Pub Date : 2020-02-04eCollection Date: 2020-01-01DOI: 10.1155/2020/7846914
George Zabrecky, Shiva Shahrampour, Cutler Whitely, Mahdi Alizadeh, Chris Conklin, Nancy Wintering, Karl Doghramji, Tingting Zhan, Feroze Mohamed, Andrew Newberg, Daniel Monti
Background: It is well known that vibratory and auditory stimuli from vehicles such as cars and trains can help induce sleep. More recent literature suggests that specific types of vibratory and acoustic stimulation might help promote sleep, but this has not been tested with neuroimaging. Thus, the purpose of this study was to observe the effects of vibroacoustic stimulation (providing both vibratory and auditory stimuli) on functional connectivity changes in the brain using resting state functional magnetic resonance imaging (rs-fMRI), and compare these changes to improvements in sleep in patients with insomnia.
Methods: For this study, 30 patients with insomnia were randomly assigned to receive one month of a vibroacoustic stimulation or be placed in a waitlist control. Patients were evaluated pre- and postprogram with qualitative sleep questionnaires and measurement of sleep duration with an actigraphy watch. In addition, patients underwent rs-fMRI to assess functional connectivity.
Results: The results demonstrated that those patients receiving the vibroacoustic stimulation had significant improvements in measured sleep minutes as well as in scores on the Insomnia Severity Index questionnaire. In addition, significant changes were noted in functional connectivity in association with the vermis, cerebellar hemispheres, thalamus, sensorimotor area, nucleus accumbens, and prefrontal cortex.
Conclusions: The results of this study show that vibroacoustic stimulation alters the brain's functional connectivity as well as improves sleep in patients with insomnia.
{"title":"An fMRI Study of the Effects of Vibroacoustic Stimulation on Functional Connectivity in Patients with Insomnia.","authors":"George Zabrecky, Shiva Shahrampour, Cutler Whitely, Mahdi Alizadeh, Chris Conklin, Nancy Wintering, Karl Doghramji, Tingting Zhan, Feroze Mohamed, Andrew Newberg, Daniel Monti","doi":"10.1155/2020/7846914","DOIUrl":"10.1155/2020/7846914","url":null,"abstract":"<p><strong>Background: </strong>It is well known that vibratory and auditory stimuli from vehicles such as cars and trains can help induce sleep. More recent literature suggests that specific types of vibratory and acoustic stimulation might help promote sleep, but this has not been tested with neuroimaging. Thus, the purpose of this study was to observe the effects of vibroacoustic stimulation (providing both vibratory and auditory stimuli) on functional connectivity changes in the brain using resting state functional magnetic resonance imaging (rs-fMRI), and compare these changes to improvements in sleep in patients with insomnia.</p><p><strong>Methods: </strong>For this study, 30 patients with insomnia were randomly assigned to receive one month of a vibroacoustic stimulation or be placed in a waitlist control. Patients were evaluated pre- and postprogram with qualitative sleep questionnaires and measurement of sleep duration with an actigraphy watch. In addition, patients underwent rs-fMRI to assess functional connectivity.</p><p><strong>Results: </strong>The results demonstrated that those patients receiving the vibroacoustic stimulation had significant improvements in measured sleep minutes as well as in scores on the Insomnia Severity Index questionnaire. In addition, significant changes were noted in functional connectivity in association with the vermis, cerebellar hemispheres, thalamus, sensorimotor area, nucleus accumbens, and prefrontal cortex.</p><p><strong>Conclusions: </strong>The results of this study show that vibroacoustic stimulation alters the brain's functional connectivity as well as improves sleep in patients with insomnia.</p>","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"2020 ","pages":"7846914"},"PeriodicalIF":0.0,"publicationDate":"2020-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37670259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28eCollection Date: 2020-01-01DOI: 10.1155/2020/5316364
Maria Jose Miguez, Diego Bueno, Caroline Perez
