15th Congress of the European Sleep Research Society, Istanbul, Turkey, September 12-16, 2000.
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Journal Article↗
Biomedical subjects
C Bassetti
Publications and source records attributed to C Bassetti.
Diffusion-weighted mr in cerebral venous thrombosis.
The diagnosis of cerebral venous thrombosis is often difficult both clinically and radiologically and until now there is no method available to predict if brain lesions, detected clinically and using conventional brain imaging methods, may lead to full recovery, as expected in vasogenic edema or ischemic infarcts and even a hematoma. New fast neuroimaging techniques such as diffusion-weighted imaging (DWI) are sensitive to different reasons of changes in local tissular water concentration thus giving further insight into the pathophysiological mechanism as well as prognosis of cerebral venous thrombosis. We report the cases of 18 consecutive patients with a diagnosis of cerebral venous thrombosis based on clinical and imaging criteria. All patients underwent magnetic resonance imaging (MRI) of the brain, which comprised isotropic diffusion-weighted MR. Diffusion-weighted MRI showed positive findings in 17/18 cases. In 7 cases the clot could be directly visualized as an area of hyperintensity in the affected vein on DWI. In 7 cases DWI showed areas of signal loss corresponding to hematomas. In 6 cases DWI showed changes in signal intensity that were more subtle. In 4 cases of superficial venous thrombosis, there were areas of decreased ADC values (0.65-0.79 x 10(-3) mm(2)/s) whereas in 2 cases of deep venous thrombosis, increased DWI intensities could be found that corresponded to both an increase and a decrease in ADC, corresponding to a coexistence of cytotoxic and vasogenic edemas. Diffusion-weighted MRI can demonstrate directly the presence of an intravenous clot in a select number of patients. It can also demonstrate early ischemic changes, and can differentiate conventional T2-weighted MR areas of cytotoxic from vasogenic edema.
Adult↗
SPECT during sleepwalking.
Sleepwalking is a dissociation between body sleep and mind sleep. We report single photon emission computed tomography (SPECT) in a man with a history of sleepwalking. Our findings suggest that this dissociation arises from activation of thalamocingulate pathways and persisting deactivation of other thalamocortical arousal systems.
Adolescent↗
[Prevalence of sleep disorders in an employed Swiss population: results of a questionnaire survey].
BACKGROUND: The aim of the study was to demonstrate the variety of sleep disorders occurring in a working population in Switzerland and to estimate the prevalence of the main sleep disorders in this Swiss cohort. We also intended to demonstrate that with just a few systematic questions a straightforward diagnostic workup is possible in general practice. METHODS: A questionnaire was sent to all 1473 clerks of the Berne main post office. The questions allowed a choice between "yes" or "no", or often (= +3), occasionally (= +2), rarely (= +) and never (= 0). Daytime sleepiness was assessed by the Epworth Sleepiness Scale. RESULTS: 668 questionnaires (45%) were available for analysis. Daytime sleepiness, assessed by an Epworth score > or = 10, was found in 13% of the respondents. Short sleep (< 7 h sleep) was reported in 47%, and long sleep (> 9 h sleep) in 5% of this population. Specific questions clearly suggested obstructive sleep apnoea in 6%, restless-legs syndrome in 4%, disorders of initiating and maintaining sleep in 19% and narcolepsy in 0.5% of respondents. CONCLUSION: Chronic sleep insufficiency and sleep complaints appear to be frequent in this relatively young Swiss working population. The questionnaire-based estimated prevalence of the main sleep disorders is comparable to previously published international data.
Adult↗
Sleepiness-related accidents in sleep apnea patients.
The frequency of motor vehicle and working accidents was analyzed by means of a strictly anonymous questionnaire in 156 patients with sleep apnea syndrome (SAS) and in 160 age-gender matched controls. In the SAS group 12.4% of all drivers had motor vehicle accidents as compared to 2.9% in the control group (p<0.005). The motor vehicle accident rate was 13.0 per million km in patients with more severe SAS (AHI > 34/h, n=78) as compared to 1.1 in patients with milder SAS (AHI 10-34/h, n=78) (p<0.05), and 0.78 in control group (p<0.005), respectively. The accident rates in both patients and the control group were also greater than the rate of 0.02 "accidents due to sleepiness" per one million km in the Swiss driving population as reported by official statistics. During treatment with nasal continuous airway pressure (nCPAP) in 85 SAS patients, the motor vehicle accident rate dropped from 10.6 to 2.7 per million km (p<0.05). We conclude that patients with moderate to severe SAS have an up to fifteen-fold risk increase of motor vehicle accidents that constitutes a serious and often underestimated hazard on the roads, which can be reduced by adequate treatment.
