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Dalva Poyares

Publications and source records attributed to Dalva Poyares.

18 recordsLinked to original sources
PubMed2006

A double-blind, placebo-controlled, crossover study of sildenafil in obstructive sleep apnea.

BACKGROUND: Sildenafil prolongs the action of cyclic guanosine monophosphate and nitric oxide by inhibiting cyclic guanosine monophosphate-specific phosphodiesterase 5. It is largely used for erectile dysfunction, a highly prevalent condition in obstructive sleep apnea. Because nitric oxide promotes upper airway congestion, muscle relaxation, and pulmonary vasodilation, the aim of this study was to establish the impact of a single 50-mg dose of sildenafil on the sleep of patients with severe obstructive sleep apnea. METHODS: Thirteen [corrected] middle-aged men with severe obstructive sleep apnea were consecutively selected for this double-blind, placebo-controlled, crossover study. Exclusion criteria were obesity, cardiovascular and/or respiratory disease, and conditions that interfere with sleep. All-night polysomnography was preceded by a single 50-mg dose of sildenafil or matching placebo randomly administered at bedtime, after a washout period of 1 week. RESULTS: In comparison to placebo, a single 50-mg dose of sildenafil significantly increased the percentage of total sleep time with an arterial oxygen saturation of less than 90% (mean +/- SD, 15.6% +/- 9.6% vs 7.9% +/- 3.3%, [corrected] P < .01), without a difference in the nadir of oxygen desaturation. The mean arterial oxygen saturation also decreased (92.1% +/- 1.9% vs 93.8% +/- 1.3%, P = .03), [corrected] and the desaturation index increased (30.3 +/- 14.5 [corrected] events per hour vs 18.5 +/- 9.1 [corrected] events per hour, P < .001). There was an increase in apnea-hypopnea index (48.1 +/- 20.8 [corrected] events per hour vs 32.3 +/- 11.3 [corrected] events per hour, P = .001), [corrected] involving mostly obstructive events. CONCLUSION: In patients with severe obstructive sleep apnea, a single 50-mg dose of sildenafil at bedtime worsens respiratory and desaturation events.

Cross-Over Studies↗
PubMed2006

Chronic fatigue, unrefreshing sleep and nocturnal polysomnography.

BACKGROUND AND PURPOSE: To investigate the complaint of unrefreshing sleep with study of sleep electroencephalogram (EEG) in patients with chronic fatigue. PATIENTS AND METHODS: Fourteen successively seen patients (mean age: 41.1 9.8) who complained of chronic fatigue but denied sleepiness and agreed to participate were compared to 14 controls (33.6+/-10.2 years) who were monitored during sleep recorded in parallel. After performing conventional sleep scoring we applied Fast Fourier Transformation (FFT) for the delta 1, delta 2, theta, alpha, sigma 1, sigma 2, beta EEG frequency bands. The presence of non-rapid eye movement (NREM) sleep instability was studied with calculation of cyclic alternating pattern (CAP) rate. Two-way analysis of variance (ANOVA) was performed to analyze FFT results and Mann-Whitney U-test to compare CAP rate in both groups of subjects. RESULTS: Slow wave sleep (SWS) percentage and sleep efficiency were lower, but there was a significant increase in delta 1 (slow delta) relative power in the chronic fatigue group when compared to normals (P<0.01). All the other frequency bands were proportionally and significantly decreased compared to controls. CAP rate was also significantly greater in subjects with chronic fatigue than in normals (P=0.04). An increase in respiratory effort and nasal flow limitation were noted with chronic fatigue. CONCLUSIONS: The complaints of chronic fatigue and unrefreshing sleep were associated with an abnormal CAP rate, with increase in slow delta power spectrum, affirming the presence of an abnormal sleep progression and NREM sleep instability. These specific patterns were related to subtle, undiagnosed sleep-disordered breathing.

Adult↗
PubMed2006

Upper airway resistance syndrome: a long-term outcome study.

