Prenatal smoking exposure,measured as maternal serum cotinine,and children’s motor developmental milestones and motor function: A follow-up study

BackgroundCohort studies have indicated an association between prenatal smoking exposure and children’s motor difficulties. However, results are inconsistent and exposure is most often self-reported. Studies indicate that measurement of serum cotinine can result in a more accurate status of smoking exposure in comparison with self-report.ObjectivesTo investigate whether prenatal smoking exposure, measured as maternal serum cotinine, is associated with maternal interview based assessment of motor development in infancy (age at crawling, standing-up and walking) and motor skills at young school age (assessed by the Developmental Coordination Disorder Questionnaire 2007 (DCDQ’07)).MethodIn 2002–2004, 1,253 pregnant women from Greenland and Ukraine were included in the INUENDO birth cohort. The participating women filled in questionnaires and 1,177 provided blood samples, which were analyzed for serum cotinine. Smokers were defined as women with a serum cotinine concentration >10 ng/ml. At follow-up when the offspring were 6–9 years of age 1,026 of the parents from the cohort participated. They completed an interview-based questionnaire including questions about age at motor milestones of their children. In addition, child motor development was assessed using the questionnaire “DCDQ’07”. Linear regression analyzes were performed and adjusted for covariates; age of the mother and child, parity, sex, maternal educational level, maternal pre-pregnancy alcohol consumption and duration of breastfeeding. Data were stratified by country.ResultsNo statistically significant difference in age at motor milestones was found comparing children of smokers with children of non-smokers. Also, there was no statistically significant difference in motor score (Developmental Coordination Disorder Questionnaire Score, DCDQ-score) among five to seven-year-old children. However, in Greenland children of smokers had a lower DCDQ-score than children of non-smokers at eight to nine years (−2.2 DCDQ points, 95% CI: −4.3;−0.1). Supplementary results for the same age group in Greenland showed that children of smokers had higher odds of being classified with motor difficulties in comparison with children of non-smokers (OR = 1.9, 95% CI: 1.1;3.3).ConclusionMaternal serum cotinine was not related to delayed motor development milestones or reduced motor function abilities in children up to 7 years of age. Reduced motor skills observed in 8–9 years old exposed children warrant further study.     

Association of secondhand smoke exposure with mental health in men and women: Cross-sectional and prospective analyses using the UK Health and Lifestyle Survey

ObjectivesWe examine cross-sectional and prospective associations between objectively measured SHS exposure and mental health using data from the Health and Lifestyle Survey (HALS), a large, UK-wide, general population-based, prospective cohort study with measurements of carbon monoxide or salivary cotinine levels.MethodsMental health was assessed using the 30-item version of the General Health Questionnaire (GHQ). Multivariate logistic regression models adjusting for age, sex, height, body mass index, alcohol intake, social status, and longstanding illness were used to analyze the association between exposure to SHS (exhaled CO and salivary cotinine categories) and psychological distress (≥ 5 GHQ).ResultsFully adjusted cross-sectional analysis revealed a positive relationship between exhaled carbon monoxide and psychological distress among smokers (OR 1.36; 95% CI 1.04-1.78) but not among non-smoking adults. In a similar cross-sectional analysis between cotinine level and psychological distress, non-significant associations were found among smokers and non-smokers. Prospective analyses of the cotinine-psychological distress relationship among participants without psychological distress at baseline showed no significant increased risk of psychological distress among both smokers and non-smokers. In a prospective analysis of poor mental health outcome with respect to self-report smoking and SHS status, smokers had an increased risk of psychological distress while SHS and non-smokers did not.ConclusionsA non-significant association between objectively measured SHS exposure and poor mental health was found in this study. Our findings show discrepancies with recent studies suggesting the need for additional future research in this growing field of study.     

