Tracking Sleep to Optimize Health.

With the advent of wearable biometric technology like smart watches, "hacking" our bodies' functions and cycles has become a tool in the never-ending quest for better health. And sleep is no exception. For example, a staggering one-third of Americans don't get enough sleep, according to the Centers for Disease Control and Prevention (CDC).

Risk factors for sleep quality disturbances in patients with lumbar spinal stenosis before operation.

PURPOSE: We aimed to explore the risk factors of preoperative sleep quality in patients with lumbar spinal stenosis (LSS) and the association of sleep-related beliefs with sleep quality in these patients. METHODS: Sleep quality and related risk factors of sleep quality disturbances in patients with LSS preoperatively were assessed by questionnaires. Pittsburgh Sleep Quality Index (PSQI) for sleep quality, Oswestry Disability Index (ODI) for clinical outcomes, Visual Analog Scale for Pain (VAS Pain), Self-Rating Anxiety Scale (SAS) for anxiety level, and Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) for sleep-related beliefs were assessed. Bivariate logistic regression analysis was used to assess the risk factors of sleep quality disturbances. RESULTS: A total of 227 patients were enrolled, mean age 64 years (SD 13.1), 119 women (52%). The incidence of sleep quality disturbances in patients was 37% (83/227). Increased DBAS-16 scores (OR = 0.781; 95% CI, 0.725-0.841; p < 0.001) significantly decreased the probability of developing sleep quality disturbances, while increased anxiety levels (OR = 1.241; 95% CI, 1.152-1.337; p < 0.001) significantly increased the probability of developing sleep quality disturbances in patients. Factors including educational level, increased age, sex, preoperative length of stay, VAS Pain scores, and ODI scores showed no significant association and were therefore excluded from the model. CONCLUSIONS: High levels of anxiety and mistaken sleep-related beliefs were risk factors of sleep quality disturbances in patients with LSS before surgery. The more mistaken sleep-related beliefs were, the greater the probability of sleep disturbances.

Sleep and respiratory outcomes in neonates with Pierre Robin sequence: a concise review.

There are no standardized management algorithms for neonates with Pierre Robin sequence. Currently available literature is variable in terms of outcomes assessed across studies. In this paper, we have aimed to summarize the currently available literature on longitudinal sleep and respiratory outcomes in Pierre Robin sequence neonates with a focus on identifying gaps in literature and areas for future research development.

Pediatric polysomnography-A review of indications, technical aspects, and interpretation.

Polysomnography is an elaborate diagnostic test composed of numerous data-collecting sensors working concomitantly to aid in the evaluation of varied sleep disorders in all age groups. Polysomnography is the study of choice for the assessment of pediatric sleep-disordered breathing, including obstructive sleep apnea syndrome, central apnea, and hypoventilation disorders, and is used to help determine treatment efficacy. Beyond the purview of snoring and breathing pauses, polysomnography can elucidate the etiology of hypersomnolence, when associated with a multiple sleep latency test, and abnormal movements or events, whether nocturnal seizure or complex parasomnia, when a thorough patient history cannot provide clear answers. This review will highlight the multitudinous indications for pediatric polysomnography and detail its technical aspects by describing the multiple neurophysiologic and respiratory parametric sources. Knowledge of these technical aspects will provide the practitioner with a thoughtful means to understand the limitations and interpretation of polysomnography.

Posttraumatic stress disorder diagnosis is associated with reduced parasympathetic activity during sleep in US veterans and military service members of the Iraq and Afghanistan wars.

