Showing papers on "Sleep disorder published in 1984"
TL;DR: The electrocardiographic changes observed in sleep apnoea syndrome are mediated by the autonomic nervous system; hypoxia is not the only factor involved.
542 citations
TL;DR: For 24 subjects of this sample, who occupied both major body positions during the evaluation night, the apnea index was found to be twice as high during the time spent sleeping on their backs as it was when they slept in the side position, suggesting sleep position adjustment may be a viable treatment for some nonobese sleep apnea patients.
Abstract: Thirty male patients evaluated sequentially for sleep apnea syndrome by all-night clinical polysomnography were compared for apnea plus hypopnea index (A + HI) during the time in the side versus time in the back sleep posture. For 24 subjects of this sample, who occupied both major body positions during the evaluation night, the apnea index was found to be twice as high during the time spent sleeping on their backs as it was when they slept in the side position. This difference is reliable and inversely related to obesity. Five patients meeting diagnostic criteria for sleep apnea on an all-night basis fell within normal limits while in the side sleep position. This suggests sleep position adjustment may be a viable treatment for some nonobese sleep apnea patients.
538 citations
TL;DR: Nasal occlusion at successively higher levels of CPAP resulted in the upper airway becoming more stable in stage III/IV NREM sleep, suggesting a reflex which augments the tone of upperAirway dilator muscles.
Abstract: We studied 18 patients with obstructive sleep apnea (OSA). Each subject slept while breathing through the nose with a specially designed valveless breathing circuit. Low levels of continuous positive airway pressure (CPAP) applied through the nose (2.5-15.0 cmH2O) prevented OSA and allowed long periods of stable stage III/IV sleep and rapid-eye-movement (REM) sleep. Externally applied complete nasal occlusion while the upper airway was patent resulted in upper airway closure during inspiration which was identified by a sudden deviation of nasal pressure from tracheal or esophageal pressure. The level of upper airway closing pressure (UACP) did not change throughout the occlusion test, suggesting that upper airway dilator muscles do not respond to asphyxia during sleep. The upper airway was more collapsible during stage I/II non-rapid-eye-movement (NREM) and REM sleep compared with stage III/IV NREM sleep. The pooled mean UACP was 3.1 +/- 0.4 cmH2O in stage I/II NREM, 4.2 +/- 0.2 cmH2O in stage III/IV NREM, and 2.4 +/- 0.2 cmH2O in REM sleep. Nasal occlusion at successively higher levels of CPAP did not alter the level of UACP in stage I/II NREM and REM sleep but resulted in the upper airway becoming more stable in stage III/IV NREM sleep, suggesting a reflex which augments the tone of upper airway dilator muscles.
240 citations
TL;DR: Ten insomniacs and matched control subjects, in whom major physiologic disorders such as sleep apnea and nocturnal myoclonus were ruled out, underwent studies of sleep, temperature, motor activity, cognitive performance, and perception of depth of sleep.
Abstract: Ten insomniacs and matched control subjects, in whom major physiologic disorders such as sleep apnea and nocturnal myoclonus were ruled out, underwent studies of sleep, temperature, motor activity, cognitive performance, and perception of depth of sleep. Subjective descriptions of sleep differed significantly between insomniacs and normals on a variety of variables. In contrast, polysomnographic evaluation showed increased intermittent waking time and decreased sleep efficiency, and only a tendency toward decreased total sleep and increased sleep latency. Minnesota Multiphasic Personality Inventory (MMPI) evaluation revealed that insomniacs had higher scores on the F,D, and SI scales, and lower values on the K scale. On cognitive testing, insomniacs did well on tests of episodic (recent) memory, but displayed major deficits in accessing semantic memory (retrieval of material already known). Compared to normals, insomniacs described rapid eye movement (REM) sleep as relatively “light” sleep.
157 citations
TL;DR: Nocturnal sleep was recorded prior to daytime testing that included the Multiple Sleep Latency Test, profile of mood states, card sorting, and Stanford Sleepiness Scale in 138 volunteers with the complaint of chronic insomnia and 89 noncomplaining sleepers ("normals").
