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NAPS 2012-05-05

Posted by admin on May 5, 2012

  New Articles and Papers in Sleep for May 05 2012.

      Books / Reviews
      Physiology / Pharmacology
      Development / Aging / Evolution
      Dreaming / Behavior / Learning
      Biological Rhythms
      Sleep Deprivation
      Sleep Apnea / COPD / Snoring
      Other Disorders
      Methodology / Miscellaneous

Books / Reviews
Cheng SK and Dizon J (2012), "Computerised Cognitive Behavioural Therapy for Insomnia: A Systematic Review and Meta-Analysis.", Psychother Psychosom., May, 2012. Vol. 81(4), pp. 206-216.
Abstract: Background: Computerised cognitive behavioural therapy (CCBT) is an innovative mode of delivering services to patients with psychological disorders. The present paper uses a meta-analysis to systematically review and evaluate the effectiveness of CCBT for insomnia (CCBT-I). Method: A comprehensive search was conducted on 7 databases including MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Library, Social Sciences Citation Index and PubMed (up to March 2011). Search terms covered 3 concepts: (1) [internet, web, online, computer-aided, computer-assisted, computer-guided, computerized OR computerised] AND (2) [CBT, cognitive therapy, behavio(u)ral therapy OR behavio(u)r therapy] AND (3) [insomnia, sleep disorders OR sleeping problem]. Results: 533 potentially relevant papers were identified, and 6 randomised controlled trials (RCTs) that met the selection criteria were included in the review and analysis. Two RCTs were done by the same group of investigators (Ritterband and colleagues) using the same internet programmes. Post-treatment mean differences between groups showed that the effects of CCBT-I on sleep quality, sleep efficiency, the number of awakenings, sleep onset latency and the Insomnia Severity Index were significant, ranging from small to large effect sizes. However, effects on wake time after sleep onset, total sleep time and time in bed were non-significant. On average, the number needed to treat was 3.59. The treatment adherence rate for CCBT-I was high (78. Conclusion: The results lend support to CCBT as a mildly to moderately effective self-help therapy in the short run for insomnia. CCBT-I can be an acceptable form of low-intensity treatment in the stepped care model for insomnia.
Ioachimescu OC and El-Solh AA (2012), "Pharmacotherapy of insomnia.", Expert Opin Pharmacother., May, 2012.
Abstract: Introduction: Insomnia is one of the most prevalent sleep disorders in developed countries, being surpassed only by chronic sleep deprivation. Patients with insomnia tend to have an altered quality of life, impaired daytime functioning and an increased risk of work accidents and motor vehicle crashes. Insomnia is commonly associated with chronic medical conditions, metabolic illnesses and mental disorders (such as depression and anxiety), with which there is a dual, reciprocal relationship. Areas covered: This paper focuses on current pharmacotherapy options for the treatment of insomnia, particularly benzodiazepine receptor agonists, which nowadays represent the mainstay of hypnotic therapy. The melatonin receptor antagonist, ramelteon, is reviewed (an alternative for some patients with only sleep-onset difficulty), as are sedating antidepressants, which are commonly used 'off-label' to treat insomnia, despite limited efficacy data and potential significant safety concerns. Orexin (OX) antagonists are also discussed, especially those that block OX2 or both OX1 and OX2 receptors, as these are the most promising new agents for the treatment of insomnia, with encouraging results in preliminary clinical trials. Expert opinion: Research to evaluate and formulate treatments for insomnia is often complicated by the fact that insomnia is usually of multifactorial etiology. Understanding the molecular and receptor mechanisms involved in promoting sleep in varied disorders could provide future approaches in new drug development. In the long term, more randomized controlled trials are needed to assess both short-term and long-term effects of these medications and their efficacy in comorbid diseases that affect sleep quality or quantity.
Kim SH, Kim H, Lim BC, Chae J-H, Kim KJ, Hwang YS and Hwang H (2012), "Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring - Single tertiary center review of 143 patients.", Epilepsy Behav., May, 2012.
Abstract: The purpose of the study was to evaluate the clinical characteristics of paroxysmal nonepileptic events (PNEs) in pediatric patients. Reports of 1108 patients who underwent long-term video-EEG monitoring at Seoul National University Children's Hospital were reviewed retrospectively. One hundred forty-three (12.9 patients were diagnosed as having PNEs. The most common type of PNE was staring. Staring, tonic posturing, sleep myoclonus, and sleep-related disorders were more common in patients younger than 6years old. Psychogenic nonepileptic seizure was the most common PNE in patients older than 6years. Patients who were younger than 6years old showed shorter disease duration and more varied types of PNEs when compared to older patients (6years old or older). Presence of epilepsy was not significantly related to clinical difference in PNEs. In patients with developmental delay, staring and tonic posture were significantly more frequent than patients without developmental delay. Thirty-two patients without concurrent epilepsy were misdiagnosed with epilepsy, and AEDs were discontinued after the correct diagnosis of PNEs. Whenever the diagnosis of paroxysmal abnormal behavior is uncertain, correct diagnosis should be made using long-term video-EEG monitoring, especially in younger pediatric patients and patients with developmental delay.
Ohayon MM, Mahowald MW, Dauvilliers Y, Krystal AD and Léger D (2012), "Prevalence and comorbidity of nocturnal wandering in the US adult general population.", Neurology., May, 2012. Vol. 78(20), pp. 1583-1589.
Abstract: To assess the prevalence and comorbid conditions of nocturnal wandering with abnormal state of consciousness (NW) in the American general population.Cross-sectional study conducted with a representative sample of 19,136 noninstitutionalized individuals of the US general population ?18 years old. The Sleep-EVAL expert system administered questions on life and sleeping habits; health; and sleep, mental, and organic disorders (DSM-IV-TR; International Classification of Sleep Disorders, version 2; International Classification of Diseases-10).Lifetime prevalence of NW was 29.2% (95% confidence interval [CI] 28.529.9. In the previous year, NW was reported by 3.6% (3.33.9 of the sample: 1% had 2 or more episodes per month and 2.6% had between 1 and 12 episodes in the previous year. Family history of NW was reported by 30.5% of NW participants. Individuals with obstructive sleep apnea syndrome (odds ratio [OR] 3.9), circadian rhythm sleep disorder (OR 3.4), insomnia disorder (OR 2.1), alcohol abuse/dependence (OR 3.5), major depressive disorder (MDD) (OR 3.5), obsessive-compulsive disorder (OCD) (OR 3.9), or using over-the-counter sleeping pills (OR 2.5) or selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 3.0) were at higher risk of frequent NW episodes (?2 times/month).With a rate of 29.2 lifetime prevalence of NW is high. SSRIs were associated with an increased risk of NW. However, these medications appear to precipitate events in individuals with a prior history of NW. Furthermore, MDD and OCD were associated with significantly greater risk of NW, and this was not due to the use of psychotropic medication. These psychiatric associations imply an increased risk due to sleep disturbance.
Rattenborg NC, Lima SL and Lesku JA (2012), "Sleep Locally, Act Globally.", Neuroscientist., May, 2012.
