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Biomedical subjects

J D Edinger

Publications and source records attributed to J D Edinger.

At least 37 records · Page 2Linked to original sources
PubMed1995

Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients.

Technology for conducting ambulatory polysomnography (APSG) has been available for more than a decade, but relatively few studies have used this technology to study the sleep of subjects in their usual home sleeping environments. Herein we suggest the usefulness of this technology for the study of normal sleepers and insomniacs, and we report our APSG findings with a large cohort (n = 117) of drug-free insomnia outpatients. All patients completed a sleep-history questionnaire, a clinical interview with a sleep-disorders clinician, and one night of APSG in their homes. Most sleep parameters derived were consistent with previously reported laboratory PSG findings for insomniacs, except that values of rapid-eye-movement sleep latencies were generally shorter than typically found in laboratory studies. Moreover, results showed that APSG served to differentiate major age groups and diagnostic subtypes within our larger sample, and patient tolerance for APSG was within acceptable limits. We conclude that APSG is a useful technique for evaluating insomnia complaints.

Adult↗
PubMed1994

Psychological status, syndromatic measures, and compliance with nasal CPAP therapy for sleep apnea.

38 male patients with obstructive sleep apnea were asked to complete 2 weeks of rating symptoms, physical examination, diagnostic polysomnography, and MMPI testing prior to being placed on nasal continuous positive airway pressure (CPAP) therapy. Six months later, 26 (72.2%) of the 36 subjects available for follow-up showed continued compliance. A regression analysis conducted with those 28 subjects who completed all pretreatment measures showed that continued therapy was predicted by such pretreatment measures as patients' body mass index, ratings of daytime sleepiness and nocturnal sleep quality, and MMPI Depression and Hypochondriasis scale scores (R2 = 0.63). Eventual compliers had a higher Body Mass Index, reported less daytime sleepiness and better nocturnal sleep quality, and scored lower on the MMPI D and Hs scales prior to treatment than did the noncompliers. A linear discriminant function analysis with analog cross-validation showed these five predictors would identify approximately 80% of eventual noncompliers and 97% of those who display compliance. It was concluded that subjective report and personality measures may be useful in predicting long-term use. Additional studies are needed to assess the clinical significance of the noted MMPI scale elevations among sleep apnea patients in general and among those patients who display eventual noncompliance.

Adult↗
PubMed1993

Aerobic fitness, acute exercise and sleep in older men.

In the current study 12 aerobically fit and 12 sedentary older men underwent two nocturnal polysomnographic (PSG) studies. A control PSG was conducted following a day without aerobic activity, whereas a postexercise PSG study was conducted following an afternoon session of exhaustive aerobic exercise. In addition to deriving usual sleep parameters, a computer scoring program was used to count the number of individual electroencephalographic (EEG) slow waves in each PSG tracing. Multivariate and univariate analyses showed that the fit subjects had shorter sleep onset latencies, less wake time after onset, fewer discrete sleep episodes, fewer sleep stage shifts during the initial portion of the night, less stage 1 sleep, a higher sleep efficiency and more total slow waves during both PSGs than did the sedentary subjects. Although no main effects were found for the acute exercise challenge, post hoc analyses showed that high levels of body heating during exercise predicted increased sleep fragmentation for both fit and sedentary subjects. These findings provide initial support for the contention that exercise and fitness may have significant effects on the sleep of older men. However, results also suggest that high levels of body heating resulting from a single exercise challenge may have adverse effects. Implications of the study are discussed and suggestions for future research are provided.

Age Factors↗
PubMed1993

Use of in vivo desensitization to treat a patient's claustrophobic response to nasal CPAP.

Continuous positive airway pressure (CPAP) has proven to be a safe, effective treatment for sleep apnea patients. However, many patients display claustrophobic reactions to the CPAP nasal mask and cannot tolerate this treatment. The current report describes the successful application of in vivo desensitization with a male apnea patient who initially failed CPAP therapy due to his claustrophobia. Over the course of treatment, the patient became able to tolerate using his CPAP device throughout his nocturnal sleep periods. Moreover, follow-up visits scheduled 6 months and again at 6 1/2 years after behavioral treatment showed that the patient continued to use CPAP on a regular basis. It is concluded that in vivo desensitization therapy may be useful in assisting claustrophobic patients to tolerate nasal CPAP. Results are discussed in view of the specific features of the case presented, and future applications of this behavioral procedure are encouraged.

