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Polysomnography
Kinds of Polysomnography Selected AbstractsPolysomnography Necessitates Experimental Control of the "First Night Effect"HEADACHE, Issue 9 2001Jeanetta C. Rains PhD No abstract is available for this article. [source] Investigation of sleep disordersJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2005MJ Davey Abstract: Polysomnography or sleep study is the main investigation for paediatric sleep disorders. It involves the continuous and simultaneous recording of multiple physiological parameters evaluating sleep and respiration. It is most commonly used to diagnose obstructive sleep apnoea and to monitor nocturnal non-invasive ventilation requirements of children. Its role in other sleep related breathing disorders, narcolepsy and parasomnias is discussed. [source] Presumed rapid eye movement behavior disorder in Machado-Joseph disease (spinocerebellar ataxia type 3)MOVEMENT DISORDERS, Issue 6 2002Joseph H. Friedman MD Abstract Rapid eye movement behavior disorder (RBD) is a recently recognized sleep disorder in which patients are occasionally not paralyzed during the dream portions of sleep. When not idiopathic, this state has been associated primarily with parkinsonian conditions but also with a small number of medications and other neurodegenerative disorders. Dopamine deficiency may play a role in some patients. This report describes the occurrence of a syndrome that appears to be RBD in 6 of 7 patients followed with Spinocerebellar ataxia type 3 (Machado-Joseph disease). Polysomnography was normal in 1 patient. Two of these patients had had single photon emission computed tomographic imaging of the dopamine transporter 1 year previously. © 2002 Movement Disorder Society [source] Sleep-Disordered Breathing and Chronic Opioid TherapyPAIN MEDICINE, Issue 4 2008Lynn R. Webster MD ABSTRACT Objective., To assess the relation between medications prescribed for chronic pain and sleep apnea. Design., An observational study of chronic pain patients on opioid therapy who received overnight polysomnographies. Generalized linear models determined whether a dose relation exists between methadone, nonmethadone opioids, and benzodiazepines and the indices measuring sleep apnea. Setting., A private clinic specializing in the treatment of chronic pain. Patients., Polysomnography was sought for all consecutive (392) patients on around-the-clock opioid therapy for at least 6 months with a stable dose for at least 4 weeks. Of these, 147 polysomnographies were completed (189 patients declined, 56 were directed to other sleep laboratories by insurance companies, and data were incomplete for seven patients). Available data were analyzed on 140 patients. Outcome Measures., The apnea,hypopnea index to assess overall severity of sleep apnea and the central apnea index to assess central sleep apnea. Results., The apnea,hypopnea index was abnormal (,5 per hour) in 75% of patients (39% had obstructive sleep apnea, 4% had sleep apnea of indeterminate type, 24% had central sleep apnea, and 8% had both central and obstructive sleep apnea); 25% had no sleep apnea. We found a direct relation between the apnea,hypopnea index and the daily dosage of methadone (P = 0.002) but not to other around-the-clock opioids. We found a direct relation between the central apnea index and the daily dosage of methadone (P = 0.008) and also with benzodiazepines (P = 0.004). Conclusions., Sleep-disordered breathing was common in chronic pain patients on opioids. The dose,response relation of sleep apnea to methadone and benzodiazepines calls for increased vigilance. [source] Are there ethnic differences in sleep architecture?AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2002Judi Profant The possibility of ethnic differences in sleep architecture was initially examined in conjunction with studies of sleep apnea (study 1). This possibility was then examined in another cohort of patients to determine whether the results might generalize (study 2). Polysomnography was obtained in both cohorts as part of larger protocols investigating sympathetic nervous system activity, blood pressure, and sleep. Sleep monitoring took place in an inpatient clinical research center of a university hospital. Study 1 focused on sleep apnea physiology and involved volunteers with sleep apnea who were otherwise healthy. Study 2 focused on differences in stress reactivity between American Black and White subjects and involved hypertensive and normotensive volunteers who were otherwise healthy. Analyses include 61 participants from study 1 and 35 participants from study 2. Ethnicity in both cohorts was determined by self-report. Participants in both studies were monitored during sleep with traditional polysomnography including electroencephalography (EEG), electromyography (EMG), electrooculography (EOG), and oximetry. In Study 1, Blacks had longer TST (P < 0.01), more REM sleep (P < 0.05), and less WASO (P < 0.05) than Whites. After controling for RDI, Blacks had longer TST and spent a smaller percentage of time in deep sleep (P < 0.05). In study 2, Blacks had longer TST and REM sleep, lower percent deep sleep, and lower percent deep sleep controling for RDI (P < 0.05). In two separate studies, Blacks had longer TST, more