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Case Reports 2010; 31(3): 290-296 PubMed PMID: 20588231 Citation  Keywords:  Adult, Anorexia Nervosa:complications, Anxiety:complications, Chronic Disease, Depression:complications, Female, Humans, Menstruation Disturbances:complications, Middle Aged, Phototherapy:methods, Pilot Projects, Sleep-Wake Transition Disorders:complicati.   

OBJECTIVE: To examine the effect of bright light therapy on the sleep-wake rhythm, the menstrual cycle, mood, and key eating pathology symptoms in chronic anorexia nervosa.

METHODS: Five chronic anorectic women (mean duration of illness: 15.3 years) received 5 daily sessions of 30 minutes bright light therapy (10,000 LUX). Participants completed a diagnostic interview and questionnaires at pre-test, post-test and at a three month follow-up.

RESULTS: At follow up there was a slight improvement on core eating pathology, a fair decrease of depressive symptoms and an clinically important improvement on global distress.

CONCLUSIONS: Bright light therapy has on short term a positive effect on the physiological and psychological well being of chronic anorectic women. However, at follow-up the effects were partly lost. It is recommended to enhance the exposure period and repeat the treatment after 3 months....

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Clinical Trial 2010; 31(1): 92-96 PubMed PMID: 20150866 Citation  Keywords:  Adolescent, Biological Clocks:physiology, Circadian Rhythm:physiology, Eyeglasses, Female, Humans, Light, Lighting:adverse effects, Male, Melatonin:metabolism, Population, Radio Waves, Schools, Sleep Disorders, Circadian Rhythm:etiology, Students, Time Fa.   

OBJECTIVE: Circadian timing affects sleep onset. Delayed sleep onset can reduce sleep duration in adolescents required to awake early for a fixed school schedule. The absence of short-wavelength ("blue") morning light, which helps entrain the circadian system, can hypothetically delay sleep onset and decrease sleep duration in adolescents. The goal of this study was to investigate whether removal of short-wavelength light during the morning hours delayed the onset of melatonin in young adults.

METHODS: Dim light melatonin onset (DLMO) was measured in eleven 8th-grade students before and after wearing orange glasses, which removed short-wavelength light, for a five-day school week.

RESULTS: DLMO was significantly delayed (30 minutes) after the five-day intervention, demonstrating that short-wavelength light exposure during the day can be important for advancing circadian rhythms in students.

CONCLUSIONS: Lack of short-wavelength light in the morning has been shown to delay the circadian clock in controlled laboratory conditions. The results presented here are the first to show, outside laboratory conditions, that removal of short-wavelength light in the morning hours can delay DLMO in 8th-grade students. These field data, consistent with results from controlled laboratory studies, are directly relevant to lighting practice in schools....

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Journal Article 2009; 30(1): 61-66 PubMed PMID: 19300383 Citation  Keywords:  Aged, Aged, 80 and over, Body Mass Index, Carotid Arteries:pathology, Carotid Stenosis:complications, Case-Control Studies, Comorbidity, Female, Humans, Incidence, Male, Middle Aged, Neck:anatomy & histology, Sleep Apnea, Obstructive:complications,.   

OBJECTIVES: Sleep apnea is associated with advanced atherosclerosis. This study was focused on sleep breathing in patients with hemodynamically significant carotid stenosis, currently free from clinical symptoms.

DESIGN AND SETTINGS: 17 patients with carotid artery stenosis of 70% and more in the absence of actual neurological symptoms indicated for non-acute endarterectomy, and 17 age- and sex-matched controls were examined using sleep polygraphy. 12 patients had a follow-up sleep polygraphy a month after the surgery.

RESULTS: The criteria of obstructive sleep apnea (OSA) were met by 4 patients prior to operation, by 2 patients after the operation, and by 2 control subjects. The pre-surgery apnea/hypopnea index (AHI) was 14 (+/-SD=17.0), post-surgery 8.3 (+/-9.0) and in the controls 6.7(+/-6.7). The pre-surgery oxygen desaturation index was 20.1 (+/-17.7), post-surgery 15.0 (+/-12.0) and in the controls 11.6 (+/-6.1). A comparison between the pre-surgery results seen in the patients and in controls after adjustment for BMI revealed no significant difference. The only significant difference between the pre-surgery and post-surgery values was found in the AHI (P=0.045).

