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PubMed2004

Baroreflex buffering of sympathetic activation during sleep: evidence from autonomic assessment of sleep macroarchitecture and microarchitecture.

We examined the effects of sleep microstructure, ie, the cyclic alternating pattern (CAP), on heart rate (HR)- and blood pressure (BP)-regulating mechanisms and on baroreflex control of HR in healthy humans and tested the hypothesis that sympathetic activation occurring in CAP epochs during non-rapid eye movement (non-REM) sleep periods is buffered by the arterial baroreflex. Ten healthy males underwent polysomnography and simultaneous recording of BP, ECG, and respiration. Baroreflex sensitivity (BRS) was calculated by the sequences method. Autoregressive power spectral analysis was used to investigate R-R interval (RRI) and BP variabilities. During overall non-REM sleep, BP decreased and RRI increased in comparison to wakefulness, with concomitant decreases in low-frequency RRI and BP oscillations and increases in high-frequency RRI oscillations. These changes were reversed during REM to wakefulness levels, with the exception of RRI. During CAP, BP increased significantly in comparison to non-CAP and did not differ from REM and wakefulness. The low-frequency component of BP variability was significantly higher during CAP than non-CAP. RRI and its low-frequency spectral component did not differ between CAP and non-CAP. BRS significantly increased during CAP in comparison to non-CAP. BRS was not different during CAP and REM and was greater during both in comparison with the awake state. Even during sleep stages, like non-REM sleep, characterized by an overall vagal predominance, phases of sustained sympathetic activation do occur that resemble that occurring during REM. Throughout the overnight sleep period, the arterial baroreflex acts to buffer surges of sympathetic activation by means of rapid changes in cardiac vagal circuits.

Adult↗
PubMed1999

Health status in obstructive sleep apnea: relationship with sleep fragmentation and daytine sleepiness, and effects of continuous positive airway pressure treatment.

Patients with obstructive sleep apnea (OSA) have impaired health status that improves with nasal continuous positive airway pressure (nCPAP). The study reported here explored the relationships between health status, its improvement with nCPAP, sleep fragmentation, and daytime sleepiness. In the study, 51 patients (46 male, five female) ranging from nonsnorers to individuals with severe OSA (median apnea/hypopnea index [AHI] 25, 90% central range: 1 to 98) had polysomnography with microarousal scoring, respiratory arousal scoring, and measurement of pulse transit time. The Short Form-36 Health Survey (SF-36) questionnaire was administered before and after 4 wk of nCPAP treatment; daytime sleepiness was also measured before starting nCPAP. Relationships between pretreatment health status and sleep fragmentation were weak, but significant associations were found between all sleep fragmentation indices and health status improvement with nCPAP (e.g., arousals according to the criteria of the American Sleep Disorders Association versus change in the physical component summary, r = 0.44, p < 0.001). Compared with general population data, the dimensions of energy and vitality and physical role limitation were abnormal before nCPAP (p < 0.05) and normalized with treatment. Sleepiness and pretreatment SF-36 values correlated significantly (Epworth Sleepiness Scale versus energy and vitality, r = -0.47, p < 0.001; modified Maintenance of Wakefulness Test versus energy and vitality, r = 0.32, p < 0.05). We conclude that the health status of patients with OSA improves with nCPAP and this improvement correlates with sleep fragmentation severity. However, the correlation is not very close, which may reflect the improvement with nCPAP of other symptoms not directly related to disease severity.

Adult↗
PubMed1989

[Effects of noise on sleep. Part 1. Development of an automatic analysing system for all-night sleep polygraphy by microcomputer].

In order to assess the effects of noise on sleep, the authors have developed a microcomputer system which determines the sleep stage based on an all-night EEG (electroencephalogram), rapid eye movement and an EMG (electromyogram). All the polygraphic parameters for each epoch (including spindle, rapid eye movement, alpha and delta waves, and amount of muscle tension), which are necessary to determine the sleep stage, were determined by a microcomputer using a digital data processing program. Recognition of EEG waves is based on Fujimori's method with some modifications. The rules of Rechtschaffen et al. were adopted for judging sleep stage with a slight modification. Data were obtained from six healthy students of a university. Each student was polygraphed for five to six nights under various conditions of noise exposure. Judgements of the sleep stage were made by two medical doctors. Using randomly selected 10 nights' data, the agreement between judgements by the microcomputer system and by the doctor was 77%. The percentage of agreement increased to 84% for the epochs in which the two doctors agreed. It takes about one hour to determine all-night sleep stages by this system.

