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PubMed1997

Quality of life consequences of sleep-disordered breathing.

Sleep-disordered breathing occurs in approximately 2% to 4% of the adult population and includes conditions in which patients stop breathing completely (apnea) or have marked reductions in airflow (hypopnea) during sleep. Typical symptoms of sleep apnea include snoring, restless sleep, excessive daytime somnolence, nocturnal enuresis, irritability, depression, memory deficits, inability to concentrate, and decreased alertness. The clinically relevant outcomes of these symptoms include impairment in work efficiency, increased automobile accident rates, and decrements in quality of life. Treatment of sleep apnea, primarily with continuous positive airway pressure, reduces sleepiness and improves mood disturbances, neurocognition, and performance. Traditional measurements of sleep apnea severity do not correlate well with current tests and scales that are used to quantify alterations in alertness, performance, quality of life, or sleepiness. A disease-specific quality of life scale has been developed following patient and physician interviews and literature reviews. The Calgary Sleep Apnea Quality of Life Index is expected to capture aspects of quality of life important to sleep apnea patients, such as cognitive function, performance, and mood, that could be improved with appropriate treatment of sleep-disordered breathing.

Accidents, Traffic↗
PubMed2000

Post-traumatic stress disorder and sleep-what a nightmare!

According to DSM IV criteria, sleep disturbances are incorporated in the definition of post-traumatic stress disorder (PTSD). These include the re-experiencing symptoms (nightmares, criteria B) and a hyperarousal state (difficulty initiating and maintaining sleep, criteria D). PTSD patients commonly complain of sleep disturbances. Moreover, insomnia, restless sleep and trauma-related dreams might be the primary complaint of some patients. However, although subjective sleep disturbances are considered characteristic of PTSD, sleep laboratory studies have provided inconsistent evidence of objective sleep disorders. A variety of sleep architectures and sleep patterns has been reported in PTSD. However, only a few studies have controlled for comorbidities. Thus, uncertainty exists to what extent the sustained complaints of sleep disturbances in chronic PTSD are specifically related to the impact of exposure to traumatic stress, or rather are a consequence of comorbid disorders. Specific changes in REM sleep suggest a pathophysiologic role of REM sleep abnormality in PTSD (e.g. anxiety dreams, increased REM density, exaggerated startle response, decreased dream recall and elevated awakening thresholds from REM sleep). However, again, studies have failed to show consistent changes in percentage of REM sleep or in REM latency. There might be a coexistence of pressure to REM along with inhibitory forces of REM that result in high variability of REM parameters across patients. Alternatively, changes in REM sleep might reflect the effect of comorbid psychiatric disorders that results in inconsistent findings between patients. The current review tries to address these issues based on recent studies carried out in this field.

Journal Article↗
PubMed2003

An assessment of sleep disturbance in patients before and after total hip arthroplasty.

Patients with osteoarthritis commonly complain of sleep disturbance that may be due to pain. Osteoarthritic hip pain is commonly alleviated by total hip arthroplasty (THA). Forty-eight patients waiting for THA completed a sleep questionnaire and were monitored using actigraphy and sleep diaries for 4 to 5 nights, 1 month before and 3 months after surgery. For the group as a whole, significant improvements were seen in subjective and objective measures of sleep after THA. In this study, 75% of participants reported that their sleep was never or rarely disturbed by hip pain after surgery. Actigraphy indicated significant reductions in time in bed and activity during sleep, more efficient sleep and less fragmented (restless) sleep. Differences between patients aged < 65 and > or = 65 years were observed. These findings support the hypothesis that relief from the pain of osteoarthritis as a result of THA improves sleep quality. Improvements in sleep contribute to the improved quality of life and day-to-day functioning seen after THA.

Adult↗
PubMed2004

Genetic influences in self-reported symptoms of obstructive sleep apnoea and restless legs: a twin study.

