Showing papers on "Polysomnography published in 1991"
TL;DR: The development and use of a new scale, the Epworth sleepiness scale (ESS), is described, which is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness.
Abstract: The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
13,788 citations
TL;DR: It is shown that snoring in this randomly selected population correlates best with neck size, smoking, and nasal stuffiness, and less so with age and general obesity.
Abstract: One thousand and one men, aged 35-65 years, were identified from the age-sex register of one group general practice. Over four years 900 men were visited at home and asked questions about symptoms potentially related to sleep apnoea and snoring. Height, weight, neck circumference, resting arterial oxygen saturation (SaO2), and spirometric values were also determined. All night oximetry was then performed at home and the tracing analysed for the number of dips in SaO2 of more than 4%. Subjects with more than five dips of 4% SaO2 or more per hour were invited for sleep laboratory polysomnography. Seventeen per cent of the men admitted to snoring "often." Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.2%), cigarette consumption (r2 = 3.4%), and nasal stuffiness (r2 = 2%) as the only significant independent predictors of snoring. Together these account for at least a sixfold variation in the likelihood of being an "often" snorer. Forty six subjects (5%) had greater than 4% SaO2 dip rates of over five an hour and 31 of these had full sleep studies. Three subjects had clinically obvious and severe symptomatic obstructive sleep apnoea, giving a prevalence of three per 1001 men (0.3%; 95% confidence interval 0.07-0.9%). Eighteen men had obstructive sleep apnoea only when supine and in 10 the cause of the SaO2 dipping on the original home tracing was not elucidated. The greater than 4% SaO2 dip rates correlated with the history of snoring. Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.9%), alcohol consumption (r2 = 3.7%), age (r2 = 1%) and obesity (r2 = 1%) as the only significant independent predictors of the rate of overnight hypoxic dipping. This study shows that snoring in this randomly selected population correlates best with neck size, smoking, and nasal stuffiness. Obstructive sleep apnoea, defined by nocturnal hypoxaemia, correlates best with neck size and alcohol, and less so with age and general obesity.
671 citations
Journal Article•
TL;DR: It is concluded that children with Down syndrome frequently in have OSAS, with OSA, hypoxemia, and hypoventilation, and it is speculated that OSAS may contribute to the unexplained pulmonary hypertension seen in children with down syndrome.
Abstract: Children with Down syndrome have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), yet the type and severity of OSAS in this population has not been characterized. Fifty-three subjects with Down syndrome (mean age 7.4 +/- 1.2 [SE] years; range 2 weeks to 51 years) were studied. Chest wall movement, heart rate, electroculogram, end-tidal PO2 and PCO2, transcutaneous PO2 and PCO2, and arterial oxygen saturation were measured during a daytime nap polysomnogram. Sixteen of these children also underwent overnight polysomnography. Nap polysomnograms were abnormal in 77% of children; 45% had obstructive sleep apnea (OSA), 4% had central apnea, and 6% had mixed apneas; 66% had hypoventilation (end-tidal PCO2 greater than 45 mm Hg) and 32% desaturation (arterial oxygen saturation less than 90%). Overnight studies were abnormal in 100% of children, with OSA in 63%, hypoventilation in 81%, and desaturation in 56%. Nap studies significantly underestimated the presence of abnormalities when compared to overnight polysomnograms. Seventeen (32%) of the children were referred for testing because OSAS was clinically suspected, but there was no clinical suspicion of OSAS in 36 (68%) children. Neither age, obesity, nor the presence of congenital heart disease affected the incidence of OSA, desaturation, or hypoventilation. Polysomnograms improved in all 8 children who underwent tonsillectomy and adenoidectomy, but they normalized in only 3. It is concluded that children with Down syndrome frequently in have OSAS, with OSA, hypoxemia, and hypoventilation. Obstructive sleep apnea syndrome is seen frequently in those children in whom it is not clinically suspected. It is speculated that OSAS may contribute to the unexplained pulmonary hypertension seen in children with Down syndrome.
398 citations
Journal Article•
TL;DR: The findings suggest that SMS is likely a contiguous-gene deletion syndrome which comprises characteristic clinical features, developmental delay, clinical signs of peripheral neuropathy, abnormal sleep function, and specific behavioral anomalies.
