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At least 1,099 records · Page 61Linked to original sources
PubMed1990

[Characteristics of sleep in abstinent alcoholics. A comparison of alcohol- and age-induced reduction of deep sleep].

Polygraphic sleep recordings were performed in 12 sober alcoholic patients, 8 young normals and 12 healthy elderly subjects. An automatic sleep analysis including two different methods (standard and adaptive) of SWS scoring was used. The standard method is based on amplitude dependent rules according to Rechtschaffen and Kales. The basis for classification of SWS in the adaptive method is the relative increase of the integrated delta-activity during NREM sleep. Whereas in young and elderly normal subjects the method used has no influence on the duration of SWS during the night, the amount of SWS in alcoholic patients is significantly higher when applying the adaptive sleep analysis compared with the results of the standard method. Alcoholics show the lowest level of integrated delta activity during NREM and also the shortest duration of SWS resulting from the standard sleep analysis. On the contrary the relative dynamic of EEG synchronization and the duration of SWS measured by the adaptive sleep analysis are comparable with the values of normal subjects. The general decrease of the delta activity during sleep in sober alcoholics is assumed to be not a reflection of the reduction of SWS.

Adult↗
PubMed1988

Periodic leg movement, sleep fragmentation and central sleep apnoea in two cases: reduction with Clonazepam.

Two subjects presented with periodic leg movement (PLM) syndrome during sleep that was characterized by marked sleep fragmentation and repetitive short central apnoeas. Treatment of PLM using Clonazepam, a benzodiazepine with hypnotic properties, markedly reduced the sleep fragmentation due to PLM and, despite its depressant properties on the central nervous system, controlled the repetitive central apnoeas. These two observations, although rare, give insight into the role of non-ventilatory variables in the development of sleep apnoea. Significant sleep fragmentation should be considered when assessing factors leading to respiratory instability during sleep and/or the pathophysiology of sleep apnoea syndromes.

Adult↗
PubMed1984

[Nocturnal sleep and cerebral hemodynamics in different sleep stages and cycles among patients with early manifestations of cerebral circulatory insufficiency].

Clinical and polygraphical (EEG, EOG, EMG, ECG, REG) studies of nocturnal sleep and of the hemodynamics were carried out in 60 patients with dyscirculatory encephalopathy induced by hypertension and atherosclerosis. The findings obtained demonstrate that the clinical picture in these patients is always characterized by sleep disturbances which decrease the level of their diurnal wakefulness and their capacity for work. Hemodynamic disturbances responsible for sleep disorders are in turn maintained by the latter which leads to the formation of the vicious circle. This is also supported by the fact that compromized cerebral circulation causes changes in the activity of the structures involved both in sleep-wakefulness function and the regulation of the cerebral and systemic hemodynamics. Hence, deviations in the nocturnal sleep pattern attended with pronounced alterations in the cerebral hemodynamics may contribute to the development of acute disorders of the cerebral circulation. The authors recommend correcting not only the disrupted structure of sleep but also the cerebral circulation with relation to he sleep-wakefulness cycle.

Cerebrovascular Circulation↗
PubMed1994

C STAGE, automated sleep scoring: development and comparison with human sleep scoring for healthy older men and women.

Using the sleep records of 200 men and women (age 55-85 years), we have developed a human-assisted computer scoring system, C STAGE. The system can have many applications, including quantitative electroencephalographic (EEG) analysis during specific stages of sleep. C STAGE classifies sleep/wake stages using power spectral analysis and other techniques applied to one channel of EEG data. Here we report comparability data between C STAGE- and human-rated sleep-stage scoring using Rechtschaffen and Kales criteria for 70 normal subjects (a subset of the 200). Because the method was developed using these subjects, we also report comparability data for an independent validation sample of 45 normal older men and women. For waking measures, sleep stages 3 and 4, and total sleep time, C STAGE yielded ratings comparable with the human rater (r = 0.73-0.91; p < 0.001). For sleep stages 1 and 2 and REM sleep, C STAGE correlated less well with human ratings (r = 0.59-0.81; p < 0.001). Overall, these correlations compare well with other currently available computer stage-scoring methods. Epoch-by-epoch comparisons in the validation sample revealed a mean proportion of agreement of 0.74 and a mean Kappa coefficient of 0.57, indicating the two methods provide reasonable agreement on an epoch-by-epoch basis. We conclude that C STAGE is a valid sleep/waking scoring system for healthy older adults.

