Showing papers on "Polysomnography published in 2013"
University of Pennsylvania1, North Carolina State University2, Case Western Reserve University3, University of Michigan4, Saint Louis University5, University of Texas Southwestern Medical Center6, Cincinnati Children's Hospital Medical Center7, Harvard University8, Yeshiva University9, University of Chicago10
TL;DR: Surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy.
Abstract: Background Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. Methods We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. Results The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was ...
957 citations
TL;DR: It is confirmed that OSA is a heterogeneous disorder and abnormalities in nonanatomic traits are also present in most patients with OSA, and a three-point scale for weighting the relative contribution of the traits is proposed.
Abstract: Rationale: The pathophysiologic causes of obstructive sleep apnea (OSA) likely vary among patients but have not been well characterized.Objectives: To define carefully the proportion of key anatomic and nonanatomic contributions in a relatively large cohort of patients with OSA and control subjects to identify pathophysiologic targets for future novel therapies for OSA.Methods: Seventy-five men and women with and without OSA aged 20–65 years were studied on three separate nights. Initially, the apnea-hypopnea index was determined by polysomnography followed by determination of anatomic (passive critical closing pressure of the upper airway [Pcrit]) and nonanatomic (genioglossus muscle responsiveness, arousal threshold, and respiratory control stability; loop gain) contributions to OSA.Measurements and Main Results: Pathophysiologic traits varied substantially among participants. A total of 36% of patients with OSA had minimal genioglossus muscle responsiveness during sleep, 37% had a low arousal threshold...
749 citations
TL;DR: It is concluded that actigraphy is overall a useful and valid means for estimating total sleep time and wakefulness after sleep onset in field and workplace studies, with some limitations in specificity.
Abstract: OBJECTIVES We validated actigraphy for detecting sleep and wakefulness versus polysomnography (PSG). DESIGN Actigraphy and polysomnography were simultaneously collected during sleep laboratory admissions. All studies involved 8.5 h time in bed, except for sleep restriction studies. Epochs (30-sec; n = 232,849) were characterized for sensitivity (actigraphy = sleep when PSG = sleep), specificity (actigraphy = wake when PSG = wake), and accuracy (total proportion correct); the amount of wakefulness after sleep onset (WASO) was also assessed. A generalized estimating equation (GEE) model included age, gender, insomnia diagnosis, and daytime/nighttime sleep timing factors. SETTING Controlled sleep laboratory conditions. PARTICIPANTS Young and older adults, healthy or chronic primary insomniac (PI) patients, and daytime sleep of 23 night-workers (n = 77, age 35.0 ± 12.5, 30F, mean nights = 3.2). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Overall, sensitivity (0.965) and accuracy (0.863) were high, whereas specificity (0.329) was low; each was only slightly modified by gender, insomnia, day/night sleep timing (magnitude of change 30 min/night. CONCLUSIONS This validation quantifies strengths and weaknesses of actigraphy as a tool measuring sleep in clinical and population studies. Overall, the participant-specific accuracy is relatively high, and for most participants, above 80%. We validate this finding across multiple nights and a variety of adults across much of the young to midlife years, in both men and women, in those with and without insomnia, and in 77 participants. We conclude that actigraphy is overall a useful and valid means for estimating total sleep time and wakefulness after sleep onset in field and workplace studies, with some limitations in specificity.
721 citations
TL;DR: Evidence is presented that insomnia with objective short sleep duration is the most biologically severe phenotype of the disorder, as it is associated with cognitive-emotional and cortical arousal, activation of both limbs of the stress system, and a higher risk for hypertension, impaired heart rate variability, diabetes, neurocognitive impairment, and mortality.
537 citations
TL;DR: In this article, the authors identified the risk of sudden cardiac death associated with obstructive sleep apnea (OSA) and proposed a risk stratification for SCD, a major cause of mortality.
478 citations
TL;DR: Overall, the literature suggests that disturbed REM or non-REM sleep can contribute to maladaptive stress and trauma responses and may constitute a modifiable risk factor for poor psychiatric outcomes.