minutes of REM, and lower percentage deep sleep. These findings suggest possible ethnic differences in sleep architecture. Am. J. Hum. Biol. 14:321,326, 2002. © 2002 Wiley-Liss, Inc. [source] Polysomnography in patients with post-traumatic stress disorderPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2010Sinan Yetkin MD Aims:, The purpose of the present study was to investigate sleep structure in post-traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. Methods:, Sleep patterns of 24 non-medicated male PTSD patients and 16 age- and sex-matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD-only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. Results:, Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. Conclusions:, PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD. [source] Sleep quality and respiratory function in children with severe cerebral palsy using night-time postural equipment: a pilot studyACTA PAEDIATRICA, Issue 11 2009Catherine M Hill Abstract Background:, Night-time postural equipment (NTPE) prevents contractures and hip subluxation in children with severe physical disabilities. However, impact on sleep quality and respiratory function has not been objectively studied. Methods:, Ten children with severe cerebral palsy (CP), mean age of 10.9 (range: 5.3,16.7) years, were recruited from a community population. Polysomnography was undertaken on two nights, once with the child sleeping in their NTPE and once sleeping unsupported. Randomization to first night condition controlled for first night effects. Results:, Night-time postural equipment use was associated with higher mean overnight oxygen saturation for three children but lower values for six children compared with sleeping unsupported. There were no differences in sleep quality between the conditions. The study group had lower overnight oxyhaemoglobin saturation values, less rapid eye movement (REM) sleep and higher arousal indices compared with typically developing children. Conclusion:, This pilot study indicated that children with severe CP risk respiratory compromise in sleep irrespective of positioning. Further study will determine if the observed trend for mean overnight oxygen saturation to be lower within positioning equipment reflects random night-to-night variation or is related to equipment use. We suggest that respiratory function is assessed when determining optimal positioning for children using night-time positioning equipment. [source] Screening of obstructive and central apnoea/hypopnoea in children using variability: A preliminary studyACTA PAEDIATRICA, Issue 5 2006Jong Yong A. Foo Abstract Aim: Polysomnography (PSG) is the current standard protocol for sleep disordered breathing (SDB) investigation in children. Presently, there are limited reliable screening tests for both central (CE) and obstructive (OE) respiratory events. This study compared three indices, derived from pulse oximetry and electrocardiogram (ECG), with the PSG gold standard. These indices were heart rate (HR) variability, arterial blood oxygen de-saturation (SaO2) and pulse transit time (PTT). Methods: 15 children (12 male) from routine PSG studies were recruited (aged 3,14 years). The characteristics of the three indices were based on known criteria for respiratory events (RPE). Their estimation singly and in combination was evaluated with simultaneous scored PSG recordings. Results: 215 RPE and 215 tidal breathing events were analysed. For OE, the obtained sensitivity was HR (0.703), SaO2 (0.047), PTT (0.750), considering all three indices (0) and either of the indices (0.828) while specificity was (0.891), (0.938), (0.922), (0.953) and (0.859) respectively. For CE, the sensitivity was HR (0.715), SaO2 (0.278), PTT (0.662), considering all indices (0.040) and either of the indices (0.868) while specificity was (0.815), (0.954), (0.901), (0.960) and (0.762) accordingly. Conclusions: Preliminary findings herein suggest that the later combination of these non-invasive indices to be a promising screening method of SDB in children. [source] The role of history, Epworth Sleepiness Scale Score and body mass index in identifying non-apnoeic snorersCLINICAL OTOLARYNGOLOGY, Issue 4 2000P.V.H. Lim Seventy-one adults referred with snoring over a 9-month period were assessed and their apnoeic-status determined by clinical assessment using symptoms suggestive of the obstructive sleep apnoea,hypopnoea syndrome, the Epworth Sleepiness Scale score (ESS) and body mass index (BMI). The results of clinical assessment were compared to that of overnight six-channel polysomnography where snoring noise level, pulse rate, capillary oxygen saturation, breathing effort, oronasal airflow and body position were monitored. Polysomnography detected an apnoea-hypopnoea index (AHI) of < 15 episodes/h in 61(86%) patients and an AHI of , 15 episodes/h in 10 (14%) patients. Clinical assessment alone identified 57 patients with AHI of < 15 episodes/h as ,non-apnoeic snorers' and six patients with AHI of , 15 episodes/h as ,apnoeic snorers'. The sensitivity of this method of clinical assessment in identifying the ,non-apnoeic snorers' from amongst patients referred with snoring was 93.4% and its specificity was 60% (P < 0.001). [source] Sleep-Disordered Breathing and Chronic Opioid