scholarly journals 1241 A Case of Chronic Hypoventilation of Unknown Etiology with Improvement from a Wake Promoting Agent

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A473-A473
Author(s):  
Melissa Cole ◽  
Thomas Isaacs ◽  
Amee Patel
Keyword(s):  
Serum Ferritin ◽  
Daytime Sleepiness ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Chronic Insomnia ◽  
Sweat Test ◽  
Unknown Etiology ◽  
Serum Bicarbonate ◽  
Sleep Study ◽  
Work Up

Abstract Introduction We present a patient with chronic insomnia, excessive daytime sleepiness, and sleep-related hypoventilation that improved with a wake promoting agent in conjunction with BPAP. Report of Case A 15-year-old male with Cystic Fibrosis (single F508del mutation, positive sweat test, FEV1% of 98%) and Autism who presented with frequent headaches, chronic insomnia, and daytime sleepiness (PDSS of 22). Current medications included albuterol as needed. Sleep history was significant for restless leg symptoms. Labs revealed low serum ferritin. Sleep study two years prior showed an AHI of 3.4 and PMLD of 18.4. After completion of iron therapy and initiation of gabapentin, his chronic insomnia and serum ferritin improved. However, patient continued to have aggressive behavior, headaches, and snoring. Sleep study was repeated and revealed mild OSA with hypoventilation (AHI of 6.41, >28% of total sleep time with TCO2 above 50 mm Hg). Initial serum bicarbonate was 29 mmol/L and progressively increased to 34 mmol/L. Due to evidence of persistent chronic hypoventilation, patient was trialed on BPAP. Subsequent sleep study with BPAP showed an AHI of 0, but with worsening sleep related hypoventilation (TCO2 of 56mmHg, > 70% total sleep time with TCO2 above 50 mm Hg). Genetic, endocrine, and neurological work up for hypoventilation was negative. Due to persistent daytime sleepiness (PDSS of 24), MSLT was performed and showed evidence of hypersomnia. Modafinil was then initiated. With the combination of nocturnal BPAP use and Modafinil, daytime sleepiness improved (PDSS of 15) and he had normalization of CO2 and bicarbonate levels. Conclusion We present a patient with CF, with minimal lung disease, who demonstrated a negative work up for sleep related hypoventilation, in which dysregulation of control of breathing improved with the use of a wake promoting agent in conjunction with BPAP.

scholarly journals 1092 Attention-deficit/hyperactivity Disorder Symptoms And Sleep Characteristics Within A Seasonal Affective Disorder Spectrum

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A415-A416
Author(s):  
K N Kim ◽  
D L Wescott ◽  
P L Franzen ◽  
B P Hasler ◽  
K A Roecklein
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Adhd Symptom ◽  
Symptom Severity ◽  
Daytime Sleepiness ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Adhd Symptoms ◽  
Depression Severity

Abstract Introduction Seasonal affective disorder (SAD) increases risk for attention-deficit/hyperactivity disorder (ADHD), although the mechanism linking SAD and ADHD is unknown. Prior research has identified insomnia and delayed sleep phase in both ADHD and SAD. We hypothesized that sleep duration and timing in SAD would be associated with the severity of ADHD symptoms. Methods Adults with SAD (n = 45) and subsyndromal SAD (S-SAD; n = 18) aged 19-66 years from Pittsburgh, PA., were assessed for ADHD symptoms, self-report sleep quality, depression severity, and daytime sleepiness in the Winter. Participants wore an Actiwatch for 4-14 days, from which we calculated sleep-onset latency, total sleep time, sleep midpoint, and sleep efficiency. We conducted a hierarchical multivariate linear regression to determine if sleep characteristics predict ADHD symptom severity in our sample while controlling for depressive symptoms. Age and gender were added in Step 1, seasonal depression severity in Step 2, actigraphy-based total sleep time, sleep onset latency, midpoint, and efficiency in Step 3, and self-reported sleep quality and daytime sleepiness in Step 4. Results Participants mostly scored in the “likely” or “highly likely” ADHD range (87.30%, n=55), higher than the national prevalence rate (4.4%). When controlling for age, gender, and depression severity, only shorter actigraphy-based total sleep time was associated with higher ADHD symptom severity (β=-0.30, p<0.05). However, when self-reported sleep quality and daytime sleepiness were added as predictors, total sleep time was no longer a statistically-significant predictor of ADHD symptom severity and only daytime sleepiness predicted ADHD symptom severity (β=0.31, p<0.05). Conclusion Our results suggest that individuals with SAD who experience daytime sleepiness and/or possibly shorter actigraphy-based sleep duration experience higher ADHD symptom severity. Treatments like Trans-C or CBT-I to improve daytime sleepiness and sleep duration may be indicated for SAD patients who present with comorbid ADHD symptoms. Support NIMH K.A.R. MH103303

