SLEEP

Hauri, Peter, J.;Olmstead, Elaine, M.

doi: 10.1093/sleep/12.2.97pmid: 2711096

Summary: This study evaluates the reverse first night effect (FNE) in insomniacs. All insomniacs evaluated at the Dartmouth Sleep Disorders Center between 975 and 1980 were studied if they met specific criteria (n = 89). First night effects were assessed using the following four variables: sleep efficiency, sleep latency, percentage of rapid eye movement (REM) sleep, and REM latency. The 20 subjects who showed the strongest normal FNE were compared with the 20 showing the strongest reverse FNE. The two groups were similar in age, sex, and most aspects of reported home sleep. They differed in their sleep on night 1, but on nights 2 and 3 their sleep was quite similar. Both groups overestimated their sleep latencies on night 1 (by subjective reports) but unlike the normal FNE group, the reverse FNE patients very accurately assessed their sleep latency on nights 2 and 3. Reverse FNE patients had significantly higher scores than normal FNE patients on the Minnesota Multiphasic Personality Inventory (MMPI) K (defensiveness, guardedness) and Pa (paranoia) scales, and they were less depressed, marginally less anxious, and somewhat more sensation-seeking and more susceptible to boredom. This study concluded that evaluations using only 1 night in the laboratory may be missing the larger picture of a patient's insomnia. When data from only 1 laboratory night are available for an insomniac, care should be taken with the label of “subjective complaint without objective findings” in patients who are defensive, guarded, and sensation-seeking. First night effect, Reverse first night effect, Sleep disorders classification, Subjective insomnia, Personality traits in insomnia This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Sugerman, Jeffrey, L.;Walsh, James, K.

doi: 10.1093/sleep/12.2.106pmid: 2711086

Summary: The maintenance of wakefulness test (MWT) and repeated test of sustained wakefulness (RTSW) were compared to the multiple sleep latency test (MSL T) during nighttime hours to evaluate differential sensitivity to variation in physiologic sleepiness/alertness. The degree of sleepiness varied by time of night and was further manipulated by varying prior sleep. Seven healthy normal sleepers were evaluated on the MWT, RTSW, MSLT, a digit symbol substitution test and the Wilkinson addition test in a protocol beginning at 2200 h and terminating at 0830 the following morning. A counterbalanced, crossover design compared an evening nap condition to a no-nap condition. The MWT and RTSW discriminated between nap and no-nap conditions, but the MSLT did not. This suggests that in some situations the MWT and RTSW may be more sensitive to changes in physiologic sleepiness/alertness than the MSLT. The data are discussed in terms of possible methodologic limits of the MSLT and the relationship between physiologic sleep tendency and the capacity to maintain alertness. Sleepiness, Circadian, Measurement, MSLT, MWT, RTSW This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Kerkhofs,, Myriam;Linkowski,, Paul;Mendlewicz,, Julien

doi: 10.1093/sleep/12.2.113pmid: N/A

Summary The effects of intravenous catheter and nocturnal blood samplings at frequent intervals on sleep electroencephalogram (EEG) variables were investigated in 8 male healthy controls and 12 depressed patients, who were studied in the same experimental conditions. After one night of habituation, sleep was recorded during 4 consecutive nights in the sleep laboratory. A catheter was inserted around noon the day before the fourth night, and blood was sampled every 15 min for 25 h. The night-to-night comparison of sleep EEG variables did not show significant sleep continuity modifications in the control subjects, other than a weak trend toward an increase in nocturnal awakenings during the night with the catheter. A lengthening of sleep onset latency during the fourth night was found in the depressed patients. No significant changes were detected in percentage of rapid eye movement (REM) sleep in the two groups. However, a gradual increase in Stage 3 was observed across the 4 nights in the control subjects. These results indicate that intravenous blood sampling via a catheter can be performed without inducing significant disruption of sleep length and structure. Catheter, Sleep EEG variables, Depression, Blood sampling, Sleep disruption, Hormone secretion This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Gaillard,, J.-M.;Blois,, R.