Abstract: Nocturnal sleep was recorded prior to daytime testing that included the Multiple Sleep Latency Test, profile of mood states, card sorting, and Stanford Sleepiness Scale in 138 volunteers with the complaint of chronic insomnia and 89 noncomplaining sleepers ("normals"). In both groups daytime sleep tendency had no significant linear correlation either with any Minnesota Multiphasic Personality Inventory scale or with tension/anxiety and other moods assessed in the morning. In normals, speed of card sorting but not subjective sleepiness tended to correlate with sleep tendency. Given that physiological sleepiness is the most predictable consequence of sleep deprivation in normals, it is particularly interesting that 14% of the insomniac group are chronic insomniacs with no measurable daytime sleep tendency. Despite this lack of sleep tendency during the day, their nocturnal sleep was just as poor as insomniacs with greater daytime sleep tendency. The lack of daytime sleepiness seen in this subgroup may reflect a basic pathophysiological aspect of their insomnia.
144 citations
TL;DR: Eight whole-night polysomnographic recordings were conducted in a 33-year-old man with a localized pontine lesion inflicted by a shrapnel fragment, and found that in spite of marked reduction of REM sleep, the patient conducted a normal life and had none of the typical symptoms of REM-sleep deprivation.
Abstract: Eight whole-night polysomnographic recordings were conducted in a 33-year-old man with a localized pontine lesion inflicted by a shrapnel fragment. Sleep recordings revealed no rapid eye movement (REM) sleep in 3 nights, and markedly reduced REM sleep in 5 nights; non-rapid eye movement (NREM) sleep was normal. In spite of marked reduction of REM sleep, the patient conducted a normal life and had none of the typical symptoms of REM-sleep deprivation.
126 citations
Journal Article•
122 citations
TL;DR: There was a significant and substantial AAT decline from early adulthood to later life in Sleep Stages 4, 2, and REM, which helps to explain increased sleep disturbance in the later years as a result of diminished intensity of sleep, which makes sleep more difficult to sustain.
Abstract: Auditory awakening thresholds ( AATs ) were assessed in sleeping men and women at three age levels (18 to 25, 40 to 48, and 52 to 71 years) with a procedure that employed a 5-sec tone in accordance with the up-and-down method. Although age was less influential than individual differences in predicting AAT levels, there was a significant and substantial AAT decline from early adulthood to later life in Sleep Stages 4, 2, and REM. With no variation by sex, this progressive decline was apparent by the 40s in Stages 4 and 2 and was sharpest from one age level to another in Stage 4. Decline was more gradual and delayed in REM, probably because of a sampling artifact based on stimulus incorporation in dreams. These findings help to explain increased sleep disturbance in the later years as a result of diminished intensity of sleep, which makes sleep more difficult to sustain.
121 citations
TL;DR: Nine men who were habitual snorers were studied during a control and a treatment night to assess the effect of nasal continuous positive airway pressure (CPAP) on snoring, sleep-disordered breathing, and nocturnal oxygen desaturation.
116 citations
TL;DR: It is tested the hypothesis that subjects with a good tolerance to shift work maintain the circadian period τ of their temperature rhythm equal to 24 h, while τ may differ from 24 h when subjects exhibit one or several clinical signs of intolerance.
Abstract: The present study tested the hypothesis that subjects with a good tolerance to shift work maintain the circadian period tau of their temperature rhythm equal to 24 h, while tau may differ from 24 h when subjects exhibit one or several clinical signs of intolerance. These latter are mainly: persisting sleep disturbance, persisting fatigue, changes in mood and behaviour, and digestive troubles, from gastritis to overt peptic ulcer. These symptoms were used here to classify the subjects studied. Medications, including all types of sleeping pills, are ineffective. As was the case in the present study, some subjects may tolerate shift work for 35 yr, reaching 57 yr of age without complaint, while others, after several months or many years, quite rapidly (within 6 months) develop symptoms of intolerance.
109 citations
TL;DR: Older subjects and subjects who had been sexually victimized prior to the current assault were at significantly higher risk for developing major depressive disorder post-assault.
