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Resumen Introducción: La somnolencia diurna excesiva se asocia a distintos desórdenes del sueño y determina un deterioro significativo de la calidad de vida. La escala de somnolencia de Epworth (ESE) es un instrumento frecuentemente utilizado en la práctica clínica para cuantificar somnolencia diurna, pero no ha sido validada en Chile. Objetivo: Validación transcultural y psicométrica de la ESE en Chile (ESE-CL), y evaluación de su sensibilidad y especificidad en el contexto de pacientes con apneas del sueño (SAHOS). Material y Método: Se realizó una adaptación transcultural y validación inicial en un grupo piloto (58 personas), aplicando en dos ocasiones separadas el mismo instrumento (ESE-CL). Se analizó el nivel de confiabilidad con alfa de Cronbach y con test retest. Para evaluar su sensibilidad se aplicó la ESE-CL a 94 pacientes con SAHOS y 100 controles. Resultados: Los valores de confiabilidad alfa de Cronbach y test re-test fue de 0,732 y 0,837, respectivamente. La capacidad de discriminación de SAHOS de la escala de somnolencia de Epworth versión chilena fue de 67%. Conclusión: La ESE-CL es un instrumento válido y confiable. Un puntaje mayor a 11 se asocia a tener mayor riesgo de padecer SAHOS y constituye una herramienta útil y de fácil aplicación clínica ante pacientes con sospecha de SAHOS.
Abstract Introduction: Excessive daytime sleepiness (EDS) is associated with different sleep disorders, which in turn causes a significant decline quality of life. Epworth sleepiness scale (ESS) is a frequently used instrument to quantify EDS, but it has not been validated in Chile. Aim: Transcultural and psychometric validation of ESS Chilean version. Material and Method: ESS-CL was initially adapted and applied to a pilot group on two separate occasions. Reliability was assessed via Cronbach's alpha and test-retest. ESS-CL was applied to 94 patients with diagnosis of obstructive sleep apnea (OSA) and 100 control to assess its sensitivity. Results: Reliability values (Cronbach's alpha and test-retest) were 0.732 y 0.837 respectively. The ability to discriminate OSA was 67%. Conclusion: The ESS-CL is a valid and reliable instrument. A score higher than 11 points is associated with a greater risk of OSA. It is a useful and accessible tool for patients in whom OSA is suspected.
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Hemos aprendido, que el sueño en neonatos y en los infantes representa un estado fisiológico formidable. Los recién nacidos (RN) invierten la mayor parte de su tiempo durmiendo y el número de horas totales de sueño, disminuye progresivamente en la medida que se incremente el grado de maduración neuronal. El sueño neonatal representa un estado crucial para la supervivencia y establecimiento de redes neuronales, por lo tanto su disrupción podría ocasionar un impacto negativo en la adquisición de hábitos de sueño, comportamiento y neurodesarrollo. Entre las semanas 28 a 32 semanas de gestación, el sueño y los ciclos de sueño juegan un papel crítico en el desarrollo de neurocircuitos a largo plazo o permanentes, y son esenciales para el aprendizaje y la memoria. Los prematuros "per se" tienen mayor riesgo de morbilidad en el neurodesarrollo que los nacidos a término. El EEG que es parte del Polisomnograma (PSG), permite calcular de una manera asertiva la Edad Gestacional (EG) con una aproximación de ±2 sem (pretérminos) ± 1 sem (a término). Esto debido que el cerebro y el EEG se desarrollan y maduran a una tasa similar independientemente de si el neonato está "in útero" o fuera de éste, excepto cuando está estresado, o en situaciones que involucran encefalopatía, convulsiones o factores relacionados con medicación. Para evaluar el sueño del RN, definimos los tres tipos de sueño, Activo, Quieto e Indeterminado. Se dan las pautas de análisis de los PSG del neonato.
Abstract: We have learned that sleep in neonates and infants represents a formidable physiological state. Newborns (RN) invest most of their time sleeping and the number of total hours of sleep progressively decreases as the degree of neural maturation increases. Neonatal sleep represents a crucial state for the survival and establishment of neural networks, so their disruption could have a negative impact on the acquisition of sleeping habits, behavior and neurodevelopment. Between 28 to 32 weeks of gestation, sleep and sleep cycles play a critical role in the development of long-term or permanent neurocircuits, and are essential for learning and memory. Preterm "per se" has a higher risk of morbidity in neurodevelopment than in children born at full term. The EEG that is part of the Polysomnogram (PSG) allows to calculate the Gestational Age (EG) in an assertive way with an approximation of 2 weeks (for preterm infants) to 1 week (for infants born at full term). This is because the brain and EEG develop and mature at a similar rate regardless of whether the newborn is in or out of the uterus, except when stressed, or in situations involving encephalopathy, seizures or factors related to medication. To evaluate newborn sleep we define the three types of sleep, Active, Still and Indeterminate. The guidelines for the analysis of newborn psGs are given.
