A comparison of idiopathic hypersomnia and narcolepsy-cataplexy using self report measures and sleep diary data.

Eighteen patients with idiopathic hypersomnia (IH) were compared with 50 patients with the narcoleptic syndrome of cataplexy and daytime sleepiness (NLS) using self report questionnaires and a diary of sleep/wake patterns. The IH group reported more consolidated nocturnal sleep, a lower propensity to nap, greater refreshment after naps, and a greater improvement in excessive daytime sleepiness since onset than the NLS group. In IH, the onset of excessive daytime sleepiness was predominantly associated with familial inheritance or a viral illness. Two variable--number of reported awakenings during nocturnal sleep and the reported change in sleepiness since onset--provided maximum discrimination between the IH and NLS groups. Confusional arousals, extended naps or nocturnal sleep, autonomic nervous system dysfunction, low ratings of medication effectiveness, or side effects of medication were not associated differentially with either IH or NLS.     

Vagus nerve stimulation reduces daytime sleepiness in epilepsy patients

BACKGROUND: Given that vagal afferents project to brainstem regions that promote alertness, the authors tested the hypothesis that vagus nerve stimulation (VNS) would improve daytime sleepiness in patients with epilepsy. METHODS: Sixteen subjects with medically refractory seizures underwent polysomnography and multiple sleep latency tests (MSLT) and completed the Epworth Sleepiness Scale (ESS), a measure of subjective daytime sleepiness, before and after 3 months of VNS. Most subjects (>80%) were maintained on constant doses of antiepileptic medications. RESULTS: In the 15 subjects who completed baseline and treatment MSLT, the mean sleep latency (MSL) improved from 6.4 +/- 4.1 minutes to 9.8 +/- 5.8 minutes (+/- SD; p = 0.033), indicating reduced daytime sleepiness. All subjects with stimulus intensities of < or =1.5 mA showed improved MSL. In the 16 subjects who completed baseline and treatment ESS, the mean ESS score decreased from 7.2 +/- 4.4 to 5.6 +/- 4.5 points (p = 0.049). Improvements in MSLT and ESS were not correlated with reduction in seizure frequency. Sleep-onset REM periods occurred more frequently in treatment naps as compared to baseline naps (p < 0.008; Cochran-Mantel-Haenszel test). The amount of REM sleep or other sleep stages recorded on overnight polysomnography did not change with VNS treatment. CONCLUSIONS: Treatment with VNS at low stimulus intensities improves daytime sleepiness, even in subjects without reductions in seizure frequency. Daytime REM sleep is enhanced with VNS. These findings support the role of VNS in activating cholinergic and other brain regions that promote alertness.     

Sleep and wakefulness disturbances in Parkinson's disease

Patients with Parkinson's disease experience prominent difficulties in maintaining sleep, painful night-time abnormal movements, and daytime sleepiness, sometimes culminating in sleep attacks. Recent insights into the pathophysiology of sleep disorders in PD points to a complex interaction between movement disorders, side-effects of dopamine agents and lesions in sleep-wake regulating systems. Treatment with dopamine agonists provides a twice higher risk of daytime sudden sleep episodes than levodopa, with no difference between ergotic and non ergotic compounds. Insomnia can be improved by a better control of night-time disability, restless legs syndrome and dystonia using subthalamic nucleus stimulation or night-time levodopa. A specific REM sleep disorder contributes to REM sleep behavior disorder and also to hallucinations (suggesting they could be awake dreams) and excessive daytime sleepiness. The management of sleep and alertness problems requires to analyze their potential causes, to monitor night-time and daytime sleep, and to subtly adjust psychotropic and dopaminergic treatment.     

A longitudinal study of the development of daytime sleepiness in children

Abstract This study aims to (i) investigate longitudinally developmental changes of diurnal variations of body temperature and sleepiness in preschool and school-age children and (ii) investigate the effect of acute 2 h sleep reduction on daytime sleepiness over a 3 year period. Three subjects were evaluated over three consecutive days:two control days and one 2 h sleep reduction day. A sleep latency test was conducted five times each day at 2 h intervals from 10.00 h, and oral temperature measured every hour. The results showed that (i) daytime sleepiness was high and decreased with increasing age, (ii) an afternoon dip occurred with pubertal development, (iii) effects of sleep loss generally increased daytime sleepiness, in particular at 10.00 h, and (iv) temperature acrophase was delayed with age.     

