Percentage Of Rapid Eye Movement Sleep Research Articles

The Effect of Type-2 Diabetes Mellitus on Sleep Architecture and Sleep Apnea Severity in Patients With Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a severe condition that is characterized by recurrent partial or complete breathing interruptions during sleep, leading to insulin resistance, microvascular complications, and cardiovascular complications. It is of great importance to know the impact of type 2 diabetes mellitus (DM), which is prevalent in the world and in our country, Turkey, leads to significant mortality and morbidity, significantly affects the quality of life, and requires continuous follow-up, on sleep in patients with OSAS and to raise awareness on this issue. In this study, we aimed to determine the effects of diabetes on sleep duration and sleep architecture in patients with OSAS and to investigate the relationship between OSAS severity and DM control. Fifty diabeticand 42 non-diabetic patientsdiagnosed with OSAS at the Sleep Disorders Center ofSüreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, between October 2022 and March 2023 were included in the study. Polysomnographic and biochemical parameters of the two groups were compared. The effect of OSAS severity and sleep architecture on diabetes control was investigated. No significant difference was found between diabetic and non-diabetic patients in terms of total sleep duration, sleep efficiency, and sleep latency, whereas REM (rapid eye movement) latency was prolonged and REM sleep duration and percentage were significantly lower in diabetic patients. The severity of OSAS was found to be greater in diabetic patients and they spent significantly more time below 90% saturation during sleep. No correlation was found between the groups in the glycated hemoglobin (HbA1c) parameter, which we examined in terms of diabetes control, sleep architecture, and OSAS severity. The presence of diabetes aggravates the severity of OSAS, prolongs the transition to REM sleep, and leads to a decrease in REM duration. Sleep is essential for both mental and physical well-being. In this regard, it is of utmost importance to examine diabetic patients for OSAS and to perform polysomnography in appropriate patients.

Dopamine agonists in restless leg syndrome treatment and their effects on sleep parameters: A systematic review and meta-analysis

BackgroundDopamine agonists (DAs) constitute the standard therapeutic scheme for restless leg syndrome (RLS) because they have been proven to be effective. However, DAs may change sleep parameters, thus having adverse effects on patient condition. This meta-analysis clarified the effects of DAs used in RLS treatment on the sleep architecture. MethodsPubMed, Embase, and Cochrane Central databases were searched for randomized control trials (RCT) (up to October 2023) that discussed the effects of DAs on sleep architecture in patients with RLS. A meta-analysis employing a random-effects model was conducted. The patients were divided into subgroups according to individual DAs and treatment duration (1 day or ≥4 weeks). ResultsThirteen eligible randomized placebo-controlled trials were included in the assessment. The effects of three DAs (i.e., pramipexole, ropinirole, and rotigotine) on rapid eye movement (REM) sleep, slow-wave sleep (SWS), and sleep efficiency (SE) were analyzed. Overall, pramipexole significantly improved SE but decreased the percentage of REM sleep among treated patients. Ropinirole also enhanced SE compared with the placebo group. Rotigotine did not affect SE and REM sleep. Subgroup analysis found that pramipexole used for 1 day and ≥4 weeks significantly diminished the percentage of REM sleep. Ropinirole used for 1 day showed similar REM sleep patterns. Finally, none of the three DAs affected SWS. ConclusionsThis meta-analysis demonstrated that DAs significantly affect sleep parameters.

Nocturnal Pressure Controlled Ventilation Improves Sleep Efficiency in Patients Receiving Mechanical Ventilation.

Patients receiving mechanical ventilation commonly experience sleep fragmentation. The present meta-analysis compared the effects of pressure controlled ventilation (PCV) and pressure support ventilation (PSV) on sleep quality. We conducted a search of the PubMed, Embase, and Cochrane Library databases for studies published before November 2023. In this meta-analysis, individual effect sizes were standardized, and the pooled effect size was determined by using random-effects models. The primary outcome was sleep efficiency. The secondary outcomes were wakefulness, percentages of REM (rapid eye movement) sleep and stages 3 and 4 non-REM sleep, the fragmentation index, and the incidence of apneic events. This meta-analysis examined 4 trials that involved 67 subjects. Sleep efficiency was significantly higher in the PCV group than in the PSV group (mean difference 15.57%, 95% CI 8.54%-22.59%). Wakefulness was significantly lower in the PCV group than in the PSV group (mean difference -18.67%, 95% CI -30.29% to -7.04%). The percentage of REM sleep was significantly higher in the PCV group than in the PSV group (mean difference 2.32%, 95% CI 0.20%-4.45%). Among the subjects with a tendency to develop sleep apnea, the fragmentation index was significantly lower in those receiving PCV than PSV (mean difference -40.00%, 95% CI -51.12% to -28.88%). The incidence of apneic events was significantly lower in the PCV group than in the PSV group (risk ratio 0.06, 95% CI 0.01-0.45). Compared with PSV, PCV may improve sleep quality in patients receiving nocturnal mechanical ventilation.

