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Biomedical subjects

A Kales

Publications and source records attributed to A Kales.

At least 127 records · Page 7Linked to original sources
PubMed1982

Endoscopic findings in sleep apnea associated with acromegaly.

Two acromegalic patients presented with the additional complaint of excessive daytime sleepiness. Subsequent sleep laboratory evaluation revealed that each patient had concurrent obstructive sleep apnea. In each patient, endoscopic examination of the upper airway revealed that on inspiration, the soft tissue of the posterior and lateral hypopharynx invaginated into the laryngeal vestibule before any posterior movement of the tongue. Neither enlargement of the tongue nor in movement in relation to respiration appeared to be the primary factors in the etiology of the upper airway obstruction. After tracheostomy, both the obstructive sleep apnea and excessive daytime sleepiness were eliminated. Our case reports indicate that the treatment and prognosis of patients with acromegaly are affected when sleep apnea is concurrently diagnosed. When a patient is suspected of being acromegalic and also complains of excessive daytime sleepiness, obtaining a through sleep history from the patient as well as from the bed partner is essential. If sleep apnea is then diagnosed, a tracheostomy should be considered an initial and continuing part of the overall treatment plan.

Acromegaly↗
PubMed1982

Nocturnal myoclonus and nocturnal myoclonic activity in the normal population.

The presence of nocturnal myoclonus (NM) and nocturnal myoclonic activity (NMA) was assessed in the sleep laboratory in 100 subjects without any complaint of sleep disturbance. Subjects were included only if they were physically and mentally healthy and not using any medication. The subject sample was selected to have a representative proportion of women and men and a wide age distribution. Six percent of the subjects met the clinical criteria for NM, and five percent had NMA. Thus, either NM or NMA was noted in 11 percent of the total sample. The prevalence of NM or NMA was slightly higher in men than in women and positively and significantly correlated with increasing age. No relationship was found between the presence of NM or NMA and weight, smoking, or the consumption of caffeinated beverages. When the amount of each sleep stage was controlled for, myoclonic activity occurred most frequently during stage 2 sleep. The degree of sleep disturbance related to myoclonic activity was minimal, with the mean total duration of both types of myoclonic activity per subject-night being only about six minutes. In addition, only about 10 percent of the events were related to EEG arousals.

Adolescent↗
PubMed1982

Sleep apneic activity in a normal population.

One hundred subjects without any complaint of sleep disturbance were evaluated in the sleep laboratory for the presence of sleep apnea and sleep apneic activity (SAA). This sample, which had a representative proportion of women and men and a wide age distribution, included only subjects who were physically and mentally healthy and were not using any medication. None of the subjects had the clinical condition of sleep apnea, and only 12 percent of the subjects met the more liberal criterion for SAA. The prevalence of SAA was slightly higher in men than in women. SAA was positively and significantly correlated with increasing age. However, relative severity, as judged by the mean number of events and the duration of events, showed no consistent pattern in relation to age. Further, it was demonstrated that those subjects with SAA were significantly heavier than those without the activity. Neither smoking nor caffeine consumption was related to the presence of SAA. When the amount of each sleep stage was controlled for, SAA occurred significantly more often during REM sleep. A relatively small number of EEG arousals were related to SAA, with only about one-fifth of the events resulting in brief arousals.

Adolescent↗
PubMed1981

Dose-response studies of quazepam.

Quazepam, an investigational benzodiazepine, was evaluated in doses of 7.5, 15, and 30 mg in a 12-night protocol including four nights of drug trial. All three doses were effective in inducing and maintaining sleep, with the highest degree of effectiveness after the first drug night. Carry-over effectiveness, which was seen after withdrawal of all three doses, persisted throughout the withdrawal period after the 30-mg dose. Quazepam's effects during both drug use and withdrawal appeared to be dose related; 15 mg induced a greater reduction in wake time after sleep onset than the 7.5-mg dose, and 30 mg induced even greater differences in both wake time after sleep onset and total wake time. Subjective reports of improved sleep were in general agreement with the objective data at each dose level. Side effects appeared to be dose related in terms of severity. The efficacy and comparatively less severe side effects of the 7.5- and 15-mg doses of quazepam suggest that these doses may be optimal when the drug is considered for the adjunctive treatment of insomnia.

Adult↗
PubMed1981

Onset of insomnia: role of life-stress events.

During the year their insomnia began, chronic insomniacs experienced a greater number of stressful life events compared with previous or subsequent years and compared with good sleepers. In addition, among the life event categories assessed, insomniacs reported a greater number of undesirable events, particularly events related to losses and to ill health. They also had lifelong histories of more illnesses and somatic complaints, beginning with more childhood illnesses and more childhood problems related to eating and sleeping. During childhood, insomniacs reported more frequent discontent with their families, and prior to the onset of insomnia, they had less satisfying relationships with their parents as well as problems in other interpersonal relations and in their self-concepts. Currently, insomniacs felt considerably less satisfied with their lives, had lower self-concepts, and had greater difficulty with interpersonal relationships. Thus, stressful life events, mediated by certain predisposing factors of personal vulnerability, were found to be closely related to the onset of chronic insomnia.

Adult↗
PubMed1981

The patient care crisis in community mental health centers: a need for more psychiatric involvement.

The authors examine the role of psychiatrists in community mental health centers and suggest that extensive psychiatric involvement is needed to ensure proper patient care. Within the context of four basic clinical models--social, psychological, behavioral, and biomedical--they describe the psychiatrist's unique clinical skills in history taking, differential diagnosis, case formulation, use of psychopharmacologic agents, and provision of leadership in patient care. Five case reports illustrate instances in which psychiatric intervention corrected serious problems in diagnosis and treatment that otherwise would have resulted in inadequate care or harm to the patient.

