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NAPS 2012-05-26

Posted by admin on May 26, 2012

  New Articles and Papers in Sleep for May 26 2012.

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

Books / Reviews
Chen H and Lowe AA (2012), "Updates in oral appliance therapy for snoring and obstructive sleep apnea.", Sleep Breath., May, 2012.
Abstract: BACKGROUND: Obstructive sleep apnea (OSA) is increasingly being recognized by the public due to its life-threatening and low curability rate nature. Oral appliances (OAs) were introduced as a treatment option for both non-apneic snoring and OSA to maintain the patency of the upper airway during sleep by repositioning the mandible, tongue, and soft palate. RESULTS: Over the past decade, OAs are enthusiastically studied and concluded as a simple, silent, bed partner-friendly, less invasive, tolerable, and efficacious choice for mild-to-moderate OSA. In the meantime, some challenges remain uncertain such as titration management, 3D image diagnostic tools reliability, and long-term adherence for adult patients. Improvement of temporomandibular joint (TMJ) monitoring and management is recommended, although there is no scientific evidence suggesting consistent undesirable long-term effects of OA on the TMJ. Now that pediatric OSA is being diagnosed more frequently, OA therapy is becoming a promising option for children as well. CONCLUSION: Consistent follow-up and management are needed to increase clinical success rates in OA therapy for OSA. Further educational preparation and support is required for dental and medical professionals to recognize OSA and ensure the best possible patient care.
Gominak SC and Stumpf WE (2012), "The world epidemic of sleep disorders is linked to vitamin D deficiency.", Med Hypotheses., May, 2012.
Abstract: An observation of sleep improvement with vitamin D supplementation led to a 2year uncontrolled trial of vitamin D supplementation in 1500 patients with neurologic complaints who also had evidence of abnormal sleep. Most patients had improvement in neurologic symptoms and sleep but only through maintaining a narrow range of 25(OH) vitamin D3 blood levels of 60-80ng/ml. Comparisons of brain regions associated with sleep-wake regulation and vitamin D target neurons in the diencephalon and several brainstem nuclei suggest direct central effects of vitamin D on sleep. We propose the hypothesis that sleep disorders have become epidemic because of widespread vitamin D deficiency. The therapeutic effects together with the anatomic-functional correspondence warrant further investigation and consideration of vitamin D in the etiology and therapy of sleep disorders.
Kielb SA, Ancoli-Israel S, Rebok GW and Spira AP (2012), "Cognition in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAS): Current Clinical Knowledge and the Impact of Treatment.", Neuromolecular Med., May, 2012.
Abstract: Obstructive sleep apnea-hypopnea syndrome (OSAS) is characterized by the presence of disordered breathing events that occur during sleep, as well as symptoms such as sleepiness and snoring. OSAS is associated with a number of adverse health consequences, and a growing literature focuses on its cognitive correlates. Although research in this field is mixed, multiple studies indicate that OSAS patients show impairment in attention, memory, and executive function. Continuous positive airway pressure (CPAP) is the most effective and widely used treatment of OSAS, and supplemental medications may supplement CPAP treatment to ameliorate associated symptoms. Here, we review the literature on OSAS and cognition, including studies that have investigated the impact of CPAP and stimulant medication on cognitive performance in patients with OSAS. In general, no consistent effect of CPAP use on cognitive performance was evident. This may be due, in part, to variability in study design and sampling methodology across studies. Studies of stimulant medications generally reported positive effects on cognitive performance. We conclude with a discussion of the mechanisms that have been proposed to explain cognitive dysfunction in OSAS and directions for future research.
Lustenberger C and Huber R (2012), "High density electroencephalography in sleep research: potential, problems, future perspective.", Front Neurol. Vol. 3, pp. 77.
Abstract: High density EEG (hdEEG) during sleep combines the superior temporal resolution of EEG recordings with high spatial resolution. Thus, this method allows a topographical analysis of sleep EEG activity and thereby fosters the shift from a global view of sleep to a local one. HdEEG allowed to investigate sleep rhythms in terms of their characteristic behavior (e.g., the traveling of slow waves) and in terms of their relationship to cortical functioning (e.g., consciousness and cognitive abilities). Moreover, recent studies successfully demonstrated that hdEEG can be used to study brain functioning in neurological and neuro-developmental disorders, and to evaluate therapeutic approaches. This review highlights the potential, the problems, and future perspective of hdEEG in sleep research.
Pritchett D, Wulff K, Oliver PL, Bannerman DM, Davies KE, Harrison PJ, Peirson SN and Foster RG (2012), "Evaluating the links between schizophrenia and sleep and circadian rhythm disruption.", J Neural Transm., May, 2012.
Abstract: Sleep and circadian rhythm disruption (SCRD) and schizophrenia are often co-morbid. Here, we propose that the co-morbidity of these disorders stems from the involvement of common brain mechanisms. We summarise recent clinical evidence that supports this hypothesis, including the observation that the treatment of SCRD leads to improvements in both the sleep quality and psychiatric symptoms of schizophrenia patients. Moreover, many SCRD-associated pathologies, such as impaired cognitive performance, are routinely observed in schizophrenia. We suggest that these associations can be explored at a mechanistic level by using animal models. Specifically, we predict that SCRD should be observed in schizophrenia-relevant mouse models. There is a rapidly accumulating body of evidence which supports this prediction, as summarised in this review. In light of these emerging data, we highlight other models which warrant investigation, and address the potential challenges associated with modelling schizophrenia and SCRD in rodents. Our view is that an understanding of the mechanistic overlap between SCRD and schizophrenia will ultimately lead to novel treatment approaches, which will not only ameliorate SCRD in schizophrenia patients, but also will improve their broader health problems and overall quality of life.
Shaefer SJM (2012), "Review finds that bed sharing increases risk of sudden infant death syndrome.", Evid Based Nurs., May, 2012.
Tosini G, Ye K and Iuvone PM (2012), "N-Acetylserotonin: Neuroprotection, Neurogenesis, and the Sleepy Brain.", Neuroscientist., May, 2012.
Abstract: N-Acetylserotonin (NAS) is a naturally occurring chemical intermediate in biosynthesis of melatonin. Previous studies have shown that NAS has different brain distribution patterns from those of serotonin and melatonin, suggesting that NAS might have functions other than as a precursor or metabolite of melatonin. Indeed, several studies have now shown that NAS may play an important role in mood regulation and may have antidepressant activity. Additional studies have shown that NAS stimulates proliferation of neuroprogenitor cells and prevents some of the negative effects of sleep deprivation. It is believed that the antidepressant and neurotrophic actions of NAS are due at least in part to the capability on this molecule to activate the TrkB receptor in a brain-derived neurotrophic factor-independent manner. Emerging evidence also indicates that NAS and its derivatives have neuroprotective properties and protect retinal photoreceptor cells from light-induced degeneration. In this review, the authors discuss the literature about this exciting and underappreciated molecule.
Vignoli A, Borgatti R, Peron A, Zucca C, Ballarati L, Bonaglia C, Bellini M, Giordano L, Romaniello R, Bedeschi MF, Epifanio R, Russo S, Caselli R, Giardino D, Darra F, La Briola F, Banderali G and Canevini MP (2012), "Electroclinical pattern in MECP2 duplication syndrome: Eight new reported cases and review of literature.", Epilepsia., May, 2012.
