Abnormalities of sleep in patients with the chronic fatigue syndrome.

OBJECTIVE--To determine whether patients with the chronic fatigue syndrome have abnormalities of sleep which may contribute to daytime fatigue. DESIGN--A case-control study of the sleep of patients with the chronic fatigue syndrome and that of healthy volunteers. SETTING--An infectious disease outpatient clinic and subjects'' homes. SUBJECTS--12 patients who met research criteria for the chronic fatigue syndrome but not for major depressive disorder and 12 healthy controls matched for age, sex, and weight. MAIN OUTCOME MEASURES--Subjective reports of sleep from patients'' diaries and measurement of sleep patterns by polysomnography. Subjects'' anxiety, depression, and functional impairment were assessed by interview. RESULTS--Patients with the chronic fatigue syndrome spent more time in bed than controls (544 min v 465 min, p < 0.001) but slept less efficiently (90% v 96%, p < 0.05) and spent more time awake after initially going to sleep (31.9 min v 16.6 min, p < 0.05). Seven patients with the chronic fatigue syndrome had a sleep disorder (four had difficulty maintaining sleep, one had difficulty getting to sleep, one had difficulty in both initiating and maintaining sleep, and one had hypersomnia) compared with none of the controls (p = 0.003). Those with sleep disorders showed greater functional impairment than the remaining five patients (score on general health survey 50.4% v 70.4%, p < 0.05), but their psychiatric scores were not significantly different. CONCLUSIONS--Most patients with the chronic fatigue syndrome had sleep disorders, which are likely to contribute to daytime fatigue. Sleep disorders may be important in the aetiology of the syndrome.     

心内科住院患者睡眠质量分析与护理干预

目的:了解心内科住院患者睡眠质量,分析睡眠障碍的原因,探讨改善患者睡眠障碍的有效护理对策。方法:对我院2010年5月-2010年12月心内科109例住院睡眠障碍患者采取问卷调查及深入访谈相结合的方法进行调查,找出心内科患者睡眠障碍的原因;随后,将109例患者随机分为两组,对照组实行组常规护理,干预组实行有针对性的护理,7d后对对两组患者睡眠障碍进行测评。结果:心内科患者睡眠障碍症状为:入眠时间长,早醒,觉醒次数多,醒后再入眠难;睡眠障碍原因为:患者自身疾病、心理、环境、其他及综合因素所致。通过有针对性的护理干预后,两组有较大差距(P<0.05),干预组患者睡眠障碍改善明显,干预组好于对照组,表明护理干预可有效改善患者的睡眠质量。结论:疾病因素、心理因素以及生活习惯是影响心内科住院患者睡眠质量的主要因素,通过科学有效的护理干预措施,可以改善心内科患者的睡眠质量,提高患者的身心健康。     

Continuous non-invasive blood pressure monitoring in patients with sleep disorders.

Sleep related breathing disorders are of high prevalence and are often associated with essential hypertension. It is therefore necessary to study blood pressure continuously in all patients with sleep related breathing disorders and arterial hypertension as well as in all patients with essential hypertension and suspected sleep apnoea. To investigate the usefulness of a non-invasive continuous volume-clamp method during sleep we used this technique in parallel with 130 sleep recordings and performed a validation study of the Finapres instrument on a subgroup where continuous invasive blood pressure recordings were available. Absolute pressure values of Finapres are valid when the position and the movement of the sensor were carefully observed and only appropriate segments of the recordings were taken for further evaluation. The high beat to beat resolution of the systolic and diastolic pressure is the main advantage of this non-invasive technique because it reflects rapid blood pressure variations as they occur in sleep related breathing disorders. This could be investigated only invasively until now.     

Movement disorders in sleep: Parkinson's disease and restless legs syndrome.

In recent years, sleep abnormalities have increasingly been observed in patients with movement disorders. During sleep, most patients with Parkinson's disease also exhibit the movements characteristically seen during the wake period. Movement activity during sleep may impair sleep quality and lead to daytime sleepiness and reduced quality of life. Disordered REM sleep with enhanced muscle tone is common in patients with neurodegenerative disease, and may precede the clinically evident symptoms of Parkinson's disease by years. Sleep disorders in patients with Parkinson's disease are common, and require the application of individual treatment strategies. A further frequent disorder primarily classified as a sleep disorder (dyssomnia) is the restless legs syndrome (RLS), which is closely related to the nocturnal periodic limb movement disorder and affects up to 15% of the population. The present review focuses on nocturnal motor activity and sleep in Parkinson's disease and RLS.     