Abstract: In most animals, sleep is considered a global brain and behavioral state. However, recent intracortical recordings have shown that aspects of non-rapid eye movement (NREM) sleep and wakefulness can occur simultaneously in different parts of the cortex in mammals, including humans. Paradoxically, however, NREM sleep still manifests as a global behavioral shutdown. In this review, the authors examine this paradox from an evolutionary perspective. On the basis of strategic modeling, they suggest that in animals with brains composed of heavily interconnected and functionally interdependent units, a global regulator of sleep maintains the behavioral shutdown that defines sleep and thereby ensures that local use-dependent functions are performed in a safe and efficient manner. This novel perspective has implications for understanding deficits in human cognitive performance resulting from sleep deprivation, sleep disorders such as sleepwalking, changes in consciousness that occur during sleep, and the function of sleep itself.
Sigurdardottir LG, Valdimarsdóttir U, Fall K, Rider JR, Lockley SW, Eva SS and Mucci LA (2012), "Circadian Disruption, Sleep Loss and Prostate Cancer Risk: A Systematic Review of Epidemiological Studies.", Cancer Epidemiol Biomarkers Prev., May, 2012.
Abstract: Disruption of the circadian system has been hypothesized to increase cancer risk, either due to direct disruption of the molecular machinery generating circadian rhythms or due to disruption of parameters controlled by the clock such as melatonin levels or sleep duration. This hypothesis has been studied in hormone-dependent cancers among women, but data are sparse regarding potential effects of circadian disruption on the risk of prostate cancer. This review systematically examines available data evaluating the effects of light at night, sleep patterns, and night shift work on prostate cancer risk.
Trotti LM, Bhadriraju S and Becker LA (2012), "Iron for restless legs syndrome.", Cochrane Database Syst Rev. Vol. 5, pp. CD007834.
Abstract: Restless legs syndrome (RLS) is a common neurologic syndrome and is associated with iron deficiency in many patients. It is unclear whether iron therapy is effective treatment for RLS.The objective of this review was to assess the effects of iron supplementation (oral or intravenous) for patients with RLS.We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Jan 1995 to April 2011); EMBASE (Jan 1995 to April 2011); PsycINFO (Jan 1995 to April 2011); and CINAHL (Jan 1995 to April 2011). Corresponding authors of included trials and additional members of the International Restless Legs Syndrome Study Group were contacted to locate additional published or unpublished trials.Controlled trials comparing any formulation of iron with placebo, other medications, or no treatment in adults diagnosed with RLS according to expert clinical interview or explicit diagnostic criteria.Two review authors extracted data and at least two authors assessed trial quality. We contacted trial authors for missing data.Six studies (192 total subjects) were identified and included in this analysis. The quality of trials was variable. Our primary outcome was restlessness or uncomfortable leg sensations, which was quantified using the IRLS severity scale in four trials and another RLS symptom scale in a fifth trial. Combining data from the four trials using the IRLS severity scale, there was no clear benefit from iron therapy (mean difference in IRLS severity scores of -3.79, 95% CI: -7.68 to 0.10, p = 0.06). However, the fifth trial did find iron therapy to be beneficial (median decrease of 3 points in the iron group and no change in the placebo group on a 10 point scale of RLS symptoms, p = 0.01). Quality of life was improved in the iron group relative to placebo in some studies but not others. Changes in periodic limb movements were not different between groups (measured in two studies). Objective sleep quality, subjective sleep quality and daytime functioning were not different between treatment groups in the studies that assessed them. The single study of subjects with end stage renal disease did show a benefit of therapy. Most trials did not require subjects to have co-morbid iron deficiency and several excluded patients with severe anemia. The single study that was limited to iron deficient subjects did not show clear benefit of iron supplementation on RLS symptoms. There was no clear superiority of oral or intravenous delivery of iron. Iron therapy did not result in significantly more side effects than placebo (RR 1.39, 95% CI 0.85 to 2.27).There is insufficient evidence to determine whether iron therapy is beneficial for the treatment of RLS. Further research to determine whether some or all types of RLS patients may benefit from iron therapy, as well as the best route of iron administration, is needed.
Vlachantoni I-T, Dikaiakou E, Antonopoulos CN, Stefanadis C, Daskalopoulou SS and Petridou ET (2012), "Effects of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea in arterial stiffness: A meta-analysis.", Sleep Med Rev., May, 2012.
Abstract: Obstructive sleep apnea (OSA) is associated with increased arterial stiffness, a cumulative indicator of arterial health. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. We conducted a meta-analysis of the available literature investigating the effect of CPAP on arterial stiffness in patients with OSA. Fifteen articles (n = 615 patients) assessing indices of arterial stiffness were identified. Five different meta-analyses were performed assessing: a) all indices of arterial stiffness, b) augmentation index (AIx), c) all pulse wave velocities (PWV), d) brachial-ankle PWV and e) carotid-femoral PWV. Pooled standardized mean differences (SMDs) and weighted mean differences (WMDs) were appropriately calculated through fixed or random effects models after assessing between-study heterogeneity. A significant improvement of all indices of arterial stiffness was observed after CPAP treatment (SMD = -0.74; 95 -1.08 to -0.41). AIx and PWVs were also significantly improved (WMD = -4.86; 95 -7.31 to -2.41 and WMD = -0.87; 95 -0.98 to -0.77, respectively), as well as brachial-ankle PWV and carotid-femoral PWV (WMD = -0.86; 95 -0.97 to -0.75 and WMD = -1.21; 95-1.92 to -0.50, respectively). Neither the proportion of compliant patients nor the duration of CPAP use altered the effect of arterial stiffness reduction after CPAP treatment. In conclusion, our meta-analyses showed significant improvements in all indices of arterial stiffness after CPAP treatment in patients with OSA. As clinical use of arterial stiffness is growing in popularity, the efficacy of this useful tool in assessing cardiovascular risk reduction among patients with OSA treated with CPAP needs to be further explored.
Physiology / Pharmacology
Byberg S, Hansen A-LS, Christensen DL, Vistisen D, Aadahl M, Linneberg A and Witte DR (2012), "Sleep duration and sleep quality are associated differently with alterations of glucose homeostasis.", Diabet Med., May, 2012.
Abstract: Aims? Studies suggest that inadequate sleep duration and poor sleep quality increase the risk of impaired glucose regulation and diabetes. However, associations with specific markers of glucose homeostasis are less well explained. The objective of this study was to explore possible associations of sleep duration and sleep quality with markers of glucose homeostasis and glucose tolerance status in a healthy population-based study sample. Methods? The study comprised 771 participants from the Danish, population-based cross-sectional 'Health2008' study. Sleep duration and sleep quality were measured by self-report. Markers of glucose homeostasis were derived from a 3-point oral glucose tolerance test and included fasting plasma glucose, 2-h plasma glucose, HbA(1c) , two measures of insulin sensitivity (the insulin sensitivity index(0,120) and homeostasis model assessment of insulin sensitivity), the homeostasis model assessment of ?-cell function and glucose tolerance status. Associations of sleep duration and sleep quality with markers of glucose homeostasis and tolerance were analysed by multiple linear and logistic regression. Results? A 1-h increment in sleep duration was associated with a 0.3?mmol/mol (0.3 decrement in HbA(1c) and a 25% reduction in the risk of having impaired glucose regulation. Further, a 1-point increment in sleep quality was associated with a 2% increase in both the insulin sensitivity index(0,120) and homeostasis model assessment of insulin sensitivity, as well as a 1% decrease in homeostasis model assessment of ?-cell function. Conclusions?In the present study, shorter sleep duration was mainly associated with later alterations in glucose homeostasis, whereas poorer sleep quality was mainly associated with earlier alterations in glucose homeostasis. Thus, adopting healthy sleep habits may benefit glucose metabolism in healthy populations. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Fernández IS, Peters JM, Hadjiloizou S, Prabhu SP, Zarowski M, Stannard KM, Takeoka M, Rotenberg A, Kothare SV and Loddenkemper T (2012), "Clinical staging and electroencephalographic evolution of continuous spikes and waves during sleep.", Epilepsia., May, 2012.
