Sleep architecture as a candidate for phenotyping sleep bruxism: A narrative physiological review.

BACKGROUND: Sleep bruxism (SB), an oral behaviour in otherwise healthy individuals, is characterised by frequent rhythmic masticatory muscle activity (RMMA) during sleep. RMMA/SB episodes occur over various sleep stages (N1-N3 and rapid eye movement (REM)), sleep cycles (non-REM to REM), and frequently with microarousals. It currently remains unclear whether these characteristics of sleep architecture are phenotype candidates for the genesis of RMMA/SB. OBJECTIVES: This narrative review investigated the relationship between sleep architecture and the occurrence of RMMA as a SB phenotype candidate. METHODS: PubMed research was performed using keywords related to RMMA/SB and sleep architecture. RESULTS: In non-SB and SB healthy individuals, RMMA episodes were most frequent in the light non-REM sleep stages N1 and N2, particularly during the ascending phase of sleep cycles. The onset of RMMA/SB episodes in healthy individuals was preceded by a physiological arousal sequence of autonomic cardiovascular to cortical activation. It was not possible to extract a consistent sleep architecture pattern in the presence of sleep comorbidities. The lack of standardisation and variability between subject complexified the search for specific sleep architecture phenotype(s). CONCLUSION: In otherwise healthy individuals, the genesis of RMMA/SB episodes is largely affected by oscillations in the sleep stage and cycle as well as the occurrence of microarousal. Furthermore, a specific sleep architecture pattern cannot be confirmed in the presence of sleep comorbidity. Further studies are needed to delineate sleep architecture phenotype candidate(s) that contribute to the more accurate diagnosis of SB and treatment approaches using standardised and innovative methodologies.

Suppressing the Morning Cortisol Rise After Memory Reactivation at 4 A.M. enhances Episodic Memory Reconsolidation in Humans.

Evidence from animal and human research shows that established memories can undergo changes after reactivation through a process called reconsolidation. Alterations of the level of the stress hormone cortisol may provide a way to manipulate reconsolidation in humans. Here, in a double-blind, within-subject design, we reactivated a 3-d-old memory at 3:55 A.M. in sixteen men and four women, immediately followed by oral administration of metyrapone versus placebo, to examine whether metyrapone-induced suppression of the morning cortisol rise may influence reconsolidation processes during and after early morning sleep. Crucially, reactivation followed by cortisol suppression versus placebo resulted in enhanced memory for the reactivated episode tested 4 d after reactivation. This enhancement after cortisol suppression was specific for the reactivated episode versus a non-reactivated episode. These findings suggest that when reactivation of memories is immediately followed by suppression of cortisol levels during early morning sleep in humans, reconsolidation processes change in a way that leads to the strengthening of episodic memory traces.SIGNIFICANCE STATEMENT How can we change formed memories? Modulation of established memories has been long debated in cognitive neuroscience and remains a crucial question to address for basic and clinical research. Stress-hormone cortisol and sleep are strong candidates for changing consolidated memories. In this double-blind, placebo-controlled, within-subject pharmacological study, we investigate the role of cortisol on the modulation of reconsolidation of episodic memories in humans. Blocking cortisol synthesis (3 g metyrapone) during early morning sleep boosts memory for a reactivated but not for a non-reactivated story. This finding contributes to our understanding of the modulatory role of cortisol and its circadian variability on reconsolidation, and moreover can critically inform clinical interventions for the case of memory dysfunctions, and trauma and stress-related disorders.

Sleep structure in sleep bruxism: A polysomnographic study including bruxism activity phenotypes across sleep stages.

