Sleep problems in ankylosing spondylitis: polysomnographic pattern and disease related variables

To identify polysomnographic sleep pattern and its correlations with disease specific variables as well as fatigue, depression and quality of life in patients with ankylosing spondylitis. Polysomnographic [PSG] sleep assessment was done for 30 males including 10 healthy subjects and 20 patients with ankylosing spondylitis [AS]. Sleep quality, fatigue and depression were evaluated. Disease specific variables such as disease activity, functional disability, global well being and quality of life were recorded. Ninety percentage of AS patients were classified as poor sleepers. In comparison to controls, patients with AS experienced prolonged sleep latency, lessened sleep efficiency, increased stages I%, II%, deficient SWS%, higher arousal and periodic leg movement indices in a significant manner. Meanwhile obstructive sleep apnea was not a significant finding. Significant correlations were detected between most of the PSG parameters as well as sleep quality index on one hand and different disease specific variables, fatigue, pain, quality of life on the other hand but not with depressive symptoms. Disease activity, fatigue and quality of life were significantly associated with most of PSG sleep components on the multiple regression analysis model. AS patients differ negatively in their sleep from normal population both in quantity and quality. Our findings suggest that multiple factors are associated with PSG sleep disturbances including disease activity, fatigue and quality of life. While treating patients, it is important to question sleep disorders followed by the performance of PSG in order to optimize the management of patients with AS

Menstrual associated sleep disturbance: a study in an Egyptian sample

To investigate the problem of sleep in relation to menstruation, addressing only women in the childbearing period. The study included 100 women with sleep complaints excluding those above the age of 40, any history of physical or mental disorder and any marked irregular menstrual cycles. A standardized sleep questionnaire was asked and polysomnography done pre- and postmenstrual in addition to assessment for the presence of premenstrual dysphoric disorders. 100 women have been asked to reply to a questionnaire concerning sleep problems in the premenstrual period. 48 reported significant sleep complaints, including insomnia, hypersomnia and excessive daytime somnolence. 9 were found to fulfill DSM-IV criteria of premenstrual dysphoric disorder [PMDD]. 19 females including those with PMDD accepted to be evaluated by polysomnography [PSG] once in the premenstrual phase and another postmenstrual. Comparing results of sleep profile pre- and postmenstrual revealed increased sleep latency, decreased efficiency and increased arousals premenstrual, Comparing patients with PMDD to other females with premenstrual sleep complaint revealed only less SWS in PMDD. Evaluation of sleep profile in women with premenstrual sleep complaints, revealed mainly sleep continuity disturbance manifested by the significant increase in sleep latency. Overall findings are in support of considering premenstrual sleep problems as a separate diagnostic entity, at least for some females, which is still in need of further studies

Flow volume loop pattern in sitting and supine positions in obstructive sleep apnea

Episodes of obstructive sleep apnea depend on posture assumed during sleep, being more frequent in the supine position. Findings on supine flow volume loop [FVL] may therefore correlate better with obstructive apneic episodes than sitting FVL. In this study we investigated the FVL pattern in 27 obstructive sleep apnea [OSA] patients having upper airway obstruction in both sitting and supine positions compared to 20 control subjects. Diagnosis of OSA was based on full night polysonographic study. Spirometric measures were done in either group in sitting and supine positions in a random fashion. Sixteen patients with oropharyngeal airway obstruction underwent uvulopalatopharyngo plasty. Polysomnography and FVL were repeated 6 weeks later and compared to preoperative pattern. Apnea-hypopnea index showed more than 50% improvement in 13 patients postoperatively. Spirometric features in OSA group were: Vital capacity [VC] was less in supine [2.4 +/- 0.5] than sitting position [2.7 +/- 0.6]. Both were less than normal group [4.2 +/- 0.9] p<0.05. Postoperatively, there was insignificantly increase in both supine [2.5 +/- 0.4] and sitting [2.8 +/- 0.5] VC in responders. The expiratory and inspiratory flow rates were less in supine position than sitting position throughout VC especially at higher lung volumes, both were less than normal group. The Expiratory flow curve showed an expiratory flow plateau which could be identified between 85-61% of VC in 83% of OSA in supine position and in 66% in sitting positions. The mid portion of expiratory curve was convex away from volume axis in 89% of cases of OSA compared to slightly concave one in normal group. On the other hand, the inspiratory flow curve showed an inspiratory plateau occurred in 66% of sitting OSA patients. It extended over 55% VC. Expiratory flow ratio MEF[50]/ M1F[50] ratio was higher in OSA[0.71 in sitting and 0.78 in supine] compared to control group [0.3 in sitting and 0.6 in supine]. In the postoperatively group the pattern of FVL was still retaining the preoperative features specially in the bad responders group. FVL reflects the dynamic upper airway narrowing in OSA patients. Two features are added to previously reported FVL characteristics in OSA patients. The pattern is more evident in supine position. It is persistent after surgical treatment. FVL is useful physiological test for studying behavior of upper airways in individual OSA patients rather than diagnostic tool for screening these patients. Supine FVL may be used as a helping tool to predict the postoperative success when sitting FVL is not fully informative in a Suspicious case