Research progress in pharmacotherapy of insomnia / 中国中药杂志

Insomnia is extremely common and is a risk factor for a variety of physical and psychological disorders in addition to contributing to the reduced quality of life of patients and the burden of healthcare costs. Although cognitive behavioral therapy is the first-line treatment for insomnia, its difficulty of access and high cost have hindered its application. Therefore, pharmacotherapy remains the common treatment choice for patients and clinicians. Existing chemical drugs including benzodiazepine receptor agonists, dual orexin receptor antagonists, melatonin and its receptor agonists, histamine antagonists, antidepressants, and antipsychotics are able to induce and/or maintain sleep and have good therapeutic effects on acute insomnia, but their efficacy on chronic insomnia is indefinite. Furthermore, they have several side effects and affect sleep structure and physiological function. Under the guiding principle of holistic view and treatment based on syndrome differentiation, traditional Chinese medicine(TCM) has shown a good effect in clinical practice, but with little high-grade clinical evidence. The mechanism, dose, half-life period, adjustment of sleep structure, and side effects of hypnotic drugs are key factors to be considered for clinical use. This paper analyzed and summarized the drugs for insomnia from the above aspects, and is expected to provide references for the application and development of sedative and hypnotic drugs.

The sleep structure of healthy children and of children with cerebral palsy / 中华物理医学与康复杂志

Objective:To compare the differences in sleep structure between healthy children and children with cerebral palsy (CP) using polysomnography (PSG).Methods:Fifty-six children aged 1-15 hospitalized for cerebral palsy formed the experimental group, while 30 healthy children served as controls. Both groups were given 24-hour PSG, and their sleep structures were compared and analyzed.Results:The incidence of sleep disorders in the children with cerebral palsy (55.4%) was significantly higher than among the healthy children (20.0%). The average sleep latency was significantly higher than among the healthy children, while the duration and the percentage of the rapid eye movement (REM) stage were significantly lower than among the healthy children. Total sleep time [(458.47±95.62)min], sleep efficiency [(74.26±13.63)%], duration of REM [(68.90±42.70)min] and REM percentage [(13.87±7.12)%] were all significantly lower for the children with severe cerebral palsy than for those with mild or moderate disorder. Their time to wake up after falling asleep was significantly longer. Moreover, the duration of REM and the REM percentage of children with dyskinetic cerebral palsy were significantly lower than for those with spastic cerebral palsy.Conclusions:The incidence of sleep disorders among children with cerebral palsy is higher than among healthy children. They have more difficulty in falling asleep and have a shorter REM stage. Children with severe cerebral palsy and involuntary cerebral palsy have more sleep problems.

Effect of Fang's scalp acupuncture on perceived stress and sleep structure in insomnia patients: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the efficacy on insomnia between Fang 's scalp acupuncture combined with conventional acupuncture and the simple conventional acupuncture.@*METHODS@#A total of 66 patients with insomnia were randomly divided into an observation group (33 cases, 1 case dropped off) and a control group (33 cases, 2 cases dropped off). In the control group, the routine acupuncture therapy was applied to Shenmen (HT 7), Baihui (GV 20), Zhaohai (KI 6) and Sanyinjiao (SP 6), etc. Based on the treatment as the control group, Fang's scalp acupuncture therapy was supplemented at fuxiang tou, fuzang shangjiao, fuzang zhongjiao, siwei, etc. At these scalp points, the needles were inserted perpendicularly with flying needling technique and manipulated with trembling one. In either group, the treatment was given once daily, continuously for 2 weeks. Before and after treatment, separately, the score of Pittsburgh sleep quality index (PSQI) and the score of Chinese perceived stress scale (CPSS) were observed, as well as the parameters monitored by polysomnography, i.g. total sleep time (TST), sleep onset latency (SOL), wakefulness after the sleep onset (WASO), sleep efficiency (SE), the percentages of the time of rapid eye movement sleep phase (REM) and non-rapid eye movement sleep phase 1, 2, 3 and 4 in TST (REM%, N1%, N2%, N3%). The efficacy was compared between two groups.@*RESULTS@#After treatment, the scores of each factor and the total scores of PSQI, as well as CPSS scores were all lower than those before treatment in the two groups (P<0.01, P<0.05); except the score for sleep quality, the score of each factor and the total score of PSQI, as well as CPSS score in the observation group were lower than those in the control group (P<0.01, P<0.05). After treatment, TST, SE%, REM% and N3% were increased and SOL, WASO, N1% were decreased as compared with before treatment in the two groups (P<0.01, P<0.05), and N2% in the observation group was decreased (P<0.01); SE%, REM% and N3% in the observation group were higher than the control group (P<0.05) and N1% and N2% were lower than the control group (P<0.05). The total effective rate was 93.8% (30/32) in the observation group, higher than 87.1% (27/31) in the control group (P<0.05).@*CONCLUSION@#Fang 's scalp acupuncture, on the base of routine acupuncture, obviously improves the sleep quality and perceived stress and adjusts the sleep structure in the patients with insomnia.

