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Biomedical subjects

D L Bliwise

Publications and source records attributed to D L Bliwise.

At least 55 records · Page 3Linked to original sources
PubMed1996

Sleep and depression in combat-related PTSD inpatients.

The sleep of 27 unmedicated Vietnam combat-related posttraumatic stress disorder (PTSD) inpatients was monitored for 3 nights. Depressive comorbidity was considered both as a diagnostic category using DMS-III-R criteria, and as a continuous variable using the Beck Depression Inventory (BDI). Data collected included sleep architecture features that have discriminated unipolar depressives from controls in many prior studies, rapid eye movement (REM) sleep latency, and slow-wave sleep time, as well as two additional indices that have sometimes discriminated depressives from controls in waking studies-baseline heart rate and facial electromyography. Structured Clinical Interview for the DSM-III-R (SCID)-diagnosed PTSD+major depressive disorder (MDD) patients failed to exhibit shorter REM latencies, greater REM percents of sleep, or greater REM densities than PTSD-MDD patients, but did exhibit less slow wave sleep. PTSD+MDD patients also exhibited less facial (mentalis) electromyographic activity. REM densities and baseline heart rates were equivocal. REM density, baseline heart rate, and mentalis electromyography all correlated with the BDI, the former two positively, the last, negatively. In summary, SCID-diagnosed PTSD+MDD patients failed to exhibit the classic REM sleep architectural modifications associated with unipolar depression, despite the fact that several other psychophysiologic indices of dysphoria were detectable in their sleep.

Adult↗
PubMed1996

Subjective versus objective sleep in Vietnam combat veterans hospitalized for PTSD.

Twenty-five Vietnam combat veterans with chronic severe posttraumatic stress disorder (PTSD) completed a sleep self-report questionnaire on admission to an inpatient treatment program. Between 1 and 2 months later each spent 3 or more nights in the sleep laboratory. When self-report and laboratory findings were compared, significant relationships were observed between sleep schedule items such as time-to-bed/time-out-of-bed and polysomnographic measures of sleep. In contrast, global ratings of sleep quality were generally unrelated to polysomnographic measures. These findings may have implications for survey research assessing sleep quality in traumatized populations.

Chronic Disease↗
PubMed1996

Cognitive function in patients with sleep apnea after acute nocturnal nasal continuous positive airway pressure (CPAP) treatment: sleepiness and hypoxemia effects.

Patients with sleep apnea are typically hypersomnolent during the daytime and may demonstrate higher order cognitive dysfunction. A persistent problem in interpreting impaired neuropsychological test performance in such patients is whether the observed deficits can be explained wholly by impaired vigilance. We examined 37 sleep apnea patients prior to and immediately subsequent to successful sleep apnea treatment with nasal continuous positive airway pressure (CPAP). Patients were evaluated immediately after morning awakening in the sleep lab. A brief neuropsychological evaluation, was administered at that time. Following this, alertness was measured with a 30-min polysomnographically determined sleep latency test. Both test (approximately 50 min in duration) were performed once following a baseline (diagnostic) night in the sleep lab and once in the morning following a CPAP (therapeutic) night in the lab. Subgroup analyses indicted that while vigilance impairment can account for some of the decreased test performance seen in sleep apnea (auditory verbal learning) the effects of severe nocturnal hypoxemia appear to affect other function (sustained attention in repetitive arithmetic calculations) that were not easily modified by treatment. Thus, performance on the recall trial of the Rey Auditory Verbal Learning Test increased from pre-CPAP to post-CPAP for the increased alertness group but decreased significantly for the decreased alertness group. On the Wilkinson Addition Test, non-hypoxemic patients showed statistically significant improvement in problems correctly solved from pre-CPAP to post-CPAP, but the hypoxemic patients showed only a marginal increase. These results are compatible with other studies suggesting that patients having sleep apnea may incur deficits as a result of both decreased vigilance and hypoxemia, and that at least some of these deficits are immediately reversible.

Adult↗
PubMed1996

First night effects in post-traumatic stress disorder inpatients.

