Reports on Polysomnograph Combined with Long-term Video Electroencephalogram for Monitoring Nocturnal Sleep-breath Events in 82 Epileptic Patients

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Hongliang Li

2013-06-01

Full Text Available Objective: To investigate the effects of epileptic discharges in sleep of epileptic patients on sleepbreath events. Methods: Polysomnograph (PSG and long-term video electroencephalogram (LTVEEG were used to monitor 82 adult epileptic patients. The condition of paroxysmal events in nocturnal sleep was analyzed, and the epileptiform discharge and effects of antiepileptic drugs were explored. Results: In epileptic group, latency to persistent sleep (LPS and REM sleep latency increased, the proportion of light sleep increased while that of deep sleep decreased, sleep efficiency reduced, nocturnal arousal times increased and apnea hyponea indexes (AHI improved, which demonstrated significant differences by comparison to control group. Periodic leg movements (PLM had no conspicuous differences compared with control group. There were no specific effects of epileptiform discharge and antiepileptic drugs on AHI and PLM indexes. Conclusion: Epileptic patients have sleep structure disorders and sleep-disordered breathing, and arousal, respiratory and leg movement events influence mutually. Synchronous detection of PSG combined with LTVEEG is in favor of comprehensively analyzing the relationship between sleep structures and epilepsy-breath events.

Delayed Diagnosis, Range of Severity, and Multiple Sleep Comorbidities: A Clinical and Polysomnographic Analysis of 100 Patients of the Innsbruck Narcolepsy Cohort

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Frauscher, Birgit; Ehrmann, Laura; Mitterling, Thomas; Gabelia, David; Gschliesser, Viola; Brandauer, Elisabeth; Poewe, Werner; Högl, Birgit

2013-01-01

Study Objectives: Narcolepsy is reported to affect 26-56/100,000 in the general population. We aimed to describe clinical and polysomnographic features of a large narcolepsy cohort in order to comprehensively characterize the narcoleptic spectrum. Methods: We performed a chart- and polysomnographybased review of all narcolepsy patients of the Innsbruck narcolepsy cohort. Results: A total of 100 consecutive narcolepsy patients (87 with cataplexy [NC], 13 without cataplexy [N]) were included in the analysis. All subjects had either excessive daytime sleepiness or cataplexy as their initial presenting clinical feature. Age at symptom onset was 20 (6-69) years. Diagnostic delay was 6.5 (0-39) years. The complete narcolepsy tetrad was present in 36/100 patients; 28/100 patients had three cardinal symptoms; 29/100 had two; and 7/100 had only excessive daytime sleepiness. Severity varied broadly with respect to excessive daytime sleepiness (median Epworth Sleepiness Scale score: 18, range 10-24), cataplexy (8-point Likert scale: median 4.5, range 1-8), hypnagogic hallucinations (median 4.5, range 1-7), and sleep paralysis (median 3, range 1-7). Sleep comorbidity was highly prevalent and ranged from sleeprelated movement disorders (n = 55/100), parasomnias (n = 34/100), and sleeprelated breathing disorders (n = 24/100), to insomnia (n = 28/100). REM sleep without atonia or a periodic limb movement in sleep index > 5/h were present in most patients (90/100 and 75/100). A high percentage of narcoleptic patients in the present study had high frequency leg movements (35%) and excessive fragmentary myoclonus (22%). Of the narcolepsy patients with clinical features of REM sleep behavior disorder (RBD), 76.5% had EMG evidence for RBD on the multiple sleep latency test (MSLT), based on a standard cutoff of a minimum of 18% of 3-sec miniepochs. Conclusion: This study is one of the largest monocentric polysomnographic studies to date of patients with narcolepsy and confirms the

The Relationship between Perceived Sleep Quality, Polysomnographic Measures and Depressive Symptoms in Chemically-Injured Veterans: A Pilot Study.

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Moshkani Farahani, Davood; Tavallaie, Abbas; Vahedi, Ensieh; Rezaiemaram, Peyman; Naderi, Zohreh; Talaie, Akram

2014-07-01

Sleep complaints are common among Iranian chemically-injured veterans. The growing body of research has investigated (in) equalities between such subjective complaints and objective sleep records. Moreover, sleep complaints are associated with depressive symptoms. Depressive symptoms, also, have been frequently reported in chemically-injured veterans. Therefore, the purpose of this pilot study was to investigate the relationship between perceived sleep quality, polysomnographic measures and depressive symptoms in Iranian veterans with chemical injuries. In this pilot study, 35 Iranian veterans with chemical injuries complaining of a sleep problem were selected. Initially, participants were evaluated via all-night polysomnography, then, they completed the research questionnaires. Collected data were analyzed using Pearson correlation coefficients. Data analyses showed that there was no significant correlation between many of self-reposted variables and polysomnogaphic recordings, however, remarkable relationships were found between the Pittsburgh Sleep Quality Index and the Beck Depression Inventory scores. The findings indicated that sleep complaints of chemically-injured veterans are not equivalent to objective sleep disturbances, however, these complaints are largely associated with level of depression. This study emphasizes the important role of mood in sleep evaluation. Further, the findings suggest using a combination of both subjective and objective measures for accurate assessment of sleep quality in Iranian veterans with chemical injuries (i.e., multimethod approach).

Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome.

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Caparroz, Fábio Azevedo; Campanholo, Milena de Almeida Torres; Regina, Caroline Gomez; Park, Sung Woo; Haddad, Leonardo; Gregório, Luís Carlos; Haddad, Fernanda Louise Martinho

2018-04-14

Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p=0.05). The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS). Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. All rights reserved.

The Relationship between Perceived Sleep Quality, Polysomnographic Measures and Depressive Symptoms in Chemically-Injured Veterans: A Pilot Study.

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Davood Moshkani Farahani

2014-09-01

Full Text Available Sleep complaints are common among Iranian chemically-injured veterans. The growing body of research has investigated (in equalities between such subjective complaints and objective sleep records. Moreover, sleep complaints are associated with depressive symptoms. Depressive symptoms, also, have been frequently reported in chemically-injured veterans. Therefore, the purpose of this pilot study was to investigate the relationship between perceived sleep quality, polysomnographic measures and depressive symptoms in Iranian veterans with chemical injuries.In this pilot study, 35 Iranian veterans with chemical injuries complaining of a sleep problem were selected. Initially, participants were evaluated via all-night polysomnography, then, they completed the research questionnaires. Collected data were analyzed using Pearson correlation coefficients.Data analyses showed that there was no significant correlation between many of self-reposted variables and polysomnogaphic recordings, however, remarkable relationships were found between the Pittsburgh Sleep Quality Index and the Beck Depression Inventory scores.The findings indicated that sleep complaints of chemically-injured veterans are not equivalent to objective sleep disturbances, however, these complaints are largely associated with level of depression. This study emphasizes the important role of mood in sleep evaluation. Further, the findings suggest using a combination of both subjective and objective measures for accurate assessment of sleep quality in Iranian veterans with chemical injuries (i.e., multimethod approach.

Clinical, polysomnographic, and CPAP titration features of obstructive sleep apnea: Mixed versus purely obstructive type.

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Lee, Sang-Ahm; Lee, Gha-Hyun; Chung, Yoo-Sam; Kim, Woo Sung

2015-08-15

To determine whether obstructive sleep apnea syndrome (OSAS) patients with mixed sleep apnea (MSA) have different clinical, polysomnographic, and continuous positive airway pressure (CPAP) titration findings compared to OSAS patients without MSA. We retrospectively reviewed the records of OSAS patients who had undergone CPAP titration and categorized them into pure-OSA and mixed-OSA groups. Demographic features, daytime sleepiness, and apnea severity were compared between the two groups using univariate and multivariate analyses. CPAP titration findings were also compared between the two groups. One hundred and ninety-five subjects (n=126 pure-OSA; n=69 mixed-OSA) were included in the analysis. Compared to the pure-OSA group, the mixed-OSA group had a higher percentage of males (p=0.003) and a higher body mass index (p=0.044), Epworth Sleepiness Scale score (p=0.028), and apnea-hypopnea index (AHI) (ptitration, and a higher titrated pressure than the pure-OSA group. Severe OSA, older age, male sex, obesity, and daytime sleepiness were related to mixed-OSA. Complex sleep apnea, less optimal titration, and a higher titrated CPAP were also associated with MSA in OSAS patients. Copyright © 2015 Elsevier B.V. All rights reserved.

Assessment Of Noise-induced Sleep Fragility In Two Age Ranges By Means Of Polysomnographic Microstructure

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Terzano, M. G.; Parrino, L.; Spaggiari, M. C.; Buccino, G. P.; Fioriti, G.; Depoortere, H.

1993-04-01

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

Effects of Homeopathic Medicines on Polysomnographic Sleep of Young Adults with Histories of Coffee-Related Insomnia

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Bell, Iris R.; Howerter, Amy; Jackson, Nicholas; Aickin, Mikel; Baldwin, Carol M.; Bootzin, Richard R.

2010-01-01

Background Homeopathy, a common form of alternative medicine worldwide, relies on subjective patient reports for diagnosis and treatment. Polysomnography offers a modern methodology for evaluating the objective effects of taking homeopathic remedies that clinicians claim exert effects on sleep quality in susceptible individuals. Animal studies have previously shown changes in non rapid eye movement sleep with certain homeopathic remedies. Methods Young adults of both sexes (ages 18–31) with above-average scores on standardized personality scales for either cynical hostility or anxiety sensitivity (but not both), and a history of coffee-induced insomnia, participated in the month-long study. At-home polysomnographic recordings were obtained on successive pairs of nights once per week for a total of eight recordings (nights 1, 2, 8, 9, 15, 16, 22, 23). Subjects (N=54) received placebo pellets on night 8 (single-blind) and verum pellets on night 22 (double-blind) in 30c doses of one of two homeopathic remedies, Nux Vomica or Coffea Cruda. Subjects completed daily morning sleep diaries and weekly Pittsburgh Sleep Quality Index scales, as well as Profile of Mood States Scales at bedtime on polysomnography nights. Results Verum remedies significantly increased PSG total sleep time and NREM, as well as awakenings and stage changes. Changes in actigraphic and self-rated scale effects were not significant. Conclusions The study demonstrated the feasibility of using in-home all-night sleep recordings to study homeopathic remedy effects. Findings are similar though not identical to those reported in animals with the same remedies. Possible mechanisms include initial disruption of the nonlinear dynamics of sleep patterns by the verum remedies. PMID:20673648

Associations of sedentary time and moderate-vigorous physical activity with sleep-disordered breathing and polysomnographic sleep in community-dwelling adults.

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Kline, Christopher E; Krafty, Robert T; Mulukutla, Suresh; Hall, Martica H

2017-05-01

The purpose of this study was to evaluate the relationship between daytime activity (sedentary time, moderate- to vigorous-intensity physical activity [MVPA]) and indices of polysomnographically (PSG) assessed sleep, including sleep-disordered breathing (SDB). One hundred and thirty-six adults (65% female, 59.8 ± 9.1 years, body mass index [BMI] 30.3 ± 6.9 kg m -2 ) provided daily estimates of time spent in light-, moderate-, and vigorous-intensity activity for 6-14 days (mean 9.9 ± 1.8 days) prior to laboratory PSG. Daily sedentary time was calculated as the amount of time spent awake and not in light-, moderate-, or vigorous-intensity activity; time spent in moderate- and vigorous-intensity activity were combined for MVPA. Indices of PSG sleep included timing (sleep midpoint), duration (total sleep time), continuity (sleep efficiency), depth (% slow-wave sleep), and SDB (apnea-hypopnea index [AHI]). Using median splits of sedentary time and MVPA, analyses of covariance examined their relationship with sleep following adjustment for age, sex, race, employment, education, BMI, existing cardiovascular disease, depression history, and mean daily wake time. Binary logistic regression examined the odds of having at least mild-severity SDB (AHI ≥ 5) according to sedentary time, MVPA, and their combination. Adults with above-median sedentary time (i.e., >841.9 min/day) had significantly greater AHI (P = .04) and lower odds of mild SDB (P = .03) compared to adults with low sedentary time; adults with high MVPA (>30.5 min/day) had significantly lower AHI compared to adults with low MVPA (P = .04). When examined in the same model, adults with high sedentary time and low MVPA had significantly higher AHI (P < .01) and higher odds of having mild SDB (P = .03) than all the other groups. No other sleep measures were related to sedentary time, MVPA, or their combination. Sedentary time and MVPA were associated with SDB. Whether reducing sedentary

Impact of Polysomnographic Parameters on Continuous Positive Airway Pressure in Patient with Obstructive Sleep Apnea in 2012

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Abolfazl Mozafari

2014-06-01

Full Text Available Background & objectives : O bstructive sleep apnea is a preventable and prevalent major health hazard with serious health consequences including excessive daytime sleepiness, cognitive disturbances, depression, cardiovascular diseases and hypertension. Obstructive sleep apnea is a disorder affecting 2 to 4% of the adult population. The continuous positive airway pressur e (CPAP i s the most efficacious therapy and is often the first option for these patients. The pressure titration during laboratory polysomnography is required for treatment by CPAP.   Methods: The patients with obstructive sleep apnea requiring continuous positive airway pressure treatment were selected . CPAP titration was done according to American Academy of Sleep Medicine protocol. Comparison among continuous positive airway pressure with polysomnographic parameters was performed and analyzed with Pearson correlation coefficient. For analysis of qualitative parameters, we used chi-square and then checked with SPSS version 18 software.   Results: From 125 patients with obstructive sleep apnea, there were 112 cases with inclusion criteria. Mean age of participants was 55.07 ± 12, male frequency was 59.2%, apnea hypopnea index was 43.62 and mean continuous positive airway pressure was 12.50 . There was significant relationship among the pressure of continuous positive airway pressure with apnea hypopnea index (P=0.028, arousal index (P=0.011, body mass index (P=0.041 and O2 desaturation index (P=0.022, although age was not significantly related.   Conclusion: In accordance to this data, we found out a prediction equation for optimal CPAP in our patients

Polysomnographic Sleep Dysregulation in Cocaine Dependence

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Edwin M. Valladares

2007-01-01

Full Text Available Insomnia and sleep disturbance are associated with declines in health functioning, alongwith increases in mortality risk. Given the prominence of reported sleep disturbance incocaine-dependent subjects and persistence into recovery, understanding the natureand severity of these disturbances in this population may help to identify relevantpathways that contribute to the increased mortality in cocaine dependence. Polysomnography provides a means of objectively characterizing sleep and, in turn, sleep disturbances. Few studies have used polysomnography to evaluate sleep incocaine-dependent persons, yet these studies have the potential to advance treatmentsthat will ultimately reduce morbidity in cocaine-dependent subjects.

Automatic sleep scoring in normals and in individuals with neurodegenerative disorders according to new international sleep scoring criteria

DEFF Research Database (Denmark)

Jensen, Peter S.; Sørensen, Helge Bjarup Dissing; Jennum, P. J.

2010-01-01

Medicine (AASM). Methods: A biomedical signal processing algorithm was developed, allowing for automatic sleep depth quantification of routine polysomnographic (PSG) recordings through feature extraction, supervised probabilistic Bayesian classification, and heuristic rule-based smoothing. The performance......Introduction: Reliable polysomnographic classification is the basis for evaluation of sleep disorders in neurological diseases. Aim: To develop a fully automatic sleep scoring algorithm on the basis of a reproduction of new international sleep scoring criteria from the American Academy of Sleep....... Conclusion: The developed algorithm was capable of scoring normal sleep with an accuracy around the manual inter-scorer reliability, it failed in accurately scoring abnormal sleep as encountered for the PD/MSA patients, which is due to the abnormal micro- and macrostructure pattern in these patients....

[Daytime tiredness correlated with nocturnal respiratory and arousal variables in patients with sleep apnea: polysomnographic and EEG mapping studies].

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Saletu, M; Hauer, C; Anderer, P; Saletu-Zyhlarz, G; Gruber, G; Oberndorfer, S; Mandl, M; Popovic, R; Saletu, B

2000-03-24

There is evidence that daytime tiredness is caused by apnea/hypopnea with oxygen desaturation and/or by sleep fragmentation due to arousals. The aim of this study was to investigate objective and subjective sleep and awakening quality and daytime vigilance--objectified by midmorning mapping of vigilance-controlled EEG (V-EEG)--in sleep apnea patients (N: 18), as compared with age- and sex-matched normal controls (N: 18) as well as to correlate nocturnal respiratory distress and arousals to daytime brain function. Statistical analyses demonstrated a deterioration in subjective and objective sleep and awakening quality in apnea patients. Midmorning V-EEG mapping in apnea patients exhibited less total power, more delta and theta, less alpha and beta activity, as well as a slower dominant frequency and centroid of the total activity compared to controls, which suggests a vigilance decrement. The Spearman rank correlation between 6 polysomnographically registered respiratory variables and 36 diurnal quantitative EEG measures demonstrated the following: the higher the apnea, apnea-hypopnea, snoring and desaturation indices and the lower the minimum and average low oxygen saturation, the more pronounced was diurnal tiredness. Eleven arousal measures based on ASDA criteria showed the following significant correlations: the higher the nocturnal arousal index and the more arousals due to hypopneas, the greater was daytime tiredness. On the other hand, the greater the average frequency change during arousals and the more spontaneous arousals, the better was daytime vigilance. Our findings show that, in contrast to the lengthy Multiple Sleep Latency (MSLT) and Maintenance of Wakefulness (MWT) tests which evaluate sleep pressure under resting conditions conducive to sleep, V-EEG mapping provides a brief objective measure of a sleep apnea patient's daytime tiredness under conditions of wakefulness more appropriate to reflect the patient's everyday life.

Sleep-related laryngospasm

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Flavio S. Aloe

1995-03-01

Full Text Available Seven patients (mean age 46.6; range 33-58; 6M.1F presented with sleep-related choking episodes and were found to have features in common that distinguished them from other known causes of choking episodes during sleep. The characteristic features include: an awakening from sleep with an acute choking sensation, stridor, panic, tachycardia, short duration of episode Gess than 60 seconds, infrequent episodes (typically less than 1 per month, and absence of any known etiology. The disorder most commonly occurs in middle-aged males who are otherwise healthy. In one patient an episode of laryngospasm was polysomnographically documented to occur during stage 3. The clinical features and the polysomnographic findings suggest spasm of the vocal cords of unknown etiology.

The scoring of movements in sleep.

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Walters, Arthur S; Lavigne, Gilles; Hening, Wayne; Picchietti, Daniel L; Allen, Richard P; Chokroverty, Sudhansu; Kushida, Clete A; Bliwise, Donald L; Mahowald, Mark W; Schenck, Carlos H; Ancoli-Israel, Sonia

2007-03-15

The International Classification of Sleep Disorders (ICSD-2) has separated sleep-related movement disorders into simple, repetitive movement disorders (such as periodic limb movements in sleep [PLMS], sleep bruxism, and rhythmic movement disorder) and parasomnias (such as REM sleep behavior disorder and disorders of partial arousal, e.g., sleep walking, confusional arousals, night terrors). Many of the parasomnias are characterized by complex behaviors in sleep that appear purposeful, goal directed and voluntary but are outside the conscious awareness of the individual and therefore inappropriate. All of the sleep-related movement disorders described here have specific polysomnographic findings. For the purposes of developing and/or revising specifications and polysomnographic scoring rules, the AASM Scoring Manual Task Force on Movements in Sleep reviewed background literature and executed evidence grading of 81 relevant articles obtained by a literature search of published articles between 1966 and 2004. Subsequent evidence grading identified limited evidence for reliability and/or validity for polysomnographic scoring criteria for periodic limb movements in sleep, REM sleep behavior disorder, and sleep bruxism. Published scoring criteria for rhythmic movement disorder, excessive fragmentary myoclonus, and hypnagogic foot tremor/alternating leg muscle activation were empirical and based on descriptive studies. The literature review disclosed no published evidence defining clinical consequences of excessive fragmentary myoclonus or hypnagogic foot tremor/alternating leg muscle activation. Because of limited or absent evidence for reliability and/or validity, a standardized RAND/UCLA consensus process was employed for recommendation of specific rules for the scoring of sleep-associated movements.

PSG-EXPERT. An expert system for the diagnosis of sleep disorders.

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Fred, A; Filipe, J; Partinen, M; Paiva, T

2000-01-01

This paper describes PSG-EXPERT, an expert system in the domain of sleep disorders exploring polysomnographic data. The developed software tool is addressed from two points of view: (1)--as an integrated environment for the development of diagnosis-oriented expert systems; (2)--as an auxiliary diagnosis tool in the particular domain of sleep disorders. Developed over a Windows platform, this software tool extends one of the most popular shells--CLIPS (C Language Integrated Production System) with the following features: backward chaining engine; graph-based explanation facilities; knowledge editor including a fuzzy fact editor and a rules editor, with facts-rules integrity checking; belief revision mechanism; built-in case generator and validation module. It therefore provides graphical support for knowledge acquisition, edition, explanation and validation. From an application domain point of view, PSG-Expert is an auxiliary diagnosis system for sleep disorders based on polysomnographic data, that aims at assisting the medical expert in his diagnosis task by providing automatic analysis of polysomnographic data, summarising the results of this analysis in terms of a report of major findings and possible diagnosis consistent with the polysomnographic data. Sleep disorders classification follows the International Classification of Sleep Disorders. Major features of the system include: browsing on patients data records; structured navigation on Sleep Disorders descriptions according to ASDA definitions; internet links to related pages; diagnosis consistent with polysomnographic data; graphical user-interface including graph-based explanatory facilities; uncertainty modelling and belief revision; production of reports; connection to remote databases.

Clinical and polysomnographic characteristics of patients with REM sleep disordered breathing

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Cláudia Chaves Loureiro

2009-09-01

Full Text Available There is a 10–36% rate of obstructive sleep apnoea syndrome (OSAS associated with rapid eye movement (REM in the OSAS population. Prior studies have suggested an increased prevalence of psychiatric disorders and an effect of gender and age on these patients.Our aim was to study the clinical and polysomnograph (PSG characteristics of our patients with REM-related sleep disordered breathing (REM SDB.Inclusion criteria was the identification of REM SDB detected by PSG defined as apnea-hypopnea index (AHI in REM sleep ≥ 5 h, AHI in non-REM sleep (NREM ≤ 15 h and REM/NREM AHI ≥ 2.Several Sleep Disorders Questionnaire (SDQ version 1.02 parameters were analysed.The study comprised 19 patients with a mean age of 54.0 (SD ± 13.97, a mean BMI of 29.01 (SD ± 4.10 and a 0.58 female / male ratio. The mean Epworth Sleepiness Scale score was 12.74 (SD ± 4.86. Mean AHI was 9.16/h (SD 4.09; mean AHI in REM sleep 37.08/h (SD 25.87 and mean REM-AHI/NREM-AHI 8.86 (SD 8.63.The anxiety disorder rate was 33.3%; 44.4% in females, 16.7% in males.The average deep sleep was 20.7% (SD 10.42 and REM sleep 15.45% (SD 9.96, with a sleep efficiency of 85.3 (SD 8.70.No significant statistical correlation was found between the REM/NREM AHI index and anxiety symptoms, daytime sleepiness and sleep quality (REM and deep sleep percentages.These patients differ from the general OSAS population: on average, they are not obese, there are a greater number of females affected and they do not present a very significant diurnal hypersomnia. Reduced deep sleep and increased REM sleep were also present versus general population data, and sleep efficiency was just below the normal limit.Anxiety disorders were more prevalent in this group than described for the general population (3% and OSAS patients. Resumo: A síndroma de apneia obstrutiva do sono (SAOS associada ao sono REM tem uma incidência de 10–36% na

Quantifying the Arousal Threshold Using Polysomnography in Obstructive Sleep Apnea.

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Sands, Scott A; Terrill, Philip I; Edwards, Bradley A; Taranto Montemurro, Luigi; Azarbarzin, Ali; Marques, Melania; de Melo, Camila M; Loring, Stephen H; Butler, James P; White, David P; Wellman, Andrew

2018-01-01

Precision medicine for obstructive sleep apnea (OSA) requires noninvasive estimates of each patient's pathophysiological "traits." Here, we provide the first automated technique to quantify the respiratory arousal threshold-defined as the level of ventilatory drive triggering arousal from sleep-using diagnostic polysomnographic signals in patients with OSA. Ventilatory drive preceding clinically scored arousals was estimated from polysomnographic studies by fitting a respiratory control model (Terrill et al.) to the pattern of ventilation during spontaneous respiratory events. Conceptually, the magnitude of the airflow signal immediately after arousal onset reveals information on the underlying ventilatory drive that triggered the arousal. Polysomnographic arousal threshold measures were compared with gold standard values taken from esophageal pressure and intraoesophageal diaphragm electromyography recorded simultaneously (N = 29). Comparisons were also made to arousal threshold measures using continuous positive airway pressure (CPAP) dial-downs (N = 28). The validity of using (linearized) nasal pressure rather than pneumotachograph ventilation was also assessed (N = 11). Polysomnographic arousal threshold values were correlated with those measured using esophageal pressure and diaphragm EMG (R = 0.79, p < .0001; R = 0.73, p = .0001), as well as CPAP manipulation (R = 0.73, p < .0001). Arousal threshold estimates were similar using nasal pressure and pneumotachograph ventilation (R = 0.96, p < .0001). The arousal threshold in patients with OSA can be estimated using polysomnographic signals and may enable more personalized therapeutic interventions for patients with a low arousal threshold. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Genetic variants associated with sleep disorders.

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Kripke, Daniel F; Kline, Lawrence E; Nievergelt, Caroline M; Murray, Sarah S; Shadan, Farhad F; Dawson, Arthur; Poceta, J Steven; Cronin, John; Jamil, Shazia M; Tranah, Gregory J; Loving, Richard T; Grizas, Alexandra P; Hahn, Elizabeth K

2015-02-01

The diagnostic boundaries of sleep disorders are under considerable debate. The main sleep disorders are partly heritable; therefore, defining heritable pathophysiologic mechanisms could delineate diagnoses and suggest treatment. We collected clinical data and DNA from consenting patients scheduled to undergo clinical polysomnograms, to expand our understanding of the polymorphisms associated with the phenotypes of particular sleep disorders. Patients at least 21 years of age were recruited to contribute research questionnaires, and to provide access to their medical records, saliva for deoxyribonucleic acid (DNA), and polysomnographic data. From these complex data, 38 partly overlapping phenotypes were derived indicating complaints, subjective and objective sleep timing, and polysomnographic disturbances. A custom chip was used to genotype 768 single-nucleotide polymorphisms (SNPs). Additional assays derived ancestry-informative markers (eg, 751 participants of European ancestry). Linear regressions controlling for age, gender, and ancestry were used to assess the associations of each phenotype with each of the SNPs, highlighting those with Bonferroni-corrected significance. In peroxisome proliferator-activated receptor gamma, coactivator 1 beta (PPARGC1B), rs6888451 was associated with several markers of obstructive sleep apnea. In aryl hydrocarbon receptor nuclear translocator-like (ARNTL), rs10766071 was associated with decreased polysomnographic sleep duration. The association of rs3923809 in BTBD9 with periodic limb movements in sleep was confirmed. SNPs in casein kinase 1 delta (CSNK1D rs11552085), cryptochrome 1 (CRY1 rs4964515), and retinoic acid receptor-related orphan receptor A (RORA rs11071547) were less persuasively associated with sleep latency and time of falling asleep. SNPs associated with several sleep phenotypes were suggested, but due to risks of false discovery, independent replications are needed before the importance of these associations

Relationships between questionnaire ratings of sleep quality and polysomnography in healthy adults

NARCIS (Netherlands)

Westerlund, A.; Trolle-Lagerros, Y.; Kecklund, L.G.; Axelsson, J.; Akerstedt, T.

2016-01-01

This study aimed to examine the association between polysomnographic sleep and subjective habitual sleep quality and restoration from sleep. Thirty-one normal sleepers completed the Karolinska Sleep Questionnaire and multiple home polysomnography recordings (n = 2-5). Using linear regression, sleep

Repetitive Arm Movements During Sleep: A Polysomnographic Assessment

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Mohammad Torabi-Nami

2016-07-01

Full Text Available Sleep-related movement disorders should be differentiated from parasomnias, sleep-associated behavioral disorders, and epilepsy. Polysomnography (PSG is the gold standard in evaluating such disorders. Periodic leg movement disorder during sleep (PLMS, hypnic jerks, bruxism, rhythmic movement disorder, restless legs syndrome, and nocturnal leg cramps have broadly been discussed in the literature. However, periodic arm movement disorder in sleep (PAMS is a less-appreciated entity perhaps because arm surface electromyography is not an integral part of the standard polysomnography. Results from our PSG study in a case suspected for PAMS prompted us to herewith discuss this problem.

The Sleep Disorder in Anti-lgLON5 Disease.

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Gaig, Carles; Iranzo, Alex; Santamaria, Joan; Graus, Francesc

2018-05-23

To review the clinical and polysomnographic features of the sleep disorder occurring in the recently described anti-IgLON5 disease. The hallmark of the disease is the presence of antibodies against IgLON5, a neural cell adhesion molecule of unknown function. The disease presents a robust HLA association, and the neuropathological examination shows a novel neuronal tauopathy with predominant hypothalamic and brainstem involvement. Most patients (> 80%) present sleep-related vocalizations with movements and behaviors and sleep-disordered breathing. Polysomnographic studies show (1) a complex NREM sleep parasomnia at sleep initiation characterized by undifferentiated NREM or poorly structured N2 sleep with sleep-talking or mumbling, and simple or finalistic movements followed by normal periods of N3 or N2 NREM sleep, (2) REM sleep behavior disorder (RBD), and (3) obstructive sleep apnea with stridor. The last two features appear mainly in periods where NREM sleep normalizes. Identification of the anti-IgLON5 sleep disorder is important to suspect the disease. The combination of abnormal NREM sleep initiation, followed by normal periods of NREM sleep and RBD, represents a novel parasomnia.

Head banging persisting during adolescence: A case with polysomnographic findings

Directory of Open Access Journals (Sweden)

Ravi Gupta

2014-01-01

Full Text Available Head banging is a sleep-related rhythmic movement disorder of unknown etiology. It is common during infancy; however, available literature suggests that prevalence decreases dramatically after childhood. We report the case of a 16-year-old male who presented with head banging. The symptoms were interfering with his functioning and he had been injured because of the same in the past. We are presenting the video-polysomnographic data of the case. Possible differential diagnoses, etiology, and treatment modalities are discussed. The boy was prescribed clonazepam and followed up for 3 months. Parents did not report any episode afterward.

The nocturnal panic attacks: polysomnographic features and comorbidities

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LI Yan-lin

2013-05-01

Full Text Available Background Panic disorder refers to the repeated or unexpected anxiety or panic attacks. It makes patients feel extreme pain. Although the episodes of most patients with panic disorder happen at daytime, the nocturnal panic attacks (NPA are quite common. Paients pay more attention to NPA. Insomnia is more serious in patients with NPA than those patients with panic disorder attack at daytime. Many patients may occur anxiety and avoidance behavior after NPA. Patients are often afraid of sleeping, or even do not sleep. The aim of this study is to analyze polysomnographic (PSG parameter changes and clinical concomitant symptoms of patietns with NPA, to explore the characteristics of sleep, in order to provide better diagnosis, differential diagnosis and treatment for these patients. Methods The features of sleep of 20 NPA patients and 23 healthy controls were monitored by video-PSG. Hamilton Anxiety Rating Scale (HAMA and Hamilton Depression Rating Scale (HAMD were used to assess the state of anxiety, depression, and dyssomnia of the patients. Results In comparison with normal control group, the NPA group showed shortened total sleep time (TST, decreased sleep efficiency (SE and sleep maintenance rate, delayed arousal time, increased number of arousal and number of arousal episode longer than 5 minutes, increased percentage of non-rapid eye movement (NREM sleep stage Ⅰ, decreased percentage of NREM sleep stageⅢ and percentage of rapid eye movement (REM sleep (P 0.05, for all. In NPA group, there were 13 cases (13/20 with anxiety, 17 (17/20 with depression, 13 cases/times (13/20 with difficulty of falling asleep, 17 cases/times (17/20 with difficulties in maintaining sleep (frequent arousals and difficult to fall asleep again and 7 cases/times (7/20 with wake up early. Conclusion NPA patients present decreased deep sleep, increased shallow sleep and poor sleep quality, and are mostly accompanied with mild or moderate depression and (or anxiety

Automatic sleep scoring: a search for an optimal combination of measures.

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Krakovská, Anna; Mezeiová, Kristína

2011-09-01

The objective of this study is to find the best set of characteristics of polysomnographic signals for the automatic classification of sleep stages. A selection was made from 74 measures, including linear spectral measures, interdependency measures, and nonlinear measures of complexity that were computed for the all-night polysomnographic recordings of 20 healthy subjects. The adopted multidimensional analysis involved quadratic discriminant analysis, forward selection procedure, and selection by the best subset procedure. Two situations were considered: the use of four polysomnographic signals (EEG, EMG, EOG, and ECG) and the use of the EEG alone. For the given database, the best automatic sleep classifier achieved approximately an 81% agreement with the hypnograms of experts. The classifier was based on the next 14 features of polysomnographic signals: the ratio of powers in the beta and delta frequency range (EEG, channel C3), the fractal exponent (EMG), the variance (EOG), the absolute power in the sigma 1 band (EEG, C3), the relative power in the delta 2 band (EEG, O2), theta/gamma (EEG, C3), theta/alpha (EEG, O1), sigma/gamma (EEG, C4), the coherence in the delta 1 band (EEG, O1-O2), the entropy (EMG), the absolute theta 2 (EEG, Fp1), theta/alpha (EEG, Fp1), the sigma 2 coherence (EEG, O1-C3), and the zero-crossing rate (ECG); however, even with only four features, we could perform sleep scoring with a 74% accuracy, which is comparable to the inter-rater agreement between two independent specialists. We have shown that 4-14 carefully selected polysomnographic features were sufficient for successful sleep scoring. The efficiency of the corresponding automatic classifiers was verified and conclusively demonstrated on all-night recordings from healthy adults. Copyright © 2011 Elsevier B.V. All rights reserved.

Sleep Apnoea Detection in Single Channel ECGs by Analyzing Heart Rate Dynamics

National Research Council Canada - National Science Library

Zywietz, C

2001-01-01

.... Sleep disorders are typically investigated by means of polysomnographic recordings. We have analyzed 70 eight-hour single-channel ECG recordings to find out to which extent sleep apneas may be detected from the ECG alone...

Objective measures of sleep and dim light melatonin onset in adolescents and young adults with delayed sleep phase disorder compared to healthy controls.

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Saxvig, Ingvild W; Wilhelmsen-Langeland, Ane; Pallesen, Ståle; Vedaa, Oystein; Nordhus, Inger H; Sørensen, Eli; Bjorvatn, Bjørn

2013-08-01

Delayed sleep phase disorder is characterized by a delay in the timing of the major sleep period relative to conventional norms. The sleep period itself has traditionally been described as normal. Nevertheless, it is possible that sleep regulatory mechanism disturbances associated with the disorder may affect sleep duration and/or architecture. Polysomnographic data that may shed light on the issue are scarce. Hence, the aim of this study was to examine polysomnographic measures of sleep in adolescents and young adults with delayed sleep phase disorder, and to compare findings to that of healthy controls. A second aim was to estimate dim light melatonin onset as a marker of circadian rhythm and to investigate the phase angle relationship (time interval) between dim light melatonin onset and the sleep period. Data from 54 adolescents and young adults were analysed, 35 diagnosed with delayed sleep phase disorder and 19 healthy controls. Results show delayed timing of sleep in participants with delayed sleep phase disorder, but once sleep was initiated no group differences in sleep parameters were observed. Dim light melatonin onset was delayed in participants with delayed sleep phase disorder, but no difference in phase angle was observed between the groups. In conclusion, both sleep and dim light melatonin onset were delayed in participants with delayed sleep phase disorder. The sleep period appeared to occur at the same circadian phase in both groups, and once sleep was initiated no differences in sleep parameters were observed. © 2013 European Sleep Research Society.

Monitoring sleep depth: analysis of bispectral index (BIS) based on polysomnographic recordings and sleep deprivation.

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Giménez, Sandra; Romero, Sergio; Alonso, Joan Francesc; Mañanas, Miguel Ángel; Pujol, Anna; Baxarias, Pilar; Antonijoan, Rosa Maria

2017-02-01

The assessment and management of sleep are increasingly recommended in the clinical practice. Polysomnography (PSG) is considered the gold standard test to monitor sleep objectively, but some practical and technical constraints exist due to environmental and patient considerations. Bispectral index (BIS) monitoring is commonly used in clinical practice for guiding anesthetic administration and provides an index based on relationships between EEG components. Due to similarities in EEG synchronization between anesthesia and sleep, several studies have assessed BIS as a sleep monitor with contradictory results. The aim of this study was to evaluate objectively both the feasibility and reliability of BIS for sleep monitoring through a robust methodology, which included full PSG recordings at a baseline situation and after 40 h of sleep deprivation. Results confirmed that the BIS index was highly correlated with the hypnogram (0.89 ± 0.02), showing a progressive decrease as sleep deepened, and an increase during REM sleep (awake: 91.77 ± 8.42; stage N1: 83.95 ± 11.05; stage N2: 71.71 ± 11.99; stage N3: 42.41 ± 9.14; REM: 80.11 ± 8.73). Mean and median BIS values were lower in the post-deprivation night than in the baseline night, showing statistical differences for the slow wave sleep (baseline: 42.41 ± 9.14 vs. post-deprivation: 39.49 ± 10.27; p = 0.02). BIS scores were able to discriminate properly between deep (N3) and light (N1, N2) sleep. BIS values during REM overlapped those of other sleep stages, although EMG activity provided by the BIS monitor could help to identify REM sleep if needed. In conclusion, BIS monitors could provide a useful measure of sleep depth in especially particular situations such as intensive care units, and they could be used as an alternative for sleep monitoring in order to reduce PSG-derived costs and to increase capacity in ambulatory care.

The role of sleep and sleep deprivation in consolidating fear memories.

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Menz, M M; Rihm, J S; Salari, N; Born, J; Kalisch, R; Pape, H C; Marshall, L; Büchel, C

2013-07-15

Sleep, in particular REM sleep, has been shown to improve the consolidation of emotional memories. Here, we investigated the role of sleep and sleep deprivation on the consolidation of fear memories and underlying neuronal mechanisms. We employed a Pavlovian fear conditioning paradigm either followed by a night of polysomnographically monitored sleep, or wakefulness in forty healthy participants. Recall of learned fear was better after sleep, as indicated by stronger explicitly perceived anxiety and autonomous nervous responses. These effects were positively correlated with the preceding time spent in REM sleep and paralleled by activation of the basolateral amygdala. These findings suggest REM sleep-associated consolidation of fear memory in the human amygdala. In view of the critical participation of fear learning mechanisms in the etiology of anxiety and post-traumatic stress disorder, deprivation of REM sleep after exposure to distressing events is an interesting target for further investigation. Copyright © 2013 Elsevier Inc. All rights reserved.

The exploding head syndrome: polysomnographic recordings and therapeutic suggestions.

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Sachs, C; Svanborg, E

1991-06-01

Attention has recently been drawn to a condition termed the exploding head syndrome, which is characterized by unpleasant, even terrifying sensations of flashing lights and/or sounds during reported sleep. Nine patients complaining of sensations of explosions in the head during sleep or drowsiness were investigated with polysomnographic recordings. None of them had any neurological disorder. Five patients reported explosions during the recording sessions. According to the recordings, the attacks always took place when the patients were awake and relaxed. In two cases abrupt electroencephalographic (EEG) and electromyographic changes indicating increasing alertness were recorded at the time of the reported attacks. In the remaining three cases no EEG changes were seen. Thus, there were no indications of an epileptic etiology to the condition. In all patients the symptoms ameliorated spontaneously with time. The severity of the symptoms was reduced by reassurance of the harmlessness of the condition. Clomipramine was prescribed to three patients who all reported immediate relief of symptoms. It is concluded that symptoms of this type are probably not true hypnagogic phenomena but may be an expression of emotional stress in the awake state.

Polysomnographic Findings and Clinical Correlates in Huntington Disease: A Cross-Sectional Cohort Study

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Piano, Carla; Losurdo, Anna; Della Marca, Giacomo; Solito, Marcella; Calandra-Buonaura, Giovanna; Provini, Federica; Bentivoglio, Anna Rita; Cortelli, Pietro

2015-01-01

Study Objectives: To evaluate the sleep pattern and the motor activity during sleep in a cohort of patients affected by Huntington disease (HD). Design: Cross-sectional cohort study. Setting: Sleep laboratory. Patients: Thirty HD patients, 16 women and 14 men (mean age 57.3 ± 12.2 y); 30 matched healthy controls (mean age 56.5 ± 11.8 y). Interventions: Subjective sleep evaluation: Epworth Sleepiness Scale (ESS); Berlin's Questionnaire, interview for restless legs syndrome (RLS), questionnaire for REM sleep behavior disorder (RBD). Clinical evaluation: disease duration, clinical severity (unified Huntington disease motor rating scale [UHDMRS]), genetic tests. Laboratory-based full-night attended video-polysomnography (V-PSG). Measurements and Results: The duration of the disease was 9.4 ± 4.4 y, UHMDRS score was 55.5 ± 23.4, CAG repeats were 44.3 ± 4.1. Body mass index was 21.9 ± 4.0 kg/m2. No patients or caregivers reported poor sleep quality. Two patients reported symptoms of RLS. Eight patients had an ESS score ≥ 9. Eight patients had high risk of obstructive sleep apnea. At the RBD questionnaire, two patients had a pathological score. HD patients, compared to controls, showed shorter sleep, reduced sleep efficiency index, and increased arousals and awakenings. Four patients presented with sleep disordered breathing (SDB). Periodic limb movements (PLMs) during wake and sleep were observed in all patients. No episode of RBD was observed in the V-PSG recordings, and no patients showed rapid eye movement (REM) sleep without atonia. The disease duration correlated with ESS score (P Marca G, Solito M, Calandra-Buonaura G, Provini F, Bentivoglio AR, Cortelli P. Polysomnographic findings and clinical correlates in Huntington disease: a cross-sectional cohort study. SLEEP 2015;38(9):1489–1495. PMID:25845698

Comorbidity and medication in REM sleep behavior disorder

DEFF Research Database (Denmark)

Frauscher, Birgit; Jennum, Poul; Ju, Yo-El S

2014-01-01

OBJECTIVE: This controlled study investigated associations between comorbidity and medication in patients with polysomnographically confirmed idiopathic REM sleep behavior disorder (iRBD), using a large multicenter clinic-based cohort. METHODS: Data of a self-administered questionnaire...

Headache secondary to sleep-related bruxism: A case with polysomnographic findings

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Sourav Das

2015-01-01

Full Text Available Sleep-related bruxism may present with headache. However, in clinical practice it may be difficult to differentiate from other causes of headache, especially in subjects with substance abuse. We are presenting a case of sleep-related bruxism that presented with headache and sleep-related symptoms in the presence of substance abuse. Polysomnography was used to ascertain cause of headache. How the other possible causes of headache ruled out is also discussed in report. In short, Sleep-related bruxism can cause headache that is worse in the morning. It is associated with poor quality sleep.

Jaw-opening reflex and corticobulbar motor excitability changes during quiet sleep in non-human primates

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Yao, Dongyuan; Lavigne, Gilles J.; Lee, Jye-Chang

2013-01-01

Study Objective: To test the hypothesis that the reflex and corticobulbar motor excitability of jaw muscles is reduced during sleep. Design: Polysomnographic recordings in the electrophysiological study. Setting: University sleep research laboratories. Participants and Interventions: The reflex a...

Noninvasive ventilation improves sleep in amyotrophic lateral sclerosis: a prospective polysomnographic study.

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Vrijsen, Bart; Buyse, Bertien; Belge, Catharina; Robberecht, Wim; Van Damme, Philip; Decramer, Marc; Testelmans, Dries

2015-04-15

To evaluate the effects of noninvasive ventilation (NIV) on sleep in patients with amyotrophic lateral sclerosis (ALS) after meticulous titration with polysomnography (PSG). In this prospective observational study, 24 ALS patients were admitted to the sleep laboratory during 4 nights for in-hospital NIV titration with PSG and nocturnal capnography. Questionnaires were used to assess subjective sleep quality and quality of life (QoL). Patients were readmitted after one month. In the total group, slow wave sleep and REM sleep increased and the arousal-awakening index improved. The group without bulbar involvement (non-bulbar) showed the same improvements, together with an increase in sleep efficiency. Nocturnal oxygen and carbon dioxide levels improved in the total and non-bulbar group. Except for oxygen saturation during REM sleep, no improvement in respiratory function or sleep structure was found in bulbar patients. However, these patients showed less room for improvement. Patient-reported outcomes showed improvement in sleep quality and QoL for the total and non-bulbar group, while bulbar patients only reported improvements in very few subscores. This study shows an improvement of sleep architecture, carbon dioxide, and nocturnal oxygen saturation at the end of NIV titration and after one month of NIV in ALS patients. More studies are needed to identify the appropriate time to start NIV in bulbar patients. Our results suggest that accurate titration of NIV by PSG improves sleep quality. A commentary on this article appears in this issue on page 511. © 2015 American Academy of Sleep Medicine.

Challenges in sleep stage R scoring in patients with autosomal dominant spinocerebellar ataxias (SCA1, SCA2 and SCA3) and oculomotor abnormalities: a whole night polysomnographic evaluation.

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Seshagiri, Doniparthi Venkata; Sasidharan, Arun; Kumar, Gulshan; Pal, Pramod Kumar; Jain, Sanjeev; Kutty, Bindu M; Yadav, Ravi

2018-02-01

Spinocerebellar ataxias are progressive neurodegenerative disorders characterized by progressive cerebellar features with additional neuro-axis involvement. Oculomotor abnormality is one of the most frequent manifestations. This study was done to assess the polysomnographic abnormalities in patients with Spinocerebellar ataxia (SCA1, SCA2 and SCA3) and also to evaluate whether oculomotor abnormalities interfere with sleep stage R scoring. The study was carried out using 36 genetically positive SCA patients. All patients underwent neurological examination with special focus on oculomotor function (optokinetic nystagmus-OKN and extraocular movement restriction-EOM). The sleep quality was measured with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Disease severity was assessed with International Cooperative Ataxia Rating Scale (ICARS). All the patients underwent over-night video-polysomnography (VPSG). Out of 36 patients studied, the data of 34 patients [SCA1 (n = 12), SCA2 (n = 13), SCA3 (n = 9)] were used for final analysis. Patients from SCA1, SCA2, and SCA3 category did not show significant differences in age and diseases severity (ICARS). All patients had vertical OKN impairment. Oculomotor impairment was higher in SCA2 patients. Sleep macro-architecture analysis showed absent stage R sleep, predominantly in SCA2 (69%) followed by SCA3 (44%) and SCA1 (8%). Patients showed a strong negative correlation of stage R sleep percentage with disease severity and oculomotor dysfunction. Voluntary saccadic eye movement velocity and rapid eye movements (REMs) in sleep are strongly correlated. The more severe the saccadic velocity impairment, the less likely was it to generate REMs (rapid eye movements) during stage R. Accordingly 69% of SCA2 patients with severe occulomotor impairments showed absent stage R as per the AASM sleep scoring. We presume that the impaired REMs generation in sleep could be due to oculomotor abnormality and has

Obstructive sleep apnea syndrome and growth failure.

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Esteller, E; Villatoro, J C; Agüero, A; Lopez, R; Matiñó, E; Argemi, J; Girabent-Farrés, M

2018-05-01

Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from

Sleep spindle density in narcolepsy

DEFF Research Database (Denmark)

Christensen, Julie Anja Engelhard; Nikolic, Miki; Hvidtfelt, Mathias

2017-01-01

BACKGROUND: Patients with narcolepsy type 1 (NT1) show alterations in sleep stage transitions, rapid-eye-movement (REM) and non-REM sleep due to the loss of hypocretinergic signaling. However, the sleep microstructure has not yet been evaluated in these patients. We aimed to evaluate whether...... the sleep spindle (SS) density is altered in patients with NT1 compared to controls and patients with narcolepsy type 2 (NT2). METHODS: All-night polysomnographic recordings from 28 NT1 patients, 19 NT2 patients, 20 controls (C) with narcolepsy-like symptoms, but with normal cerebrospinal fluid hypocretin...... levels and multiple sleep latency tests, and 18 healthy controls (HC) were included. Unspecified, slow, and fast SS were automatically detected, and SS densities were defined as number per minute and were computed across sleep stages and sleep cycles. The between-cycle trends of SS densities in N2...

[Obstructive Sleep Apnea Syndrom during pregnancy: prevalence of main symptoms and relationship with Pregnancy Induced-Hypertension and Intra-Uterine Growth Retardation].

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Calaora-Tournadre, D; Ragot, S; Meurice, J C; Pourrat, O; D'Halluin, G; Magnin, G; Pierre, F

2006-04-01

To investigate the frequency of main symptoms of Obstructive Sleep Apnea Syndrom (OSAS) and their relationship with Pregnancy Induced-Hypertension (PIH) as well as Intrauterine Growth Retardation (IGR) as suggested by recent studies. Four hundred (and) thirty-eight enquiry forms completed during post-partum period were analysed, after exclusion of multiple pregnancies. Collected data were demographic characteristics, obstetrical events, sleep disorders during last trimester, screening of snoring and vigilance troubles with an Epworth score. Forty-five percentages of the patients reported to have habitual snoring during pregnancy. Among these, 85% were non-snorers before pregnancy. Daytime somnolence concerned 84,5% of the population with an Epworth score significatively increased (P<0,0001). The prevalence of PIH was found to be 4,5%, with two apparently independent risk factors: the body mass index (OR=1,1) and an association between snoring and increased vigilance trouble (OR=2,6). No statistical difference was found concerning IGR. SAS symptoms are frequent during pregnancy and snoring appears to be linked with PIH. However, polysomnographic data are not yet sufficient to explain pathophysiological mechanisms and find relevant diagnostic markers during pregnancy.

Impact of age on intermittent hypoxia in obstructive sleep apnea: a propensity-matched analysis.

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Bostanci, Asli; Bozkurt, Selen; Turhan, Murat

2018-05-01

To determine independent relationship of aging with chronic intermittent hypoxia, we compared hypoxia-related polysomnographic variables of geriatric patients (aged ≥ 65 years) with an apnea-hypopnea index (AHI)-, gender-, body mass index (BMI)-, and neck circumference-matched cohort of non-geriatric patients. The study was conducted using clinical and polysomnographic data of 1280 consecutive patients who underwent complete polysomnographic evaluation for suspected sleep-disordered breathing (SDB) at a single sleep disorder center. A propensity score-matched analysis was performed to obtain matched cohorts of geriatric and non-geriatric patients, which resulted in successful matching of 168 patients from each group. Study groups were comparable for gender (P = 0.999), BMI (P = 0.940), neck circumference (P = 0.969), AHI (P = 0.935), and severity of SDB (P = 0.089). The oximetric variables representing the duration of chronic intermittent hypoxia such as mean (P = 0.001), the longest (P = 0.001) and total apnea durations (P = 0.003), mean (P = 0.001) and the longest hypopnea durations (P = 0.001), and total sleep time with oxygen saturation below 90% (P = 0.008) were significantly higher in the geriatric patients as compared with younger adults. Geriatric patients had significantly lower minimum (P = 0.013) and mean oxygen saturation (P = 0.001) than non-geriatric patients. The study provides evidence that elderly patients exhibit more severe and deeper nocturnal intermittent hypoxia than the younger adults, independent of severity of obstructive sleep apnea, BMI, gender, and neck circumference. Hypoxia-related polysomnographic variables in geriatric patients may in fact reflect a physiological aging process rather than the severity of a SDB.

Leg Movement Activity During Sleep in Adults With Attention-Deficit/Hyperactivity Disorder

Directory of Open Access Journals (Sweden)

Corrado Garbazza

2018-05-01

Full Text Available Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD compared to healthy controls.Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of “periodicity,” i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI and the periodic leg movement during sleep arousal index (PLMSAI. Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires.Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL, a longer duration of the periodic leg movements during sleep (PLMS in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients.Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS or periodic limb movement disorder (PLMD. The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

[Sleep disorders in the structure of cerebrovascular diseases].

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Iakupov, É Z; Aleksandrova, E A; Troshina, Iu V; Shebasheva, E V; Shagiakhmetova, L Ia

2014-01-01

The literature on the place and role of insomnia in cerebral blood circulation disturbances is reviewed. It is emphasized that insomnia is a modifying risk factor of cerebrovascular pathology. The syndrome of obstructive sleep apnea may be a cause of arterial hypertension. The diagnostic relevance of the complex examination of patients with sleep pathology, including polysomnographic technology, and its role in the choice of corrective measures and treatment of insomnia in whole are shown.

Obstructive sleep apnea alters sleep stage transition dynamics.

Directory of Open Access Journals (Sweden)

Matt T Bianchi

2010-06-01

Full Text Available Enhanced characterization of sleep architecture, compared with routine polysomnographic metrics such as stage percentages and sleep efficiency, may improve the predictive phenotyping of fragmented sleep. One approach involves using stage transition analysis to characterize sleep continuity.We analyzed hypnograms from Sleep Heart Health Study (SHHS participants using the following stage designations: wake after sleep onset (WASO, non-rapid eye movement (NREM sleep, and REM sleep. We show that individual patient hypnograms contain insufficient number of bouts to adequately describe the transition kinetics, necessitating pooling of data. We compared a control group of individuals free of medications, obstructive sleep apnea (OSA, medical co-morbidities, or sleepiness (n = 374 with mild (n = 496 or severe OSA (n = 338. WASO, REM sleep, and NREM sleep bout durations exhibited multi-exponential temporal dynamics. The presence of OSA accelerated the "decay" rate of NREM and REM sleep bouts, resulting in instability manifesting as shorter bouts and increased number of stage transitions. For WASO bouts, previously attributed to a power law process, a multi-exponential decay described the data well. Simulations demonstrated that a multi-exponential process can mimic a power law distribution.OSA alters sleep architecture dynamics by decreasing the temporal stability of NREM and REM sleep bouts. Multi-exponential fitting is superior to routine mono-exponential fitting, and may thus provide improved predictive metrics of sleep continuity. However, because a single night of sleep contains insufficient transitions to characterize these dynamics, extended monitoring of sleep, probably at home, would be necessary for individualized clinical application.

Post-Encephalitic Parkinsonism and Sleep Disorder Responsive to Immunological Treatment: A Case Report.

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Brunetti, Valerio; Testani, Elisa; Iorio, Raffaele; Frisullo, Giovanni; Luigetti, Marco; Di Giuda, Daniela; Marca, Giacomo Della

2016-10-01

We describe a 70-year-old man who, after a viral encephalitis associated with pneumonia, progressively developed a parkinsonism associated with lethargy. Encephalitis manifested with persistent hiccups, seizures and impairment of consciousness. After 2 weeks, the initial neurologic symptoms subsided and the patient progressively developed movement disorders (rigidity and bradykinesia, resistant to L-DOPA), lethargy and behavioral hypersomnia. Magnetic resonance imaging showed thalamic and hippocampal signal abnormalities, immunohistochemistry on a mouse brain substrate revealed serum autoantibodies binding to the brainstem neuropil. Polysomnographic monitoring was consistent with a very severe disruption of sleep: the sleep-wake cycle was fragmented, and the NREM-REM ultradian cycle was irregular. Intravenous immune globulin therapy resulted in the complete reversal of the movement and the sleep disorders. Our observation confirms that parkinsonism and sleep disorders may be consequences of encephalitis, that an immune-mediated pathogenesis is likely, and, consequently, that immunotherapy can be beneficial in these patients. The polysomnographic monitoring suggests that lethargia, rather than a mere hypersomnia, is the result of a combination between sleep disruption and altered motor control. © EEG and Clinical Neuroscience Society (ECNS) 2016.

[Sleep and respiratory disorders in myotonic dystrophy of Steinert].

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López-Esteban, P; Peraita-Adrados, R

2000-03-01

It has been hypothesized that hypersomnia and sleep related respiratory impairment are both central in origin in myotonic dystrophy. To describe by means of video-polysomnographic recordings the central origin of the sleep respiratory disorders. We studied 11 patients, 6 men and 5 women (mean age 42.7 years) with myotonic dystrophy. A moderate to severe ventilatory impairment of a primarily restrictive type was seen in all patients, three of them after the first episode of respiratory insufficiency. The patients were evaluated in order to determine their body mass index and presence of sleep-related complaints. Video-polysomnographic recordings (EEG, EOG, EKG, submental and tibialis anterior EMGs, respiration and Sa02) and pulmonary function tests were performed in each patient. Identical recordings were repeated in six cases, which were to undergo non-invasive bi-level ventilation (BiPAP) in order to adjust the inspiratory and expiratory pressures and the machine mode. We found slight hypopnea and apnea, predominantly of a central type, in stage 1 and REM sleep and alveolar hypoventilation in all patients. Sleep was disrupted and the efficiency index was very low. In three patients HLA typing showed a positive DQ6 haplotype. Six patients were treated with n-BiPAP. Nasal-BIPAP should be considered as an alternative in ventilatory support during sleep in these patients and video-polysomnography as a valid method of evaluating the ideal time to start treatment.

Exercise Effects on Sleep Physiology

Directory of Open Access Journals (Sweden)

Sunao eUchida

2012-04-01

Full Text Available This mini-review focuses on the effects of exercise on sleep. In its early days, sleep research largely focused on central nervous system (CNS physiology using standardized tabulations of several sleep-specific landmark electroencephalogram (EEG waveforms. Though coarse, this method has enabled the observation and inspection of numerous uninterrupted sleep phenomena. Thus, research on the effects of exercise on sleep began, in the 1960’s, with a focus primarily on sleep EEG (CNS sleep changes. Those early studies found only small effects of exercise on sleep. More recent sleep research has explored not only CNS functioning, but somatic physiology as well. As physical exercise mostly affects somatic functions, endocrine and autonomic nervous system (ANS changes that occur during sleep should be affected by daytime exercise. Since endocrinological, metabolic and autonomic changes can be measured during sleep, it should be possible to assess exercise effects on somatic physiology in addition to CNS sleep quality, building from standard polysomnographic (PSG techniques. Incorporating measures of somatic physiology in the quantitative assessment of sleep could further our understanding of sleep's function as an auto-regulatory, global phenomenon.

Sleep disorders and the prevalence of asymptomatic nocturnal acid and non-acid reflux.

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Herdman, Christine; Marzio, Dina Halegoua-De; Shah, Paurush; Denuna-Rivera, Susie; Doghramji, Karl; Cohen, Sidney; Dimarino, Anthony J

2013-01-01

Nocturnal acid reflux is associated with symptomatic and asymptomatic sleep arousals, leading to fragmented sleep. The frequency and influence of acid reflux in patients with various forms of insomnia has not been reported. The aim of this study was to quantify nocturnal acid and nonacid reflux in patients with primary sleep disorders as previously diagnosed by polysomnography. THIRTY ONE SUBJECTS WERE STUDIED: (A) 9 subjects with a polysomnographically diagnosed sleep disorder (1 with restless legs syndrome, 4 with narcolepsy, 4 with periodic limb movement disorder); (B) 12 subjects with primary insomnia (PI) and unrevealing polysomnography; and (C) 10 controls without disturbed sleep. All subjects underwent a physical examination and 24 h transnasal pH and impedance monitoring to detect acid and non-acid reflux. The 21 subjects with fragmented sleep due to a primary sleep disorder had significantly more recumbent acid exposure (>1.2% of time) as compared with control subjects (33% versus 0%). When fragmented sleep subjects were divided into two groups, 17% of PI subjects and 55% of subjects with a diagnosed sleep disorder had significant recumbent acid exposure (P=0.009). Likewise, the median recumbent nonacid events were increased in the sleep disordered group (P=0.011). This study indicates that patients with primary sleep disorders have prominent nocturnal acid reflux without symptoms of daytime acid reflux. Acid reflux is most prominent in patients with polysomnographic findings of disturbed sleep as compared to patients with PI; while non acid reflux is increased minimally in these patients.

Critical evaluation of the effect of valerian extract on sleep structure and sleep quality.

