Biomedical subjects

S Ancoli-Israel

Publications and source records attributed to S Ancoli-Israel.

88 records · Page 5Linked to original sources

PubMed1987

The diagnosis of sleep-related breathing disorders.

Information regarding sleep apnea syndromes and primary alveolar hypoventilation has been widely disseminated in both medical and lay publications. As a result, the pulmonary physician is confronted with a growing number of patients referred for evaluation of sleep-related breathing disorders. In addition, many pulmonary diseases may become worse during sleep. A wide variety of diagnostic options is available. The method chosen will depend on availability, cost, and the strength of the clinical impression. Screening studies, from the most simple (night-time Holter monitor or ear oximetry) to either a carefully performed nap study or a home recording may aid in deciding which patients require a formal polysomnogram. Centers with full all-night study capability may not use preliminary recordings at all. Because many therapeutic modalities exist, their intelligent use requires an accurate assessment of the type and severity of the breathing disorder.

Arrhythmias, Cardiac↗

PubMed1986

Thermal biofeedback and periodic movements in sleep: patients' subjective reports and a case study.

Periodic movements in sleep (PMS) is a sleep disorder characterized by repetitive leg kicks accompanied by arousals. In our clinical experience, many patients with PMS anecdotally report that they suffer from cold feet. This study explored whether there is an increased incidence of cold feet complaints in patients with periodic movements in sleep. Results indicated that, indeed, significantly more patients with leg kicks complain of cold feet as compared to patients without leg kicks. A case study was then conducted to determine whether foot thermal biofeedback training would alleviate symptoms of periodic movements in sleep. The number of leg kicks decreased from a mean of 536 per night before biofeedback training to a mean of 19.5 after training. These data lend support to our hypothesis that poor circulation may be contributing to the severity of periodic movements in sleep and that thermal biofeedback may afford an alternative treatment strategy.

Aged↗

PubMed1986

Body position changes and periodic movements in sleep.

What triggers episodes of periodic movements in sleep (PMS) remains unknown. Despite the uncertainties, there is no doubt of the widespread prevalence of PMS, particularly in elderly populations. This study explored possible consistent temporal relationships between body position and PMS episodes. Eleven subjects, monitored by polygraph and videotape, averaged 299 leg jerks in nine episodes, and 13 body position changes of greater than or equal to 90 degrees. Leg jerk episodes had a significant tendency to terminate soon before body position changes, and likewise there was a trend for leg jerk episodes to begin soon after position changes. It is hypothesized that adverse body positioning, via an influence upon the spinal cord or peripheral tissue perfusion, triggers PMS episodes, which persist until the adverse positions are changed. In this small sample, "adverse" positions could not be elucidated.

Adult↗

PubMed1985

Sleep apnea and periodic movements in an aging sample.

Individuals 65 years of age and older were randomly selected, from a primarily white upper-class population, to participate in a study of sleep disorders in elderly adults. One hundred forty-five volunteers had a brief telephone interview, a home interview, and a portable sleep recording using the Medilog and Respitrace systems. By research classifications, we found that 18% of the elderly participants had sleep apnea (apnea index greater than 5), 34% had periodic movements in sleep (myoclonus index greater than 5) (PMS), and 10% had both sleep apnea and PMS. These were not clinical diagnoses. The home recording indicated that the individuals with PMS slept significantly less than other older adults.

Age Factors↗

PubMed1985

Cheyne-Stokes breathing during sleep in patients with left ventricular heart failure.

Fifteen patients with left ventricular heart failure (LVF) without known breathing disorders during sleep had full-night recordings of sleep and breathing to study the incidence and impact of the apnea of Cheyne-Stokes breathing. This group showed a marked degree of sleep-related breathing abnormalities, 40% demonstrating Cheyne-Stokes breathing with five or more central apneas per hour of sleep. Cheyne-Stokes breathing during sleep in patients with LVF predicted an increased short-term mortality rate. All six patients with LVF and Cheyne-Stokes breathing with more than five apneas per hour of sleep were dead within six months, while only three of nine patients without recurrent apnea died within six months, a significant difference (P less than .05) even in this small group. Among seven patients with LVF studied with the polysomnogram, there were statistically significant differences between the Cheyne-Stokes and non-apnea groups in total sleep time, awakening per hour, and the number of arterial desaturations. Although sleep disturbances have been anecdotally described in patients with LVF, no previous investigation has determined the incidence and impact of Cheyne-Stokes breathing during sleep in LVF. Our findings that Cheyne-Stokes breathing predicts an adverse short-term mortality rate confirm the clinical impression that Cheyne-Stokes breathing is a poor prognostic sign in LVF.

