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Comorbidity in restless legs syndrome among a sample of Swedish adults.

Sleep Med. 2007 Nov;8(7-8):768-72

Authors: Ulfberg J, Bjorvatn B, Leissner L, Gyring J, Karlsborg M, Regeur L, Skeidsvoll H, Polo O, Partinen M,

BACKGROUND: Restless legs syndrome (RLS) is a neurological movement disorder, which often causes sleep problems. However, the comorbidity of this disorder is not well known. This study aimed to document the prevalence of RLS in the general population of Sweden and to identify factors associated with this condition. METHODS: A cross-sectional study was performed in Sweden. One thousand subjects aged 18-90 years old underwent telephone interviews. The questionnaire assessed such factors as sleep variables, depressive mood, treatment of diabetes mellitus, and treatment with drugs for depression during the previous four-week period. RLS was diagnosed based on the minimal criteria provided by the International RLS Study Group. RESULTS: The prevalence of RLS was 5% (5.7% in women, 3.5% in men). Severe or very severe RLS symptoms during the previous week were noted by 64% of the RLS subjects. Factors associated with RLS were insomnia, excessive daytime sleepiness, periodic limb movements in sleep, and depressed mood. Those affected by RLS were not more often consumers of drugs for depression than non-RLS subjects. CONCLUSIONS: RLS is prevalent in the general population in Sweden. RLS negatively influenced sleep and was associated with depressed mood. Antidepressive drug treatment was not associated with RLS.

PMID: 17825613 [PubMed - indexed for MEDLINE]

Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children.

Sleep Med. 2007 Nov;8(7-8):711-5

Authors: Konofal E, Cortese S, Marchand M, Mouren MC, Arnulf I, Lecendreux M

OBJECTIVE: Increasing evidence suggests a significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and restless legs syndrome (RLS). Iron deficiency may underlie common pathophysiological mechanisms in subjects with ADHD plus RLS (ADHD+RLS). To date, the impact of iron deficiency, RLS and familial history of RLS on ADHD severity has been scarcely examined in children. These issues are addressed in the present study. METHODS: Serum ferritin levels, familial history of RLS (diagnosed using National Institutes of Health (NIH) criteria) and previous iron supplementation in infancy were assessed in 12 ADHD+RLS children, 10 ADHD children and 10 controls. RLS was diagnosed using NIH-specific pediatric criteria, and ADHD severity was assessed using the Conners' Parent Rating scale. RESULTS: ADHD symptom severity was higher, although not significantly, in children with ADHD+RLS compared to ADHD. The mean serum ferritin levels were significantly lower in children with ADHD than in the control group (p<0.0005). There was a trend for lower ferritin levels in ADHD+RLS subjects versus ADHD. Both a positive family history of RLS and previous iron supplementation in infancy were associated with more severe ADHD scores. CONCLUSIONS: Children with ADHD and a positive family history of RLS appear to represent a subgroup particularly at risk for severe ADHD symptoms. Iron deficiency may contribute to the severity of symptoms. We suggest that clinicians consider assessing children with ADHD for RLS, a family history of RLS, and iron deficiency.

PMID: 17644481 [PubMed - indexed for MEDLINE]

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Childhood and adult factors associated with restless legs syndrome (RLS) diagnosis.

Sleep Med. 2007 Nov;8(7-8):716-22

Authors: Gamaldo CE, Benbrook AR, Allen RP, Scott JA, Henning WA, Earley CJ

BACKGROUND AND PURPOSE: RLS appears to be caused by a complex interaction of genetic and environmental factors. This study sought to identify some environmental risk factors significantly associated with the occurrence of RLS. PATIENTS AND METHODS: Three adult behaviors and 10 childhood factors potentially related to development of RLS were evaluated for significant association with the occurrence of RLS in a large case-controlled family history study. All available family members of the probands in this study were evaluated for RLS using a validated diagnostic telephone interview that included a background questionnaire covering factors potentially associated with the development of RLS. Where possible, the mothers of the subjects were also interviewed regarding developmental factors that might affect the child's health and perhaps occurrence of RLS. All family members with a definite diagnosis of RLS or Not-RLS were included in the study. Of a total of 973 participants, 262 (27%) had RLS and 711 did not. RESULTS: An odds ratio (OR) with 95% confidence limits (CI) was calculated for the relationship of each factor to RLS diagnosis. Restless sleep in childhood was associated with an increased risk of developing RLS later in life for both men (OR=2.64; 95% CI: 1.31-5.29) and women (OR=2.54; 95% CI: 1.41-4.59). Blood donation was also significantly associated with an increased risk of developing RLS among men only (OR=1.99; 95% CI: 1.10-3.58), which was more pronounced for those donating blood more than the median number of donations for this group of five (OR=2.3, 95% CI: 1.16-4.43). No other factor was significantly associated with the occurrence of RLS. CONCLUSIONS: This is the first case-controlled study that demonstrates a significant association between blood donation and the occurrence of RLS in males. The association was most significant for those men donating five or more times. Smoking and alcohol use were not related to the occurrence of RLS. Neither childhood growing pains nor attention-deficit hyperactivity disorder (ADHD) was related to RLS. The only consistent factor found related to prevalence of RLS for both men and women was the report of 'restless sleep' in childhood.

PMID: 17512781 [PubMed - indexed for MEDLINE]

Ethnic difference in periodic limb movements in children.

Sleep Med. 2007 Apr;8(3):240-6

Authors: O'Brien LM, Holbrook CR, Faye Jones V, Gozal D

BACKGROUND: Epidemiological studies have suggested that ethnicity is a risk factor for sleep-disordered breathing (SDB) and that African-American children are three times more likely than Caucasian children to have SDB. Ethnic differences in sleep architecture and other routinely assessed sleep parameters have not been critically assessed, thus the aim of this study was to compare sleep characteristics in African-American and Caucasian children. METHODS: A total of 41,363 sleep questionnaires were mailed to parents of children aged 5-7 years in Jefferson County, KY. Parents of snoring and non-snoring children were invited to have their child undergo overnight polysomnography. RESULTS: Complete questionnaires were returned by 9872 families (23% response rate). Of these, 689 agreed to undergo polysomnography, and 542 complete polysomnograms were obtained (5.7% of questionnaire respondents). There were 391 Caucasian and 151 African-American children with a mean age of 6.7+/-0.5 years who underwent overnight polysomnographic evaluation. No differences between groups were observed for sleep latency, total sleep time, sleep efficiency, or rapid eye movement (REM) latency. African-American children had slightly increased stage 3 sleep (6.0+/-2.8% vs. 5.4+/-2.8%; p=0.01), although the total proportion of slow wave sleep was similar. Higher respiratory arousal index (3.6+/-6.5/h vs. 1.4+/-2.7/h; p<0.001) and total arousal index (11.5+/-5.2/h vs. 9.8+/-4.8/h; p<0.001) emerged in African-American children, who were more likely to have mild SDB (AHI>1:34% in African-American vs. 24% in Caucasian; p=0.017) and SDB (AHI>5: 22.5% vs. 7%; p<0.001). However, Caucasian children were more likely to have periodic leg movements during sleep (PLMS; 16.5% vs. 7% in AA; p=0.004). The odds ratio for a Caucasian child to have PLMS was 2.6 (95% confidence interval (CI) 1.3-5.3; p=0.006). Furthermore, in the absence of SDB, the odds ratio for a Caucasian child to have PLMS was 9.5 (95% CI: 2.2-39.9; p=0.002). CONCLUSIONS: African-American and Caucasian children have similar sleep architecture. African-American children are more likely to display respiratory disturbances during sleep, while PLMS are significantly more prevalent among Caucasian children.

