Significant Sleep Disruption Research Articles

Association between death and loss of stage N2 sleep features among critically Ill patients with delirium

PurposeCritically ill patients experience significant sleep disruption. In this study of ICU patients with delirium, we evaluated associations between the loss of stage N2 features (K-complexes, sleep spindles), grade of encephalopathy based on electroencephalography (EEG), and intensive care unit (ICU) outcomes. We hypothesized that loss of stage N2 features is associated with more severe grades of encephalopathy and worse ICU outcomes including death. Materials and methodsThis was an observational cohort study of 93 medical ICU patients without primary acute brain injury who underwent continuous EEG. Type and severity of critical illness, sedative-hypnotic use, length of stay, modified Rankin Scale at hospital discharge, and death during hospitalization were abstracted from the medical record. EEG was evaluated for grade of encephalopathy and sleep features. ResultsPatients without K-complexes or without sleep spindles had more severe encephalopathy and higher odds of death. The odds ratio for patients without K-complexes was 18.8 (p = .046). The odds ratio for patients without sleep spindles was 6.3 (p = .036). ConclusionsLoss of stage N2 features is common and associated with more severe encephalopathy and higher odds of death. The absence of either Stage N2 feature, K complexes or sleep spindles, may have important prognostic value.

Guanfacine decreases symptoms of cannabis withdrawal in daily cannabis smokers.

The α2a-adrenergic agonist, lofexidine, reduced cannabis withdrawal-related sleep disruption in the laboratory, but side effects (e.g. fatigue, hypotension) limit its utility as a treatment for cannabis use disorder. This study tested the potential efficacy and tolerability of a daily bedtime administration of the FDA-approved α2a-adrenergic agonist, guanfacine, in a human laboratory model of cannabis use disorder. Daily, nontreatment-seeking cannabis smokers (13M, 2F) completed a within-subject study comprising two 9-day inpatient study phases. Each phase tested the effects of daily placebo or immediate-release guanfacine (2mg) on cannabis intoxication (5.6 percent THC; 2days), withdrawal (4days of abstinence) and subsequent 'relapse' (3days of cannabis self-administration). Ratings of mood, sleep, cardiovascular effects, food intake, psychomotor performance and cannabis self-administration were assessed. An outpatient phase preceded each inpatient phase for medication clearance or dose induction. Under placebo medication conditions, cannabis abstinence produced significant withdrawal, including irritability, sleep disruption and anorexia. Guanfacine reduced ratings of irritability and improved objective measures of sleep during cannabis withdrawal relative to placebo but did not reduce cannabis self-administration. Guanfacine was well tolerated with little evidence of fatigue and only small decreases in blood pressure: no dose was held due to hypotension. Thus, a single daily administration of guanfacine at bedtime improved sleep and mood during cannabis withdrawal relative to placebo. This positive signal supports further studies varying the guanfacine dose, formulation or frequency of administration, or combining it with other medications to increase the likelihood of having an impact on cannabis use.

Severity, course, and predictors of sleep disruption following hematopoietic cell transplantation: a secondary data analysis from the BMT CTN 0902 trial.

Sleep disruption has received little attention in hematopoietic cell transplantation (HCT). The goal of this study was to describe severity, course, and predictors of sleep disruption following HCT. A secondary data analysis was conducted of the Blood and Marrow Transplantation Clinical Trials Network (BMT CTN) 0902 study. Participants completed a modified version of the Pittsburgh Sleep Quality Index prior to transplant and 100 and 180 days post-transplant. Growth mixture models were used to characterize subgroups of patients based on baseline sleep disruption and change over time. A total of 570 patients (mean age 55, 42% female) were included in the current analyses. Patients could be grouped into four distinct classes based on sleep disruption: 1) clinically significant sleep disruption at baseline that did not improve over time (20%); 2) clinically significant sleep disruption at baseline that improved over time (22%); 3) sleep disruption that did not reach clinical significance at baseline and did not improve over time (45%); and 4) no sleep disruption at baseline or over time (13%). These data provide a more comprehensive understanding of sleep disruption that can be used to develop interventions to improve sleep in HCT recipients.

