Sleep disordered breathing in a cohort of patients with sporadic inclusion body myositis

ObjectiveThe aims of the study were: (1) to evaluate subjective sleep quality and daytime sleepiness in patients affected by sporadic inclusion-body myositis (IBM); (2) to define the sleep and sleep-related respiratory pattern in IBM patients.MethodsThirteen consecutive adult patients affected by definite IBM were enrolled, six women and seven men, mean age 66.2 ± 11.1 years (range: 50–80). Diagnosis was based on clinical and muscle biopsy studies. All patients underwent subjective sleep evaluation (Pittsburgh Sleep Quality Index, PSQI and Epworth Sleepiness Scale, ESS), oro-pharingo-esophageal scintigraphy, pulmonary function tests, psychometric measures, anatomic evaluation of upper airways, and laboratory-based polysomnography. Findings in IBM patients were compared to those obtained from a control group of 25 healthy subjects (13 men and 12 women, mean age 61.9 ± 8.6 years).ResultsDisease duration was >10 years in all. Mean IBM severity score was 28.8 ± 5.4 (range 18–36). Dysphagia was present in 10 patients. Nine patients had PSQI scores ? 5; patients had higher mean PSQI score (IBM: 7.2 ± 4.7, Controls: 2.76 ± 1.45, p = 0.005); one patient (and no controls) had EES > 9. Polysomnography showed that IBM patients, compared to controls, had lower sleep efficiency (IBM: 78.8 ± 12.0%, Controls: 94.0 ± 4.5%, p < 0.001), more awakenings (IBM: 11.9 ± 11.0, Controls: 5.2 ± 7.5, p = 0.009) and increased nocturnal time awake (IBM: 121.2 ± 82.0 min., Controls: 46.12 ± 28.8 min., p = 0.001). Seven Patients (and no controls) had polysomnographic findings consistent with sleep disordered breathing (SDB).ConclusionData suggest that sleep disruption, and in particular SDB, might be highly prevalent in IBM.SignificanceData indicate that IBM patients have poor sleep and high prevalence of SDB.     

Learning in children and sleep disordered breathing: findings of the Tucson Children's Assessment of Sleep Apnea (tuCASA) prospective cohort study.

We examined the relationship between nocturnal respiratory disturbance and learning and compared learning in children with and without nocturnal respiratory disturbance. Subjects were 149 participants in a prospective cohort study examining sleep in children ages 6-12: The Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep was assessed via home polysomnography. Intelligence, learning and memory, and academic achievement were assessed. Parents rated attention. Group comparisons were used to test the hypothesis that the group with an apnea/hypopnea index (AHI) of 5 or more (n = 77) would have weaker performance than the group with AHI less than 5 (n = 72). The group with AHI of 5 or more had weaker learning and memory though differences between groups decreased when arousals were taken into account. There was a greater percentage of Stage 1 sleep in the AHI 5 or more group, and Stage 1 percentage was negatively related to learning and memory in the sample (n = 149). There were negative relationships between AHI and immediate recall, Full Scale IQ, Performance IQ, and math achievement. Hypoxemia was associated with lower Performance IQ. Thus, findings suggest that nocturnal respiratory disturbance is associated with decreased learning in otherwise healthy children, that sleep fragmentation adversely impacts learning and memory, and that hypoxemia adversely influences nonverbal skills.     

Chronic insomnia,postmenopausal women,and sleep disordered breathing: part 1. Frequency of sleep disordered breathing in a cohort

OBJECTIVES: A cohort of postmenopausal women complaining of chronic insomnia for over 6 months and free of hypnotic intake was recruited mostly from the community. Three hundred and ninety-four women were included. The following questions were addressed: How many presents sleep disordered breathing (SDB)? Which type of SDB (upper airway resistance syndrome [UARS] or obstructive sleep apnea syndrome [OSAS]) is the most frequent? Is there a specific upper airway anatomical abnormality in SDB patients predisposing to the syndrome? POPULATION: Subjects were recruited in the community or referred by the Sleep Clinic and all had complaint of chronic poor sleep. METHODOLOGY: First step. Questionnaires, visual analog scales, clinical interview, clinical evaluation with work-up, actigraphy, and ambulatory monitoring were used. Second step. Otolaryngologic evaluation, ambulatory sleep monitoring, and reading of results were used. Subjects negative for SDB at ambulatory monitoring had polysomnography (PSG) with pressure transducer/nasal cannula system and esophageal manometry measurements. RESULTS: Population. Three hundred and ninety-four individuals responded to all entry criteria. Ambulatory monitoring identified 194 subjects with OSAS. Two hundred individuals were not recognized with SDB and were submitted to PSG. This further testing showed that 68 subjects had normal breathing, 62 had UARS, and 100 mild OSAS. Based on otolaryngological evaluation, subjects were classified based on the presence or absence of narrow upper airway, and the location of narrowing was assessed. CONCLUSION: A total of 326 postmenopausal women complaining of chronic insomnia had a SDB, usually with low apnea-hypopnea index (AHI). This total represents about 83% of the studied women. Questions of the role of SDB in the complaint of chronic insomnia are raised.     

