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Ziel der vorliegenden Studie war es, zu untersuchen, ob – und wenn ja wie – Alter, Geschlecht, Dauer der Immobilisierung, eine Veranderung der RLS-Medikation vor und eine Woche nach der Operation, das von der Operation betroffene Korperteil sowie die Art der Anasthesie den perioperativen Schweregrad der Symptomatik bei RLS-Patienten, die sich einer Operation unterzogen haben, beeinflussen. Die Daten wurden in der Course of Restless Legs Syndrome-Study (COR) erhoben, in deren Rahmen im Verlauf von 2 Jahren Informationen per Fragebogen prospektiv gesammelt wurden. Die nach 2 Jahren (t3) durchgefuhrte Datenerhebung umfasste ein Modul zur retrospektiven Erfassung detaillierter Informationen zu Operationen, die in den vorausgegangenen 3 Jahren durchgefuhrt wurden. Zum Zeitpunkt t3 wurden 2490 Fragebogen zuruckgeschickt, was einer Responserate von 92,4 % der ursprunglichen COR-Stichprobe (nach Ausschluss der Verstorbenen) entspricht. Der Anteil der Patienten mit einer Operation in den vorausgegangenen 3 Jahren betrug 1004 (40,3 %). Bei 95,0 % dieser Patienten wurde die RLS-Medikation vor der Operation nicht verandert; in der ersten Woche nach der Operation wurde die Medikation bei 88,8 % der Patienten nicht verandert. 71,4 % der Patienten erhielten eine Vollnarkose, 14,0 % eine regionale (spinale oder peridurale) und 9,9 % eine lokale Anasthesie; fur 4,7 % war die Art der Narkose nicht bekannt. In einer logistischen Regressionsanalyse zeigte sich, dass es verschiedene signifikante Pradiktoren fur eine postoperative Verschlechterung der RLS-Symptomatik gibt: Frauen (OR 3,6; 95 % CI: 1,2–3,7), Patienten mit einer langeren (≥ 2 Tage) Immobilisierungsdauer (OR 2,1; 95 % CI: 1,2–3,6) sowie Patienten mit einer Operation an den Beinen bzw. an der Hufte (OR 1,9; 95 % CI: 1,2–2,9) haben ein signifikant erhohtes Risiko fur das Auftreten einer Symptomverschlechterung. Lokale Anasthesie ist dagegen im Vergleich zu einer Vollnarkose mit einem protektiven Risiko (OR 0,2, 95 % CI: 0,1–0,9) behaftet Die vorgestellten Ergebnisse sollten bei der Beratung und Betreuung von RLS-Patienten, die sich einer Operation unterziehen mussen, berucksichtigt werden.

Objective In several modern society duties individuals have to maintain their attention or vigilance over prolonged periods of time, even if the monitoring task is monotonous. The aim of our study was to obtain reference data on the 60-minute monotonous Siesta sustained attention test. Methods Normative data were gathered in an age-stratified sample of 234 healthy participants (118 men; 116 women) between the ages of 20 and 79years. The impact of age, gender, time of day, and time on task during performance was analyzed. Results At least 20 participants from each age group and gender group were tested either in the morning or in the afternoon. The sample sizes were only smaller in the age group of 70 to 79years. There was a notable age effect on all performance measures, with an increase in reaction times and false response rates from the youngest to the oldest group as well as a decrease in correct reactions with increasing age. Statistical analysis revealed no differences in speed and accuracy measures between men and women participants. There was no notable time-of-day effect but a clear impact of time-on-task speed and of correct reactions during the course of the test. The vigilance decrement had already occurred during the first half of the test. Conclusions Our results provide a normative database of performance parameters for different age groups in healthy adult participants. As sustained attention is sensitive to sleep loss and nonrestorative sleep, our data can be used as a reference for performance-based assessment of daytime sleepiness in participants with hypersomnia.

In the present paper, the assessment of sleepiness in general and the status quo in “Deutsche Gesellschaft fur Schlafforschung und Schlafmedizin” (DGSM; German Sleep Society)-accredited sleep laboratories are examined. The first question deals with the definition of sleepiness; the second question refers to different methods of assessing sleepiness with a special focus on the Multiple Sleep Latency Test (MSLT), which is considered the gold standard to measure sleepiness. The main outcomes are mean sleep latency and the number of sleep onset REM periods (SOREMPs). Two or more SOREMPs are indicative for the diagnosis of narcolepsy; therefore, correct scoring and interpretation are relevant. The third question is related to the implementation of the MSLT in DGSM-accredited laboratories and whether the MSLT is performed in compliance with the latest guidelines. A questionnaire survey on implementation of the MSLT revealed that 82% apply the MSLT. Questions on the protocol and interpretation of MSLTs indicated that the practice is inhomogeneous. Results of a scoring study, in which DGSM-accredited laboratories were asked to score in total 19 MSLT sessions of 4 different patients, indicated that not only the performance of MSLTs but also evaluation varies across laboratories. For the present article, we focus on the results of the REM sleep parameters scored and reported by the laboratories, and discuss possible reasons for the relatively high heterogeneity between the laboratories, and in some cases differences between the scoring of REM and the reported REM latency and/or SOREMPs. While the scoring of REM per se seems difficult and might not be adequately detected, there is no generally applicable definition of SOREMPs. In several guidelines an observation period of 15 min after the onset of sleep is recommended, while in the German Leitlinie S3 10 min is proposed. Since the length of the recording period has consequences for the definition of SOREMPs, the apparently small difference of 5 min can have detrimental effects on the diagnosis of narcolepsy.

The International Pharmaco-EEG Society (IPEG) presents guidelines summarising the requirements for the recording and computerised evaluation of pharmaco-sleep data in man. Over the past years, technical and data-processing methods have advanced steadily, thus enhancing data quality and expanding the palette of sleep assessment tools that can be used to investigate the activity of drugs on the central nervous system (CNS), determine the time course of effects and pharmacodynamic properties of novel therapeutics, hence enabling the study of the pharmacokinetic/pharmacodynamic relationship, and evaluate the CNS penetration or toxicity of compounds. However, despite the presence of robust guidelines on the scoring of polysomnography -recordings, a review of the literature reveals inconsistent -aspects in the operating procedures from one study to another. While this fact does not invalidate results, the lack of standardisation constitutes a regrettable shortcoming, especially in the context of drug development programmes. The present guidelines are intended to assist investigators, who are using pharmaco-sleep measures in clinical research, in an effort to provide clear and concise recommendations and thereby to standardise methodology and facilitate comparability of data across laboratories.