Subject(s)
Humans , Infant, Newborn , Sleep/physiology , Polysomnography , ElectroencephalographyABSTRACT
El Síndrome de piernas inquietas (SPI) o Enfermedad de WillisEkbom, es una condición neurológica que afecta al 2-4% de los niños en edad escolar. Etiológicamente se ha relacionado al metabolismo del hierro y a factores genéticos entre otros. En niños aun es una patología poco diagnosticada. Trabajo observacional descriptivo, en el cual se realiza caracterización clínica, según criterios internacionales, en 14 pacientes menores de 18 años, 9 varones. Edad promedio 8 años. Sintomatología inicial variada, desde resistencia a ir a la cama, hasta dibujar sus molestias. En 10 se comprobó déficit de hierro. En 11 pacientes se realizó un polisomnograma, 10 de ellos con un índice elevado de movimientos periódicos de extremidades. El uso de pregabalina y aporte de hierro fue el tratamiento más utilizado. Dos pacientes tenían padres diagnosticados con SPI.
Abstract. The Restless Legs Syndrome (RLS) or Willis-Ekbom Disease is a neurological condition that affects 2-4% of school-age children. Its etiology has been related to the metabolism of iron and genetic factors among others. In children it is still a frequently undiagnosed disorder. This is a descriptive observational report, in which clinical characterization is carried out according to international criteria in 14 patients under 18 years old, 9 boys. Average age is 8 years old. The initial symptomatology was varied, from resistance to comply with bedtime, to drawing their discomfort. In 9, iron deficiency was found. A polysomnogram was performed in 11 patients, 10 of which had a high periodic limb movements index. The use of pregabalin and supplementary iron were the most used treatments. Two patients had parents diagnosed with RLS.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/physiopathology , Restless Legs Syndrome/drug therapy , Cross-Sectional Studies , Polysomnography , Ferritins/analysis , Pregabalin/therapeutic use , Iron/therapeutic useABSTRACT
Objective To explore the rapid eye movement (REM) sleep characteristics of different episode types of depression and post-stroke depression (PSD) patients and provide support for clinical diagnosis,treatment and prognosis.Methods Patients with single-episode depression (group A,n =22),patients with recurrent depression (≥ 2 episodes,group B,n=26) and patients with PSD (group C,n=19)were included from Henan Provincial Mental Hospital.20 healthy volunteers were assigned to control group.Participants in the 4 groups were performed polysomnographic recordings (PSG) from 9 PM to 6 AM before treatment.The 3 patients groups were performed the second PSG recordings and HAMD score at the end of 6 week SSRIs treatment.The REM indexes of 4 groups were compared and analyzed.Results First PSG detection showed that REM sleep latencies (RL) were shorter in group A and B (A:(65.57±18.29) min,B:(66.32±15.46) min) than that in group C ((79.17±20.18) min) and control group((87.24±16.55)min);REM activity (RA) (A:(99.82±25.71) u,B:(104.70±28.23) u)and REM density (RD) (A:(81.06± 19.35)％,B:(86.61±23.83) ％) were increased more significantly in group A and B than those in control group ((79.61 ± 18.40) u;(68.11 ± 17.54) ％);REM sleep time (RT) were decreased more signifi-cantly in group C ((51.66±22.26) min) than that in group A((71.43±20.70) min),group B((74.81±17.52) min) and control group ((70.46±16.35) min)(P＜0.05).After treatment,REM sleep latency was prolonged in group A ((65.57±18.29) min vs (81.71±21.62) min),and REM activity was decreased in group A((99.82±25.71) u vs (83.58±27.19) u),the difference was statistically significant (P＜0.05).REMdensity was decreased,but the difference was not statistically significant (P＞0.05).There was no significant difference in the indexes of REM in group C;RT was prolonged ((51.66± 22.26) min vs (68.37 ± 20.16)min) in group C,the difference was statistically significant (P＜0.05).Conclusion Most of depression patients with different episode types have REM disinhibition phenomenon.RD increase may be REM characteristic type of depression patient.Sleep disorders of PSD patients are mainly poor sleep process and sleep continuity and have no characteristics of REM sleep disorder of depression ones.
