Showing papers on "Sleep disorder published in 1981"

Delayed Sleep Phase Syndrome: A Chronobiological Disorder With Sleep-Onset Insomnia

Abstract: We describe a new syndrome called "delayed sleep phase insomnia." Thirty of 450 patients seen for a primary insomniac complaint had the following characteristics: (1) chronic inability to fall asleep at a desired clock time; (2) when not on a strict schedule, the patients have a normal sleep pattern and after a sleep of normal length awaken spontaneously and feel refreshed; and (3) a long history of unsuccessful attempts to treat the problem. These patients were younger than the general insomniac population and as a group did not have a specific psychiatric disorder. Six patients' histories are described in detail, including the successful nonpharmacological chronotherapy regimen (resetting the patients' biological clock by progressive phase delay). Delayed sleep phase insomnia is proposed to be a disorder of the circadian sleep-wake rhythm in which the "advance" portion of the phase response curve is small.

A review of 50 children with obstructive sleep apnea syndrome.

Abstract: Fifty children and adolescents with obstructive sleep apnea syndrome and related breathing disorders during sleep are reviewed. Subjects were subdivided according to whether their breathing irregularity was secondary to a medical problem (group I) or was the primary complaint (group II). The most common presenting complaint was excessive daytime somnolence; hyperactivity and antisocial behavior also were cited frequently. In 20% of cases, substantial personality changes were reported. Clinical symptoms included failure to thrive, abnormal weight for age, acute cardiac or cardiorespiratory failure, hypertension, and frequent upper airway infections. Continuous, heavy snoring was reported in all cases; disrupted nocturnal sleep, sleep walking, nightmares, and enuresis were common. All subjects, and 22 control patients, were monitored polygraphically during sleep for at least one night. Nocturnal sleep in the reported population was severely disrupted. A complete disappearance of stage 3 NREM sleep was noted in 86% of cases; REM sleep was decreased less. The management of these cases is reviewed. Eight patients received permanent tracheostomies. Thirty children had tonsillectomy and/or adenoidectomy (three later required tracheostomy). Non-surgical approaches also were used, particularly in group 1. Follow-up on these cases to date is presented.

Sleep-Wake Disorders in the Elderly: A Polysomnographic Analysis

Abstract: The experience with 83 patients aged 60 or older from the Stanford Sleep-Wake Disorders Clinic is compared with that in 423 younger clinic patients seen during the same two-year period. Each patient received a medical, psychologic and polysomnographic evaluation. The final diagnoses were recorded according to the Diagnostic Classification System of the Association of Sleep Disorders Centers. The most common major diagnoses in the elderly group were sleep apnea syndrome (39 percent) and periodic movements-restless legs syndrome (18 percent). These syndromes showed a significantly greater prevalence in the older than in the younger patients (p less than .001), and were found in 68 percent of the elderly group. The elderly manifested more objective signs of sleep disturbance, including more wake time after sleep onset, and more frequent and longer awakenings; moreover, fewer of them experienced stage-4 sleep. The diagnostic findings seemed to indicate that complaints about sleep-wake functioning in many elderly patients may be a result of specific pathologic sleep disturbances.

Comparisons of home sleep recordings and polysomnograms in older adults with sleep disorders.

Abstract: A major problem with studying the prevalence of sleep disorders is the high cost. We tested a portable home recording system which can decrease the cost of screening sleep recordings. Twenty-four senior volunteers and 12 patients referred to our sleep disorders clinic were studied for two nights. On one night, recordings were done in the laboratory with a traditional polysomnogram and the portable home recorder. On another night, portable home recorders were used in the subjects' homes. Of 36 subjects, 42% had sleep apnea and 39% had nocturnal myoclonus. Intermethod correlations were highly significant for sleep apnea index, nocturnal myoclonus index, total sleep period (TSP), total sleep time (TST), and wake time after sleep onset (WASO). The portable home recorder detected sleep apnea on 100% of nights during which sleep apnea was diagnosed by polysomnogram. The labor-saving and cost-saving benefits of home recordings as well as the increased comfort, privacy, and convenience will make the portable home recording the preferred method for many research and clinical applications.

Sleep patterns in hyperkinetic and normal children.

Abstract: Sleep patterns in nonmedicated hyperkinetic (n = 11) and normal control (n = 11) male children (8-12 years old) were compared to document possible sleep disturbance in hyperkinetic children. Electroencephalographic, electro-oculographic, electromyographic, and autonomic measures were monitored continuously for five consecutive nights. Analysis of sleep pattern variables revealed a significantly longer rapid eye movement onset latency (p less than 0.05) and marginally significant greater absolute and relative amounts of movement time (p less than 0.07) for the hyperkinetic group relative to controls. No other sleep parameters differentiated the groups. It was concluded that baseline tonic sleep parameters do not indicate marked sleep disturbance in hyperkinesis. The results are discussed within the context of hypothesized arousal dysfunction underlying this disorder. Key Words: Hyperkinetic children--Hyperkinesis--NREM and REM sleep cycles--Spontaneous skin potential responses.

