Percentage Of Slow-wave Sleep Research Articles

Decreased sleep quality and increased sleep related movements in patients with Tourette's syndrome

OBJECTIVESleep quality and movement patterns across sleep stages in patients with Tourette's syndrome were examined to determine the influence of syndrome severity on sleep quality and the differential effect of...

Compliance with nasal continuous positive airway pressure assessed with a pressure monitor: pattern of use and influence of sleep habits

The aim of the study was to assess compliance with nasal continuous positive airway pressure (N-CPAP) at home in patients with obstructive sleep apnoea syndrome (OSAS) and to search for predictors of compliance. We studied a cohort of 106 consecutive patients (91 men, 15 women) with a median apnoea hypopnoea index of 62·4 (range 21–132) h−1, equipped at home with a Rem+Soft device (Sefam, France), including a pressure monitor and a real-time clock. During the third and fourth months of treatment, the patients used their machine a median of 88% of days (16–100%), with a mean effective use of 5·6 (1·3–11·2) h per effective day. Residual apnoea index on N-CPAP, as recorded by the monitor, was 1·5 (0·3–27·6) h−1. Mean clock-time for starting with N-CPAP was 23 h 54 min (21 h 34–01 h 42). The mean effective use per effective day correlated negatively with the minimal (and the mean) level of oxyhaemoglobin saturation (rs=−0·24,P <0·05) while the percentage of days the machine was used correlated negatively with the percentage of slow wave sleep (rs=−0·22, P<0·05) at baseline polysomnography. In a subset of 30 subjects, earlier start on N-CPAP correlated with longer use of the device in 22 patients (median r−0·48). We conclude that a pressure monitor allows reporting on compliance in terms of regularity (% of days the machine is used) and length of sleep on N-CPAP (effective use per effective day). These compliance variables show modest correlations with baseline polysomnographic features. Late bedtime should be discouraged as it might decrease compliance.

The relationship between objective sleep variables and subjective sleep estimation in schizophrenia

AIM: Few investigations of sleep structure in schizophrenia have concentrated on the relationship between objective and subjective sleep variables. The aim of this study was to assess objective sleep variables and subjective estimation of sleep duration and sleep quality. METHODS: Polysomnography was performed in 20 chronic patients with schizophrenia during three consecutive nights. After final awakenings subjects answered questions concerning subjective estimations of sleep duration, sleep latency, number of awakenings, and sleep depth. Pearson correlations between ranged subjective reports and objective sleep variables were performed. RESULTS: The results showed a high positive correlation between objective sleep latency and its subjective estimation; a positive correlation between subjective estimation of sleep depth and percentage of slow wave sleep (SWS%); a positive correlation between eye movement (EM) density and subjective estimation of wakefulness during the night; and a negative correlation between EM density and dream reports. CONCLUSION: We concluded that objective sleep variables are related to subjective sleep estimation in schizophrenic patients. In these patients, EM activity in REM sleep is related to the subjective feeling of wakefulness. (Int J Psych Clin Pract 2000; 4:63-67)

The effects of slow-wave sleep (SWS) deprivation and time of night on behavioral performance upon awakening

The aim of the present study is to evaluate the effects of selective SWS deprivation on the motor and sensory motor performance impairment immediately after awakening from nocturnal sleep at different times of the night. Ten normal males slept for 6 consecutive nights in the laboratory: one adaptation, two baseline, two selective SWS deprivation, and one recovery night. During the last 4 nights performance was assessed four times: (a) before sleep, as a baseline measure; (b) within 30 s from the first nighttime awakening, after 2 h of sleep; (c) within 30 s from the second nighttime awakening, after 5 h of sleep; (d) within 30 s from the final morning awakening. After each awakening, following a 3-min cognitive test, a simple Auditory Reaction Time task (ART, about 5 min) and a Finger Tapping Task (FTT, 3 min) were administered. Median of Reaction Times (RT) and of Intertapping Intervals (ITI), 10% fastest RT, 10% slowest RT, and number of misses were considered as dependent variables. The selective SWS deprivation was very effective: SWS percentage during both the deprivation nights was close to zero. This strong manipulation of SWS amount interacted with time-of-night factors in influencing sleep inertia. The SWS deprivation procedure caused a worsening of behavioral performance during the deprivation nights, as well as upon the final awakening of the recovery night. Behavioral performance slowing upon awakening is accounted for by: (1) a general decrement in overall response speed (median of RT); (2) an “optimum response shift”, i.e., a decrease in speed of the fastest responses; (3) an increase of lapsing, with more marked response delays resulting in a further decrease in response speed in the “lapse domain”. Finally, our results do not support the existence of a circadian rhythm of sleep inertia linked to body temperature rhythm.

