SLEEP

Schechtman, V., L.;Harper, R., M.;Kluge, K., A.;Wilson, A., J.;Hoffman, H., J.;Southall, D., P.

doi: 10.1093/sleep/11.5.413pmid: 3227221

Summary: Victims of the sudden infant death syndrome (SIDS) have higher overall heart rates prior to death than do control infants (1). The objective of this study was to partition these heart rate differences by state and to identify any state-dependent differences in heart rate variability and respiratory rate and variability. Twenty-two recordings of electrocardiogram (ECG) and respiration from 16 infants who subsequently died of SIDS were compared with 66 recordings of age-matched control infants. Median cardiac and respiratory rate and variability were computed for each sleep state in each recording, and one-way analysis of variance tests were performed for each variable for infants < 1 month and for infants > 1 month of age. Heart rate was higher in SIDS victims < 1 month of age than in age-matched controls during all sleep-waking states. SIDS victims > 1 month showed higher heart rates during rapid eye movement sleep only. Heart rate variability was also diminished during waking in victims < 1 month, but much of this difference could be attributed to increased heart rate. These results suggest that, as a group, SIDS victims differ physiologically from control infants and that these differences may be especially prominent during particular sleep-waking states. SIDS, Heart rate, Heart rate variation, Infants, Sleep This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Richard, Hk., Wu;Thorpy, Michael, J.

doi: 10.1093/sleep/11.5.425pmid: 3227222

Abstract Total sleep time, sleep stages 1–4, REM, REM latency, and sleep efficiency were analyzed in seven children with growth hormone deficiency (GHD) before and after growth hormone (GH) therapy. Before GH therapy, GHD children spent 19.5% of their total sleep time in REM sleep, 9.7% in stage 1,41.0% in stage 2, 10.0% in stage 3, and 19.7% in stage 4. GHD children had more stage 1 and 3 sleep and less REM as compared with age-matched normal children reported by Williams et a1. After GH therapy was initiated, six of the seven patients had decreases in the duration of stage 3 sleep, with an average decrease of 21.8 min. The difference between stage 3 sleep before and during GH treatment was significant, with a p value of < 0.025. When the results were expressed as the percentage of the total sleep period, the difference was also significant, (10.0 ± 2.0 to 7.5 ± 3.1%, mean ± SD; p < 0.05). No other sleep parameters were significantly affected by GH therapy. The changes observed in stage 3 sleep, non-REM sleep, and the lack of any other changes in sleep before and after GH therapy have not been described before in GH-deficient children. They differ from studies in normal humans and animals which showed that REM sleep increased with administration of growth hormone. These differences suggest that GH deficiency is associated with a specific sleep EEG anomaly that is corrected in part by GH therapy. Growth hormone deficiency, Growth hormone therapy, Sleep time, Children This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Kapuniai, Linda, E.;Andrew, David, J.;Crowell, David, H.;Pearce, James, W.

doi: 10.1093/sleep/11.5.430pmid: 3227223

Summary: An apnea score (AS) was developed as a potential screening tool for sleep apnea. This was based on self-report questionnaire responses of 76 sleep disorder center patients and 20 sleep survey volunteers. Twenty volunteers and 23 patients (group I) comprised the initial AS development group. Their questionnaire responses were compared to polysomnographic apnea indexes (AI) and apnea plus hypopnea indexes (AHI). Stepwise multivariate discriminant analysis was used to test whether or not selected group I questionnaire responses could be used to correctly classify respondents into apnea (AI or AHI > 5) or nonapnea (AI, AHI ≤5) groups. Self-reports of “stops breathing during sleep,” “loud snoring,” and history of adenoidectomy best discriminated normal (AI ≤5) from apnea (AI > 5) cases. The AS derived from group I responses to these three variables was then computed for group II (n = 53). Mter examination of the AS results, the AS was modified to include just “stops breathing” and “loud snoring” and the AI criterion was raised to 10 per hour. This revised AS correctly identified 100% of the cases with moderatesevere sleep apnea (AI or AHI > 40) and 70-76% of all sleep apnea cases with AI or AHI > 5. Predictive accuracy was 88% for AI > 10. The two questions that comprise the AS should be incorporated into risk appraisal instruments or interviews to screen for sleep apnea. Sleep apnea, Self-report score, Prevalence, Sensitivity, Specificity This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Weinstein,, Lissa;Schwartz,, David;Ellman, Steven, J.

doi: 10.1093/sleep/11.5.437pmid: N/A

Abstract Summary Recent literature suggests that how the self is represented is a cardinal aspect of the dream experience. A review of studies of phasic-tonic distinctions within rapid eye movement (REM) sleep revealed that increasing self-participation marked awakenings from phasic intervals. Five scales specifically designed to measure absorption in dreaming were compared with three scales previously shown to discriminate phasic from tonic awakenings within REM sleep. Eight reports per night (two stage REM, six stage 2) were collected from each of 20 subjects on 4 baseline nights. Awakenings were controlled for time into the REMP and time of night, correcting the methodological flaws of previous studies in this area. Scales developed to measure self-participation were able to discriminate phasic from tonic awakenings better than those already in the literature. Results are discussed in terms of the psychometric properties of the individual scales. REM sleep, Phasic activity, Self-participation This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Leigh, Terry, J.;Bird, Howard, A.;Hindmarch,, Ian;Constable, Patrick D., L.;Wright,, Verna

doi: 10.1093/sleep/11.5.448pmid: 3227225

Summary: The St. Mary's Hospital Sleep Questionnaire was designed to evaluate the sleep of hospital patients. To gain an understanding of possible underlying factors, the questionnaire was factor analysed using data collected from 222 hospitalised rheumatic patients. The analysis did not produce a completely clear factor structure. Two factors relating to “sleep latency” and “sleep quality” emerged more clearly than the other factors produced. These factors correspond with two sleeping state factors (ease of getting to sleep; quality of sleep) that were extracted by a previous factor analysis of the Leeds Sleep Evaluation Questionnaire. This suggests that the two most important aspects of subjectively perceived sleep are the process of going to sleep and the quality of sleep. Sleep questionnaire, Factor analysis This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Telakivi,, T.;Kajaste,, S.;Partinen,, M.;Koskenvuo,, M.;Salmi,, T.;Kaprio,, J.