Abstract P540: Sleep Duration, Rapid Eye Movement Sleep, and Subclinical Myocardial Damage

Introduction: Sleep is strongly linked to clinical cardiovascular disease and was added in 2022 to the AHA’s Life’s Essential 8. Optimizing sleep duration and quality may reduce the risk of cardiovascular disease. Few studies have examined self-reported sleep duration and percent time in rapid eye movement (REM) sleep measured by single night in-home polysomnography with high sensitivity cardiac troponin T (hs-troponin T), a biomarker of subclinical cardiovascular disease. Methods: We conducted a cross-sectional study of adults without a history of cardiovascular disease who participated in both the Atherosclerosis Risk in Communities (ARIC) Study and the Sleep Heart Health Study (SHHS) in 1995-1998. We used linear regression with sleep duration and percentage time of REM sleep modeled as predictors with restricted cubic splines and examined associations with the outcome, hs-troponin T. We adjusted for age, sex, body mass index, waist-to-hip ratio, alcohol intake, smoking status, systolic blood pressure, hypertension medication use, diabetes, HDL- and LDL-cholesterol, and cholesterol-lowering medication use. Results: Among 1,587 participants (mean age 63, 54% female), the mean sleep duration was 7.3 hours, and mean % REM time was 20.7. Sleep duration was not associated with hs-troponin T ( Figure, Panel A ). However, percentage REM sleep was negatively associated with hs-troponin T, but with a threshold effect; there was a negative linear association of hs-troponin T with % REM sleep but only at values <15% ( Figure, Panel B ). Conclusion: While self-reported sleep duration was not associated with TnT levels, there was evidence that low % REM sleep, a specific neurophysiological sleep state, was associated with subclinical cardiovascular disease. These findings suggest that multiple sleep dimensions should be considered in efforts to optimize cardiovascular health.

Pulmonary hypertension in newly diagnosed obstructive sleep apnea-chronic obstructive pulmonary disease overlap syndrome patients attending a tertiary care centre-a cross-sectional analysis.

Overlap syndrome is the association of obstructive sleep apnea (OSA) with chronic obstructive pulmonary disorder and with other chronic respiratory diseases. Patients with overlap syndrome have a worse prognosis compared with chronic obstructive pulmonary disorder or OSA alone. Additionally, patients with combined chronic obstructive pulmonary disorder and OSA are more likely to develop pulmonary hypertension and right heart failure much earlier than those without overlap. To assess the occurrence of pulmonary hypertension (PH) in newly diagnosed OSA-chronic obstructive pulmonary disorder overlap syndrome patients attending a tertiary care centre. This cross-sectional study was conducted at Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, South India, among patients with OSA above 40years of age who were proactively evaluated to pick out those with undiagnosed overlap. A period of 6months after getting ethical clearance from June 2018 was selected as the study period. Among patients with symptoms suggestive of OSA above 40years of age who gave the informed consent were enrolled after screening with Standard Sleep questionnaires (Berlin questionnaire, STOP BANG and Epworth Sleepiness Scale). Enrolled patients underwent routine spirometry and sleep study using the standard Level 1 overnight polysomnography (Level1 OPSG). Patients were classified in to two groups as OSA patients (group I), having an apnea hypopnea index (AHI) > 5/hr alone and the second group as those OSA patients (group II), with an obstructive spirometry pattern who were the overlap group. Arterial blood gas analysis (a sample of radial arterial blood was drawn with the patient awake and supine, and was analyzed for pH, PaCO2 and PaO2) and echocardiography (ECHO) of the two groups were compared as a non-invasive method to assess pulmonary artery hypertension and results were analyzed in a systematic manner. Among the 84 patients enrolled, 16.7% had overlap syndrome and the rest had OSA alone. Statistically significant higher mean weight and BMI for those with overlap syndrome compared to the OSA group were observed. Mean FVC (forced vital capacity), FEV1 (forced expiratory volume 1s), and FEV1/FVC were lower in those with overlap syndrome compared to OSA group. The mean values of ABG parameters revealed higher PaCO2 and lower PaO2 among the group with overlap syndrome which were statistically significant. However, there was no significant difference in resting room air SaO2 value between the two groups. The mean values of sleep duration and efficiency were significantly lower in those with overlap syndrome with a p value < 0.001. The mean value of arousal and REM (rapid eye movement) sleep percentage were significantly higher among those with overlap syndrome (p < 0.001). Mean value of NREM (non-rapid eye movement) sleep percentage was lower among the group with overlap syndrome compared with the OSA group, and this difference was statistically significant. The mean AHI value of the overlap syndrome group was 39.79 ± 7.54 and this was significantly higher than the OSA group (p < 0.004). Among the 14 patients who had ECHO evidence of pulmonary hypertension, 9 (64.3%) belonged to the overlap group which shows that they are a highly vulnerable group for developing pulmonary hypertension (PH) and requires early detection and more rigorous treatment. This study confirms that OSA patients with modest daytime level of hypoxemia and mild-moderate chronic airflow limitation have a high prevalence of PH. Chronic airway obstruction may be asymptomatic in some subjects and this stresses the necessity of pulmonary function test in OSA.

