Nocturnal Disturbances Research Articles

Thinking Beyond Tremors - A Prospective Observational Study to Evaluate Depression and Sleep Pattern Disturbances in Patients of Idiopathic Parkinson's Disease

Abstract Background: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterized by motor and nonmotor symptoms. Neuropsychiatric symptoms include sleep disorders, psychosis, cognitive impairment, depression, and anxiety. Because this neuropsychiatric aspect remains unexplored in such patients, we examined depression and sleep pattern disturbances in such patients. Methodology: All patients with a confirmed PD diagnosis attending an outpatient clinic and a PD support group will participate in this study. After recording the drug name, mechanism of action, frequency and duration of treatment, and examining drug use patterns, patients were assessed on the Hamilton Depression Scale (HAM-D) and the Parkinson’s Disease Sleep Scale (PDSS-D). (2) Assess for depression and disturbed sleep patterns. Pearson’s correlation test was used for correlations between various variables. Results: Thirty-five patients fulfilling the inclusion criteria and exclusion criteria were enrolled in the study. The mean ± standard deviation age of the patients was 66.46 ± 9.21 years. A total of 6 single drugs and 4 fixed-dose combinations were prescribed in a span of a mean of 6.53 years. Levodopa + carbidopa (125 mg), followed by pramipexole, is the most prescribed drug among the study population. The mean score of the HAM-D Scale of 35 patients was 23.02. The maximum score was 52. The mean score of the PDSS-2 of 35 patients was 22.8 (out of 60) and there was a weak or moderate correlation between the different variables. Conclusion: Major part of the treatment plan in PD patients was levodopa + carbidopa (125 mg). Out of 35 patients, the majority of them were depressed and it could be one of the reasons for nocturnal disturbances based on PDSS-2 scoring. Furthermore, there was a weak correlation between different variables but it was not statistically significant.

Sleep quality of adult psychiatric outpatients at Chris Hani Baragwanath Academic Hospital.

Sleep disorders are increasingly prevalent among the general population and individuals with mental disorders. However, little research has focused on the sleep quality of psychiatric patients beyond depression, despite its relevance in diagnostic criteria. This study aimed to assess overall sleep quality in psychiatric outpatients and to assess for an association with socio-demographic variables. This study took place at the adult psychiatric outpatient department of Chris Hani Baragwanath Academic Hospital. A cross-sectional study design was employed to evaluate overall sleep quality using the self-administered Pittsburgh Sleep Quality Index (PSQI), a validated tool. The PSQI yields a global score ranging from 0 to 21, with scores of 5 or greater indicating poor sleep quality. Eligibility was determined through structured clinical interviews and data obtained from participant records. Poor sleep quality was found in 50% of participants. Sleep quality did not differ significantly based on sex or age. Subscale analysis revealed reduced sleep duration and efficiency, nocturnal disturbances and daytime dysfunction. Additionally, 38% of participants required pharmacological intervention for sleep issues, despite lacking a diagnosis of primary or comorbid sleep disorders. Half of the psychiatric outpatients experienced poor sleep quality, irrespective of socio-demographic factors, psychiatric diagnosis, symptom remission or medication type. This study highlights the importance of addressing sleep disturbances as comorbid conditions in psychiatric patients. Comprehensive evaluation and management of sleep quality can lead to improved patient outcomes and quality of life.

A Debate on Surgical and Nonsurgical Approaches for Obstructive Sleep Apnea: A Comprehensive Review.

Regular and unobstructed breathing during the night is the prerequisite for an undisturbed and restful sleep. The most prevalent nocturnal breathing disturbance with morbid consequences is obstructive sleep apnea syndrome. The prevalence of obstructive sleep apnea (OSA) is increasing, and a significant number of patients with OSA are undiagnosed. On the other hand, the "obesity epidemic" is a growing concern globally. A sleep test is required to diagnose sleep apnea and to individualize therapy. A multidisciplinary approach is the key to success. This narrative review presents a debate on whether surgery is a friend or a foe in the treatment of sleep apnea. Depending on the type and severity of the apnea, the causal factor, and the presence of obesity and hypercapnia as well as the associated pathologies, the optimal therapeutic method is determined for each individual case. The article concludes that each case is unique, and there is no ideal method. Positive pressure ventilation, although a therapeutic gold standard, has its disadvantages extensively discussed in this paper. Nevertheless, it is necessary prior to any surgical intervention, either for the curative treatment of the causal factor of apnea or for elective surgery for another condition. The anesthetic risks associated with the presence of apnea and obesity should not be neglected and should form the basis for decision making regarding surgical interventions for the treatment of sleep apnea.

