Poor sleep in middle-aged women is not associated with menopause per se

Whether sleep problems of menopausal women are associated with vasomotor symptoms and/or changes in estrogen levels associated with menopause or age-related changes in sleep architecture is unclear. This study aimed to determine if poor sleep in middle-aged women is correlated with menopause. This study recruited women seeking care for the first time at the menopause outpatient department of our hospital. Inclusion criteria were an age ≥40 years, not taking any medications for menopausal symptoms, and no sleeping problems or depression. Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), modified Kupperman Index (KI), and Menopause Rating Scale (MRS). A PSQI score of <7 indicated no sleep disorder and ≥7 indicated a sleep disorder. Blood specimens were analyzed for follicle-stimulating hormone and estradiol levels. A total of 244 women were included in the study; 103 (42.2%) were identified as having a sleep disorder and 141 as not having one. In addition, 156 (64%) women were postmenopausal and 88 (36%) were not menopausal. Follicle-stimulating hormone and estradiol levels were similar between the groups. Patients with a sleep disorder had a significantly higher total modified KI score and total MRS score (both, P<0.001) compared with those without a sleep disorder. Correlations of the PSQI total score with the KI and MRS were similar in menopausal and non-menopausal women. These results do not support that menopause per se specifically contributes to sleep problems.

Clinical and pathological challenges in the diagnosis of late-onset biliary atresia: four case studies

Biliary atresia (BA) is classically described at the neonatal age. However, rare cases of BA in older infants have also been reported. We report four cases of late-onset BA in infants older than 4 weeks (3 males, 1 female), and describe the diagnostic and management difficulties. One of the cases had a late-onset (29 weeks) presentation with a successful surgical procedure. We highlight the importance of this unusual differential diagnosis in infants with cholestatic syndrome, who may benefit from Kasai surgery, regardless of age.

Asleep or not asleep? Evaluation of the Quality of Patients’ Sleep in Critical Care Nursing

Sleep is important for the recovery of a critically ill patient, as lack of sleep is known to influence negatively a person’s cardiovascular system, mood, orientation, and metabolic and immune function and thus, it may prolong patients’ intensive care unit (ICU) and hospital stay. Intubated and mechanically ventilated patients suffer from fragmented and light sleep. However, it is not known well how non-intubated patients sleep. The evaluation of the patients’ sleep may be compromised by their fatigue and still position with no indication if they are asleep or not. The purpose of this study was to evaluate ICU patients’ sleep evaluation methods, the quality of non-intubated patients’ sleep, and the sleep evaluations performed by ICU nurses. The aims were to develop recommendations of patients’ sleep evaluation for ICU nurses and to provide a description of the quality of non-intubated patients’ sleep. The literature review of ICU patients’ sleep evaluation methods was extended to the end of 2014. The evaluation of the quality of patients’ sleep was conducted with four data: A) the nurses’ narrative documentations of the quality of patients’ sleep (n=114), B) the nurses’ sleep evaluations (n=21) with a structured observation instrument C) the patients’ self-evaluations (n=114) with the Richards-Campbell Sleep Questionnaire, and D) polysomnographic evaluations of the quality of patients’ sleep (n=21). The correspondence of data A with data C (collected 4–8/2011), and data B with data D (collected 5–8/2009) were analysed. Content analysis was used for the nurses’ documentations and statistical analyses for all the other data. The quality of non-intubated patients’ sleep varied between individuals. In many patients, sleep was light, awakenings were frequent, and the amount of sleep was insufficient as compared to sleep in healthy people. However, some patients were able to sleep well. The patients evaluated the quality of their sleep on average neither high nor low. Sleep depth was evaluated to be the worst and the speed of falling asleep the best aspect of sleep, on a scale 0 (poor sleep) to 100 (good sleep). Nursing care was mostly performed while the patients were awake, and thus the disturbing effect was low. The instruments available for nurses to evaluate the quality of patients’ sleep were limited and measured mainly the quantity of sleep. Nurses’ structured observatory evaluations of the quality of patients’ sleep were correct for approximately two thirds of the cases, and only regarding total sleep time. Nurses’ narrative documentations of the patients’ sleep corresponded with patients’ self-evaluations in just over half of the cases. However, nurses documented several dimensions of sleep that are not included in the present sleep evaluation instruments. They could be classified according to the components of the nursing process: needs assessment, sleep assessment, intervention, and effect of intervention. Valid, more comprehensive sleep evaluation methods for nurses are needed to evaluate, document, improve and study patients’ quality of sleep.

