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At least 1,153 records · Page 64Linked to original sources

Sphincter pharyngoplasty as a treatment of velopharyngeal incompetence in young people: a prospective evaluation of effects on sleep structure and sleep respiratory disturbances.

BACKGROUND: Sphincter pharyngoplasty (SP) appears to be the more "physiologic" surgical technique to treat velopharyngeal incompetence (VPI). This procedure creates a dynamic sphincter of variable diameter and keeps the flexibility of the soft palate. SP also induces velopharyngeal size reduction, mainly in the transverse diameter, which may cause upper airway (UA) occlusions during sleep. AIM: To prospectively evaluate the effects of SP by a modified Orticochea procedure on sleep structure and sleep respiratory disturbances. METHODS: Polysomnographic studies before and after surgery in 17 consecutive patients treated by a modified Orticochea procedure SP for VPI. RESULTS: For the whole group, SP did not induce significant impairment of apnea-hypopnea index or nocturnal oxygen saturation. Slow-wave sleep (SWS) was significantly reduced after surgery (25 +/- 9% of total sleep time [TST] vs 28 +/- 9% of TST before SP [p = 0.04]). Following surgery, there was a trend for an increase in the microarousal index) (p = 0.09) and more specifically in respiratory-related microarousals. CONCLUSION: SP, although creating a clinically obvious reduction of velopharyngeal diameter, generally did not lead to the occurrence of an obstructive sleep apnea syndrome. However, we found a significant reduction of SWS quantity and a trend toward an increase in the number of cortical microarousals. These findings suggest that the reduction of UA diameter associated with the surgical technique leads to increases in respiratory effort sufficient to induce sleep fragmentation and SWS reduction, even in the absence of apneas or hypopneas.

Adolescent↗

Is sedation safe during dynamic sleep fluoroscopy of children with obstructive sleep apnea?

OBJECTIVE: Airway compromise is considered a relative contraindication for pediatric sedation. This contraindication presents a paradoxical problem when patients require sedation in preparation for imaging performed to evaluate the cause of airway obstruction. We use dynamic sleep fluoroscopy in the evaluation of children who have obstructive sleep apnea. The purpose of this study was to evaluate the success and safety of a structured sedation program for dynamic sleep fluoroscopy. MATERIALS AND METHODS: Eighty consecutive dynamic sleep fluoroscopic studies were evaluated. The type of sedation used, success rate, complications related to the sedation, and characteristics of the children studied were reviewed. Patients were sedated in accordance with our departmental sedation program guidelines. Findings on fluoroscopy were correlated with episodes of oxygen desaturation or noisy breathing. RESULTS: In all 80 cases, dynamic sleep fluoroscopy was successfully performed. Seventy-two studies were performed, with sedation supervised by the radiologist. Four patients fell asleep without sedation. In four patients, sedation was performed by an anesthesiologist (preprocedural decision). Sixty-four children (80%) had complex medical problems, and 39 (49%) had a history of previous airway surgery. All studies were considered successful. Specific diagnoses were identified in 66 children (83%). No children suffered complications or required tracheal intubation. CONCLUSION: Children with airway compromise who are being evaluated for obstructive sleep apnea can be successfully and safely sedated for dynamic sleep fluoroscopy when a structured sedation program is used.

Child, Preschool↗

The effects of acute sleep restriction and extension on sleep efficiency.

This study employed a repeated measures design to assess the relationship between sleep efficiency and time-in-bed (TIB). Fourteen subjects underwent three TIB conditions: (5 hour, 8 hour, and 11 hour), which were presented in a Latin Square design. Subjects slept a total of six nights (two nights per condition) while being monitored by a wrist actigraph to determine sleep time. Sleep efficiencies (sleep time/TIB) were analyzed with a two-way repeated-measures ANOVA. The main effect of night was not significant. The main effect of TIB and the interaction of nights and TIB were significant. In the 11-hour condition, sleep efficiency fell from night one to night two, and on night two both the 5-hour and the 11-hour conditions were significantly different from the 8-hour condition. Analysis of total sleep time (TST) yielded the same results with the addition of a significant night-to-night difference in the 5-hour condition. It was concluded that sleep efficiency systematically changes with an extension or restriction of TIB from 8 hour.

