Análisis de la microestructura de sueño en pacientes con insomnio idiopático

El objetivo principal de esta investigación fue describir la actividad electroencefalográfica durante el sueño y el patrón alternante cíclico (CAP) en pacientes con insomnio idiopático. Se incluyeron 22 pacientes (8 masculinos, 14 femeninos) con diagnóstico de insomnio idiopático con rango de edad de 19 a 45 años y promedio de 30 años, de recién diagnostico y sin tratamiento previo. Se realizaron estudios polisomnográficos con el montaje internacional 10-20 y referencias bi-polares (32 electrodos con 16 derivaciones), registro del electrooculograma, electromiograma, electrocardiograma, movimientos respiratorios tóraco-abdominal, flujo nasal y oximetría. De los 22 pacientes registrados 10, que representan el 45% de la muestra, no presentaron actividad anormal en el análisis de la actividad eléctrica cerebral; mientras que los 12 pacientes restantes (55%) presentaron actividad irritativa (puntas, ondas agudas en inversión de fase y brotes de actividad lenta) en el registro electroencefalográfico. La actividad anormal se presentó únicamente en hemisferio izquierdo en el 66% de los pacientes. En el 33% restante se presentó en ambos hemisferios. En relación a los estudios polisomnográficos se encontraron diferencias significativas entre grupos (pacientes con alteración en el EEG vs pacientes sin ella) en la latencia a sueño, tiempo total de sueño, tiempo total de vigilia, eficiencia de sueño, porcentaje de sueño ligero, porcentaje de sueño de ondas lentas y en el índice del subtipo A1 del patrón alternante cíclico. Estos hallazgos sugieren que dentro de la población de pacientes con insomnio idiopático, existe un sub-grupo cuyos síntomas son más severos y la queja de sueño (insomnio) podría estar asociada íntimamente a los hallazgos electroencefalográficos presentes durante el sueño.The main purpose of this research was to describe electroencephalographic activity during sleep and the cyclical alternating pattern (CAP) in patients with idiopathic insomnia. It included 22 patients (8 male, 14 female) with a diagnosis of idiopathic insomnia, ranging in age from 19 to 45 years old, the average being 30, who were recently diagnosed and without prior treatment. Sleep studies were performed with the international 10-20 system and bipolar montages (32 electrodes with 16 derivations), record of the electrooculogram, electromyography, electrocardiogram, chest/abdominal respiratory movements, nasal flow and oximetry. Of the 22 patients registered, 10 patients, who represented 45% of the sample, did not present with any abnormal activity in the analysis of the cerebral electrical activity, while the remaining 12 patients (55%) presented with irritative activity (spikes, acute waves in phase inversion and outbreaks of slow activity) in the electroencephalographic record. The abnormal activity presented only in the left hemisphere in 66% of the patients. It presented in both hemispheres for the remaining 33%. With regard to the sleep record, significant differences were found between the groups (patients with alterations in the EEG vs. patients without alterations) in sleep latency, total sleep time, total wake time, light sleep percentage, slow waves percentage and in the A1 sub-type index of the cyclical alternating pattern. These findings suggest that within the population of patients with idiopathic insomnia, there is a sub-group whose symptoms are more severe and whose sleep complaints (insomnia) could be closely related to the electroencephalographic findings present during sleep

Changes in pharyngeal anatomy and apnea/hypopnea index after a mandibular advancement device

Objectives: This study aimed to evaluate the therapeutic effcacy of custom-made mandibular advancement devices (MAD) in the control of primary snoring and sleep apnea and to correlate with anatomical changes identified through imaging tests. Methods: Patients (n = 17) diagnosed with sleep apnea or primary snoring were included in this study and subsequently treated with MADs. Changes were assessed using a polysomnographic study (PSG), the Epworth Sleepiness Scale (ESS), and an imaging study with computed tomography scanning (CT). Studies were performed before and after the use of MAD. Anteroposterior measurements were taken in the sagittal plane at the hard palate, glottis, and supraglottic levels along the hard palate axis. Afterward, measurements were taken in the axial plane at the same levels along the hard palate axis. Results: From the six recorded measurements, the airway caliber increased by five. However, these changes were significant only in two measurements (sagittal hard palate and axial supraglottic). Snoring was controlled in 16 of the 17 subjects. From these sixteen, 12 subjects had a correct opening of the airway at the hard palate level. Moreover, daytime sleepiness decreased in all subjects. Discussion: Present results suggest that sagittal hard palate and axial supraglottic opening after use of MAD are mainly responsible for eliminating snoring and improve sleep apnea