Background. Disparities in sleep disturbances have been described in adults; nevertheless, among adolescents, data have yielded conflicting results. Therefore, analyses of our cohort study of 500 urban, normally developed Hispanic adolescents (10-18 years), aim to determine if rates of sleep debt differ between: (a) male and female adolescents, (b) US-born Hispanics and first-generation immigrant ethnic counterparts, and (c) specific activities that these teens trade for sleep. Participants' weekday and weekend sleep patterns, along with the reasons for sleeping less than the recommended hours were recorded. Standardized surveys were used to gather information regarding sociodemographics, migration, acculturation, and medical history. Using the criteria set forth by the National Sleep Foundation, analyses indicated that sleep deprivation is a pervasive problem, with 75% in the preadolescents and 45% of the late adolescents exhibiting sleep problems. Females slept on average at least one hour less per day than their male counterparts (7 vs. 8 hours). The sleep problems were rooted in several overlapping causes, including use of technology, video games, studying, and employment. Nevertheless, reasons for sleep loss differed by gender and by immigrant status. Multivariable adjusted logistic regression analyses showed that females, US-born teens, and preadolescents had higher odds of being sleep deprived. Pediatricians and sleep experts should be aware of gender-specific causes and responses of sleep problems. Cultural ecological frameworks need to be considered, and clearly indicate that findings may not generalize to youth from other cultural backgrounds.
{"title":"Disparities in Sleep Health among Adolescents: The Role of Sex, Age, and Migration.","authors":"Maria Jose Miguez, Diego Bueno, Caroline Perez","doi":"10.1155/2020/5316364","DOIUrl":"https://doi.org/10.1155/2020/5316364","url":null,"abstract":"<p><p><i>Background.</i> Disparities in sleep disturbances have been described in adults; nevertheless, among adolescents, data have yielded conflicting results. Therefore, analyses of our cohort study of 500 urban, normally developed Hispanic adolescents (10-18 years), aim to determine if rates of sleep debt differ between: (a) male and female adolescents, (b) US-born Hispanics and first-generation immigrant ethnic counterparts, and (c) specific activities that these teens trade for sleep. Participants' weekday and weekend sleep patterns, along with the reasons for sleeping less than the recommended hours were recorded. Standardized surveys were used to gather information regarding sociodemographics, migration, acculturation, and medical history. Using the criteria set forth by the National Sleep Foundation, analyses indicated that sleep deprivation is a pervasive problem, with 75% in the preadolescents and 45% of the late adolescents exhibiting sleep problems. Females slept on average at least one hour less per day than their male counterparts (7 vs. 8 hours). The sleep problems were rooted in several overlapping causes, including use of technology, video games, studying, and employment. Nevertheless, reasons for sleep loss differed by gender and by immigrant status. Multivariable adjusted logistic regression analyses showed that females, US-born teens, and preadolescents had higher odds of being sleep deprived. Pediatricians and sleep experts should be aware of gender-specific causes and responses of sleep problems. Cultural ecological frameworks need to be considered, and clearly indicate that findings may not generalize to youth from other cultural backgrounds.</p>","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"2020 ","pages":"5316364"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5316364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37670258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Data in the literature has shown poor sleep quality to be frequently observed in hospitalized patients and known to be associated with poor treatment outcome. Many factors may impact poor sleep quality, and there is currently limited available data. We aim to determine the prevalence of poor sleep quality and associated factors in patients admitted to internal medicine wards as well as the change of sleep quality over time after admission.
Methods: An analytic observational study was conducted at the internal medicine wards at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients were personally interviewed to evaluate the history of sleep quality at home, sleep quality after the first and the third days of admission, and potential associated factors. The Pittsburgh Sleep Quality Index and screening questionnaires for the common diseases associated with poor sleep quality were also utilized. The logistic regression analysis was used to determine the independent factors which led to poor sleep quality.