Monitoring noninvasive ventilation in neuromuscular patients: feasibility of unattended home polysomnography and reliability of sleep diaries

BackgroundIn-hospital polysomnography (PSG) often is performed to monitor neuromuscular patients under noninvasive ventilation (NIV), but success of home PSG has not been established for that purpose. Reliability of sleep diaries in neuromuscular patients is unknown. The aims of our study were to evaluate feasibility, quality, and acceptability of unattended home PSG, as well as the reliability of sleep diaries in neuromuscular patients on long-term NIV.MethodsFifty-two neuromuscular patients underwent unattended home or hospital PSG during NIV. Patients were questioned about their sleep during the PSG and their attitudes towards the procedure.ResultsOne home and one hospital PSG were scored as failure or low quality due to prolonged signal loss or sleep duration of <3 h. Objective and subjective sleep duration and efficiency often showed large differences. Subjective awakenings reflected objective awakenings lasting for >4 min in 86.5% patients. Preference for home PSG was expressed by 82% subjects.ConclusionsIn neuromuscular patients under NIV unattended home PSG is feasible and preferred, with a low failure rate. The degree of reliability of different parameters of subjective sleep assessment should be considered when used as a complement of nocturnal cardiorespiratory recordings.     

Smoking and sleep disorders in Chinese adolescents

ObjectiveTo investigate the association between adolescent smoking and sleep disorders.MethodsIn the Hong Kong student obesity surveillance project, 29,397 Chinese students, aged 12–18 years, completed a health survey. Insomnia was defined as having any of the following three symptoms: difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA). The presence of snoring and difficulty breathing during sleep (DBS) was also reported. Logistic regression yielded adjusted odds ratios (ORs) for each sleep disorder by smoking status.ResultsCompared with never smokers, the ORs (95% CI) of insomnia were 1.39 (1.25–1.54) for experimenters (smoked once or a few times) and 0.91 (0.83–1.00) for current smokers. The corresponding ORs were 1.42 (1.16–1.74) and 3.58 (3.15–4.06) for snoring (P for trend < 0.001) and 1.40 (1.10–1.79) and 3.39 (2.97–4.03) for DBS (P for trend < 0.001). Current smokers compared with never smokers were less likely to report DIS (OR = 0.43, 95% CI = 0.38–0.50, P < 0.001) and EMA (OR = 0.83, 95% CI = 0.73–0.94, P = 0.003), but more likely to report DMS (OR = 1.45, 95% CI = 1.28–1.63, P < 0.001).ConclusionsIn terms of dosage, adolescent smoking was associated with snoring and DBS, with increasing ORs from never smokers to experimental and current smokers. Current smoking was associated positively with DMS, but negatively with DIS and EMA.     

Disturbed sleep and musculoskeletal pain in the bed partner of patients with obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) has been recognized as a distressing experience to the female partner, but a causal association remains controversial. Furthermore, a growing body of evidence supports a relationship of distress and sleep disruptions with musculoskeletal pain, also prevalent in middle-aged women. To test the hypothesis that sharing a bed with an OSA man may contribute to manifestations of distress and impaired sleep, we conducted a case-control study of 17 OSA wives and 17 wives of healthy sleepers.MethodsClinical outcome variables were scores of the Fibromyalgia Impact Questionnaire (FIQ) and visual analog scales (VAS), tender point (TP) count and algometric index. Sleep outcome parameters were VAS scores for sleep quality and polysomnographic (PSG) parameters. Secondary outcomes were VAS scores for distress and marital relationship and coping strategies adopted by OSA wives. Clinical assessment and PSG scoring were conducted blindly.ResultsAfter controlling for age and menopausal status, OSA wives exhibited lower sleep quality and higher distress scores than controls (p < 0.05, all). Increase in pain threshold (TP count and algometric index) and in FIQ score were also observed, and in their PSG, there was an increase in awaken period and stage 1 amount during sleep, as well as in alpha power during slow wave sleep (p < 0.05, all). These sleep parameters had substantial correlation with tiredness and poor sleep quality and were moderately correlated to pain assessments and distress scores.ConclusionThus, independently of age and menopausal status of the group, wives of OSA patients exhibited an increase in pain threshold, distress and impaired sleep in comparison to controls.     

