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Biomedical subjects

C M Shapiro

Publications and source records attributed to C M Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1993

A group approach for the management of insomnia.

To date, the management of insomnia has primarily consisted of pharmacological and behavioral approaches for individual patients. This paper documents the authors' work in formulating a group intervention for patients suffering from insomnia. The treatment rationales are discussed and include group theory, cognitive-behavioral and educational frames of reference. A description of the techniques used and the structure and process of the group model used is provided.

Behavior Therapy↗
PubMed1993

Alleviating sleep-related discontinuance symptoms associated with benzodiazepine withdrawal: a new approach.

There is limited information on the time course of recovery of sleep architecture in patients withdrawn from benzodiazepines (BDZ). This study examined the effects of substituting a new class of hypnotic drugs, namely the cyclopyrrolones, for current BDZs in patients presenting with BDZ dependence. The results indicated a clear improvement in a variety of sleep parameters after commencing with a cyclopyrrolone (zopiclone). These changes remained to some extent after zopiclone was discontinued. Also, the absence of certain withdrawal effects (i.e. rebound insomnia) upon discontinuation of zopiclone allows for patients to be carried through a potentially difficult period after stopping BDZs, while expediting the eventual discontinuation of all hypnotic medication.

Adult↗
PubMed1993

Restless sleep, illness intrusiveness, and depressive symptoms in three chronic illness conditions: rheumatoid arthritis, end-stage renal disease, and multiple sclerosis.

Restless sleep was compared across 110 out-patients with rheumatoid arthritis (RA), 101 with end-stage renal disease (ESRD), 94 with multiple sclerosis (MS), and an unselected control group of 176 individuals attending their family practitioners (FP). It was also investigated in the three chronic illness groups as a contributor to illness intrusiveness--the extent to which one's illness and/or its treatment interfere with continued involvements in valued activities and interests--a determinant of depression and emotional distress in chronic conditions. Reported frequencies of restless sleep were highest in RA, lower in ESRD, and lowest in MS; FP patients reported frequencies that were similar, overall, to those observed in MS. These differences were evident among nondepressed, (chi 2 9, N = 309, p < 0.0001), but not depressed, individuals. The occurrence of restless sleep correlated significantly with increased illness intrusiveness, r (279) = 0.31, p < 0.001, in RA, ESRD, and MS. Results supported the hypothesis that the relation between restless sleep and emotional distress is mediated by illness intrusiveness. Treatment of restless sleep may offer the added benefit of diminishing illness intrusiveness and may, thereby, enhance quality of life in chronic physical illness.

Activities of Daily Living↗
PubMed1993

Snoring, asthma and sleep disturbance in Britain: a community-based survey.

A questionnaire was sent to a random sample of adults in eight locations throughout Britain, to investigate the prevalence of snoring, asthma and sleep complaints in community-based British adult. Of the 1,478 respondents (831 females, 647 males; mean +/- SD age 45 +/- 18 yrs), 37% reported snoring at least occasionally, and 11% reported snoring on at least four nights per week (frequent snorers). Frequent snorers reported spending less time asleep at night, falling asleep accidentally during the day more often, taking planned daytime naps, and falling asleep whilst driving or operating machinery more often than the other respondent. Using ordinal logistic regression analysis to allow for the age and sex of the respondents, both accidental daytime sleep and planned daytime naps were commoner in frequent snorers than other respondents. Six percent of all respondents and 6% of those aged under 40 yrs reported that they had asthma (asthmatics). Seven percent of respondents aged less than 40 yrs reported wheezing on three or more occasions per year, and had been prescribed oral or inhaled bronchodilators (young wheezers). More than 80% of the asthmatic respondents of all ages, and young wheezers, reported waking at night with wheeze at least occasionally, and more than 30% of each group reported this symptom frequently. A larger proportion of asthmatics and young wheezers reported that their night-time sleep was unrefreshing, and that they had too little sleep at night than the other respondents.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗
PubMed1992

Sleep deprivation and the postnatal blues.

