Nocturnal Complaints Research Articles

Particularities Of Sleep Habits In School Children From Tîrgu Mureș

Abstract Introduction: The international literature gives us very variable data regarding sleep disorders and the complaints related to this pathology. However, interpreting these data is difficult because of the ethnical and cultural differences and the numerous possibilities of the assessments. In this paper the authors examined and evaluated the main parameters which characterize the sleep habits of a group of children in Romania, as well as the complaints related to it, which could influence the quality of sleeping. Material and method: Distributing questionnaires amongst children in Tîrgu Mureș. We used different questionnaires, based on the Epworth and Conner’s scores, for children between 11-14 and 15-18 years and for their parents. Results: The gender ratio was approximately equal, the height and weight of the children was within the framework of Romanian standards. The most frequent nocturnal complaints were: problems with falling asleep, agitation, awakenings during the night. The most frequent daytime complaints: fatigue when in school, difficulty waking up in the morning and mood swings. The results showed significant differences between weekday sleeping hours and weekend sleep time (p = 0.0022). Conclusion: Sleep habits change with age, which is a physiological effect. Other factors that modify sleeping habits in a negative way and reduce the time spent sleeping, play a crucial role in the occurrence of persistent fatigue, reduced quality school performance and even of a depraved life quality.

Fatigue, sleep, and nocturnal complaints in patients with amyotrophic lateral sclerosis

Fatigue is a common symptom in amyotrophic lateral sclerosis (ALS). Although sleep disturbances are a candidate factor that may interfere with fatigue in patients with ALS, the role of sleep-related abnormalities in determining fatigue in ALS is unknown. To evaluate the frequency and determinants of fatigue in a group of 91 consecutive patients with ALS, with special attention to the relationship between fatigue and sleep problems. Measures included the Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), ALS Functional Rating Scale-Revised (ALSFRS-R), and Beck Depression Inventory (BDI). The mean FSS score was 4.35 ± 1.1, and 48 patients with ALS (52.75%) reported clinical significant fatigue. FSS score correlated with ALSFRS-R score, forced vital capacity, ESS, BDI, and global PSQI score. Patients with fatigue were significantly more disabled and more frequently reported difficulties staying asleep and nocturnal complaints, such as nocturia and disturbing muscle cramps. After multivariate analysis, patients' disability and nocturnal complaints were significantly associated with fatigue. In this study, we demonstrated that fatigue, a troublesome and disabling symptom in ALS, is associated with physical impairment and night-time complaints (such as nocturia and muscle cramps), suggesting that treating sleep problems might be useful in alleviating fatigue in these patients.

Orbitofrontal Gray Matter Relates to Early Morning Awakening: A Neural Correlate of Insomnia Complaints?

Sleep complaints increase profoundly with age; prevalence estimates of insomnia in the elderly reach up to 37%. The three major types of nocturnal complaints are difficulties initiating (DIS) and maintaining (DMS) sleep and early morning awakening (EMA), of which the latter appears most characteristic for aging. The neural correlates associated with these complaints have hardly been investigated, hampering the development of rational treatment and prevention. A recent study on structural brain correlates of insomnia showed that overall severity, but not duration, of insomnia complaints is associated with lower gray matter (GM) density in part of the left orbitofrontal cortex (OFC). Following up on this, we investigated, in an independent sample of people not diagnosed with insomnia, whether individual differences in GM density are associated with differences in DIS, DMS, and EMA. Sixty five healthy participants (mean age = 41 years, range 18–56) filled out questionnaires and underwent structural magnetic resonance imaging. Three compound Z-scores were computed for questionnaire items relating to DIS, DMS, and EMA. Whole-brain voxel-based morphometry was used to investigate their association with GM density. Results show that participants with lower GM density in a region where the left inferior OFC borders the insula report more EMA, but not DIS or DMS. This is the first study to investigate structural brain correlates of specific sleep characteristics that can translate into complaints in insomniacs. The selective association of EMA with orbitofrontal GM density makes our findings particularly relevant to elderly people, where EMA represents the most characteristic complaint. It is hypothesized that low GM density in aforementioned orbitofrontal area affects its role in sensing comfort. An intact ability to evaluate comfort may be crucial to maintain sleep, especially at the end of the night when sleep is vulnerable because homeostatic sleep propensity has dissipated.

