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Biomedical subjects

M J Thorpy

Publications and source records attributed to M J Thorpy.

At least 19 recordsLinked to original sources
PubMed1995

Sleep-related laryngospasm.

Seven patients (mean age 46.6; range 33-58; 6M,1F) presented with sleep-related choking episodes and were found to have features in common that distinguished them from other known causes of choking episodes during sleep. The characteristic features include: an awakening from sleep with an acute choking sensation, stridor, panic, tachycardia, short duration of episode (less than 60 seconds), infrequent episodes (typically less than 1 per month), and absence of any known etiology. The disorder most commonly occurs in middle-aged males who are otherwise healthy. In one patient an episode of laryngospasm was polysomnographically documented to occur during stage 3. The clinical features and the polysomnographic findings suggest spasm of the vocal cords of unknown etiology.

Adult↗
PubMed1994

Sleep disorders: simple or complex?

The diagnosis may be as simple as sleep deprivation or a more complex, mixed disorder, such as obstructive sleep apnea complicated by a CNS abnormality. At least 65 primary sleep disorders have been identified. Polysomnographic and other sleep evaluations may be indicated to guide diagnosis and treatment.

Adolescent↗
PubMed1994

Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial.

Three diagnostic classifications for sleep disorders have been developed recently: the International Classification of Sleep Disorders (ICSD), the Diagnostic and Statistical Manual, 4th edition (DSM-IV), and the International Classification of Diseases, 10th edition (ICD-10). No data have yet been published regarding the frequency of specific diagnoses within these systems or how the diagnostic systems relate to each other. To address these issues, we examined clinical sleep disorder diagnoses (without polysomnography) in 257 patients (216 insomnia patients and 41 medical/psychiatric patients) evaluated at five sleep centers. A sleep specialist interviewed each patient and assigned clinical diagnoses using ICSD, DSM-IV and ICD-10 classifications. "Sleep disorder associated with mood disorder" was the most frequent ICSD primary diagnosis (32.3% of cases), followed by "Psychophysiological insomnia" (12.5% of cases). The most frequent DSM-IV primary diagnoses were "Insomnia related to another mental disorder" (44% of cases) and "Primary insomnia" (20.2% of cases), and the most frequent ICD-10 diagnoses were "Insomnia due to emotional causes" (61.9% of cases) and "Insomnia of organic origin" (8.9% of cases). When primary and secondary diagnoses were considered, insomnia related to psychiatric disorders was diagnosed in over 75% of patients. The more narrowly defined ICSD diagnoses nested logically within the broader DSM-IV and ICD-10 categories. We found substantial site-related differences in diagnostic patterns. These results confirm the importance of psychiatric and behavioral factors in clinicians' assessments of insomnia patients across all three diagnostic systems. ICSD and DSM-IV sleep disorder diagnoses have similar patterns of use by experienced clinicians.

Adolescent↗
PubMed1994

Diagnostic concordance for DSM-IV sleep disorders: a report from the APA/NIMH DSM-IV field trial.

OBJECTIVE: The frequency and ranking of DSM-IV sleep disorder diagnoses of clinical patients with complaints of insomnia, as well as rates of diagnostic agreement and disagreement between two types of interviewers, were investigated. METHOD: Interviewers at five clinical sites assessed 216 patients referred for insomnia complaints. One sleep specialist and one general clinician interviewed each patient in an unstructured clinical interview, assigned DSM-IV diagnoses, and indicated their reactions to the diagnostic system. RESULTS: Insomnia due to another mental disorder was the most frequent DSM-IV diagnosis across sites, followed by primary insomnia. Interviewers at the five sites differed significantly in the rankings they assigned to different diagnoses. In addition, sleep specialists at most sites diagnosed psychiatric forms of insomnia more frequently than nonspecialists. Kappa values for agreement between the two types of clinicians on multiple DSM-IV sleep diagnoses ranged from 0.26 to 0.80 across sites, indicating moderate agreement overall. Kappa values for individual diagnoses varied across sites and specific diagnoses and ranged from poor to excellent. Interviewers' ratings of their confidence in diagnoses and the fit and ease of use of the DSM-IV categories also showed significant variability related to site and type of interviewer. CONCLUSIONS: The distribution of diagnoses highlights the importance of psychiatric and behavioral factors in the assessment of insomnia. Site-related variability indicates a need for greater standardization in the application of sleep disorder diagnostic criteria. Diagnostic concordance for these diagnoses, while only moderately good, likely reflects actual clinical practice and would be improved through the use of standardized (or structured) interviews and increased training.

Adult↗
PubMed1992

Short-term triazolam use improves nocturnal sleep of narcoleptics.