TherapyPAIN MEDICINE, Issue 4 2008Lynn R. Webster MD ABSTRACT Objective., To assess the relation between medications prescribed for chronic pain and sleep apnea. Design., An observational study of chronic pain patients on opioid therapy who received overnight polysomnographies. Generalized linear models determined whether a dose relation exists between methadone, nonmethadone opioids, and benzodiazepines and the indices measuring sleep apnea. Setting., A private clinic specializing in the treatment of chronic pain. Patients., Polysomnography was sought for all consecutive (392) patients on around-the-clock opioid therapy for at least 6 months with a stable dose for at least 4 weeks. Of these, 147 polysomnographies were completed (189 patients declined, 56 were directed to other sleep laboratories by insurance companies, and data were incomplete for seven patients). Available data were analyzed on 140 patients. Outcome Measures., The apnea,hypopnea index to assess overall severity of sleep apnea and the central apnea index to assess central sleep apnea. Results., The apnea,hypopnea index was abnormal (,5 per hour) in 75% of patients (39% had obstructive sleep apnea, 4% had sleep apnea of indeterminate type, 24% had central sleep apnea, and 8% had both central and obstructive sleep apnea); 25% had no sleep apnea. We found a direct relation between the apnea,hypopnea index and the daily dosage of methadone (P = 0.002) but not to other around-the-clock opioids. We found a direct relation between the central apnea index and the daily dosage of methadone (P = 0.008) and also with benzodiazepines (P = 0.004). Conclusions., Sleep-disordered breathing was common in chronic pain patients on opioids. The dose,response relation of sleep apnea to methadone and benzodiazepines calls for increased vigilance. [source] Impact of Adenotonsillectomy on Behavior in Children With Sleep-Disordered Breathing,THE LARYNGOSCOPE, Issue 7 2006Hsueh-Yu Li MD Abstract Objectives/Hypothesis: Children with sleep-disordered breathing may experience behavioral and learning problems such as inattentiveness and hyperactivity. The aim of this study was to measure the impact of adenotonsillectomy on sleep-related adverse events and behavioral problems in children with sleep-disordered breathing. Method: This prospective and interventional study enrolled 40 sleep-disordered breathing children (mean age, 8.4 ± 1.6 years) with hypertrophic tonsils and adenoids. All patients completed two polysomnographies, tests of variables of attention (TOVAs), and Child Behavior Checklists, one at baseline and the other 6 months after adenotonsillectomy. Results: The apnea,hypopnea index (P < .001), TOVA scores (P < .001), and 8 of 9 individual domains of the Child Behavior Checklist scores (P < .05) significantly improved after surgery. However, the change in the apnea,hypopnea index was not negatively correlated with TOVA score (r = ,0.17, P = .38). Conclusion: Adenotonsillectomy could significantly improve behavior (TOVA) scores, but the improvement may not simply be attributable to changes in sleep apnea events. [source] Validation and Clinical Utility of a Simple In-Home Testing Tool for Sleep-Disordered Breathing and Arrhythmias in Heart Failure: Results of the Sleep Events, Arrhythmias, and Respiratory Analysis in Congestive Heart Failure (SEARCH) StudyCONGESTIVE HEART FAILURE, Issue 5 2006William T. Abraham MD Fifty patients with New York Heart Association class III systolic heart failure were enrolled in this prospective multicenter study that compared the diagnostic accuracy of a home-based cardiorespiratory testing system with standard attended polysomnography. Patients underwent at least 2 nights of evaluation and were scored by blinded observers. At diagnostic cutoff points of ,5, ,10, and ,15 events per hour for respiratory disturbance severity, polysomnography demonstrated a sleep-disordered breathing prevalence of 69%, 59%, and 49%, respectively. Compared with polysomnography, the cardiorespiratory testing system demonstrated predictive accuracies of 73%, 73%, and 75%, which improved to 87%, 87%, and 83%, respectively, when analysis of covariance suggested reanalysis omitting one site's data. The system accurately identified both suspected and unsuspected arrhythmias. The device was judged by 80% of patients to be easy or very easy to use, and 74% of patients expressed a preference for the in-home system. Therefore, this system represents a reasonable home testing device in these patients. [source] Misleading hallucinations in unrecognized narcolepsyACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2003A. Sz Objective: To describe psychosis-like hallucinatory states in unrecognized narcolepsy. Method: Two patients with hypnagogic/hypnapompic hallucinations are presented. Results: Both patients had realistic and complex , multi-modal and scenic-daytime sexual hallucinations leading, in the first case, to a legal procedure because of false accusation, and in the second, to serious workplace conflicts. Both patients were convinced of the reality of their hallucinatory experiences but later both were able to recognize their hallucinatory character. Clinical data, a multiple sleep latency test, polysomnography, and HLA typing revealed that both patients suffered