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Objective: The study retrospectively evaluated the effects of quetiapine on sleep in primary insomnia and neurodegenerative diseases using polysomnographic data. Materials and Methods: Between January 1, 2010, and June 1, 2023, the records of 49 patients who were followed up in the sleep outpatient clinic of the neurology department of our hospital and who underwent polysomnography examination were retrospectively reviewed. Patients aged between 18 and 65 years with primary insomnia and neurodegenerative diseases were included in the study. Results: The mean age of 49 patients (26 females and 23 males) were 56.67 years. The mean quetiapine dose was 59.37. Sleep latency, stage 1 (N1) duration, stage 2 (N2) duration, mean and minimum SO2 and apnea-hypopnea index were similar. Total sleep duration, stage 3 (N3) duration and rapid eye movement (REM) sleep duration were higher in neurodegenerative patients. N3 duration was shorter in patients with primary insomnia on quetiapine. Sleep duration and REM duration were longer in the neurodegenerative group and sleep latency was longer in primary insomnia in quetiapine users. Among quetiapine users, the N2 sleep percentage was higher and the nonREM 3 sleep percentage was lower in primary insomnia, whereas there was no difference in sleep percentages in neurodegenerative patients. Conclusion: Quetiapine is an atypical antipsychotic agent. It shortens sleep latency and decreases the percentage of REM sleep and wake time. It increases total sleep time, sleep efficiency, and N2 sleep. In this study, in primary insomnia patients using quetiapine, N3 sleep duration was shorter and sleep percentage was lower, whereas N2 sleep percentage was longer. There has been no placebo-controlled study of any antipsychotic drug for treating insomnia. [ABSTRACT FROM AUTHOR]

Objective: We evaluated and compare sleep quality and disorders according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) A, B, C, D groups in patients with Chronic Obstructive Pulmonary Disease (COPD) and to determine sleep disorders. Materials and Methods: Our study included 94 patients who applied to Pamukkale University Medical Faculty Hospital Chest Diseases Polyclinic between January 2016 and January 2017, were diagnosed with COPD according to GOLD criteria, were not in a COPD attack at the time of admission and agreed to participate in the study. Results: In patients with COPD, as the severity of stages increased, a decrease in mean FEV1 values was detected and as the FEV1 values decreased, the mean oxygen values measured during the night decreased. According to the GOLD stage, there was no significant difference between total sleep periods, sleep activity, sleep latency, rapid eye movement (REM) sleep duration, and non-REM sleep duration. According to polysomnography results, apnea-hypopnea index (AHI) was found to be below 5 in 40% of the patients. There was no statistically significant difference between the AHI and COPD stages (p=0.581). Conclusion: No significant difference was found between the COPD stage and AHI severity. However, as COPD stages increased, a decrease in mean nocturnal oxygen saturation was detected. Nocturnal oxygen desaturation is the main cause of comorbidities observed in patients COPD. As a result, careful attention should be given to night desaturation in advanced patients with COPD, and the necessary procedures must be performed to prevent comorbidities. [ABSTRACT FROM AUTHOR]

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Objective: In this study, we aimed to compare the clinical and polysomnographic features of rapid eye movement sleep-dependent obstructive sleep apnoea syndrome (REM-OSAS) and positional OSAS (pos-OSAS). Materials and Methods: This study included all patients diagnosed with REM-OSAS and pos-OSAS who were examined at our sleep and disorders unit between January 2019 and November 2020. All patients underwent a full-night polysomnographic examination. Results: A total of 300 patients with OSAS were included in the study, of which 60 (20%) were diagnosed with REM-OSAS and 75 (25%) with pos-OSAS. REM-OSAS had a female predominance, whereas pos-OSAS demonstrated a male predominance (p<0.001). Body mass index was significantly higher in patients with REM-OSAS than in those with pos-OSAS (p=0.003). OSAS severity was found to be higher in patients with pos-OSAS than in those with REM-OSAS (apnoea-hypopnea index: 23/hour, p<0.001). The supine and REM sleep pulse rates were significantly higher and the minimum oxygen saturation level was significantly lower in patients with REM-OSAS than in those with pos-OSAS (p<0.001, p=0.010). Conclusion: The results of this study revealed that OSAS severity was higher in patients with pos-OSAS than in those with REM-OSAS. Body position plays a more significant role than sleep stage on OSAS severity. REM-OSAS was more common in female patients, whereas pos-OSAS had a male predominance. Patients diagnosed with REM-OSAS had a significant tendency to be overweight. Oxygen saturation was lower in patients with REM-OSAS than in those with pos-OSAS. [ABSTRACT FROM AUTHOR]