Adult↗

PubMed1984

Effects of a single dose of flurazepam on the sleep of healthy volunteers.

We compared the effects of a single dose of flurazepam (Dalmane) 45 mg with placebo on the sleep of twelve young, healthy male volunteers. A double-blind random-order cross-over design was used. Flurazepam 45 mg had no effect on sleep latency to stage 1 or to stage 2 sleep and no effect on percent stages 3 and 4 sleep. Total sleep time and percent stage 2 sleep significantly increased on the drug night, while wake time, percent stage 1, and percent REM decreased. It is hypothesized that decreases in stages 3 and 4 that are generally seen on second administration or withdrawal of flurazepam are due to the major metabolite, N-desalkyl-flurazepam. In addition, respiration was recorded in six subjects. The number of NREM apneas increased from 15 on the placebo night to 29 on the drug night, although this was not statistically significant. The effect of flurazepam and other benzodiazepines on respiration deserves further study.

Adolescent↗

PubMed1983

Sleep apnea: a prospective study.

Sleep apnea is remarkably prevalent among general medical patients. Of 26 men randomly selected on a Veterans Administratin hospital medical ward, with a mean age of 66.2 (SD=11.5) years, 7 (27%) had sleep apnea. Of concern is that two of the seven patients were receiving hypnotic drugs. Portable sleep recordings may need to be done when routinely assessing elderly medical patients.

Adult↗

PubMed1982

Sleep apnea and nocturnal myoclonus in the elderly.

Insomnia, daytime sleepiness, and nocturnal wandering, so common in the elderly, are caused largely by two specific pathophysiologic processes. Sleep apnea is a condition where respiration pauses during sleep, leading to arousal. Sleep apnea is due either to obstruction in the throat or failure of the central respiratory center. Periodic movements in sleep are characterized by frequent ankle and leg flexions, leading to arousal. Sleep apnea and periodic movements in sleep require specific diagnoses and treatments. Each process occurs in 20%-30% of people over 65, and perhaps the majority of older people have one or the other condition or both. Because of possible interactions with these sleep disorders, the widespread prescribing of sleeping pills to elderly patients is irrational and often dangerous. In the future, large-scale clinical trials will be needed to define effective long-term treatments for these conditions and to define when treatment is worthwhile.

Aged↗

PubMed1981

Comparisons of home sleep recordings and polysomnograms in older adults with sleep disorders.

A major problem with studying the prevalence of sleep disorders is the high cost. We tested a portable home recording system which can decrease the cost of screening sleep recordings. Twenty-four senior volunteers and 12 patients referred to our sleep disorders clinic were studied for two nights. On one night, recordings were done in the laboratory with a traditional polysomnogram and the portable home recorder. On another night, portable home recorders were used in the subjects' homes. Of 36 subjects, 42% had sleep apnea and 39% had nocturnal myoclonus. Intermethod correlations were highly significant for sleep apnea index, nocturnal myoclonus index, total sleep period (TSP), total sleep time (TST), and wake time after sleep onset (WASO). The portable home recorder detected sleep apnea on 100% of nights during which sleep apnea was diagnosed by polysomnogram. The labor-saving and cost-saving benefits of home recordings as well as the increased comfort, privacy, and convenience will make the portable home recording the preferred method for many research and clinical applications.

Aged↗

PubMed1981

Sleep apnea and nocturnal myoclonus in a senior population.