ASSOCIATION OF RAPID EYE MOVEMENT SLEEP AND APOE PROTEOTYPE TO COGNITIVE PERFORMANCE IN OLDER ADULTS

Abstract Exploring the multifaceted interaction of sleep, disease-related biomarkers and cognitive decline is of particular importance for aging populations. Sleep quality and the APOE E3/E4 allele has been linked to Alzheimer’s Disease (AD). This study aims to examine relationships between older adults’ level of cognitive performance, proportion of rapid eye movement (REM) sleep, and APOE proteotype. Analysis of sleep study data collected in an active lifestyle retirement community - The Villages, Florida was conducted using a subset of markers collected as part of a larger cognitive health study. Polysomnography, cognitive battery (Montreal Cognitive Assessment(MoCA), Trail Making Tests(TMT), Symbol Digit Modalities Test(SDMT), Psychomotor Vigilance Test(PVT)), and APOE blood-biomarker (E2/E3,E3/E3,E3/E4) data were obtained from healthy participants (n=33) aged 55-65. Descriptive statistics, multilinear regression, and ANOVA were used. Participants’ mean age was 61.9 years, with 55% being male. Cognitive test scores did not show a significant relationship with REM sleep percentage (p=0.3096). No consistent dispersion or skew was shown in box plot analysis of APOE proteotype across cognitive performance measures. Unexpectedly, although not statistically significant (p=0.396), average REM sleep percentage was higher in the APOE E3/E4 group (20.04%, Mean:75.44 minutes) as compared to the E3/E3 group (15.99%,Mean: 59.07 minutes). Proteotype E3/E4 was examined specifically due to its potential association with Alzheimer’s disease. The REM sleep proportion was lower than the average experienced on a typical night at home, possibly due to study conditions. Further research is needed examining the relationship between older adults with REM sleep insufficiency and cognitive impairment.

Variation in estimates of in‐home sleep architecture in diverse population with and without cognitive impairment

AbstractBackgroundSleep disturbances are highly prevalent in patients with cognitive impairment and have been increasingly recognized as an important risk factor for dementia. However, in‐lab sleep studies are costly and often impractical at a population level, particularly with diverse populations. There are limited data on measures of sleep continuity and architecture in the home setting among Black, Mexican American (MA) and non‐Hispanic White (NHW) adults, with and without cognitive impairment.MethodTo date, the ongoing Health and Aging Brain Study‐Health Disparities (HABS‐HD)‐Dormir study has enrolled 732 participants using a community‐based participatory research approach. In‐home sleep testing was assessed using WatchPAT (WatchPAT‐200) and the zzzPAT software (5.2.79.7p), which provides estimates of sleep duration, sleep efficiency, and rapid eye movement (REM) and non‐REM (NREM) sleep duration using a proprietary algorithm. Dementia, mild cognitive impairment (MCI) or normal cognition (NC) were determined based on a comprehensive clinical evaluation.ResultOn average, participants were aged 66.7±8.4 (50‐92) years, including 64.2% women; 34.4% MA, 23.8% Black and 41.8% NHW adults; 22.1% classified as MCI or dementia. After adjustment for age, sex, race, body mass index and comorbidities, participants with MCI or dementia compared to those with NC had shorter adjusted mean sleep duration (6.3 vs. 6.7 hours, p = 0.002), lower sleep efficiency (77.2% vs. 82.1%, p&lt;0.001), longer sleep latency (32.3 vs. 25.7 minutes, p = 0.006) and longer REM sleep latency (116.5 vs. 95.4 minutes, p = 0.002); had lower REM sleep percentage (20.1% vs. 23.1%, p&lt;0.001), and higher NREM sleep percentage (80.0% vs. 76.9%, p&lt;0.001). The association between sleep staging (REM or NREM sleep percentage) and cognitive diagnoses was only significant among Black participants (p for interaction = 0.02, Figure 1).ConclusionIndividuals with MCI/dementia differed from those with NC in key measures of sleep architecture assessed by a home sleep test, suggesting both the utility of in‐home assessments to estimate sleep in middle‐aged and older diverse samples and the need to understand the race differences underlying associations between sleep architecture and cognition in community‐based studies.