from narcolepsy. Conclusion: We suggest that in unrecognized narcolepsy with daytime hypnagogic/hypnapompic hallucinations the diagnostic procedure may mistakenly incline towards delusional psychoses. Daytime realistic hypnagogic/hypnapompic hallucinations may also have forensic consequences and mislead legal evaluation. Useful clinical features in differentiating narcolepsy from psychoses are: the presence of other narcoleptic symptoms, features of hallucinations, and response to adequate medication. [source] Paroxysmal Motor Disorders of Sleep: The Clinical Spectrum and Differentiation from EpilepsyEPILEPSIA, Issue 11 2006Christopher P. Derry Summary:, The diagnosis of paroxysmal events in sleep represents a significant challenge for the clinician, with the distinction of nocturnal epilepsy from nonepileptic sleep disorders often the primary concern. Diagnostic error or uncertainty is not uncommon in this situation, particularly with respect to nocturnal frontal lobe epilepsy (NFLE), which has a variable and often unusual presentation. Such errors can be minimized if the range of nonepileptic disorders with motor activity in sleep is fully appreciated. Here we review these disorders, before discussing the important clinical and electrographic features that allow their accurate differentiation from seizures. Particular emphasis is placed on the differentiation of nocturnal frontal lobe epilepsy from non,rapid eye movement (NREM) arousal disorders and other parasomnias. The value of recording episodes with video EEG polysomnography is discussed. [source] Gabapentin Increases Slow-wave Sleep in Normal AdultsEPILEPSIA, Issue 12 2002Nancy Foldvary-Schaefer Summary: ,Purpose: The older antiepileptic drugs (AEDs) have a variety of effects on sleep, including marked reduction in rapid-eye-movement (REM) sleep, slow-wave sleep (SWS), and sleep latency, and an increase in light sleep. The effects of the newer AEDs on sleep are unknown. Our purpose was to study the effect of gabapentin (GBP) on sleep. Methods: Ten healthy adults and nine controls were the subjects of this study. All underwent baseline and follow-up polysomnography (PSG) and completed sleep questionnaires. After baseline, the treated group received GBP titrated to 1,800 mg daily. Polygraphic variables and Epworth Sleepiness Scale (ESS) scores, a subjective measure of sleep propensity, were compared by using the Wilcoxon signed rank test. Results: Nine of the treated subjects achieved the target dose; one was studied with 1,500 mg daily because of dizziness experienced at the higher dose. GBP-treated subjects had an increase in SWS compared with baseline. No difference in the ESS or other polygraphic variables was observed. However, a minor reduction in arousals, awakenings, and stage shifts was observed in treated subjects. Conclusions: GBP appears to be less disruptive to sleep than are some of the older AEDs. These findings may underlie the drug's therapeutic effect in the treatment of disorders associated with sleep disruption. [source] Effects of Vigabatrin on Sleep,Wakefulness Cycle in Amygdala-Kindled RatsEPILEPSIA, Issue 2 2000Y. H. Raol Summary: Purpose: Our aim was to study the effect of prolonged administration of vigabatrin (VGB) on sleep-wakefulness cycle in kindled seizure-induced rats. Methods: Adult male Wistar rats were implanted stereotaxically with electrodes for kindling and polysomnography. The rats were divided into two groups, kindled and VGB-treated kindled rats. VGB was administered intraperitonially every day for 21 days, and polysomnographic recordings were taken after doses 1, 7, 14, and 21. The drug effects were evaluated by comparing the records of kindled and drug-treated kindled rats. Results: The VGB-administered kindled rats showed an increase in total sleep time (TST) due to an increase in total non-rapid eye movement (NREM) and light slow-wave sleep stage I (SI) with a decrease in wakefulness. The number of episodes and REM onset latencies were found to be decreased after drug treatment. Conclusions: It can therefore be concluded that VGB has a somnolence-inducing effect and that it might mediate its anti-convulsant effect by altering sleep architecture through sleep-regulating areas. [source] Restless legs symptoms without periodic limb movements in sleep and without response to dopaminergic agents: a restless legs-like syndrome?EUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2007C. R. Baumann Patients fulfilling the essential criteria for restless legs syndrome (RLS), but in whom the response to conventional dopaminergic treatment and the presence of periodic limb movements in sleep (PLMS) are lacking, are occasionally encountered. The aim of this study was to systematically characterize this population. In a consecutive series of 117 patients fulfilling the essential criteria for RLS, we assessed the presence of the following supportive criteria: PLMS >15/h on polysomnography, and favourable response to dopaminergic treatment. We differentiated patients with ,classical RLS' (RLS-C; fulfilling at least one of the selected supportive criteria) from those with ,RLS-like syndrome' (RLS-L) in whom supportive criteria were not fulfilled. There were 103 RLS-C and 14 RLS-L patients. Compared with RLS-C patients, RLS-L patients were