The aim of the study was to assess sleep structure, phenotypes related to bruxism activity and basic respiratory parameters among a large group of participants with sleep bruxism and without obstructive sleep apnea. Adult participants with clinical suspicion of sleep bruxism and with no other significant medical history were recruited. Video-polysomnography was performed to detect masseter muscles activity. Polysomnographic scoring was performed according to the American Academy of Sleep Medicine Criteria. Finally, 146 participants were included. The participants were divided into three subgroups: severe, mild and no sleep bruxism. There were no differences in total sleep time, sleep latency, sleep efficiency, wake duration after sleep onset, rapid eye movement, and measured respiratory parameters. The severity of sleep bruxism contributed to the increased intensity of all sleep bruxism phenotypes in almost all sleep stages, apart from tonic and mixed activity in non-rapid eye movement stage 3 sleep (slow-wave sleep). Those with bruxism spent more time in rapid eye movement sleep compared to controls; there were no differences in non-rapid eye movement sleep stages. The results confirmed that sleep bruxism does not significantly affect sleep duration, efficiency and continuity (in terms of sleep-wake cycles). Sleep bruxism contributes to a higher percentage of rapid eye movement sleep in the total sleep time. Those with bruxism present more frequent episodes during all stages of sleep; however, in the case of slow-wave sleep, tonic and mixed activity observed in participants with sleep bruxism are comparable to those of healthy people.

[Newer studies on the strong link between sleep and epilepsy: Epilepsy as an epileptic transformation of sleep plastic functions]. / Az alvás és az epilepszia szoros kapcsolatának újabb vizsgálatai: az epilepszia mint az alvási plaszticitásfunkció epilepsziás transzformációja.

Aims - Overview of the new data about the strong link of sleep and epilepsy and conjoining cognitive impairment. Methods - Search for relevant references and summary of our own research activity on the topic. Results - Strong interrealtionship exists between epilepsy and plastic brain functions (memory processing and synaptic homeostasis) and the working modes of NREM sleep. In the most frequent childhood and adult epilepsy networks responsible for plastic functions can be derailed to an epileptic level of excitability, and suffer a transitory or permanent epileptic transformation. Exampling on the three big epilepsies: absence epilepsy; medial temporal lobe epilepsy; and childhood idiopathic focal age dependent epilepsy spectrum we demonstrate the most important features of this epileptic transformation. The association of cognitive impairment to certain sleep dependent epilepsies gains explanation by the epilepsy caused interference with slow wave decline (ICFE) and memory consolidation (MTLE) during NREM sleep. This paper serves also to introduce the concept of sleep dependent system epilepsies. Conclusions - We provide evidences about shared mechanisms among sleep related epilepsies being the derailment of sleep plastic funcions toward exaggerated excitability determined by the inherent possibilities of the signal transduction properties.

Screen-printed ambulatory electrode set enables accurate diagnostics of sleep bruxism.

Currently, definite diagnosis of sleep bruxism requires polysomnography. However, it is restrictedly available, and too cumbersome and expensive for the purpose. The aim of this study was to introduce an ambulatory electrode set and evaluate its feasibility for more cost-effective diagnostics of sleep bruxism. Six self-assessed bruxers (one male, five females; aged 21-58 years) and six healthy controls (four males, two females, aged 21-25 years) underwent a standard polysomnographic study and a concurrent study with the ambulatory electrode set. Bruxism events, cortical arousals and sleep stages were scored for the two montages separately in a random order, and obtained sleep parameters were compared. In addition, the significance of video recording and sleep stage scoring for the diagnostic accuracy of ambulatory electrode set was determined. Ambulatory electrode set yielded similar diagnoses as standard polysomnography in all subjects. However, compared with standard polysomnography the median (interquartile range) tonic bruxism event index was significantly higher in the control group [+0.38 (+0.08 to +0.56) events per hour, P = 0.046], and the phasic bruxism event index was significantly lower in the bruxer group [-0.44 (-1.30 to +0.07) events per hour, P = 0.046]. Exclusion of video recording and both video recording and sleep stage scoring from analysis increased overestimation of the tonic bruxism event index in the control group +0.86 (+0.42 to +1.03) and +1.19 (+0.55 to +1.39) events per hour, P = 0.046 and P = 0.028, respectively], resulting in one misdiagnosed control subject. To conclude, ambulatory electrode set is a sensitive method for ambulatory diagnostics of sleep bruxism, and video recording and sleep stage scoring help reaching the highest specificity of sleep bruxism diagnostics.

An experimental study of adolescent sleep restriction during a simulated school week: changes in phase, sleep staging, performance and sleepiness.