PMID: 17368099 [PubMed - indexed for MEDLINE]

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Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up.

Sleep Med. 2007 Mar;8(2):128-34

Authors: Villa MP, Malagola C, Pagani J, Montesano M, Rizzoli A, Guilleminault C, Ronchetti R

OBJECTIVES: To assess the outcome of rapid maxillary expansion in the treatment of obstructive sleep apnea syndrome (OSAS) in children, we studied 16 patients (mean age 6.6+/-2.0; 9 males) with dental malocclusion, a body mass index < or =85 percentile, and OSAS confirmed by polysomnography. METHODS: At baseline and after the trial, all patients underwent physical examination, standard polysomnography and orthodontic assessment. The Brouillette questionnaire investigating symptoms of OSA was administered to parents before and during the trial to assess the clinical severity of their sleep-disordered breathing. Two treated patients were lost to follow-up and excluded from the final study. RESULTS: In the 14 treated subjects who completed the study and follow-up, polysomnography showed a significant decrease in the apnea-hypopnea index (p=0.005), hypopnea obstructive index (p=0.002) and arousal index (p=0.001). Questionnaire responses before and after treatment showed a significant decrease in the severity of symptoms. CONCLUSION: A rapid maxillary expander is an effective appliance for treating children with OSAS.

PMID: 17239661 [PubMed - indexed for MEDLINE]

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Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing.

Sleep Med. 2007 Jan;8(1):12-7

Authors: Sharma SK, Kumpawat S, Goel A, Banga A, Ramakrishnan L, Chaturvedi P

OBJECTIVE: To assess the profile of metabolic abnormalities in subjects with obstructive sleep apnea (OSA). PATIENTS AND METHODS: In a case-control study conducted in two years, from April 2003 to March 2005, data obtained from polysomnography study, lipid profile, fasting blood sugar, serum insulin, insulin resistance, leptin and adiponectin levels, were compared between the various groups. Included in the study were OSA subjects from a sleep laboratory and matched controls from the community. Those with recent myocardial infarction, upper airway surgery, class III/IV heart failure, pregnancy, acromegaly, chronic renal failure, or who were on treatment for hyperthyroidism, on systemic steroid treatment, or on hormonal replacement therapy, were excluded from the study. RESULTS: Forty apneic obese subjects (AHI=32.19, range 13-52.75) were compared with 40 non-apneic obese controls (AHI=1.3, range 0-2.45) and 40 normal weight control subjects (AHI=0.7, range 0-1). No significant difference was noted in levels of fasting blood sugar, insulin resistance (obese apneics 61.9, obese controls 47.8, non-obese controls 19.1), leptin (obese apneics 10.65 microg/L, obese controls 8.52 microg/L, non-obese controls 2.83 microg/L) or adiponectin (obese apneics 4959.3 ng/ml, obese controls 5706 ng/ml, non-obese controls 7412 ng/ml) in the OSA group compared to obese controls. CONCLUSIONS: OSA has no independent association with lipid abnormalities, insulin resistance, serum leptin and adiponectin levels. In multivariate analysis, obesity was the major determinant of metabolic abnormalities in this cohort.

PMID: 17157064 [PubMed - indexed for MEDLINE]

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Sleep cycling alternating pattern (CAP) expression is associated with hypersomnia and GH secretory pattern in Prader-Willi syndrome.

Sleep Med. 2006 Dec;7(8):627-33

Authors: Priano L, Grugni G, Miscio G, Guastamacchia G, Toffolet L, Sartorio A, Mauro A

BACKGROUND AND PURPOSE: Hypersomnia, sleep-disordered breathing and narcoleptic traits such as rapid eye movement (REM) sleep onset periods (SOREMPs) have been reported in Prader-Willi syndrome (PWS). In a group of young adult patients with genetically confirmed PWS we evaluated sleep and breathing polysomnographically, including cycling alternating pattern (CAP), and we analyzed the potential interacting role of sleep variables, sleep-related breathing abnormalities, hypersomnia, severity of illness variables and growth hormone (GH) secretory pattern. PATIENTS AND METHODS: Eleven males and 7 females (mean age: 27.5+/-5.5 years) were submitted to a full night of complete polysomnography and the multiple sleep latency test (MSLT). GH secretory pattern was evaluated by a standard GH-releasing hormone plus arginine test. Sixteen non-obese healthy subjects without sleep disturbances were recruited as controls. RESULTS: Compared to controls PWS patients showed reduced mean MSLT score (P<0.001), reduced mean latency of sleep (P=0.03), increased REM sleep periods (P=0.01), and increased mean CAP rate/non-rapid eye movement (NREM) (P<0.001). Only four PWS patients had apnea/hypopnea index (AHI)>or=10. Conversely, significant nocturnal oxygen desaturation was frequent (83% of patients) and independent from apneas or hypopneas. In the PWS group, CAP rate/NREM showed a significant negative correlation with MSLT score (P=0.02) independently from arousals, respiratory disturbance variables, severity of illness measured by Holm's score or body mass index (BMI). PWS patients with CAP expression characterized by higher proportion of A1 subtypes presented less severe GH deficiency (P=0.01). CONCLUSIONS: Our study suggests a relationship between hypersomnia and CAP rate, and between CAP expression and GH secretory pattern in PWS, possibly reflecting underlying central dysfunctions.

PMID: 17023209 [PubMed - indexed for MEDLINE]

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Preliminary evidence for sleep complaints among children referred for anxiety.

Sleep Med. 2006 Sep;7(6):467-73

Authors: Alfano CA, Beidel DC, Turner SM, Lewin DS

BACKGROUND AND PURPOSE: Clinical observation suggests that sleep complaints are common among youth with anxiety disorders though empirical data documenting this co-occurrence of symptoms are generally unavailable. PATIENTS AND METHODS: Based on retrospective chart reviews, the current study examined rates of several types of parent-reported sleep complaints among a sample of (n=35) purely anxious children and adolescents (ANX). Sleep complaints were examined in terms of age (children versus adolescents) and type of anxiety diagnosis (generalized anxiety versus other anxious diagnoses). Rates of sleep complaints among anxious youth also were compared to those among (n=38) healthy control children and (n=33) children referred for sleep problems. RESULTS: The presence of at least one intermittent sleep complaint was reported by 83% of parents of ANX, with almost half reporting at least one frequent sleep complaint. Rates of sleep complaints among anxious children versus adolescents were similar. Children with generalized anxiety disorder (GAD) had a significantly greater number of sleep complaints than children with other types of anxiety disorders, though rates for specific items varied. Although parents of sleep-referred children reported the highest rates of sleep complaints overall, the frequency of several specific types of sleep complaints was highly similar among ANX and sleep-referred children. CONCLUSIONS: Findings indicate that certain sleep complaints are common among ANX. The need for appropriate assessment practices is discussed.

