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Showing papers on "Polysomnography published in 1995"


Journal ArticleDOI
TL;DR: It is concluded that patients with obstructive sleep apnea have high sympathetic activity when awake, with further increases in blood pressure and sympathetic activity during sleep, which are attenuated by treatment with CPAP.
Abstract: Blood pressure, heart rate, sympathetic nerve activity, and polysomnography were recorded during wakefulness and sleep in 10 patients with obstructive sleep apnea. Measurements were also obtained after treatment with continuous positive airway pressure (CPAP) in four patients. Awake sympathetic activity was also measured in 10 age- and sex-matched control subjects and in 5 obese subjects without a history of sleep apnea. Patients with sleep apnea had high levels of nerve activity even when awake (P < 0.001). Blood pressure and sympathetic nerve activity did not fall during any stage of sleep. Mean blood pressure was 92 +/- 4.5 mmHg when awake and reached peak levels of 116 +/- 5 and 127 +/- 7 mmHg during stage II sleep (n = 10) and rapid eye movement (REM) sleep (n = 5), respectively (P < 0.001). Sympathetic activity increased during sleep (P = 0.01) especially during stage II (133 +/- 9% above wakefulness; P = 0.006) and REM (141 +/- 13%; P = 0.007). Peak sympathetic activity (measured over the last 10 s of each apneic event) increased to 299 +/- 96% during stage II sleep and to 246 +/- 36% during REM sleep (both P < 0.001). CPAP decreased sympathetic activity and blood pressure during sleep (P < 0.03). We conclude that patients with obstructive sleep apnea have high sympathetic activity when awake, with further increases in blood pressure and sympathetic activity during sleep. These increases are attenuated by treatment with CPAP.

2,264 citations


Journal ArticleDOI
01 Sep 1995-Chest
TL;DR: It is concluded that primary snoring in children cannot be reliably distinguished from childhood obstructive sleep apnea syndrome by clinical history alone.

605 citations


Journal ArticleDOI
01 Apr 1995-Sleep
TL;DR: Questionnaire data from patients presenting at three sleep disorders centers were used to develop and assess a screening tool for sleep apnea based on the reporting of the frequency of various symptoms ofsleep apnea and other sleep disorders plus age, body mass index (BMI) and gender.
Abstract: Questionnaire data from patients presenting at three sleep disorders centers were used to develop and assess a screening tool for sleep apnea based on the reporting of the frequency of various symptoms of sleep apnea and other sleep disorders plus age, body mass index (BMI) and gender. Patients were not specifically referred for suspicion of sleep apnea. Separate factor analyses of survey responses from 658, 193 and 77 respondents from the first, second and third sites, respectively, each yielded four orthogonal factors, one of which accounted for all the questions concerned with the frequency of disordered breathing during sleep. The survey was shown to be reliable in a subset of patients from one of the sites (test-retest correlation = 0.92). Survey data were then compared to a clinical measure of sleep apnea (respiratory disturbance index) obtained from polysomnography. A multivariable apnea risk index including survey responses, age, gender and BMI was estimated using multiple logistic regression in a total sample of 427 respondents from two of the sites. Predictive ability was assessed using receiver operating characteristic (ROC) curves. The area under the ROC curve was 0.79 (p < 0.0001). For BMI alone, it was 0.73, and for an index measuring the self-report of the frequency of apnea symptoms, it was 0.70. The multivariable apnea risk index has potential utility in clinical settings.