doi: 10.1093/sleep/12.2.120pmid: 2496452

Summary: The experiments reported here were designed to characterize in detail the spectrum of activity of flunitrazepam in human sleep. The direct and residual effects of flunitrazepam, as well as the antagonism by flumazenil, an antagonist of benzodiazepine receptors, were studied in 28 normal subjects recorded in the sleep laboratory. The five categories of variables-sleep—wake balance, sleep organization, orthodox sleep, phasic events in sleep, and sleep waveforms—were all modified by flunitrazepam. Some of these modifications were observed only on the drug night and were antagonized by flumazenil, whereas others persisted in the placebo postdrug night and were not antagonized by flumazenil. A few variables showed changes intermediate between these two types of reactivity. The results do not fit well with the multiple benzodiazepine receptors theory, but instead support the concept of spare receptors. Along these lines, the study of the reactivity of sleep components to ligands of benzodiazepine receptors can contribute to the better understanding of the neuronal systems involved in their control. Flunitrazepam, Sleep, Human, Spare receptors This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Hoelscher, Timothy, J.;McCall, W., Vaughn;Powell,, Judith;Marsh, Gail, R.;Erwin, C., William

doi: 10.1093/sleep/12.2.133pmid: N/A

Summary This study evaluated two methods of scoring taped polysomnographic data directly on the Medilog 9000 scanner: (a) screen-by-screen scoring, and (b) rapid screen scoring. Sixteen overnight polysomnograms recorded on Medilog 9000 recorders were scored using the above two methods and were also printed on paper for conventional paper scoring. Interscorer agreement was 87.8% for paper scoring, 85.5% for screen-by-screen scoring, and 84.2% for rapid screen scoring. Comparison of screen-by-screen scoring with paper scoring revealed small absolute deviations and correlations of r > 0.90 for all sleep parameters, with the exception of brief <2 min) awakenings (r = 0.69). Rapid screen scoring resulted in slightly lower correlations and greater deviations from paper scoring on several sleep parameters, but appeared acceptable for most clinical purposes and greatly reduced the required scoring time. Although some statistically significant differences between scoring methods were observed, the size of effect was small and of doubtful clinical importance. These findings suggest that polysomnographic data recorded on Medilog 9000 recorders can be reliably and accurately scored on the Medilog scanner, obviating the laborious task of printing the taped data on paper. Ambulatory sleep monitoring, Sleep scoring, Medilog 9000 scanner This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Kubicki,, St.;Höller,, L.;Berg,, I.;Pastelak-Price,, C.;Dorow,, R.

doi: 10.1093/sleep/12.2.140pmid: 2711089

Summary: Oxford Medical has introduced an automatic sleep stager based on the stage-scoring criteria by Rechtschaffen and Kales. With our study we intended to examine whether the results of the stager (version 3.0) match those of the visual evaluation by two independent raters. We also wanted to test the reliability of this automatic sleep stage-scoring system. Ten somnopolygrams of subjects without sleep disturbances served as a basis for the comparison. Each sleep recording was scored twice automatically by the stager, twice visually by the first rater, and once by the second rater. The two automatic analyses of the somnopolygrams differed by 4.3% in a total of 13,850 epochs (1 epoch ≙ 20 s) regarding sleep stage scoring. The difference between the first and the second visual evaluation by the same rater amounted to 5.7%, whereas the results of the two independent raters deviated by 8.7%. Compared with the results of the visual analysis reached as a consensus by both raters-the socalled optimized visual analysis-the stager showed a 26.9% difference. The automatic analysis scored fewer epochs as stages wake, rapid eye movement (REM), and 2 and more as stages 1, 3, and 4. The sleep stager's frequent difficulty in identifying stage wake correctly as well as its incorrect allocation to other stages-mainly stage REM-could lead to misinterpretations of sleep recordings, whereas the increase in stages 1,3, and 4, as compared with visual scoring, was negligible. Somnopolygram, Automatic analysis, Visual analysis This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Palm,, Lars;Elmqvist,, Dan;Blennow,, Gösta

