Rapid Eye Movement Periods Research Articles

Regulation action and nerve electrophysiology mechanism of acupuncture on arousal state in patients of primary insomnia

To compare the difference between acupuncture and estazolam on arousal state in patients of primary insomnia, and to explore its nerve electrophysiology mechanism. Sixty-four patients of primary insomnia were randomized into an acupuncture group (32 cases) and a medication group (32 cases). After 3 patients were excluded, 31 cases in the acupuncture group and 30 cases in the medication group were included. Patients in the acupuncture group were treated with acupuncture at Sishencong (EX-HN 1), Anmian (Extra), Shenmen (HT 7), Sanyinjiao (SP 6), Zhaohai (KI 6), Shenmai (BL 62) as main acupoints, combined with supporting acupoints, once a day, five times per week, continuously for 4 weeks. Patients in the medication group were treated with oral administration of estazolam, once a day, continuously for 4 weeks. The Pittsburgh sleep quality index (PSQI) and mean sleep latency (MSL) of multiple sleep latency test (MSLT) were compared before and after treatment in the two groups; the polysomnography (PSG) was applied to monitor the indices regarding sleep structure. Compared before treatment, PSQI score was reduced after treatment in the two groups (both P<0.01), which was more significant in the acupuncture group (P<0.05). Compared before treatment, sleep onset latency (SOL), number of awakenings (NWAK) and wake after sleep onset (WASO) were reduced, while total sleep time (TST) and sleep efficiency (SE) were significantly increased in the two groups after treatment (all P<0.01). Compared before treatment, the percentage of non-rapid eye movement period 1/2/3 (N1, N2, N3) and the percentage of rapid eye movement period (REM) to TST were not significantly changed after treatment in the medication group (all P>0.05). Compared before treatment, the percentage of N1, N2 to TST was reduced, while the percentage of N3 and REM to TST was increased after treatment in the acupuncture group (P<0.01). The SOL, NWAK, WASO, TST, SE were not statistically changed after treatment in each group (all P>0.05). Compared with the medication group, the percentage of N1 and N2 was reduced while that of N3 and REM was increased after treatment in the acupuncture group (all P<0.01). After treatment, MSL of MSLT were obviously decreased in the two groups (both P<0.01), which were more significant in the acupuncture group (P<0.05). Acupuncture can more effectively improve sleep quality of primary insomnia than estazolam, and is more beneficial for regulation of hyperarousal state.

Exploring the neural correlates of dream phenomenology and altered states of consciousness during sleep.

The science of dreaming constitutes a relevant topic in modern-day neuroscientific research and provides major insights into the study of human consciousness. Linking specific, universal, and regularly occurring stages of sleep with dreaming encourages the direct and systematic investigation of a topic that has fascinated humankind for centuries. In this review, we explore to what extent individuals dream during periods of rapid eye movement and non-rapid eye movement sleep, and we introduce research on lucid dreaming. We then discuss how dreaming during different stages of sleep varies in terms of phenomenological characteristics, and to what extent individuals are conscious throughout the sleep cycle. Finally, we provide a synopsis of the previous literature on brain activity during sleep, and we aim to clarify how the neurofunctional changes observed throughout sleep may lead to changes in phenomenological aspects of dreams, and in the domain of consciousness.

Stilbene Glucoside, a Putative Sleep Promoting Constituent from Polygonum multiflorum Affects Sleep Homeostasis by Affecting the Activities of Lactate Dehydrogenase and Salivary Alpha Amylase.

