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  • REM sleep vs exploratory wakefulness: alternatives within adult ‘sleep debt’ ?
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-12-23
    Jim Horne

    Our declining sleep duration over early human infant development is largely through REM sleep (REM), loss, not of nonREM. It coincides with the infant’s increasing locomotion providing for multisensory inputs (‘exploratory wakefulness’ - EW), together facilitating neural restructuring and behavioural adaptations (‘neuroplasticity’). EW also involves curiosity, novelty, navigation, spatial memory, associated emotions, and feeding; all having brain processes particularly active in REM. It is proposed that: (i) REM is a proxy for EW in facilitating neuroplasticity; (ii) necessitating REM having a locomotor output, actively inhibited (the atonia); (iii) human adults retain many (neotenous) infant characteristics including large amounts of REM towards the end of usual sleep, where REM’s qualitative changes indicate reduced sleep pressure, (iv) as in infancy, some of our adult REM remains replaceable by EW (without REM rebounds), mostly in this final REM episode whenever EW need prevails. Accordingly, our adult sleep duration is adaptable to habitual shortening via this REM episode substituted by purposeful EW, which could provide extra (day)light exposure for circadian synchrony. Such processes may underlie seasonally shorter (6h) sleep, eg in hunter-gather people. This flexibility of REM questions the extent of our western ‘chronic sleep debt’. Evidence is provided to counter claims that this absent REM would cause obesity and related disorders. 200w.

    更新日期:2019-12-23
  • Non-pharmacological treatment for insomnia following acquired brain injury: a systematic review
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-12-19
    Marthe E. Ford; Erny Groet; Joost G. Daams; Gert J. Geurtsen; Coen A.M. Van Bennekom; Eus J.W. Van Someren

    Insomnia symptoms following acquired brain injury are serious and common, associated with cognitive and emotional complaints. This systematic review aims to summarize and appraise the current knowledge regarding the efficacy of non-pharmacological treatments for insomnia after traumatic brain injury and stroke in adults. A systematic search in the electronic databases of Medline, PsycINFO and Embase was conducted on January 15, 2019. The search strategy included traumatic brain injury or stroke and a combination of keywords and Boolean operators to represent the concept of insomnia. Articles were restricted to those in English and study populations of human adults. A total of 4341 studies were found, of which 16 were included, representing seven different non-pharmacological treatments. While the quality and quantity of the studies does not allow for firm conclusions, the outcomes suggest that cognitive behavioural therapy improves insomnia and sleep quality. The results highlight the need for larger studies of better methodological quality on non-pharmacological interventions for insomnia following brain injury.

    更新日期:2019-12-19
  • REM sleep behavior disorder in narcolepsy: a secondary form or an intrinsic feature?
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-12-19
    Elena Antelmi;; Fabio Pizza; Christian Franceschini; Raffaele Ferri; Giuseppe Plazzi

    Disrupted nighttime sleep is one of the pentad of symptoms defining Narcolepsy. REM sleep behavior disorder (RBD) largely contributes to night sleep disruption and narcolepsy is the most common cause of secondary RBD. However, RBD linked to narcolepsy (N-RBD) has been insufficiently characterized, leaving unsolved a number of issues. Indeed, it is still debated whether N-RBD is an intrinsic feature of narcolepsy, as indubitable for cataplexy, and therefore strictly linked to the cerebrospinal fluid hypocretin-1 (CSF hcrt-1) deficiency, or an associated feature, with a still unclear pathophysiology. The current review aims at rendering a comprehensive state–of-the-art of N-RBD, highlighting the open and unsettled topics. RBD reportedly affects 30-60% of patients with Narcolepsy type 1 (NT1), but it may be seen also in Narcolepsy type 2 (NT2). When compared to idiopathic/isolated RBD (iRBD), N-RBD has been reported to be characterized by less energetic and quieter episode, which however occur with the same probability in the first and the second part of the night and sometime even subcontinuously. N-RBD patients are generally younger than those with iRBD. N-RBD has been putatively linked to wake-sleep instability due to CSF hcrt-1 deficiency, but this latter by itself cannot explain completely the phenomenon as N-RBD has not been universally linked to low CSF hcrt-1 levels and it may be observed also in NT2. Therefore, other factors may probably play a role and further studies are needed to clarify this issue. In addition, therapeutic options have been poorly investigated.

    更新日期:2019-12-19
  • Pre-sleep cognitive activity in adults: A systematic review
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-12-17
    Alexandre Lemyre; Florence Belzile; Madeleine Landry; Célyne H. Bastien; Luc Beaudoin

    This systematic review focuses on three themes: 1) the nature of pre-sleep cognitive activity in good sleepers and individuals with insomnia, 2) the links between measures of pre-sleep cognitive activity and sleep onset latency (SOL) or insomnia, and 3) the effect of manipulating pre-sleep cognitive activity on SOL or insomnia. Regarding the first theme, mentation reports have been collected in a sleep laboratory, with an ambulatory monitoring device, or using a voice-activated tape-recorder. Normal transition to sleep is characterized by sensorial imagery, deactivation of higher cognitive processes, and hallucinations. Moreover, pre-sleep thoughts in individuals with insomnia frequently relate to planning or problem-solving, and are more unpleasant than in good sleepers. Regarding the second theme, twelve questionnaires and three interviews were identified. Insomnia is associated with more thoughts interfering with sleep, counterfactual processing, worries, maladaptive thought control strategies, covert monitoring, and cognitive arousal. Regarding the third theme, several strategies have been tested: mental imagery, hypnosis, paradoxical intention, articulatory suppression, ordinary suppression, and distraction. Their effect is either beneficial, negligible, or detrimental. Future research should focus on the mechanisms through which some forms of cognitive activity affect sleep onset latency.

