Sleep is an essential biologic and physiologic process that is vital for maintaining or achieving optimal health outcomes. Care requirements in hospitalized patients frequently result in nocturnal disruptions that impact sleep quality. This exploratory, retrospective study aimed to identify and quantify nocturnal care disruptions in patients undergoing hematopoietic stem cell transplantation. A total of 1,642 nocturnal care interactions occurred during 160 patient nights of data collection. An average of 41 nocturnal care interactions occurred per patient. Most occurred from 12-12:59 am and 4-4:59 am. Most patients (73%) had sleep disturbance recorded in their chart by nurses, but physicians documented sleep disturbances for only 28% of patients. Care practices may be modifiable to promote sleep in the hospital setting. PMID:24080050
Hacker, Eileen Danaher; Patel, Purvi; Stainthorpe, Megan
Our objective was to determine, in three separate studies, the effects of controlled-release carbamazepine (CBZ-CR), lamotrigine (LTG), and gabapentin (GBP) on nocturnal sleep in epilepsy. Antiepileptic drugs (AEDs) control seizures and also modify hypnic structure. Despite widespread clinical use, their effects on sleep are not well known. PSG was performed in all three studies as follows: CBZ-CR: at baseline, after initial administration of CBZ-CR 400 mg, and after 1 month of CBZ-CR treatment (400 mg BID) in a sample of seven temporal lobe epileptic (TLE) patients. Results were compared with those of nine healthy volunteers; LTG: at baseline, after 3 months of stable treatment with LTG (300 mg/day); GBP: at baseline, after 3 months of stable treatment with GBP (1800 mg/day). Significant findings are as follows for each study. The acute administration of CBZ-CR increased number of stage shifts, reduced REM sleep, and increased REM sleep fragmentation. In the TLE group, these effects were almost completely reversed after chronic treatment. LTG increased REM sleep, reduced number of entries into REM sleep, decreased number of phase shifts, and decreased percentage of slow-wave sleep. GBP increased REM sleep percentage, increased mean duration of REM periods, reduced number of awakenings, and reduced stage 1 sleep percentage. We conclude that CBZ-CR disrupts REM sleep, but only during acute administration. LTG and GBP improve sleep stability while reducing seizures. PMID:10718681
Placidi, F; Diomedi, M; Scalise, A; Marciani, M G; Romigi, A; Gigli, G L
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
W. Plihal; S. Weaver; M. Mölle; H. L. Fehm; J. Born
Sleep disorders and daytime somnolence have not been systematically studied in the Huntington disease (HD) population. In this study we have assessed nocturnal sleep and daytime somnolence in 30 patients recruited from a subspecialty HD clinic. Disturbed nocturnal sleep and excessive daytime somnolence were common in this cohort. Further studies employing objective measures of sleep\\/daytime somnolence in the HD population
Aleksandar Videnovic; Sue Leurgans; Wenqing Fan; Jeana Jaglin; Kathleen M. Shannon
ObjectiveNocturnal awakenings are one of the most prevalent sleep disturbances in the general population. Little is known, however, about the frequency of these episodes and how difficulty resuming sleep once awakened affects subjective sleep quality and quantity.
Maurice M. Ohayon; Andrew Krystal; Timothy A. Roehrs; Thomas Roth; Michael V. Vitiello
Sleep disorders and daytime somnolence have not been systematically studied in the Huntington disease (HD) population. In this study we have assessed nocturnal sleep and daytime somnolence in 30 patients recruited from a subspecialty HD clinic. Disturbed nocturnal sleep and excessive daytime somnolence were common in this cohort. Further studies employing objective measures of sleep/daytime somnolence in the HD population are needed. PMID:19041273
Videnovic, Aleksandar; Leurgans, Sue; Fan, Wenqing; Jaglin, Jeana; Shannon, Kathleen M
It has been postulated that time estimation during nocturnal sleep in humans can be explained by an interval timing clock inside the brain. However, no systematic investigations have been carried out with respect to how the human brain perceives the passage of time during sleep. The brain mechanisms of over- or underestimation of time spent in sleep have not yet
Sayaka Aritake; Makoto Uchiyama; Hirokuni Tagaya; Hiroyuki Suzuki; Kenichi Kuriyama; Akiko Ozaki; Xin Tan; Kayo Shibui; Yuichi Kamei; Yoshiro Okubo; Kiyohisa Takahashi
Caffeine is often used to counteract sleepiness generated by sleep deprivation, jet lag, and shift-work, and is consumed at different times of day. Caffeine also has effects on sleep. However, little is known about the interaction between sleep deprivation, circadian timing, and caffeine consumption on sleep. In this study, we compared the effects of caffeine on nocturnal sleep initiated at
Julie Carrier; Marta Fernandez-Bolanos; Rébecca Robillard; Marie Dumont; Jean Paquet; Brahim Selmaoui; Daniel Filipini
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.
SAMPEI, M., MURATA, K., DAKEISHI, M. and WOOD, D.C. Cardiac Autonomic Hypofunction in Preschool Children with Short Nocturnal Sleep. Tohoku J. Exp. Med., 2006, 208 (3), 235-242 ?? Preschool children with sleep deficit may suffer from auto - nomic symptoms or hypotension. Heart rate variability, reflecting cardiac parasympathetic and sympathetic activities, and blood pressure were assessed to clarify the effects
Mari Sampei; Katsuyuki Murata; Miwako Dakeishi; Donald C. Wood
Study Objectives: Identify polysomnographic and demographic factors associated with elevation of nocturnal end-tidal CO2 in patients with obstructive sleep apnea. Methods: Forty-four adult patients with obstructive sleep apnea were selected such that the maximal nocturnal end-tidal CO2 was below 45 mm Hg in 15 studies, between 45 and 50 mm Hg in 14, and above 50 mm Hg in 15. Measurements included mean event (i.e., apneas or hypopneas) and mean inter-event duration, ratio of mean post- to mean pre-event amplitude, and percentage of total sleep time spent at an end-tidal CO2 < 45, 45-50, and > 50 mm Hg. An integrated nocturnal CO2 was calculated as the sum of the products of average end-tidal CO2 at each time interval by percent of total sleep time spent at the corresponding time interval. Results: The integrated nocturnal CO2 was inversely correlated with mean post-apnea duration, with lesser contributions from mean apnea duration and age (R2 = 0.56), but did not correlate with the apnea-hypopnea index, or the body mass index. Mean post-event to mean pre-event amplitude correlated with mean post-apnea duration (r = 0.88, p < 0.001). Mean apnea duration did not correlate with mean post-apnea duration. Conclusions: Nocturnal capnometry reflects pathophysiologic features of sleep apnea, such as the balance of apnea and post-apnea duration, which are not captured by the apnea-hypopnea index. This study expands the indications of capnometry beyond apnea detection and quantification of hypoventilation syndromes. Citation: Jaimchariyatam N; Dweik RA; Kaw R; Aboussouan LS. Polysomnographic determinants of nocturnal hypercapnia in patients with sleep apnea. J Clin Sleep Med 2013;9(3):209-215.
Jaimchariyatam, Nattapong; Dweik, Raed A.; Kaw, Roop; Aboussouan, Loutfi S.
Cigarette smoking has been associated with a high prevalence of sleep-related complaints. However, its effects on sleep architecture have not been fully examined. The primary objective of this investigation was to assess the impact of cigarette smoking on sleep architecture. Polysomnography was used to characterize sleep architecture among 6,400 participants of the Sleep Heart Health Study (United States, 1994-1999). Sleep parameters included total sleep time, latency to sleep onset, sleep efficiency, and percentage of time in each sleep stage. The study sample consisted of 2,916 never smokers, 2,705 former smokers, and 779 current smokers. Compared with never smokers, current smokers had a longer initial sleep latency (5.4 minutes, 95% confidence interval (CI): 2.9, 7.9) and less total sleep time (14.0 minutes, 95% CI: 6.4, 21.7). Furthermore, relative to never smokers, current smokers also had more stage 1 sleep (relative proportion = 1.24, 95% CI: 1.14, 1.33) and less slow wave sleep (relative proportion = 0.86, 95% CI: 0.78, 0.95). Finally, no differences in sleep architecture were noted between former and never smokers. The results of this study show that cigarette smoking is independently associated with disturbances in sleep architecture, including a longer latency to sleep onset and a shift toward lighter stages of sleep. Nicotine in cigarette smoke and acute withdrawal from it may contribute to disturbances in sleep architecture. PMID:16829553
Zhang, Lin; Samet, Jonathan; Caffo, Brian; Punjabi, Naresh M
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
Social-economic factors influence sleep habits. This research analyzes characteristics of nocturnal sleep in Brazilian Native Terena adults. Sixty-four adults (31 M; 33 F) from 18 to 75 years, with a mean age of 37.0, from the Indian Reservation village of Córrego do Meio, in the central region of Mato Grosso do Sul, an agriculturally oriented group were evaluated. Nocturnal sleep characteristics were evaluated by means of a standard questionnaire applied to each individual. It was observed that reported nocturnal sleep was longer, sleep onset was earlier and wake up time was also earlier than usually described in urban populations. The mean total time in bed was 8.5 h or more, in every age bracket. The seven-day prevalence rate of insomnia was 4.6%, while the seven-day prevalence rate of hypnotic use was 1.5%, both remarkably less than described in urban populations. These findings stress the need to consider ethnic influences on sleep patterns and disorders. PMID:10849620
Reimão, R; Souza, J C; Gaudioso, C E; Guerra, H D; Alves, A D; Oliveira, J C; Gnobie, N C; Silvério, D C
What is insomnia? Insomnia is defined as a difficulty in falling asleep and/or staying asleep resulting in poorquality sleep or few hours of sleep (Medline Plus). Insomnia has repercussions in the daytime, such as sleepiness ...
The nocturnal sleep and daytime alertness of aircrew were studied by electroencephalography and the multiple sleep latency test. After a transmeridian flight from London to San Francisco, sleep onset was faster and, although there was increased wakefulness during the second half of the night, sleep duration and efficiency over the whole night were not changed. The progressive decrease in sleep latencies observed normally in the multiple sleep latency test during the morning continued throughout the day after arrival. Of the 13 subjects, 12 took a nap of around 1-h duration in the afternoon preceding the return flight. These naps would have been encouraged by the drowsiness at this time and facilitated by the departure of the aircraft being scheduled during the early evening. An early evening departure had the further advantage that the circadian increase in vigilance expected during the early part of the day would occur during the latter part of the return flight. PMID:3800829
Nicholson, A N; Pascoe, P A; Spencer, M B; Stone, B M; Green, R L
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
As critical as waking brain function is to learning and memory, an established literature now describes an equally important yet complementary role for sleep in information processing. This overview examines the specific contribution of sleep to human hippocampal memory processing; both the detriments caused by a lack of sleep, and conversely, the proactive benefits that develop following the presence of sleep. First, a role for sleep before learning is discussed, preparing the hippocampus for initial memory encoding. Second, a role for sleep after learning is considered, modulating the post-encoding consolidation of hippocampal-dependent memory. Third, a model is outlined in which these encoding and consolidation operations are symbiotically accomplished, associated with specific NREM sleep physiological oscillations. As a result, the optimal network outcome is achieved: increasing hippocampal independence and hence overnight consolidation, while restoring next-day sparse hippocampal encoding capacity for renewed learning ability upon awakening. Finally, emerging evidence is considered suggesting that, unlike previous conceptions, sleep does not universally consolidate all information. Instead, and based on explicit as well as saliency cues during initial encoding, sleep executes the discriminatory offline consolidation only of select information. Consequently, sleep promotes the targeted strengthening of some memories while actively forgetting others; a proposal with significant theoretical and clinical ramifications.
Saletin, Jared M.; Walker, Matthew P.
Background and purpose: To investigate the complaint of unrefreshing sleep with study of sleep electroencephalogram (EEG) in patients with chronic fatigue. Patients and methods: Fourteen successively seen patients (mean age: 41.1 9.8) who complained of chronic fatigue but denied sleepiness and agreed to participate were compared to 14 controls (33.6G10.2 years) who were monitored during sleep recorded in parallel. After
Christian Guilleminault; Dalva Poyares; Agostinho da Rosa; Ceyda Kirisoglu; Tatiana Almeida; Maria Cecilia Lopes
This report documents how respiratory sleep disorders can adversely effect ischaemic heart disease. Three male patients (aged 60-67 years) with proven ischaemic heart disease are described. They illustrate a spectrum of nocturnal cardiac dysfunction, two with nocturnal angina and one with nocturnal arrhythmias. Full sleep studies were performed in a dedicated sleep laboratory on all patients, and one patient had 48 hours of continuous Holter monitoring. Two patients were found to have obstructive sleep apnoea with apnoea/hypopnoea indices of 57 and 36 per hour, respectively, the former with nocturnal arrhythmias and the latter with nocturnal angina. In both cases, nasal continuous positive airways pressure successfully treated the sleep apnoea, with an associated improvement in nocturnal arrhythmias and angina. The third patient who presented with nocturnal angina, did not demonstrate obstructive sleep apnoea (apnoea/hypopnoea index = 7.2) but had significant oxygen desaturation during rapid eye movement (REM) sleep. This patient responded to a combination of nocturnal oxygen and protriptyline, an agent known to suppress REM sleep, and had no further nocturnal angina. All patients were considered to be an optimum cardiac medication and successful symptom resolution only occurred with the addition of specific therapy aimed at their sleep-related respiratory problem. We conclude that all patients with nocturnal angina or arrhythmias should have respiratory sleep abnormalities considered in their assessment.
Liston, R.; Deegan, P. C.; McCreery, C.; McNicholas, W. T.
Although the major daily peak in plasma growth hormone (GH) level normally occurs during the early part of nocturnal sleep, it is known that in about one quarter of young healthy men, peaks in circulating human GH occur before sleep onset. Possible factors associated with these nocturnal peaks were investigated in the absence of sleep, including subjectively defined sleepiness, electroencephalographically
Janet Mullington; Dirk Hermann; Florian Holsboer; Thomas Pollmächer
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
\\u000a Narcolepsy is an under-recognized disease, but classically reported as one of the most severe conditions of chronic hypersomnia.\\u000a Excessive daytime sleepiness is usually the first symptom to appear in childhood or in young adulthood, occurring daily, often\\u000a irresistible, with short duration, capable of restoring normal vigilance for one to several hours, and associated with dreaming.\\u000a In contrast, disturbed nocturnal sleep
Yves Dauvilliers; Giuseppe Plazzi
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
Animal studies reveal that cytokines play a key role in the regulation of sleep. Alcoholic patients show profound alterations of sleep and a defect in the homeostatic recovery of sleep following sleep loss. In this study, we investigated whether nocturnal plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-? (TNF) were associated with disordered sleep in alcohol dependence by testing
Michael Irwin; Gina Rinetti; Laura Redwine; Sarosh Motivala; Jeff Dang; Cindy Ehlers
Study Objectives: To assess the stability of the multiple sleep latency test (MSLT) in primary insomnia and its relation to total sleep time. Design: Randomized, double-blind, placebo controlled, clinical trial. Setting: Outpatient with sleep laboratory assessments in months 1 and 8 of treatment. Participants: Ninety-five primary insomniacs, 32-64 years old and 55 age- and sex-matched general population-based, representative controls. Interventions: After a screening nocturnal polysomnograms (NPSG) and MSLT the following day, participants with primary insomnia were randomized to take zolpidem 10 mg (n = 50) or placebo (n = 45) nightly for 12 months. During months 1 and 8, while taking their prescribed treatments, NPSGs and MSLTs the following day were conducted. A population-based sample served as controls and received a single NPSG followed by MSLT. Results: Mean daily sleep latency on the screening MSLT of insomniacs was normally distributed across the full range of MSLT scores and significantly higher than those of a population-based representative control sample (P < 0.006). The insomniacs with the highest screening MSLTs had the shortest screening total sleep times (P < 0.05). The MSLTs of insomniacs during treatment in study month 1 were correlated (r = 0.44, P < 0.001) with their month 8 MSLT. The mean MSLT score of the zolpidem group did not differ from that of the placebo group, and the stability within treatment groups also did not differ. Conclusions: These data support the hypothesis that some insomniacs show a reliable disorder of hyperarousal with increased wake drive both at night and during the day. Citation: Roehrs TA; Randall S; Harris E; Maan R; Roth T. MSLT in primary insomnia: stability and relation to nocturnal sleep. SLEEP 2011;34(12):1647-1652.
Roehrs, Timothy A.; Randall, Surilla; Harris, Erica; Maan, Renee; Roth, Thomas
This study assessed the sleep patterns, sleep disruptions, and sleepiness of school-age children. Sleep patterns of 140 children (72 boys and 68 girls; 2nd-, 4th-, and 6th-grade students) were evaluated with activity monitors (actigraphs). In addition, the children and their parents completed complementary sleep questionnaires and daily reports. The findings reflected significant age differences, indicating that older children have more
Avi Sadeh; Amiram Raviv; Reut Gruber
Nocturnal asthma indicates poor overall control of asthma and adversely affects the quality of life of the patient. The purpose of the present study was to compare the objective measurement of nocturnal wheeze with clinical state, recall of symptoms, and changes in lung function. Nine asthmatic children aged 9 to 16 years were followed with an asthma diary and diurnal measurement of peak flow for a week before the nocturnal study; all but two were apparently well controlled. Breath sounds were recorded and analyzed continuously overnight to quantify wheeze using a phonopneumography sensor attached over the trachea. The analytical system (PulmoTrack) utilized an algorithm to detect wheeze and reject interference. The wheeze rate (Tw/Ttot = duration of wheeze/duration of recording) was calculated minute by minute throughout the night. Recordings lasted over 8 hours and all but two children had wheeze lasting for a total time of between 11 and 87 minutes. The pattern of wheezing was very variable during sleep, with episodes of wheeze separated by periods of quiet breathing. There was no relationship between subjective perception of nocturnal asthma, forced expiratory volume in 1 s (FEV(1)) next morning, and the objective measurement of wheeze. Total overnight wheeze was significantly related to the total diary symptom score and to the (small) diurnal variability of peak expiratory flow (PEF). Four of the seven children with asthma who were apparently well controlled had considerable amounts of wheeze during the night that was episodic in nature and unrelated to conventional measures of lung function or nocturnal symptoms. PMID:20394513
Boner, Attilio L; Piacentini, Giorgio L; Peroni, Diego G; Irving, Charles S; Goldstein, Diana; Gavriely, Noam; Godfrey, Simon
Background Sleep disturbances comparable with insomnia occur in up to 80% of people with schizophrenia, but very little is known about the contribution of circadian coordination to these prevalent disruptions. Aims A systematic exploration of circadian time patterns in individuals with schizophrenia with recurrent sleep disruption. Method We examined the relationship between sleep-wake activity, recorded actigraphically over 6 weeks, along with ambient light exposure and simultaneous circadian clock timing, by collecting weekly 48 h profiles of a urinary metabolite of melatonin in 20 out-patients with schizophrenia and 21 healthy control individuals matched for age, gender and being unemployed. Results Significant sleep/circadian disruption occurred in all the participants with schizophrenia. Half these individuals showed severe circadian misalignment ranging from phase-advance/delay to non-24 h periods in sleep-wake and melatonin cycles, and the other half showed patterns from excessive sleep to highly irregular and fragmented sleep epochs but with normally timed melatonin production. Conclusions Severe circadian sleep/wake disruptions exist despite stability in mood, mental state and newer antipsychotic treatment. They cannot be explained by the individuals' level of everyday function.
Wulff, Katharina; Dijk, Derk-Jan; Middleton, Benita; Foster, Russell G.; Joyce, Eileen M.
Oxygen saturation obtained from nocturnal pulse oximetry is a significant evaluation parameter for sleep related breathing disorders, especially in the diagnosis of the obstructive sleep apnea syndrome (OSA). Today clinical interpretation relies mainly on the number of desaturation events per hour (oxygen desaturation index, ODI). In this study various alternatives were established and their applicability for OSA screening was evaluated. The discussed methods include time-based approaches (?-index), non-linear analysis (central tendency measure, approximate entropy), and spectral methods (Welch transform, wavelet transform). When applied to 192 data sets (132 male, 60 female, 47.9±15.5 years, BMI 27.4±6.5 kg/m(2)) these methods showed good correlation with clinical findings. When discriminating between non-OSA and OSA patients the approaches under investigation yield sensitivity values between 96.6% and 100% and specificity values between 97.4% and 100%. Particularly spectral methods could provide parameters for an optimized OSA screening based on nocturnal pulse oximetry. PMID:21823998
Schmittendorf, Eckhard; Schultheib, Birgit; Böhning, Nikolaus
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. PMID:23853568
Vorona, Robert Daniel; Szklo-Coxe, Mariana; Fleming, Mark; Ware, J Catesby
The internal structure of night sleep in subjects with narcolepsy significantly differs as compared to the controls. The differences consist in the presence of sleep onset REM periods (SOREMPs) and in a longer duration (120 minutes versus 90 minutes) of the NREM-REM cycles. Another difference consists in the lack of increase in REM sleep duration during the night, cycle after cycle. These characteristics, taken as a whole, suggest that the sleep structure of narcoleptic patients is due to an imbalance between the homeostatic process and the enhanced pressure of REM inducing mechanisms. With regard to the intrasleep dynamics the current extension of the Two-process model cannot give a satisfactory explanation because REM sleep is included as an external trigger with no intrinsic rhythmic property. Neurobiologic studies lead to consider the REM cyclic occurrence as the result of reciprocal interaction between two populations of REM-ON and REM-OFF cells. The introduction in the Two-process-model extended to the intra-night dynamics of an ultradian oscillator, based on a REM-ON--REM-OFF reciprocal interaction, allows the theoretical possibility to simulate a SOREMP. This revised model accounts for the progressive extension of REM sleep-periods duration in the course of the night. The sleep structure of narcoleptic patients can be simulated leaving unaltered the pressure of the homeostatic process and enhancing the REM inducing pressure. Such an enhanced REM pressure can be achieved by increasing the value of the numerical coefficient, which represents the strength of connection between the two types of REM-ON and REM-OFF cells. This modification allows not only to obtain a stronger ultradian oscillator but also a longer periodicity of REM sleep occurrence. By coupling the homeostatic process, considered as normal, to such a modified ultradian oscillator, our model can explain the intra-night sleep dynamics of narcoleptic subjects. A REM-ON REM-OFF dysregulation can be hypothesized to explain the pathophysiological basis of nocturnal sleep features in narcolepsy. PMID:11924047
Nobili, L; Beelke, M; Besset, A; Billiard, M; Ferrillo, F
Summary In 10 peptic ulcer patients, 5 duodenal ulcer and 5 gastric ulcer patients, the relation of nocturnal intragastric pH to EEG\\u000a sleep stages was examined. The nocturnal intragastric pH was monitored by pH-measuring telemeter and sleep stages were recorded\\u000a simultaneously by electroencephalography throughout the night. The EEG sleep stages were classified after the criteria of\\u000a Dement and Kleitman. The average
Kose Segawa; Chiyuki Mabuchi; Zenji Shiozawa; Saburo Nakazawa
Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep.BackgroundNocturnal hemodialysis (NHD) alleviates uremia-related sleep apnea, a condition characterized by increased sympathetic activity and diminished heart rate (HR) variability. We tested the hypothesis that NHD reduces both hypoxemia and sympathetic neural contributions to HR variability during sleep.MethodsEpisodes of apnea and hypopnea and the duration
Christopher T. Chan; PAT HANLY; JONATHAN GABOR; PETER PICTON; ANDREAS PIERRATOS; John S. Floras
We investigated nocturnal sleep abnormalities in 19 patients with idiopathic hypersomnia without long sleep time (IH) in comparison with two age- and sex- matched control groups of 13 normal subjects (C) and of 17 patients with narcolepsy with cataplexy (NC), the latter considered as the extreme of excessive daytime sleepiness (EDS). Sleep macro- and micro- (i.e. cyclic alternating pattern, CAP) structure as well as quantitative analysis of EEG, of periodic leg movements during sleep (PLMS), and of muscle tone during REM sleep were compared across groups. IH and NC patients slept more than C subjects, but IH showed the highest levels of sleep fragmentation (e.g. awakenings), associated with a CAP rate higher than NC during lighter sleep stages and lower than C during slow wave sleep respectively, and with the highest relative amount of A3 and the lowest of A1 subtypes. IH showed a delta power in between C and NC groups, whereas muscle tone and PLMS had normal characteristics. A peculiar profile of microstructural sleep abnormalities may contribute to sleep fragmentation and, possibly, EDS in IH. PMID:23061443
Pizza, Fabio; Ferri, Raffaele; Poli, Francesca; Vandi, Stefano; Cosentino, Filomena I I; Plazzi, Giuseppe
Objective: We examined simultaneously alpha activity and cardiac changes during nocturnal sleep, in order to differentiate non-rapid eye movement (NREM) sleep, REM sleep, and intra-sleep awakening.Methods: Ten male subjects displaying occasionally spontaneous intra-sleep awakenings underwent EEG and cardiac recordings during one experimental night. The heart rate and heart rate variability were calculated over 5 min periods. Heart rate variability was
J Ehrhart; M Toussaint; C Simon; C Gronfier; R Luthringer; G Brandenberger
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.
The electroclinical features of autosomal dominant nocturnal frontal lobe epilepsy have been recently described. Although some patients reported a poor quality of sleep, daytime tiredness, and sleepiness, their sleep macrostructure appeared to be indistinguishable from those of the control group. The aim of this study was to evaluate the macro- and microstructure of sleep in a sample of autosomal dominant nocturnal frontal lobe epilepsy patients, diagnosed by videopolysomnography. The authors selected 16 patients, 8 with daytime complaints (morning tiredness and/or excessive sleepiness) (group 1) and 8 without those complaints (group 2). The classical macrostructure of sleep and the microstructure, according to the cyclic alternating pattern (CAP) scoring rules, were compared with another group of 8 healthy controls. In group 1 the motor attacks during sleep took place more frequently during CAP and were significantly related to phase A of the CAP cycle in comparison to group 2 (P = 0.04). Group 2 had a sleep microstructure similar to the controls, whereas group 1 showed higher CAP/nonrapid eye movement sleep (CAP rate) and a higher number of CAP cycles with respect to controls (P = 0.012 and P = 0.001) and to group 2 (P = 0.05 and P = 0.04). The analysis of sleep microstructure showed an increase in sleep instability in patients with autosomal dominant nocturnal frontal lobe epilepsy and daytime sleep complaints and indicated the relationship between sleep fragmentation, nocturnal motor seizures, and daytime symptoms. PMID:10709813
Zucconi, M; Oldani, A; Smirne, S; Ferini-Strambi, L
Nocturnal oximetry is an attractive option for the diagnosis of obstructive sleep apnoea (OSA) syndrome because of its simplicity and low cost compared to polysomnography (PSG). The present study assesses nonlinear analysis of blood oxygen saturation (SaO2) from nocturnal oximetry as a diagnostic test to discriminate between OSA positive and OSA negative patients. A sample of 187 referred outpatients, clinically
D Álvarez; R Hornero; D Abásolo; F del Campo; C Zamarrón
Influence of sampling interval on the evaluation of nocturnal blood pressure in subjects with and without obstructive sleep apnoea. O. Marrone, S. Romano, G. Insalaco, M.R. Bonsignore, A. Salvaggio, G. Bonsignore. #ERS Journals Ltd 2000. ABSTRACT: Blood pressure (BP) variability during sleep is high in obstructive sleep apnoea syndrome (OSAS). How BP sampling interval affects the estimate of mean nocturnal
O. Marrone; S. Romano; G. Insalaco; M. R. Bonsignore; A. Salvaggio; G. Bonsignore
Pontine structures are critical for the generation of rapid eye movement sleep but there are only a few reports of the effects of focal pontine lesions on sleep patterns in humans. We report the case of an 81-year-old man admitted for the acute onset of disordered speech and motor deficit in the upper right arm who developed hypersomnia within a week. A 24-hour polysomnographic study revealed a very severe disruption of both circadian rhythm and sleep organisation, and a brain MRI documented an ischaemic lesion of the anterior left paramedian portion of the pons. Our observation suggests that even small, paramedian pontine ischaemic lesions can acutely induce a very severe sleep disorder.
Tosato, Matteo; Aquila, Sara; Marca, Giacomo della; Incalzi, Raffaele Antonelli; Gambassi, Giovanni
Question of the study: Prevalence and determinants of daytime hypoxemia in patients with obstructive sleep apnea (OSA) syndrome are not well established. The aims of this study, conducted in a large series of OSA patients, were to estimate the prevalence of daytime hypoxemia, to assess the reciprocal effects between daytime PaO2 and nocturnal SpO2, and to investigate the direct and indirect role of sleep apnea severity in determining feedback gas exchange abnormalities. Materials and methods: In 456 patients a daytime hypoxemia-nocturnal hypoxia feedback structural equations model was designed. PaO2 adjusted for age (% of predicted), percent sleep time spent with SpO2 <90% (TST90), oxygen desaturation index and the apnea-hypopnea index, were determined as the measures of daytime hypoxemia, nocturnal hypoxia, and sleep apnea severity, respectively, after adjusting for the severity of obesity and lung volumes. Results: The TST90-PaO2 feed-back structural equations modeling showed that daytime PaO2 was inversely related (P<0.001) to nocturnal hypoxia (?4.0% of PaO2 per 1 SD of TST90). The severity of OSA (?1.0%) was an indirect determinant of daytime PaO2 via the TST90 pathway. In contrast, daytime PaO2 did not influence (P>0.05) the extent of nocturnal hypoxia. Conclusions: In OSA patients, the extent of nocturnal hypoxia seems to be both a direct determinant and a mediator of the indirect effect of sleep apnea on the development of daytime hypoxemia. Citation: Fanfulla F; Grassi M; Taurino AE; Lupo ND; Trentin R. The relationship of daytime hypoxemia and nocturnal hypoxia in obstructive sleep apnea syndrome. SLEEP 2008;31(2):249–255.
Fanfulla, Francesco; Grassi, Mario; Taurino, Anna Eugenia; Lupo, Nadia D'Artavilla; Trentin, Rossella
BACKGROUND--Respiratory sleep studies are frequently performed to identify sleep disruption resulting from upper airway obstruction. Traditional polysomnographic studies may not detect brief recurrent sleep disruption and thus fail to recognise a significant problem when apnoea, hypopnoea, or arterial desaturation are not present. Arousal from sleep causes a transient blood pressure rise, and each inspiration causes a transient blood pressure fall.
R J Davies; K Vardi-Visy; M Clarke; J R Stradling
INTRODUCTION: Sleep disturbances are common in critically ill patients and when sleep does occur it traverses the day-night periods. The reduction in plasma melatonin levels and loss of circadian rhythm observed in critically ill patients receiving mechanical ventilation may contribute to this irregular sleep-wake pattern. We sought to evaluate the effect of exogenous melatonin on nocturnal sleep quantity in these
Richard S Bourne; Gary H Mills; Cosetta Minelli
This study was intended to determine the effects of continuous bright light exposure on cardiovascular responses, particularly heart rate variability (HRV), at rest and during performance of mental tasks with acute nocturnal sleep deprivation. Eight healthy male subjects stayed awake from 21.00 to 04.30 hours under bright (BL, 2800 lux) or dim (DL, 120 lux) light conditions. During sleep deprivation, mental tasks (Stroop color-word conflict test: CWT) were performed for 15 min each hour. Blood pressure, electrocardiogram, respiratory rate, urinary melatonin concentrations and rectal temperature were measured. During sleep deprivation, BL exposure depressed melatonin secretion in comparison to DL conditions. During sleep deprivation, exposure to BL delayed the decline in heart rate (HR) for 4 h in resting periods. A significant increment of HR induced by each CWT was detected, especially at 03.00 h and later, under DL conditions only. In addition, at 04.00 h, an index of sympathetic activity and sympatho-vagal balance on HRV during CWT increased significantly under DL conditions. In contrast, an index of parasympathetic activity during CWT decreased significantly under DL conditions. However, the indexes of HRV during CWT did not change throughout sleep deprivation under BL conditions. Our results suggest that BL exposure not only delays the nocturnal decrease in HR at rest but also maintains HR and balance of cardiac autonomic modulation to mental tasks during nocturnal sleep deprivation. PMID:16679712
Yokoi, Mari; Aoki, Ken; Shimomura, Yoshihiro; Iwanaga, Koichi; Katsuura, Tetsuo
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
Patients with elevated blood pressure (BP) during sleep (nondipper BP profile) have excess hypertensive target organ damage and appear to be at increased risk for cardiovascular complications. However, the nondipper BP profile has modest reproducibility on repeat studies with as many as 30-40% of subjects changing categories. In order for nocturnal BP to be a therapeutic target, a better method
G. M. LaRocca; G. A. Mansoor; W. B. White; J. Kempthorne-Rawson
Background: Increasing evidence suggests that blood pressure (BP) is significantly influenced by sleep problems in children, but the association between periodic limb movement during sleep (PLMS) and BP is still unclear. This study aims to compare ambulatory blood pressure (ABP) in children with and without PLMS. Methods and Results: A cross-sectional study involving 314 children (mean (SD) age of 10.4 (1.7) years, boys 62.4%). Participants underwent an overnight polysomnographic study and ABP monitoring. Subjects were hypertensive if mean SBP or DBP > 95th percentile and prehypertensive if mean SBP or DBP > 90th percentile of reference. Children with PLMS (n = 17) were at significantly higher risk for nocturnal systolic (adjusted OR (95%CI) = 6.25 [1.87-20.88]) and diastolic (OR (95%CI) = 4.83 [1.66-14.07]) hypertension. However, mean nocturnal BP did not differ between children with and without PLMS. There was a trend for higher daytime BP in patients with PLMS than those children without PLMS (P = 0.084 for systolic BP z score; P = 0.051 for diastolic BP z score; P = 0.067 for systolic prehypertension). There were significant associations between log transformed PLM index and daytime systolic and mean BP z scores (P = 0.03 and 0.033 respectively) as well as that between log transformed PLM related arousal index (PLMSArI) and nocturnal diastolic and mean BP (P = 0.008 and 0.038 respectively). Conclusions: PLMS was independently associated with a wide range of BP elevations, especially nocturnal indices. Future studies should examine the underlying pathophysiologic mechanisms and effects of PLMS treatment on BP. Citation: Wing YK; Zhang J; Ho CKW; Au CT; Li AM. Periodic limb movement during sleep is associated with nocturnal hypertension in children. SLEEP 2010;33(6):759-765.
