Sleep arousal after lower abdominal surgery and relation to recovery from respiratory obstruction.
BACKGROUND: Hypoxemic episodes occur during sleep after abdominal surgery, possibly caused by airway obstruction. The authors found arousals from sleep more often than respiratory disturbances, so they related changes in sleep state (short arousals from sleep and longer periods of wakening) to the sudden increase in respiratory flow that indicates relief from complete or partial respiratory obstruction. METHODS: Sleep state and nasal flow were studied in 16 patients receiving patient-controlled morphine and oxygen by facemask on the night after routine gynecologic surgery. Traces were analyzed separately for sleep events and for sudden increases in respiratory flow. The authors noted sleep events (arousals from sleep and transition from sleep to wake) that occurred within 12 s of relief of obstruction. RESULTS: Sleep quality was poor, with only stage 2 sleep in most patients. Median sleep duration was 70% of the study period, with 15 arousals and 6 awakenings per hour of sleep. Only 30% of arousals and awakenings were associated with relief of obstruction. Relief of obstruction also occurred without arousal from sleep, with a median frequency of 38 (30-62) in each night. Relief of obstruction was more frequently associated with arousal from sleep after benzodiazepine premedication (33% vs. 28%; P = 0.012), but this allocation was not randomized. CONCLUSIONS: Arousals from sleep are frequent after abdominal surgery and mostly not related to respiratory disturbance. Relief of respiratory obstruction can occur during sleep without sleep arousal and during wakefulness. (+info)
In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research. (+info)
Sleep bruxism is associated to micro-arousals and an increase in cardiac sympathetic activity.
Sleep bruxism (SB) subjects show a higher incidence of rhythmic masticatory muscle activity (RMMA) than control subjects. RMMA is associated with sleep micro-arousals. This study aims to: (i) assess RMMA/SB episodes in relation to sleep cycles; (ii) establish if RMMA/SB and micro-arousals occur in relation to the slow wave activity (SWA) dynamics; (iii) analyze the association between RMMA/SB and autonomic cardiac activity across sleep cycles. Two nights of polygraphic recordings were made in three study groups (20 subjects each): moderate to high SB, low SB and control. RMMA episodes were considered to occur in clusters when several groups of RMMA or non-specific oromotor episodes were separated by less than 100 s. Correlations between sleep, RMMA/SB index and heart rate variability variables were assessed for the first four sleep cycles of each study group. Statistical analyses were done with SYSTAT and SPSS. It was observed that 75.8% of all RMMA/SB episodes occurred in clusters. Micro-arousal and SB indexes were highest during sleep cycles 2 and 3 (P < 0.001). Within each cycle, micro-arousal and RMMA/SB indexes showed an increase before each REM sleep (P +info)
Adult obstructive sleep apnea: pathophysiology and diagnosis.
Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent episodes of upper airway obstruction that result in recurrent arousals and episodic oxyhemoglobin desaturations during sleep. Significant clinical consequences of the disorder cover a wide spectrum, including daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, and cor pulmonale. The major risk factors for the disorder include obesity, male gender, and age. Current understanding of the pathophysiologic basis of the disorder suggests that a balance of anatomically imposed mechanical loads and compensatory neuromuscular responses are important in maintaining upper airway patency during sleep. OSA develops in the presence of both elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. A sleep history and physical examination is important in identification of patients and appropriate referral for polysomnography. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches. Knowledge of common patterns of OSA may help to identify patients and guide therapy. (+info)
Disorders of arousal from sleep and violent behavior: the role of physical contact and proximity.
