Biomedical subjects

T Roth

Publications and source records attributed to T Roth.

At least 127 records · Page 7Linked to original sources

PubMed1985

Pharmacological effects of sedative-hypnotics, narcotic analgesics, and alcohol during sleep.

This article briefly reviews the well known effects of sedative-hypnotics, alcohol and narcotics on sleep. These drugs also have respiratory depressant effects, and the limited information about their effects on sleep-related breathing disturbances is reviewed. They exacerbate obstructive sleep apnea syndrome and have moderate to minimal effects on occasional apnea or hypopnea, but do not induce breathing disturbances de novo.

Adult↗

PubMed1985

Eligibility requirements in hypnotic trials.

Forty-eight patients complaining of insomnia were studied at two sleep laboratories using an identical protocol to evaluate hypnotic efficacy. All met the screening requirement of a mean sleep latency of 30 min or greater on 3 laboratory nights following an adaptation night. Of these patients 34 still complaining of insomnia were screened a second time 2 to 6 months later. Sixteen of the 34 failed the second screen. Sleep parameters for the 34 on screen 1 compared with screen 2 were the same except for sleep latency (the eligibility criteria), which was significantly shorter. There was no evidence of a systematic difference between laboratories, a change in procedure from screen 1 to 2, or a systematic loss of patients from screen 1 to 2. The data show that the statistical phenomenon of regression toward the mean must be considered in designing hypnotic efficacy studies.

Adult↗

PubMed1985

The effects of midazolam and temazepam on sleep and performance when administered in the middle of the night.

A multicenter, double-blind, sleep laboratory and performance study was conducted to evaluate the hypnotic efficacy and residual effects of midazolam (15 mg) and temazepam (30 mg) compared to placebo when administered in the middle of the night. Eighteen volunteers with objectively verified sleep maintenance insomnia received placebo for 3 nights during week 1 (adaptation and screening). During weeks 2, 3, and 4 they received 2 consecutive nights of midazolam, temazepam, and placebo (one treatment per week) in a balanced crossover design. Treatment was administered in the middle of the night (3.5 hours after bedtime). Neither drug reduced the latency to return to sleep after the middle of the night awakening. Both drugs significantly increased total sleep time, reduced wake during sleep, and number of awakenings over 4.5 hours in bed after treatment. In the morning (5 to 6.5 hours postdrug) significant performance decrements and reduced daytime sleep latency (7 hours postdrug) were found with temazepam but not midazolam.

Adult↗

PubMed1985

Sleep-wake complaints in patients with sleep-related respiratory disturbances.

The relation of sleep complaint to sleep continuity and respiratory disturbance was studied by comparing 2 series of patients with sleep apnea, one group complaining of insomnia and the other of excessive daytime sleepiness. On polysomnographic evaluation, patients with insomnia complaints had fewer and shorter, primarily central, apneas that had little hypoxemic effects. Patients with excessive sleepiness complaints had more and longer, primarily obstructive, apneas that produced significant hypoxemia. Sleep of the excessively sleepy patients was lighter and longer, whereas that of the patients with insomnia was characterized by more wake time before and after sleep onset. The excessively sleepy patients were objectively sleepy on a test of daytime sleepiness, whereas patients with insomnia were alert.

Adult↗

PubMed1985

Evaluation of the effectiveness of uvulopalatopharyngoplasty.

A new surgical procedure to treat obstructive sleep apnea by uvulopalatopharyngoplasty (UPPP) was evaluated in 66 patients, 63 men and 3 women, with objectively documented sleep apnea syndrome. Removal of redundant tissue in the oropharynx (UPPP) significantly improved excessive daytime sleepiness, reduced by half the frequency of apneas and hypoxia occurring during sleep, and improved the quality of sleep. Closer analysis indicated that all 66 patients did not benefit to the same degree. Among patients classified as responders, the frequency of apnea was reduced to a level seen in healthy adults of the same age, measures of sleep approached normal, and excessive daytime sleepiness was eliminated. In nonresponders, frequency of apnea and consequent disruption of sleep was not reduced, but nocturnal hypoxia was improved.

Body Weight↗

PubMed1985

Uvulopalatopharyngoplasty. One-year followup.

Uvulopalatopharyngoplasty (UPPP), originally evaluated in 66 patients with objectively documented sleep apnea syndrome, was successful in 33 of the patients as indicated by clinical and polysomnographic improvements. One-year followup polysomnographic evaluations were obtained in 20 of these patients; the remaining 13 were lost to followup. After one year, the patients maintained the improvements seen at the six-week evaluation. Frequency and duration of apnea was significantly reduced from presurgery levels and similar to the six-week results. Oxygenation measures also did not differ from the six-week results, remaining better than presurgery values. Thus, respiration did not disrupt sleep to the degree it had before surgery. Sleep measures were improved compared to presurgery and similar to the six-week data. Body weight remained stable over the entire period.

