Showing papers on "Sleep disorder published in 1985"

Weight loss in mildly to moderately obese patients with obstructive sleep apnea.

Abstract: The therapeutic effects of weight loss were evaluated in 15 hypersomnolent patients with moderately severe obstructive sleep apnea. As patients decreased their body weight from 106.2 +/- 7.3 kg (mean +/- SE) to 96.6 +/- 5.9 kg, apnea frequency fell from 55.0 +/- 7.5 to 29.2 +/- 7.1 episodes/h (p less than 0.01) in non-rapid-eye-movement sleep with an associated significant decline in the mean oxyhemoglobin saturation during the remaining episodes of sleep apnea from 11.9 +/- 2.4% to 7.9 +/- 1.9% (p less than 0.02). Sleep patterns also improved, with a reduction in stage I sleep from 40.2 +/- 7.3% to 23.5 +/- 4.8% (p less than 0.01), and a rise in stage II sleep from 37.3 +/- 7.0% to 49.4 +/- 4.6% (p less than 0.03). In the 9 patients with the most marked fall in apnea frequency, the tendency toward daytime hypersomnolence was decreased (p less than 0.05). No significant changes in sleep patterns occurred in 8 age- and weight-matched control patients who did not lose weight. Moderate weight loss alone can alleviate sleep apnea, improve sleep architecture, and decrease daytime hypersomnolence.

Somatic Symptoms in Primary Affective Disorder: Presence and Relationship to the Classification of Depression

Abstract: The incidence and severity of somatic symptoms were determined in 132 patients with major depressive disorder and 80 normal controls. The role of somatic symptoms was analyzed in relation to the unipolar-bipolar division, Research Diagnostic Criteria (RDC) subtypes, hypersomnia, and appetite increase. The data suggest that the rate and level of somatic symptoms increased with the severity of depression and age, only appetite loss differentiated unipolar from bipolar patients, and the classic somatic symptoms of depression were present in most RDC subtypes and not exclusively associated with the "endogenous" subtype. Hypersomnia or increased appetite identified two overlapping depressive subgroups; patients in both groups were young and characterized by high interpersonal sensitivity. Hypersomniac depressed patients were less anxious and agitated; patients with increased appetite were more hostile and showed a greater decrease in libido than age-matched and sex-matched patients with neither symptom.

Sleep disturbance in pain clinic patients

Abstract: One hundred out-patients, referred to a multidisciplinary pain clinic for the management of chronic pain, were questioned regarding their sleeping habits and were grouped according to whether they reported 'good,' 'fair' or 'poor' sleep. All patients were administered questionnaires to measure illness behaviour, depression and anxiety. Information was also obtained regarding the site, intensity and quality of pain as well as amount of general activity. 'Good' and 'poor' sleepers were found to differ on most measures, particularly depression, pain intensity, activity levels and hypochondriasis. These findings suggest that reported sleep disturbance may provide an index of impairment and act as an indicator of psychological disturbance in chronic pain patients.

Sleep apnea syndrome and essential hypertension

Abstract: More than half of patients with essential hypertension have sleep apnea. The incidence of unrecognized sleep apnea in patients with essential hypertension was assessed. Twenty-three patients taking antihypertensive medication were selected at random from a hypertension clinic. They were evaluated by questionnaire for symptoms of sleep apnea, and during 3 hours of sleep, measurements were made of respiratory patterns using an impedance pneumograph, arterial O2 saturation with an ear oximeter and air flow at the mouth or nose with a face mask pneumotacograph. Abnormal sleep apneas (average 20 seconds) lasting for an average of 19% sleep time were found in 11 patients (48%). Significant arterial O2 desaturation, defined as a decrease of at least 4% and to