Adult↗
PubMed1989

[Effects of noise on sleep. Part 3. A case report of the effects of three levels of intermittent sound on sleep parameters].

One healthy twenty-eight-year old man was exposed all night to intermittent, rectangular pink noise of 5 and 10 seconds' duration 9 times per hour. The peak levels prepared were 40, 50 and 60 dB(A). One level of the noise was exposed throughout a single night. Ten non-exposed control nights were also prepared. The sleep electroencephalogram was analysed by a microcomputer system of the authors' devising. Increases of sleep latency and stage W, and decreases of the REM stage and mean sleep depth, especially in the early sleep hours, were confirmed in the sleep polygraph of the 60 dB(A) exposure but not in that of the control, 40, and 50 dB(A) exposures. It was concluded from these results that the intermittent 60 dB(A) pink noise exposure clearly disturbed sleep, and that the threshold of the effect should exist between 50 and 60 dB(A) exposure.

Adult↗
PubMed1989

Periodic leg movements in sleep following treatment of obstructive sleep apnea with nasal continuous positive airway pressure.

Periodic leg movements in sleep are shown to be a common finding in patients with OSA and may become evident or increase in severity after treatment of the OSA with NCPAP. Periodic leg movements in sleep were measured during baseline polysomnography, a NCPAP treatment trial, and a repeat NCPAP recording in 33 patients treated with NCPAP for OSA. During baseline PSG, nine patients had five or more PLMS per hour of sleep (index), while 14 patients had a PLMSI of 5 or more during the NCPAP trial and the repeat NCPAP recording. Among those patients with a PLMSI of 5 or more during repeat NCPAP studies, the PLMSI showed a significant increase from baseline to initial NCPAP (16.9 +/- 25.3 vs 39.3 +/- 29.4; p less than 0.001) and from baseline to repeat NCPAP (16.9 +/- 25.3 vs 42.9 +/- 39.8; p less than 0.05). The number of PLMS associated with electroencephalographic arousal also increased significantly from baseline to initial NCPAP (4.3 +/- 7.4 vs 9.7 +/- 8.9; p less than 0.05) and from baseline to repeat NCPAP (4.3 +/- 7.4 vs 16.5 +/- 18.6; p less than 0.05). The 14 patients with a PLMSI of 5 or more on the repeat NCPAP had significantly more stage 1 sleep and less REM sleep than 19 patients with a PLMSI of less than 5. Bilateral anterior tibialis EMG must be measured during NCPAP recordings in order to recognize sleep disruption caused by PLMS.

Electroencephalography↗
PubMed2007

Sleep stage determines the expression pattern of sleep apneas.

We report on an obese man with sleep stage-dependent apnea. His type of apnea was predominantly central during non-rapid eye movement (NREM) sleep, while it was obstructive during rapid eye movement (REM) sleep. We found significantly more and more severe apneas during REM sleep compared to NREM sleep. His apneas were remarkably reduced by position adjustment, suggesting that upper airway collapse played a key role in the induction of both types of apnea. As his apneic patterns were dependent on the sleep stages, we assumed that the balance between upper airway obstruction and instability of central respiratory control might be important in determining the expression types.

Adult↗
PubMedDate not supplied

[Changes of coefficients of sleep onset, sleep maintenance and awakenings in most common psychiatric disorders in inpatients].