Studies have suggested that sleep apnea is especially prevalent among seniors. We recruited and recorded senior volunteers who reported symptoms raising suspicion of sleep apnea or nocturnal myoclonus. Of 24 subjects, 62.5% had one of these disorders-six had sleep apnea alone, three had sleep apnea and nocturnal myoclonus, ans six had nocturnal myoclonus alone. Sleep stages were also analyzed. Subjects with sleep apnea and/or nocturnal myoclonus had significantly less rapid eye movement sleep, significantly more stage 1 sleep, and significantly more awakenings than other subjects. This sample suggests that the prevalence of sleep apnea and nocturnal myoclonus may be very substantial among seniors. Because of this high prevalence, extreme caution is needed in prescribing hypnotics for older patients with sleep complaints, since most hypnotics are respiratory depressants. We must rethink our approach to treating sleep disorders in the older population.

Aged↗

PubMed1981

Benefits of a sleep disorders clinic in a Veterans Administration Medical Center.

The Sleep Disorders Clinic at the San Diego Veterans Administration Medical Center provides a diagnostic service within a public hospital. Case records of the first 117 patients receiving polysomnograms in our clinic were reviewed. Of these patients, 44 percent were found to have sleep apnea, 24 percent nocturnal myoclonus and 8 percent narcolepsy. Our experience shows that in a health maintenance organization, a sleep disorders clinic provides diagnostic information (based on a polysomnogram and a sleep history) which is very helpful in the final diagnosis of medical disorders. Very few recordings were noncontributory. In this setting, a sleep disorders clinic is justified by its rich diagnostic yield.

Adult↗

PubMedDate not supplied

Effect of CPAP treatment on mood states in patients with sleep apnea.

Sleep apnea can lead to marked psychological distress including some mood symptoms. Previous studies on continuous positive airway pressure (CPAP) treatment usually reported significant improvement in mood symptoms in patients with sleep apnea, but most of them did not consider the placebo effect of CPAP. We examined the effect of CPAP treatment on mood states by employing both CPAP treatment and placebo CPAP. Twenty five men and nine women with sleep apnea underwent two successive nights of polysomnography (PSG) during hospitalization. The Profile of Mood States (POMS) was administered to measure mood states. Patients were randomly assigned to either CPAP treatment group or placebo CPAP group. After 7 days of CPAP use at home, all patients were re-hospitalized to undergo one more night of nocturnal PSG with their assigned treatment (CPAP treatment or placebo CPAP). They also had a repeat evaluation of mood by completing the POMS. Only patients on CPAP treatment improved significantly in apnea index, respiratory disturbance index, and mean oxygen saturation. However, both CPAP treatment group and placebo CPAP group showed significant improvement in mood states. In conclusion, the effect of CPAP treatment on mood symptoms in apneic patients could be a placebo effect. CPAP treatment may be effective in improving mood states only in patients who have severe depressive symptoms secondary to sleep apnea.

Adult↗

PubMedDate not supplied

Taking fatigue seriously: I. Variations in fatigue sampled repeatedly in healthy controls.

OBJECTIVE: The four objectives of this study were to test the ability of a 1-item fatigue scale to correlate with the fatigue subscale of the Profile of Mood States (POMS), to test the acceptability of recording hourly fatigue ratings, to examine the chronobiological variation in self-reports of fatigue, and finally to examine the degree to which self-report of fatigue correlated with actigraphy findings. METHODS: Ten healthy normal controls completed the POMS fatigue subscale hourly for three days. The same 10 healthy subjects wore an actigraph for 72 consecutive hours. The actigraph was modified to incorporate two event buttons which subjects were asked to push hourly to report their level of fatigue. RESULTS: The 1-item fatigue rating correlated significantly (mean r = 0.61) with the rest of the POMS subscale for fatigue. Subjects had no difficulty using the event button on the actigraph in entering the 1-item fatigue ratings. Fatigue ratings revealed marked differences in how healthy subjects report fatigue. There was no consistent diurnal patterning of fatigue. The fatigue ratings in general were not correlated with actigraphic measures. DISCUSSION: The study documents that fatigue can be repeatedly assessed with an ambulatory device and that self-reported fatigue levels vary enormously from hour to hour in a healthy normal sample.