PMID: 16931154 [PubMed - indexed for MEDLINE]

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Efficacy and safety of zolpidem-MR: a double-blind, placebo-controlled study in adults with primary insomnia.

Sleep Med. 2006 Aug;7(5):397-406

Authors: Roth T, Soubrane C, Titeux L, Walsh JK,

BACKGROUND AND PURPOSE: To evaluate the clinical efficacy and safety of modified-release zolpidem (zolpidem-MR 12.5mg) for the treatment of primary insomnia in adults. PATIENTS AND METHODS: Two hundred and twelve (123 women, 89 men; mean age 44.3+/-SD 3.0 years), Diagnostic and Statistical Manual of Mental Disorders--4th Edition (DSM-IV)-defined primary insomnia patients were randomized in a double-blind, placebo-controlled, parallel-group study. The study was completed by 192 patients. Patients received 3 weeks of nightly treatment with either zolpidem-MR 12.5mg or placebo, preceded and followed by two nights of single-blind placebo. The main outcome measures were mean polysomnographic (PSG) sleep parameters of nights 1/2 and nights 15/16 of double-blind treatment and daily subjective sleep estimates from sleep questionnaires to assess efficacy, and PSG parameters of nights 22 and 23 of single-blind placebo substitution to assess the effect of drug discontinuation. RESULTS: Relative to placebo, zolpidem-MR 12.5mg improved sleep maintenance by significantly reducing PSG wake time after sleep onset (WASO) during the first 6h of sleep as well as the number of awakenings. Consistent with the effects of standard zolpidem, zolpidem-MR also significantly reduced latency to persistent sleep, and significantly increased sleep efficiency, both at the beginning and after 2 weeks of double-blind treatment. There was no evidence of next-day residual effects as measured objectively by psychometric tests. Rebound insomnia on the first night after abrupt discontinuation resolved the following night. Overall, zolpidem-MR was well tolerated. CONCLUSIONS: Zolpidem-MR 12.5mg is effective and safe in treating primary insomnia in adults and improves sleep maintenance, induction and duration of sleep.

PMID: 16815744 [PubMed - indexed for MEDLINE]

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Cyclic alternating pattern (CAP) alterations in narcolepsy.

Sleep Med. 2006 Dec;7(8):619-26

Authors: Terzano MG, Smerieri A, Del Felice A, Giglia F, Palomba V, Parrino L

BACKGROUND AND PURPOSE: Narcolepsy is a sleep disorder with clinical symptoms attributed to a reduced activation of the arousal system. Cyclic alternating pattern (CAP) is the expression of rhythmic arousability during non-rapid eye movement (NREM) sleep. CAP parameters, arousals and conventional sleep measures were studied in narcoleptic patients with cataplexy. PATIENTS AND METHODS: Data were collected from all-night polysomnographic (PSG) recordings and the multiple sleep latency test (MSLT) on the intervening day of 25 drug-naive patients (10 males and 15 females; mean age: 34+/-16 years) after adaptation and exclusion of other sleep disorders. A group of 25 age- and gender-matched normal sleepers were selected as controls. Each PSG recording was subdivided into sleep cycles. Analysis of CAP included classification of A phases into subtypes A1, A2, and A3. RESULTS: There was an increase in sleep period time mainly due to an increased wake time after sleep onset. REM latency was sharply reduced. The percentage of NREM sleep was slightly reduced and the balance between light sleep (S1+S2) and deep sleep (S3+S4) showed a curtailment of the former, while deep sleep was slightly increased. Excluding sleep cycles with sleep onset REM periods (SOREMPs), the duration of ordered sleep cycles was not different between narcoleptics and controls. The two groups showed similar values of arousal index, while CAP time, CAP rate, number of CAP cycles and of phase A subtypes (in particular subtypes A1) were significantly reduced in narcoleptic patients. CONCLUSIONS: The reduced periods of CAP in narcoleptic NREM sleep could be the electroencephalographic (EEG) expression of a generally reduced arousability or an increased strength of sleep-promoting forces in the balance between sleep and arousal systems. This can explain some of the clinical correlates of the disorder, i.e. excessive sleepiness, short sleep latency and impaired attentive performances, even without any sign of arousal-induced sleep fragmentation.

PMID: 16740406 [PubMed - indexed for MEDLINE]

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Waist circumference predicts the occurrence of sleep-disordered breathing in obese children and adolescents: a questionnaire-based study.

Sleep Med. 2006 Jun;7(4):357-61

Authors: Carotenuto M, Bruni O, Santoro N, Del Giudice EM, Perrone L, Pascotto A

BACKGROUND AND PURPOSE: To assess the presence of sleep-disordered breathing (SDB) in a population of obese children and adolescents and to investigate the role of fat distribution in predicting SDB. PATIENTS AND METHODS: One hundred and thirty-two obese children and adolescents, aged 5.0-14.2 years, were consecutively referred to the Department of Pediatrics of the Second University of Naples for screening of obesity. The control group consisted of 453, sex- and age-matched lean subjects selected from local schools in Campania region. The sleep disturbances scale for children (SDSC) questionnaire was used to evaluate SDB prevalence. In all subjects, waist circumference, triceps and sub-scapular skin folds were measured, and Z-scores were calculated. RESULTS: Obese subjects showed significantly higher SDB and sleep hyperhydrosis (SHY) scores than controls. The Z-score of waist circumference correlated with SDB (r=0.32; P=0.006) and SHY factor scores (r=0.37; P=0.005), while the Z-score of body mass index (BMI), triceps and sub-scapular skin folds were not correlated with any SDSC factor scores. Subjects in the higher tertile for Z-score of waist circumference had a significantly higher risk for developing SDB (OR 1.9; 95% IC 1.8-3.2) and SHY (OR 2.1; 95% IC 2.0-4.5). CONCLUSIONS: Waist circumference is a more reliable index than total adiposity and subcutaneous fat in predicting the risk of obese children to develop SDB.

PMID: 16713341 [PubMed - indexed for MEDLINE]

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Sleep habits and risk factors for sleep-disordered breathing in infants and young toddlers in Louisville, Kentucky.