TL;DR: The findings suggest the existence of a subgroup of patients who show sleep abnormalities, in addition to clinical and possibly endocrine abnormalities, that indicate concurrent affective disorder.
Abstract: There is evidence that patients with anorexia nervosa (particularly those who also have bulimia) and patients with affective disorder share many features. The authors present sleep polygraph data from 20 young women with anorexia nervosa (17 also bulimic) and 10 age-matched normal women. Their urinary free cortisol levels were determined, and the subjects with eating disorders were also rated for depression. The findings suggest the existence of a subgroup of patients who show sleep abnormalities, in addition to clinical and possibly endocrine abnormalities, that indicate concurrent affective disorder. The authors present several models that could account for this relationship.
TL;DR: The need for early intervention with particular attention to teaching adolescents about good sleep habits and the need for stable bedtimes and waketimes and the possibility of joint intervention on daytime stress and sleeping problems are discussed.
Abstract: This study examined the prevalence and correlates of sleep disturbance in adolescents. Two hundred seventy-seven 9th- and 10th-grade students completed a questionnaire on sleep quality, sleep habits, beliefs about sleep, and daytime mood and functioning. Based on their responses, subjects were classified as good sleepers (66%), occasional poor sleepers (23%), and chronic poor sleepers (11%). Occasional and chronic poor sleepers reported being significantly more depressed, without energy, tense, moody, and irritable and less rested and alert than good sleepers. They were also more likely to describe themselves negatively. However, poor sleepers were not consistently more tired than good sleepers. Rather, they tended to be least tired in the evening, the time when most good sleepers reported feeling tired. There were few differences in the sleep habits and beliefs about sleep of good and poor sleepers. All subjects reported shifts in bedtimes and waketimes from weekdays to weekends, with occasional and chronic poor sleepers showing a tendency toward greater shifts, a possible factor contributing to their sleep disturbance. Occasional and chronic poor sleepers also reported more observable behaviors and feelings of stress than good sleepers. The need for early intervention with particular attention to teaching adolescents about good sleep habits and the need for stable bedtimes and waketimes and the possibility of joint intervention on daytime stress and sleeping problems are discussed.
TL;DR: The investigation of circumstances in which autistic children often exhibited sleep disturbance proved that abrupt changes in life environment or various problems in the way of bringing up children brought about their sleep disturbance.
Abstract: For the purpose of clarifying the pathophysiological meaning of sleep disturbance in autistic children, the sleep pattern of 75 such children was examined by a questionnaire method. Forty-nine of them showed sleep disturbance in their early life with an incidence of 65%. The poorly-developed group showed a high rate of sleep disturbance as compared with the relatively well-developed group. There was a negative correlation between the developmental level and duration period of sleep disturbance. The investigation of circumstances in which autistic children often exhibited sleep disturbance proved that abrupt changes in life environment or various problems in the way of bringing up children brought about their sleep disturbance. These findings suggest that sleep disturbance might be one of the main symptoms and related to the pathophysiology of infantile autism.
TL;DR: The somewhat greater psychosocial impact of narcolepsy appears to be due to the continuous excessive daytime sleepiness that persists between the diagnostic attacks, whereas persons with epilepsy are relatively alert between seizures.
Abstract: A questionnaire survey compared the psychosocial effects of epilepsy in 60 patients without major organic pathology (selected cases with temporal lobe epilepsy or primary generalized epilepsy) with those of matched (duration of illness, sex) patients with narcolepsy/cataplexy and with those of age- and sex-matched controls. Comparing epileptic patients with controls, we confirmed the well-documented marked deleterious effects of epilepsy upon work, education, occupational and household accidents, recreation, personality, interpersonal relations, and other parameters. Comparisons of epileptic and narcoleptic patients, however, showed that, in general, persons with narcolepsy are even more psychosocially impaired. The narcoleptic patients showed greater frequencies of disease-attributed reduced performance at work, poorer driving records, higher accident rates from smoking, greater problems in planning recreation, and other significant differences. Rather dissimilar profiles of psychosocial impairment were found to characterize the two conditions, and these were largely understandable as a function of their symptoms. The only areas in which epileptic patients showed greater problems than those with narcolepsy were in educational achievement and in ability to maintain a driving license. Most of the intergroup differences remained significant even for smaller groups matched also for age. The somewhat greater psychosocial impact of narcolepsy appears to be due to the continuous excessive daytime sleepiness that persists between the diagnostic attacks, whereas persons with epilepsy are relatively alert between seizures.