Sleep and Psychological Abuse Among Cohabiting Couples: A Pilot Study

Partner Abuse ◽  
2017 ◽  
Vol 8 (4) ◽  
pp. 347-360
Author(s):  
Sharon Rose ◽  
Linda Berg-Cross ◽  
Nancy A. Crowell
Keyword(s):  
Sleep Quality ◽  
Relationship Satisfaction ◽  
Sleep Deprivation ◽  
Daytime Sleepiness ◽  
Psychological Abuse ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Cohabiting Couples ◽  
Survey Results ◽  
The Relationship

This study explored the relationship between psychological abuse and sleep deprivation among nonclinical cohabiting couples. Thirty-one couples participated in completing a variety of sleep measures, a psychological abuse scale, and a relationship satisfaction survey. Results indicated a persistent relationship between everyday sleep deficits (sleep quality, daytime sleepiness, and self-reported total sleep time) and the perceived perpetration and felt victimization of psychological abuse. Overall, results were as hypothesized, but there were gender differences. Male psychological abuse victimization and perpetration were significantly related to sleep quality and daytime sleepiness, but for women, only sleep duration was predictive of felt victimization. The sleep variables were significantly related to women’s—but not men’s—reported relationship satisfaction. Overall, minimal sleep deprivation appears to be related to increased psychological abuse perpetration and victimization even among a normative population scoring outside the clinical range on these measures. Implications for prevention and treatment are discussed.

scholarly journals Frontal cortex myo-inositol is associated with sleep and depression in adolescents : A proton magnetic resonance spectroscopy study

2017 ◽  
Vol 41 (S1) ◽  
pp. S351-S351
Author(s):  
A.S. Urrila ◽  
A. Hakkarainen ◽  
A. Castaneda ◽  
T. Paunio ◽  
M. Marttunen ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Frontal Cortex ◽  
Daytime Sleepiness ◽  
Proton Magnetic Resonance ◽  
Proton Magnetic Resonance Spectroscopy ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Resonance Spectroscopy ◽  
Healthy Controls ◽  
Depression Severity

AimThis study used proton magnetic resonance spectroscopy (1H MRS) to evaluate neurochemistry of the frontal cortex in adolescents with symptoms of sleep and depression.Methods19 non-medicated adolescent boys (mean age 16.0 y; n = 9 clinical cases with depression/sleep symptoms and n = 10 healthy controls) underwent 1H MRS at 3 T. MR spectra were acquired from the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex, and frontal white matter. Concentrations of N-acetyl aspartate, total creatine, choline-containing compounds, total glutamine plus glutamate, and myo-inositol (mI) were compared between the two subgroups and correlated with sleep and clinical measures in the total sample. Sleep was assessed with self-report questionnaires and ambulatory polysomnography recordings.ResultsConcentrations of mI were lower in both frontal cortical regions among the depressed adolescents as compared to healthy controls. No statistically significant differences in other metabolite concentrations were observed between the subgroups. Frontal cortex mI concentrations correlated negatively with depression severity, subjective daytime sleepiness, insomnia symptoms, and the level of anxiety, and positively with total sleep time and overall psychosocial functioning. The correlations between mI in the ACC and total sleep time as well as daytime sleepiness remained statistically significant when depression severity was controlled in the analyses.ConclusionLower frontal cortex mI may indicate a disturbed second messenger system. Frontal cortical mI may thus be linked to the pathophysiology of depression and concomitant sleep symptoms among maturing adolescents. Short sleep and daytime sleepiness may be associated with frontal cortex mI independently from depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals P160 A trial of a position modification device for the prevention of supine sleep during pregnancy

