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Sguigna PV, Toranian S. Disease associations of excessive daytime sleepiness in multiple sclerosis: A prospective study. Mult Scler J Exp Transl Clin 2023; 9:20552173231159560. [PMID: 36936446 PMCID: PMC10017949 DOI: 10.1177/20552173231159560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/06/2023] [Indexed: 03/17/2023] Open
Abstract
Background Excessive daytime sleepiness (EDS) in multiple sclerosis (MS) can be a significant source of disability. Despite this, its prevalence as a patient-reported outcome in this condition has not been well established, and its causes are not well understood. Methods We prospectively assessed EDS as part of an observational study for patients referred for diagnostic neuro-ophthalmological testing. EDS was evaluated by the Epworth Sleepiness Scale (ESS), and visual data were also collected as part of a research protocol. Analysis with patient data was performed following the exclusion of patients with known primary sleep disorders. Results A total of 69 patients with MS were included in the analysis. The mean ESS was 6.5 with a SD of 4.3. ESS ≥ 10 was present in 23% of the cohort even in the presence of minimal mean neurological disability (Patient Determined Disease Steps (PDDS) = 1.5). The ESS score was not associated with age, sex, disease-related disability, retinal nerve fiber layer (RNFL), or optic neuritis (ON), but displayed an association with visual dysfunction. Conclusions There is an increased prevalence of EDS in MS. The increased values of the ESS are not explained by other sleep disorders, suggesting separate mechanisms. Further study of the underlying mechanisms is warranted.
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Affiliation(s)
- Peter V Sguigna
- Peter V Sguigna, Department of Neurology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390-8806, USA.
| | - Sabeen Toranian
- Department of Neurology, Dell Medical School, University of Texas Austin, Austin, TX, USA
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Assessment of Subjective Sleep Problems in Men With Opioid Dependence Maintained on Buprenorphine. J Addict Med 2021; 14:132-138. [PMID: 30964756 DOI: 10.1097/adm.0000000000000539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the rates of sleep disturbances in male patients with opioid dependence maintained on buprenorphine and to assess the factors associated with sleep disturbances in this population. METHODS Observational, cross-sectional study. Male patients with opioid dependence aged 18 years and older, and started on buprenorphine at least 6 months before were screened. Those with history of comorbid psychiatric illnesses (except sleep disorders), on any other substance in high-risk category (based on WHO-Alcohol Smoking Substance Involvement Screening Test (ASSIST)), or on any other psychotropic medications (in addition to OAT with buprenorphine) were excluded. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), Sleep-50, and Epworth Sleepiness Scale (ESS). Each participant was interviewed in a single session lasting 60 minutes. RESULTS One hundred six participants were included. Their mean age was 41.1 (SD 14.3) years. The participants had been on OAT with buprenorphine for a median duration of 60 months (IQR 17-120), with excellent adherence rate in past 1 month. The mean current dose of buprenorphine was 10.2 (SD 3.8) mg per day. The mean subjective total sleep time was 403.5 minutes (SD 94.8) and the median sleep latency was 35 minutes (IQR 18.8-62.5). The mean PSQI score was 6.6 (SD 3.4). Nearly 63% (n = 67) participants had PSQI scores more than 5 (PSQI > 5) suggesting sleep problems. Sociodemographic, substance use, and treatment variables were compared between participants who scored more than 5 and those who scored less than 5 on PSQI. No significant difference was found between the 2 groups. CONCLUSIONS Substantial proportion of male patients with opioid dependence maintained on buprenorphine have sleep problems. The sleep problems in buprenorphine-maintained patients seem to be independent of substance use and treatment-related attributes.