    更新日期:2019-12-18
  • Obstructive sleep apnea, cognition and Alzheimer's disease: a systematic review integrating three decades of multidisciplinary research
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-12-12
    Omonigho M. Bubu; Andreia G. Andrade; Ogie Q. Umasabor-Bubu; Megan M. Hogan; Arlener D. Turner; Mony J. de Leon; Gbenga Ogedegbe; Indu Ayappa; Girardin Jean-Louis G; Melinda L. Jackson; Andrew W. Varga; Ricardo S. Osorio

    Increasing evidence links cognitive-decline and Alzheimer’s disease (AD) to various sleep disorders, including obstructive sleep apnea (OSA). With increasing age, there are substantial differences in OSA’s prevalence, associated comorbidities and phenotypic presentation. An important question for sleep and AD researchers is whether OSA’s heterogeneity results in varying cognitive-outcomes in older-adults compared to middle-aged adults. In this review, we systematically integrated research examining OSA and cognition, mild cognitive-impairment (MCI) and AD/AD biomarkers; including the effects of continuous positive airway pressure (CPAP) treatment, particularly focusing on characterizing the heterogeneity of OSA and its cognitive-outcomes. Broadly, in middle-aged adults, OSA is often associated with mild impairment in attention, memory and executive function. In older-adults, OSA is not associated with any particular pattern of cognitive-impairment at cross-section; however, OSA is associated with the development of MCI or AD with symptomatic patients who have a higher likelihood of associated disturbed sleep/cognitive-impairment driving these findings. CPAP treatment may be effective in improving cognition in OSA patients with AD. Recent trends demonstrate links between OSA and AD-biomarkers of neurodegeneration across all age-groups. These distinct patterns provide the foundation for envisioning better characterization of OSA and the need for more sensitive/novel sleep-dependent cognitive assessments to assess OSA-related cognitive-impairment.

    更新日期:2019-12-13
  • Polysomnographic features of pregnancy: a systematic review
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-12-05
    Corrado Garbazza, Sandra Hackethal, Silvia Riccardi S, Christian Cajochen, Alessandro Cicolin, Armando D’Agostino, Fabio Cirignotta, Mauro Manconi

    Symptoms of sleep disturbances are common among pregnant women and generally worsen across gestation. Pregnancy-related sleep disorders are not only associated with a poor quality of life of the affected mothers, but also with adverse perinatal outcomes, including perinatal depression, gestational diabetes, preeclampsia, and preterm birth. The current knowledge about the impact of sleep disorders during pregnancy largely derives from the results of sleep surveys conducted in various populations. However, the number of studies examining changes in objective sleep variables during pregnancy via polysomnography has progressively increased in recent years. Here we systematically reviewed the polysomnographic studies available in the literature with the aim to describe the sleep pattern and to identify possible markers of sleep disruption in pregnant women. Based on our analysis, subjective worsening of sleep quality across gestation is related to objective changes in sleep macrostructure, which become particularly evident in the third trimester. Pregnancy per se does not represent an independent risk factor for developing major polysomnography-assessed sleep disorders in otherwise healthy women. However, in women presenting predisposing factors, such as obesity or hypertension, physiological changes occurring during pregnancy may contribute to the onset of pathological conditions, especially sleep-disordered breathing, which must be carefully considered.

    更新日期:2019-12-05
  • Many naps, one nap, none: A systematic review and meta-analysis of napping patterns in children 0-12 years
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-29
    Sally Staton, Peter S. Rankin, Mollie Harding, Simon S. Smith, Emily Westwood, Monique K. LeBourgeois, Karen J. Thorpe

    The onset of monophasic sleep, in which napping ceases and sleep consolidates into a single night period, is a key developmental milestone of childhood. Yet to date, there is little consensus regarding the timing of cessation of napping in children. The aim of the current study is to examine global evidence regarding napping patterns in childhood, and, through meta-analysis, describe patterns of napping cessation and duration observed in children aged 0-12 years. A systematic search of all published, original research articles reporting children’s napping patterns, by age, was conducted. The quality of studies was assessed, and meta-analysis of eligible studies undertaken. Risk of bias and heterogeneity of measurement was high. Current evidence indicates that less than 2.5% of children cease napping prior to age 2, while 94% cease napping by age 5. The preschool period (3-5 years; 36-60 months) represents a particularly dynamic period in napping cessation, with large variation in rates of napping across studies evidencing potential ecological effects. Future studies should focus on understanding of the underlying mechanisms explaining individual variations in napping patterns and the extent to which patterns of napping may represent a marker of child development.

    更新日期:2019-11-29
  • Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-28
    D.E. Yücel, A.A.P. van Emmerik, C. Souama, J. Lancee

    Pharmacological treatment with prazosin and psychological treatment with imagery rehearsal therapy (IRT) are the two main treatments of posttraumatic nightmares. The American Academy of Sleep Medicine task force recently listed IRT as the recommended treatment for trauma-related nightmares and changed the recommendation of prazosin to ‘may be used’. This new recommendation was based on a single prazosin trial and not on a meta-analytic review of all available trials. The current meta-analysis aims to fill this gap in the literature. Eight studies on IRT and seven studies on prazosin (N = 1.078) were analyzed based on the random effects model. Relative to control groups, prazosin had a moderate to large effect on nightmare frequency (g = 0.61), posttraumatic stress symptoms (g = 0.81), and sleep quality (g = 0.85). IRT showed small to moderate effects on nightmare frequency (g = 0.51), posttraumatic symptoms (g = 0.31), and sleep quality (g = 0.51). No significant differences in effect were observed between prazosin and IRT on any of these outcomes (all p’s > .10). It is concluded that downgrading the recommendation of prazosin may be a premature decision and that the aggregated results in this meta-analysis clearly show efficacy of both treatments.