Chinese herbal medicine (CHM) has been used for treating insomnia for centuries. The most used CHM for insomnia was Polygonum multiflorum. However, the molecular mechanism for CHM preventing insomnia is unknown. Stilbene glucoside (THSG), an important active component of P. multiflorum, may play an important role for treating insomnia. To test the hypothesis, Kunming mice were treated with different dosages of THSG. To examine the sleep duration, a computer-controlled sleep-wake detection system was implemented. Electroencephalogram (EEG) and electromyogram (EMG) electrodes were implanted to determine sleep-wake state. RT-PCR and Western blot was used to measure the levels of lactate dehydrogenase (LDH) and saliva alpha amylase. Spearman's rank correlation coefficient was used to identify the strength of correlation between the variables. The results showed that THSG significantly prolonged the sleep time of the mice (p<0.01). THSG changed sleep profile by reducing wake and rapid eye movement (REM) period, and increasing non-REM period. RT-PCR and Western blot analysis showed that THSG could down-regulate the levels of LDH and saliva alpha amylase (p<0.05). The level of lactate and glucose was positively related with the activity of LDH and saliva alpha amylase (p<0.05), respectively. On the other hand, the activities of LDH and amylase were negatively associated with sleep duration (p<0.05). The levels of lactate and glucose affect sleep homeostasis. Thus, THSG may prevent insomnia by regulating sleep duration via LDH and salivary alpha amylase.

Trypanosoma brucei Invasion and T-Cell Infiltration of the Brain Parenchyma in Experimental Sleeping Sickness: Timing and Correlation with Functional Changes.

BackgroundThe timing of Trypanosoma brucei entry into the brain parenchyma to initiate the second, meningoencephalitic stage of human African trypanosomiasis or sleeping sickness is currently debated and even parasite invasion of the neuropil has been recently questioned. Furthermore, the relationship between neurological features and disease stage are unclear, despite the important diagnostic and therapeutic implications.MethodologyUsing a rat model of chronic Trypanosoma brucei brucei infection we determined the timing of parasite and T-cell neuropil infiltration and its correlation with functional changes. Parasite DNA was detected using trypanosome-specific PCR. Body weight and sleep structure alterations represented by sleep-onset rapid eye movement (SOREM) periods, reported in human and experimental African trypanosomiasis, were monitored. The presence of parasites, as well as CD4+ and CD8+ T-cells in the neuropil was assessed over time in the brain of the same animals by immunocytochemistry and quantitative analyses.Principal findingsTrypanosome DNA was present in the brain at day 6 post-infection and increased more than 15-fold by day 21. Parasites and T-cells were observed in the parenchyma from day 9 onwards. Parasites traversing blood vessel walls were observed in the hypothalamus and other brain regions. Body weight gain was reduced from day 7 onwards. SOREM episodes started in most cases early after infection, with an increase in number and duration after parasite neuroinvasion.ConclusionThese findings demonstrate invasion of the neuropil over time, after an initial interval, by parasites and lymphocytes crossing the blood-brain barrier, and show that neurological features can precede this event. The data thus challenge the current clinical and cerebrospinal fluid criteria of disease staging.

Spectral electroencephalography profile of rapid eye movement sleep at sleep onset in narcolepsy type 1.

The sleep-onset rapid eye movement (REM) period (SOREMP), the hallmark of narcolepsy, may be a specific state and not the simple anticipation of REM sleep. We analyzed the electroencephalographic spectral content in untreated patients with narcolepsy type 1 (NT1) during the sleep-onset period (SOP) and during nocturnal REM sleep in two consecutive nocturnal recordings from 31 patients with NT1 (mean age 34 ± 15 years, 18 males) and a single nocturnal recording from 36 controls (mean age 38 ± 13 years, 21 males). The SOP was defined as the first 10 min starting at the beginning of the first epoch of any sleep stage, and further divided into two consecutive 5-min periods (SOP-1 and SOP-2); 1 min of artifact-free quiet wakefulness after lights-off was identified as well as 5 min of REM sleep in the middle of the night and another 5 min during the last REM sleep period. Electroencephalographic spectral analysis was performed using the C3/A2 channel. The SOP-1 and, more strikingly, SOP-2 had significantly less delta and sigma activity in patients with NT1 in the SOREMP condition versus both controls and patients with NT1 without SOREMP. SOP-2 also showed less theta and alpha activity. Conversely, sigma and beta activity were more represented during SOREMP compared with the nocturnal REM period in patients with NT1. The analysis of the SOP supports the concept that SOREMP is a different state compared with both nocturnal REM sleep and non-REM sleep onset.

