Showing papers on "Sleep disorder published in 1988"

Automobile Accidents Involving Patients with Obstructive Sleep Apnea

Abstract: Although patients with obstructive sleep apnea often report falling asleep while driving, the frequency of auto accidents involving these patients has not been rigorously studied. Therefore, we compared the driving records of 29 patients with obstructive sleep apnea with those of 35 subjects without sleep apnea. The patients with sleep apnea had a sevenfold greater rate of automobile accidents than did the subjects without apnea (p < 0.01). The percentage of persons with one or more accidents was also greater in the patients with apnea than in the control subjects without apnea (31% versus 6%, p < 0.01). The percentage of persons having one or more accidents in which they were at fault was also greater in the patients with apnea than in the control subjects (24% versus 3%, p < 0.02). The automobile accident rate of the patients with sleep apnea was 2.6 times the accident rate of all licensed drivers in the state of Virginia (p < 0.02). In addition, 24% of patients with sleep apnea reported falling asleep ...

The nighttime problems of Parkinson's disease.

Abstract: In a national survey conducted among 220 patients with Parkinson's disease (PD), 215 reported experiencing disabilities at night or on waking. The most common problems were inability to turn over or get out of bed and a frequent need to pass urine during the night. For the majority of patients, sleep was disrupted. Despite these difficulties, two-thirds of patients rated sleep quality as acceptable or good. The average duration of sleep was 6.5-7 h but approximately 8% of patients reported less than 5 h sleep per night. Hypnotic or sedative drugs were used by 29% of patients to help them sleep but only 6% took any antiparkinsonian medication during the night. Just over half the patients had told their doctor of nocturnal problems; prescription of hypnotic drugs or changes to antiparkinsonian therapy were the remedies most frequently tried. Problems at night are common in PD and, because of their debilitating effect on performance during the daytime, merit special attention.

Sleep Loss and “Divergent” Thinking Ability

Abstract: Although much is known about the impact of sleep loss on many aspects of psychological performance, the effects on divergent ("creative") thinking has received little attention. Twelve subjects went 32 h without sleep, and 12 others acted as normally sleeping controls. All subjects were assessed on the figural and verbal versions of the Torrance Tests of Creative Thinking. As compared with the control condition, sleep loss impaired performance on all test scales (e.g., "flexibility," the ability to change strategy, and "originality," generation of unusual ideas) for both versions, even on an initial 5-min test component. In an attempt at further understanding of whether these findings might be explained solely by a loss of motivation, two additional short and stimulating tests were also used--a word fluency task incorporating high incentive to do well and a challenging nonverbal planning test. Performance at these tasks was still significantly impaired by sleep loss. Increased perseveration was clearly apparent. Apparently, 1 night of sleep loss can affect divergent thinking. This contrasts with the outcome for convergent thinking tasks, which are more resilient to short-term sleep loss.

Nocturnal bruxism and temporomandibular disorders.

Abstract: This chapter has discussed the important aspects of nocturnal bruxism and its relation to disorders of the masticatory system and headaches. Bruxism is believed to be a stress-related sleep disorder, occurring in both men and women, in children, and in adults. In most patients, bruxism results only in minor tooth wear; however, it can become extremely severe with damage occurring in essentially every part of the masticatory apparatus. Nocturnal bruxism should not be overlooked as an etiologic factor in muscular headaches. Short-term acute therapy may involve physical therapy, nocturnal electromyographic biofeedback, and medication to relieve anxiety and improve sleep. Long-term management usually includes some form of stress reduction, change in lifestyle, and an occlusal splint or nightguard to protect the teeth and masticatory system.

Subjective Sleep Disturbance in Chronic Back Pain

Abstract: Although disturbed sleep is thought to be common in patients with chronic low back pain, little data systematically address this issue. We administered a self-report inventory of sleep performance to an unselected sample of chronic low back pain patients (n= 51) attending a general orthopedi

Identifying Sleep Apnea from Self-Reports

Abstract: An apnea score (AS) was developed as a potential screening tool for sleep apnea This was based on self-report questionnaire responses of 76 sleep disorder center patients and 20 sleep survey volunteers Twenty volunteers and 23 patients (group I) comprised the initial AS development group Their questionnaire responses were compared to polysomnographic apnea indexes (AI) and apnea plus hypopnea indexes (AHI) Stepwise multivariate discriminant analysis was used to test whether or not selected group I questionnaire responses could be used to correctly classify respondents into apnea (AI or AHI greater than 5) or nonapnea (AI, AHI less than or equal to 5) groups Self-reports of "stops breathing during sleep," "loud snoring," and history of adenoidectomy best discriminated normal (AI less than or equal to 5) from apnea (AI greater than 5) cases The AS derived from group I responses to these three variables was then computed for group II (n = 53) After examination of the AS results, the AS was modified to include just "stops breathing" and "loud snoring" and the AI criterion was raised to 10 per hour This revised AS correctly identified 100% of the cases with moderate-severe sleep apnea (AI or AHI greater than 40) and 70-76% of all sleep apnea cases with AI or AHI greater than 5 Predictive accuracy was 88% for AI greater than 10 The two questions that comprise the AS should be incorporated into risk appraisal instruments or interviews to screen for sleep apnea

A longitudinal study of depressed mood and sleep disturbances in elderly adults.

