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Journal Article 2016; 37(4): 313-317 PubMed PMID: 27857049 Citation  Keywords:  Adult, Aged, Disorders of Excessive Somnolence:complications, Epilepsy:complications, Female, Humans, Male, Middle Aged, Polysomnography, Sleep Apnea Syndromes:complications, Sleep Deprivation:complications, Sleep Stages, Sleep, REM,.   

OBJECTIVES: Epilepsy and sleep-disordered breathing (SDB) are relatively common disorders. SDB induces repetitive arousals and sleep fragmentation and may cause symptomatic epileptic seizures or hypoxic encephalopathy. Epileptic seizures change sleep architecture with increase of light sleep and reduction of REM sleep, which may lead to central apneas. The aim of this study was to evaluate the relationship between SDB and daytime sleepiness in patients with epilepsy, who underwent polysomnography (PSG) due to problems with breathing during sleep or due to excessive daytime sleepiness.

METHODS: We enrolled 40 patients with epilepsy. Type, etiology of epilepsy and actual antiepileptic therapy was recorded. All of them underwent overnight PSG. Excessive daytime sleepiness (EDS) was assessed by Epworth Sleepiness Scale (ESS).

RESULTS: SDB (apnea-hypopnea index [AHI]<5) was present in 25 patients, 15 patients had no SDB (AHI≥5). EDS was present in 16 patients (40%). ESS significantly correlated with presence of symptomatic epilepsy (r=0.385, p=0.014), presence of SDB (r=0.524, p=0.001), AHI (r=0.416, p=0.003) and duration of REM sleep (r=-0.476, p=0.002). The presence of SDB (beta=0.447, p=0.002) and duration of REM sleep (beta=-0.308, p=0.029) were the only independent variables significantly associated with ESS in regression analysis.

CONCLUSION: SDB has negative influence on quality of sleep and daytime vigility in patients with epilepsy. Sleep fragmentation with the reduction of the REM sleep seems to be the most important mechanism leading to EDS. We suppose that PSG could be beneficial in all patients with epilepsy and EDS....

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Journal Article 2015; 36(5): 430-433 PubMed PMID: 26707042 Citation  Keywords:  Adult, Aged, Antidepressive Agents:adverse effects, Case-Control Studies, Cohort Studies, Depressive Disorder:drug therapy, Female, Humans, Male, Middle Aged, Narcolepsy:chemically induced, Polysomnography, REM Sleep Behavior Disorder:chemically induced, .   

OBJECTIVES: Antidepressants substantially affect REM sleep characteristics and trigger manifestations of REM sleep behavior disorder (RBD) in the general, non-narcoleptic, population. Antidepressants are also frequently administrated in an attempt to suppress cataplexy. We investigated the role of antidepressants in the development of RBD in narcolepsy with cataplexy (NC) patients.

PATIENTS/METHODS: Seventy-five patients diagnosed with NC were assessed by a structured interview (focused on RBD manifestations and the use of antidepressants) and night video-polysomnography followed by the multiple sleep latency test.

RESULTS: Of all 75 NC patients (36 male, 39 female; mean age 46.1±18.5 years), 34 cases had a history of antidepressant use (45.3%; 18 male, 16 female). In this antidepressant-positive group, 13 patients suffered from RBD (38.2%). Among antidepressant-naïve patients, only 5 subjects (12.2%) were diagnosed with RBD. Polysomnographic data showed significantly increased REM latency (p<0.01) and reduced percentage of REM sleep (p<0.01) in the antidepressant-positive group, as well as more periodic limb movements during sleep (p=0.01).

CONCLUSIONS: NC patients with a history of antidepressant use showed a three-fold higher occurrence of RBD in comparison to antidepressant-naïve patients....

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Journal Article 2014; 35(7): 560-566 PubMed PMID: 25617878 Citation  Keywords:  Female, Humans, Sleep Apnea, Obstructive:epidemiology, Sleep Wake Disorders:epidemiology, Stress Disorders, Post-Traumatic:epidemiology, Stress, Psychological:epidemiology,.   

