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Background: Obstructive sleep apnea (OSA) in pediatric population is associated with cardiac, respiratory, metabolic, neurocognitive, and behavioral dysfunctions. Adenotonsillectomy (AT) is the treatment of choice in children who have hypertrophied adenoid and/or palatine tonsils. However, there is paucity of literature on the impact of AT on cardiorespiratory and sleep parameters in these cases. Methods: We did a retrospective study on children who had undergone AT from July 2016 to December 2018 at a tertiary hospital in north India. Only those children, whose polysomnography (PSG) was available both before and after AT were enrolled in this study. � Cardiac parameters: Mean heart rate (MHR) and highest heart rate (HHR), number and duration of arrhythmias, and pulse transit time (PTT) drops. � Respiratory parameters: Apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), mean oxygen saturation (MOS). � Sleep parameters: Time spent in different stages, sleep efficiency (SE), and arousal index (AI) on PSG were compared before and after AT. Results: A total of 56 children had undergone AT for OSA. Also, PSG, both before and after AT, was available in 37 children. After excluding children having undergone other surgeries for OSA and those with comorbidities, 32 children were enrolled. AT led to significant positive change in AHI (from 7.86 � 7.91 to 2.03 � 3.10, p = 0.01), RDI (from 16.319 � 15.64 to 7.38 � 3.72, p < 0.01), AI (from 22.10 � 14.93 to 15.90 � 8.48, p = 0.012), SE (from 91.47 � 6.31 to 95.866 � 3.03, p < 0.01), ODI (from 6.7959 � 5.03 to 1.865 � 2.09, p < 0.01), MOS (from 95.59 � 2.19 to 97.28 � 1.27), HHR (from 141.68 � 17.93 to 120.93 � 16.98, p < 0.01), MHR (86.68 � 12.95 to 80.29 � 8.81, p = 0.01), and PTT AI (from 36.67 � 27.72 to 26.93 � 24.86, p < 0.01). There was no non-sinus wide or narrow complex tachyarrhythmia in any child before or after AT. There was no statistically significant change in rapid eye movement (REM) sleep duration or number and duration of bradycardia episodes in these children (p > 0.05). Conclusion: Adenotonsillectomy improved SE and oxygenation, and decreased the number of obstructive events, arousals, heart rate, and PTT AI during sleep in children with OSA. Some children had residual disease after surgery. Heart rate and PTT can be excellent non-invasive parameters for detecting obstructive events during sleep in children and monitoring the impact of various therapeutic modalities.
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Background: A prospective cohort study to correlate perceived sleep disturbances in depressed patients with objective changes in sleep architecture using polysomnography (PSG) before and after antidepressant therapy.Methods: Patients were recruited into the study after applying strict inclusion and exclusion criterion to rule out other comorbidities which could influence sleep. A diagnosis of Depressive episode was made based on ICD-10 DCR. Psychometry, in the form of Beck Depressive inventory (BDI) and HAMD (Hamilton depression rating scale) insomnia subscale was applied on Day 1 of admission. Patients were subjected to sleep study on Day 03 of admission with Polysomnography. Patients were started on antidepressant treatment post Polysomnography. An adequate trial of antidepressants for 08 weeks was administered and BDI score ≤09 was taken as remission. Polysomnography was repeated post remission. Statistical analysis was performed using Kruskal Wallis test and Pearson correlation coefficient.Results: The results showed positive (improvement) polysomnographic findings in terms of total sleep time, sleep efficiency, wake after sleep onset, percentage wake time and these findings were statistically significant. HAM-D Insomnia subscale was found to correlate with total sleep time, sleep efficiency, wake after sleep onset, total wake time and N2 Stage percentage.Conclusions: Antidepressant treatment effectively improves sleep architecture in Depressive disorder and HAM-D Insomnia subscale correlates with objective findings of total sleep time, sleep efficiency, wake after sleep onset, total wake time and duration of N2 stage of NREM.
