Showing papers in "Somnologie - Schlafforschung Und Schlafmedizin in 2001"

Zur Validität der deutschen Übersetzung des Morningness-Eveningness-Questionnaires von Horne und Östberg

Abstract: Die Vergleichbarkeit mit der internationalen Literatur ist ein entscheidendes Kriterium bei der Wahl von Testinstrumenten. Zur Identifizierung der subjektiven zirkadianen Phasenlage (Chronotyp) werden im deutschen Sprachraum daher meist Ubersetzungen des Morningness-Eveningness-Questionnaires (MEQ, Horne & Ostberg, Int J Chronobiol 4:97–110, 1976) angewendet. In der vorliegenden Arbeit wurde die Validitat einer deutschen Ubersetzung des MEQ (D-MEQ) gepruft. Als Kriterien dienten der validierte Fragebogen zur subjektiven zirkadianen Phasenlage (SCP, R Moog, in Reinberg, Vieux, Andlauer (eds): night and shift work. Biological and social aspects. Pergamon Press Oxford, 1981) sowie der Nadir der Korperkerntemperatur und der Beginn der nachtlich erhohten Melatoninkonzentration im Speichel.

Normwerte des pupillographischen Schläfrigkeitstests für frauen und männer zwischen 20 und 60 jahren

Abstract: Fragestellung Fur den pupillographischen Schlafrigkeitstest (PST) sollen Normwerte fur gesunde Erwachsene zwischen 20 und 60 Jahren definiert werden. Sind die Testergebnisse von Alter und Geschlecht abhangig?

Polysomnographic Reference Curves for the First and Second Year of Life

Abstract: Objective To derive reference curves of polysomnographic parameters for clinically healthy infants and children in the first and second year of life.

Indications for performing polysomnography in the diagnosis and treatment of restless legs syndrome

Abstract: Restless legs syndrome (RLS) is diagnosed clinically by evaluating the patient's complaints. Diagnostic criteria based on the clinical symptoms were defined by the International Restless Legs Syndrome Study Group. Laboratory and/or neurophysiological assessments can differentiate a primary (idiopathic) RLS from a secondary (associated with an other disease) RLS. Some differential diagnostic and therapeutic issues may, however, require polysomnographic assessment. An investigation in the sleep laboratory should be considered in the following cases: 1) in patients with “atypical” RLS symptoms to support the diagnosis, before pharmacological treatment is begun: 2) in patients on sufficient dopaminergic treatment but still suffering from sleep disturbance, in order to exclude other sleep-related disorders; 3) in patients with mild RLS but marked daytime sleepiness as the main symptom; 4) to support the diagnosis in young patients with severe RLS before dopaminergic treatment is begun or in patients with severe RLS before the start of a treatment with opiates; 5) in patients with RLS and sleep-related respiratory disorders; 6) and finally in patients who are involved in a formal expert's opinion report. Further indications may exist in exceptional cases. A recommendation for performing polysomnography should be always made by a clinician experienced in the diagnosis and treatment of sleep disorders.

