REM Sleep Stages Research Articles

Sleep in ADCY5-Related Dyskinesia: Prolonged Awakenings Caused by Abnormal Movements.

ADCY5 mutations cause early-onset hyperkinetic movement disorders comprising diurnal and nocturnal paroxysmal dyskinesia, and patient-reported sleep fragmentation. We aimed to characterize all movements occurring during sleep and in the transition from sleep to awakening, to ascertain if there is a primary sleep disorder, or if the sleep disturbance is rather a consequence of the dyskinesia. Using video polysomnography, we evaluated the nocturnal motor events and abnormal movements in 7 patients with ADCY5-related dyskinesia and compared their sleep measures with those of 14 age- and sex-matched healthy controls. We observed an increased occurrence of abnormal movements during wake periods compared to sleep in patients with ADCY5-related dyskinesia. While asleep, abnormal movements occurred more frequently during stage N2 and REM sleep, in contrast with stage N3 sleep. Abnormal movements were also more frequent during morning awakenings compared to wake periods before falling asleep. The pattern of the nocturnal abnormal movements mirrored those observed during waking hours. Compared to controls, patients with ADCY5-related dyskinesia had lower sleep efficiencies due to prolonged awakenings secondary to the abnormal movements, but no other differences in sleep measures. Notably, sleep onset latency was short and devoid of violent abnormal movements. In this series of patients with ADCY5-related dyskinesia, nocturnal paroxysmal dyskinesia were not associated with drowsiness or delayed sleep onset, but emerged during nighttime awakenings with subsequent delayed sleep, whereas sleep architecture was normal.

Risk detection in patients with obstructive sleep apnea syndrome based on cardiovascular time series analysis.

Obstructive sleep apnea represents the most common form of sleep-disordered breathing and has a high prevalence in patients with cardiovascular disease. Disturbed sleep is a potential risk factor for cardiovascular disorders such as arterial hypertension, cardiac ischemia, sudden cardiac death, and stroke. In this study we investigated polysomnographic records and analyzed the ECG, plethysmogram, respiration and SpO2 time series during wakefulness (WK), NREM, and REM sleep stages applying variability and coupling analyses methods. We enrolled 55 patients with obstructive sleep apnea syndrome (OSAS) and 29 healthy control subjects (CON: 45.9±14.9 years, 21 male) in this study. OSAS patients were subdivided into a low- and high-risk group (LR: 50.8±14.1 years, n=29, 21 male; HR: 57.2±13.4 years, n=26, 19 male) based on the Apnea-Hypopnea Index (AHI) (CON: 0-5 AHI, LR: 5-15 AHI, HR: >15 AHI). We could demonstrate the presence of an altered autonomic function in OSAS patients, differing from healthy controls. This altered autonomic function was mainly based on heart rate-, respiratory-, SpO2- and plethysmogram variability and their couplings. The discriminant analysis showed that the optimal set consisting of two autonomic indices revealed a high classification power (ACC=86.7%, AUC=90.3%, SENS=89.5% and SPEC=84.6%) when comparing low-risk and high-risk OSAS patients during WK. These results were slightly improved when analyzing REM sleep stages. Based on these results it seems to be possible to perform optimal risk stratification for OSAS patients based on autonomic indices. Based on our findings it is possible to differentiate between high-risk OSAS patient and low-risk OSAS patient at an early stage and in a promising manner allowing to set up therapy strategies for those patients in an early stage.

Sleep quality after endoscopic sinus surgery in patients with sinonasal polyposis

