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PubMed1980

Sleep disturbances in a series of elderly patients: polysomnographic findings.

A group of 27 elderly patients with complaints of either chronic insomnia or excessive daytime sleepiness were studied in the Sleep Evaluation Center of Western Psychiatric Institute and Clinic during the period January 1977-June 1979. On the basis of anamnestic data from patients and bedroom partners, together with polysomnographic findings, sleep disturbances were classified according to the nosology of the Association of Sleep Disorders Centers. Of the 27 patients, 19 had disorders of initiating or maintaining sleep (DIMS), 7 had disorders of excessive somnolence (DOES), and 1 had parasomnia (episodic nocturnal wandering). Of the 19 DIMS patients, two-thirds had either a primary affective disorder (depression) or a persistent psychophysiologic disturbance. Of the 7 DOES patients, 6 had a primary sleep disorder such as a sleep apnea syndrome or narcolepsy-cataplexy. Additional electroencephalographic sleep data are presented on elderly patients with primary nonpsychotic depression. The latency of rapid eye movements (REM) in the depressed patients was shorter (p less than 0.05) than in patients with a persistent psychophysiologic disturbance. The percentage of REM sleep was significantly elevated (p less than 0.05) in the depressed group, and intermittent wakefulness was decreased (p less than 0.01). The causes of sleep disturbance in the elderly are both heterogeneous and complex. The need for accurate differential diagnosis and a multiaxial approach is stressed.

Aged↗
PubMed2000

Clinical trials of controlled-release melatonin in children with sleep-wake cycle disorders.

This is the first study to examine effective doses of controlled-release (CR) melatonin in children with chronic sleep wake cycle disorders. All 42 subjects had severe neurodevelopmental difficulties. Initially, a randomized double-blinded cross-over design was used in 16 children, comparing the effectiveness of fast-release (FR) and CR melatonin. In the remainder of the patients, the CR melatonin was studied on a clinical basis. The effectiveness of treatment was assessed by sleep charts and clinical follow-up. Emphasis was placed on the judgement of the parents, who had guidance from the physicians. The average final CR melatonin dose in the 42 patients was 5.7 mg (2-12 mg). The studies showed that the FR melatonin was most effective when there was only delayed sleep onset, but CR formulations were more useful for sleep maintenance. Children appeared to require higher doses than adults.

Adolescent↗
PubMed1984

Disorders of sleep and wakefulness.

This article provides information on the background and development of "sleep disorders medicine" and sleep disorders centers and a discussion of obstructive sleep apnea, narcolepsy, sleep-related periodic leg movements, and the use and misuse of hypnotic medication.

Humans↗
PubMedDate not supplied

Diagnosis of rapid eye movement sleep disorder with electroencephalography and treatment with tricyclic antidepressants in a dog.

A 9-month-old, female Labrador retriever mix was presented for two types of seizure-like episodes, one of which occurred only during sleep. The two types of episodes were morphologically distinct. An electroencephalogram (EEG) demonstrated that the sleep-associated episodes occurred during rapid eye movement (REM) sleep, supporting a diagnosis of a REM behavior disorder. Based on their morphology and response to antiseizure medications, the waking episodes were diagnosed as seizures. The animal was also diagnosed with an obsessive-compulsive and generalized anxiety disorder. The REM behavior disorder and anxiety-related behaviors improved with tricyclic antidepressant therapy.

Animals↗
PubMed1992

A combined behavioral/pharmacological treatment of sleep-wake schedule disorder in Angelman syndrome.

Angelman syndrome (AS) is a genetic disorder associated with a deletion on chromosome 15. Behavior problems among children with AS include sleep difficulties. Data are presented on the successful treatment of a sleep-wake schedule disorder (SWSD) in a 9-year-old boy with AS. The treatment program included behavioral and pharmacological components. During baseline, the child slept a mean of 1.9 hours per night and 1.3 hours during the day; night sleep was increased to a mean of 8.3 hours and day sleep was reduced to a mean of .08 hours after introduction of the full-treatment program. Medication was discontinued subsequently, and the child slept a mean of 7.8 hours during the night and .07 hours during the day. At 45-day follow-up, night sleep was maintained at 7.1 hours and day sleep remained stable at .29 hours. This is the first known report of an effective treatment of a SWSD in a child with AS.

