Unirekisteröinnit avattuina

Kliininen neurofysiologia tarjoaa laajan valikoiman tutkimuksia, jotka yhdistelevät erilaisia biologisia suureita ja joilla voidaan selvittää monia unen ja vireystilan häiriöitä. Tutkimusnimikkeet muistuttavat toisiaan läheisesti, ja siksi niiden käytössä voikin tulla sekaannuksia. Perusterveydenhuollon käyttöön soveltuu yöpolygrafia, jonka avulla voidaan diagnosoida valtaosa unenaikaisista hengityshäiriöistä ja tarvittaessa myös yöllinen alaraajojen jaksoittainen liikehäiriö. Erikoissairaanhoidon tasoiset tutkimukset unipolygrafia, univiivetesti, hereilläpysymistesti ja Oxford SLEep Resistance test (OSLER) tarjoavat työkaluja unen rakenteen ja erityishäiriöiden sekä päiväaikaisen väsymyksen ja sitä aiheuttavien sairauksien diagnostiikkaan. Aktigrafialla, joka myös kuuluu erikoissairaanhoidolle tarjottaviin tutkimuksiin, voidaan tutkia etenkin vuorokausirytmin häiriöitä. Erilaisten tutkimuksien tarkoituksenmukaisella käytöllä voidaan saada kattava kuva unen ja vireystilan häiriöistä kärsivien potilaiden ongelmista

Normative values for sleep parameters in pre-schoolers using actigraphy

Objective: There are currently no reference values for actigraphy-measured sleep length and fragmentation in preschool children. We created standardized parameters using a community sample. Methods: Ninety-seven 2-to-6-year-old children (56 boys) wore an actigraph on their non-dominant wrist for seven days. The data was extracted and scored, calculating total sleep time, sleep latency, sleep efficiency, fragmentation index, circadian rhythm length, cosine peak and light/dark ratio. Subjects were divided into groups of 2-3-year-olds, 4-5-year-olds and 6-year-olds. Means and standard deviations were calculated, and reference values were created using the 2.5th and the 97.5th percentiles. Results: Reference intervals were 7 h 23 min-9 h 47 min for 24-hour total sleep time, 0.2-48.4 min for sleep latency, 69-87% for sleep efficiency, 23-53% for fragmentation index, 23 h 39 min-24 h 24 min for circadian rhythm length, 12: 37-15: 53 for the timing of the cosine peak, and 1.14-5.63 for the light-dark ratio. With increasing age, daily sleep time, sleep latency, sleep fragmentation, and napping decreased. Conclusions: We were able to create previously non-established reference values, including trends with increasing age, on actigraphy-assessed sleep in preschool children. Significance: Sleep disorders in young children are easier to evaluate against normative data. (C) 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.Peer reviewe

First-Night Effect on Sleep in Different Female Reproductive States

Objectives: In sleep laboratory studies, the new environment is generally considered to disturb sleep during the first night. However, older women have rarely been studied. Although menopause and hormone therapy affect sleep, their impact on the first-night effect is virtually unknown. Participants: Four groups of women with no sleep laboratory experience: young on hormonal contraceptives (n = 11, 23.1 [0.5] years), perimenopausal (n = 15, 48.0 (0.4] years), postmenopausal without hormone therapy (HT; off-HT, n = 22, 63.4 [0.8] years) and postmenopausal with HT (n = 16, 63.1 [0.9] years). Procedure: A cross-sectional study. Methods: Polysomnography was performed over two consecutive nights and the first-night effect and group differences were evaluated. Questionnaire-based insomnia and sleepiness scores were correlated to sleep variables and their between-night changes. Results: Although sleep in young women was deeper and less fragmented than in the other groups, first-night effect was similar in all study groups. Total sleep time, sleep efficiency, and S1 and S2 sleep increased, and wake after sleep onset, awakenings per hour of sleep, S2 and REM latencies, and percentage of SWS decreased from the first to the second night. Perimenopausal women had more insomnia complaints than other women. Insomnia complaints were associated with more disturbed sleep but not with the first-night effect. Conclusions: A first night in a sleep laboratory elicits a marked interference of sleep architecture in women of all ages, with a carryover effect of lighter sleep on the second study night. Menopausal state, HT use, or insomnia complaints do not modify this effect.Peer reviewe

JCPyV microRNA in plasma inversely correlates with JCPyV seropositivity among long-term natalizumab-treated relapsing-remitting multiple sclerosis patients

