Studies evaluating the association between Central Sleep Apnea (CSA) and
positional sleep apnea are not commonly described and are barely understood.
report a case of a 51-year-old-male with moderate Obstructive Sleep Apnea (OSA)
and severe CSA probably secondary to brainstem compression, which responded to
the adoption of strict lateral body posture. The addition of Continuous Positive
Airway Pressure (CPAP) optimally resolved the remaining obstructive respiratory
events. We suggest including Magnetic Resonance Imaging (MRI) in the work-up
plan of patients with positional CSA. Keywords: Central Sleep Apnea; Continuous Positive Airway Pressure; Posture; Sleep-Disordered Breathing; Magnetic Resonance Imaging.
Keywords: Central Sleep Apnea; Continuous Positive Airway Pressure; Posture; Sleep-Disordered Breathing; Magnetic Resonance Imaging.
Narcolepsy type 1 is a sleep disorder characterized by excessive daytime
sleepiness (EDS), sleep fragmentation, hypnagogic hallucinations, sleep
paralysis, and cataplexy. Stimulant medications such as modafinil and
amphetamines are the first-line medications for treating sleepiness. However,
the management of narcolepsy during special circumstances of life such as
pregnancy is complex. MMDM is a 34-year-old female with Narcolepsy type 1
treated with modafinil (400mg/d) and citalopram (20mg/d). Before she become
pregnant, modafinil and citalopram were replaced for L-Carnitine 510mg/d with
good outcome. She underwent an usual pregnancy and was submitted to a term
cesarean delivery without child-birth complications. This is the first
description of oral L-Carnitine such an alternative to treatment narcolepsy type
1 during pregnancy. Treat these patients is not easy but care narcolepsy
pregnant is a challenging even bigger. In a disease without many treatment
options, L-Carnitine can be used to treat daytime sleepiness during pregnancy
Keywords: Narcolepsy; Pregnancy; L-Carnitine.
BACKGROUND Adequate sleep is essential for health. Both, short and long sleep durations
are associated to worse quality of life and poor health outcomes. Portugal
represents a specific population model, since according to European
statistics it has high rates of chronic diseases like depression,
hypertension, diabetes and stroke; and low quality of life as well as low
index of physical activity, while in parallel it has some other good health
indicators such as: low age-standardized mortality for both genders,
nutrition in terms of energy and fruit consumption, smoking and alcohol,
obesity and overweight prevalence. The aim of this study was to characterize
health and chronic diseases, lifestyles and quality of life in subjects with
short and long sleep duration.
METHODS A population-based cross-sectional evaluation of the third wave of follow-up of the EpiDoC Cohort was carried between 2015-2016. A sample of 5,436 adults ≥18 years, representative of the national population, self-reported their daily total sleep time. Associations between short sleep duration (SSD ≤5h), long sleep duration (LSD≥9h) and independent variables were determined.
RESULTS The prevalence for SSD was high (20.7%) and the LSD (5.9%) was low. Being older, with lower education, retired and unemployed were associated to SSD and LSD (p<0.01). Being obese was associated to SSD as well as hypertension, gastrointestinal disease and hypercholesterolemia (p<0.01). SSD and LSD, were associated with diabetes (p<0.01 and p=0.03) and depression (p<0.01 and p=0.02) respectively. Cardiovascular disease (p<0.01) was associated to LSD. Multimorbidity (p<0.01) was associated to SSD. Worse quality of life and bad physical function were associated to SSD and LSD, as well as being hospitalized in the previous 12 months (p<0.01).
CONCLUSIONS Socio-demographic, physical activity and chronic diseases were associated to reduction and extension of sleep duration. There was no association between rheumatic diseases and cancer with sleep duration, as found in other studies. This study emphasizes the burden of self-reported SSD for Portugal, its consequences to health and the need to increase sleep awareness campaigns enhancing the importance of sleep in health. Furthermore, it emphasizes that chronic diseases risks are dependent on multiple parameters which varying in different countries or regions, imply the need of regional studies and interventions.
Keywords: Sleep; Life Style; Quality of Life; Cross-Sectional Studies; Chronic Disease; Portugal.
OBJECTIVE The role of sleep architecture in consolidation of memory has not been
extensively investigated. In this study, the association of continuous
positive airway pressure (CPAP) and sleep architecture and quality, and
sleep disordered breathing on changes in memory are explored during the
course of a 6 month clinical trial of CPAP or sham CPAP (APPLES).
METHODS 848 participants had polysomnographic and memory assessments (Buschke Selective Reminding Test [Buschke] and Digit Symbol Substitution Test [DSST]) at baseline, CPAP/Sham CPAP titration, and the 2 and 6 month time points. Half were assigned to the CPAP and Sham CPAP groups respectively. Changes in performance on the Buschke and the DSST were analyzed over the course of the study between CPAP and Sham CPAP as well as in relationship to changes in sleep architecture, sleep quality and sleep disordered breathing (SDB).