Sleep–wake patterns, non-rapid eye movement, and rapid eye movement sleep cycles in teenage narcolepsy

BackgroundTo further characterize sleep disorders associated with narcolepsy, we assessed the sleep–wake patterns, rapid eye movement (REM), and non-REM (NREM) sleep cycles in Chinese teenagers with narcolepsy. MethodsA total of 14 Chinese type 1 narcoleptic patients (13.4 ± 2.6 years of age) and 14 healthy age- and sex-matched control subjects (13.6 ± 1.8 years of age) were recruited. Ambulatory 24-h polysomnography was recorded for two days, with test subjects adapting to the instruments on day one and the study data collection performed on day two. ResultsCompared with the controls, the narcoleptic patients showed a 1.5-fold increase in total sleep time over 24 h, characterized by enhanced slow-wave sleep and REM sleep. Frequent sleep–wake transitions were identified in nocturnal sleep with all sleep stages switching to wakefulness, with more awakenings and time spent in wakefulness after sleep onset. Despite eight cases of narcolepsy with sleep onset REM periods at night, the mean duration of NREM–REM sleep cycle episode and the ratio of REM/NREM sleep between patients and controls were not significantly different. ConclusionOur study identified hypersomnia in teenage narcolepsy despite excessive daytime sleepiness. Sleep fragmentation extended to all sleep stages, indicating impaired sleep–wake cycles and instability of sleep stages. The limited effects on NREM–REM sleep cycles suggest the relative conservation of ultradian regulation of sleep.

Adult Brain Serotonin Deficiency Causes Hyperactivity, Circadian Disruption, and Elimination of Siestas.

Serotonin (5-HT) is a crucial neuromodulator linked to many psychiatric disorders. However, after more than 60 years of study, its role in behavior remains poorly understood, in part because of a lack of methods to target 5-HT synthesis specifically in the adult brain. Here, we have developed a genetic approach that reproducibly achieves near-complete elimination of 5-HT synthesis from the adult ascending 5-HT system by stereotaxic injection of an adeno-associated virus expressing Cre recombinase (AAV-Cre) into the midbrain/pons of mice carrying a loxP-conditional tryptophan hydroxylase 2 (Tph2) allele. We investigated the behavioral effects of deficient brain 5-HT synthesis and discovered a unique composite phenotype. Surprisingly, adult 5-HT deficiency did not affect anxiety-like behavior, but resulted in a robust hyperactivity phenotype in novel and home cage environments. Moreover, loss of 5-HT led to an altered pattern of circadian behavior characterized by an advance in the onset and a delay in the offset of daily activity, thus revealing a requirement for adult 5-HT in the control of daily activity patterns. Notably, after normalizing for hyperactivity, we found that the normal prolonged break in nocturnal activity (siesta), a period of rapid eye movement (REM) and non-REM sleep, was absent in all animals in which 5-HT deficiency was verified. Our findings identify adult 5-HT as a requirement for siestas, implicate adult 5-HT in sleep-wake homeostasis, and highlight the importance of our adult-specific 5-HT-synthesis-targeting approach in understanding 5-HT's role in controlling behavior. Serotonin (5-HT) is a crucial neuromodulator, yet its role in behavior remains poorly understood, in part because of a lack of methods to target specifically adult brain 5-HT synthesis. We developed an approach that reproducibly achieves near-complete elimination of 5-HT synthesis from the adult ascending 5-HT system. Using this technique, we discovered that adult 5-HT deficiency led to a novel compound phenotype consisting of hyperactivity, disrupted circadian behavior patterns, and elimination of siestas, a period of increased sleep during the active phase. These findings highlight the importance of our approach in understanding 5-HT's role in behavior, especially in controlling activity levels, circadian behavior, and sleep-wake homeostasis, behaviors that are disrupted in many psychiatric disorders such as attention deficit hyperactivity disorder.

