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G Pillar

Publications and source records attributed to G Pillar.

18 recordsLinked to original sources
PubMed1998

Elevated awaking thresholds during sleep: characteristics of chronic war-related posttraumatic stress disorder patients.

BACKGROUND: Sleep disturbances are one of the hallmarks of posttraumatic stress disorder (PTSD); however, sleep laboratory studies have provided inconsistent evidence of the existence of objective sleep disturbances in PTSD patients. Reports that awaking thresholds from sleep in war-related PTSD patients were significantly elevated compared to normals are discordant with complaints of insomnia. The present study investigated the relationship between awaking threshold from REM sleep in war-related PTSD patients and their dream recall, dream content, and clinical condition. METHODS: After informed consent was obtained from 12 PTSD patients and 12 controls, they were investigated by polysomnographic recordings for 4 nights. Awaking thresholds to clicks were determined during 1 night, and dreams were collected during 2 nights. Patients' symptoms were assessed by the Zung and Beck depression scales, Impact of Events Scale, State and Trait Anxiety, and Symptom Check List questionnaires. RESULTS: Although there were no significant differences between sleep data of patients and controls, PTSD patients had significantly higher awaking thresholds. Awaking thresholds were significantly positively related to depression and anxiety scores. Patients' dreams were significantly more aggressive and hostile, and in 6 patients they included explicit war-related contents. The severity of the clinical picture was significantly related to the dreams' scores of aggression-hostility, and to sleep quality variables. CONCLUSIONS: Elevated awaking thresholds from sleep are a characteristic finding in chronic war-related PTSD patients, which may help to explain the diverse sleep laboratory findings in this syndrome.

Adult↗
PubMed1998

Rapid recovery from transverse myelopathy in children treated with methylprednisolone.

Acute transverse myelopathy is an uncommon disease that manifests with gradually developing weakness of the lower extremities associated with bladder or bowel dysfunction, sensory deficits, and pain localized in the back, legs, or abdomen. There are controversies in the literature regarding the role of steroids in the treatment of acute transverse myelopathy. Recently, a pilot open study of five children with acute transverse myelopathy treated with high-dose methylprednisolone demonstrated significant shortening of motor recovery when compared with an historic control group receiving either no treatment or low-dose steroids. The authors add their experience of 10 children with acute transverse myelopathy treated with high-dose methylprednisolone as soon as the diagnosis was confirmed. The median time of motor recovery in the present series was 5.5 compared with 23 days in the other study. No significant side effects were observed after treatment. This study provides further support that this treatment modality is safe and efficient and should be suggested for all children with acute transverse myelopathy after establishing the diagnosis.

Adolescent↗
PubMed1998

Contributions of hypoxia and respiratory disturbance index to sympathetic activation and blood pressure in obstructive sleep apnea syndrome.

Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to be caused by sympathetic hyperactivity. The present study compares the contributions of the respiratory disturbance index (RDI) as a reflection of sleep fragmentation, and the magnitude of oxygen desaturation, to sympathetic activation as indexed by urinary norepinephrine concentrations, as well as to morning and evening blood pressure in sleep apnea syndrome patients. Data (polysomnography, blood pressure [BP], and urine catecholamines) of 38 consecutive OSA patients (age, 46+/-14.5 years) were analyzed. Stepwise logistic regression analysis revealed that minimal oxygen saturation level (SaO2min) was a significant predictor of both morning and evening norepinephrine levels, and that 37% of morning systolic BP variance could be accounted for by a combination of age and norepinephrine, while 20% of the diastolic BP variance was accounted for by SaO2min alone. In contrast, RDI entered the prediction equation only when minimal oxygen saturation was rejected first. Our results indicate that the degree of nocturnal hypoxia is more closely associated with the level of sympathetic activation and with daytime level of blood pressure than with sleep fragmentation.

Adult↗
PubMed1998

Melatonin treatment in an institutionalised child with psychomotor retardation and an irregular sleep-wake pattern.

An institutionalised 13 year old girl with psychomotor retardation suffered from an irregular sleep-wake pattern. Multiple measurements of urinary sulphatoxy-melatonin (aMT6) concentrations were abnormally low, without any significant day-night differences. Administration of exogenous melatonin (3 mg) at 18:00 resulted in increased nocturnal urinary aMT6 concentrations and improvements in her sleep-wake pattern. Melatonin may help disabled children suffering from sleep disorders.

Adolescent↗
PubMed1998

Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index.

BACKGROUND: Previous studies have suggested an association between Sleep Apnea Syndrome (SAS) and several psychiatric disorders such as depression and anxiety. STUDY OBJECTIVE: To evaluate the association of SAS with psychiatric symptoms as determined by the SCL-90 psychiatric questionnaire. METHODS: The study comprised 2,271 patients (1,977 men, 294 women) referred to the Technion Sleep Laboratories with suspected SAS. They completed the SCL-90 Symptom Self-Report Inventory and then underwent a whole-night polysomnographic examination. The study population was stratified into subgroups according to gender, age, and respiratory disturbance index (RDI). RESULTS: Among men, there were no body mass index, RDI, or age-related differences in anxiety, depression, or in any other SCL-90 dimension. The depression and anxiety scores were significantly higher in women than in men for all age groups and for all levels of RDI. The depression score was higher in women with severe SAS than in women with mild SAS, for all ages. Surprisingly, in women who were only simple snorers, the depression and anxiety scores were higher than in mild SAS sufferers, for all age groups. CONCLUSIONS: In our large male population, neither the existence nor the severity of SAS was associated with depression or anxiety. Women had higher anxiety and depression scores, independent of other factors, than men. Women with severe SAS had higher depression scores than women with mild SAS.