A novel approach using actigraphy to quantify the level of disruption of sleep by in-home polysomnography: the MrOS Sleep Study: Sleep disruption by polysomnography

BackgroundThe “first-night effect” of polysomnography (PSG) has been previously studied; however, the ability to quantify the sleep disruption level has been confounded with the use of PSG on all nights. We used actigraphy to quantify disruption level and examined characteristics associated with disruption.MethodsTotally, 778 older men (76.2 ± 5.4 years) from a population-based study at six US centers underwent one night of in-home PSG. Actigraphy was performed on the PSG night and three subsequent nights. Actigraphically measured total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) from the PSG night and subsequent nights were compared. Linear regression models were used to examine the association of characteristics and sleep disruption.ResultsOn average, sleep on the PSG night was worse than the following night (p < 0.05, TST 21 ± 85 min less, SE 2.3 ± 11.3% less, WASO 4.9 ± 51.8 min more, SOL 6.6 ± 56.2 min more). Sleep on the PSG night was significantly worse than that two and three nights later. Characteristics associated with greater sleep disruption on the PSG night included older age, higher apnea–hypopnea index, worse neuromuscular function, and more depressive symptoms. Minorities and men with excessive daytime sleepiness slept somewhat better on the PSG night.ConclusionsAmong older men, there was sleep disruption on the PSG night, which may lead to sleep time underestimation. The increase of sleep on the night after the PSG suggests that data from the second monitoring may overestimate sleep.     

A follow-up study of the effect of training using the Hybrid Assistive Limb on Gait ability in chronic stroke patients

Objectives: Recently, use of the Hybrid Assistive Limb (HAL) that is effective for improvement of gait ability in chronic stroke patients has been reported. However, how long the effects are maintained remains unknown. The purpose of the present study was to investigate whether the effect of gait training using the HAL on gait ability was maintained for 3 months after the intervention.

Methods: A longitudinal, observational study with an intervention for a single group that adhered to the STROBE guidelines was performed. Nine chronic stroke patients were enrolled in this study. The patients performed gait training sessions using the HAL, 2–5 sessions/week for 3 weeks. Gait speed, stride length, cadence, and 2-minute walk distance (2MWD) were measured before and after intervention and at 3-month follow-up. The clinical trial registration number of this study is UMIN000012764 R000014756.

Results: Compared to the initial status, gait speed (p = .02), stride length (p = .03), cadence (p = .01), and 2MWD (p < .05) were significantly increased immediately after the intervention. Moreover, gait speed (p < .01), cadence (p = .03), and 2MWD (p = .02) remained significantly higher 3 months after the intervention. There were no significant changes in all outcome measures between after intervention and at 3-month follow-up.

Conclusions: This study showed that gait training using the HAL resulted in significant improvement of gait ability after the intervention and the effect was maintained for 3 months after the training.     

Treatment of stereotyped hair-pulling with overcorrection: A case study with long term follow-up

The present study reports the successful use of a positive practice overcorrection procedure for reducing sterotyped hair-pulling in a 7$\text{1}\text{2}$-yr-old severely mentally retarded girl. This procedure was implemented after the unsuccessful use of a response prevention “treatment” by her parents. In addition, a verbal warning procedure was used to maintain the near-zero rate of hair-pulling achieved through overcorrection. Follow-up data for 1 year were reported.     

Midlife stroke risk and cognitive decline: A 10-year follow-up of the Whitehall II cohort study

BackgroundStroke is associated with an increased risk of dementia. However, it is unclear whether risk of stroke in those free of stroke, particularly in nonelderly populations, leads to differential rates of cognitive decline. Our aim was to assess whether risk of stroke in mid life is associated with cognitive decline over 10 years of follow-up.MethodsWe studied 4153 men and 1657 women (mean age, 55.6 years at baseline) from the Whitehall II study, a longitudinal British cohort study. We used the Framingham Stroke Risk Profile (FSRP), which incorporates age, sex, systolic blood pressure, diabetes mellitus, smoking, prior cardiovascular disease, atrial fibrillation, left ventricular hypertrophy, and use of antihypertensive medication. Cognitive tests included reasoning, memory, verbal fluency, and vocabulary assessed three times over 10 years. Longitudinal associations between FSRP and its components were tested using mixed-effects models, and rates of cognitive change over 10 years were estimated.ResultsHigher stroke risk was associated with faster decline in verbal fluency, vocabulary, and global cognition. For example, for global cognition there was a greater decline in the highest FSRP quartile (−0.25 of a standard deviation; 95% confidence interval: −0.28 to −0.21) compared with the lowest risk quartile (P = .03). No association was observed for memory and reasoning. Of the individual components of FSRP, only diabetes mellitus was associated independently with faster cognitive decline (β = −0.06; 95% confidence interval, −0.01 to 0.003; P = .03).ConclusionElevated stroke risk at midlife is associated with accelerated cognitive decline over 10 years. Aggregation of risk factors may be especially important in this association.     

