The SleepStrip: an apnoea screener for the early detection of sleep apnoea syndrome.

Sleep apnoea svndrome (SAS) is a largely undiagnosed and prevalent disorder. It is associated with cardiovascular morbidity as well as excessive daytime sleepiness and poor quality of life. In the present study the SleepStrip, a novel screening device is introduced, which is low cost and easy to use and is aimed for widespread use. The results of three independent validation studies, which compared the SleepStrip score (Sscore) against "gold standard" polysomnographically-determined apnoea/ hypopnoea index (AHI), are reported both separately and combined. Four hundred and two patients suspected of SAS underwent full polysomnography recordings concomitantly with the use of the SleepStrip. For all samples combined, the correlation between AHI and Sscore was r=0.73, sensitivity and specificity values ranged from 80-86% and 57-86% respectively, and the area under the curve derived from receiver-operating characteristic curves ranged from 0.81-0.92 at varying AHI thresholds. Though not intended as a substitute for polysomnography, the SleepStrip may provide initial screening information, which may be useful in both clinical and experimental settings.     

Screening for early cognitive impairment in multiple sclerosis patients using the clock drawing test

The clock drawing test (CDT) is a complex task assessing integrative functions, abstract thinking and visuospatial organization. In the present study we evaluated the CDT as a possible screening instrument for early cognitive impairment in multiple sclerosis (MS) patients. In total, 107 MS patients completed the CDT as well as a battery assessing five cognitive domains. There were 73 female and 34 male participants (mean age 45.4+/-11.6 years, range 19-69). The majority (76/107) were diagnosed with a relapsing-remitting disease course. Mean expanded disability status scale (EDSS) score was 4.3+/-2.4 (range 0-8). The CDT was scored on a 1-6 point scale with "1" being a perfect score and "6" reflecting severe disorganization. Mean CDT score was 2.6+/-1.4. In 53% of patients the CDT was normal while in 11.2% dementia was apparent. The CDT score did not correlate with the total EDSS. Significant correlations were obtained with the mental functional system score of the EDSS (r = 0.78; p = 0.0001), visual learning and recall, sustained attention and concentration. Our findings demonstrate the sensitivity of the CDT to several cognitive domains. The absence of correlation with total EDSS score coupled with significant correlation with the mental functional system suggests that the CDT may be useful for screening MS patients.     

Immunohistochemical localization of three different prepro-GnRHs in the brain and pituitary of the European sea bass (Dicentrarchus labrax) using antibodies to the corresponding GnRH-associated peptides

The distribution of the cells expressing three prepro-gonadotrophin-releasing hormones (GnRH), corresponding to salmon GnRH (sGnRH), seabream GnRH (sbGnRH), and chicken GnRH-II (cGnRH-II) forms, was studied in the brain and pituitary of the sea bass (Dicentrarchus labrax) by using immunohistochemistry. To circumvent the cross-reactivity problems of antibodies raised to GnRH decapeptides, we used specific antibodies generated against the different sea bass GnRH-associated peptides (GAP): salmon GAP (sGAP), seabream GAP (sbGAP), and chicken-II GAP (cIIGAP). The salmon GAP immunostaining was mostly detected in terminal nerve neurons but also in ventral telencephalic and preoptic perikarya. Salmon GAP-immunoreactive (ir) fibers were observed mainly in the forebrain, although sGAP-ir projections were also evident in the optic tectum, mesencephalic tegmentum, and ventral rhombencephalon. The pituitary only receives a few sGAP-ir fibers. The seabream GAP-ir cells were mainly detected in the preoptic area. Nevertheless, sbGAP-ir neurons were also found in olfactory bulbs, ventral telencephalon, and ventrolateral hypothalamus. The sbGAP-ir fibers were only observed in the ventral forebrain, innervating strongly the pituitary gland. Finally, chicken-II GAP immunoreactivity was only detected in large synencephalic cells, which are the origin of a profuse innervation reaching the telencephalon, preoptic area, hypothalamus, thalamus, pretectum, posterior tuberculum, mesencephalic tectum and tegmentum, cerebellum, and rhombencephalon. However, no cIIGAP-ir fibers were detected in the hypophysis. These results corroborate the overlapping of sGAP- and sbGAP-expressing cells in the forebrain of the sea bass, and provide, for the first time, unambiguous information on the distribution of projections of the three different GnRH forms expressed in the brain of a single species.     

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.     