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Puri S, El-Chami M, Shaheen D, Ivers B, Panza GS, Badr MS, Lin HS, Mateika JH. Variations in loop gain and arousal threshold during NREM sleep are affected by time of day over a 24-hour period in participants with obstructive sleep apnea. J Appl Physiol (1985) 2020; 129:800-809. [PMID: 32790595 DOI: 10.1152/japplphysiol.00376.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigated whether time of day affects loop gain (LG) and the arousal threshold (AT) during non-rapid eye movement (NREM) sleep. Eleven men with obstructive sleep apnea (apnea-hypopnea index > 5 events/h) completed a constant-routine protocol that comprised 3-h sleep sessions in the evening [10 PM (1) to 1 AM], morning (6 AM to 9 AM), afternoon (2 PM to 5 PM), and subsequent evening [10 PM (2) to 1 AM]. During each sleep session LG and the AT were measured during NREM sleep with a model-based approach. Our results showed the presence of a rhythmicity in both LG (P < 0.0001) and the AT (P < 0.001) over a 24-h period. In addition, LG and the AT were greater in the morning compared with both evening sessions [6 AM vs. 10 PM (1) vs. 10 PM (2): LG (1 cycle/min): 0.71 ± 0.23 vs. 0.60 ± 0.22 (P = 0.01) vs. 0.56 ± 0.10 (P < 0.001), AT (fraction of eupneic breathing): 1.45 ± 0.47 vs. 1.28 ± 0.36 (P = 0.02) vs. 1.20 ± 0.18 (P = 0.001)]. No difference in LG and the AT existed between the evening sessions (LG: P = 0.27; AT: P = 0.24). LG was correlated to measures of the hypocapnic ventilatory response (i.e., a measure of chemoreflex sensitivity) (r = 0.72 and P = 0.045) and the critical closing pressure (i.e., a measure of airway collapsibility) (r = 0.77 and P = 0.02) that we previously published. We conclude that time of day, independent of hallmarks of sleep apnea, affects LG and the AT during NREM sleep. These modifications may contribute to increases in breathing instability in the morning compared with other periods throughout the day/night cycle in individuals with obstructive sleep apnea. In addition, efficaciousness of treatments for obstructive sleep apnea that target LG and the AT may be modified by a rhythmicity in these variables.NEW & NOTEWORTHY Loop gain and the arousal threshold during non-rapid eye movement (NREM) sleep are greater in the morning compared with the afternoon and evening. Loop gain measures are correlated to chemoreflex sensitivity and the critical closing pressure measured during NREM sleep in the evening, morning, and afternoon. Breathing (in)stability and efficaciousness of treatments for obstructive sleep apnea may be modulated by a circadian rhythmicity in loop gain and the arousal threshold.
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Affiliation(s)
- Shipra Puri
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Mohamad El-Chami
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - David Shaheen
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Blake Ivers
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Gino S Panza
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - M Safwan Badr
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Ho-Sheng Lin
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, Michigan
| | - Jason H Mateika
- John D. Dingell Department of Veterans Affairs Medical Center, Detroit, Michigan.,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan.,Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
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4
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Opioids and sleep – a review of literature. Sleep Med 2020; 67:269-275. [DOI: 10.1016/j.sleep.2019.06.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/05/2019] [Accepted: 06/20/2019] [Indexed: 01/03/2023]
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5
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Malungo IB, Gravett N, Bhagwandin A, Davimes JG, Manger PR. A Preliminary Description of the Sleep-Related Neural Systems in the Brain of the Blue Wildebeest, Connochaetes taurinus. Anat Rec (Hoboken) 2019; 303:1977-1997. [PMID: 31513360 DOI: 10.1002/ar.24265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/12/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022]
Abstract
The current study provides a detailed qualitative description of the organization of the cholinergic, catecholaminergic, serotonergic, orexinergic, and GABAergic sleep-related systems in the brain of the blue wildebeest (Connocheates taurinus), along with a quantitative analysis of the pontine cholinergic and noradrenergic neurons, and the hypothalamic orexinergic neurons. The aim of this study was to compare the nuclear organization of these systems to other mammalian species and specifically that reported for other Cetartiodactyla. In the brain of the blue wildebeest, from the basal forebrain to the pons, the nuclear organization of the cholinergic, catecholaminergic, serotonergic, and orexinergic systems, for the most part, showed a corresponding nuclear organization to that reported in other mammals and more specifically the Cetartiodactyla. Furthermore, the description and distribution of the GABAergic system, which was examined through immunostaining for the calcium binding proteins calbindin, calretinin, and parvalbumin, was also similar to that seen in other mammals. These findings indicate that sleep in the blue wildebeest is likely to show typically mammalian features in terms of the global brain activity of the generally recognized sleep states of mammals, but Cetartiodactyl-specific features of the orexinergic system may act to lower overall daily total sleep time in relation to similar sized non-Cetartiodactyl mammals. Anat Rec, 2019. © 2019 American Association for Anatomy Anat Rec, 303:1977-1997, 2020. © 2019 American Association for Anatomy.
