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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: Dose, Median, Hospital, Infant, Breastfeeding, Childbirth, Pregnancy, 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: Spring, Chronotype, Ageing, Season, Seasonal variation, Sunlight, Circadian rhythm, Sleep

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

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

10

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: Personal life, Neuroscience, Sleep deprivation, Psychology

7

OBJECTIVES: We aim to assess if the relationship between short or long sleep duration and hypertension is present among adults from epidemiological evidence and to investigate the relationship quantitatively. METHODS: We performed a comprehensive search of cross-sectional and longitudinal studies using PubMed and the Cochrane Library through February 2012. Our search was supplemented by reviewing reference lists of original and relevant reviews. After the related data were extracted by two investigators independently, pooled odds ratios (ORs) or relative risks (RRs) were estimated using a random-effects model or a fixed-effects model. Publication bias was evaluated, while sensitivity and meta-regression analyses were performed. RESULTS: Twenty-four adult studies met our inclusion criteria, with ages ranging from 18 to 106years. Twenty-one studies involving 225,858 subjects were included in the meta-analysis. The pooled results from the cross-sectional studies showed that short sleep duration was associated with a greater risk for hypertension (OR, 1.21; 95% confidence interval [CI], 1.09-1.34; P<0.001), and long sleep duration also increased the risk for hypertension (OR, 1.11; 95% CI, 1.04-1.18; P=0.003). There was no evidence of publication bias. Pooled analysis from the longitudinal studies indicated a significant association between short sleep duration and hypertension (RR, 1.23; 95% CI, 1.06-1.42; P=0.005), but an insignificant relationship between long sleep duration and hypertension (RR, 1.02; 95% CI, 0.91-1.14; P=0.732). The effects of sleep duration differed by gender, location of the population, and definitions of short or long sleep duration. Meta regression analysis including seven variables did not find the sources of heterogeneity. CONCLUSIONS: Among adults, a U-shaped relationship between habitual sleep duration and hypertension was found at the cross-sectional level. Short sleep duration was associated with a higher risk for hypertension even longitudinally. We must pay more attention to this lifestyle factor.

Concepts: Statistics, Cross-sectional study, Hypertension, Meta-analysis, Systematic review, Research methods, Evidence-based medicine, Epidemiology

6

To investigate the prevalence of insomnia and identify associated demographic, clinical and forensic risk factors in adult prisoners in England.

Concepts: Cross-sectional study, Medical statistics, Prison, Epidemiology

5

The objective of this study was to examine the associations between objective measures of sleep duration and sleep efficiency with the grades obtained by healthy typically developing children in math, language, science, and art while controlling for the potential confounding effects of socioeconomic status (SES), age, and gender.

Concepts: Programming language, Socioeconomic status, Interlingua, German language, Axiom, Sociology, Language, Mathematics

5

Results from longitudinal studies on sleep duration and incidence of obesity remain controversial.

Concepts: Repeated measures design, Research methods, Longitudinal study, Epidemiology