free environment; (5) distribution of spindles during a full night of sleep; and (6) effect on sleep and performance of swiftly changing shifts of work.
Webb, W. B.; Agnew, H. W., Jr.
Objectives: Short sleep duration and poor sleep quality in children have been associated with concentration, problem behavior, and emotional instability, but recently also with disrupted autonomic nervous function, which predicts cardiovascular health. Heart rate variability (HRV) was used as noninvasive indicator of autonomic function to examine the influence of sleep. Design: Cross-sectional and longitudinal observational study on the effect of sleep on HRV Participants: Belgian children (5-11 years) of the ChiBS study in 2010 (N = 334) and 2011 (N = 293). Interventions: N/A. Methods: Sleep duration was reported and in a subgroup sleep quality (efficiency, latency, awakenings) was measured with accelerometry. High-frequency (HF) power and autonomic balance (LF/HF) were calculated on supine 5-minute HRV measurements. Stress was measured by emotion and problem behavior questionnaires. Sleep duration and quality were used as HRV predictors in corrected cross-sectional and longitudinal regressions. Stress was tested as mediator (intermediate pathway) or moderator (interaction) in sleep-HRV associations. Results: In both cross-sectional and longitudinal analyses, long sleep latency could predict lower HF (parasympathetic activity), while nocturnal awakenings, sleep latency, low sleep efficiency, and low corrected sleep duration were related to higher LF/HF (sympathetic/parasympathetic balance). Parental reported sleep duration was not associated with HRV. The significances remained after correction for stress. Stress was not a mediator, but a moderator (enhancer) in the relationship between sleep quality and HRV. Conclusions: Low sleep quality but not parent-reported low sleep duration leads to an unhealthier heart rate variability pattern (sympathetic over parasympathetic dominance). This stresses the importance of good sleep quality for cardiovascular health in children. Citation: Michels N; Clays E; De Buyzere M; Vanaelst B; De Henauw S; Sioen I. Children's sleep and autonomic function: low sleep quality has an impact on heart rate variability. SLEEP 2013;36(12):1939-1946.
Michels, Nathalie; Clays, Els; De Buyzere, Marc; Vanaelst, Barbara; De Henauw, Stefaan; Sioen, Isabelle
We present the case of a 7-year-old boy, who received acetaminophen for the treatment of hyperpyrexia, due to an infection of the superior airways. 13?mg/kg (260?mg) of acetaminophen was administered orally before bedtime, and together with the expected antipyretic effect, the boy experienced sleep disruption and proprioceptive delirium. The symptoms disappeared within one hour. In the following six months, acetaminophen was administered again twice, and the reaction reappeared with similar features. Potential alternative explanations were excluded, and analysis with the Naranjo algorithm indicated a “probable” relationship between acetaminophen and this adverse reaction. We discuss the potential mechanisms involved, comprising imbalances in prostaglandin levels, alterations of dopamine, and cannabinoid and serotonin signalings.
Carnovale, Carla; Pozzi, Marco; Nisic, Andrea Angelo; Scrofani, Elisa; Perrone, Valentina; Antoniazzi, Stefania; Radice, Sonia
Sleep-related seizures characterised by choreoathetoid, dystonic and ballic movements occurred in 12 patients, repeatedly each night and over a period of years. The nocturnal attacks were short-lasting, responded well to carbamazepine and were sometimes associated with clearly or possibly epileptic seizures during night- or daytime. They resembled the paroxysmal kinesigenic dystonias of wakefulness. Similar dystonic-dyskinetic attacks, but of long duration and unresponsive to medication, were also observed in two other patients, in one 20 years before the onset of clinically apparent Huntington's chorea. Nocturnal paroxysmal dystonia represents a syndrome of sleep-related motor attacks which comprises two variants, respectively characterised by short and long-lasting seizures. Its precise nosological definition still awaits elucidation. Images
Lugaresi, E; Cirignotta, F; Montagna, P
A computer-assisted method for the evaluation of sleep and breathing in patients showing chronic ventilatory impairment is\\u000a described and validated. Signals of body and respiratory movements (static charge sensitive bed), air-flow (thermistors),\\u000a oxygen saturation (SaO2), electro-oculography (EOG), and electromyography (EMG) were recorded overnight and analysed. Using\\u000a the compressed output graphs of the data and a rapid scoring procedure, stages of
T. Salmi; P. E. Brander
Visual measurements of sleep spindles were carried out in 48 elderly and 20 young normal adults. Computed tomography brain scans and psychometric testing were also performed. Earlier findings of reduced spindle abundance, amplitude and duration in the elderly were confirmed. In addition, we demonstrated a linear increase in spindle density and duration across NREMPs in young adults that was absent in the elderly, indicating that age affects the temporal pattern as well as the quantity of spindles. Contrary to what seemed a highly plausible hypothesis, the amount of waking in the elderly was not inversely correlated with spindle abundance, confirming earlier observations (Feinberg et al. 1967) but in a much larger group. This finding suggests that spindle abundance does not reflect the integrity of the systems that maintain the brain in NREM sleep. We also were unable to show any clear evidence that relative preservation of spindles in the elderly is associated with relative preservation of cognitive skills: psychometric performance and spindle measures were, in most instances, not significantly correlated. However, the test of this hypothesis was limited by the high level of function and the narrow range of impairment of these Ss. One intriguing positive finding was the significant inverse relation between ratings of sulcal atrophy and spindle amplitude. This observation suggests an etiology for the reduced amplitude of the sleep EEG in old age. This change is one of the most striking effects of age on brain electrophysiology. PMID:2422002
Guazzelli, M; Feinberg, I; Aminoff, M; Fein, G; Floyd, T C; Maggini, C
This review describes mechanisms of immune-to-brain and brain-to-immune signaling involved in mediating physiological sleep and altered sleep with disease. The central nervous system (CNS) modulates immune function by signaling target cells of the immune system through autonomic and neuroendocrine pathways. Neurotransmitters and hormones produced and released by these pathways interact with immune cells to alter immune functions, including cytokine production.
Dianne Lorton; Cheri L. Lubahn; Chris Estus; Brooke A. Millar; Jeffery L. Carter; Carlo A. Wood; Denise L. Bellinger
Declines in self-reported sleep quotas with globalizing lifestyle changes have focused attention on their possible role in rising global health problems such as obesity or depression. Cultural factors that act across the life course and support sleep sufficiency have received scant attention, nor have the potential interactions of cultural and biological factors in age-related changes in sleep behavior been systematically investigated. This study examines the effects of cultural norms for napping and sleeping arrangements along with sleep schedules, age, and gender on sleep budgets among Egyptian households. Data were collected in 2000 from 16 households with 78 members aged 3-56 years at two sites in Egypt (Cairo and an agrarian village). Each participant provided one week of continuous activity records and details of each sleep event. Records showed that nighttime sleep onsets were late and highly variable. Napping was common and, along with wake time flexibility, played a key role in maintaining sleep sufficiency throughout the life course into later middle age. Cosleeping was prevalent and exhibited contrasting associations with reduced duration and sufficiency of both nocturnal and total sleep, and with earlier, more regular, and less disrupted sleep. Daily sleep quotas met published guidelines and showed age-related changes similar to existing reports, but differed in how they were achieved. Cultural norms organizing sleep practices by age and gender appear to tap their intrinsic biological properties as well. Moreover, flexibility in how sleep was achieved contributed to sleep sufficiency. The findings suggest how biocultural dynamics can play key roles in sleep patterns that sustain favorable sleep quotas from infancy onwards in populations pursuing globalizing contemporary lifestyles. PMID:22651897
Worthman, Carol M; Brown, Ryan A
Declines in self-reported sleep quotas with globalizing lifestyle changes have focused attention on their possible role in rising global health problems such as obesity or depression. Cultural factors that act across the life course and support sleep sufficiency have received scant attention, nor have the potential interactions of cultural and biological factors in age-related changes in sleep behavior been systematically investigated. This study examines the effects of cultural norms for napping and sleeping arrangements along with sleep schedules, age, and gender on sleep budgets among Egyptian households. Data were collected in 2000 from 16 households with 78 members aged 3–56 years at two sites in Egypt (Cairo and an agrarian village). Each participant provided one week of continuous activity records and details of each sleep event. Records showed that nighttime sleep onsets were late and highly variable. Napping was common and, along with wake time flexibility, played a key role in maintaining sleep sufficiency throughout the life course into later middle age. Cosleeping was prevalent and exhibited contrasting associations with reduced duration and sufficiency of both nocturnal and total sleep, and with earlier, more regular, and less disrupted sleep. Daily sleep quotas met published guidelines and showed age-related changes similar to existing reports, but differed in how they were achieved. Cultural norms organizing sleep practices by age and gender appear to tap their intrinsic biological properties as well. Moreover, flexibility in how sleep was achieved contributed to sleep sufficiency. The findings suggest how biocultural dynamics can play key roles in sleep patterns that sustain favorable sleep quotas from infancy onwards in populations pursuing globalizing contemporary lifestyles.
Worthman, Carol M.; Brown, Ryan A.
Human sleep is sensitive to the individual's environment. The present review examines current knowledge of human sleep patterns under different environments: heat exposure, cold exposure, altitude, high pressure and microgravity in space. Heat exposure has two effects. In people living in temperate conditions, moderate heat loads (hot bath, sauna) prior to sleep provoke a delayed reaction across time (diachronic reaction) whereby slow-wave sleep (SWS) augments in the following night (neurogenic adaptive pathway). Melanoids and Caucasians living in the Sahel dry tropical climate experience diachronic increases in SWS throughout seasonal acclimatization. Such increases are greater during the hot season, being further enhanced after daytime exercise. On the contrary, when subjects are acutely exposed to heat, diachronic decreases in total sleep time and SWS occur, being often accompanied by synchronic (concomitant) diminution in REM sleep. Stress hormones increase. Nocturnal cold exposure provokes a synchronic decrease in REM sleep along with an activation of stress hormones (synchronic somatic reaction). SWS remains undisturbed as it still occurs at the beginning of the night before nocturnal body cooling. Altitude and high pressure are deleterious to sleep, especially in non-acclimatized individuals. In their controlled environment, astronauts can sleep well in microgravity. Exercise-induced sleep changes help to understand environmental effects on sleep: well-tolerated environmental strains may improve sleep through a neurogenic adaptive pathway; when this "central" adaptive pathway is overloaded or bypassed, diachronic and synchronic sleep disruptions occur. PMID:17706676
The symptoms and corneal changes caused by sleeping with one or both eyes open are described in 102 patients. The clinical picture is identical to that of the microform recurrent erosion. The close relationship between the micro- and macro-forms of recurrent corneal erosion suggests that the latter condition is also precipitated by nocturnal lagophthalmos.
G. D. Sturrock
The effects of repeated nocturnal doses of clobazam, dipotassium chlorazepate and placebo on subjective ratings of sleep and early morning behaviour and objective measures of arousal, psychomotor performance and anxiety.
1. Repeated nocturnal doses of 30 mg clobazam and dipotassium chlorazepate 15 mg showed no significant effects compared to matching placebo on tests of psychomotor performance and serial subtraction of numbers given in the morning and afternoon of the day following treatment. 2. Both active preparations improved the perceived quality of sleep compared to placebo. 3. A reduction in rated anxiety scores was found with clobazam on the afternoon of the day following treatment together with an elevation of critical flicker fusion thresholds. 4. Dipotassium chlorazepate was found to impair performance of a low level conceptual task but not to influence performance at a more difficult level.
Hindmarch, I; Parrott, A C
Previous studies showed that treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) significantly reduced the blood pressure (BP) in hypertensive patients. We investigated the predictors of BP change in normotensive patients with OSAS who underwent CPAP. A total of 24 patients with OSAS (19 male; age: 48.7 ± 10.4 years) were enrolled. The 24-hour mean BP (24 hMBP), subjective sleepiness, fasting venous blood samples, and anthropometric measurements were assessed at baseline, 6th week and 12th week of CPAP treatment. The 24 hMBP fell at 12 weeks from 89.2 ± 8.4 to 82.9 ± 7.3 mm Hg (P < .0001) irrespective of the severity of disease. Also, both daytime and nighttime BP showed significant reduction after CPAP. Male gender, Epworth sleepiness scale, body mass index, smoking, alcohol use, and baseline 24 hMPB were the independent predictors of a fall in 24 hMBP. The CPAP therapy may provide benefit even in the absence of overt hypertension by reducing both daytime and nighttime BP. PMID:23427278
Yorgun, Hikmet; Kabakçi, Giray; Canpolat, Ugur; Kirmizigül, Engin; Sahiner, Levent; Ates, Ahmet Hakan; Sendur, Mehmet Ali; Kaya, Ergün Baris; Demir, Ahmet Ugur; Aytemir, Kudret; Tokgözoglu, Lale; Oto, Ali
Study Objectives: To determine rapid eye movement (REM) sleep phase preference in a crepuscular mammal (Octodon degus) by challenging the specific REM sleep homeostatic response during the diurnal and nocturnal anticrepuscular rest phases. Design: We have investigated REM sleep rebound, recovery, and documented REM sleep propensity measures during and after diurnal and nocturnal selective REM sleep deprivations. Subjects: Nine male wild-captured O. degus prepared for polysomnographic recordings Interventions: Animals were recorded during four consecutive baseline and two separate diurnal or nocturnal deprivation days, under a 12:12 light-dark schedule. Three-h selective REM sleep deprivations were performed, starting at midday (zeitgeber time 6) or midnight (zeitgeber time 18). Measurements and Results: Diurnal and nocturnal REM sleep deprivations provoked equivalent amounts of REM sleep debt, but a consistent REM sleep rebound was found only after nocturnal deprivation. The nocturnal rebound was characterized by a complete recovery of REM sleep associated with an augment in REM/total sleep time ratio and enhancement in REM sleep episode consolidation. Conclusions: Our results support the notion that the circadian system actively promotes REM sleep. We propose that the sleep-wake cycle of O. degus is modulated by a chorus of circadian oscillators with a bimodal crepuscular modulation of arousal and a unimodal promotion of nocturnal REM sleep. Citation: Ocampo-Garcés A; Hernández F; Palacios AG. REM sleep phase preference in the crepuscular Octodon degus assessed by selective REM sleep deprivation. SLEEP 2013;36(8):1247-1256.
Ocampo-Garces, Adrian; Hernandez, Felipe; Palacios, Adrian G.
Patients receiving conventional hemodialysis have high hospitalisation rates, poor quality of life and survival compared to the general population. Many centres around the world are providing longer hours of hemodialysis - short daily hemodialysis and nocturnal hemodialysis - with a view to improving patient survival and quality of life. Studies have shown that nocturnal haemodiaysis is more effective than conventional hemodialysis in clearing most small, middle and larger molecule toxins and suggest nocturnal dialysis enhances patient survival and quality of life. Concerns include patient acceptance, vascular access related complications and increased cost. The purpose of this review is to examine the advantages and drawbacks of nocturnal dialysis, with a focus on applicability to India where the renal physician has to face cultural and economic barriers, erratic power supply and poor water quality.
Ranganathan, D.; John, G. T.
Both chronic pain and sleep problems are common for children with intellectual and developmental disabilities (IDD). Although one study has revealed a relationship between having a medical condition and sleep problems in this population, the role of pain was not examined independently. Thus, the goal of this study was to clarify the specific role…
Breau, Lynn M.; Camfield, Carol S.
Sleep problems associated with autism spectrum disorders (ASD) have been well documented, but less is known about the effects of sleep problems on day-time cognitive and adaptive performance in this population. Children diagnosed with autism or pervasive developmental disorder-not otherwise specified (PDD-NOS) (N = 335) from 1 to 10 years of age…
Taylor, Matthew A.; Schreck, Kimberly A.; Mulick, James A.
1 Auditory awakening thresholds (AAT) and the back-to-sleep latency (BSL) after nocturnal awakenings from Stage 2 sleep were studied in normal male subjects after placebo, brotizolam (0.25, 0.375 and 0.50 mg) and flurazepam (30 mg). AAT (dB) was measured in five trials spaced across the night in a `double awakening' procedure with the second awakening in each trial made from Stage 2 sleep. 2 Each drug condition was associated with elevated mean AAT across the five trials in comparison with placebo. In a trial-by-trial analysis only 0.50 mg brotizolam and 30 mg flurazepam were consistently higher in the first three trials compared with placebo. 3 All active drug conditions decreased the mean BSL across all trials in comparison with placebo, but only 30 mg flurazepam and 0.50 mg brotizolam consistently shortened BSL in the first three trials. 4 Brotizolam (0.50 mg) and 30 mg flurazepam are similar in their effects. The subjective improvement reported in insomniac subjects following hypnotic administration may be related to elevation in arousal thresholds and a quick return to sleep after nocturnal sleep disruption.
Hartse, K. M.; Thornby, J. I.; Karacan, I.; Williams, R. L.
... recommends limiting all types of media, including computers, video games, iPads and smartphones. The recommendation calls for no ... bedrooms, Cadilla said. "The lack of TV or video games in a child's bedroom will help their sleep ...
Objectives: EEG-sleep organization of asphyxiated and non-asphyxiated full-term neonates was compared during the first 3 days after birth.Background: Aggressive fetal and neonatal resuscitative efforts have reduced the severe expression of the neonatal brain disorder termed hypoxic-ischemic encephalopathy. Neonates may alternatively express altered EEG-sleep organization over the first days of life after asphyxia which may mimic mild or moderate hypoxic-ischemic encephalopathy.
Mark S. Scher; Doris A. Steppe; Marquita E. Beggarly; Dawn G. Salerno; David L. Banks
Over time, human beings have blazed their way into the night with fire and artificial light, but we are not true creatures of the night. This Topic in Depth explores the world of nocturnal animals. From Island Discovery & Training, the first site allows visitors to listen to the sounds of several nocturnal animals. After guessing who made the sound, visitors can link to information pages for all but one of the mystery animals (1). Next is an information sheet (2) from BioMedia that answers the question: How Do Animals See In the Dark? The third site, from Enchanted Learning, provides coloring sheets and brief profiles for many nocturnal animals including the Amur Tiger, Badger, Crocodile, and Kinkajou-just to name a few (3). From the Fairbanks Museum & Planetarium in Vermont, the fourth website contains a six-page lesson plan (for students in grades one to eight) emphasizing different senses; and the roles and adaptations of nocturnal species (4). The fifth site, from Science News Online, contains an article addressing research on the ecological impact of artificial nighttime light on nocturnal animals (5). From Wild Asia, the next site contains an article by travel writer and environmental educator David Bowden, that describes his experience watching a marine turtle lay her eggs on Malaysia's Turtle Island (6). The seventh site, from PBS-Nova Online, briefly describes the work of zoologists who study nocturnal and burrowing animals of the Kalahari (7). From this site visitors can also link to a section that discusses how several different animals see at night. The final site, from the University of Utah-John Moran Eye Center, contains information about the role of photoreceptors in vision (8). This Photoreceptors section is part of a comprehensive electronic tutorial regarding neural organization of the mammalian retina.
PurposeNocturnal enuresis is characterized by nocturnal urine volumes exceeding bladder capacity and by inability to wake up to the stimulus of a full bladder. Desmopressin (DDAVP) is believed to be efficient in treating nocturnal enuresis by reducing nocturnal urine production. However, clinical observations indicate an additional mode of action since the drug appears to modify sleep architecture, apparently improving the
S. Di Michele; U. Sillen; J. A. Engel; K. Hjalmas; A. Rubenson; B. Soderpalm
OBJECTIVE—Despite a high incidence of nocturnal hypoglycemia documented by the use of continuous glucose monitoring (CGM), there are no reports in the literature of nocturnal hypoglycemic seizures while a patient is wearing a CGM device. RESEARCH DESIGN AND METHODS—In this article, we describe four such cases and assess the duration of nocturnal hypoglycemia before the seizure. RESULTS—In the cases where patients had a nocturnal hypoglycemic seizure while wearing a CGM device, sensor hypoglycemia (<60 mg/dl) was documented on the CGM record for 2.25–4 h before seizure activity. CONCLUSIONS—Even with a subcutaneous glucose lag of 18 min when compared with blood glucose measurements, glucose sensors have time to provide clinically meaningful alarms. Current nocturnal hypoglycemic alarms need to be improved, however, since patients can sleep through the current alarm systems.
Buckingham, Bruce; Wilson, Darrell M.; Lecher, Todd; Hanas, Ragnar; Kaiserman, Kevin; Cameron, Fergus
Nocturnal enuresis (NE) is increasingly seen as part of a heterogeneous phenomenon that at times will include daytime lower urinary tract symptoms such as urgency, frequency and wetting - with reduced bladder storage, usually due to an overactive bladder. In turn, these may be associated with constipation and/or faecal soiling. This paper discusses these considerations in the management of NE. PMID:22846112
Harari, Michael D
Sleep disruption in childhood is associated with clearly defined deficits in neurocognition and behaviour. Childhood eczema is also a potent cause of sleep disruption though it is unknown whether it too results in neurocognitive deficits. To test this hypothesis, neurocognitive (WISC-IV), parental-reported sleep quality (Sleep Disturbance Scale of Children (SDSC)) and overnight polysomnographic (PSG) data were collected in 21 children with eczema and 20 healthy controls (age range 6-16 years). Children with eczema had worse sleep quality on both PSG (notably increased nocturnal wakefulness, a higher number of stage shifts and a longer latency to REM onset) and parental report. In addition, they demonstrated significant neurocognitive deficits (especially verbal comprehension, perceptual reasoning and to a lesser extent working memory) with a composite Full Scale IQ 16 points lower than controls. Parental reported sleep problems but not PSG parameters were correlated with reduced neurocognitive performance. However, hierarchical regression analyses revealed that eczema status was predictive while sleep fragmentation (parental or PSG) was not predictive of neurocognitive performance. As this is the first study to systematically examine neurocognitive functioning in children with eczema and given the finding of significant deficits it merits replication especially given the prevalence of the condition. The unanswered question is whether these cognitive deficits normalise with effective eczema treatment and if this is mediated by improvements in sleep architecture. PMID:23353660
Camfferman, Danny; Kennedy, J Declan; Gold, Michael; Simpson, Carol; Lushington, Kurt
Effects of dual-responding on tracking performance after 49-h of sleep deprivation (SD) were evaluated behaviorally and with functional magnetic resonance imaging (fMRI). Continuous visuomotor tracking was performed simultaneously with an intermittent color-matching visual detection task in which a pair of color-matched stimuli constituted a…
Gazes, Yunglin; Rakitin, Brian C.; Steffener, Jason; Habeck, Christian; Butterfield, Brady; Basner, Robert C.; Ghez, Claude; Stern, Yaakov
Sleep disorders are serious issues in modern society. There has been marked scientific interest in sleep for a century, with the discoveries of the electrical activity of the brain (EEG), sleep-wake system, rapid eye movement (REM) sleep, and circadian rhythm system. Additionally, the advent of video-polysomnography in clinical research has revealed some of the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. Decades of clinical research have demonstrated that sleep disorders are intimately tied to not only physical disease (e. g., lifestyle-related disease) but psychiatric illness. According to The International Classification of Sleep Disorders (2005), sleep disorders are classified into 8 major categories: 1) insomnia, 2) sleep-related breathing disorders, 3) hypersomnias of central origin, 4) circadian rhythm sleep disorders, 5) parasomnias, 6) sleep-related movement disorders, 7) isolated symptoms, and 8) other sleep disorders. Several sleep disorders, including obstructive sleep apnea syndrome, restless legs syndrome, periodic limb movement disorder, sleepwalking, REM sleep behavior disorder, and narcolepsy, may be comorbid or possibly mimic numerous psychiatric disorders, and can even occur due to psychiatric pharmacotherapy. Moreover, sleep disorders may exacerbate underlying psychiatric disorders when left untreated. Therefore, psychiatrists should pay attention to the intimate relationship between sleep disorders and psychiatric symptoms. Sleep psychiatry is an academic field focusing on interrelations between sleep medicine and psychiatry. This mini-review summarizes recent findings in sleep psychiatry. Future research on the bidirectional relation between sleep disturbance and psychiatric symptoms will shed light on the pathophysiological view of psychiatric disorders and sleep disorders. PMID:24050022
In order to determine if the human pattern of circulating melatonin resembles that described in lower animals, men 19 to 32 years old were exposed to a light-dark cycle with 14 hours of light per day (L:D 14:10). In whites and blacks, nocturnal (dark phas...
G. M. Vaughan R. W. Pelham S. F. Pang K. M. Wilson K. L. Sandock
Narcolepsy is characterized by fragmented nighttime sleep and frequent arousals. One treatment approach to improve daytime symptoms is to consolidate nighttime sleep through decreasing arousals. Sodium oxybate is the first FDA-approved medication that follows this approach. Benzodiazepines are known to also decrease arousals at night and have been proposed to help with sleep fragmentation. In one report, clonazepam was shown to improve cataplexy in 10 of 14 patients with narcolepsy although no improvement in daytime sleepiness was reported. The purpose of this case review was to share our experience of nocturnal temazepam on daytime sleepiness in patients with narcolepsy as measured by the Epworth Sleepiness Scale (ESS). Citation: Kansagra S; Walter R; Vaughn B. Nocturnal temazepam in the treatment of narcolepsy. J Clin Sleep Med 2013;9(5):499-500.
Kansagra, Sujay; Walter, Robert; Vaughn, Bradley
Objective and BackgroundPulse wave amplitude (PWA) derived from the digital vascular bed has been used in sleep studies. The nocturnal attenuation of PWA has been shown to reflect sympathetic activation during sleep. We assessed the relationship between nocturnal PWA attenuation and office blood pressure (BP).
Ding Zou; Ludger Grote; Jakub Radlinski; Derek N. Eder; Ulf Lindblad; Jan Hedner
Translational biomarkers, such as prepulse inhibition (PPI) of the acoustic startle response, are playing an increasingly important role in the development of antipsychotic drugs for schizophrenia and related conditions. However, attempts to reliably induce a PPI deficit by psychotomimetic drugs have not been successful, leaving an unmet need for a cross-species psychosis model sensitive to this widely studied surrogate treatment target. Sleep deprivation (SD) might be such a model as it has previously been shown to induce PPI deficits in rats, which could be selectively prevented with antipsychotic but not anxiolytic or antidepressant compounds. Here, in a first proof-of-concept study we tested whether SD induces a deficit in PPI and an increase in psychosis-like symptoms in healthy humans. In two counterbalanced sessions, acoustic PPI and self-reported psychosis-like symptoms (Psychotomimetic States Inventory) were measured in 24 healthy human volunteers after a normal night's sleep and after a night of total SD. SD decreased PPI (p = 0.001) without affecting the magnitude or habituation of the startle response (all p > 0.13). SD also induced perceptual distortions, cognitive disorganization, and anhedonia (all p < 0.02). Thus, extending previous rodent work, we conclude that SD, in combination with the PPI biomarker, might be a promising translational surrogate model for psychosis as this method represents a possibility to partially and reversibly mimic the pathogenesis of psychotic states. PMID:24990933
Petrovsky, Nadine; Ettinger, Ulrich; Hill, Antje; Frenzel, Leonie; Meyhöfer, Inga; Wagner, Michael; Backhaus, Jutta; Kumari, Veena
Smith-Magenis syndrome (SMS) is a disorder characterized by multiple congenital anomalies and behavior problems, including abnormal sleep patterns. It is most commonly due to a 3.5 Mb interstitial deletion of chromosome 17 band p11.2. Secretion of melatonin, a hormone produced by the pineal gland, is the body's signal for nighttime darkness. Published reports of 24-hr melatonin secretion patterns in two independent SMS cohorts (US and France) document an inverted endogenous melatonin pattern in virtually all cases (96%), suggesting that this finding is pathognomic for the syndrome. We report on a woman with SMS due to an atypical large proximal deletion ( approximately 6Mb; cen<->TNFRSFproteinB) of chromosome band (17)(p11.2p11.2) who presents with typical sleep disturbances but a normal pattern of melatonin secretion. We further describe a melatonin light suppression test in this patient. This is the second reported patient with a normal endogenous melatonin rhythm in SMS associated with an atypical large deletion. These two patients are significant because they suggest that the sleep disturbances in SMS cannot be solely attributed to the abnormal diurnal melatonin secretion versus the normal nocturnal pattern. PMID:19530184
Boudreau, Eilis A; Johnson, Kyle P; Jackman, Angela R; Blancato, Jan; Huizing, Marjan; Bendavid, Claude; Jones, Marypat; Chandrasekharappa, Settara C; Lewy, Alfred J; Smith, Ann C M; Magenis, R Ellen
Smith-Magenis syndrome (SMS) is a disorder characterized by multiple congenital anomalies and behavior problems, including abnormal sleep patterns. It is most commonly due to a 3.5 Mb interstitial deletion of chromosome 17 band p11.2. Secretion of melatonin, a hormone produced by the pineal gland, is the body’s signal for nighttime darkness. Published reports of 24-hour melatonin secretion patterns in two independent SMS cohorts (US & France) document an inverted endogenous melatonin pattern in virtually all cases (96%), suggesting that this finding is pathognomic for the syndrome. We report on a woman with SMS due to an atypical large proximal deletion (?6Mb; cen<->TNFRSFproteinB) of chromosome band (17)(p11.1p11.2) who presents with typical sleep disturbances but a normal pattern of melatonin secretion. We further describe a melatonin light suppression test in this patient. This is the second reported patient with a normal endogenous melatonin rhythm in SMS associated with an atypical large deletion. These two patients are significant because they suggest that the sleep disturbances in SMS cannot be solely attributed to the abnormal diurnal melatonin secretion versus the normal nocturnal pattern.
Boudreau, Eilis A.; Johnson, Kyle P.; Jackman, Angela R.; Blancato, Jan; Huizing, Marjan; Bendavid, Claude; Jones, MaryPat; Chandrasekharappa, Settara C.; Lewy, Alfred J.; Smith, Ann C. M.; Magenis, R. Ellen
Introduction Nocturnal enuresis affects 15% to 20% of 5-year-old children, 5% of 10-year-old children, and 1% to 2% of people aged 15 years and over. Without treatment, 15% of affected children will become dry each year. Nocturnal enuresis is not diagnosed in children younger than 5 years, and treatment may be inappropriate for children younger than 7 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions for relief of symptoms? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, anticholinergics (oxybutynin, tolterodine, hyoscyamine), desmopressin, dry bed training, enuresis alarm, hypnotherapy, standard home alarm clock, and tricyclics (imipramine, desipramine).
Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blood pressure abnormalities including definitions, diagnostic limitations, pathogenesis and associated patient profiles, prognostic significance, and therapeutic strategies. Taken together, persistent nocturnal hypertension and non-dipping blood pressure pattern, perhaps secondary to abnormal renal sodium handling and/or altered nocturnal sympathovagal balance, are strongly associated with deaths, cardiovascular events, and progressive loss of renal function, independent of daytime and 24-hour blood pressure. Several pharmacological and non-pharmacological approaches may restore nocturnal blood pressure and circadian blood pressure rhythm to normal; however, whether this translates to a clinically meaningful reduction in unfavorable cardiovascular and renal consequences remains to be seen.
Friedman, Oded; Logan, Alexander G
Sleep at high altitude is characterized by poor subjective quality, increased awakenings, frequent brief arousals, marked nocturnal hypoxemia, and periodic breathing. A change in sleep architecture with an increase in light sleep and decreasing slow-wave and REM sleep have been demonstrated. Periodic breathing with central apnea is almost universally seen amongst sojourners to high altitude, although it is far less
Himanshu Wickramasinghe; James D. Anholm
The effects of a steady sound level of 65 dB(A) from a diesel ship engine on nocturnal sleep were studied using polygraphic and subjective sleep parameters. Three healthy men, aged 29 to 33 years, participated in the experiment. Sleep polygrams and the sound level in a sleep laboratory were recorded for each subject for five exposure nights and five control
Y. Tamura; T. Kawada; Y. Sasazawa
Narcolepsy is characterized by fragmented nighttime sleep and frequent arousals. One treatment approach to improve daytime symptoms is to consolidate nighttime sleep through decreasing arousals. Sodium oxybate is the first FDA-approved medication that follows this approach. Benzodiazepines are known to also decrease arousals at night and have been proposed to help with sleep fragmentation. In one report, clonazepam was shown to improve cataplexy in 10 of 14 patients with narcolepsy although no improvement in daytime sleepiness was reported. The purpose of this case review was to share our experience of nocturnal temazepam on daytime sleepiness in patients with narcolepsy as measured by the Epworth Sleepiness Scale (ESS). PMID:23674942
Kansagra, Sujay; Walter, Robert; Vaughn, Bradley
Effects of dual-responding on tracking performance after 49-hr of sleep deprivation (SD) were evaluated behaviorally and with functional magnetic resonance imaging (fMRI). Continuous visuomotor tracking was performed simultaneously with an intermittent color-matching visual detection task in which a pair of color-matched stimuli constituted a target and non-matches were non-targets. Tracking error means were binned time-locked to stimulus onset of the detection task in order to observe changes associated with dual-responding by comparing the error during targets and non-targets. Similar comparison was made with fMRI data. Our result showed that despite a significant increase in the overall tracking error post SD, from 20 pixels pre SD to 45 pixels post SD, error decreased to a minimum of about 25 pixels 0 to 6 s after dual-response. Despite an overall reduced activation post SD, greater activation difference between targets and non-targets was found post SD in task-related regions, such as the left cerebellum, the left somatosensory cortex, the left extrastriate cortex, bilateral precuneus, the left middle frontal gyrus, and the left motor cortex. Our results suggest that dual-response helps to alleviate performance impairment usually associated with SD. The duration of the alleviation effect was on the order of seconds after dual-responding.