Chronic sleep restriction triggers inadequate napping habits in adolescents: a population-based study

BackgroundThe prevalence of chronic sleep restriction during adolescence is a major public health issue. Napping has been adopted to alleviate sleep pressure complaints. However, it also has the potential to amplify sleep restriction due to a vicious cycle triggered by delayed sleep times. The aim of this study was to investigate sleep and napping habits in a sample of Brazilian adolescents.MethodsThis study enrolled 1554 high school students and included the evaluation of sleep times, daytime sleepiness, sleep quality, and circadian preference. The students were asked about their napping routine, ie its frequency and duration per week.ResultsThe adolescent sleep recommendation was achieved by only 27.6% of the sample. Napping habit was reported by 58.1%, with 36.2% of nappers informing naps in 1–2 times per week. Prolonged naps were reported by 44.9% of nappers. Nappers had later median bedtime (23:30) and reduced time in bed (TIB) (median = 07:00 h) compared to non-nappers. The frequency of nappers who did not achieve satisfactory TIB was higher than non-nappers. In addition, nappers reported increased daytime sleepiness and poor sleep quality. Later bedtimes and reduced TIB were associated with longer nap duration. Increased sleepiness and poor sleep quality were linked to a higher nap frequency.ConclusionsThis exploratory survey demonstrated a severe sleep restriction faced by Brazilian adolescents. Napping can be an efficient strategy to counteract sleep restriction, but it needs to be adopted with caution due to the detrimental effects of frequent and prolonged naps on nocturnal sleep.     

Sleep disturbances in Parkinson’s disease

Disorders of sleep and daytime alertness are frequent in Parkinson’s disease patients and arise from a number of diverse factors. The most common complaint of night-time sleep disturbance in Parkinson’s disease is sleep fragmentation. Sleep fragmentation can be associated with recurrent parkinsonian symptoms, the effect of medications, concomitant medical disorders such as nocturia, or psychiatric disorders such as depression or anxiety. Likewise, nocturnal sleep disturbance may arise from sleep apnea, periodic limb movements of sleep, or rapid eye movement (REM) sleep behavior disorder. Nocturnal sleep deprivation may lead to excessive daytime sleepiness. Other potential sources of daytime sleepiness include the effects of medications or disruption of central sleep mechanisms due to the pathologic processes of Parkinson’s disease itself. Diagnosis of sleep disturbances and daytime sleepiness requires a direct interview of the patient and the caregiver, and may involve consultation with the sleep specialist or medical physician. Treatment is aimed toward improving night-time sleep and daytime drowsiness by addressing the causative factors.     

The acute effects of levetiracetam on nocturnal sleep and daytime sleepiness in patients with partial epilepsy

This study investigated the effect of the novel antiepileptic drug levetiracetam (LEV) on sleep in eleven patients with partial epilepsy. At baseline and one week after therapy with LEV (1000 mg/day), patients underwent polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). Patients also rated their own degree of sleep disturbance and daytime sleepiness with the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS). A group of 10 age- and gender-matched control participants were also included in the study. Patients had decreased total sleep time and increased daytime sleepiness compared to baseline, as evaluated by AIS subscales. Furthermore, LEV therapy significantly decreased the rapid eye movement sleep time and percentage as measured by PSG. Patients reported a significant increase in ESS score but did not exhibit changes in MSLT performance after LEV treatment. The study demonstrated that short-course LEV treatment can affect subjective sleep time and objective sleep architecture. Furthermore, LEV treatment affected subjective daytime sleepiness but did not influence objective mean daytime sleep latencies in patients with partial epilepsy.     

Actigraphic evidence for night-time hyperkinesia in Parkinson's disease

Parkinson's disease is a common motor disorder that not only leads to motor symptoms but also autonomic dysregulation, mental changes, sensory disturbances, and sleep disorders such as increased daytime sleepiness and sleep fragmentation. The aim of this study was to find out how the daytime and night-time motor activity levels in individuals without motor disorders differ from patients with Parkinson's disease. Daytime and night-time motor activity levels in 17 PD patients and 69 controls were measured for three consecutive days and nights via actigraphy, a method of continuous long-term assessment of activity levels. A ratio between night-time and daytime motor activity was calculated. PD patients had a 1.5-2-fold lower daytime motor activity but also showed 1.5-2-fold higher motor activity at night time. Older controls showed a lower daytime but similar night-time motor activity when compared to younger controls. A ratio of night-time to daytime motor activity could clearly distinguish controls and patients. The possibility to distinguish patients and controls by the ratio of night-time to daytime motor activity is worth further investigation.     