Subjective and objective sleep quality in irritable bowel syndrome

OBJECTIVE: The aim of this study was to compare subjective and objective measures of sleep quality in patients with irritable bowel syndrome (IBS) and controls. METHODS: The Pittsburgh Sleep Quality Index (PSQI) was used to measure subjective sleep quality, and polysomnography was performed during one night to obtain objective measures of sleep quality, including sleep efficiency, sleep latency, number of arousals, and percentage of slow-wave sleep. Participants were 15 IBS patients and 15 healthy controls. RESULTS: The results showed a significantly increased global PSQI score in patients, as well as significantly higher scores on several subcomponents of the PSQI ( i.e., sleep quality, sleep latency, habitual sleep efficiency, and daytime dysfunction). Analysis of polysomnographic parameters revealed no significant group differences on any measure. CONCLUSIONS: Complaints of poor sleep quality in the absence of objective sleep abnormalities suggest altered sleep perception, and support that IBS involves exaggerated responses to normal internal or external stimuli.

A case report on EEG nocturnal sleep in visually impaired persons aged in their 30s and 50s.

To determine the EEG sleep structure in visually impaired persons, EEG sleep recordings were made over two or three consecutive nights on five subjects in their 30s and 50s in the laboratory or in the Welfare Center for the Blind. Sleep variables were compared to the normative data of sighted persons of comparable ages. The results indicated that the percentages of slow wave sleep in four of the five blind individuals were much less than the values of the normative data, which is in agreement with Krieger and Glick's results (1971).

The Snoring Spectrum: Acoustic Assessment of Snoring Sound Intensity in 1,139 Individuals Undergoing Polysomnography

To quantify the snoring sound intensity levels generated by individuals during polysomnographic testing and to examine the relationships between acoustic, polysomnographic, and clinical variables. The prospective acquisition of acoustic and polysomnographic data with a retrospective medical chart review. A sleep laboratory at a primary care hospital. All 1,139 of the patients referred to the sleep laboratory for polysomnographic testing from 1980 to 1994. The acoustic measurement of snoring sound intensity during sleep concurrent with polysomnographic testing. Four decibel levels were derived from snoring sound intensity recordings. L1, L5, and L10 are measures of the sound pressure measurement in decibels employing the A-weighting network that yields the response of the human ear exceeded, respectively, for 1, 5, and 10% of the test period. The Leq is a measure of the A-weighted average intensity of a fluctuating acoustic signal over the total test period. L10 levels above 55 dBA were exceeded by 12.3% of the patients. The average levels of snoring sound intensity were significantly higher for men than for women. The levels of snoring sound intensity were associated significantly with the following: polysomnographic testing results, including the respiratory disturbance index (RDI), sleep latency, and the percentage of slow-wave sleep; demographic factors, including gender and body mass; and clinical factors, including snoring history, hypersomnolence, and breathing stoppage. Men with a body mass index of > 30 and an average snoring sound intensity of > 38 dBA were 4.1 times more likely to have an RDI of > 10. Snoring sound intensity levels are related to a number of demographic, clinical, and polysomnographic test results. Snoring sound intensity is closely related to apnea/hypopnea during sleep. The noise generated by snoring can disturb or disrupt a snorer's sleep, as well as the sleep of a bed partner.

Slow wave sleep (SWS) distribution across night sleep episode in the elderly.

Slow wave sleep (SWS) distribution across night sleep was shown to be different between infants and young adults. The present research aimed at studying the SWS distribution across night sleep in elderly subjects. Nine healthy elderly subjects, 61-71 years old, were submitted to nocturnal polygraphic sleep recording. Eleven young subjects, 21-23 years old, were the control group. Recordings were visually analyzed according to Rechtschaffen and Kales rules; the method proposed by Webb and Dreblow was used for scoring SWS. An NREM-REM cycle was defined as a sequence of NREM and REM sleep not interrupted by a waking period longer than 15 minutes. SWS percentage was calculated for each successive NREM episode. No significant association between SWS percentage and cycle rank was shown in elderly subjects, whereas a significant association was observed in the young ones. This kind of SWS distribution could be interpreted as reflecting the restructuring of internal organization of sleep in the elderly.