Activities of Daily Living↗

PubMedDate not supplied

Neuropsychological effects of one-week continuous positive airway pressure treatment in patients with obstructive sleep apnea: a placebo-controlled study.

OBJECTIVE: To determine whether 1-week continuous positive airway pressure (CPAP) treatment, compared with placebo CPAP, improves cognitive functioning in patients with obstructive sleep apnea (OSA). METHODS: 36 OSA patients (aged 32-60 years, respiratory disturbance index [RDI] > 15) were monitored 2 nights with polysomnography, then randomized for 1-week treatment to CPAP or placebo (CPAP at 2 cm H2O with holes in mask). Participants completed Wechsler Adult Intelligence Scale-Revised Digit Symbol and Digit Span, Trailmaking A/B, Digit Vigilance, Stroop Color-Word, Digit Ordering, and Word Fluency tests pre- and posttreatment. These produced 22 scores per participant, which were analyzed by use of repeated-measures analysis of variance (ANOVA) and a rank-sum test. RESULTS: In ANOVA, only 1 of the 22 scores showed significant changes specific to CPAP treatment, a number that could be expected by chance alone: Digit Vigilance-Time (p = .035). The CPAP group improved their time (from 7.5 to 6.9 minutes. p = .013). The rank-sum test revealed that the CPAP group had significantly better overall cognitive functioning posttreatment than the placebo group (mean ranks of 17.8 vs. 20.2, respectively; p = .022). CONCLUSIONS: Although results suggest overall cognitive improvement due to CPAP, no beneficial effects in any specific cognitive domain were found. Future studies of neuropsychological effects of CPAP treatment should include a placebo CPAP control group. Placebo studies that use longer-term treatment might demonstrate additional effects. It is also possible that, even at 2 cm H2O, CPAP conveys some beneficial neuropsychological effects.

Adult↗

PubMedDate not supplied

"Sleep is not tangible" or what the Hebrew tradition has to say about sleep.

Much of what is known about sleep disorders has been uncovered in the last forty years. As scientists, we consider these discoveries to be landmarks. Yet there is a tremendous amount of information written about sleep in the Bible and its commentaries. Sleep, and even sleep disorders, are referred to in many instances and can be directly interpreted by what we know today. Our forefathers and foremothers generally viewed sleep as both pleasant and necessary and were aware that sleep was not one continuous stage. They referred to the function of sleep as being restorative. They deplored sleep deprivation, believing that it impaired life. They felt that excessive sleepiness was harmful. They understood that insomnia could be caused by stress and anxiety and by excessive alcohol, and that physical activity (exercise) and drinking milk could improve sleep. They suggested cures for insomnia, including some of the ideas included in today's sleep hygiene rules. They understood that there was a rhythm or timing to sleep. They even understood that it is easier to delay the circadian rhythm that to advance it. Although naps are not recommended, they sometimes took naps in the afternoon, but suggested just how long that nap should last-about one-half hour. And they knew that with age, although sleep is advanced, healthy elderly do not have difficulty sleeping. Although we think we have discovered many new features about sleep disorders, much of what we know today was suggested thousands of years ago and documented in the Bible and the Talmud.

Aging↗

PubMedDate not supplied

Evaluation of sleep disordered breathing with unattended recording: the Nightwatch System.

There is a need for studies to determine how new ambulatory systems compare to traditional polysomnography (PSG). Thirty-four subjects were recorded with the Nightwatch (NW) System (Heathdyne Inc.) at home and then recorded with PSG in the laboratory. NW records were scored automatically using the NW algorithm with manual editing. There were no significant differences in mean RDI, AI, number of apneas or hypopneas or oximetry varibles between the systems. Correlations of RDI on the Nightwatch system and laboratory nights were significant (r = 0.63). Every case of RDI > or = 10 on the PSG was also identified by Nightwatch. Specificity was lower on Nightwatch (66%); however, all three cases of false positives could be explained physiologically, i.e. by body position. Overall the NW system correlated well with traditional PSG for respiratory disturbance.

Algorithms↗