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High frequency spectral power of sleep EEG increases with depressive and insomnia symptoms in kidney transplant recipients
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Abstracts / Sleep Medicine 14S (2013) e239–e317
positions (from 7.8 to 3.9), average of total apneas (from 69.2 to 9.5), average of obstructive apneas (from 34 to 8.7), average of hypopneas (from 70.1 to 24.8), desaturation per hour index average (from 13.7 to 5.5) and average CT90 (from 1.6 to 0.6). In 72.80% of the cases the AHI was halved. In 90.30%, an AHI under 10 was reached and in 61.2%, under 5. Conclusion: In our opinion, the use of Orthoapnea MAD is an efficient therapeutic alternative in patients with mild and moderate OSAS, increasing airway area patency and volume, thus reducing the respiratory events as the AHI an desaturation and improving some of its pathophysiologic consequences. http://dx.doi.org/10.1016/j.sleep.2013.11.598
Sleep disorders in myotonic dystrophy type 2: a controlled polysomnographic study and self-reported questionnaires A. Romigi, M. Albanese, F. Placidi, F. Izzi, M. Marciani, R. Massa University of Rome Tor Vergata, Neurophysiopathology Dpt, Italy
Introduction: Sleep disturbances in myotonic dystrophy type 1 (DM1) are common and include sleep-disordered breathing (SDB), periodic limb movements (PLMS), central hypersomnia, REM sleep dysregulation. Scarce data are available regarding the occurrence of sleep disorders in Myotonic Dystrophy type 2 (DM2). To investigate sleep-wake cycle and daytime sleepiness in DM2 patients compared with healthy subjects and patients with DM1. Materials and methods: Twelve DM2 outpatients, twelve age- and sex-matched healthy controls and 18 patients with adult-onset DM1 were evaluated. Subjective quality of sleep was assessed by means of the Pittsburgh Sleep Quality Index (PSQI). Both the Epworth Sleepiness Scale and the Daytime Sleepiness Scale were performed in order to evaluate excessive daytime sleepiness (EDS). All participants underwent a 48-h polysomnographic monitoring and the Multiple Sleep Latency Test. Results: Sleep efficiency was <90% in 12/12 DM2 patients, and significantly reduced when compared with controls or with DM1. Decreased sleep efficiency was associated with SDB in 7/12 DM2 patients and/or PLMS in 3/8 patients. Six DM2 patients showed REM sleep without atonia, whereas none of controls and DM1 patients showed REM sleep dysregulation. The global PSQI score was higher in DM2 versus controls and versus DM1. Conclusion: We demonstrated a poorer sleep quality in DM2 than in DM1 patients and controls. Sleep apnoea are the most common sleep disorders in DM2. OSA and sleep fragmentation may represent the main cause of EDS, whereas PLMS are a frequent finding in DM1 but not in DM2 in our sample. Acknowledgements: No conflict of interest.
http://dx.doi.org/10.1016/j.sleep.2013.11.599
High frequency spectral power of sleep EEG increases with depressive and insomnia symptoms in kidney transplant recipients K. Ronai 1, A. Szentkiralyi 2, L. Alpar 3, I. Mucsi 4, R. Bodizs 1, M. Novak 5 1 Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary 2 Münster Institute for Epidemiology and Socialmedicine, Westfälische Wilhelms – Universität, Münster, Germany 3 Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
4 Nephrology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada 5 Neuropsychiatry Program, University of Toronto, Toronto, Canada
Introduction: The prevalence of depression and insomnia is high among kidney transplant recipients and the co-occurence of the two disorders is frequent. Hyperarousal of the central nervous system (CNS) might play a role in the pathomechanism of both conditions. The hypervigilant state of the CNS is characterized by heightened beta- and gamma spectral power of the EEG. We investigated whether depressive and isomnia symptoms correlate with high frequency spectral power among kidney transplant recipients. Materials and methods: Fitfy-six kidney tranplant recipients participated in the study (35 males, mean age 49 ± 13 years, BMI 26 ± 4 kg/ m2, estimated glomerular filtration rate 50 ± 17 ml/min). Symptoms of insomnia and depression were measured by the Athens Insomnia Scale (AIS) and the Center for Epidemiologic Studies Depression Scale (CESD), respectively. After one-night polysomnography (PSG) each recording was visually scored and EEG absolute spectral power was computed within the sigma (11.25–15 Hz), beta1 (15.25–25 Hz), beta2 (25.25–35 Hz), and gamma (35.25–45 Hz) frequency bands. Results: AIS score correlated with sleep latency (r = 0.274, p < 0.05) among the PSG macrostructure parameters while CESD score did not correlate with any PSG variables. CESD score