Wing, Yun Kwok; Zhang, Jihui; Ho, Crover Kwok Wah; Au, Chun-Ting; Li, Albert Martin
Hemodialysis (HD) induces physiological changes that may affect the ability to dissipate heat and adversely affect sleep. We studied the effects of altering dialysate temperature on polysomnographic measures of nocturnal sleep and the time course of proximal skin temperature. The sample included seven stable HD patients. The three-phase randomized trial was conducted in a research facility. After one acclimatization night, subjects were readmitted in the evening on two additional occasions for 42 h and received HD the next morning in the warm condition (dialysate 37 degrees C) and cool condition (dialysate 35 degrees C) in random order. Continuous proximal skin temperature (axillary, T(ax)) and polysomnographic measures of sleep were recorded the nights before and after HD was administered. Highly significant findings included that the time course of T(ax) was markedly affected by dialysis temperature. There was a greater drop of T(ax) in the early morning following the warm condition than during the baseline nights or in the cool condition. Logistic regression indicated that the odds for the occurrence of sleep and its deeper stages were strongly and positively associated with T(ax). Time of sleep onset was earlier in the cool condition (P = 0.03) with trends toward longer total sleep times (P = 0.09) and shorter rapid-eye-movement latencies (P = 0.09). These observations suggest that the use of cool dialysate during HD may improve nocturnal sleep by decreasing sympathetic activation and sustaining the normally elevated nocturnal skin temperature until later into the morning hours. PMID:17309762
Parker, Kathy P; Bailey, James L; Rye, David B; Bliwise, Donald L; Van Someren, Eus J W
A cross-sectional study was carried out to clarify the physiological features of spontaneous awakening from nocturnal sleep (i.e., whether a child can spontaneously wake up on weekday mornings). The study population comprised 116 children at ages 5 and 6 years. Heart rate variability reflecting cardiac sympathetic and parasympathetic activities was measured. Children's typical bedtimes and wake times for weekdays and the
Mari Sampei; Miwako Dakeishi; Donald C. Wood; Toyoto Iwata; Katsuyuki Murata
Heart rate variability (HRV) is a valuable clinical tool in diagnosing multiple diseases. This paper presents the results of a spectral HRV analysis conducted with 46 patients. HRV indices for the whole night show differences among patients with severe and mild apnea, and healthy subjects. These differences also appear when performing the analysis over 5-min intervals, regarding apneas being present or not in the intervals. Differences were also observed when analyzing the HRV nocturnal evolution. Results are consistent with the hypothesis that cardiovascular risk remains constant for OSA patients while it increases towards the end of the night for healthy subjects. PMID:23084286
Lado, María J; Méndez, Arturo J; Rodríguez-Liñares, Leandro; Otero, Abraham; Vila, Xosé A
Working memory is essential to higher order cognition (e.g. fluid intelligence) and to performance of daily activities. Though working memory capacity was traditionally thought to be inflexible, recent studies report that working memory capacity can be trained and that offline processes occurring during sleep may facilitate improvements in working memory performance. We utilized a 48-h in-laboratory protocol consisting of repeated digit span forward (short-term attention measure) and digit span backward (working memory measure) tests and overnight polysomnography to investigate the specific sleep-dependent processes that may facilitate working memory performance improvements in the synucleinopathies. We found that digit span backward performance improved following a nocturnal sleep interval in patients with Parkinson's disease on dopaminergic medication, but not in those not taking dopaminergic medication and not in patients with dementia with Lewy bodies. Furthermore, the improvements in patients with Parkinson's disease on dopaminergic medication were positively correlated with the amount of slow-wave sleep that patients obtained between training sessions and negatively correlated with severity of nocturnal oxygen desaturation. The translational implication is that working memory capacity is potentially modifiable in patients with Parkinson's disease but that sleep disturbances may first need to be corrected.
Trotti, Lynn Marie; Wilson, Anthony G.; Greer, Sophia A.; Bliwise, Donald L.
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.
Atypical cardiorespiratory patterns can be found during routine clinical use of portable monitoring for diagnosis of sleep-disordered breathing (SDB). Over 1,000 consecutive portable recordings were analysed to study the potential ictal nature of stereotyped cardiorespiratory and motor patterns. Snoring, airflow, thoracic effort, pulse rate, body position, oxygen saturation and activity of the anterior tibialis muscles were quantified. Recordings showing stereotyped polygraphic patterns recurring throughout the night, but without the features of sleep apnoea (apnoea/hypopnoea index <5 events·h(-1)), were selected for investigation. Once included in the study, patients underwent attended nocturnal video polysomnography. A total of 15 recordings showing repeated polygraphic patterns characterised by a sequence of microphone activation, respiratory activity atypical for sleep and wakefulness, heart rate acceleration and limb movements, followed by body position change, were selected for investigation. Once included in the study, patients underwent attended nocturnal video polysomnography that showed frontal epileptic discharges triggering periodic electroencephalographic arousals, autonomic activation and stereotyped motor patterns. A diagnosis of nocturnal frontal lobe epilepsy (NFLE) was established for all patients. NFLE should be taken into consideration in patients with stereotyped and recurrent behavioural features during portable monitoring carried out for diagnosis of SDB. PMID:22700842
Parrino, Liborio; Milioli, Giulia; Grassi, Andrea; De Paolis, Fernando; Riccardi, Silvia; Colizzi, Elena; Bosi, Marcello; Terzano, Mario Giovanni
A 16-year-old patient presenting with complex partial seizures occurring in the transition from a REM period to wakefulness is described. His baseline EEG showed generalized and symmetrical slow spike and wave complexes, on a normal background activity, activated by NREM sleep. Polygraphic and videotape recordings, carried out for several nights, showed that after nearly each REM period, he would wake
Rosalia Silvestri; Pietro De Domenico; Rosa Musolino; Giuseppe Mento; Luciana Marabello; Marcello Longo; Raoul Di Perri
Meals of varying energy content and episodes of sleep influence body temperature. We compared the effect of an evening meal, varying from high-energy (11.91 +/- 0.86 MJ) to average (5.74 +/- 0.88 MJ) and a 10-h fast (no evening meal), on nocturnal body temperature and sleep. Seven healthy men (20-24 years, mean body mass index of 23.4 +/- 2.6 kg/m2) reported to the laboratory for an evening meal at 2000 h having consumed similar amounts of food before 1300 h. After completing the meal, subjective hunger ratings were assessed, and a venous blood sample taken. The subjects spent 4 nonconsecutive nights (an adaptation night, followed by either of the two meal conditions or the fast in random order) in the sleep laboratory when polysomnographic recordings were made from 2300 to 0700 h. Meal energy content and serum concentrations of insulin, triglyceride, and low-density lipoproteins (LDL) varied significantly. Lower rectal temperatures were measured during the fast than following the meals. Over the 8-h recording period, thermal response indices (TRI) varied with higher body temperatures following the higher energy meal. Similar rectal temperatures were attained by the end of the sleep periods. There were no significant differences in any of the subjective or objective sleep measures. The physiological responses associated with the transient dietary changes of an evening meal or a 10-h fast altered nocturnal body temperature but did not significantly affect sleep of good sleepers when sleep was initiated 2 to 3 h after finishing the meal. PMID:10627057
Driver, H S; Shulman, I; Baker, F C; Buffenstein, R
INTRODUCTION. We present a series of children who underwent a video-polysomnographic recording at our Sleep and Epilepsy Unit, who received a diagnosis of nocturnal frontal lobe epilepsy (NFLE). AIMS. To describe electroclinical and video polygraphic features of paediatric NFLE that differentiate this condition from other sleep disorders that overlap and mimic the sleep motor and autonomic events of NFLE. PATIENTS AND METHODS. The inclusion criterion was that the patients have their first video-EEG-PSG recording in our laboratory. RESULTS. Twenty-four out of 190 children were diagnosed with NFLE (group 1); while 166 had other sleep disorders (group 2). Among children diagnosed with NFLE, seven were referred for sleep-disordered breathing, seven for parasomnias, two for insomnia, two for hypersomnia, and one for periodic limb movements, while five were referred for epilepsy. In group 1, perinatal history was normal in most cases (21 out of 24) and a familiar history of epilepsy was found in four cases. Sleep-disordered breathing was diagnosed as a comorbid condition in four children. Standard EEG was normal in 21 cases. Interictal EEG showed epileptic discharges in four cases, while ictal EEG was expressed by a rhythmic theta activity preceded by an arousal and/or a short background desynchronization, movement artifacts, and autonomic changes. All seizures, repeated highly stereotyped motor events, were followed by stage shifts and/or a postural change and, by short awakenings. CONCLUSIONS. We found a high percentage of children with NFLE, often misdiagnose or associated with other sleep disorders, which may be a trigger for nocturnal seizures. PMID:23440753
Miano, Silvia; Peraita-Adrados, Rosa
Background Sleepiness and cognitive dysfunction are recognized as prominent consequences of sleep deprivation. Experimentally induced short-term sleep fragmentation, even in the absence of any reductions in total sleep duration, will lead to the emergence of excessive daytime sleepiness and cognitive impairments in humans. Tumor necrosis factor (TNF)-? has important regulatory effects on sleep, and seems to play a role in the occurrence of excessive daytime sleepiness in children who have disrupted sleep as a result of obstructive sleep apnea, a condition associated with prominent sleep fragmentation. The aim of this study was to examine role of the TNF-? pathway after long-term sleep fragmentation in mice. Methods The effect of chronic sleep fragmentation during the sleep-predominant period on sleep architecture, sleep latency, cognitive function, behavior, and inflammatory markers was assessed in C57BL/6?J and in mice lacking the TNF-? receptor (double knockout mice). In addition, we also assessed the above parameters in C57BL/6?J mice after injection of a TNF-? neutralizing antibody. Results Mice subjected to chronic sleep fragmentation had preserved sleep duration, sleep state distribution, and cumulative delta frequency power, but also exhibited excessive sleepiness, altered cognitive abilities and mood correlates, reduced cyclic AMP response element-binding protein phosphorylation and transcriptional activity, and increased phosphodiesterase-4 expression, in the absence of AMP kinase-? phosphorylation and ATP changes. Selective increases in cortical expression of TNF-? primarily circumscribed to neurons emerged. Consequently, sleepiness and cognitive dysfunction were absent in TNF-? double receptor knockout mice subjected to sleep fragmentation, and similarly, treatment with a TNF-? neutralizing antibody abrogated sleep fragmentation-induced learning deficits and increases in sleep propensity. Conclusions Taken together, our findings show that recurrent arousals during sleep, as happens during sleep apnea, induce excessive sleepiness via activation of inflammatory mechanisms, and more specifically TNF-?-dependent pathways, despite preserved sleep duration.
Sleep frequently fragmented or disrupted for prolonged periods can result in mood changes and impaired mental ability and performance. Sleep deprivation is defined as depriving a person or organism of sleep for various periods of fixed durations. Sleep disruption (SD) occurs when a person is awakened at any time when they would normally be sleeping; sometimes on a schedule but
Carolyn A. Marks; Matthew J. Wayner
We performed nocturnal polysomnography on 11 children with autism who had symptoms of disrupted sleep and nocturnal awakenings. We identified rapid eye movement (REM) sleep behavior disorder in 5 of these 11 patients. Since REM sleep behavior disorder typically affects elderly males with neurodegenerative diseases, the identification of this phenomenon in autistic children could have profound implications for our understanding
Shanti S. Thirumalai; Richard A. Shubin; Ricki Robinson
Previous studies have reported alterations of cytokine and cytokine-receptor concentrations in psychiatric patient populations, including patients with major depressive disorder (MDD). However, study results are conflicting, and possible causes for these abnormalities are unknown. Since sleep deprivation may induce a rapid improvement of mood in depressed patients, the authors investigated the impact of total sleep deprivation (TSD) for one night, and subsequent recovery sleep, on nocturnal concentrations of interleukin-6 (IL-6), interleukin-1-receptor antagonist (IL-1RA), and soluble IL-2 receptor (sIL-2R) in 15 unmedicated patients with MDD and 16 healthy volunteers. Whereas IL-6 levels normalized again during the recovery night in depressed patients, they were still elevated in control subjects. Serum levels of IL-1RA were higher in depressed patients than in controls, but were not affected by TSD. During recovery sleep, IL-1RA levels increased as compared with the preceding TSD night only in controls. Responders (N=8) differed from nonresponders (N=7) to TSD with regard to IL-1RA, which increased significantly during TSD in responders only. Sleep deprivation therefore seems to significantly affect cytokine levels in both depressed patients and healthy subjects, but does so in different ways. Sleep disturbances in depressed patients could account for the increased levels of cytokines found in these patients in several previous studies. The interaction between antidepressant effects of TSD and alterations of cytokines warrants further investigation. PMID:23037650
Voderholzer, Ulrich; Fiebich, Bernd L; Dersch, Rick; Feige, Bernd; Piosczyk, Hannah; Kopasz, Marta; Riemann, Dieter; Lieb, Klaus
Experimental sleep deprivation in healthy humans affects levels of ghrelin and leptin, two primary hormones involved in energy balance that regulate appetite and body weight. No study to date has examined levels of these hormones in patients with chronic insomnia. In this study, men diagnosed with primary insomnia using DSM-IV criteria (n=14) and age and body weight comparable healthy control men (n=24) underwent polysomnography. Circulating levels of ghrelin and leptin were measured at 2300h, 0200h and 0600h. As compared to controls, insomnia patients showed less total sleep time, stage 2 and REM sleep and decreased sleep efficiency and more stage 1 sleep than controls (p's<.05). Ghrelin levels across the night were significantly lower in insomnia patients (p<.0001). Leptin was not significantly different between the groups. In conclusion, decreased nocturnal ghrelin in insomnia is consistent with findings for nighttime levels in sleep deprivation studies in healthy sleepers. These findings suggest that insomnia patients have a dysregulation in energy balance that may play a role in explaining prospective weight gain in this population. PMID:19059729
Motivala, Sarosh J; Tomiyama, A Janet; Ziegler, Michael; Khandrika, Srikrishna; Irwin, Michael R
Nocturnal hemodialysis has been shown to improve sleep apnea in patients who receive conventional hemodialysis. It was hypothesized that nocturnal peritoneal dialysis (NPD) also is effective in correcting sleep apnea in patients who receive continuous ambulatory PD (CAPD). Overnight polysomnography (PSG) was performed in 46 stable NPD and CAPD patients who were matched for demographic and clinical attributes. The prevalence
Sydney C. W. Tang; Bing Lam; Pui Pui Ku; Wah Shing Leung; Chung Ming Chu; Yiu Wing Ho; Mary S. M. Ip; Kar Neng Lai
Blood pressure (BP) variability during sleep is high in obstructive sleep apnoea syndrome (OSAS). How BP sampling interval affects the estimate of mean nocturnal BP in OSAS and control subjects was investigated. Nine subjects with apnoea/hypopnoea index (AHI) <5 and 18 OSAS patients with AHI >30 underwent nocturnal polysomnography with beat-by-beat BP monitoring. Mean nocturnal BP was evaluated averaging: a) all systolic (Ps) and diastolic (Pd) BP values; b) Ps and Pd sampled every 5, 10, 15, 20, and 30 min. The sampling starting point was repeatedly shifted, and several mean BP estimates for each sampling interval were obtained. Differences (deltaPs and deltaPd) between means obtained by sampling BP and by averaging all BP values were calculated. In both groups deltaPs and deltaPd scatter increased as sampling interval increased; their variance was always higher in OSAS subjects (p<0.001). Over 95% of deltaPs and deltaPd were <5% of the beat-by-beat mean values at all sampling intervals in controls, but this occurred only at sampling intervals < or =10 min in OSAS subjects. To conclude, for each blood pressure sampling time, a larger number of inaccurate nocturnal mean blood pressure estimates are obtained in obstructive sleep apnoea syndrome than in control subjects. Obstructive sleep apnoea syndrome subjects require more frequent blood pressure measurements to obtain a similar accuracy in nocturnal blood pressure evaluation. PMID:11106208
Marrone, O; Romano, S; Insalaco, G; Bonsignore, M R; Salvaggio, A; Bonsignore, G
|This paper examines the sleep disruption experienced by 36 families of technology-dependent children living at home in the United Kingdom. The paper begins with an overview of the qualitative study in which parents' experiences of sleep disruption emerged as a major theme. We then describe the nature of and reasons for the sleep disruption, the…
Heaton, Janet; Noyes, Jane; Sloper, Patricia; Shah, Robina
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 studied a sample of stable HD patients to explore relationships between quality of life and both subjective and objective measures of nocturnal sleep and daytime sleepiness Methods The sample included forty-six HD patients, 24 men and 22 women, with a mean age of 51.6 (10.8) years. Subjects underwent one night of polysomnography followed the next morning by a Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Subjects also completed: 1) a brief nocturnal sleep questionnaire; 2) the Epworth Sleepiness Scale; and, 3) the Quality of Life Index (QLI, Dialysis Version) which provides an overall QLI score and four subscale scores for Health & Functioning (H&F), Social & Economic (S&E), Psychological & Spiritual (P&S), and Family (F). (The range of scores is 0 to 30 with higher scores indicating better quality of life.) Results The mean (standard deviation; SD) of the overall QLI was 22.8 (4.0). The mean (SD) of the four subscales were as follows: H&F – 21.1 (4.7); S&E – 22.0 (4.8); P&S – 24.5 (4.4); and, F – 26.8 (3.5). H&F (rs = -0.326, p = 0.013) and F (rs = -0.248, p = 0.048) subscale scores were negatively correlated with periodic limb movement index but not other polysomnographic measures. The H&F subscale score were positively correlated with nocturnal sleep latency (rs = 0.248, p = 0.048) while the H&F (rs = 0.278, p = 0.030) and total QLI (rs = 0.263, p = 0.038) scores were positively associated with MSLT scores. Both of these latter findings indicate that higher life quality is associated with lower sleepiness levels. ESS scores were unrelated to overall QLI scores or the subscale scores. Subjective reports of difficulty falling asleep and waking up too early were significantly correlated with all four subscale scores and overall QLI. Feeling rested in the morning was positively associated with S&E, P&S, and Total QLI scores. Conclusion Selected measures of both poor nocturnal sleep and increased daytime sleepiness are associated with decreased quality of life in HD patients, underscoring the importance of recognizing and treating these patients' sleep problems.
Parker, Kathy P; Kutner, Nancy G; Bliwise, Donald L; Bailey, James L; Rye, David B
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. (Author correspondence: email@example.com)
Rahman, Shadab A.; Shapiro, Colin M.; Wang, Flora; Ainlay, Hailey; Kazmi, Syeda; Brown, Theodore J.
Exercise can cause a reduction in blood pressure (BP) that is prolonged enough to extend into nocturnal sleep. This post-exercise hypotension has been found to be less apparent in the morning when the immedi- ate (during the 20 minutes after exercise) responses are considered. However, it is currently unknown if the timing of exercise (morning vs. afternoon) mediates different BP
Helen Jones; Keith George; Greg Atkinson
To determine whether older good and poor sleepers with and without insomnia complaints differ in the nature of activities they engage in during periods of nocturnal wakefulness, the authors developed and evaluated the Sleep Behaviors Scale: 60+. Good sleepers (n = 163), low-distress poor sleepers (n = 49), and high-distress poor sleepers (n = 28) were compared on this measure
Eva Libman; Laura Creti; Rhonda Amsel; William Brender
BACKGROUNDPolysomnography (PSG) is currently the “gold standard” for the diagnosis of the sleep apnoea hypopnoea syndrome (SAHS). Nocturnal oximetry (NO) has been used with contradictory results. A prospective study was performed to determine the accuracy of NO as a diagnostic tool and to evaluate the reduction in the number of PSGs if the diagnosis of SAHS had been established by
Eusebi Chiner; Jaime Signes-Costa; Juan Manuel Arriero; Juan Marco; Isabel Fuentes; Antonia Sergado
This paper provides a checklist and summary of what is currently known of the variation in infant contact, sleeping site preference and aspects of social cohesion in the nocturnal primates of Africa. Genera and species are compared, based on previously unpublished field observations and a review of the literature. There is a clear pattern of similarity between the species within
Simon K. Bearder; Lesley Ambrose; Caroline Harcourt; Paul Honess; Andrew Perkin; Elizabeth Pimley; Samantha Pullen; Nadine Svoboda
The purpose of this study was to investigate the effect of the exposure to bright light on EEG activity and subjective sleepiness at rest and at the mental task during nocturnal sleep deprivation. Eight male subjects lay awake in semi-supine in a reclining seat from 21:00 to 04:30 under the bright (BL; >2500 lux) or the dim (DL; <150 lux) light conditions. During the sleep deprivation, the mental task (Stroop color-word conflict test: CWT) was performed each 15 min in one hour. EEG, subjective sleepiness, rectal and mean skin temperatures and urinary melatonin concentrations were measured. The subjective sleepiness increased with time of sleep deprivation during both rest and CWT under the DL condition. The exposure to bright light delayed for 2 hours the increase in subjective sleepiness at rest and suppressed the increase in that during CWT. The bright light exposure also delayed the increase in the theta and alpha wave activities in EEG at rest. In contrast, the effect of the bright light exposure on the theta and alpha wave activities disappeared by CWT. Additionally, under the BL condition, the entire theta activity during CWT throughout nocturnal sleep deprivation increased significantly from that in a rest condition. Our results suggest that the exposure to bright light throughout nocturnal sleep deprivation influences the subjective sleepiness during the mental task and the EEG activity, as well as the subjective sleepiness at rest. However, the effect of the bright light exposure on the EEG activity at the mental task diminishes throughout nocturnal sleep deprivation. PMID:14646259
Yokoi, Mari; Aoki, Ken; Shimomura, Yoshihiro; Iwanaga, Koichi; Katsuura, Tetsuo; Shiomura, Yoshihiro
This pilot study evaluated the impact of Bikram Yoga on subjective and objective sleep parameters. We compared subjective (diary) and objective (headband sleep monitor) sleep measures on yoga versus nonyoga days during a 14-day period. Subjects (n = 13) were not constrained regarding yoga-practice days, other exercise, caffeine, alcohol, or naps. These activities did not segregate by choice of yoga days. Standard sleep metrics were unaffected by yoga, including sleep latency, total sleep time, and percentage of time spent in rapid eye movement (REM), light non-REM, deep non-REM, or wake after sleep onset (WASO). Consistent with prior work, transition probability analysis was a more sensitive index of sleep architecture changes than standard metrics. Specifically, Bikram Yoga was associated with significantly faster return to sleep after nocturnal awakenings. We conclude that objective home sleep monitoring is feasible in a low-constraint, real-world study design. Further studies on patients with insomnia will determine whether the results generalize or not.
Kudesia, Ravi S.; Bianchi, Matt T.
This pilot study evaluated the impact of Bikram Yoga on subjective and objective sleep parameters. We compared subjective (diary) and objective (headband sleep monitor) sleep measures on yoga versus nonyoga days during a 14-day period. Subjects (n = 13) were not constrained regarding yoga-practice days, other exercise, caffeine, alcohol, or naps. These activities did not segregate by choice of yoga days. Standard sleep metrics were unaffected by yoga, including sleep latency, total sleep time, and percentage of time spent in rapid eye movement (REM), light non-REM, deep non-REM, or wake after sleep onset (WASO). Consistent with prior work, transition probability analysis was a more sensitive index of sleep architecture changes than standard metrics. Specifically, Bikram Yoga was associated with significantly faster return to sleep after nocturnal awakenings. We conclude that objective home sleep monitoring is feasible in a low-constraint, real-world study design. Further studies on patients with insomnia will determine whether the results generalize or not. PMID:22577578
Kudesia, Ravi S; Bianchi, Matt T
The etiology of sleep disruption in patients in intensive care units (ICUs) is poorly understood, but is thought to be related to environmental stimuli, especially noise. We sampled 203 patients (121 males and 82 females) from different ICUs (cardiac (CCU), cardiac stepdown (CICU), medical (MICU), and surgical (SICU)) by questionnaire on the day of their discharge from the unit, to
NEIL S. FREEDMAN; NATALIE KOTZER; RICHARD J. SCHWAB
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
Very few studies were devoted to permanent effects of nocturnal railway noise on sleep and cardiovascular reactivity. We investigated the effects of nocturnal railway noise on sleep and cardiovascular response in young and middle-aged adults living for many years either near a railway track or in a quiet area. Forty subjects (50% males) divided into two age groups (juniors: 26.2±3.6
Patricia Tassi; Odile Rohmer; Sarah Schimchowitsch; Arnaud Eschenlauer; Anne Bonnefond; Florence Margiocchi; Franck Poisson; Alain Muzet
The function of sleep in humans has been investigated using simultaneous electroencephalography (EEG) and functional magnetic resonance imaging recordings to provide accurate sleep scores with spatial precision. Recent studies have demonstrated that spontaneous brain oscillations and functional connectivity dissociate during nonrapid eye movement (NREM) sleep; this leads to spontaneous cognitive processes, such as memory consolidation and emotional modulation. However, variations in network connectivity across the sleep stages or between sleep/wake transitions require further elucidation. We observed changes in the connectivity of the sensorimotor and default-mode networks (DMN) mediated by midnight sleep among 18 healthy participants. The results indicated that (1) functional connectivity in both networks showed increasing dissociation as NREM sleep deepened, whereas hyperconnectivity occurred during rapid eye movement (REM) sleep; and (2) compared with connectivity before sleep, the DMN presented a comparable connectivity pattern immediately after awakening, whereas the connectivity of the sensorimotor network remained disrupted. These findings showed that connectivity patterns dissociate and reconnect coherently in both cortical networks during NREM and REM sleep, respectively. After the person awakened, the DMN connectivity was re-established before the sensorimotor reconnection. These dynamic sleep-related dissociations and reconnections between sleep/wake conditions might provide the key to understanding cognitive modulations in sleep. If so, connectivity changes might serve as an alternative indicator beyond the EEG signature to unveil the spontaneous processes that occur during sleep. PMID:22817652
Wu, Changwei W; Liu, Po-Yu; Tsai, Pei-Jung; Wu, Yu-Chin; Hung, Ching-Sui; Tsai, Yu-Che; Cho, Kuan-Hung; Biswal, Bharat B; Chen, Chia-Ju; Lin, Ching-Po
Treatment of obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) usually causes a reduction in blood pressure (BP), but several factors may interfere with its effects. In addition, although a high sympathetic activity is considered a major contributor to increased BP in OSA, a relationship between changes in BP and in sympathetic nervous system activity after OSA treatment is uncertain. This study was undertaken to assess if, in OSA subjects under no pharmacologic treatment, treatment by CPAP applied at variable levels by an automatic device (APAP) may be followed by a BP reduction, and if that treatment is associated with parallel changes in BP and catecholamine excretion during the sleep hours. Nine subjects underwent 24-h ambulatory BP monitoring and nocturnal urinary catecholamine determinations before OSA treatment and 2 months following OSA treatment by APAP (Somnosmart2, Weinmann, Hamburg, Germany). Eight control subjects were treated by CPAP at a fixed level. After APAP treatment, systolic blood pressure (SBP) decreased during sleep (p < 0.05), while diastolic blood pressure (DBP) decreased both during wakefulness (p < 0.05) and sleep (p < 0.02). Similar changes were observed in subjects receiving fixed CPAP. Nocturnal DBP changes were correlated with norepinephrine (in the whole sample: r = .61, p < 0.02) and normetanephrine (r = .71, p < 0.01) changes. In OSA subjects under no pharmacologic treatment, APAP reduces BP during wakefulness and sleep, similarly to CPAP. A reduction in nocturnal sympathetic activity could contribute to the reduction in DBP during sleep following OSA treatment. PMID:21529314
Marrone, Oreste; Salvaggio, Adriana; Bue, Anna Lo; Bonanno, Anna; Riccobono, Loredana; Insalaco, Giuseppe; Bonsignore, Maria Rosaria
Little is known about sleep\\/wake abnormalities in intensive care and less is known about the mechanisms responsible for these ab- normalities. We studied 22 (20 mechanically ventilated) medical intensive care unit (ICU) patients with continuous polysomnogra- phy (PSG) and environmental noise measurements for 24-48 h to characterize sleep-wake patterns and objectively determine the effect of environmental noise on sleep disruption.
NEIL S. FREEDMAN; JOOST GAZENDAM; LACHELLE LEVAN; ALLAN I. PACK; RICHARD J. SCHWAB
PurposeFatigue and disrupted sleep often coexist and both are prominent clinical problems in cancer affecting quality of life. Disrupted sleep patterns are likely related to cancer-related fatigue. The relationship needs further investigation. This study aimed to characterize and compare disrupted sleep patterns in fatigued breast cancer patients receiving chemotherapy with postmenopausal women without a history of cancer. Anxiety levels were
Horng-Shiuann Wu; Jean E. Davis; Josna P. Padiyar; Hossein Yarandi
Introduction Primary nocturnal enuresis (PNE) is a common problem in developmental age with an estimated overall prevalence ranging from 1.6% to 15%, and possible persistence during adolescence. There is a growing interest in the sleep habits of children affected by PNE, which is derived from the contradictory data present in clinical literature. The aim of the present study was to evaluate the presence of sleep disturbances in a population of children affected by PNE, and to identify whether PNE could be considered as a risk factor for sleep disturbances among children. Materials and methods A total of 190 PNE children (97 males, 93 females) aged 7–15 years, (mean 9.64 ± 1.35 years), and 766 typically developing children matched for age (P = 0.131) and gender (P = 0.963) were enrolled. To evaluate the presence of sleep habits and disturbances, all of the subjects’ mothers filled out the Sleep Disturbances Scale for Children (SDSC), a questionnaire consisting of six subscales: Disorders in Initiating and Maintaining Sleep (DIMS), Sleep Breathing Disorders (SBD), Disorders of Arousal (DA), Sleep–Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DOES), and Nocturnal Hyperhidrosis (SHY). The results were divided into “pathological” and “normal” scores using a cut-off value (pathological score = at least three episodes per week), according to the validation criteria of the test. Then, the Chi-square test was used to calculate the statistical difference and a univariate logistic regression analysis was applied to determine the role of PNE as a risk factor for the development of each category of sleep disorders and to calculate the odds ratio (OR). Results PNE children show a higher prevalence of all sleep disturbances (41.03% DIMS; 85.12% SBD; 63.29% DA; 67.53% SWTD; 31.28% DOES; 37.92% SHY; 25.33% SDSC total score), and according to OR results (SDSC total score OR = 8.293, 95% confidence interval [CI] = 5.079–13.540; DIMS OR = 7.639, 95% CI = 5.192–11.238; SBD OR = 35.633, 95% CI = 22.717–55.893; DA OR = 13.734, 95% CI = 9.476–19.906; SWTD OR = 14.238, 95% CI = 9.829–20.625; DOES OR = 5.602, 95% CI = 3.721–8.432; SHY OR = 6.808, 95% CI = 4.608–10.059), PNE could be considered as a risk factor for the development of sleep disorders. Conclusion Among PNE children, sleep could be strongly altered, thus helping to affirm the hypothesis that PNE tends to alter sleep architecture, or it could itself be the consequence of an abnormal sleep structure. The findings also point to the existence of a potential increase in the risk of developing sleep disorders in the presence of PNE.
Esposito, Maria; Gallai, Beatrice; Parisi, Lucia; Roccella, Michele; Marotta, Rosa; Lavano, Serena Marianna; Mazzotta, Giovanni; Carotenuto, Marco
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
Disruption of the circadian system has been hypothesized to increase cancer risk, either due to direct disruption of the molecular machinery generating circadian rhythms or due to disruption of parameters controlled by the clock such as melatonin levels or sleep duration. This hypothesis has been studied in hormone-dependent cancers among women, but data are sparse regarding potential effects of circadian disruption on the risk of prostate cancer. This review systematically examines available data evaluating the effects of light at night, sleep patterns, and night shift work on prostate cancer risk.
Sigurdardottir, Lara G.; Valdimarsdottir, Unnur A.; Fall, Katja; Rider, Jennifer R.; Lockley, Steven W.; Schernhammer, Eva S.; Mucci, Lorelei A.
summary The pineal hormone melatonin is involved in the circadian regulation and facilitation of sleep, the inhibition of cancer development and growth, and the enhancement of immune function. Individuals, such as night shift workers, who are exposed to light at night on a regular basis experience biological rhythm (i.e., circadian) disruption including circadian phase shifts, nocturnal melatonin suppression, and sleep
David E. Blask
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
hildren's sleep disorders differ from those in adults. There are differences in the physiology and pathophysiology of sleep in children, and behavioural, psychological and devel- opmental aspects of childhood sleep patterns. These factors contrib- ute to age-related differences in presentation for sleep disorders. Sleep disorders in children are common, and much can be done in primary care when parents present
Helen S Heussler
Introduction Nocturnal enuresis (NE) and obstructive sleep apnoea-hypopnoea syndrome (OSAHS) are common problems during childhood, and population studies have reported a significant correlation between them. This study aimed to assess whether habitual snoring, mouth breathing and daytime sleepiness are associated with increased incidence of NE in children with OSAHS. Material and methods Polysomnography was performed in 42 children (66.7% males), 3.5-14.5 years old, who were evaluated for sleep-disordered breathing (SDB). Results Fourteen out of 42 children (33.3%) presented mild, 16 out of 42 (38.1%) moderate and 12 out of 42 (28.6%) severe degree of OSAHS. Apnea hypopnea index (AHI) ranged between 1.30-94.20 (10.54 ±15.67) events per hour of sleep. Nocturnal enuresis was reported in 7/42 (16.7%) of them. The main observed symptoms were snoring (90.5%), restless sleep (81%), mouth breathing (71.4%), nasal congestion (76.2%), and difficulty in arousal (52.4%). A statistically significant association was found between NE and mouth breathing (p = 0.014) or nasal congestion (p = 0.005). Children with OSAHS and NE had a higher arousal index (8.14 ±8.05) compared with OSAHS children without NE (4.61 ±7.95) (p = 0.19, z = –1.28). Snorers had higher levels of AHI (11.02 ±16.37) compared with non-snorers (6.05 ±4.81) (p = 0.33, z = –0.96), and habitually snorers (23/42, 54.76%) were at greater risk of having NE (4/23) than were non-snorers (0/4, p = 0.36). However, the prevalence of enuresis was not related to the severity of OSAHS, expressed as AHI (p = 0.70). Conclusions Mouth breathing, nasal congestion and high threshold of arousal during sleep should be more carefully evaluated in cases of children with NE who do not respond to standard treatment and present SDB.
