Showing papers in "Sleep in 1986"
1,543 citations
TL;DR: These REM sleep neurobehavioral disorders constitute another category of parasomnia, replicate findings from 21 years ago in cats receiving pontine tegmental lesions, and offer additional perspectives on human behavior, neurophysiology, pharmacology, and dream phenomenology.
Abstract: Four men, aged 67-72 years, had 4-month to 6-year histories of injuring themselves or their spouses with aggressive behaviors during sleep, often during attempted dream enactment. A 60-year-old woman had disruptive though nonviolent sleep and dream behaviors. Polysomnography did not detect seizures but did document REM sleep pathology with variable loss of chin atonia, extraordinarily increased limb-twitch activity, and increased REM ocular activity and density. A broad range of REM sleep behaviors was recorded on videotape, including stereotypical hand motions, reaching and searching gestures, punches, kicks, and verified dream movements. Stage 3-4 slow wave sleep was elevated for age in all patients. NREM sleep was devoid of harmful behaviors, although three men had periodic myoclonus. There was no associated psychiatric disorder, whereas serious neurologic disorder was closely associated in four cases: olivo-ponto-cerebellar degeneration, Guillain-Barre syndrome, subarachnoid hemorrhage, and an atypical dementia. Two patients had immediate and lasting sleep behavioral suppression induced by clonazepam, and another patient had the same response with desipramine. All instances of drug discontinuation prompted immediate relapse. In four cases there was associated dream hyperactivity, which resolved with behavioral control. These REM sleep neurobehavioral disorders constitute another category of parasomnia, replicate findings from 21 years ago in cats receiving pontine tegmental lesions, and offer additional perspectives on human behavior, neurophysiology, pharmacology, and dream phenomenology.
1,013 citations
TL;DR: One hundred fifty-five unselected obstructive sleep apneic patients seen in succession had cephalometric roentgenograms and polygraphic recordings performed and common findings were a retroposition of the mandible, a different cranial base flexure, and a displacement of the hyoid bone to a lower position than expected.
Abstract: One hundred fifty-five unselected obstructive sleep apneic patients seen in succession had cephalometric roentgenograms and polygraphic recordings performed. These patients were compared to a group of 41 subjects who had consulted orthodontists for malocclusion and had no clinical indication of sleep apnea. The cephalometric landmarks were also compared to those published as normative data in the literature. The limits of "normalcy" were conservatively defined as mean +/- 2 standard deviations. Only two obstructive sleep apneic patients had normal cephalometric landmarks and 150 of the 155 patients had at least two significantly different landmarks from the normative data in the literature. The common findings were a retroposition of the mandible, a different cranial base flexure with a nasion-sella-basion angle more acute than expected, and a displacement of the hyoid bone to a lower position than expected. These combined changes reduced the space occupied by soft tissues anchored on the skull and mandible, and the length of the soft palate was increased.
316 citations
TL;DR: It is noteworthy, therefore, that the central biochemical changes induced by GHB also appear comparable to those found naturally in narcolepsy.
Abstract: Previous studies on the effects of gamma-hydroxybutyrate (GHB) on the sleep and clinical response of patients with narcolepsy are reviewed. New information on 48 patients treated with GHB for as long as 9 years is presented. These studies indicate that 2.25 to 3.00 g of GHB, taken in conjunction with a low dose of a stimulant during the day, rapidly alleviate the symptoms of narcolepsy in most patients. Tolerance does not develop to this treatment regimen; neither have any patients discontinued the treatment because of side effects. In poor responders, daytime drowsiness and not cataplexy has been the most common residual symptom. Sleep studies reveal that GHB induces REM followed by slow wave sleep. Although total sleep time at night may be unchanged, sleep is less fragmented. GHB appears to be effective because it can induce the symptoms of narcolepsy and contain them at night. It is noteworthy, therefore, that the central biochemical changes induced by GHB also appear comparable to those found naturally in narcolepsy.
227 citations
TL;DR: It was concluded that the frequency of DM among randomly selected narcoleptic patients was significantly increased, and the positive results for diabetes in six patients with definite diabetes mellitus could not be attributed to obesity, because there was no difference between the obesity indices of DM and nonDM narcoLEptic patients.