Adult↗

Two cases of premenstrual sleep terrors and injurious sleep-walking.

There are currently three recognized menstrual-related sleep disorders: premenstrual insomnia, menopausal insomnia and premenstrual hypersomnia. Another category, premenstrual parasomnia (sleep behavior disorder), is now suggested. Case 1, a 17-year-old female, presented with a 6-year history of exclusively premenstrual sleep terrors and injurious sleep-walking that began 1 year after menarche. During the four nights preceding each menses, she would scream and run from her bed. There was no history of premenstrual syndrome. Neurological evaluations had been unrevealing, apart from mild mental retardation and attention deficit disorder; there was no psychiatric history. Polysomnography 3 days before the onset of menses confirmed the diagnosis of sleep-walking. Pharmacotherapies were not satisfactory, but self-hypnosis at bedtime was rapidly effective with benefit sustained at 2.5-year follow-up. Case 2, a 46-year-old woman without psychiatric disorder, presented with a 5-year history of sleep terrors and injurious sleep-walking that initially was not menstrually related, but beginning 8 months prior to referral, she developed an exclusively premenstrual parasomnia that, after polysomnography, was partially controlled with bedtime self-hypnosis and clonazepam, 0.25 mg.

Adolescent↗

The effect of sleep position on the diagnosis of obstructive sleep apnea: a word of caution.

Sleeping in the supine position exacerbates obstructive sleep apnea. Patients sleeping off their backs during a polysomnographic study might have a normal study in spite of having a history of severe obstructive sleep apnea. This might be shown by repeating the study with the patients spending most of the study time sleeping on their backs. We report three patients illustrating this point and discuss the importance of monitoring sleep position while performing polysomnography. The effect of position in interpreting different therapeutic modes for obstructive sleep apnea should be considered.

Diagnosis, Differential↗

Granulocyte-macrophage colony-stimulating factor modulates rapid eye movement (REM) sleep and non-REM sleep in rats.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a hematopoietic cytokine that may affect various functions of the CNS because the molecule and its receptors are expressed in the brain. The present study examines the effects of GM-CSF on sleep using rats and the secretion of three neurotransmitters/hormones that are involved in sleep regulation. When infused intracerebroventricularly at doses as low as 10 pmol for 10 hr during the dark period, GM-CSF promoted predominantly rapid eye movement (REM) sleep and moderate amounts of non-REM sleep without eliciting fever. An injection of GM-CSF (3.0 pmol) into the arcuate nucleus increased the release of nitric oxide (NO) from the hypothalamus but did not alter plasma levels of growth hormone. The release of somatostatin (SRIF) from the medial basal hypothalamus was stimulated by 1 x 10(-)(11) M GM-CSF. These findings indicated that centrally administered GM-CSF stimulates SRIF release through activation of the NO system in the hypothalamus. Because SRIF promotes REM sleep, it may also mediate the effects of GM-CSF on REM sleep. The present study indicates a novel central effect of GM-CSF that modulates sleep, supporting the notion that hematopoietic cytokines also play roles in the CNS.

Animals↗

[Overview of sleep medicine and sleep respiratory disorders centers in Japan].

Sleep medicine in Japan evolved gradually, beginning with sleep research being conducted in the late 1960's exclusively on the university basis. Japan Sleep Society was founded in 1977 mainly by psychiatrists. Recently public awareness regarding sleep related breathing disorders has been raised as a result of a media campaign in Japan. However, the medical service system is unable to appropriately meet the needs of caring for sleep-disordered patients due to insufficient reimbursement and the lack of well-trained technical personnel. So far only several sleep centers existed in Japan. To make sleep be included in the mainstream of the health care system, the educational system and throughout society, many tasks remains to be done by healthcare professionals and government.