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Objective To determine the polysomnographic characteristics in idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) patients with different severity of obstructive sleep apnea (OSA).Methods A total of 206 consecutive iRBD patients (80.1％ males,mean age was (66.2 ± 10.0) years) were recruited based on international classification of sleep disorders]] diagnostic criteria and confirmed by video-polysomnography.Patients were divided into three groups according to the severity of OSA,namely no OSA group (apnea-hypopnea index (AHI) ≤ 5/hour,n =48),mild to moderate OSA group (AHI 5-30/hour,n =100),and severe OSA group (AHI ＞ 30/hour,n =58).Results When comparing the severe OSA patients with no and mild to moderate OSA patients,as expected,patients with severe OSA had higher percentage of stage Ⅰ sleep (22.9％ ± 12.2％ vs 13.2％ ±6.4％,15.4％ ± 6.0％,F =21.80,P ＜0.01),lower percentage of stage Ⅱ sleep (58.5％ ± 10.4％ vs 68.0％ ±20.5％,61.8％ ±10.5％,F=6.62,P＜0.01),less REM sleep (16.0％ ±8.2％ vs 19.3％ ±9.8％,20.0％ ± 7.8％,F=4.24,P=0.02) as well as higher arousal index ((33.4 ± 16.2)/h vs (8.9 ±4.3)/h,(14.9 ±6.5)/h,F =94.56,P ＜0.01).In addition,patients with severe OSA had a lower percentage of total electromyography (EMG) activity during REM sleep than other two groups (27.2％ (25.9％) vs 30.3％ (25.2％),39.1％ (28.0％),H =8.20,P =0.02).There were no statistically significant differences in total sleep time,sleep efficiency,sleep latency,slow wave sleep,periodic limb movement index and period limb movements during sleep.Conclusions Patients with iRBD comorbided with severe OSA have distinct polysomnographic characteristics when compared with those without OSA and those with mild-to-moderate OSA.Those patients have increased sleep time in stage Ⅰ sleep,decreased sleep time in stage Ⅱ sleep and REM sleep,and more easily awakened from total sleep.Patients with iRBD comorbided with severe OSA have a lower percentage of tonic EMG activity during REM sleep.Excessive tonic EMG activity of upper airway muscle during REM sleep in iRBD might protect patients against severe OSA.
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Objective:To assess the characteristics change of sleep architecture in drug naive patients with schizophrenia,compared with healthy control.Methods:The key words including schizophrenia and sleep architecture (or sleep structure or sleep disturbance or polysomnogram and so on) were used to search literatures in MEDLINE,Embase,Springer,PsychINFO,google scholar,Wanfang data,published from 1980 to 2015.Fifteen studies that compared sleep architecture in drug naive patients with schizophrenia and healthy control were included.Literature quality evaluation was performed with the Newcastle-Ottawa Scale.The meta-analysis was performed by using Stata13.0 software.Results:Compared to healthy control,the total sleep time decreased (P ＜ 0.01),the sleep latency increased (P ＜ 0.01),the sleep efficiency decreased (P ＜ 0.01),and the rapid-eye-movemem (REM) sleep latency increased (P ＜ 0.01) significantly in drug naive patients with schizophrenia.The proportion of stage1 was increased,and the proportions of stage4 and slow wave sleep stage were decreased,the differences between case and control were statistically significant.Conclusion:In the control of drug effects,patients with schizophrenia may have poorer sleep quality of be poorer than healthy controls,such as the decreased total sleep time,specifically slow wave sleep,prolonged sleep latency and decreased sleep efficiency.
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Epilepsy is one of the nervous system diseases,which is correlated with multiple pathogenic factors and caused by repeated discharge of neurons.Currently,there are more than 50 million people worldwide suffering from epilepsy with an average annual increase of 100 000 cases.The prevalence rate of sleep disorders in epilepsy patients is high,by up to two times than that of healthy subjects.Common sleep disorders in epilepsy patients include insomnia,sleep apnea,restless legs syndrome and parasomnias.The characteristics of sleep abnormalities have differences with the epilepsy syndromes.The relationship between epilepsy and sleep is complex and interactive.The mechanism of combined sleep disorders in epilepsy patients is still unclear.In this paper,the relationship between epilepsy and sleep disorders in epilepsy patients was summarized,which involves multiple aspects such as the possible mechanism of combined sleep disorders,the common features of sleep disorders,the possible mechanism of sleep abnormalities in different epilepsy syndromes and the characteristics of sleep structure,the effect of antiepileptic drugs on sleep architecture abnormalities and its role in combined sleep disorders.
