Background Limited data have suggested that sleep-disordered breathing, a condition of repeated episodes of apnea and hypopnea during sleep, is prevalent among adults. Data from the Wisconsin Sleep Cohort Study, a longitudinal study of the natural history of cardiopulmonary disorders of sleep, were used to estimate the prevalence of undiagnosed sleep-disordered breathing among adults and address its importance to the public health. Methods A random sample of 602 employed men and women 30 to 60 years old were studied by overnight polysomnography to determine the frequency of episodes of apnea and hypopnea per hour of sleep (the apnea-hypopnea score). We measured the age- and sex-specific prevalence of sleep-disordered breathing in this group using three cutoff points for the apnea-hypopnea score (≥ 5, ≥ 10, and ≥ 15); we used logistic regression to investigate risk factors. Results The estimated prevalence of sleep-disordered breathing, defined as an apnea-hypopnea score of 5 or higher, was 9 percent for w...

The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults

To determine whether a cumulative sleep debt (in a range commonly experienced) would result in cumulative changes in measures of waking neurobehavioral alertness, 16 healthy young adults had their sleep restricted 33% below habitual sleep duration, to an average 4.98 hours per night [standard deviation (SD) = 0.57] for seven consecutive nights. Subjects slept in the laboratory, and sleep and waking were monitored by staff and actigraphy. Three times each day (1000, 1600, and 2200 hours) subjects were assessed for subjective sleepiness (SSS) and mood (POMS) and were evaluated on a brief performance battery that included psychomotor vigilance (PVT), probed memory (PRM), and serial-addition testing, Once each day they completed a series of visual analog scales (VAS) and reported sleepiness and somatic and cognitive/emotional problems. Sleep restriction resulted in statistically robust cumulative effects on waking functions. SSS ratings, subscale scores for fatigue, confusion, tension, and total mood disturbance from the POMS and VAS ratings of mental exhaustion and stress were evaluated across days of restricted sleep (p = 0.009 to p = 0.0001). PVT performance parameters, including the frequency and duration of lapses, were also significantly increased by restriction (p = 0.018 to p = 0.0001). Significant time-of-day effects were evident in SSS and PVT data, but time-of-day did not interact with the effects of sleep restriction across days. The temporal profiles of cumulative changes in neurobehavioral measures of alertness as a function of sleep restriction were generally consistent. Subjective changes tended to precede performance changes by 1 day, but overall changes in both classes of measure were greatest during the first 2 days (P1, P2) and last 2 days (P6, P7) of sleep restriction. Data from subsets of subjects also showed: 1) that significant decreases in the MSLT occurred during sleep restriction, 2) that the elevated sleepiness and performance deficits continued beyond day 7 of restriction, and 3) that recovery from these deficits appeared to require two full nights of sleep. The cumulative increase in performance lapses across days of sleep restriction correlated closely with MSLT results (r = -0.95) from an earlier comparable experiment by Carskadon and Dement (1). These findings suggest that cumulative nocturnal sleep debt had a dynamic and escalating analog in cumulative daytime sleepiness and that asymptotic or steady-state sleepiness was not achieved in response to sleep restriction.

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Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night

Objective. To assess the impact of sleep-associated gas exchange abnormalities (SAGEA) on school academic performance in children. Design. Prospective study. Setting. Urban public elementary schools. Participants. Two hundred ninety-seven first-grade children whose school performance was in the lowest 10th percentile of their class ranking. Methods. Children were screened for obstructive sleep apnea syndrome at home using a detailed parental questionnaire and a single night recording of pulse oximetry and transcutaneous partial pressure of carbon dioxide. If SAGEA was diagnosed, parents were encouraged to seek medical intervention for SAGEA. School grades of all participating children for the school year preceding and after the overnight study were obtained. Results. SAGEA was identified in 54 children (18.1%). Of these, 24 underwent surgical tonsillectomy and adenoidectomy (TR), whereas in the remaining 30 children, parents elected not to seek any therapeutic intervention (NT). Overall mean grades during the second grade increased from 2.43 ± 0.17 (SEM) to 2.87 ± 0.19 in TR, although no significant changes occurred in NT (2.44 ± 0.13 to 2.46 ± 0.15). Similarly, no academic improvements occurred in children without SAGEA. Conclusions. SAGEA is frequently present in poorly performing first-grade students in whom it adversely affects learning performance. The data suggest that a subset of children with behavioral and learning disabilities could have SAGEA and may benefit from prospective medical evaluation and treatment.

Sleep-disordered breathing and school performance in children

A monograph communicating the current realities and future possibilities of unifying basic studies on anatomy and cellular physiology with investigations of the behavioral and physiological events of waking and sleep. Steriade established the Laboratory of Neurophysiology at Laval U., Quebec; McCarl

Brainstem control of wakefulness and sleep

The electroencephalographic records from 43 subjects who slept for four consecutive nights in a laboratory environment were studied in an effort to describe the First Night Effect. These records showed that the first night of laboratory sleep contains more awake periods and less Stage I-rapid eye movement sleep. There is a delay in the onset of Stages IV and I-REM and the sleep is more changeable. These effects rapidly adapt out by the second night of sleep.

The first night effect: an EEG study of sleep.

Comparison of stage four and 1-rem sleep deprivation.

Eight young male subjects were permitted to sleep only 3 hours out of each 24 for 8 days. Electroencephalographic recordings were made during the 3-hour period of sleep. There was an increase in the amount of deep sleep (stage 4) during this period. On a recovery night, the first 6 hours revealed a significant increase in deep sleep, and beyond this period there was a sharp increase in stage 1-rapid eye movement sleep.

https://science.sciencemag.org/content/sci/150/3704/1745.full.pdf

Sleep: Effects of a Restricted Regime

Introduction IT IS A common clinical impression that depressed patients obtain less sleep, experience early morning awakening, and complain of less restful sleep. Diaz-Guerrero et al 5 studied the sleep of six manic-depressive psychotics, depressive type, by recording their all-night electroencephalogram (EEG). They report that, after excluding the waking record time, the patients had twice as much low voltage recording of light sleep as controls, half as much spindles plus random, and more sleep depth changes. Oswald et al 7 studied the effect of heptabarbital on six depressed patients and six controls by recording for each the all-night EEG and electro-oculogram (EOG) for four successive nights. The drug was administered in 400 mg doses on two of the four nights. They report no abnormality in the sleep which was characteristic of this group of depressed patients other than excessive wakefulness, which was equally

H. W. Agnew

Papers

The first night effect: an EEG study of sleep.

Comparison of stage four and 1-rem sleep deprivation.

Sleep: Effects of a Restricted Regime

The sleep of depressed patients. An EEG and eye movement study.

Sleep patterns in late middle age males: an EEG study.