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Sleep apnea syndrome (SAS) and gastroesophageal reflux (GER) in infants
Sessiofi 53: Sleep S&dies
inDisease2
subjects had normal respiration and 1 showed hypopnea. All had epileptiform
from that of benzodiazepine
activity during sleep, with no seizures. The epikes was usually most frequent in the early morning and during light NREM sleep, Sleep spindies were herdly observed, while frequent seizure activity was found on sleep EEG. Before the onset of epileptic attacks, paroxysmal discharges, such as diffuse spike-a&wave complexes. were noted during sleep recordings. The reason for increased spike frequency in the early morning hours. Circadian variation in cortical excitability or hormonal factors or both may play a role. The mechanism of the abnorrn breathing pattern in a case, is discussed. We suggest that the alternating apnea and hyperventilation are a behaviorally determined breathing pattern.
included in a category of BDZ receptor agonist. However, effects of BDZ and ZPC on nocturnal sleep, particularly on slow wave sleep (SWS). is reported to be somewhat different with each other. That is, many of BDZ at bedtime usually decreases the amount of SWS. whereas ZPC usually does not decrease it. In order to elucidate the characteristics of the effect of ZPC on sleep, the authors administered ZPC on normai subjects and schizophrenic patients. ZPC 10 mg and inactive placebo were administered on 12 healthy male volunteers with cross over design, Polysomnographic (PSG) sleep stage was scored according to the criteria of Rechtschaffen and Kales, Sleep EEG was also analyzed quantitatively by means of period amplitude analysis (zero-cross) and frequency, amplitude, and number of delta and other waves were measured during the night. A single administration of ZPC did no? reduce the total number of delta waves (0.5-2.0 Hzj during a night, and only the number of 1.0-I .5 Hz delta waves showed a slight decrease. In 6 male schizophrenic outpatients who had been on neuroleptics and BDZ hypnotics, BDZ was replaced byZPC of flexible doses of 7.5-15 mg for 8 weeks. A slight increase of SWS and a slight decrease of BP& and negative symptom scores were observed during the ZPC administration. Resuits of quantitative analysis of sleep EEG of schizophrenic subjects will also be reported.
53 02 Evoked LL_1 Treate
Potentials in Multiple Sclerosis Patients ith W lmmunoglobulin -A Preliminary
Study R. Gilad. A. Achiron, Y. Eshel, Y Lampl, I. Sarova-Pinhas. Neurology Dept, E. Wolfson Medical
Cente’el; Holon, Israel
Ten patients with definite remitting-relapsing MS. were examined clinically, radiologically and electrophysiologicaliy, before treatment and two weeks and three months after IV lg treatment. We performed 60 eiectro-physiological studies, including visual (VEP), brainstem auditory (BAER) and nerve somatosensory EPs (SSEP) on all patients. Four out of ten parients (40%) had bilateral absence of visual EPs at baseline, and it was possible to demonstrate EPs again three months after treatment with IV lg (in a range of Plun = 125 f 12 msec). In the remaining 6 patients, we found the same improvement, but not statistically significant. The somatosensory positive peak of cortical wave N20 improved in five out of ten patients (50%) examined three months after treatment. In the BAER studies median, V-i (BIT) interpeak latency was improved in three out of ten patients (30%) after IV lg treatment. We conclude that not onlv the EPs are an objectively useful measurement for MS. therapeutic trials, but also that IV Ig treatment may improve some of the electrophysioiogical functions, This finding makes it worthwhile for the continuance of this treatment for MS. patients, being sure to check its efficacy by a re-evaluation of these patients after a year of IV lg therapy.