STUDY OBJECTIVES: To review medical and legal case reports to determine how many appear to support the belief that violence against other individuals that occurs during Disorders of Arousal - sleepwalking, confusional arousal, and sleep terrors - is triggered by direct physical contact or close proximity to that individual and does not occur randomly or spontaneously. DESIGN: Historical review of case reports in the medical and legal literature. MEASUREMENTS AND RESULTS: A total of 32 cases drawn from medical and legal literature were reviewed. Each case contained a record of violence associated with Disorders of Arousal; in each, details of the violent behavior were available. Violent behaviors associated with provocations and/or close proximity were found to be present in 100% of confusional arousal patients and 81% of sleep terror patients. Violent behaviors were associated with provocation or close proximity in 40%-90% of sleepwalking cases, depending on whether the legal verdict and other factors were taken into account. Often the provocation was quite minor and the response greatly exaggerated. The specific manner in which the violence was triggered differed among sleepwalking, confusional arousals, and sleep terrors. CONCLUSIONS: In the cases reviewed, violent behavior directed against other individuals associated with Disorders of Arousal most frequently appeared to follow direct provocation by, or close proximity to, another individual. Sleepwalkers most often did not seek out victims, but rather the victims sought out or encountered the sleepwalker. These conclusions are tempered by several limitations: the selection of cases was not random and may not represent an accurate sample of violent behaviors associated with Disorders of Arousal. Also, final verdicts by juries in reported legal cases should not be confused with scientific proof of the presence or absence of sleepwalking. The pathophysiology of Disorders of Arousal with and without violent behavior could be associated with normally occurring deactivation of the frontal lobes during slow wave sleep (SWS) connected via atypically active thalamocortical pathways to the limbic areas. It is not known if the violent sleepwalker, confusional arousal patient, or sleep terror patient differs from other patients with these disorders. The conclusions of this case series await confirmation by the results of future sleep laboratory based studies. (+info)
Kids that go bump in the night.
BACKGROUND: Incomplete arousal from deep sleep in children causes night time disruption and can present as confusional arousals, sleep walking or night terrors. These nocturnal events are common in childhood but can be extremely concerning to parents and disruptive to families. OBJECTIVE: This article provides a framework for the initial assessment of children's nocturnal events. DISCUSSION: Occasionally night time disturbances are seizures. A framework discussing the clinical features of typical benign childhood events and how to differentiate them from seizure disorders is presented. Generally, sleep walking and night terrors are self limiting and children grow out of them. However, in some cases there are ongoing precipitants that are important to identify and treat. (+info)
Nocturnal enuresis and overweight are associated with obstructive sleep apnea.
NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG analysis.
STUDY OBJECTIVES: To describe the semiological features of NREM arousal parasomnias in detail and identify features that can be used to reliably distinguish parasomnias from nocturnal frontal lobe epilepsy (NFLE). DESIGN: Systematic semiologial evaluation of parasomnias and NFLE seizures recorded on video-EEG monitoring. PATIENTS: 120 events (57 parasomnias, 63 NFLE seizures) from 44 subjects (14 males). Interventions. The presence or absence of 68 elemental clinical features was determined in parasomnias and NFLE seizures. Qualitative analysis of behavior patterns and ictal EEG was undertaken. Statistical analysis was undertaken using established techniques. RESULTS: Elemental clinical features strongly favoring parasomnias included: interactive behavior, failure to wake after event, and indistinct offset (all P < 0.001). Cluster analysis confirmed differences in both the frequency and combination of elemental features in parasomnias and NFLE. A diagnostic decision tree generated from these data correctly classified 94% of events. While sleep stage at onset was discriminatory (82% of seizures occurred during stage 1 or 2 sleep, with 100% of parasomnias occurring from stage 3 or 4 sleep), ictal EEG features were less useful. Video analysis of parasomnias identified three principal behavioral patterns: arousal behavior (92% of events); non-agitated motor behavior (72%); distressed emotional behavior (51%). CONCLUSIONS: Our results broadly support the concept of confusion arousals, somnambulism and night terrors as prototypical behavior patterns of NREM parasomnias, but as a hierarchical continuum rather than distinct entities. Our observations provide an evidence base to assist in the clinical diagnosis of NREM parasomnias, and their distinction from NFLE seizures, on semiological grounds. (+info)