Yoshio Teshima

Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome

The CSF pressure was measured continuously at the lumbar level during nocturnal sleep in 3 patients with sleep apnea hypersomnia syndrome. Nocturnal sleep was very unstable with frequent episodes of obstructive sleep apnea. When the patients were awake and relaxed in the supine position, their CSF pressure was stable and within the normal range. Episodic marked elevations of CSF pressure occurred frequently during sleep, and each elevation was preceded and accompanied by an episode of sleep apnea or hypopnea. Significant correlations were found between the duration of apneic episodes and increase of CSF pressure, and between decrease of SaO2 or TcPO2 and increase of CSF pressure. The duration of sleep apnea was longer, increase of CSF pressure was greater, and decreases of SaO2 and TcPO2 were more marked during REM sleep than during NREM sleep. It is suggested that the frequent marked episodic elevations of CSF pressure are caused by an increase in the intracranial vascular volume occurring mainly in response to transient hypercapnia and hypoxia, which are induced by pulmonary hypoventilation during the episodes of sleep apnea.

Potential distribution of vertex sharp wave and saw-toothed wave on the scalp

Potential distribution of vertex sharp wave characterizing stages 1 and 2 of NREM sleep and saw-toothed wave recorded in REM sleep were studied in 6 healthy young adults. Like the vertex sharp wave, saw-toothed wave appeared in a wide area on the scalp with the maximal amplitude at Cz and its equipotential lines showed concentric circles with their center at Cz, its amplitude decreasing with distance from Cz. The main component of saw-toothed wave was a positive wave with longer duration (about 250 msec) and lower amplitude than vertex sharp wave (about 200 msec in duration), the main component of which was a negative wave.

REM Sleep without Muscle Atonia (Stage 1‐REM) and Its Relation to Delirious Behavior during Sleep in Patients with Degenerative Diseases Involving the Brain Stem

Abstract: Nocturnal sleep was examined in 12 patients with degenerative diseases involving the brain stem and in 2 patients with late cerebellar cortical atrophy (LCCA). A peculiar sleep state, characterized by the concomitant appearance of a low‐voltage mixed frequency EEG, rapid eye movements (REMs) and tonic EMG in mental muscles, repeatedly appeared during nocturnal sleep in all of the 12 patients with degenerative diseases involving the brain stem and it was called stage 1‐REM after Tachibana et al.32 In 8 of the 12 patients, delirious or oneiric behavior appeared during, or soon after, the episodes of stage 1‐REM. Inner experiences reported by one of the subjects well corresponded to his behavior during the episode of stage 1‐REM. Stage 1‐REM was not observed during nocturnal sleep of the patients with LCCA. These results indicate that a degenerative lesion in the brain stem induced stage 1‐REM and delirious behavior during nocturnal sleep through abolishing muscle atonia of REM sleep and causing dissociation of the functional components characterizing REM sleep.

Appearance of frontal mid-line theta rhythm during sleep and its relation to mental activity

Fm theta occurred not only during mental tests in the waking state but also during nocturnal sleep in which it was most frequent during REM and secondarily most frequent during stage 1 of NREM sleep. As for the inner experience of the subjects, they frequently reported dream and distinct mentations on awakening from REM sleep whether or not it was accompanied by Fm theta. They reported dream and distinct mentations more frequently when awakened from stage 1 of NREM sleep with Fm theta than when awakened from stage 1 of NREM sleep without Fm theta. Relationship of Fm theta to mental activity during sleep was briefly discussed.

