REM sleep behavior disorder and vocal cord paralysis in Machado-Joseph disease.

We evaluated the occurrence of REM sleep behaviour disorder (RBD) and vocal cord abductor paralysis (VCAP) in a group of 9 Machado-Joseph disease (MJD) patients. RBD was diagnosed by clinical history plus audiovisual polysomnography in 4 men and 1 woman (55%). While dreaming, 4 fell out of the bed and the other injured his arms. Laryngoscopy detected bilateral VCAP in 1 patient with stridor who required emergency tracheotomy, and partial vocal cord abductor restriction in 2. RBD and VCAP are two potentially injurious conditions that should be considered part of the clinical spectrum of MJD.     

Nocturnal sleep spindle activity in blind subjects

To determine spindle activity during sleep in congenitally blind subjects, electroencephalogram sleep recordings were done on two or three consecutive nights in five subjects aged in their 20s and 30s. The number per minute and the duration of sleep spindles, scored visually, were compared with the data of sighted persons of comparable ages. The results indicated that the total number of sleep spindles a night was ranged from 117 to 585, and the number per minute ranged 0.52 to 2.06 during stage 2. Both values were much less than the values of sighted persons.     

Diagnostic approach to obstructive sleep apnea in children

Obstructive sleep apnea syndrome (OSAS) in childhood is a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep patterns. A spectrum of severity related to the degree of upper airway resistance, to the duration of the disease, to the presence or absence of hypoxemia episodes, and to certain clinical features can be described. Symptomatic children may not fit the criteria for diagnosis established for OSAS in adults; age-specific standards are needed. Both anatomical factors that increase upper airway resistance, e.g. adenotonsillar hypertrophy, and functional processes that decrease upper airway tone, e.g. REM sleep, contribute to the pathogenesis of pediatric OSAS. Sequelae of OSAS in children include neurobehavioural abnormalities, stunting of growth, and cor pulmonale. Both the history and physical examination should target the sleeping child; parents often report loud snoring, difficulty breathing, and obstructive apneas. The gold standard investigation to establish the diagnosis and to quantitate disease severity is overnight polysomnography. Home cardiopulmonary sleep studies have been shown to be an accurate and practical alternative to overnight laboratory polysomnography for routine evaluation of non-complex children with adenotonsillar hypertrophy. Children with documented severe OSAS are at increased post-operative risk for airway compromise and should be observed and monitored carefully. Adenotonsiliectomy is the most common therapy for OSAS in children; as a second-line treatment, the use of nasal CPAP in children with OSAS has been very successful in experienced hands.     

Prevalence and Severity of Sleep Apnea in a Group of Morbidly Obese Patients

Background Obesity is the most important risk factor for obstructive sleep apnea. It is estimated that 70% of sleep apnea patients are obese. In the morbidly obese, the prevalence may reach 80% in men and 50% in women. The aim of this study was to determine the prevalence and severity of sleep apnea in a group of morbidly obese patients, leading to bariatric surgery. Methods In a cross-sectional study developed in Bahia, northeastern Brazil. 108 patients (78 women and 30 men) from the Obesity Treatment and Surgery Center - “Núcleo de Tratamento e Cirurgia da Obesidade” underwent standard polysomnography. Patients with an apnea-hypopnea index (AHI) ≥ 5 events/hour were considered apneic. Results Mean ± SD for age and BMI were 37.1 ± 10.2 years and 45.2 ± 5.4 kg/m2, respectively. The calculated AHI ranged widely from 2.5 to 128.9 events/hour. Sleep apnea was detected in 93.6% of the sample, wherein 35.2% had mild, 30.6% moderate and 27.8% severe apnea. Oxyhemoglobin desaturation was directly related to the AHI and was more severe in men. Conclusion There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request polysomnography, thus enabling therapeutic management and prognostication.     

Association between a Serotonin Transporter Length Polymorphism and Primary Insomnia

Study Objective:

To test the hypothesis that a 44-base-pair insertion/deletion polymorphism in the 5'' regulatory region of the serotonin transporter gene (5-HTTLPR) is associated with primary insomnia.

Design:

Association study.

Setting:

Sleep laboratory at the Central Institute of Mental Health, Mannheim, Germany.

Patients:

157 patients with primary insomnia and 827 healthy controls.

Interventions:

N/A.

Measurement and Results:

We found the short (s-) allele of the 5-HTTLPR to be significantly more frequent in patients suffering from insomnia than in control individuals (47.1% vs. 39.9%: OR = 1.34).

Conclusions:

This finding contributes to the understanding of the pathophysiology of primary insomnia and suggests a biological basis between the prevalent comorbidity of primary insomnia and other psychiatric disorders.