53-03
PLMS in Patients with Sleep Apnea Syndrome Before and In the Midst of N-CPAP Treatment
T. Nozawa, T Takeuchi, N Takei, A. Sato, K. Narui, K. Nakata, F Kawana. Y. !shiyama. M. Ebe. Showa lJnivers&
Toranomon HospitalTokyo
It has been reported that periodic legs movement in sleep (PLMS) appeared in sleep apnea syndrome. Nasal continuous positive airway pressure (N-CPAP) is an effective to severe obstructive sleep apnea syndrome. The results of PSG in obstructive sleep apnea syndrome before and in the midst of N-CPAP were presented in this paper, Eight patients were studied; all males aged 20-58. The diagnosis of PLMS was depended on the criteria of Coleman et al, 1982. PSG were performed throughout two nights: EEG, EOG, chin-EMG, sound of snoring, oral and nasal air flow, thoracic and abdominal movement, ECG and EMG of legs. PLMS was classified two types; type 1 is not related to the apnea and type 2 is related to the resume of the respiration from the apnea. On PSG, apnea index(Al)vvas from 18 to 81. PLMS appeared in 5 patients; 1 type 2 and 4 both type 1 and 2. Movement index(Ml) was from 1 to 78, In the midst of N-CPAP treatnnent, the appearance of PLMS increased more than before treatment except one patient who was 20 year old student. The value of SaO2 in patients with PLMS decreased more than in patients without PLMS. It seems that the appearance of PI-MS in sleep apnea is related to the hypoxia and aging in CNS. uantitative Analysis of the Effect of Zopiclone on of Normal and Schizophrenic Subjects T. Okuma, M, Kate, N. Kajimura. S. Shirakawa, M. Okawa. National Center of Neurology and Psychiatry, Tokyo, Japan Zopiclone (ZPC). a cyciopirrolone
hypnotic,
has a different chemical structure
53-05
(BDZ) but acts at the GABA receptors,
Sleep Apnea Syndrome Reflux (GER) in infants
(SAS) and ~~~~~~es~
M. Shkurovich, S. Nurko, M.A. Coliado, B. Reyes. HospitaiPBC.
Mexico
and is
eel
City
Research has shown that laryngeal chemorreceptors sensitive to various liquids may induce prolonged apnea, even death, in various species of neonatal animals. These reflexes also exist in human infants. Nearly 50% of newborns develop apnea and cyanosis in various degrees during their first food intake. Cyanosis and bradycardia is common during food ingestion in preterm infants. The episodes appear during ?he neonatal period both in preterm as well as in full-term infants. These have been correlated with central or obstructive or mixed apneas. This type of apnea is not produced by bronchoaspiration. although this possibility has not been ruled out. Proximal GER may induce arousals in infants. Regurgitation after feedings and occult reflux of gastric contents are well documented in infants under the age of one year. We report a group of infants with sleep disorders with frequent arousals, associated with cyanosis. Patients were studied with EEG recordings, breathing, 02 saturation, and continuous esophageal pH. Sleep studies and esophageal pH were scored separately. The GER was more frequent during wakefulness and active sleep. Proximal pH readings below 4 during sleep were associated with arousals and apneas which correlated with 02 desaturation. Distal GER with low pH readings was not correlated with apnea nor SAS.
53-07
Psychophysiological & Psyc~~lQ~i~a~ C~nse~ue~c~s After Surgical Treatment of Qbstr~c~~v~ Sleep Aorta Syndromes
W. Yamadera, H. Itoh, M. Sasaki, M. Ozone, N. Matsunaga, T Takahashi, M. Tamura, S. Ushijima. Department of Psychiatry, The Jikei University School of Medicine, Tokyo /ntroduction: Excessive daytime sleepiness (EDS), the rnost frequent symptom associated with obstructive sleep apnea syndrome (OSA), may lead to considerable social difficulties. The purpose of this study is to investigate the effects of surgical treatment on psychophysiological and psychological measurement of OSA patients, and to clarify the interrelationships regarding an evaluation of its improvement. Subjects and Methods: The subjects were 15 OSA patients (Age: 40.6; 13 male, 2 female). Our examinations were performed, beiore (Pre-Treatment; PT) and after the surgery (14.2 days: Post-Operation; PO and 4.1 months: Follow Up; FU). Each subject slept at 21:00-6:OO with PSG. MSLT, SSS and SAM fatigue check list were applied for the changes in SDS. The psychological battery consisted of Uchida-Kraepelin test [U-K), WAIS-R and MMPI.