Comparison of actigraphy and polysomnography to assess effects of zolpidem in a clinical research unit

ObjectiveThis study sought to compare devices that use actigraphy for measuring sleep endpoints in the clinical research unit (CRU) and home environment. The abilities of polysomnography (PSG) and actigraphy monitors to detect drug effects in a CRU were also investigated.MethodsEleven healthy subjects were recruited and monitored with PSG for four consecutive nights in a CRU after receiving no treatment (night 1, N1), and then placebo or 5 mg day^?1 or 10 mg day^?1 zolpidem in a randomised, cross-over design. Subjects wore two devices that use actigraphy (a Respironics® Actiwatch® on the wrist and a BodyMedia® Sensewear® Armband on the upper-arm) on the non-dominant arm for five nights at home and four nights in the CRU during PSG.ResultsWake after sleep onset (WASO) and total sleep time (TST) measured by PSG and estimates of WASO by the Actiwatch decreased significantly with 5 mg but not 10 mg of zolpidem versus placebo. Direct activity (counts/min) with the Actiwatch decreased in response to zolpidem (both 5 and 10 mg day^?1) versus placebo. Armband recordings of direct activity were similar to the Actiwatch but not significantly different versus placebo. Both actigraphy device estimates of TST were approximately 1 h longer in CRU versus home. Agreement between actigraphy estimates of TST and WASO and PSG values of TST and WASO were closer during nights with zolpidem treatment.ConclusionsPSG can detect the effects of zolpidem on sleep in a CRU setting. Actigraphy can provide useful assessment of sleep, but direct activity endpoints may be more effective than estimates of TST and WASO.     

Association between body mass index and sleep duration assessed by objective methods in a representative sample of the adult population

IntroductionSleep duration has been associated with overweight individuals in many epidemiological studies; however, few studies have assessed sleep using objective methods. Our study was designed to evaluate the association between body mass index (BMI) and sleep duration measured by actigraphy (Acti), polysomnography (PSG) and the Pittsburgh Sleep Quality Index questionnaire (PSQIO). Furthermore, we evaluated other biochemical and polysomnographic parameters.MethodsA representative sample of 1042 individuals from Sao Paulo, Brazil, including both genders (20–80 yrs), participated in our protocol. Weight and other anthropometric parameters were measured at the onset of the study. Sleep duration was calculated by Acti, PSG, and the PSQIQ. The population was sorted by sleep duration, body, slow wave sleep (SWS) and REM sleep (REMS) duration subsets. In addition, other biochemical and polysomnographic parameters were analyzed. Differences between population subsets were analyzed by one-way analysis of variance (ANOVA). Linear regression analysis was performed between sleep and anthropometric parameters.ResultsShorter sleep duration was associated with higher BMI and waist and neck circumference when measured by Acti and PSG (p < 0.05). Lower leptin levels were associated with short sleep in normal-weight (BMI > 18 and ⩽25) individuals (p < 0.01). The association between short sleep duration Acti and higher BMI was present when apnea-hypopnea index (AHI) was less than 15 (p = 0.049). Shorter REMS and SWS also were associated with higher BMI (p < 0.01). Normal-weight individuals tended to sleep longer, have higher sleep efficiency and longer SWS and REMS than obese individuals (Acti, PSG; p = 0.05). Sleep duration was negatively correlated with BMI (Acti, PSG; p < 0.05). Short SWS and REMS were associated with higher cardiovascular risk factors (p < 0.05).ConclusionShorter sleep, SWS, and REMS duration were associated with higher BMI, central adiposity measurements, and cardiovascular risk factors when measured by objective methods.     

