scholarly journals 0738 Advance Taper of Antidepressants Prior to Multiple Sleep Latency Testing Increases the Number of Sleep-Onset Rapid Eye Movement Periods and Reduces Mean Sleep Latency

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A281-A281
Author(s):  
B Kolla ◽  
M Jahani Kondori ◽  
M Silber ◽  
H Samman ◽  
S Dhankikar ◽  
...  
Keyword(s):  
Eye Movement ◽  
Sleep Latency ◽  
Sleep Onset ◽  
Initial Assessment ◽  
Rapid Eye Movement ◽  
Regression Analyses ◽  
Practice Parameters ◽  
The Impact ◽  
Multiple Sleep Latency ◽  
Multiple Sleep Latency Testing

Abstract Introduction Patients presenting with excessive sleepiness are frequently on antidepressant medication(s). While practice parameters recommend discontinuation of antidepressants prior to multiple sleep latency testing (MSLT), data examining the impact of tapering these medications on MSLT results are limited. Methods Adult patients who underwent MSLT at Mayo Clinic Rochester, Minnesota, between 2014-2018 were included. Clinical and demographic characteristics, medications, including use of rapid eye movement suppressing antidepressants (REMS-AD) at assessment and during testing, actigraphy and polysomnography data were manually abstracted. The difference in number of sleep-onset rapid eye movement periods (SOREMS), proportion with ≥2 SOREMS and mean sleep latency (MSL) in patients who were on REMS-AD and discontinued prior to testing versus those who remained on REMS-AD were examined. At our center, all antidepressants are discontinued 2 weeks prior to MSLT wherever feasible; fluoxetine is stopped 4 weeks prior. Regression analyses accounting for demographic, clinical and other medication-related confounders were performed. Results A total of 502 patients (age=38.18±15.90 years; 67% female) underwent MSLT; 178 (35%) were on REMS-AD at the time of assessment. REMS-AD were discontinued prior to testing in 121/178 (70%) patients. Patients tapered off REMS-AD were more likely to have ≥2 SOREMS (OR-12.20; 95%CI=1.60-92.94) compared to patients who remained on REMS-AD at the time of the MSLT. They also had shorter MSL (8.77±0.46 vs 10.21±0.28; p>0.009) and higher odds of having ≥2 SOREMS (OR=2.22; 95%CI=1.23-3.98) compared to patients not on REMS-AD at initial assessment. These differences persisted after regression analyses accounting for confounders. Conclusion Patients who taper off REMS-AD prior to MSLT are more likely to demonstrate ≥2SOREMs and have a shorter MSL. Pending further prospective investigations, clinicians should preferably withdraw REMs-AD before an MSLT. If this is not done, the test interpretation should include a statement regarding the potential effect of the drugs on the results. Support None

scholarly journals Advance taper of antidepressants prior to multiple sleep latency testing increases the number of sleep-onset rapid eye movement periods and reduces mean sleep latency

2020 ◽  
Vol 16 (11) ◽  
pp. 1921-1927
Author(s):  
Bhanu Prakash Kolla ◽  
Marjan Jahani Kondori ◽  
Michael H. Silber ◽  
Hala Samman ◽  
Swati Dhankikar ◽  
...  
Keyword(s):  
Eye Movement ◽  
Sleep Latency ◽  
Sleep Onset ◽  
Rapid Eye Movement ◽  
Multiple Sleep Latency ◽  
Multiple Sleep Latency Testing

Two cases of HLA‐DR2‐negative hypersomnia manifesting sleep‐onset rapid eye movement periods in the multiple sleep latency test

1999 ◽  
Vol 53 (2) ◽  
pp. 295-297
Author(s):  
Yasushi Yoshida ◽  
Kenji Kuroda ◽  
Masaharu Mandai ◽  
Seiji Satani ◽  
Narutsugu Emura ◽  
...  
Keyword(s):  
Eye Movement ◽  
Sleep Latency ◽  
Sleep Onset ◽  
Multiple Sleep Latency Test ◽  
Rapid Eye Movement ◽  
Multiple Sleep Latency

scholarly journals Practice Parameters for the Non-Respiratory Indications for Polysomnography and Multiple Sleep Latency Testing for Children

SLEEP ◽  
2012 ◽  
Vol 35 (11) ◽  
pp. 1467-1473 ◽  
Author(s):  
R. Nisha Aurora ◽  
Carin I. Lamm ◽  
Rochelle S. Zak ◽  
David A. Kristo ◽  
Sabin R. Bista ◽  
...  
Keyword(s):  
Sleep Latency ◽  
Practice Parameters ◽  
Multiple Sleep Latency ◽  
Multiple Sleep Latency Testing

scholarly journals 1250 Agrypnia Excitata in a Patient with Paraneoplastic Autoimmune Encephalitis