UNLABELLED: This prospective study aimed to assess symptomatic evolution of patients diagnosed with Upper Airway Resistance Syndrome (UARS) four and half years after the initial UARS diagnosis. For this purpose, 138 UARS patients were contacted by mail between 43 and 69 months after the initial evaluation; 105 responded to the letter and 94 patients accepted to undergo new clinical and polysomnographic evaluations. Initial and follow-up polysomnographic recordings were scored using the same criteria. RESULTS: Of the 94 patients who completed the follow-up examination, none of them were using nasal CPAP. It was related to refusal by insurance providers to provide equipment based on initial apnea-hypopnea index (AHI) in 90/94 subjects. Percentage of patients with sleep related-complaints significantly increased over the four and half year period: daytime fatigue, insomnia and depressive mood increased by 12 to 20 times. Reports of sleep maintenance sleep onset insomnia and depressive mood was significantly increased. Hypnotic, antidepressant and stimulant prescription increased from initial to follow-up visit (from 11.7% to 61.7%; from 3.2% to 25.5% and from 0% to 9.6%, respectively) with antidepressant given as much for sleep disturbance as mood disorder. The polysomnography results at follow-up showed that 5 subjects had AHI compatible with Obstructive Sleep Apnea Syndrome (OSAS) but overall, respiratory disturbance index had no significant change. Total sleep time was significantly reduced compared to initial visit. CONCLUSIONS: Many UARS patients remained untreated following initial evaluation. Worsening of symptoms of insomnia, fatigue and depressive mood were seen with absence of treatment of UARS.

Adolescent↗
PubMed2005

[Sleep promoters and insomnia].

The purpose of this updating manuscript is to briefly describe the profile, clinical use and indication of some of the most used sedative and hypnotic compounds. About 2/3 of all hypnotic prescriptions go to chronic use. Benzodiazepines are among the most prescribed drugs worldwide. Women, elderly, psychiatric and medical disease patients are among chronic users of hypnotics. Zolpidem is now the most prescribed hypnotic in most countries. It appears to be safer, compared to benzodazepines, and might be an option for long-term and controlled use ("as needed"). Sedative antidepressants are also among the most prescribed drug for sedation in insomnia patients in USA and UK. Sedative effect and use of trazodone, mirtazapine, doxepine, amitryptilin are described. The authors also discuss the use of melatonin and its sleep properties, and the rational use of sedative antipsychotics for chronic insomnia, particularly in psychiatric patients. Finally, some phytotherapeutic compounds are mentioned.

Antidepressive Agents↗
PubMed2005

[Violent behavior during sleep].

Cases of violent behavior during sleep have been reported in the literature. However, the incidence of violent behavior during sleep is not known. One epidemiological study showed that approximately 2% of the general population, predominantly males, presented violent behavior while asleep. In the present study, the authors describe clinical and medico-legal aspects involved in violent behavior investigation. Violent behavior refers to self-injury or injury to another during sleep. It happens most frequently following partial awakening in the context of arousal disorders (parasomnias). The most frequently diagnosed sleep disorders are REM behavior disorder and somnambulism. Violent behavior might be precipitated by stress, use of alcohol or drugs, sleep deprivation or fever.

Adult↗
PubMed2005

Heart rate variability, sympathetic and vagal balance and EEG arousals in upper airway resistance and mild obstructive sleep apnea syndromes.