Abstract: Forty-eight narcoleptic patients were randomly selected from a group of 197 narcoleptic outpatients, and a 50-g oral glucose tolerance test (OGTT) was performed. Blood glucose levels were determined by oximetry before and 30, 60, and 120 min after the glucose administration. Serum insulin concentrations (IRI) were determined by enzyme immunoassay, and an insulinogenic index (II) was calculated. (II = the ratio of IRI increment to blood glucose increment in 30 min following glucose load). From the results of the OGTT, six patients with definite diabetes mellitus (DM) were identified (12.5%, 4 men and 2 women) according to World Health Organization criteria (1980). The II of the DM patients was significantly low, with an average of 0.13 +/- 0.03. From recent data in the literature on the prevalence of DM in the general Japanese adult population (1.75-5.5%), it was concluded that the frequency of DM among our randomly selected narcoleptic patients was significantly increased. The positive results for diabetes in our six narcoleptic patients could not be attributed to obesity, because there was no difference between the obesity indices of DM and nonDM narcoleptic patients, nor was there a difference between the frequency of DM in obese and nonobese patients.
144 citations
TL;DR: PPI patients and Ns revealed less psychopathology than DD patients on almost all psychological scales, and PPIs typically had difficulties initiating and maintaining sleep, as did the DDs, but showed normal sleep staging.
Abstract: Persistent psychophysiologic (learned) insomnia (PPI) is an objectively verifiable sleep disturbance that develops secondary to chronic, somatized tension and negative conditioning. Twenty-two patients diagnosed as PPI were compared on sleep and psychological questionnaires to 22 normal subjects (Ns) and to 19 insomnia patients with dysthymic disorders (DD). PPI patients typically had difficulties initiating and maintaining sleep, as did the DDs, but showed normal sleep staging. While PPIs were similar to Ns on most psychological tests, they typically were repressors and sensation avoiders. Many PPI patients suffered from tension-related symptoms such as headaches. PPI patients and Ns revealed less psychopathology than DD patients on almost all psychological scales.
144 citations
TL;DR: Experimental evidence shows that thermoregulatory mechanisms influence the waking-sleeping cycle in both the absence or the presence of a thermal load.
Abstract: Studies on the interaction between sleep and thermoregulation are reviewed with regard to the processes underlying the ultradian evolution of behavioral states. The experimental evidence shows that thermoregulatory mechanisms influence the waking-sleeping cycle in both the absence or the presence of a thermal load. Such a control appears to be a functional necessity to maintain physiological homeostasis.
127 citations
TL;DR: It is argued that in pathophysiological terms narcolepsy may best be considered a disease of state boundary control.
Abstract: The main disabling symptom of narcolepsy-cataplexy is shown to be the unrelenting excessive daytime sleepiness (EDS) based upon controlled studies of socioeconomic effects and the poor response to treatment. Objective performance deficits mainly involve tests of ability to sustain performance on repetitive boring tasks and are reversible by improved alertness. Physiologically, EDS is seen to represent relatively slow waxing and waning of alertness rather than punctate microsleeps. Evidence is provided for complex cerebral evoked potentials (P300, contingent negative variation) being very sensitive EDS measures comparable to the multiple sleep latency test (MSLT). EDS appears to have qualitatively somewhat different forms mainly reflecting pressure for REM sleep (REM sleepiness) or pressure for NREM sleep (NREM sleepiness), which have different effects on cerebral evoked potentials as well as subjective and objective (MSLT) differences. It is argued that in pathophysiological terms narcolepsy may best be considered a disease of state boundary control.
123 citations
TL;DR: A test for unintentional sleep suggested that poor sleep function in insomniacs is related to deficient sleep-controlling mechanisms, rather than psychological trait and state factors.
Abstract: A comparison was made between 16 middle-aged chronic insomniacs and 16 normal sleepers, matched by age and sex, in a psychophysiological study, including polysomnographic night sleep recordings, MMPI personality profiles, testing of cognitive performance, and relaxation capability during daytime. Both objective and subjective criteria of night sleep demonstrated a clear separation of the two groups. Insomniacs had psychosomatic personality profiles. A test for unintentional sleep suggested that poor sleep function in insomniacs is related to deficient sleep-controlling mechanisms, rather than psychological trait and state factors. Only sleep onset difficulties were susceptible to situational factors. Daytime performance was not generally impaired in insomniacs, but they had greater difficulties in the morning. Subjective daytime sleepiness was significantly higher and might represent a particular psychological problem for active behavior. Interrelations of various deficiencies in sleep-wake behavior seem to delineate specific aspects of the chronic insomniac syndrome.