Polysomnography and maintenance of wakefulness test as predictors of CPAP effectiveness in obstructive sleep apnea

Nasal continuous positive airway pressure (CPAP) therapy is usually effective in the treatment of obstructive sleep apnea (OSA), reversing the excessive daytime sleepiness associated with OSA. We investigated how polysomnography and maintenance of wakefulness test (MWT) predicted response to CPAP therapy in 10 patients with obstructive sleep apnea and 10 healthy controls. After a full polysomnography and MWT the patients were started on CPAP. MWT was repeated to quantify the treatment effect. Oxygen desaturation index and the percentage of slow wave sleep were the best predictors for baseline S1 latency in MWT. Baseline S1 latency in the MWT was the most important determinant of improvement in MWT S1 latency after CPAP, followed by the latency to 10 min of continuous nocturnal sleep, arousal index and CPAP use. We suggest that in mild sleep apnea, knowledge of sleep architecture is not necessary before deciding whether or not to initiate CPAP treatment.

Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy.

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/m2. 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, four-choice 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.

Chronic insomnia and activity of the stress system: A preliminary study

The aim of this study was to assess whether there is an association between chronic insomnia and the activity of the stress system. Fifteen young adult insomniacs (<40 years) were studied. After an adaptation night, each subject was recorded in the sleep laboratory for three consecutive nights. During this period, 24-hour urine specimens were collected for measurements of urinary free cortisol (UFC), catecholamines, and growth hormone (GH). The 24-hour UFC levels were positively correlated with total wake time ( p=0.05). In addition, 24-hour urinary levels of catecholamine metabolites, DHPG, and DOPAC were positively correlated with percent stage 1 sleep ( p<0.05) and wake time after sleep onset (WTASO) ( p<0.05). Norepinephrine tended to correlate positively with percent stage 1 sleep ( p=0.063) and WTASO ( p=0.074), and negatively with percent slow-wave sleep ( p=0.059). Twenty-four-hour urinary GH excretion was detectable in only three insomniacs, two of whom had low indices of sleep disturbance. We conclude that, in chronic insomnia, the activity of both limbs of the stress system (i.e., the HPA axis and the sympathetic system) relates positively to the degree of objective sleep disturbance.

Subjective and objective sleep quality in irritable bowel syndrome

Abstract OBJECTIVE: The aim of this study was to compare subjective and objective measures of sleep quality in patients with irritable bowel syndrome (IBS) and controls. METHODS: The Pittsburgh Sleep Quality Index (PSQI) was used to measure subjective sleep quality, and polysomnography was performed during one night to obtain objective measures of sleep quality, including sleep efficiency, sleep latency, number of arousals, and percentage of slow-wave sleep. Participants were 15 IBS patients and 15 healthy controls. RESULTS: The results showed a significantly increased global PSQI score in patients, as well as significantly higher scores on several subcomponents of the PSQI ( i.e., sleep quality, sleep latency, habitual sleep efficiency, and daytime dysfunction). Analysis of polysomnographic parameters revealed no significant group differences on any measure. CONCLUSIONS: Complaints of poor sleep quality in the absence of objective sleep abnormalities suggest altered sleep perception, and support that IBS involves exaggerated responses to normal internal or external stimuli.

Rem sleep in depressed patients: Different attempts to achieve adaptation

Twenty-seven depressed patients and 10 healthy subjects were investigated in the sleep laboratory during two to three consecutive nights. Eleven of the 27 patients demonstrated the “first night effect” (group I) and 11 other patients demonstrated a clear absence of the “first night effect” (group II). Five of the 27 depressed patients were omitted from the study because they did not fit criteria for first night effect. The 10 healthy controls demonstrated a first night effect. In group I, the duration of the first rapid eye movement (REM) sleep episode was increased on the first night and on the second night the REM sleep latency was decreased, whereas REM sleep duration and eye movement (EM) density was increased. The number of the short sleep cycles (less than 40 minutes) was greater in group I versus group II and the percentage of slow-wave sleep (SWS) was also higher in group I. In depressed patients with the “first night effect” the enhanced REM sleep requirement is satisfied not only by an increased REM sleep duration but also by the improved REM sleep quality that is crucial for adaptation. The adaptive role of the increased first REM period and the increased EM density in this period is very limited.

