Abstract: Objective To investigate abnormal breathing patterns during sleep in prepubertal children using nonstandard polysomnographic patterns in association with an apnea-hypopnea scoring technique. Patients and Methods Study participants included 400 children with suspected sleep-related breathing disorders and 60 control children. We analyzed clinical signs and symptoms at entry into the study and 3 months after otolaryngological treatment. We determined the frequency of predefined breathing patterns during sleep through blind analysis of polysomnograms obtained once in control subjects and twice in children referred to our clinic (before and after adenotonsillectomy), using the nasal cannula–pressure transducer system, mouth thermistor, esophageal manometry, microphone, and pulse oximetry. We also determined the relationship between breathing patterns during sleep and residual postsurgery symptoms. Further analysis was performed of symptoms and polysomnographic patterns in those children who underwent new treatment interventions due to persistence of symptoms and abnormal polysomnogram findings. Results Tachypnea, persistently elevated breathing effort, progressively increased breath effort, and discrete flattening of nasal airflow monitored with the nasal cannula–pressure transducer system without oxygen saturation decreases help determine disorder as much as apneas and hypopneas. Abnormal, nonstandard breathing patterns were associated with the same symptoms as those in children with apnea and hypopnea and were more commonly present when there was incomplete resolution of initial symptoms that led treating practitioners to request further treatment. Conclusion Currently published polysomnographic scoring recommendations overlook common breathing abnormalities during sleep that are associated with clinical complaints.

Abstract: The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrome. The SONA Pillow®is a triangular pillow with space to place your arm under the head while sleeping on the side. Twenty-two patients with nocturnal polysomnogram (NPSG)-proven obstructive sleep apnea syndrome were included in this study; the group included 11 mild, 8 moderate, and 3 severe sleep apnea patients. All patients had a second attended NPSG performed while utilizing this specific inclined pillow. The pillow was found to be an effective and easily used treatment for mild (respiratory disturbance index [RDI] 5 to 19) and moderate (RDI 20 to 40) obstructive sleep apnea and snoring. In this group, RDI ranged from 5.1 to 35.2 and decreased on the average from 17 events per hour to fewer than 5 events per hour while utilizing the inclined pillow (< 0.0001). Also, a statistically significant difference was noted in rapid eye movement (REM) RDI decrement in all patients with mild to moderate sleep apnea (p= 0.001) and the increase in SaO2was also significant (p= 0.004). Overall, snoring was decreased or eliminated (p= 0.017). Conclusion: A uniquely designed pillow (SONA Pillow®) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea. Using this pillow also reduces snoring.

Abstract: The spectrum of rapid eye movement behavior disorders (RBD) spans various age groups, with the greatest prevalence in elderly men. Major diagnostic features include harmful or potentially harmful sleep behaviors that disrupt sleep continuity and dream enactment during rapid eye movement sleep. In RBD patients, the polysomnogram during rapid eye movement sleep demonstrates excessive augmentation of chin electromyogram or excessive chin or limb phasic electromyogram twitching. RBD may be associated with various neurodegenerative disorders, such as multiple system atrophy, Parkinson’s disease, and dementia with Lewy bodies. Other co-morbid conditions may include narcolepsy, agrypnia excitata, sleepwalking, and sleep terrors. RBD is hypothesized to be caused by primary dysfunction of the pedunculo-pontine nucleus or other key brainstem structures associated with basal ganglia pathology or, alternatively, from abnormal afferent signals in the basal ganglia leading to dysfunction in the midbrain extrapyramidal area/ pedunculo-pontine nucleus regions.

Abstract: Obstructive sleep apnoea (OSA) is a common entity in children, most present with sleep disturbances such as snoring, choking during sleep, enuresis, restless sleep, or apnoeic spells. Other symptoms include poor school performance, hyperactivity, failure to thrive, heart failure and cor pulmonale. Most authors would concur that the polysomnogram (PSG) is the gold standard for the diagnosis of OSA, and that adenotonsillectomy is the surgical procedure of choice, with high curative rates and relatively low morbidity. Close post-operative monitoring of all children with OSA cannot be over-emphasized. The focus has been, traditionally, to anticipate post-operative airway and respiratory complications in this group of children. We present 73 children with clinical OSA and 36 children with proven OSA on PSG, with only one child having respiratory complications (mixed apnoea), and all with uneventful recovery. In view of our low complication rates, low post-operative morbidity, cost and facility factor, the need for a mandatory overnight PSG pre-operatively is questioned, and clinical criteria for performing a PSG preoperatively are suggested.

