German Nino-Murcia

The morbidity of insomnia uncomplicated by psychiatric disorders

The morbidity of sleep problems has been well documented; however, they are frequently associated with and are symptomatic of several psychiatric disorders. It is unclear how much of the morbidity can be accounted for by the associated psychiatric and substance abuse disorders and medical problems, and how much by the sleep problems per se. Sleep problems may also be an early sign of a psychiatric problem. This paper reports data from an epidemiologic community survey of over 10,000 adults living in three U.S. communities. A structured diagnostic assessment of psychiatric disorders as well as assessment of the presence of insomnia not due to medical conditions, medication, drug or alcohol abuse, and a 1-year follow-up were completed. Persons with insomnia in the past year without any psychiatric disorders ever (uncomplicated insomnia); with a psychiatric disorder in the past year (complicated insomnia); and with neither insomnia nor psychiatric disorders ever were compared on treatment utilization and the first onset of a psychiatric disorder in the subsequent year. Eight percent of those with uncomplicated as compared with 14.9% with complicated insomnia and 2.5% with neither had sought treatment from the general medical sector for emotional problems in the 6 months prior to the interview. The rates of treatment sought from the psychiatric specialty sector were 3.8%, 9.4%, and 1.2%, respectively. These differences were significant after controlling for sociodemographic characteristics and were sustained when the persons were interviewed 1 year later. Uncomplicated insomnia was also associated with an increase in risk for first onset of major depression, panic disorder, and alcohol abuse over the following year. Insomnia, even in the absence of psychiatric disorders, is associated with increased use of general medical and mental health treatment for emotional problems and for the subsequent first onset in the following year of some psychiatric disorders. Early diagnosis and treatment of uncomplicated insomnia may be useful.

Maxillary, mandibular, and hyoid advancement: an alternative to tracheostomy in obstructive sleep apnea syndrome.

Nine patients with severe obstructive sleep apnea syndrome (OSAS)—for whom several therapeutic approaches, including palatopharyngoplasty, had failed—were treated with a combined maxillary, mandibular, and hyoid advancement. Objective evaluation—performed before and 4 to 18 months after surgery, using nocturnal polysomography—indicated that the OSAS had improved or had disappeared. This surgical approach is beneficial for specific cases of OSAS, which can be identified by mandatory presurgical tests.

Sleep disturbance produced by electrical stimulation of the locus coeruleus in a human subject.

A 25-year-old man with a chronically implanted stimulating electrode placed in the region of the locus coeruleus (LC) was monitored for 5 nights in a sleep laboratory to study the role of the LC in sleep. Sleep patterns were compared between the 2 nights in which the stimulation was applied periodically every 90 min and the 2 nights in which no stimulation was applied. In contrast to the normal sleep patterns that occurred during the 2 nonstimulation nights, electrical stimulation of the LC produced a profound disruption of sleep and significant reductions in the total amounts of NREM sleep, REM sleep, REM sleep as a percent of total sleep (NREM + REM sleep), and total sleep. Results suggest that the LC has a role in maintaining normal sleep patterns.

Regular 48-hour cycling of sleep duration and mood in a 35-year-old woman: Use of lithium in time isolation

At least 20 cases of regularly occurring 48-hr mood cycles have been reported previously (Jenner et al. 1967; Kupfer and Heninger 1972; Gelenberg et al. 1978; Doerr et al. 1979; King et al. 1979; Frank and Harrer 1980; Paschalis et al. 1980; early cases reviewed in Bunney and Hartmann 1965; Sitaram et al. 1978). The disorder sometimes begins with longer, more irregular mood cycles that shorten progressively until a regular 48-hr pattern is established (Wiesel 1927; Doerr et al. 1979; Paschalis et al. 1980). In some cases, the onset of symptoms coincides with pregnancy (Pfanner 1930) or with a traumatic event, such as a head injury (Jenner et al. 1967) or a stroke (Scheiber 1901). The mood swings may be either unipolar or bipolar, of greater or lesser severity, but they nearly always exhibit remarkable regularity in timing. Patients typically switch between manic and depressive mood during each sleep period, seldom if ever missing a day. If untreated, the cycles may persist for many years, even decades. The intriguing regularity of the mood alternations in these cases provides a valuable opportunity to study the biological concomitants of affective disorders, and particularly suggests involvement of the circadian timing system in these disorders. Accordingly, we have performed an intensive evaluation of a previously undescribed patient exhibiting 48-hr mood cycles, paying particular attention to characteristics of sleep and other circadian rhythms before and during lithium treatment.

Abundant REM sleep in a patient with Alzheimer's disease

In patients with Alzheimers disease (AD), greatly diminished REM sleep might be expected because of the cholinergic deficit in this disease and because cholinergic agonists stimulate REM sleep in humans and animals. We present here an unusual case of neuropathologically verified AD with abundant REM sleep. We suggest 4 possible explanations for this phenomenon: (1) selective cell loss in caudal midbrain/rostral pontine structures known to control sleep; (2) development of narcolepsy; (3) unrecognized affective disorder; (4) disruption of circadian timekeeping system.

Sleep patterns and dexamethasone suppression in nondepressed bulimics

In this study, we attempted to find markers of depression in bulimics without major depression or a history of anorexia nervosa and to examine cortisol suppression (DST) by bulimics following administration of dexamethasone

The assessment of a new technology for evaluating respiratory abnormalities in sleep.

This study assessed the diagnostic utility of two technologies for evaluating respiratory abnormalities in sleep. We compared conventional polysomnography with a new, ambulatory microprocessor technology. Two key features of the comparison involved: (a) the use of multiple, skilled interpreters of each system; and (b) inter-rater agreement within the systems as a crucial test for the diagnostic utility of each. Results indicated that general categories of respiratory abnormalities could be judged more reliably than more specific categories, regardless of technology. For certain categories of respiratory abnormalities, however, inter-rater agreement with the newer technology was extremely low (e.g., reliability coefficients of .12, .09, and -0.6). Factors contributing to these low diagnostic reliabilities are discussed. Our data indicate that any assessment of new technology cannot be made apart from the clinical judgments to be rendered with that new technology. This approach may be generalizable to the assessment of other diagnostic technologies.