Adult↗
PubMed1992

A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults.

Older adults (3 men, 4 women, aged 55 to 68 years) with chronic sleep-maintenance insomnia were treated sequentially with relaxation therapy (RT) and then with a cognitive-behavioral therapy (CBT) specifically designed for alleviating sleep maintenance problems. Sleep diaries and an objective measure of sleep, the sleep assessment device, showed only modest improvements in measures of wake time after sleep onset, sleep efficiency, and night-to-night sleep variability following RT. However, significant improvements in these measures were observed following CBT and at a 3-month follow-up. These findings, considered in conjunction with previous reports, suggest that CBT specifically addresses factors that sustain sleep maintenance complaints. Additional trials of CBT with larger samples are warranted.

Aged↗
PubMed1992

Ambulatory polysomnography: technical aspects and normative values.

Ambulatory polysomnographic (APSG) assessment of sleep disorders is now possible, but the technique of APSG is sufficiently different from in-laboratory PSG that normative data from in-laboratory PSG may not apply to APSG. This paper reviews the technical aspects of APSG and presents normative APSG data from 20 older healthy males. Subjects underwent medical and psychiatric screening before completing APSG in their homes. Total sleep time and the rapid-eye-movement sleep latency (RL) were both shorter than those reported by others using traditional in-laboratory techniques. The shorter total sleep may be related to behaviors at home that impinge upon sleep. The shorter RL may be related to differences in calculation methods. Periodic limb movements were common in our subjects but did not contribute to sleep disturbance. We conclude that APSG is sufficiently different from traditional PSG as to warrant collection of a large normative data base.

Ambulatory Care↗
PubMed1992

Subjective total insomnia: an example of sleep state misperception.

Sleep state misperception (SSM) is the diagnostic term proposed in the International Classification of Sleep Disorders to describe those insomniacs who mislabel their sleep as wakefulness. Although sleep misperception has long been recognized among insomnia patients, it is debatable whether this clinical finding warrants a distinctive diagnosis or simply represents an extreme variation of other, more common forms of insomnia. We present two cases to explore the clinical meaningfulness of SSM. It is concluded that SSM represents a distinctive, albeit rare, sleep disorder. However, refinements in existing diagnostic criteria may be needed to improve the meaningfulness of the SSM diagnosis.

Adult↗
PubMed1992

Periodic limb movement variability in older DIMS patients across consecutive nights of home monitoring.

Older difficulty initiating and/or maintaining sleep (DIMS) patients who met criteria for periodic limb movement disorder (PLMD) were monitored for three consecutive nights in their homes using ambulatory polysomnography (PSG). Correlational analyses of the group data suggested little night-to-night variability in either movement indices or movement-related arousal indices for this sample. However, within-subjects comparisons suggested considerable variability in these indices and other sleep measures across nights. Nevertheless, for most subjects, the variability noted for these indices appeared to have little effect on PLMD severity classification or clinical treatment decisions derived from blind examinations of PSGs. Further, the initial PSG study generally led to a representative severity classification and clinical decision. Additional research is needed to determine the generalizability of these results to younger subjects, patients with complaints of excessive somnolence and other methods of home PSG monitoring.

Age Factors↗
PubMed1991

Neurological findings in insomniacs with periodic limb movements.

This study investigates the relationship between abnormal neurologic findings and periodic limb movements (PLMs). Neurologic abnormalities were found to be statistically related to the occurrence of PLMs on polysomnographic study. The neurologic abnormalities may represent a risk factor for PLMs independent of age.

Adolescent↗
PubMed1991

Sleep variability across consecutive nights of home monitoring in older mixed DIMS patients.

