Re-entrainment of the circadian rhythms of plasma melatonin in an 11-h eastward bound flight.

We investigated the re-entrainment of melatonin rhythm in an 11-h eastward-bound flight. Eight male subjects participated in the present study. Blood sampling was carried out once before the flight and twice after the flight. During the daytime the subjects were exposed to natural zeitgeber outdoors on the day except the blood sampling. Seven of eight subjects showed antidromic re-entrainment, and the other subject showed orthodromic re-entrainment. The intensity of natural day light in New York amounted to 20 000 lx. As for the direction of the re-entrainment in New York the antidromic re-entrainment is naturally dominant.

Changes in subjective sleepiness, subjective fatigue and nocturnal sleep after anaesthesia with propofol.

The purpose of this study was to clarify the changes in psycho-physiological functions after anaesthesia with propofol (PF). The subjects were seven healthy male volunteers and the duration of the anaesthesia was 1 h (14:00-15:00 h). The plasma concentration of PF immediately decreased after the anaesthesia. The subjective sleepiness and VAS (visual liner analogue scale) scores (i.e. effort to do something) increased significantly at 20 min after the anaesthesia. However, these changes were improved at 80 min after the anaesthesia. The sleep latency at the nocturnal sleep 8 h after the anaesthesia was prolonged significantly, but the other parameters including the distributions of stage 3 + 4 and the rapid eye movement 'REM' stage were not changed.

Sleep architectures of obstructive sleep apnea syndrome in the young child.

The sleep architectures of obstructive sleep apnea syndrome (OSAS) in the young child (child-OSAS, n = 17; mean age: 5.9+/-2.7 years; male:female 14:3) were compared with that of OSAS in the adult (n = 19; mean age: 44.7+/-10.7 years; male:female 18:1) and that of primary snoring in the child (n = 5; mean age: 7.0+/-2.4 years; male:female 5:0). Child-OSAS and OSAS in the adult had the same severity in oxygen desaturation. Child-OSAS showed lower Apnea-Hypopnea Index compared with OSAS in the adult. Sleep continuity in child-OSAS was not impaired compared with OSAS in the adult. Sleep fragmentation in child-OSAS was not so remarkable. The quantity of slow wave sleep in child-OSAS was similar to that of primary snoring in the child. Both profiles of sleep architectures showed nearly the same pattern.

Effect of 3 mg melatonin on jet lag syndrome in an 8-h eastward flight.

In order to assess the effect of melatonin on jet lag a field study was undertaken. The process of re-entrainment of circadian melatonin rhythm was investigated in six subjects. Except during 24-h blood sampling, the subjects were exposed to natural zeitgeber (time giver) outdoors and given 3 mg melatonin at 23:00 h. The subjects were exposed to bright sunlight from 3000 to 12000 lx. All of them showed orthodromic re-entrainment with taking melatonin, while two out of the six did not show orthodromic re-entrainment without taking melatonin. Melatonin accelerated the rate of the re-entrainment of the circadian melatonin rhythm. Melatonin was useful to jet travel from Tokyo to Los Angeles.

Re-entrainment of circadian rhythm of plasma melatonin on an 8-h eastward flight.

To estimate the process of re-entrainment we measured the melatonin rhythm on an eastward flight. After the baseline study, 24-hour blood sampling of six male subjects was done on the first and fifth days. During the daytime the subjects were exposed to natural zeitgeber outdoors every day except the blood sampling day. They were analyzed with an illuminometer when under the bright light condition. Four of the six subjects showed orthodromic re-entrainment, another subject showed antidromic re-entrainment, and the other subject kept the baseline pattern of plasma melatonin. The rate of re-entrainment in orthodromic re-entrainment was about 55 min per day. Measuring the circadian rhythm of plasma melatonin has clarified the interindividual re-entrainment difference.

Clinical features of circadian rhythm sleep disorders in outpatients.

The clinical data of 86 cases of primary circadian rhythm sleep disorder (primary CRSD) were retrospectively examined and compared to 40 cases of secondary circadian rhythm sleep disorder (secondary CRSD), who had presented with some kind of psychiatric or medical disorder, and had exhibited sleep-wake rhythm disorders that were judged to be secondary CRSD based on sleep logs. The comparison of cases found that: (i) the mean age at first presentation to the clinic was significantly younger for primary CRSD compared to secondary CRSD; (ii) more secondary CRSD cases were unemployed than were Primary CRSD cases; (iii) more cases in the secondary CRSD group had a clear trigger for sleep-wake rhythm disorder onset than cases in the primary CRSD group; and (iv) the types of sleep-wake rhythm disorders in the primary CRSD group consisted of delayed sleep phase syndrome (DSPS), 72 (83.7%), non-24 pattern, 11 (12.8%), and irregular, 3 (3.5%). In the secondary CRSD group there were 25 (62.5%) cases of DSPS pattern, 1 (2.5%) of non-24 pattern and 14 (35.0%) with irregular pattern. The 56 (65.1%) cases with primary CRSD showed good response to vitamin B12 and bright light therapy; however, 28 (70.0%) cases with secondary CRSD did not respond to such therapies.

