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At least 1,243 records · Page 69Linked to original sources
PubMed2000

Effects of a mandibular advancement device for the treatment of sleep apnea syndrome and snoring on respiratory function and sleep quality.

In this study the fabrication of a simplified mandibular advancement device for sleep apnea syndrome was described. Its effect on respiratory function and sleep quality variables was evaluated polysomnographically in 256 patients with sleep apnea syndrome and snoring. Polysomnographic recordings were performed twice, before and after insertion of the oral appliance. The mean apneahypopnea index (AHI) decreased significantly (p < 0.0001) with the appliance to 18.2 from 43.2 without it. Responders defined by AHI < 10 were 54% and those defined as a 50% decrease of AHI were 66%. Oxygen saturation, duration of apnea, sleep efficiency, and total arousal were improved significantly after treatment without major side effects. The device improved significantly the respiratory function and sleep quality in patients with sleep apnea syndrome. Compliance was about 90% followed for 2.5 years. This appliance offers some advantages over other therapies because it is noninvasive, easy to fabricate, and well accepted by patients.

Adult↗
PubMed2001

Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study.

Associations between sleep-disordered breathing and cardiovascular disease (CVD) may be mediated by higher cardiovascular risk factor levels in those with sleep-disordered breathing. The authors examined these relations in the Sleep Heart Health Study, a multiethnic cohort of 6,440 men and women over age 40 years conducted from October 1995 to February 1998 and characterized by home polysomnography. In 4,991 participants who were free of self-reported CVD at the time of the sleep study, moderate levels of sleep-disordered breathing were common, with a median Respiratory Disturbance Index (RDI) of 4.0 (interquartile range, 1.25-10.7). The level of RDI was associated cross-sectionally with age, body mass index, waist-to-hip ratio, hypertension, diabetes, and lipid levels. These relations were more pronounced in those under age 65 years than in those over age 65. Women under age 65 years with RDI in the higher quartiles were more obese than men with similar RDI. Although the pattern of associations was consistent with greater obesity in those with higher RDI, higher body mass index did not explain all of these associations. If sleep-disordered breathing is shown in future follow-up to increase the risk for incident CVD events, part of the risk is likely to be due to the higher cardiovascular risk factors in those with higher RDI.

Adult↗
PubMed1987

Differences in sleep-wake habits and EEG sleep variables between active morning and evening subjects.

This article is a survey study, followed by an experimental study, examining the differences of sleep-wake habits and sleep electroencephalographic (EEG) variables between morning and evening type subjects (Ss). In the survey study, the Japanese version of the Horne and Ostberg Morningness-Eveningness Questionnaire and Life Habits Inventory (LHI) were administered to approximately 1,500 university students. The survey results showed that the two types were significantly different from each other in terms of retiring and arising time, sleep latency, mood on arising, nap, adequate amount of sleep, number of times of staying awake all night, and variability in bedtime, arising time, and sleep length. These results suggested that evening type Ss had more irregular and/or flexible sleep-wake habits than morning type Ss. In the experimental study, 10 morning and 11 evening type Ss were selected from the population included in the survey study, and polysomnograms were obtained. The results showed that only in rapid eye movement (REM) latency did morning type Ss significantly differ from evening type Ss. REM latency might be related to personality factors, particularly to neuroticism and anxiety.

Adolescent↗
PubMed1988

The acute effects of uvulopalatopharyngoplasty on breathing during sleep in sleep apnea patients.