Abstract: Purpose:? Currently, in continuous spikes and waves during sleep (CSWS) there is a lack of systematic assessments of the clinically relevant stages and the evolution of the electroencephalographic features. The aim of this study is to describe the evolution over time of clinical and electroencephalographic features in CSWS. Methods:? We enrolled patients from our video-electroencephalography (EEG) monitoring unit with CSWS and with overnight EEG studies with at least one overnight assessment per year over a minimum period of 3?years. We studied clinical presentation and electroencephalographic features. We calculated the (1) spike-wave percentage (SWP) as the percentage of 1-s bins containing at least one spike-wave complex and (2) spike frequency (SF) as the number of spikes per 100?s. Key Findings:? Nine children (six boys) met the inclusion criteria during a 15-year period. Seven (78 had an abnormal development prior to the epilepsy onset, and in two (22 seizures were the only presenting symptom. Median age at epilepsy onset was 2?years (range 2?days to 4?years), at neuropsychological regression 5.1?years (4-7.7?years), and at seizure freedom 8.6?years (6.5-11.4?years). Median duration and range of clinically relevant stages were as follows: dormant stage (birth-epilepsy onset median 2?years, range 2?days-4?years), prodromal stage (epilepsy onset-neuropsychological regression 3.9?years, range 0.9-7.7?years), acute stage (neuropsychological regression-seizure freedom 2.9?years, range 2.1-6.6?years), and residual stage (after seizure freedom). Seven patients (78 had a structural lesion on neuroimaging. At last follow-up (median 11.4?years, range 7.2-20.3?years), eight patients (89 were receiving antiepileptic treatment, and all patients had residual neurocognitive deficits. During the acute stage, SWP was <85% in 13 (42 of 31 assessments, and after seizure freedom, 3 of 5 patients (60 had SWP >85 Evolution of electroencephalographic patterns included increasing-decreasing, continuously elevated, and fluctuating patterns (33.3% each). There was good correlation between SWP and SF (Spearman correlation-coefficient?=?0.942; p?
Kalauzi A, Vuckovic A and Boji? T (2012), "EEG alpha phase shifts during transition from wakefulness to drowsiness.", Int J Psychophysiol., May, 2012.
Abstract: Phases of alpha oscillations recorded by EEG were typically studied in the context of event or task related experiments, rarely during spontaneous alpha activity and in different brain states. During wake-to-drowsy transition they change unevenly, depending on the brain region. To explore their dynamics, we recorded ten adult healthy individuals in these two states. Alpha waves were treated as stable frequency and variable amplitude signals with one carrier frequency (CF). A method for calculating their CF phase shifts (CFPS) and CF phase potentials (CFPP) was developed and verified on surrogate signals as more accurate than phase shifts of Fourier components. Probability density estimate (PDE) of CFPS, CFPP and CF phase locking showed that frontal and fronto-temporal areas of the cortex underwent more extensive changes than posterior regions. The greatest differences were found between pairs of channels involving F7, F8, F3 and F4 (PDE of CFPS); F7, F8, T3 and T4 (CFPP); F7, F8, F3, F4, C3, C4 and T3 (decrease in CF phase locking). A topographic distribution of channels with above the average phase locking in the wake state revealed two separate regions occupying anterior and posterior brain areas (with intra regional and inter hemispheric connections). These regions merged and became mutually phase locked longitudinally in the drowsy state. Changes occurring primarily in the frontal and fronto-temporal regions correlated with an early decrease of alertness. Areas of increased phase locking might be correlated with topography of synchronous neuronal assemblies conceptualized within neural correlates of consciousness.
Parrino L, De Paolis F, Milioli G, Gioi G, Grassi A, Riccardi S, Colizzi E and Terzano MG (2012), "Distinctive polysomnographic traits in nocturnal frontal lobe epilepsy.", Epilepsia., May, 2012.
Abstract: Purpose:? To describe the polysomnographic features and distribution of epileptic motor events, in relation to conventional sleep measures and cyclic alternating pattern (CAP) parameters, in 40 untreated patients with nocturnal frontal lobe epilepsy (NFLE). Methods:? We analyzed the basal polysomnographic recordings of 40 patients (20 male and 20 female; mean age: 31?±?10?years) with a diagnosis of nocturnal frontal lobe epilepsy. Conventional sleep measures and CAP parameters were assessed. Polysomnographic recordings were subdivided in sleep cycles. The distribution of the epileptic motor events (including minor motor events, paroxysmal arousals, tonic-dystonic, or hyperkinetic seizures and epileptic nocturnal wandering) was analyzed throughout: total sleep time, non-rapid eye movement (NREM) and REM sleep, light sleep (S1?+?S2), slow wave sleep (SWS), each sleep cycle, CAP or non-CAP sleep, phase A and phase B of CAP. Only clear epileptic motor events supported by video-polysomnographic evidence were taken into consideration. Polysomnographic findings of patients with NFLE were compared with those of 24 age- and gender-balanced healthy subjects without sleep complaints. Key Findings:? Compared to controls, patients with NFLE showed a significant increase in wake after sleep onset, SWS duration, and REM latency, whereas REM sleep duration was significantly lower in NFLE patients. The patients with NFLE showed a significant increase of CAP time, CAP rate (72% vs. 32% in control group), CAP cycles, and mean duration of a CAP sequence. These findings were associated with a significant enhancement of all subtypes of the A phases of CAP (mainly subtype A1). A total of 139 epileptic motor events supported by video-polysomnographic evidence were counted: 98% of all seizures occurred in NREM sleep and 72% of NREM seizures emerged from SWS, the latter being particularly collected in the first sleep cycles and decreasing in frequency together with the progressive decline of deep sleep. Ninety percent of total NREM seizures occurred during a CAP sequence, and CAP-related seizures occurred in association with a phase A. Significance:? Significant polysomnographic alterations seem to emerge in patients with NFLE (increased REM latency, epileptic fragmentation of SWS, and increase of CAP rate). The analysis of seizure distribution showed that most epileptic events occurred in SWS, with predominance in the first sleep cycle and decreasing in frequency together with the homeostatic decline of SWS across the night. Within the NREM sleep, CAP is a manifestation of unstable sleep and represents a powerful predisposing condition for the occurrence of nocturnal motor seizures, which arise in concomitance with a phase A.
