Hisakazu Furuta

EPWORTH SLEEPINESS SCALE AND SLEEP STUDIES IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

Excessive daytime sleepiness (EDS) is the major symptom of patients with obstructive sleep apnea syndrome (OSAS). In this study, we examined the relationship between subjective EDS scored with the Epworth Sleepiness Scale (ESS), objective EDS measured with the multiple sleep latency test (MSLT) and sleep variables evaluated with polysomnography for patients with OSAS. Subjects were 10 patients (51.7 ± 19.0 years old). The average ESS and MSLT scores were 10.6 ± 5.6 and 7.7 ± 5.6, respectively. There was no significant relationship between ESS and MSLT. The Multiple Sleep Latency Test had a significant negative relationship with the number of awakenings and the apnea/hypopnea index. No relationship was found between nocturnal hypoxia and either ESS or MSLT. Our findings suggest that objective EDS in OSAS is related with fragmentation of sleep, and that several patients are not aware of their EDS.

Immunohistochemical study of neuronal intranuclear and cytoplasmic inclusions in Machado–Joseph disease

Abstract Machado–Joseph disease (MJD) is a dominantly inherited spinocerebellar disorder, and expansions of trinucleotide (CAG) at chromosome 14 have been shown to be the locus of this disorder. Polyglutamine CAG stretches in the neuronal cytoplasms and nuclei were studied with immunolabeling using 1C2, a monoclonal antibody recognizing polyglutamine stretches, and polyclonal antiubiquitin antibody in six genetically verified cases of MJD. 1C2 clearly labeled two types of neuronal intranuclear inclusions (NII) and neuronal cytoplasmic inclusions (NCI) in the substantia nigra, pontine nucleus, dentate nucleus and spinal anterior horn where NII and NCI were also positive for ubiquitin, as were extracellular dot‐like structures and oligodendroglial inclusions. 1C2‐positive NII and NCI had a lesion‐specific distribution. While the spinal motoneurons contained only 1C2‐positive NCI and lacked 1C2‐positive NII, the ventral pontine nucleus neurons had many 1C2‐positive NII and few 1C2‐positive NCI. Semi‐quantitative examination of NII and NCI positive for 1C2 or ubiquitin demonstrated that there were more 1C2‐positive NII and NCI than ubiquitin‐positive ones. It is noteworthy that the nuclei of the spinal motoneurons lacked 1C2‐positive immunoreactivity, so that ubiquitination of 1C2‐positive structures is presumed to occur late in the course of the disease.

Polysomnographic and urodynamic changes in a case of obstructive sleep apnea syndrome with enuresis.

A 53‐year‐old female patient with obstructive sleep apnea syndrome was reported. She had complained of enuresis as well as a 15‐year history of snoring, but she had no complaint of sleep and awake disturbance. Polysomnographic study showed repeated obstructive apnea and hypopnea with an apnea/hypopnea index of 52.6, and severe oxygen desaturation during sleep. On cystometography during sleep, the changing amplitude of the spike wave corresponds to the changes of respiratory efforts against a closed upper airway. The patient was treated successfully with imipramine and acetazolamide for the obstructive sleep apnea and enuresis. Apnea/ hypopnea index, nocturnal oxygen desaturation, and sleep architecture were improved, and enuresis completely disappeared. Cystometrography during sleep showed that the average amplitude of the spike wave tended to be low. Percentage urinary volume during sleep compared with 24 h volume was significantly reduced. We considered that the enuresis was mainly related to increased intra‐abdominal pressure produced by respiratory efforts and enhanced nocturnal urine production.

Comparison in symptoms between aged and younger patients with narcolepsy.

We investigated the age‐related changes in symptoms in narcolepsy. Fifty patients, 65‐year‐old and over (aged group), were recruited from the National Narcolepsy Registry. Thirty‐four patients, younger than 65 (younger group), were selected by random sampling. Although there was no difference in the age of disease onset between the two groups, the age of diagnosis was significantly earlier for the younger group. Methylphenidate was used significantly more in the aged group, and modafinil in the younger group. The aged group had lower total scores on the Ullanlinna Narcolepsy Scale, because the scores for cataplexy were significantly less for the aged group. There was no significant difference in excessive daytime sleepiness between the two groups.