Circadian characteristics of spontaneous physical activity and body temperature in narcoleptic patients

Objective To assess circadian characteristics of spontaneous physical activity and deep body temperature in narcoleptic patients. Methods Fourteen narcoleptic patients and 14 healthy age- and sex-matched control subjects were enrolled. Nocturnal polysomnography (PSG) was recorded, followed by standard multiple sleep latency test (MSLT). Then all subjects were required to wear the actigraphy (actiwatch) at home with continuous monitoring of spontaneous physical activity for 1-2 weeks and complete the daily sleep record. All subjects' deep body temperatures were measured at 20 time points. Results In comparison with control subjects, PSG data suggested narcoleptic patients had significantly longer time in bed at night ( P = 0.008), decreased sleep efficiency ( P = 0.001), increased awakenings ( P = 0.000), extended wake time after sleep onset ( P = 0.000) and sleep onset rapid eye movement period (SOREMP, P = 0.002). MSLT data suggested decreased average sleep latency ( P = 0.000) and increased SOREMPs ( P = 0.000). Actigraphy data suggested increased nocturnal activity and nocturnal activity per hour ( P = 0.000, for all), decreased daytime activity and daytime activity per hour ( P = 0.000, for all) and increased nocturnal activity per hour/daytime activity per hour ( P = 0.000, for all). The deep body temperature in both groups showed significant circadian rhythms. The differences in mesor, amplitude and peak phase of deep body temperature between 2 groups had no statistical significance ( P = 0.177, 0.730, 0.488). Conclusions Narcoleptic patients are characterized by impaired circadian rhythm of sleep-wake and spontaneous physical activity. The limited effects on deep body temperature suggest the relative conservation of thermoregulation in narcolepsy. DOI: 10.3969/j.issn.1672-6731.2016.07.010

Sleep-stage sequencing of sleep-onset REM periods in MSLT predicts treatment response in patients with narcolepsy.

Current treatment recommendations for narcolepsy suggest that modafinil should be used as a first-line treatment ahead of conventional stimulants or sodium oxybate. In this study, performed in a tertiary sleep disorders centre, treatment responses were examined following these recommendations, and the ability of sleep-stage sequencing of sleep-onset rapid eye movement periods in the multiple sleep latency test to predict treatment response. Over a 3.5-year period, 255 patients were retrospectively identified in the authors' database as patients diagnosed with narcolepsy, type 1 (with cataplexy) or type 2 (without) using clinical and polysomnographic criteria. Eligible patients were examined in detail, sleep study data were abstracted and sleep-stage sequencing of sleep-onset rapid eye movement periods were analysed. Response to treatment was graded utilizing an internally developed scale. Seventy-five patients were included (39% males). Forty (53%) were diagnosed with type 1 narcolepsy with a mean follow-up of 2.37 ± 1.35 years. Ninety-seven percent of the patients were initially started on modafinil, and overall 59% reported complete response on the last follow-up. Twenty-nine patients (39%) had the sequence of sleep stage 1 or wake to rapid eye movement in all of their sleep-onset rapid eye movement periods, with most of these diagnosed as narcolepsy type 1 (72%). The presence of this specific sleep-stage sequence in all sleep-onset rapid eye movement periods was associated with worse treatment response (P = 0.0023). Sleep-stage sequence analysis of sleep-onset rapid eye movement periods in the multiple sleep latency test may aid the prediction of treatment response in narcoleptics and provide a useful prognostic tool in clinical practice, above and beyond their classification as narcolepsy type 1 or 2.

Prevalence and Clinical Correlates of a Short Onset REM Period (SOREMP) during Routine PSG.