Abstract: The hypothesis that rapid eye movement (REM) sleep disturbances are the hallmark of posttraumatic stress disorder (PTSD), proposed by Ross and colleagues in 1989, has stimulated a wealth of clinical, preclinical, and animal studies on the role of sleep in the pathophysiology of PTSD. The present review revisits this influential hypothesis in light of clinical and experimental findings that have since accumulated. Polysomnographic studies conducted in adults with PTSD have yielded mixed findings regarding REM sleep disturbances, and they generally suggest modest and nonspecific sleep disruptions. Prospective and treatment studies have provided more robust evidence for the relationship between sleep disturbances and psychiatric outcomes and symptoms. Experimental animal and human studies that have probed the relationship between REM sleep and fear responses, as well as studies focused more broadly on sleep-dependent affective and memory processes, also provide strong support for the hypothesis that sleep pl...
456 citations
TL;DR: This guideline grades the evidence and recommendations using ACP's clinical practice guidelines grading system and recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight.
Abstract: In this guideline on the diagnosis of obstructive sleep apnea in adults, the American College of Physicians recommends a sleep study for patients with unexplained daytime sleepiness, polysomnograph...
448 citations
TL;DR: Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA, although MAD was superior to CPAP for improving four general quality-of-life domains.
Abstract: Rationale: Continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) therapy are commonly used to treat obstructive sleep apnea (OSA). Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes.Objectives: To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA.Methods: In this randomized crossover trial, we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes.Measurements and Main Results: Cardiovascular (24-h blood pressure, arterial stiffness), neurobehavioral (subjective sleepiness, driving simulator performance), and quality of life (Functional Outcomes of Sleep Questionnaire, Short Form-36) were compared between treatments. Our primary outcome was 24-hour mean arterial pressure. A total of 126 patients with moderate-severe OSA (apnea hypopnea index [AHI], 25.6 [SD 12.3]) were randomly assigned to a treatment order and 108 completed the trial...
444 citations
TL;DR: Dronabinol treatment is safe and well-tolerated in OSA patients at doses of 2.5–10 mg daily and significantly reduces AHI in the short-term and should be confirmed in a larger study in order to identify sub-populations with OSA that may benefit from cannabimimetic pharmacologic therapy.
Abstract: D THC), an exogenous Cannabinoid type 1 and type 2 (CB1 and CB2) receptor agonist in patients with Obstructive Sleep Apnea (OSA). Design and Setting: Proof of concept; single-center dose-escalation study of dron- abinol. Participants: Seventeen adults with a baseline Apnea Hypopnea Index (AHI)15/h. Baseline polysomnography (PSG) was performed after a 7-day washout of Continuous Pos- itive Airway Pressure treatment. Intervention: Dronabinol was administered after baseline PSG, starting at 2.5 mg once daily. The dose was increased weekly, as tolerated, to 5 mg and finally to 10 mg once daily. Measurements and Results: Repeat PSG assessments were performed on nights 7, 14, and 21 of dronabinol treatment. Change in AHI (DAHI, mean ± SD) was significant from baseline to night 21 (14.1 17.5; p = 0.007). No degra- dation of sleep architecture or serious adverse events was noted. Conclusion: Dronabinol treatment is safe and well-tolerated in OSA patients at doses of 2.5-10 mg daily and sig- nificantly reduces AHI in the short-term. These findings should be confirmed in a larger study in order to identify sub-populations with OSA that may benefit from cannabimimetic pharmacologic therapy.
410 citations
TL;DR: Pittsburgh Sleep Quality Index is a useful, valid and reliable tool for the assessment of sleep quality, with an overall efficiency comparable to the mother language version and differentiate “good” from “bad” sleepers.
Abstract: The aim of this study is to validate the Italian version of the Pittsburgh Sleep Quality Index (PSQI), comparing five different groups of individuals (healthy young and elderly, sleep apnoea syndrome patients, depressed patients, individuals with dementia) by both questionnaire scores and polysomnographic measures. Fifty individuals (10 for each group) participated in the study. Each of them filled in the PSQI and slept for two consecutive nights in the sleep laboratory. The PSQI showed an overall reliability coefficient (Cronbach’s α) of 0.835, indicating a high degree of internal consistency. The mean PSQI global score showed significant differences between groups, with an impaired overall quality of sleep in patients’ groups with respect to both the healthy groups. Results also indicated that the best cut-off score (differentiating “good” from “bad” sleepers) is 5. Pittsburgh Sleep Quality Index is a useful, valid and reliable tool for the assessment of sleep quality, with an overall efficiency comparable to the mother language version and differentiate “good” from “bad” sleepers. The Italian version of the questionnaire provides a good and reliable differentiation between normal and pathological groups, with higher scores reported by people characterized by impaired objectively evaluated sleep quality.