Abstract: We undertook clinical evaluation (32 cases) and molecular evaluation (31 cases) of unrelated patients affected with Smith-Magenis syndrome (SMS) associated with an interstitial deletion of band p11.2 of chromosome 17. Patients were evaluated both clinically and electrophysiologically for peripheral neuropathy, since markers showing close linkage to one form of Charcot-Marie-Tooth disease (CMT1A) map to this chromosomal region. The common clinical findings were broad flat midface with brachycephaly, broad nasal bridge, brachydactyly, speech delay, and hoarse, deep voice. Fifty-five percent of the patients showed clinical signs (e.g., decreased or absent deep tendon reflexes, pes planus or pes cavus, decreased sensitivity to pain, and decreased leg muscle mass) suggestive of peripheral neuropathy. However, unlike patients with CMT1A, these patients demonstrated normal nerve conduction velocities. Self-destructive behaviors, primarily onychotillomania and polyembolokoilamania, were observed in 67% of the patients, and significant symptoms of sleep disturbance were observed in 62%. The absence of REM sleep was demonstrated by polysomnography in two patients. Southern analysis indicated that most patients were deleted for five 17p11.2 markers--FG1 (D17S446), 1516 (D17S258), pYNM67-R5 (D17S29), pA10-41 (D17S71), and pS6.1-HB2 (D17S445)--thus defining a region which appears to be critical to SMS. The deletion was determined to be of paternal origin in nine patients and of maternal origin in six patients. The apparent random parental origin of deletion documented in 15 patients suggests that genomic imprinting does not play a role in the expression of the SMS clinical phenotype. Our findings suggest that SMS is likely a contiguous-gene deletion syndrome which comprises characteristic clinical features, developmental delay, clinical signs of peripheral neuropathy, abnormal sleep function, and specific behavioral anomalies.
332 citations
Journal Article•
TL;DR: Two studies were conducted to evaluate actigraphic home-monitoring for the assessment of infants' and children's sleep patterns and sleep measures showed significant night-to-night stability in both groups.
Abstract: Two studies were conducted to evaluate actigraphic home-monitoring for the assessment of infants' and children's sleep patterns. In the first study, 11 children (aged 12 to 48 months) were monitored in the laboratory by traditional polysomnography and by actigraphy for one night. Actigraphic automatic sleep-wake scorings were compared with those of the polysomnograph; total agreement rate was 85.3%. In the second study, sleep patterns of 63 sleep-disturbed and 34 control healthy children (aged 9 to 27 months) were compared. These children were home-monitored by actigraph for a mean of 4.45 nights (total 482 nights). Actigraphic data were analyzed by an automated scoring procedure. Sleep quality of the sleep-disturbed children, measured by actigraphically derived sleep percent and number of longer-than-5-minute wakings, was significantly lower than that of the control subjects (P less than .0001). Sleep measures showed significant night-to-night stability in both groups. The stability of specific measures and their age trends were different between the groups. Actigraphic sleep measures alone could discriminate between sleep-disturbed and control children with a highly correct assignment rate of 79.4% and 91.2%, respectively.
326 citations
TL;DR: A deep-sleep-associated statistically highly significant 25% decrease in CMRO2 is found, a magnitude of depression according with studies of glucose uptake and reaching levels otherwise associated with light anesthesia.
Abstract: It could be expected that the various stages of sleep were reflected in variation of the overall level of cerebral activity and thereby in the magnitude of cerebral metabolic rate of oxygen (CMRO2) and cerebral blood flow (CBF). The elusive nature of sleep imposes major methodological restrictions on examination of this question. We have now measured CBF and CMRO2 in young healthy volunteers using the Kety-Schmidt technique with 133Xe as the inert gas. Measurements were performed during wakefulness, deep sleep (stage 3/4), and rapid-eye-movement (REM) sleep as verified by standard polysomnography. Contrary to the only previous study in humans, which reported an insignificant 3% reduction in CMRO2 during sleep, we found a deep-sleep-associated statistically highly significant 25% decrease in CMRO2, a magnitude of depression according with studies of glucose uptake and reaching levels otherwise associated with light anesthesia. During REM sleep (dream sleep) CMRO2 was practically the same as in the awake state. Changes in CBF paralleled changes in CMRO2 during both deep and REM sleep.
222 citations
TL;DR: It is suggested that measurement of the RDI with in-home monitoring provides a valid and highly reproducible index for assessment of sleep-related respiratory disturbances for use in epidemiologic studies of general populations.
215 citations
TL;DR: The usefulness of nocturnal pulse oximetry in establishing the diagnosis of OSA is confirmed and the value of a clinical score in improving its sensitivity as a screening tool is highlighted.
168 citations
TL;DR: The sensitivity and specificity of overnight recording of arterial oxygen saturation (SaO2) in routine clinical practice was evaluated and Oximetry alone allowed recognition of a moderate or severe sleep apnoea syndrome.
