Showing papers on "Polysomnography published in 1986"
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: 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: The hypothesis that RLS and PMS may both result from reduced dopaminergic activity in the CNS, perhaps resulting from decreased sensibility of postsynaptic receptors, is raised.
Abstract: Summary: Seven patients suffering from restless legs syndrome (RLS) and periodic movements in sleep (PMS) were investigated before and after treatment with L-Dopa. The effect of treatment was evaluated by polysomnography, structured interviews, and daily questionnaires. Sleep organization and subjective complaints improved during treatment with 100 to 200 mg of L-Dopa. Polysomnographic recordings also revealed a significant decrease of periodic leg movements during the first third of the night and a rebound during the last third. These results and previous biochemical findings raise the hypothesis that RLS and PMS may both result from reduced dopaminergic activity in the CNS, perhaps resulting from decreased sensibility of postsynaptic receptors.
154 citations
TL;DR: It is concluded that periodic breathing resulting in periodic diminution ofupper airway muscle activity is associated with increased upper airway resistance that predisposes upper airways to collapse.
Abstract: To test the hypothesis that occlusive apneas result from sleep-induced periodic breathing in association with some degree of upper airway compromise, periodic breathing was induced during non-rapid-eye-movement (NREM) sleep by administering hypoxic gas mixtures with and without applied external inspiratory resistance (9 cmH2O X l-1 X s) in five normal male volunteers. In addition to standard polysomnography for sleep staging and respiratory pattern monitoring, esophageal pressure, tidal volume (VT), and airflow were measured via an esophageal catheter and pneumotachograph, respectively, with the latter attached to a tight-fitting face mask, allowing calculation of total pulmonary system resistance (Rp). During stage I/II NREM sleep minimal period breathing was evident in two of the subjects; however, in four subjects during hypoxia and/or relief from hypoxia, with and without added resistance, pronounced periodic breathing developed with waxing and waning of VT, sometimes with apneic phases. Resistive loading without hypoxia did not cause periodicity. At the nadir of periodic changes in VT, Rp was usually at its highest and there was a significant linear relationship between Rp and 1/VT, indicating the development of obstructive hypopneas. In one subject without added resistance and in the same subject and in another during resistive loading, upper airway obstruction at the nadir of the periodic fluctuations in VT was observed. We conclude that periodic breathing resulting in periodic diminution of upper airway muscle activity is associated with increased upper airway resistance that predisposes upper airways to collapse.
150 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.
113 citations
TL;DR: Results show that patients with Cheyne-Stokes respiration may develop upper airway occlusion during sleep and are consistent with the contention that sleep-induced periodic breathing in patients with sleep apnea syndrome is primary to the development of occlusive apneas.
Abstract: Sleep-induced periodic breathing has been suggested to lead to the development of occlusive apneas in patients with sleep apnea syndrome. If this were true, patients with Cheyne-Stokes respiration should also develop upper airway occlusion during sleep. To study this hypothesis, 6 nonobese patients with Cheyne-Stokes respiration lacking evidence for sleep apnea syndrome and anatomic upper airway abnormalities underwent polysomnography during daytime naps. A total of 463 apneas were analyzed in the 6 patients studied. In 1 patient, no evidence of upper airway occlusion was observed. In the remaining 5 patients, a varying frequency of upper airway occlusion resembling the pattern of mixed apnea was seen in 3 to 97% of the total apneas analyzed. The mean number (± 1 SD) of occluded inspiratory efforts per mixed apnea in these 5 patients was 1.69 ± 0.59. These results show that patients with Cheyne-Stokes respiration may develop upper airway occlusion during sleep and are consistent with the contention that s...
92 citations
TL;DR: In this article, the authors developed a systematic technique to analyze ear oximetric tracings for wakefulness, REM sleep, and non-REM (NREM) sleep for screening patients for sleep apnea syndrome.
85 citations
TL;DR: Oxygenation was well maintained, with neither mean nor minimal arterial oxygen saturation significantly different during pregnancy, and frequency of apnea and hypopnea and total apnea time were significantly reduced during pregnancy.
