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Results for “Sleep Disorders, Intrinsic”

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At least 55 records · Page 3Linked to original sources
PubMed2004

The impact of sleep-disordered breathing on cognition and behavior in children: a review and meta-synthesis of the literature.

OBJECTIVES: The goal of this review is to provide a synthesis of the current literature addressing the effects of sleep-disordered breathing on cognition and behavior in children aged 2-18. STUDY DESIGN AND SETTING: A computerized search was performed to include studies between 1966 and 2001. Studies were assessed based on research question, sampling, intervention, outcomes, confounding, and statistical methods. Sensitivity analyses were performed for quantitative assessments of selection bias, misclassification, and confounding. RESULTS: Seventeen reports with 5312 patients were reviewed. The majority of these studies demonstrated poor sampling, insufficient consideration of confounders, and imprecise use of statistical tools. However, there was little evidence of bias in two studies when scrutinized using a sensitivity analysis. CONCLUSIONS: Despite suggested links between daytime behavior problems and neurocognitive deficits, there is little certainty for causality based on the quality of the evidence. SIGNIFICANCE: By discussing the quality of the current evidence, we hope to improve study design and contribute to the development of an understanding of this complex topic.

Adolescent↗
PubMed2006

[Ondine's Curse and rare oculomotor abnormalities: a case report].

Ondine's Curse or congenital central hypoventilation syndrome (CCHS) is a neurocristopathy (failure of migration or differentiation of neural crest-derived precursor cells) and is characterized by hypoventilation or apnea, which is most pronounced during sleep, with no other abnormalities of the neuro-respiratory system. Because of respiratory distress soon after birth, patients must be intubated and ventilated for a long time. This disorder may be associated with other symptoms of neurocristopathy (Hirschsprung disease, neuroblastoma, neuroganglioma) and other abnormalities of the autonomic nervous system (vasomotor dysfunctions or ophthalmic abnormalities: abnormal pupils, insufficient convergence, strabismus, or ptosis). We report the original case of a CCHS patient who presented with alternative ptosis of both the right and left eyes and esotropia. The ocular findings should lead to earlier diagnosis and speedier adequate treatment.

Humans↗
PubMed2002

Childhood-onset epilepsy associated with polymicrogyria.

To study the electroclinical characteristics of patients with childhood-onset epilepsy who showed polymicrogyria (PMG) on MRI, we classified 15 patients according to the location of PMG on MRI. The composition of the subjects was as follows: four patients with PMG in both hemispheres; three with localized PMG in one hemisphere associated with other lesions such as porencephaly; and eight with only localized PMG in one hemisphere. We investigated the electroclinical characteristics of the epileptic syndromes associated with these different types of PMG. Four patients suffered from infantile spasms during their clinical course. Five patients suffered from epilepsy with electrical status epilepticus during slow sleep (ESES) and ESES-related epilepsy. The other six patients had only localization-related epilepsy throughout their clinical course. Patients with PMG in both hemispheres, and localized PMG in one hemisphere associated with other lesions tended to have early-onset intractable seizures, especially infantile spasms. On the other hand, patients with only localized PMG in one hemisphere had ESES and ESES-related epilepsy or localization-related epilepsy, and their seizure prognosis was relatively favorable. These findings are useful in predicting the outcome of patients with PMG.

Adolescent↗
PubMed2005

[Diagnosis of psychological and behavioural disorders in Alzheimer's disease].

Although Alzheimer's disease has long been considered mainly a cognitive disorder, behavioral and psychological symptoms are present from its onset and at all the stages of the disease in most patients. They must be identified from the beginning because they orient the diagnosis. They include affective and emotional disorders, delusions and hallucinations, disorders of instinctual behavior and behavioral problems. The best tool for assessing them is the Neuropsychiatric Inventory (NPI). They are generally related to neurobiological aspects of the disease but may, especially when acute, have multiple etiologies: somatic, iatrogenic, psychological and environmental. They condition the course of the disease. As a source of suffering and reduced quality of the life and as the primary cause of distress for the caregivers and hence of hospitalization and institutionalization, they increase the costs of care. The challenge today is to learn more about them and thus improve their treatment and especially their prevention.

Affective Symptoms↗
PubMed2000

Prednisone as initial treatment of analgesic-induced daily headache.

