ABC of sleep disorders. Sleep disorders in children.
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Child↗
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Selected sleep disorders: restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy.
Sleep disorders, including restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy, are prevalent medical conditions, likely to be seen by practicing psychiatrists. Awareness of these conditions and their presentations, pathophysiology, and treatment allows psychiatrists to treat these conditions where appropriate, to minimize complications and health consequences associated with delayed diagnosis, and to reduce the burden of disease that these conditions may place on patients already experiencing primary psychiatric disorders.
Continuous Positive Airway Pressure↗
Sleep disorders: sleep apnea and narcolepsy.
Symptoms of obstructive sleep apnea, a potentially life-threatening disorder, include excessive daytime sleepiness and sleep attacks, nocturnal breath cessation, and snorting and gasping sounds. These symptoms usually become manifest before age 40 and cluster within a few years. Most patients are obese, hypertensive men who eventually develop cardiovascular abnormalities. If sleep apnea is suspected based on clinical information, a sleep laboratory evaluation is indicated. For severe obstructive sleep apnea, tracheostomy is the most effective treatment. Narcolepsy, another sleep disorder, is a life-long and usually disabling condition. In most narcoleptic patients the first symptoms develop during childhood or adolescence, yet many years pass before the proper diagnosis is made. The presence of sleep attacks together with auxiliary symptoms, particularly cataplexy, is diagnostic. Treatment of narcolepsy includes stimulants in combination with therapeutic naps for sleep attacks and tricyclic drugs for cataplexy.
Humans↗
[Thymoleptic therapy of sleep disorders. Sleep registration following opipramol administration].
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Adult↗
ABC of sleep disorders. Sleep and sleep problems in elderly people.
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Aged↗
ABC of sleep disorders. Sleep problems in patients with medical illness.
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Adult↗
Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis.
OBJECTIVE: To conduct a systematic review of the efficacy and safety of exogenous melatonin in managing secondary sleep disorders and sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder. DATA SOURCES: 13 electronic databases and reference lists of relevant reviews and included studies; Associated Professional Sleep Society abstracts (1999 to 2003). STUDY SELECTION: The efficacy review included randomised controlled trials; the safety review included randomised and non-randomised controlled trials. QUALITY ASSESSMENT: Randomised controlled trials were assessed by using the Jadad Scale and criteria by Schulz et al, and non-randomised controlled trials by the Downs and Black checklist. DATA EXTRACTION AND SYNTHESIS: One reviewer extracted data and another reviewer verified the data extracted. The inverse variance method was used to weight studies and the random effects model was used to analyse data. MAIN RESULTS: Six randomised controlled trials with 97 participants showed no evidence that melatonin had an effect on sleep onset latency in people with secondary sleep disorders (weighted mean difference -13.2 (95% confidence interval -27.3 to 0.9) min). Nine randomised controlled trials with 427 participants showed no evidence that melatonin had an effect on sleep onset latency in people who had sleep disorders accompanying sleep restriction (-1.0 (-2.3 to 0.3) min). 17 randomised controlled trials with 651 participants showed no evidence of adverse effects of melatonin with short term use (three months or less). CONCLUSIONS: There is no evidence that melatonin is effective in treating secondary sleep disorders or sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder. There is evidence that melatonin is safe with short term use.
Adolescent↗
Practice parameters for the use of actigraphy in the clinical assessment of sleep disorders. American Sleep Disorders Association.
These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America for the use of actigraphy in the clinical assessment of sleep disorders. The American Sleep Disorders Association has produced these guidelines, based upon a critical review of the scientific literature, regarding the use of actigraphy in the clinical evaluation of sleep disorders. Though not indicated for the routine assessment of sleep disorders, actigraphy may be a useful adjunct, in certain circumstances, to a detailed history and examination when demonstration of multiday rest-activity patterns is necessary to diagnose, document severity, and guide proper treatment of sleep disorders.
Circadian Rhythm↗
Sleep disorders.
Sleep disorders occupay an important position among the pathologies which may precede the appearance of headache. Some authors consider sleep disorders an expression of a functional, biochemical and/or neurotransmission alteration at central nervous system level. Sleep disorders may be distinguished, according to the Association Sleep Disorders classification in: alteration of the sleep-awake cycle, hypersomnia, parasomnia, insomnia. We observed 1876 normal children ranging from 3 to 14 years of age, 1073 (60.4%) of whom presented sleep disorders. Few studies have been carried out on the incidence of sleep disorders on casistics of healthy children. Date reported in literature state that sleep disorders do not exceed 25% of cases that is not more than one child out of four presents sleep disorders. This percentage is much lower than the 60.4% rate observed by us in children suffering from primary headache. Our results stress the importance of sleep disorders as a cephalalgic risk factor.