Aged↗
PubMed1994

Sleep onset insomnia, sleep maintaining insomnia and insomnia with early morning awakening--temporal stability of subtypes in a longitudinal study on general practice attenders.

The present study investigated the temporal stability of insomnia patterns during a 4-month study period, classifying insomnia as sleep-onset insomnia, sleep-maintaining insomnia or insomnia with early morning awakening. In a longitudinal study design, 2,512 general practice attenders were investigated at the time of the first inquiry (T1) with a questionnaire. Four months later (T2), all patients complaining of difficulties in initiating and/or maintaining sleep and/or early morning awakening (n = 328) were again contacted by mail and received the same questionnaire as at T1. According to the reported symptoms, patients were assigned to the different subtypes of insomnia. The diagnosis at T1 was then compared with the diagnosis at T2 4 months later. Only about half of all patients who complained of difficulties in initiating sleep at T1 still exclusively reported sleep-onset insomnia 4 months later, whereas the remaining patients were distributed to different subtypes. The stability of sleep-maintaining insomnia and insomnia with early morning awakening was even lower. Comorbidity with a somatic or psychiatric disorder at T1 and change in hypnotic treatment did not account for the instability of the respective subgroup of insomnia. These findings illustrate that cross-sectional studies focusing on subtypes of insomnia, e.g. sleep-onset insomnia, may lead to erroneous results.

Adolescent↗
PubMedDate not supplied

[The regulation of the wakefulness-sleep cycle in normal rats and during sleep pathology].

Studies on the cycle wakefulness-sleep in rats with genetic predisposition to catalepsy revealed that this strain may be also used for investigation of sleep pathology. These animals exhibit abnormal regulation of the cycle which reveals itself in the onset of a "hypnotic" sleep phase. This phase is a result of a special form of sleep regulation and it cannot be classified as slow-wave or paradoxical sleep. In the hypnotic phase, no increase in spatial and temporal synchronization between structures was observed which is typical of the normal delta-sleep (0.704 +/- 0.053). Correlation connections between the visual cortex and subcortical structures remained weak (0.326 +/- 0.076) in spite of the increase in the level of EEG synchronization close to that during slow-wave sleep. It was shown that catalepsy may be due to lack of dopamine.

Animals↗
PubMed1993

[A case of sleep apnea syndrome with significant alteration of apnea index by sleep position].

An obese 37-year-old man (130% ideal body weight) was admitted to our hospital with the complaint of excessive daytime sleepiness. During all-night polysomnography, he showed predominantly obstructive sleep apnea and an apnea index (AI) of 57.5, and was diagnosed as having obstructive sleep apnea syndrome (OSAS). However, AI values calculated separately for the time in the supine position (AI-S) and in the lateral decubitus position (AI-L) were 82.4 and 5.9, respectively. Moreover, duration of apnea, lowest SaO2, and the quality of sleep were improved when sleeping in the lateral compared to the supine position. After weight reduction of 7 kg, AI in total decreased to 33.2, although AI-S was 77.3 and AI-L was 3.8. The improvement of AI in total to be due to a relative increase during sleep in the lateral position. These results suggest that in some OSAS patients, the sleep position should be taken into account in assessing the severity of the disease or in evaluating the effects of therapy. This study also suggests the efficacy of sleep position adjustment in the treatment of OSAS.

Adult↗
PubMed1993

Validation of automated sleep stage and apnoea analysis in suspected obstructive sleep apnoea.

