Causes of neuropsychological deficits Bttner 2001 2009

Two concepts play a central role, first, the hypoxia and the other the disturbed sleep architecture in the causes of the neuropsychological and or cognitive deficits in Sleep Apnea Syndrome patients. Both factors appear usually occur together, so that it is hardly possible to separate the two. Several studies confirm the link between nocturnal oxygen desaturation and neuropsychological deficits. Greenberg et al. (1987) showed, for example, that the nocturnal hypoxia is the cause of the...

Introduction

Episodes of hypoxia and hypercapnia occurring during apneas significantly dilate blood vessels in the brain (both hypercapnia and hypoxia are potent stimuli of cerebral blood vessels dilation - Guyton, 2005). This results, together with a concomitant increase of mean arterial pressure, in average blood flow increase in the cerebral vessels. Studies in healthy volunteers (Przybylowski, 2003) have shown that episodes of breath apneas cause an increase of cerebral blood flow compared with resting...

Nightmares

Nightmares are vivid nocturnal events that cause feelings of fear and terror, with or without feeling anxiety. In most cases, a person having a nightmare will be abruptly awakened from REM sleep and is able to give a detailed account of what he dreamt about. Also, the person having a nightmare has difficulty returning to sleep. Episodes typically occur in the latter half of the night. Following the awakening, the individual becomes fully alert and profoundly anxious. There is vivid recall of...

Objective

Based on the above reported background, we designed a study to investigate the possible relationships between nocturnal breathing disturbances and headache, particularly migraine, with and without allodynia. The aims of the study were - to evaluate the prevalence of different kinds of headache in a population of subjects who underwent cardiopulmonary monitoring during sleep for presumed respiratory problems - to assess the frequency of allodynia among patients with headache in this population -...

Other pharmacological treatments for RLS

A number of other therapies have be evaluated for RLS including opioids, gabapentin and pregabalin, clonazepam, and case reports of melatonin, buproprion, and other agents. Overall, there is a long experience with opioids and those drugs have been especially useful in dopaminergic resistant RLS with augmentation problems. Clonazepam has also been widely used but is not particularly efficacious and now has been largely replaced by dopaminergic agents. In April 2011, the FDA approved extended...

References

Aittokallio T, Saaresranta T, Polo-Kantola P, Nevalainen O, Polo O. (2001).Analysis of inspiratory flow shapes inpatients with partial upper-airway obstruction during sleep. Chest 119 37-44 American Academy of Sleep Medicine Task Force Report. Sleep related breathing disorders in adults. Recommendations for s ndrome definition and measurement techniques in clinical research. (1999). Sleep 22 667-689. Argod J, Pepin JL, Smith RP, Levy P.(2000) Comparison of esophageal pressure with Pulse Transit...

Results

Among the enrolled subjects, 198 did not suffer from headache (mean age 60.3 12.7 years, 159 men and 39 women) and 104 had history of headache (mean age 51.4 12.3 years, 66 men and 38 women) of which 67 migraineurs (Mig - mean age 50.8 14.9 years, 37 men and 30 women) and 37 with tension type headache (TTH - mean age 51.4 13.3 years, 29 men and 8 women). Out of 104 subjects with headache, 50 were allodynic. Allodynia was found in 41 out of 67 migraineurs and in 9 out of 37 patients with tension...

RLS and renal disease

Renal disease has been associated with RLS symptomatology. A recent hospital based study of 301 patients, revealed a prevalence for meeting RLS criteria of 18.3 . Multivariate analysis identified iron deficiency and chronic renal disease to be independent predictors for RLS in this population (Quinn C et al, 2011). In a Japanese study of 490 uremic patients on hemodialysis (HD), 12.2 were found to meet criteria for RLS. The authors found a relationship between RLS, anxiety, anemia and high...

