农村中老年人群睡眠特征与高血压关联的横断面研究

目的 通过横断面研究,探讨农村中老年人群睡眠特征与高血压的关联.方法 招募丰县12个村资料完整的429例居民进行人口学特征、疾病史和生活行为习惯、睡眠特征等调查,并进行身高、体质量、血压等体格检查.结果 总人群高血压患病率为47.6％(204/429),其中43.8％(149/340)睡眠质量较差,18.1％(76/4...     

Optogenetically induced sleep spindle rhythms alter sleep architectures in mice

Sleep spindles are rhythmic patterns of neuronal activity generated within the thalamocortical circuit. Although spindles have been hypothesized to protect sleep by reducing the influence of external stimuli, it remains to be confirmed experimentally whether there is a direct relationship between sleep spindles and the stability of sleep. We have addressed this issue by using in vivo photostimulation of the thalamic reticular nucleus of mice to generate spindle oscillations that are structurally and functionally similar to spontaneous sleep spindles. Such optogenetic generation of sleep spindles increased the duration of non-rapid eye movement (NREM) sleep. Furthermore, the density of sleep spindles was correlated with the amount of NREM sleep. These findings establish a causal relationship between sleep spindles and the stability of NREM sleep, strongly supporting a role for the thalamocortical circuit in sleep regulation.     

Association of sleep habits with blood pressure in elderly people

We investigated the impact of sleep habits on blood pressure (BP) in cross-sectional analyses of 1533 participants aged ≥ 70 without cardiovascular disease or treatment for hypertension, diabetes mellitus, and dyslipidemia. We assessed sleep habits [time in bed (TIB), bed time, and taking sleeping pills], using the Pittsburgh Sleep Quality Index. For groups where TIB was >8 h and <6 h, systolic BP was significantly higher than the group where TIB ranged 6–8 h (134.2 ± 17.5, 134.8 ± 19.6 vs. 130.1 ± 17.7, p < 0.05, p < 0.001, respectively). Systolic BP was significantly higher in the group whose bed time was before 21:00 than that whose bed time was 21:00 or later (136.6 ± 18.6 vs. 132.0 ± 18.4, p < 0.01). Both systolic and diastolic BPs were lower in the group taking sleeping pills (133.2 ± 18.6 vs. 128.1 ± 17.3, p < 0.0001; 75.3 ± 11.5 vs. 73.3 ± 10.7, p < 0.05). Multiple regression analyses revealed that after adjusting for age, gender, body mass index, smoking, and alcohol intake, taking sleeping pills and short or long TIB were significantly associated with systolic BP, whereas bed time was not. These results suggested that inappropriate TIB and sleeping pills were associated with BP in elderly people.     

复杂性睡眠呼吸紊乱

引起睡眠呼吸紊乱有两个主要因素:一是解剖因素,导致阻塞睡眠呼吸暂停;二是呼吸中枢控制因素,导致中枢睡眠呼吸暂停.当呼吸中枢控制不稳定时就可能发生复杂性睡眠呼吸紊乱.本文重点阐述复杂性睡眠呼吸紊乱的定义、病理生理、分类及治疗.     

复杂性睡眠呼吸暂停综合征诊断与治疗进展

目前持续气道正压通气(continuous positive airway pressure,CPAP)已被广泛用来治疗阻塞性睡眠呼吸暂停综合征(obstuctive sleep apnea syndrome,OSAS),然而部分OSAS患者经CPAP治疗后,当阻塞性呼吸暂停事件消除后中枢性睡眠呼吸暂停综合征和陈-施呼吸却增加,我们称这种睡眠呼吸紊乱为复杂性睡眠呼吸暂停综合征(complex sleep apnea syndrome,CompSAS).然而,它的概念、机制、治疗尚未完全明确,本文综述了近年来国内外学者对CompSAS的研究进展.     

