Obstructive Sleep Apneic Patients Have Craniomandibular AbnormalitiesJamieson,, Andrew;Guilleminault,, Christian;Partinen,, Markku;Quera-Salva, Maria, Antonia
doi: 10.1093/sleep/9.4.469pmid: 3809860
Summary: One hundred fifty-five unselected obstructive sleep apneic patients seen in succession had cephalometric roentgenograms and polygraphic recordings performed. These patients were compared to a group of 41 subjects who had consulted orthodontists for malocclusion and had no clinical indication of sleep apnea. The cephalometric landmarks were also compared to those published as normative data in the literature. The limits of “normalcy” were conservatively defined as mean ¶ 2 standard deviations. Only two obstructive sleep apneic patients had normal cephalometric landmarks and 150 of the 155 patients had at least two significantly different landmarks from the normative data in the literature. The common findings were a retroposition of the mandible, a different cranial base flexure with a nasion-sella-basion angle more acute than expected, and a displacement of the hyoid bone to a lower position than expected. These combined changes reduced the space occupied by soft tissues anchored on the skull and mandible, and the length of the soft palate was increased. Obstructive sleep apnea syndrome, Cephalometric roentgenograms This content is only available as a PDF. © 1986, Association of Professional Sleep Societies
Sleep-Disordered Breathing and its Concomitants in a Subclinical PopulationBerry, David T., R.;Webb, Wilse, B.;Block, A., Jay;Switzer, Daniel, A.
doi: 10.1093/sleep/9.4.478pmid: 3809861
Summary: In order to evaluate possible deficits accompanying sleep-disordered breathing (SDB) in a subclinical population, the nocturnal respiration, health status, and sleep/wake cycle of 46 healthy, heavy-snoring men were measured. Sixty-two percent of these subjects had at least one episode of apnea/hypopnea, while 13% had high levels of apnea/hypopnea [apnea/hypopnea index (AHI)≥5]. Most events occurred in stages 1 or 2 or in REM sleep. Strong relationships between weight and SDB were observed, as were more modest relationships between age and SDB. Correlational procedures indicated relationships between SDB and higher blood pressure, subjective sleepiness, and napping. Because similar, but stronger, relationships involving these variables are observed in patients with a sleep apnea syndrome (SAS), it appears that a continuum exists between heavy-snoring men and patients with SAS. When these subjects were grouped by level of SDB, subjects with high levels of SDB (AHI ≥ 5) had significantly lower nocturnal oxygenation parameters than the remaining subjects. However, there were no between-group differences in health or sleep/wake variables. It is concluded that while apnea/hypopnea events in subclinical populations may not be completely benign events, the level at which they may be considered frankly pathological is presently unclear. Sleep apnea syndrome, Sleep apnea activity, Hypersomnolence, Hypertension This content is only available as a PDF. © 1986, Association of Professional Sleep Societies
Body Position Changes and Periodic Movements in SleepDzvonik, M., L.;Kripke, D., F.;Klauber,, M.;Ancoli-Israel,, S.
doi: 10.1093/sleep/9.4.484pmid: 3809862
Summary: What triggers episodes of periodic movements in sleep (PMS) remains unknown. Despite the uncertainties, there is no doubt of the widespread prevalence of PMS, particularly in elderly populations. This study explored possible consistent temporal relationships between body position and PMS episodes. Eleven subjects, monitored by polygraph and videotape, averaged 299 leg jerks in nine episodes, and 13 body position changes of 90°. Leg jerk episodes had a significant tendency to terminate soon before body position changes, and likewise there was a trend for leg jerk episodes to begin soon after position changes. It is hypothesized that adverse body positioning, via an influence upon the spinal cord or peripheral tissue perfusion, triggers PMS episodes, which persist until the adverse positions are changed. In this small sample, “adverse” positions could not be elucidated. Periodic movements in sleep, Nocturnal myoclonus, Body position, Sleep disorders This content is only available as a PDF. © 1986, Association of Professional Sleep Societies
Sleep Deprivation in Healthy Elderly Men and Women: Effects on Mood and on Sleep During RecoveryReynolds, Charles, F.;Kupfer, David, J.;Hoch, Carolyn, C.;Stack, Jacqueline, A.;Houck, Patricia, R.;Berman, Susan, R.
