Showing papers on "Sleep disorder published in 1991"

A new method for measuring daytime sleepiness: the Epworth sleepiness scale.

Abstract: The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.

Therapeutic treatment of sleep disorder by nerve stimulation

Abstract: Method and apparatus for treating and controlling sleep disorders by detecting the presence of the sleep disorder under treatment, and, in response, selectively applying a predetermined electrical signal to the patient's vagus nerve for stimulation thereof to alleviate the sleep disorder under treatment. The method and apparatus includes several techniques for detecting the presence of the sleep disorder under treatment, such as sensing the patient's EEG activity in the case of insomniac and hypersomniac patients, or detecting a sudden nodding of the head in the case of narcoleptic patients, or sensing the cessation of respiration in the case of sleep apnea patients.

Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men.

Abstract: One thousand and one men, aged 35-65 years, were identified from the age-sex register of one group general practice. Over four years 900 men were visited at home and asked questions about symptoms potentially related to sleep apnoea and snoring. Height, weight, neck circumference, resting arterial oxygen saturation (SaO2), and spirometric values were also determined. All night oximetry was then performed at home and the tracing analysed for the number of dips in SaO2 of more than 4%. Subjects with more than five dips of 4% SaO2 or more per hour were invited for sleep laboratory polysomnography. Seventeen per cent of the men admitted to snoring "often." Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.2%), cigarette consumption (r2 = 3.4%), and nasal stuffiness (r2 = 2%) as the only significant independent predictors of snoring. Together these account for at least a sixfold variation in the likelihood of being an "often" snorer. Forty six subjects (5%) had greater than 4% SaO2 dip rates of over five an hour and 31 of these had full sleep studies. Three subjects had clinically obvious and severe symptomatic obstructive sleep apnoea, giving a prevalence of three per 1001 men (0.3%; 95% confidence interval 0.07-0.9%). Eighteen men had obstructive sleep apnoea only when supine and in 10 the cause of the SaO2 dipping on the original home tracing was not elucidated. The greater than 4% SaO2 dip rates correlated with the history of snoring. Multiple linear regression techniques identified and ranked neck circumference (r2 = 7.9%), alcohol consumption (r2 = 3.7%), age (r2 = 1%) and obesity (r2 = 1%) as the only significant independent predictors of the rate of overnight hypoxic dipping. This study shows that snoring in this randomly selected population correlates best with neck size, smoking, and nasal stuffiness. Obstructive sleep apnoea, defined by nocturnal hypoxaemia, correlates best with neck size and alcohol, and less so with age and general obesity.

Effect of weight loss on upper airway collapsibility in obstructive sleep apnea.

Abstract: Previous investigators have demonstrated in patients with obstructive sleep apnea that weight reduction results in a decrease in apnea severity. Although the mechanism for this decrease is not clear, we hypothesize that decreases in upper airway collapsibility account for decreases in apnea severity with weight loss. To determine whether weight loss causes decreases in collapsibility, we measured the upper airway critical pressure (Pcrit) before and after a 17.4 ± 3.4% (mean ± SD) reduction in body mass index in 13 patients with obstructive sleep apnea. Thirteen weight-stable control subjects matched for age, body mass index, gender (all men), and non-REM disordered breathing rate (DBR) also were studied before and after usual care intervention. During non-REM sleep, maximal inspiratory airflow was measured by varying the level of nasal pressure and Pcrit was determined by the level of nasal pressure below which maximal inspiratory airflow ceased. In the weight loss group, a significant decrease in DBR fr...

Obstructive sleep apnea in children with Down syndrome.