Ramesh V, Nair D, Zhang SXL, Hakim F, Kaushal N, Kayali F, Wang Y, Li RC, Carreras A and Gozal D (2012), "Disrupted sleep without sleep curtailment induces sleepiness and cognitive dysfunction via the tumor necrosis factor-alpha pathway.", J Neuroinflammation., May, 2012. Vol. 9(1), pp. 91.
Abstract: ABSTRACT: BACKGROUND: Sleepiness and cognitive dysfunction are recognized as prominent consequences of sleep deprivation. Experimentally induced short-term sleep fragmentation, even in the absence of any reductions in total sleep duration, will lead to the emergence of excessive daytime sleepiness and cognitive impairments in humans. Tumor necrosis factor (TNF)-alpha has important regulatory effects on sleep, and seems to play a role in the occurrence of excessive daytime sleepiness in children who have disrupted sleep as a result of obstructive sleep apnea, a condition associated with prominent sleep fragmentation. The aim of this study was to examine role of the TNF-alpha pathway after long-term sleep fragmentation in mice. METHODS: The effect of chronic sleep fragmentation during the sleep-predominant period on sleep architecture, sleep latency, cognitive function, behavior, and inflammatory markers was assessed in C57BL/6 J and in mice lacking the TNF-alpha receptor (double knockout mice). In addition, we also accessed the above parameters in C57BL/6 J mice after injection of a TNF-alpha neutralizing antibody. RESULTS: Mice subjected to chronic sleep fragmentation had preserved sleep duration, sleep state distribution, and cumulative delta frequency power, but also exhibited excessive sleepiness, altered cognitive abilities and mood correlates, reduced cyclic AMP response element-binding protein phosphorylation and transcriptional activity, and increased phosphodiesterase-4 expression, in the absence of AMP kinase-alpha phosphorylation and ATP changes. Selective increases in cortical expression of TNF-alpha primarily circumscribed to neurons emerged. Consequently, sleepiness and cognitive dysfunction were absent in TNF-alpha double receptor knockout mice subjected to sleep fragmentation, and similarly, treatment with a TNF-alpha neutralizing antibody abrogated sleep fragmentation-induced learning deficits and increases in sleep propensity. CONCLUSIONS: Taken together, our findings show that recurrent arousals during sleep, as happens during sleep apnea, induce excessive sleepiness via activation of inflammatory mechanisms, and more specifically TNF-alpha-dependent pathways, despite preserved sleep duration.
Salsone M, Labate A and Quattrone A (2012), "Cardiac denervation precedes nigrostriatal damage in idiopathic rapid eye movement sleep behavior disorder.", Mov Disord., May, 2012.
Zhou J-Y, Tang X-D, Huang L-L, Zhong Z-Q, Lei F and Zhou D (2012), "The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patients with partial epilepsy.", J Clin Neurosci., May, 2012.
Abstract: This study investigated the effect of the novel antiepileptic drug levetiracetam (LEV) on sleep in eleven patients with partial epilepsy. At baseline and one week after therapy with LEV (1000mg/day), patients underwent polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). Patients also rated their own degree of sleep disturbance and daytime sleepiness with the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS). A group of 10 age- and gender-matched control participants were also included in the study. Patients had decreased total sleep time and increased daytime sleepiness compared to baseline, as evaluated by AIS subscales. Furthermore, LEV therapy significantly decreased the rapid eye movement sleep time and percentage as measured by PSG. Patients reported a significant increase in ESS score but did not exhibit changes in MSLT performance after LEV treatment. The study demonstrated that short-course LEV treatment can affect subjective sleep time and objective sleep architecture. Furthermore, LEV treatment affected subjective daytime sleepiness but did not influence objective mean daytime sleep latencies in patients with partial epilepsy.
Development / Aging / Evolution
Fisher A, van Jaarsveld CHM, Llewellyn CH and Wardle J (2012), "Genetic and Environmental Influences on Infant Sleep.", Pediatrics., May, 2012.
Abstract: BACKGROUND:Sleep duration is attracting increasing attention in relation to chronic disease risk, but few large-scale studies have investigated the determinants of sleep characteristics in early life. In this study we used data from a large, population-based twin study to examine genetic and environmental influences on sleep duration and sleep difficulties in infancy.METHODS:Participants were 1931 pairs of young twins (3862 children) from the Gemini twin birth cohort. Sleep patterns were assessed at 15 months by using a modification of the Brief Infant Sleep Questionnaire completed by parents. Outcomes included nighttime and daytime sleep duration and frequency of night waking.RESULTS:Twin analyses showed that nighttime sleep duration was predominantly influenced by the shared environment (66 confidence interval [CI] 6370 with a modest genetic effect (26 CI 2230. A similar pattern was observed for daytime nap duration (shared environment: 57 CI 5362 genetic effect: 37 CI 3341 and sleep disturbance (shared environment: 55 4464 with a genetic effect of 40% (3051. These estimates were similar for boys and girls.CONCLUSIONS:These results indicate an important contribution of the shared family environment as well as genes to children's sleep behavior. There is a need for research to identify specific environmental determinants that could provide targets for interventions to improve sleep quality.
Larson AM, Ryther RCC, Jennesson M, Geffrey AL, Bruno PL, Anagnos CJ, Shoeb AH, Thibert RL and Thiele EA (2012), "Impact of pediatric epilepsy on sleep patterns and behaviors in children and parents.", Epilepsia., May, 2012.
Abstract: Purpose:? Disrupted sleep patterns in children with epilepsy and their parents are commonly described clinically. A number of studies have shown increased frequency of sleep disorders among pediatric epilepsy patients; however, few have characterized the association between epilepsy and parental sleep quality and household sleeping arrangements. The purpose of this study was to explore the effect of pediatric epilepsy on child sleep, parental sleep and fatigue, and parent-child sleeping arrangements, including room sharing and cosleeping. Methods:?Parents of children 2 to 10 years of age with and without epilepsy completed written questionnaires assessing seizure history, child and parent sleep, and household sleeping arrangements. Children's Sleep Habits Questionnaire (CSHQ) scores were used to evaluate sleep disturbances for the child. The Pittsburgh Sleep Quality Index (PSQI) and the Iowa Fatigue Scale (IFS) were used to evaluate parental sleep and fatigue, respectively. The Early Childhood Epilepsy Severity Scale (E-Chess) was used to assess epilepsy severity. Key Findings:?One hundred five households with a child with epilepsy and 79 controls participated in this study. Households with a child with epilepsy reported increased rates of both parent-child room sharing (p?
Dreaming / Behavior / Learning
Lassi G, Ball ST, Maggi S, Colonna G, Nieus T, Cero C, Bartolomucci A, Peters J and Tucci V (2012), "Loss of Gnas Imprinting Differentially Affects REM/NREM Sleep and Cognition in Mice.", PLoS Genet., May, 2012. Vol. 8(5), pp. e1002706.
