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PubMed1995

Varying photoperiod in the laboratory rat: profound effect on 24-h sleep pattern but no effect on sleep homeostasis.

To assess the influence of the photoperiod on sleep regulation, laboratory rats were adapted to a long photoperiod (LPP; 16:8-h light-dark cycle, LD 16:8) or a short photoperiod (SPP; LD 8:16). The electroencephalogram (EEG) and cortical temperature (TCRT) were continuously recorded for a baseline day, a 24-h sleep deprivation (SD) period, and a recovery day. Data obtained previously for LD 12:12 served for comparison. Whereas the photoperiod exerted a prominent effect on the 24-h sleep pattern, the 24-h baseline level of sleep and the response to SD were little affected. Recovery from SD was characterized by a marked rise in rapid eye movement sleep, a moderate rise in non-rapid eye movement sleep, and an initial enhancement of EEG slow-wave activity followed by a decrease below baseline. The amplitude and phase of the "unmasked" 24-h component of TCRT did not differ between LPP and SPP. Computer simulations demonstrated that the changes of TCRT and EEG slow-wave activity can be largely accounted for by the sequence of the vigilance states. We conclude that the photoperiod does not affect the basic processes underlying sleep regulation.

Animals↗
PubMedDate not supplied

Effect of CO2 inhalation on central sleep apnea and arousals from sleep.

BACKGROUND: CO(2) inhalation reduces central sleep apnea (CSA) in patients with congestive heart failure (CHF) and idiopathic CSA. CO(2) is also a stimulus for cortical arousal, which has been linked to increased sympathetic nerve activity (SNA) and increased mortality in CHF patients with CSA. OBJECTIVE: We have tested the hypothesis that during sleep, inhalation of CO(2) sufficient to reduce the apnea-hypopnea index (AHI) would not reduce the arousal index (AroI). METHODS: In 10 male patients with CSA (7 with CHF and 3 with idiopathic CSA), the inspired CO(2) concentration was increased to raise the sleeping end-tidal CO(2) by 2-4 mm Hg during established stage 2 sleep. Each intervention was maintained for a 10-min period. Sleep stage was monitored with electroencephalograms, electrooculograms, submental electromyogram, airflow with pneumotachometer and respiratory effort and blood gases with oxygen saturation and end-tidal CO(2). During periods of air and CO(2) breathing, AHI and AroI were compared with paired t tests; patients acted as their own controls. RESULTS: Inhalation of CO(2) produced a significant reduction in AHI (mean +/- SEM) from 74.4 +/- 12.4 events/h during air breathing to 25.8 +/- 7.8 events/h with CO(2) inhalation (p = 0.002). However, the AroI was not significantly different between the two conditions, air 67.8 +/- 12.3 events/h and CO(2) inhalation 52.8 +/- 12.4 events/h (p = 0.264). CONCLUSION: CO(2) inhalation reverses CSA but not arousals from sleep. Our findings highlight the need for treatment options that reduce both respiratory events and decrease arousals from sleep, with their associated SNA sequelae.

Administration, Inhalation↗
PubMed1991

Validity of diurnal sleep recording in the diagnosis of sleep apnea syndrome.

Two polysomnographic studies were performed in 35 subjects who had a clinical suspicion of sleep apnea syndrome: one study was done at night (N) (from 10:00 p.m. to 8:00 a.m.) and the other during the day (D) starting after lunch (from noon to 5:00 p.m.). N and D sleep studies were performed in random order at a minimal interval of 36 h. No treatment (drug, CPAP) was initiated between the two studies. Both studies included the recording of sleep stages (EEG, EOG, EMG), nasal and mouth flows, thoracoabdominal movements, electrocardiogram, and SaO2 (ear oximetry). D sleep was present in all but one subject. As expected, the total sleep time (TST) was significantly shorter during the D than during the N study (2.6 +/- 0.2 and 6.2 +/- 0.2 h, respectively, mean +/- SEM, p less than 0.001, Wilcoxon's signed-rank test). Stages III-IV and REM were significantly less represented during the D (13.1 +/- 2.4 and 7.7 +/- 1.3%, respectively) than during the N study (18.5 +/- 1.7 and 15.3 +/- 0.8%, p less than or equal to 0.005). From the results of the N study, the diagnosis of sleep apnea syndrome (apnea index greater than 5 and/or apnea + hypopnea index greater than 10) was made in 25 patients, and it was confirmed by the same criteria in 22 by the D sleep recording. There was a significant correlation between the N and D values for these indices (r greater than or equal to 0.9, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Circadian Rhythm↗
PubMed1992

