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Biomedical subjects

S Ancoli-Israel

Publications and source records attributed to S Ancoli-Israel.

At least 73 records · Page 4Linked to original sources
PubMed1994

Low illumination experienced by San Diego adults: association with atypical depressive symptoms.

We explored the illumination exposure of middle-aged adults to determine normal values and to explore several correlates of daily light exposures. Subjects aged 40-64 years in San Diego, CA were recruited by random telephone dialing. Subjects completed a demographic interview and the Center for Epidemiologic Studies Depression self-rating scale (the CES-D) supplemented with eight questions related to seasonal affective disorders (SAD). Data were analyzed for 106 volunteers who wore a device that monitors illumination exposures and activity. The median subject was exposed to illumination > or = 1000 lux for only 4% of the time observed, that is, only about 58 min per day were spent in daylight. Subjects scoring higher on the atypical SAD mood symptoms spent less time in bright illumination rs = -0.266, p = 0.003. The CES-D depression score was similarly correlated with illumination but of borderline significance (rs = -0.150, p = 0.063). These results suggest the hypothesis that many Americans may be receiving insufficient light exposure to maintain optimal mood.

Adult↗
PubMed1994

Sleep in non-institutionalized Alzheimer's disease patients.

The sleep of Alzheimer's disease (AD) patients is often disturbed by medications, depression, circadian rhythm changes and sleep disorders. Institutionalization is often precipitated by the effect of the patient's sleep and wakefulness on the caregiver. We examined reports of sleep disturbance in mild AD patients. The study cohort consisted of 246 AD patients and 94 controls. Self-reports of sleep disturbance in mild AD patients were examined as was the relationship of sleep and medication use. Results were compared to those of normal controls, and the patients' responses to the reports of their caregivers. Dementia was assessed with the Mini Mental Status Exam, the Blessed Dementia Scale, the Mattis Dementia Rating Scale, and the Pfeiffer Outpatient Disability Test. The more demented the patients, the more time they spent in bed, the more fragmented their sleep, and the more naps they took. Caregivers reports of increased wandering at night and more aggressive behavior during the day were associated with increased use of sedative-hypnotics and with going to bed early. Lengthy sleep was associated with disruptive behavior. We conclude that increased sleep may be associated with dementia and with more disruptive behavior.

Aged↗
PubMed1994

A technique for improved blood sampling during sleep studies.

Research protocols often require that blood samples be drawn during sleep. This study compares the efficacy of obtaining nocturnal blood samples using a standard heparinized intravenous setup versus the same intravenous setup used in conjunction with a small chemical heating pad. The chemical heating pad significantly improved the number of blood samples obtained and the maintenance of intravenous patency. The use of a chemical heating pad is an economical way to resolve the frustration of lost blood samples while maintaining a reasonable environment to monitor sleep.

Adult↗
PubMed1994

Comparison of patients with central sleep apnea. With and without Cheyne-Stokes respiration.

This study was designed to determine the impact of central sleep apnea with or without Cheyne-Stokes respiration (CSR) on morbidity and mortality. Central sleep apnea was found in 77 male general medical ward in-patients. Cheyne-Stokes respiration was found in 49 of the 77 men; in 15 men, CSR was severe, ie, > or = 25 percent of the night spent in CSR, in 34 men CSR was mild (1 to 25 percent CSR). Twenty-eight men had central sleep apnea but no CSR. An additional 31 patients had no sleep apnea and no CSR. The patients with severe CSR had more central apneas, more, but shorter desaturations, more awakenings and more wake time during the night, but spent more time in bed than those with no CSR or no apnea. Radiographic evidence was consistent with an association of CSR and heart failure. In addition, patients with severe CSR were at almost twice the risk of dying compared with those with no apnea and had a shorter survival time. Nevertheless, we could not confirm that CSR was an independent predictor of elevated mortality risk, implying that some other factors specific to severe CSR predispose these patients to shorter survival time.

Aged↗
PubMed1993

The effect of blood pressure cuff inflation on sleep. A polysomnographic examination.

Ambulatory blood pressure monitors are being used increasingly to define blood pressure in contexts other than the doctor's office. With increasing interest in both effects of treatment on quality of life and chronobiology of hemodynamic regulation, such monitors have also been used to define blood pressure during sleep. Unfortunately, few investigators have scrutinized the effect of such recordings on sleep, as defined precisely with polysomnography. We studied a diverse group of 12 unmedicated individuals, measuring BP by cuff inflation every 60 min. The polysomnogram was then analyzed for periods of wakefulness and arousals from sleep. Cuff inflation was associated with increased arousals (P < .0001) and wakefulness (P < .0001). In addition, subjects recalled 58% of the cuff inflations. Effects of cuff inflation on a second night of recording indicated some habituation. Nocturnal BPs measured by such techniques are still valuable, but one must have some reservations that these measures accurately reflect BP during sleep.