371 citations
15 Oct 2013-Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
TL;DR: The levels of systemic inflammatory markers were found to be higher in OSA patients compared to control subjects and these levels were higher in patients with OSA compared tocontrol group.
Abstract: Study Objectives:Obstructive sleep apnea (OSA) has been linked to and is associated with increased cardiovascular and cerebrovascular morbidity. Ongoing inflammatory responses play an important rol...
TL;DR: The impact of alcohol on SWS in the first half of night appears to be more robust than the effect on REM sleep and does not appear to be an epiphenomenon REM sleep reduction.
Abstract: This review provides a qualitative assessment of all known scientific studies on the impact of alcohol ingestion on nocturnal sleep in healthy volunteers. At all dosages, alcohol causes a reduction in sleep onset latency, a more consolidated first half sleep and an increase in sleep disruption in the second half of sleep. The effects on rapid eye movement (REM) sleep in the first half of sleep appear to be dose related with low and moderate doses showing no clear trend on REM sleep in the first half of the night whereas at high doses, REM sleep reduction in the first part of sleep is significant. Total night REM sleep percentage is decreased in the majority of studies at moderate and high doses with no clear trend apparent at low doses. The onset of the first REM sleep period is significantly delayed at all doses and appears to be the most recognizable effect of alcohol on REM sleep followed by the reduction in total night REM sleep. The majority of studies, across dose, age and gender, confirm an increase in slow wave sleep (SWS) in the first half of the night relative to baseline values. The impact of alcohol on SWS in the first half of night appears to be more robust than the effect on REM sleep and does not appear to be an epiphenomenon REM sleep reduction. Total night SWS is increased at high alcohol doses across gender and age groups.
TL;DR: A critical role of spindles in human hippocampal memory performance is demonstrated for the first time and gains in memory consolidation exceed sleep-alone or control conditions and demonstrate the potential for targeted, exceptional memory enhancement in healthy adults with pharmacologically modified sleep.
Abstract: An important function of sleep is the consolidation of memories, and features of sleep, such as rapid eye movement (REM) or sleep spindles, have been shown to correlate with improvements in discrete memory domains. Because of the methodological difficulties in modulating sleep, however, a causal link between specific sleep features and human memory consolidation is lacking. Here, we experimentally manipulated specific sleep features during a daytime nap via direct pharmacological intervention. Using zolpidem (Ambien), a short-acting GABAA agonist hypnotic, we show increased sleep spindle density and decreased REM sleep compared with placebo and sodium oxybate (Xyrem). Naps with increased spindles produced significantly better verbal memory and significantly worse perceptual learning but did not affect motor learning. The experimental spindles were similar to control spindles in amplitude and frequency, suggesting that the experimental intervention enhanced normal sleep processes. Furthermore, using statistical methods, we demonstrate for the first time a critical role of spindles in human hippocampal memory performance. The gains in memory consolidation exceed sleep-alone or control conditions and demonstrate the potential for targeted, exceptional memory enhancement in healthy adults with pharmacologically modified sleep.
TL;DR: The quantity and quality of sleep in intensive care patients are poor and may be related to noise, critical illness itself and treatment events that disturb sleep, highlighting the challenge of quantifying sleep in the critical caresetting and the need for alternative methods of measuring sleep.