Variation in estimates of in‐home sleep architecture in diverse population with and without cognitive impairment

AbstractBackgroundSleep disturbances are highly prevalent in patients with cognitive impairment and have been increasingly recognized as an important risk factor for dementia. However, in‐lab sleep studies are costly and often impractical at a population level, particularly with diverse populations. There are limited data on measures of sleep continuity and architecture in the home setting among Black, Mexican American (MA) and non‐Hispanic White (NHW) adults, with and without cognitive impairment.MethodTo date, the ongoing Health and Aging Brain Study‐Health Disparities (HABS‐HD)‐Dormir study has enrolled 732 participants using a community‐based participatory research approach. In‐home sleep testing was assessed using WatchPAT (WatchPAT‐200) and the zzzPAT software (5.2.79.7p), which provides estimates of sleep duration, sleep efficiency, and rapid eye movement (REM) and non‐REM (NREM) sleep duration using a proprietary algorithm. Dementia, mild cognitive impairment (MCI) or normal cognition (NC) were determined based on a comprehensive clinical evaluation.ResultOn average, participants were aged 66.7±8.4 (50‐92) years, including 64.2% women; 34.4% MA, 23.8% Black and 41.8% NHW adults; 22.1% classified as MCI or dementia. After adjustment for age, sex, race, body mass index and comorbidities, participants with MCI or dementia compared to those with NC had shorter adjusted mean sleep duration (6.3 vs. 6.7 hours, p = 0.002), lower sleep efficiency (77.2% vs. 82.1%, p&lt;0.001), longer sleep latency (32.3 vs. 25.7 minutes, p = 0.006) and longer REM sleep latency (116.5 vs. 95.4 minutes, p = 0.002); had lower REM sleep percentage (20.1% vs. 23.1%, p&lt;0.001), and higher NREM sleep percentage (80.0% vs. 76.9%, p&lt;0.001). The association between sleep staging (REM or NREM sleep percentage) and cognitive diagnoses was only significant among Black participants (p for interaction = 0.02, Figure 1).ConclusionIndividuals with MCI/dementia differed from those with NC in key measures of sleep architecture assessed by a home sleep test, suggesting both the utility of in‐home assessments to estimate sleep in middle‐aged and older diverse samples and the need to understand the race differences underlying associations between sleep architecture and cognition in community‐based studies.

The effects of a dual orexin receptor antagonist on fear extinction memory and sleep in mice: Implications for exposure therapy

Extinction of conditioned fear is considered a fundamental process in the recovery from posttraumatic stress disorder and anxiety disorders. Sleep, especially rapid-eye-movement (REM) sleep, has been implicated in promoting extinction memory. The orexin system contributes to the regulation of sleep and wakefulness and emotional behaviors. In rodents, administrations of an orexin receptor antagonist following fear extinction training enhanced consolidation of extinction memory. Although orexin antagonists increase sleep, including REM sleep, the possible contribution of sleep to the effects of orexin antagonists on extinction memory has not been examined. Therefore, this study examined the effects of suvorexant, a dual orexin receptor antagonist, on extinction memory and sleep and their associations in mice. C57BL/6 mice underwent sleep recording for 24 h before and after contextual fear conditioning with footshocks and extinction learning during the early light phase or early dark phase. Mice were systemically injected with either 25 mg/kg of suvorexant or vehicle immediately after the extinction session. We found that suvorexant neither altered sleep nor improved extinction memory recall compared with vehicle. The higher percentages of REM sleep during the post-extinction dark phase were associated with lower extinction memory recall and greater freezing responses to the fear context. Results also indicate that animals did not reach complete extinction of fear with the fear extinction training protocol used in this study. These findings suggest that promoting REM sleep may not enhance fear extinction memory when extinction of fear is incomplete.