Uvulopalatopharyngoplasty (UPPP) is frequently employed in the treatment of obstructive sleep apnea (OSA). Despite anecdotal reports of early post-UPPP deaths and the recommendation by some authors to perform a prophylactic tracheotomy for selected patients at the time of UPPP, there has been no systematic examination of breathing during sleep in the early post-UPPP period. In order to evaluate the early postoperative risk and the need for prophylactic tracheotomy in UPPP patients, we conducted polysomnograms (PSGs) on eight obese OSA patients on the second post-UPPP night and on another obese OSA patient on the fifth night after surgery. Postoperatively during wakefulness there was a significant increase in the alveolar-arterial oxygen gradient (p less than 0.05); in three individuals, the PaO2 was sufficiently reduced to warrant supplemental oxygen. For the group of nine patients there were no differences between the pre- and post-UPPP apnea index (AI), hypopnea index (HI), or apnea plus hypopnea index during non-rapid eye movement sleep. In individual patients, the pattern of sleep-disordered breathing events was variably altered, but there was a reciprocal relationship between the changes in AI and HI (r = 0.75; p less than 0.02). The duration of apnea in non-rapid eye movement sleep was shorter in four patients and unchanged in five patients postoperatively. Although the mean nadir of hemoglobin saturation was unchanged before and after UPPP, one patient desaturated to dramatically low levels in association with several excessively prolonged apneas post-UPPP. Desaturation was probably minimized in the three patients receiving supplemental oxygen. There were no serious adverse effects resulting directly from sleep-disordered breathing or nocturnal hemoglobin oxygen desaturation following UPPP. Our data suggest that performing a tracheotomy in a nonselective fashion in OSA patients undergoing UPPP is not warranted. In lieu of this, these individuals should be carefully monitored following surgery. In addition, patients with severe OSA and/or moderate-to-severe nocturnal hemoglobin oxygen desaturation should be considered for early postoperative PSGs as should those individuals who are more hypoxemic while awake following surgery. Patients who require supplemental oxygen postoperatively should also be studied to ensure adequate oxygenation and to monitor for acute, oxygen-related prolongation of apnea.

Adult↗
PubMed1993

Absence of REM sleep, altered NREM sleep and supranuclear horizontal gaze palsy caused by a lesion of the pontine tegmentum.

A 27-year-old woman with a mass lesion confined to the pontine tegmentum had absence of rapid eye movement (REM) sleep and abnormal nonrapid eye movement (NREM) sleep with no sleep spindles when the sole neurologic manifestation was a bilateral supranuclear horizontal gaze palsy. This study suggests that the tegmentum nuclei associated with REM sleep generation in humans and the pathways that control horizontal eye movements are closely related. Furthermore, these findings indicate that bilateral damage of the pontine tegmentum is necessary for REM sleep abolition. Interruption of connections between the tegmentum of the pons and the reticular nuclei of the thalamus could be the cause of the absence of sleep spindles.

Adult↗
PubMed1993

Infant-parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome.

Evidence suggests that infant-parent co-sleeping represents the species-wide pattern of sleep in which human infant physiology evolved. The hypothesis evaluated in this manuscript is that the co-sleeping environment may foster development of optimal sleep patterning in infants and confer other benefits, including reducing the risk of the sudden infant death syndrome (SIDS). These postulations by McKenna are considered from different perspectives by the coauthors. Using evolutionary, cross-species, crosscultural, physiological and behavioral data, our objective was to present a conceptual framework for assessing the developmental consequences of solitary sleeping and infant-parent co-sleeping.

Adult↗
PubMed2006

REM sleep behavior disorder and REM sleep without atonia in probable Alzheimer disease.

STUDY OBJECTIVE: To determine the frequency of rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia among patients with Alzheimer disease and control subjects. DESIGN: Overnight polysomnography. SETTINGS: Sleep laboratory. PATIENTS: Fifteen patients with probable Alzheimer disease (mean age +/-SD, 70.2+/-5.6) and 15 age-matched healthy control subjects (mean age +/- SD, 67.9 +/-5.4). INTERVENTION: N/A. RESULTS: Four patients with Alzheimer disease presented REM sleep with-out atonia. One of these patients had all the polysomnographic features of RBD, including behavioral manifestations during REM sleep. CONCLUSION: RBD is rare, but REM sleep without atonia is relatively fre-quent in patients with probable Alzheimer disease, a tauopathy.

Aged↗
PubMed1989

Sleep apnea, sleep disorders, and hypothyroidism.