Blood Pressure Monitors↗
PubMed1993

Natural history of sleep disordered breathing in community dwelling elderly.

Mild sleep disordered breathing is very common in the elderly, but little is known about the course of the disorder over time. Twenty-four elderly people from a population-based study were recorded three times over an 8.5-year period. There were no significant changes in either apnea index or in respiratory disturbance index (RDI) over time, even when controlled for body mass index. For most subjects, there was great variability over time in the number of respiratory disturbances. The sensitivity of RDI > or = 15 at visit 1 predicting RDI > or = 15 at visit 3 was only 20%. The predictive value was 50%. Sleep disordered breathing measured at a single point in time is rather weakly predictive of the severity of breathing disorder 4-8 years later.

Aged↗
PubMed1991

Prevalent sleep problems in the aged.

Quality of sleep influences the level of daytime functioning, including stress levels, psychosomatic complaints, general health, and overall well-being. As people age, they complain more about disturbed sleep, insomnia, increased time in bed, and sleep fragmentation. These complaints can be related to circadian rhythm desynchronization, hypnotic or other medication use, chronic bedrest, napping, dementia, or to sleep apnea, a disorder of respiratory cessation which is quite prevalent in the elderly. We review here the results of 12 years of research on sleep in the elderly. In studies of three populations of elderly, it was found that between 24% and 42% had five or more apneas per hour of sleep and 4%-14% had 20 or more apneas per hour of sleep. Since apnea is related to dementia and even to mortality, this high prevalence of apnea is of extreme importance.

Aged↗
PubMed1991

Sleep-disordered breathing in community-dwelling elderly.

These are the final results of a survey of sleep-disordered breathing, which examined objective and subjective information from a large randomly selected elderly sample. We randomly selected 427 elderly people aged 65 yr and over in the city of San Diego, California. Twenty-four percent had an apnea index, AI, greater than or equal to 5 and 62% had a respiratory disturbance index, RDI, greater than or equal to 10. Correlates of sleep-disordered breathing included high relative weight and reports of snoring, breathing cessation at night, nocturnal wandering or confusion, daytime sleepiness and depression. Body mass index, falling asleep at inappropriate times, male gender, no alcohol within 2 hr of bedtime and napping were the best predictors of sleep-disordered breathing. Despite statistical significance, all of the associations between interview variables and apnea indices were small. No combination of demographic variables and symptoms allowed highly reliable prediction of AI or RDI.

Aged↗
PubMed1991

Periodic limb movements in sleep in community-dwelling elderly.

The prevalence of periodic limb movements in sleep (PLMS) in a randomly selected elderly sample is reported. In San Diego, 427 elderly volunteers aged 65 yr and over were recorded in their homes. Forty-five percent had a myoclonus index, MI greater than or equal to 5. Correlates of PLMS included dissatisfaction with sleep, sleeping alone and reported kicking at night. Although statistically significant, the strengths of the associations between interview variables and myoclonus indices were all small. No combination of demographic variables and symptoms allowed highly reliable prediction of PLMS.

Aged↗
PubMed1991

Dementia in institutionalized elderly: relation to sleep apnea.

Sleep apnea is characterized by transient hypoxemias which are thought to affect mental functioning. Accordingly, speculation and research have focussed on relationships between sleep apnea and dementia. We studied 235 nursing home (ie institutionalized) patients (152 women with a median age of 83.5; 83 men with a median age of 79.7) with portable sleep recording equipment. The Mattis Dementia Rating Scale and the Geriatric Depression Scale were given to each. Seventy percent of the patients had five or more respiratory disturbances per hour of sleep and 96 percent showed some dementia. Sleep apnea was significantly correlated with all subscales on the dementia rating scale. There were trivial differences in dementia ratings between those with mild-moderate apnea and those with no apnea. There were significant differences, however, between the latter two groups and those with severe apnea. In particular, items reflecting attention, initiation and perseveration, conceptualization, and memory tasks on the DRS distinguished between those with and without severe sleep apnea. Among those patients with no depression, all patients with severe sleep apnea were also severely demented. Our data suggest that there is a strong relationship between dementia and sleep apnea when the sleep apnea and dementia are severe. Although causality cannot be inferred from associations, our hypothesis for study is that sleep apnea causes deficits in brain function, possibly due to global effects rather than any particular cortical or subcortical structure.

Aged↗
PubMed1990

Sleep evaluation in chronic insomniacs during 14-day use of flurazepam and midazolam.