Objective: Centrally active α-1-adrenergic-receptor antagonists such as prazosin are effective in the treatment of nightmares in patients with posttraumatic stress disorder (PTSD). A pharmacological alternative is doxazosin, which has a longer half-life and fewer side effects. However, doxazosin is currently being used without solid empirical evidence. Furthermore, no study so far has assessed the effects of α-1-antagonists on nightmares in patients with borderline personality disorder (BPD). We retrospectively assessed the effectiveness of doxazosin on nightmares in PTSD and BPD. Method: A retrospective chart review of patients treated with doxazosin for trauma-associated nightmares in our clinic was performed. As in previous prazosin studies, the B2 score of the Clinician-Administered PTSD Scale (CAPS) was used as the primary outcome measure. Furthermore, the Pittsburgh Sleep Quality Index-Addendum for PTSD (PSQI-A) and sleep logs were analyzed. Results: We identified 51 patients with PTSD and/or BPD (mean age 35.7 years, 92.3% women) who received doxazosin for nightmares. Of these, 46 patients continued doxazosin over a 4-week period and 31 patients over a 12-week period. Within the 12-week period, doxazosin treatment significantly reduced nightmares regardless of PTSD/BPD. 25 percent of patients treated for 12 weeks had full remission of nightmares. PSQI-A scores indicated that additional trauma-associated sleep symptoms improved over 12 weeks. Furthermore, recuperation of sleep improved with doxazosin within the first 4 weeks of treatment. Conclusion: Doxazosin might improve trauma associated nightmares and more general sleep parameters in patients with PTSD and BPD. Randomized controlled trials are warranted.

Study objectives To assess the acute effects of SB-649868 in male subjects with Primary Insomnia with regard to (1) objective and subjective sleep parameters, (2) safety and tolerability, (3) next-day residual effects. Design Multicenter, randomized, double-blind, placebo-controlled crossover study using a complete set of Williams orthogonal Latin Squares Setting 9 sleep centers in Germany Patients 52 male subjects with a diagnosis of primary insomnia (difficulty in sleep initiation and maintenance) confirmed by polysomnography Interventions SB-649868 (10, 30, 60 mg) and placebo administered after dinner 90 minutes before bedtime Measurements and results Sleep effects assessed by polysomnography during 2 consecutive nights and by sleep questionnaires completed by subjects after each night at the sleep laboratory. Safety and tolerability were assessed by adverse events collection, electrocardiogram (ECG), vital signs, laboratory tests. Next-day residual effects were assessed by Digit Symbol Substitution Test, and modified Verbal Learning Memory Test administered at "lights on" after night 2. SB-649868 significantly reduced latency to persistent sleep, wake after sleep onset (WASO), and increased total sleep time (TST) compared to placebo. A dose-dependent effect was observed. A dose-dependent increase in absolute and percent REM sleep and reduction in REM sleep latency was observed mainly at the 60-mg dose. SB-649868 was well tolerated with inconsistent next day residual effects. SB-649868 sleep effects were correlated with SB-649868 circulating levels. Conclusion The data demonstrate the sleep-promoting properties of the orexin antagonist SB-649868 in male patients with insomnia.

The first two decades of life are characterised complex biological processes involving growth and maturation as well as differentiation. The Central Nervous System (CNS) where among others internal and external stimuli are integrated and responses of the body are prepared starts to evolve quite early during ontogenesis. One of the complex behaviours, which are regulated by the brain, is the sleep-wake cycle. The discussion of age-related changes in sleep comprises changes at the physiological level (e.g. changes in the frequency and amplitude of EEG signal, as well as development and distribution of sleep stages), changes in the corresponding behaviour (e.g. changes in the absolute amount of sleep and its distribution in 24h perspective), and finally the subjective perception of sleep and sleep as a measure of well-being. Studies on the impact of a specific factor on sleep during childhood and adolescence have to consider chronological and biological age as well as sex as relevant biological parameters. Even when these factors are controlled for large interindividual differences persist, that is why prospective instead of cross-sectional approaches should be used whenever possible. Furthermore, it has to be distinguished between sleep assessed at the level of brain functioning (i.e. by polysomnography), which gives information on effects at the physiological level and at the level of self-assessment, which focuses on behaviour. Both, sleep at the subjective as well as at the objective level, can to a considerable degree be affected by life style factors, which hence have to be considered as potential confounders.

In the present double-blind, randomized, sham-controlled cross-over study, possible effects of electromagnetic fields emitted by Global System for Mobile Communications (GSM) 900 and Wideband Code-Division Multiple Access (WCDMA)/Universal Mobile Telecommunications System (UMTS) cell-phones on the macrostructure of sleep were investigated in a laboratory environment. An adaptation night, which served as screening night for sleep disorders and as an adjustment night to the laboratory environment, was followed by 9 study nights (separated by a 2-week interval) in which subjects were exposed to three exposure conditions (sham, GSM 900 and WCDMA/UMTS). The sample comprised 30 healthy male subjects within the age range 18-30 years (mean ± standard deviation: 25.3 ± 2.6 years). A cell-phone usage at maximum radio frequency (RF) output power was simulated and the transmitted power was adjusted in order to approach, but not to exceed, the specific absorption rate (SAR) limits of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines for general public exposure (SAR(10g) = 2.0 W kg(-1)). In this study, possible effects of long-term (8 h) continuous RF exposure on the central nervous system were analysed during sleep, because sleep is a state in which many confounding intrinsic and extrinsic factors (e.g. motivation, personality, attitude) are eliminated or controlled. Thirteen of 177 variables characterizing the initiation and maintenance of sleep in the GSM 900 and three in the WCDMA exposure condition differed from the sham condition. The few significant results are not indicative of a negative impact on sleep architecture. From the present results there is no evidence for a sleep-disturbing effect of GSM 900 and WCDMA exposure.

