French Sleepiness Scale for Adolescents-8 items: A discriminant and diagnostic validation.

The objective of the present study was to validate the Short Version of French Sleepiness Scale for Adolescents (FSSA) with eight items (FSSA8). METHODS: A total of 384 adolescents, aged between 12 and 18 years, completed the FSSA8. These included 269 nonclinical adolescents and 115 adolescents admitted for overnight polysomnography and Multiple Sleep Latency Test (MSLT) because of suspected hypersomnia (85 patients with narcolepsy and 30 with other sleep disorders). Item response theory (IRT) assumptions were tested and psychometric properties were analysed. Matching on sex ratio and age was conducted to estimate concurrent criterion, diagnostic validity and cut-offs. RESULTS: IRT assumptions were validated confirming the one-dimensionality of the FSSA8. The latent continuum sleepiness for which the scale and its items are reliable encompassed most of the clinical subjects. FSSA8 is weakly correlated with MSLT. Distribution of scores for the nonclinical group and the clinical group differed significantly; the FSSA8 had very good screening validity in sleep disorders. The cut-off was seven points. CONCLUSION: The FSSA8 appeared to be more reliable for patients than for nonclinical participants and to be a good tool for screening excessive daytime sleepiness in sleep disorders.

[Diagnostic criteria for obstructive sleep apnea syndrome in adolescent]. / Critères diagnostiques des troubles respiratoires obstructifs du sommeil de l'adolescent.

The obstructive sleep apnoea syndrome (OSAS) affects 1-4% of adolescents. It represents a transitional stage between paediatric and adult OSA and is characterized by specific symptoms. BACKGROUND: The persistence of childhood OSAS during adolescence is not frequent. Risk factors are male sex, obesity and a history of tonsillectomy or adenoidectomy. Symptoms may be misleading such as tiredness and depressive disorders. In adolescence, untreated OSAS may result in neuro-behavioural and cognitive deficits, systemic inflammation, cardiovascular and metabolic disorders. The French Society of Research and Sleep Medicine organized a meeting on OSAS in adolescents. A multidisciplinary group of specialists (pulmonologists, pediatricians, ENT and maxillo-facial surgeons, dentofacial orthopedists/orthodontists, myofunctional therapists and sleep specialists) exchanged their experience, discussed publications and drew up a consensus document on the diagnosis and polysomnographic criteria for OSAS in adolescents. They proposed a practical diagnostic guideline and follow-up for these adolescents. OUTLOOK AND CONCLUSION: A good knowledge of the particularities of this pathology by the physician will lead to an early diagnosis, propose adapted multifactorial treatments and avoid the deleterious consequences of this pathology at adult age.

[Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea]. / Diagnostic du syndrome d'apnée obstructive du sommeil chez l'enfant (2­18 ans) : place de la polysomnographie et de la polygraphie ventilatoire.

The French Society of Research and Sleep Medicine (SFRMS) organized a meeting on obstructive sleep apnea syndrome (OSAS) in children. A multidisciplinary group of specialists (pulmonologists, ENT surgeons, pediatricians, neurophysiologists, sleep specialists) drew up a consensus document on the value of electrophysiological recordings in the diagnosis of OSAS in children. Technical considerations and recommended sensors, respiratory event definitions, and scoring criteria are presented according to the 2012 and 2014 recommendations of the American Academy of Sleep Medicine (AASM). Polysomnographic criteria for sleep-disordered breathing in children and the French National Authority for Health guidelines for indications of polysomnographic studies were reported. Relevance and limits of in-lab PSG, home PSG, and respiratory polygraphy were presented and guidelines were proposed to improve the diagnosis and follow-up of these children.

[Sleep talking]. / La somniloquie.

Sleep talking is very common in the general population. Its prevalence remains stable from childhood through adulthood. Sleep talking is often associated with other parasomnias: sleep walking, sleep terrors or REM sleep behavior disorders. It may arise from either REM or non REM sleep, when associated with REM sleep it is more comprehensible and often associated with clear sentences and recall of sleep mentation. Sleep talking is a benign entity and does not require any treatment; however an exceptional organic cause or psychopathology should be suspected if the onset is late (after 25 years); if the mental content is too violent or too emotional.