Effect and underlying mechanism of obstructive sleep apnea on memory consolidation / 四川精神卫生

The purpose of this paper is to review the research progress on the effects of obstructive sleep apnea （OSA） on memory consolidation， and to speculate on possible mechanisms underlying these effects， so as to inform the exploration of effective therapeutic measures for impaired memory consolidation. Previous studies have shown that mild OSA may impair different types of memory consolidation， and the impairments are closely related to certain indices of polysomnography （such as sleep microstructure， apnea hypopnea index， arousal index， etc）. Therefore， it is hypothesized that disruption of sleep architecture and damage to brain regions and neural pathways associated with sleep-dependent memory consolidation due to intermittent hypoxia may trigger a decline in memory consolidation. Meantime， long-term continuous positive airway pressure can alleviate the impairment of memory consolidation induced by OSA， but whether other interventions can mitigate the damage remains unclear.

Clinical characteristics and pathogenesis of sleep disorder in patients with post-traumatic stress disorder / 中华行为医学与脑科学杂志

Post-traumatic stress disorder(PTSD) caused by various natural disasters and man-made events has gradually become the highlight of neuroscientists. Sleep disorders after PTSD can impair the effect of treatment and affect the patient's prognosis. In addition, treatment for sleep problems can be effective in improving outcomes for people with PTSD, which indicates that it is significant to pay attention to sleep disorders after PTSD. However, current studies have focused more on the incidence of PTSD and severity of related symptoms after a traumatic event, and less on the occurrence and mechanism of sleep disorders after PTSD. A number of articles on stress and sleep disorders published in recent years provide reliable clues to understand the probable mechanisms of sleep disorders after PTSD. After summarizing the latest research results, this article finds that the occurrence of sleep disorder after PTSD may be related to the changes of connectivity between insula, hippocampus and medial-prefrontal cortex. Apart from that, decline in the mean phase difference of slow spindles in PTSD patients may reflect pathological changes in the thalamic cortical circuit, which may contribute to the objective diagnosis of PTSD and the development of sleep-focused interventions. This paper provides a systematic review of changes in sleep characteristics and possible neural circuitry mechanisms after PTSD from clinical and basic perspectives, which may provide potential directions for future researches on the pathological mechanism of sleep disorders after PTSD and screening novel intervention targets.

Development of a New Multi-parameter Sleep Quality Evaluation System / 中国医疗器械杂志

In order to study the effects of sleep-disordered breathing on human physiology and function, and to accurately and objectively evaluate the level of human sleep quality at night, it can help patients with respiratory disorders improve sleep quality. This paper elaborates the development process of a new multi-parameter sleep quality evaluation system from the hardware circuit design, software and algorithm analysis design of the system. The system hardware platform collects the physiological signals of the 11-channel nighttime sleep period, and displays and stores them in real time on the monitoring platform. After collecting the sleep data of the whole night, it can effectively assist the sleep doctor to sleep by combining the judgment of the sleep-time respiratory disorder, the determination of the sleep cardiovascular event, the determination of the sleep-aware response event, and the sleep structure staging. The quality of sleep in patients with disorders was deeply evaluated.