Adult↗
PubMed1997

Impaired respiratory response to resistive loading during sleep in healthy offspring of patients with obstructive sleep apnea.

To evaluate the possibility that healthy offspring of patients with obstructive sleep apnea syndrome (OSAS) may have covert signs of sleep disordered breathing, we compared the respiratory response to inspiratory resistive loads (IRL) in 10 adult offspring of fathers previously diagnosed with OSAS with that of 14 offspring of healthy parents. None of the offspring in either group had any sign of OSAS, and groups were age, weight, and body mass index matched. Both ventilatory response to progressively increasing levels of IRL and the IRL required to produce severe hypopnea (tidal volume [V(T)] < 20% of unloaded magnitude) were determined, during NREM sleep. Offspring of patients with OSAS (OSAS offspring) responded to all levels of IRL with greater decreases in V(T). Their V(T) decreased in the second breath on IRL of 23 cm H2O/l/s by 39 +/- 10%, as compared with a decrease of 19 +/- 4% (mean +/- SD) in the control group (p < 0.05). Severe hypopnea occurred in the OSAS offspring in response to smaller IRL compared to controls (79 +/- 20 and 153 +/- 14 cm H2O/l/s, respectively, p < 0.005). Total upper airway occlusion in response to IRL occurred in three of the OSAS offspring, but in none of the controls. We conclude that apparently healthy offspring of patients with OSAS may inherit subtle defects that reduce their ability to compensate for increased loads and maintain upper airway patency during sleep. We speculate that offspring of OSAS patients with decreased tolerance to IRL may be prone to developing OSAS later on in life.

Adolescent↗
PubMed1997

[Narcolepsy].

Explore the source record for details and available documents.

Antidepressive Agents↗
PubMed1996

[Spontaneous pneumomediastinum in a child].

Spontaneous pneumomediastinum results from nontraumatic, mediastinal air leakage, without underlying lung disease. It is an uncommon, but important condition found in healthy young adults and children presenting with chest pain and shortness of breath. It should be considered in the differential diagnosis of chest pain. We present a 12-year-old boy who complained of chest pain and was found to have a spontaneous pneumomediastinum. We suggest that spontaneous pneumomediastinum is underdiagnosed in children.

Chest Pain↗
PubMed1996

Surgical treatment of sleep apnea syndrome.

Several surgical procedures have been developed for the treatment of sleep apnea syndrome. These include nasal, uvulopalatopharyngeal, and head and neck surgery, weight reduction surgery, and tracheostomy. Despite over 15 years of experience with some of these operations, there is still a lack of consensus regarding the indications, success rate, complications, and long-term prognosis associated with these procedures. The current status of these surgical procedures is reviewed.

Adult↗
PubMed1995

Autosomal dominant holocalvarial craniosynostosis.

Isolated holocalvarial synostosis with normal intelligence is described in two pairs of sibs from one kindred. Diagnosis was delayed until the age of 5 years in the pro-band. The gene carriers were asymptomatic and had no head deformity. The genetic pattern is consistent with autosomal dominant inheritance.

Age of Onset↗
PubMed1995

HLA class II analysis in Jewish Israeli narcoleptic patients.

HLA class II was investigated in eight Jewish narcoleptic patients, representing the total of such patients known in Israel at present, and in three patients suffering from sleep disturbances other than narcolepsy. All (11 out of 11) patients carried the serologic specificities DR2, DQ6 (DQ1). At the DNA level, all narcoleptics were found to be DRB1*1501, DQA1*0102, DQB1*0602 which indicates that the susceptibility gene may be located within the HLA class II region, DR, and/or DQ. As for the nonnarcoleptic patients with idiopathic hypersomnia, they carried different alleles of DR2 and DQ6, namely DRB1*1502, DQA1*0103, DQB1*0601. This study confirms that the incidence of narcolepsy in Israel is extremely low and that HLA class II genes or a gene(s) tightly linked to them are involved in the disease.

Alleles↗
PubMed1995

Dilatory effects of upper airway muscle contraction induced by electrical stimulation in awake humans.