Gazes, Yunglin; Rakitin, Brian C.; Steffener, Jason; Habeck, Christian; Butterfield, Brady; Basner, Robert C.; Ghez, Claude; Stern, Yaakov
The objective of this study was to evaluate the effects of nocturnal sleep, partial night sleep deprivation, and sleep stages on circulating concentrations of interleukin-6 (IL-6) in relation to the secretory pro- files of GH, cortisol, and melatonin. In 31 healthy male volunteers, blood samples were obtained every 30 min during 2 nights: uninter- rupted, baseline sleep and partial sleep
LAURA REDWINE; RICHARD L. HAUGER; J. CHRISTIAN GILLIN; MICHAEL IRWIN
Intermittent hypoxia (IH) and sleep fragmentation (SF) are major manifestations of sleep apnea, a frequent condition in aging humans. Sleep perturbations are frequent in Alzheimer's disease (AD) and may underlie the progression of disease. We hypothesized that acute short-term IH, SF, and their combination (IH+SF) may reveal unique susceptibility in sleep integrity in a murine model of AD. The effects of acute IH, SF, and IH+SF on sleep architecture, delta power, sleep latency, and core body temperature were assessed in adult male human ApoE4-targeted replacement mice (hApoE4) and wild-type (WT) controls. Slow wave sleep (SWS) was significantly reduced, and rapid eye movement (REM) sleep was almost abolished during acute exposure to IH alone and IH+SF for 6 h in hApoE4, with milder effects in WT controls. Decreased delta power during SWS did not show postexposure rebound in hApoE4 unlike WT controls. IH and IH+SF induced hypothermia, which was more prominent in hApoE4 than WT controls. Mice subjected to SF also showed sleep deficits but without hypothermia. hApoE4 mice, unlike WT controls, exhibited increased sleep propensity, especially following IH and IH+SF, suggesting limited ability for sleep recovery in hApoE4 mice. These findings substantiate the potential impact of IH and SF in modulating sleep architecture and sleep homeostasis including maintenance of body temperature. Furthermore, the increased susceptibility and limited recovery ability of hApoE4 mice to sleep apnea suggests that early recognition and treatment of the latter in AD patients may restrict the progression and clinical manifestations of this frequent neurodegenerative disorder.
Kaushal, Navita; Ramesh, Vijay
Nocturnal leg cramps are common in older people. Such cramps are associated with many common diseases and medications. Physiological methods may be useful for preventing cramps in some people, but there have been no controlled trials of these approaches. Quinine is moderately effective in preventing nocturnal leg cramps. However, there are concerns about the risk/benefit ratio with this drug. In patients with severe symptoms, a trial of 4–6 weeks' treatment with quinine is probably still justified, but the efficacy of treatment should be monitored, for example using a sleep and cramp diary.
Butler, J; Mulkerrin, E; O'Keeffe, S
Nocturnal leg cramps are common in older people. Such cramps are associated with many common diseases and medications. Physiological methods may be useful for preventing cramps in some people, but there have been no controlled trials of these approaches. Quinine is moderately effective in preventing nocturnal leg cramps. However, there are concerns about the risk/benefit ratio with this drug. In patients with severe symptoms, a trial of 4-6 weeks' treatment with quinine is probably still justified, but the efficacy of treatment should be monitored, for example using a sleep and cramp diary. PMID:12415081
Butler, J V; Mulkerrin, E C; O'Keeffe, S T
The present study investigated evening and nocturnal serum cortisol and melatonin concentrations in patients with primary insomnia to test if this clinical condition is accompanied by an increase of cortisol secretion and a simultaneous decrease of nocturnal melatonin production. Ten drug-free patients (4 males, 6 females) with primary insomnia (mean age+/-S.D.: 39.2+/-9.1 years) and 10 age- and gender-matched healthy controls participated in the study. All subjects spent three consecutive nights in the sleep laboratory with polysomnography. Measurement of cortisol and melatonin (from 19:00 h to 09:00 h) was performed prior to and during the last laboratory night. Contrary to expectation, cortisol secretion did not differ between healthy controls and insomniac patients. On the other hand, nocturnal melatonin production was significantly diminished in insomniac patients. Polysomnographically determined sleep patterns, in contrast to subjective ratings of sleep, demonstrated only minor alterations of sleep in the insomniac group. The lack of increased cortisol secretion in the patients with primary insomnia indicates that results from studies on the biological consequences of experimental sleep loss in healthy subjects cannot be applied to primary insomnia in general, especially if there are only minor objective sleep alterations. In spite of the negligible objective sleep disturbances in the present sample, nocturnal melatonin production was reduced, which tentatively suggests a role for this hormone in primary insomniacs. The pathophysiological significance of this finding is, however, still a matter of debate. PMID:12467942
Riemann, Dieter; Klein, Torsten; Rodenbeck, Andrea; Feige, Bernd; Horny, Andrea; Hummel, Ruth; Weske, Gesa; Al-Shajlawi, Anam; Voderholzer, Ulrich
Purpose/Objectives To describe nighttime sleep-wake patterns during a 12-hour night shift among school-age children with cancer receiving inpatient chemotherapy and relationships among nighttime sleep, environmental stimuli, medication doses, and symptoms during that shift. Design Exploratory, descriptive, multiple-case study. Setting Inpatient pediatric oncology unit at a tertiary pediatric hospital in the western United States. Sample 15 elementary school-age children with cancer receiving inpatient chemotherapy. Methods Wrist actigraphs measured sleep-wake patterns. Data loggers and sound pressure level meters measured bedside light, temperature, and sound levels. Medication doses and occurrences of pain, nausea, and vomiting were identified through chart review. Main Research Variables Minutes of sleep. Findings Sleep varied based on time of night (F = 56.27, p < 0.01), with sleep onset delayed past 10 pm. A basic mixed linear model identified significant fixed effects for sound (F = 50.87, p < 0.01) and light (F = 7.04, p < 0.01) on minutes of sleep. A backward regression model including sound, light, medication doses, pain, and nausea accounted for about 57% of the variance in sleep minutes (F = 62.85, p < 0.01). Conclusions Sleep was marked by frequent awakenings, limiting children’s ability to experience full sleep cycles. Multiple factors—in particular, excessive sound levels—compromise sleep quantity and quality throughout the night. Implications for Nursing Efforts to develop and test individualized and system-based interventions to modify the hospital care environment to promote nighttime sleep are needed. Oncology nurses have the opportunity to influence the care environment at an individual level and to influence unit-based practices to promote a healthy nighttime sleep environment.
Linder, Lauri A.; Christian, Becky J.
We determined whether alterations in heart rate dynamics during sleep in patients with chronic fatigue syndrome (CFS) differed from controls and/or correlated with changes of sleepiness before and after a night in the sleep laboratory. We compared beat-to-beat RR intervals (RRI) during nocturnal sleep, sleep structure, and subjective scores on visual analog scale for sleepiness in 18 CFS patients with 19 healthy controls aged 25-55 after excluding subjects with sleep disorders. A short-term fractal scaling exponent (?1) of RRI dynamics, analyzed by the detrended fluctuation analysis (DFA) method, was assessed after stratifying patients into those who reported more or less sleepiness after the night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Patients in the a.m. sleepier group showed significantly (p<0.05) higher fractal scaling index ?1 during non-rapid eye movement (non-REM) sleep (Stages 1, 2, and 3 sleep) than healthy controls, although standard polysomnographic measures did not differ between the groups. The fractal scaling index ?1 during non-REM sleep was significantly (p<0.05) higher than that during awake periods after sleep onset for healthy controls and patients in the a.m. less sleepy group, but did not differ between sleep stages for patients in the a.m. sleepier group. For patients, changes in self-reported sleepiness before and after the night correlated positively with the fractal scaling index ?1 during non-REM sleep (p<0.05). These results suggest that RRI dynamics or autonomic nervous system activity during non-REM sleep might be associated with disrupted sleep in patients with CFS. PMID:23499514
Togo, Fumiharu; Natelson, Benjamin H
We determined whether alterations in heart rate dynamics during sleep in patients with chronic fatigue syndrome (CFS) differed from controls and/or correlated with changes of sleepiness before and after a night in the sleep laboratory. We compared beat-to-beat RR intervals (RRI) during nocturnal sleep, sleep structure, and subjective scores on visual analog scale for sleepiness in 18 CFS patients with 19 healthy controls aged 25–55 after excluding subjects with sleep disorders. A short-term fractal scaling exponent (?1) of RRI dynamics, analyzed by the detrended fluctuation analysis (DFA) method, was assessed after stratifying patients into those who reported more or less sleepiness after the night’s sleep (a.m. sleepier or a.m. less sleepy, respectively). Patients in the a.m. sleepier group showed significantly (p < 0.05) higher fractal scaling index ?1 during non-rapid eye movement (non-REM) sleep (Stages 1, 2, and 3 sleep) than healthy controls, although standard polysomnographic measures did not differ between the groups. The fractal scaling index ?1 during non-REM sleep was significantly (p < 0.05) lower than that during awake periods after sleep onset for healthy controls and patients in the a.m. less sleepy group, but did not differ between sleep stages for patients in the a.m. sleepier group. For patients, changes in self-reported sleepiness before and after the night correlated positively with the fractal scaling index ?1 during non-REM sleep (p < 0.05). These results suggest that RRI dynamics or autonomic nervous system activity during non-REM sleep might be associated with disrupted sleep in patients with CFS.
Togo, Fumiharu; Natelson, Benjamin H.
Excessive daytime sleepiness (EDS) is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE). Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE. PMID:24479058
Cheng, Jocelyn Y; Wallace, Douglas M; Lopez, Maria R; Carrazana, Enrique J
Excessive daytime sleepiness (EDS) is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE). Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE.
Cheng, Jocelyn Y.; Wallace, Douglas M.; Lopez, Maria R.; Carrazana, Enrique J.
Noise protection associated with the construction and extension of airports in the Federal Republic of Germany has been regulated by the law for protection against aircraft noise since 1971. This legislation is due for revision because of different aspects. One aspect is the growth of air traffic which has led many airports to the limits of their capacity and in search of new ways of adaptation to the increasing demand for flight services. Another aspect is the increasing concern of the population about noise effects which has to be addressed by better protection against the effects of aircraft noise. The framework conditions of policy in terms of society as a whole, its health and economic environment need to be put into effect by political action. Science can contribute to this goal by performing noise effects research and by providing recommendations to the political body. However, it remains controversial, what measures are necessary or adequate to assure effective protection of the population against aircraft noise. This is particularly true for the protection of rest and sleep at night. The problem of finding a common basis for adequate recommendations is associated with (1) the low number of primary studies, which also exhibited highly variable results and assessments, (2) the handling of acoustic or psycho-acoustic dimensions for quantifying psychological or physiological reactions, and (3) the conception of how far preventive measures have to go to prove effective. With this in mind, the DLR Institute for Aerospace Medicine is conducting a large-scale, multi-stage study for investigating the acute effects of nocturnal aircraft noise on human sleep. This enterprise is implemented in the framework of the HGF/DLR project "Quiet Air Traffic" for developing sustainable assessment criteria for human-specific effects of aircraft noise at night. PMID:15070533
Basner, M; Samel, A
Nonpharmacologic and especially pharmacologic treatment options are available for nocturnal polyuria. Desmopressin represents the basis of pharmacologic treatment. Desmopressin acetate is a synthetic analogue of arginine vasopressin with high affinity to V2 receptors with antidiuretic effect. It is the only medicament currently registered for antidiuretic treatment. Desmopressin has not any relevant affinity to V1 receptors, and therefore there is no hypertensive effect in contrary to natural vasopressin. Desmopressin use before a bedtime leads to reduced production of urine during a sleep, therefore time between desires to void is prolonged and number of nocturia is reduced. Clinical effect, in a meaning of reduced urine production and increased osmolality of urine, lasts approximately 8-12 hours. In the treatment of nocturnal polyuria desmopressin is used orally one hour before a bedtime. It is essential to titrate an ideal dose, the initial dose is 60 µg of MELT formula (fast melting oral formulation) and it can be increased according to the clinical effect up to the maximal recommended daily dose 240 µg. Patients treated with desmopressin should cut down a fluid intake 1 hour before and 8 hours after the use of desmopressin. Total number of adverse events connected withdesmopressin treatment in clinical studies was higher compared to placebo but the side effects were mostly mild. The most common adverse events were headaches, nausea, diarrhoea, abdominal pain, dry mouth and hyponatremia both in the short-term and long-term clinical trials. Hyponatremia was observed mainly in patients over 65 year of age. Therefore treatment with desmopressin should not be commended in patients over 65 year of age without close monitoring of the natrium level in serum and all patients should be informed about the first symptoms of hyponatremia - headache, nausea and insomnia. According to Evidence Based Medicine, the level of evidence for treatment of nocturnal polyuria with desmopressin is 1b and the grade of recommendation for treatment is A. Keywords: nocturnal polyuria - treatment - desmopressin. PMID:24040989
Zachoval, R; Krhut, J; Šottner, O; Hanuš, T; Martan, A; Hor?i?ka, L; Feyereisl, J; Halaška, M; Švabík, K; Krofta, L
There is a strong body of data directly interrelating sleep problems with mood disorders. There is a growing data base directly associating sleep disorders with attention and memory problems. Motor disorders, especially involving the dopaminergic system, may produce sleep problems, including a possible association between disordered sleep and nocturnal falls. Sleep disorders may be causal conditions for metabolic diseases and increased risk for morbidity and mortality. Sleep and health are directly interrelated. To further probe these issues, especially as related to the aging process, investigators need to utilize tools and concepts from genomics and epigenetics, proteomics, metabolomics, any future …omics, molecular neuroimaging, and cognitive neuroscience.
Monjan, Andrew A.
Electric Status Epilepticus during Sleep (ESES) occurs in children with and without epilepsy. It may be related to disturbances as autism spectrum disorder, attention-deficit hyperactivity disorder and acquired aphasia (Landau-Kleffner syndrome). Antiepileptic drug (AED) treatment has been reported in small studies without placebo control. This study was designed to assess AED effect in a placebo-controlled double-blind cross-over study. Levetiracetam (LEV) was chosen based on clinical evidence. Eighteen patients fulfilled the inclusion criteria. The mean spike index at baseline was 56, falling to a mean of 37 at the end of the LEV treatment period. Assessed with a 2-way ANOVA, there is a significant treatment effect (p<0.0002). To the best of our knowledge, this is the first placebo-controlled double-blind cross-over study for any AED in patients with ESES. The effect of LEV is comparable with its effect in treatment of epileptic seizures. PMID:22494796
Larsson, Pål Gunnar; Bakke, Kristin A; Bjørnæs, Helge; Heminghyt, Einar; Rytter, Elisif; Brager-Larsen, Line; Eriksson, Ann-Sofie
Compared nocturnal sleep structure of 10 healthy elderly nuns to that of 10 healthy age-matched female controls. The nuns fell asleep more quickly and had less early morning awakening, as well as greater rapid eye movement sleep time. These differences may reflect the more highly entrained life style of the nuns, including modest habitual sleep…
Hoch, Carolyn C.; And Others
Sleep-related breathing disorders (SRBD) are disorders of breathing during sleep characterized by prolonged partial upper airway obstruction, intermittent complete or partial obstruction (obstructive apnea or hypopnea), or both prolonged and intermittent obstruction that disrupts normal ventilation during sleep, normal sleep patterns, or both. Children with OSAS may sleep in unusual positions, such as seated or with neck hyperextended, even if the neck position is not the only unusual posture or the special sleeping positions that is possible to detect in children with SRBD. We have hypothesized that the assumption of unusual posture during sleep, in particular legs retracting or crossing during sleep, could be a way to enlarge the diaphragmatic excursion and promoting the alveolar gas exchanges avoiding the stress of the antero-lumbar and prevertebral muscular chains in SRBD subjects. We have hypothesized that the assumption of unusual posture during sleep, in particular legs retracting or crossing during sleep, could be a way to enlarge the diaphragmatic excursion and promoting the alveolar gas exchanges avoiding the stress of the antero-lumbar and prevertebral muscular chains in SRBD subjects. We can postulate that the prevertebral and antero-lumbar muscular chains could be oversolicited during the apnoic events, and the assumption of abnormal posture could be interpreted as a way to relax or diminish the strain or muscular stress caused by the apneas. The consequence of this hypothesis could be summarized in the concept that a specific rehabilitation or muscular program to improve the tone of this kinetic chain, could be useful to limit the effect nocturnal or diurnal of this so impacting syndrome. PMID:23660129
Carotenuto, Marco; Gimigliano, Francesca; Fiordelisi, Giovanni; Ruberto, Maria; Esposito, Maria
Study Objectives: Though melatonin and melatonin receptor agonists are in clinical use and under development for treating insomnia, the role of endogenous melatonin in the regulation of the sleep-wake cycle remains uncertain. Some clinical case reports suggest that reduced nocturnal melatonin secretion is linked to sleep disruption, but pineal-gland removal in experimental animals has given variable results. Design: The present study examined the effects of pinealectomy on the diurnal sleep-wake cycle of rats implanted with a radiotransmitter to allow continuous measurement of cortical electroencephalogram, electromyogram, and core temperature (Tc) without restraint in their home cages. Measurements and Results: Tc was slightly (0.2°C) but significantly lower after pineal removal. The total amount and diurnal distribution of locomotor activity, wake, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were unaltered in pinealectomized rats compared to sham-operated controls. Sleep consolidation measured by determining wake, NREM sleep, and REM sleep bout length and frequency was also unchanged. The EEG power spectrum during NREM sleep was unchanged, but a significant decrease in theta power (5-8 Hz) during REM sleep episodes was found. Conclusions: Our data provide no evidence that endogenous circulating melatonin plays a role in regulating the sleep-wake cycle in rats. However, because cortical theta oscillations are generated in the CA1-3 layer of the hippocampus, neurons known to express melatonin receptors, this suggests that a lack of melatonin following pineal removal influences the function of these neurons and is consistent with previous work suggesting that endogenous melatonin is an important regulator of hippocampal physiology. Citation: Fisher SP; Sugden D. Endogenous melatonin is not obligatory for the regulation of the rat sleep-wake cycle. SLEEP 2010;33(6):833-840.
Fisher, Simon P.; Sugden, David
Delirium and poor sleep quality are common and often co-exist in hospitalized patients. A link between these disorders has been hypothesized but whether this link is a cause and effect relationship or simply an association resulting from shared mechanisms is yet to be determined. Potential shared mechanisms include: abnormalities of neurotransmitters, tissue ischemia, inflammation, and sedative exposure. Sedatives, while decreasing sleep latency, often cause a decrease in slow wave sleep and stage REM sleep and therefore may not provide the same restorative properties as natural sleep. Mechanical ventilation, an important cause of sleep disruption in ICU patients, may lead to sleep disruption not only from the discomfort of the endotracheal tube but also as a result of ineffective respiratory efforts and by inducing central apnea events if not properly adjusted for the patient’s physiologic needs. When possible, efforts should be made to optimize the patient-ventilator interaction to minimize sleep disruptions.
Watson, Paula L.; Ceriana, Piero; Fanfulla, Francesco
Psychiatric disorders constitute 15.4% of the disease burden in established market economies. Many psychiatric disorders are associated with sleep disturbances, and the relationship is often bidirectional. This paper reviews the prevalence of various psychiatric disorders, their clinical presentation, and their association with sleep disorders. Among the psychiatric disorders reviewed are affective disorders, psychosis, anxiety disorders (including post-traumatic stress disorder), substance abuse disorders, eating disorders, and attention deficit/hyperactivity disorders. The spectrum of associated sleep disorders includes insomnia, hypersomnia, nocturnal panic, sleep paralysis, hypnagogic hallucinations, restless legs/periodic limb movements of sleep, obstructive sleep apnea, and parasomnias. The effects on sleep of various psychotropic medications utilized to treat the above psychiatric disorders are summarized.
Abad, Vivien C.; Guilleminault, Christian
This article is intended to briefly describe common sleep disorders of interest to the dental profession and to render general management guidelines. Topics include sleep-related bruxism, xerostomia, hypersalivation, gastroesophageal reflux, apnea, and the effect of orofacial pain on sleep quality. The term sleep-related is used instead of the term nocturnal because some of the activities described can occur with daytime
Gilles J. Lavigne; Jean-Paul Goulet; Marco Zuconni; Florence Morisson; Frank Lobbezoo
Women are at higher risk than men for developing posttraumatic stress disorder (PTSD) following certain types of trauma such as accidents and assaults. Sleep disturbances have been implicated in the development of PTSD. Although gender differences in objective sleep soon after trauma have been found in a prior polysomnographic study, gender differences in subjective sleep soon after trauma and their associations to the development of PTSD have not been examined. This pilot study prospectively examined whether gender moderated the relationship between subjective sleep soon after trauma and PTSD symptom development. Injury patients (17 women, 28 men) completed a sleep questionnaire and a 1-week sleep diary 2 weeks after their injuries, and the Clinician Administered PTSD Scale at 7-weeks postinjury. Results showed that women reported greater frequency of nightmares and disruptive nocturnal behaviors (e.g., hot flashes, memories/nightmares about trauma) following the trauma and more severe PTSD symptoms at 7 weeks. Further, gender moderated the relationship between sleep-onset latency and PTSD symptom severity, such that longer sleep-onset latency predicted more severe PTSD symptoms in men, but less severe PTSD symptoms in women. These findings suggest that gender-specific mechanisms may underlie the relationship between sleep impairment and the development of PTSD. PMID:23861181
Kobayashi, Ihori; Delahanty, Douglas L
The aim of this study was to evaluate daytime and nighttime sleep, as well as daytime and nighttime sleepiness of professional shift-working bus drivers. Thirty-two licensed bus drivers were assessed by nocturnal and diurnal polysomnography (PSG) recording and multiple sleep latency testing (MSLT) sessions. Sleep length was shorter and sleep efficiency reduced during daytime sleep compared with nighttime sleep. Thirty-eight
Eduardo H. R. Santos; Marco Tulio de Mello; Marcia Pradella-Hallinan; Ligia Luchesi; Maria Laura Nogueira Pires; Sergio Tufik
Adolescents have unique sleep behaviors related to physiological and developmental differences. Research suggests that sleep debt related to these adolescent differences contributes to risk for accidents, behavioral changes, and other health concerns. In addition, the impact of pain related to trauma, surgery, and chronic illness can further alter the sleep patterns of this age group. Limited normative parameters describe the sleep of healthy adolescents. A comparative study of 26 adolescents from 12 through 18 years of age was designed to describe the sleep patterns of two groups of adolescents. Sleep parameters, including actual sleep time, sleep efficiency, nighttime awakenings, and other sleep patterns of adolescents following post-operative tonsillectomy and adenoidectomy (T & A), were compared with an age and gender-matched sample of healthy adolescents. All adolescents wore wrist-actigraphy and documented sleep information in a diary for three continuous days. Healthy adolescents had significantly less (p = 0.003) actual hours of night time sleep and significantly less (p = 0.039) sleep efficiency than adolescents in the post-operative sample during the three days. None of the adolescents in this study had sufficient actual hours of nighttime sleep. Findings support the need for nurses to assess adolescent sleep patterns and to educate teens and their families about the importance of adequate sleep. Further research is needed to establish sleep interventions that will improve the sleep hygiene of both healthy adolescents and those who experience sleep disruption due to painful conditions. PMID:24941511
Wiggins, Shirley A; Freeman, Jackie L
Objective: Many patients with panic disorder (PD) experience nocturnal panic attacks. We investigated the differences in demographic variables and symptom characteristics as well as response to treatment among patients with primary day panic (DP), primary nocturnal panic (NP), and the coexistence of DP and NP (DP/NP), and discuss whether NP is a distinct disease category. Method: One hundred one consecutive untreated patients with PD were enrolled and subsequently divided into the NP, DP, and DP/NP groups. The presence of 13 panic attack symptom items as well as scores on the Panic Disorder Severity Scale (PDSS) and the Pittsburgh Sleep Quality Index (PSQI) were compared among the groups. After 3 months of regular treatment, PDSS scores were assessed again to evaluate treatment response. Results: Nocturnal panic attacks of the participants were mostly reported to occur in the first tertile of nocturnal sleep. The number of males, onset age, and presence of choking sensation were significantly higher, and the PDSS score was significantly lower in the NP group compared with the other groups. The DP/NP group showed the highest PDSS score, and participants in this group were prescribed the highest doses of medication among all groups. Only diagnostic sub-category was significantly associated with treatment response. The total score for PDSS and PSQI correlated significantly only in the NP group. Conclusions: DP/NP could be a severe form of PD, while primary NP could be a relatively mild subcategory that may partially share common pathophysiology with adult type night terror. Citation: Nakamura M; Sugiura T; Nishida S; Komada Y; Inoue Y. Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic. J Clin Sleep Med 2013;9(5):461-467.
Nakamura, Masaki; Sugiura, Tatsuki; Nishida, Shingo; Komada, Yoko; Inoue, Yuichi
Sleep disruptions are a common clinical feature observed in children with autism spectrum disorders (ASD). These include irregular sleep-wake patterns, delayed sleep latencies, and problems with sleep maintenance. The etiology of these sleep disturbances ...
Sleep disruptions are a common clinical feature observed in children with autism spectrum disorders (ASD). These include irregular sleep-wake patterns, delayed sleep latencies, and problems with sleep maintenance. The etiology of these sleep disturbances ...
Disrupted sleep is probably the most common complaint of parents with a new baby. Night waking increases in the second half of the first year of infant life and is more pronounced for breastfed infants. Sleep-related phenotypes of infants with Prader-Willi and Angelman syndromes suggest that imprinted genes of paternal origin promote greater wakefulness whereas imprinted genes of maternal origin favor more consolidated sleep. All these observations are consistent with a hypothesis that waking at night to suckle is an adaptation of infants to extend their mothers’ lactational amenorrhea, thus delaying the birth of a younger sib and enhancing infant survival.
Sleep disorders in the menopause are common. Although these disorders may be due to the menopause itself and/or the associated vasomotor symptoms, the etiology is multifactorial and includes a number of other associated conditions. They may simply arise as part of the aging process and not be specifically related to the decrease in estrogen levels or, alternatively, because of breathing or limb movement syndromes, depression, anxiety, co-morbid medical diseases, medication, pain and/or psychosocial factors. The most commonly encountered sleep disorders in menopausal women include insomnia, nocturnal breathing disturbances and the associated sleep disorders that accompany the restless leg syndrome, periodic leg movement syndrome, depression and anxiety. This review article addresses sleep and the sleep disorders associated with menopause and briefly the role that hormone therapy may play in alleviating these disorders. PMID:23205646
Ancient philosophers and theologians believed that altered consciousness freed the mind to prophesy the future, equating sleep with seizures. Only recently has the bidirectional influences of epilepsy and sleep upon one another received more substantive analysis. This article reviews the complex and increasingly recognized interrelationships between sleep and epilepsy. NREM sleep differentially activates interictal epileptiform discharges during slow wave (N3) sleep, while ictal seizure events occur more frequently during light NREM stages N1 and N2. The most commonly encountered types of sleep-related epilepsies (those with preferential occurrence during sleep or following arousal) include frontal and temporal lobe partial epilepsies in adults, and benign epilepsy of childhood with centrotemporal spikes (benign rolandic epilepsy) and juvenile myoclonic epilepsy in children and adolescents. Comorbid sleep disorders are frequent in patients with epilepsy, particularly obstructive sleep apnea in refractory epilepsy patients which may aggravate seizure burden, while treatment with nasal continuous positive airway pressure often improves seizure frequency. Distinguishing nocturnal events such as NREM parasomnias (confusional arousals, sleep walking, and night terrors), REM parasomnias including REM sleep behavior disorder, and nocturnal seizures if frequently difficult and benefits from careful history taking and video-EEG-polysomnography in selected cases. Differentiating nocturnal seizures from primary sleep disorders is essential for determining appropriate therapy, and recognizing co-existent sleep disorders in patients with epilepsy may improve their seizure burden and quality of life.
St. Louis, Erik K.
Sleep disturbances are core symptoms of posttraumatic-stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be highly useful in both research and clinical practice. The Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A) was examined for the ability to identify cases of PTSD among male military veterans. Male military veterans (N = 119) completed the PSQI-A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI-A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI-A had good internal consistency and had convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ? 4 provided an area-under-the-curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI-A is a valid measure to possibly detect PTSD among male military veterans without directly probing trauma reactions. Assessment of disruptive nocturnal behaviors may provide a cost-effective, non-stigmatizing approach to PTSD screening among male military veterans.
Insana, Salvatore P.; Hall, Martica; Buysse, Daniel J.; Germain, Anne
OBJECTIVE: To determine the prevalence of nocturnal hypoxemia and its association with pulmonary function, nutritional status, sleep macrostructure, and obstructive respiratory events during sleep in a population of clinically stable children and adolescents with cystic fibrosis (CF). METHODS: This was a cross-sectional study involving 67 children and adolescents with CF between 2 and 14 years of age. All of the participants underwent polysomnography, and SpO2 was measured by pulse oximetry. We also evaluated the Shwachman-Kulczycki (S-K) scores, spirometry findings, and nutritional status of the patients. RESULTS: The study involved 67 patients. The mean age of the patients was 8 years. The S-K scores differed significantly between the patients with and without nocturnal hypoxemia, which was defined as an SpO2 < 90% for more than 5% of the total sleep time (73.75 ± 6.29 vs. 86.38 ± 8.70; p < 0.01). Nocturnal hypoxemia correlated with the severity of lung disease, FEV1 (rs = ?0.42; p = 0.01), FVC (rs = ?0.46; p = 0.01), microarousal index (rs = 0.32; p = 0.01), and apnea-hypopnea index (rs = 0.56; p = 0.01). CONCLUSIONS: In this sample of patients with CF and mild-to-moderate lung disease, nocturnal oxygenation correlated with the S-K score, spirometry variables, sleep macrostructure variables, and the apnea-hypopnea index.
Ramos, Regina Terse Trindade; Santana, Maria Angelica Pinheiro; Almeida, Priscila de Carvalho; Machado, Almerio de Souza; Araujo-Filho, Jose Bouzas; Salles, Cristina
The main goal of this study was to investigate to what extent polysomnographic (PSG) recordings of nocturnal human sleep can provide information about sleep quality in terms of correlation with a set of daytime measures. These measures were designed with the aim of comprising selected quality of night sleep and consist of subjective sleep quality ratings, neuropsychological tests and physiological parameters. First, a factor analysis model was applied to the large number of daytime measures of sleep quality in order to detect their latent structure. Secondly, in addition to the gold standard sleep staging method to arrive at variables about sleep architecture from PSG, we applied a recently developed continuous sleep representation by considering the probabilistic sleep model (PSM) describing the microstructure of sleep. Significant correlations between sleep architecture and daytime variables of sleep quality were found. Both the factor analysis and the PSM helped maximize the information about this relationship.
Rosipal, Roman; Lewandowski, Achim; Dorffner, Georg
Background: Children with primary nocturnal enuresis (PNE) wet the bed during all stages of sleep and irrespective of state of arousal, suggesting that during sleep, when voluntary, i.e., cortical control, is not available, the signal from the distended bladder is not registered in the subcortical centers inhibiting micturition. Deficient prepulse inhibition (PPI) of startle has been reported in PNE. This
Edward M Ornitz; Andrew T Russell; Gregory L Hanna; Patrik Gabikian; Jean-Guido Gehricke; Dale Song; Donald Guthrie
Sleep has been ascribed a critical role in cognitive functioning. Several lines of evidence implicate sleep in the consolidation of synaptic plasticity and long-term memory. Stress disrupts sleep while impairing synaptic plasticity and cognitive performance. Here, we discuss evidence linking sleep to mechanisms of protein synthesis-dependent synaptic plasticity and synaptic scaling. We then consider how disruption of sleep by acute and chronic stress may impair these mechanisms and degrade sleep function.
Gr?nli, Janne; Soule, Jonathan; Bramham, Clive R.
Disordered circadian rhythms are associated with various psychiatric conditions and metabolic diseases. We recently established a mouse model of a psychophysiological stress-induced chronic sleep disorder (CSD) characterized by reduced amplitude of circadian wheel-running activity and sleep-wake cycles, sleep fragmentation and hyperphagia. Here, we evaluate day-night fluctuations in plasma concentrations of free amino acids (FAA), appetite hormones and prolactin as well as the hepatic expression of circadian clock-related genes in mice with CSD (CSD mice). Nocturnal increases in wheel-running activity and circadian rhythms of plasma prolactin concentrations were significantly disrupted in CSD mice. Hyperphagia with a decreased leptin/ghrelin ratio was found in CSD mice. Day-night fluctuations in plasma FAA contents were severely disrupted without affecting total FAA levels in CSD mice. Nocturnal increases in branched-chain amino acids such as Ile, Leu, and Val were further augmented in CSD mice, while daytime increases in Gly, Ala, Ser, Thr, Lys, Arg, His, Tyr, Met, Cys, Glu, and Asn were significantly attenuated. Importantly, the circadian expression of hepatic clock genes was completely unaffected in CSD mice. These findings suggest that circadian clock gene expression does not always reflect disordered behavior and sleep rhythms and that plasma FFA profiles could serve as a potential biomarker of circadian rhythm disorders. PMID:24971530
Oishi, Katsutaka; Yamamoto, Saori; Itoh, Nanako; Miyazaki, Koyomi; Nemoto, Tadashi; Nakakita, Yasukazu; Kaneda, Hirotaka
The demands of sustaining high levels of neurobehavioral performance during space operations necessitate precise scheduling of sleep opportunities in order to best preserve optimal performance. We report here the results of the first split sleep, dose-response experiment involving a range of sleep/wake scenarios with chronically reduced nocturnal sleep, augmented with a diurnal nap. To characterize performance over all combinations of split sleep in the range studied, we used response surface mapping methodology. Waking neurobehavioral performance was studied in N=90 subjects each assigned to one of 18 sleep regimens consisting of a restricted nocturnal anchor sleep period and a diurnal nap. Psychomotor vigilance task performance and subjective assessments of sleepiness were found to be primarily a function of total time in bed per 24 h regardless of how sleep was divided among nocturnal anchor sleep and diurnal nap periods. Digit symbol substitution task performance was also found to be primarily a function of total time in bed per 24 h; however, accounting for nocturnal sleep duration and nap duration separately provided a small but significant enhancement in the variance explained. The results suggest that reductions in total daily sleep result in a near-linear accumulation of impairment regardless of whether sleep is scheduled as a consolidated nocturnal sleep period or split into a nocturnal anchor sleep period and a diurnal nap. Thus, split sleep schedules are feasible and can be used to enhance the flexibility of sleep/work schedules for space operations involving restricted nocturnal sleep due to mission-critical task scheduling. These results are generally applicable to any continuous industrial operation that involves sleep restriction, night operations, and shift work.