This study was undertaken to determine whether the use of triazolam by narcoleptic patients leads to improvement of nighttime sleep or excessive sleepiness. Ten narcoleptic patients, 5 males and 5 females, with complaints of sleep disturbance and aged between 18 and 60 years, were assigned to a single-blind within-subject crossover-designed study comparing placebo with 0.25 mg triazolam. All subjects completed sleep questionnaires and underwent 6 nights of polysomnographic testing. Following an adaptation night, subjects received either triazolam or placebo for 2 nights. Objective tests of sleepiness (multiple sleep latency testing/maintenance of wakefulness test) were performed. Sleep efficiency and overall sleep quality were improved on all triazolam nights. Daytime excessive sleepiness was not reduced objectively after triazolam. This study demonstrates that the short-term use of triazolam improves nocturnal sleep quality in narcoleptics. Studies of long-term administration of triazolam are required to determine if the improvement of nocturnal sleep is maintained.

Adult↗
PubMed1992

T-sleep: an improved method for scoring breathing-disordered sleep.

We developed a new method to score sleep fragmented by respiratory events that we call the T-sleep (transitional sleep scoring) method. Five control polysomnograms from subjects without sleep-related breathing abnormalities were scored by the Rechtschaffen and Kales (R&K) method, and 10 polysomnograms from patients with severe obstructive sleep apnea were scored by both the R&K and the T-sleep method. Comparative analyses were performed on sleep variables of the control and apnea polysomnograms, and interscorer correlations were assessed for sleep and apnea variables. The interscorer correlations were high for both R&K control scoring and for apnea recordings scored by the T-sleep method. The number of sleep stage events documented for the 10 apnea recordings was significantly less for the T-sleep method than the R&K method (36, SD 17.0 vs. 332, SD 144.0; p = 0.0002). The T-sleep method was shown to be an effective, accurate and quick method for scoring sleep in patients with sleep-related breathing disorders.

Adult↗
PubMed1990

The use of sleep studies in neurologic practice.

Polysomnographic studies have been shown to be useful in the diagnosis of many sleep disorders, particularly those associated with impaired respiration during sleep or impairment of daytime alertness. As with any test, unless it is performed under ideal conditions, the amount of information obtained may be limited. Because of the interaction between nighttime sleep and daytime alertness, disorders associated with impaired alertness usually require at least 24-hour assessment. The polysomnogram and MSLT, although detailed and time consuming, are essential for the accurate diagnosis of many sleep disorders. If a primary sleep disorder is suspected, polysomnographic testing, particularly early in the patient's evaluation, may obviate unnecessary neurologic and medical tests, which yield little information in the assessment of disorders of sleep and wakefulness.

Circadian Rhythm↗
PubMed1990

Effects of otolithic vestibular stimulation on sleep.

This study evaluated the effects of otolithic vestibular stimulation in the form of a linearly accelerated parallel swing on nighttime sleep parameters and daytime sleep tendency in eight normal subjects. The protocol consisted of one adaptation night following by two motion nights, one adaptation night followed by two stationary nights, and two Multiple Sleep Latency Tests (MSLT), one motion and one stationary. On the motion nights, there was a decrease in stage 2 percentage as well as a facilitative effect on sleep latency on the last night. In addition, an increase in the number of rapid eye movements (REMs) per night was found without a significant alteration of REM sleep amount or latency. No significant differences were found between the motion and stationary MSLT days.

Adaptation, Physiological↗
PubMed1990

Classification of sleep disorders.

This review discusses recent developments in classifying the sleep disorders. Several classification systems are presented, and the Diagnostic Classification of the Sleep and Arousal Disorders (DCSAD), published by the Association of Sleep Disorders Centers in 1979, is used as the basis for reviewing their differences. The four main sections of the DCSAD are presented: the disorders of initiating and maintaining sleep, the disorders of excessive somnolence, the sleep-wake schedule disorders, and the dysfunctions associated with sleep, sleep stages, or partial arousals. Disorders discovered since the publication of the DCSAD are mentioned along with the new nomenclature of the International Classification of Sleep Disorders, due to be published in 1990. References are given to the original clinical descriptions and nomenclature.

Disorders of Excessive Somnolence↗
PubMed1988

Delayed sleep phase syndrome in adolescents.