The symptoms of hypothyroidism are protean and include apathy, somnolence, lethargy, personality change, and intellectual deterioration. Many of these symptoms may be related to hypothyroid-induced sleep disorders. Hypothyroidism is associated with abnormal ventilatory drive, abnormal sleep architecture, and sleep apnea. Central, obstructive, and mixed patterns of sleep apnea are commonly observed in hypothyroidism. A case of severe sleep apnea in a grossly myxedematous patient who improved dramatically following thyroid replacement alone is presented. Myxedema is a reversible cause of sleep apnea, and thyroid function testing should be considered in its diagnostic work-up.

Adult↗
PubMed2005

Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring.

OBJECTIVES/HYPOTHESIS: The aim of this study is to quantify the correlation between a large tongue classified by the modified Mallampati score (MMS) and obstruction at the tongue base observed during sleep endoscopy in patients with socially unacceptable snoring (SUS) and obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Prospective. METHODS: One hundred twenty-seven patients with obstructive sleep apnea and SUS underwent sleep endoscopy. Patients were classified into four specific groups according to their MMS. After intravenous administration of midazolam, obstructive events in the upper airway were classified. The level of obstruction was expressed as palatal (2), palatal and to a lesser degree base of the tongue/laryngeal level (2), tongue base/laryngeal level and to a lesser degree palatal (3), and tongue base/laryngeal level (3). The degree of correlation between the level of obstruction and the MMS was analyzed by means of Spearman's rank-order correlation. RESULTS: No linear association between the level of obstruction and MMS could be found. A large tongue (MMS 3 or 4) does not predict obstruction at the base of the tongue. Patients classified as MMS 1 or 2 did not frequently show obstruction at the base of the tongue (9 of 38, 23,6%). The majority of the population showed retropalatal obstruction. A large tongue (MMS 3 or 4) was often accompanied by retropalatal obstruction, 76% of the cases (64 of 89). CONCLUSIONS: No positive correlation exists between a large tongue and obstruction at tongue base level. In both groups, retropalatal obstruction occurred more often than retrolingual obstruction. Sleep endoscopy provides qualitative insight into important changes during sleep in patients with SUS and OSAS. In addition, anatomic aberrations are clearly visualized in a dynamic setting. Classification of the size of the tongue, as assessed by the MMS, may be of great importance as well.

Airway Obstruction↗
PubMed2004

Factors associated with maintenance of wakefulness test mean sleep latency in patients with mild to moderate obstructive sleep apnoea and normal subjects.

This study investigated the possible factors related to the Maintenance of Wakefulness Test (MWT) mean sleep latency. A second analysis explored the characteristics of subjects who had discrepant Epworth Sleepiness Scale (ESS) and MWT scores. A total of 151 subjects (110 mild to moderate obstructive sleep apnoea (OSA) patients and 41 control subjects) were recruited for the study. The subjects completed an overnight Polysomnography (PSG), MWT, cognitive, performance and vigilance tasks and answered self-report questionnaires on mood and sleepiness. A forward stepwise multiple regression was performed on MWT mean sleep latency. The predictor variables age (r = 0.28), subjective sleep history for 1 week prior to MWT (sleep diary; r = 0.19) and number of >4% SaO2 Dips during the PSG (r = -0.21) best explained the MWT results, but only accounted for 12.8% of the variance in the test. It was found that 33% of subjects had discrepant ESS and MWT scores. A new variable was created to analyse these subjects (MWT/ESS discrepancy score; MED). A forward stepwise multiple regression analysis found that depression, performance errors and sleep disordered breathing explained 13.4% of the variance in MED scores. The MWT is a complex behavioural test whose scores do not seem to have a very robust relationship with potential predictors and co-correlates. Further comprehensive study is needed if the test is to be used in a diagnostically meaningful way.

Body Mass Index↗
PubMed2004

Effect of cognitive arousal on sleep latency, somatic and cortical arousal following partial sleep deprivation.