Sleepwalking

Among arousal parasomnias, sleepwalking (somnambulism) is the most common. Sleepwalking (somnambulism) includes ambulation or other intricate behaviors while still asleep, with amnesia for the event. Sleepwalking is a complex behavior that ranges from limited and noninjurious activities to dangerous activities associated with injuries to self or others. Up to 40 of normal children have experienced at least one episode of sleepwalking and 2 to 3 of children experience it at least once a month...

Stanford Sleepiness Scale SSS

The Stanford Sleepiness Scale (SSS) of Hoddes et al. (1973) is a scale on which momentary alertness can be assessed on a grading of 1 to 7 and thus serves to assess the circadian variations in daytime sleepiness. The scale describes gradual gradations of awareness it varies between very alert and drowsy conditions. The alertness descriptions are also described, each with typical sensations (e.g. some slack, slows, woozy) characterized. Studies on the sensitivity of the scale showed that ratings...

Summary

In the western and eastern industrial countries, the number of sleep disturbed subjects increased over the time. Undiagnosed and untreated, sleep disorders caused on one hand often by subjective suffering among those affected individuals and on the other hand, due to decreased attention and increased daytime fatigue or daytime sleepiness, to an increased risk of accidents in road traffic and workplace (e.g. Peter et al. 1995, Gerdesmeyer et al. 1997, Randerath et al. 1997, 1998, B ttner et al....

Treatment options

The primary therapy for disorders of arousal is reassurance and prevention. For most, the disease course is usually benign and tends to resolve spontaneously with time. It is essential that both the patient and bed partner be educated about safety precautions for the home and bedroom environment, such as reducing or eliminating potential sources of injury (e.g., relocating the bedroom to a room on the ground floor, securing doors, using heavy draperies over the windows, removing mirrors, and...

Sleep architecture

Sleep architecture with phase distribution, wake time, arousal and sleep fragmentation could be seen at best only via PSG studies. A major issue in this context is the exclusion of confounding factors such as the effect of medications, co-morbid neurological and psychiatric conditions and, above all, primary sleep disorders. In fact, ADHD children could be generally subdivided in children without sleep disorders, probably less than 50 according to most estimates, and children with sleep...

State of research

Jenkins & Dallenbach (1924) could show for the first time that learning tasks which are presented before sleep could be keep better than tasks that are presented before wakefulness. This was confirmed in other studies (Hennevin et al. 1995, Smith 1996). The discovery of REM sleep (Dement & Kleitman 1957) was the start for a more specific research program in which certain stages of sleep each were assigned specific roles for the memory processes. As follow on one hand, REM sleep, was...

The need for screening and screening methods for RBD

PSG is clearly necessary for establishing the diagnosis of RBD, but the procedure requires appropriate monitoring equipment, including time synchronized video recordings, specially trained technologists, bed availability in a sleep laboratory, and clinicians who can interpret the data. The procedure is costly, especially for patients with limited insurance coverage. Subjects must be willing and able to sleep in a sleep laboratory and undergo monitoring. Some patients with coexisting neurologic...

Sleep disorders 41 Insomnia

Chronic sleep onset insomnia (SOI) is a frequent finding in ADHD children (Mick et al., 2000 Smedje et al., 2001 Corkum et al., 2001 Owens et al., 2000a O'Brien et al., 2003a) with a prevalence rate of nearly 28 in unmedicated children (Corkum et al., 1999), almost double than the corresponding rate in the normal child population (Owens et al., 2000b Meijer et al., 2000). Its daytime sequelae heavily impact the cognitive domain of children and, specific to this age group, also behavioral...

Vigilance and attention in patients with Sleep Apnea Syndrome 31 State of research

Attention underlies performance of intellectual and everyday tasks. Depending on requirement character, novelty, intensity and level of activity, different components of attention are required. The central nervous system activation (alertness) reflects the degree of general alertness and represents a kind of basic activation and general responsiveness. It is unconscious, and affected by the autonomic nervous system and the physiological diurnal state of the organism. Two variants of the central...

