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Biomedical subjects

Donald L Bliwise

Publications and source records attributed to Donald L Bliwise.

At least 19 recordsLinked to original sources
PubMed2007

Utility of the Algase Wandering Scale in an outpatient Alzheimer's disease sample.

BACKGROUND: Wandering represents a major problem in the management of patients with Alzheimer's disease (AD). In this study we examined the utility of the Algase Wandering Scale (AWS), a newly developed psychometric instrument that asks caregivers to assess the likelihood of wandering behavior. METHODS: The AWS was administered to the caregivers of 40 AD patients and total and subscale scores were examined in relation to measures of mental and functional status, depressive symptoms and medication usage. RESULTS: AWS scores were comparable, though slightly lower, than those normative values previously published. Higher scores were associated with more severe dementia. The Negative Outcome subscale showed a significant increase in reported falls or injuries in association with anti-depressant use. CONCLUSIONS: These data provide some construct validation for the AWS as a potentially useful scale to assess wandering behaviors in AD.

Accidental Falls↗
PubMed2006

A secondary analysis of racial differences in periodic leg movements in sleep and ferritin in hemodialysis patients.

BACKGROUND AND OBJECTIVE: Hemodialysis (HD) is associated with restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS), but the mechanisms underlying these relationships remain unclear. African-American HD patients have been reported previously to have a reduced likelihood of RLS. Alterations in iron metabolism, known to be a risk factor for idiopathic forms of RLS, could represent the basis for these racial differences. PATIENTS AND METHODS: In secondary data analyses from a previously published study, we examined raw and log-transformed values for plasma ferritin and polysomnographically recorded PLMS in Caucasian and African-American HD patients. RESULTS: African-American (n=36) HD patients had higher ferritin and lower PLMS than Caucasians (n=10). However, within the African-American population, ferritin levels were unrelated to PLMS. CONCLUSIONS: These results are compatible with previously reported racial differences in RLS to the extent that PLMS were less common in the African-American population. However, they suggest that if a differential genetic vulnerability underlies those racial differences, it may not manifest as a deficiency in iron metabolism, at least within the constraints of the marker of iron stores used here (e.g. serum ferritin) and in the specific population studied (hemodialysis). Future studies with larger, more representative samples of African-Americans and Caucasians will be required to replicate such differences.

Adult↗
PubMed2006

Effect of supine knee position on obstructive sleep apnea.

We previously reported a case of a middle-aged man whose obstructive sleep apnea (OSA) was virtually eliminated when he slept in the supine "knees up" position. In this study, we attempt to replicate this phenomenon in a group of volunteers with previously diagnosed OSA. Results indicated no significant improvement in OSA when sleeping supine knees up. Examination of distribution of within subjects' change [calculated as Respiratory Disturbance Index (RDI) in the "knees down" position vs RDI in the knees up position] indicated a trend for improvement in the latter (p=0.12, two-tailed probability). These results suggest that knee position is unlikely to be a robust intervention for OSA though they allow for the possibility that some patients may have a moderation of their condition by such a manipulation.

Female↗
PubMed2006

Quantification of electromyographic activity during sleep: a phasic electromyographic metric.

Recording of electromyographic (EMG) activity is considered essential for defining rapid eye movement (REM) sleep and for quantifying certain types of movements in sleep, such as periodic leg movements in sleep (PLMS). However, routine analyses of EMG activity beyond such purposes is performed rarely and quantified seldom, and normative data are lacking. In this study, the authors examined systematic application of a visual scoring system for short-duration (approximately 100-millisecond) phasic EMG activity recorded from five different muscle groups (submentalis, left/right anterior tibialis, left/right brachioradialis) recorded from two different age groups of normal subjects and a group of patients with Parkinson's disease. Quantification of this activity was labeled as a phasic electromyographic metric (PEM). PEM data were compiled separately by REM and non-REM sleep. Results indicated that PEM is a normal part of REM sleep in all muscle groups, more specifically constituting about 5% (SD = 3.1%) of 2.5-second intervals of REM sleep in the mentalis in healthy young adults. It occurs at higher rates in patients with Parkinson's disease, and its quantification in the legs may be influenced to some degree by the presence of PLMS. PEM may be a useful metric amenable to quantification with digital techniques. It may have particular relevance for the identification of neurodegenerative conditions in which disinhibition of midbrain dopaminergic pathways results in excessive motor discharge during sleep.

Adolescent↗
PubMed2006

A nonpharmacological intervention to improve sleep in nursing home patients: results of a controlled clinical trial.