inDisease2
subjects had normal respiration and 1 showed hypopnea. All had epileptiform
from that of benzodiazepine
activity during sleep, with no seizures. The epikes was usually most frequent in the early morning and during light NREM sleep, Sleep spindies were herdly observed, while frequent seizure activity was found on sleep EEG. Before the onset of epileptic attacks, paroxysmal discharges, such as diffuse spike-a&wave complexes. were noted during sleep recordings. The reason for increased spike frequency in the early morning hours. Circadian variation in cortical excitability or hormonal factors or both may play a role. The mechanism of the abnorrn breathing pattern in a case, is discussed. We suggest that the alternating apnea and hyperventilation are a behaviorally determined breathing pattern.
included in a category of BDZ receptor agonist. However, effects of BDZ and ZPC on nocturnal sleep, particularly on slow wave sleep (SWS). is reported to be somewhat different with each other. That is, many of BDZ at bedtime usually decreases the amount of SWS. whereas ZPC usually does not decrease it. In order to elucidate the characteristics of the effect of ZPC on sleep, the authors administered ZPC on normai subjects and schizophrenic patients. ZPC 10 mg and inactive placebo were administered on 12 healthy male volunteers with cross over design, Polysomnographic (PSG) sleep stage was scored according to the criteria of Rechtschaffen and Kales, Sleep EEG was also analyzed quantitatively by means of period amplitude analysis (zero-cross) and frequency, amplitude, and number of delta and other waves were measured during the night. A single administration of ZPC did no? reduce the total number of delta waves (0.5-2.0 Hzj during a night, and only the number of 1.0-I .5 Hz delta waves showed a slight decrease. In 6 male schizophrenic outpatients who had been on neuroleptics and BDZ hypnotics, BDZ was replaced byZPC of flexible doses of 7.5-15 mg for 8 weeks. A slight increase of SWS and a slight decrease of BP& and negative symptom scores were observed during the ZPC administration. Resuits of quantitative analysis of sleep EEG of schizophrenic subjects will also be reported.
53 02 Evoked LL_1 Treate
Potentials in Multiple Sclerosis Patients ith W lmmunoglobulin -A Preliminary
Study R. Gilad. A. Achiron, Y. Eshel, Y Lampl, I. Sarova-Pinhas. Neurology Dept, E. Wolfson Medical
Cente’el; Holon, Israel
Ten patients with definite remitting-relapsing MS. were examined clinically, radiologically and electrophysiologicaliy, before treatment and two weeks and three months after IV lg treatment. We performed 60 eiectro-physiological studies, including visual (VEP), brainstem auditory (BAER) and nerve somatosensory EPs (SSEP) on all patients. Four out of ten parients (40%) had bilateral absence of visual EPs at baseline, and it was possible to demonstrate EPs again three months after treatment with IV lg (in a range of Plun = 125 f 12 msec). In the remaining 6 patients, we found the same improvement, but not statistically significant. The somatosensory positive peak of cortical wave N20 improved in five out of ten patients (50%) examined three months after treatment. In the BAER studies median, V-i (BIT) interpeak latency was improved in three out of ten patients (30%) after IV lg treatment. We conclude that not onlv the EPs are an objectively useful measurement for MS. therapeutic trials, but also that IV Ig treatment may improve some of the electrophysioiogical functions, This finding makes it worthwhile for the continuance of this treatment for MS. patients, being sure to check its efficacy by a re-evaluation of these patients after a year of IV lg therapy.