ACTIGRAPHIC EVIDENCE FOR NIGHT-TIME HYPERKINESIA IN PARKINSON’S DISEASE

Parkinson's disease is a common motor disorder that not only leads to motor symptoms but also autonomic dysregulation, mental changes, sensory disturbances, and sleep disorders such as increased daytime sleepiness and sleep fragmentation. The aim of this study was to find out how the daytime and night-time motor activity levels in individuals without motor disorders differ from patients with Parkinson's disease. Daytime and night-time motor activity levels in 17 PD patients and 69 controls were measured for three consecutive days and nights via actigraphy, a method of continuous long-term assessment of activity levels. A ratio between night-time and daytime motor activity was calculated. PD patients had a 1.5–2-fold lower daytime motor activity but also showed 1.5–2-fold higher motor activity at night time. Older controls showed a lower daytime but similar night-time motor activity when compared to younger controls. A ratio of night-time to daytime motor activity could clearly distinguish controls and patients. The possibility to distinguish patients and controls by the ratio of night-time to daytime motor activity is worth further investigation.     

The clinical and laboratory assessment of the sleepy child

Excessive sleepiness is defined as sleepiness that occurs in a situation when an individual would usually be expected to be awake and alert. Hypersomnia is characterized by recurrent episodes of excessive daytime sleepiness (EDS) or prolonged nighttime sleep, which affects the everyday life of the patient. Clinical surveys have reported that EDS is a complaint observed in up to 68% of normal high school children, with a negative impact in academic achievement and extracurricular activity. Clues toward recognizing childhood daytime sleepiness may be sleeping longer hours than expected for age, daytime naps beyond normal for age, being sleepy when other children of the same age are active and alert, and sleeping more than previously. Causes of EDS are arbitrarily divided into 3 categories: insufficient nighttime sleep, fragmented nighttime sleep, and increased drive of sleep. A list of various causes of EDS in children has been discussed. A detailed history along with examination of the upper airway is crucial in evaluating patients with EDS. Appropriate screening tools such as sleep logs, sleepiness scales, and sleep questionnaires further help in identifying and quantifying the degree of sleepiness. Confirmatory tests such as polysomnography, multiple sleep latency test, and actigraphy along with referral to a sleep physician may be necessary in appropriate cases. Details of other ancillary testing such use of cerebrospinal fluid orexin levels, HLA subtyping, and so on have also been provided.     

What sleep characteristics predict cognitive decline in the elderly?

BackgroundSleep is critical for optimal cognitive function, but as we age both cognitive impairment and sleep problems increase. Longitudinal, population-based studies can be used to investigate temporal relationships between sleep and cognition.MethodsA total of 2012 cognitively unimpaired individuals 65 years and over were drawn from the MRC Cognitive Function and Ageing Study (CFAS). They answered self-reported measures including: insomnia symptoms and age of onset, night time wakings, snoring, sleep onset latency, napping, daytime sleepiness and duration of night time sleep. Cognition was measured via the Mini-Mental State Examination.ResultsIt was found that daytime napping at baseline was associated with a lower risk of cognitive decline at two and 10 years, and that obtaining ?6.5 h of night-time sleep and excessive daytime sleepiness at baseline were associated with an increased risk at 10 years.ConclusionsDaytime napping, night-time sleep duration, and excessive daytime sleepiness may be modifiable behaviours open to intervention strategies, or, clinical indicators of future decline in older individuals.     

Assessment of the effects of antihistamine drugs on mood,sleep quality,sleepiness, and dream anxiety

Objective. There are limited comparative studies on classic and new-generation antihistamines that affect sleep quality and mood. The purpose of this study was to determine and compare the effects of classic and new-generation antihistamines on sleep quality, daytime sleepiness, dream anxiety, and mood. Methods. Ninety-two patients with chronic pruritus completed study in the dermatology outpatient clinic. Treatments with regular recommended therapeutic doses were administered. The effects of antihistaminic drugs on mood, daytime sleepiness, dream anxiety, and sleep quality were assessed on the first day and 1 month after. Results. Outpatients who received cetirizine and hydroxyzine treatments reported higher scores on the depression, anxiety, and fatigue sub-scales than those who received desloratadine, levocetirizine, and rupatadine. Pheniramine and rupatadine were found to be associated with daytime sleepiness and better sleep quality. UKU side effects scale scores were significantly elevated among outpatients receiving pheniramine. Classic antihistamines increased daytime sleepiness and decreased the sleep quality scores. New-generation antihistamines reduced sleep latency and dream anxiety, and increased daytime sleepiness and sleep quality. Conclusion. Both antihistamines, significantly increased daytime sleepiness and nocturnal sleep quality. Daytime sleepiness was significantly predicted by rupadatine and pheniramine treatment. Cetirizine and hydroxyzine, seem to have negative influences on mood states. Given the extensive use of antihistamines in clinical settings, these results should be more elaborately examined in further studies.     