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A73-A73
Author(s):  
D Wilson ◽  
C Whenn ◽  
S Walker ◽  
M Barnes ◽  
M Howard
Keyword(s):  
Total Sleep Time ◽  
Night Shift ◽  
Sleep Onset ◽  
Late Pregnancy ◽  
Sleep Time ◽  
Third Trimester ◽  
Sleep Study ◽  
Supine Sleep ◽  
Efficiency Control ◽  
The Impact

Abstract Self-reported supine position at sleep onset during late pregnancy is related to a 2.6x increase in stillbirth risk, possibly due to the enlarged uterus compressing major blood vessels supplying the placenta. This study aimed to test the effectiveness of a pillow designed to decrease supine sleep in pregnant women. Twelve women in the third trimester of pregnancy used their own pillows for a control week and the intervention pillow for 1 week, in randomised order. Sleep position for each night of both weeks was monitored with the Night Shift Sleep Positioner, with a sleep study (WatchPat300) on the last night of each week to measure the impact of the intervention on SDB. During the control week, the women slept supine for a median of 19.9% (IQR = 11.6, 27.4) of total sleep time (TST), compared to a median of 20.4% (10.2, 31.0) TST using the intervention pillow (p = .64). Use of the intervention pillow did not impact sleep efficiency (control = 85.3% (80.7, 88.0) v. intervention = 85.2% (78.3, 89.0), p = .48). On the sleep study night, supine sleep was reduced in the intervention compared to control condition (12.9% vs. 17.7%, p = .04), but AHI did not differ (intervention = 2.6/hr (0.8, 6.7) vs. control = 1.5/hr (0.6, 3.6), p = .11). We found that the adoption of a pillow designed to discourage supine sleep was not effective in late pregnancy. Considering the reasonably high amount of supine sleep in our participants, alternative devices should be investigated.

Nocturnal Polysomnographic Correlates of Daytime Sleepiness

2012 ◽  
Vol 110 (1) ◽  
pp. 63-72 ◽  
Author(s):  
William D. S. Killgore ◽  
Vincent F. Capaldi ◽  
Melanie L. Guerrero
Keyword(s):  
Linear Regression ◽  
Slow Wave ◽  
Daytime Sleepiness ◽  
Chart Review ◽  
Slow Wave Sleep ◽  
Total Sleep Time ◽  
Retrospective Chart Review ◽  
Sleep Time ◽  
Stepwise Linear Regression ◽  
Two Indices

The relations of nighttime Polysomnographic sleep variables with daytime sleepiness scores on the Epworth Sleepiness Scale were assessed in a retrospective chart review of 38 patients referred to a sleep clinic. Of the variables assessed, only slow wave sleep was statistically significantly correlated with daytime sleepiness, regardless of whether the analysis was based on absolute minutes of slow wave sleep or percentage of total sleep time spent in slow wave sleep. Stepwise linear regression suggested that other Polysomnographic variables did not provide additional predictive value beyond the two indices of slow wave sleep. Apparently, reduced quantity of slow wave sleep was weakly but significantly related to increased daytime sleepiness among these sleep-clinic patients.

Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease

2006 ◽  
Vol 104 (4) ◽  
pp. 502-505 ◽  
Author(s):  
Kelly E. Lyons ◽  
Rajesh Pahwa
Keyword(s):  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Problems ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Early Morning ◽  
Patient Reported ◽  
Stn Dbs

Object The aim of this study was to assess the long-term effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) on sleep, daytime sleepiness, and early morning dystonia and to evaluate the relationship between total sleep time and motor function. Methods Patients who had undergone bilateral STN DBS and a follow-up evaluation of 6 months (89 patients), 12 months (83 patients), and 24 months (43 patients) were included in this study. The patients were preoperatively assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) in the medication-on and -off conditions, and they completed patient diaries. A subset of patients also completed the Epworth Sleepiness Scale. These assessments were repeated postoperatively with stimulation. The UPDRS activities of daily living (ADL) and motor scores as well as total sleep hours were significantly improved at 6, 12, and 24 months poststimulation and with no medication compared with baseline values. Increased sleep time was significantly correlated with improvements in bradykinesia but not with tremor or rigidity. Patient-reported sleep problems and early morning dystonia were reduced after STN DBS. Antiparkinsonian medications were significantly reduced after STN DBS; however, there were no changes in excessive daytime sleepiness 6, 12, or 24 months after surgery. Conclusions Bilateral STN DBS increased total sleep time and reduced patient-reported sleep problems and early morning dystonia for up to 24 months posttreatment. These changes in sleep were related to improvements in functioning, specifically those affected by bradykinesia. Despite significant reductions in antiparkinsonian medications, STN DBS did not reduce excessive daytime sleepiness.

A New Thienodiazepine, Brotizolam, for the Treatment of Insomnia

1982 ◽  
Vol 10 (2) ◽  
pp. 118-121 ◽  
Author(s):  
Jaime Sanchez-Martinez ◽  
Julia Landa-Palos
Keyword(s):  
Crossover Study ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Primary Diagnosis ◽  
Chronic Insomnia ◽  
Double Blind ◽  
Blind Crossover Study ◽  
Double Blind Crossover Study

A double-blind crossover study was carried out in twenty hospitalized inpatients who, apart from their primary diagnosis, suffered from non-psychiatric chronic insomnia. The patients received 0·5 mg brotizolam or 30 mg flurazepam for a 2-week period. Both drugs improved the induction and continuity of sleep, and increased the total sleep time, although better results were observed with brotizolam in all the parameters studied.

Comparison of Continuous versus Intermittent Administration of Zolpidem in Chronic Insomniacs: A Double-Blind, Randomized Pilot Study

1998 ◽  
Vol 26 (1) ◽  
pp. 13-24 ◽  
Author(s):  
R Cluydts ◽  
K Peeters ◽  
I de Bouyalsky ◽  
J Lavoisy
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Sleep Quality ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Chronic Insomnia ◽  
Global Evaluation ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Intermittent Administration

The subjective efficacy and safety of intermittent administration of a hypnotic for insomnia was assessed, since such a regime may provide a potential means of reducing the risk of habituation and dependence. A total of 160 adult patients (mean 45 years) with chronic insomnia were treated for 2 weeks with zolpidem, 10 mg, either continuously or intermittently (five nights zolpidem, two consecutive nights placebo per week) in this multicentre, out-patient, pilot study. At the end of the 2-week treatment, patients subjectively estimated their nightly total sleep time as 6.96 ± 1.19 h (from 6.07 ± 1.25 h at baseline) and 6.94 ± 1.30 h (from 5.72 ± 1.46 h) after the continuous and intermittent treatments, respectively. Patients' reports did not indicate any differences between the two groups in global evaluation of impairment, sleep quality, or the incidence of adverse events. These results suggest that the efficacy and safety of zolpidem, 10 mg, are comparable whether the drug is administered every night or intermittently. Further studies with a broader well-defined patient base, are needed to confirm these data.

scholarly journals Comparative analysis of multiple sleep latency tests (MSLT) parameters and occurrence of dreaming in patients with daytime sleepiness of narcoleptic and non-narcoleptic origin

2006 ◽  
Vol 64 (4) ◽  
pp. 958-962 ◽  
Author(s):  
Eduardo Siqueira Waihrich ◽  
Raimundo Nonato Delgado Rodrigues ◽  
Henrique Aragão Silveira ◽  
Fernando da Fonseca Melo Fróes ◽  
Guilherme Henrique da Silva Rocha
Keyword(s):  
Comparative Analysis ◽  
Rem Sleep ◽  
Daytime Sleepiness ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Onset Latency ◽  
Multiple Sleep Latency