: Sleep disturbances are found in a majority of individuals diagnosed with posttraumatic stress disorder (PTSD). The purpose of this literature review is to provide information about PTSD, in addition to assessing sleep quality. Current research observes that the lifetime prevalence of PTSD diagnosis in women is increasing. Although there are several studies that have been conducted to assess PTSD and sleep, there is a gap in the research that pertains to women, PTSD, and sleep quality. The current study will compile information on the subject to aid in decreasing the gender disparity in PTSD research, which is important for treating the entire PTSD population. Using the PubMed and PsycINFO databases, a comprehensive search was conducted to find relevant research about sleep difficulties and PTSD. Sleep disturbances such as insomnia, re-current nightmares, REM sleep dysfunction, and obstructive sleep apnea (OSA) affect sleep quality in PTSD patients. The implications of this study suggest that more research should be conducted pertaining to women and PTSD with sleep difficulties. This research is needed to decrease both PTSD symptoms and sleep-related disorders....

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Journal Article 2014; 35(5): 405-410 PubMed PMID: 25275263 Citation  Keywords:  Adult, Algorithms, Circadian Rhythm:physiology, Disorders of Excessive Somnolence:diagnosis, Electroencephalography, Epilepsy:complications, Female, Humans, Male, Medical History Taking, Middle Aged, Polysomnography, Prospective Studies, Sleep Stages:phys.   

OBJECTIVES: Authors evaluated quality of sleep and daytime vigilance in patients with nocturnal epilepsy and compared it to those with daytime epilepsy.

BACKGROUND: Nocturnal seizures are an important type of epilepsy. They can result in morbidity due to disruption of sleep architecture. Daytime sleepiness, as a serious consequence of nocturnal seizures, has negative influence on quality of life in patients with epilepsy.

METHODS: Authors examined 100 patients with epilepsy. The occurrence of epileptic seizures in circadian rhythm, type of epilepsy and epileptic seizures, as well as aetiology of epilepsy were evaluated. Patients were divided in two groups, 17 patients with nocturnal epilepsy and 83 patients with epileptic seizures not related to sleep. All of them underwent overnight video-EEG-polysomnography and they filled in the Epworth Sleepiness Scale questionnaire (ESS) as well as The Pittsburgh Sleep Quality Index questionnaire (PSQI).

RESULTS: Overnight video-EEG-polysomnography detected significant changes in the sleep architecture in patients with nocturnal epilepsy. Significant decrease of N3 stage of NREM sleep (14.31%±8.07 in the group of nocturnal epilepsy vs. 20.12%±9.24 in the group of daytime epilepsy, p=0.01). Concurrently, significantly poorer sleep quality according to PSQI (18.52±7.51 in the group of nocturnal epilepsy vs. 6.21±3.62 in the group of daytime epilepsy, p=0.01) and tendency to increased daytime sleepiness according to ESS was revealed in these patients.

CONCLUSION: Remarkable changes in sleep architecture associated with poor quality of sleep and increased daytime sleepiness were detected in patients with nocturnal epilepsy. In conclusion, we emphasize the importance of sleep history taking in patients with epilepsy and their further evaluation in sleep laboratory....

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Journal Article 2014; 35(3): 186-197 PubMed PMID: 24977966 Citation  Keywords:  Disorders of Excessive Somnolence:drug therapy, Drug Therapy:trends, Humans, Hypnotics and Sedatives:therapeutic use, Movement Disorders:drug therapy, Sleep Apnea Syndromes:drug therapy, Sleep Disorders, Circadian Rhythm:drug therapy, Sleep Initiation and.   

: Sleep disorders are frequent and disturbing, mostly chronic conditions. Despite the fact practice of sleep medicine is a young field. Sleep disorders were reduced to insomnia and even insomnia was not well studied until 1960ies. This article maps amazing development of sleep disorders treatment from the beginning till current date. The text covers both scientific and clinical perspectives on most frequent sleep related disorders including insomnias, hypersomnias, parasomnias, sleep related movement and breathing disorders, restless legs syndrome and circadian rhythm sleep disorders....

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Journal Article 2014; 35(2): 142-148 PubMed PMID: 24878978 Citation  Keywords:  Adult, Baroreflex:physiology, Cardiovascular Diseases:diagnosis, Endothelium, Vascular:physiopathology, Female, Humans, Male, Middle Aged, Polysomnography, Prognosis, Risk Factors, Severity of Illness Index, Sleep Apnea, Obstructive:complications,.   