Diffuse cerebral hypoperfusion in epileptic patients observed from quantitative assessment with single photon emission computed tomography using N-isopropyl-(iodine-123)-p-iodoamphetamine

Quantitative assessment of regional cerebral blood flow (rCBF) in the bilateral cerebral and cerebellar cortices was performed in 15 epileptic adult patients receiving chronic high-dose antiepileptic drug therapy and 22 normal volunteers matched for sex and age, using single photon emission computed tomography with N-isopropyl-(iodine-123)-p-iodoamphetamine. The entire averaged rCBF value in the epileptic patients, i.e. 52.8 +/- 13.7 ml/10 g/min (range: 25-78 ml/100 g/min), was significantly lower as compared with that in the normal subjects, i.e. 69.1 +/- 14.2 ml/100 g/min (range: 46-102 ml/100 g/min). Six of the 15 patients showed absolute rCBF values less than the minimum of the normal range, i.e. 46 ml/100 g/min, in all or most of the measured brain tissues. There was a significant correlation between the diffuse cerebral hypoperfusion and simultaneous ingestion of phenytoin and phenobarbital. The possible effects of antiepileptic drugs on rCBF are discussed.

Regional Analysis of Differently Phosphorylated Tau Proteins in Brains from Patients with Alzheimer's Disease

Neurofibrillary tangles (NFT) in Alzheimer’s disease (AD) are composed of abnormally phosphorylated tau proteins. Many phosphorylation sites have been reported in the AD brain, and NFT distribution was now roughly classified into 3 stages by Braak stage; this classification is based on pathological studies using the specific silver impregnation technique. The aim of our study was to examine the regional distribution of differently phosphorylated tau proteins with 5 site-specific monoclonal antibodies against the tau proteins, AT8, AT180, HT7, Tau2 and Tau5. We then compared our findings with those obtained from silver-stained NFT in an attempt to clarify the relationship between abnormal phosphorylation sites of the tau protein and NFT development. AT180 and AT8 labeled the highest and Tau2 the lowest density of NFT in any regions, while Tau5 and HT7 showed inconsistent distribution. In the limbic cortex, cornu ammonis, entorhinal cortex and cingulate cortex, silver-stained NFT density significantly correlated with density of NFT labeled with the 5 anti-tau antibodies, but cerebral isocortices showed heterogenous patterns of tau-positive NFT. Quantification of tau-positive regional NFT density showed that the AD-associated phosphorylation process progresses from the C-terminal to the N-terminal of the amino acid sequence, and correlation of Gallyas-stained NFT density with tau-labeled NFT density was more significant in the limbic cortices than the cerebral isocortices, which implies that stereotypical phosphorylation occurs in the limbic structures.

Enuresis in an adult female with obstructive sleep apnea

Adult onset enuresis accompanied by obstructive sleep apnea has been reported rarely. A female patient was referred to our clinic with complaints of of a 15-year history of loud snoring and sleep apnea as well as enuresis, which was treated successfully with imipramine and acetazolamide. The mechanism of enuresis and its relationship to upper airway obstruction are reviewed here with reference to the findings of polysomnography and sleep cystometry.

Effects of Mianserin on Human Sleep

Sleep EEG and nocturnal penile tumescence (NPT) were investigated in 6 healthy men during placebo and mianserin administration and after mianserin withdrawal. The results were assessed in a historical comparison with those previously obtained with clomipramine. With mianserin, REM sleep was suppressed slightly. However, the suppressive effect of mianserin on REM sleep--based on the historical comparison--was significantly weaker than that of clomipramine throughout all the drug nights. Accordingly, a rebound increase in REM sleep was not observed after withdrawal. Less suppressive effects on NPT and disturbance of sexual function with mianserin than with clomipramine were observed. We suggest that a correlation between the prolonging effect on REM latency and the clinical antidepressant effect is limited to some antidepressants.

Changes in work performances in obstructive sleep apnea patients after dental appliance therapy

Abstract The effects of dental appliances on work performances of obstructive sleep apnea syndrome (OSAS) is not well examined. This study evaluated the polysomnographic and psychological findings before and after therapy. Nine patients were diagnosed OSAS by nocturnal polysomnography. The psychological battery was performed from 13:00 to 14:00, which consisted of Uchida‐Kraepelin psychodiagnostic test (U‐Ks test) and Bourdons cancellation test (Bourdons test). Approximately 3 months after the treatment, the examinations were performed. Apnea and desaturation index decreased significantly after the therapy. In addition, sleep architecture improved after the therapy compared with that before the therapy. Dysfunction of task performances, such as mean level of work amounts in U‐Ks test, mean error, mean performance time and mean deviation in Bourdons test improved after therapy. We conclude that dental appliances therapy is effective not only to apnea but also to work performance in OSAS.

An unusual case of rhythmic movement disorder

Rhythmic movement disorder is one of the sleep–wake transition disorders listed in the International Classification of Sleep Disorders. According to this classification, the condition commonly occurs in infants and toddlers, and persistence beyond 4 years of age is unusual. Recently, we encountered a case in which rhythmic movement disorder persisted up until the age of 12 years with spikes registering on the sleep electroencephalogram. Epileptic seizure was ruled out because of the characteristic rolling movement, absence of any other epileptic symptoms (e.g. vocalization and tonic‐clonic seizure) and cessation as a result of removal of the blanket.