Abstract: Children with Down syndrome have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), yet the type and severity of OSAS in this population has not been characterized. Fifty-three subjects with Down syndrome (mean age 7.4 +/- 1.2 [SE] years; range 2 weeks to 51 years) were studied. Chest wall movement, heart rate, electroculogram, end-tidal PO2 and PCO2, transcutaneous PO2 and PCO2, and arterial oxygen saturation were measured during a daytime nap polysomnogram. Sixteen of these children also underwent overnight polysomnography. Nap polysomnograms were abnormal in 77% of children; 45% had obstructive sleep apnea (OSA), 4% had central apnea, and 6% had mixed apneas; 66% had hypoventilation (end-tidal PCO2 greater than 45 mm Hg) and 32% desaturation (arterial oxygen saturation less than 90%). Overnight studies were abnormal in 100% of children, with OSA in 63%, hypoventilation in 81%, and desaturation in 56%. Nap studies significantly underestimated the presence of abnormalities when compared to overnight polysomnograms. Seventeen (32%) of the children were referred for testing because OSAS was clinically suspected, but there was no clinical suspicion of OSAS in 36 (68%) children. Neither age, obesity, nor the presence of congenital heart disease affected the incidence of OSA, desaturation, or hypoventilation. Polysomnograms improved in all 8 children who underwent tonsillectomy and adenoidectomy, but they normalized in only 3. It is concluded that children with Down syndrome frequently in have OSAS, with OSA, hypoxemia, and hypoventilation. Obstructive sleep apnea syndrome is seen frequently in those children in whom it is not clinically suspected. It is speculated that OSAS may contribute to the unexplained pulmonary hypertension seen in children with Down syndrome.

Sleep Problems and Institutionalization of the Elderly

Abstract: This study examined the role of sleep problems in the decisions of families to institutionalize elderly relatives. Previous work on institutionalization of the elderly has given little attention to the contribution of nocturnal, sleep-related problems. Seventy-three primary caregivers of elders recently admitted to a nursing home or psychiatric hospital were asked to identify the problems the elder was having during the night and day and rate the degree to which these influenced their decision to institutionalize the elder. Seventy percent of the caregivers in each sample cited nocturnal problems in their decision to institutionalize, often because their own sleep was disrupted. The most frequent disruptive nocturnal events were micturition, pain, and complaints of sleeplessness. Sleep problems of the elderly contribute heavily to the decision to institutionalize an elder and thus to the social and economic cost of institutional care. They appear to do this largely by interfering with the sleep of caregivers. The nature, prevalence, and treatability of the sleeping problems of both elders and their caregivers need further study.

Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits.

Abstract: Neuropsychological deficits have been documented in patients with obstructive sleep apnea syndrome (OSSA). Both nocturnal hypoxemia and impairment of daytime vigilance have been suggested as the pathogenesis of these deficits, yet it remains difficult to find good correlations between cognitive deficits and either of these physiological parameters. In the present study, 10 normal controls were compared to 10 moderately and 10 severely apneic patients, all recorded in a sleep laboratory for two consecutive nights, with a vigilance and neuropsychological assessment made during the intervening day. Relative to the controls, moderate and severe OSAS showed differences in many cognitive functions, although the severely affected showed the greater differences. Moreover, severe apneics were also worse than moderate apneics on tests that were found to be normal in the latter group. This suggests a discontinuity in the appearance of neuropsychological deficits as OSAS progresses. Further analyses revealed...

Actigraphic home-monitoring sleep-disturbed and control infants and young children: a new method for pediatric assessment of sleep-wake patterns.

Abstract: Two studies were conducted to evaluate actigraphic home-monitoring for the assessment of infants' and children's sleep patterns. In the first study, 11 children (aged 12 to 48 months) were monitored in the laboratory by traditional polysomnography and by actigraphy for one night. Actigraphic automatic sleep-wake scorings were compared with those of the polysomnograph; total agreement rate was 85.3%. In the second study, sleep patterns of 63 sleep-disturbed and 34 control healthy children (aged 9 to 27 months) were compared. These children were home-monitored by actigraph for a mean of 4.45 nights (total 482 nights). Actigraphic data were analyzed by an automated scoring procedure. Sleep quality of the sleep-disturbed children, measured by actigraphically derived sleep percent and number of longer-than-5-minute wakings, was significantly lower than that of the control subjects (P less than .0001). Sleep measures showed significant night-to-night stability in both groups. The stability of specific measures and their age trends were different between the groups. Actigraphic sleep measures alone could discriminate between sleep-disturbed and control children with a highly correct assignment rate of 79.4% and 91.2%, respectively.