OBJECTIVES: Obstructive sleep apnea syndrome (OSA) is associated with increased cardiovascular morbidity and mortality. Endothelial dysfunction (ED), accelerated atherosclerosis and autonomic dysfunction might be the key players responsible for development of vascular diseases in patients with OSA. In a population with suspected OSA and low burden of cardiovascular risk factors, we therefore aimed to investigate the association between potential cardiovascular risk factors including OSA-specific indices, ED and autonomic activity.

METHODS: ED was investigated using reperfusion hyperaemia index (RHI). OSA was assessed using standard polysomnography, autonomic activity was assessed using baroreflex sensitivity (BRS).

RESULTS: We enrolled 31 patients (42.1±11.7 years) with OSA. Significant inverse correlation was found between RHI and apnea-hypopnea index (AHI) (r=-0.550, p=0.001) and between RHI desaturation index (r=-0.533, p=0.002). Positive correlation was found between RHI and minimal nocturnal oxygen saturation (r=0.394, p=0.028). In a multiple regression model AHI was the only significant variable to predict RHI (β=-0.522, p=0.003). We found no correlation between RHI and BRS. RHI in the population with severe OSA (AHI above 30) was significantly lower than RHI in the rest of the population (p=0.012).

CONCLUSION: AHI was the only significant independent predictor of impaired endothelial function as expressed by RHI. RHI showed no association with BRS in patients with OSA....

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Case Reports 2013; 34(8): 763-766 PubMed PMID: 24522023 Citation  Keywords:  Adult, Central Nervous System Depressants:administration & dosage, Female, Fertility:drug effects, Humans, Male, Melatonin:administration & dosage, Pineal Gland:surgery, Pregnancy, Semen:drug effects, Sleep Disorders, Circadian Rhythm:drug therapy,.   

OBJECTIVES: Little is known about the effect of chronic melatonin treatment on human reproductive function. We report here on the effect of 10 months treatment with a controlled-release melatonin preparation (Circadin®, 2 mg) on spermatogenesis and gonadotropic hormone status in a pinealectomised patient whose melatonin secretion was abolished.

METHODS: Semen analysis, hormone (Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), inhibin B, prolactin, testosterone and estradiol) and Sex Hormone-Binding Globulin (SHB G) concentrations were determined before and at the end of 4 and 10 months of, treatment.

RESULTS: At the end of treatment, testosterone, sex hormone-binding globulin, prolactin and inhibin B levels did not display significant variation with time, whereas FSH and LH levels showed a tendency to a decrease, but remained in the normal range. Sperm concentration and total spermatozoa count dropped below the lower limit of the reference range during melatonin treatment, whereas motility and normal form percentages remained in the normal range. Fertility was preserved, since the patient's wife became pregnant during month 10 of melatonin treatment and gave birth to a healthy female baby.

CONCLUSIONS: this isolated clinical observation shows that more investigations in large patient series are needed to document possible side-effects of melatonin administration on male reproductive function. One should therefore be cautious about melatonin prescription for circadian rhythm sleep disorders in young males....

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Journal Article 2013; 34(1): 27-37 PubMed PMID: 23524621 Citation  Keywords:  Adult, Circadian Rhythm:genetics, Female, Genotype, Humans, Hydrocortisone:secretion, Life Change Events, Male, Middle Aged, Period Circadian Proteins:genetics, Police, Polymorphism, Genetic, Salivary Glands:secretion, Sleep Disorders, Circadian Rhythm:ge.   

OBJECTIVE: This study evaluated whether measures of waking or diurnal cortisol secretion, or self-reported psychological disturbances differed among police officers with a Period3 (PER3) clock gene length polymorphism.

METHODS: The cortisol awakening response was characterized via the area under the salivary cortisol curve with respect to the increase (AUCI) or total waking cortisol (AUCG). Diurnal cortisol measures included the slope of diurnal cortisol and the diurnal AUCG. Psychological disturbances were characterized using the Center for Epidemiologic Studies Depression Scale, Impact of Events Scale, and Life Events Scale.

RESULTS: Officers with a 4/5 or 5/5 genotype had higher awakening AUCG and greater diurnal cortisol AUCG levels compared to officers with the 4/4 genotype. Among those working more afternoon or night shifts, waking AUCI and AUCG were greater among officers with a 4/5 or 5/5 genotype compared to the 4/4 referents.

CONCLUSION: Cortisol secretion was modified among police officers with different PER3 VNTR clock gene variants....

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