Exercise-induced changes of the upper extremity in chronic stroke survivors

Problems with daily activities due to decreased aerobic capacity and decreased strength are common in people who survive a stroke. Implementation of exercise for the upper extremity is challenging because of weakness and other impairments that limit performance of exercise activities. Although maximal exercise testing protocols are difficult to administer, submaximal testing may be a safe and effective means for prescribing exercise. Research studies have demonstrated that people with stroke can improve aerobic capacity and upper extremity muscle strength with exercise intervention, although the number of randomized controlled trials is limited and this area requires further investigation.     

A four year follow-up of sleep and respiratory measures in elementary school-aged children with sleep disordered breathing

ObjectiveLittle is known of the long-term prognosis of children treated for sleep disordered breathing (SDB) and even less of children with milder forms of SDB who remain untreated. We aimed to investigate the long-term sleep and respiratory outcomes of children with a range of SDB severities.Methods41 children with SDB and 20 non snoring controls (mean age, 12.9 ± 0.2 y), underwent repeat overnight polysomnography (PSG) 4.0 ± 0.3 years after initial diagnosis. SDB severity, presence of snoring, sleep and respiratory parameters, sleep fragmentation index (SFI), the Pediatric Daytime Sleepiness Scale (PDSS), Sleep Disturbance Scale for Children (SDSC), and obstructive sleep apnea 18-item quality of life questionnaire were re assessed. Children with SDB were grouped into resolved (no snoring and obstructive apnea–hypopnea index [OAHI] <1) and unresolved (snoring or an OAHI ⩾1).ResultsAt follow-up OAHI was reduced in both SDB groups (p < 0.05); however, 54% (n = 22) of children still continued to snore, having either persistent or new OSA (n = 4). In this unresolved group, sleep was significantly disrupted; % nonrapid eye movement stage 1 (NREM1) sleep and SFI were increased (p < 0.05), and total sleep time (TST) and sleep efficiency were decreased compared to the resolved and control groups (p < 0.05). Overall, 29% of children were treated, and of these, 67% had resolved SDB. SDB groups had higher PDSS, SDSC, and OSA-18 scores compared to controls at follow-up (p < 0.01).ConclusionsOur study demonstrated that although SDB improved in the long-term, more than 50% of children had residual SDB (mostly primary snoring) and sleep disturbance. As even mild forms of SDB are known to have adverse cardiovascular, learning, and behavioral outcomes, which have implications for the health of these children.     

Three-year follow-up study of nursing home residents using rating scales in Japan

One hundred and nine nursing home residents were examined by the modified Stockton Geriatric Rating Scale (modified SGRS) and the Hasegawa Dementia Rating Scale in April 1987. Twenty-eight residents died during the three-year period. The 64 survivors remaining at the nursing home were reexamined in April 1990 and were divided into two groups according to whether they had been admitted to hospital or not during the follow-up period. Physical ability as measured by the modified SGRS and the Hasegawa Dementia Rating Scale had deteriorated in both groups, and communication failure and apathy on the modified SGRS were aggravated in the admitted group. It is considered that not only the physical care of all nursing home residents but also the psychogeriatric care of residents with severe physical impairment is necessary.     

氯氮平短程与长程不良反应比较

目的：比较精神分裂症患者服用氯氮平在短程与长程治疗中的不良反应。方法：对入组患者作副反应量表(TESS)评定。结果：在短程与长程治疗中，TESS总分及某些单项分有显著差异，单项前10位频度亦有显著差别。结论：在长程治疗中，氯氮平不良反应发生率下降、严重程度减轻，但对神经系统、心血管系统、体重及血象的影响仍应重视。     

长期生存脑恶性胶质瘤患者治疗随访研究

目的总结长期生存脑恶性胶质瘤患者的最佳治疗方式,以提高治愈率,延长生存期。方法对26例生存期达5年以上的脑恶性胶质瘤病例进行回顾分析。26例均进行手术、放疗和化疗等治疗,并进行长期随访。全组病例行肿瘤手术显微镜下全切除23例,次全切除3例。术中采用神经导航、神经内镜等先进仪器辅助切除肿瘤。术后病人全部行放疗或X刀与γ-刀治疗,并均经颈动脉注药或静脉给予宁得朗进行化疗。结果全部病人都得到随访,时间5.5~13年,其中5年生存率为100%,10年生存率42.3%。结论最大程度手术切除脑恶性胶质瘤是获得良效的首要条件,也是争取进一步治疗的前提;术后严格随访和放疗与化疗是延长生存期的重要措施。     

氯氮平长期治疗不良反应调查

目的调查精神分裂症患者长期服用氯氮平时的不良反应。方法对所有入选病例进行TESS评定,并比较长期与短期服用氯氮平中的不良反应。结果在氯氮平长期与短期治疗中,TESS前10位不良反应频度排序有较大差别,且单项分明显不同,以嗜睡、血象异常、口干、唾液增多、心动过速、脑电图（EEG）异常、脑血管多普勒（TCD）异常明显,TESS总分呈显著下降。结论氯氮平长期与短期治疗中的不良反应差异较大,长期治疗总的不良反应程度有所减轻,但对神经系统、心脑血管系统、体重、肝功能以及血象的影响仍明显。