ObjectivesEvaluate the effect of functional endoscopic sinus surgery (FESS) for nasal polyposis on sleep efficiency and polysomnographic parameters. Subjects and methodsThis clinical trial was conducted on 15 patients with bilateral massive sinonasal polyposis who underwent FESS between August 2012 and September 2013. All participants were evaluated subjectively by employing the Pittsburgh Sleep Quality Index (PSQI) questionnaire and objectively (provided by polysomnographic parameters) before and 2 months after surgery. ResultsThe evaluation of subjective criteria of sleep quality assessed by PSQI showed significant improvement, particularly in nocturnal awakening (P = 0.002). However, Apnea Hypopnea Index (AHI) was not reduced significantly after surgery (P = 0.233). Among patients who had suffered from obstructive sleep apnea, AHI was improved in 7 patients, deteriorated in 3 patients, and did not change in 1 patient. Although the mean duration of REM sleep stage increased from 15.2 ± 10.7 to 18.9 ± 7.9, this change was not statistically significant. Furthermore, arousal index decreased dramatically from 31.6 to 17.1 (P = 0.02) and sleep efficiency index was improved after the surgery (P = 0.008). ConclusionsThis study documented the effect of resuming nasal cavity patency on improvement of sleep efficiency after FESS. In spite of insignificant effect of FESS on apnea index, alteration of other sleep parameters like arousal index following surgery may have a positive effect on sleep quality.

Relationship Of Sleep Quality With The Event Of Hypertension In Elderly In Tresna Werdha Social Protection In West Java Province

Sleep is a basic human need that must be fulfilled. As you get older the quality of one's sleep will decrease. Sleep quality is a measure where a person can easily start sleeping, can maintain a state of sleep and get adequate REM and NREM sleep stages. Poor sleep quality can increase the risk of hypertension, heart disease, and other medical conditions. Hypertension is the main risk factor for cardiovascular disease and is known as the silent killer because it is asymptomatic. The purpose of this study was to determine the relationship between sleep quality and the incidence of hypertension in the elderly.
 The type of research used was correlative with a case control approach, the sampling technique was purposive sampling with 74 elderly people divided into control groups and case groups. Data collection uses PSQI (Pittsburgh Sleep Quality Index) and medical records, then analyzed by Chi-square.
 The results showed that there was a correlation between sleep quality and the incidence of hypertension in the elderly at the Tresna Werdha Social Institution in West Java Province (p = 0.047, p <0.05) with a low closeness rate of 0.225. Health workers are expected to be able to provide information about the factors that influence the incidence of hypertension and make efforts that can improve sleep quality in the elderly.

Evidence of P3a During Sleep, a Process Associated With Intrusions Into Consciousness in the Waking State.

The present study examines processes associated with intrusions into consciousness during an unconscious state, natural sleep. The definition of sleep is still much debated. Almost all researchers agree that sleep onset represents a gradual loss of consciousness of the external environment. For sleep to be beneficial, it needs to remain as undisturbed as possible. Nevertheless, unlike other unconsciousness states, sleep is reversible. For purposes of survival, it is critical that the sleeper be able to “detect” and perhaps become conscious of highly relevant biological or personal information. Therefore, even in sleep, the brain must decide whether a new incoming stimulus is relevant and if so, may require an arousal to wakefulness, or whether it is irrelevant and can be gated to prevent disruption of sleep. Event-related potentials (ERPs) were used to measure the extent processing of auditory stimuli some of which elicited an ERP component, the P3a, in the waking state. The P3a is associated with processes resulting in the interruption of frontal central executive, leading to conscious awareness. Very little research has focused on the occurrence of the P3a during sleep. A multi-feature paradigm was used to examine the processing of a frequently occurring “standard” stimulus and six rarely occurring different “deviant” stimuli during wakefulness, NREM, and REM sleep. A P3a was elicited by novel environmental sounds and white noise bursts in the waking state, replicating previous studies. Other deviant stimuli (changes in pitch, intensity, duration) failed to do so. The ERPs indicated that processing of the stimuli that did not elicit a P3a in wakefulness were much inhibited during both NREM and REM sleep. Surprisingly, those deviants that did elicit a P3a in wakefulness continued to do so in stage N2 and REM sleep. The subject did not, however, awaken. These results suggest processes leading to consciousness in wakefulness may still remain active during sleep possibly allowing subjects to act on potentially highly relevant input. This may also explain how sleep can be reversed if the stimulus input is sufficiently critical.