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A476-A476
Author(s):  
J L Sanchez ◽  
S Saeed ◽  
H Battistini
Keyword(s):  
Eye Movement ◽  
Rem Sleep ◽  
Sleep Latency ◽  
Delirium Tremens ◽  
Sleep Onset ◽  
Autoimmune Encephalitis ◽  
Cystic Teratoma ◽  
Low Grade ◽  
Rapid Eye Movement ◽  
Stage 1

Abstract Introduction Agrypnia Excitata (AE) is a syndrome characterized by loss of sleep with permanent motor and autonomic hyper activation. This case describes this peculiar syndrome in a patient with paraneoplastic autoimmune encephalitis. Report of Case DG is a 35 yr old male with a history of anti-Ma2 limbic encephalitis secondary to cystic teratoma of the left testis diagnosed 6 months prior to presenting in Sleep Clinic. His parents described significant sleep disturbances including short sleep and wake periods throughout the day and night with no apparent pattern, acting out dreams, motor activity during sleep including pulling at his clothes or using his hands to manipulate invisible objects. Additionally they described low-grade fevers, and severe hyperphagia. Polysomnogram showed absence of slow-wave sleep and what appeared to be an admixture of stage 1 non-rapid eye movement (NREM) with rapid-eye movement (REM) sleep. Multiple sleep-latency testing (MSLT) demonstrated a mean sleep latency of 5.2 minutes and four sleep-onset REM periods (SOREMPs). Magnetic resonance imaging of the brain revealed persistent inflammation of the mesial temporal lobes and hippocampal region. Cerebral spinal fluid testing showed persistent anti-Ma2 antibodies. Based on this clinical presentation we made a diagnosis of Agrypnia Excitata. Conclusion Agrypnia Excitata is a syndrome characterized by loss of the normal sleep-wake rhythm. Sleep consists of the disappearance of spindle-delta activities, and persistent stage 1 NREM sleep mixed with recurrent episodes of REM sleep. The second hallmark of AE is persistent motor and autonomic hyperactivity observed during wake and sleep. AE has been described in three distinct clinical syndromes: Morvan Syndrome (autoimmune encephalitis), Fatal Familial Insomnia, and Delirium tremens. The pathogenesis of AE consists of intra-limbic disconnection releasing the hypothalamus and brainstem reticular formation from cortico-limbic inhibitory control. In autoimmune encephalitis, antibodies that act on voltage-gated potassium channels within the limbic system have been implicated in the pathophysiology.

scholarly journals P003 The impact of forced wake from overnight polysomnography on multiple sleep latency test results

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A22-A23
Author(s):  
A Amaranayake ◽  
S Frenkel ◽  
P Lyell ◽  
A Southcott
Keyword(s):  
Diagnostic Accuracy ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Multiple Sleep Latency Test ◽  
Test Results ◽  
The Impact ◽  
Multiple Sleep Latency ◽  
Overnight Polysomnography

Abstract Introduction The multiple sleep latency test (MSLT) is used to diagnose disorders of hypersomnolence. Although internationally-recognised protocols do not stipulate whether patients should be woken from the preceding overnight polysomnography (PSG), many labs wake their patients for logistic reasons. This study analyses the impact on PSG and MSLT parameters of forced wake (FW) from the overnight PSG compared with unrestricted sleep (US). Methods 400 consecutive patients (FW=200; US=200) undergoing PSG/MSLT were included and the following parameters were compared: Epworth Sleepiness Scale (ESS), Morningness-Eveningness Questionnaire score (MEQ), PSG total sleep time (TST), wake-up time from the PSG, overall MSLT sleep latency (MSL), individual nap latencies (SLNap 1–4), number of MSLT naps with sleep-onset REM periods (#SOREMP), and percentage of MSLTs with overall MSL<8 minutes (%MSLT<8). Results The 2 groups were well-matched for ESS and MEQ. The FW group had more males (49% vs 39%). When compared to FW, patients with US had longer TST (+38 minutes; p=<0.0001), later wake-up time (+52 minutes; p<0.0001), longer MSL (+1.9 minutes; p=0.0049), 50% fewer #SOREMP (p=0.0224), and 16% fewer %MSLT<8 (p=0.0018). SLNap1 increased by 1.5 minutes (p=0.0623), SLNap2 increased by 2.0 minutes (p=0.0067), SLNap3 increased by 0.75minutes (p=0.0533) and SLNap4 increased by 2.5 minutes (p=0.0059). Discussion Allowing patients to have unrestricted sleep on the night prior to the MSLT resulted in significantly longer TST, longer sleep latencies during the MSLT, fewer SOREMP and fewer tests with MSL<8 minutes. International protocols should stipulate unrestricted sleep on the PSG prior to the MSLT to improve diagnostic accuracy.