    更新日期:2019-11-29
  • Melatonergic agents in the prevention of delirium: A network meta-analysis of randomized controlled trials
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-14
    Chun-Pai Yang, Ping-Tao Tseng, Jane Pei-Chen Chang, Huanxing Su, Senthil Kumaran Satyanarayanan, Kuan-Pin Su

    Disruption of the sleep-wake cycle is a risk factor and a prodromal indicator of delirium. Melatonergic agents may thus play a role in the prevention of delirium. Based upon literature search on eight databases, this systemic review and frequentist model network meta-analysis (NMA) aimed to determine the efficacy and tolerability of melatonergic agents in delirium prevention. Six randomized controlled trials (RCTs) were included with a total of 913 adult participants (mean age = 78.8, mean female proportion = 59.4%) investigating the preventive effects of melatonergic agents in patients with high risks of developing delirium. The outcomes of NMA demonstrated significant preventive effects with 5 mg/day of melatonin [Odds Ratio (OR) = 0.21, 95% Confidence Intervals (CIs): 0.07 to 0.64], melatonin (0.5 mg/day) [OR = 0.16 (95% CIs: 0.03 to 0.75)], and ramelteon (8 mg/day) [OR = 0.28 (95% CIs: 0.12 to 0.65)] against placebo groups. According to the surface under the cumulative ranking curve (SUCRA), 0.5 mg/day of melatonin was associated with the best preventive effect. Our findings provided the rationale for recommending low-dose melatonergic agents for delirium prevention in the practice guidelines.

    更新日期:2019-11-14
  • Interventions for sleep problems during pregnancy: a systematic review
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-14
    Valeria Bacaro, Fee Benz, Andrea Pappaccogli, Paola De Bartolo, Anna F. Johann, Laura Palagini, Caterina Lombardo, Bernd Feige, Dieter Riemann, Chiara Baglioni

    Sleep problems during pregnancy are prevalent and could be linked to negative outcomes during pregnancy or post-partum. However, these complaints are often underdiagnosed and undertreated. This review aimed to systematically assess the effectiveness of different interventions to ameliorate poor sleep quality and insomnia during pregnancy. Pubmed, PsycINFO and Medline databases were systematically searched without publication period restriction until 3rd May 2019. Eligible studies had to: include pregnant women of any age and gestational age; use clinical intervention designs targeted at improving sleep outcome; report pre- and post-treatment data for one or more sleep-related outcomes; be published in English, Italian, German, Spanish, or French. Sixteen studies were selected including 1252 expecting mothers. Studies evaluated the efficacy of various interventions: cognitive behavioral interventions for insomnia (4); pharmacotherapy (1); acupuncture (1); mindfulness and yoga (3); relaxation (5) and herbal medication (2). Only six were randomized controlled trials, and only four evaluated longitudinal outcomes. Preliminary support was found for all interventions, but our knowledge is still too limited by lack of evidence. There is an utmost urgency to perform high-quality randomized controlled trials for insomnia interventions during pregnancy and to implement effective programs in standard gynecological care.

    更新日期:2019-11-14
  • Obstructive Sleep Apnea And Venous Thromboembolism: Overview Of An Emerging Relationship
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-14
    Alberto Alonso-Fernández, Nuria Toledo-Pons, Francisco García-Río

    Obstructive sleep apnea (OSA) is a risk factor for cardiovascular syndromes. Venous thromboembolism (VTE) is a chronic disease, and pulmonary embolism (PE) is the major expression of VTE and the third most frequent cardiovascular disease. An increasing and emerging number of cross-sectional and longitudinal studies have linked OSA to VTE, and have postulated different putative pathways to explain how OSA might increase the risk of PE. We aim to provide a critical overview of the existing evidence about the complex relationship between these two conditions, with some factors and confounding variables still to be clarified. A global interpretation of the studies shows OSA is highly prevalent in VTE patients. This association represents a major public health burden, given the high prevalence and the mortality rates of both disorders. Although still not proven, OSA may induce a persistent hypercoagulable state that may contribute to increase VTE rate and its recurrence. Coagulant activity, platelet function and fibrinolytic system may improve after continuous positive airway pressure (CPAP) in OSA. However, there is a still a lack of randomized controlled trials to evaluate the potential of CPAP and/or extend oral anticoagulation to reduce PE incidence, recurrence and mortality by PE in patients with OSA.

    更新日期:2019-11-14
  • Systematic review of the efficacy of commonly prescribed pharmacological treatments for primary treatment of sleep disturbance in patients with diagnosed autoimmune disease
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-14
    Amy C. Reynolds, Nathaniel S. Marshall, Catherine L. Hill, Robert J. Adams

    Sleep disturbances are commonly reported by patients with autoimmune disease, and are negatively related to both disease activity and quality of life. Despite the potential for sleep disturbance to exacerbate inflammatory pathways, acute management of sleep disturbance with pharmacological aids is not well understood in this patient group. The objective of this review was to determine the efficacy of pharmacological treatments for sleep disturbance to improve sleep outcomes in adult patients with diagnosed autoimmune disease. Four databases and grey literature were searched for randomized controlled trials which used a pharmacological treatment specifically to treat sleep disturbance in patients with diagnosed autoimmune disease, both in hospitalized and non-hospitalized settings. A sleep outcome was required to be the primary endpoint of the study. Of the 409 studies identified, a total of six were included in the systematic review. Risk of bias across the studies was largely unclear, making an assessment challenging; meta-analysis was not undertaken due to clinical and methodological heterogeneity between studies. While there appeared to be perceived improvement in self-reported sleep quantity and quality in existing studies with pharmacological treatment, there was also evidence of placebo effect on some measures. Relatively small numbers of patients have undergone gold-standard polysomnographic (PSG) recording of sleep which limits our knowledge of objectively determined sleep quantity and quality in patients with autoimmune disease receiving pharmacological treatment for sleep disturbance. Presently there is insufficient evidence to determine whether pharmacological treatment of sleep disturbance is beneficial for improving sleep quantity and quality in this patient group beyond rheumatoid arthritis.