BACKGROUND AND PURPOSE: We questioned the role of respiratory events in obstructive sleep apnea syndrome (OSAS) and of upper airway resistance syndrome (UARS) on heart rate (HR) during sleep, paying specific attention to the termination of the abnormal breathing events and examining the presence of arousals or termination with only central nervous system (CNS) activation. PATIENTS AND METHODS: Twenty patients, 10 with UARS and 10 with mild OSAS, were studied. A nocturnal polysomnogram was performed including measurement of respiratory variables and pulse transit time (PTT). According to the presence or absence of a PTT event indicative of autonomic nervous system (ANS) activation, 148 events were extracted after having been randomly chosen in each represented sleep stage, with or without an electroencephalogram (EEG) arousal >1.5s. RR interval (RRI) in electrocardiogram (ECG) recordings, as well as heart rate variability, was calculated during 60 and 120s, respectively. Period amplitude analysis (PAA) was applied for RR-interval analysis, and fast Fourier transformation (FFT) was applied to perform HR variability analysis. RESULTS: Visually scored EEG arousal was significantly associated with an increase in sympathetic index of heart rate, while PTT was associated with a drop in parasympathetic index, after the respiratory events. Patients with mild OSAS presented persistently shorter RRI when compared to patients with UARS. The latter also exhibited a significant decrease in parasympathetic index (High Frequency (HF)) at the termination of a respiratory event. CONCLUSION: The HF component was only significantly decreased in patients with UARS, which indicates a predominant involvement of the parasympathetic tone in patients with UARS in comparison to those with OSAS.

Adult↗
PubMed2005

Cyclic alternating pattern in peripubertal children.

STUDY OBJECTIVES: The aim of this study is to complement the data on the expression and characteristics of cyclic alternating pattern (CAP) events in children, specifically in the peripubertal age group of 8 to 12 years and to analyze the association of CAP events with arousals. The study of CAP and arousal is a useful tool for assessing sleep instability and fragmentation in children. DESIGN: Descriptive study. PARTICIPANTS: Ten sex-matched healthy children, aged 8 to 12 years, underwent standard polysomnography after 1 adaptation night in the sleep laboratory. Sleep stages, CAP, and arousals were analyzed according to standard international rules. RESULTS: The mean CAP rate was 62.1% +/- 10.8% and the mean CAP cycle duration, 24.6 +/- 2.1 minutes. CAP A1 phase was the most numerous (85.5% +/- 3.9%), whereas the A2 phase was 9.1% +/- 4.7%, and the A3 phase as 5% +/- 2.3%, (P < .01). Differences between boys and girls were detected by analysis of variance, namely increases of phase A2 and A3 subtypes in girls (P < .001). Stronger phase A1 subtype expression in slow-wave sleep was verified in both sexes. Positive correlation between electroencephalogram arousals and the sum of phase A2 and A3 subtypes was also present. The overall CAP rate is higher in this age group than the rate previously reported in children aged 6 to 10 years (62.1% +/- 10.8% vs 33.4% +/- 5.3%). CONCLUSIONS: Our study provides normative data on CAP in children aged 8 to 12 years and indicates that age and Tanner stages must both be considered when investigating peripubertal children.

Child↗
PubMed2005

Heart rate variability during sleep in patients with vasovagal syncope.

BACKGROUND: There are a few studies showing no significant heart rate variability (HRV) over a 24-hour period in vasovagal syncope (VVS) patients, but no research has examined HRV and its sympathetic and parasympathetic components during rapid eye movement (REM) and non-REM sleep. The authors hypothesized that REM sleep might be a critical state in which VVS patients would show abnormal responses. OBJECTIVES: To analyze the sympathetic and parasympathetic components of HRV during REM and SWS in patients with VVS compared to normal subjects, and in patients with positive HUTT compared to negative ones. METHODS: Thirty-seven VVS patients and 20 normal age-matched controls were submitted to polysomnography with 24-hour Holter monitoring to assess HRV. Time and frequency domain techniques were carefully performed for 24 hours and during Stages 3 and 4 of REM and non-REM sleep. Variation of sympathetic activity index (VSAI) was defined as the difference in the low frequency (LF) component of HRV between REM and Stages 3 and 4 of non-REM sleep. An analysis of variance was performed to compare patients and controls; patients with positive and negative head-up tilt testing. RESULTS: The LF component was lower in syncope compared to normal patients (1,769.54 +/- 1,738.17, 3,225.37 +/- 2,585.05, respectively, P = 0.03). There was a significant decrease in VSAI in the syncope group compared to the control group (-539.39 +/- 1,930.78, 1,268.10 +/- 2,420.20, respectively, P = 0.01). The other sleep variables analyzed including very LF, high frequency, low frequency/high frequency and time domain parameters did not reach statistical significance. Syncope patients also showed an increase in slow wave sleep (28.2 +/- 10.5, 19.7 +/- 7.8, P = 0.01). CONCLUSIONS: VVS patients exhibited sympathetic suppression during REM sleep. Possible mechanisms are discussed in this article.