Abstract: It has been suggested that imprinted genes are important in the regulation of sleep. However, the fundamental question of whether genomic imprinting has a role in sleep has remained elusive up to now. In this work we show that REM and NREM sleep states are differentially modulated by the maternally expressed imprinted gene Gnas. In particular, in mice with loss of imprinting of Gnas, NREM and complex cognitive processes are enhanced while REM and REM-linked behaviors are inhibited. This is the first demonstration that a specific overexpression of an imprinted gene affects sleep states and related complex behavioral traits. Furthermore, in parallel to the Gnas overexpression, we have observed an overexpression of Ucp1 in interscapular brown adipose tissue (BAT) and a significant increase in thermoregulation that may account for the REM/NREM sleep phenotypes. We conclude that there must be significant evolutionary advantages in the monoallelic expression of Gnas for REM sleep and for the consolidation of REM-dependent memories. Conversely, biallelic expression of Gnas reinforces slow wave activity in NREM sleep, and this results in a reduction of uncertainty in temporal decision-making processes.
Biological Rhythms
Hur S-P, Takeuchi Y, Itoh H, Uchimura M, Takahashi K, Kang H-C, Lee Y-D, Kim S-J and Takemura A (2012), "Fish sleeping under sandy bottom: Interplay of melatonin and clock genes.", Gen Comp Endocrinol., May, 2012. Vol. 177(1), pp. 37-45.
Abstract: Wrasse species exhibit a definite daily rhythm in locomotor activity and bury themselves in the sand at the bottom of the ocean at night. It remains unclear how their behavior in locomotor activity is endogenously regulated. The aim of the present study was to clarify the involvement of melatonin and clock genes (Per1, Per2, Bmal1, and Cry1) in daily and circadian rhythms of the threespot wrasse, Halichoeres trimaculatus, which is a common species in coral reefs. Daily and circadian rhythms in locomotor activity were monitored under conditions of light-dark cycle (LD=12:12), constant light (LL), and darkness (DD). Daily rhythms in locomotor activity were observed under LD and persisted under LL and DD. Melatonin from a cultured pineal gland showed daily variations with an increase during the nighttime and a decrease during daytime, which persisted under DD. Melatonin treatment induced decreases in locomotor activity and respiratory rate, suggesting that melatonin has a sleep-inducing effect. Per1 and Per2 mRNA abundance in the brain under LD showed daily rhythms with an increase around lights on. Robust oscillation of Per1 and Per2 mRNA expression persisted under DD and LL, respectively. Expression of Bmal1 and Cry1 mRNA also showed daily and circadian patterns. These results suggest that clock genes are related to circadian rhythms in locomotor activity and that melatonin plays a role in inducing a sleep-like state after fish bury themselves in the sand. We conclude that the sleep-wake rhythm of the wrasse is regulated by a coordination of melatonin and clock genes.
Niu S-F, Chu H, Chen C-H, Chung M-H, Chang Y-S, Liao Y-M and Chou K-R (2012), "A Comparison of the Effects of Fixed- and Rotating-Shift Schedules on Nursing Staff Attention Levels A Randomized Trial.", Biol Res Nurs., May, 2012.
Abstract: Purpose: Sleep deficit affects neurobehavioral functioning, reduces attention and cognitive function, and negatively impacts occupational safety. This study investigated selective attention levels of nursing staff on different shifts. Methods: Using a prospective, randomized parallel group study, selective attention was measured using the d2 test in 62 nursing staff in a medical center in Taiwan. Findings: There were significant differences in selective attention indicators (E between the fixed-day-shift group (control group) and rotating-shift group (experimental group): The percentage of errors (E for night-shift workers in the rotating-shift group was higher than that of fixed-day-shift workers, while the total number of items scanned minus error (TN - E) and concentration performance (CP) scores were higher for fixed-day-shift workers. Within the experimental group, the error rate on night shift was 0.44 times more than that on day shift and .62 times more than on evening shift; the TN-E on night shift was 38.99 items less than that on day shift, and the CP was 27.68 items less on night shift than on day shift; indicating that staff on the night shift demonstrated poorer speed and accuracy on the overall test than did the staff on day shifts. Conclusions: Inadequate sleep and a state of somnolence adversely affected the attention and operation speed of work among night-shift workers. More than 2 days off is suggested when shifting from the night shift to other shifts to provide adequate time for circadian rhythms to adjust.
Sleep Deprivation
Kong D, Soon CS and Chee MWL (2012), "Functional imaging correlates of impaired distractor suppression following sleep deprivation.", Neuroimage., May, 2012. Vol. 61(1), pp. 50-55.
Abstract: Sleep deprivation (SD) has been shown to affect selective attention but it is not known how two of its component processes: target enhancement and distractor suppression, are affected. To investigate, young volunteers either attended to houses or were obliged to ignore them (when attending to faces) while viewing superimposed face-house pictures. MR signal enhancement and suppression in the parahippocampal place area (PPA) were determined relative to a passive viewing control condition. Sleep deprivation was associated with lower PPA activation across conditions. Critically SD specifically impaired distractor suppression in selective attention, leaving target enhancement relatively preserved. These findings parallel some observations in cognitive aging. Additionally, following SD, attended houses were not significantly better recognized than ignored houses in a post-experiment test of recognition memory contrasting with the finding of superior recognition of attended houses in the well-rested state. These results provide evidence for co-encoding of distracting information with targets into memory when one is sleep deprived.
Muto V, Shaffii-LE Bourdiec A, Matarazzo L, Foret A, Mascetti L, Jaspar M, Vandewalle G, Phillips C, Degueldre C, Balteau E, Luxen A, Collette F and Maquet P (2012), "Influence of acute sleep loss on the neural correlates of alerting, orientating and executive attention components.", J Sleep Res., May, 2012.
Abstract: The Attention Network Test (ANT) is deemed to assess the alerting, orientating and executive components of human attention. Capitalizing on the opportunity to investigate three facets of attention in a single task, we used functional magnetic resonance imaging (fMRI) to assess the effect of sleep deprivation (SD) on brain responses associated with the three attentional components elicited by the ANT. Twelve healthy volunteers were scanned in two conditions 1?week apart, after a normal night of sleep (rested wakefulness, RW) or after one night of total sleep deprivation. Sleep deprivation was associated with a global increase in reaction times, which did not affect specifically any of the three attention effects. Brain responses associated with the alerting effect did not differ between RW and SD. Higher-order attention components (orientating and conflict effects) were associated with significantly larger thalamic responses during SD than during RW. These results suggest that SD influences different components of human attention non-selectively, through mechanisms that might either affect centrencephalic structures maintaining vigilance or ubiquitously perturb neuronal function. Compensatory responses can counter these effects transiently by recruiting thalamic responses, thereby supporting thalamocortical function.
Schmid SM, Hallschmid M, Jauch-Chara K, Lehnert H and Schultes B (2012), "Sleep timing may modulate the effect of sleep loss on testosterone.", Clin Endocrinol (Oxf)., May, 2012.
