Sleep Medicine Reviews

Aims & Scope/ Editorial Board

2010-04-01

Rock-a-bye baby? Parenting and infant sleep

Harriet Hiscock — 2010-04-01

Infant sleep problems (typically problems settling to sleep and/or frequent night waking) are common and usually behavioral in nature. They are associated with a number of adverse outcomes including maternal fatigue and depression, paternal depression and relationship breakdown. In Sadeh et al.'s eloquent and comprehensive review of parenting and infant sleep, the authors propose a transactional model whereby parental behaviors, cognitions, emotions and psychopathology influence infant sleep and vice versa. They explore evidence for each component of the model thereby informing clinical management of both infant sleep problems and maternal psychopathology. Within each component of the model, potential barriers and enablers of successful management of infant sleep problems emerge. Finally, Sadeh et al. highlight a number of important areas for future research including the long-term outcomes of infant sleep interventions, the role of fathers in generating and managing infant sleep problems, the nature of sleep in culturally and economically diverse populations, and the need for more objective measures of infant sleep in research to minimize potential response bias.

Parenting and infant sleep

Avi Sadeh, Liat Tikotzky, Anat Scher — 2010-04-01

Summary: Infant sleep undergoes dramatic evolution during the first year of life. This process is driven by underlying biological forces but is highly dependent on environmental cues including parental influences. In this review the links between infant sleep and parental behaviors, cognitions, emotions and relationships as well as psychopathology are examined within the context of a transactional model. Parental behaviors, particularly those related to bedtime interactions and soothing routines, are closely related to infant sleep. Increased parental involvement is associated with more fragmented sleep. Intervention based on modifying parental behaviors and cognitions have direct effect on infant sleep. It appears that parental personality, psychopathology and related cognitions and emotions contribute to parental sleep-related behaviors and ultimately influence infant sleep. However, the links are bidirectional and dynamic so that poor infant sleep may influence parental behaviors and poor infant sleep appears to be a family stressor and a risk factor for maternal depression.

Sleep in disorders of consciousness

2010-04-01

Summary: From a behavioral as well as neurobiological point of view, sleep and consciousness are intimately connected. A better understanding of sleep cycles and sleep architecture of patients suffering from disorders of consciousness (DOC) might therefore improve the clinical care for these patients as well as our understanding of the neural correlations of consciousness. Defining sleep in severely brain-injured patients is however problematic as both their electrophysiological and sleep patterns differ in many ways from healthy individuals. This paper discusses the concepts involved in the study of sleep of patients suffering from DOC and critically assesses the applicability of standard sleep criteria in these patients. The available literature on comatose and vegetative states as well as that on locked-in and related states following traumatic or non-traumatic severe brain injury will be reviewed. A wide spectrum of sleep disturbances ranging from almost normal patterns to severe loss and architecture disorganization are reported in cases of DOC and some patterns correlate with diagnosis and prognosis. At the present time the interactions of sleep and consciousness in brain-injured patients are a little studied subject but, the authors suggest, a potentially very interesting field of research.

Sleep deprivation during pregnancy and maternal and fetal outcomes: Is there a relationship?

Jen Jen Chang, Grace W. Pien, Stephen P. Duntley, George A. Macones — 2010-04-01

Summary: Sleep duration in the population has been declining. Women occupy an increasingly prominent place in the work force without reducing most of their responsibilities at home. Consequently, sleep needs are often pushed to the bottom of women's daily priority list. Prior research has indicated that sleep deprivation is associated with higher levels of pro-inflammatory serum cytokines. This is important because higher plasma concentrations of pro-inflammatory serum cytokine levels are associated with postpartum depression and adverse birth outcomes such as preterm delivery. However, little research has directly examined how sleep deprivation may affect maternal and fetal outcomes. This review summarizes the existing data on the effect of sleep deprivation during pregnancy on maternal and fetal outcomes.We review supporting evidence for the hypotheses that sleep deprivation during pregnancy increases the risk of preterm delivery and postpartum depression, and that systemic inflammation is the causal mechanism in the association. Prior research on sleep in pregnancy has been limited by varying data collection methods, subjective self-reported sleep measures, small and non-representative samples, cross-sectional designs; descriptive or non-hypothesis driven studies. Future research with longitudinal study designs is needed to allow examination of the effect of sleep deprivation on adverse maternal and fetal outcomes.