Female↗

PubMed1985

Sustained performance with short evening and morning sleeps.

The effect which early evening sleep may have on overnight and subsequent daytime performance, and the effect which morning sleep may have on daytime performance after overnight sleep deprivation has been studied in six healthy male volunteers. It would appear that relatively short periods of natural and drug induced (brotizolam 0.125 mg) sleep have a beneficial effect on subsequent performance even in the absence of preceding sleep debt. In the event of disturbed sleep in shiftwork an hypnotic may be helpful, and in this context, one which is rapidly eliminated and sustains sleep is appropriate.

Adult↗

PubMed1985

Hypnotics and aircrew.

The management of sleep difficulties which arise during air operations must be related, at least initially, to the cause, but the aeromedical specialist is frequently faced with the possible use of hypnotics. There are no simple guidelines, but an understanding of various issues will help toward the effective use of these drugs in those who have to cope with irregularity of rest and carry out skilled work. Some knowledge of the pharmacokinetics of the drugs concerned is useful as persistence of effect and the potential for accumulation with repeated ingestion are important factors, while efficacy in relation to sleep of different durations and at unusual times must also be considered.

Adult↗

PubMed1984

Treatment of a 12-hour shift of sleep schedule with benzodiazepines.

Normal sleepers underwent sleep recordings and daytime tests of sleep tendency, performance, and mood while being shifted 180 degrees in their sleep-wake schedule. After two baseline 24-hour periods, subjects postponed sleep until noon. For the next three 24-hour periods, they were in bed from 1200 to 2000 and received triazolam, flurazepam, or placebo at bedtime in parallel groups. Placebo subjects showed significant sleep loss after the shift. Active medication reversed this sleep loss. Despite good sleep, flurazepam subjects appeared most impaired of the three groups on objective assessments of waking function; triazolam subjects were least impaired.

Adult↗

PubMed1984

Polysomnographic and MMPI characteristics of patients with insomnia.

This report represents the polysomnographic aspects of sleep and the psychological characteristics of a large series of patients with insomnia classified according to the diagnostic system of the Association of Sleep Disorders Centers. The findings for patients in the various diagnostic categories were compared to those of symptomatic patients with no objective findings. 9 specific diagnoses were made, but 4 diagnoses accounted for the majority of patients. The 4 most prevalent were psychophysiological disorders (15%), psychiatric disorders (17%), nocturnal myoclonus and restless legs (18%), and no objective findings (19%). Patients of a sleep disorders center are a select population and may not be representative of the general population of patients with insomnia complaints. The psychological characteristics of the different diagnostic groups were assessed by computing the number of elevations on the MMPI. Patients with a psychiatric diagnosis exhibited the highest number of MMPI elevations, as might be expected. Patients with nocturnal myoclonus had the lowest number of elevations. The other groups did not significantly differ from the group with no objective findings. Polysomnographic measures of sleep differed considerably among the diagnostic groups. The groups with medical disorders, respiratory impairment, atypical polysomnographic features, and nocturnal myoclonus had similar short sleep latencies to those of the group with no objective findings. With longer wake times before sleep and significantly different from patients with no objective findings were the psychophysiological disorder, psychiatric disorder and drug and alcohol groups. Patients with a circadian rhythm disturbance had the longest latencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Circadian Rhythm↗

PubMed1984

Amnesic effects of lormetazepam.

Sixteen healthy men, age 18-35, each received lormetazepam (1.5 mg), flurazepam (30 mg), temazepam (30 mg) and placebo (double-blind in a Latin Square design) 30 min before bedtime for 2 consecutive nights followed by a 12 day washout between conditions. Three hours after drug (2.5 h after bedtime) subjects were awakened and administered a 16-item memory task. Fifteen minutes after the awakening subjects returned to bed, were instructed to go to sleep, and remained in bed for an additional 5.5 h. Immediately after the memory tasks, before returning to bed, subjects recalled almost all of the 16 items when placebo was administered before bedtime. Immediate recall was significantly poorer than placebo after temazepam and flurazepam, but not after lormetazepam. Morning recall was reduced significantly from the immediate nighttime level in each condition; this loss was smallest with placebo. All active drug conditions produced significantly greater amnesia than placebo. This amnesia was smallest after lormetazepam and greatest after temazepam, which differed significantly from each other. All active drugs significantly reduced latency measures of the return to sleep after the 15 min awakening; it was shortest with temazepam and longest with flurazepam. This study showed a relation between the hypnotic and amnesic effects of these drugs which is consistent with their pharmacokinetic properties.

Adolescent↗

PubMed1984

Sleep fragmentation and daytime sleepiness.