Citation:

Deuschle M; Schredl M; Schilling C; Wöust S; Frank J; Witt SH; Rietschel M; Buckert M; Meyer-Lindenberg A; Schulze TG. Association between a serotonin transporter length polymorphism and primary insomnia. SLEEP 2010;33(3):343-347.     

The association between sleep spindles and IQ in healthy school-age children

Recent studies have suggested that sleep is associated with IQ measures in children, but the underlying mechanism remains unknown. An association between sleep spindles and IQ has been found in adults, but only two previous studies have explored this topic in children. The goal of this study was to examine whether sleep spindle frequency, amplitude, duration and/or density were associated with performance on the perceptual reasoning, verbal comprehension, working memory, and processing speed subscales of the Wechsler Intelligence Scale for Children-IV (WISC-IV). We recruited 29 typically developing children 7–11 years of age. We used portable polysomnography to document sleep architecture in the natural home environment and evaluated IQ. We found that lower sleep spindle frequency was associated with better performance on the perceptual reasoning and working memory WISC-IV scales, but that sleep spindle amplitude, duration and density were not associated with performance on the IQ test.     

Oxidative stress and sleep apnoea in clinically healthy infants in the first year of life

Summary Question of the study   Respiratory instability as well as tissue damage by free radicals (oxidative stress) have been hypothesized to play a role in cases of sudden and unexpected infant death in the first year of life. The ratio of the oxidized/reduced form of redox compounds in the circulation could be used as a marker of oxidative stress. Therefore, the sleep apnoea rate and redox status of coenzyme Q10 (CoQ10) (percentage of the oxidized form in total CoQ10) were measured in a population of clinically healthy infants in their first year of life in order to study whether a physiological parameter of respiratory instability is related to a biochemical parameter of oxidative stress. Patients and methods   Between May and December 1999, 323 infants in the first year of life were referred to a paediatric sleep laboratory. Sleep apnoea rate, periodic breathing and parameters of oxygenation (SaO₂ and TcPO₂) were calculated based on polysomnographic recordings. The CoQ10 redox status was calculated based on high-pressure liquid chromatographic (HPLC) analysis. Results   Statistical analysis showed an age-dependent decrease in apnoea rate ( r = – 0.38) and CoQ10 redox status ( r = – 0.40). An increased CoQ10 redox status (median: 16.6 %; range: 7.3 – 29.7 %) was found in infants with high apnoea rates above the 90^th percentile of a reference group in comparison with infants with apnoea rates below the 90^th percentile of a reference group (median: 10.4 %; range: 5.1 – 20.4 %; P = 0.031). Conclusions   These findings may indicate that high apnoea rates are accompanied by increased formation of free radicals in clinically healthy infants in the first year of life.     

海马CA1区注射吗啡对大鼠睡眠的影响

目的观察吗啡在海马CA1区对大鼠睡眠的影响。方法选择雄性成年SD大鼠39只,分为对照组(8只)、吗啡组(8只)和纳洛酮组(8只),15只不符合要求已剔除。运用脑立体定位、核团插管、药物微量注射和多导睡眠描记技术,观察海马CA1区注射药物后大鼠睡眠-觉醒指标变化情况。结果与对照组比较,吗啡组大鼠海马CA1区双侧微量注射吗啡后觉醒时间增加32.0%(P<0.05),总睡眠时间减少23.7%(P<0.05),其中深慢波睡眠减少76.1%(P<0.05)。纳洛酮组大鼠海马CA1区双侧微量注射纳洛酮后觉醒时间减少34.1%(P<0.01),总睡眠时间增加25.3%(P<0.01),其中深慢波睡眠增加247.8%(P<0.01)。结论吗啡在海马参与对睡眠-觉醒周期的调节,且吗啡对睡眠的影响主要是通过改变深慢波睡眠成分实现的。     

Quisi与睡眠脑电图检测抑郁症的比较研究

目的评价Quisi检测抑郁症的作用和适应证。方法对19例抑郁症患者和21名正常受试者分别作Quisi和睡眠脑电图检测。并以日本SEEG-1500型睡眠脑电图为检测标准,与德国Quisi进行比较研究。结果在正常对照组中,除睡眠第二阶段百分比,Quisi少于多导睡眠图(Polysomnography,PS)外(Quisi为48±8,正常人PSG56±9,t=2.48,P<0.05),其余12项指标差异均无显著性。抑郁症组中睡眠第一阶段百分比,Quisi也少于PSG(Quisi为11±4,PSG为13±3,t=2.0,P<0.05),其余12项指标差异也无显著性。结论Quisi检测抑郁症作用与PSG相似,在心理咨询、外出巡诊和家庭病床上有应用前途,但不适用于发作性疾病的评估。