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Donath, F; Quispe, S; Diefenbach, K; Maurer, A; Fietze, I; Roots, I

2000-03-01

A carefully designed study assessed the short-term (single dose) and long-term (14 days with multiple dosage) effects of a valerian extract on both objective and subjective sleep parameters. The investigation was performed as a randomised, double-blind, placebo-controlled, cross-over study. Sixteen patients (4 male, 12 female) with previously established psychophysiological insomnia (ICSD-code 1.A.1.), and with a median age of 49 (range: 22 to 55), were included in the study. The main inclusion criteria were reported primary insomnia according to ICSD criteria, which was confirmed by polysomnographic recording, and the absence of acute diseases. During the study, the patients underwent 8 polysomnographic recordings: i.e., 2 recordings (baseline and study night) at each time point at which the short and long-term effects of placebo and valerian were tested. The target variable of the study was sleep efficiency. Other parameters describing objective sleep structure were the usual features of sleep-stage analysis, based on the rules of Rechtschaffen and Kales (1968), and the arousal index (scored according to ASDA criteria, 1992) as a sleep microstructure parameter. Subjective parameters such as sleep quality, morning feeling, daytime performance, subjectively perceived duration of sleep latency, and sleep period time were assessed by means of questionnaires. After a single dose of valerian, no effects on sleep structure and subjective sleep assessment were observed. After multiple-dose treatment, sleep efficiency showed a significant increase for both the placebo and the valerian condition in comparison with baseline polysomnography. We confirmed significant differences between valerian and placebo for parameters describing slow-wave sleep. In comparison with the placebo, slow-wave sleep latency was reduced after administration of valerian (21.3 vs. 13.5 min respectively, p<0.05). The SWS percentage of time in bed (TIB) was increased after long-term valerian

Benefits of Sleep Extension on Sustained Attention and Sleep Pressure Before and During Total Sleep Deprivation and Recovery.

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Arnal, Pierrick J; Sauvet, Fabien; Leger, Damien; van Beers, Pascal; Bayon, Virginie; Bougard, Clément; Rabat, Arnaud; Millet, Guillaume Y; Chennaoui, Mounir

2015-12-01

To investigate the effects of 6 nights of sleep extension on sustained attention and sleep pressure before and during total sleep deprivation and after a subsequent recovery sleep. Subjects participated in two experimental conditions (randomized cross-over design): extended sleep (EXT, 9.8 ± 0.1 h (mean ± SE) time in bed) and habitual sleep (HAB, 8.2 ± 0.1 h time in bed). In each condition, subjects performed two consecutive phases: (1) 6 nights of either EXT or HAB (2) three days in-laboratory: baseline, total sleep deprivation and after 10 h of recovery sleep. Residential sleep extension and sleep performance laboratory (continuous polysomnographic recording). 14 healthy men (age range: 26-37 years). EXT vs. HAB sleep durations prior to total sleep deprivation. Total sleep time and duration of all sleep stages during the 6 nights were significantly higher in EXT than HAB. EXT improved psychomotor vigilance task performance (PVT, both fewer lapses and faster speed) and reduced sleep pressure as evidenced by longer multiple sleep latencies (MSLT) at baseline compared to HAB. EXT limited PVT lapses and the number of involuntary microsleeps during total sleep deprivation. Differences in PVT lapses and speed and MSLT at baseline were maintained after one night of recovery sleep. Six nights of extended sleep improve sustained attention and reduce sleep pressure. Sleep extension also protects against psychomotor vigilance task lapses and microsleep degradation during total sleep deprivation. These beneficial effects persist after one night of recovery sleep. © 2015 Associated Professional Sleep Societies, LLC.

Quantitative assessment of isolated rapid eye movement (REM) sleep without atonia without clinical REM sleep behavior disorder: clinical and research implications.

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Sasai-Sakuma, Taeko; Frauscher, Birgit; Mitterling, Thomas; Ehrmann, Laura; Gabelia, David; Brandauer, Elisabeth; Inoue, Yuichi; Poewe, Werner; Högl, Birgit

2014-09-01

Rapid eye movement (REM) sleep without atonia (RWA) is observed in some patients without a clinical history of REM sleep behavior disorder (RBD). It remains unknown whether these patients meet the refined quantitative electromyographic (EMG) criteria supporting a clinical RBD diagnosis. We quantitatively evaluated EMG activity and investigated its overnight distribution in patients with isolated qualitative RWA. Fifty participants with an incidental polysomnographic finding of RWA (isolated qualitative RWA) were included. Tonic, phasic, and 'any' EMG activity during REM sleep on PSG were quantified retrospectively. Referring to the quantitative cut-off values for a polysomnographic diagnosis of RBD, 7/50 (14%) and 6/50 (12%) of the patients showed phasic and 'any' EMG activity in the mentalis muscle above the respective cut-off values. No patient was above the cut-off value for tonic EMG activity or phasic EMG activity in the anterior tibialis muscles. Patients with RWA above the cut-off value showed higher amounts of RWA during later REM sleep periods. This is the first study showing that some subjects with incidental RWA meet the refined quantitative EMG criteria for a diagnosis of RBD. Future longitudinal studies must investigate whether this subgroup with isolated qualitative RWA is at an increased risk of developing fully expressed RBD and/or neurodegenerative disease. Copyright © 2014 Elsevier B.V. All rights reserved.

Sleep-stage transitions during polysomnographic recordings as diagnostic features of type 1 narcolepsy

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Christensen, Julie Anja Engelhard; Carrillo, Oscar; Leary, Eileen B.

2015-01-01

Objective: Type 1 narcolepsy/hypocretin deficiency is characterized by excessive daytime sleepiness, sleep fragmentation, and cataplexy. Short rapid eye movement (REM) latency (≤15 min) during nocturnal polysomnography (PSG) or during naps of the multiple sleep latency test (MSLT) defines a sleep......-onset REM sleep period (SOREMP), a diagnostic hallmark. We hypothesized that abnormal sleep transitions other than SOREMPs can be identified in type 1 narcolepsy. Methods: Sleep-stage transitions (one to 10 epochs to one to five epochs of any other stage) and bout length features (one to 10 epochs) were...... of 19 cases and 708 sleep-clinic patients was used for the validation. Results: (1) ≥5 transitions from ≥5 epochs of stage N1 or W to ≥2 epochs of REM sleep, (2) ≥22 transitions from ≥3 epochs of stage N2 or N3 to ≥2 epochs of N1 or W, and (3) ≥16 bouts of ≥6 epochs of N1 or W were found to be highly...

Sleep pattern and locomotor activity are impaired by doxorubicin in non-tumor-bearing rats.

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Lira, Fabio Santos; Esteves, Andrea Maculano; Pimentel, Gustavo Duarte; Rosa, José Cesar; Frank, Miriam Kannebley; Mariano, Melise Oliveira; Budni, Josiane; Quevedo, João; Santos, Ronaldo Vagner Dos; de Mello, Marco Túlio

2016-01-01

We sought explore the effects of doxorubicin on sleep patterns and locomotor activity. To investigate these effects, two groups were formed: a control group and a Doxorubicin (DOXO) group. Sixteen rats were randomly assigned to either the control or DOXO groups. The sleep patterns were examined by polysomnographic recording and locomotor activity was evaluated in an open-field test. In the light period, the total sleep time and slow wave sleep were decreased, while the wake after sleep onset and arousal were increased in the DOXO group compared with the control group (plocomotor activity.

Diagnostic accuracy of portable instrumental devices to measure sleep bruxism: a systematic literature review of polysomnographic studies.

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Manfredini, D; Ahlberg, J; Castroflorio, T; Poggio, C E; Guarda-Nardini, L; Lobbezoo, F

2014-11-01

This study systematically reviews the sleep bruxism (SB) literature published in the MEDLINE and Scopus databases to answer the following question: What is the validity of the different portable instrumental devices that have been proposed to measure SB if compared with polysomnographic (PSG) recordings assumed as the gold standard? Four clinical studies on humans, assessing the diagnostic accuracy of portable instrumental approaches (i.e. Bitestrip, electromyography (EMG)-telemetry recordings and Bruxoff) with respect to PSG, were included in the review. Methodological shortcomings were identified by QUADAS-2 quality assessment. Findings showed contrasting results and supported only in part the validity of the described diagnostic devices with respect to PSG. The positive predictive value (PPV) of the Bitestrip device was 59-100%, with a sensitivity of 71-84·2%, whilst EMG-telemetry recordings had an unacceptable rate of false-positive findings (76·9%), counterbalanced by an almost perfect sensitivity (98·8%). The Bruxoff device had the highest accuracy values, showing an excellent agreement with PSG for both manual (area under ROC = 0·98) and automatic scoring (0·96) options as well as for the simultaneous recording of events with respect to PSG (0·89-0·91). It can be concluded that the available information on the validity of portable instrumental diagnostic approaches with respect to PSG recordings is still scarce and not solid enough to support any non-PSG technique's employ as a stand-alone diagnostic method in the research setting, with the possible exception of the Bruxoff device that needs to be further confirmed with future investigations. © 2014 John Wiley & Sons Ltd.

Effects of quetiapine on sleep architecture in patients with unipolar or bipolar depression

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Laura Gedge

2010-08-01

Full Text Available Laura Gedge1, Lauren Lazowski1, David Murray2, Ruzica Jokic2,3, Roumen Milev2,31Centre for Neuroscience Studies, 2Department of Psychiatry, Queen’s University, Kingston, 3Providence Care-Mental Health Services, Kingston, Ontario, CanadaObjective: To determine the effect of adjunctive quetiapine therapy on the sleep architecture of patients with bipolar or unipolar depression.Methods: This is a prospective, single-blind, repeated measures polysomnographic study. Sleep architecture was analyzed by overnight polysomnography, and subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. The Hamilton Rating Scale for Depression, Montgomery Asberg Depression Rating Scale, Young Mania Rating Scale, and Clinical Global Impression-Severity Scale were employed to quantify changes in illness severity with adjunctive quetiapine treatment. Polysomnographs and clinical measures were administered at baseline, after 2–4 days of treatment, and after 21–28 days of quetiapine treatment. The average dose of quetiapine was 155 mg, ranging from 100–200 mg.Results: Adjunctive quetiapine therapy did not significantly alter sleep efficiency, sleep continuity, or Pittsburgh Sleep Quality Index scores. Respiratory Disturbance Index and percentage of total time in rapid eye movement (REM sleep significantly decreased and the percentage of total time in non-REM sleep, and duration of Stage 2 and non-REM sleep significantly increased after 2–4 days of quetiapine treatment. Illness severity significantly decreased over time.Conclusions: Adjunctive quetiapine treatment alters sleep architecture in patients with major depressive disorder or bipolar disorder, which may partially explain its early antidepressant properties. Changes in sleep architecture are more robust and significant within two to four days of starting treatment.Keywords: quetiapine, sleep architecture, depression, bipolar disorder

Diagnostic REM sleep muscle activity thresholds in patients with idiopathic REM sleep behavior disorder with and without obstructive sleep apnea.

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McCarter, Stuart J; St Louis, Erik K; Sandness, David J; Duwell, Ethan J; Timm, Paul C; Boeve, Bradley F; Silber, Michael H

2017-05-01

We aimed to determine whether visual and automated rapid eye movement (REM) sleep without atonia (RSWA) methods could accurately diagnose patients with idiopathic REM sleep behavior disorder (iRBD) and comorbid obstructive sleep apnea (OSA). In iRBD patients (n = 15) and matched controls (n = 30) with and without OSA, we visually analyzed RSWA phasic burst durations, phasic, tonic, and "any" muscle activity by 3-s mini-epochs, phasic activity by 30-s (AASM rules) epochs, and automated REM atonia index (RAI). Group RSWA metrics were analyzed with regression models. Receiver operating characteristic (ROC) curves were used to determine the best diagnostic cutoff thresholds for REM sleep behavior disorder (RBD). Both split-night and full-night polysomnographic studies were analyzed. All mean RSWA phasic burst durations and muscle activities were higher in iRBD patients than in controls (p sleep behavior disorder (PD-RBD), consistent with a common mechanism and presumed underlying etiology of synucleinopathy in both groups. Copyright © 2016 Elsevier B.V. All rights reserved.

Sleep dysfunctions influence decision making in undemented Parkinson's disease patients: a study in a virtual supermarket.

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Albani, Giovanni; Raspelli, Simona; Carelli, Laura; Priano, Lorenzo; Pignatti, Riccardo; Morganti, Francesca; Gaggioli, Andrea; Weiss, Patrice L; Kizony, Rachel; Katz, Noomi; Mauro, Alessandro; Riva, Giuseppe

2011-01-01

In the early-middle stages of Parkinson's disease (PD), polysomnographic studies show early alterations of the structure of the sleep, which may explain frequent symptoms reported by patients, such as daytime drowsiness, loss of attention and concentration, feeling of tiredness. The aim of this study was to verify if there is a correlation between the sleep dysfunction and decision making ability. We used a Virtual Reality version of the Multiple Errand Test (VMET), developed using the NeuroVR free software (http://www.neurovr2.org), to evaluate decision-making ability in 12 PD not-demented patients and 14 controls. Five of our not-demented 12 PD patients showed abnormalities in the polysomnographic recordings associated to significant differences in the VMET performance.

Sleep disorders of Whipple's disease of the brain.

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Panegyres, P K; Goh, J

2015-02-01

To understand the effects of Whipple's disease (WD) of the brain on sleep function. Clinical and polysomnographic studies of two patients with severe disruption of sleep due to WD: a 48-year-old female with primary WD of the brain and a 41-year-old male with secondary WD of the brain. The patient with primary WD had hypersomnolence with severe obstructive sleep apnoea, reduced sleep efficiency, frequent waking and sleep fragmentation. The patient with secondary WD was also hypersomnolent with oculomastictory myorhythmia. He was shown to have severe sleep initiation insomnia with poor sleep efficiency, severe obstructive sleep apnoea/hypopnoea and oculomasticatory myorhythmia at sleep-wake transitions. WD of the brain may affect sleep biology in its primary and secondary forms leading to hypersomnolence from obstructive sleep apnoea, sleep fragmentation, reduced sleep efficiency, sleep initiation insomnia and intrusive oculomasticatory myorhythmia. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Sleep: An Open-Source Python Software for Visualization, Analysis, and Staging of Sleep Data.

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Combrisson, Etienne; Vallat, Raphael; Eichenlaub, Jean-Baptiste; O'Reilly, Christian; Lajnef, Tarek; Guillot, Aymeric; Ruby, Perrine M; Jerbi, Karim

2017-01-01

We introduce Sleep, a new Python open-source graphical user interface (GUI) dedicated to visualization, scoring and analyses of sleep data. Among its most prominent features are: (1) Dynamic display of polysomnographic data, spectrogram, hypnogram and topographic maps with several customizable parameters, (2) Implementation of several automatic detection of sleep features such as spindles, K-complexes, slow waves, and rapid eye movements (REM), (3) Implementation of practical signal processing tools such as re-referencing or filtering, and (4) Display of main descriptive statistics including publication-ready tables and figures. The software package supports loading and reading raw EEG data from standard file formats such as European Data Format, in addition to a range of commercial data formats. Most importantly, Sleep is built on top of the VisPy library, which provides GPU-based fast and high-level visualization. As a result, it is capable of efficiently handling and displaying large sleep datasets. Sleep is freely available (http://visbrain.org/sleep) and comes with sample datasets and an extensive documentation. Novel functionalities will continue to be added and open-science community efforts are expected to enhance the capacities of this module.

Sleep: An Open-Source Python Software for Visualization, Analysis, and Staging of Sleep Data

Directory of Open Access Journals (Sweden)

Etienne Combrisson

2017-09-01

Full Text Available We introduce Sleep, a new Python open-source graphical user interface (GUI dedicated to visualization, scoring and analyses of sleep data. Among its most prominent features are: (1 Dynamic display of polysomnographic data, spectrogram, hypnogram and topographic maps with several customizable parameters, (2 Implementation of several automatic detection of sleep features such as spindles, K-complexes, slow waves, and rapid eye movements (REM, (3 Implementation of practical signal processing tools such as re-referencing or filtering, and (4 Display of main descriptive statistics including publication-ready tables and figures. The software package supports loading and reading raw EEG data from standard file formats such as European Data Format, in addition to a range of commercial data formats. Most importantly, Sleep is built on top of the VisPy library, which provides GPU-based fast and high-level visualization. As a result, it is capable of efficiently handling and displaying large sleep datasets. Sleep is freely available (http://visbrain.org/sleep and comes with sample datasets and an extensive documentation. Novel functionalities will continue to be added and open-science community efforts are expected to enhance the capacities of this module.

Human regional cerebral blood flow during rapid-eye-movement sleep

DEFF Research Database (Denmark)

Madsen, P L; Holm, S; Vorstrup, S

1991-01-01

Owing to the coupling between CBF and neuronal activity, regional CBF is a reflection of neural activity in different brain regions. In this study we measured regional CBF during polysomnographically well-defined rapid-eye-movement (REM) sleep by the use of single photon emission computerized...... tomography and the new tracer 99mTc-dl-hexamethylpropyleneamine. Eleven healthy volunteers aged between 22 and 27 years were studied. CBF was measured on separate nights during REM sleep and during EEG-verified wakefulness. On awakening from REM sleep, all subjects reported visual dreams. During REM sleep...... dream experiences. On the other hand, the reduced involvement of the inferior frontal cortex observed during REM sleep might explain the poor temporal organization and bizarreness often experienced in dreams....

[Etiology of sleep bruxism: a review of the literature].

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Cuccia, Antonino Marco

2008-06-01

Bruxism is a para-function with tooth clenching and grinding. Particularly, the sleep bruxism is a frequent phenomenon that causes cephalalgia and muscular/joint pains to the awakening, besides an increased dental abrasion and sensibility. The etiology of sleep bruxism is uncertain: while the occlusal discrepancies and the anatomy of the bony structures of the orofacial region play only a minor role, others factors, like smoking, alcohol, drugs, systemic diseases, stress, trauma and heredity, appear to have an important role in the sleep bruxism genesis. Recent polysomnographic studies, suggest that sleep bruxism episodes are part of an sleep arousal response. The sleep arousal response is a sudden change in the depth of sleep. Besides the sleep bruxism appears to be an disturbance in the dopaminergic system. Further psychological factors (like stress, anxiety) are implicated in the aetiology of sleep bruxism as well. The aim of this paper is to review the literature on the aetiology of bruxism.

Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review.

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Garcia, Alexandra N; Salloum, Ihsan M

2015-10-01

In the United States, approximately 60 million Americans suffer from sleep disorders and about 22 million Americans report substance dependence or use disorders annually. Sleep disturbances are common consequences of substance use disorders and are likely found in primary care as well as in specialty practices. The aim of this review was to evaluate the effects of the most frequently used substances-nicotine, alcohol, opioids, cocaine, caffeine, and cannabis-have on sleep parameters measured by polysomnography (PSG) and related clinical manifestations. We used electronic databases such as PubMED and PsycINFO to search for relevant articles. We only included studies that assessed sleep disturbances using polysomnography and reviewed the effects of these substances on six clinically relevant sleep parameters: Total sleep time, sleep onset latency, rapid-eye movement, REM latency, wake after sleep onset, and slow wave sleep. Our review indicates that these substances have significant impact on sleep and that their effects differ during intoxication, withdrawal, and chronic use. Many of the substance-induced sleep disturbances overlap with those encountered in sleep disorders, medical, and psychiatric conditions. Sleep difficulties also increase the likelihood of substance use disorder relapse, further emphasizing the need for optimizing treatment interventions in these patients. Our review highlights the importance of systematically screening for substance use in patients with sleep disturbances and highlights the need for further research to understand mechanisms underlying substances-induced sleep disturbances and on effective interventions addressing these conditions. © American Academy of Addiction Psychiatry.

Does night-shift work induce apnea events in obstructive sleep apnea patients?

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Laudencka, A; Klawe, J J; Tafil-Klawe, M; Złomańczuk, P

2007-11-01

The aim of the present study was to determine the direct effect of night-work on the occurrence of obstructive apneas during sleep after a night shift in fast-rotating shift workers with sleep-related breathing disorders. Eight obstructive sleep apnea patients were examined with the use of a polysomnograph during sleep under two conditions: after day-shift work and after night-shift work. Both sleep studies were conducted within 2 to 3 weeks of each other. In four of the 8 subjects, during sleep after a night-shift, an increase in apnea/hypopnea index was found. Night work significantly increased several breathing variables: total duration of obstructive apneas during REM sleep, mean duration of obstructive apneas during arousal, and apnea index during arousal. We conclude that in a subpopulation of sleep apnea patients, acute sleep deprivation may worsen obstructive sleep apnea index.

Sleep-disordered breathing in patients with myelomeningocele.

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Patel, Daxa M; Rocque, Brandon G; Hopson, Betsy; Arynchyna, Anastasia; Bishop, E Ralee'; Lozano, David; Blount, Jeffrey P

2015-07-01

OBJECT A paucity of literature examines sleep apnea in patients with myelomeningocele, Chiari malformation Type II (CM-II), and related hydrocephalus. Even less is known about the effect of hydrocephalus treatment or CM-II decompression on sleep hygiene. This study is an exploratory analysis of sleep-disordered breathing in patients with myelomeningocele and the effects of neurosurgical treatments, in particular CM-II decompression and hydrocephalus management, on sleep organization. METHODS The authors performed a retrospective review of all patients seen in their multidisciplinary spina bifida clinic (approximately 435 patients with myelomeningocele) to evaluate polysomnographs obtained between March 1999 and July 2013. They analyzed symptoms prompting evaluation, results, and recommended interventions by using descriptive statistics. They also conducted a subset analysis of 9 children who had undergone polysomnography both before and after neurosurgical intervention. RESULTS Fifty-two patients had polysomnographs available for review. Sleep apnea was diagnosed in 81% of these patients. The most common presenting symptom was "breathing difficulties" (18 cases [43%]). Mild sleep apnea was present in 26 cases (50%), moderate in 10 (19%), and severe in 6 (12%). Among the 42 patients with abnormal sleep architecture, 30 had predominantly obstructive apneas and 12 had predominantly central apneas. The most common pulmonology-recommended intervention was adjustment of peripheral oxygen supplementation (24 cases [57%]), followed by initiation of peripheral oxygen (10 cases [24%]). In a subset analysis of 9 patients who had sleep studies before and after neurosurgical intervention, there was a trend toward a decrease in the mean number of respiratory events (from 34.8 to 15.9, p = 0.098), obstructive events (from 14.7 to 13.9, p = 0.85), and central events (from 20.1 to 2.25, p = 0.15) and in the apnea-hypopnea index (from 5.05 to 2.03, p = 0.038, not significant when

Night sleep in patients with vegetative state.

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Pavlov, Yuri G; Gais, Steffen; Müller, Friedemann; Schönauer, Monika; Schäpers, Barbara; Born, Jan; Kotchoubey, Boris

2017-10-01

Polysomnographic recording of night sleep was carried out in 15 patients with the diagnosis vegetative state (syn. unresponsive wakefulness syndrome). Sleep scoring was performed by three raters, and confirmed by means of a spectral power analysis of the electroencephalogram, electrooculogram and electromyogram. All patients but one exhibited at least some signs of sleep. In particular, sleep stage N1 was found in 13 patients, N2 in 14 patients, N3 in nine patients, and rapid eye movement sleep in 10 patients. Three patients exhibited all phenomena characteristic for normal sleep, including spindles and rapid eye movements. However, in all but one patient, sleep patterns were severely disturbed as compared with normative data. All patients had frequent and long periods of wakefulness during the night. In some apparent rapid eye movement sleep episodes, no eye movements were recorded. Sleep spindles were detected in five patients only, and their density was very low. We conclude that the majority of vegetative state patients retain some important circadian changes. Further studies are necessary to disentangle multiple factors potentially affecting sleep pattern of vegetative state patients. © 2017 European Sleep Research Society.

Sleep disordered breathing in children with achondroplasia.

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Zaffanello, Marco; Cantalupo, Gaetano; Piacentini, Giorgio; Gasperi, Emma; Nosetti, Luana; Cavarzere, Paolo; Ramaroli, Diego Alberto; Mittal, Aliza; Antoniazzi, Franco

2017-02-01

Children with achondroplasia often have breathing problems, especially during sleep. The most important treatments are adenotonsillectomy (for treating upper obstruction) and/or neurosurgery (for resolving cervicomedullar junction stenosis). We reviewed the scientific literature on polysomnographic investigations which assessed the severity of respiratory disorders during sleep. Recent findings have highlighted the importance of clinical investigations in patients with achondroplasia, differentiating between those that look for neurological patterns and those that look for respiratory problems during sleep. In particular, magnetic resonance imaging (MRI) and somatosensory evoked potentials are the main tools to evaluate necessary neurosurgery and over myelopathy, respectively. The use of polysomnography enables clinicians to identify children with upper airway obstruction and to quantify disease severity; it is not suitable for MRI and/or neurosurgery considerations.

Quantifying Infra-slow Dynamics of Spectral Power and Heart Rate in Sleeping Mice.

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Fernandez, Laura M J; Lecci, Sandro; Cardis, Romain; Vantomme, Gil; Béard, Elidie; Lüthi, Anita

2017-08-02

Three vigilance states dominate mammalian life: wakefulness, non-rapid eye movement (non-REM) sleep, and REM sleep. As more neural correlates of behavior are identified in freely moving animals, this three-fold subdivision becomes too simplistic. During wakefulness, ensembles of global and local cortical activities, together with peripheral parameters such as pupillary diameter and sympathovagal balance, define various degrees of arousal. It remains unclear the extent to which sleep also forms a continuum of brain states-within which the degree of resilience to sensory stimuli and arousability, and perhaps other sleep functions, vary gradually-and how peripheral physiological states co-vary. Research advancing the methods to monitor multiple parameters during sleep, as well as attributing to constellations of these functional attributes, is central to refining our understanding of sleep as a multifunctional process during which many beneficial effects must be executed. Identifying novel parameters characterizing sleep states will open opportunities for novel diagnostic avenues in sleep disorders. We present a procedure to describe dynamic variations of mouse non-REM sleep states via the combined monitoring and analysis of electroencephalogram (EEG)/electrocorticogram (ECoG), electromyogram (EMG), and electrocardiogram (ECG) signals using standard polysomnographic recording techniques. Using this approach, we found that mouse non-REM sleep is organized into cycles of coordinated neural and cardiac oscillations that generate successive 25-s intervals of high and low fragility to external stimuli. Therefore, central and autonomic nervous systems are coordinated to form behaviorally distinct sleep states during consolidated non-REM sleep. We present surgical manipulations for polysomnographic (i.e., EEG/EMG combined with ECG) monitoring to track these cycles in the freely sleeping mouse, the analysis to quantify their dynamics, and the acoustic stimulation protocols to

Sleep in critically ill, mechanically ventilated patients with severe sepsis or COPD

DEFF Research Database (Denmark)

Boyko, Y; Jennum, P; Oerding, H

2018-01-01

BACKGROUND: The standard method for scoring polysomnographic (PSG) sleep is insufficient in the intensive care unit (ICU). A modified classification has been proposed, but has not been tested in specific groups of ICU patients. We aimed firstly to (1) use the modified classification to describe...... with severe sepsis or COPD completed up to 20-hours PSG recording in each patient. A modified classification for scoring sleep in ICU was used for scoring the PSGs. Sleep assessment by nurses was done at 15 minutes intervals. RESULTS: We included 16 patients with severe sepsis and 17 patients with COPD. Half...

Rapid Eye Movement Sleep Behavior Disorder in Paraneoplastic Cerebellar Degeneration: Improvement with Immunotherapy.

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Vale, Thiago Cardoso; Fernandes do Prado, Lucila Bizari; do Prado, Gilmar Fernandes; Povoas Barsottini, Orlando Graziani; Pedroso, José Luiz

2016-01-01

To report two female patients with paraneoplastic cerebellar degeneration (PCD) related to breast cancer that presented with rapid eye movement-sleep behavior disorder (RBD) and improved sleep symptoms with immunotherapy. The two patients were evaluated through clinical scale and polysomnography before and after therapy with intravenous immunoglobulin. RBD was successfully treated with immunotherapy in both patients. Score on the RBD screening questionnaire dropped from 10 to 1 or 0, allied with the normalization of polysomnographic findings. A marked improvement in RBD after immunotherapy in PCD raises the hypothesis that secondary RBD may be an immune-mediated sleep disorder. © 2016 Associated Professional Sleep Societies, LLC.

In-flight sleep of flight crew during a 7-hour rest break: implications for research and flight safety.

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Signal, T Leigh; Gander, Philippa H; van den Berg, Margo J; Graeber, R Curtis

2013-01-01

To assess the amount and quality of sleep that flight crew are able to obtain during flight, and identify factors that influence the sleep obtained. Flight crew operating flights between Everett, WA, USA and Asia had their sleep recorded polysomnographically for 1 night in a layover hotel and during a 7-h in-flight rest opportunity on flights averaging 15.7 h. Layover hotel and in-flight crew rest facilities onboard the Boeing 777-200ER aircraft. Twenty-one male flight crew (11 Captains, mean age 48 yr and 10 First Officers, mean age 35 yr). N/A. Sleep was recorded using actigraphy during the entire tour of duty, and polysomnographically in a layover hotel and during the flight. Mixed model analysis of covariance was used to determine the factors affecting in-flight sleep. In-flight sleep was less efficient (70% vs. 88%), with more nonrapid eye movement Stage 1/Stage 2 and more frequent awakenings per h (7.7/h vs. 4.6/h) than sleep in the layover hotel. In-flight sleep included very little slow wave sleep (median 0.5%). Less time was spent trying to sleep and less sleep was obtained when sleep opportunities occurred during the first half of the flight. Multivariate analyses suggest age is the most consistent factor affecting in-flight sleep duration and quality. This study confirms that even during long sleep opportunities, in-flight sleep is of poorer quality than sleep on the ground. With longer flight times, the quality and recuperative value of in-flight sleep is increasingly important for flight safety. Because the age limit for flight crew is being challenged, the consequences of age adversely affecting sleep quantity and quality need to be evaluated.

Impulse control disorder and rapid eye movement sleep behavior disorder in Parkinson's disease.

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Bayard, Sophie; Dauvilliers, Yves; Yu, Huan; Croisier-Langenier, Muriel; Rossignol, Alexia; Charif, Mahmoud; Geny, Christian; Carlander, Bertrand; Cochen De Cock, Valérie

2014-12-01

The relationship between ICD and RBD is still not yet understood and the results from the current literature are contradictory in PD. We aimed to explore the association between rapid eye movement (REM) sleep behavior disorder (RBD) and impulse control disorder in Parkinson's disease. Ninety-eight non-demented patients with Parkinson's disease underwent one night of video-polysomnography recording. The diagnosis of RBD was established according to clinical and polysomnographic criteria. Impulse control disorders were determined by a gold standard, semi-structured diagnostic interview. Half of the patients (n = 49) reported clinical history of RBD while polysomnographic diagnosis of RBD was confirmed in 31.6% of the patients (n = 31). At least one impulse control disorder was identified in 21.4% of patients, 22.6% with RBD and 20.9% without. Logistic regression controlling for potential confounders indicated that both clinical RBD (OR = 0.34, 95% CI = 0.07-1.48, P = 0.15) and polysomnographic confirmed RBD diagnoses (OR = 0.1.28, 95% CI = 0.31-5.33, P = 0.34) were not associated with impulse control disorder. In Parkinson's disease, REM Sleep Behavior Disorder is not associated with impulse control disorder. The results of our study do not support the notion that PSG-confirmed RBD and ICD share a common pathophysiology. Copyright © 2014 Elsevier Ltd. All rights reserved.

Migraine, arousal and sleep deprivation: comment on: "sleep quality, arousal and pain thresholds in migraineurs: a blinded controlled polysomnographic study".

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Vollono, Catello; Testani, Elisa; Losurdo, Anna; Mazza, Salvatore; Della Marca, Giacomo

2013-06-10

We discuss the hypothesis proposed by Engstrom and coworkers that Migraineurs have a relative sleep deprivation, which lowers the pain threshold and predispose to attacks. Previous data indicate that Migraineurs have a reduction of Cyclic Alternating Pattern (CAP), an essential mechanism of NREM sleep regulation which allows to dump the effect of incoming disruptive stimuli, and to protect sleep. The modifications of CAP observed in Migraineurs are similar to those observed in patients with impaired arousal (narcolepsy) and after sleep deprivation. The impairment of this mechanism makes Migraineurs more vulnerable to stimuli triggering attacks during sleep, and represents part of a more general vulnerability to incoming stimuli.

REM Sleep Phase Preference in the Crepuscular Octodon degus Assessed by Selective REM Sleep Deprivation

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Ocampo-Garcés, Adrián; Hernández, Felipe; Palacios, Adrian G.

2013-01-01

Study Objectives: To determine rapid eye movement (REM) sleep phase preference in a crepuscular mammal (Octodon degus) by challenging the specific REM sleep homeostatic response during the diurnal and nocturnal anticrepuscular rest phases. Design: We have investigated REM sleep rebound, recovery, and documented REM sleep propensity measures during and after diurnal and nocturnal selective REM sleep deprivations. Subjects: Nine male wild-captured O. degus prepared for polysomnographic recordings Interventions: Animals were recorded during four consecutive baseline and two separate diurnal or nocturnal deprivation days, under a 12:12 light-dark schedule. Three-h selective REM sleep deprivations were performed, starting at midday (zeitgeber time 6) or midnight (zeitgeber time 18). Measurements and Results: Diurnal and nocturnal REM sleep deprivations provoked equivalent amounts of REM sleep debt, but a consistent REM sleep rebound was found only after nocturnal deprivation. The nocturnal rebound was characterized by a complete recovery of REM sleep associated with an augment in REM/total sleep time ratio and enhancement in REM sleep episode consolidation. Conclusions: Our results support the notion that the circadian system actively promotes REM sleep. We propose that the sleep-wake cycle of O. degus is modulated by a chorus of circadian oscillators with a bimodal crepuscular modulation of arousal and a unimodal promotion of nocturnal REM sleep. Citation: Ocampo-Garcés A; Hernández F; Palacios AG. REM sleep phase preference in the crepuscular Octodon degus assessed by selective REM sleep deprivation. SLEEP 2013;36(8):1247-1256. PMID:23904685

Polysomnographic Technology

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... problems during sleep and helping individuals develop good sleep habits. Job Description The technologist gathers and analyzes patient ... curriculum of an accredited program focuses on correct performance of ... of sleep disorders. Through lecture and observation they gain experience ...

Impact of singular excessive computer game and television exposure on sleep patterns and memory performance of school-aged children.

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Dworak, Markus; Schierl, Thomas; Bruns, Thomas; Strüder, Heiko Klaus

2007-11-01

Television and computer game consumption are a powerful influence in the lives of most children. Previous evidence has supported the notion that media exposure could impair a variety of behavioral characteristics. Excessive television viewing and computer game playing have been associated with many psychiatric symptoms, especially emotional and behavioral symptoms, somatic complaints, attention problems such as hyperactivity, and family interaction problems. Nevertheless, there is insufficient knowledge about the relationship between singular excessive media consumption on sleep patterns and linked implications on children. The aim of this study was to investigate the effects of singular excessive television and computer game consumption on sleep patterns and memory performance of children. Eleven school-aged children were recruited for this polysomnographic study. Children were exposed to voluntary excessive television and computer game consumption. In the subsequent night, polysomnographic measurements were conducted to measure sleep-architecture and sleep-continuity parameters. In addition, a visual and verbal memory test was conducted before media stimulation and after the subsequent sleeping period to determine visuospatial and verbal memory performance. Only computer game playing resulted in significant reduced amounts of slow-wave sleep as well as significant declines in verbal memory performance. Prolonged sleep-onset latency and more stage 2 sleep were also detected after previous computer game consumption. No effects on rapid eye movement sleep were observed. Television viewing reduced sleep efficiency significantly but did not affect sleep patterns. The results suggest that television and computer game exposure affect children's sleep and deteriorate verbal cognitive performance, which supports the hypothesis of the negative influence of media consumption on children's sleep, learning, and memory.

Patients with primary insomnia in the sleep laboratory: do they present with typical nights of sleep?

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Hirscher, Verena; Unbehaun, Thomas; Feige, Bernd; Nissen, Christoph; Riemann, Dieter; Spiegelhalder, Kai

2015-08-01

The validity of sleep laboratory investigations in patients with insomnia is important for researchers and clinicians. The objective of this study was to examine the first-night effect and the reverse first-night effect in patients with chronic primary insomnia compared with good sleeper controls. A retrospective comparison of a well-characterised sample of 50 patients with primary insomnia and 50 good sleeper controls was conducted with respect to 2 nights of polysomnography, and subjective sleep parameters in the sleep laboratory and the home setting. When comparing the first and second sleep laboratory night, a significant first-night effect was observed across both groups in the great majority of the investigated polysomnographic and subjective variables. However, patients with primary insomnia and good sleeper controls did not differ with respect to this effect. Regarding the comparison between the sleep laboratory nights and the home setting, unlike good sleeper controls, patients with primary insomnia reported an increased subjective sleep efficiency on both nights (in part due to a reduced bed time) and an increased subjective total sleep time on the second night. These results suggest that even the second sleep laboratory night does not necessarily provide clinicians and researchers with a representative insight into the sleep perception of patients with primary insomnia. Future studies should investigate whether these findings also hold for other patient populations. © 2015 European Sleep Research Society.

Prevalence and correlates of sleep disorders in Parkinson’s disease: a polysomnographic study

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Vanessa Alatriste-Booth

2015-03-01

Full Text Available Objective Sleep disorders in Parkinson’s disease are very common. Polysomnography (PSG is considered the gold standard for diagnosis. The aim of the present study is to assess the prevalence of nocturnal sleep disorders diagnosed by polysomnography and to determine the associated clinical factors. Method A total of 120 patients with Parkinson’s disease were included. All patients underwent a standardized overnight, single night polysomnography. Results Ninety-four (78.3% patients had an abnormal PSG. Half of the patients fulfilled criteria for sleep apnea-hypopnea syndrome (SAHS; rapid eye movement behavior disorder (RBD was present in 37.5%. Characteristics associated with SAHS were age (p = 0.049 and body mass index (p = 0.016. Regarding RBD, age (p < 0.001, left motor onset (p = 0.047 and levodopa equivalent dose (p = 0.002 were the main predictors. Conclusion SAHS and RBD were the most frequent sleep disorders. Higher levodopa equivalent dose and body mass index appear to be risk factors for RBD and SAHS, respectively.

Sleep in Patients with Chronic Migraine.

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Yang, Chun-Pai; Wang, Shuu-Jiun

2017-09-01

The biological and pathophysiological interaction between sleep and chronic migraine (CM) remains to be fully elucidated. In this article, we provide a narrative review of the literature on sleep disturbance and CM, highlighting recent advances in sleep research and insights into mechanisms that could mediate a role of sleep disturbances in migraine chronification. We discuss the potential for cognitive-behavioral insomnia therapy (CBTi) as an intervention for CM with comorbid insomnia. Finally, we propose a model of the mechanisms underlying the interactions among sleep physiology, maladaptive migraine-coping behaviors, and coexisting factors which contribute to sleep disturbances in CM based on conceptual models used in sleep research. Insomnia is the most common sleep complaint among patients with CM. CM patients experience more frequent and severe insomnia symptoms than patients with episodic migraine (EM). It has been suggested that sleep disturbances may predispose individuals to migraine attacks, which may affect the pain-processing trigeminovascular system and thus play a role in migraine progression. Encouraging but limited evidence suggests that management of insomnia via behavioral sleep therapy may reverse CM to EM and possibly prevent migraine chronification. Migraine has a complex relationship with sleep. The use of objective sleep study such as polysomnographic microstructural sleep analysis and actigraphy could help connect sleep disturbances and processes related to CM. Future longitudinal studies should examine whether effective behavioral treatments such as CBTi can reverse migraine chronification.

Prevalence of Parasomnia in Autistic Children with Sleep Disorders

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Xue Ming

2009-01-01

Full Text Available The prevalence of sleep related complaints is reported by questionnaire studies to be as high as 83.3% in children with autism spectrum disorders (ASD. Questionnaire studies report the presence of various parasomnia in ASD. However, no polysomnographic study reports non-REM parasomnias and only a single study reports REM related parasomnias in ASD. We investigated the prevalence and characteristics of sleep disorders by polysomnographic study and questionnaires in a cohort of 23 children with ASD and 23 age-matched children of a non-autistic comparison group. The results showed significantly more non-REM parasomnias in 14 children with ASD on polysomnograms (PSG and 16 ASD children by questionnaire, a finding that was not associated with medication use, other comorbid medical or psychiatric disorders, or sleep disordered breathing. Of the 14 children with ASD who had PSG evidence of parasomnia, 11 of them had a history suggestive of parasomnia by questionnaire. There was a high sensitivity but a low specificity of parasomnia in ASD by questionnaire in predicting the presence of parasomnia in the PSG. Of the parasomnias recorded in the laboratory, 13 ASD children had Disorders of Partial Arousal, consistent with sleep terrors or confusional arousals. Furthermore, multiple episodes of partial arousal occurred in 11 of the 13 ASD children who had PSG evidence of Disorders of Partial Arousal. Of the 11 ASD children with multiple episodes of partial arousal, 6 ASD children had multiple partial arousals during both nights’ PSG study. Sleep architecture was abnormal in children with ASD, characterized by increased spontaneous arousals, prolonged REM latency and reduced REM percentage. These results suggest a high prevalence of parasomnia in this cohort of children with ASD and a careful history intake of symptoms compatible with parasomnia could be prudent to diagnose parasomnia in ASD children when performing a PSG is not possible.

Evaluation of an automated single-channel sleep staging algorithm

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Wang Y

2015-09-01

Full Text Available Ying Wang,1 Kenneth A Loparo,1,2 Monica R Kelly,3 Richard F Kaplan1 1General Sleep Corporation, Euclid, OH, 2Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, 3Department of Psychology, University of Arizona, Tucson, AZ, USA Background: We previously published the performance evaluation of an automated electroencephalography (EEG-based single-channel sleep–wake detection algorithm called Z-ALG used by the Zmachine® sleep monitoring system. The objective of this paper is to evaluate the performance of a new algorithm called Z-PLUS, which further differentiates sleep as detected by Z-ALG into Light Sleep, Deep Sleep, and Rapid Eye Movement (REM Sleep, against laboratory polysomnography (PSG using a consensus of expert visual scorers. Methods: Single night, in-lab PSG recordings from 99 subjects (52F/47M, 18–60 years, median age 32.7 years, including both normal sleepers and those reporting a variety of sleep complaints consistent with chronic insomnia, sleep apnea, and restless leg syndrome, as well as those taking selective serotonin reuptake inhibitor/serotonin–norepinephrine reuptake inhibitor antidepressant medications, previously evaluated using Z-ALG were re-examined using Z-PLUS. EEG data collected from electrodes placed at the differential-mastoids (A1–A2 were processed by Z-ALG to determine wake and sleep, then those epochs detected as sleep were further processed by Z-PLUS to differentiate into Light Sleep, Deep Sleep, and REM. EEG data were visually scored by multiple certified polysomnographic technologists according to the Rechtschaffen and Kales criterion, and then combined using a majority-voting rule to create a PSG Consensus score file for each of the 99 subjects. Z-PLUS output was compared to the PSG Consensus score files for both epoch-by-epoch (eg, sensitivity, specificity, and kappa and sleep stage-related statistics (eg, Latency to Deep Sleep, Latency to REM

Analysis of automated quantification of motor activity in REM sleep behaviour disorder

DEFF Research Database (Denmark)

Frandsen, Rune; Nikolic, Miki; Zoetmulder, Marielle

2015-01-01

Rapid eye movement (REM) sleep behaviour disorder (RBD) is characterized by dream enactment and REM sleep without atonia. Atonia is evaluated on the basis of visual criteria, but there is a need for more objective, quantitative measurements. We aimed to define and optimize a method for establishing...... baseline and all other parameters in automatic quantifying submental motor activity during REM sleep. We analysed the electromyographic activity of the submental muscle in polysomnographs of 29 patients with idiopathic RBD (iRBD), 29 controls and 43 Parkinson's (PD) patients. Six adjustable parameters...... were validated on PD patients. Automatic baseline estimation improved characterization of atonia during REM sleep, as it eliminates inter/intra-observer variability and can be standardized across diagnostic centres. We found an optimized method for quantifying motor activity during REM sleep...

Diagnostic thresholds for quantitative REM sleep phasic burst duration, phasic and tonic muscle activity, and REM atonia index in REM sleep behavior disorder with and without comorbid obstructive sleep apnea.

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McCarter, Stuart J; St Louis, Erik K; Duwell, Ethan J; Timm, Paul C; Sandness, David J; Boeve, Bradley F; Silber, Michael H

2014-10-01

We aimed to determine whether phasic burst duration and conventional REM sleep without atonia (RSWA) methods could accurately diagnose REM sleep behavior disorder (RBD) patients with comorbid OSA. We visually analyzed RSWA phasic burst durations, phasic, "any," and tonic muscle activity by 3-s mini-epochs, phasic activity by 30-s (AASM rules) epochs, and conducted automated REM atonia index (RAI) analysis. Group RSWA metrics were analyzed and regression models fit, with receiver operating characteristic (ROC) curves determining the best diagnostic cutoff thresholds for RBD. Both split-night and full-night polysomnographic studies were analyzed. N/A. Parkinson disease (PD)-RBD (n = 20) and matched controls with (n = 20) and without (n = 20) OSA. N/A. All mean RSWA phasic burst durations and muscle activities were higher in PD-RBD patients than controls (P sleep without atonia diagnostic thresholds applicable in Parkinson disease-REM sleep behavior disorder (PD-RBD) patient populations with comorbid OSA that may be useful toward distinguishing PD-RBD in typical outpatient populations. © 2014 Associated Professional Sleep Societies, LLC.

Sleep-Related Disorders in Children with Attention-Deficit Hyperactivity Disorder: Preliminary Results of a Full Sleep Assessment Study.

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Miano, Silvia; Esposito, Maria; Foderaro, Giuseppe; Ramelli, Gian Paolo; Pezzoli, Valdo; Manconi, Mauro

2016-11-01

We present the preliminary results of a prospective case-control sleep study in children with a diagnosis of attention-deficit hyperactivity disorder (ADHD). A deep sleep assessment including sleep questionnaires, sleep habits, a video-polysomnographic recording with full high-density electroencephalography (EEG) and cardiorespiratory polygraphy, multiple sleep latency test, and 1-week actigraphic recording were performed to verify whether children with ADHD may be classified into one of the following five phenotypes: (1) hypoarousal state, resembling narcolepsy, which may be considered a "primary" form of ADHD; (2) delayed sleep onset insomnia; (3) sleep-disordered breathing; (4) restless legs syndrome and/or periodic limb movements; and (5) sleep epilepsy and/or EEG interictal epileptiform discharges. Fifteen consecutive outpatients with ADHD were recruited (two female, mean age 10.6 ± 2.2, age range 8-13.7 years) over 6 months. The narcolepsy-like sleep phenotype was observed in three children, the sleep onset insomnia phenotype was observed in one child, mild obstructive sleep apnea was observed in three children, sleep hyperkinesia and/or PLMs were observed in five children, while IEDs and or nocturnal epilepsy were observed in three children. Depending on the sleep phenotype, children received melatonin, iron supplementation, antiepileptic drugs, or stimulants. Our study further highlights the need to design an efficient sleep diagnostic algorithm for children with ADHD, thereby more accurately identifying cases in which a full sleep assessment is indicated. © 2016 John Wiley & Sons Ltd.

In-Flight Sleep of Flight Crew During a 7-hour Rest Break: Implications for Research and Flight Safety

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Signal, T. Leigh; Gander, Philippa H.; van den Berg, Margo J.; Graeber, R. Curtis

2013-01-01

Study Objectives: To assess the amount and quality of sleep that flight crew are able to obtain during flight, and identify factors that influence the sleep obtained. Design: Flight crew operating flights between Everett, WA, USA and Asia had their sleep recorded polysomnographically for 1 night in a layover hotel and during a 7-h in-flight rest opportunity on flights averaging 15.7 h. Setting: Layover hotel and in-flight crew rest facilities onboard the Boeing 777-200ER aircraft. Participants: Twenty-one male flight crew (11 Captains, mean age 48 yr and 10 First Officers, mean age 35 yr). Interventions: N/A. Measurements and Results: Sleep was recorded using actigraphy during the entire tour of duty, and polysomnographically in a layover hotel and during the flight. Mixed model analysis of covariance was used to determine the factors affecting in-flight sleep. In-flight sleep was less efficient (70% vs. 88%), with more nonrapid eye movement Stage 1/Stage 2 and more frequent awakenings per h (7.7/h vs. 4.6/h) than sleep in the layover hotel. In-flight sleep included very little slow wave sleep (median 0.5%). Less time was spent trying to sleep and less sleep was obtained when sleep opportunities occurred during the first half of the flight. Multivariate analyses suggest age is the most consistent factor affecting in-flight sleep duration and quality. Conclusions: This study confirms that even during long sleep opportunities, in-flight sleep is of poorer quality than sleep on the ground. With longer flight times, the quality and recuperative value of in-flight sleep is increasingly important for flight safety. Because the age limit for flight crew is being challenged, the consequences of age adversely affecting sleep quantity and quality need to be evaluated. Citation: Signal TL; Gander PH; van den Berg MJ; Graeber RC. In-flight sleep of flight crew during a 7-hour rest break: implications for research and flight safety. SLEEP 2013;36(1):109–115. PMID:23288977

Sleep problems during the menopausal transition: prevalence, impact, and management challenges

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Baker FC

2018-02-01

Full Text Available Fiona C Baker,1,2 Massimiliano de Zambotti,1 Ian M Colrain,1,3 Bei Bei4,5 1Center for Health Sciences, SRI International, Menlo Park, CA, USA; 2Brain Function Research Group, University of the Witwatersrand, Johannesburg, South Africa; 3Melbourne School of Psychological Sciences, University of Melbourne, 4Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 5Centre for Women’s Mental Health, Department of Psychiatry, University of Melbourne, Royal Women’s Hospital, Melbourne, VIC, Australia Abstract: A substantial number of women experience sleep difficulties in the approach to menopause and beyond, with 26% experiencing severe symptoms that impact daytime functioning, qualifying them for a diagnosis of insomnia. Here, we review both self-report and polysomnographic evidence for sleep difficulties in the context of the menopausal transition, considering severity of sleep complaints and links between hot flashes (HFs and depression with poor sleep. Longitudinal population-based studies show that sleep difficulties are uniquely linked with menopausal stage and changes in follicle-stimulating hormone and estradiol, over and above the effects of age. A major contributor to sleep complaints in the context of the menopausal transition is HFs, and many, although not all, HFs are linked with polysomnographic-defined awakenings, with HF-associated wake time contributing significantly to overall wakefulness after sleep onset. Some sleep complaints may be comorbid with depressive disorders or attributed to sleep-related breathing or movement disorders, which increase in prevalence especially after menopause, and for some women, menopause, age, and environmental/behavioral factors may interact to disrupt sleep. Considering the unique and multifactorial basis for sleep difficulties in women transitioning menopause, we describe clinical assessment

Validation of an integrated software for the detection of rapid eye movement sleep behavior disorder.

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Frauscher, Birgit; Gabelia, David; Biermayr, Marlene; Stefani, Ambra; Hackner, Heinz; Mitterling, Thomas; Poewe, Werner; Högl, Birgit

2014-10-01

Rapid eye movement sleep without atonia (RWA) is the polysomnographic hallmark of REM sleep behavior disorder (RBD). To partially overcome the disadvantages of manual RWA scoring, which is time consuming but essential for the accurate diagnosis of RBD, we aimed to validate software specifically developed and integrated with polysomnography for RWA detection against the gold standard of manual RWA quantification. Academic referral center sleep laboratory. Polysomnographic recordings of 20 patients with RBD and 60 healthy volunteers were analyzed. N/A. Motor activity during REM sleep was quantified manually and computer assisted (with and without artifact detection) according to Sleep Innsbruck Barcelona (SINBAR) criteria for the mentalis ("any," phasic, tonic electromyographic [EMG] activity) and the flexor digitorum superficialis (FDS) muscle (phasic EMG activity). Computer-derived indices (with and without artifact correction) for "any," phasic, tonic mentalis EMG activity, phasic FDS EMG activity, and the SINBAR index ("any" mentalis + phasic FDS) correlated well with the manually derived indices (all Spearman rhos 0.66-0.98). In contrast with computerized scoring alone, computerized scoring plus manual artifact correction (median duration 5.4 min) led to a significant reduction of false positives for "any" mentalis (40%), phasic mentalis (40.6%), and the SINBAR index (41.2%). Quantification of tonic mentalis and phasic FDS EMG activity was not influenced by artifact correction. The computer algorithm used here appears to be a promising tool for REM sleep behavior disorder detection in both research and clinical routine. A short check for plausibility of automatic detection should be a basic prerequisite for this and all other available computer algorithms. © 2014 Associated Professional Sleep Societies, LLC.

Ventilatory control sensitivity in patients with obstructive sleep apnea is sleep stage dependent.

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Landry, Shane A; Andara, Christopher; Terrill, Philip I; Joosten, Simon A; Leong, Paul; Mann, Dwayne L; Sands, Scott A; Hamilton, Garun S; Edwards, Bradley A

2018-05-01

The severity of obstructive sleep apnea (OSA) is known to vary according to sleep stage; however, the pathophysiology responsible for this robust observation is incompletely understood. The objective of the present work was to examine how ventilatory control system sensitivity (i.e. loop gain) varies during sleep in patients with OSA. Loop gain was estimated using signals collected from standard diagnostic polysomnographic recordings performed in 44 patients with OSA. Loop gain measurements associated with nonrapid eye movement (NREM) stage 2 (N2), stage 3 (N3), and REM sleep were calculated and compared. The sleep period was also split into three equal duration tertiles to investigate how loop gain changes over the course of sleep. Loop gain was significantly lower (i.e. ventilatory control more stable) in REM (Mean ± SEM: 0.51 ± 0.04) compared with N2 sleep (0.63 ± 0.04; p = 0.001). Differences in loop gain between REM and N3 (p = 0.095), and N2 and N3 (p = 0.247) sleep were not significant. Furthermore, N2 loop gain was significantly lower in the first third (0.57 ± 0.03) of the sleep period compared with later second (0.64 ± 0.03, p = 0.012) and third (0.64 ± 0.03, p = 0.015) tertiles. REM loop gain also tended to increase across the night; however, this trend was not statistically significant [F(2, 12) = 3.49, p = 0.09]. These data suggest that loop gain varies between REM and NREM sleep and modestly increases over the course of sleep. Lower loop gain in REM is unlikely to contribute to the worsened OSA severity typically observed in REM sleep, but may explain the reduced propensity for central sleep apnea in this sleep stage.

Data-driven modeling of sleep EEG and EOG reveals characteristics indicative of pre-Parkinson's and Parkinson's disease

DEFF Research Database (Denmark)

Christensen, Julie Anja Engelhard; Zoetmulder, Marielle; Koch, Henriette

2014-01-01

patients with idiopathic REM sleep behavior disorder (iRBD) and 36 patients with Parkinson's disease (PD). The data were divided into training and validation datasets and features reflecting EEG and EOG characteristics based on topics were computed. The most discriminative feature subset for separating i...... and the ability to maintain NREM and REM sleep have potential as early PD biomarkers. Data-driven analysis of sleep may contribute to the evaluation of neurodegenerative patients. (C) 2014 Elsevier B.V. All rights reserved.......Background: Manual scoring of sleep relies on identifying certain characteristics in polysomnograph (PSG) signals. However, these characteristics are disrupted in patients with neurodegenerative diseases. New method: This study evaluates sleep using a topic modeling and unsupervised learning...

Effects of daytime food intake on memory consolidation during sleep or sleep deprivation.

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Nina Herzog

Full Text Available 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

Effects of daytime food intake on memory consolidation during sleep or sleep deprivation.

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Herzog, Nina; Friedrich, Alexia; Fujita, Naoko; Gais, Steffen; Jauch-Chara, Kamila; Oltmanns, Kerstin M; Benedict, Christian

2012-01-01

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

Unsupervised online classifier in sleep scoring for sleep deprivation studies.

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Libourel, Paul-Antoine; Corneyllie, Alexandra; Luppi, Pierre-Hervé; Chouvet, Guy; Gervasoni, Damien

2015-05-01

This study was designed to evaluate an unsupervised adaptive algorithm for real-time detection of sleep and wake states in rodents. We designed a Bayesian classifier that automatically extracts electroencephalogram (EEG) and electromyogram (EMG) features and categorizes non-overlapping 5-s epochs into one of the three major sleep and wake states without any human supervision. This sleep-scoring algorithm is coupled online with a new device to perform selective paradoxical sleep deprivation (PSD). Controlled laboratory settings for chronic polygraphic sleep recordings and selective PSD. Ten adult Sprague-Dawley rats instrumented for chronic polysomnographic recordings. The performance of the algorithm is evaluated by comparison with the score obtained by a human expert reader. Online detection of PS is then validated with a PSD protocol with duration of 72 hours. Our algorithm gave a high concordance with human scoring with an average κ coefficient > 70%. Notably, the specificity to detect PS reached 92%. Selective PSD using real-time detection of PS strongly reduced PS amounts, leaving only brief PS bouts necessary for the detection of PS in EEG and EMG signals (4.7 ± 0.7% over 72 h, versus 8.9 ± 0.5% in baseline), and was followed by a significant PS rebound (23.3 ± 3.3% over 150 minutes). Our fully unsupervised data-driven algorithm overcomes some limitations of the other automated methods such as the selection of representative descriptors or threshold settings. When used online and coupled with our sleep deprivation device, it represents a better option for selective PSD than other methods like the tedious gentle handling or the platform method. © 2015 Associated Professional Sleep Societies, LLC.

[Analysis of fatigue associated to periodic limb movement during sleep in former poliomyelitis patients].

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Oliveira, A R; Correa, F I; Correa, J C F; Oliveira, L V F

2012-01-01

Following poliomyelitis, patients may experience sleep disorders stemming from periodic limb movement, leading to fatigue and compromised muscle function the following day. To establish the presence or absence of muscle fatigue in these patients using electromyography and relating the data to polysomnographic findings. An analytical cross-sectional study was carried out involving 19 individuals with motor sequelae in the lower limbs stemming from poliomyelitis. Quantitative tests for the assessment of neurophysiological aspects (knee-jerk/Achilles reflexes and peripheral muscle strength of rectus femoris) and a sleep study (standard, level I polysomnography) were administered. A statistically significant difference was detected (p fatigue associated to sleep disorder. Individuals with sequelae from poliomyelitis exhibit sleep disorders that may lead to muscle fatigue. Periodic limb movement may contribute to this phenomenon.

Orthodontic Treatment with Rapid Maxillary Expansion for Treating a Boy with Severe Obstructive Sleep Apnea

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Myungrip Kim

2014-06-01

Full Text Available This case report shows that orthodontic treatment with rapid maxillary expansion (RME is an effective treatment option for managing pediatric obstructive sleep apnea (OSA. An 11-year-old boy with severe pediatric OSA received comprehensive orthodontic treatment with RME. Four sleep studies were done: before orthodontic treatment, after RME, just after comprehensive orthodontic treatment and at the 2-year and 5-month follow-up. Polysomnographic findings showed that the orthodontic treatment with RME was successful for managing severe OSA in the patient.

A simple system for detection of EEG artifacts in polysomnographic recordings.

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Durka, P J; Klekowicz, H; Blinowska, K J; Szelenberger, W; Niemcewicz, Sz

2003-04-01

We present an efficient parametric system for automatic detection of electroencephalogram (EEG) artifacts in polysomnographic recordings. For each of the selected types of artifacts, a relevant parameter was calculated for a given epoch. If any of these parameters exceeded a threshold, the epoch was marked as an artifact. Performance of the system, evaluated on 18 overnight polysomnographic recordings, revealed concordance with decisions of human experts close to the interexpert agreement and the repeatability of expert's decisions, assessed via a double-blind test. Complete software (Matlab source code) for the presented system is freely available from the Internet at http://brain.fuw.edu.pl/artifacts.

Sleep architecture in insomniacs with severe benzodiazepine abuse.

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Manconi, Mauro; Ferri, Raffaele; Miano, Silvia; Maestri, Michelangelo; Bottasini, Valentina; Zucconi, Marco; Ferini-Strambi, Luigi

2017-06-01

Benzodiazepines (BZDs) are the most commonly prescribed compounds in insomnia. A long-term of BZDs use may cause dependence and abuse. The aim of this study was to evaluate sleep architecture and microstructure (in terms of cyclic alternating pattern - CAP - analysis and of sleep EEG power spectral analysis) in a group of long-term users of high doses of BZDs for their primary chronic insomnia. Twenty patients consecutively admitted at the Sleep Centre for drug discontinuation and 13 matched healthy controls underwent a full nocturnal video-polysomnographic recording, after one adaptation night. Significant differences were found in time in bed, REM sleep latency and sleep stage 1% which were increased in patients compared to controls, while CAP rate was dramatically decreased. During NREM sleep, patients showed a clear decrease in the relative power of delta band. Our data demonstrate that in adults with chronic insomnia, long-term use of high doses of BZDs induces a severe disruption of sleep microstructure, while sleep architecture seems to be much less affected. The long term use of high doses of BZDs for chronic insomnia induces a marked depression of slow wave activity and of its physiological instability. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Sleep-related memory consolidation in primary insomnia.