This laboratory study investigated the impact of restricted sleep during a simulated school week on circadian phase, sleep stages and daytime functioning. Changes were examined across and within days and during a simulated weekend recovery. Participants were 12 healthy secondary school students (six male) aged 15-17 years [mean = 16.1 years, standard deviation (SD) = 0.9]. After 2 nights with 10 h (21:30-07:30 hours), time in bed was restricted to 5 h for 5 nights (02:30-07:30 hours), then returned to 10 h time in bed for 2 nights (21:30-07:30 hours). Saliva was collected in dim light on the first and last sleep restriction nights to measure melatonin onset phase. Sleep was recorded polysomnographically, and the Psychomotor Vigilance Task (PVT) and Karolinska Sleepiness Scale were undertaken 3-hourly while awake. Average phase delay measured by melatonin was 3 h (SD = 50 min). Compared to baseline, sleep during the restriction period contained a smaller percentage of Stages 1 and 2 and rapid eye movement (REM) and a greater percentage of Stage 4. PVT lapses increased significantly during sleep restriction and did not return to baseline levels during recovery. Subjective sleepiness showed a similar pattern during restriction, but returned to baseline levels during recovery. Results suggest that sustained attention in adolescents is affected negatively by sleep restriction, particularly in the early morning, and that a weekend of recovery sleep is insufficient to restore performance. The discrepancy between sleepiness ratings and performance may indicate a lack of perception of this residual impairment.

Assessment of the suitability of using a forehead EEG electrode set and chin EMG electrodes for sleep staging in polysomnography.

Recently, a number of portable devices designed for full polysomnography at home have appeared. However, current scalp electrodes used for electroencephalograms are not practical for patient self-application. The aim of this study was to evaluate the suitability of recently introduced forehead electroencephalogram electrode set and supplementary chin electromyogram electrodes for sleep staging. From 31 subjects (10 male, 21 female; age 31.3 ± 11.8 years), sleep was recorded simultaneously with a forehead electroencephalogram electrode set and with a standard polysomnography setup consisting of six recommended electroencephalogram channels, two electrooculogram channels and chin electromyogram. Thereafter, two experienced specialists scored each recording twice, based on either standard polysomnography or forehead recordings. Sleep variables recorded with the forehead electroencephalogram electrode set and separate chin electromyogram electrodes were highly consistent with those obtained with the standard polysomnography. There were no statistically significant differences in total sleep time, sleep efficiency or sleep latencies. However, compared with the standard polysomnography, there was a significant increase in the amount of stage N1 and N2, and a significant reduction in stage N3 and rapid eye movement sleep. Overall, epoch-by-epoch agreement between the methods was 79.5%. Inter-scorer agreement for the forehead electroencephalogram was only slightly lower than that for standard polysomnography (76.1% versus 83.2%). Forehead electroencephalogram electrode set as supplemented with chin electromyogram electrodes may serve as a reliable and simple solution for recording total sleep time, and may be adequate for measuring sleep architecture. Because this electrode concept is well suited for patient's self-application, it may offer a significant advancement in home polysomnography.

Objective and Subjective Outcomes Following Maxillomandibular Advancement Surgery for Treatment of Patients With Extremely Severe Obstructive Sleep Apnea (Apnea-Hypopnea Index >100).

PURPOSE: It is important for patients and treating clinicians to know whether maxillomandibular advancement (MMA) surgery is effective when treating patients with obstructive sleep apnea syndrome (OSAS) and an extremely high apnea-hypopnea index (AHI) score. The purpose of this study was to evaluate objective and subjective treatment outcomes after MMA surgery for the treatment of OSAS in patients with a preoperative AHI score higher than 100. PATIENTS AND METHODS: This retrospective study included all patients who underwent MMA surgery for OSAS by members of the Department of Oral and Maxillofacial Surgery, QEII Health Science Centre (Halifax, Nova Scotia, Canada) from November 1996 through February 2014. Objective data were available in the form of polysomnographs (PSGs) obtained before and a minimum of 6 months after surgery. Patients completed a self-administered questionnaire before and after surgery regarding snoring, witnessed apneas, continuous positive airway pressure (CPAP) use, daytime somnolence, and overall satisfaction. RESULTS: Two hundred sixty-five patients had MMA surgery, of which 13 had pre- and postoperative PSGs. PSGs showed a mean preoperative AHI score of 117.9 and a mean postsurgical AHI score of 16.1 (P < .001). Pre- and postoperative questionnaires were available for 9 patients. After surgery, 7 patients denied having any daytime sleepiness and 2 patients reported minimal daytime sleepiness. The mean preoperative Epworth Sleepiness Scale score was 12.9 (standard deviation [SD], 5.5), whereas the postoperative mean score was 5.0 (SD, 4.1; P = .004). Before surgery, all 9 patients reported loud snoring and 8 reported witnessed apneas. After surgery, 2 patients reported minimal snoring and only 1 patient continued to have witnessed apneas. Six patients used CPAP preoperatively and only 1 patient continued to use CPAP after surgery. CONCLUSIONS: The results of this study suggest that MMA surgery for treatment of extremely severe OSA can be a highly successful 1-stage surgery, which eliminates the use of CPAP, improves subjective outcomes, and considerably decreases the AHI score.