Abstract: Purpose:? Duplications encompassing the MECP2 gene on the Xq28 region have been described in male patients with moderate to severe mental retardation, absent speech, neonatal hypotonia, progressive spasticity and/or ataxia, recurrent severe respiratory infections, gastrointestinal problems, mild facial dysmorphisms (midface hypoplasia, depressed nasal bridge, large ears) and epilepsy. Epilepsy can occur in >50% of cases, but the types of seizures and the electroclinical findings in affected male individuals have been poorly investigated up to the present. Herein we describe eight patients with MECP2 duplication syndrome and a specific clinical and electroencephalographic pattern. Methods:? Array CGH of genomic DNA from the probands was performed, and an Xq28 duplication ranging from 209?kb to 6.36?Mb was found in each patient. Electroencephalography studies and clinical and seizure features of all the patients were analyzed. Key findings:?We found that epilepsy tended to occur between late childhood and adolescence. Episodes of loss of tone of the head and/or the trunk were the most represented seizure types. Generalized tonic-clonic seizures were rarely observed. The typical interictal EEG pattern showed abnormal background activity, with generalized slow spike and wave asynchronous discharge with frontotemporal predominance. Sleep electroencephalography studies also demonstrated abnormal background activity; spindles and K complex were often abnormal in morphology and amplitude. Response to therapy was generally poor and drug resistance was a significant feature. Significance:? Although these cases and a review of the literature indicate that epilepsy associated with MECP2 duplication syndrome cannot be considered a useful marker for early diagnosis, epilepsy is present in >90% of adolescent patients and shows a peculiar electroclinical pattern. Consequently, it should be considered a significant sign of the syndrome, and an EEG follow-up of these patients should be encouraged from early childhood. Moreover, the definition of a more specific epileptic phenotype could be useful in order to suspect MECP2 duplication syndrome in older undiagnosed patients.
Physiology / Pharmacology
Bonaventure P, Dugovic C, Kramer M, De Boer P, Singh J, Wilson S, Bertelsen K, Di J, Shelton J, Aluisio L, Dvorak L, Fraser I, Lord B, Nepomuceno D, Ahnaou A, Drinkenburg W, Chai W, Dvorak C, Carruthers N, Sands S and Lovenberg T (2012), "Translational evaluation of JNJ-18038683, a 5-HT7 receptor antagonist, on REM sleep and in major depressive disorder.", J Pharmacol Exp Ther., May, 2012.
Abstract: In rodents, 5-HT7 receptor blockade has been shown to be effective in models of depression and to increase the latency to REM sleep and decrease REM duration. In the clinic, the REM sleep reduction observed with many antidepressants may serve as a biomarker. We report here the preclinical and clinical evaluation of a selective 5-HT7 receptor antagonist, JNJ-18038683. In rodents, JNJ-18038683 increased the latency to REM sleep and decreased REM duration and this effect was maintained after repeated administration for 7 days. The compound was effective in the mouse tail suspension test. JNJ-18038683 enhanced serotonin transmission, antidepressant-like behavior, and REM sleep suppression induced by citalopram in rodents. In healthy human volunteers, JNJ-18038683 prolonged REM latency and reduced REM sleep duration demonstrating that the effect of 5-HT7 blockade on REM sleep translated from rodents to humans. Like in rats, JNJ-18038683 enhanced REM sleep suppression induced by citalopram in humans, although a drug-drug interaction could not be ruled out. In a double blind, active- and placebo-controlled clinical trial in 225 patients suffering from major depressive disorder, neither treatment with pharmacologically active doses of JNJ-18038683 or citalopram separated from placebo indicating a failed study lacking assay sensitivity. A post hoc analyses using an enrichment window strategy, where all the efficacy data from sites with an implausible high placebo response and from sites with no placebo response are removed, there was a clinically meaningful and statistically significant difference between JNJ-18038683 and placebo. Further clinical studies are required to characterize the potential antidepressant efficacy of JNJ-18038683.
Faraut B, Touchette E, Gamble H, Royant-Parola S, Safar ME, Varsat B and Léger D (2012), "Short sleep duration and increased risk of hypertension: a primary care medicine investigation.", J Hypertens., May, 2012.
Abstract: OBJECTIVES:: Compelling evidence from laboratory-based and population-based studies link sleep loss to negative cardiovascular health outcomes. However, little is known about the association between sleep duration and hypertension in primary care health settings, independently of other well controlled clinical and biochemical characteristics. We investigated the association between sleep duration and the prevalence of hypertension adjusting for 21 potential confounding factors in a noncontrolled primary care sample. METHODS:: The sample included 1046 French adults older than 40 years (mean age, 55.5 years), who visited any of the general practitioners of primary care centers in the Paris area. Blood pressure (BP) readings, blood samples and standardized health and sleep questionnaires were performed on each participant. Hypertension inclusion criteria were either high BP measurements (SBP ?140?mmHg or DBP ?90?mmHg) or the use of antihypertensive medications. Sleep duration was recorded as the self-reported average number of hours of sleep per night during the week. Logistic regressions were performed to test the association between hypertension and sleep duration adjusted for sociodemographic, clinical, biochemical, lifestyle, psychological and sleep disorder covariates. RESULTS:: Compared to the group sleeping 7?h, individuals sleeping 5?h or less had an increased odds ratio (OR) for the prevalence of hypertension [OR?=?1.80, 95% confidence interval (1.06-3.05)], after adjusting for 21 potential confounders which did not markedly attenuate this association. CONCLUSION:: Our data provide further epidemiologic evidence that with no specific selection in primary care medicine, usual short-sleep duration increases the risk of hypertension prevalence in adults over 40 years.
Geoghegan P, T O'Donovan M and Lawlor BA (2012), "Investigation of the Effects of Alcohol on Sleep Using Actigraphy.", Alcohol Alcohol., May, 2012.
Abstract: AIMS: To investigate the effect of alcohol consumption on the sleep and mood of healthy individuals in a college-based, mixed gender population. METHODS: Forty-seven individuals participated in this study, of whom 33 consumed alcohol and were included in the analysis. Sleep quality was objectively recorded using actigraphy. Subjects completed a daily sleep diary and bipolar Profile of Mood States Questionnaire, recording the subjective perception of sleep quality and waking mood respectively. RESULTS: Mean self-reported alcohol consumption among the drinkers was 84.6 ml ethanol/night. Mean total sleep time for those who consumed less than the mean reported intake was significantly reduced on alcohol. This reduction in sleep time was associated with increased wakefulness in the second half of the night, a truncated sleeping period and increased waking fatigue. This rebound wakefulness could not be demonstrated in those who consumed higher than the mean intake, though these individuals also reported increased waking fatigue. CONCLUSION: These results add weight to the clinical evidence that ethanol should not be used as a hypnotic due to its potential to affect both the quantity and quality of sleep. The finding that total sleep time is reduced on low doses of alcohol is novel and may arise from measuring sleep in an environment other than the sleep laboratory.
Mukherjee D, Kaushik MK, Jaryal AK, Kumar VM and Mallick HN (2012), "Glutamate microinjection in the medial septum of rats decreases paradoxical sleep and increases slow wave sleep.", Neuroreport., May, 2012. Vol. 23(7), pp. 451-456.
Abstract: The role of the medial septum in suppressing paradoxical sleep and promoting slow wave sleep was suggested on the basis of neurotoxic lesion studies. However, these conclusions need to be substantiated with further experiments, including chemical stimulation studies. In this report, the medial septum was stimulated in adult male rats by microinjection of L-glutamate. Sleep-wakefulness was electrophysiologically recorded, through chronically implanted electrodes, for 2 h before the injection and 4 h after the injection. There was a decrease in paradoxical sleep during the first hour and an increase in slow wave sleep during the second hour after the injection. The present findings not only supported the lesion studies but also showed that the major role of the medial septum is to suppress paradoxical sleep.
