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O0060 Sleep and circadian rhythm disorder in Parkinson's Disease: association with hallucinations
Oral Platform Presentations / Sleep Medicine 8 Suppl. 1 (2007) S49–S66 contrast transesophageal echo as large when at least 20 bubbles passed over to left atrium after a single injection. Results: The prevalence of large PFO was 9 of 15 (60%) in the high-proportional desaturation group versus 2 of 15 (13%) in the lowproportional desaturation group (p = 0.02). The median number of bubbles passing correlated with minimum oxygen saturation recorded during the sleep study among those with a PFO (r = 0.62, p = 0.02). Conclusion: Oxygen desaturation occurs more often in proportion to the frequency of respiratory disturbances in OSA subjects with PFO than in those without. Polygraphic/polysomnographic recordings as regularly practiced in sleep medicine may be used to identify subjects with high likelihood of PFO. Contributed support: The Swedish Heart and Lung Foundation.
O0060 Sleep and circadian rhythm disorder in Parkinson’s Disease: association with hallucinations D.L. Whitehead1 *, A.D.M. Davies2,3 , J.R. Playfer4 , C.J. Turnbull5 . 1 MRC Centre for Neurodegeneration, Institute of Psychiatry, London, UK, 2 School of Psychology, University of Liverpool, Liverpool, UK, 3 Mersey Care NHS Trust, Merseyside, UK, 4 Department of Medicine for the Elderly, Arrowe Park Hospital, Wirral, UK, 5 Department of Geriatric Medicine, Royal Liverpool University Hospital, Liverpool, UK Purpose: Hallucinations affect around one-third of patients with Parkinson’s Disease (PD) and have been associated with both night-time disturbances and excessive daytime sleepiness, and also with a more rapid decline in cognitive abilities leading to dementia. Circadian rhythm indexed by rest-activity rhythm has rarely been assessed in Parkinson’s Disease, although it is a hallmark of Alzheimer’s Disease. This study aimed to assess the association between hallucinations, cognition and circadian rhythm breakdown in Parkinson’s Disease. Methods: 77 patients with PD and 31 healthy older adults were monitored over 5-7 days using actigraphy and sleep diaries. Mean age of PD patients was 74.4(±7.9) years, with a mean disease duration of 5.7(±5.3) years. Circadian rhythm indices were calculated using Non-Parametric Circadian Rhythm Analysis (NPCRA; Sleep Analysis 98, Cambridge Neurotechnology Ltd). Sleep characteristics of hallucinators (n = 35) were compared to those of non-hallucinators (n = 28) and with controls. Results: Hallucinators demonstrated greater levels of nocturnal sleep fragmentation (F = 4.13, p < 0.05) and daytime sleep than non-hallucinators (F = 5.21, p < 0.01), independently of disease severity. Rest–activity rhythm variables were associated primarily with disease-related factors disease duration and severity of motor fluctuations, but were not associated with cognitive decline. The PD group as a whole showed a more disrupted circadian rhythm than controls, and hallucinators showed lower interdaily stability across the period of monitoring, independently of motor fluctuations and disease duration than non-hallucinators (F = 4.40, p = 0.02). Conclusions: PD patients with hallucinations show a greater degree of breakdown in rest-activity rhythms than do their non-hallucinating counterparts, which is independent of cognitive decline. Degeneration of the suprachiasmatic nucleus is thought to underlie circadian rhythm dysfunction in Alzheimer’s Disease, however it is likely that changes in rest-activity rhythm in PD are driven by degeneration of brainstem nucleii sleep centres which is characteristic of the a-synucleinopathies, and which may also play a role in the pathogenesis of hallucinations. Contributed support: This study was supported by a PhD studentship from the University of Liverpool, School of Psychology
O0061 Nocturnal heart rate entropy is related to daytime blood pressure L. Grote *, D. Zou, J. Radlinski, D.N. Eder, J. Hedner. Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Sweden Subject Objective: It is hypothesized that dynamic fluctuations of heart rate are more complex (higher entropy) in young healthy subjects than in older subjects or in those with cardiovascular disease. We used multiscale
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entropy (MSE) as a measure of the complexity in heart rate variability and investigated the association between MSE and daytime blood pressure. Study design and Subjects: Cross-sectional analysis in 112 subjects (70 men; age 49±13 yrs; BMI 27.7±6.2 kg/m2 ; apnea hypopnea index, AHI, 21±31 events/h) recruited consecutively from the hospital sleep laboratory. Single night standard ambulatory polysomnography recording was performed in all subjects. Office systolic blood pressure (SBP, 129±18 mmHg) and diastolic blood pressure (DBP, 78±10 mmHg) were determined from office recordings obtained in the afternoon prior to the sleep study. Methods and Results: The R−R interval derived from the ECG signal was analyzed using MSE (entropy scale factors 1 to 20). Multivariate analysis was used to investigate the association between different entropy scale factors