Von der Deutschen Gesellschaft fur Schlafmedizin (DGSM) akkreditierte Schlaflabore wurden aktuell zur Praxis der Durchfuhrung von Multiplen Wachbleibetests (MWTs) befragt. Fragebogen wurden an 308 solcher Schlaflabore versandt. Ein Teil der Fragen war bereits 2004 in einer Umfrageaktion zur Durchfuhrung von Multiplen Schlaflatenztests und MWTs gestellt worden. Die Auswertung umfasste alle bis Ende April 2009 ausgefullt zuruckgesandten Fragebogen. Die Ergebnisse wurden mit den Daten aus 2004 verglichen. Die Rucklaufquote betrug 75,3% (232 Zentren). Davon fuhren 38,4% den MWT in ihrem Labor regelmasig durch, 2,6% unregelmasig und 59,1% wenden den MWT nicht an. Die Mehrzahl dieser Zentren (47,4%) gab an, den MWT in einer Testdauer von 40 min anzuwenden. 43,2% der Zentren setzt eine 20-min-Version ein und die restlichen 9,4% andere Langen. Am haufigsten eingesetzt wird der MWT in der Diagnostik der Hypersomnie (47,0%), Narkolepsie (29,5%) und bei schlafbezogenen Atmungsstorungen (27,4%). Weitere Indikationen sind die Testung von gefahrdeten Berufsgruppen (z. B. Berufskraftfahrer; 45,3% der Labore) und die Therapiekontrolle (21,1%). Die Durchfuhrung, Auswertung und Interpretation unterscheiden sich sehr zwischen den Laboren. Gegenuber dem Jahr 2004 wird der MWT jetzt deutlich haufiger eingesetzt. Die Anwendung eines einheitlichen Protokolls, wie es von der American Academy of Sleep Medicine empfohlen wird, ist wunschenswert.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition borderline personality disorder (BPD) seems to constitute a very heterogeneous category. Therefore, pharmacological therapy is symptom-oriented or targets comorbid conditions. A high comorbidity exists between BPD and posttraumatic stress disorder (PTSD). In a double-blind, randomized, placebo-controlled crossover study, we sought to determine whether the antinoradrenergic agent clonidine was effective in reducing hyperarousal and measures of BPD-specific and general psychopathology in a sample of 18 patients with BPD, with or without comorbid PTSD, and with a prominent hyperarousal syndrome. Hyperarousal as measured by the Clinician Administered PTSD scale improved significantly compared with placebo (P = 0.003) irrespective of PTSD comorbidity. Improvements in general and BPD-typical psychopathology were mainly seen in the PTSD-positive subgroup, whereas the subjective sleep latency (P = 0.005) and the restorative qualities of the sleep (P = 0.014) improved in the whole sample. Improvements, despite the small sample size of this pilot study, lead us to conclude that clonidine might be a useful adjunct to pharmacotherapy in patients with BPD who have marked hyperarousal and/or sleep problems and, in particular, in patients with BPD who have a PTSD comorbidity.

Interrater variability of sleep stage scorings has an essential impact not only on the reading of polysomnographic sleep studies (PSGs) for clinical trials but also on the evaluation of patients' sleep. With the introduction of a new standard for sleep stage scorings (AASM standard) there is a need for studies on interrater reliability (IRR). The SIESTA database resulting from an EU-funded project provides a large number of studies (n = 72; 56 healthy controls and 16 subjects with different sleep disorders, mean age +/- SD: 57.7 +/- 18.7, 34 females) for which scorings according to both standards (AASM and RK) were done. Differences in IRR were analysed at two levels: (1) based on quantitative sleep parameter by means of intraclass correlations; and (2) based on an epoch-by-epoch comparison by means of Cohen's kappa and Fleiss' kappa. The overall agreement was for the AASM standard 82.0% (Cohen's kappa = 0.76) and for the RK standard 80.6% (Cohen's kappa = 0.68). Agreements increased from RK to AASM for all sleep stages, except N2. The results of this study underline that the modification of the scoring rules improve IRR as a result of the integration of occipital, central and frontal leads on the one hand, but decline IRR on the other hand specifically for N2, due to the new rule that cortical arousals with or without concurrent increase in submental electromyogram are critical events for the end of N2.

The Epworth Sleepiness Scale (ESS) is a widespread, self-administered questionnaire to measure the tendency to fall asleep in 8 different activities of daily life. A German version of the scale is provided by the German Sleep Research Society, but normative data for this version are lacking. Within the context of a multicenter study aiming at collecting normative data on a monotonous sustained attention test, 239 healthy subjects (120 males, 119 females) aged between 20 to 79 years completed the German Version of the Epworth Sleepiness Scale. At least 20 subjects from each age decade and gender were tested; only in the group of 70 to 79 years of age was the sample size smaller (16 males and 10 females). All subjects were screened for sleep disorders by the Pittsburgh Sleep Quality Index and the Landecker Sleep Disorders Inventory and for depression and anxiety by the Zung self-rating scales. Exclusion criteria comprised the presence of sleep disorders, shift-work, irregular sleep-wake patterns and chronic illness as well as the use of CNS active substances, and excessive caffeine or nicotine consumption. Statistical analysis revealed no differences between age and gender groups. The ESS total score for all subjects was 6.6±3.5 (SD). 85% of subjects scored

The neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are important mediators of brain and neuronal development, the maintenance of homeostatic conditions in the adult nervous system, and the complex interplay of central and peripheral physiological and pathophysiological factors. To date there are few studies examining blood concentrations of neurotrophic factors in large samples of healthy and diseased individuals and no published study specifically addresses peripheral BDNF and NGF levels in late life. Using improved highly sensitive and specific fluorometric two-site enzyme-linked immunosorbent assays we examined BDNF (n = 465) and NGF (n = 175) serum levels in a large cohort of elderly individuals (age range: 70–103 years). Neither BDNF nor NGF serum levels proved to be normally distributed, indicating that previously published studies with small sample sizes using parametric testing may be misleading. A significant correlation was found between BDNF and platelet count (r = 0.344, p < 0.01), age and BDNF protein (r = −0.101, p = 0.029) and BDNF and NGF serum levels (r = 0.152, p = 0.04). No other major influencing factors were found including gender, depression, and dementia.

Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique which had recently been investigated as a putative antidepressant intervention. However, there is little agreement about clinically useful predictors of rTMS outcome. Therefore, the objective of the present study was to determine whether specific biographical, clinical, and psychopathological parameters are associated with the antidepressant response to rTMS in a large sample of 70 depressive patients. We performed a logistic regression analysis in 70 patients with major depressive disorder treated with rTMS of the left dorsolateral prefrontal cortex testing the predictive value of various domains of the depression syndrome as well as the variables episode duration, degree of treatment resistance, and CORE criteria. Response was defined as a 50% reduction of the initial Hamilton score (HAMD). After two weeks of treatment, 21% of the patients showed a response to rTMS. The binary logistic regression model correctly assigned 86.7% of the responders and 96.4% of the non-responders to their final response group. In the model, a high level of sleep disturbances was a significant predictor for treatment response to rTMS. Also, a low score of treatment resistance and a short duration of episode were positive predictors. These findings provide new evidence that especially pronounced sleep disturbances may be a significant clinical predictor of a response to rTMS. Prospective rTMS studies are necessary to validate the predictive value of the derived model.