Abstract: Previous studies have suggested that depression might be more strongly related to sleep disturbances in older than in younger individuals. However, few of these studies have simultaneously considered variables other than depression that have been demonstrated to influence the sleep of elderly persons, and none has examined the relationship between depression and sleep longitudinally. The present study examined the association between frequency of depressed mood, using the Depression Adjective Checklist (DACL), and self-reports of four sleep problems over a 3-year period in a sample of community-residing elderly persons. Results showed that frequency of depressed affect was related positively to sleep disturbance, even when subjects' age, gender, and health status were considered simultaneously. Early morning awakening was the sleep symptom that most consistently related to depressed mood over the course of the study. Poor health and female gender showed positive but less consistent relationships to the sleep complaints than depressed affect. Research on biological mechanisms underlying the disturbed sleep of elderly depressed individuals is discussed.

Alteration of sleep in rabbits by Staphylococcus aureus infection.

Abstract: Abundant evidence suggests that sleep might be altered during infectious disease, although the relationship between sleep and infectious disease has never been examined systematically. To address this issue, we determined the effects of Staphylococcus aureus infection on rabbit sleep. Rabbits inoculated intravenously with S. aureus demonstrated the expected physiological changes consistent with a state of infectious disease (e.g., lymphopenia, neutrophilia, and fever), as well as time-dependent changes in sleep patterns. The sleep changes were characterized initially by increases in (i) the time spent in slow-wave sleep, (ii) the electroencephalographic slow-wave amplitudes during slow-wave sleep, and (iii) the duration of individual bouts of slow-wave sleep. At 20 to 36 h after inoculation, sleep responses fell to levels below corresponding control values for 6 to 12 h. At 6 to 10 h after inoculation, rapid-eye-movement sleep was suppressed and remained at low levels throughout the remainder of the 48-h recording period. These effects of bacterial infection on sleep were attenuated by antibiotic (cephalothin) therapy. Inoculation with killed bacteria produced similar changes in sleep and other physiological parameters, although significantly higher numbers of organisms were required to produce equivalent responses. We postulate that changes in sleep may represent an adaptive response of the host to infectious disease.

Do Sleep Studies Contribute to the Management of Patients with Severe Chronic Obstructive Pulmonary Disease

Abstract: To determine whether studies of breathing and oxygenation during sleep are clinically useful, we have assessed whether the detection of excess nocturnal hypoxemia in patients with chronic obstructive pulmonary disease (COPD) is of prognostic importance. Ninety-seven patients with COPD were followed for 32 to 108 (median, 70) months after studies of overnight oxygenation. Significant relationships (p less than 0.001) were obtained between mean oxygen saturation (SaO2) asleep and awake. There was similarly a significant relationship between lowest SaO2 asleep and awake, but this relationship was improved by the inclusion of awake arterial carbon dioxide tension (PaCO2). The patients who were more hypoxic at night than predicted from these regression relationships had similar survivals to the patients who were less hypoxic at night than predicted, whether excess nocturnal hypoxia was defined in terms of mean or lowest SaO2 during sleep. In the 66 patients who did not subsequently receive long-term oxygen therapy, none of the indices of nocturnal oxygenation was related to survival, the only significant predictor of survival being daytime arterial oxygen tension (PaO2). For all 97 patients, both mean nocturnal SaO2 and lowest SaO2 during sleep were related to survival (p less than 0.05), and percent predicted vital capacity was also related to survival (p less than 0.05). Neither of the oxygen saturations during sleep significantly added to the more readily and cheaply measured percent predicted vital capacity in determining survival in these patients. Thus, in patients with COPD, excess nocturnal hypoxemia is not associated with an impaired prognosis, and so studies of oxygenation during sleep cannot be recommended in the routine clinical management of these patients.

Destructive bruxism: sleep stage relationship.

Abstract: Despite apparent similar amounts of bruxism, two groups that had been evaluated polysomnographically differed dramatically in symptomatology. Patients with severe symptoms were referred to as the destructive bruxism group and were compared with (a) a group with sleep disturbance complaints who had bruxism and (b) a group of insomniac depressed patients chosen without regard to bruxism. It was hypothesized that not only the presence of bruxism during sleep but its pattern and sleep stage relationship were factors affecting clinical symptoms. The results indicated that the sleep stage relationship was an important factor. Patients with severe symptoms attributed to nocturnal bruxism were likely to have more bruxism in REM sleep than the other groups. These results if replicated prospectively would help explain some of the discrepancies in the literature concerning sleep stage relationship of bruxism, as well as help explain differences in symptomatology of bruxism patients.

