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Biomedical subjects

R Broughton

Publications and source records attributed to R Broughton.

At least 55 records · Page 3Linked to original sources
PubMed1982

Human consciousness and sleep/waking rhythms: a review and some neuropsychological considerations.

The relevance of sleep/waking rhythms to issues of human consciousness is reviewed from data in the literature and from personal studies. Consciousness is often considered to be markedly attenuated or absent in sleep. There is, however, much evidence for a rich subjective experience during sleep, much of which is not recalled later. This implies that William James' "stream of consciousness' persists continuously throughout sleep as well as wakefulness, but that problems of memory recall interfere with its being reported as such. Sleeping subjects show selective awareness of external stimuli, with significant stimuli generally leading to awakening and relatively nonsignificant stimuli, at least at times, being incorporated into the ongoing mental activity of REM or NREM sleep. Mentation throughout sleep is characterized by a high degree of autonomy and little willful control. Creative insight and problem solving of a very high order may occur in sleep and involve either dreaming or thought-like mentation. Parameters of waking consciousness show possibly sleep-related rhythmic fluctuations at both circadian (24 hr sleep/waking) and ultradian (90-120) min, NREM/REM sleep) rates. Moreover, waking consciousness is markedly influenced by the quality of temporal stability of preceding sleep. A substantial number of so-called "altered states of consciousness" is found to involve primarily or exclusively dysfunction of sleep/waking mechanisms. Cerebral lesions can produce selective impairment of aspects of sleep mentation. It is concluded that further analysis of subjective awareness in sleep or in partial sleep states is very relevant and indeed vital to a more comprehensive understanding of human consciousness.

Arousal↗
PubMed1981

Daytime performance deficits and physiological vigilance in untreated patients with narcolepsy-cataplexy compared to controls.

Ten patients, 7 female, 3 male, aged 17-65 years (mean 40) with narcolepsy-cataplexy were compared off treatment to matched controls on 4 performance tests. The tests were the 1 h Wilkinson auditory vigilance task, and 3 shorter tests including the 4-choice serial reaction time, the paced auditory serial addition task (PASAT) and digit span. Tests were counterbalanced and polygraphic recordings were done during all but the 4-choice serial RT. Subjective sleepiness was assessed by the 1-7 levels of the Stanford Sleepiness Scale and effort in the tests by a similar 1-7 scale. Practice sessions were held. Narcoleptics showed poorer performance on the more monotonous tests of auditory vigilance (fewer hits) and the 4-choice serial RT (longer reaction times, more 'gaps'). There were no significant differences between groups on the other performance tests. Narcoleptics were subjectively sleepier during all tests and over-all. But there was no good correlation between perceived degree of sleepiness and performance. They also expressed greater effort to perform the PASAT. The narcoleptics showed greater amounts of drowsiness and light sleep only during the 1 h vigilance test. For the detections of those signals (shorter times) occurring after 13 sec or more of polygraphic wakefulness, narcoleptics performed as well as controls.

Adolescent↗
PubMed1981

Life effects of narcolepsy in 180 patients from North America, Asia and Europe compared to matched controls.

A questionnaire survey has been made of the life effects of narcolepsy in 180 patients, 60 each from North American, Asian and European populations, with 180 similarly distributed age and sex matched controls. Life-effects were attributed by the patients to the primary symptoms of excessive daytime drowsiness, sleep attacks, cataplexy, vivid hypnagogic hallucinations and sleep paralysis, and also to other frequent symptoms such as visual problems (blurring, diplopia) and memory impairment. Occupational problems were prevalent (over 75%) and included statistically significant deleterious effects upon performance, promotion, earning capacity, fear of or actual job loss and increased disability insurance. Driving was greatly affected and patients fell asleep at the wheel more frequently (66%), had near or actual accidents from drowsiness or falling asleep at the wheel (67%), and could experience cataplexy (29%) or sleep paralysis (12%) while driving. Work or home accidents attributed to sleepiness or sleep (49%) or related to smoking (49%) were much more common in patients. There were also deleterious effects on education, recreation and personality related to disease. Narcolepsy can produce a variety of life-effects probably more serious and pervasive than, for instance, those of epilepsy, therefore emphasizing the importance of early diagnosis and treatment.

Accidents↗
PubMed1981

Sensitivity of the stanford sleepiness scale to the effects of cumulative partial sleep deprivation and recovery oversleeping.

The sensitivity of the Stanford Sleepiness Scale (SSS) to short-term cumulative partial sleep deprivation (PSD) and subsequent recovery oversleeping was examined. A repeated-measures design included 7 paid healthy undergraduate volunteers, who were normal sleepers (mean sleep time 7.6 hr), and consisted of the following schedule: (a) pre-baseline; (b)sleep reduction of 40% of 1 night (mean, 4.6 hr) for 5 nights; (c) recovery oversleeping for night 1 (mean, 10.6 Hr) and night 2 (mean, 9.1 hr); (d) post-baseline. Daytime performance testing utilized a 1 hr auditory vigilance task and four short-duration (10 min) tests, two of which have been shown sensitive to total and partial sleep loss effects. Subjects completed SSS forms every min while awake and 1-9 scales of mood and energy upon awakening. Subjective measures were analyzed across conditions for mean all-day and task-related SSS values and mood and energy ratings. A correlational analysis investigated individual correspondences between ratings and performance. Results indicate that SSS is sensitive to deficits in alertness following PSD. However, it generally does not predict individual performance efficiency and therefore cannot act as a substitute for performance measures in studies involving chronic sleep loss.