A relationship between nightmare content and somatic stimuli in a sleep-disordered population: A preliminary study.

This study aimed to examine the influence of specific sleep disorders on dream content. The authors hypothesized that: (a) waking somatic concerns influence dream content and (b) somatic stimulation associated with specific sleep disorders influence dream content items. The subjects (N = 124) were included if they demonstrated obstructive sleep apnea, narcolepsy, an EEG arousal disorder during sleep, or periodic leg movements during sleep (PLMS), based on standard polysomnography. The 42-item Wahler Physical Symptom Inventory was used to quantify somatic concerns. Dream content and frequency was assessed with a 37-item Dream Questionnaire. Ten symptom-dream pairs were selected as mutually relevant and subjected to chi-square analysis. 84.6% of all subjects reported having bad dreams (N = 105). A significant proportion of patients who complain of excessive perspiration dream about perspiring, and significant proportions of those who report difficulty breathing while awake dream about feelings of choking and suffocation. Recurring dreams and dreams of paralysis are significantly more prominent in patients with narcolepsy. Patients with sleep apnea do not dream of choking/feelings of suffocation with greater frequency than nonapneics. These findings suggest that somatic stimulation associated with specific sleep disorders appears to have an inconsistent influence on certain dream content items. Furthermore, dream mentation appears to feature waking concerns, rather that being related to events associated with during sleep disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Invited review: genetic dissection of sleep.

Recent advances in genomics open up new avenues in the analysis of complex behaviors such as sleep. In this analysis, the mouse is the model species of choice because it is amenable to high throughput phenotype and genotype analysis. With the use of the mouse model, unprecedented progress in our understanding of sleep physiology and the treatment of sleep disorders is awaited. This review is intended to provide an overview of available methods and techniques for genetic dissection of sleep in mice. Limits and advantages of different approaches are discussed to highlight the necessity for combining methods to avoid erroneous interpretations. The gap between understanding mechanisms of sleep and its functions may be bridged by finding its molecular bases.     

Prevalence of sleep disorders and their impact on academic performance in medical students/University of Duhok

Full-time students experiencing high levels of stress due to a high bulk of teaching materials and academic performance demands are the most susceptible population class for different types of sleep disorders. The current study examined the prevalence of sleep disorders and their impacts on academic performance of a random sample of medical college students. In this regard, a random sample of 316 medical students of a large public university in Iraq participated in a cross-sectional study. The participants completed the SLEEP-50 self-reported questionnaire and questions about socio-demographic factors. The variables set included sleep apnea, insomnia, narcolepsy, restless legs syndrome, circadian rhythm sleep disorder, sleepwalking, nightmares, grade point average, and some socio-demographic characteristics. The study showed that to some extent, the students suffer from different types of sleep disorders with no substantial difference between males and females. Students with worse level of sleep disorders had a lower grade point average compared with those with normal sleep patterns (p = 0.001). The study confirmed that students with sleep disorders had poorer academic performance at college.

     

Sleep disorders in elderly, the sleep apnea syndrome in particular: are they a cause of insomnia? A review of literature

In this publication a review is presented based on the findings resulting from sleep-wake investigations searching for sleep disorders associated with insomnia in relatively healthy elderly. 44 Relevant journal articles published between 1980-1998 were found. The four most important sleep disorders which can be accompanied by sleeplessness in relatively healthy elderly people are periodic leg movements disorder (PLM), restless legs syndrome (RLS), REM sleep behaviour disorder (RBD) and sleep apnea syndrome (SAS). Of these disorders, sleep apnea and periodic leg movements occur most frequently, in a quarter of the elderly. The latter, however, seldom complain about sleeplessness. Within the category of older people disorders characterized by movements during sleep increase significantly with age, nightly respiration disorders do not. SAS, PLM and RBD appear most frequently in men and RLS in women. The disorders characterized by movements during sleep (especially RLS and RBD) are often accompanied by sleeplessness. SAS, however, is more closely associated with day-time sleepiness than with sleeplessness. No combination of demographic variables and symptoms allows a reliable prediction of these sleep disorders. Fortunately, these disorders are not a major threat to the health of older people.     