Abstract: BACKGROUND: Sleep loss has been shown to reduce secretory activity of the pituitary-gonadal axis in men, but the determinants of this effect are unknown. OBJECTIVE: To discriminate the effects of sleep duration and sleep timing on serum concentrations of luteinizing hormone (LH), testosterone (T), and prolactin (PRL). METHODS: Fifteen young, healthy men (27.1 ± 1.3 years; BMI 22.9 ± 0.3 kg/m(2) ) were examined in a condition of sleep time restriction to 4 h (bedtime 0245h-0700h) for two consecutive nights and in a control condition of 8 h regular sleep (bedtime 2245h-0700h). After the second night, serum concentrations of LH, T, and PRL were monitored over a 15 h period. In addition, these hormones were measured in serum samples obtained in a further experiment in 8 healthy men (24.5 ± 1.1 years; BMI 23.7 ± 0.6 kg/m(2) ) in the morning after one night of total sleep deprivation, of 4.5 h sleep (bedtime 2230h-0330h), and of regular 7 h sleep (bedtime 2230h-0600h). RESULTS: Serum LH, T, and PRL concentrations showed characteristic diurnal variations across the 15-h period without any differences between the 4 h and 8 h sleep conditions. However, total sleep deprivation and 4.5 h of sleep restricted to the first night-half markedly decreased morning T and PRL concentrations (both P ? 0.05). CONCLUSION: Collectively, our data suggest that the effect of sleep restriction on pituitary-gonadal secretory activity may be modulated by sleep timing. While sleep loss in the early part of the night does not affect T and PRL, early awakening and wakefulness during the second part of the night reduces morning circulating T and PRL concentrations. © 2012 Blackwell Publishing Ltd.
Volkow ND, Tomasi D, Wang G-J, Telang F, Fowler JS, Logan J, Benveniste H, Kim R, Thanos PK and Ferré S (2012), "Evidence That Sleep Deprivation Downregulates Dopamine D2R in Ventral Striatum in the Human Brain.", J Neurosci., May, 2012. Vol. 32(19), pp. 6711-6717.
Abstract: Dopamine D2 receptors are involved with wakefulness, but their role in the decreased alertness associated with sleep deprivation is unclear. We had shown that sleep deprivation reduced dopamine D2/D3 receptor availability (measured with PET and [(11)C]raclopride in controls) in striatum, but could not determine whether this reflected dopamine increases ([(11)C]raclopride competes with dopamine for D2/D3 receptor binding) or receptor downregulation. To clarify this, we compared the dopamine increases induced by methylphenidate (a drug that increases dopamine by blocking dopamine transporters) during sleep deprivation versus rested sleep, with the assumption that methylphenidate's effects would be greater if, indeed, dopamine release was increased during sleep deprivation. We scanned 20 controls with [(11)C]raclopride after rested sleep and after 1 night of sleep deprivation; both after placebo and after methylphenidate. We corroborated a decrease in D2/D3 receptor availability in the ventral striatum with sleep deprivation (compared with rested sleep) that was associated with reduced alertness and increased sleepiness. However, the dopamine increases induced by methylphenidate (measured as decreases in D2/D3 receptor availability compared with placebo) did not differ between rested sleep and sleep deprivation, and were associated with the increased alertness and reduced sleepiness when methylphenidate was administered after sleep deprivation. Similar findings were obtained by microdialysis in rodents subjected to 1 night of paradoxical sleep deprivation. These findings are consistent with a downregulation of D2/D3 receptors in ventral striatum with sleep deprivation that may contribute to the associated decreased wakefulness and also corroborate an enhancement of D2 receptor signaling in the arousing effects of methylphenidate in humans.
Sleep Apnea / COPD / Snoring
Dieltjens M, Vanderveken OM, Hamans E, Verbraecken JA, Wouters K, Willemen M, De Backer WA, Van de Heyning PH and Braem MJ (2012), "Treatment of obstructive sleep apnea using a custom-made titratable duobloc oral appliance: a prospective clinical study.", Sleep Breath., May, 2012.
Abstract: PURPOSE: This prospective clinical study investigates the efficacy of a specific custom-made titratable mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA). This MAD has attachments in the frontal teeth area that allow for progressive titration of the mandible. METHODS: Sixty-one adult OSA patients were included (age, 46.7?±?9.0 years; male/female ratio, 45/16; apnea-hypopnea index (AHI), 23.2?±?15.4 events/h sleep; body mass index, 27.9?±?4.1 kg/m²). After an adaptation period, titration started based on a protocol of symptomatic benefit or upon reaching the physiological limits of protrusion. As a primary outcome, treatment response was defined as an objective reduction in AHI following MAD treatment of ?50 % compared to baseline, and treatment success as a reduction in AHI with MAD to less than 5 and 10 events/h sleep. Compliance failure was defined as an inability to continue treatment. RESULTS: A statistically significant decrease was observed in AHI, from 23.4?±?15.7 at baseline to 8.9?±?8.6 events/h with MAD (p?
Doff MHJ, Finnema KJ, Hoekema A, Wijkstra PJ, de Bont LGM and Stegenga B (2012), "Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects.", Clin Oral Investig., May, 2012.
Abstract: OBJECTIVES: This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy. MATERIALS AND METHODS: As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables. RESULTS: Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior-posterior change in the occlusion (-1.3?±?1.5 mm) in the oral appliance group compared to the CPAP group (-0.1?±?0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (?)?=?-0.02, 95 % confidence interval (-0.04 to -0.00)]. CONCLUSIONS: Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur. CLINICAL RELEVANCE: Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.
Ito K, Kawayama T, Shoji Y, Fukushima N, Matsunaga K, Edakuni N, Uchimura N and Hoshino T (2012), "Depression but not sleep disorder is an independent factor affecting exacerbations and hospitalization in patients with chronic obstructive pulmonary disease.", Respirology., May, 2012.
Abstract: SUMMARY AT A GLANCE: The prevalence of depression and sleep disorders was higher in COPD patients than in control subjects. Lower BMI, more severe dyspnoea, lower HRQOL and PaO(2) , and higher PaCO(2) were associated with depression and sleep disorders among COPD patients. Depression, but not sleep disorder, was independently associated with exacerbations and hospitalization among COPD patients. ABSTRACT: Background and objective:? Patients with chronic obstructive pulmonary disease (COPD) may experience depression and sleep disorders, which can adversely affect their health-related quality of life (HRQOL). The aim of this study was to investigate depression and sleep disorders among 85 COPD patients and 46 control subjects, aged 40 years and over. Methods:? Patients underwent spirometry and arterial blood gas analysis, self-completed St. George's Respiratory Questionnaires, and were assessed on the Center for Epidemiologic Studies Depression (CES-D) scale, and the Pittsburgh Sleep Quality Index (PSQI). The frequency of exacerbations among COPD patients was prospectively monitored for 12 months. Results:? The prevalence of depression and sleep disorders was significantly higher among COPD patients than control subjects. The relative risks (95% confidence interval) of depression and sleep disorders were 7.58 (1.03 to 55.8) and 1.82 (1.03 to 3.22), respectively, in COPD patients compared with control subjects. Among COPD patients, there was a correlation between CES-D and PSQI scores. Lower BMI, more severe dyspnoea, poorer HRQOL, lower partial pressure of arterial oxygen, and higher partial pressure of arterial carbon dioxide were significantly associated with the incidence of depression and sleep disorders. Exacerbations and hospitalizations were more frequent among COPD patients with depression than those with sleep disorders alone or those without depression or sleep disorders. Conclusions:? Depression and sleep disorders are very common comorbidities among COPD patients, and significantly reduce activities and HRQOL among these patients. Depression, but not sleep disorder, is an independent risk factor for exacerbations and hospitalization among COPD patients. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.