Effects of the Seasons and of Bright Light Administered at Different Times of Day on Sleep EEG and Mood in Patients with Seasonal Affective Disorder

The study examines objective characteristics of sleep in women (n=31) with and without seasonal affective disorder, winter type, before and after a week of light treatment (at either 0800–1000 h, 1600–1800 h or 1800–2000 h). Subsamples of 13 patients and 7 controls were studied additionally in summer, and, among these patients, 9 were also recorded in spring and fall. Ranking the results from the lowest to the largest degree of deviation of sleep structure in patients from the norm yields the sequence: spring –> summer –> winter after light treatment –> fall –> winter before light treatment. In winter before light treatment the total amounts and percentage of slow wave sleep were significantly lower in responders to light (n=13) compared to both nonresponders (n=8) and controls (n=10), while following light treatment the difference disappeared. The reduced amounts of slow wave sleep in the depressive state predicted higher reduction and low posttreatment scores on psychiatric scales. Light treatment and summer season showed similar effects on patients’ sleep: they caused an increase of slow wave sleep and a decline of sleep stage 2. Our data do not suggest that time of light treatment is important to achieve an antidepressant effect. Moreover, phase shifting effects of light treatment and of changing season on sleep EEG were not considerable. At the same time, subjective ratings of arousal demonstrated an advance shift of the arousal rhythm after morning and a delay shift after afternoon LT. We did not find significant changes in total amounts and percentage of REM sleep over time. The data suggest that abnormally increased need for REM sleep results in the hypersomnia and may be considered as a trait marker of winter depression. An abnormal architecture of nonREM sleep appears to be a state marker of those patients who benefit from bright light administered during waking hours.

The sleep of non-depressed patients with panic disorder: a comparison with normal controls.

All-night sleep EEG recordings were performed in non-depressed patients with panic disorder, agoraphobia, and a group of age- and sex-matched normal controls. Patients were selected according to DSM-IV and all subjects were studied under drug-free conditions. In addition to sleep continuity disturbances, patients with panic disorder have a reduced percentage of slow wave sleep, mainly due to diminished amounts of stage 4. REM sleep characteristics are identical in the two groups. When depressive co-morbidity and non-specific causes of insomnia are excluded, the sleep EEG of panic patients seems to be characterized by modest changes in sleep continuity and sleep architecture. These findings favour the existence of a neurophysiological frontier between anxiety disorders and depressive illness.

Slow Wave Sleep and Cyclic Alternating Pattern (CAP) in HIV-infected Asymptomatic Men

Alterations of sleep structure have been reported in asymptomatic human immunodeficiency virus (HIV)-infected subjects. In these patients some authors have found an increased percentage of slow wave sleep (SWS) and a SWS preponderance in the second half of the night, as well as subjective sleep complaints. Other authors have found an increased stage 1 non-rapid eye movement (NREM) and reduced stage 2 NREM percentages in asymptomatic subjects. We evaluated the macrostructure and the microstructure (cyclic alternating pattern, CAP) of sleep in nine HIV-infected asymptomatic men without sleep complaints or psychiatric illness, in comparison with nine age-matched controls. Our study showed a decreased amount of SWS and a significantly higher CAP rate in HIV-subjects, suggesting an altered organization of the sleep process in these patients.

Sleep after spousal bereavement: A study of recovery from stress

Aim: In this study, we compared repeated measures of electroencephalographic (EEG) sleep and subjective sleep quality in nondepressed, spousally bereaved elders and a healthy control group, in order to search for possible psychobiological correlates of bereavement not confounded by concurrent major depression. Method: Laboratory-based EEG sleep studies and measures of subjective sleep quality (Pittsburgh Sleep Quality Index [PSQ1]) were repeated at 3, 6, 11, 18, and 23 months after spousal bereavement in a study group of 27 elderly volunteers. Data were compared with similar measures from a control group of 27 nonbereaved subjects recorded on three occasions 1 year apart. Repeated-measures analysis of variance (ANOVA), using age as a covariate, examined effects due to time on selected variables in the bereaved group, as well as effects due to group, time, and group-by-time interactions in the experimental and control subjects. Results: Bereaved and control groups showed consistent differences over time in the phasic measures of rapid eye movement (REM) sleep (higher in bereaved subjects during the first and third REM sleep periods), but were similar on all other EEG sleep measures over the 2 years of observation. The bereaved showed a small decline in the percentage of slow-wave sleep over 2 years, but measures of sleep efficiency, REM latency, and delta sleep ratio were stable and did not differ from values seen in control subjects. Bereaved and control subjects were also similar on subjective sleep quality. Conclusion: During successful adaptation to the loss of a spouse, and in the absence of major depression, spousal bereavement is associated with elevation in the phasic measures of REM sleep but does not appear to be associated with other physiologic sleep changes typical of major depression when studied at 3 to 23 months after the event. Although this observation does not preclude the possibility of significant sleep disturbance nearer the time of the event, it suggests that preservation of normal sleep following a major negative life event may be an important correlate of the resilience seen in successful aging. The elevation in REM density may provide a psychobiological correlate of bereavement not confounded by concurrent major depression.