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Nissen, Christoph; Kloepfer, Corinna; Feige, Bernd; Piosczyk, Hannah; Spiegelhalder, Kai; Voderholzer, Ulrich; Riemann, Dieter

2011-03-01

It has been suggested that healthy sleep facilitates the consolidation of newly acquired memories and underlying brain plasticity. The authors tested the hypothesis that patients with primary insomnia (PI) would show deficits in sleep-related memory consolidation compared to good sleeper controls (GSC). The study used a four-group parallel design (n=86) to investigate the effects of 12 h of night-time, including polysomnographically monitored sleep ('sleep condition' in PI and GSC), versus 12 h of daytime wakefulness ('wake condition' in PI and GSC) on procedural (mirror tracing task) and declarative memory consolidation (visual and verbal learning task). Demographic characteristics and memory encoding did not differ between the groups at baseline. Polysomnography revealed a significantly disturbed sleep profile in PI compared to GSC in the sleep condition. Night-time periods including sleep in GSC were associated with (i) a significantly enhanced procedural and declarative verbal memory consolidation compared to equal periods of daytime wakefulness in GSC and (ii) a significantly enhanced procedural memory consolidation compared to equal periods of daytime wakefulness and night-time sleep in PI. Across retention intervals of daytime wakefulness, no differences between the experimental groups were observed. This pattern of results suggests that healthy sleep fosters the consolidation of new memories, and that this process is impaired for procedural memories in patients with PI. Future work is needed to investigate the impact of treatment on improving sleep and memory. © 2010 European Sleep Research Society.

Poincaré analysis of an overnight arterial oxygen saturation signal applied to the diagnosis of sleep apnea hypopnea syndrome

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Morillo, Daniel S; Rojas, Juan L; Crespo, Luis F; León, Antonio; Gross, Nicole

2009-01-01

The analysis of oxygen desaturations is a basic variable in polysomnographic studies for the diagnosis of sleep apnea. Several algorithms operating in the time domain already exist for sleep apnea detection via pulse oximetry, but in a disadvantageous way—they achieve either a high sensitivity or a high specificity. The aim of this study was to assess whether an alternative analysis of arterial oxygen saturation (SaO 2 ) signals from overnight pulse oximetry could yield essential information on the diagnosis of sleep apnea hypopnea syndrome (SAHS). SaO 2 signals from 117 subjects were analyzed. The population was divided into a learning dataset (70 patients) and a test set (47 patients). The learning set was used for tuning thresholds among the applied Poincaré quantitative descriptors. Results showed that the presence of apnea events in SAHS patients caused an increase in the SD 1 Poincaré parameter. This conclusion was assessed prospectively using the test dataset. 90.9% sensitivity and 84.0% specificity were obtained in the test group. We conclude that Poincaré analysis could be useful in the study of SAHS, contributing to reduce the demand for polysomnographic studies in SAHS screening

[Treatment of supine position-related obstructive sleep apnea with smartphone applications].

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Haas, D; Birk, R; Maurer, J T; Hörmann, K; Stuck, B A; Sommer, J U

2017-02-01

Positional obstructive sleep apnea (POSA) is common in mild and moderate forms of obstructive sleep apnea (OSA). Two smartphone applications (apps) professing to avoid the supine position (SP) are available: for Android the "Apnea Sleep Position Trainer" and for iOS the "SomnoPose-Sleep Position Monitor". The smartphone needs to be attached to the chest to recognize SP, which then triggers a vibration alarm. This is intended to encourage the patient to change position and the vibration stops as soon as SP is left. These apps, however, have not yet undergone a systematic evaluation. Adult patients with polysomnographically diagnosed POSA were invited to participate in the study. POSA was defined as an apnea-hypopnea index (AHI) in SP >10, with AHI in a lateral position sleep time and to an overall AHI smartphone apps have the capability to prevent PS in POSA patients and can potentially offer a cost-effective option in the treatment of POSA.

Is there a First Night Effect on Sleep Bruxism? A Sleep Laboratory Study

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Hasegawa, Yoko; Lavigne, Gilles; Rompré, Pierre; Kato, Takafumi; Urade, Masahiro; Huynh, Nelly

2013-01-01

Study Objectives: Sleep bruxism (SB) is reported to vary in frequency over time. The aim of this study was to assess the first night effect on SB. Methods: A retrospective polysomnographic (PSG) analysis was performed of data from a sample of SB patients (12 females, 4 males; age range: 17-39 years) recorded in a sleep laboratory over 2 consecutive nights. Sleep parameters and jaw muscle activity variables (i.e., rhythmic masticatory muscle activity [RMMA]) for SB were quantified and compared between the 2 nights. Subjects were classified into groups according to severity of RMMA frequency, such as low frequency (2-4 episodes/h and/or bruxism time index, and mean burst duration (repeated measure ANOVAs, p ≤ 0.05). Five patients of 8 in the low frequency group were classified into the moderate-high frequency group on the second night, whereas only one patient in the moderate-high frequency group moved to the low frequency group. Conclusions: The results showed no overall first night effect on severity of RMMA frequency in young and healthy patients with SB. In clinical practice, one-night sleep recording may be sufficient for moderate-high frequency SB patients. However, low RMMA frequency in the first night could be confirmed by a second night based on the patient's medical and dental history. Citation: Hasegawa Y; Lavigne G; Rompré P; Kato T; Urade M; Huynh N. Is there a first night effect on sleep bruxism? A sleep laboratory study. J Clin Sleep Med 2013;9(11):1139-1145. PMID:24235894

Global Assessment of the Impact of Type 2 Diabetes on Sleep through Specific Questionnaires. A Case-Control Study.

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Albert Lecube

Full Text Available Type 2 diabetes (T2D is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters.A case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS. In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI to calculate sleep quality.Daytime sleepiness was higher in T2D than in control subjects (p = 0.003, with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10. Patients with fasting plasma glucose (FPG ≥13.1 mmol/l were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8-7.9, p = 0.0003. A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90% independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0-18.0 vs. 4 (0.0-12.0, p<0.001].The presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted.

Sustained Partial Sleep Deprivation: Effects on Immune Modulation and Growth Factors

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Mullington, Janet M.

1999-01-01

The vulnerability to medical emergencies is greatest in space where there are real limits to the availability or effectiveness of ground based assistance. Moreover, astronaut safety and health maintenance will be of increasing importance as we venture out into space for extended periods of time. It is therefore critical to understand the mechanisms of the regulatory physiology of homeostatic systems (sleep, circadian, neuroendocrine, fluid and nutritional balance) and the key roles played in adaptation. This synergy project has combined aims of the "Human Performance Factors, Sleep and Chronobiology Team"; the "Immunology, Infection and Hematology Team"; and the "Muscle Alterations and Atrophy Team", to broadly address the effects of long term sleep reduction, as is frequently encountered in space exploration, on neuroendocrine, neuroimmune and circulating growth factors. Astronaut sleep is frequently curtailed to averages of between 4- 6.5 hours per night. There is evidence that this amount of sleep is inadequate for maintaining optimal daytime functioning. However, there is a lack of information concerning the effects of chronic sleep restriction, or reduction, on regulatory physiology in general, and there have been no controlled studies of the cumulative effects of chronic sleep reduction on neuroendocrine and neuroimmune parameters. This synergy project represents a pilot study designed to characterize the effects of chronic partial sleep deprivation (PSD) on neuroendocrine, neuroimmune and growth factors. This project draws its subjects from two (of 18) conditions of the larger NSBRI project, "Countermeasures to Neurobehavioral Deficits from Cumulative Partial Sleep Deprivation During Space Flight", one of the projects on the "Human Performance Factors, Sleep and Chronobiology Team ". For the purposes of this study, to investigate the effects of chronic sleep loss on neuroendocrine and neuroimmune function, we have focused on the two extreme sleep conditions

Clinical characteristics of sleep disorders in patients with Parkinson's disease.

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Mao, Zhi-Juan; Liu, Chan-Chan; Ji, Su-Qiong; Yang, Qing-Mei; Ye, Hong-Xiang; Han, Hai-Yan; Xue, Zheng

2017-02-01

In order to investigate the sleep quality and influencing factors in patients with Parkinson's disease (PD), 201 PD patients were enrolled and underwent extensive clinical evaluations. Subjective sleep evaluation was assessed using the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). It was found that poor sleep quality (77.11%) and excessive daytime sleepiness (32.34%) were commonly seen in PD patients and positively correlated with disease severity. Then 70 out of the 201 PD patients and 70 age- and sex-matched controls underwent a polysomnographic recording. The parameters were compared between PD group and control group and the influencing factors of sleep in PD patients were analyzed. The results showed that sleep efficiency (SE) was significantly decreased (Psleep latency (SL) and the arousal index (AI) were increased (Psleep time (TST) were positively correlated with the Hoehn and Yahr (H&Y) stage. There was significant difference in the extent of hypopnea and hypoxemia between the PD group and the control group (Psleep quality and a high prevalence of sleep disorder, which may be correlated with the disease severity. Respiratory function and oxygen supply are also affected to a certain degree in PD patients.

Emotional and behavioral problems associated with sleep disorders in children

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I. A. Kelmanson

2014-01-01

Full Text Available The paper considers whether parasomnia may be associated with emotional and behavioral problems. It gives data on the relationship of impaired sleep duration and integrity to increased emotional responsiveness and lability, high levels of anxiety, and depression symptoms. Whether the clinical symptoms of attention-deficit/hyperactivity disorder, aggression, and academic underachievement are related to sleep disorders, including those in the presence of sleep disordered breathing, restless legs syndrome and periodic limb movement disorder, is discussed. There are data on the characteristic polysomnographic changes detected in the presence of the discussed emotional and behavioral disorders in children. A possible pathophysiological rationale is provided for the found associations. Practical guidelines for examination of children with complaints about emotional and behavioral disorders for possible concomitant parasomnias are substantiated. 

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing.

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El-Hamad, Fatima; Immanuel, Sarah; Liu, Xiao; Pamula, Yvonne; Kontos, Anna; Martin, James; Kennedy, Declan; Kohler, Mark; Porta, Alberto; Baumert, Mathias

2017-10-01

To assess cardiovascular control during sleep in children with sleep-disordered breathing (SDB) and the effect of adenotonsillectomy in comparison to healthy nonsnoring children. Cardiorespiratory signals obtained from overnight polysomnographic recordings of 28 children with SDB and 34 healthy nonsnoring children were analyzed. We employed an autoregressive closed-loop model with heart period (RR) and pulse transit time (PTT) as outputs and respiration as an external input to obtain estimates of respiratory gain and baroreflex gain. Mean and variability of PTT were increased in children with SDB across all stages of sleep. Low frequency power of RR and PTT were attenuated during non-rapid eye movement (REM) sleep. Baroreflex sensitivity was reduced in children with SDB in stage 2 sleep, while respiratory gain was increased in slow wave sleep. After adenotonsillectomy, these indices normalized in the SDB group attaining values comparable to those of healthy children. In children with mild-to-moderate SDB, vasomotor activity is increased and baroreflex sensitivity decreased during quiet, event-free non-REM sleep. Adenotonsillectomy appears to reverse this effect. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

REM Sleep Behavior Disorder: Updated Review of the Core Features, the RBD-Neurodegenerative Disease Association, Evolving Concepts, Controversies, and Future Directions

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Boeve, Bradley F.

2010-01-01

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid, often frightening dreams associated with simple or complex motor behavior during REM sleep. Patients appear to “act out their dreams,” in which the exhibited behaviors mirror the content of the dreams, and the dream content often involves a chasing or attacking theme. The polysomnographic features of RBD include increased electromyographic tone +/- dream enactment behavior during REM sleep. Management with counseling and pharmacologic measures is usually straight-forward and effective. In this review, the terminology, clinical and polysomnographic features, demographic and epidemiologic features, diagnostic criteria, differential diagnosis, and management strategies are discussed. Recent data on the suspected pathophysiologic mechanisms of RBD are also reviewed. The literature and our institutional experience on RBD are next discussed, with an emphasis on the RBD-neurodegenerative disease association and particularly the RBD-synucleinopathy association. Several issues relating to evolving concepts, controversies, and future directions are then reviewed, with an emphasis on idiopathic RBD representing an early feature of a neurodegenerative disease and particularly an evolving synucleinopathy. Planning for future therapies that impact patients with idiopathic RBD is reviewed in detail. PMID:20146689

Sleep instability and cognitive status in drug-resistant epilepsies.

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Pereira, Alessandra Marques; Bruni, Oliviero; Ferri, Raffaele; Nunes, Magda Lahorgue

2012-05-01

The aims of this study were to evaluate the sleep habits of children with drug resistant epilepsy and to correlate sleep abnormalities with epilepsy and level of intelligence. Twenty five subjects with drug resistant epilepsy (14 males, age range 2-16.4 years) were recruited for this study. A control group was formed by 23 normal children. Two instruments to assess sleep habits were administered to the patients with epilepsy: a questionnaire on sleep habits (to preschool children) and a questionnaire on sleep behavior (for children aged more than seven years old); a cognitive test (Wechsler Intelligence Scale for Children-WISC) was also performed. Patients underwent a complete polysomnographic study and sleep parameters, including CAP, were analyzed and correlated according to cognitive-behavioral measures in children with epilepsy. Children with drug-resistant epilepsy and severe mental retardation showed sleep abnormalities such as low sleep efficiency, high percentage of wakefulness after sleep onset, reduced slow wave sleep, and reduced REM sleep. Sleep microstructure evaluated by means of CAP analysis showed a decrease in A1 index during N3 in patients with more severe cognitive impairment. Children with epilepsy and cognitive impairment (n=10) had higher Sleep Behavior Questionnaire for Children (SBQC) total scores (65.60 ± 18.56) compared to children with epilepsy and normal IQ (50.00 ± 10.40), pintellectual disability. Copyright © 2012 Elsevier B.V. All rights reserved.

Comparison of polysomnographic data in age-, sex- and Axis I psychiatric diagnosis matched HIV-seropositive and HIV-seronegative insomnia patients.

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Low, Yinghui; Goforth, Harold W; Omonuwa, Toma; Preud'homme, Xavier; Edinger, Jack; Krystal, Andrew

2012-12-01

There is a high prevalence of insomnia in HIV-seropositive patients. Insomnia is associated with poorer disease outcomes, cognitive impairment and HIV-associated dementia. However there is limited data characterizing the type of sleep disturbances, and the cause. Previous studies report conflicting results, and observed changes in the distribution of REM and SWS were hypothesized to result from co-morbid mood disorders, although this is not established. We carried out this study to determine if there are differences in polysomnographic (PSG) sleep data in age-, sex- and Axis I diagnoses- matched HIV-seropositive and HIV-seronegative patients. Eighteen HIV-seropositive insomniacs were matched to HIV-seronegative insomniacs based on age, sex and Axis I diagnoses. Participants spent 2 consecutive nights in a sleep lab recording of PSG data. Multivariate analysis revealed an overall significant match-by-variable interaction (p=0.0126). Follow-up analysis show that compared to HIV-seronegative insomnia controls, HIV-seropositive insomniacs have significantly longer SOL, 8% decreased sleep efficiency, and 8-10% decreased time spent in REM sleep (p'saccounting for differences in age, sex and psychiatric diagnoses, HIV-seropositive patients with insomnia have significantly worse sleep than HIV-seronegative patients with insomnia. Unlike what previous authors have proposed, our results do not support the view that comorbid psychiatric disorders like depression are responsible for the observed differences in PSG findings and the greater incidence of insomnia, in HIV-seropositive patients when compared with other groups of insomnia patients. This suggests the presence of other etiologies including neuronal damage, psychosocial stressors, or comorbid medical conditions. Further studies are needed to determine the extent to which these play a role in insomnia in the HIV-seropositive population. Copyright © 2012 International Federation of Clinical Neurophysiology. Published by

Assessment of ventilatory neuromuscular drive in patients with obstructive sleep apnea

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L.R.A. Bittencourt

1998-04-01

Full Text Available The presence of abnormalities of the respiratory center in obstructive sleep apnea (OSA patients and their correlation with polysomnographic data are still a matter of controversy. Moderately obese, sleep-deprived OSA patients presenting daytime hypersomnolence, with normocapnia and no clinical or spirometric evidence of pulmonary disease, were selected. We assessed the ventilatory control and correlated it with polysomnographic data. Ventilatory neuromuscular drive was evaluated in these patients by measuring the ventilatory response (VE, the inspiratory occlusion pressure (P.1 and the ventilatory pattern (VT/TI, TI/TTOT at rest and during submaximal exercise, breathing room air. These analyses were also performed after inhalation of a hypercapnic mixture of CO2 (DP.1/DPETCO2, DVE/DPETCO2. Average rest and exercise ventilatory response (VE: 12.2 and 32.6 l/min, respectively, inspiratory occlusion pressure (P.1: 1.5 and 4.7 cmH2O, respectively, and ventilatory pattern (VT/TI: 0.42 and 1.09 l/s; TI/TTOT: 0.47 and 0.46 l/s, respectively were within the normal range. In response to hypercapnia, the values of ventilatory response (DVE/DPETCO2: 1.51 l min-1 mmHg-1 and inspiratory occlusion pressure (DP.1/DPETCO2: 0.22 cmH2O were normal or slightly reduced in the normocapnic OSA patients. No association or correlation between ventilatory neuromuscular drive and ventilatory pattern, hypersomnolence score and polysomnographic data was found; however a significant positive correlation was observed between P.1 and weight. Our results indicate the existence of a group of normocapnic OSA patients who have a normal awake neuromuscular ventilatory drive at rest or during exercise that is partially influenced by obesity

Insomnia with short sleep duration and mortality: the Penn State cohort.

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Vgontzas, Alexandros N; Liao, Duanping; Pejovic, Slobodanka; Calhoun, Susan; Karataraki, Maria; Basta, Maria; Fernández-Mendoza, Julio; Bixler, Edward O

2010-09-01

Because insomnia with objective short sleep duration is associated with increased morbidity, we examined the effects of this insomnia subtype on all-cause mortality. Longitudinal. Sleep laboratory. 1,741 men and women randomly selected from Central Pennsylvania. Participants were studied in the sleep laboratory and were followed-up for 14 years (men) and 10 years (women). "Insomnia" was defined by a complaint of insomnia with duration > or = 1 year. "Normal sleeping" was defined as absence of insomnia. Polysomnographic sleep duration was classified into two categories: the "normal sleep duration group" subjects who slept > or = 6 h and the "short sleep duration group" subjects who slept insomnia" group, (OR = 4.00, CI 1.14-13.99) after adjusting for diabetes, hypertension, and other confounders. Furthermore, there was a marginally significant trend (P = 0.15) towards higher mortality risk from insomnia and short sleep in patients with diabetes or hypertension (OR = 7.17, 95% CI 1.41-36.62) than in those without these comorbid conditions (OR = 1.45, 95% CI 0.13-16.14). In women, mortality was not associated with insomnia and short sleep duration. Insomnia with objective short sleep duration in men is associated with increased mortality, a risk that has been underestimated.

Effects on neuropsychological performance and sleep quality in patients with obstructive sleep apnea syndrome

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Cristina Staub

2009-11-01

Full Text Available Patients with obstructive sleep apnea syndrome (OSAS may have impaired neuropsychological performance. The aim of the study is to assess neuropsychological function in OSAS patients before and on continous positive airway pressure (CPAP therapy to assess different neuropsychological tests – especially of sensomotor memory – in OSAS patients, and to relate neuropsychological test results to polysomnographic findings. Therefore, 36 normal controls and 18 OSAS patients performed tests of attention capacity and memory with retrieval in the evening and the following morning. Six weeks later, the tests were repeated (patients on CPAP. Controls performed significantly better than patients in the tests of attention and of memory of facts without and on CPAP therapy. Moreover, good compliance of CPAP therapy was not associated with better performance. However, there was no significant difference between controls and patients in the tests of sensomotor memory. The neuropsychological results depended on oxygen values, the arousal index, and sleep stages. There is no group difference in overnight improvement in the neuropsychological tests, which could indicate that sleep has an important function in homeostatic regulation rather than in consolidation.

Sleep EEG findings in ICD-10 borderline personality disorder in Egypt.

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Asaad, Tarek; Okasha, Tarek; Okasha, Ahmed

2002-09-01

Previous work has demonstrated that patients with borderline personality disorder show some similarities to patients with major depression, especially regarding their sleep profile. This study aimed at investigating such a hypothesis in an Egyptian sample, considering the possible influence of cultural differences. All night polysomnographic assessments were made for 20 ICD-10 diagnosed borderline patients (without co-morbid depression), in addition to 20 patients with major depression and 20 healthy matched controls. The two patient groups differed significantly from controls in their sleep profile, especially regarding sleep continuity measures, decreased SWS and REM sleep abnormalities. High similarity was found in EEG sleep profile of the two patient groups, though the changes were more robust in patients with depression. The small number of subjects precluded finer analyses of sleep microstructure by depressive symptoms. The great similarity in EEG sleep profile between borderline personality disorder patients and patients with major depression suggests a common biological origin for both conditions, with the difference being 'quantitative' rather than 'qualitative'. Our data are all the more compelling in that the presumed personality disturbance in the Egyptian culture manifests neurophysiologically as in the Western world.

The influence of upper airways diameter on the intensity of obstructive sleep apnea

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Jolanta Szymańska

2014-03-01

Full Text Available Introduction and Objective. Obstructive sleep apnea (OSA is characterized by at least 5 ten-second-long episodes of apnea or hypopnea, per hour of sleep. This disease may lead to severe, life-threatening complications. Therefore, risk analysis and its influence on disease intensity is crucial for proper implementation of preventive treatments. Objective. To determine the relation between the intensity of OSA expressed in Apnea-Hypopnea Index (AHI, and the anterior-posterior diameter of upper airways at the levels of soft palate and tongue base. Material and Method. Medical records of 41 patients with sleep apnea (AHI>4 diagnosed through polysomnographic examination obstructive were used for the study. The data consisted of: age and gender, polysomnographic examination results (AHI, lateral cephalogram with cephalomertic analysis, together with measurements of the upper and lower pharyngeal depth according to McNamara. Statistical analysis was carried out in accordance with Pearson’s r correlation coefficient test (Statistica 8.0 software package. Results. Analysis of the influence of upper airways diameter on the intensity of OSA showed that the value of upper Airways diameter at the tongue base level had no statistically significant impact on the value of AHI (p=0.795. However, a statistically significant impact of the value of upper airways diameter on the AHI value (p=0.008 at the soft palate level was observed. Patients with OSA have narrowed upper airways diameter. The value of AHI increases with the decrease of upper diameter and is not dependent on a lower diameter value. Patients with a decreased upper airways diameter should be informed about potential breathing disorders during sleep.

Cold-induced bradycardia in man during sleep in Arctic winter nights

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Buguet, A. G. C.

1987-03-01

Two young male Caucasians volunteered for a study on the effects of cold exposure during night sleep in winter in the Arctic. The 14-day experiment was divided in three consecutive periods, baseline (2 nights), cold exposure (10 night) and recovery (2 nights). Both baseline and recovery data were obtained in neutral thermal conditions in a laboratory. The subjects slept in a sleeping bag under an unheated tent during the cold exposure. Apart from polysomnographic and body temperature recordings, electrocardiograms were taken through a telemetric system for safety purposes. Heart rates were noted at 5-min intervals and averaged hourly. In both environmental conditions, heart rate decreased within the first two hours of sleep. Comparison of the data obtained during cold exposure vs. thermal neutrality revealed lower values of heart rate in the cold, while body temperatures remained within normal range. This cold-induced bradycardia supervening during night sleep is discussed in terms of the occurrence of a vagal reflex preventing central blood pressure to rise.

Systematic review: the influence of nasal obstruction on sleep apnea

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Debora Petrungaro Migueis

2016-04-01

Full Text Available ABSTRACT INTRODUCTION: Obstructive sleep apnea syndrome (OSAS is a common disorder that can lead to cardiovascular morbidity and mortality, as well as to metabolic, neurological, and behavioral consequences. It is currently believed that nasal obstruction compromises the quality of sleep when it results in breathing disorders and fragmentation of sleep. However, recent studies have failed to objectively associate sleep quality and nasal obstruction. OBJECTIVE: The aim of this systematic review is to evaluate the influence of nasal obstruction on OSAS and polysomnographic indices associated with respiratory events. METHODS: Eleven original articles published from 2003 to 2013 were selected, which addressed surgical and non-surgical treatment for nasal obstruction, performing polysomnography type 1 before and after the intervention. RESULTS/CONCLUSIONS: In most trials, nasal obstruction was not related to the apnea-hypopnea index (AHI, indicating no improvement in OSAS with reduction in nasal resistance. However, few researchers evaluated other polysomnography indices, such as the arousal index and rapid eye movement (REM sleep percentage. These could change with nasal obstruction, since it is possible that the nasal obstruction does not completely block the upper airways, but can increase negative intrathoracic pressure, leading to sleep fragmentation.

Clinical significance of sleep bruxism on several occlusal and functional parameters.

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Ommerborn, Michelle A; Giraki, Maria; Schneider, Christine; Fuck, Lars Michael; Zimmer, Stefan; Franz, Matthias; Raab, Wolfgang Hans-michael; Schaefer, Ralf

2010-10-01

The aim of this study was to evaluate the association between various functional and occlusal parameters and sleep bruxism. Thirty-nine (39) sleep bruxism patients and 30 controls participated in this investigation. The assessment of sleep bruxism was performed using the Bruxcore Bruxism-Monitoring Device (BBMD) combined with a new computer-based analyzing method. Sixteen functional and/or occlusal parameters were recorded. With a mean slide of 0.95 mm in the sleep bruxism group and a mean slide of 0.42 mm in the control group (Mann Whitney U test; p<0.003), results solely demonstrated a significant group difference regarding the length of a slide from centric occlusion to maximum intercuspation. The results suggest that the slightly pronounced slide could be of clinical importance in the development of increased wear facets in patients with current sleep bruxism activity. Following further evaluation including polysomnographic recordings, the BBMD combined with this new analyzing technique seems to be a clinically feasible instrument that allows the practitioner to quantify abrasion over a short period.

Sleep-disordered breathing and its management in children with achondroplasia.

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Tenconi, Rossana; Khirani, Sonia; Amaddeo, Alessandro; Michot, Caroline; Baujat, Geneviève; Couloigner, Vincent; De Sanctis, Livio; James, Syril; Zerah, Michel; Cormier-Daire, Valérie; Fauroux, Brigitte

2017-04-01

Sleep-disordered breathing is a common feature in children with achondroplasia. The aim of our study was to review the poly(somno)graphic (P(S)G) findings and consequent treatments in children with achondroplasia followed in the national reference center for skeletal dysplasia. A retrospective review of the clinical charts and P(S)G of 43 consecutive children (mean age 3.9 ± 3.5 years) with achondroplasia seen over a period of 2 years was performed. Twenty four (59%) children had obstructive sleep apnea (OSA). Thirteen children had an obstructive apnea-hypopnea index (OAHI) achondroplasia. The observation of a reduced prevalence of OSA after (adeno-)tonsillectomy is in favor of this type of surgery when possible. © 2017 Wiley Periodicals, Inc.

Effect of CPAP Therapy on Symptoms of Nocturnal Gastroesophageal Reflux among Patients with Obstructive Sleep Apnea.

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Tamanna, Sadeka; Campbell, Douglas; Warren, Richard; Ullah, Mohammad I

2016-09-15

Nocturnal gastroesophageal reflux (nGER) is common among patients with obstructive sleep apnea (OSA). Previous studies demonstrated that continuous positive airway pressure (CPAP) reduces symptoms of nGER. However, improvement in nGER symptoms based on objective CPAP compliance has not been documented. We have examined the polysomnographic characteristics of patients with nGER and OSA and looked for association of OSA severity and CPAP compliance with improvement in nGER symptoms. We interviewed 85 veterans with OSA to assess their daytime sleepiness (Epworth Sleepiness scale [ESS]) and nGER symptom frequency after their polysomnography and polysomnographic data were reviewed. At 6 months' follow-up, ESS score, nGER score, and CPAP machine compliance data were reassessed. Data from 6 subjects were dropped from final analysis due to their initiation of new medication for nGER symptom since the initial evaluation. Sixty-two of 79 (78%) patients complained of nGER symptoms during initial visit. At baseline, nGER score was correlated with sleep efficiency (r = 0.43), and BMI correlated with the severity of OSA (r = 0.41). ESS and nGER improved (p CPAP compliant patients. A minimum CPAP compliance of 25% was needed to achieve any benefit in nGER improvement. Nocturnal gastroesophageal reflux is common among patients with OSA which increases sleep disruption and worsens the symptoms of daytime sleepiness. CPAP therapy may help improve the symptoms of both nocturnal acid reflux and daytime sleepiness, but adherence to CPAP is crucial to achieve this benefit. © 2016 American Academy of Sleep Medicine.

Proton Pump Inhibition Increases Rapid Eye Movement Sleep in the Rat

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Munazah Fazal Qureshi

2014-01-01

Full Text Available Increased bodily CO2 concentration alters cellular pH as well as sleep. The proton pump, which plays an important role in the homeostatic regulation of cellular pH, therefore, may modulate sleep. We investigated the effects of the proton pump inhibitor “lansoprazole” on sleep-wakefulness. Male Wistar rats were surgically prepared for chronic polysomnographic recordings. Two different doses of lansoprazole (low: 1 mg/kg; high: 10 mg/kg were injected intraperitoneally in the same animal (n=7 and sleep-wakefulness was recorded for 6 hrs. The changes in sleep-wakefulness were compared statistically. Percent REM sleep amount in the vehicle and lansoprazole low dose groups was 9.26±1.03 and 9.09±0.54, respectively, which increased significantly in the lansoprazole high dose group by 31.75% (from vehicle and 34.21% (from low dose. Also, REM sleep episode numbers significantly increased in lansoprazole high dose group. Further, the sodium-hydrogen exchanger blocker “amiloride” (10 mg/kg; i.p. (n=5 did not alter sleep-wake architecture. Our results suggest that the proton pump plays an important role in REM sleep modulation and supports our view that REM sleep might act as a sentinel to help maintain normal CO2 level for unperturbed sleep.

Polysomnographic findings in craniopharyngioma patients

DEFF Research Database (Denmark)

Pickering, Line; Klose, Marianne; Feldt-Rasmussen, Ulla

2017-01-01

of the same age (p = 0.09). No subjects had symptoms of hypnagogic hallucinations, sleep paralyses, or cataplexies. Four patients and one control had periodic leg movements (PLMs). One patient had fragmented sleep pattern, rapid eye movement (REM) sleep without atonia, and PLMs. One patient had short sleep...... periods during the daytime. Four patients had fragmented sleep pattern. With the MSLT, four patients and two controls had mean sleep latency of REM sleep in 2/5 and 3/5 sleep periods, respectively. All subjects showed normal hypocretin-1 levels......PURPOSE: The purpose of this study is to evaluate whether damage to the hypothalamus due to craniopharyngioma or consequent surgery may involve the sleep-wake regulatory system, resulting in sleep disturbances and sleepiness. METHODS: Seven craniopharyngioma patients and 10 healthy controls were...

Pain and the alpha-sleep anomaly: a mechanism of sleep disruption in facioscapulohumeral muscular dystrophy.

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Della Marca, Giacomo; Frusciante, Roberto; Vollono, Catello; Iannaccone, Elisabetta; Dittoni, Serena; Losurdo, Anna; Testani, Elisa; Gnoni, Valentina; Colicchio, Salvatore; Di Blasi, Chiara; Erra, Carmen; Mazza, Salvatore; Ricci, Enzo

2013-04-01

To measure the presence of the alpha-sleep anomaly in facioscapulohumeral muscular dystrophy (FSHD) and to evaluate the association between the sleep electroencephalogram (EEG) pattern and the presence of musculoskeletal pain. Cross-sectional study. Sleep laboratory. Fifty-five consecutive adult FSHD patients, 26 women and 29 men, age 49.6 ± 15.1 years (range 18-76). Questionnaires and polysomnography. Patients were asked to indicate if in the 3 months before the sleep study they presented persisting or recurring musculoskeletal pain. Patients who reported pain were asked to fill in the Italian version of the Brief Pain Inventory and the McGill Pain questionnaire, and a 101-point visual analog scale (VAS) for pain intensity. Polysomnographic recordings were performed. EEG was analyzed by means of Fast Fourier Transform. Four power spectra bands (δ 0-4 Hz, θ 4-8 Hz, α 8-14 Hz, β 14-32 Hz) were computed. Sleep macrostructure parameters and alpha/delta EEG power ratio during non rapid eye movement (NREM) sleep were compared between patients with and without pain. Forty-two patients in our sample reported chronic pain. VAS mean score was 55.2 ± 23.8 (range 10-100), pain rating index score was 13.8 ± 10.2, and present pain intensity was 2.5 ± 0.8. The statistical analysis documented an increased occurrence of the alpha and beta rhythms during NREM sleep in FSHD patients with pain. Significant correlations were observed between the alpha/delta power ratio during NREM sleep and pain measures. Chronic musculoskeletal pain is frequent in FSHD patients, and it represents a major mechanism of sleep disruption. Wiley Periodicals, Inc.

Alpha-wave frequency characteristics in health and insomnia during sleep.

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Schwabedal, Justus T C; Riedl, Maik; Penzel, Thomas; Wessel, Niels

2016-06-01

Appearances of alpha waves in the sleep electrencephalogram indicate physiological, brief states of awakening that lie in between wakefulness and sleep. These microstates may also cause the loss in sleep quality experienced by individuals suffering from insomnia. To distinguish such pathological awakenings from physiological ones, differences in alpha-wave characteristics between transient awakening and wakefulness observed before the onset of sleep were studied. In polysomnographic datasets of sleep-healthy participants (n = 18) and patients with insomnia (n = 10), alpha waves were extracted from the relaxed, wake state before sleep onset, wake after sleep-onset periods and arousals of sleep. In these, alpha frequency and variability were determined as the median and standard deviation of inverse peak-to-peak intervals. Before sleep onset, patients with insomnia showed a decreased alpha variability compared with healthy participants (P insomnia, alpha variability increased for short wake after sleep-onset periods. Major differences between the two groups were encountered during arousal. In particular, the alpha frequency in patients with insomnia rebounded to wake levels, while the frequency in healthy participants remained at the reduced level of short wake after sleep-onset periods. Reductions in alpha frequency during wake after sleep-onset periods may be related to the microstate between sleep and wakefulness that was described for such brief awakenings. Reduced alpha variability before sleep may indicate a dysfunction of the alpha generation mechanism in insomnia. Alpha characteristics may also prove valuable in the study of other sleep and attention disorders. © 2016 European Sleep Research Society.

A polysomnographic placebo-controlled evaluation of the efficacy and safety of eszopiclone relative to placebo and zolpidem in the treatment of primary insomnia.

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Erman, Milton K; Zammit, Gary; Rubens, Robert; Schaefer, Kendyl; Wessel, Thomas; Amato, David; Caron, Judy; Walsh, James K

2008-06-15

To evaluate the polysomnographic efficacy and the safety of a range of doses of eszopiclone relative to placebo in patients with primary insomnia. Zolpidem 10 mg was included as an active control. This multicenter, randomized, crossover study enrolled patients aged 21-64 years meeting the DSM-IV criteria for primary insomnia (n = 65). Patients received 2 nights treatment each with placebo, eszopiclone 1 mg, 2 mg, 2.5 mg, or 3 mg, and zolpidem 10 mg after randomization to one of 6 treatment sequences. Visits were separated by a 3-7 day washout. Objective efficacy was assessed by polysomnography (PSG). The primary endpoint was latency to persistent sleep (LPS); key secondary endpoints were sleep efficiency (SE) and wake time after sleep onset (WASO); other endpoints included wake time during sleep (WTDS) and number of awakenings (NAW), as well as patient-reported variables. LPS and SE were significantly different than placebo for all active treatments (p zolpidem 10 mg or the other eszopiclone doses. The incidence of central nervous system adverse events was 23.4% for zolpidem 10 mg, 6.2% to 12.5% for the eszopiclone doses, and 7.9% for placebo. Relative to placebo, all active treatments were effective in reducing LPS and increasing SE. Eszopiclone 3 mg was significantly different from placebo on the 3 PSG measures of sleep maintenance (WASO, WTDS, and NAW). Significant differences between zolpidem 10 mg and eszopiclone (2 mg or 3 mg) were not observed for PSG-measured outcomes, although the study was not powered to detect differences between the active drug conditions.

Polysomnographic findings in craniopharyngioma patients.

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Pickering, Line; Klose, Marianne; Feldt-Rasmussen, Ulla; Jennum, Poul

2017-12-01

The purpose of this study is to evaluate whether damage to the hypothalamus due to craniopharyngioma or consequent surgery may involve the sleep-wake regulatory system, resulting in sleep disturbances and sleepiness. Seven craniopharyngioma patients and 10 healthy controls were evaluated with sleep questionnaires including the Epworth Sleepiness Scale, polysomnography, and a multiple sleep latency test (MSLT). Five patients and eight controls had lumbar puncture performed to determine hypocretin-1 levels. Patients tended to feel sleepier than control individuals of the same age (p = 0.09). No subjects had symptoms of hypnagogic hallucinations, sleep paralyses, or cataplexies. Four patients and one control had periodic leg movements (PLMs). One patient had fragmented sleep pattern, rapid eye movement (REM) sleep without atonia, and PLMs. One patient had short sleep periods during the daytime. Four patients had fragmented sleep pattern. With the MSLT, four patients and two controls had mean sleep latency of < 8 min. One patient and three controls had sudden onset of REM sleep in 2/5 and 3/5 sleep periods, respectively. All subjects showed normal hypocretin-1 levels. Four patients had electrophysiological findings indicative of central hypersomnia including one patient meeting the criteria of narcolepsy. The sleep-wake regulatory system may be involved in craniopharyngioma patients.

Sleep and neurocognitive functioning in children with eczema.

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Camfferman, Danny; Kennedy, J Declan; Gold, Michael; Simpson, Carol; Lushington, Kurt

2013-08-01

Sleep disruption in childhood is associated with clearly defined deficits in neurocognition and behaviour. Childhood eczema is also a potent cause of sleep disruption though it is unknown whether it too results in neurocognitive deficits. To test this hypothesis, neurocognitive (WISC-IV), parental-reported sleep quality (Sleep Disturbance Scale of Children (SDSC)) and overnight polysomnographic (PSG) data were collected in 21 children with eczema and 20 healthy controls (age range 6-16 years). Children with eczema had worse sleep quality on both PSG (notably increased nocturnal wakefulness, a higher number of stage shifts and a longer latency to REM onset) and parental report. In addition, they demonstrated significant neurocognitive deficits (especially verbal comprehension, perceptual reasoning and to a lesser extent working memory) with a composite Full Scale IQ 16 points lower than controls. Parental reported sleep problems but not PSG parameters were correlated with reduced neurocognitive performance. However, hierarchical regression analyses revealed that eczema status was predictive while sleep fragmentation (parental or PSG) was not predictive of neurocognitive performance. As this is the first study to systematically examine neurocognitive functioning in children with eczema and given the finding of significant deficits it merits replication especially given the prevalence of the condition. The unanswered question is whether these cognitive deficits normalise with effective eczema treatment and if this is mediated by improvements in sleep architecture. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Linear and non-linear interdependence of EEG and HRV frequency bands in human sleep.

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Chaparro-Vargas, Ramiro; Dissanayaka, P Chamila; Patti, Chanakya Reddy; Schilling, Claudia; Schredl, Michael; Cvetkovic, Dean

2014-01-01

The characterisation of functional interdependencies of the autonomic nervous system (ANS) stands an evergrowing interest to unveil electroencephalographic (EEG) and Heart Rate Variability (HRV) interactions. This paper presents a biosignal processing approach as a supportive computational resource in the estimation of sleep dynamics. The application of linear, non-linear methods and statistical tests upon 10 overnight polysomnographic (PSG) recordings, allowed the computation of wavelet coherence and phase locking values, in order to identify discerning features amongst the clinical healthy subjects. Our findings showed that neuronal oscillations θ, α and σ interact with cardiac power bands at mid-to-high rank of coherence and phase locking, particularly during NREM sleep stages.

Modulation of the Muscle Activity During Sleep in Cervical Dystonia.

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Antelmi, Elena; Ferri, Raffaele; Provini, Federica; Scaglione, Cesa M L; Mignani, Francesco; Rundo, Francesco; Vandi, Stefano; Fabbri, Margherita; Pizza, Fabio; Plazzi, Giuseppe; Martinelli, Paolo; Liguori, Rocco

2017-07-01

Impaired sleep has been reported as an important nonmotor feature in dystonia, but so far, self-reported complaints have never been compared with nocturnal video-polysomnographic (PSG) recording, which is the gold standard to assess sleep-related disorders. Twenty patients with idiopathic isolated cervical dystonia and 22 healthy controls (HC) underwent extensive clinical investigations, neurological examination, and questionnaire screening for excessive daytime sleepiness and sleep-related disorders. A full-night video PSG was performed in both patients and HC. An ad hoc montage, adding electromyographic leads over the muscle affected with dystonia, was used. When compared to controls, patients showed significantly increased pathological values on the scale assessing self-reported complaints of impaired nocturnal sleep. Higher scores of impaired nocturnal sleep did not correlate with any clinical descriptors but for a weak correlation with higher scores on the scale for depression. On video-PSG, patients had significantly affected sleep architecture (with decreased sleep efficiency and increased sleep latency). Activity over cervical muscles disappears during all the sleep stages, reaching significantly decreased values when compared to controls both in nonrapid eye movements and rapid eye movements sleep. Patients with cervical dystonia reported poor sleep quality and showed impaired sleep architecture. These features however cannot be related to the persistence of muscle activity over the cervical muscles, which disappears in all the sleep stages, reaching significantly decreased values when compared to HC. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Polysomnographic evaluation of uninfected babies born to human immunodeficiency virus type 1 positive mothers = Evaluación polisomnográfica de bebés no infectados nacidos de madres VIH-1 positivas

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Archila Melendez, Mario Eduardo

2013-07-01

Full Text Available Introduction: Type 1 human immunodeficiency virus (HIV-1 is a lymphotropic and neurotropic retrovirus. Thus, it causes immunological and neurological alterations particularly in children. In the neonatal period the maturational changes of the central nervous system occur rapidly, and their alteration can be reflected in processes such as the sleep-awake pattern. Objective: To evaluate sleep organization, EEG and respiratory pattern in newborns to HIV-1 positive mothers. Methods: 22 infants underwent polysomnography. Delta brushes number in REM and NREM sleep, duration of interburst interval and interhemispheric synchrony were used to calculate EEG maturation. Analysis of the sleep architecture was based on polysomnographic sleep percentage of REM, NREM and transitional sleep to total sleep time. Results: The difference between electroencephalographically calculated and clinically calculated conceptional age was less than two weeks. Percentages of REM and NREM sleep ranged from 39-64 and 30-58 with a median of 52.5 and 36.5 respectively. Concordance was lower in newborns who had high transitional sleep percentages, compared to that in newborns who did not have high such characteristic (p less 0.05. Discussion: Despite intrauterine exposure to HIV-1 and to antiretroviral drugs we did not observe a significant effect on EEG maturation. The decreased concordance in newborns with high transitional sleep percentages would suggest an alteration in the maturation process, but this aspect itself is not sufficient to consider that intrauterine exposure to HIV-1 and antiretrovirals affect the entire sleep architecture Future studies should clarify whether the decreased concordance between behavior and NREM sleep is replicable.

Sleep and sleepiness in children with attention deficit / hyperactivity disorder and controls.

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Wiebe, Sabrina; Carrier, Julie; Frenette, Sonia; Gruber, Reut

2013-02-01

The present study assessed the association between habitual sleep patterns and one night of PSG measured sleep with daytime sleepiness in children with ADHD and typically developing children. Eighty-two children (26 ADHD, 56 typically developing children), between 7 and 11 years, had nighttime sleep recorded using actigraphy over five nights (habitual sleep patterns) and polysomnography during one night (immediate sleep patterns), both within their home environments. Daytime sleepiness was examined using the multiple sleep latency test within a controlled laboratory setting the following day. Using Spearman correlations, the relationships between mean sleep latencies on the multiple sleep latency test and scores on a modified Epworth Sleepiness Scale with polysomnographic measures of sleep quality and architecture and with actigraphic sleep quality measures were examined. Longer sleep latency, measured using polysomnography and actigraphy, was related to longer mean sleep latencies on the multiple sleep latency test in typically developing participants, whereas actigraphic measures of sleep restlessness (time awake and activity during the night), as well as time in slow-wave sleep, were positively related to mean sleep latency on the multiple sleep latency test in children with ADHD. These results show a differential relationship for children with ADHD and typically developing children between habitual and immediate sleep patterns with daytime sleepiness and suggest that problems initiating and maintaining sleep may be present both in nighttime and daytime sleep. © 2012 European Sleep Research Society.

Evening electronic device use: The effects on alertness, sleep and next-day physical performance in athletes.

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Jones, Maddison J; Peeling, Peter; Dawson, Brian; Halson, Shona; Miller, Joanna; Dunican, Ian; Clarke, Michael; Goodman, Carmel; Eastwood, Peter

2018-01-01

The aim of the present study was to investigate the influence of different types of tasks performed with or without an electronic device (tablet) on pre-sleep alertness, subsequent sleep quality and next-day athletic performance. Eight highly trained netball players attended a sleep laboratory for pre-sleep testing, polysomnographic sleep monitoring and next-day physical performance testing on 5 separate occasions (1 familiarisation and 4 experimental sessions). For 2 h prior to bedtime, athletes completed cognitively stimulating tasks (puzzles) or passive tasks (reading) with or without a tablet. Sleepiness tended to be greater after reading compared to completing puzzles without a tablet (d = 0.80), but not with a tablet. Melatonin concentration increased more so after reading compared to completing puzzles on a tablet (P = 0.02). There were no significant differences in sleep quality or quantity or next-day athletic performance between any of the conditions. These data suggest that using a tablet for 2 h prior to sleep does not negatively affect subsequent sleep or next-day performance in athletes.

[Effects of long-term isolation and anticipation of significant event on sleep: results of the project "Mars-520"].

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Zavalko, I M; Rasskazova, E I; Gordeev, S A; Palatov, S Iu; Kovrov, G V

2013-01-01

The purpose of the research was to study effect of long-term isolation on night sleep. The data were collected during international ground simulation of an interplanetary manned flight--"Mars-500". The polysomnographic recordings of six healthy men were performed before, four times during and after 520-days confinement. During the isolation sleep efficiency and delta-latency decreased, while sleep latency increased. Post-hoc analysis demonstrate significant differences between background and the last (1.5 months before the end of the experiment) measure during isolation. Frequency of nights with low sleep efficiency rose on the eve of the important for the crew events (simulation of Mars landing and the end of the confinement). Two weeks after the landing simulation, amount of the nights with a low sleep efficiency significantly decreased. Therefore, anticipation of significant event under condition of long-term isolation might result in sleep worsening in previously healthy men, predominantly difficulties getting to sleep.

Abnormalities in the Polysomnographic, Adenosine and Metabolic Response to Sleep Deprivation in an Animal Model of Hyperammonemia

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Selena Marini

2017-08-01

Full Text Available Patients with liver cirrhosis can develop hyperammonemia and hepatic encephalopathy (HE, accompanied by pronounced daytime sleepiness. Previous studies with healthy volunteers show that experimental increase in blood ammonium levels increases sleepiness and slows the waking electroencephalogram. As ammonium increases adenosine levels in vitro, and adenosine is a known regulator of sleep/wake homeostasis, we hypothesized that the sleepiness-inducing effect of ammonium is mediated by adenosine. Eight adult male Wistar rats were fed with an ammonium-enriched diet for 4 weeks; eight rats on standard diet served as controls. Each animal was implanted with electroencephalography/electromyography (EEG/EMG electrodes and a microdialysis probe. Sleep EEG recording and cerebral microdialysis were carried out at baseline and after 6 h of sleep deprivation. Adenosine and metabolite levels were measured by high-performance liquid chromatography (HPLC and targeted LC/MS metabolomics, respectively. Baseline adenosine and metabolite levels (12 of 16 amino acids, taurine, t4-hydroxy-proline, and acetylcarnitine were lower in hyperammonemic animals, while putrescine was higher. After sleep deprivation, hyperammonemic animals exhibited a larger increase in adenosine levels, and a number of metabolites showed a different time-course in the two groups. In both groups the recovery period was characterized by a significant decrease in wakefulness/increase in NREM and REM sleep. However, while control animals exhibited a gradual compensatory effect, hyperammonemic animals showed a significantly shorter recovery phase. In conclusion, the adenosine/metabolite/EEG response to sleep deprivation was modulated by hyperammonemia, suggesting that ammonia affects homeostatic sleep regulation and its metabolic correlates.

Exercise Improves Immune Function, Antidepressive Response, and Sleep Quality in Patients with Chronic Primary Insomnia

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Passos, Giselle Soares; Poyares, Dalva; Santana, Marcos Gonçalves; Teixeira, Alexandre Abílio de Souza; Lira, Fábio Santos; Youngstedt, Shawn D.; dos Santos, Ronaldo Vagner Thomatieli; Tufik, Sergio; de Mello, Marco Túlio

2014-01-01

The aim of this study was to evaluate the effects of moderate aerobic exercise training on sleep, depression, cortisol, and markers of immune function in patients with chronic primary insomnia. Twenty-one sedentary participants (16 women aged 44.7 +/- 9 years) with chronic primary insomnia completed a 4-month intervention of moderate aerobic exercise. Compared with baseline, polysomnographic data showed improvements following exercise training. Also observed were reductions in depression symp...

Polysomnographic Aspects of Sleep Architecture on Self-limited Epilepsy with Centrotemporal Spikes: A Systematic Review and Meta-analysis

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Camila dos Santos Halal

Full Text Available Self-limited epilepsy with centrotemporal spikes is the most common paediatric epileptic syndrome, with growing evidence linking it to various degrees and presentations of neuropsychological dysfunction. The objective of this study is to evaluate the possible sleep macro and microstructural alterations in children with this diagnosis. A systematic review of published manuscripts was carried out in Medline, LILACS and Scielo databases, using the MeSH terms epilepsy, sleep and polysomnography. From 753 retrieved references, 5 were selected, and data from macro and, when available, microstructure of sleep were extracted. Meta-analysis was performed with data from 4 studies using standardized mean difference. Findings were heterogeneous between studies, being the most frequent macrostructural findings a smaller proportion and greater latency of REM sleep in two studies and, in meta-analysis, a longer sleep latency was the most significant finding among epileptic patients. Only one study evaluated sleep microstructure, suggesting possible alterations in cyclic alternating pattern in diagnosed children. Studies evaluating macro and microstructure of sleep in children with self-limited epilepsy with centrotemporal spikes are necessary to a better understanding of mechanisms of the neuropsychologic disturbances that are frequently seen in children with this diagnosis.

Tumor Necrosis Factor Antagonism Normalizes Rapid Eye Movement Sleep in Alcohol Dependence

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Irwin, Michael R.; Olmstead, Richard; Valladares, Edwin M.; Breen, Elizabeth Crabb; Ehlers, Cindy L.

2009-01-01

Background In alcohol dependence, markers of inflammation are associated with increases in rapid eye movement (REM) sleep, which is thought to be a prognostic indicator of alcohol relapse. This study was undertaken to test whether blockade of biologically active tumor necrosis factor-α (TNF-α) normalizes REM sleep in alcohol-dependent adults. Methods In a randomized, placebo-controlled, double-blind, crossover trial, 18 abstinent alcohol-dependent male adults received a single dose of etanercept (25 mg) versus placebo in a counterbalanced order. Polysomnographic sleep was measured at baseline and for 3 nights after the acute dose of etanercept or placebo. Results Compared with placebo, administration of etanercept produced significant decreases in the amount and percentage of REM sleep. Decreases in REM sleep were robust and approached low levels typically found in age-comparable control subjects. Individual differences in biologically active drug as indexed by circulating levels of soluble tumor necrosis factor receptor II negatively correlated with the percentage of REM sleep. Conclusions Pharmacologic neutralization of TNF-α activity is associated with significant reductions in REM sleep in abstinent alcohol-dependent patients. These data suggest that circulating levels of TNF-α may have a physiologic role in the regulation of REM sleep in humans. PMID:19185287

Polysomnographic and neurometabolic features may mark preclinical autosomal dominant cerebellar ataxia, deafness, and narcolepsy due to a mutation in the DNA (cytosine-5-)-methyltransferase gene, DNMT1.

Science.gov (United States)

Moghadam, Keivan Kaveh; Pizza, Fabio; Tonon, Caterina; Lodi, Raffaele; Carelli, Valerio; Poli, Francesca; Franceschini, Christian; Barboni, Piero; Seri, Marco; Ferrari, Simona; La Morgia, Chiara; Testa, Claudia; Cornelio, Ferdinando; Liguori, Rocco; Winkelmann, Juliane; Lin, Ling; Mignot, Emmanuel; Plazzi, Giuseppe

2014-05-01

We aimed to report the clinical picture of two asymptomatic daughters of a patient with autosomal dominant cerebellar ataxia, deafness, and narcolepsy (ADCA-DN) due to a mutation in the DNA (cytosine-5-)-methyltransferase gene, DNMT1. Clinical assessment based on history, neurologic examination, sleep recordings, neurophysiologic neuroimaging, and genetic tests was performed. History and neurologic examination in both subjects were unremarkable. Genetic analysis disclosed in both the paternally-inherited heterozygous point mutation in the DNMT1 gene. Sleep recordings found sleep-onset rapid eye movement periods (SOREMPs) and proton magnetic resonance spectroscopy (MRS) revealed increased cerebellar myoinositol (mI) in both subjects. Auditory and ophthalmologic investigations as well as structural brain magnetic resonance imaging (MRI) scans revealed no abnormalities. The two asymptomatic carriers of the heterozygous DNMT1 mutation for ADCA-DN, a late-onset neurodegenerative disease, presented with SOREMPs associated with an increase of mI in the brain, a marker of glial cell activity and density characteristic of early stages of neurodegenerative diseases. Therefore, SOREMPs may precede the clinical picture of ADCA-DN as an early polysomnographic marker of central nervous system involvement detected by MRS. Copyright © 2014 Elsevier B.V. All rights reserved.

Systematic review: the influence of nasal obstruction on sleep apnea.

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Migueis, Debora Petrungaro; Thuler, Luiz Claudio Santos; Lemes, Lucas Neves de Andrade; Moreira, Chirlene Santos Souza; Joffily, Lucia; Araujo-Melo, Maria Helena de

2016-01-01

Obstructive sleep apnea syndrome (OSAS) is a common disorder that can lead to cardiovascular morbidity and mortality, as well as to metabolic, neurological, and behavioral consequences. It is currently believed that nasal obstruction compromises the quality of sleep when it results in breathing disorders and fragmentation of sleep. However, recent studies have failed to objectively associate sleep quality and nasal obstruction. The aim of this systematic review is to evaluate the influence of nasal obstruction on OSAS and polysomnographic indices associated with respiratory events. Eleven original articles published from 2003 to 2013 were selected, which addressed surgical and non-surgical treatment for nasal obstruction, performing polysomnography type 1 before and after the intervention. In most trials, nasal obstruction was not related to the apnea-hypopnea index (AHI), indicating no improvement in OSAS with reduction in nasal resistance. However, few researchers evaluated other polysomnography indices, such as the arousal index and rapid eye movement (REM) sleep percentage. These could change with nasal obstruction, since it is possible that the nasal obstruction does not completely block the upper airways, but can increase negative intrathoracic pressure, leading to sleep fragmentation. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

How do people with drug-resistant mesial temporal lobe epilepsy sleep? A clinical and video-EEG with EOG and submental EMG for sleep staging study

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Aline Vieira Scarlatelli-Lima

2016-09-01

Full Text Available This study aimed to assess subjective and objective sleep parameters in a homogeneous group of drug-resistant mesial temporal lobe epilepsy (MTLE patients through internationally validated clinical questionnaires, video-electroencephalographic (VEEG and polysomnographic (PSG studies. Fifty-six patients with definite diagnosis of MTLE who were candidates for epilepsy surgery underwent a detailed clinical history, the Pittsburgh Sleep Quality Index (PSQI, Epworth Sleepiness Scale (ESS, Stanford Sleepiness Scale (SSS, neurological examination, 1.5 T brain magnetic resonance imaging, VEEG and PSG. Sixteen percent of patients reported significant daytime sleepiness as measured by ESS and 27% reported low levels of sleep quality as measured by PSQI. Patients with medically resistant epilepsy by MTLE showed increased wakefulness after sleep onset (WASO with mean ± standard deviation of 17.4 ± 15.6, longer non-rapid eye movement (NREM 1 (7.5 ± 4.6% and NREM3 sleep (26.6 ± 11.8%, abnormal rapid eye movement (REM latency in 30/56 patients, shorter REM sleep (16.7 ± 6.6%, and abnormal alpha delta patterns were observed in 41/56 patients. The analysis of interictal epileptic discharges (IEDs evidenced highest spiking rate during NREM3 sleep and higher concordance with imaging data when IEDs were recorded in sleep, mainly during REM sleep. We concluded that patients with MTLE showed disrupted sleep architecture that may result in daytime dysfunction and sleep complaints. Furthermore, NREM sleep activated focal IEDs and them - when recorded during sleep - had higher localizing value.

Sleep apnea-hypopnea quantification by cardiovascular data analysis.

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Sabrina Camargo

Full Text Available Sleep disorders are a major risk factor for cardiovascular diseases. Sleep apnea is the most common sleep disturbance and its detection relies on a polysomnography, i.e., a combination of several medical examinations performed during a monitored sleep night. In order to detect occurrences of sleep apnea without the need of combined recordings, we focus our efforts on extracting a quantifier related to the events of sleep apnea from a cardiovascular time series, namely systolic blood pressure (SBP. Physiologic time series are generally highly nonstationary and entrap the application of conventional tools that require a stationary condition. In our study, data nonstationarities are uncovered by a segmentation procedure which splits the signal into stationary patches, providing local quantities such as mean and variance of the SBP signal in each stationary patch, as well as its duration L. We analysed the data of 26 apneic diagnosed individuals, divided into hypertensive and normotensive groups, and compared the results with those of a control group. From the segmentation procedure, we identified that the average duration , as well as the average variance , are correlated to the apnea-hypoapnea index (AHI, previously obtained by polysomnographic exams. Moreover, our results unveil an oscillatory pattern in apneic subjects, whose amplitude S* is also correlated with AHI. All these quantities allow to separate apneic individuals, with an accuracy of at least 79%. Therefore, they provide alternative criteria to detect sleep apnea based on a single time series, the systolic blood pressure.

Effects of lunar phase on sleep in men and women in Surrey.

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Della Monica, Ciro; Atzori, Giuseppe; Dijk, Derk-Jan

2015-12-01

Recently, evidence has emerged that the phases of the moon may modulate subjective sleep quality and polysomnographically assessed sleep structure in humans. We aimed to explore further the putative effects of circa-lunar periodicity (~29.5 days) on subjective and objective parameters of human sleep in a retrospective analysis. The baseline sleep recordings of 205 (91 males and 114 females; mean age = 47.47 years, standard deviation =19.01; range: 20-84 years) healthy and carefully screened participants who participated in two clinical trials in the Surrey Clinical Research Centre were included in the analyses. Sleep was recorded in windowless sleep laboratories. For each study night, we calculated the distance, in days, to the date of the closest full moon phase and based on this distance, classified sleep records in three lunar classes. Univariate analysis of variance with factors lunar class, age and sex was applied to each of 21 sleep parameters. No significant main effect for the factor lunar class was observed for any of the objective sleep parameters and subjective sleep quality but some significant interactions were observed. The interaction between lunar class and sex was significant for total sleep time, Stage 4 sleep and rapid eye movement (REM) sleep. Separate analyses for men and women indicated that in women total sleep time, Stage 4 sleep and REM sleep were reduced when sleep occurred close to full moon, whereas in men REM duration increased around full moon. These data provide limited evidence for an effect of lunar phase on human sleep. © 2015 European Sleep Research Society.

Development and validation of an algorithm for the study of sleep using a biometric shirt in young healthy adults.