Impact of sound stimulation during different sleep stages in patients with tinnitus

It is known that auditory information is continuously processed both during wakefulness and sleep. Consistently, it has been shown that sound stimulation mimicking tinnitus during sleep decreases the intensity of tinnitus and improves the patients’ quality of life. The mechanisms underlying this effect are not known. To begin to address this question, eleven patients suffering from tinnitus were stimulated with sound mimicking tinnitus at different sleep stages; 4 were stimulated in N2, 4 in stage N3 (slow waves sleep) and 3 in REM sleep (stage with Rapid Eyes Movements). Patients’ sleep stage was monitored through polysomnography, for sound stimulation application. Tinnitus level reported by subjects were compared the days before and after stimulation and statistically analyzed (paired Student t test). All patients stimulated at stage N2 reported significantly lower tinnitus intensity the day after stimulation, while none stimulated during stage N3 and only one out of three stimulated during REM sleep showed changes. These results are consistent with studies showing that sound stimulation during N2 (sleep stage with spindles) changes power spectrum and coherence of electroencephalographic signals, and suggest that the N2 sleep stage is a critical period for reducing tinnitus intensity using this therapeutic strategy, during which auditory processing networks are more malleable by sound stimulation.

Analysis of Sleep Macrostructure in Patients Diagnosed with Parkinson's Disease.

Patients diagnosed with Parkinson’s disease present sleep disorders with a higher frequency than the general population. The sleep architecture in these patients shows variations with respect to the normal population, so in this work it was decided to investigate the characteristics of the macroarchitecture of sleep in patients diagnosed with Parkinson’s disease. A polysomnographic study was carried out on 77 patients diagnosed with Parkinson’s disease. All the studies were processed according to the AASM Manual for the Scoring of Sleep and Associated Events v.2.2, and to the criteria of the International Classification of Sleep Disorders 3rd ed. (2014). Processing was carried out using descriptive statistics, as well as non-parametric analysis for comparison between cases and controls. The group of patients showed significant reductions of the N2, N3, and REM sleep stages when compared with a control group, as well as a significant increase in intra-sleep wakefulness. The number of REM–NoREM sleep cycles and sleep efficiency showed marked reduction compared to the control group. There was a statistically significant difference in the macroarchitecture of sleep between patients diagnosed with Parkinson’s disease and healthy controls.

Heart rate variability of typically developing and autistic children and adults before, during and after sleep.

Studies suggest a sympathetic-parasympathetic disequilibrium in children with autism spectrum disorder (ASD), compared to typically developing (TD) children. The autonomic nervous system (ANS) shows profound modification with age but studies in ASD adults are lacking. The ANS is also influenced by vigilance states such as wakefulness and sleep. The aim of this study is to explore differences in ANS activity in typically developing (TD) and ASD individuals during sleep and wakefulness, as a function of age. Four groups of participants (17 adults with ASD, 16 TD adults, 13 children with ASD and 13 TD children) were recorded for two consecutive nights in a sleep laboratory. Electrocardiogram (ECG) was sampled during wakefulness (before and after sleep) and during stage N2 and REM sleep. Groups were compared on their heart rate variability parameters (LFnu, HFnu, LF/HF ratio) in each vigilance state. Results show that ASD adults had lower HFnu in the morning than TD adults (p < 0.05). During REM sleep, adults had higher LF/HF ratio than children, regardless of their clinical status (p < 0.05). Results of this study show autonomic distinctiveness during wakefulness specifically in ASD adults, suggesting a lower parasympathetic activity in the morning. Whether this characteristic represents a developmental feature or is related to lower sleep quality remains to be clarified.

Polysomnographic findings in Rett syndrome.

