- Email: [email protected]
Sleep and working memory among individuals with depressive and anxiety disorders
Abstracts/Sleep Medicine 16 (2015) S2–S199
Sleep matters? Twenty-four hours’ monitoring of daytime and nocturnal changes of heart rate variability in schizophrenic patients on different antipsychotics H. Huang 1, Y. Yueh-Ming Tai 2, T. Kuo 3, C. Yang 4 1 Dr. Happy’s Clinic, National Yang-Ming University, National Defense Medical Center, Taipei, Taiwan 2 Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 3 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan 4 Sleep Research Institute, National Yang-Ming University, Taipei, Taiwan
Introduction: Patients with long-term therapy of clozapine were noted to have higher risk of mortality due to clozapine-related medical illnesses. Our study is to hypothesize the difference of heart rate variability – a predictor of sudden death – between daytime and nocturnal in schizophrenic patients taking clozapine or the other antipsychotics. Materials and methods: A total of 32 schizophrenic patients were recruited from the chronic ward at the Beitou branch of Tri-Service General Hospital. The case group consists of 10 schizophrenic patients with clozapine treatment of at least 3 months. The remained 22 were controls who were treated with other antipsychotics. All subjects underwent 24-hour HRV recorder by a wireless detector; subjects were asked to do aerobic step exercise for at least 3 minutes. We reviewed whole-day HRV records, which were divided into five statuses, namely, sleep, nap, daytime, exercise and after-exercise. The one-way and repeated measure ANOVA model were applied to compare the differences between five statuses and two groups. Results: Comparing with controls, a significant higher mean heart rate (HR) was found among case group, as well as significantly lower very-low frequency (VLF) and LF/HF ratio. As lower activity and HR during sleep than during daytime, only the VLF parameter of HRV represented significant difference between clozapine/non-clozapine group and sleep/daytime status. Interestingly, although there is no significant difference in LF/HF between groups and status, a significant interaction between clozapine/non-clozapine groups and sleep/ daytime statuses were found. Under the linear models with covariates like age, height, weight and PANSS, the association between clozapine and VLF seems robust even controlling significant effects of body weight. Conclusion: This study shows that all subjects with schizophrenia have a significantly abnormal autonomic dysregulation during sleeping hours than that during daytime. And patients with schizophrenia on clozapine therapy exhibited marked differences in ANS functioning which reflect a basal autono. http://dx.doi.org/10.1016/j.sleep.2015.02.173
Sleep disturbances in children with attention-deficit/ hyperactivity disorder and learning disorders A.C. Stokes Brackett, Federec Guatemala
Introduction: Children with (ADHD) commonly experience behavioural sleep problems. Sleep problems are complex in children; the etiology is likely to be multifactorial. Materials and methods: Our sleep clinic of pediatrics is defined as a multidisciplinary service that offers assistance in sleep disorders, assisted by neurologist and neuropsychologist who perform a wide range of clinical activity. We evaluate 30 patients in 1 year.