A case of late-onset oligomeganephronia

A 33-year old caucasian man was investigated for pain in the right flank, proteinuria, hemathuria and an elevated serum creatinine level. He also presented an abnormal ultrasonography, which revealed asymmetric kidneys. Through renal biopsy, the diagnosis of oligomeganephronia (OMN) was confirmed. OMN is a very rare form of renal hypoplasia, and late-onset in adulthood is even rarer. In the pediatric population, OMN leads to end-stage-renal-failure(ESRF) in a few years. This is the sixth case related in the literature of a late-onset OMN who have not yet developed ESRF.

Late-onset spinal motor neuronopathy- a new neuromuscular disease

The aim of this study was to clarify the clinical phenotype of late-onset spinal motor neuronopathy (LOSMoN), an adult-onset autosomal dominant lower motor neuron disorder identified first in two families in Eastern Finland, in order to clarify its genetic background. Motor neuron disorders (MNDs) are characterized by dysfunction and premature death of motor neurons in the brain and spinal cord. MNDs can manifest at any age of the human lifespan, ranging from pre- or neonatal forms such as spinal muscular atrophy type I (SMA I) to those preferentially affecting the older age groups exemplified by sporadic amyotrophic lateral sclerosis (ALS). With a combination of genetic linkage analysis and genome sequencing using DNA from a total of 55 affected members of 17 families and a whole genome scan, we were able to show that LOSMoN is caused by the c.197G>T p.G66V mutation in the gene CHCHD10. This study showed that LOSMoN has very characteristic features that help to differentiate it from other more malignant forms of motor neuron disease, such as ALS, which was erroneously diagnosed in many patients in our cohort. Lack of fibrillations in the first dorsal interosseus muscle on EMG and extensive grouping of non-atrophic type IIA/2A fibers on muscle biopsy were shown to be common findings in LOSMoN, but rare or absent in ALS patients. The results of this study will help clinicians recognize the characteristic phenotype of LOSMoN disease and thus improve their diagnostic accuracy, and will also allow physicians to provide adequate genetic counseling for patients.

A dose-response investigation of the attentional blink during sleep restriction /

Recent dose-response sleep restriction studies, in which nightly sleep is curtailed to varying degrees (e.g., 3-, 5-, 7-hours), have found cumulative, dose-dependent changes in sleepiness, mood, and reaction time. However, brain activity has typically not been measured, and attentionbased tests employed tend to be simple (e.g., reaction time). One task addressing the behavioural and electrophysiological aspects of a specific attention mechanism is the Attentional Blink (AB), which shows that the report accuracy of a second target (T2) is impaired when it is presented soon after a first target (Tl). The aim of the present study was to examine behavioural and electrophysioiogical responses to the AB task to elucidate how sleep restriction impacts attentional capacity. Thirty-six young-adults spent four consecutive days and nights in a sleep laboratory where sleep, food, and activity were controlled. Nightly sleep began with a baseline sleep (8 hours), followed by two nights of sleep restriction (3,5 or 8 hours of sleep), and a recovery sleep (8 hours). An AB task was administered each day at 11 am. Results from a basic battery oftests (e.g., sleepiness, mood, reaction time) confirmed the effectiveness of the sleep restriction manipulation. In terms of the AB, baseline performance was typical (Le., T2 accuracy impaired when presented soon after Tl); however, no changes in any AB behavioural measures were observed following sleep restriction for the 3- or 5-hour groups. The only statistically significant electrophysiological result was a decrease in P300 amplitude (for Tl) from baseline to the second sleep restriction night for the 3-hour group. Therefore, following a brief, two night sleep restriction paradigm, brain functioning was impaired for the TI of the AB in the absence of behavioural deficit. Study limitations and future directions are discussed.