TL;DR: Irrespective of seizure type, the epileptic patients with the most frequent seizures also had the most sleep disturbances, and sleep disorder symptoms did not increase with age in the seizure groups.
Abstract: Three groups of adult epileptic subjects with simple partial, complex partial, and generalized seizures and normal control subjects completed a brief self-report sleep questionnaire. The simple partial and complex partial groups indicated significantly more sleep disorder symptoms, especially frequent night awakenings. The generalized group was most similar to the controls. Irrespective of seizure type, the epileptic patients with the most frequent seizures also had the most sleep disturbances. Sleep disorder symptoms did not increase with age in the seizure groups. It would thus seem that epileptic patients with partial seizures and those with more frequent seizures are at risk for developing sleep disorders.
TL;DR: Sleep fragmentation resulting from muscle aches decreased, as indicated by the diminution in alpha electroencephalographic arousals and K complexes, and its effect on sleep was dose related: as dosages Ceased, delta sleep progressively increased and REM sleep decreased.
Abstract: Five patients with nocturnal myoclonus (periodic leg movements during sleep), mean age 59.6 years, were monitored polygraphically for fifteen successive nights. Using a double-blind drug study design with placebo at baseline, we investigated the effect of baclofen on these patients. All patients had the repetitive sleep-related abnormal movements during both the baseline nights and those on which baclofen had been administered. The number of movements varied during the four baseline nights, but the movements induced sleep fragmentation, i.e., very short electroencephalographic changes. Baclofen increased the number of movements but decreased their amplitude during non-rapid eye movement (REM) sleep and shortened the interval between movements. Its effect on sleep was dose related: as dosages increased, delta sleep progressively increased and REM sleep decreased. Sleep fragmentation resulting from muscle twitches decreased, as indicated by the diminution in alpha electroencephalographic arousals and K complexes. Baclofen dosages of 20 mg and 40 mg were the most efficacious.
TL;DR: Despite significant clinical overlap in depressive symptomatology between the two groups, REM% and REM latency appear as sturdy psychophysiological markers in differentiating primary dysthymics and anxious depressives on both nights, suggesting that distinct anxious depressive and subaffective dysthyonic subtypes can be distinguished within the universe of the atypical depressions.
TL;DR: Sleep in men was characterized by a higher number of nocturnal awakenings, and in elderly men by a longer final awakening; however, other parameters of sleep efficiency did not differ considerably between the sexes.
Abstract: Sleep patterns were evaluated in 100 normal men and women who did not have any complaints of a sleep disorder and who were divided into three broad age groups: 19-29, 30-49, and 50-80 years Total laboratory recording time was held constant across all four study nights The amount of nightly wakefulness was positively correlated with age; total wake time for the oldest age group was about two times that of the youngest group, due primarily to an increase in wake time after sleep onset, because sleep latency did not change with age Within each of the three age groups, especially the two oldest groups, the greatest amount of wakefulness following sleep onset occurred in the final hours of the recording period Sleep in men was characterized by a higher number of nocturnal awakenings, and in elderly men by a longer final awakening; however, other parameters of sleep efficiency did not differ considerably between the sexes
TL;DR: A systematic review of the 19th-century literature related to sleep disorders revealed that patients with obstructive sleep apnea were vividly described in the second half of the century and the coining of the term "pickwickian" to describe an obese somnolent patient was made.
