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Biomedical subjects

D L Bliwise

Publications and source records attributed to D L Bliwise.

At least 37 records · Page 2Linked to original sources
PubMed1999

Objective and subjective sleep disturbances in patients with systemic lupus erythematosus.

OBJECTIVE: To assess objective and subjective evidence of sleep disorders in patients with systemic lupus erythematosus (SLE) and to examine correlations between parameters of lupus activity, depression, and sleep disturbances. METHODS: Fourteen SLE patients and 11 normal control subjects of similar age underwent all-night polysomnography on 3 consecutive nights. The patients and controls were also evaluated for daytime sleepiness by the Multiple Sleep Latency Test and completed a sleep disorders questionnaire and the Beck Depression Inventory. RESULTS: The polysomnographic data showed that sleep in SLE patients was characterized by respiratory and movement disorders. These intrinsic primary sleep disorders are related to the symptom of restless, poor sleep at night. Lupus patients were more sleepy during the day, and their sleepiness was related to sleep fragmentation, with more arousals and stage transitions than the control group. Disease activity was associated with decreases in sleep efficiency and delta sleep and with increases in sleep fragmentation. Depression was not correlated with the activity of the disease. CONCLUSION: There is an enhanced presence of sleep disorders in patients with SLE. The most frequent primary sleep disorders are respiratory and movement disorders.

Adult↗
PubMed1999

Rate of 24-hour blood pressure decline and mortality after spontaneous intracerebral hemorrhage: a retrospective analysis with a random effects regression model.

OBJECTIVE: To study the effect of decline in blood pressure on mortality in patients with spontaneous intracerebral hemorrhage (ICH). DESIGN: Retrospective chart review. SETTING: University-affiliated teaching hospital. PATIENTS: Consecutive patients admitted with spontaneous ICH over a 3-year period. MEASURES: Blood pressure recordings were obtained from the first 24 hrs. Patients (n = 105) with more than five blood pressure recordings and on average greater than one measurement per 2 hrs were included (mean measurements per patient = 20.3). Mean arterial pressure (MAP) recordings over the first 24 hrs after presentation were regressed on time for each patient. Each patient's MAP was calculated as a slope (change mm Hg/hr). We performed logistic regression analyses to determine the effect of MAP slope on mortality and functional outcome, adjusting for other predictive factors including Glasgow Coma Scale (GCS) score and hematoma volume. The effect of MAP slope on mortality was also evaluated in subsets of patients based on age, gender, initial GCS score, initial MAP, treatment status, hematoma volume, and presence of ventricular blood. MAIN RESULTS: Mean slope of change in MAP was -2.0 mm Hg/hr (+/- 1.9, range -8.5 to +0.6). The slope of MAP (faster rate of decline) within the first 24 hrs was significantly associated with higher mortality (p =.04), independent of initial GCS score and hematoma volume. In subgroup analyses, MAP slope was significantly associated with mortality in men (p = .08), patients with hematoma volume <50 mm3 (p =.08), initial MAP < or = 146 mm Hg (p = .006), and those with initial GCS score > or = 10 (p= .07). MAP slope did not predict functional outcome among survivors. CONCLUSIONS: A rapid decline in MAP within 24 hrs after presentation is independently associated with increased mortality in patients with ICH. A large, prospective, randomized trial is required to confirm these findings.

Antihypertensive Agents↗
PubMed1999

Sleep fragmentation and morning cerebrovasomotor reactivity to hypercapnia.