Effects of enhancing slow-wave sleep by gamma-hydroxybutyrate on obstructive sleep apnea.

Sleep apneas are rarely observed during slow-wave sleep (SWS), which is poorly represented in patients with obstructive sleep apnea (OSA). Gamma-hydroxybutyrate (gamma OH), a natural metabolite of the brainstem, increases the percentage of total sleep time (TST) spent in SWS. We evaluated the effects of gamma OH on sleep and breathing disorders in eight patients with OSA (age, 45 +/- 2 yr; body mass index, 35.0 +/- 1.5 kg/m2; mean +/- SEM). Three conventional sleep studies were done within a week; the first and third were control studies, and the second was the gamma OH study (30 mg/kg at bedtime and 3 h later). Because the effects of the drug last only 3 h, we analyzed and compared the results of the first 6 h of sleep recording. The percentage of TST spent in SWS increased with gamma OH (30.7 +/- 3.9%) compared with that in the control studies (12.5 +/- 1.1 and 11.0 +/- 2.1%) at the expense of stages I and II. There was no difference between apnea index obtained during the control studies (26.3 +/- 5.3 and 25.4 +/- 6.2/h) and that obtained during the gamma OH study (29.6 +/- 4.9/h). Most apneic events occurred during Stages I and II, and REM, but this proportion was less during the gamma OH study (77.9 +/- 8.9%) than during the control studies (92.3 +/- 1.9 and 95.9 +/- 2.2%), apneas occurring even during SWS with gamma OH.(ABSTRACT TRUNCATED AT 250 WORDS)

Electroencephalography↗
PubMed2002

Evidence of a sleep-specific blunted cortical response to inspiratory occlusions in mild obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) patients have elevated non-rapid eye movement (REM) sleep arousal thresholds to inspiratory loading. To test the hypothesis that this is due to sleep-specific dampening of cortical responses to inspiratory effort, respiratory-related evoked potentials (RREPs) were evaluated in six mild OSAS patients and six age- and body mass index-matched controls during wakefulness and Stage 2 non-REM sleep. Electroencephalogram was recorded from six scalp sites (Fz, FCz, Cz, CPz, Pz, and O(2)). Electrooculogram, electromyogram, and mask pressure signals were also recorded. During sleep, pharyngeal pressure was recorded using a Millar pressure catheter placed 2 cm below the glottis. The RREP waveform was broadly similar in the two groups during wakefulness, but was markedly different during Stage 2 non-REM sleep. During wakefulness, only the N1 component showed reduced amplitude in the OSAS group. During sleep, the occlusion stimulus elicited fewer K-complexes in the OSAS patients. In addition, the N550 component in the average of K-complex responses was smaller in amplitude in the OSAS group. The data suggest that patients with mild OSAS have a "blunted" response to the respiratory occlusion stimulus. This appears not to be related to compromised mechanoreceptor function, as the RREP was normal in the patients when they were awake.

Adult↗
PubMed2000

An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults.

We compared the efficacy of sleep restriction therapy combined with sleep hygiene, nap modification of sleep restriction therapy combined with sleep hygiene, and sleep hygiene alone as treatments for insomnia in 39 community-dwelling men and women 55 years and older. We used the wrist actigraph as an objective outcome measure for all subjects at baseline, end of treatment, and 3-month follow-up; polysomnography (PSG) was conducted in a subgroup of subjects. Although subjects appeared to follow restriction instructions through follow-up, we found few between-group differences in treatment efficacy. Lack of treatment effect might be explained by the efficacy of HYG as a treatment in itself and the relatively low symptom level in these healthy older poor sleepers. At baseline, actigraphic results were found to correlate more highly than sleep log data with PSG in our sample. Actigraphic total sleep time, in particular, was highly correlated with PSG.

