Episodic Cluster Headache: NREM Prevalence of Nocturnal Attacks. Time to Look Beyond Macrostructural Analysis?

(Headache 2010;50:1050‐1054) Background.— A high prevalence of nocturnal sleep‐related attacks is reported in patients with cluster headache (CH). Episodic CH is considered closely related to rapid eye movement (REM) sleep. Objective.— The aim of this study was to analyze the relationships between episodic CH attacks and sleep macrostructure. Methods.— Data were obtained by means of 24‐hour continuous ambulatory polysomnography (PSG) capturing CH attacks in 4 out of 7 episodic CH patients (all males; mean age 38.4 ± 9.2 years) studied. Results.— Eight CH attacks were captured during the PSG monitoring; 5 arose from sleep: 4 from non‐rapid eye movement (NREM) sleep (stage 2 NREM), and 1 from REM sleep. One patient experienced CH attacks during both NREM and REM sleep in the same night. Conclusions.— In the light of previous literature findings, the prevalence of NREM‐related episodic CH attacks observed, and the finding of attacks arising during both REM and NREM sleep in the same subject, suggest that the relationship between CH and sleep stages is heterogeneous, and the existence of a specific macrostructural pattern associated with episodic CH attacks appears to be uncertain. A more comprehensive approach taking into account the microstructure of NREM and REM sleep is expected to provide more in depth information about the pathophysiology of CH, whose complexity might overcome the simplistic dichotomy of REM/NREM staging.     

Sympathetic neural mechanisms in obstructive sleep apnea.

Blood pressure, heart rate, sympathetic nerve activity, and polysomnography were recorded during wakefulness and sleep in 10 patients with obstructive sleep apnea. Measurements were also obtained after treatment with continuous positive airway pressure (CPAP) in four patients. Awake sympathetic activity was also measured in 10 age- and sex-matched control subjects and in 5 obese subjects without a history of sleep apnea. Patients with sleep apnea had high levels of nerve activity even when awake (P < 0.001). Blood pressure and sympathetic nerve activity did not fall during any stage of sleep. Mean blood pressure was 92 +/- 4.5 mmHg when awake and reached peak levels of 116 +/- 5 and 127 +/- 7 mmHg during stage II sleep (n = 10) and rapid eye movement (REM) sleep (n = 5), respectively (P < 0.001). Sympathetic activity increased during sleep (P = 0.01) especially during stage II (133 +/- 9% above wakefulness; P = 0.006) and REM (141 +/- 13%; P = 0.007). Peak sympathetic activity (measured over the last 10 s of each apneic event) increased to 299 +/- 96% during stage II sleep and to 246 +/- 36% during REM sleep (both P < 0.001). CPAP decreased sympathetic activity and blood pressure during sleep (P < 0.03). We conclude that patients with obstructive sleep apnea have high sympathetic activity when awake, with further increases in blood pressure and sympathetic activity during sleep. These increases are attenuated by treatment with CPAP.     

睡眠监测技术对日间过度思睡患者病因诊断的研究

目的:探讨睡眠监测技术对日间过度思睡(Excessive Daytime Sleepiness,EDS)的病因学诊断价值.方法:选取2017年6月至2019年6月安徽医科大学附属巢湖医院收治的EDS患者115例作为研究对象,行整夜多导睡眠监测及次日的多次睡眠潜伏期试验(Multiple Sleep Latency Te...     

Dilatation of the pulmonary veins in atrial fibrillation: a transesophageal echocardiographic evaluation