The acute effects of differential dietary fatty acids on PDHa activity in human skeletal muscle at the onset of exercise

Pyruvate dehydrogenase (PDH) is an important regulator of carbohydrate oxidation during exercise and its activity can be down-regulated by an increase in dietary fat. The purpose of this study was to determine the acute metabolic effects of differential dietary fatty acids on the activation of PDH in its active form (PDHa) at rest and at the onset of moderate-intensity exercise. University-aged male subjects (n=7) underwent 2 fat loading trials spaced at least 2 weeks apart. Subjects consumed saturated (SFA) or polyunsaturated (PUFA) fat over the course of 5 hours. Following this, participants cycled at 65% VO2 max for 15 min. Muscle biopsies were taken prior to and following fat loading and at 1 min exercise. Plasma free fatty acids increased from 0.15 ± 0.07 to 0.54 ± 0.19 mM over 5 hours with SFA and from 0.1 1 ± 0.04 to 0.35 ±0.13 mM with PUFA. PDHa activity was unchanged following fat loading, but increased at the onset of exercise in the SFA trial, from 1 .4 ± 0.4 to 2.2 ± 0.4 /xmol/min/kg wet wt. This effect was negated in the PUFA trial (1 .2 ± 0.3 to 1 .3 ± 0.3 pimol/min/kg wet wt.). PDH kinase (PDK) was unchanged in both trials, suggesting that the attenuation of PDHa activity with PUFA was a result of changes in the concentrations of intramitochondrial effectors, more specifically intramitochondrial NADH or Ca^*. Our findings suggest that attenuated PDHa activity participates in the preferential oxidation of PUFA during moderateintensity exercise.

The effects of simple procedural, cognitive procedural and declarative learning on sleep /

Sleep spindles have been found to increase following an intense period of learning on a combination of motor tasks. It is not clear whether these changes are task specific, or a result of learning in general. The current study investigated changes in sleep spindles and spectral power following learning on cognitive procedural (C-PM), simple procedural (S-PM) or declarative (DM) learning tasks. It was hypothesized that S-PM learning would result in increases in Sigma power during Non-REM sleep, whereas C-PM and DM learning would not affect Sigma power. It was also hypothesized that DM learning would increase Theta power during REM sleep, whereas S-PM and C-PM learning would not affect Theta power. Thirty-six participants spent three consecutive nights in the sleep laboratory. Baseline polysomnographic recordings were collected on night 2. Participants were randomly assigned to one of four conditions: C-PM, S-PM, DM or control (C). Memory task training occurred on night 3 followed by polysomnographic recording. Re-testing on respective memory tasks occurred one-week following training. EEG was sampled at 256Hz from 16 sites during sleep. Artifact-free EEG from each sleep stage was submitted to power spectral analysis. The C-PM group made significantly fewer errors, the DM group recalled more, and the S-PM improved on performance from test to re-test. There was a significant night by group interaction for the duration of Stage 2 sleep. Independent t-tests revealed that the S-PM group had significantly more Stage 2 sleep on the test night than the C group. The C-PM and the DM group did not differ from controls in the duration of Stage 2 sleep on test night. There was no significant change in the duration of slow wave sleep (SWS) or REM sleep. Sleep spindle density (spindles/minute) increased significantly from baseline to test night following S-PM learning, but not for C-PM, DM or C groups. This is the first study to have shown that the same pattern of results was found for spindles in SWS. Low Sigma power (12-14Hz) increased significantly during SWS following S-PM learning but not for C-PM, DM or C groups. This effect was maximal at Cz, and the largest increase in Sigma power was at Oz. It was also found that Theta power increased significantly during REM sleep following DM learning, but not for S-PM, C-PM or C groups. This effect was maximal at Cz and the largest change in Theta power was observed at Cz. These findings are consistent with the previous research that simple procedural learning is consolidated during Stage 2 sleep, and provide additional data to suggest that sleep spindles across all non-REM stages and not just Stage 2 sleep may be a mechanism for brain plasticity. This study also provides the first evidence to suggest that Theta activity during REM sleep is involved in memory consolidation.