Accidents, Traffic↗
Diffusion-weighted MRI suggests the coexistence of cytotoxic and vasogenic oedema in a case of deep cerebral venous thrombosis.
We report a 20-year-old woman who suffered headaches before presenting with a state of fluctuating vigilance. MRI showed diffuse high signal in the basal ganglia bilaterally on diffusion- and T2-weighted images, which had areas of both low and high apparent diffusion coefficient, presumed to correspond to cytotoxic and vasogenic oedema. MR venography showed no flow in the deep cerebral veins or straight sinus. Heparin was given, with clinical recovery. On follow-up MRI, the appearances became normal.
Adult↗
Diffusion-weighted MRI for monitoring neurovascular interventions.
Carotid stenting is increasingly considered as treatment for carotid artery disease. A reliable noninvasive method is desirable for assessing the safety of the procedure. Diffusion-weighted MRI (DWI) is sensitive to early brain ischaemia which becoming widely available and might therefore serve this purpose. We prospectively studied 19 patients referred for investigation of carotid artery disease by echo-planar whole-brain DWI before and within 24 h of stenting. The images obtained at a high b value were examined by two independent blinded reviewers for new high-signal areas consistent with ischaemia. We found that 15 patients had no new changes after stenting. One patient showed enlargement of a posterior watershed lesion after the procedure, which correlated with an increase in neurological deficit. Three other patients had presumed small embolic infarcts on DWI; two were asymptomatic and one had weakness at the hand that corresponded to an embolic infarct with a lesion on DWI in the hand notch. There were no false- positive or -negative results on DWI, when compared to clinical findings. DWI is thus a new method that can demonstrate neurologically silent or asymptomatic infants. It can be used to help to assess the safety and efficacy of neurovascular intervention.
Adult↗
Postanoxic alpha (theta) coma: a reappraisal of its prognostic significance.
OBJECTIVES: To appraise the controversial prognostic significance of postanoxic alpha or theta coma (ATC). METHODS: We prospectively assessed 14 comatose patients with ATC after cardiac arrest by means of a protocol which included repeated clinical examinations, EEG, and median somatosensory evoked potentials (SEP). Good outcome was defined by the reappearance of cognition (Glasgow outcome scale 3-5) at any time during the 1 year follow-up. RESULTS: Nine of 14 patients had a monotonous, frontally accentuated and a reactive alpha (theta) EEG activity (complete ATC). In these patients ATC was recorded a mean of 47 h after resuscitation, the mean Glasgow coma scale (GCS) was 4 at 48 h, and early cortical SEPs were altered or absent in 5 of 7 patients. All nine patients died. In five of 14 patients the alpha (theta) EEG activity was either not monotonous, partially reactive or posteriorly dominant (incomplete ATC). In these patients ATC was recorded a mean of 43 h after resuscitation, the mean GCS was 8 at 48 h, and early cortical SEP were normal in 4 of 5 patients. Three of 5 patients regained cognition, two of them remained however dependent in activities of everyday life. CONCLUSIONS: This study and a review 283 cases of postanoxic ATC reported in the literature suggest the existence of incomplete and complete variants of postanoxic ATC. Whereas complete ATC is invariably associated with a poor outcome, full recovery is possible in patients with incomplete ATC. The combination of EEG, clinical, and SEP findings improves the prognostic accuracy of postanoxic ATC.
Adult↗
[Hypersomnia--etiology, clinic, diagnosis and therapy of excessive sleepiness].