The long-term follow-up of patients with endoscopically diagnosed reflux oesophagitis with specific emphasis to complaints

Patients with gastroesophageal reflux disease (GERD) need long-term treatment with acid-suppressive therapy. Data on long-term follow-up are very rare. For this reason, a study was performed to detect complaints many years after diagnosis. All patients diagnosed with reflux oesophagitis in the years 1998-2000 were included. In the summer of 2010, they received a questionnaire with four different lists of questions pertaining to reflux complaints and use of medication. Severity and frequency were scored on 5-point and 6-point Likert scales, respectively; the GerdQ, a symptom activity index, and the gastrointestinal symptom-rating scale were also used. Complaints were reported by 130 patients (63%); the majority of these, 115 (88%), used acid suppressive therapy. Only 78 patients were in clinical remission, with or without therapy. The respondents with complaints were divided into two groups. Group 1: all patients with reflux complaints using acid suppressive therapy. Group 2: all patients with complaints without medication. Patients in group 1 were significantly older at the time of the endoscopic diagnosis compared with patients of group 2, and patients in group 1 had a hiatal hernia more often (P<0.001). There was no difference in the overall symptom or the frequency score per patient between both groups, with a mean of 5.97 versus 6.8 and 13.4 versus 13.8 respectively. However, heartburn, nausea, acid regurgitation, epigastric pain, dysphagia and nocturnal complaints showed a significantly higher prevalence in patients of group 2. Scores for specific complaints were significantly lower in group 2 and there was no difference between the GerdQ, the symptom activity index and the gastrointestinal symptom-rating scale. Despite effective therapy, only 37% of the patients are in complete remission. However, the individual symptom score is rather low. Patients without medication more often have reflux complaints but lower severity scores. Patients who still had complaints and used medication had a hiatal hernia significantly more often.

The strong presence of REM sleep behavior disorder in PD

This issue of Neurology ® contains a landmark study in which an unprecedented number of patients with Parkinson disease (PD) (n = 457) at one institution underwent video-polysomnography (vPSG) for nocturnal complaints.1 A robust 46% were diagnosed with REM sleep behavior disorder (RBD) by recognized criteria,2 suggesting a strong association with PD; there is a similar association with dementia with Lewy bodies and MSA.3,4 RBD is deeply embedded within these 3 major synucleinopathies. Limitations of this retrospective study should be noted. There is sampling bias, as patients with acute psychosis, patients with severe dementia, and noncooperative patients were excluded. The study lacks an untreated gender- and age-matched control group, and there was no randomization for subjectively disturbed vs undisturbed sleep. Diagnosis of RBD did not rely on the usual behavioral histories of patients, spouses, or other caregivers (dream-enacting behaviors, sleep-related injury, or behaviors causing sleep disruption), but rather was based exclusively on vPSG findings, the combination of REM sleep without atonia (RWA) and RBD behaviors. Consequently, the 46% RBD frequency may have been an underestimate of RBD in PD, since RBD can be diagnosed in the absence of vPSG behavioral findings if there is RWA and a history of RBD.2 The authors address this issue and provide insights into the difficulties with RBD assessment in treated patients with PD. This study thus alerts clinicians managing patients with PD about RBD, particularly since there is increased risk for recurrent injury or death.5 In this study, RBD appeared to be of mild to moderate severity, although the retrospective design and lack of historical information limit …

Diagnosis and Psychological and Behavioral Treatment of Insomnia

nsomnia is a common clinical complaint characterized by difficulty alling asleep, staying asleep, or nonrestorative sleep, which is associated ith significant distress. These nocturnal complaints are accompanied by mpairments of social, occupational, or other areas of daily functioning. aytime complaints may include difficulties with memory, concentration roblems, daytime fatigue, and disturbance of mood. Insomnia comlaints may be secondary to other conditions, including psychiatric iagnoses, medical diagnoses, substance abuse problems, or another sleep isorder. However, insomnia may also be its own disorder, ie, primary nsomnia. The severity of the insomnia may be classified by its requency, intensity, or duration. Insomnia may be a transient or an acute xperience or a chronic disorder. It is considered chronic if it persists for ore than 6 months. While the causative factors and the duration of nsomnia may vary widely, clinical attention to in-depth evaluation and ppropriate treatment is warranted due to its significant effect on all spects of an individual’s life. An assessment of insomnia should include thorough investigation of the causative factors, so these factors may be ddressed if possible. There are 3 groups of factors that are helpful to dentify a better understanding of the insomnia and therefore select ppropriate treatment strategies. These are predisposing, precipitating, nd perpetuating factors. Predisposing factors include personality (anxety-prone), gender (female), circadian rhythm (delayed phase or adanced phase pattern), ability to cope with stressors, and age. Insomnia is requently precipitated by events that may be situational (such as arriage or divorce), environmental (change in sleep environment), edical (hospitalization or illness), psychiatric (depression or anxiety are he most common), or by medication that is prescribed, over-the-counter,

Frequent Nocturnal Complaints of Heartburn and Acid Regurgitation Are Associated with Higher GERD Severity Scores