115 citations
TL;DR: It was concluded that HLA-DR2 is a prerequisite for the development of narcolepsy and that the diagnosis of nar colepsy can be excluded if HLA/Dw2 is negative, and the distinction between idiopathic and symptomatic narCOlepsy needs to be reconsidered.
Abstract: Studies on HLA antigens were conducted in several patient populations with the following findings: (a) All 135 Japanese narcoleptic patients, eight of whom were considered to have "symptomatic" narcolepsy, were found to be HLA-DR2 and HLA-DQw1 positive. All 17 members of a subgroup of the original population were also found to be HLA-Dw2-positive. It was concluded that HLA-DR2 is a prerequisite for the development of narcolepsy and that the diagnosis of narcolepsy can be excluded if HLA-DR2 or HLA-Dw2 is negative. The distinction between idiopathic and symptomatic narcolepsy needs to be reconsidered. (b) Haplotype studies in three families with narcoleptic members enabled detection of children at high risk for narcolepsy. (c) Of the 54 patients with disorders of excessive daytime sleepiness other than narcolepsy, those with essential hypersomnia (EHS) had a higher frequency of HLA-DR2; the others had a lower frequency. The DR2-positive EHS group could include members with an incomplete form of narcolepsy; the DR2-negative EHS group had disorders essentially different from narcolepsy, although both positive and negative groups manifested hypnagogic hallucinations, sleep paralysis, and sleep onset REMs. Two further studies were conducted in subgroups of the original narcoleptic population studied. In a subgroup of 30 patients who underwent lymphocyte subset studies, no T-cell abnormalities were detected; it is unlikely that an autoimmune mechanism is involved in the development of narcolepsy. In a subgroup of 33 narcoleptic patients, Southern's blot analysis of DNA using a DQ beta probe revealed three specific restriction fragments. Further studies are necessary to locate the DNA locus that carries the susceptibility gene for narcolepsy.
113 citations
TL;DR: In this paper, a 5-year study of patients with a primary diagnosis of narcolepsy or idiopathic CNS hypersomnia seen at Stanford University Sleep Disorders Clinic over a five-year period were studied retrospectively.
Abstract: Patients with a primary diagnosis of narcolepsy or idiopathic CNS hypersomnia seen at Stanford University Sleep Disorders Clinic over a 5-year period were studied retrospectively. The two patient groups were compared with respect to blood pressure, Minnesota Multiphasic Personality Inventory (MMPI) psychological profile, nocturnal sleep structure, prevalence and severity of sleep apnea and periodic leg movements in sleep, and daytime sleep tendency. Narcoleptic patients tended to have higher blood pressure, higher prevalence of abnormally elevated MMPI scores, more abbreviated and more disrupted sleep at night, and greater daytime sleep tendency. Sleep apnea and periodic leg movements were more prevalent in narcoleptic patients, but only periodic leg movements in sleep were more prevalent in narcoleptic patients than in the general population. Periodic leg movements during REM sleep were observed in more than one-third of narcoleptic patients, which may be an important pathophysiologic feature of this disorder.
TL;DR: This up-regulation of brainstem cholinergic receptors suggests a problem with release of acetylcholine, which, together with previous reports of an impairment of dopamine release, may be indicative of a fundamental membrane problem in narcolepsy.
Abstract: The role of the muscarinic cholinergic receptor in narcolepsy was examined using radioligand binding to various brain regions of normal and genetically narcoleptic Doberman pinschers. In this multi-litter study, a previous report of a proliferation of muscarinic cholinergic receptors in the brainstem was confirmed, and the concentration of the M2 receptor subtype, in particular, was elevated. This up-regulation of brainstem cholinergic receptors suggests a problem with release of acetylcholine, which, together with previous reports of an impairment of dopamine release, may be indicative of a fundamental membrane problem in narcolepsy.
TL;DR: The data support clinical reports that clonazepam, a benzodiazepine marketed for the indication of seizure, is useful in improving sleep disturbances associated with nocturnal myoclonus and suggest the need for a model that explains why leg movements and sleep disturbances may wax and wane independently.
