Severe sleep problems among infants in a normal population in Sweden: prevalence, severity and correlates

The aim of this study was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2518 infants aged 6-18 mo. Correlates to severe sleep problems were sought. The families were approached using a questionnaire and 83% responded. Data from the collection procedure point to a non-selective dropout. Sixteen percent of the parents reported their children as having moderate or severe difficulties in falling asleep at night (sleep refusal, bedtime struggles) and 30% reported frequent night waking. Almost all (93%) of the parents had sought help at the Child Health Centre (CHC), but only 48% were satisfied with the support and advice they got. Severe sleep problems as defined by the ICSD (International Classification of Sleep Disorders, 1990) were found in 129 of the children (6.2%), who were studied in detail, with the rest of the population as controls. Severe sleep problems were found to be correlated with parental worries and anxiety concerning infant health (although the children were reported as being as healthy as the controls), infant feeding problems and intensive parental interventional behaviour (especially feeding) during the evening and night. A common factor of insecurity in the parental role is suggested.     

Efficacy and safety assessment of expiratory positive airway pressure (EPAP) mask for OSAHS therapy

Objective

We have designed the expiratory positive airway pressure (EPAP) mask to provide a new sort of therapeutic strategies for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). And this study aims to assess the safety, efficacy and compliance of the EPAP therapy.

Effects of daytime administration of zolpidem versus triazolam on memory

To determine whether zolpidem (an imidazopyridine hypnotic) produces amnestic effects which are similar to those produced by triazolam (a benzodiazepine hypnotic), 70 subjects were administered either triazolam (0.125, 0.25, or 0.5 mg), zolpidem (5, 10 or 15 mg) or placebo, then tested on Simulated Escape, Restricted Reminding, and Paired-Associates memory tests at 1.5 hours post-dosing (i.e., near the time of estimated peak blood concentration for both drugs) and again at 6 hours post-dosing. Triazolam 0.5 mg produced the greatest memory impairment at both test times, and also produced the greatest degree of sedation during intervening daytime naps in a non-sleep-conducive environment. Other doses of triazolam and zolpidem produced less memory impairment, but also failed to significantly enhance sleep. The results are consistent with the view that the amnestic and hypnotic effects of these sleep-inducing medications are functionally coupled.     

Enhancement of acetylcholine release during REM sleep in the caudomedial medulla as measured by in vivo microdialysis

Previous studies in our laboratory have found that muscle atonia could be triggered by two distinct areas of the medial medulla, a caudal region, corresponding to the nucleus paramedianus (NPM) and a rostral region, corresponding to the nucleus magnocellularis (NMC). The former region is responsive to acetylcholine (ACh) and the latter region is responsive to glutamate. In this study we have measured the endogenous ACh release across the sleep-wake cycle in these two areas with the microdialysis technique in unanesthetized, freely moving cats. We found that ACh release in NPM was state-dependent and was about 30% higher ( P0.001) during rapid eye movement (REM) sleep than during slow-wave sleep and wakefulness. However, ACh release in NMC was not selectively elevated in REM sleep. The enhancement of ACh release in NPM during REM sleep supports our hypothesis that ACh release onto cholinoceptive neurons in this area mediates the muscle atonia of REM sleep.     

耳塞改善噪声环境中睡眠效果的观察

对探讨在噪声控制中的睡眠防护问题，设计了三种状态的睡眠实验；（１）安静状态，背景噪声低于４５ｄＢ（Ａ）；（２）噪声状态，环境噪声９０ｄＢ（Ａ）；（３）噪声防护状态，环境噪声９０ｄＢ（Ａ），受试者配戴耳塞，睡眠期间记录了６名受试得的脑电，眼动和肌电，分析了睡眠潜伏期，醒觉次数和时间，各期睡眠率和总睡眠率，结果表明，耳塞对噪声环境中睡眠有改善作用。     

Poor sleepers who do not complain of insomnia: Myths and realities about psychological and lifestyle characteristics of older good and poor sleepers

Psychological adjustment, lifestyle, and sleep parameters were investigated in 634 older community residents. Participants were divided into three categories: good sleepers, poor sleepers experiencing high distress, and poor sleepers experiencing minimal distress. Results indicate that (1) highly distressed poor sleepers manifested an anxious, depressed, negative cognitive-affective set; (2) many coped well with age related changes in sleep quality—they resembled good sleepers in the relative absence of psychological maladjustment they displayed; (3) the three groups had similar lifestyles, but they differed in the cognitive-affective evaluation of their activities, (4) the insomnia complaint is itself multifaceted and is comprised of three distinct elements—difficulty sleeping, distress, and daytime fatigue; (5) sleep practices (e.g., naps, bedtimes) are not implicated in chronic poor sleep; and (6) many commonly held assumptions about sleep disruptions in older individuals are myth rather than reality. Implications for better understanding and treating insomnia in older individuals are discussed.This article was prepared during the tenure of grants from the Conseil Québécois de la recherche sociale, Health and Welfare Canada, and the Direction générale de l'enseignement collégial. We are grateful for the generous support of these organizations. In addition, we would like to thank the dedicated members of our research team: Sally Bailes, Ann Gay, Jason Lavers, John Martos, Kathleen McAdams, Vicki Tagalakis, and most especially, Harriet Lennox for their substantial contribution to this research.Dawson College.Sir Mortimer B. Davis—Jewish General Hospital.Concordia University.McGill University.     