464 citations


Journal ArticleDOI
TL;DR: All patients improved with adenotonsillectomy, but patients with the most severe RDI often had many respiratory events after surgery, and history and physical findings were not useful in predicting outcome.
Abstract: Objectives: To determine (1) the prevalence of obstructive sleep apnea (OSA) in children with a suggestive history; (2) the effectiveness of surgery in treating OSA in children; and (3) factors that may help the physician select patients who have physiologically significant OSA and are likely to respond to surgery. Design: Prospective study. Patients: Sixty-nine children aged 1 to 14 years who were referred to the otolaryngologist for evaluation of suspected OSA. Interventions: Thirty children with a respiratory disturbance index (RDI) greater than 5 underwent adenotonsillectomy. Twenty-six of the 30 children had follow-up polysomnography. Main Outcome Measures: Polysomnography after surgery. Results: Thirty-five (51%) of 69 children had an RDI greater than 5 on polysomnography. Twenty-six of the 30 children who underwent adenotonsillectomy for OSA had follow-up polysomnography. All 26 children had a lower RDI after surgery, although four patients still had an RDI greater than 5. A preoperative RDI of 19.1 or less predicted a postoperative RDI of 5 or less. History and physical findings were not useful in predicting outcome. Conclusions: All patients improved with adenotonsillectomy, but patients with the most severe RDI often had many respiratory events after surgery. History and physical examination alone are not sufficient to assess the severity of OSA or the likelihood of an adequate response to surgical treatment. (Arch Otolarygol Head Neck Surg. 1995;121:525-530)

448 citations


Journal ArticleDOI
01 Feb 1995-Chest
TL;DR: The clinical presentation as to the clinical benefits obtained from N-CPAP were different when comparing mild vs moderate-to-severe SAS, however, no differences were shown in the two subgroups regarding the side effects regarding the nasal mask.

367 citations


Journal ArticleDOI
TL;DR: This was a genetic-epidemiologic study that assessed the distribution of SDB in families identified through a proband with diagnosedSleep apnea and among families in the same community with no relative with known sleep apnea.
Abstract: An inherited basis for sleep-disordered breathing (SDB) has been suggested by reports of families with multiple affected members and by a previous study of the familial aggregation of symptoms of SDB. In this study, we quantify and characterize the aggregation of SDB and assess the degree to which familial similarities may be independent of obesity. This was a genetic-epidemiologic study that assessed the distribution of SDB in families identified through a proband with diagnosed sleep apnea and among families in the same community with no relative with known sleep apnea. SDB was assessed with overnight in-home monitoring of airflow, oxygen saturation, chest wall impedance, heart rate, and body movement. Standardized questionnaires were used to assess symptoms, and weight, height, and neck circumference were measured directly. Intergenerational and intragenerational correlation coefficients and pairwise odds ratios (ORs) were calculated with adjustment for proband sampling. In toto, 561 members of 91 families were studied: (1) 47 subjects with laboratory-confirmed SDB (index probands), (2) 44 community control subjects, and (3) the spouses and relatives of 1 and 2. Of all 91 families, 32 (35%) had two or more members with SDB, 30 (33%) had one affected member, and 29 had no affected members. SDB was more prevalent in the relatives of index probands (21%) than among neighborhood control subjects (12%) (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

363 citations


Journal ArticleDOI
TL;DR: It is concluded that pharyngeal cross-sectional area is reduced during central apnea in the absence of inspiratory effort and subatmospheric intraluminal pressure is not required for pharynGEal occlusion to occur.
Abstract: We hypothesized that subatmospheric intraluminal pressure is not required for pharyngeal occlusion during sleep. Six normal subjects and six subjects with sleep apnea or hypopnea (SAH) were studied during non-rapid-eye-movement sleep. Pharyngeal patency was determined by using fiber-optic nasopharyngoscopy during spontaneous central sleep apnea (n = 4) and induced hypocapnic central apnea via nasal mechanical ventilation (n = 10). Complete pharyngeal occlusion occurred in 146 of 160 spontaneously occurring central apneas in patients with central sleep apnea syndrome. During induced hypocapnic central apnea, gradual progressive pharyngeal narrowing occurred. More pronounced narrowing was noted at the velopharynx relative to the oropharynx and in subjects with SAH relative to normals. Complete pharyngeal occlusion frequently occurred in subjects with SAH (31 of 44 apneas) but rarely occurred in normals (3 of 25 apneas). Resumption of inspiratory effort was associated with persistent narrowing or complete occlusion unless electroencephalogram signs of arousal were noted. Thus pharyngeal cross-sectional area is reduced during central apnea in the absence of inspiratory effort. Velopharyngeal narrowing consistently occurs during induced hypocapnic central apnea even in normal subjects. Complete pharyngeal occlusion occurs during spontaneous or induced central apnea in patients with SAH. We conclude that subatmospheric intraluminal pressure is not required for pharyngeal occlusion to occur. Pharyngeal narrowing or occlusion during central apnea may be due to passive collapse or active constriction.