Diagnosis

UARS is defined as daytime sleepiness associated to a sleep disordered breathing and arousals related to respiratory effort (RERA) but without sufficient apneas hypopneas for OSAS. The diagnosis is based on the association of clinical symptoms and polysomnographic findings. Nocturnal polysomnography, which is the gold standard for diagnosing SAHS, sometimes demonstrates the presence of apneic events and non apneic breathing (hypopneas), but does not definitively diagnose UARS. Nevertheless, an...

Therapeutic management and options to address comorbid sleep disorders in ADHD

The effect of immediate (IR) or extended (ER) release stimulants in ADHD is well known and beyond the purpose of this review. Stimulants still represent the first line of treatment of ADHD in pediatric populations across the world. The majority of subjective report studies indicate increased parental complaints of sleep disturbance in medicated versus unmedicated ADHD children, irrespective of stimulant type or regimen (Cohen-Zion & Ancoli-Israel, 2004). However, objective studies, whether...

Materials methods

We enrolled a sample of 302 subjects (225 men and 77 women) presenting consecutively at the Unit of Pneumology of the Luigi Sacco Hospital of Milan, for a full cardiopulmonary monitoring during sleep. - History of headache was evaluated in each subject, and headache diagnosis was clinically made according to the ICHD-II criteria. - The presence of allodynia was assessed by a set of semistructured questions, that had been used by our group in previous studies 04, 05 . This tool investigates if...

Rapid Eye Movement REM sleep behavior disorder

REM sleep is characterized by a paucity of muscle activity with near complete somatic muscular atonia. REM sleep behaviour disorder is characterized by the intermittent loss of REM atonia due to disinhibition of normally inhibitory mid-brain projections to spinal motor neurons. This, in conjunction with an active dream state, results in behavioural release and the apparent acting out of dreams. Abnormal behaviours include sleep talking, yelling, limb movement, and complex motor activities....

Conclusions

Despite the time elapsed since its initial description, UARS remains controversial as it has yet to be accepted as its own entity. However, the literature continues to reflect interest in this disorder. Perhaps SAHS and UARS share the same pathophysiological mechanism, although their clinical expression and pathophysiologic consequences are different. We could say that UARS and OSAS are distinct entities in the spectrum of sleep-disordered breathing. SAHS is one of the most common sleep...

SDB in epilepsy

The increased incidence of seizures during the night has been known for a long time. Mechanisms associated with the generation of epileptic seizures during sleep are not fully understood. It has been suggested there are several mechanisms of pathological synchronization of brain bioelectrical activity, triggered by physiological stages of sleep (Gigli, 1992). The phases of sleep in which there is greatest risk of seizures include the phases associated with a higher probability of awakening -...

Sleep Apnea Syndromes and neuropsychological disorders

In addition to nocturnal Sleep Apnea Syndrome symptoms there are a lot of daytime symptoms. It is assumed that the reduced sleep quality, arising out of deep sleep or REM- suppression, resulting in increased nocturnal arousal responses, or constantly occurring waking or a reduced relaxation function (Wee et al. 1998a b) and cognitive damage caused by intermittent hypoxia (Montplaisir et al. 1992). As the main symptom is excessive daytime sleepiness (EDS) is considered. It is also assumed that...

Epidemiology

Generally parasomnias, particularly those that are associated with non-REM sleep are commoner in childhood, but studies showed that non- REM parasomnias are not uncommon in adults. Parasomnias have been reported in approximately 4 of the adult population (Ohayon et al., 2000). Prevalence of sleepwalking, which consists of a series of complex behaviours that are initiated during slow wave sleep and result in walking during sleep, varies from 10 per 1,000 to 145 per 1,000. In a population of...

Sleep and pregnancy

Pregnancy is associated with many maternal physiological and psychological changes both of which may have an effect on sleep. In the first trimester, hormonal changes may disrupt sleep and in the third trimester the large baby and the anxiety regarding delivery may have associated effects on sleep. Likewise post-partum, a newborn may disrupt sleep patterns. The review by Lee in 1998 demonstrated that there was a paucity of studies, which addressed the alterations of sleep in pregnant women,...