Abstract: Many intensive care patients experience sleep disruption potentially related tonoise, light and treatment interventions. The purpose of this study was tocharacterise, in terms of quantity and quality, the sleep of intensive carepatients, taking into account the impact of environmental factors. This observational study was conducted in the adult ICU of a tertiary referralhospital in Australia, enrolling 57 patients. Polysomnography (PSG) was performedover a 24-hour period to assess the quantity (total sleep time: hh:mm) and quality(percentage per stage, duration of sleep episode) of patients' sleep while in ICU.Rechtschaffen and Kales criteria were used to categorise sleep. Interrater checkswere performed. Sound pressure and illuminance levels and care events weresimultaneously recorded. Patients reported on their sleep quality in ICU using theRichards Campbell Sleep Questionnaire and the Sleep in Intensive CareQuestionnaire. Data were summarised using frequencies and proportions or measuresof central tendency and dispersion as appropriate and Cohen's Kappa statistic wasused for interrater reliability of the sleep data analysis. Patients' median total sleep time was 05:00 (IQR: 02:52 to 07:14). The majority ofsleep was stage 1 and 2 (medians: 19 and 73%) with scant slow wave and REM sleep.The median duration of sleep without waking was 00:03. Sound levels were high(mean Leq 53.95 dB(A) during the day and 50.20 dB(A) at night) and illuminancelevels were appropriate at night (median <2 lux) but low during the day(median: 74.20 lux). There was a median 1.7 care events/h. Patients' meanself-reported sleep quality was poor. Interrater reliability of sleep staging washighest for slow wave sleep and lowest for stage 1 sleep. The quantity and quality of sleep in intensive care patients are poor and may berelated to noise, critical illness itself and treatment events that disturb sleep.The study highlights the challenge of quantifying sleep in the critical caresetting and the need for alternative methods of measuring sleep. The resultssuggest that a sound reduction program is required and other interventions toimprove clinical practices to promote sleep in intensive care patients. Australian New Zealand clinical trial registry(
http://www.anzctr.org.au
/): ACTRN12610000688088.
TL;DR: The results confirmed that this complex is affected in Parkinson’s disease and showed a gradual relationship between damage to this structure, presumably the locus subcoeruleus, and abnormal muscle tone during rapid eye movement sleep, which is the cardinal marker of rapidEye movement sleep behaviour disorder.
Abstract: In Parkinson’s disease, rapid eye movement sleep behaviour disorder is an early non-dopaminergic syndrome with nocturnal violence and increased muscle tone during rapid eye movement sleep that can precede Parkinsonism by several years. The neuronal origin of rapid eye movement sleep behaviour disorder in Parkinson’s disease is not precisely known; however, the locus subcoeruleus in the brainstem has been implicated as this structure blocks muscle tone during normal rapid eye movement sleep in animal models and can be damaged in Parkinson’s disease. Here, we studied the integrity of the locus coeruleus/subcoeruleus complex in patients with Parkinson’s disease using combined neuromelanin-sensitive, structural and diffusion magnetic resonance imaging approaches. We compared 24 patients with Parkinson’s disease and rapid eye movement sleep behaviour disorder, 12 patients without rapid eye movement sleep behaviour disorder and 19 age- and gender-matched healthy volunteers. All subjects underwent clinical examination and characterization of rapid eye movement sleep using video-polysomnography and multimodal imaging at 3 T. Using neuromelanin-sensitive imaging, reduced signal intensity was evident in the locus coeruleus/subcoeruleus area in patients with Parkinson’s disease that was more marked in patients with than those without rapid eye movement sleep behaviour disorder. Reduced signal intensity correlated with the percentage of abnormally increased muscle tone during rapid eye movement sleep. The results confirmed that this complex is affected in Parkinson’s disease and showed a gradual relationship between damage to this structure, presumably the locus subcoeruleus, and abnormal muscle tone during rapid eye movement sleep, which is the cardinal marker of rapid eye movement sleep behaviour disorder. In longitudinal studies, the technique may also provide early markers of non-dopaminergic Parkinson’s disease pathology to predict the occurrence of Parkinson’s disease.
TL;DR: The absence of palatal CCC during DISE may predict therapeutic success with implanted UAS therapy, and DISE can be recommended as a patient selection tool for implantation of a UAS system to treat OSA.
Abstract: Study Objectives:To study the possible predictive value of drug-induced sleep endoscopy (DISE) in assessing therapeutic response to implanted upper airway stimulation (UAS) for obstructive sleep ap...
01 Jan 2013
TL;DR: Quantitative analysis of sleep stages and CNS arousals provide evidence for, contribute to the definition of, and index severity of some sleep disorders and can provide objective outcome measures for assessing therapeutic interventions.