Prevalence and treatment of insomnia in the community: results from the Upper Bavarian Field Study.

Abstract: In the Upper Bavarian Field Study a total of 1,536 persons (15 yr of age and older) were interviewed by research psychiatrists. The prevalence of insomnia (last 7 days) identified with the aid of the Clinical Interview Schedule (CIS) was 28.5% (mild: 15.0%; moderate/severe: 13.5%). For both sexes sleep disorders increased with age. The female preponderance of insomnia was mainly associated with the middle and older age groups. In contrast to other psychiatric disorders, sleep disturbances were not associated with social class. Moderate/severe insomnia was strongly related to psychiatric diagnoses, the use of psychiatric in- and outpatient services and general hospitals. It also constituted a significant burden for the primary-care physicians, whereby the average annual consultation rate among mild (10.61) and moderate/severe insomniacs (12.87) was significantly higher compared to that for those without sleep disorders (5.25). A total of 33.7% of the insomniacs were treated with hypnotic and/or other psychotropic drugs during the week prior to the interview, whereby the drug consumption among moderate/severe insomniacs (48.5%) was significantly higher than that of mild insomniacs (20.4%).

Dementia in institutionalized elderly : relation to sleep apnea

Abstract: Sleep apnea is characterized by transient hypoxemias which are thought to affect mental functioning. Accordingly, speculation and research have focussed on relationships between sleep apnea and dementia. We studied 235 nursing home (ie institutionalized) patients (152 women with a median age of 83.5; 83 men with a median age of 79.7) with portable sleep recording equipment. The Mattis Dementia Rating Scale and the Geriatric Depression Scale were given to each. Seventy percent of the patients had five or more respiratory disturbances per hour of sleep and 96 percent showed some dementia. Sleep apnea was significantly correlated with all subscales on the dementia rating scale. There were trivial differences in dementia ratings between those with mild-moderate apnea and those with no apnea. There were significant differences, however, between the latter two groups and those with severe apnea. In particular, items reflecting attention, initiation and perseveration, conceptualization, and memory tasks on the DRS distinguished between those with and without severe sleep apnea. Among those patients with no depression, all patients with severe sleep apnea were also severely demented. Our data suggest that there is a strong relationship between dementia and sleep apnea when the sleep apnea and dementia are severe. Although causality cannot be inferred from associations, our hypothesis for study is that sleep apnea causes deficits in brain function, possibly due to global effects rather than any particular cortical or subcortical structure.

A comparative study of treatments for positional sleep apnea

Abstract: Sixty male patients all with apnea plus hypopnea indices (A + HI) above 12.5, who met a criterion of positionality by having two or more times the rate of these events during supine sleep in comparison to their lateral sleep rate, were randomly assigned to one of four treatments for 8 weeks. All were restudied for two nights, one with and one without treatment devices. On treatment more than half the patients in each group reduced their A + HI to within normal limits and a third remained WNL without the use of devices. Half of those trained to sleep in the lateral position with the help of an alarm maintained this learning without the alarm as did half of those who were encouraged to learn this sleep posture on their own. There is an additive effect for the positional patient from wearing a tongue retaining device (TRD) if they continue to sleep in the supine position. Factors associated with successful treatment include overall severity, severity in the lateral position, weight, weight change, nasal patency and motivation to help their condition.

Circadian rhythm disorders in sleep-waking and body temperature in elderly patients with dementia and their treatment.