Adult↗
PubMed1995

Sleep onset: scoring criteria in patients with sleep apnea syndrome.

It has been suggested that in patients with sleep apnea syndrome (SAS) modified scoring criteria may improve accuracy in the determination of sleep onset in the Multiple Sleep Latency Test (MSLT). Scoring in 30-sec epochs according to the standard criteria requires more than 50% of the epoch asleep to score sleep latency (SL). In patients with SAS, short apneas with arousals could prevent the accurate determination of SL. This study compared three time-duration epochs (5-sec, 10-sec, 30-sec) for scoring SL in patients with SAS. Sleep onset during a single sleep latency test, the morning subsequent to a nocturnal polysomnogram, was determined by the criterion of at least 50% of the epoch asleep. Neuropsychological evaluation was performed immediately after the single sleep latency test. There was no statistically significant difference in time to fall asleep as defined by 10-sec and 30-sec epochs, but SL defined by 5-sec epochs was significantly shorter than SL defined by 10-sec and 30-sec epochs. Wilkinson Addition Test correct score correlated better with SL as defined by 30-sec epochs. The results imply that the level of sleepiness measured by 30-sec epochs may be more useful to appreciate behavior and performance.

Adult↗
PubMed1997

Measurement of P300 and sleep characteristics in patients with hypersomnia: do P300 latencies, P300 amplitudes, and multiple sleep latency and maintenance of wakefulness tests measure different factors?

To explore further the relationship between ease of falling asleep, ability to maintain wakefulness, attention and information processing in sleep apnea and other sleep disorders, we conducted a thorough analysis of the similarities, differences and correlations between auditory and visual P300 amplitudes and latencies, and tests of sleepiness. The 283 consecutive patients presenting with hypersomnia were administered nocturnal polysomnography. Next day they underwent auditory and visual P300 recordings, Multiple Sleep Latency Test (MSLT) and Maintenance of Wakefulness Test (MWT). Correlation coefficients were calculated between auditory and visual P300 amplitudes and latencies, respiratory disturbance index (RDI), sleep efficiency, % stage 1, and the tests for sleepiness. Factor analysis was performed with data from P300 testing, MSLT and MWT. Auditory P300 amplitude was correlated with sleep efficiency. Auditory P300 latency was correlated with % stage 1, RDI, MSLT and MWT. Visual P300 latency was correlated with % stage 1, sleep efficiency and MWT. MSLT but not MWT was negatively correlated with sleep efficiency. Factor analysis suggests three factors: attention, information processing, and sleepiness. We conclude that P300 latencies and tests of sleepiness (MSLT and MWT) measure different abilities in patients with diagnosable disorders of daytime sleepiness.

Adult↗
PubMed2006

The effect of sleep-disordered breathing on stages of sleep in patients with Alzheimer's disease.

Patients with Alzheimer's disease (AD) commonly have poor sleep and a high reported incidence of sleep-disordered breathing (SDB). This study examined how the presence of SDB affected sleep stages in AD patients. Sixty-six volunteers with mild - moderate AD underwent home polysomnography. Results showed that patients with SDB spent less of the night in REM sleep than those with no SDB, but there were no differences in other sleep stages. The findings suggest that the decreased amount of REM sleep may be due to the presence of AD and SDB. Treating these patients' SDB may increase their amount of REM sleep, which may result in improved daytime functioning. Controlled trials of SDB treatment in AD are needed to answer this question.

Aged↗
PubMed1991

Hypoxemia vs sleep fragmentation as cause of excessive daytime sleepiness in obstructive sleep apnea.