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Pion-Massicotte, Joëlle; Godbout, Roger; Savard, Pierre; Roy, Jean-François

2018-02-23

Portable polysomnography is often too complex and encumbering for recording sleep at home. We recorded sleep using a biometric shirt (electrocardiogram sensors, respiratory inductance plethysmography bands and an accelerometer) in 21 healthy young adults recorded in a sleep laboratory for two consecutive nights, together with standard polysomnography. Polysomnographic recordings were scored using standard methods. An algorithm was developed to classify the biometric shirt recordings into rapid eye movement sleep, non-rapid eye movement sleep and wake. The algorithm was based on breathing rate and heart rate variability, body movement, and included a correction for sleep onset and offset. The overall mean percentage of agreement between the two sets of recordings was 77.4%; when non-rapid eye movement and rapid eye movement sleep epochs were grouped together, it increased to 90.8%. The overall kappa coefficient was 0.53. Five of the seven sleep variables were significantly correlated. The findings of this pilot study indicate that this simple portable system could be used to estimate the general sleep pattern of young healthy adults. © 2018 European Sleep Research Society.

Persistent insomnia: the role of objective short sleep duration and mental health.

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Vgontzas, Alexandros N; Fernandez-Mendoza, Julio; Bixler, Edward O; Singareddy, Ravi; Shaffer, Michele L; Calhoun, Susan L; Liao, Duanping; Basta, Maria; Chrousos, George P

2012-01-01

Few population-based, longitudinal studies have examined risk factors for persistent insomnia, and the results are inconsistent. Furthermore, none of these studies have examined the role of polysomnographic (PSG) variables such as sleep duration or sleep apnea on the persistence of insomnia. Representative longitudinal study. Sleep laboratory. From a random, general population sample of 1741 individuals of the adult Penn State Cohort, 1395 were followed-up after 7.5 years. Individuals underwent one-night PSG and full medical evaluation at baseline and a telephone interview at follow-up. PSG sleep duration was analyzed as a continuous variable and as a categorical variable: insomnia persistence, partial remission, and full remission were 44.0%, 30.0%, and 26.0%, respectively. Objective short sleep duration significantly increased the odds of persistent insomnia as compared to normal sleep (OR = 3.19) and to fully remitted insomnia (OR = 4.92). Mental health problems at baseline were strongly associated with persistent insomnia as compared to normal sleep (OR = 9.67) and to a lesser degree compared to fully remitted insomnia (OR = 3.68). Smoking, caffeine, and alcohol consumption and sleep apnea did not predict persistent insomnia. Objective short sleep duration and mental health problems are the strongest predictors of persistent insomnia. These data further support the validity and clinical utility of objective short sleep duration as a novel marker of the biological severity of insomnia.

Obstructive sleep apnea in epilepsy: a preliminary Egyptian study.

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Shaheen, Hala A; Abd El-Kader, Ann A; El Gohary, Amira M; El-Fayoumy, Neveen M; Afifi, Lamia M

2012-09-01

The extent and clinical relevance of the association between epilepsy and sleep apnea are not previously studied in Egypt. What we wanted to know was the frequency of sleep apnea in Egyptian children with epilepsy and its influence on seizure frequency, other seizure characteristics, sleep complaint, and architecture. All patients with epilepsy, aged up to 18 years, who underwent polysomnography were studied. Patients with any neurological disease apart from epilepsy, with psychiatric illness, had hypnotics, or sedatives or those with liver or kidney failure were excluded from the study. The patients were divided into two subgroups according to apnea/hypopnea index: group (1) patients without obstructive sleep apnea (OSA) and group (2) patients with OSA. For control group, we choose 12 healthy individuals, with age and sex matched to that of our patients. We studied the clinical characteristics of epilepsy, sleep history, and polysomnographic recording of the patients with epilepsy and the control. EEG digital and video monitoring was done for all patients. Eleven patients (42.3%) were found to have obstructive sleep apnea. Seizure frequency was significantly higher in the patients with OSA. Apart from apnea and hypopnea indices, all other sleep parameters did not differ between patients' subgroups. Hypopnea index in REM positively correlates with number of awaking. Apnea index in REM positively correlates with latency to deep sleep and to periodic leg movement. Sleep apnea is frequent in patients with epilepsy. OSA may contribute to increase seizure frequency. We recommend investigating sleep apnea in all patients with epilepsy.

Phosphorous31 magnetic resonance spectroscopy after total sleep deprivation in healthy adult men.

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Dorsey, Cynthia M; Lukas, Scott E; Moore, Constance M; Tartarini, Wendy L; Parow, Aimee M; Villafuerte, Rosemond A; Renshaw, Perry F

2003-08-01

To investigate chemical changes in the brains of healthy adults after sleep deprivation and recovery sleep, using phosphorous magnetic resonance spectroscopy. Three consecutive nights (baseline, sleep deprivation, recovery) were spent in the laboratory. Objective sleep measures were assessed on the baseline and recovery nights using polysomnography. Phosphorous magnetic resonance spectroscopy scans took place beginning at 7 am to 8 am on the morning after each of the 3 nights. Sleep laboratory in a private psychiatric teaching hospital. Eleven healthy young men. Following a baseline night of sleep, subjects underwent a night of total sleep deprivation, which involved supervision to ensure the absence of sleep but was not polysomnographically monitored. No significant changes in any measure of brain chemistry were observed the morning after a night of total sleep deprivation. However, after the recovery night, significant increases in total and beta-nucleoside triphosphate and decreases in phospholipid catabolism, measured by an increase in the concentration of glycerylphosphorylcholine, were observed. Chemical changes paralleled some changes in objective sleep measures. Significant chemical changes in the brain were observed following recovery sleep after 1 night of total sleep deprivation. The specific process underlying these changes is unclear due to the large brain region sampled in this exploratory study, but changes may reflect sleep inertia or some aspect of the homeostatic sleep mechanism that underlies the depletion and restoration of sleep. Phosphorous magnetic resonance spectroscopy is a technique that may be of value in further exploration of such sleep-wake functions.

Reliability of scoring arousals in normal children and children with obstructive sleep apnea syndrome.

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Wong, Tat Kong; Galster, Patricia; Lau, Tai Shing; Lutz, Janita M; Marcus, Carole L

2004-09-15

Scoring of arousals in children is based on an extension of adult criteria, as defined by the American Sleep Disorders Association (ASDA). By this, a minimum duration of 3 seconds is required. A few recent studies utilized modified criteria for the study of children, with durations as short as 1 second. However, the validity and reliability of scoring these shorter arousals have never been verified. Based on studies in adults, we hypothesized that interscorer agreement for scoring arousals shorter than 3 seconds was poor. Retrospective review of polysomnograms by 2 experienced sleep practitioners who independently scored arousals according to the ASDA 3-second criteria and modified duration criteria of 1 and 2 seconds. Academic hospital. 20 polysomnographic studies from children aged 3 to 8 years with mild to severe obstructive sleep apnea syndrome, and 16 polysomnographic studies from normal children. None. The intraclass correlation coefficient for scoring ASDA arousals was 0.90 (95% confidence interval: 0.81-0.95), indicating excellent interscorer agreement. The intraclass correlation coefficient for scoring modified 1-second and 2-second arousals were 0.35 (95% confidence interval: 0.02-0.61) and 0.42 (95% confidence interval: 0.12-0.65) respectively, indicating poor to fair interscorer agreement. Furthermore, modified 1-second and 2-second arousals accounted for less than 15% of all arousals scored. We conclude that there is much poorer interscorer agreement for scoring arousals shorter than 3 seconds, when compared to the standard ASDA criteria. We propose that scoring of arousals in children should follow the standard ASDA criteria.

Relationship between sleep stages and nocturnal trapezius muscle activity.

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Müller, Christian; Nicoletti, Corinne; Omlin, Sarah; Brink, Mark; Läubli, Thomas

2015-06-01

Former studies reported a relationship between increased nocturnal low level trapezius muscle activity and neck or shoulder pain but it has not been explored whether trapezius muscle relaxation is related to sleep stages. The goal of the present study was to investigate whether trapezius muscle activity is related to different sleep stages, as measured by polysomnography. Twenty one healthy subjects were measured on four consecutive nights in their homes, whereas the first night served as adaptation night. The measurements included full polysomnography (electroencephalography (EEG), electrooculography (EOG), electromyography (EMG) and electrocardiography (ECG)), as well as surface EMG of the m. trapezius descendens of the dominant arm. Periods with detectable EMG activity of the trapezius muscle lasted on average 1.5% of the length of the nights and only in four nights it lasted longer than 5% of sleeping time. Neither rest time nor the length of periods with higher activity levels of the trapezius muscle did significantly differ between sleep stages. We found no evidence that nocturnal trapezius muscle activity is markedly moderated by the different sleep stages. Thus the results support that EMG measurements of trapezius muscle activity in healthy subjects can be carried out without concurrent polysomnographic recordings. Copyright © 2015 Elsevier Ltd. All rights reserved.

Polysomnographic Sleep and Circadian Temperature Rhythms as a Function of Prior Shift Work Exposure in Retired Seniors.

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Monk, Timothy H; Buysse, Daniel J; Billy, Bart D; Fletcher, Mary E; Kennedy, Kathy S

2013-04-29

In an earlier published telephone interview study (n > 1,000) we have shown that retired shift workers subjectively report worse sleep than retired day workers. This laboratory study sought to determine whether these findings held up when objective polysomnograhic (PSG) measures of sleep were taken and whether retirees' circadian temperature rhythms differed as a function of shift work exposure. All completers of the telephone interview were invited to attend a 36-hour laboratory study for which participants were paid. This involved continuous core body temperature measurement (using an ingestible pill-based system) and 2 nights of PSG. Shift work exposure (plus other measures) was collected by taking a detailed work history. The second laboratory night was scored into sleep stages. Post hoc, we divided participants into 4 shift work exposure groups: 0 years (ie, no exposure to shift work), 1 to 7 years, 7 to 20 years, and >20 years. Sample sizes were 11, 16, 15, and 15, respectively, with approximate equality in mean age (71.7 years of age, 69.1 years of age, 70.0 years of age, and 70.4 years of age, respectively) and percent male (63%, 50%, 67%, and 73%, respectively). Shift work exposure was associated with worse PSG sleep in a dose-related fashion. The percentages of participants with sleep efficiency, 80% for the 0 years, 1 to 7 years, 7 to 20 years, and >20 years groups were 36%, 63%, 67%, and 73%, respectively ( P work exposure appeared to result ( P = 0.06) in an increased spread of phase angles (difference between habitual bedtime and time of temperature trough). In conclusion, it appears likely that shift work may be related to a scarring of sleep and circadian rhythms. This may be associated with a change in the relationship between habitual sleep timing and the phase of the circadian pacemaker.

A Review of Sleep Disorder Diagnosis by Electromyogram Signal Analysis.

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Shokrollahi, Mehrnaz; Krishnan, Sridhar

2015-01-01

Sleep and sleep-related problems play a role in a large number of human disorders and affect every field of medicine. It is estimated that 50 to 70 million Americans suffer from a chronic sleep disorder, which hinders their daily life, affects their health, and confers a significant economic burden to society. The negative public health consequences of sleep disorders are enormous and could have long-term effects, including increased risk of hypertension, diabetes, obesity, heart attack, stroke and in some cases death. Polysomnographic modalities can monitor sleep cycles to identify disrupted sleep patterns, adjust the treatments, increase therapeutic options and enhance the quality of life of recording the electroencephalogram (EEG), electromyogram (EMG) and electrocardiogram (ECG). Although the skills acquired by medical facilitators are quite extensive, it is just as important for them to have access to an assortment of technologies and to further improve their monitoring and treatment capabilities. Computer-aided analysis is one advantageous technique that could provide quantitative indices for sleep disorder screening. Evolving evidence suggests that Parkinson's disease may be associated with rapid eye movement sleep behavior disorder (RBD). With this article, we are reviewing studies that are related to EMG signal analysis for detection of neuromuscular diseases that result from sleep movement disorders. As well, the article describes the recent progress in analysis of EMG signals using temporal analysis, frequency-domain analysis, time-frequency, and sparse representations, followed by the comparison of the recent research.

A mechanism for upper airway stability during slow wave sleep.

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McSharry, David G; Saboisky, Julian P; Deyoung, Pam; Matteis, Paul; Jordan, Amy S; Trinder, John; Smales, Erik; Hess, Lauren; Guo, Mengshuang; Malhotra, Atul

2013-04-01

The severity of obstructive sleep apnea is diminished (sometimes markedly) during slow wave sleep (SWS). We sought to understand why SWS stabilizes the upper airway. Increased single motor unit (SMU) activity of the major upper airway dilating muscle (genioglossus) should improve upper airway stability. Therefore, we hypothesized that genioglossus SMUs would increase their activity during SWS in comparison with Stage N2 sleep. The activity of genioglossus SMUs was studied on both sides of the transition between Stage N2 sleep and SWS. Sleep laboratory. Twenty-nine subjects (age 38 ± 13 yr, 17 males) were studied. SWS. Subjects slept overnight with fine-wire electrodes in their genioglossus muscles and with full polysomnographic and end tidal carbon dioxide monitors. Fifteen inspiratory phasic (IP) and 11 inspiratory tonic (IT) units were identified from seven subjects and these units exhibited significantly increased inspiratory discharge frequencies during SWS compared with Stage N2 sleep. The peak discharge frequency of the inspiratory units (IP and IT) was 22.7 ± 4.1 Hz in SWS versus 20.3 ± 4.5 Hz in Stage N2 (P sleep (82.6 ± 39.5 %TI, P sleep (12.6 ± 3.1 Hz, P = 0.035). There was minimal recruitment or derecruitment of units between SWS and Stage N2 sleep. Increased genioglossus SMU activity likely makes the airway more stable and resistant to collapse throughout the respiratory cycle during SWS.

Survey on the Relationship between Sleep Habits and Children`s Growth in Ahvaz City 2015

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Sara Moradnia

2016-06-01

Full Text Available Background: Exact determination between children's sleep habits and their growth could help us to prevent this risk factor of children's growth disorders. Thus this research was performed to investigate the correlation between sleep habits and growth of preschool children in Ahvaz- Iran. Materials and Methods: In this cross-sectional study, the data was obtained by using available sampling from 208 children of 3-6 years old that came to a private pediatric clinic in Ahvaz, South West of Iran in 2015 without regard to their gender. Measurement of height and weight of all patients with the meter and scale was performed. After measuring height and weight, stature-for- age and weight-for- age percentiles was calculated using child growth chart calculator of CDC for each child. Information on the onset time of night sleep, time to wake up in the morning and nap duration of children were gathered using researcher made questionnaire. Data analysis was performed with descriptive statistic and Kendall's tau-b statistical test using SPSS-19. Results: Results of this study showed of the 208 children that were evaluated, 32 of them (15.38% was stunted, underweight, or both and 176 (84.6% of them hadn`t any growth disorder. Results of Kendall's tau test showed that there is no significant relationship between the onset time of night sleep, waking up time in the morning, nap duration and neither height-for-age percentile nor weight-for-age percentile of preschool children (P>0.05. Conclusion The results of this study showed that children sleep habits does not affect their stature and weight- percentile. But this isn`t mean that going to sleep late has no effect on children's health, since the establishment of a normal sleep-wake rhythm is essential for both physical and mental development in children, so it is necessary to educate parents regarding the importance of children's sleep.

Do Circadian Preferences Influence the Sleep Patterns of Night Shift Drivers?

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Narciso, Fernanda V.; Esteves, Andrea M.; Oliveira e Silva, Luciana; Bittencourt, Lia R.A.; Silva, Rogerio S.; Pires, Maria Laura N.; Tufik, Sergio; de Mello, Marco Tulio

2013-01-01

Objective The objective of this study was to analyze the effect of individual circadian preferences of drivers with fixed night work schedules on sleep patterns. Subjects and Methods A total of 123 professional drivers, 32 indifferent preference drivers and 91 morning preference drivers of an intermunicipality and interstate bus transportation company were evaluated. All drivers underwent polysomnographic recordings after their shifts. Furthermore, they filled out a questionnaire that contained sociodemographic and health questions. The Horne and Östberg questionnaire was used to assess the subjects' morningness-eveningness preference. Results The mean age was 42.54 ± 6.98 years and 82 (66.66%) of the drivers had worked for ≥15 years. A significant effect on rapid eye movement (REM) was observed in the morning preference drivers. They showed an increased sleep latency and an REM sleep percentage of 5% of the total REM time. This reveals a significant effect on sleep architecture associated with work time. Conclusion The drivers reported that morning preference had a significant effect on their sleep pattern indicating less REM sleep and longer REM sleep latency in the morning preference group. Thus, it is important to evaluate interactions between individual aspects of health and other parameters, such as sleep quality and work organizational factors, to promote night shift workers' health and well-being. PMID:23988815

Do circadian preferences influence the sleep patterns of night shift drivers?

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Narciso, Fernanda V; Esteves, Andrea M; Oliveira e Silva, Luciana; Bittencourt, Lia R A; Silva, Rogerio S; Pires, Maria Laura N; Tufik, Sergio; de Mello, Marco Tulio

2013-01-01

The objective of this study was to analyze the effect of individual circadian preferences of drivers with fixed night work schedules on sleep patterns. A total of 123 professional drivers, 32 indifferent preference drivers and 91 morning preference drivers of an intermunicipality and interstate bus transportation company were evaluated. All drivers underwent polysomnographic recordings after their shifts. Furthermore, they filled out a questionnaire that contained sociodemographic and health questions. The Horne and Östberg questionnaire was used to assess the subjects' morningness-eveningness preference. The mean age was 42.54 ± 6.98 years and 82 (66.66%) of the drivers had worked for ≥15 years. A significant effect on rapid eye movement (REM) was observed in the morning preference drivers. They showed an increased sleep latency and an REM sleep percentage of 5% of the total REM time. This reveals a significant effect on sleep architecture associated with work time. The drivers reported that morning preference had a significant effect on their sleep pattern indicating less REM sleep and longer REM sleep latency in the morning preference group. Thus, it is important to evaluate interactions between individual aspects of health and other parameters, such as sleep quality and work organizational factors, to promote night shift workers' health and well-being. © 2013 S. Karger AG, Basel.

Information dynamics of brain–heart physiological networks during sleep

International Nuclear Information System (INIS)

Faes, L; Nollo, G; Jurysta, F; Marinazzo, D

2014-01-01

This study proposes an integrated approach, framed in the emerging fields of network physiology and information dynamics, for the quantitative analysis of brain–heart interaction networks during sleep. With this approach, the time series of cardiac vagal autonomic activity and brain wave activities measured respectively as the normalized high frequency component of heart rate variability and the EEG power in the δ, θ, α, σ, and β bands, are considered as realizations of the stochastic processes describing the dynamics of the heart system and of different brain sub-systems. Entropy-based measures are exploited to quantify the predictive information carried by each (sub)system, and to dissect this information into a part actively stored in the system and a part transferred to it from the other connected systems. The application of this approach to polysomnographic recordings of ten healthy subjects led us to identify a structured network of sleep brain–brain and brain–heart interactions, with the node described by the β EEG power acting as a hub which conveys the largest amount of information flowing between the heart and brain nodes. This network was found to be sustained mostly by the transitions across different sleep stages, as the information transfer was weaker during specific stages than during the whole night, and vanished progressively when moving from light sleep to deep sleep and to REM sleep. (paper)

Information dynamics of brain-heart physiological networks during sleep

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Faes, L.; Nollo, G.; Jurysta, F.; Marinazzo, D.

2014-10-01

This study proposes an integrated approach, framed in the emerging fields of network physiology and information dynamics, for the quantitative analysis of brain-heart interaction networks during sleep. With this approach, the time series of cardiac vagal autonomic activity and brain wave activities measured respectively as the normalized high frequency component of heart rate variability and the EEG power in the δ, θ, α, σ, and β bands, are considered as realizations of the stochastic processes describing the dynamics of the heart system and of different brain sub-systems. Entropy-based measures are exploited to quantify the predictive information carried by each (sub)system, and to dissect this information into a part actively stored in the system and a part transferred to it from the other connected systems. The application of this approach to polysomnographic recordings of ten healthy subjects led us to identify a structured network of sleep brain-brain and brain-heart interactions, with the node described by the β EEG power acting as a hub which conveys the largest amount of information flowing between the heart and brain nodes. This network was found to be sustained mostly by the transitions across different sleep stages, as the information transfer was weaker during specific stages than during the whole night, and vanished progressively when moving from light sleep to deep sleep and to REM sleep.

Non-dreamers.

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Pagel, J F

2003-05-01

Assess incidence and clarify whether diagnostic correlates exist for sleep laboratory patients reporting a lack of dream recall. To awaken, during polysomnographically defined sleep including rapid eye movement (REM) sleep, individuals reporting never having experienced a dream, and determine whether they report dreaming. Study # 1 - Incidence and polysomnographic correlates of sleep lab patients responding on questionnaire that they had never experienced dreaming. Study # 2 - Phone interviews with those individuals reporting non-dreaming on questionnaire to reassess incidence. Study # 3 - After reassessment, individuals (non-dreamers - # 16) are awakened during polysomnographic defined sleep (including REM sleep) and queried about dream recall. This group is compared statistically to a group (rare-dreamers - # 12) that reported dreaming as an extremely rare occurrence (mean dream recall latency - 13.5 years). Study # 1: Incidence of questionnaire reported non-dreaming in this sleep laboratory population is 6.5% (N=534) and is associated with the diagnosis of obstructive sleep apnea (specificity 95.6% for respiratory disturbance index >15). Study # 2 - Individuals who report after interview to have never experienced dreaming are more unusual (0.38% of this sleep laboratory population). Study # 3 - None of the non-dreamers (# 16) reported dream recall after waking in the sleep laboratory (36 awakenings in total for this group). This group does not differ, based on polysomnographic, clinical, or demographic variables, from the rare-dreaming group that occasionally reported dreams when awakened (3/12 patients, 3/32 awakenings) - a finding consistent with the reports of previous studies. The experience of dreaming may not be as ubiquitous as generally accepted. The group of non-dreamers evaluated in this study reports never having recalled a dream and reports no dreams when awakened during polysomnographicly defined sleep. These individuals might not experience

Phenotyping Pharyngeal Pathophysiology using Polysomnography in Patients with Obstructive Sleep Apnea.

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Sands, Scott A; Edwards, Bradley A; Terrill, Philip I; Taranto-Montemurro, Luigi; Azarbarzin, Ali; Marques, Melania; Hess, Lauren B; White, David P; Wellman, Andrew

2018-05-01

Therapies for obstructive sleep apnea (OSA) could be administered on the basis of a patient's own phenotypic causes ("traits") if a clinically applicable approach were available. Here we aimed to provide a means to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography. Based on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive. Thus, measuring ventilation and ventilatory drive (e.g., during spontaneous cyclic events) should reveal a patient's phenotypic traits without specialized intervention. We demonstrate this concept in patients with OSA (N = 29), using a novel automated noninvasive method to estimate ventilatory drive (polysomnographic method) and using "gold standard" ventilatory drive (intraesophageal diaphragm EMG) for comparison. Specialized physiological measurements using continuous positive airway pressure manipulation were employed for further comparison. The validity of nasal pressure as a ventilation surrogate was also tested (N = 11). Polysomnography-derived collapsibility and compensation estimates correlated favorably with those quantified using gold standard ventilatory drive (R = 0.83, P < 0.0001; and R = 0.76, P < 0.0001; respectively) and using continuous positive airway pressure manipulation (R = 0.67, P < 0.0001; and R = 0.64, P < 0.001; respectively). Polysomnographic estimates effectively stratified patients into high versus low subgroups (accuracy, 69-86% vs. ventilatory drive measures; P < 0.05). Traits were near-identical using nasal pressure versus pneumotach (N = 11, R ≥ 0.98, both traits; P < 0.001). Phenotypes of pharyngeal dysfunction in OSA are evident from spontaneous changes in ventilation and

Sleep disturbance and its relationship to psychiatric morbidity after Hurricane Andrew.

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Mellman, T A; David, D; Kulick-Bell, R; Hebding, J; Nolan, B

1995-11-01

Sleep disturbance is an important dimension of posttraumatic stress disorder (PTSD), but most of the limited available data were obtained years after the original traumatic event. This study provides information on sleep disturbance and its relationship to posttraumatic morbidity from evaluations done within a year after the trauma. Sleep and psychiatric symptoms of 54 victims (12 men and 42 women) of Hurricane Andrew who had no psychiatric illness in the 6 months before the hurricane were evaluated. A subset of hurricane victims with active psychiatric morbidity (N = 10) and nine comparison subjects who were unaffected by the hurricane were examined in a sleep laboratory. A broad range of sleep-related complaints were rated as being greater after the hurricane, and psychiatric morbidity (which was most commonly PTSD, followed by depression) had a significant effect on most of the subjective sleep measures. In addition, subjects with active morbidity endorsed greater frequencies of "bad dreams" and general sleep disturbances before the hurricane. Polysomnographic results for the hurricane victims revealed a greater number of arousals and entries into stage 1 sleep. REM density correlated positively with both the PTSD symptom of reexperiencing trauma and global distress. Subjects affected by Hurricane Andrew reported sleep disturbances, particularly those subjects with psychiatric morbidity. Tendencies to experience bad dreams and interrupted sleep before a trauma appear to mark vulnerability to posttraumatic morbidity. Results of sleep laboratory evaluations suggested brief shifts toward higher arousal levels during sleep for PTSD subjects and a relationship of REM phasic activity and symptom severity.

Automatic sleep spindle detection: Benchmarking with fine temporal resolution using open science tools

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Christian eO'Reilly

2015-06-01

Full Text Available Sleep spindle properties index cognitive faculties such as memory consolidation and diseases such as major depression. For this reason, scoring sleep spindle properties in polysomnographic recordings has become an important activity in both research and clinical settings. The tediousness of this manual task has motivated efforts for its automation. Although some progress has been made, increasing the temporal accuracy of spindle scoring and improving the performance assessment methodology are two aspects needing more attention. In this paper, four open-access automated spindle detectors with fine temporal resolution are proposed and tested against expert scoring of two proprietary and two open-access databases. Results highlight several findings: 1 that expert scoring and polysomnographic databases are important confounders when comparing the performance of spindle detectors tested using different databases or scorings; 2 because spindles are sparse events, specificity estimates are potentially misleading for assessing automated detector performance; 3 reporting the performance of spindle detectors exclusively with sensitivity and specificity estimates, as is often seen in the literature, is insufficient; including sensitivity, precision and a more comprehensive statistic such as Matthew’s correlation coefficient, F1-score, or Cohen’s κ is necessary for adequate evaluation; 4 reporting statistics for some reasonable range of decision thresholds provides a much more complete and useful benchmarking; 5 performance differences between tested automated detectors were found to be similar to those between available expert scorings; 6 much more development is needed to effectively compare the performance of spindle detectors developed by different research teams. Finally, this work clarifies a long-standing but only seldom posed question regarding whether expert scoring truly is a reliable gold standard for sleep spindle assessment.

Changes in growth and sleep across school nights, weekends and a winter holiday period in two Australian schools.

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Agostini, Alex; Pignata, Silvia; Camporeale, Roberta; Scott, Kathryn; Dorrian, Jillian; Way, Anne; Ryan, Paul; Martin, James; Kennedy, Declan; Lushington, Kurt

2018-01-26

Studies suggest that there may be an association between sleep and growth; however, the relationship is not well understood. Changes in biology and external factors such as school schedule heavily impact the sleep of adolescents, during a critical phase for growth. This study assessed the changes in sleep across school days, weekends and school holidays, while also measuring height and weight changes, and self-reported alterations in food intake and physical activity. The impact of morningness-eveningness (M-E) on height change and weight gain was also investigated. In a sample of 63 adolescents (mean age = 13.13, SD = 0.33, 31 males) from two independent schools in South Australia, height and weight were measured weekly for 4 weeks prior to the school holidays and 4 weeks after the school holidays. Participants also completed a Morningness/Eveningness Scale and 7-day sleep, diet and physical activity diaries prior to, during and after the school holidays. Participants at one school had earlier wake times during the weekends than participants attending the other school, leading to a significantly shorter sleep duration on weekends for those participants. Regardless of school, sleep was significantly later and longer during the holidays (p holiday weeks. For those attending the school with limited sleep in opportunities, growth after the holidays was lower for those with greater evening preference, whereas for those at the other school, growth was greater for those with greater evening preference. The increase in average weight from pre- to post-holidays was greater for those attending the school with limited opportunities to sleep longer. Participants reported greater food intake during the holidays compared to school days and greater physical activity levels on weekends compared to school days, and school days compared to holidays. Results suggest that time of day preference may impact growth, with evening types who cannot sleep in growing at a slower rate

Automatic Sleep Staging using Multi-dimensional Feature Extraction and Multi-kernel Fuzzy Support Vector Machine

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Yanjun Zhang

2014-01-01

Full Text Available This paper employed the clinical Polysomnographic (PSG data, mainly including all-night Electroencephalogram (EEG, Electrooculogram (EOG and Electromyogram (EMG signals of subjects, and adopted the American Academy of Sleep Medicine (AASM clinical staging manual as standards to realize automatic sleep staging. Authors extracted eighteen different features of EEG, EOG and EMG in time domains and frequency domains to construct the vectors according to the existing literatures as well as clinical experience. By adopting sleep samples self-learning, the linear combination of weights and parameters of multiple kernels of the fuzzy support vector machine (FSVM were learned and the multi-kernel FSVM (MK-FSVM was constructed. The overall agreement between the experts' scores and the results presented was 82.53%. Compared with previous results, the accuracy of N1 was improved to some extent while the accuracies of other stages were approximate, which well reflected the sleep structure. The staging algorithm proposed in this paper is transparent, and worth further investigation.

Modulation of Total Sleep Time by Transcranial Direct Current Stimulation (tDCS).

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Frase, Lukas; Piosczyk, Hannah; Zittel, Sulamith; Jahn, Friederike; Selhausen, Peter; Krone, Lukas; Feige, Bernd; Mainberger, Florian; Maier, Jonathan G; Kuhn, Marion; Klöppel, Stefan; Normann, Claus; Sterr, Annette; Spiegelhalder, Kai; Riemann, Dieter; Nitsche, Michael A; Nissen, Christoph

2016-09-01

Arousal and sleep are fundamental physiological processes, and their modulation is of high clinical significance. This study tested the hypothesis that total sleep time (TST) in humans can be modulated by the non-invasive brain stimulation technique transcranial direct current stimulation (tDCS) targeting a 'top-down' cortico-thalamic pathway of sleep-wake regulation. Nineteen healthy participants underwent a within-subject, repeated-measures protocol across five nights in the sleep laboratory with polysomnographic monitoring (adaptation, baseline, three experimental nights). tDCS was delivered via bi-frontal target electrodes and bi-parietal return electrodes before sleep (anodal 'activation', cathodal 'deactivation', and sham stimulation). Bi-frontal anodal stimulation significantly decreased TST, compared with cathodal and sham stimulation. This effect was location specific. Bi-frontal cathodal stimulation did not significantly increase TST, potentially due to ceiling effects in good sleepers. Exploratory resting-state EEG analyses before and after the tDCS protocols were consistent with the notion of increased cortical arousal after anodal stimulation and decreased cortical arousal after cathodal stimulation. The study provides proof-of-concept that TST can be decreased by non-invasive bi-frontal anodal tDCS in healthy humans. Further elucidating the 'top-down' pathway of sleep-wake regulation is expected to increase knowledge on the fundamentals of sleep-wake regulation and to contribute to the development of novel treatments for clinical conditions of disturbed arousal and sleep.

The Influence of Sleep on the Consolidation of Positive Emotional Memories: Preliminary Evidence

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Alexis M. Chambers

2014-05-01

Full Text Available Studies have not only shown that a period of sleep following learning offers greater benefits to later memory than a period of wakefulness, but also that sleep actively promotes those components of memories that are emotionally salient. However, sleep's role in emotional memory consolidation has largely been investigated with memories that are specifically negative in content, such as memory for negative images or texts, leaving open the question of whether sleep influences positive memories in a similar manner. The current study investigated the emotional memory trade-off effect for positive versus neutral information. Scenes in which a positive or neutral object was placed on a neutral background were encoded prior to a period of polysomnographically-monitored nocturnal sleep or daytime wakefulness. Recognition memory was tested for the objects and backgrounds separately following the delay using the Remember/Know paradigm. Compared to wake participants, those who slept during the delay had increased recollection memory performance for positive objects, but not the neutral components of the studied scenes. Further, familiarity of positive objects was negatively correlated with REM latency. These results provide preliminary evidence that sleep contributes to the selective processing of positive memories, and point toward a role for REM sleep in positive memory formation.

Biomechanics-based active control of bedding support properties and its influence on sleep.

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Van Deun, D; Verhaert, V; Willemen, T; Wuyts, J; Verbraecken, J; Exadaktylos, V; Haex, B; Vander Sloten, J

2012-01-01

Proper body support plays an import role in the recuperation of our body during sleep. Therefore, this study uses an automatically adapting bedding system that optimises spinal alignment throughout the night by altering the stiffness of eight comfort zones. The aim is to investigate the influence of such a dynamic sleep environment on objective and subjective sleep parameters. The bedding system contains 165 sensors that measure mattress indentation. It also includes eight actuators that control the comfort zones. Based on the measured mattress indentation, body movements and posture changes are detected. Control of spinal alignment is established by fitting personalized human models in the measured indentation. A total of 11 normal sleepers participated in this study. Sleep experiments were performed in a sleep laboratory where subjects slept three nights: a first night for adaptation, a reference night and an active support night (in counterbalanced order). Polysomnographic measurements were recorded during the nights, combined with questionnaires aiming at assessing subjective information. Subjective information on sleep quality, daytime quality and perceived number of awakenings shows significant improvements during the active support (ACS) night. Objective results showed a trend towards increased slow wave sleep. On the other hand, it was noticed that % N1-sleep was significantly increased during ACS night, while % N2-sleep was significantly decreased. No prolonged N1 periods were found during or immediately after steering.

The sleep architecture of Saudi Arabian patients with Kleine-Levin syndrome

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Al Shareef, Saad M.; Almeneessier, Aljohara S.; Hammad, Omeima; Smith, Richard M.; BaHammam, Ahmed S.

2018-01-01

Objectives: To establish baseline sleep architecture during an acute attack of Kleine-Levin syndrome (KLS) in a cohort of Saudi Arabian KLS patients and compare these characteristics with other published cohorts. Methods: This was a retrospective cohort study of the polysomnographic characteristics of 10 typical symptomatic Saudi Arabian KLS patients attending the University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia between 2002 and 2015. Data were captured by nocturnal polysomnography during an acute attack of hypersomnia and compared with other published cohorts identified via a systematic literature search. Results: Self-reported time asleep during episodes (11.1±6.7 hours) and recorded total sleep time (TST) (322.5±108.7 minutes) were generally shorter than other published cohorts. Sleep efficiency was poor at 75.0%±25.1%, with low relative amounts of rapid eye movement (REM) sleep (16.5±5.9% of TST) and deep non-REM sleep (stage N3; 10.5±6.0% of TST) and high relative amounts of non-REM sleep (stage N1; 7.0±4.3% of TST). The sleep architecture of Saudi Arabian KLS patients was similar to other published cohorts. Conclusions: Sleep architecture of our cohort was relatively normal and broadly similar to other published studies, the main features being low sleep efficiency and low relative amounts of REM and stage N3 sleep. Time-course polysomnography studies with functional imaging may be useful to further establish the exact pathophysiology of this disease. PMID:29332107

The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation

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Van Dongen, Hans P A.; Maislin, Greg; Mullington, Janet M.; Dinges, David F.

2003-01-01

OBJECTIVES: To inform the debate over whether human sleep can be chronically reduced without consequences, we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation. DESIGN: The chronic sleep restriction experiment involved randomization to one of three sleep doses (4 h, 6 h, or 8 h time in bed per night), which were maintained for 14 consecutive days. The total sleep deprivation experiment involved 3 nights without sleep (0 h time in bed). Each study also involved 3 baseline (pre-deprivation) days and 3 recovery days. SETTING: Both experiments were conducted under standardized laboratory conditions with continuous behavioral, physiological and medical monitoring. PARTICIPANTS: A total of n = 48 healthy adults (ages 21-38) participated in the experiments. INTERVENTIONS: Noctumal sleep periods were restricted to 8 h, 6 h or 4 h per day for 14 days, or to 0 h for 3 days. All other sleep was prohibited. RESULTS: Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days resulted in significant cumulative, dose-dependent deficits in cognitive performance on all tasks. Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days, and did not significantly differentiate the 6 h and 4 h conditions. Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis--displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights. Comparison of chronic sleep restriction to total sleep deprivation showed that the latter resulted in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost. A statistical model revealed that, regardless of the mode of sleep deprivation, lapses in behavioral alertness

Patient-ventilator asynchrony, leaks and sleep in patients with amyotrophic lateral sclerosis.

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Vrijsen, Bart; Testelmans, Dries; Belge, Catharina; Vanpee, Goele; Van Damme, Philip; Buyse, Bertien

2016-01-01

Sleeping with non-invasive ventilation (NIV) in amyotrophic lateral sclerosis appears to be accompanied by a high patient-ventilator asynchrony (PVA) index. This prospective observational cohort study quantifies PVA and leaks, and searches for effects of these events on sleep after polysomnographic NIV titration. Full-video polysomnography, with incorporation of transcutaneous carbon dioxide and ventilator software, was used to analyse sleep epoch-by-epoch and respiratory events and PVA breath-by-breath in 35 patients (17 non-bulbar). After diagnostic polysomnography, NIV was titrated during three consecutive nights. Sleep, PVA and leaks were evaluated at discharge and after one month. Results showed that non-bulbar patients improved in sleep architecture and oxygen and carbon dioxide levels while bulbar patients only improved oxygen saturation. PVA remained present at discharge (non-bulbar 54 (21-101) and bulbar 31 (9-39)/h sleep) and one month (non-bulbar 31 (9-39) and bulbar 32 (17-55)/h sleep), with ineffective effort as most prominent asynchrony. Leaks also persisted after titration (non-bulbar 16.6 (3.1-44.6) and bulbar 5.1 (0.0-19.5)% of total sleep time (TST)) and one month (non-bulbar 7.7 (1.4-29.3) and bulbar 12.7 (0.0-35.2)% TST). PVA and leaks have none to minor effect on sleep architecture. In conclusion, although PVA and leaks remain present after meticulous NIV titration, these events seem not to interfere with sleep.

Masticatory Muscle Sleep Background EMG Activity is Elevated in Myofascial TMD Patients

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Raphael, Karen G.; Janal, Malvin N.; Sirois, David A.; Dubrovsky, Boris; Wigren, Pia E.; Klausner, Jack J.; Krieger, Ana C.; Lavigne, Gilles J.

2013-01-01

Despite theoretical speculation and strong clinical belief, recent research using laboratory polysomnographic (PSG) recording has provided new evidence that frequency of sleep bruxism (SB) masseter muscle events, including grinding or clenching of the teeth during sleep, is not increased for women with chronic myofascial temporomandibular disorder (TMD). The current case-control study compares a large sample of women suffering from chronic myofascial TMD (n=124) with a demographically matched control group without TMD (n=46) on sleep background electromyography (EMG) during a laboratory PSG study. Background EMG activity was measured as EMG root mean square (RMS) from the right masseter muscle after lights out. Sleep background EMG activity was defined as EMG RMS remaining after activity attributable to SB, other orofacial activity, other oromotor activity and movement artifacts were removed. Results indicated that median background EMG during these non SB-event periods was significantly higher (pcases exceeding control activity. Moreover, for TMD cases, background EMG was positively associated and SB event-related EMG was negatively associated with pain intensity ratings (0–10 numerical scale) on post sleep waking. These data provide the foundation for a new focus on small, but persistent, elevations in sleep EMG activity over the course of the night as a mechanism of pain induction or maintenance. PMID:24237356

Efficacy of custom made oral appliance for treatment of obstructive sleep apnea

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V R Cilil

2015-01-01

Full Text Available Introduction: oral appliance for the treatment of OSA is considered as an effective, low-risk alternative to CPAP. Demand for oral appliance increases as an alternative for those who cannot tolerate CPAP and refuse surgery. Oral appliances uses the traditional methods to advance the mandible thus modify the posture and their by enlarge the airway or otherwise reduce the collapsibility. Aims and Objectives: The main objective of this study was to evaluate the efficacy of custom made oral appliance on sleep characteristics of OSA patients. Materials and Methods: Polysomnography was done on 15 patients of 24-60 years of age before (T1, and after the delivery of the custom made oral appliance (T2. Statistical Analysis: Paired t tests were performed to determine the significance of change in the polysomnographic and cephalometric variables. P < 0.05 was considered as significant. Results: All patients with oral appliance showed an improvement in sleep parameters with an increase in sleep efficiency, and desaturation index with the use of oral appliance. ESS and cephalometric findings showed improvement in the sleep apnea in concordance with the sleep parameters. Conclusions: Custom made oral appliance is a useful treatment option for improving quality of sleep and can be considered as an alternative treatment modality.

Sleep disorders and depressive feelings: a global survey with the Beck depression scale.

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Vandeputte, Melissa; de Weerd, Al

2003-07-01

Patients with (chronic) sleep disorders are prone to depression. Until now studies on the prevalence of depression in the various sleep disorders focused mainly on obstructive sleep apnea patients and narcolepsy. Studies in other common sleep disorders are scarce. The aim of our study was to estimate the prevalence of depressive feelings in the various sleep disorders diagnosed in a Center for Sleep and Wake Disorders. We included 917 consecutive patients (age between 14 and 84 years, median age: 49, 396 male and 521 female), seen in our center for sleep and wake disorders during 2001 and first half of 2002. The diagnosis was based on the history taken at the outpatient-clinic and two consecutive 24-h polysomnographic recordings at home (APSG). The final decisions on the diagnosis were made according to the ASDA international classification of sleep disorders. The severity of depressive feelings was based on the Beck depression scale. Overall, the prevalence of depressive feelings was high. There were no significant differences in age and gender. In psychophysiological insomnia, inadequate sleep- and wake hygiene, sleep state misperception and periodic limb movement disorder/restless legs syndrome some form of depression occurred in more than half of the patients. Moderate to severe depression was found in 3.5% of the patients. The study suggests that the use of a depression scale in the daily routine of diagnosing and treating sleep disorders should be encouraged in order to optimise diagnosis and therapy in these patients.

The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea

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Aylin Pıhtılı

2017-02-01

Full Text Available Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001, oxygen desaturation index (p<0.001 and sleep time with SpO2<90% (p<0.001 were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001 and lowest SpO2 (p<0.001 were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Conclusion: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high

Sleep-disordered breathing, behavior, and academic performance in Taiwan schoolchildren.

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Ting, Hua; Wong, Ruey-Hong; Yang, Hao-Jan; Lee, Shu-Ping; Lee, Shin-Da; Wang, Lee

2011-01-01

The behaviors of children may be affected by sleep-disordered breathing (SDB). This study adopts a cross-sectional approach to investigate the relationship between the sleep apneas-hypopneas index during sleep and the behavioral and academic performance of schoolchildren in Taiwan. A total of 138 children (85 boys and 53 girls), ages 6-11, were recruited from two elementary schools to participate in this study. Overnight polysomnographic examinations in hospital were performed to assess sleep quality, including total sleep time, arousal index, apneas-hypopneas index, desaturation index, and lowest oxygen saturation, as well as the percentage of total sleep time spent in rapid eye movement, stage 1, stage 2, stage 3, and stage 4. The children's parents and teachers were required to complete a Chinese version of the Child Behavior Checklist and Teacher's Report Form to assess child behavior and academic achievement. Compared with children without SDB (apneas-hypopneas index ≤1), those with severe SDB (apneas-hypopneas index >15) exhibited more irregular behavioral performance in somatic complaints (odds ratio (OR) = 9.43; 95% confidence interval (CI) = 1.04-85.71) and attention (OR = 9.95; 95% CI = 1.02-97.00). However, different severities of SDB groups did not show significant associations in academic performance. Our study suggests that children with severe SDB may predispose to somatic complaints and attention problems so that sleep examination or medical intervention might be provided at an early age in these children.

Regional cerebral metabolic correlates of WASO during NREM sleep in insomnia.

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Nofzinger, Eric A; Nissen, Christoph; Germain, Anne; Moul, Douglas; Hall, Martica; Price, Julie C; Miewald, Jean M; Buysse, Daniel J

2006-07-15

To investigate the non-rapid eye movement (NREM) sleep-related regional cerebral metabolic correlates of wakefulness after sleep onset (WASO) in patients with primary insomnia. Fifteen patients who met DSM-IV criteria for primary insomnia completed 1-week sleep diary (subjective) and polysomnographic (objective) assessments of WASO and regional cerebral glucose metabolic assessments during NREM sleep using [18F] fluoro-2-deoxy-D-glucose positron emission tomography. Whole-brain voxel-by-voxel correlations, as well as region of interest analyses, were performed between subjective and objective WASO and relative regional cerebral metabolism using the statistical software SPM2. Subjective WASO was significantly greater than objective WASO, but the 2 measures were positively correlated. Objective WASO correlated positively with the percentage of stage 2 sleep and negatively with the percentage of stages 3 and 4 sleep. Both subjective and objective WASO positively correlated with NREM sleep-related cerebral glucose metabolism in the pontine tegmentum and in thalamocortical networks in a frontal, anterior temporal, and anterior cingulate distribution. Increased relative metabolism in these brain regions during NREM sleep in patients with insomnia is associated with increased WASO measured either subjectively or objectively. These effects are related to the lighter sleep stages of patients with more WASO and may result from increased activity in arousal systems during sleep and or to activity in higher-order cognitive processes related to goal-directed behavior, conflict monitoring, emotional awareness, anxiety, and fear. Such changes may decrease arousal thresholds and/or increase perceptions of wakefulness in insomnia.

The sedating antidepressant trazodone impairs sleep-dependent cortical plasticity.

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Sara J Aton

2009-07-01

Full Text Available Recent findings indicate that certain classes of hypnotics that target GABA(A receptors impair sleep-dependent brain plasticity. However, the effects of hypnotics acting at monoamine receptors (e.g., the antidepressant trazodone on this process are unknown. We therefore assessed the effects of commonly-prescribed medications for the treatment of insomnia (trazodone and the non-benzodiazepine GABA(A receptor agonists zaleplon and eszopiclone in a canonical model of sleep-dependent, in vivo synaptic plasticity in the primary visual cortex (V1 known as ocular dominance plasticity.After a 6-h baseline period of sleep/wake polysomnographic recording, cats underwent 6 h of continuous waking combined with monocular deprivation (MD to trigger synaptic remodeling. Cats subsequently received an i.p. injection of either vehicle, trazodone (10 mg/kg, zaleplon (10 mg/kg, or eszopiclone (1-10 mg/kg, and were allowed an 8-h period of post-MD sleep before ocular dominance plasticity was assessed. We found that while zaleplon and eszopiclone had profound effects on sleeping cortical electroencephalographic (EEG activity, only trazodone (which did not alter EEG activity significantly impaired sleep-dependent consolidation of ocular dominance plasticity. This was associated with deficits in both the normal depression of V1 neuronal responses to deprived-eye stimulation, and potentiation of responses to non-deprived eye stimulation, which accompany ocular dominance plasticity.Taken together, our data suggest that the monoamine receptors targeted by trazodone play an important role in sleep-dependent consolidation of synaptic plasticity. They also demonstrate that changes in sleep architecture are not necessarily reliable predictors of how hypnotics affect sleep-dependent neural functions.

Avaliação polissonográfica de pacientes ambulatoriais portadores de transtornos do humor Polysomnographic evaluation of clinical patients suffering from mood disturbance

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Mônica M. Souza

2003-06-01

Full Text Available A avaliação do sono e os achados polissonográficos de 60 pacientes portadores de transtorno do humor, acompanhados em ambulatório, com média de idade de 36,1 ± 11,3 anos são apresentados ( 12 M, 48 F. Os pacientes foram submetidos a entrevista clínica, questionário do sono e a duas noites de polissonografia, sendo a segunda noite utilizada para dados estatísticos. A distimia foi o diagnóstico mais comum em 25 casos. (41,6%. Para o delineamento do estudo utilizou-se análise descritiva. As avaliações estatísticas empregadas foram o teste exato de Fisher e o teste de Kruskal-Wallis. Houve tendência para redução da continuidade do sono e aumento da densidade REM, em níveis estatisticamente não significantes. Ocorreu redução significante do sono profundo (estágio 4 diretamente relacionada com a maior severidade da depressão (p=0,0253.The sleep patterns of sixty patients suffering from mood disturbance, were studied, with mean age of 36.1 ± 11.3 years ( 12 males, 48 females. These patients were submitted to two nights of nocturnal polysomnographic evaluation; the second night acquired data was employed in the statistics. The following parameters were analyzed: parameters of sleep continuity, parameters of sleep architecture, REM and non-REM sleep parameters. The patients were analyzed in accordance to depression severity, presence of sleep disorders and relevant mood disturbances. The most common diagnosis was dysthymia in 25 cases (41.6%. Descriptive analysis was used to delineate the study. The statistics evaluation used the Fisher exact test and the Kruskal-Wallis statistics heterogeneity test. There was reduction in sleep continuity and increase in REM density, both not statistic significant. Stage 4 sleep showed significant reduction in severely depressed patients (p=0.0253.

[Comparison of polysomnographic characteristics in preschool and school aged children with obstructive sleep apnea hypopnea syndrome].

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Sun, Yuanfeng; Lei, Fei; Du, Lina; Tang, Xiangdong; Yang, Linghui

2016-03-01

To compare the characteristics of polysomnography in preschool and school aged children with obstructive sleep apnea hypopnea syndrome (OSAHS). The clinical data were collected from October 2009 to October 2013 among children monitored in Sleep Medical Center of West China Hospital. Among them, 189 preschool aged (aged 3-5 years) and 211 school aged (aged 6-13 years) children with sleep breathing disorder, and 33 children complained with sleep talking as controls were enrolled and underwent polysomnography. According to apnea hyponea index (AHI), they were classified as primary snoring (AHIstage and N2 stage among groups (P>0.05). In preschool aged children, the percentage of N1 stage in the moderate/severe group was more than other three groups (moderate/severe group vs control group, primary snoring group, mild group: 24.7%±13.7% vs 17.0%±8.7%, 21.7%±12.4%, 20.9%±11.6%, all Pstage in the moderate/severe group was more than the control group (moderate/severe group vs control group: 18.0%±10.4% vs 12.0%±4.8%, Pstage in the moderate/severe group and the mild group were less than the control group (moderate/severe group, mild group vs control group: 28.3%±9.6%, 28.8%±8.8% vs 33.9%±13.0%, both Ppreschool and school aged children group, the arouse index in the moderate/severe group was higher than other three groups, the mean oxygen saturation and the lowest oxygen saturation in the moderate/severe group were lower than those of the other three groups, the differences were statistically significant (all Ppreschool children (r=-0.02, P>0.05). However, there was significance in school aged children (r=0.26, Ppreschool and school aged (r=0.42, 0.55, both Ppreschool children than in school aged children. The severity is mainly related to enlarged tonsils and adenoids. School aged children with OSAHS may be more susceptible to sleep structure disorder and the severity is mainly related to BMI.

Nightmares in United States Military Personnel With Sleep Disturbances

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Creamer, Jennifer L.; Brock, Matthew S.; Matsangas, Panagiotis; Motamedi, Vida; Mysliwiec, Vincent

2018-01-01

Study Objectives: Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. Methods: Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center. The Pittsburgh Sleep Quality Index and the Pittsburgh Sleep Quality Index-Addendum were used to characterize clinically significant nightmares. Subjective and objective sleep attributes were compared between groups. Results: At least weekly nightmares were present in 31.2%; yet, only 3.9% reported nightmares as a reason for evaluation. Trauma-related nightmares occurred in 60% of those patients with nightmares. Patients with nightmares had increased sleep onset latency (SOL) and rapid eye movement (REM) sleep latency (mean SOL/REM sleep latency 16.6/145 minutes, P = .02 and P = .01 respectively) compared to those without (mean SOL/REM sleep latency 12.5/126 minutes). The comorbid disorders of depression (P ≤ .01, relative risk [RR] 3.55 [95% CI, 2.52–4.98]), anxiety (P ≤ .01, RR 2.57 [95% CI, 1.93–3.44]), posttraumatic stress disorder (P ≤ .01, RR 5.11 [95% CI, 3.43–7.62]), and insomnia (P ≤ .01, RR 1.59 [95% CI, 1.42–1.79]) were all associated with nightmares. Conclusions: Clinically significant nightmares are highly prevalent in United States military personnel with sleep disturbances. Nightmares are associated with both subjective and objective sleep disturbances and are frequently comorbid with other sleep and mental health disorders. Commentary: A commentary on this article appears in this issue on page 303. Citation: Creamer JL, Brock MS, Matsangas P, Motamedi V, Mysliwiec V. Nightmares in United States military

Pediatric Obstructive Sleep Apnea and the critical role of oral-facial growth: evidences

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Christian eGuilleminault

2013-01-01

Full Text Available Aims: Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese childrenMethod: Review of experimental data from infant monkeys with experimentally induced nasal resistance. Review of early historical data in the orthodontic literature indicating the abnormal oral-facial development associated with mouth breathing and nasal resistance. Review of the progressive demonstration of sleep disordered breathing in children who underwent incomplete treatment of OSA with adenotonsillectomy, and demonstration of abnormal oral-facial anatomy that must often to be treated in order for the resolution of OSA. Review of long term recurrence data on OSA and indication of oral-facial myofunctional dysfunction in association with the recurrence of OSA. Results: Presentation of prospective data on premature infants and sleep-disordered-breathing (SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral facial muscle tone, maxillary-mandibular growth and development of SDB. Role of myofunctional re-education with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children. Conclusion: Pediatric OSA in non-obese children is a disorder of oral facial growth.

Increased delta power and discrepancies in objective and subjective sleep measurements in borderline personality disorder.

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Philipsen, Alexandra; Feige, Bernd; Al-Shajlawi, Anam; Schmahl, Christian; Bohus, Martin; Richter, Harald; Voderholzer, Ulrich; Lieb, Klaus; Riemann, Dieter

2005-09-01

Previous studies have shown depression-like sleep abnormalities in borderline personality disorder (BPD). However, findings in BPD are not unequivocal for REM dysregulation, as well as for a decrement of slow wave sleep and sleep continuity disturbances. Earlier findings in sleep EEG abnormalities in BPD may have been confounded by concomitant depressive symptoms. Twenty unmedicated female BPD patients without current comorbid major depression and 20 sex- and age-matched control subjects entered the study. Conventional polysomnographic parameters and for the first time sleep EEG spectral power analysis was performed on two sleep laboratory nights. Subjective sleep parameters were collected by sleep questionnaires in order to assess the relationship between objective and subjective sleep measurements. BPD patients showed a tendency for shortened REM latency and significantly decreased NonREM sleep (stage 2). Spectral EEG analysis showed increased delta power in total NREM sleep as well as in REM sleep in BPD patients. Subjective ratings documented drastically impaired sleep quality in BPD patients for the two weeks before the study and during the two laboratory nights. Not-depressed BPD patients only showed tendencies for depression-like REM sleep abnormalities. Surprisingly, BPD patients displayed higher levels of delta power in the sleep EEG in NREM sleep than healthy control subjects. There was a marked discrepancy between objective and subjective sleep measurements, which indicates an altered perception of sleep in BPD. The underlying psychological and neurobiological mechanisms of these alterations are still unclear and need to be clarified in future studies including interventions on a pharmacological and cognitive-behavioral level.

Effects of Social Defeat Stress on Sleep in Mice.

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Henderson, Fiona; Vialou, Vincent; El Mestikawy, Salah; Fabre, Véronique

2017-01-01

Stress plays a key role in the development of psychiatric disorders and has a negative impact on sleep integrity. In mice, chronic social defeat stress (CSDS) is an ethologically valid model of stress-related disorders but little is known about its effects on sleep regulation. Here, we investigated the immediate and long-term effects of 10 consecutive days of social defeat (SD) on vigilance states in C57Bl/6J male mice. Social behavior was assessed to identify susceptible mice, i.e., mice that develop long-lasting social avoidance, and unsusceptible mice. Sleep-wake stages in mice of both groups were analyzed by means of polysomnographic recordings at baseline, after the first, third, and tenth stress sessions and on the 5th recovery day (R5) following the 10-day CSDS. In susceptible mice, each SD session produced biphasic changes in sleep-wake states that were preserved all along 10-day CSDS. These sessions elicited a short-term enhancement of wake time while rapid eye-movement (REM) sleep was strongly inhibited. Concomitantly, delta power was increased during non REM (NREM) sleep. During the following dark period, an increase in total sleep time, as well as wake fragmentation, were observed after each analyzed SD session. Similar changes were observed in unsusceptible mice. At R5, elevated high-frequency EEG activity, as observed in insomniacs, emerged during NREM sleep in both susceptible and unsusceptible groups suggesting that CSDS impaired sleep quality. Furthermore, susceptible but not unsusceptible mice displayed stress-anticipatory arousal during recovery, a common feature of anxiety disorders. Altogether, our findings show that CSDS has profound impacts on vigilance states and further support that sleep is tightly regulated by exposure to stressful events. They also revealed that susceptibility to chronic psychological stress is associated with heightened arousal, a physiological feature of stress vulnerability.

Effects of Social Defeat Stress on Sleep in Mice

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Fiona Henderson

2017-11-01

Full Text Available Stress plays a key role in the development of psychiatric disorders and has a negative impact on sleep integrity. In mice, chronic social defeat stress (CSDS is an ethologically valid model of stress-related disorders but little is known about its effects on sleep regulation. Here, we investigated the immediate and long-term effects of 10 consecutive days of social defeat (SD on vigilance states in C57Bl/6J male mice. Social behavior was assessed to identify susceptible mice, i.e., mice that develop long-lasting social avoidance, and unsusceptible mice. Sleep-wake stages in mice of both groups were analyzed by means of polysomnographic recordings at baseline, after the first, third, and tenth stress sessions and on the 5th recovery day (R5 following the 10-day CSDS. In susceptible mice, each SD session produced biphasic changes in sleep-wake states that were preserved all along 10-day CSDS. These sessions elicited a short-term enhancement of wake time while rapid eye-movement (REM sleep was strongly inhibited. Concomitantly, delta power was increased during non REM (NREM sleep. During the following dark period, an increase in total sleep time, as well as wake fragmentation, were observed after each analyzed SD session. Similar changes were observed in unsusceptible mice. At R5, elevated high-frequency EEG activity, as observed in insomniacs, emerged during NREM sleep in both susceptible and unsusceptible groups suggesting that CSDS impaired sleep quality. Furthermore, susceptible but not unsusceptible mice displayed stress-anticipatory arousal during recovery, a common feature of anxiety disorders. Altogether, our findings show that CSDS has profound impacts on vigilance states and further support that sleep is tightly regulated by exposure to stressful events. They also revealed that susceptibility to chronic psychological stress is associated with heightened arousal, a physiological feature of stress vulnerability.

Effect of a warm footbath before bedtime on body temperature and sleep in older adults with good and poor sleep: an experimental crossover trial.

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Liao, Wen-Chun; Wang, Lee; Kuo, Ching-Pyng; Lo, Chyi; Chiu, Ming-Jang; Ting, Hua

2013-12-01

The decrease in core body temperature before sleep onset and during sleep is associated with dilation of peripheral blood vessels, which permits heat dissipation from the body core to the periphery. A lower core temperature coupled with a higher distal (hands and feet) temperature before sleep are associated with shorter sleep latency and better sleep quality. A warm footbath is thought to facilitate heat dissipation to improve sleep outcomes. This study examined the effect of a warm footbath (40°C water temperature, 20-min duration) on body temperature and sleep in older adults (≥55 years) with good and poor sleep. Two groups and an experimental crossover design was used. Forty-three adults responded to our flyer and 25 participants aged 59.8±3.7 years (poor sleeper with a Pittsburgh Sleep Quality Index score≥5=17; good sleepers with a Pittsburgh Sleep Quality Index scoretemperatures (core, abdomen, and foot) and polysomnography recorded for 3 consecutive nights. The first night was for adaptation and sleep apnea screening. Participants were then randomly assigned to either the structured foot bathing first (second night) and non-bathing second (third night) condition or the non-bathing first (second night) and foot bathing second (third night) condition. A footbath before sleep significantly increased and retained foot temperatures in both good and poor sleepers. The pattern of core temperatures during foot bathing was gradually elevated (poor sleepers vs. good sleepers=+0.40±0.58°C vs. +0.66±0.17°C). There were no significant changes in polysomnographic sleep and perceived sleep quality between non-bathing and bathing nights for both groups. A footbath of 40°C water temperature and 20-min duration before sleep onset increases foot temperatures and distal-proximal skin temperature gradients to facilitate vessel dilatation and elevates core temperature to provide heat load to the body. This footbath does not alter sleep in older adults with good and

Characteristics of objective daytime sleep among individuals with earthquake-related posttraumatic stress disorder: A pilot community-based polysomnographic and multiple sleep latency test study.