and daytime blood pressure. We found that age was inversely related to entropy only at scale factors 1, 2, and 3 (P < 0.01) while AHI was related to entropy at scale factors greater than 4 (P < 0.01). Age and AHI were significantly proportional to SBP and DBP. SBP was inversely proportional to entropy at scale factors 1, 2 and 3 (P < 0.01) and DBP was inversely proportional to entropy at scale factor 3 (P = 0.04). Even after adjustment for age and AHI, entropy scale factors 1, 2, 3 and 4 were negatively correlated with SBP (P < 0.05) but not with DBP. Conclusions: Heart rate at low entropy scales in an overnight ECG recording was negatively associated with daytime SBP. Analysis of MSE from standard sleep recordings may provide a potential novel factor useful in the assessment of cardiovascular risk. Contributed support: The Swedish Heart and Lung Foundation. O0062 Sleep-disordered-breathing is more prevalent among children with community acquired pneumonia A.D. Goldbart1 *, A. Tal A, N. Givon-Lavi2 , D. Greenberg2 . 1 Dept. of Pediatrics and 2 Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel. Background: Children with obstructive sleep apnea (OSA) experience significantly more lower and upper respiratory infections during early childhood. We aimed to assess the prevalence of sleep disordered breathing (SDB) symptoms in children with community acquired pneumonia (CAP) as compared to age matched controls. Methods: A prospective nested case-control study assessing children <5 years with CAP presenting to Pediatric Emergency Room during 8 months period. Children were included if they were diagnosed based on WHO criteria following X-ray interpretation by a pediatrician and a pediatric radiologist independently. Controls were age and seasonal matched healthy children. Symptoms of SDB were documented using a structured questionnaire. Results: 635 children with CAP and 229 controls were prospectively enrolled. Snoring was reported in 45 (7%) vs 3 (1.3%), CAP vs. controls respectively, p < 0.001. Restless sleep was reported in 67 (11%) vs. 5 (2%), p < 0.001; daytime sleepiness in 25 (4%) vs. none, p < 0.001; chronic runny nose in 45 (7%) vs. 4 (1.4%), p = 0.003. Eleven of the children with CAP (vs none of the controls) had had a previous polysomnographic evaluation; p < 0.001. Conclusion: SDB symptoms are more common in children evaluated for CAP in comparison to healthy children. SDB is possibly a predisposing risk for CAP in children <5 years of age. Underlying mechanisms for this observation needs further corroboration. O0063 REM sleep behavioral disorder in Hong Kong Chinese elderly Y.K. Wing. Department of Psychiatry, The Chinese University of Hong Kong, China Over past two decades, REM sleep behavior disorder (RSBD) was increasingly recognized in the elderly. Our previous epidemiological study showed that the prevalence rate of RSBD among the non-institutional elderly was 0.38% (Chiu et al., 2000). RSBD is a potentially dangerous condition leading to significant sleep-related injuries as well as violence to the bed-partners. These consequences of RSBD were further supported by our clinical data.
O0060 Sleep and circadian rhythm disorder in Parkinson’s Disease: association with hallucinations D.L. Whitehead1 *, A.D.M. Davies2,3 , J.R. Playfer4 , C.J. Turnbull5 . 1 MRC Centre for Neurodegeneration, Institute of Psychiatry, London, UK, 2 School of Psychology, University of Liverpool, Liverpool, UK, 3 Mersey Care NHS Trust, Merseyside, UK, 4 Department of Medicine for the Elderly, Arrowe Park Hospital, Wirral, UK, 5 Department of Geriatric Medicine, Royal Liverpool University Hospital, Liverpool, UK Purpose: Hallucinations affect around one-third of patients with Parkinson’s Disease (PD) and have been associated with both night-time disturbances and excessive daytime sleepiness, and also with a more rapid decline in cognitive abilities leading to dementia. Circadian rhythm indexed by rest-activity rhythm has rarely been assessed in Parkinson’s Disease, although it is a hallmark of Alzheimer’s Disease. This study aimed to assess the association between hallucinations, cognition and circadian rhythm breakdown in Parkinson’s Disease. Methods: 77 patients with PD and 31 healthy older adults were monitored over 5-7 days using actigraphy and sleep diaries. Mean age of PD patients was 74.4(±7.9) years, with a mean disease duration of 5.7(±5.3) years. Circadian rhythm indices were calculated using Non-Parametric Circadian Rhythm Analysis (NPCRA; Sleep Analysis 98, Cambridge Neurotechnology Ltd). Sleep characteristics of hallucinators (n = 35) were compared to those of non-hallucinators (n = 28) and with controls. Results: Hallucinators demonstrated greater levels of nocturnal sleep fragmentation (F = 4.13, p < 0.05) and daytime sleep than non-hallucinators (F = 5.21, p < 0.01), independently of disease severity. Rest–activity rhythm variables were associated primarily with disease-related factors disease duration and severity of motor fluctuations, but were not associated with cognitive decline. The PD group as a whole showed a more disrupted circadian rhythm than controls, and hallucinators showed lower interdaily stability across the period