Hatzistilianou, Maria N.; Emporiadou, Maria N.; Aivazis, Victor T.; Goudakos, John; Markou, Konstantinos; Athanasiadou-Piperopoulou, Fanni
Sleep and wake represent two profoundly different states of physiology that arise within the brain from a complex interaction between multiple neural circuits and neurotransmitter systems. These neural networks are, in turn, adjusted by three key drivers that collectively determine the duration, quality, and efficiency of sleep. Two of these drivers are endogenous, namely, the circadian system and a homeostatic hourglass oscillator, while the third is exogenous-our societal structure (social time). In this chapter, we outline the neuroscience of sleep and highlight the links between sleep, mood, cognition, and mental health. We emphasize that the complexity of sleep/wake generation and regulation makes this behavioral cycle very vulnerable to disruption and then explore this concept by examining sleep and circadian rhythm disruption (SCRD) when the exogenous and endogenous drivers of sleep are in conflict. SCRD can be particularly severe when social timing forces an abnormal pattern of sleep and wake upon our endogenous sleep biology. SCRD is also very common in mental illness, and although well known, this association is poorly understood or treated. Recent studies suggest that the generation of sleep and mental health shares overlapping neural mechanisms such that defects in these endogenous pathways result in pathologies to both behaviors. The evidence for this association is examined in some detail. We conclude this review by suggesting that the emerging understanding of the neurobiology of sleep/wake behavior, and of the health consequences of sleep disruption, will provide new ways to decrease the conflict between biological and societal timing in both the healthy and individuals with mental illness. PMID:23899602
Foster, Russell G; Peirson, Stuart N; Wulff, Katharina; Winnebeck, Eva; Vetter, Céline; Roenneberg, Till
Hyperglycemia after severe burn injury has long been recognized, whereas sleep deprivation after burns is a more recent finding. The postburn metabolic effects of poor sleep are not clear despite reports in other populations demonstrating the association between sleep insufficiency and deleterious endocrine consequences. The aim of this study was to determine whether a relationship between sleep and glucose dynamics exists in acutely burned children. Two overnight polysomnography runs (2200 to 0600) per subject were conducted in 40 patients with a mean (± SEM) age of 9.4?±?0.7 years, 50.1?±?2.9% TBSA burn, and 43.2?±?3.6% full-thickness injury. Serum glucose was drawn in the morning (0600) immediately after the sleep test. Insulin requirements during the 24-hour period preceding the 0600 glucose measurement were recorded. Generalized linear models were used by the authors to evaluate percent time in each stage of sleep, percent wake time, total sleep time, sleep efficiency, and morning serum glucose, accounting for insulin use. Increased time awake (P = .04, linear; P = .02, quadratic) and reduced time spent in stage 1 sleep (P = .03, linear) were associated with higher glucose levels. Sleep efficiency (P = .01, linear; P = .02, quadratic) and total sleep time (P = .01 linear; P = .02, quadratic) were inversely associated with glucose level. Morning glucose levels appear to be affected by the quality and quantity of overnight sleep in children who have sustained extensive burn injuries. Future research is needed to elucidate the metabolic and neuroendocrine consequences of sleep deprivation on metabolism after burns. PMID:23966118
Mayes, Theresa; Gottschlich, Michele M; Khoury, Jane; Simakajornboon, Narong; Kagan, Richard 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
Sleep disturbance is one of the most prominent complaints of alcohol-dependent patients. In view of recent evidence that the immune system is integrated with other homeostatic processes ultimately regulated by the brain, the influence of sleep on host defense mechanisms and the expression of proinflammatory and T helper cell cytokines deserves attention in alcohol dependence. Although not all immune alterations
Michael R. Irwin; Gina Rinetti
Fifty patients with chronic obstructive lung disease were questioned about their sleep quality and their responses were compared with those of 40 similarly aged patients without symptomatic lung disease. Patients with chronic obstructive lung disease reported more difficulty in getting to sleep and staying asleep and more daytime sleepiness than the control group. More than twice as many patients (28%)
W Cormick; L G Olson; M J Hensley; N A Saunders
Background. The role of aging, disease, medications, and mood disturbances in sleep disturbances (SD) in patients with Parkinson's disease (PD) is poorly understood, and the impact of SD on the quality of life of their caregivers (CG) largely undocumented.Objectives. To evaluate the pattern and determinants of disturbed sleep in PD patients complaining of SD, and in their primary CG.Methods. A
P. K Pal; K Thennarasu; J Fleming; M Schulzer; T Brown; S. M Calne
The strong and potentially reciprocal relationship between cancer-related fatigue (CRF) and disrupted sleep-wake patterns suggests a possible shared physiologic pathway. A growing body of evidence supports this and shows that abnormalities in the 24-hour rhythm of stress-related hormones may be related to chronic fatigue and sleep disturbances. Aberrations in the hypothalamic-pituitary-adrenal (HPA) axis, the primary neuroendocrine interface responding to stress, induce important biologic and behavioral consequences. HPA aberrations have long been associated with chronic fatigue syndrome. Many overlapping symptoms exist between chronic fatigue syndrome and CRF, including sleep disruption. Therefore, in the absence of knowledge about CRF mechanisms, emerging biologic models from chronic fatigue syndrome may assist in understanding the cause of CRF. Cancer-associated stressors also may alter the circadian functions of HPA-associated neuroendocrine activities, which result in the symptoms of fatigue and disrupted sleep-wake patterns in patients with cancer. Exploring promising physiologic models furthers the knowledge about CRF and disrupted sleep and may foster hypothesis-based studies of mechanisms that underlie apparent overlapping symptoms, providing the basis for new management to improve sleep and lessen fatigue. PMID:22459538
Wu, Horng-Shiuann; Davis, Jean E; Natavio, Teofanes
Purpose Patients with CFS report that exertion produces dramatic symptom worsening. We hypothesized this might be due to exacerbation of an underlying sleep disorder which we have previously demonstrated to exist. Methods Female patients with CFS and matched healthy controls with no evidence of major depressive disorder were studied with overnight polysomnography on a baseline night and on a night following their performing a maximal exercise test. Results CFS patients as a group had evidence for disturbed sleep compared to controls. While exercise improved sleep for healthy subjects, it did not do this for the group as a whole. When we stratified the sample based on self-reported sleepiness after a night's sleep, the patient group with reduced AM sleepiness showed improvement in sleep structure while those with increased AM sleepiness continued to show evidence for sleep disruption. Conclusion: Sleep is disturbed in CFS patients as a group, but exercise does not further exacerbate this sleep disturbance. Approximately half the patients studied actually sleep better after exercise. Therefore, activity-related symptom worsening is not caused by worsened sleep.
Togo, Fumiharu; Natelson, Benjamin H.; Cherniack, Neil S.; Klapholz, Marc; Rapoport, David M.; Cook, Dane B.
Current treatments for insomnia, such as zolpidem (Ambien) and eszopiclone (Lunesta), are ?-aminobutyric acid type A (GABAA)-positive allosteric modulators that carry a number of side effects including the potential to disrupt cognition. In an effort to develop better tolerated medicines, we have identified dual orexin 1 and 2 receptor antagonists (DORAs), which promote sleep in preclinical animal models and humans. We compare the effects of orally administered eszopiclone, zolpidem, and diazepam to the dual orexin receptor antagonist DORA-22 on sleep and the novel object recognition test in rat, and on sleep and two cognition tests (delayed match to sample and serial choice reaction time) in the rhesus monkey. Each compound's minimal dose that promoted sleep versus the minimal dose that exerted deficits in these cognitive tests was determined, and a therapeutic margin was established. We found that DORA-22 has a wider therapeutic margin for sleep versus cognitive impairment in rat and rhesus monkey compared to the other compounds tested. These data were further supported with the demonstration of a wider therapeutic margin for DORA-22 compared to the other compounds on sleep versus the expression of hippocampal activity-regulated cytoskeletal-associated protein (Arc), an immediate-early gene product involved in synaptic plasticity. These findings suggest that DORAs might provide an effective treatment for insomnia with a greater therapeutic margin for sleep versus cognitive disturbances compared to the GABAA-positive allosteric modulators currently in use. PMID:23552372
Uslaner, Jason M; Tye, Spencer J; Eddins, Donnie M; Wang, Xiaohai; Fox, Steven V; Savitz, Alan T; Binns, Jacquelyn; Cannon, Christopher E; Garson, Susan L; Yao, Lihang; Hodgson, Robert; Stevens, Joanne; Bowlby, Mark R; Tannenbaum, Pamela L; Brunner, Joseph; Mcdonald, Terrence P; Gotter, Anthony L; Kuduk, Scott D; Coleman, Paul J; Winrow, Christopher J; Renger, John J
Study Objectives: The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL). Methods: Participants in this cross-sectional study of long-term (> 5 years) CRC survivors received care at Kaiser Permanente. Measures included the City of Hope QOL Ostomy questionnaire with narrative comments for ostomy-related “greatest challenges.” The Short Form-36 Version 2 (SF-36v2) health survey provided physical (PCS) and mental composite scale (MCS) scores to examine generic HR-QOL. The “sleep disruption” and “fatigue” items from the ostomy questionnaire (scale from 0 to 10 with higher scores indicating better HR-QOL) were dependent variables, while independent variables included age, ethnicity, education, partnered status, body mass index, and time since surgery. Data were analyzed using chi-square for nominal variables, Student t-tests for continuous variables, and logistic regression with significance set at p < 0.05. Results: On the ostomy-specific measure, women (n = 118) compared to men (n = 168) reported more sleep disruption (p < 0.01), adjusted for age, and greater levels of fatigue (p < 0.01), adjusted for time since surgery. Women's PCS and MCS scores indicated poorer HR-QOL compared to men, and differences were clinically meaningful. Qualitative narrative comments suggested that sleep disruption could stem from ostomy-associated fear of or actual leakage during sleep. Conclusion: Although women CRC survivors with ostomies report more sleep disruption and fatigue, which is reflected in their reduced physical and mental health scores on the SF-36v2 compared to men with ostomies, their stated reasons for disrupted sleep are similar to their male counterparts. These findings can provide a foundation for gender-relevant ostomy interventions to improve sleep and HR-QOL in this patient population. Citation: Baldwin CM; Grant M; Wendel C; Hornbrook MC; Herrinton LJ; McMullen C; Krouse RS. Gender Differences in Sleep Disruption and Fatigue on Quality of Life Among Persons with Ostomies. J Clin Sleep Med 2009;5(4):335-343.
Baldwin, Carol M.; Grant, Marcia; Wendel, Christopher; Hornbrook, Mark C.; Herrinton, Lisa J.; McMullen, Carmit; Krouse, Robert S.
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.
O’Connor, P. J., M. J. Breus, and S. D. Youngstedt. Exercise-induced Increase in Core Temperature Does Not Disrupt a Behavioral Measure of Sleep. PHYSIOL BEHAV 64(3) 213–217, 1998.—On separate nights 90 to 30 min before typical bedtime, eight physically active men completed three conditions: seated rest, low-intensity and moderate-intensity cycle exercise. Low-and moderate-intensity exercise had no significant effect on sleep
Patrick J O’Connor; Michael J Breus; Shawn D Youngstedt
Shift work and trans-time zone travel lead to insufficient sleep and numerous pathologies. Here, we examined sleep/wake dynamics during chronic exposure to environmental circadian disruption (ECD), and if chronic partial sleep loss associated with ECD influences the induction of shift-related inflammatory disorder. Sleep and wakefulness were telemetrically recorded across three months of ECD, in which the dark-phase of a light-dark cycle was advanced weekly by 6 h. A three month regimen of ECD caused a temporary reorganization of sleep (NREM and REM) and wake processes across each week, resulting in an approximately 10% net loss of sleep each week relative to baseline levels. A separate group of mice were subjected to ECD or a regimen of imposed wakefulness (IW) aimed to mimic sleep amounts under ECD for one month. Fos-immunoreactivity (IR) was quantified in sleep-wake regulatory areas: the nucleus accumbens (NAc), basal forebrain (BF), and medial preoptic area (MnPO). To assess the inflammatory response, trunk blood was treated with lipopolysaccharide (LPS) and subsequent release of IL-6 was measured. Fos-IR was greatest in the NAc, BF, and MnPO of mice subjected to IW. The inflammatory response to LPS was elevated in mice subjected to ECD, but not mice subjected to IW. Thus, the net sleep loss that occurs under ECD is not associated with a pathological immune response.
Castanon-Cervantes, Oscar; Natarajan, Divya; Delisser, Patrick; Davidson, Alec J.; Paul, Ketema N.
Effects of 2Week Nocturnal Oxygen Supplementation and Continuous Positive Airway Pressure Treatment on Psychological Symptoms in Patients With Obstructive Sleep Apnea: A Randomized Placebo-Controlled Study
Psychological symptom improvement has been observed after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation, the mechanism of psychological symptom improvement is unclear. Using a 3-arm placebo-controlled design, we parsed out the separate effects of treatment on psychological symptoms. OSA patients (N = 38) were monitored 2 nights
Wayne A. Bardwell; Daniel Norman; Sonia Ancoli-Israel; Jose S. Loredo; Amy Lowery; Weonjeong Lim; Joel E. Dimsdale
Introduction Environmental stimulus, especially noise and light, is thought to disrupt sleep in patients in the intensive care unit (ICU).\\u000a This study aimed to determine the physiological and psychological effects of ICU noise and light, and of earplugs and eye\\u000a masks, used in these conditions in healthy subjects.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Fourteen subjects underwent polysomnography under four conditions: adaptation, baseline, exposure to recorded ICU
Rong-fang Hu; Xiao-ying Jiang; Yi-ming Zeng; Xiao-yang Chen; You-hua Zhang
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
Patient histories suggest that obstructive sleep apnea syndrome (OSAS) is a progressive condition. To investigate whether this could be shown in data from sleep recordings, 42 patients with OSAS were retrospectively studied. All had undergone a screening recording of respiration movements and oximetry at least 6 months (average, 16 months) prior to a diagnostic polysomnogram including these parameters. No treatment was given in the meantime. In the first recording, mean oxygen desaturation index (ODI, average number of desaturations of > 4 percent per sleeping hour) was 10; periodic, obstructive respiration movements occurred during (average) 36 percent of total estimated sleeping time, and mean nadir SaO2 was 85 percent. In the second recording, mean ODI was 21 (significant change, p = 0.0002), periodic respiration time was 61 percent, and nadir SaO2 was 80 percent (p = 0.0001, respectively). In 26 of 42 patients (62 percent), ODI had increased by > 50 percent. Increases in ODIs and periodic breathing were significantly correlated to increases in body weight. There were, however, exceptional patients with considerable increases in respiratory disturbance despite weight loss. The greatest changes were found in the patients who had the highest apnea indices in the polysomnograms. Early treatment may therefore be justified, since a borderline case may change to severe OSAS in 1 to 2 years' time. Follow-up recordings of untreated patients are important. PMID:8339616
Svanborg, E; Larsson, H
Recent human studies suggest that genetic polymorphisms allow an individual to maintain optimal cognitive functioning during sleep deprivation. If such polymorphisms were not associated with additional costs, selective pressures would allow these alleles to spread through the population such that an evolutionary alternative to sleep would emerge. To determine whether there are indeed costs associated with resiliency to sleep loss, we challenged natural allelic variants of the foraging gene (for) with either sleep deprivation or starvation. Flies with high levels of Protein Kinase G (PKG) (for(R)) do not display deficits in short-term memory following 12 h of sleep deprivation. However, short-term memory is significantly disrupted when for(R) flies are starved overnight. In contrast, flies with low levels of PKG (for(s), for(s2)) show substantial deficits in short-term memory following sleep deprivation but retain their ability to learn after 12 h of starvation. We found that for(R) phenotypes could be largely recapitulated in for(s) flies by selectively increasing the level of PKG in the ?/? lobes of the mushroom bodies, a structure known to regulate both sleep and memory. Together, these data indicate that whereas the expression of for may appear to provide resilience in one environmental context, it may confer an unexpected vulnerability in other situations. Understanding how these tradeoffs confer resilience or vulnerability to specific environmental challenges may provide additional clues as to why an evolutionary alternative to sleep has not emerged. PMID:22308351
Donlea, Jeffrey; Leahy, Averi; Thimgan, Matthew S; Suzuki, Yasuko; Hughson, Bryon N; Sokolowski, Marla B; Shaw, Paul J
Recent human studies suggest that genetic polymorphisms allow an individual to maintain optimal cognitive functioning during sleep deprivation. If such polymorphisms were not associated with additional costs, selective pressures would allow these alleles to spread through the population such that an evolutionary alternative to sleep would emerge. To determine whether there are indeed costs associated with resiliency to sleep loss, we challenged natural allelic variants of the foraging gene (for) with either sleep deprivation or starvation. Flies with high levels of Protein Kinase G (PKG) (forR) do not display deficits in short-term memory following 12 h of sleep deprivation. However, short-term memory is significantly disrupted when forR flies are starved overnight. In contrast, flies with low levels of PKG (fors, fors2) show substantial deficits in short-term memory following sleep deprivation but retain their ability to learn after 12 h of starvation. We found that forR phenotypes could be largely recapitulated in fors flies by selectively increasing the level of PKG in the ?/? lobes of the mushroom bodies, a structure known to regulate both sleep and memory. Together, these data indicate that whereas the expression of for may appear to provide resilience in one environmental context, it may confer an unexpected vulnerability in other situations. Understanding how these tradeoffs confer resilience or vulnerability to specific environmental challenges may provide additional clues as to why an evolutionary alternative to sleep has not emerged.
Donlea, Jeffrey; Leahy, Averi; Thimgan, Matthew S.; Suzuki, Yasuko; Hughson, Bryon N.; Sokolowski, Marla B.; Shaw, Paul J.
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.
Purpose It is known that a moderate to large volume of alcohol produces deterioration in obstructive sleep apnea (OSA), however, no\\u000a consensus has been achieved with respect to the influence of a moderate volume of alcohol on mild to moderate OSA. In this\\u000a study, we investigated the influence of alcohol on OSA-associated parameters in healthy middle-aged males drinking a moderate\\u000a volume
Ichiro Izumi; Ali Nasermoaddeli; Michikazu Sekine; Sadanobu Kagamimori
The aim of this study is to assess the ability of radial basis function (RBF) classifiers as an assistant tool for the diagnosis of the obstructive sleep apnoea syndrome (OSAS). A total of 187 subjects suspected of suffering from OSAS were available for our research. The initial population was divided into training, validation and test sets for deriving and testing our neural classifiers. We used nonlinear features from nocturnal oxygen saturation (SaO(2)) to perform patients' classification. We evaluated three different RBF construction techniques based on the following algorithms: k-means (KM), fuzzy c-means (FCM) and orthogonal least squares (OLS). A diagnostic accuracy of 86.1, 84.7 and 85.5% was provided by the networks developed with KM, FCM and OLS, respectively. The three proposed networks achieved an area under the receiver operating characteristic (ROC) curve over 0.90. Our results showed that a useful non-invasive method could be applied to diagnose OSAS from nonlinear features of SaO(2) with RBF classifiers. PMID:17968604
Marcos, J Víctor; Hornero, Roberto; Alvarez, Daniel; del Campo, Félix; López, Miguel; Zamarrón, Carlos
|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
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
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
Frequently disrupted and restricted sleep is a common problem for many people in our modern around-the-clock society. In this context, it is an important question how sleep loss affects the stress systems in our bodies since these systems enable us to deal with everyday challenges. Altered activity and reactivity of these systems following insufficient sleep might have serious repercussions for health and well-being. Studies on both humans and rodents have shown that sleep deprivation and sleep restriction are conditions often associated with mild, temporary increases in the activity of the major neuroendocrine stress systems, i.e., the autonomic sympatho-adrenal system and the hypothalamic-pituitary-adrenal axis. Sleep deprivation may not only have a direct activating effect by itself but, in the long run, it may also affect the reactivity of these systems to other stressors and challenges. Although the first signs of alterations in the way people deal with challenges under conditions of restricted sleep appear to be on the level of emotional perception, chronic sleep restriction may ultimately change the fundamental properties of neuroendocrine stress systems as well. Understandably, few controlled studies in humans have been devoted to this topic. Yet, experimental studies in rodents show that chronic sleep restriction may gradually alter neuroendocrine stress responses as well as the central mechanisms involved in the regulation of these responses. Importantly, the available data from studies in laboratory animals suggest that sleep restriction may gradually change certain brain systems and neuroendocrine systems in a manner that is similar to what is seen in stress-related disorders such as depression (e.g., reduced serotonin receptor sensitivity and altered regulation of the hypothalamic-pituitary-adrenal axis). Such data support the view that insufficient sleep, by acting on stress systems, may sensitize individuals to stress-related disorders. Indeed, epidemiological studies suggest that sleep complaints and sleep restriction may be important risk factors for a variety of diseases that are often linked to stress, including cardiovascular diseases and mood disorders. PMID:18222099
Meerlo, Peter; Sgoifo, Andrea; Suchecki, Deborah
Sleep is important for declarative memory consolidation in healthy adults. Sleep disruptions are typical in Alzheimer’s disease, but whether they contribute to memory impairment is unknown. Sleep has not been formally examined in amnestic mild cognitive impairment (aMCI), which is characterized by declarative-memory deficits without dementia and can signify prodromal Alzheimer’s disease. We studied 10 aMCI patients and 10 controls over 2 weeks using daily sleep surveys, wrist-worn activity sensors, and daily recognition tests. Recognition was impaired and more variable in aMCI patients, whereas sleep was similar across groups. However, lower recognition of items learned the previous day was associated with lower subjective sleep quality in aMCI patients. This correlation was not present for information learned the same day, thus did not reflect nonspecific effects of poor sleep on memory. These results indicate that inadequate memory consolidation in aMCI patients is related to declines in subjective sleep indices. Furthermore, participants with greater across-night sleep variability exhibited lower scores on a standardized recall test taken prior to the 2-week protocol, suggesting that consistent sleep across nights also contributes to successful memory. Physiological analyses are needed to further specify which aspects of sleep in neurological disorders impact memory function and consolidation.
Westerberg, Carmen E.; Lundgren, Eric M.; Florczak, Susan M.; Mesulam, M.-Marsel; Weintraub, Sandra; Zee, Phyllis C.; Paller, Ken A.
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
Background and methods This study investigated the effects of sleep deprivation on total and partial (early and late) declarative memory and activation in the areas of the brain involved in these activities. The study included two experiments. Experiment 1 included 40 male residents of an orphanage aged 16–19 years, who were divided into four groups (n = 10 each) and subjected to total sleep deprivation, normal sleep, early-night sleep deprivation, or late-night sleep deprivation. Experiment 2 included eight students from the same institution who were divided into the same four groups (n = 2) as in experiment 1. Declarative memory was tested using lists of associated word pairs in both experiments, and activation of the relevant brain regions was measured before and after retrieval by single-photon emission computed tomography for subjects in experiment 2 only. Results Students subjected to normal sleep had significantly higher scores for declarative memory retrieval than those subjected to total sleep deprivation (P = 0.002), early-night sleep deprivation (P = 0.005), or late-night sleep deprivation (P = 0.02). The left temporal lobe showed the highest rate of activity during memory retrieval after normal sleep, whereas the frontal, parietal, and right temporal lobes were more active after sleep deprivation. Conclusion Both slow wave sleep and rapid eye movement sleep play an active role in consolidation of declarative memory, which in turn allows memory traces to be actively reprocessed and strengthened during sleep, leading to improved performance in memory recall.
Tantawy, Ahmed O; Tallawy, Hamdy N El; Farghaly, Hussein RS; Farghaly, Wafaa M; Hussein, Amr S
INTRODUCTION.Habitual snoring and obstructive sleep apnea have been associated with bed-wetting in children, and effective obstructive sleep apnea treatment may im- prove enuresis. OBJECTIVES.The purpose of this work was to assess whether habitual snoring is associ- ated with increased incidence of enuresis and whether severity of obstructive sleep apnea correlates with enuretic frequency and to evaluate brain natriuretic peptide levels.
Oscar Sans Capdevila; Valerie McLaughlin Crabtree; Leila Kheirandish-Gozal; David Gozal
Background. Numerous factors probably contribute to the high prevalence of sleep problems in haemodialysis (HD) patients including metabolic changes and treatment-related factors. In contrast, the sleep prob- lems of patients with chronic kidney disease (CKD) may be more related to psychological factors rather than the metabolic changes associated with renal disease. Thus, the objective of this study was to compare
Kathy P. Parker; Donald L. Bliwise; James L. Bailey; David B. Rye
It is well documented that the quality and quantity of prior sleep influence future sleep. For instance, nocturnal sleep restriction leads to an increase in slow wave sleep (SWS) (i.e. SWS rebound) during a subsequent sleep period. However, few studies have examined how prior napping affects daytime sleep architecture. Because daytime naps are recommended for management of disrupted sleep, understanding the impact of napping on subsequent sleep may be important. We monitored sleep-wake patterns for one week with actigraphy followed by a 75-minute polysomnographically-recorded nap. We found that greater nap frequency was correlated with increased Stage 1 and decreased SWS. We categorized subjects based on nap frequency during the prior week (0 nap, 1 to 2 naps, and 3 to 4 naps) and found differences in Stage 1, Stage 2, and SWS between groups. Subjects who took no naps had the greatest amount of SWS, those who took 1 to 2 naps had the most Stage 2 sleep, and those who took 3 to 4 naps had the most Stage 1. While correlations were not found between nap frequency and nocturnal sleep measures, frequent napping was associated with increased subjective sleepiness. Therefore, frequent napping appears to be associated with lighter daytime sleep and increased sleepiness during the day. Speculatively, low levels of daytime sleepiness and increased SWS in non-nappers may help explain why these individuals choose not to nap. PMID:22659474
McDevitt, Elizabeth A; Alaynick, William A; Mednick, Sara C
It is well documented that the quality and quantity of prior sleep influences future sleep. For instance, nocturnal sleep restriction leads to an increase in slow wave sleep (SWS) (i.e. SWS rebound) during a subsequent sleep period. However, few studies have examined how prior napping affects daytime sleep architecture. Becuase daytime naps are recommended for management of disrupted sleep, understanding the impact of napping on subsequent sleep may be important. We monitored sleep-wake patterns for one week with actigraphy followed by a 75-minute polysomnographically-recorded nap. We found that greater nap frequency was correlated with increased Stage 1 and decreased SWS. We categorized subjects based on nap frequency during the prior week (0 naps, 1 to 2 naps, and 3 to 4 naps) and found differences in Stage 1, Stage 2, and SWS between groups. Subjects who took no naps had the greatest amount of SWS, those who took 1 to 2 naps had the most Stage 2 sleep, and those who took 3 to 4 naps had the most Stage 1. While correlations were not found between nap frequency and nocturnal sleep measures, frequent napping was associated with increased subjective sleepiness. Therefore, frequent napping appears to be associated with lighter daytime sleep and increased sleepiness during the day. Speculatively, low levels of daytime sleepiness and increased SWS in non-nappers may help explain why these individuals choose not to nap.
McDevitt, Elizabeth A.; Alaynick, William A.; Mednick, Sara C.
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
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
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. PMID:23573447
Carnovale, Carla; Pozzi, Marco; Nisic, Andrea Angelo; Scrofani, Elisa; Perrone, Valentina; Antoniazzi, Stefania; Clementi, Emilio; Radice, Sonia
The feasibility of using ambulatory Medilog home recordings to diagnose sleep disorders in aged volunteers, and the accuracy of measurement of total sleep time and diagnosis of sleep apnea and nocturnal myoclonus was investigated. Sleep apnea is a life th...
D. F. Kripke S. Ancoli-Israel
The timing of sleep and sleep EEG parameters in 10 healthy male subjects were investigated in four seasons under controlled conditions. The phase of nocturnal sleep was delayed about one and a half hours in winter as compared to that in summer. The duration of stage 4 sleep decreased and REM sleep increased significantly in winter compared with summer. The
M. Kohsaka; N. Fukuda; K. Honma; S. Honma; N. Morita
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; (...
W. B. Webb H. W. Agnew
A 4-year old boy presented severe obstructive sleep apnoea due to complete nasal obstruction secondary to cherubism. Because of anticipatory anxiety due to numerous surgical interventions, medical hypnosis was proposed to facilitate non-invasive continuous positive pressure ventilation (CPAP) acceptance. CPAP by means of an oral interface was completely accepted after three hypnosis sessions and resulted in the correction of his obstructive sleep apnea (OSA) syndrome. This report highlights the benefit of medical hypnosis in facilitating CPAP acceptance as well as the efficacy of mouthpiece ventilation in a severe form of cherubism with complete nasal obstruction. PMID:23129383
Khirani, Sonia; Kadlub, Natacha; Delord, Vincent; Picard, Arnaud; Fauroux, Brigitte
OBJECTIVE:: The phenomenon of morning blood pressure (BP) surge (MBPS) is known to increase the risk for cardiovascular events and stroke. The purposes of this study were to explore associations between MBPS and nighttime BP and to examine arterial stiffness and sleep pattern in association with MBPS. METHODS:: This study included 30 healthy Korean American women aged 25 to 60 years. Ambulatory BP was monitored for 24 hours. To evaluate MBPS, maximum morning BPpower was calculated. Arterial stiffness was measured by carotid-femoral pulse wave velocity, and sleep pattern was evaluated using an actigraphy. RESULTS:: The participants (n = 8) in the upper quartile of MBPS had higher morning systolic BPs (SBPs; P = 0.015) and lower nighttime diastolic BPs (P = 0.031). The MBPS in SBP was significantly increased in the participants who had a more wakeful night (P = 0.038) and who slept longer at night (P = 0.041). Although MBPS was not significantly related to arterial stiffness, higher morning SBP (P = 0.005), morning diastolic BP (P = 0.048), and prewake SBP (P = 0.005) were associated with arterial stiffness. CONCLUSIONS:: Our findings imply a possible link between disturbed sleep and MBPS. Clinicians should understand the importance of the modification of altered sleep pattern for reducing MBPS in nonhypertensive participants. PMID:23612041
Suh, Minhee; Barksdale, Debra J; Logan, Jeongok G
Nocturnal wheeze is common in patients with asthma, and slow release theophyllines may reduce symptoms. As theophyllines are stimulants of the central nervous system the effect of 10 days' twice daily treatment with sustained release choline theophyllinate or placebo on symptoms, overnight bronchoconstriction, nocturnal oxygen saturation, and quality of sleep were studied in a double blind crossover study in nine
G B Rhind; J J Connaughton; J McFie; N J Douglas; D C Flenley
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
Objective: The purpose of this study was to determine possible relations between the quality and amount of children's sleep and cortisol in healthy children. Design: Children's sleep was monitored with actigraphs for 7 nights. Children came to the laboratory to provide saliva samples, which were used to assess cortisol. Children reported on their sleepiness and sleep\\/wake problems. Sixty-four healthy children
Mona El-Sheikh; Joseph A. Buckhalt; Peggy S. Keller; Douglas A. Granger
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.
Lynn M. Breau; Carol S. Camfield
|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…
Chen, C.-C.; Spano, G.; Edgin, J. O.
Background. Xerostomia is associated with a diffi- culty of maintaining oral hygeine and with symptoms of daytime oral discomfort and nocturnal sleep disturbance. Methods. A pilot study was conducted to test the efficacy of a new method of delivering heated humidified air (37 degrees C, 100% water vapor saturated, at 20-25 L\\/min flow rate via spe- cially designed nasal prongs)
K. David Hay; Randall P. Morton
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. Images
Sturrock, G. D.
Although sleep and exercise may seem to be mediated by completely different physiological mechanisms, there is growing evidence for clinically important relationships between these two behaviors. It is known that passive body heating facilitates the nocturnal sleep of healthy elderly people with insomnia. This finding supports the hypothesis that changes in body temperature trigger somnogenic brain areas to initiate sleep. Nevertheless, little is known about how the core and distal thermoregulatory responses to exercise fit into this hypothesis. Such knowledge could also help in reducing sleep problems associated with nocturnal shiftwork. It is difficult to incorporate physical activity into a shiftworker's lifestyle, since it is already disrupted in terms of family commitments and eating habits. A multi-research strategy is needed to identify what the optimal amounts and timing of physical activity are for reducing shiftwork-related sleep problems. The relationships between sleep, exercise and diet are also important, given the recently reported associations between short sleep length and obesity. The cardiovascular safety of exercise timing should also be considered, since recent data suggest that the reactivity of blood pressure to a change in general physical activity is highest during the morning. This time is associated with an increased risk in general of a sudden cardiac event, but more research work is needed to separate the influences of light, posture and exercise per se on the haemodynamic responses to sleep and physical activity following sleep taken at night and during the day as a nap.
Atkinson, Greg; Davenne, Damien
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.
A leucine to alanine substitution (L9'A) was introduced in the M2 region of the mouse alpha4 neuronal nicotinic acetylcholine receptor (nAChR) subunit. Expressed in Xenopus oocytes, alpha4(L9'A)beta2 nAChRs were > or =30-fold more sensitive than wild type (WT) to both ACh and nicotine. We generated knock-in mice with the L9'A mutation and studied their cellular responses, seizure phenotype, and sleep-wake cycle. Seizure studies on alpha4-mutated animals are relevant to epilepsy research because all known mutations linked to autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) occur in the M2 region of alpha4or beta2 subunits. Thalamic cultures and synaptosomes from L9'A mice were hypersensitive to nicotine-induced ion flux. L9'A mice were approximately 15-fold more sensitive to seizures elicited by nicotine injection than their WT littermates. Seizures in L9'A mice differed qualitatively from those in WT: L9'A seizures started earlier, were prevented by nicotine pretreatment, lacked EEG spike-wave discharges, and consisted of fast repetitive movements. Nicotine-induced seizures in L9'A mice were partial, whereas WT seizures were generalized. When L9'A homozygous mice received a 10 mg/kg nicotine injection, there was temporal and phenomenological separation of mutant and WT-like seizures: an initial seizure approximately 20 s after injection was clonic and showed no EEG changes. A second seizure began 3-4 min after injection, was tonic-clonic, and had EEG spike-wave activity. No spontaneous seizures were detected in L9'A mice during chronic video/EEG recordings, but their sleep-wake cycle was altered. Our findings show that hypersensitive alpha4* nicotinic receptors in mice mediate changes in the sleep-wake cycle and nicotine-induced seizures resembling ADNFLE. PMID:16339034
Fonck, Carlos; Cohen, Bruce N; Nashmi, Raad; Whiteaker, Paul; Wagenaar, Daniel A; Rodrigues-Pinguet, Nivalda; Deshpande, Purnima; McKinney, Sheri; Kwoh, Steven; Munoz, Jose; Labarca, Cesar; Collins, Allan C; Marks, Michael J; Lester, Henry A
This study examined the associations among neuroticism (N), conscientiousness (C), and sleep quality in the context of a life transition. The interactive effects of N and C on the association between sleep quality and mental and physical well-being were also examined. Seventy-seven college freshmen (mean age=19.5) completed personality measures at the beginning of the academic year, and measures of sleep
Paula G. Williams; Tammy L. Moroz
The aim of this study is to assess the utility of traditional statistical pattern recognition techniques to help in obstructive sleep apnoea (OSA) diagnosis. Classifiers based on quadratic (QDA) and linear (LDA) discriminant analysis, K-nearest neighbours (KNN) and logistic regression (LR) were evaluated. Spectral and nonlinear input features from oxygen saturation (SaO(2)) signals were applied. A total of 187 recordings from patients suspected of suffering from OSA were available. This initial dataset was divided into training set (74 subjects) and test set (113 subjects). Twelve classification algorithms were developed by applying QDA, LDA, KNN and LR with spectral features, nonlinear features and combination of both groups. The performance of each algorithm was measured on the test set by means of classification accuracy and receiver operating characteristic (ROC) analysis. QDA, LDA and LR showed better classification capability than KNN. The classifier based on LDA with spectral features provided the best diagnostic ability with an accuracy of 87.61% (91.05% sensitivity and 82.61% specificity) and an area under the ROC curve (AROC) of 0.925. The proposed statistical pattern recognition techniques could be applied as an OSA screening tool. PMID:19592290
Marcos, J Víctor; Hornero, Roberto; Alvarez, Daniel; del Campo, Félix; Zamarrón, Carlos
Probable rapid eye movement sleep behavior disorder, nocturnal disturbances and quality of life in patients with Parkinson's disease: a case-controlled study using the rapid eye movement sleep behavior disorder screening questionnaire
Background Increasing evidence provides a clear association between rapid eye movement sleep behavior disorders (RBD) and Parkinson’s disease (PD), but the clinical features that determine the co-morbidity of RBD and PD are not yet fully understood. Methods We evaluated the characteristics of nocturnal disturbances and other motor and non-motor features related to RBD in patients with PD and the impact of RBD on their quality of life. Probable RBD (pRBD) was evaluated using the Japanese version of the RBD screening questionnaire (RBDSQ-J). Results A significantly higher frequency of pRBD was observed in PD patients than in the controls (RBDSQ-J???5 or???6: 29.0% vs. 8.6%; 17.2% vs. 2.2%, respectively). After excluding restless legs syndrome and snorers in the PD patients, the pRBD group (RBDSQ-J?5) showed higher scores compared with the non-pRBD group on the Parkinson’s disease sleep scale-2 (PDSS-2) total and three-domain scores. Early morning dystonia was more frequent in the pRBD group. The Parkinson’s Disease Questionnaire (PDQ-39) domain scores for cognition and emotional well-being were higher in the patients with pRBD than in the patients without pRBD. There were no differences between these two groups with respect to the clinical subtype, disease severity or motor function. When using a cut-off of RBDSQ-J?=?6, a similar trend was observed for the PDSS-2 and PDQ-39 scores. Patients with PD and pRBD had frequent sleep onset insomnia, distressing dreams and hallucinations. The stepwise linear regression analysis showed that the PDSS-2 domain “motor symptoms at night”, particularly the PDSS sub-item 6 “distressing dreams”, was the only predictor of RBDSQ-J in PD. Conclusion Our results indicate a significant impact of RBD co-morbidity on night-time disturbances and quality of life in PD, particularly on cognition and emotional well-being. RBDSQ may be a useful tool for not only screening RBD in PD patients but also predicting diffuse and complex clinical PD phenotypes associated with RBD, cognitive impairment and hallucinations.
|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.
|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.
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.
Although continued total sleep deprivation is fatal, the function of sleep remains a mystery. Shorter durations of sleep deprivation\\u000a are followed by rebound increases in non-rapid eye movement (non-REM) sleep, suggesting a homeostatic control. Measurements\\u000a of the power spectrum of the electroencephalograph (EEG) suggest that a more accurate marker of the homeostasis may be ? frequency\\u000a power, because it most
Robert Greene; Jerome Siegel
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.