Academic Medical Centers↗

A review of sleep disorders. The history and diagnosis of sleep disorders related to the dentist.

The last 4 decades have seen the emergence of a new medical specialty, sleep medicine. In response to an unfulfilled clinical need, and fueled by better understanding of the significance of sleep disorders, sleep medicine developed medical solutions for age-old problems with sleep and wakefulness. Sleep-disordered breathing has played a central role in this story. Therapy and management offered by the dentist has become recognized as an important aspect of care for patients with SDB. Dentists who offer this service need to become acquainted with the multifactorial nature of sleep medicine to serve their patients better and to facilitate their interaction with other sleep medicine clinicians.

History of Dentistry↗

Sleep after immobilization stress and sleep deprivation: common features and theoretical integration.

The goal of the present paper is to elucidate and to resolve contradictions in the relationships among different forms of stress, sleep deprivation, and paradoxical sleep (PS) functions. Acute immobilization stress and the stress of learned helplessness are accompanied by an increase of PS, whereas the stress of defense behavior and the stress of self-stimulation cause PS reduction. Recovery sleep after total sleep deprivation performed on the rotating platform is marked by a dramatic rebound of PS although NREM (non-rapid eye movement) sleep deprivation is more prominent than PS deprivation. This PS rebound leads to a quick reversal of the pathology caused by prolonged sleep deprivation. The search activity (SA) concept presents an explanation for these contradictions. SA increases body resistance to stress and diseases, whereas renunciation of search (giving up, helplessness) decreases body resistance. PS and dreams contain covert SA, which compensates for the lack of the overt SA in the preceding period of wakefulness. The requirement for PS increases after giving up and decreases after active defense behavior and self-stimulation. Immobilization stress prevents SA in waking behavior and increases the need in PS. Sleep deprivation on the rotating platform, like immobilization stress, prevents SA, produces conditions for learned helplessness and, suppresses PS. Such a combination increases PS pressure and decreases body resistance.

Animals↗

Sleep quality in patients with fibromyalgia using the Pittsburgh Sleep Quality Index.

OBJECTIVE: To characterize and quantify the sleep complaints of patients with fibromyalgia (FM) using the Pittsburgh Sleep Quality Index (PSQI). METHODS: The PSQI was applied to 30 patients with FM according to American College of Rheumatology classification criteria and to 30 healthy controls in individual sessions under similar conditions. RESULTS: The median global PSQI scores were [median (25-75%)] 12.0 (10-16) and 3.0 (2.0-5.0) in patients with FM and controls, respectively (p < 0.001). All PSQI component scores except sleep medications were significantly higher in patients than controls. Sleep latency, sleep disturbances, and daytime dysfunction were the most frequent sleep difficulties experienced by patients with FM. CONCLUSION: Our results indicate that the PSQI is a useful instrument for characterizing and quantifying sleep disturbances in patients with FM.

Female↗

[Pharmacology of a new sleep inducer, 1H-1,2,4-triazolyl benzophenone derivative, 450191-S (II). Sleep-inducing activity and effect on the motor system].