Diagnosis of sleep disorders and medical sleep-related diseases--a review]

A person's well-being and health are greatly affected by disorders of sleep and wakefulness. It is of the utmost importance to diagnose and treat such conditions, since the associated daytime sleepiness is a major risk factor for accidents. Early establishment of the correct diagnosis paves the way to achieving an excellent therapeutic outcome. Health-economic requirements of appropriateness and necessity mandate the specific use of cost- and time-intensive examinations in the sleep laboratory. In accordance with the guidelines for "non-restorative sleep", severe and chronic sleep disorders can be diagnosed outside the sleep lab if the underlying cause can already be identified on the basis of the patient's history. Such is usually the case in sleep disorders caused by external influences, disturbed circadian rhythm or pre-existing neurological, psychiatric or internal disorders. Standardized questionnaires are used to record and evaluate the patient's complaints, and vigilance testing to assess impaired sustained attention during the day. Excessive daytime sleepiness is quantified by the multiple sleep latency test (MSLT). In the case of some disorders such as apnoea, or periodic leg movements, simplified ambulatory methods have been developed to enable their detection at an early stage. The gold standard for the diagnosis of sleep disorders in the sleep lab is cardiorespiratory polysomnography. The relevant biosignals for the assessment of sleep, respiration, heart function, the cardiovascular system and movement are well established. Some of the sensors employed need further improvement. Numerous methods for signal analysis are still undergoing development, and currently available automatic evaluation systems are not yet reliable enough to obviate the need for manual interpretation.     

A controlled study of Tourette syndrome. VI. Early development, sleep problems, allergies, and handedness.

Developmental milestones, problems with bladder and bowel control, sleep disturbances, allergies, and handedness were compared in 247 consecutive Tourette syndrome (TS) patients, 17 patients with attention-deficit disorder (ADD), 15 patients with ADD secondary to TS (ADD 2(0) TS), and 47 random controls. There were no significant differences in age of first talking or walking. By contrast, there were significant differences in problems with bladder and bowel control between TS patients and controls, as measured by age of first toilet training, age of last bed-wetting, frequency of enuresis, and age that bowel control was achieved. Sleep problems were pervasive in TS patients, with a significantly increased frequency of sleepwalking, night terrors, trouble getting to sleep, early awakening, and inability to take afternoon naps as a young child. In all diagnostic categories, including mild (grade 1) TS patients, a total sleep-problem score was significantly greater than that in controls. The sleep disorders and other TS symptoms are consistent with TS as a disorder of disinhibition of the limbic system. Allergies and left-handedness have been evoked as contributing to or being associated with ADD and learning disorders. There were no significant differences in the frequency of allergies or left-handedness in TS patients compared with that in controls. We conclude that when there is a clearly defined genetic cause of ADD and learning disorders, it is not associated with an increased frequency of allergies or left-handedness.     

Peculiarities of human sleep in the case of double alternation of "sleep-waking" cycles

The dynamics of sleep was studied in seven healthy subjects in two schedules, differing in the magnitude of the sleep intervals and their distribution over the 24 hour period. The first series provided for the use of two four-hour sleep intervals, the second six- and two-hour intervals. The investigations showed that the transition to a new schedule was accompanied by substantial qualitative and quantitative sleep disturbances, followed by a restoration of sleep as the subjects adapted. Less pronounced sleep disorders and more rapid restoration were observed in the schedule with nonuniform distribution of the intervals; more pronounced sleep disorders and a slowed restoration of sleep were observed on the schedule with two four-hour intervals.     