Abstract: Physiologic changes during the last trimester of pregnancy include reduced functional residual capacity and residual volume, increased alveolar-arterial difference for oxygen, and in the supine position reduced cardiac output. In conjunction with sleep-related apnea or hypoventilation, these could lead to maternal oxygen desaturation during sleep. Because we could not find detailed respiratory sleep studies in late pregnancy, we performed complete polysomnography on 6 pregnant women at 36 wk gestation and again postpartum. Contrary to what we expected, oxygenation was well maintained, with neither mean nor minimal arterial oxygen saturation significantly different during pregnancy. Frequency of apnea and hypopnea and total apnea and hypopnea time were significantly reduced during pregnancy. This finding may be due to increased levels of progesterone during pregnancy and may contribute to preservation of maternal oxygenation during late pregnancy.
79 citations
TL;DR: It was shown that patients whose narrowest part of the upper airway is atlevel 1 and whose first point of airway collapse during apnea episodes is at level 1 are good candidtates for the UPPP.
Abstract: The purpose of this study was to evaluate the efficacy of somnofluoroscopy in the selection of candidates for uvulopalatopharyngoplasty (UPPP). Somnofluoroscopy is a lateral fluoroscopic examination of the upper airway with synchronous polysomnography that provides information about the dynamic function of the airway and the level of stenosis or occlusion during sleep. Somnofluoroscopies were performed preoperatively in 26 consecutive patients undergoing UPPP. Preoperative and postoperative polysomnographic data were obtained on each patient. On review of the somnofluoroscopic recordings, two levels of the airway were considered: level 1, above the horizontal plane through the midportion of body of the second cervical disk, and level 2, below this plane. The examinations were then scored for the following: (A) most narrow level of airway during wakefulness, (B) first level(s) of airway to collapse during apnea, and (C) all levels of the airway to collapse during apnea. It was shown that patients whose nar...
69 citations
TL;DR: The separation of the PRI MDD from Panic and Normals, however, is clear, suggesting that sleep can be successfully used as a physiological marker in the separation of these conditions.
Abstract: Four groups of subjects were compared with respect to their clinical and demographic status and electroencephalographic (EEG) characteristics, namely: primary major depressive disorder (PRI MDD); panic disorder (Panic); “Mixed” group comprising patients meeting full syndromal criteria for MDD and panic occuring concomitantly; and normal controls. The “Mixed” (MDD + Panic) patients were characterized by earlier age of onset of psychiatric illness, longer duration of current episode, greater intensity of symptoms, higher impairment of functioning, increased miscellaneous psychopathology, and greater objective stress and anger. With respect to sleep EEG variables, PRI MDD patients were clearly different from the other three groups. The sleep profile of the “Mixed” group occupies an intermediate position between the “pure” Panic and MDD groups. Classification of the “Mixed” patients based on the discriminant function coefficients of the Schedule for Affective Disorders and Schizophrenia and sleep analysis of the “pure” groups (PRI MDD and Panic) reveals that some patients are classified as true PRI MDD while others are classified as falling somewhere along the PRI-MDD/Panic spectrum. The separation of the PRI MDD from Panic and Normals, however, is clear, suggesting that sleep can be successfully used as a physiological marker in the separation of these conditions.
51 citations
TL;DR: In an open trial of codeine in five narcoleptic subjects, dramatic clinical improvement was reported, but all-night polysomnography and maintenance of wakefulness tests before and after codeine showed no significant differences.
Abstract: The effectiveness of codeine as a treatment for the excessive daytime sleepiness of narcolepsy was studied in two experimental trials. In an open trial of codeine in five narcoleptic subjects, dramatic clinical improvement was reported. However, all-night polysomnography and maintenance of wakefulness tests before and after codeine showed no significant differences. A double-blind placebo-codeine trial was conducted in which eight narcoleptic subjects received codeine for 1 week and placebo for 1 week in a random order. During the week they kept a diary, and on the sixth evening and for 10 h following awakening on the seventh day they were monitored by radiotelemetry in the sleep laboratory for electroencephalogram, electro-oculogram, and electromyogram. The results were analyzed for sleep stages as well as four levels of wakefulness. The results showed no significant differences in any of the objective sleep or wakefulness parameters. However, the diaries showed significantly fewer naps during the week on codeine as compared with the placebo week. Eighteen of 27 narcoleptic patients treated with codeine report clinical improvement. Codeine consistently results in subjective clinical improvement. However, this is not reflected in the objective measures generally used to assess daytime sleepiness.