Periodic Leg Movements and Sleep‐Disordered Breathing in Children

Abstract: Children with OSAS (obstructive sleep apnea syndrome) have a restless sleep. Furthermore they show a changed daytime behavior comparable with attention deficit hyperactivity disorder (ADHD). We investigated the prevalence of periodic leg movements in sleep in OSAS patients to answer the question whether OSAS can be misinterpreted by insufficient diagnostics for example actigraphy alone. 25 children who had no OSAS (controls) (age 3.1 to 14.3 years, median 7.3 years) were examined polysomnographically. 25 age-matched patients with clinically confirmed OSAS and an apnea/hypopnea index (AHI)≥5/h were investigated polysomnographically in one night before treatment (diagnostic night-baseline) and in one night with therapy. In the 3 groups the number of all leg movements (LM) and periodic leg movements (PLM) were counted in the time in bed as well as in the total sleep time (LMS/PLMS). Furthermore the number of LM and PLM was calculated in wakefulness, NREM and REM. The ratio of PLM to LM was calculated. Additionally we calculated, how frequently LMS and PLMS were accompanied by EEG-arousals. 92% of OSAS patients had an enhanced PLMS-Index > 5/h TST. OSAS patients without therapy had a significantly enhanced number of LMS (LMS: 19.2/h TST [qr=12.3]) and PLMS (11.8/h TST [qr=10.6]) in comparison to controls (LMS: 8.9/h TST [qr=2.4], PLMS: 2.3/h TST [qr=2.1]) and treated OSAS patients (LMS: 9.9/h TST [qr=4.7], PLMS: 3.7/h TST [qr=3.6]). Under therapy there was a significant diminution of LM and PLM in NREM and REM but not during wakefulness. Without therapy two thirds of all LMS were PLMS (66.3% [qr=16.4]) while in treated patients the total LMS included one third PLMS (39.6% [qr=32.9]) comparable with controls (28.4% [qr=15.9]). 90.1% [qr=18.9] of all PLMS in controls were accompanied by EEG-arousals but 61.0% [qr=23.9] in OSAS patients and 71.4% [qr=36.7] in treated OSAS patients. OSAS patients in childhood have a PLMD by definition (PLMS>5 per hour TST, changed daytime behavior [2]) resolving by the therapy of sleep disturbed breathing. Because of the overlap of the symptoms sleep-disordered breathing should be considered in the differential diagnosis of children with PLMD, RLS (restless legs syndrome) and ADHD (attention deficit hyperactivity disorder). Different pathogenesis needs an appropriate therapeutic strategy.

Obstructive sleep apnea syndrome. Effects of therapy on dyslipidemia

Abstract: Dyslipidemia is frequently observed in patients with obstructive sleep apnea syndrome (OSAS). The effects of OSAS treatment on lipid levels in these patients have been examined. 95 consecutive patients (aged 56.6±9.5 years) with polysomnographically verified OSAS and LDL cholesterol levels of more than 130 mg per deciliter have been included in a prospective trial. Plasma total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, apolipoprotein B, and lipoprotein (a) levels were determined in all patients at baseline and after long term therapy. Total cholesterol (249.9±31.4 vs. 240.0±34.1 mg/dL; p=0.01) and LDL cholesterol levels (179.4±29.4 vs. 165.5±32.5 mg/dL; p<0.001) decreased significantly after 6 months in patients effectively treated, while they did not change significantly in those OSAS patients in whom treatment proved to be ineffective. Body mass index, HDL cholesterol, triglyceride, apolipoprotein B, and lipoprotein (a) levels did not change during follow-up. Both the change of total and LDL cholesterol levels were independently associated with treatment efficacy as indicated by the change of the apnea/hypopnea index. The results suggest that effective treatment of sleep-disordered breathing may have significant effects on the total and LDL cholesterol levels in OSAS patients.

Schlafbezogene Atmungsstörungen bei Parkinsonsyndromen: Häufigkeit, Art und Behandlungsansätze

Abstract: Fragestellung Uber die Bedeutung schlafbezogener Atmungsstorungen [SBAS] in der Genese der multifaktoriellen Schlafstorung bei Parkinsonpatienten finden sich in der Literatur widerspruchliche Aussagen. Unsere Studie ging der Frage nach, in welchem Ausmas SBAS beobachtet werden konnen und welcher Art die Storungen sind.

Nasale CPAP-Therapie beim obstruktiven Schlafapnoe-Syndrom: Verbessert funktionelle Rhinochirurgie die Compliance?

Abstract: In einer retrospektiven Untersuchung sollte gepruft werden, ob funktionelle Rhinochirurgie die Akzeptanz einer nCPAP-Therapie beeinflusst.