Polysomnographic characteristics of sleep in adults with and without physician-diagnosed atopic dermatitis: results from the Study of Health in Pomerania.

To analyze sleep characteristics as measured with polysomnography (PSG) in adults from the general populationwith and without physician-diagnosed atopic dermatitis (AD). We analyzed data from participants from the German population-based Study of Health in Pomerania (SHIP) TREND-0. AD was diagnosed in a standardized skin examination. The following polysomnographic parameters were measured: total sleep duration (min), sleep latency (min), wake after sleep onset (WASO; min), rapid eye movement (REM) latency (min), sleep efficiency (%), total number of wakefulness and movement episodes, stages of sleep (%), and apnea-hypopnea index (AHI). Additionally, the subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). We compared sleep characteristics of participants with and without AD. Among 1187 participants, 47 (4.0%) had AD. We found no differences between participants with and without AD in any of the analyzed PSG parameters except for the total number of wakefulness and movement episodes and the percentage of REM sleep. Participants with AD had a higher number of wakefulness and movement episodes, and a lower proportion of REM sleep compared to those withoutAD. Regarding subjective sleep parameters, no significant differences were foundbetween participants with and without AD. Our data do not provide evidence for poor sleep quality in individuals with AD. Major limitationsof the study include the unavailability of data on AD severity and the small number of participants with AD. Larger-scaled longitudinal studies considering disease severity and specific AD symptoms with an effect on sleep are required.

0146 Associations Between Mood and Sleep Architecture in Sedentary Office Workers

Abstract Introduction Sleep, and rapid eye movement (REM) sleep in particular, has been suggested to play an important role in mood regulation. Currently, most of this research has come from laboratory settings under constrained conditions; less is known about one’s sleep in their own home. The purpose of this study was to further examine the associations between home-based polysomnography (PSG) sleep parameters and mood disturbance. Methods This cross-sectional study used baseline data from 120 inactive adults with desk-based jobs (52.5% female, 43.8±10.7 y) who were enrolled in an ongoing clinical trial. Mood was assessed using the Profile of Mood States (POMS); its 7 subscales (tension, anger, fatigue, depression, esteem-affect, vigor, confusion) were summed (with a constant of 100) to generate a Total Mood Disturbance (TMD) score with a higher score indicating greater TMD. Sleep stages were assessed after a full workday using one night of at-home PSG. Multiple linear regression models examined associations between sleep stages and mood adjusting for age, gender, and whether the assessment occurred pre- or post-COVID-19 emergence. Results The mean TMD score was 98.6±18.3. On average, participants slept for 397.4±60.0 minutes with a sleep efficiency of 84.6±9.1%. The mean percentage of time spent in REM sleep was 22.5±6.6%; the mean percentage of time spent in non-rapid eye movement (NREM) sleep, stage 1 (N1), stage 2 (N2), and stage 3 (N3) sleep were 7.8±5.0%, 53.7±10.1%, and 16.0±9.1%, respectively. A greater percentage of REM sleep was associated with lower TMD (β=-0.22, p=0.01). A greater percentage of N1 sleep was also associated with lower TMD (β=-0.23, p=0.01). However, neither percent of N2 nor N3 sleep were associated with TMD (p=0.10 and p=0.12, respectively). Conclusion Overall, the findings of this study support current literature that suggests REM sleep plays a significant role in mood regulation. They also suggest, aside from N1 sleep, NREM sleep may not impact mood disturbance. In the future, the effects of sleep architecture on mood disturbance could further be explored through randomized controlled trials. Support (if any) This study was funded by National Institutes of Health (NIH) grants R01HL134809 and R01HL147610.

Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans.