The sleep tutorial.

A multimedia Sleep tutorial for General Practitioners was implemented from scratch. The implementation had into account the following features: 1) Specific needs of GPs evaluated in 3 different countries, related with Tutorial contents and technical features; 2) Multinational authorship from European experts; 3) Multilingual possibilities; 4) User friendliness and easy navigation. The tutorial was implemented and tested and its gama version is now available for commercialization.

[Electroencephalography of the premature and term newborn. Maturational aspects and glossary]. / Electroencéphalographie du nouveau-né prématuré et à terme. Aspects maturatifs et glossaire.

From the first publication of C. Dreyfus-Brisac and N. Monod, a strong tradition combined with tremendous development of neonatal EEG has taken place in France. After 3 years of collaborative work, 12 clinical neurophysiologists trained at the Port-Royal medical school in Paris detail in this paper the currently available neonatal EEG recording techniques. They have synthesized the criteria of maturational state analysis and have defined the normal and pathological neonatal EEG patterns, including descriptions already present in the French as well as the English literature. In this review one may find a complete description of neonatal EEG patterns according to the states of vigilance and to gestational age. Furthermore, definitions of all normal and pathological patterns are provided in a glossary. Both chapters are illustrated by numerous figures. This detailed terminology in neonatal EEG should allow a better homogeneity in EEG reports, and could lead to multicentric studies on normal, unusual or pathological patterns, according to etiology. Although based on analogic EEG data, this work can equally be applied to digitized EEG tracings.

[Diurnal and nocturnal paroxysmal dyskinesia in young children: a new entity?]. / Dyskinésie paroxystique diurne et nocturne du jeune enfant: une nouvelle entité?

Paroxysmal dyskinesias are intermittent attacks of involuntary hyperkinetics abnormal movements. Among paroxysmal dyskinesias were individualized three entities: paroxysmal kinesigenic choreoathetosis, paroxysmal choreoathetosis of Mount and Reback, hypnogenic paroxysmal dystonia. New classifications are based upon the circumstances of occurrence, the duration of attacks and their etiology. We report here two observations of idiopathic non familial paroxysmal dyskinesias in three-year-old children. Both were seen first in consultation for falls and nocturnal motor agitation. The attacks were paroxysmal jerky "puppet-like" movements lasting from 20 seconds to 15 minutes. They could occur during non REM sleep, during the day, at rest, after a sudden movement, or during prolonged exercise. Carbamazepine was inefficient. These cases were not classifiable according to the classical criteria and could constitute a new entity. Moreover, some sleep-EEG showed abnormal patterns (frontal rapid rhythms, central spikes in one case) and led us to discuss the pathophysiology of this episodic movements disorder, and its relation with frontal partial epilepsy.

Sleep ontogenesis revisited: a longitudinal 24-hour home polygraphic study on 15 normal infants during the first two years of life.

The sleep organization of 15 normal infants (seven boys, eight girls) was studied at their homes during six 24-hour periods, i.e. at 3, 6, 9, 12, 18, and 24 months of age, using the Oxford Medical System. Sleep states and stages were scored visually at 30-second intervals, according to Rechtschaffen and Kales' criteria, adapted for children by Guilleminault. All sleep parameters were analyzed for the entire 24-hour period, i.e. during both the nocturnal and the diurnal part of the nycthemere. The results showed a continuous decrease in total sleep time, rapid eye movement (REM) sleep, and indeterminate sleep, and also an increase in waking time, quiet sleep, and stages 1 and 2 sleep. Except for slow-wave sleep, which remained very stable for the different ages, analysis of variance applied to the data showed clear age and day-night effects on sleep ontogenesis. Modifications with age were more precocious and more pronounced for the diurnal part of the nycthemere, especially as regards REM sleep. For the nocturnal part, there was a significant increase in sleep efficiency and in the length of the REM period after 12 months of age, while total sleep duration and number of awakenings decreased. In addition to normative data for clinical use, this study provides three new interesting results related to the maturation of sleep mechanisms and functions: 1) the high stability of the percentage of slow-wave sleep along these 2 years, 2) the presence (from 12 months of age) of a stage 2/REM sleep ratio equal to one, and a sleep change occuring earlier, during the diurnal rather than the nocturnal part of the nycthemere. The first two points could be regarded as indexes of sleep maturation reflecting developmental and neurophysiological changes in central nervous system structures. The third point underlines the importance of the circadian rhythm and the concept of "experience" in the maturation of sleep.

