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Results for “Sleep Paralysis”

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At least 559 records · Page 31Linked to original sources
PubMed1983

beta-Endorphin plasma levels during neuromuscular blockade in unanesthetized cat.

Plasma concentrations of beta-endorphin were measured by radioimmunoassay in cats prepared chronically for sleep-waking polygraphic recordings and blood collection. beta-Endorphin (beta-END) levels were found to be stable in baseline conditions and were used as an index of stress. After habituation of each cat to experimental conditions in a veterinary pouch with head restraint, this partial restraint (45 min) or a short-lasting paralysis (30 min) induced by gallamine triethiodide did not significantly elevate plasma concentrations of beta-END. In contrast, hypoxia, ether-induced stress or tight immobilization of the limbs promoted a 7--8-fold increase in beta-END plasma levels. Sleep-waking patterns were not significantly different in restrained and paralyzed conditions. It is concluded that short-lasting paralysis induced in habituated animals by curarizing agents is not accompanied by a significant neuroendocrine response if all possible sources of pain are carefully avoided.

Animals↗
PubMed1977

The assessment of diaphragm function.

Paralysis or severe weakness of the diaphragm (the principal muscle of inspiration) is commonly associated with hypoventilation which may be profound during sleep, but the disorder is often unrecognized. The clinical sign of paradoxical (inward) movement of the abdominal wall during spontaneous inspiration in the supine posture may be overlooked, or the appearances at fluoroscopy may mislead, for it is not generally appreciated that descent of the diaphragm in early inspiration in these patients may be an entirely passive event. Measurement of transdiaphragmatic pressure is a simple, reliable and quantitative means of assessing diaphragm function, and will aid in the diagnosis of diaphragm paralysis which has important implications for clinical management.

Diaphragm↗
PubMed1993

[Idiopathic bilateral paralysis of the diaphragm].

The case of a 38-year old Caucasian man with acute irreversible idiopathic bilateral paralysis of the diaphragm is presented. The relevant diagnostic procedures are discussed. Paralysis of diaphragm during fluoroscopy in the supine position, observation of paradoxical movement of the anterior abdominal wall and upright position during sleep are the major characteristics of this condition. Elevation of both hemidiaphragms on thoracic X-ray during maximal inspiration, lack of phrenic nerve conduction, gradually increasing dyspnoea without ongoing infection or simultaneous vaccination and decreased functional status may further confirm the diagnosis.

Adult↗
PubMed2000

Sleep-related breathing disorders in acute respiratory failure assisted by non-invasive ventilatory treatment: utility of portable polysomnographic system.

In the majority of patients admitted to an Intensive Care Unit with acute respiratory failure (ARF), the aetiology for ARF is quite evident. In a minority of patients no obvious aetiology is apparent at presentation. In this group a previously unrecognized sleep-related breathing disorder (SRBD) may be the cause of the ARF. In spite of clinical suspicion SRBD remains infrequently diagnosed in ARF also because the technology necessary for this type of diagnosis (polysomnography) is usually unavailable in Intensive Care Units. The aim of this study was to evaluate the utility of portable polysomnography system (PSGp) in a group of patients with ARF of unclear aetiology and with a clinical suspicion of SRBD. We studied a selected group of 14 patients (eight males, six females) admitted to an Intermediate Intensive care unit with varying degree of acute respiratory failure. Mean (SD) age was 57 (13) years, pH 7.28 (0.04), PaO2 5.6 (0.7) kPa), PaO2 (8.8 (1.6) kPa), Body mass index 42.7 (9.6) kg m(-2). The patients had no history of skeletal, neuromuscular or cardiovascular disease. None of them had a history of overt chronic lung diseases or had obvious respiratory tract infections. They were submitted to cardiac and respiratory functional evaluation and to nightly PSGp (VITALOG HMS 5000, Respironics Inc., Redwood City, CA, U.S.A.) which was performed in an intermediate intensive care unit. Ten subjects had obstructive sleep apnoea-hypopnoea syndrome (OSAS), with mean respiratory disorder index h(-1) (RDI) 60.1 (25.9) [in five associated with obesity-hypoventilation syndrome (OHS)]; two had central sleep apnoea with mean RDI 45 (28.3) (one with hypothyroidism and one with cerebral multiple infarctions and right hemidiaphragmatic paralysis) and two had OHS with mean RDI 12.5 (3.5). Nocturnal hypoventilation was present in almost all patients. Continuous positive airway pressure (CPAP) was effective in three patients. Eight patients needed to be treated with BILEVEL (BiPAP, Respironics Inc.) airway positive pressure in timed or spontaneous/timed modes. Two patients required intubation and mechanical ventilatory treatment. In one patient with hypothyroidism was sufficient to institute hormonal therapy. Our study shows that acute respiratory failure due to SRBD is not exceptional in an Intermediate Intensive Care Unit and that if clinical suspicion is strong, portable polysomnography may yield diagnostic confirmation and help in establishing appropriate treatment and in avoiding the invasive ventilatory treatment.

