SLEEP

Martin, Thomas, J.;Sanders, Mark, H.

doi: 10.1093/sleep/18.8.617pmid: 8560127

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Grunstein,, R.R.;Stenlöf,, K.;Hedner, J., A.;Sjöström,, L.

doi: 10.1093/sleep/18.8.635pmid: 8560128

Summary: Patients with severe obesity commonly have obstructive sleep apnea (OSA). In order to determine the impact of OSA on psychosocial morbidity in severe obesity, subjects enrolled in the Swedish Obese Subjects (SOS) Study were classified into two subgroups based on questionnaire data: one group with a high likelihood and one with a low likelihood of OSA. These groups were contrasted and multivariable analysis was used to examine whether OSA had independent effects on divorce rate, sick leave, work performance, income and self-estimated general health after adjustment for obesity, fat distribution, alcohol, smoking, medications and coexisting medical conditions. A high likelihood of OSA was identified in 338 men and 155 women, compared with 216 men and 481 women who had a low likelihood of OSA. Men with OSA were identical in age to men without OSA and had slightly higher levels of visceral fat (p = 0.01), but were similar in most psychosocial variables except self-perceived general health. Women with OSA were identical in age and visceral fat mass to women without OSA, but were characterized by a higher rate of impaired work performance, sick leave and divorce. When frequent sleepiness was used as an additional discriminator between OSA and non-OSA groups, marked differences in psychosocial morbidity were observed. Multivariable analysis revealed either OSA or frequent sleepiness or both to be independent predictors of amount of sick leave, worse self-rated general health, impaired work performance and divorce rate. Therefore OSA, measured by self report, is an important independent predictor of psychosocial morbidity in subjects with severe obesity. Sleep apnea, Obesity, Sick leave, Divorce, Quality of life This content is only available as a PDF. © 1995 American Sleep Disorders Association and Sleep Research Society

Camacho, Maria, E.;Morin, Charles, M.

doi: 10.1093/sleep/18.8.644pmid: 8560129

Summary: This study evaluated the respiratory effect of temazepam in elderly subjects (mean age 65 ± 3.8 years), with mild sleep apnea. The 15 subjects of this report were enrolled in a larger randomized trial comparing pharmacological and behavioral treatments for insomnia. Seven subjects received temazepam 15–30 mg/day either alone or in combination with behavior therapy, and eight subjects received placebo or behavior therapy. The mean baseline respiratory disturbance index (RDI) was 9.2 ±2.8 for the nondrug and 8.8 ± 5.3 for the temazepam group. There were no significant time, group or interaction effects. There was no increase in the RDI in elderly subjects with mild respiratory apnea receiving 15–30 mg of temazepam. Temazepam, Respiration, Sleep apnea, Elderly, Insomniac This content is only available as a PDF. © 1995 American Sleep Disorders Association and Sleep Research Society

McCall, W., Vaughn;Turpin,, Ed;Reboussin,, David;Edinger, Jack, D.;Haponik, Edward, F.

doi: 10.1093/sleep/18.8.646pmid: 8560130

Summary: It is well established that, as a group, insomnia patients overestimate sleep onset latency (SOL) and underestimate total sleep time (TST) when compared to objective polysomnographic (PSG) findings. Whether a similar phenomenon occurs with other sleep disorders is not fully established. We compared the PSG sleep of 84 patients with suspected sleep apnea (SA) to their subjective experience of sleep reported on a sleep diary the morning after PSG testing. Both patients with SA (SA+) and those without (SA—) tended to overestimate SOL, but the SA+ group (n = 50) made larger overestimations (p < 0.02). The SA+ and SA– groups also differed in their accuracy at estimating TST, with SA+ patients underestimating TST (p < 0.05). These findings support the premise that marked discrepancies between subjective and PSG-determined sleep may not be limited to insomnia, but present in other sleep disorders as well, and should be appreciated by practitioners when obtaining sleep histories. Sleep apnea, Sleep diary, Subjective, Ambulatory testing, Polysomnogram This content is only available as a PDF. © 1995 American Sleep Disorders Association and Sleep Research Society

Morrell, Mary, J.;Badr, M., Safwan;Harms, Craig, A.;Dempsey, Jerome, A.

doi: 10.1093/sleep/18.8.651pmid: 8560131

Summary: We investigated the relationship between airway patency and the occurrence of cardiogenic related oscillations in the airflow signal during 67 apneas occurring in non-rapid eye movement sleep in eight subjects. Spontaneously occurring apneas and apneas induced by mechanical ventilation were analyzed. Airway occlusion was determined by direct observation of the pharyngeal lumen using fiberoptic endoscopy. The presence or absence of cardiogenic oscillations was determined from an expanded airflow signal by an investigator blinded to the airway patency. Of the total 67 apneas, complete airway occlusion occurred during 51, and the airway remained patent throughout in 16. Cardiogenic oscillations were seen throughout 39 of the 51 occluded apneas and throughout 9 of the 16 apneas with the airway patent. There was no relationship between the occurrence of cardiogenic oscillations and airway patency. In addition, in a canine model where the upper airway was anatomically isolated, cardiogenic oscillations were evident during apneas in pressure signals recorded from the isolated upper airway and in airflow signals at the tracheal stoma. We conclude that cardiogenic oscillations cannot be used to predict airway patency during apnea. Pulse artifact, Central apnea, NREM sleep, Upper airway This content is only available as a PDF. © 1995 American Sleep Disorders Association and Sleep Research Society

