Anthony Kales

SLEEP APNOEA IN A HYPERTENSIVE POPULATION

50 hypertensive patients and 50 normal controls were evaluated in the sleep laboratory for the presence of sleep apnoea or sleep apnoeic activity. Hypertensive patients were at high risk of sleep apnoea; 15 hypertensive patients (30%) had sleep apnoea and another 17 (34%) had sleep apnoeic activity. In contrast, none of the age-matched and sex-matched control subjects had sleep apnoea, and 24% had sleep apnoeic activity. The degree of oxygen desaturation was correlated with the duration as well as the number of apnoeic events. Presence of sleep apnoea in the patients was significantly correlated with higher blood pressure levels when they were initially seen in the clinic. Patients with the most severe sleep apnoea had the highest initial blood-pressure levels and were more refractory to treatment.

Chronic insomnia and activity of the stress system ☆: A preliminary study

The aim of this study was to assess whether there is an association between chronic insomnia and the activity of the stress system. Fifteen young adult insomniacs (<40 years) were studied. After an adaptation night, each subject was recorded in the sleep laboratory for three consecutive nights. During this period, 24-hour urine specimens were collected for measurements of urinary free cortisol (UFC), catecholamines, and growth hormone (GH). The 24-hour UFC levels were positively correlated with total wake time (p=0.05). In addition, 24-hour urinary levels of catecholamine metabolites, DHPG, and DOPAC were positively correlated with percent stage 1 sleep (p<0.05) and wake time after sleep onset (WTASO) (p<0.05). Norepinephrine tended to correlate positively with percent stage 1 sleep (p=0.063) and WTASO (p=0.074), and negatively with percent slow-wave sleep (p=0.059). Twenty-four-hour urinary GH excretion was detectable in only three insomniacs, two of whom had low indices of sleep disturbance. We conclude that, in chronic insomnia, the activity of both limbs of the stress system (i.e., the HPA axis and the sympathetic system) relates positively to the degree of objective sleep disturbance.

Onset of insomnia: role of life-stress events.

&NA; During the year their insomnia began, chronic insomniacs experienced a greater number of stressful life events compared with previous or subsequent years and compared with good sleepers. In addition, among the life event categories assessed, insomniacs reported a greater number of undesirable events, particularly events related to losses and to ill health. They also had lifelong histories of more illnesses and somatic complaints, beginning with more childhood illnesses and more childhood problems related to eating and sleeping. During childhood, insomniacs reported more frequent discontent with their families, and prior to the onset of insomnia, they had less satisfying relationships with their parents as well as problems in other interpersonal relations and in their self‐concepts. Currently, insomniacs felt considerably less satisfied with their lives, had lower self‐concepts, and had greater difficulty with interpersonal relationships. Thus, stressful life events, mediated by certain predisposing factors of personal vulnerability, were found to be closely related to the onset of chronic insomnia.

Sleep deprivation effects on the activity of the hypothalamic–pituitary–adrenal and growth axes: potential clinical implications

Although several studies have shown that sleep deprivation is associated with increased slow wave sleep during the recovery night, the effects of sleep deprivation on cortisol and growth hormone (GH) secretion the next day and recovery night have not been assessed systematically. We hypothesized that increased slow wave sleep postsleep deprivation is associated with decreased cortisol levels and that the enhanced GH secretion is driven by the decreased activity of the HPA axis.

Sleep in patients with Parkinson's disease and normal subiects prior to and following levodopa administration

Six patients with parkinsonism and 4 spouse control subjects were studied in the sleep laboratory prior to administration of levodopa and during initial, short‐term, long‐term, and chronic usage. The parkinsonian patients had a significant amount of sleeping difficulty, taking much longer to fall asleep and awakening frequently for long periods during the night, as compared with spouse control subjects and a normal, elderly control group. Values for rapid eye movement (REM) sleep were similar to those of both control groups, while Stage 3 sleep was decreased. Three of the 6 patients showed a decrease in REM sleep with initial drug administration at the 1.0 Gm. per day dosage level. One had a marked increase in REM sleep for about the first 2 weeks of drug administration. However, REM sleep values for all patients with long‐term and chronic drug administration were similar to base‐line values. In the spouse control subjects, other than a slight increase in REM sleep with initial drug administration which was not maintained with long‐term use, no changes were noted in REM sleep, even during withdrawal of the drug. In both patients and control subjects, values for sleep induction and sleep maintenance were essentially unaltered by the administration of levodopa. Biochemical implications of these data are discussed. In addition, the clinical implications in terms of evaluating and treating the moderately severe insomnia in parkinsonian patients are described.