Hypersomnia (excessive sleepiness) refers to an increased sleep propensity with a subjective craving for sleep, involuntary naps and "sleep attacks" during the day and/or prolonged nighttime sleep with sleep drunkeness. Excessive sleepiness should be separated from fatigue and lack of energy associated with a variety of medical and psychiatric diseases. Hypersomnia is reported by 2-5% of the adult population and can lead to poor work, accidents and neuropsychiatric disturbances. Sleep apnea syndrome (SAS), narcolepsy, chronic sleep deprivation (insufficiency), and restless legs/periodic limb movements in sleep syndrome (RLS/PLMS) represent the most common causes of hypersomnia. The diagnosis of these conditions can often be suspected on clinical grounds. However, an overnight polysomnography and a multiple sleep latency test are often additionally required for definite diagnosis. Treatment options include nasal CPAP for SAS, stimulants for narcolepsy, sleep prolongation for sleep insufficiency, and dopaminergic agents for RLS/PLMS.
Adult↗
[Effectiveness of nasal CPAP-treatment (continuous positive airway pressure)].
Nasal continuous positive airway pressure (n-CPAP) is an effective treatment for the obstructive sleep apnea syndrome (OSAS). It is currently regarded as the first line therapy for OSAS. The principal indication for n-CPAP treatment is daytime sleepiness. Nasal-CPAP improves daytime sleepiness dramatically in severe cases and the effect is objectively measurable with the multiple sleep latency test (MSLT). It is noteworthy that n-CPAP also improves symptoms, subjective daytime sleepiness, cognitive function, IQ, mood, quality of life and driving ability already in patients with mild sleep apnea with an apnea/hypopneaindex (AHI) between 5 and 15 per hour of sleep during overnight polysomnography. Although not yet 100% robust, there is clear evidence that patients with OSAS have an increased frequency of systemic hypertension. Some early and imperfect studies suggest that CPAP reduces cardiovascular and cerebrovascular outcomes; however unequivocal evidence that n-CPAP reduces mortality is still awaited. There is now good evidence that treatment with n-CPAP reduces the two- to sevenfold increased risk of road accidents of untreated patients with OSAS. In summary, there exists abundant evidence today that n-CPAP is an efficient therapy for symptomatic patients with the obstructive sleep apnea syndrome. A trial with n-CPAP is therefore justified in all symptomatic patients. Based on the large number of randomized controlled trials of n-CPAP a therapeutic trial is indicated even in only mildly symptomatic patients with OSAS. Nasal-CPAP use and outcomes of therapy can be improved by provision of an intensive CPAP-education and support program.
Accidents, Traffic↗
[Nocturnal measurements of intraocular pressure in patients with normal-tension glaucoma and sleep apnea syndrome].
BACKGROUND: About half of all normal-tension glaucoma patients and about one third of all primary open-angle glaucoma patients have sleep apnea syndrome. If sleep apnea syndrome causes some cases of glaucoma, the optic nerve damage could result from repetitive nocturnal hypoxias or from repetitive intraocular pressure elevations at the end of the apneas. In this study, we determined the intraocular pressure at the end of long apneas. PATIENTS AND METHODS: In three patients having sleep apnea syndrome and normal-tension glaucoma we recorded in a sleep laboratory during at least six hours of sleep the respiration (oxymetry, nasal and oral air flow, and inductive plethysmography). The intraocular pressure was measured with a pneumatonometer at predetermined times and compared to the values measured at the end of prolonged apneas. RESULTS: The intraocular pressure during normal respiration was in the first patient 19.5 +/- 1.0 mm Hg OD and 19.3 +/- 1.7 mm Hg OS, in the second patient 25.0 +/- 4.2 respectively 25.5 +/- 4.9 mm Hg and in the third one 22 +/- 1.0 respectively 21.3 +/- 1.3 mm Hg. At the end of prolonged apneas the intraocular pressure was in the first patient 19.0 +/- 0.0 mm Hg OD and 19.5 +/- 0.7 mm Hg OS, in the second patient 26.5 +/- 0.6 and 26.8 +/- 0.1 mm Hg and in the third one 20.0 +/- 0.0 respectively 21.0 +/- 0.0 mm Hg. The difference between intraocular pressures during normal respiration and at the end of prolonged apneas was not significant (p > 0.1 for each comparison, paired t-test). CONCLUSIONS: We did not find an increase of intraocular pressure at the end of prolonged apneas compared to periods of normal respiration in patients with sleep apnea syndrome and normal-tension glaucoma. If sleep apnea syndrome causes some cases of glaucoma, it seems more probable that the the optic nerve is damaged by the repetitive hypoxias. Alternatively, an unknown factor might induce both, sleep apnea syndrome and normal-tension glaucoma.