This prospective study of 63 women was designed to investigate the relationship between sleep disruption prior to the birth, during labour and in the early postpartum period and the subsequent development of the postnatal blues. The results from this preliminary study suggest that two factors: (a) a night-time labour; and (b) a history of sleep disruption in the latter stages of pregnancy, may have aetiological importance in the development of postnatal blues. There was little evidence from this study to suggest that sleep disruption on the nights following the birth, the third sleep factor investigated, had any impact on the expression of the blues.

Adult↗
PubMed1992

A longitudinal study of sleep stages in young women during pregnancy and postpartum.

We conducted a longitudinal polysomnographic study in five healthy primiparous subjects, whose sleep was first recorded between 8 and 16 weeks of gestation, then every 2 months until parturition and at 1 month postpartum. The first 6 hours of sleep were used for statistical analysis. In contrast to previous studies, we found no reduction in stage 4 sleep with pregnancy. Slow-wave sleep (comprising stages 3 and 4), was significantly higher at 27-39 weeks of gestation than at 8-16 weeks, as predicted by the restorative theory of sleep. There was no significant difference in rapid eye movement (REM) sleep time. When compared to a group of normal ovulating women, however, REM sleep time decreased during the last two months of pregnancy and, although there was no change in sleep onset latency, the time spent awake during the first six hours of sleep was increased. Future research into the effects of cortisol and progesterone is indicated.

Adolescent↗
PubMed1992

Effect of therapeutic theophylline levels on the sleep quality and daytime cognitive performance of normal subjects.

The effect of theophylline on sleep quality and cognitive performance in patients with obstructive lung disease has been the subject of controversy. To examine the direct effects of theophylline on sleep quality and cognitive performance, without confounding effects from bronchodilatation, we have undertaken a study of the drug in healthy subjects. A double-blind, placebo-controlled crossover protocol was used to study the effect of oral sustained-release theophylline (Theodur) on subjective sleep quality, objective sleep quality, and cognitive performance. Overnight sleep studies were carried out on Nights 13 and 14 of each 2-wk study limb, and cognitive performance tests administered on Days 1 and 13 of each limb. A total of 18 subjects satisfactorily completed the study (8 males, median age 37, range 24 to 67 yr). Theophylline levels were median 10.2, range 2.3 to 13.3 micrograms/ml on Day 1 and 14.7, range 9.6 to 17.5 micrograms/ml on Day 13. No significant difference was observed between theophylline and placebo on subjective or objective sleep quality or on acute or medium-term cognitive performance. We conclude that theophylline does not affect sleep quality or cognitive performance in normal adults.

Adult↗
PubMed1992

Seasonality in psychiatry--a review.

This paper reviews the literature pertaining to seasonal patterns in psychiatric illnesses. Evidence on the season of birth phenomenon suggests that a greater risk of pre-, peri-, or post-natal damage is associated with the winter months. There is currently insufficient evidence to pinpoint the exact mechanism involved or to ascertain whether the mechanism is common to each condition. Studies of seasonal patterns of incidence of psychiatric disorders have highlighted the role of seasonally regulated environmental factors on internal biological processes. There is growing evidence that serotonin is involved in a variety of psychiatric disorders. Seasonal patterns have been observed in processes involving serotonergic functioning. Furthermore, it has been postulated that these processes may be influenced by photoperiod, suggesting that the seasonal patterns of incidence of several psychiatric conditions may share a common neurophysiological substrate.

Female↗
PubMed1992

Psychiatric morbidity among overseas students.

As immigration for higher education is becoming more common now a days, the adjustment of overseas students to the host country is receiving more attention. This paper describes the results of a study which examined the prevalence and pattern of psychological disturbances among overseas and British students studying at Edinburgh University. The practical implications of these findings and suggestions for future research are discussed.