RESULTS Sleep architecture, sleep quality and SDB improved in the CPAP group at 6 months; performance on the Buschke and DSST improved equally in both CPAP and Sham CPAP groups. There also were no significant correlations between changes in the amount or percentage of sleep stages between baseline and the 6 months, and corresponding changes in either the Buschke or the DSST. However, when stratified by the upper quartile and lower 3 quartiles, greater changes in the Buschke occurred over 6 months in the top quartile of total sleep time (5.7±7.3 vs. 4.0±6.8, p≤0.01) and amount of N3 sleep (55.9±7.7 vs. 53.6±8.9 min, p≤0.01). Those with more %N3 at 6 months scored better on the Buschke as well (55.9±7.8 vs. 53.6±8.9, p≤0.01). Borderline improvement in the DSST over 6 months was observed in the top quartiles of amount of N3 and %N3. Those in the top quartile of the amount of REM and %REM also showed greater improvement in the Buschke after 6 months. No differences were observed for the AHI, but those in the top quartile of oxygen desaturation had worse scores on the Buschke at 6 months. CPAP/Sham CPAP adherence did not impact 6 month Buschke or DSST performance.
CONCLUSIONS CPAP improved long-term sleep duration, quality and architecture, but did not memory. However, large changes in REM and N3 sleep as well as moderate amounts of nocturnal hypoxemia are associated with changes in assessments of memory.
Keywords: Sleep; Obstructive Sleep Apnea Syndrome; Memory; Continuous Positive Airway Pressure.
INTRODUCTION Sleep bruxism (SB) is a frequent condition in children. Its pathophysiology
involves certain neurotransmitters (serotonin, dopamine, noradrenalin,
histamine), but the environment seems to influence its occurrence.
OBJECTIVE The objective of this study was to investigate the prevalence of SB in children and their biological mothers, relating it to stress through a case control study.
METHODS AND MATERIAL The group of cases (SG) was composed of 48 subjects, including 24 children with SB and their mothers, and the control group (CG), formed by 36 children without SB and their mothers. The chi-Square test was used and the probability was computed with 95% confidence intervals (p<0.05). Results: The prevalence of probable awareness of SB in children was 22.6%, while it was 30.8% among caregivers. There were no significant associations between the socio-demographic variables and SB. There was an increase in the occurrence of SB in children (p=0.02) when their caregiver also had this condition.
CONCLUSIONS Psychological stress did not establish a significant relationship with SB in either the child or their mothers.
Keywords: bruxism; sleep bruxism; child; Stress; Physiological.
BACKGROUND Rapid Eye Movement sleep deprivation (REMSD) of rats causes inflammation of
the liver and apoptotic cell death of neurons and hepatocytes. Studies also
suggest that REM sleep deprivation can cause muscle as well as cardiac
injury and neurodegenerative diseases.
OBJECTIVE AND METHODS The aim of this research was to determine whether REM sleep deprivation of rats would increase the levels of reactive oxygen species (ROS) in the hepatocytes and create oxidative stress in them. We selectively deprived the rats for REM sleep using the standard flower pot method.
RESULTS We observed that when rats were subjected to REM sleep deprivation, the levels of ROS in their hepatocytes increased ~184.33% compared to large platform control (LPC) group by day 9 of deprivation, but it returned towards normal level (~49.27%) after recovery sleep for 5 days. Nitric oxide synthase (iNOS) gene expression and protein levels as determined by real-time PCR and western blot analysis respectively were found to be elevated in hepatocytes of REM sleep deprived rats as compared to the LPC group. The level of nitric oxide (NO) in the hepatocytes of REMSD rats also increased by ~404.40% as compared to the LPC group but sleep recovery for 5 days normalized the effect (~135.35% compared to LPC group). We used a large platform control group as a reference group to compare with the REM sleep deprived group as the effect on the hepatocytes of both LPC group and cage control groups were not significantly different.
DISCUSSION We have analyzed the oxidative stress generated in the hepatocytes of rats due to REM sleep deprivation and further consequences of it. REMS deprivation not only increased the levels of ROS in the hepatocytes but also induced iNOS and NO in them. REM sleep deprived hepatocytes became more susceptible to oxidative stresses on further exposures. Furthermore, our study has great pathological and physiological.
Keywords: Reactive Oxygen Species; Nitric Oxide; Nitric Oxide Synthase; Catalase; Sleep, REM.
OBJECTIVES To evaluate patient's satisfaction, efficacy and adherence to CPAP with a
hybrid nasal mask (DW) we tested patients with OSA in unattended setting
under real-life conditions.
MATERIAL AND METHODS Prospective, comparative study using DW mask 7 days against habitual mask in patients adapted to CPAP therapy.