It has been noted that clinical populations complaining of excessive daytime sleepiness (EDS) frequently have disrupted or fragmented nocturnal sleep. The relation between sleep fragmentation and daytime sleepiness has not been systematically studied. This study was designed to use correlational techniques evaluating the relation between these variables in patients complaining of EDS, patients complaining of insomnia, and asymptomatic controls. The four groups studied included patients complaining of EDS with sleep apnea (n = 15) or with periodic leg movements (n = 15), patients complaining of insomnia (n = 15), and healthy volunteers with no sleep complaint (n = 10). One night of polysomnography followed by a Multiple Sleep Latency Test was obtained for each subject. Each recording was evaluated using standard criteria and also by a four-level arousal scoring system. Across all subjects, the total number of arousals correlated significantly with sleepiness index (r = 0.48, p less than 0.001). Closer analysis of the data shows that, depending upon the sleep complaint, different types of arousals are predictive of degree of daytime sleepiness. It is concluded that the number and type of nocturnal arousals play an important role in subsequent daytime sleepiness.

Adult↗

PubMed1984

Daytime sleepiness and antihistamines.

A daytime nap procedure was used to evaluate the daytime sleepiness associated with antihistamines, as well as to assess their hypnotic potential. Healthy, normal subjects received diphenhydramine (150 mg), terfenadine (120 mg), and placebo and went to bed at 900, 1100, 2000, and 2200 h with the instruction to try to fall asleep. The remained in bed for 60 min while standard sleep recordings were made. Across all conditions latency to stage 1 sleep increased significantly from nap 1 to nap 4 and the amount of sleep (all nonstage 1 sleep) decreased significantly. Over the four naps the mean latency to stage 1 sleep with diphenhydramine was significantly shorter than terfenadine and placebo, which did not differ. On the other hand, there were no differences among the drug conditions in the amount of nonstage 1 sleep. In sum, diphenhydramine at this dose produces sleepiness but shows little potential as a hypnotic, and accumulated sleep across the day makes people progressively more alert.

Adult↗

PubMed1984

Periodic movements during sleep, sleep fragmentation, and sleep-wake complaints.

To better understand the relation of sleep complaint to sleep continuity and periodic movements during sleep (PMS), two groups of patients were studied retrospectively. One group of 51 patients, 26 men and 25 women, with a mean age of 56.4 years, complained of insomnia. The other group of 29 patients, 20 men and nine women, with a mean age of 55.8 years, complained of excessive daytime sleepiness. Sleepy patients differed significantly from insomnia patients in that they fell asleep faster and slept longer. They showed more frequent arousals (shifts to stage 1 sleep and number of awakenings) than insomnia patients who had longer arousals (mean duration of awakenings). Insomnia patients had more series of PMS, but sleepy patients had more PMS bursts per series.

Arousal↗

PubMed1984

Temazepam's efficacy in patients with sleep onset insomnia.

The hypnotic efficacy of temazepam capsules (30 mg) was studied in twelve patients who had objective polysomnographic evidence of sleep onset insomnia. Patients slept in the laboratory, retiring at their usual bedtime after taking placebo or temazepam 30 min earlier, and were monitored for 8 h using standard polysomnographic techniques. Acute (nights 5-7) and chronic (nights 11-13) temazepam improved the sleep of these patients by reducing sleep latency and increasing sleep time compared to the placebo baseline (nights 2-4). No detrimental effects on daytime function the following morning were observed using questionnaires and objective tests of performance. No consistent evidence of disturbed sleep after discontinuation of treatment was obtained over three recovery nights.

Adult↗

PubMed1984

Benzodiazepines and memory.

Benzodiazepines possess anterograde amnesic properties, disrupting both short-term and long-term memory function. The amount of amnesia is systematically related to dose effects and half-life differences among the benzodiazepines. Memory deficits are found for episodic, semantic, and iconic memory function. The deficits in long-term memory are probably the result of a disruption of consolidation of information in memory and not retrieval from memory. The disruption is produced by rapid sleep onset. Thus the long-term amnesia is really a retrograde effect of sleep and not the anterograde effect of the drug.

Amnesia↗

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↗

PubMed1984

Night-to-night consistency of apneas during sleep.

The consistency of apneas from night to night was examined in 2 groups of patients. The first group had more than 100 apneas per night (frequent apnea) and the second group had less than 100 apneas per night (infrequent apnea). All patients underwent clinical polysomnography for 2 nights, with no significant weight change or treatment occurring between recordings. The frequent apnea group showed a consistent number of apneas on the 2 nights (r = 0.92, p less than 0.01), whereas the infrequent apnea group showed a highly variable number of apneas (r = 0.35, p greater than 0.10). The correlations on apnea index (apneas per hours of sleep) showed a similar result. Apnea duration and type were consistent in both groups of patients.

Humans↗