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Zhang, Yan; Li, Yun; Zhu, Hongru; Cui, Haofei; Qiu, Changjian; Tang, Xiangdong; Zhang, Wei

2017-01-01

Little is known about the objective sleep characteristics of patients with posttraumatic stress disorder (PTSD). The present study examines the association between PTSD symptom severity and objective daytime sleep characteristics measured using the Multiple Sleep Latency Test (MSLT) in therapy-naïve patients with earthquake-related PTSD. A total of 23 PTSD patients and 13 trauma-exposed non-PTSD (TEN-PTSD) subjects completed one-night in-lab polysomnography (PSG) followed by a standard MSLT. 8 of the 23 PTSD patients received paroxetine treatment. Compared to the TEN-PTSD subjects, no significant nighttime sleep disturbances were detected by PSG in the subjects with PTSD; however, a shorter mean MSLT value was found in the subjects with PTSD. After adjustment for age, sex, and body mass index, PTSD symptoms, particularly hyperarousal, were found to be independently associated with a shorter MSLT value. Further, the mean MSLT value increased significantly after therapy in PTSD subjects. A shorter MSLT value may be a reliable index of the medical severity of PTSD, while an improvement in MSLT values might also be a reliable marker for evaluating therapeutic efficacy in PTSD patients. Copyright © 2016. Published by Elsevier Ireland Ltd.

Growth and development of children with a special focus on sleep.

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Danker-Hopfe, Heidi

2011-12-01

The first two decades of life are characterised complex biological processes involving growth and maturation as well as differentiation. The Central Nervous System (CNS) where among others internal and external stimuli are integrated and responses of the body are prepared starts to evolve quite early during ontogenesis. One of the complex behaviours, which are regulated by the brain, is the sleep-wake cycle. The discussion of age-related changes in sleep comprises changes at the physiological level (e.g. changes in the frequency and amplitude of EEG signal, as well as development and distribution of sleep stages), changes in the corresponding behaviour (e.g. changes in the absolute amount of sleep and its distribution in 24h perspective), and finally the subjective perception of sleep and sleep as a measure of well-being. Studies on the impact of a specific factor on sleep during childhood and adolescence have to consider chronological and biological age as well as sex as relevant biological parameters. Even when these factors are controlled for large interindividual differences persist, that is why prospective instead of cross-sectional approaches should be used whenever possible. Furthermore, it has to be distinguished between sleep assessed at the level of brain functioning (i.e. by polysomnography), which gives information on effects at the physiological level and at the level of self-assessment, which focuses on behaviour. Both, sleep at the subjective as well as at the objective level, can to a considerable degree be affected by life style factors, which hence have to be considered as potential confounders. Copyright © 2011 Elsevier Ltd. All rights reserved.

Subjectively and objectively measured sleep with and without posttraumatic stress disorder and trauma exposure.

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Kobayashi, Ihori; Huntley, Edward; Lavela, Joseph; Mellman, Thomas A

2012-07-01

Although reports of sleep disturbances are common among individuals with posttraumatic stress disorder (PTSD), results of polysomnographic (PSG) studies have inconsistently documented abnormalities and have therefore suggested "sleep state misperception." The authors' study objectives were to compare sleep parameters measured objectively and subjectively in the laboratory and at home in civilians with and without trauma exposure and PTSD. Cross-sectional study. PSG recordings in a sleep laboratory and actigraphic recordings in participants' homes. One hundred three urban-residing African Americans with and without trauma exposure and PTSD who participated in a larger study. N/A. Sleep parameters (total sleep time [TST], sleep onset latency [SOL], and wake after sleep onset [WASO]) were assessed using laboratory PSG and home actigraphy. A sleep diary was completed in the morning after PSG and actigraphy recordings. Habitual TST, SOL, and WASO were assessed using a sleep questionnaire. The Clinician Administered PTSD Scale was administered to assess participants' trauma exposure and PTSD diagnostic status. Participants, regardless of their trauma exposure/PTSD status, underestimated WASO in the diary and questionnaire relative to actigraphy and overestimated SOL in the diary relative to PSG. Among participants with current PTSD, TST diary estimates did not differ from the actigraphy measure in contrast with those without current PTSD who overestimated TST. No other significant group differences in discrepancies between subjective and objective sleep measures were found. Discrepancies between subjectively and objectively measured sleep parameters were not associated with trauma exposure or PTSD. This challenges prior assertions that individuals with PTSD overreport their sleep disturbances.

Childhood obstructive sleep-disordered breathing: a clinical update and discussion of technological innovations and challenges.

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Halbower, Ann C; Ishman, Stacey L; McGinley, Brian M

2007-12-01

Childhood sleep-disordered breathing (SDB) has been known to be associated with health and cognitive impacts for more than a century, and yet our understanding of this disorder is in its infancy. Neuropsychological consequences in children with snoring or subtle breathing disturbances not meeting the traditional definition of sleep apnea suggest that "benign, or primary snoring" may be clinically significant, and that the true prevalence of SDB might be underestimated. There is no standard definition of SDB in children. The polysomnographic technology used in many sleep laboratories may be inadequate to diagnose serious but subtle forms of clinically important airflow limitation. In the last several years, advances in digital technology as well as new observational studies of respiratory and arousal patterns in large populations of healthy children have led to alternative views of what constitutes sleep-related breathing and arousal abnormalities that may refine our diagnostic criteria. This article reviews our knowledge of childhood SDB, highlights recent advances in technology, and discusses diagnostic and treatment strategies that will advance the management of children with pediatric SDB.

Learning machines and sleeping brains: Automatic sleep stage classification using decision-tree multi-class support vector machines.

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Lajnef, Tarek; Chaibi, Sahbi; Ruby, Perrine; Aguera, Pierre-Emmanuel; Eichenlaub, Jean-Baptiste; Samet, Mounir; Kachouri, Abdennaceur; Jerbi, Karim

2015-07-30

Sleep staging is a critical step in a range of electrophysiological signal processing pipelines used in clinical routine as well as in sleep research. Although the results currently achievable with automatic sleep staging methods are promising, there is need for improvement, especially given the time-consuming and tedious nature of visual sleep scoring. Here we propose a sleep staging framework that consists of a multi-class support vector machine (SVM) classification based on a decision tree approach. The performance of the method was evaluated using polysomnographic data from 15 subjects (electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) recordings). The decision tree, or dendrogram, was obtained using a hierarchical clustering technique and a wide range of time and frequency-domain features were extracted. Feature selection was carried out using forward sequential selection and classification was evaluated using k-fold cross-validation. The dendrogram-based SVM (DSVM) achieved mean specificity, sensitivity and overall accuracy of 0.92, 0.74 and 0.88 respectively, compared to expert visual scoring. Restricting DSVM classification to data where both experts' scoring was consistent (76.73% of the data) led to a mean specificity, sensitivity and overall accuracy of 0.94, 0.82 and 0.92 respectively. The DSVM framework outperforms classification with more standard multi-class "one-against-all" SVM and linear-discriminant analysis. The promising results of the proposed methodology suggest that it may be a valuable alternative to existing automatic methods and that it could accelerate visual scoring by providing a robust starting hypnogram that can be further fine-tuned by expert inspection. Copyright © 2015 Elsevier B.V. All rights reserved.

Pediatric sleep apnea

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Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... Untreated pediatric sleep apnea may lead to: High blood pressure Heart or lung problems Slow growth and development

[Symptoms of obstructive sleep apnea-hypopnea syndrome in children].

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Gregório, Paloma Baiardi; Athanazio, Rodrigo Abensur; Bitencourt, Almir Galvão Vieira; Neves, Flávia Branco Cerqueira Serra; Terse, Regina; Hora, Francisco

2008-06-01

To investigate the symptoms most frequently found in children with a polysomnographic diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS). We evaluated 38 children consecutively referred to the sleep laboratory with suspicion of OSAHS between June of 2003 and December of 2004. The patients were submitted to a pre-sleep questionnaire and to polysomnography. The mean age was 7.8 +/- 4 years (range, 2-15 years), and 50% of the children were male. Children without apnea accounted for 7.9% of the sample. The obstructive sleep apnea observed in the remainder was mild in 42.1%, moderate in 28.9% and severe in 22.1%. Severe cases of apnea were most common among children under the age of six (pre-school age). In children with OSAHS, the most common symptoms were snoring and nasal obstruction, which were observed in 74.3 and 72.7% of the children, respectively. Excessive sleepiness and bruxism were seen in 29.4 and 34.3%, respectively, and reflux disease was seen in only 3.1%. Restless legs and difficulty in falling asleep were identified in 65 and 33%, respectively. All of the children diagnosed with severe OSAHS also presented snoring and bruxism. Snoring and nasal obstruction were the most common symptoms found in our sample of children and adolescents with OSAHS. In addition, OSAHS severity was associated with being in the lower age bracket.

Effect of repeated gaboxadol administration on night sleep and next-day performance in healthy elderly subjects.

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Mathias, Stefan; Zihl, Josef; Steiger, Axel; Lancel, Marike

2005-04-01

Aging is associated with dramatic reductions in sleep continuity and sleep intensity. Since gaboxadol, a selective GABA(A) receptor agonist, has been demonstrated to improve sleep consolidation and promote deep sleep, it may be an effective hypnotic, particularly for elderly patients with insomnia. In the present study, we investigated the effects of subchronic gaboxadol administration on nocturnal sleep and its residual effects during the next days in elderly subjects. This was a randomized, double-blind, placebo-controlled, balanced crossover study in 10 healthy elderly subjects without sleep complaints. The subjects were administered either placebo or 15 mg gaboxadol hydrochloride at bedtime on three consecutive nights. Sleep was recorded during each night from 2300 to 0700 h and tests assessing attention (target detection, stroop test) and memory function (visual form recognition, immediate word recall, digit span) were applied at 0900, 1400, and 1700 h during the following days. Compared with placebo, gaboxadol significantly shortened subjective sleep onset latency and increased self-rated sleep intensity and quality. Polysomnographic recordings showed that it significantly decreased the number of awakenings, the amount of intermittent wakefulness, and stage 1, and increased slow wave sleep and stage 2. These effects were stable over the three nights. None of the subjects reported side effects. Next-day cognitive performance was not affected by gaboxadol. Gaboxadol persistently improved subjective and objective sleep quality and was devoid of residual effects. Thus, at the employed dose, it seems an effective hypnotic in elderly subjects.

Sleep architecture, insulin resistance and the nasal cycle: Implications for positive airway pressure therapy

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Catherine A.P. Crofts

2018-03-01

Full Text Available Background: The global pandemic of metabolic disease is worsening. The metabolic theory of obesity proposes that hormonal changes, especially hyperinsulinaemia, precede metabolic disease development. Although quality sleep is recognised as a key factor for good health, less is known about disrupted sleep as a risk factor for hyperinsulinaemia.   Aim: To explore the relationship between sleep, especially sleep architecture and the nasal cycle, on insulin secretion in obstructive sleep apnoea (OSA with comorbid metabolic disease. This review includes a discussion of the potential role of Rest-Activity-Cycler positive airway pressure (RACer-PAP, a novel non-pharmacological OSA treatment strategy.   Methods: A narrative review of all the relevant papers known to the authors was conducted. This review also included results from a polysomnographic sleep clinic pilot study (n = 3 comparing sleep efficiency of RACer-PAP to nasal continuous positive airways pressure (n-CPAP in OSA patients.   Results: Metabolic disease is strongly associated with disturbed sleep. Sleep architecture influences cerebral hormonal secretion, lateral shifts in the autonomic nervous system and nasal airflow dominance. Disturbed sleep shortens short-wave sleep periods, decreasing insulin sensitivity and glucose tolerance. Improvements to metabolic function during n-CPAP treatment are inconsistent. If RACer-PAP demonstrates superior effects on sleep architecture and autonomic function, it may offer advantages in OSA patients with comorbid metabolic disease.   Conclusion: Improving sleep architecture by maintaining the nasal cycle proposes a novel non-pharmacological treatment paradigm for treating OSA with comorbid metabolic disease. Research is required to demonstrate if RACer-PAP therapy influences whole night sleep architecture, sympathovagal balance and markers of metabolic disease.

A transition-constrained discrete hidden Markov model for automatic sleep staging

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Pan Shing-Tai

2012-08-01

Full Text Available Abstract Background Approximately one-third of the human lifespan is spent sleeping. To diagnose sleep problems, all-night polysomnographic (PSG recordings including electroencephalograms (EEGs, electrooculograms (EOGs and electromyograms (EMGs, are usually acquired from the patient and scored by a well-trained expert according to Rechtschaffen & Kales (R&K rules. Visual sleep scoring is a time-consuming and subjective process. Therefore, the development of an automatic sleep scoring method is desirable. Method The EEG, EOG and EMG signals from twenty subjects were measured. In addition to selecting sleep characteristics based on the 1968 R&K rules, features utilized in other research were collected. Thirteen features were utilized including temporal and spectrum analyses of the EEG, EOG and EMG signals, and a total of 158 hours of sleep data were recorded. Ten subjects were used to train the Discrete Hidden Markov Model (DHMM, and the remaining ten were tested by the trained DHMM for recognition. Furthermore, the 2-fold cross validation was performed during this experiment. Results Overall agreement between the expert and the results presented is 85.29%. With the exception of S1, the sensitivities of each stage were more than 81%. The most accurate stage was SWS (94.9%, and the least-accurately classified stage was S1 ( Conclusion The results of the experiments demonstrate that the proposed method significantly enhances the recognition rate when compared with prior studies.

Masticatory muscle sleep background electromyographic activity is elevated in myofascial temporomandibular disorder patients.

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Raphael, K G; Janal, M N; Sirois, D A; Dubrovsky, B; Wigren, P E; Klausner, J J; Krieger, A C; Lavigne, G J

2013-12-01

Despite theoretical speculation and strong clinical belief, recent research using laboratory polysomnographic (PSG) recording has provided new evidence that frequency of sleep bruxism (SB) masseter muscle events, including grinding or clenching of the teeth during sleep, is not increased for women with chronic myofascial temporomandibular disorder (TMD). The current case-control study compares a large sample of women suffering from chronic myofascial TMD (n = 124) with a demographically matched control group without TMD (n = 46) on sleep background electromyography (EMG) during a laboratory PSG study. Background EMG activity was measured as EMG root mean square (RMS) from the right masseter muscle after lights out. Sleep background EMG activity was defined as EMG RMS remaining after activity attributable to SB, other orofacial activity, other oromotor activity and movement artefacts were removed. Results indicated that median background EMG during these non-SB event periods was significantly higher (P cases exceeding control activity. Moreover, for TMD cases, background EMG was positively associated and SB event-related EMG was negatively associated with pain intensity ratings (0-10 numerical scale) on post-sleep waking. These data provide the foundation for a new focus on small, but persistent, elevations in sleep EMG activity over the course of the night as a mechanism of pain induction or maintenance. © 2013 John Wiley & Sons Ltd.

Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences.

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Huang, Yu-Shu; Guilleminault, Christian

2012-01-01

Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children. Review of experimental data from infant monkeys with experimentally induced nasal resistance. Review of early historical data in the orthodontic literature indicating the abnormal oral-facial development associated with mouth breathing and nasal resistance. Review of the progressive demonstration of sleep-disordered-breathing (SDB) in children who underwent incomplete treatment of OSA with adenotonsillectomy, and demonstration of abnormal oral-facial anatomy that must often be treated in order for the resolution of OSA. Review of data of long-term recurrence of OSA and indication of oral-facial myofunctional dysfunction in association with the recurrence of OSA. Presentation of prospective data on premature infants and SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB. Role of myofunctional reeducation with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children. Pediatric OSA in non-obese children is a disorder of oral-facial growth.

Comparison of rhythmic masticatory muscle activity during non-rapid eye movement sleep in guinea pigs and humans.

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Kato, Takafumi; Toyota, Risa; Haraki, Shingo; Yano, Hiroyuki; Higashiyama, Makoto; Ueno, Yoshio; Yano, Hiroshi; Sato, Fumihiko; Yatani, Hirofumi; Yoshida, Atsushi

2017-09-27

Rhythmic masticatory muscle activity can be a normal variant of oromotor activity, which can be exaggerated in patients with sleep bruxism. However, few studies have tested the possibility in naturally sleeping animals to study the neurophysiological mechanisms of rhythmic masticatory muscle activity. This study aimed to investigate the similarity of cortical, cardiac and electromyographic manifestations of rhythmic masticatory muscle activity occurring during non-rapid eye movement sleep between guinea pigs and human subjects. Polysomnographic recordings were made in 30 freely moving guinea pigs and in eight healthy human subjects. Burst cycle length, duration and activity of rhythmic masticatory muscle activity were compared with those for chewing. The time between R-waves in the electrocardiogram (RR interval) and electroencephalogram power spectrum were calculated to assess time-course changes in cardiac and cortical activities in relation to rhythmic masticatory muscle activity. In animals, in comparison with chewing, rhythmic masticatory muscle activity had a lower burst activity, longer burst duration and longer cycle length (P motor activation in comparison to human subjects. © 2017 European Sleep Research Society.

Measurement of endogenous acetone and isoprene in exhaled breath during sleep

International Nuclear Information System (INIS)

King, Julian; Kupferthaler, Alexander; Unterkofler, Karl; Amann, Anton; Frauscher, Birgit; Hackner, Heinz; Högl, Birgit; Teschl, Gerald; Hinterhuber, Hartmann

2012-01-01

This explorative study aims at characterizing the breath behavior of two prototypic volatile organic compounds, acetone and isoprene, during normal human sleep and to possibly relate changes in the respective concentration time courses to the underlying sleep architecture. For this purpose, six normal healthy volunteers (two females, four males, age 20–29 years) were monitored over two consecutive nights (the first one being an adaption night) by combining real-time proton-transfer-reaction mass spectrometry measurements from end-tidal exhalation segments with laboratory-based polysomnographic data. Breath acetone concentrations increased overnight in all measurements, with an average relative change by a factor of up to 4 (median 2.5). Nighttime concentration maxima were usually recorded 2–3 h before lights on. For breath isoprene, a nocturnal increase in baseline concentrations of about 74% was observed, with individual changes ranging from 36–110%. Isoprene profiles exhibited pronounced concentration peaks, which were highly specific for leg movements as scored by tibial electromyography. Furthermore, relative to a linear trend, baseline isoprene concentrations decreased during the transition from the NREM to the REM phase of a complete sleep cycle. (paper)

Diaphragm pacing improves sleep in patients with amyotrophic lateral sclerosis.

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Gonzalez-Bermejo, Jesus; Morélot-Panzini, Capucine; Salachas, François; Redolfi, Stefania; Straus, Christian; Becquemin, Marie-Hélène; Arnulf, Isabelle; Pradat, Pierre-François; Bruneteau, Gaëlle; Ignagni, Anthony R; Diop, Moustapha; Onders, Raymond; Nelson, Teresa; Menegaux, Fabrice; Meininger, Vincent; Similowski, Thomas

2012-01-01

In amyotrophic lateral sclerosis (ALS) patients, respiratory insufficiency is a major burden. Diaphragm conditioning by electrical stimulation could interfere with lung function decline by promoting the development of type 1 muscle fibres. We describe an ancillary study to a prospective, non-randomized trial (NCT00420719) assessing the effects of diaphragm pacing on forced vital capacity (FVC). Sleep-related disturbances being early clues to diaphragmatic dysfunction, we postulated that they would provide a sensitive marker. Stimulators were implanted laparoscopically in the diaphragm close to the phrenic motor point in 18 ALS patients for daily conditioning. ALS functioning score (ALSFRS), FVC, sniff nasal inspiratory pressure (SNIP), and polysomnographic recordings (PSG, performed with the stimulator turned off) were assessed before implantation and after four months of conditioning (n = 14). Sleep efficiency improved (69 ± 15% to 75 ± 11%, p = 0.0394) with fewer arousals and micro-arousals. This occurred against a background of deterioration as ALSFRS-R, FVC, and SNIP declined. There was, however, no change in NIV status or the ALSFRS respiratory subscore, and the FVC decline was mostly due to impaired expiration. Supporting a better diaphragm function, apnoeas and hypopnoeas during REM sleep decreased. In conclusion, in these severe patients not expected to experience spontaneous improvements, diaphragm conditioning improved sleep and there were hints at diaphragm function changes.

Prader-Willi syndrome, excessive daytime sleepiness, and narcoleptic symptoms: a case report.

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Weselake, Sara V; Foulds, Jessica L; Couch, Robert; Witmans, Manisha B; Rubin, Daniela; Haqq, Andrea M

2014-04-17

Sleep abnormalities, including narcolepsy and cataplexy, are a common feature of Prader-Willi syndrome. Long-term treatment with the central nervous system stimulant modafinil has not been reported. In this case report we present a longitudinal perspective of sleep abnormalities in a nine-year-old Caucasian girl with Prader-Willi syndrome from age two to age nine, and detail the response to treatment with the central nervous system stimulant modafinil. Our patient presented at two years of age with hypersomnia and narcoleptic episodes with cataplectic features. Initial polysomnograph testing revealed adequate sleep efficiency, but increased sleep fragmentation especially during rapid eye movement sleep. The narcoleptic episodes continued and a repeat polysomnograph at age five years confirmed features consistent with narcolepsy. Further sleep studies at six years, including a multiple sleep latency test, demonstrated signs of excessive daytime sleepiness. Treatment with modafinil was initiated at age seven years six months due to persistent hypersomnia and narcoleptic symptoms. Two polysomnograph studies were performed following treatment with modafinil, at age eight years six months and nine years three months. These studies showed excellent sleep efficiency and improvement of rapid eye movement sleep parameters, supporting the beneficial effects of long-term modafinil therapy. Long-term modafinil therapy may ameliorate the sleep disturbances of Prader-Willi syndrome and should be the focus of future clinical trials.

Reading from an iPad or from a book in bed: the impact on human sleep. A randomized controlled crossover trial.

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Grønli, Janne; Byrkjedal, Ida Kristiansen; Bjorvatn, Bjørn; Nødtvedt, Øystein; Hamre, Børge; Pallesen, Ståle

2016-05-01

To objectively and subjectively compare whether reading a story for 30 min from an iPad or from a book in bed prior to sleep will differentially affect sleep. Sixteen students (12 females, mean age 25.1 ± 2.9 years) underwent ambulatory (sleeping in their own beds at home) polysomnographic (PSG) recordings in a counterbalanced crossover design consisting of three PSG nights (one adaptation night, two test nights) and two different reading materials: read from an iPad or from a book. Illumination was measured during reading and Karolinska Sleepiness Scale was completed prior to turning the light off. Sleep diaries were kept to assess subjective sleep parameters from day to day. Illumination was higher in the iPad condition compared to the book condition (58.3 ± 6.9 vs 26.7 ± 8.0 lux, p book. No parameters of sleep state timing and sleep onset latency differed between the two reading conditions. Although there was no direct effect on time spent in different sleep states and self-reported sleep onset latency, the use of an iPad which emits blue enriched light impinges acutely on sleepiness and EEG characteristics of sleep pressure. Hence, the use of commercially available tablets may have consequences in terms of alertness, circadian physiology, and sleep. Published by Elsevier B.V.

Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients.

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Al-Samsam, Rim H; Cullen, Pauline

2005-09-01

To document the quantity and architecture of sleep using objective electrophysiologic assessment in sedated mechanically ventilated pediatric intensive care unit patients over a 24-hr period and to investigate the effect of noise and staff interventions on sleep pattern in these subjects. Prospective observational study. Pediatric intensive care unit at a university hospital. A total of 11 patients studied between September 2000 and June 2001, with ages ranging from 3 to 21 months. All patients were intubated, mechanically ventilated, and sedated with morphine and midazolam infusions. Limited sleep polysomnograph, staff interventions, and noise levels were continuously monitored during a 24-hr period. Noise levels were consistently >48 dB(A); the highest night peak reached 103 dB(A). Staff interventions lasted for a mean of 240 (SD 90) mins in a 24-hr period. There was no significant difference in the number of interventions between day and night. Severe alterations to sleep architecture were found throughout the 24 hrs, with no diurnal variations. Active sleep was severely reduced to a mean of 3% (SD 4%; range, 0-11%) of total sleep time. There was severe sleep fragmentation as reflected by the high number (mean, 40 [SD 20]) of wake episodes. The above findings suggest a significant electrophysiologic abnormality of sleep in the pediatric intensive care unit patients. Our pediatric intensive care unit environment is characterized by both, high noise levels and frequent staff interventions. This study has several limitations and future studies are needed, with larger sample size and an attempt to manipulate the environmental factors to minimize their negative effects on sleep.

Bruxism in children: effect on sleep architecture and daytime cognitive performance and behavior.

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Herrera, Marcela; Valencia, Ignacio; Grant, Mitzie; Metroka, David; Chialastri, Augustine; Kothare, Sanjeev V

2006-09-01

Sleep bruxism is an involuntary mandibular movement with tooth grinding during sleep. The prevalence of sleep bruxism in children is high and may lead to frequent arousals with altered daytime functioning. We investigated the sleep architecture, the incidence of gastroesophageal reflux, and the daytime cognitive behavioral functioning in a group of children with sleep bruxism. DESIGN-PATIENTS: This prospective pilot study included 10 children. Polysomnographic data with pH-probe analysis was compared with 10 age- and sex-matched controls. Each patient completed a dental evaluation, a nighttime polysomnogram, and cognitive behavioral tests (Kaufman Brief Intelligence Test and Achenbach Child Behavior Checklist). Eight of 10 children had clinically significant bruxism and the 2 remaining patients had recent teeth exfoliation. There was no difference on sleep architecture between patients and controls, except for a higher arousal index for the bruxism group (36.7 vs 20.7, p Sleep bruxism occurred more frequently in stage 2 and rapid eye movement sleep, with arousals in 66% of the cases. There was no relationship of bruxism to gastroesophageal reflux or intelligence. However, 40% of the patients had elevated scores on the Achenbach Child Behavior Checklist, indicating significant attention and behavior problems, and there were moderate correlations between the arousal index and several of the behavior-problem scales from the Achenbach Child Behavior Checklist (0.5 to 0.6). The data suggest that children with bruxism have a higher arousal index, which may be associated with an increased incidence of attention-behavior problems. Future studies investigating pediatric sleep bruxism will need to focus on behavior issues that may be prevalent in this population.

Sleep Characteristics in Children with Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analyses.

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Díaz-Román, Amparo; Hita-Yáñez, Eva; Buela-Casal, Gualberto

2016-05-15

Sleep disturbances have been associated with attention deficit hyperactivity disorder (ADHD), but such relationship is still unclear. The results from the studies conducted do not provide enough evidence to support a sleep physiology inherent to ADHD. This study tries to determine if that sleep physiology really exists by comparing children with ADHD and control children in some sleep parameters. A search was conducted in several databases (Web of Science, Scopus, Pubmed and PsycINFO), and a manual search, to retrieve all the articles available from 1987 until March 2014. Of 8,678 non-duplicate studies retrieved, 11 studies met the inclusion and methodological quality criteria. Two meta-analyses were performed with eight of those studies, depending on data provided by them: polysomnographic or actigraphic. A fixed-effects model, and the standardized mean difference (SMD) as the index of effect size, were used in both meta-analyses. Significant differences were found only in the meta-analysis with polysomnography as outcome. Children with ADHD were found to spend more time in stage 1 sleep than controls (pooled SMD = 0.32, 95% CI = 0.08-0.55, p value = 0.009). Although few differences in sleep between children with ADHD and controls have been found in this review, further studies are required on this matter. Those studies should consider some variables discussed in this review, in order to obtain useful and reliable conclusions for research and clinical practice. Particularly, the influence of assessment criteria and ADHD subtypes in the sleep characteristics of children with ADHD should be addressed. © 2016 American Academy of Sleep Medicine.

Relationship of slow and rapid EEG components of CAP to ASDA arousals in normal sleep.

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Parrino, L; Smerieri, A; Rossi, M; Terzano, M G

2001-12-15

Besides arousals (according to the ASDA definition), sleep contains also K-complexes and delta bursts which, in spite of their sleep-like features, are endowed with activating effects on autonomic functions. The link between phasic delta activities and enhancement of vegetative functions indicates the possibility of physiological activation without sleep disruption (i.e., arousal without awakening). A functional connection seems to include slow (K-complexes and delta bursts) and rapid (arousals) EEG events within the comprehensive term of activating complexes. CAP (cyclic alternating pattern) is the spontaneous EEG rhythm that ties both slow and rapid activating complexes together during NREM sleep. The present study aims at exploring the relationship between arousals and CAP components in a selected sample of healthy sleepers. Polysomnographic analysis according to the scoring rules for sleep stages and arousals. CAP analysis included also tabulation of subtypes A1 (slow EEG activating complexes), A2 and A3 (activating complexes with fast EEG components). 40 sleep-lab accomplished recordings. Healthy subjects belonging to a wide age range (38 +/- 20 yrs.). N/A. Of all the arousals occurring in NREM sleep, 87% were inserted within CAP. Subtypes A2 and A3 of CAP corresponded strikingly with arousals (r=0.843; p<0.0001), while no statistical relationship emerged when arousals were matched with subtypes A1 of CAP. Subtypes A1 instead correlated positively with the percentages of deep sleep (r=0.366; p<0.02). The CAP subtype classification encompasses both the process of sleep maintenance (subtypes A1) and sleep fragmentation (subtypes A2 and A3), and provides a periodicity dimension to the activating events of NREM sleep.

Work stressors, sleep quality, and alcohol-related problems across deployment: A parallel process latent growth modeling approach among Navy members.

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Bravo, Adrian J; Kelley, Michelle L; Hollis, Brittany F

2017-10-01

This study examined how work stressors were associated with sleep quality and alcohol-related problems among U.S. Navy members over the course of deployment. Participants were 101 U.S. Navy members assigned to an Arleigh Burke-class destroyer who experienced an 8-month deployment after Operational Enduring Freedom/Operation Iraqi Freedom. Approximately 6 weeks prior to deployment, 6 weeks after deployment, and 6 months reintegration, participants completed measures that assessed work stressors, sleep quality, and alcohol-related problems. A piecewise latent growth model was conducted in which the structural paths assessed if work stressors influenced sleep quality or its growth over time, and in turn if sleep quality influenced alcohol-related problems intercepts or growth over time. A significant indirect effect was found such that increases in work stressors from pre- to postdeployment predicted decreases in sleep quality, which in turn were associated with increases in alcohol-related problems from pre- to postdeployment. These effects were maintained from postdeployment through the 6-month reintegration. Findings suggest that work stressors may have important implications for sleep quality and alcohol-related problems. Positive methods of addressing stress and techniques to improve sleep quality are needed as both may be associated with alcohol-related problems among current Navy members. Copyright © 2016 John Wiley & Sons, Ltd.

Improvement of mood and sleep alterations in posttraumatic stress disorder patients by eye movement desensitization and reprocessing

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Mara Regina Raboni

2014-06-01

Full Text Available Posttraumatic stress disorder (PTSD patients exhibit depressive and anxiety symptoms, in addition to nightmares, which interfere with sleep continuity. Pharmacologic treatment of these sleep problems improves PTSD symptoms, but very few studies have used psychotherapeutic interventions to treat PTSD and examined their effects on sleep quality. Therefore, in the present study, we sought to investigate the effects of Eye Movement Desensitization Reprocessing therapy on indices of mood, anxiety, subjective and objective sleep. The sample was composed of 11 healthy controls and 13 PTSD patients that were victims of assault and/or kidnapping. All participants were assessed before, and one day after, the end of treatment for depressive and anxiety profile, general well-being and subjective sleep by filling out specific questionnaires. In addition, objective sleep patterns were evaluated by polysomnographic recording. Healthy volunteers were submitted to the therapy for three weekly sessions, whereas PTSD patients underwent five sessions, on average. Before treatment, PTSD patients exhibited high levels of anxiety and depression, poor quality of life and poor sleep, assessed both subjectively and objectively; the latter was reflected by increased time of waking after sleep onset. After completion of treatment, patients exhibited improvement in depression and anxiety symptoms, and in quality of life; with indices that were no longer different from control volunteers. Moreover, these patients showed more consolidated sleep, with reduction of time spent awake after sleep onset. In conclusion, Eye Movement Desensitization and Reprocessing was an effective treatment of PTSD patients and improved the associated sleep and psychological symptoms.

The Correlation between Clinical Variables and Sleep Onset Rapid Eye Movement Period Frequencies in Narcoleptic Patients

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Jin Hwa Jeong

2010-11-01

Full Text Available Background and Objective A diagnosis of narcolepsy is defined by less than 8 minutes of mean sleep latency, and two or more sleep onset rapid eye movement periods on the Multiple Sleep Latency Test. This study examined the relationship between the sleep onset rapid eye movement period frequencies during Multiple Sleep Latency Test and narcoleptic symptom severity. Methods From March 2004 to August 2009, 126 patients suffering from excessive daytime sleepiness who visited the Sleep Disorders Clinic of St. Vincent’s Hospital at the Catholic University of Korea were tested by polysomnography and Multiple Sleep Latency Test. Subjects were divided into three groups according to the number of sleep onset rapid eye movement periods that appeared on the Multiple Sleep Latency Test. Symptom severity instruments included the Epworth Sleepiness Scale and the Stanford Center for Narcolepsy Sleep Inventory, and various sleep parameters. In addition, we performed human leukocyte antigen genotyping for human leukocyte antigen-DQB1*0602 on all patients. Results Among the three groups classified by the number of sleep onset rapid eye movement periods during Multiple Sleep Latency Test, we found no significant differences in demographic features, Epworth Sleepiness Scale, and most polysomnographic findings. However, we observed cataplexy, hypnagogic hallucination, sleep paralysis, and human leukocyte antigen-DQB1*0602 positivity more frequently in groups with higher sleep onset rapid eye movement period frequencies. In addition, the proportions of stage II sleep, REM sleep latency from polysomnography, and mean sleep latency and mean REM sleep latency from the Multiple Sleep Latency Test significantly decreased with increasing sleep onset rapid eye movement period frequency. Conclusions In this study, we demonstrated that sleep onset rapid eye movement period frequency during Multiple Sleep Latency Test correlated with sleep architecture, daytime symptom

Classification of iRBD and Parkinson's disease patients based on eye movements during sleep.

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Christensen, Julie A E; Koch, Henriette; Frandsen, Rune; Kempfner, Jacob; Arvastson, Lars; Christensen, Soren R; Sorensen, Helge B D; Jennum, Poul

2013-01-01

Patients suffering from the sleep disorder idiopathic rapid-eye-movement sleep behavior disorder (iRBD) have been observed to be in high risk of developing Parkinson's disease (PD). This makes it essential to analyze them in the search for PD biomarkers. This study aims at classifying patients suffering from iRBD or PD based on features reflecting eye movements (EMs) during sleep. A Latent Dirichlet Allocation (LDA) topic model was developed based on features extracted from two electrooculographic (EOG) signals measured as parts in full night polysomnographic (PSG) recordings from ten control subjects. The trained model was tested on ten other control subjects, ten iRBD patients and ten PD patients, obtaining a EM topic mixture diagram for each subject in the test dataset. Three features were extracted from the topic mixture diagrams, reflecting "certainty", "fragmentation" and "stability" in the timely distribution of the EM topics. Using a Naive Bayes (NB) classifier and the features "certainty" and "stability" yielded the best classification result and the subjects were classified with a sensitivity of 95 %, a specificity of 80% and an accuracy of 90 %. This study demonstrates in a data-driven approach, that iRBD and PD patients may exhibit abnorm form and/or timely distribution of EMs during sleep.

Montreal Archive of Sleep Studies: an open-access resource for instrument benchmarking and exploratory research.

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O'Reilly, Christian; Gosselin, Nadia; Carrier, Julie; Nielsen, Tore

2014-12-01

Manual processing of sleep recordings is extremely time-consuming. Efforts to automate this process have shown promising results, but automatic systems are generally evaluated on private databases, not allowing accurate cross-validation with other systems. In lacking a common benchmark, the relative performances of different systems are not compared easily and advances are compromised. To address this fundamental methodological impediment to sleep study, we propose an open-access database of polysomnographic biosignals. To build this database, whole-night recordings from 200 participants [97 males (aged 42.9 ± 19.8 years) and 103 females (aged 38.3 ± 18.9 years); age range: 18-76 years] were pooled from eight different research protocols performed in three different hospital-based sleep laboratories. All recordings feature a sampling frequency of 256 Hz and an electroencephalography (EEG) montage of 4-20 channels plus standard electro-oculography (EOG), electromyography (EMG), electrocardiography (ECG) and respiratory signals. Access to the database can be obtained through the Montreal Archive of Sleep Studies (MASS) website (http://www.ceams-carsm.ca/en/MASS), and requires only affiliation with a research institution and prior approval by the applicant's local ethical review board. Providing the research community with access to this free and open sleep database is expected to facilitate the development and cross-validation of sleep analysis automation systems. It is also expected that such a shared resource will be a catalyst for cross-centre collaborations on difficult topics such as improving inter-rater agreement on sleep stage scoring. © 2014 European Sleep Research Society.

Insomnia and incident depression: role of objective sleep duration and natural history.

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Fernandez-Mendoza, Julio; Shea, Sarah; Vgontzas, Alexandros N; Calhoun, Susan L; Liao, Duanping; Bixler, Edward O

2015-08-01

Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was to examine the predictive role of the severity of insomnia for incident depression in a general population sample using psychometric and polysomnographic data. From a random, general population sample of 1741 individuals of the Penn State Adult Cohort, 1137 adults without depression were followed up with a structured telephone interview after 7.5 years. All subjects completed a full medical evaluation, 1-night polysomnogram and Multiphasic Minnesota Personality Inventory at baseline. The incidence of depression was 15%. Poor sleep (odds ratio = 1.5, P = 0.001) and insomnia (odds ratio = 1.9, P = 0.031) were significantly associated with incident depression. The odds of incident depression were highest (odds ratio = 2.2, P = 0.019) in insomnia with objective short sleep duration and independent of Multiphasic Minnesota Personality Inventory Ego Strength scores, an index of poor coping resources. The persistence of insomnia and worsening of poor sleep into insomnia significantly increased the odds of incident depression (odds ratios ranged from 1.8 to 6.3), whereas their full remission did not (odds ratio ranged from 1.2 to 1.8). Insomnia with short sleep duration is associated with incident depression independent of poor coping resources, whereas the association of insomnia with normal sleep duration with incident depression was mediated by poor coping resources. Persistence and worsening of poor sleep or insomnia, but not their full remission, are significant predictors of incident depression. These data suggest that there is a significant relationship between the severity of insomnia and incident depression. © 2015 European Sleep Research Society.

Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep.

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Van Herzeele, Charlotte; Dhondt, Karlien; Roels, Sanne P; Raes, Ann; Hoebeke, Piet; Groen, Luitzen-Albert; Vande Walle, Johan

2016-09-01

There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. The aim of this study was to investigate whether a decrease in nocturnal diuresis volume not only improves enuresis but also ameliorates disrupted sleep and (neuro)psychological dysfunction, the major comorbidities of this disorder. In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis (MNE) underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and 6 months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void. Thirty children aged between 6 and 16 (mean 10.43, standard deviation 3.08) years completed the study. The results demonstrated a significant decrease in periodic limb movements during sleep (PLMS) and a prolonged first undisturbed sleep period. Additionally, (neuro)psychological functioning was improved on several domains. The study demonstrates that the degree of comorbidity symptoms is at least aggravated by enuresis (and/or high nocturnal diuresis rate) since sleep and (neuro)psychological functioning were significantly ameliorated by treatment of enuresis. These results indicate that enuresis is not such a benign condition as has previously been assumed.

The relationship between brain morphology and polysomnography in healthy good sleepers.

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Matthias A Reinhard

Full Text Available Normal sleep continuity and architecture show remarkable inter-individual variability. Previous studies suggest that brain morphology may explain inter-individual differences in sleep variables.Thirty-eight healthy subjects spent two consecutive nights at the sleep laboratory with polysomnographic monitoring. Furthermore, high-resolution T1-weighted MRI datasets were acquired in all participants. EEG sleep recordings were analyzed using standard sleep staging criteria and power spectral analysis. Using the FreeSurfer software for automated segmentation, 174 variables were determined representing the volume and thickness of cortical segments and the volume of subcortical brain areas. Regression analyses were performed to examine the relationship with polysomnographic and spectral EEG power variables.The analysis did not provide any support for the a-priori formulated hypotheses of an association between brain morphology and polysomnographic variables. Exploratory analyses revealed that the thickness of the left caudal anterior cingulate cortex was positively associated with EEG beta2 power (24-32 Hz during REM sleep. The volume of the left postcentral gyrus was positively associated with periodic leg movements during sleep (PLMS.The function of the anterior cingulate cortex as well as EEG beta power during REM sleep have been related to dreaming and sleep-related memory consolidation, which may explain the observed correlation. Increased volumes of the postcentral gyrus may be the result of increased sensory input associated with PLMS. However, due to the exploratory nature of the corresponding analyses, these results have to be replicated before drawing firm conclusions.

Correlations of sleep disorders with severity of obstructive airway disease in mustard gas-injured patients.

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Vahedi, Ensieh; Taheri, Saeed; Alaedini, Farshid; Poursaleh, Zohreh; Ameli, Javad; Ghanei, Mostafa

2012-06-01

Mustard gas has serious adverse effects on several organs and functions in humans. In this study, we analyzed potential correlations between obstructive airway disease and sleep disorders in Iranian mustard gas-injured patients. We enrolled 30 male mustard gas-injured veterans and civilians from the Chemical Warfare Exposure Clinic at Baqiyatallah Hospital, Tehran. All the subjects underwent comprehensive polysomnographic and spirometric evaluations for diagnosis of sleep disorders. Patients were categorized into three groups according to the severity of their obstructive airway disease based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria: group 1 (GOLD I and II), group 2 (GOLD III), and group 3 (GOLD IV). Patients with less severe obstructive airway disease had significantly higher rate of hypopnea (p = 0.05) and AHI (p = 0.05). The number of REM events was significantly higher in patients with less severe airway disease (p = 0.028). Stage 1 sleep among patients with higher FEV1 significantly constituted a higher proportion of sleep, and stage 4 sleep was significantly longer in patients with higher DLCO (p = 0.043, both). We found that sleep parameters in SM-exposed patients have some relations with spirometric parameters. Future studies with large patient populations are needed for confirmation of our results, and therapeutic interventions are needed to evaluate endeavors we can do to enhance health and quality of life in our mustard gas-injured population.

Observations on sleep-disordered breathing in idiopathic Parkinson's disease.

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Philipp O Valko

Full Text Available BACKGROUND: This study has two main goals: 1. to determine the potential influence of dopaminergic drugs on sleep-disordered breathing (SDB in Parkinson's disease (PD and 2. to elucidate whether NREM and REM sleep differentially impact SDB severity in PD. METHODS: Retrospective clinical and polysomnographic study of 119 consecutive PD patients and comparison with age-, sex- and apnea-hypopnea-index-matched controls. RESULTS: SDB was diagnosed in 57 PD patients (48%. Apnea-hypopnea index was significantly higher in PD patients with central SDB predominance (n = 7; 39.3±16.7/h than obstructive SDB predominance (n = 50; 20.9±16.8/h; p = 0.003. All PD patients with central SDB predominance appeared to be treated with both levodopa and dopamine agonists, whereas only 56% of those with obstructive SDB predominance were on this combined treatment (p = 0.03. In the whole PD group with SDB (n = 57, we observed a significant decrease of apnea-hypopnea index from NREM to REM sleep (p = 0.02, while controls revealed the opposite tendency. However, only the PD subgroup with SDB and treatment with dopamine agonists showed this phenomenon, while those without dopamine agonists had a similar NREM/REM pattern as controls. CONCLUSIONS: Our findings suggest an ambiguous impact of dopamine agonists on SDB. Medication with dopamine agonists seems to enhance the risk of central SDB predominance. Loss of normal muscle atonia may be responsible for decreased SDB severity during REM sleep in PD patients with dopamine agonists.

Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients,

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Marcos Marques Rodrigues

Full Text Available Abstract Introduction Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea or partial (hypopnea reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. Objective To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. Methods A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females. The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. Results The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: −0.415 (p = 0.025, 0.186 (p = 0.334 and −0329 (p = 0.089. The Spearman's rank controlled by the Body Mass Index, the age and the gender was: −0.206 (p = 0.304, −0.155 (p = 0.439 and 0.242 (p = 0.284. Conclusion There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors.

Volumetric evaluation of pharyngeal segments in obstructive sleep apnea patients.

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Rodrigues, Marcos Marques; Pereira Filho, Valfrido Antonio; Gabrielli, Mário Francisco Real; Oliveira, Talles Fernando Medeiros de; Batatinha, Júlio Américo Pereira; Passeri, Luis Augusto

2017-01-30

Obstructive sleep apnea occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea) reduction of the airflow and has intimate relation with changes in the upper airway. Cone Beam CT allows the analysis of the upper airway and its volume by three-dimensional reconstruction. To evaluate a possible correlation between the volume of the upper airway and the severity of the obstructive sleep apnea. A retrospective study was performed reviewing polysomnographic data and Cone Beam CT records of 29 patients (13 males and 16 females). The correlation between the volume of the nasopharynx, the oropharynx and the total superior pharynx with the AHI was assessed by Pearson's rank correlation coefficient. The obstructive sleep apnea severity division was: ten patients had severe, 7 had moderate, 6 had mild and 6 of them were healthy. The correlation between the nasopharynx, the oropharynx and the total superior pharynx volumes and the Apnea-Hypopnea-Index was respectively: -0.415 (p=0.025), 0.186 (p=0.334) and -0329 (p=0.089). The Spearman's rank controlled by the Body Mass Index, the age and the gender was: -0.206 (p=0.304), -0.155 (p=0.439) and 0.242 (p=0.284). There is no correlation between the volume of the airway and the obstructive sleep apnea, assessed by Apnea-Hypopnea-Index and controlled by the Body Mass Index, the age and the gender. The volume of the upper airways as an isolated parameter did not correlate to the severity of the obstructive sleep apnea syndrome, and should be evaluated together with other factors. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Sleep fragmentation and periodic limb movements in children with monosymptomatic nocturnal enuresis and polyuria.

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Dhondt, Karlien; Van Herzeele, Charlotte; Roels, Sanne Patrick; Raes, Ann; Groen, Luitzen-Albert; Hoebeke, Piet; Walle, Johan Vande

2015-07-01

Children with nocturnal enuresis (NE) have been found to have sleep fragmentation and a high incidence of periodic limb movements in sleep (PLMS). This study explored the association of monosymptomatic NE and polyuria in relation to fluid intake, bladder volume, number of wet nights, and number of nights with polyuria to the frequency of PLMS and cortical arousals during sleep. Thirty children with monosymptomatic NE and polyuria were enrolled in the study. Enuretic parameters were determined by diaries, forced drinking, uroflow, and ultrasound examination. All subjects participated in one polysomnographic study. The number of cortical arousals and PLMS were compared with those recorded in a former pilot study which included only children with refractory NE. Of the 30 children who participated in the study, the mean age was 10.43 ± 3.08 (range 6-16) years, and 23 were boys. The PLMS index was positively associated with the arousal index and the awakening index (p polyuria, without a significant association with the enuretic parameters. These observations suggest the presence of a comorbid mechanism driven by a common, independent pacemaker. We hypothesize the autonomic system, its sympathetic branch, and the dopaminergic system as candidates for this pacemaker.

Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification.

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Cavusoglu, M; Ciloglu, T; Serinagaoglu, Y; Kamasak, M; Erogul, O; Akcam, T

2008-08-01

In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification

International Nuclear Information System (INIS)

Cavusoglu, M; Ciloglu, T; Serinagaoglu, Y; Kamasak, M; Erogul, O; Akcam, T

2008-01-01

In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

Feature ranking and rank aggregation for automatic sleep stage classification: a comparative study.

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Najdi, Shirin; Gharbali, Ali Abdollahi; Fonseca, José Manuel

2017-08-18

Nowadays, sleep quality is one of the most important measures of healthy life, especially considering the huge number of sleep-related disorders. Identifying sleep stages using polysomnographic (PSG) signals is the traditional way of assessing sleep quality. However, the manual process of sleep stage classification is time-consuming, subjective and costly. Therefore, in order to improve the accuracy and efficiency of the sleep stage classification, researchers have been trying to develop automatic classification algorithms. Automatic sleep stage classification mainly consists of three steps: pre-processing, feature extraction and classification. Since classification accuracy is deeply affected by the extracted features, a poor feature vector will adversely affect the classifier and eventually lead to low classification accuracy. Therefore, special attention should be given to the feature extraction and selection process. In this paper the performance of seven feature selection methods, as well as two feature rank aggregation methods, were compared. Pz-Oz EEG, horizontal EOG and submental chin EMG recordings of 22 healthy males and females were used. A comprehensive feature set including 49 features was extracted from these recordings. The extracted features are among the most common and effective features used in sleep stage classification from temporal, spectral, entropy-based and nonlinear categories. The feature selection methods were evaluated and compared using three criteria: classification accuracy, stability, and similarity. Simulation results show that MRMR-MID achieves the highest classification performance while Fisher method provides the most stable ranking. In our simulations, the performance of the aggregation methods was in the average level, although they are known to generate more stable results and better accuracy. The Borda and RRA rank aggregation methods could not outperform significantly the conventional feature ranking methods. Among

The role of sleep spindles and slow-wave activity in integrating new information in semantic memory.

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Tamminen, Jakke; Lambon Ralph, Matthew A; Lewis, Penelope A

2013-09-25

Assimilating new information into existing knowledge is a fundamental part of consolidating new memories and allowing them to guide behavior optimally and is vital for conceptual knowledge (semantic memory), which is accrued over many years. Sleep is important for memory consolidation, but its impact upon assimilation of new information into existing semantic knowledge has received minimal examination. Here, we examined the integration process by training human participants on novel words with meanings that fell into densely or sparsely populated areas of semantic memory in two separate sessions. Overnight sleep was polysomnographically monitored after each training session and recall was tested immediately after training, after a night of sleep, and 1 week later. Results showed that participants learned equal numbers of both word types, thus equating amount and difficulty of learning across the conditions. Measures of word recognition speed showed a disadvantage for novel words in dense semantic neighborhoods, presumably due to interference from many semantically related concepts, suggesting that the novel words had been successfully integrated into semantic memory. Most critically, semantic neighborhood density influenced sleep architecture, with participants exhibiting more sleep spindles and slow-wave activity after learning the sparse compared with the dense neighborhood words. These findings provide the first evidence that spindles and slow-wave activity mediate integration of new information into existing semantic networks.

Data-driven modeling of sleep EEG and EOG reveals characteristics indicative of pre-Parkinson's and Parkinson's disease.

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Christensen, Julie A E; Zoetmulder, Marielle; Koch, Henriette; Frandsen, Rune; Arvastson, Lars; Christensen, Søren R; Jennum, Poul; Sorensen, Helge B D

2014-09-30

Manual scoring of sleep relies on identifying certain characteristics in polysomnograph (PSG) signals. However, these characteristics are disrupted in patients with neurodegenerative diseases. This study evaluates sleep using a topic modeling and unsupervised learning approach to identify sleep topics directly from electroencephalography (EEG) and electrooculography (EOG). PSG data from control subjects were used to develop an EOG and an EEG topic model. The models were applied to PSG data from 23 control subjects, 25 patients with periodic leg movements (PLMs), 31 patients with idiopathic REM sleep behavior disorder (iRBD) and 36 patients with Parkinson's disease (PD). The data were divided into training and validation datasets and features reflecting EEG and EOG characteristics based on topics were computed. The most discriminative feature subset for separating iRBD/PD and PLM/controls was estimated using a Lasso-regularized regression model. The features with highest discriminability were the number and stability of EEG topics linked to REM and N3, respectively. Validation of the model indicated a sensitivity of 91.4% and a specificity of 68.8% when classifying iRBD/PD patients. The topics showed visual accordance with the manually scored sleep stages, and the features revealed sleep characteristics containing information indicative of neurodegeneration. This study suggests that the amount of N3 and the ability to maintain NREM and REM sleep have potential as early PD biomarkers. Data-driven analysis of sleep may contribute to the evaluation of neurodegenerative patients. Copyright © 2014 Elsevier B.V. All rights reserved.

Obstructive Sleep-Disordered Breathing Is More Common than Central in Mild Familial Dysautonomia

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Hilz, Max J.; Moeller, Sebastian; Buechner, Susanne; Czarkowska, Hanna; Ayappa, Indu; Axelrod, Felicia B.; Rapoport, David M.

2016-01-01

Study Objectives: In familial dysautonomia (FD) patients, sleep-disordered breathing (SDB) might contribute to their high risk of sleep-related sudden death. Prevalence of central versus obstructive sleep apneas is controversial but may be therapeutically relevant. We, therefore, assessed sleep structure and SDB in FD-patients with no history of SDB. Methods: 11 mildly affected FD-patients (28 ± 11 years) without clinically overt SDB and 13 controls (28 ± 10 years) underwent polysomnographic recording during one night. We assessed sleep stages, obstructive and central apneas (≥ 90% air flow reduction) and hypopneas (> 30% decrease in airflow with ≥ 4% oxygen-desaturation), and determined obstructive (oAI) and central (cAI) apnea indices and the hypopnea index (HI) as count of respective apneas/hypopneas divided by sleep time. We obtained the apnea-hypopnea index (AHI4%) from the total of apneas and hypopneas divided by sleep time. We determined differences between FD-patients and controls using the U-test and within-group differences between oAIs, cAIs, and HIs using the Friedman test and Wilcoxon test. Results: Sleep structure was similar in FD-patients and controls. AHI4% and HI were significantly higher in patients than controls. In patients, HIs were higher than oAIs and oAIs were higher than cAIs. In controls, there was no difference between HIs, oAIs, and cAIs. Only patients had apneas and hypopneas during slow wave sleep. Conclusions: In our FD-patients, obstructive apneas were more common than central apneas. These findings may be related to FD-specific pathophysiology. The potential ramifications of SDB in FD-patients suggest the utility of polysomnography to unveil SDB and initiate treatment. Commentary: A commentary on this article appears in this issue on page 1583. Citation: Hilz MJ, Moeller S, Buechner S, Czarkowska H, Ayappa I, Axelrod FB, Rapoport DM. Obstructive sleep-disordered breathing is more common than central in mild familial

Effects of neuromuscular electrical stimulation, laser therapy and LED therapy on the masticatory system and the impact on sleep variables in cerebral palsy patients: a randomized, five arms clinical trial

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Giannasi Lilian

2012-05-01

Full Text Available Abstract Background Few studies demonstrate effectiveness of therapies for oral rehabilitation of patients with cerebral palsy (CP, given the difficulties in chewing, swallowing and speech, besides the intellectual, sensory and social limitations. Due to upper airway obstruction, they are also vulnerable to sleep disorders. This study aims to assess the sleep variables, through polysomnography, and masticatory dynamics, using electromiography, before and after neuromuscular electrical stimulation, associated or not with low power laser (Gallium Arsenide- Aluminun, =780 nm and LED (= 660 nm irradiation in CP patients. Methods/design 50 patients with CP, both gender, aged between 19 and 60 years will be enrolled in this study. The inclusion criteria are: voluntary participation, patient with hemiparesis, quadriparesis or diparetic CP, with ability to understand and respond to verbal commands. The exclusion criteria are: patients undergoing/underwent orthodontic, functional maxillary orthopedic or botulinum toxin treatment. Polysomnographic and surface electromyographic exams on masseter, temporalis and suprahyoid will be carry out in all sample. Questionnaire assessing oral characteristics will be applied. The sample will be divided into 5 treatment groups: Group 1: neuromuscular electrical stimulation; Group 2: laser therapy; Group 3: LED therapy; Group 4: neuromuscular electrical stimulation and laser therapy and Group 5: neuromuscular electrical stimulation and LED therapy. All patients will be treated during 8 consecutive weeks. After treatment, polysomnographic and electromiographic exams will be collected again. Discussion This paper describes a five arm clinical trial assessing the examination of sleep quality and masticatory function in patients with CP under non-invasive therapies. Trial registration The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC RBR-994XFS Descriptors Cerebral Palsy

Excessive Daytime Sleepiness Predicts Neurodegeneration in Idiopathic REM Sleep Behavior Disorder.

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Zhou, Junying; Zhang, Jihui; Lam, Siu Ping; Chan, Joey Wy; Mok, Vincent; Chan, Anne; Li, Shirley Xin; Liu, Yaping; Tang, Xiangdong; Yung, Wing Ho; Wing, Yun Kwok

2017-05-01

To determine the association of excessive daytime sleepiness (EDS) with the conversion of neurodegenerative diseases in patients with idiopathic REM sleep behavior disorder (iRBD). A total of 179 patients with iRBD (79.1% males, mean age = 66.3 ± 9.8 years) were consecutively recruited. Forty-five patients with Epworth Sleepiness Scale score ≥14 were defined as having EDS. Demographic, clinical, and polysomnographic data were compared between iRBD patients with and without EDS. The risk of developing neurodegenerative diseases was examined using Cox proportional hazards model. After a mean follow-up of 5.8 years (SD = 4.3 years), 50 (27.9%) patients developed neurodegenerative diseases. There was a significantly higher proportion of conversion in patients with EDS compared to those without EDS (42.2 % vs. 23.1%, p = .01). EDS significantly predicted an increased risk of developing neurodegenerative diseases (adjusted hazard ratios [HR] = 2.56, 95% confidence interval [CI] 1.37 to 4.77) after adjusting for age, sex, body mass index, current depression, obstructive sleep apnea, and periodic limb movements during sleep. Further analyses demonstrated that EDS predicted the conversion of Parkinson's disease (PD) (adjusted HR = 3.55, 95% CI 1.59 to 7.89) but not dementia (adjusted HR = 1.48, 95% CI 0.44 to 4.97). EDS is associated with an increased risk of developing neurodegenerative diseases, especially PD, in patients with iRBD. Our findings suggest that EDS is a potential clinical biomarker of α-synucleinopathies in iRBD. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Nightmares : Assessment, theory, and treatment

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Spoormaker, V.I.

2005-01-01

Nightmares tend to occur less often in a sleep laboratory. To test this, twelve PTSD-inpatients suffering from posttraumatic nightmares kept a diary and filled out a questionnaire considering their sleep and nightmares. Polysomnographic sleep-data were recorded in the clinic for two consecutive

Sleep spindling and fluid intelligence across adolescent development: sex matters

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Róbert eBódizs

2014-11-01

Full Text Available Evidence supports the intricate relationship between sleep electroencephalogram (EEG spindling and cognitive abilities in children and adults. Although sleep EEG changes during adolescence index fundamental brain reorganization, a detailed analysis of sleep spindling and the spindle-intelligence relationship was not yet provided for adolescents. Therefore, adolescent development of sleep spindle oscillations were studied in a home polysomnographic study focusing on the effects of chronological age and developmentally acquired overall mental efficiency (fluid IQ with sex as a potential modulating factor. Subjects were 24 healthy adolescents (12 males with an age range of 15–22 years (mean: 18 years and fluid IQ of 91-126 (mean: 104.12, Raven Progressive Matrices Test. Slow spindles (SSs and fast spindles (FSs were analyzed in 21 EEG derivations by using the individual adjustment method. A significant age-dependent increase in average FS density (r = .57; p = .005 was found. Moreover, fluid IQ correlated with FS density (r = .43; p = .04 and amplitude (r = .41; p = .049. The latter effects were entirely driven by particularly reliable FS-IQ correlations in females [r = .80 (p = .002 and r = .67 (p = .012, for density and amplitude, respectively]. Region-specific analyses revealed that these correlations peak in the fronto-central regions. The control of the age-dependence of FS measures and IQ scores did not considerably reduce the spindle-IQ correlations with respect to FS density. The only positive spindle-index of fluid IQ in males turned out to be the frequency of FSs (r = .60, p = .04. Increases in FS density during adolescence may index reshaped structural connectivity related to white matter maturation in the late developing human brain. The continued development over this age range of cognitive functions is indexed by specific measures of sleep spindling unravelling gender differences in adolescent brain maturation and perhaps cognitive

Interepisode Sleep Bruxism Intervals and Myofascial Face Pain.