Abstract: Clonazepam (1 mg hs) and temazepam (30 mg hs) were studied in 10 patients diagnosed as having insomnia with nocturnal myoclonus Each subject underwent two nocturnal polysomnographic recordings while drug-free, two during treatment with clonazepam, and two during treatment with temazepam Treatment sessions were 7 days long, and recordings were done on nights 6 and 7 of the treatment sessions A 14-day washout period separated the treatment sessions The order of drugs used in the first and second treatment sessions was randomized Objective and subjective sleep laboratory data showed that both drugs improved the sleep of patients with insomnia in association with nocturnal myoclonus Neither drug significantly reduced the number of nocturnal myoclonic events Sleep changes were consistent with those produced by sedative benzodiazepines in general Thus, the data support clinical reports that clonazepam, a benzodiazepine marketed for the indication of seizure, is useful in improving sleep disturbances associated with nocturnal myoclonus Temazepam, a benzodiazepine marketed for the indication of insomnia, was found to be a suitable alternative to clonazepam in the treatment of insomnia associated with nocturnal myoclonus The present data and other studies suggest the need for a model that explains why leg movements and sleep disturbances may wax and wane independently
TL;DR: It is suggested that the ability of older women to achieve slow wave sleep and to have long uninterrupted sleep in greater than that of men.
Abstract: Elderly women had better recovery sleep than elderly men following 36-h sleep deprivation, as evidenced by higher sleep maintenance/efficiency and more slow wave sleep (particularly in the amount of stage 4 sleep). During recovery sleep, both groups showed REM latency reduction (two men and three women had seven sleep-onset REM periods out of a total of 40 recovery nights), decrease in percentage of early REM sleep and increase in whole-night REM sleep time. Total Mood Disturbance scores on the Profile of Mood States increased in both men and women following sleep deprivation (reflecting a decrease in vigor and increase in fatigue and tension). While the increase tended to be greater in women, in both groups self-ratings of mood returned to baseline after 1 night of recovery sleep. These observations underscore the importance of gender in determining late-life sleep structure and suggest that the ability of older women to achieve slow wave sleep and to have long uninterrupted sleep in greater than that of men.
TL;DR: The results indicated that the descending noradrenaline locus coeruleus fibers and the "longitudinal catecholamine bundle," which course through the dorsal tegmentum, are not necessary for the generation of muscle atonia or the state of paradoxical sleep.
Abstract: A retractable wire knife was employed to transect the reticular formation at the pontomedullary junction in order to assess the respective importance of pontine and medullary reticular neurons and their pathways in paradoxical sleep. Thirteen cats were implanted with a standard array of electrodes for polygraphic recording of sleep-wakefulness states during 3 days in baseline condition and during 21 days after transections. Average electroencephalographic (EEG) amplitude, average electromyographic (EMG) amplitude, and ponto-geniculo-occipital (PGO) spike rate were measured per 1-min epoch for each day. A trivariate computer graphics display of 1 day's data revealed three major clusters of points that corresponded to wakefulness, slow wave sleep, and paradoxical sleep in baseline. (a) After transections through the entire reticular formation at the pontomedullary junction, paradoxical sleep was no longer evident in the trivariate computer graphics or polygraphic record, either by the presence of a high PGO spike rate or by that of muscle atonia in association with a low-amplitude EEG. These results indicated that the reticular fibers that pass through the pontomedullary junction and interconnect the pontine tegmentum and the medullary reticular formation are necessary for generating the cluster of electrographic variables that normally characterizes paradoxical sleep. (b) After transections through the dorsal half of the reticular formation, paradoxical sleep was still evident, though with a reduced PGO spike rate, and muscle atonia was normal. These results indicated that the descending noradrenaline locus coeruleus fibers and the "longitudinal catecholamine bundle," which course through the dorsal tegmentum, are not necessary for the generation of muscle atonia or the state of paradoxical sleep. (c) After transections through the ventral half of the reticular formation, paradoxical sleep was still apparent by the association of a moderate, though reduced, rate of PGO spiking in association with low-amplitude EEG activity and a high-amplitude EMG, indicating a loss of muscle atonia. The duration of the PS episodes, however, was greatly reduced. These results indicated that the descending "tegmentoreticular" and ascending reticulotegmental pathways, which course ventrally through the pontomedullary junction and interconnect the dorsolateral pontine tegmentum and the ventromedial medullary reticular formation, are essential for the muscle atonia of paradoxical sleep and important for the normal cyclic generation and maintenance of the state of paradoxical sleep.