Sleepiness in a population of Italian shiftwork policemen

The aim of this study was to evaluate the effects of shiftwork on sleepiness, sleep disorders and sleep related accidents in a population of policemen. Data concerning age and physical characteristics, working conditions, sleep problems and accidents were collected by a questionnaire. Sleepiness was evaluated by the Epworth Sleepiness Scale (ESS) while the presence of sleep disorders was evaluated by a score (SD-score) drawn from indicators of insomnia, breathing disorders, periodic limb movements-restless leg syndrome and hypersomnia. The effects of age, gender, body mass index, working condition and seniority on ESS, SD-score and accidents were analysed by linear and logistic regression. Participants were 1280 policemen: 611 shiftworkers and 669 non-shiftworkers. The ESS scores were not higher in shiftworkers than in non-shiftworkers, but the SD-score was found to be significantly influenced by shiftwork condition and seniority. The occurrence of sleep-related accidents was found to have been significantly increased for shiftworkers and related to the presence of indicators of sleep disorders. The sleepiness could be underestimated or even overcome by the influence of stressing conditions. However our data should alert occupational health physicians for the diagnosis and prevention of possible lurking intrinsic sleep disorders likely to influence health problems and risk of accidents in shiftworkers.     

Obstructive sleep apnea. Trends in therapy.

The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders. Obstructive sleep apnea carries a risk of substantial morbidity and mortality. Excessive daytime sleepiness results from fragmented sleep and microarousals associated with apneic events. It causes poor work performance and increases the incidence of automobile accidents due to driving while drowsy. The commission estimates that the loss of productivity in the United States from excessive daytime sleepiness is more than $20 billion per year. Obstructive sleep apnea is strongly associated with hypertension, myocardial infarction, and stroke. Risk factors for obstructive sleep apnea include male sex, obesity, older age, craniofacial anomalies, and familial risk. Treatment is based on documenting the disorder by polysomnography. Medical management of the syndrome includes weight loss and nasal continuous positive airway pressure. A network of follow-up and support is necessary to maintain compliance. Surgical treatment is reserved for those for whom nasal airway pressure treatment fails. A surgical protocol is presented that demonstrates efficacy equal to nasal airway pressure treatment. Primary care physicians should assume the responsibility of identifying patients at risk for obstructive sleep apnea and refer them appropriately.     

Disorders of glucose metabolism in sleep apnea.

Sleep is a complex behavioral state that occupies one-third of the human life span. Although viewed as a passive condition, sleep is a highly active and dynamic process. The sleep-related decrease in muscle tone is associated with an increase in resistance to airflow through the upper airway. Partial or complete collapse of the airway during sleep can lead to the occurrence of apneas and hypopneas during sleep that define the syndrome of sleep apnea. Sleep apnea has become pervasive in Western society, affecting approximately 5% of adults in industrialized countries. Given the pandemic of obesity, the prevalence of Type 2 diabetes mellitus and metabolic syndrome has also increased dramatically over the last decade. Although the role of sleep apnea in cardiovascular disease is uncertain, there is a growing body of literature that implicates sleep apnea in the pathogenesis of altered glucose metabolism. Intermittent hypoxemia and sleep fragmentation in sleep apnea can trigger a cascade of pathophysiological events, including autonomic activation, alterations in neuroendocrine function, and release of potent proinflammatory mediators such as tumor necrosis factor-alpha and interleukin-6. Epidemiologic and experimental evidence linking sleep apnea and disorders of glucose metabolism is reviewed and discussed here. Although the cause-and-effect relationship remains to be determined, the available data suggest that sleep apnea is independently associated with altered glucose metabolism and may predispose to the eventual development of Type 2 diabetes mellitus.     

终末期肾脏病患者睡眠质量的影响因素及其与生活质量、焦虑抑郁的关系研究

目的:探讨终末期肾脏病(ESRD)患者睡眠质量的影响因素及其与生活质量、焦虑抑郁的关系.方法:选取2018年3月～2019年12月期间我院收治的ESRD患者198例为研究对象.患者睡眠质量采用匹兹堡睡眠指数量表(PSQI)评价.采用焦虑自评量表(SAS)与抑郁自评量表(SDS)评估患者焦虑、抑郁状态.采用肾病生活质量评...     