Flurazepam-induced sleep apnea syndrome in a patient with insomnia and mild sleep-related respiratory changes.

Abstract: Sleep EEG and respiratory measures were examined in a 38-year-old man with a long-standing history of insomnia and daytime sleepiness. He was found to have seven to 18 primarily obstructive apneas per night on four baseline recordings, a finding not generally considered to be indicative of pathology. On the first two nights on which he received 30 mg of the benzodiazepine hypnotic flurazepam, there were 22 and 100 apneas, and during the daytime he became extremely sleepy. Upon cessation of medication, his clinical condition improved, and the number of apneas decreased to 11 and 6 on withdrawal nights 4 and 6. Although respiratory depression is neither invariable nor unique to flurazepam, this case suggests that it may be a clinically significant problem with recommended oral doses in some individuals.

Differentiating psychological characteristics of patients with sleep apnea and narcolepsy.

Abstract: Fifty male subjects were group-matched for age and socioeconomic status. Twenty of the subjects were diagnosed as having sleep apnea and 20 were diagnosed as having narcolepsy on the basis of sleep studies. The remaining 10 subjects served as normal controls. Differences among the groups were evaluated on the bases of two psychological instruments designed to assess personality characteristics and mood states. The findings suggest that narcoleptics and apneics both present discriminatively different psychological profiles than do normals. Moreover, personality characteristics of these two groups are distinguishable from one another. Apneics tend to be individuals with hypochondriacal and hysterical characteristics, whereas narcoleptics are more easily characterized by anxiety and social introversion. Both severity of psychological disturbance (mean Minnesota Multiphasic Personality Inventory elevations) and personality pattern (two-point codes) distinguish the groups. Key Words: Sleep apnea-Narcolepsy-Psychological profiles.

Electrocardiographic signs of pulmonary hypertension in children who snore.

Abstract: Two children presented with sleep disturbances due to enlarged tonsils and adenoids One child died during induction of anaesthesia, and postmortem examination showed hypertrophy of the right ventricle and atrium As a result a prospective survey was carried out of children undergoing tonsillectomy or adenoidectomy, or both During a nine-month period an electrocardiogram was taken in 92 children Three electrocardiograms (33%) showed evidence of right heart strain The children with abnormal electrocardiograms had symptoms of sleep disturbance with apnoea, snoring, and daytime somnolence These symptoms and the electrocardiographic changes were reserved by adenotonsillectomy The prevalence of pulmonary hypertension in children with enlarged tonsils and adenoids is still underestimated When signs and symptoms of sleep disturbance, particularly snoring, are present an electrocardiogram should be obtained and a cardiologist's opinion sought before embarking on routine surgery in view of the potentially fatal consequences

Epilepsy complicated by sleep apnea.

Abstract: A patient with a medically intractable seizure disorder was found to suffer sleep apnea as well. Treating the sleep apnea with permanent tracheostomy improved his generalized seizures. Although this combination of neurological disorders is probably rare, it should be considered if a suggestive history is obtained.

Evaluation and diagnosis of persistent insomnia.

Abstract: The authors placed 84 patients who complained of insomnia into 10 diagnostic categories on the basis of medical, psychiatric, and polysomnographic evaluations. Only half the patients had objectively defined difficulty inducing or maintaining sleep when compared with 20 normal control subjects. However, all but 16 patients showed polysomnographic evidence of some sleep disorder. Diagnostic categories within the insomnia groups could be distinguished from one another by polysomnography. Patients in only 3 of the 10 diagnostic categories showed evidence of psychological distress on the MMPI; patients in the other 7 categories displayed few psychological symptoms. These results have implications for the treatment of insomnia.

Hypothyroidism with presenting symptoms of fibrositis.

Abstract: Eight patients who initially presented with signs and symptoms of the fibrositis syndrome, without overt hypothyroid disease, were found to have chemical evidence of hypothyroidism. Myalgic symptoms resolved in 6 of 8 patients treated with low dose thyroid replacement. In addition, another hypothesis of pathophysiology of the myalgic symptoms observed in patients with hypothyroidism related to sleep disturbance is offered.