Sleep disorders, such as obstructive sleep apnoea (OSA) and restless legs syndrome (RLS), are very common. The relative importance of genetic and nongenetic (environmental) influences on the symptomatology of these conditions has not been well studied. This study uses the twin design to examine this by evaluating OSA and RLS symptoms in monozygotic (MZ) and dizygotic (DZ) twins. Six thousand six hundred unselected female twin pairs, identified from a national volunteer twin register, were asked to complete a medical questionnaire. This questionnaire included questions on OSA and RLS symptoms, as well as questions on subject demographics, past medical history, smoking history and menopausal status. Responses were obtained from 4503 individuals (68% response rate). A total of 1937 twin pairs were evaluable: 933 MZ pairs (mean [range] age 51 [20-76] years) and 1004 DZ pairs (age 51 [20-80] years). Concordance rates were higher for MZ than DZ twins for OSA and RLS symptoms. Multifactorial liability threshold modeling suggests that additive genetic effects combined with unique environmental factors provide the best model for OSA and RLS symptoms. Heritability was estimated to be 52% (95% confidence interval 36% to 68%) for disruptive snoring, 48% (37% to 58%) for daytime sleepiness, 54% (44% to 63%) for restless legs, and 60% (51% to 69%) for legs jerking. These estimates dropped only slightly after adjustment for potential confounding influences on the symptoms of snoring and daytime sleepiness. These results suggest a substantial genetic contribution to the symptomatology of OSA and RLS. More research is needed to identify the genes responsible, and may ultimately lead to new therapies.

Adult↗
PubMed2001

Snoring and obstructive sleep apnea in Thai school-age children: prevalence and predisposing factors.

We studied the prevalence of habitual snoring and its associations with tonsillar size, allergic rhinitis, obesity, and parental smoking, as well as prevalence of obstructive sleep apnea (OSAS) in a sample of 1,142 children aged 6-13 years (mean, 7.25 +/- 0.58) from seven randomly selected schools in Hat yai, Southern Thailand. Eighty-five (8.5%) of the children were habitual snorers; the prevalence was the same in boys and girls. Significant and independent association was present between snoring and allergic rhinitis with an odds ratio of 5.27 (95% CI, 1.57-17.77). The odds ratio was significantly increased to 2.65 (CI, 1.31-5.39), 5.72 (CI, 2.67-12.25), and 11.06 (CI, 1.91-63.84) in children with tonsillar size of 2+, 3+, and 4+, respectively. Of the 85 habitual snorers, 69 could be contacted by telephone call or by hospital visit. Eight of these were reported to have at least one of the following symptoms: difficulty breathing during sleep, stop breathing at night, restless sleeping and frequent awakening, sleeping with the head tipped back, and a tendency to breathe through the mouth rather than the nose. Polysomnographic studies in these 8 children demonstrated an apnea/hypopnea index of 0.6-4.7 per hr. Seven children met the criteria for OSAS. Thus, our estimate of the prevalence of OSAS among Thai schoolchildren was 7/1,008 (0.69%). We have shown that the prevalence of habitual snoring was 8.5%, and the prevalence of OSAS in a sample of Asian school-age children in Southern Thailand was 0.69%, which was similar to that observed in Western populations. An association of snoring with tonsillar size or allergic rhinitis was demonstrated. All but one of the snoring children with sleep-related symptoms had OSAS, but all were mild cases.

Adenoids↗
PubMed2000

Doppler echocardiography in adenotonsillar hypertrophy.

OBJECTIVE: Adenotonsillar hypertrophy causing upper airway obstruction may lead to the pulmonary hypertension and cor pulmonale. This study aimed to clarify the diagnostic methods of this complication, besides polysomnography, to find another objective criterion for surgical intervention and to demonstrate the curative effect of adenotonsillectomy on this complication using this objective criterion. METHODS: We studied the outcomes of 17 children with pulmonary hypertension secondary to the adenotonsillar hypertrophy. Pulmonary arterial pressure measurement was performed noninvasively by Doppler echocardiography. RESULTS: Mean preoperative pulmonary arterial pressure was 29.12+/-4.41 mmHg and decreased dramatically after relief of upper airway obstruction by adenoidectomy and/or tonsillectomy to the normal level of 12.06+/-3.09 mmHg. These results were analyzed by equal variances t-test and found very significant (P<0.01). Regarding the symptoms of upper respiratory obstruction, symptom scores of these children decreased very significantly and were analyzed by equal variances t-test (P<0. 01) in the postoperative period. For all the symptoms individually (snoring, mouth-breathing during sleep and daytime, hyponasal voice, restless sleeping, daytime somnolence, enuresis nocturna), comparing percentages of preoperative and postoperative symptoms by unequal variances t-test, we obtained very significant decrease (P<0.01). CONCLUSIONS: This study illustrates that Doppler echocardiography is a safe, practical and noninvasive-method in diagnosing cardiovascular disturbances--one of the complications of adenotonsillar hypertrophy and especially for measuring the pulmonary arterial pressure. All the symptoms and disorders due to the adenotonsillar hypertrophy may be reversible by performing early adeno- and/or tonsillectomy.