Behavior Therapy↗
PubMed1996

A first case of progressive supranuclear palsy and pre-clinical REM sleep behavior disorder presenting as inhibition of speech during wakefulness and somniloquy with phasic muscle twitching during REM sleep.

It is known that a pre-clinical stage may precede the full-fledged form of REM sleep behavior disorder (RBD) and that somniloquy, yelling and limb jerking may be prodromes of RBD. In the present paper, the case of a woman exhibiting both somniloquy and daytime inhibition of speech is discussed. Clinical and polysomnographic findings were consistent with the dual diagnosis of progressive supranuclear palsy (PSP) and preclinical RBD. Severe akinesia and supranuclear palsy of phonation are postulated as likely mechanisms for the inhibition of speech, whereas the overexcitation of the motor system by the RBD process seemed to account for the sleeptalking episodes.

Aged↗
PubMed2006

Sleep quality of patients with acute myocardial infarction outside the CCU environment: a preliminary study.

BACKGROUND: Environmental factors have been implicated as major causes of sleep disruption in patients in critical care units, including coronary care units (CCU). We hypothesized that myocardial infarction may disturb sleep architecture regardless of the surrounding environmental factors. MATERIAL/METHODS: Twenty consecutive patients with a first-ever acute myocardial infarction (AMI) who were not on sedation or ionotropes underwent a full polysomnography (PSG) in our sleep disorders center, away from the CCU environment, within three days of AMI, with a follow-up PSG performed six months later. During patient stay in the CCU, each resided in a single room in which normal light-dark exposure was maintained. RESULTS: The 20 patients with AMI consisted of 18 males and 2 females, of a mean +/-SE age of 51.1+/-1.7 years. Compared with the follow-up PSG, the initial PSG revealed significant increases in arousal index, spontaneous arousal index, wake time, and REM latency and significant reductions in sleep efficiency and REM sleep. CONCLUSIONS: Patients with AMI have altered sleep architecture, despite controlling for common sleep-disrupting environmental factors. Future research should explore other possible etiologies of sleep disruption in patients with AMI, including the underlying infarction itself and its associated physiological and inflammatory changes.

Coronary Care Units↗
PubMed1992

Daily activity and persistent sleep-wake schedule disorders.

1. Patients with disorders of entrainment to external time cues such as delayed sleep phase syndrome (DSPS) and non-24-hour sleep-wake syndrome (HNS) were treated with non-pharmacological interventions and/or pharmacological agents. 2. Resetting the circadian clock with chronotherapy was easy in all DSPS patients, but it was not as easy to maintain the reset rhythm without additional therapy. Triazolam was effective in treating the phase delay that reappeared after chronotherapy. 3. Vitamin B12 (methylcobalamin) was strikingly effective in some patients with DSPS or HNS. 4. All the adolescent patients who complained of inability to attend school finally returned to their classes after treatment. Maintaining the reset rhythm in adolescent patients was easier than in adults.

Adolescent↗
PubMed2000

Effective treatment of sleep disturbances in older adults.

Sleep disturbance is a common and complex clinical problem, particularly in older adults. With advancing age, the normal sleep cycle begins to break down, resulting in a reduction in the deeper stages of sleep and an often-profound increase in the fragmentation of nighttime sleep by periods of intrusive wakefulness. Sleep disorders exacerbate these age-related changes, leading to reports of daytime fatigue, sleepiness, and impaired daily function. The resultant chronic sleep deprivation invariably leads to often-unsuccessful attempts by the patient to overcome the problem. Patients may stay in bed longer, take more naps during the day, or seek out agents that putatively restore normal sleep patterns. Paradoxically, these efforts often result in exacerbation of the sleep disturbance. This review delineates the common causes of disordered sleep in older persons. Further, it reviews effective diagnostic approaches and treatments for these conditions, including limitations of hypnotic medications and melatonin.

Aged↗
PubMed2005

Sleep and movement disorders.

Polygraphic monitoring of abnormal movements during sleep started in the 1960s in the wake of the interest in sleep and sleep disorders triggered by the discovery of REM sleep. This paper reviews the contribution of the Bologna school to the identification and understanding of motor disorders in sleep.

Animals↗
PubMed1985

Respiration and sleep in Parkinson's disease.