Increased levels of circulating ICAM-1, VCAM-1, and L-selectin in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) may be one of the most important risk factors of cardiovascular disorders, although the exact mechanism remains to be elucidated. In the present study, we hypothesized that OSAS-induced hypoxic stress might be involved in the etiology of cardiovascular disorders by activating adhesion molecules, including intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and L-selectin. To examine this hypothesis, we measured circulating ICAM-1, VCAM-1, and L-selectin levels before and after sleep in OSAS patients and age-matched controls. The circulating ICAM-1, VCAM-1, and L-selectin levels increased in the OSAS patients before sleep compared with the normal subjects (ICAM-1: 392.9 +/- 48.5 vs. 201.2 +/- 55.0 ng/ml, P < 0.05; VCAM-1: 811.0 +/- 87.8 vs. 574.2 +/- 42.7 ng/ml, P < 0.05; L-selectin: 1,386.6 +/- 77.9 vs. 1,038.8 +/- 78.6 ng/ml, P < 0.01, respectively). After sleep, significantly greater levels of ICAM-1 and L-selectin, but not VCAM-1, were observed in the OSAS group. These observations suggest that OSAS-induced hypoxia activates adhesion molecules, resulting in the important risk factor of cardiovascular disorders. Treatment of OSAS can be, therefore, a potential approach to prevention of cardiovascular events.     

注意缺陷多动障碍低觉醒模型的新证据

注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder,ADHD）是儿童期常见的一种发展性的异常,其病因及发生机理至今未明。低觉醒模型是ADHD成因的一种假设。本文从睡眠障碍导致的低觉醒探讨ADHD发生机理。通过对ADHD儿童的睡眠障碍进行分析以及将ADHD外在表现与睡眠剥夺后的表现进行对比分析,得出ADHD儿童存在的低觉醒是由于外显的或内隐的睡眠障碍引起的,一方面间接证明了低觉醒模型,另一方面为ADHD的成因研究开拓了新的思路。     

Genome-wide expression profiling and bioinformatics analysis of diurnally regulated genes in the mouse prefrontal cortex

Background  

The prefrontal cortex is important in regulating sleep and mood. Diurnally regulated genes in the prefrontal cortex may be controlled by the circadian system, by sleep:wake states, or by cellular metabolism or environmental responses. Bioinformatics analysis of these genes will provide insights into a wide-range of pathways that are involved in the pathophysiology of sleep disorders and psychiatric disorders with sleep disturbances.     

Development of REM sleep drive and clinical implications.

Rapid eye movement (REM) sleep in the human declines from approximately 50% of total sleep time ( approximately 8 h) in the newborn to approximately 15% of total sleep time (approximately 1 h) in the adult, and this decrease takes place mainly between birth and the end of puberty. We hypothesize that without this developmental decrease in REM sleep drive, lifelong increases in REM sleep drive may ensue. In the rat, the developmental decrease in REM sleep occurs 10-30 days after birth, declining from >70% of total sleep time in the newborn to the adult level of approximately 15% of sleep time during this period. Rats at 12-21 days of age were anesthetized with ketamine and decapitated, and brain stem slices were cut for intracellular recordings. We found that excitatory responses of pedunculopontine nucleus (PPN) neurons to N-methyl-D-aspartic acid decrease, while responses to kainic acid increase, over this critical period. During this developmental period, inhibitory responses to serotonergic type 1 agonists increase but responses to serotonergic type 2 agonists do not change. The results suggest that as PPN neurons develop, they are increasingly activated by kainic acid and increasingly inhibited by serotonergic type 1 receptors. These processes may be related to the developmental decrease in REM sleep. Developmental disturbances in each of these systems could induce differential increases in REM sleep drive, accounting for the postpubertal onset of a number of different disorders manifesting increases in REM sleep drive. Examination of modulation by PPN projections to ascending and descending targets revealed the presence of common signals modulating ascending arousal-related functions and descending postural/locomotor-related functions.     

Melatonin and clinical application.

A review of the different publications dealing with melatonin in humans shows that this field has been very active in the last few years. Normative melatonin values have been defined. Various relationships between melatonin and other traits have been studied, such as sleep, circadian rhythm, surgical stress and anaesthesia. Age-related melatonin studies and melatonin during depression and other psychiatric disorders have been reviewed. Finally, some studies have been performed to use melatonin as a medication for sleep disturbance in depression, for jet-lag and as a skin protector for ultraviolet light.