Abstract: A systematic review of the 19th-century literature related to sleep disorders revealed that patients with obstructive sleep apnea were vividly described in the second half of the century. Also, there were documented observations on the linkage between airway obstructions and noisy snoring, nocturnal insomnia, and excessive somnolence. The coining of the term "pickwickian" to describe an obese somnolent patient was made in 1889 during a clinical presentation of a patient with sleep apnea. Respiratory failure in sleep because of "failure of the chest and diaphragmatic movements" was defined as a specific sleep disorder by Silas Weir Mitchell in 1890. The two main reasons for overlooking the sleep apnea syndrome for so long have been misdiagnosis of patients with sleep apnea as having narcolepsy and skepticism regarding the validity of excessive somnolence as a clinical sign.
TL;DR: It is found that sleep disturbance secondary to other sleep disorders, especially during the period of NREM sleep preceding the first REM episode, accounts in large part for prolonged REM latencies observed in some narcoleptics.
Abstract: A retrospective study of 92 narcoleptics was undertaken to investigate the significance of prolonged nocturnal REM latencies observed in approximately one in every five narcoleptics undergoing single all-night clinical polysomnograms in our laboratory. Clinical and laboratory findings were examined as a function of REM latency. Our findings emphasize a high incidence of other sleep disorders, particularly sleep-related periodic leg movements, in narcoleptics. Furthermore, sleep disturbance secondary to other sleep disorders, especially during the period of NREM sleep preceding the first REM episode, accounts in large part for prolonged REM latencies observed in some narcoleptics. This study also provides one of the most extensive compilations of clinical and laboratory findings in a large population of narcoleptics.
TL;DR: Of all life events measures, negative life events listed on the Readjustment Scale were the most closely associated with reports of sleep disorders; all 14 coefficients involving negative events were significant and in the clinically expected direction.
Abstract: Scales to assess nightmare recall frequency and recalled frequency of insomnia-related disorders (sleep onset, sleep-maintenance problems, unrefreshing sleep, and restless sleep) were administered, together with the Social Readjustment Rating Scale of Holmes and Rahe to 170 part-time undergraduate students (mean age 27.4 yr., 97 men, 73 women), and together with the Life Events Inventory of Tennant and Andrews to another sample of 91 part-time undergraduates (mean age 26 yr., 53 men, 37 women). The time span for which life events and sleep disorders were to be assessed was the previous 6 mo. Pearson rs suggested that the relationships of different types of scores for life events (scores for change, for distress, for amount of control over events, weighted and unweighted scores for negative and positive events) to reports of sleep disorders were mostly weak (the largest coefficient was .29) and nonsignificant. Of all life events measures, negative life events listed on the Readjustment Scale were the most closely associated with reports of sleep disorders; all 14 coefficients involving negative events were significant and in the clinically expected direction. Further research is needed to examine whether the size of correlations between events and sleep disorders is related to factors such as readiness to recall and report negative personal experiences.
TL;DR: A developmental approach to the management of sleep disturbance was successful in 85% (44/52) of the children (aged 2–36 months) within 2–6 weeks and no drugs were used.
Abstract: A developmental approach to the management of sleep disturbances was successful in 85% (44/52) of the children (aged 2-36 months) within 2-6 weeks. No drugs were used. The approach was based on the following two principles: taking into account the characteristics of sleep behavior in infants and young children by setting up seven rules of normal sleep behavior, and dealing with the expectations and anxieties of the parents by means of a sleep chart.
TL;DR: A systematic review of the 19th-century literature related to sleep apnea revealed that patients with obstructive apnea were vividly described in the second half of the literatureury.
Abstract: • A systematic review of the 19th-century literature related [ill]sleep disorders revealed that patients with obstructive [ill]ep apnea were vividly described in the second half of the [ill]tury. Also, there were documented observations on the [ill]tage between airway obstructions and noisy snoring, noc[ill]nal insomnia, and excessive somnolence. The coining of [ill] term "pickwickian" to describe an obese somnolent pa[ill]t was made in 1889 during a clinical presentation of a [ill]ient with sleep apnea. Respiratory failure in sleep because "failure of the chest and diaphragmatic movements" was [ill]ned as a specific sleep disorder by Silas Weir Mitchell in [ill]0. The two main reasons for overlooking the sleep apnea [ill]drome for so long have been misdiagnosis of patients with [ill]ep apnea as having narcolepsy and skepticism regarding [ill] validity of excessive somnolence as a clinical sign. Arch Intern Med 1984;144:2025-2028)
TL;DR: The effect of posture on the occurrence of abnormalities in the flow-volume loop suggests that position alters the configuration of the upper airway.