To determine the effects of intermittent hypoxemia on daytime sleepiness in the clinical setting of obstructive sleep apnea syndrome, we enrolled seven patients in a prospective, randomized, crossover study. We had two experimental conditions with NCPAP treatment as follow: (1) to correct apneas, sleep fragmentation, and hypoxemia; and (2) to correct apneas and sleep fragmentation and at the same time, induce intermittent hypoxemia. The outcome variable, daytime sleepiness, was measured objectively with the multiple sleep latency test following completion of baseline and each treatment condition. Compared with sleep latencies in the untreated condition, both experimental treatment arms prolonged sleep latencies (p less than 0.05). We found no statistically significant differences between mean MSLT scores obtained after NCPAP treatment under hypoxemic and nonhypoxemic conditions. In summary, two nights of intermittent nocturnal hypoxemia during NCPAP treatment for OSAS did not diminish the objective improvement in daytime somnolence seen with NCPAP treatment in the absence of nocturnal hypoxemia. Results lend further support to the hypothesis relating excessive daytime sleepiness to sleep fragmentation.

Adult↗
PubMed2002

Sawtooth waves during REM sleep after administration of haloperidol combined with total sleep deprivation in healthy young subjects.

We sought to examine the possible participation of dopaminergic receptors in the phasic events that occur during rapid eye movement (REM) sleep, known as sawtooth waves (STW). These phasic phenomena of REM sleep exhibit a unique morphology and, although they represent a characteristic feature of REM sleep, little is known about the mechanisms which generate them and which are apparently different from rapid eye movements. STW behavior was studied in 10 male volunteers aged 20 to 35 years, who were submitted to polysomnographic monitoring (PSG). On the adaptation night they were submitted to the first PSG and on the second night, to the basal PSG. On the third night the volunteers received placebo or haloperidol and spent the whole night awake. On the fourth night they were submitted to the third PSG. After a 15-day rest period, the volunteers returned to the sleep laboratory and, according to a double-blind crossover randomized design, received haloperidol or placebo and spent the whole night awake, after which they were submitted to the fourth PSG. The volunteers who were given haloperidol combined with sleep deprivation exhibited an elevation of the duration and density of the STW, without significant alterations of the other REM sleep phasic phenomena such as rapid eye movement. These findings suggest that sawtooth waves must have their own generating mechanisms and that the dopaminergic receptors must exert a modulating role since REM sleep deprivation, as well as administration of neuroleptics, produces supersensitivity of dopaminergic receptors.

Adult↗
PubMed1983

Associative relationships between pre-sleep sentence stimuli and reports of mental sleep experience.

The aim of this experiment was to study some linguistic relationships between pre-sleep verbal stimuli and contents of reports of mental experience during sleep. In 4 weekly sessions 16 subjects listened before sleep to a sentence stimulus, which was either semantically acceptable (SEM+) or not (SEM-), and were told to retain it for a recall test after awakening; they were awakened once each night during NREM or REM sleep and asked to report their mental experience during sleep. The relationships between the stimulus and the contents of the reports were classified using Clark's (1970) associative rules. Both pre-sleep sentence stimuli were frequently incorporated into contents of NREM and REM reports, without significant differences between the two types of sleep. The SEM+ sentence led prevalently to incorporations through paradigmatic associative relationships, while the SEM- sentence led to incorporations through both paradigmatic and syntagmatic relationships. It appears that all the features of the lexical constituents of the stimulus may be involved in the processing leading to incorporation.

Adult↗
PubMedDate not supplied

Three measures of sleep, sleepiness, and sleep deprivation and the risk of injury: a case-control and case-crossover study.