[Parasomnias]. / Parasomnies.

Parasomnias are classified as dysfunctions associated with sleep, sleep stages, or partial arousals from sleep. The main part of this article is devoted to the parasomnias which occur in slow wave sleep and correspond to a partial arousal during this state, that is: night terrors, confusional arousals and somnambulism. The diagnosis of parasomnias is done on a very precise description of the behavior and on its time of occurrence during the night, the notion of a familial history of parasomnias is also important. Management depends on the age, the frequency of the episodes and the presence or not of a family disruption. Most parasomnias are precipitated by stress, and in the younger subjects by an interaction between ontogenetic characteristics of sleep and immaturity. In the older patients psychological or organic factors must be eliminated.

Narcolepsy in children.

The clinical and polygraphic characteristics of narcolepsy in children were established on the analysis of 97 reported cases in children (including 12 personal cases). In idiopathic narcolepsies (77 cases) narcoleptic attacks occurred in 97% of the cases, cataplexy in 80.5%, hypnagogic hallucination in 39% and sleep paralysis in 29%; 13% of the children had the tetrad; dyssomnia was a prominent feature. Polygraphic data showed no significant differences between adults and children. In symptomatic narcolepsies (20 cases): cataplexy was the prominent feature occurring in 95% of the cases, 26% of the children had status cataplecticus; in these narcoleptic-cataplectic syndromes there was often an absence of polygraphic evidence of narcolepsy. Symptomatic narcolepsy should be suspected in cases where narcolepsy is detected in preteenage children, where cataplectic attacks are abnormally frequent, where there is an absence of polygraphic evidence of classical narcolepsy (although this criterion may not apply in the case of younger children) or where human leukocyte antigen typing for DR2 is negative. An association with a Niemann-Pick disease type C was found in 12 out of the 20 symptomatic cases, this association merits further study.

Effect of sleep stages on transiently evoked oto-acoustic emissions in infants.

Transiently evoked oto-acoustic emissions (TEOAEs) are generated by active contractions of the outer hair cells (OHC) of the organ of Corti. TEOAE are inhibited by the medial efferent olivocochlear system which originates in the brainstem and innervates the OHC. TEOAEs are a rapid non-invasive objective method of auditory screening in infants. Because in infants sleep represents 75% of their time, it was of interest to determine whether sleep stages which are induced in the brainstem could concomitantly affect TEOAEs. Repeated TEOAE recordings during polygraphic recordings of sleep stages were made on seven, 6-week-old infants. Results showed that: (i) TEOAE spectrum frequency components remained stable over sleep stages; (ii) TEOAE amplitude tended to increase during recording sessions; (iii) sleep stages (quiet, active and indeterminate sleep) did not affect TEOAE amplitude. This pilot study reveals that sleep mechanisms seem to have no effect on active OHC micromechanical properties. Therefore, in auditory screening, TEOAEs may serve to study active cochlear mechanisms in infants even during sleep which is the better time to perform recordings because of the quietness required.

Ontogenesis of nocturnal organization of sleep spindles: a longitudinal study during the first 6 months of life.

Ontogenesis of sleep spindles was studied on overnight longitudinal recordings in 12 full-term infants at 1.5-3-4.5 and 6 months of life. Six parameters (density, duration, frequency, amplitude, asymmetry and asynchrony) were analyzed during both slow wave sleep (SII and delta) and during 5 periods of the night. Results show a significant increase of most parameters between 1.5 and 3 months of age. All spindle patterns developed quite rapidly during the first 3 months of infancy, possibly reflecting developmental changes in thalamo-cortical structures and maturation of the physiological system that produces spindles. The density of 12-14 Hz spindle frequency was higher in stage II when compared to stage delta, as in adults. Our data confirm previous reports on spindle ontogenesis and give a more complete aspect of this ontogenesis in relation to sleep development. Three months of age appeared to be a turning point in maturational processes and might reflect changes in central nervous system activity and behavior which take place during that period. Sleep spindle evolution seems to be an accurate reflection of the slow wave sleep (SWS) development, and our results are discussed in terms of the developmental aspect of SWS production and characterization of sleep stages in young infants. Concordance between quantitative aspects and nocturnal organization leads us to consider that the individualization of slow wave sleep (SWS) in infants occurs from 4.5 months of life.

