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 1,062 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An 18-year-old blind man suffered from chronic sleep disturbances associated with daytime fatigue and excessive daytime somnolence. After two unsuccessful treatment regimens with 5 mg and 10 mg melatonin administered at bedtime (2200-2230), a third regimen of 5 mg melatonin administered at 2000 for 3 weeks resulted in a successful resolution of his sleep disturbances. We suggest that the efficacy of melatonin in ameliorating sleep disturbances because of alterations in circadian rhythmicity may be dependent on the time of administration.
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PMID:The importance of timing in melatonin administration in a blind man. 150 54

Excessive daytime sleepiness is one of the main symptoms of sleep apnoea, which can, especially in monotonous situations, lead to real nodding off. Since driving a motor vehicle can also be monotonous, patients suffering from untreated sleep apnoea may be a possible traffic risk. Before undergoing a polysomnographic examination, 123 patients filled in a questionnaire inquiring about fatigue and sleepiness while driving a vehicle as well as accidents during the past three years. Five groups were formed according to severity of sleep apnoea. Right through these groups, the increase in heavy fatigue during driving (median) was significant: from "seldom" (AI less than 5) via "sometimes" to "often" (AI greater than or equal to 35). Occurrences of short periods of falling asleep (means) were practically not reported (0.02) by the group without sleep apnoea but increased considerably to 3.37 times per 1000 km for the group with an AI greater than or equal to 35. The frequency of accidents due to sleepiness rises significantly in concurrence with the seriousness of sleep apnoea. Besides, patients with an AI greater than or equal to 5 attribute 23 out of 28 accidents to sleepiness, whereas patients without sleep apnoea attribute all four accidents to other reasons (p = .0035). These findings emphasise the importance of an early diagnosis and effective therapy of sleep apnoea - which is available as nasal continuous positive airway pressure ventilation (nCPAP). Sleep medicine can thus not only help patients suffering from sleep apnoea but may also reduce the health risk of other traffic participants and be cost-saving.
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PMID:[Risk of accidents in patients with nocturnal respiration disorders]. 186 6

We describe a new syndrome, Rheumatic Pain Modulation Disorder (RPMD) ("fibrositis syndrome") with sleep-related myoclonus (involuntary periodic leg movements). Measures of sleepiness, fatigue and pain, before and after sleep, and aspects of sleep of nine subjects (Ss) with RPMD and sleep-related myoclonus were compared to nine subjects with excessive daytime somnolence and sleep-related myoclonus. In eight of the RPMD with sleep-related myoclonus and three of those with daytime sleepiness, an alpha (7.5-11 Hz) EEG Non-Rapid Eye Movement sleep disorder was demonstrated. The RPMD with sleep-related myoclonus group contained a greater number of women, more pain, morning fatigue, and disturbances in sleep (more stage changes and alpha EEG sleep prior to leg myoclonus); but in comparison to the sleep-related myoclonus, daytime somnolent group, there were no differences in evening and morning sleepiness, number of limb movements, movement arousals, awakenings after sleep onset, sleep duration, and percent sleep stages.
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PMID:Sleep-related myoclonus in rheumatic pain modulation disorder (fibrositis syndrome) and in excessive daytime somnolence. 658 52

The objective of this questionnaire-based survey was to evaluate the prevalence and causes of sleep disturbances in 90 nondepressive patients with Parkinson's disease (PD) and 71 age-matched healthy subjects. We also assessed the prevalence and characteristics of excessive daytime sleepiness (both groups) and excessive fatigue (PD patients). A high prevalence of sleep disturbances in PD patients was found; this is to a large extent probably the result of aging. As compared with controls, patients had a more severely disturbed sleep maintenance because of nycturia, pain, stiffness, and problems with turning in bed. The prevalence of excessive dreaming is similar in both groups, but altered dream experiences almost exclusively occurred in PD. Patients rated themselves more often to be morning-types than controls. This finding may account for the reported adaptation effects in experimental settings and the reduced REM latency in PD patients. The prevalence of daytime sleepiness was similar in both groups. Excessive daytime sleepiness showed a clear diurnal pattern with a peak in the early afternoon. As for excessive fatigue, the majority of the patients did not report a preferential time for this symptom. Our findings further argue against an association of fatigue with any circadian factor, and instead suggest a relationship with the motor deficits of PD.
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PMID:Sleep, excessive daytime sleepiness and fatigue in Parkinson's disease. 836 3