The objectives of this study were to quantify the (1) sensitivity and specificity of nocturnal PSG SOREMP (REM latency ≤ 15 min) for narcolepsy in those being evaluated for hypersomnolence and (2) prevalence and predictors of SOREMP during baseline PSG for patients being evaluated for various sleep disorders. This was a retrospective analysis of a large repository of de-identified PSG and MSLT test results from 2007 to 2013. Patient records were retrieved from a repository of studies completed at a variety of sleep laboratories across the USA. Included in the analyses were 79,651 general sleep clinic patients (without an MSLT; 48% male; 72% Caucasian) and an additional 3,059 patients (31.3% male; 72% Caucasian) being evaluated for hypersomnolence (with a consecutive MSLT). NA. For patients being evaluated for hypersomnolence, the prevalence of PSG SOREMP increased in a dose-response fashion with the number of REM onsets that occurred on a consecutive MSLT (0.5% for no MSLT SOREMPs to > 33.0% for those with 5 MSLT SOREMPs). Overall, having a PSG SOREMP was highly specific (99.5%; 95% CI: 99.1-99.7%) but not sensitive (6.7%; 95% CI: 4.7-9.2%) for narcolepsy. The prevalence of PSG SOREMP for patients in the general sleep clinic sample (i.e., not being evaluated by a consecutive MSLT) was 0.8% and was much higher in those that work night/swing shift. In adjusted models, African American race contributed to the most variance in PSG SOREMP. A short onset rapid eye movement (REM) latency occurs rarely in general sleep clinic samples (< 1.0%), but is highly specific for the diagnosis of narcolepsy. Although rare, the prevalence of the phenomenon is much higher than the estimated prevalence of narcolepsy and may provide a critical opportunity for practitioners to identify narcolepsy in sleep clinic patients. These data also suggest that the utility of polysomnography (PSG) short onset REM peroid (SOREMP) for the diagnosis of narcolepsy may be altered by a history of shift/night work and/ or other factors that may allow for a rebound of REM sleep (e.g., undergoing a positive airway pressure titration), supporting published guidelines that other sleep disorders and insufficient and/or poorly timed sleep should be ruled out and/or adequately controlled for prior to conducting sleep testing. Further research is needed to understand racial differences in PSG SOREMP and narcolepsy. This study was limited in that data on cataplexy (with exception to that in final diagnosis) and habitual sleep duration were not available.

Nocturnal Sleep Dynamics Identify Narcolepsy Type 1

To evaluate the reliability of nocturnal sleep dynamics in the differential diagnosis of central disorders of hypersomnolence. Cross-sectional. Sleep laboratory. One hundred seventy-five patients with hypocretin-deficient narcolepsy type 1 (NT1, n = 79), narcolepsy type 2 (NT2, n = 22), idiopathic hypersomnia (IH, n = 22), and "subjective" hypersomnolence (sHS, n = 52). None. Polysomnographic (PSG) work-up included 48 h of continuous PSG recording. From nocturnal PSG conventional sleep macrostructure, occurrence of sleep onset rapid eye movement period (SOREMP), sleep stages distribution, and sleep stage transitions were calculated. Patient groups were compared, and receiver operating characteristic (ROC) curve analysis was used to test the diagnostic utility of nocturnal PSG data to identify NT1. Sleep macrostructure was substantially stable in the 2 nights of each diagnostic group. NT1 and NT2 patients had lower latency to rapid eye movement (REM) sleep, and NT1 patients showed the highest number of awakenings, sleep stage transitions, and more time spent in N1 sleep, as well as most SOREMPs at daytime PSG and at multiple sleep latency test (MSLT) than all other groups. ROC curve analysis showed that nocturnal SOREMP (area under the curve of 0.724 ± 0.041, P < 0.0001), percent of total sleep time spent in N1 (0.896 ± 0.023, P < 0.0001), and the wakefulness-sleep transition index (0.796 ± 0.034, P < 0.0001) had a good sensitivity and specificity profile to identify NT1 sleep, especially when used in combination (0.903 ± 0.023, P < 0.0001), similarly to SOREMP number at continuous daytime PSG (0.899 ± 0.026, P < 0.0001) and at MSLT (0.956 ± 0.015, P < 0.0001). Sleep macrostructure (i.e. SOREMP, N1 timing) including stage transitions reliably identifies hypocretin-deficient narcolepsy type 1 among central disorders of hypersomnolence.

What Does One Sleep-Onset REM Period—During Either Nocturnal Polysomnography or Multiple Sleep Latency Test—Mean in Differential Diagnosis of Central Hypersomnias?