Effect of acupuncture and estazolam on episodic memory and sleep structure in patients with chronic insomnia disorder: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the effect on chronic insomnia disorder (CID) and influences on episodic memory and sleep structure between acupuncture and estazolam tablets.@*METHODS@#A total of 140 CID patients were randomized into a meridian-point group (46 cases, 1 case dropped off), a non-meridian-and-non-acupoint group (47 cases, 2 cases dropped off) and a medication group (47 cases, 2 cases dropped off). In the meridian-point group, Baihui (GV 20), Shenmen (HT 7), Sanyinjiao (SP 6), Zhaohai (KI 6) and Shenmai (BL 62) were selected and the routine acupuncture was applied. In the non-meridian-and-non-acupoint group, the needling technique was same as the meridian-point group. Acupuncture was given once daily for 4 weeks in the above two groups. In the medication group, estazolam tablets were administered orally, taken 1 to 2 mg per night, consecutively for 4 weeks. Before and after treatment, the changes in the following indexes were observed in each group, i.e. the score of insomnia severity index (ISI), the score of auditory verbal memory test (AVMT) and the relevant indexes of sleep structure [total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE) and the percentage of non rapid eye movement phase 1, 2 and 3 (N1, N2 and N3) and rapid eye movement time (REM) in TST].@*RESULTS@#After treatment, ISI scores were reduced in the meridian-point group and the medication group (<0.01), the score in the meridian-point group was lower than the medication group and the non-meridian-and-non- acupoint group respectively (<0.01) and that in the medication group was lower than the non-meridian-and-non-acupoint group (<0.01). After treatment, the score of each of immediate recall, short-term delayed recall, long-term delayed recall and delayed recognition of AVMT was increased in the meridian-point group and the medication group respectively (<0.01, <0.05) and the score of each item of AVMT in the meridian-point group was higher than the medication group and the non-meridian-and-non-acupoint group respectively (<0.01, <0.05). The scores of immediate memory and delayed recognition in the medication group were higher than the non-meridian-and-non-acupoint group respectively (<0.01). After treatment, SOL, WASO and N1% were all reduced (<0.01) and TST, SE, N3% and REM% were all increased (<0.01, <0.05) in the meridian-point group and the medication group, N2% in the meridian-point group was reduced (<0.01). After treatment, N1% and N2% in the meridian-point group were lower than the medication group (<0.01) and N3% and REM% were higher than the medication group (<0.01). After treatment, TST, SE and N3% in the meridian-point group and the medication group were all higher than the non-meridian-and-non-acupoint group respectively (<0.01, <0.05) and SOL, WASO and N1% were lower than the non-meridian-and-non-acupoint group respectively (<0.01). REM% in the meridian-point group was also higher than the non-meridion-and-non-acupoint group (<0.01), and N2% in the meridian-point group was also lower than the non-meridian-and-non-acupoint group (<0.01).@*CONCLUSION@#Compared with estazolam, acupuncture much better improves sleep quality and episodic memory in patients with chronic insomnia disorder, which is possibly related to the regulation of sleep structure of patients in treatment with acupuncture.

Study of sleep features in patients with temporal lobe epilepsy / 天津医药

Objective To study sleep characteristics in patients with temporal lobe epilepsy (TLE) through polysomnography (PSG). Methods Twenty-five TLE patients (TLE group) and eighteen healthy volunteer subjects (control group) were recruited to our study. Patients of two groups were evaluated by whole-night PSG, including total time in bed (TIB), total sleep time (TST), sleep efficiency (SE), sleep latency (SL), rapid eye movement latency (REML), wake after sleep onset (WASO), the percentages of non-REM (NREM) 1, 2 and 3 stages and the percentages of rapid eye movement (REM) occupied TST (N1％, N2％, N3％and REM％), the apnea-hypopnea index (AHI), hypopnea index, mean oxygen saturation (SpO2) and nadir SpO2, periodic leg movements (PLMs) index and PLMs index of REM sleep, sleep stage shifts (SSS) and sleep stage shifts per hour (SSS/h), NREM1, NREM2, NREM3 and REM sleep stage and wake shifts (abbreviated as N1, N2, N3, REM and W) and their proportions of SSS (abbreviated as N1/SSS, N2/SSS, N3/SSS, REM/SSS and W/SSS). Results Compared with control group, WASO, PLMs, PLMs index of REM sleep, SSS, SSS/H and N2 were significantly increased in TLE group. Moreover, compared with control group, SpO2 was decreased in TLE group (P<0.05). Conclusion Our results suggest that TLE patients have sleep disorder manifested as disorder of sleep structure, increased incidents of respiratory and motion events.

