R Ri is sk k o of f t tr ra af ff fi ic c a ac cc ci id de en nt ts s i in n p pa at ti ie en nt ts s w wi it th h s sl le ee ep p--d di is so or rd de er re ed d b br re ea at th h--i in ng g: : r re ed du uc ct ti io on n w wi it th h n na as sa al l C CP PA AP P Fifty nine patients completed the study. The accident rate was significantly decreased from 0.8 per 100,000 km (untreated) to 0.15 per 100,000 km with nCPAP treatment. Variables that were considered to be likely to increase accident risk (sleeping spells, fatigue, vigilance test reaction time, daytime sleep latency) also improved with treatment.We conclude that treatment of sleep-disordered breathing by nasal continuous positive airway pressure is related to reduction in patient motor vehicle accident rates, probably due to the reversal of excessive daytime sleepiness. Eur Respir J., 1996Respir J., , 9, 2606 This study is part of the research project 2.9107: "Sleep related breathing disorders and traffic security", carried out on behalf of the "Bundesanstalt für Straβenwesen".

No abstract

With respect to the ongoing discussion of "sleep attacks" in Parkinson's disease (PD), we sought to estimate the prevalence of sudden onset of sleep (SOS) with and without preceding sleepiness in PD, to identify associated factors, and to define the role of antiparkinsonian medication in SOS. We sent a questionnaire about SOS, sleep behaviour, and medication to 12,000 PD patients. The response rate was 63%, from which 6,620 complete data sets could be analysed. A total of 42.9% of our population reported SOS, 10% of whom never experienced sleepiness before the appearance of SOS (4.3% of all), and we identified the administration of all dopaminergic drugs as a risk factor for SOS. However, SOS occurred earlier after introduction of nonergoline dopamine agonists (DA) and was more strongly associated with nonergoline DA in younger patients (below 70 years) with a shorter disease duration (up to 7 years) but, actually, medication was less efficient in predicting SOS than most other factors considered such as higher age, male sex, longer disease duration, and the report of sleep disturbances. This survey strongly suggests that SOS is a multifactorial phenomenon. Some subgroups are at particular risk of experiencing SOS under nonergoline DA, especially at the beginning of this therapy. Our results support the current notion that SOS, in part, can be attributed to PD-specific pathology because disease duration and subjective disease severity have been shown to be predictors of SOS. We recommend the development of a standardised question to recognise SOS and to facilitate the comparison of prevalence estimates.

Complex sleep apnoea (CompSA) may be observed following continuous positive airway pressure (CPAP) treatment.In a prospective study, 675 obstructive sleep apnoea patients (mean age 55.9 yrs; 13.9% female) participated. Full-night polysomnography was performed at diagnosis, during the first night with stable CPAP and after 3 months of CPAP.12.2% (82 out of 675 patients) had initial CompSA. 28 of those were lost to follow-up. Only 14 out of the remaining 54 patients continued to satisfy criteria for CompSA at follow-up. 16 out of 382 patients not initially diagnosed with CompSA exhibited novel CompSA after 3 months. 30 (6.9%) out of 436 patients had follow-up CompSA. Individuals with CompSA were 5 yrs older and 40% had coronary artery disease. At diagnosis, they had similar sleep quality but more central and mixed apnoeas. On the first CPAP night and at follow-up, sleep quality was impaired (more wakefulness after sleep onset) for patients with CompSA. Sleepiness was improved with CPAP, and was similar for patients with or without CompSA at diagnosis and follow-up.CompSA is not stable over time and is mainly observed in predisposed patients on nights with impaired sleep quality. It remains unclear to what extent sleep impairment is cause or effect of CompSA.

Single-evening cabergoline is an efficacious and well-tolerated short-term therapy for sensorimotor symptoms of restless legs syndrome and associated sleep disturbances.