Cognitive behavioral therapy for insomnia helps to reverse cognitive impairment in insomnia patients

Introduction: Insomnia is the most common of sleep disorders, it induces a wide variety of organic symptoms, including somatic and cognitive impairments. There are pharmacological drugs nowadays that help diminish sleep impairments due to insomnia. However, most of them seem to be worsening cognitive impairments, benzodiazepine receptor agonists, in particular, seem to induce an even worst deterioration of cognitive function. On the other hand, cognitive behavioral therapy for insomnia (CBT-I) has shown to be a reliable tool to improve the whole picture of insomnia. Objectives: To analyze the effect of CBT-I on insomnia symptoms and cognitive performance in patients suffering from chronic insomnia. Material and Methods: Ten subjects with a diagnosis of insomnia and no pharmacological treatment were evaluated pre- and post-six biweekly sessions of CBT-I with two neuropsychological batteries, BANFE and NEUROPSI attention and memory. Results: CBT-I significantly improves both the symptoms of insomnia, measured subjectively with a sleep diary and the Athens insomnia scale, and the cognitive performance measured with the neuropsychological batteries. Discussion: CBT-I is not only an effective tool for the treatment of insomnia but also helps to ameliorate cognitive performance

Reduced Systemic Levels of IL-10 Are Associated with the Severity of Obstructive Sleep Apnea and Insulin Resistance in Morbidly Obese Humans

Obstructive sleep apnea (OSA) has been related to elevation of inflammatory cytokines and development of insulin resistance in morbidly obese (MO) subjects. However, it is still unclear whether the systemic concentration of anti-inflammatory mediators is also affected in MO subjects directly related to the severity of OSA and level of insulin resistance. Normal weight and MO subjects were subjected to overnight polysomnography in order to establish the severity of OSA, according to the apnea-hypopnea index (AHI). Blood samples were obtained for estimation of total cholesterol and triglycerides, insulin, glucose, insulin resistance, tumor necrosis factor alpha (TNF-α), interleukin 12 (IL12), and interleukin 10 (IL-10). Serum levels of IL-10 were significantly lower in MO subjects with OSA than in MO and control individuals without OSA. Besides being inversely associated with serum TNF-α and IL-12, decreased IL-10 levels were significantly related to increased AHI, hyperinsulinemia, and insulin resistance. Serum IL-10 is significantly reduced in morbidly obese subjects with severe OSA while also showing a clear relationship with a state of hyperinsulinemia and insulin resistance probably regardless of obesity in the present sample. It may be of potential clinical interest to identify the stimulatory mechanisms of IL-10 in obese individuals with OSA

Sleep and Mental Health Disturbances Due to Social Isolation during the COVID-19 Pandemic in Mexico

The coronavirus disease (COVID-19) that broke out in China in December 2019 rapidly became a worldwide pandemic. In Mexico, the conditions requiring the declaration of a sanitary emergency were reached by the last week of March 2020, and health authorities’ limited mobility and imposed social isolation were the main strategies to keep the virus from spreading. Thus, daily living conditions changed drastically in a few days, generating a stressful situation characterized by an almost complete lack of mobility, social isolation, and forced full-time interactions with family members. Soon, complaints of sleep disturbances, anxiety, and symptoms of depression were reported. The present study reports the results of an online survey performed during the first two months of isolation. Questionnaires exploring sleep disturbances, anxiety, and depression were sent to people who responded to an open invitation. A total of 1230 participants filled out the sleep questionnaire, 812 responded to the anxiety questionnaire, and 814 responded to the depression questionnaire. Both men and women reported poor sleep quality, but women showed a higher proportion (79%) than men (60%); young women were more likely to be affected by social isolation. Concerning anxiety and depression, both sexes reported high similar symptoms. These data suggest that stressful conditions related to social isolation and the economic uncertainty caused by the pandemic may induce mental health disturbances, which may become worse with sleep restriction