SLEEP

Roehrs,, Timothy;Zwyghuizen-Doorenbos,, Ardith;Roth,, Thomas

doi: 10.1093/sleep/16.4.301pmid: 8341890

Summary: Twelve, healthy, young men received 0.25 mg triazolam and ethanol placebo, 50 mg diphenhydramine and ethanol placebo, 0.6 g/kg ethanol and placebo pill and ethanol placebo and placebo pill in a double-blind Latin Square design. Each of the four treatments were administered for 2 days at 0900 hours with blood samples drawn on day one at 0830, 1030, 1230, 1430 and 1630 hours, and sleep latency and performance assessed on day two at 1000, 1200, 1400 and 1600 hours. Significant sedative effects of ethanol, triazolam and diphenhydramine relative to placebo were observed on the sleep latency and performance measures with the effects being detected over the full 6.5 hours of assessment. Among the active drugs, triazolam and diphenhydramine had similar sedative effects which differed from that of ethanol. Plasma concentration of each drug declined significantly over the 6.5 hours. Ethanol reached zero, but triazolam and diphenhydramine did not. Continued sedation (sedative effects after plasma concentration reached zero) was observed with ethanol. Alcohol, Diphenhydramine, Triazolam, Hypersomnia, Electroencephalography This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society

Mitler, Merrill, M.;Hajdukovic,, Roza;Erman, Milton, K.

doi: 10.1093/sleep/16.4.306pmid: N/A

Summary: Eight pairs of subjects (each consisting of a narcoleptic and a control matched on the basis of age, sex, educational background and job) were evaluated under the following double-blind, randomized treatment conditions: baseline, placebo, low dose and high dose methamphetamine. Subjects were drug-free for 2 weeks prior to beginning the protocol. Methamphetamine was the only drug taken during the protocol and was given in a single morning dose of 0, 20 or 40–60 mg to narcoleptics and 0, 5 or 10 mg to controls. The protocol was 28 days long, with each of the four treatment conditions lasting 4 days followed by 3 days of washout. Nighttime polysomnography and daytime testing were done during the last 24 hours of each treatment condition. Daytime sleep tendency was assessed with the multiple sleep latency test (MSLT). Daytime performance was assessed with performance tests including a simple, computer-based driving task. Narcoleptics’ mean MSLT sleep latency increased from 4.3 minutes on placebo to 9.3 minutes on high dose, compared with an increase from 10.4 to 17.1 minutes for controls. Narcoleptics’ error rate on the driving task decreased from 2.53% on placebo to 0.33% on high dose, compared with a decrease from 0.22% to 0.16% for controls. The effects of methamphetamine on nocturnal sleep were generally dose-dependent and affected sleep continuity and rapid eye movement (REM) sleep. Elimination half life was estimated to be between 15.9 and 22.0 hours. Mild side effects emerged in a dose-dependent fashion and most often involved the central nervous system and gastrointestinal tract. We concluded that methamphetamine caused a dose-dependent decrease in daytime sleep tendency and improvement in performance in both narcoleptics and controls. Methamphetamine at doses of 40–60 mg allowed narcoleptics to function at levels comparable to those of unmedicated controls. Narcolepsy, CNS stimulants, Methamphetamine, MSLT, Polysomnography, Driving task This content is only available as a PDF.

Steens, Rodney, D.;Pouliot,, Zoe;Millar, Thomas, W.;Kryger, Meir, H.;George, Charles, F.

doi: 10.1093/sleep/16.4.318pmid: 8341892

Summary: Sleep problems and nocturnal arterial oxygen desaturation are common in patients with chronic obstructive pulmonary disease (COPD). Hence, the safety and efficacy of new hypnotic agents must be ascertained in this group of patients. We performed a double-blind, randomized, single-dose, placebo and active drug controlled, crossover study in 24 patients with insomnia (subjective sleep latency >30 minutes and sleep duration 4–6 hours) and mild to moderate COPD (mean FEV, 61 ± 12(SD)% predicted) in order to establish the effects of Zolpidem 5 mg and 10 mg on sleep and respiration and to compare these effects with triazolam 0.25 mg. Arterial oxygen saturation for the entire night, by hour and by stage, and the apnea-hypopnea index for the entire night were not significantly different with placebo and the various drug conditions. Total sleep time and sleep efficiency were increased over placebo by all three drug conditions. Triazolam was more effective than Zolpidem 5 mg but not Zolpidem 10 mg, and there was no significant difference between Zolpidem 5 mg and zolpidem 10 mg. Zolpidem 10 mg and triazolam both reduced the number of awakenings (> 15 seconds duration) per hour of sleep. Although there was a trend for triazolam to be more efficacious than zolpidem 10 mg, no statistically significant difference was found for any objective or subjective sleep variable. Likewise, Zolpidem 10 mg tended to be more efficacious than Zolpidem 5 mg, but the difference was only significant in terms of perceived sleep quality and ease of falling asleep. In patients with mild to moderate COPD without severe awake resting hypoxemia or hypercapnia, Zolpidem and triazolam in suggested therapeutic doses are safe (with respect to respiration) and effective hypnotics. Zolpidem 10 mg is similar in its hypnotic effect to triazolam 0.25 mg. However, possible individual adverse effects suggest that caution is still required when these hypnotics are prescribed to these patients. Additional caution must be exercised because this study evaluated only a single night of treatment with each dose of sedative, but usually hypnotics are prescribed for more than one night. Zolpidem, Triazolam, Chronic obstructive pulmonary disease, Respiration, Sleep, Hypnotics This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society

