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A high risk of obstructive sleep apnea (OSA) has been reported in patients with schizophrenia. However, existing screening questionnaires for OSA haven't been validated in this population and the impact of OSA on schizophrenia symptoms has rarely been studied. This study aimed to investigate the prevalence and impact of OSA in patients with schizophrenia and validate the existing OSA screening scales.Patients with schizophrenia consecutively admitted to hospital (n = 51) and patients with schizophrenia and obesity (n = 31) were compared to healthy controls (n = 51). Apnea risk was measured with STOP-BANG, NoSAS, No-Apnea, and the Berlin Questionnaire; psychiatric symptoms were measured with the PANSS and Calgary scales and B-CATS battery. Daytime sleepiness was measured with the Epworth sleepiness scale. OSA was diagnosed using the Embletta system.OSA was found more frequently in obese schizophrenia patients than in those consecutively admitted to hospital (45% vs. 22%, p 0.05). Significant differences between patients with and without OSA were found on the PANSS negative symptoms subscale, B-CATS digit symbol test, and in daytime sleepiness. None of the used screening scales showed satisfactory sensitivity and specificity. Obesity with coexisting neck circumference ≥41 cm in women or ≥43 cm in men (BMI-NECK model) predicted OSA in 57% of cases.OSA should be screened in patients with schizophrenia as it has a negative influence on psychiatric symptoms and may contribute to the higher mortality of these patients. Assessment of BMI and neck circumference proves a good screening test in ambulatory contexts.

Numerous studies have shown dysfunctional mechanism of interaction between bottom-up emotional and top-down cognitive processes in persons with schizophrenia (SCZ). During the emotional directed forgetting (DF) paradigm participants have to apply volitional mechanisms to resist automatic emotional enhancement of the memory. Here we sought to compare mechanisms underlying emotional DF in SCZ and in healthy persons (HC). Eighteen SCZ and eighteen HC completed a DF paradigm with neutral and negative pictures. EEG was recorded during study and test phase of the task. We analyzed both the behavioral outcomes and event-related potential components, indicating emotional enhancement of memory (Late Positive Potential elicited by pictures) and DF strategies (N2/P3 elicited by forget/remember cues during study-phase; “old/new” and “reversed old/new” effects during test-phase of the task). Directed forgetting effects and emotional enhancement of memory were observed in both groups, even despite overall lower recognition rates in SCZ. Furthermore, cue presentation elicited similar pattern of N2/P3s in SCZ and in HC. However, “reversed old/new” effect was observed only in HC for negative stimuli. Patients may show similar reaction to affective stimuli as healthy controls during the emotional DF task. However, further investigation is needed to elicit the specific mechanisms underlying the DF strategies in SCZ.

Objective The aim of the study was to investigate the prevalence of difficulty with initiation or maintenance of sleep (DIMS) and excessive daytime sleepiness (EDS) in a general pediatric population, and to evaluate the relationship between these conditions and sleep-disordered breathing (SDB) symptom intensity. Methods This population-based cross-sectional study from 27 primary schools in a medium-sized city in Poland was based on use of a questionnaire regarding demographic data, symptoms of SDB, DIMS, and EDS. Data were collected between September and December 2014. In all, 2940 caregivers were recruited and were asked to fill-out questionnaires and written consent. Results A total of 68% of the questionnaires (n = 1987) were returned and analyzed. Habitual snoring (HS) was reported in 104 (5.3%) children. DIMS and EDS were seen in 137 children (6.9%) and 117 children (5.9%), respectively. The prevalence of DIMS increased from 3.5% in children who never snored to 28.6% in children who snored very often or always. Similarly, the prevalence of EDS was 2.7% in children who did not snore and increased to 19% in children who snored very often or always. No correlation was seen between increasing DIMS (r = 0.006, p > 0.05) or EDS (r = −0.031, p > 0.05) scores and body mass index. Conclusions This study is the first to measure the symptoms of both DIMS and EDS in a general pediatric population and to assess the relationship between both DIMS and EDS and SDB in children. We found that children with more frequent snoring had a higher prevalence of DIMS as well as EDS; however, there was no correlation between body mass index and either DIMS or EDS symptom severity.

Metabolic disturbances are a growing concern for the treatment of schizophrenia. As decreased activity and poor sleep quality are risk factors for metabolic disturbances, we investigated the activity and sleep patterns of schizophrenic patients using actigraphy. Seventy-three patients with schizophrenia spectrum disorder (mean age 29.2 ± 10.2 years, 27 females) treated with olanzapine (n = 54) or risperidone (n = 19) and 36 age- and sex-matched healthy controls were examined. Actigraphic recordings were obtained throughout seven consecutive days. The Athens Insomnia Scale (AIS) and Epworth Sleepiness Scale (ESS) were used to assess sleep and daytime sleepiness. Drug side effects were evaluated with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and Barnes Akathisia Rating Scale (BARS). Mental status was rated with the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS). The patients had lower mean 24 h-activity (p 0.001) and mean 10 h-daytime-activity (p 0.001), and longer time in bed (p 0.001). Higher PANSS scores, especially in the negative symptoms scale, were related to lower activity (r(s) = -0.508, p 0.001). Higher depressive symptoms were related to lower mean 24 h-activity (r(s) = -0.233, p = 0.049), longer time in bed (r(s) = 0.315, p = 0.007) and higher AIS (r(s) = 0.377, p = 0.001) and ESS scores (r(s) = 0.321, p = 0.006). Healthy females presented higher activity than healthy males (p 0.001). Similar but not significant gender differences were observed in the patients. These findings show that patients with schizophrenia treated with olanzapine or risperidone exhibit low physical activity and altered sleep pattern which may promote metabolic side effects. These changes are linked to negative and depressive symptoms.