Sleep and its Disorders

Abstract: The advances in research on sleep an biological rhythms have recently been applied to the diagnosis and treatment of sleep disorders. A new clinical specialty has developed with the establishment of sleep disorder centers and a diagnostic classification of sleep and arousal disorders. This new nosological approach has evolved from an extensive base of new scientific information concerning descriptive polygraphic and analysis of clinical case series. Four major categories have been defined: (a) disorders of initiating and maintaining sleep (insomnias), (b) disorders of excessive somnolence, (c) disorders of the sleep-wake schedule, and (d) dysfunctions associated with sleep. Within this comprehensive classification certain major pathophysiological advances are described for the "insomnias." These include polysomnographic identification of altered sleep stage patterns in the major effective illnesses, insomnias related to hypnotic drugs and alcohol, sleep disturbances associated with sleep-induced respiratory impairment, and sleep-related periodic movements during sleep (nocturnal myoclonus). Excessive daytime somnolence is primarily associated with the hypersomnia sleep-apnea syndrome and with narcolepsy. The relationship between biological rhythms (chronobiology) and disorders of the human sleep-wake schedules is very actively investigated. The recognition that sleep length, internal organization, and timing within neurophysiological circadian time-keeping systems has lead to better diagnosis of these sleep-wake disorders and new chronotherapeutic regimens. Finally, increasing identification and description of "parasomnias," i.e. dysfunctions associated with sleep, has led sleep research into important new areas that are of general physiological interest. It is now clear that sleep disorders medicine has become a new scientific and clinical discipline in its own right.

Behavioral self-management in treating sleep-maintenance insomnia

Abstract: Three controlled case studies are presented to demonstrate the application of behavioral self-management to two subtypes of sleep-maintenance insomnia. Patient 1 suffered from brief but frequent arousals to wakefulness and to NREM Stage 1 sleep. Patient 2 suffered from brief but frequent arousals and extended minutes awake after sleep onset. Patient 3 suffered from an extended latency to sleep onset and also extended minutes awake after sleep onset. The self-management treatment program was designed to teach these patients skills for identifying and modifying environmental, behavioral, physiological, and cognitive conditions related to poor sleep. Results are documented using home and laboratory all-night sleep recordings during treatment and at 3 and 12 months following the end of treatment.

Sleep paralysis among medical students

Abstract: Sleep paralysis is a sensation of an inability to speak or move other muscles when falling asleep or awakening. Sleep paralysis by itself has been reported as occurring infrequently and many clinicians are uncertain of its significance. In contrast, sleep paralysis in conjunction with sleep attacks has been reported as a concomitant of narcolepsy. To further examine the incidence of sleep paralysis, the responses of 80 first-year medical students, 16.25% had experienced predormital, postdormital, or both types of sleep paralysis. These episodes occurred infrequently--only once or twice for most of these students. Reports of sleep paralysis were not associated with sleep attacks or cataplexy. These results support two previous studies which found that sleep paralysis alone occurs frequently among normals.

The perception of wakefulness within sleep

Abstract: We studied the relationship between electroencephalographic (EEG)-defined awakenings and subjects' awareness of them at the time of their occurrence in 40 men (mean age, 55.3 years). The subjects used a push-button device to signal wakefulness during an evening's sleep in the laboratory; continuous EEG and electro-oculograms were also made. Results were as follows (after eliminating data for 12 nonresponders): 52% of the responses occurred during EEG-defined wakefulness (stage 0), 12% in a sleep stage that was followed immediately by stage 0, and 36% in a sleep stage not followed by stage 0. However, analysis of the last finding indicated that 73% of these responses were associated with at least 4-6 sec of preceding alpha activity. Thus, signals in the absence of EEG criteria were actually less than 10% of the total recorded. Signals of wakefulness were closely associated with the onset of EEG-defined wakefulness (and 84% of the signals occurred within 4 sec to 1 min of the EEG period). We conclude that self-signaled arousals deserve consideration in clinical analyses in which reports of arousals are a part of the reported sleep disturbance.

An Etiology of Narcolepsy-Cataplexy and a Proposed Cataplexy Neuromechanism

Abstract: Narcolepsy-cataplexy is an idiopathic sleep disorder that reflects a complex neuropathology. Surveys and physiological investigations indicate that genetic and stress factors are involved in its onset and that stress is associated with symptomatic fluctuations and exacerbations of its clinical course. This paper summarizes the literature regarding the evolution, characteristics and treatment of the disorder. A comprehensive etiology is advanced, integrating neurophysiological and psychological factors specific to narcolepsy-cataplexy with recent advances in blood pressure regulation. Moreover, a testable neuromechanism of cataplexy is proposed, based on longitudinal effects of chronic drowsiness, the strong hynogenic effect obtained by carotid sinus stimulation, an experimental animal model of narcolepsy-cataplexy, the adaptive characteristics of baroreceptors and, finally, the interconnections between CNS sleep and blood pressure regulators of the brain stem. Through better understanding of the causes an...