Walters, Arthur, S.;Wagner, Mary, L.;Hening, Wayne, A.;Grasing,, Kenneth;Mills,, Richard;Chokroverty,, Sudhansu;Kavey,, Neil

doi: 10.1093/sleep/16.4.327pmid: 8341893

Summary: In a double-blind randomized crossover trial, oxycodone or placebo was given in divided night-time doses to 11 patients with idiopathic restless legs syndrome (RLS) for 2 weeks prior to appropriate polysomnographic studies. Under double-blinded conditions, patients were asked to do daily ratings of their leg sensations, motor restlessness and daytime alertness on a 1–4 scale for the 2 weeks prior to the polysomnographic studies and for the nights of the polysomnographic studies as well. Leg sensations (p < 0.009), motor restlessness (p < 0.006) and daytime alertness (p < 0.03) were significantly improved on oxycodone as compared to baseline or placebo. Patients were studied polysomnographically under double-blinded conditions for 2 nights in each phase of the protocol. On an average dose of 15.9 mg oxycodone (equivalent to approximately three 5-mg tablets of commercial preparation), there was a statistically significant reduction in the number of periodic limb movements in sleep [(PLMS)/hour sleep (p < 0.004)] and in the number of arousals/hour sleep (p < 0.009) on drug as compared to baseline or placebo. A statistically significant improvement was also noted in sleep efficiency (p < 0.006) and 10 of the 11 patients preferred oxycodone over placebo. We conclude that oxycodone is an effective treatment for RLS and PLMS. Restless legs, Periodic limb movements in sleep, Opioids, Oxycodone This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society

doi: 10.1093/sleep/16.4.332pmid: N/A

Article PDF first page preview Close This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society

Klein,, Torsten;Martens,, Heinz;Dijk,, Derk-Jan;Kronauer, Richard, E.;Seely, Ellen, W.;Czeisler, Charles, A.

doi: 10.1093/sleep/16.4.333pmid: 8341894

Summary Sleep disturbances and the failure to entrain circadian rhythms to the 24-hour day have been reported in the majority of totally blind sUbjects. The present case study of a totally blind man with a well-documented recurring sleep disturbance was designed to investigate the mutual relationship between sleep and the circadian timing system. The 63-year-old subject, a high school teacher with a regular work schedule, had suffered from cyclically recurring insomnia for the past 28 years. Analysis of a sleep log that he had kept for the past 15 years suggested that his circadian rhythms were not entrained to the 24-hour day. During a 3-month inpatient study, the period of the endogenous circadian pacemaker was assessed by analysis of ambulatory core body temperature, urinary excretion and a series of estimates of the phase of core body temperature cycles and plasma cortisol levels during constant routines. All circadian markers revealed periods in the range of 24.22–24.27 hours, with no evidence for a modulation of the observed periods by the sleep-wake cycle. During this 3-month inpatient study, a complete cycle of the subject's sleep disturbance and remission was polysomnographically documented while the subject lived on a regular 24-hour schedule. Because the subject's circadian rhythms were free-running and his sleep times were fixed, sleep occurred at virtually all circadian phases. Analysis of sleep latency, REM sleep latency, sleep duration, wake in sleep episode and REM sleep during sleep episode revealed a strong modulation by circadian phase. These findings in this blind man suggest that: I) the period of his cyclically recurring sleep disturbance is directly related to the nonentrained period of an endogenous circadian pacemaker that drives circadian variation in core body temperature, urinary excretion, plasma cortisol and sleep propensity; 2) both his sleep structure and the severity of his daily sleep disruption are directly related to circadian phase and 3) his circadian pacemaker, which has an endogenous period that deviates only 0.2–0.3 hours from 24 hours, cannot be entrained by periodic daily exposure to non photic time cues, including a very regular 24-hour sleep-wake schedule. Circadian rhythm, Blindnes, Slee, Nonentrainment This content is only available as a PDF. Author notes * Present address: Fachbereich Medizin, Philipps Universitöt Marburg, 3550 Marburg, Federal Republic of Germany. © 1993 American Sleep Disorders Association and Sleep Research Society

Hauri, Peter, J.