Background Recent findings in young adults suggest that rapid eye movement (REM) sleep plays a role in procedural memory consolidation. The significance of REM sleep for memory consolidation in old age has not yet been investigated. Methods Effects of REM sleep manipulation on declarative and procedural memory consolidation were investigated in 107 healthy older adults, ages 60–82 years. Rapid eye movement sleep deprivation was achieved by REM sleep awakenings and compared with non-REM sleep awakenings. Rapid eye movement sleep augmentation was realized physiologically by REM sleep rebound and pharmacologically by administering an acetylcholinesterase inhibitor in a double-blind, placebo-controlled design. Memory performance was tested by a paired associate list and a mirror tracing task at 9:30 pm and 7:30 am with sleep intervening between 11:00 pm and 7:00 am . Results Although REM sleep deprivation led to a significant reduction in total and phasic REM sleep, memory consolidation remained unaffected. Both REM sleep augmentation groups showed a significant increase in phasic REM sleep, whereas only pharmacological cholinergic REM sleep manipulation exerted a significant positive effect on procedural memory consolidation. Conclusions Because only after cholinergic stimulation of phasic REM sleep procedural memory consolidation is improved, cholinergic activation seems to be a crucial component of REM sleep-related memory consolidation in old age.

Generalized anxiety disorder (GAD) is a chronic stress disease with permanent physical tension and cognitive strain. Raised nerve growth factor (NGF) serum levels were reported as an acute stress reaction in soldiers before their first parachute jump even before the rise in cortisol. Taking GAD as a clinical model of chronic stress, we measured NGF in the serum of 22 patients with GAD before and after cognitive-behavioural therapy (CBT) and compared them to those of healthy normal controls. Treatment response was tested by the values of the State and Trait of Anxiety Inventory (STAI) and the Hamilton Anxiety Scale (HAM-A) as treatment outcome variables. The NGF values of patients and controls were similar at baseline (p=0.8941); however, with successful treatment, corresponding to a mean reduction in the HAM-A by more than 50% and a reduction in the clinical global impression scale (CGI) median from 4 to 1, the patients' NGF serum concentrations rose significantly (p=0.0006) which might correspond to an altered stress reaction, possibly contributing to good therapeutic response with CBT. There were 3 patients with a HAM-A decrease of less than 15%. In those patients NGF rose only marginally. Hence, the increase in serum NGF seems to indicate good treatment response.

Background Studies have shown that exposure to radiofrequency electromagnetic fields (RF-EMF) in the mobile communication frequency range may induce physiological modifications of both spontaneous as well as event-related human electroencephalogram. So far, there are very few peer-reviewed studies on effects of Terrestrial Trunked Radio (TETRA), which is a digital radio communication standard used by security authorities and organizations in several European countries, on the central nervous system. Objectives To analyze the impact of simulated TETRA handset signals at 385 MHz on slow cortical potentials (SCPs). Methods 30 young healthy males (25.2±2.7 years) were exposed in a double-blind, counterbalanced, cross-over design to one of three exposure levels (TETRA with 10 g averaged peak spatial SAR: 1.5 W/kg, 6.0 W/kg and sham). Exposure was conducted with a body worn antenna (especially designed for this study), positioned at the left side of the head. Subjects had 9 test sessions (three per exposure condition) in which three SCPs were assessed: SCP related to a clock monitoring task (CMT), Contingent negative variation (CNV) and Bereitschaftspotential (BP). Results Neither behavioral measures nor the electrophysiological activity was significantly affected by exposure in the three investigated SCP paradigms. Independent of exposure, significant amplitude differences between scalp regions could be observed for the CMT-related SCP and for the CNV. Conclusions The present results reveal no evidence of RF-EMF exposure-dependent brain activity modifications investigated at the behavioral and the physiological level.

Stress-induced helplessness in rodents constitutes a well-defined model to investigate neurobiological mechanisms of depression. Neurotrophins like nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) have both been shown to be involved in neurobiological changes of physiological and pathological reactions to stress. In this study we investigated NGF and BDNF protein levels in the frontal cortex and hippocampus in mice treated with an established model of inducible helplessness via electric footshocks compared to untreated controls at various times (0 h up to 14 days after treatment). NGF levels were transiently decreased by one forth in the frontal cortex of shocked mice at 6 h after the stress treatment, whereas BDNF levels remained unchanged in the brain areas investigated throughout the time course. In addition, frontal cortex BDNF levels showed a significantly higher concentration in the right compared to the left hemisphere (up to 3-fold). This effect was detectable independently of treatment, namely in shocked and control mice at any time point measured. In conclusion, a transient decrease of frontal NGF constitutes the most striking correlate of neurobiological changes in this animal model of stress-induced change of behaviour. Interhemispherical differences of BDNF content in the frontal cortex are a new finding that might reflect intracerebral side dominance. Thus, subsequent studies of frontal cortex BDNF expression should carefully consider an interhemispherical variance to avoid misinterpretation.

The reliable evaluation of polysomnographic recordings (PSG) is an essential precondition for good clinical practice in sleep medicine. Although the scoring rules of Rechtschaffen and Kales [86] are internationally well established, they leave some room for different interpretations, and this may contribute to the limited reliability of visual sleep scoring. The German Sleep Society (DGSM) has set up a task force to devise ways to improve scoring reliability in the framework of their quality management programme. The intention was not to revise the rules of Rechtschaffen and Kales (R&K), but to facilitate their reliable application in sleep scoring and to support the development of standardized algorithms for computerized sleep analysis. The task force was formed in September 2004 as a subcommittee of the educational panel of the DGSM: The members of the task force are experienced in sleep scoring and have a background either in physiology, neurology, psychiatry, psychology, or biology. The aim of the task force was to provide interpretation aids and, if needed, specifications or amendments to the R&K rules for the scoring of sleep electroencephalogram (EEG) waveforms and patterns. Decisions were based on the nominal group technique of a nominal panel as the formal consensus-building process. The consensus process was based on scoring and face-to-face discussions of at least 40 examples for each pattern in four 2-day meetings. Relevant EEG patterns for sleep stage scoring are alpha, theta, and delta waves, sleep spindles, K-complexes, vertex sharp waves, and sawtooth waves. If definitions for a given EEG pattern differed in the literature, the nominal group technique resulted in specifications and amended scoring rules for these EEG patterns. A second part including a series of examples with explanatory comments for each of these EEG patterns is under preparation. Amendatory scoring rules of those EEG patterns that are relevant for sleep scoring may contribute to increasing the reliability of visual sleep scoring and to support the development of standardized algorithms for computerized sleep analysis.