Sleep Med. 2006 Apr;7(3):211-9

Authors: Montgomery-Downs HE, Gozal D

INTRODUCTION: Snoring affects biobehavioral development among preschool and early school-age children. The goals of the present study were to survey the parents of a large community sample of infants and young toddlers to evaluate (a) naturalistic sleep duration and location; (b) snoring prevalence; and (c) demographic measures and sleep behaviors related to the presence of snoring either 2 or >or=3 days/week. METHODS: Questionnaires were completed by parents of children ages 2 weeks to 2 years attending well-baby checkups and were also mailed to the homes of six-month-old infants. RESULTS: Data from 944 children were available for analyses. No age differences were reported for total sleep duration, co-sleeping, or snoring. Average daily sleep duration was 12.5+/-1.8h (standard deviation (SD)), with daytime naps accounting for an increased proportion of total sleep duration among younger infants. Co-sleeping was reported by 15% of families. Snoring 2 days/week was reported in 11.8% and> days/week in 5.3% of participants. Survey items indicating risk for sleep-disordered breathing (SDB) clustered into factors related to the child, their environment, and their family; restless sleep was exclusively related to snoring 2 days/week and ethnicity, sweating during sleep, and noisy breathing exclusive to snoring >or=3 days/week. CONCLUSIONS: Young infants appear to sleep less than currently recommended. Co-sleeping is relatively common and not age-dependent through the first 2 years of life. Items relating to the child's sleep behaviors, environment, and parents' perceptions were predictive of positive report of snoring, with snoring rates consistent with a significant risk for SDB being similar to those reported for older children.

PMID: 16564742 [PubMed - indexed for MEDLINE]

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The Epworth sleepiness scale: relationship to sleep and mental disorders in a sleep clinic.

Sleep Med. 2006 Jun;7(4):327-32

Authors: DeZee KJ, Jackson JL, Hatzigeorgiou C, Kristo D

BACKGROUND AND PURPOSE: Both sleep disorders and mental disorders are associated with excessive daytime sleepiness as measured by the Epworth sleepiness scale (ESS). We sought to assess the relationship between the ESS scores and mental disorders in a sleep clinic. METHODS: One hundred sixty-five consecutive new referrals to a sleep clinic completed the ESS prior to their initial visit. Mental disorders (major depression, minor depression, anxiety not otherwise specified, and panic disorder) were diagnosed with the primary care evaluation of mental disorders (PRIME-MD) questionnaire, a reliable and valid instrument. Nearly all sleep diagnoses (95%) were made by polysomnography. RESULTS: The mean ESS for the cohort was 12.3 (standard deviation (SD) 5.1). There was no difference in the mean ESS for those with and without mental disorders (12.8 vs. 12.2, P=0.48) or sleep-disordered breathing (SDB) (12.3 vs. 12.3, P=0.99). ESS scores were not different between patients with a comorbid mental disorder and SDB compared with the presence of a mental disorder or SDB alone (combination: 13.0 vs. mental disorder: 11.5 vs. SDB: 12.2, P=0.70). There was also no relationship between ESS scores and the respiratory disturbance index (RDI) (P=0.63). CONCLUSIONS: We found no relationship between ESS scores and mental disorders among referrals to a sleep clinic. ESS cannot be used to screen for mental disorders among sleep clinic patients.

PMID: 16564218 [PubMed - indexed for MEDLINE]

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Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.

Sleep Med. 2006 Mar;7(2):123-30

Authors: Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C

BACKGROUND AND PURPOSE: To estimate the prevalence of insomnia symptoms and syndrome in the general population, describe the types of self-help treatments and consultations initiated for insomnia, and examine help-seeking determinants. PATIENTS AND METHODS: A randomly selected sample of 2001 French-speaking adults from the province of Quebec (Canada) responded to a telephone survey about sleep, insomnia, and its treatments. RESULTS: Of the total sample, 25.3% were dissatisfied with their sleep, 29.9% reported insomnia symptoms, and 9.5% met criteria for an insomnia syndrome. Thirteen percent of the respondents had consulted a healthcare provider specifically for insomnia in their lifetime, with general practitioners being the most frequently consulted. Daytime fatigue (48%), psychological distress (40%), and physical discomfort (22%) were the main determinants prompting individuals with insomnia to seek treatment. Of the total sample, 15% had used at least once herbal/dietary products to facilitate sleep and 11% had used prescribed sleep medications in the year preceding the survey. Other self-help strategies employed to facilitate sleep included reading, listening to music, and relaxation. CONCLUSIONS: These findings confirm the high prevalence of insomnia in the general population. While few insomnia sufferers seek professional consultations, many individuals initiate self-help treatments, particularly when daytime impairments such as fatigue become more noticeable. Improved knowledge of the determinants of help-seeking behaviors could guide the development of effective public health prevention and intervention programs to promote healthy sleep.

PMID: 16459140 [PubMed - indexed for MEDLINE]

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Sleep disturbances and teacher ratings of school achievement and temperament in children.

Sleep Med. 2006 Jan;7(1):43-8

Authors: Bruni O, Ferini-Strambi L, Russo PM, Antignani M, Innocenzi M, Ottaviano P, Valente D, Ottaviano S

BACKGROUND: The current study examined the relationships between academic achievement, sleep, temperament and demographic-historical data in school-age children. METHODS: Teachers were asked to fill out the teacher temperament questionnaire and a form for school achievement, while mothers filled out a demographic-historical form and the sleep disturbance scale for children (SDSC), a 26-item questionnaire that consisted of six factors: difficulty in initiating and maintaining sleep (DIMS), sleep breathing disorders (SBD), arousal disorders (DA), sleep-wake transition disorders (SWTD), disorders of excessive somnolence (DOES), sleep hyperhydrosis (SHY). From a sample of 380 school children, 264 (70%) were suitable for the analyses (141 M and 123 F aged 8-11 years, mean 9.6 years). A school achievement index (SAI) was derived, summing up four items (reading ability, reading comprehension, mathematics, executive ability) of the teacher form for school achievement. RESULTS: SAI mean for the total sample was 11.1 (SD=2.8). A significant gender difference was found: females have higher SAI than males. The analysis of the demographic-historical form showed that only two factors appeared to affect SAI score: enuresis and the low educational level of the mother. The pattern of correlations showed that (a) the SAI was negatively related to the SDSC total score, in particular to DIMS and DOES sub-factors, and (b) the SAI was significantly and positively correlated with the temperamental traits of task-orientation and personal-social flexibility. A multiple stepwise regression analysis showed that the temperamental traits task-orientation and personal-social flexibility are the most predictive factors for SAI while the mother's educational level and the SDSC total score, although they contributed significantly to the prediction of SAI, accounted for only a small portion of variance. CONCLUSIONS: Temperament and sleep are important factors influencing school achievement, and their assessment could help to identify children at risk regarding school achievement.

PMID: 16309959 [PubMed - indexed for MEDLINE]

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The validation of a new actigraphy system for the measurement of periodic leg movements in sleep.