Spectral composition of NREM sleep in healthy subjects with moderately increased daytime sleepiness.

OBJECTIVE: This study addressed the relationship between daytime sleepiness and spectral composition of the preceding NREM sleep.METHODS: Nineteen healthy volunteers (mean age: 36.5 years; SD: 10.1) underwent polysomnography during two consecutive nights and the multiple sleep latency test (MSLT) on the following day. Daytime sleepiness was also assessed by the Epworth sleepiness scale (ESS). The sleep recordings were visually scored according to standard criteria. The quantitative sleep EEG analysis was performed using a fast Fourier transform routine. The sleep parameters were compared between subjects with short and long MSLT sleep latencies (cut-off=10 min) and between subjects with low and high ESS scores (cut-off=6 points).RESULTS: Subjects with short MSLT sleep latencies showed a reduced theta EEG activity. There was no evidence of reduced synchronization of sleep EEG in subjects with high ESS scores.CONCLUSIONS: Moderately increased daytime sleepiness as indicated by MSLT sleep latency less than 10 min is accompanied by decreased power of theta activity during NREM sleep indicating a deficit of sleep EEG synchronization.     

Assessment of sleepiness and unintended sleep in Parkinson's disease patients taking dopamine agonists

OBJECTIVE: We sought to determine if patients with Parkinson's disease (PD), taking dopamine agonists (DAs) and reporting unintended sleep episodes (SEs), exhibit physiologically defined daytime sleepiness and can thus be differentiated from those taking DAs but not reporting SEs. METHODS: Twenty-four patients with abnormal Epworth Sleepiness Scale scores of >10 who were taking DAs were enrolled into one of two groups: those with SEs (SE+, n=16) and those without (SE-, n=8). Three consecutive days of testing included two nights of polysomnography followed by the Multiple Sleep Latency Test (MSLT). RESULTS: Overall frequency of pathological sleepiness (MSLT <5 min) was 42% (10/24). Mean levels of sleepiness, frequencies of pathological sleepiness, and naps with stage 2 or REM-sleep were similar between SE+ and SE- groups. Sleep tendency was similar in patients prescribed pergolide, ropinirole, and pramipexole combined with levodopa. Polysomnography testing revealed no significant differences between the groups in total sleep time, sleep efficiency, sleep architecture, or presence of restless legs syndrome or periodic leg movements. There was no relation between degree of nocturnal sleep disturbance and level of daytime sleepiness. CONCLUSIONS: The results of this study suggest SEs in PD patients occur upon a background of excessive daytime sleepiness and are unrelated to nocturnal sleep or use of a specific DA.     

The relationship between sleep disturbance,symptoms and daytime functioning in psoriasis: a prospective study integrating actigraphy and experience sampling methodology

Objective/backgroundSleep disturbance is common in individuals with psoriasis and appears to be related to both physical and psychological factors. We sought to examine whether psoriasis symptoms, night-time arousal and low mood predicted subsequent objective and self-reported sleep; and whether objective and self-reported sleep predicted next-day psoriasis symptoms and day-time functioning.Participants/MethodsA total of 19 individuals (Female: 11 [57.9%], median age: 39 years) with chronic plaque psoriasis and poor sleep quality (mean Pittsburgh Sleep Quality Index, PSQI = 9.11) participated. Momentary assessments of psoriasis symptoms, mood and daytime functioning were completed at five pseudo-random intervals each day for 15 days using time-stamped digital diary entry. Objective sleep was estimated using wrist-worn actigraphy. Self-reported sleep and night-time arousal were assessed each morning using validated measures.Results and conclusionsTwo-level random intercept models showed that increased night-time arousal was associated with poorer diary-reported sleep. Neither self-reported nor objective sleep parameters were associated with daytime psoriasis symptoms in bi-directional analyses. Diary-reported sleep predicted next-day functioning, specifically sleepiness, concentration, and fatigue. Actigraphy-defined total sleep time predicted next-day fatigue. Night-time arousal is associated with poorer self-reported sleep in people with psoriasis, and sleep predicts next-day functioning. Contrary to our hypothesis, sleep disturbance does not appear to be associated with momentary assessments of psoriasis symptoms.     

