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[The nocturnal eating syndrome (2 case reports and polysomnography)].

The nocturnal eating syndrome (NES) is a nocturnal sleep disorder caused by repeated awakening and the inability to fall a sleep again unless the patient ingests some food or drinks something. In children the NES is frequent, in adults rather rare and may be associated with various pathological conditions. The latter include in particular somnabulism, periodic movements of the lower extremities, narcolepsy, chronic triazolam intoxication, probably anorexia nervosa, and other eating disorders. The authors submit two case-histories of middle aged women (30 and 37 years old) without disturbances of the day-time eating behaviour, without obvious psychopathology where the symptomatology of NES developed slowly from the age of 14 and 25 years resp. Both patients ate at night small amounts of easily consumed foods which they went to fetch in the kitchen as often as five times per night. Their behaviour was calm and aimed. Usually they did not remember the nocturnal eating. Polysomnographic examination in both patients revealed poor sleep with frequent changes of the sleep stages, with frequent awakenings, in both patients incl. even awakening from deep NREM sleep. The authors conclude that in these two patients NES with somnabulism is involved.

Adult↗

[Ambulatory monitoring of patients with suspected sleep apnea syndrome using a thermistor sensor in comparison with nocturnal polysomnography].

Simple ambulatory monitoring methods can be used in step-by-step diagnosis of sleep apnoea syndrome to differentiate between high-risk and low-risk patients, or to exclude the syndrome for achieving more efficient utilisation of sleep laboratory facilities. The question was whether a new method using a thermistor sensor measuring respiration-conditioned thermal convection at the mouth and nose can reliably record the frequency of apnoea (ambulatory thermistor method = ATM). The study was subdivided into two sections. In phase I the respiratory impulses measured via ATM were polygraphically recorded in 20 patients simultaneously with conventional cardiopulmonary data of nocturnal polygraphy (heart rate, oxygen saturation, thorax and abdominal excursions and oronasal respiratory flow). 40 patients participated in phase II. During a first night the patients slept under ATM in their patient rooms. In the 2nd night nocturnal polygraphy was conducted with the parameters mentioned above; the results of both nights were then compared. Taking 35 phases of apnoea in one night as threshold or baseline value, a sensitivity of 100% and a specificity of 84.6% were attained in phase I, the simultaneous comparison of ATM and nocturnal polygraphy, in the recording of an enhanced nocturnal apnoea frequency by ATM. In phase 2 (1st night ATM, 2nd night polygraphy) ATM also yielded a sensitivity of 100% and a specificity of 76%. When measuring with a borderline value of 70 nocturnal phases of apnoea, ATM yielded a specificity and sensitivity of 100%, in phase 2 a sensitivity of 80.7% and a specificity of 88.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Ambulatory polysomnography using a new programmable amplifier system with on-line digitization of data: technical and clinical findings.

A new system for polysomnographic recording at home is presented. It consists of a 12 to 24-channel amplifier system with direct digitization of the polygraph signals using a portable computer. Sampling frequency, amplification and filter settings can be defined by the user, and the signals are evaluated at bedside. Technical testing proved a high signal/noise ratio, linear amplification and a good signal quality. Clinical testing of the first 100 recordings showed that they were acceptable for conventional sleep scoring in 98 cases. A comparison of two consecutive recordings was done in 9 healthy subjects and 11 patients with rheumatic disorders. Using conventional sleep staging, only a slight "first night effect" (FNE) was demonstrated in the sleep architecture. Power spectral analysis using autoregressive modeling demonstrated only a difference of power between the 2 nights in the beta (14.5-25 Hz) band. In conclusion, the usability and technical advantages make the system very suitable for ambulatory recordings and only a minimal FNE should be considered when results are evaluated.

Adult↗

["Tailored" polysomnography: an alternative method in the assessment of obstructive sleep apnea syndrome].

The conventional study of obstructive sleep apnea syndrome (OSAS) requires two polysomnographic recordings on two different nights, one for diagnosis and the other for determining an effective level of continuous positive airway pressure (CPAP). In this study we examined an alternative method requiring a single night of polysomnographic recording encompassing both diagnostic and treatment functions. In order to obtain recordings of all phases of sleep, as well as recordings taken in supine decubitus position, the duration of polysomnographic readings was individualized ("made to order" polysomnograms). A single-night session was sufficient for diagnosis and for adjusting treatment in most cases. In some cases the night was extended well into the morning hours in an effort to obtain all the necessary data. "Made-to-order" polysomnograms were compared to traditional ones by contrasting breathing parameters (the U of Mann Whitney) and sleep architecture findings for two groups of men diagnosed consecutively of OSAS. Thirty-four patients were studied over two nights (mean age: 50 years; BMI 37 Kg/m2). Forty-six patients (mean age: 49 years; BMI: 38 Kg/m2) were studied in single-night sessions. The differences between the two groups were not significant. For most patients studied in "made to order" sessions, all sleep stages were recorded and readings were taken in supine position. REM sleep was not recorded, however, for 26% of the patients in this group. No significant differences between the double- and single-session groups were found for apnea (51 versus 62), maximum oxygen desaturation (72% versus 75%) and effective CPAP level (9 versus 10 cm H2O). These data suggest that both study methods are equally useful for evaluating OSAS severity and for prescribing effective CPAP treatment. We discuss, however, the need to arrange for two-night studies in the minority of patients for whom no REM sleep recordings become available during a single session.

Humans↗

Unattended home diagnosis and treatment of obstructive sleep apnea without polysomnography.