Investigating nocturnal UAS treatments in an applied context to prevent gulls from nesting on rooftops

AbstractRing‐billed (Larus delawarensis) and herring (L. argentatus) gulls are numerous and widespread in North America. These gulls rank among the top 9 species for risk of bird‐aircraft collisions (hereafter strikes). The ubiquitous presence of gulls in urban coastal environments, including rooftop nesting behavior, are factors impacting strike risk. Our purpose was to assess gull response to a small uncrewed aircraft system (UAS) in hazing flights at night during the nest‐building phase. We hypothesized that nocturnal UAS operation, like nocturnal predator disturbance, might reduce gull numbers and, thus, strike risk to aircraft. In spring 2021, we conducted UAS treatments over target roofs at least once every hour from 2000 until 0200, weather permitting, for 15 min and over a 14‐day period for each site. The UAS flew directly above (~4 m) and then descended (~4 m/s) within 1 m of loafing gulls. No gulls interacted with the UAS and most flushed within 6 minutes. Generally, the first treatment of a night dispersed all gulls (min–max = 1–130 individuals) from the target roof for an extended period. Our operations were often grounded because of weather and our gull response data were limited because of few individuals present. We discuss our observations with particular attention to feasibility and possible implications such as shifting birds to other sites which, potentially, could be counterproductive for management.

Cross talk mechanism of disturbed sleep patterns in neurological and psychological disorders

The incidence and prevalence of sleep disorders continue to increase in the elderly populace, particularly those suffering from neurodegenerative and neuropsychiatric disorders. This not only affects the quality of life but also accelerates the progression of the disease. There are many reasons behind sleep disturbances in such patients, for instance, medication use, nocturia, obesity, environmental factors, nocturnal motor disturbances and depressive symptoms. This review focuses on the mechanism and effects of sleep dysfunction in neurodegenerative and neuropsychiatric disorders. Wherein we discuss disturbed circadian rhythm, signaling cascade and regulation of genes during sleep deprivation. Moreover, we explain the perturbation in brainwaves during disturbed sleep and the ocular perspective of neurodegenerative and neuropsychiatric manifestations in sleep disorders. Further, as the pharmacological approach is often futile and carries side effects, therefore, the non-pharmacological approach opens newer possibilities to treat these disorders and widens the landscape of treatment options for patients.

Validation of technology to monitor sleep and bed occupancy in older men and women

AbstractBackgroundNocturnal disturbance is frequently observed in dementia and is a major contributor to institutionalisation. Unobtrusive technology that can quantify sleep/wake and determine bed occupancy during the major nocturnal sleep episode may be beneficial for long‐term clinical monitoring and the carer. Such technologies have, however, not been validated in older people. Here we assessed the performance of the Withings Sleep Mattress (WSM) in a heterogenous older population to ensure external validity.MethodEighteen participants (65 – 80 years, 10M:8F) completed 7‐12 days of sleep/wake monitoring at home prior to an overnight laboratory session. WSM performance was compared to gold‐standard (laboratory polysomnography [PSG] with video) and silver standard (actiwatch [AWS] and sleep diary at home). WSM data were downloaded from a third party API and the minute‐to‐minute sleep/wake timeseries extracted and time‐ordered to create a sleep profile. Discontinuities in the timeseries were labelled as ‘missing data’ events.ResultsParticipants contributed 107 nights with WSM and PSG or AWS data. In the laboratory, the overall epoch to epoch agreement (accuracy) of sleep/wake detection of WSM compared to PSG was 0.71 (sensitivity 0.8; specificity 0.45) and to AWS was 0.74 (sensitivity 0.77; specificity 0.53). Visual inspection of video recordings demonstrated that 20 of 21 ‘missing data’ events were true ‘out of bed’ events. These events were always associated with an increase in activity (AWS). At home, all 97 WSM ‘missing data’ events that occurred within the major nocturnal sleep episode defined by sleep diary data, were associated with an increase in activity levels in the AWS data and 36 of these events were also associated with an increase in light levels, indicating that the participant had left the bed. In several participants, data recorded by the WSM during daytime coincided with reported naps in the sleep diary.ConclusionAlthough WSM cannot reliably distinguish between sleep and wake, the presence/absence of data in WSM seem to be an accurate representation of whether older people are in or out of bed (bed occupancy). Thus, in dementia, this contactless, low‐burden technology may be able to provide information about nocturnal disturbances and daytime naps in bed.

