SLEEP

Zee, Phyllis C.

doi: 10.5665/sleep/31.7.923pmid: N/A

Morgenthaler, Timothy I.; Lee-Chiong, Teofilo; Alessi, Cathy; Friedman, Leah; Aurora, R. Nisha; Boehlecke, Brian; Brown, Terry; Chesson, Andrew L.; Kapur, Vishesh; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Swick, Todd J.; Zak, Rochelle; ,

doi: 10.5665/sleep/31.7.925pmid: N/A

Koban, Michael; Sita, Luciane V.; Le, Wei Wei; Hoffman, Gloria E.

doi: 10.5665/sleep/31.7.927pmid: N/A

AbstractStudy Objectives:Chronic sleep deprivation of rats causes hyperphagia without body weight gain. Sleep deprivation hyperphagia is prompted by changes in pathways governing food intake; hyperphagia may be adaptive to sleep deprivation hypermetabolism. A recent paper suggested that sleep deprivation might inhibit ability of rats to increase food intake and that hyperphagia may be an artifact of uncorrected chow spillage. To resolve this, a palatable liquid diet (Ensure) was used where spillage is insignificant.Design:Sleep deprivation of male Sprague Dawley rats was enforced for 10 days by the flowerpot/platform paradigm. Daily food intake and body weight were measured. On day 10, rats were transcardially perfused for analysis of hypothalamic mRNA expression of the orexigen, neuropeptide Y (NPY).Setting:Morgan State University, sleep deprivation and transcardial perfusion; University of Maryland, NPY in situ hybridization and analysis.Measurements and Results:Using a liquid diet for accurate daily measurements, there was no change in food intake in the first 5 days of sleep deprivation. Importantly, from days 6–10 it increased significantly, peaking at 29% above baseline. Control rats steadily gained weight but sleep-deprived rats did not. Hypothalamic NPY mRNA levels were positively correlated to stimulation of food intake and negatively correlated with changes in body weight.Conclusion:Sleep deprivation hyperphagia may not be apparent over the short term (i.e., ≤5 days), but when extended beyond 6 days, it is readily observed. The timing of changes in body weight and food intake suggests that the negative energy balance induced by sleep deprivation prompts the neural changes that evoke hyperphagia.

Jamasebi, Reza; Redline, Susan; Patel, Sanjay R; Loparo, Kenneth A.

doi: 10.5665/sleep/31.7.935pmid: N/A

AbstractStudy Objectives:We propose a generation of PSG-derived measures that using entropy can quantify temporal patterns of sleep, and investigate the role of these measures as predictors of hypertension. We also investigate the influence of age on these entropy-based measures as compared to traditional indices.Design and Setting:Cross-sectional analyses of the association between hypertension status with traditional PSG and novel measures using adjusted and unadjusted logistic regression models. The novel measures were developed to quantify variability of the arousal event process.Patients or Participants:Analyses were based on a subsample of subjects from the Cleveland Family Study with clearly disparate hypertension status.Measurements and Results:Among traditional PSG indices, the apnea hypopnea index (AHI) has the highest Odds Ratio (unadjusted and adjusted for age, gender, race, BMI: OR = 2.36 (95% CI: 1.48, 3.75, P = 0.0003) and 1.18, (95% CI: 0.76, 1.84, P = 0.46), respectively). The best predictor among the entropy-based measures is derived from analysis of the temporal patterns of arousal duration with unadjusted and adjusted ORs of 1.36 (95% CI: 1.08, 1.71, P = 0.0085) and 2.08 (95% CI: 1.19, 3.64, P = 0.01), respectively.Conclusions:Our findings suggest that when adjusted for common confounders such as age, gender, race, and BMI, the entropy-based features that quantify the variability of the arousal event process are more strongly associated with hypertension as compared to traditional PSG indices; they are not as strongly influenced by age as are the traditional indices. The result implies that the regularity of arousals may be an important feature associated with hypertension. These measures may provide a powerful tool for discriminating individuals at risk for comorbidities, such as hypertension, associated with sleep disturbances.

