Migrating motor complex and sleep in health and irritable bowel syndrome.

The human migrating motor complex (MMC) and sleep cycle have a similar periodicity, and there is some contention as to whether these biorhythms are linked. In irritable bowel syndrome (IBS), episodes of intestinal dysmotility have been described almost exclusively during wakefulness, but IRS patients often complain of poor sleep, and it has been suggested that IBS patients have increased rapid eye movement (REM) sleep. This study sought to identify any associations between sleep stage and small intestinal motility and any objective sleep abnormalities in IBS. Nocturnal motility was recorded from six small intestinal sensors mounted on a fine nasoenteric catheter in eight IBS patients and 10 healthy volunteers. Polysomnography to determine sleep stage was recorded simultaneously. The proportions of time awake, in non-REM and REM sleep was similar in controls and IBS. REM latency did not differ between the two groups despite increased depression in the IBS patients (Hamilton Depression Rating of 8.3 +/- 1.7 in IBS, 3.0 +/- 0.7 in controls, P < 0.01). Nocturnal motility was similar, with phase I occupying most of the MMC cycles. There was no temporal association between MMCs and sleep stage, with no synchrony of phase III for REM episodes. The mean motility index of 4.5 +/- 0.4 during wakefulness was greater than during all sleep stages (P < 0.05). During non-REM sleep stages 1 and 2, motility index of 3.2 +/- 0.3 was greater than 2.3 +/- 0.2 during stages 3 and 4 (P < 0.05), but similar to motility index of 3.3 +/- 0.4 during REM sleep. This sleep architecture and nocturnal small intestinal motility are normal in IBS.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormal REM sleep in the irritable bowel syndrome.

Motor abnormalities of the small bowel that occur only during the waking state have been reported in the irritable bowel syndrome (IBS), suggesting that central nervous system arousal is a necessary condition for expression of the disorder and that it may reflect inappropriate brain-gut interaction. This possible relationship was explored further by synchronous polysomnography and recording of upper small bowel motility in six healthy subjects and six patients with IBS. During sleep, there was no difference in the patterns of intestinal motility between the two groups. There was no difference between the rapid eye movement (REM) latency or number of REM episodes, but the proportion of REM sleep was markedly increased (36.5% +/- 5.7% vs. 18.2% +/- 5.7%; P less than 0.01) in the IBS group, although the duration of sleep was similar (468 +/- 13 minutes in IBS vs. 444 +/- 10 minutes in controls; P greater than 0.1). Sleep apnea was detected in three of six patients with IBS but was not seen in controls. The data are consistent with the model of IBS as a disorder of brain-gut interaction.

A live vaccine against pertussis.

Animal experiments have shown that oral administration of live Bordetella pertussis induces a protective immune response. The biological properties of a nonpathogenic Bordetella pertussis strain, its toxicity and immunogenicity in mice were investigated. Comparative studies of the intraperitoneal and the oral route of immunization have shown that there was high mortality following intraperitoneal administration of the highest dose, whereas none of the doses of vaccine given orally led to appreciably higher mortality than that observed in control animals. The oral method of immunization when employing a stable, non-toxic, live vaccine strain, may be of value for women of child-bearing age, pregnant women, and for pediatric and nursing personnel exposed to the risk of pertussis infection. Infants may benefit by transplacentally conferred protection as well as being actively immunized at an early age after birth.

The effects of immunisation upon the natural history of pertussis. A family study in the Cardiff area.

During an outbreak of pertussis in the Cardiff area in 1974, 229 children with the disease were studied to assess the effect of immunisation upon its natural history and severity. The typical clinical features of pertussis, such as paroxysmal cough, whooping, vomiting, cyanosis, and irregular breathing, were less prevalent in both the immunised and the older children. Immunisation is the main factor in protecting against complications such as fits; and, together with older age, it protects against hospitalisation. Nevertheless, pertussis today can be just as severe as it was 40 years ago, and the vaccine remains the major factor ameliorating its natural history. The immunisation programme needs more active support by all child health workers.

Influenza vaccination and mortality from bronchopneumonia in the elderly.

In a three-year influenza vaccination programme carried out among elderly patients these were found to have a lower haemagglutination-inhibiting antibody level and a poorer serological response to vaccination than younger persons in the same city. Although there was little difference in overall respiratory illness between the vaccinated and unvaccinated groups until the third year of observation, those who received vaccine showed a substantially smaller incidence of bronchopneumonia and a significantly lower mortality than those not so protected. The observations are believed to justify the giving of influenza vaccine in this age-group.