Ectopic beats originating from sleeves of atrial tissue within the pulmonary veins (PVs) can induce and sustain paroxysmal atrial fibrillation (AF). Left atrial stretch and dilatation favors the development of atrial ectopy and AF. Similarly, PV dilatation, if present, might trigger PV ectopy in patients with AF. This study was designed to evaluate whether PV dilatation is present in patients with nonfocal AF and whether the PV diameter correlates to the left atrial diameter (LAD). The diameters of the right superior (RSPV) and left superior PV (LSPV) were measured at the ostium and at a depth of 1 cm in 170 patients (AF, n = 75; sinus rhythm [SR], n = 95) using transesophageal echocardiography. The LAD was determined by transthoracic echocardiography. The diameters of the PVs were significantly larger in patients with AF than in patients with SR (LSPV(ostium): AF 13.6 +/- 3.5 mm vs SR 10.6 +/- 2.7 mm, P < 0.001; LSVP(1cm): AF 12.5 +/- 2.9 mm vs SR 10.2 +/- 2.5 mm, P < 0.001; RSPV(ostium): AF 13.9 +/- 3.5 mm vs SR 11.7 +/- 2.9 mm, P < 0.001; RSVP(1cm): AF 12.8 +/- 2.8 mm vs SR 10.6 +/- 2.6 mm, P < 0.05). Similarly, LAD was larger in patients with AF (44.7 +/- 7.7 mm) as compared to patients with SR (38.8 +/- 6.8 mm, P < 0.001). Neither for the SR nor the AF group did the PV size correlate to the LAD. AF is associated with a significant enlargement of the RSPV, LSPV, and LAD. There is no correlation between LAD and PV diameters. This raises the question whether PV dilatation in patients with AF is a cause or a consequence of AF and whether it may contribute to the development and perpetuation of AF.     

The risk profile for obstructive sleep apnea does not affect the recurrence of atrial fibrillation

BACKGROUND: Obstructive sleep apnea (OSA) has been linked to increased prevalence and recurrence of atrial fibrillation (AF). We hypothesized that OSA may aggravate AF in patients with pacemakers implanted for sinus bradycardia who had documented paroxysmal AF. METHODS: Seventy-two patients (36 M, aged 77 +/- 6 years) completed the study. All patients received a dual-chamber pacemaker equipped with diagnostic and preventive functions for AF. OSA was diagnosed with the Berlin Questionnaire, which is validated to identify patients with OSA. Four-month continuous pacemaker recordings were collected for all patients. RESULTS: OSA was diagnosed in 28% of patients. Patients at high risk for OSA (HR group) and patients at low risk for OSA (LR group) were equivalent for gender, age, and body mass index. The rate of hypertension was higher in HR than in LR group (90% vs 44%, P < 0.01). The prevalence of paroxysmal AF during the study period was similar in HR and LR group (53% vs 44%, P = NS). Overall number of AF episodes per month was not significantly different between HR and LR group (7 +/- 13 vs 36 +/- 122, P = NS). Similarly, AF burden (AF%) was not significantly different between HR and LR group (0.3 +/- 0.6 vs 2.0 +/- 4.8, P = NS). Circadian distribution of AF episodes was similar in both groups. CONCLUSION: Long-term pacemaker recording of AF recurrence, AF burden, and its circadian distribution is similar in patients with paroxysmal AF at high risk for OSA and those at low risk for OSA.     

Sleep disturbance in patients with lichen simplex chronicus and its relationship to nocturnal scratching: A case control study

BACKGROUND: Lichen simplex chronicus (LSC) is a common pruritic disorder resulting from repeated rubbing and scratching. Nighttime pruritus is a common feature in LSC and may disrupt the sleep pattern. The aim of this study is to determine whether there are sleep abnormalities in patients with LSC. PATIENTS AND METHODS: Fifteen patients with LSC and 15 age-, sex- and body mass index-matched control subjects were enrolled in the study. No participant had any other medical or psychiatric illness. All subjects were evaluated by overnight polysomnography, scratch electrodes, Epworth sleepiness scale and a general questionnaire for demographic data and sleep problems. RESULTS: There were no significant differences in the groups for total sleep time, sleep efficiency, sleep latency, rapid eye movement (REM) latency, percentage of stage 1 non-REM sleep and REM sleep. The percentage of stage 2 non-REM sleep was higher (P < 0.05) and the percentage of slow wave sleep (stages 3 and 4) was lower in the study group (P < 0.05) than in the controls. The patient group had a mean of 15.9 +/- 7.5 arousal index and 22.8 +/- 14.1 awakenings compared with 9.5 +/- 3.1 and 10.4 +/- 3.9, respectively, in the controls (P < 0.05, P < 0.01, respectively). Arousals of patients were mainly observed in non-REM sleep. The number of scratching bouts ranged from 6 to 20 per night. Scratching episodes were observed frequently during stage 2 non-REM sleep. CONCLUSION: Polysomnographic findings of patients with LSC demonstrated that sleep structure is disturbed by arousals and awakenings related to scratching bouts during sleep.     