Comparison of sleep in osteoarthritic patients and age and sex matched healthy controls.

Abstract: A sleep laboratory comparison of the sleep of 14 osteoarthritic patients with that of 16 age and sex matched healthy controls was undertaken. After three nights of adaptation continuous recordings of electroencephalographic (EEG), electro-oculographic (EOG), and electromyographic (EMG) activity were obtained for the next two nights. A comparison of EEG sleep variables during this baseline period showed that osteoarthritic patients had a significantly greater percentage of stage 1 and significantly smaller percentage of stage 2 sleep than control subjects. These findings indicate sleep disturbance in osteoarthritic patients. The limited degree of disturbance observed in these patients may be due to the fact that they were allowed to continue with their normal anti-inflammatory and analgesic medication for the course of the study.

Altitude insomnia: studies during an expedition to the Himalayas.

Abstract: During an expedition to the Himalayas, we studied the sleep and respiration of six climbers. Three ingested acetazolamide (500 mg) daily throughout the climb and the other three ingested placebo. At high altitude (4,150-4,846 m), each subject ingested temazepam (10 mg) for one night and placebo for another. Acetazolamide improved sleep above 2,750 m, but it is uncertain whether this was due to sedation or to improvements in arterial oxygen saturation. Sleep was markedly disturbed in all subjects above 4,000 m. Temazepam improved sleep, and in subjects taking acetazolamide, it reduced sleep-onset latencies and increased sleep efficiency close to that of sea level values. These observations suggest that the prophylactic use of acetazolamide is likely to improve sleep in climbers and that a low dose of a benzodiazepine such as temazepam (10 mg) may be beneficial at high altitude. Studies are now needed to exclude any possibility of respiratory impairment at altitude before a firm recommendation can be made regarding the routine use of this hypnotic.

The role of polysomnography in the differential diagnosis of chronic insomnia.

Abstract: The authors examined the accuracy of the differential diagnosis of chronic insomnia with and without sleep laboratory studies in a consecutive series of 123 patients. All patients were evaluated by means of a sleep/wake log, a sleep habits questionnaire, structured psychiatric and clinical interviews, and a minimum of two consecutive nights ofpolysomnography. Notwithstanding a high rate of Research Diagnostic Criteria (RDC)-diagnosed psychopathology (63%) in this sampie, the major finding was that in 49% of the patients laboratory results added to, refuted, and/or failed to support the clinical impression. This resulted in substantial modification of the initial diagnostic formulation and therefore in increased specificity of diagnosis. (Am J Psychiatry 1988; 145:346-349)

Sleep apnea and sleep-related periodic leg movements in community resident seniors.

Abstract: The elderly have a high incidence of sleep complaints A high incidence of sleep apnea (SA) and sleep-related periodic leg movements (PLMs) is also suspected The relationship between the incidence and severity of SA and PLMs and sleep complaints has not, however, been determined in terms of symptomatology and physiologic abnormality In a group of 46 community resident seniors (60 to 95 years old), the incidence of SA and PLMs was correlated with subjective sleep-wake complaints Sixty-one percent of subjects had SA and/or PLMs Apneas/hypopneas were associated with an average oxygen desaturation of less than 5% and an average change in heart rate of less than 10 beats per minute While subjects with SA or PLMs had clear evidence of objective sleep disturbance, only one quarter of them admitted to any subjective sleep complaints or daytime sleepiness Furthermore, severity of SA or PLMs failed to predict sleep-wake complaints, and vice versa This study confirms that typically mild SA and PLMs are widespread in the elderly but tend not to be manifested in sleep-wake complaints and probably go untreated as a result Further research is needed to determine any long-term medical significance

Cluster analysis of insomniacs' MMPI profiles: relation of subtypes to sleep history and treatment outcome.

Abstract: The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 100 insomniacs who presented for treatment at a university medical center were analyzed by a hierarchical clustering procedure. This analysis revealed two major personality types that accounted for 88% of the sample. The two types referred to as "Type 1" and "Type 2" insomniacs differed significantly in regard to sleep history questionnaire responses and responsivity to treatment. MMPI scales and sleep history questionnaire items suggested that Type 1 insomniacs were less defended, more aroused/activated, and had sleep histories characterized by more childhood sleep problems and greater difficulties with sleep-disruptive cognitions than did Type 2 patients. Further, Type 1 patients had a poorer response to behavioral treatment as measured by change in sleep-onset latency than did Type 2 patients. These results suggest that the MMPI may be useful in identifying distinctive personality subgroups among insomniacs. Treatment implications are discussed, and mechanisms underlying the group differences are considered.