Abstract: The sensitivity and specificity of overnight recording of arterial oxygen saturation (SaO2) in routine clinical practice was evaluated in 41 subjects who were being investigated for possible sleep apnoea-hypopnoea syndrome. SaO2 was measured with an ear probe oximeter (Biox IIa) and chart recorder during an "acclimatisation" night immediately before a detailed polysomnographic study. The recordings were classified by two observers as positive, negative, or uninterpretable. Twelve of the 41 patients had the obstructive sleep apnoea syndrome when defined in terms of an apnoea-hypopnoea index greater than 15 events an hour on the second night. The sensitivity of nocturnal SaO2 on the acclimatisation night when the diagnostic criterion was an apnoea-hypopnoea index of greater than 5, greater than 15, and greater than 25/h was 60%, 75%, and 100% respectively. Corresponding values for specificity were 95%, 86%, and 80%. Oximetry alone therefore allowed recognition of a moderate or severe sleep apnoea syndrome. In routine practice an appreciable number of equivocal results is likely and repeat oximetry or more detailed polysomnography will then be required if clinical suspicion is high.
106 citations
TL;DR: Sleep quality, attention, concentration and reaction performance improved under paroxetine as compared to baseline, and the deterioration of well-being under PX 40 might be related to the appearance of drowsiness and nausea.
Abstract: Paroxetine is a novel antidepressant drug with selective serotonin (5-HT) reuptake inhibitory properties. In a double-blind placebo-controlled crossover sleep laboratory study the single-dose effects on objective and subjective sleep and awakening qualities were investigated after paroxetine 20, 30 and 40 mg morning doses (PX 20, 30, 40), paroxetine 30 mg evening dose, fluoxetine 40 mg morning dose (FX 40) and placebo in 18 healthy young volunteers. The drugs were orally administered in 2-wk intervals. In addition to each drug night, the adaptation night and washout night were recorded. Polysomnographic investigations (10:30 p.m. to 6:00 a.m.) showed a delayed sleep onset only after the morning intake of paroxetine, PX 40 being statistically different from placebo. Total sleep time and sleep efficiency deteriorated under morning PX 30, PX 40 and evening PX 30 as compared to placebo. The nocturnal wake time and sleep stage 1 increased under the paroxetine. Rapid eye movement (REM) reduction (min and %) occurred dose dependently after all paroxetine doses, but the REM latency was lengthened only after the morning intake. The suppressant effect on REM sleep is characteristic for antidepressants and was still significant in the washout nights following PX 40 and evening PX 30. The only statistically relevant finding under 40 mg fluoxetine referred to the increase of REM latency in both drug and washout nights. In contrast to objective results, subjective sleep quality remained generally unchanged. Attention, concentration and reaction performance improved under paroxetine as compared to baseline. The deterioration of well-being under PX 40 might be related to the appearance of drowsiness and nausea. Blood pressure and pulse rate were unaffected.
95 citations
TL;DR: The polysomnographic findings indicated a shortened sleep latency, increased total sleep time, decreased total wake time and increased sleep efficiency when patients ingested zolpidem 30 minutes before bedtime, and the PSG remains the keystone in the evaluation of hypnotic efficacy.
Abstract: There is little published literature on the correlation between subjective and objective efficacy of hypnotics. We wanted to determine whether there was a correlation between the patient's subjective evaluation of the efficacy of the hypnotic with the polysomnographic (PSG) findings. We studied 16 patients with chronic insomnia (sleep latency, greater than or equal to 30 minutes; total sleep time, greater than 240 but less than 420 minutes) for 11 nights who took placebos on nights 1 and 2, zolpidem (imidazopyridine) on nights 3-9 and placebo on nights 10 and 11. Patients completed a questionnaire each morning following PSG, which evaluated subjective sleep quality, sleep latency and total sleep time. These data were compared to PSG findings to answer specific questions about sleep latency reduction, efficacy of the hypnotic after a week's use, sleep quality after discontinuing the drug, and any correlation between subjective and objective measures. PSG findings indicated a shortened sleep latency, increased total sleep time, decreased total wake time and increased sleep efficiency when patients ingested zolpidem 30 minutes before bedtime. We found that after 7 nights (nights 3-9) the drug was still effective in reducing sleep latency and increasing total sleep time. Upon withdrawal (nights 10 and 11) sleep returned to baseline (nights 1 and 2). Subjectively, the patients confirmed those findings on the questionnaire, as well as a subjective reduction in the number of awakenings and, interestingly, a subjective increase in the time spent awake after sleep. Many of the objective variables we examined correlated highly with the subjective variables. While on zolpidem, subjects believed and were objectively shown to have a decreased sleep latency, increased total sleep time and decreased time awake before persistent sleep, although they tended to overestimate sleep latency and time spent awake before persistent sleep and underestimated total sleep time. Although the correlation between objective and subjective measures was high for the group, in individual patients there was an impressive difference between the two, and the highest coefficient of variation between a subjective and objective measures was 0.453. No correlations were found with subjective measures of refreshing quality of sleep, decrease in number of awakenings, how sleepy patients felt in the morning or their ability to concentrate in the morning. Thus, we believe the PSG remains the keystone in the evaluation of hypnotic efficacy.