Aged↗
PubMedDate not supplied

[Prolonged artificial ventilation of the lungs in nervous system diseases].

Artificial ventilation of the lungs (AVL) has been carried out for many years in 25 patients with nervous diseases. Spontaneous respiration ceased because of peripheral neuron involvement in malignant myasthenia (5 cases), chronic polyneuropathy (1), paralysis of motor muscles after poliomyelitis (1), amyotrophic lateral sclerosis (11), spinopontocerebellar atrophy (1), and because of the central neuron involvement in 5 patients, 3 of these with the apnea syndrome during sleeping caused by syringobulbomyelia, atrophic process in the cerebellum and stem, and Arnold-Chiari's syndrome, and 2 with an extensive infarction in the pons (deefferentiation or locked-in syndrome). AVL was the longest in patients with paralysis of the motor muscles following acute poliomyelitis (23 years) and with amyotrophic lateral sclerosis (about 14 years). Prolonged AVL is possible in malignant myasthenia, but it may be discontinued during obligatory specific treatment. Specific features of many-year AVL, somatic functions and metabolic disorders associated with it are described.

Adolescent↗
PubMed2002

Factor structure of the Cornell Scale for Depression in Dementia among Japanese poststroke patients.

BACKGROUND: the present study reports on the first translation and use of the Cornell Scale for Depression in Dementia (CSDD) (Alexopoulos, Abrams, Young, & Shamoian, 1988) among poststroke patients (n = 101) in Japan. OBJECTIVES: the study had three main purposes: 1. To examine the factor structure of the CSDD among Japanese poststroke patients; 2. To compare this with the factor structure identified for Anglo-American Alzheimer's (AD) patients; and 3. To examine the prevalence and covariates of depressive symptoms among the Japanese stroke survivors. METHODS: poststroke patients and their caregivers (n = 202), at a random sample of neurological hospitals in western Japan, were interviewed using the study instruments. Data was also collected from patient charts. All subjects at each site who met the study criteria participated in the study. RESULTS: the four-factor solution for poststroke subjects was analogous to that found among AD patients with 2 main exceptions. In contrast to AD patients: 1. Physical complaints were unrelated to depressed mood in stroke patients; and 2. Agitation and psychosis loaded with depressed mood in stroke patients rather than as a separate unique factor as in AD patients. However, in the exploratory 5-factor model, agitation and suicidal ideation comprised a unique factor. Using standard cutoff scores for the CSDD, 58.2% of poststroke patients had scores suggesting possible depression. CSDD scores were not related to functional ability, or stroke characteristics such as aphasia or right or left-sided paralysis. However, scores were significantly higher among subjects < or = 2 years poststroke. Feelings of irritability, anxiety, sadness, and sleep problems were most prevalent. DISCUSSION: despite the prevalence of depressive symptoms, none of the subjects were currently receiving any mental health treatment. Findings suggest that symptoms differ by poststroke duration, which may necessitate different treatment approaches.

Aged↗
PubMed2002

Unaided speech in tube-free tracheostomy: The supplementary sling procedure.

OBJECTIVE: In some patients after tube-free tracheostomy, air escape hinders voice optimization. Our objective was to determine whether a supplementary sling procedure could reduce air escape and improve unaided speech and cough in these patients. STUDY DESIGN AND SETTING: From September 1998 through June 2001, 12 patients underwent supplementary sling procedures at the Cleveland Clinic. After surgery, stoma constriction and voice production were assessed. RESULTS: Fifteen procedures were performed in 12 patients. Two patients required revision procedures. All 9 patients with sufficient follow-up have markedly improved stoma constriction and speech production. Three patients with less than 3 months' follow-up already show early improvement. CONCLUSION: The supplementary sling procedure effectively reduces air escape and helps unaided speech and cough in patients with tube-free tracheostomata. SIGNIFICANCE: As more patients undergo tube-free tracheostomy, the pool of patients who might benefit from a sling procedure will grow. Indications might extend to postlaryngectomy or post-laryngeal transplant patients.

