Sleep problems in the aged in relation to senility

Abstract As a part of an epidemiologic survey of dementia in a community of aged persons, correlation between sleep complaints and physical illness and senility were studied. A total of 3302 randomly sampled aged individuals (aged 65 yean) were studied using a questionnaire. In this sample the prevalence of poor sleep and habitual snoring did not increase with age. The prevalence of excessive daytime sleepiness showed an increase with age. Male predominance of habitual snoring and female predominance of poor sleep were observed. Female predominance of excessive daytime sleepiness was noted among the aged 70 and over. Age-related excessive daytime sleepiness was significantly correlated with senility.     

Hypnotics and caffeine as countermeasures for shiftwork-related sleepiness and sleep disturbance

SUMMARY  Hypnotic medication reliably improves sleep during the day, in terms of increasing total sleep time (TST) and reducing awakenings and light sleep. Middle-aged individuals may benefit more than young adults. In addition, the time of day during which sleep is attempted may influence the efficacious dose of short-acting drugs. Available data suggest that improving sleep during the day may improve alertness/performance at night to a mild degree, but significant circadian-related sleepiness remains. Hypnotic medication may help minimize the cumulative effects of sleep loss associated with daytime sleep. Use for more than one week has not been adequately studied; however, as most night and rotating workers' schedules allow for night-time sleep for two or more nights per week, available evidence indicates that hypnotics can be used effectively on an intermittent basis, e.g. for the first 2–4 day-sleep periods of night shifts. Caffeine has been shown to increase alertness and improve psychomotor performance during usual night-shift hours when taken between 22.30 and 01.20 hours. Available data indicate that at approximate dosages of 250–400 mg, the beneficial effects persist until at least 05.30 hours. For most subjects, caffeine taken at the start of the night-shift does not interfere significantly with daytime sleep beginning at 09.00 hours. There is also some evidence that single doses of caffeine at the beginning of a night shift may be more alerting than divided doses. If caffeine is to be used therapeutically, avoidance of social use may be required to avoid tolerance to CNS stimulant effects. Despite the positive results of laboratory research examining hypnotics or caffeine as shiftwork countermeasures, field trials have not been conducted.     

Sleep-related disorders in carpal tunnel syndrome

Introduction – Patients with carpal tunnel syndrome (CTS) often wake up at night due to pain and numbness of affected fingers and hand. We studied the sleep disorder caused by CTS. Subjects and methods – 34 consecutive patients referred for operative treatment of CTS answered to a sleep questionnaire and the results were compared to a stratified random sample of 1600 Finns aged 36–50 year, whose response rate to the mailed questionnaires was 75.2% (n=1186). Six CTS patients underwent a polygraphic sleep study before and after operative treatment of CTS. Results – CTS patients reported suffering from poor sleep quality, fragmentary sleep and daytime sleepiness more often than controls. Before operative treatment of CTS there were more nocturnal body movements (p<0.01) and awakenings lasted longer (p<0.05) than after operation. During preoperative sleep studies no drop in median nerve conduction was detected during awakenings. Conclusions – Patients with CTS suffer from fragmentary sleep. Although patients reported waking up for the pain or numbness of hands no impairment in median and ulnar nerve conduction could be observed during these awakenings. Operative treatment of hand entrapment significantly reduced the number of nocturnal movements.     

The clinical diagnosis of the narcoleptic syndrome

Sleep–wake habits and control of postural muscle tone were investigated by self-report questionnaire in 183 subjects considered to have the narcoleptic syndrome, 62 subjects with hypersomnia and 10 with obstructive sleep apnoea. Results were compared with those in a group of 188 control subjects with normal sleep–wake habits. Excessive daytime sleepiness, determined by the Epworth Sleepiness Scale (ESS), was five times greater in the narcoleptic syndrome than in control subjects (score range 0–24, mean scores ±SD 19.6±3.0; and 4.5±3.3 respectively; P<0.001). The propensity to cataplexy, as determined by a rating scale developed to estimate the likelihood of loss of postural tone in response to sudden emotional stimuli, including laughter, was 10 times greater in narcoleptic syndrome than in control subjects (postural atonia total score range 0–600; mean±SD 334±122 and 28±45, respectively; P<0.001). Narcoleptics had more disturbances of night sleep than controls with episodes of muscle jerking, sleep walking, sleep talking and sleep terrors, as well as sleep paralysis, and higher insomnia self-rating scores. Sleep latency from bedtime to sleep-onset time was shorter in narcoleptics than controls. The hypersomniac group of 62 subjects was heterogeneous. Subsequent investigation showed that 18 subjects (29%) had idiopathic hypersomnia, four (6%) ‘incomplete’ narcolepsy without cataplexy and 10 (16%) hypersomnia accompanying a mood disorder. The mean ESS scores in this group and in subjects with obstructive sleep apnoea were comparable to those of the narcoleptic syndrome subject group. Mean postural atonia scores were similar to those of control subjects.     