The authors examined children's sleep as an intervening variable in the connection between emotional insecurity in the family and academic achievement. The role of ethnicity (African American and European American) and socioeconomic status (SES) in moderating the examined relations was assessed. One hundred sixty-six children (8- and 9-year-olds) reported their emotional insecurity, and the quantity and quality of children's sleep
Mona El-Sheikh; Joseph A. Buckhalt; Peggy S. Keller; E. Mark Cummings; Christine Acebo
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
About 1.5 million Australians are shift workers. Shift work is associated with adverse health, safety and performance outcomes. Circadian rhythm misalignment, inadequate and poor-quality sleep, and sleep disorders such as sleep apnoea, insomnia and shift work disorder (excessive sleepiness and/or insomnia temporally associated with the work schedule) contribute to these associations. Falling asleep at work at least once a week occurs in 32%-36% of shift workers. Risk of occupational accidents is at least 60% higher for non-day shift workers. Shift workers also have higher rates of cardiometabolic diseases and mood disturbances. Road and workplace accidents related to excessive sleepiness, to which shift work is a significant contributor, are estimated to cost $71-$93 billion per annum in the United States. There is growing evidence that understanding the interindividual variability in sleep-wake responses to shift work will help detect and manage workers vulnerable to the health consequences of shift work. A range of approaches can be used to enhance alertness in shift workers, including screening and treating sleep disorders, melatonin treatment to promote sleep during the daytime, and avoidance of inappropriate use of sedatives and wakefulness-promoters such as modafinil and caffeine. Short naps, which minimise sleep inertia, are generally effective. Shifting the circadian pacemaker with appropriately timed melatonin and/or bright light may be used to facilitate adjustment to a shift work schedule in some situations, such as a long sequence of night work. It is important to manage the health risk of shift workers by minimising vascular risk factors through dietary and other lifestyle approaches. PMID:24138359
Rajaratnam, Shantha M W; Howard, Mark E; Grunstein, Ronald R
This paper, intended to provide useful insights for the clinical management of sleep disturbances in attention-deficit\\/hyperactivity disorder (ADHD), presents a critical, updated overview of the most relevant studies on the prevalence, etiopathophysiology and treatment strategies of sleep problems associated with ADHD, including restless legs syndrome, periodic limb movements in sleep, sleep-onset delay, increased nocturnal motor activity, sleep-disordered breathing, deficit in
Eric Konofal; Michel Lecendreux; Samuele Cortese
The intake of a large variety of substances has a negative impact on sleep. Widely used, readily available substances like alcohol, nicotine, or caffeine need to be mentioned here. Illicit drugs (e.g., heroin or ecstasy) have different mechanisms of action with a high sleep-disrupting potential. Prescription drugs, i.e., corticosteroids or ?-blockers, may also negatively affect sleep. An important question is whether the intake of hypnotics, especially benzodiazepines, may have a negative long-term effect on sleep. Classical benzodiazepines (BZ) initially lead to a reduction of nocturnal wake time and prolong total sleep time as a desired effect. Regarding the microstructure of sleep, BZ lead to a reduction of slow frequencies and an increase of fast frequencies in the EEG. With many BZ, tolerance may occur, thus, leading to unwanted dose increases. Further problems include rebound effects that occur upon discontinuation of BZ, including a drastic deterioration of sleep upon drug withdrawal. This phenomenon may pave the way for the development of drug dependency. Further unwanted side-effects (e.g., nocturnal falls) and the question of BZ abuse and dependency will be discussed. PMID:22116483
Riemann, D; Nissen, C
Background Although obstructive sleep apnea (OSA) is more common in patients with kidney disease, whether nocturnal hypoxia affects kidney function is unknown. Methods We studied all adult subjects referred for diagnostic testing of sleep apnea between July 2005 and December 31 2007 who had serial measurement of their kidney function. Nocturnal hypoxia was defined as oxygen saturation (SaO2) below 90% for ?12% of the nocturnal monitoring time. The primary outcome, accelerated loss of kidney function, was defined as a decline in estimated glomerular filtration rate (eGFR) ?4 ml/min/1.73 m2 per year. Results 858 participants were included and followed for a mean study period of 2.1 years. Overall 374 (44%) had nocturnal hypoxia, and 49 (5.7%) had accelerated loss of kidney function. Compared to controls without hypoxia, patients with nocturnal hypoxia had a significant increase in the adjusted risk of accelerated kidney function loss (odds ratio (OR) 2.89, 95% confidence interval [CI] 1.25, 6.67). Conclusion Nocturnal hypoxia was independently associated with an increased risk of accelerated kidney function loss. Further studies are required to determine whether treatment and correction of nocturnal hypoxia reduces loss of kidney function.
Ahmed, Sofia B.; Ronksley, Paul E.; Hemmelgarn, Brenda R.; Tsai, Willis H.; Manns, Braden J.; Tonelli, Marcello; Klarenbach, Scott W.; Chin, Rick; Clement, Fiona M.; Hanly, Patrick J.
|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
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
The preceding companion study (Eckenrode et al., 1992) showed that cell suspension transplants of fetal habenula cells placed near the interpeduncular nucleus (IPN) following lesions of the fasciculus retroflexus (FR) restore the normal pattern of substance P (SP) staining in habenular target subnuclei of the IPN in both perinatal and adult hosts, and restore ChAT staining in the IPN of perinatal hosts. Similarly placed transplants of fetal thalamus cells only restore ChAT staining in the IPN of adult hosts. In this study, we examined the functional significance of these restored staining patterns. We used a behavioral measure of the integrity of REM-stage and non-REM-stage sleep, the "flower pot" test, and assayed (1) normal adult rats, (2) FR-lesioned control animals (neonatal or adult operates), (3) animals receiving FR lesions and transplants of fetal habenula cells (perinatal or adult hosts), and (4) animals receiving FR lesions and transplants of fetal thalamus cells (adult hosts). FR lesions decrease markedly the muscle atonia component of REM sleep and reduce duration of sleep episodes. Transplants that restore SP staining in the IPN (habenular transplants into either perinatal or adult lesion hosts) restore normal frequency of REM atonia; transplants that restore ChAT staining (habenular transplants into perinatal hosts or thalamic transplants into adult hosts) restore normal duration of sleep episodes. The number of SP-immunoreactive cells in the transplants predicts recovery of REM atonia, and the number of ChAT cells in habenular (but not thalamic) transplants predicts restoration of sleep duration.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1494957
Haun, F; Eckenrode, T C; Murray, M
The objective of this study was to evaluate the effects of nocturnal sleep, partial night sleep deprivation, and sleep stages on catecholamine and interleukin-2 (IL-2) levels in humans. Circulating levels of catecholamines and IL-2 were sampled every 30 min during 2 nights: undisturbed, baseline sleep and partial sleep deprivation-late night (PSD-L; awake from 0300-0600 h) in 17 healthy male volunteers. Sleep was monitored somnopolygraphically. Sleep onset was associated with a significant (P < 0.05) decline of circulating concentrations of norepinephrine and epinephrine, with a nocturnal nadir that occurred 1 h after nocturnal sleep. On the PSD-L night, levels of norepinephrine and epinephrine significantly (P < 0.05) increased in association with nocturnal awakening. During stage 3-4 sleep, levels of norepinephrine, but not epinephrine, were significantly lower (P < 0.05) compared to average levels during the awake period, stages 1-2 sleep, and rapid eye movement sleep. Nocturnal levels of circulating IL-2 did not change with sleep onset or in relation to PSD-L or the various sleep stages. We conclude that sleep onset is associated with changes in levels of circulating catecholamines. Loss of sleep and disordered sleep with decreases in slow wave sleep may serve to elevate nocturnal catecholamine levels and contribute to cardiovascular disease. PMID:10372697
Irwin, M; Thompson, J; Miller, C; Gillin, J C; Ziegler, M
The objectives of the study were to measure the prevalence of periodic leg movements during NREM and REM sleep (PLMS) and while awake (PLMW) and to assess the impact of PLMS on nocturnal sleep and daytime functioning in patients with narcolepsy. One hundred and sixty-nine patients with narcolepsy and 116 normal controls matched for age and gender were included. Narcoleptics with high and low PLMS indices were compared to assess the impact of PLMS on sleep and Multiple Sleep Latency Test (MSLT) variables. More narcoleptics than controls had a PLMS index greater than 5 per hour of sleep (67% versus 37%) and an index greater than 10 (53% versus 21%). PLMS indices were higher both in NREM and REM sleep in narcoleptic patients, but the between-group difference was greater for REM sleep. A significant increase of PLMS index was also found with aging in both narcoleptic patients and controls. PLMW indices were also significantly higher in narcoleptic patients. Patients with an elevated index of PLMS had a higher percentage of stage 1 sleep, a lower percentage of REM sleep, a lower REM efficiency and a shorter MSLT latency. The present study demonstrates a high frequency of PLMS and PLMW in narcolepsy, an association between the presence of PLMS and measures of REM sleep and daytime functioning disruption. These results suggest that PLMS represent an intrinsic feature of narcolepsy. PMID:17716283
Dauvilliers, Yves; Pennestri, Marie-Hélène; Petit, Dominique; Dang-Vu, Thanh; Lavigne, Gilles; Montplaisir, Jacques
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 6-16years). 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
The recently described intranigral rotenone model of Parkinson's disease (PD) in rodents provides an interesting model for studying mechanisms of toxin-induced dopaminergic neuronal injury. The relevance of this model remains unexplored with regard to sleep disorders that occur in PD. On this basis, the construction of a PD model depicting several behavioral and neurochemical alterations related to sleep would be helpful in understanding the association between PD and sleep regulation. We performed bilateral intranigral injections of rotenone (12??g) on day 0 and the open-field test initially on day 20 after rotenone. Acquisition phase of the object-recognition test, executed also during day 20, was followed by an exact period of 24 hr of rapid eye movement (REM) sleep deprivation (REMSD; day 21). In the subsequent day (22), the rats were re-exposed to the open-field test and to the object-recognition test (choice phase). After the last session of behavioral tests, the rat brains were immediately dissected, and their striata were collected for neurochemical purposes. We observed that a brief exposure to REMSD was able to impair drastically the object-recognition test, similarly to a nigrostriatal lesion promoted by intranigral rotenone. However, the combination of REMSD and rotenone surprisingly did not inflict memory impairment, concomitant with a moderate compensatory mechanism mediated by striatal dopamine release. In addition, we demonstrated the existence of changes in serotonin and noradrenaline neurotransmissions within the striatum mostly as a function of REMSD and REMSD plus rotenone, respectively. © 2013 Wiley Periodicals, Inc. PMID:23908011
Dos Santos, Ana Carolina D; Castro, Marcela Alexandra V; Jose, Elis Angela K; Delattre, Ana Márcia; Dombrowski, Patrícia A; Da Cunha, Claudio; Ferraz, Anete C; Lima, Marcelo M S
Due to undisputable effects of noise on sleep structure, especially in terms of sleep fragmentation, the expected development of railway transportation in the next few years might represent a potential risk factor for people living alongside the rail tracks. The aim of this study was to compare the effects of different types of train (freight, automotive, passenger) on arousal from sleep and to determine any differential impact as a function of sound level and age. Twenty young (16 women, 4 men; 25.8 years+/-2.6) and 18 middle-aged (15 women, 3 men; 52.2 years+/-2.5) healthy subjects participated in three whole-night polysomnographic recordings including one control night (35 dBA), and two noisy nights with equivalent noise levels of 40 or 50 dB(A), respectively. Arousal responsiveness increased with sound level. It was the highest in S2 and the lowest in REM sleep. Micro-arousals (3-10 s) occurred at a rate of 25-30%, irrespective of the type of train. Awakenings (>10 s) were produced more frequently by freight train than by automotive and passenger trains. Normal age-related changes in sleep were observed, but they were not aggravated by railway noise, thus questioning whether older persons are less sensitive to noise during sleep. These evidences led to the conclusion that microscopic detection of sleep fragmentation may provide advantageous information on sleep disturbances caused by environmental noises. PMID:18773929
Saremi, Mahnaz; Grenèche, Jérôme; Bonnefond, Anne; Rohmer, Odile; Eschenlauer, Arnaud; Tassi, Patricia
Mirtazapine is a commonly prescribed antidepressant with sedative properties. We report a case of nocturnal involuntary limb movements developing in an opioid-dependent young man after starting mirtazapine. The involuntary repetitive bilateral leg movements during initial phase of sleep began when mirtazapine was initiated. They continued for 4 days till mirtazapine was stopped and did not recur subsequently. The role of mirtazapine should be considered when a patient on this drug complains of leg movement during early phase of sleep. PMID:23273829
Mattoo, Surendra K; Mahajan, Sudhir; Sarkar, Siddharth; Nebhinani, Naresh
Sleep disordered breathing with or without nocturnal hypercapnic hypoventilation is a common complication of respiratory muscle weakness in childhood neuromuscular disorders. Nocturnal hypercapnic hypoventilation as a sign of respiratory muscle fatigue, portends a particularly poor prognosis. We aimed at identifying daytime predictors of sleep disordered breathing at its onset and sleep disordered breathing with nocturnal hypercapnic hypoventilation. Forty-nine children and
Uwe Mellies; Regine Ragettesupbsu; Christian Schwake; Holger Boehm; Thomas Voit; Helmut Teschler
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
Purpose We investigated the impact of the 6.3 magnitude 2009 L’Aquila (Italy) earthquake on standardized self-report measures of sleep quality (Pittsburgh Sleep Quality Index, PSQI) and frequency of disruptive nocturnal behaviours (Pittsburgh Sleep Quality Index-Addendum, PSQI-A) two years after the natural disaster. Methods Self-reported sleep quality was assessed in 665 L’Aquila citizens exposed to the earthquake compared with a different sample (n?=?754) of L'Aquila citizens tested 24 months before the earthquake. In addition, sleep quality and disruptive nocturnal behaviours (DNB) of people exposed to the traumatic experience were compared with people that in the same period lived in different areas ranging between 40 and 115 km from the earthquake epicenter (n?=?3574). Results The comparison between L’Aquila citizens before and after the earthquake showed a significant deterioration of sleep quality after the exposure to the trauma. In addition, two years after the earthquake L'Aquila citizens showed the highest PSQI scores and the highest incidence of DNB compared to subjects living in the surroundings. Interestingly, above-the-threshold PSQI scores were found in the participants living within 70 km from the epicenter, while trauma-related DNBs were found in people living in a range of 40 km. Multiple regressions confirmed that proximity to the epicenter is predictive of sleep disturbances and DNB, also suggesting a possible mediating effect of depression on PSQI scores. Conclusions The psychological effects of an earthquake may be much more pervasive and long-lasting of its building destruction, lasting for years and involving a much larger population. A reduced sleep quality and an increased frequency of DNB after two years may be a risk factor for the development of depression and posttraumatic stress disorder.
Tempesta, Daniela; Curcio, Giuseppe; De Gennaro, Luigi; Ferrara, Michele
In order to clarify whether nocturnal hypoxaemia (arterial oxygen saturation, SaO2 <90% may exist in the long-term before daytime hypoxaemia (PaO2 <8·0 kPa) occurs in chronic obstructive pulmonary disease (COPD), 21 patients with stable severe COPD without daytime hypoxaemia (PaO2 ?8·0 kPa) were studied prospectively. Subjects were monitored twice by polysomnography (PSG) 12 months apart. Spirometry was performed, and diffusion
K. Sandek; T. Andersson; T. Bratel; G. Hellström; L. Lagerstrand
Objectives To investigate the feasibility of implementing a Sleep Education Program (SEP) for improving sleep in adult family home (AFH) residents with dementia, and the relative efficacy of SEP compared to usual care control in a pilot randomized controlled trial. Participants Thirty-seven AFH staff-caregivers and 47 residents with co-morbid dementia and sleep disturbances. Intervention SEP consisted of four training sessions with staff-caregivers to develop and implement individualized resident behavioral sleep plans. Measurements Treatment fidelity to the SEP was assessed following the NIH Behavior Change Consortium model utilizing trainer observations and staff-caregiver reports. Resident sleep was assessed by wrist actigraphy at baseline, 1-month post-treatment, and 6-month follow-up. Caregiver reports of resident daytime sleepiness, depression, and disruptive behaviors were also collected. Results Each key area of treatment fidelity (SEP delivery, receipt, enactment) was identified, measured, and yielded significant outcomes. Staff-caregivers learned how to identify sleep scheduling, daily activity, and environmental factors that could contribute to nocturnal disturbances, and developed and implemented strategies for modifying these factors. SEP decreased the frequency and disturbance level of target resident nocturnal behaviors, and improved actigraphically-measured sleep percent and total sleep time over the 6-month follow-up period compared to the control condition. Conclusion Results suggest behavioral interventions to improve sleep are feasible to implement in adult family homes, and merit further investigation as a promising intervention for use with AFH residents with dementia.
McCurry, Susan M.; LaFazia, David M.; Pike, Kenneth C.; Logsdon, Rebecca G.; Teri, Linda
Two groups of patients with nocturnal arterial oxygen desaturation were compared. The degree of nocturnal oxygen desaturation, as reflected by the percentage of total sleep time spent with an oxygen saturation less than 90 and 80%, was similar in patients with the obstructive sleep apnoea syndrome (OSAS) and in those with nocturnal hypoventilation (NH) secondary to restrictive chest wall disease. Systemic hypertension was present in 16 of the 24 OSAS patients but in only 6 of the 24 with NH (p less than 0.005). Multiple regression analysis demonstrated that this difference remained significant even after adjustment for age, sex, weight and history of smoking. It is likely that factors other than nocturnal hypoxaemia are important in the aetiology of systemic hypertension in patients with sleep-related breathing disorders. PMID:2354475
Shiner, R J; Carroll, N; Sawicka, E H; Simonds, A K; Branthwaite, M A
Study Objectives: The purpose of this study was to analyze the relationship between food intake and sleep patterns in healthy individuals. Methods: Fifty-two healthy volunteers (27 women and 25 men) were recruited to participate in the study. Volunteers underwent sleep evaluation through nocturnal polysomnography and completed a 3-day food diary to evaluate food intake. Results: No differences in sleep patterns were observed in either gender, except in the percentage of stage 1 sleep, which was greater in men. Different correlations were observed between sleep and dietary variables according to gender. The correlation between dietary and sleep variables in men indicated a negative relationship between nocturnal fat intake and the sleep latency, including REM sleep. The percentage of nocturnal fat intake correlated with sleep efficiency, sleep latency, REM latency, stage 2 sleep, REM sleep, and wake after sleep onset (WASO) in women. The percentage of nocturnal caloric intake correlated with sleep latency and efficiency in women. Conclusions: We conclude that food intake during the nocturnal period is correlated with negative effects on the sleep quality of healthy individuals. Indeed, food intake near the sleeping period (dinner and late night snack) was negatively associated with sleep quality variables. More studies are necessary to elucidate the real effect of food intake on sleep. Citation: Crispim CA; Zimberg IZ; dos Reis BG; Diniz RM; Tufik S; de Mello MT. Relationship between food intake and sleep pattern in healthy individuals. J Clin Sleep Med 2011;7(6):659-664.
Crispim, Cibele Aparecida; Zimberg, Iona Zalcman; dos Reis, Bruno Gomes; Diniz, Rafael Marques; Tufik, Sergio; de Mello, Marco Tulio
This report describes studies of delta-sleep-inducing peptide in the mechanism of compensating emotional behavior following\\u000a disruption of a number of structures of the limbic complex (the septum and amygdala). Studies were performed in male Wistar\\u000a rats. Peptide was given i.p. at a dose of 60 nmol\\/kg. The individual\\/typological characteristics of the rats' behavior and\\u000a their resistance to stress was predicted
E. V. Koplik; K. V. Sudakov
Background: Conversely to other neurodegenerative diseases (i.e., Alzheimer's disease, AD), sleep in frontotemporal dementia (FTD) has not been studied adequately. Although some evidence exists that sleep-wake disturbances occur in FTD, very little is known regarding sleep macrostructure and/or primary sleep disorders. Objective: To investigate these issues in this population and compare them to similar issues in AD and in healthy elderly (HE). Methods: Twelve drug-naïve behavioral-variant FTD (bvFTD) patients (7 men/5 women) of mean age 62.5 ± 8.6 years were compared to seventeen drug-naïve AD patients (8 men/9 women) of mean age 69.0 ± 9.9 years and twenty drug-naïve HE (12 men/8 women) of mean age 70.2 ± 12.5 years. All participants were fully assessed clinically, through a sleep questionnaire, an interview, and video-polysomnography recordings. Results: The two patient groups were comparably cognitively impaired. However, compared to FTD patients, the AD patients had a statistically significant longer disease duration. Overall, the sleep profile was better preserved in HE. Sleep complaints did not differ considerably between the two patient groups. Sleep parameters and sleep macrostructure were better preserved in AD compared to FTD patients, regardless of primary sleep disorders, which occurred equally in the two groups. Conclusions: With respect to AD, FTD patients had several sleep parameters similarly or even more affected by neurodegeneration, but in a much shorter time span. The findings probably indicate a centrally originating sleep deregulation. Since in FTD patients sleep disturbances may be obvious from an early stage of their disease, and possibly earlier than in AD patients, physicians and caregivers should be alert for the early detection and treatment of these symptoms. PMID:24077430
Bonakis, Anastasios; Economou, Nicholas-Tiberio; Paparrigopoulos, Thomas; Bonanni, Enrica; Maestri, Michelangelo; Carnicelli, Luca; Di Coscio, Elisa; Ktonas, Periklis; Vagiakis, Emmanouil; Theodoropoulos, Panagiotis; Papageorgiou, Sokratis G
Background: Posttraumatic stress disorder (PTSD) is one of the most prevalent psychiatric disorders in young adults. Early diagnosis and treatment of PTSD are essential to avoid possible long-term neuropsychiatric changes in brain physiology and function. A cardinal symptom of PTSD is chronic sleep disruption, often with recurring nightmares. If untreated, PTSD symptoms often contribute to substance abuse and the development of other comorbid psychiatric disorders. Once PTSD is diagnosed, drug treatment should begin with antidepressant therapy. If antidepressants do not correct the sleep disruption, adjunctive treatment with the atypical antipsychotic olanzapine or other agents should be considered. Method: This case series reviews 7 cases of patients with PTSD (DSM-IV criteria) seen in primary care clinics who were successfully treated with olanzapine. In most cases, olanzapine therapy was adjunctive and followed failed treatment with antidepressant monotherapy for sleep disturbances. Results: All patients reported improved sleep with decreased or absent nightmares, as well as improvements in other PTSD symptom clusters. Conclusion: Further controlled studies are needed to better characterize and validate this therapeutic indication.
States, James H.; St.Dennis, Clarke D.
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
Two hundreds epileptic patients with nocturnal seizures were studied. The study included evaluation of anamnesis, clinical and neurological examination, routine EEG and/or video-EEG-monitoring, MRI of the brain. The period of observation was 6 months - 10 years (on average 3.5 years). Epilepsy started with nocturnal seizures in 48% cases, in 30.5% of patients all seizures persisted during sleep. In 25% patients, nocturnal seizures were different from seizures in awakening. In 18.5% cases, seizures were randomly dispersed in the sleep-wake cycle. Different types of nocturnal nonepileptic seizures were noted in 8.5% cases. The relationship between sleep and epilepsy as well as different types of parasomnias that mimicked epileptic seizures were described and analyzed. PMID:23994912
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
The primary care physician commonly encounters patients who complain of insomnia, defined as persistent difficulty in falling or staying asleep that affects daytime functioning. Causes include circadian rhythm disturbances, primary sleep disorders, psychiatric or medical disorders, medications, and substance abuse. Older patients have shortened total nocturnal sleep, easier arousal, more difficulty falling asleep, and less deep sleep. These physiologic sleep
Faith M. Whittier; Eugene C. Toy; Benton Baker
We elicited isolated sleep paralysis (ISP) from normal subjects by a nocturnal sleep interruption schedule. On four experimental nights, 16 subjects had their sleep interrupted for 60 minutes by forced awakening at the time when 40 minutes of nonrapid eye movement (NREM) sleep had elapsed from the termination of rapid eye movement (REM) sleep in the first or third sleep cycle. This schedule produced a sleep onset REM period (SOREMP) after the interruption at a high rate of 71.9%. We succeeded in eliciting six episodes of ISP in the sleep interruptions performed (9.4%). All episodes of ISP except one occurred from SOREMP, indicating a close correlation between ISP and SOREMP. We recorded verbal reports about ISP experiences and recorded the polysomnogram (PSG) during ISP. All of the subjects with ISP experienced inability to move and were simultaneously aware of lying in the laboratory. All but one reported auditory/visual hallucinations and unpleasant emotions. PSG recordings during ISP were characterized by a REM/W stage dissociated state, i.e. abundant alpha electroencephalographs and persistence of muscle atonia shown by the tonic electromyogram. Judging from the PSG recordings, ISP differs from other dissociated states such as lucid dreaming, nocturnal panic attacks and REM sleep behavior disorders. We compare some of the sleep variables between ISP and non-ISP nights. We also discuss the similarities and differences between ISP and sleep paralysis in narcolepsy. PMID:1621022
Takeuchi, T; Miyasita, A; Sasaki, Y; Inugami, M; Fukuda, K
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.
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
Sleep symptoms in Parkinson's disease (PD) are frequent and have multifactorial and multilayered causes. Primary involvement of sleep\\/wake regulating centers in the brainstem, sleep problems caused by the nocturnal manifestation of motor and dysautonomic signs and medication-induced sleep problems are often impossible to disentangle in the individual patient. Two syndromes, hypersomnia and REM sleep behavior disorder (RBD), are increasingly recognized
Nico J. Diederich; Deborah J. McIntyre
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
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; Sottner, O; Hanuš, T; Martan, A; Hor?i?ka, L; Feyereisl, J; Halaška, M; Svabík, K; Krofta, L
This study has investigated differences in the nocturnal sleep and daytime sleepiness among patients with obstructive sleep apnoea syndrome (OSAS), upper airway resistance (UARS), sleep hypopnoea syndrome, and normal control subjects, using sleep scoring and spectral activity analysis of the electroencephalogram (EEG). Twelve nonobese males with UARS aged 30 - 60 yrs were recruited. These subjects were strictly matched for
C. Guilleminault; Y. Do Kim; S. Chowdhuri; M. Horita; M. Ohayon; C. Kushida
When it comes to improving overall health, few activities are cited as frequently as exercising regularly and getting enough sleep. These activities are not only important in their own right, but now appear to be connected. Research in recent years has uncovered exercise’s ability to help people fall asleep faster and stay in deeper stages of sleep longer, revealing that
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
Background Sleep apnea, hypertension, atherosclerosis, and obesity are features of metabolic syndrome associated with decreased restorative sleep and increased pain. These traits are relevant for anesthesiology because they confer increased risks of a negative anesthetic outcome. This study tested the one-tailed hypothesis that rats bred for low intrinsic aerobic capacity have enhanced nociception and disordered sleep. Methods Rats were from a breeding strategy that selected for low aerobic capacity runners (LCR) and high aerobic capacity runners (HCR). Four different phenotypes were quantified. Rats (n=12) underwent von Frey sensory testing, thermal nociceptive testing (n=12), electrographic recordings of sleep and wakefulness (n=16), and thermal nociceptive testing before and for six weeks after a unilateral chronic neuropathy of the sciatic nerve (n=14). Results Paw withdrawal latency to a thermal nociceptive stimulus was significantly (P<0.01) less in LCR than HCR rats. There were significant differences in sleep. LCR rats spent significantly (P<0.01) more time awake (18%) and less time in non-rapid eye movement sleep (?19%) than HCR rats. Non-rapid eye movement sleep episodes were of shorter duration (?34%) in LCR than HCR rats. Rapid eye movement sleep of LCR rats was significantly more fragmented than Rapid eye movement sleep of HCR rats. LCR rats required two weeks longer than HCR rats to recover from peripheral neuropathy. Conclusions Rodents with low aerobic capacity exhibit features homologous to human metabolic syndrome. This rodent model offers a novel tool for characterizing the mechanisms through which low aerobic function and obesity might confer increased risks for anesthesia.
Muncey, Aaron R.; Saulles, Adam R.; Koch, Lauren G.; Britton, Steven L.; Baghdoyan, Helen A.; Lydic, Ralph
The role of sleep in the pathogenesis of coronary ischaemic events such as myocardial infarction, transient myocardial ischaemia, or cardiac sudden death, is unclear. This review will analyse the available data on the subject according to: (i) the autonomic and cardiovascular changes during sleep that may potentially favour myocardial ischaemia; (ii) the evidence of a circadian distribution of coronary events; and (iii) the factors possibly involved in the pathogenesis of nocturnal angina. Available data suggest that myocardial ischaemia may occur by different mechanisms in non-rapid eye movement (NREM) (decreased coronary perfusion pressure) and rapid eye movement (REM) sleep (increased myocardial oxygen demand). Coronary events show a major peak of occurrence between 6.00 a.m. and noon; however, the myocardial ischaemic threshold, defined as the heart rate value at which myocardial ischaemia develops, may be lower at night than during the daytime, suggesting an unexpectedly higher susceptibility to myocardial ischaemia during sleep than during wakefulness. These data warrant further study on the pathophysiology of coronary circulation during sleep. Finally, some evidence is available that sleep disordered breathing may precipitate nocturnal angina especially in REM sleep, through decreased arterial oxygen content secondary to hypoventilation or true apnoeas. More data are needed to better understand the effects of sleep on the coronary circulation, and to improve the therapeutic approach of nocturnal angina. PMID:15310478
Bonsignore, M R; Smirne, S; Marrone, O; Insalaco, G; Salvaggio, A; Bonsignore, G
We describe an obese child with severe obstructive sleep apnea syndrome in whom nocturnal frontal lobe seizures developed within a week after therapy was started with continuous positive airway pressure. The video polysomnographic study after the onset of nocturnal episodes showed 3 seizures: 2 starting from slow-wave sleep when he was sleeping with continuous positive airway pressure, and 1 from
Silvia Miano; Andrea Pelliccia; Melania Evangelisti; Jacopo Pagani; Maria Pia Villa
... en... Favorites Delicious Digg Google Bookmarks Sleep and Sleep Disorders Tired? Insufficient sleep is associated with a number ... hygiene by sending a sleep Health-e-Card . Sleep Disorders Sleep-related difficulties – typically called sleep disorders – affect ...
Summary Nocturnal frontal lobe epilepsy (NFLE) has been delineated as a distinct syndrome in the heterogeneous group of paroxysmal sleep-related disturbances. The variable duration and intensity of the seizures distinguish three non-rapid eye movement-related subtypes: paroxysmal arousals, characterized by brief and sudden recurrent motor paroxysmal behaviour; nocturnal paroxysmal dystonia, motor attacks with complex dystonic-dyskinetic features; and episodic nocturnal wanderings, stereotyped,
Federica Provini; Giuseppe Plazzi; Paolo Tinuper; Stefano Vandi; Elio Lugaresi; Pasquale Montagna
Background: Chronic obstructive pulmonary disease (COPD) patients are very sensitive to changes in pulmonary mechanics and central ventilation control during sleep and may develop significant gas exchange alterations with increased hypoxemia and hypercapnia. Oxygen therapy improves nocturnal desaturation but can worsen hypoventilation. Objectives: To analyze the prevalence of nocturnal hypoventilation (NHV) in hypercapnic COPD patients and to determine predictive factors
Julia Tarrega; Antonio Anton; Rosa Guell; Mercedes Mayos; Daniel Samolski; Sergi Marti; Eva Farrero; Enric Prats; Joaquin Sanchis
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
Knowledge of sleep architecture and disorders of nocturnal sleep in dementia with Lewy bodies (DLB) is limited by a lack of systematic video-polysomnographic (video-PSG) investigations. We describe video-PSG findings in 29 consecutive subjects diagnosed with DLB. All the patients underwent a clinical interview and overnight video-PSG monitoring. Twenty-nine nondemented patients with Parkinson's disease (PD) matched for age and sex with the DLB cases were selected for comparison. The DLB subjects showed less 1NREM sleep (P?=?.000) and more 2NREM sleep (P?=?.000) than the PD subjects. Sleep apnea (30.7% vs. 34.8%) and periodic limb movements (60.9% versus 50.0%) were frequent in both groups. Disruptive motor behavioral manifestations were more frequent in subjects with DLB (69.6% vs. 26.9%, P?=?.008) and consisted of not only REM sleep behavior disorder (RBD) but also confusional events (30.3% vs. 3.8%, P?=?.020) and arousal-related episodes mimicking RBD. Subjects with DLB in whom a sleep disturbance had been the presenting symptom performed better than those with other onset symptoms on both the Mini-Mental State Examination (22.2?±?4.1 vs. 18.1?±?4.6, P?=?.019) and the Frontal Assessment Battery (15.8 vs. 10.3, P?=?.010). Polysomnographic findings in DLB show a complex mix of overlapping sleep alterations: impaired sleep structure, sleep comorbidities, and various motor-behavioral events (not restricted to RBD). Clinicians should be aware of the possibility of misleading symptoms and of the risk of overlooking sleep comorbidities, and consider performing polysomnographic sleep investigations in selected cases. We found evidence that a sleep disturbance as the presenting symptom might indicate a different phenotype of the disease, characterized by milder cognitive impairment. © 2013 International Parkinson and Movement Disorder Society. PMID:23744574
Terzaghi, Michele; Arnaldi, Dario; Rizzetti, Maria Cristina; Minafra, Brigida; Cremascoli, Riccardo; Rustioni, Valter; Zangaglia, Roberta; Pasotti, Chiara; Sinforiani, Elena; Pacchetti, Claudio; Manni, Raffaele
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
Many species of diurnal birds migrate nocturnally. Here, a series of studies of the blackcap (Sylvia atricapilla) on the relationship between nocturnal restlessness and melatonin, a hormone that in birds modulates day-night rhythms, are reviewed. Migratory populations from Sweden and Kenya were compared with resident populations from Cape Verde. In blackcaps of migratory populations, night levels of melatonin were lower during the migratory period, when birds showed nocturnal activity, than before and after this period, when birds did not show nocturnal activity. On the contrary, the occurrence of periodic or irregular phases of nocturnal activity in some nonmigratory birds from Cape Verde was not accompanied by a reduction in melatonin levels. In a second series of experiments, it was studied whether melatonin levels change when nocturnally active blackcaps are experimentally transferred from a migratory to a nonmigratory state. A long migratory flight and a refueling stopover were simulated by depriving birds of food for 2 days, subsequently readministering food. The experiments were done in autumn with birds collected in Sweden, and repeated in spring with birds collected in Kenya. In autumn, there was a suppression of nocturnal activity and an increase in melatonin in the night following food reintroduction. In spring, the effects were qualitatively similar, but their extent depended on the amount of body fat reserves. Taken together, the studies demonstrate the existence of a functional relationship between melatonin and nocturnal restlessness and of seasonal differences in the response of the migratory program to food availability. PMID:16055859
Fusani, Leonida; Gwinner, Eberhard
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
Diagnosis of sleep-disordered breathing is based on the presence of an abnormal breathing pattern during sleep. In this study,\\u000a an algorithm was developed for the offline breath-to-breath analysis of the nocturnal respiratory recordings. For that purpose,\\u000a respiratory signals (nasal airway pressure, thoracic and abdominal movements) were divided into half waves using period amplitude\\u000a analysis. Individual breaths were characterized by the
P. J. van HoudtP; P. P. W. Ossenblok; M. G. van Erp; K. E. Schreuder; R. J. J. Krijn; P. A. J. M. Boon; P. J. M. Cluitmans
During the month of Ramadan intermittent fasting, Muslims eat exclusively between sunset and sunrise, which may affect nocturnal sleep. The effects of Ramadan on sleep and rectal temperature (Tre) were examined in eight healthy young male subjects who reported at the laboratory on four occasions: (i) baseline 15 days before Ramadan (BL); (ii) on the eleventh day of Ramadan (beginning of Ramadan, BR); (iii) on the twenty-fifth day of Ramadan (end of Ramadan, ER); and (iv) 2 weeks after Ramadan (AR). Although each session was preceded by an adaptation night, data from the first night were discarded. Polysomnography was taken on ambulatory 8-channel Oxford Medilog MR-9000 II recorders. Standard electroencephalogram (EEG), electro-oculogram (EOG) and electromyogram (EMG) recordings were scored visually with the PhiTools ERA. The main finding of the study was that during Ramadan sleep latency is increased and sleep architecture modified. Sleep period time and total sleep time decreased in BR and ER. The proportion of non-rapid eye movement (NREM) sleep increased during Ramadan and its structure changed, with an increase in stage 2 proportion and a decrease in slow wave sleep (SWS) duration. Rapid eye movement (REM) sleep duration and proportion decreased during Ramadan. These changes in sleep parameters were associated with a delay in the occurrence of the acrophase of Tre and an increase in nocturnal Tre during Ramadan. However, the 24-h mean value (mesor) of Tre did not vary. The nocturnal elevation of Tre was related to a 2-3-h delay in the acrophase of the circadian rhythm. The amplitude of the circadian rhythm of Tre was decreased during Ramadan. The effects of Ramadan fasting on nocturnal sleep, with an increase in sleep latency and a decrease in SWS and REM sleep, and changes in Tre, were attributed to the inversion of drinking and meal schedule, rather than to an altered energy intake which was preserved in this study. PMID:11903862
Roky, R; Chapotot, F; Hakkou, F; Benchekroun, M T; Buguet, A
SS WERE STUDIED WHILE SLEEPING IN THE LABORATORY DURING THE AFTERNOON HOURS. THE SLEEP OF THESE SS NEITHER RESEMBLED THAT FOUND DURING THE LAST 2 HR. OF NOCTURNAL SLEEP NOR THAT FOUND IN THE 1ST 2 HR. THE DATA INDICATED THAT THE AMOUNT OF STAGE 4 AND 1 REM FOUND DURING AN INTERJECTED SLEEP EVENT IS A FUNCTION OF ITS
Wilse B. Webb; Harman W. Agnew
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 ...