Benton Test

The Benton Visual Retention Test is one of the best known and most widely used tests of immediate remembering for visual-spatial stimuli. The test consists of three parallel series, each with 10 geometric stimulus cards. The test person or the patient is shown one stimulus card for a short time (10 seconds), the figure of the card is to be draw directly after showing or after a short delay as accurately as possible. Further testing variations allow a shorter presentation time from 5 seconds,...

Rbdsqj

We developed a Japanese version of the RBDSQ (RBDSQ-J) after obtaining approval from the patent owner and investigated its validity and reliability (Miyamoto et al., 2009). The RBDSQ-J was administered to 52 consecutive patients with iRBD diagnosed according to criteria in the ICSD-2 (mean age 66.4 years 36 males, 16 females), 55 consecutive OSAS patients who had responded well to CPAP therapy (mean age 63.1 years 44 males, 11 females) after a diagnosis of RBD was ruled out by history and PSG...

Sustained attention test Quatember Maly

With the computerized sustained attention Clock test of Quatember and Maly (Wiener Testsystem TM, Schufried, Austria 1994 modified for Task force Vigilance and SIESTA group of DGSM2) the sustained attention will be evaluated under monotone conditions and the processing diligence will be measured in the kind of errors and reaction times over a period of 60 minutes. There are two types of errors missed and incorrect (delayed) responses reactions. Patients are instructed to press a key on the...

Pathophysiology

The upper airway is a very complex structure. In SAHS patients, apneas during sleep are caused by upper airway obstruction, wich leads to progressive asphyxia and awakening. The inspiratory efforts to overcome occlusion lead to arousal, sleep fragmentation, and oxyhemoglobin desaturation. From a physiological standpoint, both UARS and OSAS present intermittent upper airway collapse. This increase in upper airway resistance occasionally accompanies airflow limitation and arousals, with little...

RLS and rheumatic diseases

In the rheumatoid arthritis (RA) patient population, increased prevalence of RLS has been reported by several investigators. Reynolds et al studied hospitalized RA patients employing a 'control' group of osteoarthritis (OA) patients, and found a 30 prevalence of RLS in RA compared to 3 in OA (Reynolds G et al, 1986). A subsequent study again comparing RA and OA found comparable prevalence rates for RLS of 25 in RA and 4 in OA (Salih AM, et al, 2004). Auger et al in their study of MS patients...

Rbdsq Questionnaire

Stiasny-Kolster et al. in 2007 developed the original German English RBD Screening Questionnaire (RBDSQ) (Stiasny-Kolster et al., 2007). The RBDSQ is a 10-item patient self-rating instrument that assesses sleep behavior with short questions that have to be answered by either yes or no by the patient. Since patients do not always have a long-time companion, the bed partner's input was encouraged but not required. Items 1 to 4 address the frequency and content of dreams and their relationship to...

Causes of parasomnias

Parasomnias occur due to abnormal transitions between the three primary states of being wake, rapid eye movement (REM) sleep, and non rapid eye movement (NREM) sleep. These different states may overlap or intrude into one another, and it is the overlap of wakefulness and NREM sleep that gives rise to confusional arousals, and the intrusion of REM sleep into waking that produces REM sleep behaviour disorder (Matwiyoff et al, 2010). Parasomnias may have genetic basis, but occurrence is usually...

Sequential compression devices

There is a hypothesis that reduced blood flow to the extremities may play a role in RLS symptoms. Research has been undertaken to ascertain whether sequential (pneumatic) compression devices may alleviate RLS symptomatology. In a small preliminary study from 2005, researchers from New Jersey evaluated 6 patients using enhanced external counter pulsation (EECP) devices on the legs for one hour daily Monday to Friday for 7 weeks (Rajaram SS, 2004). All 6 patients met the 2003 IRLSSG criteria and...

