scholarly journals 0758 Quantification of Late REM Periods in Patients With Prolonged Sleep Duration

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A288-A288
Author(s):  
M S Blattner ◽  
J August ◽  
S Chopra ◽  
L Dalal ◽  
S Luthra ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Rem Sleep ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Onset Time ◽  
Sleep Time ◽  
Sleep Studies ◽  
Long Sleep ◽  
Idiopathic Hypersomnia

Abstract Introduction Evaluation of hypersomnia includes polysomnography followed by mean sleep latency testing (MSLT). As consistent with guidelines as applied in most centers, the overnight portion of the study will be terminated to begin sleep latency testing. For patients with prolonged sleep duration, this interruption could result in REM sleep on nap testing that reflects continuation of their biological night, rather than abnormalities in REM sleep pressure/regulation. Methods We reviewed 42 consecutive extended (unrestricted) sleep studies for patients with a total sleep time greater than 600 minutes. For studies with sleep onset before midnight, we evaluated for REM period onset after 6AM, the number of REM periods after 6AM and 8AM, and the time of the final REM period onset. Results 42 hypnograms were reviewed for patients undergoing evaluation of hypersomnia, median age 32 years (range 19-92) with a median total sleep time of 663 minutes (range 602-832), of these 28/42 (67%) had sleep onset before midnight (12 AM) and were included in the analysis. 27/28 (96%) of hypnograms reviewed had REM sleep after 6 AM, 24/28 (86%) had REM sleep after 8 AM, with the onset of the final REM period ranging from 4:46 AM-12:30 PM for patients with sleep onset time before midnight (12 AM). Conclusion These data suggest that termination of overnight polysomnography to complete mean sleep latency testing, as is standard in most sleep labs, may influence the presence of REM sleep on MSLT for patients with prolonged total sleep duration. These results may have implications for the interpretation of MSLT for patients with long sleep duration, and may explain why a given individual may test as type II narcolepsy or idiopathic hypersomnia unpredictably on repeat testing. Support Sleep Medicine Fellowship at BIDMC

511 Pathological sleep prolongation and sleep onset REM period

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A201-A201
Author(s):  
Makoto Honda ◽  
Shinya Kimura ◽  
Kaori Sasaki ◽  
Masataka Wada ◽  
Wakako Ito
Keyword(s):  
Clinical Symptoms ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Studies ◽  
Long Sleep ◽  
The Status ◽  
Idiopathic Hypersomnia ◽  
Sleep Propensity

Abstract Introduction ICSD-3 employs two definitions of pathological sleepiness: sleep prolongation with 24-hour total sleep time (24hrPSG TST) ≥660 and high sleep propensity with mean sleep latency(mSL) ≤8 min on MSLT. Multiple SOREMPs on MSLT reflects the pathophysiology (sleep instability) of narcolepsy, but it is not clear whether the lack of SOREMPs is associated with the pathophysiology of idiopathic hypersomnia. We performed 24hr PSG and PSG-MSLT sequentially to understand the meaning of SOREMP in those with pathological sleep prolongation. Methods Fifty-six consecutive patients visiting Seiwa Hospital or Koishikawa Tokyo Hospital affiliated to Institute of Neuropsychiatry with suspected idiopathic hypersomnia with habitually long sleep time were evaluated by 3-day sleep studies: unattended 24hr PSG followed by PSG and MSLT from January 2017 to November 2020. After excluding inadequate recordings or other sleep pathologies, we analyzed 52 data and found that 39 patients (23 females, 21.8 ± 7.9 years old, BMI 20.4 ± 2.5 kg/m2) exhibited pathological sleep prolongation. Results We divided 39 patients with pathological sleep prolongation into those with at least one SOREMP(n=9) and those without SOREMP(n=30) and explored differences in clinical symptoms and PSG variables. There were no differences in conventional sleep variables except for PSG sleep latency, shorter in those with SOREMP (20.8min vs 43.8min, p=0.032). Also 24hr PSG sleep variables showed no differences except for the number of NREM-REM cycles, more in those with SOREMP (10.4 vs 8.1, p=0.037). Frequency of clinical symptoms such as REM related phenomena and various symptoms characteristic for idiopathic hypersomnia did not differ between groups except for less frequency of general malaise p=0.003 and orthostatic hypotension p=0.049 in those with SOREMP. We had similar results when we compared 5 patients with multiple SOREMPs and 30 patients without SOREMP. Conclusion Our results indicated that sleep variables and clinical characteristics of idiopathic hypersomnia in those with pathological sleep prolongation were mostly the same regardless of the status of SOREMP on MSLT, suggesting that the absence of SOREMPs on MSLT were not fundamentally related to the pathophysiology of those with pathological sleep prolongation (idiopathic hypersomnia with long sleep time). Support (if any):

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.