330 citations


Journal ArticleDOI
TL;DR: The prevalence and effect of sleep-disordered breathing in a relatively large group of clinically well-defined patients with stable, optimally treated congestive heart failure is determined and the predictors ofsleep-disorder breathing in these patients are determined.
Abstract: Objective: To determine the prevalence and effect of sleep-disordered breathing in ambulatory patients with stable, optimally treated congestive heart failure. Design: A prospective, longitudinal s...

303 citations


Journal ArticleDOI
TL;DR: Recurrent awakenings, threatening dreams, thrashing movements during sleep, and awakenings with startle or panic features represented the most prevalently reported sleep-related symptoms in combat veterans with PTSD.
Abstract: Objective: Sleep disturbances are important features of posttraumatic stress disorder (PTSD); however, the published data characterizing PTSD sleep phenomena are limited. The authors report on the phenomenology and physiological correlates ofsymptomatic sleep events in PTSD. Method: The study data included survey results that addressed sleep symptoms during the past month in combat veterans with and without PTSD (N-_58), sleep diary records of awakenings from combat veterans with PTSD hospitalized on an inpatient rehabilitation unit (N=52), and overnight polysomnography recordings obtained from 2 1 medication-free combat veterans with PTSD and eight healthy comparison subjects not exposed to combat. Results: Recurrent awakenings, threatening dreams, thrashing movements during sleep, and awakenings with startle or panic features represented the most prevalently reported sleep-related symptoms. Laboratory findings of longer time awake, micro-awakenings, and a trend for patients to exhibit body and limb movements during sleep are consistent with the subjectively reported symptom profile. Prospectively assessed symptomatic awakenings featured startle or panic symptoms or anxiety related to threatening dreams. Laboratory findings revealed a trend for the symptomatic awakenings (with and without dream recall) to be disproportionately preceded by REM sleep, and the two recorded awakenings with objective physiological arousal were preceded by REM. Conclusions: PTSD features intrusions into sleep of more highly aroused behaviors and states, which appear partially conditioned to REM sleep. (Am J Psychiatry 1995; 152:110-115)

296 citations


Journal ArticleDOI
TL;DR: Exogenous melatonin may be useful in treating insomnia and nocturnal melatonin secretion may be involved in physiologic sleep onset, as assessed with mood and performance tests administered on the morning after treatment.
Abstract: We previously observed tht low oral doses of melatonin given at noon increase blood melatonin concentrations to those normally occurring nocturnally and facilitate sleep onset, as assessed using and involuntary muscle relaxation test. In this study we examined the induction of polysomnographically recorded sleep by similar doses given later in the evening, close to the times of endogenous melatonin release and habitual sleep onset. Volunteers received the hormone (oral doses of 0.3 or 1.0 mg) or placebo at 6, 8, or 9 PM. Latencies to sleep onset, to stage 2 sleep, and to rapid eye movement (REM) sleep were measured polysomnographically. Either dose given at any of the three time points decreased sleep onset latency and latency to stage 2 sleep. Melatonin did not suppress REM sleep or delay its onset. Most volunteers could clearly distinguish between the effects of melatonin and those of placebo when the hormone was tested at 6 or 8 PM. Neither melatonin dose induced "hangover" effects, as assessed with mood and performance tests administered on the morning after treatment. These data provide new evidence that nocturnal melatonin secretion may be involved in physiologic sleep onset and that exogenous melatonin may be useful in treating insomnia.