Linz D, Mahfoud F, Schotten U, Ukena C, Neuberger H-R, Wirth K and Böhm M (2012), "Renal Sympathetic Denervation Suppresses Postapneic Blood Pressure Rises and Atrial Fibrillation in a Model for Sleep Apnea.", Hypertension., May, 2012.
Abstract: The aim of this study was to identify the relative impact of adrenergic and cholinergic activity on atrial fibrillation (AF) inducibility and blood pressure (BP) in a model for obstructive sleep apnea. Obstructive sleep apnea is associated with sympathovagal disbalance, AF, and postapneic BP rises. Renal denervation (RDN) reduces renal efferent and possibly also afferent sympathetic activity and BP in resistant hypertension. The effects of RDN compared with ?-blockade by atenolol on atrial electrophysiological changes, AF inducibility, and BP during obstructive events and on shortening of atrial effective refractory period (AERP) induced by high-frequency stimulation of ganglionated plexi were investigated in 20 anesthetized pigs. Tracheal occlusion with applied negative tracheal pressure (NTP; at -80 mbar) induced pronounced AERP shortening and increased AF inducibility in all of the pigs. RDN but not atenolol reduced NTP-induced AF-inducibility (20% versus 100% at baseline; P=0.0001) and attenuated NTP-induced AERP shortening more than atenolol (27±5 versus 43±3 ms after atenolol; P=0.0272). Administration of atropine after RDN or atenolol completely inhibited NTP-induced AERP shortening. AERP shortening induced by high-frequency stimulation of ganglionated plexi was not influenced by RDN, suggesting that changes in sensitivity of ganglionated plexi do not play a role in the antiarrhythmic effect of RDN. Postapneic BP rise was inhibited by RDN and not modified by atenolol. We showed that vagally mediated NTP-induced AERP shortening is modulated by RDN or atenolol, which emphasizes the importance of autonomic disbalance in obstructive sleep apnea-associated AF. Renal denervation displays antiarrhythmic effects by reducing NTP-induced AERP shortening and inhibits postapneic BP rises associated with obstructive events.
Mwenge GB, Rombaux P, Dury M, Lengelé B and Rodenstein D (2012), "Targeted hypoglossal neurostimulation for obstructive sleep apnoea. A 1 year pilot Study.", Eur Respir J., May, 2012.
Abstract: CPAP is an effective but cumbersome treatment for obstructive sleep apnoea (OSA). Non-compliant patients need alternative therapies.We studied a tongue neurostimulation approach: Targeted Hypoglossal Neurostimulation (THN) therapy with the aura6000™ System. A multicontact electrode positioned around the main trunk of the XIIth nerve connected to an implanted pulse generator (IPG) stimulates segments of the nerve, activating dilator muscles. The primary objective was to improve the polysomnographically determined apnoea-hypopnoea index (AHI) at 3 months, and maintain the improvement after 12 months treatment. Thirteen out of 14 operated patients were successfully implanted.At 12 months the AHI decreased from 45±18 to 21±17, a 53% reduction, p< 0.001. The 4% Oxygen Desaturation Index fell from 29±20 to 15±16 and the Arousal Index from 37±13 to 25±14, both p<0.001. The Epworth Sleepiness Scale decreased from 11±7 to 8 ±4, p=0.09. THN was neither painful nor awakened patients, who all complied with therapy. There were two transient tongue paresis.The present study represents the longest study of any hypoglossal neurostimulation reported to date. We conclude that THN is safe and effective to treat OSA in patients not compliant with CPAP.
Ngiam J and Kyung H-M (2012), "Microimplant-based mandibular advancement therapy for the treatment of snoring and obstructive sleep apnea: a prospective study.", Angle Orthod., May, 2012.
Abstract: Abstract Objective: To investigate the efficacy of orthodontic microimplant-based mandibular advancement therapies for the treatment of snoring and obstructive sleep apnea (OSA) in adult patients. Materials and Methods: Ten adult OSA patients (seven men, three women; mean age 60.00 ± 9.25 years) were each treated with two mandibular orthodontic microimplants attached to a customized reverse face mask for mandibular advancement. Pretreatment and posttreatment outcome measures of microimplant mobility, apnea-hypopnea index, snoring, respiratory movement, and Epworth sleepiness scores were evaluated after 6 months. Results: Highly significant reductions in the apnea-hypopnea index, snoring, and sleep variables were observed. Sixteen of the 20 (80 microimplants were stable and showed no mobility, and four (20 demonstrated grade 1 or 2 mobility and required removal and reinsertion of a new microimplant. Conclusions: Favorable reductions in sleep variables highlight the potential of microimplant-based mandibular advancement therapy as an alternative treatment modality for OSA patients who cannot tolerate continuous positive airway pressure and oral appliance therapy.
Rigatelli G and Sharma S (2012), "Patent foramen ovale-obstructive sleep apnea relationships: Pro and cons.", Cardiovasc Revasc Med., May, 2012.
Abstract: Patent foramen ovale (PFO) has a prevalence of 2527% in the general population [1] and it has been suggested to be the mediator for a wide variety of syndromes based on the paradoxical embolism. The obstructive sleep apnea syndrome (OSAS) is a common disorder in the middle-aged population. An echocardiographically visible PFO was detected in 2769% of patients with documented OSAS suggesting a relationship between PFO and OSAS, but the pathophysiology of this potential relationship is still unclear. It has been shown that obstructive apnea can induce right-to-left shunting (RLS) through PFO with two proposed mechanisms including a large swing in pleural pressure and pulmonary hypertension. Pulmonary artery hypertension and oxygen desaturation have been suggested to be caused by the concurrence of OSAS and PFO. Arguments against and in favour of this potential relationship are discussed in this brief review.
Other Disorders
Barber A and Dashtipour K (2012), "Sleep Disturbances in Parkinson's Disease With Emphasis on Rapid Eye Movement Sleep Behavior Disorder.", Int J Neurosci., May, 2012.
Abstract: ABSTRACT Sleep disturbances are common in patients with Parkinson's disease (PD). These disturbances can primarily affect the patient's quality of life and may worsen the symptoms of PD. Among the multiple sleep disturbances in PD patients, there has been a marked growing interest in rapid eye movement (REM) sleep behavior disorder (RBD). This is likely due to the fact that RBD has been proven to precede the motor symptoms of PD by many years. The aim of this article is to examine the sleep disturbances found in PD, with special attention to RBD as a premotor symptom of PD, as well as to assess its proposed related pathophysiology. MEDLINE (1966-March 2010), American Academy of Sleep Medicine's, The International Classification of Sleep Disorders, and current textbooks of sleep medicine were searched for relevant information. Search terms: RBD, sleep disturbances, Parkinson's disease, and pre-motor were used. Excessive daytime sleepiness (EDS), sleep attack, insomnia, restless leg syndrome (RLS), sleep-disordered breathing (SDB), and RBD are sleep disturbances commonly found in the literature related to PD. Sleep benefit has been proven to lessen PD motor symptoms. RBD has been described as a premotor symptom of PD in several prospective, retrospective, and cross-sectional studies. Sleep disturbances in PD can result secondarily to natural disease progression, as a side effect of the medications used in PD, or in result of pre-clinical pathology. Treatment of sleep disturbances in PD patients is crucial, as what is termed as, "sleep benefit effect" has been shown to improve the symptoms of PD.