doi: 10.1093/sleep/16.4.344pmid: 8341895

Summary: Sleep specialists are increasingly asked to advise other health care workers and patients about specific cases of insomnia, even when the patients do not plan to seek actual treatment of their insomnia at a sleep center. This paper describes a procedure for such one-time consultations. It also provides some preliminary data on the subjective efficacy of such insomnia consultations by reporting data from follow-up telephone calls placed 1, 3 and 12 months after the interview. The patients' estimates of their sleep seemed significantly improved on all three follow-up contacts, and the telephone calls also provided information on what type of recommendations were actually tried by the insomniacs and which ones seemed beneficial. Acceptance of individual sleep hygiene suggestions ranged between 68 percent and 11 percent, but those who tried a given suggestion generally reported its usefulness to be about 70 percent. Advice to seek relaxation or behavioral therapy and suggestions for various medication changes were accepted by about half of those insomniacs who received such advice, and about two-thirds of those who tried them reported them as being helpful. Advice to seek psychotherapy—although quite carefully given— typically was tried by only one-third of those who received it. Overall, the survey shows good patient acceptance of once-only insomnia consultations. Insomnia, Consultations, Sleep hygiene, Behavioral methods, Follow-up This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society

Edinger, Jack, D.;Morey, Miriam, C.;Sullivan, Robert, J.;Higginbotham, Michael, B.;Marsh, Gail, R.;Dailey, Dorothy, S.;McCall, W., Vaughn

doi: 10.1093/sleep/16.4.351pmid: 8341896

Summary: In the current study 12 aerobically fit and 12 sedentary older men underwent two nocturnal polysomnographic (PSG) studies. A control PSG was conducted following a day without aerobic activity, whereas a postexercise PSG study was conducted following an afternoon session of exhaustive aerobic exercise. In addition to deriving usual sleep parameters, a computer scoring program was used to count the number of individual electroencephalographic (EEG) slow waves in each PSG tracing. Multivariate and univariate analyses showed that the fit subjects had shorter sleep onset latencies, less wake time after onset, fewer discrete sleep episodes, fewer sleep stage shifts during the initial portion of the night, less stage 1 sleep, a higher sleep efficiency and more total slow waves during both PSGs than did the sedentary subjects. Although no main effects were found for the acute exercise challenge, post hoc analyses showed that high levels of body heating during exercise predicted increased sleep fragmentation for both fit and sedentary subjects. These findings provide initial support for the contention that exercise and fitness may have significant effects on the sleep of older men. However, results also suggest that high levels of body heating resulting from a single exercise challenge may have adverse effects. Implications of the study are discussed and suggestions for future research are provided. Aerobic fitness, Exercise, Aging, Sleep fragmentation, Slow wave sleep This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society

Hoffstein,, V.;Mateika,, S.;Metes,, A.

doi: 10.1093/sleep/16.4.360pmid: 8141871

Summary: This study was designed to test the hypothesis that nasal dilation reduces snoring. To achieve this we performed nocturnal polysomnography, including measurement of snoring, in 15 patients without nasal pathology before and after insertion of a nasal dilator (NOZOVENT™ ). Snoring was quantified for each sleep stage by recording the number of snores per minute of sleep, number of snores per minute of snoring time and nocturnal sound intensities (maximum, average and minimum). We found that nasal dilation had no effect on the number of apneas, hypopneas or oxygen saturation. Snoring parameters were unaffected by NOZOVENT during stages I, II and REM sleep, but were all significantly reduced during slow wave sleep. We conclude that dilation of the anterior nares in patients without nasal pathology has a relatively weak effect on snoring, and routine use of nasal dilating appliances is not recommended for treatment of snoring. Snoring, Sleep architecture, NOZOVENT™ This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society

Hertz,, Gila;Cataletto,, Mary;Feinsilver, Steven, H.;Angulo,, Moris

doi: 10.1093/sleep/16.4.366pmid: 8341897

Summary: Patients with Prader Willi syndrome (PWS) often complain of daytime hypersomnolence. Because of reported daytime sleepiness and high prevalence of morbid obesity, these patients have been considered at risk for sleep related disordered breathing, but polysomnographic studies have been limited. We evaluated sleep and breathing polysomnographically in 24 PWS patients including 15 adults and 9 children. All adult patients completed MSLT testing on the day following the nocturnal sleep study. Both adult and children groups showed little or no sleep apnea, but REM related oxygen desaturation was quite common, its severity significantly correlated with increased obesity. Sleep patterns in both groups showed abnormal REM sleep cycles with variable REM latency (at times significantly shortened) and fragmented REM sleep with multiple brief REM periods. REM sleep abnormalities were still present in some patients without REM related desaturation. As a group, patients with PWS demonstrated pathological somnolence as measured by MSLT, which correlated with nocturnal sleep efficiency but not with nocturnal REM latency. It is hypothesized that the abnormal sleep findings in PWS reflect an underlying hypothalamic dysfunction characteristic of this syndrome. Prader Willi Syndrome, REM sleep abnormaltiies, REM related oxygen desaturation, daytime sleepiness This content is only available as a PDF. © 1993 American Sleep Disorders Association and Sleep Research Society