The objective of this study was to evaluate the effects of nocturnal sleep, partial night sleep deprivation, and sleep stages on catechol- amine and interleukin-2 (IL-2) levels in humans. Circulating levels of catecholamines and IL-2 were sampled every 30 min during 2 nights: undisturbed, baseline sleep and partial sleep deprivation-late night (PSD-L; awake from 0300 - 0600 h) in 17
MICHAEL IRWIN; JOHN THOMPSON; CLAUDINE MILLER; J. CHRISTIAN GILLIN; MICHAEL ZIEGLER
Summary Sudden Unexpected Nocturnal. Deaths (SUND) occur in young, apparently healthy immigrant workers from Thailand, the Philippines and Bangladesh living among ex-patriot labour forces in countries such as Singapore and Saudi Arabia. Several factors associated with these deaths are similar to those observed for Sudden Infant Death Syndrome (SIDS): sleep related and mainly noturnal occurrence; no prodromal illnesses other than
C. C. Blackwell; A. Busuttil; D. M. Weir; A. T. Saudi; S. D. Esseryl
A nocturnal succession of manually scored sleep stages was transformed to a time series (sleep profile) by assigning numerical weights to each sleep stage. This time series was fitted to the set of damped sinusodial waves within the ultradian range. The o...
P. Naitoh L. C. Johnson A. Lubin C. Nute
Baroreflex control of heart rate during sleep (baroreflex sensitivity; BRS) has been shown to be depressed in obstructive sleep apnoea (OSA), and improved after treatment with continuous positive airway pressure (CPAP). Whether CPAP also acutely affects BRS during sleep in uncomplicated severe OSA is still debatable. Blood pressure was monitored during nocturnal polysomnography in 18 patients at baseline and during
M. R. Bonsignore; G. Parati; G. Insalaco; P. Castiglioni; O. Marrone; S. Romano; A. Salvaggio; G. Mancia; G. Bonsignore; M. Di Rienzo
Sleep enhances memory consolidation. Bearing in mind that food intake produces many metabolic signals that can influence memory processing in humans (e.g., insulin), the present study addressed the question as to whether the enhancing effect of sleep on memory consolidation is affected by the amount of energy consumed during the preceding daytime. Compared to sleep, nocturnal wakefulness has been shown
Nina Herzog; Alexia Friedrich; Naoko Fujita; Steffen Gais; Kamila Jauch-Chara; Kerstin M. Oltmanns; Christian Benedict
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the US. Numerous studies have demonstrated that sleep disturbances are common in COPD patients, with more prominent complaints in patients with more severe disease and with increasing age. Sleep disturbances may occur due to the effects of breathing abnormalities on sleep and sleep disruption. However, other
Sleep disordered breathing is common in patients with tetraplegia. Nocturnal arterial hypoxemia and sleep fragmentation due to sleep apnoea may be associated with cognitive dysfunction. We therefore studied the influence of sleep disordered breathing on neuropsychological function in 37 representative tetraplegic patients (mean age 34±9.7 years). Thirty percent (11 of 37 patients) had clinically significant sleep disordered breathing, defined as
Dimitar Sajkov; Ruth Marshall; Pieter Walker; Ivanka Mykytyn; R Douglas McEvoy; Jo Wale; Howard Flavell; Andrew T Thornton; Ral Antic
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 abnormalities are common in severe emphysema, and include poor sleep quality, the development of nocturnal oxygen desaturation, and the presence of coexistent obstructive sleep apnea. With lower baseline oxygenation and abnormal respiratory mechanics in patients with severe emphysema, alterations in ventilatory control and respiratory muscle function that normally occur during sleep can have profound effects, and contribute to the development of sleep abnormalities. The impact on quality of life, cardiopulmonary hemodynamics, and overall survival remains uncertain. In addition, treatment for chronic obstructive pulmonary disease and its effect on sleep abnormalities have demonstrated conflicting results. More recently, as part of the National Emphysema Treatment Trial, lung volume reduction surgery has been shown to improve both sleep quality and nocturnal oxygenation in emphysema. Although indications for performing an overnight polysomnogram in patients with emphysema have been debated, recommendations have been presented. Future studies investigating disease mechanism and response to therapy in patients with sleep abnormalities and severe emphysema are warranted.
Krachman, Samuel; Minai, Omar A.; Scharf, Steven M.
Up to 60 percent of adults report that they have had nocturnal leg cramps. The recurrent, painful tightening usually occurs in the calf muscles and can cause severe insomnia. The exact mechanism is unknown, but the cramps are probably caused by muscle fatigue and nerve dysfunction rather than electrolyte or other abnormalities. Nocturnal leg cramps are associated with vascular disease, lumbar canal stenosis, cirrhosis, hemodialysis, pregnancy, and other medical conditions. Medications that are strongly associated with leg cramps include intravenous iron sucrose, conjugated estrogens, raloxifene, naproxen, and teriparatide. A history and physical examination are usually sufficient to differentiate nocturnal leg cramps from other conditions, such as restless legs syndrome, claudication, myositis, and peripheral neuropathy. Laboratory evaluation and specialized testing usually are unnecessary to confirm the diagnosis. Limited evidence supports treating nocturnal leg cramps with exercise and stretching, or with medications such as magnesium, calcium channel blockers, carisoprodol, or vitamin B(12). Quinine is no longer recommended to treat leg cramps. PMID:22963024
Allen, Richard E; Kirby, Karl A
Previous studies have shown increased sleepiness and mood changes in shiftworkers, which may be due to sleep deprivation or circadian disruption. Few studies, however, have compared responses of experienced shiftworkers and non-shiftworkers to sleep deprivation in an identical laboratory setting. The aim of this laboratory study, therefore, was to compare long-term shiftworkers and non-shiftworkers and to investigate the effects of one night of total sleep deprivation (30.5 h of continuous wakefulness) and recovery sleep on psychomotor vigilance, self-rated alertness, and mood. Eleven experienced male shiftworkers (shiftwork ?5 yrs) were matched with 14 non-shiftworkers for age (mean ± SD: 35.7 ± 7.2 and 32.5 ± 6.2 yrs, respectively) and body mass index (BMI) (28.7 ± 3.8 and 26.6 ± 3.4 kg/m(2), respectively). After keeping a 7-d self-selected sleep/wake cycle (7.5/8 h nocturnal sleep), both groups entered a laboratory session consisting of a night of adaptation sleep and a baseline sleep (each 7.5/8 h), a sleep deprivation night, and recovery sleep (4-h nap plus 7.5/8 h nighttime sleep). Subjective alertness and mood were assessed with the Karolinska Sleepiness Scale (KSS) and 9-digit rating scales, and vigilance was measured by the visual psychomotor vigilance test (PVT). A mixed-model regression analysis was carried out on data collected every hour during the sleep deprivation night and on all days (except for the adaptation day), at .25, 4.25, 5.25, 11.5, 12.5, and 13.5 h after habitual wake-up time. Despite similar circadian phase (melatonin onset), demographics, food intake, body posture, and environmental light, shiftworkers felt significantly more alert, more cheerful, more elated, and calmer than non-shiftworkers throughout the laboratory study. In addition, shiftworkers showed a faster median reaction time (RT) compared to non-shiftworkers, although four other PVT parameters did not differ between the groups. As expected, both groups showed a decrease in subjective alertness and PVT performance during and following the sleep deprivation night. Subjective sleepiness and most aspects of PVT performance returned to baseline levels after a nap and recovery sleep. The mechanisms underlying the observed differences between shiftworkers and non-shiftworkers require further study, but may be related to the absence of shiftwork the week prior to and during the laboratory study as well as selection into and out of shiftwork. PMID:22621349
Wehrens, Sophie M T; Hampton, Shelagh M; Kerkhofs, Myriam; Skene, Debra J
Fibromyalgia (FM) is a complex syndrome, primarily of women, characterized by chronic pain, fatigue, and sleep disturbance. Altered function of the somatotropic axis has been documented in patients with FM, but little is known about nocturnal levels of PRL. As part of a laboratory study of sleep patterns in FM, we measured the serum concentrations of GH and PRL hourly
CAROL A. LANDIS; MARTHA J. LENTZ; JAMES ROTHERMEL; STACY C. RIFFLE; DARLA CHAPMAN; DEDRA BUCHWALD; JOAN L. F. SHAVER
Summary During sleep, in thermoneutral conditions, the noise of a passing vehicle induces a biphasic cardiac response, a transient peripheral vasoconstriction and sleep disturbances. The present study was performed to determine whether or not the physiological responses were modified in a hot environment or after daytime exposure to both heat and noise. Eight young men were exposed to a nocturnal thermoneutral
V. Bach; J. P. Libert; P. Tassi; G. Wittersheim; L. C. Johnson; J. Ehrhart
The understanding of the neuropharmacologic reciprocal interactions between the sleep and wake cycles has progressed significantly in the past decade. It was also recently appreciated that sleep disruption or deprivation can have adverse metabolic consequences. Multiple medications have a direct or indirect impact on sleep and the waking state. This article reviews how commonly prescribed medications can significantly affect the sleep-wake cycle. PMID:20488296
Roux, Francoise J; Kryger, Meir H
Video-polysomnographic monitoring of a female patient with spinocerebellar ataxia 3 (SCA-3) in whom rapid eye movement (REM) sleep behavior disorder was clinically suspected demonstrated recurrent episodes of unusual nocturnal motor restlessness occurring during non-REM sleep and severely disturbing both the patient and her bed partner's sleep. Even if nocturnal manifestations are common features of SCA-3 and increasingly recognized, such a case has never been reported before. We discuss this peculiar movement disorder as a particular manifestation of the wide spectrum of parasomnias occurring in such a rare neurodegenerative disease. PMID:15799016
Ghorayeb, Imad; Provini, Federica; Bioulac, Bernard; Tison, François
Abnormalities of sleep are extremely common in critically ill patients, but the mechanisms are poorly understood. About half of total sleep time occurs during the daytime, and circadian rhythm is markedly diminished or lost. Judgments based on inspection consistently overestimate sleep time and do not detect sleep disruption. Accordingly, reliable polygraphic recordings are needed to measure sleep quantity and quality
Sairam Parthasarathy; Martin J. Tobin
Sleep apnea syndrome (SAS), a common disorder, is characterized by repetitive episodes of cessation of breathing during sleep, resulting in hypoxemia and sleep disruption. The consequences of the abnormal breathing during sleep include daytime sleepiness, neurocognitive dysfunction, development of cardiovascular disorders, metabolic dysfunction, and impaired quality of life. There are two types of SAS: obstructive sleep apnea syndrome (OSAS) and
Katsuhisa Banno; Meir H. Kryger
Sleep apnea is the cessation of breathing during sleep. These episodes result in hypoxemia and sleep disruption; thus the consequences are both cardiorespiratory and neural. Sleep apnea syndrome is defined by a constellation of signs and symptoms, with the main presenting symptom being excessive daytime sleepiness. A diagnosis requires documentation of episodes of abnormal breathing during sleep. This disorder, once
Meir H. Kryger
Sleep-wake problems are common during childhood and adolescence. They are of diverse cause, and can contribute significantly to alterations in behavior, cognition, and learning. Obstructive sleep apnea, central hypoventilation syndrome, narcolepsy, periodic hypersomnia, delayed sleep phase syndrome, restless legs syndrome, parasomnias, and sleep disruption consequent to psychiatric disorders are some of the commonly encountered conditions. Some aspects of sleep architecture and its organization change with age and maturation. Diagnostic criteria and sleep laboratory techniques and findings for some childhood sleep disorders differ from those of adults. Most pharmacologic agents used to treat pediatric sleep disorders are off-label. PMID:23099134
Kotagal, Suresh; Chopra, Amit
Patients with spinal cord injury (SCI) commonly have sleep- disordered breathing due to obstructive sleep apnea (OSA) and/or nocturnal hypoventilation (NH) due to respiratory muscle weakness. In the general population, OSA has been linked to excess cardio...
R. G. Sitrin
The study of alcohol's effects on sleep dates back to the late 1930s. Since then, an extensive literature has described alcohol's effects on the sleep of healthy, nonalcoholic people. For example, studies found that in nonalcoholics who occasionally use alcohol, both high and low doses of alcohol initially improve sleep, although high alcohol doses can result in sleep disturbances during the second half of the nocturnal sleep period. Furthermore, people can rapidly develop tolerance to the sedative effects of alcohol. Researchers have investigated the interactive effects of alcohol with other determinants of daytime sleepiness. Such studies indicate that alcohol interacts with sleep deprivation and sleep restriction to exacerbate daytime sleepiness and alcohol-induced performance impairments. Alcohol's effects on other physiological functions during sleep have yet to be documented thoroughly and unequivocally. PMID:11584549
Roehrs, T; Roth, T
|Background: Sleep problems are a common complaint of parents of preschool children. Children with neurodevelopmental disorders have even more disrupted sleep than typically developing children. Although disrupted nighttime sleep has been reported to affect daytime behavior, the pathway from sleep disruption to sleep problems, to impairments in…
Goodlin-Jones, Beth; Tang, Karen; Liu, Jingyi; Anders, Thomas F.
We describe an obese child with severe obstructive sleep apnea syndrome in whom nocturnal frontal lobe seizures developed within a week after therapy was started with continuous positive airway pressure. The video polysomnographic study after the onset of nocturnal episodes showed 3 seizures: 2 starting from slow-wave sleep when he was sleeping with continuous positive airway pressure, and 1 from stage 2 non-rapid eye movement sleep when he was sleeping without continuous positive airway pressure. Cyclic alternating pattern analysis during the video polysomnography recorded after the onset of nocturnal seizures disclosed a high cyclic alternating pattern rate during slow-wave sleep, and the recording obtained after antiepileptic therapy began showed a low cyclic pattern analysis rate. In this child, we describe the non-rapid eye movement sleep instability induced by continuous positive airway pressure therapy might have had a role in triggering the nocturnal seizures. PMID:18079319
Miano, Silvia; Pelliccia, Andrea; Evangelisti, Melania; Pagani, Jacopo; Villa, Maria Pia
Daytime sleepiness is common in myotonic dystrophy and might be attributed to disturbed nocturnal breathing. Seventeen out of 22 patients complained of excessive daytime sleepiness, resembling "idiopathic hypersomnolence". Sleep apnoea might have contributed to daytime sleepiness in only three of 17 patients. Treatment with the central stimulant methylphenidate produced sustained benefit in seven out of 11 patients tested. Daytime sleepiness in myotonic dystrophy is usually caused by dysfunction of central sleep regulation and not by disturbed nocturnal breathing.
van der Meche, F G; Bogaard, J M; van der Sluys, J C; Schimsheimer, R J; Ververs, C C; Busch, H F
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.
Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that leads to progressive weakness of the respiratory and limb muscles. Consequently, most patients with ALS exhibit progressive hypoventilation, which worsens during sleep. The aim of this study was to evaluate the relationship between nocturnal hypoxia and cognitive dysfunction and to assess the pattern of nocturnal hypoxia in patients with ALS. Method Twenty-five patients with definite or probable ALS underwent neuropsychologic testing, nocturnal pulse oximetry, and capnography. Patients were grouped according to the presence of nocturnal hypoxia (SpO2<95% for ?10% of the night) and their clinical characteristics and cognitive function were compared. Results Compared to patients without nocturnal hypoxia, those with nocturnal hypoxia (n?=?10, 40%) had poor memory retention (p?=?0.039) and retrieval efficiency (p?=?0.045). A cluster-of-desaturation pattern was identified in 7 patients (70%) in the Hypoxia Group. Conclusions These results suggest that nocturnal hypoxia can be related to cognitive dysfunction in ALS. In addition, a considerable number of patients with ALS may be exposed to repeated episodes of deoxygenation–reoxygenation (a cluster-of-desaturation pattern) during sleep, which could be associated with the generation of reactive oxygen species. Further studies are required to define the exact causal relationships between these phenomena, the exact manifestations of nocturnal cluster-of-desaturation patterns, and the effect of clusters of desaturation on ALS progression.
Park, Su-Yeon; Lee, Kyung-Min; Park, Kyung-Seok; Kim, Sang-Yun; Nam, Hyun-woo; Lee, Kwang-Woo
This study has investigated differences in the nocturnal sleep and daytime sleepiness among patients with obstructive sleep apnoea syndrome (OSAS), upper airway resistance (UARS), sleep hypopnoea syndrome, and normal control subjects, using sleep scoring and spectral activity analysis of the electroencephalogram (EEG). Twelve nonobese males with UARS aged 30-60 yrs were recruited. These subjects were strictly matched for age and body mass index with twelve OSAS patients, 12 sleep hypopnoea syndrome patients, and 12 normal controls, all male. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) and the Multiple Sleep Latency Test (MSLT). The macrostructure of sleep was determined using international criteria and spectral analysis of the sleep EEG was obtained from a central lead. The sleep macrostructure of OSAS and UARS patients was significantly different from that of controls. These patients were also sleepier during the daytime than controls. Complaints of tiredness and daytime sleepiness, ESS and MSLT scores were similar in the different patient groups. Mild dysmorphia was present in all three patient groups. However, nocturnal sleep was significantly different among the different groups. OSAS patients had significantly more awake time during sleep than the UARS patients. The spectral activity of the total sleep time of the patient groups also differed significantly from that of controls. When the sleep spectral activity of UARS and OSAS patients were compared, OSAS patients had less slow wave sleep activity than UARS patients. UARS patients had a significantly higher absolute power in the 7-9 Hz bandwidth than OSAS patients. The absolute delta power over the different sleep cycles was also different between controls and patients, and between UARS and OSAS patients. There are clear differences in the macrostructure and spectral activity of sleep between upper airway resistance and obstructive sleep apnoea syndrome patients, demonstrated by differences in the cortical activity recorded in the central lead during sleep. Despite these nocturnal sleep differences, the tests of subjective daytime sleepiness are not significantly different. PMID:11488314
Guilleminault, C; Do Kim, Y; Chowdhuri, S; Horita, M; Ohayon, M; Kushida, C
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 and migraine.Noxious stimuli administered into muscles during slow-wave sleep (SWS) result in decreases in delta and sigma but an increase in alpha and beta EEG frequencies during sleep. Noise stimuli that disrupt SWS result in unrefreshing sleep, diffuse musculoskeletal pain, tenderness, and fatigue in normal healthy subjects. Such symptoms accompany alpha EEG sleep patterns that often occur in patients with fibromyalgia. The alpha EEG patterns include phasic and tonic alpha EEG sleep as well as periodic K alpha EEG sleep or frequent periodic cyclical alternating pattern. Moreover, alpha EEG sleep, as well as sleep-related breathing disorder and periodic limb movement disorder, occur in some patients with fibromyalgia, rheumatoid arthritis and osteoarthritis. Depression and not alpha EEG sleep are features of somatoform pain disorder. Disturbances in sleep, pain behaviour and psychological distress influence return to work in workers who have suffered a soft tissue injury, e.g. low back pain. Patients with irritable bowel disorder have disturbed sleep and have increased REM sleep. In conclusion, there is a reciprocal relationship between sleep quality and pain. The recognition of disturbed or unrefreshing sleep influences the management of painful medical disorders. PMID:12531004
Although sleep disturbances in children are common, little is known about the relationship between children's sleep disruptions and maternal sleep and daytime functioning. Forty-seven mothers completed measures of sleep, depression, parenting stress, fatigue, and sleepiness. Significant differences in maternal mood and parenting stress were found between mothers of children with and without significant sleep disturbances. Regression analyses showed that the
Lisa J. Meltzer; Jodi A. Mindell
Sleep disordered breathing (SDB) is a spectrum of nocturnal breathing events. It consists of obstructive, central, and mixed sleep apnea as well as upper airway resistance syndrome and snoring. Obstructive sleep apnea is characterized by repetitive upper airway obstructive events. The primary symptoms include excessive daytime sleepiness, snoring, and impairment of cognition. In some cases, it can be associated with
Alon Y. Avidan
Summary In 12 patients with Huntington's disease, the relationship between brain morphology, nocturnal sleep EEG, and clinical variables was studied. Global cerebral atrophy did not significantly correlate with sleep parameters, whereas atrophy of the caudate nuclei was associated with reduced slow wave sleep and increased time spent awake. Several clinical parameters (e.g., anergia and thought disturbance scores of the Brief
Michael Wiegand; Arnulf A. Möller; Wolfgang Schreiber; Christoph Lauer; Jiirgen-Christian Krieg
Respiratory failure has been described in myotonic dystrophy; it worsens during sleep but its central or peripheral origin has yet to be determined. Moreover, patients may present severely disturbed sleep and daytime somnolence. Eight patients with mild to moderate myotonic dystrophy were studied to assess breathing function while awake and during sleep by means of the pulmonary function tests, nocturnal
Fabio Cirignotta; Susanna Mondini; Marco Zucconi I; Emilia Barrot-Cortes; Carlo Sturani; Mario Schiavina; Giorgio Coccagna; Elio Lugaresi
Although sleep and exercise may seem to be mediated by completely different physiological mechanisms, there is growing evidence for clinically important relationships between these two behaviors. It is known that passive body heating facilitates the nocturnal sleep of healthy elderly people with insomnia. This finding supports the hypothesis that changes in body temperature trigger somnogenic brain areas to initiate sleep.
Greg Atkinson; Damien Davenne
A young patient with FFI was started on agomelatine 25?mg to medicate nocturnal insomnia. Under this treatment sleep efficiency was improved, slow wave sleep was high and awakenings during sleep period time were far less than before. Clinically the patient was less restless during nighttime. PMID:21979926
Froböse, T; Slawik, H; Schreiner, R; Veselý, Z; Wiegand, M; Bäuml, J; Förstl, H
The microstructure of sleep, which translates the short-lived fluctuations of the arousal level, is a commonly neglected feature in polysomnographic studies. Specifically arranged microstructural EEG events may provide important information on the dynamic characteristics of the sleep process. CAP (cyclic alternating pattern) and non-CAP are complementary modalities in which arousal-related "phasic" EEG phenomena are organized in non-REM sleep, and they correspond to opposite conditions of unstable and stable sleep depth, respectively. Thus, arousal instability can be measured by the CAP rate, the percentage ratio of total CAP time to total non-REM sleep time. The CAP rate, an age-related physiological variable that increases in several pathological conditions, is highly sensitive to acoustic perturbation. In the present study, two groups of healthy subjects without complaints about sleep, belonging to different age ranges (six young adults, three males and three females, between 20 and 30 years, and six middle-aged individuals, three males and three females, between 40 and 55 years) slept, after adaptation to the sleep laboratory, in a random sequence for two non-consecutive nights either under silent baseline (27.3 dB(A) Lcq) or noise-disturbed (continuous 55 dB(A) white noise) conditions. Age-related and noise-related effects on traditional sleep parameters and on the CAP rate were statistically evaluated by a split-plot test. Compared to young adults, the middle-aged individuals showed a significant reduction of total sleep time, stage 2 and REM sleep and significantly higher values of nocturnal awakenings and the CAP rate. The noisy nights were characterized by similar alterations. The disruptive effects of acoustic perturbation were greater on the more fragile sleep architecture of the older group. The increased fragility of sleep associated with aging probably reflects the decreased capacity of the sleeping brain to maintain steady states of vigilance. Total non-REM sleep described by traditional parameters was statistically unaffected during the disturbed nights, but the perturbing effects of noise on non-REM sleep stability and continuity were revealed by a significant increase in the CAP rate. The perspectives for a wide-ranging exploitation of this sleep parameter are discussed.
Terzano, M. G.; Parrino, L.; Spaggiari, M. C.; Buccino, G. P.; Fioriti, G.; Depoortere, H.
Faces are processed and stored in distinct neuroanatomical systems. Based on evidence of a critical role of sleep in memory processes, we investigated the impact of nocturnal sleep on implicit memories for faces in healthy men. Face repetition effects in reaction times were compared across sleep periods early in the night, which are dominated by slow wave sleep (SWS), and
Ullrich Wagner; Manfred Hallschmid; Rolf Verleger; Jan Born
Faces are processed and stored in distinct neuroanatomical systems. Based on evidence of a critical role of sleep in memory processes, we investigated the impact of nocturnal sleep on implicit memories for faces in healthy men. Face repetition effects in reaction times were compared across sleep periods early in the night, which are dominated by slow wave sleep (SWS), and
Ullrich Wagner; Manfred Hallschmid; Rolf Verleger; Jan Born
Patients affected by Parkinson's disease (PD) often complain of disturbed sleep resulting from nighttime motor disabilities such as nocturnal akinesia, tremor and rigidity, motor behaviour during REM sleep or periodic leg movements (PLM) during sleep. Sleep may also be affected by dopaminergic and anticholinergic drugs or coexisting depressive syndrome. Deep brain stimulation (DBS) of subthalamic nucleus (STN) effectively reduces PD
Alessandro Cicolin; Leonardo Lopiano; Maurizio Zibetti; Elena Torre; Alessia Tavella; Giulia Guastamacchia; Anna Terreni; George Makrydakis; Elisa Fattori; Michele Maria Lanotte; Bruno Bergamasco; Roberto Mutani
In patients with depression, characteristic changes of sleep electroencephalogram and nocturnal hormone secretion occur including rapid eye movement (REM) sleep disinhibition, reduced non-REM sleep and impaired sleep continuity. Neuropeptides are common regulators of the sleep electroencephalogram (EEG) and nocturnal hormone secretion and changes in their activity appear to contribute to the aberrances of sleep in affective disorders. A reciprocal interaction of the sleep-promoting growth hormone-releasing hormone (GHRH) and corticotrophin-releasing hormone (CRH), which promotes wakefulness and REM sleep, plays a key role in sleep regulation, at least in male subjects. Also galanin and ghrelin promote sleep in men. Neuropeptide Y is involved in the timing of sleep onset. The effects of peptides of sleep are influenced by the time of administration, age, gender and depression. In healthy subjects and in remitted depressed patients motoric memory learning is consolidated during sleep. This effect is absent in depressed patients who are at least 30 years old, and is probably related to elevated glucocorticoid levels. PMID:23599243
Steiger, A; Dresler, M; Kluge, M; Schüssler, P
The use of opioids has been associated with development of sleep-disordered breathing, including central apneas, nocturnal\\u000a oxygen desaturations, and abnormal breathing patterns. We describe sleep-disordered breathing and its subsequent treatment\\u000a in a group of obstructive sleep apneic patients on chronic opioid therapy. Clinical evaluation followed by diagnostic overnight\\u000a polysomnogram was performed in subjects on chronic opioid therapy who met the
Christian Guilleminault; Michelle Cao; Herbert J. Yue; Pawan Chawla
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
Obstructive sleep apnea (OSA) is a form of sleep disordered breathing char- acterized by episodes of apnea (during sleep) lasting at least 10 seconds per episode. The apneic periods are associated with arterial hypoxemia and disruption of normal sleep as a result of awakenings. It is increasingly being recognized that OSA is a public health hazard and there is increasing
There is evidence that sleep enhances memory and learning. Childhood is a critical period for neurodevelopment, and minor but persistent disruption of sleep may have long?term implications for cognitive performance. Sleep is critical for health and is undervalued both in our 24?h society and in paediatric clinical practice. Paediatricians need to understand the neurodevelopmental consequences of poor quality sleep in children.
Hill, Catherine M; Hogan, Alexandra M; Karmiloff-Smith, Annette
To explore the neuronal signaling mechanisms underlying sleep regulation in the rat, the present study examined continuous intra-third ventricle infusion of N-ethylmaleimide (NEM), a sulphydryl reagent that inhibits Gi\\/o protein-coupled receptor-mediated signaling pathways. The diurnal infusion of NEM (0.01–10 ?mol\\/10 h) dose-dependently inhibited both non-rapid eye movement sleep and rapid eye movement sleep. A maximal dose of NEM (10 ?mol\\/10
M. IKEDA; M. SAGARA; Y. SEKINO; T. SHIRAO; K. HONDA; T. YOSHIOKA; C. N Allen; S Inoué
Patients with COPD may show slow, progressive deteriorations in arterial blood gases during the night, particularly during rapid eye movement (REM) sleep. This is mainly due to hypoventilation, while a deterioration of ventilation/perfusion mismatch plays a minor role. The severity of gas exchanges alterations is proportional to the degree of impairment of diurnal pulmonary function tests, particularly of partial pressure of oxygen (PaO2) and of carbon dioxide (PaCO2) in arterial blood, but correlations between diurnal and nocturnal blood gas levels are rather loose. Subjects with diurnal PaO2 of 60–70 mmHg are distinguished in “desaturators” and “nondesaturators” according to nocturnal oxyhemoglobin saturation behavior. The role of nocturnal hypoxemia as a determinant of alterations in sleep structure observed in COPD is dubious. Effects of the “desaturator” condition on pulmonary hemodynamics, evolution of diurnal blood gases, and life expectancy are also controversial. Conversely, it is generally accepted that occurrence of sleep apneas in COPD is associated with a worse evolution of the disease. Nocturnal polysomnographic monitoring in COPD is usually performed when coexistence of sleep apnea (“overlap syndrome”) is suspected, while in most other cases nocturnal oximetry may be enough. Nocturnal oxygen attenuates sleep desaturations among stable patients, without increases in PaCO2 of clinical concern. Nocturnal treatment with positive pressure ventilators may give benefit to some stable hypercapnic subjects and patients with the overlap syndrome.
Marrone, Oreste; Salvaggio, Adriana; Insalaco, Giuseppe
Patients with COPD may show slow, progressive deteriorations in arterial blood gases during the night, particularly during rapid eye movement (REM) sleep. This is mainly due to hypoventilation, while a deterioration of ventilation/perfusion mismatch plays a minor role. The severity of gas exchanges alterations is proportional to the degree of impairment of diurnal pulmonary function tests, particularly of partial pressure of oxygen (PaO2) and of carbon dioxide (PaCO2) in arterial blood, but correlations between diurnal and nocturnal blood gas levels are rather loose. Subjects with diurnal PaO2 of 60-70 mmHg are distinguished in "desaturators" and "nondesaturators" according to nocturnal oxyhemoglobin saturation behavior. The role of nocturnal hypoxemia as a determinant of alterations in sleep structure observed in COPD is dubious. Effects of the "desaturator" condition on pulmonary hemodynamics, evolution of diurnal blood gases, and life expectancy are also controversial. Conversely, it is generally accepted that occurrence of sleep apneas in COPD is associated with a worse evolution of the disease. Nocturnal polysomnographic monitoring in COPD is usually performed when coexistence of sleep apnea ("overlap syndrome") is suspected, while in most other cases nocturnal oximetry may be enough. Nocturnal oxygen attenuates sleep desaturations among stable patients, without increases in PaCO2 of clinical concern. Nocturnal treatment with positive pressure ventilators may give benefit to some stable hypercapnic subjects and patients with the overlap syndrome. PMID:18044093
Marrone, Oreste; Salvaggio, Adriana; Insalaco, Giuseppe
This study was designed to provide data on sleep patterns during the first 3 years, based on a large US-Canada Internet sample, to assess the prevalence of parental interventions and related factors of infant sleep ecology and to evaluate the links between sleep ecology and sleep. Five thousand six parents completed a web-based online questionnaire about their children, aged from birth to 36 months. The questionnaire included items pertaining to sleep patterns, sleep environment, sleep-related parental interventions, sleep position, and demographic information. The results reflected clear sleep-related developmental changes including a decrease in daytime sleep and total sleep time, as well as consolidation of sleep during the night, which was manifested in a decrease in night wakings and nocturnal wakefulness. Sleep ecology and parental behaviors significantly explained a portion of the variance in the child's sleep patterns. Parental interventions that encourage independence and self-soothing were associated with extended and more consolidated sleep, especially in comparison to more active interactions that were associated with shorter and more fragmented sleep. These findings provide parents and professionals reference data for assessing sleep in young children. Furthermore, the results provide information on specific ecological factors that are associated with increased risk for sleep problems. PMID:19021850
Sadeh, Avi; Mindell, Jodi A; Luedtke, Kathryn; Wiegand, Benjamin
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
Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during\\u000a sleep. The sleep fragmentation and the accompanying hypoxemia lead to many negative consequences including cardiovascular\\u000a diseases, cognitive impairment, daytime sleepiness, fatigue, and depressive symptoms (Parish and Somers 2004; Reimer and Flemons\\u000a 2003). Originally viewed as an interesting but rare malady, OSA is now
Paul J. Mills; Michael G. Ziegler; Joel E. Dimsdale
Sleep-related painful erection is a rare syndrome recognized by reports of painful nocturnal erection, an association between REM sleep and pain, and the absence of pain during wakeful sexual activity. Approximately 30 cases have been reported in the literature. We add two more cases, each of which seemed to be associated with severe sleep apnea. Treatment of the apnea with Continuous Positive Airway Pressure device lessened the symptom in both men. Implications of this association are discussed. PMID:22350120
Ferré, Alex; Vila, Josepa; Jurado, M José; Arcalis, Nuria; Camps, Juaquim; Cambrodi, Roser; Romero, Odile
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.