Aged↗
Diffusion-weighted magnetic resonance imaging in brain death.
UNLABELLED: BACKGROUND; Traditionally the diagnosis of brain death is established on the basis of a combination of clinical signs and paraclinical methods. Diffusion-weighted MRI is a new method sensitive to cerebral ischemia. Its value in brain death has not been demonstrated until now. CASE DESCRIPTION: A patient was referred to MRI with suspicion of a brain stem stroke. Echo-planar whole-brain, multislice, diffusion-weighted MRI was performed in addition to conventional sequences and MR angiography sequences. In addition to the extensive bilateral hyperintensities observed on T2-weighted images, diffusion-weighted MRI showed diffuse hyperintensities involving both hemispheres as well as a severe drop in the apparent diffusion coefficient in both affected hemispheres. There was also transtentorial herniation with compression of the brain stem as well as absence of flow voids on the T2-weighted images and absence of intracranial vessels on MR angiography. On the basis of the clinical and imaging findings, it was concluded that the patient was in a state of brain death. The patient died the same day. CONCLUSIONS: With the use of new fast techniques such as diffusion-weighted imaging, now MRI can not only display anatomic changes associated with severe brain suffering but can also demonstrate ultrastructural changes secondary to brain death and differentiate them from edematous changes seen on T2-weighted images.
Aged↗
[International Stroke Trial Switzerland: some epidemiologic data].
Randomised trials provide the best evidence on the effects of treatment on a particular disease. They can also provide valuable data on outcome. In the present article, data from 1631 Swiss patients randomised in the International Stroke Trial (IST) are presented. Baseline characteristics and outcome in the Swiss patients were compared with the 17,804 patients randomised in other countries. On average, compared with other countries, Swiss patients were: 2.5 years older (CI: 1.9-3.1; p < 0.001); more likely to have presented with total anterior circulation infarcts (28 vs 23%); less likely to have lacunar strokes (16 vs 25%; p < 0.00001); more likely to be randomised and treated early (within 3 hours, 7 vs 4%, and within 6 hours, 25 vs 15%; p < 0.00001). However, Swiss patients were more likely to be dead or dependent 6 months after the stroke (66.9 vs 62.2%; p < 0.00001). The difference in death or dependency was almost entirely explained by the difference in age and baseline severity of strokes. These data highlight the difficulties inherent in between-country comparisons of outcome after stroke. They also emphasise the need for international multicentre trials to use methods of randomisation (either stratification or minimisation), as IST did, to ensure balance of prognostic factors within each participating country; to do otherwise might confound the assessment of the effect of treatment.
Aged↗
Silent functional magnetic resonance imaging demonstrates focal activation in rapid eye movement sleep.
Functional imaging of human sleep has been performed with nuclear medicine methods, but MRI has been difficult to implement, in part because of the noise associated with echo-planar imaging as well as the difficulty in reading physiologic signals in the MRI environment. We describe a silent MR sequence that can record brain activation over many hours with simultaneous acquisition of an EEG. This shows activation of occipital cortex and deactivation of frontal cortex during REM sleep, in agreement with previous studies using other techniques. MRI-Sleep-REM sleep.
Adult↗
[Objective value of adenotonsillectomy in the child. A prospective study of incidence of tonsillitis, snoring, pulse oximetry and polysomnography and general development before and after adenotonsillectomy].
65 children were analysed prospectively before and after adeno-tonsillectomy to determine the incidence of upper airway infections, snoring and nocturnal obstructive symptoms. The weight and height percentiles were also determined before and after adeno-tonsillectomy. The Oxygen Desaturation Index (ODI) was measured in 27 children suspected of having a sleep apnea syndrome. In six of these children polysomnographic studies were carried out. A statistically significant reduction (p < 0,005) of upper airway infections could be seen six to twelve months after adeno-tonsillectomy. In 25 children (38%), we observed a postoperative weight gain and in eight cases (12%) a height gain. The obstructive symptoms, especially snoring and respiratory apneas, disappeared or were significantly reduced in 90% of the cases after adeno-tonsillectomy. All preoperatively pathological ODI and AHI normalised after the operation (p < 0,005).
Adenoidectomy↗
Sleep apnea in acute cerebrovascular diseases: final report on 128 patients.