doi: 10.1093/sleep/12.2.150pmid: N/A

Summary Ambulant sleep polygrams were obtained from 14 normal subjects (9 boys and 5 girls) and from 3 boys with attention deficit disorder. The children were aged 8-12 years. Two consecutive nights were recorded with an eight-channel electroencephalographic (EEG) tape cassette recorder. The results were analyzed automatically by the Oxford Medilog 9000 Sleep Stager and by visual scoring from the Medilog Display Unit. Twenty-seven nights were analyzed; 7 nights were excluded because of electrode problems or other technical failures. The main sleep stage shifts and the length of sleep cycles as measured from the hypnogram of the automatic printout agreed well with corresponding values from our visual scoring. In the automatic scoring, rapid eye movement (REM) sleep time was shorter and slow wave sleep was longer than in the visual rating. This can be explained partly by specific properties of the EEG in this age group. The Oxford Medilog 9000 sleep stager can be used to survey sleep quality, but the results must be carefully checked visually. In cases of EEG pathology or sleep abnormalities in childhood it is doubtful if any time or labor is saved by using automatic scoring. Sleep, Childhood, Preadolescence, Automatic analysis, Ambulant monitoring This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Mamelak,, Adam;Hobson, J., Allan

doi: 10.1093/sleep/12.2.157pmid: 2711091

Summary: In an attempt to offer a home-based adjunct to traditional sleep laboratory methods, we developed a system to monitor sleep, and to predict algorithmically non-rapid-eye-movement (NREM) and rapid-eye-movement (REM) sleep states, using eye and body motility as the only parameters. Eye movement was measured using a strain gauge transducer applied to the eyelid of subjects, while body movement was measured using a piezo-ceramic phono cartridge. Both transducers were mounted on a tennis headband, along with electronics that amplified, filtered, and digitized the signals. Digital pulse signals were input to a portable computer in minute-long epochs, and statepredicting algorithms were run based on this motility data. Four subjects were monitored in the sleep lab with both our headgear and standard polysomnography. Hand-scored sleep records were compared with those predicted by computer algorithms. Algorithm-predicted states agreed with hand-scored ones an average of 85.57% (SEM ± 1.7%). Mean values for sleep onset and REM latency were within 1.6 and 10.8 min of polysomnographic records, respectively. These results are encouraging, and suggest that this system could provide a comfortable, subject operable, and inexpensive method for the evaluation of sleep at home. Automated sleep scoring, Home-based, Transducers, Algorithm This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Landis, Carol, A.;Levine, Jon, D.;Robinson, Connie, R.

doi: 10.1093/sleep/12.2.167pmid: 2711092

Summary: Diurnal sleep-wake patterns in the normal and the adjuvant arthritic rat were measured during the first 3 h of both light and dark periods. During the hours of maximal sleep in the normal rat, arthritic rats showed a significant increase in wakefulness (Wake), a shift to non-rapid-eye-movement (NREM) stages with lower amplitudes (LS and HSl), and a large reduction of NREM sleep with the highest-amplitude (HS2) and paradoxical sleep. Arthritic rats also showed marked sleep fragmentation manifested by more episodes of Wake, LS, and HSI and shorter episodes of HS2 during both the light and the dark periods. Thus, arthritic rats cannot sustain long periods of sleep. In contrast to control rats, arthritic rats lacked a diurnal variation in Wake, total sleep, and electroencephalographic (EEG) delta activity. They also showed a decrease in overall EEG amplitude. In addition, there was a positive correlation between the severity of arthritis and the percentages of NREM sleep with low (LS) and moderate (HSl) amplitude. Thus, the decline in EEG amplitude could indicate a deficit of EEG generating mechanisms or some aspect of disease severity, such as pain. Chronic pain, Adjuvant arthritis, Sleep stages, REM sleep, Sleep deprivation This content is only available as a PDF. © 1989 Association of Professional Sleep Societies

Griffith, James, L.;Slovik, Lois, S.

doi: 10.1093/sleep/12.2.178pmid: N/A

Summary Münchausen syndrome by proxy is a factitious disorder of childhood in which a parent fabricates medical history or produces signs of illness in a child to keep the child in a sick role. Since approximately half of all cases of Miinchausen syndrome by proxy are presentations of central nervous system illness, such as excessive daytime sleepiness and near-miss sudden infant death syndrome, sleep disorders centers are likely diagnostic consultants for the evaluation of children involved in this disorder. We review characteristics that may suggest that a particular case has an increased likelihood of Miinchausen syndrome by proxy. The recent presentations of two cases of Miinchausen syndrome by proxy to sleep disorders centers are discussed as examples. Münchausen syndrome by proxy, Factitious disorder, Apnea monitor This content is only available as a PDF. © 1989 Association of Professional Sleep Societies