Twenty patients with difficulties initiating and maintaining sleep (DIMS) were monitored in their homes for three consecutive nights using ambulatory polysomnography (PSG). Following each night of monitoring, patients provided subjective ratings of sleep disturbance and tolerance of the PSG equipment. Friedman analyses of variance performed on the objective and subjective parameters showed that the sample, as a whole, evidenced no systematic first night effects (FNE) in response to monitoring. Inspection of the data from each individual subject, nevertheless, showed that half of the sample did experience multiple FNE. Further, several scales from the Minnesota Multiphasic Personality Inventory discriminated those patients who showed multiple FNE from those who did not. However, far more striking was the finding that clinically and statistically significant intrasubject variability across nights was observed for each sleep parameter measured. Given this finding, a single ambulatory PSG study may not fully convey the nature of the sleep disturbance experienced by the DIMS patient even when FNE are absent. We thus, recommend multiple ambulatory sleep studies for those clinical and research situations in which it is necessary to document patients' night-to-night sleep variability. In contrast, when the goal of the PSG study is that of determining a sleep diagnosis, a single ambulatory study, in combination with other clinical data, may be sufficient.

Aged↗
PubMed1990

Daytime functioning and nighttime sleep before, during, and after a 146-hour tennis match.

Two adult males (ages 31 and 35 years) were studied while they participated in a week-long marathon tennis match under conditions of extreme sleep restriction (4-5 h reductions per night). Polysomnographic monitoring was conducted on the two nights prior to the marathon, continuously throughout the match, and on two recovery nights. In addition, measures of daytime sleepiness, mood state, and cognitive performance were obtained during the course of the study. Despite undergoing marked sleep restriction, both players continued to obtain their usual (baseline) amounts of slow wave sleep throughout the marathon. Both players showed a gradually increasing tendency toward daytime dozing across the first few days of the marathon. This tendency decreased on the fifth day but increased again on the sixth day of the match. Also, both players showed a pre- to postmatch decline on some cognitive measures. However, the players differed markedly in their ratings of sleepiness, mood ratings, recovery sleep patterns, and endurance with respect to the demands of the match. Results appear to be consistent with previous laboratory studies in documenting the primacy of the "slow wave sleep drive." Given the marked differences observed between the players, research designed to identify factors that predict response to sleep loss seems to be warranted.

Adult↗
PubMed1989

Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value.

This investigation examined the diagnostic value of polysomnography (PSG) for evaluating disorders of initiating and maintaining sleep (DIMS). The sample consisted of 100 outpatients who presented to the Duke Sleep Disorders Center with a complaint of chronic insomnia. All patients were given comprehensive medical, psychiatric, behavioral, and ambulatory PSG evaluations. Sleep disorder diagnoses were assigned using the criteria of the Association of Sleep Disorders Centers. Overall, PSG yielded important diagnostic information in 65% of the sample: 34% were given a primary sleep disorder diagnosis that was heavily dependent on PSG data [periodic movements of sleep (PMS) = 25%, apnea = 3%, and subjective insomnia = 6%]; 15% were given a secondary diagnosis of one of these three disorders; and PSG ruled out suspected PMS in 9% and sleep apnea in 7% of the sample. Patients greater than 40 years of age had a significantly higher rate of positive PSG findings than younger patients. Using only the clinical exam, two experienced sleep clinicians were able to predict only 14 of 25 PMS cases and one of three cases of sleep apnea. Based on these data, we suggest using PSG routinely with older insomniacs and with younger patients who fail initial treatment.

Adult↗
PubMed1988

Treatment of sleep-maintenance insomnia in older adults: sleep period reduction, sleep education, and modified stimulus control.

We evaluated a behavioral treatment package consisting of sleep period restriction, sleep education, and modified stimulus control in the treatment of sleep-maintenance insomnia in older adults. A multiple baseline design was used with 4 chronic insomniac subjects, ages 59, 65, 65, and 72. Sleep diaries and an objective behavioral measure of sleep were used to monitor improvement. Results revealed clinically significant reductions in time awake after sleep onset in 3 subjects, coincident with the initiation of treatment. These improvements were maintained at 2- and 6-month follow-ups. The 4th subject showed little improvement; however, a polysomnogram conducted on this subject at the end of the study revealed a fragmented sleep pattern secondary to periodic movements of sleep (nocturnal myoclonus). These encouraging but preliminary results call for further controlled evaluations of the efficacy of this behavioral treatment package for sleep-maintenance insomnia. The importance of conducting polysomnographic studies on elderly insomniacs is discussed.

Aged↗