Adult↗
PubMed1989

[Bilateral abductor vocal cord paralysis (Gerhardt syndrome) in the Shy-Drager syndrome].

Ten consecutive patients with a progressive pan-autonomic failure of the Shy-Drager syndrome were investigated. Movement disorders of the vocal cords were examined with a fiber-optic laryngoscope as well as a video-recorder. Moderate to severe vocal cord paralysis was present in five of ten patients. The vocal cords were almost immobile during inspiration, while there was no limitation of the adduction during phonation. In two cases, grade of vocal cord paralysis was asymmetric. One patient developed peculiar twisting-like dystonic movements of the vocal cord. Polygraphic studies revealed that SaO2 was lowered in spite of tachypnea during sleep. In two cases, the expiratory flow volume curve in effort-dependent portion near TLC showed a plateau and the inspiratory part of the curve also showed a plateau indicating constant flow. These functional disorders suggest an upper airway obstruction probably due to the vocal cord dysfunction. There was no vocal cord paralysis in two patients who had neither snore nor stridor. Development of a severe vocal cord dysfunction usually manifested itself clinically as stridor, snore or respiratory failure requiring tracheostomy. There was little information on the pathology of the vagal nerves and nuclei supplying motor control to the laryngeal muscles. The mechanism of the selective involvement of abductor muscle (posterior muscle) of the vocal cord (Gerhardt syndrome) remains unsolved. Vocal cord paralysis should be looked for since it can result in respiratory failure leading to death.

Adult↗
PubMed1987

The sudden infant death syndrome induced by "the fear paralysis reflex'?

The sudden infant death syndrome (SIDS) is the greatest single cause of death between one month and one year of age in industrial countries. Its etiology still remains a mystery despite extensive research during the past decades. The outstanding problem is to define the trigger mechanism leading to death. Most theories have dealt with bodily malfunctions, infections and toxic agents, and only minor attention has been paid to a possible psychical trigger mechanism. The hypothesis is advanced that the so-called 'fear paralysis reflex' (for other terms, see below), an atavistic reflex present in the entire animal kingdom, may be a major trigger mechanism for SIDS. The reflex is evoked by fear resulting from any threatening event which is perceived as a danger, and with which the organism is unable to cope, typically in a predator confrontation. Important threatening stimuli in animals, and which may be of particular importance in human infants, are restraint of movement, sudden and unfamiliar noises, separation from the mother and companions, and sudden exposure to an unfamiliar environment. The main response characteristics are an immediate motor 'paralysis' (prolonged and generalized immobility), unresponsiveness, and abrupt and profound bradycardia. The latter may proceed to asystole and fatal cardiac arrythmias. Any hypothesis attempting to explain the cause of SIDS must account for the unique age distribution of SIDS' victims with a peak age incidence at 2-4 months, its frequent occurrence in REM sleep, and the observation that most deaths are silent. Further, it must be consistent with previously established risk factors (genetic determination, opiate-addicted mothers and cigarette smoking). The fear paralysis hypothesis is in accordance with all these facts, and it suggests new and potentially hazardous triggering mechanisms which, one recognized, possibly can be avoided. As a central reflex, it does not leave any trace in the organism, which explains the negative postmortem findings. Suggestions for testing the hypothesis are given, and possible preventive measures are presented.

Age Factors↗
PubMed1988

Recovery from Gz-induced loss of consciousness: psychophysiologic considerations.

Eight healthy male volunteer members of the USAFSAM acceleration panel were exposed to two consecutive acceleration runs of +1 Gz to +7 Gz at 6 G.s-1 onset rates. The subjects were instructed to relax during the acceleration exposure in order to voluntarily induce loss of consciousness (LOC). The subjects were asked to relate dreams, thoughts, or other mental illusions experienced during G-LOC episodes. Most subjects were amused and surprised, as well as interested in, relating their experience, although they were embarrassed about the G-LOC episode itself. Early post-G-LOC transient paralysis, as well as late LOC myoclonic (flailing) movements, were evident. Heart-rate response to the acceleratory stress was uneventful; maximum heart rate occurred 3.2 s after the onset of LOC. The study of dreams during normal sleep stages has been reviewed by many investigators, but this research has not extended to acceleration/hypoxic types of unconsciousness where dreams also seem to occur. G-LOC dream-state analysis, post-G-LOC paralysis, and their possible repercussions upon performance and incapacitation periods should be investigated, not only as curious events, but as operationally important and psychophysiologically significant.

