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PubMedDate not supplied

Effects of a 25-h sleep deprivation on daytime sleep in the middle-aged.

Our understanding of the mechanisms by which sleep deteriorates with age almost exclusively stems from comparisons of young and elderly subjects. The present study investigated the different effects of a 25-h sleep deprivation on the recovery sleep initiated in the morning (when circadian sleep propensity decreases) of young (20-39 y) and middle-aged subjects (40-60 y). Middle-aged subjects showed a steeper increase in the duration of wakefulness during daytime recovery sleep than the young subjects. Slow-wave sleep (SWS) and EEG slow-wave activity (SWA: spectral power between 0.5-4.5 Hz) were potentiated in both groups following sleep deprivation. However, the rebound of SWS and SWA was significantly less pronounced in the middle-aged than in the young. This reduction in homeostatic recuperative drive in middle-aged subjects might account for the decrease in their ability to maintain sleep when they have to recuperate at an abnormal circadian phase. These results helps to understand the increase in complaints related to shift work and jet lag in the middle years of life.

Adult↗
PubMed1988

Sleep apnea and body position during sleep.

In patients with obstructive sleep apnea, it is believed that body position influences apnea frequency. Sleeping in the lateral decubitus position often results in significantly fewer apneas, and some have recommended sleeping on the side as the major treatment intervention. Previous studies, although calculating apnea-hypopnea index (AHI) for supine and lateral decubitus positions, have not taken sleep stage into account. To examine the effect of both sleep stage and body position on apnea duration (AD) and frequency, we determined AHI and AD in all spontaneous body positions during rapid eye movement (REM) and non-REM (NREM) sleep by reviewing videotapes and polysomnograms from 11 overnight studies of 7 obese patients with severe sleep apnea. Consistent with previous work, AD was significantly longer in REM then in NREM (32.5 +/- 2.3 s versus 23.5 +/- 1.9 s; p less than 0.05). This difference persisted when adjusting for body position. AHI was greater on the back than on the sides (84.4 +/- 4.9/h versus 73.6 +/- 7.5/h, p less than 0.05), but after accounting for sleep stage, this difference remained only for NREM (103 +/- 4.8/h versus 80.3 +/- 9.2/h, p less than 0.05) and not for REM (83.6 +/- 5.3/h versus 71.1 +/- 4.2/h, p NS). Although reduced, AHI on the sides still remained clinically very high. Body position changed frequently throughout the night, but some patients spent little or no time on their back. We conclude that AD is longer in REM than NREM, regardless of position, and AHI is higher on the back only in NREM. As AHI remains very high on the sides, favoring the lateral decubitus position may not be as beneficial as previously thought in very obese patients. Less obese patients are more likely to benefit by position changes.

Adult↗
PubMed1996

Sleep fragmentation in obstructive sleep apnea.

Obstructive sleep apnea is associated with fragmentation of sleep due to the repeated occurrence of end-apneic arousal throughout the night. Arousals are provoked by stimuli generated during upper airway obstruction. Mechanoreceptor stimuli produced during obstructed inspiratory efforts appear to play a major role in mediating the end-apneic arousal response. The sleep disruption resulting from repeated arousals plays a major role in the pathogenesis of most of the consequences of OSA (i.e. neuropsychiatric, respiratory, and cardiovascular) and may contribute to the progression of OSA severity. However, the relative contribution of sleep fragmentation versus hypoxia in producing these complications and the precise mechanisms require further studies to be elucidated. A recently developed animal model of long-term repeated airway occlusion during sleep and a modification of the model to produce isolated sleep fragmentation should provide important new insights in this field. Treatment of the sleep disruption owing to OSA is achieved by minimizing the occurrence of arousal-promoting stimuli. This is obtained by maintaining upper airway patency during sleep.

Airway Obstruction↗
PubMed2006

Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration.