Full-night polysomnography is necessary for the diagnosis of obstructive sleep apnoea (OSA). However, analysis of the sleep stages and apnoeas is time-consuming. Computer systems for automated analysis have, thus, been developed to alleviate this task. We investigated 27 consecutive patients referred to our sleep laboratory with suspected OSA. The analysis of sleep stages and apnoeas was performed by visual scoring, according to Rechtschaffen and Kales, and by commercially available automated analysis device. The mean difference between visual scoring and automated analysis was -1, 111, -140, -3, 1 and 27 min, for sleep stages awake, I, II, III, IV and rapid eye movement (REM) respectively. For the apnoea index, the automated analysis rated a lower figure (mean difference 7.h-1, 95% confidence interval 2-12.h-1). The diagnosis of OSA was performed with a sensitivity of 85% and a specificity of 93% by automated analysis. Comparison of two independent handscores showed good agreement, with a mean difference of 6, 4, 3, -7, 1 and -1 min, for sleep stages awake, I, II, III, IV and REM, respectively. In conclusion, the automated analysis underestimates stage I sleep and the apnoea index. Visual scoring is advisable for control of the results. Automated analysis should only be used by those who are able to perform a visual analysis.

Aged↗
PubMed1996

Expiratory flow limitation during sleep in heavy snorers and obstructive sleep apnoea patients.

Inspiratory flow limitation (FL) during sleep has previously been reported both in obstructive sleep apnoea (OSA) patients and heavy snorers (HS). Recent results from this laboratory have shown the occurrence both of inspiratory and expiratory flow limitation during muscular relaxation in awake healthy subjects and OSA patients. In this study, we have investigated whether expiratory flow limitation occurs during sleep in heavy snorers and in patients with OSA. We studied four nonapnoeic, heavy snorers and five OSA patients. Airflow was measured with a pneumotachograph attached to a tight-fitting mask, and supraglottic pressure with a catheter placed at the supraglottic level. Scoring for flow limitation was achieved by visual inspection of 200 breaths recorded during sleep. About 20% of the respiratory cycles presented isolated inspiratory flow limitation. Approximately the same percentage was observed in heavy snorers and OSA patients. Isolated expiratory flow limitation was less frequently recorded. Coupled inspiratory and expiratory flow limitations were more numerous, especially in heavy snorers. We conclude that both in heavy snorers and obstructive sleep apnoea patients, inspiratory flow limitation is associated with expiratory flow limitation. This suggests that upper airway obstruction during sleep is both an inspiratory and expiratory event.

Adult↗
PubMed2002

[Relationship of changes in sleep architecture and cognitive function in patients with obstructive sleep apnea syndrome].

OBJECTIVES: To explore the relationship between sleep architecture changes and cognitive impairment in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Thirty-six patients with OSAS and 18 controls were administered polysomnography and neuropsychological tests of visual regeneration, digital symbol, comprehensive memory and digital span. RESULTS: Performances on the visual regeneration test and digital symbol test in patients with OSAS were impaired significantly compared with the control group (P < 0.01). Patients' performance on the visual regeneration test was significantly associated with slow wave sleep duration (r = 0.423, P < 0.05) and that on the digital symbol test was significantly associated with REM sleep duration (r = 0.378, P < 0.05). CONCLUSIONS: Slow wave sleep and REM sleep derivation may play a role in the cognitive impairment in patients with OSAS.

Adult↗
PubMed1976

The pathophysiology of sleep disorders in pediatrics. Part I. Sleep in infancy.

In this part of the chapter we have described the characteristics of two alternating sleep states - REM and NREM sleep in preterm and full-term infants. We have indicated how individual physiologic measures, recorded during sleep, mature and become synchromized into patterns that define the sleep states. We have described abnormalities in this process and have related them to clinical populations of deviant infants. Throughout, we have emphasized the complexity of the process and the methodologic sophistication required to investigate adequately the multiple dimensions of sleep. Despite somewhat discrepant and confusing reports in the literature, we continue to believe that sleep studies will provide rewarding insights into the central nervous system functioning of the developing young infant.

Apnea↗
PubMed1976

The pathophysiology of sleep disorders in pediatrics. Part II. Sleep disorders in children.