Correlational Analysis of Supine Position Time and Sleep-related Variables in Obstructive Sleep Apnea Syndrome / 수면정신생리

OBJECTIVES: A supine sleep position increases sleep apneas compared to non-supine positions in obstructive sleep apnea syndrome (OSAS). However, supine position time (SPT) is not highly associated with apnea-hypopnea index (AHI) in OSAS. We evaluated the correlation among sleep-related variables and SPT in OSAS. METHODS: A total of 365 men with OSAS were enrolled in this study. We analyzed how SPT was correlated with demographic data, sleep structure-related variables, OSAS-related variables and heart rate variability (HRV). Multiple linear regression analysis was conducted to investigate the factors that affected SPT. RESULTS: SPT had the most significant correlation with total sleep time (TST ; r = 0.443, p < 0.001), followed by sleep efficiency (SE ; r = 0.300, p < 0.001). Snoring time (r = 0.238, p < 0.001), time at < 90% SpO2 (r = 0.188, p < 0.001), apnea-hypopnea index (AHI ; r = 0.180, p = 0.001) and oxygen desaturation index (ODI ; r = 0.149, p = 0.004) were significantly correlated with SPT. Multiple regression analysis revealed that TST (t = 7.781, p < 0.001), snoring time (t = 3.794, p < 0.001), AHI (t = 3.768, p < 0.001) and NN50 count (t = 1.993, p = 0.047) were associated with SPT. CONCLUSION: SPT was more highly associated with sleep structure-related parameters than OSAS-related variables. SPT was correlated with TST, SE, AHI, snoring time and NN50 count. This suggests that SPT is likely to be determined by sleep structure, HRV and the severity of OSAS.

The sleep structure of children with attention deficit hyperactivity disorder / 中华实用儿科临床杂志

Objective To investigate the sleep structure of children with attention deficit hyperactivity disorder (ADHD) and the differences among subtypes of ADHD.Methods Ninety children with ADHD were diagnosed in Department of Neurology, the Children's Hospital Affiliated to Capital Institute of Pediatrics between June 2012 and June 2013, including 75 boys and 15 girls,6-14 years old [(9.5 ± 2.4) years old], and among them there were 55 cases of ADHD-combined type, 25 cases of ADHD-inattentive type, and 10 cases of ADHD-hyperactive impulsive type.Thirty healthy children whose age and sex matched with ADHD group,came from Beijing and the surrounding area,were selected as the healthy control group,including 23 boys and 7 girls,6-14 years old [(9.2 ± 2.9) years old].Two groups underwent full overnight sleep assessment.Results The latency of rapid eye movement(REM) in children with ADHD was (146.58 ± 47.28) minutes, and the sleep latency was 19.00 minutes [(8.25-37.50) minutes];while the latency of REM in healthy control group was (87.55-± 13.59) minutes, and the sleep latency was 9.00 minutes [(3.50-13.63)minutes].Compared with healthy control group, children with ADHD demonstrated the increased latency REM and sleep latency, and decreased sleep efficiency,the increasing times of awakening and total duration,and these differences were all statistically significant(all P ＜ 0.05).The percentage of non-rapid eye movement(NREM) phase Ⅱ in ADHD hybrid was lower than the ADHD attention-deficit(t =2.012,P ＜ 0.05).Sleep latency in ADHD attention-deficit was longer than the ADHD hybrid(t =2.964,P ＜ 0.05).No statistical differences were found among the various types in other indicators.The prevalence of periodic limb movements in sleep(PLMS) was 27.78％ (25/90 cases) in ADHD group and the prevalence of PLMS was 3.30％ (1/30 cases) in the healthy control group.The differences in prevalence between 2 groups were statistically significant (x2 =8.053, P ＜ 0.05).Conclusions Children with ADHD significantly display more problems with sleep.Sleep latency and NREM Ⅱ are different between ADHD attention-deficit and ADHD hybrid.

Effects of Transcranial Magnetic Stimulation on Polysomnography in Patients with Insomnia / 中国康复理论与实践

Objective To explore the effect of transcranial magnetic stimulation (TMS) on polysomnography in patients with insomnia. Methods 20 healthy volunteers and 60 patients with primary insomnia from the outpatient department were chosen. The insomnia patients were divided into 2 groups with 30 patients in each group, one group received TMS every day, the other group received benzodiazepine 5 mg every night, both groups were treated for 14 days. The healthy volunteer received no treatment. The effect was assessed with polysom-nography before and after treatment. 20 healthy volunteers were as the normal group and they were assessed by polysomnography only when they were collected. Results TMS and benzodiazepine have the same effect on sleep latency, sleep time, awakening time and sleep effi-ciency. And TMS may increase S3~S4 and rapid eye movement sleep. Conclusion TMS has better effect than benzodiazepine in the treat-ment of sleep disorder.