Purpose: To assess the relationship between frequent nighttime symptoms of gastroesophageal reflux disease (GERD) and patient perception of GERD severity. Methods: A general population of US adults participated in a web survey, which included the GERD Symptom & Medication Questionnaire (GERD-SMQ), a validated GERD screener. Frequency and severity of nighttime and daytime heartburn and acid regurgitation during the previous 3 months were each assessed. Nighttime GERD (NTG) cases were defined as: (a) ≥2 nights/week with symptoms, or (b) <2 nights/week with symptoms but no daytime symptoms. Daytime GERD (DTG) cases were GERD cases not satisfying NTG criteria. The highest value from the nighttime heartburn and acid regurgitation severity ratings was used as the severity score for each NTG case, and the highest from the two daytime ratings was used for each DTG case. Severity classification was: mild (1–4), moderate (5–7) and severe (8–10). Results: 2805 of 18213 invited to participate responded. 2603 satisfied the study criteria (mean age = 46 years, 55% women). Among GERD cases with current symptoms (n = 668), 303 (45%) met criteria for NTG. 33% of NTG cases were severe compared with 9% of the DTG group (see table). The odds of having moderate GERD symptoms as opposed to mild symptoms were 2.1 times greater among those with NTG compared with DTG) (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.4, 3.1). The odds increased 8-fold for having severe (vs. mild) GERD among NTG cases compared with DTG cases (OR = 8.5; 95% CI: 5.0, 14.7).Table: Nighttime GERD (NTG) and Daytime GERD (DTG) by Severity.Conclusions: Patients with nocturnal heartburn or acid regurgitation may report more severe symptoms. Clinicians should inquire specifically about nighttime symptoms in addition to daytime symptoms when evaluating patients with GERD.

Correlates of daytime sleepiness in 4578 elderly persons: the Cardiovascular Health Study.

To describe the prevalence of self-reported daytime sleepiness in older men and women and to describe their relationships with demographic factors, nocturnal complaints, health status, and cardiovascular diseases (CVD). Cross-sectional survey and clinical exam. Participants in the Cardiovascular Health Study, 4578 adults aged 65 and older, recruited from a random sample of non-institutionalized Medicare enrollees in four U.S. communities. Daytime sleepiness measured by the Epworth Sleepiness Scale (ESS), magnetic resonance imaging of the brain (MRI), cognitive function tests, and standardized questionnaires for cardiopulmonary symptoms and diseases, depressive symptoms, social support, activities of daily living, physical activity, and current medications. Approximately 20% of the participants reported that they were "usually sleepy in the daytime". Although elderly black men were less likely to report frequent awakenings than those in the other three race and gender groups, they had significantly higher mean ESS scores. The following were independently associated with higher ESS scores in gender-specific models: non-white race, depression, loud snoring, awakening with dyspnea or snorting, frequent nocturnal awakenings, medications used to treat congestive heart failure, non-use of sleeping pills, a sedentary lifestyle, and limitation of activities of daily living in both men and women; additional correlates included hip circumference and current smoking in men, and hayfever in women. The following were not independently associated with ESS in the models: age, education, use of wine or beer to aid sleep, use of tricyclic antidepressants, long- or short-acting benzodiazepines, asthma, angina, myocardial infarction, congestive heart failure itself, forced vital capacity, social support, cognitive function, or MRI evidence of global brain atrophy or white matter abnormality. Daytime sleepiness is common in the elderly, probably due to nocturnal disturbances such as frequent awakenings and snoring. The occasional use of sleeping pills for insomnia is associated with reduced daytime sleepiness in the elderly, while the use of medications for congestive heart failure is associated with daytime sleepiness. Surprisingly, anatomic abnormalities such as evidence of previous strokes and brain atrophy (as seen on brain MRI scans) were not associated with daytime sleepiness in these non-institutionalized elderly persons.

Treatment of Nocturnal Asthma by Addition of Oral Slow-Release Albuterol to Standard Treatment in Stable Asthma Patients

Nocturnal and early-morning complaints in asthma patients are sometimes difficult to treat. We investigated the efficacy of an oral osmotically controlled release (OR) formulation of albuterol 8 mg in 35 patients with stable asthma and nocturnal complaints and/or morning dipping of the peak expiratory flow (PEF). The mean age was 45 years (range 22-70), the FEV(1) was 61 +/- 20% of predicted, and inhaled steroids were used by 32 patients. Albuterol OR was added to their usual treatment. The use of theophyllines and oral adrenergics was not allowed. Twice-daily (b.i.d.) dosing was compared to one dose at night and to placebo. The three-period crossover study was double-blind placebo-controlled with treatment periods of 2 weeks. Responses have been analyzed by means of multiple regression analysis at a significance level of 5%. There was no significant difference of the FEV(1) or the weekly means of PEFs between the periods. During the b.i.d. treatment, the daytime and nocturnal symptom scores, used rescue medication, subjective sleep quality, and nocturnal waking tended to be better. Mental fitness was improved, but significantly only in the morning. We concluded that additional treatment with albuterol 8 mg OR once or twice daily did not lead to an overall clinical improvement in this group of patients with nocturnal asthma during standard treatment. In view of the tendency to improvement, it may be worth trying this treatment in individual patients.