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OBJECTIVE:To study the effect of paroxetine combined with low dose of olanzapine on sleep process and architec-ture of depression patients with insomnia. METHODS:84 depression patients with insomnia were randomly divided into control group and observation group. Control group was given 20 mg Paroxetine tablet,once every morning;observation group was addi-tionally given 2.5 mg Olanzapine tablet,once before going to bed. Sleep quality [Pittsburgh Sleep Quality Index(PSQI)],depres-sion scores [Hamilton Depression Scale (HAMD)],sleep process [sleep latency (SL),awakening times (AT),the actual total sleep time (TST),sleep efficiency (SE),rapid eye movement (REM) sleep latency (RL)] and sleep architecture [sleep stage 1 (S1),2(S2),3(S3)and the proportion of REM to sleep] in 2 groups before and 3,6 months after treatment and the incidence of adverse reactions(ADR)were observed. RESULTS:After treatment,PSQI and HAMD scores in 2 groups were significantly lower than before,and gradually decreased by time,and observation group was lower than control group;TST in observation group was significantly higher than before and control group,S1 in observation group was significantly lower than before,SE,S3 and REM in 2 groups were significantly higher than before,and observation group was higher than control group,SL,AT,RL and S2 were significantly lower than before,and observation group was lower than control group,the differences were statistically significant (P<0.05). There were no obvious ADR in 2 groups. CONCLUSIONS:Paroxetine combined with low dose of olanzapine can sig-nificantly relieve depression,optimize sleep process and sleep architecture,then impove sleep quality.
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The present study aimed to evaluate sleep architecture at 4300m in a sample of 10 healthy Indian lowlanders, mean age 25.7±5.1 yrs. Polysomnography on two consecutive nights each was performed at sea level and 4300 m, the first night for adaptation and the second one for actual recording. Total sleep time reduced from 433.33±8.95 to 412.06±13.13 minutes (P<0.0005), sleep latency increased from 11.56±6.85 to 22.22±7.95 minutes (P<0.0025), deep NREM sleep (S3+S4) reduced from 79.56±28.45 to 45.39±25.32 minutes (P<0.01), light NREM sleep (S1+S2) increased from 272.94±20.63 to 296.72±23.24 minutes (P<0.05), REM decreased from 80.89±7.65 to 69.94±11.30 minutes (P<0.02) and periodic breathing was present in 4 of 10 participants on the second night at 4300 m. Decreased sleep quality (P<0.0005) and increased sleep disturbances (P<0.0005) were reported in subjective ratings at high altitude. Changes in sleep architecture similar to but of a greater magnitude are present on the second night of staged induction to 4300 m, than reported at 3500 m in our earlier study.
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Sleep disturbance is a common complaint in depression. However, objective data in relation to the architecture of sleep associated with depression in childhood have been inconsistent. The objective measurement of sleepiness and executive functions is little known in depressive children. The objective of this study was to determine the differences in the sleep architecture, daytime sleepiness and executive functions in children with and without depression. Method The participants were 20 children with an average of 10.5 (SD=1.5) years old; nine were girls. Ten met the diagnostic criteria for major depression and ten were control. There were no differences by sex and age between groups with and without depression (p>.05). The instruments were: Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), the Children Depression Inventory, and the Battery of Executive Frontal Functions. Also, there were two consecutive nights of polysomnographic recording and Multiple Sleep Latency Test (MSLT). Results No differences were found in the architecture of sleep, sleep efficiency was greater than 90% in both groups and the indexes of initiation and sleep maintenance did not show statistically significant differences. There were no differences in daytime sleepiness, sleep onset latency in the MSLT was 22.8 (SD=6.4) minutes for the group with depression and 23.7 (SD=4.1) for the control. The executive functions showed differences in tasks involving: visual-motor and impulse control, working memory and identification of the risk-benefit ratio. Conclusions The results suggest that prefrontal structures are more vulnerable to depression than the structures that regulate the circadian and homeostatic sleep.
La alteración del sueño es una queja común en la depresión. Sin embargo, los datos objetivos sobre las alteraciones en la estructura del sueño asociadas a la depresión infantil han sido inconsistentes. Por otro lado, el estudio objetivo de la somnolencia y las funciones ejecutivas en niños con depresión es poco conocida. El objetivo fue conocer si existen diferencias en la estructura del sueño, la somnolencia diurna y las funciones ejecutivas en niños con y sin depresión. Método Participaron 20 niños con promedio de 10.5 (DE=1.5) años de edad, de los cuales 45% fueron niñas. Diez cumplieron los criterios diagnósticos de depresión mayor y 10 fueron controles. No hubo diferencias por sexo y edad entre los grupos (p>.05). Los instrumentos fueron: La entrevista Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), el Inventario de Depresión Infantil, y la Batería de Funciones Frontales y Ejecutivas. Asimismo, se realizaron dos noches consecutivas de registro polisomnográfico y la Prueba de Latencias Múltiples a Sueño (PLMS). Resultados No se encontraron diferencias en la estructura del sueño, la eficiencia del sueño fue mayor al 90% en ambos grupos y no hubo diferencias en los índices de inicio y continuidad del sueño, así como en las diferentes etapas de sueño. Tampoco se obtuvieron diferencias en la somnolencia diurna, la latencia al inicio de sueño en la PLMS fue de 22.8 (DE=6.4) minutos para el grupo con depresión y 23.7 (DE=4.1) para el control. Las funciones ejecutivas mostraron diferencias en tareas que implican: control visomotor y de impulsos, memoria de trabajo e identificación de la relación riesgo-beneficio. Conclusiones Los resultados sugieren que las estructuras prefrontales son más vulnerables a la depresión que las estructuras que regulan el ritmo circadiano y homeostático del sueño.