Results: Data were collected from 96 patients during the period of June 2015 to February 2016. The mean age of the patients was 50.8 ± 16.7 years, and 51% were male. Infectious disease was the most common principal diagnosis accounted for 29.2%. The results show high prevalence of poor sleep quality after the first night of admission compared to baseline sleep quality at home (50% vs. 18.8%; p < 0.001). After 3 days of admission, the prevalence of poor sleep quality was reduced to the level close to baseline sleep quality at home (28.1% vs. 18.8%; p = 0.13). Multivariate analysis demonstrated that light exposure and pain were the main independent factors for poor sleep quality on the first day (odds ratio 6.68; 95% CI 2.25-19.84) and on the third day (odds ratio 3.47; 95% CI 1.24-9.71), respectively.
Conclusions: This is the first study conducted on the sleep quality of hospitalized patients that included the follow-up period during hospital admission. Our study demonstrated high prevalence of poor sleep quality in hospitalized patients on the first day. Interestingly, the sleep quality was partly improved during hospitalization. Light exposure and pain were demonstrated to be the factors associated with poor sleep quality.
背景:文献资料显示，住院患者经常观察到睡眠质量差，并且已知睡眠质量差与治疗效果差有关。许多因素可能影响睡眠质量差，目前可用的数据有限。我们的目的是确定内科病房住院患者睡眠质量差的患病率及相关因素，以及住院后睡眠质量随时间的变化。方法:在泰国曼谷朱拉隆功国王纪念医院内科病房进行了一项分析性观察研究。对患者进行个人访谈，评估患者在家中的睡眠质量史、入院第1天和第3天后的睡眠质量以及潜在的相关因素。匹兹堡睡眠质量指数和与睡眠质量差相关的常见疾病的筛选问卷也被使用。采用logistic回归分析确定导致睡眠质量差的独立因素。结果:收集了2015年6月至2016年2月期间96例患者的数据。患者平均年龄50.8±16.7岁，男性占51%。传染病是最常见的主要诊断，占29.2%。结果显示，与在家时的基线睡眠质量相比，入院后第一晚睡眠质量差的患病率较高(50%比18.8%;P < 0.001)。入院3天后，睡眠质量差的患病率降至接近家中基线睡眠质量的水平(28.1% vs. 18.8%;P = 0.13)。多因素分析显示，光照和疼痛是第一天睡眠质量差的主要独立因素(优势比6.68;95% CI 2.25-19.84)和第三天(优势比3.47;95% CI 1.24-9.71)。结论:本研究首次对住院患者的睡眠质量进行了纳入住院期间随访期的研究。我们的研究表明，住院患者第一天睡眠质量差的发生率很高。有趣的是，住院期间睡眠质量得到了部分改善。光照和疼痛被证明是与睡眠质量差相关的因素。
{"title":"Sleep Quality of Hospitalized Patients, Contributing Factors, and Prevalence of Associated Disorders.","authors":"Santi Kulpatcharapong, Pol Chewcharat, Kiat Ruxrungtham, Sutep Gonlachanvit, Tanisa Patcharatrakul, Busarakum Chaitusaney, Dittapol Muntham, Sirimon Reutrakul, Naricha Chirakalwasan","doi":"10.1155/2020/8518396","DOIUrl":"https://doi.org/10.1155/2020/8518396","url":null,"abstract":"<p><strong>Background: </strong>Data in the literature has shown poor sleep quality to be frequently observed in hospitalized patients and known to be associated with poor treatment outcome. Many factors may impact poor sleep quality, and there is currently limited available data. We aim to determine the prevalence of poor sleep quality and associated factors in patients admitted to internal medicine wards as well as the change of sleep quality over time after admission.</p><p><strong>Methods: </strong>An analytic observational study was conducted at the internal medicine wards at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients were personally interviewed to evaluate the history of sleep quality at home, sleep quality after the first and the third days of admission, and potential associated factors. The Pittsburgh Sleep Quality Index and screening questionnaires for the common diseases associated with poor sleep quality were also utilized. The logistic regression analysis was used to determine the independent factors which led to poor sleep quality.</p><p><strong>Results: </strong>Data were collected from 96 patients during the period of June 2015 to February 2016. The mean age of the patients was 50.8 ± 16.7 years, and 51% were male. Infectious disease was the most common principal diagnosis accounted for 29.2%. The results show high prevalence of poor sleep quality after the first night of admission compared to baseline sleep quality at home (50% vs. 18.8%; <i>p</i> < 0.001). After 3 days of admission, the prevalence of poor sleep quality was reduced to the level close to baseline sleep quality at home (28.1% vs. 18.8%; <i>p</i> = 0.13). Multivariate analysis demonstrated that light exposure and pain were the main independent factors for poor sleep quality on the first day (odds ratio 6.68; 95% CI 2.25-19.84) and on the third day (odds ratio 3.47; 95% CI 1.24-9.71), respectively.