OBJECTIVES: To improve nighttime sleep in nursing home patients. DESIGN: Controlled clinical trial. SETTING: Eight community nursing homes enrolled two at a time. PARTICIPANTS: Of 1,077 patients assessed in the eight nursing homes, 638 (59%) were eligible, and consent was obtained for 273 (43% of those eligible). Of the 230 who underwent baseline assessments, 173 completed the immediate-intervention phase of the trial (77 in the intervention group and 96 in the control group). A total of 160 subjects completed the intervention (77 in the immediate-intervention group and 83 in the delayed-intervention phase). INTERVENTION: Trained research staff provided the intervention, which included daytime physical activity and attempts to keep subjects out of bed, evening bright light exposure, a consistent bedtime routine, nighttime care routines designed to minimize sleep disruption, and strategies to reduce nighttime noise. Subjects from one nursing home received the intervention (Group 1), whereas subjects in the second nursing home served as a control group (Group 2); then Group 2 received the intervention. MEASUREMENTS: Primary outcomes included measures of sleep recorded using wrist actigraphy in all subjects and polysomnography in a subgroup of subjects. Secondary measures included assessments of mood and behavior using the Neuropsychiatric Inventory, the Geriatric Depression Scale, and behavioral observations. RESULTS: There were no significant differences in any of the primary actigraphic sleep outcome measures between the intervention and control group after the immediate-intervention phase of the trial. In the 160 subjects who completed the intervention, there were no significant changes in any actigraphic measure of nighttime sleep, nor were there any significant changes in measures of sleep in the 45 subjects who had baseline and intervention polysomnography. CONCLUSION: This multicomponent, nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients. Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible. Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials.

Aged↗
PubMed2006

Prolonged assessment of sleep and daytime sleepiness in unrestrained Macaca mulatta.

STUDY OBJECTIVE: To establish a method for the prolonged recording of electrophysiologic variables of sleep in freely moving nonhuman primates. To establish and validate means for scoring nocturnal sleep and quantifying daytime alertness in these subjects. DESIGN: Four animals (M. mulatta) were permanently instrumented for the recording of electroencephalograms, electrooculograms, and electromyograms. A telemetry unit housed in a backpack transmitted these variables for several overnight periods to establish normal sleep. During the day, a modified Multiple Sleep Latency Test protocol was followed to quantify daytime alertness. High-quality recordings were maintained from a minimum of 8 months to a maximum of 5.5 years. MEASUREMENTS AND RESULTS: Across 6 to 7 nights per animal, average total sleep time was 522 minutes, with a sleep latency of 20 minutes. The proportion of total sleep spent in the various stages of sleep was 10.8%, stage 1; 56.4%, stage 2; 20.0%, stages 3-4; and 12.7%, rapid eye movement sleep. Mean sleep latency across testing sessions for each monkey was 12.5 minutes, 20 minutes (no daytime sleep), 14.6 minutes, and 8.6 minutes for animals 1 to 4, respectively. Intrarater and interrater reliabilities were high and similar to those obtained when the same scorers evaluated human sleep and Multiple Sleep Latency Tests. CONCLUSIONS: Similarities in sleep architecture between M. mulatta and humans make this an excellent animal model for investigations of normal and pathologic human sleep. This study confirms and extends previous findings in nonhuman primates. Stable, high-quality data were obtained for months to years using a telemetric system capable of long-term data collection.

Animals↗
PubMed2005

Polysomnographic measures of nocturnal sleep in patients on chronic, intermittent daytime haemodialysis vs those with chronic kidney disease.