During sleep, diminished activity of upper airway dilator muscles (UADMs) is believed to increase upper airway (UAW) resistance and ultimately cause collapse of the UAW. In anesthetized dogs, electrically induced UADM contraction reduces UAW resistance and collapsibility. In this study, we measured the effects of electrically induced contraction of UADMs on pharyngeal resistance (Rph) in seven awake healthy subjects. UAW partial occlusion was achieved by applying external pressure to the submental hyoid region, leading to increased Rph. Transmucosal electrical stimulation (ES) of the base of the tongue was used to preferentially stimulate the genioglossus muscle. Transcutaneous ES using submental and paralaryngeal electrodes were used to preferentially stimulate the geniohyoid and the sternohyoid and sternothyroid muscles, respectively. During the unobstructed state, Rph averaged 6.11 +/- 0.48 cmH2O.l-1.s, and ES produced minimal resistance changes for all stimulation sites tested. In contrast, during the application of external pressure, when Rph was raised to an average of 190 +/- 14% of the baseline value, sublingual ES reduced resistance from 11.67 +/- 1.90 to 6.77 +/- 1.30 cmH2O.l-1.s (P < 0.01). ES at the other sites during the raised Rph state produced only minor statistically insignificant changes in Rph, even when combined submental and paralaryngeal ES was applied. Likewise, only sublingual ES produced measurable anterior movement of the tongue. We conclude that when Rph is raised by exogenous means, sublingual transmucosal ES effectively reduces Rph in awake humans.

Adult↗
PubMed1995

Assessment of the role of inheritance in sleep apnea syndrome.

Several reports have suggested a genetic importance in the pathogenesis of the sleep apnea syndrome (SAS). In this study, all adult (> 16 yr of age) offspring of 45 randomly selected parents with previously diagnosed SAS were asked to undergo a whole-night polysomnographic study. One hundred and five of 120 candidates participated in the study (66M:39F), with a high rate of compliance. Forty-seven percent of the offspring (36 males and 13 females; mean age, 32 yr) were found to have SAS. These results appear considerably higher (p < 0.001) than the common estimation of the prevalence of SAS in the population (4%). Another 21.9% of the offspring were "simple snorers" (17 males and 6 females; mean age, = 26 yr). Thirty-one percent were unaffected (13 males, 20 females; mean age, 29 yr). Only 16% of males over 35 yr of age were unaffected. In the single family studied in which both parents were affected, all three of their children (sons) had SAS: two grandsons older than 16 yr were simple snorers. Considering the well-established prevalence of SAS in the general population (1 to 4%), these results may suggest that SAS is an inherited syndrome.

Adult↗
PubMed1994

Recurrence of sleep apnea without concomitant weight increase 7.5 years after weight reduction surgery.

In this study we report on a long-term follow-up of 14 morbidly obese sleep apneic patients, 11 of whom were male and 3 female. The mean age was 46 +/- 8.5 years. These patients had undergone weight reduction surgery. Before surgery, body mass index (BMI) and apnea index (AI) were 45 +/- 7.2 kg/m2 and 40 +/- 28.8 (SD) h-1, respectively. Four and a half months after surgery (range, 2 to 7 months), both BMI and AI significantly decreased to 33 +/- 7.5 kg/m2 and 11 +/- 16.4 h-1, respectively. Seven and half years after surgery (range, 5 to 10 years), BMI increased only slightly to 35 +/- 6.0 kg/m2 (p > 0.2), while AI increased significantly to 24 +/- 23 h-1 (p < 0.05). There were poor and insignificant correlations between changes in BMI and AI prior to 4.5 months after operation (r = 0.23; p > 0.4). and 4.5 months to 7.5 years after operation (r = 0.41; p > 0.1). We conclude that morbid obesity is not the only causative factor in the sleep apnea syndrome for these patients. Weight reduction surgery alone does not "cure" their sleep apnea, and they are still at risk.

Adult↗
PubMed1992

Amelioration of sleep apnea by salicylate-induced hyperventilation.

It is well documented that upper airway (UAW) muscle activity is augmented in response to increased respiratory drive, the overall effect being an improvement in UAW patency. We have recently shown that salicylate-induced ventilatory stimulation increased UAW muscle electrical activity and decreased UAW resistance and collapsibility in anesthetized dogs. In the present study, we evaluated the effect of respiratory stimulation produced by high therapeutic doses of aspirin on sleep in nine patients with previously diagnosed sleep apnea. A control, all-night, polysomnographic sleep study, including oximetry and ventilatory monitoring by inductive plethysmography, was compared with a second study undertaken after patients ingested 8 to 10 g of aspirin over a period of 4 to 5 h. Aspirin ingestion resulted in high therapeutic salicylate serum levels (33 +/- 2.5 mg/dl, mean +/- SE) the following morning and was associated with marked ventilatory stimulation. Mean sleep duration and the relative partitioning of sleep stages were not affected by aspirin. However, aspirin-induced hyperventilation was associated with a significant non-rapid decrease in periodic breathing and the frequency of both obstructive and mixed apneas in all non-rapid eye movement (REM) sleep stages. The total number of apneas over the whole night was reduced in all subjects and on average fell from a control rate of 42 +/- 7 to 28 +/- 7 apneas/h (p less than 0.01). Similarly, the mean duration of apneas fell from 23 +/- 2 to 20 +/- 1 s (p less than 0.05), and the overall time spent in apneas decreased from 17 +/- 3 to 10 +/- 3 min/h (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