Adenoidectomy↗
PubMed2000

Parent satisfaction 1 year after adenotonsillectomy of their children.

BACKGROUND: Tonsillectomy is one of the most frequent as well as one of the most controversial operations performed in childhood. OBJECTIVE: To assess the expectations of parents before tonsillectomy and to assess their satisfaction 1 year after surgery. STUDY DESIGN: 664 children undergoing (adeno-)tonsillectomy were enrolled in a nation-wide prospective multicenter study. The child's medical history, clinical findings, and indication for tonsillectomy were recorded by the physicians at the time of surgery. The parents were asked to fill out a questionnaire and to list all symptoms from which they expected relief at the time of surgery and to assess the subjective benefit of the surgery 1 year post-operatively. Five-hundred and seventy six of the 664 patients' parents (87%) returned the follow-up questionnaire. RESULTS: 88% of the (adeno-)tonsillectomies were performed because of documented recurrent febrile tonsillitis or obstructive symptoms such as sleep apnea or snoring with restless sleep and daytime irritability. The number of episodes of febrile sore throat dropped from a mean of 6.7 in the year prior to surgery to a mean of 1.5 in the year after surgery (P<0.001). Obstructive symptoms disappeared in 80% of cases, 524 parents (91%) were satisfied with the benefit, 159 parents (28%) regretted not having arranged to have surgery performed earlier. CONCLUSION: Our study shows that parents assess the outcome of tonsillectomy not with regard to one main symptom (e.g. recurrent sore throat) but with regard to a number of complaints. It also shows a high rate (91%) of parent satisfaction after tonsillectomy. For the indications studied, tonsillectomy remains the treatment of choice and should not be delayed or even denied to those children.

Adenoidectomy↗
PubMed1992

Sleep in normal late pregnancy.

Twelve women in their third trimester of pregnancy and 10 age-matched nonpregnant controls underwent complete polysomnography for one night in the laboratory. Seven of the original women returned for a second study 3-5 months postpartum. During late pregnancy, women showed increased wake after sleep onset (WASO) and a lower sleep efficiency in comparison with the control group. The percentage of rapid eye movement (REM) sleep was significantly decreased and the percentage of stage 1 significantly increased compared to the nonpregnant group. At 3-5 months postpartum, a significant reduction in WASO and increased sleep efficiency were noted. However, only a slight increase was noted in REM sleep during the postpartum period compared to the prepartum period. The most frequent sleep complaints in the pregnant group were restless sleep, low back pain, leg cramps and frightening dreams. In summary, in accordance with their complaints, women in their third trimester demonstrated polysomnographic patterns of sleep maintenance insomnia.

Adult↗
PubMed2004

[Management of restless legs and periodic movements of sleep].

INTRODUCTION: Restless legs syndrome and periodic leg movements in sleep are frequently observed, often in association. Misdiagnosis of these two conditions is common. STATE OF ART: Physical examination can provide the diagnosis of restless legs syndrome but polysomnography recording must be performed to confirm the presence of periodic leg movements. Dopaminergic pathways are implicated in the pathophysiology of these two syndromes and the same treatment is given: dopaminergic agents, benzodiazepines, opioids and/or antiepileptic drugs. PERSPECTIVES AND CONCLUSION: Treatment provides an improvement in quality-of-life for these patients.