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Objective To explore the rapid eye movement (REM) sleep characteristics of different episode types of depression and post-stroke depression (PSD) patients and provide support for clinical diagnosis,treatment and prognosis.Methods Patients with single-episode depression (group A,n =22),patients with recurrent depression (≥ 2 episodes,group B,n=26) and patients with PSD (group C,n=19)were included from Henan Provincial Mental Hospital.20 healthy volunteers were assigned to control group.Participants in the 4 groups were performed polysomnographic recordings (PSG) from 9 PM to 6 AM before treatment.The 3 patients groups were performed the second PSG recordings and HAMD score at the end of 6 week SSRIs treatment.The REM indexes of 4 groups were compared and analyzed.Results First PSG detection showed that REM sleep latencies (RL) were shorter in group A and B (A:(65.57±18.29) min,B:(66.32±15.46) min) than that in group C ((79.17±20.18) min) and control group((87.24±16.55)min);REM activity (RA) (A:(99.82±25.71) u,B:(104.70±28.23) u)and REM density (RD) (A:(81.06± 19.35)％,B:(86.61±23.83) ％) were increased more significantly in group A and B than those in control group ((79.61 ± 18.40) u;(68.11 ± 17.54) ％);REM sleep time (RT) were decreased more signifi-cantly in group C ((51.66±22.26) min) than that in group A((71.43±20.70) min),group B((74.81±17.52) min) and control group ((70.46±16.35) min)(P＜0.05).After treatment,REM sleep latency was prolonged in group A ((65.57±18.29) min vs (81.71±21.62) min),and REM activity was decreased in group A((99.82±25.71) u vs (83.58±27.19) u),the difference was statistically significant (P＜0.05).REMdensity was decreased,but the difference was not statistically significant (P＞0.05).There was no significant difference in the indexes of REM in group C;RT was prolonged ((51.66± 22.26) min vs (68.37 ± 20.16)min) in group C,the difference was statistically significant (P＜0.05).Conclusion Most of depression patients with different episode types have REM disinhibition phenomenon.RD increase may be REM characteristic type of depression patient.Sleep disorders of PSD patients are mainly poor sleep process and sleep continuity and have no characteristics of REM sleep disorder of depression ones.
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Obstructive sleep apnea syndrome (OSAS) is caused by repetitive upper-airway narrowing or collapse during sleep resulting in hypopneas and apneas. When a patient is diagnosed of OSAS with polysomnogram, he/she should receive upper airway evaluation to find the narrow site. The anatomic narrow site can be nasal cavity, nasopharynx, oropharynx, and/or hypopharynx. Surgical treatment for OSAS should be tailored to the anatomic narrow site. In this article, the authors describe surgical treatment options for OSAS.
Subject(s)
Humans , Apnea , Hypopharynx , Nasal Cavity , Nasopharynx , Oropharynx , Polysomnography , Sleep Apnea, ObstructiveABSTRACT
Objective To explore ihe physiological changes of the late-onset depressive(LOD) persons during sleep.Methods 15 cases of LOD patients formed a group and 10 healthy aging persons formed a control group.Hamilton Depression Scale (HAMD) was used to score the severity of depression and polysomnographic recorders were used to monitor the whole night long.The subjective feelings of the sleep and the daytime mental status were assessed in the morning.Results Compared with the controlde group, the LOD patients obviously possessed a disordered sleeping process: sleep efficiency was lower( ( 59.20 ± 2.90 ) %, ( 77.09 ± 1.55 ) %, P ＜0.01 ); their sleep latency was longer( (54.00 ± 4.97 ), ( 24.00 ± 2.91 ), P ＜ 0.01 ); the numbers of rapid eye movement(REM) sleep phase and rapid eye movement latency(REML) were strikingly different(P＜0.01 ).Compad with the control group, the LOD patients' awakening time and percent were significantly increased.Not only were the time and percentage of S2 sleep phase much higher, but the time of slow wave sleep was shorter.Besides,REM sleep activity, its density, and its intensity were raised (P ＜ 0.05 ).Conclusion There is a disturbance of the objective physiological indexes happening among the LOD patients.The increase of S2 sleeping time and percentage and the disinhibition of REM sleep can be used as the diagnosis indexes of LOD patients' specificity.