TL;DR: It is reported that there is no significant positive correlation between the residuals of alpha and rho, contrary to the prediction of restorative models of sleep duration and much-needed tests of mathematical models of the sleep-wake cycle.
Abstract: During prolonged temporal isolation in caves or windowless rooms, human subjects often develop complicated sleep-wake patterns. Seeking lawful structure in these patterns, we have reanalyzed the spontaneous timing of 359 sleep-wake cycles recorded from 15 internally desynchronized human subjects. The observed sleep-wake patterns obey a simple rule: The phase of the circadian temperature rhythm at bedtime determines the lengths of both prior wake (alpha) and subsequent sleep (rho). From this rule we derive an average alpha:rho relationship that depends on circadian phase. The relationship reconciles the established negative alpha:rho correlation observed in synchronized subjects with the positive alpha:rho correlation found in desynchronized subjects. Our most surprising result concerns the residual deviations of alpha and rho from their circadian phase-adjusted mean values. We report that there is no significant positive correlation between the residuals of alpha and rho, contrary to the prediction of restorative models of sleep duration. Our findings illuminate the mechanisms underlying sleep regulation and provide much-needed tests of mathematical models of the sleep-wake cycle.
TL;DR: Evidence that dreaming is not single-minded but variable along a self-reflective process continuum is provided, and functional and organizational levels that are consistent with the conception of dreaming as higher order cognitive activity are suggested.
Abstract: This research was directed toward the contradiction sustained by cognitive dream psychology, which on the one hand regards dreaming as higher symbolic activity and, on the other, sees its organizational and functional characteristics as derivative and/or inferior to those of waking consciousness. Study 1 evaluates the degree of self-reflective meta-cognition in dreams from different sleep stages. Subjects were 24 college students selected such that half were self-reported high-frequency dream recallers and half were low-frequency recallers. Both groups were composed equally of men and women. Greater self-reflectiveness (SR) was found in REM dreams as compared with those from stages 2 and 4, which did not differ. High-frequency recallers showed more dream SR than did low-frequency recallers. Study 2 assessed the extent to which self-reflective and lucid dreaming can be learned as a cognitive skill by varying levels of intention and attention paid to dreaming. After 3 weeks of home dream collection, results showed that four experimental groups had greater dream SR than did a baseline group. The most effective treatment was the mnemonic, wherein attention patterning schemas learned in waking resulted in more self-reflective and lucid dreaming than did either baseline or attention-control conditions. These results provide evidence that dreaming is not single-minded but variable along a self-reflective process continuum, and suggest functional and organizational levels that are consistent with the conception of dreaming as higher order cognitive activity.
TL;DR: The results indicate that narcolepsy and idiopathic CNS hypersomnolence are two different entities, and locate the hypothetic gene associated with nar colepsy more precisely.
Abstract: Several studies have shown familial incidence of narcolepsy and idiopathic central nervous system (CNS) hypersomnia. HLA antigen studies performed in mongoloid and caucasoid narcoleptic patients on the A, B, and C loci have yielded conflicting results. The aim of this study is to document a possible association between the HLA system, including the DR locus and excessive daytime somnolence. Thirty-one narcoleptic patients and 10 idiopathic hypersomniac patients were selected and typed for 54 HLA antigens. A family with narcoleptic members in 3 generations was also studied. HLA-DR2 was found in 100% of narcoleptic patients. The frequency of HLA-A3 and B7, which are in linkage disequilibrium with DR2 was also increased in this group. Idiopathic hypersomniac patients showed an increase of HLA-Cw2, DR5, and B27, three antigens known to be in linkage disequilibrium. In the family study, narcoleptic patients were also HLA-DR2; moreover, 3 subjects, one of whom was narcoleptic, were HLA-DR2 as a result of recombination (i.e., genetic crossing-over). These results locate the hypothetic gene associated with narcolepsy more precisely, and indicate that narcolepsy and idiopathic CNS hypersomnolence are two different entities.