In this part of the chapter we have used new terminology and developed a new system for classification of sleep disorders in children. We suggest that excessive daytime sleepiness should be investigated by clinicians before troubles at school necessitate referral. The narcolepsy-hypersomnia syndrome generally has not been recognized in the pediatric age group. Symptoms of excessive fear of falling asleep need to be viewed in this context. Sleep apnea-hypersomnia has received insufficient attention in the American literature. It is a syndrome that affects both adults and children with potentially disastrous cardiovascular and pulmonary complications. The relationship of the sleep apnea-hypersomnia syndrome to the sudded infant death syndrome remains speculative, although preliminary results from our longitudinal study have indicated a possible link. Both the narcolepsy-hypersomnia and the sleep apnea-hypersomnia syndromes are reviewed in detail. In contrast, we review briefly the NREM dyssomnias, including night terrors, sleepwalking, sleep talking and enuresis. All are well known to clinicians dealing with children, and we have related them to findings emanating from the sleep laboratory. We suggest that they are physiologically rather than psychogenically based and frequently represent immaturities of the central nervous system. Finally, the insomnias of childhood are presented. We emphasize that they are rare, and after ruling out organic conditions and drug-dependency syndromes, cultural styles or family stresses generally account for the majority of complaints.

Apnea↗
PubMed2002

Evaluation of sleep and driving performance in six patients with Parkinson's disease reporting sudden onset of sleep under dopaminergic medication: a pilot study.

Six patients with Parkinson's disease (PD) reporting unusually fast or sudden onset of sleep under the addition of dopamine agonists to a previous levodopa-containing therapy were examined using a sleep-wake diary, the Epworth sleepiness scale (ESS), polysomnography, multiple sleep latency tests (MSLT), a standardized vigilance test, and driving simulation. In all patients, ESS scores were increased and polysomnography showed disruption of the sleep pattern, a tendency towards poor sleep efficiency, and reduced proportions of slow- wave and rapid eye movement sleep. Pathological results in the MSLT or the vigilance test were obtained in five cases. For evaluation of driving performance, the standard deviation from the mean lane position during driving simulation was calculated. Three of five patients had clearly increased mean SDLP values. With respect to the measurement of daytime sleepiness (ESS, MSLT, vigilance test, and driving simulation), each patient had pathological results in at least two of these examinations. However, only a limited transfer of the routine vigilance assessment to driving performance was possible. In summary, this pilot study indicates that unusually fast or sudden onset of sleep in PD patients is a phenomenon of daytime sleepiness.

Adult↗
PubMed1993

Effect of some factors on sleep polygraphic parameters and subjective evaluations of sleep.

In this study a bedroom in a noisy area and one in a quiet area were used to investigate the effects of road traffic noise on sleep. Subjective sleep and objective sleep polygraphic parameters were obtained from subjects sleeping in each bedroom. Differences in these parameters at the two locations were compared. The experimental environment differed from those formerly used. The authors thus examined the influences on sleep of covariates in terms of subject differences, age differences, sex difference, differences in the order of experimental nights, set differences, and noise differences. From Spearman's rank correlation coefficient and two-way analysis of variance, subject and age differences were found to have greater effects on many sleep parameters than noise differences. Principal factor analysis was done for young and old subjects separately. The sixth factor was related to noise differences. The sleep parameter common to young and old subjects of the sixth factor was %REM.

Adult↗
PubMed1978

The diagnostic value of the short sleep EEG and other provocative methods following sleep deprivation.

One hundred and eighty-five EEGs recorded after deprivation of sleep for 24 h were evaluated. Valuable diagnostic information was found in 59% of the EEG recordings; 24% of the EEGs contained seizure activity. The duration of the stages of sleep and the frequency of seizure activity, paroxysmal sharp wave groups and localizing findings were analyzed. The sleep stages A to C (based on the Loomis scale) were reached for about equal duration by an EEG recording of 30--40 min; sleep stage D was reached only shortly and stage E was not observed. Pathological EEG findings appeared for the most part in the sleep stages A and B. Localized findings were pronounced in stage C. No significant differences pertaining to the occurrence and form of EEG patterns were found between patient groups with primary generalized seizures, psychomotor seizures or those with unclarified disturbances of consciousness. The combination of the short sleep EEG following 24 h of sleep deprivation with subsequent use of the additional provocative methods of hyperventilation, photostimulation and hydration, yielded, in all, new information in 50% of the patients. Each of these additional methods contributed nearly equally to this information.