Degree of pineal calcification (DOC) is associated with polysomnographic sleep measures in primary insomnia patients

ObjectiveMelatonin plays a key role in the proper functioning of the circadian timing system (CTS), and exogenous melatonin has been shown to be beneficial in cases of CTS and sleep disturbances. Nevertheless, the concept of “melatonin deficit” has yet to be defined. The aim of our study was, therefore, to determine the relationship between the degree of pineal calcification (DOC) and a range of sleep parameters measured objectively using polysomnography (PSG).MethodsA total of 31 outpatients (17 women, 14 men, mean age 45.9 years; SD 14.4) with primary insomnia were included in our study. Following an adaptation night, a PSG recording night was performed in the sleep laboratory. Urine samples were collected at predefined intervals over a 32-h period that included both PSG nights. The measurement of 6-sulphatoxymelatonin (aMT6s) levels was determined using ELISA. DOC and volume of calcified pineal tissue (CPT) and uncalcified pineal tissue (UPT) were estimated by means of cranial computed tomography.ResultsUPT was positively associated with 24-h aMT6s excretion (r = 0.569; P = 0.002), but CPT was not. After controlling for age, aMT6s parameters, CPT, and UPT did not correlate with any of the PSG parameters evaluated. In contrast, DOC was negatively associated with REM sleep percentage (r = ?0.567, P = 0.001), total sleep time (r = ?0.463, P = 0.010), and sleep efficiency (r = ?0.422, P = 0.020).ConclusionDOC appears to be a superior indicator of melatonin deficit compared to the absolute amount of melatonin in the circulation. High DOC values indicate changes predominantly in the PSG parameters governed by the circadian timing system. DOC may thus serve as a marker of CTS instability.     

Invalidity of one actigraphy brand for identifying sleep and wake among infants

Study objectivesFew commercially available brands of actigraphs (ACT) have been subjected to rigorous validation with infant participants. The purpose of this study was to examine the agreement between concurrent polysomnography (PSG) and one brand of ACT (AW-64, Mitter Co. Inc.) using appropriate statistical techniques among a sample of healthy infants.MethodsTwenty-two healthy infants (14.1 ± 0.6 months) had one night of ankle ACT recording during research PSG at Kosair Children’s Hospital Sleep Research Center in Louisville, Kentucky. Macroanalyses were conducted using the Bland–Altman concordance technique to assess agreement between total sleep time (TST) and wake after sleep onset (WASO) simultaneously measured by PSG and ACT, using two ACT algorithm settings. Microanalyses were also calculated to examine sensitivity, specificity, and accuracy of ACT within each PSG-identified sleep state. Correlations were calculated between PSG-identified arousals and the discrepancies between ACT and PSG.ResultsThe Bland–Altman concordance technique revealed that ACT underestimated TST by 72.25 (SD = 61.48) minutes and by ?60 min among 54.55% of infants. Furthermore, ACT overestimated WASO by 13.85 (SD = 30.94) minutes and by ?30 min among 40.91% of infants. Sensitivity, specificity, and accuracy analyses revealed that ACT adequately identified sleep, but poorly identified wake. PSG and ACT discrepancies were positively associated with PSG-identified arousals (r = .45).ConclusionsImproved device and/or software development is needed before the AW-64 can be considered a valid method for identifying infant sleep and wake.     

Let there be no light: the effect of bedside light on sleep quality and background electroencephalographic rhythms

ObjectivesArtificial lighting has been beneficial to society, but unnecessary light exposure at night may cause various health problems. We aimed to investigate how whole-night bedside light can affect sleep quality and brain activity.Patients and methodsTen healthy sleepers underwent two polysomnography (PSG) sessions, one with the lights off and one with the lights on. PSG variables related to sleep quality were extracted and compared between lights-off and lights-on sleep. Spectral analysis was performed to rapid eye movement (REM) sleep and non-REM (NREM) sleep epochs to reveal any light-induced differences in background brain rhythms.ResultsLights-on sleep was associated with increased stage 1 sleep (N1), decreased slow-wave sleep (SWS), and increased arousal index. Spectral analysis revealed that theta power (4–8 Hz) during REM sleep and slow oscillation (0.5–1 Hz), delta (1–4 Hz), and spindle (10–16 Hz) power during NREM sleep were decreased in lights-on sleep conditions.ConclusionsSleeping with the light on not only causes shallow sleep and frequent arousals but also has a persistent effect on brain oscillations, especially those implicated in sleep depth and stability. Our study demonstrates additional hazardous effect of light pollution on health.     

Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactivity disorder: A two-night polysomnographic study with a multiple sleep latency test

ObjectiveTo evaluate sleep macrostructure, sleep disorders incidence and daytime sleepiness in attention-deficit/hyperactivity disorder (ADHD) affected children compared with controls.MethodsThirty-one patients (26 boys, 5 girls, mean age 9.3 ± 1.7, age range 6–12 years) with ADHD diagnosed according to DSM-IV criteria, without comorbid psychiatric or other disorders, as never before pharmacologically treated for ADHD. The controls were 26 age- and sex-matched children (22 boys, 4 girls, age range 6–12 years, mean age 9.2 ± 1.5). Nocturnal polysomnography (PSG) was performed for two nights followed by the multiple sleep latency test (MSLT).ResultsNo differences between the two groups comparing both nights were found in the basic sleep macrostructure parameters or in the time (duration) of sleep onset. A first-night effect on sleep variables was apparent in the ADHD group. Occurrence of sleep disorders (sleep-disordered breathing [SDB], periodic limb movements in sleep [PLMS], parasomnias) did not show any significant differences between the investigated groups. A statistically significant difference (p = 0.015) was found in the trend of the periodic limb movement index (PLMI) between two nights (a decrease of PLMI in the ADHD group and an increase of PLMI in the control group during the second night). While the mean sleep latency in the MSLT was comparable in both groups, children with ADHD showed significant (sleep latency) inter-test differences (between tests 1 and 2, 1 and 4, 1 and 5, p < 0.01).ConclusionAfter the inclusion of adaptation night and exclusion of psychiatric comorbidities, PSG showed no changes in basic sleep parameters or sleep timing, or in the frequency of sleep disorders (SDB, PLMS) in children with ADHD compared with controls, thus not supporting the hypothesis that specific changes in the sleep macrostructure and sleep disturbances are connected with ADHD. A first-night effect on sleep variables was apparent only in the ADHD group. Though we found no proof of increased daytime sleepiness in children with ADHD against the controls, we did find significant vigilance variability during MSLT in the ADHD group, possibly a sign of dysregulated arousal.     

Sleep in women: Normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension

ObjectivesTo define normal values for total sleep time, sleep latency, sleep efficiency, sleep stages and sleeping positions in women and to investigate how sleep is affected by age, obesity, sleep apnea, smoking, alcohol dependency and hypertension.MethodsIn a population-based study, 400 Swedish women aged 20–70 years with over-sampling of snorers were investigated using overnight in-home polysomnography. All results are weighted.ResultsThe mean normal total sleep time was 392 min, sleep latency 22 min and sleep efficiency 82%. Women spent 31 min in sleep stage 1, 244 min in stage 2, 41 min in stage 3/4 and 76 min in rapid eye movement (REM) sleep. They spent 41% of their sleep time in the supine position, 50% in the lateral position and 9% in the prone position. Multivariate analyses revealed that sleep efficiency was lower in older women and in women with hypertension. Sleep latency was short in women with severe sleep apnea and long in smokers, alcohol-dependent and hypertensive women. Sleep stage 3/4 was inversely related to age and body mass index. Less REM sleep occurred in alcohol-dependent women. Women younger than 45 years old slept a mean of 42% in the lateral position while women of 45 years and older slept 57% in the lateral position (p < 0.001).ConclusionsIn this population-based study of women, we present normal values for sleep stages and sleeping position. We conclude that age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality. With age, women spend more time sleeping in the lateral position.     

Time course of EEG slow-wave activity in pre-school children with sleep disordered breathing: A possible mechanism for daytime deficits?

