PURPOSE: Nocturnal enuresis (NE) is one of the most common problems in childhood. NE has a multifactorial etiology and is influenced by sleep and arousal mechanisms. The aim of the present study was to prospectively evaluate sleep problems and patterns in children with NE compared with normal healthy controls. METHODS: Twenty-eight children with NE and 16 healthy controls were included in the study. To evaluate sleep habits and disturbances, parents and children filled out a questionnaire that included items about sleep patterns and sleep-related behaviors prior to treatment for NE. Demographic factors and other data were compared for the two groups based on the responses to the sleep questionnaire. RESULTS: Night awakening, sleepwalking, and periodic limb movements were more prevalent in children with NE, but symptoms of sleep-disordered breathing were not increased in this group. There were statistically significant differences in periodic limb movements and daytime sleepiness between the two groups. CONCLUSION: Children with NE seemed to have more sleep problems such as night awakening, sleepwalking, and periodic limb movements. In addition, a higher level of daytime sleepiness and hyperactivity in patients with NE suggested a relationship between NE and sleep disorders.
Arousal ; Child* ; Demography ; Extremities ; Humans ; Nocturnal Enuresis* ; Parents ; Prospective Studies ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Somnambulism

Insomnia is a subjective experience of difficulty in falling asleep and/or maintaining sleep accompanied by the impairment of daytime social functioning due to insufficient sleep quality or quantity to meet normal physiological needs.It has chronic damage to all the human body systems and is the most common sleep disorder.The main mechanism for the occurrence and maintenance of insomnia is the hyperarousal hypothesis,and microarousal,as a cortical arousal,is also involved in the formation of the hyperarousal mechanism.The mechanism and clinical significance of microarousal were reviewed and summarized in this paper in order to guide the clinical work.
Arousal ; Humans ; Sleep ; Sleep Initiation and Maintenance Disorders ; Sleep Quality

Two chronic insomnia cases are presented to illustrate the clinical application of hypnotic techniques. The treatment procedures, which incorporate the demand characteristics of the therapeutic setting, positive expectancies, a reduction in physiological arousal, and a reduction of excessive cognitive activity are discussed.
Arousal ; Hypnosis ; Sleep Initiation and Maintenance Disorders

Sleep-related eating disorder (SRED) is a newly recognized parasomnia that describes a clinical condition of compulsive eating under an altered level of consciousness during sleep. Recently, it is increasingly recognized in clinical practice. The exact etiology of SRED is unclear, but it is assumed that SRED might share features of both sleepwalking and eating disorder. There have been also accumulating reports of SRED related to the administration of various psychotropic drugs, such as zolpidem, triazolam, olanzapine, and combinations of psychotropics. Especially, zolpidem in patients with underlying sleep disorders that cause frequent arousals, may cause or augment sleep related eating behavior. A thorough sleep history is essential to recognition and diagnosis of SRED. The timing, frequency, and description of food ingested during eating episodes should be elicited, and a history of concurrent psychiatric, medical, sleep disorders must also be sought and evaluated. Interestingly, dopaminergic agents as monotherapy were effective in some trials. Success with combinations of dopaminergic and opioid drugs, with the addition of sedatives, has also been reported in some case reports.
Arousal ; Benzodiazepines ; Consciousness Disorders ; Dopamine Agents ; Eating ; Feeding and Eating Disorders ; Feeding Behavior ; Humans ; Hypnotics and Sedatives ; Parasomnias ; Psychotropic Drugs ; Pyridines ; Sleep Wake Disorders ; Somnambulism ; Triazolam

