Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients.

Based on self-rating questionnaire evaluation of symptoms of major affective disorder, 67% of patients who presented to a major sleep disorders center reported an episode of depression within the previous 5 years, and 26% described themselves as depressed at presentation. Furthermore, patients with sleep apnea, narcolepsy, or sleep-related periodic leg movements all averaged high rates of self-reported depressive symptomatology, which suggests that sleep disorders should be considered in the differential diagnosis of affective disorders, and vice versa. Change scores on the Profile of Mood States were obtained for four subgroups of patients who were undergoing conventional treatment.

Sleep apnea and sleep-related periodic leg movements in community resident seniors.

The elderly have a high incidence of sleep complaints. A high incidence of sleep apnea (SA) and sleep-related periodic leg movements (PLMs) is also suspected. The relationship between the incidence and severity of SA and PLMs and sleep complaints has not, however, been determined in terms of symptomatology and physiologic abnormality.

A historical perspective on sleep disorders medicine.

The recent development of sleep disorders medicine traces its origins to the increased understanding of basic human sleep physiology gained over the past 30 years. The primary tool for diagnosis and management is the long-term polygraphic recording of multiple physiologic variables (polysomnography). A "style" of practice is emerging that is multidisciplinary and often institutionally-based in sleep disorders centers.

Disorders of sleep and wakefulness.

This article provides information on the background and development of "sleep disorders medicine" and sleep disorders centers and a discussion of obstructive sleep apnea, narcolepsy, sleep-related periodic leg movements, and the use and misuse of hypnotic medication.

Nocturnal REM latency and sleep disturbance in narcolepsy.

A retrospective study of 92 narcoleptics was undertaken to investigate the significance of prolonged nocturnal REM latencies observed in approximately one in every five narcoleptics undergoing single all-night clinical polysomnograms in our laboratory. Clinical and laboratory findings were examined as a function of REM latency. Our findings emphasize a high incidence of other sleep disorders, particularly sleep-related periodic leg movements, in narcoleptics.

Middle latency auditory evoked potentials in sleep apneics during waking and as a function of arterial oxygen saturation during apneas.

In adults with obstructive sleep apnea middle latency auditory evoked responses were recorded as a function of apnea-related arterial oxygen desaturation both before sleep onset and during nocturnal sleep. In waking, wave Pa latency was normal in five of six subjects, and Pa amplitude was normal in all. During sleep apneas, wave Pa remained stable even during intervals of severe oxygen desaturation (e.

Flow-volume curves reflect pharyngeal airway abnormalities in sleep apnea syndrome.

Twenty-nine patients with disorders of excessive somnolence were evaluated with standard nocturnal polysomnography, fiberoptic laryngoscopy, and flow-volume curves. Twenty-two had evidence of obstructive sleep apnea (OSA) by polysomnography and most had abnormal flow-volume curves, supporting earlier observations. Three of 7 patients without obstructive sleep apnea also had abnormal curves.

Surgical treatment of sleep apnea.

Contemporary surgical techniques and the preoperative and postoperative treatment of patients with this condition were analyzed, based on surgical treatment of 51 cases of obstructive sleep apnea syndrome (OSAS) and review of the relevant literature. The results indicate the permanent tracheostomy remains the established and highly successful method of treatment of carefully chosen patients with OSAS. Palatopharyngoplasty may also prove useful in treating certain select cases of OSAS, although careful analysis of a large number of successful cases followed up over an extended period of time will be needed.

The 24-hour rhythm of core temperature in narcolepsy.

A circadian rhythm disturbance in narcolepsy has been postulated. To investigate this issue, the 24-h pattern of rectal temperature variation was monitored under entrained conditions in narcoleptics selected on the basis of documented sleep-onset REM episode(s). The 24-h temperature mesor of narcoleptics was elevated in comparison with control subjects.

Sleep-stage-dependent Cheyne-Stokes respiration after cerebral infarct: a case study.

Polysomnographic studies of nocturnal sleep were performed on a 63-year-old women. Sleep-onset and sleep-maintenance insomnia dated back to a cerebral infarction at age 53, which resulted in bilateral cerebral injury. Two patterns of respiration were observed, and both were sleep-stage-dependent.

Normal brain stem auditory evoked potentials recorded in sleep apneics during waking and as a function of arterial oxygen saturation during sleep.

Brain stem auditory evoked potentials (BAEPs) can be utilized as an index of neuronal dysfunction at the level of the brain stem. These waves are known to be independent of level of arousal. In the present study, BAEPs (waves I-V) to monaural click stimulation were recorded during daytime waking and as a function of arterial oxygen saturation during nocturnal sleep in 6 subjects with obstructive sleep apnea syndrome.