BACKGROUND: Numerous factors probably contribute to the high prevalence of sleep problems in haemodialysis (HD) patients including metabolic changes and treatment-related factors. In contrast, the sleep problems of patients with chronic kidney disease (CKD) may be more related to psychological factors rather than the metabolic changes associated with renal disease. Thus, the objective of this study was to compare polysomnographic measures of nocturnal sleep in a group of stable patients on chronic, intermittent daytime HD and an age- and gender-matched, metabolically comparable group with CKD, and evaluate the role that quality of life (including psychological factors) and the effects of treatment may play in sleep outcomes. METHODS: The sample included 16 patients on HD and eight patients with CKD all of whom were free from other significant physical and psychological morbidity. To assess for psychological, functional, family and economic responses to the disease and treatment, all subjects took the Ferrans and Powers Quality of Life Index. HD subjects received treatment three times a week and were adequately dialysed [Kt/V >1.2, equivalent to a weekly glomerular filtration rate (GFR) of 10-15 ml/min]; CKD subjects had an estimated GFR of 14.5 (+/-7.2; range 5.4-28.8) ml/min. All subjects underwent one night of laboratory-based polysomnography. Appropriate statistical procedures were used to explore group differences in sleep variables and their relationship to quality of life dimensions and the effect of treatment. RESULTS: The CKD patients reported significantly poorer functional and psychological quality of life; both groups had reduced total sleep time and sleep efficiency in comparison with normative data. However, HD subjects had less rapid eye movement sleep (P = 0.032). They also had a higher brief arousal index (P = 0.000), an independent predictor of which was treatment with HD, and respiratory disturbance index (P = 0.061). Less total sleep time, increased wake after sleep onset, lower sleep efficiency, higher periodic limb movement index, and longer latencies to sleep onset and rapid eye movement sleep were also noted in the HD group. Quality of life scores did not predict sleep variables in this small sample. CONCLUSIONS: The results suggest that the sleep problems of patients with CKD and those receiving chronic, intermittent daytime HD may have different aetiologies; functional and psychological factors may play a more prominent role in the former group, while intrinsic sleep disruption (arousals, apnoeas and limb movements) secondary to the effects of chronic, intermittent daytime HD may play a more significant role in the latter. The findings suggest that further exploration is warranted and that population-specific sleep-promoting interventions may be indicated.

Adult↗
PubMed2005

Age changes in timing and 24-hour distribution of self-reported sleep.

OBJECTIVE: Aging has been associated with increased nocturnal awakenings, increased napping, earlier bedtimes and wake-up times, and more regular sleep-wake schedules. These patterns have often been ascribed to both psychosocial and medical factors, but nearly all studies to-date have been cross-sectional. METHODS: The authors present self-reported sleep data from 31 elderly subjects followed over a decade. RESULTS: With aging, the number of nightly awakenings and daytime napping increased over time. Exploratory analyses suggested that individuals who lived with another person had earlier bedtimes, later wake-up times, and greater daytime napping. Intervening medical comorbidities also appeared to be associated with increased napping. CONCLUSION: These results confirm previous cross-sectional studies and suggest a complex biopsychosocial matrix for the timing and placement of sleep in elderly persons within the 24-hour day.

Adolescent↗
PubMed2004

Genetic and environmental influences in sleep-disordered breathing in older male twins.

STUDY OBJECTIVES: To estimate the extent to which genetic factors contribute to the variation in several indices of sleep-disordered breathing in elderly male twins. DESIGN AND SETTING: A biometric genetic study based on data from unattended Edentrace recordings in a sample of elderly male twins. PARTICIPANTS: 122 World War II male veteran twin pairs, including 68 monozygotic pairs aged 78.9 (+/- 2.7) years and 54 dizygotic pairs aged 78.4 (+/- 2.4) years. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The average (+/- SD) respiratory disturbance index for this sample was 17.2 +/- 14.5, the average (+/- SD) oxygen desaturation index was 18.8 +/- 16.4, and the average (+/- SD) minimum SaO2 level was 79.6 +/- 8.1%. Intraclass twin-pair correlations for log-transformed respiratory disturbance index were 0.59 in monozygotic pairs and 0.36 in dizygotic pairs. For oxygen desaturation index, intraclass correlations were 0.44 in monozygotic pairs and 0.24 in dizygotic pairs. For minimum SaO2, intraclass correlations were 0.38 and 0.11, respectively. Maximum likelihood estimates of heritability with associated 95% confidence intervals were 37% [22%, 52%] for respiratory disturbance index, 36% [19%, 53%] for oxygen desaturation index, and 10% [0%, 30%] for minimum SaO2. Adjustments of sleep-disordered breathing measures for age, body mass index, and waist and neck circumference had minimal effect on estimates of heritability. CONCLUSIONS: The present data indicate that sleep-disordered breathing, even in old age, is determined, in part, by genetic factors.

Aged↗
PubMed2004

Polysomnographic correlates of spontaneous nocturnal wetness episodes in incontinent geriatric patients.