Child↗
Daytime predictors of sleep disordered breathing in children and adolescents with neuromuscular disorders.
Sleep disordered breathing with or without nocturnal hypercapnic hypoventilation is a common complication of respiratory muscle weakness in childhood neuromuscular disorders. Nocturnal hypercapnic hypoventilation as a sign of respiratory muscle fatigue, portends a particularly poor prognosis. We aimed at identifying daytime predictors of sleep disordered breathing at its onset and sleep disordered breathing with nocturnal hypercapnic hypoventilation. Forty-nine children and adolescents (11.3+/-4.4 years) with progressive neuromuscular disorders were studied with inspiratory vital capacity, peak inspiratory pressure, arterial blood gases, polysomnography, and a ten-item symptoms questionnaire. Daytime respiratory function was prospectively compared with polysomnographic variables. Sleep disordered breathing was found in 35/49 patients (71%). Twenty-four (49%) had sleep disordered breathing with nocturnal hypercapnic hypoventilation. Inspiratory vital capacity and peak inspiratory pressure, but not symptom score, correlated with sleep disordered breathing and severity of nocturnal hypercapnic hypoventilation. Sleep disordered breathing-onset was predicted by inspiratory vital capacity<60% (sens. 97%, spec. 87%). Sleep disordered breathing with nocturnal hypercapnic hypoventilation was predicted by inspiratory vital capacity<40% (sens. 96%, spec. 88%) and PaCO(2)>40 mmHg (sens. 92%, spec. 72%,). Sleep disordered breathing can reliably be predicted from simple daytime respiratory function tests, which, if applied systematically, will improve recognition of nocturnal respiratory failure.
Adolescent↗
Overview of sleep disorders.
Sleep disorders are common and can affect anyone, from every social class and every ethnic background. It is estimated that more than 70 million Americans are afflicted by chronic sleep disorders. Currently about 88 sleep disorders are described by the International Classification of Sleep Disorders as established by The American Academy of Sleep Medicine. This article describes the dyssomnias and parasomnias most commonly seen in the clinical setting of the sleep disorder clinic or laboratory.
Dreams↗
Melatonin for the treatment of handicapped children with severe sleep disorders.
Sleep disorders are common in children with mental retardation and neurologic disorders. Melatonin, a recently developed natural compound, has been used successfully in sleep disorders. I report my experience with melatonin in an open, prospective trial to treat circadian rhythm sleep disorder in handicapped children. The sleep disorder had been present for at least 6 months and had not responded to at least one hypnotic drug. The therapeutic response was recorded according to the average number of hours asleep per 24 hours, average number of awakening per night, average number of nights with delayed sleep onset, and average number of nights with early morning arousals. Ten consecutive children (four males, six females; age range = 1-11 years, mean 5.4) were included. Nine children had documented mental retardation that was severe in six (67%). Most had epilepsy and visual impairment (70%). All children were monitored for 4-12 months (mean 7.5 months) after the initiation of 3-mg bedtime melatonin. Most (80%) had a dramatic response to melatonin. No side effects were reported. Melatonin is a well-tolerated, safe, relatively inexpensive, and effective drug, with minimal side effects, for the treatment of severe circadian rhythm sleep disorder in handicapped children. Wider use of this drug is recommended.
Child↗
Evaluation of Sleep Expert--a computer-aided decision support system for sleep disorders.
Sleep Expert--a medical decision support system--is a prototype program, with knowledge based on the International Classification of Sleep Disorders (1990). The goal of this project was to evaluate Sleep Expert. In the evaluation project the knowledge of the program was first validated. Three physicians, experts in sleep disorders, were asked to choose 10 typical patient cases with sleep disorders, and to write a description. They also made a diagnosis for each case. Next, each expert made a diagnosis of the cases supplied by the other experts. They were not given the original diagnosis. The 'right diagnosis' (so-called majority agreement) was determined from the three diagnoses. Then the diagnosis of each expert was compared with the 'right diagnosis'. Two physicians, not experts in sleep disorders, were asked to make a diagnosis by using Sleep Expert. Compared to the 'right diagnosis' the diagnoses of each user (non-expert physician) were correct to 63 and 70% of cases, which is quite a good result, although it does not reach the level of the expert physicians (> or = 87%). The functionality of Sleep Expert was studied by using a limited inquiry. On the basis of the user inquiry Sleep Expert provided a useful clinical tool for non-experts.