Study Objectives: To determine whether high-frequency heart rate variability (HF-HRV) during sleep differs between those with and without posttraumatic stress disorder (PTSD) as a function of sleep type (non-rapid eye movement [NREM] vs. rapid eye movement [REM]), and to explore this relationship across successive sleep cycles. Participants with PTSD were hypothesized to have lower HF-HRV across both REM and NREM sleep. Methods: Sixty-two post-9/11 military veterans and service members completed self-report measures of sleep quality, insomnia severity, and disruptive nocturnal behaviors. Participants then completed a laboratory-based polysomnographic study night with concurrent HRV assessment. Results: Participants with PTSD (N = 29) had lower HF-HRV in overall NREM sleep relative to those without PTSD (N = 33) (F(1, 54) = 4.24, p = .04). Groups did not differ on overall HF-HRV during REM sleep. HF-HRV increased over the night for the sample as a whole during both NREM and REM sleep. PTSD status did not moderate the association between HF-HRV and sleep cycles. However, the PTSD group had lower HF-HRV in the first t(155) = 2.67, p = .008, and fourth NREM cycles, t(155) = 2.11, p = .036, relative to participants without PTSD. Conclusions: Findings suggest blunted parasympathetic modulation during NREM sleep in a young cohort of military veterans and service-members with PTSD. Findings are concerning considering the increased risk of incident cardiovascular events associated with impaired parasympathetic nervous system function. Reduced parasympathetic modulation may be one mechanism underlying the increased prevalence of cardiovascular disease (CVD) among veterans with PTSD.

Can subjective sleep problems detect latent sleep disorders among commercial drivers?

INTRODUCTION: Long-haul truck drivers experience poor sleep health and heightened accident rates, and undiagnosed sleep disorders contribute to these negative outcomes. Subjective sleep disorder screening tools may aid in detecting drivers' sleep disorders. This study sought to evaluate the value of subjective screening methods for detecting latent sleep disorders and identifying truck drivers at-risk for poor sleep health and safety-relevant performance. MATERIALS AND METHODS: Using cross-sectional data from 260 long-haul truck drivers, we: 1) used factor analysis to identify possible latent sleep disorders; 2) explored the construct validity of extracted sleep disorder factors by determining their associations with established sleep disorder risk factors and symptoms; and 3) explored the predictive validity of resulting sleep disorder factors by determining their associations with sleep health and safety-relevant performance. RESULTS: Five latent sleep disorder factors were extracted: 1) circadian rhythm sleep disorders; 2) sleep-related breathing disorders; 3) parasomnias; 4) insomnias; 5) and sleep-related movement disorders. Patterns of associations between these factors generally corresponded with known risk factors and symptoms. One or more of the extracted latent sleep disorder factors were significantly associated with all the sleep health and safety outcomes. DISCUSSION: Using subjective sleep problems to detect latent sleep disorders among long-haul truck drivers may be a timely and effective way to screen this highly mobile occupational segment. This approach should constitute one component of comprehensive efforts to diagnose and treat sleep disorders among commercial transport operators.

Sleep disruption in chronic rhinosinusitis.

INTRODUCTION: Chronic rhinosinusitis (CRS) is a common disease of the upper airways and paranasal sinuses with a marked decline in quality of life (QOL). CRS patients suffer from sleep disruption at a significantly higher proportion (60 to 75%) than in the general population (8-18 %). Sleep disruption in CRS causes decreased QOL and is linked to poor functional outcomes such as impaired cognitive function and depression. Areas covered: A systematic PubMed/Medline search was done to assess the results of studies that have investigated sleep and sleep disturbances in CRS. Expert commentary: These studies reported sleep disruption in most CRS patients. The main risk factors for sleep disruption in CRS include allergic rhinitis, smoking, and high SNOT-22 total scores. The literature is inconsistent with regard to the prevalence of sleep-related disordered breathing (e.g. obstructive sleep apnea) in CRS patients. Although nasal obstruction is linked to sleep disruption, the extent of sleep disruption in CRS seems to expand beyond that expected from physical blockage of the upper airways alone. Despite the high prevalence of sleep disruption in CRS, and its detrimental effects on QOL, the literature contains a paucity of studies that have investigated the mechanisms underlying this major problem in CRS.

The enduring effects of early-childhood adversities and troubled sleep among Canadian adults: a population-based study.