Vivid dreams are dreams that feel real or are associated with dream enactment behavior. They are prevalent in veterans, especially in those with psychiatric disorders such as post-traumatic stress disorders. Such psychiatric disorders have known association with abnormalities in rapid eye movement (REM) sleep. Vivid dreams are also described in neurological conditions, such Lewy body dementias, which are also associated with REM sleep abnormality. Although vivid dreams occur in neuropsychiatric disorders that have REM sleep abnormalities, there are no studies that have directly investigated an association between vivid dreams and REM sleep. We sought to study vivid dreams and REM sleep in veterans. Veterans undergoing polysomnography at our hospital were invited to enroll. Participants completed a dream-related questionnaire the morning after their polysomnography. We prospectively enrolled 505 veterans. After a night in the sleep laboratory, 196 of 504 (39%) reported experiencing a dream, and, of those, 117 of 190 (62%) described their dream as vivid. Discrepancies in patient totals are secondary to missing questionnaire data. Our novel finding is that participants with a high percentage of REM sleep (above 25%) were more than twice likely to report a vivid dream than participants with a lower percentage of REM sleep (P < .0001). Nonvivid dreams were not associated with a high percentage of REM sleep. Vivid dreams are associated with a high percentage of REM sleep. Further research into the role of REM sleep abnormalities in vivid dreams may help to advance understanding of neuropsychiatric disorders. Fattal D, Platti N, Hester S, Wendt L. Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans. J Clin Sleep Med. 2023;19(9):1661-1668.

Reduction in the propensity of rapid eye movement sleep and phasic-to-tonic ratio in patients with refractory epilepsy.

Patients with epilepsy exhibit disturbed sleep architecture and shorter rapid eye movement (REM) sleep compared with healthy controls. REM sleep consists of two microstates, phasic and tonic REM. Studies suggest that epileptic activity is suppressed in phasic but not in tonic REM. However, changes in the REM microstructure in patients with epilepsy are still unknown. Therefore, this study evaluated the differences in REM microstructure between patients with refractory and medically controlled epilepsy. This retrospective case-control study included patients with refractory and medically controlled epilepsy. Sleep parameters of the patients were recorded by standard polysomnography. In addition, the microstructures of sleep and REM sleep were compared between the two epilepsy groups. Forty-two patients with refractory epilepsy and 106 with medically controlled epilepsy were evaluated. The refractory group showed significantly decreased REM sleep (p = 0.0062), particularly in the first and second sleep cycles (p = 0.0028 and 0.00482, respectively), as well as longer REM latency (p = 0.0056). Eighteen and 28 subjects in the refractory and medically controlled epilepsy groups, respectively, with comparable REM sleep percentages, underwent REM microstructure examination. Phasic REM sleep was significantly lower in the refractory group (4.5% ± 2.1% vs. 8.0% ± 4.1%; p = 0.002). In addition, the phasic-to-tonic ratio was significantly decreased (4.8 ± 2.3 vs. 8.9 ± 4.9; p = 0.002) and negatively associated with refractory epilepsy (coefficient = -0.308, p = 0.0079). Patients with refractory epilepsy exhibited REM sleep disturbance at both macro and microstructure levels.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Variations in Sleep Architecture among Different Subtypes of Schizophrenia: A Cross-sectional Study

Introduction: Schizophrenia is a severe mental disorder characterised by positive symptoms such as delusions and hallucinations, as well as negative symptoms including anhedonia, asociality, avolition, and affective blunting. It may also be associated with cognitive deficits. Sleep disturbances are commonly encountered in schizophrenia, and there may be variations in sleep patterns among its different subtypes. These differences in sleep patterns could have prognostic implications for the various subtypes of schizophrenia. Effective management of sleep disturbances could contribute to the recovery and wellbeing of individuals diagnosed with schizophrenia. Aim: To compare the differences in sleep architecture between the various subtypes of schizophrenia and to compare them with socio-demographically matched healthy volunteers. Materials and Methods: A cross-sectional study was conducted at the Institute of Psychiatry-Centre of Excellence, Kolkata, West Bengal, India over a duration of one year (May 2016 to June 2017). The study included 60 medication-naïve patients diagnosed with schizophrenia according to International Classification of Diseases (ICD)-10 criteria, and a control group of 30 demographically matched healthy volunteers. All study participants were aged between 18 and 60 years and free from any co-morbid illnesses. Patients with schizophrenia were further classified into four groups based on the ICD-10 subtypes: paranoid, hebephrenic, catatonic, and undifferentiated. Overnight polysomnography was performed to assess sleep parameters, including total record time, total sleep time, sleep onset latency, Rapid Eye Movement (REM), sleep latency, sleep efficiency, durations of Total Non Rapid Eye Movement (NREM) Sleep, Total REM sleep, and the different phases of NREM sleep. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. Analysis of Variance (ANOVA), Chi-square, and t-test were used as applicable, with a p-value &lt;0.05 considered statistically significant. Results: The results showed a decrease in sleep efficiency, total sleep time, and shorter duration of mean N1, N2, and N3 sleep in schizophrenia patients compared to the control group. There was a significant difference in N3 sleep duration, reduced duration of total NREM and REM sleep, reduced REM latency, increased sleep onset latency, and the number of awakenings during sleep in schizophrenia patients. Statistically significant differences (p-values &lt;0.05) were also noted in some sleep parameters among the various subtypes of schizophrenia. The paranoid subtype had the shortest REM latency, while the catatonic subtype had the longest. The hebephrenic subtype had the lowest percentage of REM sleep and sleep efficiency, while the catatonic subtype had the highest. The duration of Slow Wave Sleep (SWS) was lowest in the undifferentiated subtype and highest in the catatonic subtype. Conclusion: This study reveals significant differences in sleep patterns between patients with schizophrenia and the control group, as well as among the various subtypes of schizophrenia. These distinctions provide insight into the relationship between schizophrenia subtypes, sleep irregularities, and clinical consequences. Further investigation is necessary to explore differences in sleep architecture among the various subtypes of schizophrenia and yield clinically meaningful results.