Prakash S (2012), "Dopa responsive insomnia: a forme fruste or precursor of restless legs syndrome?", J Neurol Sci., May, 2012. Vol. 316(1-2), pp. 170-172.
Abstract: Restless leg syndrome (RLS) is a movement disorder that has a profound impact on sleep, and sleep disturbances are considered as the primary morbidity for seeking treatment in most patients. However, isolated sleep has not been described as a symptom of RLS. Low dose dopaminergic agonists are considered for the treatment in patients with RLS. Herein, we describe 7 patients with isolated insomnia in whom insomnia responded to low dose levo-dopa. Six of them had a family history of RLS. We discuss a possibility of RLS in these patients and suggest to take a trial of l-dopa in patients with isolated insomnia who has a positive family history of RLS or in a patient who do not show response to usual therapies for RLS.
Ramgopal S, Shah A, Zarowski M, Vendrame M, Gregas M, Alexopoulos AV, Loddenkemper T and Kothare SV (2012), "Diurnal and sleep/wake patterns of epileptic spasms in different age groups.", Epilepsia., May, 2012.
Abstract: Purpose:? Epileptic spasms are seizures that occur predominantly in children and are characterized by clusters of brief axial movements. Epileptic spasms may occur in the context of a variety of syndromes. Previous research has found that epileptic spasms occur in a sleep/wake and diurnal rhythm. The purpose of this study was to identify these patterns in different age groups. Methods:? Charts of 2,021 patients with epilepsy undergoing video-electroencephalography (EEG) monitoring over a 10-year period were reviewed for presence of epileptic spasms and analyzed for their occurrence during the day (6?a.m. to 6?p.m.) or night, out of wake or sleep, and in 3-h time-blocks throughout the day. Exact epileptic spasm time, EEG localization, and the presence or absence of magnetic resonance imaging lesion were also recorded. Patients were separated into two age groups: A ages 3 and under, and over age 3. Statistical analysis of seizure occurrence in time bins was carried out using binomial calculations. p-Values <0.05 were taken as significant. Using exact seizure times, a generalized linear mixed model of the Poisson-family with a square root link function was used to calculate mean seizure times. Age, as a binary variable, and time, as a categorical variable, was treated as fixed effect predictors, and individual effects were modeled as random effects. For comparison between the two age groups, over age 3 and under age 3, seizure times were transformed into circular variables. A circular analysis of variance test was used to assess for the difference in mean seizure time, assuming a von Mises distribution of the circle. Key Findings:? We analyzed 219 clusters of epileptic spasms in 51 patients (15 girls; mean age 2.15 ± 2.22 years). Forty-two patients younger than 3 years of age had 163 seizures and nine patients older than 3?years had 56 seizures. Epileptic spasms occurred predominantly during wakefulness (p?
Unno K, Ozaki T, Mohammad S, Tsuno S, Ikeda-Sagara M, Honda K and Ikeda M (2012), "First and second generation H(1) histamine receptor antagonists produce different sleep-inducing profiles in rats.", Eur J Pharmacol., May, 2012. Vol. 683(1-3), pp. 179-185.
Abstract: First generation H(1) histamine receptor antagonists, such as d-chlorpheniramine (d-CPA) and diphenhydramine, produce drowsiness in humans. They are currently used as over-the-counter sleep aids. However, the mechanisms underlying drowsiness induced by these H(1) histamine receptor antagonists remain obscure because they produce heterogeneous receptor-independent actions. Ketotifen is a second generation H(1) histamine receptor antagonist which is more permeable to the brain than newer H(1) histamine receptor antagonists. Therefore, to access sleep-inducing profiles by H(1) histamine receptor blocking actions, the present study compared the dose-dependent effects of diphenhydramine and ketotifen (1-40mg/kg, intraperitoneal injection at dark onset time) on daily sleep-wake patterns in rats. Ketotifen dose-dependently decreased rapid-eye-movement (REM) sleep and increased non-REM sleep by amplifying slow-wave electroencephalogram powers. Diphenhydramine at 4mg/kg transiently increased non-REM sleep and reduced REM sleep similar to the effects of ketotifen. The larger injections of diphenhydramine (10-40mg/kg), however, reduced non-REM sleep, abolished slow-wave enhancements and facilitated wakefulness. The bi-directional action of diphenhydramine on sleep is similar to our former results using d-CPA. Taken together, the arousal effects caused by over-dose administrations of the first generation H(1) histamine receptor antagonists may be mediated by H(1) histamine receptor-independent actions. To further examine the tolerance of ketotifen-induced sleep, 3mg/kg ketotifen was injected daily for 5days 3h before light onset time. These experiments consistently enhanced non-REM-sleep at the end of the active phase of rats, suggesting that ketotifen may function as a desirable sleep aid although the coincidental REM sleep reduction requires attention.
Development / Aging / Evolution
Cohen G, Vella S, Jeffery H, Lagercrantz H and Katz-Salamon M (2012), "Positional circulatory control in the sleeping infant and toddler: role of the inner ear and arterial pulse pressure.", J Physiol., May, 2012.
Abstract: Heart rate (HR) and arterial blood pressure (BP) are rapidly and reflexively adjusted as body position and the force / direction of gravity alters. Anomalies in these mechanisms may predispose to circulatory failure during sleep. We analysed the development of two key reflexes involved by undertaking a longitudinal (birth - 1 year) comparison of instantaneous HR and BP changes evoked by abrupt upright, sideways or horizontal repositioning. Each manoeuvre triggered an identical rise in HR (tachycardia) followed by a slower rise in DBP/SBP and variable pulse pressure (PP) change. We show that tachycardia is triggered by acceleration (vestibular) sensors located in the inner ear and slight changes in the pulsatile component of BP then signal to the arterial baroreceptors to reinforce or oppose these actions as needed. We also identified a PP anomaly in sleeping 1 year-olds of smokers that prematurely slows HR and is associated with mild positional hypotension. We conclude that positional circulatory compensation is initiated pre-emptively in a feed forward manner and that feedback changes in vago-sympathetic drive to the heart (and perhaps blood vessels) by PP exerts a slower but powerful modulating effect. An anomaly in either or both mechanisms may weaken positional compensation in some sleeping infants.
Krouse A, Craig J, Watson U, Matthews Z, Kolski G and Isola K (2012), "Bed-sharing influences, attitudes, and practices: Implications for promoting safe infant sleep.", J Child Health Care., May, 2012.
Abstract: The purpose of this study was to examine the infant bed-sharing practices of mothers from the birth of the infant to three months of age. The study was a longitudinal descriptive design using a self-report instrument immediately after delivery with follow-up phone interviews at one and three months after discharge. While no mothers intended to bed-share with their infants immediately after delivery, 60 percent reported bed-sharing at some time at one month after discharge and 9 percent at three months. Only 19 percent of mothers reported receiving information about infant sleeping practices from their physician and 22 percent from their nurse. One month post discharge was identified as a high-risk period for infant bed-sharing. Interventions aimed at teaching new mothers about responding to infant cues and ways to manage a fussy infant may minimize the rate of bed-sharing.
Dreaming / Behavior / Learning
Holz J, Piosczyk H, Feige B, Spiegelhalder K, Baglioni C, Riemann D and Nissen C (2012), "EEG sigma and slow-wave activity during NREM sleep correlate with overnight declarative and procedural memory consolidation.", J Sleep Res., May, 2012.