Treatment of Sleep Apnea with Prosthetic Mandibular Advancement (PMA)

Nine males with sleep apnea DOES syndrome and three males with sleep apnea DIMS syndrome were treated with prosthetic mandibular advancement (PMA). The method uses a prosthesis, which is designed to advance the mandible 3-5 mm to prevent upper airway occlusion during sleep. The apnea index in the obstructive-type apnea and the percentage of time spent in obstructive apnea decreased significantly with PMA. Although the apnea index showed merely a tendency to decrease in central apnea (p < 0.1), the percentage of time spent in central apnea decreased significantly with PMA. A marked improvement in sleep structures was observed with PMA; a significant increase was seen in total sleep time, percent slow wave sleep (SWS) and percent rapid eye movement (REM) sleep, and the time spent in intra-sleep awakening decreased remarkably. PMA had excellent effects on snoring, and daytime hypersomnolence was reduced in almost all patients. Moreover, a survey on the therapeutic effects of PMA on sleep apnea syndrome and problems associated with wearing PMA was performed with a questionnaire for the sample of nine DOES patients and an additional 22 patients who were treated over a long time. The therapeutic effects could be maintained without any problems in about 2/3 of these patients. The therapeutic mechanisms of PMA in its reduction of both obstructive and central apnea are discussed.

Effect of dexfenfluramine on sleep in healthy subjects

The acute effects of dexfenfluramine on nocturnal sleep were studied in ten healthy male subjects by means of sleep EEG recordings and ratings of subjective sleep quality. Four different dosages (3 mg, 7 mg, 15 mg, and 30 mg) were tested, administered over a period of 3 days each. Under 15 mg and 30 mg dexfenfluramine, only slight effects on sleep were observed: 15 mg led to decreased sleep efficiency in the first night of medication, and to reduced percentage of slow wave sleep in the first and third night. A significant lengthening of REM latency was present in the third night under 30 mg dexfenfluramine, without changes in other REM sleep parameters. Daily doses of 3 mg and 7 mg dexfenfluramine did not influence sleep, except for a significant REM latency reduction observed in the first night under 3 mg. Apart from a transient slight impairment under 30 mg, ratings of subjective sleep quality did not mirror any impact of dexfenfluramine. The data suggest that therapeutic dosages of dexfenfluramine only slightly influence nocturnal sleep, which contrasts with the known impact of other anti-obesity agents like the amphetamines. Unlike classical antidepressants, dexfenfluramine does not reduce REM sleep; in light of a hypothetical link between REM sleep reduction and antidepressant action of a drug, dexfenfluramine is not expected to have a pronounced antidepressant effect.

Gluco- and antimineralocorticoid effects on human sleep: a role of central corticosteroid receptors

Cortisol modulates brain functions in humans. This principal endogenous glucocorticoid in humans decreases rapid-eye-movement (REM) sleep and increases slow-wave sleep (SWS). Because cortisol exerts its effect on brain functions via mineralocorticoid receptors (MR) and glucocorticoid receptors (GR), we were interested in which type of corticosteroid receptor mediates these steroid effects on sleep. Healthy men were tested in two double-blind experiments. In experiment I (n = 8), the subject's sleep was tested during four nights: 1) after pretreatment with dexamethasone (Dex, 4 mg/day) for 4 or 6 days and after additional infusion of placebo or cortisol (10 mg/h) during the experimental night, 2) after pretreatment with placebo for 4 or 6 days and after infusion of placebo or cortisol (10 mg/h) during the experimental night. In experiment II, subjects (n = 10) slept after intravenous administration of potassium canrenoate (200 mg, at 0800 and 1700 h before experimental nights) or placebo. Cortisol infusion moderately increased the percentage of SWS (P less than 0.05) and markedly decreased REM sleep (P less than 0.01); influence of cortisol on SWS did not depend on pretreatment with Dex. Dex reduced both SWS and REM sleep (P less than 0.05). Canrenoate markedly diminished SWS (P less than 0.01) but left REM sleep unaffected. The results suggest that corticosteroid-induced changes in SWS are mediated via MR-like central receptors in humans, whereas changes in REM sleep involve GR.