289 citations


Journal ArticleDOI
01 Feb 1995-Chest
TL;DR: For a given degree of upper-body obesity, men had more severe sleep apnea than women, and this may explain, at least in part, the greater severity of OSA in the men.

Journal ArticleDOI
TL;DR: In this article, the authors studied an 84-year-old man with a 20-year history of nocturnal violent behavior during sleep, but no other clinically evident neuropsychiatric disorders.
Abstract: We studied an 84-year-old man with a 20-year history of nocturnal violent behavior during sleep, but no other clinically evident neuropsychiatric disorders. Polysomnographic investigations confirmed that he suffered from REM sleep behavior disorder (RBD). Histopathologic examination revealed he had Lewy body disease with a marked decrease of pigmented neurons in the locus ceruleus and substantia nigra. These histologic findings represent the first documented evidence of a loss of brainstem monoaminergic neurons in clinically idiopathic RBD and suggest that Lewy body disease might provide an explanation for idiopathic RBD in the aged.

Journal ArticleDOI
01 Sep 1995-Chest
TL;DR: In this paper, platelet activation and platelet aggregation were measured during sleep in patients with OSA and N-CPAP was used to reduce the platelet reactivity during OSA.

Journal ArticleDOI
TL;DR: Continuous positive airway pressure is safe, effective, and well tolerated by children and adolescents with OSA and as pressure requirements change with patient growth, it is recommended that CPAP requirements be regularly reevaluated over time.

Journal ArticleDOI
01 Aug 1995-Chest
TL;DR: It is concluded that there is a spectrum of upper airway soft-tissue and craniofacial abnormalities among OSA patients: obese patients with increased upper airways soft-Tissue structures, nonobese patients with abnormal cranio-facial structure, and an intermediate group of patients with abnormalities in both cranioFacial structure and upper air way soft- tissue structures.

Journal ArticleDOI
01 Oct 1995-Sleep
TL;DR: It is concluded that L-dopa 100-200 mg proved to be effective in idiopathic RLS and for the first time under controlled conditions in uremic R LS without any severe side effects.
Abstract: We report the effects of a single bedtime dose of L-dopa 100-200 mg on sleep quality, frequency of periodic leg movements (PLM) and daily living in patients with idiopathic and uremic restless legs syndrome (RLS) Seventeen patients with idiopathic and 11 with uremic (on continuous hemodialysis) RLS were evaluated comparatively by polysomnography, actigraphy and subjective ratings in a randomized, controlled and double-blind crossover trial with L-dopa and placebo for 4 weeks each Neurophysiologic assessments showed significant reduction of the number of periodic leg movements (p = 0003) and the PLM-index (p = 0005) most pronounced during the first 4 hours of bedtime after L-dopa (p = 0001) Subjective evaluation confirmed improvement of sleep quality (p = 0002) and showed significantly higher quality of life during daytime (p = 0030) while the patients received L-dopa therapy We conclude that L-dopa 100-200 mg proved to be effective in idiopathic RLS and for the first time under controlled conditions in uremic RLS without any severe side effects

Journal ArticleDOI
TL;DR: Neurocognitive abilities were measured in 14 morbidly obese children, five of whom had obstructive sleep apnea as determined by polysomnography, and apneic/hypopneic events were inversely related to memory and learning performance among the entire sample.

Journal ArticleDOI
01 Sep 1995-Chest
TL;DR: Impaired vigilance as measured by Steer Clear is associated with a high automobile accident rate in patients with either sleep apnea or narcolepsy.