Rhesus macaques (Macaca mulatta) displaying self-injurious behavior show more sleep disruption than controls

Self-injurious behavior (SIB) is a pathology observed in both humans and animals. In humans, SIB has been linked to various mental health conditions that are also associated with significant sleep disruption. In rhesus macaques, SIB consists of self-directed biting which can range from mild skin abrasions to wounds requiring veterinary care. However, only one study suggests possible sleep disruption in macaques with SIB. We evaluated sleep disruption using a non-invasive system (infra-red camera and a video surveillance program) which created videos for every movement over the nighttime hours. Nighttime activity was examined in 13 macaques (three females) of which six were classified as having SIB (one female). Each monkey was studied for a total of 6 nights spanning a period of 4 months. Measures included total movement time (TMT), time moving in the first hour (HR1), time moving in the last hour (HR11), and number of videos <10s, ≥10s, and ≥30s in length. Overall, SIB monkeys had higher TMT (p<0.01), higher HR1 (p<0.001), and generated more videos ≥10s (p<0.01) and ≥30s (p<0.01). Thus, SIB monkeys showed significant sleep disruption. A four-fold difference between SIB and control monkeys in the ≥30s videos revealed many more significant awakenings in the SIB group. Overall higher nighttime activity, in the first hour but not in the last hour, is consistent with sleep-onset insomnia in humans. Whether increased nighttime activity contributes to the SIB condition during the day or, conversely, SIB causes higher nighttime activity remains undetermined.

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care.

0599 SLEEP APNEA SEVERITY IS ASSOCIATED WITH MOTOR RECOVERY AND PROCESSING SPEED IN ACUTE TBI REHABILITATION ADMISSIONS: A VA TBI MODEL SYSTEM STUDY

During a time of critical neural repair, significant proportions of persons with traumatic brain injury (TBI) undergoing neuro-rehabilitation have significant sleep disruption. Recent reports indicate up to 37% of consecutive TBI rehabilitation admissions have undiagnosed sleep apnea (SA) that may hinder neurologic repair due to hypoxemia and sleep disruption. To date, no study has examined outcomes associated with SA in early stages of TBI recovery. This is a consecutive prospective observational cohort study with IRB-approved research participants part of the TBI Model Systems lifetime study and who received PSG during inpatient neurorehabilitation. The Functional Independence Measure (FIM, Cognitive and Motor Subscales) and Disability Rating Scale were rated on admission and discharge by clinical teams. A subset recovered sufficiently and underwent neuropsychological testing including measures of memory (CVLT-2) and processing speed (Trail Making Test). Sample (n=68) was primarily male (96%), white (87%), married (35%), with ≥ 12 years of education. The median age was 31 years (interquartile range [IQR], 25,50). The most common TBI mechanism was motor-related (68%) with most having a severe injury (Median Emergency Department Glasgow Coma Scale =3, IQR, 3,11). Half of the sample (43%) had SA that was primarily mild (62%) and obstructive type. Individuals were divided into SA severity groups based on AHI of ≤4 (none), 5–14 (mild), and ≥ 15 (moderate to severe). One-way between subjects ANOVA revealed group differences for FIM Motor (F, (2,64) = 3.86, p=.026) and Total scores (F, (2,64) = 3.18, p=.048) on rehabilitation admission. Post-hoc (Tukey) comparisons revealed worse scores for participants with moderate-severe SA compared to those with mild. SA severity was significantly correlated with processing speed (r=0.4, p=0.007) but not verbal memory during early TBI recovery. Greater SA severity was significantly associated with lower motor functioning and slower processing speed during inpatient rehabilitation. Earlier detection of SA may improve rehabilitation outcomes following TBI. VA TBI Model Systems Program of Research, Subcontract from General Dynamics Information Technology (W91YTZ-13-C-0015), Defense and Veterans Brain Injury Center; Defense Health Agency (DHA); and Department of Veterans Affairs grants (1 I50 HX001233-01, W81XWH-13-2-0095).

A Review of Assessment of Sleep Disruption in Adults Following Traumatic Brain Injury

Sleep disruptions are prevalent following head injury, but are presently poorly understood. The current paper examines literature that pertains to assessment of sleep function during acute, intermediate and chronic periods following Traumatic Brain Injury (TBI). Review of the literature indicates that initial assessment was focused on primarily self-report measures, which may have psychometric limitations. Many of the findings from previous studies are not directly comparable, as there is significant heterogeneity between sample populations. However, more recent focus on objective measures such as overnight Polysomnography (PSG), Multiple Sleep Latency Test (MSLT) and ambulatory measurements such as actigraphy during multiple time periods post-injury has the potential for further identification and classification of patients with significant sleep disruption following TBI and holds promise in assisting with the treatment of identifiable sleep disorders. The development of state of the art assessment techniques should ultimately assist with evolution of the identification and management of sleep disorders that are related to TBI.