The sleep-inducing activity and effect on the motor system of the 1H-1,2,4-triazolyl benzophenone derivative 450191-S were examined behaviorally, electroencephalographically and electro-physiologically with various species of animals and were compared with those of diazepam, nitrazepam, estazolam and triazolam. In the rhesus monkey, rabbit and rat with chronically indwelling brain electrodes, 0.6 to 3 mg/kg, p.o. of 450191-S caused a shorter latency of sleep onset, an increase of and a stable continuity of slow wave deep sleep (SWDS) with higher amplitude, and the appearance of clear spindle bursts in the slow wave light sleeping (SWLS) state with little muscle relaxation. Animals treated with nitrazepam and/or estazolam showed a smaller increase in SWDS and its unstable continuity with remarkable disturbance of gait. The doses needed to induce sleep in the rhesus monkey were 0.6 to 1 mg/kg p.o. for 450191-S, 3 mg/kg for nitrazepam, 1 mg/kg for estazolam and 0.3 mg/kg for triazolam. The cat treated with 450191-S showed the phenomena caused by benzodiazepines (BDZ), i.e., behavioral excitation and decrease of frequencies in the hippocampal theta waves. The suppressive effects of 450191-S on the EEG arousal reaction and/or blood pressure elevation induced by hypothalamic stimulation in the rabbit suggested that the inhibitory effects acted on the posterior hypothalamus to the limbic system. The inhibitory effect of 450191-S on the amygdaloid kindling in the rat was as potent as those of diazepam and nitrazepam. Successive daily oral administration of both 3 mg/kg of 450191-S and/or 3 to 6 mg/kg of nitrazepam for 15 days in the rabbit caused slight decrease of SWDS and increase of fast wave (REM) sleep (FWS). During the withdrawal period of both compounds, a slight but insignificant increase in the waking state was noticed for 1 to 2 days, but not a rebound increase of FWS. Intravenously administered 450191-S showed the same action as BDZ on the spinal reflex and the dorsal root potential of the rat; it particularly acted on the crossed extensor reflex in the same manner as the commercial BDZ sleep inducers.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

[Histochemical determination of RNA and protein in the brain during primary sleep in the frog Rana temporaria and during intermediate sleep in the turtle Emys orbicularis].

It has been shown that resting forms of the primary sleep in the frog and intermediate sleep in the tortoise (P-1, P-2 and P-3) differ from each other with respect to neurochemical characteristics. Cytospectrophotometric studies reveal the increase in the content (per one cell) and concentration of total protein and RNA in cells of the preoptic nuclei of the frog only during one of the resting forms of the primary sleep (P-3), which represents functional homologue of the intermediate sleep of reptiles and sleep of homoiothermic animals. These anabolic changes were not observed during two other resting forms of the primary sleep, this finding being consistent with divergent development of resting forms of the primary sleep in evolution of vertebrates.

Animals↗

K-complexes and sleep spindles before transient activation during sleep.

Six subjects spent three consecutive nights in the sleep laboratory. Activation phases (PATs), spontaneous K-complexes, and sleep spindles were visually detected in sleep stages 2 and 3 for nights 2 and 3. The K-complex rate was significantly greater in the 10 sec prior to the PATs than at any other time spent in stage 2 or 3. K-complexes associated with sheep spindles occurred significantly less frequently during the epochs just preceding the PATs. In all subjects, there was a sharp increase of sleep spindles associated with K-complexes when PATs did not follow within 10 sec. These results suggest that spontaneous K-complexes and sleep spindles act antagonistically with respect to the occurrence of PATs. These two phasic events are significantly related to regulating the probability of occurrence of PATs in sleep stages 2 and 3; K-complexes may reflect an organismic state leading towards PAT, whereas sleep spindles may inhibit the occurrence of PAT.

Adult↗

Effects of sleep deprivation on performance of Naval seamen: I. Total sleep deprivation on performance.

Sleep deprivation leads to impairment in performance, loss of efficiency and deterioration in mood states such as tension, depression, aggression, fatigue, confusion and vigour. These can be detrimental to combat readiness and could contribute to "battle stress". In the present study, a homogeneous group of 20 seamen under total sleep deprivation was rated 6 hourly with the Stanford Sleepiness Scale (SSS), Profile of Mood States (POMS) and a battery of performance tests including the trail making, grooved peg board, digit span, digit symbol, sea-shore rhythm, flicker fusion, dynamometer and naval tasks. With the exception of the trail making test and naval tasks, the test performance was observed to correlate significantly (P < 0.05) with the SSS. A higher sleepiness score was associated with a poorer performance in test scores. On the time trends of sleep deprivation on the performance tests measured, a dip in performance was observed in all the tests at 42 hours of sleep deprivation and continuous deterioration of performance was observed after 72 hours of sleep deprivation. The cognitive, vigilance, mood and sleepiness tests were substantially affected by sleep deprivation. Greater effect was observed in tests that involved cognition, speed and precision and smaller effect was observed in routine tasks that involved gross manual movement. The decrease in performance observed at 42 hours of sleep deprivation was 5.9 standard deviation from initial values for SSS; 3.9 for sea-shore rhythm, 3.0 for grooved peg board; 2.6 for dynamometer; 2.4 for mood; 1.8 for digit span; 1.6 for trail making and digit symbol; 1.0 for naval tasks and addition; and 0.9 for flicker fusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Sleep, sleep disorders and motor vehicle crashes.

