PubMed · 14057250
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R F TERWILLIGER. 1963. PATTERN COMPLEXITY AND AFFECTIVE AROUSAL.. https://doi.org/10.2466/pms.1963.17.2.387
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STUDY OBJECTIVES: The aim of this study was to investigate the autonomic drive to the heart in cardiac transplant patients (CTP) using heart rate (HR) and HR variability (HRV) analysis during non-rapid eye movement (NREM)-rapid eye movement (REM) sleep cycles, in particular during arousal associated with the emergence from slow wave sleep (SWS). In healthy subjects, this arousal is characterized by a pronounced HR surge, and HRV is lower during SWS than during the subsequent "active" sleep stage 2 and REM sleep. PARTICIPANTS: The participants were 24 adults, 14 CTP (men, n = 11; women, n = 3; mean age, 62.2 +/- 2.2 years; time after transplantation, 4-14 years) and 10 control subjects (men, n = 7; women, n = 3; mean age, 61.0 +/- 1.8 years). DESIGN: The subjects underwent polygraphic sleep, cardiac, and respiratory recordings during an experimental night. HR was measured during the arousal. HRV was estimated from the R-R intervals in 5-minute stationary segments preceding and following arousal, ie, during SWS and active sleep stage 2 from the first 2 complete NREM-REM sleep cycles. RESULTS: In controls, HR increased during arousal associated with the emergence from SWS during the 2 sleep cycles (P < .05). Sleep-stage-dependent increases of all HRV indexes were observed in the 2 sleep cycles. Concerning CTP, 5 of them displayed a smaller HR increase at arousal, whereas 9 other patients had no HR variation. This distinction between the 2 groups of CTP was confirmed by HRV analysis. The patients with HR reactivity to arousal presented significant sleep-stage-dependent increases in global HRV and sympathetic HRV indexes, whereas the nonreactive group was characterized by an inability of HRV to change with sleep-stage alternation. Sympathetic HRV indexes were significantly higher in the reactive patients than in nonreactive patients, but high frequency power reflecting parasympathetic activity did not differ. However, the absolute HRV indexes were greatly decreased in both groups of patients compared to controls. CONCLUSION: HR reactivity during arousal associated with the emergence from SWS, corroborated by HRV surrounding arousal, may suggest a partial improvement of the sympathetic drive to the heart in some CTP, with no indication of increased parasympathetic activity. Other signs of reinnervation have to be identified to validate this hypothesis.
STUDY OBJECTIVES: To determine the frequency of classical markers of non-rapid eye movement (NREM) parasomnias--hypersynchronous delta sleep (HSD) electroencephalogram waves and sudden arousals from slow-wave sleep (SWS)--in patients without histories of somnambulism or other NREM parasomnias. DESIGN: Retrospective review. SETTING: Sleep disorders center laboratory. PATIENTS: 82 consecutive patients without a history of parasomnias who underwent diagnostic polysomnograms; 57 men and 25 women, mean age 48+/-13.3 years, were included without regard to diagnosis or findings. All patients had at least 30 seconds of stage 3 or 4 sleep during the polysomnogram. MEASUREMENTS AND RESULTS: The primary diagnosis of all but 4 patients was obstructive sleep apnea (mean respiratory disturbance index, 30 +/- 23.6 [range, 2.7-117] per hour of sleep). Polysomnograms were then reviewed for the presence of HSD and SWS arousals. A total of 235 arousals (mean, 2.9 +/- 2.7; range, 0-14) from stage 3 or 4 sleep were noted. Eight-five percent of all patients had at least 1 SWS arousal and 45% had 3 or more SWS arousals; 85.1% of all arousals from SWS were secondary to sleep-disordered breathing, and 5.9% were secondary to leg movements. At least 1 episode of HSD (mean, 1.4 +/- 1.6; range, 0-9) was noted in 65.8% of patients. CONCLUSIONS: HSD and SWS arousals were a common finding in patients without clinical histories of sleepwalking or other parasomnias but who were found to have frequent respiratory-related arousals during sleep. HSD and SWS arousals thus have a low specificity for NREM parasomnias and, without further research, are not useful for the objective confirmation of parasomnias in clinical evaluations and in the forensic evaluation of sleepwalking as a legal defense.
STUDY OBJECTIVES: Peripheral arterial tonometry (PAT) is a sensitive measure of moment-to-moment changes in sympathetic activity and reliably identifies arousals in adult subjects. We investigated whether PAT events during sleep are associated with visually recognizable electroencephalographic arousals in healthy children and in children with sleep-disordered breathing. DESIGN: Prospective cohort. SETTING: Pediatric Sleep Research Laboratory. PARTICIPANTS: Twenty children with obstructive sleep apnea syndrome, 20 children with mild sleep-disordered breathing, and 20 control children with a mean age of 7.6 +/- 2.6 years (range: 5.7-16.5 years); 53% of children were boys. INTERVENTIONS AND MEASUREMENTS: Polysomnographic evaluation in the sleep laboratory with concomitant recording of PAT. PAT events were defined as attenuations from immediately preceding baseline of 20% to 50% (PAT20) and > 50% (PAT50) for at least 5 seconds and the indexes calculated per hour of sleep time that included good-quality PAT signals. Total PAT index (the sum of PAT20 index and PAT50 index) was also calculated. RESULTS: Total PAT index correlated with total arousal index and spontaneous arousal index (r = 0.55, P < .0001, r = 0.64, P < .001, respectively), especially in the group with obstructive sleep apnea syndrome (r = 0.71, P < .0001). The sensitivity and specificity of PAT for identifying electroencephalographic arousals were 95% and 35%, respectively. The PAT device identified pathologic arousals indexes (> or = 16 per hour) (area under the curve 0.79, P = .002). Thirty-five percent of respiratory events (eg, obstructive apnea or hypopnea) were associated with a visual electroencephalographic arousal, compared to 92% being associated with PAT attenuation events. CONCLUSIONS: Arousals in sleeping children are associated with increased sympathetic discharge, as evidenced by attenuations in PAT signal. However, a significant proportion of PAT attenuations were not accompanied by visual electroencephalographic arousals. Thus, the importance of these autonomic arousals has yet to be explored in association with morbidities related to sleep-disordered breathing and, therefore, PAT technology cannot be recommended as an alternative tool for measuring arousals in children. Nevertheless, these data further support the contention that adult criteria for the measurement for arousals may not be adequate in children.