This study investigates the human vulnerability caused by tornadoes that occurred between sunset and sunrise from 1880 to 2007. Nocturnal tornadoes are theorized to enhance vulnerability because they are difficult to spot and occur when the public tends to be asleep and in weak building structures. Results illustrate that the nocturnal tornado death rate over the past century has not
Walker S. Ashley; Andrew J. Krmenec; Rick Schwantes
Fatal familial insomnia (FFI) is a disease characterized by loss of sleep activity due to selective thalamic degeneration. To assess the secretory pattern of melatonin (MT) in FFI, we studied two cases of overt disease under standardized conditions and polysomnographic control. Each patient underwent repeated 24-h study sessions, and MT was assayed at 30-min intervals. Six healthy volunteers were used as controls. Slow wave sleep was never recorded, whereas occasional episodes of enacted dreaming accompanied by rapid ocular movements and complex muscular activities were documented, with no detectable rhythm. Plasma MT concentrations gradually decreased as the disease progressed. A significant circadian rhythm was detected in the earlier recordings, with decreasing amplitudes with disease progression. Complete rhythm obliteration was achieved in the most advanced stage. Normally placed nocturnal acrophases were detected in the earlier stages, but then a shift toward the daytime hours was observed. Thalamic lesions of FFI appear to determine a progressive disruption of the sleep/wake cycle accompanied by decreased circulating levels of MT, with progressive alterations in the circadian rhythm of this hormone. On the other hand, decreased secretion of MT may contribute to the sleep disturbances of FFI. PMID:8175963
Portaluppi, F; Cortelli, P; Avoni, P; Vergnani, L; Maltoni, P; Pavani, A; Sforza, E; Degli Uberti, E C; Gambetti, P; Lugaresi, E
Alterations in sleep organization were longitudinally studied in 6 new cases of fatal familial insomnia (FFI) by 24 h polygraphic recording. All patients showed an early reduction in sleep spindles and K complexes, and a drastic reduction in total sleep time and disruption of the cyclic sleep organization. Complete abolition of NREM sleep and persistence of only brief residual periods
E. Sforza; P. Montagna; P. Tinuper; P. Cortelli; P. Avoni; F. Ferrillo; R. Petersen; P. Gambetti; E. Lugaresi
Though fatigue and sleepiness at the wheel are well-known risk factors for traffic accidents, many drivers combine extended driving and sleep deprivation. Fatigue-related accidents occur mainly at night but there is no experimental data available to determine if the duration of prior driving affects driving performance at night. Participants drove in 3 nocturnal driving sessions (3–5am, 1–5am and 9pm–5am) on open highway. Fourteen young healthy men (mean age [±SD]?=?23.4 [±1.7] years) participated Inappropriate line crossings (ILC) in the last hour of driving of each session, sleep variables, self-perceived fatigue and sleepiness were measured. Compared to the short (3–5am) driving session, the incidence rate ratio of inappropriate line crossings increased by 2.6 (95% CI, 1.1 to 6.0; P<.05) for the intermediate (1–5am) driving session and by 4.0 (CI, 1.7 to 9.4; P<.001) for the long (9pm–5am) driving session. Compared to the reference session (9–10pm), the incidence rate ratio of inappropriate line crossings were 6.0 (95% CI, 2.3 to 15.5; P<.001), 15.4 (CI, 4.6 to 51.5; P<.001) and 24.3 (CI, 7.4 to 79.5; P<.001), respectively, for the three different durations of driving. Self-rated fatigue and sleepiness scores were both positively correlated to driving impairment in the intermediate and long duration sessions (P<.05) and increased significantly during the nocturnal driving sessions compared to the reference session (P<.01). At night, extended driving impairs driving performances and therefore should be limited.
Sagaspe, Patricia; Taillard, Jacques; Akerstedt, Torbjorn; Bayon, Virginie; Espie, Stephane; Chaumet, Guillaume; Bioulac, Bernard; Philip, Pierre
The aim of this study was to measure the incidence of nocturnal panic attacks in a sample of 60 referrals who met DSM-III-R criteria for panic disorders. We also examine the relationship of nocturnal panic and clinical variables and family history. Probands with or without nocturnal panic were compared in regard to the existence of anxiety, affective, personality and alcohol-dependence disorders using the SCID-P and SCID-II interviews for DSM-III-R criteria and the FISC for the family study. Severity was assessed by means of age of onset, percentage of remissions, subtype of agoraphobia and Global Phobic and Global Incapacity Scale. The percentage of panic disorder patients with nocturnal panic attacks was 40%. The existence of nocturnal panic seem to be in relation to the presence of affective disorders and to modify the severity of illness. PMID:8079671
Alfonso Suárez, S; Fernández Vega, F
Obstructive sleep apnoea syndrome (OSAS) is a sleep related breathing disorder caused by pharynx obstruction that often terminates in abrupt arousals and is capable of disrupting physiological sleep profile. Its' severity has been associated, among others, with craniofacial skeletal morphology. To investigate this relationship and elucidate craniofacial skeleton patterns in individuals without obvious maxillofacial abnormalities, 171 OSAS patients were studied with nocturnal polysomnographic record and chephalometric X-ray (24 variables). Chephalometric variables were compared between three apnoea/hypopnoea index (AHI) groups (AHI ? 15; 15 < AHI < 30; AHI ? 30) and uni/multivariate analysis between chephalometric variables and AHI were performed. The patients were predominantly men (83%), with a mean age of 48.1 years. Mean BMI and AHI were 28.4 kg/m(2) and 26.2, respectively. Most chephalometric variables differed among the three AHI groups. Fifteen chephalometric variables showed a correlation with AHI. Five chephalometric variables and BMI were independent AHI predictors. Chephalometric variables were better AHI predictors in normal weight patients. Significant evidence of craniofacial skeleton influence was found on OSAS severity, caudalization of the hyoid and lower sagittal facial projection being the most important patterns. From the chephalometric variables analysed, the hypopharynx calibre demonstrated a higher predictive value for AHI, independently of BMI. PMID:23517815
Costa E Sousa, Rui Augusto; Dos Santos Gil, Nuno Alexandre
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
Episodic nocturnal wanderings (ENWs) have rarely been associated with gross abnormalities of brain structures. We describe the case of a patient with ENWs in coexistence with an arachnoid cyst (AC). The patient was a 15-year-old boy who presented with nocturnal attacks characterized by complex motor behaviors. An MRI revealed a left temporal cyst and a SPECT Tc99 scan showed left temporal hypoperfusion and bilateral frontal hyperperfusion, more evident on the right side. During an all-night polysomnographic recording with audiovisual monitoring, dystonic posture followed by sleepwalking-like behavior was documented. The sleepwalking-like behavior was preceded by a spike discharge over the left frontocentral region with contralateral projection and secondary generalization during stage 2 sleep. Treatment with levetiracetam produced a striking remission of seizures. This supports a conservative management of an AC, considering that it may be an incidental finding. In epileptic patients, an AC may not necessarily be related to the location of the seizure focus. Citation: Jiménez-Genchi A; Díaz-Galviz JL; García-Reyna JC et al. Coexistence of epileptic nocturnal wanderings and an arachnoid cyst. J Clin Sleep Med 2007;3(4):399-401.
Jimenez-Genchi, Alejandro; Diaz-Galviz, John L.; Garcia-Reyna, Juan Carlos; Avila-Ordonez, Mario U.
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
|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.
BACKGROUND: A study was undertaken to evaluate the reliability of a digital tracheal sound analyser (ELENS-DSA) in predicting nocturnal changes in airways resistance in asthmatic patients. This device allows continuous measurement of the proportion of the time occupied by wheezing (Wh%). METHODS: Nocturnal polygraphic studies with simultaneous continuous monitoring of tracheal sounds and airways resistance were performed in seven patients with nocturnal asthma. In order to evaluate the possible bias in wheezing estimation, each tracheal sound recording was passed through the automatic analyser and simultaneously monitored with earphones by an experienced observer. RESULTS: The device detected audible wheezing with an optimal sensitivity and specificity of 70%. Snoring was a minor cause of the relatively poor characteristics of the system. A close correlation (p < 0.001) between Wh% and airways resistance was observed only in those patients with the highest increase in resistance; when the results of all the subjects were pooled the correlation observed was poor. The predictive value of Wh% in detecting changes in airways resistance during 10 minute intervals was lower than 70%. The positive and negative predictive values of Wh% were raised to 79% and 83%, respectively, for 30 minute intervals. CONCLUSIONS: The ELENS-DSA system is a relatively crude means of detecting wheezing and assessing bronchoconstriction quantitatively. However, it is able to detect accurately nocturnal bronchoconstriction for 30 minute intervals. This finding, along with the fact that the monitoring is non-invasive, suggests that it may be a promising tool, especially for patients during sleep.
Lenclud, C.; Cuttitta, G.; Van Gansbeke, D.; Visconti, A.; Van Muylem, A.; Bellia, V.; Yernault, J. C.
Sleep has repeatedly been connected to processes of memory consolidation. While extensive research indeed documents beneficial effects of sleep on memory, little is yet known about the role of sleep for interference effects in episodic memory. Although two prior studies reported sleep to reduce retroactive interference, no sleep effect has previously been found for proactive interference. Here we applied a study format differing from that employed by the prior studies to induce a high degree of proactive interference, and asked participants to encode a single list or two interfering lists of paired associates via pure study cycles. Testing occurred after 12 hours of diurnal wakefulness or nocturnal sleep. Consistent with the prior work, we found sleep in comparison to wake did not affect memory for the single list, but reduced retroactive interference. In addition we found sleep reduced proactive interference, and reduced retroactive and proactive interference to the same extent. The finding is consistent with the view that arising benefits of sleep are caused by the reactivation of memory contents during sleep, which has been suggested to strengthen and stabilise memories. Such stabilisation may make memories less susceptible to competition from interfering memories at test and thus reduce interference effects. PMID:23556992
Abel, Magdalena; Bäuml, Karl-Heinz T
Sleep Disordered Breathing describes a group of disorders characterized by abnormalities of respiratory pattern or the quantity of ventilation during sleep. Sleep Disordered Breathing causes disruptions in sleep, yielding waking somnolence, diminished neurocognitive performance, adverse cardiovascular outcomes, insulin resistance and other metabolic dysfunctions. Electroencephalography and Electromyography signal analysis enables neurologists and sleep specialists to diagnose and monitor Sleep Disordered Breathing
M. R. Azim; S. A. Haque; M. S. Amin; T. Latif
Sleep apnea syndrome (SAS) is one of the most common breathing related sleep disorders. Sleep apnea (SA) may be of particular concern in chronic heart failure patients due to its high levels of cardiovascular morbidity and mortality. Our aim was to assess the diagnostic potential of SA using spectral analysis of nocturnal heart rate, and to introduce new simple time
Abed Elhamid Lawabni; Ahmed H. Tewfik
Objectives: caregivers of patients with various diseases frequently report sleep disturbances and depressive symptoms. Care intensity for individuals with Parkinson's disease is mainly influenced by the severity of their motor impairment. The latter is associated with sleep fragmentation, nocturnal pain and cramps. These disease-specific characteristics contribute to sleep-related problems in patients. However, little is known about prevalence and causes of
SVENJA HAPPE; K LAUS BERGER
The effect of altered sleep-wake schedules on the rapid eye movement (Stage REM) cycle in sleep was studied in 25 human adults. The sleep time between stage REM onsets during the altered schedules did not differ significantly from that in normal nocturnal...
J. Moses A. Lubin L. C. Johnson P. Naitoh
Sleep apnoea, both central and obstructive disordered breathing, commonly occurs in patients with heart failure. Obstructive sleep apnoea occurs both in systolic and diastolic heart failure and is best treated with nasal positive airway pressure devices. Central sleep apnoea occurs primarily in systolic heart failure and therapeutic options are evolving. Optimal therapy of systolic heart failure, nocturnal use of supplemental
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
Background. While the prevalence of obstructive sleep apnoea syndrome among children with Down syndrome is reported to vary from 30 to 50%, the nocturnal respiratory pat- terns of adults with Down syndrome is not well known. Objectives. The aim of this study is to eval- uate sleep-related breathing disorders in a sample of adults with Down syndrome. Methods. We studied
Onofrio Resta; Maria Pia Foschino Barbaro; Tiziana Giliberti; Gennaro Caratozzolo; Maria Grazia Cagnazzo; Franco Scarpelli; Maria Cristina
Exogenous melatonin reportedly induces drowsiness and sleep, and may ameliorate sleep disturbances, including the nocturnal awakenings associated with old age. However, existing studies on the soporific efficacy of melatonin have been highly heterogeneous in regard to inclusion and exclusion criteria, measures to evaluate insomnia, doses of the medication, and routes of administration. We reviewed and analyzed (by meta-analysis) available information
Amnon Brzezinski; Mark G. Vangel; Richard J. Wurtman; Gillian Norrie; Irina Zhdanova; Abraham Ben-Shushan; Ian Ford
Previous studies showing a relationship between nocturnal slow-wave sleep (SWS) and subsequent diurnal performance among young normal sleepers and older insomnia sufferers have provided limited support for the notion that this sleep stage serves a restorative role for neurocognitive functioning. The current study, which examined the relationship between SWS and reaction time performance among middle-aged adults with and without insomnia
Jack D Edinger; D. Michael Glenn; Lori A Bastian; Gail R Marsh
|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
Obstructive sleep apnea is characterized by repetitive nocturnal upper airway obstructions that are associated with sleep disruption and cyclic intermittent hypoxia (CIH) The cyclic oscillations in O2 saturation are thought to contribute to cardiovascular and other morbidity, but animal and patient studies of the pathogenic link between CIH and these diseases have been complicated by species differences and by the effects of confounding factors such as obesity, hypertension, and impaired glucose metabolism. To minimize these limitations, we set up a model of nocturnal CIH in healthy humans. We delivered O2 for 15 s every 2 min during sleep while subjects breathed 13% O2 in a hypoxic tent to create 30 cycles/h of cyclic desaturation-reoxygenation [saturation of peripheral O2 (SpO2) range: 95–85%]. We exposed subjects overnight for 8–9 h/day for 2 wk (10 subjects) and 4 wk (8 subjects). CIH exposure induced respiratory disturbances (central apnea hypopnea index: 3.0 ± 1.9 to 31.1 ± 9.6 events/h of sleep at 2 wk). Exposure to CIH for 14 days induced an increase in slopes of hypoxic and hypercapnic ventilatory responses (1.5 ± 0.6 to 3.1 ± 1.2 l·min?1·% drop in SpO2 and 2.2 ± 1.0 to 3.3 ± 0.9 l·min?1·mmHg CO2?1, respectively), consistent with hypoxic acclimatization. Waking normoxic arterial pressure increased significantly at 2 wk at systolic (114 ± 2 to 122 ± 2 mmHg) and for diastolic at 4 wk (71 ± 1.3 to 74 ± 1.7 mmHg). We propose this model as a new technique to study the cardiovascular and metabolic consequences of CIH in human volunteers.
Tamisier, R.; Gilmartin, G. S.; Launois, S. H.; Pepin, J. L.; Nespoulet, H.; Thomas, R.; Levy, P.; Weiss, J. W.
Seven cases of sexual behavior during sleep (SBS) have been recently reported. The subjects had histories of behavioral parasomnias as well as positive family histories of parasomnia. A 27 year-old man with a history of sexual behavior during sleep was reported. His sleep history disclosed sleepwalking (SW) since 9 years of age. He also developed episodes of highly disruptive and violent nocturnal behavior with dream enactment at age 20 years, which often resulted in physical injuries either to himself or his wife and infant. His wife also reported episodes of amnestic sexual behavior that began 4 years before referral. During the episodes, the patient typically procured his wife, achieving complete sexual intercourse with total amnesia. Physical and neurological diagnostic workups were unremarkable. Family history disclosed sleepwalking in his brother. He was put on 2mg/day of bedtime clonazepam with a remarkable clinical improvement. This case involves either the combination of violent and non-violent sleepwalking with SBS, or the superimposition of presumed REM sleep behavior disorder (RBD) on top of preexisting SW in a man who also developed SBS in adulthood. Thus, this is a case report of probable parasomnia overlap syndrome. PMID:11382885
Alves, R; Alóe, F; Tavares, S; Vidrio, S; Yáñez, L; Aguilar-Roblero, R; Rosenthal, L; Villalobos, L; Fernández-Cancino, F; Drucker-Colín, R; Chagoya De Sanchez, V
Complaints about sleep disorders and excessive daytime sleepiness are common among patients with multiple system atrophy. The diffuse neurodegenerative process that encompasses the key structures involved in the regulation of the sleep/wake transition and respiratory function may account for these complaints and for the most frequent polysomnographic findings in MSA, i.e., sleep-related breathing disturbances and REM sleep behaviour disorder, which are both treatable conditions. Nocturnal stridor is an inspiratory sound produced by complex vocal cord muscle dysfunction. Often occurring with sleep apnoea, stridor is associated with decreased survival. REM sleep behaviour disorder, a parasomnia characterized by loss of normal skeletal muscle atonia during REM sleep with prominent motor activity, is detected in almost all patients. The pathophysiology of both disorders is partially elucidated but increasing evidence points to the role of basal ganglia dysfunction. PMID:16082509
Ghorayeb, I; Bioulac, B; Tison, F
J. NeumannIsrael Meteorological ServiceAfter extension of the definition of land breeze and introductory discussion of the problem of nocturnal thunderstorms, tables are presented for Lydda Airport, Israel, showing the diurnal variation of thunderstorms and the associated surface wind-directions. There is a notable excess of nocturnal thunderstorms with wind directions in the quadrant from which the land breeze blows.The fundamental fact
The aim of this pilot study was to investigate the effects of 2 years’ nocturnal treatment with a mandibular advancement splint in adult patients with snoring and obstructive sleep apnea syndrome with respect to possible development of a forward position of the mandible or other dentofacial changes. Thirty snoring and sleep apnea patients, mean age 55.3 years (SD, 8.61; range,
This article describes three cases of ;ogun oru' (nocturnal warefare), a condition reported in southwest Nigeria involving an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming. Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer's earthly spouse and a ;spiritual' spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements. Ogun oru may be a label applied to medical problems. The differential diagnosis includes mainly parasomnias, for example, sleep terror, sleepwalking and sleep paralysis and, to a lesser extent, nocturnal or sleep epilepsy. PMID:17379609
Aina, O F; Famuyiwa, O O
The management of sleep disturbances in patients with dementia is a complicated and enormously important clinical and societal\\u000a problem. In this review, we present one approach to the diagnosis and management of such sleep disturbances. Most disturbances\\u000a can be categorized into four primary symptoms: insomnia, hypersomnia, excessive nocturnal motor activity, and hallucinations\\u000a or behavioral problems. We describe how each symptom
Bradley F. Boeve; Michael H. Silber; Tanis J. Ferman
Sleep is undoubtedly disturbed during pregnancy. The disturbances include an increase in nocturnal awakenings and greater\\u000a periods of time spent awake during the night, as well as complaints of fatigue during the day. Although nausea (i.e., morning\\u000a sickness) is most commonly expected in the first trimester, an increase in fatigue, which is often a consequence of disturbed\\u000a sleep, is actually
Michele L. Okun; Mary E. Coussons-Read
The technologies of genomics and proteomics are powerful tools for discovering novel gene and protein expression responses to disease. Considerable evidence indicates that a genetic basis exists to the causes of sleep-disordered breathing, in particular its most common form of obstructive sleep apnea (OSA), which is character- ized by periods of intermittent hypoxia and disrupted sleep. How- ever, the genetic
Vsevolod Y. Polotsky; Christopher P. O'Donnell
This paper focuses on infant sleep behaviour that is of concern to mothers of young infants, and disruptive to families. It reports on the incidence of sleep problems in dyads that self?referred to a specialist clinic, and the relationship between the mother's sensitive responsiveness and infant sleep patterns in a sample of 65 Australian infants. It briefly considers an intervention
Lynn E. Priddis
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
|This paper focuses on infant sleep behaviour that is of concern to mothers of young infants, and disruptive to families. It reports on the incidence of sleep problems in dyads that self-referred to a specialist clinic, and the relationship between the mother's sensitive responsiveness and infant sleep patterns in a sample of 65 Australian…
Priddis, Lynn E.
Study Objectives: Examine associations of vasomotor and mood symptoms with visually scored and computer-generated measures of EEG sleep. Design: Cross-sectional analysis. Setting: Community-based in-home polysomnography (PSG). Participants: 343 African American, Caucasian, and Chinese women; ages 48–58 years; pre-, peri- or post-menopausal; participating in the Study of Women's Health Across the Nation Sleep Study (SWAN Sleep Study). Interventions: None. Measurements and Results: Measures included PSG-assessed sleep duration, continuity, and architecture, delta sleep ratio (DSR) computed from automated counts of delta wave activity, daily diary-assessed vasomotor symptoms (VMS), questionnaires to collect mood (depression, anxiety) symptoms, medication, and lifestyle information, and menopausal status using bleeding criteria. Sleep outcomes were modeled using linear regression. Nocturnal VMS were associated with longer sleep time. Higher anxiety symptom scores were associated with longer sleep latency and lower sleep efficiency, but only in women reporting nocturnal VMS. Contrary to expectations, VMS and mood symptoms were unrelated to either DSR or REM latency. Conclusions: Vasomotor symptoms moderated associations of anxiety with EEG sleep measures of sleep latency and sleep efficiency and was associated with longer sleep duration in this multi-ethnic sample of midlife women. Citation: Kravitz HM; Avery E; Sowers MF; Bromberger JT; Owens JF; Matthews KA; Hall M; Zheng H; Gold EB; Buysse DJ. Relationships between menopausal and mood symptoms and Eeg sleep measures in a multi-ethnic sample of middle-aged women: the SWAN Sleep Study. SLEEP 2011;34(9):1221-1232.
Kravitz, Howard M.; Avery, Elizabeth; Sowers, MaryFran; Bromberger, Joyce T.; Owens, Jane F.; Matthews, Karen A.; Hall, Martica; Zheng, Huiyong; Gold, Ellen B.; Buysse, Daniel J.
Asthmatic patients from our outpatient pulmonary clinic were asked to fill out a questionnaire about their sleep and daytime fitness. Seventy-eight responded. Sixty-five healthy persons served as a control group. Patients reported decreased sleep quality, decreased daytime mental fitness, and increased daytime somnolence. There was no relation between these features and lung function, bronchial hyperreactivity, or nocturnal asthma. We conclude that these asthmatic patients reported more sleep disturbances and daytime somnolence than healthy control persons. PMID:7844092
van Keimpema, A R; Ariaansz, M; Nauta, J J; Postmus, P E
Sleep deprivation has become a common phenomenon of the Western world and is associated with a variety of medical problems in children. This retrospective longitudinal analysis of a community-based birth cohort was undertaken to determine whether frequent nocturnal awakening during early life was associated with the development of childhood asthma. 2,398 children born to mothers recruited from the antenatal clinics of a single hospital in Perth, Australia during 1989-1991 were followed up at years 1, 2, 3, 6, 8, 10 and 14. Parent-completed questionnaires were analysed. The odds ratio for asthma at age 6 and 14 yrs in children with frequent nocturnal awakening during the first 3 yrs after birth was determined from multiple logistic regression. Following adjustment for asthma risk factors, co-sleeping and family stress, persistent nocturnal awakening was associated with nonatopic asthma at age 6 and 14 yrs (at age 14 yrs: OR 2.18, 95% CI 1.15-4.13) but not with atopic asthma. We found an increased risk of nonatopic asthma in children following frequent nocturnal awakening during the first 3 yrs of life. These hypothesis-generating data suggest the need for further systematic study of the effects of disordered sleep in early life on the development of asthma. PMID:19948910
Kozyrskyj, A L; Kendall, G E; Zubrick, S R; Newnham, J P; Sly, P 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.
Barclay, Johanna L.; Husse, Jana; Bode, Brid; Naujokat, Nadine; Meyer-Kovac, Judit; Schmid, Sebastian M.; Lehnert, Hendrik; Oster, Henrik
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
This study assessed the relationship between hematocrit levels and severity of obstructive sleep apnea (OSA) and examined how this relationship was affected by the degree of hypoxia as well as by possible confounding factors. Two-hundred sixty three subjects (189 men and 74 women) underwent nocturnal polysomnography with oximetry and had measurements of hematocrit, hemoglobin, white blood cell count, body mass
Jong Bae Choi; José S. Loredo; Daniel Norman; Paul J. Mills; Sonia Ancoli-Israel; Michael G. Ziegler; Joel E. Dimsdale
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
This study described and compared the sleep experience of medical and surgical patients during a hospital stay. During 3 consecutive nights, patients (n = 110) self-reported sleep quality using the Verran and Snyder Sleep Scale (VSH) and potentially disruptive factors using items from the Factors Influencing Sleep Questionnaire (FISQ). Surgical patients, on the first night, received more procedural care (p
Joan E. Tranmer; Janice Minard; Lee Ann Fox; L. Rebelo
Purpose Awakening from sleep to urinate is the hallmark of nocturia, a condition that impacts several facets of health related quality of life and for which current therapy is suboptimal. Given the paucity of prospective data on antimuscarinics for the management of nocturia, we investigated the efficacy and safety of flexible dose fesoterodine for the treatment of nocturnal urgency in subjects with nocturia and overactive bladder. Materials and Methods Subjects with 2 to 8 nocturnal urgency episodes per 24 hours began a 2-week, single-blind, placebo run-in followed by 1:1 randomization to 12 weeks of double-blind treatment with fesoterodine (4 mg daily for 4 weeks with an optional increase to 8 mg) or placebo using predefined criteria for nocturnal urgency episodes, nocturnal urine volume voided and total 24-hour urine volume voided. The primary end point was change from baseline to week 12 in the mean number of micturition related nocturnal urgency episodes per 24 hours. Results Overall 963 subjects were randomized from 2,990 screened, and 82% of subjects treated with fesoterodine and 84% of those treated with placebo completed the study. Significant improvements in the primary end point (?1.28 vs ?1.07), in nocturnal micturitions per 24 hours (?1.02 vs ?0.85) and in nocturnal frequency urgency sum (?4.01 vs ?3.42) were observed with fesoterodine vs placebo (all p ?0.01). Health related quality of life measures (overactive bladder questionnaire Symptom Bother ?20.1 vs ?16.5, sleep 22.3 vs 19.9 and other domains; all p <0.05) were improved with fesoterodine. Conclusions To our knowledge this is the first prospective study to assess antimuscarinic efficacy for reducing nocturnal urgency. Flexible dose fesoterodine significantly reduced nocturnal urgency episodes vs placebo in subjects with overactive bladder.
Weiss, Jeffrey P.; Jumadilova, Zhanna; Johnson, Theodore M.; FitzGerald, Mary P.; Carlsson, Martin; Martire, Diane L.; Malhotra, Atul
|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.
Thermoregulatory processes have long been implicated in initiation of human sleep. A meta-analysis of studies carried out under the controlled conditions of a constant routine protocol followed by nocturnal sleep revealed that heat loss, indirectly measured by the distal-proximal skin temperature gradient, was the best predictor variable for sleep onset latency (compared with core body temperature or its rate of change, heart rate, melatonin onset, and subjective sleepiness ratings). The cognitive signal of "lights out" induced relaxation, with a consequent shift in heat redistribution from the core to the periphery (as measured by an abrupt increase in skin temperatures and a rapid fall in heart rate). These thermoregulatory changes took place before sleep onset: sleep itself had minor further effects. Thus, when the confounding, long-lasting masking effects of lying down are controlled for, circadian thermoregulation initiates sleep, but does not appear to play a major role in its maintenance. PMID:11682282
Kräuchi, K; Wirz-Justice, A
Activation of 5-HT1A receptors in the medullary raphé decreases sympathetically mediated brown adipose tissue (BAT) thermogenesis and peripheral vasoconstriction when previously activated with leptin, LPS, prostaglandins, or cooling. It is not known whether shivering is also modulated by medullary raphé 5-HT1A receptors. We previously showed in conscious piglets that activation of 5-HT1A receptors with (+/-)-8-hydroxy-2-(dipropylamino)-tetralin (8-OH-DPAT) in the paragigantocellularis lateralis (PGCL), a medullary region lateral to the raphé that contains substantial numbers of 5-HT neurons, eliminates rapid eye movement (REM) sleep and decreases shivering in a cold environment, but does not attenuate peripheral vasoconstriction. Hoffman JM, Brown JW, Sirlin EA, Benoit AM, Gill WH, Harris MB, Darnall RA. Am J Physiol Regul Integr Comp Physiol 293: R518-R527, 2007. We hypothesized that, during cooling, activation of 5-HT1A receptors in the medullary raphé would also eliminate REM sleep and, in contrast to activation of 5-HT1A receptors in the PGCL, would attenuate both shivering and peripheral vasoconstriction. In a continuously cool environment, dialysis of 8-OH-DPAT into the medullary raphé resulted in alternating brief periods of non-REM sleep and wakefulness and eliminated REM sleep, as observed when 8-OH-DPAT is dialyzed into the PGCL. Moreover, both shivering and peripheral vasoconstriction were significantly attenuated after 8-OH-DPAT dialysis into the medullary raphé. The effects of 8-OH-DPAT were prevented after dialysis of the selective 5-HT1A receptor antagonist WAY-100635. We conclude that, during cooling, exogenous activation of 5-HT1A receptors in the medullary raphé decreases both shivering and peripheral vasoconstriction. Our data are consistent with the hypothesis that neurons expressing 5-HT1A receptors in the medullary raphé facilitate spinal motor circuits involved in shivering, as well as sympathetic stimulation of other thermoregulatory effector mechanisms. PMID:18094064
Brown, J W; Sirlin, E A; Benoit, A M; Hoffman, J M; Darnall, R A
This review summarizes the brain mechanisms controlling sleep and wakefulness. Wakefulness promoting systems cause low-voltage, fast activity in the electroencephalogram (EEG). Multiple interacting neurotransmitter systems in the brain stem, hypothalamus, and basal forebrain converge onto common effector systems in the thalamus and cortex. Sleep results from the inhibition of wake-promoting systems by homeostatic sleep factors such as adenosine and nitric oxide and GABAergic neurons in the preoptic area of the hypothalamus, resulting in large-amplitude, slow EEG oscillations. Local, activity-dependent factors modulate the amplitude and frequency of cortical slow oscillations. Non-rapid-eye-movement (NREM) sleep results in conservation of brain energy and facilitates memory consolidation through the modulation of synaptic weights. Rapid-eye-movement (REM) sleep results from the interaction of brain stem cholinergic, aminergic, and GABAergic neurons which control the activity of glutamatergic reticular formation neurons leading to REM sleep phenomena such as muscle atonia, REMs, dreaming, and cortical activation. Strong activation of limbic regions during REM sleep suggests a role in regulation of emotion. Genetic studies suggest that brain mechanisms controlling waking and NREM sleep are strongly conserved throughout evolution, underscoring their enormous importance for brain function. Sleep disruption interferes with the normal restorative functions of NREM and REM sleep, resulting in disruptions of breathing and cardiovascular function, changes in emotional reactivity, and cognitive impairments in attention, memory, and decision making. PMID:22811426
Brown, Ritchie E; Basheer, Radhika; McKenna, James T; Strecker, Robert E; McCarley, Robert W
This analysis is on the hypothesis that nocturnal traffic noise affects sleep quality whereas performance decrement is avoided by increased effort expressed by a decrease in blink rates (BRs) during a visual task. Twenty-four persons (12 women, 12 men; 19-28 years, 23.56+/-2.49 years) slept during three consecutive weeks in the laboratory while exposed to road, rail, or aircraft noise with weekly permuted changes. Each week consisted of a random sequence of a quiet night (32 dBA) and three nights with equivalent noise levels of 39, 44 and 50 dBA respectively. The polysomnogram was recorded during all nights. Every morning the participants rated their sleep quality and then completed two executive tasks (Go/Nogo-, Switch-task). Neither of the two performance tests was affected by nocturnal noise. Sleep efficiency and subjective sleep quality decreased with increasing noise levels but were not associated with the type of noise. In contrast, BRs were associated with the type of noise, not with noise levels. The results do not support the hypothesis concerning the BR. The possible reasons are discussed. However, the results do not exclude that other physiological parameters such as heart rate or brain potentials measured during the tests might have revealed alterations associated with nocturnal noise exposure. PMID:19805931
Breimhorst, Markus; Marks, Anke; Robens, Sibylle; Griefahn, Barbara
Objectives The objective of the study was to find the prevalence of sleep-related disturbances in patients of Eisenmenger syndrome. Design Prospective observational study. Setting Tertiary care referral centre in North India. Participants The study included 25 patients with Eisenmenger syndrome (mean age 25.2±9.6?years, 18 men) and 12 patients with cyanotic congenital heart disease with pulmonary stenosis physiology (mean age 20.5±8.5?years, 8 men) as controls. Interventions All the patients underwent an overnight comprehensive polysomnogram study and pulmonary function testing. Main outcome measure Oxygen desaturation index, which is the number of oxygen drops per hour. Results The patients and controls had significant nocturnal hypoxaemia in the absence of apnoea and hypopnoea. The mean oxygen drop index in Eisenmenger syndrome group was 9.0±6.2 and in the control group was 8.0±5.9 (p=0.63). The apnoea–hypopnoea index was 3.37±5.0 in the Eisenmenger syndrome group and was 2.1±3.6 in the control group. Patients with >10 oxygen drops per hour had significantly higher haemoglobin (17.2±1.3% vs 14.4±1.5%, p<0.001) than those with oxygen drops less than 10. Conclusions Eisenmenger syndrome patients have significant nocturnal hypoxaemia unrelated to hypopnoea and apnoea. Nocturnal desaturation occurred more frequently in patients with greater haemoglobin values.
Ramakrishnan, Sivasubramanian; Juneja, Rajnish; Bardolei, Neil; Sharma, Ajay; Shukla, Garima; Bhatia, Manvir; Kalaivani, Mani; Kothari, Shyam S; Saxena, Anita; Bahl, Vinay K; Guleria, Randeep
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
Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a recently identified seizure disorder. The disease maps to the long arm of chromosome 20 and may be related in some families to a missense mutation in the neuronal nicotinic acetylcholine receptor alpha 4 subunit. We describe one of the first European family with ADNFLE, including five affected individuals spanning four generations. In the most severely affected subject, the onset was during the second month of life and persisted through adult life. Seizures were very frequent during infancy, although long-term evolution was relatively benign. Ictal video-EEG studies showed that attacks occurred in clusters during sleep and were partial seizures that were consistent with a frontal origin. Neuro-imaging was normal. Carbamazepine had a dramatic effectiveness. Although recognition of this syndrome is important for appropriate therapy and genetic counselling, underestimation of cases is likely: the disease was in our family perceived like a hereditary curse, and subsequently concealed, including to medical attention. Relationships with other partial familial epilepsies and with idiopathic benign partial epilepsies of childhood are discussed. PMID:9773047
Thomas, P; Picard, F; Hirsch, E; Chatel, M; Marescaux, C
Sleep symptoms in Parkinson's disease (PD) are frequent and have multifactorial and multilayered causes. Primary involvement of sleep/wake regulating centers in the brainstem, sleep problems caused by the nocturnal manifestation of motor and dysautonomic signs and medication-induced sleep problems are often impossible to disentangle in the individual patient. Two syndromes, hypersomnia and REM sleep behavior disorder (RBD), are increasingly recognized as harbingers of the core PD motor syndrome. RBD, associated with a panoply of other nonmotor symptoms, may predispose to a specific PD phenotype. Long-acting dopaminergic stimulation, when abating nocturnal akinesia, also improves subjective sleep quantity. While this strategy is backed up by several randomized controlled trials (RCT), other treatment recommendations are mostly based on case series or expert opinion. Thus we identified only two other RCT, one treating insomnia with eszopiclone, the other nocturnal behavioral abnormalities in demented PD patients with memantine. While the causal complexity of sleep problems in PD certainly hampers the design of therapeutic studies, multiple general treatment strategies against sleep disorders can however be applied efficiently in PD patients as well. PMID:22118862
Diederich, Nico J; McIntyre, Deborah J
Study Objectives: To identify the extent of sleep disruption in children with various severities of sleep disordered breathing (SDB) using both conventional visually scored assessment of sleep stages and arousal indices together with EEG power spectral analysis. Design: Sleep stages and power spectral analysis of the sleep EEG in children with varying severities of SDB with matched control subjects with no history of snoring were compared across the whole night, across sequential hours from sleep onset, and across sleep stages. Measurements: Overnight polysomnography was performed on 90 children (49M/41F) aged 7-12 y with SDB and 30 age-matched healthy controls (13M/17F). Sleep stages were visually scored and the EEG spectra were analyzed in 5-s epochs. Results: Conventional visual scoring indicated that, although sleep duration was reduced in severely affected children, sleep quality during the essential stages of SWS and REM was preserved, as evidenced by the lack of any significant decrease in their duration in SDB severity groups. This finding was supported by the lack of substantial differences in EEG spectral power between the groups over the whole night, within specific hours, and in individual sleep stages. Conclusions: Both conventional scoring and EEG spectral analysis indicated only minor disruptions to sleep quality in children with SDB when assessed across the night, in any specific hour of the night, or in any specific sleep stage. These results suggest that reduced daytime functioning previously reported in children with SDB may not be due to sleep disruption. We speculate that in children, in contrast to adults, a stronger sleep drive may preserve sleep quality even in severe SDB. Citation: Yang JSC; Nicholas CL; Nixon GM; Davey MJ; Anderson V; Walker AM; Trinder JA; Horne RSC. Determining sleep quality in children with sleep disordered breathing: EEG spectral analysis compared with conventional polysomnography. SLEEP 2010;33(9):1165-1172.