Abstract: Circadian rhythms in elderly patients with severe dementia and behavioral disorders such as wandering, agitation and/or delirium were examined. The subjects consisted of 24 patients with dementia (5 with senile dementia of Alzheimer's type and 19 with multi-infarct dementia), aged 56-89 (means = 75.5 +/- 8.7) and 8 control patients without dementia or with dementia of slight degree, aged 65-81 (means = 75 +/- 5.4). The sleep-wake state of the patients was judged every hour by nurses over periods of 1-4 mo and recorded in the form of a sleep diary. Oral temperature was recorded for 4-7 consecutive days. For the treatment of sleep-wake rhythm disorders, social interaction with nurses was encouraged in addition to drug therapy. The patients showed various types of sleep-wake disorders such as reversed day-night rhythm or irregular sleep-wake rhythm corresponding to a decreased amplitude of the sleep-wake rhythm. Circadian rhythm of oral temperature was irregularly disturbed in 59.0% of the patients in the dementia group and in only 12.5% of the patients in the control group. The effects of treatment by enforcement of social interaction with nurses was effective in reducing behavioral problems and sleep-wake rhythm disorder in 30.0% of the patients tested. However, body temperature rhythm disorganization remained after the treatment. These observations indicate that behavioral disorders such as delirium, agitation or wandering in patients with severe dementia might be closely related to disrupted biological rhythms of sleep-waking and the autonomic system (body temperature).

Sleep-related eating disorders: polysomnographic correlates of a heterogeneous syndrome distinct from daytime eating disorders.

Abstract: Over a 5-yr period, 19 adults presented to our sleep disorders center with histories of involuntary, nocturnal, sleep-related eating that usually occurred with other problematic nocturnal behaviors. Mean age (+/- SD) at presentation was 37.4 (+/- 9.1) yr (range 18-54); 73.7% of the patients (n = 14) were female. Mean age of sleep-related eating onset was 24.7 (+/- 12.9) yr (range 5-44). Eating occurred from sleep nightly in 57.9% (n = 11) of patients. Chief complaints included excessive weight gain, concerns about choking while eating or about starting fires from cooking and sleep disruption. Extensive polysomnographic studies, clinical evaluations and treatment outcome data identified three etiologic categories for the sleep-related eating: (a) sleepwalking (SW), 84.2% (n = 16); (b) periodic movements of sleep (PMS), 10.5% (n = 2) and (c) triazolam abuse (0.75 mg hs), 5.3% (n = 1). DSM-III Axis 1 psychiatric disorders (affective, anxiety) were present in 47.4% (n = 9) of the patients, and only two patients had a daytime eating disorder (anorexia nervosa), each in remission for 3-7 yr. Nearly half of all patients fulfilled established criteria for being overweight, based on the body mass index. Onset of sleep-related eating was linked directly to the onset of SW, PMS, triazolam abuse, nicotine abstinence, chronic autoimmune hepatitis, narcolepsy, encephalitis or acute stress. In the SW group, 72.7% (8/11) of patients had nocturnal eating and other SW behavior suppressed by clonazepam (n = 7) and/or bromocriptine (n = 2) treatment. Both patients with PMS likewise responded to treatment with combinations of carbidopa/L-dopa, codeine and clonazepam. Thus, sleep-related eating disorders can generally be controlled with treatment of the underlying sleep disorder.

The Role of Sleep Disturbances in Attention Deficit Disorder Symptoms: A Case Study

Abstract: Identified a 10-year-old girl with ADD and a 5-year history of sleep difficulties. Sleep difficulties (delayed sleep phase insomnia) were corrected while performing blind assessments of behavioral symptoms. The intervention (chronotherapy combined with a behavior modification program) resulted in an increase of sleep from 7.2 to 9.2 hours per night. Pre/postintervention behavioral measures indicated significant improvement in positive interactions with peers, increased productivity on a timed arithmetic task, and significantly increased percentage of assigned seatwork completed. Four-month follow-up in the natural school setting indicated improvement in teacher ratings and classroom performance. Despite the persistence of ADD symptomatology, the improvement in sleep apparently contributed to a clinically significant reduction in ADD. Language: en

Sleep organization and epilepsy.

Abstract: Sleep is known to facilitate epileptic manifestations but can also protect the sleeper against the recurrence of seizures. This has been demonstrated in studies on sleep deprivation, and is particularly evident in alcoholic epilepsy and matutinal myoclonus epilepsy. Sleep organization in the epileptic patient is permanently altered by frequent awakenings and stage shifts. Nocturnal grand mal and repetitive partial seizures worsen the sleep disorder by reducing total sleep time and decreasing REM percentage by half. The cumulative effect of these sleep disorders may act on day-time vigilance in epileptics, and may even exert an influence on the recurrence of seizures.