Sleep bruxism: an updated review of an old problem.

Objective To provide an update on what is known about bruxism and some of the major clinical highlights derived from new insights into this old problem in dentistry. Materials and methods A selective, non-systematic but critical review of the available scientific literature was performed. Results There are two main different types of bruxism, which are related to different circadian periods (sleep and awake bruxism) that may differ in terms of pathophysiology, but they share some common signs and symptoms. Approximately one out of 10 adult individuals may suffer from bruxism, but not all bruxers may need treatment. Bruxism is complicated to diagnose in the clinic and self-report of bruxism may not necessarily reflect the true presence of jaw muscle activity. Better understanding has been acquired of bruxism relationships with sleep stages, arousal responses and autonomic function with the help of polysomnography and controlled sleep studies. Meanwhile, there is still much more to learn about awake bruxism. With the available scientific knowledge it is possible to systematically assess the effects of bruxism and its potential risk factors for oral and general health. Moreover, we can be aware of the realistic possibilities to manage/treat the patient suffering from bruxism. Conclusion Bruxism is a parafunctional activity involving the masticatory muscles and probably it is as old as human mankind. Different ways have been proposed to define, diagnose, assess the impact and consequences, understand the pathophysiology and treat or manage bruxism. Despite the vast research efforts made in this field, there are still significant gaps in our knowledge.

Chronotype in patients with epilepsy: A controlled study in 60 subjects with late-onset focal epilepsy.

Studies based on self-administered questionnaires indicate that most patients with epilepsy are morning-oriented. We aimed to investigate chronotype in patients with epilepsy with late-onset focal epilepsy by combining subjective data with dim light melatonin onset (DLMO) as an objective marker of the circadian phase. Sixty adult patients (mean age 46.5±13.8; 27 males) with late-onset focal epilepsy under pharmacological treatment were prospectively studied. Subjective chronotype was determined using the Morningness-Eveningness Questionnaire (MEQ) and circadian phase through analysis of salivary melatonin secretion, considering 3pg/ml as the dim light melatonin onset (DLMO) threshold. The mean MEQ score was significantly higher in the patients with epilepsy than in the controls, and significantly, more patients had a MEQ score indicative of the morning type (50.0% vs 30.0%, p=0.02). However, no significant differences were found in mean time of DLMO (21:38±01:21 vs 21:26±01:03; p=ns), and DLMO time was in the range indicative of an intermediate chronotype in both patients and controls. Sleep onset and sleep offset phase angles were significantly shorter in the patients. Patients whose global MEQ score identified them as morning types were significantly older than those with an intermediate or evening chronotype, and they had less social jet lag. No difference in epilepsy features and treatments was found between morning-oriented and nonmorning-oriented patients. Our analyses showed that the patients with epilepsy tended to be morning-oriented and to perceive themselves as morning types, even though this was not reflected in their DLMO values which did not differ significantly from those of controls and mostly fell within the intermediate chronotype range. Several factors may considerably influence subjective chronotype. We speculate that, in patients with epilepsy, the disease itself, prompting certain lifestyle choices, including a regular sleep schedule and early bedtime, may induce morning orientation and a morning-type self-perception.

Linear and volumetric airway changes after maxillomandibular advancement for obstructive sleep apnea.