Nocturnal eczema: Review of sleep and circadian rhythms in children with atopic dermatitis and future research directions

Children with atopic dermatitis (AD) experience significant sleep disruption, and clinically, the disease is noted to worsen in a circadian manner at night. Epidemiologic findings highlight many negative consequences of AD, such as impaired linear growth, which is uniquely related to disturbed sleep. Clinical guidelines currently recommend assessing sleep in patients with AD as a crucial parameter of disease control with appropriate treatment. In this review we describe our current understanding of the roles of sleep cycles and circadian rhythms in the nighttime exacerbation of AD (nocturnal eczema). We present a schematic to explain the mechanism of nocturnal eczema. Treatment options for sleep disturbance and future directions for research are discussed in the context of AD.

Sleep patterns and sleep disturbances across pregnancy

ObjectiveThis study sought to characterize sleep patterns and sleep problems in a large sample of women across all months of pregnancy. MethodsA total of 2427 women completed an Internet-based survey that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, vitality scale of the Short Form 36 Health Survey (SF-36), Insomnia Severity Index (ISI), Berlin questionnaire, International Restless Legs Syndrome (IRLS) question set, and a short version of the Pregnancy Symptoms Inventory (PSI). ResultsAcross all months of pregnancy, women experienced poor sleep quality (76%), insufficient nighttime sleep (38%), and significant daytime sleepiness (49%). All women reported frequent nighttime awakenings (100%), and most women took daytime naps (78%). Symptoms of insomnia (57%), sleep-disordered breathing (19%), and restless legs syndrome (24%) were commonly endorsed, with no difference across the month of pregnancy for insomnia, sleep-disorder breathing, daytime sleepiness, or fatigue. In addition, high rates of pregnancy-related symptoms were found to disturb sleep, especially frequent urination (83%) and difficulty finding a comfortable sleep position (79%). ConclusionsWomen experience significant sleep disruption, inadequate sleep, and high rates of symptoms of sleep disorder throughout pregnancy. These results suggest that all women should be screened and treated for sleep disturbances throughout pregnancy, especially given the impact of inadequate sleep and sleep disorders on fetal, pregnancy, and postpartum outcomes.

Poor Sleep May Increase Suicide Risk in Older Adults

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessPoor Sleep May Increase Suicide Risk in Older AdultsLynne LambergLynne LambergSearch for more papers by this authorPublished Online:15 Sep 2014https://doi.org/10.1176/appi.pn.2014.9b12AbstractTargeting disturbed sleep in older adults may be a novel way to reduce the risk of suicide in a population in whom such risk is elevated.Sleep disturbances confer an increased risk for suicidal behaviors in older adults, even when depressed mood is accounted for, a study of more than 14,000 people aged 66 to 90 suggests.Rebecca Bernert, Ph.D., says “Targeting disturbed sleep as a visible warning sign of suicide may constitute a novel opportunity for improved risk detection. . . “Norbert von der Groeben/Stanford School of MedicineOlder adults have more trouble sleeping than younger adults. Approximately 57 percent of people aged 65 and older report experiencing clinically significant sleep disruption, Rebecca Bernert, Ph.D., director of the Suicide Prevention Research Laboratory at Stanford University School of Medicine, and colleagues noted in a study published online August 13 in JAMA Psychiatry.Older adults also die by suicide more frequently than younger people, the researchers said. More than 33,000 Americans died by suicide in 2010, according to the Centers for Disease Control and Prevention. Among Americans of all ages, the rate was 12.4 per 100,000. In those aged 65 to 74, the rate was 13.7. In people aged 85 and older, the rate jumped to 17.6. To assess the contribution of poor sleep to suicide risk, Bernert and colleagues drew upon data from a longitudinal, multisite study of 14,456 community-dwelling adults aged 65 and older, the Established Populations for Epidemiologic Studies of the Elderly project.They compared self-reported sleep quality in 20 people who died by suicide over a 10-year observation period with sleep quality reported by 400 other participants randomly selected and matched for age, sex, study site, and duration in the study.People who reported poor sleep quality at baseline had a 1.4 times higher risk of death by suicide over the 10-year observation period than those who said they slept well, Bernert’s group found. Even after the researchers controlled for effects of depressed mood, they found that poor sleep quality at baseline was associated with a 1.2 times greater risk for suicide death.While people who died by suicide had higher rates of both sleep disturbances and depressive symptoms than controls did, sleep disturbances outperformed depressive symptoms in predicting risk of death by suicide 10 years later. Two sleep complaints—difficulty falling asleep and nonrestorative sleep, particularly in combination—specifically predicted increased risk for suicide.Older adults frequently visit their primary care physician in the weeks preceding their death by suicide, the researchers said. Friends and family often know when someone close to them is sleeping poorly. Thus, “Targeting disturbed sleep as a visible warning sign of suicide may constitute a novel opportunity for improved risk detection, particularly among those at elevated risk,” Bernert and colleagues suggested. Poor subjective sleep quality, they said, also may represent a novel therapeutic target for suicide prevention in late life. ■“Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period: A Longitudinal, Population-Based Study of Late Life” can be accessed here. ISSUES NewArchived