The majority of the patients who seek medical care in tertiary headache centres present with transformed migraine, and convert to daily headache, as a result of excessive intake of symptomatic medications (SM). This study aimed to analyse the possibility of using a short course of oral prednisone for detoxifying patients with chronic daily headache due to medication overuse in an out-patient setting. Four hundred patients with headache occurring more than 28 days per month for longer than 6 months were studied (mean baseline frequency of 0.96). Symptomatic medications were stopped suddenly and prednisone was initiated in tapering doses during 6 days, followed by the introduction of preventive treatment. Withdrawal symptoms and the frequency, intensity and duration of the headache, as well as the consumption of rescue medications, were analysed during the first 16 and 30 days of withdrawal. Eighty-five percent of the patients experienced a reduction in headache frequency and no patients presented severe attacks during the first 6 days. With regard to the following 10 days, 46% of the patients experienced at least 2 days without headache and 58% less intense attacks. Most of the patients noticed attacks with longer duration. After the 30-day period there was a significant decrease in headache frequency (mean 0.83, P<0.001), and no patients returned to overuse of SM. This study demonstrates that it is possible to detoxify patients suffering from rebound headaches, using oral prednisone during the first days of withdrawal, in an out-patient setting.

Adult↗
PubMed2003

Forced oscillation technique in the sleep apnoea/hypopnoea syndrome: identification of respiratory events and nasal continuous positive airway pressure titration.

Sleep breathing disorders (SBD) are related to obstructions resulting from repetitive narrowing and closure of the pharyngeal airway. Their diagnoses and treatment are critically dependent on an accurate identification of and discrimination between types of respiratory events. However, these disorders have been diagnosed using indirect or invasive measurements, which resulted in serious doubts concerning the correct evaluation of breathing events. The forced oscillation technique (FOT) has recently been suggested as a clinical tool able to accurately and non-invasively quantify respiratory obstruction during sleep. The present study investigates the morphology of the impedance signal during different sleep respiratory events and evaluates the ability of impedance measurements in providing adequate nasal continuous positive airway pressure (nCPAP) titration. The results evidenced characteristic patterns in impedance signal morphology that are useful in the identification and classification of abnormal respiratory events. Moreover, significantly higher impedance values were obtained during apnoea and hypopnoea events when compared with normal values (p < 0.01). Studies using impedance measurements to adjust nCPAP showed a significant reduction (p < 0.01) of abnormal respiratory events, and a consequent normalization of the patients. These findings support the use of the FOT as a versatile clinic diagnostic tool helping SBD diagnosis and treatment.

Airway Resistance↗
PubMed2006

Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study.

Despite mounting evidence that sleep duration is a risk factor across diverse health and functional domains, little is known about the distribution and determinants of sleep. In 2003-2004, the authors used wrist activity monitoring and sleep logs to measure time in bed, sleep latency (time required to fall asleep), sleep duration, and sleep efficiency (percentage of time in bed spent sleeping) over 3 days for 669 participants at one of the four sites of the Coronary Artery Risk Development in Young Adults (CARDIA) study (Chicago, Illinois). Participants were aged 38-50 years, 58% were women, and 44% were Black. For the entire sample, mean time in bed was 7.5 (standard deviation (SD), 1.2) hours, mean sleep latency was 21.9 (SD, 29.0) minutes, mean sleep duration was 6.1 (SD, 1.2) hours, and mean sleep efficiency was 80.9 (SD, 11.3)%. All four parameters varied by race-sex group. Average sleep duration was 6.7 hours for White women, 6.1 hours for White men, 5.9 hours for Black women, and 5.1 hours for Black men. Race-sex differences (p < 0.001) remained after adjustment for socioeconomic, employment, household, and lifestyle factors and for apnea risk. Income was independently associated with sleep latency and efficiency. Sleep duration and quality, which have consequences for health, are strongly associated with race, sex, and socioeconomic status.

Adult↗
PubMed2000

Assessing ambulatory geriatric sleep complaints.

Sleep disturbances afflict more than 50% of adults age 65 and older. Sleep apnea and periodic limb movements of sleep are the primary sleep disorders in the elderly. Patient assessment tools, a thorough physical examination, and appropriate tests can simplify the diagnostic process; sleep center referral is not always warranted. Ultimately, accurate sleep disorder diagnoses can result in decreased geriatric morbidity and mortality, and increased patient quality of life.

Aged↗
PubMedDate not supplied

Variability in clinical phenotype despite common chromosomal deletion in Smith-Magenis syndrome [del(17)(p11.2p11.2)].