INTRODUCTION: The study's purpose was to find differences of selected psychopathological syndromes according to characteristic disturbances of sleep which are present in them. METHODS: Among 194 patients (mean age: 42.27 +/- 14.15) 108 were women (mean age: 42.97 +/- 14.13) and 86 were men (mean age: 41.38 +/- 14.22). Psychiatric examination and sleep disturbance evaluation was done with the use of our own questionnaire: Multidimensional System for Evaluation of Sleep Disorders (MSESD) were performed the third day after admission to a psychiatric ward. Sleep was analysed according to coefficients which described falling asleep, sleep maintenance and awakenings. These coefficients were created according to parameters obtained from MSESD. RESULTS: Coefficients obtained from the "schizophrenic disorders" and "personality disorders" groups did not differ significantly from the average coefficients for all the patients. The common feature among other groups of patients was the elevation of the coefficient of falling asleep especially for the "organic" and "depressive" disorders groups. The most pronounced elevation of the falling asleep coefficient was detected in the "depression without somatic features" group, however this elevation was also clearly seen in the "reactive disorders" group. In the latter group all other coefficients were also significantly elevated. CONCLUSIONS: Constructed coefficients of sleep disturbances may be useful for diagnosing and differentiating the most often psychiatric disorders in inpatients.

Adult↗
PubMed1978

Effects of rapidly rotating shifts on sleep patterns and sleep structure.

Six young adult males were assigned to a rapidly rotating shift work schedule (2 d 6 am-4 pm, 2 d 4 pm-10 pm, and 2 d 10 pm-6 am). They lived in the laboratory and completed two rotations. Their nonshift activities were ad libitum including sleep times. The patterns and structure of sleep were analyzed. Shift times systematically affected sleep patterns. Within shifts, Ss slept as late as possible prior to the morning shift, went to bed shortly after the night shift, and slept approximately midway between shifts on the afternoon shift. In transitioning to a new shift, the new shift time tended to determine sleep time. Sleep was significantly longer in transitions between shifts. Sleep structure was not markedly changed.

Adolescent↗
PubMed1994

Sleep deprivation in the rat at different ambient temperatures: effect on sleep, EEG spectra and brain temperature.

To investigate the relationship between thermoregulation and sleep regulation, rats were sleep-deprived for 3 hours at two different ambient temperatures. Sleep deprivations (SD) were performed at 23 degrees C (SD-23) and at 32 degrees C (SD-32) in the beginning of the 12-h light period in animals chronically implanted with ECoG and EMG electrodes, and with epidural and hypothalamic thermistors. SD-32 enhanced cerebral temperature more than SD-23 at both brain sites. The SD-induced hyperthermia was followed by a fall of brain temperature below baseline. During recovery from either SD procedure, waking was reduced and sleep continuity increased. REM sleep was increased after SD-32. EEG slow-wave activity (spectral power density in the 0.75-4.0 Hz band) exceeded the baseline level in the first 3-h interval of recovery; however, the effects of SD-23 and SD-32 did not differ. In the same time interval, power density in the 1.25-1.5 Hz bin as well as in some bins in the theta and alpha band was higher after SD-32 than after SD-23. The increase in hypothalamic temperature during SD did not correlate with the increase in SWA during recovery. It is concluded that even a brief SD has major repercussions on recovery sleep whereas the extent of cerebral hyperthermia during SD is only a minor factor.

Animals↗
PubMed1997

An overview of sleep and common sleep problems.

The purpose of this article is to review what is currently known about healthy sleep patterns, physiological alterations during various sleep stages, and factors that affect sleep patterns. How sleep patterns are altered, either by illness or environmental situations is of major concern to nursing practice. Sleep pattern disturbances are categorized and discussed as dyssomnias, parasomnias, and sleep disorders associated with medical or psychiatric disorders. Implications for nursing research and practice are briefly addressed in the conclusion.

Humans↗
PubMed2006

The Epworth sleepiness scale: relationship to sleep and mental disorders in a sleep clinic.