[Functions of paradoxical sleep and ontogenesis]. / Fonctions du sommeil paradoxal et ontogenèse.

The hypotheses directly linked to cognitive and neurologic ontogenic processes ie consolidation of memory and learning, the maturation hypothesis of Roffwarg and the hypothesis of endogenous genetic programming of Jouvet, are analysed. The discussion of these theories are based on the analysis of: the neurophysiologic mechanism of REM sleep and its ontogenesis in human, the results of REM sleep deprivation in young animals and by a personal study of facial mimics during sleep in neonates. Active sleep could be assimilated, very early during ontogenesis, to REM sleep, it probably plays an important role in brain maturation during early development but the stimulation is probably, at this time, not very specific, later it could be a link between genetic programming and epigenetic processes.

Hemispheric asymmetry of late auditory evoked response induced by pitch changes in infants: influence of sleep stages.

Late auditory evoked potentials (LAEPs) have been recorded in response to a 1000 Hz standard (occurrence 80%) or a 2000 Hz deviant (occurrence 20%) tone on the left (T3) and right (T4) temporal scalp in 6-week-old full-term newborns during pure quiet or active sleep states. Sleep states were premanently controlled by polygraphic recording including EEG, EOG, EMG, EKG and respiratory movements. During quiet sleep LAEPs consisted of a clear polygraphic response: N1-P2-N2-P3. Mean latencies ranges on T3 and T4 were: N1 = 28-70 ms; P2 = 343-407 ms; N2 = 966-1178 ms; and P3 = 1461-1492 ms. During active sleep LAEPs consisted of a N1-P2-N2 response. Mean latency ranges on T3 and T4 were: N1 = 36-79 ms; P2 = 278-304 ms; N2 = 555-620 ms. N2 latency was significantly shorter in AS than in QS. Amplitude of the N1-P2-N2 complex was significantly lower during active sleep. In response to standard stimuli, mean amplitudes and latencies of the LAEP were similar on T3 and T4 during active or quiet sleep states. In response to deviant stimuli mean amplitude of the N1-P2-N2 complex was significantly higher and mean latencies of N1 and N2 were significantly shorter on T3 during quiet sleep. No significant difference was observed during active sleep. These results confirm that sleep stages have a considerable influence on cortical auditory pathways. The auditory message is amplified during quiet sleep and inhibited during active sleep. Therefore sleep states need to be controlled to analyze LAEPs in young children.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma dopamine, norepinephrine, epinephrine and DOPAC levels in preterm infants prior to and immediately after a sleep ventilation hypercarbia test.

The postnatal maturation and the adaptational ability of the sympathoadrenal system has been investigated in preterm neonates (n = 8), and in sick preterm neonates with respiratory disorders (n = 10). Plasma levels of dopamine (DA), norepinephrine (NE), epinephrine (E) and 3-4 dihydroxyphenylacetic acid (DOPAC) were evaluated at rest during the first month of life, and following an inhalation of a 5% carbon dioxide-21% oxygen mixture for 10 min. During the first month of life the sick preterm neonates exhibited similar NE, E, and DOPAC plasma levels but higher DA amounts than healthy infants. Plasma DA levels were inversely correlated with the transcutaneous oxygen tension (r = -0.636) indicating that hypoxemia was able to enhance the release of DA. Immediately following the hypercarbia test, there were no significant changes of plasma catecholamine levels in the sick preterms, but there was a significant increase of E plasma levels (+140%, p less than 0.05) and a moderate elevation of NE and DA amounts in the healthy preterms. It is concluded that preterm neonates who have had respiratory disorders did not exhibit an immaturity of the sympathoadrenal system at rest, but had a defect in the release of E following hypercarbia exposure, which may be secondary to an alteration in chemoreceptor function and/or reduced catecholamine stores.