Yang, Joel S.C.; Nicholas, Christian L.; Nixon, Gillian M.; Davey, Margot J.; Anderson, Vicki; Walker, Adrian M.; Trinder, John A.; Horne, Rosemary S.C.
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.
Baroreflex control of heart rate during sleep (baroreflex sensitivity; BRS) has been shown to be depressed in obstructive sleep apnoea (OSA), and improved after treatment with continuous positive airway pressure (CPAP). Whether CPAP also acutely affects BRS during sleep in uncomplicated severe OSA is still debatable. Blood pressure was monitored during nocturnal polysomnography in 18 patients at baseline and during first-time CPAP application. Spontaneous BRS was analysed by the sequence method, and estimated as the mean sequence slope. CPAP did not acutely affect mean blood pressure or heart rate but decreased cardiovascular variability during sleep. Mean BRS increased slightly during CPAP application (from 6.5+/-2.4 to 7.5+/-2.9 ms x mmHg(-1)), mostly in response to decreasing blood pressure. The change in BRS did not correlate with changes in arterial oxygen saturation or apnoea/hypopnoea index. The small change in baroreflex control of heart rate during sleep at first application of continuous positive airway pressure in severe obstructive sleep apnoea was unrelated to the acute resolution of nocturnal hypoxaemia, and might reflect autonomic adjustments to positive intrathoracic pressure, and/or improved sleep architecture. The small increase in baroreflex control of heart rate during sleep may be of clinical relevance as it was accompanied by reduced cardiovascular variability, which is acknowledged as an independent cardiovascular risk factor. PMID:16387945
Bonsignore, M R; Parati, G; Insalaco, G; Castiglioni, P; Marrone, O; Romano, S; Salvaggio, A; Mancia, G; Bonsignore, G; Di Rienzo, M
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. PMID:21875679
McCoy, John G; Strecker, Robert E
Obstructive sleep apnea (OSA)is the most common form of sleep-disordered breathing, affecting 5-15% of the population. It is characterized by intermittent episodes of partial or complete obstruction of the upper airway during sleep that disrupts normal ventilation and sleep architecture, and is typically associated with excessive daytime sleepiness, snoring, and wit - nessed apneas. Patients with obstructive sleep apnea present
Mosharraf Hossain; Mostofa Midhat Pasha; A. K. M. Mosharraf-Hossain
Diagnosis of sleep-disordered breathing (SDB) is most accurately obtained with a nocturnal polysomnogram. However, limitations on availability make alternative screening tools necessary. Nocturnal oximetry studies or nap polysomnography can be useful if positive; however, further testing is necessary to if these tests are negative. History and physical examination have insufficient sensitivity and specificity for diagnosingpediatric SDB. Adenotonsillectomy remains first-line therapy for pediatric SDB and obstructive sleep apnea (OSA). Additional study of limited therapies for mild OSA are necessary to determine if these are reasonable primary methods of treatment or if they should be reserved for children with persistent OSA. PMID:22980685
Ishman, Stacey L
The beneficial effects of nocturnal oxygen therapy (NOT) in chronic obstructive pulmonary disease (COPD) patients with mild-to-moderate daytime hypoxaemia (arterial oxygen tension (Pa,O2) in the range 7.4-9.2 kPa (56-69 mmHg)) and exhibiting sleep-related oxygen desaturation remains controversial. The effec- tiveness of NOT in that category of COPD patients was studied. The end points included pulmonary haemodynamic effects after 2 yrs
A. Chaouat; E. Weitzenblum; R. Kessler; C. Charpentier; M. Ehrhart; R. Schott; P. Levi-Valensi; J. Zielinski; L. delaunois; R. Cornudella; J. Moutinho dos Santos
Beware not to confuse talk about children with children's talk: this should be the golden rule for childhood professionals. Agitation and somatization disrupt the functioning of what is called the functional spheres. The child eats poorly, sleeps poorly, and has problems controlling his sphincters. He presents symptoms that the growing importance of education in today's modern world can no longer neglect. The diversity of the circumstances in which the child is recognized as "disruptive" shows just how much the borders between children and adults are permeable. The disruptive child is also a child disturbed by the adult world in which he is evolving. The author supports his hypotheses with several examples from his practice as a psychoanalyst. PMID:19419849
The Rechtschaffen and Kales system for scoring sleep states distinguishes a waking state, nonrapid eye movement (NREM) sleep,\\u000a and rapid eye movement (REM) sleep. From the polysomnographic point of view, four stages are conventionally distinguished\\u000a during NREM sleep. The young adult spends 20–28 of a night’s sleep in REM sleep, 4–5 in stage 1, 46–50 in stage 2, 6–8 in
Jaime M. Monti; Daniel Monti
Time patterns in nocturnal concentrations of circulating melatonin of children are quantified in 8 girls and 8 boys, 8.7-16.8 yr of age, classified by Tanner pubertal stage. Between 1900 and 0700 h, each provided blood samples at 30-min intervals for melatonin RIA. As- sociations with gender, body mass index, and chronological and pu- bertal age determined by multiple linear regression
R. SALTI; F. GALLUZZI; G. BINDI; F. PERFETTO; R. TARQUINI; F. HALBERG; G. CORNELISSEN
Paroxysmal nocturnal haemoglobinuria (PNH) was diagnosed in 11 patients attending the haematology clinic of a private community hospital in Hyderabad, India over a 3-year period. Compared to PNH occurring in Caucasians, the patients were younger, and showed a marked male preponderance; severe thrombocytopenia, haemorrhagic complications from thrombocytopenia and infectious complications were not seen. Thrombotic complications were common. Fever during periods of haemoglobinuria was a notable feature in 4 patients. None of the patients had the aplastic anaemia PNH syndrome. PMID:1466194
Koduri, P R; Gowrishankar, S
Laboratory tests reveal a preference for illuminances in a broad range of night light by individuals belonging to four species\\u000a of nocturnal primates (Aotus trivirgatus, Galago crassicaudatus, Galago senegalensis, andNycticebus coucang). In volitional tests the animals altered the light level very frequently, in one case as often as every 7 sec. In these\\u000a tests the animals tended to avoid total
J. Lee Kavanau; Charles R. Peters
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
This research was conducted to further validate the Ogilvie and Wilkinson (1988) behavioural model for providing a detailed characterization of nocturnal sleep and wakefulness. 18 chronic insomniacs and 11 good sleepers used behavioural response sleep\\/wake monitors in their homes for three consecutive nights. A 2 (insomnia × control) × 3 (nights) MANOVA was performed with age as a covariate as
KIMBERLY A. CÔTÉ; ROBERT D. OGILVIE
CRH is known to enhance wakefulness and to reduce SWS. In addition, some but not all, studies suggest that CRH promotes REM sleep. Alpha-helical CRH exerts CRH-antagonistic effects in various studies. We studied its effect on sleep EEG and nocturnal secretion of ACTH, cortisol, GH (n = 7) in young normal male subjects. After administering the substance cortisol and ACTH
Katja Held; Irina Antonijevic; Harald Murck; Heike Künzel; Axel Steiger
: Sleep disturbances are common in critically ill patients and have been characterised by numerous studies using polysomnography. Issues regarding patient populations, monitoring duration and timing (nocturnal versus continuous), as well as practical problems encountered in critical care studies using polysomnography are considered with regard to future interventional studies on sleep. Polysomnography is the gold standard in objectively measuring the
Richard S Bourne; Cosetta Minelli; Gary H Mills; Rosalind Kandler
Divergence of primitive sleep into REM and NREM states is thought to have occurred in the nocturnal Triassic ancestors of mammals as a natural accompaniment of the evolution of warm-bloodedness. As ambient temperatures during twilight portions of primitive sleep traversed these evolving ancestors' core temperature, mechanisms of thermoregulatory control that employ muscle contractions became superfluous. The resulting loss of need
J Lee Kavanau
We previously observed that low oral doses of melatonin given at noon increase blood melatonin concentrations to those normally occurring nocturnally and facilitate sleep onset, as assessed using an involuntary muscle relaxation test. In this study we examined the induction of polysomnographically recorded sleep by similar doses given later in the evening, close to the times of endogenous melatonin release
Irina V. Zhdanova; Richard J. Wurtman; Harry J. Lynch; John R. Ives; Andrew B. Dollins; Claudia Morabito; Jean K. Matheson; Donald L. Schomer
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
Objective: To define, in a group of children with nasal obstruction, the anatomical differences that differenti- ate those with quiet, unobstructed nocturnal respira- tion from those with obstructive sleep-related breathing abnormalities (snoring and obstructive sleep apnea). Design: Case series. Patients: Fifty-nine children aged 3 to 13 years (35 boys and 24 girls) with nasal obstruction and without tonsil- lar hypertrophy,
Yehuda Finkelstein; David Wexler; Gilead Berger; Ariela Nachmany; Myra Shapiro-Feinberg; Dov Ophir
To understand better the clinical impact of periodic limb movements during sleep (PLMS) we analysed data from 51 patients who, following an adaptation night, presented a PLMS index > 5 during two consecutive nocturnal polysomnographic recordings. In the morning following each recording patients completed a questionnaire including five visual analogic scales (VAS): (1) I did not sleep well\\/I slept very
José Haba-Rubio; Luc Staner; Jean Krieger; Jean Paul Macher
Caffeine is one of the most widely consumed psychoactive substances and it has profound effects on sleep and wake function. Laboratory studies have documented its sleep-disruptive effects. It clearly enhances alertness and performance in studies with explicit sleep deprivation, restriction, or circadian sleep schedule reversals. But, under conditions of habitual sleep the evidence indicates that caffeine, rather then enhancing performance, is merely restoring performance degraded by sleepiness. The sleepiness and degraded function may be due to basal sleep insufficiency, circadian sleep schedule reversals, rebound sleepiness, and/or a withdrawal syndrome after the acute, over-night, caffeine discontinuation typical of most studies. Studies have shown that caffeine dependence develops at relatively low daily doses and after short periods of regular daily use. Large sample and population-based studies indicate that regular daily dietary caffeine intake is associated with disturbed sleep and associated daytime sleepiness. Further, children and adolescents, while reporting lower daily, weight-corrected caffeine intake, similarly experience sleep disturbance and daytime sleepiness associated with their caffeine use. The risks to sleep and alertness of regular caffeine use are greatly underestimated by both the general population and physicians. PMID:17950009
Roehrs, Timothy; Roth, Thomas
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
Type 2 diabetes mellitus (T2DM) is complex metabolic disease that arises as a consequence of interactions between genetic predisposition and environmental triggers. One recently described environmental trigger associated with development of T2DM is disturbance of circadian rhythms due to shift work, sleep loss, or nocturnal lifestyle. However, the underlying mechanisms behind this association are largely unknown. To address this, the authors examined the metabolic and physiological consequences of experimentally controlled circadian rhythm disruption in wild-type (WT) Sprague Dawley and diabetes-prone human islet amyloid polypeptide transgenic (HIP) rats: a validated model of T2DM. WT and HIP rats at 3 months of age were exposed to 10 weeks of either a normal light regimen (LD: 12:12-h light/dark) or experimental disruption in the light-dark cycle produced by either (1) 6-h advance of the light cycle every 3 days or (2) constant light protocol. Subsequently, blood glucose control, beta-cell function, beta-cell mass, turnover, and insulin sensitivity were examined. In WT rats, 10 weeks of experimental disruption of circadian rhythms failed to significantly alter fasting blood glucose levels, glucose-stimulated insulin secretion, beta-cell mass/turnover, or insulin sensitivity. In contrast, experimental disruption of circadian rhythms in diabetes-prone HIP rats led to accelerated development of diabetes. The mechanism subserving early-onset diabetes was due to accelerated loss of beta-cell function and loss of beta-cell mass attributed to increases in beta-cell apoptosis. Disruption of circadian rhythms may increase the risk of T2DM by accelerating the loss of beta-cell function and mass characteristic in T2DM.
Gale, John E.; Cox, Heather I.; Qian, Jingyi; Block, Gene D.; Colwell, Christopher S.; Matveyenko, Aleksey V.
Type 2 diabetes mellitus (T2DM) is complex metabolic disease that arises as a consequence of interactions between genetic predisposition and environmental triggers. One recently described environmental trigger associated with development of T2DM is disturbance of circadian rhythms due to shift work, sleep loss, or nocturnal lifestyle. However, the underlying mechanisms behind this association are largely unknown. To address this, the authors examined the metabolic and physiological consequences of experimentally controlled circadian rhythm disruption in wild-type (WT) Sprague Dawley and diabetes-prone human islet amyloid polypeptide transgenic (HIP) rats: a validated model of T2DM. WT and HIP rats at 3 months of age were exposed to 10 weeks of either a normal light regimen (LD: 12:12-h light/dark) or experimental disruption in the light-dark cycle produced by either (1) 6-h advance of the light cycle every 3 days or (2) constant light protocol. Subsequently, blood glucose control, beta-cell function, beta-cell mass, turnover, and insulin sensitivity were examined. In WT rats, 10 weeks of experimental disruption of circadian rhythms failed to significantly alter fasting blood glucose levels, glucose-stimulated insulin secretion, beta-cell mass/turnover, or insulin sensitivity. In contrast, experimental disruption of circadian rhythms in diabetes-prone HIP rats led to accelerated development of diabetes. The mechanism subserving early-onset diabetes was due to accelerated loss of beta-cell function and loss of beta-cell mass attributed to increases in beta-cell apoptosis. Disruption of circadian rhythms may increase the risk of T2DM by accelerating the loss of beta-cell function and mass characteristic in T2DM. PMID:21921296
Gale, John E; Cox, Heather I; Qian, Jingyi; Block, Gene D; Colwell, Christopher S; Matveyenko, Aleksey V
Patients in the acute care units (ACU) are usually critically ill, making them more susceptible to the unfavorable atmosphere in the hospital. One of these unfavorable factors is sleep disruption and deprivation. Many factors may affect sleep in the ACU, including therapeutic interventions, diagnostic procedures, medications, the underlying disease process, and noise generated in the ACU environment. Many detrimental physiological effects can occur secondary to noise and sleep deprivation, including cardiovascular stimulation, increased gastric secretion, pituitary and adrenal stimulation, suppression of the immune system and wound healing, and possible contribution to delirium. Over the past few years, many studies have endeavored to objectively assess sleep in the ACUs, as well as the effect of mechanical ventilation and circadian rhythm changes critically ill patients. At this time, therefore, it is important to review published data regarding sleep in ACUs, in order to improve the knowledge and recognition of this problem by health care professionals. We have therefore reviewed the methods used to assess sleep in ACUs, factors that may affect sleep in the ACU environment, and the clinical implications of sleep disruption in the ACU. PMID:16435158
Recent studies have shown that certain nocturnal insect and vertebrate species have true color vision under nocturnal illumination. Thus, their vision is potentially affected by changes in the spectral quality of twilight and nocturnal illumination, due to the presence or absence of the moon, artificial light pollution and other factors. We investigated this in the following manner. First we measured
Sönke Johnsen; Almut Kelber; Eric Warrant; Alison M. Sweeney; Edith A. Widder; Raymond L. Lee; Javier Hernández-Andrés
Sleep represents organized complex behavior necessary and vital for the survival of the species. It is reversible, internally regulated and homeostatically controlled process. Sleep consists of two separate states designated as NREM and REM sleep. NREM sleep has four sleep states (1 through 4) easily defined by the PSG and EEG components. REM sleep consists of tonic and phasic components. The tonic component of REM sleep by default includes the duration while phasic component consists of clusters of rapid eye movement, muscle twitches and PGO activity. The two states of sleep differ fundamentally both from one another as well as from the state of wakefulness. NREM and REM sleep is organized in sleep cycles with a typical duration between 90 and 110 minutes. Approximately 4 to 6 cycles emerge during the night with the REM episodes being prolonged towards the morning. About 70-80% of sleep process belongs to NREM and 20-25% to REM sleep. Normal aging carries the reduction in slow high-voltage activity (delta sleep) while REM sleep is of the relatively constant duration. Overall, sleep in elderly is characterized by the increase in the number of sleep stage shifts, increase in the number of awakenings and a shift towards the superficial sleep stages. PMID:18069349
Sleep enhances memory consolidation. Bearing in mind that food intake produces many metabolic signals that can influence memory processing in humans (e.g., insulin), the present study addressed the question as to whether the enhancing effect of sleep on memory consolidation is affected by the amount of energy consumed during the preceding daytime. Compared to sleep, nocturnal wakefulness has been shown to impair memory consolidation in humans. Thus, a second question was to examine whether the impaired memory consolidation associated with sleep deprivation (SD) could be compensated by increased daytime energy consumption. To these aims, 14 healthy normal-weight men learned a finger tapping sequence (procedural memory) and a list of semantically associated word pairs (declarative memory). After the learning period, standardized meals were administered, equaling either ?50% or ?150% of the estimated daily energy expenditure. In the morning, after sleep or wakefulness, memory consolidation was tested. Plasma glucose was measured both before learning and retrieval. Polysomnographic sleep recordings were performed by electroencephalography (EEG). Independent of energy intake, subjects recalled significantly more word pairs after sleep than they did after SD. When subjects stayed awake and received an energy oversupply, the number of correctly recalled finger sequences was equal to those seen after sleep. Plasma glucose did not differ among conditions, and sleep time in the sleep conditions was not influenced by the energy intake interventions. These data indicate that the daytime energy intake level affects neither sleep’s capacity to boost the consolidation of declarative and procedural memories, nor sleep’s quality. However, high energy intake was followed by an improved procedural but not declarative memory consolidation under conditions of SD. This suggests that the formation of procedural memory is not only triggered by sleep but is also sensitive to the fluctuations in the energy state of the body.
Herzog, Nina; Friedrich, Alexia; Fujita, Naoko; Gais, Steffen; Jauch-Chara, Kamila; Oltmanns, Kerstin M.; Benedict, Christian
The actual therapy of choice for the common obstructive sleep-apnea syndrome is the application of continuous positive airway pressure (CPAP) via a nose-mask. This ventilation by positive pressure is explained in some detail. Mechanical ventilation for treatment of nocturnal respiratory failure in outpatients of various etiologies is covered in the companion paper by J. C. Chevrolet. Treatment of sleep disorders due to other pulmonary diseases such as bronchial asthma and others require treatment of the underlying disorder. PMID:8506438
NORMAL nocturnal monophasic sleep is characterised by the cyclic alternation of rapid eye movement (REM) and nonrapid eye movement (NREM) sleep, with the REM phase of this cycle recurring approximately every 90-110 min. Kleitman1 hypothesised that an analogous 90-110 min basic rest-activity cycle (BRAC) exists during the awake state, implying a biological clock that continues to operate with the same
Julie Moses; Ardie Lubin; Laverne C. Johnson; Paul Naitoh
Respiratory muscle weakness is a common feature of many neuromuscular disorders contributing to the development of daytime\\u000a respiratory failure. However sleep-related breathing abnormalities and sleep disturbance can occur months or years before\\u000a the emergence of daytime hypercapnia. Although obstructive events are commonly seen in the early stages of many disorders\\u000a with age and disease progression central events and nocturnal hypoventilation
Amanda J. Piper
Recent surveys in Japan reported that more than half of children interviewed complained of daytime sleepiness, approximately one quarter reported insomnia, and some complained of both nocturnal insomnia and daytime sleepiness. To explain the pathophysiology of this type of sleep disturbance, a novel clinical concept of asynchronization has been proposed. Asynchronization involves disturbances in various aspects of biological rhythms that normally exhibit circadian oscillations. The putative major triggers for asynchronization include a combination of nighttime light exposure, which can disturb the biological clock and decrease melatonin secretion, and a lack of morning light exposure, which can prohibit normal synchronization of the biological clock to a 24-h cycle and decrease activity in the serotonergic system. The early phase of asynchronization may be caused by inadequate sleep hygiene, is likely to be functional, and to be relatively easily resolved by establishing a regular sleep-wakefulness cycle. However, without adequate intervention, these disturbances may gradually worsen, resulting into the chronic phase. No single symptom appears to be specific for the clinical phases, and the chronic phase is defined in terms of the response to interventions. The factors causing the transition from the early to chronic phase of asynchronization and those producing the difficulties of recovering patients with the chronic phase of asynchronization are currently unclear. PMID:20937552
Recent studies in the rat demonstrated that systemic administration of muscimol and THIP, both selective GABAA receptor agonists, elevates slow wave activity in the EEG during non-rapid eye movement (NREM) sleep. In this placebo-controlled\\u000a study, we assessed the influence of an oral dose of 20?mg THIP on nocturnal sleep in young healthy humans. Compared to placebo,\\u000a THIP increased slow wave
Johannes Faulhaber; Axel Steiger; Marike Lancel
31 short-sleeping college students tended to eat more small meals or snacks than 37 long sleepers, all of whom were satisfied with their sleep. This disrupted pattern of larger meals was predicted from work of Elomaa and Johansson with rats who were partially REM-sleep deprived. PMID:3960667
Hicks, R A; McTighe, S; Juarez, M
Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore,
Carlos Zamarron; Felix del Campo Matias; Carlos J. Egea
The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as
Caryl L. Gay; Kathryn A. Lee; Shih-Yu Lee
Sleep–waking cycles are fundamental in human circadian rhythms and their disruption can have consequences for behaviour and performance. Such disturbances occur due to domestic or occupational schedules that do not permit normal sleep quotas, rapid travel across multiple meridians and extreme athletic and recreational endeavours where sleep is restricted or totally deprived. There are methodological issues in quantifying the physiological
Thomas Reilly; Ben Edwards
Sleep deprivation disrupts vital biological processes that are necessary for cognitive ability and physical health, but the physiological changes that underlie these outward effects are largely unknown. The purpose of the present studies in the laboratory rat is to prolong sleep deprivation to delineate the pathophysiology and to determine its mediation. In the rat, the course of prolonged sleep deprivation
Carol A. Everson
Sudden unexpected nocturnal death syndrome (SUNDS) is a distinct clinical entity in previously healthy, young, Southeast Asian males. It is well known in the Philippines and more recently recognized in the U.S. by nonspecific autopsy findings, with no evidence of underlying disease and absence of toxic drug or alcohol levels. In 1973-89, 14 cases of apparent SUNDS came to coroner's autopsy in the Commonwealth of the Northern Marianas (CNMI) and Guam. All 14 cases, with the exception of one Yapese, were previously healthy, male Filipinos, aged 23 to 55, who were either found dead in bed, or described by their colleagues as having nocturnal seizure activity consisting of gurgling, frothing, and tongue biting immediately prior to death. Autopsy findings showed no anatomic findings to account for death. Comprehensive serum and urine drug analyses were negative. All decedents showed absence of significant atherosclerosis or grossly detectable structural cardiac anomaly, while four showed cardiomegaly. Migrants from Southeast Asia carry with them a pre-disposition to this syndrome, which appears to decline with longer residence in the new country. The mechanism of death in SUNDS is believed to be ventricular fibrillation, possibly precipitated by sudden sympathetic discharge. Studies suggest at least some deaths may be associated with an abnormal cardiac conduction system. Acute pancreatitis has been a finding in some series, but not our cases. Why the condition is virtually limited to males and seemingly sleep-triggered, has not been adequately explained. Stress and depression are believed to be predisposing factors. PMID:2220705
Park, H Y; Weinstein, S R
Changes in normal lung sounds are an important sign of pathophysiological processes in the bronchial system and lung tissue. For the diagnosis of bronchial asthma, coughing and wheezing are important symptoms that indicate the existence of obstruction. In particular, nocturnal long-term acoustic monitoring and assessment make sense for qualitative and quantitative detection and documentation. Previous methods used for lung function diagnosis require active patient cooperation that is not possible during sleep. We developed a mobile device based on the CORSA standard that allows the recording of respiratory sounds throughout the night. To date, we have recorded 133 patients with different diagnoses (80 male, 53 female), of whom 38 were children. In 68 of the patients we could detect cough events and in 87 we detected wheezing. The recording method was tolerated by all participating adults and children. Our mobile system allows non-invasive and cooperation-independent nocturnal monitoring of acoustic symptoms in the domestic environment, especially at night, when most ailments occur. PMID:17313338
Gross, Volker; Reinke, Christian; Dette, Frank; Koch, Roland; Vasilescu, Dragos; Penzel, Thomas; Koehler, Ulrich
Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is an idiopathic epilepsy, with a spectrum of clinical manifestations, ranging from brief, stereotyped, sudden arousals to more complex dystonic–dyskinetic seizures. Video–polysomnography allows a correct differential diagnosis. There is no difference between sporadic nocturnal frontal lobe epilepsy (NFLE) and ADNFLE in the clinical and neurophysiological findings. ADNFLE is the first idiopathic epilepsy for
Romina Combi; Leda Dalprà; Maria Luisa Tenchini; Luigi Ferini-Strambi
The relationship between workplace characteristics and nocturnal sleep in a working population was investigated. Data from 709 employees (mean age=39 years; 87% men) from two German companies were analysed at the entry of the longitudinal cohort study (overall accrual 73%). We investigated the association between the effort-reward imbalance model at work (Siegrist, 1996) and self-reported sleep quality and sleep disturbances,
Brigitte M. Kudielka; Roland Von Känel; Marie-Louise Gander; Joachim E. Fischer
Twenty-four-hour ambulatory polysomnography was performed in 20 patients with PD who were having visual hallucinations (12 men and 8 women, mean age 70 +/- 6 years). Visual hallucinations were clearly related to daytime NREM sleep or nocturnal REM sleep in 33% of the instances. The data reinforce the hypothesis that neural mechanisms implicated in generating sleep and, in particular, in dream imagery play a role in the occurrence of visual hallucinations in PD. PMID:12499497
Manni, R; Pacchetti, C; Terzaghi, M; Sartori, I; Mancini, F; Nappi, G
Impaired sleep and alertness, initially recognized by James Parkinson in his famous monograph "An Essay on the Shaking Palsy" in 1817, is one of the most common and disabling nonmotor symptoms of Parkinson's disease (PD). It is only recently, however, that sleep disturbances in PD have received the attention of medical and research community. Dopamine, the major neurotransmitter implicated in the pathogenesis of PD, plays a pivotal role in the regulation of sleep and circadian homeostasis. Sleep dysfunction affects up to 90% of patients with PD, and may precede the onset of the disease by decades. Sleep dysfunction in PD may be categorized into disturbances of overnight sleep and daytime alertness. Etiology of impaired sleep and alertness in PD is multifactorial. Co-existent primary sleep disorders, medication side effects, overnight re-emergence of motor symptoms, and primary neurodegeneration itself, are main causes of sleep disruption and excessive daytime sleepiness among patients with PD. Increasing body of evidence suggests that the circadian system becomes dysregulated in PD, which may lead to poor sleep and alertness. Treatment options are limited and frequently associated with unwanted side effects. Further studies that will examine pathophysiology of sleep dysfunction in PD, and focus on novel treatment approaches are therefore very much needed. In this article we review the role of dopamine in regulation of sleep and alertness and discuss main sleep and circadian disturbances associated with PD. PMID:22935723
Videnovic, Aleksandar; Golombek, Diego
Mice lacking the GABAA receptor ?3 subunit exhibit a profound disruption in thalamic circuitry. We have studied sleep in these mice under baseline conditions and following treatment with the benzodiazepine midazolam. Under baseline conditions, NREM sleep time did not differ between ?3 subunit knockout mice and wild type mice, while REM sleep time was significantly lower in knockout mice than
Jonathan P Wisor; Timothy M DeLorey; Gregg E Homanics; Dale M Edgar
Objective: Recent evidence suggests that women with gestational hypertension (GH) have a high rate of sleep disordered breathing (SDB), and treatment for even marginal SDB may improve blood pressure control in women with GH. We assessed whether the application SDB treatment could improve blood pressure in women with GH. Methods: This was a single-center randomized study. Subjects underwent an unattended home-based diagnostic sleep study. The study was then repeated with subjects wearing one of two randomly assigned treatments: auto-titrating continuous positive airway pressure (auto-CPAP) or mandibular advancement device (MAD) + nasal strip. First morning blood pressure and blood for standard GH measures plus inflammatory markers were taken after each study. Subjects completed a series of questionnaires addressing sleep quality and tolerance of assigned therapy. Results: Twenty-four women completed the protocol—13 in the MAD group and 11 in auto-CPAP. The overall rate of SDB was 38%. Auto-CPAP was more effective at treating SDB than MAD + nasal strip, although the women randomized to MAD + nasal strip reported the greater comfort with therapy. First morning blood pressure was not consistently improved with either therapy. When subjects were stratified according to those whose blood pressure increased or decreased with therapy, an association was suggested between blood pressure improvement and reduced levels of tumour necrosis factor-?. Conclusion: We demonstrated that 38% of women with GH had concurrent SDB. We did not find an improvement in blood pressure or inflammatory markers with a single night of either the auto-CPAP or MAD + nasal strip interventions. However important lessons from this study may guide future investigations in this area. Citation: Reid J; Taylor-Gjevre R; Gjevre J; Skomro R; Fenton M; Olatunbosun F; Gordon JR; Cotton D. Can gestational hypertension be modified by treating nocturnal airflow limitation? J Clin Sleep Med 2013;9(4):311-317.
Reid, John; Taylor-Gjevre, Regina; Gjevre, John; Skomro, Robert; Fenton, Mark; Olatunbosun, Femi; Gordon, John R.; Cotton, David
Sleep-related eating disorder (SRED) is characterized by nocturnal partial arousals associated with compulsive consumption of food and altered levels of consciousness. Reports of an increased incidence of SRED in relatives of affected individuals suggest a genetic predisposition. We report a woman with SRED whose fraternal twin sister and father are also affected.
Joel De Ocampo; Nancy Foldvary; Dudley S Dinner; Joseph Golish
Results. A wide range of OSA severity was found (ap- noea\\/hypopnoea index (AHI): 44.3±30.4, range 0.3-105; sleep time spent at oxyhaemoglobin saturation <90%: 18.1±22.2%, range 0-81%). Both reticulocyte count and IRF slightly exceeded the normal range. Patients with a reticulocyte concentration >2% had higher EPO levels (p<0.05), but not worse nocturnal desaturations, than those with values <2%. By contrast, subjects
O. Marrone; A. Salvaggio; M. Gioia; A. Bonanno; M. Profita; L. Riccobono; A. Zito; G. Insalaco; M. R. Bonsignore
Approximately one third of adults report difficulty sleeping, and 10% to 15% have the clinical disorder of insomnia. Among primary care patients, approximately half have sleep difficulties, but these difficulties often are undetected. Sleep disorders, especially chronic insomnia, results in impaired occupational performance and diminished quality of life. Insomnia is associated with higher healthcare usage and costs, including a 2-fold increase in hospitalizations and physician visits. Insomnia is also a risk factor for a number of other medical and psychiatric disorders, such as depression, hypertension. This presentation describes different sleep disorders (insomnia, hypersomnia, obstructive sleep apnea, sleep related movement disorders, circadian rhythms sleep disorders, parasomnias), diagnostic methods available in sleep medicine. The various treatment options for these sleep disorders are also identified. PMID:21387812
|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.
ABSTRACT: Delirium occurs frequently in critically ill patients and has been associated with both short-term and long-term consequences. Efforts to decrease delirium prevalence have been directed at identifying and modifying its risk factors. One potentially modifiable risk factor is sleep deprivation. Critically ill patients are known to experience poor sleep quality with severe sleep fragmentation and disruption of sleep architecture.
Gerald L Weinhouse; Richard J Schwab; Paula L Watson; Namrata Patil; Bernardino Vaccaro; Pratik Pandharipande; E Wesley Ely
This review article summarizes the major findings about the interactions of human sleep structure and the hypothalamo-pituitary-adrenocortical (HPA) system under physiological and pathophysiological conditions, including studies that probe the sleep effects of systemically administered HPA hormones. Human sleep is regulated by a concerted action of various signal compounds acting at sleep-generating neurons whose central organization is not yet fully understood. During nocturnal sleep the endocrine system is remarkably active, the longest established finding being that growth hormone (GH) release is associated with the initiation of sleep and that there is a steep morning rise of cortisol (Weitzman et al., 1966; Takahashi et al., 1968). Moreover, the effects of exogenously administered corticosteroids and of their excessive endogenous release (e.g. Cushing's disease) were recognized more than 20 years ago. PMID:7496607
Friess, E; Wiedemann, K; Steiger, A; Holsboer, F
... national organization focused on improving public awareness about sleep disorders and sleep health, promoting sleep medicine research, and ... volunteer efforts. - Basic information on sleep - Symptoms of sleep disorders - Insomnia treatments - Information on good sleep health - Treatments ...
