Sleep disorder

About: Sleep disorder is a research topic. Over the lifetime, 19380 publications have been published within this topic receiving 884281 citations. The topic is also known as: somnipathy & non-organic sleep disorder.

The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias.

Abstract: Context Narcolepsy, a neurological disorder affecting 1 in 2000 individuals, is associated with HLA-DQB1*0602 and low cerebrospinal fluid (CSF) hypocretin (orexin) levels. Objectives To delineate the spectrum of the hypocretin deficiency syndrome and to establish CSF hypocretin-1 measurements as a diagnostic tool for narcolepsy. Design Diagnosis, HLA-DQ, clinical data, the multiple sleep latency test (MSLT), and CSF hypocretin-1 were studied in a case series of patients with sleep disorders from 1999 to 2002. Signal detection analysis was used to determine the CSF hypocretin-1 levels best predictive for International Classification of Sleep Disorders (ICSD)–defined narcolepsy (blinded criterion standard). Clinical and demographic features were compared in narcoleptic subjects with and without low CSF hypocretin-1 levels. Setting Sleep disorder and neurology clinics in the United States and Europe, with biological testing performed at Stanford University, Stanford, Calif. Participants There were 274 patients with narcolepsy; hypersomnia; obstructive sleep apnea; restless legs syndrome; insomnia; and atypical hypersomnia cases such as familial cases, narcolepsy without cataplexy or without HLA-DQB1*0602, recurrent hypersomnias, and symptomatic cases (eg, Parkinson disease, depression, Prader-Willi syndrome, Niemann-Pick disease type C). The subject group also included 296 controls (healthy and with neurological disorders). Intervention Venopuncture for HLA typing, lumbar puncture for CSF analysis, primary diagnosis using the International Classification of Sleep Disorders, Stanford Sleep Inventory for evaluation of narcolepsy, and sleep recording studies. Main Outcome Measures Diagnostic threshold for CSF hypocretin-1, HLA-DQB1*0602 positivity, and clinical and polysomnographic features. Results HLA-DQB1*0602 frequency was increased in narcolepsy with typical cataplexy (93% vs 17% in controls), narcolepsy without cataplexy (56%), and in essential hypersomnia (52%). Hypocretin-1 levels below 110 pg/mL were diagnostic for narcolepsy. Values above 200 pg/mL were considered normal. Most subjects with low levels were HLA-DQB1*0602–positive narcolepsy-cataplexy patients. These patients did not always have abnormal MSLT. Rare subjects without cataplexy, DQB1*0602, and/or with secondary narcolepsy had low levels. Ten subjects with hypersomnia had intermediate levels, 7 with narcolepsy (often HLA negative, of secondary nature, and/or with atypical cataplexy or no cataplexy), and 1 with periodic hypersomnia. Healthy controls and subjects with other sleep disorders all had normal levels. Neurological subjects had generally normal levels (n = 194). Intermediate (n = 30) and low (n = 3) levels were observed in various acute neuropathologic conditions. Conclusions Narcolepsy-cataplexy with hypocretin deficiency is a genuine disease entity. Measuring CSF hypocretin-1 is a definitive diagnostic test, provided that it is interpreted within the clinical context. It may be most useful in cases with cataplexy and when the MSLT is difficult to interpret (ie, in subjects already treated with psychoactive drugs or with other concurrent sleep disorders).

Shift work and disturbed sleep/wakefulness.

Abstract: Of the many health-related effects of shift work, disturbed sleep is the most common. This review describes the main observed effects of the three principal shifts (night, morning and afternoon) on patterns of sleep and wakefulness. The mechanism of sleep disruption in relation to circadian rhythms and the specific impact of aspects of shift organization (speed and direction of rotation) are discussed. The most troublesome acute symptoms are difficulty getting to sleep, shortened sleep and somnolence during working hours that continues into successive days off. These are only partially amenable to amelioration by manipulating shift patterns. However, there is no clear indication that chronic sleep problems result from long-term shift work.