S69
Results: We found a significant correlation between ADHD and learning disorders associated with lack of sleep hygiene, daytime sleepiness and sleep apnea. Sleep disorders have become an increasing health issue and its prevalence and consequences are increasingly seen as a serious public health problem. Conclusion: The use of drugs in conjunction with neuropsychological intervention have provided broad and distinct benefits to children attending and improve their development prospects. Also, further studies using polysomnography have allowed more accurate diagnoses between the prevalence of nocturnal epilepsy and cognitive impairment associated with it. Acknowledgements: The evolution of the sleep clinic has led to a better understanding of the broad scope of prevalent problem in the Guatemalan population, which mostly ignores the sleep hygiene and the correlation between it and health. http://dx.doi.org/10.1016/j.sleep.2015.02.174
Sleep and working memory among individuals with depressive and anxiety disorders M. Wong 1, E. Lau 1, Y. Wing 2 1 Sleep Laboratory, The University of Hong Kong, Hong Kong 2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
Introduction: While working memory deficits and sleep complaints were widely reported among individuals with affective disorders, we aim to investigate the relationship between sleep duration with working memory capacity and learning among individuals with/without depressive and/or anxiety disorders (DepAnx). Materials and methods: Ninety college students (17–24 years, 60% female) were administered the structured clinical interview for DSMIV Axis I Disorders for assessment of DepAnx. They completed a sleep diary and wore actigraphy for 5 days before completing a twoback spatial working-memory task (two-back), with performance (accuracy and reaction time (RT)) and learning (differences of accuracy and RT across experimental blocks) measures. The average of 5-day sleep duration <6.5 hours was referred as short sleep duration (SSD). The final sample consisted of 48 healthy controls (26% SSD) and 42 with DepAnx (34%SSD). Results: The groups were matched on demographics (ps > .05). A 2 × 2 factorial model (SSD*DepAnx) was tested on two-back performance and learning measures. There was a significant interaction effect (SSD*DepAnx) on accuracy, F2,88 = 9.376, p = 0.003. Post-hoc analysis (LSD) showed that individuals with neither SSD nor DepAnx had higher accuracy than other groups (mean differences = 0.05 to 0.09, p = < 0.001 to 0.039). There was a significant main effect of SSD on RT, F1,89 = 4.116, p = 0.046. For learning, there was a significant interaction effect between SSD and DepAnx on the change of RT from block 1 to block 2, F2,88 = 5.895, p = 0.017. Post-hoc analysis (LSD) showed that the DepAnx group without SSD had significantly greater improvement in RT from block 1 to block 2 than the DepAnx group with SSD (mean difference = 144.9, p = 0.015). Conclusion: Short sleep duration was found to associate with worse executive working-memory. Furthermore, DepAnx individuals were more vulnerable to the adverse effect of short sleep duration on learning in working-memory task. Sleep behaviors of individuals with depressive and anxiety disorders therefore warrant clinicians’ extra attention especially when working-memory issues were observed.
S70
Abstracts/Sleep Medicine 16 (2015) S2–S199
Acknowledgements: This study was funded by the Health and Medical Research Fund (#11122051). We sincerely thank the research participants, the student interns and research assistants of the project. http://dx.doi.org/10.1016/j.sleep.2015.02.175
The prevalence and characteristics of REM sleep without atonia in patients taking certain antidepressants K. Lee, K. Baron, R. Soca, H. Attarian Northwestern University, USA
Introduction: The association of REM sleep without atonia (RSWA) as well as REM behavior disorder (RBD) with the intake of selective serotonin reuptake inhibitors (SSRI) and selective norepinephrine reuptake inhibitor (SNRI) is well established. Their prevalence in this population and the characteristics of those individuals who develop them remain unknown. Materials and methods: Using the Sleep Cataloguer Software we searched polysomnographic records from October 1, 2007 through October 31, 2013 (a total of 10,746 records) for the following key words: Celexa, Citalopram, Cymbalta, Duloxetine, Pristiq, Desvenlafaxine, Effexor, Venlafaxine, Escitalopram, Lexapro, Fluoxetine, Prozac, Sarafem, Floxyfral, Fluvoxamine, Fevarin, Paroxetine, Paxil, Brisdelle, Sertraline, Zoloft. The resulting 1444 records (after eliminating duplicate reports) were then searched for RSWA and RBD. We used the AASM scoring criteria to determine RSWA. Reports of patients with known narcolepsy or synucleinopathies were excluded. The remaining records were mined for age, sex, presence or absence of obstructive sleep apnea (OSA), type of antidepressant and diagnosis for which antidepressant was prescribed. We used multiple regression analysis to account for the impact of age, OSA and sex