A Preliminary Study Comparing Sleep Restriction and Relaxation Treatments for Insomnia in Older Adults

Abstract: This study compared Sleep Restriction Therapy (SRT) and Relaxation Therapy (RLT) as treatments for insomnia in a sample of community-residing elderly (mean age, 69.7 years). SRT subjects (n = 10) and RLT subjects (n = 12) reported information about their sleep twice daily to a telephone recording machine for 2 weeks of baseline, 4 weeks of treatment, and 2 weeks at 3-month follow-up. Results showed sleep latency and waking after sleep onset were significantly reduced for both treatment groups under active treatment. Predictable reductions in time in bed and improved sleep efficiency reported during active treatment by SRT subjects were still apparent at 3-month follow-up; no corresponding changes were found for RLT. In both groups, increased total sleep time was reported at follow-up; the improvement for SRT subjects was approximately twice that seen in RLT. These findings, at this early stage in the development of behavioral treatments for insomnia in older adults, encourage further study.

Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea

Abstract: Cephalometry is often used to assess patients with sleep apnoea but whether these measurements differ from those in non-apnoeic snorers and how they are influenced by age is not clear. Cephalometric radiographs of patients with sleep apnoea were compared with those of snorers without sleep apnoea and those of non-snorers. Fifty two snorers with suspected sleep apnoea had a conventional sleep study and were divided into two groups: those with an apnoea-hypopnoea index greater than 10/h (n = 40, sleep apnoea group) and those whose apnoea-hypopnoea index was 10/h or less (n = 12, snorer group). The cephalometric measurements in these patients were compared with those of 34 non-snoring control subjects. Controls were subdivided into two groups: control group 1 included 17 subjects similar in age to the sleep apnoea and snorer groups (mean (SD) age 50.0 (10.9), 50.7 (9.4), and 50.6 (9.7) years); control group 2 included 15 young men (25.4 (2.6) years). The distance from the mandibular plane to the hyoid bone (MP-H) and the length of the soft palate were greater in the patients with sleep apnoea (28.7 (7.8) and 43.6 (5.0) mm) than in the snorers (23.7 (4.2) and 40.3 (4.9 mm). The MP-H was similar in snorers and age matched control subjects, but was significantly greater in the older than in the younger control subjects (22.1 (6.1) vs 17.0 (6.8]. The soft palate was longer in subjects who snored (both sleep apnoea patients and snorers) than in control subjects. The MP-H distance significantly correlated with age for all subjects (snorers and controls) and for the control subjects alone. This study shows that non-apnoeic snorers have cephalometric abnormalities that differ from those of patients with sleep apnoea and that cephalometric values are influenced by the subject's age.

Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia.

Abstract: Objective: This study compared differential effects of behavioral therapy and triazolam in a clinical population with sleep-onset insomnia. Triazolam was hypothesized to decrease sleep latency and frequency and duration of awakenings, with some effects during the first night’s administration. But at follow-up, sleep measures were predicted to return to baseline levels. Behavioral treatment was hypothesized to effect sleep after 2 or more weeks of training which persisted at follow-up. Method: Thirty patients with average sleep latencies of 81 .48 minutes, who reported chronic insomnia for an average of 2.6 years, were randomly assigned to one oftwo treatment groups: behavioral stimulus control/relaxation training and triazolam. Results: Both treatments decreased sleep latency but differentially. Triazolam was effective immediately but maintained only some gains at follow-up. Behavioral treatment decreased sleep latency beginning the second week, when subjects expected no improvement, with gains maintained at follow-up. Comparisons showed that triazolam group latencies returned toward baseline, while behavioral group gains were maintained at follow-up. �in. clusions: Triazolam treatment showed superior immediate treatment effects, while behavioral treatment showed superior treatment effects at follow-up, effects that accrued during the training period and differentially persisted at follow-up. One treatment strategy implied by these results would be to combine these two interventions concurrently. This would seem to use the immediate effects produced by the medication until the behavioral skills were learned, at which point medication would be terminated. This strategy could offer immediate relief and sustained effects at drug termination.