OBJECTIVE: Although many studies have consistently found that early-childhood adversities are important risk factors for physical and mental health problems later in adulthood, few have examined the association between early-childhood adversities and troubled sleep. The objective of this study was to examine the association between early-childhood adversities and troubled sleep among adult Canadians. METHODS: Data for this paper (N = 19,349) were obtained from Statistics Canada's 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Logistic regression analysis was conducted to examine the association between early childhood adversities and troubled sleep, while accounting for various sociodemographic, socioeconomic, health, and mental health factors. RESULTS: Of the 19,349 respondents examined, 2748 representing 14.2% had troubled sleep. Controlling for sociodemographic, socioeconomic, health, and mental health factors, it was observed that for each additional childhood adversity experienced, the odds of having troubled sleep increased by 10% (odds ratio = 1.10, p <0.001, 95% confidence interval = 1.07-1.13). In addition, psychological distress, older age, being female, being unmarried, being white, a lower annual income, chronic pain, poor perceived health, and mental health difficulties were associated with troubled sleep. CONCLUSION: The results of this paper provide population-based evidence for childhood adversities as a major predictor of troubled sleep in adulthood. The long-standing effects of these adversities on sleep highlight the importance of early detection, such as consistent assessment of sleep habits for children, adolescents, and adults, who have experienced childhood adversities, in health and mental health settings.

[Electrical status epilepticus during sleep: a retrospective multi-centre study of 29 cases]. / Estado epiléptico eléctrico durante el sueño: estudio retrospectivo multicéntrico de 29 casos.

INTRODUCTION: Electrical status epilepticus during sleep (ESES) is an epileptic syndrome characterised by the presence of very persistent slow spike-wave-type epileptic discharges during non-REM sleep. The management of this pathology, today, is heterogeneous and no controlled studies have been conducted with the treatments employed; similarly, whether or not they improve patients' cognitive development or not has still to be determined. PATIENTS AND METHODS: A review was carried out of the patients diagnosed with ESES at four hospitals over a period of 15 years; data concerning their clinical presentation, therapeutic management and clinical course were collected and compared with the literature. RESULTS: Altogether 29 patients with ESES were detected, 20 of them idiopathic and 26 generalised. The drugs with which the greatest control of the electrical activity was achieved were corticoids/adrenocorticotropic hormone (ACTH), clobazam and levetiracetam. In the primary cases ESES lasted an average of six months and the duration was twice that time in the secondary cases. Findings showed that the intelligence quotient remained normal in 45% of patients and 40% presented differing degrees of cognitive disability in the course of the pathology. CONCLUSIONS: The developmental neuropsychological prognosis is usually unfavourable and the cognitive development seems to be related with the duration of ESES and the area where the epileptic activity is concentrated, which suggests that the poor prognosis can be avoided if treatment is established at an early stage. The antiepileptic drugs that are most commonly used are valproic acid, ethosuximide and levetiracetam, and in our milieu clobazam and lamotrigine were commonly employed. The most effective drugs for controlling ESES were corticoids/ACTH, clobazam and levetiracetam.

TITLE: Estado epileptico electrico durante el sueño: estudio retrospectivo multicentrico de 29 casos.Introduccion. El estado epileptico electrico durante el sueño (ESES) es un sindrome epileptico caracterizado por la presencia de descargas epilepticas tipo punta-onda lenta de manera muy persistente durante el sueño no REM. En la actualidad, el manejo de esta patologia es heterogeneo y no hay estudios controlados con los tratamientos utilizados, ni se ha comprobado si estos mejoran la evolucion cognitiva de los pacientes. Pacientes y metodos. Se revisan los pacientes diagnosticados de ESES durante 15 años en cuatro centros hospitalarios, se recoge la presentacion clinica, el manejo terapeutico y la evolucion clinica, y se compara con la bibliografia. Resultados. Se seleccionaron 29 pacientes con ESES, 20 de ellos idiopatico y 26 de ellos generalizado. Los farmacos con los que se consiguio mayor control de la actividad electrica fueron los corticoides/hormona adrenocorticotropa (ACTH), el clobazam y el levetiracetam. La mediana de duracion del ESES en los casos primarios fue de seis meses, y en los secundarios, el doble. El 45% de los pacientes mantuvo un cociente intelectual normal y un 40% presento en la evolucion discapacidad cognitiva de diferente grado. Conclusiones. El pronostico neuropsicologico evolutivo suele ser desfavorable y la evolucion cognitiva parece estar en relacion con la duracion del ESES y el area donde este concentrada la actividad epileptica, lo que sugiere que el mal pronostico, si se trata precozmente, se puede evitar. Los antiepilepticos mas frecuentemente utilizados son el acido valproico, la etosuximida y el levetiracetam, y en nuestra muestra tambien se utilizaron con frecuencia el clobazam y la lamotrigina. Los farmacos mas eficaces para el control del ESES fueron los corticoides/ACTH, el clobazam y el levetiracetam.

