Search PubMed⌕ Search

Biomedical subjects

C Guilleminault

Publications and source records attributed to C Guilleminault.

At least 253 records · Page 14Linked to original sources

Effects of central alpha-2 adrenergic compounds on canine narcolepsy, a disorder of rapid eye movement sleep.

Recent experiments have demonstrated that pharmacological activation of central noradrenergic systems by monoaminergic stimulators or uptake blockers or through the stimulation of alpha-1 adrenergic receptors improved cataplexy, a major symptom of narcolepsy. In order to further the understanding of the control of cataplexy by noradrenergic mechanisms, the involvement of central alpha-2 adrenoceptors was examined in genetically narcoleptic Doberman pinschers using in vivo pharmacology. Yohimbine (1.5-96.0 micrograms/kg i.v.) and seven other selective and centrally acting alpha-2 adrenoceptor antagonists (rauwolscine: 1.5-96 micrograms/kg i.v.; atipemazole: 1.5-96 micrograms/kg i.v.; Wy-25309: 1.5-386 micrograms/kg i.v.; CGS-7525A: 1.5-386 micrograms/kg i.v.; idazoxan, 6-1536 micrograms/kg i.v.; piperoxan, 6-1536 micrograms/kg i.v.; and mianserin, 6-1536 micrograms/kg i.v.) significantly suppressed cataplexy. The alpha-2 mediation of this effect was demonstrated by a close correlation between drug affinities (Ki) toward the alpha-2 site (defined using [3H]yohimbine in canine cortex) and the ability of these drugs to reduce cataplexy [ED50 in nanomoles per kilogram i.v.) (r2 = 0.71, n = 8, P less than .01). The effects of six centrally acting alpha-2 agonists on canine cataplexy were also examined and two groups of compounds were distinguished on the basis of their pharmacological profile. Classical alpha-2 agonists such as clonidine (0.0625-4.0 micrograms/kg i.v.), p-aminoclonidine (0.0625-4.0 micrograms/kg i.v.) and guanfacine (0.0625-4.0 micrograms/kg i.v.) had no effect on cataplexy whereas BHT-920 (0.01875-3.0 micrograms/kg i.v.), BHT-933 (16.0-258 micrograms/kg i.v.) and xylazine (16.0-258 micrograms/kg i.v.) dramatically aggravated cataplexy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗

Obstructive sleep apnea syndrome in children.

Partial or complete repetitive obstructions of the upper airway during sleep give rise to clinical symptoms associated with heavy, chronic snoring. The number of obstructive sleep apneas during the night may be less important than the repetitive inspiratory increases in upper airway resistance, even if these are associated only with a partial airway collapse. Oxygen saturation may not be severely affected by partial occlusion during nocturnal recording, although clinical symptoms may occur. Esophageal pressure measurements and breathing frequency during sleep are key features in the polygraphic evaluation of prepubertal children. Tonsillectomy and adenoidectomy may be helpful in treating children with small upper airway during sleep. The marked interaction between upper airway adequacy and craniofacial morphology make it critical to evaluate the impact of partial or complete airway occlusion during sleep on facial prognathism. Nasal continuous positive airway pressure is a safe treatment for persistent, partial or complete upper airway occlusion during sleep, but it does not address the mandibular deficiency often seen in symptomatic children. Orthodontic evaluation and treatment may make maxillomandibular surgery unnecessary during the pubertal years.

Child↗

Investigations of an automatic screening device (MESAM) for obstructive sleep apnoea.

A digital recording device developed to monitor heart rate (HR) and breathing sounds (snoring), and used to screen subjects for obstructive sleep apnoea syndrome (OSAS), was investigated. This device is called the MESAM and is currently commercially available in some western European countries. The computer-based automatic scoring systems provided with the equipment and a hand-scoring technique developed at Stanford and requiring 10-15 min to perform, were used. Polysomnography and MESAM recordings were performed simultaneously on two groups of 25 sleep disorder patients (each with respiratory disturbance index greater than or less than 10). Patients were randomly monitored and records were analysed by two teams blind to the initial clinical impression, to the events which occurred during the recordings, and to each other's findings. Specificity and sensitivity were calculated for each of the MESAM scoring techniques considered, with polysomnography being selected as the recording standard, With "automatic HR scoring" specificity was 12%, sensitivity 92%; with "automatic breathing sounds (snoring)" scoring, specificity was 8% and sensitivity 96%; with "hand-scoring" specificity was 72% and sensitivity 92%. If the three scoring techniques were combined, all patients with a respiratory disturbance index (RD) greater than 10 were recognized as having OSAS.