Journal ArticleDOI
TL;DR: Objective sleep assessments using polysomnography reveal sleep impairments (increased wakefulness and arousal from sleep; decreased slow wave sleep) even in healthy seniors, with an emphasis on behavioral and educative treatment approaches.
Abstract: Complaints of sleep disturbance increase with age. Objective sleep assessments using polysomnography reveal sleep impairments (increased wakefulness and arousal from sleep; decreased slow wave sleep) even in healthy seniors. Both polysomnographic sleep and subjective sleep worsen in the presence of health impairments related to drug use, pain, cardiovascular disease, diabetes, depression, or other emotional disorders. In addition to normal aging and chronic disease, sleep complaints can also result from poor sleep habits, specific occult disorders during sleep, or some combination of these factors. Occult disorders include sleep apnea syndrome, periodic leg movements, and restless legs syndrome during sleep. Diagnosis and treatment of these and other sleep disorders is discussed. Both pharmacological and nonpharmacological treatments are considered, with an emphasis on behavioral and educative treatment approaches.

Journal ArticleDOI
TL;DR: A higher frequency of irregular breathing during sleep in relatives of patients with this syndrome than in previously studied healthy controls is found and a familial tendency does exist for the sleep apneahypopnea syndrome is determined.
Abstract: Objective: To determine whether familial factors affect development of the sleep apnea–hypopnea syndrome and upper airway caliber. Design: A case–control study. Setting: Tertiary, referral clinical...

Journal ArticleDOI
01 Jun 1995-Chest
TL;DR: Obstructive sleep apnea syndrome was diagnosed in157 subjects based on clinical symptoms, physical evaluation, cephalometric x-ray films, and polysomnography, and Craniofacial familial features can be a strong indicator of risk for the development of OSAS.

Journal ArticleDOI
01 Jun 1995-Sleep
TL;DR: Results showed that subgroups, formed on the basis of presenting complaints and diagnostic criteria, differed in regard to the magnitude and direction of their sleep distortions, which appeared consistent with the types of objective sleep disturbances these subgroups commonly experience.
Abstract: It is well recognized that sleep time misperceptions are common among insomniacs, but little is known about the distribution and clinical significance of these subjective distortions. The current investigation was conducted to examine the distribution of sleep time misperceptions among a large (n = 173), diverse group of insomniacs and to determine if such misperceptions might relate to the patients' clinical characteristics. Consistent with previous studies, our subjects, as a group, produced sleep estimates that were significantly (p < 0.0001) lower than polysomnographically determined sleep times. However, patients' sleep time perceptions were widely distributed across a broad continuum, which ranged between gross underestimates and remarkable overestimates of actual sleep times. Results also showed that subgroups, formed on the basis of presenting complaints and diagnostic criteria (i.e. International Classification of Sleep Disorders nosology), differed in regard to the magnitude and direction of their sleep distortions. Moreover, these differences appeared consistent with the types of objective sleep disturbances these subgroups commonly experience. Hence, the tendency to underestimate actual sleep time is not a generic attribute of all insomniacs. Furthermore, it appears that the accuracy and nature of sleep time perceptions may relate to the type of sleep pathology underlying insomniacs' presenting complaints.

