Nonorganic Sleep Disorders Research Articles

한국인 수면장애 환자의 최근 3년간 한방 진료 양태

Objectives: Though there are many studies about sleep disorder, no research has been performed on the utilization of oriental medicine as a treatment. Therefore, the oriental medical treatment pattern of Korean patients with sleep disorders was examined herein using the Health Insurance Review and Assessment Service (HIRAS). Methods: The medical records of patients with sleep disorders (G47) or nonorganic sleep disorders (F51) as a main diagnosis were adopted from the HIRAS database from 2011 to 2013. Analysis was performed on the number of patients and cost per patient, with comparison between oriental and western medicine in terms of gender, age, patient care service type, and hospital type. Results: 1) Regarding sleep disorders, the medical visits and insurance charges have been increasing. Western medicine was utilized 8 times more often than oriental medicine during 3 years. 2) There were 2.5 times more women than men. 3) Among all ages, the 50~59 year group had the highest representation. 4) In comparison of average portions of patient care type over 3 years, outpatients were the majority, while the number of visits of outpatients and hospitalization has been increasing. 5) Comparison of average portion of oriental hospital type over 3 years revealed oriental clinics to be used most. The use of general hospitals was higher in western medicine treatment, while public health centers used oriental medicine more. 6) Regarding average oriental medical cost per patient over 3 years, the total was 88,000 won, with 353,000 won for hospitalization and 85,000 won for outpatients. The outpatient cost has been increasing. 7) In line with 6, oriental medical hospitals cost 126,000 won, local clinics were 85,000 won, and etc. was 95,000 won. Average costs of all types have increased during 3 years, except oriental medical hospitals in 2013. Conclusions: This study provided objective information about the epidemiologic characteristic of oriental medicine used for treatment of sleep disorder. For expansion of oriental medical demand for sleep disorder, this study would be helpful in understanding the recent status.

Effects of hops on clinical efficacy of a valerian-hops-extract combination (Ze 91019) in patients suffering from non-organic sleep disorder

The fixed valerian-hops extract combination Ze 91019 is used as a sleep aid. For this combination pharmacodynamic actions [1, 2] as well as efficacy has been demonstrated in patients suffering from sleep problems [3]. While the main focus of research has been on valerian or the extract combination as a single active entity less is known about the contributions of hops to the sleep inducing effect of the combination. In this report, sleep onset latency (SL2) of the combination Ze 91019 was tested in comparison to valerian extract using a mobile device to allow for recording of sleep parameters at home while participating in the trial. Patients suffering from sleep disorders (ICD10: F 51.0, F 51.2) were enrolled when SL2 was prolonged at baseline (≥30min, inclusion criteria). The hypnograms to calculate the objective sleep parameters were recorded with a mobile device (QUISI) twice before including the patient into the study. Treatment period lasted for 4 weeks with placebo, valerian extract (500mg) or the valerian-hops-extract combination (500mg plus 120mg). Both of the extracts were prepared with 45% methanol m/m with a DER for valerian: 5–8:1 and for hops 7–10:1. The results of this trial clearly indicate that hops added to the clinical efficacy as Ze 91019 was superior to placebo in reducing the originally prolonged sleep onset latency.

An E-Health Solution for Automatic Sleep Classification according to Rechtschaffen and Kales: Validation Study of the Somnolyzer 24 × 7 Utilizing the Siesta Database

To date, the only standard for the classification of sleep-EEG recordings that has found worldwide acceptance are the rules published in 1968 by Rechtschaffen and Kales. Even though several attempts have been made to automate the classification process, so far no method has been published that has proven its validity in a study including a sufficiently large number of controls and patients of all adult age ranges. The present paper describes the development and optimization of an automatic classification system that is based on one central EEG channel, two EOG channels and one chin EMG channel. It adheres to the decision rules for visual scoring as closely as possible and includes a structured quality control procedure by a human expert. The final system (Somnolyzer 24 × 7™) consists of a raw data quality check, a feature extraction algorithm (density and intensity of sleep/wake-related patterns such as sleep spindles, delta waves, SEMs and REMs), a feature matrix plausibility check, a classifier designed as an expert system, a rule-based smoothing procedure for the start and the end of stages REM, and finally a statistical comparison to age- and sex-matched normal healthy controls (Siesta Spot Report™). The expert system considers different prior probabilities of stage changes depending on the preceding sleep stage, the occurrence of a movement arousal and the position of the epoch within the NREM/REM sleep cycles. Moreover, results obtained with and without using the chin EMG signal are combined. The Siesta polysomnographic database (590 recordings in both normal healthy subjects aged 20–95 years and patients suffering from organic or nonorganic sleep disorders) was split into two halves, which were randomly assigned to a training and a validation set, respectively. The final validation revealed an overall epoch-by-epoch agreement of 80% (Cohen’s kappa: 0.72) between the Somnolyzer 24 × 7 and the human expert scoring, as compared with an inter-rater reliability of 77% (Cohen’s kappa: 0.68) between two human experts scoring the same dataset. Two Somnolyzer 24 × 7 analyses (including a structured quality control by two human experts) revealed an inter-rater reliability close to 1 (Cohen’s kappa: 0.991), which confirmed that the variability induced by the quality control procedure, whereby approximately 1% of the epochs (in 9.5% of the recordings) are changed, can definitely be neglected. Thus, the validation study proved the high reliability and validity of the Somnolyzer 24 × 7 and demonstrated its applicability in clinical routine and sleep studies.