Adolescent↗
PubMed2003

Further validation of actigraphy for sleep studies.

STUDY OBJECTIVES: Actigraphy is generally compared to polysomnography (PSG), which has been considered the gold standard for sleep studies. The objective of the present study was to evaluate the concordance between PSG and two previously proposed algorithms (Cole et al, 1992; Sadeh et al, 1994) to analyze actigraphic recordings. The minute-by-minute agreement rate was evaluated through calculation of sensitivity, specificity, and accuracy. Regarding the sleep parameters, the concordance was performed through the Bland and Altman technique. DESIGN: A night of adaptation to the sleep laboratory followed by simultaneous polysomnographic and actigraphic recordings throughout the night. PARTICIPANTS: 21 healthy volunteers. SETTING: A sleep laboratory INTERVENTIONS: None. RESULTS: Ninety-one percent of all PSG epochs were correctly identified by both algorithms, and this accuracy is reasonably satisfactory. The actigraphy was a sensitive method, with values of 99% and 97% for Cole's and Sadeh's algorithms, respectively. However, actigraphy had a low specificity: 34% and 44% for Cole's and Sadeh's algorithms, respectively. The Bland and Altman technique showed that actigraphy systematically overestimated Sleep Latency, Total Sleep Time and Sleep Efficiency while it underestimated Intermittent Awakenings. CONCLUSIONS: The results of this study show the utility of actigraphy as a useful method for assessment of sleep, despite its limitations regarding identification of waking epochs during sleep. The Bland and Altman concordance technique was revealed to be a powerful tool to evaluate how well actigraphy agreed with polysomnography. This technique, combined with calculations of sensitivity and specificity, appears to be the most adequate procedure for the assessment of concordance.

Adolescent↗
PubMed2002

The DSM-IV 'minor depression' disorder in the oldest-old: prevalence rate, sleep patterns, memory function and quality of life in elderly people of Italian descent in Southern Brazil.

OBJECTIVES: (1) To describe the prevalence of minor depression in a community-dwelling population aged 80 years and over. (2) To compare the sleep pattern, memory function and the prevalence rate of other psychiatric diagnoses between normal controls and subjects with minor depressive disorder. DESIGN: A random representative sample (sample=77 subjects/county population of oldest-old =219--35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, eight subjects who met the DSM-IV criteria for minor depression, and 50 subjects without diagnosed delirium disorder, cognitive or affective problems were compared. RESULTS: The prevalence rate of minor depression was 12%. Subjects with this diagnosis were more likely to complain about sleep and memory problems than elderly people without any other affective disorder (major depression or dysthymic disorder). Otherwise, objective evaluation of these two areas, memory and sleep, did not show differences between the groups. Moreover, in terms of factors such as life satisfaction and some domains from the Short-form 36 Quality of Life Scale (SF-36), subjects with minor depression presented worse self-reported evaluations. Female gender was associated (p=0.01) with a more frequent presence of minor depression disorder, and those with this diagnosis were more likely to have co-morbidity with generalized anxiety disorder (p=0.007) when compared with elderly people without any depressive disorder. CONCLUSION: In this study, minor depression has been significantly associated with lower life satisfaction and worse indexes of life quality. The results supported the current concept that minor depression is prevalent in later life, especially among the oldest-old. Subjects with minor depression had worse self-reported opinions about memory and sleep patterns, but when these variables were objectively measured, no meaningful differences could be determined by the research team. Female gender and the concurring presence of generalized anxiety disorder were both significantly associated with the presence of minor depression diagnosis.

Activities of Daily Living↗
PubMed2002

Chronic insomnia, postmenopausal women, and sleep disordered breathing: part 1. Frequency of sleep disordered breathing in a cohort.