</p><p><strong>Conclusions: </strong>This is the first study conducted on the sleep quality of hospitalized patients that included the follow-up period during hospital admission. Our study demonstrated high prevalence of poor sleep quality in hospitalized patients on the first day. Interestingly, the sleep quality was partly improved during hospitalization. Light exposure and pain were demonstrated to be the factors associated with poor sleep quality.</p>","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"2020 ","pages":"8518396"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8518396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37849632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Facco, Victoria Lopata, Jennifer Wolsk, S. Patel, S. Wisniewski
Objective To evaluate the performance of a type III home sleep testing (HST) monitor including its autoscoring algorithm, in a population of obese pregnant women. Methods This was an ancillary study of an ongoing prospective study of obese (BMI of ≥30) pregnant women. For the primary study, women undergo serial in-lab polysomnograms (PSG) during pregnancy. Sleep apnea was defined as an apnea hypopnea index (AHI) of ≥ 5 events/hour. A subgroup of women were asked to wear an ApneaLink HST device for 1 night, within 2 weeks of a late pregnancy PSG (≥ 28 weeks' gestation). The AHI obtained from PSG was compared to the AHI from the HST via autoscoring (HST-auto) as well as the AHI via technician scoring (HST-tech). We calculated Shrout Fleiss Fixed correlation coefficients (ICC) and looked at positive-positive and negative-negative agreement. Results 43 women were recruited and we obtained 30 valid HST. The mean PSH AHI was 3.3 (±3.2, range 0.5-16.6). Six (20%) women had a positive PSG study. ICCs were 0.78 for HST-auto versus HST-tech, 0.76 for HST-auto versus PSG, and 0.70 for HST-tech versus PSG. Categorical agreement was also strong, with 24/30 (80.0%) for HST-auto versus HST-tech, 25/30 (83.3%) for HST-auto versus PSG, and 23/30 (76.7%) for HST-tech versus PSG. Conclusion In obese women evaluated in late pregnancy, we found relatively high intraclass correlation and categorical agreement among HST-auto scores, HST-tech scores, and in-lab PSG results obtained within a two-week window. These results suggest that HST may be used to screen pregnant women for OSA.
{"title":"Can We Use Home Sleep Testing for the Evaluation of Sleep Apnea in Obese Pregnant Women?","authors":"F. Facco, Victoria Lopata, Jennifer Wolsk, S. Patel, S. Wisniewski","doi":"10.1155/2019/3827579","DOIUrl":"https://doi.org/10.1155/2019/3827579","url":null,"abstract":"Objective To evaluate the performance of a type III home sleep testing (HST) monitor including its autoscoring algorithm, in a population of obese pregnant women. Methods This was an ancillary study of an ongoing prospective study of obese (BMI of ≥30) pregnant women. For the primary study, women undergo serial in-lab polysomnograms (PSG) during pregnancy. Sleep apnea was defined as an apnea hypopnea index (AHI) of ≥ 5 events/hour. A subgroup of women were asked to wear an ApneaLink HST device for 1 night, within 2 weeks of a late pregnancy PSG (≥ 28 weeks' gestation). The AHI obtained from PSG was compared to the AHI from the HST via autoscoring (HST-auto) as well as the AHI via technician scoring (HST-tech). We calculated Shrout Fleiss Fixed correlation coefficients (ICC) and looked at positive-positive and negative-negative agreement. Results 43 women were recruited and we obtained 30 valid HST. The mean PSH AHI was 3.3 (±3.2, range 0.5-16.6). Six (20%) women had a positive PSG study. ICCs were 0.78 for HST-auto versus HST-tech, 0.76 for HST-auto versus PSG, and 0.70 for HST-tech versus PSG. Categorical agreement was also strong, with 24/30 (80.0%) for HST-auto versus HST-tech, 25/30 (83.3%) for HST-auto versus PSG, and 23/30 (76.7%) for HST-tech versus PSG. Conclusion In obese women evaluated in late pregnancy, we found relatively high intraclass correlation and categorical agreement among HST-auto scores, HST-tech scores, and in-lab PSG results obtained within a two-week window. These results suggest that HST may be used to screen pregnant women for OSA.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84425104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0047