Quality of life in nonorganic and organic sleep disorders: II. Correlation with objective and subjective quality of sleep and awakening.

The purpose of this study of 100 patients suffering from sleep-disorders was to determine correlations between their subjective health-related quality of life (HRQoL) and objective variables in sleep initiation and maintenance, sleep architecture, objective quality of awakening, psychophysiological parameters and subjective quality of sleep and awakening. Objective measurements were obtained from overnight diagnostic polysomnography. Subjective HRQoL was determined from the Quality of Life Index (QLI, Mezzich and Cohen) completed prior to the adaptation night. Other measurements included subjective and objective quality of sleep and awakening (psychometry) the evening before and morning after polysomnographic investigations. 63% of the patients were suffering from nonorganic and 37% from organic sleep disorders (SDs). Within the first group, nonorganic insomnia predominated; within the second, sleep apnea. Subjective HRQoL correlated well with subjective sleep and awakening quality, especially in nonorganic SDs. There were only a few correlations of objective measurements with subjective HRQoL: in the total group of SD patients HRQoL correlated with sleep stage S2, and in nonorganic SDs with attention scores and psychophysiological measurements (mainly the pulse rate in the evening and morning). Our findings suggest only a weak relationship between objective sleep variables and subjective HRQoL in both organic and nonorganic SDs. However, we found various significant correlations of HRQoL with subjective measurements of sleep, especially in nonorganic SDs.

Quality of life in nonorganic and organic sleep disorders: I. Comparison with normative data.

Subjective health-related quality of life (HRQoL) was investigated in 100 patients with disturbed sleep (39 women aged 52 +/- 13 years and 61 men aged 53 +/- 10 years) referred to the sleep laboratory and compared with HRQoL in 100 normal healthy adults. Measurements included the Quality of Life Index (QLI) (Mezzich and Cohen), and objective (polysomnographic) and subjective (psychometric) quality of sleep and awakening. Statistical analysis (Mann-Whitney U-test) showed HRQoL to be significantly reduced in sleep disorders (SDs), with a more pronounced reduction in nonorganic than in organic SDs. Patients with nonorganic hypersomnia were more disturbed than those with nonorganic insomnia. Within organic SDs, patients with apnea were more disturbed than those with obstructive snoring. Out of ten elementary HRQoL components, seven were disturbed in SDs: physical well-being, psychological well-being, self-care and independent functioning, occupational functioning, interpersonal functioning, personal fulfillment, and overall quality of life. No differences between patients and normal healthy subjects where found in the components social support, community and services support or spiritual fulfillment. Patients suffering from nonorganic SDs had significantly worse scores in physical and psychological well-being and overall quality of life than those with organic SDs. Patients with both SDs and additional diagnoses of affective disorders had more profoundly reduced HRQoL than those with anxiety disorders. Follow-up of 51 patients (31 with nonorganic SDs and 20 with organic SDs) one year after sleep laboratory investigation and subsequent treatment found significantly improved HRQoL compared with pre-treatment. Moreover, patients diagnosed and treated in the sleep laboratory showed lower re-hospitalization rats.

Self-reported organic and nonorganic sleep problems in schoolchildren aged 11 to 15 years in Vienna.

To estimate the prevalence of self-reported sleep problems, to examine associations among demographic characteristics, familial factors, and sleep problems, and to investigate the association between the symptoms of obstructive sleep apnea (OSA) and nonorganic sleep disorders. An anonymous questionnaire with 22 questions was designed. 332 schoolchildren (aged 11-15 years, mean age 12 years and 9 months; median, 12 years; 56% female, 44% male) from two high schools in Vienna were investigated with regard to self-reported symptoms characteristic for obstructive sleep apnea and for parasomnia/insomnia. Data were analyzed by definition of three groups (problem, occasional problem, and nonproblem sleepers, and by calculation of an insomnia/parasomnia sum score). Statistical analysis included nonparametric tests (Mann Whitney-U and Kruskal), Pearson correlation test, and multiple regression analysis. Twelve percent reported at least one sleep problem every night, 76% reported occasional sleep problems, and 12% had no sleep problems. Girls were affected more frequently than boys (p <.01). Children with sleep problems suffered more often from concentration difficulties (p <.05), daytime fatigue (p <.001), and daytime naps (p <.05). Children who snored had nightmares (10% vs. 2%, p <.01), night terrors (4% vs. 1.5%, p <.001), sleepwalking (1.4% vs. 1%, p <.05), and nocturnal awakening (16% vs. 5%, p <.01) more frequently. On multiple regression analysis, 23% of the variability of a defined parasomnia/insomnia sum score had the characteristic OSA symptoms of nocturnal sweating, dryness of the mouth, snoring, hyperactivity, and daytime fatigue. 12% of schoolchildren aged 11-15 years reported sleep problems almost every night. The children suffer from daytime fatigue, naps, and concentration difficulties. Nearly one-fourth of the symptoms of parasomnia/insomnia were associated with characteristic signs of OSA, suggesting the importance of a routine clinical investigation in children with so-called nonorganic sleep disorders.