The cyclic alternating pattern (CAP) is a periodic EEG activity in NREM sleep, characterized by sequences of transient electrocortical events that are distinct from background EEG activities. A CAP cycle consists of two periodic EEG features, phase A and subsequent phase B whose durations are 2-60 s. At least two consecutive CAP cycles are required to define a CAP sequence. The CAP phase A is a phasic EEG event, such as delta bursts, vertex sharp transients, K-complex sequences, polyphasic bursts, K-alpha, intermittent alpha, and arousals. Phase B is repetitive periods of background EEG activity. The absence of CAP more than 60 seconds or an isolated phase A is classified as non-CAP. Phase A activities can be classified into three subtypes (A1, A2, and A3), based on the amounts of high-voltage slow waves (EEG synchrony) and low-amplitude fast rhythms (EEG desynchrony). CAP rate, the percentage of CAP durations in NREM sleep is considered to be a physiologic marker of the NREM sleep instability. In insomnia, the frequent discrepancy between self-reports and polysomnographic findings could be attributed to subtle abnormalities in the sleep tracing, which are overlooked by the conventional scoring methods. The conventional scoring scheme has superiority in analysis of macrostructure of sleep but shows limited power in finding arousals and transient EEG events that are major component of microstructure of sleep. But, it has recently been found that a significant correlation exists between CAP rate and the subjective estimates of the sleep quality in insomniacs and sleep-improving treatments often reduce the amount of CAP. Thus, the extension of conventional sleep measures with the new CAP variables, which appear to be the more sensitive to sleep disturbance, may improve our knowledge on the diagnosis and management of insomnia.
Arousal ; Electroencephalography ; Research Design ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: Periodic leg movements in sleep (PLMS) might be subdivided based upon whether or not they are associated with visible EEG microarousals (MA). MA is considered to be responsible for nonrestorative sleep and daytime fatigue. The American Sleep Disorders Association's (ASDA) scoring rules for MA based on visual analysis of the EEG changes suggest that MA should last more than 3 seconds. However, it has been suggested that visual analysis may not detect some changes in EEG activity. This study is aimed at measuring changes in EEG spectra during PLMS without MA in order to better understand the arousing response of PLMS. METHODS: Ten drug-free patients (three men and seven women) diagnosed with PLMS by polysomnography were studied. Spectral analysis of the EEG was performed in each patient on 30 episodes of PLMS without MA, chosen randomly across the night in stage 2 non-REM sleep. We applied stricter criteria for MA compared to ASDA, by defining it as a return to alpha and theta frequency lasting at least 1 second. RESULTS: The mean PLMS index was 16.7 10.0. The mean PLMS duration was 1.3 0.7 seconds. Comparison of 4-second EEG activity both before and after the onset of PLMS without MA using independent t-test showed that the movements were associated with significant increase of relative activity in the delta band (p=0.000) and significant decrease of activity in the alpha (p=0.01) and sigma (p=0.000) bands. No significant decrease in the theta (p=0.05), beta (p=0.129), or gamma (p=0.062) bands was found. CONCLUSIONS: PLMS without MA was found to be associated with EEG change characterized by increase in the delta frequency band. This finding seems to be compatible with the hypothesis of an integrative hierarchy of arousal responses of Sforza's. Considering that the subjects had lower PLMS index and shorter PLMS duration than those of the previous study, it is suggested that an even less severe form of PLMS without MA could induce neurophysiologic change, which may potentially be of clinical significance.
Arousal* ; Electroencephalography* ; Fatigue ; Humans ; Leg* ; Male ; Polysomnography ; Sleep Wake Disorders

The present study compared the actigraphic indices between both wrist actigraphies (WATGs), and the sleep estimates between each WATG and nocturnal polysomnography (NPSG) to assess their differences and consistencies. We studied 22 right-handed subjects (mean age 43.9+/-13.3 years, M:F=14:8) with untreated primary sleep disorders (primary insomnia=8, simple snorer=2, obstructive sleep apnea=12) undergone by overnight both WATGs and NPSG, simultaneously. Comparison and correlation were analyzed between right and left wrist actigraphic data. In the sleep estimates of both WATGs and NPSG, each WATG was compared and correlated with NPSG in sleep period time (SPT), total sleep time (TST), sleep latency (SL), sleep efficiency (SE) and wake time (WT). Sleep indices between both WATGs showed significant positive correlations with no correlations in SL and fragmentation index (FI). There were no differences in sleep indices between both WATGs. SPTs of both WATGs, SL of left WATG, and TST of right WATG showed positively significant correlations, and SE of right WATG did negatively significant correlation in sleep indices between each WATG and NPSG. As each WATG was compared to PSG, SPTs of both WATGs and WT of right WATG were decreased, and TST and SE of right WATG and SL of left WATG were increased. Inconsistent SL and FI between both WATGs indicate that the activities between both WATGs can differentially happen during wake or arousal. Inconsistent sleep estimates between each WATG and NPSG may indicate the limited usefulness in measuring and analyzing one-night sleep by using WATG.
Arousal ; Functional Laterality ; Polysomnography* ; Sleep Wake Disorders ; Wrist*