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Muzalev, Konstantin; Lobbezoo, Frank; Janal, Malvin N; Raphael, Karen G

2017-08-01

Sleep bruxism (SB) is considered as a possible etiological factor for temporomandibular disorder (TMD) pain. However, polysomnographic (PSG) studies, which are current "gold standard" diagnostic approach to SB, failed to prove an association between SB and TMD. A possible explanation could be that PSG studies have considered only limited characteristics of SB activity: the number of SB events per hour and, sometimes, the total duration of SB per night. According to the sports sciences literature, lack of adequate rest time between muscle activities leads to muscle overloading and pain. Therefore, the aim of this study was to determine whether the intervals between bruxism events differ between patients with and without TMD pain. Two groups of female volunteers were recruited: myofascial TMD pain group (n=124) and non-TMD control group (n=46). From these groups, we selected 86 (69%) case participants and 37 (80%) controls who had at least two SB episodes per night based on PSG recordings. A linear mixed model was used to compare case and control groups over the repeated observations of interepisode intervals. The duration of interepisode intervals was statistically similar in the case (mean [standard deviation {SD}] 1137.7 [1975.8] seconds)] and control (mean [SD] 1192.0 [1972.0] seconds) groups. There were also a similar number of SB episodes per hour and a total duration of SB episodes in both groups. The current data fail to support the idea that TMD pain can be explained by increasing number of SB episodes per hour of sleep or decreasing the time between SB events. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep quality and sleep associated problems in female pharmacy students

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Vivek Jain

2013-01-01

Full Text Available Background: Sleep is an essential element for adolescent mental and physical growth and development, but today′s young adolescents are deprived of this. Earlier studies in Europe and America showed pitiable sleep quality of young college students, which affect their academic growth. However, as per our literature search there is a lack of such studies in Indian context especially, within pharmacy education. Objective: The present study was designed to investigate the interrelation between the demographic characteristics, life-style, and academic progress with sleep quality and sleep problems along with daytime and nighttime habits in young female pharmacy students of India. Materials and Methods: Questionnaire on sleep and daytime habits (QS and DH was prepared. Our sample survey consists of 226 female pharmacy students of Banasthali University. QS and DH of multiple choice type, covered demographic characteristic (3 questions sleep and daytime habits (25 questions, life-style and academic progress (3 questions, and one question of course curriculum. Parameters were co-related by point scale method using the SPSS 16.0 software. Results: Data derived and analyze from survey illustrated that quality of sleep was as: Excellent - 20.4%, good - 38.5%, satisfactory - 35.8%, poor - 4%, and very poor - 1.3% of participants. Living condition (ρ=0.168, P =0.011, academic progress (ρ=0.151, P=0.023, leisure activity (ρ=0.133, P<0.05, and daytime naps (ρ=0.160, P=0.016 were significantly correlated with sleep quality. In addition, daytime sleepiness caused a significant problem for students and created a number of sleep disorders. Nevertheless, Sleep quality was not associated with age, body mass index, and coffee in the late evening. Conclusion: Study reported that sleep associated problems were common complaints in female pharmacy students.

Sleep disordered breathing in a cohort of patients with sporadic inclusion body myositis.

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Della Marca, Giacomo; Sancricca, Cristina; Losurdo, Anna; Di Blasi, Chiara; De Fino, Chiara; Morosetti, Roberta; Broccolini, Aldobrando; Testani, Elisa; Scarano, Emanuele; Servidei, Serenella; Mirabella, Massimiliano

2013-08-01

The aims of the study were: (1) to evaluate subjective sleep quality and daytime sleepiness in patients affected by sporadic inclusion-body myositis (IBM); (2) to define the sleep and sleep-related respiratory pattern in IBM patients. Thirteen consecutive adult patients affected by definite IBM were enrolled, six women and seven men, mean age 66.2 ± 11.1 years (range: 50-80). Diagnosis was based on clinical and muscle biopsy studies. All patients underwent subjective sleep evaluation (Pittsburgh Sleep Quality Index, PSQI and Epworth Sleepiness Scale, ESS), oro-pharingo-esophageal scintigraphy, pulmonary function tests, psychometric measures, anatomic evaluation of upper airways, and laboratory-based polysomnography. Findings in IBM patients were compared to those obtained from a control group of 25 healthy subjects (13 men and 12 women, mean age 61.9 ± 8.6 years). Disease duration was >10 years in all. Mean IBM severity score was 28.8 ± 5.4 (range 18-36). Dysphagia was present in 10 patients. Nine patients had PSQI scores ≥ 5; patients had higher mean PSQI score (IBM: 7.2 ± 4.7, CONTROLS: 2.76 ± 1.45, p=0.005); one patient (and no controls) had EES>9. Polysomnography showed that IBM patients, compared to controls, had lower sleep efficiency (IBM: 78.8 ± 12.0%, 94.0 ± 4.5%, p<0.001), more awakenings (IBM: 11.9 ± 11.0, CONTROLS: 5.2 ± 7.5, p=0.009) and increased nocturnal time awake (IBM: 121.2 ± 82.0 min., 46.12 ± 28.8 min., p=0.001). Seven Patients (and no controls) had polysomnographic findings consistent with sleep disordered breathing (SDB). Data suggest that sleep disruption, and in particular SDB, might be highly prevalent in IBM. Data indicate that IBM patients have poor sleep and high prevalence of SDB. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

The predictive value of drug-induced sleep endoscopy for CPAP titration in OSA patients.

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Lan, Ming-Chin; Hsu, Yen-Bin; Lan, Ming-Ying; Huang, Yun-Chen; Kao, Ming-Chang; Huang, Tung-Tsun; Chiu, Tsan-Jen; Yang, Mei-Chen

2017-12-15

The aim of this study was to identify possible upper airway obstructions causing a higher continuous positive airway pressure (CPAP) titration level, utilizing drug-induced sleep endoscopy (DISE). A total of 76 patients with obstructive sleep apnea (OSA) underwent CPAP titration and DISE. DISE findings were recorded using the VOTE classification system. Polysomnographic (PSG) data, anthropometric variables, and patterns of airway collapse during DISE were analyzed with CPAP titration levels. A significant association was found between the CPAP titration level and BMI, oxygen desaturation index (ODI), apnea-hypopnea index (AHI), and neck circumference (NC) (P CPAP titration level (P CPAP titration level and any other collapse at the tongue base or epiglottis. By analyzing PSG data, anthropometric variables, and DISE results with CPAP titration levels, we can better understand possible mechanisms resulting in a higher CPAP titration level. We believe that the role of DISE can be expanded as a tool to identify the possible anatomical structures that may be corrected by oral appliance therapy or surgical intervention to improve CPAP compliance.

Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study.

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Gileles-Hillel, Alex; Alonso-Álvarez, María Luz; Kheirandish-Gozal, Leila; Peris, Eduard; Cordero-Guevara, José Aurelio; Terán-Santos, Joaquin; Martinez, Mónica Gonzalez; Jurado-Luque, María José; Corral-Peñafiel, Jaime; Duran-Cantolla, Joaquin; Gozal, David

2014-01-01

Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4-15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.

A relationship between REM sleep measures and the duration of posttraumatic stress disorder in a young adult urban minority population.

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Mellman, Thomas A; Kobayashi, Ihori; Lavela, Joseph; Wilson, Bryonna; Hall Brown, Tyish S

2014-08-01

To determine relationships of polysomnographic (PSG) measures with posttraumatic stress disorder (PTSD) in a young adult, urban African American population. Cross-sectional, clinical and laboratory evaluation. Community recruitment, evaluation in the clinical research unit of an urban University hospital. Participants (n = 145) were Black, 59.3% female, with a mean age of 23.1 y (SD = 4.8). One hundred twenty-one participants (83.4%) met criteria for trauma exposure, the most common being nonsexual violence. Thirty-nine participants (26.9%) met full (n = 19) or subthreshold criteria (n = 20) for current PTSD, 41 (28.3%) had met lifetime PTSD criteria and were recovered, and 65 (45%) were negative for PTSD. Evaluations included the Clinician Administered PTSD Scale (CAPS) and 2 consecutive nights of overnight PSG. Analysis of variance did not reveal differences in measures of sleep duration and maintenance, percentage of sleep stages, and the latency to and duration of uninterrupted segments of rapid eye movement (REM) sleep by study group. There were significant relationships between the duration of PTSD and REM sleep percentage (r = 0.53, P = 0.001), REM segment length (r = 0.43, P = 0.006), and REM sleep latency (r = -0.34, P sleep with posttraumatic stress disorder (PTSD) relatively proximate to trauma exposure and nondisrupted or increased REM sleep with chronic PTSD. Mellman TA, Kobayashi I, Lavela J, Wilson B, Hall Brown TS. A relationship between REM sleep measures and the duration of posttraumatic stress disorder in a young adult urban minority population.

Comparing the Effects of Reflexology and Footbath on Sleep Quality in the Elderly: A Controlled Clinical Trial.

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Valizadeh, Leila; Seyyedrasooli, Alehe; Zamanazadeh, Vahid; Nasiri, Khadijeh

2015-11-01

Sleep disorders are common mental disorders reported among the elderly in all countries, and with nonpharmacological interventions, they could be helped to improve their sleep quality. The aim of this study was to compare the effects of two interventions, foot reflexology and foot bath, on sleep quality in elderly people. This three-group randomized clinical trial (two experimental groups and a control group) was conducted on 69 elderly men. The two experimental groups had reflexology (n = 23) and foot bath (n = 23) interventions for 6 weeks. The reflexology intervention was done in the mornings, once a week for ten minutes on each foot. The participants in the foot bath group were asked to soak their feet in 41°C to 42°C water one hour before sleeping. The pittsburgh sleep quality index (PSQI) was completed before and after the intervention through an interview process. The results showed that the PSQI scores after intervention compared to before it in the reflexology and foot bath groups were statistically significant (P = 0.01 , P = 0.001); however, in the control group did not show a statistically significant difference (P = 0.14). In addition, the total score changes among the three groups were statistically significant (P = 0.01). Comparing the score changes of quality of sleep between the reflexology and foot bath groups showed that there was no significant difference in none of the components and the total score (P = 0.09). The two interventions had the same impact on the quality of sleep. It is suggested that the training of nonpharmacological methods to improve sleep quality such as reflexology and foot bath be included in the elderly health programs. In addition, it is recommended that the impact of these interventions on subjective sleep quality using polysomnographic recordings be explored in future research.

Effects of neuromuscular electrical stimulation, laser therapy and LED therapy on the masticatory system and the impact on sleep variables in cerebral palsy patients: a randomized, five arms clinical trial.

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Giannasi, Lilian Chrystiane; Matsui, Miriam Yumi; de Freitas Batista, Sandra Regina; Hardt, Camila Teixeira; Gomes, Carla Paes; Amorim, José Benedito Oliveira; de Carvalho Aguiar, Isabella; Collange, Luanda; Dos Reis Dos Santos, Israel; Dias, Ismael Souza; de Oliveira, Cláudia Santos; de Oliveira, Luis Vicente Franco; Gomes, Mônica Fernandes

2012-05-15

Few studies demonstrate effectiveness of therapies for oral rehabilitation of patients with cerebral palsy (CP), given the difficulties in chewing, swallowing and speech, besides the intellectual, sensory and social limitations. Due to upper airway obstruction, they are also vulnerable to sleep disorders. This study aims to assess the sleep variables, through polysomnography, and masticatory dynamics, using electromiography, before and after neuromuscular electrical stimulation, associated or not with low power laser (Gallium Arsenide- Aluminun, =780 nm) and LED (= 660 nm) irradiation in CP patients. 50 patients with CP, both gender, aged between 19 and 60 years will be enrolled in this study. The inclusion criteria are: voluntary participation, patient with hemiparesis, quadriparesis or diparetic CP, with ability to understand and respond to verbal commands. The exclusion criteria are: patients undergoing/underwent orthodontic, functional maxillary orthopedic or botulinum toxin treatment. Polysomnographic and surface electromyographic exams on masseter, temporalis and suprahyoid will be carry out in all sample. Questionnaire assessing oral characteristics will be applied. The sample will be divided into 5 treatment groups: Group 1: neuromuscular electrical stimulation; Group 2: laser therapy; Group 3: LED therapy; Group 4: neuromuscular electrical stimulation and laser therapy and Group 5: neuromuscular electrical stimulation and LED therapy. All patients will be treated during 8 consecutive weeks. After treatment, polysomnographic and electromiographic exams will be collected again. This paper describes a five arm clinical trial assessing the examination of sleep quality and masticatory function in patients with CP under non-invasive therapies. The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC RBR-994XFS.

Excessive Fragmentary Myoclonus: What Do We Know?

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Jiří Nepožitek

2017-03-01

Full Text Available Excessive fragmentary myoclonus (EFM is a polysomnographic finding registered by the surface electromyography (EMG and characterized as a result of the muscle activity consisting of sudden, isolated, arrhythmic, asynchronous and asymmetric brief twitches. The EMG potentials are defined by the exact criteria in The International Classification of the Sleep Disorders, 3rd edition and they appear with high intensity in all sleep stages. Clinical significance of EFM is unclear. It was observed in combination with other diseases and features such as obstructive and central sleep apnea, narcolepsy, periodic limb movements, insomnia, neurodegenerative disorders and peripheral nerve dysfunction. Relation to such wide range of diseases supports the opinion that EFM is nor a specific sleep disorder nor a specific polysomnographic sign. The option that EFM is a normal variant has also not been ruled out so far.

Efficacy of Submucosal Sodium Tetradecyl Sulfate in the Soft Palate as a Treatment of the Mild Obstructive Sleep Apnea Syndrome: A Pilot Study

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Alberto Labra

2012-01-01

Full Text Available Background. As described by Mair et al. in 2001, snoreplasty, the application of sclerosant agents in the palate is a promising and cheap alternative to treat snoring. We decided to try this kind of therapy for the management of mild sleep apnea. Study Design. Experimental, longitudinal, prospective, nonrandomized, self-controlled pilot study. Methods. 11 patients were included, all of them with a polysomnographic study showing an Apnea-Hypopnea Index (AHI from 5 to 20, and with a Müller maneuver showing only retropalatal collapse. Results. We found significant decrease in the number of apneas hypopneas and oxygen desaturation as well as in the snoring index (<0.05, although no differences were found in the number of arousals. Conclusion. Sclerosant agents might become a relevant part in the treatment of sleep apnea, in very well-selected patients.

Effects of train noise and vibration on human heart rate during sleep: an experimental study.

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Croy, Ilona; Smith, Michael G; Waye, Kerstin Persson

2013-05-28

Transportation of goods on railways is increasing and the majority of the increased numbers of freight trains run during the night. Transportation noise has adverse effects on sleep structure, affects the heart rate (HR) during sleep and may be linked to cardiovascular disease. Freight trains also generate vibration and little is known regarding the impact of vibration on human sleep. A laboratory study was conducted to examine how a realistic nocturnal railway traffic scenario influences HR during sleep. Case-control. Healthy participants. 24 healthy volunteers (11 men, 13 women, 19-28 years) spent six consecutive nights in the sleep laboratory. All participants slept during one habituation night, one control and four experimental nights in which train noise and vibration were reproduced. In the experimental nights, 20 or 36 trains with low-vibration or high-vibration characteristics were presented. Polysomnographical data and ECG were recorded. The train exposure led to a significant change of HR within 1 min of exposure onset (p=0.002), characterised by an initial and a delayed increase of HR. The high-vibration condition provoked an average increase of at least 3 bpm per train in 79% of the participants. Cardiac responses were in general higher in the high-vibration condition than in the low-vibration condition (p=0.006). No significant effect of noise sensitivity and gender was revealed, although there was a tendency for men to exhibit stronger HR acceleration than women. Freight trains provoke HR accelerations during sleep, and the vibration characteristics of the trains are of special importance. In the long term, this may affect cardiovascular functioning of persons living close to railways.

Effects of nocturnal railway noise on sleep fragmentation in young and middle-aged subjects as a function of type of train and sound level.

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Saremi, Mahnaz; Grenèche, Jérôme; Bonnefond, Anne; Rohmer, Odile; Eschenlauer, Arnaud; Tassi, Patricia

2008-12-01

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.

Effects of intrauterine growth restriction on sleep and the cardiovascular system: The use of melatonin as a potential therapy?

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Yiallourou, Stephanie R; Wallace, Euan M; Miller, Suzanne L; Horne, Rosemary S C

2016-04-01

Intrauterine growth restriction (IUGR) complicates 5-10% of pregnancies and is associated with increased risk of preterm birth, mortality and neurodevelopmental delay. The development of sleep and cardiovascular control are closely coupled and IUGR is known to alter this development. In the long-term, IUGR is associated with altered sleep and an increased risk of hypertension in adulthood. Melatonin plays an important role in the sleep-wake cycle. Experimental animal studies have shown that melatonin therapy has neuroprotective and cardioprotective effects in the IUGR fetus. Consequently, clinical trials are currently underway to assess the short and long term effects of antenatal melatonin therapy in IUGR pregnancies. Given melatonin's role in sleep regulation, this hormone could affect the developing infants' sleep-wake cycle and cardiovascular function after birth. In this review, we will 1) examine the role of melatonin as a therapy for IUGR pregnancies and the potential implications on sleep and the cardiovascular system; 2) examine the development of sleep-wake cycle in fetal and neonatal life; 3) discuss the development of cardiovascular control during sleep; 4) discuss the effect of IUGR on sleep and the cardiovascular system and 5) discuss the future implications of melatonin therapy in IUGR pregnancies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Beneficial Effects of Long-Term CPAP Treatment on Sleep Quality and Blood Pressure in Adherent Subjects With Obstructive Sleep Apnea.

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Yang, Mei-Chen; Huang, Yi-Chih; Lan, Chou-Chin; Wu, Yao-Kuang; Huang, Kuo-Feng

2015-12-01

Obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular diseases. Although CPAP is the first treatment choice for moderate-to-severe OSA, acceptance of and adherence to CPAP remain problematic. High CPAP adherence is generally defined as ≥4 h of use/night for ≥70% of the nights monitored. We investigated the long-term beneficial effects of CPAP on sleep quality and blood pressure in subjects with moderate-to-severe OSA according to high or low CPAP adherence. We retrospectively analyzed 121 subjects with moderate-to-severe OSA from August 2008 to July 2012. These subjects were divided into 3 groups: (1) no CPAP treatment (n = 29), (2) low CPAP adherence (n = 28), and (3) high CPAP adherence (n = 64). All subjects were followed up for at least 1 y. The 3 groups were compared regarding anthropometric and polysomnographic variables, presence of cardiovascular comorbidities, and blood pressure at baseline and at the last follow-up. The no-treatment group showed significant increases in oxygen desaturation index and blood pressure. The high-adherence group showed significant improvement in daytime sleepiness, apnea-hypopnea index (AHI), oxygen desaturation index, and blood pressure. Although the AHI was also significantly decreased after CPAP treatment in the low-adherence group, blood pressure remained unchanged. CPAP treatment had beneficial effects on both sleep quality and blood pressure only in subjects with OSA and high CPAP adherence who used CPAP for ≥4 h/night for ≥70% of nights monitored. Subjects with low CPAP adherence received beneficial effects on AHI, but not blood pressure. Copyright © 2015 by Daedalus Enterprises.

Dynamic loop gain increases upon adopting the supine body position during sleep in patients with obstructive sleep apnoea.

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Joosten, Simon A; Landry, Shane A; Sands, Scott A; Terrill, Philip I; Mann, Dwayne; Andara, Christopher; Skuza, Elizabeth; Turton, Anthony; Berger, Philip; Hamilton, Garun S; Edwards, Bradley A

2017-11-01

Obstructive sleep apnoea (OSA) is typically worse in the supine versus lateral sleeping position. One potential factor driving this observation is a decrease in lung volume in the supine position which is expected by theory to increase a key OSA pathogenic factor: dynamic ventilatory control instability (i.e. loop gain). We aimed to quantify dynamic loop gain in OSA patients in the lateral and supine positions, and to explore the relationship between change in dynamic loop gain and change in lung volume with position. Data from 20 patients enrolled in previous studies on the effect of body position on OSA pathogenesis were retrospectively analysed. Dynamic loop gain was calculated from routinely collected polysomnographic signals using a previously validated mathematical model. Lung volumes were measured in the awake state with a nitrogen washout technique. Dynamic loop gain was significantly higher in the supine than in the lateral position (0.77 ± 0.15 vs 0.68 ± 0.14, P = 0.012). Supine functional residual capacity (FRC) was significantly lower than lateral FRC (81.0 ± 15.4% vs 87.3 ± 18.4% of the seated FRC, P = 0.021). The reduced FRC we observed on moving to the supine position was predicted by theory to increase loop gain by 10.2 (0.6, 17.1)%, a value similar to the observed increase of 8.4 (-1.5, 31.0)%. Dynamic loop gain increased by a small but statistically significant amount when moving from the lateral to supine position and this may, in part, contribute to the worsening of OSA in the supine sleeping position. © 2017 Asian Pacific Society of Respirology.

Portable recording in the assessment of obstructive sleep apnea. ASDA standards of practice.

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Ferber, R; Millman, R; Coppola, M; Fleetham, J; Murray, C F; Iber, C; McCall, V; Nino-Murcia, G; Pressman, M; Sanders, M

1994-06-01

The objective assessment of patients with a presumptive diagnosis of obstructive sleep apnea (OSA) has primarily used attended polysomnographic study. Recent technologic advances and issues of availability, convenience and cost have led to a rapid increase in the use of portable recording devices. However, limited scientific information has been published regarding the evaluation of the efficacy, accuracy, validity, utility, cost effectiveness and limitations of this portable equipment. Attaining a clear assessment of the role of portable devices is complicated by the multiplicity of recording systems and the variability of clinical settings in which they have been analyzed. This paper reviews the current knowledge base regarding portable recording in the assessment of OSA, including technical considerations, validation studies, potential advantages and disadvantages, issues of safety, current clinical usage and areas most in need of further study.

Work stressors, depressive symptoms and sleep quality among US Navy members: a parallel process latent growth modelling approach across deployment.

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Bravo, Adrian J; Kelley, Michelle L; Swinkels, Cindy M; Ulmer, Christi S

2017-11-03

The present study examined whether work stressors contribute to sleep problems and depressive symptoms over the course of deployment (i.e. pre-deployment, post-deployment and 6-month reintegration) among US Navy members. Specifically, we examined whether depressive symptoms or sleep quality mediate the relationships between work stressors and these outcomes. Participants were 101 US Navy members who experienced an 8-month deployment after Operational Enduring Freedom/Operation Iraqi Freedom. Using piecewise latent growth models, we found that increased work stressors were linked to increased depressive symptoms and decreased sleep quality across all three deployment stages. Further, increases in work stressors from pre- to post-deployment contributed to poorer sleep quality post-deployment via increasing depressive symptoms. Moreover, sleep quality mediated the association between increases in work stressors and increases in depressive symptoms from pre- to post-deployment. These effects were maintained from post-deployment through the 6-month reintegration. Although preliminary, our results suggest that changes in work stressors may have small, but significant implications for both depressive symptoms and quality of sleep over time, and a bi-directional relationship persists between sleep quality and depression across deployment. Strategies that target both stress and sleep could address both precipitating and perpetuating factors that affect sleep and depressive symptoms. © 2017 European Sleep Research Society.

Sleep Disordered Breathing in Children and Adolescents with Chiari Malformation Type I

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Losurdo, Anna; Dittoni, Serena; Testani, Elisa; Di Blasi, Chiara; Scarano, Emanuele; Mariotti, Paolo; Paternoster, Giovanna; Di Rocco, Concezio; Massimi, Luca; Della Marca, Giacomo

2013-01-01

Study Objectives: Chiari malformation Type I (CM-I) has been associated with sleep disordered breathing (SDB). The aim of this study was to evaluate the prevalence of SDB in CM-I and its clinical correlates in a population of children and adolescents. Methods: Fifty-three consecutive children and adolescents affected by CM-I were enrolled (27 girls and 26 boys, mean age 10.3 ± 4.3, range: 3-18 years). All patients underwent neurological examination, MRI, and polysomnography (PSG). Otorhinolaryngologic clinical evaluation was performed in patients with polysomnographic evidence of sleep-related upper airway obstruction. Results: Mean size of the herniation was 9.5 ± 5.4 mm. Fourteen patients had syringomyelia, 5 had hydrocephalus, 31 presented neurological signs, 14 had epileptic seizures, and 7 reported poor sleep. PSG revealed SDB in 13 subjects. Patients with SDB, compared to those without SDB, had a higher prevalence hydrocephalus (p = 0.002), syringomyelia (p = 0.001), and neurological symptoms (p = 0.028). No significant difference was observed in age, gender, prevalence of epilepsy, and size of the herniation. Obstructive SDB was associated with syringomyelia (p = 0.004), whereas central SDB was associated with hydrocephalus (p = 0.034). Conclusions: In our population of CM-I patients the prevalence of SDB was 24%, lower than that reported in literature. Moreover, our findings suggest that abnormalities in cerebrospinal fluid dynamics in CM-I, particularly syringomyelia and hydro-cephalus, are associated with SDB. Citation: Losurdo A; Dittoni S; Testani E; Di Blasi C; Scarano E; Mariotti P; Paternoster G; Di Rocco C; Massimi L; Della Marca G. Sleep disordered breathing in children and adolescents with Chiari malformation Type I. J Clin Sleep Med 2013;9(4):371-377. PMID:23585753

Starting a sleep center.

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Epstein, Lawrence J; Valentine, Paul S

2010-05-01

The demand for sleep medicine services has grown tremendously during the last decade and will likely continue. To date, growth in demand has been met by growth in the number of new sleep centers. The need for more new centers will be dependent on market drivers that include increasing regulatory requirements, personnel shortages, integration of home sleep testing, changes in reimbursement, a shift in emphasis from diagnostics to treatment, and an increased consumer focus on sleep. The decision to open a new center should be based on understanding the market dynamics, completing a market analysis, and developing a business plan. The business plan should include an overview of the facility, a personnel and organizational structure, an evaluation of the business environment, a financial plan, a description of services provided, and a strategy for obtaining, managing, and extending a referral base. Implementation of the business plan and successful operation require ongoing planning and monitoring of operational parameters. The need for new sleep centers will likely continue, but the shifting market dynamics indicate a greater need for understanding the marketplace and careful planning.

Pitot-tube flowmeter for quantification of airflow during sleep

International Nuclear Information System (INIS)

Kirkness, J P; McGinley, B M; Schwartz, A R; Smith, P L; Patil, S P; Schneider, H; Verma, M; Wheatley, J R; Amis, T C; Erlacher, M

2011-01-01

-measured airflow. Our data validate the pitot flowmeter for quantification of airflow and detecting breathing reduction during polysomnographic sleep studies. We speculate that quantifying airflow during sleep can differentiate phenotypic traits related to sleep disordered breathing

Pitot-tube flowmeter for quantification of airflow during sleep.

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Kirkness, J P; Verma, M; McGinley, B M; Erlacher, M; Schwartz, A R; Smith, P L; Wheatley, J R; Patil, S P; Amis, T C; Schneider, H

2011-02-01

validate the pitot flowmeter for quantification of airflow and detecting breathing reduction during polysomnographic sleep studies. We speculate that quantifying airflow during sleep can differentiate phenotypic traits related to sleep disordered breathing.

Inflammatory Markers and Obstructive Sleep Apnea in Obese Children: The NANOS Study

Directory of Open Access Journals (Sweden)

Alex Gileles-Hillel

2014-01-01

Full Text Available Introduction. Obesity and obstructive sleep apnea syndrome (OSA are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. Aim. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4–15 years were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. Results. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI of 3 events/hour total sleep time (TST. BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1 and plasminogen activator inhibitor-1 (PAI-1 levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P<0.01, while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P<0.001. Conclusion. IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.

Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism.

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van der Zaag, Jacques; Lobbezoo, Frank; Wicks, Darrel J; Visscher, Corine M; Hamburger, Hans L; Naeije, Machiel

2005-01-01

To assess the efficacy of occlusal stabilization splints in the management of sleep bruxism (SB) in a double-blind, parallel, controlled, randomized clinical trial. Twenty-one participants were randomly assigned to an occlusal splint group (n = 11; mean age = 34.2 +/- 13.1 years) or a palatal splint (ie, an acrylic palatal coverage) group (n = 10; mean age = 34.9 +/- 11.2 years). Two polysomnographic recordings that included bilateral masseter electromyographic activity were made: one prior to treatment, the other after a treatment period of 4 weeks. The number of bruxism episodes per hour of sleep (Epi/h), the number of bursts per hour (Bur/h), and the bruxism time index (ie, the percentage of total sleep time spent bruxing) were established as outcome variables at a 10% maximum voluntary contraction threshold level. A general linear model was used to test both the effects between splint groups and within the treatment phase as well as their interaction for each outcome variable. Neither occlusal stabilization splints nor palatal splints had an influence on the SB outcome variables or on the sleep variables measured on a group level. In individual cases, variable outcomes were found: Some patients had an increase (33% to 48% of the cases), while others showed no change (33% to 48%) or a decrease (19% to 29%) in SB outcome variables. The absence of significant group effects of splints in the management of SB indicates that caution is required when splints are indicated, apart from their role in the protection against dental wear. The application of splints should therefore be considered at the individual patient level.

Effects of oxcarbazepine on monoamines content in hippocampus and head and body shakes and sleep patterns in kainic acid-treated rats.

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Alfaro-Rodríguez, Alfonso; González-Piña, Rigoberto; Bueno-Nava, Antonio; Arch-Tirado, Emilio; Ávila-Luna, Alberto; Uribe-Escamilla, Rebeca; Vargas-Sánchez, Javier

2011-09-01

The aim of this work was to analyze the effect of oxcarbazepine (OXC) on sleep patterns, "head and body shakes" and monoamine neurotransmitters level in a model of kainic-induced seizures. Adult Wistar rats were administered kainic acid (KA), OXC or OXC + KA. A polysomnographic study showed that KA induced animals to stay awake for the whole initial 10 h. OXC administration 30 min prior to KA diminished the effect of KA on the sleep parameters. As a measure of the effects of the drug treatments on behavior, head and body shakes were visually recorded for 4 h after administration of KA, OXC + KA or saline. The presence of OXC diminished the shakes frequency. 4 h after drug application, the hippocampus was dissected out, and the content of monoamines was analyzed. The presence of OXC still more increased serotonin, 5-hidroxyindole acetic acid, dopamine, and homovanilic acid, induced by KA.

Sleep spindling and fluid intelligence across adolescent development: sex matters.

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Bódizs, Róbert; Gombos, Ferenc; Ujma, Péter P; Kovács, Ilona

2014-01-01

Evidence supports the intricate relationship between sleep electroencephalogram (EEG) spindling and cognitive abilities in children and adults. Although sleep EEG changes during adolescence index fundamental brain reorganization, a detailed analysis of sleep spindling and the spindle-intelligence relationship was not yet provided for adolescents. Therefore, adolescent development of sleep spindle oscillations were studied in a home polysomnographic study focusing on the effects of chronological age and developmentally acquired overall mental efficiency (fluid IQ) with sex as a potential modulating factor. Subjects were 24 healthy adolescents (12 males) with an age range of 15-22 years (mean: 18 years) and fluid IQ of 91-126 (mean: 104.12, Raven Progressive Matrices Test). Slow spindles (SSs) and fast spindles (FSs) were analyzed in 21 EEG derivations by using the individual adjustment method (IAM). A significant age-dependent increase in average FS density (r = 0.57; p = 0.005) was found. Moreover, fluid IQ correlated with FS density (r = 0.43; p = 0.04) and amplitude (r = 0.41; p = 0.049). The latter effects were entirely driven by particularly reliable FS-IQ correlations in females [r = 0.80 (p = 0.002) and r = 0.67 (p = 0.012), for density and amplitude, respectively]. Region-specific analyses revealed that these correlations peak in the fronto-central regions. The control of the age-dependence of FS measures and IQ scores did not considerably reduce the spindle-IQ correlations with respect to FS density. The only positive spindle-index of fluid IQ in males turned out to be the frequency of FSs (r = 0.60, p = 0.04). Increases in FS density during adolescence may index reshaped structural connectivity related to white matter maturation in the late developing human brain. The continued development over this age range of cognitive functions is indexed by specific measures of sleep spindling unraveling gender differences in adolescent brain maturation and perhaps

Is Period3 Genotype Associated With Sleep and Recovery in Patients With Disorders of Consciousness?

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Bedini, Gloria; Bersano, Anna; Sebastiano, Davide Rossi; Sattin, Davide; Ciaraffa, Francesca; Tosetti, Valentina; Brenna, Greta; Franceschetti, Silvana; Ciusani, Emilio; Leonardi, Matilde; Vela-Gomez, Jesus; Boncoraglio, Giorgio B; Parati, Eugenio A

2016-06-01

Background Sleep evaluation is increasingly being used as prognostic tool in patients with disorders of consciousness, but, surprisingly, the role of Period3 (Per3) gene polymorphism has never been evaluated. Objective The aim of this study was to investigate the contribution of Per3 genotype on sleep quantity and consciousness recovery level in patients with disorders of consciousness (DOC). Methods In this observational study, we evaluated 71 patients with DOC classified as vegetative state/unresponsive wakefulness syndrome or minimally conscious state. Demographic and clinical data were collected and a standardised diagnostic workup, including a polysomnographic record, was applied. After informed consent provided by proxy, genomic DNA was obtained and Per3 polymorphism was analysed by polymerase chain reaction to identify 5/5, 4/5, or 4/4 genotype. Results Per3(5/5) genotype was found in 12.7% of our DOC patients. The median total Coma Recovery Scale-revised score in Per3(5/5) carriers was significantly higher than 4/4 genotype (10, range 5-16 vs 7, range 4-11; post hoc P = .036). Moreover, total sleep time seemed to be higher in 5/5 genotype (5/5, 221 minutes, range 88-515 minutes; 4/4, 151.5 minutes, range 36-477 minutes; and 4/5, 188 minutes, range 44-422 minutes). Conclusion For the first time we have shown a possible association between Per3 polymorphism and consciousness recovery level in DOC patients. Even though the exact molecular mechanism has not been defined, we speculate that its effect is mediated by higher total sleep time and slow wave sleep, which would improve the preservation of main cerebral connections. © The Author(s) 2015.

Evaluation of Candidate Measures for Home-Based Screening of Sleep Disordered Breathing in Taiwanese Bus Drivers

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Hua Ting

2014-05-01

Full Text Available Background: Sleepiness-at-the-wheel has been identified as a major cause of highway accidents. The aim of our study is identifying the candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers, instead of polysomnography. Methods: Overnight polysomnography accompanied with simultaneous measurements of alternative screening devices (pulse oximetry, ApneaLink, and Actigraphy, heart rate variability, wake-up systolic blood pressure and questionnaires were completed by 151 eligible participants who were long-haul bus drivers with a duty period of more than 12 h a day and duty shifting. Results: 63.6% of professional bus drivers were diagnosed as having sleep disordered breathing and had a higher body mass index, neck circumference, systolic blood pressure, arousal index and desaturation index than those professional bus drivers without evidence of sleep disordered breathing. Simple home-based candidate measures: (1 Pulse oximetry, oxygen-desaturation indices by ≥3% and 4% (r = 0.87~0.92; (2 Pulse oximetry, pulse-rising indices by ≥7% and 8% from a baseline (r = 0.61~0.89; and (3 ApneaLink airflow detection, apnea-hypopnea indices (r = 0.70~0.70, based on recording-time or Actigraphy-corrected total sleep time were all significantly correlated with, and had high agreement with, corresponding polysomnographic apnea-hypopnea indices [(1 94.5%~96.6%, (2 93.8%~97.2%, (3 91.1%~91.3%, respectively]. Conversely, no validities of SDB screening were found in the multi-variables apnea prediction questionnaire, Epworth Sleepiness Scale, night-sleep heart rate variability, wake-up systolic blood pressure and anthropometric variables. Conclusions: The indices of pulse oximetry and apnea flow detection are eligible criteria for home-based screening of sleep disordered breathing, specifically for professional drivers.

Multivariate analysis of full-term neonatal polysomnographic data.

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Gerla, V; Paul, K; Lhotska, L; Krajca, V

2009-01-01

Polysomnography (PSG) is one of the most important noninvasive methods for studying maturation of the child brain. Sleep in infants is significantly different from sleep in adults. This paper addresses the problem of computer analysis of neonatal polygraphic signals. We applied methods designed for differentiating three important neonatal behavioral states: quiet sleep, active sleep, and wakefulness. The proportion of these states is a significant indicator of the maturity of the newborn brain in clinical practice. In this study, we used data provided by the Institute for Care of Mother and Child, Prague (12 newborn infants of similar postconceptional age). The data were scored by an experienced physician to four states (wake, quiet sleep, active sleep, movement artifact). For accurate classification, it was necessary to determine the most informative features. We used a method based on power spectral density (PSD) applied to each EEG channel. We also used features derived from electrooculogram (EOG), electromyogram (EMG), ECG, and respiration [pneumogram (PNG)] signals. The most informative feature was the measure of regularity of respiration from the PNG signal. We designed an algorithm for interpreting these characteristics. This algorithm was based on Markov models. The results of automatic detection of sleep states were compared to the "sleep profiles" determined visually. We evaluated both the success rate and the true positive rate of the classification, and statistically significant agreement of the two scorings was found. Two variants, for learning and for testing, were applied, namely learning from the data of all 12 newborns and tenfold cross-validation, and learning from the data of 11 newborns and testing on the data from the 12th newborn. We utilized information obtained from several biological signals (EEG, ECG, PNG, EMG, EOG) for our final classification. We reached the final success rate of 82.5%. The true positive rate was 81.8% and the false

Polysomnographic characteristics in nonmalignant chronic pain populations: A review of controlled studies.

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Bjurstrom, Martin F; Irwin, Michael R

2016-04-01

Sleep and pain are critical homeostatic systems that interact in a bidirectional manner. Complaints of sleep disturbance are ubiquitous among patients with chronic pain disorders, and conversely, patients with persistent insomnia symptoms commonly report suffering from chronic pain. Sleep deprivation paradigms demonstrate that partial or complete sleep loss induce hyperalgesia, possibly due to shared mechanistic pathways including neuroanatomic and molecular substrates. Further, chronic pain conditions and sleep disturbances are intertwined through comorbidities, which together cause detrimental psychological and physical consequences. This critical review examines 29 polysomnography studies to evaluate whether nonmalignant chronic pain patients, as compared to controls, show differences in objective measures of sleep continuity and sleep architecture. Whereas these controlled studies did not reveal a consistent pattern of objective sleep disturbances, alterations of sleep continuity were commonly reported. Alterations of sleep architecture such as increases in light sleep or decreases in slow-wave sleep were less commonly reported and findings were mixed and also inconsistent. Methodological flaws were identified, which complicated interpretation and limited conclusions; hence, recommendations for future research are suggested. Knowledge of abnormalities in the sleep process has implications for understanding the pathophysiology of chronic pain conditions, which might also direct the development of novel intervention strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls.

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Raphael, K G; Janal, M N; Sirois, D A; Dubrovsky, B; Klausner, J J; Krieger, A C; Lavigne, G J

2015-10-01

Sleep bruxism (SB), primarily involving rhythmic grinding of the teeth during sleep, has been advanced as a causal or maintenance factor for a variety of oro-facial problems, including temporomandibular disorders (TMD). As laboratory polysomnographic (PSG) assessment is extremely expensive and time-consuming, most research testing this belief has relied on patient self-report of SB. The current case-control study examined the accuracy of those self-reports relative to laboratory-based PSG assessment of SB in a large sample of women suffering from chronic myofascial TMD (n = 124) and a demographically matched control group without TMD (n = 46). A clinical research coordinator administered a structured questionnaire to assess self-reported SB. Participants then spent two consecutive nights in a sleep laboratory. Audiovisual and electromyographic data from the second night were scored to assess whether participants met criteria for the presence of 2 or more (2+) rhythmic masticatory muscle activity episodes accompanied by grinding sounds, moderate SB, or severe SB, using previously validated research scoring standards. Contingency tables were constructed to assess positive and negative predictive values, sensitivity and specificity, and 95% confidence intervals surrounding the point estimates. Results showed that self-report significantly predicted 2+ grinding sounds during sleep for TMD cases. However, self-reported SB failed to significantly predict the presence or absence of either moderate or severe SB as assessed by PSG, for both cases and controls. These data show that self-report of tooth grinding awareness is highly unlikely to be a valid indicator of true SB. Studies relying on self-report to assess SB must be viewed with extreme caution. © 2015 John Wiley & Sons Ltd.

Paradoxical (REM) sleep deprivation in mice using the small-platforms-over-water method: polysomnographic analyses and melanin-concentrating hormone and hypocretin/orexin neuronal activation before, during and after deprivation.

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Arthaud, Sebastien; Varin, Christophe; Gay, Nadine; Libourel, Paul-Antoine; Chauveau, Frederic; Fort, Patrice; Luppi, Pierre-Herve; Peyron, Christelle

2015-06-01

Studying paradoxical sleep homeostasis requires the specific and efficient deprivation of paradoxical sleep and the evaluation of the subsequent recovery period. With this aim, the small-platforms-over-water technique has been used extensively in rats, but only rare studies were conducted in mice, with no sleep data reported during deprivation. Mice are used increasingly with the emergence of transgenic mice and technologies such as optogenetics, raising the need for a reliable method to manipulate paradoxical sleep. To fulfil this need, we refined this deprivation method and analysed vigilance states thoroughly during the entire protocol. We also studied activation of hypocretin/orexin and melanin-concentrating hormone neurones using Fos immunohistochemistry to verify whether mechanisms regulating paradoxical sleep in mice are similar to those in rats. We showed that 48 h of deprivation was highly efficient, with a residual amount of paradoxical sleep of only 2.2%. Slow wave sleep and wake quantities were similar to baseline, except during the first 4 h of deprivation, where slow wave sleep was strongly reduced. After deprivation, we observed a 124% increase in paradoxical sleep quantities during the first hour of rebound. In addition, 34% of hypocretin/orexin neurones were activated during deprivation, whereas melanin-concentrated hormone neurones were activated only during paradoxical sleep rebound. Corticosterone level showed a twofold increase after deprivation and returned to baseline level after 4 h of recovery. In summary, a fairly selective deprivation and a significant rebound of paradoxical sleep can be obtained in mice using the small-platforms-over-water method. As in rats, rebound is accompanied by a selective activation of melanin-concentrating hormone neurones. © 2014 European Sleep Research Society.

Period3 gene in disorder of consciousness: The role of neuroimaging in understanding the relationship between genotype and sleep. A brief communication.

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Bedini, Gloria; Bersano, Anna; D'Incerti, Ludovico; Marotta, Giorgio; Rosazza, Cristina; Rossi Sebastiano, Davide; Franceschetti, Silvana; Sattin, Davide; Leonardi, Matilde; Nigri, Anna; Ferraro, Stefania; Parati, Eugenio Agostino

2017-10-15

Several methodologies including neuroimaging and sleep evaluation are being developed to complement the clinical bedside examinations in patients with disorder of consciousness (DOC). Recently, we demonstrated a possible association between Period3 (Per3) variable number tandem repeat (VNTR) polymorphism and functional impairment of DOC patients, speculating a possible role of this gene in sleep regulation. To assess whether the degree of structural and metabolic damage of the main brain areas involved in the sleep generation and homeostasis may influence the different outcome of DOC patients carrying the Per3 5/5 genotype in comparison to Per3 4/4 ones. For the present study, we reviewed 44 DOC patients from the Coma Research Centre of the Fondazione IRCCS Istituto Neurologico "C. Besta" of Milan. All patients underwent to polysomnographic sleep evaluation, cerebral structural magnetic resonance imaging (MRI) and 18 F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) analysis. Our DOC patients presented a moderate anatomical (median score 2) and metabolic damage (median value 2.36 SUVmean) of the sleep areas at both MRI and FDG-PET evaluation. Total sleep time seemed to be higher in 5/5 genotype DOC patients (median value Per3 5/5 , 221min, range 126-323min; median value Per3 4/4 , 167min, range 36-477min; and median value Per3 4/5 , 187min, range 29-422min). However, the MRI scores and FDG-PET values of whole brain, overall sleep areas, hypothalamus, midbrain and thalamus did not differ by genotype distribution. Although limited by the small sample size, our data might support the idea that Per3 genetic predisposition in DOC patients could affect impairment and residual cognitive functions through sleep homeostasis independently from structural and/or metabolic integrity of sleep areas. Copyright © 2017 Elsevier B.V. All rights reserved.

The Clinical Phenotype of Idiopathic Rapid Eye Movement Sleep Behavior Disorder at Presentation: A Study in 203 Consecutive Patients.

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Fernández-Arcos, Ana; Iranzo, Alex; Serradell, Mónica; Gaig, Carles; Santamaria, Joan

2016-01-01

To describe the clinical phenotype of idiopathic rapid eye movement (REM) sleep behavior disorder (IRBD) at presentation in a sleep center. Clinical history review of 203 consecutive patients with IRBD identified between 1990 and 2014. IRBD was diagnosed by clinical history plus video-polysomnographic demonstration of REM sleep with increased electromyographic activity linked to abnormal behaviors. Patients were 80% men with median age at IRBD diagnosis of 68 y (range, 50-85 y). In addition to the already known clinical picture of IRBD, other important features were apparent: 44% of the patients were not aware of their dream-enactment behaviors and 70% reported good sleep quality. In most of these cases bed partners were essential to convince patients to seek medical help. In 11% IRBD was elicited only after specific questioning when patients consulted for other reasons. Seven percent did not recall unpleasant dreams. Leaving the bed occurred occasionally in 24% of subjects in whom dementia with Lewy bodies often developed eventually. For the correct diagnosis of IRBD, video-polysomnography had to be repeated in 16% because of insufficient REM sleep or electromyographic artifacts from coexistent apneas. Some subjects with comorbid obstructive sleep apnea reported partial improvement of RBD symptoms following continuous positive airway pressure therapy. Lack of therapy with clonazepam resulted in an increased risk of sleep related injuries. Synucleinopathy was frequently diagnosed, even in patients with mild severity or uncommon IRBD presentations (e.g., patients who reported sleeping well, onset triggered by a life event, nocturnal ambulation) indicating that the development of a neurodegenerative disease is independent of the clinical presentation of IRBD. We report the largest IRBD cohort observed in a single center to date and highlight frequent features that were not reported or not sufficiently emphasized in previous publications. Physicians should be aware of

Nightmares: from anxiety symptom to sleep disorder.

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Spoormaker, Victor I; Schredl, Michael; van den Bout, Jan

2006-02-01

The DSM-IV-TR definition of nightmares-extremely frightening dreams from which the person wakes up directly-is unnecessarily narrow. Other emotions (anger, grief) have also been reported in nightmares, and direct awakening from a bad dream seems to be unrelated to increased distress. In addition, assessment of nightmares is problematic. Polysomnographic recordings have an ameliorating effect on nightmare frequency, retrospective measurements tend to underestimate nightmare frequency, and persons with frequent nightmares may feel reluctant to fill out (daily) prospective measurements. For studying nightmares, it is necessary to distinguish idiopathic nightmares from posttraumatic nightmares, which are part of a posttraumatic stress reaction or disorder that may result from experiencing a traumatic event. Both types of nightmares have been associated with an elevated level of periodic limb movements, although only posttraumatic nightmares seem to be related to more and longer nocturnal awakenings. Nightmares have also been repeatedly associated with the general level of psychopathology, or the so-called personality factor neuroticism. Nightmare distress, the impact on daily functioning caused by nightmares, may function as a mediating variable. Several studies in the last decades have shown that nightmares can be treated with several cognitive-behavioral techniques. The cognitive-restructuring technique imagery rehearsal therapy is the treatment of choice for nightmares, although a randomized controlled trial with an attention control-group has not yet been carried out. Nightmares are more than a symptom of a larger (anxiety) syndrome and need to be viewed from a sleep medicine perspective: nightmares are a highly prevalent and separate sleep disorder that can and should receive specific treatment.

Determinants of compliance with nasal continuous positive airway pressure treatment applied in a community setting.

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Ball, E M.; Banks, M B.

2001-05-01

Objectives: To assess determinants of nasal continuous positive airway pressure (CPAP) compliance when applied in a community setting.Background: One-third of obstructive sleep apnea patients eventually refuse CPAP therapy. Treatment outcomes may be improved by identifying predictors of CPAP failure, including whether management by primary care physicians without sleep consultation affects results.Methods: Polysomnogram, chart review, and questionnaire results for regular CPAP users (n=123) were compared with those returning the CPAP machine (n=26).Results: Polysomnographic data and the presence of multiple sleep disorders were only modestly predictive of CPAP compliance. Striking differences in questionnaire responses separated CPAP users from non-users, who reported less satisfaction with all phases of their diagnosis and management. Rates of CPAP use were not significantly different between patients managed solely by their primary care physician or by a sleep consultant.Conclusions: Polysomnographic findings are unlikely to identify eventual CPAP non-compliers in a cost-effective fashion. Improvements in sleep apnea management may result from addressing the role of personality factors and multiple sleep disorders in determining compliance. In this practice setting, management by primary care physicians did not significantly degrade CPAP compliance.

Relationship between the severity of obstructive sleep apnea syndrome and asymptomatic cerebrovascular disease

International Nuclear Information System (INIS)

Nishibayashi, Momoka

2008-01-01

In this study, examined were prevalence of asymptomatic cerebrovascular disease (ACD) in patients with obstructive sleep apnea syndrome (OSAS) and relationship between its severity and ACD prevalence. Subjects were 192 cases (M 170/F 20, av. age 50.6 y) with chief complaint of snore, sleep apnea (apnea-hypopnea index/AHI 0-118.4/h), midday drowsiness and so on without CD history, who underwent the overnight polysomnographic recording, vascular risk assessment like life habits, blood pressure and impaired GT, and brain MRI. The last item was conducted with Siemence 1.5T machine to get T1-, T2-weighted and FLAIR images to evaluate asymptomatic lacunar infarction (ALI) and periventricular hyperintensity (PVH). Light (AHI<15/h), moderate (15≤AHI<30) and severe (AHI≥30) OSASs were found in 44, 35 and 61 cases, respectively. ALIs were found in 7 light, 17 moderate and 61 severe cases and PVH, in 9, 19 and 61 cases, respectively. Thus it was revealed that patients with moderate to severe OSAS had complication of ACD in a higher rate than those with light OSAS and that prevalence of ACD was higher in OSAS patients with AHI 15/h or more. (R.T.)

Pulmonary hypertension and echocardiogram parameters in obstructive sleep apnea.

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Wong, H T; Chee, K H; Chong, A W

2017-06-01

Obstructive sleep apnea (OSA) is a growing health hazard in the United States and worldwide. OSA is now recognized as a disorder with systemic manifestations and its association with obesity and adverse cardiovascular consequences. There is increasing evidence that OSA may be associated with systemic hypertension and an increased incidence of stroke, heart failure, myocardial infarction, and arrhythmias. Less information is available about the association between OSA and pulmonary hypertension (PH). We therefore conduct this study to look at the prevalence of the pulmonary hypertension in obstructive sleep apnea patient and to identify risk factors leading to pulmonary hypertension among OSA patient. We studied and analyzed all OSA patient confirmed by polysomnograph in the year 2015. Twenty-five patients with OSA were included in this study with prevalence of pulmonary hypertension of 16%. Univariate analysis of various factors revealed a statistically significant association between having the lowest SpO 2 of pulmonary hypertension (p = 0.016). There were no statistically significant associations between age, gender, smoking status, hypertension, body mass index (BMI), or apnea-hypopnea index (AHI) with occurrence of pulmonary hypertension. AHI is not a good predictor for pulmonary hypertension. The real value of using AHI to predict the health risk of OSA is doubtful. We recommend routine echocardiogram among OSA patient. The objective information in the echocardiogram provides evidence for counseling of patient with disease of OSA and hence hopefully can improve compliance of patient to treatment especially usage of CPAP.

Longitudinal associations between sleep and anxiety during pregnancy, and the moderating effect of resilience, using parallel process latent growth curve models.

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van der Zwan, Judith Esi; de Vente, Wieke; Tolvanen, Mimmi; Karlsson, Hasse; Buil, J Marieke; Koot, Hans M; Paavonen, E Juulia; Polo-Kantola, Päivi; Huizink, Anja C; Karlsson, Linnea

2017-12-01

For many women, pregnancy-related sleep disturbances and pregnancy-related anxiety change as pregnancy progresses and both are associated with lower maternal quality of life and less favorable birth outcomes. Thus, the interplay between these two problems across pregnancy is of interest. In addition, psychological resilience may explain individual differences in this association, as it may promote coping with both sleep disturbances and anxiety, and thereby reduce their mutual effects. Therefore, the aim of the current study was to examine whether sleep quality and sleep duration, and changes in sleep are associated with the level of and changes in anxiety during pregnancy. Furthermore, the study tested the moderating effect of resilience on these associations. At gestational weeks 14, 24, and 34, 532 pregnant women from the FinnBrain Birth Cohort Study in Finland filled out questionnaires on general sleep quality, sleep duration and pregnancy-related anxiety; resilience was assessed in week 14. Parallel process latent growth curve models showed that shorter initial sleep duration predicted a higher initial level of anxiety, and a higher initial anxiety level predicted a faster shortening of sleep duration. Changes in sleep duration and changes in anxiety over the course of pregnancy were not related. The predicted moderating effect of resilience was not found. The results suggested that pregnant women reporting anxiety problems should also be screened for sleeping problems, and vice versa, because women who experienced one of these pregnancy-related problems were also at risk of experiencing or developing the other problem. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of positive airway pressure therapy on cardiovascular and metabolic markers in males with obstructive sleep apnea.

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Feliciano, A; Oliveira, M J; Cysneiros, A; Martinho, C; Reis, R P; Penque, D; Pinto, P; Bárbara, C

Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular/metabolic complications. Some analytical parameters (homocysteine, glycemic and lipidic profiles) are recognized markers of these consequences. Limited data is available on the association of these markers and OSAS's severity/response to positive airway pressure therapy (PAP). In this prospective study we analyzed polysomnographic and analytical data of male patients admitted to sleep laboratory. The aim was to evaluate metabolic/cardiovascular markers in snorers and OSAS patients, to relate with sleep parameters and PAP response. One-hundred and three patients were included, and 73 (71%) were OSAS patients. OSAS patients were similar to snorers except for higher body mass index (BMI) and dyslipidemia. Severe OSAS patients showed higher glycemia, HbA1c, insulin, and insulin resistance, and lower HDL cholesterol in comparison to mild-moderate (pprofile and triglycerides were slightly correlated with OSAS severity. 46 OSAS patients were submitted to 6 months of PAP, with a statistical decrease in mean values of homocysteine, glycemia, total and LDL cholesterol (pprofiles changed significantly after 6 months of PAP therapy in OSAS, supporting its cardiovascular and metabolic protective effect. Our study has reinforced the importance of analytical cardiovascular/metabolic evaluation as complementary tool of diagnosis/treatment response in OSAS. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

[Obstructive sleep apnea syndrome. Analytical study of 63 cases].

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Battikh, Mohamed H; Joobeur, Sameh; Ben Sayeh, Mohamed M; Rouetbi, Naceur; Maatallah, Anis; Daami, Monia; el Kamel, Ali

2004-02-01

Obstructive sleep apnoea (OSA) is a relatively common disorder, in developed country with prevalence estimated to lie between 2 and 4% in adult population. The diagnosis of this syndrome is made on the basis of characteristic clinical features and the results of nocturnal polysomnography. There is no data concerning the OSA in developing country. It is therefore of interest to determine the clinic and polysomnographic profile of this disease and to landmark factors correlated with severity in our country. This was achieved by studying a set of 63 OSA. The mean of age was 53 + 13 years with sex ratio 1. The means of Epworth sleepiness scale score, BMI and Apnoea/Hypopnoea index (AHI) were respectively 16 + 4, 38.8 + 7 kg/m2 and 51.7 + 28.6. 44% of patients have OSA severe with IAH > 50/h. Arousal index and desaturation index were respectively 36.4 + 21.7 and 49 + 26. Trial of continuous positive airway pressure (CPAP) therapy was proposed first to 40 patients, 17 were able to use CPAP.

Wake and Sleep EEG in Patients With Huntington Disease: An eLORETA Study and Review of the Literature.

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Piano, Carla; Mazzucchi, Edoardo; Bentivoglio, Anna Rita; Losurdo, Anna; Calandra Buonaura, Giovanna; Imperatori, Claudio; Cortelli, Pietro; Della Marca, Giacomo

2017-01-01

The aim of the study was to evaluate the EEG modifications in patients with Huntington disease (HD) compared with controls, by means of the exact LOw REsolution Tomography (eLORETA) software. We evaluated EEG changes during wake, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Moreover, we reviewed the literature concerning EEG modifications in HD. Twenty-three consecutive adult patients affected by HD were enrolled, 14 women and 9 men, mean age was 57.0 ± 12.4 years. Control subjects were healthy volunteers (mean age 58.2 ± 14.6 years). EEG and polygraphic recordings were performed during wake (before sleep) and during sleep. Sources of EEG activities were determined using the eLORETA software. In wake EEG, significant differences between patients and controls were detected in the delta frequency band (threshold T = ±4.606; P < .01) in the Brodmann areas (BAs) 3, 4, and 6 bilaterally. In NREM sleep, HD patients showed increased alpha power (T = ±4.516; P < .01) in BAs 4 and 6 bilaterally; decreased theta power (T = ±4.516; P < .01) in the BAs 23, 29, and 30; and decreased beta power (T = ±4.516; P < .01) in the left BA 30. During REM, HD patients presented decreased theta and alpha power (threshold T = ±4.640; P < .01) in the BAs 23, 29, 30, and 31 bilaterally. In conclusion, EEG data suggest a motor cortex dysfunction during wake and sleep in HD patients, which correlates with the clinical and polysomnographic evidence of increased motor activity during wake and NREM, and nearly absent motor abnormalities in REM. © EEG and Clinical Neuroscience Society (ECNS) 2016.

Multiscale Entropy Analysis of Heart Rate Variability for Assessing the Severity of Sleep Disordered Breathing

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Wen-Yao Pan

2015-01-01

Full Text Available Obstructive sleep apnea (OSA is an independent cardiovascular risk factor to which autonomic nervous dysfunction has been reported to be an important contributor. Ninety subjects recruited from the sleep center of a single medical center were divided into four groups: normal snoring subjects without OSA (apnea hypopnea index, AHI < 5, n = 11, mild OSA (5 ≤ AHI < 15, n = 10, moderate OSA (15 ≤ AHI < 30, n = 24, and severe OSA (AHI ≥ 30, n = 45. Demographic (i.e., age, gender, anthropometric (i.e., body mass index, neck circumference, and polysomnographic (PSG data were recorded and compared among the different groups. For each subject, R-R intervals (RRI from 10 segments of 10-minute electrocardiogram recordings during non-rapid eye movement sleep at stage N2 were acquired and analyzed for heart rate variability (HRV and sample entropy using multiscale entropy index (MEI that was divided into small scale (MEISS, scale 1–5 and large scale (MEILS, scale 6–10. Our results not only demonstrated that MEISS could successfully distinguish normal snoring subjects and those with mild OSA from those with moderate and severe disease, but also revealed good correlation between MEISS and AHI with Spearman correlation analysis (r = −0.684, p < 0.001. Therefore, using the two parameters of EEG and ECG, MEISS may serve as a simple preliminary screening tool for assessing the severity of OSA before proceeding to PSG analysis.