[Clinical approach to the first epileptic crisis in adults]. / Aproximación clínica a una primera crisis epiléptica en adultos.

Seizures are one of the main reasons for visits to emergency and neurology. Represent a traumatic event with potential medical and social consequences. A first epileptic seizure, can be the initial manifestation of malignancy, systemic disorder or infection, but can also be the first manifestation of epilepsy. The misdiagnosis of symptomatic seizures and unprovoked seizure, significantly affects prognosis and patient outcomes. The aim of this review is to examine the general concepts that enable successful diagnostic and therapeutic approach to the patient presenting with a first epileptic seizure.

TITLE: Aproximacion clinica a una primera crisis epileptica en adultos.Las crisis epilepticas son uno de los principales motivos de consulta en urgencias y en neurologia. Representan un evento traumatico con potenciales consecuencias medicas y sociales. Una primera crisis epileptica puede ser la manifestacion inicial de una neoplasia, un trastorno sistemico o una infeccion, pero tambien puede ser la primera manifestacion de la epilepsia. El diagnostico y el tratamiento erroneo de crisis epilepticas sintomaticas y no provocadas repercuten de manera significativa en el pronostico y la evolucion de los pacientes. El objetivo de esta revision es profundizar en los conceptos generales que permitan una aproximacion diagnostica y terapeutica acertada al paciente que se presenta con una primera crisis epileptica.

Pediatric insomnia: clinical, diagnosis, and treatment.

Pediatric insomnia is an extrinsic sleep disorder subdivided into two categories: behavioral insomnia and insomnia related to medical, neurological, and psychiatric diseases. This review will cover several types of insomnia, comorbidities and specific pediatric therapies according to clinical characteristics and age. Behavioral insomnia should be differentiated from pediatric insomnia due to medical conditions, mostly occurring during the first year of life. Multiple night awakenings and diurnal hypersomnolence are strong indicators of insomnia due to medical conditions. Insomnia during adolescence and pediatric insomnia associated with psychiatric comorbidity, cognitive disabilities and epilepsy, will be discussed in terms of diagnosis, clinical features and implications for treatment.

TITLE: Insomnio pediatrico: clinica, diagnostico y tratamiento.El insomnio pediatrico es un trastorno de sueño extrinseco que puede subdividirse en dos categorias: insomnio conductual e insomnio relacionado con trastornos medicos, neurologicos y psiquiatricos. En esta revision presentamos varios tipos de insomnios, comorbilidad y terapias especificas de acuerdo con la edad y con las caracteristicas clinicas. El insomnio conductual se debe diferenciar del insomnio pediatrico por causas medicas, ya que este ultimo aparece, normalmente, en el primer año de vida. Los despertares nocturnos frecuentes y la somnolencia diurna excesiva indican un insomnio debido a causas medicas. El insomnio del adolescente y el insomnio pediatrico asociado a trastornos psiquiatricos, alteraciones cognitivas y epilepsia se discutiran en terminos de diagnostico, hallazgos clinicos e implicaciones terapeuticas.

Sleep disorders in perinatal women.