STUDY OBJECTIVE: To examine polysomnographic correlates of spontaneously occurring nocturnal wetness episodes (NWEs) in incontinent geriatric patients. DESIGN: Cross-sectional, descriptive study. SETTING AND PARTICIPANTS: Subjects were 27 long-term nursing home residents known to be incontinent at night who were studied polysomnographically for 1 (n = 22) or 2 (n = 5) nights in their own rooms. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Traditional polysomnographic measurements were supplemented with a wetness monitor with a relay switch worn inside a diaper. A total of 106 NWEs were recorded, with approximately one third of all originating from sleep (non-rapid eye movement = 31; rapid eye movement = 4). Of the 106 total episodes, 11 (10.4%) began during a sleep-disordered breathing (SDB) event and 43 (40.6%) commenced within 60 seconds of termination of a breathing event. Urine volumes were calculated by weighing the diaper before and after each NWE. Volumes were significantly lower in NWEs originating during SDB events (127.1 mL vs 163.9 mL, t = 2.09, P < .05). CONCLUSIONS: These results demonstrate that in a geriatric nursing-home population, many NWEs arise specifically from sleep and do not simply represent nocturnal voids made in response to difficulties in ambulation and arising from bed. A relatively large proportion of NWEs were related to SDB. Although SDB may be associated with nocturnal diuresis, the lower urine volumes associated with NWEs co-occurring with SDB raise the possibility that mechanical factors, such as downward displacement of the diaphragm exerting pressure on the detrusor, may contribute to urine leakage during sleep in such patients.

Aged↗
PubMed2004

Improvement in obstructive sleep apnea in the supine knees-up position.

We report a 38-year-old man with obstructive sleep apnea whose sleep-disordered breathing was substantially reduced by sleep in the supine, "knees-up" position, relative to his sleep in the customary supine, "knees-down" position. No obvious anatomic or pathophysiologic alterations explained this phenomenon. The effect was reproducible in the patient 4 years later. Potential mechanisms underlying such improvement, including alterations in upper airway/lung volume dependence and venous supply to upper airway vasculature, are discussed. This manipulation could be an important adjunctive treatment for a subset of obstructive sleep apnea patients demonstrating such an effect.

Adult↗
PubMed2004

Sleep disorders in Alzheimer's disease and other dementias.

Patients with dementias, such as Alzheimer's disease (AD), often have nocturnally disrupted sleep. Clinically, this may present as agitation during the nighttime hours, which may affect as many as a quarter of AD patients during some stage of their illness. Sleep disturbance in AD may be multifactorial and involve sleep-disordered breathing and disrupted chronobiology, both often characterized by excessive daytime napping. Polysomnographically, AD patients show decreased rapid eye movement (REM) sleep in proportion to the extent of their dementia; some evidence suggests that cholinesterase inhibitors, commonly used pharmacologic agents for cognitive loss in AD, may increase REM sleep measures. Unfortunately, such agents may also induce insomnia and vivid dreams. There have been no randomized clinical trials of sedative-hypnotic medications specifically targeted at AD patients with sleep problems. Evidence suggests that sedative-hypnotics, such as benzodiazepine site-specific agonists, may have a role in some cases, whereas atypical antipsychotics may be necessary in other cases. There are also reports of successful interventions with nonpharmacologic options (eg, exercise, illumination). The utility of melatonin as a hypnotic in this population appears equivocal.

Accidental Falls↗
PubMed2004

Sleep-disordered breathing and nocturia in older adults.

OBJECTIVES: To investigate the relationship between sleep-disordered breathing (SDB) and nocturia episodes in community-dwelling older adults. DESIGN: A cross-sectional study. SETTING: Community. PARTICIPANTS: Community-dwelling older adults (N=72) recruited from independent living facilities and adult learning centers in Atlanta, Georgia. MEASUREMENTS: Three-day voiding diary, ambulatory sleep recording, focused physical examination, Epworth Sleepiness Scale, and Geriatric Depression Scale. RESULTS: Fifty-eight of the 72 subjects completed the study. The mean age+/-standard deviation was 77.7+/-6.7; 44 (76%) were female. Of the 58 subjects, 26 (45%) had an apnea-hypopnea index (AHI) of less than 10 per hour of sleep, 21 (36%) had an AHI between 10 and 24 per hour sleep, and 11 (19%) had an AHI of 25 or higher per hour of sleep. The mean nocturia episodes were 1.7+/-1.1, 1.6+/-0.9, and 2.6+/-1.4 for subjects in these groups, respectively (F=3.82; P=.028). Those with an AHI of 25 or higher had more nocturia episodes, higher mean arterial blood pressure, and higher body mass index than those with a lower AHI. CONCLUSION: These results suggest that older adults with severe SDB have a greater number of nocturia episodes. These findings underscore the importance of considering SDB as a differential diagnosis in the evaluation of older patients with nocturia.

Aged↗
PubMed2004

Association of denture use with sleep-disordered breathing among older adults.