Parietal Fast Sleep Spindle Density Decrease in Alzheimer's Disease and Amnesic Mild Cognitive Impairment

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Gorgoni, Maurizio; Lauri, Giulia; Truglia, Ilaria; Cordone, Susanna; Sarasso, Simone; Scarpelli, Serena; Mangiaruga, Anastasia; D'Atri, Aurora; Tempesta, Daniela; Ferrara, Michele; Marra, Camillo; Rossini, Paolo Maria; De Gennaro, Luigi

2016-01-01

Several studies have identified two types of sleep spindles: fast (13–15 Hz) centroparietal and slow (11–13 Hz) frontal spindles. Alterations in spindle activity have been observed in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). Only few studies have separately assessed fast and slow spindles in these patients showing a reduction of fast spindle count, but the possible local specificity of this phenomenon and its relation to cognitive decline severity are not clear. Moreover, fast and slow spindle density have never been assessed in AD/MCI. We have assessed fast and slow spindles in 15 AD patients, 15 amnesic MCI patients, and 15 healthy elderly controls (HC). Participants underwent baseline polysomnographic recording (19 cortical derivations). Spindles during nonrapid eye movements sleep were automatically detected, and spindle densities of the three groups were compared in the derivations where fast and slow spindles exhibited their maximum expression (parietal and frontal, resp.). AD and MCI patients showed a significant parietal fast spindle density decrease, positively correlated with Minimental State Examination scores. Our results suggest that AD-related changes in spindle density are specific for frequency and location, are related to cognitive decline severity, and may have an early onset in the pathology development. PMID:27066274

Clinical and Polysomnographic Comparison between Narcolepsy without Cataplexy and Idiopathic Hypersomnia

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Tae Won Kim

2012-10-01

Full Text Available Background and Objective The aim of this study is to compare the clinical, electrophysiological (Polysomnography, PSG; Multiple Sleep Latency Test, MSLT and biological data (HLA DQB1*0602 typing in idiopathic hypersomnia with narcolepsy without cataplexy. Methods 80 patients with narcolepsy without cataplexy and 71 patients with idiopathic hypersomnia without a long sleep time were recruited at the Sleep Center of St. Vincent’s Hospital. MSLT data and PSG findings from the time of their diagnosis were reviewed. HLA typing was performed. Results Results indicated that the idiopathic hypersomnia group showed a significant longer mean sleep latency in MSLT compared with the narcolepsy without cataplexy group. But there was no significant difference in the Epworth Sleepiness Scale (ESS scores between the two groups. Although HLA positivity of both groups was not statistically significant (p = 0.065, HLA positivity tended to be higher in the narcolepsy without cataplexy group than the idiopathic hypersomnia group. The number of awakenings was slightly higher in the idiopathic hypersomnia group, but there was no statistical significance. The number of spontaneous arousal and total arousal indices was not significantly different between the groups. For the PSG, the idiopathic hypersomnia group showed a significantly longer sleep latency than the narcolepsy without cataplexy group (p = 0.009. REM sleep latency (REML was significantly shorter in the narcolepsy without cataplexy group compared to the idiopathic hypersomnia group. The percentage of REM (SREM was significantly higher in the narcolepsy without cataplexy group, and the percentage of the wake time during sleep period (SWT was significantly lower in the narcolepsy without cataplexy group. Conclusions There were no significant differences of subjective sleep measures such as ESS, disturbed nocturnal sleep, number of naps, age of onset of hypnagogic hallucination, and age of onset of sleep

Sleep and sedation in the pediatric intensive care unit.

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Carno, Margaret-Ann; Connolly, Heidi V

2005-09-01

Sleep is an important and necessary function of the human body. Somatic growth and cellular repair occur during sleep. Critically ill children have disturbed sleep while in the pediatric intensive care unit related both to the illness itself and to light, noise, and caregiver activities disrupting an environment conducive to sleep. Medications administered in the pediatric intensive care unit can also disrupt sleep. This article reviews what is known about sleep in the pediatric intensive care unit and the effects of common sedation medications on sleep.

Sleep Sleeping Patch

Institute of Scientific and Technical Information of China (English)

2008-01-01

The Sleep Sleeping Patch is a new kind of external patch based on modern sleep medicine research achievements, which uses the internationally advanced transdermal therapeutic system (TTS). The Sleep Sleeping Patch transmits natural sleep inducers such as peppermint and liquorice extracts and melatonin through the skin to induce sleep. Clinical research proves that the Sleep Sleeping Patch can effectively improve insomnia and the quality of sleep. Highly effective: With the modern TTS therapy,

Effects of growth hormone-releasing hormone on sleep and brain interstitial fluid amyloid-β in an APP transgenic mouse model.

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Liao, Fan; Zhang, Tony J; Mahan, Thomas E; Jiang, Hong; Holtzman, David M

2015-07-01

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by impairment of cognitive function, extracellular amyloid plaques, intracellular neurofibrillary tangles, and synaptic and neuronal loss. There is substantial evidence that the aggregation of amyloid β (Aβ) in the brain plays a key role in the pathogenesis of AD and that Aβ aggregation is a concentration dependent process. Recently, it was found that Aβ levels in the brain interstitial fluid (ISF) are regulated by the sleep-wake cycle in both humans and mice; ISF Aβ is higher during wakefulness and lower during sleep. Intracerebroventricular infusion of orexin increased wakefulness and ISF Aβ levels, and chronic sleep deprivation significantly increased Aβ plaque formation in amyloid precursor protein transgenic (APP) mice. Growth hormone-releasing hormone (GHRH) is a well-documented sleep regulatory substance which promotes non-rapid eye movement sleep. GHRHR(lit/lit) mice that lack functional GHRH receptor have shorter sleep duration and longer wakefulness during light periods. The current study was undertaken to determine whether manipulating sleep by interfering with GHRH signaling affects brain ISF Aβ levels in APPswe/PS1ΔE9 (PS1APP) transgenic mice that overexpress mutant forms of APP and PSEN1 that cause autosomal dominant AD. We found that intraperitoneal injection of GHRH at dark onset increased sleep and decreased ISF Aβ and that delivery of a GHRH antagonist via reverse-microdialysis suppressed sleep and increased ISF Aβ. The diurnal fluctuation of ISF Aβ in PS1APP/GHRHR(lit/lit) mice was significantly smaller than that in PS1APP/GHRHR(lit/+) mice. However despite decreased sleep in GHRHR deficient mice, this was not associated with an increase in Aβ accumulation later in life. One of several possibilities for the finding is the fact that GHRHR deficient mice have GHRH-dependent but sleep-independent factors which protect against Aβ deposition. Copyright © 2014

Qualidade de sono e função pulmonar em adolescentes portadores de anemia falciforme clinicamente estáveis Quality of sleep and pulmonary function in clinically stable adolescents with sickle cell anemia

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Lisliê Capoulade Nogueira Arrais de Souza

2007-06-01

Full Text Available OBJETIVO: Avaliar a qualidade de sono e função pulmonar em adolescentes portadores de anemia falciforme (AF, clinicamente estáveis. MÉTODOS: Estudo trasversal descritivo de 50 pacientes portadores de AF submetidos a polissonografia noturna e espirometria no Hospital Universitário de Brasília. Analisamos dados antropométricos, polissonográficos e de função pulmonar. Dividimos os pacientes em dois grupos segundo a saturação periférica de oxigênio (SpO2 em sono com movimentos oculares rápidos (MOR: SpO2 93%. Realizamos estatística descritiva, teste t de Student, qui-quadrado e correlação de Pearson. RESULTADOS: A média de idade foi de 13,9 ± 2,5 anos. O tempo total de sono e percentagem do sono em MOR estavam diminuídos; dois pacientes (4% não apresentaram sono MOR. Latência de sono MOR, número de despertares, movimentação em sono, mudança de estágio, índice de distúrbios respiratórios e índice de apnéia obstrutiva estavam aumentados. Entre os dois grupos, houve diferenças estatisticamente significativas na maioria das variáveis polissonográficas. A SpO2 em sono MOR correlacionou-se de forma forte e positiva com a SpO2 em vigília, bem como com a SpO2 em sono não-MOR; e correlacionou-se de forma forte e negativa com a percentagem do tempo total de sono em que a SPO2 foi OBJECTIVE: To evaluate quality of sleep and pulmonary function in clinically stable adolescents with sickle cell anemia (SCA. METHODS: A cross-sectional descriptive study involving 50 patients with SCA submitted to nocturnal polysomnography and spirometry at the Brasília University Hospital. Anthropometric, polysomnographic and pulmonary function data were analyzed. Patients were divided into two groups according to oxygen saturation by pulse oximetry (SpO2 during rapid eye movement (REM sleep: SpO2 93%. Descriptive statistics, Student's t-test, chi-square test and Pearson's correlation coefficient were used. RESULTS: Mean age was 13.9 ± 2

Feeding methods, sleep arrangement, and infant sleep patterns: a Chinese population-based study.

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Huang, Xiao-Na; Wang, Hui-Shan; Chang, Jen-Jen; Wang, Lin-Hong; Liu, Xi-Cheng; Jiang, Jing-Xiong; An, Lin

2016-02-01

Findings from prior research into the effect of feeding methods on infant sleep are inconsistent. The objectives of this study were to examine infants' sleep patterns by feeding methods and sleep arrangement from birth to eight months old. This longitudinal cohort study enrolled 524 pregnant women at 34-41 weeks of gestation and their infants after delivery in 2006 and followed up until eight months postpartum. The study subjects were recruited from nine women and children hospitals in nine cities in China (Beijing, Chongqing, Wuhan, Changsha, Nanning, Xiamen, Xi'an, Jinan, and Hailin). Participating infants were followed up weekly during the first month and monthly from the second to the eighth month after birth. Twenty-four hour sleep diaries recording infants' sleeping and feeding methods were administered based on caregiver's self-report. Multivariable mixed growth curve models were fitted to estimate the effects of feeding methods and sleep arrangement on infants' sleep patterns over time, controlling for maternal and paternal age, maternal and paternal education level, household income, supplementation of complementary food, and infant birth weight and length. Exclusively formula fed infants had the greatest sleep percentage/24 h, followed by exclusively breast milk fed infants and partially breast milk fed infants (Psleep percentage and night waking frequency between exclusively formula and exclusively breast milk fed infants weakened over time as infants developed. In addition, compared to infants with bed-sharing sleep arrangement, those with room sharing sleep arrangement had greater daytime and 24-hour infant sleep percentage, whereas those with sleeping alone sleep arrangement had greater nighttime sleep percentage. Our data based on caregiver's self-report suggested that partial breastfeeding and bed-sharing may be associated with less sleep in infants. Health care professionals need to work with parents of newborns to develop coping strategies that

BDNF in sleep, insomnia, and sleep deprivation.

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Schmitt, Karen; Holsboer-Trachsler, Edith; Eckert, Anne

2016-01-01

The protein brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family of growth factors involved in plasticity of neurons in several brain regions. There are numerous evidence that BDNF expression is decreased by experiencing psychological stress and that, accordingly, a lack of neurotrophic support causes major depression. Furthermore, disruption in sleep homeostatic processes results in higher stress vulnerability and is often associated with stress-related mental disorders. Recently, we reported, for the first time, a relationship between BDNF and insomnia and sleep deprivation (SD). Using a biphasic stress model as explanation approach, we discuss here the hypothesis that chronic stress might induce a deregulation of the hypothalamic-pituitary-adrenal system. In the long-term it leads to sleep disturbance and depression as well as decreased BDNF levels, whereas acute stress like SD can be used as therapeutic intervention in some insomniac or depressed patients as compensatory process to normalize BDNF levels. Indeed, partial SD (PSD) induced a fast increase in BDNF serum levels within hours after PSD which is similar to effects seen after ketamine infusion, another fast-acting antidepressant intervention, while traditional antidepressants are characterized by a major delay until treatment response as well as delayed BDNF level increase. Key messages Brain-derived neurotrophic factor (BDNF) plays a key role in the pathophysiology of stress-related mood disorders. The interplay of stress and sleep impacts on BDNF level. Partial sleep deprivation (PSD) shows a fast action on BDNF level increase.

Increased neck soft tissue mass and worsening of obstructive sleep apnea after growth hormone treatment in men with abdominal obesity

DEFF Research Database (Denmark)

Karimi, Mahssa; Koranyi, Josef; Franco, Celina

2010-01-01

Risk factors for obstructive sleep apnea (OSA) are male gender, obesity and abnormalities in neck soft tissue mass. OSA is associated with both growth hormone (GH) excess and severe GH deficiency in adults. Adults with abdominal obesity have markedly suppressed GH secretion....

Associations between period 3 gene polymorphisms and sleep- /chronotype-related variables in patients with late-life insomnia.

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Mansour, Hader A; Wood, Joel; Chowdari, Kodavali V; Tumuluru, Divya; Bamne, Mikhil; Monk, Timothy H; Hall, Martica H; Buysse, Daniel J; Nimgaonkar, Vishwajit L

2017-01-01

A variable number tandem repeat polymorphism (VNTR) in the period 3 (PER3) gene has been associated with heritable sleep and circadian variables, including self-rated chronotypes, polysomnographic (PSG) variables, insomnia and circadian sleep-wake disorders. This report describes novel molecular and clinical analyses of PER3 VNTR polymorphisms to better define their functional consequences. As the PER3 VNTR is located in the exonic (protein coding) region of PER3, we initially investigated whether both alleles (variants) are transcribed into messenger RNA in human fibroblasts. The VNTR showed bi-allelic gene expression. We next investigated genetic associations in relation to clinical variables in 274 older adult Caucasian individuals. Independent variables included genotypes for the PER3 VNTR as well as a representative set of single nucleotide polymorphisms (SNPs) that tag common variants at the PER3 locus (linkage disequilibrium (LD) between genetic variants sleep time and sleep latency, self-rated chronotype, estimated with the Composite Scale (CS), and lifestyle regularity, estimated using the social rhythm metric (SRM). Initially, genetic polymorphisms were individually analyzed in relation to each outcome variable using analysis of variance (ANOVA). Nominally significant associations were further tested using regression analyses that incorporated individual ANOVA-associated DNA variants as potential predictors and each of the selected sleep/circadian variables as outcomes. The covariates included age, gender, body mass index and an index of medical co-morbidity. Significant genetic associations with the VNTR were not detected with the sleep or circadian variables. Nominally significant associations were detected between SNP rs1012477 and CS scores (p = 0.003) and between rs10462021 and SRM (p = 0.047); rs11579477 and average delta power (p = 0.043) (analyses uncorrected for multiple comparisons). In conclusion, alleles of the VNTR are expressed at the

Avaliação clínica e polissonográfica do aparelho BRD no tratamento da Síndrome da Apneia Obstrutiva do Sono Clinical and polysomnographic assessment of Obstructive Sleep Apnea Syndrome treatment with BRD appliance

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Cibele Dal-Fabbro

2010-02-01

Full Text Available OBJETIVOS: este trabalho de pesquisa teve o intuito de realizar uma avaliação clínica e polissonográfica do efeito de um aparelho intraoral (AIO para tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS, desenvolvido e testado por duas universidades federais brasileiras. MÉTODOS: a amostra constou de 50 pacientes (idades entre 18 e 65 anos, sendo 33 homens e 17 mulheres com diagnóstico polissonográfico inicial de SAOS de grau leve e moderado. Todos os pacientes submeteram-se a uma nova avaliação polissonográfica de noite inteira (em uso do AIO aproximadamente 6 meses após a primeira avaliação. Baseado na diminuição dos eventos respiratórios obstrutivos, obtida com o uso do AIO, os pacientes foram então divididos em bons respondedores (redução de 50% ou mais no índice de apneia e hipopneia (IAH, permanecendo abaixo de 10 eventos/hora e maus respondedores (IAH permanecendo maior ou igual a 10 eventos/hora. RESULTADOS E CONCLUSÕES: em 54% da amostra o IAH diminuiu para menos de cinco eventos/hora com o uso do AIO; em 38% a redução do IAH foi maior do que 50%, mas permaneceu acima de cinco eventos/hora; e em 6% da amostra o IAH reduziu menos que 50%. Os bons respondedores corresponderam a 86% da amostra estudada, enquanto os maus respondedores a 14%. Houve melhora significativa na escala de sonolência, no IAH, nos microdespertares e na saturação mínima de oxihemoglobina com a terapia utilizada. O Índice de Massa Corpórea elevado parece interferir desfavoravelmente no desempenho do aparelho em estudo.OBJECTIVES: The current investigation aimed to carry out a clinical and polysomnographic assessment of treatment of Obstructive Sleep Apnea Syndrome (OSAS with an oral appliance (OA developed and tested by two Brazilian federal universities. METHODOLOGY: The sample was composed of 50 patients (aged between 18 and 65 years, 33 men and 17 women with initial polysomnographic diagnosis of light to moderate OSAS. All

The correlation of anxiety and depression with obstructive sleep apnea syndrome

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Fariborz Rezaeitalab

2014-01-01

Full Text Available Background: Obstructive sleep apnea syndrome (OSAS is a common sleep disorder characterized by repeated upper airway obstruction during sleep. While respiratory pauses followed by loud snoring and daytime sleepiness are the main symptoms of OSAS, the patients may complain from sleep disruption, headache, mood disturbance, irritability, and memory impairment. However, the association of sleep apnea with anxiety and depression is not completely understood. Adherence to continuous positive airway pressure (CPAP, the treatment of choice for OSAS, may be influenced by psychological conditions, especially claustrophobia. The aim of this study was to evaluate the association of OSAS with anxiety and depression symptoms. This study also investigated the association of anxiety with body mass index (BMI and the severity of OSAS. Materials and Methods: We conducted a cross-sectional study on 178 adult individuals diagnosed with OSAS at the sleep laboratory between September 2008 and May 2012. The participants were interviewed according to a checklist regarding both their chief complaints and other associated symptoms. The psychological status was assessed according to Beck anxiety inventory (BAI and Beck depression inventory (BDI scoring. The severity of breathing disorder was classified as mild, moderate, and severe based on apnea-hypopnea index (AHI which was ascertained by overnight polysomnography. Daytime sleepiness was assessed by Epworth sleepiness scale (ESS. Results: The mean (SD age of participants was 50.33 years. In terms of sex, 85.5% of the study population were males and14.4% were females. We found no relation between sex and the symptoms of OSAS. Regarding the frequency of anxiety and depression symptoms, 53.9% of the individuals had some degree of anxiety, while 46.1% demonstrated depressive symptoms. In terms of OSAS severity, this study showed that OSAS severity was associated with the frequency of anxiety, chocking, and sleepiness (P

Aircraft noise effects on sleep: a systematic comparison of EEG awakenings and automatically detected cardiac activations

International Nuclear Information System (INIS)

Basner, Mathias; Müller, Uwe; Elmenhorst, Eva-Maria; Kluge, Götz; Griefahn, Barbara

2008-01-01

Polysomnography is the gold standard for investigating noise effects on sleep, but data collection and analysis are sumptuous and expensive. We recently developed an algorithm for the automatic identification of cardiac activations associated with cortical arousals, which uses heart rate information derived from a single electrocardiogram (ECG) channel. We hypothesized that cardiac activations can be used as estimates for EEG awakenings. Polysomnographic EEG awakenings and automatically detected cardiac activations were systematically compared using laboratory data of 112 subjects (47 male, mean ± SD age 37.9 ± 13 years), 985 nights and 23 855 aircraft noise events (ANEs). The probability of automatically detected cardiac activations increased monotonically with increasing maximum sound pressure levels of ANEs, exceeding the probability of EEG awakenings by up to 18.1%. If spontaneous reactions were taken into account, exposure–response curves were practically identical for EEG awakenings and cardiac activations. Automatically detected cardiac activations may be used as estimates for EEG awakenings. More investigations are needed to further validate the ECG algorithm in the field and to investigate inter-individual differences in its ability to predict EEG awakenings. This inexpensive, objective and non-invasive method facilitates large-scale field studies on the effects of traffic noise on sleep

Physiology of Normal Sleep: From Young to Old

Directory of Open Access Journals (Sweden)

V Mohan Kumar

2014-03-01

Full Text Available Human sleep, defined on the basis of electroencephalogram (EEG, electromyogram(EMG and electrooculogram (EOG, is divided into rapid eye movement (REM sleepand four stages of non–rapid eye movement (NREM sleep. Collective monitoring andrecording of physiological data during sleep is called polysomnography. Sleep whichnormally starts with a period of NREM alternates with REM, about 4-5 times, everynight. Sleep pattern changes with increasing age. Newborns sleep for about 14-16hours in a day of 24 hours. Although there is a wide variation among individuals, sleepof 7-8.5 hours is considered fully restorative in adults. Apart from restorative andrecovery function, energy conservation could be one of the functions of sleep. The roleof sleep in neurogenesis, memory consolidation and brain growth has been suggested.Though progress in medical science has vastly improved our understanding of sleepphysiology, we still do not know all the functions of sleep.Key words : electroencephalogram, electromyogram, electrooculogram,polysomnography, REM sleep, non–REM sleep, newborns, circadian rhythm, autoregulation,sleep function

Duration of sleep inertia after napping during simulated night work and in extended operations.

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Signal, Tracey Leigh; van den Berg, Margo J; Mulrine, Hannah M; Gander, Philippa H

2012-07-01

Due to the mixed findings of previous studies, it is still difficult to provide guidance on how to best manage sleep inertia after waking from naps in operational settings. One of the few factors that can be manipulated is the duration of the nap opportunity. The aim of the present study was to investigate the magnitude and time course of sleep inertia after waking from short (20-, 40- or 60-min) naps during simulated night work and extended operations. In addition, the effect of sleep stage on awakening and duration of slow wave sleep (SWS) on sleep inertia was assessed. Two within-subject protocols were conducted in a controlled laboratory setting. Twenty-four healthy young men (Protocol 1: n = 12, mean age = 25.1 yrs; Protocol 2: n = 12, mean age = 23.2 yrs) were provided with nap opportunities of 20-, 40-, and 60-min (and a control condition of no nap) ending at 02:00 h after ∼20 h of wakefulness (Protocol 1 [P1]: simulated night work) or ending at 12:00 h after ∼30 h of wakefulness (Protocol 2 [P2]: simulated extended operations). A 6-min test battery, including the Karolinska Sleepiness Scale (KSS) and the 4-min 2-Back Working Memory Task (WMT), was repeated every 15 min the first hour after waking. Nap sleep was recorded polysomnographically, and in all nap opportunities sleep onset latency was short and sleep efficiency high. Mixed-model analyses of variance (ANOVA) for repeated measures were calculated and included the factors time (time post-nap), nap opportunity (duration of nap provided), order (order in which the four protocols were completed), and the interaction of these terms. Results showed no test x nap opportunity effect (i.e., no effect of sleep inertia) on KSS. However, WMT performance was impaired (slower reaction time, fewer correct responses, and increased omissions) on the first test post-nap, primarily after a 40- or 60-min nap. In P2 only, performance improvement was evident 45 min post-awakening for naps of 40 min or more. In ANOVAs

A Data-Driven Analysis of the Rules Defining Bilateral Leg Movements during Sleep.

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Ferri, Raffaele; Manconi, Mauro; Rundo, Francesco; Zucconi, Marco; Aricò, Debora; Bruni, Oliviero; Ferini-Strambi, Luigi; Fulda, Stephany

2016-02-01

The aim of this study was to describe and analyze the association between bilateral leg movements (LMs) during sleep in subjects with restless legs syndrome (RLS), in order to eventually support or challenge the current scoring rules defining bilateral LMs. Polysomnographic recordings of 100 untreated patients with RLS (57 women and 43 males, mean age 57 y) were included. In each recording, we selected as reference all LMs that occurred during sleep and that were separated from another ipsilateral LM by at least 10 sec of EMG inactivity. For each reference LM and an evaluation interval from 5 sec before the onset to 5 sec after the offset of the reference LM, we evaluated (1) the presence or absence of contralateral leg movement activity and (2) the distribution of the onset-to-onset and (3) the offset-to-onset differences between bilateral LMs. We selected a mean of 368 (± 222 standard deviation [SD]) reference LMs per subject. For 42% (± 22%) of the reference LMs no contralateral leg movement activity was observed within the evaluation interval. In 55% (± 22%) exactly one and in 3% (± 2%) more than one contralateral LM was observed. A further evaluation of events where exactly one contralateral LM was observed showed that in most (1) the two LMs were overlapping (93% ± 9% SD) and (2) were classified as bilateral according to the World Association of Sleep Medicine and the International Restless Legs Syndrome Study Group (WASM/ IRLSSG) (96% ± 6% SD) and (3) the American Academy of Sleep Medicine scoring rules (99% ± 2% SD). Although there was a systematic and statistically significant difference in standard LM indices during sleep based on the two different definitions of bilateral LMs, the size of the difference was not clinically meaningful (maximum individual, absolute difference in LM indices ± 2.5). In addition, we found that the duration of LMs within bilateral LM pairs was longer compared to monolateral LMs and that the duration of the single LMs in

Sleep extension increases IGF-I concentrations before and during sleep deprivation in healthy young men.

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Chennaoui, Mounir; Arnal, Pierrick J; Drogou, Catherine; Sauvet, Fabien; Gomez-Merino, Danielle

2016-09-01

Sleep deprivation is known to suppress circulating trophic factors such as insulin-like growth factor (IGF)-I and brain-derived neurotrophic factor (BDNF). This experiment examined the effect of an intervention involving 6 nights of extended sleep before total sleep deprivation on this catabolic profile. In a randomized crossover design, 14 young men (age range: 26-37 years) were either in an extended (EXT; time in bed: 2100-0700 h) or habitual (HAB: 2230-0700 h) sleep condition, followed by 3 days in the laboratory with blood sampling at baseline (B), after 24 h of sleep deprivation (24h-SD), and after 1 night of recovery sleep (R). In the EXT condition compared with the HAB condition, free IGF-I levels were significantly higher at B, 24h-SD, and R (P sleep deprivation was for insulin levels, which were significantly higher after R compared with B. In a healthy adult, additional sleep over 1 week increased blood concentrations of the anabolic factor IGF-I before and during 24 h of sleep deprivation and after the subsequent recovery night without effects on BDNF. With further research, these findings may prove to be important in guiding effective lifestyle modifications to limit physical or cognitive deficits associated with IGF-I decrease with age.

TST, as a polysomnographic variable, is superior to the apnea hypopnea index for evaluating intermittent hypoxia in severe obstructive sleep apnea.

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Zhang, Xiao-Bin; Zen, Hui-Qing; Lin, Qi-Chang; Chen, Gong-Ping; Chen, Li-Da; Chen, Hua

2014-10-01

The polysomnography (PSG) index of the apnea hypopnea index (AHI) is considered the 'gold standard' for stratifying the severity of obstructive sleep apnea (OSA). However, AHI cannot reflect the true characteristic of chronic intermittent hypoxia (CIH), which may trigger systemic inflammation in some OSA patients. High-sensitivity C-reactive protein (hsCRP) is considered a biomarker of systemic inflammation in OSA patients. The aim of the present study was to evaluate the relationship between PSG variables and hsCRP in men with severe OSA. Men with severe OSA (AHI ≥ 30 events/h) diagnosed by PSG were enrolled. AHI and body mass index were matched between a high hsCRP group (hsCRP ≥ 3.0 mg/L) and a low hsCRP group. A blood sample was taken for serum hsCRP analysis. Multiple regression analysis was performed to assess independent predictors of high hsCRP. One hundred and fifty-two subjects were enrolled in the study (76 in each group). Mean serum hsCRP was 3.76 ± 2.13 mg/L. The mean percentage of total sleep time spent with SaO2 hypoxia variables.

The effect of exogenous cortisol during sleep on the behavioral and neural correlates of emotional memory consolidation in humans.

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van Marle, Hein J F; Hermans, Erno J; Qin, Shaozheng; Overeem, Sebastiaan; Fernández, Guillén

2013-09-01

A host of animal work demonstrates that the retention benefit for emotionally aversive over neutral memories is regulated by glucocorticoid action during memory consolidation. Particularly, glucocorticoids may affect systems-level processes that promote the gradual reorganization of emotional memory traces. These effects remain largely uninvestigated in humans. Therefore, in this functional magnetic resonance imaging study we administered hydrocortisone during a polysomnographically monitored night of sleep directly after healthy volunteers studied negative and neutral pictures in a double-blind, placebo-controlled, between-subjects design. The following evening memory consolidation was probed during a recognition memory test in the MR scanner by assessing the difference in brain activity associated with memory for the consolidated items studied before sleep and new, unconsolidated items studied shortly before test (remote vs. recent memory paradigm). Hydrocortisone administration resulted in elevated cortisol levels throughout the experimental night with no group difference at recent encoding or test. Behaviorally, we showed that cortisol enhanced the difference between emotional and neutral consolidated memory, effectively prioritizing emotional memory consolidation. On a neural level, we found that cortisol reduced amygdala reactivity related to the retrieval of these same consolidated, negative items. These findings show that cortisol administration during first post-encoding sleep had a twofold effect on the first 24h of emotional memory consolidation. While cortisol prioritized recognition memory for emotional items, it reduced reactivation of the neural circuitry underlying emotional responsiveness during retrieval. These findings fit recent theories on emotional depotentiation following consolidation during sleep, although future research should establish the sleep-dependence of this effect. Moreover, our data may shed light on mechanisms underlying

The effect of dim light at night on cerebral hemodynamic oscillations during sleep: A near-infrared spectroscopy study.

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Kim, Tae-Joon; Lee, Byeong Uk; Sunwoo, Jun-Sang; Byun, Jung-Ick; Moon, Jangsup; Lee, Soon-Tae; Jung, Keun-Hwa; Chu, Kon; Kim, Manho; Lim, Jong-Min; Lee, Eunil; Lee, Sang Kun; Jung, Ki-Young

2017-01-01

Recent studies have reported that dim light at night (dLAN) is associated with risks of cardiovascular complications, such as hypertension and carotid atherosclerosis; however, little is known about the underlying mechanism. Here, we evaluated the effect of dLAN on the cerebrovascular system by analyzing cerebral hemodynamic oscillations using near-infrared spectroscopy (NIRS). Fourteen healthy male subjects underwent polysomnography coupled with cerebral NIRS. The data collected during sleep with dim light (10 lux) were compared with those collected during sleep under the control dark conditions for the sleep structure, cerebral hemodynamic oscillations, heart rate variability (HRV), and their electroencephalographic (EEG) power spectrum. Power spectral analysis was applied to oxy-hemoglobin concentrations calculated from the NIRS signal. Spectral densities over endothelial very-low-frequency oscillations (VLFOs) (0.003-0.02 Hz), neurogenic VLFOs (0.02-0.04 Hz), myogenic low-frequency oscillations (LFOs) (0.04-0.15 Hz), and total LFOs (0.003-0.15 Hz) were obtained for each sleep stage. The polysomnographic data revealed an increase in the N2 stage under the dLAN conditions. The spectral analysis of cerebral hemodynamics showed that the total LFOs increased significantly during slow-wave sleep (SWS) and decreased during rapid eye movement (REM) sleep. Specifically, endothelial (median of normalized value, 0.46 vs. 0.72, p = 0.019) and neurogenic (median, 0.58 vs. 0.84, p = 0.019) VLFOs were enhanced during SWS, whereas endothelial VLFOs (median, 1.93 vs. 1.47, p = 0.030) were attenuated during REM sleep. HRV analysis exhibited altered spectral densities during SWS induced by dLAN, including an increase in very-low-frequency and decreases in low-frequency and high-frequency ranges. In the EEG power spectral analysis, no significant difference was detected between the control and dLAN conditions. In conclusion, dLAN can disturb cerebral hemodynamics via the

A three-phase epidemiological study of short and long sleepers in a middle-aged Chinese population: prevalence and characteristics

International Nuclear Information System (INIS)

Hao, Y.L.; Zhang, B.; Jia, F.J.; Li, X.L.; Tang, Y.; Ren, Y.Z.; Liu, W.H.

2014-01-01

Epidemiological studies of short and long sleepers have not been conducted previously. We collected socioeconomic, psychological, and polysomnographic characteristics of 6501 parents (3252 men and 3249 women) of 4036 primary school children in Guangzhou city. The study data were collected in three phases. The overall prevalence of short (5 h or less) and long (10 h or more) sleep duration was 0.52 and 0.64%, respectively. Long sleepers had higher Eysenck Personality Questionnaire neuroticism scores [odds ratio (OR)=1.224, 95% confidence interval (CI)=1.047-1.409] and lower education levels (OR=0.740, 95%CI=0.631-0.849) than short sleepers. In the polysomnographic assessment, short, long, and normal sleepers (7-8 h) shared similar durations of Stage 3 sleep (short=25.7±10.7, long=20.3±7.9, and normal=28.0±12.8 min, F=1.402, P=0.181). In daytime multiple sleep latency tests, short sleepers (10/19, 52.6%) were more prone to have a short sleep latency (≤8 min) than long sleepers (2/23, 8.7%). In addition to different sleep durations, neuroticism might also contribute to differences between short and long sleepers in social achievements. Stage 3 sleep might be essential for humans. The short sleep latency (≤8 min) of short sleepers in multiple sleep latency tests should be interpreted cautiously, since it was of the same severity as required for a diagnosis of narcolepsy or idiopathic hypersomnia

A three-phase epidemiological study of short and long sleepers in a middle-aged Chinese population: prevalence and characteristics

Energy Technology Data Exchange (ETDEWEB)

Hao, Y.L. [Department of Human Anatomy, Guangzhou Medical University, Guangzhou, China, Department of Human Anatomy, Guangzhou Medical University, Guangzhou (China); Zhang, B.; Jia, F.J.; Li, X.L.; Tang, Y. [Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guangzhou, China, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guangzhou (China); Ren, Y.Z. [Zhongshan The Third People' s Hospital, Zhongshan, China, Zhongshan The Third People' s Hospital, Zhongshan (China); Liu, W.H. [Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guangzhou, China, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guangzhou (China)

2014-02-17

Epidemiological studies of short and long sleepers have not been conducted previously. We collected socioeconomic, psychological, and polysomnographic characteristics of 6501 parents (3252 men and 3249 women) of 4036 primary school children in Guangzhou city. The study data were collected in three phases. The overall prevalence of short (5 h or less) and long (10 h or more) sleep duration was 0.52 and 0.64%, respectively. Long sleepers had higher Eysenck Personality Questionnaire neuroticism scores [odds ratio (OR)=1.224, 95% confidence interval (CI)=1.047-1.409] and lower education levels (OR=0.740, 95%CI=0.631-0.849) than short sleepers. In the polysomnographic assessment, short, long, and normal sleepers (7-8 h) shared similar durations of Stage 3 sleep (short=25.7±10.7, long=20.3±7.9, and normal=28.0±12.8 min, F=1.402, P=0.181). In daytime multiple sleep latency tests, short sleepers (10/19, 52.6%) were more prone to have a short sleep latency (≤8 min) than long sleepers (2/23, 8.7%). In addition to different sleep durations, neuroticism might also contribute to differences between short and long sleepers in social achievements. Stage 3 sleep might be essential for humans. The short sleep latency (≤8 min) of short sleepers in multiple sleep latency tests should be interpreted cautiously, since it was of the same severity as required for a diagnosis of narcolepsy or idiopathic hypersomnia.

From Sleep Duration to Childhood Obesity

DEFF Research Database (Denmark)

Börnhorst, Claudia; Hense, Sabrina; Ahrens, Wolfgang

2012-01-01

Sleep duration has been identified as risk factor for obesity already in children. Besides investigating the role of fat mass (FM), this study addressed the question whether endocrine mechanisms act as intermediates in the association between sleep duration and overweight/obesity. Within...... the framework of the IDEFICS study, the present research was conducted in 609 German resident children aged 2–9 years with information on fasting insulin, C-reactive protein and cortisol levels next to anthropometric measurements and parental questionnaires. Emphasising methodological aspects, an age......-specific measure of sleep duration was derived to account for alteration in sleep duration during childhood/period of growth. Multivariate linear regression and quantile regression models confirmed an inverse relationship between sleep duration and measures of overweight/obesity. The estimate for the association...

The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review

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Kastoer, Chloé; Dieltjens, Marijke; Oorts, Eline; Hamans, Evert; Braem, Marc J.; Van de Heyning, Paul H.; Vanderveken, Olivier M.

2016-01-01

Study Objectives: To perform a review of the current evidence regarding the use of a remotely controlled mandibular positioner (RCMP) and to analyze the efficacy of RCMP as a predictive selection tool in the treatment of obstructive sleep apnea (OSA) with oral appliances that protrude the mandible (OAm), exclusively relying on single-night RCMP titration. Methods: An extensive literature search is performed through PubMed.com, Thecochranelibrary.com (CENTRAL only), Embase.com, and recent conference meeting abstracts in the field. Results: A total of 254 OSA patients from four full-text articles and 5 conference meeting abstracts contribute data to the review. Criteria for successful RCMP test and success with OAm differed between studies. Study populations were not fully comparable due to range-difference in baseline apneahypopnea index (AHI). However, in all studies elimination of airway obstruction events during sleep by RCMP titration predicted OAm therapy success by the determination of the most effective target protrusive position (ETPP). A statistically significant association is found between mean AHI predicted outcome with RCMP and treatment outcome with OAm on polysomnographic or portable sleep monitoring evaluation (p titration of the mandible: a systematic review. J Clin Sleep Med 2016;12(10):1411–1421. PMID:27568892

Influence of uvulopalatopharyngoplasty on alpha-EEG arousals in nonapnoeic snorers.

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Boudewyns, A; De Cock, W; Willemen, M; Wagemans, M; De Backer, W; Van de Heyning, P H

1997-01-01

Arousals are more numerous in heavy snorers than in nonsnorers and might be a cause of excessive daytime sleepiness (EDS) in these patients. The present study investigated whether treatment of snoring by uvulopalatopharyngoplasty (UPPP) had an influence on sleep microstructure in nonapnoeic snorers. The polysomnographic records of 10 nonapnoeic snorers were reviewed retrospectively and arousals scored according to the American Sleep Disorders Association (ASDA) 3 s definition. Scores for snoring, EDS and polysomnographic data were compared before and after UPPP (mean (+/-SD) time interval 249 +/- 183 days). UPPP resulted in a subjective improvement of snoring and a significant decrease in the arousal index (mean 14.6, 95% confidence interval (95% CI) 8.5-20.8 vs mean 9.1, 95% CI 6.6-11.5) (p = 0.01). EDS and the amount of slow-wave sleep remained unchanged. Uvulopalatopharyngoplasty resulted in an improvement of subjective snoring and a significant decrease of arousals in nonapnoeic snorers. Although these data do not provide any insight into whether the improvement observed can be maintained on a long-term basis, uvulopalatopharyngoplasty can be considered as a useful treatment modality to reduce sleep fragmentation and snoring in nonapnoeic snorers.

Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy

DEFF Research Database (Denmark)

Luca, Gianina; Haba-Rubio, José; Dauvilliers, Yves

2013-01-01

diagnosed according to International Classification of Sleep Disorders-2. Demographic and clinical characteristics, polysomnography and multiple sleep latency test data, hypocretin-1 levels, and genome-wide genotypes were available. We found a significantly lower age at sleepiness onset (men versus women...

Sleep bruxism and myofascial temporomandibular disorders

Science.gov (United States)

Raphael, Karen G.; Sirois, David A.; Janal, Malvin N.; Wigren, Pia E.; Dubrovsky, Boris; Nemelivsky, Lena V.; Klausner, Jack J.; Krieger, Ana C.; Lavigne, Gilles J.

2015-01-01

Background Many dentists believe that sleep bruxism (SB) is a pathogenic factor in myofascial temporomandibular disorder (TMD), but almost all supportive data rely on patients’ self-reports rather than on direct observation. Methods The authors administered a structured self-report interview to determine whether a large and well-characterized sample of patients with myofascial TMD (124 women) experienced SB more often than did matched control participants (46 women). The authors then used data from a two-night laboratory-based polysomnographic (PSG) study to determine whether the case participants exhibited more SB than the control participants. Results The results of independent sample t tests and χ2 analyses showed that, although self-reported rates of SB were significantly higher in case participants (55.3 percent) than in control participants (15.2 percent), PSG-based measures showed much lower and statistically similar rates of SB in the two groups (9.7 percent and 10.9 percent, respectively). Grinding noises were common in both case participants (59.7 percent) and control participants (78.3 percent). Conclusions Most case participants did not exhibit SB, and the common belief that SB is a sufficient explanation for myofascial TMD should be abandoned. Clinical Implications Although other reasons to consider treating SB may exist, misplaced concern about SB’s sustaining or exacerbating a chronic myofascial TMD condition should not be used to justify SB treatment. PMID:23115152

Sleep and aggression in substance-abusing adolescents: results from an integrative behavioral sleep-treatment pilot program.

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Haynes, Patricia L; Bootzin, Richard R; Smith, Leisha; Cousins, Jennifer; Cameron, Michael; Stevens, Sally

2006-04-01

To examine whether change in total sleep time during an integrative, behavioral sleep intervention is associated with aggression. Specifically, we tested whether adolescents who reported experiencing aggressive thoughts or actions after treatment had worse treatment trajectories (e.g., less total sleep time across treatment) than adolescents with no aggressive thoughts or actions after treatment. Nonpharmacologic open trial with 9 weeks of weekly assessment. University of Arizona Sleep Research Laboratory Twenty-three adolescents recently treated for substance abuse in outpatient community centers. Six-week integrative, behavioral sleep intervention. Weekly sleep-summary indexes were calculated from daily sleep diaries and entered as dependent variables in a series of growth-curve analyses. Statistically significant Session x Post-treatment Aggressive Ideation interactions emerged when predicting changes in total sleep time, gamma13 = 9.76 (SE = 4.12), p aggressive ideation and the frequency of substance use, as assessed at baseline. A similar pattern of results was seen for self-reported aggressive actions occurring during conflicts. These pilot data suggest that inadequate sleep in substance-abusing adolescents may contribute to the experiencing of aggressive thoughts and actions. Limitations include a small sample size and a restricted assessment of aggression. Nonetheless, these findings lend preliminary support to the breadth of therapeutic effectiveness of an integrative, behavioral sleep-therapy program for adolescents with a history of substance abuse and related behaviors.

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep

Science.gov (United States)

McGuire, Sarah

2018-01-01

To evaluate the quality of available evidence on the effects of environmental noise exposure on sleep a systematic review was conducted. The databases PSYCINFO, PubMed, Science Direct, Scopus, Web of Science and the TNO Repository were searched for non-laboratory studies on the effects of environmental noise on sleep with measured or predicted noise levels and published in or after the year 2000. The quality of the evidence was assessed using GRADE criteria. Seventy four studies predominately conducted between 2000 and 2015 were included in the review. A meta-analysis of surveys linking road, rail, and aircraft noise exposure to self-reports of sleep disturbance was conducted. The odds ratio for the percent highly sleep disturbed for a 10 dB increase in Lnight was significant for aircraft (1.94; 95% CI 1.61–2.3), road (2.13; 95% CI 1.82–2.48), and rail (3.06; 95% CI 2.38–3.93) noise when the question referred to noise, but non-significant for aircraft (1.17; 95% CI 0.54–2.53), road (1.09; 95% CI 0.94–1.27), and rail (1.27; 95% CI 0.89–1.81) noise when the question did not refer to noise. A pooled analysis of polysomnographic studies on the acute effects of transportation noise on sleep was also conducted and the unadjusted odds ratio for the probability of awakening for a 10 dBA increase in the indoor Lmax was significant for aircraft (1.35; 95% CI 1.22–1.50), road (1.36; 95% CI 1.19–1.55), and rail (1.35; 95% CI 1.21–1.52) noise. Due to a limited number of studies and the use of different outcome measures, a narrative review only was conducted for motility, cardiac and blood pressure outcomes, and for children’s sleep. The effect of wind turbine and hospital noise on sleep was also assessed. Based on the available evidence, transportation noise affects objectively measured sleep physiology and subjectively assessed sleep disturbance in adults. For other outcome measures and noise sources the examined evidence was conflicting or only emerging

Creating an Environment for Safe and Healthy Sleep in Child Care Programs

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Rose, Bobbie

2012-01-01

Along with nutrition, physical activity, and secure attachments, sleep is a basic requirement for a child's growth and brain development. Sleep is important for health and wellness, especially for growing infants and young children. Unfortunately, the amount of time children spend sleeping seems to be declining. If only sleep-deprived children…

Sleep Problems and Early Developmental Delay: Implications for Early Intervention Programs

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Bonuck, Karen; Grant, Roy

2012-01-01

Sleep disorders negatively impact behavior, cognition, and growth--the same areas targeted by early intervention. Conversely, developmental delays and disabilities may themselves precipitate sleep disorders. Young children with developmental delays experience sleep disorders at a higher rate than do typically developing children; the most common…

Modelling of polysomnographic respiratory measurements for artefact detection and signal restoration

International Nuclear Information System (INIS)

Rathnayake, S I; Abeyratne, U R; Hukins, C; Duce, B

2008-01-01

Polysomnography (PSG), which incorporates measures of sleep with measures of EEG arousal, air flow, respiratory movement and oxygenation, is universally regarded as the reference standard in diagnosing sleep-related respiratory diseases such as obstructive sleep apnoea syndrome. Over 15 channels of physiological signals are measured from a subject undergoing a typical overnight PSG session. The signals often suffer from data losses, interferences and artefacts. In a typical sleep scoring session, artefact-corrupted signal segments are visually detected and removed from further consideration. This is a highly time-consuming process, and subjective judgement is required for the job. During typical sleep scoring sessions, the target is the detection of segments of diagnostic interest, and signal restoration is not utilized for distorted segments. In this paper, we propose a novel framework for artefact detection and signal restoration based on the redundancy among respiratory flow signals. We focus on the air flow (thermistor sensors) and nasal pressure signals which are clinically significant in detecting respiratory disturbances. The method treats the respiratory system and other organs that provide respiratory-related inputs/outputs to it (e.g., cardiovascular, brain) as a possibly nonlinear coupled-dynamical system, and uses the celebrated Takens embedding theorem as the theoretical basis for signal prediction. Nonlinear prediction across time (self-prediction) and signals (cross-prediction) provides us with a mechanism to detect artefacts as unexplained deviations. In addition to detection, the proposed method carries the potential to correct certain classes of artefacts and restore the signal. In this study, we categorize commonly occurring artefacts and distortions in air flow and nasal pressure measurements into several groups and explore the efficacy of the proposed technique in detecting/recovering them. The results we obtained from a database of clinical

Polysomnographic findings in a cohort of chronic insomnia patients with benzodiazepine abuse.

Science.gov (United States)

Mazza, Marianna; Losurdo, Anna; Testani, Elisa; Marano, Giuseppe; Di Nicola, Marco; Dittoni, Serena; Gnoni, Valentina; Di Blasi, Chiara; Giannantoni, Nadia Mariagrazia; Lapenta, Leonardo; Brunetti, Valerio; Bria, Pietro; Janiri, Luigi; Mazza, Salvatore; Della Marca, Giacomo

2014-01-15

To evaluate sleep modifications induced by chronic benzodiazepine (BDZ) abuse. Cohort study, comparison of sleep measures between BDZs abusers and controls. Drug Addiction Unit (Institute of Psychiatry) and Unit of Sleep Disorders (Institute of Neurology) of the Catholic University in Rome. Six outpatients affected by chronic BDZ abuse were enrolled, (4 men, 2 women, mean age 53.3 ± 14.8, range: 34-70 years); 55 healthy controls were also enrolled (23 men, 32 women, mean age 54.2 ± 13.0, range: 27-76 years). All patients underwent clinical evaluation, psychometric measures, ambulatory polysomnography, scoring of sleep macrostructure and microstructure (power spectral fast-frequency EEG arousal, cyclic alternating pattern [CAP]), and heart rate variability. BDZ abusers had relevant modification of sleep macrostructure and a marked reduction of fast-frequency EEG arousal in NREM (patients: 6.6 ± 3.7 events/h, controls 13.7 ± 4.9 events/h, U-test: 294, p = 0.002) and REM (patients: 8.4 ± 2.4 events/h, controls 13.3 ± 5.1 events/h, U-test: 264, p = 0.016), and of CAP rate (patients: 15.0 ± 8.6%, controls: 51.2% ± 12.1%, U-test: 325, p < 0.001). BDZ abusers have reduction of arousals associated with increased number of nocturnal awakenings and severe impairment of sleep architecture. The effect of chronic BDZ abuse on sleep may be described as a severe impairment of arousal dynamics; the result is the inability to modulate levels of vigilance.

Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea.

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Shilo, Dekel; Emodi, Omri; Aizenbud, Dror; Rachmiel, Adi

2016-01-01

Obstructive sleep apnea (OSA) in individuals with craniofacial anomalies can compromise airway and is a serious life-threatening condition. In many cases, tracheostomy is carried out as the treatment of choice. Distraction osteogenesis of the mandible as a treatment modality for OSA is very useful and may spare the need for tracheostomy or allow decannulation, yet controlling the vector of distraction is still a major challenge. We present a method for controlling the vector of distraction. Eight patients with severe respiratory distress secondary to a micrognathic mandible were treated by mandibular distraction osteogenesis using either external or internal devices. Temporary anchorage devices (TADs) and orthodontic elastics were used to control the vector of distraction. Cephalometric X-rays, computed tomography, and polysomnographic sleep studies were used to analyze the results. A mean distraction of 22 mm using the internal devices and a mean of 30 mm using the external devices were achieved. Increase in the pharyngeal airway and hyoid bone advancement was also observed. Anterior-posterior advancement of the mandible was noted with no clockwise rotation. Most importantly, clinical improvement in symptoms of OSA, respiratory distress, and feeding was noted. We describe a method for controlling the vector of distraction used as a treatment for OSA. In these cases, TADs were used as an anchorage unit to control the vector of distraction. Our results show excellent clinical and radiographical results. TADs are a simple and nonexpensive method to control the vector of distraction.

Polysomnographic indicators of mortality in stroke patients

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Ponsaing, Laura B; Iversen, Helle K; Jennum, Poul

2017-01-01

a 19-37-month follow-up period. RESULTS: Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher...... receive increased attention....

Why the dim light melatonin onset (DLMO) should be measured before treatment of patients with circadian rhythm sleep disorders.

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Keijzer, Henry; Smits, Marcel G; Duffy, Jeanne F; Curfs, Leopold M G

2014-08-01

Treatment of circadian rhythm sleep disorders (CRSD) may include light therapy, chronotherapy and melatonin. Exogenous melatonin is increasingly being used in patients with insomnia or CRSD. Although pharmacopoeias and the European food safety authority (EFSA) recommend administering melatonin 1-2 h before desired bedtime, several studies have shown that melatonin is not always effective if administered according to that recommendation. Crucial for optimal treatment of CRSD, melatonin and other treatments should be administered at a time related to individual circadian timing (typically assessed using the dim light melatonin onset (DLMO)). If not administered according to the individual patient's circadian timing, melatonin and other treatments may not only be ineffective, they may even result in contrary effects. Endogenous melatonin levels can be measured reliably in saliva collected at the patient's home. A clinically reliably DLMO can be calculated using a fixed threshold. Diary and polysomnographic sleep-onset time do not reliably predict DLMO or circadian timing in patients with CRSD. Knowing the patient's individual circadian timing by assessing DLMO can improve diagnosis and treatment of CRSD with melatonin as well as other therapies such as light or chronotherapy, and optimizing treatment timing will shorten the time required to achieve results. Copyright © 2013 Elsevier Ltd. All rights reserved.

Changing Adolescent Sleep Patterns: Factors Affecting them and the Related Problems.

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Kaur, Harpreet; Bhoday, Harpreet Singh

2017-03-01

Sleep affects physical growth, behavior and emotional development besides determining cognitive functioning, learning and attention especially of a growing child. Adolescence represents one of the critical transitions in the life span and is characterized by a tremendous pace in growth and change that is second only to that of infancy. Adolescent sleep patterns deserve particular attention because of the potential impact on school performance. Average sleep period in adolescents is reduced during school days to around seven hours. The reasons may be biological mainly the sleep phase delay or psychosocial and environmental. These include academic demands, social activities, sports, internet, television viewing, part-time employment, and use of mobile phone at night, peer and parental influence and socioeconomic status. These changing patterns of sleep in adolescents lead to many behavioral sleep problems like Delayed Sleep-phase Syndrome; Difficulties in falling asleep (insomnia); excessive daytime sleepiness, poor academic performance. Decreased sleep in adolescents also causes obesity and other cardio-metabolic abnormalities. This needs an integrated approach involving adolescents themselves, their parents, teachers and specialized physicians to help improve the sleep quantity and quality and lead to a better quality of life and daytime functioning in adolescents. © Journal of the Association of Physicians of India 2011.

A three-phase epidemiological study of short and long sleepers in a middle-aged Chinese population: prevalence and characteristics

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Y.L. Hao

2014-02-01

Full Text Available Epidemiological studies of short and long sleepers have not been conducted previously. We collected socioeconomic, psychological, and polysomnographic characteristics of 6501 parents (3252 men and 3249 women of 4036 primary school children in Guangzhou city. The study data were collected in three phases. The overall prevalence of short (5 h or less and long (10 h or more sleep duration was 0.52 and 0.64%, respectively. Long sleepers had higher Eysenck Personality Questionnaire neuroticism scores [odds ratio (OR=1.224, 95% confidence interval (CI=1.047-1.409] and lower education levels (OR=0.740, 95%CI=0.631-0.849 than short sleepers. In the polysomnographic assessment, short, long, and normal sleepers (7-8 h shared similar durations of Stage 3 sleep (short=25.7±10.7, long=20.3±7.9, and normal=28.0±12.8 min, F=1.402, P=0.181. In daytime multiple sleep latency tests, short sleepers (10/19, 52.6% were more prone to have a short sleep latency (≤8 min than long sleepers (2/23, 8.7%. In addition to different sleep durations, neuroticism might also contribute to differences between short and long sleepers in social achievements. Stage 3 sleep might be essential for humans. The short sleep latency (≤8 min of short sleepers in multiple sleep latency tests should be interpreted cautiously, since it was of the same severity as required for a diagnosis of narcolepsy or idiopathic hypersomnia.

Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study.

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Kheirandish-Gozal, L; Gileles-Hillel, A; Alonso-Álvarez, M L; Peris, E; Bhattacharjee, R; Terán-Santos, J; Duran-Cantolla, J; Gozal, D

2015-07-01

Obesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions. To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community. Obese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the two PSGs were assayed for multiple inflammatory and metabolic markers including interleukin (IL)-6, IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), adiponectin, apelin C, leptin and osteocrin. Out of 122 potential candidates, 100 obese children with OSA completed the study with only one-third exhibiting normalization of their PSG after T&A (that is, apnea-hypopnea index (AHI) ≤1/hour total sleep time). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST). A defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

NREM sleep architecture and relation to GH/IGF-1 axis in Laron syndrome.

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Verrillo, Elisabetta; Bizzarri, Carla; Cappa, Marco; Bruni, Oliviero; Pavone, Martino; Cutrera, Renato

2010-01-01

Laron syndrome (LS), known as growth hormone (GH) receptor deficiency, is a rare form of inherited GH resistance. Sleep disorders were described as a common feature of adult LS patients, while no data are available in children. Bi-directional interactions between human sleep and the somatotropic system were previously described, mainly between slow wave sleep and the nocturnal GH surge. To analyze the sleep macro- and microstructure in LS and to evaluate the influence of substitutive insulin-like growth factor 1 (IGF-1) therapy on it. Two young LS females underwent polysomnography; the first study was performed during IGF-1 therapy, the second one after a 3-month wash-out period. In both patients, the sleep macrostructure showed that time in bed, sleep period time, total sleep time, sleep efficiency and rapid eye movement (REM) percentage were all increased during wash-out. The sleep microstructure (cyclic alternating pattern: CAP) showed significantly higher EEG slow oscillations (A1%) in NREM sleep, both during IGF-1 therapy and wash-out. Sleep macrostructure in LS children is slightly affected by substitutive IGF-1 therapy. Sleep microstructure shows an increase of A1%, probably related to abnormally high hypothalamic GHRH secretion, due to GH insensitivity. Copyright 2010 S. Karger AG, Basel.

Nocturnal sleep, daytime sleepiness, and quality of life in stable patients on hemodialysis

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Bliwise Donald L

2003-11-01

Full Text Available Abstract 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

Remission of severe restless legs syndrome and periodic limb movements in sleep after bilateral excision of multiple foot neuromas: a case report

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Lettau Ludwig A

2010-09-01

quality index, fatigue severity scale, and the international restless legs syndrome rating scale (36 to 4. Polysomnography six weeks post-operatively showed improved sleep efficiency, a marked increase in rapid eye movement sleep, and marked reductions in hourly rates of both periodic limb movements in sleep with arousal (135.3 to 3.3 and spontaneous arousals (17.3 to 0. Conclusion The immediate and near complete remission of symptoms, the histopathology of the excised tissues, and the marked improvement in polysomnographic parameters documented six weeks after surgery together indicate that this patient's severe restless legs syndrome and periodic limb movements in sleep was of peripheral nerve (foot neuroma origin. Further study of foot neuromas as a source of periodic limb movements in sleep and as a cause of sleep dysfunction in patients with or without concomitant restless legs syndrome, is warranted.

Sleep quality and duration are related to microvascular function: the Amsterdam Growth and Health Longitudinal Study

NARCIS (Netherlands)

Bonsen, T.; Wijnstok, N.J.; Hoekstra, T.; Eringa, E.C.; Serne, E.H.; Smulders, Y.M.; Twisk, J.W.R.

2015-01-01

Sleep and sleep disorders are related to cardiovascular disease, and microvascular function is an early cardiovascular disease marker. Therefore, the relationship of sleep (measured in sleep quality and duration) with microvascular function was examined in healthy adults. Sleep quality was assessed

Sleep disturbances in IDDM patients with nocturnal hypoglycemia

DEFF Research Database (Denmark)

Bendtson, I; Gade, J; Thomsen, C E

1992-01-01

Eight insulin-dependent diabetic patients were studied to evaluate sleep patterns during normoglycemia and spontaneous and insulin-induced hypoglycemia. Two channels of electroencephalogram (EEG), electromyogram and actooculogram were recorded. The signals were analyzed off-line, using...... a polygraphic sleep analysis system. The scoring was mainly based on the color density spectral array of the EEG. Blood glucose and growth hormone were measured serially. Asymptomatic, spontaneous nocturnal hypoglycemia occurred in 38% of the nights. Conventional sleep analysis showed a tendency toward...

Sleep, circadian dysrhythmia, obesity and diabetes

OpenAIRE

Sridhar, Gumpeny Ramachandra; Sanjana, Narasimhadevara Santhi Nirmala

2016-01-01

Synchrony of biological processes with environmental cues developed over millennia to match growth, reproduction and senescence. This entails a complex interplay of genetic, metabolic, chemical, light, hormonal and hedonistic factors across life forms. Sleep is one of the most prominent rhythms where such a match is established. Over the past 100 years or so, it has been possible to disturb the synchrony between sleep-wake cycle and environmental cues. Development of electric lights, shift wo...

Obstructive sleep apnoea syndrome in children

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Anna Włodarska

2016-09-01

Full Text Available Sleep-related breathing disorders in children are a clinical problem which is more and more often diagnosed by doctors nowadays. They can be the basis for diagnosing obstructive sleep apnoea syndrome that causes a number of complications: lowering the quality of life, behavioural problems, complications involving cardiovascular system. The incidence of obstructive sleep apnoea syndrome in the paediatric population is estimated to be at the level of 2%. The symptoms of obstructive sleep apnoea syndrome can be divided into daytime and night ones. Night symptoms in children include: snoring, apnoea, breathing with open mouth (both during the day and at night, dry tongue and mouth during sleep, agitated sleep in unnatural positions. Among daytime symptoms of obstructive sleep apnoea syndrome there are: irritability, aggressiveness, hyperactivity, attention deficit disorder, delayed development and growth pattern (mainly failure to thrive, learning problems, morning headaches. Parents often do not connect the night and daytime symptoms with the possible development of obstructive sleep apnoea syndrome in their children. The main predisposing factor of obstructive sleep apnoea syndrome in children is adenotonsillar hypertrophy. Effective and in most cases preferred treatment for the management of obstructive sleep apnoea syndrome in children is adenotonsillectomy. Polysomnography and polygraphy are diagnostic tools helpful in the study of sleep-related disorders. The objective of this study was to systematise the knowledge on the epidemiology, aetiology, clinical image and prevention of obstructive sleep apnoea syndrome in children.

Pulmonary functions and sleep-related breathing disorders in lipid storage disease.

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Bingöl, Züleyha; Tekce, Hacer Durmuş; Sağcan, Gülseren; Serdaroğlu, Piraye; Kıyan, Esen

2018-03-01

Pulmonary function abnormalities and sleep-related breathing disorders (SRBD) are frequent in subjects with several neuromuscular diseases but there is no data about lipid storage diseases (LSD). Therefore, we aimed to evaluate pulmonary functions and SRBD in adults with LSD. Pulmonary functions (forced expiratory volume (FEV 1 ), forced vital capacity (FVC), supine FVC, upright-supine FVC% change, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak cough flow (PCF)), arterial blood gases, and polysomnographic data of all subjects were evaluated. Twenty-five subjects with LSD were evaluated [17 males, 8 females; age 34.9 ± 15 years; BMI 26.5 ± 3.4 kg/m 2 ]. MIP was - 72.2 ± 32.7 cmH 2 O ( 45 mmHg). REM sleep had decreased in all subjects (10.2% ± 6.1). Obstructive sleep apnea (OSA) was found in 80% of the subjects (n = 20; 9 mild, 9 moderate, 2 severe). For subjects with OSA, apnea-hypopnea index (AHI) was 20.8 ± 15.9/h, oxygen desaturation index (ODI) was 11.9 ± 15.4/h, AHI REM was 30.6 ± 19.7/h, AHI NREM was 19.7 ± 16.6/h, ODI REM was 27.2 ± 26.1/h, and ODI NREM was 11.4 ± 15/h. Five subjects (20%) diagnosed as REM-related OSA. Nocturnal mean SpO 2 was 94.9% ± 1.7, lowest SpO 2 was 73.3% ± 13.9, and time spent with SpO 2 < 90% was 2.4% ± 7.2. In subjects with LSD, pulmonary function impairment, daytime hypercapnia and hypoxemia, and OSA, especially REM-related OSA, are frequent. Therefore, pulmonary functions and polysomnography should be performed routinely.