Recent data have suggested that first night effects are attenuated in inpatient depressive subjects. We examined first night effects in 80 inpatients hospitalized for post-traumatic stress disorder (PTSD) as well as non-hospitalized PTSD sufferers and non-ill control subjects. PTSD inpatients exhibited attenuated first night effects compared to non-hospitalized PTSD sufferers and non-trauma-exposed controls. Non-ill combat-exposed subjects also exhibited small first night effects. Within the inpatient sample, severity indices of PTSD, depression and anxiety failed to account for variance in first night effects. These data demonstrate attenuation of first night effects in a new inpatient population and suggest their statistical independence vis-a-vis a range of relevant symptoms. Both the attenuation of first night effects in PTSD inpatients and their accentuation in PTSD outpatients may be indicative of enhanced sensitivity to the sleep environment. Conversely, the trend to small first night effects in non-ill combat-exposed subjects may reflect a dimension of their apparent resistance to traumatic stress.

Depressive Disorder↗
PubMed1996

Historical change in the report of daytime fatigue.

Population-based data suggesting that contemporary society does not value sleep are difficult to obtain. In this report, historical change in item endorsements relevant for disturbed sleep and daytime fatigue from the Minnesota Multiphasic Personality Inventory (MMPI) generated from normative, upper Midwestern adult populations was analyzed. Response rates from the 1930s and 1980 were compared. The data indicated that, relative to individuals in the post-Great Depression/pre-World War II era, contemporary men were more likely to report fatigue and tiredness, although they were no more likely to report disturbed nocturnal sleep. The results are compatible with the voluntary curtailment of sleep typical in modern society described in the report of the National Commission on Sleep Disorders Research.

Adult↗
PubMed1996

Sleepiness in clinical and nonclinical populations.

Sleepiness is a commonplace experience for all individuals at some point in their daily lives. Whether such a ubiquitous experience has utility in discriminating a diseased population from the general population has yet to be determined. The purpose of this study was to determine the accuracy of reports of sleepiness across different situations by identifying individuals with sleep apnea. We compared a clinical population of 630 patients aged 50-65 with polysomnographically diagnosed sleep apnea with a randomly sampled population of 1,877 individuals of similar age from a nearby community. Sleepiness while watching television was the most prevalent behavior (about 36% of the reference population and 90% of the apnea patients), but potentially better discrimination occurred with items inquiring about sleepiness in other situations. The data suggest that discrimination between diseased and nondiseased populations may be more successful with sleepiness items involving relatively low, rather than high, rates of endorsement.

Activities of Daily Living↗
PubMed1995

Prediction of outcome in behaviorally based insomnia treatments.

Factors related to successful behavioral intervention for individuals with insomnia are not well understood. In this study we employed the Neuroticism, Extraversion and Openness (NEO) Personality Inventory, to predict successful treatment outcome. Two behavioral treatments for insomnia, sleep restriction therapy (SRT) and relaxation training (RT) were employed in 32 elderly insomniacs. Following two baseline weeks, subjects underwent four weeks of individual treatment. Daily telephone call-ins generated data on sleep times and sleep latency. Follow-up occurred three months after the end of treatment. Results indicated that subjects showing the greatest improvement in total sleep time with both treatments were more traditional, conventional and rigid. Improvement in sleep onset latency was unrelated to NEO Scores. SRT appeared to be more effective for increasing total sleep time in these older subjects.

Aged↗
PubMed1995

Perceptions of life stress and chronic insomnia in older adults.

This study compared the level of self-reported stress of 42 older good sleepers (M age = 68.2 years) and 42 poor sleepers (M age = 68.7 years). The relations among subjective ratings of sleep, level of perceived stress, and negative mood were analyzed for each group. Good and poor sleepers reported similar amounts of life stress, but the relations between life stress and sleep perceptions differed for the 2 groups. Specifically, within the group of poor sleepers, those with higher life stress had greater difficulty falling asleep and less early morning waking than did poor sleepers with lower life stress. There was no association between life stress and any sleep measures for good sleepers. These results are compatible with the notion that good and poor sleepers may have different susceptibilities to poor sleep despite experiencing similar stressful life events.