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O reconhecimento dos distúrbios respiratórios do sono tem aumentado a cada ano. Manifestações, como o ronco, consideradas meros incômodos vêm adquirindo importância no que diz respeito à qualidade de vida e seu impacto social. OBJETIVO: Comparar a história clínica com os resultados da polissonografia (PSG), na Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS), é o principal objetivo deste trabalho. MATERIAL E MÉTODOS: Foi realizado um estudo retrospectivo, com 125 pacientes, através da análise de questionários específicos, IMC e Escala de Epworth. RESULTADOS: Dentre os pacientes, 75 eram do sexo masculino e 50 do feminino. O principal sintoma foi a roncopatia. 46 por cento apresentaram PSG normais, 30 por cento SAHOS leve, 15 por cento moderada e 9 por cento severa, não se evidenciando correlação estatística entre a clínica e a PSG. Dentre as queixas, somente a insônia foi relevante, em análise univariada e em pacientes normais e com SAHOS leve (p<0,05), comparada aos pacientes com SAHOS moderada e severa, perdendo sua importância quando analisada na presença de outros fatores. CONCLUSÃO: A história clínica, por si só, não é suficiente para a definição do diagnóstico ou do grau de severidade dos casos de SAHOS.
Recognizing sleep-disordered breathing is on the rise every year. Manifestations, such as snoring, that were earlier considered mere inconvenients are now acquiring greater importance concerning life quality and social impact. AIM OF THE STUDY: To compare the clinical history to polysomnogram (PSG) results in the Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS). MATERIALS AND METHODS: 125 patients were analyzed, in a retrospective study. Specific questionnaires, avaliations of Body Mass Index and Epworth Scale were carried out. RESULTS: Among the patients, 75 were males and 50 were females. The main symptom was snoring. 46 percent had normal PSG, 30 percent had light OSAHS, 15 percent moderate and 9 percent severe OSAHS and it was not observed a correlation between clinical data and PSG results. Concerning clinical symptoms, only insomnia has shown relevance when univariably analyzed in normal and light OSAHS patients (p<0,05) compared to patients with moderate and severe OSAHS, losing its importance when analyzed together with other factors. CONCLUSION: the clinical history, per se, is not sufficient to define OSAHS' diagnosis or it's severity.
Subject(s)
Female , Humans , Male , Middle Aged , Adult , Adolescent , Sleep Apnea, Obstructive/diagnosis , Body Mass Index , Polysomnography , Surveys and Questionnaires , Retrospective Studies , Severity of Illness IndexABSTRACT
Background The severity of difficulty in falling asleep and the insufficiency of the sleeping time in the primary insomniacs always were overestimated, even after medication and improving the objective sleep quality. Moreover, remarkable psychosomatic symptoms were found in patients and the symptoms were significantly linked to the self-reported sleep quality. So in this study, it was designed to explore the differences between objective and subjective sleep quality and its correlative factors in chronic insomniacs.Methods A total of 55 chronic primary insomniac cases diagnosed by DSM-Ⅳ diagnostic criteria for primary insomnia and 15 normal controls were rated with Pittsburgh sleep quality index (PSQI),State-Trait Anxiety Inventory (STAI), and the Subjective General Condition Form. All cases and the controls were then examined by the whole-night polysomnography (PSG) records.Results Compared with the objective parameters of PSG, the subjective parametersiu chronic insomniacs had significantly longer sleep latency and lower total sleep time and sleep efficiency [ (80. 3± 73.7)min v.s. (23.2 ± 25.4) min, (157.8±141.7)min v.s. (332.2±154.7)min , (0.52 ±0. 27) min v.s. (0. 67 ± 0. 28) min, respectively, P ＜0. 001 ]. The difference between subjective and objective sleep latency was related to the total scores of STAI, TAI and SAI ( r = 0. 402,0. 374 and 0. 397, respectively, P ＜ 0. 05).Conclusions There were significant differences between objective and subjective estimations of sleep quality in chronic insomniacs,and they might result in the overestimation of the severity of insomnia. The differences between subjective and objective sleep quality in the chronic insomniacs were significantly correlated with the levels of anxiety.
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@#ObjectiveTo verify the homology hypothesis of depression and insomnia.Methods All-night physiological signals of electroencephalogram (EEG), electrosculogram (EOG) and electromyogram (EEG) of 30 depression cases and 30 insomnia cases were recorded and analyzed with polysomnogram.ResultsThe rapid eye movement (REM) sleep of depression patients was more active, and there was a significant difference in all REM indexes compared with insomnia cases (P<0.01). Characteristics of insomnia cases were poor sleep continuity, easy wake after sleep-onset, and depression of slow wave sleep and REM sleep. There was no slow wave sleep in some insomnia cases.Conclusion The sleep patterns of depression and insomnia are different, REM sleep is hyperactive in depression; non-REM sleep is disturbance in insomnia.
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5,6 or 7 respectively,the specificity became gradually higher.But the sensitivity and the diagnoses according rate became lower.Conclusion Holter is a simple shortcut useful tool as a non-invasive means of assessing and filtrating OSAS.