Sleep-disordered breathing in pregnancy: a brief summary of current knowledge.

Despite the fact that pregnant women may be predisposed to obstructive sleep apnoea (OSA) caused by the normal physiological changes associated with the gravid state, the impact of sleep-disordered breathing (SDB) on pregnancy remains undetermined. This case–control study reports that hypertensive disorders (chronic hypertension, gestational hypertension, and pre-eclampsia) and frequent snoring are associated with SDB in pregnancy. Although several cross-sectional, case–control, and retrospective cohort studies suggest that SDB may increase the risk of developing hypertensive disorders during pregnancy, there are limited and conflicting data from prospective observational cohorts in which SDB exposure and pregnancy outcomes were meticulously assessed and confounding variables (e.g. body mass index) carefully considered. In one recently published prospective study, objectively assessed SDB (apnoea hypopnoea index, AHI ≥ 5) in pregnancy was associated with a greater risk of pre-eclampsia (aOR 3.5, 95% CI 1.3–9.9; Louis et al. Obstet Gynecol 2012;120:1085–92). Two subsequent, similarly designed studies failed to confirm this finding (Facco et al. Am J Obstet Gynecol 2013; Pien et al. Thorax 2014;69:371–7). Complicating this discussion, there is no evidence that treatment of SDB in pregnancy impacts maternal or neonatal outcomes. Even in non- pregnant adults, the evidence of improved clinical outcomes after SDB treatment is limited. Most supporting data focus on intermediate outcomes such as blood pressure changes after 2–24 weeks of treatment, rather than long-term clinical outcomes such as incident hypertension, stroke, or myocardial infraction (Qaseem et al. Ann Intern Med 2013;159:471–83). To date, studies to examine the effect of continuous positive airway pressure (CPAP) treatment on pregnancy end points have been insufficiently powered or limited in the scope of end points. The largest of these trials followed women already diagnosed with pre-eclampsia who were treated with CPAP, and used improvements in fetal movement and cardiac output as primary clinical end points (Blyton et al. Sleep 2004; 27:79–84; Blyton et al. Sleep 2013; 36:15–21). At the time of writing, there are not enough data to support a strategy of universal screening and treatment for SDB in pregnancy. Large, prospective cohorts that use objective SDB assessments across pregnancy are needed to accurately define the impact of SDB on maternal and neonatal health. Subsequently, well-designed clinical trials of CPAP use in pregnancy are needed to determine whether treatment of SDB during pregnancy can improve pregnancy outcomes; however, in the meantime we have to recognise that as our obstetrical patient population is becoming more obese, we will encounter more women with symptomatic SDB in pregnancy. It is well documented that patients with symptomatic SDB, typically those who snore and report persistent complaints of significant sleep disruption and excessive daytime sleepiness, can benefit from CPAP in terms of sleep quality and daytime function. Therefore, in addition to encouraging women already prescribed CPAP to continue their therapy during pregnancy, obstetricians who suspect a patient may suffer from symptomatic SDB should refer her to a sleep specialist for diagnosis and possible treatment.