The differentiation of narcolepsy without cataplexy from idiopathic hypersomnia is based on the number of sleep-onset rapid eye movement periods (SOREMPs) observed by multiple sleep latency test (MSLT) and nocturnal polysomnography. The main aim of this study was to investigate the utility of SOREMP in differential diagnosis of central hypersomnias. The authors retrospectively evaluated consecutive 101 patients with a normal polysomnography other than the presence of SOREMP and/or REM without atonia and a latency of ≤8 minutes in MSLT. The authors classified patients as follows: 52 patients had at least 2 SOREMPs (narcolepsy group), 23 had no SOREMPs (idiopathic hypersomnia group), and 26 patients had only 1 SOREMP (intermediate group). In polysomnographic recordings, both mean sleep latency and REM latency were significantly shorter in the narcolepsy (P = 0.012, P < 0.001, respectively) and intermediate groups (P = 0.005 and P = 0.035, respectively) compared with the idiopathic hypersomnia group. In MSLT recordings, sleep latency was 2.7 ± 2.2 minutes in the narcolepsy group, 3.6 ± 1.4 minutes in the intermediate group, and 5.2 ± 2.7 minutes in the idiopathic hypersomnia group (P < 0.001). The mean REM latency and sleep stages SOREMPs arised from were similar between the narcolepsy and intermediate groups. To date, SOREMPs in MSLT and polysomnography remain the sole electrodiagnostic feature that discriminates narcolepsy without cataplexy from idiopathic hypersomnia. Different parameters or combined criteria are being increasingly investigated to increase the sensitivity and specificity of MSLT. The findings showed an altered instability of REM sleep not only in patients with 2 or more SOREMPs in MSLT but also in patients with one SOREMP.

Narcolepsy in childhood

Narcolepsy is characterized by excessive daytime sleepiness and symptoms of disordered control of rapid eye movement (REM) sleep. The boundaries between waking and REM sleep become blurred resulting in REM phenomena in wakefulness and features of wakefulness during sleep. Narcolepsy is not rare, with a prevalence of 25–50/100,000 in Western Europe, however many individuals remain undiagnosed for many years after the onset of symptoms [1]. One third of adults with narcolepsy describe their first symptoms appearing before the age of 15 and there is a clear peak of onset in the teenage years [2]. The classic narcolepsy tetrad comprised excessive daytime sleepiness, cataplexy (loss of muscle tone triggered by strong emotion, most frequently laughter), sleep paralysis and hypnagogic (on falling asleep) and hypnopompic (on waking) hallucinations. Disturbed nighttime sleep was often added to make up a pentad. These symptoms apart from excessive daytime sleep and cataplexy are not uncommon in unaffected individuals and other sleep disorders. The International Classification of Sleep Disorders defines narcolepsy without cataplexy as excessive daytime sleepiness and multiple sleep onset REM periods on multiple sleep latency testing (MSLT) [3]. Narcolepsy with cataplexy is associated with a deficiency of cerebrospinal fluid (CSF) hypocretin, a

Four Narcolepsy Cases after H1N1 Infection or Vaccination

Narcolepsy was known as a disease caused by loss of hypocretin cells in the hypothalamus, might be an autoimmune disorder or involve an infectious agent with participation of immune system.1 The diagnostic criteria of narcolepsy according to the third edition of International Classification of Sleep Disorders-3 is: 1) The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least three months. 2) The presence of one or both of the following: (1) Cataplexy (as defined under Essential Features) and a mean sleep latency of ≤ 8 minutes and two or more sleep onset rapid eye movement (REM) periods (SOREMPs) on an multiple sleep latency tests (MSLT) performed according to standard techniques. A SOREMP (within 15 minutes of sleep onset) on the preceding nocturnal polysomnogram may replace one of the SOREMPs on the MSLT. (2) Cerebrospinal fluid (CSF) hypocretin-1 concentration, measured by immunoreactivity, is either ≤ 110 pg/mL or <1/3 of mean values obtained in normal subjects with the same standardized assay. The mechanism seems to be associated with human leukocyte antigen (HLA), T-cell receptor polymorphisms and recently reported Tribbles 2 autoantibodies.2 However, only 1–2% of first degree relatives of narcoleptics develop the disease and 70–75% of monozygotic twins are discordant for the disorder, suggesting strong environmental influence.3,4 Previous studies proposed Streptococcal infections as probable environmental trigger for narcolepsy.5 We report 4 cases of narcolepsy that were developed after Influenza A/H1N1 infection or vaccination who had neither previous medicosurgical nor neuropsychiatric history.