OBJECTIVE: To test the effectiveness of unattended home monitoring along with automatic titrating continuous positive airway pressure (auto-CPAP) as an acceptable method for diagnosing and prescribing proper CPAP pressure for treatment of patients presenting with classic symptoms of obstructive sleep apnea (OSA). DESIGN: Nonrandomized, prospective case study of 63 patients with a presumptive diagnosis of OSA. SETTING: University hospital and veterans affairs medical center ambulatory sleep disorders clinics. PARTICIPANTS: Fifty-eight men and 5 women were recruited for symptoms of excessive daytime sleepiness, heavy snoring, and witnessed apnea. INTERVENTION: Subjects with 10 or more respiratory events per hour were titrated by automatic, unattended home monitoring to an optimal CPAP pressure. MAIN OUTCOME MEASURES: Number of subjects able to be diagnosed by unattended home monitoring, titrated to optimal CPAP pressure, accepted an auto-CPAP machine for home use, and symptoms improved. RESULTS: Fifty-four (86%) of 63 patients completed sufficient diagnostic studies, and in 45 (83%) of these, a diagnosis of OSA was established. Nine subjects were unable to adjust to the nasal mask for an adequate diagnostic recording, and 9 had fewer than 10 respiratory events per hour. Ten subjects with OSA could not complete a titration study. Thirty-five of the subjects diagnosed with OSA accepted the auto-CPAP machine into their home, while 30 used it for therapy longer than 3 weeks. The estimated cost of performing in-home studies was less than one fourth of the estimated cost for in-laboratory polysomnographic examinations had they been performed. CONCLUSION: Unattended monitoring plus auto-CPAP allows cost-effective diagnosis and CPAP titration of most patients with OSA with straightforward symptoms.

Diagnosis, Differential↗

Polysomnography of torsion dystonia.

Nocturnal EEG, electro-oculograms, and electromyograms were studied in nine patients with dystonia musculorum deformans and in nine healthy controls. Electrodes were placed over frontal, central, and occipital regions in accordance with the international 10-20 system of electrode placement. A standard bipolar montage was used for the recordings, and records were scored independently in accordance with the manual of Rechtschaffen and Kales. All patients were found to sleep poorly. Patients in advanced stages of dystonia all displayed an EEG pattern characterized by pronounced, high-amplitude (greater than 150 microV) spindles that were continuous for all stage 2 and portions of stage 3 sleep. Other sleep parameters were also disturbed. Sleep spindles become less frequent and diminish in amplitude with advancing age. The spindle activity of patients with advanced dystonia presents a stark contrast to this pattern and may underscore their clinical significance.

Adolescent↗

How much polysomnography is enough?

Sleep studies combined with the analysis of autonomic functions are, in several cases, necessary in order to make an accurate diagnosis. Polysomnograms require minimal technical equipment, the absence of which may cause the data obtained to be unreliable.

Humans↗

Polysomnography in locked-in syndrome.

Sleep patterns were evaluated in a case of 'locked-in' syndrome. This patient had an ischemic infarction involving the ventral portion of the upper half of the pons bilaterally, with a posteromedial extension into the tegmentum. Reticular structures, notably the median raphe nuclei, supposed to play a major regulatory role in sleep, were most probably involved. Unexpectedly, repeated polysomnographic studies revealed sleep patterns with only minor abnormalities.

Electroencephalography↗

Polysomnography--functional topographical examination of the basal ganglia.

Polysomnographical examinations were performed on two cases with unilateral lesion in the basal ganglia. One (case 1) was a 10-year-old girl with tuberous sclerosis with subependymal nodules on the left thalamostriatal sulcus and rotatory seizures, and pharmacologically the existence of a postsynaptic supersensitivity of the dopaminergic (DA) neurons, was suggested. The other (case 2) was an 8-year-old boy with infarction of the left putamen. Two types of body movements (BMs); gross movements (GM) and twitch movements (TM), were evaluated. The mode of occurrence of these BMs against each sleep stage, the pattern of BMs, and the ratio of the number of TM in the mentalis muscle in stage REM against the number of rapid eye movements (REMs) (ment TM REM/REMs) were estimated. The modulation of these parameters by L-Dopa and pimozide was studied. The pattern of GM reflected the DA activity of the side of the lesion. TM of the contralateral side reflected the pathophysiology of the lesion. TM of the ipsilateral extremities of case 1 showed the pattern of DA hyperactivity, which were reduced by small doses of L-Dopa. In case 2, TM of the ipsilateral extremities showed a normal pattern and rate, which increased markedly after L-Dopa. The TM of the sternocleidomastoideus revealed abnormal ipsilaterally in case 1 and contralaterally in case 2. The ment TM REM/REMs ratio reflected the real function of the DA neurons and did not reflect their hyperfunction due to postsynaptic supersensitivity. The numbers and direction of REMs might reflect the function of the basal ganglia, particularly of the DA neurons.

Basal Ganglia↗

[Anamnesis and polysomnography in patients who snore and in obstructive apnea syndrome: a comparative study in 140 patients].

Results of a questionnaire comprising 23 questions concerning general data, snoring, and daytime sleepiness were compared with polysomnographic data. 140 consecutive patients, 89 of them chronic snorers and 51 with obstructive sleep apnea syndrome (OSAS) were included in the study. The results show that ten questions, four about snoring and six about daytime sleepiness, are sufficient cause to suspect of OSAS in a snoring patient. This patient should be diagnosed and treated immediately.

Age Factors↗