Sleep Med. 2005 Nov;6(6):507-13

Authors: King MA, Jaffre MO, Morrish E, Shneerson JM, Smith IE

BACKGROUND AND PURPOSE: To determine the accuracy of a new actigraphy system for the measurement of periodic leg movements (PLMs). Continuous measurements of leg movements, made overnight, are essential to diagnose and monitor treatment for PLMs. We have developed the Actiwatch with Cambridge Neuro-Technology Ltd (Cambridge, UK) to detect leg movements consistent with PLMs, to record these movements from both feet over three consecutive nights and to report standard indices of PLMs. We describe three studies designed to validate this device. PATIENTS AND METHODS: The Actiwatch was assessed on a bench model across a range of movement amplitudes. The level of agreement on individual movements between the Actiwatch and bilateral anterior tibialis electromyography (BATEMG) measures was assessed in 199 epochs from five patients with known PLMs. The ability of the Actiwatch to correctly identify patients with PLMs was assessed in a comparison with polysomnography (PSG) in 50 consecutive patients investigated in the sleep laboratory. RESULTS: The Actiwatch detected all mechanically generated movements (100% sensitivity and 100% specificity) on the bench test. On individual movements BATEMG measurement and the Actiwatch agreed on 94% of epochs. The sensitivity and specificity of the Actiwatch to detect leg movements in severe PLMs as defined by BATEMG (PLMI>or=25) are high (100% sensitive and 97% specific). Our bilateral system gave better agreement with BATEMG than previous systems but the two measures are still not interchangeable. CONCLUSIONS: EMG is only a surrogate measure of limb movement and indices measured in this way correlate poorly with symptoms. We have demonstrated that the Actiwatch faithfully records movement, which offers the potential to reassess the relationships between limb movement indices and symptoms. This which offers a convenient and economical alternative to PSG in the study of large populations to increase our understanding of the epidemiology and clinical significance of PLMs.

PMID: 16271695 [PubMed - indexed for MEDLINE]

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Global sleep dissatisfaction for the assessment of insomnia severity in the general population of Portugal.

Sleep Med. 2005 Sep;6(5):435-41

Authors: Ohayon MM, Paiva T

BACKGROUND AND PURPOSE: This study examines the prevalence and associated factors of insomnia symptoms and sleep dissatisfaction in the general population of Portugal. PATIENTS AND METHODS: We interviewed by telephone 1858 participants aged 18 years or older and representative of the general population of Portugal using the Sleep-EVAL system. Participation rate was 83%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to DSM-IV and ICSD classifications, associated and sleep/mental disorders and daytime consequences. RESULTS: Insomnia symptoms occurring at least 3 nights per week were reported by 28.1% of the sample and global sleep dissatisfaction (GSD) by 10.1%. Difficulty maintaining sleep was the most frequent symptom (21.0%); 29.4% of subjects with insomnia symptoms reported GSD. Daytime consequences, medical consultations for sleep and use of sleep medication were at least 2 times more frequent among subjects with insomnia symptoms and GSD compared to subjects with insomnia symptoms without GSD; insomnia diagnoses were also more frequent in the GSD group. CONCLUSIONS: The results show a severity gradation among subjects with only 1 insomnia symptom, those with 2 or 3 insomnia symptoms but without GSD and those with at least 1 insomnia symptom and GSD. Specific sleep or psychiatric disorders were identified for the majority of GSD subjects (86%); this rate dropped to 50.6% when only 1 insomnia symptom without GSD was reported. GSD appeared to be a good indicator of the presence of a sleep or psychiatric disorder and a good discriminator of the severity of sleep disturbances among subjects with insomnia symptoms.

PMID: 16085459 [PubMed - indexed for MEDLINE]

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Is insomnia a marker for psychiatric disorders in general hospitals?

Sleep Med. 2005 Nov;6(6):549-53

Authors: Rocha FL, Hara C, Rodrigues CV, Costa MA, Castro e Costa E, Fuzikawa C, Santos VG

BACKGROUND AND PURPOSE: The aim was to evaluate the relationship between insomnia and psychiatric disorders in general hospital inpatients. PATIENTS AND METHODS: Information about insomnia was collected using a structured and codified questionnaire adapted from a previously validated one in Brazil. For Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) psychiatric diagnosis, the Portuguese version of the International Neuropsychiatric Interview (MINI) was used. RESULTS: Out of the 200 patients interviewed, 56.5% complained of insomnia, and 50.0% suffered from at least one psychiatric disorder. Major depressive episode (MDE) (P<0.001), generalized anxiety disorder (P=0.025) and suicide risk (P=0.034) were associated with insomnia (univariate analysis). The results of the multivariate analysis showed that only MDE had a statistically significant association with insomnia (OR=3.6; 95% CI=1.9-6.9). CONCLUSIONS: This study found a high prevalence of psychiatric disorders and insomnia in a general hospital population and found that insomnia can be a marker for MDE.

PMID: 15994126 [PubMed - indexed for MEDLINE]

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Non-REM-sleep instability in recurrent sleepwalking in pre-pubertal children.

Sleep Med. 2005 Nov;6(6):515-21

Authors: Guilleminault C, Lee JH, Chan A, Lopes MC, Huang YS, da Rosa A

BACKGROUND AND PURPOSE: We questioned whether or not the sleep of pre-pubertal children with recurrent sleepwalking was different from that recorded in normal children. PATIENTS AND METHODS: Twelve pre-pubertal chronic sleepwalkers were compared to age- and gender-matched normal children. All children had a clinical evaluation covering pediatric, sleep, neuropsychiatric and otolaryngological fields. Two standardized sleep questionnaires were administered, and a minimum of two successive polysomnograms were performed with monitoring of sleep electroencephalographic (EEG) and cardiorespiratory variables. The research investigations were performed on nights without sleepwalking to search for the presence of other sleep disorders, including upper airway resistance syndrome (UARS). Sleep was scored using standard atlases, but it was also evaluated for the cyclic alternating pattern (CAP) rate. RESULTS: All sleepwalkers presented with either obstructive sleep apnea (n=2) or UARS (n=10). Compared to normal children, sleepwalkers had shorter total sleep time but no significant change in wake after sleep onset when considering all arousals > 3 s. CAP analysis showed a significantly higher CAP rate than in controls. CONCLUSIONS: Chronic sleepwalkers have instability of non-rapid eye movement (NREM) sleep detectable only by the calculation of CAP rate. Instability of NREM sleep was seen even on nights without sleepwalking and is probably related to the presence of the associated sleep disorders. We hypothesize that chronic NREM-sleep instability is a risk factor for occurrence of sleepwalking when further sleep disruption is triggered by external events.

PMID: 15994122 [PubMed - indexed for MEDLINE]

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Cultural influences on the bedtime behaviors of young children.