    更新日期:2019-11-14
  • Changes in Dysfunctional Beliefs about Sleep after Cognitive Behavioral Therapy for Insomnia: A Systematic Literature Review and Meta-analysis
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-09
    Manu Thakral, Michael Von Korff, Susan M. McCurry, Charles M. Morin, Michael V. Vitiello

    Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990-2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge’s g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment Three trials contributed data to estimate effect size for long-term effects (g= -1.04 (95% CI -2.07, -0.02) with follow up time ranging from 3 – 18 months. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.

    更新日期:2019-11-11
  • Bidirectional associations between sleep and dietary intake in 0-5 year old children: A systematic review with evidence mapping
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-08
    Aimee L. Ward, Andrew N. Reynolds, Sarahmarie Kuroko, Louise J. Fangupo, Barbara C. Galland, Rachael W. Taylor

    We have undertaken a systematic review examining the role of diet on sleep, and sleep on diet, in children aged 0-5 years. Controlled trials and cohort or cross-sectional studies were identified with online searches of PubMed, Medline, Embase, Scopus, and CENTRAL up to 1 June 2019, and hand searching of relevant publications. Searches, extraction, and risk of bias assessments were undertaken independently by at least two researchers. Fifty articles involving 72,491 children on a diverse range of topics were eligible. All five studies that investigated the effect of sleep on diet indicated that poorer sleep (measured by a variety of indices) was associated with greater dietary energy intake or poorer diet quality. Conversely, the findings regarding how diet might influence sleep were less consistent when considering feeding practices, energy and macronutrient intake, or micronutrient and small metabolite intake. Studies were typically of short duration and relied on subjective measures of sleep (66%) or diet (88%). While we identified a clear relationship between reduced sleep and poorer diets, future studies require improved methodological reporting and support from transdisciplinary collaborations to better understand the possible role of diet on sleep. Prospectively registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42018091647).

    更新日期:2019-11-08
  • The role of sleep in the pathophysiology of nocturnal enuresis
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-06
    Malthe Jessen Pedersen, Søren Rittig, Poul Jørgen Jennum, Konstantinos Kamperis

    Nocturnal enuresis (NE) is a common condition affecting 5-10 % of all 7-year-old children. NE pathophysiology relies on three main factors, abnormal bladder function, excess urine production during sleep and the inability to awaken to the signals of a full bladder. The aim of this review is to evaluate the connection between sleep and its structure and the pathophysiology of NE. NE often occurs early at night and primarily in sleep stage 2 and “deep sleep”. Although sleep stage distribution seems similar between NE and healthy children recent studies indicate differences in sleep microstructure. Several lines of research support the common notion among parents that children with NE are difficult to awaken. Moreover, children with NE and nocturnal polyuria differ in terms of hemodynamics and possibly autonomic activation at night compared to healthy controls and the hypothesis has formed that these changes are attributable to different sleep characteristics. In support of this hypothesis, children with NE often suffer sleep disordered breathing, as well as disturbed sleep due to awakenings and arousals. Periodic limb movements (PLM) have been seen in children with refractory enuresis but the clinical significance remains unclear.

    更新日期:2019-11-06
  • Phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients: a systematic review and meta-analysis
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-06
    Hui Chen, Danny J. Eckert, Paul F. van der Stelt, Jing Guo, Shaohua Ge, Elham Emami, Fernanda R. Almeida, Nelly T. Huynh

    Mandibular advancement device (MAD) therapy is the most commonly used non-continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). Although OSA patients prefer MAD over CPAP, on average over one third have minimal or no major reduction in OSA severity with MAD therapy. Improved understanding of responder characteristics (or “phenotypes”) to MAD may facilitate more efficient use of limited medical resources and optimize treatment efficacy. The aim of this review is to describe the baseline phenotypic characteristics of responders to MAD therapy in OSA patients. Pubmed, Web of Science, EMBASE, Scopus were searched for eligible studies published until Feb 2019. A total of 650 studies were identified. 41 studies were included in this review and meta-analysis. The quality of the studies was assessed using the risk of bias assessment tool for non-randomized studies (RoBANS). Based on meta-analysis, the responders to MAD therapy had certain clinical phenotypic characteristics: lower age (95% CI: -4.55 to -1.62, p<0.00001), female (95% CI: 0.56 to 0.91, p=0.006), lower body mass index (95% CI: -2.80 to -1.11, p<0.00001), smaller neck circumference (95% CI: -1.57 to -0.52, p<0.00001), lower apnea-hypopnea index (95% CI: -7.23 to -1.89, p<0.00001), a retracted maxilla and mandible, a narrower airway and a shorter soft palate than non-responders. The above-mentioned phenotypic responder characteristics provides useful information for the clinician when considering prescribing MAD therapy for OSA patients.

    更新日期:2019-11-06
  • A systematic review of the accuracy of sleep wearable devices for estimating sleep onset
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-06
    Hannah Scott, Leon Lack, Nicole Lovato

    The accurate estimation of sleep onset is required for many purposes, including the administration of a behavioural treatment for insomnia called Intensive Sleep Retraining, facilitating power naps, and conducting objective daytime sleepiness tests. Specialised equipment and trained individuals are presently required to administer these applications in the laboratory: a costly and impractical procedure which limits their utility in practice. A wearable device could be used to administer these applications outside the laboratory, increasing accessibility. This systematic review aimed to identify practical wearable devices that accurately estimate sleep onset. The search strategy identified seventy-one articles which compared estimations of sleep onset latency from wearable devices against polysomnography. Actigraphy devices produced average estimations of sleep onset latency that were often not significantly different from polysomnography, but there was large inter-individual variability depending on participant characteristics. As expected, electroencephalography-based devices produced more accurate and less variable estimates. Devices that measured behavioural aspects of sleep onset consistently overestimated PSG-determined sleep onset latency, but to a comparatively low degree. This sleep measurement method could be deployed in a simple wearable device to accurately estimate sleep onset and administer Intensive Sleep Retraining, power naps, and objective daytime sleepiness tests outside the laboratory setting.