Although obstructive sleep apnea (OSA) appears to be a cardiovascular risk factor, its frequency in patients with transient ischemic attack (TIA) and stroke remains poorly known. We prospectively studied 128 patients (mean +/- SD age = 59 +/- 15 years) with stroke (n = 75) or TIA (n = 53). Assessment included body mass index (BMI); history of snoring and daytime sleepiness; cardiovascular risk factors and diseases; and severity of stroke (Scandinavian Stroke Scale = SSS). Polysomnography (PSG) was obtained in 80 subjects (group 1), a mean of 9 days (range, 1-71 days) after TIA or stroke. In 48 subjects (group 2), PSG was not available, refused, or inadequate. Groups 1 and 2 were similar with the exception of gender distribution. Clinical and PSG data were compared to those of 25 healthy controls matched for age, gender, and BMI. An apnea-hypopnea index (AHI) > 10 was found in 62.5% of subjects and 12.5% of controls. Between patients and controls there was a significant difference in AHI (mean [range]: 28 (0-140) vs 5 (0-24), p < 0.001), maximal apnea duration (mean + SD: 37 +/- 23 vs 23 +/- 13 seconds, p = 0.009), and minimal oxygen saturation (mean + SD: 82 +/- 10% vs 90 +/- 5%, p < 0.001). Conversely, frequency and severity of OSA were similar in stroke and TIA subjects. Multiple regression analysis identified age, BMI, diabetes, and SSS as independent predictors of AHI. Sleep apnea has a high frequency in patients with TIA and stroke, particularly in older patients with high BMI, diabetes, and severe stroke. These results may have implications for prevention, acute treatment, and rehabilitation of patients with acute cerebrovascular diseases.
Adolescent↗
Narcolepsy.
Narcolepsy is a disabling, chronic sleep-wake disorder that typically starts in a patient's second or third decade of life. Its key features are hypersomnia and cataplexy. Sleep paralysis, hallucinations, and disrupted sleep are nonspecific symptoms and are not always present. Disability relates primarily to sleepiness- related cognitive impairment, accidents, and psychosocial problems. Treatment, which includes counseling, scheduled napping, and pharmacologic intervention, is effective for most patients. Hypersomnia is best treated with such indirect sympathomimetics as mazindol, pemoline, methylphenidate, and amphetamine. Modafinil may become the drug of choice because it has fewer side effects. Cataplexy, sleep paralysis, and hallucinations may be ameliorated by compounds, including clomipramine and imipramine, that suppress rapid eye movement (REM) sleep. Regular follow-up visits enable the clinician to recognize uncommon but serious side effects (tolerance, substance abuse, psychosis, and hypertension) and additional sleep disturbances (sleep apnea, periodic limb movements in sleep, REM sleep behavior disorder), which can be specifically treated.
Journal Article↗
High prevalence of glaucoma in patients with sleep apnea syndrome.
OBJECTIVE: To determine the prevalence of glaucoma in sleep apnea syndrome (SAS), an entity characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption with the risk of cardiovascular and neurologic sequelae. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 114 white patients consecutively referred for polysomnographic evaluation of suspected SAS. INTERVENTION: Complete ophthalmologic examination, including computerized perimetry and simultaneous stereoscopic optic disc photographs. MAIN OUTCOME MEASURES: Spearman rank correlations between the respiratory disturbance index during night sleep (RDI), a value used to diagnose and grade SAS, and visual acuity, intraocular pressure (IOP), visual field indices, presence or absence of glaucomatous optic disc changes, and diagnosis of glaucoma. Each correlation was controlled for age and body mass index. To compare proportions of patients harboring glaucoma, the binomial test was used. RESULTS: Sixty-nine (60.5%) of the 114 patients had an RDI > or =10, which indicates SAS. Three patients had primary open-angle glaucoma, and two had normal-tension glaucoma. All patients with glaucoma had SAS. The observed prevalence of glaucoma in patients with SAS (5 of 69, 7.2%) was significantly higher than expected in a white population (2%) (P = 0.01). The RDI correlated positively with IOP (P = 0.025), visual field loss variance (P = 0.03), glaucomatous optic disc changes (P = 0.001), and diagnosis of glaucoma (P = 0.01). CONCLUSIONS: Patients with SAS constitute a high-risk population for glaucoma and should therefore be screened for glaucoma.
Adult↗