, ; Manconi, Mauro; Ferini-Strambi, Luigi; Filippi, Massimo; Bonanni, Enrica; Iudice, Alfonso; Murri, Luigi; Gigli, Gian Luigi; Fratticci, Lara; Merlino, Giovanni; Terzano, Giovanni; Granella, Franco; Parrino, Liborio; Silvestri, Rosalia; Aricò, Irene;

Guilleminault, Christian; Quo, Stacey; Huynh, Nelly T.; Li, Kasey

doi: 10.5665/sleep/31.7.953pmid: N/A

AbstractStudy objective:Rapid maxillary expansion and adenotonsillectomy are proven treatments of obstructive sleep apnea (OSA) in children. Our goal was to investigate whether rapid maxillary expansion should be offered as an alternative to surgery in select patients. In addition, if both therapies are required, the order in which to perform these interventions needs to be determined.Design:Prepubertal children with moderate OSA clinically judged to require both adenotonsillectomy and orthodontic treatment were randomized into 2 treatment groups. Group 1 underwent adenotonsillectomy followed by orthodontic expansion. Group 2 underwent therapies in the reverse sequence.Subjects:Thirty-two children (16 girls) in an academic sleep clinic.Method:Clinical evaluation and polysomnography were performed after each stage to assess efficacy of each treatment modality.Results:The 2 groups were similar in age, symptoms, apnea-hypopnea index, and lowest oxygen saturation. Two children with orthodontic treatment first did not require subsequent adenotonsillectomy. Thirty children underwent both treatments. Two of them were still symptomatic and presented with abnormal polysomogram results following both therapies. In the remaining 28 children, all results were significantly different from those at entry (P = 0.001) and from single therapy (P = 0.01), regardless of the order of treatment. Both therapies were necessary to obtain complete resolution of OSA.Conclusion:In our study, 87.5% of the children with sleep-disordered breathing had both treatments. In terms of treatment order, 2 of 16 children underwent orthodontic treatment alone, whereas no children underwent surgery alone to resolve OSA. Two children who underwent both treatments continued to have OSA.

Baumert, Mathias; Smith, Janet; Catcheside, Peter; McEvoy, R Douglas; Abbott, Derek; Sanders, Prashanthan; Nalivaiko, Eugene

doi: 10.5665/sleep/31.7.959pmid: N/A

AbstractStudy Objective:To determine OSA-related changes in variability of QT interval duration and in heart rate variability (HRV), and to evaluate the relationship of these parameters to disease severity.Design:Retrospective analysis of diagnostic sleep records.Settings:Clinical sleep laboratory in a hospital setting.Patients:Twenty patients (12 males and 8 females) without significant comorbidities who were undergoing polysomnography were studied.Measurements and Results:Standard heart rate variability measures and QT variability (Berger algorithm) were computed over consecutive 5-minute ECG epochs throughout the night. The effect of sleep stage and the relationship between these parameters and the severity of OSA as determined by the respiratory disturbance index (RDI) were explored. Further, a linear regression model of QT variability was developed. Severity of OSA (RDI) was 49 ± 28 (range from 17–107) events/ hr. QT variability was the only ECG measure significantly correlated with RDI (both log-transformed; r = 0.6, P = 0.006). Further, QT variability was correlated with the minimum oxygen saturation (r = −0.55, P = 0.01). Sleep stage showed a significant effect on HRV, but not on QT variability. In the regression model, RDI was the strongest predictor of QT variability (R2 increase 38%), followed by high and low frequency power of HRV (R2 increase 10% each).Conclusion:Obstructive sleep apnea is associated with changes in QT interval variability during sleep. The variance of beat-to-beat QT intervals correlates more strongly with the severity of OSA (as determined by RDI) than standard measures of heart rate variability, and is correlated with blood oxygenation, but not sleep stage.

Macey, Paul M.; Kumar, Rajesh; Woo, Mary A.; Valladares, Edwin M.; Yan-Go, Frisca L.; Harper, Ronald M.

doi: 10.5665/sleep/31.7.967pmid: N/A

AbstractStudy Objectives:Determine whether obstructive sleep apnea (OSA) subjects show indications of axonal injury.Design:We assessed fiber integrity in OSA and control subjects with diffusion tensor imaging (DTI). We acquired four whole-brain DTI series from each subject. The four series were realigned, and the diffusion tensor calculated at each voxel. Fractional anisotropy (FA), a measure of fiber integrity, was derived from the diffusion tensor, resulting in a whole brain FA “map.” The FA maps were spatially normalized, smoothed, and compared using voxel-based statistics to determine differences between OSA and control groups, with age as a covariate (P < 0.05, corrected for multiple comparisons).Setting:University medical center.Subjects:We studied 41 patients with untreated OSA (mean age ± SD: 46.3 ± 8.9 years; female/male: 7/34) with apnea-hypopnea index 15 to 101 (mean ± SD: 35.7 ± 18.1 events/hour), and 69 control subjects (mean age ± SD: 47.5 ± 8.79 years; female/male: 25/44).Measurements and Results:Multiple regions of lower FA appeared within white matter in the OSA group, and included fibers of the anterior corpus callosum, anterior and posterior cingulate cortex and cingulum bundle, right column of the fornix, portions of the frontal, ventral prefrontal, parietal and insular cortices, bilateral internal capsule, left cerebral peduncle, middle cerebellar peduncle and corticospinal tract, and deep cerebellar nuclei.Conclusions:White matter is extensively affected in OSA patients; the alterations include axons linking major structures within the limbic system, pons, frontal, temporal and parietal cortices, and projections to and from the cerebellum.