Journal ArticleDOI
TL;DR: Using the MAS significantly improved OSA: AHI decreased from 32.2 +/- 28.5 to 17.5 +/- 22.7 (p < 0.01) and arousal index decreased from 31.4 +/- 20.6 to 19.0 +/- 14.6 (p +0.01).
Abstract: Snoring and obstructive sleep apnea (OSA) are related to narrowing of the upper airway. A mandibular advancement splint (MAS) could improve both conditions by increasing oropharyngeal and hypopharyngeal dimensions. The effects of a MAS on snoring and OSA was evaluated 3.5 +/- 2.1 (mean +/- SD) mo after issue in 57 subjects with habitual loud snoring, 39 of whom had an apnea-hypopnea index (AHI) > or = 10. Assessment was by questionnaire (all subjects) and polysomnography (51 subjects, 47 male) including measurement of sound intensity. Use of the MAS was randomized to first or second half of study. Snores were scored where inspiratory noise was greater than 5 dB above background. Total sleep time, sleep efficiency, % REM sleep, and % sleep spent supine were similar (p > 0.05) with and without the MAS. Snores per sleep minute, corrected for time in apnea, and sound intensity of snores (% snores > or = 50 dB) decreased with the MAS from 11.0 +/- 5.8 and 42.0 +/- 25.0% to 9.0 +/- 6.0 (p 60. Forty-five patients continued to use the MAS regularly.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal ArticleDOI
01 Jun 1995-Sleep
TL;DR: It is important that those scoring arousals on routine polysomnography recognize that high arousal frequencies occur in the normal population on 1-night polysOMnography, as well as those scoring brief arousals according to three different criteria, including the ASDA definition.
Abstract: Brief arousals are clinically important and increasingly scored during polysomnography. However, the frequency of arousals during routine polysomnography in the normal population is unknown. We performed overnight polysomnography in the 55 of 59 control subjects from a family practice list who were approached and agreed to undergo polysomnography. Awakenings were scored according to the criteria of Rechtschaffen and Kales and briefer arousals according to three different criteria, including the American Sleep Disorders Association (ASDA) definition. There was a mean of 4 [95% confidence interval (CI), 1-15) Rechtschaffen and Kales awakenings per hour, whereas the ASDA definition gave 21 (95% CI, 7-56) per hour slept. Arousal frequencies increased significantly (p < 0.001) with age in our subjects, who ranged from the late teens to early 70s. The high upper limit of the frequency of brief arousals was not altered by exclusion of patients who snored or had witnessed apneas or daytime sleepiness. It is important that those scoring arousals on routine polysomnography recognize that high arousal frequencies occur in the normal population on 1-night polysomnography.

Journal ArticleDOI
TL;DR: The pathogenic mechanism of sleep-disordered breathing in patients with hemispheric stroke seems to be related to the physiological effect of sleep on already compromised upper airway muscle control.

Journal ArticleDOI
TL;DR: Results of sleep laboratory evaluations suggested brief shifts toward higher arousal levels during sleep for PTSD subjects and a relationship of REM phasic activity and symptom severity.
Abstract: Objective : Sleep disturbance is an important dimension of posttraumatic stress disorder (PTSD), but most of the limited available data were obtained years after the original traumatic event. This study provides information on sleep disturbance and its relationship to posttraumatic morbidity from evaluations done within a year after the trauma. Method : Sleep and psychiatric symptoms of 54 victims (12 men and 42 women) of Hurricane Andrew who had no psychiatric illness in the 6 months before the hurricane were evaluated. A subset of hurricane victims with active psychiatric morbidity (N=10) and nine comparison subjects who were unaffected by the hurricane were examined in a sleep laboratory. Results : A broad range of sleep-related complaints were rated as being greater after the hurricane, and psychiatric morbidity (which was most commonly PTSD, followed by depression) had a significant effect on most of the subjective sleep measures. In addition, subjects with active morbidity endorsed greater frequencies of bad dreams and general sleep disturbances before the hurricane. Polysomnographic results for the hurricane victims revealed a greater number ofarousals and entries into stage 1 sleep. REM density correlated positively with both the PTSD symptom of reexperiencing trauma and global distress. Conclusions : Subjects affected by Hurricane Andrew reported sleep disturbances, particularly those subjects with psychiatric morbidity. Tendencies to experience bad dreams and interrupted sleep before a trauma appear to mark vulnerability to posttraumatic morbidity. Results ofsleep laboratory evaluations suggested brief shifts toward higher arousal levels during sleep for PTSD subjects and a relationship of REM phasic activity and symptom severity.