Rett syndrome (RS) is a severe neurodevelopment disorder associated with abnormal breathing during wakefulness and disturbed nocturnal behaviour. Breathing abnormalities during daytime have been extensively reported but polysomnographic (PSG) findings have been poorly studied. Consecutive patients with RS carrying distinct mutations in MECP2 gene, who underwent a PSG between October 2014 and January 2018, were included in the study. Clinical and PSG data were collected. Seventeen RS girls, mean age 9.5±2.8 years, were included in the study. Mean total sleep time was 366±102min. Mean sleep efficiency was reduced (66±19%) with only 3 girls presenting a sleep efficiency above 80%. Wake after sleep onset was increased (33±20%) with an arousal index of 7±6 events/hour. Sleep stages were altered with a normal N1 (2±3%), a decreased N2 (34±20%), an increase of N3 (51±23%) and a decrease of REM sleep (12±9%). Mean apnea hypopnea index (AHI) was increased at 19±37 events/hour, with a predominance of obstructive events. Thirteen patients had an AHI>1.5 event/hour. Four patients had an obstructive AHI >10 events/hour with one patient having associated tonsillar hypertrophy. Two patients had predominant severe central apneas (central AHI 53 and 132 events/hour) which resolved with noninvasive ventilation and nocturnal oxygen therapy respectively. Girls with RS have poor sleep quality with alterations in slow wave and REM sleep stages. Obstructive respiratory events are uncommon in patients without adenotonsillar hypertrophy. Central respiratory events are rare. Longitudinal studies should help understanding the natural history of sleep disturbances in RS and their relationship with the neurocognitive decline.

Severity of obstructive sleep apnea (OSA) in 382 Han and Uyghur patients with sleep disorders

Objective: Race and ethnicity may impact the prevalence and severity of Obstructive Sleep Apnea (OSA) in adults and children. In this study, we aim to investigate the ethnologic influence on OSA severity between Han and Uyghur OSA patients in Xinjiang, China.Methods: We enrolled total of 382 (205 Han and 177 Uyghur) patients diagnosed with OSA with apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) [Formula: see text] 5. During admission, the severity of OSA was evaluated by polysomnography (PSG).Results: From demographic characteristics of enrolled patients, we found that there was no significant difference in sex, age, BMI, and neck circumference between two study populations. Uyghur OSA patients had longer sleep latency, longer REM sleep and N3 stage, but shorter N1 phase than Han OSA patients. AHI and apnea RDI level, but not hypopnea RDI, were evidently higher in Han patients compared with Uyghur patients. There was no distinctive difference between two ethnic populations in average and minimum peripheral capillary oxygen saturation (SaO2) level.Conclusion: Better understanding of impact factors encompassing ethnicity may help improve OSA diagnosis accuracy, management and treatment for patients in Xinjiang.

Analysing the relationship between polysomnographic measures of sleep with measures of physical and cognitive fatigue in people with multiple sclerosis

ObjectivesWe aimed to determine whether there was a relationship between objective measures of sleep measured by polysomnography and measures of physical and cognitive fatigue in patients with Multiple Sclerosis (MS). MethodsPeople with MS of age 18–50 years of any subtype attending the OPD satisfying the revised 2010 McDonald criteria were recruited. Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS) were used to assess physical fatigue. Cognitive fatigue was measured with modified versions of the Stroop test, modified Symbol Digit Modalities Test, Serial Addition Test, and with latency and amplitude of the P300 evoked potential. Percentage of N1, N2, N3 and REM sleep stages, Sleep onset latency, Sleep efficiency, Wake after sleep onset, Respiratory event index, Periodic limb movement index were the measures recorded with polysomnography. ResultsAmong 113 patients, 43 (38.05%) complained of disturbed sleep and 88 (77.88%) complained of increased fatigability and tiredness. Mean MFIS score of the sample was 42.34 ± 9.09. Mean FSS score was 19.12 ± 9.42. Polysomnographic measures of sleep showed a significant correlation with objective measures of cognitive fatigue and did not show any significant correlation with measures of physical fatigue. ConclusionsSleep impairment is a very common problem in people with MS justifying routine polysomnographic evaluation. We have found evidence that though sleep impairment is not related to physical fatigue, it is strongly related to cognitive fatigue.

Overnight Pulse Oximetry Unwoven.

Overnight Pulse Oximetry Unwoven.

Analysis of Multichannel EEG Patterns During Human Sleep: A Novel Approach.