INTRODUCTION: The influence of sleeping position on obstructive sleep apnea severity is well established. However, in central sleep apnea with Cheyne Stokes respiration (CSA-CSR) in which respiratory-control instability plays a major pathophysiologic role, the effect of position is less clear. STUDY OBJECTIVES: To examine the influence of position on CSA-CSR severity as well as central and mixed apnea frequency. METHODS: Polysomnograms with digitized video surveillance of 20 consecutive patients with heart failure and CSA-CSR were analyzed for total apnea-hypopnea index, mean event duration, and mean oxygen desaturation according to sleep stage and position. Position effects on mixed and central apnea index, mean apnea duration, and mean desaturation were also examined in non-rapid eye movement sleep. RESULTS: Data are presented as mean +/- SEM unless otherwise indicated. Group age was 59.9 +/- 2.3 years, and total apnea-hypopnea index was 26.4 +/- 3.0 events per hour. Compared with supine position, lateral position reduced the apnea-hypopnea index in all sleep stages (Stage 1, 54.7 +/- 4.2 events per hour vs 27.2 +/- 4.1 events per hour [p < .001]; Stage 2, 43.3 +/- 6.1 events per hour vs 14.4 +/- 3.6 events per hour [p < .001]; slow-wave sleep, 15.9 +/- 6.4 events per hour vs 5.4 +/- 2.9 events per hour [p < .01]; rapid eye movement sleep, 38.0 +/- 7.3 events per hour vs 11.0 +/- 3.0 events per hour [p < .001]). Lateral position attenuated apnea and hypopnea associated desaturation (supine 4.7% +/- 0.3%, lateral 3.0% +/- 0.4%; p < .001) with no difference in event duration (supine 25.7 +/- 2.8 seconds, lateral 26.9 +/- 3.4 seconds; p = .921). Mixed apneas were longer than central (29.1 +/- 2.1 seconds and 19.3 +/- 1.1 seconds; p < .001) and produced greater desaturation (6.1% +/- 0.5% and 4.5% +/- 0.5%, p = .003). Lateral position decreased desaturation independent of apnea type (supine 5.4% +/- 0.5%, lateral 3.9% < or = 0.4%; p = .003). CONCLUSIONS: Lateral position attenuates severity of CSA-CSR. This effect is independent of postural effects on the upper airway and is likely to be due to changes in pulmonary oxygen stores. Further studies are required to investigate mechanisms involved.

Adult↗
PubMed1998

Involvement of stress in the sleep rebound mechanism induced by sleep deprivation in the rat: use of alpha-helical CRH (9-41).

A previous study demonstrated the efficacy of the corticotropin-releasing hormone (CRH) receptor antagonist, alpha-helical CRH (9-41), in blocking the paradoxical sleep increase induced by stress. In the present study, this peptide was used to evaluate the involvement of the stress component of the sleep deprivation, in the paradoxical sleep rebound. Rats were subjected for 10 h to the classical water-tank sleep-deprivation technique and were given, every 2 h throughout the sleep deprivation period, intracerebroventricular injections of either 100 microg/5 microl of alpha-helical CRH (9-41) or vehicle alone. Continuous recordings showed that antagonist treatment decreased the PS rebound, but not the SWS rebound, following sleep deprivation. These findings suggest that, in the water-tank sleep deprivation method, stress, acting via CRH activation, is the main factor inducing the paradoxical sleep rebound.

Animals↗
PubMed1991

Sleep patterns and sleep problems amongst people with mental handicap.

This paper is in two parts. The first part reviews the available literature describing sleep patterns of people with mental handicap and the nature and prevalence of sleep disorders amongst this client group. Both electroencephalographic studies and informant-based reports are included. The literature is small, particularly in terms of the latter reports, and most of the information from both E.E.G. and informant sources describes populations of children with mental handicap. The need for further investigation of sleep and sleep problems, particularly amongst adults with mental handicap, therefore, becomes evident. The second part presents the results of a detailed sleep survey of 120 adults with mental handicap, approximately half of whom were resident in hospital and half in the community. A descriptive summary of the total sample is provided. Fifteen per cent of the sample presented significant sleep problems, particularly in the form of intermittent wakenings. The results of comparisons between (1) good and poor sleepers (2) hospital and community residents and (3) people with mental handicap and 'normal' adults (using data from another study) are then presented. The relationships between sleep and daytime functioning and the potential usefulness of behavioural approaches to management of sleep pattern are discussed.

Adult↗
PubMed2005

Sleep tendency during extended wakefulness: insights into adolescent sleep regulation and behavior.