Assessment of glymphatic function in narcolepsy using DTI-ALPS index

IntroductionSleep is a modulator of glymphatic activity which is altered in various sleep disorders. Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness (EDS), rapid onset of rapid eye movement (REM) sleep, cataplexy, disturbed night sleep with fragmentation. It is categorized into two types, type 1 (NT1) and type 2 (NT2) depending on the presence of cataplexy and/or absence of orexin. We sought for alterations in glymphatic activity in narcoleptic patients using diffusion tensor imaging (DTI) along perivascular space (ALPS) index on magnetic resonance imaging (MRI). Material and methodsAdult patients diagnosed with NT1 or NT2 who had polysomnography (PSG) and MRI with DTI were included in the study. Sleep recording included Epworth Sleepiness Scale (ESS) score, sleep latency during multiple sleep latency test (MSLT), sleep efficiency during night PSG, wake after sleep onset (WASO), REM sleep latency during PSG, percentage of non-REM (NREM), REM sleep and wakefulness during night PSG. DTI-ALPS index was calculated for each patient and age-sex matched healthy control(HC)s. ResultsThe study group was composed of 25 patients [F/M = 15/10, median age = 34 (29.5–44.5)], 14 with NT1 and 11 with NT2 disease. ESS, WASO and percentage of wakefulness were significantly higher in NT1 patients (p < 0.05). Mean DTI-ALPS was not significantly different neither between narcoleptic patients and HCs, nor between NT1 and NT2 patients (all, p > 0.05). However, DTI-ALPS was negatively correlated with WASO (r = −0.745, p = 0.013) and percentage of wakefulness (r = −0.837, p = 0.005) in NT1 patients. DTI-ALPS correlated negatively with percentage of N1 sleep (r = −0.781, p = 0.005) but positively with REM percentage (r = 0.618, p = 0.043) in NT2 patients. ConclusionIn this study, DTI-ALPS was not significantly different in narcoleptic patients than the HCs. However, the glymphatic index as assessed by DTI-ALPS correlated with PSG parameters; negatively with WASO, percentage of wakefulness in NT1, percentage of N1 sleep in NT2, and positively with REM sleep in NT2. A tendency for a reduction in DTI-ALPS in NT1 patients compared to both NT2 patients and HCs was also found. These findings might show the first evidence of an alteration of glymphatic activity, especially in NT1 patients, thus warrant further prospective studies in larger size of narcoleptic patient cohorts.

The Effect of Bi-Level Positive Airway Pressure on Sleep Structure in Patients with Overlap Syndrome