TL;DR: The authors used polysomnography, echocardiography and ventilatory measurements to study 50 patients suspected of having OSA to determine a link to RVH and found those with RVH had a higher AI, longer average apnea time, a greater duration of longest apnea and a lower average oxygen saturation for the period of the sleep study.
TL;DR: It is concluded that there is a positive association--relative risk estimate between 1.3 and 40--for sleep apnea syndrome and hypertension, but the risk association is unstable and there is insufficient data to justify doing polysomnography as part of the routine diagnostic work-up for patients with hypertension.
TL;DR: VPSG is superior to standard polysomnography for the evaluation of parasomnias because of the increased capability to identify and localize EEG abnormalities and to correlate behavior with EEG and polysOMnography.
Abstract: To investigate the diagnostic value of video-EEG polysomnography (VPSG), we reviewed our experience in 122 patients with suspected parasomnias who underwent one or two nights of VPSG. Of 86 patients without known epilepsy, VPSG provided useful diagnostic information for 41 (69%) of those with a history of prominent motor activity during sleep and for 11 (41%) of those with a history of minor motor activity during sleep. Two children and one adult with clinical histories suggestive of sleep terrors had unequivocal partial seizures during VPSG. Of 36 patients with known epilepsy, VPSG was useful diagnostically in 28 (78%). VPSG is superior to standard polysomnography for the evaluation of parasomnias because of the increased capability to identify and localize EEG abnormalities and to correlate behavior with EEG and polysomnography. VPSG may also be a suitable alternative to intensive inpatient monitoring for some patients with known or suspected epilepsy who have frequent undiagnosed nocturnal spells.
TL;DR: Older subjects' morningness test scores were significantly associated with objectively measured sleep durations, with a tendency toward "morning-type" circadian orientation being associated with longer sleep.
Abstract: Thirty-four healthy older adults (self-described "good sleepers") in their ninth decade of life (16m/18f, mean age 83.1) were compared to 30 young controls in their third decade (21m/9f, mean age 25.5) with regard to: (a) circadian and personality characteristics as measured by the Horne-Ostberg Morningness Questionnaire (HOM), Circadian Type Questionnaire (CTQ) and Eysenck Personality Inventory (EPI); (b) measures of habitual bedtime, waketime, and time in bed from a 2-week sleep diary; and (c) polysomnographic measures from a (post-adaptation) night of sleep recording in the laboratory. In almost all laboratory measures the older group slept poorly compared with the young, acquiring about one hour less total recorded sleep. The older group showed earlier habitual time of waking than the young, and showed higher (more "morning-type") scores on test instruments (HOM, CTQ-M) designed to assess morning-evening orientation. They also showed a lack of flexibility in sleep patterns (higher CTQ-Rs score) and less intersubject and intrasubject variability in habitual sleep timing compared to the young. Older subjects' morningness test scores were significantly associated with objectively measured sleep durations, with a tendency toward "morning-type" circadian orientation being associated with longer sleep.
TL;DR: This study describes a simple method, based on a movable catheter technique, for use during routine polysomnography to identify the site of obstruction, and this has been applied to 51 patients with suspected sleep apnea.
Abstract: This study describes a simple method, based on a movable catheter technique, for use during routine polysomnography to identify the site of obstruction, and this has been applied to 51 patients with suspected sleep apnea. The obstruction was found to be retropalatal in 30, retrolingual in 7, and could not be determined in 14 patients (12 had no sleep apnea, 1 did not sleep, and 1 had central sleep apnea). Twelve of these patients had uvulopalatopharyngoplasty with preoperative and postoperative polysomnograms to determine the site of obstruction. The preoperative obstruction was retropalatal in nine and retrolingual in three. Postoperatively, four patients (one with retrolingual obstruction and three with retropalatal obstruction) no longer had sleep apnea. In the remaining eight patients, the site of obstruction was unchanged from the preoperative one. Several conclusions result: 1. the movable catheter technique offers a simple way to determine the site of obstruction in patients with significant obstructive sleep apnea, 2. most such patients obstruct in the retropalatal region, and 3. preoperative localization of the site of obstruction to the retropalatal region does not seem to improve the surgical outcome of uvulopalatopharyngoplasty.