on RSWA prevalence. The significance of the risk ratio was calculated by Fisher exact test. Results: Out of the 1444 subjects on antidepressants 176 (12.4%) had RSWA compared with 226 out of the entire sleep lab population of 10,746 (2.1%), risk ratio 9.978, (8.149, 12.22) CI 95%, z-score 26.33, Fisher exact p < 0.0000001. Seven out of the 176 had RBD (0.48%) compared with 108 out of 10,746 (1%). The difference was significant with a p value of 0.005. The lower prevalence of RBD among those with antidepressant induced RSWA is likely an artifact of the study design as we excluded patients with narcolepsy or with neurodegenerative disorders. None of the seven had developed neurodegenerative disorders as of their last visit. With logistic regression analysis there were no significant differences in mean age between the larger population (53.7) and those with RSWA (52.4) p = 0.11 nor was there a difference in the prevalence of OSA in either group p = 0.25 (66% of both groups had OSA). Men constituted 53% of the general population and 49% of those with antidepressant induced RSWA, the difference was not significant p = 0.053. No single diagnosis and no single SSRI/SNRI was significantly associated with higher risk of RSWA or RBD. These results suggest that age, OSA and gender are not driving the effect. Conclusion: SSRIs and SNRIs are associated with a higher prevalence of RSWA but not of RBD. This is independent of medication and of the diagnosis for which antidepressants are started. Clinical significance of this remains to be elucidated. Acknowledgements: Dr. Neil SenGupta for developing Sleep Cataloguer and allowing us to use it. http://dx.doi.org/10.1016/j.sleep.2015.02.176
A quantitative analysis of rapid eye movement sleep atonia in healthy adults Y. Jung 1, S. Mccarter 2, E. St. Louis 3 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA 2 Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA 3 Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
Introduction: Abnormally elevated muscle tone during rapid eye movement (REM) sleep, known as REM sleep without atonia (RSWA), is seen in patients with REM sleep behavior disorder (RBD). Normative values for physiologic atonia during REM sleep are not wellestablished, which makes quantitatively defining RSWA difficult. Materials and methods: Here, we analyzed phasic and tonic muscle activity in submentalis and anterior tibialis muscles during REM sleep as well as automated submentalis REM atonia index (RAI) in neurologically normal adults who had normal polysomnography or primary snoring without RBD or other parasomnia. Statistical comparisons were made in 36 subjects subdivided into four age groups: 20–39 years; 40–59 years; 60–74 years; and ≥75 years. p Value < 0.01 was considered statistically significant in order to reasonably correct for multiple comparisons. Results: Submentalis and anterior tibialis phasic burst durations were similar across the age groups (0.36 ± 0.29 seconds and 0.41 ± 0.28 seconds, respectively). Combined submentalis and anterior tibialis phasic muscle activity was increased in subjects aged 60–74 years (16.8 ± 15.6%) in comparison with the activity observed in subjects aged 40–59 years (1.7 ± 1.2%). There was a trend for a statistical significant difference in combined submentalis and anterior tibialis phasic muscle activity between groups 60–74 years and 20–39 years. Anterior tibialis phasic muscle activity in subjects aged 60–74 years showed a trend for statistical significance in comparison with that of younger age groups. No significant differences were seen in submentalis phasic muscle activity across the age groups. No tonic muscle activity was observed in these subjects. All subjects had submentalis RAI > 0.9, indicating absence of RSWA. Men who are older than 60 years had increased anterior tibialis and combined submentalis and anterior tibialis phasic muscle activity compared with younger men and women (20–59 years) and older women (≥60 years). No gender differences were observed in submentalis phasic muscle activity. Conclusion: The findings suggest that physiologic REM atonia may be increased in older adults, especially in men, although the study is limited given a small number of subjects used in this analysis. A further study of a large number of healthy adults will be important for quantification of physiologic REM atonia. http://dx.doi.org/10.1016/j.sleep.2015.02.177
Ictal SPECT in patients with REM sleep behavior disorder G. Mayer 1, T. Kuwert 2, P. Ritt 2, H. Stefan 3, M. Bitterlich 4 1 Department of Neurology Hephata Klinik, Schwalmstadt/University Marburg, Germany 2 Department of Nuclear Medicine, University Erlangen, Germany 3 Department of Neurology, University Erlangen, Germany 4 Sleep Medicine Hephata Klinik, Schwalmstadt, Germany
Introduction: Patients with idiopathic REM sleep behavior disorder (iRBD) have the same phenotype. Little is known if different types of RBD share the same pathways during their nocturnal activities. The aim of the study was to compare ictal SPECT of different types of RBD.