Impaired vasomotor reactivity of the cerebral vessels on morning awakening has been suggested as one of the mechanisms underlying the predisposition to stroke in the morning. This study investigated cerebrovascular reactivity to hypercapnia on morning awakening and its association with specific sleep-related parameters, including sleep-disordered breathing. Thirty patients undergoing nocturnal diagnostic polysomnography for sleep apnea underwent transcranial Doppler ultrasonography of the middle cerebral artery immediately before going to bed and immediately on morning awakening. Results indicated a morning reduction in cerebral blood flow velocity (CBFV) relative to values from the preceding evening both while breathing room air and 5% CO(2). Hypercapnia was associated with the expected increase in CBFV in both evening and morning. The evening-to-morning difference in CBFV during CO(2) inhalation was independently associated with both overnight CO(2) retention and number of movements with arousal per hour of sleep. Results indicated that more fragmented sleep and greater CO(2) retention during sleep predicted a diminished hypercapnic vasomotor response in the morning. Sleep fragmentation predicted approximately twice the variance in morning hypercapnic vasomotor reactivity relative to overnight CO(2) retention (24 versus 13%). No other polysomnographic measures predicted evening-to-morning differences in vasomotor reactivity. These results are consistent with a body of literature suggesting that sleep loss and sleep fragmentation are associated with blunted hypercapnic ventilatory response.

Blood Flow Velocity↗
PubMed1999

Correlates of the "don't know" response to questions about snoring.

Many persons say that they "don't know" whether they snore. The purpose of this study was to investigate the prevalence and correlates of such responses in an elderly population. Subjects were 1715 members (1,155 men, 560 women) of a previously defined cohort (Western Group Collaborative Study) followed prospectively since 1960-1961 with a current mean age of 75.9 (SD = 4.3) for the men and 71.4 (SD = 5.3) for the women. We collected survey questionnaires and reviewed medical records. Results indicated that risk factors for the "don't know" response in this population were similar to those for frequent snoring and included: male sex, higher Body Mass Index, smoking, and use of sinus medication. Between 28 and 44% of the cohort answered questions about snoring with a "don't know" response. These data are compatible with the interpretation that subjects may disavow knowledge of their own snoring and suggest that future studies consider the "don't know" response to questions about snoring as a response of potential interest.

Aged↗
PubMed1998

The siesta culture concept is not supported by the sleep habits of urban Mexican students.

Evidence in support for the concept of the so-called 'siesta culture' is not well developed and has, to date, relied largely on qualitative anthropological data. Presumably such cultures are characterized by a strong tendency for daytime naps and daytime sleepiness, phenomena which may partially represent the effects of geographic, climatic or light conditions and/or cultural influences. In this study we surveyed the nocturnal sleep habits and daytime sleep tendencies of 577 Mexican college students residing in Mexico City (19 degrees N latitude). Results indicated a number of parallels between the reported sleep habits of these students and those reported from other cultures at latitudes far to the north (North America, Europe), such as longer sleep at the weekends, an association between snoring and daytime sleepiness and a lack of relationship between nocturnal sleep duration and the reported tendency to nap. There was some suggestion that these Mexican students may actually nap less when compared to other college student populations. Taken together, these results call into question what is meant by the concept of a 'siesta culture', at least in this urban, educated, upper social economic scale (SES) population, and suggest that future studies in equatorial regions be undertaken to further appreciate the role of climate, photoperiod and/or culture in the tendency for humans to nap during the day.

Adolescent↗
PubMed1998

A follow-up study of actigraphic measures in home-residing Alzheimer's disease patients.

This article reports cross-sectional and follow-up data with actigraphic measures of nocturnal sleep and rest/activity in 61 Alzheimer's disease (AD) patients as well as the relation of actigraphic measures to levels of behavioral disturbance across different stages of the disease. Over the course of approximately 1.5 years' follow-up, patients showed significant deterioration of nocturnal sleep parameters, but no significant change in rest/activity circadian rhythm parameters. There were also significant correlations among nocturnal sleep, rest/activity circadian rhythm, and behavioral disturbance measures, but only in relatively early stages of AD. It is argued that study of nocturnal sleep and circadian rhythm in relation to behavioral disturbance in AD requires longitudinal data and analyses that take into account the stage of disease at which patients are assessed.