Clinical long-term nocturnal sleeping disturbances and excessive daytime sleepiness in Parkinson's disease.

ObjectiveTo prospectively evaluate nocturnal sleep problems and excessive daytime sleepiness (EDS) in Parkinson’s disease (PD) patients, and analyze the influence of motor symptoms, treatment, and sex differences on sleep problems in PD.MethodsSleep disturbances of 103 PD patients were assessed with Parkinson’s Disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale (ESS). Student’s t-test for related samples, one-way ANOVA with Tukey’s HSD post hoc test were used to assess group differences. Bivariate correlations and mixed-effects linear regression models were used to analyze the association between clinical aspects and sleep disturbances over time.ResultsAt baseline, 48.5% of PD patients presented nocturnal problems and 40% of patients presented EDS. The PDSS and ESS total score slightly improve over time. Nocturnal problems were associated with age and motor impartment, explaining the 51% of the variance of the PDSS model. Males presented less nocturnal disturbances and more EDS than females. Higher motor impairment and combined treatment (L-dopa and agonist) were related to more EDS, while disease duration and L-dopa in monotherapy were related to lower scores, explaining the 59% of the model.ConclusionsSleep disturbances changed over time and age, diseases duration, motor impairment, treatment and sex were associated with nocturnal sleep problems and EDS. Agonist treatment alone or in combination with L-dopa might predict worse daytime sleepiness, while L-dopa in monotherapy is related to lower EDS, which significantly affects the quality of life of PD patients.

Sensory stimulation for nursing home residents: Systematic review and meta‐analysis of its effects on sleep quality and rest‐activity rhythm in dementia

AbstractBackgroundDespite the evidence that disrupted sleep‐wake cycles are associated with an exacerbation of behavioural disturbances and an acceleration of the disease progression in dementia, the effect of sensory stimulation for improving sleep quality and rest‐activity rhythm is unclear. The aim of the current meta‐analysis is to give an overview of the effectiveness of sensory stimulation interventions on reduction and prevention of sleep disturbances in nursing homes residents with dementia.MethodA systematic literature search and meta‐analysis were performed on December 3, 2019. Twenty‐seven studies examining the effects of a sensory stimulation intervention on rest‐activity rhythm and/or nocturnal restlessness in nursing home residents with dementia were included. Outcomes were measured with Actiwatches and/or standardized observation scales. Extensive subgroup meta‐analyses were performed to adjust for varying characteristics of included studies.ResultUni‐sensory stimulation including tactile and visual stimulation (i.e. light therapy, massage, acupuncture, animal‐assisted interventions) seemed effective for improving sleep quality and strengthen the rest‐activity rhythm (Hedges g=.47, p ≤ .01, Figure 1). More specifically, visual and tactile stimulation with a minimum of 30 minutes/day for two weeks have effectively reduced the duration of nocturnal awakenings (g=‐.29, p≤.05), sleep onset latency (g=‐.25, p≤.05), and nocturnal behaviour disturbances (g=‐.57, p≤.01), and have improved nocturnal sleep duration (g = .38, p ≤ .01), and sleep efficiency (g=.48, p≤.01). The heterogeneity within the majority of outcomes varied between medium and large. The majority of studies were of poor quality (59%, Figure 2). Dementia type and severity, gender, treatment duration and intensity (light levels in lux values) were not related to the effectiveness of sensory stimulation in all outcomes.ConclusionAlthough the methodological quality of the studies was limited, we found indications that sleep quality and nocturnal restlessness in nursing home residents with dementia may benefit from sensory stimulation. Recommended is to use a sensory stimulating environment in nursing homes which may prevent or improve sleep disturbances, and therefore can contribute to higher quality of life of their patients. Future research should conduct RCTs, while using comparable interventions, measuring instruments and procure, so the quality of dementia can be further improved.