Clinical analysis of the sleep structure in patients with obstructive sleep apnea syndrome / 中国基层医药

ObjectiveTo analyze the features of sleep structure of patients with different severity of obstructive sleep apnea syndrome (OSAHS). Methods168 adult patients with OSAHS were selected as study group, and 136 patients with simple snoring were selected as control group. All patients were monitored with polysonmography (PSG) throughout the night ,and compared the sleep structure of patients with different severity of OSAHS and simple snoring at night. ResultsOSAHS group compared with simple snoring group,sleep time and sleep efficiency were not significantly different(P ＞ 0. 05);while OSAHS group had increased stage I,and decreased stage Ⅱ, SWS％ and REM％, the differences were statistically significance (P ＜ 0.05 ). The difference in severe classification group( AHI ≥40) was more significant. ConclusionOSAHS patients presented more drowsy sleep, and less deep sleep, and with the grade of OSAHS increasing,the influence of sleep structure was more obvious.

Sleep in Panic Disorder and Nocturnal Panic Attack / 수면정신생리

Sleep disturbance is a one of common complaints among patients with panic disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of panic disorder yet. Several previous studies suggested that the sleep disturbance in panic disorder is mediated by nocturnal panic attack. In terms of the pathophysiology of panic disorder, nocturnal panic attack seems to be closely associated with the sleep problems in panic disorder. In this article, the authors reviewed various previous studies about sleep of panic disorder and intended to give importance of evaluating sleep disturbances and nocturnal panic attack in panic disorder for both clinical and research purpose.

Correlation between Heart Rate Variability and Sleep Structure in Primary Insomnia / 수면정신생리

OBJECTIVES: It is well established that primary insomnia affects the activity of autonomic nervous system. We tried to know how the activity of autonomic nervous system during night sleep changes by analyzing correlation between heart rate variability (HRV) index and the variables related with sleep structure in primary insomnia. METHODS: Thirty three subjects (mean age:36.2+/-14.2 years, male:female=15:18) who were diagnosed with primary insomnia were selected for the study. Nocturnal polysomnography (NPSG) was carried out on each subject and correlation was analyzed between high frequency/low frequency ratio (LF/HF ratio), one of HRV indices and the variables related with sleep structure which were calculated from NPSG. RESULTS: When age and sex were controlled, LF/HF ratio showed negative correlations with slow wave sleep and stage 2 sleep, respectively (r(p)=-0.43, p=0.01;r(p)=-0.37, p=0.04). On the other hands LF/HF ratio showed a positive correlation with arousal index (r(p)=0.65, p<0.001). The activity of autonomic nervous system responded differentially depending on the change of sleep structure in primary insomnia. Especially the increase of arousal index and the decrease of slow wave sleep and stage 2 sleep which are the components of non-REM sleep provoked hyperactivity of sympathetic nervous system. CONCLUSION: This study suggests that the typical change of sleep structure in primary insomnia can negatively impact on cardiovascular system.

Correlation Between State-trait Anxiety and Sleep Structure in Patients with Insomnia / 中国心理卫生杂志

Objective:To explore the relationship between sleep structure changes and state or trait anxiety in patients with insomnia.Methods:Investigations were conducted with the State-trait Anxiety Inventory (STAI) and whole-night ploysomnography (PSG) recorded in 31 patients with insomnia and 20 normal controls.Repeated examinations were conducted in return visits 3～4 months after discharge.Results:Compared to control group,the patients with insomnia had decreased sleep time[(333.71±84.33) min vs.(403.65±19.29) min] and sleep efficiency[(70.41±17.35) % vs.(83.45±4.42) %],and increased sleep latency[(39.48±24.24) min vs.(19.65±8.57) min],REM sleep latency[(106.60±42.89) min vs.(86.80±12.25) min],proportion of S_1 sleep time[(25.36±14.22) % vs.(8.86±1.77) %]and awakening times[(4.45±2.51)vs.(1.75±1.07)].The proportions of S_(3+4) time[(7.38±9.70) % vs.(13.78±4.24) %] and REM sleep time reduced[(14.54±5.61) % vs.(19.18±2.14)%] (Ps<0.05).According to the STAI,scores of both state anxiety[(47.94±8.96) vs.(39.15±4.51)] and trait anxiety[(49.94±8.90) vs.(42.05±7.13)] were significantly higher in insomnia group than in control group (Ps<0.05).State anxiety was positively correlated with sleep latency (r=0.42),REM sleep latency (r=0.25),awakening times (r=0.44) and proportion of S_1 sleep time (r=0.34) (Ps<0.05),and negatively correlated with proportion of REM sleep time (r=-0.41,P<0.01).Trait anxiety was positively correlated with sleep latency (r=0.37,P<0.01) and wakefulness frequency (r=0.29,P<0.05).In return visits,the sleep structure improved,state anxiety score reduced,and trait anxiety had no significant changes.Conclusion:Patients with insomnia have significant sleep structural changes and higher state and trait anxiety.Their sleep structural changes are possilly related to state and trait anxiety.

