Traffic accidents in commercial long-haul truck drivers: the influence of sleep-disordered breathing and obesity.

This study assesses a possible independent effect of sleep-related breathing disorders on traffic accidents in long-haul commercial truck drivers. The study design included integrated analysis of recordings of sleep-related breathing disorders, self-reported automotive and company-recorded automotive accidents. A cross-sectional population of 90 commercial long-haul truck drivers 20-64 years of age was studied.

Ambulatory monitoring of blood pressure in patients with sleep-disordered breathing.

Patients with obstructive sleep apnea and other sleep-related breathing disorders that cause sleep disruption frequently present with abnormal circadian blood pressure patterns or frank hypertension. Ambulatory blood pressure monitoring has been useful in research documenting nocturnal hypertension and the normalization of blood pressure when sleep apnea is treated. In practice, similar measurements can provide a clue to the presence of an undiagnosed sleep disorder and can be valuable in following the blood pressure response to the treatment of sleep-disordered breathing.

The prevalence of narcolepsy: an epidemiological study of the Finnish Twin Cohort.

We investigated the prevalence of narcolepsy using a well-defined white population previously used for epidemiological investigations: the Finnish Twin Cohort. The Cohort consists of 13,888 monozygotic and dizygotic twin pairs born before 1958. There were 16,179 individuals who participated in the study, with a 77.

Stability of cataplexy over several months--information for the design of therapeutic trials.

Twenty-seven narcoleptic patients severely affected with cataplexy completed four symptom diaries over a 4-month period in order to clarify some of the controversies surrounding assessment of anticataplectic medications. The home diary method was found to be a viable model for the assessment of anticataplectic activity. Assessment of reliability in 1-, 2-, 3-, 4-, 5- and 10-day intervals indicated that reliability increases with the number of days included.

Sleep fragmentation in normals: a model for sleepiness associated with upper airway resistance syndrome.

Eight young adults underwent 1 night of auditory sleep fragmentation followed by four naps of the multiple sleep latency test and performance testing the next day. A latin-square design was used to compare results with baseline. Efforts were made to eliminate effects of learning on repeated performance tests.

Load detection in subjects with sleep-induced upper airway obstruction.

Respiratory flow-resistive load detection in obese patients has been shown to be impaired. We tested the hypothesis that there is no difference in inspiratory flow-resistive load detection measured in nonobese obstructive sleep apnea patients, nonobese snorers, and normal control subjects. Eleven male obstructive sleep apnea patients and seven male snorers were investigated and compared with 10 normal male control subjects.

The Sleep Disorders Questionnaire. I: Creation and multivariate structure of SDQ.

The development of the Sleep Disorders Questionnaire (SDQ) from the Sleep Questionnaire and Assessment of Wakefulness (SQAW) of Stanford University is described in detail. The extraction of the best question items from the SQAW and their subsequent rewording in the SDQ to insure greater completion rates are described. Two item test-retest reliability studies are reported on 71 controls and on 130 sleep-disorder patients, which confirmed adequate reliability.

Pseudo-hypersomnia and pre-sleep behaviour with bilateral paramedian thalamic lesions.

The sleep/wake status of three patients with bilateral lesions involving the paramedian thalamic regions was investigated. Long-term monitoring with infrared video camera and polygraphy were performed. In spite of presenting a behavioural aspect of sleep with sleep posture, eyes closed and lack of activity for 15-17 h per day, these subjects did not develop the normal non-rapid eye movement (NREM) and rapid eye movement (REM) sleep states during the daytime.

Cardiac failure, snoring, ventricular arrhythmias and nasal bilevel positive pressure ventilation.

Patients with stable cardiac failure who snore may present sleep hypopnea and cardiac arrhythmias. Nasal continuous positive airway pressure (CPAP) may worsen the disordered breathing. Nasal bilevel positive airway pressure (BiPAP), however, may help alleviate the breathing problem and eliminate sleep-related arrhythmias.

Excessive daytime somnolence in women with abnormal respiratory efforts during sleep.