Mollicone, Daniel J.; Van Dongen, Hans P. A.; Rogers, Naomi L.; Dinges, David F.
The aim of the study was to identify daytime predictors of nocturnal gas exchange anomalies in children with neuromuscular disease (NMD) and normal daytime gas exchange. Lung function tests, respiratory muscle evaluation and nocturnal gas exchange were obtained as part of routine evaluation. We included 52 consecutive children with Duchenne muscular dystrophy (n = 20), spinal muscular atrophy (n = 10) and other NMD (n = 22). 20 patients had nocturnal hypoxaemia, defined as minimal arterial oxygen saturation measured by pulse oximetry (S(p,O(2))) <90% for ? 2% of night time, and 22 had nocturnal hypercapnia, defined as maximal transcutaneous carbon dioxide tension (P(tc,CO(2))) >50 mmHg for ? 2% of night time. Forced vital capacity and helium functional residual capacity correlated with minimal nocturnal S(p,O(2)) (p = 0.009 and p = 0.01, respectively). Daytime pH correlated negatively with maximal nocturnal P(tc,CO(2)) (p=0.005) and daytime arterial carbon dioxide tension (P(a,CO(2))) correlated with the percentage of time with a P(tc,CO(2)) >50 mmHg (p = 0.02). Sniff nasal inspiratory pressure correlated with minimal nocturnal S(p,O(2)) (p = 0.02). Daytime P(a,CO(2)) was a weak predictor of nocturnal hypercapnia (sensitivity 80%; specificity 57%). Daytime lung function and respiratory muscle parameters correlate poorly with nocturnal hypoxaemia and hypercapnia in children with NMD and normal daytime gas exchange, which necessitates more systematic sleep studies in these children. PMID:22135279
Bersanini, Chiara; Khirani, Sonia; Ramirez, Adriana; Lofaso, Frédéric; Aubertin, Guillaume; Beydon, Nicole; Mayer, Michèle; Maincent, Kim; Boulé, Michèle; Fauroux, Brigitte
Sleep and circadian rhythms modulate or control daily physiological patterns with importance for normal metabolic health. Sleep deficiencies associated with insufficient sleep schedules, insomnia with short-sleep duration, sleep apnea, narcolepsy, circadian misalignment, shift work, night eating syndrome, and sleep-related eating disorder may all contribute to metabolic dysregulation. Sleep deficiencies and circadian disruption associated with metabolic dysregulation may contribute to weight gain, obesity, and type 2 diabetes potentially by altering timing and amount of food intake, disrupting energy balance, inflammation, impairing glucose tolerance, and insulin sensitivity. Given the rapidly increasing prevalence of metabolic diseases, it is important to recognize the role of sleep and circadian disruption in the development, progression, and morbidity of metabolic disease. Some findings indicate sleep treatments and countermeasures improve metabolic health, but future clinical research investigating prevention and treatment of chronic metabolic disorders through treatment of sleep and circadian disruption is needed. PMID:24816752
Depner, Christopher M; Stothard, Ellen R; Wright, Kenneth P
Workers who were on rotating shifts for several years served as subjects for the recording of the EEG during nocturnal and diurnal sleep. It was found that the duration of sleep is reduced when it must take place during the daytime, or at times other than...
J. Foret O. Benoit
Rationale: Sleep-disordered breathing (SDB), the recurrent episodic disruption of normal breathing during sleep, affects as much as 17% of U.S. adults, and may be more prevalent in poor urban environments. SDB and air pollution have been linked to increased cardiovascular diseases and mortality, but the association between pollution and SDB is poorly understood. Objectives: We used data from the Sleep Heart Health Study (SHHS), a U.S. multicenter cohort study assessing cardiovascular and other consequences of SDB, to examine whether particulate air matter less than 10 ?m in aerodynamic diameter (PM10) was associated with SDB among persons 39 years of age and older. Methods: Using baseline data from SHHS urban sites, outcomes included the following: the respiratory disturbance index (RDI); percentage of sleep time at less than 90% O2 saturation; and sleep efficiency, measured by overnight in-home polysomnography. We applied a fixed-effect model containing a city effect, controlling for potential predictors. In all models we included both the 365-day moving averages of PM10 and temperature (long-term effects) and the differences between the daily measures of these two predictors and their 365-day average (short-term effects). Measurements and Main Results: In summer, increases in RDI or percentage of sleep time at less than 90% O2 saturation, and decreases in sleep efficiency, were all associated with increases in short-term variation in PM10. Over all seasons, we found that increased RDI was associated with an 11.5% (95% confidence interval: 1.96, 22.01) increase per interquartile range increase (25.5°F) in temperature. Conclusions: Reduction in air pollution exposure may decrease the severity of SDB and nocturnal hypoxemia and may improve cardiac risk.
Zanobetti, Antonella; Redline, Susan; Schwartz, Joel; Rosen, Dennis; Patel, Sanjay; O'Connor, George T.; Lebowitz, Michael; Coull, Brent A.; Gold, Diane R.
Headache and sleep have long been recognised as being interdependent due to specific causative factors. Yet, the precise understanding of the roles played by these factors in this interdependency remains elusive. Many observations have suggested a reciprocal relationship between headache and sleep; however, these hypotheses have only been partially substantiated by robust findings. Being so, additional well-designed clinical and laboratory studies are required to confirm these relationships. Nonetheless, sleep and headache are known to be related in several ways: primary headache such as migraine, cluster headache (CH) and hypnic headache (HH) can be triggered by sleep, while chronic morning headaches can be caused by sleep disorders such as sleep apnoea and insomnia. Furthermore, headache and sleep disorders can also be symptoms of other underlying pathologies. Migraine, CH and HH seems to be related to sleep stages suggesting that they may in fact be a chronobiological disorder. Patients suffering from chronic morning or nocturnal headache should be considered for the presence of possible sleep disturbances. PMID:16872851
Glutatione is implicated in sleep regulation. There are circadian changes in brain glutathione levels, and nocturnal intracerebroventricular (i.c.v.) slow infusion of oxidized glutathione (GSSG) or reduced glutathione (GSH) promotes rapid-eye-movement sleep (REMS) and non-REMS (NREMS) in rats. In the present experiments, we tested the effects of GSSG on duration of sleep, NREMS intensity, and brain temperature in another species, rabbits.
Mayumi Kimura; Levente Kapás; James M Krueger
Study Objectives: We investigated the prevalence and association of excessive daytime sleepiness (EDS) with a wide range of factors (e.g., medical complaints, obesity, objective sleep [including sleep disordered breathing], and parent-reported anxiety/depression and sleep difficulties) in a large general population sample of children. Few studies have researched the prevalence and predictors of EDS in young children, none in a general population sample of children, and the results are inconsistent. Design: Cross-sectional Setting: Population -based. Participants: 508 school-aged children from the general population. Interventions: N/A Measurements and Results: Children underwent a 9-hour polysomnogram (PSG), physical exam, and parent completed health, sleep and psychological questionnaires. Children were divided into 2 groups: those with and without parent reported EDS. The prevalence of subjective EDS was approximately 15%. Significant univariate relationships were found between children with EDS and BMI percentile, waist circumference, heartburn, asthma, and parent reported anxiety/depression, and sleep difficulties. The strongest predictors of EDS were waist circumference, asthma, and parent-reported symptoms of anxiety/depression and trouble falling asleep. All PSG sleep variables including apnea/hypopnea index, caffeine consumption, and allergies were not significantly related to EDS. Conclusions: It appears that the presence of EDS is more strongly associated with obesity, asthma, parent reported anxiety/depression, and trouble falling asleep than with sleep disordered breathing (SDB) or objective sleep disruption per se. Our findings suggest that children with EDS should be thoroughly assessed for anxiety/depression, nocturnal sleep difficulties, asthma, obesity, and other metabolic factors, whereas objective sleep findings may not be as clinically useful. Citation: Calhoun SL; Vgontzas AN; Fernandez-Mendoza J; Mayes SD; Tsaoussoglou M; Basta M; Bixler EO. Prevalence and risk factors of excessive daytime sleepiness in a community sample of young children: the role of obesity, asthma, anxiety/depression, and sleep. SLEEP 2011;34(4):503-507.
Calhoun, Susan L.; Vgontzas, Alexandros N.; Fernandez-Mendoza, Julio; Mayes, Susan D.; Tsaoussoglou, Marina; Basta, Maria; Bixler, Edward O.
The aim of the present study was to investigate whether there is a difference in evening\\/nocturnal interleukin-6 (IL-6) serum excretion in patients with primary insomnia compared to controls. We hypothesized that in insomniac patients, the excretion of evening\\/nocturnal IL-6 is enhanced, like observed in aged adults and after sleep deprivation in healthy subjects. We studied IL-6 serum concentrations in 11
Ivonne Burgos; Linda Richter; Torsten Klein; Bernd Fiebich; Bernd Feige; Klaus Lieb; Ulrich Voderholzer; Dieter Riemann
Objective: Sleep disordered breathing is common in patients with cerebrovascular disease. Nocturnal hypoxia may lead to daytime tiredness and cognitive impairment, thus affecting progress. This study assessed the prevalence of nocturnal hypoxia during rehabilitation from stroke.Design: Prospective observational trial.Setting: The stroke rehabilitation wards of the North Staffordshire Hospital, UK and of Kreiskrankenhaus Grevenbroich, Germany.Subjects: Adult patients on a stroke rehabilitation
Christine Roffe; Helmut Frohnhofen; Sheila Sills; John Hodsoll; Martin B Allen; Peter W Jones
During the past decade, associations between sleep disorders and certain ophthalmologic disorders have been increasingly recognized. To review the literature on these important associations, we conducted a PubMed search using combinations of the following terms: sleep disorders, sleep apnea, circadian rhythm disorder, continuous positive airway pressure, eye disease, floppy eyelid syndrome, glaucoma, ischemic optic neuropathy, papilledema, nocturnal lagophthalmos, and vision loss. We limited our search to articles published in English that involved human participants. All available dates were included. One of the most common sleep disorders, obstructive sleep apnea, has been associated with a variety of eye diseases, including glaucoma, nonarteritic anterior ischemic optic neuropathy, floppy eyelid syndrome, papilledema, and continuous positive airway pressure-associated eye complications. Nocturnal lagophthalmos manifests during sleep and is defined as the failure to fully close the eyelids at night. Finally, blindness is associated with increased risk of circadian rhythm disorders. On the basis of the existing published literature, we discuss these rarely recognized associations, potential pathophysiologic mechanisms, and the effect these associations have on the clinical management of patients. The knowledge of these associations is important for the primary care physician, ophthalmologist, and sleep physician so that underlying sleep disorders or ophthalmologic disorders can be detected. PMID:18990324
Waller, E Andrew; Bendel, Rick E; Kaplan, Joseph
In downwind flight, track and heading are the same, and the question of drift by wind, or correction for drift, does not arise. Many passerine nocturnal migrants selectively fly downwind, regardless of the direction of the wind. It is shown that waders an...
K. P. Able, S. A. Gauthreaux
The essential feature of obstructive sleep apnea (OSA) in chil- dren is increased upper airway resistance during sleep. Airway narrowing may be due to craniofacial abnormalities and\\/or soft tissue hypertrophy. The resultant breathing patterns during sleep are highly variable, but include obstructive cycling, in- creased respiratory effort, flow limitation, tachypnea, and\\/or gas exchange abnormalities. Consequently, sleep disruption occurs, ranging from
Eliot S. Katz; Carolyn M. D'Ambrosio
Study Objectives: To compare nocturnal sleep duration in children from 8 European countries and identify its determinants. Design: Cross-sectional. Setting: Primary schools and preschools participating in the IDEFICS study. Participants: 8,542 children aged 2 to 9 years from 8 European countries with complete information on nocturnal sleep duration. Interventions: Not applicable. Measurements: Nocturnal sleep duration was assessed by means of a computer based parental 24-h recall. Data on personal, social, environmental, and behavioral factors were collected by means of standardized parental questionnaire. Physical activity was surveyed with accelerometers. Results: Nocturnal sleep duration in the participating countries ranged from 9.5 h (SD 0.8) in Estonia to 11.2 h (SD 0.7) in Belgium and differed significantly between countries (P < 0.001) in univariate as well as in multivariate analyses, with children from northern countries sleeping the longest. Sleep duration decreased by about 6 min with each year of age over all countries. No effect of season, daylight duration, overweight, parental education level, or lifestyle factors could be seen. Conclusion: Sleep duration differs significantly between countries. Our findings allow for the conclusion that regional affiliation, including culture and environmental characteristics, seems to overlay individual determinants of sleep duration. Citation: Hense S; Barba G; Pohlabeln H; De Henauw S; Marild S; Molnar D; Moreno LA; Hadjigeorgiou C; Veidebaum T; Ahrens W. Factors that influence weekday sleep duration in European children. SLEEP 2011;34(5):633-639.
Hense, Sabrina; Barba, Gianvincenzo; Pohlabeln, Hermann; De Henauw, Stefaan; Marild, Staffan; Molnar, Denes; Moreno, Luis A.; Hadjigeorgiou, Charalampos; Veidebaum, Toomas; Ahrens, Wolfgang
Sleep can integrate information into existing memory networks, look for common patterns and distil overarching rules, or simply stabilize and strengthen the memory exactly as it was learned. Recent research has shown that sleep facilitates abstraction of gist information as well as integration across multiple memories, insight into hidden solutions, and even the ability to make creative connections between distantly related ideas and concepts. To investigate the effect of sleep on memory organization, 35 normal volunteers were randomly assigned either to the sleep (n?=?17) or wake group (n?=?18). The sleep subjects performed the Japanese Verbal Learning Test (JVLT), a measure of learning and memory, three times in the evening, and slept. On the following morning (9?h later), they were asked to recall the words on the list. The wake subjects took the same test in the morning, and were asked to recall the words in the same time interval as in the sleep group. The semantic clustering ratio (SCR), divided by the total number of words recalled, was used as an index of memory organization. Our main interest was whether the sleep subjects elicit a greater increase in this measure from the third to the fourth assessments. Time?×?Group interaction effect on SCR was not significant between the sleep group and wake group as a whole. Meanwhile, the change in the SCR between the third and fourth trials was negatively correlated with duration of nocturnal waking in the sleep group, but not other sleep indices. Based on this observation, further analysis was conducted for subjects in the sleep group who awoke nocturnally for <60?min for comparison with the wake group. A significant Time?×?Group interaction was noted; these “good-sleepers” showed a significantly greater improvement in the memory index compared with the wake subjects. These results provide the first suggestion that sleep may enhance memory organization, which requires further study.
Takeuchi, Masashi; Furuta, Hisakazu; Sumiyoshi, Tomiki; Suzuki, Michio; Ochiai, Yoko; Hosokawa, Munehito; Matsui, Mie; Kurachi, Masayoshi
Different paroxysmal movements occur during sleep. They correspond either to epileptic seizures of sleep, or to parasomnia. Recently, other nocturnal motor phenomena have been described in the literature as nocturnal or hypnogenic paroxysmal dystonia (NPD), paroxysmal arousal, episodic nocturnal wanderings, etc. The NPD are involuntary nocturnal movements characterized by the association of dystonic postures, tonic movements of the four limbs and the body axis, automatisms, affective mimicry, and vocalization. In certain patients, the EEG records show abnormalities characteristic of epilepsy; in others, the EEG appears normal. A large proportion of the patients present epileptic seizures as antecedents. Typical generalized tonic-clonic seizures can follow an NPD. The NPD are improved with anti-epileptics. The considerable similarity of the clinical and paraclinical signs and of the effects of anti-epileptic treatments do not seem to justify the individualization of different subgroups as a function of the EEG patterns: the NPD are always the result of focal epilepsy, and never of a pathology of movement or of parasomnia. Numerous arguments based on the symptoms and the EEG suggest that these seizures involve the mesial frontal regions. PMID:8090154
Hirsch, E; Sellal, F; Maton, B; Rumbach, L; Marescaux, C
Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma.
Salles, Cristina; Terse-Ramos, Regina; Souza-Machado, Adelmir; Cruz, Alvaro A
Aging is associated with several well-described changes in patterns of sleep. Typically, there is a phase advance in the normal circadian sleep cycle: older people tend to go to sleep earlier in the evening but also to wake earlier. They may also wake more frequently during the night and experience fragmented sleep. The prevalence of many sleep disorders increases with age. Insomnia, whether primary or secondary to coexistant illness or medication use, is very common among elderly people. Rapid eye movement (REM) sleep behaviour disorder and narcolepsy, although less common, are frequently not considered for this population. Periodic leg-movement disorder, a frequent cause of interrupted sleep, can be easily diagnosed with electromyography during nocturnal polysomnography. Restless legs syndrome, however, is diagnosed clinically. Snoring is a common sleep-related respiratory disorder; so is obstructive sleep apnea, which is increasingly seen among older people and is significantly associated with cardio-and cerebrovascular disease as well as cognitive impairment.
Wolkove, Norman; Elkholy, Osama; Baltzan, Marc; Palayew, Mark
Objective The ACS1 (Azilsartan Circadian and Sleep Pressure – the first study) is a multicenter, randomized, open-label, two parallel-group study carried out to investigate the efficacy of an 8-week oral treatment with azilsartan 20 mg in comparison with amlodipine 5 mg. Materials and methods The patients with stage I or II primary hypertension will be randomly assigned to either an azilsartan group (n=350) or an amlodipine group (n=350). The primary endpoint is a change in nocturnal systolic blood pressure (BP) as measured by ambulatory BP monitoring at the end of follow-up relative to the baseline level during the run-in period. In addition, we will carry out the same analysis after dividing four different nocturnal BP dipping statuses (extreme-dippers, dippers, nondipper, and risers). Conclusion The findings of this study will help in establishing an appropriate antihypertensive treatment for hypertensive patients with a disrupted circadian BP rhythm.
Sleep studies conducted during the STS-90 Neurolab mission are explored. The relationship between sleep, melatonin, and circadian phase is reviewed. The study contained both sleep and awake components. The objectives of the sleep component were to test five hypotheses: that circadian rhythms of core body temperature and urinary melatonin are synchronized to required sleep-wake schedules, that spaceflight results in substantial disruption of sleep, that the pattern of chest and abdominal wall motion alters during the different sleep stages in microgravity, that arterial oxygen saturation is reduced during some stages of sleep in microgravity, and that pre-sleep administration of melatonin during microgravity results in improved sleep quality. The awake component tested three hypotheses: that ventilatory response to carbon dioxide is increased during exposure to microgravity and that this exacerbates sleep disruption, that ventilatory response to hypoxia is increased by exposure to microgravity, and that the improved sleep resulting from the pre-sleep administration of melatonin enhances next day cognition when compared to placebo.
Prisk, G. K.
Background Obstructive sleep apnea (OSA) is characterized by recurrent nocturnal hypoxia and sleep disruption. Sleep fragmentation caused hyperalgesia in volunteers, while nocturnal hypoxemia enhanced morphine analgesic potency in children with OSA. This evidence directly relates to surgical OSA patients who are at risk for airway compromise due to postoperative use of opioids. Using accepted experimental pain models, we characterized pain processing and opioid analgesia in male volunteers recruited based on their risk for OSA. Methods After approval from the Intitutional Review Board and informed consent, we assessed heat and cold pain thresholds and tolerances in volunteers after overnight polysomnography (PSG). Three pro-inflammatory and 3 hypoxia markers were determined in the serum. Pain tests were performed at baseline, placebo, and two effect site concentrations of remifentanil (1 and 2 µg/ml), an ?-opioid agonist. Linear mixed effects regression models were employed to evaluate the association of 3 PSG descriptors [wake after sleep onset, number of sleep stage shifts, and lowest oxyhemoglobin saturation (SaO2) during sleep] and all serum markers with pain thresholds and tolerances at baseline, as well as their changes under remifentanil. Results Forty-three volunteers (12 normal and 31 with a PSG-based diagnosis of OSA) were included in the analysis. The lower nadir SaO2 and higher insulin growth factor binding protein-1 (IGFBP-1) were associated with higher analgesic sensitivity to remifentanil (SaO2, P?=?0.0440; IGFBP-1, P?=?0.0013). Other pro-inflammatory mediators like interleukin-1? and tumor necrosis factor-? (TNF-?) were associated with an enhanced sensitivity to the opioid analgesic effect (IL-1?, P?=?0.0218; TNF-?, P?=?0.0276). Conclusions Nocturnal hypoxemia in subjects at high risk for OSA was associated with an increased potency of opioid analgesia. A serum hypoxia marker (IGFBP-1) was associated with hypoalgesia and increased potency to opioid analgesia; other pro-inflammatory mediators also predicted an enhanced opioid potency. Trial Registration: ClinicalTrials.gov NCT00672737.
Doufas, Anthony G.; Tian, Lu; Padrez, Kevin A.; Suwanprathes, Puntarica; Cardell, James A.; Maecker, Holden T.; Panousis, Periklis
The hospital is not conducive to sleep. Patients in the ICU are particularly susceptible to sleep disruption secondary to environmental and medical issues. Despite the frequency of sleep disruption in the ICU, the quality of critically ill patients' sleep is often overlooked. This article discusses the following issues essential to understanding the factors associated with sleep loss in the ICU: (1) core elements to consider from the baseline sleep history, (2) impact of the ICU environment on the ICU patient's sleep pattern, and (3) overall systematic impact of sleep deprivation on the ICU patient. PMID:18538195
Salas, Rachel E; Gamaldo, Charlene E
We describe the case of a 22-year-old male affected by NFLE reporting paroxysmal RLS-like symptoms. The patient was referred\\u000a to our Sleep Center due to nocturnal paresthesias and cramps involving the left leg and leading to sleep fragmentation. At\\u000a age 4, the patient presented with secondary generalized seizures preceded by left leg discomfort, controlled on CBZ. After\\u000a successive therapy discontinuation,
Irene Aricò; Rosaria Condurso; Francesca Granata; Lino Nobili; Oliviero Bruni; Rosalia Silvestri
367 children with nocturnal enuresis (NE) were divided into randomly selected groups. Two groups were treated with amitriptylin (the 1st group) or imipramine (the 2nd one). In the third group the treatment was differentiated and depended on coexist clinical sleep disturbances. In such cases there were used according to indications amitriptylin (including in combination with cyclodol), imipramine, diazepam. Additionally nootropic drugs (pyracetam, pantogam) were also administrated. In 3 month after the treatment 68.3% of the patients of the 3rd group still had complete remission. These results were better then in the 1st (20.9%) and in the 2nd (45.6%) groups of patients in which the treatment of NE was not depended on coexist disturbances. PMID:9343478
Gruzman, A V
Sleep disorders are becoming more prevalent. There is an overlap of symptoms related to obstructive sleep apnea syndrome (OSAS) and many psychiatric conditions. Complaints of excessive sleepiness, insomnia, cognitive dysfunction, and depressive symptoms can be related to both disease states. Obstructive sleep apnea syndrome is characterized by repetitive disruption of sleep by cessation of breathing and was first described in the 19th century by bedside observation during sleep. Physicians observed this cessation of breathing while the patient slept and postulated that these episodes were responsible for subsequent complaints of sleepiness. OSAS can coexist with major depressive disorder, exacerbate depressive symptoms, or be responsible for a large part of the symptom complex of depression. Additionally, in schizophrenia, sleep apnea may develop as a result of chronic neuroleptic treatment and its effect on gains in body weight, a major risk factor for the development of OSAS. It is important to recognize the signs and symptoms of sleep apnea, namely excessive daytime sleepiness, snoring, and witnessed apneas. Recognition of the existence of sleep apnea, prompt referral to a sleep specialist, and ultimately treatment of an underlying sleep disorder, such as OSAS, can ameliorate symptoms of psychiatric disease.
Markov, Dimitri; Doghramji, Karl
Psychiatric disorders are frequently associated with disturbances of sleep and circadian rhythms. This review focus on the relationship between sleep disturbances and eating disorders. In the first part are discussed the presence of sleep disorders among patients suffering from anorexia nervosa and bulimia nervosa, the macrostructure and microstructure of theirs sleep, the differences between the various subtypes in ED patients, the dreams of eating disordered patients and their recurrent contents. In the second part, there are treated sleep disturbances in binge eating disorder and other eating disorders not otherwise specified, such as nocturnal (night) eating syndrome and sleep-related eating disorder. In the third part, there are presented data concerning the neurobiological and neuroendocrinological correlates between feeding, metabolism, weight restoration and the processes regulating sleep. In conclusion, possible future investigations are proposed. PMID:22262340
Cinosi, E; Di Iorio, G; Acciavatti, T; Cornelio, M; Vellante, F; De Risio, L; Martinotti, G
This study evaluated sleep-related breathing disorders in six adults with Down syndrome. Five were found to have respiratory events justifying the diagnosis of sleep apnea syndrome. Results suggest that the nocturnal respiratory pattern of adults with Down syndrome depends on several pathogenetic factors such as age, severity of upper airway…
Resta, Onofrio; Barbaro, Maria Pia Foschino; Giliberti, Tiziana; Caratozzolo, Gennaro; Cagnazzo, Maria Grazia; Scarpelli, Franco; Nocerino, Maria Cristina
Study Objective: To test the hypothesis that low iron availability, measured as transferrin saturation, is associated with low nocturnal hemoglobin oxygen saturation (SpO2) in children with homozygous sickle cell anemia (SCA; hemoglobin SS). Methods: This was a cross-sectional study of Tanzanian children with SCA who were not receiving regular blood transfusions. Thirty-two children (16 boys) with SCA (mean age 8.0, range 3.6-15.3 years) underwent motion-resistant nocturnal oximetry (Masimo Radical) and had steady state serum transferrin saturation and hematological indices assessed. Results: Higher transferrin saturation, adjusted for age and ?-thalassemia deletion, was associated with lower nocturnal mean SpO2 (p = 0.013, r2 = 0.41), number of SpO2 dips/h > 3% from baseline (p = 0.008, r2 = 0.19) and with min/h with SpO2 < 90% (p = 0.026 r2 = 0.16). Transferrin saturation < 16% (indicative of iron deficiency) was associated with a 2.2% higher nocturnal mean SpO2. Conclusions: Contrary to our hypothesis, higher iron availability, assessed by transferrin saturation, is associated with nocturnal chronic and intermittent hemoglobin oxygen desaturation in SCA. Whether these associations are causal and are driven by hypoxia-inducible factor and hepcidin-mediated upregulation of demand for iron warrants further investigation. Citation: Cox SE; L'Esperance V; Makani J; Soka D; Prentice AM; Hill CM; Kirkham FJ. Sickle cell anemia: iron availability and nocturnal oximetry. J Clin Sleep Med 2012;8(5):541-545.
Cox, Sharon E.; L'Esperance, Veline; Makani, Julie; Soka, Deogratius; Prentice, Andrew M.; Hill, Catherine M.; Kirkham, Fenella J.
Nocturnal enuresis is one of the most prevalent and distressing of all childhood problems. The treatment of nocturnal enuresis has shifted in the past few decades from a strictly psychopathological perspective to a biobehavioral perspective. Although the primary clinical features of this disorder are medical/organic, there is currently strong…
Friman, Patrick C.; Jones, Kevin M.
A total of 774 female undergraduates were administered a structured questionnaire and an anxiety scale. It was found that women do experience nocturnal orgasms during sleep. Differences were found according to year at school as well as a positive correlation between level of anxiety and sexual excitement. (MS)
Henton, Comradge L.
Restless legs syndrome was the first isolated clinical manifestation in four siblings of a family with familial amyloid polyneuropathy. Clinical and electrophysiological evidence of peripheral neuropathy appeared after a variable time interval. Polysomnography showed abnormal sleep patterns and nocturnal myoclonus in all patients. The restless legs syndrome responded favourably to clonazepam.
F Salvi; P Montagna; R Plasmati; G Rubboli; F Cirignotta; M Veilleux; E Lugaresi; C A Tassinari
We observed the 24-hour patterns of endocrine in medical students who lived either a diurnal life or nocturnal life. Nocturnal life was designed by skipping their breakfast but consuming much (>50% of their daily food intake) in the evening and at night with the sleep from 0130 h to 0830 h the next morning. After 3 weeks in the experimental life, the 24-hour plasma concentrations of melatonin, leptin, glucose and insulin were measured every three hours. Both plasma melatonin and leptin showed peaks at 0300 h in the diurnal lifestyle group, and the night peaks decreased in the nocturnal lifestyle group. The changes in the patterns of melatonin and leptin were highly consistent with that of night-eating syndrome (NES). Plasma glucose increased after all meals in both groups. Its concentration maintained a high level in the nocturnal lifestyle group between midnight and early morning while insulin secretion decreased markedly during this period. Furthermore, the strong association between glucose and insulin in the diurnal lifestyle group after meals was damaged in the nocturnal lifestyle group. It was suggested that nocturnal life leads to the impairment of insulin response to glucose. Taking these results together, nocturnal life is likely to be one of the risk factors to health of modern people, including NES, obesity and diabetes. PMID:12954455
Qin, Li-Qiang; Li, Jue; Wang, Yuan; Wang, Jing; Xu, Jia-Ying; Kaneko, Takashi
Nocturnal transpiration is an important source of water loss, accounting for up to 25% of daytime transpiration in some species. Nocturnal water losses cannot be explained under the prevailing 'paradigm' of optimizing carbon gain while minimizing water loss because carbon fixation does not occur at night. Alternative explanations regarding the function and potential evolutionary advantage of nocturnal transpiration have been proposed, such as enhanced nutrient uptake and transport or delivery of O2 to parenchyma cells for respiration. However, recent evidence suggests that the role of nocturnal transpiration in supplementing the overall plant nutrient budget is relatively small, and the O2 hypothesis is difficult to test experimentally. Here, we propose that the main function of nocturnal transpiration (and water transport) is to prevent catastrophic xylem failure by restoring depleted stem 'capacitors' and enhancing early morning CO2 uptake, as stomata 'prepare' for daytime conditions. Nocturnal sap flux was highest in Eucalyptus grandis trees in the field following a heat wave (reaching 47C with VPDs > 8kPa in the daytime) generating maximal daytime water losses compared with cooler and lower VPD periods, indicating the importance of nocturnal stomatal conductance for stem refilling. Moreover, we observed that the time for stomata to respond to light early in the morning (dawn) across 25 different genotypes of E. camaldulensis in a glasshouse was shortest in those genotypes with highest nocturnal stomatal conductance, which was also correlated with higher daytime photosynthesis. This observation is consistent with previous observations that nocturnal stomatal conductance is partially controlled by the clock, which is utilised to anticipate daytime conditions. Data from the literature suggests that eucalypts respond similarly to other C3 species, suggesting that mechanisms regulating night-time transpiration may be universal.
Pfautsch, Sebastian; Resco de Dios, Víctor; Loik, Michael; Tissue, David
Complaints of sleep disturbances are common among alcohol dependent patients during subacute abstinence. Recovered patients\\u000a may show persistent sleep abnormalities for months or even years. In the present study we studied the issue whether periodic\\u000a limb movements in sleep and disturbances of nocturnal respiration are more frequent in alcohol dependent patients than healthy\\u000a subjects and may be of predictive value
Horst Gann; Bernd Feige; Saeid Fasihi; Dietrich van Calker; Ulrich Voderholzer; Dieter Riemann
Objective This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption (e.g., depression and posttraumatic stress disorder (PTSD)). Method Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up
Jennie G. Noll; Penelope K. Trickett; Elizabeth J. Susman; Frank W. Putnam
Polysomnographic recordings and the Suggested Immobilization Test (SIT) are frequently used to support the clinical diagnosis of restless legs syndrome (RLS). The present study evaluated the discriminant power of 5 different parameters: (1) index of periodic leg movements during sleep (PLMS), (2) index of PLMS with an associated microarousal (PLMS-arousal), (3) index of PLM during nocturnal wakefulness (PLMW), (4) SIT
Martin Michaud; Jean Paquet; Gilles Lavigne; Alex Desautels; Jacques Montplaisir
We used hypnosis to facilitate eye closure during sleep for a 44-year-old woman whose nocturnal lagophthalmos prevented use of a contact lens following cataract surgery and could have resulted in severe corneal damage. On three separate occasions the symptoms remitted following a very brief course of treatment. We discuss the results in terms of alternate theories of hypnotic performance.