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Unlike the case of adult obstructive sleep apnea syndrome (OSAS), there was no consistent finding on the changes of sleep architecture in childhood OSAS. Further understanding of the sleep electroencephalogram (EEG) should be needed. Non-linear analysis of EEG is particularly useful in giving us a new perspective and in understanding the brain system. The objective of the current study is to compare the sleep architecture and the scaling exponent (alpha) from detrended fluctuation analysis (DFA) on sleep EEG between OSAS and normal children. Fifteen normal children (8 boys/7 girls, 6.0+/-2.2 years old) and twelve OSAS children (10 boys/2 girls, 6.4+/-3.4 years old) were studied with polysomnography (PSG). Sleep-related variables and OSAS severity indices were obtained. Scaling exponent of DFA were calculated from the EEG channels (C3/A2, C4/A1, O1/A2, and O2/A1), and compared between normal and OSAS children. No difference in sleep architecture was found between OSAS and normal controls except stage 1 sleep (%) and REM sleep latency (min). Stage 1 sleep (%) was significantly higher and REM latency was longer in OSAS group (9.3+/-4.3%, 181.5+/-59.9 min) than in controls (5.6+/-2.8%, 133.5+/-42.0 min). Scaling exponent (alpha) showed that sleep EEG of OSAS children also followed the 'longrange temporal correlation' characteristics. Value of alpha increased as sleep stages increased from stage 1 to stage 4. Value of alpha from C3/A2, C4/A1, O1/A2, O2/A1 were significantly lower in OSAS than in control (1.36+/-0.05 vs. 1.41+/-0.04, 1.37+/-0.04 vs. 1.41+/-0.04, 1.37+/-0.05 vs. 1.41+/-0.05, and 1.36+/-0.07 vs. 1.41+/-0.05, p<0.05). Higher stage 1 sleep (%) in OSAS children was consistent finding with OSAS adults. Lower 'alpha' in OSAS children suggests decrease of self-organized criticality or the decreased piling-up energy of brain system during sleep in OSAS children.
Subject(s)
Adult , Child , Humans , Brain , Electroencephalography , Polysomnography , Sleep Apnea, Obstructive , Sleep Stages , Sleep, REMABSTRACT
OBJECTIVE: To determine the correlations between excessive daytime sleepiness (EDS), assessed by the Epworth sleepiness scale (ESS), and the multiple sleep latency test (MSLT) and nocturnal sleep architecture features, clinical symptoms of narcolepsy (CSN) and subjective sleep quality (SSQ) in patients with narcolepsy. METHOD: Twenty three untreated patients were studied and compared with a matched control group. Diagnosis of narcolepsy was carried out employing a clinical interview, a polysomnographic (PSG) record, and an MSLT. RESULTS: Subjective number of awakenings was the SSQ indicator that best correlated with EDS (ESS and MSLT). Regarding clinical features, diurnal tiredness and sleep paralysis correlated with ESS values. Increase in ESS was related with decrease in total sleep time, SWS, and sleep onset latency. On the other hand, increase in MSLT was related with decrease in SWS. CONCLUSION: These data suggest that EDS in patients with narcolepsy could be impaired by disturbed nocturnal sleep.
OBJETIVO: Determinar as correlações entre hipersonolência, avaliada pela escala de sonolência Epworth (ESE) e o teste múltiplo de latência do sono (TMLS) com a arquitetura do sono (AS), sintomas e qualidade subjetiva do sono em pacientes narcolepticos. MÉTODO: Comparou-se um grupo de vinte e tres pacientes narcolepticos sem tratamento com grupo controle. O diagnóstico de narcolepsia foi realizado por uma entrevista clinica, polissonografia e o TMLS. RESULTADOS: O número subjetivo de despertares foi o indicador com maior relação com a hipersonolência, o cansaço diurno e a paralisia do sono também foi correlacionados com a ESE.O aumento do índice na ESE foi correlacionado com uma diminuição do tempo total do sono, no sono de ondas lentas (SOL) e com a latência para o início do sono. O incremento na TMLS foi relacionado com diminuição do SOL. CONCLUSÃO: Os dados sugerem que a hipersonolência diurna em pacientes portadores de narcolepsia pode se correlacionar com as alterações da arquitetura do sono noturno.