Natural evolution of snoring: a 5-year follow-up study

Introduction – The natural evolution of snoring was studied in a middle-aged population in Finland. Material and methods – A questionnaire was mailed to a stratified random sample of 1600 people aged 36–50 years in 1985 with a response rate of 75.2%; 53% of them completed also the 5-year-follow-up questionnaire. Clinical examinations (N = 36) and whole-night polygraphic recordings (N = 22) were made to habitual (every or almost every night) snorers and daily sleepy persons. Results – A total of 626 persons completed the 5-year-follow-up questionnaire. The prevalence of habitual snoring among men was 28.3–43.8% and among women 6.3–18.8%, increasing with age. Sleepiness was common: doze-off at the wheel was reported by 23% of snorers and traffic accidents because of sleepiness by 4.5%. Hypertension was clearly more common (p = 0.002) among habitual snorers, but the self-reported rates of strokes and coronary heart disease were not increased in this study. None of the snorers had been investigated because of their snoring or sleepiness during the five years. In polygraphic recordings 11/22 showed an oxygen desaturation index (ODI4) more than 5/h; active treatment was started for 8 of them. The observed prevalence of sleep apnea syndrome with ODI4> 10 was 1.1% in this study. Conclusions – Snorers, even with clear sleepiness, are passive in seeking help for their symptoms. Physicians should actively diagnose this treatable condition impairing the quality of life and increasing the risk of traffic accidents and vascular diseases.     

A case of sub wakefulness syndrome

Abstract We report a patient, a 30-year-old male Japanese-Brazilian migrant construction worker, suffering from excessive daytime sleepiness for at least 6 months. Electroencephalogram recordings during his waking states showed that 10-Hz and 60-µV alpha activity was present prominently in the occipital regions. From the multiple sleep latency test, it was found that stages 1–2 NREM sleep episodes appeared repetitively without any REM episodes, and that the mean sleep latency was 10.2 min. These findings support the diagnosis that this patient suffers from subwakefulness syndrome.     

Jet lag and sleepiness In aircrew

SUMMARY  Jet-lag and day-time sleepiness cannot be avoided in transmeridian operations, because work hours of aircrews interfere with the circadian system through irregular work-rest schedules and rapid time-zone transitions. Although the primary cause of accidents is usually the human factor, jet lag and sleepiness have seldom been officially identified as causes of inadequate functioning in the cockpit. However, research clearly indicates that flights at night and/or across time zones will impair performance and reduce safety. Research on countermeasures have focused on on-board napping, crew augmentation, behavioural strategies against jet-lag, light treatment and melatonin administration. Regrettably, scientific knowledge has been successfully transmitted to only a very few national authorities responsible for work hours of aircrews.     

Daytime sleepiness and automobile accidents in patients with obstructive sleep apnea syndrome

Abstract We evaluated the rate of automobile accidents and daytime sleepiness using the Epworth sleepiness scale (ESS) in 44 patients with obstructive sleep apnea syndrome (OSAS). We defined the automobile accident score as a sum of two points for every one automobile accident and one point for every near-miss accident. Automobile accidents and near-misses were found in 54.5% and 50.0% in patients with OSAS. Automobile accident score was significantly correlated with the ESS score ( r = 0.56, P < 0.01). Our findings suggest that ESS score may be useful in detecting patients with the potential risk of automobile accidents associated with daytime sleepiness.     

阻塞性睡眠呼吸暂停低通气综合征白天嗜睡机制的研究现状

白天嗜睡是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)特征性的症状之一,其危害性大.白天嗜睡最主要的评价方法是Epworth嗜睡量表和多次睡眠潜伏期试验.OSAHS患者白天嗜睡的发生机制未明,但可能主要与睡眠片段化、夜间缺氧、肿瘤坏死因子及P物质等因素有关.     

合并睡眠呼吸暂停低通气综合征的老年慢性阻塞性肺病患者的临床特点分析

目的分析慢性阻塞性肺疾病（COPD）合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）,即重叠综合征患者睡眠呼吸紊乱的临床特点,比较门诊和住院COPD患者的呼吸紊乱情况。方法对Epworth嗜睡量表评分≥10,夜间氧减饱和指数ODI4（每小时血氧饱和度下降4％的次数）≥5的门诊及住院稳定期300例COPD患者进行多导睡眠图监测。结果住院COPD患者的呼吸紊乱程度更严重,住院与门诊COPD合并OSAHS患者在体重指数、血氧饱和度低于90％的时间占总记录时间的百分比、夜间平均血氧饱和度、夜间最低血氧饱和度、呼吸紊乱指数等方面差异显著。此外,住院COPD患者睡眠中心率增快。结论睡眠呼吸紊乱可以影响并加重COPD患者病情。