C. Ievers-Landis, C. Rosen
Difficulty falling asleep and frequent nocturnal awakenings are common sleep problems in young children. These are highly influenced by parent choices about sleep schedules, bedtime routines, and psychosocial factors but are usually very treatable with effective behavioral interventions. Parents may respond with actions that actually end up perpetuating sleep problems based on their beliefs about the nature of the sleep disturbances. Parents may misattribute the sleep disturbance to other medical problems or misinterpret benign sleep disturbances such as confusional arousals. Even if these conditions are ruled out or identified, the learned negative sleep-onset associations can be challenging to alter. Fortunately, children’s sleep habits are amenable to change when caregivers apply empirically supported behavioral sleep medicine strategies. Sleep physicians and psychologists specializing in behavioral sleep medicine can work collaboratively to solve the mystery of complex toddler sleep problems, tailoring parent guidance and behavioral treatments to the individual child and family dynamics.
{"title":"The Curious Incident of the Toddler Who Wakes and Flails in Pain in the Night","authors":"C. Ievers-Landis, C. Rosen","doi":"10.1093/MED/9780190671099.003.0047","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0047","url":null,"abstract":"Difficulty falling asleep and frequent nocturnal awakenings are common sleep problems in young children. These are highly influenced by parent choices about sleep schedules, bedtime routines, and psychosocial factors but are usually very treatable with effective behavioral interventions. Parents may respond with actions that actually end up perpetuating sleep problems based on their beliefs about the nature of the sleep disturbances. Parents may misattribute the sleep disturbance to other medical problems or misinterpret benign sleep disturbances such as confusional arousals. Even if these conditions are ruled out or identified, the learned negative sleep-onset associations can be challenging to alter. Fortunately, children’s sleep habits are amenable to change when caregivers apply empirically supported behavioral sleep medicine strategies. Sleep physicians and psychologists specializing in behavioral sleep medicine can work collaboratively to solve the mystery of complex toddler sleep problems, tailoring parent guidance and behavioral treatments to the individual child and family dynamics.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74578595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/med/9780190671099.003.0045
A. May, R. Mehra
This chapter evaluates strategies for obstructive sleep apnea (OSA) testing and discusses the risk for arrhythmia in patients with OSA. Arrhythmia generation has been associated with sleep apnea, and the case presented here highlights that particularly in heart failure, respiratory events can be a ventricular arrhythmia trigger secondary to OSA-related physiologic consequences such as autonomic nervous system fluctuations, intrathoracic pressure alterations, and upregulation of pathways of systemic inflammation. Untreated OSA increases the risk for sudden cardiac death, particularly between midnight and 6 a.m. Individuals with heart failure, even if they do not report sleepiness, should be evaluated for OSA, as nearly half will have this disorder. Limited data suggest that OSA treatment can decrease arrhythmogenesis in heart failure and may be a potential avenue to decrease morbidity in patients with heart failure.