Jean Holroyd; Ezra Maguen
This study was performed on four simulated professional divers (31 ATA, PO2 = 0.4 bar, PN2 = 0.79 bar) to investigate the function of their sleep polygraphically. All-night electrographical recording of the subjects' sleep was taken from 23:00 until 07:00 the next morning, predive, saturation, decompression, and postdive from Nov. 20 to Dec. 13, 1985. Polygraphic analysis of nocturnal sleep was done by a microcomputer technique developed by us for comparison with visual scoring. This system is a real-time processing system. Therefore, a sleep chart is completed when the experiment is finished. This system was very useful for the analysis of the tremendous volume of sleep records during a nearly one-month experiment. The following results were obtained: In the predive control, total amount of stages (3 + 4) of NREM and REM sleep decreased. In the hyperbaric environment at 31 ATA, all the divers had to interrupt their sleep once or twice for nocturnal sleep urination, and also total waking time increased during nocturnal sleep. At 31 ATA, the length and the cycle of the sleep profile vacillated. A high degree of correlation was observed between the sleep profile recorded by the polygraph and the subjective appreciation of sleep. PMID:3764220
Matsuoka, S; Inoue, K; Okuda, S; Ishikawa, T; Lee, H D; Mouri, M
Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular morbidity as well as excessive daytime sleepiness and poor quality of life. In this study, we apply a machine learning technique [support vector machines (SVMs)] for automated recognition of OSAS types from their nocturnal ECG recordings. A total of 125 sets of nocturnal ECG recordings acquired from normal subjects (OSAS- )
Ahsan H. Khandoker; Marimuthu Palaniswami; Chandan K. Karmakar
Background Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance. Methods We examined the prevalence of nocturia and examined its role in self-reported insomnia and poor sleep quality in a survey of 1,424 elderly individuals, ages 55–84. Data were derived from a 2003 National Sleep Foundation telephone poll conducted in a representative sample of the United States population who underwent a 20-minute structured telephone interview. Nocturia was not a focus of the survey, but data collected relevant to this topic allowed examination of relevant associations with sleep. Results When inquired about in a checklist format, nocturia was listed as a self-perceived cause of nocturnal sleep “every night or almost every night” by 53% of the sample, which was over four times as frequently as the next most often cited cause of poor sleep, pain (12%). In multivariate logistic models, nocturia was an independent predictor both of self-reported insomnia (75% increased risk) and reduced sleep quality (71% increased risk), along with female gender and other medical and psychiatric conditions. Conclusions Nocturia is a frequently overlooked cause of poor sleep in the elderly and may warrant targeted interventions.
Bliwise, Donald L.; Foley, Daniel J.; Vitiello, Michael V.; Ansari, Farzaneh Pour; Ancoli-Israel, Sonia; Walsh, James K.
The need for optimal nocturnal performance continues to increase in our society. Nighttime function is dependent upon the ability to sleep effectively during the day. The current study examined daytime sleep after placebo, 0.125 mg (364 nmol), 0.25 mg (729 nmol), or 0.50 mg (1458 nmol) of triazolam, and nocturnal performance in the work shift that followed. Forty-one normal young adult subjects participated in a repeated-measures design in which each subject received each medication dose level in a separate week. The results indicated that day sleep increased as a linear function of drug dose from 234 to 374 minutes. Nocturnal alertness, as measured by subjective report and objective nap latency test, increased significantly following the use of triazolam, 0.25 and 0.50 mg, for the day sleep period. Nocturnal performance, as measured by auditory vigilance and additions, also increased significantly following the use of triazolam. Marginal evidence for medication hangover was found at the 0.50-mg dose, and it was therefore recommended that the use of the 0.50-mg dose be monitored carefully if performance demand were to follow medication use by less than 12 hours. The results for the study were interpreted as indicating that under certain conditions, triazolam could effectively increase daytime sleep and improve alertness and performance in the following nocturnal work period. PMID:3251503
Bonnet, M H; Dexter, J R; Gillin, J C; James, S P; Kripke, D; Mendelson, W; Mitler, M
Nocturnal radiation reversal is essentially an unsteady, advective effect. It requires that clouds or fog drift over a previously cooled surface. In the case of higher clouds, reversal can occur only with a sufficiently intense surface temperature inversi...
R. H. Clarke
Who doesn't love a good night's sleep? The Division of Sleep Medicine at Harvard and WGBH have collaborated to produce the Healthy Sleep website to help "illuminate the relevance of sleep, explain the underlying science of sleep, and, most importantly, provide practical information for getting the sleep you need." Visitors interested in getting the sleep they need will find the many videos and interactive features here well worth their time. Under the "Why Sleep Matters" link, visitors will find an interactive timeline entitled "Historical and Cultural Perspectives of Sleep". The "Consequences of Insufficient Sleep" gives visitors the choice of several short videos to watch, including those that address the consequences of driving while drowsy, the link between disease risk and poor sleep, and the public safety and performance issues that arise due to insufficient sleep. The "Getting the Sleep You Need" link has many tips for visitors on how to approach poor sleep habits, including when to seek treatment.
Sleep disturbances are common in infants and children. Sleep disturbances in children not only disrupt the child and family but also impact parental and child well-being, daytime functioning, and behavior. Pediatric nurses care for the individual child as well as their family members. Understanding the importance of healthy sleep habits and the implications of inadequate sleep on child behavior and family-peer interactions provides nurses an opportunity to decrease family stress and increase positive coping, adaptation, and family function. Common types of sleep problems are presented, and recommendations for screening tools are included to help nurses better assess sleep problems in children and make appropriate referrals. PMID:17645956
Ward, Teresa M; Rankin, Sally; Lee, Kathryn A
Sleep difficulties are frequent among stroke patients. Sleep and stroke can be related in several ways: sleep disturbances such as insomnia and hypersomnia can be triggered by stroke; sleep-related breathing disorders such as snoring and sleep apnea are well-recognized risk factors of ischemic stroke; finally, sleep disorders can be aggravated by stroke. Sleep problems are associated with all stroke types and worsened stroke outcome. Post-stroke sleep disturbances may be a direct consequence of lesions caused by stroke or may be secondary to pain, disability and mood disorders due to stroke. Clinicians need to thoroughly investigate for the presence of sleep disorders in rehabilitating stroke patients. PMID:22377859
The effect of sleep on learning was investigated, comparing results of memorizing and reproduction of an unknown text before and after subsequent sleep, with a detailed analysis of sleep patterns. Psychological tests excluded the possibility of emotional and stress factors. Presleep learning did not influence mean values of such sleep parameters as total sleep time or duration of different sleep stages. The main finding ot the present experiment was a redistribution of stage REM during nocturnal sleep following learning--its increase in the second sleep cycle with a corresponding decrease toward the end of night. Also, individual difficulties in learning were inversely related to REM latency. Changes in sleep patterns after learning didn't influence the total number of sleep cycles. It is suggested that the REM phase of sleep might be involved in the processing of information acquired during wakefulness. PMID:2169146
Arons, E K
The increasing prevalence of obesity has lead to an increase in the prevalence of sleep disordered breathing in the general population. The disproportionate structural characteristics of the pharyngeal airway and the diminished neural regulation of the pharyngeal dilating muscles during sleep predispose the obese patients to pharyngeal airway collapsibility. A subgroup of obese apneic patients is unable to compensate for the added load of obesity on the respiratory system, with resultant daytime hypercapnia. Weight loss using dietary modification and life style changes is the safest approach to reducing the severity of sleep apnea, but its efficacy is limited on the long run. Although it has inherent risks, bariatric surgery provides the most immediate result in alleviating sleep apnea. Obesity has been linked also to narcolepsy. The loss of neuropeptides co-localized in hypocretin neurons is suggested as the potential mechanism. Poor sleep quality, which leads to overall sleep loss and excessive daytime sleepiness has also become a frequent complaint in this population. Identifying abnormal nocturnal eating is critically important for patient care. Both sleep related eating disorder and night eating syndrome are treatable and represent potentially reversible forms of obesity. PMID:22385877
Akinnusi, Morohunfolu E; Saliba, Ranime; Porhomayon, Jahan; El-Solh, Ali A
Background Disturbed sleep and nocturnal altered breathing are related to disturbances of glucose metabolism. The present uncontrolled observational study explores the role of these factors on the variability of fasting glycemia. Methods The number and duration of nocturnal awakenings and the fasting glycemia of 97 patients with type 2 diabetes treated with diet, metformin, or gliptins were recorded over seven consecutive days. During the same time period, the main respiratory indexes—oxygen disturbance index, apnea/hypopnea index, and respiratory disturbance index—were recorded for one night. Results The three respiratory indexes and the number of nocturnal awakenings are highly correlated with the coefficient of variation of the fasting blood glucose recorded over the 7-day period at p <.005 level. A multiple regression analysis showed that the variables in the model explained 86% of the variability. Results Respiratory/sleep disturbances appear to be modulators superimposed on blood glucose levels determined by other factors.
Tatti, Patrizio; Strollo, Felice; Passali, Desiderio
The present research presents data relative to the objective evaluation of the effects of a specific complex auditory stimulus presented during sleep. The auditory stimulus was a jet aircraft flyover of approximately 20-sec duration and a peak intensity level of approximately 80 dB (A). Our specific interests were in terms of how this stimulus would interact with the frequency pattern of the sleeping EEG and whether there would be any carry-over effects of the nocturnally presented stimuli to the waking state. The results indicated that the physiological effects (changes in electroencephalographic activity) produced by the jet aircraft stimuli outlasted the physical presence of the auditory stimuli by a considerable degree. Further, it was possible to note both behavioral and electroencephalographic changes during waking performances subsequent to nights disturbed by the jet aircraft flyovers which were not apparent during performances subsequent to undisturbed nights.
Levere, T. E.; Bartus, R. T.; Hart, F. D.
Shiftwork is associated with adverse metabolic pathophysiology, and the rising incidence of shiftwork in modern societies is thought to contribute to the worldwide increase in obesity and metabolic syndrome. The underlying mechanisms are largely unknown, but may involve direct physiological effects of nocturnal light exposure, or indirect consequences of perturbed endogenous circadian clocks. This study employs a two-week paradigm in mice to model the early molecular and physiological effects of shiftwork. Two weeks of timed sleep restriction has moderate effects on diurnal activity patterns, feeding behavior, and clock gene regulation in the circadian pacemaker of the suprachiasmatic nucleus. In contrast, microarray analyses reveal global disruption of diurnal liver transcriptome rhythms, enriched for pathways involved in glucose and lipid metabolism and correlating with first indications of altered metabolism. Although altered food timing itself is not sufficient to provoke these effects, stabilizing peripheral clocks by timed food access can restore molecular rhythms and metabolic function under sleep restriction conditions. This study suggests that peripheral circadian desynchrony marks an early event in the metabolic disruption associated with chronic shiftwork. Thus, strengthening the peripheral circadian system by minimizing food intake during night shifts may counteract the adverse physiological consequences frequently observed in human shift workers. PMID:22629359
Barclay, Johanna L; Husse, Jana; Bode, Brid; Naujokat, Nadine; Meyer-Kovac, Judit; Schmid, Sebastian M; Lehnert, Hendrik; Oster, Henrik
Previous studies have found beneficial effects of aromatherapy massage for agitation in people with dementia, for pain relief and for poor sleep. Children with autism often have sleep difficulties, and it was thought that aromatherapy massage might enable more rapid sleep onset, less sleep disruption and longer sleep duration. Twelve children with autism and learning difficulties (2 girls and 10
Tim I. Williams
Objective To determine if sleep talkers with REM sleep behavior disorder (RBD) would utter during REM sleep sentences learned before sleep, and to evaluate their verbal memory consolidation during sleep. Methods Eighteen patients with RBD and 10 controls performed two verbal memory tasks (16 words from the Free and Cued Selective Reminding Test and a 220-263 word long modified Story Recall Test) in the evening, followed by nocturnal video-polysomnography and morning recall (night-time consolidation). In 9 patients with RBD, daytime consolidation (morning learning/recall, evening recall) was also evaluated with the modified Story Recall Test in a cross-over order. Two RBD patients with dementia were studied separately. Sleep talking was recorded using video-polysomnography, and the utterances were compared to the studied texts by two external judges. Results Sleep-related verbal memory consolidation was maintained in patients with RBD (+24±36% words) as in controls (+9±18%, p=0.3). The two demented patients with RBD also exhibited excellent nighttime consolidation. The post-sleep performance was unrelated to the sleep measures (including continuity, stages, fragmentation and apnea-hypopnea index). Daytime consolidation (-9±19%) was worse than night-time consolidation (+29±45%, p=0.03) in the subgroup of 9 patients with RBD. Eleven patients with RBD spoke during REM sleep and pronounced a median of 20 words, which represented 0.0003% of sleep with spoken language. A single patient uttered a sentence that was judged to be semantically (but not literally) related to the text learned before sleep. Conclusion Verbal declarative memory normally consolidates during sleep in patients with RBD. The incorporation of learned material within REM sleep-associated sleep talking in one patient (unbeknownst to himself) at the semantic level suggests a replay at a highly cognitive creative level.
Uguccioni, Ginevra; Pallanca, Olivier; Golmard, Jean-Louis; Dodet, Pauline; Herlin, Bastien; Leu-Semenescu, Smaranda; Arnulf, Isabelle
In children with nocturnal enuresis, a higher rate of minor neurological dysfunction has been found. The aim of this study was to assess timed performance (a measure of motor performance speed) and associated movements using a standardized and reliable instrument. The motor function of 37 children with nocturnal enuresis (27 males, 10 females; mean age 10y 7mo [SD 1y 10mo]; age range 8y-14y 8mo) and 40 comparison children without enuresis (17 males, 23 females; mean age 10y 7mo [SD 1y 6mo]; age range 8y-14y 8mo) was assessed using the Zurich Neuromotor Assessment. Children with nocturnal enuresis showed a slower motor performance than comparison children, particularly for repetitive hand and finger movements. This study provides evidence for a maturational deficit in motor performance in children with nocturnal enuresis. In addition to a maturational deficit of the brainstem, it is proposed that there is a possible maturational deficit of the motor cortex circuitry and related cortical areas in children with nocturnal enuresis. PMID:16904021
von Gontard, Alexander; Freitag, Christine M; Seifen, Stephanie; Pukrop, Ralf; Röhling, Dagmar
The article reports a multimodal treatment of nocturnal enuresis and anxious behavior in a mildly mentally retarded woman. Behavioral treatment and removal of caffeine from the subject's diet eliminated both nocturnal enuresis and anxious behavior. (Author/DB)
Mohr, Caroline; Sharpley, Christopher F.
Obesity is increasing worldwide and it is accompanied by major health effects. In adults and school-aged children, obesity is associated with decreased respiratory function, which may lead to disturbed sleeping and subsequently difficulties in concentration and behavioural disorders. The evidence for the association between obesity and decreased respiratory function in younger children is scarce. To explore the association between body weight and nocturnal respiratory function in young children, 1 to 3 years old, nocturnal pulse oximetry was performed at home. Children with tonsillar hypertrophy were excluded. Percentage of time with oxygen saturation (SpO(2)) <95 % was measured and its association with body mass index (BMI) for age z scores was analysed. Pulse oximetric data of 51 children, including 18 children with a BMI for age above +2 standard deviations, were obtained for this study. Linear regression analysis, correction for gender and parental smoking, showed a positive association between the natural logarithm of SpO(2) <95 % and BMI for age z score [regression coefficient (?) 0.19, 95 % confidence interval 0.00-0.39]. Conclusion: In young children, higher body weight is associated with a decrease in nocturnal oxygen saturation. PMID:22875313
Korndewal, Marjolein J; Geurts van Kessel, Willem M H; Jak, Lia G; Uiterwaal, Cuno S P M; Rövekamp, Mechelien H; van der Ent, Cornelis K
A substantial body of literature supports the intuitive notion that a good night’s sleep can facilitate human cognitive performance the next day. Deficits in attention, learning & memory, emotional reactivity, and higher-order cognitive processes, such as executive function and decision making, have all been documented following sleep disruption in humans. Thus, whilst numerous clinical and experimental studies link human sleep disturbance to cognitive deficits, attempts to develop valid and reliable rodent models of these phenomena are fewer, and relatively more recent. This review focuses primarily on the cognitive impairments produced by sleep disruption in rodent models of several human patterns of sleep loss/sleep disturbance. Though not an exclusive list, this review will focus on four specific types of sleep disturbance: total sleep deprivation, experimental sleep fragmentation, selective REM sleep deprivation, and chronic sleep restriction. The use of rodent models can provide greater opportunities to understand the neurobiological changes underlying sleep loss induced cognitive impairments. Thus, this review concludes with a description of recent neurobiological findings concerning the neuroplastic changes and putative brain mechanisms that may underlie the cognitive deficits produced by sleep disturbances.
McCoy, John G.; Strecker, Robert E.
BACKGROUND--Nocturnal airway narrowing is a common problem for patients with asthma but the role of inflammation in its pathogenesis is unclear. Overnight changes in airway inflammatory cell populations were studied in patients with nocturnal asthma and in control normal subjects. METHODS--Bronchoscopies were performed at 0400 hours and 1600 hours in eight healthy subjects and in 10 patients with nocturnal asthma
T W Mackay; W A Wallace; S E Howie; P H Brown; A P Greening; M K Church; N J Douglas
This review attempts to assemble the characteristics of a distinct variant of sleepwalking called sexsomnia/sleepsex from the seemingly scarce literature into a coherent theoretical framework. Common features of sexsomnia include sexual arousal with autonomic activation (e.g. nocturnal erection, vaginal lubrication, nocturnal emission, dream orgasms). Somnambulistic sexual behavior and its clinical implications, the role of precipitating factors, diagnostic, treatment, and medico-legal issues are also reviewed. The characteristics of several individuals described in literature including their family/personal history of parasomnia as well as the abnormal behaviors occurring during sleep are reported. PMID:17706786
Andersen, Monica L; Poyares, Dalva; Alves, Rosana S C; Skomro, Robert; Tufik, Sergio
Current evidence indicates that chronically disrupted sleep in children and adolescents can lead to problems in cognitive functioning. Behavioral interventions for pediatric sleep problems (e.g., graduated extinction, parent education, positive bedtime routines), especially in young children, have been shown to produce clinically significant improvements. This review describes a few pertinent conditions of sleep disorders in children and adolescents as well as provides clinically useful approaches to sleep complaints and both pharmacologic and nonpharmacological treatments of some common pediatric sleep disorders.
Study Objectives: Nocturnal cardiovascular events are more frequent at the beginning and end of the night. It was proposed that this pattern reflects the nocturnal distribution of sleep and sleep stages. Using heart rate variability (HRV), we recently showed an interaction between the circadian system and vigilance states on the regulation of cardiac rhythmicity. Here, we further investigate this interaction in order to clarify the specific effects of sleep stages on the regulation of the heart. Design: Participants underwent a 72-h ultradian sleep-wake cycle procedure in time isolation consisting of alternating 60-min wake episodes in dim light and 60-min nap opportunities in total darkness. Setting: Time isolation suite. Patients or participants: Fifteen healthy young participants; two were subsequently excluded. Interventions: N/A. Measurements and Results: The current study revealed that sleep onset and progression to deeper sleep stages was associated with a shift toward greater parasympathetic modulation, whereas rapid eye movement (REM) sleep was associated with a shift toward greater sympathetic modulation. We found a circadian rhythm of heart rate (HR) and high-frequency power during wakefulness and all non-REM sleep stages. A significant circadian rhythm of HR and sympathovagal balance of the heart was also observed during REM sleep. During slow wave sleep, maximal parasympathetic modulation was observed at ?02:00, whereas during REM sleep, maximal sympathetic modulation occurred in the early morning. Conclusion: The circadian and sleep stage-specific effects on heart rate variability are clinically relevant and contribute to the understanding of the degree of cardiovascular vulnerability during sleep. Citation: Boudreau P; Yeh WH; Dumont GA; Boivin DB. Circadian variation of heart rate variability across sleep stages. SLEEP 2013;36(12):1919-1928.
Boudreau, Philippe; Yeh, Wei-Hsien; Dumont, Guy A.; Boivin, Diane B.
Complaints about disturbed sleep or increased daytime sleepiness are among the most frequent symptoms reported to psychiatrists by patients. Such complaints can be symptoms of an underlying psychiatric disorder or indicative of a separate or comorbid sleep disorder. Hence, basic knowledge in the differential diagnosis of sleep medicine pathologies is pivotal for psychiatrists and psychotherapists. In the present overview following a description of the diagnostic methods, the diagnostic work-up according to the major symptomatic clusters, namely disturbances in initiating and maintaining sleep, abnormal nocturnal movements and excessive daytime sleepiness will be presented. PMID:24356713
Pollmächer, T; Wetter, T C; Happe, S; Richter, K; Acker, J; Riemann, D
Introduction Nocturnal enuresis has been found a common symptom among children with breathing problems and sleep apnea. The purpose of this study was to evaluate the therapeutic and placebo effects of slow maxillary expansion on nocturnal enuresis. Material and methods Four children with enuresis aged 7–12 years were selected. Rigid acrylic expansion appliances were fabricated and delivered to them. Frequency of enuresis was recorded by the parents during three stages: 1) before appliance delivery; 2) after appliance insertion without expansion; and 3) during expansion and retention. Results The frequency of wetting decreased significantly during the period of appliance use without expansion. During the expansion and retention phase, two patients became completely dry, and two patients improved significantly. Conclusions Maxillary expansion can have a positive effect on the treatment of nocturnal enuresis. Also, the placebo effect of the expansion appliance has significant effects on enuresis.
Oshagh, Morteza; Aminsharifi, Ali Reza; Fallahzadeh, Mohammad Hossein; Ghodrati, Parisa
Sleep is often reported to be of poor quality in microgravity, and studies on the ground have shown a strong relationship between sleep-disordered breathing and sleep disruption. During the 16-day Neurolab mission, we studied the influence of possible changes in respiratory function on sleep by performing comprehensive sleep recordings on the payload crew on four nights during the mission. In addition, we measured the changes in the ventilatory response to low oxygen and high carbon dioxide in the same subjects during the day, hypothesizing that changes in ventilatory control might affect respiration during sleep. Microgravity caused a large reduction in the ventilatory response to reduced oxygen. This is likely the result of an increase in blood pressure at the peripheral chemoreceptors in the neck that occurs when the normally present hydrostatic pressure gradient between the heart and upper body is abolished. This reduction was similar to that seen when the subjects were placed acutely in the supine position in one-G. In sharp contrast to low oxygen, the ventilatory response to elevated carbon dioxide was unaltered by microgravity or the supine position. Because of the similarities of the findings in microgravity and the supine position, it is unlikely that changes in ventilatory control alter respiration during sleep in microgravity. During sleep on the ground, there were a small number of apneas (cessation of breathing) and hypopneas (reduced breathing) in these normal subjects. During sleep in microgravity, there was a reduction in the number of apneas and hypopneas per hour compared to preflight. Obstructive apneas virtually disappeared in microgravity, suggesting that the removal of gravity prevents the collapse of upper airways during sleep. Arousals from sleep were reduced in microgravity compared to preflight, and virtually all of this reduction was as a result of a reduction in the number of arousals from apneas and hypopneas. We conclude that any sleep disruption in microgravity is not the result of respiratory factors.
West, John B.; Elliott, Ann R.; Prisk, G. Kim; Paiva, Manuel
Background Breast cancer incidence is increasing globally for largely unknown reasons. The possibility that a portion of the breast cancer burden might be explained by the introduction and increasing use of electricity to light the night was suggested >20 years ago. Methods The theory is based on nocturnal light-induced disruption of circadian rhythms, notably reduction of melatonin synthesis. It has formed the basis for a series of predictions including that non-day shift work would increase risk, blind women would be at lower risk, long sleep duration would lower risk and community nighttime light level would co-distribute with breast cancer incidence on the population level. Results Accumulation of epidemiological evidence has accelerated in recent years, reflected in an International Agency for Research on Cancer (IARC) classification of shift work as a probable human carcinogen (2A). There is also a strong rodent model in support of the light-at-night (LAN) idea. Conclusion If a consensus eventually emerges that LAN does increase risk, then the mechanisms for the effect are important to elucidate for intervention and mitigation. The basic understanding of phototransduction for the circadian system, and of the molecular genetics of circadian rhythm generation are both advancing rapidly, and will provide for the development of lighting technologies at home and at work that minimize circadian disruption, while maintaining visual efficiency and aesthetics. In the interim, there are strategies now available to reduce the potential for circadian disruption, which include extending the daily dark period, appreciate nocturnal awakening in the dark, using dim red light for nighttime necessities, and unless recommended by a physician, not taking melatonin tablets.
Stevens, Richard G
Study Objectives: To determine the frequency of nocturnal eating (NE) and sleep related eating disorder (SRED) in restless legs syndrome (RLS) versus psychophysiological insomnia (INS), and the relationship of these conditions with dopaminergic and sedative-hypnotic medications. Design: Prospective case series. Setting: Sleep disorders center. Patients: Newly diagnosed RLS or INS. Intervention: RLS or INS pharmacotherapy with systematic follow up interview for NE/SRED. Measurements and Results: Patients presenting with RLS (n = 88) or INS (n = 42) were queried for the presence of NE and SRED. RLS patients described nocturnal eating (61%) and SRED (36%) more frequently than INS patients (12% and 0%; both p < 0.0001). These findings were not due to arousal frequency, as INS patients were more likely to have prolonged nightly awakenings (93%) than RLS patients (64%; p = 0.003). Among patients on sedative-hypnotics, amnestic SRED and sleepwalking were more common in the setting of RLS (80%) than INS (8%; p < 0.0001). Further, NE and SRED in RLS were not secondary to dopaminergic therapy, as RLS patients demonstrated a substantial drop (68% to 34%; p = 0.0026) in the frequency of NE after dopamine agents were initiated, and there were no cases of dopaminergic agents inducing novel NE or SRED. Conclusion: NE is common in RLS and not due to frequent nocturnal awakenings or dopaminergic agents. Amnestic SRED occurs predominantly in the setting of RLS mistreatment with sedating agents. In light of previous reports, these findings suggest that nocturnal eating is a non-motor manifestation of RLS with several clinical implications discussed here. Citation: Howell MJ; Schenck CH. Restless nocturnal eating: a common feature of Willis-Ekbom Syndrome (RLS). J Clin Sleep Med 2012;8(4):413-419.
Howell, Michael J.; Schenck, Carlos H.
Complete or partial collapse of the upper airway during sleep has different effects on the human body ranging from noisy breathing (snoring) to significant cardiovascular sequelae as seen in obstructive sleep apnea (OSA). Snoring is very common in the adult population and has been associated with morbidity in epidemiological studies. A variety of treatments may be used for primary snoring (snoring without symptoms) but none are universally successful. The upper airway resistance syndrome is thought to occur when incomplete obstruction of the upper airway results in frequent disruptions in sleep. Whether it is a true "syndrome" or just one end of the continuum of OSA is unclear. Obstructive sleep apnea causes not only sleep disruption but oxygen desaturation. It has been associated with numerous cardiovascular sequelae, including hypertension (systemic and pulmonary), arrhythmias, and stroke. Nasal continuous positive airway pressure (CPAP) is the current treatment of choice, with lesser alternatives including oral appliances, surgery, and weight loss. Further study on outcomes is required to determine how aggressively to treat these syndromes. PMID:16052414
Collop, Nancy A
Administered the Imaginal Processes Inventory (IPI) to 55 male undergraduates, and asked them to record their nocturnal dreams in a diary. The dreams of Ss selected as representing extremely different styles of waking fantasy according to the IPI were analyzed with regard to bizarreness, emotionality, emotional polarity, and variety of content. Significant differences in the dream structure were found among
METHOD The locality chosen was a climax beech-sugar maple-wood frog association in northern Indiana. The authors were familiar with the forest in both the nocturnal and diurnal phase, the area having been studied irregularly since 1927. Preliminary details were arranged in the afternoon before regular class work had started. In this work white paint, strips of white cloth or paper
Simple sleep-related movement disorders must be distinguished from daytime movement disorders that persist during sleep, sleep-related epilepsy, and parasomnias, which are generally characterized by activity that appears to be simultaneously complex, goal-directed, and purposeful but is outside the conscious awareness of the patient and, therefore, inappropriate. Once it is determined that the patient has a simple sleep-related movement disorder, the part of the body affected by the movement and the age of the patient give clues as to which sleep-related movement disorder is present. In some cases, all-night polysomnography with accompanying video may be necessary to make the diagnosis. Hypnic jerks (ie, sleep starts), bruxism, rhythmic movement disorder (ie, head banging/body rocking), and nocturnal leg cramps are discussed in addition to less well-appreciated disorders such as benign sleep myoclonus of infancy, excessive fragmentary myoclonus, and hypnagogic foot tremor/alternating leg muscle activation. PMID:17426241
Walters, Arthur S
BACKGROUND: Negative pressure ventilation provides intermittent non-invasive ventilatory assistance for patients with advanced chronic obstructive lung disease. Upper airway obstruction during sleep, a reported complication of the technique, may, however, limit its clinical applicability. METHODS: The effects of nocturnal negative pressure ventilation on ventilation and on indices of sleep quality were investigated in five patients with severe chronic obstructive lung
R D Levy; M G Cosio; L Gibbons; P T Macklem; J G Martin
BACKGROUND: Inpatients with restrictive thoracic disease, little is known about changes in sleep and breathing if the patient stops using nocturnal noninvasive ventilation (NIV). Better understanding of those changes may affect NIV management and improve our understanding of the relationship of night-to-night variability of respiratory and sleep variables and morning gas exchange. METHODS: With 6 stable patients with restrictive chronic
Thierry Petitjean; Francois Philit; Michele Germain-Pastenne; Bruno Langevin; Claude Guerin
Objective: To review our experience with home nasal continuous positive airway pressure (CPAP) in infants with small upper airways and abnormal breathing during sleep. Study design: Seventy-four infants with sleep-disordered breathing and narrow upper airways, as identified by nocturnal polygraphic recording and endoscopic evaluation, were treated at home with nasal CPAP. Infants with craniofacial anomalies and trisomy 21, and infants
Christian Guilleminault; Rafael Pelayo; Alex Clerk; Damien Leger; Robert C. Bocian
It has been described a neuro developmental disorder labelled "Benign nocturnal alternating hemiplegia of childhood" (BNAHC) characterized by recurrent attacks of nocturnal hemiplegia without progression to neurological or intellectual impairment. We report a female patient who at 11months revealed a motionless left arm, unusual crying without impairment of consciousness and obvious precipitating factors. The attacks occur during sleep in the early morning with lack of ictal and interictal electroencephalographic abnormalities, progressive neurological deficit, and cognitive impairment. Unlike previous reports of BNAHC our patient come from a family with a history of both migraine, hemiplegic migraine, and sleep disorders. Our study remarks on the typical features described in previous studies and stresses the uncommon aspects that could help to identify the disorder which is likely to have been underestimated. Despite some clinical similarities between BNAHC and familiar hemiplegic migraine and alternating hemiplegia of childhood, the genetic analyses of our patient did not reveal genetic mutations found in both disorders. PMID:23820111
Mangano, Salvatore; Fontana, Antonina; Spitaleri, Chiara; Mangano, Giuseppa Renata
Objectives To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease. Methods After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned. Results MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P<0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis. Conclusions The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.
Ozkan, Secil; Durukan, Elif; Iseri, Elvan; Gurocak, Serhat; Maral, Isil; Ali Bumin, M.
Several epidemiological surveys performed in Western Europe reported a prevalence of insomnia symptoms between 20% and 40% of the general population. Women and elderly individuals were the most affected. Many events can occur during sleep and affect its quality. Daytime sleepiness, a consequence of lack of sleep and/or insomnia, is responsible for many road, work and domestic accidents. Therefore, insomnia may have important consequences both for individuals and society. This study performed in the non institutionalized French population reports the sleep habits of that population and the factors associated with insomnia. This epidemiological study was conducted with 5,622 subjects representative of the French general population. They were aged between 15 and 96 Years. The participation rate was 80.8%. The results showed that men and women have different sleep habits. Generally speaking, women went to bed about 12 minutes earlier than men and woke up later than men (p<0.001). Women also took more time to fall asleep than men but only when they were aged between 35 and 65 Years. Furthermore, women had a longer sleep than men except between the ages of 55 and 74, where men slept significantly more than women. However, sleep efficiency was lower in women than in men who were over age 35. This was due to a greater frequency of nocturnal awakenings in women than in men. Sleep habits also changed with age: Bedtime became progressively earlier with advancing age and wake-up time was later when the subjects reached retirement age. Sleep latency progressively increased with age after 35. Similarly, disrupted sleep increased with age and was reported by more than half of subjects 75 years or older. We found also that evening or night workers showed irregularities in their sleep patterns: sleep latency was significantly longer - at least 12 minutes - compared to daytime and shift workers (p<0.001). They also had a shorter sleep duration of about 30 minutes compared to shift workers, and 40 minutes compared to daytime workers (p<0.001). Shift workers and evening or night workers had a lower sleep efficiency compared to daytime workers. Finally, in regions with greater density population (>100,000 inhabitants) sleep duration was shorter by approximately 10 minutes compared to localities with fewer than 5,000 residents (p<0.01). Similarly, bedtime and wake up hours were more related in regions with more than 100,000 inhabitants compared to small localities (fewer than 5,000 residents). Insomnia complaints, defined as the presence of at least one insomnia symptom accompanied by sleep dissatisfaction or use of a sleep medication, were reported by 18.6% of the sample. The prevalence was higher in women (22.4%) than in men (14.5%) and increased with age. However, the proportion of subjects dissatisfied with their sleep remained comparable for all age groups; it was the number of subjects using a sleep medication that increased with age. This was 3.2% in subjects 44 years or younger, 13.3% in subjects between 45 and 64 years, 22% of those between 65 and 74 years and almost a third of individuals 75 Years or older (32%; p<0.001). However, insomnia symptoms remained present for most of these consumers: 80.4% of those between 15 and 44 years, 87.9% of those between 45 and 64 Years, 81.4% of those between 65 and 74 years and 78.8% of subjects of 75 years or older. Compared to subjects in other epidemiological studies undertaken in England, Germany and Italy and using the same methodology, subjects in this study complained with their sleep more often. Insufficient sleep was found more often in the active population, which is subject to schedule constraints. Shift workers as well as evening or night workers were the most likely to have a sleep debt. PMID:15107715
Ohayon, M M; Lemoine, P
SummaryQuestion of the study Sleep loss and weight gain are assumed to be positively correlated, probably mediated by a decreased leptin secretion and\\/or an increased production of ghrelin. The present study measured evening and nocturnal serum leptin secretion in patients with chronic primary insomnia and healthy controls.Methods Eleven healthy controls (9 females, 2 males) and 11 patients suffering from primary insomnia (matched
Dieter Riemann; Ivonne Burgos; Linda Richter; Torsten Klein; Bernd Fiebich; Bernd Feige; Tobias Freyer; Klaus Lieb; Ulrich Voderholzer
Objective To explore whether standardized survey instruments and objective performance measures differentiate traditional constructs of sleepiness and fatigue among a sample of postpartum mothers. Additionally, we wanted to explore the independent associations among these measures with actigraphically measured nocturnal sleep variables. Method Seventy-nine postpartum mothers’ subjective sleepiness, fatigue, and performance measures (Stanford Sleepiness Scale [SSS], Epworth Sleepiness Scale [ESS], Visual Analogue of Fatigue Scale [VAS], Profile of Mood States [POMS] subscale items, and the Psychomotor Vigilance Test [PVT]) and objective actigraphically measured sleep were collected during postpartum week 11. A Principal Components Analysis was calculated, then regressions were calculated among resulting factors and among individual measures with total sleep time and sleep efficiency. Results Three factors accounted for 83.84% of model variance. Factor 1 (41.41%) included the SSS, ESS, and the VAS. Factor 2 (28.13%) included only PVT variables. Factor 3 (14.30%) included the two POMS subscale items. Factor 1 was associated with nocturnal sleep time and Factor 2 was associated with sleep efficiency. The ESS was independently associated with nocturnal sleep time, whereas, POMS-Vigor subscale and median reaction time, together, were associated with sleep efficiency. Conclusion Among postpartum mothers, standard instruments used to measure sleepiness, fatigue, and performance were distributed among three distinct factors that did not clearly identify traditional sleepiness and fatigue constructs. Objectively measured sleep time and sleep efficiency were associated with specific factors, as well as specific measures, that correspond to sleepiness and fatigue states.