Further Evidence of Abnormal Non-Rapid-Eye-Movement Sleep in Schizophrenia

Abstract: • Very low levels of visually scored stage 4 sleep are found in 40% to 50% of acute and chronic schizophrenics. Stage 4 is a visual estimate of high-amplitude delta (0.5 to 3 Hz) electroencephalographic waves; these waves can now be measured directly and reliably by computer. In this pilot study, we carried out such measurement in the successive non-rapid-eye-movement periods (NREMPs). We also sampled and measured visually sleep spindles by NREMP; spindles constitute a second distinctive feature of the NREM electroencephalogram. In five unmedicated, recently rehospitalized schizophrenic patients we found reduced delta amplitude and abundance (and increased spindle density) in NREMP1 (also called "REM latency") as compared with ambulatory normal controls. NREMP1 was also abnormally short with an average length similar to that reported for major depression. These striking abnormalities of NREM sleep may underlie the abnormal rapid eye movement distributions sometimes found in schizophrenic and depressed patients. Further studies are required to evaluate the relation of these NREM abnormalities to psychopathology (and hence their utility as biological "markers") and to rule out confounding effects of hospitalization or undetected napping.

Behavioural methods in the treatment of sleep disorders—a pilot study

Abstract: The efficacy of behavioural methods of treatment for severe sleep disorders was examined in a pilot study involving 35 children aged 1-5 years. Improvement occurred in 77%. Methodological issues concerning the selection of children for treatment, selecting adequate controls and outcome measures, and using parents as therapists, are discussed.

Reversal of sleep disturbance in Parkinson's disease by antiparkinsonian therapy a preliminary study

Abstract: In a previous study, the sleep pattern in Parkinson9s disease patients was found to be altered. The disturbance consisted of a “light fragmented sleep pattern” with increased muscle activity. Using a combined polysomnographic and electromyographic recording technique, we found that a reversal of the light fragmented sleep pattern and normalization of muscle activity during sleep occurred after clinical improvement with dopaminergic treatment. The effect of dopaminergic treatment on sleep disturbance was analyzed. There is an intimate relationship between sleep pattern and the normalization of sleep muscle activity produced by dopaminergic agents.

Breathing during sleep in patients with interstitial lung disease.

Abstract: Patients with interstitial lung disease (ILD) have a rapid shallow breathing pattern while awake that is thought to be due to activation of lung reflexes. We wondered whether sleep would result in changes in respiratory control and thus cause hypoxemia and poor sleep quality. Eleven patients with ILD (5 men and 6 women) and 11 age- and sex-matched control subjects were studied during sleep. Sleep quality was worse in patients with ILD, with more time in Stage 1 (33.7% of total sleep time (TST) versus 13.5%) and less time in REM sleep (11.8 versus 19.9% TST) than found in control subjects, and more fragmentation of sleep (13.7 +/- 3.1 arousals/h and 24.3 +/- 6.0 sleep stage changes/h versus 6.9 +/- 1.0 and 12.7 +/- 1.4, respectively). Patients with ILD with awake SaO2 less than 90% had greater abnormalities in sleep structure than did those with SaO2 greater than 90%. The incidence of apneas and hypopnea periods in patients with ILD was low (apnea plus hypoventilation index of 1.3 +/- 0.45 versus 2.9 +/- 0.82 in control subjects, p = NS). Oxygen saturation dropped during REM sleep in patients, especially in those with more severe awake hypoxemia. Expiratory time (Te), inspiratory time (Ti), and their sum (Ttot) were shorter in the patients, whereas Ti/Ttot was the same as in control subjects. No systematic changes during sleep were seen in these variables. The variability of inspiratory volume index, Ti, Te, and Ti/Ttot was similar to that in control subjects, and was lowest during NREM sleep. The incidence of snoring was comparable in patients and control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea.