TL;DR: This work compared preoperative and postoperative polysomnography (PSG) in 27 patients with OSA and found that no single PSG parameter could accurately reflect the changes in respiration seen after UPPP.
Abstract: Uvulopalatopharyngoplasty (UPPP) is an operation that is frequently performed for the treatment of obstructive sleep apnea (OSA). While UPPP usually eliminates or decreases snoring and often reduces excessive daytime sleepiness, the decrease in the number of episodes of apnea and hypopnea, and the improvement in oxygen saturation (SaO2) have been less predictable. We compared preoperative and postoperative polysomnography (PSG) in 27 patients with OSA and found that no single PSG parameter could accurately reflect the changes in respiration seen after UPPP. We suggest that a combination of indices including the apnea index, the apnea and hypopnea index, the frequency and severity of decreases in SaO2, and the lowest SaO2 be used to assess the effect of UPPP. Using this combination we determined that 30% of our patients were markedly improved, 33% were somewhat improved, and 37% were unimproved. To rely solely on the patient's subjective improvement often results in overestimating the therapeutic results of surgery, whereas to rely only on one PSG parameter may underestimate or overestimate the degree of improvement.
TL;DR: There was no significant difference between C and SS, C and NM, and SS and NM in DPSG and NPSG for all categories of central, mixed and obstructive apnea as well as the percentage of periodic breathing in different sleep states and over TRT.
Abstract: Between 1974 and 1984 we have studied 204 control infants (C) comparing them with 650 SIDS siblings (SS) and 146 near-miss for SIDS (NM). These 1,000 full-term infants were recorded by day polysomnography (DPSG; n = 417), night polysomnography (NPSG; n = 257) and cardiopneumography (CPG; n = 2,600). Records were visually analyzed. In DPSG and NPSG, total amount of central, mixed and obstructive apnea as well as the percentage of periodic breathing was studied in each sleep state (active sleep, AS; quiet sleep, QS; indeterminate sleep, IS, and total sleep, TS) and over the total recording time (TRT). In CPG, only the total amount of central apnea and percentage of periodic breathing over TRT were studied. Infants were grouped according to postnatal age: less than 5, greater than or equal to 5 to less than or equal to 13, and greater than 13 to less than or equal to 26 weeks. In each age group results were compared as follows: C vs. SS, C vs. NM, and SS vs. NM for each parameter studied. Before 5 weeks and after 13 weeks there was no significant difference between C and SS, C and NM, and SS and NM in DPSG and NPSG for all categories of central, mixed and obstructive apnea as well as the percentage of periodic breathing in different sleep states and over TRT. Similar results were obtained in CPG for all categories of central apnea and percentage of periodic breathing over TRT.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal Article•
TL;DR: The results suggest that further investigation of the individual differences in circadian phase position may be important for understanding the effects of multiple time zone flights.
Abstract: This study investigated changes in sleep-wake rhythms due to time zone changes. The subjects were 12 commercial airline cockpit crewmembers on active duty who spent their baseline nights in a sleep facility in Tokyo. After flying from Tokyo to San Francisco, they underwent two consecutive nights of sleep polysomnography and daytime sleep latency tests (MSLTs). During the San Francisco layover, slight changes in sleep quality were observed. REM sleep (%) was decreased, while slow wave sleep (%) tended to increase during the major sleeps. Subjective sleep quality assessments also exhibited a decrease in comparison to the baseline values. Daytime sleepiness as measured by MSLTs was generally greater in the latter half of the awake period during layover as compared with baseline. When the subjects were divided into "morning" or "evening" types, the daytime MSLTs of each type showed different patterns. The former displayed a decreasing L-shaped trend, while the latter showed a pronounced W-shaped pattern. These results suggest that further investigation of the individual differences in circadian phase position may be important for understanding the effects of multiple time zone flights.
TL;DR: The lack of significant abnormalities in post-ictal polysomnograms corresponds to a functional integrity of the brainstem structures involved in the global organization of sleep and may represent a useful laboratory feature in the diagnosis of ACM.