BackgroundDaytime deficits in children with sleep disordered breathing (SDB) are theorized to result from hypoxic insult to the developing brain or fragmented sleep. Yet, these do not explain why deficits occur in primary snorers (PS). The time course of slow wave EEG activity (SWA), a proxy of homeostatic regulation and cortical maturation, may provide insight.MethodsClinical and control subjects (N = 175: mean age 4.3 ± 0.9 y: 61% male) participated in overnight polysomnography (PSG). Standard sleep scoring and power spectral analyses were conducted on EEG (C4/A1; 0.5–<3.9 Hz). Univariate ANOVA’s evaluated group differences in sleep stages and respiratory parameters. Repeated-measures ANCOVA evaluated group differences in the time course of SWA.ResultsFour groups were classified: controls (OAHI ? 1 event/h; no clinical history); PS (OAHI ? 1 event/h; clinical history); mild OSA (OAHI=1–5 events/h); and moderate to severe OSA (MS OSA: OAHI > 5 events/h). Group differences were found in the percentage of time spent in NREM Stages 1 and 4 (p < 0.001) and in the time course of SWA. PS and Mild OSA children had higher SWA in the first NREM period than controls (p < 0.05). All SDB groups had higher SWA in the fourth NREM period (p < 0.01).ConclusionsThese results suggest enhanced sleep pressure but impaired restorative sleep function in pre-school children with SDB, providing new insights into the possible mechanism for daytime deficits observed in all severities of SDB.     

The importance of polysomnography in the evaluation of prolonged disorders of consciousness: sleep recordings more adequately correlate than stimulus-related evoked potentials with patients’ clinical status

ObjectivesThe aim of our study was to evaluate the importance of sleep recordings and stimulus-related evoked potentials (EPs) in patients with prolonged disorders of consciousness (DOCs) by correlating neurophysiologic variables with clinical evaluation obtained using specific standardized scales.MethodsThere were 27 vegetative state (VS) and 5 minimally conscious state (MCS) patients who were evaluated from a clinical and neurophysiologic perspective. Clinical evaluation included the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS), and Glasgow Coma Scale (GCS). Neurophysiologic evaluation included 24-h polysomnography (PSG), somatosensory EPs (SEPs), brainstem auditory EPs (BAEPs), and visual EPs (VEPs).ResultsPatients with preservation of each single sleep element (sleep–wake cycle, sleep spindles, K-complexes, and rapid eye movement [REM] sleep) always showed better clinical scores compared to those who did not have preservation. Statistical significance was only achieved for REM sleep. In 7 patients PSG showed the presence of all considered sleep elements, and they had a CRS-R score of 8.29 ± 1.38. In contrast, 25 patients who lacked one or more of the sleep elements had a CRS-R score of 4.84 ± 1.46 (P < .05). Our multivariate analysis clarified that concurrent presence of sleep spindles and REM sleep were associated with a much higher CRS-R score (positive interaction, P < .0001). On the other hand, no significant associations were found between EPs and CRS-R scores.ConclusionsPSG recordings have proved to be a reliable tool in the neurophysiologic assessment of patients with prolonged DOCs, correlating more adequately than EPs with the clinical evaluation and the level of consciousness. The main contribution to higher clinical scores was determined by the concomitant presence of REM sleep and sleep spindles. PSG recordings may be considered inexpensive, noninvasive, and easy-to-perform examinations to provide supplementary information in patients with prolonged DOCs.     

