Morning versus evening hemodialysis.
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Aged↗
Biomedical subjects
Donald L Bliwise
Publications and source records attributed to Donald L Bliwise.
Assessment of sleepiness and unintended sleep in Parkinson's disease patients taking dopamine agonists.
OBJECTIVE: We sought to determine if patients with Parkinson's disease (PD), taking dopamine agonists (DAs) and reporting unintended sleep episodes (SEs), exhibit physiologically defined daytime sleepiness and can thus be differentiated from those taking DAs but not reporting SEs. METHODS: Twenty-four patients with abnormal Epworth Sleepiness Scale scores of >10 who were taking DAs were enrolled into one of two groups: those with SEs (SE+, n=16) and those without (SE-, n=8). Three consecutive days of testing included two nights of polysomnography followed by the Multiple Sleep Latency Test (MSLT). RESULTS: Overall frequency of pathological sleepiness (MSLT <5 min) was 42% (10/24). Mean levels of sleepiness, frequencies of pathological sleepiness, and naps with stage 2 or REM-sleep were similar between SE+ and SE- groups. Sleep tendency was similar in patients prescribed pergolide, ropinirole, and pramipexole combined with levodopa. Polysomnography testing revealed no significant differences between the groups in total sleep time, sleep efficiency, sleep architecture, or presence of restless legs syndrome or periodic leg movements. There was no relation between degree of nocturnal sleep disturbance and level of daytime sleepiness. CONCLUSIONS: The results of this study suggest SEs in PD patients occur upon a background of excessive daytime sleepiness and are unrelated to nocturnal sleep or use of a specific DA.
Circadian Rhythm↗
Daytime sleepiness in stable hemodialysis patients.
BACKGROUND: Patients frequently sleep during hemodialysis (HD), a behavior often attributed to treatment-related fatigue and/or simple boredom. The possibility that this behavior reflects a more pervasive underlying increase in daytime sleepiness has never been systematically examined. Thus, we studied a sample of HD patients on an off-dialysis day to establish the presence or absence of daytime sleepiness independent of effects of treatment, quantify its severity, and identify associated demographic, metabolic, and sleep-related variables. METHODS: Forty-six stable HD patients underwent polysomnography, followed the next day (a nondialysis day) by the Multiple Sleep Latency Test (MSLT; low score = greater sleepiness), a measure of physiological daytime sleepiness. Subjects also completed the Epworth Sleepiness Scale (ESS; high score = greater sleepiness), a measure of subjective daytime sleepiness. RESULTS: One third (n = 15) of subjects had MSLT scores suggesting abnormal levels of physiological daytime sleepiness, and six subjects had scores consistent with severe, pathological sleepiness. Thirty percent (n = 14) had significant subjective daytime sleepiness as measured by the ESS. However, MSLT and ESS scores were unrelated. Higher indices of sleep apnea (r = -0.324; P = 0.028) and brief arousals (r = -0.370; P = 0.009) correlated significantly with increased physiological, but not subjective, sleepiness. Longer nocturnal sleep latencies (r = 0.350; P = 0.017) and greater percentage of rapid-eye-movement sleep (r = 0.302; P = 0.042) were associated with decreased physiological sleepiness. Other major demographic, metabolic, and sleep-related variables did not correlate with MSLT scores, and none of the variables examined were related to ESS scores. CONCLUSION: Daytime sleepiness is common in HD patients and may be severe despite the absence of obvious clinical risk factors for the condition. Thus, research designed to identify cost-effective indicators of daytime sleepiness and evaluate the detrimental effects of sleepiness on clinical outcomes in HD patients is warranted.
Female↗
Sleep apnea, APOE4 and Alzheimer's disease 20 years and counting?
Alzheimer's disease (AD) is acknowledged to be at least partially genetic, and one of the key genotypic markers for this condition is the APOE4 allele. Links between sleep apnea and AD have long been suspected because of mental impairment seen in some sleep apnea patients and possible evidence suggesting higher rates of sleep apnea in some dementia patients. The recent demonstration of an association between the APOE4 genotype and sleep apnea has rekindled further interest in this topic, particularly because sleep apnea is characterized by multiple genetic vulnerabilities. We review here evidence related to associations between sleep apnea and dementia, the role of APOE4 as a likely marker for cerebrovascular disease, and discuss treatment considerations relevant to sleep apnea as a potentially reversible cause of dementia.
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Restless legs complaint in African-American and Caucasian hemodialysis patients.
OBJECTIVES: To compare the prevalence of Restless Legs Syndrome (RLS) symptoms in older African-American and Caucasian chronic renal failure patients undergoing maintenance hemodialysis (HD). BACKGROUND: Few data are available about the prevalence of RLS in racial groups, although it has been suggested that the African-American population is at lower risk relative to the Caucasian population. Chronic renal failure patients on HD are known to be at increased risk for RLS. METHODS: In-person interviews with 308 chronic renal failure patients aged 60-87 living in Georgia being treated by in-center HD. RESULTS: More Caucasian patients than African-American patients reported experiencing RLS symptoms during the past 6 months (68 vs. 48%; P=0.0006). In a logistic regression analysis, African-American patients' reduced risk of RLS complaint was independent of patients' age, gender, education, body mass index (BMI), months on dialysis, diabetes as primary diagnosis, presence of cardiovascular comorbidity, and average number of weekly hours of HD. CONCLUSIONS: Our data suggested a lower prevalence of RLS among older African-American than among older Caucasian patients on chronic HD. Further study is needed to determine whether this difference also occurs in idiopathic RLS and/or at different ages. The possibility of systematic reporting differences related to race should also be considered.
Journal Article↗
Greater daytime sleepiness in subcortical stroke relative to Parkinson's disease and Alzheimer's disease.
Deficits in daytime alertness in the elderly may reflect, in part, deterioration of the critical neural systems modulating circadian control of sleep and wakefulness. In this study, 47 patients with subcortical stroke (n = 9), Alzheimer's disease (n = 6), and parkinsonism (n = 32) underwent a 24-hour in-laboratory evaluation consisting of overnight polysomnography and next-day evaluation of daytime sleep tendency with the Multiple Sleep Latency Test. Patients with stroke were significantly sleepier during the daytime relative to the Parkinson's and Alzheimer's disease patients. Nocturnal sleep parameters did not account for these differences. In the stroke patients, some infarcts occurred in the vasculature, impacting blood supply to the hypothalamus. We interpret these effects as representing functional interruptions of the suprachiasmatic nucleus (SCN). These results are also compatible with a wake-promoting function of the human SCN.
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Resolution of dyshidrotic dermatitis of the hand after treatment with continuous positive airway pressure for obstructive sleep apnea.
Eczema of the palm and obstructive sleep apnea (OSA) are common disorders. Proinflammatory cytokines and cell adhesion molecules are elevated in both of these disorders. We describe an unusual patient with OSA who had recurrent free remission of dermatitis after treatment with continuous positive airway pressure. We speculate that the resolution of the patient's skin condition may reflect the effects of increased tissue oxygenation during sleep, reduced sleep fragmentation, and/or a reduction in sympathetic tone associated with successful sleep apnea treatment.
Cytokines↗