There is wide consensus that drowsiness and sleep during driving put the driver and others at high risk for motor vehicle crashes. A large percentage of both private automobile and commercial vehicle crashes and crash fatalities are associated with the sleepy driver each year. Sleepiness in persons without sleep disorders may occur from potentially preventable causes such as sleep deprivation, drinking alcohol or taking sedative medications. Sleepiness also occurs uncontrollably in persons with certain sleep disorders. It is important, therefore, for persons to have a diagnosis of a sleep disorder, objectively confirmed with an MSLT, to be considered for restriction of driving privileges. The MSLT serves as a marker for the sleep disorder and also as evidence of effective treatment. While sleepiness is widespread, this regulation addresses only the highest risk group for attention. Proposed guidelines for sleep related disorders and driving in Wisconsin are presented with this background in mind.

Accidents, Traffic↗

[Restless legs syndrome and periodic leg movements during sleep in patients with sleep apnea--a therapeutic problem?].

Restless-legs syndrome and periodic movements during sleep are associated with sleep apnoea syndrome. Similar to sleep apnoea syndrome, restless-legs syndrome and periodic movements during sleep may cause severe hyposomnia and hypersomnia. Exact diagnosis may partly fail in severe obstructive sleep apnoea syndrome if only cardiorespiratory polygraphy is performed. Simultaneous videorecordings and EMG of mm. tibialis ant. ensure diagnosis. Therapeutic regime may be difficult due to failure or side effects, however. We report on our experience in an one-year follow-up of 12 patients with sleep apnoea syndrome and restless-legs syndrome and/or periodic movements during sleep. Despite adequate interdisciplinary initiation of therapy and monitoring, these patients are often subject to therapy changes, failures or side effects. There was no correlation between jerks and the complaints of the patients.

Aged↗

A general index of self-reported sleep: the sleep quotient.

Utilizing multiple sleep measures, a practice common to virtually all sleep assessments, poses problems both for statistical analyses in the form of inflated Type I error rate and for interpretation by the inability to specify general sleep change. A sleep quotient (SQ) is proposed that appears to overcome these problems. The paper presents archival norms for self-report sleep data, demonstrates the use of these norms in transforming novel data to standardized units, and casts the standardized score in the form of an intelligence quotient, now called a SQ, with a mean of 100 and a standard deviation of 15. Previously published data are reanalyzed by use of SQ scores, methods of interpreting SQ data are demonstrated, and advantages of SQ analyses are described. The SQ appears to be a valid, useful composite sleep index permitting the measurement of general sleep.

Adolescent↗

Periodic movements in sleep (nocturnal myoclonus): relation to sleep disorders.

Periodic movements in sleep (PMS) are stereotyped, repetitive, nonepileptiform movements of the lower extremities. A total of 409 sleep disorder patients were studied with all-night polysomnogram recording, and 53 (13%) had PMS. Such movements occurred in a wide variety of sleep-wake disorders in addition to insomnia. The prevalence and magnitude of PMS were not statistically greater in patients with insomniac disorders than in those with syndromes of excessive daytime sleepiness or other sleep-wake disorders. The results suggest that although PMS is responsible for disturbed sleep in relatively few patients, chronic sleep-wake disturbance is associated with PMS and may lead to the development of these movements.

Electroencephalography↗