An abnormal level of respiratory efforts, indicated by significant increase in peak negative esophageal pressure (Pes), can be associated with daytime somnolence in snoring pre-menopausal women. No drop in oxygen saturation (SaO2) or visual evidence of transient electroencephalographic (EEG) arousals can be found at repeat polysomnography. Nasal continuous positive airway pressure (CPAP) titrated on Pes measurements eliminates somnolence.

Obstructed breathing in children during sleep monitored by echocardiography.

Six 3 to 14-year-old boys with snoring and obstructive sleep apnea syndrome were monitored polygraphically during sleep with and without nasal continuous positive airway pressure with simultaneous recording of esophageal pressure (Pes) and M-mode and two-dimensional echocardiograms. Continuous non-invasive blood pressure monitoring was performed in two older children. Three of the six children demonstrated a diastolic leftward shift of the interventricular septum related to the negativity of Pes.

A cause of excessive daytime sleepiness. The upper airway resistance syndrome.

Subjects with isolated complaints of chronic daytime sleepiness are usually classified as "idiopathic hypersomniacs" and treated symptomatically. A group of these subjects was investigated during nocturnal sleep and daytime naps. In a subgroup of them, sleep was fragmented by very short alpha EEG arousals throughout the sleeping period.

Long-term nasal continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnea patients.

We investigated the way in which nasal continuous positive airway pressure (CPAP) affects the circadian profiles of blood pressure (BP) and heart rate (HR) in obstructive sleep apnea syndrome (OSAS) patients. Nine patients with OSAS, confirmed by nocturnal polysomnography, were studied with ambulatory blood pressure monitoring (Colin ABPM-630) during two 48-hour periods, before and during nasal CPAP treatment, at the Stanford University Sleep Disorders Clinic. During each 48-hour monitoring period, blood pressure measurements were taken by the ambulatory device every 30 minutes.

Cardiac failure and benzodiazepines.

Nine patients with stable cardiac failure and mean left ventricular ejection fraction of 30% were investigated. All had previously been prescribed a benzodiazepine hypnotic by their home physicians, but the medication had been discontinued for at least 1 month. Subjects were monitored under three conditions: 1) without any sleeping medication, 2) during nasal CPAP administration and 3) at two points during a month-long administration of the benzodiazepine that had initially been prescribed to them.

Light therapy as treatment of dyschronosis in brain impaired children.

Fourteen children aged 9 months-4 years with moderate to severe mental retardation and varying neurologic lesions were referred for severe and continuous nocturnal sleep disturbances and very abnormal day/night schedules. All children had previously been given hypnotic medications and behavioral treatments which had little or no effect on nocturnal sleep. The severity of the sleep disturbances significantly affected family life and was a major handicap to the children.

Obstructive sleep apnea syndrome: a surgical protocol for dynamic upper airway reconstruction.

A surgical protocol for dynamic upper airway reconstruction in the treatment of obstructive sleep apnea syndrome is presented. Two hundred thirty-nine consecutively treated patients were evaluated. All patients underwent a presurgical evaluation that included a physical examination, fiberoptic pharyngoscopy, cephalometric analysis, and polygraphic monitoring.

Upper airway resistance in infants at risk for sudden infant death syndrome.

To investigate the relationship between sudden infant death syndrome and upper airway obstruction, we studied 14 term infants at a mean age of 11 weeks who had been identified as being at risk for sudden infant death syndrome on the basis of clinical and family histories and polygraphic monitoring. Respiratory efforts during sleep were investigated by esophageal pressure monitoring (all 14 infants) and by monitoring of flow with a pneumotachometer (6 infants). During apparently normal sleep, increased respiratory efforts were shown by intermittent increases in the magnitude of the negativity of esophageal pressure.

Dream-disturbed sleep in insomnia and narcolepsy.

Both patients with narcolepsy and insomnia frequently present clinically with nocturnal sleep disrupted by disturbing dreams. Polysomnographic correlates of these reports are unclear. In this study, 24 patients with psychophysiological insomnia and 16 patients with narcolepsy were compared on selected polysomnographic and self-reported typical dream characteristics.