Abstract: Previous studies suggest that sleep-specific brain activity patterns such as sleep spindles and electroencephalographic slow-wave activity contribute to the consolidation of novel memories. The generation of both sleep spindles and slow-wave activity relies on synchronized oscillations in a thalamo-cortical network that might be implicated in synaptic strengthening (spindles) and downscaling (slow-wave activity) during sleep. This study further examined the association between electroencephalographic power during non-rapid eye movement sleep in the spindle (sigma, 12-16?Hz) and slow-wave frequency range (0.1-3.5?Hz) and overnight memory consolidation in 20 healthy subjects (10 men, 27.1?±?4.6?years). We found that both electroencephalographic sigma power and slow-wave activity were positively correlated with the pre-post-sleep consolidation of declarative (word list) and procedural (mirror-tracing) memories. These results, although only correlative in nature, are consistent with the view that processes of synaptic strengthening (sleep spindles) and synaptic downscaling (slow-wave activity) might act in concert to promote synaptic plasticity and the consolidation of both declarative and procedural memories during sleep.
Pace-Schott EF, Verga PW, Bennett TS and Spencer RMC (2012), "Sleep promotes consolidation and generalization of extinction learning in simulated exposure therapy for spider fear.", J Psychiatr Res., May, 2012.
Abstract: Simulated exposure therapy for spider phobia served as a clinically naturalistic model to study effects of sleep on extinction. Spider-fearing, young adult women (N = 66), instrumented for skin conductance response (SCR), heart rate acceleration (HRA) and corrugator electromyography (EMG), viewed 14 identical 1-min videos of a behaving spider before a 12-hr delay containing a normal night's Sleep (N = 20) or continuous daytime Wake (N = 23), or a 2-hr delay of continuous wake in the Morning (N = 11) or Evening (N = 12). Following the delay, all groups viewed this same video 6 times followed by six 1-min videos of a novel spider. After each video, participants rated disgust, fearfulness and unpleasantness. In all 4 groups, all measures except corrugator EMG diminished across Session 1 (extinction learning) and, excepting SCR to a sudden noise, increased from the old to novel spider in Session 2. In Wake only, summed subjective ratings and SCR to the old spider significantly increased across the delay (extinction loss) and were greater for the novel vs. the old spider when it was equally novel at the beginning of Session 1 (sensitization). In Sleep only, SCR to a sudden noise decreased across the inter-session delay (extinction augmentation) and, along with HRA, was lower to the novel spider than initially to the old spider in Session 1 (extinction generalization). None of the above differentiated Morning and Evening groups suggesting that intervening sleep, rather than time-of-testing, produced differences between Sleep and Wake. Thus, sleep following exposure therapy may promote retention and generalization of extinction learning.
Biological Rhythms
Figueiro MG and Rea MS (2012), "Preliminary evidence that light through the eyelids can suppress melatonin and phase shift dim light melatonin onset.", BMC Res Notes., May, 2012. Vol. 5(1), pp. 221.
Abstract: ABSTRACT: BACKGROUND: A previous study reported a method for measuring the spectral transmittance of individual human eyelids. A prototype light mask using narrow-band "green" light (lambdamax = 527 nm) was used to deliver light through closed eyelids in two within-subjects studies. The first study investigated whether an individual-specific light dose could suppress melatonin by 40% through the closed eyelid without disrupting sleep. The light doses were delivered at three times during the night: 1) beginning (while subjects were awake), 2) middle (during rapid eye movement (REM) sleep), and 3) end (during non-REM sleep). The second study investigated whether two individual-specific light doses expected to suppress melatonin by 30% and 60% and delivered through subjects' closed eyelids before the time of their predicted minimum core body temperature would phase delay the timing of their dim light melatonin onset (DLMO). FINDINGS: Compared to a dark control night, light delivered through eyelids suppressed melatonin by 36% (p = 0.01) after 60-minute light exposure at the beginning, 45% (p = 0.01) at the middle, and 56% (p < 0.0001) at the end of the night. In the second study, compared to a dark control night, melatonin was suppressed by 25% (p = 0.03) and by 45% (p = 0.009) and circadian phase, as measured by DLMO, was delayed by 17 minutes (p = 0.03) and 71 minutes (ns) after 60-minute exposures to light levels 1 and 2, respectively. CONCLUSIONS: These studies demonstrate that individual-specific doses of light delivered through closed eyelids can suppress melatonin and phase shift DLMO and may be used to treat circadian sleep disorders.
Lee S-Y, Aycock DM and Moloney MF (2012), "Bright Light Therapy to Promote Sleep in Mothers of Low-Birth-Weight Infants: A Pilot Study.", Biol Res Nurs., May, 2012.
Abstract: Having a low-birth-weight (LBW) infant in a neonatal intensive care unit (NICU) can intensify a mother's sleep disturbances due to both stress and the dim lighting in the ICU setting, which desynchronizes circadian rhythms. The purpose of this pilot study was to examine the effectiveness of a 3-week bright light therapy intervention on sleep and health outcomes of mothers with LBW infants in the NICU. Controlled stratified randomization was used to assign 30 mothers to a treatment or control group. Data were collected at pretreatment (second week postpartum) and after the 3-week intervention. Sleep data were assessed by wrist actigraph (total sleep time [TST], circadian activity rhythms [CARs]) and the General Sleep Disturbance scale. Other outcome variables were measured by the Lee's Fatigue scale, Edinburgh Postpartum Depression scale, and the Medical Outcomes Short Form 36, version 2. Mothers averaged 26.6 (SD = 6.3) years of age, and the majority were Black (73. The mean gestational age for the infants was 27.7 (SD = 2.0) weeks. Small to large effect sizes were found when comparing the pre- to posttreatment differences between groups. Although none of the differences were statistically significant in this small sample, for mothers in the treatment group nocturnal TST (d = .33), CAR (d = 1.06), morning fatigue (d = .22), depressive symptoms (d = .40), physical health-related quality of life (d = .33), and mental health-related quality of life (d = .60) all improved compared to the control group. Bright light therapy is feasible for mothers with infants in an NICU. Clinically significant improvements have been evidenced; a larger-scale trial of effectiveness is needed.
Williams SR, Zies D, Mullegama SV, Grotewiel MS and Elsea SH (2012), "Smith-Magenis Syndrome Results in Disruption of CLOCK Gene Transcription and Reveals an Integral Role for RAI1 in the Maintenance of Circadian Rhythmicity.", Am J Hum Genet., May, 2012.
Abstract: Haploinsufficiency of RAI1 results in Smith-Magenis syndrome (SMS), a disorder characterized by intellectual disability, multiple congenital anomalies, obesity, neurobehavioral abnormalities, and a disrupted circadian sleep-wake pattern. An inverted melatonin rhythm (i.e., melatonin peaks during the day instead of at night) and associated sleep-phase disturbances in individuals with SMS, as well as a short-period circadian rhythm in mice with a chromosomal deletion of Rai1, support SMS as a circadian-rhythm-dysfunction disorder. However, the molecular cause of the circadian defect in SMS has not been described. The circadian oscillator temporally orchestrates metabolism, physiology, and behavior largely through transcriptional modulation. Data support RAI1 as a transcriptional regulator, but the genes it might regulate are largely unknown. Investigation into the role that RAI1 plays in the regulation of gene transcription and circadian maintenance revealed that RAI1 regulates the transcription of circadian locomotor output cycles kaput (CLOCK), a key component of the mammalian circadian oscillator that transcriptionally regulates many critical circadian genes. Data further show that haploinsufficiency of RAI1 and Rai1 in SMS fibroblasts and the mouse hypothalamus, respectively, results in the transcriptional dysregulation of the circadian clock and causes altered expression and regulation of multiple circadian genes, including PER2, PER3, CRY1, BMAL1, and others. These data suggest that heterozygous mutation of RAI1 and Rai1 leads to a disrupted circadian rhythm and thus results in an abnormal sleep-wake cycle, which can contribute to an abnormal feeding pattern and dependent cognitive performance. Finally, we conclude that RAI1 is a positive transcriptional regulator of CLOCK, pinpointing a novel and important role for this gene in the circadian oscillator.