Aged↗
PubMed1998

Presentation of narcolepsy after 40.

To advance understanding of the clinical spectra of narcolepsy, we retrospectively reviewed the histories and clinical and polysomnographic features of 41 consecutive patients in whom this diagnosis was established in our center over 3 years. A total of 51% presented after the age of 40 years. Among the older patients, three subpopulations were noted: 1) narcolepsy/cataplexy with presentation delayed because of mild disease severity or misdiagnosis; 2) narcolepsy/cataplexy with diagnosis delayed until late-life expression of cataplexy; and 3) narcolepsy lacking cataplexy with later-life onset of excessive daytime sleepiness. Clinical, polysomnographic, and multiple sleep latency test assessments of rapid eye movement sleep dyscontrol and sleepiness were unrelated to age. This analysis identified older patients lacking cataplexy as the least severely affected narcoleptic subgroup. Narcolepsy, a continuum of phenotypes and severities that masks its recognition, should be considered in the differential diagnosis of sleepiness or transient loss of muscle tone in older patients.

Adult↗
PubMed1998

Reversal of atypical depression, sleepiness, and REM-sleep propensity in narcolepsy with bupropion.

We successfully treated a 46-year-old narcoleptic woman suffering from atypical depression with bupropion hydrochloride. Diagnostic evaluation revealed a Beck Depression Inventory (BDI) score of 24, a short nocturnal REM-sleep latency, subjective and objective sleepiness (mean sleep latency (MSL) = 1.8 minutes), and three sleep onset REM-sleep periods during the five nap multiple sleep latency test. Bupropion (100 mg t.i.d.) normalized her mood (BDI = 6), sleepiness (MSL = 9.1 minutes), and REM-sleep propensity. Upon discontinuation of bupropion, these parameters reverted to pretreatment levels. This "activating" antidepressant's reversal of the sleepiness and REM-sleep propensity in narcolepsy may be due to blockade of dopamine or norepinephrine reuptake. Clinicians need to be alert to the fact that depression can mask the diagnosis of narcolepsy. Bupropion warrants further investigation as a treatment for narcolepsy in an open-label, double-blind, placebo-controlled paradigm.

Antidepressive Agents, Second-Generation↗
PubMed1997

Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial.

OBJECTIVE: To determine the effects of moderate-intensity exercise training on self-rated (subjective) sleep quality among healthy, sedentary older adults reporting moderate sleep complaints. DESIGN: Randomized controlled trial of 16 weeks' duration. SETTING: General community. PARTICIPANTS: Volunteer sample of 29 women and 14 men (of 67 eligible subjects) aged 50 to 76 years who were sedentary, free of cardiovascular disease, and reported moderate sleep complaints. No participant was withdrawn for adverse effects. INTERVENTION: Randomized to 16 weeks of community-based, moderate-intensity exercise training or to a wait-listed control condition. Exercise consisted primarily of four 30- to 40-minute endurance training sessions (low-impact aerobics; brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate. MAIN OUTCOME MEASURE: Pittsburgh Sleep Quality Index (PSQI). RESULTS: Compared with controls (C), subjects in the exercise training condition (E) showed significant improvement in the PSQI global sleep score at 16 weeks (baseline and posttest values in mean [SD] for C=8.93 [3.1] and 8.8 [2.6]; baseline and posttest values for E=8.7 [3.0] and 5.4 [2.8]; mean posttest difference between conditions=3.4; P<.001; 95% confidence interval, 1.9-5.4), as well as in the sleep parameters of rated sleep quality, sleep-onset latency (baseline and posttest values for C=26.1 [20.0] and 23.8 [15.3]; for E=28.4 [20.2] and 14.6 [13.0]; net improvement=11.5 minutes), and sleep duration baseline and posttest scores for C=5.8 [1.1] and 6.0 [1.0]; for E=6.0 [1.1] and 6.8 [1.2]; net improvement=42 minutes) assessed via PSQI and sleep diaries (P=.05). CONCLUSIONS: Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program.