The Sleep Heart Health Study: design, rationale, and methods.

Abstract: The Sleep Heart Health Study (SHHS) is a prospective cohort study designed to investigate obstructive sleep apnea (OSA) and other sleep-disordered breathing (SDB) as risk factors for the development of cardiovascular disease. The study is designed to enroll 6,600 adult participants aged 40 years and older who will undergo a home polysomnogram to assess the presence of OSA and other SDB. Participants in SHHS have been recruited from cohort studies in progress. Therefore, SHHS adds the assessment of OSA to the protocols of these studies and will use already collected data on the principal risk factors for cardiovascular disease as well as follow-up and outcome information pertaining to cardiovascular disease. Parent cohort studies and recruitment targets for these cohorts are the following: Atherosclerosis Risk in Communities Study (1,750 participants), Cardiovascular Health Study (1,350 participants), Framingham Heart Study (1,000 participants), Strong Heart Study (600 participants), New York Hypertension Cohorts (1,000 participants), and Tucson Epidemiologic Study of Airways Obstructive Diseases and the Health and Environment Study (900 participants). As part of the parent study follow-up procedures, participants will be surveyed at periodic intervals for the incidence and recurrence of cardiovascular disease events. The study provides sufficient statistical power for assessing OSA and other SDB as risk factors for major cardiovascular events, including myocardial infarction and stroke.

Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial.

Abstract: ContextInsomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia.ObjectiveTo evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia.Design and SettingRandomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months.SubjectsSeventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia.InterventionsCognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n=18), pharmacotherapy (temazepam) (n=20), or both (n=20) compared with placebo (n=20).Main Outcome MeasuresTime awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians.ResultsThe 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach.ConclusionsBehavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment.

Risk Factors for Obstructive Sleep Apnea in Adults

Abstract: OBSTRUCTIVE SLEEP APNEA (OSA) is a sleep disorder characterized by intermittent complete and partial airway collapse, resulting in frequent episodes of apnea and hypopnea. The breathing pauses cause acute adverse effects, including oxyhemoglobin desaturation, fluctuations in blood pressure and heart rate, increased sympathetic activity, cortical arousal, and sleep fragmentation. The condition has received increasing attention during the past 3 decades. Until 1981, the only effective treatment for OSA was tracheostomy. The advent of continuous positive air pressure therapy, an effective noninvasive treatment, was a turning point, and clinical interest began to increase in tandem with the accumulation of research linking OSA to cognitive, behavioral, cardiovascular, and cerebrovascular morbidities (FIGURE). Findings from large population studies in different countries during the last decade have contributed to a better understanding of the epidemiology of OSA. In most population studies, OSA status has been indicated by the frequency of apnea and hypopnea events per hour of sleep (apnea-hypopnea index) as determined by polysomnography (a continuous overnight recording of sleep, breathing, and cardiac parameters). The apnea-hypopnea index cutpoints of 5, 15, and 30 (with or without daytime sleepiness) are commonly used to indicate mild, moderate, and severe OSA, respectively. These studies have demonstrated that OSA is highly prevalent in adults (TABLE). Approximately 1 in 5 adults has at least mild OSA and 1 in 15 adults has OSA of moderate or worse severity. In the United States, 75% to 80% of OSA cases that could benefit from treatment remain undiagnosed. Associations of OSA with serious morbidity have raised concern that untreated OSA is a substantial but underappreciated public health threat. Primary care physicians are currently being encouraged to be alert to OSA symptoms of disruptive snoring, breathing pauses, and excessive daytime sleepiness in their patients. It is important that physicians also recognize that not all OSA patients are “Pickwickian” (ie, male, obese, sleepy, snoring, and middle-aged), a stereotype that emerged from clinical observations of the highly selective patient populations observed in earlier years. The goal of this article is to review recent findings from populationbased epidemiology studies on risk factors for OSA in adults.