CONCLUSION: According to this study there exists an association between carotid stenosis and OSA, however this association is explainable by a higher BMI. The study also found a tendency toward OSA alleviation in response to endarterectomy....

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Journal Article 2009; 30(6): 757-760 PubMed PMID: 20038925 Citation  Keywords:  Adult, Female, Humans, Male, Middle Aged, Muscle Tonus:physiology, Muscle, Skeletal:physiology, Narcolepsy:physiopathology, Polysomnography, REM Sleep Parasomnias:physiopathology, Retrospective Studies, Sleep, REM:physiology,.   

OBJECTIVE: While there are a number of observations/quantifications indicating a greater proportion of REM sleep without atonia (RWA) in narcolepsy, the intra-night distribution of this parameter has not been evaluated.

MATERIALS AND METHODS: Thirty-four patients (15 men and 19 women; mean age 44.9 +/- 18.9) with narcolepsy-cataplexy were included in this retrospective study. The clinical diagnosis was confirmed by MSLT, video-polysomnography and HLA typing. Polysomnographic recordings were scored with particular regard to REM sleep without atonia (RWA) across all the nocturnal REM periods. RWA scoring was done according to a standard method.

RESULTS: The analysis showed a significant increase in the proportion of REM sleep without atonia during successive nocturnal REM periods in narcoleptic patients (p<0.01). No correlation was found between the percentage of RWA and the severity or duration of the disease, no age effect was documented.

CONCLUSION: The study demonstrates for the first time an increasing amount of RWA during the night suggesting enhanced nocturnal REM sleep motor disturbance....

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Journal Article 2009; 30(5): 599-603 PubMed PMID: 20035264 Citation  Keywords:  Adolescent, Adult, Anticonvulsants:therapeutic use, Child, Circadian Rhythm, Epilepsy:drug therapy, Female, Humans, Male, Middle Aged, Sleep:physiology, Sleep Wake Disorders:physiopathology, Surveys and Questionnaires, Young Adult,.   

OBJECTIVE: The relationship between epilepsy and sleep has been known for many years. Yet is still not well understood because of it's reciprocal and intrinsic influences. Epileptic manifestations during sleep may lead to fragmentation of sleep stages. On the other hand insomnia or other sleep disorders may cause sleep deprivation and increase number of epileptic seizures in patients with epilepsy. The study is designed to compare daytime sleepiness and architecture of sleep in patients with epilepsy and control subjects. We tried to evaluate factors that have influence on sleep architecture of patients with epilepsy.

METHODS: We evaluated the daytime sleepiness through a certain type of questionnaire called Epworth Scale of Sleepiness (ESS). The questionnaire was filled out by patients with epilepsy (83 patients) and a group of healthy controls (80 persons). Furthermore we evaluated the quatity of night sleep in both groups using polysomnograph (electroencephalography - EEG, electrooculography - EOG, electromyography - EMG). Sleep stages were scored according to Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects (Rechtschaffen, Kales, 9). Multiple sleep latency test (MSLT) was performed in the group of patients with epilepsy in order to objectivise daytime sleepiness.

RESULTS: Measuring by Epworth scale of sleepiness we found out that the patients with epilepsy suffered from a significantly higher daytime sleepiness than the healthy controls. Patients with epilepsy also experienced significant changes in sleep architecture, the reduction of NREM S3, S4 and REM stages and the increase of NREM S2 stage. These changes were not related to used antiepileptic medication....

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Comparative Study 2008; 29(6): 895-901 PubMed PMID: 19112384 Citation  Keywords:  Adult, Antidepressive Agents, Second-Generation:therapeutic use, Cognitive Therapy:methods, Combined Modality Therapy, Female, Humans, Hypnotics and Sedatives:therapeutic use, Male, Middle Aged, Polysomnography, Sleep Initiation and Maintenance Disorders:.   

OBJECTIVES: Cognitive behaviour therapy (CBT) of primary insomnia is frequently combined with various pharmacological treatments, including sedative antidepressants. The present study was undertaken to evaluate the clinical efficacy of CBT, singly and combined with trazodone pharmacotherapy, for primary insomnia.

DESIGN AND SETTING: Randomised, comparative clinical trial, at a single academic medical centre.

