Sleep-waking cycle disturbance in patients with obstructive sleep apnea syndrome.

Eighteen (18) obese patients with clinically confirmed obstructive sleep apnea syndrome (OSAS) and five (5) obese persons with no apnea crises noticed during sleep apart from occassional loud snoring, have been polysomnographically assessed. The obtained results show that the patients with apnea syndrome sleep very badly, and consequently, shortened sleep latency and frequent body movements, along with apneas, are regarded as the leading polysomnographic symptoms. Vigilance profile during sleep, that is, interchange and frequency of each of sleep stages (I, II, III, IV, REM) are similar in both tested groups. The suppression of restitutive stages of sleep (III, IV, REM) is considered to be a dominant characteristic of vigilance during sleep in obese persons and obese persons with manifest apnea syndrome. Relatively prolonged sleep latency in obese persons without manifest apnea syndrome indicates, however, restitutively higher quality of their nocturnal sleep. Contrary to the patients with apnea syndrome, they do not suffer from excessive evening somnolence, so that their daily alertness and sleep vigilance during night are of a better quality, although the lack of deep and REM sleep is observed in them as well.

The effect of fetal hypoxia and acidosis on the changes in fetal electroencephalogram during labor.

As artefact-free recordings of the fetal brain bioelectric potentials can only be obtained by specially designed electrodes, an electrode for taking electroencephalogram (EEG) and cardiotocogram (CTG), according to the principle of vacuum electrode developed by Rosen and Scibetta, has been designed. The polygraphic technique was used to examine a total of 65 deliveries, divided into two groups. The first group (n = 33) consisted of newborns free of any signs of hypoxia and acidosis, whereas the second group (n = 32) was comprised of newborns with evident clinical and biochemical signs of hypoxia and acidosis. Fetal hypoxia and acidosis were observed to entail some characteristic changes in EEG, that is, a decrease in the frequency and wave amplitude through the appearance of the isoelectric line (ISO) featuring in severe cases of fetal hypoxia and acidosis. The following changes were found to occur during the development of hypoxia and acidosis:hypoxia, a decrease in the EEG frequency and amplitude, preacidosis with the appearance of both early and late decelerations coupled with a significant drop in the oscillation and, eventually, severe variable decelerations accompanied by terminal bradycardia. The time interval between the manifestation of initial signs of a decreasing central nervous system (CNS) activity and changes in the fetal heart rate was found to be about 10 minutes.

Effects of lithium carbonate on the clinical picture and the sleep of depressive patients.

5 patients with endogenous depression of uni- and bipolar type, classified according to sleep characteristics as normo- (1), hypo- (3) and hypersomniacs (1), were treated for 3 weeks with a daily dose of 900 mg lithium carbonate. Polygraphic sleep recordings were taken in every patient in the course of 3 placebo nights, 3 nights during therapy and 2 registrations after lithium carbonate was discontinued. Before therapy, a prolonged sleep and a shortened REM latency were observed, which were changed in the course of the treatment especially in the normosomniac patient. In the other examined sleep parameters (total sleep time, sleep efficiency, percentage of REM sleep, slow wave sleep), discrepancies among hypo-, hyper- and normosomniac patients were present. From the clinical point of view all patients showed an improvement subjectively and objectively measured by means of Hamilton and Beck questionnaires for depression. This study emphasizes the necessity of administering daily lithium carbonate doses higher than 900 mg because of only a mild therapeutic effect.