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Narcolepsy/physiopathology , Sleep/physiology , Wakefulness/physiology , Case-Control Studies , Polysomnography , Reaction Time , Young AdultABSTRACT
Objective To investigate the characteristics in sleep architecture of sub-healthy people with in-somnia,and to study the relationship between the sleep architecture and the degree of insomnia.Methods Sleep ar-chitecmre and Pittsburg sleep quality index(PSQI)value and PSQI scale were detected respectively.Results Sleep architecture of 46 subjects was abnormal-including shortened total-sleep-time(26.1%),excessive superficial-sleep stage(100%).inadequate deep-sleep stage(87.0%),insufficient rapid eye movement sleep(REM) (60.9%),longer sleep latency(65.2%)-more wakening times(47.8%)and longer wakeful time(43.5%).PSQI value of each insomniac exceeded 7,and the valtie of most objects was between 12 and 16(73.9%).The in-gredients of sleep architecture were not significantly correlated with the values of PSQI (P>0.05).Conclusion The sleep architecture of sub-healthy people with insomnia is mainly characterized with difficulty in falling asleep,light sleep and festless sleep,but the characteristics of sleep architecture is not inevitablly related with the degree of insomnia.
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Obstructive sleep apnea (OSA) syndrome disrupts normal sleep. However, there were few studies to evaluate the asymmetric distribution, the one of the important factors of normal sleep in OSA subjects. We hypothesized that asymmetry would be broken in OSA patients. 49 male subjects with the complaint of heavy snoring were studied with polysomnography. We divided them into two groups based on the apnea-hypopnea index (AHI) fifteen: 13 simple snoring group (SSN, average AHI 5.9+/-4.4) and 32 OSA group (average AHI 47.3+/-23.9). We compared split sleep variables between the first half and the second half of sleep within each group with paired t-test for the evaluation of asymmetry. Changes of sleep architecture of OSA were higher stage 1 sleep% (S1), total arousal index (TAI), AHI, and mean heart rate (HR) and lower stage 2 sleep% (S2), REM sleep%, and mean arterial O2 saturation (SaO2) than SSN subjects. SWS and wake time after sleep onset (WASO) were not different between two groups. In split-night analysis, OSA subjects showed higher S2, slow wave sleep% (SWS), spontaneous arousal index (SAI), and mean HR in the first half, and higher REM sleep% and mean SaO2 in the second half. Those were same pattern as in SSN subjects. Mean apnea duration and longest apnea duration were higher in the second half only in the OSA. No differences of AHI, ODI, WASO, and S1 were found between the first and the second half of sleep in both groups. TAI was higher in the first half only in the SSN. SWS and WASO seemed to be influenced sensitively by simple snoring as well as OSA. Unlike our hypothesis, asymmetric distributions of major sleep architecture variables were preserved in OSA group. Losing asymmetry of TAI might be related to pathophysiology of OSA. We need more studies that include large number of subjects in the future.
Subject(s)
Humans , Male , Apnea , Arousal , Heart Rate , Polysomnography , Sleep Apnea, Obstructive , SnoringABSTRACT
Objective To investigate influences of nasal continuous positive airway pressure to sleep architecture of obstructive sleep apnea syndrome and the reason of daytime sleepiness. Methods 34 patients with severe OSAS were monitored with polysomnography (PSG) before and after nCPAP treatment. Results Apnea hypoventilation index (AHI) decreased and the lowest SaO2 increased and sleep architecture was improved in all patients. Conclusion The nCPAP therapy can effectively improve the disturbances of sleep architecture and respiratory parameters.
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Objective To observe the relations of sleep structure changes and cognitive behavior abnormalities in children with idiopathic epilepsy.Methods All night polysomnographies, day attention test and Achenbach child behavior checklist were done on 64 children with idiopathic epilepsy and 20 healthy controls the requirement. Spearman correlations were made to evaluate the correlations between the parameters of sleep structure and the results of attention and cognitive behavior abnormalities.Results All children with epilepsy had longer stage Ⅰ sleep percentage and latency of rapid eye movement (REM) sleep compared with controls (all P