Exhaled breath condensate cytokine level as a diagnostic tool for obstructive sleep apnea syndrome

BackgroundRelationships between exhaled breath condensate (EBC) and serum cytokines and apnea–hypopnea index (AHI) in patients with excessive daytime sleepiness and loud snoring were evaluated for their potential to predict the severity of obstructive sleep apnea syndrome (OSAS).MethodsNon-smoking patients with suspected OSAS who had undergone polysomnography (PSG) were selected until 22 non-OSAS, and 22 mild, 22 moderate and 24 severe OSAS cases based on AHI were achieved. Ten healthy smokers served as a smoker control group. Interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and 8-isoprostane were measured in EBC and serum on the morning after PSG and related to OSAS severity using linear discriminant analysis (LDA) and logistic regression (LR).ResultsBiomarker levels, in both EBC and serum, differed significantly across the four groups. Classification by LDA using IL-10 in EBC showed the highest agreement with AHI classification (kappa = 0.88). LR distinguished moderate and severe OSAS from mild OSAS and non-OSAS perfectly using IL-6 in EBC and almost perfectly using IL-10 in EBC (area under the ROC curve = 0.997). The levels of biomarkers among smokers overlapped with mild to severe OSAS patients.ConclusionsAmong non-smoker OSAS suspects, EBC IL-6 and IL-10 have potential to predict severity of OSAS.     

Effect of successful epilepsy surgery on subjective and objective sleep parameters – a prospective study

ObjectiveTo evaluate the effect of surgery on subjective and objective measures of sleep quality among patients with medically refractory focal epilepsy.MethodsIn a prospective cohort study, patients with medically refractory epilepsy undergoing epilepsy surgery were recruited. All patients were assessed seven days pre- and three months post-surgery in terms of history pertaining to epilepsy and sleep, Epworth sleepiness score (ESS), one week sleep log and over night polysomnography (PSG).ResultsAmong 17 patients (mean age 18, 11 males), seizure frequency had reduced (p = 0.04) and self reported sleep parameters had significantly improved (reduced total duration of night time sleep, regularity on one week sleep log and ESS (p < 0.05)) three months following epilepsy surgery. Patients with good surgical outcome (n = 12) showed reduced seizure frequency (p = 0.01) and reduced ESS with corresponding reduction in arousal index (AI) (p = 0.02) and increase in total sleep time (p = 0.03), postoperatively. Three patients in the good surgical outcome group showed reduction in apnea–hypopnea index (AHI) from more than five to less than five. There was no significant change either in seizure frequency, self reported clinical parameters or PSG parameters among patients with poor surgical outcome.ConclusionEpilepsy surgery improves subjective sleep parameters in patients with medically refractory epilepsy during the early post operative period. Successful epilepsy surgery may improve objective (PSG documented) sleep quality, sleep architecture and obstructive sleep apnea with resultant reduction in excessive daytime sleepiness.     

Trajectories of cigarette smoking in adulthood predict insomnia among women in late mid-life

Objective: To examine the relationship between trajectories of cigarette smoking among a community sample of women (N = 498) with insomnia in late mid-life.Methods: Participants were administered structured interviews at four time waves in adulthood, spanning approximately 25 years (mean ages = 40, 43, 48, and 65 years). At each wave, data were collected on participants’ cigarette smoking. At the most recent time wave, in late mid-life, participants reported on their insomnia (difficulty falling asleep, staying asleep, early morning wakening, and daytime consequences of these sleep problems).Results: Growth mixture modeling extracted four trajectory groups of cigarette smoking (from mean ages 40–65 years): chronic heavy smokers, moderate smokers, late quitters, and non-smokers. Multivariate logistic regression analysis then examined the relationship between participants’ probabilities of trajectory group membership and insomnia in late mid-life, with controls for age, educational level, marital status, depressive symptoms, body mass index, and the number of health conditions. Compared with the non-smokers group, members of the chronic heavy smoking trajectory group were more likely to report insomnia at mean age 65 (Adjusted Odds Ratio = 2.76; 95% confidence interval = 1.10–6.92; p < 0.05).Conclusions: Smoking cessation programs and clinicians treating female patients in mid-life should be aware that chronic heavy smoking in adulthood is a significant risk factor for insomnia.     

