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Introduction Intellectual giftedness is characterized by an intellectual development superior to peers (QI > 120) while emotional and relational development corresponds to the age norms. Anecdotal reports from parents suggest that they sleep poorly compared to typically developing (TD) peers. We measured sleep of gifted children using actigraphy. Methods Thirteen gifted children (10 boys, mean age = 10.58, SD = 2.11) were studied. Giftedness was identified using Renzulli’s three-factor definition of giftedness conceptualise in terms of above-average ability and high levels of task commitment (refined or focused form of motivation), and creativity. Sleep was measured with actigraphy for two weeks and compared to normative data from TD children using T-tests. Results Compared to normative data from TD children, gifted children had a significantly shorter sleep latency (p < 0.001), longer sleep periods (p = 0.001), shorter total sleep time and more wake time after sleep onset (p = 0.03). These differences were present both on week nights and weekend nights except that total sleep time was shorter in gifted children only during weekends (p < 0.001). Conclusion These data suggest that gifted children sleep poorly, and more so upon weekends. Whether this correlates with daytime functioning remains to be determined. Support N/A

Introduction Gifted (G) children display an asynchrony between intellectual development and social and emotional development. Twice exceptional (2e) children are G children with a neuropsychological disability. We compared the sleep and daytime behavior of G, 2e and typically developing (TD) children and we sought for group-specific relationships between sleep and daytime behavior. Methods 23 children were recruited: seven G (8.7 years old, SD = 1.7), six 2e (9.8 years old, SD = 1.8) and 10 TD children (10.0 years old, SD = 2.2). Giftedness was diagnosed with neuropsychological tools. The Children’s Sleep Habits Questionnaire (CSHQ) assessed sleep quality, the Child Behavior Checklist (CBCL) assessed daytime functioning. Sleep quality and its impact on daytime functioning was measured with a MANCOVA, with the CBCL’s three main factors as dependent variables (internalizing problems, IP; externalizing problems, EP and total problems, TP), children group as the independent variable and the CSHQ total score as the covariate. Results G, 2e and TD groups scored 39.86, 39.17 and 39.70 on the CSHQ, respectively (n.s.). The three groups were not different on the CBCL, with respective mean T scores of 57.86, 50.33 and 48.60 for IP, 56.43, 55.67 and 47.80 for EP and 55.29, 53.83 and 46.40 for TP. Pillai’s trace statistics disclosed a significant relationship between CSHQ and CBCL scores regardless of groups (p = 0.04) but the influence of sleep quality did not differ among the groups for any of the three factors. The CSHQ total score was positively and significantly related to IP (p = 0.03, r = 0.47); relationships were not significant for EP (p = 0.96, r = -0.01) and TP (p = 0.17, r = 0.31). Conclusion Sleep quality influences internalizing problems in children, without group-specific relationships, but this association does not seem to differ between gifted, twice exceptional and TD children. Support N/A

Introduction Sleep disturbance in children with attention-deficit/hyperactivity disorder (ADHD) is frequent, and lead to shorter sleep duration which has been associated with lower performance on sustained attention tasks. However, no study has investigated this association in adolescents with ADHD. We sought to explore whether the association between sleep and sustained attention performance of children with ADHD is similar in adolescents with ADHD given that sleep patterns are different. Methods Parents of 32 children (mean age = 8.0; SD = 1.3) and 10 adolescents (mean = 15.2; SD = 1.3) with ADHD completed a developmental questionnaire including sleep questions. Children and adolescents were medication free and underwent a comprehensive neuropsychological evaluation. Three sleep variables were extracted from the questionnaire, namely the duration of the sleep period during week nights and weekends as well as the difference between the two (“weekend shift”). The Continuous Performance Test was used to measure sustained attention (omission, commission, hit reaction time). Pearson correlations between sleep variables and sustained attention measures were calculated. Results Children showed a positive correlation between hit reaction time and the duration of the sleep period during week nights (r = 0.37; p =0.04), weekends (r = 0.51; p = 0.004) and the weekend shift (r = 0.37; p =0.04). No significant correlations were found in the adolescent group. Conclusion The fact that no significant associations were found in the adolescent group suggest an improvement of the arousal system through brain development in ADHD, or that other mechanisms could be involved in the etiology of ADHD in adolescents. Support Centre d’apprentissage aux 1001 astuces; Fonds de recherche du Québec - Santé