Abstract: One of every 15 adults in the United States has at least moderate sleep apnea. The true prevalence is higher, as approximately 0.3 to 5% of adults with sleep apnea are undiagnosed. Sleep apnea has major health consequences; therefore, neurologists must recognize and treat sleep apnea syndromes appropriately. There are three main categories of sleep apnea: obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea. OSA results from upper airway obstruction, and CSA is due to lack of inspiratory muscle effort; mixed apnea results from a combination of these factors. Sleep apnea syndromes can present within the spectrum of "typical" neurological complaints, including forgetfulness, headaches, sleepiness, fatigability, seizures, and muscle and nerve weakness. A good sleep history, a nocturnal polysomnogram, and multiple sleep latency test are important in elucidating the diagnosis and validating the complaints of sleepiness. The gold standard for treatment of OSA is positive airway pressure, although some patients may benefit from surgical interventions designed to bypass the site of airway obstruction. With CSA, treatment is directed toward the underlying disorder. Patients with CSA may also benefit from several types of nasal positive airway pressure treatment, while some require mechanical ventilation.

Abstract: In recent years, sleep medicine has become a rapidly advancing field filled with exciting new discoveries. Many sleep disorders are diagnosed by clinical history alone. Sleep disorders such as sleep apnea, narcolepsy, periodic limb movement disorder, parasomnias, and nocturnal seizures usually require evaluation in the sleep laboratory. Sleep studies are used for diagnostic purposes, to assess disease severity, and to evaluate treatment efficacy. Sleep testing should be tailored to answer the specific clinical question at hand. This article reviews the techniques most commonly performed in the sleep laboratory and their indications, interpretation, and limitations. These include the polysomnogram, the multiple sleep latency test, and the maintenance of wakefulness test. The accurate interpretation of these studies requires a comprehensive sleep and medical history.

Abstract: UNLABELLED Major depression, seasonal pattern (seasonal affective disorder SAD) characterize the winter recurrence depressive episodes with remission of symptoms in spring and summer. Patients with winter depression report hypersomnia, fatigue, loss of energy, carbohydrate craving, appetite and weight gain. AIM The aim of this study was to assess the effect of phototherapy on the quality of sleep parameters and subjective estimation of mood disorders in patients with seasonal affective disorders. METHOD The investigated group consisted of 17 patients with SAD (15 female, 2 male) aged 18-64 (mean 38+/-12) years. Phototherapy (bright light therapy) was applied for 14 days, everyday morning--30 minutes, between 6.00 to 10.00--exposition to light of about 10,000 lux intensity. Polysomnogram (sleep EEG) was recorded before and after treatment. RESULTS After phototherapy patients reported a significant mood improvement (57%) measured by the Seasonal Pattern Assessment Questionnaire. Sleep investigation showed: increased sleep efficiency, decreased sleep latency, decreased slow wave sleep latency and increased of sleep spindles in the first hour of sleep. CONCLUSIONS Research confirms that phototherapy is an effective method of treatment of choice for patients with SAD. The result indicates that phototherapy markedly improved mood and sleep quality.