Sleep Med. 2005 Jul;6(4):319-24

Authors: McLaughlin Crabtree V, Beal Korhonen J, Montgomery-Downs HE, Faye Jones V, O'Brien LM, Gozal D

BACKGROUND AND PURPOSE: This study was designed to assess potential relationships of race and socioeconomic status (SES) to bedtime behavior from a community sample of 2- to 7-year-old children. PATIENTS AND METHODS: A previously validated sleep questionnaire was administered to parents of children enrolled in the Jefferson County, Kentucky school system. The sleep behavior of African-American (n=973) and Caucasian (n=2398) children was analyzed. Median annual income of residential zip codes was used as a proxy for SES. RESULTS: Mean age was 4.8+/-1.1 years. Two composite 'sleep behavior scores' were generated related to excessive daytime sleepiness and sleep-related behavior. Children in the lower SES group had significantly more impaired 'sleep behavior scores' than those in the higher SES group, regardless of race or age. African-American children had later bedtimes than Caucasian children with similar rise times, resulting in significantly shorter sleep duration and more excessive daytime sleepiness, independent of SES and age. CONCLUSIONS: Cultural variables impact sleep-related behavior in children. Race and SES have independent relationships with sleep behavior. Independent of SES, African-American children sleep less due to later bedtimes. SES does play a role, however, in parentally reported sleep-related behavior problems. Thus, cultural variables such as race and SES are important modifiers of sleep behaviors in children and should be addressed in sleep education programs.

PMID: 15978515 [PubMed - indexed for MEDLINE]

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Complex nocturnal visual hallucinations.

Sleep Med. 2005 Jul;6(4):363-6

Authors: Silber MH, Hansen MR, Girish M

BACKGROUND AND PURPOSE: To describe the clinical features and associations of complex nocturnal visual hallucinations. PATIENTS AND METHODS: We identified 12 patients seen between 1997 and 2004 with complex nocturnal visual hallucinations. Charts were reviewed and data analyzed. RESULTS: Of the 12 patients, 11 were women. Vivid, silent, often distorted images of people and animals occurred after waking, disappearing with increased light. Idiopathic hypersomnia, beta blocker use, dementia with Lewy bodies, macular degeneration and anxiety were associated factors. The hallucinations appeared to be a primary parasomnia in four patients with anxiety being the only associated feature. CONCLUSIONS: Complex nocturnal visual hallucinations represent a well-defined syndrome with diverse causes which should be differentiated from other parasomnias causing arousals.

PMID: 15946898 [PubMed - indexed for MEDLINE]

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The association between narcolepsy and REM behavior disorder (RBD).

Sleep Med. 2005 May;6(3):253-8

Authors: Nightingale S, Orgill JC, Ebrahim IO, de Lacy SF, Agrawal S, Williams AJ

BACKGROUND AND PURPOSE: Rapid eye movement (REM) sleep Behavior Disorder (RBD) is a movement disorder associated with loss of REM-related muscle atonia and is characterized by complex, vigorous and frequently violent dream-enacting behavior during REM sleep. RBD is usually idiopathic or secondary to neurological problems such as Parkinson's disease. This study looked at the association of RBD with another sleep disorder, narcolepsy. PATIENTS AND METHODS: Seventy-eight questionnaires were sent to known narcoleptics chosen at random from those with contact details available at the center. The questionnaire addressed current narcolepsy symptoms, medication use and symptoms of RBD. Positive questionnaire results were followed up with a telephone interview. Limited polysomnography (PSG) data was also analyzed. RESULTS: Fifty-five patients responded (response rate 71%). Of these, 20 (36%) had symptoms suggestive of RBD. The typical RBD patient is an older male (mean age of onset 60.9 years, 87% male); however, in this study, females were as likely to have RBD as males, and the mean age was 41 years. Sixty-eight percent of patients who regularly experienced cataplexy and the associated symptoms of narcolepsy (sleep paralysis, hypnogogic hallucinations and automatic behavior) had RBD, compared to 14% of those who never or rarely experienced these symptoms. CONCLUSION: This study implies a stronger relationship between these disorders than a previously published figure of 7-12% This is clinically significant as RBD is a potentially distressing but readily treatable disorder. It follows that narcoleptics, especially those with cataplexy and other associated symptoms, should be questioned about symptoms of RBD and treated accordingly. Similarly, anyone presenting with RBD should be assessed for symptoms of narcolepsy, particularly if female or of a younger age group than would otherwise be expected.

PMID: 15854856 [PubMed - indexed for MEDLINE]

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Use of the 'BEARS' sleep screening tool in a pediatric residents' continuity clinic: a pilot study.

Sleep Med. 2005 Jan;6(1):63-9

Authors: Owens JA, Dalzell V

OBJECTIVE: To assess the effectiveness of a simple, 5-item pediatric sleep screening instrument, the BEARS (B=Bedtime Issues, E=Excessive Daytime Sleepiness, A=Night Awakenings, R=Regularity and Duration of Sleep, S=Snoring) in obtaining sleep-related information and identifying sleep problems in the primary care setting. SETTING: Pediatric residents' continuity clinic in a tertiary care children's hospital. Methods: BEARS forms were placed in the medical records of a convenience sample of 2 to 12 year old children presenting for well child visits over the 5 month study period. Sleep-related information recorded in the BEARS visit and in the pre-BEARS visit, which was the subject's most recent previous well child check (WCC), was coded with respect to whether or not a sleep problem was indicated, and whether sleep issues were addressed. RESULTS: A total of 195 children had both a documented pre-BEARS and BEARS WCC visit. BEARS visits were significantly more likely than the pre-BEARS visits to have any sleep information recorded (98.5% vs. 87.7%, p<0.001), and to have information recorded about bedtime issues (93.3% vs. 7.7%, p<0.001), excessive daytime sleepiness (93.9% vs. 5.6%, p<0.001), snoring (92.8% vs. 7.2%, p<0.001), nighttime awakenings (91.3% vs. 29.2%, p<0.001), and regularity and duration of sleep (65.3% vs. 31.5%, p<0.001). Significantly more sleep problems were identified during the BEARS visits in the domains of bedtime issues (16.3% vs. 4.1%, p<0.001), nighttime awakenings (18.4% vs. 6.8%, p<0.001) and snoring (10.7% vs. 4.6%, p=0.012). Finally, almost twice as many BEARS charts had sleep mentioned in the Impression and Plan (13.1% vs. 7.3%), which approached significance (p=0.07). CONCLUSIONS: The BEARS appears to be a user-friendly pediatric sleep screening tool which significantly increases the amount of sleep information recorded as well as the likelihood of identifying sleep problems in the primary care setting.

PMID: 15680298 [PubMed - indexed for MEDLINE]

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Automated EEG-sleep analyses and neonatal neurointensive care.

Sleep Med. 2004 Nov;5(6):533-40

Authors: Scher MS

Clinical applications of neonatal EEG-sleep studies can improve neurointensive care for preterm and fullterm infants. Behavioral and physiologic assessments of neonatal sleep by nursing and physician personnel can result in more developmentally appropriate state regulation for infants, particularly for those who require medical care for many weeks to months in the intensive care unit. Secondly, prediction of altered expressions of EEG-sleep patterns for those children at higher risk for neurological sequelae can anticipate the need for aggressive interventional strategies. The application of digital analyses of specific cerebral and noncerebral physiologic measures for long-term monitoring periods can utilize efficient and novel strategies of automated EEG and sleep state identification which can also assist in daily medical care and prediction of neurodevelopmental outcome.