Arousals: Aktueller Stand, Klinische Bedeutung und offene Fragen

Abstract: Aufgrund der erheblichen Bedeutung von Arousals fur die Interpretation von Schlaf-Wachstorungen werden in einem umfassenden Uberblick die Genese und Bedeutung, methodische Aspekte und ihre klinische Relevanz dargestellt. Es existiert eine Vielzahl von extero- und enteroceptiven Arousal-Stimuli, wobei die Reizantwort als EEG-Arousal, vegetatives Arousal oder Verhaltensanderung mit Bewegungen registriet werden kann. Auch in der padiatrischen Schlafmedizin gewinnt die Analyse von Arousals zunehmend an Bedeutung, da Arousal-Storungen als Erklarung fur lebensbedrohliche Ereignisse, aber auch fur gestorte Tagesbefindlichkeit herangezogen werden konnen. Trotz klarer Diagnosekriterien von Arousals (ASDA) besteht eine gewisse Interrater-Variabilitat, die zu einer unterschiedlichen Beurteilung von Schlaffragmentation fuhrt. Eine automatische Computeranalyse bietet keine Alternative. Sie dient lediglich zur Vorauswertung und sollte immer durch geschulte Experten kontrolliert und eventuell korrigiert werden. Die Detektion respiratorischer Ereignisse mit konsekutivem EEG-Arousal wurde in den letzten Jahren durch nicht-invasive Verfahren, wie Standruck, Impedanz-Messung, Effort-/Phasenwinkel-Analyse verbessert. Die Registrierung der puls-transit-time (PTT) und des kontinuierlich erfassten Blutdruckes ist geeignet, vegetative Arousals zu quantifizieren, wobei Aussagen uber Sensitivitat und Spezifitat noch nicht moglich sind. Am Beispiel verschiedener Krankheitsbilder, wie obstruktives Schlafapnoesyndrom, zentrales Schlafapnoesyndrom, chronisch-obstruktive Ventilationsstorung, periodische Beinbewegungen im Schlaf, psychophysiologische Insomnie, Epilepsie, Parasomnien und Hypersomnien werden die Effekte von Arousals erortert. In Zukunft ist zusatzlich zur Erfassung von Arousals die Suche nach weiteren Messgrosen/Methoden erforderlich, um die Leistungseinschrankungen durch Schlafstorungen noch besser objektivieren zu konnen.

Zusammenhang zwischen Schlafqualität, Morgen‐ und Tagesbefindlichkeit bei schlafgestörten Patienten

Abstract: Schlafstorungen fuhren unabhangig von der zugrunde liegenden Ursache zu einer verminderten Tagesbefindlichkeit. Das Ausmas dieser Einschrankung bestimmt den Schweregrad der Erkrankung. Bei Gesunden hangt die Tagesbefindlichkeit vor allem von der Schlafqualitat ab, wahrend Daten bei Schlafgestorten weitestgehend fehlen. Zudem kann die Schlafqualitat mit einfachen Kategorieskalen, komplexen Fragebogen oder vergleichend zu ublichen Nachten mit visuellen Analogskalen erfasst werden. Wir untersuchten daher den Zusammenhang zwischen Schlafqualitat, Morgenbefindlichkeit und Tagesbefindlichkeit bei 64 Patienten (48.2±10.9 Jahre) mit unterschiedlichen Schlafstorungen. Gleichzeitig gingen wir der Frage nach, inwieweit die Beurteilung der Schlafqualitat und Morgenbefindlichkeit in verschiedenen Messinstrumenten, insbesondere zwischen Kategorieskalen und visuellen Analogskalen ubereinstimmen. Sowohl bei insomnischen (n=35) als auch bei hypersomnischen (n=24) Patienten fanden sich fur die Schlafqualitat (r=0,6715, p≤0,01) und Morgenbefindlichkeit (r=−0.6706, p≤0.01) befriedigend gute Korrelationen zwischen den Kategorie-Skalen und den visuellen Analogskalen. Die Tagesbefindlichkeit korrelierte insgesamt eher zur Morgenbefindlichkeit (r=−0.5546, p≤0.01) als zur Schlafqualitat. Dabei waren die Koeffizienten einer Korrelation mit der Antriebslage am Tage groser als fur die Konzentrationsfahigkeit. Die hohen Korrelationen zwischen den einzelnen Skalen zur Erfassung der Schlafqualitat und Morgenbefindlichkeit weisen darauf hin, dass die Wahl der Messskala weitestgehend dem Untersucher uberlassen bleiben kann. Dagegen sollte die Tagesbefindlichkeit stets und vor allem in klinischen Untersuchungen in moglichst mehreren Parametern erfasst werden.