Adolescent↗
PubMed1980

Effects of nocturnal gamma-hydroxybutyrate on sleep/waking patterns in narcolepsy-cataplexy.

Continuous 48-hour polygraphic recordings of sleep/waking patterns were performed on 14 patients with narcolepsy-cataplexy before and after 7-10 days of treatment of their nocturnal sleep with gamma-hydroxybutyrate (GBH). GBH improved the quality of night sleep by increasing the amount of slow wave sleep, reducing stage I, increasing sleep efficiency (percentage of time in bed spent asleep), and reducing the number of periods of short sleep under 15 minutes. Also nighttime REM sleep was reduced in latency and became less fragmented. The daytime period contained less slow wave sleep and REM sleep, and fewer episodes of prolonged sleep. Patients experienced reduction or loss of daytime attacks of irresistible sleep, cataplectic attacks, and other auxiliary symptoms. Residual daytime drowsiness subsequently improved on low doses of methylphenidate. Tolerance did not develop and there were no serious toxic side-effects. Four of the patients had been refractory to previous combinations of antidepressants and high doses of stimulants.

Adult↗
PubMed1979

The treatment of narcolepsy-cataplexy with nocturnal gamma-hydroxybutyrate.

Sixteen patients with narcolepsy and cataplexy were treated with gamma-hydroxybutyrate (GHB) given at night and tailored to achieve as continuous a night's sleep as possible. The dosage usually consisted of 1.5-2.25 gm orally at bedtime and then one or two further 1.0-1.5 gm doses with awakenings during the night, and totaled about 50 mg/kg. Apart from one patient who took only the bedtime dose, the subjective quality of night sleep improved in all patients and the number of irresistible daytime attacks of sleep and cataplexy substantially diminished. Some residual daytime drowsiness remained and this usually responded well to low doses of methylphenidate. Improvement has been maintained for up to 20 months without the development of tolerance. Two patients experienced adverse side effects necessitating withdrawal of GHB treatment, but no serious toxic effects have occurred.

Adult↗
PubMed1979

A cure for recurrent furunculosis.

A therapy for recurrent boils using antibiotic ointment over the entire integument is described herein. Rather than eradicating the individual nidus of infection, the skin is allowed to muster its own defenses, resulting in fewer, and eventually no, eruptions.

Anti-Bacterial Agents↗
PubMed1978

Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction.

Twelve patients aged 33--70 years (mean 49.5) underwent nightly recordings in the ICU and subsequently on the ward following acute myocardial infarction. Sleep patterns were analyzed according to night after infarct and ICU versus ward environment. Significant differences in nocturnal sleep patterns from matched controls initially after infarction included greater wakefulness, low REM sleep per cent, long REM latency, fewer REM periods, more awakenings, more stage shifts and decreased sleep efficiency. The usual circadian variation in HR was absent, and there was an estimated 8--10 h of unrecorded daytime sleep, which together suggested a quite generalized disruption of biological rhythms. With time, there was loss of daytime sleep, lowered nocturnal wakefulness and increased REM sleep. Slow-wave sleep (sometimes with very long duration delta waves) increased above normal over post-infarction nights 3--9, and sleep was otherwise renormalized by post-infarction night 9. No sudden sleep changes occurred with transfer from ICU to ward. The altered sleep patterns appeared mainly attributable to infarction itself. Twelve nocturnal anginal attacks occurred. Ten began in NREM sleep and two in REM periods without particularly intense phasic activity. Post-infarction nocturnal angina therefore appears to differ in pathogenesis from angina outside this period, which usually occurs in REM sleep. ECG changes could occur during sleep before awakening with pain, and overall decrease in ECG amplitude sometimes accompanied angina. Most attacks (10 of 12) occurred on post-infarction nights 4 and 5, indicating that undetermined that undetermined factors produce a secondary period of heightened risk at that time.

Adult↗
PubMed1978

Effects of sleep deprivation on short duration performance measures compared to the Wilkinson auditory vigilance task.

The effects of one night's total sleep deprivation were examined using the Wilkinson vigilance task and four 10 min duration performance tests. A repeated measures design was used in which eight male subjects experienced one night of sleep loss, the order of sleep loss being balanced across subjects. The four short duration performance tests consisted of choice reaction time, simple reaction time, short-term memory, and a motor task, handwriting. The results confirm the effects of one night's sleep deprivation on the vigilance task and also show that performance on the two reaction time tests was significantly impaired by the loss of sleep, but not at such a high level as for the vigilance. The short-term memory test failed to show any adverse effects of sleep loss and similarly for the handwriting. The experiment shows that two portable and brief (10 min) performance tests are sensitive indices of sleep loss and should be particularly useful for assessing levels of alertness in the field.

Adult↗