Neurotrophins such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are important for the development and maintenance of neuron function. Neurodevelopment is thought to be impaired in schizophrenia, and vulnerable schizophrenic brains may be more sensitive to toxic influences. Thus, cannabis as a neurotoxin (and other substances) may be more harmful to schizophrenic brains than to non-schizophrenic brains, when used chronically. In a previous study we demonstrated an earlier disease onset and significantly higher serum NGF concentrations in drug-naive schizophrenic patients with previous long-term cannabis abuse than in schizophrenics without cannabis abuse or cannabis abusers without schizophrenia. We therefore investigated whether this difference is still observed after treatment. Serum NGF measured in 114 treated schizophrenic patients (schizophrenia alone, n=66; schizophrenia plus cannabis abuse, n=42; schizophrenia plus multiple substance abuse, n=6) no longer differed significantly among those groups and from the control groups (healthy controls, n=51; cannabis controls, n=24; multiple substance controls, n=6). These results were confirmed by an additional prospective study in 28 patients suffering from schizophrenia (S) or schizophrenia with cannabis abuse (SC). Previously elevated serum NGF levels in the drug-naive state, also differing between the groups (S: 83.44+/-265.25 pg/ml; SC: 246.89+/-310.24 pg/ml, S versus SC: p=0.03) dropped to 10.72+/-14.13 pg/ml (S) and 34.19+/-38.96 pg/ml (SC) (S versus SC, p>0.05), respectively, after adequate antipsychotic treatment. We thus conclude that antipsychotic treatment leads to recovery of neural integrity, as indicated by renormalized NGF values.

Vor dem Hintergrund der Ergebnisse einer von der Arbeitsgruppe Methodik der Deutschen Gesellschaft fur Schlafforschung und Schlafmedizin (DGSM) durchgefuhrten Untersuchung zur Reliabilitat der visuellen Auswertung von Schlafstadien in akkreditierten Schlaflaboren [18] hat die Arbeitsgruppe Vigilanz der DGSM eine Studie zur Reliabilitat von Ergebnissen aus Multiplen Schlaflatenztests (MSLT) in akkreditierten Schlaflaboren initiiert. Die Studie wird in 2 Schritten durchgefuhrt. In diesem Beitrag werden zunachst die Ergebnisse einer Fragebogenaktion zur Erfassung der Praxis der Durchfuhrung des MSLT dargestellt. Es wurde ein Fragebogen entwickelt, mit dem Informationen zur Durchfuhrung von MSLT erhoben wurden. Dieser Fragebogen wurde im Januar 2004 an alle zu dieser Zeit akkreditierten Schlaflabore (N=268) verschickt. Die Responserate betrug bis Anfang April 2004 73,1%. Die Ergebnisse belegen eine grose Variabilitat hinsichtlich der durchschnittlichen Anzahl der pro Jahr durchgefuhrten MSLT, der Anzahl der Tests pro Untersuchungstag, des Spektrums von Verdachtsdiagnosen, bei denen ein MSLT durchgefuhrt wird sowie der Kriterien zur Definition des Schlafbeginns, der REM-Schlaf-Latenz, der Beendigung eines MSLT-Durchgangs und der Bewertung von Ergebnissen als pathologisch. Die beschriebene Heterogenitat in der Durchfuhrung und Bewertung von MSLT in akkreditierten Schlaflaboren hat Konsequenzen fur die Reliabilitat der Ergebnisse im Hinblick auf einen Vergleich der Ergebnisparameter mit Referenzdaten, die sich auf eine standardisierte Datenerhebung [1, 2, 7, 17, 22] beziehen. Eine Durchfuhrung und Bewertung von MSLT nach den publizierten Richtlinien ist deshalb dringend zu empfehlen.

Background Several lines of evidence suggest that central cortical inhibitory mechanisms, especially associated with gamma-aminobutyric acid (GABA) neurotransmission, may play a role in the pathophysiology of major depression. Transcranial magnetic stimulation is a useful tool for investigating central cortical inhibitory mechanisms associated with GABAergic neurotransmission in psychiatric and neurological disorders. Methods By means of transcranial magnetic stimulation, different parameters of cortical excitability, including motor threshold, the cortical silent period, and intracortical inhibition/facilitation, were investigated in 20 medication-free depressed patients and 20 age- and gender-matched healthy volunteers. Results Silent period and intracortical inhibition were reduced in depressed patients, consistent with a reduced GABAergic tone. Moreover, patients showed a significant hemispheric asymmetry in motor threshold. Conclusions This study provides evidence of reduced GABAergic tone and motor threshold asymmetry in patients with major depression.

ZusammenfassungDie rTMS gilt derzeit als mögliche Therapieoption für depressive Patienten, welche auf andere antidepressive Behandlungsverfahren nicht oder nur unzulänglich ansprechen. Die Datenlage zur Effektivität spricht insgesamt für eine moderate antidepressive Wirksamkeit der rTMS, allerdings ist die klinische Bedeutung der beobachteten Effekte eher gering, sodass Studien zur Optimierung der Effektivität von Nöten sind. In der Berliner Prädiktor Studie wurden mit der rTMS des linken DLPFC über einen Zeitraum von zwei Wochen 70 depressive Patienten behandelt, von denen 21% respondierten. Da insbesondere Einsicht in Veränderungen der individuellen klinischen Symptomcluster gewonnen werden sollte, wurden fünf Cluster im Verlauf analysiert. Durch regressionsanalytische Methoden konnte gezeigt werden, dass neben generellen Prädiktoren wie eine kurze Episodendauer und ein geringes Maß an Therapieresistenz, besonders motorische Retardierung und Schlafstörungen klinische Prädiktoren für ein Ansprechen auf rTMS sind.

Background TETRA (terrestrial trunked radio) is a digital radio communication standard, which has been implemented in several European countries and is used by public executives, transportation services, and by private companies. Studies on possible impacts on the users' health considering different exposure conditions are missing. Objectives To investigate possible acute effects of electromagnetic fields (EMF) of two different levels of TETRA hand-held transmitter signals on cognitive function and well-being in healthy young males. Methods In the present double-blind cross-over study possible effects of short-term (2.5 h) EMF exposure of handset-like signals of TETRA (385 MHz) were studied in 30 healthy male participants (mean±SD: 25.4±2.6 years). Individuals were tested on nine study days, on which they were exposed to three different exposure conditions (Sham, TETRA 1.5 W/kg and TETRA 6.0 W/kg) in a randomly assigned and balanced order. Participants were tested in the afternoon at a fixed timeframe. Results Attention remained unchanged in two out of three tasks. In the working memory significant changes were observed in two out of four subtasks. Significant results were found in 5 out of 35 tested parameters, four of them led to an improvement in performance. Mood, well-being and subjective somatic complaints were not affected by TETRA exposure. Conclusions The results of the present study do not indicate a negative impact of a short-term EMF-effect of TETRA on cognitive function and well-being in healthy young men.

Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex is a relatively non-invasive technique with putative therapeutic effects in major depression. However, the exact neurophysiological basis of these effects needs further clarification. Therefore, we studied the impact of ten daily sessions of left, dorsolateral prefrontal rTMS on motor cortical excitability, as revealed by transcranial magnetic stimulation-elicited motor-evoked potentials in 30 patients. As compared to the non-responders, responders (33%) showed changes in parameters pointing towards a reduced cortical excitability. These results suggest that repetitive transcranial magnetic stimulation of the dorsolateral, prefrontal cortex may have inhibitory effects on motor cortical neuronal excitability in patients with major depressive disorder. Furthermore, measurement of motor cortical excitability may be a useful tool for investigating and monitoring inhibitory brain effects of antidepressant stimulation techniques like rTMS.

Question of the study For a long time, biological effects of electromagnetic fields at mobile phone frequencies have been subject to public debate. While the initial interest was on direct effects causing health problems or diseases, especially cancer, in more recent times the focus has changed to effects that reflect impairments of well-being, such as headaches, sleep disturbances, and other unspecific health symptoms.

Aging is accompanied by changes on many different levels, including sleep and memory processes. In light of recent findings, which underline the importance of sleep for memory consolidation in young adults, the relationship between sleep and memory in older adults is of particular interest. This review takes a closer look at commonalities and interrelationships of the two aging trajectories in sleep and memory. A link between these two research domains on aging will be proposed and discussed on the basis of recent findings within the cognitive neuroscience of sleep.

One of the aims of the SIESTA project was to establish a normative database of sleep parameters for healthy and sleep-disturbed patients. Reference data for sleep parameters in non-sleep-disturbed subjects are scarce and usually refer to means and standard deviations. However, since most of the parameters do not follow a Gaussian distribution, percentiles of the distribution provide more detailed information. The present results are based on data from 198 healthy, non-sleep-disturbed subjects (104 females) in the age range of 20 to 95 years. For every subject, two consecutive nights were polysomnographically recorded in one of the eight participating clinical centres. Percentile charts were created on the basis of moving averages computed for 10 year age intervals with the presented age being the midpoint of the underlying interval. The resulting percentile curves were smoothed by a spline function. Since sample size in the oldest age groups is comparatively small, the percentile curves are restricted to the age range of 20 to 80 years. Percentile curves have been created for the parameters sleep period time (SPT), total sleep time (TST), sleep onset latency, REM sleep latency, sleep efficiency index, and percentages of NREM1, NREM2, REM sleep, SWS, and WAKE (with reference to SPT). The charts reflect the known changes of sleep parameters with age, e.g. decrease of TST and sleep efficiency with increasing age. The reference charts are intended to be a helpful tool to evaluate selected aspects of sleep quality in sleep-disturbed patients.

Interrater variability of sleep stage scorings is a well-known phenomenon. The SIESTA project offered the opportunity to analyse interrater reliability (IRR) between experienced scorers from eight European sleep laboratories within a large sample of patients with different (sleep) disorders: depression, general anxiety disorder with and without non-organic insomnia, Parkinson's disease, period limb movements in sleep and sleep apnoea. The results were based on 196 recordings from 98 patients (73 males: 52.3 +/- 12.1 years and 25 females: 49.5 +/- 11.9 years) for which two independent expert scorings from two different laboratories were available. Cohen's kappa was used to evaluate the IRR on the basis of epochs and intraclass correlation was used to analyse the agreement on quantitative sleep parameters. The overall level of agreement when five different stages were distinguished was kappa = 0.6816 (76.8%), which in terms of kappa reflects a 'substantial' agreement (Landis and Koch, 1977). For different groups of patients kappa values varied from 0.6138 (Parkinson's disease) to 0.8176 (generalized anxiety disorder). With regard to (sleep) stages, the IRR was highest for rapid eye movement (REM), followed by Wake, slow-wave sleep (SWS), non-rapid eye movement 2 (NREM2) and NREM1. The results of regression analysis showed that age and sex only had a statistically significant effect on kappa when the (sleep) stages are considered separately. For NREM2 and SWS a statistically significant decrease of IRR with age has been observed and the IRR for SWS was lower for males than for females. These variations of IRR most probably reflect changes of the sleep electroencephalography (EEG) with age and gender.

Nerve growth factor (NGF) is the most widely examined neurotrophin in the experimental models of Alzheimer's disease (AD) and has been shown to prevent the retrograde degeneration of cholinergic neurons. In this study we examined NGF and cholineacetyltransferase (ChAT) changes in several rat brain regions after excitotoxic lesion of the entorhinal cortex with quinolinic acid and tested the effect of memantine on spatial learning in the radial maze after lesion. We observed a significant increase (+26%, p=0.02) of NGF concentrations in the hippocampus of the lesioned rats when compared to sham-lesioned rats. Chronic treatment with memantine showed no significant effect on the NGF increase in the hippocampus (p=0.72). The ChAT activity was significantly increased in the lesioned rats when compared to controls (+16%, p

Long-term cannabis abuse may increase the risk of schizophrenia. Nerve growth factor (NGF) is a pleiotropic neurotrophic protein that is implicated in development, protection and regeneration of NFG-sensitive neurones. We tested the hypothesis that damage to neuronal cells in schizophrenia is precipitated by the consumption of cannabis and other neurotoxic substances, resulting in raised NGF serum concentrations and a younger age for disease onset. The NGF serum levels of 109 consecutive drug-naive schizophrenic patients were measured and compared with those of healthy controls. The results were correlated with the long-term intake of cannabis and other illegal drugs. Mean (± SD) NGF serum levels of 61 control persons (33.1 ± 31.0 pg/ml) and 76 schizophrenics who did not consume illegal drugs (26.3 ± 19.5 pg/ml) did not differ significantly. Schizophrenic patients with regular cannabis intake (> 0.5 g on average per day for at least 2 years) had significantly raised NGF serum levels of 412.9 ± 288.4 pg/ml (n = 21) compared to controls and schizophrenic patients not consuming cannabis (p < 0.001). In schizophrenic patients who abused not only cannabis, but also additional substances, NGF concentrations were as high as 2336.2 ± 1711.4 pg/ml (n = 12). On average, heavy cannabis consumers suffered their first episode of schizophrenia 3.5 years (n = 21) earlier than schizophrenic patients who abstained from cannabis. These results indicate that cannabis is a possible risk factor for the development of schizophrenia. This might be reflected in the raised NGF-serum concentrations when both schizophrenia and long-term cannabis abuse prevail.