Insana, Salvatore P.; Montgomery-Downs, Hawley E.
Zolpidem is a hypnotic drug used in sleep disorders. It binds selectively to alpha 1 subunit of the GABA A benzodiazepine receptor. Zolpidem reduces sleep latency, number of arousals and increases the total time of sleep. However, it is considered that it may increase phase 3 of non rapid eye movement sleep, where somnambulism can take place. Our aim is to report 8 cases of sleep related eating disorders associated with the use of this drug. We have evaluated the medical history of 8 patients who had received zolpidem for sleeping disorders and who have presented sleep related eating disorders. Eight patients (6 women, 2 men) aged between 32 to 72 years old, which received 10 mg of zolpidem/night except 1 that received 12.5 mg, were presented. They have referred strange eating behavior compatible to sleep related eating disorder. Symptoms appeared at a mean of 39.8 days after starting the medication. The numbers of nocturnal episodes recorded by the family or by the patient were 1 to 8 episodes of nocturnal eating per night. The morning after, patients found leftovers from the night before which they did not recall to have eaten. The remission was complete after discontinuing zolpidem. Zolpidem may induce sleep related eating disorder in about 1% of patients, although we consider there may be a subdiagnosis of this phenomenon. It will be important to bear in mind and look for this side effect because all the episodes could easily be controlled by withdrawing the drug. PMID:20529770
Valiensi, Stella Maris; Cristiano, Edgardo; Martínez, Oscar A; Reisin, Ricardo C; Alvarez, Florencia
Background: The cause of nocturnal awakenings in patients with chronic insomnia is rarely researched. This study prospectively assessed the etiology of nocturnal awakenings (subjectively and objectively) among patients with insomnia at a private, community-based sleep medical center. Methods: Twenty adult patients with chronic insomnia enrolled between April 2008 and February 2010 met diagnostic criteria for an insomnia disorder, never previously visited a sleep specialist or underwent sleep testing, and reported no classic sleep disordered breathing symptoms. Patients completed validated scales for insomnia, sleepiness, impairment, anxiety, depression, and quality of life, a qualitative interview to assess subjective reasons for awakenings, and a diagnostic sleep study to objectively assess awakenings and their precipitants. Results: Subjective and objective data showed clinically meaningful insomnia, primarily sleep maintenance insomnia. The most common self-reported reasons for awakenings were: uncertain cause (50%), nightmares (45%), nocturia (35%), bedroom distractions (20%), or pain (15%). No patient identified breathing symptoms as a cause. Objectively, 531 awakenings were observed in the total sample, and 478 (90%) were preceded by sleep breathing events (apnea, hypopnea, or respiratory effort-related event). Fifty-three awakenings were caused by other factors (independent leg jerks , spontaneous , and sleep that was laboratory-induced ). Thirty awakenings ? 5 min—a duration sufficient to predispose toward an insomnia episode—were each preceded by a breathing event. Conclusions: Among patients with insomnia with no classic sleep breathing symptoms and therefore low probability of a sleep breathing disorder, most of their awakenings were precipitated by a medical condition (sleep disordered breathing), which contrasted sharply with their perceptions about their awakenings. Citation: Krakow B; Romero E; Ulibarri VA; Kikta S. Prospective assessment of nocturnal awakenings in a case series of treatment-seeking chronic insomnia patients: a pilot study of subjective and objective causes. SLEEP 2012;35(12):1685-1692.
Krakow, Barry; Romero, Edward; Ulibarri, Victor A.; Kikta, Shara
We investigated the prevalence of nocturnal eating (sleep-related eating disorder-SRED or night-eating syndrome-NES) in patients with restless legs syndrome (RLS). One hundred RLS patients living in Emilia-Romagna (Northern Italy) and 100 matched controls randomly selected from the general population received two telephone interviews, and were investigated for socio-demographic characteristics, general health status, and presence of nocturnal eating. Additionally, subjects underwent interviews for psychopathological traits [by means of the Eating Disorder Inventory-2 (EDI-2), the Maudsley Obsessive-Compulsive Inventory (MOCI), the Beck Depression Inventory (BDI)], excessive daytime sleepiness (EDS), and subjective sleep quality. Compared with controls, RLS patients had more frequently pathological MOCI scores (24% versus 10%, P = 0.03), used significantly more drugs for concomitant diseases and had more nocturnal sleep impairment and EDS. SRED was more prevalent in RLS patients than controls (SRED: 33% versus 1%, P < 0.001). Medication use and pathological MOCI scores were more prevalent in RLS patients with SRED than among RLS patients without SRED. Use of dopaminergic or hypnotic drugs for RLS was not correlated with the presence of SRED. We demonstrate an association between RLS and SRED. Prospective studies are needed to establish the mechanisms underlying such association and whether it is causal. PMID:19199358
Provini, Federica; Antelmi, Elena; Vignatelli, Luca; Zaniboni, Anna; Naldi, Giulia; Calandra-Buonaura, Giovanna; Vetrugno, Roberto; Plazzi, Giuseppe; Montagna, Pasquale
ELECTROENCEPHALOGRAPHIC studies of sleep suggest that the magnitude of sleep disturbances in depressed and schizophrenic subjects varies with the degree of psychic turmoil1-6. Psychoendocrine studies of psychiatric patients have suggested that adrenal cortical steroid excretion is elevated with subjective distress7-13. Some endocrine studies have shown that nocturnal secretion of adrenal cortical steroids is elevated at least part of the time
J. Christian Gillin; Leonard S. Jacobs; David H. Fram; Frederick Snyder
Various neurodegenerative diseases involving brainstem structures as one of the main pathological lesions are reported to be associated with REM sleep behaviour disorder. Full blown REM sleep behaviour disorder can be diagnosed clinically, but REM sleep motor dysfunction, a pathophysiological basis of REM sleep behaviour disorder, is difficult to detect without all night polysomnography. Twenty one consecutive patients with multiple system atrophy with no complaints of nocturnal abnormal behaviours were clinically evaluated to determine the presence of sleep related symptoms. All night polysomnography with video monitoring was performed to investigate REM sleep characteristics and patients' behaviours. In 85.7% (18 of 21) of the patients' sleep talk started or increased around or after the clinical onset of the primary diseases. REM sleep without atonia occupied more than 15%(16.2%-100%) of the REM sleep time in all but one patient. In 90.5% (19 of 21) of patients, motor events such as sleep talk and various combinations of craniofacial, orofacial, or limb movements occurred at various frequencies mostly during REM sleep without atonia. In patients with multiple system atrophy, REM sleep motor dysfunction is a common polysomnographic finding which is otherwise overlooked, and sleep talk may be its early clinical manifestation.??
Tachibana, N; Kimura, K; Kitajima, K; Shinde, A; Kimura, J; Shibasaki, H
The frequency of sleep disturbance and cognitive impairment in Parkinson's disease has led to the suggestion that these processes might share common neural circuitry. This study aimed to identify the relationships between measures of cognitive functioning and an objective measure of sleep disturbance. Ninety-five patients with idiopathic Parkinson's disease and 48 healthy controls underwent neurological and neuropsychological examination. They wore an actigraphy watch for 2weeks, from which a measure of nocturnal sleep efficiency was calculated. Multiple regression models showed that working memory and verbal memory consolidation were significantly associated with sleep efficiency, as well as education and age. By contrast, verbal fluency and attentional set-shifting were not associated with sleep efficiency, after accounting for age and education. These findings reveal that nocturnal sleep disturbance in Parkinson's disease is associated with specific cognitive difficulties, rather than a global pattern of cognitive dysfunction. This may in part reflect common neural underpinnings. PMID:24411329
Gunn, David G; Naismith, Sharon L; Bolitho, Samuel J; Lewis, Simon J G
Sleep is defined on the basis of behavioural and physiological criteria dividing it into two states: non rapid eye movement (NREM) sleep which is subdivided into three stages (N1, N2, N3); and rapid eye movement (REM) sleep characterized by rapid eye movements, muscle atonia and desynchronized EEG. Circadian rhythm of sleep-wakefulness is controlled by the master clock located in the suprachiasmatic nuclei of the hypothalamus. The neuroanatomical substrates of the NREM sleep are located principally in the ventrolateral preoptic nucleus of the hypothalamus and those of REM sleep are located in pons. A variety of significant physiological changes occur in all body systems and organs during sleep as a result of functional alterations in the autonomic and somatic nervous systems. The international classification of sleep disorders (ICSD, ed 2) lists eight categories of sleep disorders along with appendix A and appendix B. The four major sleep complaints include excessive daytime sleepiness, insomnia, abnormal movements or behaviour during sleep and inability to sleep at the desired time. The most important step in assessing a patient with a sleep complaint is obtaining a detailed history including family and previous histories, medical, psychiatric, neurological, drug, alcohol and substance abuse disorders. Some important laboratory tests for investigating sleep disorders consist of an overnight polysomnography, multiple sleep latency and maintenance of wakefulness tests as well as actigraphy. General physicians should have a basic knowledge of the salient clinical features of common sleep disorders, such as insomnia, obstructive sleep apnoea syndrome, narcolepsy-cataplexy syndrome, circadian rhythm sleep disorders (e.g., jet leg, shift work disorder, etc.) and parasomnias (e.g., partial arousal disorders, REM behaviour disorder, etc.) and these are briefly described in this chapter. The principle of treatment of sleep disorders is first to find cause of the sleep disturbance and vigorously treat the co-morbid conditions causing the sleep disturbance. If a satisfactory treatment is not available for the primary condition or does not resolve the problem, the treatment should be directed at the specific sleep disturbance. Most sleep disorders, once diagnosed, can be managed with limited consultations. The treatment of primary sleep disorders, however, is best handled by a sleep specialist. An overview of sleep and sleep disorders viz., Basic science; international classification and approach; and phenomenology of common sleep disorders are presented. PMID:20308738
Each of us spend one-third of our lives asleep. Dysfunctions in this basic state lead to declines in quality of life, diminished\\u000a waking performance, more frequent illness, and increases in both morbidity and mortality. Recent epidemiological data have\\u000a emphasized the significant contribution of obstructive sleep apnea (OSA), one of the most physiological disruptive and dangerous\\u000a sleep-related diagnosis, to pulmonary, cardiac,
James F. Pagel
Smith–Magenis syndrome (SMS) is a multiple congenital anomaly syndrome characterized by an interstitial deletion of chromosome 17p11.2. Sleep problems such as nocturnal awakening and abnormality in the percentage of rapid eye movement (REM) sleep are frequently observed in patients with SMS, and several medications have been administered to improve the sleep disorders. Here we present a female case of SMS
Masahiro Itoh; Masaharu Hayashi; Takeshi Hasegawa; Masayuki Shimohira; Jun Kohyama
Sleep-wake circadian rhythms are well documented for nocturnal rodents, but little is known about sleep regulation in diurnal or crepuscular rodent species. This study examined the circadian sleep-wake rhythms in Octodon degus by means of electroencephalogram (EEG) analysis. Recordings were made from animals housed with or without running wheels in the cages. In a 24-h light-dark (LD) cycle (LD 12:12),
Martien J. H. Kas; Dale M. Edgar
Rotating shift and permanent night work arrangements are known to compromise sleep. This study examined the effects of work schedule on sleep duration, excessive sleepiness, sleep attacks, driving, and domestic/professional accidents. A representative sample of the general population of the state of New York--3,345 individuals > or = 18 yrs of age--was interviewed by telephone regarding their sleep and psychiatric and organic disorders. Multivariate models were applied to derive odds ratios (OR) after adjustment for age, sex, physical illness, mental disorders, obstructive sleep apnea, and sleep duration. On average (+/-SE), workers slept 6.7 +/- 1.5 h, but 40% slept < 6.5 h/main sleep episode. Short-sleep duration (< 6 h) was strongly associated with fixed night (OR: 1.7) and day-evening-night shiftwork arrangement (OR: 1.9). Some 20% of the workers manifested excessive sleepiness in situations requiring high attention, and it was associated with the fixed night (OR: 3.3) and day-evening-night work arrangements (OR: 1.5). Overall, 5% of the workers reported sleep attacks; however, they occurred three-times more frequently in the fixed night (15.3%) than other work arrangements (OR: 3.2). Driving accidents during the previous 12 months were reported by 3.6% of the workers and were associated with fixed night (OR: 3.9) and day-evening-night (OR: 2.1) work schedules. The findings of this study indicate that working outside the regular daytime hours was strongly associated with shorter sleep duration, sleepiness, and driving accident risk. Night work is the most disrupting, as it is associated with insufficient sleep during the designated rest span and excessive sleepiness and sleep attacks during the span of activity, with an associated consequence being increased driving accident risk. PMID:20524802
Ohayon, Maurice M; Smolensky, Michael H; Roth, Thomas
To alleviate the overcrowding of in-center hemodialysis (HD) facilities, we have developed slow nocturnal home hemodialysis (SNHHD), an innovative form of renal replacement therapy. SNHHD is performed 5 to 7 nights/week for 8 hours, during sleep, with a blood flow of 300 mL/min and a dialysate flow of 100 mL/min. The vascular access is by means of the Uldall-Cook catheter, which allows for easy patient access with low infection rates. Special precautions were taken to prevent accidental disconnection during sleep. Dialysis functions were monitored via a modem from the patient's home to the SNHHD center and have proven valuable in increasing patient confidence. The removal of urea, phosphate, and B2 microglobulin (B2M) during 1 week of SNHHD greatly exceeds that of thrice weekly conventional HD. Five patients have completed training and have been successfully performing SNHHD for 6 to 16 months. All patients have discontinued phosphate binders and increased dietary phosphate intake. Four out of five patients report sleeping soundly and experience greatly increased energy and stamina. Repeated in situ reuse of the dialyzer and the blood lines will reduce the patients work and make SNHHD a very inexpensive modality. PMID:8814919
Uldall, R; Ouwendyk, M; Francoeur, R; Wallace, L; Sit, W; Vas, S; Pierratos, A
OSA (obstructive sleep apnoea), the most common respiratory disorder of sleep, is caused by the loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. This results in recurrent nocturnal asphyxia. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxaemia, which leads to poor quality sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Furthermore, patients with untreated sleep apnoea are at an increased risk of hypertension, stroke, heart failure and atrial fibrillation. Although there are many predisposing risk factors for OSA, including male gender, endocrine disorders, use of muscle relaxants, smoking, fluid retention and increased age, the strongest risk factor is obesity. The aim of the present review is to focus on three cutting-edge topics with respect to OSA. The section on animal models covers various strategies used to simulate the physiology or the effects of OSA in animals, and how these have helped to understand some of the underlying mechanisms of OSA. The section on diabetes discusses current evidence in both humans and animal models demonstrating that intermittent hypoxia and sleep fragmentation has a negative impact on glucose tolerance. Finally, the section on cardiovascular biomarkers reviews the evidence supporting the use of these biomarkers to both measure some of the negative consequences of OSA, as well as the potential benefits of OSA therapies. PMID:24780001
Ayas, Najib T; Hirsch, Allen A J; Laher, Ismail; Bradley, T Douglas; Malhotra, Atul; Polotsky, Vsevolod Y; Tasali, Esra
Investigated the relationship between sleep patterns and behavioral adjustment with 4- to 5-year-old children from low-income families. Found that disrupted child sleep patterns, including variability in parentally reported amount of sleep, variability in bedtime, and lateness of bedtime, predicted less optimal adjustment in preschool, even after…
Bates, John E.; Viken, Richard J.; Alexander, Douglas B.; Beyers, Jennifer; Stockton, Lesley
Sleep may have several negative consequences in patients with chronic obstructive pulmonary disease (COPD). Sleep is typically fragmented with diminished slow wave and rapid-eye-movement sleep, which likely represents an important contributing factor to daytime symptoms such as fatigue and lethargy. Furthermore, normal physiological adaptations during sleep, which result in mild hypoventilation in normal subjects, are more pronounced in COPD, which can result in clinically important nocturnal oxygen desaturation. The co-existence of obstructive sleep apnea and COPD is also common, principally because of the high prevalence of each disorder, and there is little convincing evidence that one disorder predisposes to the other. Nonetheless, this co-existence, termed the overlap syndrome, typically results in more pronounced nocturnal oxygen desaturation and there is a high prevalence of pulmonary hypertension in such patients. Management of sleep disorders in patients with COPD should address both sleep quality and disordered gas exchange. Non-invasive pressure support is beneficial in selected cases, particularly during acute exacerbations associated with respiratory failure, and is particularly helpful in patients with the overlap syndrome. There is limited evidence of benefit from pressure support in the chronic setting in COPD patients without obstructive sleep apnea. PMID:24378218
Crinion, Sophie J; McNicholas, Walter T
Disruption of sleep causes adverse health outcomes and poor quality of life. People with sleep disruption have higher levels than people without disrupted sleep of depression and anxiety and increased rates of cardiovascular diseases. Women have a higher incidence than men of insomnia and depression related to poor sleep. The types of complaints differ significantly between the sexes. Women are more likely than men to complain of insomnia, headache, irritability, and fatigue than the "typical" symptoms of loud snoring and breathing cessation during sleep. Hormones play an important role in sleep in women. Reproductive hormones were found to have a protective effect on sleep apnea in women of premenopausal age. Pregnancy is another period when the prevalence of sleep apnea and restless leg syndrome increases from hormonal effect. Cardiovascular mortality is high in women with obstructive sleep apnea. Continuous positive airway pressure therapy improves outcomes in most cases of obstructive sleep apnea. The epidemiology, risk factors, diagnostic criteria, and therapies for the three most common sleep disorders (insomnia, obstructive sleep apnea, and restless leg syndrome), along with effects of menopause, pregnancy, and social factors on sleep in women, are key considerations for clinicians caring for female patients across the adult life span. PMID:23912143
Tamanna, Sadeka; Geraci, Stephen A
Background: Chronic illness may not only directly im- pact the sleep of a patient but also indirectly impact the sleep of the family members who provide nighttime care. For parents of children with chronic illnesses, few stud- ies have examined sleep disruptions that may account for elevated rates of depression and fatigue. Our objectives were to examine sleep patterns and
Lisa J. Meltzer; Jodi A. Mindell
Recent research suggests bi-directional interactions between the experience of pain and the process of sleep; pain interferes with the ability to obtain sleep, and disrupted sleep contributes to enhanced pain perception. Our group recently reported, in a controlled experimental study, that sleep fragmentation among healthy adults resulted in subsequent decrements in endogenous pain inhibition. The present report follows up that
R. R. Edwards; E. Grace; S. Peterson; B. Klick; J. A. Haythornthwaite; M. T. Smith
Sleep and behavioural difficulties are common in children with developmental disabilities. Mothers often wake and tend to their child when their child is having sleep difficulties. Therefore, mothers of children with developmental disabilities can have poor sleep quality due to these disruptions. The present study investigated the impact of sleep…
Chu, Judy; Richdale, Amanda L.
The authors describe a behavioral intervention designed to reduce sleep problems without increasing disruption at bedtime or throughout the evening. Sleep restriction was used to reduce the bedtime and nighttime sleep problems of two children, a 4-year-old girl with autism and a 4-year-old girl with developmental delay. Sleep restriction involved…
Durand, V. Mark; Christodulu, Kristin V.
Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant ‘bother’. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night might be an indication of the severity of sleep disruption in patients with nocturia.
Ancoli-Israel, Sonia; Bliwise, Donald L.; N?rgaard, Jens Peter
In this activity about sleep rhythms (on page 21 of the PDF), learners will collect data about their own sleep cycles and use a fraction wheel to examine their data. This lesson guide includes background information, information about astronauts' sleep in space, setup and management tips, extensions and a handout.
Moreno, Nancy P.; Tharp, Barbara Z.; Vogt, Greg L.
BackgroundPatients with Restless Legs Syndrome (RLS) often seek treatment because of sleep problems related to nocturnal symptoms. Our goal was to test the ability of pramipexole to improve sleep in RLS patients and to reconfirm its efficacy for primary RLS symptoms.
Luigi Ferini-Strambi; Dagfinn Aarskog; Markku Partinen; K. Ray Chaudhuri; Mandy Sohr; Daniela Verri; Stefan Albrecht
Background Sleep duration may be an important regulator of body weight and metabolism. An association between short habitual sleep time and increased body mass index (BMI) has been reported in large population samples. The potential role of metabolic hormones in this association is unknown. Methods and Findings Study participants were 1,024 volunteers from the Wisconsin Sleep Cohort Study, a population-based longitudinal study of sleep disorders. Participants underwent nocturnal polysomnography and reported on their sleep habits through questionnaires and sleep diaries. Following polysomnography, morning, fasted blood samples were evaluated for serum leptin and ghrelin (two key opposing hormones in appetite regulation), adiponectin, insulin, glucose, and lipid profile. Relationships among these measures, BMI, and sleep duration (habitual and immediately prior to blood sampling) were examined using multiple variable regressions with control for confounding factors. A U-shaped curvilinear association between sleep duration and BMI was observed. In persons sleeping less than 8 h (74.4% of the sample), increased BMI was proportional to decreased sleep. Short sleep was associated with low leptin (p for slope = 0.01), with a predicted 15.5% lower leptin for habitual sleep of 5 h versus 8 h, and high ghrelin (p for slope = 0.008), with a predicted 14.9% higher ghrelin for nocturnal (polysomnographic) sleep of 5 h versus 8 h, independent of BMI. Conclusion Participants with short sleep had reduced leptin and elevated ghrelin. These differences in leptin and ghrelin are likely to increase appetite, possibly explaining the increased BMI observed with short sleep duration. In Western societies, where chronic sleep restriction is common and food is widely available, changes in appetite regulatory hormones with sleep curtailment may contribute to obesity.
A patient was studied who every night experienced several attacks characterized by loud screaming, violent movements of limbs and trunk, and a tonic phase. No epileptiform activity was noted preceding or following these attacks. Prolonged EEG and videotape recordings before and after sleep deprivation, along with neuropsychological and pharmacological data, support the hypothesis of a seizure disorder involving the left temporal region. Nocturnal attacks completely disappeared with carbamazepine. This therapeutic effect was still present after six months of treatment. Sleep organization was also greatly influenced by this medication. The most striking change was the marked and sustained increase of stages 3 and 4 NREM sleep after treatment. PMID:4042381
Godbout, R; Montplaisir, J; Rouleau, I
First-degree relatives of narcoleptic subjects (probands) may have sleep pathology related to the transmission of the disorder through their family members. The authors examined four groups: probands (n = 96), first-degree relative (n = 337), environmental reference (n = 85), and general population (n = 6,694) groups. Compared with the general population, family members have a 75-fold increased risk for narcolepsy. They are also at greater risk for insufficient sleep syndrome (odds ratio [OR] 6.1), nocturnal eating (OR 5.7), and adjustment sleep disorder (OR 3.1). PMID:16924030
Ohayon, Maurice M; Okun, Michele L
Although sleep problems often comprise core features of psychiatric disorders, inadequate attention has been paid to the complex, reciprocal relationships involved in the early regulation of sleep, emotion, and behavior. In this paper, we review the pediatric literature examining sleep in children with primary psychiatric disorders as well as evidence for the role of early sleep problems as a risk factor for the development of psychopathology. Based on these cumulative data, possible mechanisms and implications of early sleep disruption are considered. Finally, assessment recommendations for mental health clinicians working with children and adolescents are provided toward reducing the risk of and improving treatments for sleep disorders and psychopathology in children and adolescents.
Alfano, Candice A.; Gamble, Amanda L.
We describe the case of a 22-year-old male affected by NFLE reporting paroxysmal RLS-like symptoms. The patient was referred to our Sleep Center due to nocturnal paresthesias and cramps involving the left leg and leading to sleep fragmentation. At age 4, the patient presented with secondary generalized seizures preceded by left leg discomfort, controlled on CBZ. After successive therapy discontinuation, leg symptoms built up in frequency and duration until a secondary generalized seizure re-occurred. On CBZ prompt resumption no further GM seizures occurred albeit persistence of night-time frequent cramps and paraesthesia. Sleep EEG demonstrated asymmetric interictal sharp theta on the right posterior frontal areas, whereas brain MRI results were consistent with a Taylor type right frontal cortical dysplasia. CBZ augmentation and add on therapy with LEV led to further frequency reduction of sensory symptoms. PMID:21088977
Aricò, Irene; Condurso, Rosaria; Granata, Francesca; Nobili, Lino; Bruni, Oliviero; Silvestri, Rosalia
... 2013 New Insights Found in Pain Processing and Sleep Disturbance Among Rheumatoid Arthritis Patients People with rheumatoid ... in the journal Arthritis and Rheumatism. In addition, sleep disruptions, which are common among people with RA, ...
Several species which have a single daily wake-sleep cycle show a progressive fall in cardiac output and rise in total peripheral resistance during sleep, a cardiovascular response which may reflect a progressive decrease in plasma volume. The present study showed that no such progressive overnight changes in cardiac output or total peripheral resistance occur in the dog, a carnivore which tends to be awake and to drink intermittently during the night. Progressive overnight bradycardia (-12.7 +/- 3.1%) and compensatory increase in stroke volume (14.8 +/- 6.0%) were observed in this species, however. These findings are consistent with the view that differences between primates and carnivores in overnight hemodynamic function are related to species differences in sleep and ingestive behavior. PMID:2267257
Anderson, D E; Talan, M I; Engel, B T
To assess the prevalence of nocturnal enuresis in children and adolescents with sickle cell disease (SCD) and associated factors, structured telephone interviews were conducted with primary caregivers of 217 children and adolescents with SCD aged 5 years or older. Prevalence, perceived causes, interventions undertaken, and emotional impact were assessed. Nocturnal enuresis was significantly higher for males (28.2% of males) than for females (11% of females), p = .002, and compared with cited population prevalence rates, nocturnal enuresis was significantly higher for children with SCD, p < .01. SCD was the most common reason given by primary caregivers for enuresis. Primary caregivers used a wide range of interventions for nocturnal enuresis, but few used empirically supported treatments for enuresis or spoke with their health care team about the enuresis. These data suggest that systematic assessment and intervention for nocturnal enuresis must be implemented in the follow-up care of children and adolescents with SCD. PMID:11718233
Barakat, L P; Smith-Whitley, K; Schulman, S; Rosenberg, D; Puri, R; Ohene-Frempong, K
Summary Background Large ventral lateral clock neurons (lLNv) exhibit higher daytime light-driven spontaneous action potential firing rates in Drosophila, coinciding with wakefulness and locomotor activity behaviour. To determine whether the lLNv are involved in arousal and sleep/wake behaviour we examined the effects of altered electrical excitation of the LNv. Results LNv-hyperexcited flies reverse the normal day/night firing pattern, showing higher lLNv firing rates at night and pigment dispersing factor-mediated enhancement of nocturnal locomotor activity behaviour and reduced quantity and quality of sleep. lLNv hyperexcitation impairs sensory arousal, as shown by physiological and behavioural assays. lLNv hyperexcited flies lacking sLNv neurons exhibit robust hyperexcitation-induced increases in nocturnal behaviour, suggesting that the sLNv are not essential for mediation of arousal. Conclusions Light-activated lLNv neurons modulate behavioural arousal and sleep in Drosophila.
Sheeba, Vasu; Fogle, Keri J; Kaneko, Maki; Rashid, Saima; Chou, Yu-Ting; Sharma, Vijay K; Holmes, Todd C
The sleep patterns of 58 Space Shuttle crew members are analyzed statistically on the basis of debriefing forms filled out within 3 days postflight. The data are compiled in a table, and photographs of typical sleep conditions on the Shuttle are provided. It is found that sleep disruption is relatively common on Shuttle missions, especially on the first and last days. Sleep medication was used by 19.4 percent of crew on single-shift flights and 50 percent of crew on dual-shift flights.
Santy, Patricia A.; Kapanka, Heidi; Davis, Jeffrey R.; Stewart, Donald F.
Despite the complex influences of normal sleep physiology and sleep disorders on the development or presentation of headache, it is important to recognize and understand these relationships. Successful outcomes depend on the provision of treatment interventions specifically directed toward each condition. Nocturnal or early morning headaches that are associated with OSA are often eradicated after the sleep disorder is successfully managed with CPAP, oral appliances, or surgery. Substantial improvement in headache can also result from the successful management of other sleep disorders that may incite headaches such as heavy snoring, PLMS, or the various forms of insomnia. To improve headache patterns associated with bruxism and TMD, it is often necessary to formulate a multidisciplinary treatment approach that combines oral appliance therapy, stress management, biofeedback, oromandibular physical therapy, and, at times, pharmacologic treatment (i.e., tricyclic antidepressant, intramuscular botulinum toxin injections). There are still many gaps in the understanding of the interrelationships of sleep physiology and headache pathophysiology. More well-designed clinical trials are needed so that enough data can be amassed for the formulation of evidence-based guidelines or consensus statements that can better delineate the identification, diagnostic evaluation, and treatment of sleep-related headache disorders and headaches that develop as a consequence of disordered sleep. PMID:11699236
Biondi, D M
Congestive heart failure (CHF) is a major cause of mortality and morbidity. Among patients with heart failure, sleep disordered breathing (SDB) is a common problem. Current evidence suggests that SDB, particularly central SDB, is more prevalent in patients with CHF than in the general population, but it is underdiagnosed as SDB symptoms that are less prevalent in CHF. The main aims of this study were to determine the relationship between nocturnal hypoxemia and left ventricular ejection fraction in patients with chronic heart failure. By means of echocardiography, 108 patients with left ventricular ejection fraction ?45% were divided into mild, moderate, and severe CHF. Hypoxemia was recorded overnight in the hospital and was measured by portable pulse oximetry. In the 108 patients with CHF, 44 (40.7%) were severe, 17 (15.7%) moderate, and 47 (43.6%) mild CHF. 95 (88%) of patients with CHF had abnormal patterns of nocturnal hypoxemia suggestive of Cheyne-Stokes respiration. Ejection fraction correlated negatively with dip frequency. There was no correlation between nocturnal hypoxemia with BMI and snoring. This study confirms strong associations between sleep apnea and heart disease in patients with CHF. Overnight oximetry is a useful screening test for Cheyne-Stokes respiration in patients with known heart failure. PMID:24693442
Mirzaaghazadeh, Mohammad; Bahtouee, Mehrzad; Mehdiniya, Fariba; Maleki, Nasrollah; Tavosi, Zahra
Sleep related arterial oxygen desaturation has been described in clinically stable young adults with cystic fibrosis. The incidence and severity of nocturnal oxygen desaturation in children during infective exacerbations and the changes that occur with treatment were examined. Forty five children with proved cystic fibrosis, median age 8.9 years, admitted to the Regional Cystic Fibrosis Unit underwent clinical evaluation, spirometry, and measurement of peak flow and nocturnal oxygen saturation on admission and after 10 days' treatment. There was a significant improvement in all the above measurements, with the averaged overnight saturation changing from a mean (SD) 92.7 (2.7)% to 94.3 (2.0)%, mean (SE) difference 1.58 (0.37). The time spent with a saturation 4% or more below their clinic value showed a marked improvement from 122 (152) minutes on the first night to 21 (30.7) on the second, mean (SE) difference 101 (22.4). Eight young children could not perform pulmonary function tests, all desaturated on the admission night. Nocturnal hypoxaemia is a common finding in young cystic fibrosis patients during infective exacerbations but improves with treatment. Overnight oximetry is simple to perform, well tolerated, and identifies patients with marked nocturnal desaturation.
Allen, M B; Mellon, A F; Simmonds, E J; Page, R L; Littlewood, J M
Objectives To compare objective and subjective measurements of napping, and to examine the relationship between evening napping and nocturnal sleep in older adults. Design For twelve days, participants wore actigraphs and completed sleep diaries. Setting Community Participants 100 individuals who napped, 60–89 years (including good and poor sleepers with typical age-related medical comorbidities). Measurements Twelve days of sleep diary and actigraphy provided subjective and objective napping and sleep data. Results Evening naps (within 2 hours of bedtime) were characteristic of the sample with peak nap time occurring between 20:30–21:00 (average nap time occurred between 14:30–15:00). Two categories of nappers were identified: 1) day/evening – those who took both daytime and evening naps, and 2) daytime-only. Interestingly, no participants napped during the evening only. Day/evening nappers significantly underreported evening napping and demonstrated lower objectively measured sleep onset latencies (20 vs 26.5 minutes), less wake after sleep onset (51.4 vs 72.8 minutes), and higher sleep efficiencies (76.8 vs 82%) than daytime-only nappers. Conclusion Day/evening napping was prevalent amongst this sample of community-dwelling good/poor sleepers, but was not associated with impaired nocturnal sleep. Although the elimination or restriction of napping is a common element of cognitive-behavioral therapy for insomnia (CBTi), these results suggest that a uniform recommendation to restrict/eliminate napping (particularly evening napping) may not meet the needs of all older individuals with insomnia.