Adjustment Disorders↗
PubMed1991

Central projections of the sciatic, saphenous, median, and ulnar nerves of the rat demonstrated by transganglionic transport of choleragenoid-HRP (B-HRP) and wheat germ agglutinin-HRP (WGA-HRP).

The central projections of the rat sciatic, saphenous, median, and ulnar nerves were labeled by injecting each nerve with 0.05 mg B-HRP, or 0.5 mg WGA-HRP, or a mixture of both. The B-HRP labeled large dorsal root ganglion cells (30-50 microns) and, correspondingly, 98% of axons labeled in a rootlet were meyelinated; although all sizes of myelinated axons were labeled, a greater proportion fell in the large ranges (2-6.5 microns axon diameter) than in the small ranges (0.5-2 microns). Primary afferents labeled with B-HRP were distributed in laminae I, III, IV, and V of the dorsal horn and extended into the intermediate grey and the ventral horn; Clarke's column and the respective dorsal column nuclei were also densely labeled. Motoneurons of the nerve were densely labeled by B-HRP, including extensive regions of their dendritic trees. In contrast, WGA-HRP labeled small dorsal root ganglion cells (15-25 microns) and in the dorsal rootlets, 84% of the labeled axons were nonmyelinated; the small population of labeled myelinated afferents mainly fell within the smaller ranges (0.5-2.0 microns). Terminal fields of WGA-HRP labeled afferents were restricted to the superficial dorsal horn (laminae I-III), and to limited regions in the dorsal column nuclei. Sciatic nerve projections traced by labeling with B-HRP alone or in combination with WGA-HRP were more extensive than previously described when using either native HRP or WGA-HRP. Afferents to the dorsal horn extended from L1-S1, to Clarke's nucleus from T8-L1, to the ventral horn from L2-L5, and extended throughout the medial and dorsal region of the gracilie nucleus. Motoneurons were found from L4-L6. Using the same tracers, saphenous projections extended in the superficial dorsal horn from caudal L1 to rostral L4, in the deep dorsal horn to mid L4 and along the length of the central part of the gracilie nucleus. The median nerve projected to the internal basilar nucleus from C1-C6, the dorsal horn from C3-T2, Clarke's nucleus from T1-T6, the external cuneate nucleus, and a large central area throughout the length of the cuneate nucleus. Motoneurons were located in dorsolateral and ventrolateral nuclear groups from C4 through C8. The ulnar nerve projections were less extensive but also included the internal basilar nucleus from C1-C6, the medial region of the dorsal horn from C4-T1, Clarke's nucleus from T1-T6, the external cuneate nucleus, and the medial part of the cuneate nucleus.(ABSTRACT TRUNCATED AT 400 WORDS)

Afferent Pathways↗
PubMed1991

Ultrastructural localization of substance P, met-enkephalin, and somatostatin immunoreactivity in lamina X of the primate spinal cord.