Sleep tendency (latency to sleep onset) was examined during extended waking in prepubertal and mature adolescents to determine whether sleep pressure is lower near bedtime in the latter group. Participants were nine prepubertal (pubertal stage Tanner 1, mean age 11.1 years, SD+/-1.3 years, five males) and 11 pubertally mature adolescents (Tanner 5, 13.9+/-1.2 years, three males). They spent 10 nights at home on an identical fixed 10-h sleep schedule followed by a 36-h constant routine with sleep latency tests at 2-h intervals using standard polysomnography. Saliva was collected to assess dim-light melatonin onset (DLMO) phase. DLMO was earlier in the Tanner 1 (mean clock time=20:33 hours, SD=49 min) than Tanner 5 group (21:29 hours+/-42 min). Sleep latency compared at a 'critical period' spanning 12.5 (20:30 hours clock time) to 18.5 h (02:30 hours) after waking did not differ at 20:30 hours, but was shorter for the Tanner 1 group at 22:30 hours (Tanner 1=9.2+/-6.3 min; Tanner 5=15.7+/-5.8 min), 00:30 hours (Tanner 1=3.6+/-1.7 min; Tanner 5=9.0+/-6.4 min), and 02:30 hours (Tanner 1=2.0+/-1.7 min; Tanner 5=4.3+/-3.2 min; trend). These differences were apparent controlling for circadian phase by partial correlation. Sleep tendency after 14.5, 16.5, and 18.5 h awake was lower in mature versus prepubertal adolescents, supporting our hypothesis that a developmental change of intrinsic sleep-wake regulation may provide physiologically mediated 'permission' for later bedtimes in older adolescents.

Adolescent↗
PubMed1989

Effects of sleep deprivation on respiratory events during sleep in healthy infants.

This study was designed to determine the effects of sleep deprivation on respiratory events during sleep in healthy infants. Ten unsedated full-term infants (1-6 mo) were monitored polygraphically during "afternoon naps" on a control day and on the day after sleep deprivation. Respiratory events, i.e., central apnea, obstructive apnea and hypopnea, and periodic breathing were tabulated. Results for respiratory events were expressed as 1) indexes of the total number of respiratory events and of specific respiratory events per hour of total sleep (TST), "quiet" sleep (QS) and "active" sleep (AS) times; 2) total duration of total and specific respiratory events, expressed as a percentage of TST, QS, and AS times. After sleep deprivation, significant increases were observed for 1) respiratory event (P less than 0.001), central apnea (P less than 0.05), and obstructive respiratory event (P less than 0.01) indexes; 2) respiratory event time as a percentage of TST (P less than 0.002) and as a percentage of AS time (P less than 0.001); 3) obstructive respiratory event time as a percentage of TST (P less than 0.01), QS (P less than 0.05), and AS times (P less than 0.002). The present study shows that short-term sleep deprivation in healthy infants increases the number and timing of respiratory events, especially obstructive events in AS.

Female↗
PubMed1992

Effects of delta sleep-inducing peptide on sleep of chronic insomniac patients. A double-blind study.

The influence of delta sleep-inducing peptide (DSIP) on sleep was studied in 16 chronic insomniac patients according to a double-blind matched-pairs parallel-groups design. Subjects slept for 5 consecutive nights in the laboratory. Night 1 was used for adaptation, night 2 for baseline measurements. In the afternoon before the 3rd, 4th and 5th night, half of the patients received intravenously 25 nmol/kg body weight DSIP, and half of the patients a glucose solution (placebo). Measures for sleep structure, objective (polysomnography) and subjective sleep quality and for subjective tiredness were assessed. The results for objective sleep quality indicated higher sleep efficiency and shorter sleep latency with DSIP as compared to placebo. One measure of subjectively estimated tiredness decreased within the DSIP group. Data analysis suggested, however, that the statistically significant effects were weak and in part could be due to an incidental change in the placebo group. As none of the other measures, including subjective sleep quality, showed any change, it was concluded that short-term treatment of chronic insomnia with DSIP is not likely to be of major therapeutic benefit.