    更新日期:2019-11-06
  • SLEEP AND THE GH/IGF-1 AXIS: Consequences and countermeasures of sleep loss/disorders
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-01
    Mounir Chennaoui, Damien Léger, Danielle Gomez-Merino

    This article presents an up-to-date review of the state-of-the-art knowledge regarding the effect of sleep on the anabolic growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis. This axis is involved in learning and memory and neuroprotection at the central level, and in the crosstalk between sleep and the immune system, with respect to its anti-inflammatory properties. We also aim to provide insight into the consequences of sleep loss on cognitive capacities in healthy individuals and patients with obstructive sleep apnea (OSA), regarding the mechanistic association with the GH/IGF-1 axis. Finally, this review examines the inflammatory/endocrine pathways that are affected by sleep loss, and which may consequently interact with the GH/IGF-1 axis. The deleterious effects of sleep loss include fatigue, and can cause several adverse age-dependent health outcomes. It is therefore important to improve our understanding of the fundamental physiology underlying these effects in order to better apply non-pharmacological countermeasures (e.g. sleep strategies, exercise training, continuous positive airway pressure therapy) as well as pharmacological solutions, so as to limit the deleterious consequences of sleep loss/disorders.

    更新日期:2019-11-01
  • Associations of Screen Time, Sedentary Time and Physical Activity with Sleep in Under 5s: A Systematic Review and meta-analysis
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-01
    Xanne Janssen, Anne Martin, Adrienne R. Hughes, Catherine M. Hill, Grigorios Kotronoulas, Kathryn R. Hesketh

    Sleep is crucial to children's health and development. Reduced physical activity and increased screen time adversely impact older children’s sleep, but little is known about these associations in children under 5 years. This systematic review examined the association between screen time/movement behaviors (sedentary behavior, physical activity) and sleep outcomes in infants (0-1 year); toddlers (1-2 years); and preschoolers (3-4 years). Evidence was selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and synthesized using vote counting based on the direction of association. Quality assessment and a Grading of Recommendations, Assessment, Development and Evaluation was performed, stratified according to child age, exposure and outcome measure. Thirty-one papers were included. Results indicate that screen time is associated with poorer sleep outcomes in infants, toddlers and preschoolers. Meta-analysis confirmed these unfavorable associations in infants and toddlers but not preschoolers. For movement behaviors results were mixed, though physical activity and outdoor play in particular were favorably associated with most sleep outcomes in toddlers and preschoolers. Overall, quality of evidence was very low, with strongest evidence for daily/evening screen time use in toddlers and preschoolers. Although high-quality experimental evidence is required, our findings should prompt parents, clinicians and educators to encourage sleep-promoting behaviors (e.g. less evening screen time) in the under 5s.

    更新日期:2019-11-01
  • Role of Menopause and Hormone Replacement Therapy in Sleep-disordered Breathing
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-10-31
    Eva Lindberg, Maria R. Bonsignore, Päivi Polo-Kantola

    There are suggestions that the loss of female sex hormones following menopause is critical for the development or progression of sleep-disordered breathing (SDB). We conducted a review of the literature on the role of menopause and hormone replacement therapy (HRT) in SDB risk. There is an increase in SDB during the menopausal transition period, but data on an effect beyond that of increasing age and changes in body habitus are weak or absent. Early community-based, observational studies reported a protective effect by HRT on SDB prevalence, but this could possibly be explained as a healthy user effect. Interventional studies of the effect of HRT on SDB are sparse, with only a few randomized placebo-controlled studies, often performed on small samples of women without clinically significant SDB. HRT regimens have varied and all the studies are fairly old. They do not definitely assure the alleviation of SDB and HRT cannot thus be recommended as treatment for SDB. It is concluded that there is no evidence that female sex hormone changes during menopause per se are able to explain the increase in SDB in midlife women and conclusions on the effect of HRT on SDB cannot be drawn from the current literature.

    更新日期:2019-11-01
  • Sleep EEG oscillations in neurodevelopmental disorders without intellectual disabilities
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-10-30
    Maurizio Gorgoni, Serena Scarpelli, Flaminia Reda, Luigi De Gennaro

    Neurodevelopmental disorders (NDDs) are often characterised by sleep problems, and recent evidence indicates alterations of the sleep electroencephalographic (EEG) oscillations in these patients. Sleep microstructure plays a crucial role in cognitive functioning and brain maturation. In this view, modifications in sleep EEG oscillations in NDDs could further impair the cognitive maturation process in these patients. We provide an overview of sleep microstructure alterations observed in three NDDs without intellectual disabilities (attention-deficit/hyperactivity disorder, high-functioning autism/Asperger syndrome and developmental dyslexia) and their relationships with the disorders’ phenomenology. For each NDD, we discuss empirical evidence of altered EEG oscillations, and we consider their interaction with patients’ cognitive and behavioural functioning, with the aim to elucidate their functional meaning. We highlight the limits of the present literature and propose possible future directions while underlining the clinical relevance of the research in this field. Beyond confirming the importance of sleep management in atypically developing children, the review findings suggest that sleep EEG oscillations in NDDs could become a target for specific clinical intervention.