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Affiliation(s)
- Illke B Malungo
- School of Anatomical Sciences, Faulty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nadine Gravett
- School of Anatomical Sciences, Faulty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adhil Bhagwandin
- School of Anatomical Sciences, Faulty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joshua G Davimes
- School of Anatomical Sciences, Faulty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul R Manger
- School of Anatomical Sciences, Faulty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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The role of co-neurotransmitters in sleep and wake regulation. Mol Psychiatry 2019; 24:1284-1295. [PMID: 30377299 PMCID: PMC6491268 DOI: 10.1038/s41380-018-0291-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 09/17/2018] [Accepted: 10/08/2018] [Indexed: 12/11/2022]
Abstract
Sleep and wakefulness control in the mammalian brain requires the coordination of various discrete interconnected neurons. According to the most conventional sleep model, wake-promoting neurons (WPNs) and sleep-promoting neurons (SPNs) compete for network dominance, creating a systematic "switch" that results in either the sleep or awake state. WPNs and SPNs are ubiquitous in the brainstem and diencephalon, areas that together contain <1% of the neurons in the human brain. Interestingly, many of these WPNs and SPNs co-express and co-release various types of the neurotransmitters that often have opposing modulatory effects on the network. Co-transmission is often beneficial to structures with limited numbers of neurons because it provides increasing computational capability and flexibility. Moreover, co-transmission allows subcortical structures to bi-directionally control postsynaptic neurons, thus helping to orchestrate several complex physiological functions such as sleep. Here, we present an in-depth review of co-transmission in hypothalamic WPNs and SPNs and discuss its functional significance in the sleep-wake network.
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Priano L, Bigoni M, Albani G, Sellitti L, Giacomotti E, Picconi R, Cremascoli R, Zibetti M, Lopiano L, Mauro A. Sleep microstructure in Parkinson's disease: cycling alternating pattern (CAP) as a sensitive marker of early NREM sleep instability. Sleep Med 2019; 61:57-62. [DOI: 10.1016/j.sleep.2019.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
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8
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Mateika JH, Komnenov D, Pop A, Kuhn DM. Genetic depletion of 5-HT increases central apnea frequency and duration and dampens arousal but does not impact the circadian modulation of these variables. J Appl Physiol (1985) 2019; 126:1-10. [DOI: 10.1152/japplphysiol.00724.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We examined the impact of serotonin (5-HT) on the frequency and duration of central apneic events and the frequency of accompanying arousals during nonrapid and rapid eye movement (NREM and REM, respectively) sleep across the light/dark cycle. Electroencephalography, electromyography, core body temperature, and activity were recorded for 24 h following implantation of telemeters in wild-type (Tph2+/+) and tryptophan hydroxylase 2 knockout (Tph2−/−) male mice. The frequency and duration of central apneic events were increased, the number of apneic events coupled to an arousal was decreased, and the ventilatory sensitivity to hypoxia and hypercapnia was decreased in the Tph2−/− compared with the Tph2+/+ mice during NREM sleep. Apnea frequency and duration were similar in the Tph2−/− and Tph2+/+ mice during REM sleep. The duration of apneic events during REM compared with NREM sleep was similar in the Tph2−/− mice. In contrast, the duration was greater during REM sleep in the Tph2+/+ mice. Our results also revealed that apnea frequency was greater during the light compared with the dark cycle. Circadian modulation of this variable was evident in both the Tph2−/− and Tph2+/+ mice during NREM and REM sleep. We conclude that depletion of 5-HT increases the frequency and duration of central apneic events, dampens arousal, and blunts the ventilatory response to hypoxia and hypercapnia during NREM sleep but is not essential for the circadian modulation of these variables. NEW & NOTEWORTHY The presence of serotonin (5-HT) in the central nervous system diminishes the frequency of central apneic events. This neuromodulator also moderates the duration of central apneic events and promotes arousal from central events if they occur during nonrapid eye movement (NREM) sleep. However, 5-HT is not responsible for the circadian modulation of apnea frequency, which we found was greater during NREM sleep in the light compared with the dark cycle.