Anticonvulsants↗
PubMed1989

Effects of lofepramine on human sleep: a pilot study.

The influence on objective and subjective sleep variables and tolerance of lofepramine (140 mg) given as a single night time dose was compared with placebo in a double-blind cross-over study. Four healthy male volunteers on the same 2 nights of 2 consecutive weeks took either lofepramine or placebo in a randomized order. On 2 successive mornings of the third week all subjects took 140 mg lofepramine after breakfast. The main variables were electrophysiological measures of all night sleep. Supplementary, scores on a sleep questionnaire after each night, and scores on a side-effect questionnaire every morning and evening of the experiment were obtained. Lofepramine reduced paradoxical sleep and increased REM latency. There was a tendency for more intra-sleep restlessness but no relevant changes in sleep continuity variables. In these subjects lofepramine did not change subjective judgement of sleep quality and of feeling refreshed after sleep. No side-effects were reported.

Adult↗
PubMed2004

Assessment and treatment of disturbed sleep in attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder affects 3-5% of children in the USA, and is commonly accompanied by disrupted sleep in the form of insomnia, restless sleep or excessive daytime tiredness. In addition, daytime inattention and hyperactivity which mimicks attention deficit hyperactivity disorder can result from intrinsic sleep disorders such as obstructive sleep apnea or periodic limb movement disorder. In most cases, the correct clinical evaluation permits appropriate diagnosis and management. Current research investigating the relationship between attention deficit hyperactivity disorder and sleep, as well as general precepts of clinical assessment and treatment are reviewed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1976

Polygraphic sleep studies in rats and humans: their use in psychopharmacological research.

The effects of selected centrally acting drugs on sleep after single administration to rats and humans were studied using polygraphic sleep recording techniques. D-Amphetamine, a stimulant, had similar effects in both species: reduction of total sleep time, of N(non-)REM- and particularly REM (rapid eye movement)-sleep, increased restlessness during sleep. The psychodepressants mesoridazine and, in particular, nitrazepam had relatively little effects on sleep stages. In doses which did not cause side effects they reduced restlessness during sleep. The most typical effect of the antidepressant imipramine was a dose dependent reduction of REM-sleep duration in both species, without impairment of NREM-sleep. The central dopamine agonist, bromocriptin, had little effect on sleep and did not reduce total sleep and REM-sleep. These examples suggest that polygraphic sleep studies are a sensitive and stable method for the study of centrally acting drugs. The specificity of the model is illustrated by its ability to differentiate chemically and pharmacologically different drug classes. The validity of the model, i.e., its ability to allow predictions from the laboratory conditions to the therapeutic situation, varies in different drug classes. Investigations in normal subjects and animals appear to be relevant for the study of CNS-stimulants, whereas for CNS-depressants studies in sleep-disturbed subjects or animals are more likely to provide dependable results.

Adult↗
PubMed2004

Sleep problems in children with autism.

Autism is a developmental disability characterized by severe deficits in social interaction and communication, and the presence of repetitive-ritualistic behaviors. Sleep problems are frequently reported by parents of children with autism with prevalence estimates of 44-83% for sleep disorders in this population. To better understand sleep in autism, we surveyed sleep problems in 210 children with autism using a Likert-based questionnaire for parent report. The most frequently reported sleep problems included difficulty in falling asleep, restless sleep, not falling asleep in own bed, and frequent wakenings. Least frequently reported sleep problems were sleep walking, morning headaches, crying during sleep, apnea, and nightmares. When surveys were divided into mental retardation (MR)/not MR categories, no significant differences were identified in frequencies of reported sleep problems except for waking at night which occurred much more frequently in the MR group. There was also no difference in sleep problems related to age of the child other than nocturnal enuresis. An association was noted between certain medical problems and sleep problems. Vision problems, upper respiratory problems, and runny nose were associated with decreased nighttime sleep. Vision problems, poor appetite, and poor growth were associated with increased nighttime waking. Poor appetite and poor growth were associated with decreased willingness to fall asleep. This study confirms a high prevalence of sleep problems reported by parents of children with autism and points to the need for more systematic research as an initial step in developing treatment strategies.

