Patterns of sleep and wakefulness in treated narcoleptic subjects.

In most reported studies of treatment for narcolepsy, the efficacy of treatment has been assessed in the sleep laboratory, but not in the natural work and home settings. We therefore assessed the sleep/wake patterns of 25 subjects with narcolepsy, whose symptoms were considered under satisfactory control by the subjects and their physicians, using polygraphic recorders, and compared these with the patterns of 25 control subjects matched for age and gender. Data from one matched pair of subjects were excluded for technical reasons. There was no difference between the two groups of subjects in the total amount of sleep obtained during the 24-hour monitoring period. Narcoleptic subjects had shorter nocturnal sleep latencies and more disrupted nocturnal sleep than control subjects. Despite taking their usual medications, narcoleptic subjects averaged 44 minutes of daytime sleep compared to 4.8 minutes for controls. There was wide variation in the amount of daytime sleep among narcoleptics: 10 subjects did not sleep during the day, whereas the other 14 averaged 2.7 naps per day for an average of 76.2 minutes of daytime sleep. These findings indicate that daytime sleep episodes were common in narcoleptic patients who considered their treatment satisfactory. Wide variations in the amount of daytime sleep may reflect differences in disease severity, responsiveness to medications or willingness to tolerate daytime sleep episodes.

Reliability of sleep diaries for assessment of sleep/wake patterns.

Although sleep diaries are widely used in clinical and research settings, only a few studies have compared the subjective information recorded in these diaries to objective information about sleep recorded. The goal of this study was to determine if a sleep diary could be used to obtain reliable data about home sleep/wake patterns over a 24-hour period. Fifty subjects (25 narcoleptic and 25 matched control subjects) completed a sleep diary while undergoing 24-hour ambulatory polysomnographic monitoring. The percentage agreement between the subjective data recorded in the sleep diaries and polysomnographic data was acceptable (kappa = .87). Sensitivity and specificity were also high (92.3% and 95.6%). The sleep diary is a reliable instrument for collecting data about sleep/wake patterns, but should be used with caution when collecting data from subjects who are likely to take frequent daytime naps.

Cooling effects and comfort of four cooling blanket temperatures in humans with fever.

Adult patients with fever (N = 89) were randomized into four blanket temperature groups: 7.2, 12.8, 18.3, and 23.9 degrees C. With their extremities protected, subjects were given acetaminophen and placed between two cooling blankets. There were no differences in the mean time (in minutes) to cool to a body temperature of 38.9 degrees C among groups. Although there were no differences in mean time for shivering, a trend of less shivering was apparent with warmer blanket temperatures. Few patients shivered (n = 17). There were no differences in the mean time (in minutes) for afterfall among the groups. The mean amount of afterfall for the 7.2 degrees C group (1.04 degrees C, SD = 0.50) was significantly greater than the 23.9 degrees C group (0.68 degrees C, SD = 0.47). Comfort scores significantly improved with warmer blanket temperatures. Thus, warmer blanket temperatures provided similar rates of cooling as the colder temperatures, yet were perceived to be more comfortable by the patient.

Intraoperative tissue injury. Major causes and preventive measures.

The patient has been on the OR bed for seven hours undergoing an abdominal aortic aneurysm repair. During the postoperative assessment, the perioperative nurse notices a reddened spot over the patient's sacral area. Why did this injury occur? Was it caused by the length of the surgery, hyperthermia blanket, pooling of povidone-iodine, decreased circulation, or another factor that occurred during the surgical procedure?