Features of REM-related Sleep Disordered Breathing in the Japanese Population.

Rapid eye movement (REM)-related sleep disordered breathing (SDB) is an entity in which the cessation or reduction of breathing occurs primarily during the REM period. Most studies have shown that REM-related SDB more frequently affects women, younger people and patients with mild or moderate SDB. The aim of this study was to prospectively investigate the prevalence and features of REM-related SDB in Japanese subjects compared with the findings of previous reports. A total of 468 patients were evaluated in this study. The diagnosis of SDB was established using polysomnographic monitoring. The patient variables included age, gender, body characteristics, comorbidities, etc. REM-related SDB was more prevalent in women than non-REM-related SDB (male ratio; 66.3% vs. 79.5%, p=0.03). Moreover, the patients with REM-related SDB had lower body mass indexes (25.9 ± 6.9 vs. 28.5 ± 7.7; p=0.003), arousal indexes (31.8 ± 10.7 vs. 61.0 ± 29.1; p<0.001), apnea hypopnea indexes (15.0 ± 8.0 vs. 54.9 ± 35.9) and glycosylated hemoglobin (HbA1c) levels (5.5 ± 0.9 vs. 5.9 ± 2.6; p=0.02) than the patients with non-REM-related SDB. However, the overall and female gender prevalence of REM-related SDB among the Japanese subjects was lower than that shown in previous reports. The finding that REM-related SDB was not prevalent in younger individuals or severely obese patients was not consistent with the results of previous studies. The present findings suggest that REM-related SDB may have different clinical characteristics in the Japanese population than that observed in previous reports.

Cognitive Dysfunction in Patients With Rapid Eye Movement Dependent and Other Types of Obstructive Sleep Apnea Syndrome

Background: Some cognitive functions have shown to be impaired in patients with obstructive sleep apnea syndrome (OSAS); however, differences between substypes have not been investigated yet. We aim to compare patients with rapid eye movement (REM) dependent sleep apnea syndrome (ROSAS) and control OSAS (COSAS) with regard to the impairment in cognitive functions and several sleep parameters. Methods: Fifty COSAS and 20 ROSAS patients who met the inclusion criteria and diagnosed via polysomnographic examination were assessed using a data collection form and several scales. Results and conclusion: No significant statistical difference was detected between groups regarding cognitive functions. The findings indicate that the cognitive function impairments in OSAS do not get more significant with the intensifying of the abnormal respiratory functions in REM periods. J Neurol Res. 2015;5(6):283-290 doi: http://dx.doi.org/10.14740/jnr363w

Cognitive Dysfunction in Patients With Rapid Eye Movement Dependent and Other Types of Obstructive Sleep Apnea Syndrome

Background: Some cognitive functions have shown to be impaired in patients with obstructive sleep apnea syndrome (OSAS); however, differences between substypes have not been investigated yet. We aim to compare patients with rapid eye movement (REM) dependent sleep apnea syndrome (ROSAS) and control OSAS (COSAS) with regard to the impairment in cognitive functions and several sleep parameters. Methods: Fifty COSAS and 20 ROSAS patients who met the inclusion criteria and diagnosed via polysomnographic examination were assessed using a data collection form and several scales. Results and conclusion: No significant statistical difference was detected between groups regarding cognitive functions. The findings indicate that the cognitive function impairments in OSAS do not get more significant with the intensifying of the abnormal respiratory functions in REM periods. J Neurol Res. 2015;5(6):283-290 doi: http://dx.doi.org/10.14740/jnr363w