Moderating effect of schizotypy on the relationship between smoking and neurocognition

PurposeSmoking rates in schizotypic individuals are shown to be elevated, as in patients with schizophrenia, although findings on the association of smoking with different symptomatology of schizotypy have been mixed. Moreover, possible moderating effects of schizotypy on the relationship between smoking and cognition have not been well documented.Subjects and methodsThe Schizotypal Personality Questionnaire (SPQ) and the full version of the Wechsler Memory Scale-Revised (WMS-R) were administered to 501 healthy adults. Subjects were divided into smokers (n = 85) and non-smokers (n = 416) based on the presence/absence of current smoking.ResultsThe analysis of covariance (ANCOVA) on the three factor scores as well as the total score of the SPQ, controlling for age and gender, revealed that cognitive-perceptual factor was significantly associated with an increased rate of smoking (P = 0.048). The ANCOVA on the WMS-R indices, with smoking group as a fixed factor and age, gender and total SPQ score as covariates, revealed that the schizotypy-by-smoking interaction was significant for attention/working memory (P = 0.029).Discussion and conclusionPositive schizotypy may be associated with more smoking. Schizotypy and smoking could interact with each other to negatively affect attention/working memory.     

Sleep and risk for high blood pressure and hypertension in midlife women: the SWAN (Study of Women’s Health Across the Nation) Sleep Study

ObjectiveInadequate self-reported sleep is related to high blood pressure (BP). Our study investigated cross-sectional and longitudinal relationships between poor sleep measured by in-home polysomnography (PSG) and BP.MethodsMidlife participants (132 black, 164 white, and 59 Chinese) were from the SWAN (Study of Women’s Health Across the Nation) ancillary sleep study. In-home PSG measured sleep apnea, duration, efficiency, and electroencephalogram (EEG) total delta and beta power during nonrapid eye movement (NREM) sleep. Women subsequently were followed annually for 4.5 (1–7) years for BP and hypertensive status (>140/90 mmHg or use of antihypertensive medication). Covariates were age, race, site, and educational attainment, with time-covariates of BP medications, body mass index, diabetes mellitus (DM), cigarette smoking, and menopausal status.ResultsSleep duration and efficiency were unrelated to BP cross-sectionally or longitudinally in multivariate models. Women with higher total beta power were more likely to be hypertensive at the time of the sleep study; women with lower total delta power were more likely to show increases in diastolic BP (DBP) and to be at risk for incident hypertension across follow-up.ConclusionsLow NREM delta power may be a risk factor for future hypertension. Quantitative EEG measures are worthy of future investigations of hypertension risk.     

Sleep disturbances in Malaysian patients with Parkinson's disease using polysomnography and PDSS

BackgroundSleep disturbances such as sleep fragmentation, sleep disordered breathing (SDB), periodic limb movements (PLM), excessive daytime somnolence (EDS) and insomnia are prevalent in Parkinson's disease (PD). However, studies in the Asian population are limited.MethodsThis was a cross-sectional study involving 46 Malaysians with PD using polysomnography (PSG) and standardized translated Parkinson's disease sleep scale (PDSS). Overnight PSG recordings, UPDRS and PDSS scores, and baseline demographic data were obtained.ResultsData from 44 patients were analysed. Thirty-six patients (81.8%) had PSG-quantified sleep disorders. Twenty-three (52.3%) had sleep fragmentation, 24 (54.6%) had SDB and 14 (32%) had PLM. EDS was present in 9.1%. Insomnia was reported by 31.8%. Patients with sleep fragmentation had significantly higher UPDRS scores and lower PDSS insomnia sub-scores. The UPDRS scores correlated negatively with the TST and sleep efficiency. All patients with EDS had SDB (p = 0.056). The PDSS insomnia sub-items correlated with sleep fragmentation on PSG.Conclusion: The prevalence of sleep disorders based on PSG and PDSS in our PD patients was high, the commonest being sleep fragmentation and SDB, while EDS was the least prevalent. Problem specific sub-items of the PDSS were more accurate in predicting the relevant PSG-related changes compared to the PDSS as a whole.