PURPOSE: This report delineates the phenotypic features in a cohort of 58 individuals with Smith-Magenis syndrome (SMS) and compares features of patients with the common microdeletion to those of patients with variable sized deletions, and the three previously reported patients who harbor a mutation in RAI1 (retinoic acid induced 1). METHODS: From December 1990 thru September 1999, 58 persons with SMS were enrolled in a 5-day multidisciplinary clinical protocol at the General Clinical Research Center (GCRC), Texas Children's Hospital. Each patient had a cytogenetically evident deletion in 17p11.2. RESULTS: Of the 51 patients in whom the molecular extent of the chromosomal deletion could be delineated by pulsed-field gel electrophoresis (PFGE) and/or fluorescent in situ hybridization (FISH), 39 (approximately 76%) had the common SMS deletion. Smaller or larger deletions were seen in approximately 12% and approximately 10% of patients, respectively, and 1 patient had a complex chromosomal rearrangement including a deletion in 17p11.2. Parent of origin was determined by polymorphic marker analysis in a subset of patients: maternal approximately 43%, paternal approximately 57%. All patients had impaired cognitive and adaptive functioning and had at least one objective measure of sleep disturbance. Other common features (seen in >50% of patients) include short stature, ophthalmological, and otolaryngological anomalies, hearing impairment, abnormal EEG, and scoliosis. Cardiac and renal anomalies were seen in approximately 45% and approximately 19% of patients, respectively. There are no statistically significant differences in the incidence of these abnormalities in patients with the common deletion compared to those patients with smaller or larger sized deletions. CONCLUSIONS: Despite a common deletion size in 76% of patients with SMS, the only constant objectively defined features among these patients are sleep disturbances, low adaptive functioning, and mental retardation. There is no pathognomonic clinical feature, no characteristic cardiovascular defect, renal anomaly, otolaryngological or ophthalmic abnormality in SMS.

Adolescent↗
PubMed2006

Sleep exacerbation of persistent sexual arousal syndrome in a postmenopausal woman.

AIM: To investigate possible causes and treatment of persistent sexual arousal syndrome, which was exacerbated by sleep onset, in a postmenopausal subject. METHODS: A clinical examination and interviews with the patient to obtain her case history and follow-up of the effects of drug treatments. Pretreatment laboratory investigations monitored vaginal blood flow by photoplethysmography and heated electrode. Routine blood chemistry and endocrine assessments were undertaken. Magnetic resonance imaging (MRI) scans of brain, pelvis, and spinal cord and genito-sensory neural analysis of clitoral and vaginal areas were performed. A selective internal iliac artery arteriogram was utilized to check the normality of the pelvic blood supply. RESULTS: Genitalia appeared normal and uncongested. No structural abnormalities were observed in the MRI scans. Hormonal levels and blood chemistry were commensurate with the subject's postmenopausal status. Basal vaginal blood flow (heat electrode) was within the range of normal premenopausal women and showed (photoplethysmography) normal vasomotion. On becoming drowsy and falling lightly asleep in the laboratory the vaginal pulse amplitude (VPA) increased by 95% of the basal value and the low-amplitude VPAs were replaced by high-amplitude VPAs--all evidence of increased vaginal blood flow and congestion and confirming the subject's complaint of persistent sexual arousal during sleep. A simple cognitive task of repeatedly subtracting 7 from 500 out aloud did not hasten the reversion to the basal level. There was no evidence of malfunction of the brain, spinal cord, or pelvic area by MRI but genito-sensory analysis of the clitoral and vaginal area showed evidence of reduced sensory function. CONCLUSIONS: Of the treatments tried only risperidone has been effective allowing the subject to sleep throughout the night without disturbance and according to the subject has significantly reduced the aggravation of the arousal during the day.

Arousal↗
PubMed2001

Are all older adults with persistent pain created equal? Preliminary evidence for a multiaxial taxonomy.

BACKGROUND: Persistent pain is grossly undertreated in older adult sufferers, despite its high prevalence in this age group. Because of its multidimensional impacts, including depression, sleep disruption and physical disability, patients with persistent pain often benefit from interdisciplinary pain clinic treatment. This treatment is expensive, however, and may not be required by all patients. The Multiaxial Assessment of Pain (MAP) has demonstrated value in predicting response to treatment in younger adults with persistent pain. OBJECTIVE: To examine the feasibility of a MAP taxonomy for community-dwelling adults age 65 years or older. PARTICIPANTS AND PROCEDURES: One hundred eight subjects with persistent pain (mean age 73.8 years, SD=8.4 years) were interviewed and data collected on demographics, pain intensity, depressive symptoms, sleep disruption, pain interference with performance of basic and instrumental activities of daily living, frequency of engagement in advanced activities of daily living, cognitive function and comorbidity. A subset of these subjects underwent physical capacities testing, including maximal isometric lift strength, dynamic lifting endurance, timed chair rise and balance. RESULTS: Analyses derived three primary clusters of patients. Cluster 1 (24%) reported less intense pain, less depression and sleep disruption, and higher activity levels. Cluster 3 (30%) suffered from more pain and were more functionally disabled. Cluster 2 (46%) had characteristics of cluster 1 and cluster 3, but with some characteristics that were clearly unique. CONCLUSIONS: While these results are preliminary and require further validation, they indicate that older adults are heterogeneous in their response to persistent pain. Future studies should be performed to examine whether the MAP taxonomy is applicable to older adults regardless of medical diagnosis. Ultimately, this information may have meaning with regard to both treatment prescribing, and the design and interpretation of intervention studies.