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Nocturnal paroxysmal dystonia is characterized by brief, abrupt, dystonic or dyskinetic movement during NREMsleep. It has been considered as a form of nocturnal frontal lobe epilepsy. A 35-year-old man complained of sleep disturbance and abnormal movement during sleep. In video-polysomnography recordings, he showed frequent stereotyped abnormal dystonic movements in upper and lower extremities. The dystonic movements occurred during stage IV sleep. He was treated with carbamazepine and the symptoms improved. (J Korean Neurol Assoc 19(3):305~308, 2001)
Subject(s)
Adult , Humans , Carbamazepine , Dyskinesias , Epilepsy, Frontal Lobe , Lower Extremity , Nocturnal Paroxysmal Dystonia , PolysomnographyABSTRACT
BACKGROUND: Uvulopalatopharyngoplasty(UPPP) is the most frequently performed surgical treatment of obstructive sleep apnea syndrome(OSAS). Even though polysomnogram is the best method to evaluate the results after UPPP, the patients are often unwilling to undergo postoperative testing, particularly if the patients' symptoms have improved. As the perioperative evaluation of UPPP only based on subjective symptoms may lead to incorrect results, objective indexes such as respiratory parameters and sleep structures should also be analyzed. OBJECTIVES: To evaluate the long-term outcome of UPPP in OSAS patients by comparing preoperative subjective symptoms and objective indexes with postoperative results. MATERIALS AND METHODS: We compared preoperative subjective symptoms and objective indexes including respiratory and sleep parameters in 16 OSAS patients who underwent UPPP and were followed up for 15 months or more. RESULTS: Snoring improved in 10(62.5%) of the 16 patients and apnea in 13(81.3%). In respiratory parameters, apnea index(AI) and respiratory disturbance index(RDI) decreased more than 50% in 11 patients(68.8%), respectively. There was no significant change of sleep structure except for in stage I. Only changes of subjective apnea symptom were significantly correlated with changes of AI and RDI, but there were no correlations between the other variables. CONCLUSIONS: In evaluating the surgical outcome after UPPP of OSAS patients, objective analysis on long-term follow-up is needed in addition to assessment of subjective symptom changes.
Subject(s)
Humans , Apnea , Follow-Up Studies , Polysomnography , Sleep Apnea, Obstructive , SnoringABSTRACT
Sleep Apnea Syndrome is characterized by hypersomnolence, snoring, and sleep apnea. The symptoms of hypothyroidism include apathy, somnolence, lethargy, personality change, and intellectual deterioration and may be related to hypothyroid-related sleep disorders. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A 60-yr-old man was admitted due to hypersomnolence, snoring and generalized edema. Polysomnogram showed obstructive pattern of sleep apnea syndrome. Neck CT scan revealed narrowing of upper airway which is consistent with obstructive sleep apnea syndrome. Physical examination and hormonal study also disclosed the evidence of hypothyroidism. We report a case of sleep apnea syndrome due to primary hypothyroidism with review of literatures.
Subject(s)
Apathy , Disorders of Excessive Somnolence , Edema , Hypothyroidism , Lethargy , Neck , Physical Examination , Polysomnography , Sleep Apnea Syndromes , Sleep Apnea, Obstructive , Sleep Wake Disorders , Snoring , Tomography, X-Ray ComputedABSTRACT
Se describe el síndrome de apnea del sueño (SAS) abarcando los aspectos históricos, signos y síntomas, las diversas modalidades (apneas obstructiva, central y mixta), complicaciones, principalmente cardiovasculares y cerebrovasculares y formas de tratamiento. Se hace énfasis en la ayuda diagnóstica del polisomnograma que ha permitido definir como SAS síntomas antes considerados inespecíficos y cuantificar su gravedad. Se describen las diversas medidas terapéuticas, locales y generales, recalcando los beneficios que se obtienen con la aplicación de los aparatos de respiración a presión positiva. Estos permiten tratamientos no invasivos que hacen desaparecer la totalidad de los síntomas y evitan los riesgos incrementados de trastornos cardiovasculares y accidentes laborales o de tránsito. Este grave síndrome afecta a un grupo grande de población por lo que su importancia es indudable
Different aspects of the sleep apnea síndrome (SAS) are described, including history, clinical manifestations, clinical forms (obstructive, central and mixed), cardiovascular, cerebrovascular and other complications and treatment. With the use of the polysomnogram it has been possible to define non-specific symptoms as due to SAS and to quantitate their seriousness. Different therapeutic approaches are described, both local and systemic, with emphasis on the benefits obtained from the use of positive pressure breathing machines which control every manifestation of the syndrome and avoid the increased cardiovascular risks aswell as work and traffic accidents. This syndrome is important in terms of frequency and of increased death risk