Sleep Deprivation
Kaushal N, Nair D, Gozal D and Ramesh V (2012), "Socially isolated mice exhibit a blunted homeostatic sleep response to acute sleep deprivation compared to socially paired mice.", Brain Res., May, 2012. Vol. 1454, pp. 65-79.
Abstract: Sleep is an important physiological process underlying maintenance of physical, mental and emotional health. Consequently, sleep deprivation (SD) is associated with adverse consequences and increases the risk for anxiety, immune, and cognitive disorders. SD is characterized by increased energy expenditure responses and sleep rebound upon recovery that are regulated by homeostatic processes, which in turn are influenced by stress. Since all previous studies on SD were conducted in a setting of social isolation, the impact of the social contextual setting is unknown. Therefore, we used a relatively stress-free SD paradigm in mice to assess the impact of social isolation on sleep, wakefulness and delta electroencephalogram (EEG) power during non-rapid eye movement (NREM) sleep. Paired or isolated C57BL/6J adult chronically-implanted male mice were exposed to SD for 6h and telemetric polygraphic recordings were conducted, including 18h recovery. Recovery from SD in the paired group showed a significant decrease in wake and significant increase in NREM sleep and rapid eye movement (REM), and a similar, albeit less robust response occurred in the isolated mice. Delta power during NREM sleep was increased in both groups immediately following SD, but paired mice exhibited significantly higher delta power throughout the dark period. The increase in body temperature and gross motor activity observed during the SD procedure was decreased during the dark period. In both open field and elevated plus maze tests, socially isolated mice showed significantly higher anxiety than paired mice. The homeostatic processes altered by SD are differentially affected in paired and isolated mice, suggesting that the social context of isolation stress may adversely affect the quantity and quality of sleep in mice.
Menz MM, Büchel C and Peters J (2012), "Sleep Deprivation Is Associated with Attenuated Parametric Valuation and Control Signals in the Midbrain during Value-Based Decision Making.", J Neurosci., May, 2012. Vol. 32(20), pp. 6937-6946.
Abstract: Sleep deprivation (SD) has detrimental effects on cognition, but the affected psychological processes and underlying neural mechanisms are still essentially unclear. Here we combined functional magnetic resonance imaging and computational modeling to examine how SD alters neural representation of specific choice variables (subjective value and decision conflict) during reward-related decision making. Twenty-two human subjects underwent two functional neuroimaging sessions in counterbalanced order, once during rested wakefulness and once after 24 h of SD. Behaviorally, SD attenuated conflict-dependent slowing of response times, which was reflected in an attenuated conflict-induced decrease in drift rates in the drift diffusion model. Furthermore, SD increased overall choice stochasticity during risky choice. Model-based functional neuroimaging revealed attenuated parametric subjective value signals in the midbrain, parietal cortex, and ventromedial prefrontal cortex after SD. Conflict-related midbrain signals showed a similar downregulation. Findings are discussed with respect to changes in dopaminergic signaling associated with the sleep-deprived state.
Rai B, Foing BH and Kaur J (2012), "Working hours, sleep, salivary cortisol, fatigue and neuro-behavior during Mars analog mission: Five crews study.", Neurosci Lett., May, 2012. Vol. 516(2), pp. 177-181.
Abstract: The buoyancy of humans in exploring extreme space environments has been established during missions to the moon. Long duration missions like mission to Mars however, requires humans to adapt to systemic and complex environments beyond the human body's capacity. Astronauts will encounter both physiological and psychological extremes during this trip. Very few studies are conducted on effect of long duration work and sleepiness on cognitive performance. So, this study was planned to find out effects of leadership responsibility, sleepiness and long duration working hours on cognitive performance. The 30 members (leadership: normal; 10:20) were selected from MDRS crews (Mars Desert Research Station, USA). Neurobehavioral test performance, self-ratings of fatigue and sleepiness, and salivary cortisol levels were evaluated during first day, mid and end day of mission. The leadership group did not show any signs of reduced test performance, even in elevated fatigue and sleepiness. The leadership group had faster reaction times on end of mission as compared to first and after 7day of mission. Salivary cortisol levels were significantly higher in leadership group as compared to normal group. The results suggest that long duration work and sleepiness does not affect the cognitive performance of crew member. Further study is required while taking into account all factors and large sample size to prove this fact.
Soltani M, Haytabakhsh MR, Najman JM, Williams GM, O'Callaghan MJ, Bor W, Dingle K and Clavarino A (2012), "Sleepless nights: the effect of socioeconomic status, physical activity, and lifestyle factors on sleep quality in a large cohort of Australian women.", Arch Womens Ment Health., May, 2012.
Abstract: The aims of this study were to examine: (1) the association between sociodemographic and lifestyle factors and sleep quality in a population-based cohort of Australian women and (2) possible influence of reproductive status and mental and physical health factors on these associations. Data on 3,655 women (mean age?=?46.6 years, range 34.3-67.4) were obtained from the Mater Hospital University of Queensland Study of Pregnancy for this cross-sectional study. Self-rated sleep quality was assessed using the Pittsburgh Sleep Quality Index. For the purpose of this study, two cutoff points (scores 5 and 10) were used to divide women into three categories: normal (65.2 , moderately poor (26.4 , and very poor sleep quality (8.5 . Other covariates were measured at 21-year follow-up as well. After adjusting for reproductive status, mental and physical health, there were significant associations between moderately poor sleep quality and education and between very poor sleep quality and unemployment, both measures of socioeconomic status. In addition, work-related exertion was associated with increased rates of moderately poor sleep quality, whereas those women undertaking moderate exercise were less likely to experience very poor sleep quality. Independent associations between sociodemographic factors and exercise with moderately poor and very poor sleep quality were identified. These findings demonstrate the dynamic nature of the association between exercise/exertion, socioeconomic status, and sleep quality and highlight the importance of taking these into consideration when dealing with issues of poor sleep quality in women.
Sleep Apnea / COPD / Snoring
Braga A, Carboni LH, do Lago T, Küpper DS, Eckeli A and Valera FCP (2012), "Is uvulopalatopharyngoplasty still an option for the treatment of obstructive sleep apnea?", Eur Arch Otorhinolaryngol., May, 2012.
Abstract: Uvulopalatopharyngoplasty (UPPP) has been widely described as a surgical option for the treatment of obstructive sleep apnea syndrome. Several studies have demonstrated variable success rates, and different criteria have been used to define success of surgery. The aim of the present study was to assess the efficiency of UPPP by polysomnography and to correlate it to the clinical findings. Also, we correlated to the various studies dealing with this topic, considering the different criteria adopted in each of this. Sixty-four patients were included in the study. The efficiency of surgery for UPPP was analyzed to the variables such as body mass index, age, preoperative polysomnography results and follow-up period. Based on the criteria for postoperative cure, the success rate was 44  Younger patients presented a better success rate than older ones. No other correlation was found between clinical findings and UPPP success. UPPP can be curative in some patients, but combination with other treatment modalities must be considered. This should be mentioned to the patients, since in many cases the sites of airway collapse may be multiple and no clinical aspect (except for age) is indicative of good prognosis.