This article contains the sleep results of the efficacy study of flurazepam 30 mg and 15 mg, midazolam 15 mg, and placebo in the 99 chronic insomniacs studied as part of this multicenter study. After a 20-day drug washout, all-night sleep was recorded on 2 baseline nights, on the first 2 treatment nights, on treatment night 7, and on the last 2 nights of the study (nights 13 and 14). To reduce the number of comparisons, electroencephalographic (EEG) sleep latency, EEG wake time, EEG sleep efficiency, post-sleep questionnaire (PSQ) sleep latency, and PSQ total sleep were preselected as the major sleep variables. Between-groups comparisons indicated that, when compared with the placebo control, all drugs improved sleep, but differences were statistically significant only for the first 2 nights, i.e., the early interval. Midazolam was more effective than either dose level of flurazepam on treatment night 1. Within-group analyses indicated that all drug groups showed significantly improved sleep from baseline throughout drug administration, but the placebo group did not significantly improve from baseline by either objective or subjective measures at any of the three time intervals. The sleep of patients taking flurazepam 30 mg did not differ significantly from the sleep of those receiving the 15 mg dose for any of the five major sleep variables at any interval. Objective EEG and subjective PSQ sleep variables showed significant positive correlations.

Adult↗
PubMed1989

Twenty-four-hour sleep-wake patterns in a nursing home population.

Sleep-activity patterns were objectively recorded over a 24-hr period in 19 elderly nursing home residents. On average, both sleep and wake times were observed during every hour of the 24 recorded hours; however, the sleep pattern of the residents was fragmented so that they rarely experienced even a single hour of consolidated time spent sleeping. It is hypothesized that several independent factors, including compensation for lost sleep, increased total time in bed, weakening of social constraints, and deterioration of the circadian sleep-wake rhythm, are interacting to produce this increase in sleep fragmentation.

Activities of Daily Living↗
PubMed1989

Sleep fragmentation in patients from a nursing home.

Institutionalized elderly persons are said to have very disturbed sleep, yet few studies have collected empirical data on the sleep of these patients. We recorded sleep in 200 patients (131 females and 69 males; mean age = 81.9 years, SD = 8.6) in a skilled nursing facility. A modified Respitrace-Medilog portable recording system was used. In recordings averaging 15.4 hours, the patients were asleep for 7 hours, 58 minutes and awake for 7 hours, 28 minutes. To obtain that amount of sleep, the patients spent an extended time in bed during the day, for they averaged no more than 39.5 minutes of sleep per hour in any hour of the night, and 50% woke up at least 2 to 3 times per hour. In summary, although nursing home patients slept on average only one hour longer than independently living elderly, they had to spend substantially more time in bed to obtain the same amount of sleep.

Activity Cycles↗
PubMed1989

Apnea revisited: a longitudinal follow-up.

Volunteers aged 65 years and over who were previously studied underwent follow-up interviews and sleep recordings several years later (mean follow-up, 4.6 years). Modest correlations between the initial and subsequent recordings were found for apnea index, hypopnea index, and respiratory disturbance index. Sleep apnea indices did not increase over time; however, individual subjects showed great variability in amount of apnea. Periodic leg movement indices, on the other hand, significantly increased. Subjective reports indicated a significant increase in the amount of time spent awake and a significant decrease in the amount of loud snoring.

Aged↗
PubMed1989

Sleep apnea in female patients in a nursing home. Increased risk of mortality.

There has been much speculation on the risk of mortality associated with sleep apnea. We followed-up 233 elderly patients in nursing homes, 70 percent of whom had five or more respiratory disturbances per hour of sleep, to determine if sleep apnea is a predictor of mortality. Cox proportional hazards survival analyses indicated a gender effect, with women having a much better survival rate than men. In women, but not in men, there was a strong association between mortality and the RDI. In addition, patients with obstructive sleep apnea had a greater tendency to die in their sleep. These results show that respiratory disturbances in sleep are an extremely significant risk factor for mortality in elderly women who are in poor health.

Aged↗
PubMed1989

Epidemiology of sleep disorders.

Sleep apnea and PLMS are extremely prevalent in the elderly. The subjective reports of poor sleep, insomnia, snoring, and excessive daytime sleepiness should not be taken lightly and should not be assumed to be a normal sign of aging. These problems may be interrelated and may be symptoms of the sleep disorders discussed above. Physicians and gerontologists need to become more sensitive to the special problems and needs related to sleep disorders in the geriatric population.

Aged↗
PubMed1987

Characteristics of obstructive and central sleep apnea in the elderly: an interim report.

Home sleep recordings were done on 358 randomly selected elderly volunteers (mean age 72.4). When men and women were combined, 62 (17%) had predominantly obstructive sleep apnea, 21 (6%) had predominantly central sleep apnea, and 3 (1%) had mixed sleep apnea. Although the prevalence of sleep apnea in women does increase after menopause, sleep apnea was still significantly more common in older men (31%) than in older women (19%). There were no significant differences in age among groups with different types of apnea. There was a significant correlation of age with increasing apnea index within the obstructive sleep apnea group. Elderly volunteers with central sleep apnea had more midsleep awakenings. Elderly volunteers with obstructive sleep apnea had longer apneas. Unlike previous studies, we found many similarities and only modest differences in the presentations of central and obstructive sleep apnea.

Age Factors↗