TL;DR: Several scales from the Minnesota Multiphasic Personality Inventory discriminated those patients who showed multiple FNE from those who did not, and the finding that clinically and statistically significant intrasubject variability across nights was observed for each sleep parameter measured was striking.
Abstract: Twenty patients with difficulties initiating and maintaining sleep (DIMS) were monitored in their homes for three consecutive nights using ambulatory polysomnography (PSG). Following each night of monitoring, patients provided subjective ratings of sleep disturbance and tolerance of the PSG equipment. Friedman analyses of variance performed on the objective and subjective parameters showed that the sample, as a whole, evidenced no systematic first night effects (FNE) in response to monitoring. Inspection of the data from each individual subject, nevertheless, showed that half of the sample did experience multiple FNE. Further, several scales from the Minnesota Multiphasic Personality Inventory discriminated those patients who showed multiple FNE from those who did not. However, far more striking was the finding that clinically and statistically significant intrasubject variability across nights was observed for each sleep parameter measured. Given this finding, a single ambulatory PSG study may not fully convey the nature of the sleep disturbance experienced by the DIMS patient even when FNE are absent. We thus, recommend multiple ambulatory sleep studies for those clinical and research situations in which it is necessary to document patients' night-to-night sleep variability. In contrast, when the goal of the PSG study is that of determining a sleep diagnosis, a single ambulatory study, in combination with other clinical data, may be sufficient.
TL;DR: Postoperative monitoring for apnea, desaturation, and dysrhythmias is a necessity in sleep apnea patients and postoperative pain is effectively controlled with acetaminophen and topical anesthetic sprays.
TL;DR: In this paper, the ability of continuous nocturnal oximetry to detect sleep apnea syndrome (SAS) and to recognize nonapneic oxyhemoglobin desaturations was assessed.
TL;DR: One postoperative recording is not enough to estimate the outcome of uvulopalatopharyngoplasty and statements of the patient's subjective recovery alone must not be used for this purpose.
Abstract: Larsson H. Carlsson-Nordlander B, Svanborg E. Long-time follow-up after UPPP for obstructive sleep apnea syndrome. Results of sleep apnea recordings and subjective evaluation 6 months and 2 years after surgery. Acta Otolaryngol (Stockh) 1991: 111: 582-590.Fifty unselected consecutive patients with obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). the diagnosis was based on the patient's history and recording of respiration movements (Static Charge Sensitive Bed. SCSB) and oximetry, alone or combined with polysomnography. Renewed SCSB oximetry recordings were used to evaluate the success of the treatment. Six months postoperatively 40 Vc of the patients were classified as non-responders. i.e. their oxygen desaturation indices (ODD were reduced by less than 50% or were still above 20. the mean body mass index (BMI) was significantly higher in the non-responder group. a second recording with complete data was obtained in 45 patients after an average of 21 months. It was foun...
TL;DR: It is concluded that PSG during 2 h of sleep is an appropriate method for evaluating SDB, and sensitivities, specificities, and predictive values of each PSG-1/2 parameter were determined by comparing the values with those measured duringPSG-T.
Abstract: We hypothesized that sleep-disordered breathing (SDB), defined by the apnea index (AI), the apnea + hypopnea index (A+H/I), or the desaturation event frequency (number of desaturations > 5%/h slept) (DEF), could be diagnosed after less than full-night polysomnography (PSG). Forty-eight consecutive full-night PSG sessions were evaluated by separately analyzing the first half (PSG-½) and the total (PSG-T) sleep time: 134.42 ± 35.7 and 277.15 ± 56.5 min (mean ± SD), respectively.PSG-½ and PSG-T were not different with respect to AI. The DEF was statistically but not clinically higher during PSG-½ (41.72 ± 41 versus 37.95 ± 35.8, p = 0.04). Sensitivities, specificities, and predictive values of each PSG-½ parameter were determined by comparing the values with those measured during PSG-T, using cutoff frequencies of both 5 and 10 events/h slept to define SDB. At a cutoff frequency of 10, sensitivities and positive predictive values were high for all PSG-½ parameters (range, 94.6 to 96.9%). The specificities of...
TL;DR: Physicians should be alerted about the possibility of injurious, but usually treatable, parasomnias in ICU patients.