The delayed sleep phase syndrome is characterized by difficulty in falling asleep at a socially acceptable time of night and an inability to be easily aroused in the morning. Most commonly encountered in adolescents, this condition can produce daytime sleepiness and poor school performance, and it can lead to behavioral problems. The clinical features of the syndrome are described in 22 adolescents. Nine subjects participated in a protocol of polysomnographic recordings to simulate habitual "weekday" and "weekend" sleep patterns. There was a significant increase in total sleep time (p less than 0.005) and REM sleep (p less than 0.001) during the "weekend" sleep period. A multiple sleep latency test was performed between the two nights to assess daytime sleep tendency. Daytime sleepiness was maximal in the morning, with a tendency for greater alertness as the day progressed. The reduced amount of REM sleep during the "weekdays" plus the tendency for sleepiness in the mornings may contribute to the behavioral and educational difficulties seen in these patients. Recognition of this syndrome enables a specific sleep schedule change to be made that effectively treats the problem.

Adolescent↗
PubMed1988

Effect of growth hormone treatment on sleep EEGs in growth hormone-deficient children.

Total sleep time, sleep stages 1-4, REM, REM latency, and sleep efficiency were analyzed in seven children with growth hormone deficiency (GHD) before and after growth hormone (GH) therapy. Before GH therapy, GHD children spent 19.5% of their total sleep time in REM sleep, 9.7% in stage 1, 41.0% in stage 2, 10.0% in stage 3, and 19.7% in stage 4. GHD children had more stage 1 and 3 sleep and less REM as compared with age-matched normal children reported by Williams et al. After GH therapy was initiated, six of the seven patients had decreases in the duration of stage 3 sleep, with an average decrease of 21.8 min. The difference between stage 3 sleep before and during GH treatment was significant, with a p value of less than 0.025. When the results were expressed as the percentage of the total sleep period, the difference was also significant, (10.0 +/- 2.0 to 7.5 +/- 3.1%, mean +/- SD; p less than 0.05). No other sleep parameters were significantly affected by GH therapy. The changes observed in stage 3 sleep, non-REM sleep, and the lack of any other changes in sleep before and after GH therapy have not been described before in GH-deficient children. They differ from studies in normal humans and animals which showed that REM sleep increased with administration of growth hormone. These differences suggest that GH deficiency is associated with a specific sleep EEG anomaly that is corrected in part by GH therapy.

Child↗
PubMed1987

Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea.

Obstructive sleep apnea may lead to disordered sleep architecture and impair the physiologic slow wave sleep related growth hormone release. Obstructive sleep apnea occurs with craniofacial syndromes and in children with airway narrowing, pharyngeal hypoplasia, tonsillar adenoidal hypertrophy, micrognathia and achondroplasia. To examine the relationship between disordered sleep and growth hormone release we studied a 9 year old male with achondroplasia, growth failure (3 cm/year) and obstructive sleep apnea. Polysomnography data and a 20 min sampling for sleep entrained growth hormone showed before therapeutic tracheostomy numerous apneic episodes, absent slow wave sleep and abnormal low growth hormone secretion during sleep. Normalized slow wave sleep entrained growth hormone secretion after tracheostomy led to a sustained increase in growth rate. Normal growth rate (greater than 5 cm/year) continues 2 years after tracheostomy. We conclude that obstructive sleep apnea may impair sleep related growth hormone release. Obstructive sleep apnea may be a useful model for other diseases in which growth failure and sleep disturbances are linked.

Achondroplasia↗
PubMed1987

Parasomnias.

This article presents four examples of parasomnia activity. Sleepwalking, sleep terror, and rhythmic movement disorder all occur more commonly in children; however, they can persist into adulthood. REM behavior disorder frequently occurs in elderly patients with neurologic lesions. The sleep stage associations of the different disorders differ. Two of the disorders, sleepwalking and sleep terrors, have a clear association with stage 3/4 sleep, and REM behavior disorder occurs in REM sleep. Rhythmic movement disorder episodes can present solely in REM sleep but more typically occur in light non-REM sleep, and there are usually voluntary episodes during wakefulness.

Adolescent↗
PubMed1987

Treatment of chronic insomnia by restriction of time in bed.

A treatment of chronic insomnia is described that is based on the recognition that excessive time spent in bed is one of the important factors that perpetuates insomnia. Thirty-five patients, with a mean age of 46 years and a mean history of insomnia of 15.4 years, were treated initially by marked restriction of time available for sleep, followed by an extension of time in bed contingent upon improved sleep efficiency. At the end of the 8-week treatment program, patients reported an increase in total sleep time (p less than 0.05) as well as improvement in sleep latency, total wake time, sleep efficiency, and subjective assessment of their insomnia (all p less than 0.0001). Improvement remained significant for all sleep parameters at a mean of 36 weeks after treatment in 23 subjects participating in a follow-up assessment. Although compliance with the restricted schedule is difficult for some patients, sleep restriction therapy is an effective treatment for common forms of chronic insomnia.

Analysis of Variance↗