Digoy GP, Shukry M and Stoner JA (2012), "Sleep Apnea in Children with Laryngomalacia: Diagnosis via Sedated Endoscopy and Objective Outcomes after Supraglottoplasty.", Otolaryngol Head Neck Surg., May, 2012.
Abstract: Objective. The authors study the contribution of laryngomalacia to obstructive sleep apnea syndrome (OSAS) in children older than 12 months. The clinical and polysomnographic outcomes in patients with OSAS who underwent a supraglottoplasty were also studied.Setting. Tertiary care children's hospital.Study Design. A case series with chart review.Subjects and Methods. A review of consecutive pediatric patients diagnosed with both OSAS and state-dependant laryngomalacia (SDL) between 2005 and 2008. The diagnosis of SDL was made via laryngoscopy under light general anesthesia (sleep endoscopy). All subjects underwent a supraglottoplasty.Results. A total of 43 patients met inclusion criteria, and 36 patients had complete pre- and postoperative data available for review. The apnea-hypopnea index (AHI) score decreased following supraglottoplasty for 33 (92 95% confidence interval [CI], 7898 of the 36 patients. The mean (SD) change in AHI score (calculated as the postoperative minus the preoperative measure) was -9.2 (11.2), representing a statistically significant reduction (95% CI, -13.0 to -5.5; P < .0001). The mean (SD) preoperative AHI was 13.3 (12.9). The minimum oxygen saturation increased following supraglottoplasty for 21 (58 95% CI, 4174. The mean (SD) change in the minimum oxygen saturation was 3.5 (8.3), which was a statistically significant increase (95% CI, 0.7-6.3; P = .015).Conclusion. Laryngomalacia may contribute significantly to OSAS in some children who are 12 months and older. Sleep endoscopy appears to be an effective method in the diagnosis of SDL. When present, a supraglottoplasty can be an effective procedure and may significantly improve symptoms of OSAS.
Faria AC, da Silva-Junior SN, Garcia LV, Dos Santos AC, Fernandes MRF and de Mello-Filho FV (2012), "Volumetric analysis of the pharynx in patients with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA).", Sleep Breath., May, 2012.
Abstract: INTRODUCTION: Maxillomandibular advancement (MMA) has been reported to be the most effective surgical treatment of obstructive sleep apnea (OSA). Most reports about MMA aim to confirm the efficiency of this treatment modality, but few describe the anatomical changes produced in the pharynx by the surgery. Thus, the objective of the present investigation was to quantify the anatomical changes of the pharynx that occur in patients with OSA after MMA surgery using magnetic resonance (MR). METHODS: Twenty patients with a polysomnographic diagnosis of OSA participated in the study. All patients were submitted to image acquisition by MR performed during wakefulness. Polysomnography and MR were performed preoperatively and 6 months after MMA. Volume analysis (in cubic millimeters) was performed as the sum of the areas multiplied by their thickness, with no intervals between sections. The pharyngeal air space of the region between the hard palate and the base of the epiglottis was divided into a retropalatal (RP) region and a retrolingual (RL) region. RESULTS: Postoperative MR showed a mean volumetric increase of 26.72 % in the RP region and of 27.2 % in the RL region. DISCUSSION: MMA increases the air space of the pharynx by expanding the facial skeletal structure to which the soft tissues of the pharynx and tongue are fixed, with a consequent reduction of collapsibility in the presence of negative pressure during inspiration. This reduced possibility of pharyngeal collapse may contribute to the reduction of obstructive events.
Jain SV, Horn PS, Simakajornboon N and Glauser TA (2012), "Obstructive Sleep Apnea and Primary Snoring in Children With Epilepsy.", J Child Neurol., May, 2012.
Abstract: Sleep-related breathing disruptions in children with epilepsy are common and can range from primary snoring to obstructive sleep apnea. Untreated obstructive sleep apnea can lead to significant morbidity. This study aimed to identify factors associated with its occurrence and severity in children with epilepsy. Children with epilepsy and sleep disruption were evaluated with polysomnography and diagnosed with obstructive sleep apnea or primary snoring. Statistical analyses were done to identify differences within both the groups and among the subjects in the obstructive sleep apnea group. Uncontrolled epilepsy was a risk factor for obstructive sleep apnea (80 compared with primary snoring (47 P = .02). Obstructive index increased with increasing number of antiepileptic drugs. In children with epilepsy and disturbed sleep, obstructive sleep apnea is associated with uncontrolled epilepsy and is more severe with polytherapy use. Children with uncontrolled seizures on antiepileptic polytherapy should be routinely screened for obstructive sleep apnea.
Mirrakhimov AE (2012), "Non drowsy obstructive sleep apnea as a potential cause of resistant hypertension: a case report.", BMC Pulm Med. Vol. 12(1), pp. 16.
Abstract: ABSTRACT:Obstructive sleep apnea (OSA) and arterial hypertension (AH) are common and underrecognized medical disorders. OSA is a potential risk factor for the development of AH and/or may act as a factor complicating AH management. The symptoms of excessive daytime sleepiness (EDS) are considered essential for the initiation of continuous positive airway pressure (CPAP) therapy, which is a first line treatment of OSA. The medical literature and practice is controversial about the treatment of people with asymptomatic OSA. Thus, OSA patients without EDS may be left at increased cardiovascular risk.The report presents a case of 42year old Asian woman with symptoms of heart failure and angina like chest pain upon admission. She didnt experience symptoms of EDS, and the Epworth Sleepiness Scale was seven points. Snoring was reported on direct questioning. The patient had prior medical history of three unsuccessful pregnancies complicated by gestational AH and preeclampsia with C-section during the last pregnancy. The admission blood pressure (BP) was 200/120mm Hg. The patients treatment regimen consisted of five hypotensive medications including diuretic. However, a target BP wasnt achieved in about one and half month. The patient was offered to undergo a polysomnography (PSG) study, which she rejected. One month after discharge the PSG study was done, and this showed an apnea-hypopnea index (AHI) of 46 events per hour. CPAP therapy was initiated with a pressure of 11H20cm. After 2months of compliant CPAP use, adherence to pharmacologic regimen and lifestyle modifications the patients BP decreased to 134/82mm Hg.OSA and AH are common and often underdiagnosed medical disorders independently imposing excessive cardiovascular risk on a diseased subject. When two conditions coexist the cardiovascular risk is likely much greater. This case highlights a possible clinical phenotype of OSA without EDS and its association with resistant AH. Most importantly a good hypotensive response to medical treatment in tandem with CPAP therapy was achieved in this patient. Thus, it is reasonable to include OSA in the differential list of resistant AH, even if EDS is not clinically obvious.
Nakano H, Mishima K, Matsushita A, Suga H, Matsumura M, Mano T, Fukuda T, Hara H, Yamashita H and Ueyama Y (2012), "Efficacy of the Silensor for treating obstructive sleep apnea syndrome.", Oral Maxillofac Surg., May, 2012.
