OBJECTIVES: The sense of rest after sleep and its relation to various sleep parameters is still a debatable issue. The purpose of the present study was to analyse sleep fragmentation by scoring various arousals (microarousals (MA), vegetative (VA) and behavioural (BA) arousals) in all sleep stages and to evaluate their relation with subjective sleep quality without paying attention to the type of insomnia.
METHODS: The overnight sleep cycles of 60 subjects were analyzed according to their stage composition and arousals. Arousal indices (AI) were calculated for all types of arousals in all sleep stages and sleep cycles. The sleep quality was quantified using the Pittsburgh sleep quality index (PSQI).
RESULTS: AI differences between sleep cycles were not statistically significant. MAI value in total sleep time (TST) - 5.8 ± SD 4.1 - was the highest among all the three arousal types. Differences between AI in most sleep stages were statistically significant for all types of arousals. This suggests that human sleep development within a single sleep cycle is more important for the sleep quality than the changes between different sleep cycles. The highest AI scores for the three types of arousals were found in NREM stage 2. The strongest and significant correlation was between PSQI and MAI (r = 0.42; p = 0 .001).
CONCLUSION: The density of microarousals is important for the subjective sleep quality. The highest values of MAI and other arousal types are found in NREM stage 2. The importance of this stage might be higher than thought before and especially in initial sleep cycles.
Keywords: sleep, sleep arousals disorders, sleep stages.
OBJECTIVES: The aim of this study was to evaluate stroke patients' sleep quality and its relationship with sleep disturbances complaints.
METHODS: A total of 70 subjects, 40 patients (57 ± 7 years) and 30 healthy controls (52 ± 6 years), assessed by the Pittsburg Sleep Quality Index (PSQI) took part in the study. Data analysis was realized by ANCOVA and multiple linear regression.
RESULTS: Significant differences in average PSQI were found between the groups (patients: 6.3 ± 3.5; healthy: 3.9 ± 2.2; p = 0.002). Regression analysis showed that the strongest predictor of sleep quality was compromised sleep efficiency (R2 adjusted = 0.78) which may indicate less deep sleep can be compensated with increased daytime dysfunction, latency and sleep duration.
CONCLUSIONS: We suggest that complaints of poor sleep quality be priority during clinical diagnosis.
Keywords: homeostasis, nervous system diseases, sleep disorders, stroke.
FFI, a rare prion disease, constitutes by their wake and sleep abnormalities a unique pathophysiological model of disease. Recently, a neurobiological-mathematical model of the human sleep/wake cycle (MMSWC) developed by Rempe, BestJ and Terman, reconciles circadian/homeostatic influences with new findings like the proposed sleep/wake flip-flop switch and REM-NoREM switch. We attempt now to modeling sleep abnormalities seen in FFI patients with the hypothesis that different degrees of perturbation (activation/deactivation) of circadian and homeostatic drives are related with sleep findings previously reported. We modeling our sleep data using MMSWC, where, briefly, the ventrolateral preoptic neurons (VLPO) and monoaminergic neurons (AMIN) inhibit each other and are modeled as a system of two ordinary differential equations. A similar interaction between REM-on and REM-off was also implemented. Both models were able to produce simulations that we confront with reanalyzed polysomnograms of a proven and peculiar case of FFI. IntraREM sleep fragmentation, the cyclic alternating pattern reported in atypical REM sleep and the reversal of atypical REM-NoREM presentation, seen in our case of FFI, can be simulated according the MMSWC by increasing random and Poisson perturbations on circadian and/or REM-on inputs. This was made by modifying the term I AMIN that corresponds to REM-on equations of this model. These mathematical models support the hypothesis that in FFI the extended neuronal network that regulates sleep and wakefulness could be disrupt by altered circadian/homeostatic and REM inputs.
Keywords: fatal familial, insomnia, mathematical models, sleep disorders.
OBJECTIVES: Patients in coronary care unit (CCU) are at risk of sleep deprivation. This study investigated effects of eye mask on sleep quality in patients of CCU in Southeast of Iran by a cross-over design.
METHODS: Using Verran and Snyder-Halpern Sleep Scale (VSH Sleep Scale), quality sleep of 60 patients with and without usage of eye mask were evaluated. This tool consists of 16 items that includes three main sleep sub scales: disturbance, effectiveness, and supplementation.
RESULTS: In total, 34, 22 and 4 out of 60 patients were admitted to CCU due to myocardial infarction (MI), chest pain and angina pectoris, respectively. Mean time of patients' nocturnal sleep was 6.6 ± 1.1 hours. Using eye mask have statistically significant increased the quality of sleep in subscales disturbance and effectiveness (p < 0.05).
CONCLUSION: In general, the use of eye mask is an easy and cheap method to improve the quality of sleep in CCU patients.
Keywords: heart diseases, sleep, sleep deprivation.
OBJECTIVES: The primary objective of this systematic review is assessing whether treatment of gastroesophageal disease (GERD) may reduce the apnea and hypopnea index (HAI) and the secondary objective of assessing whether there is a correlation between the HAI and gastroesophageal acid reflux.
METHODS: Using a systematic review of clinical studies that investigated the relationship between obstructive sleep apnea and GERD. The search included all cited publications up to April 22, 2012, using the keywords "sleep apnea, obstructive" AND "gastroesophageal reflux/diagnosis" OR "gastroesophageal reflux/drug therapy" OR "gastroesophageal reflux/therapy" AND "randomized controlled trial". The following electronic databases were used: PubMed, EMBASE, LILACS, MedLine, SCISEARCH, WEB of Science, CINAHL, BIREMI, SCOPUS, and the database of controlled clinical trials of the COCHANE collaboration. The total sample size was 60 patients (55% males). All patients in the eligible studies were submitted to both polysomnography and esophageal pH measurements before and after treatment.
RESULTS: Initially, 24 articles were selected. Of these, only three met the criteria for this study All the 3 studies found in this analysis were "before and after" clinical trials. Through the grouping of patients in our systematic review, we found a statistically significant decline in the average time of GERD after treatment, and a trend for reduction in the rate of HAI.
CONCLUSION: The studies examined demonstrate that medical treatment of GERD may reduce apnea and hypopnea. Nevertheless, more controlled clinical trials are needed to confirm the benefits of drug therapy for GERD in the context of obstructive sleep apnea.
Keywords: adults, apnea, clinical trial, upper airway.
Temporomandibular disorder (TMD) is a generic term for a group of musculoskeletal disorders of the masticatory apparatus. Patients with TMD present with several common symptoms: mandibular function pain, articular noise, headaches, bruxism and poor and unrestful sleep. Poor sleep quality can severely harm the patient's health, as it can be an etiological or perpetuating factor in TMD patients. The aims of this systematic review were to analyze the cause and effect relationship between sleep disorders and TMD and to determine the prevalence of this relationship. Studies were selected from the MedLine, Cochrane, PubMed, LILACS and BBO databases using keywords and predefined criteria. Studies published between 1990 and 2012 were included. The methods used in the articles were qualitatively analyzed, with special attention given to cross-section and case-control studies. After the inclusion criteria were applied, only 13 articles had the necessary methodological quality to be included in this systematic review. Eight of the articles analyzed sleep quality in TMD patients using validated questionnaires, two articles analyzed their sample groups using polysomnography, and three articles used only questions to collect data regarding sleep quality. Although the cause and effect relationship between sleep disorders and TMD has not been proven, there was a considerably high prevalence for the correlation of these disorders. Additional studies that use objective methods and analyze more representative patient groups are necessary.
Keywords: pain, sleep, sleep apnea syndromes, sleep disorders, temporomandibular joint dysfunction syndrome.