Prevalence and profile of nocturnal disturbances in Chinese patients with advanced-stage Parkinson\u2019s disease: a cross-sectional epidemiology study

BackgroundThe impact of nocturnal disturbance (ND) in Parkinson’s disease on quality of life of patients in Western Countries is increasingly understood. Our study aimed to investigate ND prevalence and its quality of life impact in patients with advanced Parkinson’s disease in China.MethodsIn a multicenter, tertiary-care hospital, outpatient-based, cross-sectional study, patients with advanced Parkinson’s disease (Modified Hoehn & Yahr [H&Y] Stage II–IV with ≥3 h awake “off” time/day) from 10 tertiary hospitals throughout China completed the Parkinson’s Disease Sleep Scale-2 (PDSS-2) and Parkinson’s Disease Questionnaire-39 (PDQ-39). The primary endpoint was the percentage of patients with significant ND (PDSS-2 total score ≥ 15). Additional endpoints were demographic and clinical characteristics, PDSS-2 and PDQ-39 total and subscale scores, correlation between PDSS-2 and PDQ-39, and risk factors for ND and higher PDSS-2 or PDQ-39 scores.ResultsOf 448 patients analyzed (mean age 63.5 years, 47.3% female), 70.92% (95% confidence interval: 66.71, 75.13) had significant ND. Presence of ND and higher PDSS-2 scores were associated with longer disease duration and higher H&Y stage. Presence of ND was also associated with more awake “off” time/day and female sex. PDQ-39 scores were significantly worse for patients with ND versus those without ND; worse scores were associated with more awake “off” time/day, female sex, and higher H&Y stage. PDSS-2 and PDQ-39 total scores were associated: Pearson correlation coefficient 0.62 (p < 0.001).ConclusionsIn China, ND was highly prevalent in patients with advanced Parkinson’s disease and adversely impacted quality of life. This study highlights the importance of early diagnosis and optimized management of ND in patients with Parkinson’s disease in China.

Shedding Light on Nocturnal Movements in Parkinson's Disease: Evidence from Wearable Technologies.

In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.

Effect of Nocturnal Oxygen Therapy on Nocturnal Hypoxemia and Sleep Apnea Among Patients With Chronic Obstructive Pulmonary Disease Traveling to 2048 Meters

There are no established measures to prevent nocturnal breathing disturbances and other altitude-related adverse health effects (ARAHEs) among lowlanders with chronic obstructive pulmonary disease (COPD) traveling to high altitude. To evaluate whether nocturnal oxygen therapy (NOT) prevents nocturnal hypoxemia and breathing disturbances during the first night of a stay at 2048 m and reduces the incidence of ARAHEs. This randomized, placebo-controlled crossover trial was performed from January to October 2014 with 32 patients with COPD living below 800 m with forced expiratory volume in the first second of expiration (FEV1) between 30% and 80% predicted, pulse oximetry of at least 92%, not requiring oxygen therapy, and without history of sleep apnea. Evaluations were performed at the University Hospital Zurich (490 m, baseline) and during 2 stays of 2 days and nights each in a Swiss Alpine hotel at 2048 m while NOT or placebo treatment was administered in a randomized order. Between altitude sojourns, patients spent at least 2 weeks below 800 m. Data analysis was performed from January 1, 2015, to December 31, 2018. During nights at 2048 m, NOT or placebo (room air) was administered at 3 L/min by nasal cannula. Coprimary outcomes were differences between NOT and placebo intervention in altitude-induced change in mean nocturnal oxygen saturation (SpO2) as measured by pulse oximetry and apnea-hypopnea index (AHI) measured by polysomnography during night 1 at 2048 m and analyzed according to the intention-to-treat principle. Further outcomes were the incidence of predefined ARAHE, other variables from polysomnography results and respiratory sleep studies in the 2 nights at 2048 m, clinical findings, and symptoms. Of the 32 patients included, 17 (53%) were women, with a mean (SD) age of 65.6 (5.6) years and a mean (SD) FEV1 of 53.1% (13.2%) predicted. At 490 m, mean (SD) SpO2 was 92% (2%) and mean (SD) AHI was 21.6/h (22.2/h). At 2048 m with placebo, mean (SD) SpO2 was 86% (3%) and mean (SD) AHI was 34.9/h (20.7/h) (P < .001 for both comparisons). Compared with placebo, NOT increased SpO2 by a mean of 9 percentage points (95% CI, 8-11 percentage points; P < .001), decreased AHI by 19.7/h (95% CI, 11.4/h-27.9/h; P < .001), and improved subjective sleep quality measured on a visual analog scale by 9 percentage points (95% CI, 0-17 percentage points; P = .04). During visits to 2048 m or within 24 hours after descent, 8 patients (26%) using placebo and 1 (4%) using NOT experienced ARAHEs (P < .001). Lowlanders with COPD experienced hypoxemia, sleep apnea, and impaired well-being when staying at 2048 m. Because NOT significantly mitigated these undesirable effects, patients with moderate to severe COPD may benefit from preventive NOT during high altitude travel. ClinicalTrials.gov Identifier: NCT02150590.