Kravitz, Howard M.; Zhao, Xinhua; Bromberger, Joyce T.; Gold, Ellen B.; Hall, Martica H.; Matthews, Karen A.; Sowers, MaryFran R.

doi: 10.5665/sleep/31.7.979pmid: N/A

AbstractStudy Objectives:Examine age-adjusted odds and racial/ethnic differences in self-reported difficulties falling and staying asleep and early morning awakening in midlife women to determine whether difficulty sleeping increased with progression through the menopausal transition.Design:Longitudinal analysis.Setting:Community-based.Participants:3,045 Caucasian, African American, Chinese, Japanese, and Hispanic women, aged 42–52 years and pre- or early peri-menopausal at baseline, participating in the Study of Women's Health Across the Nation (SWAN).Interventions:None.Measurements and Results:Self-reported number of nights of difficulty falling asleep, staying asleep, and early morning awakening during the previous 2 weeks were obtained at baseline and 7 annual assessments. Random effects logistic regression was used to model associations between each of the 3 sleep measures and the menopausal transition, defined by bleeding patterns, vasomotor symptoms (VMS), and estradiol (E2) and follicle stimulating hormone (FSH) serum levels. Adjusted odds ratios (ORs) for difficulty falling asleep and staying asleep increased through the menopausal transition, but decreased for early morning awakening from late perimenopause to postmenopause. Naturally and surgically postmenopausal women using hormones, compared with those who were not, generally had lower ORs for disturbed sleep. More frequent VMS were associated with higher ORs of each sleep difficulty. Decreasing E2 levels were associated with higher ORs of trouble falling and staying asleep, and increasing FSH levels were associated with higher ORs of trouble staying asleep. Racial/ethnic differences were found for staying asleep and early morning awakening.Conclusions:Progression through the menopausal transition as indicated by 3 menopausal characteristics—symptoms, bleeding-defined stages, and endogenous hormone levels—is associated with self-reported sleep disturbances.

Pien, Grace W.; Sammel, Mary D.; Freeman, Ellen W.; Lin, Hui; DeBlasis, Tracey L.

doi: 10.5665/sleep/31.7.991pmid: N/A

AbstractStudy Objectives:To determine associations between menopausal status, reproductive hormone levels, menopausal symptoms, and poor sleep quality.Design:The present study examines subjective sleep quality over an 8-year period in participants in an ongoing longitudinal study of ovarian aging in a randomly identified cohort of African American and Caucasian women.Participants:The Penn Ovarian Aging Study, a population-based cohort of 436 women from Philadelphia County who were 35 to 47 years of age and had regular menstrual cycles at enrollment.Interventions:N/A.Measurements and Results:The primary outcome measure was the Sleep Quality factor score, derived from the St. Mary's Hospital Sleep Questionnaire, which was adapted for this population and collected at each assessment period over the 8-year follow-up. Associations between menopausal status, reproductive hormone levels, menopausal symptoms, sleep quality, age, and race were examined in multivariable linear mixed regression models for repeated measures. Menopausal status was not significantly associated with sleep quality (P = 0.12).In the adjusted model, independent predictors of sleep quality were hot flashes (P < 0.0001), Center for Epidemiological Studies Depression Scale scores (P < 0.0001) and levels of the reproductive hormone inhibin B (P = 0.05).Conclusions:Sleep quality was predicted by hormone levels and symptoms that occur in the menopausal transition but did not worsen with advancing menopausal status alone. Lower inhibin B levels, hot flashes, and symptoms of depression were all strong and independent predictors of difficulty sleeping. Race was not a significant contributor to sleep quality. Together, the findings demonstrate that women who experience other perimenopausal symptoms are likely to experience sleep problems during the menopausal transition.