    更新日期:2019-11-01
  • Continuing to strive for timeliness, quality and impact.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-12-02
    Michael V Vitiello

    更新日期:2019-11-01
  • Fatigue management in practice - It's just good teamwork.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-11-07
    Drew Dawson,Matthew J W Thomas

    更新日期:2019-11-01
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  • Drug therapy for obstructive sleep apnea: From pump to pill?
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-06-13
    Peter A Cistulli,Jan Hedner

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  • Reply to Rana's comment on sleep and sleep disordered breathing in children with Down syndrome.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2019-03-13
    Rosemary Sc Horne,Poornima Wijayaratne,Gillian M Nixon,Lisa M Walter

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  • REM sleep behavior disorder: clinical and physiopathological findings.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    E Sforza,J Krieger,C Petiau

    Abnormalities of REM sleep i.e. absence of atonia and abnormal motor control which are described in patients with REM sleep behavior disorder, have induced clinical and physiopathological interest. Initial hypothesis of a simple dysfunction of REM sleep generators has not been confirmed. The prevalence in older subjects and in patients with parkinsonian syndromes suggest that the appearance of the parasomnia is related to alteration in the neurons of pontine area i.e. nucleus peduncolopontine, in which there is an integration of sleep-wake mechanisms and locomotor systems. Controversy surrounds the specificity of absence of atonia in the diagnosis of the parasomnia. Since this polygraphic finding may be present in subjects without any sleep complaint and in patients with initial neurological impairment, diagnosis of the sleep disorders might be allowed only when the polygraphic characteristic of persistent tonus and complex motor behavior are recorded.

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  • Sleep and mood disorders.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    R M Benca,M Okawa,M Uchiyama,S Ozaki,T Nakajima,K Shibui,W H Obermeyer

    Mood disorders are found in one-third to one-half of patients with chronic sleep problems. Likewise, most patients with mood disorders experience insomnia, but a minority obtain significantly increased amounts of sleep. Although mood disorders cause significant morbidity and mortality, they often go undiagnosed. Attention to sleep complaints could lead to better identification of mood disorders. Management of sleep problems in patients with mood disorders should focus on treating underlying mood disorders with attention to the nature of the sleep complaint. Patients with depression show characteristic abnormalities in sleep continuity, slow-wave sleep and REM sleep patterns. Differences in sleep patterns cannot reliably distinguish patients with depression from those with other psychiatric disorders, but sleep changes may provide a window on neurobiologieal abnormalities in depression.

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  • Compliance with nasal CPAP in obstructive sleep apnea patients.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    P Collard,T Pieters,G Aubert,P Delguste,D O Rodenstein

    Continuous positive airway pressure (CPAP) is currently the treatment of choice for the majority of patients with obstructive sleep apnea (OSA). After a CPAP trial, the initial acceptance rate is 70-80%. Patients who derive no subjective benefit from such a trial are poor candidates for home treatment with CPAP because they are likely to exhibit lower adherence and compliance rates. About 90% of OSA patients provided with CPAP apparatus will adhere to long-term CPAP treatment. Patients abandoning CPAP do so during the first few months of home therapy, a period during which close monitoring and support is warranted. Because of the strong correlation between the machine run time and effective pressure delivered at the nasal mask (90-95%), the time-counter of the CPAP device is sufficient to monitor compliance in clinical practice, allowing for early intervention in cases of suboptimal use. Longterm acceptors of CPAP display a satisfactory compliance (5-6.5 h of average daily use) which compares favourably with compliance with treatment in other chronic diseases. Lower acceptance and compliance rates have been reported in North America as compared to Europe. This could be related to cultural differences or different routines of prescription and follow-up.

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  • Clinical prediction of the sleep apnea syndrome.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    W Ward Flemons,W T McNicholas

    Polysomnography, the standard diagnostic test for people suspected of having sleep apnea, is a limited resource due to its expense. Decisions about which patients to refer to a sleep center and which require polysomnography can be made based on an estimate of the probability that they have sleep apnea. Clinical features that are associated with the severity of sleep apnea, as judged by the apnea-hypopnea index, can be combined together using statistical modeling into a clinical prediction rule, whose diagnostic performance can be summarized by its sensitivity and specificity or by likelihood ratios. To date, at least seven different sleep apnea clinical prediction rules have been developed, most incorporate anthropomorphic variables such as the body mass index, waist circumference, and/or neck circumference, and some type of abnormal respiration during sleep (snoring, apneas, choking and/or gasping) witnessed by a bed partner. In general these rules have reasonably high sensitivities but only intermediate specificities, thus they can be useful in excluding the diagnosis but do not usually raise the probability of sleep apnea high enough to warrant initiating therapy without at least some type of additional testing to confirm the diagnosis. In isolation the apnea-hypopnea index is not an optimal indicator of disease severity, thus ultimately clinical decisions about the need for polysomnography and/or the need for treatment must take into account other important clinical information such as symptom severity, quality of life, and the presence or absence of comorbid illness.

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  • Identification and treatment of sleep problems in the elderly.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    S Ancoli-Israel,J S Poceta,C Stepnowsky,J Martin,P Gehrman

    For many adults, changes in sleep occur with aging. An estimated 15 million elderly, or 50% of older Americans, experience some sleep problem. The elderly complain that their sleep is more fragmented and that as they have gotten older, they experience more daytime sleepiness. Laboratory studies have confirmed these complaints. Research has shown that it is not the need for sleep that decreases with age, but rather the ability to sleep. Circadian rhythm disturbances, sleep disorders such as sleep disordered breathing and periodic movements in sleep, medical illness, medication use, and impaired cognitive functioning all contribute to poor sleep and decreased daytime alertness. In institutionalized elderly, sleep is even more disturbed and disrupted. With careful assessment, many of these problems can be addressed and treated, and sometimes cured.