The value of auto-adjustable CPAP devices in pressure titration and treatment of patients with obstructive sleep apnea syndrome

Katrien Hertegonne, Fré Bauters — 2010-04-01

SUMMARY: In moderate to severe obstructive sleep apnea syndrome (OSAS), the use of Continuous Positive Airway Pressure (CPAP) is the gold standard therapy. In the last decade, new technologies such as auto-adjustable CPAP (APAP) have been promoted as having an added advantage over CPAP, because of their ability to adapt the pressure level to the patient's need at all times. This could logically result in the deliverance of lower pressures, which was hypothesized to improve patient acceptance and compliance for therapy.Several clinical trials have been performed with APAP in different modalities, as a titration tool in attended or unattended conditions, or as a treatment device for chronic use. Comparison of these trials is challenging, since APAP technology is evolving promptly and devices differ not only in how sleep-disordered breathing is detected, but also in how the operational algorithm responds accordingly. Although the question remains whether proof has yet been delivered of the superiority of this technology over CPAP, there is a tendency to accept it as common standard practice in OSAS titration and treatment. This review will bring available evidence on this subject into perspective.

Sleep disorders in patients with multiple sclerosis

Steven D. Brass, Pierre Duquette, Joëlle Proulx-Therrien, Sanford Auerbach — 2010-04-01

Summary: Patients with multiple sclerosis (MS) often have unrecognized sleep disorders at higher frequency than the general population. Sleep disorders such as sleep disordered breathing, insomnia, REM sleep behavior disorder, narcolepsy and restless legs syndrome have all been reported in the MS population. Notably, the most common symptom of MS is “fatigue,” which itself has been correlated with sleep disturbances. Sleep disorders may impact the quality of life of the MS patient population. This paper reviews the association of sleep disorders with MS, and discusses the association of sleep disruption with MS fatigue.

The acoustics of snoring

Dirk Pevernagie, Ronald M. Aarts, Micheline De Meyer — 2010-04-01

Summary: Snoring is a prevalent disorder affecting 20–40% of the general population. The mechanism of snoring is vibration of anatomical structures in the pharyngeal airway. Flutter of the soft palate accounts for the harsh aspect of the snoring sound. Natural or drug-induced sleep is required for its appearance. Snoring is subject to many influences such as body position, sleep stage, route of breathing and the presence or absence of sleep-disordered breathing. Its presentation may be variable within or between nights. While snoring is generally perceived as a social nuisance, rating of its noisiness is subjective and, therefore, inconsistent. Objective assessment of snoring is important to evaluate the effect of treatment interventions. Moreover, snoring carries information relating to the site and degree of obstruction of the upper airway. If evidence for monolevel snoring at the site of the soft palate is provided, the patient may benefit from palatal surgery. These considerations have inspired researchers to scrutinize the acoustic characteristics of snoring events. Similarly to speech, snoring is produced in the vocal tract. Because of this analogy, existing techniques for speech analysis have been applied to evaluate snoring sounds. It appears that the pitch of the snoring sound is in the low-frequency range (<500Hz) and corresponds to a fundamental frequency with associated harmonics. The pitch of snoring is determined by vibration of the soft palate, while nonpalatal snoring is more ‘noise-like’, and has scattered energy content in the higher spectral sub-bands (>500Hz). To evaluate acoustic properties of snoring, sleep nasendoscopy is often performed. Recent evidence suggests that the acoustic quality of snoring is markedly different in drug-induced sleep as compared with natural sleep. Most often, palatal surgery alters sound characteristics of snoring, but is no cure for this disorder. It is uncertain whether the perceived improvement after palatal surgery, as judged by the bed partner, is due to an altered sound spectrum. Whether some acoustic aspects of snoring, such as changes in pitch, have predictive value for the presence of obstructive sleep apnea is at present not sufficiently substantiated.

Articles to appear in forthcoming issues of Sleep Medicine Reviews

2010-04-01

PERsonalizing sleep Tom de Boer