Differential localization of carbachol- and bicuculline-sensitive pontine sites for eliciting REM sleep-like effects in anesthetized rats

Carbachol, a cholinergic agonist, and GABA_A receptor antagonists injected into the pontine dorsomedial reticular formation can trigger rapid eye movement (REM) sleep-like state. Data suggest that GABAergic and cholinergic effects interact to produce this effect but the sites where this occurs have not been delineated. In urethane-anesthetized rats, in which carbachol effectively elicits REM sleep-like episodes (REMSLE), we tested the ability of 10 nL microinjections of carbachol (10 m m ) and bicuculline (0.5 or 2 m m ) to elicit REMSLE at 47 sites located within the dorsal pontine reticular formation at the levels -8.00 to -10.80 from bregma (B) (Paxinos and Watson, The Rat Brain in Stereotaxic Coordinates , Academic Press, San Diego, 1997). At rostral levels, most carbachol and some bicuculline injections elicited REMSLE with latencies that gradually decreased from 242 to 12 s for carbachol and from 908 to 38 s for bicuculline for more caudal injection sites. As the latencies decreased, the durations of bicuculline-elicited REMSLE increased from 104 s to over 38 min, and the effect was dose dependent, whereas the duration of carbachol-elicited REMSLE changed little (104–354 s). Plots of REMSLE latency versus the antero-posterior coordinates revealed that both drugs were maximally effective near B-8.80. At levels caudal to B-8.80, carbachol was effective at few sites, whereas bicuculline-elicited REMSLE to at least B-9.30 level. Thus, the bicuculline-sensitive sites extended further caudally than those for carbachol and antagonism of GABA_A receptors both triggered REMSLE and controlled their duration, whereas carbachol effects on REMSLE duration were small or limited by its concurrent REMSLE-opposing actions.     

Sleep Disturbance in Midlife Women

Emphasizing midlife women, this review describes sleep and compares self-report sleep data with objective findings from laboratory studies of women. Sleep disturbance is a more prevalent complaint for women than men. Not due to chronologic age per se, it is associated with menopausal symptoms and most importantly with comorbidities and stress. Sleep problems in midlife women should not be attributed only to the menopausal symptom experience and should trigger a clinical evaluation. Assessment guidelines are included.     

止鼾枕对阻塞性睡眠呼吸暂停低通气综合征患者微觉醒、AHI以及血清中Th1、Th2细胞的影响

目的探讨止鼾枕对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者微觉醒、AHI以及Th1、Th2细胞的影响。方法将本院门诊或住院处就诊的41例OSAHS患者和17例单纯打鼾患者纳入本研究。本研究分为3组,分别为对照组(单纯打鼾患者)17例、OSAHS组(未经止鼾枕矫正)19例和OSAHS+止鼾枕矫正组(经止鼾枕矫正2周)22例。采用多导睡眠监测患者整晚的睡眠情况,记录患者的微觉醒次数和睡眠呼吸暂停低通气指数(AHI),运用流式细胞仪测定Th1和Th2细胞所占的比例。结果 3组受试者的年龄、性别比例以及BMI均无统计学差异(P0.05)。与对照组相比,OSAHS组患者的微觉醒次数显著增加(P0.05),AHI指数显著升高(P0.05),Th1细胞所占比例也大幅提升(P0.05),而Th2细胞所占比例则显著下降(P0.05)。与OSAHS组相比,OSAHS+止鼾枕组患者的微觉醒次数、AHI和Th1细胞所占比例均显著降低(P0.05)。结论 OSAHS患者微觉醒次数和AHI显著升高,体内Th1/Th2的平衡发生偏移,止鼾枕可以降低微觉醒次数和AHI的升高,并在一定程度上恢复Th1/Th2的动态平衡。     

睡眠性头痛的研究进展

睡眠性头痛是一种少见的与睡眠直接相关的原发性头痛.临床上以患者因头痛从睡眠中觉醒为特征,头痛多为轻到中度.本文简要综述睡眠性头痛的临床表现、病理生理、诊断及治疗.     