Hypersomnia in bipolar depression: a comparison with narcolepsy using the multiple sleep latency test.

Abstract: Objective: This study characterized objectively the hypersomnia frequently seen in the depressed phase ofbipolar affective disorder. On the basis ofprevious work in sleep and affective disorders, it has been hypothesized that the hypersomnia is related to greater REM sleep. This hypothesis was tested by using a multiple sleep latency test to compare bipolar affective disorder with narcolepsy, a well-defined primary sleep disorder associated with known REM sleep dysfunction. Method: Twenty-five bipolar depressed patients were selected on the basis ofcomplaints ofhypersomnia. They underwent 2 nights ofpolysomnography followed by a multiple sleep latency test. Data on their nocturnal sleep and daytime naps were compared with similar data on 23 nondepressed narcoleptic patients referred for sleep evaluation. & �yjj�� Despite their complaints of hypersomnia, no abnormalities were noted for the bipolar group in the results from the multiple sleep latency test. Contrary to the working hypothesis, REM sleep was notably absent during daytime naps in the depressed patients, in marked contrast to the findings for the narcoleptic group. Conclusions: The complaint of sleepiness in the hypersomnic bipolar depressed patient appears to be related to the lack of interest, withdrawal, decreased energy, or psychomotor retardation inherent in the anergic depressed condition, rather than an increase in true sleep propensity or REM sleep propensity. (AmJ Psychiatry1991; 148:1177-1181)

Metabolism during normal, fragmented, and recovery sleep

Abstract: Average metabolic data (O2 uptake and CO2 output) were obtained for each 3-min period during consecutive nights of normal, experimentally fragmented, and recovery sleep in a group of 12 normal young adult males. Naturally occurring arousals and awakenings resulted in a characteristic increase in metabolism on the baseline night. The placement of brief frequent experimental arousals on the following night resulted in significantly increased metabolism throughout the night and significantly decreased sleep restoration as measured by morning performance, mood, and alertness tests, even though total sleep time was minimally reduced. Metabolic variables were significantly decreased compared with baseline on the nondisturbed recovery night that followed the sleep fragmentation night. The data cannot be used to infer that increased metabolism during sleep causes nonrestorative sleep, but the direction and time course of metabolic change accompanying arousal are consistent with that hypothesis.

Correction of non-24-hour sleep/wake cycle by melatonin in a blind retarded boy.

Abstract: A 9-year-old, blind boy with severe mental retardation with a chronic sleep/wake disturbance had a circadian rhythm of 24.75 hours and an internal desynchronization of the endogenous rhythms. Treatment with oral melatonin given at 6 PM induced a regular sleep/wake pattern. Melatonin, in this patient, convincingly entrained the endogenous rhythm to the appropriate chronological 24-hour day.

Sleep Hygiene, Relaxation Therapy, and Cognitive Interventions

Abstract: Sleep hygiene, relaxation therapy, and some cognitive interventions make a good package that can often be administered conjointly. I typically use an individualized mix of them in my initial treatment sessions with chronic insomniacs.

Long-term treatment of social phobia with clonazepam.

Abstract: Findings from a four-city study of the beneficial and adverse effects of hypnotics are reported The study employed a new volunteer call-in method for monitoring drug effects outside of the clinical setting Respondents were recruited through newspaper advertisements They were invited to complete a short telephone interview if, during the past 12 months, they (1) had significant trouble with insomnia or (2) had taken a medication to induce sleep Comparison groups were flurazepam, temazepam, triazolam, and over-the-counter (OTC) sleep medications An untreated insomnia group also was included Results indicate that most users of prescription hypnotics attributed positive effects to their sleep medications and that adverse effects were infrequent OTC hypnotics were less effective and more likely to produce negative effects The untreated insomnia group was more symptomatic than any of the medication groups