Adolescent↗
PubMed1980

Cigarette smoking associated with sleep difficulty.

A group of 50 smokers experienced greater sleep difficulty than a group of 50 nonsmokers matched by age and sex. The two groups did not differ in personality patterns or drug consumption. Also, sleep patterns significantly improved in a group of eight chronic smokers when they abstained from cigarette smoking. These findings are consistent with reports on the stimulant effects of nicotine.

Adult↗
PubMed1980

Somnambulism. Clinical characteristics and personality patterns.

Fifty adults with either a present or past complaint of somnambulism were evaluated to determine the development and clinical course of their disorder as well as their personality patterns. Generally, when sleepwalking was outgrown, its onset was before age 10 years and its termination before age 15 years. Current sleepwalkers, compared with past sleepwalkers, started sleepwalking at a later age, had a higher frequency of events, and had episodes earlier in the night. Their episodes were also characterized by more intense clinical manifestations. Furthermore, current sleepwalkers demonstrated high levels of psychopathology, whereas past sleepwalkers had essentially normal psychological patterns. Specifically, the current sleepwalkers showed active, outwardly directed behavioral patterns, suggestive of difficulties in handling aggression. The clinical application of these findings is discussed and practical recommendations are given for the evaluation and management of sleepwalking.

Adolescent↗
PubMed1980

Night terrors. Clinical characteristics and personality patterns.

The development and clinical course of night terrors and the personality patterns of patients with this disorder were evaluated in 40 adults who had a current complaint of night terrors. Compared with a group of adult sleepwalkers, the patients with night terrors had a later age of onset for their disorder, a higher frequency of events, and an earlier time of night for the occurrence of episodes. Both groups had high levels of psychopathology, with higher values for the night terror group. This sleepwalkers showed active, outwardly directed behavioral patterns, whereas the night terror patients showed an inhibition of outward expressions of aggression and a predominance of anxiety, depression, tendencies obsessive-compulsive/, and phobicness. Although night terrors and sleepwalking in childhood seem to be related primarily to genetic and developmental factors, their persistence and especially their onset in adulthood are found to be related more to psychological factors.

Adolescent↗
PubMed1980

Nightmares: clinical characteristics and personality patterns.

The authors evaluated the development and clinical course of nightmares and the personality patterns of people with this dosorder by studying 30 adults who had a current complaint of nightmares. Nightmares usually began in childhood or adolescence and were chronic. Psychological factors played a major role in the development and persistence of nightmares, major life events were often associated with the onset of the disorder, mental stress usually increased the frequency of events, and psychological testing indicated relatively high levels of psychopathology. Nightmares sufferers in general were distrusful, alienated, sufferers in general were distrustful, alienated, and emotionally estranged, and many showed a chronic schizoid pattern of adjustment, but they were not overtly psychotic.

Adult↗
PubMed1980

Sleepwalking and night terrors in adulthood clinical EEG findings.

This is the first controlled study to show a lack of relation between a positive history of sleepwalking or night terrors in adults and daytime EEG abnormalities. We recorded a standard clinical EEG on 35 adult sleepwalkers (SW), 35 adult night terror patients (NT), and 35 control subjects (CS). Three subjects in the SW group showed abnormalities: one during both the resting record (RR) and hyperventilation (HV), and two only during HV. None in the NT group showed any EEG abnormality. Two control subjects showed abnormalities of both RR and HV, and a third only during HV. The number of abnormal EEGs within each group was limited, and the three groups did not significantly differ from one another. Our results suggest that the daytime clinical EEG is of limited value in evaluating adults with the primary complaint of sleepwalking or night terrors. However, further all-night sleep EEG studies utilizing clinical montage are needed to investigate the temporal relationship of sleepwalking and night terror events to possible EEG abnormalities.

Adolescent↗
PubMed1980

Hereditary factors in sleepwalking and night terrors.

The families of 25 probands with sleepwalking and 27 probands with night terrors were studied. Eighty per cent of the sleepwalking pedigrees and 96 per cent of the night terror pedigrees included one or more individuals, other than the proband, who were affected by sleepwalking, night terrors, or both. Our data appear to fit a 'two threshold' multifactorial mode of inheritance. This finding supports the hypothesis that sleepwalking and night terrors share a common genetic predisposition, with sleepwalking being a more prevalent and less severe manifestation of the same substrate that underlies night terrors. Heritable factors predispose an individual to develop sleepwalking and/or night terrors, but expression of the trait may be influenced by environmental factors.

Female↗
PubMed1980

Taking a sleep history.

In taking a sleep history, the physician determines the onset, course and clinical characteristics of the disorder; assesses the 24-hour sleep/wakefulness patterns; obtains additional information from the bed partner, and inquires about a personal or family history of other sleep disorders. The impact of the disorder on the patient's life is evaluated, and the attitudes of the patient and his family toward the sleep problem are assessed.

Attitude↗
PubMed1979

Resource for managing sleep disorders.

To enhance physicians' knowledge of the prevalent problem of sleep disorders, a 50-minute videotape program designed as a learning and self-assessment experience in evaluating and treating these disorders was coproduced with the Network for Continuing Medical Education. The program has been presented nationally to about 25,000 medical professionals. The mean correct score was 50% for the pretest, 69% for the instructional section, and 79% for the posttest; the composite score on the posttest was 59% higher than that on the pretest. Physicians' responses indicated strengths and weaknesses in their knowledge of sleep disorders, thus delineating future directions for medical education in insomnia, narcolepsy/cataplexy, nightmares, night terrors, sleepwalking, and enuresis. All of these sleep disorders can be best evaluated and treated by the general physician.

Audiovisual Aids↗