TL;DR: Data suggested that methylphenidate significantly improves ability to stay awake and pemoline seems to improve ability to perform while protriptyline does not significantly alter ability toStay awake or to perform.
Abstract: Methylphenidate, pemoline, and protriptyline were studied for their treatment efficacy in narcolepsy. A low, intermediate, and high dose level of each drug was studied for 1 week. For methylphenidate the doses were 10, 30, or 60 mg/day; for pemoline, 18.75, 56.25, or 112.5 mg/day; and for protriptyline 10, 30, or 60 mg/day. The order of dose levels was random from subject to subject and the daily dose was divided into thirds and taken in identically appearing capsules morning, noon, and afternoon. Subjects were 6 narcoleptic patients studied on methylphenidate (5 women and 1 man; mean age 54.5 + 11.7 years), 7 narcoleptic patients studied on pemoline (5 women and 2 men; mean age 43.0 + 7.1 years), and 4 narcoleptic patients studied on protriptyline (2 women and 2 men; mean age 42.5 + 16.9 years). Testing consisted of day-long sessions occurring at the end of each dose level and involving a clinical status questionnaire as well as maintenance of wakefulness, Wilkinson addition, and Digit-Symbol Substitution tests. Results were compared with 9 control subjects with no sleep disorder (5 women and 4 men; mean age 39.2 + 8.4 years) who were given placebo that was purported to be a "stimulant drug" and tested in a similar manner. Results demonstrated profound differences in ability to stay awake and perform between narcoleptic patients and controls. Data also suggested that methylphenidate significantly improves ability to stay awake. Pemoline seems to improve ability to perform. Protriptyline does not significantly alter ability to stay awake or to perform.
TL;DR: Polysomnographic and multiple sleep latency studies documented recurrent apneic episodes during NREM sleep stages 1 and 2 and REM sleep in 11 of 16 narcoleptic patients.
Abstract: Polysomnographic and multiple sleep latency studies documented recurrent apneic episodes during NREM sleep stages 1 and 2 and REM sleep in 11 of 16 narcoleptic patients. Episodes were predominantly central, but obstructive and mixed events were also observed. Apneas were accompanied by mild to moderate oxygen desaturation.
TL;DR: It is concluded that the similarity of the changes in sleep pattern in young and old rats after increased environmental complexity may reflect a preserved capacity of the senescent nervous system to adapt to environmental changes.
Abstract: The effects of aging and housing in an enriched environment were assessed in young adult (4-7 months) and old (27-31 months) male Brown Norway rats by conducting 24-h sleep-wake recordings. Comparison of recordings made in rats of different ages, housed in a standard laboratory environment, revealed a reduction of the time spent in slow wave and desynchronized sleep during the light period in the old rats. Furthermore in the old rats, sleep was more fragmented and the amplitude of the circadian sleep-wake rhythm was reduced. In both age groups, housing in an enriched environment resulted in an increase of the time spent in slow wave and desynchronized sleep during the light period. Old "enriched" rats showed an additional alleviation of the senescence-related shortening of sleep cycles and desynchronized sleep epochs. The reduction of the circadian sleep-wake amplitude observed in old age was, however, not affected by the differential housing period. It is concluded that the similarity of the changes in sleep pattern in young and old rats after increased environmental complexity may reflect a preserved capacity of the senescent nervous system to adapt to environmental changes.
TL;DR: The Markov chain model simulates both probabilistic and the above-mentioned predictable dynamics of sleep, but only if these time-varying, individual rates are applied.
Abstract: Summary: A Markov chain model has been proposed as a mechanism that generates human sleep stages, A method for estimating the parameters of the model, i.e., the transition probabilities (rates) between sleep stages, has been introduced and applied to 95 hypnograms taken from 23 subjects. The rates characterize interindividual differences and nightly variations of the sleep mechanism, related to sleep-onset behavior, to the decreasing amount of slow wave sleep in the course of the night, and to the REM-NREM periodicity, The model simulates both probabilistic and the above-mentioned predictable dy namics of sleep, but only if these time-varying, individual rates are applied.
TL;DR: It is highly likely that the narcoleptic syndrome is an immune-mediated disorder, occurring in a genetically susceptible (DR2/DQ1-positive) subject.