Dautovich, Natalie D.; McCrae, Christina S.; Rowe, Meredeth
Previous work has indicated that a small but significant number of participants in sleep deprivation studies or in simulated shift work experiments manifests an exaggerated performance decrement when they reach a critical point in the experiment, usually near the trough of the circadian cycle or the middle of the night. Those who show this exaggerated response do not appear to differ from other non-nal volunteers in any substantial way according to usual screening criteria or baseline values. The present study aims to examine factors that may provide the basis for this extreme response. We propose that a preexisting sleep deficit-as manifested by low values on the Multiple Sleep Latency Test (MSLT)-may account for extreme responders. It has been shown that among normal volunteers screened for a variety of studies, approximately 20 to 25 percent show low (< 6 minutes) MSLT scores on a consistent basis, whereas a like proportion shows consistently high MSLT scores (> 13 minutes). Additionally, studies by this group have indicated that subjects with low MSLT scores may suffer from chronic insufficient sleep, as further substantiated by the finding that they have consistently higher nocturnal sleep efficiency and that their MSLT scores rise to normal values when sleep is extended. We hypothesize that the short MSLT subjects have a significant long-term sleep deficit that leads to a marked intolerance for sleep deprivation or shift work. We further suggest that this sleep debt may signify an increased sleep need in these individuals that is not met either due to personal preference or to societal pressures (or both). If this speculation is accurate, then we predict that the tolerance for sleep deprivation in such individuals can be increased by "pretreatment" with sleep extension. Thus, the present study is designed to test the following two hypotheses: (1) subjects with nominal sleep patterns who have low MSLT scores (e.g., Sleepy subjects) will show an exaggerated response (performance decrement) to sleep loss compared to subjects who have high MSLT scores (Alert subjects) on a nominal sleep schedule; (2) when permitted to extend sleep--thus discharging their sleep debt-the Sleepy subjects will show a sleep-loss response resembling that of the Alert subjects.
Carskadon, Mary A.
Previous work has indicated that a small but significant number of participants in sleep deprivation studies or in simulated shift work experiments manifests an exaggerated performance decrement when they reach a critical point in the experiment, usually near the trough of the circadian cycle or the middle of the night. Those who show this exaggerated response do not appear to differ from other normal volunteers in any substantial way according to usual screening criteria or baseline values. The present study aims to examine factors that may provide the basis for this extreme response. We propose that a preexisting sleep deficit-as manifested by low values on the Multiple Sleep Latency Test (MSLT)-may account for extreme responders. Roth and colleagues (1993) have shown that among normal volunteers screened for a variety of studies, approximately 20 to 25 percent show low (< or = 6 minutes) MSLT scores on a consistent basis, whereas a like proportion shows consistently high MSLT scores (> or = 13 minutes). Additionally, studies by this group have indicated that subjects with low MSLT scores may suffer from chronic insufficient sleep (Roth et al., 1993), as further substantiated by the finding that they have consistently higher nocturnal sleep efficiency and that their MSLT scores rise to normal values when sleep is extended (Roehrs et al., 1996). We hypothesize that the short MSLT subjects have a significant long-term sleep deficit that leads to a marked intolerance for sleep deprivation or shift work. We further suggest that this sleep debt may signify an increased sleep need in these individuals that is not met either due to personal preference or to societal pressures (or both). If this speculation is accurate, then we predict that the tolerance for sleep deprivation in such individuals can be increased by "pretreatment" with sleep extension. Thus, the present study is designed to test the following two hypotheses: subjects with nominal sleep patterns who have low MSLT scores (e.g., Sleepy subjects) will show an exaggerated response (performance decrement) to sleep loss compared to subjects who have high MSLT scores (Alert subjects) on a nominal sleep schedule. When permitted to extend sleep-thus discharging their sleep debt-the Sleepy subjects will show a sleep-loss response resembling that of the Alert subjects.
Carskadon, Mary A.
Previous work has indicated that a small but significant number of participants in sleep deprivation studies or in simulated shift work experiments manifests an exaggerated performance decrement when they reach a critical point in the experiment, usually near the trough of the circadian cycle or the middle of the night. Those who show this exaggerated response do not appear to differ from other non-nal volunteers in any substantial way according to usual screening criteria or baseline values. The present study aims to examine factors that may provide the basis for this extreme response. We propose that a preexisting sleep deficit-as manifested by low values on the Multiple Sleep Latency Test (MSLT)-may account for extreme responders. Roth and colleagues (1993) have shown that among normal volunteers screened for a variety of studies, approximately 20 to 25 percent show low (< 6 minutes) MSLT scores on a consistent basis, whereas a like proportion shows consistently high MSLT scores (> 13 minutes). Additionally, studies by this group have indicated that subjects with low MSLT scores may suffer from chronic insufficient sleep (Roth et al., 1993), as further substantiated by the finding that they have consistently higher nocturnal sleep efficiency and that their MSLT scores rise to normal values when sleep is extended (Roehrs et al., 1996). We hypothesize that the short MSLT subjects have a significant long-term sleep deficit that leads to a marked intolerance for sleep deprivation or shift work. We further suggest that this sleep debt may signify an increased sleep need in these individuals that is not met either due to personal preference or to societal pressures (or both). If this speculation is accurate, then we predict that the tolerance for sleep deprivation in such individuals can be increased by "pretreatment" with sleep extension. Thus, the present study is designed to test the following two hypotheses: subjects with nominal sleep patterns who have low MSLT scores (e.g., Sleepy subjects) will show an exaggerated response (performance decrement) to sleep loss compared to subjects who have high MSLT scores (Alert subjects) on a nominal sleep schedule. when permitted to extend sleep-thus discharging their sleep debt-the Sleepy subjects will show a sleep-loss response resembling that of the Alert subjects.
Carskadon, Mary A.
Sleep is usually associated with a reduction in the frequency of ventricular arrhythmias. We analyzed 1260 24-hour Holter recordings exhibiting ventricular ectopy and identified 50 patients who had significant increases in sleep-related ectopy. This study group was compared to an age, sex, and 24-hour ventricular ectopic frequency matched control group. There were 21 females and 29 males with a mean age of 64 years in each group. During sleep, the study patients had more frequency of ventricular ectopy per hour than did controls (mean +/- SEM; 143.2 +/- 30.7 vs 62.9 +/- 16.3; p less than 0.005). The study group had fewer daytime ventricular premature beats per hour than did the control patients (45.2 +/- 13.6 vs 67.7 +/- 13.8; p less than 0.05). The study patients also exhibited a significant sleep-related increase in complexity of ventricular arrhythmias (chi 2 = 22.1; p less than 0.001) and the control group a decrease (chi 2 = 19.1; p less 0.001). Nocturnal heart rates were slower than daytime rates in both the study (69.4 +/- 14.5 vs 79.2 +/- 12.2 bpm; p less than 0.005) and control groups (75.5 +/- 15.8 vs 82.6 +/- 16.4 bpm; p less than 0.005), without significant differences between the two groups. No significant differences in clinical and ECG characteristics of the study and control groups were found regarding presence or type of organic heart disease, pulmonary disease, hypertension, medication use, intraventricular conduction delay, abnormal Q waves, ventricular hypertrophy, or QT prolongation. Neurologic abnormalities (60% vs 28%; chi 2 = 9.38 p less than 0.005), in particular cerebrovascular disease (30% vs 14%; chi 2 = 7.56; p less than 0.01), were significantly more common in the study group. We have identified a subgroup of individuals with ventricular ectopy who increase the frequency and complexity of premature ventricular beats during sleep. The higher prevalence of neurologic disease in these individuals suggests a neurologic or neurohumoral mediation of these arrhythmias. PMID:6613817
Rosenberg, M J; Uretz, E; Denes, P
Findings from previous research assessing sleep quality in caregivers are inconsistent due to differences in sleep assessment methods. This study evaluated sleep in dementia caregivers using a comprehensive sleep assessment utilizing an ambulatory polysomnography (PSG) device. A total of 20 caregivers and 20 noncaregivers rated their perceived sleep quality, stress, and depressive symptoms; provided samples of cortisol and inflammatory biomarkers; and completed an objective sleep assessment using a portable PSG device. Caregivers reported greater perceived stress than noncaregivers. Next, the groups had different sleep architecture: caregivers spent less proportion of their sleep in restorative sleep stages compared to noncaregivers. Further, levels of C-reactive protein and awakening salivary cortisol were greater in caregivers than in noncaregivers, and these measures were related to sleep quality. Our findings indicate that sleep disruption is a significant concomitant of caregiving and may affect caregiver's health. Sleep quality of caregivers might be a useful target for a clinical intervention. PMID:21320949
Fonareva, Irina; Amen, Alexandra M; Zajdel, Daniel P; Ellingson, Roger M; Oken, Barry S
Findings from previous research assessing sleep quality in caregivers are inconsistent due to differences in sleep assessment methods. This study evaluated sleep in dementia caregivers using a comprehensive sleep assessment utilizing an ambulatory polysomnography (PSG) device. Twenty caregivers and twenty non-caregivers rated their perceived sleep quality, stress, and depressive symptoms; provided samples of cortisol and inflammatory biomarkers; and completed an objective sleep assessment using a portable PSG device. Caregivers reported greater perceived stress than non-caregivers. Next, the groups had different sleep architecture: caregivers spent less proportion of their sleep in restorative sleep stages compared to non-caregivers. Further, levels of C-reactive protein and awakening salivary cortisol were greater in caregivers than in non-caregivers, and these measures were related to sleep quality. Our findings indicate that sleep disruption is a significant concomitant of caregiving and may affect caregiver’s health. Sleep quality of caregivers might be a useful target for a clinical intervention.
Fonareva, Irina; Amen, Alexandra M.; Zajdel, Daniel P.; Ellingson, Roger M.; Oken, Barry S.
Various human biological functions adhere to a circadian rhythm that to some extent may be affected by environmental factors, including light and temperature . Recent evidence from Cajochen et al. indicates that human sleep is influenced by the cycle of the moon, measured in conditions precluding the potential impact of nocturnal lunar illumination Here in a similarly retrospective study of 47 healthy volunteers (mean age 23.3, S.D. ±2.9 years) we demonstrate that total sleep time decreases by 25 minutes and cortical reactivity to environmental stimuli during sleep increases around full moon, and rapid eye movement (REM) sleep latency lengthens by 30 minutes around new moon. The findings strengthen the notion that human sleep is modulated by lunar phase but point to important deviations from the study of Cajochen et al. that need to be addressed, particularly with regard to individual susceptibility. PMID:24937276
Smith, Michael; Croy, Ilona; Persson Waye, Kerstin
We report the case of a 13-year-old boy who complained of complex motor episodes during sleep characterized by sudden arousal followed by deambulation associated with automatic movements and vocalization. His family history included both epileptic and psychiatric disorders. The patient himself presented psychopathologic traits and adaptive difficulties. In support of an epileptic origin of these phenomena were the stereotyped fashion in which they appeared and their responsiveness to carbamazepine. We classified the present case as a nocturnal frontal epilepsy with variable manifestations that can be classified as paroxysmal arousals, paroxysmal dystonia, and epileptic nocturnal wanderings. It was possible to differentiate such events from the most common parasomnias on the basis of videopolysomnographic studies. PMID:11510944
Gaggero, R; Devescovi, R; Nobili, L; Baglietto, M G; Zucconi, M; Schinardi, A
BackgroundSerum gamma-glutamyl transferase (GGT) is a well-known marker of alcohol consumption and liver dysfunction. GGT is also associated with components of metabolic syndrome, cardiovascular risk factors and obstructive sleep apnea. In a population-based study, we investigated serum GGT levels in relation to markers of nocturnal hypoxemia, adjusting for potential confounders. In addition, we investigated the possible relationship between GGT concentrations
Francisco Gude; Jesús Rey-Garcia; Carmen Fernandez-Merino; Luis Meijide; Luis García-Ortiz; Carlos Zamarron; Arturo Gonzalez-Quintela
Sleep has traditionally been recognized as a precipitating factor for some forms of epilepsy, although differential diagnosis between some seizure types and parasomnias may be difficult. Autosomal dominant frontal lobe epilepsy is characterized by nocturnal seizures with hyperkinetic automatisms and poorly organized stereotyped movements and has been associated with mutations of the ?4 and ?2 subunits of the neuronal nicotinic acetylcholine receptor. We performed a clinical and molecular genetic study of a large pedigree segregating sleep-related epilepsy in which seizures are associated with fear sensation, tongue movements, and nocturnal wandering, closely resembling nightmares and sleep walking. We identified a new genetic locus for familial sleep-related focal epilepsy on chromosome 8p12.3-8q12.3. By sequencing the positional candidate neuronal cholinergic receptor ?2 subunit gene (CHRNA2), we detected a heterozygous missense mutation, I279N, in the first transmembrane domain that is crucial for receptor function. Whole-cell recordings of transiently transfected HEK293 cells expressing either the mutant or the wild-type receptor showed that the new CHRNA2 mutation markedly increases the receptor sensitivity to acetylcholine, therefore indicating that the nicotinic ?2 subunit alteration is the underlying cause. CHRNA2 is the third neuronal cholinergic receptor gene to be associated with familial sleep-related epilepsies. Compared with the CHRNA4 and CHRNB2 mutations reported elsewhere, CHRNA2 mutations cause a more complex and finalized ictal behavior.
Aridon, Paolo; Marini, Carla; Di Resta, Chiara; Brilli, Elisa; De Fusco, Maurizio; Politi, Fausta; Parrini, Elena; Manfredi, Irene; Pisano, Tiziana; Pruna, Dario; Curia, Giulia; Cianchetti, Carlo; Pasqualetti, Massimo; Becchetti, Andrea; Guerrini, Renzo; Casari, Giorgio
This paper summarizes the findings from the past 3 year's research on the effects of environmental noise on sleep and identifies key future research goals. The past 3 years have seen continued interest in both short term effects of noise on sleep (arousals, awakenings), as well as epidemiological studies focusing on long term health impacts of nocturnal noise exposure. This research corroborated findings that noise events induce arousals at relatively low exposure levels, and independent of the noise source (air, road, and rail traffic, neighbors, church bells) and the environment (home, laboratory, hospital). New epidemiological studies support already existing evidence that night-time noise is likely associated with cardiovascular disease and stroke in the elderly. These studies collectively also suggest that nocturnal noise exposure may be more relevant for the genesis of cardiovascular disease than daytime noise exposure. Relative to noise policy, new effect-oriented noise protection concepts, and rating methods based on limiting awakening reactions were introduced. The publications of WHO's ''Night Noise Guidelines for Europe'' and ''Burden of Disease from Environmental Noise'' both stress the importance of nocturnal noise exposure for health and well-being. However, studies demonstrating a causal pathway that directly link noise (at ecological levels) and disturbed sleep with cardiovascular disease and/or other long term health outcomes are still missing. These studies, as well as the quantification of the impact of emerging noise sources (e.g., high speed rail, wind turbines) have been identified as the most relevant issues that should be addressed in the field on the effects of noise on sleep in the near future. PMID:23257581
Hume, Kenneth I; Brink, Mark; Basner, Mathias
Simultaneous measurements of noise exposure and sleep electrophysiology were made in homes before and after cessation of nighttime aircraft landing noise. Six people were tested, all of whom had been exposed to intense aircraft noise for at least two years. Noise measurements indicated a large reduction in the hourly noise level during nighttime hours, but no charge during the daytime hours. Sleep measures indicated no dramatic changes in sleep patterns either immediately after a marked change in nocturnal noise exposure or approximately a month thereafter. No strong relationship was observed between noise level and sleep disturbances over the range from 60 to 90 db(A).
Pearsons, K. S.; Fidell, S.; Bennett, R. L.; Friedman, J.; Globus, G.
To determine some of the risks and benefits of being a long or short sleeper, psychological adjustment, lifestyle, and sleep parameters were investigated in 239 older adults. Responses of people who slept well and who were either long or short sleepers were studied on 48 variables investigating sleep parameters and sleep-related affect and beliefs; daytime fatigue and sleepiness; demographic factors, including age, sex, and income satisfaction; sleep lifestyle factors, including naps, bedtimes, arising times, and the regularity of these; general lifestyle factors, including regularity of mealtimes, overall daytime pleasantness, perceived busyness, diversity and valence of daily activities, and potentially stressful major life events. In addition, 14 variables evaluated aspects of psychological adjustment, including cognitive and somatic arousal, nocturnal tension, anxious, negative, unpleasant and worrying self-talk, depression, anxiety, overall psychopathology, neuroticism, and life satisfaction. Overall, the results indicate that short sleepers get up earlier, spend less time in bed, and have lower sleep efficiencies than their long sleeper counterparts. They eat breakfast earlier, and of course, they sleep less. Only one of the 14 psychological adjustment variables was significant. In view of the many differences between short and long sleepers described in prior research, the lack of differences observed between long and short sleepers is noteworthy. PMID:15600221
Fichten, Catherine S; Libman, Eva; Creti, Laura; Bailes, Sally; Sabourin, Stéphane
Background Children living in urban environments have many risk factors for disrupted sleep, including environmental disturbances, stressors related to ethnic minority status, and higher rates of stress and anxiety. Asthma can further disrupt sleep in children, but little research has examined the effects of missed sleep on asthma morbidity. Objective To examine the associations among missed sleep, asthma-related quality of life (QoL), and indicators of asthma morbidity in urban children with asthma from Latino, African American, and non-Latino white backgrounds. Given the importance of anxiety as a trigger for asthma symptoms and the link between anxiety and disrupted sleep, the associations among anxiety, asthma morbidity indicators, and missed sleep were also tested. Methods Parents of 147 children ages 6 to 13 years completed measures of asthma morbidity and missed sleep, parental QoL, and child behavior. Results Higher reports of missed sleep were related to more frequent school absences, more activity limitations, and lower QoL across the sample. The associations between missed sleep and asthma morbidity were stronger for Latino children compared with non-Latino white and African American children. For children with higher anxiety, the associations between missed sleep and asthma morbidity were stronger than for children with lower anxiety. Conclusion Results offer preliminary support for missed sleep as a contributor to daily functioning of children with asthma in urban neighborhoods. Missed sleep may be more relevant to Latino families. Furthermore, anxiety may serve as a link between sleep and asthma morbidity because higher anxiety may exacerbate the effects of disrupted sleep on asthma.
Daniel, Lauren C.; Boergers, Julie; Kopel, Sheryl J.; Koinis-Mitchell, Daphne
Three interacting processes are involved in the preservation of circadian rhythms: (1) endogenous rhythm generation mechanisms, (2) entrainment mechanisms to keep these rhythms 'on track', and (3) exogenous masking processes stemming from changes in environment and bahavior. These processes, particularly the latter two, can be dramatically affected in individuals of advanced age and in space travelers, with a consequent disruption in sleep and daytime functioning. This paper presents results of a phase-shift experiment investigating the age-related effects of the exogeneous component of circadian rhythms in various physiological and psychological functions by comparing these functions in middle aged and old subjects. Dramatic differences were found between the two age groups in measures of sleep, mood, activation, and performance efficiency.
Monk, Timothy H.
Sleep complaints such as insufficient sleep and insomnia are twice as prevalent in women. Symptoms of sleep disruption are often coincident with changes in the gonadal hormone profile across a women’s lifespan. Data from a number of different species, including humans, non-human primates and rodents strongly implicate a role for gonadal hormones in the modulation of sleep. In female rats, increased levels of circulating estradiol increase wakefulness and reduce sleep in the dark phase. In this study, we asked whether this reduction in sleep is driven by estradiol-dependent reduction in sleep need during the dark phase by assessing sleep before and after sleep deprivation (SD). Ovariectomized rats implanted with EEG telemetry transmitters were given Silastic capsules containing either 17-? estradiol in sesame oil (E2) or sesame oil alone. After a 24-hour baseline, animals were sleep-deprived via gentle handling for the entire 12-hour light phase, and then allowed to recover. E2 treatment suppressed baseline REM sleep duration in the dark phase, but not NREM or Wake duration, within three days. While SD induced a compensatory increase in REM duration in both groups, this increase was smaller in E2-treated rats compared to oils, as measured in absolute duration as well as by relative increase over baseline. Thus, E2 suppressed REM sleep in the dark phase both before and after SD. E2 also suppressed NREM and increased waking in the early- to mid-dark phase on the day after SD. NREM delta power tracked NREM sleep before and after SD, with small hormone-dependent reductions in delta power in recovery, but not spontaneous sleep. These results demonstrate that E2 powerfully and specifically suppresses spontaneous and recovery REM sleep in the dark phase, and suggest that ovarian steroids may consolidate circadian sleep-wake rhythms.
Schwartz, Michael D.; Mong, Jessica A.
Sleep disruption is a growing problem that may have serious health effects. As stress-induced increases in cortisol are thought to be a key adaptive process it is important to examine how this response is affected by sleep. The current study investigated the association of four sleep parameters (objective\\/subjectively measured sleep quality and quantity) and subsequent salivary cortisol reactivity (maximal change
Caroline E. Wright; Heiddis B. Valdimarsdottir; Joel Erblich; Dana H. Bovbjerg
Paroxysmal nocturnal hemoglobinuria Related Gene(s) References Quick links to this topic MedlinePlus Health information Genetic and Rare Diseases Information Center Information about genetic conditions and rare diseases ...
Aim:Disrupted sleep may be a prodromal symptom or a predictor of depressive disorders. In this study we investigated the relationship between depression symptoms and disrupted sleep using a novel model of stress-mimicked sleep disorders in rats.Methods:SD rats were injected with corticosterone (10, 20 or 40 mg/kg, sc) or vehicle for 7 d. Their sleep-wake behavior was monitored through implanted EEG and EMG electrodes. Their depressive behaviors were assessed using forced swim test, open field test and sucrose preference test.Results:The corticosterone-treated rats showed significantly reduced sleep time, disinhibition of rapid-eye-movement (REM) sleep and altered power spectra during non-REM sleep. All depressive behavioral tests did not show significant difference across the groups. However, individual correlation analysis revealed statistically significance: the immobility time (despair) was negatively correlated with REM sleep latency, slow wave sleep (SWS) time ratio, SWS bouts and delta power density, and it was positively correlated with REM sleep bouts and beta power density. Meanwhile, sucrose preference (anhedonia) was positively correlated with total sleep time and light sleep bouts, and it was negatively correlated with the REM sleep time ratio.Conclusion:In stress-mimicked rats, sleep disturbances are a predictor of depressive disorders, and certain symptoms of depression may be related to the disruption of several specific sleep parameters. PMID:24989251
Wang, Zi-Jun; Yu, Bin; Zhang, Xue-Qiong; Sheng, Zhao-Fu; Li, Sheng-Jie; Huang, Yuan-Li; Cao, Qing; Cui, Xiang-Yu; Cui, Su-Ying; Zhang, Yong-He
Objective: To assess the prevalence and comorbid conditions of nocturnal wandering with abnormal state of consciousness (NW) in the American general population. Methods: Cross-sectional study conducted with a representative sample of 19,136 noninstitutionalized individuals of the US general population ?18 years old. The Sleep-EVAL expert system administered questions on life and sleeping habits; health; and sleep, mental, and organic disorders (DSM-IV-TR; International Classification of Sleep Disorders, version 2; International Classification of Diseases–10). Results: Lifetime prevalence of NW was 29.2% (95% confidence interval [CI] 28.5%–29.9%). In the previous year, NW was reported by 3.6% (3.3%–3.9%) of the sample: 1% had 2 or more episodes per month and 2.6% had between 1 and 12 episodes in the previous year. Family history of NW was reported by 30.5% of NW participants. Individuals with obstructive sleep apnea syndrome (odds ratio [OR] 3.9), circadian rhythm sleep disorder (OR 3.4), insomnia disorder (OR 2.1), alcohol abuse/dependence (OR 3.5), major depressive disorder (MDD) (OR 3.5), obsessive-compulsive disorder (OCD) (OR 3.9), or using over-the-counter sleeping pills (OR 2.5) or selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 3.0) were at higher risk of frequent NW episodes (?2 times/month). Conclusions: With a rate of 29.2%, lifetime prevalence of NW is high. SSRIs were associated with an increased risk of NW. However, these medications appear to precipitate events in individuals with a prior history of NW. Furthermore, MDD and OCD were associated with significantly greater risk of NW, and this was not due to the use of psychotropic medication. These psychiatric associations imply an increased risk due to sleep disturbance.
Mahowald, M.W.; Dauvilliers, Y.; Krystal, A.D.; Leger, D.
1.The compound eyes of three species ofCamponotus ants, one exclusively nocturnal (Camponotus irritans), one crepuscular and nocturnal (Camponotus ligniperda), and the third diurnal (Camponotus detritus) are compared with respect to day\\/night light sensitivity changes. AsCamponotus detritus sometimes stays outside the nest during the night, the strictly diurnal speciesCataglyphis bicolor is included in the comparison. Even though all four species are
At the same time their biological systems program them for later sleep and waking times, adolescents' schedules and lifestyles keep them from getting a healthy amount of sleep. Although a few schools have altered their schedules, most are confounded by costs and contractual complications. Minnesota schools are leaders. (MLH)
A telephone survey of 1166 community resident seniors (658 male, 508 female, age between 65 and 97 years, mean 74.8 years) was undertaken, which included among other components telephone versions of the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Sleep Timing Questionnaire (STQ). The median PSQI score was 5 and the median ESS score 6, suggesting that neither sleep problems, nor daytime sleepiness problems, were particularly prevalent in this sample of seniors. The STQ indicated that the habitual timing of the sleep episode appeared to be within the usual 11 pm to 7:30 am range, with about 7.5 hours of actual sleep within that interval being reported. There was, however, a sizable minority who broke this pattern, with 25% of the sample reporting less than 6.7 hours of sleep, and problems with nocturnal sleep and daytime sleepiness.
Monk, Timothy H.; Buysse, Daniel J.; Schlarb, Janet E.; Beach, Scott R.
This sleep research explored the effect of total sleep loss, sleep stage deprivation, gradual sleep reduction, and the effect of varying the sleep/wake schedule. While subjects are unable to function effectively without sleep, the type of sleep obtained i...
L. C. Johnson P. Naitoh J. M. Moses A. Lubin
Concerns regarding sleep disorders in Hmong immigrants in the US emerged when an astonishingly high mortality rate of Sudden Unexplained Nocturnal Death Syndrome (SUNDS) was documented in Hmong men. Stress, genetics, and cardiac abnormalities interacting with disordered sleep were hypothesized as contributing factors to SUNDS. Most recently, sleep apnea has been implicated in nighttime deaths of Brugada Syndrome. This syndrome is thought to comprise a spectrum of sudden cardiac death disorders, including SUNDS. However, little research since has placed SUNDS in its context of Hmong cultural beliefs, health, or the prevalence of other sleep disorders. Because the epidemiology of sleep disorders and terrifying nighttime experiences in Hmong is poorly documented, we investigated the prevalence and correlates of sleep apnea, rapid eye movement (REM) sleep stage related disorders, and insomnia in 3 population-based samples (collected from 1996 to 2001) comprising 747 Hmong immigrants in Wisconsin. Participants were questioned on sleep problems, cultural beliefs, health, and other factors. A random subsample (n = 37) underwent in-home polysomnography to investigate sleep apnea prevalence. Self-report and laboratory findings were compared with similarly collected data from the Wisconsin Sleep Cohort (WSC) study (n = 1170), a population-based longitudinal study of sleep. The results inform a unique Hmong sleep disorder profile of a high prevalence of sleep apnea, sleep paralysis, and other REM-related sleep abnormalities as well the interaction of culturally related nighttime stressors with these sleep problems. For example, experiences of dab tsog (frightening night spirit pressing on chest) was prevalent and related to sleep apnea indicators, sleep paralysis, nightmares, hypnogogic hallucinations, and insomnia. Understanding the role of sleep disorders and the cultural mechanisms that may trigger or condition response to them could ultimately provide a basis for screening and intervention to reduce the adverse health and emotional consequences of these conditions in Hmong.
Young, Eric; Xiong, Se; Finn, Laurel; Young, Terry
Concerns regarding sleep disorders in Hmong immigrants in the US emerged when an astonishingly high mortality rate of Sudden Unexplained Nocturnal Death Syndrome (SUNDS) was documented in Hmong men. Stress, genetics, and cardiac abnormalities interacting with disordered sleep were hypothesized as contributing factors to SUNDS. Most recently, sleep apnea has been implicated in nighttime deaths of Brugada Syndrome. This syndrome is thought to comprise a spectrum of sudden cardiac death disorders, including SUNDS. However, little research since has placed SUNDS in its context of Hmong cultural beliefs, health, or the prevalence of other sleep disorders. Because the epidemiology of sleep disorders and terrifying nighttime experiences in Hmong is poorly documented, we investigated the prevalence and correlates of sleep apnea, rapid eye movement (REM) sleep stage related disorders, and insomnia in 3 population-based samples (collected from 1996 to 2001) comprising 747 Hmong immigrants in Wisconsin. Participants were questioned on sleep problems, cultural beliefs, health, and other factors. A random subsample (n = 37) underwent in-home polysomnography to investigate sleep apnea prevalence. Self-report and laboratory findings were compared with similarly collected data from the Wisconsin Sleep Cohort (WSC) study (n = 1170), a population-based longitudinal study of sleep. The results inform a unique Hmong sleep disorder profile of a high prevalence of sleep apnea, sleep paralysis, and other REM-related sleep abnormalities as well the interaction of culturally related nighttime stressors with these sleep problems. For example, experiences of dab tsog (frightening night spirit pressing on chest) was prevalent and related to sleep apnea indicators, sleep paralysis, nightmares, hypnogogic hallucinations, and insomnia. Understanding the role of sleep disorders and the cultural mechanisms that may trigger or condition response to them could ultimately provide a basis for screening and intervention to reduce the adverse health and emotional consequences of these conditions in Hmong. PMID:22832325
Young, Eric; Xiong, Se; Finn, Laurel; Young, Terry
Objective: We report a series of seven consecutive cases of catathrenia (sleep related groaning) that differ from limited previous reports in the literature with regard to sleep stage and response to treatment. Background: Catathrenia was recently defined as a parasomnia in the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2), but there is debate about its classification, and its response to CPAP is unknown. Methods: We present 7 consecutive patients presenting with catathrenia over a 5-year period. They were all young women, ranging in age from 20 to 34 years with a body mass index (BMI) <25. They underwent standard clinical evaluation, questionnaires, physical exam, craniofacial evaluations, and nocturnal polysomnography. All seven were titrated on continuous passive airway pressure (CPAP) treatment for sleep disordered breathing then offered surgical treatment if unable to tolerate or adhere to CPAP recommendations. Results: Groaning was present throughout all stages of sleep. The mean (SD) AHI and RDI were 3.2 (0.56) and 13.1 (2.4) respectively. CPAP resolved groaning in all cases. 5 patients (71%) elected subsequent surgical intervention. Three of the 4 that followed up after surgery required adjuvant oral appliance treatment, but all four ultimately had resolution of groaning. Conclusions: Catathrenia may have subtypes related to sleep stage specificity or presence of sleep disordered breathing. In our heterogeneous group of non-obese women with a normal AHI and elevated RDI, CPAP and select soft tissue surgeries of the upper airway (often augmented with an oral appliance) successfully treated nocturnal groaning. Citation: Guilleminault C; Hagen CC; Khaja AM. Catathrenia: parasomnia or uncommon feature of sleep disordered breathing?. SLEEP 2008;31(1):132-139.