PMID: 15511699 [PubMed - indexed for MEDLINE]

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A putative link between childhood narcolepsy and obesity.

Sleep Med. 2004 Mar;5(2):147-50

Authors: Kotagal S, Krahn LE, Slocumb N

BACKGROUND AND PURPOSE: While there have been anecdotal observations of binge eating in childhood-onset narcolepsy, the possible relationship between increased weight gain and childhood-onset narcolepsy has not been evaluated. PATIENTS AND METHODS: A retrospective, case-control design was used to compare the body mass index (BMI) of 31 narcolepsy children at the time of diagnosis with that of healthy, age- and gender-matched controls. RESULTS: The median BMI in the narcolepsy subjects was 22.93 as compared to that in controls of 20.36 (P=0.001). BMI did not differ significantly between narcolepsy subjects who had received prior psychotropic medications and those who had not. The mean BMI of 22 of 31 narcolepsy subjects who had not received psychotropic medications prior to diagnosis was also significantly higher than that of controls (25.1, SEM 1.53 versus 21.1, SEM 0.56; P=0.008 ). CONCLUSION: The tendency for increased weight gain is intrinsic to childhood narcolepsy and is manifested relatively early in the course of the disorder. Correlation of this finding with hypocretin and leptin metabolism may further understanding of the pathogenesis of narcolepsy.

PMID: 15033134 [PubMed - indexed for MEDLINE]

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Factors associated with a delay in the diagnosis of narcolepsy.

Sleep Med. 2004 Jan;5(1):37-41

Authors: Morrish E, King MA, Smith IE, Shneerson JM

BACKGROUND: There can be a long interval from the onset of symptoms before a diagnosis of narcolepsy is made. There are no multivariate analyses reported in the literature of factors that may contribute to this delay. The aims of this study were to describe the delay in diagnosis of people with narcolepsy living in the UK and to identify associated factors. METHODS: The study comprised a postal survey of 500 members of the Narcolepsy Association UK, which included questions regarding age of onset of symptoms, year of diagnosis and subject demographics. Cox's proportional hazards regression was performed. RESULTS: A total of 313 questionnaires were returned of which 219 had been completed sufficiently for analysis. The interval between symptom onset and diagnosis ranged from within 1 to 61 years with a median of 10.5 years. Multivariate analysis showed that the presence of cataplexy as one of the initial symptoms and a more recent year of symptom onset were the only factors associated with time to diagnosis. CONCLUSIONS: We have confirmed that the diagnosis of narcolepsy can be delayed for many years particularly when cataplexy is absent initially. The delay in diagnosis in the UK appears to be decreasing, probably through greater doctor and patient awareness of the clinical manifestations of narcolepsy.

PMID: 14725825 [PubMed - indexed for MEDLINE]

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Modafinil in the treatment of excessive daytime sleepiness in children.

Sleep Med. 2003 Nov;4(6):579-82

Authors: Ivanenko A, Tauman R, Gozal D

BACKGROUND: Modafinil is an alerting agent approved for the treatment of narcolepsy in adults. There are no studies examining the long-term effects and safety profile of modafinil in children with excessive daytime somnolence (EDS). OBJECTIVES: To determine the effects of modafinil on clinical manifestations of narcolepsy and idiopathic hypersomnia. METHODS: A systematic chart review was conducted for 13 children (mean age 11.0+/-5.3 years, six males, 10 with narcolepsy and three with idiopathic hypersomnia) receiving modafinil. RESULTS: The mean modafinil dose was 346+/-119 mg/day, with a mean treatment duration of 15.6+/-7.8 months. For approximately 90% of the children treated, parents reported a favorable response with the reduction in sudden sleep attacks, as documented by sleep-wake diaries. One child failed to improve on 400 mg/day modafinil and was switched to methylphenidate. Two other children showed only partial improvement and required additional stimulant medication to control EDS symptoms. Seven children underwent repeated nocturnal polysomnography and multiple sleep latency tests (MSLT). Compared to baseline MSLT measures (mean sleep latency: 6.6+/-3.7 min), modafinil prolonged mean sleep latency (10.2+/-4.8 min, p=0.02) without significant alteration in nocturnal polysomnographic measures. However, a trend towards REM sleep reduction was noted (16.8+/-5.1%TST vs. 11.8+/-6.2%TST). Exacerbation of seizures and psychotic symptoms was reported with modafinil therapy in two children with preexisting conditions. Hematological and hepatic functions assessed every 3 months remained unaltered. CONCLUSION: Modafinil has a modest, yet significant effect on EDS in children and appears to be safe and well tolerated.

PMID: 14607353 [PubMed - indexed for MEDLINE]

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Comparison of quantitative EEG characteristics of quiet and active sleep in newborns.

Sleep Med. 2003 Nov;4(6):543-52

Authors: Paul K, Krajca V, Roth Z, Melichar J, Petránek S

BACKGROUND AND PURPOSE: The aim of the present study was to verify whether the proposed method of computer-supported EEG analysis is able to differentiate the EEG activity in quiet sleep (QS) from that in active sleep (AS) in newborns. A quantitative description of the neonatal EEG may contribute to a more exact evaluation of the functional state of the brain, as well as to a refinement of diagnostics of brain dysfunction manifesting itself frequently as 'dysrhythmia' or 'dysmaturity'. PATIENTS AND METHODS: Twenty-one healthy newborns (10 full-term and 11 pre-term) were examined polygraphically (EEG-eight channels, respiration, ECG, EOG and EMG) in the course of sleep. From each EEG record, two 5-min samples (one from QS and one from AS) were subject to an off-line computerized analysis. The obtained data were averaged with respect to the sleep state and to the conceptional age. The number of variables was reduced by means of factor analysis. RESULTS: All factors identified by factor analysis were highly significantly influenced by sleep states in both developmental periods. Likewise, a comparison of the measured variables between QS and AS revealed many statistically significant differences. The variables describing (a) the number and length of quasi-stationary segments, (b) voltage and (c) power in delta and theta bands contributed to the greatest degree to the differentiation of EEGs between both sleep states. CONCLUSION: The presented method of the computerized EEG analysis which has good discriminative potential is adequately sensitive and describes the neonatal EEG with convenient accuracy.

PMID: 14607349 [PubMed - indexed for MEDLINE]

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Efficacy and safety of modafinil for improving daytime wakefulness in patients treated previously with psychostimulants.