强迫症患者睡眠特征初步探讨

背景强迫症患者睡眠参数与正常人及强迫症患病时期有何关系?揭示强迫症患者的睡眠特征是目前睡眠研究中的热点. 目的探讨并分析强迫症患者异常睡眠现象与睡眠特征的关系. 设计以诊断为依据的病例对照研究. 地点、对象和方法全部病例为宁波市康宁医院门诊和住院的强迫症患者,共 21例,对照组为浙江宁波市康宁医院职工、家属和进修生 20例,均为自愿参加研究.对强迫症患者进行多导睡眠图( polysomnogram,PSG)检查,并与对照组进行对比分析. 主要观察指标两组受检者睡眠进程、睡眠结构和快速眼动期睡眠 (rapid eye movement,REM)各指标. 结果强迫症患者全夜中睡眠觉醒次数、觉醒总时间(平均 32.95次, 73.26 min)比对照组多(平均 11.46次 ,18.97 min)( t=6.55, 1.16,P< 0.01);睡眠效率下降 (对照组、强迫症组平均分别为 91.44%, 86.70% )( t=0.79, P< 0.05);非快速眼动期睡眠 (NREM)第 1期( S1期)百分比减少 (对照组平均为 6.23%,强迫症组平均为 4.00% )(t=0.89, P< 0.05); REM时间增加 (对照组平均为 18.10 min,强迫症组平均为 68.86 min)(t=1.73, P< 0.05).强迫症患者的病程与 REM睡眠首次潜伏期呈正相关 (r=0.57, P< 0.01),与 REM睡眠时间呈负相关 (r=- 0.60, P< 0.01),即随着强迫症患者的病程增长, REM睡眠的首次潜伏期时间后移,而 REM睡眠时间减少. 结论强迫症患者的异常睡眠现象,可能与发病机制有关.     

阻塞性睡眠呼吸暂停低通气综合征患者心理状况研究

目的 分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的心理状况。方法 对经多导睡眠监测(PSG)确诊且符合纳入、排除标准的200例OSAHS患者进行SCL 90心理量表测评,并着重分析焦虑、抑郁得分与PSG指标的相关性,探讨两者之间的关系。结果 OSAHS患者整体心理状况较正常人差,其中：躯体化、强迫症状、人际关系敏感、抑郁、焦虑、恐怖、偏执、精神病性因子分较国内常模高（P<0.05）,且不同病情程度的OSAHS患者心理状况差异有统计学意义（P<0.05）。OSAHS患者焦虑、抑郁得分与呼吸暂停低通气指数(AHI)、微觉醒指数(MAI)、血氧饱和度低于90%的时间占睡眠总时间比(TS90)呈正相关（P<0.05）,与最低血氧饱和度(LSaO2)、快动眼睡眠(REM)及深睡眠时间占比呈负相关（P<0.05）。结论 OSAHS患者整体心理状况较正常人差,病情程度不同的患者心理状况也存在差异,其焦虑、抑郁得分与慢性夜间缺氧、睡眠片段化及睡眠结构紊乱有关。     