PURPOSE: Maxillomandibular advancement (MMA) surgery is a well-established treatment of obstructive sleep apnea (OSA). Although many studies have assessed the efficacy of MMA in treating OSA, very few studies have quantified the magnitude of its changes to airway morphology. Therefore, the present study investigated the linear and volumetric morphologic changes that occur in the pharyngeal airway after treatment of OSA using MMA. MATERIALS AND METHODS: A retrospective cohort study of patients with OSA treated from May 2010 to February 2014 was performed. Each patient underwent preoperative clinical and fiberoptic nasopharyngoscopic examinations. Pre- and postoperative polysomnograms, lateral cephalograms, and cone-beam computed tomography scans were acquired. The radiographic images were used to determine the linear and volumetric airway measurements. The time and magnitude of skeletal movement were used as the independent variables. The dependent variables included assessment of success or cure, apnea hypopnea index (AHI), cephalometric changes, Epworth score, rapid eye movement sleep, body mass index, and various airway morphologic parameters. RESULTS: A total of 15 patients (13 men and 2 women) participated in the present study. The surgical success and cure rate was 73.33% and 40.00%, respectively. Statistically significant improvements were found in the airway total volume, minimal cross-sectional area, anteroposterior and lateral dimensions, airway index, airway length, posterior airway space morphology, AHI, and Epworth sleepiness score. CONCLUSIONS: MMA is a highly successful surgical treatment of OSA that improves airway morphology and sleep quality. MMA results in a shorter and broader airway and associated improvements in the AHI.

Effect of Modified Fujita Technique Uvulopalatoplasty on Oxidative DNA Damage Levels in Patients With Obstructive Sleep Apnea Syndrome.

Snoring is a social hindrance problem and it can cause life threatening problems. Because of this it must be taken seriously and must be treated. Although there are many ways for treating this problem, still uvulopalatopharngoplasty (UPPP) which is an accepted classical method maintains its importance. Antioxidant status in patients with snoring have been investigated. All studies investigated the effect of CPAP treatment on the level of antioxidant agents. In this study we have examined the effect of UPPP on the level of antioxidant agents in patients with snoring.

Could transient hypoxia be associated with rhythmic masticatory muscle activity in sleep bruxism in the absence of sleep-disordered breathing? A preliminary report.

Sleep bruxism (SB) is a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth during sleep. Sleep bruxism activity is characterised by rhythmic masticatory muscle activity (RMMA). Many but not all RMMA episodes are associated with sleep arousal. The aim of this study was to evaluate whether transient oxygen saturation level change can be temporally associated with genesis of RMMA/SB. Sleep laboratory or home recordings data from 22 SB (tooth grinding history in the absence of reported sleep-disordered breathing) and healthy subjects were analysed. A total of 143 RMMA/SB episodes were classified in four categories: (i) no arousal + no body movement; (ii) arousal + no body movement; (iii) no arousal + body movement; (iv) arousal + body movement. Blood oxygen levels (SaO2 ) were assessed from finger oximetry signal at the baseline (before RMMA), and during RMMA. Significant variation in SaO2 over time (P = 0·001) was found after RMMA onset (+7 to +9 s). No difference between categories (P = 0·91) and no interaction between categories and SaO2 variation over time (P = 0·10) were observed. SaO2 of six of 22 subjects (27%) remained equal or slight increase after the RMMA/SB onset (+8 s) compared to baseline; 10 subjects (45%) slightly decreased (drop 0·01-1%) and the remaining (27%) decreased between 1% and 2%. These preliminary findings suggest that a subgroup of SB subjects had (i) a minor transient hypoxia potentially associated with the onset of RMMA episodes, and this (ii) independently of concomitant sleep arousal or body movements.

Sleep bruxism associated with obstructive sleep apnea syndrome in children.

AIMS: Sleep bruxism (SB) and obstructive sleep apnea syndrome (OSAS) are often observed in children and may have several health implications. The aim of this paper is to evaluate their prevalence and to test for possible associations between these two conditions. METHODOLOGY: The sample consisted of 496 children randomly selected among the preschoolers of Taubaté, Brazil; 249 (50·2%) were boys and 247 (49·8%) were girls. Diagnoses of SB and OSAS were made by clinical examinations and questionnaires filled out by the children's parents in a cross-sectional design. Analysis of variance and Chi-square tests were applied to verify possible association among the variables in question. RESULTS: The average age was 4·49 years (SD: ±1·04 years). A total of 25·6% were diagnosed with SB, while 4·83% were diagnosed with OSAS, and only 2·82% presented both conditions. A statistical association was found between SB and OSAS (P<0·001; Chi-square test): 11·03% of subjects with SB also presented with OSAS, and 97·18% of subjects without SB did not present with OSAS. No association was found among children's gender and age and the presence of SB or OSAS. CONCLUSIONS: Within the limits of this study, SB was associated with OSAS.