Journal ArticleDOI
TL;DR: Treating selected CA patients with low dose acetazolamide (ACET) for a longer time period than has been done before to treat selected patients with suspicion of sleep-related breathing disorders (SRBD) with success.
Abstract: Only a limited number of studies dealing with the epidemiology and therapy of central sleep apnea syndrome (CA) are available. The treatment strategies are poorly defined and not well evaluated. The aim of our present study was to treat selected CA patients with low dose acetazolamide (ACET) for a longer time period than has been done before. Previous studies were performed with high dose ACET provoking severe metabolic acidosis, not for more than 1 wk or only in obstructive apnea patients. Referred patients with suspicion of sleep-related breathing disorders (SRBD) were included in the study if, after a first selection night, their central apnea index (CAI) was > 5 or their apnea-hypopnea index (AHI) > 10 and their obstructive apnea index (OAI) < 5. Of 327 screened patients, 14 (4.3%) fulfilled these criteria. Patients were then treated with ACET (250 mg, 1 h before sleep): Polysomnography was repeated once after one single dose (N2) and twice after 1-mo chronic treatment without (N3) and with (N4) additional ACET administration. After each study night, arterial blood gases and chemical drive were measured. CAI (25.5 +/- 6.8 at N1) already decreased during N2 (13.8 +/- 5.2) and further during N3 (6.6 +/- 2.9) and N4 (6.8 +/- 2.8) p < 0.01). OAI remained unchanged. Total sleep time (TST) and sleep efficiency index (SEI) did not change significantly. The number of arousals decreased from 62 +/- 11 at N1 to 40 +/- 5 at N3 (p = 0.019).(ABSTRACT TRUNCATED AT 250 WORDS)

Journal ArticleDOI
01 Aug 1995-Sleep
TL;DR: The results showed clearly that there was a first-night effect in normal subjects, similar to that reported in previously published data, characterized by a longer rapid eye movement (REM) sleep latency (p < 0.05), increased wakefulness, and total sleep time and a decreased sleep efficiency.
Abstract: The goal of the present study was to evaluate the first-night effect in psychiatric inpatients using large subject samples (n > 30) in order to obtain a good statistical evaluation. Thirty-two normal subjects and 94 psychiatric inpatients (38 depressives and 56 insomniacs) were studied for three consecutive nights in the hospital sleep laboratory. Our results showed clearly that there was a first-night effect in normal subjects, similar to that reported in previously published data, characterized by a longer rapid eye movement (REM) sleep latency (p < 0.05), increased wakefulness (p < 0.01) and total sleep time (p < 0.02) and a decreased sleep efficiency (p < 0.01). REM sleep latency and stage REM in the first third of the night were still altered in the second night. Both clinical groups had a less marked first-night effect than normal subjects, showing alterations only observed in REM sleep (p < 0.01) (decreased REM sleep, longer REM sleep latency, increased REM sleep gravity center). However, the first-night effect was more pronounced in insomniacs than in depressed patients. No statistical differences between the second and third nights' recordings were found in sleep parameters. It is suggested that first-night data should not be simply discarded but could be used in subsequent analyses.

Journal ArticleDOI
TL;DR: An increase in sleep instability and in arousal oscillation seems to be a typical microstructural feature of delta sleep-related parasomnias and probably plays a role in triggering abnormal motor episodes during sleep in patients with motor and behavioral phenomena during sleep.
Abstract: Some non-rapid eye movement (NREM) parasomnias, such as sleep-walking (SW), sleep terror (ST) and, in some aspects, sleep enuresis (SE), are considered "arousal disorders" without significant polysomnographic changes in classic sleep macrostructure. The aim of our study was to evaluate sleep microstructure and oscillations of arousal level by cyclic alternating pattern (CAP) scoring in some NREM parasomnias. Nocturnal polysomnography and videotape recording was used to study 21 patients with motor and behavioral phenomena during sleep: 13 in Group A (seven SW, six ST) with delta sleep-related episodes, eight in Group B with other parasomnias (six sleep bruxism and two SE), and six healthy controls. Classic sleep macrostructural parameters were no different in the parasomniacs and controls. Compared with the controls, our patients' sleep microstructure, scored by CAP analysis, showed increases in CAP rate (a measure of NREM instability with high level of arousal oscillation), in number of the CAP cycles, and in arousals with EEG synchronization, the increases being more significant in Group A than in Group B. An increase in sleep instability and in arousal oscillation seems to be a typical microstructural feature of delta sleep-related parasomnias and probably plays a role in triggering abnormal motor episodes during sleep in these patients.