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PubMed2000

Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems.

Although the interaction between sleep and pain is generating considerable interest (NIH Technology Assessment Panel, 1996), it is still unknown if chronic pain is the cause or effect of poor sleep. To further this understanding, subjects free of pain and sleep problems need to be studied in order to assess their response to pain during sleep, defined as a behavioral and a physiological state in which sensory processing is altered. (For example, while auditory perception remains active, other sensory inputs are facilitated, attenuated, or suppressed (Velluti, 199746 degrees C) was statistically greater in the lighter sleep stage 2 (48.3%) than in the deeper stages 3&4 (27.9%). A nocifensive behavioral-motor response was associated with only 2.5% of the 351 heat pain stimuli. Two other markers of sleep quality-sleep stage shift and awakening-were not influenced by the thermal stimuli. None of the subjects demonstrated any burns in the morning following the thermal stimulations applied during sleep. We conclude that the processing of nociceptive inputs is attenuated across sleep stages.

Adult↗
PubMed1988

Treatment of sleep-maintenance insomnia in older adults: sleep period reduction, sleep education, and modified stimulus control.

We evaluated a behavioral treatment package consisting of sleep period restriction, sleep education, and modified stimulus control in the treatment of sleep-maintenance insomnia in older adults. A multiple baseline design was used with 4 chronic insomniac subjects, ages 59, 65, 65, and 72. Sleep diaries and an objective behavioral measure of sleep were used to monitor improvement. Results revealed clinically significant reductions in time awake after sleep onset in 3 subjects, coincident with the initiation of treatment. These improvements were maintained at 2- and 6-month follow-ups. The 4th subject showed little improvement; however, a polysomnogram conducted on this subject at the end of the study revealed a fragmented sleep pattern secondary to periodic movements of sleep (nocturnal myoclonus). These encouraging but preliminary results call for further controlled evaluations of the efficacy of this behavioral treatment package for sleep-maintenance insomnia. The importance of conducting polysomnographic studies on elderly insomniacs is discussed.

Aged↗
PubMed1987

The effects of aminophylline on sleep and sleep-disordered breathing in patients with obstructive sleep apnea syndrome.

The methylxanthine derivatives are known to have respiratory stimulant properties. To determine whether these drugs would improve obstructive sleep apnea, 10 male patients with obstructive sleep apnea (OSA) (Apnea Index greater than 15/h) were given infusions of aminophylline and a saline placebo on 2 separate nights a week apart, using a randomized crossover design. There was a significant decrease during aminophylline infusion in the frequency of those apneas, which contained periods of complete respiratory inactivity (central and mixed apneas; placebo, 4.3 +/- 1.8/h; aminophylline, 0.7 +/- 0.5/h; p less than 0.05). There was no change in either the frequency (placebo, 31.8 +/- 5.9/h; aminophylline, 28.7 +/- 8.7/h; NS) or duration of obstructive apneas. Mean and minimal arterial oxygen saturation values were also unchanged. Sleep architecture was markedly disturbed by aminophylline. There was a reduction in sleep efficiency (placebo, 84.8 +/- 2.0%; aminophylline, 60.2 +/- 5.0%; p less than 0.005), an increase in sleep fragmentation (sleep stage shifts/h: placebo, 11.6 +/- 1.3: aminophylline, 21.0 +/- 2.9; p less than 0.05) and less Stage 2 and more Stage 1 non-REM sleep. We conclude that aminophylline reduces central apnea and the central component of mixed apneas but has no effect on obstructive apnea. Theophylline is therefore unlikely to be therapeutically useful in patients with OSA, and because it leads to marked sleep disruption, its long-term use could conceivably increase the propensity to upper airway occlusion during sleep.

Aminophylline↗
PubMed2000

Glossoptosis (posterior displacement of the tongue) during sleep: a frequent cause of sleep apnea in pediatric patients referred for dynamic sleep fluoroscopy.

