The utility of the REM latency test in psychiatric diagnosis: A study of 81 depressed outpatients

To examine the utility of the REM (rapid eye movement) latency test in identifying outpatient primary depressions, 81 consecutive referrals to a sleep disorders center were evaluated in a phenomenologic, sleep polygraphic, and psychometric study. Modified Feighner (St. Louis) diagnoses were definite primary depression (n=19), probable primary depression (n=30), depression chronologically secondary to preexisting psychiatric disorders (n=19), and nonaffective psychiatric disorder (n=13). There were 18 nonpsychiatric controls. REM latency less than 70 minutes on 2 consecutive nights detected 62% of primary depressions, discriminating them from the other diagnostic groups with 88% specificity. There were no false positives among controls. These data provided a 90% confidence for the diagnosis of primary depression in this outpatient sample. Requiring 2 consecutive nights of shortened REM latency appears to improve significantly the specificity of a test previously considered to have high sensitivity but relatively low specificity for depressive disorders.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23905/1/0000148.pd

REM density in the differential diagnosis of psychiatric from medical-neurologic disorders: A replication

The discriminatory power of rapid eye movement (REM) density in 61 outpatients with medical, neurologic, and psychiatric disorders and 8 noncase controls was assessed. REM density was significantly lower in a group of patients with medical-neurologic disease as compared with psychiatric and control subjects without evidence for such disease. Furthermore, low scores discriminated depressions occurring in the context of somatic disease when compared with those in the absence of such disease. The differences between groups were not accounted for by age or sex. The cutoff REM density score of 12.56, based on the 99% lower confidence limit of the noncase controls, provided the highest sensitivity (0.82) without loss of specificity (0.80). It was concluded that REM density may have merit as a general measure of diffuse central nervous system pathology, whether primary or secondary to widespread systemic disease. The findings of Kupfer's group are upheld and extended to a broader medical and neuropsychiatric population than in the original Pittsburgh study.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24174/1/0000433.pd

Narcolefsia e apnéia do sono concomitantes: registro de caso

Relata-se um caso de concomitância de narcolepsia e apnéia do sono tipo obstrutiva documentado clinicamente e em traçados polissonográficos em laboratório de sono. Após correção cirúrgica da apnéia do sono, com traqueostomia, houve manutenção da sintomatologia narcoléptica e de seu registro característico. Este estudo apoia a necessidade de emprego sistemático da polissonografia de noite inteira e do teste de latência múltipla do sono na avaliação de pacientes com sonolência excessiva diurna

Sonolência excessiva diurna, apnéia do sono tipo central e distrofia miotônica

São relatados dois casos de distrofia miotônica acompanhada de sonolência excessiva diurna. A avaliação polissonográfica de noite inteira revelou grande número de apnéias do sono tipo central deflagrando despertares freqüentes. As apnéias dos tipos obstrutivo e misto ocorreram em níveis normais e não se constatou hipoxia. Houve diminuição da eficiência do sono e redução dos estágios 3, 4 e REM. A apnéia central e a sonolência diurna que acarreta representariam manifestações precoces do comprometimento do sistema nervoso central na distrofia miotônica

Parasagittal cortical atrophy: a cause of "primary lateral sclerosis"

A case of severe spastic paraparesis of the lower extremities is presented as an example of the late sequelae of thrombosis of the superior longitudinal sinus. Evidence in support of this presumptive diagnosis is given by analysis of the clinical history and the remarkable pneumoencephalographic findings. This case affords the opportunity to stress the need for caution and restraint in the use of the diagnosis "primary lateral sclerosis"

Studies in A-scan echoencephalography: evaluation of a proposed two phase shift

A series of 440 patients studied by echoencephalography is reported. Rather than dividing the patients in the classic two groups of less than 3 mm and more than 3 mm deviation of the midline, the patients in this study were divided into three groups, correlating the degree of midline shift to the presence of intracranial pathology. Group I, showing 0 to 2.5 mm shift proves to be normal with a "miss" rate of only 10%. Group II, showing 2.5 to 3.5 mm shift is regarded as a borderline group with an incidence of significant intracranial pathology of 46%, clearly indicating the need for further evaluation. Group III, demonstrating greater than 3.5 mm shift from the midline, is designated with confidence as abnormal, with a yield of significant intracranial pathology of 100% in this study

Narcolepsia e início súbito de períodos REM após despertares noturnos

O objetivo deste estudo foi verificar as relações entre aspectos polissono-gráficos e em especial a passagem súbita da vigília para o sono REM a partir de despertares espontâneos noturnos e a síndrome narcoléptica. Comparamos os dados de 55 narcolépticos com os de 93 não-narcolépticos com sonolência excessiva diurna. A distribuição etária e de sexo foi semelhante nas duas amostras. Os seguintes parâmetros não revelaram diferença significante entre os dois grupos: tempo total na cama, tempo total de sono como percentagem do tempo na cama, tempo nos estágios 3, 4 e REM, número de despertares breves, número de movimentos corpóreos e densidade REM. Número de episódios de início súbito de períodos REM após despertares espontâneos, tempo no estágio 1 e número de despertares completos e prolongados foram maiores nos narcolépticos. Tempo total de sono, latência de sono, latência do estágio REM e tempo no estágio 2 foram mais curtos nos narcolépticos. Em conclusão, a arquitetura do sono mostrou diferenças nítidas entre os dois grupos analisados. O início abrupto de períodos REM após despertares noturnos espontâneos foi típico dos narcolépticos e, com as demais características do registro, pode auxiliar na diferenciação destes dois grupos nosológicos

Spinocerebellar degeneration and slow saccades in three generations of a kinship: clinical and electrophysiologic findings

Four members of a family with spinocerebellar degeneration and slow saccadic eye movements are described. Detailed electrophysiological studies revealed abnormalities of neurological pathways not apparent clinically. The patients had slow saccades as mesasured electrophysiologically, as well as absence of rapid eye movements (REM) despite REM stages of sleep. These studies suggest that although saccadic eye movement and REM are mediated through the pontine paramedian reticular formation, other characteristics of REM sleep are not necessarily mediated through the same neurons

Gender differences dominate sleep disorder patients' body problem complaints

We studied it age, gender, diagnostic status, and psychiatric features affected 291 consecutive sleep disorder patient's body complaints on a brief checklist. Gender had a strong impact on all four (tested) dependent measures, with women reporting more distress than men. Age produced significant regressions on two measures, with younger patients complaining more than older. Presence of psychiatric features was associated with more complaints on one dependent measure - previously found to reflect internal medicine patients' emotional distress. The results of regression analyses were largely supported by follow-up ANOVAs. However, contrasting insomniac versus hypersomniac versus all other sleep disorder diagnoses did not affect body complaints on any dependent measure. The results caution against combining males and females to compare self-reported distress between sleep disorders