Classic visual sleep stage scoring is based on electroencephalogram (EEG) frequency band analysis of 30 s epochs and is commonly performed by highly trained medical sleep specialists using additional information from submental EMG and eye movements electrooculogram (EOG). In this study, we provide the proof-of-principle in 40 subjects that sleep stages can be consistently differentiated solely on the basis of spatial 3-channel EEG patterns based on root-mean-square (RMS) amplitudes. The polysomnographic 3-channel EEG data are pre-processed by RMS averaging over intervals of 30 s leading to spatial cortical activity patterns represented by 3-dimensional vectors. These patterns are visualized using multidimensional scaling (MDS), allowing a comparison of the spatial cortical activity patterns with the conventional visual sleep scoring system according to the American Academy of Sleep Medicine (AASM). Spatial cortical activity patterns based on RMS amplitudes naturally divide into different clusters that correspond to visually scored sleep stages. Furthermore, these clusters are reproducible between different subjects. Especially the cluster associated with the REM sleep stage seems to be very different from the one associated with the wake state. This study provides a proof-of-principle that it is possible to separate sleep stages solely by analyzing spatially distributed EEG RMS amplitudes reflecting cortical activity and without classical EEG feature extractions like power spectrum analysis.

Методика диалога со спящим испытуемым в состоянии осознанного сновидения с использованием дыхательных движений

In research of lucid dreams (LD), an altered state of consciousness that occurs during the REM sleep stage, the task of LD identification is normally solved with a unidirectional communication method. An experimental subject, while sleeping, signals about his/hers state by performing a series of eye movements. We have developed a new alternative method that allows for bidirectional information exchange (dialogue) between the researcher and the sleeping subject. A researcher was presenting the arithmetic tasks via audio playback. The subject analyzed the received instruction and used respiratory activity (fast series of breathing movements) or eye movements as signals to answer. Pilot series of experiments have verified the ability of the subject to maintain the dialogue and correctly execute the instructions without waking up. This indicates the subject’s sensitivity in regards to external auditory stimuli and the ability to consciously process them in the state of LD. This is the first reported method of bidirectional communication with a person in the state of LD to date, which expands the possibilities for the objective investigation of this altered state of consciousness. We also report our modification of the sleeping subject/researcher dialogue method that is currently under development. It utilizes smartphone sensors and allows conducting the experiment in remote mode via the Internet, which makes it possible to engage a broad circle of lucid dreaming enthusiasts who practice at home.

КЛАСИФІКАЦІЯ ФАЗ СНУ НА ОСНОВІ БІОРАДАРУ ЗА ДОПОМОГОЮ НЕЙРОННОЇ МЕРЕЖІ CNN-LSTM

The research is devoted to the automatic sleep stages classification based on non-invasive biosensor. A deep learning framework for classification of wakefulness, REM and NREM sleep stages (N1, N2, and N3) is proposed. The system consists of a combined convolutional and recurrent (long short-term memory, LSTM) neural network (CNN-LSTM). The proposed CNNLSTM neural network significantly outperforms existing machine learning methods based on traditional manual feature engineering. The model achieves an accuracy of 0.88 and a Cohen's Kappa agreement coefficient of 0.84, that is almost perfect agreement. The results of the study could be a promising solution for automatic sleep assessment without manual data processing and can be very useful for sleep screening.

Non-Rapid Eye Movement Sleep and Overlap Parasomnias.

This article reviews the spectrum of non-rapid eye movement (non-REM) sleep parasomnias, including sleepwalking, confusional arousals, and sleep terrors, which represent the range of phenotypic disorders of arousal from non-REM sleep that occurs in children and adults. The International Classification of Sleep Disorders, Third Edition (ICSD-3) classifies parasomnias according to the sleep stage they emerge from: REM, non-REM, or other. Demographics, clinical features, and diagnosis of non-REM parasomnias are reviewed in this article, and an up-to-date synopsis of guidelines for management strategies to assist in the treatment of these sleep disorders is provided. The non-REM parasomnias are most common in children and adolescents but may persist into adulthood. They can be distinguishable from REM parasomnias and nocturnal epilepsies, and, importantly, may lead to injury. Additionally, other parasomnias in this spectrum include sleep-related eating disorder and sexsomnia. Overlap parasomnia disorder includes one or more manifestations of a non-REM parasomnia seen in combination with REM sleep behavior disorder, representing an apparent erosion of the normally distinct stages of non-REM and REM sleep. A similar yet much more extreme dissociation of states underlies agrypnia excitata and status dissociatus, which represent rare, severe dissociations between non-REM, REM, and wake states resulting clinically in oneiric behaviors and severe derangement of normal polysomnographic wake and sleep stage characteristics. Management of non-REM and overlap parasomnias and state dissociation disorders include ensuring bedroom safety and prescription of clonazepam or hypnosis, in select cases, although in children and adolescents with noninjurious behaviors, non-REM parasomnias are often age-limited developmental disorders, which may ultimately remit by adulthood, and, in these cases, counseling and education alone may suffice. Timely and accurate recognition of the non-REM and overlap parasomnias is crucial to limiting potential patient injury.