doi: 10.1093/sleep/9.4.492pmid: 3809863
Summary: Elderly women had better recovery sleep than elderly men following 36-h sleep deprivation, as evidenced by higher sleep maintenance/efficiency and more slow wave sleep (particularly in the amount of stage 4 sleep). During recovery sleep, both groups showed REM latency reduction (two men and three women had seven sleep-onset REM periods out of a total of 40 recovery nights), decrease in percentage of early REM sleep and increase in whole-night REM sleep time. Total Mood Disturbance scores on the Profile of Mood States increased in both men and women following sleep deprivation (reflecting a decrease in vigor and increase in fatigue and tension). While the increase tended to be greater in women, in both groups self-ratings of mood returned to baseline after 1 night of recovery sleep. These observations underscore the importance of gender in determining late-life sleep structure and suggest that the ability of older women to achieve slow wave sleep and to have long uninterrupted sleep in greater than that of men. Sleep deprivation, Healthy elderly This content is only available as a PDF. © 1986, Association of Professional Sleep Societies
Internal Structure of Sleep Cycles in a Healthy PopulationMerica,, H.;Gaillard,, J.-M.
doi: 10.1093/sleep/9.4.502pmid: 3809864
Summary: A large body of data has been gathered on the sleep characteristics of normal subjects. The evolution of each sleep stage within each NREM/REM cycle is presented in detail, showing stage intensities minute by minute. There is a three-phase pattern in each stage intensity diagram: an initial phase of rapid change; a central phase of relative stability; and a terminating phase, again, of rapid change. The details of this pattern change progressively during the night. Throughout all cycles, there is a complementary relationship between the intensities of stage 2 sleep and the other stages that underlines the central role of stage 2 sleep in all stage transitions. Stage intensity diagrams for two groups, one group with and one group without stage 4 sleep, were compared. Subjects without stage 4 sleep tended to have a shorter duration and greater latency of stage 3 sleep. Surprisingly, cycles interrupted by abnormally long periods of continuous wake showed a negative correlation between the intensities of wake and slow wave sleep, and these interruptions did not appear to reset the cycle clock to zero. Sleep stage intensity diagrams may be useful to study the sleep patterns of populations of insomniac and depressive patients, as well as the effect of drugs on sleep Human sleep, Temporal organization, Cycle structure, Stage intensities This content is only available as a PDF. © 1986, Association of Professional Sleep Societies
Preamble Guidelinedoi: 10.1093/sleep/9.4.518pmid: N/A
Abstract Excessive Daytime Sleepiness is a primary and disabling symptom of a number of sleep-wake disorders. Studies that have investigated the prevalence ofthis symptom in the general population find that between 0.5 to 5.0% of the persons surveyed complain of EDS. Among patients seen in sleep-wake disorder clinics in the United States, the majority (51%) present with daytime somnolence. EDS has a great impact and a disruptive effect on patients' lives. They report car accidents, occupational accidents, the loss of employment and disability, difficulties in social adjustment and in children, learning disabilities, all in association with their EDS. In addition, failure of attention, memory lapses and an intolerance to CNS depressant drugs including alcohol are also associated with the experience of daytime somnolence. For the clinician a test to objectively evaluate the severity of this symptom and to evaluate the adequacy of treatment is critical to the practice of sleep disorders medicine. This content is only available as a PDF. © 1986, Association of Professional Sleep Societies
Guidelines for the Multiple Sleep Latency Test (MSLT): A Standard Measure of SleepinessCarskadon, Mary, A.
doi: 10.1093/sleep/9.4.519pmid: 3809866
Introduction The multiple sleep latency test (MSLT) is used in the assessment and diagnosis of disorders of excessive somnolence and to evaluate daytime sleepiness in relation to various therapeutic or experimental manipulations, such as administering drugs and altering the length of timing of nocturnal sleep. The repeated measurement of sleep latency across a day provides direct access to the diurnal fraction of the sleep/wake interaction, which is of fundamental concern to the sleep specialist. Objective laboratory documentation of the clinical symptoms of slepiness well as abnormal sleep structure has greatly facilitated the diagnosis of narcolepsy, in particular, and has also been useful to determine the severity of somnolence and therapeutic response in other disorders. At the current level of clinical experience, a diagnosis of narcolepsy or other disorders of excessive somnolence usually has lifelong consequences for the patients, for example, chronic chemotherapy with psychoactive compounds, legal proscription from driving, or surgery. It therefore is incumbent upon the clinical sleep specialist to achieve as much diagnostic precision as possible. The MSLT greatly enhances the accurate diagnosis of disorders of excessive somnolence. This content is only available as a PDF. © 1986, Association of Professional Sleep Societies