RESULTS We analyzed 52 patients: 35 men (67%) with IAH mean; 24.3±12.3 events/hour. At baseline mean compliance of 5.42±1.83 hours/night. After using DW mask, patients reported fewer marks, more comfort, greater partners acceptance, easier to use and was ranked higher to preventing leaks; p<0.05, and adherence (1 more hour per night, p>0.0042).Differences were not found in pressure 90th-95th percentile (9.6±9.2 cm of H2O, p<0.5), leaks (19.8±17 liters/min. p<0.37) or residual AHI (3.38±3.05 events/hour. p<0.93).
CONCLUSION In an uncontrolled non-randomized study, patients can use DW mask with similar leak level and better adherence as compared to conventional masks.
Keywords: Treatment Adherence and Compliance; Continuous Positive Airway Pressure; Monitoring; Sleep Apnea Syndromes.
OBJECTIVE: Poor sleep patterns are common in undergraduates and may turn them prone to
mood disorders, substance abuse and impaired academic performance. The aim
of this study was to assess sleep disturbances among medical students, and
whether associations with academic performance, depressive symptoms or
substance use were present.
METHODS: Cross-sectional study in which 544 medical students of the Pontificia Universidad Javeriana in Bogota, Colombia were included. Using a computer-based survey, self-reported variables were assessed, including demographics, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Berlin Questionnaire, Diagnostic and Statistical Manual of Mental Disorders (DSM) - IV depression criteria, Grade Point Average (GPA), and substance use. Associations between these variables were obtained.
RESULTS: Fifty-four percent of students were women. Poor sleep quality (PSQI>5) and daytime sleepiness (ESS>10) were found in 65% of the population. A higher GPA was more frequent in students with good sleep quality (OR= 2.6 [1.5-4.5]), lack of daytime sleepiness (OR= 2 [1.3-3.1]) and low risk of Obstructive Sleep Apnea Syndrome (OSAS) (OR= 3.1 [1.6-5.9]). DSM-IV depression criteria were fulfilled by 26% of the students and were associated with poor sleep patterns. Energy drinks use was associated with poor sleep quality.
DISCUSSION: Poor sleep quality, daytime sleepiness and depressive symptoms are frequent among medical students and are associated with lower academic performance. The identification of students at risk and the implementation of targeted interventions are warranted. Fostering adequate sleep habits and training on sleep medicine may partly counteract these issues.
Keywords: Students, Medical; Sleep; Sleep Disorders; Mood Disorders; Substance-Related Disorders; Latin America.
OBJECTIVES: To: 1) evaluate the quality of an ambulatory monitoring technique for
diagnosing Obstructive Sleep Apnea Syndrome (OSAS) while patients move
through the city; and 2) identify factors that lead to data loss.
METHODS: Clinical histories were reviewed and ambulatory portable monitorings of adults with high pretest probability for OSAS were included, the signals monitored were pulse oximetry, heart rate, nasal pressure, snoring, chest band and body position. The equipment was connected from 14:00-20:00 h and then patients moved through the city turning it off and on at home. Results were analyzed visually to record all the minutes lost. A good-quality study was defined as recording time 240 min and signal loss <20%. A cost/benefit analysis was performed using Golpe et al.'s methodology.
RESULTS: A total of 70 recordings were analyzed. Most subjects were obese men with severe OSAS. Signal quality was determined to be good with a median signal loss of 4.9 min (0-405) that represented 1% (0-99) of total recording time. The signal lost most often was pulse oximetry at 1.8 min (0-403, p=0.0001). Of the 70 studies performed, 57 (81%) met the definition of good quality, while 13 (19%) had to be repeated. Men lost the pulse oximetry signal more often than women. This technique could represent savings of 65-75%.
CONCLUSIONS: Placing a portable OSAS monitor during the day while patients move around the city turning it on and off at home does not affect the quality of the study results obtained and is a cost-effective method.
Keywords: Sleep Apnea; Obstructive; Polysomnography; diagnosis.
OBJECTIVE: This study aimed to investigate subjective sleep quality and its association
with demographics, psychological health, and sleep hygiene related behaviors
in pre-clinical medical students.
METHODS: In this cross-sectional study, a self-administered questionnaire consisting of demographics, sleep hygiene behaviors, Pittsburgh Sleep Quality Index (PSQI), and Depression, Anxiety and Stress Scale-21 (DASS21) was handed out to all medical students of Tehran University of Medical Sciences at pre-clinical stage.
RESULTS: The questionnaire was filled out by 553 (89.7%) of 616 students approached. About 60% of our sample had a global PSQI score of more than 5 (cut off of poor sleep quality) with mean global PSQI score of 6.32 (SD=2.72). The prevalence of moderate to extremely severe depression, anxiety and stress scores were 26.1%, 29.61%, and 14.5% respectively. Poor sleep quality was associated with later year in the school, psychological distress and several lifestyle behaviors. Constructing a multivariate logistic model, depression, anxiety and some sleep hygiene behaviors were significantly associated with higher PSQI score.
