Sleepiness/alertness among healthy evening and morning type individuals.

Objective: The aim of this study was to determine the level of sleepiness/alertness among different chronotypes.Background: The Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) has allowed the characterization of chronotypes that are associated with a number of biological factors including: body temperature, cortisol rhythm, sleep patterns, and architecture.Methods: Fifty-six consecutive normal volunteers underwent an 8-h polysomnogram followed by a multiple sleep latency test (MSLT). Each subject also completed the MEQ and the Sleep/Wake Activity Inventory.Results: Evening types (ET) reported significantly later bedtimes and risetimes than both morning types (MT) and neither types (NT, P<0.05). On nocturnal polysomnography, the ET documented significantly longer latencies to stage 1 and persistent sleep when compared to both the NT and MT (P<0.01). There were no significant differences in the level of sleepiness on the MSLT across the different chronotypes. However, the pattern of sleepiness differed among them. While ET and NT showed differential sleep latencies across nap opportunities, MT showed no evidence of circadian variation on their level of sleepiness.Conclusions: There were no overall differences in daytime sleepiness/alertness across chronotypes. However, a differential pattern of sleep latencies was noted on the MSLT.

Efficacy of uvulopalatopharyngoplasty in unselected patients with mild obstructive sleep apnea.

OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is widely used as a first-step procedure for the surgical management of obstructive sleep apnea (OSA) syndrome but best manages obstruction occurring at the level of the oropharynx alone and not the hypopharynx. Previous publications have noted mediocre results with use of this procedure in unselected patients with OSA, but less clear is the effectiveness of this procedure in the unselected patient with mild OSA (respiratory event index [REI] 5-25). Using objective and subjective criteria, we retrospectively analyzed the results of UPPP in patients with mild OSA. METHODS: We examined 37 patients with mild OSA (REI 13.5 +/- 5.1, range 5.6-23.1) who had been operated on during 1996 with UPPP with or without tonsillectomy and/or septoplasty. Follow-up polysomnography was obtained in 25 (68%) an average of 40.5 weeks after surgery and compared with findings before surgery. Subjective assessment of sleepiness was performed with the Sleep-Wake Activity Inventory. RESULTS: Ten patients (40%) had a postoperative reduction in the REI of more than 50%, comparable with the improvements reported in those with more severe apnea. Those who did not have a reduction in REI after surgery actually saw an increase in average REI from 16.6 +/- 5 to 26.7 +/- 18.4. Similarly, subjective assessment of sleepiness with the Sleep-Wake Activity Inventory showed no statistically significant improvement after surgery. CONCLUSION: Overall, these results indicate that UPPP alone in the unselected patient provides little benefit in the management of mild OSA, similar to findings for more severe OSA. Surgeons must use great care in discerning the level of obstruction in the patient with mild OSA to tailor the appropriate retropalatal and/or retrolingual procedures and thereby achieve excellent surgical outcomes.

CPAP therapy in patients with mild OSA: implementation and treatment outcome.

Objectives: To determine continuous positive airway pressure (CPAP) treatment compliance and reversal of excessive daytime sleepiness in patients with mild OSA.Background: CPAP therapy is the most widely accepted and used intervention in patients with a diagnosis of obstructive sleep apnea (OSA). There are, however, no widely accepted protocols to help guide the rational use of CPAP therapy. Patients with mild OSA (respiratory event index (REI) >5 or

Repeated nocturnal sleep latencies in narcoleptic, sleepy and alert subjects.

OBJECTIVES: The purpose of this study was to assess nocturnal sleep latencies among narcoleptics. METHODS: Thirteen narcoleptics and matched sleepy and alert controls participated in this study. Subjects were awakened three times on each of two experimental nights. The latencies to sleep and rapid eye movement sleep were evaluated at the beginning of the night and following each experimental awakening. RESULTS: The alert group (AG) had a significantly longer mean nocturnal sleep latency than the narcoleptic (NG) and sleepy groups (SG). The sleep latencies at 23:00 and 01:10 h were significantly longer than the latencies at 03:10 and 05:10 h. The interaction between group and time of night demonstrated longer latencies at 23:00 and 03:10 h for the AG when compared to the SG and the NG. At 01:10 and 05:10 h all groups had comparable latencies. The number of subjects in the NG who had multiple sleep onset REM periods (SOREMPs) was significantly higher than in either the AG or the SG. CONCLUSIONS: Narcoleptics were found to have a heightened propensity to fall asleep and increased number of SOREMPs during nocturnal sleep opportunities. These characteristics are consistent with the daytime polysomnographic findings known in this patient population.

Narcolepsy and other causes of excessive daytime sleepiness.

Narcolepsy is a chronic disorder characterized by excessive daytime sleepiness, cataplexy, and other auxiliary symptoms. An interview can ascertain specific symptomatology, whereas a polysomnogram can reveal distinct clinical features. The clinical and laboratory evaluation together enable an accurate diagnosis of narcolepsy. This diagnosis includes a wide spectrum of symptom combinations. Treatment of narcolepsy should include the empathic guidance of a sleep clinician, an emphasis on sleep hygiene, and in many cases pharmacotherapy.

The behavioral morbidity of obstructive sleep apnea.

The behavioral morbidity associated with obstructive sleep apnea (OSA) includes symptoms of excessive daytime sleepiness (EDS), neurocognitive deficits, psychological problems, and possibly an increased chance of accidents. EDS is among the most frequently reported symptoms in patients diagnosed with OSA. The available data suggest that the primary cause of EDS is sleep fragmentation. The subjective measures of sleepiness include the sleep wake activity inventory and the epworth sleepiness scale. Sleepiness can also be evaluated objectively in the sleep laboratory using the multiple sleep latency test or the maintenance of wakefulness test. The neurocognitive manifestations of OSA include impairments in vigilance, concentration, memory, and executive function. There is no agreed on consensus as to how to best quantify neurocognitive deficits in this population. Symptoms consistent with depression or personality changes have also been described, but are likely to be correlates of EDS and/or the chronicity of the disorder. Manifestations of the behavioral morbidity of OSA are reversible, but dependent on the degree of normalization in sleep-disordered breathing and the individual's sleep habits.

Treatment-resistant schizophrenia: controlled study of moderate- and high-dose thiothixene.

Double blind controlled study on fifty treatment-resistant schizophrenic inpatients showed a statistically significant improvement in favour of the high dose group.