Nocturnal Asthma: β2-Adrenoceptors on Peripheral Mononuclear Leukocytes, cAMP- and Cortisol-Plasma Concentrations

To evaluate pathophysiologic mechanisms of the predominantly nocturnal complaints in atopic bronchial asthma, the expression and function of beta 2-adrenoceptors on peripheral mononuclear leukocytes (pMNL), the cAMP--as well as the cortisol--plasma concentrations were studied in eight healthy men and ten so far untreated male asthmatic patients at 4-h intervals for 24 h. No difference was seen in the beta 2-adrenoceptor density (Bmax) on pMNL between healthy and asthmatic men (24-h means +/- SE: 908 +/- 59 sites per cell and 821 +/- 54 sites per cell, respectively). The equilibrium dissociation constant (Kd), however, was significantly higher in the asthmatic patients (24-h mean +/- SE: 8.8 +/- 1.2 pmol/L vs 3.0 +/- 0.2 pmol/L in healthy men, p less than 0.0001), which is equivalent to a lower affinity of the beta 2-adrenoceptors for the radioligand 125iodocyanopindolol. Bmax showed a statistically significant circadian variation, but Kd did not. The circadian variation in Bmax was reflected in the basal intracellular cyclic adenosine-monophosphate (cAMP) content of the cells investigated. High Kd values (equivalent to low receptor affinities) tended to be associated with small increases of the intracellular cAMP content after in vitro stimulation by 10(-7) mol/L isoprenaline (isoproterenol) (24-h mean +/- SE: 1.4 +/- 0.2 pmol/10(6) cells; r = -0.529, p = 0.05 at r = -0.549, n = 10). Plasma cAMP concentrations were found to be significantly lower in the asthmatic patients (24-h means +/- SE: 22.9 +/- 1.3 nmol/L vs 29.1 +/- 1.1 nmol/L, p less than 0.0001). Plasma cortisol concentrations were significantly higher in the asthmatic patients (24-h means +/- SE: 0.500 +/- 0.084 mumol/L vs 0.319 +/- 0.063 mumol/L). The results support the hypothesis that a lesion of the beta-adrenergic system contributes to the pathophysiology of atopic bronchial asthma. In the patients investigated in this study, such a lesion could be demonstrated in the affinity rather than in the number of beta 2-adrenoceptors expressed on peripheral cells of the immune system (pMNL). According to present-day knowledge of adrenergic effects on pMNL, such an affinity decrease of beta 2-adrenoceptors could account for overshooting immune responses. In association with other factors influencing respiratory function, it could be responsible for the predominantly nocturnal complaints in atopic bronchial asthma. Plasma cortisol concentrations did not appear to be related to the principal cause of "nocturnal asthma;" they rather reflected an endogenous defense mechanism to the disease.

Breathing during Sleep in Stable Asthmatic Subjects: Influence of Inhaled Bronchodilators

The bronchoconstriction of asthma displays a circadian rhythm with exacerbations often occurring in the early morning hours. Gas exchange abnormalities during sleep in patients with severe asthma have been documented; however, the influence of sleep on gas exchange in the asthmatic with few or no daytime or nocturnal symptoms is poorly understood. To determine if abnormalities in oxygenation might occur during sleep, we studied 12 stable adult asthmatic patients with reversible airflow obstruction during sleep on three consecutive nights, with night 1 being for acclimatization. On test nights 2 and 3, the subjects received, in random double-blind fashion, either inhaled fenoterol or its placebo. Spirometry was performed before and after bronchodilator treatment and on the next morning. The mean FEV1 was 63 percent predicted before treatment. There was significant (p less than 0.05) improvement in FEV1 on fenoterol night after treatment which was also present the next morning. Mean prefenoterol FEV1 was 2.04 +/- .15 (SEM) and increased to 2.61 +/- .17 after the bronchodilator. The mean morning FEV1 was 2.27 +/- .20. Mean preplacebo FEV1 was 2.07 +/- .12 and did not change significantly with placebo bronchodilator. Sleep analysis demonstrated no significant differences in total sleep time or duration of oxyhemoglobin desaturation between nights. The incidence of sleep disordered breathing was very low (0.14 apneas/hour). The frequency of apneas and hypopneas did not change significantly with treatment. Two of the 12 subjects experienced an asthma attack on placebo night which did not recur following active bronchodilator administration. We conclude that stable asthmatic patients with few nocturnal complaints have a low frequency of disordered breathing and desaturation events during sleep.

Analysis of Nocturnal Complaints by All-night ECG

Analysis of Nocturnal Complaints by All-night ECG