Emerging research has shown that sleepiness, defined as the tendency to fall asleep, is not only determined by sleep pressure and time of day, but also by physiological and cognitive arousal. In this study we evaluated (i) the impact of experimentally induced cognitive arousal on electroencephalogram (EEG) defined sleep latency, and subjective, somatic and cortical arousal, and (ii) whether experimentally induced cognitive arousal enhances performance on a driving simulator test. Twelve healthy sleepers each spent three nights and the following day in the sleep laboratory: an adaptation, a cognitive arousal and a neutral testing day. In the cognitive arousal condition, a visit of a television camera crew took place and subjects were asked to be interviewed. On each testing day, a 5-min heart rate recording, subjective sleepiness and arousal scales, Multiple Sleep Latency Test and a 25-min driving simulator task were scheduled three times at 2-h intervals. Experimentally induced cognitive arousal resulted in significant increases in objective sleep latency. Significantly elevated levels of subjective and somatic arousal--as indexed by a subjective arousal scale and heart rate--were also evidenced following cognitive arousal induction. A marginally significant trend for increased cortical arousal, measured by EEG beta activity, was also found. No effects were found on driving simulator performance. These findings support the concept of cognitive arousal as a significant component in determining sleep latency. In addition, it was illustrated that cognitively induced arousal can provoke increases in somatic and possibly even cortical arousal in normal sleepers. However, this was not accompanied by an enhanced ability to perform adequately on a driving simulator test.

Adaptation, Physiological↗
PubMed2005

Cluster headache with obstructive sleep apnea and periodic limb movements during sleep: a case report.

We report the case of a man with episodic cluster headache who suffered from severe obstructive sleep apnea (OSA) as well as periodic limb movements during sleep (PLMS). His attacks of headache occurred primarily during sleep being timely to REM sleep as 90 to 120 minutes interval. OSAs were more frequent and prolonged during REM sleep and oxygen saturation decreased to 81% during this sleep period. Periodic limb movements were also observed in our patient that were more frequent during the first half of the polysomnographic recordings. This case is one of the few reporting cases with CH who had both OSA and PLMS.

Adult↗
PubMed1990

The effects of total sleep deprivation and subsequent treatment with clomipramine on depressive symptoms and sleep electroencephalography in patients with a major depressive disorder.

In the present study patients with a major depressive disorder were first subjected to total sleep deprivation (TSD) and then treated with clomipramine. Sleep electroencephalography (EEG) was registered prior to and after TSD, during the 2 initial nights of antidepressive treatment and after 19 days. A negative correlation between response to TSD and clomipramine was found. TSD did not differentially influence the sleep EEG (responders vs nonresponders): responders tended, however, to show a more classical depressive sleep pattern prior to TSD. Clomipramine profoundly suppressed rapid eye movement (REM) sleep; the amount of initial REM sleep reduction, however, did not correlate significantly with therapy response after 3 weeks of treatment.

Adolescent↗
PubMed1992

Vasopressin regulates human sleep by reducing rapid-eye-movement sleep.

In two double-blind experiments, effects of intravenous infusion of arginine vasopressin (AVP) on sleep were evaluated in 2 groups of 10 men (20-35 yr). In experiment I, subjects were tested on two occasions, during which they received either placebo or 0.33 IU/h AVP. In experiment II, on three different occasions, subjects received either placebo or 0.66 or 0.99 IU/h AVP. Infusions were administered between 2200 and 0700 h. Nocturnal plasma AVP concentrations were close to the upper limit of the normal physiological range during 0.66 IU/h AVP (16.6 +/- 2.2 pg/ml) but markedly exceeded this range during 0.99 IU/h AVP (25.0 +/- 1.6 pg/ml). Results indicate primary effects of AVP on rapid-eye-movement (REM) sleep, with moderate reductions in REM sleep during 0.33 IU/h AVP (averaging -10.5%) and with substantial reductions in REM sleep (-24.0%) during 0.66 IU/h AVP. During 0.99 IU/h AVP the effect did not further increase (-24.4%). Less consistent effects of AVP were an increase in stage 2 sleep and in time awake. Effects of AVP were not mediated by changes in cortisol or blood pressure. Results suggest AVP to participate in REM sleep regulation under normal physiological conditions.

Adult↗
PubMed1977

Gamma-aminobutyric acid (GABA) and sleep. The influence of di-n-propylacetic acid on sleep in man.