Heart rate variability during sleep in patients with vasovagal syncope

Background: There are a few studies showing no significant heart rate variability (HRV) over a 24-hour period in vasovagal syncope (VVS) patients, but no research has examined HRV and its sympathetic and parasympathetic components during rapid eye movement (REM) and non-REM sleep. The authors hypothesized that REM sleep might be a critical state in which VVS patients would show abnormal responses.
Objectives: To analyze the sympathetic and parasympathetic components of HRV during REM and SWS in patients with VVS compared to normal subjects, and in patients with positive HUTT compared to negative ones.
Methods: Thirty-seven VVS patients and 20 normal age-matched controls were submitted to polysomnography with 24-hour Holter monitoring to assess HRV. Time and frequency domain techniques were carefully performed for 24 hours and during Stages 3 and 4 of REM and non-REM sleep. Variation of sympathetic activity index (VSAI) was defined as the difference in the low frequency (LF) component of HRV between REM and Stages 3 and 4 of non-REM sleep. An analysis of variance was performed to compare patients and controls; patients with positive and negative head-up tilt testing.
Results: The LF component was lower in syncope compared to normal patients (1,769.54 ± 1,738.17, 3,225.37 ± 2,585.05, respectively, P = 0.03). There was a significant decrease in VSAI in the syncope group compared to the control group (−539.39 ± 1,930.78, 1,268.10 ± 2,420.20, respectively, P = 0.01). The other sleep variables analyzed including very LF, high frequency, low frequency/high frequency and time domain parameters did not reach statistical significance. Syncope patients also showed an increase in slow wave sleep (28.2 ± 10.5, 19.7 ± 7.8, P = 0.01).
Conclusions: VVS patients exhibited sympathetic suppression during REM sleep. Possible mechanisms are discussed in this article.     

奥氮平对精神分裂症患者睡眠脑电活动的影响

目的：应用多导睡眠图探讨奥氮平对精神分裂症患睡眠脑电活动的影响。方法：对13例精神分裂症患连续进行3个晚上多导睡眠图检查，其中第2、3晚上睡前予10mg奥氮平，观察用药后多导睡眠图的变化。正常对照组14名，作2夜基础多导睡眠图监测。结果：精神分裂症患服用奥氮平后睡眠进程和睡眠总时间有所改善，觉醒时间减少和S1缩短，S2和慢波睡眠(S3、S4）显增加，而快速眼动(REM)时间和潜伏期未见明显变化。结论：奥氮平能增加睡眠总时间，改善睡眠质量，这可能与奥氮平拮抗5-羟色胺能神经元作用相关。     

多道睡眠图指标评估脑卒中后抑郁的价值

目的探讨多道睡眠图 ( polysomnograph,PSG)指标对脑卒中后抑郁 (post-stroke depression,PSD)的诊断价值. 方法 30例研究对象分为 3组进行多道睡眠图检查并分析其结果病例组为 10例 PSD患者,根据 DSM-Ⅳ诊断标准确诊;对照组为 10例脑卒中后无抑郁的患者;正常组为年龄、性别匹配的健康者. 结果与对照组、正常组比较,病例组睡眠结构发生明显变化,表现为睡眠潜伏期延长,快速动眼睡眠与非快速动眼睡眠( REM-NREM)周期次数增加;快速动眼睡眠( rapid eye movements,REM)潜伏期缩短; REM活动度、强度、密度增加; S1阶段睡眠增加, S2和 S3+ 4阶段睡眠减少.总睡眠时间、慢波睡眠时间比正常组少,但与对照组之间无差异. 3组之间觉醒时间、睡眠效率无明显差异. 结论 PSD患者存在 PSG指标变化,这些改变可能有助于 PSD的诊断参考.     

Feasibility of automated detection of advanced sleep disordered breathing utilizing an implantable pacemaker ventilation sensor