Abstract: INTRODUCTION: Although mandibular repositioning devices were found to be very effective for treating obstructive sleep apnea (OSAS), they can cause side effects such as temporomandibular joint disorder and occlusal deviation. A semi-rigid device with a low frequency of side effects, the Silensor, (Erkodent Gmbh, Tuttlingen, Germany) was reported previously. The purpose of this study is to determine whether the Silensor is effective for treating OSAS. MATERIALS AND METHODS: Thirty-five OSAS patients (27 males and 8 females) who were treated with the Silensor were enrolled in this study. The mean age and body mass index of the patients were 52.2 years (23-72 years) and 24.5 kg/m(2) (19.3-31.6 kg/m(2)), respectively. The patients were classified into two groups based on the length of the apparatus connector: 0-2 or 3-4 mm. A polysomnography test was performed twice, at the first visit and after the improvement of subjective symptoms. These data were statistically analyzed using the Wilcoxon signed-rank test. RESULTS: The apnea-hypopnea index significantly improved in all OSAS patients, the mild to moderate OSAS patients, severe OSAS patients, 0- to 2-mm group, and the 3- to 4-mm group (91.4  p?
Porhomayon J, Nader ND, Leissner KB and El-Solh AA (2012), "Respiratory Perioperative Management of Patients With Obstructive Sleep Apnea.", J Intensive Care Med., May, 2012.
Abstract: Obstructive sleep apnea (OSA) has become a major public health problem in the United State and Europe. However, perioperative strategies regarding diagnostic options and management of untreated OSA remain inadequate. Preoperative screening and identification of patients with undiagnosed OSA may lead to early perioperative interventions that may alter cardiopulmonary events associated with surgery and anesthesia.(1) Hence, clinicians need to become familiar with the preoperative screening and diagnosis of OSA. Perioperative management of a patient with OSA should be modified and may include regional anesthesia and alternative analgesic techniques such as nonsteroidal anti-inflammatory drugs that may reduce the need for systemic opioids. Additionally, supplemental oxygen and continuous pulse oximetry monitoring should be utilized to maintain baseline oxygen saturation. Postoperatively patients should remain in a semi-upright position and positive pressure therapy should be used in patients with high-risk OSA.
Zur B, Ludwig M and Stoffel-Wagner B (2012), "Case-control studies of novel hemoglobin anomalies as differential diagnosis in sleep apnea syndrome.", Sleep Breath., May, 2012.
Abstract: PURPOSE: Pulse oximetry plays an essential role in the diagnosis of sleep apnea syndrome. We discovered two novel hemoglobin anomalies, Hb Bonn and Hb Venusberg, which initially resulted in avoidable sleep disorder examinations and therapeutic consequences due to their low oxygen saturation levels as measured by pulse oximetry. METHODS: Hematological as well as clinical chemical diagnosis was carried out. Hemoglobin anomalies were detected through electrophoresis, chromatography, spectrophotometry, and pulse oximetry as well as hemoglobin gene sequencing. RESULTS: Hb Bonn is a novel hemoglobin mutation of the proximal ?1 globin with an additional absorption maximum of the oxyhemoglobin at 668 nm. This results in pulse oximetry measurements of false low oxygen saturation due to incorrect calculations at the pulse oximetry measuring point 660 m. Hb Venusberg is a novel oxygen-affine hemoglobin mutation of the ?-globin which is electrophoretically silent. Clinical symptoms include intermittent low oxygen saturation levels, cyanosis of lips and nail beds, and limited physical resistance to stress. CONCLUSIONS: Hemoglobin anomalies, such as Hb Bonn and Hb Venusberg, should be included in differential diagnosis as potential causes of low oxygen saturation especially in case of nonspecific or conflicting findings.
Other Disorders
Bakker RH, Pedersen E, van den Berg GP, Stewart RE, Lok W and Bouma J (2012), "Impact of wind turbine sound on annoyance, self-reported sleep disturbance and psychological distress.", Sci Total Environ., May, 2012. Vol. 425, pp. 42-51.
Abstract: The present government in the Netherlands intends to realize a substantial growth of wind energy before 2020, both onshore and offshore. Wind turbines, when positioned in the neighborhood of residents may cause visual annoyance and noise annoyance. Studies on other environmental sound sources, such as railway, road traffic, industry and aircraft noise show that (long-term) exposure to sound can have negative effects other than annoyance from noise. This study aims to elucidate the relation between exposure to the sound of wind turbines and annoyance, self-reported sleep disturbance and psychological distress of people that live in their vicinity. Data were gathered by questionnaire that was sent by mail to a representative sample of residents of the Netherlands living in the vicinity of wind turbinesA dose-response relationship was found between immission levels of wind turbine sound and selfreported noise annoyance. Sound exposure was also related to sleep disturbance and psychological distress among those who reported that they could hear the sound, however not directly but with noise annoyance acting as a mediator. Respondents living in areas with other background sounds were less affected than respondents in quiet areas.People living in the vicinity of wind turbines are at risk of being annoyed by the noise, an adverse effect in itself. Noise annoyance in turn could lead to sleep disturbance and psychological distress. No direct effects of wind turbine noise on sleep disturbance or psychological stress has been demonstrated, which means that residents, who do not hear the sound, or do not feel disturbed, are not adversely affected.
Covassin N, Neikrug AB, Liu L, Corey-Bloom J, Loredo JS, Palmer BW, Maglione J and Ancoli-Israel S (2012), "Clinical correlates of periodic limb movements in sleep in Parkinson's disease.", J Neurol Sci., May, 2012. Vol. 316(1-2), pp. 131-136.
Abstract: The aim of the current study was to investigate the frequency of periodic limb movements in sleep (PLMS) in Parkinson's disease (PD) and their impact on nocturnal sleep and daytime functioning.Forty-five PD patients (mean age 68.5 ± 8.7 years; 32 males) underwent one night of polysomnography (PSG). Clinical assessment and questionnaires evaluating sleep disturbance and quality of life (QoL) were completed. Patients were divided into two groups based on their PLMS index (PLMSI): PLMSI ? 15 (PLMS+) and PLMSI <15 (PLMS-).There were 26 (57.8 PD patients in the PLMS+group and 19 (42.2 patients in the PLMS-group. Subjective assessment revealed an association between PLMS+status and greater PD symptom severity, more subjective sleep disturbance, and decreased QoL. All patients showed poor sleep, and no significant group differences were detected on PSG measures.We observed that PLMS occurred frequently in PD and increased with more severe PD. Although PLMS did not affect objective sleep, it was associated with increased sleep complaints and reduced QoL. Overall, our findings support the association between PLMS and PD as well as the clinical relevance of sleep disturbances in PD.
Gjevre JA, Taylor-Gjevre RM, Nair BV and Lim HJ (2012), "Do Sleepy Rheumatoid Arthritis Patients Have A Sleep Disorder?", Musculoskeletal Care., May, 2012.
Abstract: OBJECTIVE: Subjective reports of sleep dysfunction are common in people with rheumatoid arthritis (RA). Our objective was to determine whether excess sleepiness in RA is associated with polysomnographic (PSG) abnormalities. METHODS: Twelve RA participants with abnormal sleep scores were identified in clinic and age/gender matched to RA participants with normal Epworth Sleepiness Scale (ESS) scores. A total of 25 participants were recruited. All participants underwent overnight PSG studies with measurement of apnoea-hypopnoea indexes (AHI). Questionnaire instruments, including the ESS, Berlin questionnaire for sleep apnoea risk, visual analogue scale for fatigue, modified Health Assessment Questionnaire (mHAQ) and the Center for Epidemiologic Studies - Depression (CES-D) score, along with RA assessments, were reapplied on the PSG study night. RESULTS: Seven men and 18 women participated. Ten participants had abnormal ESS scores and 15 had normal ESS scores on the PSG night. PSG data revealed that 68% of patients had abnormal AHI (? 5). Abnormal ESS (> 10) had an 80% positive predictive value (PPV) for abnormal AHI; the negative predictive value (NPV) of normal ESS was 40 By contrast, high-risk categorization for obstructive sleep apnoea (OSA) by the Berlin questionnaire had a PPV of 77.8 and for low-risk status, an NPV of 37.5 CONCLUSIONS: In the present study population, there was a high prevalence of abnormal AHI consistent with OSA. An abnormal ESS had high positive predictive value for an abnormal AHI. Copyright © 2012 John Wiley & Sons, Ltd.