Sleep characteristics of menopausal insomnia: A polysomnographic study

Abstract  Although menopausal insomnia is of clinical significance, the essential features of this form of disrupted sleep are poorly understood. The aim of the present study was to identify the sleep characteristics of menopausal insomnia by using overnight polysomnography (PSG). Twenty‐one subjects with menopausal insomnia (MI) and 13 sex‐ and age‐matched normal control (NC) subjects without sleep complaints took part in the present study. All MI and NC subjects underwent PSG on two consecutive nights. In comparison with NC, MI subjects had non‐specific findings such as significantly shorter total sleep time, longer sleep latency, higher wake time after sleep onset, and lower sleep efficiency. As for rapid eye movement (REM) sleep variables, MI subjects had significantly shorter total REM sleep time, fewer numbers of REM sleep periods, longer REM latency, and higher REM density than did the NC subjects. As for the time course of REM density, REM density during the first 3 h period of nocturnal sleep was significantly higher for MI than for NC subjects. Unlike NC subjects, REM density for MI subjects did not tend to rise progressively during nocturnal sleep. The MI subjects had objective evidence of disrupted sleep and the most striking characteristics of this dysfunction were observed in REM sleep variables. The sleep characteristics of MI subjects were found to differ in REM sleep variables from those of patients with major depression (except for REM density). Menopausal insomnia patients appear to be similar to patients with generalized anxiety disorder accompanied by severe sleep disruption. These data lend support to the clinical distinction between menopausal insomnia and insomnia associated with major psychiatric disorders.

Clinical characteristics of upper airway resistance syndrome

Polysomnographic findings and clinical symptoms were investigated in 14 cases of upper airway resistance syndrome. The mean scores of the Epworth sleepiness scale and self‐rating depression scale in eight cases were 13.5 and 38.6, respectively. The mean sleep latency of the multiple sleep latency test in four cases was 10.2 min. Seven cases were treated with continuous positive airway pressure (CPAP), and one with hormone replacement therapy. The most common symptom was daytime sleepiness. Five cases had hypertension. CPAP reduced increasing negative esophageal pressure (Pes) and frequency of EEG arousals, and improved hypertension in one case. Hormone replacement therapy ameliorated increasing negative Pes and clinical symptoms.

Efficacy of risperidone in the treatment of delirium in elderly patients

Background:  Despite increasing recognition of delirium as a serious complication of physical illness, little has been reported in this area. Interest has been raised in treatment options other than haloperidol, such as atypical antipsychotic agents.

Therapeutic Effects of Tracheostomy in Two Cases of Hypersomnia with Respiratory Disturbance during Sleep

Abstract: Recently the association of hypersomnia and respiratory insufficiency without lesion in the respiratory organ has attracted attention of many investigators. Obese patients with such a condition have been called the Pickwickian syndrome. In this report, two non‐obese patients with a similar condition were presented, one with micrognathia and frequent apneic episodes during sleep, and the other with laryngeal stenosis due to paralysis of the bilateral laryngeal nerves and chronic laryngitis. Tracheostomy had a prompt and long‐lasting therapeutic effect to make their sleep stable and also to relieve their excessive daytime sleepiness. These findings suggest that the obstruction or stenosis of the upper airway during sleep disturbed their nocturnal sleep, and that their excessive daytime sleepiness was a phenomenon compensating for their disturbed nocturnal sleep.

Frequent breathing-related electroencephalogram arousals in four patients with mild obstructive sleep apneas.

We report cases of four patients with mild obstructive sleep apnea syndrome (OSAS) with frequent breathing‐related electroencephalogram (EEG) arousals which led to excessive daytime sleepiness. In spite of a relatively low apnea hypopnea index (AHI), sleep was disrupted by frequent EEG arousals associated with respiratory effort as observed in upper airway resistance syndrome. The effects of sleep stage and sleep position on EEG arousals were also investigated. We consider that AHI alone is not a sufficient index to assess severity of OSAS, and it is very important to examine microarousals by the alteration of esophageal pressure in addition to the effect of sleep position.

Idiopathic REM Sleep Behavior Disorder in the Aged

As showing in Table 1, rapid eye movement (REM) sleep behavior disorder (RBD), is characterized by the intermittent loss of electromyogram (EMG) atonia and by the appearance of the elaborate motor activity associated with dream. Therefore, it is considered that diagnosing typical RBD patients according to these minimal criteria is not difficult, but that polysomnographic (PSG) examination is required to differentiate accurately between this and other sleep disorders.