Sleep and respiration during sleep were studied in patients with idiopathic Parkinson's disease, patients with Parkinsonism with autonomic disturbance, and normal age and sex matched controls. Patients with idiopathic Parkinson's disease showed significantly reduced REM sleep, and more frequent and prolonged waking throughout the night. Hypoventilation and sleep apnoea did not occur in the idiopathic Parkinson's disease or normal groups, but respiration was disorganised with frequent central and obstructive apnoeas in the autonomic disturbance group. Respiratory rate during non rapid eye movement sleep was similar in the idiopathic Parkinson's disease and normal groups, but patients with idiopathic Parkinson's disease showed tachypnoea awake and during REM sleep.

Adult↗
PubMed1987

Sleep research in affective illness: state of the art circa 1987.

Future sleep research in affective illness will probably continue the current evolution beyond cross-sectional to longitudinal studies, and beyond a largely descriptive emphasis to the testing of specific hypotheses and predictions derived from models of the pathophysiology of depression. These models are and will be variously neurochemical, chronobiological, genetic, and developmental in nature. Adequate testing of these models and predictions from them will require the use of pharmacologic and naturalistic probes and the use of sophisticated CNS imaging techniques. These probes will help further characterize the physiology of depression under conditions of disequilibrium or perturbation, such as following sleep deprivation, REM deprivation, phase advancement of the major sleep period, or the administration of antidepressant drugs with specific monoaminergic activity. Concurrently, if one is to understand further whether the sleep abnormalities of depression are part of a larger circadian rhythm disturbance, investigations will necessarily include 24-h measures of sleep-wake activity, psychomotor activity, and probably core body temperature rhythm under constant routine conditions. A complementary point of view would suggest that more intensive investigative efforts be focused on the first 100 min of sleep at night, since it is the first NREM-REM cycle that seems to show the greatest and most specific deviation in depressed patients from normal controls. Efforts to characterize further this part of the 24-h cycle, with respect to age- and gender-related variance as well as responses to physiologic, hormonal, pharmacologic, and naturalistic probes, are strongly warranted.

Aging↗
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↗
PubMed1984

Sleep in the Prader-Willi syndrome. Clinical and polygraphic findings.

Nine patients with the Prader-Willi syndrome, ranging in age from 3 to 21 years, were examined clinically as well as studied in the sleep laboratory. They had striking disturbances of sleep-wakefulness patterns. All patients except one had the symptom of excessive daytime sleepiness. The most striking finding was the presence in five patients of rapid-eye-movement (REM) sleep occurring at sleep onset (SOREM). None of the patients had the condition of sleep apnea. One patient, however, demonstrated severe hypoventilation during REM sleep; the lowest value recorded for O2 saturation was 40%, with a consistent value below 50% for as long as ten to 15 minutes. Previous findings have indicated that the Prader-Willi syndrome is of hypothalamic origin. We hypothesize that both the SOREM and O2 desaturation findings in our patients with the Prader-Willi syndrome are also a result of hypothalamic changes.

Adolescent↗
PubMed1978

Kleine-Levin syndrome associated with fire setting.

Kleine-Levin syndrome is characterized by periodic hypersomnia associated with megaphagia and striking behavioral and psychiatric symptoms; it occurs primarily in adolescent boys. We treated a 17-year-old boy who had typical recurring somnolent episodes. His bizarre behavior included fire setting and stealing, both of which may have represented compulsions. His EEG during a sleepy episode was diffusely abnormal with generalized slowing of background activity; as he awoke and improved clinically, his EEG returned to normal. Between episodes, his EEG was normal. The relationship between Kleine-Levin syndrome and other sleep disorders is discussed. The neurochemistry and neurocircuitry that may provide the requisite substrate for this complex and fascinating neuropsychiatric disorder are briefly reviewed.

Adolescent↗
PubMed1982

The sleep of patients with obsessive-compulsive disorder.

Fourteen patients with obsessive-compulsive disorder (OCD) were studied with all-night sleep EEG recordings. Nine of these patients reported abnormal sleep patterns before the polygraphic study. Analysis of the sleep records disclosed significantly decreased total sleep time with more awakenings, less stage 4 sleep, decreased rapid-eye-movement (REM) efficiency, and shortened REM latency compared with those of a group of age- and sex-matched normal subjects. These abnormalities generally resembled those of an age-matched group of depressed patients, although significant differences remained. These findings suggest that such sleep abnormalities as shortened REM latency may not be entirely specific for primary affective illness. They also point to a possible biological link between OCD and affective illness.

Adult↗