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Affiliation(s)
- Jason H. Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Dragana Komnenov
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Alexandru Pop
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Donald M. Kuhn
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
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Bosch L, Fernández-Candil J, León A, Gambús PL. Influence of general anaesthesia on the brainstem. ACTA ACUST UNITED AC 2016; 64:157-167. [PMID: 27887735 DOI: 10.1016/j.redar.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/17/2022]
Abstract
The exact role of the brainstem in the control of body functions is not yet well known and the same applies to the influence of general anaesthesia on brainstem functions. Nevertheless in all general anaesthesia the anaesthesiologist should be aware of the interaction of anaesthetic drugs and brainstem function in relation to whole body homeostasis. As a result of this interaction there will be changes in consciousness, protective reflexes, breathing pattern, heart rate, temperature or arterial blood pressure to name a few. Brainstem function can be explored using three different approaches: clinically, analyzing changes in brain electric activity or using neuroimaging techniques. With the aim of providing the clinician anaesthesiologist with a global view of the interaction between the anaesthetic state and homeostatic changes related to brainstem function, the present review article addresses the influence of anaesthetic drug effects on brainstem function through clinical exploration of cranial nerves and reflexes, analysis of electric signals such as electroencephalographic changes and what it is known about brainstem through the use of imaging techniques, more specifically functional magnetic resonance imaging.
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Affiliation(s)
- L Bosch
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar (PSM), Barcelona, España.
| | - J Fernández-Candil
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar (PSM), Barcelona, España
| | - A León
- Servicio de Neurología, Sección de Neurofisiología Clínica; Parc de Salut Mar (PSM), Barcelona, España
| | - P L Gambús
- Servicio de Anestesiología y Reanimación; Hospital CLINIC de Barcelona, Barcelona, España
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Effect and Potential Mechanism of Electroacupuncture Add-On Treatment in Patients with Parkinson's Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:692795. [PMID: 26351515 PMCID: PMC4550783 DOI: 10.1155/2015/692795] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 07/28/2015] [Indexed: 11/23/2022]
Abstract
Objectives. To explore effectiveness and mechanisms of electroacupuncture (EA) add-on treatment in Parkinson's disease (PD) patients. Methods. Fifty PD patients were randomly assigned to drug plus EA (D + EA) group and drug alone (D) group. Subjects in D + EA group received stimulation in points of bilateral fengfu, fengchi, hegu, and central dazhui. Participants were evaluated by scales for motor and nonmotor symptoms. Levels of neuroinflammatory factors and neurotransmitters in serum were detected. Results. EA add-on treatment remarkably reduced scores of Unified Parkinson's Disease Rating Scale (UPDRS) III and its subitems of tremor, rigidity, and bradykinesia and conspicuously decreased UPDRS III scores in patients with bradykinesia-rigidity and mixed types and mild severity. Depression and sleep disturbances were eased, which were reflected by decreased scores of Hamilton Depression Rating Scale, Pittsburgh Sleep Quality Index, and elevated noradrenaline level. Effects of EA add-on treatment on motor symptoms and sleep disturbances were superior to drug alone treatment, markedly improving life quality of PD patients. EA add-on treatment decreased nitric oxide level in serum. Conclusions. EA add-on treatment is effective on most motor symptoms and some nonmotor symptoms and is particularly efficacious in PD patients at early stage. Antineuroinflammation may be a mechanism of EA add-on treatment.