doi: 10.1093/sleep/11.5.454pmid: N/A

Abstract Summary Association of snoring and cognitive function was studied in 46 habitually snoring men ages 41-52 years, and 60 occasionally or never-snoring control male subjects of the same age group. Sleep recordings with monitoring of apneas and hypopneas were made with the static-charge sensitive bed method. Blood oxygen saturation was measured with an oximeter and the snoring sounds were recorded with a microphone after clinical and neuropsychological assessment. A questionnaire with items on excessive daytime somnolence (EDS), sleep, and snoring quality was also used. EDS (as measured by items on the questionnaire) associated with tests requiring concentration, memory retention, and verbal and spatial skills in the habitual snorers group. The number of oxygen de saturation episodes exceeding 4% associated with defective delayed Recall of Logical Stories of the Wechsler Memory Scale and with spatial orientation (Clock test) in the habitual snorers' group even after adjusting for age and obesity. Snoring, and cognitive function, Excessive daytime somnolence, Hypoxic events This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Whyte, K., F.;Gould, G., A.;Airlie, M. A., A.;Shapiro, C., M.;Douglas, N., J.

doi: 10.1093/sleep/11.5.463pmid: 3067313

Summary: The role of drug therapy in the treatment of the sleep apnea/hypopnea syndrome is unclear. In a randomised, double-blind, placebocontrolled study, we investigated the value of 14-day therapy with protriptyline (20 mg daily) or acetazolamide (250 mg 4 times per day) on symptoms and on the frequency of apneas, hypopneas, arousals, and 4% de saturations in 10 patients with obstructive sleep apnea/hypopnea syndrome. Overall, protriptyline did not have a significant effect either on symptoms or on any of the above polysomnographic criteria. Acetazolamide reduced the apnea/hypopnea frequency [placebo 50 ± 26 (SD); acetazolamide 26 ± 20/h of sleep, p < 0.03] and tended to decrease the frequency of 4% desaturations (placebo 29 ± 20; acetazolamide 19 ± 16/h of sleep, p = 0.06). Despite these physiological improvements, acetazolamide did not significantly improve symptoms and paraesthesiae were common. Contrary to earlier studies, we conclude that protriptyline may have a limited role in the treatment of the sleep apnea syndrome. The reason why acetazolamide produced a physiological, but not a symptomatic, response requires further investigation. Protriptyline, Acetazolamide, Apnea/hypopnea syndrome This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Feinberg,, I.;Baker,, T.;Leder,, R.;March, J., D.

doi: 10.1093/sleep/11.5.473pmid: N/A

Abstract Summary In one of a series of experiments aimed at gathering the empirical data required to formulate mathematically our recovery model of sleep, we recently (1) measured the increase in delta electroencephalogram (EEG) following one night of total sleep deprivation (TSD). We found that the delta rebound was confined to the first non-rapid eye movement period (NREM-Pl) of recovery sleep; this unexpected result was documented with direct computer measurement of 0-3 Hz EEG, as well as with visual scoring of stages 3 and 4. We also found a robust decrease in eye movement density during the second and third REM periods, which we hypothesized to be due to the increased depth of recovery sleep. In the present experiment, we awakened young adult subjects after 100 min of sleep, a duration that includes the first cycle for this age group, and analyzed visual and computer measures of delta and eye movement density during recovery sleep. We again found eye movement density to be significantly reduced in REM-P2 and P3, but to a lesser degree than after total sleep deprivation, a condition that may be presumed to produce a greater increase in sleep depth. Delta increases were again limited to the first cycle, although all subjects completed this cycle on the 100-min night. The major difference between recovery sleep patterns following the total deprivation and the 100-min sleep conditions was that 0-3-Hz wave amplitude increased significantly after the former, but not after the latter. In both studies, recovery sleep showed increased 0-3-Hz wave density. The neurophysiological implications of a response of EEG amplitude as opposed to wave density are briefly considered; separate measurement ofthese variables is more readily accomplished with period-amplitude than with spectral analysis. Our results further illustrate the importance of measuring sleep by physiological units, such as the successive NREMPs and REMPs. They also support other data that indicate that NREM-Pl plays a special role in human sleep: it responds selectively to sleep deprivation, shows the greatest ontogenetic variation across the human lifespan, and is the component of sleep that is most frequently abnormal in psychiatric patients. As we have long argued, it is inappropriate to conceptualize this high priority component of NREM sleep as “REM latency” and as a measure of REM “pressure” exclusively. Sleep, Cycle, Deprivation, EEG, Delta, Computer, Period analysis, REM, Eye movement density This content is only available as a PDF. © 1988 Association of Professional Sleep Societies

Webb, Wilse, B.

doi: 10.1093/sleep/11.5.488pmid: 3227228

Summary: Theories and models are useful in organizing research data. This paper reviews earlier models and a recent model that combines restorative and adaptive models into a two-factor theory. A model emphasizing a three-factor model with modulators is presented as an organizing schema. Theory, Sleep, Restorative model, Adaptive model This content is only available as a PDF. © 1988 Association of Professional Sleep Societies