OBJECTIVES: This study tested the feasibility of automatically detecting advanced sleep disordered breathing (SDB) from a pacemaker trans-thoracic impedance sensor. BACKGROUND: SDB is prevalent yet under-diagnosed in patients with cardiovascular disease. The potential for automated detection of SDB in patients receiving pacemakers with respiration sensors has not been fully explored. We hypothesized that the trans-thoracic impedance sensor could be utilized for automatic detection of advanced SDB. METHODS: Patients underwent overnight polysomnography (PSG). The pacemaker trans-thoracic impedance signal was simultaneously recorded and time synchronized with the polysomnograph. Cardiovascular health variables were abstracted from medical records. Apnea was defined as cessation of inspiratory airflow lasting 10 seconds or longer. Hypopnea was defined as a reduction of tidal volume of at least 30% from baseline tidal volume, lasting 10 seconds or more. A computer algorithm (PM-A) was developed to automatically detect SDB from the pacemaker impedance sensor data. The performance of automated SDB detection was compared against PSG. RESULTS: Sixty patients (aged 69 +/- 12 years, 45 males) were studied. Advanced SDB (moderate or severe) was diagnosed in 40 patients. Severe SDB (apnea-hypopnea index [AHI]> or = 30) was diagnosed in 32 patients (53%), but only 5 patients had prior diagnosis of the disease. Moderate SDB (30 > AHI > 15) was diagnosed in 8 patients of whom only two were previously diagnosed. Cardiovascular health variables did not predict the presence of advanced SDB. PM-A derived AHI correlated with that of the PSG (r = 0.80, P < 0.01). The algorithm identified patients with advanced SDB with 82% sensitivity and 88% specificity. CONCLUSIONS: It is feasible to automatically measure SDB severity using a pacemaker trans-thoracic impedance sensor. Advanced SDB was frequently undiagnosed in this cohort of pacemaker patients.     

Monitoring sleep depth: analysis of bispectral index (BIS) based on polysomnographic recordings and sleep deprivation

The assessment and management of sleep are increasingly recommended in the clinical practice. Polysomnography (PSG) is considered the gold standard test to monitor sleep objectively, but some practical and technical constraints exist due to environmental and patient considerations. Bispectral index (BIS) monitoring is commonly used in clinical practice for guiding anesthetic administration and provides an index based on relationships between EEG components. Due to similarities in EEG synchronization between anesthesia and sleep, several studies have assessed BIS as a sleep monitor with contradictory results. The aim of this study was to evaluate objectively both the feasibility and reliability of BIS for sleep monitoring through a robust methodology, which included full PSG recordings at a baseline situation and after 40 h of sleep deprivation. Results confirmed that the BIS index was highly correlated with the hypnogram (0.89 ± 0.02), showing a progressive decrease as sleep deepened, and an increase during REM sleep (awake: 91.77 ± 8.42; stage N1: 83.95 ± 11.05; stage N2: 71.71 ± 11.99; stage N3: 42.41 ± 9.14; REM: 80.11 ± 8.73). Mean and median BIS values were lower in the post-deprivation night than in the baseline night, showing statistical differences for the slow wave sleep (baseline: 42.41 ± 9.14 vs. post-deprivation: 39.49 ± 10.27; p = 0.02). BIS scores were able to discriminate properly between deep (N3) and light (N1, N2) sleep. BIS values during REM overlapped those of other sleep stages, although EMG activity provided by the BIS monitor could help to identify REM sleep if needed. In conclusion, BIS monitors could provide a useful measure of sleep depth in especially particular situations such as intensive care units, and they could be used as an alternative for sleep monitoring in order to reduce PSG-derived costs and to increase capacity in ambulatory care.     

抑郁症的多导睡眠脑电图研究

目的探讨抑郁症患者的多导睡眠图异常改变，与正常对照组之间的差异。方法采用多导睡眠仪（PSG）对20例抑郁症患者进行整夜睡眠描记，并与对照组比较。结果抑郁症组与正常组比较：睡眠潜伏期延长，慢波睡眠减少，维持率低；REM潜伏期缩短，密度增加。结论我们认为抑郁症患者存在入睡困难、易醒、早醒及浅睡为主的睡眠障碍，多导睡眠图特征性变化是以快动眼睡眠过度活跃为特征，表现为REM潜伏期（RL）缩短，REM密度增加，原因可能与5-羟色胺／去甲肾上腺素（5-HT/NE）能神经传递减少及／或胆碱能传递增加有关。笔者认为抑郁症患者REM睡眠的特征性改变对抑郁症的诊断及鉴别诊断有一定临床意义。     