Objective: The present study aimed to observe the effect of bi-level positive airway pressure on sleep structure in patients with overlap syndrome (OS). Method: Forty patients with OS were randomly divided into control and experimental groups, respectively, with 20 cases in each group. Patients in both the control and experimental groups were given anti-infection, dilating bronchi, expectoration, and oxygen inhalation treatment according to the conditions. Bi-level positive airway pressure was conducted in patients in the experimental group for approximately 10 hr a day over a one-week therapeutic course. Polysomnography, Sleep questionnaire survey was performed before treatment and after one week of treatment in both the control and experimental groups to measure sleep structure to investigate the drowsiness and quality of life of the patients. Results: (1) Prior to treatment, differences in the total sleep time, sleep latency, rapid eye movement (REM) latency, sleep efficiency, phase I, II, and III sleep, REM phase sleep and sleep questionnaire survey was not statistically significant between the two groups (P &gt; 0.05). (2) One week after treatment, compared with the control group, the REM latency in the experimental group was shortened, the percentage of REM sleep and Rem sleep in total sleep time was prolonged, the second stage sleep time and the percentage of second stage sleep in total sleep time were shortened, and the scores of Epworth drowsiness, fatigue, dizziness, lack of energy and anxiety decreased in the sleep questionnaire. There was no significant difference in other indexes (P &gt; 0.05). After treatment in the experimental group, REM latency was shortened, REM sleep time and the percentage of Rem sleep in total sleep time were prolonged, second-stage sleep time and second-stage sleep in total sleep time were shortened. Sleep questionnaire survey showed that Epworth drowsiness score, fatigue, dizziness, mental in concentration and anxiety symptoms decreased. There was no significant difference in other indexes (P &gt; 0.05). The sleep questionnaire in the control group after treatment showed that the score of fatigue symptoms decreased, and the difference was statistically significant (P &lt; 0.05). There was no significant difference in other indexes (P &gt; 0.05). Conclusion: Bi-level positive airway pressure can potentially shorten REM latency, prolong REM sleep, and shorten phase II sleep, alleviate the symptoms of drowsiness, fatigue, dizziness, distraction and anxiety, and improve the quality of life in patients with OS.

Increased Rapid Eye Movement Sleep Is Associated With a Reduced Risk of Heart Failure in Middle-Aged and Older Adults.

ObjectivesRapid eye movement (REM) sleep is closely related to all-cause mortality. The aim of this study is to explore the role of REM sleep on the incident heart failure (HF).MethodsWe selected 4490 participants (2480 women and 2010 men; mean age, 63.2 ± 11.0 years) from the Sleep Heart Health Study. HF was identified as the first occurrence during a mean follow-up period of 10.9 years. REM sleep including percentage of REM sleep and total REM sleep time were monitored using in-home polysomnography at baseline. Multivariable Cox regression analysis was utilized to explore the relationship between REM sleep and HF.ResultsIn total, 436 (9.7%) cases of HF were observed during the entire follow-up period. After adjusting for potential covariates, an increased percentage of REM sleep (per 5%) was independently associated with a reduced incidence of HF [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.82–0.94, P < 0.001]. A similar result was also found between total REM sleep time (increased per 5 min) and incident HF (HR 0.97, 95% CI 0.95–0.99, P < 0.001). Moreover, the fourth quartile of both percentage of REM sleep (HR 0.65, 95% CI 0.48–0.88, P = 0.005) and total REM sleep time (HR 0.64, 95% CI 0.45–0.90, P = 0.010) had lower risk of incident HF when compared with the first quartile.ConclusionAn increased percentage of REM sleep and total REM sleep time were associated with a reduced risk of HF. REM sleep may be a predictor of the incident HF.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT00005275].

Self-Conscious Affect Is Modulated by Rapid Eye Movement Sleep but Not by Targeted Memory Reactivation–A Pilot Study

The neurophysiological properties of rapid eye movement sleep (REMS) are believed to tune down stressor-related emotional responses. While prior experimental findings are controversial, evidence suggests that affective habituation is hindered if REMS is fragmented. To elucidate the topic, we evoked self-conscious negative affect in the participants (N = 32) by exposing them to their own out-of-tune singing in the evening. Affective response to the stressor was measured with skin conductance response and subjectively reported embarrassment. To address possible inter-individual variance toward the stressor, we measured the shame-proneness of participants with an established questionnaire. The stressor was paired with a sound cue to pilot a targeted memory reactivation (TMR) protocol during the subsequent night's sleep. The sample was divided into three conditions: control (no TMR), TMR during slow-wave sleep, and TMR during REMS. We found that pre- to post-sleep change in affective response was not influenced by TMR. However, REMS percentage was associated negatively with overnight skin conductance response habituation, especially in those individuals whose REMS was fragmented. Moreover, shame-proneness interacted with REM fragmentation such that the higher the shame-proneness, the more the affective habituation was dependent on non-fragmented REMS. In summary, the potential of REMS in affective processing may depend on the quality of REMS as well as on individual vulnerability toward the stressor type.

Subjective-objective sleepiness discrepancy in adult-onset myotonic dystrophy type 1.

Subjective-objective sleepiness discrepancy in adult-onset myotonic dystrophy type 1.