Aged↗
PubMed1995

Observed sleep/wakefulness and severity of dementia in an Alzheimer's disease special care unit.

BACKGROUND: This study tested the hypothesis that behaviorally defined sleep disturbance among residents in a Special Care Unit (SCU) for Alzheimer's disease (AD) was related to the severity of their dementia. Previously, sleep laboratory studies have reported such relationships when sleep has been recorded polysomnographically over several nights. Observational studies of sleep have not shown such relationships, presumably because of the impression involved in determining sleep/wake state behaviorally. METHODS: Nightly sleep data based on observations made every two hours by nursing staff for a period of 13 to 18 months were examined for 47 AD residents with a mean age of 80.7 +/- 6.5 years. Level of dementia and functional capacity were assessed with the Mattis Dementia Rating Scale (DRS) and the Katz Activities of Daily Living Scale (ADL). RESULTS: Data indicated that these SCU residents experienced a moderately disturbed night of sleep an average of 24% +/- 10% of their nights in the facility and a severely disturbed night of sleep on 7% +/- 6% of those nights. More profound dementia was associated with more sleep disturbance; however, incapacity in ADLs, age, gender, and psychoactive medications were unrelated to such disturbances. CONCLUSIONS: The results indicate that patterns of relationships noted between laboratory-based measures of sleep and variables such as severity of dementia can be detected using behavioral observations of sleep, provided that the number of nights of observation are sufficiently large to offset the measurement error involved in their use.

Aged↗
PubMed1995

Predictors of early deterioration and mortality in black Americans with spontaneous intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Black Americans with spontaneous intracerebral hemorrhage (SICH) may have unique clinical characteristics that affect outcome. The aim of this study was to determine the prognostic value of clinical characteristics and initial CT scan for outcome in black Americans with SICH. METHODS: Clinical and demographic data were extracted from the charts of 182 consecutive black Americans admitted for SICH diagnosed by clinical criteria and initial CT scan. Hemorrhage volumes were calculated from admission CT scans by a computerized method. Univariate and multiple logistic regression analyses were performed to determine independent predictors of early deterioration (defined as a decrease from an initial Glasgow Coma Scale score > 12 by > or = 4 points within 24 hours from presentation) and mortality. RESULTS: Both hemorrhage volume and ventricular extension were significant, independent predictors of early deterioration (odds ratio [OR], 6.78; 95% confidence interval [CI], 1.89 to 24.35 and OR, 4.67; 95% CI, 1.30 to 16.72, respectively) and mortality (OR, 6.66; 95% CI, 2.85 to 15.58 and OR, 4.23; 95% CI, 1.82 to 9.82, respectively). A Glasgow Coma Scale score < or = 12 also predicted mortality (OR, 3.23; 95% CI, 1.46 to 7.14). Initial mean arterial pressure was not an independent predictor of early deterioration or mortality. CONCLUSIONS: Hemorrhage volume and ventricular extension are the best predictors of early deterioration and mortality in black Americans with SICH.

Black People↗
PubMed1995

Disruptive nocturnal behavior in Parkinson's disease and Alzheimer's disease.

Disruptive nocturnal behavior, often referred to as sundowning, is a commonly encountered clinical problem in most forms of dementia. This study compared disruptive nocturnal behavior in patients with Alzheimer's disease (AD) and Parkinson's disease (PD). Questionnaire data were collected from 60 AD and 48 PD caregivers. Respondents were asked to record the typical time of day when any of seven disruptive behaviors were evidenced in their patients, if at all. Two scores were computed: (1) a sundowning score (number of nocturnal disruptive behaviors, range 0-7), and (2) a total score (number of disruptive behaviors without regard to time, range 0-7). Results indicated PD patients were more likely than AD patients to exhibit disruptive nocturnal behavior. The dose, timing, or number of years on antiparkinsonian medication were not related to nocturnal disruptive behavior within the PD patient group. These findings raise the possibility that sundowning in PD patients may be a manifestation of dopaminergic depletion within the basal ganglia or other abnormalities involving the cholinergic, serotoninergic and/or noradrenergic systems in the brainstem.

