[Effect of partial and generalised epileptic seizures on sleep architecture in rats]. / Efecto de las crisis epilépticas parciales y generalizadas sobre la arquitectura del sueño en ratas.

INTRODUCTION: It is a well-known fact that epileptic seizures disrupt sleep, yet little information is available about sleep disorders according to the type of epileptic seizures. MATERIALS AND METHODS: The sleep architecture of rats was evaluated in polysomnography recordings 36 hours after inducing partial and generalised epileptic seizures in them. The epileptic seizures were induced by applying 50-100 IU of sodium G penicillin in the amygdala of the temporal lobe. RESULTS: Partial and generalised seizures triggered an increase in the latency of slow wave sleep (SWS) and rapid eye movement (REM) sleep. The number of episodes of the phases of wakefulness, SWS and REM sleep was reduced and the mean duration of the episodes of wakefulness and SWS increased, while that of REM sleep diminished. The total percentage of REM sleep diminished significantly. During the first period of light the partial and generalised seizures triggered an increase in wakefulness and a reduction in the phases of SWS and REM sleep. In the period of darkness, the SWS increased and wakefulness decreased, while there were no changes in REM sleep. In the second period of light, the percentages of the phases of wakefulness and SWS returned to control values and the percentage of REM sleep continued to be reduced. CONCLUSIONS: Changes in the structuring of sleep depend on the type of epileptic seizure that presents. Generalised epileptic seizures caused greater deterioration in REM sleep.

TITLE: Efecto de las crisis epilepticas parciales y generalizadas sobre la arquitectura del sueño en ratas.Introduccion. La alteracion del sueño producido por las crisis epilepticas se conoce; sin embargo, aun se tiene poca informacion de la alteracion en el sueño por el tipo de crisis epileptica. Materiales y metodos. Se evaluo la arquitectura del sueño de ratas en registros polisomnograficos de 36 horas tras inducirles crisis epilepticas parciales y generalizadas. Para la induccion de las crisis epilepticas se aplicaron in situ 50-100 UI de penicilina G sodica en la amigdala del lobulo temporal. Resultados. Las crisis parciales y generalizadas provocaron el aumento en la latencia del sueño de ondas lentas (SOL) y sueño de movimiento oculares rapidos (MOR). El numero de episodios de las fases de vigilia, SOL y sueño MOR disminuyo y la duracion media de los episodios de la vigilia y del SOL aumento, mientras que la del sueño MOR disminuyo. El porcentaje total del sueño MOR disminuyo significativamente. Durante el primer periodo de luz, las crisis parciales y generalizadas provocaron el incremento de la vigilia y la reduccion de las fases del SOL y sueño MOR. En el periodo de oscuridad, aumento el SOL, disminuyo la vigilia y no hubo cambios en el sueño MOR. En el segundo periodo de luz los porcentajes de las fases de vigilia y SOL regresaron a los valores control y el porcentaje del sueño MOR continuo disminuido. Conclusion. Los cambios en la organizacion del sueño dependen del tipo de crisis epileptica que se presenta. Las crisis epilepticas generalizadas provocaron mayor deterioro en el sueño MOR.

Sleep desaturation and its relationship to lung function, exercise and quality of life in LAM.

BACKGROUND: Lymphangioleiomyomatosis (LAM) is characterised by progressive airway obstruction and hypoxaemia in young women. Although sleep may trigger hypoxaemia in patients with airway obstruction, it has not been previously investigated in patients with LAM. METHODS: Consecutive women with lung biopsy proven LAM and absence of hypoxaemia while awake were evaluated with pulmonary function test, echocardiography, 6-min walk test, overnight full polysomnography, and Short Form 36 health-related quality-of-life questionnaire. RESULTS: Twenty-five patients with (mean±SD) age 45±10 years, SpO(2) awake 95%±2, forced expiratory volume in the first second (median-interquartile) FEV(1)(% predicted) 77 (47-90) and carbonic monoxide diffusion capacity, DL(CO) (%) 55 (34-74) were evaluated. Six-minute walk test distance and minimum SpO(2) (median-interquartile) were, respectively, 447m (411-503) and 90% (82-94). Median-interquartile apnoea-hypopnoea index was in the normal range 2 (1-5). Fourteen patients (56%) had nocturnal hypoxaemia (10% total sleep time with SpO(2) <90%), and the median sleep time spent with SpO(2) <90% was 136 (13-201)min. Sleep time spent with SpO(2) <90% correlated with the residual volume/total lung capacity ratio (r(s)=0.5, p: 0.02), DL(CO) (r(s)=-0.7, p: 0.001), FEV(1) (r(s)=-0.6, p: 0.002). Multivariate linear regression model showed that RV/TLC ratio was the most important functional variable related to sleep hypoxaemia. CONCLUSION: Significant hypoxaemia during sleep is common in LAM patients with normal SpO(2) while awake, especially among those with some degree of hyperinflation in lung function tests.

Obesity, diabetes and OSAS induce of sleep disorders: exercise as therapy.