Insufficient sleep is common in the general population, and can result from environmental and psychosocial factors, medical and psychiatric disorders, and sleep disorders, such as insomnia, circadian rhythm disorders, sleep apnoea and restless legs. Women are particularly at risk for sleep disorders, and complaints of sleep disturbance are more prevalent among women than men across the life span. During the perinatal period, many common sleep disorders, such as obstructive sleep apnoea or restless legs may be exacerbated, or in the case of insomnia or narcolepsy, treatment options may change. In addition, the role of circadian rhythms in fertility and perinatal health is just beginning to be appreciated. In this chapter, we provide an overview of the current knowledge of the unique aspects of diagnosis and treatment of sleep disorders during the perinatal period.

Magnetoencephalography correlate of EEG POSTS (positive occipital sharp transients of sleep).

PURPOSE: In contrast to EEG, which has guidelines for interpretation and a plethora of textbooks, the full range of activity seen in magnetoencephalography (MEG) has not been fleshed out. Currently, magnetoencephalographers apply criteria for EEG waveforms to MEG signals based on an assumption that MEG activity should have morphology that is similar to EEG. The purpose of this article was to show the characteristic MEG profile of positive occipital sharp transients of sleep. METHODS: Simultaneous MEG-EEG recordings of two cases are shown. RESULTS: In both the cases, the morphologic features of positive occipital sharp transients of sleep in MEG vary and sometimes mimic epileptic spikes. CONCLUSION: This report raises a caution that a normal variant may have an even more epileptic appearance on MEG than on EEG. Using the simultaneously recorded EEG to avoid misinterpretation of spikey-looking positive occipital sharp transients of sleep in MEG is a natural and prudent practice.

Hypnic headache: a review of 2012 publications.

Hypnic headache is a rare primary headache disorder affecting middle age and above with a dull pain exclusively at nighttime. This article aims to review and discuss the most recent articles published in the year 2012 regarding hypnic headache. We will also discuss specific cases of pharmacological and nonpharmacologic successes in treating this rare disorder.

Diagnostic and management approach to common sleep disorders during pregnancy.

The significance for maternal and fetal health of gestational obstructive sleep apnea, primary insomnia, restless legs syndrome, and narcolepsy are summarized. The pathophysiology, signs, symptoms, and basic Sleep Medicine concepts that assist the obstetrician in suspecting these 4 conditions are described. Where appropriate, initial management options are also outlined. Referral guidelines to a Sleep Medicine specialist are included when further diagnostic, severity assessment, and management suggestions are needed.

Recurrent hypersomnia following traumatic brain injury.

BACKGROUND: Recurrent hypersomnia (RH) following a traumatic brain injury (TBI) is a rare form of RH. According to the International Classification of sleep disorders, 2nd edition (ICSD-2), RH must be considered in the differential diagnosis as secondary to an organic insult of the central nervous system and not as the clinical subtype of RH, Kleine-Levin syndrome (KLS). The aim of our study was to investigate if cases of RH following TBI should be considered in the differential diagnosis of RH as indicated by the International classification of sleep disorders, 2nd edition or as genuine, or indicated by ICSD-2, RH must cases of KLS. METHODS: Twelve cases of RH developed after TBI were collected and analyzed for circumstance at onset, severity of TBI, delay between TBI and occurrence of first episode of RH, symptoms of RH, duration and cycle length of episodes of hypersomnia, physical signs, and brain morphological imaging at the time of hypersomnia episodes. RESULTS: Factors such as the delay between TBI and the first episode of RH, the presence of other triggering factors and potential genetic factors, the degree of the severity of TBI, the presence or absence of any consistent brain imaging abnormality, provided the following results: (1) two of the cases could be considered as symptomatic of the underlying pathological brain process, (2) eight of the cases could be considered as simply triggered by TBI in patients at risk for KLS, and (3) two cases could be considered neither symptomatic nor triggered by TBI, due to the long delay between TBI and occurrence of symptoms. CONCLUSION: Cases of RH following TBI do not present under a single mechanism. Clinical assessment and laboratory tests are necessary to correctly classify them.