METHODS: Twenty outpatients (15 women, 5 men) with chronic primary insomnia were randomly assigned to CBT or CBT +100mg trazodone and treated for 8 weeks. The treatment outcome was estimated by mean changes from baseline in self-reported clinical scales, sleep continuity data and sleep architecture parameters.

RESULTS: All patients perceived significant subjective sleep improvements. Sleep latency significantly shortened (p=0.03), sleep efficiency increased (p=0.004) and the total sleep time was significantly prolonged (p=0.006) after the CBT treatment in both groups. Sleep architecture showed that the combined approach (CBT + trazodone) resulted in a significant increase in slow wave sleep duration compared to treatment by CBT only (p=0.04).

CONCLUSIONS: CBT, singly and combined with the sedative antidepressant trazodone, is effective for the short-term management of chronic primary insomnia. Trazodone combined with CBT significantly increases slow wave sleep duration and this influence seems to be unrelated to its antidepressant effect....

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Journal Article 2008; 29(4): 512-517 PubMed PMID: 18766147 Citation  Keywords:  Autistic Disorder:physiopathology, Child, Child, Preschool, Electroencephalography, Humans, Intellectual Disability:physiopathology, Polysomnography, Sleep:physiology,.   

OBJECTIVES: Autism is a severe neurodevelopmental disorder with a high rate of epilepsy and subclinical epileptiform activity. High physical connectivity on a microcolumnar level leading to epileptiform activity and low functional informational connectivity are assumed in autism. The aim of this study was to investigate nonlinear EEG brain dynamics in terms of synchronization in a group of children with autism spectrum disorders compared to a control group. We expected a lower degree of synchronization in autistic subjects.

METHODS: The autistic group consisted of 27 patients with autism spectrum disorders diagnosed according to ICD-10. The mean age of the sample was 7.1 (SD 3.6) years, 14 of them were mentally retarded. Normal EEG was found in 9 patients, epileptiform EEG in 18 autistic patients. Four patients had a history of epileptic seizures, fully compensated in long term. The control group consisted of 20 children (mean age of 8.4, SD 2.3 years) with normal intelligence, without an epileptic history, investigated within the frame of the research program for cochlear implantation. They had normal neurological examination and suffered from perceptive deafness. Normal EEG was found in 17 of the control subjects, epileptiform EEG was in 3 control subjects. We analyzed night sleep EEG recordings from 10 channels (F3, F4, F7, F8, C3, C4, T3, T4, P3 and P4) with the inclusion of sleep stages NREM 2, 3 and 4 in the subsequent analyses. Coarse-grained entropy information rates between neighbouring electrodes were computed, expressing the synchronization between 11 selected electrode couples.

RESULTS: Synchronization was significantly lower in the autistic group in all three examined NREM stages even when age and intelligence were taken into account as covariates.

CONCLUSIONS: The results of the study confirmed the validity of the underconnectivity model in autism....

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Journal Article 2007; 28(6): 757-760 PubMed PMID: 18063930 Citation  Keywords:  Activity Cycles:physiology, Aging:immunology, Animals, Columbidae, Leukocytes:physiology, Melatonin:physiology, Neuroimmunomodulation:physiology, Phagocytosis:physiology, Serotonin:blood, Sleep:physiology, Superoxides:blood, Tryptophan:physiology, Wakeful.   

: All organisms present circadian rhythm in most of their physiological functions, and among them there stand out sleep, motor activity, immune function, the secretion of melatonin, and the production and release of numerous neurotransmitters, in particular of serotonin because of its relationship with the aforementioned factors. Aging changes these rhythms, altering sleep quality and contributing to immunosenescence. Treatment with exogenously administered melatonin or tryptophan may restore these impaired functions due to aging. In our animal model (Streptopelia risoria), both the hormone and the amino acid acted on the activity-rest rhythms, modulating the circulating levels of melatonin and serotonin, and increased the cell viability and resistance to induced oxidative stress of blood heterophils, at the same time as enhancing the phagocytic function and neutralizing the superoxide anions deriving from this immune function. Also, in the old individuals, the treatments with melatonin and tryptophan at the concentrations and times of administration considered suitable improved nocturnal rest besides reverting the immunosuppressory and oxidative effects accompanying phagocytosis at these advanced ages....

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