{"title":"Not for the Faint of Heart","authors":"A. May, R. Mehra","doi":"10.1093/med/9780190671099.003.0045","DOIUrl":"https://doi.org/10.1093/med/9780190671099.003.0045","url":null,"abstract":"This chapter evaluates strategies for obstructive sleep apnea (OSA) testing and discusses the risk for arrhythmia in patients with OSA. Arrhythmia generation has been associated with sleep apnea, and the case presented here highlights that particularly in heart failure, respiratory events can be a ventricular arrhythmia trigger secondary to OSA-related physiologic consequences such as autonomic nervous system fluctuations, intrathoracic pressure alterations, and upregulation of pathways of systemic inflammation. Untreated OSA increases the risk for sudden cardiac death, particularly between midnight and 6 a.m. Individuals with heart failure, even if they do not report sleepiness, should be evaluated for OSA, as nearly half will have this disorder. Limited data suggest that OSA treatment can decrease arrhythmogenesis in heart failure and may be a potential avenue to decrease morbidity in patients with heart failure.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79813612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0034
Carlos L. Rodriguez, Jagan A. Pillai
This chapter reviews the diagnosis and management of irregular sleep/wake rhythm disorder (ISWRD) and sundowning. ISWRD is characterized by lack of a clearly defined sleep/wake circadian rhythm with episodes of sleep and wake at varying times of the day or night, unrelated to a normal sleep/wake, day/night circadian rhythm Patients with neurodegenerative disorders are at increased risk for ISWRD. The diagnosis of ISWRD requires sleep log or actigraphy monitoring for at least 7 days. ISWRD is a common cause of institutionalization. Sundowning can further disrupt sleep and has been associated with more rapid progression of dementia. Mixed-modality treatment is used for the treatment of ISWRD and involves the integration of approaches to optimize entrainment to synchronizing factors and behavioral therapy.
{"title":"Deep into that Darkness Peering . . . Stood There Wondering, Fearing","authors":"Carlos L. Rodriguez, Jagan A. Pillai","doi":"10.1093/MED/9780190671099.003.0034","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0034","url":null,"abstract":"This chapter reviews the diagnosis and management of irregular sleep/wake rhythm disorder (ISWRD) and sundowning. ISWRD is characterized by lack of a clearly defined sleep/wake circadian rhythm with episodes of sleep and wake at varying times of the day or night, unrelated to a normal sleep/wake, day/night circadian rhythm Patients with neurodegenerative disorders are at increased risk for ISWRD. The diagnosis of ISWRD requires sleep log or actigraphy monitoring for at least 7 days. ISWRD is a common cause of institutionalization. Sundowning can further disrupt sleep and has been associated with more rapid progression of dementia. Mixed-modality treatment is used for the treatment of ISWRD and involves the integration of approaches to optimize entrainment to synchronizing factors and behavioral therapy.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84291961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0004
A. Avidan, M. Grigg-Damberger
Two cases of non–rapid-eye-movement (NREM) arousal parasomnias in adults are discussed in this chapter. NREM arousal parasomnias occur in 2% of adults and are often triggered by sleep deprivation, emotional stress, circadian rhythm disorders, and sleep fragmentation. Disorders of arousal include confusional arousal, sleepwalking, and sleep terrors. Research into the pathogenesis of arousal disorders in adults suggests that they reflect aberrant slow-wave sleep regulation, impaired arousal specifically from NREM 3 sleep, and/or sleep/wake state dissociations. Treatment of DoA includes avoidance of sleep deprivation/restriction, irregular sleep/wake schedules, and predisposing/precipitating factors. Pharmacotherapy can be considered when events pose a danger and/or sleep disturbance to the patient and/or others; involve potentially violent, dangerous, or sexual behavior; are frequent, chronic, and refractory to initial therapies; and/or have secondary consequences such as excessive daytime sleepiness, impaired quality of life, excessive weight gain, and injuries.