Sleep Apnea

Background: Sleep apnea is a condition that interrupts breathing while sleeping, usually caused by an obstruction blocking the back of the throat so that the air cannot reach the lungs. The brief cessation in breath automatically forces individuals to wake up and restart breathing. This can happen many times during the night, making it hard for the body to get enough oxygen, and impacts the sleep quality. It is the most common type of sleep disorder breathing.Objectives: The present study was designed to investigate the effects of obstructive sleep apnea (OSA) on different mental, physical and nervous disorders which are manifested in such patients. This study would not only benefit in ascertaining the causes of OSA through assessment of higher mental functions of autonomic and peripheral nervous systems but also in the development of algorithm for estimation of degree of damage to the nervous system with severity of OSA.Methods: A total of 1365 consecutive participants participated in this study at the Department of Pulmonary Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana State, India for suspected sleep disordered breathing (SDB) between October 2012 and February 2016. In this cohort, 1140 participants were deemed ineligible, as per the inclusion criteria. Therefore, 225 patients were considered in the study along with 75 control subjects, who were healthy individuals. The cohort was diagnosed by an experienced pulmonologist for the symptoms of snoring and daytime somnolence. The data included documentation of age, gender, weight, height, BMI, waist and neck circumference, and clinical data such as history of apnea, insomnia, dyslipidemia, hypertension, and coronary heart disease. All participants underwent overnight polysomnography (PSG) in sleep laboratory. The cognitive function tests consisted of mini-mental state examination and by employing the depression questionnaire (Using Zung self report depression scale). The autonomic function tests were performed. Variabilities in heart rate were determined. Brain natriuretic peptide (BNP) levels in the blood were measured.Results: The study group had an AHI ≥5 per hour of sleep while the control group had AHI &lt;5 per hour of sleep. Overall, patients in the OSA cohort were older compared to those in the Control cohort. The overnight polysomnography values indicated distinct differences among the parameters of the analysis depending upon the category of the patient (i.e., mild, moderate and severe). Oxygen saturation in blood during both REM and NREM sleep stages clearly indicated lower oxygen in patient cohort than the control group. The cognitive function tests revealed that in comparison to the control group, OSA patients had significantly impaired cognition. OSA patients had significantly higher (p ≤0.05) depression. Motor action, muscle action potential and nerve action potential was significantly lower (p ≤0.05) than that of the control group of healthy patients. The plasma BNP in OSA patients was significantly higher (p ≤0.05) than control subjects. RR intervals in the patient group were significantly shorter than in the control group. The blood pressure of the OSA patients in general was relatively higher than the control group, both during the postural response and in handgrip test.Conclusions: Among the enrolled individuals, those with severe OSA were affected in all faculties, namely, cognitive abilities and health attributes; and had high BNP levels in their blood. In aggregate, OSA patients can be alleviated from the syndrome, if accurate diagnosis is made on time. This study developed an algorithm which would aid the clinicians in early detection of OSA symptoms and mitigate the prognosis of the syndrome. Journal of Gandaki Medical CollegeVolume, 09, Number 2, July December 2016, 29-37

Stereo-electroencephalography identifies N2 sleep and spindles in human hippocampus.