Eszopiclone in the treatment of insomnia

2020 ◽  
Vol 36 (1) ◽  
pp. 9-21
Author(s):  
Marek Jarema ◽  
Adam Wichniak
Keyword(s):  
Sleep Latency ◽  
Total Sleep Time ◽  
Subjective Evaluation ◽  
Sleep Onset ◽  
The Elderly ◽  
Pharmacological Action ◽  
Sleep Time ◽  
Medical Problem ◽  
Quality Of Sleep

Insomnia is an important medical problem; its treatment requires both nonpharmacological methods (education and psychotherapy) and the use of hypnotic agents. The benzodiazepine derivatives may be used as hypnotic agents but their use is substantially limited. The alter­native treatment includes so-called z-drugs, which means nonbenzodiazepine hypnotic agents. Their mechanism of pharmacological action is a GABA-receptor agonism. In general, these drugs improve the quality of sleep (sleep latency, wake after sleep onset, number and duration of awakenings, total sleep time). Contrary to the benzo­diazepines they do not possess anti-anxiety, myorelaxant, and anti-seizure properties, and are better tolerated. Eszopiclone for the treatment of insomnia was not available in Poland. It is not only effective in the treatment of insomnia in comparison to placebo but is also well tolerated. It may be used for a longer time than the benzodiazepines – not only a couple of weeks but per several months. Eszopiclone shortens the sleep latency, decreases the number of wakes after sleep onset and increases total sleep time. It improves the subjective evaluation of sleep by the patients, the quality of sleep and functioning during the day. Its efficacy in the treatment of insomnia in the elderly has also been proved. It is quite well-tolerated and the most frequent side-effect of eszopiclone in the unpleasant taste.

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&lt;8 minutes (%MSLT&lt;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=&lt;0.0001), later wake-up time (+52 minutes; p&lt;0.0001), longer MSL (+1.9 minutes; p=0.0049), 50% fewer #SOREMP (p=0.0224), and 16% fewer %MSLT&lt;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&lt;8 minutes. International protocols should stipulate unrestricted sleep on the PSG prior to the MSLT to improve diagnostic accuracy.

scholarly journals Sleep Organisation in Depression and Schizophrenia: Index of Endogenous Periodicity of Sleep as a State Marker [Retracted]

2013 ◽  
Vol 1 (1) ◽  
pp. 70-75
Author(s):  
Andrej Ilankovic ◽  
Aleksandar Damjanovic ◽  
Vera Ilankovic ◽  
Srdjan Milovanovic ◽  
Dusan Petrovic ◽  
...  
Keyword(s):  
Major Depression ◽  
Eye Movement ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Psychiatric Patients ◽  
Sleep Onset ◽  
Sleep Time ◽  
Rapid Eye Movement Sleep ◽  
Control Subjects ◽  
Healthy Control

Background: Sleep disorders are frequent symptoms described in psychiatric patients with major depression or schizophrenia. These patients also exhibit changes in the sleep architecture measured by polysomnography (PSG) during sleep. The aim of the present study was to identify potential biomarkers that would facilitate the diagnosis based on polysomnography (PSG) measurements.Subjects and Methods: 30 patients with schizophrenia, 30 patients with major depression and 30 healthy control subjects were investigated in the present study. The mean age in the group with schizophrenia was 36.73 (SD 6.43), in the group of patients with depression 40.77 (SD 7.66), in the healthy controls group 34.40 (SD 5.70). The gender distribution was as follows: 18 male, 12 female in the group with schizophrenia; in the group of patients with depression 11 male, 19 female; in the control group 16 male and 14 female. All subjects underwent polysomnography (PSG) for a minimum time of 8 hours according to the criteria of Rechtschaffen & Kales (1968). The following polysomnographic (PSG) parameters were analyzed: sleep latency (SL), total sleep time (TST), waking time after sleep onset (WTASO), number of awakenings (NAW), slow wave sleep (SWS), rapid eye movement sleep (REM), rapid eye movement sleep latency (REML), first REM period (REM 1), and first NREM period (NREM 1). We tested the potential of multiple sleep variables to predict diagnosis in different groups by using linear discriminate analysis (LDA).Results: There were significant differences in polysomnography (PSG) variables between healthy control subjects and psychiatric patients (total sleep time, sleep latency, number of awakenings, time of awakening after sleep onset, REM 1 latency, REM 1 and index of endogenous periodicity). Importantly, LDA was able to predict the correct diagnosis in 88% of all cases.Conclusions: The presented analysis showed commonalities and differences in polysomnography (PSG) changes in patients with major depressive disorder and in patients with schizophrenia. Our results underline the potential of polysomnography (PSG) measurements to facilitate diagnostic processes.