Schechtman, Kenneth, B.;Sher, Aaron, E.;Piccirillo, Jay, F.

doi: 10.1093/sleep/18.8.659pmid: 8560132

Summary: A comprehensive review of the literature on the surgical treatment of sleep apnea found 37 appropriate papers (total n = 992) on uvulopalatopharyngoplasty (UPPP). Methodological and statistical problems in these papers included the following: 1) There were no randomized studies and few (n = 4) with control groups. 2) Median sample size was only 21.5; thus statistical power was low and clinically important associations were routinely classified as “not statistically significant”. 3) Only one paper presented the confidence bounds that might distinguish between statistical and clinical significance. 4) Because of short follow-up time and infrequent repeat follow-ups, little is known about whether UPPP results deteriorate with time. 5) In at least 15 papers, bias caused by retrospective designs and nonrandom loss to follow-up raised questions about the generalizability of results. 6) Few papers associated polysomnographic data with patient-based quality of life measures. 7) Missing data and missing and inconsistent definitions were common. 8) Baseline measures were often biased because the same assessment was inappropriately but routinely used for both screening and baseline. We conclude that because of these and other problems, there is much that is needlessly unknown about UPPP. It is the responsibility of the research and professional communities to define training, editorial and review procedures that will raise the methodological and statistical quality of published research. Methodological problems, Control groups, Sample size-Confidence bounds, Bias, Sleep apnea, Uvulopalatopharyngoplasty This content is only available as a PDF. © 1995 American Sleep Disorders Association and Sleep Research Society

Gau,, Shur-Fen;Soong,, Wei-Tsuen

doi: 10.1093/sleep/18.8.667pmid: 8560133

Summary: The objective of this work was to study the relationship between daily sleep time and characteristics of students, e.g. grade level, gender, and academic program. A sleep habit questionnaire was designed to survey students at two junior high schools, one from northern Taipei and the other from southern Taipei. The impact of shortened duration of sleep on daily function was also evaluated. A total of 965 students and their parents were selected randomly in December 1993 for the questionnaire study. The response rate was 96.4% (930) for students and 88.6% (855) for parents. The self-reported daily sleep time of students declined, and daytime sleepiness and moodiness increased in the higher grades. The girls slept fewer hours than the boys and did not show an increase in daytime sleepiness. Those students not taking the senior high school joint entrance examination slept more hours at night and maintained more alertness in the daytime than those who were taking the examination. The more academic pressures that adolescents faced, the fewer hours they slept. Students not participating in the joint entrance examination seemed to show a healthier sleep pattern. Little sleep at night made the students feel sleepy in the daytime and tired, drowsy, moody and difficult at arising in the morning. The reason why girls slept less than boys needs further investigation. Daytime sleepiness, Adolescents, Academic pressure, Grade This content is only available as a PDF. © 1995 American Sleep Disorders Association and Sleep Research Society

Cohen-Mansfield,, Jiska;Werner,, Perla;Freedman,, Laurence

doi: 10.1093/sleep/18.8.674pmid: N/A

Summary: An observational study was conducted to describe the physical and social environment of sleep of 16 highly agitated and cognitively impaired nursing home residents, and the relationships between manifestations of agitation and sleep. Results showed that nursing home residents were more likely to be observed asleep when alone, in their own rooms, and between 9 p.m. and 5 a.m. Considerable amounts of sleep were also observed during the day. Great individual variation was observed in the presence of sleep-related disorders, although a tendency was observed for more fragmented sleep during the day hours. Almost all the agitated behaviors observed decreased immediately after sleep. Similar to findings of objective studies, much individual variation was found in sleep patterns and sleep pathology of cognitively impaired and highly agitated nursing home residents. Findings suggest that agitation may be exacerbated by fatigue. Sleep, Agitation, Nursing home residents, Dementia This content is only available as a PDF.

Trenkwalder,, C.;Stiasny,, K.;Pollmächer,, Th.;Wetter,, Th.;Schwarz,, J.;Kohnen,, R.;Kazenwadel,, J.;Krüger, H., P.;Ramm,, S.;Küinzel,, M.;Oertel, W., H.

doi: 10.1093/sleep/18.8.681pmid: 8560135

Kazenwadel,, J.;Pollmacher,, Th.;Trenkwalder,, C.;Oertel, W., H.;Kohnen,, R.;Kiinzel,, M.;Krüger,, H.-P.

doi: 10.1093/sleep/18.8.689pmid: 8560136

Summary: A new actigraphic method by which periodic leg movements (PLM) can be measured is presented. Data acquisition and analysis were brought into line to distinguish short-lasting repetitive leg movements from random motor restlessness. The definition of PLM follows the generally accepted criteria for PLM scoring. Thirty restless legs patients, all also suffering from PLM, were investigated three times by polysomnography, including tibialis anterior surface electromyography and actigraphy. A high correlation (reliability) was found for the number of PLM per hour spent in bed between the two methods. Furthermore, the actigraph records PLM specifically. An index of random motor restlessness is not sufficient for a reliable PLM recording. In addition, periodic movements in sleep (PMS) and PLM show comparable variability in general. The actigraphic assessment of PLM, however, gives a better measure because PMS recordings may result in a substantial underestimation of PLM when sleep efficiency is reduced. This method is an ambulatory assessment tool that can also be used for screening purposes. Periodic leg movements, Restless legs syndrome, Actigraph, Reliability, PLM specificity, Methodology This content is only available as a PDF. © 1995 American Sleep Disorders Association and Sleep Research Society