PURPOSE: Sleepiness and sleep deprivation are associated with injury, but few case-control studies have addressed them. We sought to add to the body of analytic observational studies. METHODS: Case-control and case-crossover study of 2517 injured patients interviewed in person in 3 emergency departments and matched by age, sex, rural versus urban, day of week, and hour of day with 1856 controls. Sleep constructs were measured by the following: (1) self-perceived sleepiness at injury or matched control time using 3 adjectives (tired, sleepy, drowsy); (2) usual sleep quality and quantity, and differences in those in the past 7 days; and (3) hours of sleep in the 24 hours before injury and the 24 hours before that. RESULTS: Better sleep quality in the past 7 days was associated with a lower risk of injury (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80 to 0.97). Self-reported sleepiness just before injury compared with control time was associated with a lower risk of injury, with ORs of 0.82 per unit on a 0-to-12 scale (95% CI 0.78 to 0.86) in case-control analysis and 0.76 (0.73 to 0.80) in case-crossover analysis. In case-crossover analysis, additional sleep in the 24 hours before injury compared with the 24 hours before that was associated with an increased risk of injury (OR 1.06 per hour, 95% CI 1.03 to 1.09), but this effect disappeared when we controlled for activity, location, and recent alcohol consumption. CONCLUSIONS: Better recent sleep quality was associated with a lower risk of injury, but surprisingly, feeling sleepy was also.

Adolescent↗
PubMed2005

Olanzapine increases slow wave sleep and sleep continuity in SSRI-resistant depressed patients.

OBJECTIVE: The atypical antipsychotic drug olanzapine has been employed as an augmentation treatment in depressed patients unresponsive to treatment with selective serotonin reuptake inhibitors (SSRIs). In healthy subjects, acute olanzapine administration increases sleep continuity and enhances slow wave sleep (SWS). The aim of the present study was to determine if the addition of olanzapine to SSRI treatment in depressed patients produced similar effects on sleep. METHOD: We measured the effect of open-label olanzapine addition (2.5 mg/day initially) on the polysomnograms of 12 patients referred from primary care sources who met DSM-IV criteria for major depressive disorder and who had had an unsatisfactory response to therapeutic doses of an SSRI. Patients were first enrolled in November 2001; final assessment occurred in November 2003. Sleep polysomnogram recordings were made on 3 occasions: before olanzapine addition, on the first night of olanzapine treatment, and after 3 weeks of olanzapine treatment. RESULTS: After the first night of olanzapine treatment and during the third week, subjects showed improvements in sleep efficiency (p < .001), subjective sleep quality (p < .05), and SWS (p < .01). Scores on the Hamilton Rating Scale for Depression fell significantly (p = .001), with the majority of the decrease being apparent after the first week of treatment. CONCLUSION: Olanzapine improves sleep continuity and increases SWS in patients receiving SSRI treatment. These effects are apparent after the first dose of olanzapine and are maintained for the next 3 weeks. The ability of olanzapine to increase SWS is probably attributable to 5-HT(2A/2C) receptor blockade, which has been identified as a relevant mechanism in the therapeutic effect of olanzapine in SSRI-resistant depressed patients.

Adult↗
PubMed2005

9. Common causes of sleep disruption and daytime sleepiness: childhood sleep disorders II.

There are strong associations between childhood sleep disorders and behavioural, concentration and mood problems. Sleep disorders caused and maintained by behavioural factors (eg, sleep-onset association disorder) are common in young children, and have a significant impact on families. Evaluation should include a medical history, a physical, neurological and developmental examination, a description of any nocturnal events or daytime effects of the child's disturbed sleep, and a good understanding of the family situation and parental management of the child. Management involves recognising the developmental age of the child and the family dynamics, and educating and supporting families in applying behavioural techniques to establish good sleep hygiene. Children with parasomnias (eg, night terrors) also benefit from good sleep hygiene, while those with respiratory or neurological causes of sleep disturbance should be referred for specialist treatment.

Adolescent↗
PubMed2004

[Changes of sleep architecture in children with obstructive sleep apnea syndrome].