OBJECTIVE: This study investigates the relationship between sleep-disordered breathing and denture use. METHODS: This was a cross-sectional study of community-dwelling older adults. Information about denture use was obtained using a questionnaire. Ambulatory sleep recording in subjects' homes was performed using Embletta PDS (Medcare, Iceland). Chi-square tests and logistic regression analysis were used for statistical analysis. RESULTS: A total of 58 subjects completed the study. The mean apnea hypopnea (AHI) index was 15.1+/-16.1. Twenty-two subjects (38%) used dentures and most removed them before sleep. There was significant association between denture use and AHI > or = 15 per hour of sleep (odds ratio [OR]=6.29; 95% confidence interval [CI]= 1.71, 23.22; P=.006). CONCLUSIONS: This preliminary study found an association between sleep-disordered breathing and denture use, which may represent a proxy for a relationship between sleep-disordered breathing and edentulism. Given the common occurrence of both conditions among older adults, the observed relationship warrants a more detailed investigation of the mechanisms whereby loss of teeth leads to upper airway closure during sleep.

Age Factors↗
PubMed2004

Linking race and well-being within a biopsychosocial framework: variation in subjective sleep quality in two racially diverse older adult samples.

Differential life experiences associated with race may critically affect the balance between physical and psychological well-being. This study investigated an age-related and disease-related symptom, restless sleep, among older African American and white members of two sociodemographically matched cohorts, community-dwelling older adults and older adults with chronic renal failure undergoing maintenance dialysis therapy. Sleep behaviors reflect age-dependent and disease-dependent homeostatic and circadian state regulation but are also socioculturally patterned. As hypothesized, restless sleep was significantly more characteristic of the older adults in the chronic disease cohort. With non-renal health conditions, depressed mood, perceived health, medication use, and sociodemographic variables controlled, however, African Americans were significantly less likely than whites in the chronic disease cohort to report restless sleep. African American and white patients differed in their expression of public and private religiousness, which in turn were associated, respectively, with depressed mood and restless sleep complaint. In addition, we suggest that differences for African American and white patients in the environmental exposure of chronic dialysis therapy, including African Americans' greater social integration within the dialysis treatment setting, contributed to their being less at risk than their white peers for subjective perception of sleep decay, a marker of overall well-being.

Black or African American↗
PubMed2003

Nocturnal sleep, daytime sleepiness, and quality of life in stable patients on hemodialysis.

BACKGROUND: Although considerable progress has been made in the treatment of chronic kidney disease, compromised quality of life continues to be a significant problem for patients receiving hemodialysis (HD). However, in spite of the high prevalence of sleep complaints and disorders in this population, the relationship between these problems and quality of life remains to be well characterized. Thus, we studied a sample of stable HD patients to explore relationships between quality of life and both subjective and objective measures of nocturnal sleep and daytime sleepiness METHODS: The sample included forty-six HD patients, 24 men and 22 women, with a mean age of 51.6 (10.8) years. Subjects underwent one night of polysomnography followed the next morning by a Multiple Sleep Latency Test (MSLT), an objective measure of daytime sleepiness. Subjects also completed: 1) a brief nocturnal sleep questionnaire; 2) the Epworth Sleepiness Scale; and, 3) the Quality of Life Index (QLI, Dialysis Version) which provides an overall QLI score and four subscale scores for Health & Functioning (H&F), Social & Economic (S&E), Psychological & Spiritual (P&S), and Family (F). (The range of scores is 0 to 30 with higher scores indicating better quality of life.) RESULTS: The mean (standard deviation; SD) of the overall QLI was 22.8 (4.0). The mean (SD) of the four subscales were as follows: H&F - 21.1 (4.7); S&E - 22.0 (4.8); P&S - 24.5 (4.4); and, F - 26.8 (3.5). H&F (rs = -0.326, p = 0.013) and F (rs = -0.248, p = 0.048) subscale scores were negatively correlated with periodic limb movement index but not other polysomnographic measures. The H&F subscale score were positively correlated with nocturnal sleep latency (rs = 0.248, p = 0.048) while the H&F (rs = 0.278, p = 0.030) and total QLI (rs = 0.263, p = 0.038) scores were positively associated with MSLT scores. Both of these latter findings indicate that higher life quality is associated with lower sleepiness levels. ESS scores were unrelated to overall QLI scores or the subscale scores. Subjective reports of difficulty falling asleep and waking up too early were significantly correlated with all four subscale scores and overall QLI. Feeling rested in the morning was positively associated with S&E, P&S, and Total QLI scores. CONCLUSION: Selected measures of both poor nocturnal sleep and increased daytime sleepiness are associated with decreased quality of life in HD patients, underscoring the importance of recognizing and treating these patients' sleep problems.

Female↗