Gender and Age Differences in Symptoms' Profile in Sleep Apnea Syndrome: A Possible Cause of Gender Bias in Diagnosis

Abstract: To compare the age-dependent severity and clinical profile of men and women with polysomnographically-documented obstructive sleep apnea syndrome (OSAS). A retrospective comparison of polysomnographic and clinical data obtained from 358 carefully age- and RDI-matched men and women with OSAS diagnosed in the Technion Sleep Laboratories. We found that women complained significantly more on “difficulties falling asleep”, “early morning awakenings”, “morning fatigue”, “mid-sleep awakenings” and “morning headaches”. Nevertheless, stepwise regression analysis revealed that subjective complaints were significant predictors of RDI in men only. We conclude that the clinical profile of OSAS in women is different from that in men, and that these differences should be taken into account when evaluating women suspected of having OSAS.

Subjektive Parameter des Schlafs bei Patienten mit primärer Alkoholabhängigkeit

Abstract: Schlafstorungen bei alkoholkranken Patienten treten sowohl wahrend der Phase des aktiven Trinkens als auch im akuten oder subakuten Entzug sowie wahrend der Abstinenz haufig auf.

The clinical value of the maintenance of wakefulness test (MWT) in the differentiation of children with attention deficit hyperactivity disorder (ADHD) and disorders of excessive somnolence

Abstract: Introduction Attention deficit hyperactivity disorder is one of the most common child and adolescent psychiatric disorders. Probably a dysfunctional arousal regulation may play an important role in its pathogenesis. According to this hypothesis ADHD children may present an hypoarousal state with impaired daytime vigilance when confrontated with monotonous, repetetive tasks.

The impact of nasal obstruction on obstructive sleep apnea syndrome

Abstract: Nasal obstruction is a predictive factor for snoring and may contribute to the development of obstructive sleep apnea syndrome (OSAS) by causing a higher negative intrapharyngeal pressure during inspiration. This may lead to obstructive apneas and hypopneas in predisposed people. The aim of this study was to further enrole the impact of nasal obstruction on OSAS. We investigated two groups of OSAS patients, matched paris concerning gender, age, and BMI: OSAS patients with nasal obstruction (N, n=28): total nasal airflow 1 pa/ml/s*; and 28 OSAS patients without nasal obstruction (control-group C; total nasal airflow >700 ml/l/s*). All patients had routine examination including a standardized questionnaire, examination by an otorhinolaryngologist, anterior rhinomanometry, skin prick-testing with 18 common allergens, lung function testing, and full polysomnography. We found the following significant differences: 1) In N more patients (n=17) complained about nocturnal dyspnea than in C (n=7; p<0,05, (Chi2-test); 2) N had a higher apnea index (20,4±19,0/h) than C (9,6±10,0/h; p<0,05, student's t-test). There were, however, no significant differences concerning lung function, skin prick test, otorhinolaryngologistical results, sleep architecture, number of hypopneas, nocturnal SaO2, heart rate, and level of CPAP pressure. p Hence, beside pathophysiologically interesting effects increased nasal resistance has no clinically relevant importance in patients with OSAS.