Sleep matters? Twenty-four hours’ monitoring of daytime and nocturnal changes of heart rate variability in schizophrenic patients on different antipsychotics H. Huang 1, Y. Yueh-Ming Tai 2, T. Kuo 3, C. Yang 4 1 Dr. Happy’s Clinic, National Yang-Ming University, National Defense Medical Center, Taipei, Taiwan 2 Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 3 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan 4 Sleep Research Institute, National Yang-Ming University, Taipei, Taiwan
Introduction: Patients with long-term therapy of clozapine were noted to have higher risk of mortality due to clozapine-related medical illnesses. Our study is to hypothesize the difference of heart rate variability – a predictor of sudden death – between daytime and nocturnal in schizophrenic patients taking clozapine or the other antipsychotics. Materials and methods: A total of 32 schizophrenic patients were recruited from the chronic ward at the Beitou branch of Tri-Service General Hospital. The case group consists of 10 schizophrenic patients with clozapine treatment of at least 3 months. The remained 22 were controls who were treated with other antipsychotics. All subjects underwent 24-hour HRV recorder by a wireless detector; subjects were asked to do aerobic step exercise for at least 3 minutes. We reviewed whole-day HRV records, which were divided into five statuses, namely, sleep, nap, daytime, exercise and after-exercise. The one-way and repeated measure ANOVA model were applied to compare the differences between five statuses and two groups. Results: Comparing with controls, a significant higher mean heart rate (HR) was found among case group, as well as significantly lower very-low frequency (VLF) and LF/HF ratio. As lower activity and HR during sleep than during daytime, only the VLF parameter of HRV represented significant difference between clozapine/non-clozapine group and sleep/daytime status. Interestingly, although there is no significant difference in LF/HF between groups and status, a significant interaction between clozapine/non-clozapine groups and sleep/ daytime statuses were found. Under the linear models with covariates like age, height, weight and PANSS, the association between clozapine and VLF seems robust even controlling significant effects of body weight. Conclusion: This study shows that all subjects with schizophrenia have a significantly abnormal autonomic dysregulation during sleeping hours than that during daytime. And patients with schizophrenia on clozapine therapy exhibited marked differences in ANS functioning which reflect a basal autono. http://dx.doi.org/10.1016/j.sleep.2015.02.173
Sleep disturbances in children with attention-deficit/ hyperactivity disorder and learning disorders A.C. Stokes Brackett, Federec Guatemala
Introduction: Children with (ADHD) commonly experience behavioural sleep problems. Sleep problems are complex in children; the etiology is likely to be multifactorial. Materials and methods: Our sleep clinic of pediatrics is defined as a multidisciplinary service that offers assistance in sleep disorders, assisted by neurologist and neuropsychologist who perform a wide range of clinical activity. We evaluate 30 patients in 1 year.
S69
Results: We found a significant correlation between ADHD and learning disorders associated with lack of sleep hygiene, daytime sleepiness and sleep apnea. Sleep disorders have become an increasing health issue and its prevalence and consequences are increasingly seen as a serious public health problem. Conclusion: The use of drugs in conjunction with neuropsychological intervention have provided broad and distinct benefits to children attending and improve their development prospects. Also, further studies using polysomnography have allowed more accurate diagnoses between the prevalence of nocturnal epilepsy and cognitive impairment associated with it. Acknowledgements: The evolution of the sleep clinic has led to a better understanding of the broad scope of prevalent problem in the Guatemalan population, which mostly ignores the sleep hygiene and the correlation between it and health. http://dx.doi.org/10.1016/j.sleep.2015.02.174
Sleep and working memory among individuals with depressive and anxiety disorders M. Wong 1, E. Lau 1, Y. Wing 2 1 Sleep Laboratory, The University of Hong Kong, Hong Kong 2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