Die visuelle Auswertung der Schlafstadien nach Rechtschaffen und Kales weist eine begrenzte Interrater-Reliabilitat auf. Es wurde die Interrater-Reliabilitat einer computergestutzten visuellen Auswertung bei neun akkreditierten Schlaflaboren in Deutschland untersucht. Fur den Vergleich wurden acht kardiorespiratorische Polysomnographien (drei Probanden, drei Apnoe-Patienten, zwei PLMS-Patienten) auf CD-ROM mit einem programm zur Darstellung und Auswertung am Computermonitor zur Verfugung gestellt. Es wurden die quantitativen Werte (Schlafperiodendauer, Gesamtschlafdauer, Latenzen und Anteile der Schlafstadien) verglichen. Ein Vergleich auf der Basis der einzelnen Epochen erfolgte durch Bestimmung des Fleiss-Kappa-Koeffizienten. Neun Schlaflabore sandten jeweils alle acht Auswertungen fur einen systematischen Vergleich zuruck. Bereits der Vergleich der quantitativen Werte zeigte eine sehr hohe Variabilitat. Diese war bei den Patienten noch ausgepragter als bei den Probanden. Bezogen auf den Vergleich einzelner Epochen fand sich die beste Ubereinstimmung fur REM-Schlaf und die schlechteste fur NREM1. Die Ubereinstimmung ist generell bei den Patienten schlechter und muss bei Apnoe-Patienten mit k≤0,40 als schwach bezeichnet werden. Die Ergebnisse zeigen, dass die Schulung in der visuellen Auswertung der Schlafstadien intensiviert werden muss und dass auserdem Interpretationshilfen fur die Bewertung der Schlafstadient bei Schlafapnoe erarbeitet werden mussen.

Transcranial direct current stimulation (tDCS) is a method to stimulate the brain in a noninvasive manner leading either to an increased (anodal stimulation) or a decreased (cathodal stimulation) excitability of cortical neurons. Slow oscillations with a frequency below 1 Hz are assumed to be associated with sleep-dependent consolidation of declarative memories by exerting a temporal synchronizing influence on hippocampal reactivations and thalamic spindle activity. Many studies have revealed that offline consolidation during sleep varies with age showing better performances in the young compared to the elderly. A study in young subjects provided evidence of a beneficial impact of an anodal slow oscillation tDCS (0.75 Hz) during early SWS-rich on declarative memory but not on procedural memory. These results could not be confirmed in a study on elderly subjects (Eggert et al., 2013). The present study aims to replicate the results, which have been observed in younger subjects (Marshal et al., 2006). To be able to test an effect of 0.65 with a power of 0.8 and a double-sided alpha 2 ) is triggered after the first 8 consecutive epochs of NREM sleep 2 immediately before the first occurrence of slow wave sleep. The total 25 ′ 8 ″ stimulation period is divided into five 5 ′ 16 ″ intervals, each of them followed by 1 min break without stimulation. To test for a stimulation-dependent effect on offline consolidation during sleep a declarative memory task (word pair test) and a procedural memory task (finger-tapping) have to be completed before sleep and after awakening. Furthermore, sleep stages were scored and EEG power and spindle densities were computed. Statistical analysis was based upon comparisons between the tDCS and the sham stimulation condition. Currently 18 subjects (10 males and 8 females) are already enrolled. First results will be presented at the meeting.

To the Editor:In their correspondence, the colleagues Youssef and McCallraise important issues concerning our study in which wecompared efficacy and tolerability of continuation electrocon-vulsive therapy (ECT), cognitive-behavioral therapy, and antide-pressant medication after successful acute ECT (1). We arethankful for their thoughtful remarks, which give us the oppor-tunity to explain in more detail the rational for some key studydesign details.Youssef and McCall are concerned that the study results mighthave been biased in not favoring ECT due to the use of propofolinstead of methohexital. They argue that anticonvulsant effects ofpropofol might have reduced the efficacy of ECT. We are aware ofstudies indicating reduced effects due to shorter seizure duration;therefore, we ensured that all stimulation parameters indicating asuccessful seizure, such as seizure duration, were adjusted toachieve the recommended range. Of relevance in this context,several previous studies have indicated that ECT with propofol isas effective as treatments with other anesthetics [for review, see(2)]. Even more, there are first evidences that propofol is capableof enhancing effects of ECT in an animal model in both thebehavioral and molecular levels (3).They correctly note that the switch from bilateral ECT in theacute phase to unilateral ECT in the continuation phase mighthave biased the data in not favoring ECT by providing apotentially ineffective treatment to some of the patients. How-ever, in our study, the number of patients receiving bilateral ECTwas small and exploratory comparison revealed that ECT was notless effective here as compared with those patients in whichacute ECT was already effective when administered unilaterally.On another note, Youssef and McCall stress the unexpectedresults that continuation ECT plus medication is less effective thanmedication alone. Like them, we were surprised by these findings,which from our perspective might indicate that the interaction ofultrabrief ECT and pharmacologic agents (including propofol) isnot sufficiently understood and urgently need to be investigatedin more detail in future studies.Finally, they state that the findings might not be generalizableto practice in the United States, since methohexital is mostly usedand propofol is rarely used. From our perspective, we agree thatat the present stage our data should not be generalized.However, negative (or positive) impact of propofol on efficacyand tolerability of ECT has yet to be determined in studiescomparing different anesthesia regimes. In this context, we wouldeven extend this point and state that the good tolerability asindicated with the positive cognitive profile also cannot begeneralized.In sum, we think that our data provide first evidence thatcognitive-behavioral therapy can be used as a helpful interven-tion in the continuation phase of treatment of depressive illnessafter successful ECT.Eva-Lotta Brakemeier

An experimental investigation of warming and warmth perception caused by handset EMF exposure was performed in order to examine its possible impact on blinding. Healthy male participants (15) were exposed to three different exposure conditions: sham and Terrestrial Trunked Radio (TETRA) handsets with maximum 10 g averaged SAR values of 1.5 and 6 W/kg each on three days. The study followed a randomized, double-blind design. TETRA signals simulated exposure from a handheld device consisting of a 385 MHz carrier modulated with a pulse length of 14.17 ms and a pulse period of 56.67 ms (i.e., duty cycle 25%; 17.65 Hz pulse modulation). A body worn antenna was used and fixed at the left ear. In addition to subjective ratings, skin temperatures at two locations close to the radiating element of the body-worn antenna were measured. The measurements revealed a temperature rise proportional to the supplied RF power with an average temperature increase measured at the two locations of 0.8 °C following the high exposure level of 6 W/kg. However, subjects were not able to distinguish between exposure conditions based on their subjective perception and thus the double-blinding was ensured.