Adult↗
PubMed1997

Effect of obstructive sleep apnea versus sleep fragmentation on responses to airway occlusion.

Although the acute physiologic responses to apnea in patients with obstructive sleep apnea (OSA) have been well documented, the changes in these responses over the course of the disease have not been investigated. The purpose of this study was to use a canine model of OSA to examine the long-term effects of sleep apnea on the acute responses to airway occlusion during sleep. Four dogs were studied during a control period before induction of OSA, during a period of OSA (83-133 d), and following cessation of OSA. At least 6 mo after completion of the OSA protocol, the dogs were re-studied on a sleep fragmentation protocol (30-60 d) to determine the impact of a similar degree of sleep disruption, without OSA, on the acute responses to airway occlusion. OSA and sleep fragmentation both resulted in lengthening of the time to arousal in response to acute airway occlusion (p < 0.02) and in greater arterial oxygen desaturation (p < 0.05), peak inspiratory pressures (p < 0.003), and surges in maximum systolic and diastolic blood pressure during airway occlusion (p < 0.01). There were no differences between the changes observed during OSA and during sleep fragmentation. We conclude that the changes in the acute responses to airway occlusion resulting from OSA are primarily the result of the associated sleep fragmentation.

Airway Obstruction↗
PubMed1975

Plasma growth hormone and slow wave sleep increase after interruption of sleep.

A comparison was made of plasma hGH and of sleep stages during one night of undistrubed sleep and one night in which sleep was interupted by an hour of enforced wakefulness folowing the end of the second NREM-REM sleep cycle in 8 normal subjects. Plasma was sampled at 15-min intervals. HGH and slow wave sleep were both significantly increased in the two cycles immediately following the period awake compared with the same two cycles during nights of uninterruped sleep. The difference arose predominantly in the fourth cycle of the night, i.e., in the second cycle after the sleep interuption. The findings are consistent with the belief that extra wakefulness brings additional sleep of high RESTORATIVE properties.

Adult↗
PubMed1997

Respiratory effort during obstructive sleep apnea: role of age and sleep state.

OBJECTIVE: To evaluate the patients' individual characteristics predictive of the degree of respiratory effort developed during obstructive sleep apneas (OSAs). DESIGN: Prospective consecutive sample, collection of clinical and polysomnographic data. SETTING: University teaching hospital. PATIENTS: One hundred sixteen consecutive OSA patients with clinical symptoms of OSA and more than 20 apneas per hour of sleep. MEASUREMENTS: Anthropomorphic data, daytime blood gas values, and polysomnographic data. From esophageal pressure measurements during sleep, three indexes of respiratory effort during OSAs were derived: the maximal end-apneic esophageal pressure swing (PesMax), the increase in esophageal pressure swing (deltaPes) during the apnea, and its ratio to apnea duration (RPes). RESULTS: The indexes of respiratory effort were significantly lower in rapid eye movement (REM) than in non-REM sleep (PesMax: 50.9+/-2.5 vs 39.6+/-1.9 cm H2O, p<0.001; deltaPes: 30.9+/-1.7 vs 23.4+/-1.4 cm H2O, p<0.001; RPes: 1.05+/-0.05 vs 0.53+/-0.03 cm H2O/s, p<0.001); therefore, a separate analysis was conducted in non-REM and in REM sleep. Indexes were also significantly lower in subgroups of older as compared to younger patients (PesMax: 55.6+/-3.5 vs 40.0+/-2.2 cm H2O, p<0.001; deltaPes: 34.2+/-2.3 vs 24.1+/-1.6 cm H2O, p=0.001; RPes: 1.21+/-0.08 vs 0.8+/-0.05 cm H2O/s, p<0.001). The three indexes were closely correlated with each other and only PesMax correlation data are reported. In non-REM sleep, age was the most important single independent correlate of PesMax (r=-0.37, p=0.000). In REM sleep, the apnea-related hypoxemia, apnea duration, and age were the main contributors to the variance of PesMax. CONCLUSIONS: Respiratory effort in response to upper airway occlusion in OSA patients is lower in REM than in non-REM sleep and decreases with increasing age.

Adult↗
PubMed1998

The relation between multiple sleep latency test findings and the frequency of apneic events in REM and non-REM sleep.