Abstract: We evaluated the effect of posture on the sensitivity and specificity of abnormalities in the flow-volume loop in 30 patients with suspected obstructive sleep apnoea. Flow-volume loops were judged as abnormal if the FEF50/FIF50 ratio was greater than 1 or if the sawtooth sign was judged to be present by at least two of three chest physicians. Detailed nocturnal recordings confirmed the presence of obstructive sleep apnoea in 17 of the 30 patients. Our results showed that both the sensitivity and the specificity of each of the flow-volume criteria for the diagnosis of obstructive sleep apnoea were higher when the loops were recorded in the supine than when they were recorded in the sitting position. The sensitivities were low, however, even with the supine posture--sawtoothing 41% and FEF50/FIF50 ratio greater than 1 47%. The highest sensitivity (71%) was obtained by considering a positive result as being the presence of either of the abnormalities in either the sitting or the supine posture. This sensitivity of the flow-volume loop was too low to recommend it as a routine screening test for the diagnosis of obstructive sleep apnoea but the presence of the sawtooth sign had a high specificity (92%) for the diagnosis of obstructive sleep apnoea. Furthermore, there was a greater fall in oxygen saturation in patients with apnoea who had sawtoothing than in those without sawtoothing. The presence of the sawtooth sign should increase the suspicion of sleep apnoea and suggest the need for further investigation. The effect of posture on the occurrence of abnormalities in the flow-volume loop suggests that position alters the configuration of the upper airway.
TL;DR: A new syndrome, Rheumatic Pain Modulation Disorder (RPMD) with sleep‐related myoclonus (involuntary periodic leg movements), with no differences in evening and morning sleepiness, number of limb movements, movement arousals, awakenings after sleep onset, sleep duration, and percent sleep stages is described.
Abstract: We describe a new syndrome, Rheumatic Pain Modulation Disorder (RPMD) ("fibrositis syndrome") with sleep-related myoclonus (involuntary periodic leg movements). Measures of sleepiness, fatigue and pain, before and after sleep, and aspects of sleep of nine subjects (Ss) with RPMD and sleep-related myoclonus were compared to nine subjects with excessive daytime somnolence and sleep-related myoclonus. In eight of the RPMD with sleep-related myoclonus and three of those with daytime sleepiness, an alpha (7.5-11 Hz) EEG Non-Rapid Eye Movement sleep disorder was demonstrated. The RPMD with sleep-related myoclonus group contained a greater number of women, more pain, morning fatigue, and disturbances in sleep (more stage changes and alpha EEG sleep prior to leg myoclonus); but in comparison to the sleep-related myoclonus, daytime somnolent group, there were no differences in evening and morning sleepiness, number of limb movements, movement arousals, awakenings after sleep onset, sleep duration, and percent sleep stages.
TL;DR: The ES procedure was unsatisfactory for managing insomnia during opiate withdrawal, but neither methadone can be regarded as fully satisfactory in this respect.
01 Jan 1984
TL;DR: This paper reviews a number of issues in the diagnosis and treatment of insomnia, including the criteria of hypnotic efficacy and the effects of triazolam and flurazepam on sleep and daytime alertness, which have been investigated in normals, chronic insomniacs and the elderly.
Abstract: Most people attribute a restorative function to sleep. This is because experimental or clinical sleep disturbance is usually followed by annoying symptoms of fatigue and sleepiness the following day. Can these daytime changes be documented objectively? In the past several years, the Multiple Sleep Latency Test (MSLT) has been developed and validated as an objective quantitative measure of sleepiness. Multiple assessments of sleep latency yield a profile of sleepiness across the day. This profile changes in the predicted direction with acute total and partial sleep deprivation, chronic sleep deprivation, sleep satiation, and in comparisons between hypersomnia patients and controls.