significantly younger, more severely affected by RSL symptoms, and were more probably to suffer from psychiatric comorbidities, than RLS-C patients. This study proves the existence of patients with severe RLS symptoms, but without PLMS and without response to dopaminergic treatment, who are clinically distinct from patients with ,classical RLS'. [source] Report of an EFNS task force on management of sleep disorders in neurologic disease (degenerative neurologic disorders and stroke)EUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007P. Jennum A task force to develop guidelines for diagnostic evaluation and treatment of sleep disorders in degenerative neurologic disorders and stroke was initiated by the European Federation of Neurological Societies (EFNS). The aims were to provide evidence-based recommendations in the management of sleep disorders associated with degenerative neurologic disorders and stroke. Neurological patients often have significant sleep disorders like sleep-related breathing disorders (SBD), insomnia, sleep-related motor and rapid eye movement behavioral disorders affecting nocturnal sleep and daytime function. A polysomnography (PSG) is usually a diagnostic minimum for the diagnoses of the most commonly reported sleep disorders in patients with neurologic diseases. A full video-PSG/video-EEG-PSG should be considered in patients with nocturnal motor and/behavior manifestations. Respiratory polygraphy has a moderate sensitivity and specificity in the diagnosis of SBD without neurologic diseases, but its value in patients with neurologic diseases has not been evaluated. Oximetry has a poor sensitivity-specificity for the identification of SDB. Continuous and bi-level positive airway pressure devices are the most effective treatment of SDB in patients with neurologic diseases. There is a need for further studies focusing on the diagnostic procedures and treatment modalities in patients with sleep disorders and degenerative neurologic diseases and stroke. [source] Clinical significance of geriatric sleep apnea syndromeGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2002Shinji Teramoto The prevalence of sleep apnea syndrome (SAS) is known to increase with advancing age, contributing to excessive daytime sleepiness, cardiovascular dysfunction and the impairment of health-related quality of life. However SAS is often undiagnosed and overlooked in the elderly. It is important to note that SAS is a differential diagnosis of insomnia, dementia, and depression in the elderly. For an accurate diagnosis of geriatric SAS, the apnea and hypopnea index as measured by polysomnography must be greater than 10 or 15. Many untoward effects of SAS on the health status of the elderly are considered to be clinically significant. Although it has been suggested that geriatric SAS has less effect on the mortality and morbidity of sufferers than does middle-aged SAS, sleep apnea in any age group, if severe and accompanied by symptoms, should be treated. However, the clinical significance of geriatric SAS should be further elucidated. [source] Effect on Sleep of Posterior Hypothalamus Stimulation in Cluster HeadacheHEADACHE, Issue 7 2007Roberto Vetrugno MD Objective.,To evaluate the structure and quality of sleep and the circadian rhythm of body core temperature (BcT°) in patients with drug-resistant chronic cluster headache (CH) before and during deep brain stimulation (DBS) of the posterior hypothalamus. Background.,Chronic CH is a severe primary headache and frequently associated with disturbances in sleep. Posterior hypothalamus DBS is performed as an effective treatment of drug-resistant chronic CH. The effects of posterior hypothalamus DBS on sleep and the circadian rhythm of BcT° are unknown. Methods.,Three male patients with chronic drug-resistant CH underwent 48-hour consecutive polysomnography (PSG) by means of the VITAPORT® system with determination of BcT° by means of a rectal probe. Recordings were done before electrode implantation in the posterior hypothalamus and after optimized DBS of posterior hypothalamus. Results.,Before electrode implantation PSG showed nocturnal CH attacks, reduced sleep efficiency, fragmented sleep and increased periodic limb movements in sleep (PLMS). During DBS nocturnal CH attacks were abolished and sleep efficiency and PLMS improved. BcT° circadian rhythm was normal both before and during DBS. Conclusions.,Our data show that DBS of posterior hypothalamus in drug-resistant chronic CH is effective in curtailing nocturnal CH attacks, and is associated with improved sleep structure and quality. Chronic CH displays a normal circadian rhythm of BcT°, unchanged during hypothalamic DBS. [source] Sleep and Headache Disorders: Clinical Recommendations for Headache ManagementHEADACHE, Issue 2006Jeanetta C. Rains PhD Clinical practice points were drawn from a review of sleep and headache disorders published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Sleep as well as psychiatric disorders tend to become prevalent in more complex and severe headache patterns and regulation of sleep and mood may favorably impact headache threshold; (2) Specific headache patterns, irrespective of headache diagnosis, are suggestive of a potential sleep disorder (eg, "awakening" or morning headache, chronic daily