Adolescent↗
PubMed2005

Brief report: An epidemiologic survey of the prevalence of sleep disorders among children 2 to 12 years old in Beijing, China.

OBJECTIVE: This survey was conducted to examine the prevalence of sleep disorders in 2- to 12-year-old children in the Beijing area of China. METHODS: From October 2001 to June 2002, 5979 children 2 to 12 years old in 6 randomly selected counties in Beijing were investigated with questionnaires. RESULTS: The average total sleep time per day ranged from 11.38 hours among 2-year-olds down to 9.34 hours among 12-year-olds. The overall prevalence of sleep disorders was 21.2% and included parasomnia symptoms (bruxism [6.5%], sleep talking [4.9%], enuresis [1.0%], sleepwalking [0.6%], restless sleep [5.0%], and leg movements [1.9%]) and symptoms of sleep-disordered breathing (frequent snoring [5.6%], mouth breathing [4.1%], choking/gasping [0.9%], and breathing pauses [0.2%]). CONCLUSION: The overall prevalence of parent-reported symptoms of sleep disorders in a large sample of children in Beijing, China, was comparable to that reported in other countries, although the prevalence of some specific symptoms differed somewhat.

Child↗
PubMed1996

Periodic limb movements of sleep and the restless legs syndrome.

Periodic limb movements of sleep and the restless legs syndrome are not diagnoses but rather an indication that there is some CNS disturbance and are associated with an ever-growing number of conditions. They are very common, exist in many forms and are often overlooked by physicians. It is the author's opinion that they are parts of what has been called an akathisia syndrome in the most severe situations and may include the same mechanisms that underlie attention disorders, chronic fatigue syndrome and "sun-downing." They are likely parts of a syndrome caused by dysfunction in a complex brainstem center. This center's normal function is to maintain a smooth electrical template on which discrete neuronal impulses sculpture the rich repertoire we recognize as sensory and motor function awake and to effect a smooth "switching" mechanism allowing sleep to occur without motor and sensory input invading consciousness (awakening). While the DA-ergic CNS pathways have been thought to be the primary neurotransmitter involved, the opioids secondary, there is mounting evidence that the situation is far more complicated, that many neurotransmitter, including stimulating and inhibiting amino acids, play a part. These patients agonize with their indisposition but can be helped by various treatments. Treatment alleviates not only the distress caused by the symptoms but also the devastating insomnia and excessive daytime sleepiness associated with it.

Acetates↗
PubMed2005

Periodic limb movements and other movement disorders in sleep: neuropsychiatric dimensions.

Movement disorders such as Parkinson's disease and Tourette's syndrome, primarily manifest during wakefulness, intrude into sleep. There are some disorders, however, such as periodic limb movements in sleep, restless legs syndrome, paroxysmal nocturnal dystonia, bruxism, and somnambulism, which occur primarily during sleep. The diagnosis and management of these disorders pose a challenge to neuropsychiatric practice, not only because they may be difficult to distinguish from other neuropsychiatric disorders, but also because psychiatric disorders are often co-morbid with them. Study of these disorders is necessary for an understanding of the interaction of sleep and movement, and how disturbance in one may affect the other.

Adult↗
PubMed1990

Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children.

61 snoring children selected for adenotonsillectomy, mainly for recurrent tonsillitis, were compared with a matched group of 31 healthy children for symptoms of sleep apnoea, extent of sleep hypoxaemia, and amount of sleep disturbance. The studies were repeated six months postoperatively, and after six months in the healthy children. Preoperatively, 61% of the children had degrees of sleep hypoxaemia above normal and 65% had abnormally disturbed sleep. A questionnaire administered to the parents about their children showed abnormal patterns of answers about sleep problems daytime sleepiness, hyperactivity, aggression, learning difficulties, restless sleep, and odd sleeping positions. After adenotonsillectomy, the abnormal hypoxaemia, excessive sleep disturbance, and multiple symptoms almost resolved; a growth spurt also occurred.

Adenoidectomy↗