Rationale: A reduced amplitude of the auditory evoked P300 was interpreted as a trait marker of schizophrenia but reports about correlations between schizophrenic psychopathology and P300 amplitude indicate also a state character. Objectives: To shed light upon these trait and state aspects a longitudinal study was performed to investigate the influence of symptom improvement and atypical neuroleptics on the amplitudes of the P300 and their subcomponents. Methods: P300 was recorded in 17 schizophrenic patients before and after 4 weeks under either clozapine or olanzapine in a double-blind controlled design. For comparison, 17 age- and sex-matched healthy subjects were investigated. Parietal and frontal P300 subcomponents were investigated separately using dipole source analysis. Results: Schizophrenic patients had smaller parietal (temporo-basal dipole) but not frontal subcomponent amplitudes (temporo-superior dipole) than controls. For the whole sample subcomponent amplitudes did not change over 4 weeks despite clinical improvement but patients with a pronounced improvement of the PANSS positive score showed a slight enhancement of both subcomponents. This was not significant when the P300 amplitude was measured at a single electrode (Pz). No significant difference between clozapine and olanzapine concerning effects on P300 amplitudes were observed. Conclusions: The results indicate that P300 subcomponents are modulated by changes of positive but not by changes of negative symptoms or different neuroleptics. This result was obvious for P300 subcomponents but not for Pz electrode measurement, which may be due to a higher reliability of the dipole source activity. The results can be integrated into a hypothetical model containing two pathophysiological subgroups of schizophrenia.

No previous studies have evaluated the influence of significant international sports events on qualified detoxification treatment outcome. This prospective study examines the impact of the 2012 UEFA European Football Championship on inpatient treatment outcome of alcohol dependent patients. Hospital admission and premature drop-out rates of consecutively admitted alcohol dependent patients were determined before, during and immediately after the UEFA Championship in the year 2012. The admission rate of male patients increased significantly after the European Football Championship had ended whereas for female patients, no change in admission rate was found. Daily average discharge rate was calculated. No statistically relevant differences between the treatment days before, during and after the UEFA Championship was found for the discharges. During the tournament, exclusively male patients dropped out. Our results are consistent with an interpretation of an association between European Football Championship and detoxification treatment outcome. Further research to replicate and extend our findings is necessary.

Background: A study was performed to analyze time-of-day variations of different indicators of attention and their interrelations. Methods: After a sufficiently long all-night sleep 12 healthy non–sleep-deprived subjects ran through a test battery (Stanford Sleepiness Scale, Visual Analogue Scale, Critical Flicker Fusion Test [CFF], Visualization Test, Number Facility Test, Reaction Time, Pupillometry, and modified Multiple Sleep Latency Test) every 2 hours from 7:00 am until 11:00 pm . Time-of-day variations were tested nonparametrically with Friedman’s test for repeated measurements. Principal component factor analysis (of individually standardized values) was used to identify variable complexes with the same pattern of time-of-day variation. Results: Statistically significant time-of-day variations were found for all variables, except for Fusion Frequency in CFF and Reaction Time. In factor analysis the physiologic parameters (pupillometric variables and sleep latencies) load on one factor, whereas the self-assessment scales, the Visualization Test, Number Facilty Test, and CFF load on the second factor. The variables that load primarily on factor 1 show peak levels of alertness immediately after getting up (at 7:00 am ) and again at 9:00 pm . Those variables that load primarily on factor 2 indicate a peak level of alertness around noon (11:00 am –3:00 pm ). Conclusions: Different aspects of attention follow different time-of-day variations. It is discussed, that these findings can be attributed to underlying circadian and homeostatic factors.

Secular trends in growth processes of children can be important indicators of changes in public health. Common to studies on secular trends in children is that evaluation is based on comparison of data collected at two (or more) distinct points on a time scale. The quantitative characteristic of the secular trend is estimated by linear interpolation between the two end points of the underlying time interval, which in studies of children are usually at least 10 years apart. The purpose of the present paper is to analyse secular trends in height, weight and body mass index (BMI) of 6-year-old children from Bremerhaven over the period 1968-1987 (the year refers to the birth cohort). The results are based on data drawn from health records of the City Health Centre, where all 6-year-old children are routinely measured in a school entrance examination. Thus the data represent complete birth cohorts of children entering school in Bremerhaven and not selected samples. The data reported here refer only to children of German origin. The sample sizes vary from n = 313 (girls born in 1982) to n = 737 (boys born in 1968), and total sample size is n = 7601. Regression of the arithmetic means of height on year of birth showed that the trend in stature for children born between 1968 and 1987 was 0.67 cm/decade for boys and 0.49 cm/decade in girls. Both trends are statistically significant (p0.05). Although there was an increasing tendency for weight as well, which was more marked for the 95th percentile than for the median, neither of the trends in both sexes was statistically significant. While the BMI in both sexes showed no trend at all for the median and the 5th percentile, there was a significant linear increase of the 95th percentile. Furthermore, the results for height show that an evaluation of secular trends under qualitative and quantitative perspective critically depends on the selection of points on the time scale.

Auf Anregung der Deutschen Narkolepsie Gesellschaft (DNG) Berlin/Brandenburg wurde eine Studie durchgefuhrt, um zu untersuchen, ob mit Hilfe der Psychophonie eine Milderung der Tagesmudigkeit bei Narkolepsie-Kranken erreicht werden kann. Bei der Psychophonie werden digital aufgezeichnete EEG-Signale mit einem mathematischen Algorithmus in horbare Tonfolgen umgewandelt. Die so hergestellten Musikkassetten wurden von den Teilnehmern uber einen Zeitraum von 46 Tagen mehrfach taglich fur mindestens 8 bis 10 min gehort. Es wurden subjektive Einschatzungen von Mudigkeit. Befindlichkeit und Schlafverhalten vor und unter der Anwendung der Psychophonie mittels etablierter Meβinstrumente an insgesamt neun Patienten erhoben. Die Ergebnisse, lieβen keinen eindeutigen Effekt erkennen.