No abstract

Twenty-five children, age range 2 to 14 years (mean age = 7), were referred to the Stanford University Sleep Disorders Clinic for various clinical symptoms, including excessive daytime somnolence, heavy nocturnal snoring, and abnormal daytime behavior. All children (10 girls and 15 boys) were polygraphically monitored during sleep. No sleep apnea syndrome or oxygen desaturation was revealed. However, each child presented significant respiratory resistive load during sleep associated with electrocardiographic R-R interval and endoesophageal pressure swings. The most laborious breathing occurred during REM sleep. Second degree atrioventricular blocks were also noted. Tonsillectomy and/or adenoidectomy was performed in every case and resulted in a complete disappearance or substantial amelioration of the reported symptoms. Objective evaluation by Multiple Sleep Latency Test and Wilkinson Addition Test confirmed the beneficial effect of surgery.

Five men free of lung or cardiovascular diseases and with severe obstructive sleep apnea participated in a study on the impact of sleep states on cardiovascular variables during sleep apneas. A total of 128 obstructive apneas [72 from stage 2 non-rapid-eye-movement (NREM) sleep and 56 from rapid-eye-movement (REM) sleep] were analyzed. Each apnea was comprised of an obstructive period (OP) followed by a hyperventilation period, which was normally associated with an arousal. Heart rate (HR), stroke volume (SV), cardiac output (CO) (determined with an electrical impedance system), radial artery blood pressures (BP), esophageal pressure nadir, and arterial O2 saturation during each OP and hyperventilation period were calculated for NREM and REM sleep. During stage 2 NREM sleep, the lowest HR always occurred during the first third of the OP, and the highest was always seen during the last third. In contrast, during REM sleep the lowest HR was always noted during the last third of the OP. There was an inverse correlation when the percentage of change in HR over the percentage of change in SV during an OP was considered. The HR and SV changes during NREM sleep allowed maintenance of a near-stable CO during OPs. During REM sleep, absence of a compensatory change in SV led to a significant drop in CO. Systolic, diastolic, and mean BP always increased during the studied OPs.(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract

A cross-sectional study of insomnia and hypnotic use was performed in a sample of the French population. The quota method was used to select the sample of 1,003 subjects, with less than 3% substitution. Subjects were 15 years old and older and were representative of the French population based on gender, age, marital status and living environment. Subjects were asked questions relevant to the complaint of insomnia and hypnotic use and filled out questionnaires measuring anxiety and depression. The complaint of insomnia is common, even in the 15-24-year-old group. Overall, more women than men were afflicted. The largest group of insomniac subjects, and the group who most often used hypnotics "frequently and chronically", were women 45 years and older. Men presented a sharp increase in hypnotic use after 65 years of age. Ten percent of the entire sample used hypnotics, 8% for more than 6 months and 6.17% on a chronic and frequent basis. Retired and unemployed elderly were also chronic and frequent hypnotic users: aging and social isolation correlate with chronic and frequent hypnotic usage. Higher scores on anxiety and depression scales correlate with more frequent complaints of nocturnal sleep disturbances. Young individuals are a significant complainer group but use hypnotics rarely. A rural environment was associated, overall, with fewer insomnia complaints, but environment had much less impact on complaints and hypnotic use in the elderly than in other age groups. One may question whether, in the French population, hypnotic prescription and intake are not responses to a social rather than a medical problem.

No abstract

Narcolepsy is considered a homogeneous clinical entity when excessive daytime sleepiness and cataplexy are present. Cataplexy is a polymorphic symptom that can be very mild and is thus subjectively defined. The Multiple Sleep Latency Test (MSLT) is widely used as a diagnostic test for narcolepsy. A short mean sleep latency and multiple sleep onset REM periods (SOREMPs) are typically observed in narcoleptic patients. The discovery of a tight association of narcolepsy with HLA class II antigens offers a unique opportunity to explore the respective value of the MSLT or of the presence of clear-cut cataplexy in defining an etiologically homogeneous group of narcoleptic patients. In this study, we carried out HLA typing for DR15(DR2) and DQB1*0602 in 188 narcoleptic patients with cataplexy in three ethnic groups (24 Asians, 61 Blacks, and 103 Caucasians). These results confirm the importance of DQB1*0602 typing rather than DR15 (DR2) typing in Black narcoleptic patients and demonstrate that the presence of clear-cut cataplexy is a better predictor for DQB1*0602 positivity than the presence of abnormal MSLT results.

In children adenotonsillectomy (AT)\ud is the recommended treatment in the\ud presence of obstructive sleep apnea\ud (OSA) [1]. It should be performed, if\ud needed, in association with nasal inferior\ud turbinate reduction usually\ud with radiofrequency [2]. But as shown\ud in previous reports, upper airway soft\ud tissues treatment is not always successful\ud in completely controlling abnormal\ud breathing during sleep in children,\ud despite the fact that subjective\ud improvement is often reported [3, 4,\ud 5, 6]