[Polysomnography (PSG) for studying sleep disorders]. / Polysomnografi ved utredning av søvnlidelser.

BACKGROUND: Sleeping problems are very common, and many patients need a comprehensive assessment with polysomnography, possibly followed by a sleep latency test. These methods and indications for the tests are described below. METHOD: The article is based on the authors' own literature archives, clinical experience and Retningslinjer for metoder i klinisk neurofysiologi [Guidelines for methodology in clinical neurophysiology] RESULTS: Polysomnography involves monitoring sleep through the course of one night and scoring the stages of sleep on the basis of EEG activity, eye movements and muscular tension. Also recorded are inter alia respiratory variables. Polysomnography followed by a multiple sleep latency test (MSLT) is used when narcolepsy or excessive daytime sleepiness is suspected. If parasomnia is suspected, the examination should include polysomnography, preferably with video recording. If sleep apnoea is suspected in adults, respiratory polygraphy is often sufficient. As a rule, polysomnography is preferable to respiratory polygraphy for studying sleep disorders in children. INTERPRETATION: Sleep disorders take many forms and are dealt with by many different specialities. Good cooperation between the different specialities is necessary to ensure an optimal result for the patients.

Colour vision and light sensitivity in tunnel workers previously exposed to acrylamide and N-methylolacrylamide containing grouting agents.

OBJECTIVES: The aim of the study was to examine possible persisting visual system effects in tunnel workers previously exposed to acrylamide and N-methylolacrylamide during grouting work. MATERIAL AND METHODS: Visual field light sensitivity threshold and colour vision has been examined among 44 tunnel workers 2-10 years after exposure to acrylamide and N-methylolacrylamide containing grouting agents. Forty-four tunnel workers not involved in grouting operations served as control group. Information on exposure and background variables was obtained for all participants from a questionnaire. Visual light sensitivity threshold was measured using Humphrey Visual Field Static Perimeter 740, program 30-2 Fastpack, with red stimuli on white background, and colour vision, using Lanthony D-15 Desaturated Color test. Based on D-15d test results, colour confusion index (CCI), and a severity index (C-index) was calculated. RESULTS: The exposed group had a significantly higher threshold for detecting single stimuli in all parts of the inner 30 degrees of the visual field compared to the control group. The foveal threshold group difference was 1.4 dB (p=0.002) (mean value, both eyes). On the Lanthony 15 Hue Desaturated test, the exposed subjects made more errors in sorting blue colours, and a statistically significant increase in C-index was observed. Surrogate measures for duration and intensity of exposure gave no further improvement of the model. CONCLUSIONS: The results indicate slightly reduced light sensitivity and reduced colour discrimination among the exposed subjects compared to the controls. The findings may be due to previous exposure to acrylamide containing grouts among the tunnel workers.

Nerve conduction, visual evoked responses and electroretinography in tunnel workers previously exposed to acrylamide and N-methylolacrylamide containing grouting agents.

The study examines possible persisting effects on the peripheral nervous system and visual system in tunnel workers previously exposed to acrylamide and N-methylolacrylamide during grouting work. We compared neurophysiological function in 44 tunnel workers previously exposed during grouting operations (2-10 years post exposure), with 49 tunnel workers with no history of exposure to acrylamide. Nerve conduction velocities (NCV), distal delay, F-response and amplitude in median and ulnar nerves of the right arm, peroneal, sural and tibial nerves of the right leg, visual evoked response (VER) and electroretinography (ERG) were measured. VER and ERG were also performed in 24 subjects more recently exposed to acrylamide grout (16 months post exposure). Exposure to acrylamide containing grouts was assessed by questionnaires. A statistically significant reduction in the mean sensory NCV of the sural nerve (p=0.005), as well as a non-significant reduction of sural amplitude was found in the previously exposed group compared to the control group. VER latencies to the onset of the occipital potential (N75) were prolonged in both exposed groups compared to the control group (p<0.05). ERG 30 Hz flicker amplitude was reduced in the recently exposed group compared to the referents (p<0.05). The results indicate slight subclinical, but persistent toxic effects in the sural nerve and the visual system in tunnel workers exposed to N-methylolacrylamide and acrylamide during grouting operations.

CSF hypocretin-1 levels and clinical profiles in narcolepsy and idiopathic CNS hypersomnia in Norway.

OBJECTIVE: To evaluate the relationship between CSF hypocretin-1 levels and clinical profiles in narcolepsy and CNS hypersomnia in Norwegian patients. METHOD: CSF hypocretin-1 was measured by a sensitive radioimmunoassay in 47 patients with narcolepsy with cataplexy, 7 with narcolepsy without cataplexy, 10 with idiopathic CNS hypersomnia, and a control group. RESULTS: Low hypocretin-1 values were found in 72% of the HLA DQB1*0602 positive patients with narcolepsy and cataplexy. Patients with low CSF hypocretin-1 levels reported more extensive muscular involvement during cataplectic attacks than patients with normal levels. Hypnagogic hallucinations and sleep paralysis occurred more frequently in patients with cataplexy than in the other patient groups, but with no correlation to hypocretin-1 levels. CONCLUSION: About three quarters of the HLA DQB1*0602 positive patients with narcolepsy and cataplexy had low CSF hypocretin-1 values, and appear to form a distinct clinical entity. Narcolepsy without cataplexy could not be distinguished from idiopathic CNS hypersomnia by clinical symptoms or biochemical findings.

Effects on the peripheral nervous system of tunnel workers exposed to acrylamide and N-methylolacrylamide.

OBJECTIVES: This study evaluates the possible toxic effects on the peripheral nervous system of tunnel workers exposed to acrylamide and N-methylolacrylamide during grouting work. METHODS: Symptoms and nerve conduction velocities (NCV) were recorded for 24 tunnel workers 4 and 16 months after the cessation of exposure during grouting operations. Fifty tunnel workers not involved in grouting operations served as referents. Exposure was assessed by questionnaires, qualitative exposure indices, and measurements of hemoglobin adducts after the cessation of exposure. RESULTS: The exposed workers reported a higher prevalence of symptoms during grouting work than they did in an examination 16 months later. A statistically significant reduction in the mean sensory NCV of the ulnar nerve was observed 4 months postexposure when compared with the values of the reference group (52.3 versus 58.9 m/s, P = 0.001), and the mean ulnar distal delay was prolonged (3.1 versus 2.5 ms, P = 0.001). Both measures were significantly improved when measured 1 year later. Exposure-related improvements were observed from 4 to 16 months postexposure for both the median (motor and sensory NCV and F-response) and ulnar (sensory NCV, F-response) nerves. A significant reversible reduction in the mean sensory amplitude of the median nerve was also observed, while the mean sensory amplitude of the sural nerve was significantly reduced after 16 months. CONCLUSIONS: The results indicate demyelinating and axonal changes in peripheral nerves of tunnel workers in relation to exposure to N-methylolacrylamide and acrylamide during grouting operations. The changes were slight, mostly subclinical, and most of the effects were reversible, with normalization after 1 year.