headache); (3) Sleep disorders most implicated with headache include obstructive sleep apnea, primary insomnia, and circadian phase abnormalities, and treatment of such sleep disorders may improve or resolve headache; (4) Inexpensive screening tools (eg, sleep history interview, headache/sleep diary, validated questionnaires, prediction equations) aid identification of patients warranting polysomnography; and (5) Pharmacologic and behavioral therapies are effective in the regulation of sleep and are compatible with usual headache care. [source] Impact of the novel antidepressant agomelatine on disturbed sleep,wake cycles in depressed patients,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 3 2010Maria-Antonia Quera-Salva Abstract Background Disturbance of sleep,wake cycles is common in major depressive disorder (MDD), usually as insomnia, but also as hypersomnia or reduced daytime alertness. Agomelatine, an MT1 and MT2 receptor agonist and 5-HT2C receptor antagonist, represents a novel approach in MDD, with proven antidepressant efficacy and a positive impact on the sleep,wake cycle. We review the effects of agomelatine 25/50,mg/day on objective and subjective measures of the sleep,wake cycle in MDD. Subjective measures Agomelatine improved all aspects of the sleep,wake cycle from as early as 1 week in randomized trials versus selective serotonin reuptake inhibitors and venlafaxine, particularly getting off to sleep and quality of sleep, with an improvement in daytime alertness. Objective measures Agomelatine's effect on sleep architecture in MDD has been measured by polysomnography (PSG). There were significant improvements in sleep efficiency, slow-wave sleep (SWS), and the distribution of delta activity throughout the night, but no change in amount or latency of rapid eye movement (REM) sleep. Furthermore, the slow-wave sleep was resynchronized to the first sleep cycle of the night. Conclusion Agomelatine, a novel antidepressant, improves disturbed sleep,wake cycles in MDD. The improvement of both nighttime sleep and daytime functioning with agomelatine are promising features of this antidepressant regarding the management of MDD. Copyright © 2010 John Wiley & Sons, Ltd. [source] Approaches to measuring the effects of wake-promoting drugs: a focus on cognitive functionHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 5 2009Christopher J. Edgar Abstract Objectives In clinical drug development, wakefulness and wake-promotion may be assessed by a large number of scales and questionnaires. Objective assessment of wakefulness is most commonly made using sleep latency/maintenance of wakefulness tests, polysomnography and/or behavioral measures. The purpose of the present review is to highlight the degree of overlap in the assessment of wakefulness and cognition, with consideration of assessment techniques and the underlying neurobiology of both concepts. Design Reviews of four key areas were conducted: commonly used techniques in the assessment of wakefulness; neurobiology of sleep/wake and cognition; targets of wake promoting and/or cognition enhancing drugs; and ongoing clinical trials investigating wake promoting effects. Results There is clear overlap between the assessment of wakefulness and cognition. There are common techniques which may be used to assess both concepts; aspects of the neurobiology of both concepts may be closely related; and wake-promoting drugs may have nootropic properties (and vice versa). Clinical trials of wake-promoting drugs often, though not routinely, assess aspects of cognition. Conclusions Routine and broad assessment of cognition in the development of wake-promoting drugs may reveal important nootropic effects, which are not secondary to alertness/wakefulness, whilst existing cognitive enhancers may have underexplored or unknown wake promoting properties. Copyright © 2009 John Wiley & Sons, Ltd. [source] Association Between Sleep and Physical Function in Older Men: The Osteoporotic Fractures in Men Sleep StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2008Thuy-Tien L. Dam MD OBJECTIVES: To determine whether sleep quality is associated with physical function in older men. DESIGN: Cross-sectional. SETTING: Six U.S. centers. PARTICIPANTS: Two thousand eight hundred sixty-two community-dwelling men. MEASUREMENTS: Total hours of nighttime sleep (TST), wake after sleep onset (WASO), sleep latency (SL), and sleep efficiency (SE) measured using actigraphy; sleep stage distribution, respiratory disturbance index (RDI), and hypoxia measured using polysomnography; measures of physical function: grip strength, walking speed, chair stand, and narrow walk. RESULTS: In age-adjusted models, <6 or >8 hours TST, SE less than 80%, WASO of 90 minutes or longer, RDI of 30 or greater, and hypoxia were associated with poorer physical function. (Mean grip strength was 2.9% lower and mean walking speed was 4.3% lower in men with WASO ,90 minutes than men with WASO <90 minutes.) After adjusting for potential covariates, differences in grip strength and walking speed remained significantly associated with WASO of 90 minutes or longer, SE less than 80%, and hypoxia but not with TST or RDI of 30 or greater. CONCLUSION: Greater sleep fragmentation and hypoxia are associated with poorer physical function