of monitoring, independently of motor fluctuations and disease duration than non-hallucinators (F = 4.40, p = 0.02). Conclusions: PD patients with hallucinations show a greater degree of breakdown in rest-activity rhythms than do their non-hallucinating counterparts, which is independent of cognitive decline. Degeneration of the suprachiasmatic nucleus is thought to underlie circadian rhythm dysfunction in Alzheimer’s Disease, however it is likely that changes in rest-activity rhythm in PD are driven by degeneration of brainstem nucleii sleep centres which is characteristic of the a-synucleinopathies, and which may also play a role in the pathogenesis of hallucinations. Contributed support: This study was supported by a PhD studentship from the University of Liverpool, School of Psychology
O0061 Nocturnal heart rate entropy is related to daytime blood pressure L. Grote *, D. Zou, J. Radlinski, D.N. Eder, J. Hedner. Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Sweden Subject Objective: It is hypothesized that dynamic fluctuations of heart rate are more complex (higher entropy) in young healthy subjects than in older subjects or in those with cardiovascular disease. We used multiscale
S63
entropy (MSE) as a measure of the complexity in heart rate variability and investigated the association between MSE and daytime blood pressure. Study design and Subjects: Cross-sectional analysis in 112 subjects (70 men; age 49±13 yrs; BMI 27.7±6.2 kg/m2 ; apnea hypopnea index, AHI, 21±31 events/h) recruited consecutively from the hospital sleep laboratory. Single night standard ambulatory polysomnography recording was performed in all subjects. Office systolic blood pressure (SBP, 129±18 mmHg) and diastolic blood pressure (DBP, 78±10 mmHg) were determined from office recordings obtained in the afternoon prior to the sleep study. Methods and Results: The R−R interval derived from the ECG signal was analyzed using MSE (entropy scale factors 1 to 20). Multivariate analysis was used to investigate the association between different entropy scale factors and daytime blood pressure. We found that age was inversely related to entropy only at scale factors 1, 2, and 3 (P < 0.01) while AHI was related to entropy at scale factors greater than 4 (P < 0.01). Age and AHI were significantly proportional to SBP and DBP. SBP was inversely proportional to entropy at scale factors 1, 2 and 3 (P < 0.01) and DBP was inversely proportional to entropy at scale factor 3 (P = 0.04). Even after adjustment for age and AHI, entropy scale factors 1, 2, 3 and 4 were negatively correlated with SBP (P < 0.05) but not with DBP. Conclusions: Heart rate at low entropy scales in an overnight ECG recording was negatively associated with daytime SBP. Analysis of MSE from standard sleep recordings may provide a potential novel factor useful in the assessment of cardiovascular risk. Contributed support: The Swedish Heart and Lung Foundation. O0062 Sleep-disordered-breathing is more prevalent among children with community acquired pneumonia A.D. Goldbart1 *, A. Tal A, N. Givon-Lavi2 , D. Greenberg2 . 1 Dept. of Pediatrics and 2 Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel. Background: Children with obstructive sleep apnea (OSA) experience significantly more lower and upper respiratory infections during early childhood. We aimed to assess the prevalence of sleep disordered breathing (SDB) symptoms in children with community acquired pneumonia (CAP) as compared to age matched controls. Methods: A prospective nested case-control study assessing children <5 years with CAP presenting to Pediatric Emergency Room during 8 months period. Children were included if they were diagnosed based on WHO criteria following X-ray interpretation by a pediatrician and a pediatric radiologist independently. Controls were age and seasonal matched healthy children. Symptoms of SDB were documented using a structured questionnaire. Results: 635 children with CAP and 229 controls were prospectively enrolled. Snoring was reported in 45 (7%) vs 3 (1.3%), CAP vs. controls respectively, p < 0.001. Restless sleep was reported in 67 (11%) vs. 5 (2%), p < 0.001; daytime sleepiness in 25 (4%) vs. none, p < 0.001; chronic runny nose in 45 (7%) vs. 4 (1.4%), p = 0.003. Eleven of the children with CAP (vs none of the controls) had had a previous polysomnographic evaluation; p < 0.001. Conclusion: SDB symptoms are more common in children evaluated for CAP in comparison to healthy children. SDB is possibly a predisposing risk for CAP in children <5 years of age. Underlying mechanisms for this observation needs further corroboration. O0063 REM sleep behavioral disorder in Hong Kong Chinese elderly Y.K. Wing. Department of Psychiatry, The Chinese University of Hong Kong, China Over past two decades, REM sleep behavior disorder (RSBD) was increasingly recognized in the elderly. Our previous epidemiological study showed that the prevalence rate of RSBD among the non-institutional elderly was 0.38% (Chiu et al., 2000). RSBD is a potentially dangerous condition leading to significant sleep-related injuries as well as violence to the bed-partners. These consequences of RSBD were further supported by our clinical data.