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  • Sleep medicine reviews.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    J Krieger,M V Vitiello

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  • EEG sleep in non-affective psychiatric disorders.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    M Kerkhofs

    Several sleep complaints and disturbances have been documented in psychiatric disorders. These modifications of sleep in anxiety disorders, alcoholism, schizophrenia, dementia and eating disorders are reviewed and discussed. At the present time, there is no evidence for any specific sleep pattern in non-affective psychiatric disorders. The co-morbidity of sleep disorders like sleep apnoea, periodic leg movements and parasomnia in psychiatric illness is not very well known at the present time.

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  • Hyperarousal and insomnia.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    M H Bonnet,D L Arand

    Primary or psychophysiological insomnia has alternatively been viewed as either a predominantly psychological problem or as a predominantly physiological problem. Several early studies of patients were not able to document physiological differences, but more recent studies have found that many patients with primary insomnia take longer than control subjects to fall asleep on daytime nap tests despite feeling fatigued and they have elevated metabolic rate throughout both night and day. Other recent studies have found that increasing physiological arousal level for a week in normal sleepers produced the major secondary symptoms reported by insomniacs. In contrast, producing the disturbed sleep of insomniacs in a group of normal sleepers did not produce the typical pattern of secondary symptoms. Taken together, evidence is presented which supports the contention that primary insomniacs suffer from a disorder of hyperarousal and that the elevated arousal produces the poor sleep and other symptoms reported by patients. It is therefore suggested that new treatment strategies directed at reduction of arousal level be considered in these patients.

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  • What is an arousal and how should it be quantified?
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    R J Davies,L S Bennett,J R Stradling

    Pathologically severe daytime sleepiness is one of the main symptoms seen in a respiratory sleep clinic and is due to repeated arousal from sleep. Which types of arousal are most important in causing this is uncertain and most studies have only found loose relationships between indices of arousal frequency and the severity of the ensuing daytime sleepiness. Recent attempts to improve these disappointing correlations have concentrated on detecting more minor arousal events through the use of novel EEG signal analysis techniques and non-EEG based signals such as blood pressure and heart rate. To date there are no good data sets which allow the relative merits of these various techniques to be compared and it is unclear whether these efforts to increase the sensitivity of arousal detection will lead to improvements in the clinical usefulness of sleep fragmentation scoring. Studies which relate both the traditional indices of sleep fragmentation and the newer methodologies to clinically relevant reference standards (such as measured excessive daytime sleepiness) are needed to clarify these issues.

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  • Surgical treatment for obstructive sleep apnoea.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    N J Douglas

    Surgical therapy of the sleep apnoea/hypopnoea syndrome is an attractive option to many patients as it avoids using therapy nightly for the remainder of one's life. This article reviews the outcomes of the surgical options available. The role of uvulopalatopharyngoplasty is not yet clear. It may be useful second line therapy for some patients but cannot at present be advocated as first-line therapy. Mandibular maxillary osteotomy and advancement is an effective therapy of value in a minority of patients. Other procedures such as partial glossectomy and genioglossal advancement may also be of value in some patients. There is an urgent need for more randomized controlled trials examining the outcomes of surgical therapy for the sleep apnoea/hypopnoea syndrome in comparison to continuous positive airway pressure therapy.

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  • Surgical treatment of obstructive sleep apnea.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    C Guilleminault

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  • Cardiac arrhythmias during normal sleep and in obstructive sleep apnea syndrome.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    A Adlakha,J W Shepard

    Normal sleep is associated with a slowing in heart rate due to a relative shift from sympathetic to parasympathetic neural dominance. Bradyarrhythmias consisting of sinus bradycardia, sinus arrest and second degree (Mobitz type 1) heart block are not uncommon in young adults. With aging, bradyarrhythmias decrease in frequency while atrial arrhythmias and ventricular ectopy increases. Patients with obstructive sleep apnea (OSA) have been demonstrated to have bradyarrhythmias and increased ventricular ectopy in association with apneas when oxyhemoglobin desaturations become severe. Although retrospective studies have suggested that cardiovascular mortality may be increased in patients with OSA, this remains to be proven in prospective clinical studies. Sudden death during sleep secondary to apnea related brady or ventricular tachyarrhythmias may occur. However, this is likely to be a very rare event that remains to be documented in the literature.

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  • Models of human sleep regulation.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    D G Beersma

    Non-REM sleep deprivation and REM sleep deprivation both lead to specific rebounds, suggesting that these states fulfil physiological needs. In view of impaired performance after sleep deprivation, a recovery function of sleep seems likely. The timing of this recovery is restricted to a narrow time interval within the 24 hour day, i.e. the night. Generally, nocturnal sleep in humans is considered a consequence of the impact of the circadian pacemaker in the hypothalamus on sleep propensity. The interaction between the homeostatic recovery process and the circadian pacemaker has been modelled in the two-process model of sleep regulation. This model is used as a starting point in the present review. A series of refinements and several alternative models are discussed, both with respect to the quality of fit of theory and data, as well as with respect to the concepts behind the models.

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  • Ultradian rhythms in pituitary and adrenal hormones: their relations to sleep.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    C Gronfier,G Brandenberger

    Sleep and circadian rhythmicity both influence the 24-h profiles of the main pituitary and adrenal hormones. From studies using experimental strategies including complete and partial sleep deprivation, acute and chronic shifts in the sleep period, or complete sleep-wake reversal as occurs with transmeridian travel or shift-work, it appears that prolactin (PRL) and growth hormone (GH) profiles are mainly sleep related, while cortisol profile is mainly controlled by the circadian clock with a weak influence of sleep processes. Thyrotropin (TSH) profile is under the dual influence of sleep and circadian rhythmicity. Recent studies, in which we used spectral analysis of sleep electroencephalogram (EEG) rather than visual scoring of sleep stages, have evaluated the temporal associations between pulsatile hormonal release and the variations in sleep EEG activity. Pulses in PRL and in GH are positively linked to increases in delta wave activity, whereas TSH and cortisol pulses are related to decreases in delta wave activity. It is yet not clear whether sleep influences endocrine secretion, or conversely, whether hormone secretion affects sleep structure. These well-defined relationships raise the question of their physiological significance and of their clinical implications.