Aged↗
PubMed1995

Sleep onset: scoring criteria in patients with sleep apnea syndrome.

It has been suggested that in patients with sleep apnea syndrome (SAS) modified scoring criteria may improve accuracy in the determination of sleep onset in the Multiple Sleep Latency Test (MSLT). Scoring in 30-sec epochs according to the standard criteria requires more than 50% of the epoch asleep to score sleep latency (SL). In patients with SAS, short apneas with arousals could prevent the accurate determination of SL. This study compared three time-duration epochs (5-sec, 10-sec, 30-sec) for scoring SL in patients with SAS. Sleep onset during a single sleep latency test, the morning subsequent to a nocturnal polysomnogram, was determined by the criterion of at least 50% of the epoch asleep. Neuropsychological evaluation was performed immediately after the single sleep latency test. There was no statistically significant difference in time to fall asleep as defined by 10-sec and 30-sec epochs, but SL defined by 5-sec epochs was significantly shorter than SL defined by 10-sec and 30-sec epochs. Wilkinson Addition Test correct score correlated better with SL as defined by 30-sec epochs. The results imply that the level of sleepiness measured by 30-sec epochs may be more useful to appreciate behavior and performance.

Adult↗
PubMed1994

Habitual sleep durations and health in a 50-65 year old population.

Several studies have suggested that individuals with long or short sleep durations are at greater risk for adverse outcomes relative to individuals sleeping 7-8 hours a night. The mechanisms leading to these results have never been fully explained, but individual differences in how long an individual sleeps are usually considered to reflect lifestyle rather than disease. Alternatively, individuals may sleep a particular amount because of characteristics of their sleep physiology. In this study, we examined population-based data on the associations between sleep duration and several symptoms of sleep-related disease, reported snoring and daytime sleepiness. Results from 1877 independently living individuals between the ages of 50 and 65 years suggested that long, but not short, sleep durations were related to greater reported snoring. Higher levels of reported snoring and daytime sleepiness, but not habitual sleep duration, were related to measures of disease and lower psychosocial function. We suggest that future epidemiologic studies use such additional items as potential indicators of sleep-related disease.

Cardiovascular Diseases↗
PubMed1994

What is sundowning?

Explore the source record for details and available documents.

Circadian Rhythm↗
PubMed1993

Depression as a confounding variable in the estimation of habitual sleep time.

Self-reported habitual sleep time is an important variable because short and long sleep times are associated with mortality. Speculation with regard to these results usually focuses on physical health, rather than psychological factors. We investigated the role of anxiety and depression in reports of habitual sleep times by examining the relative and absolute discrepancy between individuals' initial estimates of their sleep times and sleep diaries made over a 2-week period. Results indicated that depressed mood was associated not only with a tendency initially to underestimate length of sleep (relative discrepancy), but also to exaggerate reported sleep time regardless of direction (absolute discrepancy). These results imply that studies that examine relationships between reported sleep times and mortality should take mental health factors into account.

Aged↗
PubMed1993

Sleep and "sundowning" in nursing home patients with dementia.

"Sundowning," a term that is sometimes equated with sleep disturbance or nocturnal delirium in dementia, is a poorly understood psychiatric phenomenon. In this study, we performed systematic, temporally specific, behavioral observations of nine profoundly demented nursing home patients 4 times an hour over a 12-hour period (1300 to 0100h) to determine whether their agitation was more likely to occur at a particular time of day. Results indicated only equivocal evidence that agitation was any worse nocturnally or during the time near sunset, thus raising the possibility that at least some components of sundowning may reflect disruptive behaviors occurring with identical frequency throughout the day but with differential impact upon nursing staff. Additional data indicated that awakening from sleep during darkness was also associated with agitation. A final result was a trend indicating the apparent worsening of agitation seasonally (greater agitation during winter), which may suggest involvement of the circadian timing system.

Activities of Daily Living↗