Guilleminault, Christian; Hagen, Chad C.; Khaja, Aliuddin M
Sleep-disordered breathing and sleep-related motor phenomena are part of the clinical spectrum of multiple system atrophy (MSA). Stridor has been attributed to denervation of laryngeal muscles or instead to dystonic vocal cord motion. We studied 3 patients with nocturnal stridor in the setting of MSA. All patients underwent nocturnal videopolysomnography (VPSG) with breathing and heart rate, O(2) saturation and intra-esophageal pressure recordings, and simultaneous EMG recordings of the posterior cricoarytenoid, cricothyroid, and thyroarytenoid muscles and continuous vocal cord motion evaluation by means of fiberoptic laryngoscopy. VPSG/EMG and fiberoptic laryngoscopy documented normal vocal cord motion without denervation during wake and stridor only during sleep when hyperactivation of vocal cords adductors appeared in the absence of significant O(2) desaturation. All patients had tachycardia and tachypnea and paradoxical breathing during sleep, erratic intercostalis and diaphragmatic EMG activity and Rem sleep behavior disorder. One of the patients had restless legs syndrome with periodic limb movement during sleep and excessive fragmentary hypnic myoclonus. In conclusion, our patients with MSA had nocturnal stridor due to sleep-related laryngeal dystonia. Stridor was associated with other abnormal sleep-related respiratory and motor disorders, suggesting an impairment of homeostatic brainstem integration in MSA. PMID:17266093
Vetrugno, Roberto; Liguori, Rocco; Cortelli, Pietro; Plazzi, Giuseppe; Vicini, Claudio; Campanini, Aldo; D'Angelo, Roberto; Provini, Federica; Montagna, Pasquale
Shortened nocturnal sleep impairs morning glucose tolerance. The underlying mechanism of this effect is supposed to involve a reduced fraction of slow wave sleep (SWS). However, it remains unanswered if impaired glucose tolerance occurs due to specific SWS reduction or a general disturbance of sleep. Sixteen healthy men participated in three experimental conditions in a crossover design: SWS suppression, rapid eye movement (REM)-sleep disturbance, and regular sleep. Selective sleep stage disturbance was performed by means of an acoustic tone (532Hz) with gradually rising sound intensity. Blood concentrations of glucoregulatory parameters were measured upon an oral glucose tolerance test the next morning. Our data show that morning plasma glucose and serum insulin responses were significantly increased after selective SWS suppression. Moreover, SWS suppression reduced postprandial insulin sensitivity up to 20%, as determined by Matsuda Index. Contrastingly, disturbed REM-sleep did not affect glucose homeostasis. We conclude that specifically SWS reduction is critically involved in the impairment of glucose tolerance associated with disturbed sleep. Therefore, glucose metabolism in subjects predisposed to reduced SWS (e.g. depression, aging, obstructive sleep apnea, pharmacological treatment) should be thoroughly monitored. PMID:23602132
Herzog, Nina; Jauch-Chara, Kamila; Hyzy, Franziska; Richter, Annekatrin; Friedrich, Alexia; Benedict, Christian; Oltmanns, Kerstin M
Background—Enhanced nocturnal heart rate variability (HRV) has been evoked in sleep-related breathing disorders. However, its capacity to detect obstructive sleep apnea syndrome (OSAS) has not been systematically determined. Thus, we evaluated the discriminant power of HRV parameters in a first group of patients (G1) and validated their discriminant capacity in a second group (G2). Methods and Results—In G1, 39 of
Frederic Roche; Jean-Michel Gaspoz; Isabelle Court-Fortune; Pascal Minini; Vincent Pichot; David Duverney; Frederic Costes; Jean-Claude Barthelemy
Aim To compare pulse oximetry in children with sickle cell anaemia (SCA) and controls and test the hypothesis that vitamin C deficiency (VCD; <11.4 ?mol/L) is associated with nocturnal haemoglobin oxygen desaturation in SCA. Methods We undertook nocturnal and daytime pulse oximetry in 23 children with SCA (median age 8 years) with known steady-state plasma vitamin C concentrations and 18 siblings (median 7 years). Results Median nocturnal delta 12 s index (delta12 s), a measure of haemoglobin oxygen saturation (SpO2) variability, was 0.38 (interquartile range 0.28–0.51) in SCA and 0.35 (0.23–0.48) in controls, with 9/23 and 6/18, respectively, having a delta12 s >0.4, compatible with obstructive sleep apnoea (OSA). Eleven of twenty-three with SCA had VCD; logged vitamin C concentrations showed a 66% decrease per 0.1 unit increase in delta12 s ([95% CI ?86%, ?15%]; p = 0.023) and delta12 s >0.4 was associated with VCD (odds ratio 8.75 [1.24–61.7], p = 0.029). Daytime and mean nocturnal SpO2 were lower in SCA but there was no association with vitamin C. Conclusion Obstructive sleep apnoea (OSA), detected from nocturnal haemoglobin oxygen saturation variability, is common in Tanzanian children and associated with vitamin C Deficiency in SCA. The direction of causality could be determined by comparing OSA treatment with vitamin C supplementation.
Cox, SE; L'Esperance, V; Makani, J; Soka, D; Hill, CM; Kirkham, FJ
Objective Cognitive impairment is a common nonmotor symptom of Parkinson’s disease (PD) and is associated with high mortality, caregiver distress, and nursing home placement. The risk factors for cognitive decline in PD patients include advanced age, longer disease duration, rapid eye movement sleep behavior disorder, hallucinations, excessive daytime sleepiness, and nontremor symptoms including bradykinesia, rigidity, postural instability, and gait disturbance. We conducted a cross-sectional study to determine which types of sleep disturbances are related to cognitive function in PD patients. Methods A total of 71 PD patients (29 males, mean age 66.46 ± 8.87 years) were recruited. All patients underwent the Mini- Mental State Examination (MMSE) and the Korean Version of the Montreal Cognitive Assessments (MoCA-K) to assess global cognitive function. Sleep disorders were evaluated with the Stanford Sleepiness Scale, Epworth Sleepiness Scale, Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index, and Parkinson’s Disease Sleep Scale in Korea (PDSS). Results The ISI was correlated with the MMSE, and total PDSS scores were correlated with the MMSE and the MoCA-K. In each item of the PDSS, nocturnal restlessness, vivid dreams, hallucinations, and nocturnal motor symptoms were positively correlated with the MMSE, and nocturnal restlessness and vivid dreams were significantly related to the MoCA-K. Vivid dreams and nocturnal restlessness are considered the most powerful correlation factors with global cognitive function, because they commonly had significant correlation to cognition assessed with both the MMSE and the MoCA-K. Conclusions We found a correlation between global cognitive function and sleep disturbances, including vivid dreams and nocturnal restlessness, in PD patients.
Kim, Eun Ja; Baek, Joon Hyun; Shin, Dong Jin; Park, Hyeon-Mi; Lee, Yeong-Bae; Park, Kee-Hyung; Shin, Dong Hoon; Noh, Young; Sung, Young Hee
Given the relationship between sleep and plasticity, we examined the role of Extracellular signal-regulated kinase (ERK) in regulating baseline sleep, and modulating the response to waking experience. Both sleep deprivation and social enrichment increase ERK phosphorylation in wild-type flies. The effects of both sleep deprivation and social enrichment on structural plasticity in the LNvs can be recapitulated by expressing an active version of ERK (UAS-ERKSEM) pan-neuronally in the adult fly using GeneSwitch (Gsw) Gsw-elav-GAL4. Conversely, disrupting ERK reduces sleep and prevents both the behavioral and structural plasticity normally induced by social enrichment. Finally, using transgenic flies carrying a cAMP response Element (CRE)-luciferase reporter we show that activating ERK enhances CRE-Luc activity while disrupting ERK reduces it. These data suggest that ERK phosphorylation is an important mediator in transducing waking experience into sleep.
Vanderheyden, William M.; Gerstner, Jason R.; Tanenhaus, Anne; Yin, Jerry C.; Shaw, Paul J.
Maintaining a stable and adequate sleeping pattern is associated with good health and disease prevention. As a restorative process, sleep is important for supporting immune function and aiding the body in healing and recovery. Aging is associated with characteristic changes to sleep quantity and quality, which make it more difficult to adjust sleep–wake rhythms to changing environmental conditions. Sleep disturbance and abnormal sleep–wake cycles are commonly reported in seriously ill older patients in the intensive care unit (ICU). A combination of intrinsic and extrinsic factors appears to contribute to these disruptions. Little is known regarding the effect that sleep disturbance has on health status in the oldest of old (80+), a group, who with diminishing physiological reserve and increasing prevalence of frailty, is at a greater risk of adverse health outcomes, such as cognitive decline and mortality. Here we review how sleep is altered in the ICU, with particular attention to older patients, especially those aged ?80 years. Further work is required to understand what impact sleep disturbance has on frailty levels and poor outcomes in older critically ill patients.
Sterniczuk, Roxanne; Rusak, Benjamin; Rockwood, Kenneth
In this activity about sleep rhythms (on page 25 of the PDF), learners will investigate how changing the time they go to bed impacts their own sleep patterns. For one night, learners will go to bed one hour earlier than usual. They will observe and record any impacts that this change has on their abilities to fall asleep, and on their usual wake times the next morning. This lesson guide includes background information, setup and management tips, extensions and a handout.
Moreno, Nancy P.; Tharp, Barbara Z.; Vogt, Greg L.
Some of our best descriptions of sleep disorders come from literature. While Shakespeare is well known for his references to insomnia and sleep walking, his works also demonstrate a keen awareness of many other sleep disorders. This paper examines sleep themes in Shakespeare's play Othello. The play indicates Shakespeare's astute eye for sleep deprivation, sexual parasomnias, and effects of stress and drugs on sleep. Citation: Dimsdale JE. Sleep in Othello. J Clin Sleep Med 2009;5(3):280-281.
Dimsdale, Joel E.
The automatic computation of the hypnogram and sleep Parameters, from the data acquired with portable sensors, is a challenging problem with important clinical applications. In this paper, the hypnogram, the sleep efficiency (SE), rapid eye movement (REM), and nonREM (NREM) sleep percentages are automatically estimated from physiological (ECG and respiration) and behavioral (Actigraphy) nocturnal data. Two methods are described; the first deals with the problem of the hypnogram estimation and the second is specifically designed to compute the sleep parameters, outperforming the traditional estimation approach based on the hypnogram. Using an extended set of features the first method achieves an accuracy of 72.8%, 77.4%, and 80.3% in the detection of wakefulness, REM, and NREM states, respectively, and the second an estimation error of 4.3%, 9.8%, and 5.4% for the SE, REM, and NREM percentages, respectively. PMID:24845281
Domingues, Alexandre; Paiva, Teresa; Sanches, J Miguel
... disorder catalog Conditions > Autosomal dominant nocturnal frontal lobe epilepsy (often shortened to ADNFLE ) On this page: Description ... What is ADNFLE? Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is an uncommon form of epilepsy that ...
Study Objectives: In adults with narcolepsy, periodic limb movements of sleep (PLMS) occur more frequently than in control population, and presence of increased PLMS is associated with greater sleep disruption and shorter mean sleep latency. This study was performed to determine whether PLMS are common in children with narcolepsy, and whether the presence of PLMS is associated with greater sleep disruption. Design: Demographic and polysomnographic information were collected from consecutive patients diagnosed with narcolepsy identified retrospectively by diagnosis-based search. Descriptive data were compiled, and sleep characteristics of children with and without PLMS were compared. Setting: Sleep disorders center in a children's hospital. Patients: 44 patients, 6-19 years old (mean 13 years, SD 3.57), were identified. Twenty-eight were African American. Interventions: None. Measurements and Results: Four patients had a PLMS index (PLMI) ? 5/h (considered abnormal in literature). Sixteen (36%) had “any PLMS” (PLMI > 0/h). The mean PLMI was 1.3/h (SD 2.5). Sleep was significantly more disrupted, and the mean sleep latency was shorter in patients with “any PLMS” as compared to those with no PLMS. There was no correlation between the PLMI and other diagnostic criteria for narcolepsy. “Any PLMS” were present equally in children of African American and Caucasian heritage, 35.7% vs. 37.5%. Conclusions: As in adults, children with PLMS and narcolepsy have more sleep disruption and shorter mean sleep latencies than those with narcolepsy but without PLMS. Our findings also suggest that the use of adult criteria for diagnosis of “significant” PLMS in children may not be sufficiently sensitive. Citation: Jambhekar SK; Com G; Jones E; Jackson R; Castro MM; Knight F; Carroll JL; Griebel ML. Periodic limb movements during sleep in children with narcolepsy. J Clin Sleep Med 2011;7(6):597–601.
Jambhekar, Supriya K.; Com, Gulnur; Jones, Elizabeth; Jackson, Rithea; Castro, Maria Melguizo; Knight, Frances; Carroll, John L.; Griebel, May L.
Psychological stressors have a prominent effect on sleep in general, and rapid eye movement (REM) sleep in particular. Disruptions in sleep are a prominent feature, and potentially even the hallmark, of posttraumatic stress disorder (PTSD) (Ross, R.J., Ball, W.A., Sullivan, K., Caroff, S., 1989. Sleep disturbance as the hallmark of posttraumatic stress disorder. American Journal of Psychiatry 146, 697-707). Animal models are critical in understanding both the causes and potential treatments of psychiatric disorders. The current review describes a number of studies that have focused on the impact of stress on sleep in rodent models. The studies are also in Table 1, summarizing the effects of stress in 4-h blocks in both the light and dark phases. Although mild stress procedures have sometimes produced increases in REM sleep, more intense stressors appear to model the human condition by leading to disruptions in sleep, particularly REM sleep. We also discuss work conducted by our group and others looking at conditioning as a factor in the temporal extension of stress-related sleep disruptions. Finally, we attempt to describe the probable neural mechanisms of the sleep disruptions. A complete understanding of the neural correlates of stress-induced sleep alterations may lead to novel treatments for a variety of debilitating sleep disorders. PMID:17764741
Pawlyk, Aaron C; Morrison, Adrian R; Ross, Richard J; Brennan, Francis X
Objectives Parents of children with opsoclonus-myoclonus syndrome (OMS) frequently describe poor sleep and rage attacks. We hypothesized that these manifestations are related and could result from underlying monoaminergic dysfunction. Study design We clinically characterized the sleep and behavioral characteristics of 51 young children with OMS; 19 of those with the most disruptive sleep patterns were treated with trazodone, a soporific
MICHAEL R. PRANZATELLI; ELIZABETH D. TATE; WILLIAM S. DUKART; MARY Jo FLINT; MICHAEL T. HOFFMAN; AMY E. OKSA
Obstructive sleep apnea is a chronic condition characterized by frequent episodes of upper airway collapse during sleep. Its effect on nocturnal sleep quality and ensuing daytime fatigue and sleepiness are widely acknowledged. Increasingly, obstructive sleep apnea is also being recognized as an independent risk factor for several clinical consequences, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. Estimates of disease prevalence are in the range of 3% to 7%, with certain subgroups of the population bearing higher risk. Factors that increase vulnerability for the disorder include age, male sex, obesity, family history, menopause, craniofacial abnormalities, and certain health behaviors such as cigarette smoking and alcohol use. Despite the numerous advancements in our understanding of the pathogenesis and clinical consequences of the disorder, a majority of those affected remain undiagnosed. Simple queries of the patient or bed-partner for the symptoms and signs of the disorder, namely, loud snoring, observed apneas, and daytime sleepiness, would help identify those in need of further diagnostic evaluation. The primary objective of this article is to review some of the epidemiologic aspects of obstructive sleep apnea in adults.
Punjabi, Naresh M.
In acute stroke, OSA has been found to impair rehabilitation and increase mortality but the effect of central apnea is more unclear. The aim of the present study was to evaluate the feasibility of using limited ambulatory recording system (sleep mattress to evaluate nocturnal breathing and EOG-electrodes for sleep staging) in sleep disordered breathing (SDB) diagnostics in mild acute cerebral ischemia patients and to discover the prevalence of various SDB-patterns among these patients. 42 patients with mild ischemic stroke or transient ischemic attack were studied. OSA was found in 22 patients (52.4%). Central apnea was found in two patients (4.8%) and sustained partial obstruction in only one patient (2.4%). Sleep staging with EOG-electrodes only yielded a similar outcome as scoring with standard rules. OSA was found to be common even after mild stroke. Its early diagnosis and treatment would be favourable in order to improve recovery and reduce mortality. Our results suggest that OSA can be assessed by a limited recording setting with EOG-electrodes, sleep mattress, and pulse oximetry.
Vayrynen, Kirsi; Numminen, Heikki; Miettinen, Katja; Keso, Anna; Tenhunen, Mirja; Huhtala, Heini
Melatonin, the hormone produced nocturnally by the pineal gland, is an endogenous regulator of the sleep–wake cycle. The effects of melatonin on brain activities and their relation to induction of sleepiness were studied in a randomized, double-blind, placebo controlled functional magnetic resonance imaging (fMRI) study. Melatonin, but not placebo, reduced task-related activity in the rostro-medial aspect of the occipital cortex
Tali Gorfine; Yaniv Assaf; Yonatan Goshen-Gottstein; Yaara Yeshurun; Nava Zisapel
Noxious stimuli and painful disorders interfere with sleep, but disturbances in sleep also contribute to the experience of pain.Chronic paroxysmal hemicrania and possibly cluster headaches are related to REM sleep. Whereas headache is associated with snoring and sleep apnea, morning headaches are not specific for any primary sleep disorder. Nevertheless, the management of the sleep disorder ameliorates both morning headache
Disorders of sleep afflict over half of the people 65 and older who live at home and about two thirds of those who live in long-term care facilities. Problems of nighttime sleep and daytime wakefulness disrupt not only the older persons' lives but also th...
L. J. Klein L. D. Ulincy A. A. Monjan
Eight ambulant children aged 6-13 years, four with congenital myopathy, two with congenital muscular dystrophy and two with the rigid spine syndrome, presented with recurrent chest infections, morning headaches, shallow breathing at night, or respiratory failure. Polysomnography confirmed the presence of nocturnal hypoxaemia with oxygen saturation on average less than 90% for 49% of sleep and less than 80% for
Y Khan; J Z Heckmatt; V Dubowitz
The association between nocturnal apneas and transient pulmonary hypertension (PHT) has been well documented. However, there is controversy over the frequency and pathophysiological mechanisms of daytime pulmonary hypertension in patients with obstructive sleep apnea (OSAS). The present study sought to evaluate frequency and mechanisms of pulmonary hypertension in patients with OSAS. It included 49 consecutive patients with polysomnographically proven OSAS
M. Hetzel; M. Kochs; N. Marx; H. Woehrle; I. Mobarak; V. Hombach; J. Hetzel
Background. Sleep apnoea (SA) is often observed in haemodialysis patients, but there have been few studies on types of SA and their predictors. We therefore investigated the prevalence and types of SA and the associations between types of SA and clinical factors in haemodialysis patients. Methods. We initially examined nocturnal oxygen desaturation index (ODI) (desaturation of >4%\\/ events per hour)
Takeshi Tada; Kengo Fukushima Kusano; Aiko Ogawa; Jun Iwasaki; Satoru Sakuragi; Isao Kusano; Seiko Takatsu; Masashi Miyazaki; Tohru Ohe
Preeclampsia is the predominant cause of admissions to neonatal intensive care. The diurnal blood pressure pattern is flattened or reversed in preeclampsia. We hypothesized that snoring and par- tial upper airway obstruction contribute to nocturnal rises in blood pressure. We tested this hypothesis by controlling sleep- induced upper airway flow limitation and snoring with nasal posi- tive pressure. Eleven women
N. EDWARDS; D. M. BLYTON; T. KIRJAVAINEN; G. J. KESBY; C. E. SULLIVAN
Background: Cardiovascular complications are common in patients with obstructive sleep apnea (OSA). Blood rheology is a major determent of coagulation and an established risk factor for cardiovascular events. Since nocturnal hypoxemia could influence parameters of blood rheology, we hypothesized that OSA alters blood rheology independent of other cardiovascular risk factors. Methods: One hundred and ten consecutive patients admitted to the
Stephan Steiner; Thomas Jax; Stefanie Evers; Marcus Hennersdorf; Andreas Schwalen; Bodo E. Strauer
The urofacial syndrome is a rare condition that occurs in both genders and characterized by uropathy and facial abnormalities. Early diagnosis is crucial for the management and prognosis of urinary problems. Paradoxical inversion of facial musculature when smiling, giving an appearance of crying associated with severe urinary tract dysfunction is typical in these patients. Although facial signs and symptoms are generally ignored and shadowed by the dominant bladder symptoms, we have recently realized a unique but constant finding in majority of these patients, nocturnal lagophthalmos which is described as inability to close the eyelids during sleep. We report 15 patients with urofacial syndrome (Ochoa) whom mostly had admitted with major urological symptoms and 12 of the cases had nocturnal lagophthalmos. Lagophthalmos may lead to keratitis, corneal abrasion, infection, vascularization, and in extreme cases, ocular perforation, endophthalmitis and loss of the eye. Basic modalities like lubricant drops during the day and ointments at night are usually enough to protect the cornea from exposure keratopathy. In moderate to severe cases, overnight taping of the lid or the use of a moisture chamber might be necessary. Majority of our patients responded to basic therapy. Conclusion Nocturnal lagophthalmos is a novel symptom described in patients with urofacial syndrome. The pediatricians and urologists should be careful about this symptom to prevent eye damage and quality of life problems. PMID:24248520
Mermerkaya, Murat; Süer, Evren; Oztürk, Erdem; Gülp?nar, Omer; Gökçe, Mehmet Ilker; Yalç?nda?, Fatime Nilüfer; Soygür, Tarkan; Burgu, Berk
Sleep apnea is an entity characterized by repetitive upper airway obstruction resulting in nocturnal hypoxia and sleep fragmentation. It is estimated that 2%–4% of the middle-aged population has sleep apnea with a predilection in men relative to women. Risk factors of sleep apnea include obesity, gender, age, menopause, familial factors, craniofacial abnormalities, and alcohol. Sleep apnea has been increasingly recognized as a major health burden associated with hypertension and increased risk of cardiovascular disease and death. Increased airway collapsibility and derangement in ventilatory control responses are the major pathological features of this disorder. Polysomnography (PSG) is the gold-standard method for diagnosis of sleep apnea and assessment of sleep apnea severity; however, portable sleep monitoring has a diagnostic role in the setting of high pretest probability sleep apnea in the absence of significant comorbidity. Positive pressure therapy is the mainstay therapy of sleep apnea. Other treatment modalities, such as upper airway surgery or oral appliances, may be used for the treatment of sleep apnea in select cases. In this review, we focus on describing the sleep apnea definition, risk factor profile, underlying pathophysiologic mechanisms, associated adverse consequences, diagnostic modalities, and treatment strategies.
Gharibeh, Tarek; Mehra, Reena
Sleeping sites, their patterns of use, and cryptic pre-retirement behavior mitigate predation risk at sleeping sites and could influence prey fitness. We evaluated sleeping-site usage for 10 groups of golden lion tamarins (GLTs) from a population that recently suffered a substantial decline due to predation at sleeping sites. We recorded the average number of nights that groups spent at their different sleeping sites to determine whether patterns of sleeping-site use were influenced by predation risk, as measured by the rate of encounters with predators, or the availability of suitable sleeping sites, as measured by the size of a group's home range and amount of mature forest within their home range. In addition, we measured travel speed to sleeping sites and compared this speed with that recorded at other times of day. GLT groups spent more nights on average at each of their sleeping sites compared to other callitrichid species for which data are available. Predation risk and habitat characteristics were not significant predictors of how many times groups used each of their different sleeping sites. Groups significantly increased their travel speed just before entering the sleeping site. Rapid locomotion to secure tree cavities may help GLTs avoid crepuscular and nocturnal predators; however, we speculate that this strategy failed numerous GLTs in our study population during the previous decade because they used sleeping sites that were accessible to predators. PMID:17154389
Franklin, Samuel P; Hankerson, Sarah J; Baker, Andrew J; Dietz, James M
Epidemiological studies have shown that playing a computer game at night delays bedtime and shortens sleeping hours, but the effects on sleep architecture and quality have remained unclear. In the present study, the effects of playing a computer game and using a bright display on nocturnal sleep were examined in a laboratory. Seven male adults (24.7+/-5.6 years old) played exciting computer games with a bright display (game-BD) and a dark display (game-DD) and performed simple tasks with low mental load as a control condition in front of a BD (control-BD) and DD (control-DD) between 23:00 and 1:45 hours in randomized order and then went to bed at 2:00 hours and slept until 8:00 hours. Rectal temperature, electroencephalogram (EEG), heart rate and subjective sleepiness were recorded before sleep and a polysomnogram was recorded during sleep. Heart rate was significantly higher after playing games than after the control conditions, and it was also significantly higher after using the BD than after using the DD. Subjective sleepiness and relative theta power of EEG were significantly lower after playing games than after the control conditions. Sleep latency was significantly longer after playing games than after the control conditions. REM sleep was significantly shorter after the playing games than after the control conditions. No significant effects of either computer games or BD were found on slow-wave sleep. These results suggest that playing an exciting computer game affects sleep latency and REM sleep but that a bright display does not affect sleep variables. PMID:16120101
Higuchi, Shigekazu; Motohashi, Yutaka; Liu, Yang; Maeda, Akira
Introduction: There is a general consensus that sleep disruption in children causes daytime behavioral deficits. It is unclear if sleep disruption in children with eczema has similar effects particularly after controlling for known comorbid disorders such as asthma and rhinitis. Methods: Parents of children (6-16 y) with eczema (n = 77) and healthy controls (n = 30) completed a validated omnibus questionnaire which included the Sleep Disturbance Scale for Children, Conners Parent Rating Scale-Revised (S), Child Health Questionnaire, Children's Dermatology Life Quality Index, and additional items assessing eczema, asthma, rhinitis, and demographics. Results: Compared to controls, children with eczema had a greater number of sleep problems with a greater percentage in the clinical range, lower quality of life, and higher levels of ADHD and oppositional behavior. They also had elevated rhinitis and asthma severity scores. Importantly, structural equation modelling revealed that the effect of eczema on the behavioral variables of Hyperactivity, ADHD Index, and Oppositional Behaviors were mediated through sleep with no direct effect of eczema on these behaviors. The comorbid atopic disorders of rhinitis and asthma also had independent effects on behavior mediated through their effects on sleep. Conclusions: The present findings suggest that the daytime behaviors seen in children with eczema are mediated independently by the effects of eczema, asthma, and rhinitis on sleep quality. These findings highlight the importance of sleep in eczematous children and its role in regulating daytime behavior. Citation: Camfferman D; Kennedy JD; Gold M; Martin AJ; Winwood P; Lushington K. Eczema, sleep, and behavior in children. J Clin Sleep Med 2010;6(6):581-588.
Camfferman, Danny; Kennedy, J. Declan; Gold, Michael; Martin, A. James; Winwood, Peter; Lushington, Kurt
Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder causing motor and non-motor symptoms. The latter are common and include autonomic dysfunction, cognitive impairment, and sleep difficulties. Many of the non-motor aspects of PD such as sleep disturbance are more common and significantly affect the day-to-day activities of patients and their quality of life. The most important aim of this study was to evaluate the sleep quality in patients with PD. Methods: This case-control study was performed on patients with PD referred to the Neurology Clinic of our teaching hospital in 2011. Thirty-four patients with PD and 34 healthy people as control group were enrolled in this study. Sleep quality of patients and control was evaluated by Parkinson's disease sleep scale (PDSS) questionnaire. PDSS is a reliable and valid tool to measure sleep disorders in PD. Results: The mean total PDSS score in patient group was 55.29 (SD = 26.92) indicating moderate to severe sleep disturbances whereas, the mean total score in control group was 20.34 (SD = 10.65). Difference between the two groups’ mean scores was significant (P < 0.05). Conclusions: Our study demonstrated that patients with PD experienced poorer nocturnal sleep quality than the control group.
Najafi, Mohammad Reza; Chitsaz, Ahmad; Askarian, Zahra; Najafi, Mohammad Amin
The sleep electroencephalogram (EEG) was recorded from anterior (Fz/Cz) and posterior (Pz/Oz) bipolar derivations in two developmental groups: 20 pre- or early pubertal (Tanner 1/2, mean age 11.4 +/- 1.1 years, 11 boys) and 20 late pubertal or mature adolescents (Tanner 4/5, 14.1 +/- 1.3 years, 8 boys). A sleep-state independent reduction of EEG power over almost the entire frequency range was present in Tanner 4/5 compared with Tanner 1/2 adolescents. Spectral characteristics of the sleep EEG yielded state- and frequency-dependent regional differences that were similar in both developmental groups. Anterior predominance of power in delta and sigma ranges occurred in non-rapid eye movement sleep. Rapid eye movement sleep EEG power was greater in low delta, alpha, and sigma ranges for the posterior derivation and in theta and beta ranges for the anterior derivation. The decay rate of the sleep homeostatic process--reflected by the exponential decline of the 2-Hz EEG power band across the sleep episode--did not differ for derivations or groups. These results indicate that the nocturnal dynamics of sleep homeostasis are independent of derivation and remain stable across puberty. PMID:15910511
Jenni, Oskar G; van Reen, Eliza; Carskadon, Mary A
Previous work has demonstrated reliable electroencephalographic (EEG) sleep and hypothalamic-pituitary-adrenal (HPA) changes associated with adult major depressive disorder. These changes might be evident before clinical manifestation of the illness in at-risk persons. The aim of the study was to identify depression-related EEG sleep and HPA changes in healthy adolescents at high-risk for depression, and to examine the relationship between EEG sleep (or HPA) changes and the onset of depression. Forty-eight adolescent volunteers with no personal history of a psychiatric illness, including depression, but who were at high-risk for developing depression by virtue of parental depression (high-risk group), and 48 adolescent volunteers with no personal or family history of a psychiatric disorder (normal controls) were recruited. EEG sleep and HPA measures were collected on three consecutive evenings and nights at baseline. Clinical follow-up evaluations were conducted at regular intervals over a 5-year period. Compared with normal controls, adolescents at high-risk for depression had shorter latency to rapid eye movement (REM) sleep, increased phasic REM sleep, more REM sleep and elevated nocturnal urinary free cortisol (NUFC) excretion at baseline. Shorter REM latency, higher REM density and elevated NUFC (measured at baseline) were associated with the development of depression during follow-up. The findings that REM sleep abnormalities and elevated HPA activity occur prior to the onset of depression in at-risk adolescents suggest that these variables serve as vulnerability markers for the illness.
Rao, Uma; Hammen, Constance L.; Poland, Russell E.
BACKGROUND: Previous isolation studies have shown increased 24-h urine volumes and body weight gains in subjects. This project examined those and other physiological variables in relationship to sleep motor activity, subjective sleep quality, mood, and complaints during confinement. METHODS: Six male and two female subjects lived for 7 d in the National Space Development Agency of Japan's isolation chamber, which simulates the interior of the Japanese Experiment Module. Each 24-h period included 6 h of sleep, 3 meals, and 20 min of exercise. Each morning, subjects completed Sleep Sensation and Complaint Index questionnaires. Catecholamine and creatinine excretion, urine volume, and body weight were measured on the 2 d before and 2 d after confinement, and sleep motor activity was measured during confinement. RESULTS: Confinement produced no significant change in body weight, urine volume, or questionnaire results. In contrast, epinephrine, norepinephrine, and sleep motor activity exhibited significant differences during confinement (p < 0.05). Higher nocturnal norepinephrine excretion correlated with higher sleep motor activity. CONCLUSION: The 24-h epinephrine values were slightly higher than normal throughout the experiment, but lower than for subjects working under time-stress. High sympathetic activity (as indicated by norepinephrine) may have interfered with sleep.
Kraft, Norbert O.; Inoue, Natsuhiko; Mizuno, Koh; Ohshima, Hiroshi; Murai, Tadashi; Sekiguchi, Chiharu; Orasanu, J. M. (Principal Investigator)
We examined associations between measures of sleep propensity on the Epworth Sleepiness Scale, sleep quality on the Pittsburgh Sleep Quality Index and academic performance by GPA and grades in introductory psychology for 414 students. In the total sample, neither sleep propensity nor sleep quality correlated with GPA or introductory psychology grades. However, among students carrying a full course load, those reporting poor sleep quality performed less well on academic measures than those reporting a better quality of sleep. Further research is needed to assess the moderating influence of overall demands of daytime functioning on the association between sleep quality and academic performance. PMID:15560340
Howell, Andrew J; Jahrig, Jesse C; Powell, Russell A
Shift workers, who are exposed to irregular sleep schedules resulting in sleep deprivation and misalignment of circadian rhythms, have an increased risk of diabetes relative to day workers. In healthy adults, sleep restriction without circadian misalignment promotes insulin resistance. To determine whether the misalignment of circadian rhythms that typically occurs in shift work involves intrinsic adverse metabolic effects independently of sleep loss, a parallel group design was used to study 26 healthy adults. Both interventions involved 3 inpatient days with 10-h bedtimes, followed by 8 inpatient days of sleep restriction to 5 h with fixed nocturnal bedtimes (circadian alignment) or with bedtimes delayed by 8.5 h on 4 of the 8 days (circadian misalignment). Daily total sleep time (SD) during the intervention was nearly identical in the aligned and misaligned conditions (4 h 48 min [5 min] vs. 4 h 45 min [6 min]). In both groups, insulin sensitivity (SI) significantly decreased after sleep restriction, without a compensatory increase in insulin secretion, and inflammation increased. In male participants exposed to circadian misalignment, the reduction in SI and the increase in inflammation both doubled compared with those who maintained regular nocturnal bedtimes. Circadian misalignment that occurs in shift work may increase diabetes risk and inflammation, independently of sleep loss. PMID:24458353
Leproult, Rachel; Holmbäck, Ulf; Van Cauter, Eve
The role of sleep deprivation in aggressive behavior has not been systematically investigated, despite a great deal of evidence to suggest a relationship. We investigated the impact of 33 h of sleep loss on endocrine function and reactive aggression using the Point Subtraction Aggression Paradigm (PSAP) task. PSAP performance was assessed in 24 young men and 25 women who were randomly assigned to a sleep deprivation or control condition. Sleep deprivation lowered reactive aggression and testosterone (but not cortisol) in men, and disrupted the positive relationship between a pre-post PSAP increase in testosterone and aggression that was evident in rested control men. While women increased aggression following provocation as expected, no influence of sleep deprivation was found. This is the first experimental study to demonstrate that sleep deprivation lowers reactive aggression in men. Testosterone, but not cortisol, played a role in the relationship between sleep and reactive aggression in men. PMID:23046906
Cote, Kimberly A; McCormick, Cheryl M; Geniole, Shawn N; Renn, Ryan P; MacAulay, Stacey D
Hypoxia is a common feature in children with sickle cell disease (SCD) that is inconsistently associated with painful crises and acute chest syndrome. To assess the prevalence and risk factors of hypoxia, we recorded daytime, nocturnal, and postexercise pulse oximetry (SpO2) values in 39 SCD patients with a median age of 10.8 years. Median daytime SpO2 was 97% (range, 89%–100%), and 36% of patients had daytime hypoxia defined as SpO2<96%. Median nocturnal SpO2 was 94.7% (range, 87.7%–99.5%), 50% of patients had nocturnal hypoxia defined as SpO2?93%, and 11(37%) patients spent more than 10% of their total sleep time with SpO2<90%. Median postexercise SpO2 was 94% (range, 72%–100%) and 44.7% of patients had postexercise hypoxia defined as an SpO2 decrease ?3% after a 6-minute walk test. Among patients with normal daytime SpO2, 35% had nocturnal and 42% postexercise hypoxia. Compared to 9 patients without daytime, nocturnal, or postexercise hypoxia, 25 patients with hypoxia under at least one of these three conditions had greater anemia severity (P?=?0.01), lower HbF levels (P?=?0.04), and higher aspartate aminotransferase levels (P?=?0.03). Males predominated among patients with postexercise hypoxia (P?=?0.004). Hypoxia correlated neither with painful crises nor with acute chest syndrome. Of 32 evaluable patients, 6 (18.8%) had a tricuspid regurgitation velocity ?2.6 m/s, and this feature was associated with anemia (P?=?0.044). Median percentage of the predicted distance covered during a 6-minute walk test was 86% [46–120]; the distance was negatively associated with LDH (P?=?0.044) and with a past history of acute chest syndrome (P?=?0.009). In conclusion, severe episodes of nocturnal and postexercise hypoxia are common in children with SCD, even those with normal daytime SpO2.