The Impact of Restless Legs Syndrome/Willis-Ekbom Disorder on Quality of Life

Restless legs syndrome (RLS), also known as Willis–Ekbom Disorder (WED), is a condition associated with nocturnal sensorimotor symptoms that can result in significant sleep disruption. RLS is a prevalent condition, affecting an estimated 3.9–14.3 % of the US population. Despite the most recently reported prevalence studies, many experts in the field still believe RLS is a generally underdiagnosed condition. RLS can negatively affect a patient’s quality of life (QoL) across several domains, such as daytime sleepiness, decreased general health, decreased immune function, stress, and mood. Of those patients with moderate-to-severe symptoms that require treatment, the currently available therapeutic options (e.g. iron supplements, dopamine agonists, benzodiazepines, opioids, and anticonvulsants) can also come with adverse side effects that can further impact QoL. The purpose of this article is to examine the QoL deficits experienced by RLS patients.

Sleep disturbance in adopted children with a history of maltreatment

This study aimed to investigate whether children with a history of maltreatment and current behaviour problems demonstrate greater sleep disruption than controls; and also whether sleep disturbances are associated with these behavioural problems using standardised carer report measures. Sixty-three participants were assessed using the Children’s Sleep Habits Questionnaire (CSHQ) (Owens, Spirito and McGuinn, 2000) and the Strengths and Difficulties Questionnaire (SDQ) (Goodman, et al., 2003). Thirty-four participants aged 5–12 years were recruited via Adoption UK – Scotland. Inclusion criteria included a history of maltreatment (confirmed from social work documents) with associated social/behavioural problems. Twenty-nine controls with no psychiatric or maltreatment history, also aged 5–12 years, were recruited from two general practices.Mean CSHQ total sleep difficulty scores were significantly higher in maltreated children than in controls (48.9 vs 23.6, P &lt; 0.001). Rates of clinically significant sleep problems (total sleep score&gt;41) were also higher in the maltreatment group at 50% compared to 12% in controls (P = 0.002). There was a significant association between high scores on the CSHQ and the SDQ (P &lt; 0.000). Overall, this study suggests that behaviourally disturbed children with a history of maltreatment experience significant sleep disruption, which is in turn associated with their behavioural disturbance. This has clear implications for both clinical assessment and intervention with this vulnerable group and is worthy of further research.

Sleep in family caregivers of patients admitted to hospice: A pilot study

Caring for a dying family member is known to interfere with sleep, yet little is known about caregiver sleep once the patient is admitted to hospice. The aim of this pilot study was to describe the sleep of partners and other family caregivers of patients in hospice. The pilot study used a cross-sectional, descriptive, and comparative design. Participants included the primary family caregivers of patients recently admitted to a hospice in Norway. Caregiver sleep during the prior month was measured with the Pittsburgh Sleep Quality Index (PSQI). During the patient's hospice stay, caregiver sleep was measured using wrist actigraphy for four nights and three days. Twenty family caregivers (12 partners and 8 other relatives) completed the study protocol without difficulty. On the PSQI, most caregivers (n=13) reported clinically significant sleep problems during the prior month. Once the patient was admitted to hospice, actigraphy indicated that 10 caregivers had clinically significant sleep disruption (≥15% wake after sleep onset) and six averaged <7 hours of sleep per night. Partner caregivers reported more trouble falling asleep, and less sleep medication use, in the prior month than other types of family caregivers. However, once the patient was admitted to hospice, and after adjusting for caregiver age, partner caregivers experienced less sleep disruption than other caregivers. Findings demonstrate feasibility of the study protocol and indicate that sleep problems are common for caregivers of dying patients, even after the patient is admitted to hospice. The caregiver's relationship to the patient may be an important factor to consider in future studies.

Impact of seizures on sleep and memory

Memory performance is of concern to everyone, but particularly to people with epilepsy. It is known that seizures, particularly when occurring early in the sleep cycle, can cause significant sleep disruption. Less certain is whether inter-ictal activity significantly disrupts sleep. There is a spectrum, however, from virtually constant “ictal” or “inter-ictal” activity seen in some children with electrical status epilepticus of sleep, or even benign rolandic epilepsy, to those with infrequent spikes.