Complaints of chronic fatigue as well as sleep disturbances are prevalent in Lyme disease. We compared polysomnographic measures of sleep in patients with documented Lyme disease with those of a group of age-matched normal control subjects. Eleven patients meeting Centers for Disease Control criteria for late Lyme disease with serologic confirmation by enzyme-linked immunosorbent assay and Western blot without a history of other medical or psychiatric illness and 10 age-matched control subjects were studied. Lyme disease patients and controls underwent 2 nights of polysomnography. Multiple sleep latency testing (MSLT) was performed in the patients. Sleep was staged by standard criteria, and continuity of sleep was assessed for each stage of frequency analysis of consecutive epochs. All patients studied reported sleep-related complaints, including difficulty initiating sleep (27%), frequent nocturnal awakenings (27%), excessive daytime somnolence (73%) and restless legs/nocturnal leg jerking (9%). Greater sleep latency, decreased sleep efficiency and a greater arousal index were noted in Lyme patients. The median length of uninterrupted occurrences of stage 2 and stage 4 non-rapid eye movement (NREM) sleep was less in Lyme patients (6.3 +/- 3.0 epochs in patients vs. 11.4 +/- 4.4 epochs in controls for stage 2, p < 0.01, and 4.3 +/- 4.4 epochs in patients vs. 11.2 +/- 6.3 epochs in controls for stage 4, p < 0.01), indicating greater sleep fragmentation. Mean sleep onset latency during the MSLT was normal (12.7 +/- 5.6 minutes). Three patients demonstrated alpha-wave intrusion into NREM sleep. These sleep abnormalities may contribute to the fatigue and sleep complaints common in this disease.
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PMID:Sleep quality in Lyme disease. 874 1

Infrared video pupillography (IVP) allows continuous recording of spontaneous pupillary oscillations in darkness which change characteristically with fatigue. Pupil size in darkness is age-related, has its maximum in the second decade and subsequently decreases during life time. Normally, the pupil oscillates in darkness with a frequency of about 1 Hz and amplitudes of less than 0.3 mm. Excessive daytime sleepiness causes instability of this pupillary behaviour which is constant in alert normals, and so called fatigue waves appear with an amplitude reaching several millimeters. The frequency profile is dominated by slow frequencies below 0.5 Hz, while average pupil size decreases continuously with time. As IVP is an objective and time-saving method it could become an important supplement to test procedures used in sleep medicine and sleep research to measure daytime sleepiness.
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PMID:[Pupillography as an objective attention test]. 901 95

Excessive daytime sleepiness (EDS) and fatigue are frequent symptoms in the general population and the chief complaint of the majority of patients at Sleep Disorders Centers. There is evidence that the inflammatory cytokines tumor necrosis factor-alpha (TNF alpha), interleukin-1beta (IL-1beta), and IL-6 are involved in physiological sleep regulation and that their administration to humans is associated with sleepiness and fatigue. To explore whether plasma levels of TNF alpha, IL-1beta, and IL-6 are elevated in patients with EDS, we measured morning plasma levels of TNF alpha, IL-1beta, and IL-6 in 12 sleep apneics, 11 narcoleptics, 8 idiopathic hypersomniacs, and 10 normal controls. TNF alpha was significantly elevated in sleep apneics and narcoleptics compared to that in normal controls (P < 0.001 and P = 0.001, respectively). Plasma IL-1beta concentrations were not different between sleep disorder patients and controls, whereas IL-6 was markedly and significantly elevated in sleep apneics compared to that in normal controls (P = 0.028). The primary factor influencing TNF alpha values was the degree of nocturnal sleep disturbance, whereas the primary determinant for IL-6 levels was the body mass index. Our findings suggest that TNF alpha and IL-6 might play a significant role in mediating sleepiness and fatigue in disorders of EDS in humans.
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PMID:Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. 914 8