Sleep deprivation and false confessions

False confession is a major contributor to the problem of wrongful convictions in the United States. Here, we provide direct evidence linking sleep deprivation and false confessions. In a procedure adapted from Kassin and Kiechel [(1996) Psychol Sci 7(3):125–128], participants completed computer tasks across multiple sessions and repeatedly received warnings that pressing the “Escape” key on their keyboard would cause the loss of study data. In their final session, participants either slept all night in laboratory bedrooms or remained awake all night. In the morning, all participants were asked to sign a statement, which summarized their activities in the laboratory and falsely alleged that they pressed the Escape key during an earlier session. After a single request, the odds of signing were 4.5 times higher for the sleep-deprived participants than for the rested participants. These findings have important implications and highlight the need for further research on factors affecting true and false confessions.In the United States, an alarming number of people are convicted of crimes they did not commit (1). Although it has proven exceedingly difficult to measure the scope of this problem, a recent investigation suggested that at least 4% of people who have been sentenced to death in the United States were actually innocent (2). Studies of known wrongful convictions reveal that false confessions are a substantial contributor to this problem, implicated in 15–25% of cases (1, 3). A false confession occurs when an innocent person makes a false admission of guilt and subsequently produces a postadmission narrative, which includes details about how or why the crime was committed (4). Confessions are extremely powerful forms of evidence. An admission of guilt alone, even without a postadmission narrative, will have serious consequences for an innocent suspect who is the target of a criminal investigation, as will confessions that are later recanted (5). Surprisingly, even when jurors understand that a confession has been coerced, it nonetheless inflates their perception of the defendant’s guilt and influences their construal of other, unrelated evidence (5, 6).False confessions can clearly have dire consequences and it might seem that they would only arise after some form of physical coercion. However, interrogators more often capitalize on psychologically coercive interrogation strategies, which are known to increase the risk of false confession in innocent suspects (3, 4, 7–10). As such, the use of these strategies contribute to an inordinately stressful and mentally taxing experience for an innocent suspect (11), who must rely on a number of complex cognitions and decision making skills to protect their interests and avoid self-incrimination during a potentially lengthy interrogation.A robust literature reveals that sleep deprivation impairs many of the cognitive skills that may be crucial in resisting this type of coercive environment. In addition to disrupting mood and impairing a whole host of cognitive operations (12, 13), there is evidence suggesting that sleep deprivation reduces inhibitory control, leading people to make riskier decisions (14–16), and interferes with their ability to anticipate and measure the consequences of their actions (17). Finally, recent research has linked sleep deprivation with false and distorted memories of past events (18), suggesting that sleep-deprived people may be especially vulnerable to suggestive influences.These findings are cause for serious concern; studies have shown that as many as 17% of interrogations occur during typical sleep hours (between midnight and 8:00 AM) (19). Studies of known false confessions have found that a majority occurred following interrogations that lasted more than 12 h, with many lasting for longer than 24 consecutive hours (20). Moreover, as the Senate Select Committee on Intelligence recently revealed, the Central Intelligence Agency routinely used sleep deprivation for up to 1 wk to assist in their hardline interrogations of detainees, some of whom were later revealed to be wrongfully held (21). It is increasingly evident that the interrogation of unrested, possibly sleep-deprived, suspects is not out of the ordinary and may even be commonplace.In the present research, we capitalized on available laboratory techniques for examining false confession processes (22) and compared the tendency of rested and sleep-deprived participants to falsely admit to wrongdoing that never occurred. Specifically, participants completed computer-based tasks, writing exercises, and questionnaires during three separate laboratory sessions (see Figs. S1–S3). Throughout their time in the laboratory, participants were repeatedly warned to never press the Escape key on their computer keyboards because doing so, they were told, would result in the loss of important study data. Importantly, the location of the Escape key on a standard PC keyboard made it highly unlikely that participants would have pressed this key accidentally during the course of the experiment.Open in a separate windowFig. S1.Outline of study procedure across three laboratory sessions.Open in a separate windowFig. S3.Example of participant signing her name to the statement containing a false allegation.Following session 2, participants either slept for 8 h in laboratory bedrooms or remained awake throughout the night, carefully monitored by research staff (see Fig. S3).

Table S1.

Mean (SD) amount of time spent in each sleep stage and total sleep time for the participants who slept in the laboratory

Clinical characteristics of obstructive sleep apnea in community-dwelling older adults