correlated with NREM and REM gamma (r = 0.35; r = 0.27), beta2 (r = 0.28; r = 0.3), beta1 (r = 0.32; r = 0.27) spectra, respectively. AIS score correlated with NREM and REM gamma (r = 0.27; r = 0.31), beta2 (r = 0.27; r = 0.44), NREM sigma (r = 0.29) and REM beta1 (r = 0.37) spectra, respectively (p < 0.05 for each correlation). In multivariable linear model after controlling for age, gender, kidney function and BMI, the CESD score was an independent predictor of NREM gamma (Beta: 0.276; p < 0.05) and AIS was in independent relation with REM beta2 (Beta: 0.328; p < 0.05). Conclusion: We demonstrated for the first time in this population that the symptoms of depression and insomnia correlate with increased neurocognitive activity of the CNS during sleep, in particular, with increased NREM gamma and REM beta2 activity. These data support the hypothesis that CNS hyperarousal might contribute to the emergence of both conditions among kidney transplant recipients. Compared to routinely used sleep variables, quantitative analysis of EEG reveals further information about these conditions. Acknowledgements: The authors have no conflict of interest to declare in relation to this work. http://dx.doi.org/10.1016/j.sleep.2013.11.600
The impact of sleep position preference on supine sleep during overnight polysomnography L. Rosenthal, A. Rosenthal Sleep Medicine Associates of Texas, United States
Introduction: Body position influences upper airway configuration and lung volumes. In particular, increased frequency of respiratory events is documented among some OSA patients when sleeping in the supine position. Concern about possible underestimation of the AHI when supine sleep is not recorded during a diagnostic assessment has raised uneasiness about possible diagnostic misclassification. However, little data is available on how the subjects’ preferred sleep position is reflected on diagnostic assessments. We have previously reported on subjective sleep position preference in a cohort of subjects completing ambulatory assessment of sleepdisordered breathing; the study showed that those subjects who
Abstracts / Sleep Medicine 14S (2013) e239–e317
positions (from 7.8 to 3.9), average of total apneas (from 69.2 to 9.5), average of obstructive apneas (from 34 to 8.7), average of hypopneas (from 70.1 to 24.8), desaturation per hour index average (from 13.7 to 5.5) and average CT90 (from 1.6 to 0.6). In 72.80% of the cases the AHI was halved. In 90.30%, an AHI under 10 was reached and in 61.2%, under 5. Conclusion: In our opinion, the use of Orthoapnea MAD is an efficient therapeutic alternative in patients with mild and moderate OSAS, increasing airway area patency and volume, thus reducing the respiratory events as the AHI an desaturation and improving some of its pathophysiologic consequences. http://dx.doi.org/10.1016/j.sleep.2013.11.598
Sleep disorders in myotonic dystrophy type 2: a controlled polysomnographic study and self-reported questionnaires A. Romigi, M. Albanese, F. Placidi, F. Izzi, M. Marciani, R. Massa University of Rome Tor Vergata, Neurophysiopathology Dpt, Italy
Introduction: Sleep disturbances in myotonic dystrophy type 1 (DM1) are common and include sleep-disordered breathing (SDB), periodic limb movements (PLMS), central hypersomnia, REM sleep dysregulation. Scarce data are available regarding the occurrence of sleep disorders in Myotonic Dystrophy type 2 (DM2). To investigate sleep-wake cycle and daytime sleepiness in DM2 patients compared with healthy subjects and patients with DM1. Materials and methods: Twelve DM2 outpatients, twelve age- and sex-matched healthy controls and 18 patients with adult-onset DM1 were evaluated. Subjective quality of sleep was assessed by means of the Pittsburgh Sleep Quality Index (PSQI). Both the Epworth Sleepiness Scale and the Daytime Sleepiness Scale were performed in order to evaluate excessive daytime sleepiness (EDS). All participants underwent a 48-h polysomnographic monitoring and the Multiple Sleep Latency Test. Results: Sleep efficiency was <90% in 12/12 DM2 patients, and significantly reduced when compared with controls or with DM1. Decreased sleep efficiency was associated with SDB in 7/12 DM2 patients and/or PLMS in 3/8 patients. Six DM2 patients showed REM sleep without atonia, whereas none of controls and DM1 patients showed REM sleep dysregulation. The global PSQI score was higher in DM2 versus controls and versus DM1. Conclusion: We demonstrated a poorer sleep quality in DM2 than in DM1 patients and controls. Sleep apnoea are the most common sleep disorders in DM2. OSA and sleep fragmentation may represent the main cause of EDS, whereas PLMS are a frequent finding in DM1 but not in DM2 in our sample. Acknowledgements: No conflict of interest.