Inflammation and Growth in Young Children with Obstructive Sleep Apnea Syndrome before and after Adenotonsillectomy

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Yuval Nachalon

2014-01-01

Full Text Available Background. Obstructive sleep apnea (OSA is associated with growth impairment that usually improves following effective treatment. In this study we investigated the mechanisms underlying the growth processes in young children diagnosed with OSA, before and after adenotonsillectomy (T&A. Methods. Young children (6–36 months old were enrolled and evaluated before and several months after T&A surgery for height, weight, circulating high sensitive C-reactive protein (CRP, and insulin-like growth factor 1 (IGF-1 levels. Caloric intake was assessed by a validated Short Food Frequency Questionnaire (SFFQ. Results. Following T&A, children added 4.81 cm and 1.88 kg to their height and weight, respectively (P<0.001 for both and had a significant increase in BMI Z score (P=0.002. Increased caloric intake of 377 kcal/day was noted (P<0.001, with increased protein and decreased fat intake. The decrease in CRP levels correlated with the increase in body weight in boys (P<0.05, adjusted for caloric intake. Conclusions. Adenotonsillectomy results in enhanced somatic growth in young children that correlates with a decrease in systemic inflammation and caloric intake increment. Our findings imply that systemic inflammation may have an important role in this OSA-related morbidity.

Genetic Dissociation of Daily Sleep and Sleep Following Thermogenetic Sleep Deprivation in Drosophila.

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Dubowy, Christine; Moravcevic, Katarina; Yue, Zhifeng; Wan, Joy Y; Van Dongen, Hans P A; Sehgal, Amita

2016-05-01

Sleep rebound-the increase in sleep that follows sleep deprivation-is a hallmark of homeostatic sleep regulation that is conserved across the animal kingdom. However, both the mechanisms that underlie sleep rebound and its relationship to habitual daily sleep remain unclear. To address this, we developed an efficient thermogenetic method of inducing sleep deprivation in Drosophila that produces a substantial rebound, and applied the newly developed method to assess sleep rebound in a screen of 1,741 mutated lines. We used data generated by this screen to identify lines with reduced sleep rebound following thermogenetic sleep deprivation, and to probe the relationship between habitual sleep amount and sleep following thermogenetic sleep deprivation in Drosophila. To develop a thermogenetic method of sleep deprivation suitable for screening, we thermogenetically stimulated different populations of wake-promoting neurons labeled by Gal4 drivers. Sleep rebound following thermogenetically-induced wakefulness varies across the different sets of wake-promoting neurons that were stimulated, from very little to quite substantial. Thermogenetic activation of neurons marked by the c584-Gal4 driver produces both strong sleep loss and a substantial rebound that is more consistent within genotypes than rebound following mechanical or caffeine-induced sleep deprivation. We therefore used this driver to induce sleep deprivation in a screen of 1,741 mutagenized lines generated by the Drosophila Gene Disruption Project. Flies were subjected to 9 h of sleep deprivation during the dark period and released from sleep deprivation 3 h before lights-on. Recovery was measured over the 15 h following sleep deprivation. Following identification of lines with reduced sleep rebound, we characterized baseline sleep and sleep depth before and after sleep deprivation for these hits. We identified two lines that consistently exhibit a blunted increase in the duration and depth of sleep after

Corticotropin-releasing hormone induces depression-like changes of sleep electroencephalogram in healthy women.

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Schüssler, P; Kluge, M; Gamringer, W; Wetter, T C; Yassouridis, A; Uhr, M; Rupprecht, R; Steiger, A

2016-12-01

We reported previously that repetitive intravenous injections of corticotropin-releasing hormone (CRH) around sleep onset prompt depression-like changes in certain sleep and endocrine activity parameters (e.g. decrease of slow-wave sleep during the second half of the night, blunted growth hormone peak, elevated cortisol concentration during the first half of the night). Furthermore a sexual dimorphism of the sleep-endocrine effects of the hormones growth hormone-releasing hormone and ghrelin was observed. In the present placebo-controlled study we investigated the effect of pulsatile administration of 4×50μg CRH on sleep electroencephalogram (EEG) and nocturnal cortisol and GH concentration in young healthy women. After CRH compared to placebo, intermittent wakefulness increased during the total night and the sleep efficiency index decreased. During the first third of the night, REM sleep and stage 2 sleep increased and sleep stage 3 decreased. Cortisol concentration was elevated throughout the night and during the first and second third of the night. GH secretion remained unchanged. Our data suggest that after CRH some sleep and endocrine activity parameters show also depression-like changes in healthy women. These changes are more distinct in women than in men. Copyright © 2016 Elsevier Ltd. All rights reserved.

Basal ganglia dysfunction in idiopathic REM sleep behaviour disorder parallels that in early Parkinson's disease.

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Rolinski, Michal; Griffanti, Ludovica; Piccini, Paola; Roussakis, Andreas A; Szewczyk-Krolikowski, Konrad; Menke, Ricarda A; Quinnell, Timothy; Zaiwalla, Zenobia; Klein, Johannes C; Mackay, Clare E; Hu, Michele T M

2016-08-01

SEE POSTUMA DOI101093/AWW131 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Resting state functional magnetic resonance imaging dysfunction within the basal ganglia network is a feature of early Parkinson's disease and may be a diagnostic biomarker of basal ganglia dysfunction. Currently, it is unclear whether these changes are present in so-called idiopathic rapid eye movement sleep behaviour disorder, a condition associated with a high rate of future conversion to Parkinson's disease. In this study, we explore the utility of resting state functional magnetic resonance imaging to detect basal ganglia network dysfunction in rapid eye movement sleep behaviour disorder. We compare these data to a set of healthy control subjects, and to a set of patients with established early Parkinson's disease. Furthermore, we explore the relationship between resting state functional magnetic resonance imaging basal ganglia network dysfunction and loss of dopaminergic neurons assessed with dopamine transporter single photon emission computerized tomography, and perform morphometric analyses to assess grey matter loss. Twenty-six patients with polysomnographically-established rapid eye movement sleep behaviour disorder, 48 patients with Parkinson's disease and 23 healthy control subjects were included in this study. Resting state networks were isolated from task-free functional magnetic resonance imaging data using dual regression with a template derived from a separate cohort of 80 elderly healthy control participants. Resting state functional magnetic resonance imaging parameter estimates were extracted from the study subjects in the basal ganglia network. In addition, eight patients with rapid eye movement sleep behaviour disorder, 10 with Parkinson's disease and 10 control subjects received (123)I-ioflupane single photon emission computerized tomography. We tested for reduction of basal ganglia network connectivity, and for loss of tracer uptake in rapid eye movement sleep

Waking the Sleeping Giant

NARCIS (Netherlands)

Ollenburger, Mary H.; Descheemaeker, Katrien; Crane, Todd A.; Sanogo, Ousmane M.; Giller, Ken E.

2016-01-01

The World Bank argued that West Africa's Guinea Savannah zone forms part of “Africa's Sleeping Giant,” where increases in agricultural production could be an engine of economic growth, through expansion of cultivated land in sparsely populated areas. The district of Bougouni, in southern Mali,

Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

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Camacho, Macario; Zaghi, Soroush; Chang, Edward T.; Song, Sungjin A.; Szelestey, Blake; Certal, Victor

2016-01-01

Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed. PMID:26925105

Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

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Macario Camacho

2016-01-01

Full Text Available Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes in adult obstructive sleep apnea (OSA patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed.

EVALUATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA - OVERLAP SYNDROME

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Vaddadi Sailendra

2016-09-01

Full Text Available BACKGROUND The drop in oxygen saturation during sleep is more than during exercise and patients of COPD who spend more time in sleeping. Significant sleep desaturation and the sleep disturbances are greater in overlap syndrome than in OSA alone. The present study is conducted in Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, to find the prevalence of obstructive sleep apnoea in the patients with COPD. AIMS The present study was a cross-sectional study prospectively carried out with an aim to evaluate the breathing disorders during sleep in patients with COPD and to correlate these disorders with the stage of the disease. SETTINGS AND DESIGN The study Cohort was constituted by patients of COPD registered into Chest OPD or admitted in Indoor units of Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, from July 2014 to May 2016. A total of thirty six consecutive COPD patients who consented to be enrolled into the study were classified into Mild, Moderate and Severe stages based on the Indian Guidelines for the management of COPD. METHODS AND MATERIAL Spirometric evaluation and bronchial reversibility testing was conducted in all the patients. Arterial Blood Gas Analysis was done using ABL3 arterial blood gas analyser (Radiometer, Copenhagen. POLYSOMNOGRAPHY Patients were hooked to Compumedics ProFusion Polysomnographic Machine (Compumedics Private Limited 2001, USA, by standard gold cups/electrodes. Thereafter, the patients were subjected to a full night sleep study (Overnight polysomnography. The electrode and sensor connection system utilises E-series EEG/PSG system in order to record the PSG study. The impedance of electrodes was checked and set to <10. A total of 20 leads were utilised for the study. The various parameters monitored included Electroencephalogram (EEG, Electro-oculogram (EOG, Electrocardiogram (ECG, chin and leg Electromyogram (EMG

Basal ganglia dysfunction in idiopathic REM sleep behaviour disorder parallels that in early Parkinson’s disease

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Rolinski, Michal; Griffanti, Ludovica; Piccini, Paola; Roussakis, Andreas A.; Szewczyk-Krolikowski, Konrad; Menke, Ricarda A.; Quinnell, Timothy; Zaiwalla, Zenobia; Klein, Johannes C.; Mackay, Clare E.

2016-01-01

Abstract See Postuma (doi:10.1093/aww131) for a scientific commentary on this article. Resting state functional magnetic resonance imaging dysfunction within the basal ganglia network is a feature of early Parkinson’s disease and may be a diagnostic biomarker of basal ganglia dysfunction. Currently, it is unclear whether these changes are present in so-called idiopathic rapid eye movement sleep behaviour disorder, a condition associated with a high rate of future conversion to Parkinson’s disease. In this study, we explore the utility of resting state functional magnetic resonance imaging to detect basal ganglia network dysfunction in rapid eye movement sleep behaviour disorder. We compare these data to a set of healthy control subjects, and to a set of patients with established early Parkinson’s disease. Furthermore, we explore the relationship between resting state functional magnetic resonance imaging basal ganglia network dysfunction and loss of dopaminergic neurons assessed with dopamine transporter single photon emission computerized tomography, and perform morphometric analyses to assess grey matter loss. Twenty-six patients with polysomnographically-established rapid eye movement sleep behaviour disorder, 48 patients with Parkinson’s disease and 23 healthy control subjects were included in this study. Resting state networks were isolated from task-free functional magnetic resonance imaging data using dual regression with a template derived from a separate cohort of 80 elderly healthy control participants. Resting state functional magnetic resonance imaging parameter estimates were extracted from the study subjects in the basal ganglia network. In addition, eight patients with rapid eye movement sleep behaviour disorder, 10 with Parkinson’s disease and 10 control subjects received 123I-ioflupane single photon emission computerized tomography. We tested for reduction of basal ganglia network connectivity, and for loss of tracer uptake in rapid eye

Tracheostomy for Severe Pediatric Obstructive Sleep Apnea: Indications and Outcomes.

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Rizzi, Christopher J; Amin, Julian D; Isaiah, Amal; Valdez, Tulio A; Jeyakumar, Anita; Smart, Suzanne E; Pereira, Kevin D

2017-08-01

Objectives (1) To describe characteristics of pediatric patients undergoing tracheostomy for obstructive sleep apnea (OSA). (2) To highlight perioperative events and outcomes of the procedure. Study Design Case series with chart review. Setting Four tertiary care academic children's hospitals. Subjects and Methods Twenty-nine children aged tracheostomy for severe OSA, defined as an apnea-hypopnea index (AHI) >10, were included in the study. Data on patient characteristics, polysomnographic findings, comorbidities, and perioperative events and outcomes were collected and analyzed. Results Twenty-nine patients were included. Mean age at tracheostomy was 2.0 years (95% CI, -2.2 to 6.2). Mean body mass index z score was -1.2 (95% CI, -4.9 to -2.5). Mean preoperative AHI was 60.2 (95% CI, -15.7 to 136.1). Mean postoperative intensive care unit stay was 23.2 days (95% CI, 1.44-45.0). One procedure was complicated by bronchospasm. Thirteen patients had craniofacial abnormalities; 10 had a neurologic disorder resulting in hypotonia; and 5 had a diagnosis of laryngomalacia. Mean follow-up was 30.6 months (95% CI, -10.4 to 71.6). Six patients were decannulated, with a mean time to decannulation of 40.8 months (95% CI, 7.9-73.7). Five patients underwent capped sleep study prior to decannulation with a mean AHI of 6.6 (95% CI, -9.9 to 23.1) and a mean oxygen nadir of 90.0% (95% CI, 80%-100%). Conclusion OSA is an uncommon indication for tracheostomy in children. Patients who require the procedure usually have an associated syndromic diagnosis resulting in upper airway obstruction. The majority of children who undergo tracheostomy for OSA will remain dependent at 24 months.

Nocturnal Wakefulness Is Associated With Next-Day Suicidal Ideation in Major Depressive Disorder and Bipolar Disorder.

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Ballard, Elizabeth D; Vande Voort, Jennifer L; Bernert, Rebecca A; Luckenbaugh, David A; Richards, Erica M; Niciu, Mark J; Furey, Maura L; Duncan, Wallace C; Zarate, Carlos A

2016-06-01

Self-reported sleep disturbances may confer elevated risk for suicidal ideation, suicide attempts, and death. However, limited research has evaluated polysomnographically determined sleep disturbance as an acute physiologic risk factor for suicidal thoughts. This study sought to investigate the relationship between nocturnal wakefulness in association with next-day suicidal ideation using overnight polysomnography assessment from data collected between 2006 and 2013. Sixty-five participants with DSM-IV-diagnosed major depressive disorder or bipolar depression underwent overnight polysomnography monitoring in a sleep laboratory. The Hamilton Depression Rating Scale (HDRS) was administered the morning after polysomnography recording to assess next-day suicidal ideation, severity of depressive symptoms, and subjective sleep disturbances. Using a generalized linear mixed model, a significant time-by-ideation interaction was found indicating greater nocturnal wakefulness at 4:00 am among participants with suicidal ideation (F4,136 = 3.65, P = .007). Increased time awake during the 4:00 am hour (4:00 to 4:59) was significantly associated with elevated suicidal thoughts the next day (standardized β = 0.31, P = .008). This relationship persisted after controlling for age, gender, diagnosis, and severity of depressive symptoms. Greater nocturnal wakefulness, particularly in the early morning hours, was significantly associated with next-day suicidal thoughts. Polysomnographically documented sleep disruption at specific times of night may represent an acute risk factor of suicidal ideation that warrants additional research. ClinicalTrials.gov identifier: NCT00024635. © Copyright 2016 Physicians Postgraduate Press, Inc.

Sleep Applications to Assess Sleep Quality.

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Fietze, Ingo

2016-12-01

This article highlights the potential uses that smartphone applications may have for helping those with sleep problems. Applications in smartphones offer the promised possibility of detection of sleep. From the author's own experience, one can also conclude that sleep applications are approximately as good as polysomnography in detection of sleep time, similar to the conventional wearable actimeters. In the future, sleep applications will help to further enhance awareness of sleep health and to distinguish those who actually poorly and only briefly sleep from those who suffer more likely from paradox insomnia. Copyright © 2016 Elsevier Inc. All rights reserved.

Sleep inertia associated with a 10-min nap before the commute home following a night shift: A laboratory simulation study.

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Hilditch, Cassie J; Dorrian, Jillian; Centofanti, Stephanie A; Van Dongen, Hans P; Banks, Siobhan

2017-02-01

Night shift workers are at risk of road accidents due to sleepiness on the commute home. A brief nap at the end of the night shift, before the commute, may serve as a sleepiness countermeasure. However, there is potential for sleep inertia, i.e. transient impairment immediately after awakening from the nap. We investigated whether sleep inertia diminishes the effectiveness of napping as a sleepiness countermeasure before a simulated commute after a simulated night shift. N=21 healthy subjects (aged 21-35 y; 12 females) participated in a 3-day laboratory study. After a baseline night, subjects were kept awake for 27h for a simulated night shift. They were randomised to either receive a 10-min nap ending at 04:00 plus a 10-min pre-drive nap ending at 07:10 (10-NAP) or total sleep deprivation (NO-NAP). A 40-min York highway driving task was performed at 07:15 to simulate the commute. A 3-min psychomotor vigilance test (PVT-B) and the Samn-Perelli Fatigue Scale (SP-Fatigue) were administered at 06:30 (pre-nap), 07:12 (post-nap), and 07:55 (post-drive). In the 10-NAP condition, total pre-drive nap sleep time was 9.1±1.2min (mean±SD), with 1.3±1.9min spent in slow wave sleep, as determined polysomnographically. There was no difference between conditions in PVT-B performance at 06:30 (before the nap). In the 10-NAP condition, PVT-B performance was worse after the nap (07:12) compared to before the nap (06:30); no change across time was found in the NO-NAP condition. There was no significant difference between conditions in PVT-B performance after the drive. SP-Fatigue and driving performance did not differ significantly between conditions. In conclusion, the pre-drive nap showed objective, but not subjective, evidence of sleep inertia immediately after awakening. The 10-min nap did not affect driving performance during the simulated commute home, and was not effective as a sleepiness countermeasure. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mean Platelet Volume, Vitamin D and C Reactive Protein Levels in Normal Weight Children with Primary Snoring and Obstructive Sleep Apnea Syndrome.

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Zicari, Anna Maria; Occasi, Francesca; Di Mauro, Federica; Lollobrigida, Valeria; Di Fraia, Marco; Savastano, Vincenzo; Loffredo, Lorenzo; Nicita, Francesco; Spalice, Alberto; Duse, Marzia

2016-01-01

Studies on Mean Platelet Volume (MPV) in children with Sleep Disordered Breathing (SDB) report conflicting results and the hypothesis of an intermittent hypoxemia leading to a systemic inflammation is reaching consensus. Vitamin D exerts anti-inflammatory properties and its deficiency has been supposed to play a role in sleep disorders. Emerging interest is rising about Primary Snoring (PS) since it is reasonable that also undetectable alteration of hypoxia might predispose to an increased production of inflammatory mediators. In this perspective, in a group of children affected by SDB, our aim was to investigate MPV, vitamin D and C Reactive Protein (CRP) levels, which had been previously evaluated separately in different studies focused only on Obstructive Sleep Apnea Syndrome (OSAS). We enrolled 137 children: 70 healthy controls (HC), 67 affected by SDB undergoing a polysomnographic evaluation, 22 with a diagnosis of PS and 45 with a diagnosis of OSAS. All patients underwent routine biochemical evaluations including blood cell counts, CRP and vitamin D. Children affected by SDB had a mean age of 8.49±2.19 and were prevalently males (23 females, 34%; 44 males, 66%). MPV levels were higher in OSAS and PS when compared to HC; platelet count (PLT) and CRP levels were higher while Vitamin D levels were lower in children with SDB when compared to HC. MPV levels were correlated with PLT (r = -0.54; pchildren with PS as well as in children with OSAS, and supports the underlying inflammation, hence, highlighting the importance of an early diagnosis of this previously considered benign form of SDB.

[Comparison of efficacy between continuous positive airway pressure and renal artery sympathetic denervation by radiofrequency ablation in obstructive sleep apnea syndrome patients with hypertension].

Science.gov (United States)

Zhao, Meng-meng; Tan, Xue-xue; Ding, Ning; Zhang, Xi-long

2013-04-23

To compare the efficacy of renal arterial sympathetic denervation (RSD) and continuous positive airway pressure (CPAP) in patients with coexisting moderate-to-severe obstructive sleep apnea syndrome (OSAS) and hypertension. Retrospective analysis was conducted for patients with coexisting moderate to severe OSAS and hypertension for the efficacy of RSD (RSD group, n = 15) and CPAP (CPAP group, n = 16). Comparison was made for polysomnographic parameters and 24 hours ambulatory blood pressure (Bp) between two groups. There was no significant difference in age, gender, body mass index, nocturnal apnea hypopnea index (AHI), mean and minimal pulse oxygen saturation (mean SpO2 and mini SpO2) between two groups. Compared with those at pre-treatment, the following changes were observed at Day 30 post-treatment: in RSD group, the nocturnal AHI and T90 statistically decreased (27 ± 14 vs 32 ± 12, 8.7% ± 7.8% vs 13.8% ± 13.1%, all P 0.05); in CPAP group during treatment, nocturnal AHI and the ratio of duration SpO2 hypertension, both RSD and CPAP may improve sleep respiratory parameters and blood pressure to varying degrees. There is a more significant improvement of nocturnal AHI and SpO2 in CPAP group and more lower MSBp in RSD group.

The effect of obstructive sleep apnea syndrome on growth and development in nonobese children: a parallel study of twins.

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Zhang, Xiao Man; Shi, Jun; Meng, Guo Zhen; Chen, Hong Sai; Zhang, Li Na; Wang, Zhao Yan; Wu, Hao

2015-03-01

To explore the effects of obstructive sleep apnea syndrome (OSAS) on children's growth by the study of identical twins. Seventeen cases of nonobese children with OSAS were included in this study. The control group was their identical twin sibling, who had no signs of OSAS. Data including height, weight, and serum insulin-like growth factor 1 levels were analyzed before tonsillectomy and adenoidectomy (T&A) and at 3, 6, and 12 months after surgery. The mean apnea hyponea index was 3.9 times/hour in patients with OSAS and became normal after surgery. Minimum oxygen saturation gradually increased after T&A. The height and weight of the OSAS group before T&A was lower than the control group. During the follow-up period, height and weight increased but were lower than the control group. Serum insulin-like growth factor 1 levels in the OSAS group before T&A were lower than the control group. The level was significantly increased 3 months after T&A. OSAS impairs growth and development. Significant growth recovery occurs after T&A, and early surgical intervention is an important factor for improvement in growth. Copyright © 2015. Published by Elsevier Inc.

Sleep and Wakefulness Handbook for Flight Medical Officers,

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1982-01-01

related growth hormone secretion is simila, during all four seasons . Pituitary-Adrenal Axis Blood cortisol levels are lowest in the early hours of sleep...to increased caffeine and smoking which is common in nightworkers. Diabetics and patients with thyrotoxicosis may also find it difficult to ensure...must also be remembered that even after a long period of abstinence unusual sleep patterns may persist in the alcoholic who may still complain of

The Effects of Sleep Disturbance on School Performance: A Preliminary Investigation of Children Attending Elementary Grades

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Reale, Laura; Guarnera, Manuela; Mazzone, Luigi

2014-01-01

Sleep disorders in children are common. Sleep plays an important role in children's development and sleep disorders can have a substantial impact on their quality of life. Indeed, sleep is crucial for physical growth, behavior, and emotional development and it is also closely related to cognitive functioning, learning and attention, and therefore…

Ultradian rhythms in pituitary and adrenal hormones: their relations to sleep.

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Gronfier, C; Brandenberger, G

1998-02-01

Sleep and circadian rhythmicity both influence the 24-h profiles of the main pituitary and adrenal hormones. From studies using experimental strategies including complete and partial sleep deprivation, acute and chronic shifts in the sleep period, or complete sleep-wake reversal as occurs with transmeridian travel or shift-work, it appears that prolactin (PRL) and growth hormone (GH) profiles are mainly sleep related, while cortisol profile is mainly controlled by the circadian clock with a weak influence of sleep processes. Thyrotropin (TSH) profile is under the dual influence of sleep and circadian rhythmicity. Recent studies, in which we used spectral analysis of sleep electroencephalogram (EEG) rather than visual scoring of sleep stages, have evaluated the temporal associations between pulsatile hormonal release and the variations in sleep EEG activity. Pulses in PRL and in GH are positively linked to increases in delta wave activity, whereas TSH and cortisol pulses are related to decreases in delta wave activity. It is yet not clear whether sleep influences endocrine secretion, or conversely, whether hormone secretion affects sleep structure. These well-defined relationships raise the question of their physiological significance and of their clinical implications.

Sleep less and bite more: sleep disorders associated with occlusal loads during sleep.

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Kato, Takafumi; Yamaguchi, Taihiko; Okura, Kazuo; Abe, Susumu; Lavigne, Gilles J

2013-04-01

Occlusal overload during sleep is a significant clinical issue that has negative impacts on the maintenance of teeth and the longevity of dental prostheses. Sleep is usually viewed as an 'out-of-functional' mode for masticatory muscles. However, orodental structures and prostheses are not free from occlusal loads during sleep since masticatory muscles can be activated at a low level within normal sleep continuity. Thus, an increase in masticatory muscle contractions, by whatever the cause, can be associated with a risk of increased occlusal loads during sleep. Among such conditions, sleep bruxism (SB) is a type of sleep-related movement disorders with potential load challenge to the tooth and orofacial structures. Patients with SB usually report frequent tooth grinding noises during sleep and there is a consecutive increase in number and strength of rhythmic masticatory muscle activity (RMMA). Other types of masticatory muscle contractions can be non-specifically activated during sleep, such as brief contractions with tooth tapping, sleep talking, non-rhythmic contractions related to non-specific body movements, etc.; these occur more frequently in sleep disorders. Studies have shown that clinical signs and symptoms of SB can be found in patients with sleep disorders. In addition, sleep becomes compromised with aging process, and a prevalence of most sleep disorders is high in the elderly populations, in which prosthodontic rehabilitations are more required. Therefore, the recognition and understanding of the role of sleep disorders can provide a comprehensive vision for prosthodontic rehabilitations when prosthodontists manage complex orodental cases needing interdisciplinary collaborations between dentistry and sleep medicine. Copyright © 2013 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Sleep-Active Neurons: Conserved Motors of Sleep

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Bringmann, Henrik

2018-01-01

Sleep is crucial for survival and well-being. This behavioral and physiological state has been studied in all major genetically accessible model animals, including rodents, fish, flies, and worms. Genetic and optogenetic studies have identified several neurons that control sleep, making it now possible to compare circuit mechanisms across species. The “motor” of sleep across animal species is formed by neurons that depolarize at the onset of sleep to actively induce this state by directly inhibiting wakefulness. These sleep-inducing neurons are themselves controlled by inhibitory or activating upstream pathways, which act as the “drivers” of the sleep motor: arousal inhibits “sleep-active” neurons whereas various sleep-promoting “tiredness” pathways converge onto sleep-active neurons to depolarize them. This review provides the first overview of sleep-active neurons across the major model animals. The occurrence of sleep-active neurons and their regulation by upstream pathways in both vertebrate and invertebrate species suggests that these neurons are general and ancient components that evolved early in the history of nervous systems. PMID:29618588

Sleep Disorders

DEFF Research Database (Denmark)

Rahbek Kornum, Birgitte; Mignot, Emmanuel

2014-01-01

mediates circadian regulation of sleep. Misalignment with the rhythm of the sun results in circadian disorders and jet lag. The molecular basis of homeostatic sleep regulation is mostly unknown. A network of mutually inhibitory brain nuclei regulates sleep states and sleep-wake transitions. Abnormalities...... in these networks create sleep disorders, including rapid eye movement sleep behavior disorder, sleep walking, and narcolepsy. Physiological changes associated with sleep can be imbalanced, resulting in excess movements such as periodic leg movements during sleep or abnormal breathing in obstructive sleep apneas....... As every organ in the body is affected by sleep directly or indirectly, sleep and sleep-associated disorders are frequent and only now starting to be understood....

Detecting obstructive sleep apnea in children by self-affine visualization of oximetry

NARCIS (Netherlands)

Garde, Ainara; Dekhordi, Parastoo; Petersen, Christian L.; Ansermino, John Mark; Dumont, Guy A.

2017-01-01

Obstructive sleep apnea (OSA), characterized by cessations of breathing during sleep due to upper airway collapse, can affect the healthy growth and development of children. The gold standard for OSA diagnosis, polysomnography (PSG), is expensive and resource intensive, resulting in long waiting

Lessons from sleeping flies: insights from Drosophila melanogaster on the neuronal circuitry and importance of sleep.

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Potdar, Sheetal; Sheeba, Vasu

2013-06-01

Sleep is a highly conserved behavior whose role is as yet unknown, although it is widely acknowledged as being important. Here we provide an overview of many vital questions regarding this behavior, that have been addressed in recent years using the genetically tractable model organism Drosophila melanogaster in several laboratories around the world. Rest in D. melanogaster has been compared to mammalian sleep and its homeostatic and circadian regulation have been shown to be controlled by intricate neuronal circuitry involving circadian clock neurons, mushroom bodies, and pars intercerebralis, although their exact roles are not entirely clear. We draw attention to the yet unanswered questions and contradictions regarding the nature of the interactions between the brain regions implicated in the control of sleep. Dopamine, octopamine, γ-aminobutyric acid (GABA), and serotonin are the chief neurotransmitters identified as functioning in different limbs of this circuit, either promoting arousal or sleep by modulating membrane excitability of underlying neurons. Some studies have suggested that certain brain areas may contribute towards both sleep and arousal depending on activation of specific subsets of neurons. Signaling pathways implicated in the sleep circuit include cyclic adenosine monophosphate (cAMP) and epidermal growth factor receptor-extracellular signal-regulated kinase (EGFR-ERK) signaling pathways that operate on different neural substrates. Thus, this field of research appears to be on the cusp of many new and exciting findings that may eventually help in understanding how this complex physiological phenomenon is modulated by various neuronal circuits in the brain. Finally, some efforts to approach the "Holy Grail" of why we sleep have been summarized.

Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions

Directory of Open Access Journals (Sweden)

Br

2011-06-01

Full Text Available Serge Brand1, Roumen Kirov21Depression and Sleep Research Unit, Psychiatric Hospital of the University of Basel, Basel, Switzerland; 2Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, BulgariaThe authors contributed equally to this workAbstract: Restoring sleep is strongly associated with a better physical, cognitive, and psychological well-being. By contrast, poor or disordered sleep is related to impairment of cognitive and psychological functioning and worsened physical health. These associations are well documented not only in adults but also in children and adolescents. Importantly, adolescence is hallmarked by dramatic maturational changes in sleep and its neurobiological regulation, hormonal status, and many psychosocial and physical processes. Thus, the role of sleep in mental and physical health during adolescence and in adolescent patients is complex. However, it has so far received little attention. This review first presents contemporary views about the complex neurobiology of sleep and its functions with important implications for adolescence. Second, existing complex relationships between common adolescent somatic/organic, sleep-related, and psychiatric disorders and certain sleep alterations are discussed. It is concluded that poor or altered sleep in adolescent patients may trigger and maintain many psychiatric and physical disorders or combinations of these conditions, which presumably hinder recovery and may cross into later stages of life. Therefore, timely diagnosis and management of sleep problems appear critical for growth and development in adolescent patients.Keywords: cognitive, psychological, neurobiology, growth, development, sleep physiology, rapid eye movement, non-REM sleep, behavioral disorders, adolescents

Comparing sleep disorders in urban and suburban adolescents

Directory of Open Access Journals (Sweden)

Nur'aini Nur'aini

2014-10-01

Full Text Available Background Sleep disturbances commonly occur in adolescents. Socioeconomic levels, lifestyle, and urban or suburban environments influence the sleep patterns of adolescents. The modernization process in urban environments is marked by the development of information technology media, and the lack of parental monitoring potentially influencing adolescent sleep disturbances. Sleep disturbances may affect children's physical growth, as well as their emotional, cognitive, and social development. Objective To assess for sleep disorders in urban and suburban adolescents, and to determine the factors that influence the prevalence of sleep disturbances. Methods A cross-sectional study was conducted on 12 to 15-year-old junior high school students in urban (n=350 and suburban (n=350 environments in the city of Medan, North Sumatera. The study was undertaken from May to June 2010 using the Sleep Disorders Scale for Children (SDSC, a set of questionnaires. The SDSC was filled out by parents based on what they remembered about their children's sleep patterns in the prior 6 months. Results In the urban group, there were 133 (38.0% subjects with sleep disturbances, 182 (52.0% were borderline, and 35 (10.0% were normal. In the suburban group, there were 132 (37.7% subjects with sleep disturbances, 180 (51.4% were borderline, and 38 (10.9% were normal. The most influential factors for sleep disturbances in urban and suburban youth were environmental noise (P=0.001 and consuming beverages that contain caffeine (P=0.001. There were three types of sleep disorders that significantly found more in urban adolescents: disorders of initiating and maintaining sleep, disorders of excessive somnolence, and sleep hyperhidrosis. Conclusion The prevalence of sleep disturbances do not differ between urban and suburban adolescents. Howevet; there are significant differences in the types of sleep disorders experienced. The most influential factors on sleep disturbance in both

Effects of nocturnal aircraft noise on sleep: results from the ''quiet air traffic'' project; Wirkungen des Nachtfluglaerms auf den Schlaf: Ergebnisse aus dem Projekt ''Leiser Flugverkehr''

Energy Technology Data Exchange (ETDEWEB)

Samel, A.; Basner, M.; Maass, H.; Mueller, U.; Quehl, J.; Wenzel, J. [Deutsches Zentrum fuer Luft- und Raumfahrt (DLR) in der Helmholtz-Gemeinschaft (HGF), Inst. fuer Luft- und Raumfahrtmedizin, Koeln (Germany)

2005-07-01

In 192 sleep-healthy subjects (18 to 65 y) effects of nocturnal aircraft noise on sleep, stress, performance and subjective factors were investigated in 2240 nights under laboratory and field conditions. In the sleep lab, 112 volunteers were subjected to aircraft noise events by varying numbers and noise levels during 9 nights within a period of 13 nights. 16 further subjects served as control group (i.e. without any noise). 64 subjects were studied in the vicinity of Cologne-Bonn airport during 9 nights. Polysomnographical and acoustical recordings, determination of excretion rates of stress hormones from night urines, performance tests and questionnaires were conducted during all days for the assessment of nocturnal aircraft noise effects. By simultaneous recording of electrophysiological and acoustical data the probability of noise induced awakenings was estimated. Performance and most of psychological parameters did not show significant dose-effect relationships, whereas annoyance did. Epinephrine and norepinephrine did not change under aircraft noise, cortisol did change only in the lab. In the lab, a comparison between all noisy nights and noise-free baseline nights exhibited a non-significant 2-min. reduction of sleep and a 4-min. decrease of slow-wave sleep. In the field, awakenings caused by aircraft noise were detected above a threshold of 33 dB(A) ''at the sleeper's ear''. All effects were much less pronounced in the field than in the lab. For the first time, precise dose-effect curves between maximum aircraft noise event levels and electrophysiologically detectable awakenings, and a threshold were empirically established. The results of these studies broadens the knowledge on aircraft noise induced sleep disturbances and immediate consequences for the next day. (orig.)

Adolescents' sleep behaviors and perceptions of sleep.

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Noland, Heather; Price, James H; Dake, Joseph; Telljohann, Susan K

2009-05-01

Sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents. This study extends our understanding of how adolescents perceive and deal with their sleep issues. General education classes were randomly selected from a convenience sample of three high schools in the Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviors and perceptions of sleep. Most respondents (91.9%) obtained inadequate sleep (sleep each week night. The majority indicated that not getting enough sleep had the following effects on them: being more tired during the day (93.7%), having difficulty paying attention (83.6%), lower grades (60.8%), increase in stress (59.0%), and having difficulty getting along with others (57.7%). Some students reported engaging in harmful behaviors to help them sleep: taking sleeping pills (6.0%), smoking a cigarette to relax (5.7%), and drinking alcohol in the evening (2.9%). Students who received fewer hours of sleep were significantly more likely to report being stressed (p = .02) and were more likely to be overweight (p = .04). Inadequate sleep time may be contributing to adolescent health problems such as increased stress and obesity. Findings indicate a need for sleep hygiene education for adolescents and their parents. A long-term solution to chronic sleep deprivation among high school students could include delaying high school start times, such as was done successfully in the Minneapolis Public School District.

Sleep behaviour in a sample of preschool children in Singapore.

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Aishworiya, Ramkumar; Chan, Pofun; Kiing, Jennifer; Chong, Shang Chee; Laino, Armi G; Tay, Stacey Kh

2012-03-01

Sleep problems are common in all ages, but may be particularly acute in urban Singapore. This study aims to describe the sleep behaviour of, and to identify any sleep problems in, preschool children. This was a cross-sectional questionnaire survey of 372 children attending local childcare centers. The questionnaire was based on the Children's Sleep Habits Questionnaire (CSHQ), a validated parent-report sleep screening questionnaire that contains 54 items identifying sleep behaviours in children. A total of 372 (40.0%) children participated. The mean age was 4.1 (SD 1.3) years (range, 2 to 6 years). Average total sleep duration was 10.8 hours (SD 1.1) with average night-time sleep duration of 8.5 hours (SD 0.6) and average nap duration of 1.6 hours (SD 1.0). Co-sleeping was common; 80.9% of children shared a room with someone else. The most common sleep problems were in the domains of sleep resistance and morning behaviour; namely: requiring company to fall asleep (n = 272, 73.1%), being afraid to sleep alone (n = 228, 61.6%) and diffi culty in waking up (n = 165, 44.4%). Among parents, 84.1 % (n = 313) perceived that their child's sleep duration was adequate. The duration of sleep in the Singaporean preschool population sampled is signifi cantly lower than recommended values and that of previously described Caucasian populations. Parental perception of sleep adequacy deviates from current recommendations. Given the clear relation of sleep duration with cognitive functioning, learning, and physical growth, this sleep deprivation should be addressed with parental education and opportunistic screening of sleep in well-child follow-ups.

Sleep Habits and Sleep Problems in Healthy Preschoolers.

Science.gov (United States)

Murthy, C L Srinivasa; Bharti, Bhavneet; Malhi, Prahbhjot; Khadwal, Alka

2015-07-01

To describe the sleep patterns and problems in children aged between 12 and 36 mo of age. This cross sectional survey was collected over a span of 1 y in Advanced Pediatric Centre, PGIMER, Chandigarh and crèches of Chandigarh. Children in the age group of 12 to 36 mo were included in study. Children with chronic illness, developmental delay, seizure disorder and lack of consent were excluded. A total of 368 children were enrolled. Main outcome measures were sleep duration over 1 to 3 y of life; sleep behavior at onset, during and waking of sleep and parent reported sleep problems and their predictors. The average duration of sleep was 12.5 h (S.D = 1.9). The mean total sleep duration and mean day time sleep duration decreased, while mean night time sleep increased as the age advanced from 12 to 36 mo. Following were the frequency of sleep habits seen in the index study; bed time routine was seen only in 68(18.5 %), a regular bed time ritual was seen in 281(76.4 %), 329(89.4 %) children frequently required 0-20 min time to fall asleep, 11(3 %) parents used sleep inducing drugs. Night waking (1 to 3 times a night) was seen in 297(80.7 %) and its frequency declined with age. Parent reported sleep problems were seen in 12.8 % (47/368). Lack of co-sleeping and night waking were considered as strongest predictors of parent reported sleep problems. Toddlers' sleep duration, night waking behavior, and day time naps decrease as the age progress while night time sleep duration increases with age. Lack of co-sleeping and night waking are considered as strongest predictors of parent reported sleep problems.

Sleep

Science.gov (United States)

... Institute (NHLBI). 1 Mood. Sleep affects your mood. Insufficient sleep can cause irritability that can lead to trouble with relationships, ... basics/understanding_sleep.htm#dynamic_activity Centers for Disease ... insufficient rest or sleep among adults—United States, 2008. MMWR, 58 (42), ...

Immediate postarousal sleep dynamics: an important determinant of sleep stability in obstructive sleep apnea.

Science.gov (United States)

Younes, Magdy; Hanly, Patrick J

2016-04-01

Arousability from sleep is increasingly recognized as an important determinant of the clinical spectrum of sleep disordered breathing (SDB). Patients with SDB display a wide range of arousability. The reason for these differences is not known. We hypothesized that differences in the speed with which sleep deepens following arousals/awakenings (postarousal sleep dynamics) is a major determinant of these differences in arousability in patients with SDB. We analyzed 40 preexisting clinical polysomnography records from patients with a range of SDB severity (apnea-hypopnea index 5-135/h). Sleep depth was determined every 3 s using the odds ratio product (ORP) method, a continuous index of sleep depth (0 = deep sleep, 2.5 = full wakefulness) that correlates strongly (r = 0.98) with arousability (Younes M, Ostrowski M, Soiferman M, Younes H, Younes M, Raneri J, and Hanly P. Sleep 38: 641-654, 2015). Time course of ORP was determined from end of arousal until the next arousal. All arousals were analyzed (142 ± 65/polysomnogram). ORP increased from 0.58 ± 0.32 during sleep to 1.67 ± 0.35 during arousals. ORP immediately (first 9 s) following arousals/awakenings (ORP-9) ranged from 0.21(very deep sleep) to 1.71 (highly arousable state) in different patients. In patients with high ORP-9, sleep deepened slowly (over minutes) beyond 9 s but only if no arousals/awakenings recurred. ORP-9 correlated strongly with average non-rapid eye movement sleep depth (r = 0.87, P sleep architecture. We conclude that postarousal sleep dynamics are highly variable among patients with sleep-disordered breathing and largely determine average sleep depth and continuity. Copyright © 2016 the American Physiological Society.

Detection of arousals in Parkinson’s disease patients

DEFF Research Database (Denmark)

Sørensen, Gertrud Laura; Kempfner, Jacob; Jennum, Poul

2011-01-01

sleepiness. Manual scoring of arousals is time-consuming and the inter-score agreement is highly varying especially for patients with sleep related disorders. The aim of this study was to design an arousal detection algorithm capable of detecting arousals from sleep, in both non-REM and REM sleep in patients......Arousal from sleep are short awakenings, which can be identified in the EEG as an abrupt change in frequency. Arousals can occur in all sleep stages and the number and frequency increase with age. Frequent arousals during sleep results in sleep fragmentation and is associated with daytime...... suffering from Parkinson’s disease (PD). The proposed algorithm uses features from EEG, EMG and the manual sleep stage scoring as input to a feed-forward artificial neural network (ANN). The performance of the algorithm has been assessed using polysomnographic (PSG) recordings from a total of 8 patients...

Detection of arousals in Parkinson's disease patients

DEFF Research Database (Denmark)

Sørensen, Gertrud Laura; Kempfner, Jacob; Jennum, Poul

2011-01-01

sleepiness. Manual scoring of arousals is time-consuming and the inter-score agreement is highly varying especially for patients with sleep related disorders. The aim of this study was to design an arousal detection algorithm capable of detecting arousals from sleep, in both non-REM and REM sleep in patients......Arousal from sleep are short awakenings, which can be identified in the EEG as an abrupt change in frequency. Arousals can occur in all sleep stages and the number and frequency increase with age. Frequent arousals during sleep results in sleep fragmentation and is associated with daytime...... suffering from Parkinson's disease (PD). The proposed algorithm uses features from EEG, EMG and the manual sleep stage scoring as input to a feed-forward artificial neural network (ANN). The performance of the algorithm has been assessed using polysomnographic (PSG) recordings from a total of 8 patients...

Physical neighborhood and social environment, beliefs about sleep, sleep hygiene behaviors, and sleep quality among African Americans.

Science.gov (United States)

Nam, Soohyun; Whittemore, Robin; Jung, Sunyoung; Latkin, Carl; Kershaw, Trace; Redeker, Nancy S

2018-06-01

African Americans (AAs) have a higher prevalence of sleep disorders than other racial/ethnic groups. However, little is known about the relationships among individual and neighborhood factors related to sleep quality in AAs. The purposes of this study were to (1) describe beliefs about sleep, sleep hygiene behaviors, and sleep quality among AAs; and (2) examine the relationships among sociodemographic characteristics, neighborhood environment, beliefs about sleep, sleep hygiene behaviors, and sleep quality. We conducted a cross-sectional study of 252 AA men and women in the Greater New Haven, CT, USA community. We assessed their sociodemographic characteristics, neighborhood environment, beliefs about sleep, sleep hygiene, and sleep quality with the following measures, respectively: the Neighborhood Environment Scale, the brief version of Dysfunctional Beliefs and Attitudes about Sleep, the Sleep Hygiene Practice Scale, the Pittsburgh Sleep Quality Index. We performed descriptive statistics, correlations and multiple hierarchical regression. About 72% of the participants (mean age: 53.88 ± 14.17 years, 77.8% women) reported experiencing sleep disturbance. People with poor sleep quality were more likely to report poorer neighborhood social environment (social cohesion), poorer overall neighborhood environment, more dysfunctional beliefs toward sleep, and poorer sleep hygiene than those who had good sleep quality. In the final multivariate model that controlled for a number of chronic comorbid conditions, neighborhood environment, beliefs about sleep, and sleep hygiene behaviors were significantly associated with sleep quality. Future efforts are needed to improve sleep among AAs by considering both the individual's belief about sleep, sleep hygiene behaviors and neighborhood factors. Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

The effect of aromatherapy with Rosa damascena essential oil on sleep quality in children

OpenAIRE

A.S. Keyhanmehr; M. Movahhed; S. Sahranavard; L. Gachkar; M. Hamdieh; Sh. Afsharpaiman*; H. Nikfarjad

2018-01-01

Background and objectives: Sleep disorder is one of the main problems in children. Poor sleep quality can lead to adverse effects on their growth and development. Aromatherapy is a kind of method for improving sleep. In Iranian traditional medicine, inhaling Rosa damascena has been recommended for treating sleep disorder. Due to the side effects of chemical drugs and trend to alternative medicine due to less complication, the aim of this study was to investigate the effect of aromatherapy wit...

Sleep physiology and sleep disorders in childhood

Directory of Open Access Journals (Sweden)

El Shakankiry HM

2011-09-01

Full Text Available Hanan M El ShakankiryKing Fahd University Hospital, Al Dammam University, Al Khobar, Kingdom of Saudi ArabiaAbstract: Sleep has long been considered as a passive phenomenon, but it is now clear that it is a period of intense brain activity involving higher cortical functions. Overall, sleep affects every aspect of a child's development, particularly higher cognitive functions. Sleep concerns are ranked as the fifth leading concern of parents. Close to one third of all children suffer from sleep disorders, the prevalence of which is increased in certain pediatric populations, such as children with special needs, children with psychiatric or medical diagnoses and children with autism or pervasive developmental disorders. The paper reviews sleep physiology and the impact, classification, and management of sleep disorders in the pediatric age group.Keywords: sleep physiology, sleep disorders, childhood, epilepsy

Sleep and awake bruxism in adults and its relationship with temporomandibular disorders: A systematic review from 2003 to 2014.

Science.gov (United States)

Jiménez-Silva, Antonio; Peña-Durán, Consuelo; Tobar-Reyes, Julio; Frugone-Zambra, Raúl

2017-01-01

In order to establish a relationship between bruxism and temporomandibular disorders (TMDs), a systematic review was performed. A systematic research was performed based on PubMed, Cochrane Library, Medline, Embase, BIREME, Lilacs and Scielo data bases, between 2003 and 2014 including all languages. Descriptive clinical cases were identified. Two independent authors selected the articles. PICO format was used to analyse the studies and the Newcastle-Ottawa Scale (NOS) was used to verify the quality of the evidence. Thirty-nine studies (n = 39) were analysed in this review. According to bruxism diagnosis, articles were grouped as follows: polysomnographic diagnosis (PSG) (n = 7), clinical diagnosis (n = 11) and survey/self-report (n = 21). Thirty-three articles (n = 33) established a positive relation between bruxism and TMD and six (n = 6) did not. Quality of evidence was low to moderate. In general, the most part of the studies showed shortcomings on their design with bias risk, and also had a low sensitivity on bruxism diagnosis. The evidence based on PSG was not as conclusive as the studies that used surveys and clinical exam to diagnosis bruxism, when bruxism was related to TMD. Sleep bruxism could be associated with myofascial pain, arthralgia and joint pathology as disc displacement and joint noises. Although the evidence at present is inconclusive and does not provide information according to the type of bruxism (bruxism sleep and wakefulness), it is possible to suggest that bruxism would be associated with TMD.

I sleep, because we sleep: a synthesis on the role of culture in sleep behavior research.

Science.gov (United States)

Airhihenbuwa, C O; Iwelunmor, J I; Ezepue, C J; Williams, N J; Jean-Louis, G

2016-02-01

The aim of this study was to synthesize the literature on the cultural aspects of sleep and their relevance to behavioral sleep research. A narrative synthesis of the existing literature on sleep was conducted with a focus on its biological, sociological, political, and anthropological aspects. This synthesis was guided by the PEN-3 cultural model, developed by the primary author. The findings highlight the cross-cultural contexts within which people sleep and the role of varied sleeping arrangements in influencing sleep behavior and perspectives. Furthermore, the contexts in which sleep occurs, coupled with the influence of the family, and the positive aspects of sleep helped illustrate why cultural aspects of sleep are vital for a broader understanding of sleep. The authors conclude by highlighting the need to integrate studies on the biological, sociological, and political aspects of sleep. Our examination of the literature strongly suggests that careful assessment of epidemiological and clinical sleep data should consider the cultural aspects of sleep as well as the context in which sleep occurs, the role of the family, and positive aspects of sleep. Copyright © 2015 Elsevier B.V. All rights reserved.

A link between sleep loss, glucose metabolism and adipokines

Directory of Open Access Journals (Sweden)

H.G. Padilha

2011-10-01

Full Text Available The present review evaluates the role of sleep and its alteration in triggering problems of glucose metabolism and the possible involvement of adipokines in this process. A reduction in the amount of time spent sleeping has become an endemic condition in modern society, and a search of the current literature has found important associations between sleep loss and alterations of nutritional and metabolic contexts. Studies suggest that sleep loss is associated with problems in glucose metabolism and a higher risk for the development of insulin resistance and type 2 diabetes mellitus. The mechanism involved may be associated with the decreased efficacy of regulation of the hypothalamus-pituitary-adrenal axis by negative feedback mechanisms in sleep-deprivation conditions. In addition, changes in the circadian pattern of growth hormone (GH secretion might also contribute to the alterations in glucose regulation observed during sleep loss. On the other hand, sleep deprivation stress affects adipokines - increasing tumor necrosis factor-α (TNF-α and interleukin-6 (IL-6 and decreasing leptin and adiponectin -, thus establishing a possible association between sleep-debt, adipokines and glucose metabolism. Thus, a modified release of adipokines resulting from sleep deprivation could lead to a chronic sub-inflammatory state that could play a central role in the development of insulin resistance and type 2 diabetes mellitus. Further studies are necessary to investigate the role of sleep loss in adipokine release and its relationship with glucose metabolism.

Train hard, sleep well? Perceived training load, sleep quantity and sleep stage distribution in elite level athletes.

Science.gov (United States)

Knufinke, Melanie; Nieuwenhuys, Arne; Geurts, Sabine A E; Møst, Els I S; Maase, Kamiel; Moen, Maarten H; Coenen, Anton M L; Kompier, Michiel A J

2018-04-01

Sleep is essential for recovery and performance in elite athletes. While it is generally assumed that exercise benefits sleep, high training load may jeopardize sleep and hence limit adequate recovery. To examine this, the current study assessed objective sleep quantity and sleep stage distributions in elite athletes and calculated their association with perceived training load. Mixed-methods. Perceived training load, actigraphy and one-channel EEG recordings were collected among 98 elite athletes during 7 consecutive days of regular training. Actigraphy revealed total sleep durations of 7:50±1:08h, sleep onset latencies of 13±15min, wake after sleep onset of 33±17min and sleep efficiencies of 88±5%. Distribution of sleep stages indicated 51±9% light sleep, 21±8% deep sleep, and 27±7% REM sleep. On average, perceived training load was 5.40±2.50 (scale 1-10), showing large daily variability. Mixed-effects models revealed no alteration in sleep quantity or sleep stage distributions as a function of day-to-day variation in preceding training load (all p's>.05). Results indicate healthy sleep durations, but elevated wake after sleep onset, suggesting a potential need for sleep optimization. Large proportions of deep sleep potentially reflect an elevated recovery need. With sleep quantity and sleep stage distributions remaining irresponsive to variations in perceived training load, it is questionable whether athletes' current sleep provides sufficient recovery after strenuous exercise. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

REM sleep complicates period adding bifurcations from monophasic to polyphasic sleep behavior in a sleep-wake regulatory network model for human sleep

OpenAIRE

Kalmbach, K.; Booth, V.; Behn, C. G. Diniz

2017-01-01

The structure of human sleep changes across development as it consolidates from the polyphasic sleep of infants to the single nighttime sleep period typical in adults. Across this same developmental period, time scales of the homeostatic sleep drive, the physiological drive to sleep that increases with time spent awake, also change and presumably govern the transition from polyphasic to monophasic sleep behavior. Using a physiologically-based, sleep-wake regulatory network model for human sle...

Sustained sleep fragmentation induces sleep homeostasis in mice

KAUST Repository

Baud, Maxime O.; Magistretti, Pierre J.; Petit, Jean Marie

2015-01-01

Study Objectives: Sleep fragmentation (SF) is an integral feature of sleep apnea and other prevalent sleep disorders. Although the effect of repetitive arousals on cognitive performance is well documented, the effects of long-term SF on electroencephalography (EEG) and molecular markers of sleep homeostasis remain poorly investigated. To address this question, we developed a mouse model of chronic SF and characterized its effect on EEG spectral frequencies and the expression of genes previously linked to sleep homeostasis including clock genes, heat shock proteins, and plasticity-related genes. Design: N/A. Setting: Animal sleep research laboratory. Participants : Sixty-six C57BL6/J adult mice. Interventions: Instrumental sleep disruption at a rate of 60/h during 14 days Measurements and Results: Locomotor activity and EEG were recorded during 14 days of SF followed by recovery for 2 days. Despite a dramatic number of arousals and decreased sleep bout duration, SF minimally reduced total quantity of sleep and did not significantly alter its circadian distribution. Spectral analysis during SF revealed a homeostatic drive for slow wave activity (SWA; 1-4 Hz) and other frequencies as well (4-40 Hz). Recordings during recovery revealed slow wave sleep consolidation and a transient rebound in SWA, and paradoxical sleep duration. The expression of selected genes was not induced following chronic SF. Conclusions: Chronic sleep fragmentation (SF) increased sleep pressure confirming that altered quality with preserved quantity triggers core sleep homeostasis mechanisms. However, it did not induce the expression of genes induced by sleep loss, suggesting that these molecular pathways are not sustainably activated in chronic diseases involving SF.

Sustained sleep fragmentation induces sleep homeostasis in mice

KAUST Repository

Baud, Maxime O.

2015-04-01

Study Objectives: Sleep fragmentation (SF) is an integral feature of sleep apnea and other prevalent sleep disorders. Although the effect of repetitive arousals on cognitive performance is well documented, the effects of long-term SF on electroencephalography (EEG) and molecular markers of sleep homeostasis remain poorly investigated. To address this question, we developed a mouse model of chronic SF and characterized its effect on EEG spectral frequencies and the expression of genes previously linked to sleep homeostasis including clock genes, heat shock proteins, and plasticity-related genes. Design: N/A. Setting: Animal sleep research laboratory. Participants : Sixty-six C57BL6/J adult mice. Interventions: Instrumental sleep disruption at a rate of 60/h during 14 days Measurements and Results: Locomotor activity and EEG were recorded during 14 days of SF followed by recovery for 2 days. Despite a dramatic number of arousals and decreased sleep bout duration, SF minimally reduced total quantity of sleep and did not significantly alter its circadian distribution. Spectral analysis during SF revealed a homeostatic drive for slow wave activity (SWA; 1-4 Hz) and other frequencies as well (4-40 Hz). Recordings during recovery revealed slow wave sleep consolidation and a transient rebound in SWA, and paradoxical sleep duration. The expression of selected genes was not induced following chronic SF. Conclusions: Chronic sleep fragmentation (SF) increased sleep pressure confirming that altered quality with preserved quantity triggers core sleep homeostasis mechanisms. However, it did not induce the expression of genes induced by sleep loss, suggesting that these molecular pathways are not sustainably activated in chronic diseases involving SF.

Loop Gain Predicts the Response to Upper Airway Surgery in Patients With Obstructive Sleep Apnea.

Science.gov (United States)

Joosten, Simon A; Leong, Paul; Landry, Shane A; Sands, Scott A; Terrill, Philip I; Mann, Dwayne; Turton, Anthony; Rangaswamy, Jhanavi; Andara, Christopher; Burgess, Glen; Mansfield, Darren; Hamilton, Garun S; Edwards, Bradley A

2017-07-01

Upper airway surgery is often recommended to treat patients with obstructive sleep apnea (OSA) who cannot tolerate continuous positive airways pressure. However, the response to surgery is variable, potentially because it does not improve the nonanatomical factors (ie, loop gain [LG] and arousal threshold) causing OSA. Measuring these traits clinically might predict responses to surgery. Our primary objective was to test the value of LG and arousal threshold to predict surgical success defined as 50% reduction in apnea-hypopnea index (AHI) and AHI <10 events/hour post surgery. We retrospectively analyzed data from patients who underwent upper airway surgery for OSA (n = 46). Clinical estimates of LG and arousal threshold were calculated from routine polysomnographic recordings presurgery and postsurgery (median of 124 [91-170] days follow-up). Surgery reduced both the AHI (39.1 ± 4.2 vs. 26.5 ± 3.6 events/hour; p < .005) and estimated arousal threshold (-14.8 [-22.9 to -10.2] vs. -9.4 [-14.5 to -6.0] cmH2O) but did not alter LG (0.45 ± 0.08 vs. 0.45 ± 0.12; p = .278). Responders to surgery had a lower baseline LG (0.38 ± 0.02 vs. 0.48 ± 0.01, p < .05) and were younger (31.0 [27.3-42.5] vs. 43.0 [33.0-55.3] years, p < .05) than nonresponders. Lower LG remained a significant predictor of surgical success after controlling for covariates (logistic regression p = .018; receiver operating characteristic area under curve = 0.80). Our study provides proof-of-principle that upper airway surgery most effectively resolves OSA in patients with lower LG. Predicting the failure of surgical treatment, consequent to less stable ventilatory control (elevated LG), can be achieved in the clinic and may facilitate avoidance of surgical failures. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep disorders and work performance: findings from the 2008 National Sleep Foundation Sleep in America poll.

Science.gov (United States)

Swanson, Leslie M; Arnedt, J Todd; Rosekind, Mark R; Belenky, Gregory; Balkin, Thomas J; Drake, Christopher

2011-09-01

Chronic sleep deprivation is common among workers, and has been associated with negative work outcomes, including absenteeism and occupational accidents. The objective of the present study is to characterize reciprocal relationships between sleep and work. Specifically, we examined how sleep impacts work performance and how work affects sleep in individuals not at-risk for a sleep disorder; assessed work performance outcomes for individuals at-risk for sleep disorders, including insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS); and characterized work performance impairments in shift workers (SW) at-risk for shift work sleep disorders relative to SW and day workers. One-thousand Americans who work 30 h per week or more were asked questions about employment, work performance and sleep in the National Sleep Foundation's 2008 Sleep in America telephone poll. Long work hours were associated with shorter sleep times, and shorter sleep times were associated with more work impairments. Thirty-seven percent of respondents were classified as at-risk for any sleep disorder. These individuals had more negative work outcomes as compared with those not at-risk for a sleep disorder. Presenteeism was a significant problem for individuals with insomnia symptoms, OSA and RLS as compared with respondents not at-risk. These results suggest that long work hours may contribute to chronic sleep loss, which may in turn result in work impairment. Risk for sleep disorders substantially increases the likelihood of negative work outcomes, including occupational accidents, absenteeism and presenteeism. © 2010 European Sleep Research Society.

Support system and method for detecting neurodegenerative disorder

DEFF Research Database (Denmark)

2013-01-01

The present invention relates to a system and a method for detection of abnormal motor activity during REM sleep, and further to systems and method for assisting in detecting neurodegenerative disorders such as Parkinson's. One embodiment relates to a method for detection of abnormal motor activity...... during REM sleep comprising the steps of: performing polysomnographic recordings of a sleeping subject, thereby obtaining one or more electromyography (EMG) derivations, preferably surface EMG recordings, and one or more EEG derivations, and/or one or more electrooculargraphy (EOG) derivations, detecting...... one or more REM sleep stages, preferably based on the one or more EEG and/or EOG derivations, determining the level of muscle activity during the one or more REM sleep stages based on the one or more EMG derivations, wherein a subject having an increased level of muscle activity during REM sleep...