OBJECTIVES: A cohort of postmenopausal women complaining of chronic insomnia for over 6 months and free of hypnotic intake was recruited mostly from the community. Three hundred and ninety-four women were included. The following questions were addressed: How many presents sleep disordered breathing (SDB)? Which type of SDB (upper airway resistance syndrome [UARS] or obstructive sleep apnea syndrome [OSAS]) is the most frequent? Is there a specific upper airway anatomical abnormality in SDB patients predisposing to the syndrome? POPULATION: Subjects were recruited in the community or referred by the Sleep Clinic and all had complaint of chronic poor sleep. METHODOLOGY: First step. Questionnaires, visual analog scales, clinical interview, clinical evaluation with work-up, actigraphy, and ambulatory monitoring were used. Second step. Otolaryngologic evaluation, ambulatory sleep monitoring, and reading of results were used. Subjects negative for SDB at ambulatory monitoring had polysomnography (PSG) with pressure transducer/nasal cannula system and esophageal manometry measurements. RESULTS: Population. Three hundred and ninety-four individuals responded to all entry criteria. Ambulatory monitoring identified 194 subjects with OSAS. Two hundred individuals were not recognized with SDB and were submitted to PSG. This further testing showed that 68 subjects had normal breathing, 62 had UARS, and 100 mild OSAS. Based on otolaryngological evaluation, subjects were classified based on the presence or absence of narrow upper airway, and the location of narrowing was assessed. CONCLUSION: A total of 326 postmenopausal women complaining of chronic insomnia had a SDB, usually with low apnea-hypopnea index (AHI). This total represents about 83% of the studied women. Questions of the role of SDB in the complaint of chronic insomnia are raised.

Aged↗
PubMed2002

Chronic insomnia, premenopausal women and sleep disordered breathing: part 2. Comparison of nondrug treatment trials in normal breathing and UARS post menopausal women complaining of chronic insomnia.

OBJECTIVE: The question addressed here is: Can a discrete sleep disordered breathing (SDB) play a role in the insomnia complaint of postmenopausal chronic insomniacs? To respond to the query, two groups of individuals derived from a cohort of postmenopausal chronic insomniacs recruited mostly from the community were enlisted in a treatment protocol. These subjects were all individuals identified with normal breathing (n=68) and all those recognized with Upper Airway Resistance Syndrome (UARS) (n=62) pooled from a cohort of 349 postmenopausal insomniacs. TREATMENT PROTOCOL: The 62 UARS were allocated to either treatment of chronic insomnia by behavioral approaches or treatment of SDB. Based on ENT evaluation, health professionals in charge of patients selected either treatment with nasal CPAP or treatment of nasal turbinates. A stratification correction was performed to obtain a near equal number of both treatment modalities in each of the two subgroups. The 68 individuals with normal breathing were randomly allocated to immediate behavioral treatment of insomnia or delay treatment of insomnia. The delay treatment received a list of 10 sleep hygiene recommendations by mail. METHODOLOGY: Questionnaires, visual analog scales (VAS), Epworth Sleepiness Scale (ESS), clinical interviews, clinical evaluation with oto-laryngologic clinical assessment of a presence/absence of narrow upper airway and location of narrowing. Actigraphy and polysomnography (PSG) with pressure transducer/and nasal cannula system and esophageal manometry. DATA ANALYSES: All recording data were scored blind to patient's condition. RESULTS: Two subjects in the SBD-CPAP treated group (Group B) and two subjects in the delayed treatment group (Group D) dropped out. Total sleep time was improved compared to baseline in all groups, including the delayed treatment group. One group was significantly better (ANOVA, P=.05) with a more important delta score compared to baseline, and this was the behaviorally treated non-SDB. Sleep latency was significantly decreased in the behaviorally treated group (with or without SBD), P=.05, compared to SBD-treated and delayed treatment groups. Sleep latency was, however, improved in all groups. VAS for "quality of sleep" was higher at 6 months in all the groups when compared to "baseline" values. VAS for "daytime fatigue" showed significant differences among the four groups (ANOVA, P=.01); the overall score at the end of treatment was significantly better in the SDB-treated group than the other three groups. SBD was treated either by radio frequency on nasal turbinate or by nasal CPAP. CPAP-treated patients had a lower VAS score than nasal turbinate treatment, but the difference was only a trend. The delta improvement (6-month baseline condition) in "daytime fatigue" of each subgroup was calculated and compared within and between groups. Despite the small number of subjects, the turbinate-treated subgroup was significantly different from Groups B, C and D (ANOVA, P=.05). When a similar comparison was made with the nasal CPAP group, there was only a nonsignificant trend when compared to Groups B, C and D. CONCLUSION: Abnormal breathing during sleep significantly enhanced complaints of daytime fatigue in postmenopausal chronic insomniacs and this complaint improved with SDB treatment. This improvement is significantly better compared to SDB insomniacs treated with a behavioral regimen. Behavioral treatment, however, gave the best response in the non-SDB chronic insomnia group and improved better long sleep latency even in the SDB group. These results suggest the need to find an appropriate treatment for SBD even if mild and to recognize the role of SDB in relation to symptoms seen with chronic insomnia.