scholarly journals Dreams and Rapid Eye Movement Sleep in the Multiple Sleep Latency Test

SLEEP ◽  
1995 ◽  
Vol 18 (2) ◽  
pp. 105-108 ◽  
Author(s):  
Selim R. Benbadis ◽  
Barbara R. Wolgamuth ◽  
Michael C. Perry ◽  
Dudley S. Dinner
Keyword(s):  
Eye Movement ◽  
Sleep Latency ◽  
Multiple Sleep Latency Test ◽  
Rapid Eye Movement ◽  
Rapid Eye Movement Sleep ◽  
Multiple Sleep Latency

scholarly journals The Relationship Between Daily Rapid-Eye Movement Sleep and Cognitive Functioning in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 159-159
Author(s):  
Tiana Broen ◽  
Tomiko Yoneda ◽  
Jonathan Rush ◽  
Jamie Knight ◽  
Nathan Lewis ◽  
...  
Keyword(s):  
Older Adults ◽  
Working Memory ◽  
Cognitive Functioning ◽  
Eye Movement ◽  
Rem Sleep ◽  
Cognitive Tests ◽  
Rapid Eye Movement ◽  
Targeted Interventions ◽  
The Impact ◽  
The Relationship

Abstract Previous cross-sectional research suggests that age-related decreases in Rapid-Eye Movement (REM) sleep may contribute to poorer cognitive functioning (CF); however, few studies have examined the relationship at the intraindividual level by measuring habitual sleep over multiple days. Applying a 14-day daily diary design, the current study examines the dynamic relationship between REM sleep and CF in 69 healthy older adults (M age=70.8 years, SD=3.37; 73.9% female; 66.6% completed at least an undergraduate degree). A Fitbit device provided actigraphy indices of REM sleep (minutes and percentage of total sleep time), while CF was measured four times daily on a smartphone via ambulatory cognitive tests that captured processing speed and working memory. This research addressed the following questions: At the within-person level, are fluctuations in quantity of REM sleep associated with fluctuations in next day cognitive measures across days? Do individuals who spend more time in REM sleep on average, perform better on cognitive tests than adults who spend less time in REM sleep? A series of multilevel models were fit to examine the extent to which each index of sleep accounted for daily fluctuations in performance on next day cognitive tests. Results indicated that during nights when individuals had more REM sleep minutes than was typical, they performed better on the working memory task the next morning (estimate = -.003, SE = .002, p = .02). These results highlight the impact of REM sleep on CF, and further research may allow for targeted interventions for earlier treatment of sleep-related cognitive impairment.

scholarly journals 1253 Multiple sleep onset REM episodes in middle age woman with excessive daytime sleepiness – Is this automatically assumed narcolepsy?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A477-A477
Author(s):  
Kamal Patel ◽  
Bianca J Lang
Keyword(s):  
Daytime Sleepiness ◽  
Sleep Latency ◽  
Sleep Onset ◽  
Sleep Time ◽  
Multiple Sleep Latency Test ◽  
Sleep Onset Latency ◽  
Onset Latency ◽  
Obstructive Sleep ◽  
Falling Asleep ◽  
Multiple Sleep Latency

Abstract Introduction Presence of sleep onset REM episodes often raises concerns of narcolepsy. However other conditions have shown to have presence of sleep on REM episodes which include but not limited to obstructive sleep apnea, sleep wake schedule disturbance, alcoholism, neurodegenerative disorders, depression and anxiety Report of Case Here we present a case of 30 year old female with history of asthma, patent foraman ovale, migraine headache, and anxiety who presented with daytime sleepiness, falling asleep while at work, occasional scheduled naps, non-restorative sleep, sleep paralysis, and hypnopompic hallucination. Pertinent physical exam included; mallampati score of 4/4, retrognathia, high arched hard palate, crowded posterior oropharynx. She had a score of 16 on Epworth sleepiness scale. Patient previously had multiple sleep latency test at outside facility which revealed 4/5 SOREM, with mean sleep onset latency of 11.5 minutes. She however was diagnosed with narcolepsy and tried on modafinil which she failed to tolerate. She was tried on sertraline as well which was discontinued due to lack of benefit. She had repeat multiple sleep latency test work up which revealed 2/5 SOREM, with mean sleep onset latency was 13.1 minutes. Her overnight polysomnogram prior to repeat MSLT showed SOREM with sleep onset latency of 10 minutes. Actigraphy showed consistent sleep pattern overall with sufficient sleep time but was taking hydroxyzine and herbal medication. Patient did not meet criteria for hypersomnolence disorder and sleep disordered breathing. Conclusion There is possibility her medication may have played pivotal role with her daytime symptoms. We also emphasize SOREMs can be present in other disorders such as anxiety in this case and not solely in narcolepsy

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