To describe the hippocampal stereo-electroencephalogram during sleep according to sleep stages (including N2 sleep) and cycles, together with the hippocampal spindles. All patients with drug-resistant focal epilepsy undergoing intra-hippocampal implantation between August 2012 and June 2013 at Nancy University Hospital were screened. Six patients with explored hippocampus devoid of pathological features were analyzed. During one night, we identified continuous periods of successive N2, N3 and REM sleep for two full cycles. We performed a spectral analysis of the hippocampal signal for each labeled sleep period. N2, N3 and REM sleeps were individualized according to their spectral powers, for each frequency band and sleep cycle. Hippocampal spindles showed dynamic intrinsic properties, the 11.5-16Hz frequency band being mainly dominant, whereas the 9-11.5Hz frequency band heightening during the beginning and the end of the transient. For N3 and REM sleep stages, the power of the hippocampal signal was significantly decreased between the first and the second sleep cycle. Distinct N2 sleep, fast spindles and homeostatic profile are all common properties shared by hippocampus and cortex during sleep. The close functional link between hippocampus and cortex may have various sleep-related substrates.

Blood count values and ratios for predicting sleep apnea in obese children

ObjectivesTo detect whether the mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are contributing factors in the diagnosis and severity of sleep apnea in obese children. IntroductionObesity is a public health problem, and its prevalence increases daily. Although PSG is the gold standard test in the investigation of sleep apnea, the application of this test requires equipment, personnel, time, and cost. There is no simple laboratory test for diagnosing and determining the severity of sleep apnea. Recently, MPV, NLR, and PLR, known as the inflammatory markers in CBC test parameters, have been investigated in some studies. We aim to investigate whether these parameters could provide a method for diagnosing and determining the severity of OSAS in obese children. MethodsClinical records of 180 patients were evaluated. All subjects had venous blood samples collected from the antecubital vein in the morning, after an overnight fasting, one day before PSG. Hemoglobin, RDW, MPV, PLT, platelet distribution width (PDW), and WBC count were measured. After anthropometric and laboratory analysis, 127 obese children were assessed for sleep study. Eighty-three patients who met the required polysomnographic criteria were divided into three groups as follows: group A [non-OSAS, apnea-plus-hypopnea index (AHI) < 1], groupB (1 ≤ AHI < 5), and groupC (AHI ≥ 5). ResultsTotal recording time, total sleep time, sleep efficiency, REM, and NREM sleep stage latency values were not statistically significant among groups. However, the number of awakenings, AHI, oxygen desaturation events, mean oxygen saturation, lowest oxygen saturation, average desaturation, and snoring time values had significant difference among the groups. There was no statistically significant difference among the groups in terms of WBC, Hemoglobin, platelets, PDW, neutrophil, and lymphocyte values. However, RDW values showed a statistically significant difference between groups A and C. Although there was no statistically significant difference of MPV values among groups, NLR and PLR values were statistically significant between groups A and C. ConclusionAccording to our study, NLR, PLR, and RDW were found to be significantly higher in children whose AHI was ≥5 than in children from the other groups. However, no correlation was found between MPV levels and OSAS in children.

Sleep architecture in insomniacs with severe benzodiazepine abuse

Benzodiazepines (BZDs) are the most commonly prescribed compounds in insomnia. A long-term of BZDs use may cause dependence and abuse. The aim of this study was to evaluate sleep architecture and microstructure (in terms of cyclic alternating pattern - CAP - analysis and of sleep EEG power spectral analysis) in a group of long-term users of high doses of BZDs for their primary chronic insomnia. Twenty patients consecutively admitted at the Sleep Centre for drug discontinuation and 13 matched healthy controls underwent a full nocturnal video-polysomnographic recording, after one adaptation night. Significant differences were found in time in bed, REM sleep latency and sleep stage 1% which were increased in patients compared to controls, while CAP rate was dramatically decreased. During NREM sleep, patients showed a clear decrease in the relative power of delta band. Our data demonstrate that in adults with chronic insomnia, long-term use of high doses of BZDs induces a severe disruption of sleep microstructure, while sleep architecture seems to be much less affected. The long term use of high doses of BZDs for chronic insomnia induces a marked depression of slow wave activity and of its physiological instability.