Aged↗
PubMed2002

Sleep and EEG power spectrum in post encephalitis hypersomnia: a case report.

The nocturnal recordings of breathing, and sleep and daytime multiple sleep latency tests over the 5 year follow-up of a patient with post encephalitis hypersomnia are presented. EEG power spectrum analysis was performed on the last polysomnographic recording, and the results were compared with those obtained for a matched control subject. The patient presented initially a hypoventilation syndrome controlled by nasal bilevel positive pressure at night. The syndrome progressively improved, but daytime sleepiness stayed unchanged with limited help from stimulants. Fast Fourier transformation analysis of the last nocturnal recording demonstrates a decrease in absolute power for all frequency bands in all sleep stages, but a cyclical presence of the NREM/REM.

Journal Article↗
PubMed2002

Arousal and upper airway resistance (UAR).

OBJECTIVE: The objective of this study is to investigate upper airway resistance (UAR) in infants and children and presence/absence of electroencephalogram (EEG) arousal. METHODS: Polysomnography with nasal cannula/pressure transducer and esophageal manometry; pattern recognition of sleep disordered breathing (SDB) in children. Identification of visually scored arousals in response to SDB. Power spectrum analysis of EEG associated with SDB. RESULTS: Several breathing patterns and change in heart rate (HR) can be seen with abnormal UAR during sleep. SDB may end with or without visual arousal. Power spectrum analysis shows different EEG patterns with termination of UAR and SDB. HR is also variably modified. CONCLUSIONS: Airway reopening and decline in UAR is associated with variable central nervous system activation and only intermittently with arousals.

Journal Article↗
PubMed2002

Two-point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea syndrome, and normal control subjects.

STUDY OBJECTIVE: To compare the results of a two-point palatal discrimination response in normal subjects (n = 15), patients with obstructive sleep apnea syndrome (OSAS) [n = 15], and patients with upper airway resistance syndrome (UARS) [n = 15] matched for age, sex, and body mass index. DESIGN: Comparison study of three subject groups. SETTING: A sleep-disorders clinic. SUBJECTS: Participants were selected based on clinical questionnaire, clinical evaluation, and polysomnography. INTERVENTION: Polysomnography involving measurement of flow limitation with a nasal cannula pressure transducer system and of respiratory effort with esophageal pressure was performed in order to recognize the presence, absence, and types of sleep-disordered breathing. The 45 subjects were submitted to a two-point palatal discrimination study during wakefulness performed by an investigator blinded to the polysomnogram results. RESULTS: Patients with OSAS had a clear impairment of their palatal sensory input with a significant decrement in two-point discrimination, but patients with UARS and normal control subjects had similar responses. Patients with UARS exhibited at least intermittent snoring in most cases. CONCLUSION: The normal responses seen in patients with UARS indicate that these patients are more capable of transmitting sensory inputs than patients with OSAS. This may be one element explaining the difference in arousal response previously documented in UARS compared to OSAS.