Sleep and information processing in individuals who have sustained a traumatic brain injury

Individuals who have sustained a traumatic brain injury (TBI) often complain of t roubl e sleeping and daytime fatigue but little is known about the neurophysiological underpinnings of the s e sleep difficulties. The fragile sleep of thos e with a TBI was predicted to be characterized by impairments in gating, hyperarousal and a breakdown in sleep homeostatic mechanisms. To test these hypotheses, 20 individuals with a TBI (18- 64 years old, 10 men) and 20 age-matched controls (18-61 years old, 9 men) took part in a comprehensive investigation of their sleep. While TBI participants were not recruited based on sleep complaint, the fmal sample was comprised of individuals with a variety of sleep complaints, across a range of injury severities. Rigorous screening procedures were used to reduce potential confounds (e.g., medication). Sleep and waking data were recorded with a 20-channel montage on three consecutive nights. Results showed dysregulation in sleep/wake mechanisms. The sleep of individuals with a TBI was less efficient than that of controls, as measured by sleep architecture variables. There was a clear breakdown in both spontaneous and evoked K-complexes in those with a TBI. Greater injury severities were associated with reductions in spindle density, though sleep spindles in slow wave sleep were longer for individuals with TBI than controls. Quantitative EEG revealed an impairment in sleep homeostatic mechanisms during sleep in the TBI group. As well, results showed the presence of hyper arousal based on quantitative EEG during sleep. In wakefulness, quantitative EEG showed a clear dissociation in arousal level between TBls with complaints of insomnia and TBls with daytime fatigue. In addition, ERPs indicated that the experience of hyper arousal in persons with a TBI was supported by neural evidence, particularly in wakefulness and Stage 2 sleep, and especially for those with insomnia symptoms. ERPs during sleep suggested that individuals with a TBI experienced impairments in information processing and sensory gating. Whereas neuropsychological testing and subjective data confirmed predicted deficits in the waking function of those with a TBI, particularly for those with more severe injuries, there were few group differences on laboratory computer-based tasks. Finally, the use of correlation analyses confirmed distinct sleep-wake relationships for each group. In sum, the mechanisms contributing to sleep disruption in TBI are particular to this condition, and unique neurobiological mechanisms predict the experience of insomnia versus daytime fatigue following a TBI. An understanding of how sleep becomes disrupted after a TBI is important to directing future research and neurorehabilitation.

The Association of Sleep Disorder, Obesity Status, and Diabetes Mellitus among US Adults—The NHANES 2009-2010 Survey Results

To examine the association between sleep disorders, obesity status, and the risk of diabetes in adults, a total of 3668 individuals aged 40+ years fromtheNHANES 2009-2010 withoutmissing information on sleep-related questions,measurements related to diabetes, and BMI were included in this analysis. Subjects were categorized into three sleep groups based on two sleep questions: (a) no sleep problems; (b) sleep disturbance; and (c) sleep disorder. Diabetes was defined as having one of a diagnosis from a physician; an overnight fasting glucose > 125 mg/dL; Glycohemoglobin > 6.4%; or an oral glucose tolerance test > 199mg/dL. Overall, 19% of subjects were diabetics, 37% were obese, and 32% had either sleep disturbance or sleep disorder. Using multiple logistic regression models adjusting for covariates without including BMI, the odds ratios (OR, (95% CI)) of diabetes were 1.40 (1.06, 1.84) and 2.04 (1.40, 2.95) for those with sleep disturbance and with sleep disorder, respectively. When further adjusting for BMI, the ORs were similar for those with sleep disturbance 1.36 (1.06, 1.73) but greatly attenuated for those with sleep disorders (1.38 [0.95, 2.00]). In conclusion, the impact of sleep disorders on diabetes may be explained through the individuals’ obesity status.