Excessive daytime sleepiness (EDS) is a frequent symptom of patients with obstructive sleep apnoea (OSA). EDS is a high-risk factor for accidents at work and on the road. Thirty untreated patients with different levels of severity of OSA were studied concerning night sleep and EDS. The criterion for severity was the respiratory disturbance index (RDI): 15 patients were classified as 'moderately' apnoeic (RDI < 40), 15 as 'severely' apnoeic (RDI > 40). Following night-time polysomnography, objective and subjective aspects of EDS were studied. To assess objective EDS the Maintenance of Wakefulness Test (MWT) and a computer-based vigilance performance test were used. Subjective EDS was determined using the Stanford Sleepiness Scale (SSS), the Epworth Sleepiness Scale (ESS) and the Visual Analogue Scales for Performance (VAS-P) and Tiredness (VAS-T). Well-being was assessed using the Scale of Well-Being by von Zerssen (Bf-S/Bf-S'). Severe apnoea patients spent more time in stage 1 and less in slow-wave sleep. MWT latencies tended to be shorter in the severe apnoea group. Vigilance testing revealed no group differences. Patients with moderate apnoea described themselves as more impaired in all subjective scales, but only SSS scores reached statistical significance. Our results suggest that there is no simple correlation between polysomnographic and respiratory sleep variables at night on the one hand, and the extent of EDS on the other hand. Furthermore, subjective and objective evaluation of EDS does not yield the same results. New approaches which allow a more detailed analysis of night sleep and daytime function are required to identify high-risked patients.
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PMID:Excessive daytime sleepiness in patients suffering from different levels of obstructive sleep apnoea syndrome. 1101 70

We present data from an exploratory study of 174 adults with Marfan syndrome regarding their cognitive perceptions of the condition as postulated by the self-regulatory model (Leventhal H, Benyamini Y, Brownlee S et al. In: Petrie KI, Weinman JA, eds. Perceptions of Health and Illness: Current Research and Applications. Amsterdam, The Netherlands: Harwood Academic, 1997: 19-45; Leventhal H, Nerenz DR, Steele DJ. In: Baum A, Taylor SE, Singer JE, eds. Handbook of Psychology and Health. Hillsdale, NJ: Lawrence Erlbaum Associates, 1984: 219-252). The vast majority of the respondents had adequate general knowledge about Marfan syndrome. Eighty-three percent of the respondents perceived Marfan syndrome as having had significant adverse consequences on their lives. Having striae, pain (sore joints), and depression were each independently correlated with this view. Fifty-eight percent of the respondents indicated that they felt they had low to moderate control over their condition, demonstrating variability. History of aortic dissection, pain (sore joints), and depressive symptoms were each negatively correlated with the view that Marfan syndrome is a curable/controllable condition. Moreover, approximately 28% view the condition as a lethal condition, whereas 67% view it as a serious condition. Forty-four percent of the cohort were found to have significant symptomatology of depression independent of beta- and Ca2+-channel blockade use. Respondents cited both advantages and disadvantages of being affected. Genetic counseling that addresses patients' perceptions of Marfan syndrome, and its associated pain, fatigue, and depressive symptoms, may enhance patient adaptation to the condition.
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PMID:Living with Marfan syndrome I. Perceptions of the condition. 1168 73

Sleep apnoea is a condition in which people stop breathing during sleep. A number of studies in general and worker populations have shown that the prevalence of an apnoea-hypopnoea index (AHI) >10 is in the range of 20%. Subjects with an AHI >10 that complain of excessive daytime somnolence, tiredness, asphyxic episodes during the night or non-refreshing sleep, among other symptoms, suffer from the sleep apnoea hypopnoea syndrome (SAHS). The prevalence of SAHS is around 4%. Owing to its high prevalence, clinical symptoms, probable secondary cardiovascular consequences and associated social problems, SAHS has a considerable impact on health, management of which is worth considering. Despite the fact that SAHS treatment has been challenged recent studies conclude that nasal continuous positive airway pressure (nCPAP) is undoubtedly effective in clearly symptomatic patients. Its use in clinical practice is adequately supported in the treatment of moderate to severe SAHS. Further studies are needed in order to define the lower range of symptoms to be treated. One of the most important problems encountered in this area results from the combination of two situations. On the one hand, different epidemiological studies have demonstrated that an AHI >10 without symptoms is present in around 15% of the general population. On the other hand, several studies suggest that having a high AHI, even without secondary symptoms, gives rise to some undesirable effects such as traffic accidents and cardiovascular consequences. In this context, comprehensive epidemiological studies are therefore warranted to define the role of nCPAP treatment especially in those subjects with a high AHI but with few or no symptoms.
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PMID:Should all sleep apnoea patients be treated? 1253 Nov 38


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