Showing papers by "Michael H. Silber published in 2007"

The visual scoring of sleep in adults

Abstract: The 1968 Rechtschaffen and Kales (R & K) sleep scoring man- ual was published 15 years after REM sleep was discovered. Advances in the ensuing 28 years warranted a re-look at visual scoring of sleep stages. This paper describes the work of the AASM Visual Scoring Task Force, including methodology, a literature review and the rationale behind the new rules. Reliability studies of R & K scoring were reviewed; reliabil- ity was low for stage one and moderate for slow wave sleep. Evidence indicated that K complexes and slow waves are expressed maximal fron- tally, spindles centrally and alpha rhythm over the occipital region. Three derivations of EEG, two of electro-oculography, and one of chin EMG were recommended. Scoring by 30-second epochs was retained. New terminology for sleep stages was proposed. Attenuation of alpha rhythm was determined to be the most valid electrophysiological marker of sleep onset. Alternative measures were proposed for non-alpha generating subjects. K complexes associated with arousals were determined to be insufficient alone to define the new stage N2. No evidence was found to justify dividing slow wave sleep into two stages. No reasons were found to alter the current slow wave amplitude criteria at any age. The phenomena of REM sleep were defined. The rules for defining onset and termination of REM sleep periods were simplified. Movement time was eliminated and major body movements defined. Studies are needed to test the reliability of the new rules. Future advances in technology may require modification of these rules with time.

Pathologic gambling in patients with restless legs syndrome treated with dopaminergic agonists

Abstract: Pathologic gambling is an impulse control disorder previously reported to complicate dopamine agonist therapy in patients with Parkinson disease. It has not been described in association with dopamine agonist therapy of other conditions. We report three patients treated in our sleep disorders center who developed pathologic gambling while receiving treatment with dopamine agonists for restless legs syndrome.

Digital analysis and technical specifications.

Abstract: Digital acquisition and analysis of sleep data has become more common over the past 20 years. Many investigators have devel- oped strategies to record and analyze sleep in a quantitative way. Initial- ly, digital recording and analysis were restricted by technical limitations. With current technology, the technical limitations of computer acquisition, data storage, and analysis are less constraining, and the development of recommendations for the specifications and scoring of sleep can be more clearly guided by the goal of characterizing physiologic phenom- ena. In order to develop recommendations and specifications regarding digital acquisition and analysis, a literature search, evidence review, and standardized consensus process focused on 5 questions regarding com- puter-assisted sleep recording and analysis. These questions included: 1) the reliability of computerized scoring of sleep stages, 2) the analysis of elemental events and waveforms, 3) the physiological and/or clinical significance of digitally-analyzed signals, 4) the importance of proposed changes in standardized scoring that could incorporate digital analysis, and 5) the potential advantages and disadvantages of computerized sleep recordings. Of 154 studies identified by the search, 119 were found to be suitable for evidence review. The evidence review suggest- ed that computer scoring and quantitative analysis of sleep is still in the formative stage of development. For many technical specification deci- sions, little or no direct evidence was found, although basic engineering principles or standard practices provided some rationale which was uti- lized to develop the recommendations formulated during the subsequent UCLA/Rand standardized consensus process.

The treatment of parasomnias with hypnosis: a 5-year follow-up study.

Abstract: Study Objectives:This study involves a replication and extension of a previous one reported by Hurwitz et al (1991) on the treatment of certain parasomnias with hypnosis.Methods:Thirty-six patients...

Cataplexy Emotional Trigger Questionnaire (CETQ)--a brief patient screen to identify cataplexy in patients with narcolepsy.

Abstract: Study objectives This pilot study explored the sensitivity and specificity of a brief survey to determine the presence of cataplexy. We hypothesized that the brief questionnaire could provide a quick, sensitive, and specific screening tool to identify those patients with cataplexy, which would result in more timely referrals for further diagnostic testing. Design The pilot study utilized a brief questionnaire that was developed by including 5 questions that were found to be strong positive predictors of cataplexy from a previous 51-item cataplexy questionnaire. Setting Participants with a laboratory-confirmed diagnosis completed the questionnaire via mail correspondence or at the time of scheduled appointments in the Mayo Clinic Sleep Disorder Center, Rochester, Minn. Participants Seventy-eight patients with narcolepsy and cataplexy and 78 patients with obstructive sleep apnea completed the questionnaire. Interventions NA. Measurements and results The sensitivity, specificity, area under the curve, positive predictive value, and negative predictive value/were computed for each question individually, along with appropriate 95% confidence intervals. Conclusions The first item of the cataplexy emotional trigger questionnaire (CETQ) discriminates patients with cataplexy from controls with excellent sensitivity and specificity. The addition of the other 4 questions, in the context of question 1, did not improve specificity, area under the curve, positive predictive value, or negative predictive value but did provide useful confirmatory data. Thus, a single question provides a brief practical tool that could improve the recognition of cataplexy in the clinical setting. Depending on the circumstance, users may be interested in utilizing 1 or all 5 questions.

Multiple Skeletal Injuries Resulting From Uncontrolled Restless Legs Syndrome

Abstract: Restless legs syndrome is a common condition that results in difficulties falling and staying asleep and perception of poor sleep quality. We report a case of a 73-year-old woman with uncontrolled restless legs syndrome who spent most of the night standing and walking. As a result of her nighttime behaviors, she fell several times and sustained, on several separate occasions, fractures of both forearms, ribs, and nose. Iron replacement therapy and changing of her dopamine-agonist medications resulted in almost complete relief of symptoms. Physicians should be aware of the potential for injury in patients with uncontrolled RLS. Language: en