In danger of jammed minds: A deconstructive discourse analysis of the criteria for early onset schizophrenia and imagination in children's literature

The purpose of this research is to expose and complicate those discourses of childhood imagination as demonstrated in the diagnostic criteria for early onset schizophrenia by using an antipsychiatry perspective. This will be done by evaluating those discourses alongside those found in popular children’s literature, specifically, Harry Potter and The Philosopher’s Stone, Bridge to Terabithia, and A Wrinkle in Time. Once uncovered, the underlying power discourses were then exposed. This research will then employ a minor reading as provided by Deleuze and Guattari’s (1987) approach to minor literature to demonstrate the ways in which the child can subvert those dominant discourses. The potential of literature is evaluated for its ability to provide alternative modes of experience and lines of flight for the child subjected to the diagnostic criteria of schizophrenia.

A Longitudinal Examination of Bidirectional Associations between Subjective Sleep Characteristics and Psychosocial Functioning among University Students

A number of studies have found a significant link between sleep and psychosocial functioning among university students. A critical examination of this literature, however, indicates that one important gap within the literature is the need for longitudinal studies that specifically test for bidirectional associations between these two constructs. The main purpose of my dissertation was to address this gap by conducting three studies that examined bidirectional associations between sleep and psychosocial functioning among a sample of university students. Participants were 942 (71.5% female) undergraduate students enrolled at a Canadian university, who completed survey assessments annually for three consecutive years, beginning in their first year of university. In the first study, I assessed bidirectional associations between two sleep characteristics (sleep quality and sleep duration) and three psychosocial functioning variables (academics, friendship quality, and intrapersonal adjustment). Results based on cross-lagged models indicated a significant bidirectional association between sleep quality and intrapersonal adjustment, such that more sleep problems predicted more negative intrapersonal adjustment over time, and vice versa. Unidirectional associations indicated that both higher academic achievement and more positive friendship quality were significant predictors of less sleep problems over time. In the second study, in which I examined bidirectional associations between sleep and media use, results provided support only for unidirectional associations; such that more sleep problems predicted increases in both time spent watching television and time spent engaged in online social networking. In the third study of my dissertation, in which I examined social ties at university and sleep quality, results indicated a significant bidirectional association, such that more positive social ties predicted less sleep problems over time, and vice versa. Importantly, emotion regulation was a significant mediator of this association. Findings across the three studies, highlight the importance of determining the direction of effects between different sleep characteristics and various aspects of university students’ psychosocial functioning, as such findings have important implications for both methodology and practice. A better understanding of the nature of the associations between sleep and psychosocial functioning will equip students, parents and university administrators with the tools necessary to facilitate successful adjustment across the university years.

The Role of Sleep in the Selective Reconsolidation of Declarative Memories

While sleep has been shown to be involved in memory consolidation and the selective enhancement of newly acquired memories of future relevance (Wilhelm, et al., 2011), limited research has investigated the role of sleep or future relevance in processes of memory reconsolidation. The current research employed a list-method directed forgetting procedure in which participants learned two lists of syllable pairs on Night 1 and received directed forgetting instructions on Night 2. On Night 2, one group (Labile; n = 15) received a memory reactivation treatment consisting of reminders designed to return memories of the learned lists to a labile state. A second group (Stable, n = 16) received similar reminders designed to leave memories of the learned lists in their stable state. No differences in forgetting were found across the two lists or groups. However, a negative correlation between frontal delta (1 – 4 Hz) electroencephalographic (EEG) power during Early Stage 2 non-rapid eye movement (NREM) sleep and forgetting of to-beremembered material was found exclusively in the Labile group (r = -.61, p < .05). Further, central theta (4 – 8 Hz ) EEG power during rapid eye movement (REM) sleep was found to correlate with directed forgetting exclusively in the Labile group (r = .81, p < .001) and total forgetting in the Stable group (r = .50, p < .05). These observed relationships support the proposed hypothesis suggesting that sleep processes are involved in the reconsolidation of labile memories, and that this reconsolidation may be selective for memories of future relevance. A role for sleep in the beneficial reprocessing of memories through the selective reconsolidation of labile memories in NREM sleep and the weakening of memories in REM sleep is discussed.