CPAP Use in Patients with OSAHS: In OSAHS, PROVIGIL is indicated as an adjunct to standard treatment(s) for the underlying obstruction. If continuous positive airway pressure (CPAP) is the treatment of choice for a patient, a maximal effort to treat with CPAP for an adequate period of time should be made prior to initiating PROVIGIL. If PROVIGIL is used adjunctively with CPAP, the encouragement of and periodic assessment of CPAP compliance is necessary. General: Patients should be cautioned about operating an automobile or other hazardous machinery until they are reasonably certain that PROVIGIL therapy will not adversely affect their ability to engage in such activities. Patients Using Contraceptives: The effectiveness of steroidal contraceptives may be reduced when used with PROVIGIL and for one month after discontinu- ation. Alternative or concomitant methods of contraception are recommended during and for one month after discontinuation of PROVIGIL. Cardiovascular System: In clinical studies of PROVIGIL, signs and symptoms including chest pain, palpitations, dyspnea and transient ischemic T-wave changes on ECG were observed in three subjects in association with mitral valve prolapse or left ventricular hypertrophy. It is recommended that PROVIGIL tablets not be used in patients with a history of left ventricular hypertrophy or in patients with mitral valve prolapse who have experienced the mitral valve prolapse syndrome when previously receiving CNS stimulants. Such signs may include but are not limited to ischemic ECG changes, chest pain, or arrhythmia. Patients with a recent history of MI or unstable angina should be treated with caution. Blood pressure monitoring in short-term controlled trials showed no clinically significant changes in mean systolic and diastolic blood pressure in patients receiving PROVIGIL as compared to placebo. However, a greater proportion of patients on PROVIGIL required new or increased use of antihypertensive medications (2.4%) compared to patients on placebo (0.7%). The differential use was slightly larger when only studies in OSAHS were included, with 3.4% of patients on PROVIGIL and 1.1% of patients on placebo requiring such alterations in the use of antihypertensive medication. Increased monitoring of blood pressure may be appropriate in patients on PROVIGIL. Central Nervous System: There have been reports of psychotic episodes associated with PROVIGIL use. One healthy male volunteer developed ideas of reference, paranoid delusions, and auditory hallucinations in association with multiple daily 600 mg doses of PROVIGIL and sleep deprivation. There was no evidence of psychosis 36 hours after drug discontinuation. Caution should be exercised when PROVIGIL is given to patients with a history of psychosis. Patients with Severe Renal Impairment: Treatment with PROVIGIL resulted in much higher exposure to its inactive metabolite, modafinil acid, but not PROVIGIL itself. Patients with Severe Hepatic Impairment: PROVIGIL should be administered at a reduced dose because its clearance is decreased. Elderly Patients: Elderly patients may have diminished renal and/or hepatic function; therefore, dosage reduction should be considered. Information for Patients: Physicians are advised to discuss the following with patients taking PROVIGIL. PROVIGIL is indicated for patients who have abnormal levels of sleepiness. PROVIGIL has been shown to improve, but not eliminate this abnormal tendency to fall asleep. Therefore, patients should not alter their previous behavior with regard to potentially dangerous activities (eg, driving, operating machinery) or other activities requiring appropriate levels of wakefulness, until and unless treatment with PROVIGIL has been shown to produce levels of wakefulness that permit such activities. Patients should be advised that PROVIGIL is not a replacement for sleep.

This study compared the performance of narcoleptic and control subjects on one psychomotor task, examined the recuperative power of naps in narcoleptic subjects, and evaluated the respective recuperative values of REM and NREM sleep. Ten untreated narcoleptic and eight control subjects repeatedly responded to a choice reaction time task during days with and days without napping. Narcoleptic subjects exhibited low performance levels relative to control subjects on all variables. Napping improved the performance of narcoleptic subjects except for the number of long latency (reaction time greater than 1,000 ms) responses. Finally, performance, particularly on accuracy measures, was better, although not significantly, after NREM naps when compared with REM naps. Language: en

Zimelidine, a selective inhibitor of serotonin (5-HT) reuptake in the CNS, was administered to narcoleptic patients. This medication has a potent anticataplectic action without improving daytime somnolence. These results suggest that 5-HT neuronal systems are involved in the physiopathology of cataplexy. Zimelidine, however, has no anticholinergic effect, so it is unlikely that cholinergic mechanisms thought to be important in animal cataplexy would play a major role in human cataplexy. In addition, zimelidine had no effect on nocturnal sleep patterns of these patients which is surprising considering the importance of 5-HT neuronal systems in sleep physiology. A 5-HT hypothesis of cataplexy is formulated, and the mechanisms of action of other anticataplectic agents are discussed.

Narcoleptic patients were compared to idiopathic hypersomniac patients and REM hypersomnia patients with regard to nocturnal sleep disruption. Results showed specificity of the narcoleptic sleep pattern and a possible correlation between REM fragmentation and cataplexy. Patients with and without periodic movements in sleep (PMS) were compared and no difference was found in their nocturnal sleep pattern, suggesting that PMS is not the major determinant of sleep disruption previously described in narcoleptic patients. Finally, nocturnal sleep disruption was treated with gamma-hydroxybutyrate (GHB) and results further indicate a possible link between REM fragmentation and cataplexy.