Aged↗
PubMedDate not supplied

Overweight hypothesis in asthma and eczema in young adolescents.

BACKGROUND: A positive association between body mass index (BMI) and allergic diseases has recently been suggested; however the sex-dependence of this association remains controversial. The aim of the present study was to explore the relationship between BMI and asthma and eczema, as well as its sex-dependence in young adolescents. METHODS: Self-reported data obtained through the standardized International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three written questionnaires of 2926 young adolescents aged 13-14 years old from randomly selected schools in Skopje (Republic of Macedonia) were used. The BMI for each individual was calculated and used-both unadjusted and adjusted for confounding factors-as a variable for analysis. The international cut-off points for BMI for overweight and obesity by sex and age were used. Because of the very low prevalence of obesity (1.5 %), obese respondents were included in the overweight group. The data were statistically analyzed by the chi-square test, the t-test for independent samples and odds ratios (OR, 95 % CI) in binary logistic regression. RESULTS: Being overweight was significantly associated with an increased risk of having a dry night cough without a cold or chest infection (adjusted OR: 1.54; 95 % CI: 1.09-2.16; p = 0.01) and with having had self-reported asthma at some time (adjusted OR: 2.36; 95 % CI: 1.02-5.44; p = 0.04) in boys only. A significant association between overweight and other symptoms of asthma or atopic eczema was not established. CONCLUSION: These findings suggest a male-specific positive association between overweight and a current dry night cough and having received a diagnosis of asthma at some time. No association was found with other asthma symptoms or atopic eczema in young adolescents.

Adolescent↗
PubMed2001

Sleep and its disturbance in a variant form of late infantile neuronal ceroid lipofuscinosis (CLN5).

To examine the nature of sleep disturbance in patients with a variant form of late infantile neuronal ceroid lipofuscinosis (CLN5), we studied 12 patients (age range 7-32 years). We used a sleep questionnaire to assess sleep and its disturbances quantitatively. To identify the periodicity in the diurnal rest-activity rhythms, the motor activity level was recorded by activity monitors continuously for a 1-week period with concomitant sleep logs. In addition, whole-night polysomnographic recordings were performed. The patients under 20 years of age had an excess of nocturnal sleep (the mean of the usual duration of nighttime sleep was 10.0 hours) and frequent daytime naps. Frequent shifts of the longest sleep period into the daytime hours and fragmented diurnal rest-activity patterns with no distinct rhythm occurred in the older patients. The progressive disease may damage the internal circadian timing system and also impair the ability of patients with variant late infantile neuronal ceroid lipofuscinosis to use external time cues for synchronization of their sleep and environmental time.

Adolescent↗
PubMed2005

Opioids for non-operable osteoarthritis and soft-tissue rheumatism.

Reviews of oral opioid trials have shown that many side-effects need to be considered when treating patients with non-operable osteoarthritis and soft-tissue problems. European and American guidelines recommend their use with or without paracetamol. The controversy surrounding the use of non-steroidal anti-inflammatory drugs/cyclo-oxygenase-2 inhibitors is limiting physician and patient choices. There is a great need for alternative medication or ways of using current compounds.

Acetaminophen↗
PubMed2003

Melatonin acutely improves the neuroendocrine architecture of sleep in blind individuals.

In blind individuals, the absence of light cues results in disturbances of sleep and sleep-related neuroendocrine patterns. The Zeitgeber influence of light on the timing of sleep is assumed to be mediated by melatonin, a hormone of the pineal gland, whose secretion is inhibited by light and enhanced during darkness. Here, we investigated whether a single administration of melatonin improves sleep and associated neuroendocrine patterns in blind individuals. In a double-blind crossover study, 12 totally blind subjects received 5 mg melatonin and placebo orally 1 h before bedtime starting at 2300 h. The dose used enhanced blood melatonin concentrations to clearly supraphysiological levels. Melatonin increased total sleep time and sleep efficiency (P < 0.05, respectively) and reduced time awake (P < 0.05). The increment in total sleep time was primarily due to an increase in stage 2 sleep (P < 0.01) and a slight increase in rapid eye movement sleep (P < 0.06). Most important, melatonin normalized in parallel the temporal pattern of ACTH and cortisol plasma concentration. While after placebo, ACTH and cortisol levels did not differ between early and late sleep, melatonin induced the typical suppression of pituitary-adrenal activity during early sleep and a distinct rise during late sleep (P < 0.01, respectively). Cortisol nadir values were also decreased after melatonin (P < 0.05). We conclude from these data that in totally blind individuals the single administration of a clearly pharmacological dose of melatonin can improve sleep function by synchronizing in time the inhibition of pituitary-adrenal activity with central nervous sleep processes.

Adjuvants, Immunologic↗