Polygraphic screening after ischemic stroke: A consecutive study on 258 patients

Abstract: Recently carried out studies have suggested that sleep-related breathing disorders [SRBD] may play an important role in the pathogenesis of cerebrovascular diseases. The focus of the present study was laid on the assessment of risk factors causing stroke through polygraphic recordings and sleep questionnaires. We wanted to find out to what extent such data can lead to changes in therapy after a stroke. Within a 135 day period 258 patients admitted to our neurological rehabilitation clinic with first-ever stroke (MCA, brainstem) were invited to take part in the study. The protocol consisted of a sleep questionnaire, a structured interview and a whole-night polygraphic recording including ECG and leg EMG. Respiration was measured by inductance plethysmography and capnography. 159 patients aged between 18 to 92 (average 63.1) years gave written consent and completed the study. SRBD with an apnea-hypopnea index [AHI]>5/h were found in 52.2% of patients. 27.7% had an AHI>15/h, 12.6%>30/h. 37.5% of the male subjects showed AHI values >15/h which was significantly higher than in females (9.1%). Obstructive sleep apnea was the most common respiratory disorder. 4.4% presented a vital indication for IPPV, 14.5% were advised to undergo treatment with nCPAP, 5% to undergo oxygen therapy. 12.6% patients needed further pneumologic diagnostics. Cases of cardiac arrhythmia were observed in 70/159 subjects, in 29 out of those they had not been diagnosed previously. Periodic leg movements occured in 13%. In 71 out of 159 cases (44.7%) polygraphic recordings led to important changes in the stroke rehabilitation management. Therefore we strongly recommend the inclusion of polygraphic recordings into the screening programmes after a stroke has occurred in order to reduce the re-infarction risk and to improve the outcome.

Untersuchungen zur Stabilität der Herzfrequenzvariabilität im Kindes- und Jugendalter unter standardisierten Bedingungen im Schlaf (S4)

Abstract: Einfuhrung Das Ziel dieser Studie war eine Untersuchung zur Stabilitat von Parametern der Herzfrequenzvariabilitat (HRV) in der Tiefschlafphase—S4. Uns interessierte, ob Merkmale der HRV stabil sind, wenn sie zu verschiedenen Zeitpunkten abgeleitet werden, z. B. vor und nach Mitternacht.

Absent Autonomic Regulation Following Severe Cerebral Hypoxia – a Case Report

Abstract: Can severe cerebral hypoxia result in an impaired modulation of autonomic regulation? We describe the case of a 35-year-old worker who was buried alive during his work on a building site and sustained severe cerebral hypoxia of unknown duration. For the duration of three months until the patient deceased, he was comatose with eyes closed and no recognizable psychological or motor response to stimulation. MRI of the brain showed hyperintense lesions bilaterally in the periventricular white matter and bilateral destruction of the lentiform nucleus. The breathing pattern was shallow with temporary intermissions, and polysomnography indicated an increased number of centrally mediated apneic and hypopneic periods, however, without critically decreased oxygen saturation. 24-hour-EEG revealed a continuous theta activity without frequency modulation, different sleep stages could not be observed. The 24-hour profile of plasma melatonin revealed an absent nocturnal rise of plasma melatonin levels. Severe cerebral hypoxia may result in an impaired modulation of autonomic regulation as a consequence of disturbed interactions between autonomic centers in the brainstem and diencephalon.

Evidenzbasierte Medizin und die Cochrane Collaboration – Bedeutung für die Schlafmedizin

Abstract: In einer Zeit einschneidender Reformen des Gesundheitswesens erlangt die aus dem angloamerikanischen Sprachraum stammende „Evidence-based Medicine” zunehmende Bedeutung. Evidenzbasierte Medizin bedeutet die Moglichkeit, medizinische Entscheidungen auf der Basis der besten zur Zeit verfugbaren externen Evidenz in Verbindung mit der individuellen klinischen Erfahrung zu treffen.

Durch Monotonie provozierte komplex-partielle Anfälle – Seltene Differentialdiagnose der Hypersomnie

Abstract: Fragestellung Bei Patienten mit einer Einschlafneigung in monotonen Situationen werden meistens Schlaf-Apnoe-Syndrom oder eine Narkolepsie als ursachliche Erkrankungen diagnostiziert. Sind weitere neurologische Ursachen zu bedenken?

Automatic CPAP Based on Impedance – Comparison of Constant CPAP with an Individual Pressure Range

Abstract: Introduction Self-adjusting positive airways pressure treatment based on the impedance of the airways (APAPFOT) has proven effective in obstructive sleep apnoea syndrome. To avoid patient discomfort during periods of high treatment pressure we lowered the upper pressure limit with APAPFOT and investigated whether this provided equally as effective treatment as constant CPAP.