Activity patterns in the reintroduced Pyrenean brown bear population

Mammals usually adjust behavioral patterns when exposed to disturbances. Elusiveness and low-risk time selection may reduce their stress in periods of highest risk. In Europe, brown bears (Ursus arctos) coexist with humans in densely populated and modified landscapes and, consequently, are exposed to human-caused disturbances during the daytime hours. Furthermore, intraspecific interactions might also influence their behavioral responses, especially during the mating season. Activity patterns of several large carnivores have been thoroughly studied; however, research is scarce for relocated populations. Here, we report the activity patterns in the reintroduced brown bear population in the Pyrenees. We expected the bears to reduce their activity depending on the type and level of disturbances. We analyzed individual behavior of both sexes (males, solitary females, and females with offspring) and age groups (adults and subadults) using camera-trap surveys under different types of intraspecific and anthropogenic disturbances. In general, bears were more active during the night (2200–0600 h) and avoided peaks of human activity (1000–1800 h). Furthermore, with the increasing nocturnal disturbance of adult males during the mating season, females with offspring and subadults were more active during daylight. This suggests that vulnerable individuals showed high tolerance for human presence. These results contribute to improve our knowledge of how a threatened and relocated bear population behaves in a human-modified landscape of southern Europe. Further research on this population will be crucial to establish optimal management interventions during translocations, and the prevention of human-bear encounters and conflicts.

Endoscopic Versus Open Carpal Tunnel Release.

Carpal tunnel syndrome is the most common compressive neuropathy encountered by hand and upper extremity surgeons. The predominant presentation includes symptomatic paresthesias in the median nerve distribution of the affected hand, frequently causing nocturnal disturbances. Surgical treatment requires division of the transverse carpal ligament, which can be performed through open and endoscopic means. Endoscopic techniques have evolved significantly since they were first introduced in the late 1980s. This manuscript reviews the literature to summarize the current state of carpal tunnel surgery. While endoscopic techniques have demonstrated superior early functional outcomes and a more rapid recovery, there are lingering concerns over the potential for nerve, vessel, and tendon injuries. These concerns have not been validated by the hand surgery literature, which ascribes similar rates of complications for both open and endoscopic surgical approaches. Moreover, patients report greater satisfaction with endoscopic surgical approaches compared with open techniques. In summary, the debate between proponents of open versus endoscopic carpal tunnel surgery continues. While surgeons who employ endoscopic techniques appear to be in the minority, there is a plethora of evidence to suggest that both approaches are comparably safe and equally effective.

Sympathetic Hyperactivity and Sleep Disorders in Individuals With Type 2 Diabetes.