Factors associated with psychiatric symptoms in patients undergoing chronic hemodialysis.

Abstract: Psychiatric morbidity in a sample of 85 patients undergoing chronic hemodialysis was assessed using standard questionnaires (General Health Questionnaire and Middlesex Hospital Questionnaire). Examination of the effects of demographic, illness, treatment, and history variables on questionnaire scores revealed that psychiatric symptoms were more frequent in women than in men, in those on home dialysis, in those living in rural areas, in unemployed men and in those with a disturbed nuclear family. Factor analysis of symptoms assessed by one of the questionnaires (GHQ) revealed six factors: general general dissatisfaction, suicidal ideation, confidence and well-being usefulness and enjoyment, concentration and alertness, sleep disturbance, Interview responses revealed a high incidence of general distress and anxiety and also a high incidence of sexual problems

Sleep disorders: Insomnia and narcolepsy

Abstract: Sleep Disorders : Insomnia and Narcolepsy , Sleep Disorders : Insomnia and Narcolepsy , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Influence of acth therapy on overnight sleep polygrams in infantile spasms

Abstract: Overnight sleep polygrams were recorded before and during therapy in nine patients with infantile spasms. Results showed that ACTH therapy increased the waking time and decreased rapid eye movement sleep. Thus it caused sleep disturbance in patients with infantile spasms. During ACTH therapy the number of rapid eye movements/min and the pulse rate decreased significantly. Body movements/min also decreased, but not significantly. These results suggest that ACTH therapy may inhibit functions of the central nervous system. The respiratory rate increased during ACTH and clonazepam therapy, probably in association with the decrease or the absence of seizures. These findings indicate the necessity for further studies on whether ACTH therapy is really of value in patients with infantile spasms, and show that if ACTH is given, the period of therapy should be as short as possible.

Effects of Anti-Convulsant Medication on Sleep Patterns.

Abstract: : A review of the published literature on effects of anti-convulsant medication on sleep patterns revealed few studies. The paucity of studies is probably due to the fact that all-night EEG-recorded sleep studies are not part of the usual diagnostic procedures for seizure patients. Seizure patients are seldom referred to the sleep laboratories and clinics, where the all-night sleep recording is routine. Also, few patients are treated by a single convulsant. Most studies have used barbiturates, and the effects of this class of drug on sleep stages appear to be the same whether the barbiturate is prescribed as an anti-convulsant or sedative-hypnotic. The same sleep stage changes are also found for the benzodiazepines used as a sedative-hypnotic and as an anti-convulsant. Acute studies indicate that anti-convulsants decrease REM sleep, while chronic ingestion decreases SWS, but total amount of NREM sleep is less affected. Sleep spindles usually are increased. An epileptic patient's sleep pattern is most likely to be more normal or stabilized after effective treatment. This normalization appears to be due to the control of nocturnal seizures, which previously disrupted sleep, rather than due to any effect of the anti-convulsant per se on sleep patterns. (Author)

Personality differences between insomniac and non-insomniac psychiatry outpatients

Abstract: The relationship between self-reported measures of sleep disturbance and psychopathology was investigated. Previous studies on this topic have failed to use appropriate control groups. The current study examined the relationship between sleep disturbance and personality using insomniac and non-insomniac outpatient counseling clients. The results confirm the significant and positive relation between emotional disturbance and insomnia. The insomniac group showed the expected pattern of MMPI abnormalities (elevated D, Hy, Pt and Sc). However, only the Pt scale of the MMPI and the Cornell Medical Index significantly differentiated the two groups. This suggests that characteristics such as obsessional worry which lead to elevated Pt scores play a more important and unique role in insomnia than previously hypothesized.

Management of Sleep Disorders in the Elderly

Abstract: Western society is somewhat preoccupied with the concept of consolidated nocturnal sleep, the satisfying occurrence of which allows us to work and socialise during the intervening hours. The elderly person may experience some difficulty when sleep, which once came naturally , no longer does so. Sleeping for an uninterrupted 8 hours is frequently replaced by a pattern in which there is a greater delay in falling asleep with subsequent more fitful sleep during which the individual is more easily disturbed . Thus the older person is likely to seek medical help and may ultimately come to depend on hypnotic drugs. Insomnia is a highly subjective symptom primarily that of not being able to sleep when, or as well as, the individual feelshe or she should and the anxiety this generates may be worse than the insomnia itself. Generally, the number of elderly female patients with this complaint greatly exceeds that of males perhaps reflecting such sociological factors as living alone or loss of security.