PO-0473 Caffeine Treatment Has No Significant Effect On Sleep Quality In Preterm Infants: Abstract PO-0473 Table 1

Background and aims Sleep stages begin to emerge from 20 weeks’ gestational age. Typical EEG changes appear at 28–30 weeks with periods of rapid eye movement (REM) and non-REM (NREM) sleep. Sleep patterns develop into near adult like patterns by 3–5 months of age. Sleep cycles (REM/NREM) are essential for infant brain development. Caffeine is routinely used for treatment and prevention of apnea of prematurity. Its effect on sleep organisation in preterm infants has been controversial. This study aimed to find differences in sleep organisation in preterm infants before and after initiation of caffeine treatment. Methods Polysomnography was recorded in 10 preterm infants [GA 27+2–36+6 (mean 30+1) weeks, BW 790–2875 (mean 1465) g] at 34–41 (avg. 36) weeks’ GA before and the day after administration of caffeine citrate loading dose (20 mg/kg). The analysis was done with visual scoring. Results Sleep quality was variable. Some infants had very interrupted sleep structure. Uninterrupted phasic REM sleep periods seemed to be more readily identified after caffeine. However, we were unable to show this by using standard indexes. There was no difference in sleep stage distribution, number of awakenings, number of sleep stage transitions or average REM period (Table 1). Conclusions We did not find any evident effect of caffeine on sleep quality in preterm infants.

"Estou sempre com sono, será doença?" – Caso clínico de narcolepsia na adolescência

AIMS: Excessive daytime sleepiness is relatively common in adolescence, and rarely has a pathological etiology. The authors report a case of excessive daytime sleepiness due to narcolepsy in a teenager, and a review of the literature about this disease. CASE DESCRIPTION: A 16 year-old adolescent, female, since one year ago with excessive daytime sleepiness and microsleeps during her daily activities, despite adequate sleep hygiene. Physical examination was normal. Analytical study, electroencephalogram and polysomnography unremarkable. The multiple sleep latency test revealed a sleep latency of 4:22 minutes and two REM (Rapid Eye Movement) periods at sleep onset (SOREMp), suggestive of severe hypersomnia with criteria of narcolepsy. Treatment with modafinil was started, with favorable outcome. CONCLUSIONS: Narcolepsy is a rare and under diagnosed disorder in children. The disease has a negative impact on the child’s emotional, behavioral and school/work life, which can be minimized by an adequate and timely diagnosis and therapeutics.

Effects of cold exposure on autonomic changes during the last rapid eye movement sleep transition and morning blood pressure surge in humans

BackgroundVarious studies have linked the occurrence of cardiovascular events and low ambient temperatures as well as the morning blood pressure surge (MBPS). We hypothesized that low ambient temperatures produce a higher sympathetic change during the last rapid eye movement (REM) sleep transition and that this may play an important role in cold-related cardiovascular events. MethodsAll experiments were carried out on 12 healthy male adults, aged 24.00±0.74years, who participated in two experimental conditions randomly (>1day apart): warm (23°C) and cold (16°C). Blood pressure (BP) was measured every 30min for 24h by autonomic ambulatory BP monitoring. The electroencephalograms, electrocardiograms, ambient temperature, near-body temperature, and physical activity were recorded by miniature polysomnography for 24h. ResultsThe cold conditions resulted in: (i) higher MBPS than under warm conditions; (ii) significant and greater sympathetic index changes during the sleep–wake transition than during cover-to-uncover and supine-to-sit position tests; (iii) the non-REM–REM transition-related sympathetic elevation during the cold conditions being significantly higher in late sleep period than in early sleep period; (iv) at 1h prior to morning awakening, the value of total power of heart rate variability changes being significantly negatively correlated with the changes of near-body temperature; and (v) significantly higher arousal index and shorter average interval of REM periods than in warm conditions. ConclusionCold exposure elevates the amplitude of MBPS and is associated with late sleep stage transition sympathetic activation, which might have important implications for cold-related cardiovascular events.