SUMMARY Impaired vigilance is a frequent daytime complaint of patients with obstructive sleep apnoea (OSA). To date, continuous positive airway pressure (CPAP) is a well established therapy for OSA. Nevertheless, in patients with certain craniofacial characteristics, maxillomandibular advancement osteotomy (MMO) is a promising surgical treatment. Twenty-four male patients with OSA (pretreatment respiratory disturbance index (RDI) 59.3 SD±24.1 events/h) participated in this investigation. The mean age was 42.7±10.7 years and the mean body mass index was 26.7±2.9 kg/ m 2 . According to cephalometric evaluation, all patients had a narrow posterior airway space, more or less due to severe maxillary and mandibular retrognathia. All patients except two were treated first with CPAP for at least 3 months and afterwards by MMO. Two patients only tolerated a CPAP trial for 2 nights. Polysomnographic investigation and daytime vigilance were assessed before therapy, with CPAP therapy and 3 months after surgical treatment. Patients' reports of impaired daytime performance were confirmed by a pretreatment vigilance test using a 90-min, fourchoice reaction-time test. The test was repeated with effective CPAP therapy and postoperatively. Daytime vigilance was increased with CPAP and after surgical treatment in a similar manner. Respiratory and polysomnographic patterns clearly improved, both with CPAP and after surgery, and showed significant changes compared to the pretreatment investigation. The RDI decreased significantly, both with CPAP (5.3±6.0) and postoperatively (5.6±9.6 events/h). The percentages of non-rapid eye movement Stage 1 (NREM 1) sleep showed a marked decrease (with CPAP 8.2±3.6% and after MMO 8.2±4.4% vs. 13.3±7.4% before treatment), whereas percentages of slow wave sleep increased significantly from 8.0±6.1% before therapy to 18.2±12.8 with CPAP and 14.4±7.3% after MMO. The number of awakenings per hour time in bed (TIB) was significantly reduced after surgery (2.8±1.3), compared to both preoperative investigation (baseline 4.2±2.0 and CPAP 3.4±1.5). Brief arousals per hour TIB were reduced to half with CPAP (19.3±20.0) and after MMO (19.7±13.6), compared to baseline (54.3±20.0). We conclude that the treatment of OSA by MMO in carefully selected cases has positive effects on sleep, respiration and daytime vigilance, which are comparable to CPAP therapy. maxillomandibular advancement, sleep apnoea, surgical treatment, daytime vigilance

We conclude that from NREM to REM sleep, short-term regulation of respiratory drive remains strongly metabolically controlled and clearly different from the short-term regulation of the rhythm-generating function. Regulation of respiratory timing and drive during REM sleep is characterized by additional long-term correlations. We speculate that this is the result of cortical influences during phasic REM sleep. Thus, the variability of breathing during REM sleep contains a nonrandom component, such that breathing components remain dependent upon each other even with large time lags between components.

ZusammenfassungSchlaftagebticher sind das in Schlafforschung und Schlafmedizin am h~iufigsten eingesetzte Instrument. Sie gelten trotz erheblicher Abweichungen von objektiven MeBverfahren des Schlafs (Polysomnographie) als reliabel und valide und sind in Diagnostik und Therapie von fundamentaler Bedeutung. Bedauerlicherweise gibt es nur wenige Untersuchungen zu Reliabilit~it und Validit~it eines solchen Instruments, Normuntersuchungen fehlen vrllig. Die vorliegende Untersuchung beschreibt die Entwicklung eines solchen Instruments ftir den deutschen Sprachraum. Die statistische Analyse eines umfangreichen Datenpools von Normo-und lnsomnikern ergab auf allen wesentlichen Parametern zufriedenstellende Trennf~ihigkeit zwischen den kritischen Populationen. Reliabilit~its-und Validit~itskoeffizienten waren ebenfalls zufriedenstellend. Insgesamt ist das Instrument zum stani:lardisierten Gebrauch zumindest ftir die Routine von Schlafuntersuchungen geeignet. AnschlieBen sollte sich demn~ichst eine umfangreiche Normierung yon subjektiven Schlafparametern anhand des neuen Instruments.SchliisselwOrter Schlaftagebiicher -Abend-Morgenprotokolle -Schlafst6rungen -Diagnostik -Methoden. SummarySleep logs are used both in clinical and research everyday routine within sleep laboratories all over the world. Although there is a significant difference between subjective (sleep logs) and objective (polysomnography) measures of sleep, sleep logs are highly estimated tools in sleep research, because they reflect the subjective dimension of sleepwake disorders in the best way. The following study describes the development of such an instrument for the German-speaking countries in order to set a new standard for sleep laboratories with special respect to the possibility of standardized data transfer. The new developed instrument was given to a large population of normo-and insomniacs. Statistical evaluation showed good discrimination values between both populations for nearly all items. Reliability and validity were satisfactory as well. Population norms should be developed as a next step. The sleep diary discussed here is recommended for future use in German sleep laboratories. Results of different sleep laboratories could then be compared with respect to subjective sleep parameters as well.