Objective To investigate whether the outcome of treatment with trazodone CR in primary insomnia differs between patients with and without subthreshold depression. Methods 14 patients (9 females, mean age 57.3 ± 13.3) with primary insomnia and increased Beck Depression Inventory (BDI) scores (> 10) and 15 sex- and age-matched patients with primary insomnia and low BDI scores (≤ 10) were treated with trazodone CR 25–150 mg/d for 3 months and followed for 1 month after discontinuation of the medication. The Athens Insomnia Scale (AIS), Sheehan Disability Scale (SDS), and Clinical Global Impression scale (CGI) were completed at baseline, after each month of treatment and after the first week of run-out phase. Additional assessment tools comprised sleep diaries, the Leeds Sleep Evaluation Questionnaire (LSEQ) and actigraphic recordings. Results Subjective sleep time increased by 61.5 ± 72.3 min in the group with low BDI and 60.0 ± 59.4 min in the group with increased BDI at the end of the treatment phase. The significant improvements were also observed in the AIS, CGI, LSEQ and SDS. During the run-out phase the improvement was sustained in patients with low BDI, while AIS scores, sleep latency and total sleep time deteriorated in patients with increased BDI. Conclusions Patients with subthreshold depression, even if the depressive symptoms do not fulfill the time criteria for depressive episode, show marked worsening of insomnia after discontinuation of sleep promoting medication.

Background Understanding the basis of sleep-related endophenotypes might help to pinpoint factors modulating susceptibility to psychiatric disorders. However, the genetic underpinnings of sleep microarchitecture in humans remain largely unknown. Here we report on the results of a classical twin study in monozygotic (MZ) and dizygotic (DZ) twin pairs examining the genetic effect on sleep electroencephalogram (EEG) composition. Methods Polysomnographic recordings were obtained in 35 pairs of MZ (26.4 ± 5.4 years, 17–43 years, 17 male pairs, 18 female pairs) and 14 same-gender pairs of DZ twins (22.1 ± 2.7 years, 18–26 years, 7 male pairs, 7 female pairs). The EEG power spectra were generated on the basis of Fast Fourier transformations combined with conventional sleep parameters, according to standardized criteria. Results We tested the genetic variance contributing to the observed overall variance of the sleep measures and found that the relative contributions of the δ, θ, α, and σ frequency bands at central derivations were significantly correlated to the genetic background. In these frequency bands, MZ twins also showed within-pair concordance in spectral power that was significantly higher than that of DZ twins. Conclusions The broad overlap of EEG frequencies during non-REM sleep and wakefulness, which shows a significant genetic variance, supports the hypothesis of common neuronal mechanisms generating EEG oscillations in humans. Our findings strongly support the suitability of the spectral composition of non-REM sleep for defining endophenotypes.

Objective : This study addressed the relationship between daytime sleepiness and spectral composition of the preceding NREM sleep. Methods : Nineteen healthy volunteers (mean age: 36.5 years; SD: 10.1) underwent polysomnography during two consecutive nights and the multiple sleep latency test (MSLT) on the following day. Daytime sleepiness was also assessed by the Epworth sleepiness scale (ESS). The sleep recordings were visually scored according to standard criteria. The quantitative sleep EEG analysis was performed using a fast Fourier transform routine. The sleep parameters were compared between subjects with short and long MSLT sleep latencies (cut-off=10 min) and between subjects with low and high ESS scores (cut-off=6 points). Results : Subjects with short MSLT sleep latencies showed a reduced theta EEG activity. There was no evidence of reduced synchronization of sleep EEG in subjects with high ESS scores. Conclusions : Moderately increased daytime sleepiness as indicated by MSLT sleep latency less than 10 min is accompanied by decreased power of theta activity during NREM sleep indicating a deficit of sleep EEG synchronization.

activity was more disorganized. These differences are reflections of the neurophysiologic aspects of the presented symptomatology. Conclusion: Different spectral EEG parameters are correlated with some clinical characteristics of schizophrenia. Standardization of the methodology and knowledge of these QEEG parameters would allow wider application in the field of clinical psychiatry. In the future, these could help us in the distinction of the diseases in some peculiar cases and even in optimizing the treatment in a much more successful way.