Impaired sexual maturation associated with sleep apnea syndrome during puberty: a case study.

A 20-year-old hypogonadal man was discovered to have had obstructive sleep apnea syndrome--secondary to hypertrophied tonsils, adenoids, and uvula--spanning the years of puberty. All-night polysomnographic recordings and 24 hr measurements of plasma luteinizing hormone (LH) concentrations (sampling at 20 min intervals) were performed before and after combined tonsillectomy, adenoidectomy, and uvulectomy. Two weeks preoperatively, nocturnal sleep was markedly disturbed by 407 apneic episodes, and the patient was found to be hypogonadotropic.

Relaxin immunoactivity in human plasma during a 24-hr period.

Relaxin was secreted episodically in all 6 human subjects studied. A 24-hr rhythm was detected in the pooled data, with maximum secretion in the early-midmorning hours and a nadir in the early evening.

Cortisol and GH responses to D- and L-amphetamine in monkeys.

Equimolar doses of D-amphetamine and L-amphetamine, and a water placebo were injected intravenously on different days into rhesus monkeys, and their plasma cortisol and GH responses were determined over a 3-hour period. D- and L-amphetamine (but not the placebo) equally suppressed plasma cortisol concentration and equally increased plasma GH concentration. Pretreatment of the monkeys with large doses of pimozide, a specific dopamine receptor blocker, did not appear to block the hormonal responses to either isomer of amphetamine.

Neuroendocrine studies of depressive illness.

Interest in possible neuroendocrine disturbances in endogenous depression is prompted by two lines of evidence: (1) clinical features of the illness suggest hypothalamic dysfunction; (2) the brain neurotransmitters implicated in depression also regulate neuroendocrine function. Our research reveals a marked, sustained hypersecretion in cortisol in severe depressive illness, which is apparently unrelated to stress and sleep disturbance, and which is associated with a distortion of the 24-hour cortisol secretory pattern. The hypersecretion is manifested primarily in the late afternoon, evening, and early morning hours, when cortisol secretion is normally inhibited.

Human growth hormone response to levodopa. Relation to menopause, depression, and plasma dopa concentration.

After ingestion of 500 mg of levodopa, postmenopausal women had significantly diminished human growth hormone (HGH) responses (mean, 4.6 ng/ml), as compared with those of age-matched men (mean, 9.1 ng/ml; P smaller than .

Altered growth of hormone secretory pattern following prolonged sleep deprivation in the rhesus monkey.

Plasma concentrations of growth hormone (GH) were determined in samples obtained sequentially at 15-min intervals during the last 4 h in monkeys deprived of sleep for 76 h and the first 8 h of ensuing recovery sleep. Electroencephalographic (EEG), electro-oculographic (EOG), and electromyographic (EMG) activities were recorded. Stages 3-4 sleep occurred rapidly after sleep onset and were of long duration.

Growth hormone responses to hypoglycemia in postmenopausal depressed women.

Human growth hormone (HGH) responses to insulin-induced hypoglycemia were measured in ten postmenopausal women suffering from primary unipolar depressive illness, and in ten age-matched normal postmenopausal women. The mean maximal HGH response in the depressed patients was 4.6 plus or minus 4.

Drug-induced dyskinesia in monkeys.

Easily definable dyskinetic syndromes have been produced by injection of L-DOPA, apomorphine, trivastal, carbachol, sodium azide, tetrahydrocannabinol, phenothiazines, and amphetamines into one or more sites. Three species of monkeys have been used: rhesus, green, and squirrel. The descriptive information available on each of these dyskinetic syndromes indicates a striking degree of similarity among the effects of these various drugs and combinations of drugs.

Growth hormone effects on sleep and wakefulness in the rat.

The sleep-wakefulness pattern and brain protein levels were determined in rats for 3 h following these conditions: administration of an inhibitor of protein synthesis (anisomycin), administration of several doses of rat growth hormone (GH) or thyrotropin, and administration of a combination of anisomycin + GH or thyrotropin. Anisomycin inhibited sleep and increased wakefulness, GH increased REM sleep, and thyrotropin produced no change. The combined administration of GH and anisomycin returned sleep to control levels.

Seasonal patterns of sleep stages and secretion of cortisol and growth hormone during 24 hour periods in northern Norway.

A group of 7 healthy male subjects was studied in regard to sleep stages and 24 h plasma cortisol and growth hormone patterns during the 4 seasons of the year in an Arctic environment (Tromsø, Norway). No difference in total sleep or sleep stage per cents was found for any of the yearly seasons. A small but statistical significant increase in mean plasma cortisol concentration and amount secreted for 24 h was found for the autumn-winter seasons, as compared with the spring and summer.