STUDY OBJECTIVES: A recent study of 34 patients with mild obstructive sleep apnea syndrome (OSAS) suggested that the number of apneas and hypopneas per hour of sleep (apnea/hypopnea index [AHI]) may show a stronger correlation with sleepiness, as measured by the Multiple Sleep Latency Test (MSLT), when calculated for rapid eye movement (REM) sleep alone (AHIR) as opposed to the entire night. We sought to reexamine this possibility in a larger group of similar patients and in patients who had a wider range of OSAS severity. DESIGN: Retrospective and observational. SETTING: A large, accredited, academic sleep disorders center where a database of sleep study results is maintained. PATIENTS: We studied 1,146 persons who had polysomnography and MSLTs for clinical indications. RESULTS: In linear regression models, the AHI explained 11.0% of the variance in MSLT results, AHIN (AHI during non-REM sleep) explained 10.8%, and AHIR explained only 6.0% (p < or = 0.0001 for each). Among subjects with AHI < 10, the AHI explained 3.1% of the variance (p=0.0012), the AHIN 2.3% (p=0.0049), and the AHIR 0.2% (p=0.40). Among all subjects, the ratio AHIR/AHIN had no influence on the overall relationship between AHI and sleepiness (p=0.23). CONCLUSIONS: We conclude that apneic events during REM and non-REM sleep probably contribute equally to sleepiness as measured by the MSLT.

Adult↗
PubMed1988

[Characteristics of the night sleep of patients with neuroses and a subjectively good and bad sleep].

Polysomnographic analysis of the night sleep in neurotic patients with subjectively good (SGS, 12 patients) and bad (SBS, 18 patients) sleep showed that a certain degree of sleep impairment is an obligatory sign of neurosis, though night sleep characteristics changed in SGS to a greater extent than in SBS, irrespective of clinical equivalence and high anxiousness in both groups. Discriminative analysis provided a reliable differentiation between groups of SGS, SBS and normal with SGS occupying an intermediate position in sleep characteristics. The conclusion is that not only anxiousness, but also the brain somnifacient systems' resistance against challenging factors determine the sleep structure. Of no lesser importance are the general peculiarities of night sleep organization. The role of the 2 stages in sleep regulation are discussed.

Adult↗
PubMed1986

Sleep, sleep apnea and the fibromyalgia syndrome.

A patient who presented with primary fibromyalgia syndrome (PFS) was found to have sleep apnea. Since frequent wakening and nonrestorative sleep are prominent clinical complaints in both disorders, we hypothesized an etiologic relationship. A subsequent clinical survey of 11 additional sleep apneics revealed that 3 (27%) fulfilled proposed criteria for PFS. This was significantly greater than local and literature reported studies of nonrheumatologic patients and was comparable to reported prevalence of fibromyalgia in rheumatologic referral populations. A blinded sleep physiology study of 7 patients with PFS revealed a significantly increased percentage of transitional sleep and increased frequency of miniarousals/h, but no significant evidence of occult sleep apnea compared to matched normal controls. The frequent arousals of sleep apnea may be associated with fibromyalgia in some patients but do not explain the sleep disorder of PFS.

Fibromyalgia↗
PubMed1981

Acute and delayed effects of DSIP (delta sleep-inducing peptide) on human sleep behavior.

A first study of DSIP (= synthetic delta sleep-inducing peptide) application to humans was carried out in six normal volunteers (four males and two females) under extensive psychophysiologic observations and measurements in a double-blind cross-over design. DSIP was applied as slow intravenous infusions at a dosage of 25 nmol/kg in the morning. The subjects immediately reported a feeling of sleep pressure, and sleep increased by 59% (median of total sleep time) within a 130-min interval after the treatment as compared with placebo. Delayed effects on subsequent night sleep were shorter sleep onset, reduced percentage of stage 1, and better sleep efficiency. Nevertheless, sophisticated behavioral and EEG analyses revealed no sedation in the classic pharmacologic way. The results suggest that DSIP in humans is also efficacious by sustaining natural sleep functions. The compound was well-tolerated and no psychologic, physiologic, or biochemical side effects were observed.

Delta Sleep-Inducing Peptide↗