Effects of ritanserin on sleep disturbances of dysthymic patients.

Abstract: Ritanserin, a selective and potent serotonin-2 antagonist, is effective in the treatment of a variety of syndromes related to anxiety and depression, including dysthymic disorder. In animals and healthy volunteers, ritanserin specifically increases slow-wave sleep and the hypothesis arises that this effect on sleep may contribute to its therapeutic properties. Therefore, we studied the effects of ritanserin on sleep in a group of dysthymic patients (DSM-III). Polygraphic recording as well as subjective evaluations of the quality of sleep were performed before and at the end of a 4-week period of double-blind medication with either ritanserin (10 mg o.d. in the morning) or placebo. At baseline, patients showed at fragmented and superficial sleep, with low amounts of slow wave sleep. Ritanserin significantly increased Slow Wave Sleep and changed the frequency and distribution of some stage transitions during the night. No other sleep parameters were modified by ritanserin treatment.

Sleep disorders in the elderly.

Abstract: In their own practices and in consultation, requests to psychiatrists to evaluate and treat sleep disorders in the elderly are common. The five million elders in this country receive 35%-40% of the sedative-hypnotics prescribed, despite the fact that they represent only 12% of the population. Since their sleep disturbances are usually secondary to medical, psychiatric, pharmacologic, or environmental causes, they should receive a thorough evaluation and differential diagnostic approach. Before prescribing a sedative-hypnotic, one should consider nonpharmacologic interventions and education about normal sleep changes due to aging. As a foundation for the judicious prescribing of sedative-hypnotics, the pharmacokinetic changes associated with aging are discussed.

Synthetic food colourings and 'hyperactivity': a double-blind crossover study.

Abstract: Of 220 children referred for suspected 'hyperactivity', 55 were subjected to a 6 week trial of the Feingold diet. Forty (72.7%) demonstrated improved behaviour and 26 (47.3%) remained improved following liberalization of the diet over a period of 3-6 months. The parents of 14 children claimed that a particular cluster of behaviours was associated with the ingestion of foods containing synthetic colourings. A double-blind crossover study, employing a single-subject repeated measures design was conducted, using eight of these children. Subjects were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo (during lead-in and washout periods) or 50 mg of either tartrazine or carmoisine, each for 2 separate weeks. Two significant reactors were identified whose behavioural pattern featured extreme irritability, restlessness and sleep disturbance. One of the reactors did not have inattention as a feature. The findings raise the issue of whether the strict criteria for inclusion in studies concerned with 'hyperactivity' based on 'attention deficit disorder' may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.

Abnormal diurnal variation in salt and water excretion in patients with obstructive sleep apnoea.

Abstract: 1. In healthy individuals, sleep is associated with a fall in urine and sodium output. 2. Seven male patients with obstructive sleep apnoea exhibited a paradoxical rise in both urine and sodium output during the hours of sleep. 3. Continuous positive airway pressure applied via the nose abolished both the apnoea and the nocturnal rise in urine and sodium output, thereby restoring the diurnal pattern towards normal.

REM sleep behavioral disorders.

Abstract: REM sleep behaviors were recently described as wild, dream-enacting behaviors during REM sleep with loss of usual atonia on submental muscles. We examined 6 patients (5 M, 1F) with characteristic episodes of behavioral manifestations during REM sleep. Polysomnographic data indicate a decrease in first REM latency, an absence of stage 4 NREM, altered phasic motor activity and behavioral episodes during REM sleep even with normal chin muscle atonia. Three patients had Shy-Drager syndrome, 1 olivopontocerebellar atrophy and 2 patients had no neurological disease. The crucial importance of a disinhibited locomotor system during sleep appears to be responsible for this REM parasomnia.

Sleep disturbances in HIV-seropositive patients.

Abstract: To the Editor.— Human immunodeficiency virus (HIV) infects the central nervous system and is associated with neurological and psychiatric disease. 1,2 Neuropsychological disorders may appear as the primary or only manifestation of HIV infection. 3 Sleep/wake disturbances have been reported among HIV-seropositive individuals. To provide a better understanding of the etiology of sleep complaints, a pilot study that evaluated sleep variables was performed. Study.— Eight asymptomatic HIV-seropositive patients (enzyme-linked immunosorbent assay and Western blot) (group A) and four HIV-seronegative and culture-negative patients (group B) were included. Patients with neuropsychiatric diseases were excluded. All were homosexual and did not differ in life-styles. None were sleep-deprived "shift workers" and none were taking medications known to affect sleep. None abused intravenous drugs or alcohol and none used sedatives or narcotics. An interview, written questionnaires, and a standardized polysomnogram (sleep study) were administered to provide objective measurements of sleep. A two-sample t test was