The effects of modafinil on clinical features and sleep structure of narcolepsy patients and healthy controls / 수면정신생리

INTRODUCTION: Excessive daytime sleepiness and cataplexy are key features of narcolepsy. Modafinil is psychostimulant used in the treatment of narcolepsy. In this study, we evaluated effects of modafinil on nocturnal sleep structure and sleep latency in multiple sleep latency test and clinical features. METHODS: Twelve narcoleptic patients (7 male, age: 22.9 +/- 2.6 yrs) were participated in the study. All of them had done nocturnal polysomnography (nPSG), multiple sleep latency test (MSLT), clinical symptoms scales and have repeated same procedure after taking 200 mg of modafinil. We have done linear mixed model analysis to describe effects of group, medication and nap time on these measures. RESULTS: Modafinil did not affect clinical scales except PSQI which had been reduced after medication. In this study, Modafinil reduced total sleep time, sleep efficiency and increased wake after sleep onset and percent of arousal during sleep in nocturnal polysomnography and prolonged mean sleep latency in multiple sleep latency tests in both group. DISCUSSION: Modafinil has stimulant effect of central nervous system but its effect on night sleep is less than other psychostimulants such as methylphenidate. We ascertained that modafinil affected total sleep time, sleep efficiency and percent of wake during sleep but did not effect on sleep structure. Modafinil was effective in the management of day time sleepiness. Modafinil can enhance alertness of control group without day time sleepiness.

Sleep structure analysis in fifteen patients with Parkinson's disease before and after transcranial magnetic stimulation treatment / 中国实用内科杂志

Objective To study the possible effects of transcranial magnetic stimulation (TMS)on the sleep structure of the patients with Parkinson's disease.Methods Fifteen PD patients attending an outpatient Movement Disorders Unit at Department of Neurology,Cerrahpasa Faculty of Medicine,between September 2006 and December 2007 were included in the study.All patients had received TMS treatment.The stimuli were delivered through a circular coil with a 12 cm diameter and a 2.0 T peak magnetic field.They underwent clinical evaluation and polys omnographic (PSG) evaluation before and after a minimum treatment period of 10 days with TMS.Results The mean UPDRS score was significantly decreased after TMS(before treatment,38.83?16.72;after treatment,25.09?11.10).PSG revealed that administration of TMS resulted in significant decrease in mean Sleep latency[before treatment,(53.50?46.40)min;after treatment,(30.43?23.91)min].Slow wave (stage 3+4) was found in somes patients after treatment.But here was a trend towards an decrease in Percentage of stage 1,REM latency and REM sleep without significance.Conclusion This study demonstrates that motor symptom of PD was improved and Sleep latency was decreased by TMS.Sleep structure was not changed before and after TMS treatment.

Long-term Outcome of Uvulopalatopharyngoplasty in Obstructive Sleep Apnea Syndrome Patients: Comparison between Changes of Subjective Symptoms and Objective Indexes Including Respiratory and Sleep Parameters / 대한이비인후과학회지

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.

Modulation of Interictal Spikes by Sleep Structure in Complex Partial Seizure

We analyzed interictal spikes of complex partial seizure by two parameters of sleep structure. They are macrostrure and microstructure of sleep. The macrostructure of sleep is traditional parameter and includes REM and NREM sleep. The microstructure of sleep is recently identified modalities of arousal control during NREM sleep: (a) the cyclic alternating pattern (CAP) expressed by alternating and successive phasic fluctuation of sleep; and (b) non-CAP(NCAP) characterized by prolonged stable periods of EEG. We performed polygraphical analysis of extended daytime-sleep of eight patients with complex partial seizure. The mean spike index(SI) was 4.9+3.6. The percentage of CAP time in total NREM was 50.7+5.8 and phase A in CAP time was 32.5+4.2. Significant increase in discharge rates was observed in NREM compared with REM sleep (pO. 05). Spiking activities were significantly enhanced during CAP sleep. Patients showed significant SI differences between CAP and NCAP sleep (p