http://dx.doi.org/10.1016/j.sleep.2013.11.599
High frequency spectral power of sleep EEG increases with depressive and insomnia symptoms in kidney transplant recipients K. Ronai 1, A. Szentkiralyi 2, L. Alpar 3, I. Mucsi 4, R. Bodizs 1, M. Novak 5 1 Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary 2 Münster Institute for Epidemiology and Socialmedicine, Westfälische Wilhelms – Universität, Münster, Germany 3 Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
4 Nephrology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada 5 Neuropsychiatry Program, University of Toronto, Toronto, Canada
Introduction: The prevalence of depression and insomnia is high among kidney transplant recipients and the co-occurence of the two disorders is frequent. Hyperarousal of the central nervous system (CNS) might play a role in the pathomechanism of both conditions. The hypervigilant state of the CNS is characterized by heightened beta- and gamma spectral power of the EEG. We investigated whether depressive and isomnia symptoms correlate with high frequency spectral power among kidney transplant recipients. Materials and methods: Fitfy-six kidney tranplant recipients participated in the study (35 males, mean age 49 ± 13 years, BMI 26 ± 4 kg/ m2, estimated glomerular filtration rate 50 ± 17 ml/min). Symptoms of insomnia and depression were measured by the Athens Insomnia Scale (AIS) and the Center for Epidemiologic Studies Depression Scale (CESD), respectively. After one-night polysomnography (PSG) each recording was visually scored and EEG absolute spectral power was computed within the sigma (11.25–15 Hz), beta1 (15.25–25 Hz), beta2 (25.25–35 Hz), and gamma (35.25–45 Hz) frequency bands. Results: AIS score correlated with sleep latency (r = 0.274, p < 0.05) among the PSG macrostructure parameters while CESD score did not correlate with any PSG variables. CESD score correlated with NREM and REM gamma (r = 0.35; r = 0.27), beta2 (r = 0.28; r = 0.3), beta1 (r = 0.32; r = 0.27) spectra, respectively. AIS score correlated with NREM and REM gamma (r = 0.27; r = 0.31), beta2 (r = 0.27; r = 0.44), NREM sigma (r = 0.29) and REM beta1 (r = 0.37) spectra, respectively (p < 0.05 for each correlation). In multivariable linear model after controlling for age, gender, kidney function and BMI, the CESD score was an independent predictor of NREM gamma (Beta: 0.276; p < 0.05) and AIS was in independent relation with REM beta2 (Beta: 0.328; p < 0.05). Conclusion: We demonstrated for the first time in this population that the symptoms of depression and insomnia correlate with increased neurocognitive activity of the CNS during sleep, in particular, with increased NREM gamma and REM beta2 activity. These data support the hypothesis that CNS hyperarousal might contribute to the emergence of both conditions among kidney transplant recipients. Compared to routinely used sleep variables, quantitative analysis of EEG reveals further information about these conditions. Acknowledgements: The authors have no conflict of interest to declare in relation to this work. http://dx.doi.org/10.1016/j.sleep.2013.11.600
The impact of sleep position preference on supine sleep during overnight polysomnography L. Rosenthal, A. Rosenthal Sleep Medicine Associates of Texas, United States
Introduction: Body position influences upper airway configuration and lung volumes. In particular, increased frequency of respiratory events is documented among some OSA patients when sleeping in the supine position. Concern about possible underestimation of the AHI when supine sleep is not recorded during a diagnostic assessment has raised uneasiness about possible diagnostic misclassification. However, little data is available on how the subjects’ preferred sleep position is reflected on diagnostic assessments. We have previously reported on subjective sleep position preference in a cohort of subjects completing ambulatory assessment of sleepdisordered breathing; the study showed that those subjects who