in older men. [source] Exploratory Analysis of Cerebral Oxygen Reserves During Sleep Onset in Older and Younger AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2008Barbara W. Carlson RN OBJECTIVES: To explore differences in cerebral oxygen reserves during sleep in old and young adults. DESIGN: Descriptive cross-sectional study. SETTING: General clinical research center. PARTICIPANTS: Nine old (aged 65,84) and 10 young (aged 21,39) adults. MEASUREMENTS: Subjects were monitored during the first nightly sleep cycle using standard polysomnography, including measures of arterial oxyhemoglobin saturation (SaO2). Changes in regional cerebral oxyhemoglobin saturation (rcSO2) were used to estimate cerebral oxygen reserves. General linear models were used to test group differences in the change in SaO2 and rcSO2 during sleep. RESULTS: Older subjects had lower SaO2 than young subjects before sleep (baseline) (F(1,18)=5.1, P=.04) and during sleep (F(1,18)=10.7, P=.01). During sleep, half of the older subjects and none of the younger ones had SaO2 values below 95%. In addition, the older subjects had more periods of oxygen desaturation (drops in SaO2,4%) (chi-square=24.3, P=.01) and lower SaO2 levels during desaturation (F(1,18)=11.1, P<.01). Although baseline values were similar, rcSO2 decreased during sleep 2.1% in older subjects (F(1,8)=3.8, P=.05) but increased 2.1% during sleep in younger subjects (F(1,9)=4.6, P=.04). When the older subjects awakened from sleep, rcSO2, but not SaO2, returned to baseline; both returned to baseline in younger subjects. CONCLUSION: This exploratory analysis generated the hypothesis that lower SaO2, combined with declines in regional blood flow, contributes to decline in cerebral oxygen reserves during sleep in older subjects. Further study will assess the effects of factors (e.g., medical conditions, subclinical disorders, and sleep architecture) that might account for these differences. [source] Ambulatory polysomnography for the assessment of sleep bruxismJOURNAL OF ORAL REHABILITATION, Issue 8 2008S. DOERING Summary, Ambulatory polysomnography (PSG) is introduced as a new method for assessing sleep bruxism. Nocturnal recordings of masseter electromyography (EMG), electro-encephalography, electro-oculography, electrocardiography, thoracic effort and body position allow for the detection of typical nocturnal masseter activity as well as the determination of sleep stages. Twelve patients with a clinical diagnosis of bruxism were assessed with the ambulatory PSG, all of them fulfilled diagnostic PSG criteria according to Kato et al. (Dent Clin North Am. 2001; 45: 657,684). Per hour of sleep patients showed 34·2 (±10·6) EMG bursts and 5·6 (±1·3) sleep bruxism episodes. Because of the ability to determine sleep stages and the application in the home environment the ambulatory PSG represents a cost-saving alternative to sleep laboratory investigations that might be especially useful in field studies and clinical application. [source] Time-variant nature of sleep bruxism outcome variables using ambulatory polysomnography: implications for recognition and therapy evaluationJOURNAL OF ORAL REHABILITATION, Issue 8 2008J. VAN DER ZAAG Summary, The aim of this study was to quantify the time-variant nature of sleep bruxism (SB) and to discuss its consequences. Six clinically diagnosed bruxers and six non-bruxers participated. Four ambulatory polysomnographic (PSG) recordings were obtained for every participant. As SB outcome variables, the number of episodes per hour of sleep (Epi h,1), the number of bursts per hour (Bur h,1) and the bruxism time index (BTI: the percentage of total sleep time spent bruxing) were established. To quantify the time-variant nature of SB, standard errors of measurement (SEMs) were calculated. For the non-bruxers, the SEMs for Epi h,1, Bur h,1 and BTI were 1·0, 5·7 and 0·1. For the bruxers, the respective values were 2·1, 14·9 and 0·4. In the discussion, arguments are given that because of the time-variant nature of the PSG recordings, cut-off bands around cut-off points might be useful for the recognition of SB. [source] Craniomandibular pain, oral parafunctions, and psychological stress in a longitudinal case studyJOURNAL OF ORAL REHABILITATION, Issue 8 2004M. K. A. van Selms summary, In a single case study, the most frequently suggested contributing factors to craniomandibular pain, viz., oral parafunctions and psychological stress, were studied in more detail. During a 13-week study period, questionnaires were completed, in which, among others, jaw muscle pain, bruxism behaviour, and experienced/anticipated stress were noted. During about 40% of the nights, nocturnal masticatory muscle activity (NMMA) was recorded, using single-channel electromyography (EMG). The number of NMMA events per recorded hour was scored, using a detection threshold of 10% of the maximum voluntary contraction level. This threshold was established in a separate study, in which EMG was compared with polysomnography. Stepwise regression analyses indicated, that morning jaw muscle pain could be explained by evening jaw muscle pain for 64% and by alcohol intake for another 2%. In turn, evening jaw muscle pain was explained by daytime clenching for 56% and by vacuum sucking of the tongue for an additional 