The Impact of Restless Legs Syndrome/ Willis–Ekbom Disorder on Quality of Life

Restless legs syndrome (RLS), also known as Willis–Ekbom Disorder (WED), is a condition associated with nocturnal sensorimotor symptoms that can result in significant sleep disruption. RLS is a prevalent condition, affecting an estimated 3.9–14.3 % of the US population. Despite the most recently reported prevalence studies, many experts in the field still believe RLS is a generally underdiagnosed condition. RLS can negatively affect a patient’s quality of life (QoL) across several domains, such as daytime sleepiness, decreased general health, decreased immune function, stress and mood. Of those patients with moderate-to-severe symptoms that require treatment, the currently available therapeutic options (e.g. iron supplements, dopamine agonists, benzodiazepines, opioids and anticonvulsants) can also come with adverse side effects that can further impact QoL. The purpose of this article is to examine the QoL deficits experienced by RLS patients.

Dehydration during sleep affects cognitive performance

To the Editor, We read with interest the response by Drs. Thornton and Trabalon to our recent article, ‘‘Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing,’’ published in Sleep Medicine 12:489–496, 2011. Their suggestion that dehydration caused by mouth breathing in children with sleep disordered breathing (SDB) is the underlying mechanism for the impairments that we and others have observed is novel. Our findings of impairment in cognition and academic performance are in keeping with those of numerous other researchers [1–9]. It has been hypothesised that these deficits are at least in part due to disruption to sleep and/or repeated hypoxic episodes which are a feature of SDB [10]. In our study, we did not observe any significant sleep disruption using either conventional measures of measurement or spectral analysis of the EEG [11]. In addition, we observed significant impairments in children with primary snoring in the absence of any hypoxic episodes. Thus there must be other mechanisms involved. The idea that this may be dehydration is novel and was not tested in either our study or those carried out previously. To confirm this possibility, further studies would need to be carried out.

Sleep disturbance and the effects of extended-release zolpidem during cannabis withdrawal

Background Sleep difficulty is a common symptom of cannabis withdrawal, but little research has objectively measured sleep or explored the effects of hypnotic medication on sleep during cannabis withdrawal. Methods Twenty daily cannabis users completed a within-subject crossover study. Participants alternated between periods of ad libitum cannabis use and short-term cannabis abstinence (3 days). Placebo was administered at bedtime during one abstinence period (withdrawal test) and extended-release zolpidem, a non-benzodiazepine GABA A receptor agonist, was administered during the other. Polysomnographic (PSG) sleep architecture measures, subjective ratings, and cognitive performance effects were assessed each day. Results During the placebo-abstinence period, participants had decreased sleep efficiency, total sleep time, percent time spent in Stage 1 and Stage 2 sleep, REM latency and subjective sleep quality, as well as increased sleep latency and time spent in REM sleep compared with when they were using cannabis. Zolpidem attenuated the effects of abstinence on sleep architecture and normalized sleep efficiency scores, but had no effect on sleep latency. Zolpidem was not associated with any significant side effects or next-day cognitive performance impairments. Conclusions These data extend prior research that indicates abrupt abstinence from cannabis can lead to clinically significant sleep disruption in daily users. The findings also indicate that sleep disruption associated with cannabis withdrawal can be attenuated by zolpidem, suggesting that hypnotic medications might be useful adjunct pharmacotherapies in the treatment of cannabis use disorders.

P159 HOT HMV UK: sleep disruption following initiation of domiciliary NIV in hypercapnic COPD