Introduction: While working memory deficits and sleep complaints were widely reported among individuals with affective disorders, we aim to investigate the relationship between sleep duration with working memory capacity and learning among individuals with/without depressive and/or anxiety disorders (DepAnx). Materials and methods: Ninety college students (17–24 years, 60% female) were administered the structured clinical interview for DSMIV Axis I Disorders for assessment of DepAnx. They completed a sleep diary and wore actigraphy for 5 days before completing a twoback spatial working-memory task (two-back), with performance (accuracy and reaction time (RT)) and learning (differences of accuracy and RT across experimental blocks) measures. The average of 5-day sleep duration <6.5 hours was referred as short sleep duration (SSD). The final sample consisted of 48 healthy controls (26% SSD) and 42 with DepAnx (34%SSD). Results: The groups were matched on demographics (ps > .05). A 2 × 2 factorial model (SSD*DepAnx) was tested on two-back performance and learning measures. There was a significant interaction effect (SSD*DepAnx) on accuracy, F2,88 = 9.376, p = 0.003. Post-hoc analysis (LSD) showed that individuals with neither SSD nor DepAnx had higher accuracy than other groups (mean differences = 0.05 to 0.09, p = < 0.001 to 0.039). There was a significant main effect of SSD on RT, F1,89 = 4.116, p = 0.046. For learning, there was a significant interaction effect between SSD and DepAnx on the change of RT from block 1 to block 2, F2,88 = 5.895, p = 0.017. Post-hoc analysis (LSD) showed that the DepAnx group without SSD had significantly greater improvement in RT from block 1 to block 2 than the DepAnx group with SSD (mean difference = 144.9, p = 0.015). Conclusion: Short sleep duration was found to associate with worse executive working-memory. Furthermore, DepAnx individuals were more vulnerable to the adverse effect of short sleep duration on learning in working-memory task. Sleep behaviors of individuals with depressive and anxiety disorders therefore warrant clinicians’ extra attention especially when working-memory issues were observed.
S70
Abstracts/Sleep Medicine 16 (2015) S2–S199
Acknowledgements: This study was funded by the Health and Medical Research Fund (#11122051). We sincerely thank the research participants, the student interns and research assistants of the project. http://dx.doi.org/10.1016/j.sleep.2015.02.175
The prevalence and characteristics of REM sleep without atonia in patients taking certain antidepressants K. Lee, K. Baron, R. Soca, H. Attarian Northwestern University, USA
Introduction: The association of REM sleep without atonia (RSWA) as well as REM behavior disorder (RBD) with the intake of selective serotonin reuptake inhibitors (SSRI) and selective norepinephrine reuptake inhibitor (SNRI) is well established. Their prevalence in this population and the characteristics of those individuals who develop them remain unknown. Materials and methods: Using the Sleep Cataloguer Software we searched polysomnographic records from October 1, 2007 through October 31, 2013 (a total of 10,746 records) for the following key words: Celexa, Citalopram, Cymbalta, Duloxetine, Pristiq, Desvenlafaxine, Effexor, Venlafaxine, Escitalopram, Lexapro, Fluoxetine, Prozac, Sarafem, Floxyfral, Fluvoxamine, Fevarin, Paroxetine, Paxil, Brisdelle, Sertraline, Zoloft. The resulting 1444 records (after eliminating duplicate reports) were then searched for RSWA and RBD. We used the AASM scoring criteria to determine RSWA. Reports of patients with known narcolepsy or synucleinopathies were excluded. The remaining records were mined for age, sex, presence or absence of obstructive sleep apnea (OSA), type of antidepressant and diagnosis for which antidepressant was prescribed. We used multiple regression analysis to account for the impact of age, OSA and sex on RSWA prevalence. The significance of the risk ratio was calculated by Fisher exact test. Results: Out of the 1444 subjects on antidepressants 176 (12.4%) had RSWA compared with 226 out of the entire sleep lab population of 10,746 (2.1%), risk ratio 9.978, (8.149, 12.22) CI 95%, z-score 26.33, Fisher exact p < 0.0000001. Seven out of the 176 had RBD (0.48%) compared with 108 out of 10,746 (1%). The difference was significant with a p value of 0.005. The lower prevalence of RBD among those with antidepressant induced RSWA is likely an artifact of the study design as we excluded patients with narcolepsy or with