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  • Rethinking the assessment of sleepiness.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    M Johns

    The consequences of dozing off when intending to stay awake, e.g. while driving or at work, are potentially catastrophic. The accurate assessment of this tendency is important, but is currently difficult. Several different methods give disparate results. A way out of this dilemma is suggested that involves modification of existing concepts of sleep and wakefulness to conclude the powerful influence of behaviour on sleep propensity. This propensity at a particular time depends, hypothetically, on a mutually inhibitory interaction between a sleep and a wake drive, not on the magnitude of either drive alone. Measurements of sleep propensity are partly situation-specific, whether measured objectively by laboratory tests or subjectively by a questionnaire such as the Epworth Sleepiness Scale. The latter is believed to measure a general characteristic, the average sleep propensity across a range of specified situations in daily life. Any one situational sleep propensity is not always an accurate predictor of another, even in the same subject. The Multiple Sleep Latency test should not be a gold standard for such measurements. Wider discussion and more research into "sleepiness" is needed.

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  • Sleepiness.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    T Akerstedt

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  • Shift work and disturbed sleep/wakefulness.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    T Akerstedt

    This paper reviews the effects of shift work and finds strong, acute effects on sleep and alertness in relation to night and morning work. The effects seem, however, to linger and also affect days off. The level of the disturbances is similar to that seen in clinical insomnia and may be responsible for considerable human and economical costs due to fatigue related accidents and reduced productivity. The mechanism behind the disturbances is the sleep interfering properties of the circadian system during day sleep and the corresponding sleep promoting properties during night work. Various strategies may be used to counteract the effects of shift work, such as napping, sufficient recovery time between shifts, clockwise rotation, etc. Still it does not seem possible to more eliminate the effects-only to reduce them.

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  • Heart failure and central apnoea.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    M T Naughton

    Central sleep apnoea with a Cheyne-Stokes pattern of respiration is a disorder commonly observed in patients with established symptomatic congestive heart failure (CHF). It is associated with hyperventilation and hypocapnia which are likely to result from either increased pulmonary vagal afferent nerve stimulation due to pulmonary oedema or from upregulation of chemoreceptors induced by increased sympathoneural activity. Treatment should be aimed at improving underlying cardiac function which may include angiotensin-converting enzyme inhibitors, nasal continuous positive airway pressure (CPAP) or possibly supplemental oxygen.

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  • Heart failure and obstructive apnoea.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    M T Naughton

    Obstructive sleep apnoea (OSA) may aggravate heart failure through the mechanisms of sleep related arousals, systemic hypertension (awake and asleep) and negative intrathoracic pressure which increase cardiac afterload at times of asphyxia and hypoxaemia. Reversal of OSA with nasal continuous positive airway pressure (CPAP), in the setting of heart failure, may return cardiac function to near normal values.

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  • Obstructive sleep apnoea and the autonomic nervous system.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    R P Smith,D Veale,J L Pépin,P A Lévy

    Understanding of the pathophysiology of obstructive sleep apnoea, a common yet relatively newly recognized condition, has advanced rapidly in recent years. This condition produces major acute haemodynamic changes and causal relationships with hypertension and cardiovascular morbidity have been proposed. The role that the autonomic nervous system plays in mediating these cardiovascular changes has been the focus of intensive research activity and the development of few techniques in physiological monitoring, such as spectral analysis of heart rate variability, Finapres blood pressure monitoring, measurement of muscle sympathetic nerve activity, radionuclide tests and animal models of obstructive sleep apnoea have substantially increased the knowledge base. The acute haemodynamic changes are associated with high levels of sympathetic discharge and with fluctuating parasympathetic activity. There are also chronic changes in baroreceptor and chemoreceptor reflexes associated with an increase in baseline daytime sympathetic activity and abnormal vagal reflex responses to voluntary respiratory manoeuvres. These acute autonomic changes appear to be provoked by a combination of stimuli triggered by hypoxaemia, upper airway responses, ventilatory changes and arousal. The mechanisms of the chronic autonomic changes are less clear; it is likely that recurrent hypoxaemia is important, but the roles of recurrent ventilatory stress and arousal are not clear. Normalizing respiration with CPAP therapy prevents the acute cardiovascular changes and reduces the acute sympathetic over-activity, and in compliant patients, restores abnormal vagal responses to normal and reduces excess chronic sympathetic activity. Whether or not this produces a reduction in long-term cardiovascular morbidity is not established.

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  • Sleep-inducing effects of exogenous melatonin administration.
    Sleep Med. Rev. (IF 10.517) Pub Date : 2004-08-18
    R Luboshizsky,P Lavie

    In this report current data is reviewed indicating that melatonin, the main hormone secreted by the pineal gland at night, participates in sleep regulation in humans. Evidence supporting this role relies on findings that abnormal melatonin secretion, induced by a variety of commonly used drugs, and in clinical disorders of the nervous system, are associated with sleep disturbances, and that melatonin has beneficial sleep-inducing effects in elderly melatonin-deficient insomniacs, and in children with sleep disorders. The time of melatonin administration, rather than the pharmacological dose, is a crucial factor regarding its potency as a sleep-inducing agent. Possible operating mechanisms explaining melatonin hypnotic effects are discussed.

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