Detection of periodic leg movements with a static-charge-sensitive bed

SUMMARY We evaluated the performance of the static-charge-sensitive bed (SCSB), a non- invasive movement sensor, in detecting nocturnal periodic movement activity using simultaneous bilateral anterior tibialis electromyography (EMG,) as a reference. Two different study setups were used, one with 500 random record extracts, another with 10 continuous recordings. The inter-rater reliability between two independent scorers was 0.92 in scoring EMG, and 0.91 in scoring SCSB. In an epoch based analysis, depending on the study setup and scorer, the sensitivity of the SCSB to detect periodic leg movements was 0.81-0.94 whereas the specificity was 0.84-0.89. In a movement-by-movement analysis, despite incomplete concordance between the two methods the total number of movements per hour were comparable. Our findings support the use of the SCSB as a non-invasive alternative to anterior tibialis EMG recordings to reveal the presence of nocturnal periodic movement activity and estimate its frequency.     

Polysomnography and body temperature changes by phototherapy in a delayed sleep phase syndrome case

Abstract We examined polysomnography (PSG) and body temperature in a patient with delayed sleep phase syndrome who responded to phototherapy. The patient was a 31-year-old woman whose condition had slightly improved by a vitamin B₁₂ administration. Phototherapy was administered to her in combination with the vitamin B₁₂ medication, and this combined treatment successfully advanced her delayed sleep phase. On PSG, the regimen showed shortened sleep latency, decreased total sleep time and stages 1 and 2 sleep, and increased slow wave sleep. Phototherapy also improved temporal distribution of delta half-waves (0.5-2.0 Hz, 31 µV) as well as phase relationship between sleep and body temperature.     

New insights into the therapy and pathophysiology of patients with obstructive sleep apnoea syndrome

Abstract The objective of this study was to investigate the effects of obstructive sleep apnoea on: (i) PaCO₂ levels; (ii) coagulation systems (plasma fibrinogen levels and whole blood viscosity); and (iii) heat shock proteins (HSPs) levels, which are also called stress proteins, in patients with obstructive sleep apnoea syndrome (OSAS). Patients treated with or without nasal continuous positive airway pressure (NCPAP) had arterial blood gases, plasma fibrinogen, haematocrit, serum total protein and changes in PaCO₂ (estimated by transcutaneous PaCO₂) measured before and after polysomnography. Heat shock protein 72 levels in peripheral blood mononuclear cells were also measured during sleep with and without NCPAP. OSAS patients with hypercapnia demonstrated significant increases in PaCO₂ in the morning compared with the previous night. In such OSAS patients, treatment with NCPAP resulted in a normalization of the 20 mg/dL increase in fibrinogen levels which had been seen previously in the morning after sleep. Basal HSP 72 levels (08.00 pm before sleep) were high in OSAS patients compared to normal subjects and progressively decreased during sleep in the absence of NCPAP therapy. NCPAP relieved disabling day-to-day symptoms in addition to improving cardiovascular morbidity in patients with OSAS. Therefore it is important to understand the effects of OSAS on various organ systems as the prevalence of patients with OSAS is high.     

Difficult laryngoscopy and cephalometric roentgenograms in obstructive sleep apnea syndrome patients undergoing uvulopalatopharyngoplasty

We retrospectively studied the incidence of difficult laryngoscopy in 53 subjects with obstructive sleep apnea syndrome (OSAS) undergoing uvulopalatopharyngoplasty (UPPP) and 72 subjects with chronic otitis media undergoing tympanoplasty (control group). The incidence of difficult laryngoscopy in the UPPP group was significantly higher than in the control group (18.9%vs 4.2%,P<0.001). To analyze the anatomical findings of difficult laryngoscopy in UPPP patients, cephalometric roentgenograms were compared between patients in whom direct laryngoscopy was difficult (difficult patients,n=10) and patients in whom direct laryngoscopy was not difficult (nondifficult patients,n=43). Cephalometric atlanto-occipital distance (cAOD) was less than 4mm in 80% of the difficult patients, and there were significant differences between the difficult patients and the nondifficult patients (2.8±3.3 mmvs 6.7±3.0 mm, mean ±SD,P<0.001). There were significant differences in cephalometric effective mandibular length/cephalometric posterior depth of mandible ratio (cEML/cPDM) between the difficult patients and the nondifficult patients (4.0±0.6vs 4.5 ±0.8,P<0.01); however, the calculation of cEML/cPDM was more difficult than cAOD. We concluded that OSAS patients undergoing UPPP are at high risk for difficult laryngoscopy, and that cAOD calculated from cephalometric roentgenograms is an easy and sensitive predictive indicator for the estimation of difficult laryngoscopy.