Introduction: Many studies on the impact of type 2 diabetes mellitus (T2DM) on sleep breathing have shown a higher prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) in those with T2DM. Moreover, an increased activity of the sympathetic nervous system has been described in both pathologies. This cross-sectional study aimed to assess sympathetic activity in patients with T2DM, and to investigate the relationship between sympathetic activity and polysomnographic parameters.Materials and Methods: Thirty-six patients with T2DM without known clinical macrovascular nor pulmonary disease and 11 controls underwent respiratory polygraphy, and their cardiac variability and 24-h urine total metanephrines were measured.Results: SAHS was highly prevalent with a mean apnea-hypopnea index (AHI) in the range of moderate SAHS. In patients with T2DM, the nocturnal concentration of total metanephrines in urine were higher than diurnal levels [247.0 (120.0–1375.0) vs. 210.0 (92.0–670.0), p = 0.039]. The nocturnal total metanephrine concentration was positively and significantly associatedwith the percentage of sleeping time spent with oxygen saturation <90%(CT90). In the entire population and in subjects with T2DM, the multivariate regression analysis showed a direct interaction between the nocturnal concentration of urine metanephrines and the CT90.Conclusion: These findings suggest that the increase in sympathetic activity previously described in patients with T2DM could be mediated through nocturnal breathing disturbances. The diagnosis and treatment of SAHS may influence sympathetic activity disorders and may contribute to an improvement in T2DM and cardiovascular risk.

Association between Sleep Disturbances and Daytime Somnolence in Parkinson’s Disease

Background: Sleep disturbance is a common problem among patients with Parkinson’s disease (PD). Objectives: To investigate the prevalence of daytime somnolence and night-time sleep disturbances; to characterise the night-time sleep disturbance in patients with daytime somnolence; and to determine the correlation between daytime somnolence and night-time sleep disturbances. Methods: One hundred and sixty patients with PD were included in the study. Each patient completed the Thai version of the Epworth Sleepiness Scale (ESS) questionnaire to evaluate excessive daytime sleepiness (EDS), and the PD Sleep Scale version-2 (PDSS-2) questionnaire to evaluate night-time sleep disturbance. Subjective sleep information and details about the presence or absence of sleep attack (SA) were also obtained from the patients. Results: The types of daytime somnolence found in this study were EDS, SA, and combination of EDS and SA (EDS + SA) with the prevalence rates of 22.5, 3.1 and 6.3%, respectively. The prevalence of night-time sleep disturbance was 46.9%. The most common nocturnal disturbance (82.5%) was “get up at night to pass urine”. There was a significant positive correlation between the ESS score and PDSS-2 total score with a correlation coefficient of 0.16 (p = 0.043). Patients with “EDS + SA” were the most affected by nocturnal disturbances, as they represented the largest group among those patients with night-time disturbances and had the highest PDSS-2 total score (p < 0.05). Conclusion: There are differences in nocturnal sleep disturbances among PD patients with different types of daytime somnolence. The significant positive correlation between the ESS and the PDSS-2 total scores suggests that night-time sleep disturbance may influence daytime somnolence.

Health Benefit Manifestation of Improved Sleep, Physical Exercise and Selective Diets

The conflicting and vicarious demands of occupations schedules, stressful life situations, unrestricted dietary habits, sedentary life-styles and metabolic compromization present some of the hazards that culminate in individuals’ sleep problems whether de facto experience, physiological expressions of health parameters or disorder/drug-related. Interventional therapies aimed at the avoidance of damaging insulin resistance and type II diabetes conditions extend the physical exercise benefits by their influences upon skeletal muscle tissue, with in addition exercise training inducing profound effects on adipose tissue. Regular exercise precludes nocturnal disturbance with associations to reductions in the prevalence of sleep disorders, i.e. most particularly obstructive sleep apnea and thereby improving sleep efficiency and integrity among, and across, most age-groups. In obstructive sleep apnea patients, dysregulated cardiovascular health, that may or may not counteract the elevated oxidative stress, proinflammatory development and sympathetic activation may alleviated through selective regimes of physical exercise. The presence of major gender difference in the quality and sufficiency of healthy sleep reinforces the requirement for selective life-styles to combat the encroachment of sleep inadequacy as a health hazard. Proper assessment of somatic and psychological health variables requires major planning and preparation.