Aged↗
PubMed1997

Disruptive behavior and actigraphic measures in home-dwelling patients with Alzheimer's disease: preliminary report.

The purpose of this preliminary report was to explore overall level and diurnal patterning of caregiver reports of abnormal behavior and to explore relationships with actigraphic measures of sleep/wake activity in Alzheimer's disease (AD) patients. Our primary behavioral measure was the Time-based Behavioral Disturbance Questionnaire (TBDQ). The overall score on this measure was shown to have adequate test-retest reliability and convergent validity with another behavioral measure. Significant correlations were obtained between the TBDQ overall score and actigraphically scored sleep efficiency (r = -.35, P < .05) and wake after sleep onset (r = .43, P < .01) in 41 subjects. The data suggest a moderate relationship between actigraphic measures of sleep/wake and disturbed behavior in home-dwelling AD patients.

Aged↗
PubMed1997

Habitual sleep patterns and risk for stroke and coronary heart disease: a 10-year follow-up from NHANES I.

BACKGROUND: Habitual sleep patterns may independently affect morbidity and mortality. However, the effect of habitual sleep patterns on the risk for stroke and coronary heart disease is unclear. METHODS: We evaluated the association between sleep duration and daytime somnolence (often or almost always taking daytime naps) with the incidence of stroke and coronary heart disease in a national cohort of 7,844 adults who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Cox proportional hazards analyses were used to examine these relationships during the 10-year follow-up. RESULTS: After adjusting for differences in age, race, gender, education, cigarette smoking, body mass index, serum cholesterol, systolic blood pressure, and diabetes mellitus, the risk for stroke was increased in persons who reported sleeping greater than 8 hours at night compared with persons who slept between 6 and 8 hours (relative risk [RR] = 1.5, 95% confidence interval [CI] = 1.1 to 2.0). Daytime somnolence was also associated with stroke incidence (RR = 1.4, 95% CI = 1.1 to 1.8). Persons who reported both greater than 8 hours of sleep and daytime somnolence were at the greatest risk for stroke (RR = 1.9, 95% CI = 1.2 to 3.1). Similar results were also found for coronary heart disease, although the results did not reach statistical significance in the multivariate adjusted model. CONCLUSIONS: Habitual sleep patterns have significant effects on the risk for stroke.

Adult↗
PubMed1997

The treatment of sundowning. A selective review of pharmacological and nonpharmacological studies.

Sundowning refers to episodes of agitated behaviour that are more frequent or are more severe at night. Although the effects of different psychoactive medications on agitated behaviour in dementia patients have been documented in hundreds of reports over the last 30 years, less than 20 studies make explicit reference to time of day for which outcome measures were derived, and even fewer have also examined sleep as an outcome. Thus, despite varying claims of efficacy and effectiveness for various medications, there are few data to support informed management of disruptive nocturnal behaviour in these patients. In this brief article, we selectively review those few studies explicitly mentioning temporal dimensions of behavioural outcome, including some newer studies of unconventional types of treatment that may be useful for the treatment of sundowning. We conclude that future pharmacological studies should systematically assess behaviour throughout the 24-hour day to provide outcome data relevant to this phenomenon.

Antipsychotic Agents↗
PubMed1997

A factor replication of the Sleep-Wake Activity Inventory (SWAI) in a Mexican population.

The purpose of this study was to describe the factor structure of the Sleep-Wake Activity Inventory (SWAI) in a Mexican population. In a sample of 722 Mexican college students, we replicated five of the six factors originally described in the SWAI. Retained factors included: excessive daytime sleepiness (similarity coefficient of 0.735), psychic distress (0.609), social desirability (0.638), individual's ability to relax (0.864), and nocturnal sleep (0.660). These results confirm the factor structure and extend the possible utility of the SWAI in a siesta culture.

Adolescent↗