Sleep Med. 2003 Jan;4(1):43-9

Authors: Schwartz JR, Feldman NT, Fry JM, Harsh J

OBJECTIVES: To assess the efficacy and safety of modafinil for improving wakefulness in narcolepsy patients treated previously with psychostimulants. BACKGROUND: Modafinil has become a standard therapy for improving daytime wakefulness in narcolepsy patients and may be a useful therapeutic alternative to psychostimulants used to improve waking function in other medical conditions. Modafinil is chemically dissimilar to and has a pharmacological profile that differs from the psychostimulants. Modafinil has a low abuse potential and is well tolerated.METHODS: Patients (N=151) with narcolepsy who had been unsatisfactorily treated with dextroamphetamine (N=48), methylphenidate (N=66), or pemoline (N=37) were enrolled in this 6-week, open-label, multicenter study. Following a 2-week washout period, patients received modafinil once daily (Week 1, 200 mg; Weeks 2-6, 200 or 400 mg). Efficacy was evaluated at Weeks 1, 2, and 6 using the Epworth Sleepiness Scale and the Clinical Global Impression of Change. Adverse events were monitored throughout the study. RESULTS: Treatment with modafinil improved daytime wakefulness versus baseline regardless of which psychostimulant was taken previously. Mean ESS scores were improved after 1 week of treatment with modafinil. Improvements were maintained throughout the 6 weeks of treatment (all P<0.001 versus baseline after washout). At Week 6, 79% of all patients were considered to be clinically improved relative to post-washout baseline. The most frequent adverse events were headache, nausea, and insomnia; the majority of adverse events were mild or moderate in nature. Approximately 70% of patients were receiving 400 mg of modafinil once daily at the end of the study. CONCLUSION: During this 6-week, open-label study, modafinil was an effective and well-tolerated treatment for improving daytime wakefulness in narcolepsy patients previously treated with psychostimulants.

PMID: 14592359 [PubMed - indexed for MEDLINE]

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Sleep architecture in normal Caucasian and Hispanic children aged 6-11 years recorded during unattended home polysomnography: experience from the Tucson Children's Assessment of Sleep Apnea Study (TuCASA).

Sleep Med. 2003 Jan;4(1):13-9

Authors: Quan SF, Goodwin JL, Babar SI, Kaemingk KL, Enright PL, Rosen GM, Fregosi RF, Morgan WJ

OBJECTIVE: To obtain normative sleep architecture data from unattended home polysomnography in Caucasian and Hispanic children aged 6-11 years. DESIGN AND SUBJECTS: Unattended home polysomnography was performed on a single night in Caucasian and Hispanic children aged 6-11 years as part of the Tucson Children's Assessment of Sleep Apnea Study (TuCASA), a cohort study designed to examine the prevalence and correlates of sleep disordered breathing. A subset of 42 children enrolled in TuCASA who had no symptoms of any sleep disorder and had polysomnograms without technical recording problems. RESULTS: Sleep architecture in preadolescent Caucasian and Hispanic children was not different between boys and girls. However, total sleep time (TST), sleep efficiency (SLE) and time spent in REM sleep declined with increasing age. In addition, the number of sleep to wake stage shifts was slightly higher in younger children. Hispanic children had less Stage 3/4 sleep (18+/-1 vs. 22+/-1%, P</=0.02) and correspondingly more Stage 2 sleep (55+/-2 vs. 50.0+/-1%, P</=0.02) than their Caucasian counterparts. CONCLUSIONS: Using unattended home polysomnography, indices of sleep duration and architecture are not different between preadolescent boys and girls. However, with increasing age, TST and SLE decreased. In addition, there are differences in sleep architecture between Caucasians and Hispanics, which may be an important consideration in the evaluation of children with sleep disorders.

PMID: 14592355 [PubMed - indexed for MEDLINE]

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Preliminary observations on the effects of sleep time in a sleep restriction paradigm.

Sleep Med. 2003 May;4(3):177-84

Authors: Guilleminault C, Powell NB, Martinez S, Kushida C, Raffray T, Palombini L, Philip P

OBJECTIVE: To evaluate of the effect of 7 days of sleep restriction--with sleep placed at the beginning of night or early morning hours - on sleep variables, maintenance of wakefulness test, and serum leptin. METHODS: After screening young adults with questionnaires and actigraphy for 1 week, eight young adult males were recruited to participate in a sleep restriction study. The subjects were studied for baseline data for 2.5 days, with 8.5 h per night in bed, and then over 7 days of sleep restriction to 4 h per night with a 22:30 h bedtime for half the group and a 02:15 h bedtime for the other half. At the end of study, after one night of ad libitum sleep, subjects again had 2 days of 8.5 h in bed. Wakefulness was continuously verified and tests, including Maintenance of Wakefulness (MWT), were performed during the scheduled wake time. Blood was drawn six times throughout the 24 h of the 7th day of sleep restriction and after 2 days of the post-restriction schedule. RESULTS: There was individual variability in response to sleep restriction, but independent of group distribution, MWT was significantly affected by sleep restriction, with the early morning sleep group having less decrease in MWT score. Sleep efficiency was also better in this group, which also had shorter sleep latency. Independent of group distribution there was a greater increase in the percentage of slow wave sleep than rapid eye movement sleep, despite a clear internal variability and variability between subjects. Peak serum leptin was significantly decreased with 7 days of sleep restriction for all subjects. CONCLUSION: Sleep restriction to 4 h affected all subjects, but there were individual and group differences in MWT and sleep data. In this group of young adult males (mean age 19 years), there was a better overall adaptation to the early morning sleep, perhaps related to the general tendency in most adolescents to present some phase-delay during late teen-aged years.

PMID: 14592319 [PubMed - indexed for MEDLINE]

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The effect of stimulants on sleep characteristics in children with attention deficit/hyperactivity disorder.

Sleep Med. 2003 Jul;4(4):309-16

Authors: O'Brien LM, Ivanenko A, Crabtree VM, Holbrook CR, Bruner JL, Klaus CJ, Gozal D

OBJECTIVE: To investigate the effects of stimulant medications on subjective and objective sleep characteristics of children with attention deficit/hyperactivity disorder (ADHD) compared with control children. METHODS: An observational study in the sleep clinic and the community. Children with characteristics of ADHD, both stimulant-medicated (n=53), and non-medicated (n=34), together with control children (n=53) completed a sleep habits questionnaire prior to undergoing full overnight polysomnographic assessment. RESULTS: Medicated and non-medicated ADHD subjects were reported to have more sleep disturbances compared with controls. Both groups of ADHD children also demonstrated decreased REM sleep percentage compared with controls (P=0.006 for ADHDmed; P=0.02 for ADHDnon). However, the use of stimulant medication (n=53) was not associated with differences in subjective sleep quality or objective sleep measures, compared to ADHD children not taking any medication (n=34; P=n.s.). CONCLUSIONS: Despite the high prevalence of reported sleep disturbance in children with ADHD, stimulant medication appears to have minimal effects on subjective and objective sleep characteristics in children with reported ADHD.

PMID: 14592303 [PubMed - indexed for MEDLINE]

Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: is there a problem?

Sleep Med. 2003 Jul;4(4):273-4

Authors: Rosen G

PMID: 14592298 [PubMed - indexed for MEDLINE]