Effizienter Einsatz von Schlafkissen bei Personen mit nicht-organischen Schlafstörungen – eine Pilotuntersuchung

Efficient Action of Sleep Pillows in Patients Suffering from Non-Organic Sleep Disorders – a Pilot Study Objective: Sleep disorders may critically affect working performance and quality of life. Sleep pillows have been traditionally used to overcome such disorders. Scientifically based clinical trials to demonstrate the efficacy are missing. Methods: 28 patients with problems falling asleep and/or staying asleep not related to psychiatric or organic diseases were investigated in an accredited sleep laboratory. The diagnosis was confirmed by polysomnography. After 2 and 4 weeks of treatment the polysomnography was repeated to document any influences by the sleep pillows. Results: The polysomnographic records showed a monotonic trend to regain an age-related distribution of the non-REM sleep stages. The REM sleep phase increased nearly twofold; however, the norm values were not reached within the 4-week period of treatment. Sleep pillows of intensity 2 were superior to those of intensity 1; a further increase to intensity 3 did not create any additional effect. Conclusion: The results demonstrate an effective treatment of non-complicated sleep disorders with sleep pillows, which has been shown with objective measurements in a sleep laboratory.

Placebo-Controlled Sleep Laboratory Studies on the Acute Effects of Zolpidem on Objective and Subjective Sleep and Awakening Quality in Nonorganic Insomnia Related to Neurotic and Stress-Related Disorder

Recent investigations in our sleep outpatient clinic demonstrated that 30% of patients exhibited organic and 70% nonorganic sleep disorders, with 41% showing as an additional diagnosis neurotic, stress-related, and somatoform disorders, 31% affective disorders and 15% mental and behavioral disorders due to psychoactive substance use. Thus, the aim of the study was to investigate the acute effects of the imidazopyridine zolpidem on objective and subjective sleep and awakening quality in the largest of the above-mentioned groups. In this single-blind, placebo-controlled cross-over study, 15 patients (9 females and 6 males aged 51.1 + 11.3 years) diagnosed as having nonorganic insomnia (ICD–10: F 51.0) related to neurotic and stress-related disorders (F 1.1:12, F 41.2:2 and F 43.2:1) were included. Objective and subjective sleep and awakening quality measures were investigated in 3 subsequent nights in the sleep laboratory (adaptation, baseline/placebo and zolpidem 10 mg night), utilizing clinical, polysomnographic, psychometric and psychophysiological methods. The drug-free patients were matched according to age and sex with 15 normal healthy controls (age 51.2 + 11.8 years). Statistical analysis of polysomnographic variables demonstrated a significant lengthening of the total sleep period (TSP) and total sleep time (TST), an improvement in sleep efficiency and a shortening of sleep latencies after zolpidem as compared with placebo. These changes were opposite to the differences between patients and controls. Concerning sleep architecture, zolpidem increased the length of S4 and S3 + S4 as compared with placebo. Subjective sleep and awakening quality and the thymopsychic variables drive, mood, affectivity and wakefulness in the morning showed no significant changes, as a significant improvement had already occurred from the adaptation to the baseline/placebo night. Noopsychic variables (attention, concentration, attention variability, numerical memory, fine motor activity, reaction time measures) showed similar findings. Moreover, subjective sleep and awakening quality, thymopsychic and noopsychic measures during baseline/placebo recordings did not differ significantly from normative data (except for fine motor activity). Psychophysiological measures did not show any significant alterations either, except for a decrease in systolic blood pressure in the evening. Conclusion: As compared with placebo, zolpidem induced a significant improvement in objective sleep quality, mainly by increasing TSP, TST and sleep efficiency and shortening sleep latencies, thereby normalizing the disorder of initiating and maintaining sleep. Deep sleep stages S3 + S4 increased (although at baseline/placebo these stages did not differ from controls), while S1, S2 and SREM did not change significantly. Subjective sleep and awakening quality as well as thymopsychic and noopsychic performance in the morning mainly showed a placebo and ‘first- night effect’ phenomenon in these patients. Thus, the changes induced by zolpidem were somewhat different from those after classical benzodiazepines.