Daytime sleepiness fall asleep and driving performance Bttner 2001 2009

The ability to drive safely and without accident needs sustained attention and alertness (Guilleminault et al. 1978, Bradley et al. 1985, Podszus et al. 1986, Findley et al. 1988a b, 1989b, 1990, 1991, 1995, He et al. 1988, Mitler et al. 1988, Lamphere et al. 1989, Roehrs et al. 1989, Bedard et al. 1991, Cassel et al. 1991a b, 1993, 1996, Kribbs et al. 1993a b, ATS 1994, Martin et al. 1996, Gerdesmeyer et al. 1997, Krieger et al. 1997, Randerath et al. 1997, 1998, Wee 1997, Wee et al. 1998a b)....

Sleep nasendoscopy

Tonsil Nasendosocpy

Sleep nasendoscopy (SNE) which is also known as drug induced sedation endoscopy (DISE) was pioneered at our institute.13 The beauty of this technique lies in the fact that it allows a three dimensional visualisation of the upper airway during sleep albeit drug induced. This assessment is carried out in an operating theatre setting with the help of an anaesthetist who provides sedation to the patient and closely monitors the patients cardiovascular and respiratory parameters. The sedative agents...

Sleepdisordered breathing SDB in patients with ischemic stroke

2.1 Sleep-disordered breathing (SDB) as a risk factor for ischemic stroke The first controlled study of sleep related breathing disorders in cerebrovascular diseases were carried out in the 80s. They concerned the snoring as a risk factor for ischemic stroke. The first studies were published by a group of Palomaki (Partinen et al, 1985). They compared the incidence of snoring in 50 men with ischemic stroke with a control group. The study was retrospective with use of a standardized...

Neurodegenerative diseases of the central nervous system and SDB 41 Alzheimer disease

Searching for links between Alzheimer's disease and sleep-disordered breathing has already started in the eighties. Cognitive deficits observed in individuals with SDB was seen as a preliminary stage in the development of dementia. Cognitive deficits in individuals with impaired respiratory function were found on both verbal, spatial and executive functions as well as short-term memory (Naegele, 1995 Alchanatis, 2005). A number of pathomechanisms may contribute to cognitive impairment in...

ADHD and sleep

Sleep disturbance is by far one of the most reported problems (> 80 ) especially by parents and care-takers, who commonly recount restless, inadequate and often delayed and or fragmented sleep in their children. A clear distinction, however, needs to be drawn between subjective and objective sleep reports and, with respect to the latter, actigraphyc versus video-polysomnographic (vPSG) studies present a palpable difference in terms of method and quality of data accessed. Several metanalytic...

Conclusion

A lack of sleep is known to affect both our physical and mental health. The few studies that have investigated sleep in pregnancy have found both an increase in total sleep time and an increase in daytime sleepiness in the first trimester whereas the third trimester appears to be associated with a decrease in sleep time and an increase in the number of awakenings. Sleep has an important impact on maternal and foetal health. It has been associated with an increased duration and pain perception...

Discussion

Deranged circadian rhythms have been well recognized in jet lag. In this condition, one may have symptoms, and i.e. dysfunction of the autonomic nervous system, sleep awake rhythm, mental and physical activity. We presume that those patients with sleep disturbance suffered from an atypical but continuous jet lag condition in their daily life. The international classification of sleep disorders (ICSD) was revised as a new sleep disorder nosology by the Association of Sleep Disorders Center in...

Multiple Sleep Latency Test MSLT

The Multiple Sleep Latency Test by Carskadon and Dement (1977) recorded the sleep latency lying down and is recommended for the investigation of daytime sleepiness in OSAS patients in the ICSD-2. The MSLT is based on the assumption that a strong physiological sleepiness can reduce the sleep latency (Arand et al. 2005). For a long time the MSLT has been considered a gold standard for the investigation of daytime sleepiness (Carskadon et al. 1986). The MSLT (as well as the Maintenance of...