DISCUSSION: Our findings suggest that poor sleep quality is a common problem among pre-clinical medical students and is associated with some psychological symptoms and sleep hygiene behaviors. This issue demonstrates necessity of interventions to improve the sleep quality in this population group.
Keywords: sleep; Students; Medical; behavior.
The purpose of this study was to analyze the rest-activity rhythm of type 2
diabetics mellitus (T2DM) and compare it to healthy controls using the
nonparametric analytic approach. Twenty-one diabetics and 21 healthy subjects
matched for gender and age were recruited to participate in the study. Data were
analyzed using the Independent t-test, Mann-Whitney U test, and Spearmans
correlation. T2DM subjects demonstrate lower interdaily stability (IS)
(p=.03), higher intradaily variability
(p=.046) and lower rhythm amplitude (p=.02)
when compared to healthy controls. Also, there was a positive correlation
between IS and most active 10 hr (M10) in the average of 24 hours pattern (r
=.44; p=.046) in the diabetes group and a negative correlation
between IV and M10 in the healthy group (r =-.57; p=.007).
These data together suggest that T2DM exhibits a dysfunction in the
rest-activity rhythm due to alterations in the circadian function as well as
the homeostatic capacity to maintain sleep; mainly characterized by less
consistency across days of the daily circadian signal, higher rhythm
fragmentation and lower rhythm amplitude. Future approaches may be developed
considering the influence of circadian glucose variations throughout the day
the coupling of the rest-activity rhythm to zeitgeber and rhythm
Keywords: Sleep Wake Disorders; Diabetes Mellitus, Type 2; Circadian Rhythm.
BACKGROUND: Nowadays, sleep-related problems are a prevalent occurrence among university
students. Poor sleep quality is one of the most studied aspects of sleep
complaints, affecting from 10% to 50% of this population. Poor sleep quality
consequences are many and have a profound impact in the student's
psychobiological health. University students live through a period of
psychological challenge and adaptation, since the transition from high
school to professional life. Abrupt autonomy challenges students to deal
with many choices, from their academic and social life to their intimate
habits. Frequently, sleep hygiene is neglected, or they are unable to use
proper coping mechanisms, resulting in disturbing consequences that could
impact their lives as adults. Research has found a significant association
between sleep quality and depression or depressive symptoms, but this
relationship is still somewhat difficult to interpret.
OBJECTIVE: The objective of this review is to appraise the current knowledge around the relationship of sleep with depression in this group of young adults. Data Source: Articles included in Medline database.
METHODS: After a careful search, the articles selected aimed mainly college students. The studies had sleep quality and depression objectively assessed, focused in the relationship between both, and addressed possible influencing factors.
RESULTS: The current literature still supports a bidirectional relationship between sleep and depression, however, the importance of sleep quality is becoming a very relevant variable.
CONCLUSION: Education and the application of policies regarding sleep hygiene may prevent, in some cases, the development of depression and improve the quality of sleep in other cases. Future research should clarify the relationship between sleep problems and depression in a way they could be prevented or, at least, minimalized with effective and achievable interventions.
Keywords: Sleep Hygiene; Depression; Students; Universities.
The public opinion is ever more interested and worried about possible effects of
exposure to VGs (video games) on human life and well-being. Scientific
literature shows several evidences highlighting negative outcomes on
behavioural, emotive, cognitive and physical health spheres. All these aspects
are intrinsically linked to sleep quality and quantity and to date very few
studies directly investigated the effects of videogame (VG) exposure on sleep
and post-sleep cognitive status. The aim of the present systematic review is
examine the impact that the exposure to VGs can produce on sleep pattern and
consequent post-sleep cognitive abilities. To this extent, only studies directly
investigating the effects of VGs on sleep features and post-sleep cognitive
abilities have been selected and discussed. Data currently present in literature
show the alteration of sleep pattern after exposure to VGs. The analysis
indicated a reduction of Total Sleep Time (TST) and an increase of Sleep Onset
Latency (SOL), modifications of the REM sleep and Slow Wave Sleep (SWS), and
increased sleepiness and self-perceived fatigue. Moreover, post-sleep sustained
attention and verbal memory also appear to be impaired. It can be concluded that
playing VGs for long periods, particularly in the evening, is a significant,
common and probable cause of sleep problems: evening exposure to VGs, in fact,
can bring to insufficient and low quality sleep, with possible effects on
cognition in the subsequent waking days. Potential methodological flaws and
limitations of these studies have also been described and discussed. Because
the very limited number of available study on this topic further research is
Keywords: Adolescent; Video Games; Sleep; Disorders of Excessive Somnolence; Memory; Attention.