Objective: Obstructive Sleep Apnoea syndrome (OSAS) is common in patients with epilepsy. A reduction in seizure frequency was reported following positive airway pressure (PAP) therapy. Thus, changes in seizures and related factors have been studied in patients with nocturnal epilepsy and OSAS. Materials and Methods: All patients with nocturnal epilepsy admitted to our sleep and disorders unit were evaluated consecutively for the last 5 years. Results: Of the 58 patients with nocturnal epilepsy and OSAS, 74.1% were male. The mean age was 48.6±14.3 years, and disease duration was 10.1±10.6 years. Moreover, 34 (58.7%) patients underwent successful PAP therapy. Conversely, seizures persisted or increased in 18 (31.0%) patients and decreased in 14 (24.2%), whereas 26 (44.8%) patients were seizure-free. Gender (p=0.773) and age (p=0.998) were not related to changes in seizure frequency. However, decrease in seizures was more common in patients with a shorter disease duration (p=0.032), higher number of seizures (p=0.027) and abnormality in electroencephalography (p=0.005). Sleep efficiency (p=0.468), slowwave sleep duration (p=0.264), or rapid eye movement sleep (p=0.238) was found to be unrelated. In patients without any decrease in seizures, the Apnoea-hypopnoea index was higher but not significant (p=0.160), whereas oxygen saturation level was significantly lower (p=0.037). Decrease in seizures was present in 71.9% of the patients under successful PAP therapy but in 66.7% of patients with non-compliance, although this disparity was not statistically significant (p=0.351). Conclusion: A decrease in seizures was associated with a shorter duration of epilepsy, higher number of seizures and abnormality in electroencephalography. Although the reduction in seizures was more prominent in patients with successful PAP therapy, this was not statistically significant. [ABSTRACT FROM AUTHOR]

Objective: Duchenne muscular dystrophy (DMD) is a hereditary neuromuscular disorder in which respiratory problems arise secondary to the involvement of skeletal muscles. Spinal muscular atrophy (SMA) is a disorder group characterized by the involvement of anterior horn cells. The most common respiratory problems in DMD and SMA patients are pharyngeal muscle weakness in sleep and sleep-related respiratory disorders. In this study, we evaluated sleep structure and sleep-related disorders in pediatric age group diagnosed with DMD and SMA. Materials and Methods: In pediatric patients who were diagnosed to have DMD or SMA upon genetic analysis between 2014 and 2018 were performed polysomnographic investigations in our Sleep and Disorder Units. Results: Age (p=0.074), gender (p=0.065) or Body Mass index (p=0.473) were compatible between the three groups, including 13 DMD patients, seven SMA patients, and six healthy control children. In DMD patients, although rapid eye movement (REM) sleep phase latency was longer and REM sleep phase duration was shorter compared to both healthy controls and SMA patients; it was not statistically significant. In SMA patients, total sleep time and deep non-REM (NREM) sleep duration were shorter than both healthy controls and DMD patients; though this difference was not statistically significant. Pediatric Obstructive Sleep Apnea syndrome (OSAS) was detected in three DMD patients (23.1%) and six SMA patients (85.7%), no pediatric OSAS was detected in the control group (p=0.010). Mean Apnea-hypopnea index was 2.15+4.60/hr in DMD patients, 7.43+6.19/hr in SMA patients and 0.33+0.52/hr in control group (p=0.018). Conclusion: In our study, it was found that sleep structure is disturbed and pediatric OSAS is more commonly encountered in DMD and SMA patient groups, which two disorders causing muscle and respiratory problems due to muscular and neurogenic involvement. [ABSTRACT FROM AUTHOR]

Objective: Deep brain stimulation (DBS) intended to bilateral subthalamic nucleus (STN) used in the Parkinson's disease (PD) has been reported to lead improved subjective sleep quality, increased sleep efficiency, decreased wakefulness time after sleep, and increased total sleep time. On this basis, we aimed to evaluate the sleep structure and quality by polysomnographic (PSG) investigation parameters in patients diagnosed with idiopathic PD who were planned to undergo bilateral STN-DBS. Materials and Methods: Inclusion criteria were determined as the presence of a clinical diagnosis of idiopathic PD, being 70 years and below, having at least 5 years of disease duration, and being a suitable candidate for STN DBS surgery. Patients were excluded from the study in the presence of dementia or psychiatric disturbances, cardiac pacemaker, and history of cerebrovascular disease. Our study was approved by Local Ethical Committe of Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, and signed consent form was obtained from participants. Results: Eight patients were included in our study; the mean age was calculated as 53.6±4.1 years. When pre- and postoperation PSG parameters were compared, the total sleep time was decreased, however it was not found statistically significant (p=0.840). REM sleep latancy was significantly shortened postoperatively (p=0.003). It was observed that other PSG parameters measuring the macro- and micro-structure of sleep did not change significantly (p>0.050). Conclusion: Many studies have reported substantial improvements in parameters obtained by polysomnography, while only one study has reported that sleep was not normalized although subjective sleep quality was increased. In our study, except for shortening in the REM sleep period, no significant improvement in PSG parameters was observed. The effect of bilateral STB-DBS on sleep is still one of the controversial issues and waits to be demonstrated in the larger series. [ABSTRACT FROM AUTHOR]