Sleep is an integral part of good health. Sleep disorders and variations in sleep habits are associated with a low-grade inflammatory status, which may be either a cause or consequence of other conditions, including obesity, diabetes and cardiovascular disease. Several strategies are available to counteract these conditions including continuous positive airway pressure (CPAP), pharmacological and nutritional interventions, and even surgery. At present, our group is investigating the effect of chronic endurance exercise on sleep alterations.

Late-onset, "Gastaut type", childhood occipital epilepsy: an unusual evolution.

We report on two girls and one boy with clinical and electroencephalographic features of late-onset childhood epilepsy with occipital paroxysms of the "Gastaut type", showing an unusual evolution. Neurological examination and brain imaging were normal in all three. At the age of 7.5 years, eight years and ten years respectively, the three children presented with episodes of visual symptoms when awake, and in one of them, the seizures were occasionally followed by oculocephalic deviation. The interictal EEG showed bilateral occipital spike-wave activated by eye closing. In two patients, the occipital seizures had been immediately followed by typical absences, since onset; in the other patient, five months after onset. The ictal EEG showed irregular bilateral occipital spike-wave discharges during the visual symptoms, followed by generalized spike-wave activity during the typical absences. The typical absences were activated by hyperventilation; the EEG did not show continuous spikes and waves during slow sleep. These three patients, with typical electroclinical features of "Gastaut type", childhood occipital epilepsy, demonstrated an evolution which, to our knowledge, has not been previously described. We investigated whether this unusual, age-dependent evolution was due to secondary bilateral synchrony or if these electroclinical features represent two types of idiopathic epileptic syndromes in the same patients.

[Prevalence of asthma in Cuban adolescents by different clinical criteria]. / Prevalencia de asma en adolescentes cubanos por diferentes criterios clínicos.

BACKGROUND: Despite of the knowledge about asthma, its diagnosis is clinical and its prevalence depends on the case criterion. Several methodologies have been applied to determine its prevalence; the International Study of Asthma and Allergies in Childhood (ISAAC) is the newest, although some inconsistencies have been attributed to their results. OBJECTIVE: To estimate the prevalence of asthma according to five diagnostic criteria and according to respiratory symptoms in order to contribute to improve the diagnosis quality. MATERIAL AND METHODS: Data of the first phase of the ISAAC study made at the Centro Cubano Playa-Marianao in 2003 were collected. Three thousand twenty-six children of 13 to 14 years of age answered a survey, and prevalence of established criteria was estimated; confidence intervals were used to compare them. Estimations were presented with 95% of confidence; the chi square test and the odds ratio were applied for prevalence rates by gender. RESULTS: When comparing all the prevalences among different criteria, those corresponding to criteria I and II were statistically significant. Criterion I was the least discriminatory and criterion V had the highest power to discriminate. Criterion III offered an intermediate value of prevalence, with a proper level to discern. The first three criteria had higher prevalences in women, with statistically significant values among genders (p = 0.002, p = 0.045 and p = 0.008, respectively). CONCLUSIONS: Using a criterion that could include several symptoms, especially in low income-countries, where hospitals do not have current and expensive diagnostic methods, would be useful and would contribute to diminish the diagnostic error.

Sleep organization in children with partial refractory epilepsy.

Although it is currently known that sleep can influence epilepsy and epilepsy can influence sleep organization, few data have been published on this mutual interaction concerning the pediatric population. The objective of this study was to verify the eventual presence of sleep alterations in children with partial refractory epilepsy. Seventeen patients with partial refractory epilepsy were submitted to whole-night polysomnography as part of their epilepsy investigation. Polysomnographic recordings were performed on a digital video-electroencephalography (EEG) system and consisted of the registration of EEG (24 channels), electro-oculogram, electromyogram, electrocardiogram, and nasal airflow and abdominal respiratory movements. Sleep stages were visually scored following standard criteria, and ictal events were classified according to the international classification of seizures. The patients were also subdivided into two subgroups based on the presence or absence of ictal episodes during the recording night. The results concerning sleep organization were compared with those obtained from a normal control group. The analysis of the sleep parameters showed a reduction of total time in bed and total sleep time in both subgroups of epileptic children; there was a higher number of stage shifts per hour in the control group than in both epileptic subgroups. The percentage of stage 2 shifts is significantly reduced in patients with epilepsy and seizures during the night and the percentage of stage 3 to 4 shifts is increased. Nonsignificant differences are evident for the number of awakenings per hour and the percentage of stage 1 shifts. The percentage of rapid eye movement (REM) sleep is reduced, and first REM latency is increased in both epileptic subgroups, compared with normal controls, without statistical significance. Nine of 17 patients had seizures during the polysomnographic recording; nocturnal ictal events occurred mostly during non-REM sleep stage 2. Our results show that patients with partial refractory epilepsies have only mild sleep structure abnormalities, and this can be considered as an effect of the epileptic syndrome per se or as a result of the chronic antiepilepsy drug treatment.