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Journal: Sleep medicine

168

BACKGROUND: The management of pregnancy in patients with narcolepsy poses many questions regarding therapy, including the risk to the mother and fetus related to the disease, potential risks at the time of conception, the risk to both the mother and the fetus of the medications used to treat narcolepsy, and the risk to the infant from medications that might be secreted in breast milk. There are no detailed practice parameters on the treatment of narcolepsy patients during pregnancy. We surveyed narcolepsy specialists from around the world to determine their clinical approach to the management of patients with narcolepsy at the time of conception, during pregnancy and while breastfeeding. METHODS: Survey invitations were sent via e-mail to 75 clinicians worldwide between 2/2011 and 3/2011 with 34 responses (USA, n=10; Brazil, n=3; Czech Republic, n=2; France, n=2; Italy; n=2; Netherlands, n=2; Canada, n=1; Denmark, n=1; Finland, n=1; Germany, n=1; Japan, n=1; Spain, n=1; unknown n=7). Responders who completed the survey had 20years (median range, 5-35) of experience in sleep medicine practice with a median number of five narcolepsy patients seen per week. The number of pregnant narcoleptic patients followed per physician was five (median range 1-40). RESULTS: The survey results indicated that the management of patients with narcolepsy varies greatly from clinician to clinician and from country to country. The majority of the clinicians stopped the narcolepsy medications at the time of conception, during pregnancy, and during breastfeeding some reduced the dose and others did not change the dosage, depending on the particular medication. CONCLUSIONS: The findings from our survey and literature review suggest that the perceived risks of narcolepsy medication during pregnancy to the mother and the fetus usually are overestimated, as the risk for teratogenic effects from narcolepsy medications in therapeutic doses is essentially nonexistent. However, the potential for rare complications during pregnancy and congenital abnormalities cannot be excluded. Most narcolepsy patients have vaginal delivery without complications. In rare cases patients had cataplexy that interfered with delivery, but if caesarian is required there appears to be no increased anaesthetic or surgical risks. Further prospective information for the appropriate treatment of narcolepsy patients during pregnancy is needed.

Concepts: Pregnancy, Childbirth, Infant, Hospital, Median, Breastfeeding, Dose, Narcolepsy

28

This study aimed to examine the associations of self-reported sleep duration with adolescent health outcomes, taking into account time spent on Internet use.

Concepts: Internet

28

OBJECTIVE: Sleep timing and duration are influenced by outdoor light, but few studies have addressed these relationships in subarctic populations. We aimed to investigate how the extreme photic environment at 69 degrees north, with absence of daylight for 2months in the winter and constant light for 2months in the summer, would affect the sleep-wake rhythm. METHODS: 4811 people ages 35-70years, from the cross sectional study ‘Tromsø 6’ responded to the Munich Chronotype Questionnaire, in addition to socio-demographic and health-related information. The seasonal distribution of chronotypes was calculated based on the MCTQ at the participation dates. RESULTS: Late types had a 10min increase in sleep duration on free days from winter to spring, but had no seasonal variation in the average sleep duration; as well as no seasonal variations in mid sleep on free days was found. However, when chronotype distribution was adjusted for confounding factors e.g. age and sex, we found a significant advance in phase (8min) in the summer compared to the wintertime. This advance in MSFsc was significant both for the employed and the unemployed. CONCLUSION: Other factors may be more important than daylight exposure in the regulation of sleep patterns for people in the subarctic. Moreover, the use of stimulants or excessive indoor and outdoor light may have masked the seasonal effect of variation in daylight. Further prospective studies and more research on clock-gene polymorphism, photosensitivity and other biological variables among subgroups of subarctic populations are needed.

Concepts: Sleep, Sunlight, Ageing, Season, Circadian rhythm, Chronotype, Spring, Seasonal variation

27

Sodium oxybate (γ-hydroxybutyric acid, GHB) is a neurotransmitter in the human brain which exerts sedative effects and is used therapeutically in the treatment of narcolepsy. Current safety recommendations have been formulated for the use of GHB in patients with preexisting breathing disorders. We report the case of a 39-year-old female with narcolepsy and cataplexy revealing the de novo emergence of central sleep apneas in a Cheyne-Stokes pattern under constant treatment with GHB. After discontinuation of GHB, polysomnographic re-evaluation demonstrated the disappearance of central sleep apneas. To our knowledge, this is the first report of de novo central sleep apneas induced by GHB in a patient without pre-existing sleep-disordered breathing, suggesting that there is a need for further investigation and potentially an extension of the safety guidelines to patients without a pre-existing breathing disorder.