Rhythmic movement disorder (RMD) is usually observed in children during drowsiness. However, here we present an adult patient experiencing RMD associated with Obstructive Sleep Apnea syndrome (OSAS) during rapid eye movement (REM) sleep. A 50-year old male was admitted with a complaint of head rocking during sleep for about one year. Video-polysomnography revealed OSAS (43/hour) and RMD. Following positive airway therapy, all the symptoms related to OSAS and head rocking disappeared. Adult-onset RMD occurring in REM sleep is rare; OSAS related arousals, increased cyclic alternating pattern, and possible association with REM sleep without atonia were suggested to be the underlying reasons for the condition. [ABSTRACT FROM AUTHOR]

Objective: Interstitial lung disease (ILD) may create sleep disturbances due to chronic disease-related stress, respiratory abnormalities and adverse effects of treatment. We aimed to determine the quality of sleep in ILD patients, and the incidence of Obstructive sleep apnea syndrome (OSAS) in these patients. Materials and Methods: Taken to this study were 52 patients who were followed up in our center due to ILD. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were applied to the patients. Spirometry and diffusion test were performed. Polysomnography (PSG) was performed to 27 patients whose ESS were more than or equal to 10. Results: Demographic characteristics, body mass index, spirometry and diffusion measurements, PSQI global score and the sub-components of it didn’t show difference according to ESS daytime sleepiness. Sleep quality of 44% of the patients was determined to be poor by PSQI. PSQI global score and sub-components weren’t correlated with apnea-hypopnea index, stage 1 latency, sleep efficiency and nocturnal desaturation (p>0.05) in 27 patients who underwent PSG. We observed increased stage 1 sleep and decreased stage 2-3 and rapid eye movement sleep. As nocturnal hypoxemia was seen arousals (p=0.000, r=0.698) increased. OSAS was diagnosed in 19 (70%) of subjects. Conclusion: Although ILD patients don’t have daytime hypoxemia; they may have nocturnal hypoxemia and OSAS, which may effect their sleep quality. Therefore ILD patients should be evaluated for daytime sleepiness, and sleep-related breathing disorders. [ABSTRACT FROM AUTHOR]

Noradrenergic system is one of the major central nervous system effectors of the human stress response. The studies suggest that the patients with post-traumatic stress disorder have hyperreactive noradrenergic systems, and this exaggerated noradrenergic activity is associated with a number of hyperarousal symptoms in post-traumatic stress disorder. Central noradrenergic system also has a role in the regulation of arousal state during sleep. In this study, it was therefore aimed to investigate the relationship between nocturnal urinary levels of noradrenaline and sleep variables. Fourteen patients with chronic post-traumatic stress disorder and 12 age- and sex-matched healthy normal controls were investigated with polysomnographic recordings on two consecutive nights. Urine samples were collected for 24 hours in three 8-hour collections following the adaptation night in the sleep laboratory. Patients with post-traumatic stress disorder had difficulty in initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep, and a reduced rapid eye movement sleep latency when compared to the normal controls. There was not any correlation between nocturnal urinary noradrenaline values and sleep variables. This study did not demonstrate any significant relationship between urinary noradrenaline levels and disturbed sleep measures in patients with posttraumatic stress disorder. [ABSTRACT FROM AUTHOR]