Abstract: We observed acute confusional migraine (ACM) attacks in two adolescents, and in both cases the episodes ended when the patients fell asleep spontaneously. Laboratory and neuroradiologic examinations were unremarkable. The post-ictal polysomnograms displayed a regular quality and duration of the physiologic components of sleep. Random posterior slow waves occurred only during the nocturnal awakenings and REM periods. The observation that sleep may resolve migraine attacks is emphasized. ACM is characterized by peculiar and relatively quickly reversible clinical manifestations and EEG abnormalities. The lack of significant abnormalities in post-ictal polysomnograms corresponds to a functional integrity of the brainstem structures involved in the global organization of sleep and may represent a useful laboratory feature in the diagnosis of ACM.
TL;DR: Although PPP surgery is a one‐time intervention with possibility of permanent correction, reports of percentages of successful treatment have varied widely from 85% to 0%.
Abstract: As awareness and understanding of obstructive sleep apnea has increased so has the number of treatments for this disorder Options include surgical procedures: tracheostomy, palatopharyngoplasty(PPP), and mandibular advancement Other treatments are medication, nasal CPAP, Tongue Retaining Device, and a position alarm With these numerous choices available, it is important that reliable indicators be developed to guide treatment choice And although PPP surgery is a one-time intervention with possibility of permanent correction, reports of percentages of successful treatment have varied widely from 85% to 0% This has led us to investigate predictors of successful treatment
Twenty-two patients treated with PPP following their diagnosis by standard clinical polysomnography were restudied an average of 8 weeks later When 11 successful cases were compared to 11 unsuccessful cases, successes were found to be initially more severely apneic (X AI=9055 versus 4945)
Palatopharyngoplasty appears to be most appropriate for the sleep apnea patient whose apnea index is 70 or above and less effective for milder cases
TL;DR: Autopsy evaluation demonstrated no evidence of hemorrhage, aspiration, or airway edema following UPPP; however, it caused us to reassess the postoperative program.
Abstract: Uvulopalatopharyngoplasty (UPPP) has been acclaimed in the treatment of obstructive sleep apnea (OSA). Evaluation of the effect of UPPP has usually been done 6 to 8 weeks postoperatively. Recently, a patient died suddenly at home of unknown causes 48 hours following UPPP. Autopsy evaluation demonstrated no evidence of hemorrhage, aspiration, or airway edema; however, it caused us to reassess our postoperative program. Three obese patients (192%, 162% and 157% of ideal body weight) with OSA underwent polysomnography on the second postoperative night. The mean duration of the postoperative apneas was not significantly different; however, the nadir SaO2 during apnea in one patient was significantly lower postoperatively. Those individuals with awake hypercapnia nad hypoxemia who had significant sleep associated hemoglobin unsaturation preoperatively may be at greatest risk. These observations indicate that careful postoperative monitoring is warranted in this group of patients.
Journal Article•
TL;DR: Estazolam 2.0 mg significantly improved sleep onset and total sleep time for up to six weeks of nightly administration without consistent recovery effects upon discontinuation.
Abstract: The chronic hypnotic efficacy of estazolam 2.0 mg was studied in five female and seven male subjects. Subjects with a complaint of insomnia verified by polysomnography were included in the study. Following a screening and adaptation period, subjects spent two consecutive nights a week in the laboratory. The protocol for medication was placebo for weeks 1, 2, 9 and 10 and estazolam for weeks 3-8. Estazolam 2.0 mg significantly improved sleep onset and total sleep time for up to six weeks of nightly administration without consistent recovery effects upon discontinuation.
TL;DR: Sleep apnea syndromes were diagnosed in 26 patients who visited a private hospital located in Naka Ward, Nagoya, from November 1, 1983, until April 30, 1985, and the percentage was specifically high in male patients between the age of 40 and 69, which might actually have been higher because there were more than six patients with suspicious symptoms, whose diagnostic work-up could not be completed.
