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Sleep is such a crucial aspect of health that it can have
an adverse impact on some very serious diseases such as:
- Parkinson disease (PD)
- Alzheimer disease (AD)
- Multiple sclerosis (MS)
- Gastrointestinal tract disorders
- Kidney disease
- Behavioral problems in children
This is all according to a report in a recent issue of the
Journal of the American Medical Association (JAMA). The report
is based on studies presented at annual joint meeting of the
American Academy of Sleep Medicine and Sleep Research Society.
"Many medical illnesses disrupt sleep and impair alertness.
Moreover, sleep disorders may coexist with medical disorders
in people of all ages. Improving sleep problems in the medically
ill, sleep specialists say, may enhance patients' overall
health and quality of life," says Lynne Lamberg of JAMA.
Sleep and Problems in Children
A study has found that children
with attention deficit-hyperactivity disorder (ADHD) have
more sleep apnea than do other children. Researchers
conducted a retrospective review of 86 children aged 5 years
or older evaluated for snoring in a pediatric sleep laboratory.
Of the 40 found to have sleep apnea, five were diagnosed with
ADHD. Of the remaining 46 children with primary snoring but
no OSA, only one had been diagnosed with ADHD.
Whether OSA contributes to or worsens ADHD or whether children
with ADHD are at increased risk for OSA is not clear, the
researchers said, but they suggest screening children with
ADHD for trouble breathing, bed-wetting, restless sleep, and
other sleep apnea symptoms.
In another study of children, researchers found that 31%
of 114 children evaluated for sleep apnea in their laboratory
were overweight. Researchers recommend intensive weight
intervention for at-risk children.
Light Therapy, Sleep, and Alzheimer
Disease
According to the JAMA report, "A
simple nondrug therapy exposure to bright light reduced nighttime
agitated behavior and improved continuity of nighttime sleep
in institutionalized people with AD."
Researchers from the Goldman Institute on Aging of the University
of California, San Francisco, randomly assigned 26 subjects
(avg. age 86 years), to spend 1 hour outdoors in the morning
or to receive usual indoor light exposure for 10 weeks.
Participants in the study wore actigraphs, wristwatch-style
movement-activated recording devices, at periodic intervals
to provide objective indicators of the change in their activity
and sleep.
Parkinson Disease (PD)
According to the JAMA report:
German researchers found that people with PD and impaired
cognitive performance had sleep of worse quality, with more
trouble falling asleep, staying asleep, and moving at night,
than healthy controls did. They were also more likely to
have depression. As their depression deepened, their memory
deteriorated further. Improving sleep and depression
may improve cognitive performance in these patients,
suggest Bertram Holinka, MD, and colleagues at the University-Hospital
Knappschaftskrankenhaus in Bochum.
In another study, French researchers note that People with
PD who are receiving dopaminergic drugs often report visual
hallucinations while awake and unusually vivid dreams during
sleep. They confirmed the abnormal sleep patterns by observing
10 PD patients taking levdopa. (LOOK UP) They found that all
the patients had abnormal motor behaviors during rapid eye
movement (REM) sleep, a state in which skeletal muscles ordinarily
lie virtually paralyzed.
Multiple Sclerosis (MS)
A new wakefulness-promoting drug, modafinil (Provigil),
lessens the common and disabling symptom of fatigue in people
with MS, researchers found.
Researchers performed a multicenter, single-blind, placebo-controlled
trial, using 72 adults with stable MS and fatigue. The study
lasted 9-weeks, with patients taking a placebo in weeks 1
and 2, 200 mg/d of modafinil in weeks 3 and 4, 400 mg/d of
modafinil in weeks 5 and 6, and a placebo in weeks 7, 8, and
9.
The lower dosage of the drug significantly reduced daytime
sleepiness and fatigue without disturbing nighttime sleep.
Patients generally tolerated the drug well, the researchers
found, with nervousness and headache being the most common
adverse effects.
Modafinil was approved by the US Food and Drug Administration
in 1998 to combat sleepiness in people with narcolepsy.
In another study, researchers found that modafinil reduced
excessive daytime sleepiness in the majority of nearly 500
people with narcolepsy at dosages of 200 mg, 300 mg, or 400
mg per day for 40 weeks, with continuing efficacy, few adverse
effects, and no evidence of tolerance.
Cancer
Several reports examined sleep disruption in people with
cancer. Barry Fortner, PhD, of Rush-Presbyterian-St Luke's
Medical Center, and colleagues, using a standard self-report
assessment of sleep, found that 44%
of 128 adult outpatients with cancer slept poorly. The higher
the sleep disturbance, the lower the patients' overall quality
of life.
Epilepsy and Sleep Apnea
According to the JAMA report:
The frequency of patients having both epilepsy and obstructive
sleep apnea (OSA), a sleep-related breathing disorder, is
greater than would be expected by chance, according to Peter
Höllinger, MD, and colleagues at the University Hospital,
Bern, Switzerland.
Of 615 patients with OSA seen in their sleep center in
the last 6 years, 21 also had epilepsy ... Successful treatment
with continuous positive airway pressure often improved
seizure control and reduced excessive daytime sleepiness
in at least one third of these patients.
Nocturia (Nighttime Urination)
Research at the University of Alabama at Birmingham schools
of nursing and medicine suggests that sleep apnea can increases
nighttime voiding.
Another study found a 60% rate of undiagnosed sleep apnea
as well as strong associations between sleep apnea symptoms
and nighttime urination. In addition, many of the subjects
also appeared to be relatively dehydrated on arising. The
dehydration, the researchers caution, may
trigger acute orthostatic hypotension on getting out of bed
and potential toxicity from taking water-soluble drugs,
such as digoxin, early in the day. They found that treatment
of the sleep apnea eliminated the nocturia and other sleep
apnea symptoms.
To view the abstracts presented at the sleep meetings, go
to http://www.apss.org.
Journal of the American
Medical Association, November 1, 2000; 284 and annual joint
meeting of the American Academy of Sleep Medicine and Sleep
Research Society
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