Background. Sleep-disordered breathing (SDB) is common in older adults and has been implicated as a cause of decreased quality of life and even death. Sparse data exist on SDB in the nursing home setting. The authors evaluated SDB (using attended nocturnal pulse oximetry) in nursing home residents with daytime sleepiness and nighttime sleep disturbance. Methods. Pulse oximetry was used to
Jennifer L. Martin; Aaron K. Mory; Cathy A. Alessi
We evaluated the efficiency of two different treatment procedures with continuous positive airway pressure (CPAP) on sleep, nocturnal breathing character- istics and daytime vigilance in 18 newly diagnosed patients with untreated sleep apnoea\\/hypopnoea syndrome (SAHS) randomly allocated to two different groups. In group I, the positive pressure (PP) level was set to suppress flow limitation (PFL), while in group II
J. C. Meurice; J. Paquereau; A. Denjean; F. Patte
Myotonic dystrophy type 1 (DM1), or Steinert's disease, is the most common adult-onset form of muscular dystrophy. DM1 also constitutes the neuromuscular condition with the most significant sleep disorders including excessive daytime sleepiness (EDS), central and obstructive sleep apneas, restless legs syndrome (RLS), periodic leg movements in wake (PLMW) and periodic leg movements in sleep (PLMS) as well as nocturnal and diurnal rapid eye movement (REM) sleep dysregulation. EDS is the most frequent non-muscular complaint in DM1, being present in about 70-80% of patients. Different phenotypes of sleep-related problems may mimic several sleep disorders, including idiopathic hypersomnia, narcolepsy without cataplexy, sleep apnea syndrome, and periodic leg movement disorder. Subjective and objective daytime sleepiness may be associated with the degree of muscular impairment. However, available evidence suggests that DM1-related EDS is primarily caused by a central dysfunction of sleep regulation rather than by sleep fragmentation, sleep-related respiratory events or periodic leg movements. EDS also tends to persist despite successful treatment of sleep-disordered breathing in DM1 patients. As EDS clearly impacts on physical and social functioning of DM1 patients, studies are needed to identify the best appropriate tools to identify hypersomnia, and clarify the indications for polysomnography (PSG) and multiple sleep latency test (MSLT) in DM1. In addition, further structured trials of assisted nocturnal ventilation and randomized trials of central nervous system (CNS) stimulant drugs in large samples of DM1 patients are required to optimally treat patients affected by this progressive, incurable condition. PMID:22465566
Dauvilliers, Yves A; Laberge, Luc
Sleep disturbances in Parkinson’s disease (PD) are both widespread and wide-ranging. Emerging early in the disease process,\\u000a sometimes prior to the onset of motor symptoms, sleep disruption results from the degeneration of the basal ganglia that is\\u000a the hallmark of the disease, as well as changes in brain stem sleep centres. Accordingly, sleep problems consist of motor\\u000a symptoms such as
Daisy L. Whitehead; Rosalind Mitchell-Hay; Prashant Reddy; Sharon Muzerengi; K. Ray Chaudhuri
This chapter discusses various levels of interactions between the brain and the immune system in sleep. Sleep-wake behavior and the architecture of sleep are influenced by microbial products and cytokines. On the other hand, sleep processes, and perhaps also specific sleep states, appear to promote the production and/or release of certain cytokines. The effects of immune factors such as endotoxin and cytokines on sleep reveal species specificity and usually strong dependence on parameters such as substance concentration, time relative to administration or infection with microbial products, and phase relation to sleep and/or the light-dark cycle. For instance, endotoxin increased SWS and EEG SWA in humans only at very low concentrations, whereas higher concentrations increased sleep stage 2 only, but not SWS. In animals, increases in NREM sleep and SWA were more consistent over a wide range of endotoxin doses. Also, administration of pro-inflammatory cytokines such as IL-6 and IFN-alpha in humans acutely disturbed sleep while in rats such cytokines enhanced SWS and sleep. Overall, the findings in humans indicate that strong nonspecific immune responses are acutely linked to an arousing effect. Although subjects feel subjectively tired, their sleep flattens. However, some observations indicate a delayed enhancing effect on sleep which could be related to the induction of secondary, perhaps T-cell-related factors. This would also fit with results in animals in which the T-cell-derived cytokine IL-2 enhanced sleep while cytokines with immunosuppressive functions like IL-4 and L-10 suppressed sleep. The most straightforward similarity in the cascade of events inducing sleep in both animals and humans is the enhancing effect of GHRH on SWS, and possibly the involvement of the pro-inflammatory cytokine systems of IL-1 beta and TNF-alpha. The precise mechanisms through which administered cytokines influence the central nervous system sleep processes are still unclear, although extensive research has identified the involvement of various molecular intermediates, neuropeptides, and neurotransmitters (cp. Fig. 5, Section III.B). Cytokines are not only released and found in peripheral blood mononuclear cells, but also in peripheral nerves and the brain (e.g., Hansen and Krueger, 1997; März et al., 1998). Cytokines are thereby able to influence the central nervous system sleep processes through different routes. In addition, neuronal and glial sources have been reported for various cytokines as well as for their soluble receptors (e.g., Kubota et al., 2001a). Links between the immune and endocrine systems represent a further important route through which cytokines influence sleep and, vice versa, sleep-associated processes, including variations in neurotransmitter and neuronal activity may influence cytokine levels. The ability of sleep to enhance the release and/or production of certain cytokines was also discussed. Most consistent results were found for IL-2, which may indicate a sleep-associated increase in activity of the specific immune system. Furthermore, in humans the primary response to antigens following viral challenge is enhanced by sleep. In animals results are less consistent and have focused on the secondary response. The sleep-associated modulation in cytokine levels may be mediated by endocrine parameters. Patterns of endocrine activity during sleep are probably essential for the enhancement of IL-2 and T-cell diurnal functions seen in humans: Whereas prolactin and GH release stimulate Th1-derived cytokines such as IL-2, cortisol which is decreased during the beginning of nocturnal sleep inhibits Th1-derived cytokines. The immunological function of neurotrophins, in particular NGF and BDNF, has received great interest. Effects of sleep and sleep deprivation on this cytokine family are particularly relevant in view of the effects these endogenous neurotrophins can have not only on specific immune functions and the development of immunological memories, but also on synaptic reorganization and neuronal memory formation
Marshall, Lisa; Born, Jan
Cataplexy is a complex neurologic phenomenon during wakefulness probably resulting from impairment of pontine and hypothalamic control over muscle tone. REM sleep behavior disorder (RSBD) is characterized by the presence of REM sleep without atonia manifesting clinically as disruptive or injurious behaviors. We present here a patient with both cataplexy and RSBD following pontine encephalomalacia. The clinical presentation provides insight into the possible pathobiology of both waking and sleeping disorders of REM sleep regulation. Citation: Reynolds TQ; Roy A. Isolated cataplexy and REM sleep behavior disorder after pontine stroke. J Clin Sleep Med 2011;7(2):211-213.
Reynolds, Thomas Q.; Roy, Asim
For something as critical to our well being as good sleep, human beings suffer from an amazing number of sleeping disorders. The following Web sites explore just a few of these disorders, starting with a brief introduction to the normal stages of sleep from the Sleep Disorders Center of Central Texas (1). Next, the University of Waterloo offers a fascinating look at sleep paralysis, which many researchers consider the "likely source of beliefs concerning not only alien abductions, but all manner of beliefs in alternative realities and otherworldly creatures" (2). The third site (3), provided by the National Women's Health Information Center, is an easy-to-read source for information about insomnia. Likewise, the American Sleep Apnea Association (ASAA) offers an in-depth information packet on snoring and sleep apnea, as well as the ASAA newsletter and other resources (4). The next Web site (5 ) comes from the National Institute of Neurological Disorders and Stroke, and offers an introduction to the phenomenon of narcolepsy, including treatment, prognosis, and related research. Restless legs syndrome may not be as immediately familiar as some of the other sleep disorders addressed above, but a visit to the homepage of the Restless Legs Syndrome Foundation (6) should answer any questions about this "creepy-crawly" sensation in the limbs that occurs during sleep or other inactive periods. Of course, you don't have to have a bona fide sleeping disorder to suffer from sleep deprivation. Visitors to the next Web site from Loughborough University's Sleep Research Centre will find detailed information on how sleep deprivation affects brain function (7). Not surprisingly, the news isn't good. Finally, the Sleep Foundation offers How's Your Sleep, an online quiz designed to help users learn more about what may be affecting their sleep (8).
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.
Sudden Unexpected Nocturnal Deaths (SUND) occur in young, apparently healthy immigrant workers from Thailand, the Philippines and Bangladesh living among ex-patriot labour forces in countries such as Singapore and Saudi Arabia. Several factors associated with these deaths are similar to those observed for Sudden Infant Death Syndrome (SIDS): sleep related and mainly nocturnal occurrence; no prodromal illnesses other than mild respiratory tract infection; exposure to cigarette smoke; absence of invasive microorganisms at autopsy. The hypotheses proposed to explain these deaths in adults are examined. Based on our studies of the role toxigenic bacteria might play in some cases of SIDS, we suggest a new approach to the investigation of SUND. PMID:8038113
Blackwell, C C; Busuttil, A; Weir, D M; Saadi, A T; Essery, S D
Nocturnal bruxism (NB) is a temporomandibular disorder characterized by an excessive clenching and involuntary parafunctional grinding of the teeth during sleep. It can cause dental damage and irreversible temporomandibular joint dysfunction. We designed a device that generates electrical stimulation on inhibitory sensory afferents when an EMG signal is measured. This stimulation was applied to the right mental nerve to produce a decrease in the contraction intensity of the mandibular elevation muscles. To measure the intensity of contraction, electromyographic (EMG) signal of the left temporalis anterior (LTa) muscle was used. The results showed that, on average, the percentage decrease in the bruxist group was 30.53% and for the control group was 28.91%. These results indicate that the device implemented generates an important decrease in the muscle contractile activity. Therefore, the device could be useful as a possible treatment to decrease nocturnal bruxism. PMID:24110501
Aqueveque, P; Pino, E; Lopez, R
Recent studies of humans and rats show that neuronal firing patterns initiated by prior sensory stimulation, and even learning, can occur during sleep. But what they tell us about the functions of sleep remains unclear.
J. Allan Hobson; Robert Stickgold
Generally blood pressure (BP) should drop or dip by 10-20% during sleep. The phenomenon of nondipping BP during sleep has gained interest because of its association with various damaging effects to end-organs. This exploratory study examined nighttime nondipping BP, acculturative stress and quality of sleep in 30 Korean American women. Acculturative stress and sleep quality were measured using the Revised Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale (R-SAFE) and the Pittsburg Sleep Quality Index (PSQI), respectively. Participants' BP was monitored over a 24-hour period. Participants were categorized as dippers and nondippers based on the drop in nocturnal systolic BP. Of the 30 women, 8 (26.7%) were nondippers. A shorter sleep duration and more disturbed sleep were associated with nondipping and, interestingly, less acculturative stress was also associated with nondipping BP. Our finding supports that sleep evaluation is needed in caring for individuals with nondipping BP. PMID:22872182
Suh, Minhee; Barksdale, Debra J; Logan, Jeongok
The role of the arterial baroreflex in the cardiovascular changes associated with the obstructive sleep apnea syndrome (OSAS), and the effect of nasal continuous positive airway pressure (CPAP) treatment on baroreflex function during sleep are unknown. Baroreflex control of heart rate was studied in 29 normotensive patients with OSAS under no treatment, in 11 age-matched control subjects, and in 10 patients at CPAP withdrawal after 5.5 +/- 3.7 (range 3-14) months of treatment. Baroreflex control of heart rate was assessed by "sequence method" analysis of continuous blood pressure recordings (Finapres) obtained during nocturnal polysomnography. In untreated OSAS, baroreflex sensitivity (BRS) was low during wakefulness and non-rapid eye movement (REM) stage 2 sleep compared with control subjects, and correlated inversely with mean lowest Sa(O(2)) and the blood pressure increase after apneas. After CPAP treatment, the apnea-hypopnea index was lower, and mean lowest Sa(O(2)) higher than before treatment. After CPAP, patients were more bradycardic, blood pressure and its standard deviation decreased as Sa(O(2)) improved in non-REM stage 2 sleep, and BRS increased (nocturnal wakefulness: +59%; non-REM stage 2 sleep: +68% over pretreatment values). Our data suggest that baroreflex dysfunction in OSAS may be at least partly accounted for by nocturnal intermittent hypoxemia, and can be reversed by long-term CPAP treatment. PMID:12153958
Bonsignore, Maria R; Parati, Gianfranco; Insalaco, Giuseppe; Marrone, Oreste; Castiglioni, Paolo; Romano, Salvatore; Di Rienzo, Marco; Mancia, Giuseppe; Bonsignore, Giovanni
... susceptible than normal cells to a process called apoptosis, which causes cells to self-destruct when they ... with understanding paroxysmal nocturnal hemoglobinuria? anemia ; aplastic anemia ; apoptosis ; autoimmune ; bacteria ; blood clotting ; bone marrow ; cancer ; cell ; ...
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
Our experiences of managing nocturnal enuresis in Greek children at our Outpatient Clinics of Pediatric Urology are described. Between March 2001 and October 2003, 142 children with primary nocturnal enuresis (93 boys and 49 girls), aged 7–18 years old (mean: 9.0±0.5) were included in this prospective study. Initially, behavioral conditioning therapy, using a body-worn urinary alarm, was instructed in all
A. Triantafyllidis; S. Charalambous; A. G. Papatsoris; A. Papathanasiou; C. Kalaitzis; V. Rombis; S. Touloupidis
CME EDUCATIONAL OBJECTIVES 1. Recognize the signs and symptoms of parasomnias in children. 2. Develop a clinical framework to evaluate common parasomnias in children. 3. Distinguish the unique features of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD). The clinical spectrum of sleep disorders in children is broad, ranging from primary snoring and obstructive sleep apnea (OSA) syndrome to complex sleep-related behaviors and movement disorders. Although snoring and OSA typically receive significant attention and discussion, other biologically based sleep disorders are as common, if not more common, in children. A general pediatrician is frequently presented with the complaint of sleep talking, sleep walking, or abnormal movements during sleep. Even more alarming is the presentation of the child suddenly and explosively screaming during sleep. Such complaints fall under the category of parasomnias. Exclusive to sleep and wake-to-sleep transitions, these parasomnias include arousals with abnormal motor, behavioral, autonomic, or sensory symptoms. Parasomnias can be noticeably dissimilar in clinical manifestations, but most share biologic characteristics. Three parasomnias associated with loud vocalizations associated with sleep that can present to general practitioners include sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD). Although usually benign, these sleep disorders can be disruptive and even potentially dangerous to the patient and can often be threatening to quality of life. In this article, we describe the clinical features of some of these disorders and how to differentiate between their alarming presentations. PMID:24126984
Haupt, Mark; Sheldon, Stephen H; Loghmanee, Darius
SYNOPSIS Nighttime sleep disruption is characteristic of long-term care residents, is typically accompanied by daytime sleepiness and may be caused by a multitude of factors. Causal factors include medical and psychiatric illness, medications, circadian rhythm abnormalities, sleep disordered breathing and other primary sleep disorders, environmental factors and lifestyle habits. There is some suggestion that these factors are amenable to treatment; however, further research on the implementation of treatments within the long-term care setting is needed. Additional work is also needed to understand the administrative and policy factors that might lead to systemic changes in how sleep is viewed and sleep problems are addressed in long-term care settings. A growing number of older adults reside in long-term care facilities. In this setting, residents commonly suffer from nighttime sleep disruption, which is often accompanied by daytime sleepiness and may be caused by a multitude of factors. Importantly, sleep disturbance is associated with negative health outcomes, including risk for falling, and elevated mortality risk among long-term care residents. A number of factors contribute to sleep disturbance in the long-term care setting including medical and psychiatric illness, medications, circadian rhythm abnormalities, sleep disordered breathing and other primary sleep disorders, environmental conditions (e.g., noise and light) and lifestyle habits. Based on research with older adults in the community and work conducted within long-term care settings, there is some suggestion that these factors are amenable to nonpharmacological treatments. Further research on the broad implementation of treatments for sleep problems within the long-term care setting is still needed. Additional work is also needed to understand the administrative and policy factors that might lead to systemic changes in how sleep is viewed and sleep problems are addressed in long-term care settings.
Martin, Jennifer L.; Ancoli-Israel, Sonia
Nocturnal asthma is a major problem in many asthma patients and it is important to recognize and treat it. We previously reported the incidence of nocturnal asthma in our practice (1); the current study was done to try to improve upon the incidence of nocturnal asthma in our patients. After our previous survey, which indicated a 67% incidence of nocturnal asthma in our practice, we instituted a previsit questionnaire regarding nocturnal asthma to be filled out by all follow-up asthma patients in our office. After a period of time, we mailed a nocturnal asthma questionnaire to all asthma patients to see if the intervention had improved our incidence of nocturnal asthma. This questionnaire was identical to the one used in our prior study and was mailed to 2019 patients. We had 602 responders, 560 of whom had asthma. A total of 328 of these patients (59%) had nocturnal asthma. This was similar to the results of our previous survey, and our initial conclusion was that the new in-office questionnaire that we instituted had not improved the situation. Then we discovered that the in-office questionnaire had inadvertently been distributed only to the patients of one or our physicians (Dr. A). His patients were then compared with those of the other two doctors (Drs. B and C), and it was found that Dr. A's patients had fewer nocturnal symptoms than did the patients of the other doctors. The percent of asthmatics with nocturnal asthma 4-7 nights per week (more than half the nights in a week) for Dr. A was 16%, for Dr. B 47%, and for Dr. C 39%. The use of a short office questinnaire for asthma patients before they see the doctor for follow-up visits leads to greater recognition and better treatment of nocturnal asthma. PMID:8675495
Storms, W W; Nathan, R A; Bodman, S F; Byer, P
The relation between the pituitary-gonadal hormones' rhythm and sleep physiology in men is not fully elucidated. To examine whether the reproductive hormones are correlated with sleep architecture, we determined the nocturnal serum levels of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in six healthy young men. Serum hormone levels were obtained every 15 minutes from 1900 to 0700 hours with simultaneous polysomnographic sleep recordings. Hourly testosterone levels were lowest when subjects were awake (1900-2200 hours) than during sleep (2300-0700 hours). Testosterone nocturnal rise antedated the first REM by about 90 minutes. The rise in testosterone levels was slower when REM latency was longer. Mean nocturnal testosterone levels did not correlate with the number of rapid eye movement (REM) episodes. Also, pre-non-REM (NREM) testosterone levels were higher as compared with the pre-REM periods and lower during the first NREM period as compared with other nocturnal NREM periods. Serum LH levels disclosed a nocturnal rise that preceeded a similar rise in testosterone by about an hour. We conclude that in young adult men, testosterone levels begin to rise on falling asleep, peak at about the time of first REM, and remain at the same levels until awakening. PMID:10591612
Luboshitzky, R; Herer, P; Levi, M; Shen-Orr, Z; Lavie, P
Patterns of home range overlap between individuals are key parameters used in discussions of sociality in nocturnal prosimians. Despite the importance of space use variables in defining social structure in nocturnal prosimians, researchers have yet to reach a consensus concerning the most reliable techniques for measuring patterns of home range use. In this paper, we review the methods used in 27 studies of nocturnal prosimian ranging behavior published since 1977. We discuss the usefulness and limitations of the various methods of data collection (radio tracking, trap mark, and identification of sleeping site locations) and data analysis (minimum convex polygon method, minimum concave polygon method, and quadrat analysis) used in these studies. We conclude that the most effective method for gathering data on individual movements and social interactions is direct observation of individual radio tagged animals during all-night follows. In those cases where radio tracking and/or all-night follows are not possible, trap mark techniques can be used, although they tend to greatly underestimate home range size. We recommend that data collected on nocturnal prosimian ranging behavior be analyzed using the minimum convex polygon method, quadrat analysis, and, perhaps, one other of the more mathematically sophisticated techniques popular in studies of non-primate mammals. Finally, we urge researchers to employ standardized methods of data collection and data analysis in future studies of range use in nocturnal prosimians. Without standardization of methods, quantitative comparisons of the findings from different studies are biologically meaningless and prevent cross-species comparisons of space use and its relation to sociality. PMID:10811437
Sterling, E J; Nguyen, N; Fashing, P J
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.
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.
The purpose of the present investigation was to characterize and compare traditional sleep architecture and non-rapid eye movement (NREM) sleep microstructure in a well-defined cohort of children with regressive and non-regressive autism, and in typically developing children (TD). We hypothesized that children with regressive autism would demonstrate a greater degree of sleep disruption either at a macrostructural or microstructural level and a more problematic sleep as reported by parents. Twenty-two children with non-regressive autism, 18 with regressive autism without comorbid pathologies and 12 with TD, aged 5-10years, underwent standard overnight multi-channel polysomnographic evaluation. Parents completed a structured questionnaire (Childrens' Sleep Habits Questionnaire-CSHQ). The initial hypothesis, that regressed children have more disrupted sleep, was supported by our findings that they scored significantly higher on CSHQ, particularly on bedtime resistance, sleep onset delay, sleep duration and night wakings CSHQ subdomains than non-regressed peers, and both scored more than typically developing controls. Regressive subjects had significantly less efficient sleep, less total sleep time, prolonged sleep latency, prolonged REM latency and more time awake after sleep onset than non-regressive children and the TD group. Regressive children showed lower cyclic alternating pattern (CAP) rates and A1 index in light sleep than non-regressive and TD children. Our findings suggest that, even though no particular differences in sleep architecture were found between the two groups of children with autism, those who experienced regression showed more sleep disorders and a disruption of sleep either from a macro- or from a microstructural viewpoint. PMID:21518065
Giannotti, Flavia; Cortesi, Flavia; Cerquiglini, Antonella; Vagnoni, Cristina; Valente, Donatella
Objectives: Sleep disturbances commonly follow traumatic brain injury (TBI) and contribute to ongoing disability. However, there are no conclusive findings regarding specific changes to sleep quality and sleep architecture measured using polysomnography. Possible causes of the sleep disturbances include disruption of circadian regulation of sleep-wakefulness, psychological distress, and a neuronal response to injury. We investigated sleep-wake disturbances and their underlying mechanisms in a TBI patient sample. Methods: This was an observational study comparing 23 patients with TBI (429.7 ± 287.6 days post injury) and 23 age- and gender-matched healthy volunteers on polysomnographic sleep measures, salivary dim light melatonin onset (DLMO) time, and self-reported sleep quality, anxiety, and depression. Results: Patients with TBI reported higher anxiety and depressive symptoms and sleep disturbance than controls. Patients with TBI showed decreased sleep efficiency (SE) and increased wake after sleep onset (WASO). Although no significant group differences were found in sleep architecture, when anxiety and depression scores were controlled, patients with TBI showed higher amount of slow wave sleep. No differences in self-reported sleep timing or salivary DLMO time were found. However, patients with TBI showed significantly lower levels of evening melatonin production. Melatonin level was significantly correlated with REM sleep but not SE or WASO. Conclusions: Reduced evening melatonin production may indicate disruption to circadian regulation of melatonin synthesis. The results suggest that there are at least 2 factors contributing to sleep disturbances in patients with traumatic brain injury. We propose that elevated depression is associated with reduced sleep quality, and increased slow wave sleep is attributed to the effects of mechanical brain damage.
Shekleton, J.A.; Parcell, D.L.; Redman, J.R.; Phipps-Nelson, J.; Ponsford, J.L.; Rajaratnam, S.M.W.
AIM: To study the effect of rabeprazole (RAB) on nocturnal acid breakthrough (NAB) and nocturnal alkaline amplitude (NAKA) and to compare it with omeprazole (OME) and pantoprazole (PAN). METHODS: By an open comparative study, forty patients with active peptic ulcer were randomly assigned to receive one of the three PPIs (proton pump inhibitor) with a single oral dose. They were
Jin-Yan Luo; Chun-Yan Niu; Xue-Qin Wang; You-Ling Zhu; Jun Gong
... found at http://www.usa.gov . Sleep and Sleep Disorders ? Sleep About Us About Sleep Key Sleep Disorders Sleep and Chronic Disease How Much Sleep Do ... of depression be monitored among persons with a sleep disorder. 4, 5 References Knutson KL, Ryden AM, Mander ...
Sleep, a natural alteration in consciousness, is increasingly difficult to achieve for more than a third of the U.S. population. Despite breathtaking advances in our understanding of sleep, there remains a considerable need for increased awareness and education concerning this growing public health problem. In November 2011, the National Institutes of Health published a sleep disorders research plan geared toward advancing understanding of sleep disorders and their societal impact, improving treatment of sleep disorders, and recruiting and expanding research in this area. Imaging, with its fast-paced innovations and applications, plays an expanding role in exploring sleep, how it affects the brain, and how lack of sleep can be diagnosed and treated more effectively. PMID:22763834
Church, Elizabeth J
A new concept is put forward to explain the act of micturition and urinary continence. This depends mainly on, the presence of an intact, sound and strong internal sphincter, and, an acquired behavior gained by learning in early childhood how to maintain a high alpha-sympathetic tone, thus keeping the internal sphincter closed all the time. On desire, and at the appropriate time and place, this acquired high alpha-sympathetic tone is inhibited, thereby opening the internal sphincter and allowing voiding to occur. The aim of the study was to test the effects of giving an alpha-sympathomimetic drug, ephedrine hydrochloride to control nocturnal enuresis. Three hundred patients suffering from enuresis were evaluated by a systematic history, physical examination, urinalysis and urodynamic studies. They were divided into a study group of 150 and a control group of 150. The study group were given ephedrine hydrochloride tablets after lunch and before bedtime for 2 months. The control group were given one of the following: imipramine hydrochloride, desmoporessin, ritaline, cetiprin, or behavioral therapy. Immediate continence was gained by 86% of the study patients; 6.7% had slower gain of continence. In the control group there was a short-term success rate of 30%-70% while on treatment, and a high relapse rate of more than 90% after stopping the treatment. It was concluded that giving ephedrine hydrochloride will improve internal sphincter tone, thus preventing uncontrolled urination. PMID:9745969
El Hemaly, A K
This review examines the biological background to the development of ideas on rapid eye movement sleep (REM sleep), so-called paradoxical sleep (PS), and its relation to dreaming. Aspects of the phenomenon which are discussed include physiological changes and their anatomical location, the effects of total and selective sleep deprivation in the human and animal, and REM sleep behavior disorder, the latter with its clinical manifestations in the human. Although dreaming also occurs in other sleep phases (non-REM or NREM sleep), in the human, there is a contingent relation between REM sleep and dreaming. Thus, REM is taken as a marker for dreaming and as REM is distributed ubiquitously throughout the mammalian class, it is suggested that other mammals also dream. It is suggested that the overall function of REM sleep/dreaming is more important than the content of the individual dream; its function is to place the dreamer protagonist/observer on the topographical world. This has importance for the developing infant who needs to develop a sense of self and separateness from the world which it requires to navigate and from which it is separated for long periods in sleep. Dreaming may also serve to maintain a sense of ‘I’ness or “self” in the adult, in whom a fragility of this faculty is revealed in neurological disorders.
Osteoarthritis (OA) is a major healthcare burden of increasing prevalence. It has been demonstrated that the relationship between pain and sleep produces changes in sleep patterns and pain perception. However, electrophysiological studies in animal models of pain are limited. The current study examined the effect of chronic articular pain on sleep patterns in an experimental model of OA. Rats were implanted with electrodes for electrocorticography and electromyography. OA was induced in these rats by the intra-articular administration of monosodium iodoacetate into the left knee joint. Sleep recordings were monitored during light and dark periods lasting 12h each and were evaluated at baseline as well as on days 1, 10, 15, 20 and 28 after iodoacetate injection or assignment to sham or control groups. The pain threshold was also assessed by hot plate testing in other groups of rats at the same time points. The results demonstrated that OA significantly reduced the thermal pain threshold from day 10 until the end of experiment. OA rats exhibited reduced sleep efficiency, slow-wave sleep, paradoxical sleep and an increased number of microarousals during the light periods compared with the baseline as well as control and sham groups. These changes in sleep pattern occurred mostly between days 10 and 28. In the dark period, sleep disturbances were also characterized by decreased sleep efficiency, slow-wave sleep, and paradoxical sleep, although sleep was only initially fragmented. Thus, pain associated with the rat OA model causes alterations in sleep architecture by disrupting the sleep pattern. PMID:18950940
Silva, A; Andersen, M L; Tufik, S
Thermoregulatory processes have long been implicated in initiation of human sleep. The purpose of this study was to evaluate the role of heat loss in sleep initiation, under the controlled conditions of a constant-routine protocol modified to permit nocturnal sleep. Heat loss was indirectly measured by means of the distal-to-proximal skin temperature gradient (DPG). A stepwise regression analysis revealed that the DPG was the best predictor variable for sleep-onset latency (compared with core body temperature or its rate of change, heart rate, melatonin onset, and subjective sleepiness ratings). This study provides evidence that selective vasodilation of distal skin regions (and hence heat loss) promotes the rapid onset of sleep. PMID:10712296
Kräuchi, K; Cajochen, C; Werth, E; Wirz-Justice, A
Besides several risk factors for suicide, there is a recent increase in clinical and epidemiological studies pointing to a potential relationship between sleep loss or sleep disturbances and suicidality. This work, based on a systematic literature research, gives an overview on the findings of relationships between suicidality (i. e., suicidal thoughts, suicide attempts, suicides) and sleep disturbances, especially insomnia, nightmares, but also hypersomnia and nocturnal panic attacks. There is evidence that sleep disturbances in suicidal insomniacs with comorbid psychiatric disorder are independently predictive for suicidality, too. Shared aspects of pathogenesis of the two entities and therapeutic options are also discussed. Recognition of sleep disturbances is essential for suicide prevention in clinical practice. PMID:24081516
Norra, C; Richter, N
Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is an uncommon, idiopathic partial epilepsy characterized by clusters of motor seizures occurring in sleep. We describe a mutation of the beta2 subunit of the nicotinic acetylcholine receptor, effecting a V287M substitution within the M2 domain. The mutation, in an evolutionary conserved region of CHRNB2, is associated with ADNFLE in a Scottish family. Functional receptors with the V287M mutation are highly expressed in Xenopus oocytes and characterized by an approximately 10-fold increase in acetylcholine sensitivity. CHRNB2 is a new gene for idiopathic epilepsy, the second acetylcholine receptor subunit implicated in ADNFLE. PMID:11104662
Phillips, H A; Favre, I; Kirkpatrick, M; Zuberi, S M; Goudie, D; Heron, S E; Scheffer, I E; Sutherland, G R; Berkovic, S F; Bertrand, D; Mulley, J C
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
Divergence of primitive sleep into REM and NREM states is thought to have occurred in the nocturnal Triassic ancestors of mammals as a natural accompaniment of the evolution of warm-bloodedness. As ambient temperatures during twilight portions of primitive sleep traversed these evolving ancestors' core temperature, mechanisms of thermoregulatory control that employ muscle contractions became superfluous. The resulting loss of need for such contractions during twilight sleep led to muscle atonia. With muscle tone absent, selection favored the persistence of the fast waves of nocturnal activity during twilight sleep. Stimulations by these waves reinforce motor circuits at the increasing temperatures of evolving warm-bloodedness without leading to sleep-disturbing muscle contractions. By these and related interlinked adaptations, twilight sleep evolved into REM sleep. The daytime period of sleep became NREM sleep. The evolution of NREM and REM sleep following this scenario has implications for sleep's maintenance processes for long-term memories. During NREM sleep, there is an unsynchronized, uncoordinated stimulation and reinforcement of individual distributed component circuits of consolidated memories by slow wave potentials, a process termed 'uncoordinated reinforcement'. The corresponding process during REM sleep is the coordinated stimulation and reinforcement of these circuits by fast wave potentials. This action temporally binds the individual component circuit outputs into fully formed memories, a process termed 'coordinated reinforcement'. Sequential uncoordinated and coordinated reinforcement, that is, NREM followed by REM sleep, emerges as the most effective mechanism of long-term memory maintenance in vertebrates. With the evolution of this two-stage mechanism of long-term memory maintenance, it became adaptive to partition sleep into several NREM-REM cycles, thereby achieving a more lengthy application of the cooperative sequential actions. PMID:12667495
Lee Kavanau, J
Background Prior studies suggest that obstructive sleep apnea may be associated with gastroesophageal reflux disease, a strong risk factor for Barrett’s esophagus. The goals of this pilot case–control study were to determine whether Barrett’s esophagus patients have an increased likelihood of obstructive sleep apnea and to determine whether nocturnal gastroesophageal reflux symptoms affect the relationship between Barrett’s esophagus and obstructive sleep apnea risk. Methods Patients with Barrett’s esophagus completed the Berlin Questionnaire, a validated survey instrument identifying subjects at high risk for obstructive sleep apnea. Two outpatient control groups were recruited: 1) EGD Group, subjects matched to Barrett’s esophagus cases by age, race, and gender with esophagogastroduodenoscopy negative for Barrett’s esophagus; and 2) Colonoscopy Group, patients getting colonoscopy. Rates of scoring at high risk for obstructive sleep apnea were compared. Respondents were also questioned regarding severity of their typical gastroesophageal reflux symptoms and presence of nocturnal gastroesophageal reflux symptoms. Results The study included 287 patients (54 Barrett’s esophagus, 62 EGD, and 171 colonoscopy subjects). Barrett’s esophagus patients were slightly older than colonoscopy patients and more obese. 56% (n = 30) of Barrett’s esophagus subjects scored at high risk for obstructive sleep apnea, compared with 42% (n = 26) of EGD subjects (OR 1.73, 95% CI [0.83, 3.62]) and 37% (n = 64) of colonoscopy patients (OR 2.08, 95% CI [1.12, 3.88]). The association between Barrett’s esophagus and scoring at high risk for obstructive sleep apnea compared with colonoscopy patients disappeared after adjusting for age. Barrett’s esophagus patients reported more severe typical heartburn and regurgitation symptoms than either control group. Among all subjects, patients with nocturnal reflux symptoms were more likely to score at high risk for obstructive sleep apnea than patients without nocturnal reflux. Conclusions In this pilot study, a high proportion of Barrett’s esophagus subjects scored at high risk for obstructive sleep apnea. Having Barrett’s esophagus was associated with more severe gastroesophageal reflux symptoms, and nocturnal reflux symptoms were associated with scoring at high risk for obstructive sleep apnea. The need for obstructive sleep apnea screening in Barrett’s esophagus patients with nocturnal gastroesophageal reflux symptoms should be further evaluated.
Impaired sleep, particularly in the context of sleep-disordered breathing (SDB), is associated with a vast array of comorbidities, including obesity. It is well known that the etiology of obesity is both complex and multifactorial. Recent trends have shown that obesity rates have risen at an alarming rate in children, and this has likely contributed to an increased prevalence of SDB in children. Like the ‘chicken and the egg’ hypothesis, the temporal relationship of obesity and SDB is unclear but it is speculated that these two conditions converge to promote a fundamental disruption to normal lipid homeostasis. In this review, the effect of sleep disruption and SDB on lipid homeostasis in both murine and human models will be critically examined, with the intent of demonstrating that disrupted sleep in children is itself a precursor to obesity via disordered lipid homeostasis.
Bhattacharjee, Rakesh; Hakim, Fahed; Gozal, David
Type 2 diabetes mellitus (T2DM) is complex metabolic disease that arises as a consequence of interactions between genetic predisposition and environmental triggers. One recently described environmental trigger associated with development of T2DM is disturbance of circadian rhythms due to shift work, sleep loss, or nocturnal lifestyle. However, the underlying mechanisms behind this association are largely unknown. To address this, the
John E. Gale; Heather I. Cox; Jingyi Qian; Gene D. Block; Christopher S. Colwell; Aleksey V. Matveyenko
Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome.
Rocco, Michael V.; Lockridge, Robert S.; Beck, Gerald J.; Eggers, Paul W.; Gassman, Jennifer J.; Greene, Tom; Larive, Brett; Chan, Christopher T.; Chertow, Glenn M.; Copland, Michael; Hoy, Christopher D.; Lindsay, Robert M.; Levin, Nathan W.; Ornt, Daniel B.; Pierratos, Andreas; Pipkin, Mary F.; Rajagopalan, Sanjay; Stokes, John B.; Unruh, Mark L.; Star, Robert A.; Kliger, Alan S.
With their highly sensitive visual systems, nocturnal insects have evolved a remarkable capacity to discriminate colors, orient themselves using faint celestial cues, fly unimpeded through a complicated habitat, and navigate to and from a nest using learned visual landmarks. Even though the compound eyes of nocturnal insects are significantly more sensitive to light than those of their closely related diurnal relatives, their photoreceptors absorb photons at very low rates in dim light, even during demanding nocturnal visual tasks. To explain this apparent paradox, it is hypothesized that the necessary bridge between retinal signaling and visual behavior is a neural strategy of spatial and temporal summation at a higher level in the visual system. Exactly where in the visual system this summation takes place, and the nature of the neural circuitry that is involved, is currently unknown but provides a promising avenue for future research. PMID:20822443
Warrant, Eric; Dacke, Marie
Sleep is a fundamental component of good health, however its promotion in acute hospital settings does not appear to be a priority. This literature review, which considered qualitative and quantitative research methodology, aimed to determine the factors that affect the quality of sleep experienced by patients in hospital, and the effects of sleep deprivation on the health and wellbeing of these individuals. Causes of sleep disruption are varied and include environmental and bio-cognitive factors, including pain, bright light, noise, anxiety and stress. The environmental and bio-cognitive consequences of sleep deprivation on the health and recovery of hospital inpatients are outlined. PMID:23924135
Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem and zaleplon, have fewer side effects, yet good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines). Nonpharmacologic behavioral methods may also have therapeutic benefit. An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including a