Quisi与睡眠脑电图检测抑郁症的比较研究

目的评价Quisi检测抑郁症的作用和适应证。方法对19例抑郁症患者和21名正常受试者分别作Quisi和睡眠脑电图检测。并以日本SEEG-1500型睡眠脑电图为检测标准,与德国Quisi进行比较研究。结果在正常对照组中,除睡眠第二阶段百分比,Quisi少于多导睡眠图(Polysomnography,PS)外(Quisi为48±8,正常人PSG56±9,t=2.48,P<0.05),其余12项指标差异均无显著性。抑郁症组中睡眠第一阶段百分比,Quisi也少于PSG(Quisi为11±4,PSG为13±3,t=2.0,P<0.05),其余12项指标差异也无显著性。结论Quisi检测抑郁症作用与PSG相似,在心理咨询、外出巡诊和家庭病床上有应用前途,但不适用于发作性疾病的评估。     

抑郁症状与睡眠脑电图参数的相关分析

目的调查抑郁症状与睡眠脑电图参数的相关性。方法对停用精神药物3d的18例病人估价其汉密顿抑郁量表(HAMD)总分/诸因子分与14项睡眠脑电图参数的相关性。结果(1)焦虑/躯体化因子与快波睡眠百分率呈显著负相关性(r=-0.5097,df=16,P<0.05);(2)绝望感因子与慢波睡眠2相百分率呈显著正相关性(r=0.4874,df=16,P<0.05);(3)绝望感因子与快波睡眠活动量及强度分别呈显著负相关性(r分别为-0.5067和-0.5657,df=16,P均<0.05)。结论慢波睡眠2相百分率、快波睡眠活动量及强度可作为绝望感因子的生物学标记。     

Continuous positive airway pressure treatment improves the QT rate dependence adaptation of obstructive sleep apnea patients

BACKGROUND: QT rate dependence is one of the major properties of ventricular repolarization, with its circadian and autonomic modulations. The alteration of cardiac autonomic tone occurring in obstructive sleep apnea syndrome (OSAS) patients could explain the altered rate-dependent adaptation of the myocardial repolarization. Thus, we postulated that dynamic alterations in QT interval adaptation could be ameliorated in OSAS patients under continuous positive airway pressure (CPAP) treatment. To assess ventricular repolarization features in patients with OSAS, we compared QT parameters and their dynamicities along RR intervals from 24-hour ECG. METHODS: The study groups consisted of 38 consecutive OSAS patients and 38 healthy age-matched subjects. The syndrome was confirmed for OSAS patients according to standard polysomnographic criteria (apnea plus hypopnea index: 56.9 +/- 28.4/h). A second polysomnography synchronized with 24-hour ECG Holter and realized under efficient CPAP therapy confirmed the control of sleep-related breathing disorder. RESULTS: QT length related to heart rate was found significantly altered in patients with OSAS compared with controls (QTend/RR slope: -0.126 +/- 0.031 vs -0.173 +/- 0.038; P < 0.01). This flattened relationship was significantly improved with the treatment of the OSAS (-0.151 +/- 0.051; P < 0.01 vs pretreatment status). There was no significant impact of CPAP therapy on ventricular ectopic activity as well as on static repolarization parameters (QT, RT, QTc, RTc) measured separately over daytime and nighttime. CONCLUSIONS: The prognostic implications of such findings and the protective role of CPAP treatment to prevent sudden cardiac death in OSAS need to be evaluated.     

Sleep apnea in childhood migraine

In our previous study we found a high prevalence of disordered sleep breathing in migraine children vs. controls. Since no quantitative studies about sleep respiratory disorders have been carried out in migraine children, we performed a polysomnographic (PSG) study in 10 migraine patients (7 boys, 3 girls; mean age 8.11 years, range, 5.8–14.5) attending the Headache Center of our department, to evaluate the presence of sleep apnea. Mothers completed a headache diary and a sleep diary for at least 1 month and filled out a sleep questionnaire. PSG data showed a normal sleep architecture in 3 cases, an insomnia pattern in 2, a reduction of slow wave sleep in 3 and a reduction of REM sleep in 2. Respiratory analysis revealed that 2 of 10 patients had obstructive sleep apnea. These 2 patients presented habitual snoring and associated sleep disturbances such as restless sleep and hypnic jerks. Sleep apnea may be a subtle and often undiagnosed symptom in several migraine patients. The report of habitual snoring associated with other sleep disturbances such as restless sleep and other parasomnias may be a sign of sleep apnea in migraine children. Received: 21 August 2000 / Accepted in revised form: 5 January 2001     