Morphology and function: MR pineal volume and melatonin level in human saliva are correlated.

PURPOSE: To investigate the relation between circadian saliva melatonin levels and pineal volume as determined by MRI. Plasma melatonin levels follow a circadian rhythm with a high interindividual variability. MATERIALS AND METHODS: In 103 healthy individuals saliva melatonin levels were determined at four time points within 24 h and MRI was performed once (3.0 Tesla, including three-dimensional T2 turbo spin echo [3D-T2-TSE], susceptibility-weighted imaging [SWI]). Pineal volume as well as cyst volume were assessed from multiplanar reconstructed 3D-T2-TSE images. Pineal calcification volume tissue was determined on SWI. To correct for hormonal inactive pineal tissue, cystic and calcified areas were excluded. Sleep quality was assessed with the Landeck Inventory for sleep quality disturbance. RESULTS: Solid and uncalcified pineal volume correlated to melatonin maximum (r = 0.28; P < 0.05) and area under the curve (r = 0.29; P < 0.05). Of interest, solid and uncalcified pineal volume correlated negatively with the sleep rhythm disturbances subscore (r = -0.17; P < 0.05) despite a very homogenous population. CONCLUSION: Uncalcified solid pineal tissue measured by 3D-T2-TSE and SWI is related to human saliva melatonin levels. The analysis of the sleep quality and pineal volume suggests a linkage between better sleep quality and hormonal active pineal tissue.

Mastication movements and sleep quality of patients with myofascial pain: occlusal device therapy improvements.

STATEMENT OF PROBLEM: Patients with myofascial pain experience impaired mastication, which might also interfere with their sleep quality. PURPOSE: The purpose of this study was to evaluate the jaw motion and sleep quality of patients with myofascial pain and the impact of a stabilization device therapy on both parameters. MATERIAL AND METHODS: Fifty women diagnosed with myofascial pain by the Research Diagnostic Criteria were enrolled. Pain levels (visual analog scale), jaw movements (kinesiography), and sleep quality (Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index) were evaluated before (control) and after stabilization device use. Range of motion (maximum opening, right and left excursions, and protrusion) and masticatory movements during Optosil mastication (opening, closing, and total cycle time; opening and closing angles; and maximum velocity) also were evaluated. Repeated-measures analysis of variance in a generalized linear mixed models procedure was used for statistical analysis (α=.05). RESULTS: At baseline, participants with myofascial pain showed a reduced range of jaw motion and poorer sleep quality. Treatment with a stabilization device reduced pain (P<.001) and increased both mouth opening (P<.001) and anteroposterior movement (P=.01). Also, after treatment, the maximum opening (P<.001) and closing (P=.04) velocities during mastication increased, and improvements in sleep scores for the Pittsburgh Sleep Quality Index (P<.001) and Epworth Sleepiness Scale (P=.04) were found. CONCLUSION: Myofascial pain impairs jaw motion and quality of sleep; the reduction of pain after the use of a stabilization device improves the range of motion and sleep parameters.

A pilot study to compare patient perception of obstructive sleep apnea treatment with CPAP or appliance therapy.

