Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium.

Objective: Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies.

Methods: Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2).

Double-Blind, Placebo-Controlled, Crossover Study of Armodafinil Treatment of Daytime Sleepiness Associated With Treated Nocturia.

Study Objectives: Nocturia, voids which disturb sleep, is the most common cause of awakenings and is associated with daytime sleepiness. Because the standard treatments for the most common causes of nocturia are relatively ineffective, many treated patients with nocturia are left with residual sleepiness. We carried out this pilot study to evaluate the potential of armodafinil to be an effective means of addressing the sleepiness that persists in many nocturia patients, despite their receiving standard therapy.

Prolonged Delirium With Catatonia Following Orthotopic Liver Transplant Responsive to Memantine.

A 59-year-old man with nonalcoholic steatohepatitis cirrhosis underwent an orthotopic liver transplant and experienced a complicated postoperative course, including a prolonged delirium. After discharge to rehabilitation, he had 2 subsequent admissions for delirium. On the first readmission, the transplant team started the patient on risperidone and resumed treatment with sertraline.

A randomized, double-blind, placebo-controlled trial of eszopiclone for the treatment of insomnia in patients with chronic low back pain.

Study Objectives: Insomnia, which is very common in patients with chronic low back pain (LBP), has long been viewed as a pain symptom that did not merit specific treatment. Recent data suggest that adding insomnia therapy to pain-targeted treatment should improve outcome; however, this has not been empirically tested in LBP or in any pain condition treated with a standardized pain medication regimen. We sought to test the hypothesis that adding insomnia therapy to pain-targeted treatment might improve sleep and pain in LBP.

Insomnia in HIV-infected patients: pathophysiologic implications.

The prevalence of insomnia in the HIV-seropositive population is estimated to be 29-97%, far greater than the 10% general population prevalence. We carried out a systematic review to assess whether the prevalence of insomnia is indeed higher in HIV-seropositive patients and to better understand the correlates of insomnia in order to attempt to explain the dramatically higher prevalence. Nineteen studies met our search criteria and were included in this review.

Comparison of diary-derived bladder and sleep measurements across OAB individuals, primary insomniacs, and healthy controls.

Introduction And Hypothesis: Can diary-derived bladder and sleep measurements differentiate individuals with overactive bladder syndrome (OAB) from individuals with primary insomnia and healthy controls?

Methods: Bladder- and sleep-diary data were compared in nine OAB, ten insomnia, and five control individuals. One-way analysis of variance (ANOVA) was used for normally and Kruskal-Wallis test for nonnormally distributed variables, followed, when significant effects were found, by pairwise comparisons.

Results: OAB individuals woke up as frequently as insomniacs, but their awakenings were respectively shorter in duration (18.

Comparison of polysomnographic data in age-, sex- and Axis I psychiatric diagnosis matched HIV-seropositive and HIV-seronegative insomnia patients.

Objective: There is a high prevalence of insomnia in HIV-seropositive patients. Insomnia is associated with poorer disease outcomes, cognitive impairment and HIV-associated dementia. However there is limited data characterizing the type of sleep disturbances, and the cause.

The association of fatigue with depression and insomnia in HIV-seropositive patients: a pilot study.

Objective: Fatigue is a pervasive symptom associated with HIV, resulting in significant functioning impairment; but little is known about its etiology or treatment. In patients with primary insomnia, data have shown improvement in fatigue following successful treatment of insomnia. However, little is known about the role of insomnia in patients with fatigue in HIV.

Laboratory diagnosis of factitious disorder: a systematic review of tools useful in the diagnosis of Munchausen's syndrome.

Aims: To assist clinicians in the diagnosis of factitious disorder.

Methods: This is a systematic review of the role of laboratory, radiologic, procedural, and pathological modalities to assist in the diagnosis of factitious disorder (Munchausen's syndrome). The review evaluated 3104 article titles and abstracts that were identified from MEDLINE as of January 2010.

Repetitive transcranial magnetic stimulation of the superior frontal gyrus modulates craving for cigarettes.

Background: Previous functional magnetic resonance imaging studies have shown strong correlations between cue-elicited craving for cigarettes and activation of the superior frontal gyrus (SFG). Repetitive transcranial magnetic stimulation (rTMS) offers a noninvasive means to reversibly affect brain cortical activity, which can be applied to testing hypotheses about the causal role of SFG in modulating craving.

Methods: Fifteen volunteer smokers were recruited to investigate the effects of rTMS on subjective responses to smoking versus neutral cues and to controlled presentations of cigarette smoke.

A case of delirium, motor disturbances, and autonomic dysfunction due to baclofen and tizanidine withdrawal: a review of the literature.

We report a case of delirium accompanied by extrapyramidal symptoms and autonomic dysfunction in a 59-year-old man following abrupt cessation of baclofen and tizanidine. An extensive search for the etiology was undertaken, but it was only after a careful history was taken that suspicion for baclofen and tizanidine withdrawal was raised. The delirium and motor disturbances resolved within 24 h of reintroduction of baclofen.

Topiramate-induced confusion following a single ingestion of 400 mg.

Background: Topiramate is an anticonvulsant medication commonly used for a variety of neurological disorders including migraine prophylaxis. Broadened use of topiramate has brought an increased awareness of toxicity from this medication, particularly central nervous system side effects and metabolic acidosis.

Objective: We describe a case of topiramate toxicity occurring in a 22-year-old female following the ingestion of two 200 mg tablets, which she was prescribed for the treatment of migraines.

Serotonin syndrome after a massive overdose of controlled-release paroxetine.

Background: Serotonin syndrome is a condition resulting from an overabundance of serotonin at postsynaptic receptors. The syndrome usually responds to cyproheptadine and benzodiazepines. However, some patients do not respond to conventional treatment.

Detrusor overactivity persisting at night and preceding nocturia in patients with overactive bladder syndrome: a nocturnal cystometrogram and polysomnogram study.

Purpose: Nocturia, a common symptom of overactive bladder syndrome, is associated with substantial adverse consequences and yet its pathophysiology has hardly been studied and the capacity to treat it remains limited. We established methods to study the physiology of overactive bladder associated nocturia and better understand this phenomenon.

Materials And Methods: We recorded simultaneous, time aligned, nocturnal cystometrogram and polysomnogram data during a single night at a sleep laboratory in 9 patients with overactive bladder and detrusor overactivity on daytime cystometrogram, in 10 patients with insomnia and in 5 healthy controls.

The pharmacologic management of insomnia in patients with HIV.

Insomnia is common in human immunodeficiency virus (HIV) seropositive populations. Some studies have estimated as many as 70% of HIV patients experience insomnia at some point during their illness. Insomnia has been linked to reduced quality of life as well as treatment non-adherence in these patients.

Modeling slow-wave activity dynamics: does an exponentially dampened periodic function really fit a single night of normal human sleep?

Objective: Slow-wave activity (SWA) is believed to be a fundamental measure of sleep homeostasis and is frequently characterized as an exponentially declining periodic dynamical system. The objective of this study is to carry out the first rigorous statistical test of this hypothesized dynamical behavior.

Methods: Delta power (DP) was computed for each epoch and artifacts were visually scored for 18 randomly selected nights from 18 healthy young men.