OBJECTIVE: To explore how obstructive sleep apnea syndrome (OSAS) affects children's sleep architecture. METHODS: Eighty-three children with OSAS were reviewed; every patient was monitored with polysommography for 7 hours at night for 11 parameters, including the number of arousal, snoring index, nadir O(2) desaturation, stage I %, stage II %, show wave sleep (SWS)% and rapid eye movement (REM)%. The basis for diagnosis of OSAS was the widely accepted pediatric diagnostic criteria of apnea/hypopnea index, apnea/ hypopnea index of > 1 episode/hour, nadir O(2) desaturation < 92%. Sleep was scored manually according to the standard set by Rechtschaffen. RESULTS: In OSAS group, the number of arousal was 22.5 +/- 1.4, snoring index was 70.6 +/- 16.5, and/or SaO(2) was (73.8 +/- 1.9)%. OSAS group had increased stage I : (45.8 +/- 2.0)% vs. (2.3 +/- 1.1)%, t = 22.46, P < 0.01 and decreased stage II : (23.9 = 1.7)% vs (47.9 = 4.4)%, t = - 14.18, P < 0.01, SWS (15.6 +/- 1.8)% vs. (21.1 +/- 5.0)%, t = - 3.123, P < 0.01, REM (14.7 +/- 1.5)% VS. (28.2 +/- 4.1)%, T = -8.923, p < 0.01. CONCLUSION: The severity of OSAS relates to changes of sleep architecture in children. Intermittent nocturnal hypoxia secondary to apnea/hypopnea, and frequent electroencephalogram arousals from sleep may result in significant sleep fragmentation. Children with OSAS had learning problems and failure to thrive.

Child↗
PubMed1991

Triazolam diminishes daytime sleepiness and sleep fragmentation in patients with periodic leg movements in sleep.

Fifteen subjects (9 men and 6 women) exhibiting objective evidence of excessive daytime somnolence and periodic leg movements in sleep underwent 4-7 days of treatment with triazolam (0.25 or 0.50 mg) and placebo in a double-blind crossover design. One night of polysomnography followed by daytime multiple sleep latency testing were conducted on the first and last days of each treatment block. By the last day of treatment, the mean multiple sleep latency test score after triazolam (9.0 minutes) was significantly greater than that after placebo (5.7 minutes). Thus, triazolam treatment led to a decrease in daytime somnolence. Triazolam also improved sleep architecture and continuity; it increased total sleep time, decreased the number of awakenings and arousals, and decreased stage 1 and increased stage 2 percentages. Although the frequency of periodic electromyographic bursts remained unchanged, the frequency of associated arousals decreased after treatment. Short-term treatment with triazolam is thus effective in diminishing daytime sleepiness and in improving sleep architecture, continuity and duration in patients with periodic leg movements in sleep. These effects do not seem to be mediated through a decrease in periodic leg movement activity.

Adult↗
PubMed1991

Changes in left ventricular ejection fraction during REM sleep and exercise in chronic obstructive pulmonary disease and sleep apnoea syndrome.

Nine patients, 4 with chronic obstructive pulmonary disease (COPD) and 5 with obstructive sleep apnoea syndrome (OSAS) were monitored during sleep, rest and exercise. Left ventricular ejection fraction (LVEF) was investigated using gated equilibrium 99mtechnetium ventricular scintigraphy during rapid eye movement (REM) sleep, during exercise, and during wakeful rest. Control wakeful rest periods used for comparison with a study state (either REM sleep or exercise) were always selected during the same circadian segment as that state. Myocardial stress thallium-201 scintigraphy was performed during, and 4 h after, exercise, and results were compared to a daytime rest period. Several patients had myocardial hypoperfusion despite a normal electrocardiographic (ECG) treadmill test. During REM sleep, all patients exhibited a significant change in LVEF (greater than 5%) compared to wakefulness. During exercise, 5 subjects increased their LVEF normally (greater than 5%) and 4 (1 COPD, 3 OSAS) decreased it. All patients had a similar change (increase or decrease) during REM and at maximal exercise. Our results suggest that REM sleep in COPD and in OSAS can produce a myocardial stress as great as that produced by exercise. We conclude that REM sleep, like exercise, is a state in which morbidity may become higher and that it may account for mortality in COPD and OSAS patients with compromised myocardial circulation.

Adult↗