OBJECTIVES: To examine whether traditional risk factors are common in older adults with obstructive sleep apnea (OSA). DESIGN: Cross-sectional study. SETTING: Atlanta, Georgia. PARTICIPANTS: A convenience sample of 94 community-dwelling adults aged 62 to 91. MEASUREMENTS: Demographic, medical, and sleep-related information obtained using questionnaires. Epworth Sleepiness Scale (ESS) and 72-hour voiding diary were used to determine daytime sleepiness and nocturia frequency, respectively. Overnight ambulatory sleep recording device was used to screen for OSA. RESULTS: Fifteen female and 15 male subjects had an apnea-hypopnea index (AHI) of 15 or more per hour of sleep (moderate to severe OSA). Traditional risk factors such as snoring, body mass index, and neck circumference were not significantly associated with OSA. An AHI of 15 or more per hour was independently associated with not feeling well rested in the morning, higher ESS score, and greater frequency of nocturia. CONCLUSION: Traditional risk factors for OSA were not common presenting symptoms and signs in study subjects with an AHI of 15 or more per hour of sleep; this may contribute to underdiagnosis of OSA in this population. Subjects with an AHI of 15 or more per hour had more sleep-related complaints and excessive daytime sleepiness. Although occult, this suggests that OSA may contribute to disease burden in this group of people.     

Phenotypes of patients with mild to moderate obstructive sleep apnoea as confirmed by cluster analysis

Background and objective: Patients with OSA manifest different patterns of disease. However, this heterogeneity is more evident in patients with mild‐moderate OSA than in those with severe disease and a high total AHI. We hypothesized that mild‐moderate OSA can be categorized into discreet disease phenotypes, and the aim of this study was to comprehensively describe the pattern of OSA phenotypes through the use of cluster analysis techniques. Methods: The data for 1184 consecutive patients, collected over 24 months, was analysed. Patients with a total AHI of 5–30/h were categorized according to the sleep stage and position in which they were predominantly affected. This categorization was compared with one in which patients were grouped using a K‐means clustering technique with log linear modelling and cross‐tabulation. Results: Patients with mild‐moderate OSA can be categorized according to polysomnographic parameters. This clinical categorization was validated by comparison with a categorization in which patients were grouped by unsupervised K‐means cluster analysis. The clinical groups identified were: (i) rapid eye movement (REM) predominant OSA, 44.6%; (ii) non‐REM predominant OSA, 18.9%; (iii) supine predominant OSA, 61.9%; and (iv) intermittent OSA, 12.4%. Patients categorized as having both REM and supine predominant OSA showed characteristics of both the REM predominant and supine predominant OSA groups. Conclusions: Patients with mild‐moderate OSA show different polysomnographic phenotypes. This approach to categorization more appropriately reflects disease heterogeneity and the likely multiple pathophysiological processes involved in OSA.     

Tick–tock–tick–tock: the impact of circadian rhythm disorders on cardiovascular health and wellness

Humans spend a third of their lives asleep. A well–balanced synchrony between sleep and wakefulness is needed to maintain a healthy lifestyle. Optimal sleep is based on an individual's inherent sleep requirement and circadian rhythm. If either one or both of these critical elements are disrupted, daytime dysfunction, non–restorative sleep, and/or reduced sense of well-being may result. While the medical community is more familiar with sleep disorders such as sleep apnea, insomnia, and narcolepsy, circadian rhythm sleep wake disorders (CRSWDs) are less known, despite these being common within the general population. CRSWDs are comprised of the following: shiftwork disorder, delayed sleep phase disorder, advanced sleep phase disorder, jet lag disorder, non–24–hour sleep–wake disorder, and irregular sleep–wake rhythm disorder. In general, a CRSWD results when there is misalignment between the sleep pattern and the desired sleep schedule, dictated by work, family, and social schedules. Subsequently, patients have difficulty falling asleep, maintaining sleep, and/or experience poor quality sleep predisposing them to insomnia or excessive sleepiness. In this article, we review the core concepts related to sleep, and sleep deprivation in the context of CRSWDs.     

Sleep history is neglected diagnostic information

Sleep problems are treatable causes of morbidity and mortality, but little is known about how often the history fundamental to diagnosis is obtained. We recorded the frequency of sleep histories during encounters with simulated patients by 20 experienced primary care practitioners, 23 uninstructed medical interns, and 22 interns who had previous instruction about sleep disorders. Sleep histories were uncommonly obtained by uninstructed physicians (0% of practitioners, 13% of interns), but trained interns more often (81.8%) asked about sleep. If sleep problems are to be prioritized, major changes in physician education and behaviors are essential. Focused instruction about sleep influences physician behavior. Supported by National Heart, Lung, and Blood Institute Sleep Academic Award 1K07HLO 3647-012HL1CCP-1 (SI) and by Grant 1K07HL0 2479-01A1.