Sleep is a vital physiologic process with important restorative functions. Although the high prevalence, complexity, and health implications associated with sleep related disorders in older individuals are known, many clinicians are unaware of the seriousness and potential morbidity posed by sleep issues. The healthcare community has a responsibility to translate the growing knowledge of sleep medicine into clinical practice in geriatric medicine. Physiological, psychological, and environmental factors can influence the sleep-wake process. Sleep issues related to aging include: decreased total nocturnal sleep time, delayed onset of sleep, advanced circadian phase, reduced slow-wave sleep, reduced rapid-eye-movement (REM) sleep, reduced threshold for arousal from sleep, fragmented sleep with multiple arousals and daytime napping. Sleep-related disorders are common in the general adult population, and as the population ages, the prevalence of these disorders increases. This higher prevalence of sleep disruption is often the result of the increased presence of medical and psychosocial comorbidities in this population. Insomnia in the older adult is most often comorbid with medical and psychiatric illness and complicated by the polypharmacy. Obstructive sleep apnea is more frequent among older people but may not be recognized in older patients because its symptoms (fatigue, somnolence and morning headaches) are attributed to other diseases, or to aging. Sleep apnea contributes to decreased quality of life, increased neurocognitive impairment and cardiovascular disease such as arterial hypertension, heart failure and stroke. Increasing prevalence of restless legs syndrome with age may also occur in association with the increasing presence of secondary causes in the aging population. The combination of age-related changes in sleep and circadian rhythm regulation paired with decreased levels of light exposure and activity contribute to the development of circadian rhythm-based sleep disorders in older people. Parasomnias are undesirable non-deliberate physical or emotional events that occur during sleep. The non-REM sleep parasomnias are more common in children, whereas REM sleep behavior disorder is more common in older adults. The prevalence of narcolepsy with cataplexy and the other hypersomnias specifically in older adults is unknown, although the medical conditions, comorbidities, and medication usage typically associated with hypersomnia are prevalent in older adults. There is the strong bidirectional relationship between sleep disorders and serious medical problems in older persons. Individuals with sleep disorders are more likely to develop hypertension, depression, cardiovascular, and cerebrovascular disease. Thus, sleep-related concerns in elderly persons may provide the opportunity for improving not only their sleep, but also their overall morbidity and mortality. [ABSTRACT FROM AUTHOR]

Parasomnias, as described in the recent second edition of the International Classification of Sleep Disorders, are "undesirable physical events or experiences" occurring during sleep transition, during arousal from sleep, or within the sleep period. These events encompass abnormal sleep related movements, behaviors, emotions, perceptions, dreaming, and autonomic nervous system functioning. Parasomnias are classified as: 1) disorders of arousal (from non-rapid eye movement, or NREM, sleep); 2) parasomnias usually associated with REM (rapid eye movement) sleep; and 3) other parasomnias. This sleep disorders in childhood are common, and often more frequent than in adults. Clinicians should be aware that many pediatric parasomnias have benign and self-limited nature. Most of the parasomnias may not persist into late childhood or adolescence. Parasomnias in adults often differ in type from childhood parasomnias and may portend significant psychiatric disturbances or neurodegenerative disorders. A reliable diagnosis can often be made from a detailed history from the patient and, if possible, the parents or bed partner. Detailed overnight investigations of parasomnias are usually not required. The non-REM parasomnias are more common in community although REM parasomnias are more likely to be seen in general neurological practice. Sleep related eating disorder, sleep related dissociative disorders and sleep related sexual behavior and sleep related violence are novel and rarely reported sleep disorders. REM sleep behavior disorder is common and should be sought in all neurodegenerative diseases. They are included among clinical disorders due to the resulting injuries, and adverse health and psychosocial effects, which may affect the bed partner as well as the patient. Finally, parasomnias are common disturbances of sleep that may significantly affect the patient's quality of life and that of the bed partner . Therefore, appropriate diagnostic and therapeutic strategies are warranted. [ABSTRACT FROM AUTHOR]

Kleine-Levin Syndrome (KLS) is a rare disorder characterized intermittent hypersomnia, hyperphagia, hypersexuality, abnormal behaviors, and confusion. Patients are asymptomatic between episodes. The aim of this case series study was to determine the clinical features of patients with KLS and to compare the polysomnography (PSG) findings between symptomatic and asymptomatic periods.We compared the results of PSG investigations performed in symptomatic and asymptomatic periods in six patients diagnosed with KLS at Gulhane Military Medical Faculty Sleep Research Center between 1998 and 2005. The age at onset of KLS was approximately 18 years, the diagnosis delayed 2.67 years, hypersomnia episodes lasted approximately 11.5 days, until the correct diagnosis, the patients had experienced on average 5 episodes. Total sleep time in KLS patients during symptomatic period and stage 2 sleep percent was higher than in asymptomatic period. REM latency was shorter and stage 3 and REM percent was lower in asymptomatic period. The clinical features including the age of onset and episode duration are compatible with those from the previous studies. It was observed that the sleep architecture during symptomatic period was different from that in asymptomatic period. [ABSTRACT FROM AUTHOR]