Special Issue:
Challenges and Opportunities in Skin Disorders
Gilbert Seda, MD, PhD
Division of Pulmonary and Critical Care Medicine, Scripps Mercy Chula Vista, 435 H. Street, CV 31, Chula Vista, CA 91910, United States
Sharonya Shrivastava, MD
Internal Medicine Program, 1601 Precision Park Ln, San Diego, CA 92173-1345, United States
Abstract
Purpose of Review. Obstructive sleep apnea and chronic insomnia are the most common sleep disorders in adults. Both sleep disorders can adversely affect physical and mental well-being. Cognitive function has been extensively studied in relation to chronic insomnia and obstructive sleep apnea. This paper reviews the recent studies investigating the cognitive effects of insomnia and obstructive sleep apnea as well as the potential benefits of treatment.
Recent Findings. Recent studies indicate that insomnia is associated with impairments in attention, memory, and executive function. Chronic insomnia may have a moderating role in mild cognitive impairment and Alzheimer’s dementia. Mood and anxiety disorders may moderate the effects of insomnia on cognitive function. Hyperarousal and short sleep time associated with insomnia are risk factors for cognitive impairment. Cognitive behavior therapy for insomnia may improve cognitive function but more studies are needed. Nonbenzodiazepine receptor agonists improve insomnia without causing cognitive impairment. Benzodiazepine use is associated with cognitive impairment.
Obstructive sleep apnea is associated with impairments in attention, concentration, memory, and executive function with apnea severity as measured by the apnea hypopnea index and severity of nocturnal hypoxemia being the largest risk factors. Untreated obstructive sleep apnea may have a significant impact on the progression of mild cognitive impairment and Alzheimer’s dementia. The impact of obstructive sleep apnea treatment, particularly with continuous positive airway pressure, appears to mitigate and slow the rate of cognitive decline but more randomized controlled studies are needed.
Summary. Standardized cognitive assessments and larger, long-term controlled prospective studies with diverse populations are needed to further elucidate the cognitive impairments associated with chronic insomnia and obstructive sleep apnea. More studies are needed on the benefits of various treatments for obstructive sleep apnea and insomnia.
A Robert Spitzer
Mackinac Neurology
Abstract
The treatment of sleep disorders is problematic because the diagnoses consist of an array of unrelated terms, there is little knowledge or link to disease processes, and progression from the patient presentation to effective therapy is not systematic. The purpose of this paper is to provide a coherent framework for understanding sleep disorders, based on anatomy and pathophysiology.
A classification of sleep disorders based on classical neurological diagnosis is presented. First, the diagnostic process in classical, clinical neurology is reviewed. In this traditional approach, diagnoses are not inferred directly from symptoms. Rather, symptoms are used to identify putative anatomic localizations, and pathophysiological mechanisms. Diagnoses are inferred as a second step from the localizations and mechanisms of disease. Subsequently, testing may be applied as necessary, using a probabilistic interpretation to guide treatment. Treatment for diseases classified in this manner is more likely to be successful. In addition, be generating alternative hypotheses during this process, if initial treatments are not successful, alternative approaches may be considered.
The anatomy and physiology of sleep disorders is briefly reviewed. The process of diagnosis is then presented, starting with specific symptoms, including insomnia, hypersomnia, limb movement disorders, fatigue and pain syndromes. Groups of symptoms, as syndromes, are considered. By relating the symptoms to the localizations and pathophysiology, a more ordered approach to management is presented. The distinction of etiology from diagnosis is discussed. Etiologies that have resolved are typically not treatable.
Prior research on fibromyalgia is summarized, including possible anatomic and pathophysiological substrates, and underlying sleep disorders. Other forms of fatigue are contrasted, with implications for different treatments.