{"title":"LA Night Moves","authors":"A. Avidan, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0004","url":null,"abstract":"Two cases of non–rapid-eye-movement (NREM) arousal parasomnias in adults are discussed in this chapter. NREM arousal parasomnias occur in 2% of adults and are often triggered by sleep deprivation, emotional stress, circadian rhythm disorders, and sleep fragmentation. Disorders of arousal include confusional arousal, sleepwalking, and sleep terrors. Research into the pathogenesis of arousal disorders in adults suggests that they reflect aberrant slow-wave sleep regulation, impaired arousal specifically from NREM 3 sleep, and/or sleep/wake state dissociations. Treatment of DoA includes avoidance of sleep deprivation/restriction, irregular sleep/wake schedules, and predisposing/precipitating factors. Pharmacotherapy can be considered when events pose a danger and/or sleep disturbance to the patient and/or others; involve potentially violent, dangerous, or sexual behavior; are frequent, chronic, and refractory to initial therapies; and/or have secondary consequences such as excessive daytime sleepiness, impaired quality of life, excessive weight gain, and injuries.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"PP 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84292839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0009
S. Gorantla, M. Grigg-Damberger
Polysomnography and multiple sleep latency testing (MSLT), along with detailed history and sleep logs and actigraphy, are essential for the diagnosis of narcolepsy with cataplexy (narcolepsy type 1). Interpreting polysomnography and MSLT data is challenging in patients with substance abuse. This chapter presents the case of a young woman with a history of substance abuse and confounding MSLT results due to covert use of recreational drugs. Recreational drugs affect sleep architecture, and the results of urine drug screening become a critical part of diagnostic evaluation in patients with substance abuse. Patients undergoing MSLT to characterize and confirm central hypersomnia need proper preparation to reduce false-positive, false-negative, and confounding results. Unexpected positive urine toxicology results are common in adolescents and adults undergoing MSLT and maintenance of wakefulness testing.
{"title":"But I Need Marijuana to Function as a Mother!","authors":"S. Gorantla, M. Grigg-Damberger","doi":"10.1093/MED/9780190671099.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0009","url":null,"abstract":"Polysomnography and multiple sleep latency testing (MSLT), along with detailed history and sleep logs and actigraphy, are essential for the diagnosis of narcolepsy with cataplexy (narcolepsy type 1). Interpreting polysomnography and MSLT data is challenging in patients with substance abuse. This chapter presents the case of a young woman with a history of substance abuse and confounding MSLT results due to covert use of recreational drugs. Recreational drugs affect sleep architecture, and the results of urine drug screening become a critical part of diagnostic evaluation in patients with substance abuse. Patients undergoing MSLT to characterize and confirm central hypersomnia need proper preparation to reduce false-positive, false-negative, and confounding results. Unexpected positive urine toxicology results are common in adolescents and adults undergoing MSLT and maintenance of wakefulness testing.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82447627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/MED/9780190671099.003.0017
S. Ibrahim, J. Louis
This chapter illustrates the impact of sleep disorders in pregnancy by demonstrating a case of obstructive sleep apnea (OSA) associated with preeclampsia. Maternal-fetal health complications are well documented in association with maternal OSA. OSA in pregnancy is a risk for preeclampsia, eclampsia, gestational hypertension, and gestational diabetes mellitus. A growing body of literature supports the importance of detection and diagnosis of OSA in pregnant women. Pregnancy-related complications may be mitigated by OSA treatment. Treatment with continuous PAP therapy is well tolerated in pregnancy and can be offered during pregnancy. Further investigation is needed to understand the effects of treatment on outcomes in pregnancy.
{"title":"Pregnancy and Health","authors":"S. Ibrahim, J. Louis","doi":"10.1093/MED/9780190671099.003.0017","DOIUrl":"https://doi.org/10.1093/MED/9780190671099.003.0017","url":null,"abstract":"This chapter illustrates the impact of sleep disorders in pregnancy by demonstrating a case of obstructive sleep apnea (OSA) associated with preeclampsia. Maternal-fetal health complications are well documented in association with maternal OSA. OSA in pregnancy is a risk for preeclampsia, eclampsia, gestational hypertension, and gestational diabetes mellitus. A growing body of literature supports the importance of detection and diagnosis of OSA in pregnant women. Pregnancy-related complications may be mitigated by OSA treatment. Treatment with continuous PAP therapy is well tolerated in pregnancy and can be offered during pregnancy. Further investigation is needed to understand the effects of treatment on outcomes in pregnancy.","PeriodicalId":30275,"journal":{"name":"Sleep Disorders","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87905167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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