Abstract: Polysomnography involves recording a wide assortment of bioparameters while an individual sleeps. Knowledge of the fundamental principles of electrode application, equipment calibration, and recording technology is essential for high-quality data collection. The findings from the electroencephalogram (EEG), electrooculogram, and electromyogram (EMG) can be summarized according to specific scoring criteria as sleep stages N1, N2, N3, and R (previously called stage 1, 2, 3, 4, and REM). Scoring criteria depend on EEG bandwidth activity (delta, theta, alpha, and beta), EEG events (vertex sharp waves, sleep spindles, and K-complexes), eye movement activity (slow and rapid eye movements), and the level of muscle tone. Stage N1 is characterized by a low-voltage, mixed frequency background EEG, as well as EMG similar to relaxed wakefulness, and may include slow rolling eye movements and vertex sharp waves. Stage N2 is characterized by the presence of sleep spindles and K-complexes, combined with a low-voltage, mixed frequency background. Stage N3 is characterized by high-voltage slow-wave activity present for at least 20% of the epoch. Stage R (or REM) sleep is scored when rapid eye movements and low skeletal muscle tone accompany a low-voltage, mixed frequency background EEG. Central nervous system (CNS) arousals also may occur from sleep, either spontaneously or resulting from pathophysiologies or environmental stimuli (e.g., noise or touch). Quantitative analysis of sleep stages and CNS arousals provide evidence for, contribute to the definition of, and index severity of some sleep disorders. Similarly, these measures can provide objective outcome measures for assessing therapeutic interventions. This article summarizes recording, digital processing, and scoring techniques used for evaluating brain activity during human sleep and its disturbance by CNS arousals.
TL;DR: Service-related illnesses are prevalent in military personnel who undergo polysomnography with significant associations between PTSD, pain syndromes, and insomnia.
Abstract: STUDY OBJECTIVES Describe the prevalence of sleep disorders in military personnel referred for polysomnography and identify relationships between demographic characteristics, comorbid diagnoses, and specific sleep disorders. DESIGN Retrospective cross-sectional study. SETTING Military medical treatment facility. PARTICIPANTS Active duty military personnel with diagnostic polysomnogram in 2010. MEASUREMENTS Primary sleep disorder rendered by review of polysomnogram and medical record by a board certified sleep medicine physician. Demographic characteristics and conditions of posttraumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), anxiety, depression, and pain syndromes determined by medical record review. RESULTS Primary sleep diagnoses (n = 725) included: mild obstructive sleep apnea (OSA), 207 (27.2%); insomnia, 188 (24.7%); moderate-to-severe OSA, 183 (24.0 %); and paradoxical insomnia,39 (5.1%); behaviorally induced insufficient sleep syndrome, 68 (8.9%) and snoring, 40 (5.3%) comprised our control group. Short sleep duration (< 5 h) was reported by 41.8%. Overall 85.2% had deployed, with 58.1% having one or more comorbid diagnoses. Characteristics associated with moderate-to-severe OSA were age (adjusted odds ratio [OR], 1.03 [95% confidence interval {CI}, 1.0-1.05], sex (male) (adjusted OR, 19.97 [95% CI, 2.66-150.05], anxiety (adjusted OR, 0.58 [95% CI, 0.34-0.99]), and body mass index, BMI (adjusted OR 1.19 [95% CI, 1.13-1.25]; for insomnia, characteristics included PTSD (adjusted OR, 2.12 [95% CI, 1.31-3.44]), pain syndromes (adjusted OR, 1.48 [95%CI, 1.01-2.12]), sex (female) (adjusted OR, 0.22 [95% CI, 0.12-0.41]) and lower BMI (adjusted OR, 0.91 [95% CI, 0.87, 0.95]). CONCLUSIONS Service-related illnesses are prevalent in military personnel who undergo polysomnography with significant associations between PTSD, pain syndromes, and insomnia. Despite having sleep disorders, almost half reported short sleep duration. Multidisciplinary assessment and treatment of military personnel with sleep disorders and service-related illnesses are required. CITATION Mysliwiec V; McGraw L; Pierce R; Smith P; Trapp B; Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. SLEEP 2013;36(2):167-174.