OBJECTIVE: The purpose of this study was to evaluate the frequency of glossoptosis (posterior displacement of the tongue) as a cause of sleep apnea in pediatric patients referred for fluoroscopic sleep studies. MATERIALS AND METHODS: Seventy consecutive dynamic fluoroscopic sleep studies performed to evaluate sleep apnea were reviewed. All patients had been sedated and examined with lateral fluoroscopy during sleep. Anatomic changes in the airway were correlated with episodes of oxygen desaturation. Cases of glossoptosis, in which the tongue moved posteriorly during sleep and abutted the posterior pharynx, resulting in airway obstruction and oxygen desaturation, were identified. Associated factors were reviewed. RESULTS: Of 70 sleep studies reviewed, glossoptosis was the cause of airway obstruction in 17 patients (24%). Mean age in these 17 patients was 3 years (range, 5 days to 13 years). Seven of the 17 children were younger than 1 year old. Only three patients had no underlying medical problems. Four patients had macroglossia (Down syndrome, n = 3; duplicated tongue, n = 1) as a cause, and three patients had micro- or retrognathia (Pierre Robin syndrome, n = 2; Rubinstein-Taybi syndrome, n =1) as a cause. Six patients had neuromuscular abnormalities. CONCLUSION: Glossoptosis was a cause of airway obstruction in 25% of pediatric patients referred for fluoroscopic sleep studies. Attention to this anatomic region is important when evaluating children with sleep apnea.

Airway Obstruction↗
PubMed2005

Is sleep's 'supreme mystery' unraveling? An evolutionary analysis of sleep encounters no mystery; nor does life's earliest sleep, recently discovered in jellyfish.

Biotelemetry has revealed daily 15-h behavioral sleep periods in a cubomedusan jellyfish, Chironex fleckeri. Its sleep is expected to be phylogenetically most primitive, since jellyfish possess only two germ layers. They belong to the phylum Cnidaria, the 'simplest' multicellular organisms with an organized nervous system. Cubomedusae have a complex visual system with 24 eyes of four different types, each type specialized for a different task. Input to these eyes during visually guided fast-swimming predation requires enormous amounts of neural processing, possibly nearly saturating the capacity of their comparatively simple nervous system. These heavy neural demands may account for the need for fifteen hours of sleep. C. fleckeri is the only animal known for which sleep may be either present or absent, dependent on lifestyle. Limited knowledge of behavior of some other cubomedusae suggests that they also possess this faculty. The finding of sleep in C. fleckeri supports current proposals of sleep's origin and basic function. Evolutionary analyses link sleep to a conflict produced by excessive processing demands on multifunctional neural circuitry for detailed focal vision by complex lensed eyes. The conflict arises between the enormous demands of complex visual analysis and needs for split-second control of actions, on the one hand, and non-urgent processing of memories of ongoing and stored events, on the other. Conflict is resolved by deferring the non-urgent processing to periods of sleep. Without sleep, selection would favor the evolution of circuitry 'dedicated' to single or but few tasks, with corresponding lesser efficiency. Had complex lensed eyes of medusae originated as a consequence of selection for increased mating success of males pursuing females, it could have occurred before the evolution of fast-swimming bilateral (three-germ-layered) prey. But if it was a consequence of selection for increased prey-hunting success, the origin of such eyes probably awaited the coexistence of bilateral prey.

Animals↗
PubMed2004

Sleep deprivation and injuries in part-time Kentucky farmers: impact of self reported sleep habits and sleep problems on injury risk.

Part-time farmers who hold off-farm jobs may be at risk for injuries because of impaired performance resulting from inadequate sleep. For this study, 1004 part-time male Kentucky farmers completed a telephone interview for the 1994 to 1995 National Institute for Occupational Safety and Health-funded Farm Family Health and Hazard Surveillance Project. Questions were included about demographics, sleep habits, and injury occurrence. Twelve percent of the farmers reported an injury requiring medical intervention in the previous year. Farmers reported sleeping an average of 7.6 hours daily. Approximately 6.7% of the sample had three symptoms of sleep apnea. Although hours of sleep were not related to injury incidence, sleep medication use (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.01 to 4.40) and presence of three sleep apnea symptoms (OR = 2.48, 95% CI = 1.13 to 5.41) were related to injury incidence. These data support the need for further research to examine sleep habits and promote strategies that reduce the risk for injuries caused by lack of sleep.