Acceleration↗
PubMed1996

Carbamazepine as a treatment for cataplexy.

Cataplexy is a common symptom associated with narcolepsy. We evaluated a 51-year-old female who developed symptoms of progressive daytime sleepiness with cataplexy. The diagnosis of narcolepsy was confirmed by overnight polysomnogram and was consistent with results of a multiple sleep latency study, and episodes of cataplexy were documented by video-EEG-EMG monitoring. Examination during a catapletic episode was significant for areflexia and paralysis. The frequency of cataplexy increased with fluoxetine, protriptyline and sertraline and the patient developed frank choreiform movements with protriptyline and sertraline. The cataplexy resolved following treatment with carbamazepine. We feel carbamazepine is a potential treatment for patients with refractory cataplexy.

Anticonvulsants↗
PubMed1976

Diaphragm function and alveolar hypoventilation.

A syndrome of alveolar hypoventilation has been identified in a group of patients with bilateral diaphragm paralysis. Eight patients were studied in whom diaphragm weakness had been suggested by paradoxical (inward) movement of the abdominal wall on inspiration, of whom seven had evidence of a generalized neuromuscular disorder. Diaphragm function was assessed quantitatively by measurement of the change in transdiaphragmatic pressure during a maximum inspiration (deltaPDi). In five patients, deltaPDi was zero and in the others ranged from 2-6 cm H2O (normal greater than 25 cm H2O) indicating paralysis and severe weakness in the respective groups. Fluoroscopy of the diaphragm was found to give misleading results, and the resons for this are considered. Vital capacity ranged from 65-30 per cent of the predicted normal in the upright posture, typically falling by about a half in the supine posture. Alveolar hypoventilation was present in five patients when supine and in six when asleep, the deterioration in blood gases associated with sleep generally being much greater in these patients than in normal subjects. Respiratory rate was significantly greater than age-matched controls. The ventilatory response to CO2 was impaired. The PCO2 could be brought to normal levels by voluntary hyperventilation, and the unreliability of voluntary respiratory manoeuvres of this kind as indices of ventilatory reserve is emphasized. Alveolar hypoventilation was associated with disturbed sleep, morning headache and day-time fatigue. Symptomatic benefit was achieved by the use of a cuirass respirator at night.

Adult↗
PubMed1999

Genetic factors in human sleep disorders with special reference to Norrie disease, Prader-Willi syndrome and Moebius syndrome.

Sleep-wake problems are common in specific inborn errors of metabolism and structure of the central nervous system. Psychological factors, behavioural difficulties, metabolic disturbances, and widespread rather than focal damage to the nervous system are present in many of these diseases and all influence the sleep-wake cycle. However, a number of conditions cause relatively focal damage to the neuroanatomical substrate of sleeping and waking. These include fatal familial insomnia, with involvement of the prion protein gene on chromosome 20, Norrie disease, the Prader-Willi syndrome and the Moebius syndrome. The last three important conditions, although rare, are considered in detail in this review. They result in sensory deprivation, hypothalamic and mid-brain damage, and involve the X-chromosome, chromosome 15, and chromosome 13, respectively. These conditions cause a wide variety of sleep disturbance, including parasomnias, daytime sleepiness, and a condition like cataplexy. The place of the relevant gene products in normal sleep regulation needs further exploration.

Adolescent↗
PubMed1988

Diaphragmatic movement in newborn infants.

Axial movement of the right hemidiaphragm during tidal breathing was recorded using real-time ultrasonography in 46 healthy term infants. Displacement was 2.6 +/- 0.1, 3.6 +/- 0.2, and 4.5 +/- 0.2 mm (mean +/- SEM) for the anterior, middle, and posterior thirds, respectively. Diaphragmatic movement was significantly greater in the middle and posterior segments than in the anterior segment (P less than 0.0001). Excursion of the diaphragm was similar in sleeping and awake infants, and during quiet and active sleep, as identified by behavioral criteria. Diaphragmatic movement was also assessed in nine infants who required mechanical ventilation and pharmacologic paralysis because of respiratory disease. In these infants, axial movement of the right hemidiaphragm was less in the middle and posterior thirds (P less than 0.05 and P less than 0.01, respectively) than in spontaneously breathing infants, and posterior movement was not predominant. Normative data for axial diaphragmatic movement may be of clinical value in the assessment of defects of the diaphragm, rib cage, or abdomen in newborn infants and may allow further understanding of the direct effects of therapeutic interventions on the respiratory system in infancy.

Diaphragm↗