Concepts: Nervous system, Neuron, Brain, Sleep, Human brain, Narcolepsy, Gamma-Hydroxybutyric acid, Cataplexy

27

OBJECTIVES: Although sleep disorders have been reported to affect more than half of adults with attention-deficit/hyperactivity disorder (ADHD), the association between sleep and ADHD is poorly understood. The aims of our study were to investigate sleep-related variables in adults with ADHD and to assess if any differences exist between ADHD of the predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes. METHODS: We used the Epworth sleepiness scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the fatigue severity scale (FSS) to collect data on daytime sleepiness, sleep quality, and fatigue in 126 subjects (45 ADHD-I and 81 ADHD-C subjects). RESULTS: Approximately 85% of subjects reported excessive daytime sleepiness or poor sleep quality. The most common sleep concerns were initial insomnia, interrupted sleep, and feeling too hot. When examining ADHD subtype differences, ADHD-I subtypes reported poorer sleep quality and more fatigue than ADHD-C subtypes. Partial correlation analyses revealed that interrelationships between sleep quality, daytime sleepiness, and fatigue differ between ADHD subtypes; in ADHD-I subtypes fatigue was associated with sleep quality, while in the ADHD-C subtypes fatigue was associated with both sleep quality and daytime sleepiness. There also appears to be a subtype×gender interaction that affects the perception of fatigue, as subjective fatigue was markedly higher in ADHD-I women than in ADHD-C women. CONCLUSION: Altogether our data indicate that the interplay of variables associated with daytime function and sleep varies between ADHD subtypes. This finding may have considerable relevance in the management and pathophysiologic understanding of ADHD, and thus lead to tailored treatments for ADHD subtypes.

Concepts: Sleep, Sleep deprivation, Sleep disorder, Attention-deficit hyperactivity disorder, ADHD predominantly inattentive, Epworth Sleepiness Scale, Excessive daytime sleepiness, Sleep disorders

23

The mid-day nap, sometimes called a siesta, is a ubiquitous occurrence across the lifespan. It is well established that in addition to reducing sleepiness, mid-day naps offer a variety of benefits: memory consolidation, preparation for subsequent learning, executive functioning enhancement, and a boost in emotional stability. These benefits are present even if a sufficient amount of sleep is obtained during the night prior. However, we present a paradox: in spite of these reported benefits of naps, frequent napping has also been associated with numerous negative outcomes (eg, cognitive decline, hypertension, diabetes), particularly in older populations. This association exists even when statistically controlling for relevant health- and sleep-affecting determinants. An emerging hypothesis suggests inflammation is a mediator between mid-day naps and poor health outcomes, yet further research is necessary. Given this, it may be premature to ‘prescribe’ naps as a health enhancer. Herein, we aggregate findings from several branches of sleep research (eg, developmental neuroscience, cognitive neuroscience, sleep medicine) to critically examine the paradoxical role of naps in cognitive and somatic health. This review uncovers gaps in the literature to guide research opportunities in the field.

Concepts: Psychology, Sleep, Neuroscience, Cognition, Memory, Cognitive science, Siesta, Nap

17

Sleep affects adolescents in various ways. However, the effects of multiple factors on sleep hygiene remain unclear. A comprehensive assessment of the effects of life habits on sleep in high-school students was conducted.

Concepts: Life, Sleep, Sleep disorder, Circadian rhythm, Sleep hygiene

11

Despite their high prevalence in daily life, repeated night-wakings and their cognitive and emotional consequences have received less research attention compared to other types of sleep disturbances. Our aim was to experimentally compare the effects of one night of induced infrequent night-wakings (of ∼15min, each requiring a purposeful response) and sleep restriction on sustained attention and mood in young adults.

Concepts: Psychology, Sleep deprivation, Neuroscience, Personal life

9

Poor sleep is one of the most common problems reported during menopause, and is known to vary throughout the menopause transition. The objective of this study was to describe the dynamics of poor sleep among participants of the Midlife Women’s Health Study and to identify risk factors associated with poor sleep during the menopausal transition.

8

To clarify sleep disorder risk factors among student athletes, this study examined the relationship between lifestyle habits, competition activities, psychological distress, and sleep disorders.

Concepts: Sleep, Sleep deprivation, Sleep disorder, Sleep apnea, Polysomnography, Circadian rhythm, Narcolepsy, Sleep hygiene