Abstract: Most but not all subjects with the narcoleptic syndrome have the human leukocyte antigen (HLA) DR2 (and DQ1). The narcolepsy-DR2 association is the highest disease-HLA linkage known, and occurs in nonfamilial as well as familial cases of the narcoleptic syndrome. In other forms of daytime drowsiness, there is no relationship with a specific HLA, although some subjects considered to have "essential" hypersomnolence probably have the narcoleptic syndrome. The cause of the narcoleptic syndrome remains unknown, although in a few instances the condition follows infection. There is no evidence for a circulating sleep factor in the blood or in the cerebrospinal fluid of narcoleptic subjects, and no unequivocal marker of cellular immunity has yet been found. However, a few subjects with the narcoleptic syndrome have oligoclonal bands or raised immunoglobulin concentration in the cerebrospinal fluid. It is highly likely that the narcoleptic syndrome is an immune-mediated disorder, occurring in a genetically susceptible (DR2/DQ1-positive) subject.
TL;DR: Performance measures were compared to the multiple sleep latency test (MSLT) as indices to assess tolerance to the residual effects of benzodiazepine hypnotics during repeated nightly administration and mean sleep latency on the MSLT was reduced by both drugs during the early phase.
Abstract: Performance measures were compared to the multiple sleep latency test (MSLT) as indices to assess tolerance to the residual effects of benzodiazepine hypnotics during repeated nightly administration. Twelve healthy, normal sleepers received flurazepam 30 mg, temazepam 30 mg, and placebo for nine nights in a repeated measures, Latin-square design with 19 nights of recovery separating the treatments. As compared to placebo, both drugs altered sleep stage parameters in the early (nights 1-2) and late (nights 8-9) phases of the study. Hypnotic effects were found for both drugs in the early phase, but diminished for both in the late phase. The subjects' performance the next day was disrupted following treatment with flurazepam, but not with temazepam, during the early phase. Mean sleep latency on the MSLT was reduced by both drugs during the early phase. During the late phase, flurazepam did not disrupt performance but still affected the MSLT. Temazepam affected neither index the next day during the late phase.
TL;DR: Performance, particularly on accuracy measures, was better, although not significantly, after NREM naps when compared with REM naps, and recuperative values of REM and NREM sleep were evaluated.
Abstract: This study compared the performance of narcoleptic and control subjects on one psychomotor task, examined the recuperative power of naps in narcoleptic subjects, and evaluated the respective recuperative values of REM and NREM sleep. Ten untreated narcoleptic and eight control subjects repeatedly responded to a choice reaction time task during days with and days without napping. Narcoleptic subjects exhibited low performance levels relative to control subjects on all variables. Napping improved the performance of narcoleptic subjects except for the number of long latency (reaction time greater than 1,000 ms) responses. Finally, performance, particularly on accuracy measures, was better, although not significantly, after NREM naps when compared with REM naps. Language: en
TL;DR: An autoimmune mechanism of narcolepsy is proposed with three successive stages, as well as relevant methodology for further investigation, and a dominant mode of inheritance of narCOlepsy, with an incomplete penetrance, is suggested.
Abstract: A positive association between HLA-DR2, DQw1, and narcolepsy was documented in 23 French caucasoid narcoleptic patients, 18 who were heterozygous for DR2 and 5 who were possibly homozygous. An autoimmune mechanism of narcolepsy is proposed with three successive stages, as well as relevant methodology for further investigation. A dominant mode of inheritance of narcolepsy, with an incomplete penetrance, is suggested although not yet evidenced.
TL;DR: No difference was found in patients with and without periodic movements in sleep (PMS), suggesting that PMS is not the major determinant of sleep disruption previously described in narcoleptic patients, and results indicate a possible link between REM fragmentation and cataplexy.
Abstract: Narcoleptic patients were compared to idiopathic hypersomniac patients and REM hypersomnia patients with regard to nocturnal sleep disruption. Results showed specificity of the narcoleptic sleep pattern and a possible correlation between REM fragmentation and cataplexy. Patients with and without periodic movements in sleep (PMS) were compared and no difference was found in their nocturnal sleep pattern, suggesting that PMS is not the major determinant of sleep disruption previously described in narcoleptic patients. Finally, nocturnal sleep disruption was treated with gamma-hydroxybutyrate (GHB) and results further indicate a possible link between REM fragmentation and cataplexy.