STATEMENT OF PROBLEM: The continuous positive airway pressure (CPAP) device yields optimum results in treating mild to moderate obstructive sleep apnea (OSA). However it may be bulky, noisy, and difficult to sleep with for the patient. Mandibular advancement devices (MAD) have shown better compliance but at the expense of lesser efficiency. PURPOSE: The purpose of this study was to evaluate the patient's posttreatment subjective perception of the effectiveness of 2 common treatments of OSA. MATERIAL AND METHODS: Thirty-two patients diagnosed with OSA filled out the Epworth Sleepiness Scale and Berlin Sleep Quality Questionnaire before treatment and again at 4 to 6 weeks after treatment. Two groups were formed (n=16 each); one group was treated with MAD and the other with CPAP. The data obtained were recorded and compared with the Mann Whitney U test (between groups) and the Wilcoxon signed rank test (within groups) (α=.05). RESULTS: The analysis showed that the participants perceived significant posttreatment improvement (P<.05) for all variables of the Berlin Sleep Quality Questionnaire and the Epworth Sleepiness Scale for both the MAD and CPAP groups. CONCLUSIONS: According to the questionnaires, participants perceived significant improvement in OSA symptoms after treatment in both the MAD and CPAP groups. The study was inconclusive as to whether improvement of perceived symptoms was higher with MAD or CPAP.

Lamentations in the night: A systematic review on catathrenia.

Catathrenia is a loud expiratory moan during sleep that is a social embarrassment and is sometimes confused with central apnea on polysomnography. It affects about 4% of adults, but cases are rarely referred to sleep centers. Catathrenia affects males and females, children and adults, who are usually young and thin. A "typical" catathrenia begins with a deep inhalation, followed by a long, noisy exhalation, then a short, more pronounced exhalation, followed by another deep inhalation, often accompanied by arousal. The many harmonics of the sound indicate that it is produced by the vocal cords. It is often repeated in clusters, especially during REM sleep and at the end of the night. It does not disturb the sleepers, but their neighbors, and is associated with excessive daytime sleepiness in one-third of cases. The pathophysiology and treatment of typical catathrenia are still unknown. Later, a more atypical catathrenia was described, consisting of episodes of short (2 s), regular, semi-continuous expiratory moans during NREM sleep (mainly in stages N1 and N2) and REM sleep, often in people with mild upper airway obstruction. This atypical catathrenia is more commonly reduced by positive airway pressure and mandibular advancement devices that promote vertical opening.

Evening ambient light exposure can reduce circadian phase advances to morning light independent of sleep deprivation.

Short sleep/dark durations are common in modern society. We investigated if exposure to additional evening ambient light, often associated with later bedtimes and short sleep, reduces circadian phase advances to morning bright light. Twelve healthy subjects participated in two conditions that differed in the distribution of sleep before exposure to morning bright light. Subjects had a consolidated 9-h night time sleep opportunity, or a 3-h daytime nap followed by a 6-h night time sleep opportunity, each before morning bright light. Eight of the 12 subjects obtained similar amounts of sleep in both conditions, and yet still showed significant reductions in phase advances with 6-h nights (1.7 versus 0.7 h, P < 0.05). These results suggest that the exposure to additional evening ambient light often associated with short sleep episodes can significantly reduce phase advances to morning light, and may therefore increase the risk for circadian misalignment.

Combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty decrease apnea hypopnea index and subjective daytime sleepiness in obstructive sleep apnea.

PURPOSE: The objective and subjective outcomes of combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures have not been evaluated. This study was conducted to evaluate postoperative changes in the apnea hypopnea index (AHI) and subjective daytime sleepiness with this combination of procedures in the surgical management of obstructive sleep apnea (OSA). PATIENTS AND METHODS: This was a retrospective cohort analysis of patients who had undergone combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty performed at Allegheny General Hospital (Pittsburgh, PA) from July 1, 2006 through December 31, 2008 for polysomnogram-confirmed OSA. Inclusion criteria included patients who had undergone the combined elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures with preoperative and minimum 6-month postoperative AHI and Epworth Sleepiness Scale (ESS). Statistical significance between mean differences of pre- and postoperative AHI and ESS was determined with the 2-tailed paired t test and 95% confidence intervals. RESULTS: Thirteen male patients (average age, 43.0 ± 2.4 yr; average follow-up, 18.0 ± 3.6 months) were included in this study. There were statistically significant differences between mean pre- and postoperative AHI (28.3 vs 12.1; P < .05; mean change, -16.2; 57.2% decrease) and ESS (15.2 vs 6.3; P < .05; mean change, -8.9; 58.6% decrease). CONCLUSION: The combined mandibular elliptical window genioglossus advancement, hyoid bone suspension, and uvulopalatopharyngoplasty procedures for the treatment of OSA decrease AHI and subjective daytime sleepiness.