Adult↗
PubMed1998

Homeostatic process and sleep spindles in patients with sleep-maintenance insomnia: effect of partial (21 h) sleep deprivation.

OBJECTIVES: A low level of process 5 at bed time would be responsible for a reduced amount of slow-wave activity (SWA) leading to increased alpha activity and awakenings at the end of the night. METHODS: Following a base-line night (BLN) recording, 7 sleep-maintenance insomnia (SMI) subjects and 7 sex- and age-matched controls were maintained on 21 h of sleep deprivation. Thereafter, a recovery night (RN) was performed from 2300 h until spontaneous awakening. SWA (power density of the EEG delta band between 0.75 and 4.5 Hz) was monitored by means of spectral analysis (FFT). Sleep spindles and the occupation ratio of Rechtschaffen and Kales EEG bands were observed by integrated digital filtering analysis. RESULTS: SWA was lower in SMI subjects than in controls during RN but was higher than in BLN indicating that the homeostatic process was operating, but weaker in SMI subjects. On the other hand in SMI subjects the sleep spindle index (SSI) did not decrease during slow-wave sleep and was significantly lower than in controls. Moreover during RN the SSI decreased significantly during the first sleep cycle in controls and not in SMI subjects. The existence of an inverse relationship between SWA and SSI was therefore not observed in insomniacs. Finally the mean duration of alpha frequency significantly increased in SMI subjects. CONCLUSIONS: It is hypothesised that in SMI subjects, an alteration of the homeostatic process is responsible for insufficient sleep pressure leading to an inability to maintain sleep for an extended period.

Adult↗
PubMed1988

Evidence for a role of delta sleep-inducing peptide in slow-wave sleep and sleep-related growth hormone release in the rat.

To examine the role of delta sleep-inducing peptide (DSIP) in sleep-related growth hormone (GH) release, male rats were deprived of sleep for 4 hr by placing them on a slowly rotating wheel. Sleep deprivation by this method caused a significant increase in GH release, as indicated by the increase in plasma GH concentrations (P less than 0.01), and also in the amount of slow-wave sleep (SWS) (P less than 0.001) above initial values after removal of the animals from the rotating wheel. These increases were blocked by microinjection into the third cerebral ventricle of highly specific antiserum to DSIP. In control rats receiving an equal volume of normal rabbit serum, the significant increase in plasma GH as well as SWS remained after removal of the rats from the wheel. The increased release of endogenous DSIP in the sleep-deprived animals may have caused an increase in SWS as well as plasma GH. Since DSIP increases plasma GH after its injection into the third cerebral ventricle and since passive immunization against DSIP blocks the increase in SWS and GH release that follows the 4 hr of sleep deprivation, the results suggest that DSIP can be a physiological stimulus for sleep-related GH release as well as for the induction of SWS.

Animals↗
PubMed2006

Transition to daylight saving time reduces sleep duration plus sleep efficiency of the deprived sleep.

Daylight saving time (DST) is widely adopted. We explored the effects of transition to daylight saving time on sleep. With the use of wrist-worn accelerometers, we monitored the rest-activity cycles on a sample of 10 healthy adults for 10 days around the transition to summer time. Identical measurement protocols were carried out twice on the same individuals during the transitions in the years of 2003 and 2004, yielding data on 200 person-days for analysis. Both sleep duration and sleep efficiency were reduced after the transition both years. After the transition sleep time was shortened by 60.14min (P<0.01) and sleep efficiency was reduced by 10% (P<0.01) on average. Transition to daylight saving time appears to compromise the process of sleep by decreasing both sleep duration and sleep efficiency.

Adaptation, Physiological↗
PubMed2002

Effect of sleep deprivation on NREM sleep ERPs and related activity at sleep onset.