Sensitive biomarkers are needed to better manage multiple sclerosis (MS) patients for natalizumab (NTZ)-associated risk of progressive multifocal leukoencephalopathy (PML). A currently used risk stratification algorithm, mainly based on JC polyomavirus (JCPyV) serology, has not led to a reduction of PML incidence. Therefore, this study was designed to evaluate the presence and prevalence of JCPyV miRNAs in plasma of NTZ-treated MS patients, and to explore their biomarker potential for NTZ-associated PML risk assessment. Altogether, 102 plasma samples from 49 NTZ-treated and 28 interferon-beta (IFN-beta)-treated relapsing-remitting MS patients, and 25 healthy controls (HCs) were analyzed for jcv-miR-J1-5p (5p miRNA) and jcv-miR-J1-3p (3p miRNA) expression. The overall detection rate of 5p miRNA was 84% (41/49) among NTZ-treated patients, 75% (21/28) among IFN-beta-treated patients, and 92% (23/25) in HCs. Relative 5p miRNA expression levels were lower in NTZ-treated patients as compared to patients treated with IFN-beta (p = 0.027) but not to HCs. Moreover, 5p miRNA expression inversely correlated with anti-JCPyV antibody index among JCPyV seropositive long-term NTZ-treated patients (r = -0.756; p = 0.002). The overall detection rate of 3p miRNA was low. Our results suggest that JCPyV miRNA in plasma may be linked to the reactivation of persistent JCPyV, to enhanced virus replication, and eventually to the risk of developing PML among NTZ-treated MS patients. However, further study is warranted in a larger data set including samples from PML patients to confirm the clinical relevance of JCPyV miRNA as a sign of/in viral reactivation, and to identify its potential to predict developing PML risk.Peer reviewe

Poor parental sleep did not predict future sleep problems in children aged 2-6 years

Peer reviewe

Child Eveningness as a Predictor of Parental Sleep

Child eveningness has been associated with many adverse outcomes for children. The aim of this study was to assess whether child eveningness poses a risk to parental sleep quality in follow-up. A total of 146 children (57% adopted, 47% boys, mean age at follow-up 5.1 years [standard deviation 1.7]) completed a 1-week actigraph recording to analyze their sleep twice, 1 year apart. The parents completed the Child ChronoType Questionnaire for their child and a short version of the Morningness–Eveningness Questionnaire for themselves and the Jenkins Sleep Scale for their sleep quality. Linear regression analyses showed that subjective parental sleeping problems at baseline were associated with subjective parental sleeping problems at follow-up. A morning-type child decreased the risk of parental sleeping problems at the 1-year follow-up compared to the child evening chronotype. Additionally, the child intermediate chronotype decreased the risk of maternal sleeping problems at the 1-year follow-up compared to the evening chronotype of the child. Parents of evening-type children experienced more sleeping problems in the follow-up, compared to parents of morning-type children. This finding encourages parents and professionals to steer the diurnal rhythm of evening-type children toward an earlier daily routine

Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families

Background Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study. Objective To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents. Methods To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age. Results Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P < 0.001) than the controls. There were no significant differences in sleep fragmentation or sleep efficiency between the groups. During the 1-year follow-up, the sleep patterns of the adopted children approached those of the controls. Conclusions The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.Peer reviewe

Diagnostic efficiency of whole-body 18F-FDG PET/MRI, MRI alone, and SUV and ADC values in staging of primary uterine cervical cancer

Background: The use of PET/MRI for gynecological cancers is emerging. The purpose of this study was to assess the additional diagnostic value of PET over MRI alone in local and whole-body staging of cervical cancer, and to evaluate the benefit of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) in staging.Methods: Patients with histopathologically-proven cervical cancer and whole-body F-18-FDG PET/MRI obtained before definitive treatment were retrospectively registered. Local tumor spread, nodal involvement, and distant metastases were evaluated using PET/MRI or MRI dataset alone. Histopathology or clinical consensus with follow-up imaging were used as reference standard. Tumor SUVmax and ADC were measured and SUVmax/ADC ratio calculated. Area under the curve (AUC) was determined to predict diagnostic performance and Mann-Whitney U test was applied for group comparisons.Results: In total, 33 patients who underwent surgery (n = 23) or first-line chemoradiation (n = 10) were included. PET/MRI resulted in higher AUC compared with MRI alone in detecting parametrial (0.89 versus 0.73), vaginal (0.85 versus 0.74), and deep cervical stromal invasion (0.96 versus 0.74), respectively. PET/MRI had higher diagnostic confidence than MRI in identifying patients with radical cone biopsy and no residual at hysterectomy (sensitivity 89% versus 44%). PET/MRI and MRI showed equal AUC for pelvic nodal staging (both 0.73), whereas AUC for distant metastases was higher using PET/MRI (0.80 versus 0.67). Tumor SUVmax/ADC ratio, but not SUVmax or ADC alone, was significantly higher in the presence of metastatic pelvic lymph nodes (P Conclusions: PET/MRI shows higher accuracy than MRI alone for determining local tumor spread and distant metastasis emphasizing the added value of PET over MRI alone in staging of cervical cancer. Tumor SUVmax/ADC ratio may predict pelvic nodal involvement.</div

Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families

Background Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study.Objective To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents.Methods To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age.Results Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P Conclusions The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.</p