Abstract: There are no previous reports on parasomnias (sleep behavior disorders) affecting patients on intensive care units (ICUs). During 8 years of clinical practice, we evaluated over 200 adults with complaints of injurious, sleep-related behaviors, 20 of whom had ICU admissions while their parasomnias had been active and generally undiagnosed/untreated. Mean age during ICU confinement was 62.8 (+/- SD 13.1) years; 85.0% (17/20) were males. Patients underwent comprehensive clinical examinations along with extensive polysomnographic and audiovisual monitoring (electrooculogram, 9 channel EEG with paper speeds of 15 and 30 mm/sec, electromyogram [submental and 4 limbs], EKG, airflow). The polysomnographic studies were diagnostic for the REM sleep behavior disorder (vigorous dream-enactment during rapid eye movement [REM] sleep) in 85.0% (17/20) of patients, and for night terrors/sleepwalking in 15.0% (3/20). Three groups of parasomnia-ICU relationships were identified: i) Parasomnias originating in ICUs, stroke-induced (n = 3); ii) Admission to ICUs resulting from parasomnia-induced injuries: C2 odontoid process fracture and C3 spinous process fracture with severe concussion (n = 2); iii) Parasomnias in patients admitted to ICUs for various other medical problems (n = 15). Physicians should be thus alerted about the possibility of injurious, but usually treatable, parasomnias in ICU patients.
TL;DR: Although there was improvement in the patients' clinical condition, there were no treatment-related changes in any of the sleep parameters and eight of the 13 patients, however, were found to have primary sleep disorders.
Abstract: Thirteen patients with rheumatoid arthritis (mean +/- SD age 55.8 +/- 10.5 years) received 20 mg of tenoxicam daily for 90 days following a 3-7 day "washout" period and 4 days of placebo treatment. Clinical evaluations were conducted at the end of the washout period and at monthly intervals thereafter. All-night polysomnography was performed in a sleep laboratory during the last 2 days of placebo treatment and on days 13, 14, 89, and 90 of tenoxicam treatment. Although there was improvement in the patients' clinical condition, there were no treatment-related changes in any of the sleep parameters. Eight of the 13 patients, however, were found to have primary sleep disorders. Four had periodic leg movements during sleep, 3 had sleep apneas, and 1 had a combination of both disorders. The implications of these findings in the treatment of sleep disorders in patients with rheumatoid arthritis are discussed.
TL;DR: The beneficial effect of uvulopalatopharyn‐goplasty is established, which is the recommended surgical procedure for obstructive sleep apnea syndrome.
Abstract: A study of 71 patients with obstructive sleep apnea syndrome was performed to evaluate the effectiveness, complications, and late sequelae of uvulopalatopharyngoplasty. Postoperative immediate complications were of minor importance. In 96% of the patients, the snoring was improved; it was completely resolved in 48%. The postoperative apnea index remained pathologic in all patients who underwent postoperative polysomnography, although mild improvement was noted. Seventy-four percent of our patients felt a subjective postoperative improvement which was not always confirmed by the polysomnographic examination. A record of improvement was obtained in 64% of the operated patients. Our results establish the beneficial effect of uvulopalatopharyngoplasty, which is the recommended surgical procedure for obstructive sleep apnea syndrome.
TL;DR: The results suggest that during non-rapid eye movement sleep cerebral metabolism and thereby cerebral synaptic activity is correlated to cerebral readiness rather than to mental activity.
TL;DR: Computer-found rapid resaturations are more sensitive than desaturations for the detection of respiratory events during sleep from oximetry and accompanied by relatively well-preserved specificity.
Abstract: A computerized search for rapid resaturation (RES)—defined as increases in oxyhemoglobin saturation (SaO2) of 3% or more within 10 s—was used to detect apneas and hypopneas during sleep by the episodes of compensatory hyperventilation following them. Results were compared to those from computerized search for desaturations (DESAT)—defined as decreases in SaO2 of 4% or more within 40 s—and to simultaneous polysomnography. We studied 30 patients with obstructive sleep apnea (OSA) with an apnea plus hypopnea index (AHI) of 30.8±6.9 (median ± SEM) and 23 habitual snorers (HSN) with an AHI of 7±1.5. Manual scoring of polysomnography revealed 7965 respiratory events (6192 apneas, 1773 hypopneas) in OSA patients and 940 events (411 apneas, 529 hypopneas) in the HSN group. In OSA patients, the computer found 96% of events by searching for RES and 87% by searching for DESAT. The percentage of computer-found events in OSA classified as true positive was 91% for RES and 97% for DESAT. In the HSN group, 83% of polysomnographically scored events were found by RES and 55% by DESAT, with 72% of RES and 84% of DESAT being true positive. The correlation of the number of computer-found RES with the number of events from polysomnography was better in OSA (r=0.862, p<0.0001) than in HSN (r=0.722, p<0.001). The same was true for DESAT (OSA: r=0.896, p<0.0001; HSN: r=0.637, p<0.01). In conclusion, computer-found rapid resaturations are more sensitive than desaturations for the detection of respiratory events during sleep from oximetry. Increased sensitivity of RES is accompanied by relatively well-preserved specificity.