scholarly journals Association between Sleep Time and Blood Pressure in Korean Adolescents: Cross-Sectional Analysis of KNHANES VII

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1202
Author(s):  
Suk-Won Chang ◽  
Ju-Wan Kang
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Sleep Duration ◽  
Sleep Onset ◽  
Onset Time ◽  
Sleep Time ◽  
Multivariate Linear Regression Analysis ◽  
Wake Time ◽  
Korean Adolescents ◽  
The Relationship

Background: Hypertension is highly related to sleep, and there have been a number of studies on sleep deprivation and the occurrence of hypertension. However, there is still insufficient research on the relationship between hypertension and various factors related to sleep. Thus, this study attempted to investigate the relationship between hypertension and sleep time-related variables in Korean adolescents. Methods: A total of 1470 adolescents (709 girls and 761 boys) between 12 and 18 years of age were enrolled through the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII). The systolic and diastolic blood pressure were measured. Sleep time-related variables such as sleep onset time, wake time, and sleep duration (weekday and weekend, each) were also investigated using a questionnaire. We performed multivariate regression analyses to determine the independent effects of the variables. Results: Systolic blood pressure was negatively correlated with the wake time (r = −0.081; p = 0.002) and sleep onset time (r = −0.088; p = 0.001) on weekends. There was a positive correlation between diastolic blood pressure and weekday sleep onset time (r = 0.158; p = 0.000) and weekend sleep onset time (r = 0.184; p = 0.000). The sleep duration on weekdays and weekends showed a negative correlation (r = −0.136; p = 0.000, r = −0.088; p = 0.001, respectively). In the multivariate linear regression analysis results, the sleep onset time on weekends was significantly correlated with elevated diastolic blood pressure. Conclusions: Delayed sleep onset time on weekends was significantly associated with increased diastolic blood pressure in Korean adolescents. Further investigation is needed to confirm the clinical significance of these findings.

scholarly journals The Effects of Caffeine on Sleep Patterns Among Adolescents

2009 ◽  
Vol 5 ◽  
Author(s):  
Lauren E Margolis
Keyword(s):  
Sleep Quality ◽  
Total Sleep Time ◽  
Adult Population ◽  
Sleep Onset ◽  
Onset Time ◽  
Sleep Time ◽  
Caffeine Intake ◽  
Sleep Patterns ◽  
Sleep Habits ◽  
Caffeine Consumption

This review of literature examines whether there is a causal relationship between caffeine consumption and sleep patterns among adolescents. Literature suggests that there is a cause and effect relationship between caffeine intake and cognitive performance in adults. Researchers also found that among the adult population, consuming caffeine before sleep resulted in increased sleep onset time, reduced total sleep time, and poorer sleep quality. Specifically, adolescents ingest the majority of their total caffeine intake through caffeinated sodas. Studies have shown that adolescents consume more caffeine later in the week, which correlates with shorter total sleep time and decreased sleep quality. Thus, in review of the literature, it was determined that caffeine negatively affects sleep habits among adults, but further research should be conducted in order to conclude whether this relationship holds true among adolescents.