TL;DR: Appropriate treatment with CPAP in patients with OSA is associated with a lower recurrence of AF, and patients with untreated OSA have a higher recurrences of AF after ablation.
TL;DR: The magnitude of reduction in total sleep time suggests that caffeine taken 6 hours before bedtime has important disruptive effects on sleep and provides empirical support for sleep hygiene recommendations to refrain from substantial caffeine use for a minimum of 6 hours prior to bedtime.
Abstract: Study Objective:Sleep hygiene recommendations are widely disseminated despite the fact that few systematic studies have investigated the empirical bases of sleep hygiene in the home environment. Fo...
TL;DR: Nocturnal gasping or choking is the most reliable indicator of obstructive sleep apnea, whereas snoring is not very specific and the clinical examination of patients with suspected obstructiveSleep apnea is useful for selecting patients for more definitive testing.
Abstract: Importance Obstructive sleep apnea is a common disease, responsible for daytime sleepiness. Prior to referring patients for definitive testing, the likelihood of obstructive sleep apnea should be established in the clinical examination. Objective To systematically review the clinical examination accuracy in diagnosing obstructive sleep apnea. Data Sources MEDLINE and reference lists from articles were searched from 1966 to June 2013. Titles and abstracts (n = 4449) were reviewed for eligibility and appraised for evidence levels. Study Selection For inclusion, studies must have used full, attended nocturnal polysomnography for the reference standard (n = 42). Main Outcomes and Measures Community and referral-based prevalence of obstructive sleep apnea; accuracy of symptoms and signs for the diagnosis of obstructive sleep apnea. Results The prevalence of sleep apnea in community-screened patients is 2% to 14% (sample sizes 360-1741) and 21% to 90% (sample sizes 42-2677) for patients referred for sleep evaluation. The prevalence varies based on the apnea-hypopnea index (AHI) threshold used for the evaluation (≥5 events/h, prevalence 14%; ≥15/h, prevalence 6%) and whether the disease definition requires symptoms in addition to an abnormal AHI (≥5/h with symptoms, prevalence 2%-4%). Among patients referred for sleep evaluation, those with sleep apnea weighed more (summary body mass index, 31.4; 95% CI, 30.5-32.2) than those without sleep apnea (summary BMI, 28.3; 95% CI, 27.6-29.0; P Conclusions and Relevance Nocturnal gasping or choking is the most reliable indicator of obstructive sleep apnea, whereas snoring is not very specific. The clinical examination of patients with suspected obstructive sleep apnea is useful for selecting patients for more definitive testing.
TL;DR: Evidence is shown that classroom naps support learning in preschool children by enhancing memories acquired earlier in the day as compared with equivalent intervals spent awake, suggesting that distributed sleep is critical in early learning.
Abstract: Despite the fact that midday naps are characteristic of early childhood, very little is understood about the structure and function of these sleep bouts. Given that sleep benefits memory in young adults, it is possible that naps serve a similar function for young children. However, children transition from biphasic to monophasic sleep patterns in early childhood, eliminating the nap from their daily sleep schedule. As such, naps may contain mostly light sleep stages and serve little function for learning and memory during this transitional age. Lacking scientific understanding of the function of naps in early childhood, policy makers may eliminate preschool classroom nap opportunities due to increasing curriculum demands. Here we show evidence that classroom naps support learning in preschool children by enhancing memories acquired earlier in the day compared with equivalent intervals spent awake. This nap benefit is greatest for children who nap habitually, regardless of age. Performance losses when nap-deprived are not recovered during subsequent overnight sleep. Physiological recordings of naps support a role of sleep spindles in memory performance. These results suggest that distributed sleep is critical in early learning; when short-term memory stores are limited, memory consolidation must take place frequently.
TL;DR: Long-term compliance for PT remains an issue, and although remarkable results have been shown using innovative treatment concepts for PT, there is room for both technical improvement of the devices and for further research.