[A case of metastatic testicular tumor in a schizophrenic patient: experience of multidisciplinary treatment at the urology ward].

A 39-year-old man with schizophrenia and suicide attempt was diagnosed with stage IIb testicular tumor. He was initially admitted to the psychiatry ward and underwent high orchiectomy. After schizophrenia became stable by administration of antipsychopathic drugs, he was transferred to the ordinary urology ward and treated with 3 courses of chemotherapy (bleomycin, etoposide, cisplatin) and retroperitoneal lymph noded dissection. The mental status of the patient remained under good control throughout the course of treatment. He has been free of recurrence for 8 months postoperatively. We discussed general medical issues concerning the treatment of malignant diseases in patients with psychosis.

Improvement in excessive daytime sleepiness after surgical treatment for obstructive sleep apnea syndrome.

The author's goal was to investigate the effects of surgical treatment on psychophysiological measurements in 17 patients with obstructive sleep apnea syndrome (OSAS) and also to clarify the improvement process of each evaluation. Given the changes in respiratory disturbance and sleep architecture, it was obvious that surgical treatment had therapeutic effects on OSAS patients a few months after the surgery. In that process, a dissociation between objective and subjective sleepiness was observed. The improvement in objective sleepiness [multiple sleep latency test (MSLT)] was more delayed than the improvement in subjective sleepiness (Stanford Sleepiness Scale, Spaceaeromedicine fatigue checklist). The improvement of MSLT was associated with an improvement in sleep fragmentation. This finding suggests that the disruption of sleep continuity accompanied by respiratory disturbance might be responsible for the occurrence of objective sleepiness. It can be concluded that the effective management of OSAS needs to address the full range of psychophysiological manifestations, especially objective measurement of daytime sleepiness.

[Psychophysiological and psychological consequences after surgical treatment of obstructive sleep apnea syndromes].

The purpose of this study is to investigate the effects of surgical treatment of psychophysiological and psychological measurement of obstructive sleep apnea syndromes (OSAS) patients, and to clarify the interrelationships regarding an evaluation of its improvement. The subjects, 17 inpatients (mean age: 41.9 +/- 13.8 [17-61] 15 males, 2 females), were given the diagnosis of OSAS at the International Classification of Sleep Disorders. 4-5 days before (Pre-Treatment: PT), 5-22 days after (13.0 +/- 4.8 days, Post-Operation: PO) and 3-6 months after (4.2 +/- 1.0 months, Follow Up: FU) the surgery, the examinations were performed. Polysomnography (PSG) were recorded from 21:00 to 6:00. Following PSG, for the changes in daytime sleepiness, Multiple Sleep Latency Test (MSLT), Stanford Sleepiness Scale (SSS) and Spaceaeromedicine fatigue check list (SAM) were applied with the interval of 2 hours from 8:00 to 20:00. The psychological battery were performed at PT and FU, that consisted of Uchida-Kraepelin Test (U-K), Wechsler Adult Intelligence Scale-Revised (WAIS-R), Benton Visual Retention Test (BVRT) and Minnesota Multiphasic Personality Inventory (MMPI). Surgical procedures were determined by means of radiological and endoscopic examinations. The results were as follows. A. Psychophysiological measurement (1) Apnea Index (AI) decreased at PO compared with PT. Further at FU. AI improved significantly compared with PT and PO [AI: 43.9 +/- 19.2-->20.5 +/- 16.5-->11.2 +/- 11.4]. And apnea duration shortened significantly at PO and FU. In addition, % time O2 saturation below 90% (SaO2 < or = 90%) decreased significantly at FU compared with PT. (2) With the improvement of respiratory disturbance, the sleep architecture of FU improved more than those of PO, such as increase of sleep efficiency, %stage 2 and %stage 3 + 4, decrease of No. of stage shift, %Wake and %stage 1. (3) Daily average of MSLT Scores at PO did not change compared with PT. But at FU, they improved significantly to normal range [6.7 +/- 3.0-->8.0 +/- 3.5-->11.4 +/- 3.9 (min.)], whereas daily average of SSS and SAM improved significantly at both PO and FU compared with PT. B. Psychological measurement (1) Dysfunction of task performance improved at FU. Mean value in U-K (1st and 2nd half) and mean IQ (performance and total) in WAIS-R increased significantly at FU compared with PT. (2) Immediate visual memories in BVRT did not change within normal range. (3) MMPI profiles at PT didn't show any personality or mood characteristics.(ABSTRACT TRUNCATED AT 400 WORDS)