Fujiwara Y, Arakawa T and Fass R (2012), "Gastroesophageal reflux disease and sleep disturbances.", J Gastroenterol., May, 2012.
Abstract: Nighttime reflux during sleep plays a crucial role in several conditions associated with gastroesophageal reflux disease (GERD). Reflux patterns during arousal and sleep are different because of delayed gastric emptying, reduced esophageal peristalsis, decreases in swallowing and salivary secretion, and prolonged esophageal clearance during sleep. Clinical evidence strongly suggests that GERD is associated with sleep disturbances such as shorter sleep duration, difficulty falling asleep, arousals during sleep, poor sleep quality, and awakening early in the morning. New mechanisms on how GERD affects sleep have been recently identified by using actigraphy, and sleep deprivation was found to induce esophageal hyperalgesia to acid perfusion. Thus, the relationship between GERD and sleep disturbances is bidirectional. Among lifestyle modifications, avoidance of a late night meal plays a role in prevention of nighttime reflux. Treatment with a proton pump inhibitor (PPI) improves both nighttime symptoms and subjective sleep parameters, but its effects on objective sleep parameters remain unclear. Better control of nighttime acid secretion by administering a PPI at different times or by providing a double-dose PPI, adding H(2) receptor antagonists, or other new agents is proposed. The effects of such treatments on sleep disturbances remain to be elucidated. GERD patients with sleep disturbances report more severe symptoms and poorer quality of life as compared to those without sleep disturbances. Consequently, GERD should also be classified as GERD with sleep disturbance and GERD without sleep disturbance.
Hanning CD and Evans A (2012), "Authors' reply to Chapman.", BMJ. Vol. 344, pp. e3367.
Li Y, Munger KL, Batool-Anwar S, De Vito K, Ascherio A and Gao X (2012), "Association of multiple sclerosis with restless legs syndrome and other sleep disorders in women.", Neurology., May, 2012. Vol. 78(19), pp. 1500-1506.
Abstract: To assess the association of multiple sclerosis (MS) with concurrent restless legs syndrome (RLS) and daytime sleepiness. We also prospectively examined whether women with MS had an increased risk of developing RLS during 4 years of follow-up.The main analysis was based on a cross-sectional study of 65,544 women (aged 41-58 years) free of diabetes, arthritis, and pregnancy, who were participating in the Nurses' Health Study II cohort. Participants were considered to have RLS if they met 4 RLS diagnostic criteria recommended by the International Restless Leg Syndrome Study Group and had restless legs ?5 times/month. MS was self-reported and confirmed by medical record review.Among women with MS, the prevalence of RLS and severe RLS (15+ times/month) were 15.5% and 9.9% in 2005, respectively, relative to 6.4% and 2.6% among women without MS. After adjustment for potential confounders and the presence of other sleep disorders, women with MS had a higher likelihood of having RLS (odds ratio [OR] = 2.72, 95% confidence interval [CI] 1.89-3.93), severe RLS (OR = 4.12, 95% CI 2.65-6.42), and daily daytime sleepiness (OR = 2.11, 95% CI 1.31-3.42) compared with women without MS. Among the 172 women who had MS and were free of RLS in 2005, 9 developed RLS (5.2 during a 4-year period and all had severe RLS. The adjusted relative risk of severe RLS was 3.58 (95% CI 1.53-8.35), comparing women with MS at baseline with those without MS.Women with MS had a significantly higher prevalence of RLS and daytime sleepiness and an increased risk of developing RLS in the future.
Trojan DA, Kaminska M, Bar-Or A, Benedetti A, Lapierre Y, Da Costa D, Robinson A, Cardoso M, Schwartzman K and Kimoff RJ (2012), "Polysomnographic measures of disturbed sleep are associated with reduced quality of life in multiple sclerosis.", J Neurol Sci., May, 2012. Vol. 316(1-2), pp. 158-163.
Abstract: The relationship of objective sleep parameters with health-related quality of life (HRQoL) in multiple sclerosis (MS) has not been studied.To evaluate the relationship between polysomnographic (PSG) parameters and HRQoL in MS.Ambulatory MS patients without a known sleep disorder completed the Short Form (36) Health Survey (SF-36), pain visual analog scale, and two consecutive overnight PSGs. HRQoL was assessed using SF-36 Physical and Mental Component Summary (PCS, MCS) scores. Standard objective PSG measures of sleep quality were determined. The relationship between objective sleep parameters and HRQoL was evaluated with multivariate linear regression, adjusting for age, sex, body mass index, disability, and pain.62 MS patients were included. PSG measures of sleep disruption including stage changes, awakenings, time in N1 sleep, and apnea-hypopnea and total arousal indices were negatively associated (p<0.05) with MCS scores (lower scores indicating poorer HRQoL). PSG parameters reflective of better sleep quality including total sleep time, sleep efficiency, and time in REM sleep were positively associated with MCS scores. PSG parameters were not significantly associated with PCS scores.PSG-documented sleep disruption negatively impacts, while better objective sleep quality positively impacts on the mental domain of HRQoL in MS.
Methodology / Miscellaneous
Boyne K, Sherry DD, Gallagher PR, Olsen M and Brooks LJ (2012), "Accuracy of computer algorithms and the human eye in scoring actigraphy.", Sleep Breath., May, 2012.
Abstract: PURPOSE: The purpose of this study is to determine the optimal scoring method and parameter settings of actigraphy by comparison to simultaneous polysomnography (PSG). METHODS: Fifteen studies of simultaneous PSG and actigraphy were completed in adolescents (mean age = 16.3 years) and analyzed. Scoring actigraphy by the human eye was compared to a commercial computerized algorithm using various parameters. The PSG was considered the reference standard. RESULTS: There was a better correlation between actigraphy and PSG sleep start/end, total sleep time, wake after sleep onset, and sleep efficiency when the rest period was determined by the human (mean r?=?0.640) rather than auto-set by the software (r?=?0.406). The best results came when the rest intervals were set based on the PSG (r?=?0.694). Scoring the printed actogram by the human eye was superior to the auto analyses as well (r?=?0.575). Higher correlations and lower biases were obtained from lower wake threshold settings (low and medium) and higher immobility times (10 and 15 min). CONCLUSIONS: Visual scoring by simple inspection of the actigraphy tracing had a reasonable correlation with the gold standard PSG. Accurate determination of the rest interval is important in scoring actigraphy. Scoring actigraphy by the human eye is superior to this computer algorithm when auto-setting major rest periods. A low wake threshold and 10-15 min of immobility for sleep onset and sleep end yield the most accurate computerized results. Auto-setting major rest intervals should be avoided to set start/end of rest intervals; adjustments for artifacts and/or a sleep diary for comparison are helpful.
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