53-03
PLMS in Patients with Sleep Apnea Syndrome Before and In the Midst of N-CPAP Treatment
T. Nozawa, T Takeuchi, N Takei, A. Sato, K. Narui, K. Nakata, F Kawana. Y. !shiyama. M. Ebe. Showa lJnivers&
Toranomon HospitalTokyo
It has been reported that periodic legs movement in sleep (PLMS) appeared in sleep apnea syndrome. Nasal continuous positive airway pressure (N-CPAP) is an effective to severe obstructive sleep apnea syndrome. The results of PSG in obstructive sleep apnea syndrome before and in the midst of N-CPAP were presented in this paper, Eight patients were studied; all males aged 20-58. The diagnosis of PLMS was depended on the criteria of Coleman et al, 1982. PSG were performed throughout two nights: EEG, EOG, chin-EMG, sound of snoring, oral and nasal air flow, thoracic and abdominal movement, ECG and EMG of legs. PLMS was classified two types; type 1 is not related to the apnea and type 2 is related to the resume of the respiration from the apnea. On PSG, apnea index(Al)vvas from 18 to 81. PLMS appeared in 5 patients; 1 type 2 and 4 both type 1 and 2. Movement index(Ml) was from 1 to 78, In the midst of N-CPAP treatnnent, the appearance of PLMS increased more than before treatment except one patient who was 20 year old student. The value of SaO2 in patients with PLMS decreased more than in patients without PLMS. It seems that the appearance of PI-MS in sleep apnea is related to the hypoxia and aging in CNS. uantitative Analysis of the Effect of Zopiclone on of Normal and Schizophrenic Subjects T. Okuma, M, Kate, N. Kajimura. S. Shirakawa, M. Okawa. National Center of Neurology and Psychiatry, Tokyo, Japan Zopiclone (ZPC). a cyciopirrolone
hypnotic,
has a different chemical structure
53-05
(BDZ) but acts at the GABA receptors,
Sleep Apnea Syndrome Reflux (GER) in infants
(SAS) and ~~~~~~es~
M. Shkurovich, S. Nurko, M.A. Coliado, B. Reyes. HospitaiPBC.
Mexico
and is
eel
City
Research has shown that laryngeal chemorreceptors sensitive to various liquids may induce prolonged apnea, even death, in various species of neonatal animals. These reflexes also exist in human infants. Nearly 50% of newborns develop apnea and cyanosis in various degrees during their first food intake. Cyanosis and bradycardia is common during food ingestion in preterm infants. The episodes appear during ?he neonatal period both in preterm as well as in full-term infants. These have been correlated with central or obstructive or mixed apneas. This type of apnea is not produced by bronchoaspiration. although this possibility has not been ruled out. Proximal GER may induce arousals in infants. Regurgitation after feedings and occult reflux of gastric contents are well documented in infants under the age of one year. We report a group of infants with sleep disorders with frequent arousals, associated with cyanosis. Patients were studied with EEG recordings, breathing, 02 saturation, and continuous esophageal pH. Sleep studies and esophageal pH were scored separately. The GER was more frequent during wakefulness and active sleep. Proximal pH readings below 4 during sleep were associated with arousals and apneas which correlated with 02 desaturation. Distal GER with low pH readings was not correlated with apnea nor SAS.
53-07
Psychophysiological & Psyc~~lQ~i~a~ C~nse~ue~c~s After Surgical Treatment of Qbstr~c~~v~ Sleep Aorta Syndromes
W. Yamadera, H. Itoh, M. Sasaki, M. Ozone, N. Matsunaga, T Takahashi, M. Tamura, S. Ushijima. Department of Psychiatry, The Jikei University School of Medicine, Tokyo /ntroduction: Excessive daytime sleepiness (EDS), the rnost frequent symptom associated with obstructive sleep apnea syndrome (OSA), may lead to considerable social difficulties. The purpose of this study is to investigate the effects of surgical treatment on psychophysiological and psychological measurement of OSA patients, and to clarify the interrelationships regarding an evaluation of its improvement. Subjects and Methods: The subjects were 15 OSA patients (Age: 40.6; 13 male, 2 female). Our examinations were performed, beiore (Pre-Treatment; PT) and after the surgery (14.2 days: Post-Operation; PO and 4.1 months: Follow Up; FU). Each subject slept at 21:00-6:OO with PSG. MSLT, SSS and SAM fatigue check list were applied for the changes in SDS. The psychological battery consisted of Uchida-Kraepelin test [U-K), WAIS-R and MMPI.