Polysomnographic measures in Parkinson's disease: a comparison between patients with and without REM sleep disturbances

STUDY OBJECTIVE: To assess the frequency of rapid eye movement (REM) sleep abnormalities in Parkinson's disease (PD) patients and compare polygraphic sleep measures in those with and without REM sleep disturbances. DESIGN: Polysomnographic recordings of 2 consecutive nights were performed in 45 patients with PD (mean age 65 years, mean Hoehn and Yahr stage 2.2). Twenty patients were treated with dopaminergic drugs, 10 were drug-free for two weeks and 15 had never been treated with L-dopa or dopamine agonists. According to the polysomnographic findings, the patients were divided into those with and without REM sleep abnormalities. Abnormal REM sleep features were defined as REM sleep without atonia (RWA) and REM sleep behavior disorder (RBD). RESULTS: Eighteen (40%) of the PD patients showed either RWA (24%; 6 men, 5 women) or RBD (16%; 6 men, 1 woman). Patients with REM sleep disturbances had a significantly longer duration of the disease (8.3 vs. 3.9 years), a more severe stage of the disease (2.6 vs. 2.0 Hoehn and Yahr stage) and were treated with a higher dosage of dopaminergic drugs (L-dopa, pergolide and bromocriptin). 67% of the patients with normal REM sleep were untreated at the time of the sleep study, but only 39% of those with REM sleep abnormalities. Sleep EEG measures (sleep efficiency, sleep onset latency, sleep period time, relative amounts of sleep stages) for the second night showed no significant differences between both groups apart from a significantly lower sleep period time in PD patients with RWA/RBD. CONCLUSIONS: Abnormal REM sleep features are a frequent finding in patients with PD. The prevalence seems to increase with a longer disease duration. Therefore, a careful follow-up is necessary. A sleep architecture not different from PD patients without RWA/RBD suggests that the underlying abnormality is confined to REM sleep.     

Computer assisted detection of REM and non-REM sleep for analysis of nocturnal hypoxaemia in patients with ventilatory impairment

A computer-assisted method for the evaluation of sleep and breathing in patients showing chronic ventilatory impairment is described and validated. Signals of body and respiratory movements (static charge sensitive bed), air-flow (thermistors), oxygen saturation (SaO2), electro-oculography (EOG), and electromyography (EMG) were recorded overnight and analysed. Using the compressed output graphs of the data and a rapid scoring procedure, stages of wakefulness, non-REM (stages S1–S4) and REM sleep were identified. The procedure allowed analysis of oxygen saturation data separately for each sleep stage. For validation of the method, the sleep stages identified were compared with traditional sleep staging based on a simultaneous recording of EEG, EMG and EOG in 10 patients with chronic obstructive pulmonary disease (COPD) and in 15 patients treated by thoracoplasty (TPL) for pulmonary tuberculosis. The recordings were performed in a patient ward. In total, 32 night recordings were analysed. In the COPD patients, the sensitivity and specificity of the new method were 87% and 84% in detecting non-REM sleep, and 72% and 87% in detecting REM sleep, respectively. In the TPL patients the sensitivity and specificity were 93% and 89% with respect to non-REM sleep, and 92% and 94% in regard to REM sleep. The new method and traditional sleep staging provided closely similar quantitative estimates of the degree of sleep stage-(REM and non-REM) dependent arterial oxygen desaturation. It is concluded that the computer-assisted method, which is considerably less time consuming than traditional polysomnography, is reliable in studying sleep-related oxygenation in patients with chronic lung diseases.Abbreviations COPD chronic obstructive pulmonary disease - EEG electroencephalography - EMG electromyography - EOG electro-oculography - MIB movement in bed - REM rapid eye movement - SaO2 transcutaneous arterial oxygen saturation - SCSB static charge sensitive bed - TPL thoracoplasty - wSD within-patient standard deviation