Electronics, Medical↗

Familial patterns of narcolepsy.

Familial patterns of narcolepsy were investigated in a clinic population of 334 unrelated narcoleptic patients. 40% of probands had at least 1 family member with an isolated daytime sleepiness complaint and 6% had a positive family history of narcolepsy. Multicase families were rare; only two families were found with 3 or more affected relatives. Family members often shared the same HLA-DR2 haplotype as the proband but did not have narcolepsy. However, the risk of disease for first-degree relatives was six to eighteen times greater than that for unrelated individuals. Although most patients were HLA-DR2+, 2 new HLA-DR2- individuals were found. The data predict that as many as 9% of unrelated North-American white patients with narcolepsy will be DR2-. Analysis of these and other data indicates that although strongly associated with disease, the HLA-DR2 haplotype is neither sufficient nor necessary for the development of narcolepsy.

Adult↗

Canine narcolepsy is associated with an elevated number of alpha 2-receptors in the locus coeruleus.

alpha 2-Receptors in the canine brain were pharmacologically characterized using [3H]yohimbine binding. Competition studies revealed a single class of binding sites in frontal cortex but two distinct subtypes in nucleus caudatus. The role of central alpha 2-receptors in narcolepsy was investigated in 5 normal and 5 narcoleptic Doberman pinschers. Scatchard analysis of [3H]yohimbine binding in different brain areas revealed an increase in the number of alpha 2-binding sites limited to the locus coeruleus. This suggests that altered autoinhibition of norepinephrine release may be associated with the narcoleptic symptomatology.

Animals↗

Central alpha 1 adrenoceptor subtypes in narcolepsy-cataplexy: a disorder of REM sleep.

The present study suggests the specific involvement within the central nervous system of an alpha 1 adrenoceptor subtype in a behavior, the control of cataplexy, a pathological analogue of rapid eye movement (REM) sleep atonia. Experiments have shown that prazosin, an alpha 1 antagonist, dramatically aggravates canine narcolepsy-cataplexy through a central mechanism, and that [3H]prazosin binding sites are increased in the amygdala of narcoleptic dogs. However, the corresponding Scatchard plots were curvilinear and best fit was obtained with a two-site model, suggesting the existence of two [3H]prazosin binding sites. These two sites (high and low affinity [3H]prazosin binding sites) met the criteria for authentic receptors and were respectively very similar to the alpha 1a and alpha 1b (high and low affinity for WB4101, respectively) subtypes recently described in the rat and rabbit. Our results of in vivo pharmacology and in vitro [3H]prazosin binding in canine narcolepsy now clearly implicate the low affinity [3H]prazosin binding site (alpha 1b) in canine narcolepsy: (1) Prazosin, an alpha 1 antagonist with similar affinity for both subtypes, was much more potent in increasing cataplexy than WB4101, a compound with more affinity for the alpha 1a receptor. (2) Chlorethylclonidine and phenoxybenzamine, two irreversible blockers of the alpha 1 receptors with more affinity for the alpha 1b receptors, aggravate cataplexy for up to two weeks. (3) The alpha 1 receptor upregulation previously reported by our group in the amygdala of narcoleptic dogs was due to a selective increase in the low affinity [3H]prazosin binding sites. A role for noradrenaline in REM sleep regulation has been suspected for many years, but has never been clearly elucidated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗

REM latency in Alzheimer's disease.

Latency to the first episode of rapid eye movement sleep (REML) has been proposed as a potential biomarker for Alzheimer's disease (AD). In this study, we compared REML values from 28 AD patients and 28 age- and sex-matched controls. We employed multiple definitions of REML and multiple cutoffs to classify patients and controls. Results indicated that the best REML definition and optimal cutoff criterion resulted in only 65% correct classifications. We discuss the longer REML in AD patients relative to controls in terms of both overall sleep disturbance and selective deterioration of the REM-cholinergic system. As REML may be relatively short in other forms of psychopathology (e.g., affective disorders), REML may still hold promise in the differential diagnosis of dementia and pseudodementia.