Halphen, Isabelle; Elie, Caroline; Brousse, Valentine; Le Bourgeois, Muriel; Allali, Slimane; Bonnet, Damien; de Montalembert, Mariane
This study aims to examine the phase advance of sleep-wake rhythm, napping habit, nocturnal sleep duration, prolonged sleep latency and insomnia and their relationship with cognitive function. This is a cross-sectional study. Participants in this study are 2,947 community-dwelling adults older than 65 years old. Measurements of mini-mental examination (MMSE) score, go-to-bed time, wake-up time, nocturnal sleep duration, prolonged sleep latency, napping, and insomnia were done. The mean (standard deviation) nocturnal sleep hours was 7.96 (1.39) h. Twenty-one percent and 16.2% of the participants complained of prolonged sleep latency longer than 1 h and insomnia, respectively. Fifty-six percent of the participants napped once or more than once weekly. With advancing age, the participants reported longer sleep duration (p<0.001), went to bed earlier, and woke up earlier, which were significant both before and after adjustment. The participants who had lower MMSE score went to bed earlier and woke up earlier, which were statistically significant both before and after adjustment. An inverted U-shaped relationship was observed between MMSE score and napping frequency, p for tend 0.026.The MMSE score decreased when the sleep duration prolonged from 7 h to ?10 h (p for trend 0.006). No trend was observed from the sleep duration <4 up to 7.9 h (p for trend 0.500). Modest age-independent phase advance of the sleep-wake rhythm is associated with lower cognitive function. Whether this is a manifestation of early pre-clinical dementia and whether its recognition with early stabilization can slow cognitive decline remain elusive. PMID:22215376
Auyeung, Tung Wai; Lee, Jenny Shun Wah; Leung, Jason; Kwok, Timothy; Leung, Ping Chung; Woo, Jean; Wing, Yun Kwok
Particulate matter with aerodynamic diameter of <2.5?m (PM2.5) is associated with blood pressure and hemodynamic changes. Blunted nocturnal blood pressure dipping is a major risk factor for cardiovascular events; limited information is available on whether PM2.5 exposure-related hemodynamic changes vary with day-night blood pressure circadian rhythms. In this study, we enrolled 161 subjects and monitored the changes in ambulatory blood pressure and hemodynamics for 24h. The day-night blood pressure and cardiovascular metrics were calculated according to the sleep-wake cycles logged in the subject?s diary. The effects of PM2.5 exposure on blood pressure and hemodynamic changes were analyzed using generalized linear mixed-effect model. After adjusting for potential confounders, a 10-?g/m(3) increase in PM2.5 was associated with 1.0mmHg [95% confidence interval (CI): 0.2-1.8mmHg] narrowing in the pulse pressure, 3.1% (95% CI: 1.4-4.8%) decrease in the maximum rate of left ventricular pressure rise, and 3.6% (95% CI: 1.6-5.7%) increase in systemic vascular resistance among 79 subjects with nocturnal blood pressure dip of <10%. In contrast, PM2.5 was not associated with any changes in cardiovascular metrics among 82 subjects with nocturnal blood pressure dip of ?10%. Our findings demonstrate that short-term exposure to PM2.5 contributes to pulse pressure narrowing along with cardiac and vasomotor dysfunctions in subjects with nocturnal blood pressure dip of <10%. PMID:24607658
Chen, Szu-Ying; Chan, Chang-Chuan; Lin, Yu-Lun; Hwang, Jing-Shiang; Su, Ta-Chen
The classification of the various types of urination disorders among children as well as the latest theories explaining the causes of nocturnal enuresis were presented in the first part of the article entitled "Nocturnal Enuresis in Children" (in "Medycyna Wieku Rozwojowego" 1998, II, 1 pp. 55-69). The second part of this article concentrates on the differential diagnostics of urination disorders amongst patients seeking help for nocturnal enuresis. The diagnostic model developed by the Urodynamic Unit at the Department of Paediatric Surgery, National Research Institute of Mother and Child can be applied in an outpatient clinic. Hospitalization of the patient is not necessary to carry out the study, meaning that the child is spared any additional stress. Currently applied methods for treating nocturnal enuresis by non-pharmacological methods are also discussed in this text. PMID:10910655
Sleep restriction and circadian clock disruption are associated with metabolic disorders such as obesity, insulin resistance, and diabetes. The metabolic pathways involved in human sleep, however, have yet to be investigated with the use of a metabolomics approach. Here we have used untargeted and targeted liquid chromatography (LC)/MS metabolomics to examine the effect of acute sleep deprivation on plasma metabolite rhythms. Twelve healthy young male subjects remained in controlled laboratory conditions with respect to environmental light, sleep, meals, and posture during a 24-h wake/sleep cycle, followed by 24 h of wakefulness. Two-hourly plasma samples collected over the 48 h period were analyzed by LC/MS. Principal component analysis revealed a clear time of day variation with a significant cosine fit during the wake/sleep cycle and during 24 h of wakefulness in untargeted and targeted analysis. Of 171 metabolites quantified, daily rhythms were observed in the majority (n = 109), with 78 of these maintaining their rhythmicity during 24 h of wakefulness, most with reduced amplitude (n = 66). During sleep deprivation, 27 metabolites (tryptophan, serotonin, taurine, 8 acylcarnitines, 13 glycerophospholipids, and 3 sphingolipids) exhibited significantly increased levels compared with during sleep. The increased levels of serotonin, tryptophan, and taurine may explain the antidepressive effect of acute sleep deprivation and deserve further study. This report, to our knowledge the first of metabolic profiling during sleep and sleep deprivation and characterization of 24 h rhythms under these conditions, offers a novel view of human sleep/wake regulation. PMID:25002497
Davies, Sarah K; Ang, Joo Ern; Revell, Victoria L; Holmes, Ben; Mann, Anuska; Robertson, Francesca P; Cui, Nanyi; Middleton, Benita; Ackermann, Katrin; Kayser, Manfred; Thumser, Alfred E; Raynaud, Florence I; Skene, Debra J
The neural correlates of the wake-sleep continuum remain incompletely understood, limiting the development of adaptive drug delivery systems for promoting sleep maintenance. The most useful measure for resolving early positions along this continuum is the alpha oscillation, an 8–13 Hz electroencephalographic rhythm prominent over posterior scalp locations. The brain activation signature of wakefulness, alpha expression discloses immediate levels of alertness and dissipates in concert with fading awareness as sleep begins. This brain activity pattern, however, is largely ignored once sleep begins. Here we show that the intensity of spectral power in the alpha band actually continues to disclose instantaneous responsiveness to noise—a measure of sleep depth—throughout a night of sleep. By systematically challenging sleep with realistic and varied acoustic disruption, we found that sleepers exhibited markedly greater sensitivity to sounds during moments of elevated alpha expression. This result demonstrates that alpha power is not a binary marker of the transition between sleep and wakefulness, but carries rich information about immediate sleep stability. Further, it shows that an empirical and ecologically relevant form of sleep depth is revealed in real-time by EEG spectral content in the alpha band, a measure that affords prediction on the order of minutes. This signal, which transcends the boundaries of classical sleep stages, could potentially be used for real-time feedback to novel, adaptive drug delivery systems for inducing sleep.
McKinney, Scott M.; Dang-Vu, Thien Thanh; Buxton, Orfeu M.; Solet, Jo M.; Ellenbogen, Jeffrey M.
Objectives. To assess the prevalence of nocturnal enuresis in school children aged 5 to 15 years, and to investigate the association of bedwetting with ethnicity, the educational level of the parents, and the type of education (mainstream or special) received by the child.Methods. Data were obtained for 5360 children in mainstream education and 2571 children in special education. The data
J Spee-van der Wekke; R. A Hirasing; J. F Meulmeester; J. J Radder
Lidar observations to study the nocturnal boundary layer in the atmosphere were made on selected evenings during December 1997 - March 1998 at the City University of Hong Kong (lat. 20 degree(s)20'6', long. 114 degree(s)10'18', at 57 m AMSL), Hong Kong. The ground-based Nd:YAG lidar has been operated to detect the vertical distribution of aerosols in the NBL at a subtropical urban site. It is shown that the vertical relative signal profiles can be employed to determine the heights of the single or multiple nocturnal inversions. In a clear sky and light wind evening transition period, the strong radiative cooling caused the air near the ground becomes stably stratified. The nocturnal inversion starts to emerge soon before sunset and grows vertically as the night progresses. The study also showed that the temporal evolution of the nocturnal inversion depth was rapidly increased soon after sunset and a slower rate in the midnight hours. The results of the study indicate that the vertical aerosol distribution in the multiple-layer is more complicated than that in the single-layer, of NBL. The early morning transition of the NBL is also discussed. A comparison of the lidar aerosol signals and radiosonde measurements was performed to evaluate the consistency of observations between the different systems.
Mok, T. M.; Leung, Kang M.; Ho, A. H.; Chan, J. C.; Ng, C. N.
Notes that of the treatments attempted for nocturnal enuresis, pharmacotherapy, individual psychotherapy, and behavioral conditioning, the most effective is behavioral conditioning with a urine alarm. Reviews the enuresis literature and provides recommendations for use of the urine alarm approach. (Author/ABB)
Wagner, William G.
A five-year experience with the vasopressin analogue desmopressin acetate (DDAVP) for nocturnal enuresis is described in 59 children. The initial starting dose of 5 ?g at bedtime is lower than that reported in other series. Eighty-one percent of patients required 10 ?g or less to achieve improvement or resolution of bedwetting.
David W. Key; David A. Bloom; Jill Sanvordenker
Introduction Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, arousals from sleep, and daytime sleepiness. Accumulating\\u000a evidence indicates that hypoxemia and sleep disruption contribute to the development of cardiovascular abnormalities in OSA.\\u000a OSA is effectively treated with continuous positive airway pressure (CPAP) therapy that splints open the airway during sleep.\\u000a Studies have shown that CPAP therapy improves daytime sleepiness and
John M. Dopp; Barbara J. Morgan
In space, astronauts may experience effects of cumulative sleep loss due to demanding work schedules that can result in cognitive performance impairments, mood state deteriorations, and sleep-wake cycle disruption. Individuals who experience sleep deprivation of six hours beyond normal sleep times experience detrimental changes in their mood and performance states. Hence, the potential for life threatening errors increases exponentially with sleep deprivation. We explored the effects of 36-hours of sleep deprivation on cognitive performance, mood states, and physiological responses to identify which metrics may best predict fatigue induced performance decrements of individuals.
Martinez, Jacqueline; Cowings, Patricia S.; Toscano, William B.
As the U.S. population ages, families must assume increasing responsibility for the care of elderly members. Disruptive nocturnal behaviors (DNBs) of elders, such as complaining and demanding help, may result in interactions with caregivers that threaten such arrangements. This study aimed to quantify such interactions by cross-correlating motor activity that was simultaneously recorded from the elders and caregivers. Forty-four elder-caregiver
Charles P. Pollak; Peter E. Stokes; Daniel R. Wagner
Sleep dynamics emerges from complex interactions between neuronal populations in many brain regions. Annotated sleep stages from electroencephalography (EEG) recordings could potentially provide a non-invasive way to obtain valuable insights into the mechanisms of these interactions, and ultimately into the very nature of sleep regulation. However, to date, sleep stage analysis has been restricted, only very recently expanding the scope of the traditional descriptive statistics to more dynamical concepts of the duration of and transitions between vigilance states and temporal evaluation of transition probabilities among different stages. Physiological and/or pathological implications of the dynamics of sleep stage transitions have, to date, not been investigated. Here, we study detailed duration and transition statistics among sleep stages in healthy humans and patients with chronic fatigue syndrome, known to be associated with disturbed sleep. We find that the durations of waking and non-REM sleep, in particular deep sleep (Stages III and IV), during the nighttime, follow a power-law probability distribution function, while REM sleep durations follow an exponential function, suggestive of complex underlying mechanisms governing the onset of light sleep. We also find a substantial number of REM to non-REM transitions in humans, while this transition is reported to be virtually non-existent in rats. Interestingly, the probability of this REM to non-REM transition is significantly lower in the patients than in controls, resulting in a significantly greater REM to awake, together with Stage I to awake, transition probability. This might potentially account for the reported poor sleep quality in the patients because the normal continuation of sleep after either the lightest or REM sleep is disrupted. We conclude that the dynamical transition analysis of sleep stages is useful for elucidating yet-to-be-determined human sleep regulation mechanisms with a pathophysiological implication.
Kishi, Akifumi; Struzik, Zbigniew R.; Natelson, Benjamin H.; Togo, Fumiharu; Yamamoto, Yoshiharu
BackgroundSleep disordered breathing is frequently observed in patients with cardiovascular disease. Even in the absence of heart disease, acute and chronic hypoxia have been shown to promote sleep-related periodic breathing with central apnea characterized by a repetitive reduction or lack of respiratory activity. Cyanotic congenital heart disease (CCHD) is associated with chronic hypoxia, regardless of whether an increase in pulmonary
Sylvie Legault; Paola Lanfranchi; Jacques Montplaisir; Tore Nielsen; Annie Dore; Paul Khairy; François Marcotte; Lise-Andrée Mercier
The lack of sufficient amounts of sleep is a hallmark of modern living, and it is commonly perceived that in the long run this makes us sick. An increasing amount of scientific data indicate that sleep deprivation has detrimental effects on immune function. Conversely, immune responses feedback on sleep phase and architecture. Several studies have investigated the impact of short-term sleep deprivation on different immune parameters, whereas only a few studies have addressed the influence of sleep restriction on the immune system. In many cases, sleep deprivation and restriction impair immune responses by disrupting circadian rhythms at the level of immune cells, which might be a consequence of disrupted endocrine and physiological circadian rhythms. Little is known about the mechanisms underlying the circadian regulation of immunity, but recent studies have suggested that local as well as central circadian clocks drive the rhythms of immune function. In this review, we present a mechanistic model which proposes that sleep (through soluble factors and body temperature) primes immune cells on the one hand, and, on the other hand, provides a timing signal for hematopoietic circadian clocks. We hypothesize that chronic sleep disruption desynchronizes these clocks and, through this mechanism, deregulates immune responses. PMID:20130392
Bollinger, Thomas; Bollinger, Annalena; Oster, Henrik; Solbach, Werner
Women with ovulatory menstrual cycles have a circadian rhythm superimposed on the menstrual-associated rhythm; in turn, menstrual events affect the circadian rhythm. In this paper, we review circadian rhythms in temperature, selected hormone profiles, and sleep–wake behavior in healthy women at different phases of the menstrual cycle. The effects on menstrual cycle rhythmicity of disrupted circadian rhythms, for example, with
Fiona C. Baker; Helen S. Driver
The relation of sleep stages to performance is reviewed. Data from 12 subjects who were deprived of sleep for two nights, to study the recuperative effects of slow-wave sleep and REM sleep following sleep deprivation, are presented. There was no significa...
L. C. Johnson P. Naitch A. Lubin J. Moses
The development of neuroimaging techniques has made possible the characterization of cerebral function throughout the sleep-wake cycle in normal human subjects. Indeed, human brain activity during sleep is segregated within specific cortical and subcortical areas in relation to the sleep stage, sleep physiological events and previous waking activity. This approach has allowed sleep physiological theories developed from animal data to
Thien Thanh Dang-Vu; Martin Desseilles; Dominique Petit; Stéphanie Mazza; Jacques Montplaisir; Pierre Maquet
Study Objectives: To determine the effect of the drug combination domperidone and pseudoephedrine on nocturnal oximetry measurements and daytime sleepiness in patients with obstructive sleep apnea. Methods: We recruited patients with severe snoring and apneic episodes willing to undergo repeated nocturnal oximetry testing. Following baseline clinical history, Epworth Sleepiness Scale administration, and home overnight nocturnal oximetry, patients were started on weight-adjusted doses of domperidone and pseudoephedrine. Follow-up oximetry studies were performed at the patient's convenience. On the final visit, a repeat clinical history, Epworth score, and oximetry were obtained. Results: Sixteen of 23 patients noted disappearance of snoring and apneic episodes. Another 3 patients reported improvement in snoring and no apneic episodes. All but one patient had a decrease in Epworth scores (mean decrease 9.9 (95% CI, 7.2-12.6, p < 0.0001). Mean oxygen saturation (2.5; 95% CI, 0.66-4.41, p = 0.008), percent time with oxygen saturation < 90% (14.8; 95% CI, 24.4 to 5.2, p = 0.003), and the 4% oxygen desaturation index (18.2; 95% CI, 27.3 to 9.1, p < 0.0001) improved significantly. No adverse effects of treatment were noted. Conclusions: The combination of domperidone and pseudoephedrine improved self reported snoring and sleepiness, and may have improved apneic episodes and sleep-related nocturnal oxygen desaturation in patients with obstructive sleep apnea provided the proportion of time spent asleep did not diminish. This drug combination warrants further study as a treatment for obstructive sleep apnea. Citation: Larrain A; Kapur VK; Gooley TA; Pope CE. Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone. J Clin Sleep Med 2010;6(2):117-123.
Larrain, Augusto; Kapur, Vishesh K.; Gooley, Ted A.; Pope, Charles E.
Objective To test the hypothesis that non-frail older men with poorer sleep at baseline are at increased risk for frailty and death at follow-up. Methods In this prospective cohort study, subjective (questionnaires) and objective sleep parameters (actigraphy and in-home overnight polysomnography) were measured at baseline in 2,505 non-frail men aged ?67 years. Repeat frailty status assessment was performed an average of 3.4 years later; vital status was assessed every four months. Sleep parameters were expressed as dichotomized predictors using clinical cut-points. Statuses at follow-up exam were classified as robust, intermediate (pre-frail) stage, frail, or died in interim. Results None of the sleep disturbances were associated with the odds of being intermediate/frail/dead (vs. robust) at follow-up. Poor subjective sleep quality (multivariable odds ratio [MOR] 1.26, 95%CI 1.01–1.58), greater nighttime wakefulness (MOR 1.31, 95% CI 1.04–1.66), and greater nocturnal hypoxemia (MOR 1.47, 95% CI 1.02–2.10) were associated with a higher odds of frailty/death at follow-up (vs. robust/intermediate). Excessive daytime sleepiness (MOR 1.60, 95% CI 1.03–2.47), greater nighttime wakefulness (MOR 1.57, 95% CI 1.12–2.20), severe sleep apnea (MOR 1.74, 95% CI 1.04–2.89), and nocturnal hypoxemia (MOR 2.28, 95% CI 1.45–3.58) were associated with higher odds of death (vs. robust/intermediate/frail at follow-up). The association between poor sleep efficiency and mortality nearly reached significance (MOR 1.48, 95% CI 0.99–2.22). Short sleep duration and prolonged sleep latency were not associated with frailty/death or death at follow-up. Conclusions Among non-frail older men, poor subjective sleep quality, greater nighttime wakefulness, and greater nocturnal hypoxemia were independently associated with a higher odds of frailty or death at follow-up, while excessive daytime sleepiness, greater nighttime wakefulness, severe sleep apnea, and greater nocturnal hypoxemia were independently associated with an increased risk of mortality.
Ensrud, Kristine E.; Blackwell, Terri L.; Ancoli-Israel, Sonia; Redline, Susan; Cawthon, Peggy M.; Paudel, Misti L.; Dam, Thuy-Tien L.; Stone, Katie L.
This study investigated changes in sleep after multiple transmeridian flights. The subjects were 12 B747 airline pilots operating on the following polar flight: Tokyo (TYO)-Anchorage (ANC)-London (LON)-Anchorage-Tokyo. Sleep polysmonograms were recorded on two baseline nights (B1, B2), during layovers, and, after returning to Tokyo, two recovery nights were recorded (R1, R2). In ANC (outbound), total sleep time was reduced and, sleep efficiency was low (72.0 percent). In London, time in bed increased slightly, but sleep efficiency was still reduced. On return to ANC (inbound), there was considerable slow wave sleep rebound and multiple awakenings reduced sleep efficiency to 76.8 percent. Sleep efficiency on R2 was significantly lower than on B1 but not different from R1. To sum up, sleep of aircrews flying multiple transmeridian flights is disrupted during layovers and this effect persists during the two recovery nights. As a result, there is a marked cumulative sleep loss during multilegs polar route trip in comparison to single leg flights. These findings suggest that following such extensive transmeridian trips, crews should have at least three nights of recovery sleep in their home time zone before returning to duty.
Sasaki, Mitsuo; Kurosaki, Yuko S.; Spinweber, Cheryl L.; Graeber, R. C.; Takahashi, Toshiharu
Physiological recordings of sleep and wakefulness in operating international (B-747) flight crews were obtained. Crews spent their first layover (48 h) of a trip in a sleep laboratory where standardized EEG, electro-oculograph (EOC), and electromyograph (EMG) sleep recordings were carried out whenever volunteers chose to sleep. During periods of wakefulness they underwent multiple sleep latency tests every 2 h in order to assess daytime drowsiness. The same standardized recordings were carried out at a home-based laboratory before departure. Approximately four crews each participated in flights over 7 to 9 time zones on five routes. All participants were encouraged to use whatever sleep-wake strategies they thought would provide them with the most satisfactory crew rest. Overall, layover sleep quality was not seriously disturbed, but eastward flights produced greater sleep disruption. The contributors of individual factors and the usefulness of various sleep strategies are discussed in the individual laboratory reports and in an operational summary.
Graeber, R. C.
Circadian rhythms are a prominent and critical feature of cells, tissues, organs, and behavior that help an organism function most efficiently and anticipate things such as food availability. Therefore, it is not surprising that disrupted circadian rhythmicity, a prominent feature of modern-day society, promotes the development and/or progression of a wide variety of diseases, including inflammatory, metabolic, and alcohol-associated disorders. This article will discuss the influence of interplay between alcohol consumption and circadian rhythmicity and how circadian rhythm disruption affects immune function and metabolism as well as potential epigenetic mechanisms that may be contributing to this phenomenon.
Voigt, Robin M.; Forsyth, Christopher B.; Keshavarzian, Ali
Study Objectives: To explore the time of day effects of alcohol on sleep, we examined sleep following alcohol administered at four times of day and three homeostatic loads during a 20-hr forced desynchrony (FD) protocol. Participants: Twenty-six healthy young adults (21–25 yrs) were studied. Design: Participants were dosed at 4 clock times: 0400 (n = 6; 2 females), 1600 (n = 7; 4 females), 1000 (n = 6; 1 female) or 2200 (n = 7; 2 females). Participants slept 2300 to 0800 for at least 12 nights before the in-lab FD study. Double blind placebo and alcohol (vodka tonic targeting 0.05g% concentration) beverages were each administered three times during FD at different homeostatic loads: low (4.25 or 2.24 hrs awake), medium (8.25 or 6.25 hrs awake), high (12.25 or 10.25 hrs awake) in the 0400 and 1600 or 1000 and 2200 groups, respectively. Sleep was staged and subjected to spectral analysis. Measurements and Results: Breath Alcohol Concentration (BrAC) confirmed targeted maximal levels. At bedtime, BrAC was 0 in the low and medium homeostatic load conditions; however, at high homeostatic load, BrAC was still measurable. Spectral characteristics of sleep were unaffected with alcohol at any time of day. Few alcohol related changes were seen for sleep stages; however, with alcohol given at 0400 at a high homeostatic load there was an increase in wake. Conclusions: These data lend support to the idea that alcohol may be disruptive to sleep; however, our findings are inconsistent with the idea that a low dose of alcohol is a useful sleep aid when attempting to sleep at an adverse circadian phase. Citation: Van Reen E; Tarokh L; Rupp TL; Seifer R; Carskadon MA. Does timing of alcohol administration affect sleep? SLEEP 2011;34(2):195-205.
Van Reen, Eliza; Tarokh, Leila; Rupp, Tracy L.; Seifer, Ron; Carskadon, Mary A.
Study Objective: Sleep hygiene recommendations are widely disseminated despite the fact that few systematic studies have investigated the empirical bases of sleep hygiene in the home environment. For example, studies have yet to investigate the relative effects of a given dose of caffeine administered at different times of day on subsequent sleep. Methods: This study compared the potential sleep disruptive effects of a fixed dose of caffeine (400 mg) administered at 0, 3, and 6 hours prior to habitual bedtime relative to a placebo on self-reported sleep in the home. Sleep disturbance was also monitored objectively using a validated portable sleep monitor. Results: Results demonstrated a moderate dose of caffeine at bedtime, 3 hours prior to bedtime, or 6 hours prior to bedtime each have significant effects on sleep disturbance relative to placebo (p < 0.05 for all). Conclusion: The magnitude of reduction in total sleep time suggests that caffeine taken 6 hours before bedtime has important disruptive effects on sleep and provides empirical support for sleep hygiene recommendations to refrain from substantial caffeine use for a minimum of 6 hours prior to bedtime. Citation: Drake C; Roehrs T; Shambroom J; Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med 2013;9(11):1195-1200.
Drake, Christopher; Roehrs, Timothy; Shambroom, John; Roth, Thomas
Describes the nature of sleep among the elderly. Points to a number of correlations between sleep patterns and aging. Suggests that mortality rate is very high among those who sleep either extremely long or short periods. (GA)
Prolonged wakefulness greatly decreases nocturnal driving performance. The development of in-car countermeasures is a future challenge to prevent sleep-related accidents. The aim of this study is to determine whether continuous exposure to monochromatic light in the short wavelengths (blue light), placed on the dashboard, improves night-time driving performance. In this randomized, double-blind, placebo-controlled, cross-over study, 48 healthy male participants (aged 20–50 years) drove 400 km (250 miles) on motorway during night-time. They randomly and consecutively received either continuous blue light exposure (GOLite, Philips, 468 nm) during driving or 2*200 mg of caffeine or placebo of caffeine before and during the break. Treatments were separated by at least 1 week. The outcomes were number of inappropriate line crossings (ILC) and mean standard deviation of the lateral position (SDLP). Eight participants (17%) complained about dazzle during blue light exposure and were removed from the analysis. Results from the 40 remaining participants (mean age ± SD: 32.9±11.1) showed that countermeasures reduced the number of inappropriate line crossings (ILC) (F(2,91.11)?=?6.64; p<0.05). Indeed, ILC were lower with coffee (12.51 [95% CI, 5.86 to 19.66], p?=?0.001) and blue light (14.58 [CI, 8.75 to 22.58], p?=?0.003) than with placebo (26.42 [CI, 19.90 to 33.71]). Similar results were found for SDLP. Treatments did not modify the quality, quantity and timing of 3 subsequent nocturnal sleep episodes. Despite a lesser tolerance, a non-inferior efficacy of continuous nocturnal blue light exposure compared with caffeine suggests that this in-car countermeasure, used occasionally, could be used to fight nocturnal sleepiness at the wheel in blue light-tolerant drivers, whatever their age. More studies are needed to determine the reproducibility of data and to verify if it can be generalized to women. Trial Registration ClinicalTrials.gov NCT01070004
Taillard, Jacques; Capelli, Aurore; Sagaspe, Patricia; Anund, Anna; Akerstedt, Torbjorn; Philip, Pierre
Prolonged wakefulness greatly decreases nocturnal driving performance. The development of in-car countermeasures is a future challenge to prevent sleep-related accidents. The aim of this study is to determine whether continuous exposure to monochromatic light in the short wavelengths (blue light), placed on the dashboard, improves night-time driving performance. In this randomized, double-blind, placebo-controlled, cross-over study, 48 healthy male participants (aged 20-50 years) drove 400 km (250 miles) on motorway during night-time. They randomly and consecutively received either continuous blue light exposure (GOLite, Philips, 468 nm) during driving or 2*200 mg of caffeine or placebo of caffeine before and during the break. Treatments were separated by at least 1 week. The outcomes were number of inappropriate line crossings (ILC) and mean standard deviation of the lateral position (SDLP). Eight participants (17%) complained about dazzle during blue light exposure and were removed from the analysis. Results from the 40 remaining participants (mean age ± SD: 32.9±11.1) showed that countermeasures reduced the number of inappropriate line crossings (ILC) (F(2,91.11)?=?6.64; p<0.05). Indeed, ILC were lower with coffee (12.51 [95% CI, 5.86 to 19.66], p?=?0.001) and blue light (14.58 [CI, 8.75 to 22.58], p?=?0.003) than with placebo (26.42 [CI, 19.90 to 33.71]). Similar results were found for SDLP. Treatments did not modify the quality, quantity and timing of 3 subsequent nocturnal sleep episodes. Despite a lesser tolerance, a non-inferior efficacy of continuous nocturnal blue light exposure compared with caffeine suggests that this in-car countermeasure, used occasionally, could be used to fight nocturnal sleepiness at the wheel in blue light-tolerant drivers, whatever their age. More studies are needed to determine the reproducibility of data and to verify if it can be generalized to women. Trial registration: ClinicalTrials.gov NCT01070004. PMID:23094031
Taillard, Jacques; Capelli, Aurore; Sagaspe, Patricia; Anund, Anna; Akerstedt, Torbjorn; Philip, Pierre
This investigation examined precompetitive sleep behaviour of 103 athletes and how it relates to precompetitive mood and subsequent performance. Results revealed that on the night before competition athletes slept well under the recommended target of eight hours of sleep for healthy adults, with almost 70% of athletes experiencing poorer sleep than usual. It was found that anxiety, noise, the need to use the bathroom and early event times were amongst the most commonly reported causes of disrupted sleep in athletes on the night prior to competition. The negative moods of fatigue and tension were both significantly negatively correlated with precompetitive relative sleep quality (r = -0.28, P = 0.004, r = -0.21, P = 0.030, respectively) and total sleep time (r = -0.23, P = 0.023, r = -0.20, P = 0.044, respectively). Additionally, tension was positively correlated with number of awakenings (r = -0.20, P = 0.045). Vigour was seen to be significantly positively associated with relative sleep quality (r = 0.24, P=0.013). The relationships between relative sleep quality and fatigue, tension and vigour accounted for approximately 4 - 5% of the variance in mood scores. Disrupted sleep did not demonstrate any significant relationship with relative sporting performance. Conclusions from the present investigation are that athletes may be at particular risk of disrupted sleep on the night prior to competition, and this disruption can negatively relate to an athlete's precompetitive mood states. PMID:24444196
Lastella, Michele; Lovell, Geoff Peter; Sargent, Charli
Sleep is important for health; however, poor sleep is a growing problem in many Western societies, particularly among women. Alterations in immune function following poor sleep (defined by duration and disruption) may be linked to ill health. Not yet investigated are the possible effects on stress-induced mobilization of lymphocytes. As natural killer (NK) cells are particularly responsive to acute stress,
Caroline E. Wright; Joel Erblich; Heiddis B. Valdimarsdottir; Dana H. Bovbjerg
Background: Although a level 1 nocturnal polysomnogram (PSG) is often used to evaluate children with non-respiratory sleep disorders, there are no published evidence-based practice parameters focused on the pediatric age group. In this report, we present practice parameters for the indications of polysomnography and the multiple sleep latency test (MSLT) in the assessment of non-respiratory sleep disorders in children. These practice parameters were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine (AASM). Methods: A task force of content experts was appointed by the AASM to review the literature and grade the evidence according to the American Academy of Neurology grading system. Recommendations For PSG and MSLT Use: PSG is indicated for children suspected of having periodic limb movement disorder (PLMD) for diagnosing PLMD. (STANDARD) The MSLT, preceded by nocturnal PSG, is indicated in children as part of the evaluation for suspected narcolepsy. (STANDARD) Children with frequent NREM parasomnias, epilepsy, or nocturnal enuresis should be clinically screened for the presence of comorbid sleep disorders and polysomnography should be performed if there is a suspicion for sleep-disordered breathing or periodic limb movement disorder. (GUIDELINE) The MSLT, preceded by nocturnal PSG, is indicated in children suspected of having hypersomnia from causes other than narcolepsy to assess excessive sleepiness and to aid in differentiation from narcolepsy. (OPTION) The polysomnogram using an expanded EEG montage is indicated in children to confirm the diagnosis of an atypical or potentially injurious parasomnia or differentiate a parasomnia from sleep-related epilepsy (OPTION) Polysomnography is indicated in children suspected of having restless legs syndrome (RLS) who require supportive data for diagnosing RLS. (OPTION) Recommendations Against PSG Use: Polysomnography is not routinely indicated for evaluation of children with sleep-related bruxism. (STANDARD) Conclusions: The nocturnal polysomnogram and MSLT are useful clinical tools for evaluating pediatric non-respiratory sleep disorders when integrated with the clinical evaluation. Citation: Aurora RN; Lamm CI; Zak RS; Kristo DA; Bista SR; Rowley JA; Casey KR. Practice parameters for the non-respiratory indications for polysomnography and multiple sleep latency testing for children. SLEEP 2012;35(11):1467-1473.
Aurora, R. Nisha; Lamm, Carin I.; Zak, Rochelle S.; Kristo, David A.; Bista, Sabin R.; Rowley, James A.; Casey, Kenneth R.