Abstract: Purpose Research during the past 10–20 years shows that positional therapy (PT) has a significant influence on the apnea–hypopnea index. These studies are predominantly performed as case series on a comparably small number of patients. Still, results have not found their way into the daily diagnostic and treatment routine. An average of 56% of patients with obstructive sleep apnea (OSA) have positiondependent OSA (POSA), commonly defined as a difference of 50% or more in apnea index between supine and nonsupine positions. A great deal could be gained in treating patients with POSA with PT. The aim of this paper was to perform a thorough review of the literature on positional sleep apnea and its therapy. Methods A broad search strategy was run electronically in the MEDLINE and EMBASE databases using synonyms for position and sleep apnea. Results Sixteen studies were found which examined the effect of PT on OSA. In this literature review, we discuss the various techniques, results, and compliance rates. Conclusion Long-term compliance for PT remains an issue, and although remarkable results have been shown using innovative treatment concepts for PT, there is room for both technical improvement of the devices and for further research.
TL;DR: It is proposed that objective measures of sleep duration may become part of the routine evaluation and diagnosis of insomnia, and that these two insomnia phenotypes may respond differentially to biological versus psychological treatments.
Abstract: In contrast to the association of insomnia with mental health, its association with physical health has remained largely unexplored until recently. Based on findings that insomnia with objective short sleep duration is associated with activation of both limbs of the stress system and other indices of physiological hyperarousal, which should adversely affect physical and mental health, we have recently demonstrated that this insomnia phenotype is associated with a significant risk of cardiometabolic and neurocognitive morbidity and mortality. In contrast, insomnia with normal sleep duration is associated with sleep misperception and cognitive-emotional arousal, but not with signs of physiological hyperarousal or cardiometabolic or neurocognitive morbidity. Interestingly, both insomnia phenotypes are associated with mental health, although most likely through different pathophysiological mechanisms. We propose that objective measures of sleep duration may become part of the routine evaluation and diagnosis of insomnia, and that these two insomnia phenotypes may respond differentially to biological versus psychological treatments.
TL;DR: The major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment are delineated.
Abstract: Obstructive sleep apnea (OSA) in children is a highly prevalent disorder caused by a conglomeration of complex pathophysiological processes, leading to recurrent upper airway dysfunction during sleep. The clinical relevance of OSA resides in its association with significant morbidities that affect the cardiovascular, neurocognitive, and metabolic systems. The American Academy of Pediatrics recently reiterated its recommendations that children with symptoms and signs suggestive of OSA should be investigated with polysomnography (PSG), and treated accordingly. However, treatment decisions should not only be guided by PSG results, but should also integrate the magnitude of symptoms and the presence or absence of risk factors and signs of OSA morbidity. The first-line therapy in children with adenotonsillar hypertrophy is adenotonsillectomy, although there is increasing evidence that medical therapy, in the form of intranasal steroids or montelukast, may be considered in mild OSA. In this review, we delineate the major concepts regarding the pathophysiology of OSA, its morbidity, diagnosis, and treatment.
TL;DR: Evidence for a direct causal relationship between craniofacial structure and pediatric sleep-disordered breathing is unsupported by this meta-analysis, but there is strong support for reduced upper airway width in children with obstructive sleep apnea.
TL;DR: The results corroborate that REM sleep contributes to the consolidation of emotional contents in memory, but suggest that the affective tone is preserved rather than reduced by the processing of emotional memories during REM sleep.
TL;DR: A very high variability in sleep Bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism, which prevented from supporting any reliable estimates of the prevalence of sleep bruXism in children.
Abstract: The aim of the present investigation was to perform a systematic review of the literature dealing with the issue of sleep bruxism prevalence in children at the general population level. Quality assessment of the reviewed papers was performed to identify flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. A total of 22 publications were included in the review, most of which had methodological problems limiting their external validity. Prevalence data extraction was performed only on eight papers that were consistent as for the sampling strategy and showed only minor external validity problems, but they had some common internal validity flaws related with the definition of sleep bruxism measures. All the selected papers based sleep bruxism diagnosis on proxy reports by the parents, and no epidemiological data were available from studies adopting other diagnostic strategies (e.g. polysomnography or electromyography). The reported prevalence was highly variable between the studies (3·5-40·6%), with a commonly described decrease with age and no gender differences. A very high variability in sleep bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism. This prevented from supporting any reliable estimates of the prevalence of sleep bruxism in children.