Characteristics associated with hypersomnia and excessive daytime sleepiness identified by extended polysomnography recording

SLEEP ◽  
2020 ◽  
Author(s):  
E Evangelista ◽  
A L Rassu ◽  
L Barateau ◽  
R Lopez ◽  
S Chenini ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Latency ◽  
Bed Rest ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Idiopathic Hypersomnia ◽  
Normal Sleep ◽  
Nighttime Sleep

Abstract Study Objectives Hypersomnolence, defined by excessive daytime sleepiness (EDS) or excessive quantity of sleep (EQS), has been associated with increased morbidity. The aim of this study was to determine the clinical and polysomnographic characteristics associated with EQS and EDS assessed objectively during extended polysomnography recording. Methods Two hundred and sixty-six drug-free subjects (201 women; mean age: 26.5 years [16.08;60.87]) underwent 32-hour bed-rest polysomnography recording preceded by polysomnography and modified multiple sleep latency test (mMSLT). Participants were categorized according to their total sleep time (bed-rest TST ≥19h, hypersomnia), objective EDS (mean sleep latency on MSLT ≤8 min), and self-reported EDS (Epworth sleepiness scale score &gt;10) and EQS (≥9 hours/24h per week). Results Subjects with hypersomnia were often younger, with normal sleep architecture, high nighttime sleep efficiency, and severe objective EDS. No association with sex, body mass index, ESS, EQS and depressive symptoms was detected. Subjects with objective EDS had less EQS, higher sleep efficiency, and increased hypersomnia. Discrepancies were observed between objective and self-reported measures of sleep duration and EDS. Finally, 71 subjects were identified who had objective hypersomnia and/or EDS, no medical and psychiatric conditions and normal polysomnography parameters, and therefore met the stringent criteria of idiopathic hypersomnia, an orphan disorder. Conclusion Sleep duration and EDS should be quantified using self-reported and objective measures in a controlled procedure to differentiate long sleepers, patients with hypersomnia and patients with idiopathic hypersomnia. This will help to better understand their biology, to identify specific biomarkers, and to assess related health outcomes.

scholarly journals P086 The organization of sleep-wake patterns around daily schedules in college students

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A49-A49
Author(s):  
S Lu ◽  
E Klerman ◽  
J Stone ◽  
A McHill ◽  
L Barger ◽  
...  
Keyword(s):  
College Students ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Total Duration ◽  
Onset Time ◽  
Sleep Time ◽  
Previous Night ◽  
Daily Schedule ◽  
Wrist Actigraphy ◽  
Wake Patterns

Abstract A potential contributor to insufficient sleep among college students is their daily schedule, with sleep sacrificed for other waking activities. We investigated how daily schedules predict day-to-day sleep-wake timing in college students. 223 undergraduate college students (M±SD = 19.2±1.4 years, 37% females) attending a Massachusetts university in the US between 2013–2016 were monitored for approximately 30 days during semester. Sleep-wake timing was measured using daily online sleep diaries and wrist-actigraphy. Daily schedules were measured using daily online diaries that included self-reported timing and duration of academic, exercise-based, and extracurricular activities, and duration of self-study. Linear mixed models were used to examine the association between sleep-wake patterns and daily schedules at both the between-person and within-person levels. An earlier start time of the first-reported activity predicted earlier sleep onset (between and within: p&lt;.001) and shorter total sleep time (within: p&lt;.001) for the previous night, as well as earlier wake onset on the corresponding day (between and within: p&lt;.001). A later end time of the last-reported activity predicted later sleep onset (within: p=.002) and shorter total sleep time (within: p=.02) on that night. A more intense daily schedule (i.e., greater total duration of reported activities) predicted an earlier wake onset time (between: p=.003, within: p&lt;.001), a later sleep onset time (within: p&lt;.001), a shortened total night-time sleep duration (between: p=.03, within: p&lt;.001), and greater sleep efficiency (within: p&lt;.001). These results indicate that college students may organize their sleep and wake times based on their daily schedule.

scholarly journals Evaluating Sleep Characteristics in Intensive Care Unit and Non-Intensive Care Unit Physicians

2011 ◽  
Vol 39 (6) ◽  
pp. 1071-1075 ◽  
Author(s):  
G. Ok ◽  
H. Yilmaz ◽  
D. Tok ◽  
K. Erbüyün ◽  
S. Çoban ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Shift Work ◽  
Pittsburgh Sleep Quality Index ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Total Activity ◽  
Sleep Time ◽  
Sleep Parameters ◽  
Icu Physicians

Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.

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