Insomnia in central Pennsylvania.

OBJECTIVE Establish the association between insomnia and various physical and mental health symptoms as well as objective measures of sleep disturbance while controlling for age, gender and BMI in a large random sample of the general public. METHODS A subsample (N=1741) was selected for a single-night sleep laboratory evaluation from a larger random sample (N=16,583) of the general public (20-100 years old). RESULTS The prevalence of insomnia was 7.5% and difficulty sleeping an additional 22.4%. The complaints were more frequent in women and in non-Caucasian minorities. A multivariate logistic regression analysis indicated that depression was the single strongest factor followed by female gender associated with either insomnia or difficulty sleeping. Minority status and a history of colitis, hypertension and anemia were also associated, but to a lesser degree. The final model did not include age, BMI as well as any of the sleep laboratory findings. CONCLUSION These findings support the conclusion that mental health variables have the primary independent association with a complaint of insomnia. Other factors including minorities and hypertension are also independently associated, though to a lesser degree. Other primary sleep disorders, e.g., sleep apnea, do not seem to play a major role in insomnia. These findings underscore the fact that insomnia is a symptom associated with a wide variety of mental and physical health problems requiring a proper psychiatric and medical management.

Rebound Insomnia and Rebound Anxiety: A Review

Rebound insomnia and rebound anxiety are clinical conditions related to withdrawal of certain benzodiazepine drugs. Numerous studies of benzodiazepine and nonbenzodiazepine hypnotics conducted in our sleep laboratory demonstrated that rebound insomnia developed following withdrawal from benzodiazepines with a rapid or intermediate elimination rate. Several studies conducted by other investigators also indicated the development of rebound insomnia under similar conditions. Rebound insomnia and rebound anxiety are discussed in terms of their interrelationship, clinical implications, and receptor mechanisms. Evidence suggests that drugs producing rebound insomnia and rebound anxiety also show a more rapid development of tolerance and greater potential for drug dependence than benzodiazepines where the parent compound or its metabolites have a long elimination half-life.

Biopsychobehavioral correlates of insomnia. II: Pattern specificity and consistency with the Minnesota Multiphasic Personality Inventory

&NA; In a study designed to assess personality patterns of patients with chronic insomnia, a total of 528 subjects (428 insomniacs and 100 controls) completed the Minnesota Multiphasic Personality Inventory (MMPI). Comparison of the MMPI profiles of insomniacs from a semirural area and of those from an urban area, each in a completely different geographic region, showed results consistent for high levels of psychopathology as well as for specific personality patterns within and between groups. The personality patterns of insomniac subjects were remarkably homogeneous: only a few MMPI code types accounted for about one‐half of each insomniac sample. The insomniac profiles were consistently characterized by the presence of neurotic depression, rumination, chronic anxiety, inhibition of emotions, and an inability to discharge anger outwardly. The results of this study confirm the original hypothesis that the handling of stresses and conflicts through an internalization of emotions leads to physiologic activation and is a major factor underlying the development and maintenance of chronic insomnia.

Severe obstructive sleep apnea—I: Onset, clinical course, and characteristics

The clinical course and characteristics of severe obstructive sleep apnea are described for 50 adults whose condition warranted recommendation for tracheostomy. All patients had a history of snoring, excessive daytime sleepiness and sleep attacks, nocturnal snorting and gasping sounds and observer-noted nocturnal breath cessations. Generally, these symptoms became manifest before age 40, their appearance tended to cluster together within only a few years and, invariably, they were chronic. Aside from snoring, excessive daytime sleepiness was on average often the first symptom and began at a mean age of 36 years. However, in half of the patients either hypertension or overweight preceded excessive daytime sleepiness by at least 1 year. Physicians in the office setting should suspect severe obstructive sleep apnea in patients who have loud snoring and either excessive daytime sleepiness, hypertension, or obesity. Further evidence of apnea can be obtained by determining the presence of the additional signs of loud nocturnal snorting and gasping sounds and nocturnal breath cessations.

Somnambulism: All-Night Electroencephalographic Studies

Using special techniques allowing for subject mobility, we obtained continuous electroencephalographic recordings of known sleepwalkers. Somnambulistic incidents occurred during periods of slow-wave sleep. The incidents were not related temporally to dream periods, nor did they affect the total time or the percentage of time spent dreaming during the nights on which the subjects were studied.