TL;DR: RBD and subclinical RBD are not rare in the elderly in the community with abnormal REM sleep behaviors of RBD being mild to injurious and violent.
Abstract: STUDY OBJECTIVES: To examine the prevalence and clinical characteristics of REM sleep behavior disorder (RBD) and subclinical RBD in the Korean elderly population. DESIGN: A community-based Korean Longitudinal Study on Cognitive Aging and Dementia and time-synchronized video-polysomnography (vPSG) in a laboratory. SETTING: Sleep laboratory in a university hospital. PARTICIPANTS: 348 individuals aged 60 years or older. INTERVENTION: N/A. MEASUREMENTS AND RESULTS: Among 696 subjects who were invited to participate in a vPSG study, 348 completed the vPSG. RBD was diagnosed when subjects showed REM sleep without atonia (RSWA) in the vPSG, and had history of complex and vigorous behaviors during sleep or abnormal REM sleep behaviors in the vPSG. Subjects with RSWA but no abnormal REM sleep behaviors were diagnosed with subclinical RBD. Seven subjects (5 male, 2 female) had RBD, three of whom (1 male, 2 female) had Parkinson disease. Two subjects reported history of sleep-related injury. The crude prevalence of RBD and idiopathic RBD was 2.01% (95% confidence interval [CI] = 0.54% to 3.49%) and 1.15% (95% CI = 0.03% to 2.27%). An age and sex-adjusted prevalence estimate of RBD and idiopathic RBD in the Korean elderly was 2.01% and 1.34%. Eighteen subjects were diagnosed with subclinical RBD, and the prevalence of subclinical RBD was estimated to be 4.95%. CONCLUSIONS: RBD and subclinical RBD are not rare in the elderly in the community with abnormal REM sleep behaviors of RBD being mild to injurious and violent. The clinical significance and long-term progression of subclinical RBD needs to be further explored, given the prevalence and its possible relation to RBD. CITATION: Kang SH; Yoon IY; Lee SD; Han JW; Kim TH; Kim KW. REM sleep behavior disorder in the Korean elderly population: prevalence and clinical characteristics. SLEEP 2013;36(8):1147-1152. Language: en
University of Lausanne1, University Hospital of Lausanne2, French Institute of Health and Medical Research3, Leiden University4, University of Barcelona5, Hospital General Universitario Gregorio Marañón6, Swiss Institute of Bioinformatics7, University of Bologna8, University of Bern9, University of Copenhagen10, University Hospital Regensburg11, University of Zurich12
TL;DR: The results indicate that the diagnostic delay remains extremely long, age and gender substantially affect symptoms, and that a genetic predisposition affects the age at onset of symptoms.
Abstract: The aim of this study was to describe the clinical and PSG characteristics of narcolepsy with cataplexy and their genetic predisposition by using the retrospective patient database of the European Narcolepsy Network (EU-NN). We have analysed retrospective data of 1099 patients with narcolepsy diagnosed according to International Classification of Sleep Disorders-2. Demographic and clinical characteristics, polysomnography and multiple sleep latency test data, hypocretin-1 levels, and genome-wide genotypes were available. We found a significantly lower age at sleepiness onset (men versus women: 23.74 ± 12.43 versus 21.49 ± 11.83, P = 0.003) and longer diagnostic delay in women (men versus women: 13.82 ± 13.79 versus 15.62 ± 14.94, P = 0.044). The mean diagnostic delay was 14.63 ± 14.31 years, and longer delay was associated with higher body mass index. The best predictors of short diagnostic delay were young age at diagnosis, cataplexy as the first symptom and higher frequency of cataplexy attacks. The mean multiple sleep latency negatively correlated with Epworth Sleepiness Scale (ESS) and with the number of sleep-onset rapid eye movement periods (SOREMPs), but none of the polysomnographic variables was associated with subjective or objective measures of sleepiness. Variant rs2859998 in UBXN2B gene showed a strong association (P = 1.28E-07) with the age at onset of excessive daytime sleepiness, and rs12425451 near the transcription factor TEAD4 (P = 1.97E-07) with the age at onset of cataplexy. Altogether, our results indicate that the diagnostic delay remains extremely long, age and gender substantially affect symptoms, and that a genetic predisposition affects the age at onset of symptoms.