This research assessed the impact of one night of sleep deprivation on the amplitudes of NREM-sleep event-related potentials (NREM ERPs) and on the frequency of occurrence of related electroencephalogram activity including sleep spindles, arousals, K-complexes, and vertex sharp waves (VSWs). The NREM ERPs identified included P220, N350, P450, N550 and P900. During a pre-deprivation night, ten subjects took two 20-min naps separated by a 20-min break at their normal bedtime. Brief tones were presented at three intensity levels (60, 75 and 90 dB) with a 5-s interstimulus interval. Following these naps, subjects were kept awake until their normal bedtime the following day. At that time, they repeated the two-nap procedure. The ERPs obtained for each tone and wake/sleep state for pre- and post-deprivation conditions were analyzed using repeated measures statistical procedures. As anticipated, NREM ERP amplitudes recorded both pre- and post-deprivation increased with tone intensity and with approaching sleep. Also, sleep deprivation was associated with more rapid sleep onset, reduced arousability, and greater spindle production. While sleep deprivation had no effect on the amplitude of P220. Post-deprivation amplitudes of N350, N550 and P900 were greater, especially following the 90-dB tone. There was a corresponding increase in VSWs and K-complexes. These findings are inconsistent with the view that NREM ERPs reflect arousal. The underlying mechanism(s) may facilitate initiation and maintenance of sleep.

Adult↗
PubMed2002

Worry and sleep length revisited: worry, sleep length, and sleep disturbance ascribed to worry.

The author administered university students (N = 222; 152 women, 70 men) the Worry Domains Questionnaire (F. Tallis, G. C. L. Davey, & A. Bond, 1994) and a newly constructed scale (the Sleep Disturbance Ascribed to Worry Scale) to measure sleep disturbance attributed to worry. To revisit previous studies (i.e., E. Hartmann, F. Baekeland, & G. R. Zwilling, 1972; S. J. H. McCann & L. L. Stewin, 1988) that suggested that sleep length was positively related to worry, the author also asked the students a question about habitual sleep length. The results indicated that worry and sleep disturbance attributed to worry were negatively related to sleep length. A regression analysis revealed that worry was significantly negatively related to habitual sleep length irrespective of sleep disturbance ascribed to worry.

Adult↗
PubMed1996

Periodic K-alpha sleep EEG activity and periodic limb movements during sleep: comparisons of clinical features and sleep parameters.

The K-alpha sleep electroencephalographic (EEG) phenomenon is characterized by periodic (approximately 20-40 seconds) K-complexes, immediately followed by alpha-EEG activity (7.5-11 Hz) of 0.5- to 5.0-second duration. A group of 14 subjects with the periodic K-alpha anomaly was found to have a similar distribution pattern of interevent intervals as compared with previously published data for sleep-related periodic limb movements during sleep (PLMS). Sleep parameters and somatic symptoms of 30 patients with K-alpha were compared with 30 patients with PLMS. The periodic K-alpha group was predominantly female, younger, exhibiting more slow-wave sleep, gastrointestinal symptoms and muscular complaints and fewer movement arousals on overnight polysomnography. The K-alpha group presented uniformly with complaints of unrefreshing sleep, often associated with fibromyalgia and chronic fatigue syndrome. The PLMS group was predominantly male, showed greater sleep disruption and presented with a variety of sleep-related symptoms.

Adult↗
PubMed1999

Periodicity of a noninvasive measure of cardiac vagal tone during non-rapid eye movement sleep in non-sleep deprived and sleep-deprived normal subjects.

Cyclic alternating pattern (CAP) of microarousals reported in EEG studies is now regarded as an integrating mechanism for the different parts of the central nervous system including the autonomic system. A recently developed continuous index of cardiac parasympathetic activity (CIPA) can be time locked to the EEG allowing the relationship between EEG and autonomic changes to be studied in sleep. Eleven normal subjects were studied for evidence of periodicity in CIPA in non-REM sleep, five of whom had been sleep deprived. Fast Fourier's transformation of the CIPA data confirmed its periodicity with four frequency peaks in the range of 0.015 to 0.3 Hz. The frequency peaks previously reported as caused by respiration, Mayer waves and vasomotor thermoregulatory activity, were within what we called the alpha and beta rhythms of CIPA. There was an additional very slow peak not previously described and we called it the gamma rhythm. It covered the frequency range below 0.03 Hz. The gamma rhythm was the largest of all peaks in CIPA rhythms and its magnitude increased further in sleep-deprived subjects, but it invariably decreased during stage 4 sleep in both groups. Bursts of alpha waves in the EEG recorded concomitantly with CIPA in stage 1 sleep were associated with both peaks and troughs of the gamma rhythm. These results support previous proposals that cyclic alternating pattern in the EEG may be an integrating mechanism associated with functions of the central nervous system, and we have shown here its relationship with CIPA. Because cyclic alternating pattern can also be measured in CIPA, clinical exploitation of this phenomenon could include monitoring of epilepsy, studies of the effects of drug therapy, and assessment of other sleep disorders. All these are known to affect cyclic patterns of sleep EEG.