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12
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Watson NF, Buchwald D, Harden KP. A twin study of genetic influences on diurnal preference and risk for alcohol use outcomes. J Clin Sleep Med 2013; 9:1333-9. [PMID: 24340296 DOI: 10.5664/jcsm.3282] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The population-based University of Washington Twin Registry (UWTR) was used to examine (1) genetic influences on chronobiology and (2) whether these genetic factors influence alcohol-use phenotypes. METHODS We used a reduced Horne-Östberg Morningness-Eveningness Questionnaire (rMEQ) to survey UWTR participants for diurnal preference. Frequency and quantity of alcohol use, as well as binge drinking (6+ drinks per occasion), were assessed on a 5-point Likert scale. Both diurnal preference and alcohol use were self-reported. Twin data were analyzed by using structural equation models. RESULTS The sample consisted of 2,945 participants (mean age = 36.4 years), including 1,127 same-sex and opposite-sex twin pairs and 691 individual twins. The rMEQ range was 4-25, with a mean score of 15.3 (SD 4.0). Diurnal "morning types" comprised 30.7% (N = 903) of participants, while 17.4% (N = 513) were "evening types." Regarding alcohol use, 21.2% (N = 624) reported never drinking. Among drinkers, 35.7% (N = 829) reported ≥ 3 drinks per occasion and 48.1% (N = 1,116) reported at least one instance of binge drinking. Genetic influences accounted for 37% of the variance in diurnal preference, with the remaining 63% due to non-shared environmental influences. Genetic propensities toward diurnal eveningness were significantly associated with increased alcohol quantity (β = -0.17; SE = 0.05, p < 0.001) and increased binge drinking (β = -0.19; SE = 0.04, p < 0.001), but not with frequency of alcohol use. Environmental paths between diurnal preference and alcohol use phenotypes were not significant. CONCLUSIONS Genetic influences on diurnal preference confer elevated risk for problematic alcohol use, including increased quantity and binge drinking. Differences in circadian rhythm may be an important and understudied pathway of risk for genetic influences on alcohol use.
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Affiliation(s)
- Nathaniel F Watson
- Department of Neurology, School of Medicine, University of Washington, Seattle, WA ; University of Washington Medicine Sleep Center, Seattle, WA ; University of Washington Twin Registry, Seattle, WA
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Wu D, Tseng IJ, Yuan RY, Hsieh CY, Hu CJ. Memory consolidation and inducible nitric oxide synthase expression during different sleep stages in Parkinson disease. Sleep Med 2013; 15:116-20. [PMID: 24286896 DOI: 10.1016/j.sleep.2013.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 09/04/2013] [Accepted: 09/25/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parkinson disease (PD) is a neurodegenerative disease characterized by motor and nonmotor dysfunctions, which include sleep disturbances. Rapid eye movement (REM) sleep is associated with numerous physiologic changes such as memory consolidation. Compelling evidence suggests that nitric oxide (NO) is crucial to both sleep regulation and memory consolidation. In our study, we explored changes in biologic molecules during various sleep stages and the effects of sleep on memory consolidation in PD. METHODS Ten PD patients and 14 volunteers without PD participated in our study. The gene expression of inducible NO synthase (iNOS) in all sleep stages was measured using realtime polymerase chain reaction (PCR) based on polysomnography (PSG)-guided peripheral blood sampling. In addition, the efficiency of memory consolidation during the sleep of the participants was measured using the Wechsler Memory Scale, third edition (WMS-III). RESULTS The iNOS expression increased in all sleep stages among the PD patients compared to the control participants, in whom iNOS expression decreased during REM sleep. Regarding memory consolidation, the performance of the controls in logic memory and the patients in visual reproduction tasks improved after sleep. CONCLUSIONS The iNOS synthase expression was different from control participants among PD patients, and the expression was dissimilar in various sleep stages. Sleep might enhance memory consolidation and there are different memory consolidation profiles between PD and control participants demonstrating distinct memory consolidation profiles.