OBJECTIVE: To compare MSLT parameters in two groups of patients with daytime sleepiness, correlated to the occurrence and onset of dreams. METHOD: Patients were submitted to the MSLT between January/1999 and June/2002. Sleep onset latency, REM sleep latency and total sleep time were determined. The occurrence of dreams was inquired following each MSLT series. Patients were classified as narcoleptic (N) or non-narcoleptic (NN). RESULTS: Thirty patients were studied, 12 were classified as narcoleptics (N group; 40%), while the remaining 18 as non-narcoleptic (NN group; 60%). Thirty MSLT were performed, resulting in 146 series. Sleep was detected in 126 series (86%) and dreams in 56 series (44.44%). Mean sleep time in the N group was 16.0±6.3 min, while 10.5±7.5 min in the NN group (p<0.0001). Mean sleep latency was 2.0±2.2 min and 7.2±6.0 min in the N and NN group, respectively (p<0.001). Mean REM sleep latency in the N group was 3.2±3.1min and 6.9±3.7 min in the NN group (p=0.021). Dreams occurred in 56.9% of the N group series and 28.4% in that of the NN group (p=0.0009). Dream frequency was detected in 29.8% and 75% of the NREM series of the N and NN groups, respectively (p=0.0001). CONCLUSION: Patients from the N group, compared to the NN group, slept longer and earlier, demonstrated a shorter REM sleep onset and greater dream frequency. NN patients had a greater dream frequency in NREM series. Thus, the occurrence of dreams during NREM in the MSLT may contribute to differentially diagnose narcolepsy and daytime sleepiness.

scholarly journals 673 Did the COVID-19 pandemic increase insomnia?

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A263-A263
Author(s):  
Neil Stanley ◽  
Alison Gardiner ◽  
Nicola Sunter
Keyword(s):  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Economic Consequences ◽  
Age Related ◽  
Significant Difference ◽  
The Difference ◽  
The Uk ◽  
The Impact

Abstract Introduction COVID-19 has been an unprecedented health event with far-reaching health and economic consequences. There have been numerous surveys published that have suggested that insomnia has increased during the pandemic. However, there have been no comparisons of data from the pandemic with that from other years. Here we present baseline data from people signing up to an online CBTi course to investigate the impact of COVID-19 on sleep. Methods We investigated the difference in age; diary-reported Sleep Efficiency (SE%) and Total Sleep Time (TST); sleep quality and disturbances as measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale (ESS); between the first wave of COVID-19 in the UK (1st March -31st July 2020) as compared to the same period in 2019. Results In 2019 n=2231 patients were assessed as compared to n=6173 in 2020. There were no significant differences in the age of the two cohorts (47.1 years v 46.3 years, NS). SE% was significantly lower in the 2019 cohort (66% v 67.6, p &lt;0.001) as was their total sleep time (5.71 hrs v 6.05 hrs, p&lt;0.0001). PSQI scores were also higher in 2019 (13.13 v 12.72. p&lt;0.0001). The level of daytime sleepiness was lower in the 2019 cohort (5.4 v 5.6 p &lt;0.001) Conclusion Our results show that there was no evidence of an increase in the severity of sleep disturbance during the 1st wave of the COVID-19 pandemic in the UK in contrast to what numerous surveys have suggested. Indeed, we found that people signing up to Sleepstation’s online dCBTi course during the 1st wave of the pandemic had statistically significant better subjective sleep, although they had a higher level of daytime sleepiness than those in the same period a year previously. Although statistically significant, our results do not demonstrate a clinically relevant difference between the two cohorts. It is also interesting that despite the age-related impact of COVID-19, there was no significant difference in the age of the patients. Thus, in contrast to the survey data, we found no evidence for a worsening of sleep during the 1st wave of the pandemic. Support (if any):

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