BACKGROUND/AIMS: The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis. METHODS: Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks. RESULTS: The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture. CONCLUSIONS: Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.
Arousal ; Cytidine Triphosphate ; Extremities ; Fibrosis ; Humans ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Although actigraphy has been used to evaluated sleep-wake patterns and quality of sleep disorders patients, its usefulness in obstructive sleep apnea syndrome (OSAS) and primary insomnia is unclear. To investigate the value of actigraphy in OSAS and differentiating OSAS from primary insomnia, night polysomnography (PSG) and actigraphy were performed simultaneously. METHODS: 31 OSAS patients and 21 primary insomnia patients were included (16 females, 36 males). Sleep latency, total sleep time, sleep efficiency and actual wake time, movement and fragmentation index (MFI) were obtained in actigraphy and compared with PSG results. Spearmann correlation analysis and Mann-Whitney U test were used. RESULTS: The sleep efficiency and total sleep time are highly correlated in PSG and actigraphy (p<0.05, p<0.01). Respiratory disturbance index and arousal index in PSG was relatively correlated with MFI in actigraphy (p<0.05). Sleep latency is not correlated in PSG and actigraphy (p>0.05). OSAS had a significantly higher movement and fragmentation index (MFI) than that of primary insomnia (p<0.05) CONCLUSIONS: Actigraphy is a useful and convenient test in differentiating OSAS from insomnia as well as sleep-wake cycle disorders.
Actigraphy* ; Arousal ; Female ; Humans ; Polysomnography* ; Sleep Apnea, Obstructive* ; Sleep Wake Disorders* ; Sleep Disorders, Circadian Rhythm ; Sleep Initiation and Maintenance Disorders*

OBJECTIVES: To characterize sleep of subjects with obstructive sleep apnea syndrome (OSA) with insomnia compared to OSA without insomnia in terms of polysomnography (PSG) and cardiopulmonary coupling (CPC) analysis. METHODS: Subjects with OSA (apnea-hypopnea index, AHI > or =5 /h, n=200) were enrolled and divided into subjects OSA with insomnia (OSA-I) and subjects with OSA only (OSA-O). OSA-I complained of difficulty falling and/or staying asleep at an initial interview in clinic. We compared demographics including mood states, daytime sleepiness, PSG, and CPC parameters between groups, and performed correlation analyses between PSG and CPC parameters for each group. RESULTS: Female ratio was higher in OSA-I than OSA-O. OSA-I were older and slimmer than OSA-O. OSA-O were much drowsier (Epworth Sleepiness Scale 10.0 vs. 6.8). However, mood states were not different between two groups. OSA-I showed significantly longer sleep latency and lower sleep efficiency than OSA-O. Despite of higher arousal index (AI) and AHI of OSA-O, wakefulness after sleep onset was greater in OSA-I. There was no significant difference of CPC parameters between two groups after adjustment of AHI. In correlation analyses, low frequency coupling and high frequency coupling duration were associated with AHI, AI, and lowest SaO2 in both groups. CONCLUSIONS: OSA-I demonstrated more fragmented sleep architecture and disruptive sleep in spite of lower sleep-disordered breathing related distress than OSA-O. CPC analysis is unable to differentiate sleep patterns of OSA subjects with or without insomnia. It is needed to explore factors causing fragmented sleep architecture and disruptive sleep rather than respiratory disturbances in OSA subjects complaining of insomnia.
Arousal ; Demography ; Female ; Humans ; Polysomnography* ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders ; Wakefulness