阻塞性睡眠呼吸暂停低通气综合征与脑梗塞患者脑出血的相关性研究

目的探究并分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与脑梗塞患者脑出血的相关性。方法我院收治的OSAHS合并脑出血患者45例,将其作为本次的研究对象,作为观察组;将同期入院的45例非OSAHS的脑出血患者作为对照组。观察并比较两组患者的各项指标情况、昏迷程度及预后。结果与对照组比较,观察组患者的MAP、GLU、LDL-C、Fg、HCT均较高,但氧饱和度低;观察组和对照组重度昏迷的人数分别占55.56%、20.00%,观察组昏迷情况较对照组严重,观察组的无效人数占71.11%,对照组占22.22%,观察组预后较对照组差,P<0.05。结论合并OSAHS的脑梗塞患者更易发生脑出血,且患者的昏迷程度较重,预后较差,OSAHS是导致脑出血的重要危险因素。     

Obstructive sleep apnoea – an update

Obstructive sleep apnoea (OSA) is a common disorder characterized by the repetitive complete or partial collapse of the upper airway during sleep. It results in intermittent hypoxaemia and hypercapnia, cortical arousals and surges of sympathetic activity. The occurrence of OSA has also been linked to serious long‐term adverse health consequences; such as hypertension, metabolic dysfunction, cardiovascular disease, neurocognitive deficits and motor vehicle accidents. There have been several advances in the field of particular clinical importance: (i) the development of portable monitoring as part of a simplified clinical algorithm for the diagnosis of OSA in selected patients; (ii) growing awareness of the cardio‐metabolic health consequences of OSA and (iii) emerging evidence to support a range of non‐continuous positive airway pressure (CPAP) treatment modalities, such as oral appliances.     

Quality of sleep, fatigue and daytime sleepiness in migraine— a controlled study

The objective of this study was to evaluate whether the quality of sleep and the degree of fatigue and daytime sleepiness are related to migraine. We investigated 489 subjects comprising 97 patients with eight or more, 77 patients with five to seven and 196 patients with one to four migraine days per month, and 119 migraine-free controls with fewer than six headache days per year. The patients were recruited via articles in newspapers not stressing the subject of the study. All participants underwent a semistructured interview and completed the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS) and the Self-rating Depression Scale and the Self-rating Anxiety Scale. For statistical analysis we used two way manova s, post hoc univariate two-way anova s and Hochberg's GT2 tests as well as three-way mixed design anova s. The PSQI total score was highest in patients with frequent migraine (5.9 ± 4.3) and lowest in controls (4.3 ± 2.5, P  = 0.04). Four subscores of the PSQI showed similar statistically significant differences. The FSS and ESS scores did not differ in the four study groups. Analysing depression and anxiety revealed a significant impact on PSQI, FSS and ESS, but did not demonstrate interactions with migraine, thus suggesting that the impact of migraine is similar in patients without and with psychiatric comorbidity. In conclusion, the quality of sleep is decreased in patients with migraine, whereas fatigue and daytime sleepiness do not differ from healthy controls. The decreased quality of sleep in migraineurs is also a consequence of migraine itself and cannot be explained exclusively by comorbidity with depression or anxiety.     

Stress and quality of sleep among individuals diagnosed with diabetes

Several studies have suggested that stress and sleep may be related to diabetic disease progression. Cortisol is one physiological indicator of stress that has been well validated in previous research. The primary objectives of the present study were (1) to examine the experiences of stress among patients diagnosed with diabetes and (2) to evaluate the quality of sleep among these participants. Participants (mean age = 34.99 years) were 20 adolescents and adults with Diabetes Mellitus; 13 had Type 1 and 17 were female. Primary measures included actigraphy, the Pittsburgh Sleep Quality Index (PSQI), salivary cortisol and the Perceived Stress Scale (PSS). Participants reported a moderate amount of stress (mean PSS scores = 20.2), slept an average of 6.51 h and exhibited at least one clinical indicator of sleep disturbance. Objectively measured total sleep time was associated with awakening cortisol (r = 0.62, p = 0.004) and PSQI Global scores (r = ‐0.51, p = 0.021). Awakening cortisol and PSS scores were not associated with PSQI Global scores, but were related to specific self‐reported sleep disturbances. Given the interacting physiological pathways of stress and sleep, both of which were evident in this small sample, these variables warrant further study. Copyright © 2009 John Wiley & Sons, Ltd.