Marina Lancaster D. de Moraes Salles
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Nataly Garcia
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Lucas Fornari Laurindo
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Angiseli Damaceno Scanavacca
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Karla Regina Ezídio
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Ricardo José Tofano
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Cláudia Rucco Penteado Detregiachi
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Jesselina F. dos Santos Haber
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Mara Silva Foratto Marconatto
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Sandra Maria Barbalho
Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Department of Biochemistry, School of Food and Technology of Marilia (FATEC), Avenida Castro Alves, 62, Marília, São Paulo 17500-000, Brazil
Karina Quesada
Department of Biochemistry and Nutrition, School of Nutrition, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil; Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Hygino Muzzy Filho, 1001, Marília, São Paulo 17525-902, Brazil
Abstract
Poor sleep quality can affect cardiovascular health and is considered a significant risk factor for the development of risk factors for Metabolic syndrome (MetS). This study aimed to investigate possible associations between sleep quality measured by the Pittsburgh Sleep Quality Index and the MetS. This was a cross-sectional that comprised data from 208 patients. Biochemical and anthropometric parameters were assessed. The identification of MetS was performed according to the International Diabetes Federation guidelines. The quantitative variables were described with the support of the BioEstat 5.3 software. To assess the association of the studied variables with the diagnosis of MetS, the Mann-Whitney and Chi-square (n x n) statistical tests were used. The level of significance considered was 5%. According to the International Diabetes Federation criteria, 111 (53,36%) men and women presented MetS. There were no statically significant differences between the groups with or without sleep disorders and the values of waist circumference (p=0.6996), high-density lipoprotein cholesterol levels (p=0.7940), triglycerides levels (p=0.8703), blood pressure values (p= 0.9851, and p=0.9795 for systolic and diastolic blood pressure, respectively), and glycemia (p=0.5351). Eighty-eight volunteers (42%) presented sleep quality dysfunction, with the highest proportion observed among individuals affected by MetS (p=0.0019). Our results indicate an association between sleep quality and the prevalence of MetS . Therefore, sleep quality could be evaluated in patients with MetS so that the therapeutic strategy would not be limited to the intervention in biochemical and anthropometric factors.
Natan Gadoth, MD
Department of Neurology, Ma’ayanei HaYeshua Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Israel
Abstract
Kliene Levin syndrome (KLS) is a peculiar sleep disorder of youth, consisting of idiopathic periodic hypersomnia attacks associated with behavioral and sometimes psychiatric symptoms during an attack. With the growing awareness of the syndrome and a steep rise in published cases, it became evident that psychiatric abnormalities may be present before the onset of hypersomnic events, in between events and first appear following years after complete recovery. Those observations suggest that psychiatric morbidity may be part of the symptomatology of KLS. In the present paper the results of a systematic literature search of publications using the key words KLS with psychiatric features, Atypical KLS, KLS like, KLS mimic and sleeping beauty syndrome will be discussed, in attempt to support the view that KLS is indeed a neuropsychiatric disorder and not just a sleep disorder of youth. Moreover, the recognition that KLS might imitate psychosis and other psychiatric disorders in which periodic hypersomnia is present, may decrease the number of KLS patients in whom the correct diagnosis may be delayed or totally missed.
Ramirez-Yanez German O., DDS, MDSc, MSc, PhD
Private Practice Aurora, Ontario, Canada
Abstract
Mouth breathing is a sign associated with Sleep and Breathing related Disorders and Obstructive Sleep Apnea in children. The aim of this paper is to provide a comprehensive overview of the changes in the human physiology when mouth breathing and, how it may affect the oral and general health in humans. The potential reactions produced at the cellular level and, how those reactions may lead to a negative impact in the human health are presented. Mouth breathing affects the O2/CO2 exchange at the lungs, which may lead to the production of the Hypoxia Inducible Factor (HIF) in all the cells in the human body, as well as stimulates the production of Erythropoietin in the kidney. Mouth breathing also causes a major loose of CO2, which increases the production of bicarbonates in the kidney and release of essential minerals through the urine. All those reactions may facilitate the development and progression of chronic diseases in humans. It is recommended to consider mouth breathing as an oral habit that may associate with a cascade of events in the human physiology leading to chronic health problems. The health professionals should consider mouth breathing as a health risk factor and treat it as early as possible.