Journal Article•
TL;DR: Hormone changes support the hypothesis that reduced hypothalamic dopaminergic tone is present in the SMP compared to the ASMP in Kleine-Levin patients.
Abstract: A patient with Kleine-Levin syndrome had polysomnography and neuroendocrinological assays performed during asymptomatic (ASMP) and symptomatic (SMP) 24-hr periods. During the SMP, sleep data revealed poor nocturnal sleep efficiency, increased sleep fragmentation and reduced stages 3, 4 and rapid eye movement (REM). No sleep onset REM episodes were seen. Sleep staging in the ASMP was normal. Blood samples were obtained every 20 min and assayed for thyroid-stimulating hormone (TSH), cortisol (CORT), prolactin (PRL) and growth hormone (GH). Patterns of secretion, 24-hr mean and total integrated concentrations, and mean sleep period time values during the ASMP and SMP were compared. The mean 24-hr level of TSH was increased and GH decreased in the SMP. Comparing sleep period time in the SMP to the ASMP, values for TSH and PRL were increased and GH and CORT were reduced in the SMP. These hormone changes support the hypothesis that reduced hypothalamic dopaminergic tone is present in the SMP compared to the ASMP in Kleine-Levin patients.
Book•
01 May 1991
TL;DR: The present state of Ambulatory Monitoring of Sleep and problem-Oriented Diagnosis of Sleep Disorders using Computerized Methods and Electroencephalographic Analysis for the Determination of Stable and Unstable Processes are presented.
Abstract: 1 Sleep and Health Risk: Methodology.- The Present State of Ambulatory Monitoring of Sleep.- Problem-Oriented Diagnosis of Sleep Disorders Using Computerized Methods.- Computer-Assisted Polysomnography.- Vitalog "Lunchbox" Home Monitor for Evaluation of Obstructive Sleep Apnea.- A Mobile Ten-Channel Unit (Sidas 2010) for the Diagnosis of Sleep-Related Breathing Disorders.- Model-Based Sleep Analysis.- A New Method of Electroencephalographic Analysis for the Determination of Stable and Unstable Processes.- 2 Sleep and Health Risk: Epidemiology.- Two-Peak 24-Hour Patterns in Sleep, Mortality, and Error.- Sleepiness in an Adult Population: Prevalence, Validity, and Correlates.- Epidemiology and Natural History of Obstructive Sleep Apnea Syndrome.- Insomnia and Menopause Among Middle-Aged Women: An Epidemiological Survey of Icelandic Women.- Symptoms and Findings in 489 Outpatients with Suspected Sleep Apnea.- Long-Term Evolution of Obstructive Sleep Apnea.- 3 Sleep and Health Risk in Neurology.- Physiological Risks During Sleep.- Health Risks Associated with Autonomic Nervous System Malfunction.- Sleep Disturbances Caused by Rest-Dependent Muscular and Motor Dysfunctions.- Health Risk Narcolepsy: Evidence for an Involvement of Alpha-Adrenergic Mechanisms.- Sleep-Related Respiratory Impairment in Muscular and Skeletal Diseases.- Ambulatory Monitoring of Sleep-Related Panic Attacks.- Psychological Problems Correlated with Sleep Apnea.- Interaction and Classification of Sleep and Health Risk.- 4 Sleep and Health Risk: Breathing Disorders.- Central Venous Oxygen Saturation, Abnormal Gas Exchange, and Rate of Fall of Arterial Oxyhemoglobin Saturation During Obstructive Apnea.- Advances in Respiration Acoustic Monitoring.- Variability of Breathing Pattern.- Sleep and Asthma.- Mechanical Ventilation in the Treatment of Sleep-Related Breathing Disorders.- The Efficiency of the MESAM System in Long-Term Control of nCPAP Therapy.- Cyclical Variation of Heart Rate in Sleep Apnea Before and Under Nasal Continuous Positive Airway Pressure Therapy.- Prevalence of Oxygen Desaturations and Associated Breathing Disorders During Sleep in Patients with Chronic Obstructive Pulmonary Disease.- Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea.- Results of ENT Examination in Patients with Obstructive Sleep Apnea Syndrome and Continuous Positive Airway Pressure Therapy.- 5 Sleep and Health Risk in Occupational Medicine.- Shift Work and Sleep Disturbances.- Sleep Apnea and Accidents: Health Risk for Healthy People?.- Association Between Sleep Disturbances and Blood Pressure in Shiftworkers.- 6 Sleep and Health Risk in Cardiovascular Diseases.- Blood Pressure in Sleep-Related Disordered Breathing: A Hypothesis.- Changes in General Circulation in Sleep Apnea Syndrome.- Sleep-Related Breathing Disorders and Arterial Hypertension.- Investigations of Arterial Baro- and Chemoreflexes in Patients with Arterial Hypertension and Obstructive Sleep Apnea Syndrome.