Abstract: Among patients with similar degrees of obstructive sleep apnea (OSA) there is considerable variability in the degree of associated nocturnal hypoxemia. The factors responsible for this variability have not been clearly defined. Therefore we studied 44 patients with OSA to identify the physiological determinants of nocturnal arterial O2 saturation (SaO2). All patients underwent pulmonary function testing, arterial blood gas analysis, and overnight polysomnography. Mean nocturnal SaO2 ranged from 96 to 66% and apnea-hypopnea index from 11 to 128 per hour of sleep. Several anthropometric, respiratory physiological, and polysomnographic variables that could be expected to influence nocturnal SaO2 were entered into a stepwise multiple linear regression analysis, with mean nocturnal SaO2 as the dependent variable. Three variables [awake supine arterial PO2 (PaO2), expiratory reserve volume, and percentage of sleep time spent in apnea] were found to correlate strongly with mean nocturnal SaO2 (multiple R, 0.854; P less than 0.0001) and accounted for 73% of its variability among patients. Body weight, other lung volumes, and airflow rates influenced awake PaO2 and expiratory reserve volume but had no independent influence on nocturnal SaO2. In a further group of 15 patients with OSA a high correlation was obtained between measured nocturnal SaO2 and that predicted by the model (r = 0.87; P less than 0.001). We conclude that derangements of pulmonary mechanics and awake PaO2 (generally attributable to obesity and diffuse airway obstruction) are of major importance in establishing the severity of nocturnal hypoxemia in patients with OSA.

A double-blind drug trial of treatment in young children with waking problems.

Abstract: A double-blind trial using trimeprazine tartrate was carried out in 22 children with severe waking problems. On parental verbal reports sleep was significantly improved on the drug compared with the original baseline and the placebo, but diaries kept by the parents showed that this improvement was clinically only moderate, with many wakeful nights still occurring. Taking the drug produced no permanent effect on sleep patterns and a follow-up of 14 children 6 months later showed persisting sleep problems in the majority.

Sleep disturbances and severity of Huntington's disease.

Abstract: We studied sleep functions in two patients with mild and five with moderately severe Huntington's disease. In mild disease there was chorea, but intelligence, mental function, and sleep were all normal. In moderately severe disease, intelligence and mental function were also affected, and there was a sleep disturbance characterized by prolonged sleep-onset latency, increased interspersed wakefulness, and reduced sleep efficiency.

Extended sleep (hypersomnia) in young depressed patients.

Abstract: To test the hypothesis that young depressed patients have prolonged rather than shortened sleep, 14 depressed patients aged 17-25 and age-matched normal control subjects were allowed to sleep as long as they wanted. All subjects increased their sleep over baseline values, but the extended sleep period of the depressed patients was almost twice as long as that of the control subjects. The distribution of sleep stages in the extended period did not differ. The depressed patients had changes in the length of REM periods similar to those of older subjects. The findings suggest an interaction between age, sleep, and depression.

Nasal surgery in the management of sleep apnea.

Abstract: We present our experience with short- and long-term beneficial results obtained from surgery of the nasal valve area in carefully selected patients with obstructive sleep apnea (OSA). In six cases reported here, surgical treatment resulted in subjective improvement in snoring and daytime somnolence. Objective improvement was noted in three patients who had nasal valve area obstruction. Although the role of surgery in patients with mild OSA needs further assessment, surgical correction of nasal valve area obstruction in patients with moderately severe to severe OSA appears clearly indicated.

Beta-blockers and sleep: a controlled trial.

Abstract: The effects on sleep of four β-Blockers, atenolol, propranolol, metoprolol and pindolol, were studied in a placebo-controlled trial. Drugs were administered in random order to 10 female volunteers who acted as their own controls. Subjects were tested five times, each test period lasting 10 nights (2 baseline, 2 low dose, 4 high dose, and 2 withdrawal). A questionnaire concerning subjective appreciation of the quality of the previous night's sleep was completed each morning. Night recordings of muscle tension, eye movement, heart rate and electroencephalogram were recorded on paper and magnetic tape. Analysis of the subjective questionnaires showed that recollection of dreaming and awakening in the night was increased by the three lipophilic drugs, propranolol, metoprolol, and pindolol. These results confirm reports in the literature but are contrary to those expected from considering the effects of noradrenaline on sleep. Analysis of physiological records confirmed subjects' reports that waking was increased by the lipophilic drugs. Dreaming (rapid eye movement sleep, REM) was reduced, as predicted from knowledge of the effect of noradrenaline on sleep. Increased awakening leads to an increase in remembered dreaming which explains the otherwise paradoxical results. Although atenolol had no effect on subjective measures of sleep this hydrophilic drug also reduced REM frequency, suggesting that either it has some central effect, or that REM reduction is due to a peripheral ‘shielding’ effect.