Diagnosis, Computer-Assisted↗
A review of pediatric nonrespiratory sleep disorders.
Sleep problems are extremely common during childhood, from infancy to adolescence. Despite the prevalence of sleep problems, childhood sleep disorders are often underrecognized and undiagnosed, despite being either preventable or treatable. Sleep impacts almost all aspects of a child's functioning, and thus the increased recognition and treatment of sleep disorders will positively affect a child's well-being. Children experience the same broad range of sleep disturbances encountered in adults, including sleep apnea, insomnia, parasomnia, delayed sleep phase, narcolepsy, and restless legs, but their clinical presentation, evaluation, and management may differ. Although snoring and sleep apnea may be the most common indication for an overnight sleep study in a child, one quarter of children presenting to a sleep clinic for evaluation will have a second sleep diagnosis, which is often nonrespiratory in nature. Especially in children, ruling out sleep apnea is rarely the end point of the sleep evaluation. Clinicians involved in sleep medicine must be prepared to recognize, evaluate, and manage plans for sleep disorders across the lifespan of the patient. This article will provide an updated review of nonrespiratory pediatric sleep disorders within a developmental framework.
Adolescent↗
Genetics of sleep and sleep disorders.
Sleep has been observed in all vertebrates studied and in several invertebrates, notably the fruit fly Drosophila melanogaster. In all species, a substantial portion of life is spent in this behavioral state and disturbed sleep or lack of sleep has immediate negative impacts on performance and health. Although it is agreed upon that sleep fulfills a fundamental biological need, the function of sleep remains an enigma. Because the expression and regulation of sleep and some sleep disorders have strong genetic components, the recent progress in human, mouse, and fruit-fly genome sequencing projects have given rise to the expectation that the molecular pathways underlying sleep disorders and sleep regulation or even function can now be more readily identified. We review here available genetic data both from basic sleep research and sleep disorders with emphasis on recent advances in our understanding of the molecular basis of the homeostatic regulation of sleep. Recent studies in the dog, the mouse, and the fruit-fly have begun to reveal exciting new molecular pathways that regulate sleep. This illustrates that only the continued use of multiple animal models and genetic approaches will ensure a rapid progress in the relatively new field of sleep genetics.
Animals↗
An update on sleep disorders.
Sleep disorders are so common that approximately 38% of the general population complains about a current sleep problem and 52% complains about a current or past sleep problem. Psychiatric factors are prominent in virtually all sleep disorders, either as primary factors (insomnia and adult parasomnias) or as significant secondary consequences (sleep apnea and narcolepsy). The authors describe normal sleep; delineate the prevalence of sleep disorders, both those associated with psychiatric disturbance and those of organic etiology; and outline procedures for evaluation and treatment, which is multidimensional and comprises general measures, psychotherapy, and, when indicated, pharmacotherapy.
Adult↗
Genetic basis for sleep regulation and sleep disorders.
Sleep disorders arise by an interaction between the environment and the genetic makeup of the individual but the relative contribution of nature and nurture varies with diseases. At one extreme are the disorders with simple Mendelian patterns of inheritance such as familial advanced sleep phase syndrome, and at the other extreme are diseases such as insomnia, which can be associated with a multitude of medical and psychiatric conditions. In this article, we review data on the relative contribution of genetic and environmental factors in the pathogenesis of various sleep disorders. The understanding of many of these disorders has been advanced by the study of sleep and circadian rhythms in model laboratory organisms. We summarize this model system research and how it relates to human sleep disorders. The current challenge in this field is the identification of susceptibility genetic loci for complex diseases such as obstructive sleep apnea. We anticipate such identification will increase our ability to assess risk for disease before symptom onset and by doing so will shift the focus from treatment to prevention of disease.
Circadian Rhythm↗
Genes for normal sleep and sleep disorders.
Sleep and wakefulness are complex behaviors that are influenced by many genetic and environmental factors, which are beginning to be discovered. The contribution of genetic components to sleep disorders is also increasingly recognized as important. Point mutations in the prion protein, period 2, and the prepro-hypocretin/orexin gene have been found as the cause of a few sleep disorders but the possibility that other gene defects may contribute to the pathophysiology of major sleep disorders is worth in-depth investigations. However, single gene disorders are rare and most common disorders are complex in terms of their genetic susceptibility, environmental effects, gene-gene, and gene-environment interactions. We review here the current progress in the genetics of normal and pathological sleep.
Circadian Rhythm↗