- Analysis of Central Apnea in Patients with and Without Left Ventricular Failure.- Increased Sympathetic Activity as Possible Etiology of Hypertension and Left Ventricular Hypertrophy in Patients with Obstructive Sleep Apnea.- Changes in Left Ventricular Ejection Fraction During Arterial REM Sleep Desaturation and Exercise in Chronic Obstructive Pulmonary Disease and Sleep Apnea Syndrome.- Pulmonary Hemodynamics in the Obstructive Sleep Apnea Syndrome.- Pulmonary Artery Pressure During Central Sleep Apnea.- Prevalence of Sleep Apnea in Patients Without Evidence of Cardiac Disease.- Nocturnal Myocardial Ischemia and Cardiac Arrhythmias in Patients with Coronary Heart Disease and Sleep-Related Breathing Disorders.- Blood Pressure Behavior in Patients with Sleep Apnea Under Cilazapril Versus Metoprolol.- 7 Sleep and Health Risk in Infancy.- Respiratory Adaptation During Sleep in Infants and Children: Risk Factors.- Infant Obstructive Sleep Apnea, Near-Miss Sudden Infant Death Syndrome, and the Development of Obstructive Sleep Apnea Syndrome.- Respiratory Mechanisms During Sleep That Might Be Responsible for Sudden Infant Death Syndrome.- Respiratory Control Development and Sleep States in Newborns and During the First Weeks of Life in Humans.- Sudden Infant Death Syndrome: Risk Reduction.- Children Intolerant to Cow's Milk May Suffer from Severe Insomnia.- Indications of Sleep-Related Upper Airway Obstruction in Children.- Development, Disturbances, and Training of Respiratory Regulation in Infants.- Daytime Hypoxia, Sleep Disturbance, Nocturnal Hypoxaemia and Retarded Growth in Young Children Who Snore (Before and After Adenotonsillectomy) Compared with Control Children.- Pathophysiological Study of the Respiratory Disturbance Caused by Adenoid-Tonsillar Hypertrophy.- Unreliability of Apnea Monitoring in Infants with Sleep-Dependent Hypoventilation.- 8 Sleep and Health Risk: Endocrinology.- Interactions Between the Hypothalamus-Pituitary-Adrenal System and Sleep in Humans.- Circardian Rhythms of Biogenic Amines in Health, Stress, and Depression.- Changes in Volume- and Pressure-Regulating Hormone Systems During Nasal CPAP Therapy in Patients with Obstructive Sleep Apnea Syndrome.- Nighttime and Daytime Water and Sodium Excretion in Patients with the Obstructive Sleep Apnea Syndrome: Effects of Nasal Continuous Positive Airway Pressure.- 9 Sleep and Health Risk: Insomnia.- Health Risk of Insomnia.- Sleep Quality and Health: Description of the Sleep Quality Index.- From Sleep Disorders to Hypnotic Use:What Happens in the French Population.- Prognostic Significance of EEG Sleep Changes in Late-Life Depression.
TL;DR: The results suggest that abnormal breathing during sleep is common in myotonic dystrophy and is not due solely to the direct effects of respiratory muscle weakness.
Abstract: Sleep apnoea and hypopnoea have been reported in myotonic dystrophy, but it is unclear whether this is simply attributable to the respiratory muscle weakness which is common in this condition. We therefore investigated whether breathing and oxygenation during sleep were more abnormal in patients with myotonic dystrophy than in patients with non-myotonic muscle weakness. Seven subjects were studied in each of three groups: normal controls, myotonic dystrophy and non-myotonic weakness. Patients in the latter group were chosen to represent a similar range of severity of respiratory muscle weakness to those with myotonic dystrophy. Detailed polysomnography was performed; the severity of breathing disorders during sleep was quantified in terms of the frequencies of apnoea and hypopnoea and the degree of arterial desaturation. The myotonic patients showed more frequent apnoea and hypopnoea and more severe desaturation than the other two groups; the results in the non-myotonic patients were generally intermediate. The results suggest that abnormal breathing during sleep is common in myotonic dystrophy and is not due solely to the direct effects of respiratory muscle weakness. Somnolence, which is a well recognized symptom of myotonic dystrophy, was not clearly attributable to the sleep apnoea/hypopnoea syndrome nor to abnormal sleep architecture in the myotonic patients.
TL;DR: It is concluded that BV use is associated with significant dSaO2 in over 50 percent of patients and is predominantly obstructive in nature but may be due to chronic underventilation in patients using less effective BVs.