Residual effects of daytime administration of melatonin on performance relevant to flight

There is a general consensus that melatonin possesses time-dependent hypnotic effects, but there is no information yet whether it has residual effects on neurobehavioral performance, especially after daytime administration. In the present study we investigated the possible residual effects of 3 mg melatonin on performance relevant to flight and on subjective feelings of sleepiness, arousal, activation and affect after a daytime nap, as a function of nap length. Fifteen reserve pilots of the Israeli Air Force participated in the study. The experiment consisted of four sessions during which either melatonin or placebo was administered at 16:00 h. In two conditions, subjects were allowed to sleep for 2 h (17:00-19:00 h) whereas in the other two only a 0.5-h nap was allowed. After the naps they started performing a flight simulator task every 2 h. Sleep efficiency significantly increased and sleep latency significantly decreased in both melatonin conditions compared to placebo. Flight performance was only mildly affected in the 0.5-h nap condition. Subjective assessment of sleepiness significantly differed between the two treatment conditions, only in the 0.5-h nap condition. Subjects felt sleepier 2-4 h after melatonin administration. To conclude, our data suggest that administration of melatonin before a brief daytime nap (about 0.5 h) may be associated with mild residual effects on psychomotor performance and may significantly affect subjective feeling of sleepiness for 2-4 h.     

Dopamine agonists and sleepiness in PD: review of the literature and personal findings

BACKGROUND AND PURPOSE: This study is aimed at evaluating daytime sleepiness in a series of Parkinson's disease (PD) patients chronically treated with dopamine agonists (DAs) alone or in combination with L-Dopa. PATIENTS AND METHODS: A preliminary series of 22 non-demented, adult PD patients (mean age 68.9, 13 men and 9 women) were evaluated by means of structured sleep interview, Epworth sleepiness scale (ESS) and 24-h ambulatory polysomnography (A-PSG). RESULTS: Sleep attacks (SAs) were reported by 32% of the patients, in three of them (43%) after DA treatment was initiated (alone or in addition to L-Dopa). In two patients, both with chronic use of ropinirole, we documented NREM SAs during a continuous ambulatory polysomnography (A-PSG) performed in the patients' real-life settings. The subjects experiencing SAs showed a higher degree of daytime sleep propensity than those without SA, having higher ESS scores and a higher proportion of microsleeps and intentional naps on A-PSG. Interestingly, we found that nocturnal total sleep time is higher in PD patients with SAs than in the others. CONCLUSIONS: All in all, our data indicate that SAs are an extreme manifestation of increased daytime sleepiness. The occurrence of SAs in our series of PD patients is unlikely to depend simply on the demands of homeostatic mechanisms.     

The effect of 2-h sleep reduction by a delayed bedtime on daytime sleepiness in children

The purpose of the present study was to investigate the effect of acute 2h sleep reduction by a delayed bedtime on daytime sleepiness. Three children were evaluated over three consecutive days: two control days and a 2h sleep reduction day. A sleep latency test was conducted five times each day at 2h intervals from 10.00 h. The results showed that the effects of sleep loss generally increased daytime sleepiness, in particular, at 10.00 h, and suggested that the intensity of morning sleepiness may become a useful measure which reflects sleep loss.     

Narcolepsy/cataplexy. IV: Diagnostic value of daytime nap recordings

Sleep and wakefulness patterns in daytime naps of 50 patients with narcolepsy/cataplexy were compared with those of 50 controls. Each subject was monitored polygraphically during 2 one-hour nap periods. A sleep-onset REM period in either of the 2 daytime naps was observed to have a higher diagnostic sensitivity (78%) than an abnormally shortened sleep latency (68%). However, the specificities of a sleep-onset REM period (88%) or abnormally shortened sleep latency (90%) were quite similar. When the occurrence of either a sleep-onset REM period or a shortened sleep latency was evaluated in either of the two naps, the overall sensitivity was increased to 84% while the specificity was decreased only to 80%. The limitations of and indications for the use of testing for sleep and REM latencies in the diagnosis of narcolepsy in clinical practice are discussed.     

Two cases of HLA-DR2-negative hypersomnia manifesting sleep-onset rapid eye movement periods in the multiple sleep latency test

We encountered two cases expressing excessive daytime sleepiness (EDS) and manifesting two or more sleep-onset rapid eye movement (REM) periods in the multiple sleep latency test. Unbearable daytime sleepiness occurred abruptly, which usually led to short-lasting naps, after which the patients felt refreshed. The EDS was successfully reduced by treatment with methylphenidate. In spite of these features similar to narcolepsy, these cases of REM hypersomnia did not present cataplexy or other auxiliary symptoms of narcolepsy, and, furthermore, the class-II human leukocyte antigen DR2 appeared to be negative.