Symptoms

Although OSAS and UARS share common symptoms, in most cases the clinical manifestations are different (Stoohs 2008). The most common symptoms of SAHS patients include chronic loud snoring, excessive daytime sleepiness, personality changes, depression and deterioration of quality of life (Pichel 2004). Hypersomnolence is the principal daytime manifestation of sleep disordered breathing. Excessive sleepiness resulting from increased breathing effort and sleep disruption is the guide symptom of...

MSLT and MWT criticism

Although MWT and MSLT are often used in practice, since years there is the assumption that its operationalization does not correspond to the tonic activation. Johns (1998) excludes that the MSLT is suitable as a predictor of daytime sleepiness in everyday situations, regardless how strict are implementation and evaluation standards. Although have the sleep latency on both tests satisfactory correlations as Sangal and colleagues (1992, 1997a) showed in subjects with various sleep disorders (r...

Sleepdisordered breathing disorders in neurological diseases

Respiratory disorders in patients with neurological diseases may be a result of damage to different parts of the respiratory rhythm generator and controlling structures responsible for generation of respiratory movements (neuromuscular disorders). Vascular damage to the respiratory center may lead to central respiratory disturbances. Neurodegenerative disease can damage the respiratory center (Cormican, 2004), as well as demyelinating lesions (Auer, 1996) located within the respiratory center....

Other parasomnias

Ten disorders are classified under this category (Table 1). The most common are sleep bruxism, sleep enuresis, and primary snoring. Sleep bruxism is the third most common parasomnia and it can be bothersome to the bed partner. Bruxism is not a dangerous disorder. However, it can cause permanent damage to the teeth and uncomfortable jaw pain, headaches, or ear pain. Approximately 8.2 of people experience it at least once a week. Sleep apnea and anxiety disorders are the most prominent risk...

RLS and other neurologic disorders

Peripheral neuropathy has also been associated with RLS. A recent case-control study (Hattan E et al 2009) in a Quebec population examined 245 patients with a diagnosis of peripheral neuropathy and 245 age and gender matched controls. The authors considered a positive response to three of the four essential criteria to be 'screen-positive'. All 'screen-positive' patients were subsequently evaluated by a blinded movement disorders specialist. Of the 245 peripheral neuropathy patients, 26.5 were...

Differential diagnosis of REM sleep behavior disorder

RBD is a relatively rare condition and is largely unknown to most physicians (see above 2), therefore it is often misdiagnosed and mistreated. The differential diagnosis of recurrent dream enactment behavior includes NREM parasomnia, nocturnal panic attacks, nocturnal seizures, nightmares, nocturnal wandering associated with dementia, and OSAS (Boeve, 2010a). A complaint of nocturnal disruptive behaviors is the major clinical feature of several other conditions, such as primary and secondary...

Mayo sleep questionnaire

RBD is a parasomnia that can develop in otherwise neurologically-normal adults as well as in those with a neurodegenerative disease. Confirmation of RBD requires PSG. A simple screening measure for RBD is desirable for clinical and research purposes. Boeve et al. developed the Mayo Sleep Questionnaire (MSQ), a 16-item measure to screen for the presence of RBD, periodic legs movement disorder (PLMD), restless legs syndrome (RLS), sleepwalking, OSAS and sleep-related leg cramps (Boeve, 2010a...

Intech

Free online editions of InTech Books and Journals can be found at www.intechopen.com Sleep and Pregnancy Sleep Deprivation, Sleep Disturbed Breathing and Sleep Disorders in Pregnancy 1 Michelle A. Miller, Manisha Ahuja and Francesco P. Cappuccio Adolescents with Sleep Disturbance Causes and Diagnosis 21 Sleep Disorders Diagnosis and Management in Children with Attention Deficit Hyperactivity Disorder ADHD 31 Elemental Mercury Exposure and Sleep Disorder 47 Alfred Bogomir Kobal and Darja Kobal...