These findings support the therapeutic potential of cannabinoids in people with OSA. In comparison to placebo, dronabinol was associated with lower AHI, improved self-reported sleepiness, and greater overall treatment satisfaction. Larger scale clinical trials will be necessary to clarify the best potential approach(es) to cannabinoid therapy in OSA.

Symptoms of narcolepsy tend to arise during adolescence or young adulthood, a formative time in human development during which people are usually completing their education and launching a career. Little is known about the impact of narcolepsy on the social aspects of health-related quality of life in young adults. The purpose of this study was to examine relationships between health-related stigma, mood (anxiety and depression) and daytime functioning in young adults with narcolepsy compared to those without narcolepsy. Young adults (age 18–35) with narcolepsy (N = 122) and without narcolepsy (N = 93) were mailed a packet that included questionnaires and a self-addressed postage paid envelope. The questionnaire included demographic information and a composite of instruments including the SF 36, Functional Outcomes of Sleep Questionnaire (FOSQ), Fife Stigma Scale (FSS), Epworth Sleepiness Scale (ESS) and Hospital Anxiety and Depression Scale (HADS). Variable associations were assessed using descriptive statistics, ANOVA, Mann-Whitney U Test, correlations, stepwise multiple regression and path analysis. Young adults with narcolepsy perceived significantly more stigma and lower mood and health-related quality of life than young adults without narcolepsy (p<0.01). Health-related stigma was directly and indirectly associated with lower functioning through depressed mood. Fifty-two percent of the variance in functioning was explained by the final model in the young adults with narcolepsy. Health-related stigma in young adults with narcolepsy is at a level consistent with other chronic medical illnesses. Health-related stigma may be an important determinant of functioning in young adults with narcolepsy. Future work is indicated toward further characterizing stigma and developing interventions that address various domains of stigma in people with narcolepsy.

No abstract

In a double-blind trial with a placebo phase, low-dose bromocriptine therapy (average dose, 15 mg per day) produced a significant improvement in 25 idiopathic parkinsonian patients. Tremor and bradykinesia were equally and significantly improved in both the levodopa-treated and the de novo patients. Rigidity was most improved in the levodopa-treated subjects. Age was not a factor in determining the dose of bromocriptine or the degree of improvement. Adverse effects occurred in 30% but were mild and dose-dependent. Four subjects, unable to tolerate initial doses of bromocriptine, withdrew from the trial. A low initial dose (1 mg per day) and slow escalation in dosage produced an optimal, though delayed improvement. Low-dose bromocriptine therapy is effective, does not induce significant dyskinesia nor on-off phenomenon, and is probably an alternative to levodopa as a drug of first choice in Parkinson disease.

Summary:To study the changes in cortical oxidative me tabolism and blood volume during behavioral state tran sitions, we employed reflectance spectrophotometry of the cortical cytochrome c oxidase (cyt aa3) redox state and blood volume in unanesthetized cats implanted with bilateral cortical windows and EEG electrodes. Contin uous oscillations in the redox state and blood volume (�9/min) were observed during waking and sleep. These primarily metabolic oscillations of relatively high ampli tude were usually synchronous in homotopic cortical areas, and persisted during barbiturate-induced electro cortical silence. Their mean amplitude and frequency did not vary across different behaviorallEEG states, although the mean levels of cyt aa3 oxidation and blood volume Determinations of cortical energy consumption and blood flow in studies of cerebrovascular physi ology and higher cortical functions have revealed important features of cortical behavior after depar tures from the resting steady state. For example, it is now clear that experimental cortical "activation" by electrical, pharmacologic, or behavioral stimuli is followed by increases in cortical metabolism and/ or blood flow (Rosenthal and J obsis, 1971; Dymond and Crandall, 1976; Vern et aI., 1979; LaManna et Received May 29. 1987; accepted October 19, 1987 Abbreviations used: cyt aa3' cytochrome c oxidase (cy tochrome aa3) ; cyt min and max, minimal and maximal excur sions of cyt aa3 redox state, respectively; EMG, electromyog raphy; EOG, electrooculography; 590 min and max, minimal and maximal excursions of 590-nm signals, respectively; PMT, pho tomultiplier tube; REM, rapid eye movement. 215during rapid eye movement (REM) sleep significantly ex ceeded those during waking and slow-wave sleep. These data suggest the existence of a spontaneously oscillating metabolic phenomenon in cortex that is not directly re lated to neuroelectric activity. A superimposed increase in cortical oxidative metabolism and blood volume occurs during REM sleep. Experimental data concerning cerebral metabolism and blood flow that are obtained by clinical methods that employ relatively long sample ac quisition times should therefore be interpreted with cau tion. Key Words: Cortical blood flow-Cortical oxidative metabolism-Cytochrome aa3-Metabolic oscillations -Rapid eye movement sleep-Reflectance spectropho tometry.