Johannessen R, Petersen H, Olberg P, Johnsen G, Fjøsne U and Kleveland PM (2012), "Airway symptoms and sleeping difficulties in operated and non-operated patients with gastroesophageal reflux disease.", Scand J Gastroenterol., May, 2012.
Abstract: Abstract Introduction. Anti-reflux treatment studies have not succeeded in proving a causal relationship between gastroesophageal reflux disease (GERD), airway symptoms and sleeping difficulties. In a recent follow-up study we showed that patients operated for GERD have significantly less heartburn/acid regurgitation symptoms than matched non-operated patients. These two groups probably had different degrees of reflux over a long period of time. It is thus hypothesized that operated patients would report less airway symptoms and sleeping difficulties than comparable non-operated patients. A new follow-up study of the same patients was therefore conducted. Material and methods. A total of 179 patients operated for GERD and 179 matched non-operated patients with confirmed GERD were sent the Reflux, Airway & Sleep Questionnaire (RASQ), which is a new, validated questionnaire dealing with heartburn/acid regurgitation, airway symptoms, and sleeping difficulties. Answers are given on a 7-point Likert scale and the assessment period is 1 year. Results. Response rates were 68% in both groups. Operated patients reported significantly less reflux symptoms than non-operated patients (p < 0.001). Patients in the surgery group also reported less symptoms in two subscales of the RASQ dealing with airway symptoms: Laryngopharyngitis (p = 0.04) and Bronchitis (p = 0.01). There was a tendency toward less sleeplessness in operated patients, but this was not statistically significant. Snoring was less bothersome in operated patients (p = 0.02). Conclusions. Patients operated for GERD have less heartburn/acid regurgitation symptoms and less airway symptoms than non-operated patients. The findings lend support to the hypothesis of a causal relationship between gastroesophageal reflux, airway symptoms, and sleeping difficulties.
Soreca I, Wallace ML, Frank E, Hasler BP, Levenson JC and Kupfer DJ (2012), "Sleep duration is associated with dyslipidemia in patients with bipolar disorder in clinical remission.", J Affect Disord., May, 2012.
Abstract: BACKGROUND: The pathways to increased cardiovascular risk in bipolar disorder include health behaviors, psychosocial stress and long-term medication exposure. However, the evidence that the association between cardiovascular risk factors and bipolar disorder remains significant after controlling for these co-factors suggests that additional important risk factors have yet to be identified. Our hypothesis is that disturbances in the sleep-wake cycle are an important and under-recognized pathway through which affective disorders lead to increased cardiovascular risk. METHODS: In patients with bipolar disorder type 1 in clinical remission, we: 1) explored whether sleep disturbance predicted the endorsement of NCEP ATP-III criteria for dyslipidemia, independent of other lifestyle factors and 2) tested the association between low HDL (NCEP-ATP III) and sleep duration measured with actigraphy over an eight-day period. RESULTS: Median sleep duration is significantly associated with low HDL. The risk of having low HDL increases by 1.23 with every 30 minutes of reduced sleep time. LIMITATIONS: Since sleep patterns in patients with bipolar disorder are variable and irregular, it is possible that other sleep characteristics, not present during the span of our study, or the variability itself may be what drives the increased cardiovascular risk. CONCLUSIONS: Sleep characteristics of patients with bipolar disorder in clinical remission are associated with cardiovascular risk. More specifically, sleep duration was associated with low HDL. Clinicians should pay special attention to sleep hygiene in treating individuals with bipolar disorder, even when they are in clinical remission.
Winkelmann J, Lin L, Schormair B, Kornum BR, Faraco J, Plazzi G, Melberg A, Cornelio F, Urban AE, Pizza F, Poli F, Grubert F, Wieland T, Graf E, Hallmayer J, Strom TM and Mignot E (2012), "Mutations in DNMT1 cause autosomal dominant cerebellar ataxia, deafness and narcolepsy.", Hum Mol Genet., May, 2012. Vol. 21(10), pp. 2205-2210.
Abstract: Autosomal dominant cerebellar ataxia, deafness and narcolepsy (ADCA-DN) is characterized by late onset (30-40 years old) cerebellar ataxia, sensory neuronal deafness, narcolepsy-cataplexy and dementia. We performed exome sequencing in five individuals from three ADCA-DN kindreds and identified DNMT1 as the only gene with mutations found in all five affected individuals. Sanger sequencing confirmed the de novo mutation p.Ala570Val in one family, and showed co-segregation of p.Val606Phe and p.Ala570Val, with the ADCA-DN phenotype, in two other kindreds. An additional ADCA-DN kindred with a p.GLY605Ala mutation was subsequently identified. Narcolepsy and deafness were the first symptoms to appear in all pedigrees, followed by ataxia. DNMT1 is a widely expressed DNA methyltransferase maintaining methylation patterns in development, and mediating transcriptional repression by direct binding to HDAC2. It is also highly expressed in immune cells and required for the differentiation of CD4+ into T regulatory cells. Mutations in exon 20 of this gene were recently reported to cause hereditary sensory neuropathy with dementia and hearing loss (HSAN1). Our mutations are all located in exon 21 and in very close spatial proximity, suggesting distinct phenotypes depending on mutation location within this gene.
Methodology / Miscellaneous
Berthomier C and Brandewinder M (2012), "Sleep scoring: man vs. machine?", Sleep Breath., May, 2012.
Stege G, Vos PJE, Dekhuijzen PNR, Hilkens PHE, van de Ven MJT, Heijdra YF and van den Elshout FJJ (2012), "Manual vs. automated analysis of polysomnographic recordings in patients with chronic obstructive pulmonary disease.", Sleep Breath., May, 2012.
Abstract: PURPOSE: The sleep quality, as assessed by polysomnography (PSG), of patients with chronic obstructive pulmonary disease (COPD) can be severely disturbed. The manual analysis of PSGs is time-consuming, and computer systems have been developed to automatically analyze PSGs. Studies on the reliability of automated analyses in healthy subjects show varying results, and the purpose of this study was to assess whether automated analysis of PSG by one certain automatic system in patients with COPD provide accurate outcomes when compared to manual analysis. METHODS: In a retrospective study, the full-night polysomnographic recordings of patients with and without COPD were analyzed automatically by Matrix Sleep Analysis software and manually. The outcomes of manual and automated analyses in both groups were compared using Bland-Altman plots and Students' paired t tests. RESULTS: Fifty PSGs from patients with COPD and 57 PSGs from patients without COPD were included. In both study groups, agreement between manual and automated analysis was poor in nearly all sleep and respiratory parameters, like total sleep time, sleep efficiency, sleep latency, amount of rapid eye movement sleep and other sleep stages, number of arousals, apnea-hypopnea index, and desaturation index. CONCLUSION: Automated analysis of PSGs by the studied automated system in patients with COPD has poor agreement with manual analysis when looking at sleep and respiratory parameters and should, therefore, not replace the manual analysis of PSG recordings in patients with COPD.
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