Rôle de l’apport prénatal en acides gras oméga-3 sur le développement à long terme des fonctions visuelles chez les enfants Inuits

La consommation de poisson et de mammifères marins représente une source importante d’acides gras oméga-3 connus pour leurs effets bénéfiques sur le développement des fonctions cérébrales et notamment, sur le développement du système visuel. Afin de tester l’hypothèse selon laquelle l’exposition prénatale aux acides gras oméga-3 a des effets bénéfiques à long terme, nous avons examiné les fonctions visuelles chez des enfants Inuits d’âge scolaire exposés à de grandes quantités d’oméga-3 durant la période de gestation. Des enfants Inuits (n = 136; moyenne d’âge = 11.3 ans) du nord du Québec (Nunavik) ont participé à cette étude. Un protocole de potentiels évoqués visuels (PEVs) utilisant des stimuli en couleur et en mouvement a été employé afin d’appréhender les réponses parvo- et magnocellulaires respectivement. Les concentrations d’acide docosahexaénoïque (ADH) ont été mesurées à la naissance à partir du sang de cordon ombilical et au moment du testing, reflétant ainsi les expositions pré- et post-natales. Les relations entre les niveaux sanguins d’ADH et les PEVs ont été examinées à l’aide d’analyses de régression multiples, en tenant compte des contaminants environnementaux et d’autres variables potentiellement confondantes. Aucune association significative n’a été trouvée en ce qui concerne les stimuli de mouvement. Cependant, après ajustement pour les covariables, les concentrations d’ADH à la naissance étaient associées à une latence plus courte des composantes N1 et P1 des PEVs couleur. Notre étude démontre, pour la première fois, des effets bénéfiques de l’exposition prénatale à l’ADH sur le système parvocellulaire à l’âge scolaire.

Analyse de l’activité en ondes lentes et des oscillations lentes précédant le somnambulisme

Diverses études se sont penchées sur les paramètres EEG du sommeil en ondes lentes, y compris l’activité en ondes lentes en lien avec le somnambulisme, mais les résultats se révèlent inconsistants et contradictoires. Le premier objectif de la présente étude était d’analyser quantitativement l’EEG en sommeil en mesurant les fluctuations de puissance spectrale en delta (1-4 Hz) et delta lent (0.5-1 Hz) avant des épisodes de somnambulisme. Le second était de détecter les oscillations lentes (> 75 μV, fréquence d'environ 0.7-0.8 Hz) et très lentes (> 140 μV, fréquence d'environ 0.7-0.8 Hz) afin d'examiner leur changement d'amplitude et de densité avant de tels épisodes. Suite à une privation de sommeil de 25 heures, les enregistrements polysomnographiques de 22 adultes atteints de somnambulisme ont été scrutés. L’analyse des 200 secondes avant les épisodes révèle que ceux-ci ne sont pas précédés d’une augmentation graduelle de puissance spectrale en delta ni en delta lent, tant sur les dérivations frontale, centrale que pariétale. Toutefois, une hausse statistiquement significative de la densité des oscillations lentes et des oscillations très lentes a été observée au cours des 20 sec immédiatement avant le début des épisodes. Reste à déterminer le rôle exact de ces paramètres de l’EEG en sommeil par rapport à la manifestation et au diagnostic des parasomnies en sommeil lent.