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Affiliation(s)
- Dean Wu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Sleep Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ing-Jy Tseng
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Rey-Yue Yuan
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chia-Yu Hsieh
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Sleep Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan; Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Sleep Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan; Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Gulyani S, Salas RE, Gamaldo CE. Sleep medicine pharmacotherapeutics overview: today, tomorrow, and the future (Part 1: insomnia and circadian rhythm disorders). Chest 2013. [PMID: 23208340 DOI: 10.1378/chest.12-0465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Over the past 10 years, significant strides have been made in the understanding, development, and availability of sleep disorder therapeutics. In this review series, we discuss the current evidence surrounding the mechanisms of actions, indications, efficacy, and adverse side effects associated with the available armamentarium of sleep over-the-counter and pharmacotherapeutics. This article is the first of a two-part series that covers the therapeutics for insomnia and circadian rhythm disorders.
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Affiliation(s)
- Seema Gulyani
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
| | - Rachel E Salas
- Department of Neurology, Johns Hopkins University, Baltimore, MD
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Abstract
Anesthetics have been used in clinical practice for over a hundred years, yet their mechanisms of action remain poorly understood. One tempting hypothesis to explain their hypnotic properties posits that anesthetics exert a component of their effects by "hijacking" the endogenous arousal circuitry of the brain. Modulation of activity within sleep- and wake-related neuroanatomic systems could thus explain some of the varied effects produced by anesthetics. There has been a recent explosion of research into the neuroanatomic substrates affected by various anesthetics. In this review, we will highlight the relevant sleep architecture and systems and focus on studies over the past few years that implicate these sleep-related structures as targets of anesthetics. These studies highlight a promising area of investigation regarding the mechanisms of action of anesthetics and provide an important model for future study.
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Gominak SC, Stumpf WE. The world epidemic of sleep disorders is linked to vitamin D deficiency. Med Hypotheses 2012; 79:132-5. [PMID: 22583560 DOI: 10.1016/j.mehy.2012.03.031] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/08/2012] [Accepted: 03/30/2012] [Indexed: 12/21/2022]
Abstract
An observation of sleep improvement with vitamin D supplementation led to a 2 year uncontrolled trial of vitamin D supplementation in 1500 patients with neurologic complaints who also had evidence of abnormal sleep. Most patients had improvement in neurologic symptoms and sleep but only through maintaining a narrow range of 25(OH) vitamin D3 blood levels of 60-80 ng/ml. Comparisons of brain regions associated with sleep-wake regulation and vitamin D target neurons in the diencephalon and several brainstem nuclei suggest direct central effects of vitamin D on sleep. We propose the hypothesis that sleep disorders have become epidemic because of widespread vitamin D deficiency. The therapeutic effects together with the anatomic-functional correspondence warrant further investigation and consideration of vitamin D in the etiology and therapy of sleep disorders.
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Affiliation(s)
- S C Gominak
- East Texas Medical Center, Neurologic Institute, Tyler, TX 75701, USA.
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Schulte EC, Winkelmann J. When Parkinson's disease patients go to sleep: specific sleep disturbances related to Parkinson's disease. J Neurol 2012; 258:S328-35. [PMID: 21560064 DOI: 10.1007/s00415-011-5933-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nonmotor symptoms of Parkinson's disease can be as disabling as the much better studied motor symptoms. Among the nonmotor manifestations are numerous forms of alterations of physiologic sleep patterns that may present at different stages during the course of disease. These include changes believed to be primarily related to the underlying neurodegenerative process of the disease as well as those brought about secondarily, for example, by pharmacologic treatment. Also, sleep disturbances seen in Parkinson's disease can range from temporarily increased daytime sleepiness after introduction of a dopamine agonist to the therapeutic regime to specific sleep-related diagnoses such as restless legs syndrome, rapid eye movement sleep behavior disorder, periodic limb movements in sleep, and sleep-related breathing disorders such as obstructive sleep apnea. In this review, we discuss the different specific sleep disturbances that arise in the context of Parkinson's disease with a special emphasis on epidemiology, pathophysiology, and diagnosis.
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Affiliation(s)
- Eva C Schulte
- Neurologische Klinik und Poliklinik, Klinkum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675 Munich, Germany
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