Sleep-wake complaints in patients with sleep-related respiratory disturbances

Abstract: The relation of sleep complaint to sleep continuity and respiratory disturbance was studied by comparing 2 series of patients with sleep apnea, one group complaining of insomnia and the other of excessive daytime sleepiness. On polysomnographic evaluation, patients with insomnia complaints had fewer and shorter, primarily central, apneas that had little hypoxemic effects. Patients with excessive sleepiness complaints had more and longer, primarily obstructive, apneas that produced significant hypoxemia. Sleep of the excessively sleepy patients was lighter and longer, whereas that of the patients with insomnia was characterized by more wake time before and after sleep onset. The excessively sleepy patients were objectively sleepy on a test of daytime sleepiness, whereas patients with insomnia were alert.

CNS-related side-effects with metoprolol and atenolol.

Abstract: Vivid and bizarre dreams, hallucinations, sleep disturbance and psychosis have all been described following treatment with beta-blockers. It has been suggested that these central nervous system (CNS) side-effects are related to the degree of lipophilicity of the beta-blocker. A randomized double-blind crossover study was performed to compare the incidence of CNS side-effects with atenolol and metoprolol in hypertensive patients who had reported CNS side-effects with lipophilic beta-blockers. Eleven women and six men completed the study, in which a 30-item psychiatric questionnaire was used to detect changes in psychological status and possible CNS side-effects. Discontinuation of the original lipophilic beta-blocker produced a significant improvement in quality of sleep, dreams, concentration, memory, energy, and anxiety. No significant CNS side-effects were reported with atenolol, but introduction of metoprolol caused a significant increase in the incidence of sleep disturbance (p less than 0.01) and restless nights (p less than 0.05), as well as failure to achieve satisfactory sexual intercourse (p less than 0.05). When compared with atenolol, metoprolol was associated with a significantly higher incidence of restless disturbed nights (p less than 0.05). Blood pressure control was identical for both beta-blockers. This study appears to confirm the association between CNS-related side-effects and the lipophilicity of beta-blockers.

Sleep and sleepiness following a behaviourally 'active' day

Abstract: During 4 day periods in which a total of nine subjects expected to spend each daytime under relatively stereotyped environmental conditions, a substitution was made for 1 day (experimental day) on a random basis. Here, subjects spent the time in a variety of novel, interesting and perceptually stimulating environments. Sleep EEG recordings were made each night following an adaptation night. Self-assessment sleepiness ratings were made night and morning. Following the experimental day subjects felt significantly more sleepy at bedtime, and sleep onset latency was significantly reduced. Although sleep length was unchanged, deep (slow wave) sleep, particularly stage 4 sleep, was increased significantly. There was some increase in sleep disturbance. REM sleep was unaffected. Subjects awoke feeling refreshed the next day. There was a small but significant carryover of a further SWS increase in the first part of the following night.

Sleep and epilepsy.

Abstract: One of the main advantages of long-term recording of epileptics is the possibility to monitor these patients during natural sleep. In this chapter, we first describe the reciprocal influence of sleep and epilepsy. On the one hand, sleep and circadian fluctuation of the state of vigilance have a marked influence on the occurrence of generalized and partial seizures as well as on the frequency, morphology and distribution of interictal epileptic discharges. On the other hand, a wide range of sleep disturbances has been documented in epileptics and there is some evidence that sleep disturbance and epilepsy may aggravate and perpetuate one another. Long-term EEG monitoring during sleep is of major importance when investigating epileptics with nocturnal attacks to determine whether these nocturnal episodes represent an ictal manifestation or an independent non-epileptic sleep disorder. In special forms of epilepsy, sleep recording is not only useful but necessary for the diagnosis. Various activation procedures are carried out on patients in whom there is diagnostic uncertainty regarding the presence or the type of epilepsy. Some of these procedures employ sleep: namely sedated sleep, sleep after sleep deprivation and all-night sleep recording. The diagnostic value and the indications of these activation studies are reviewed.