<h3>Introduction</h3> The use of domiciliary NIV for the treatment of chronic hypercapnic respiratory failure (CHRF) in COPD remains controversial. Previous data from randomised controlled trials do not show a sustained clinical benefit, but to date there has been no RCT that has titrated NIV to nocturnal oximetry and capnometry. Although one randomised cross-over trial has shown that high intensity NIV produced greater improvements in health-related quality of life (HRQL) compared to low intensity set up (Dreher et al <i>Thorax</i> 2010) concern remains that this strategy may cause significant sleep disruption that would be expected to adversely effect the clinical benefits. <h3>Method</h3> Patient who remained persistently hypercapnic (PaCO₂ &gt;7 kPa) following acute exacerbations of COPD requiring NIV were offered participation in the home oxygen therapy versus home mechanical ventilation in COPD trial (HOT-HMV Trial). Baseline arterial blood gas analysis, HRQL and lung function parameters were performed prior to randomisation. Patients had nasal oxygen therapy or NIV established over a 3 day in-patient hospital stay. Sleep disruption and daytime activity was monitored for 7 days following HMV or HOT set up using a sleep diary and actigraphy (Actiwatch spectrum, Phillips-Respironics, Murrysville, PA, USA). <h3>Results</h3> 7 patients were enrolled (4 HMV, 3 HOT). Mean ± SD age of 65 ± 11 years, BMI 25.5 ± 6.4 kg/m², FEV₁ 30 ± 12%, FVC 58 ± 14%, FEV₁/FVC 39 ± 12%, PaCO₂ 8.22 ± 0.72 kPa, PaO₂ 6.65 ± 0.58 kPa and MRC dyspnoea score of 4 ± 1. Actigraphy analysis showed HMV patients total sleep time (TST) was 241 ± 29 min with wake after sleep onset (WASO) time of 111 ± 41 min and a mobile time of 709 ± 119 min. Patients in the HOT arm had a TST of 373 ± 143 min with a WASO 116 ± 87 min and a mobile time 674 ± 132 min. No significant between group differences could be demonstrated in the sleep or activity variables. HMV settings Ipap 26 ± 3 cm H₂O, Epap 5 ± 1 cm H₂O, back up rate 15 ± 1 bpm. <h3>Conclusion</h3> Although these data must be interpreted with caution, as the number of patients currently enrolled in this trial is small, there was no difference between the HOT and HMV groups. These data support the view that high pressure HMV does not cause significant sleep disruption when compared with HOT.

Parasomnias

Event Abstract Back to Event Parasomnias Hrayr Attarian1* 1 Loyola University Health System, Department of Neurology, United States Learning objectives: Recognize the major categories of parasomnias Know the clinical presentations of the common parasomnias Understand the treatment options available Parasomnias are undesirable physical or experiential events that occur in and around sleep and although most of them are benign they can, occasionally, lead to significant morbidity primarily through injury to self or bed partners. They remain poorly recognized and understood. They fall under 3 categories; "NREM parasomnias", "REM parasomnias" and "Other parasomnias". Sleepwalking, sleep terrors and confusional arousals constitute the first category. The key differentiating characteristic of sleepwalking is the extensive wandering, of sleep terrors the autonomic hyperarousal and of confusional arousal the complex behaviors and sluggish response to the environment. There is a degree of overlap among all three. Among the REM parasomnias the most common is nightmares and the most injurious REM sleep behavior disorder or RBD. Nightmares are anxiety and fear provoking recurrent dreams and most do not require treatment but of those that do tend to respond to cognitive therapy low dose prazosin, an alpha 1 antagonist. RBD is a condition where the normal atonia of REM is absent and patients tend to act out their dreams hence risking injury to self or bed partner. This condition can be idiopathic but may also be related to neurodegenerative disorders, other sleep disorders or secondary to exposure to antidepressant medication. Treatment is generally successful with either clonazepam or high dose melatonin. The category of other parasomnias comprises of conditions that are not state dependant. Catathrenia or nocturnal groaning is such a condition that although benign can lead to significant sleep disruption and social embarrassment. It usually responds to CPAP even in the absence of sleep related breathing disorder. Sleep related eating disorder is another such parasomnia which can lead to injury, obesity and other adverse health outcomes. The treatment of choice is usually topiramate although pramipexole and SSRIs have been shown effective as well. Conference: Paroxysmal Neurology Symposium, Chicago, United States, 7 Apr - 7 Apr, 2010. Presentation Type: Oral Presentation Topic: Abstracts Citation: Attarian H (2010). Parasomnias. Front. Neurol. Conference Abstract: Paroxysmal Neurology Symposium. doi: 10.3389/conf.fneur.2010.07.00006 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 07 Apr 2010; Published Online: 07 Apr 2010. * Correspondence: Hrayr Attarian, Loyola University Health System, Department of Neurology, Maywood, IL, United States, h-attarian@northwestern.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Hrayr Attarian Google Hrayr Attarian Google Scholar Hrayr Attarian PubMed Hrayr Attarian Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.