neurodegenerative disorders. None of the seven had developed neurodegenerative disorders as of their last visit. With logistic regression analysis there were no significant differences in mean age between the larger population (53.7) and those with RSWA (52.4) p = 0.11 nor was there a difference in the prevalence of OSA in either group p = 0.25 (66% of both groups had OSA). Men constituted 53% of the general population and 49% of those with antidepressant induced RSWA, the difference was not significant p = 0.053. No single diagnosis and no single SSRI/SNRI was significantly associated with higher risk of RSWA or RBD. These results suggest that age, OSA and gender are not driving the effect. Conclusion: SSRIs and SNRIs are associated with a higher prevalence of RSWA but not of RBD. This is independent of medication and of the diagnosis for which antidepressants are started. Clinical significance of this remains to be elucidated. Acknowledgements: Dr. Neil SenGupta for developing Sleep Cataloguer and allowing us to use it. http://dx.doi.org/10.1016/j.sleep.2015.02.176
A quantitative analysis of rapid eye movement sleep atonia in healthy adults Y. Jung 1, S. Mccarter 2, E. St. Louis 3 1 Department of Neurology, Mayo Clinic, Rochester, MN, USA 2 Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA 3 Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
Introduction: Abnormally elevated muscle tone during rapid eye movement (REM) sleep, known as REM sleep without atonia (RSWA), is seen in patients with REM sleep behavior disorder (RBD). Normative values for physiologic atonia during REM sleep are not wellestablished, which makes quantitatively defining RSWA difficult. Materials and methods: Here, we analyzed phasic and tonic muscle activity in submentalis and anterior tibialis muscles during REM sleep as well as automated submentalis REM atonia index (RAI) in neurologically normal adults who had normal polysomnography or primary snoring without RBD or other parasomnia. Statistical comparisons were made in 36 subjects subdivided into four age groups: 20–39 years; 40–59 years; 60–74 years; and ≥75 years. p Value < 0.01 was considered statistically significant in order to reasonably correct for multiple comparisons. Results: Submentalis and anterior tibialis phasic burst durations were similar across the age groups (0.36 ± 0.29 seconds and 0.41 ± 0.28 seconds, respectively). Combined submentalis and anterior tibialis phasic muscle activity was increased in subjects aged 60–74 years (16.8 ± 15.6%) in comparison with the activity observed in subjects aged 40–59 years (1.7 ± 1.2%). There was a trend for a statistical significant difference in combined submentalis and anterior tibialis phasic muscle activity between groups 60–74 years and 20–39 years. Anterior tibialis phasic muscle activity in subjects aged 60–74 years showed a trend for statistical significance in comparison with that of younger age groups. No significant differences were seen in submentalis phasic muscle activity across the age groups. No tonic muscle activity was observed in these subjects. All subjects had submentalis RAI > 0.9, indicating absence of RSWA. Men who are older than 60 years had increased anterior tibialis and combined submentalis and anterior tibialis phasic muscle activity compared with younger men and women (20–59 years) and older women (≥60 years). No gender differences were observed in submentalis phasic muscle activity. Conclusion: The findings suggest that physiologic REM atonia may be increased in older adults, especially in men, although the study is limited given a small number of subjects used in this analysis. A further study of a large number of healthy adults will be important for quantification of physiologic REM atonia. http://dx.doi.org/10.1016/j.sleep.2015.02.177
Ictal SPECT in patients with REM sleep behavior disorder G. Mayer 1, T. Kuwert 2, P. Ritt 2, H. Stefan 3, M. Bitterlich 4 1 Department of Neurology Hephata Klinik, Schwalmstadt/University Marburg, Germany 2 Department of Nuclear Medicine, University Erlangen, Germany 3 Department of Neurology, University Erlangen, Germany 4 Sleep Medicine Hephata Klinik, Schwalmstadt, Germany
Introduction: Patients with idiopathic REM sleep behavior disorder (iRBD) have the same phenotype. Little is known if different types of RBD share the same pathways during their nocturnal activities. The aim of the study was to compare ictal SPECT of different types of RBD.