Adult↗
PubMed1992

[Quality of day time sleep in the multiple sleep latency tests in patients with narcolepsy, obstructive sleep apnea and psychogenic hypersomnia].

The multiple sleep latency test (MSLT) has proved to be a useful diagnostical tool for patients complaining of excessive daytime sleepiness (EDS). The intention of the present study was to investigate the structure of MSLT naps and in particular sleep spindle and k-complex density in three different groups of EDS patients. MSLT was performed at 8 a.m., 10 a.m. 12 a.m., 2. p.m. and 4 p.m.. Each recording lasted 20 minutes and was not stopped even if sleep occurred before 20 min. Sleep was scored visually. Spindle and k-complex density was determined per minute of S2 sleep. Statistical analysis used ANOVA. Each of the three groups consisted of 15 patients. Diagnosis of narcolepsy, sleep apnea, of EDS due to a psychiatric disorder has been confirmed subsequently. There were 5 female and 10 male narcoleptics (mean age: 43.9 +/- 10.9 years), 2 female and 13 male obstructive sleep apnea patients (mean age: 53.9 +/- 10.9 years) and 7 female and 8 male patients complaining of EDS, in whom a psychiatric disorder was diagnosed (mean age: 38.8 +/- 13.8 years). Narcoleptics sent more than half of the recording time of 100 min asleep (52.9%). Apnea patients slept 41.3% and psychogenic EDS patients 22.7%. The proportion of sleep stages 1 and 2 in narcoleptics (S2/S1 = 1:1) was clearly different from the other two (apnea patients: S2/S1 = 4:1; psychogenic EDS patients: S2/S1 = 3:1). 18.5% of the naps contained stage REM and during the afternoon naps 0.9% of S3 in the narcoleptics. Neither REM nor S3 was observed in the others.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Sleep apnea: a model for studying cytokines, sleep, and sleep disruption.

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. The sleep fragmentation and accompanying hypoxemia lead to many negative consequences including cardiac arrhythmias, nocturnal hypertension, confusion, cognitive impairment, daytime sleepiness, as well as depressive symptoms. From the perspective of psychoneuroimmunology (PNI), OSA holds promise as a model for studying sleep and cytokines because of its many relevant characteristics, including neuroimmune interactions, mood changes, and behaviors that directly affect the course of the disorder. In this minireview we briefly summarize the existing literature on cytokines and sleep and then discuss work on cytokines and OSA. We believe that the study of OSA presents researchers with an excellent opportunity to tease apart the many complex and interwoven components of sleep that are relevant to PNI.

Arousal↗
PubMed1993

Sleep in nondepressed patients with panic disorder: II. Polysomnographic assessment of sleep architecture and sleep continuity.

This study assessed the EEG sleep of 16 patients with panic disorder who did not currently meet criteria for major depression in comparison to 16 age-comparable healthy controls. Patients with panic disorder had remarkably normal sleep, with only a modest reduction in total sleep time (374 +/- 46 min vs. 399 +/- 36 min) and delta sleep (11.4 +/- 6.2% vs. 16.4 +/- 6.6%) noted. Contrary to expectation, impairment in sleep maintenance and continuity was not found in the patients with panic disorder. We conclude (a) sleep in non-depressed patients with panic disorder is fairly unremarkable, and does not resemble that classically described for depressed patients, and (b) excessive arousability is not a characteristic feature of sleep in panic disorder.

Adult↗