Abstract: Study Objective: To compare polysomnographic recordings obtained in the home and laboratory setting Design and Setting: Multicenter study comparing unsupervised polysomnography performed in the participant's home with polysomnography supervised at an academic sleep disorders center, using a randomized sequence of study setting Sleep Heart Health Study (SHHS) standardized polysomnographic recording and scoring techniques were used for both settings Participants: 64 of 76 non-SHHS participants recruited from 7 SHHS field sites who had both a laboratory and home polysomnogram meeting acceptable quality criteria Measurements and Results: Median sleep duration was greater in the home than in the laboratory (375 vs 318 minutes, respectively, P <0001) as was sleep efficiency (86% vs 82%, respectively, P <0024) Very small, but significant increases in percentage of rapid eye movement sleep and decreases in stage 1 sleep were noted in the laboratory Employing multiple definitions of respiratory disturbance index (RDI), median RDI was similar in both settings (for example, RDI with 3% desaturation: home 124, range 06-67; laboratory 95, range 01-934, P =41) Quartile analysis of laboratory RDI showed moderate agreement with home RDI measurements Based on the mean of laboratory and home RDI and using a cutpoint of 20, there was a biphasic distribution, with the RDI 3% above 20 being more common in the recordings performed in the laboratory than in the home and below 20 being more common in the recordings performed in the home than in the laboratory These differences could not be attributed to quality of recording, age, sex, or body mass index Conclusions: Using SHHS methodology, median RDI was similar in the unattended home and attended laboratory setting with differences of small magnitude in some sleep parameters Differences in RDI between settings resulted in a rate of disease misclassification that is similar to repeated studies in the same setting Abbreviations: Arl, arousal index; BMI, body mass index; ICC, intraclass correlation coefficient; PSG, polysomnography; RDI, respiratory disturbance index; REM, rapid eye movement sleep; SHHS, Sleep Heart Health Study Citation: Iber C; Redline S; Kaplan Gilpin AM et al Polysomnography performed in the unattended home versus the attended laboratory setting-sleep heart health study methodology

Abstract: Objectives Since there is no consensus definition of sleep onset, we studied different aspects of initial sleep periods in healthy volunteers taking melatonin. Two criteria for sleep latency were used: 10 minutes of uninterrupted sleep and 1.5 minutes of stage 1 sleep. Participants Forty healthy male volunteers (mean age 28 +/- 5 years) were assigned to 2 groups: 30 ingested melatonin and 10 placebo. Design All volunteers underwent an initial polysomnogram (baseline) after a 1-night adaptation period. The next day, the placebo or a 10-mg dose of melatonin was administered for 28 days, 1 hour before sleep time, in double-blind fashion. The second polysomnogram was recorded on day 14. Setting Sleep laboratory Results Chronic melatonin administration led to a significant reduction in sleep latency, using only the criterion 10 minutes of uninterrupted sleep. This effect suggests that melatonin may have a hypnotic effect, and the use of melatonin may lead to better sleep consolidation. Conclusions These results show differences that have clinical implications, since the criteria used to diagnose initial insomnia were based on sleep onset.

Abstract: Study Objectives: In sleep-disordered breathing (SDB), visual or computerized analysis of electroencephalogram (EEG) signals shows that disruption of sleep architecture occurs in association with apneas and hypopneas. We developed a new signal analysis algorithm to investigate whether brief changes in cortical activity can also occur with individual respiratory cycles. Design: Retrospective. Setting: University sleep laboratory. Participants: A 6 year-old boy with SDB. Intervention: Polysomnography before and after clinically indicated adenotonsillectomy. Measurements: For the first 3 hours of nocturnal sleep, a computer algorithm divided nonapneic respiratory cycles into 4 segments and, for each, computed mean EEG powers within delta, theta, alpha, sigma, and beta frequency ranges. Differences between segment-specific EEG powers were tested by analysis of variance. Respiratory cycle-related EEG changes (RCREC) were quantified. Results: Preoperative RCREC were statistically significant in delta (P .01) ranges. One year after the operation, RCREC in all ranges showed statistical significance (P < .01), but delta, theta, and sigma RCREC had decreased, whereas alpha and beta RCREC had increased. Preoperative RCREC also were demonstrated in a sequence of 101 breaths that contained no apneas or hypopneas (P < .0001). Several tested variations in the signal-analysis approach, including analysis of the entire nocturnal polysomnogram, did not meaningfully improve the significance of RCREC. Conclusions: In this child with SDB, the EEG varied with respiratory cycles to a quantifiable extent that changed after adenotonsillectomy. We speculate that RCREC may reflect brief but extremely numerous microarousals.

Abstract: We describe the first reported case of subclinical rhythmic electrographic discharge of adults (SREDA) during rapid eye movement (REM) sleep. This 48-year-old man, with a history of witnessed apneic spells, was sent for a baseline polysomnogram. Besides demonstrating obstructive sleep apnea, his study showed the occurrence of paroxysmal delta waves evolving into a theta frequency during REM sleep. A repeat polysomnogram with 16-channel electroencephalography confirmed SREDA in the bilateral temporal/parietal regions during REM sleep. This uncommon paroxysmal electrographic pattern should not be mistaken for seizure activity and is now recognized to occur in all stages of sleep, including REM. q 2003 Elsevier B.V. All rights reserved.