Adult↗
PubMed2004

Effects of humid heat exposure in later sleep segments on sleep stages and body temperature in humans.

This study sought to investigate the effects of humid heat exposure in later sleep segments on sleep stages and body temperature in humans. The subjects were eight healthy males, from whom informed consent had been obtained. The experiments were carried out under three different sets of conditions: a control climate [air temperature (Ta)=26 degrees C, relative humidity (RH)=50%] (C); a humid heat climate (Ta=32 degrees C, RH=80%) (H); and a humid heat exposure in later sleep segments (C for the first 3 h 45 min, followed by a 30-min transition to H, which was then maintained for the last 3 h 45 min) (C-H). Electroencephalogram, EOG, and mental electromyogram, rectal temperature (Tre), and skin temperature (Tsk) were continuously measured. The total amount of wakefulness was significantly increased in H compared to C-H or C. Compared to C, wakefulness in C-H and H was significantly increased during later sleep segments. Tre and mean Tsk were significantly higher in H than in C-H or C. In C-H, Tsk and Tre increased to levels equal to those observed in H after Ta and RH increase. Whole body sweat loss was significantly lower in C-H and C than in H. These results suggest that humid heat exposure in the later sleep segment reduces thermal load as compared to full-night humid heat exposure. In daily life, the use of air conditioning in the initial sleep hours can protect sleep and thermoregulation.

Adult↗
PubMed2004

Sleep apnea avoidance pillow effects on obstructive sleep apnea syndrome and snoring.

UNLABELLED: The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrome. The SONA Pillow is a triangular pillow with space to place your arm under the head while sleeping on the side. Twenty-two patients with nocturnal polysomnogram (NPSG)-proven obstructive sleep apnea syndrome were included in this study; the group included 11 mild, 8 moderate, and 3 severe sleep apnea patients. All patients had a second attended NPSG performed while utilizing this specific inclined pillow. The pillow was found to be an effective and easily used treatment for mild (respiratory disturbance index [RDI] 5 to 19) and moderate (RDI 20 to 40) obstructive sleep apnea and snoring. In this group, RDI ranged from 5.1 to 35.2 and decreased on the average from 17 events per hour to fewer than 5 events per hour while utilizing the inclined pillow (<0.0001). Also, a statistically significant difference was noted in rapid eye movement (REM) RDI decrement in all patients with mild to moderate sleep apnea (p=0.001) and the increase in SaO2 was also significant (p=0.004). Overall, snoring was decreased or eliminated (p=0.017). CONCLUSION: A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea. Using this pillow also reduces snoring.

Adult↗
PubMed2005

Sleep problems and the risk for sleep disorders in an outpatient veteran population.

We used a self-report questionnaire to identify outpatients with chronic symptoms of sleep disorders and/or high pretest probability for sleep apnea as well as for restless legs syndrome (RLS), insomnia, and narcolepsy. Surveys were presented to patients waiting for an appointment in Veterans Administration (VA) Medical Center clinics in Northeast Ohio, USA. Items addressed the frequency of snoring behavior; wake time sleepiness or fatigue and history of obesity/hypertension for high risk for sleep apnea (Netzer et al. 1999), along with other symptoms, were scored as positive vs negative risk for insomnia, narcolepsy, and RLS. Of the patients offered the surveys, 886 (59.2%) provided timely responses to the questionnaire. Mean age was 62.5 years (range, 19 to 85 years); 95% were males; mean body mass index was 29.3 kg/cm(2) (range, 15.1 to 57.5 kg/cm(2)); and mean Epworth Sleepiness Scale score was 8.3 (range, 1 to 22) with 4.6% having a score >17. Of the respondents, 47.4% met high-risk criteria for sleep apnea, 41.7% for insomnia, 19% for restless leg syndrome, and 4.7% for narcolepsy. Twenty-four percent reported use of sleeping pills or bedtime alcohol. Drowsy driving >3-4 days a week or every day was reported in 5.7%. VA primary care patients have high prevalence for pretest probability for sleep apnea. This population also reports chronic symptoms for other sleep disorders and for drowsy driving.

Adult↗