The ultrastructural localization of substance P (SP), met-enkephalin (MENK), and somatostatin (SS) in the lamina X area surrounding the central canal of the macaque monkey was examined by the indirect peroxidase-antiperoxidase method. The most common synaptic terminals in lamina X were simple terminals (S) with small rounded or pleomorphic clear vesicles; one to two dense-core vesicles were occasionally also present. These were found on soma, dendrites, and dendritic spines, in all regions of lamina X. A second class of terminal with round or oval clear vesicles was glomerular (G) in shape, with scalloped edges, and contained many mitochondria. These large terminals had several synaptic contacts onto dendrites, spines, and small terminals and were found mainly in the lateral region. The third class (L) contained small clear vesicles and several vesicles with large, dense cores (100-125 nm), and also contacted dendrites, mainly lateral to the canal. The fourth class of terminal (D) contained small clear vesicles and several vesicles with small, dense cores (75-100 nm); these contacted dendrites and somata in all areas. Very few terminals with flat vesicles were identified. There was an unequal distribution of immunoreactivity among the several terminal classes identified in lamina X. Most SP terminals were S terminals, but SP L terminals were also common; few were D terminals. MENK terminals were usually either S terminals or D terminals; L terminals were rarely MENK positive. SS terminals were commonly D terminals or S terminals; L terminals were also rarely SS positive. Only SP terminals were identified as G terminals. Synaptic targets of SP, MENK, and SS terminals were most commonly dendrites. In addition to unlabelled neurons, peptidergic neurons and their processes were also synaptic targets of terminals containing the same peptide. The distributions of these peptides in primate lamina X differ from that of the same peptides in primate superficial dorsal horn. These differences are important, in consideration of some of the parallels that may be drawn between the lamina X area and the superficial dorsal horn; both areas have high concentrations of the same peptides, receive nociceptive primary afferents, and contain spinothalamic and other projection neurons. Nevertheless, comparison of the distribution of immunoreactivity among terminal classes indicates that neurochemical organization at the ultrastructural level is quite distinct in each of the two areas. This may also reflect other roles of the lamina X area, including its involvement in visceral functions, although it would be expected that this element might be less prominent at the cervical levels we investigated.

Animals↗
PubMed1991

Twenty four hour heart rate variability: effects of posture, sleep, and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients.

Heart rate variability was measured in 77 healthy controls and 343 diabetic patients by a count of the number of beat-to-beat differences greater than 50 ms in the RR interval during a 24 hour ambulatory electrocardiogram. In the healthy controls the lower 95% tolerance limits for total 24 hour RR interval counts were approximately 2000 at age 25, 1000 at 45, and 500 at 65 years. Six controls confined to bed after injury had normal 24 hour patterns of RR counts, while eight other controls showed loss of diurnal variation in both heart rate and RR counts during a period of sleep deprivation. RR counts in ten controls on and off night duty increased during sleep whenever it occurred. Nearly half (146) the 343 diabetic patients had abnormal 24 hour RR counts. The percentage of abnormal RR counts increased with increasing autonomic abnormality assessed by a standard battery of tests of cardiovascular autonomic function. A quarter of those with normal cardiovascular reflex tests had abnormal 24 hour RR counts. There were close correlations between 24 hour RR count results and the individual heart rate tests (r = 0.6). The assessment of cardiac parasympathetic activity by 24 hour RR counts was reliable. The diurnal variations in RR counts seen in the controls were probably related to sleep rather than either posture or time of day. The method was more sensitive than conventional tests of cardiovascular reflexes.

Adolescent↗
PubMed1991

Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance.

Most patients with asthma waken with nocturnal asthma from time to time. To assess morbidity in patients with nocturnal asthma nocturnal sleep quality, daytime sleepiness, and daytime cognitive performance were measured prospectively in 12 patients with nocturnal asthma (median age 43 years) and 12 age and intellect matched normal subjects. The median (range) percentage overnight fall in peak expiratory flow rate (PEF) was 22 (15 to 50) in the patients with nocturnal asthma and 4 (-4 to 7) in the normal subjects. The patients with asthma had poorer average scores for subjective sleep quality than the normal subjects (median paired difference 1.1 (95% confidence limits 0.1, 2.3)). Objective overnight sleep quality was also worse in the asthmatic patients, who spent more time awake at night (median difference 51 (95% CL 8.1, 74) minutes), had a longer sleep onset latency (12 (10, 30) minutes), and tended to have less stage 4 (deep) sleep (-33 (-58, 4) minutes). Daytime cognitive performance was worse in the patients with nocturnal asthma, who took a longer time to complete the trail making tests (median difference 62 (22, 75) seconds) and achieved a lower score on the paced serial addition tests (-10 (-24, -3)). Mean daytime sleep latency did not differ significantly between the two groups (2 (-3, 7) minutes). It is concluded that hospital outpatients with stable nocturnal asthma have impaired sleep quality and daytime cognitive performance even when having their usual maintenance asthma treatment.

Adult↗