Abstract: Incidence of sleep apnea syndromes in the general population in Japan is unknown. To investigate this incidence in Japan, sleep apnea syndromes were carefully diagnosed for all patients who visited a private hospital located in Naka Ward, Nagoya, from November 1, 1983, until April 30, 1985. A total of 9132 patients were examined by four doctors. Insomnia, heavy snoring, daytime hypersomnia, short thick neck, hypertrophied tonsils, obesity, and micrognathia were considered important clues for diagnosis of sleep apnea syndromes. Patients with signs and symptoms of possible sleep apnea syn dromes underwent either an ear-oximeter test or a recording of snoring. Final diagnosis was determined by polysomnography. Sleep apnea syndromes were diagnosed in 26 (23 males and 3 females) out of 9132 patients, the percentage among general patients being 0.285%. The percentage was specifically high (0.785%) in male patients between the age of 40 and 69; and 19 out of all 26 patients with sleep apnea syndromes were in this age group. Among the 26 sleep apnea patients, 17 had hypertension, 9 had diabetes mellitus, and 5 suffered from depression. The percentage of patients with sleep apnea syndromes in this study might actually have been higher because there were more than six patients with suspicious symptoms, whose diagnostic work-up could not be completed.
TL;DR: To the authors' knowledge, this is the first case description of a sleep-wake rhythm that shows not only a breakdown in the regulation of sleep and waking as distinct states, but also a redistribution of electroencephalographic (EEG) sleep architecture across the 24-hr period.
TL;DR: A male infant born to a mother who had been suffering from primary hyperaldosteronism with the administration of alpha-methyldopa (MD) during pregnancy, it is assumed that his behavior and sleep disorders are the effects of the maternal MD administration during pregnancy.
Abstract: A male infant was born to a mother who had been suffering from primary hyperaldosteronism with the administration of alpha-methyldopa (MD) during pregnancy. His behavioral development, especially that of sleep, was studied by means of sleep-awake rhythm and polysomnography recordings (PSG) from 2 months to 2 years and 5 months of age. His daily sleep-awake rhythm showed some abnormal pattern. As to the PSG, the proportion of each sleep stage was normal and the two types of body movements (BM) showed various patterns. A paradoxical increase was seen in the twitch movement of some muscles. MD affects the cathecolamine system in the CNS and human sleep. Since the sleep-awake rhythm and BM are thought to be related to the monoaminergic system in the CNS, we assume that his behavior and sleep disorders are the effects of the maternal MD administration during pregnancy.
TL;DR: Polysomnography and blood gas measurements during sleep in a young man with craniofacial dysostosis, who presented with an extremely severe sleep apnea syndrome, are reported and suggest that hypersomnia was primarily caused by severe nighttime oxygen desaturations and that the hypnagogic hallucinations were caused by apnea-induced chronic REM sleep deprivation.
Abstract: Polysomnography and blood gas measurements during sleep in a young man with craniofacial dysostosis, who presented with an extremely severe sleep apnea syndrome, are reported. Tracheostomy relieved al
TL;DR: Findings support the need for systematic use of all-night polysomnography and multiple sleep latency test in patients with excessive daytime sleepiness.
Abstract: A case of concomitant narcolepsy and obstructive sleep apnea evaluated in a sleep disorder center is reported. Tracheostomy decreased the frequency of the apneas but the clinical and polysomnographic features of narcolepsy remained on 3 and 6 months post-surgical follow-ups. These findings support the need for systematic use of all-night polysomnography and multiple sleep latency test in patients with excessive daytime sleepiness.
TL;DR: It is suggested that gastroplasty may be used as an alternative treatment for weight reduction in selected OSA patients and normal sleep apnea indices are documented in three out of 4 cases.
Abstract: Four male obese patients with obstructive sleep apnea were evaluated by polysomnography, both prior and 3-4 months following gastroplasty. The surgery was performed as an alternative weight loss treatment. These patients were selected for gastroplasty because they had severe obesity, obstructive sleep apnea with cardiopulmonary impairment and noncompliance on a weight loss diet. Tracheostomy was performed concomitantly in three cases. Preoperative recording demonstrated 21.2 to 100.3 apneas per hour of sleep; stage 3 was decreased in three and absent in one case; stage 4 was absent in every patient; stage REM was decreased in three cases; arterial oxygen saturation (Sa02) was below 80% in every case during apenas. Follow-up recordings with occluded tracheostomy were obtained 3-4 months after surgery. The weight reduction varied from 16.3 to 41.4% of the initial weight. The recording documented normal sleep apnea indices in three cases and partial recovery in the remainder; increase in stages 3, 4 and REM; normal Sa02 in three out of 4 cases. These findings suggest that gastroplasty may be used as an alternative treatment for weight reduction in selected OSA patients.