The effects of di-n-propylacetic acid (DPA) on sleep, for some years used as an anticonvulsive drug, has been investigated in 11 healthy volunteers using all-night sleep EEG recordings. DPA acts by an enhancement of the gamma-aminobutyric acid (GABA) level of the brain. Its influence on sleep seemed to be of interest on account of the metabolic relationship of GABA to other short chain fatty acids. After short-term application only a shortening of the time to fall asleep and of the waking time could be found, whereas under long-term administration a decrease in deep synchronous sleep could be observed. In contrast to the results known from animal studies no marked influence on REM sleep was observed. The action of DPA on sleep is similar to that of diphenylhydantoin. No so-called matitudinal 'hangover' could be revelaed in either drug;

Adult↗
PubMed1986

Effect of biologically active light and partial sleep deprivation on sleep, awakening and circadian rhythms in normals.

The effects of biologically active light (BL) on subjective and objective quality of sleep and awakening, as well as circadian rhythms in cortisol, temperature and well-being were studied in 10 hospitalized normal female volunteers as compared with partial sleep deprivation (PSD). After 2 adaption days, three 24-hour periods were recorded before (baseline), during (intervention) and after (recovery) treatment with BL (exposure between 5.00-9.00 p.m. and 6.00-9.00 a.m.; light sensitivity: 2,800 lx at eye level) and PSD (1.30-6.00 a.m.). Somnopolygraphic investigations demonstrated a significant improvement in sleep maintenance both after BL and PSD, while sleep induction improved only after PSD. Subjectively experienced sleep quality increased after both treatments. However, subjective and objective awakening quality (objectivated by means of psychometric test battery) was improved by BL only, while PSD produced no changes or even a deterioration. Cortisol levels tended to be lowered by BL, while the troughs increased after PSD; there was also an earlier rise in cortisol levels after PSD than BL. No significant differences were found in regard to temperature. Subjectively experienced well-being tended to improve after both interventions. Our findings concerning the beneficial effect of BL on objective and subjective quality of sleep and awakening in normals encourages us to initiate a single-dose study with BL in depressed patients.

Adult↗
PubMed1983

Correlates of adaptation to the sleep laboratory. Behavior, sleep organization, quantitative EEG.

The present study aims at establishing to what extent adaptation phenomena should be taken into consideration for the definition of an independent baseline in sleep research. To this purpose we have studied: (1) a standard battery of neuropsychological test evaluating performance, subjective assessments of moods and sleep quality; (2) classical sleep parameters; (3) data derived from quantitative analysis of sleep EEG. 19 young male volunteers have been recorded for consecutive nights; 7 of them underwent the recordings for 3, 8 for 6 and 4 for 10 nights. Results can be summarized as follows: (A) both interindividual and intraindividual variability show a progressively decreasing trend toward homogeneity for most of the explored parameters; (B) steady state is reached in different times for different groups of parameters; (C) an adequate group homogeneity was achieved from the 5th night onwards. Implications of these data in sleep studies, namely in sleep active drug research are discussed.

Adaptation, Psychological↗
PubMed1985

Exercise and subsequent sleep in male runners: failure to support the slow wave sleep-mood-exercise hypothesis.

10 male joggers participated in a 3-week experimental protocol designed to look at the effects of three levels of energy expenditure (no exercise, regular exercise, and double exercise) on mood and subsequent nocturnal sleep focusing on REM sleep and delta sleep parameters. Exercise conditions were well discriminated by daily (F(2,18) = 65.8, p less than 0.0000) mean hip activity counts during monitored field exercise and by the mean weekly body weights (F(2,14) = 7.24, p less than 0.007). Subjects slept for 2 nights in the laboratory following each exercise condition and filled out two brief, clinical self-rating scales each night prior to sleep. These two self-rating instruments together index 105 somatic and psychobiological symptoms that are subsumed by the five major clinical symptom clusters of: Depression, Mania, Anxiety, Cognitive Disorganization, and Organicity. There were no significant differences in manually scored whole-night sleep parameters with the exception of REM latency (F(2,18) = 3.63, p less than 0.05), and there were no significant differences in self-ratings of psychobiological symptoms by night or exercise condition. These results are discussed in the context of failure to support either the slow wave sleep-exercise hypothesis or the exercise-mood elevation hypothesis.

Adult↗