Excessive daytime sleepiness: from an unknown medical condition to a known public health risk.
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Asian People↗
Biomedical subjects
Leon Rosenthal
Publications and source records attributed to Leon Rosenthal.
The alerting effects of dexamethasone.
The purpose of this study was to characterize the level of sleepiness/alertness following the nocturnal administration of dexamethasone. Thirteen healthy men participated in this study. Following the initial screening, dexamethasone (4 mg) or placebo was administered at 22:30 hr in a randomized double-blind procedure. Subjects were given nap opportunities at 23:00, 1:00, 3:00, 4:30, 5:30, 7:30, 9:30, 11:30, 13:30, 15:30, 17:30, and 19:30 hr. The administration of dexamethasone resulted in an overall lengthening of sleep latency. Although the two groups displayed comparable latencies to stage 1 for the 23:00-7:30 hr nap opportunities, the administration of dexamethasone resulted in significantly longer latencies on the 9:30-19:30 hr nap opportunities. Consistent with these results, participants reported significantly greater levels of alertness on the Stanford Sleepiness Scale. The results of this study revealed greater levels of daytime alertness following the nocturnal administration of dexamethasone.
Adolescent↗
Disturbed sleep predicts hypnotic self-administration.
OBJECTIVES: To evaluative whether polysomnographically determined sleep variables in a large group of subjects reflecting a wide range of sleep disturbance would be predictive of the self-administration of capsules before sleep. METHODS: Sixty-four healthy men and women with and without insomnia (aged 21-55 years) were given an opportunity to self-administer placebo or triazolam (0.25 mg) capsules (single-choice method - available capsule or no capsule) before sleep in three separate studies. All qualified using the identical criteria based on a standard nocturnal polysomnogram. Screening sleep measures then were used to predict subsequent placebo and triazolam self-administration. RESULTS: The percent of placebo and triazolam choices did not differ between or within the three studies. Persons with persistent psychophysiologic insomnia self-administered more capsules than persons with sleep state misperception or normals, with the subject groups not differing in placebo vs. active drug preference. Screening polysomnographic measures predicted percent of capsule choices. The single best predictor was the ratio of minutes of stage 3-4 sleep to minutes of wake plus stage 1 sleep with R=0.44. The addition of % stage 3-4 sleep, wake before sleep and total sleep time increased R to 0.49. On morning mood ratings less ability to concentrate and greater fatigue (Profile of Mood States) predicted percent of capsule choices with R=0.36. CONCLUSIONS: These results show that the extent of sleep disturbance predicts the likelihood of self-administering a capsule before sleep regardless of whether it is placebo or active drug.
Journal Article↗
Tolerance to daytime sedative effects of H1 antihistamines.
Sedation is the principal side effect of first generation H1 antihistamines, and recent studies have suggested that this side effect should limit the clinical application of these drugs. The sedative effect also underlies the use of these first-generation drugs as nonprescriptive remedies for insomnia. In both cases, the potential for tolerance to the sedative effect of these drugs is an important issue for which there are few objective data. In the study reported here, 15 healthy men age 18 to 50 years received either diphenhydramine 50 mg or placebo twice a day for 4 days in a randomized, double-blind, crossover trial design. Dependent measures included objective and subjective assessments of sleepiness and computer-based tests of psychomotor performance. Both objective and subjective measures of sleepiness showed significantly higher levels on day 1 for diphenhydramine compared to placebo. By day 4, however, levels of sleepiness on diphenhydramine were indistinguishable from placebo. Similarly, diphenhydramine produced significant impairment of performance that was completely reversed by day 4. These data provide the first objective confirmation that tolerance develops to the sedative effect of a prototypical first-generation H1 antihistamine, diphenhydramine. On this dosing regimen, tolerance was complete by the end of 3 days of administration. While other antihistamines and dosing regimens may differ, these results suggest that tolerance to the sedation produced by these drugs develops with remarkable rapidity.
Adolescent↗