Adult↗
PubMedDate not supplied

Chronic benzodiazepine usage and withdrawal in insomnia patients.

UNLABELLED: We studied the sleep of patients with insomnia during continuous and very long-term use of benzodiazepines (BZDs), and after withdrawal. A group of 25 patients (mean age 44.3+/-11.8 years) with persistent insomnia, who had been taking BZDs nightly for 6.8+/-5.4 years was selected. The control group was comprised of 18 age-matched healthy individuals. Sleep stage parameters were analyzed during Night 1 (while taking BZDs), Night 2 (first night after completing BZD withdrawal), and Night 3 (15 days after gradual BZD withdrawal). Sleep data for control subjects was monitored in parallel. Sleep EEGs of the patients were analyzed using Period Amplitude Analysis (PAA), during Nights 1 and 3 only. During BZD use, a significant reduction of Total Sleep Time (TST) and increased sleep latency were found in the insomniac group when compared to controls. We found an increase in stage 2 non-REM (NREM) sleep, and a reduction in Slow Wave Sleep (SWS) when comparing to night 3 (after withdrawal). Sleep EEGs analysis showed an increase in sigma band and decrease in delta count in stages 2, 3, 4 NREM and REM sleep in the BZD group when comparing to night 3 (after withdrawal). During the BZD withdrawal period, six out of nine subjects taking lorazepam failed withdrawal. In the remaining 19 subjects, gradual withdrawal of BZDs was associated with immediate worsening of nocturnal sleep, as indicated by sleep parameters. However, 15 days after withdrawal (Night 3), some of the sleep structure parameters of patients were not significantly different from baseline (while taking BZDs), except for a significant increase in SWS and in delta count throughout most sleep stages, and a decrease in stage 2 NREM sleep. These values were not different from those shown by control subjects. REM sleep parameters showed no significant variation across the experimental conditions. Subjective sleep quality was significantly improved on Night 3 compared with Night 1. CONCLUSIONS: Chronic intake of BZDs may be associated with poor sleep in this population. A progressive 15-day withdrawal did not avoid an immediate worsening of sleep parameters. But at the end of the protocol, SWS, delta count, and sleep quality were improved compared to those recorded during the chronic BZD intake, despite the lack of change in sleep efficiency.

Adult↗
PubMedDate not supplied

Atypical sexual behavior during sleep.

OBJECTIVE: This article reports a case series of atypical sexual behavior during sleep, which is often harmful to patients or bed partners. METHODS: Eleven subjects underwent clinical evaluation of complaints of sleep-related atypical sexual behavior. Complaints included violent masturbation, sexual assaults, and continuous (and loud) sexual vocalizations during sleep. One case was a medical-legal case. Sleep logs, clinical evaluations, sleep questionnaires, structured psychiatric interviews, polysomnography, actigraphy, home electroencephalographic monitoring during sleep, and clinical electroencephalographic monitoring while awake and asleep were used to determine clinical diagnoses. RESULTS: Atypical sexual behaviors during sleep were associated with feelings of guilt, shame, and depression. Because of these feelings, patients and bed partners often tolerated the abnormal behavior for long periods of time without seeking medical attention. The following pathologic sleep disorders were demonstrated on polysomnography: partial complex seizures, sleep-disordered breathing, stage 3 to 4 non-rapid eye movement (REM) sleep parasomnias, and REM sleep behavior disorder. These findings were concurrent with morning amnesia. CONCLUSIONS: The atypical behaviors were related to different syndromes despite the similarity of complaints from bed partners. In most cases the disturbing and often harmful symptoms were controlled when counseling was instituted and sleep disorders were treated. In some cases treatment of seizures or psychiatric disorders was also needed. Clonazepam with simultaneous psychotherapy was the most common successful treatment combination. The addition of antidepressant or antiepileptic medications was required in specific cases.

Adolescent↗