BACKGROUND AND PURPOSE: Both sleep disorders and mental disorders are associated with excessive daytime sleepiness as measured by the Epworth sleepiness scale (ESS). We sought to assess the relationship between the ESS scores and mental disorders in a sleep clinic. METHODS: One hundred sixty-five consecutive new referrals to a sleep clinic completed the ESS prior to their initial visit. Mental disorders (major depression, minor depression, anxiety not otherwise specified, and panic disorder) were diagnosed with the primary care evaluation of mental disorders (PRIME-MD) questionnaire, a reliable and valid instrument. Nearly all sleep diagnoses (95%) were made by polysomnography. RESULTS: The mean ESS for the cohort was 12.3 (standard deviation (SD) 5.1). There was no difference in the mean ESS for those with and without mental disorders (12.8 vs. 12.2, P=0.48) or sleep-disordered breathing (SDB) (12.3 vs. 12.3, P=0.99). ESS scores were not different between patients with a comorbid mental disorder and SDB compared with the presence of a mental disorder or SDB alone (combination: 13.0 vs. mental disorder: 11.5 vs. SDB: 12.2, P=0.70). There was also no relationship between ESS scores and the respiratory disturbance index (RDI) (P=0.63). CONCLUSIONS: We found no relationship between ESS scores and mental disorders among referrals to a sleep clinic. ESS cannot be used to screen for mental disorders among sleep clinic patients.

Adolescent↗
PubMed1999

Why we sleep: a theoretical view of sleep function.

We propose that sleep begins within small groups of highly interconnected neurons and is characterized by altered input --> output (i-->0) relationships for any specific neuronal group. Further, experimental findings suggest that growth factors, released locally in response to neuronal activity, and acting in paracrine and autocrine fashions, induce the altered i-->0 relationships. These growth factors also act to provide the structural basis for synapses. Thus, we envision that sleep mechanisms (neural use-dependent induction of growth factors and their subsequent effects on i-->0 relationships) cannot be separated from sleep function (growth factor-induced synaptic sculpturing). This mechanism/firnction is envisioned to take place in all areas of the brain, including sleep regulatory circuits as well as throughout the cortex. Finally, the "sleep" of neuronal groups (altered i-->o relationships) is coordinated by the known sleep regulatory circuits and activational-projection systems in the brain. The theory extends and integrates existing sleep theories to cover a broader range of phenomena.

Journal Article↗
PubMed1992

Gender differences in sleep architecture in sleep apnoea syndrome.

This study compared sleep architecture in women and men with sleep apnoea syndrome. Women (n = 126) had longer sleep latencies, greater amounts of slow wave sleep, and fewer awakenings during the night than men (n = 181), despite no differences in age, RDI (Respiratory Disturbance Index) or oxygen saturation. In a subgroup of men and women treated with nasal CPAP, gender differences generally persisted. There was no difference in the complaint of daytime sleepiness between the groups, but the women reported more fatigue during the day than the men, as well as complaining about more sleep disturbance at night. We interpret these differences in terms of known gender differences in sleep architecture and sleep complaints.

Journal Article↗
PubMed1993

Symposium: Normal and abnormal REM sleep regulation: REM sleep in successful, usual, and pathological aging: the Pittsburgh experience 1980-1993.

Successful psychological and physical adaptation in late life correlates with preservation of sleep quality and physiological integrity of nocturnal EEG sleep measures. Failure to adapt is associated with loss of sleep continuity, alterations in the temporal distribution of delta wave activity, and by either a relative increase in REM sleep (e.g. in mood disorders) or a decrease in REM sleep (e.g. neurodegenerative disorders). Maintenance of sleep (particularly REM sleep) into late life may not be just a correlate, but also possibly a mechanism, of successful aging and thus necessary to the long-term maintenance of vitality and engagement in life.

Journal Article↗
PubMed1994

Effect of unilateral somatosensory stimulation prior to sleep on the sleep EEG in humans.

The hypothesis that local activation of brain regions during wakefulness affects the EEG recorded from these regions during sleep was tested by applying vibratory stimuli to one hand prior to sleep. Eight subjects slept in the laboratory for five consecutive nights. During a 6-h period prior to night 3, either the left or the right hand was vibrated intermittently (20 min on-8 min off), while prior to night 5 the same treatment was applied to the contralateral hand. The sleep EEG was recorded from frontal, central, parietal and occipital derivations and subjected to spectral analysis. The interhemispheric asymmetry index (IAI) was calculated for spectral power in nonREM sleep in the frequency range 0.25-25.0 Hz for 0.5-Hz or 1-Hz bins. In the first hour of sleep following right-hand stimulation, the IAI of the central derivation was increased relative to baseline, which corresponds to a shift of power towards the left hemisphere. This effect was most prominent in the delta range, was limited to the first hour of sleep and was restricted to the central derivation situated over the somatosensory cortex. No significant changes were observed following left-hand stimulation. Although the effect was small, it is consistent with the hypothesis that the activation of specific neuronal populations during wakefulness may have repercussions on their electrical activity pattern during subsequent sleep.