Defense mechanisms, negative emotions, and psychopathology in adolescent inpatients

Ego defense mechanisms were compared in adolescent psychiatric inpatients and healthy adolescents to determine their relationship to specific diagnoses and to negative emotions. Seventy-one patients with schizophrenia, 28 with major depressive disorder, and 24 with obsessive-compulsive disorder (OCD) and 87 normal adolescents were assessed for defense mechanisms by the Life Style Index (LSI) and Ego Defense Scale (EDS). The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Multidimensional Anger Inventory (MAI) were used to assess depression, anxiety, and anger. Several defenses distinguished all psychiatric patients from controls, and a few defenses characterized different patient groups, especially those with OCD. Projection (on the LSI), displacement, and regression correlated significantly with anger; displacement, reaction formation, and undoing on the EDS correlated with anxiety, and denial was negatively correlated with depression. These findings have some relevance for the evaluation of Plutchik's psychoevolutionary theory of emotions and for the further empirical study of defenses in psychopathology.     

Processing of irrelevant visual motion during performance of an auditory attention task

The extent to which irrelevant perception of visual motion distractors can be modulated by manipulating auditory load in a relevant task was assessed with Positron Emission Tomography (PET) and behavioural experiments. Subjects performed an auditory task and ignored an irrelevant visual motion stimulus, under two conditions. In a low load condition, subjects were asked to detect words spoken in a loud voice among words spoken in a quiet voice, while in a high load condition they attempted to detect bisyllabic words among monosyllabic and trisyllabic words. We found that motion-related visual areas were strongly activated by the irrelevant motion stimulus, compared to a static stimulus, under both conditions of load in the auditory task. In a second behavioural experiment, the duration of the motion after-effect was similarly unaffected by adaptation under low or high auditory load. These results are in clear contrast with the strong modulation of irrelevant motion processing by visual load, as reflected in the duration of the motion after effect (Section 6) and neural responses in motion-related visual areas (Rees et al., Science, (1997) 278, 338). These findings support the claim that attentional capacity is restricted within but not between sensory modalities, and indicate that processing of visual distractors may occur whenever there is sufficient visual capacity to process them, despite being task- and modality-irrelevant.     

Sleep characteristics of asthmatics in the first four years of life: a comparative study

The association between asthma and sleep disturbances was assessed as part of a community survey of sleep patterns in children aged 4-48 months. A questionnaire covering the area of past and present sleep and settling behaviour, as well as health history and demographic data, was administered to 752 mothers of children visiting 14 well baby clinics. Fifty one (6.8%) of the children who were diagnosed as having asthma by their paediatricians were compared with the remaining healthy controls (children with perinatal problems, other chronic illnesses, developmental problems, or repeat admissions to hospital were excluded). Thirty nine per cent of the children with asthma and 38% of the normal controls were identified as regular wakers. The number of interrupted nights each week, settling time, and sleep duration were comparable. In the children with asthma an uninterrupted night's sleep was acquired later than in the control group. Parental perception of the severity of the sleep problem was similar in the two groups, as were the calming techniques. It is concluded that this study does not support a significantly increased prevalence of sleep disturbances among young children with asthma compared with their healthy peers.     

Prevalence of hostility in young coronary artery disease patients and effects of cardiac rehabilitation and exercise training

OBJECTIVE: To determine the prevalence of hostility symptoms in young patients with coronary artery disease (CAD), the associated risk factor profile in these patients, and the effects of a formal phase 2 cardiac rehabilitation and exercise training program. PATIENTS AND METHODS: Our study included consecutive CAD patients referred for cardiac rehabilitation from May 1999 through December 2000. At baseline and after rehabilitation, behavioral factors and quality of life were assessed by validated questionnaires, and standard CAD risk factors were measured, including exercise capacity. We specifically evaluated detailed data for young patients. RESULTS: A total of 500 patients were included in the study. Hostility scores were 2.5 times higher (P<.001) in the 81 young patients (< 50 years; mean +/- SD age, 45 +/- 5 years) than in the 268 elderly patients (> or = 65 years; mean +/- SD age, 70 +/- 4 years), and the prevalence of hostility symptoms was 3.5 times higher in young patients (28% vs 8%; P<.001). Young patients with hostility symptoms also had more adverse CAD risk profiles, including higher total cholesterol levels, triglyceride levels, total cholesterol/high-density lipoprotein cholesterol ratios, fasting glucose levels, and glycosylated hemoglobin levels and lower quality-of-life scores compared with young patients with low hostility scores. After cardiac rehabilitation, young patients with hostility symptoms had marked improvements in CAD risk factors, behavioral characteristics (including hostility), and quality of life, and a nearly 50% (P=.005) reduction in the prevalence of hostility symptoms occurred. CONCLUSIONS: Young CAD patients have a high prevalence of hostility symptoms and adverse CAD risk profiles. Reducing hostility symptoms and other parameters of psychological distress in young CAD patients should be emphasized, and the potential benefits of cardiac rehabilitation programs in the secondary prevention of CAD should be highlighted.