Motion Artifact Detection and Reduction in Bed-Based Ballistocardiogram

Non-intrusive sleep monitoring is critical for certain populations such as severely disabled autistic children. Nocturnal disturbance analysis is an important diagnostic tool for assessing sleep issues. The objective of this paper is to detect and minimize the effects of motion artifacts in signals recorded via an unobtrusive electromechanical film-based ballistocardiogram (BCG) sensor integrated into a smart bed system. The goal is to have a reliable estimation of beat-to-beat (B-B) interval. The proposed algorithm includes two main stages: a motion detection algorithm followed by a motion artifact removal system. Motion detection involves a sequential detection algorithm in which successive data frames are compared to two thresholds: upper and lower thresholds. Each motion corrupted frame can then be reconstructed by an approach that relies on a parametric model of the BCG signal. Exploiting the fact that the underlying BCG parameters (J-peak-to-J-peak interval, J-peak-to-K-peak amplitude, and the most significant frequency component) change slowly and are correlated across time; an autoregressive model-based tracking and Wiener smoother based parameter estimation strategies are proposed. The experimental results are presented to demonstrate the effectiveness of the proposed motion artifact detection and removal algorithms. The probability of detection of 96% and high average coverage of 84% with over 90% precision for the estimated B-B intervals are achieved on recordings for 19 h of sleep from three subjects. Our novel motion detection and removal methods demonstrate the feasibility of using bed-based BCG signals for providing a reliable unobtrusive way to estimate the B-B interval in the presence of motion.

The Potential Role of Atmospheric Bores and Gravity Waves in the Initiation and Maintenance of Nocturnal Convection over the Southern Great Plains

Abstract This investigation explores the relationship among bores, gravity waves, and convection within the nocturnal environment through the utilization of measurements taken during the International H2O Project (IHOP_2002) over the Southern Great Plains. The most favorable conditions for deep convection were found to occur within the boundary layer during the late afternoon and early evening hours in association with the diurnal cycle of solar insolation. At night, the layers most favorable for deep convection occur at and above the height of the nocturnal southerly low-level jet in association with distinct maxima in both the southerly and westerly components of the wind. Observations taken during the passage of 13 nocturnal wave disturbances over a comprehensive profiling site show the average maximum and net upward displacements with these waves were estimated to be ~900 and ~660 m, respectively. The lifting was not limited to the stable boundary layer, but reached into the conditionally unstable layers aloft. Since the net upward displacements persisted for many hours as the disturbances propagated away from the convection, areas well in excess of 10 000 km2 are likely impacted by this ascent. This lifting can directly maintain existing convection and aid in the initiation of new convection by reducing the convective inhibition in the vicinity of the active convection. In agreement with past studies, strong ascent in the lowest ~1.5 km was generally consistent with the passage of a bore. However, separate wave responses also occurred well above the bores, and low-frequency gravity waves may explain such disturbances.

P157 Effect of repeated altitude exposure on nocturnal breathing disturbances in lowlanders.

P157 Effect of repeated altitude exposure on nocturnal breathing disturbances in lowlanders.

Caring burden of REM sleep behavior disorder – spouses' health and marital relationship

ObjectivesIdiopathic REM sleep behavior disorder (iRBD) is noxious due to the high prevalence of sleep-related injuries to patients and their bed-partners. In this study, we aimed to investigate the impact of patients' RBD symptoms on their spouses, in terms of the quality of sleep, and physical, mental and marital aspects. MethodA cross-sectional study comparing spouses of iRBD patients to the spouses of the age-and-sex-matched OSAS patients. Results40 iRBD patients and their spouses (patients' age 66.6 ± 9.1, male 90%; spouses' age 62.9 ± 7.5), and 35 OSAS patients and their spouses (patients' age 67.8 ± 8.7 years old, male 80%; spouses' age 64.1 ± 9.1) were recruited. Almost all iRBD spouses (90%) reported disturbances by the nocturnal RBD behavioral symptoms of their bedpartners. About two-thirds (62.5%, N = 25) of the iRBD spouses reported a history of being injured during sleep. Spouses of both iRBD and OSAS patients reported a comparably high prevalence of insomnia, anxiety and depressive symptoms. Spouses of iRBD patients, however, reported more impaired quality of life and marital relationship. Nearly two-thirds of RBD couples continued co-sleeping, despite the risk of sleep-related injuries and nocturnal disturbances. ConclusionsBoth iRBD and OSAS spouses exhibited a high prevalence of insomnia and mood problems. In particular, iRBD significantly and negatively affect the spouses' quality of life and the marital relationship. Optimization of iRBD treatment, proper diagnosis, and management of sleep and mental health aspects of spouses may help to lessen the caring burden.