Journal Article↗
PubMed2003

Adaptation of a cardiac monitor for collection of infant sleep data and development of a computer program to categorize infant sleep state.

This article describes the adaptation of a cardiac Holter monitor to more conveniently collect and store infant sleep data. The cardiac monitor was first adapted to connect to a sleep mattress, then refined until readable infant sleep signal data were produced. System data were compared to data collected by a live observer of infant sleep (kappa = 0.84). The IRB-approved testing used newborn infants, conducted with parental consent. Development of a rule-based computer program was designed to categorize the physiologic data into infant sleep wake states. The cardiac monitor was found to be lightweight, portable, battery powered, nonintrusive, and safe for collecting infant sleep data. Preliminary assessment of the validity of the program in scoring infant sleep was compared to hand scored data (kappa = 0.76). Refinement of the system and software program is ongoing and expected to greatly facilitate the study of infant state behavior.

Diagnosis, Computer-Assisted↗
PubMed2000

Zaleplon shortens subjective sleep latency and improves subjective sleep quality in elderly patients with insomnia. The Zaleplon Clinical Investigator Study Group.

Insomnia is a frequent complaint in the elderly population. Hypnotic agents, including benzodiazepines, with longer pharmacological half-lives have been associated with side effects, including residual sedation, memory impairment, and discontinuation effects. Zaleplon is a short-acting (elimination half-life of 1 hour), non-benzodiazepine hypnotic that acts on the benzodiazepine type 1 site of the gamma-aminobutyric acid type A (GABA(A)) receptor complex. The pharmacology and pharmacokinetics of Zaleplon suggest a safety profile that is improved over other hypnotics. The objective of this placebo-controlled study was to evaluate the efficacy and safety of Zaleplon (5 and 10 mg) in elderly (> or =65 years) outpatients with primary insomnia. This was a multicenter, double-blind, randomised, placebo-controlled 2-week outpatient study. Postsleep questionnaires were used to record subjective sleep variables: sleep latency, sleep duration, number of awakenings, and sleep quality. Zaleplon significantly reduced subjective sleep latency during both weeks of the study with both 5- and 10-mg doses. Subjective sleep quality was improved for significantly more patients treated with zaleplon 10 mg than those treated with placebo during both weeks of treatment. There was a weak indication of rebound insomnia after discontinuation of treatment with the 10-mg dose, but no significant difference in common treatment-emergent adverse events across treatment groups. Zaleplon is an effective and safe hypnotic for the treatment of insomnia in the elderly.

Acetamides↗
PubMed2005

Slow-wave sleep and delta power in rapid eye movement sleep behavior disorder.

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by the loss of normal muscle atonia during REM sleep, leading to an increase of phasic muscle activity and complex motor behaviors during the night. There is some evidence that RBD patients have more of slow-wave sleep (SWS) than healthy elderly subjects. No study has looked at quantitative electroencephalogram analysis during non-REM sleep in either primary or secondary RBD. The aim of this study was to assess the increase of SWS and to analyze different electroencephalographic frequency ranges during non-REM sleep in 28 idiopathic RBD patients compared with 28 age- and sex-matched healthy volunteers. Idiopathic RBD patients spent more time in SWS (men: 1.4%; women: 5.9%) than control subjects (men: 0.4%; women: 0.6%; p = 0.004). Spectral analyses demonstrated that idiopathic RBD patients had increased all-night delta power in comparison with control subjects (p = 002). This study shows an increase of SWS and power in the delta band during non-REM sleep in idiopathic RBD patients compared with control subjects. Results are discussed about the possible nigrostriatal dopaminergic impairment in RBD patients and the association between RBD and neurodegenerative disorders.

Aged↗