6%. Finally, daytime clenching was significantly explained by experienced stress for 30%. Data of the recorded nights showed, that variations in NMMA did not contribute to variations in morning jaw muscle pain. This case study corroborates the paradigm that experienced stress may be related to daytime clenching and, in turn, to evening and morning jaw muscle pain. [source] Sleep architecture in children with adenoidal hypertrophyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2006Xiao-Wen Zhang Aim: Adenoidal hypertrophy (AH) in children is associated with obstructive manifestations like mouth breathing, snoring. Unfortunately, little is known regarding sleep architecture of AH in children. The purpose of this study was therefore undertaken to investigate the polysomnographic variables in children with AH. Method: 47 children with AH and 11 controls underwent nocturnal polysomnography. Sleep was scored manually according to the standard set by Rechtschaffen. Results: In AH, stage 1 sleep percentage and rapid eye movement (REM) latency were increased significantly, while the sleep percentage of stage 2 and REM was decreased remarkably compared with that of controls. Arousal index in AH was much more higher than that in controls. Arousal index in REM sleep was higher than that in non-rapid eye movement (NREM) sleep in AH, but the number of arousals in REM sleep was lower than that in NREM sleep. Hypopnea events were the most common type of respiratory events, followed by obstructive events in AH and controls. Apnea/hypopnea index in AH was higher in comparison to controls. No significant difference was found between the children with AH and controls in SaO2 nadir (%) and base mean SaO2 (%). Apnea/hypopnea index was related to hypopnea arousal in REM sleep and hypoxemia arousal in NREM sleep. Conclusion: AH is predominantly characterised by a hypopnea with little obstruction in children. Our results clearly and for the first time demonstrated that sleep architecture was abnormal in children with AH. We therefore speculate that hypopnea arousal in REM sleep and hypoxemia arousal in NREM sleep may play an important role in the course of respiratory disturbance. [source] Effects of Alcohol on Polysomnographically Recorded Sleep in Healthy SubjectsALCOHOLISM, Issue 9 2006Bernd Feige Background: After studying the sleep of alcohol-dependent patients at the beginning and over the course of abstinence in earlier studies, our interest in the current study focused on the direct effect of 2 doses of alcohol [0.03 and 0.1% blood alcohol level (BAL)] on healthy sleep. This is the first polysomnographic study testing the impact of 2 doses of alcohol ingestion (thus reflecting "normal" social drinking and alcohol abuse) in a single-blind randomized design in healthy volunteers. The study evaluated a short-term acute drinking period for 3 and 2 days of withdrawal from alcohol not only for polysomnographic variables but also for subjective estimates of sleep quality. Methods: In a crossover design with a 1-week interval, healthy subjects received alcohol to raise their blood alcohol to either 0.03 or 0.1% BAL at bedtime for 3 consecutive nights after an alcohol-free baseline night. Objective (polysomnography) and subjective sleep (questionnaires) was recorded each night. During the following 2 days, alcohol was discontinued with simultaneous measurements of sleep to gauge withdrawal effects. Results: At a dose of alcohol leading to BAL of 0.03%, no clear effects could be detected. Following an evening BAL of 0.1%, a hypnotic-like effect (shortened sleep latency, reduced number of wake periods, decreased stage 1 sleep) occurred primarily during the first half of the night with signs of rebound effects being already present during the second half of the night (increased stage 1 sleep). At this dose, alcohol significantly increased slow-wave sleep (SWS) in the first half of the night and reduced REM density in the beginning of the night. After discontinuation of the higher alcohol dose, REM sleep amount increased. No significant withdrawal or rebound effects could be observed for parameters of sleep continuity during the 2 nights after discontinuation from alcohol at a BAL of 0.1%. Conclusions: Owing to the small sample size, the results of this study need to be interpreted with caution. Short-term moderate alcohol consumption (BAL 0.03%) did not significantly alter objective or subjective parameters of sleep. Higher doses of alcohol resulting in a BAL level of 0.10% immediately before going to bed mainly influenced sleep in the first half of the night, resembling the effects of a short-acting hypnotic drug, including a suppression of phasic aspects of REM sleep (REM density). Interestingly, analysis of the latter part of these nights indicated the immediate presence of withdrawal effects (increased light sleep). No statistically significant effects on sleep parameters were observable during the 2 nights of withdrawal from alcohol at the higher BAL. Interpreted carefully, our data indicate that negative effects on sleep occur already with short-term use of alcohol at doses of BAL of 0.10%, despite hypnotic-like effects during the first hours of sleep, especially during the latter part of the night. [source] | ||||||||||||||||||||||||||||||||||||||||