Aged↗

Inferior mandibular osteotomy and hyoid myotomy suspension for obstructive sleep apnea: a review of 55 patients.

Fifty-five patients with obstructive sleep apnea syndrome (OSAS) were evaluated following inferior mandibular osteotomy with hyoid myotomy and suspension. Patients were objectively examined by polysomnography before and 6 months following the surgical procedure. Thirty-seven patients (67%) had a good response from surgery, and 18 patients (33%) were considered nonresponders. Lung disease, mandibular deficiency, and obesity were factors found to affect the success of surgical treatment.

Adult↗

Maxillofacial surgery and obstructive sleep apnea: a review of 80 patients.

To determine the effectiveness of the surgical treatment of obstructive sleep apnea, we retrospectively evaluated 80 patients. One group consisted of 55 patients who had undergone a limited osteotomy of the anterior mandible: inferior sagittal osteotomy with hyoid myotomy and suspension. Important criteria for the selection of these patients were normal pulmonary function, normal mandibular skeletal development, and the absence of morbid obesity. Polysomnography revealed that 37 patients (67%) had responded to the surgical treatment and 18 patients (33%) had not. The second group of 25 patients, selected for morbid obesity, severe mandibular deficiency, and failure of other surgical procedures, had undergone maxillomandibular osteotomy with hyoid advancement. All patients in the second group showed good results, as determined by polysomnography.

Adult↗

Sleep-related abdominal muscle behavior during partial or complete obstructed breathing in prepubertal children.

We have evaluated the influence of nonrapid eye movement (NREM), REM sleep, and arousal on abdominal muscle contractions during snoring and/or obstructive apnea in 10 prepubertal children. All children were known habitual snorers and eight had a sleep apnea index above 10. During stage 3-4 non-REM sleep, non-apneic breathing with snoring was always associated with the presence of expiratory abdominal muscle electromyogram (EMG) discharges. During non-REM sleep apneas, abdominal muscle EMG discharges increased from the beginning to the end of each apnea. Termination of non-REM sleep apnea was marked by an "EEG arousal" in 12% of the apneic events and by a "movement arousal" in the other 88%. The highest abdominal muscle EMG discharge was always observed during the arousal response. During "phasic" REM sleep, abdominal muscle EMG discharges were absent during both nonapneic breathing (with or without snoring) and obstructive apneas. All REM sleep apneas ended with a "movement arousal," during which abdominal muscle EMG discharges were observed. Thus, abdominal muscle EMG discharges associated with "arousal" were seen independent of the immediately preceding sleep state.

Abdominal Muscles↗

Central alveolar hypoventilation and sleep. Treatment by intermittent positive-pressure ventilation through nasal mask in an adult.

Idiopathic central alveolar hypoventilation, uncommonly seen in middle-aged adults, has often been treated by tracheostomy and assisted ventilation during sleep or by implantation of a diaphragmatic pacemaker with or without tracheostomy. We report the successful treatment of a middle-aged man by the easy application of intermittent positive-pressure ventilation through a nose mask.

Humans↗

The diurnal variability of ventricular premature depolarizations: influence of heart rate, sleep, and wakefulness.

The relationships between ventricular premature depolarizations (VPDs) and heart rate (HR) were determined in 14 patients with ventricular arrhythmias and the influence of these relationships on the diurnal variability of ventricular arrhythmias was evaluated. The influence of sleep state, wakefulness, and level of activity on the frequency of VPDs was also studied. Subjects completed 48-72 h of ambulatory electrocardiographic monitoring and nocturnal sleep recordings. Plots of VPD frequency vs. HR were examined and subjects were categorized as HR-dependent if they manifested log-linear increase in VPDs with increasing HR and as HR-independent if no relation between VPD frequency and HR was detected. Sleep suppression of VPDs was observed in the HR-dependent group (p less than 0.05). The reduction in VPD frequency correlated with the reduction in HR and was independent of sleep state or wakefulness. No change in VPD frequency was observed during wakefulness, rapid eye movement sleep, or non-rapid-eye-movement sleep in the HR-independent group. The influence of level of activity on ventricular arrhythmia frequency was also assessed in seven subjects. Any decreases in VPD frequency observed during inactivity were associated with a decrease in HR. These observations suggest that HR is a major determinant of the diurnal variation of VPD frequency in a subset of patients with frequent VPDs.

Arousal↗