Selective REM sleep deprivation in narcolepsy

Narcolepsy is characterized by excessive daytime sleepiness and rapid eye movement (REM) sleep abnormalities, including cataplexy. The aim of this study was to assess REM sleep pressure and homeostasis in narcolepsy. Six patients with narcolepsy and six healthy controls underwent a REM sleep deprivation protocol, including one habituation, one baseline, two deprivation nights (D1, D2) and one recovery night. Multiple sleep latency tests (MSLTs) were performed during the day after baseline and after D2. During D1 and D2 REM sleep was prevented by awakening the subjects at the first polysomnographic signs of REM sleep for 2 min. Mean sleep latency and number of sleep-onset REM periods (SOREMs) were determined on all MSLT. More interventions were required to prevent REM sleep in narcoleptics compared with control subjects during D1 (57 ± 16 versus 24 ± 10) and D2 (87 ± 22 versus 35 ± 8, P = 0.004). Interventions increased from D1 to D2 by 46% in controls and by 53% in narcoleptics (P < 0.03). Selective REM sleep deprivation was successful in both controls (mean reduction of REM to 6% of baseline) and narcoleptics (11%). Both groups had a reduction of total sleep time during the deprivation nights (P = 0.03). Neither group had REM sleep rebound in the recovery night. Narcoleptics had, however, an increase in the number of SOREMs on MSLT (P = 0.005). There was no increase in the number of cataplexies after selective REM sleep deprivation. We conclude that: (i) REM sleep pressure is higher in narcoleptics; (ii) REM sleep homeostasis is similar in narcoleptics and controls; (iii) in narcoleptics selective REM sleep deprivation may have an effect on sleep propensity but not on cataplexy.

REM sleep behavior disorder in Parkinson's disease: a questionnaire-based survey

REM sleep behavior disorder (RBD) is reported in up to 50% of patients with Parkinson's disease (PD). Only a few systematic, large-scale studies have addressed the characteristics of RBD in PD. The aim of the present study is to assess the frequency of RBD in patients with PD and the association with PD characteristics.

Effects of sleep fragmentation on the arousability to resistive loading in NREM and REM sleep in normal men

STUDY OBJECTIVE: In healthy subjects, arousability to inspiratory resistive loading is greater during rapid eye movement (REM) sleep compared with non-REM (NREM) sleep but is poorest in REM sleep in patients with sleep apnea. We therefore examined the hypothesis that sleep fragmentation impairs arousability, especially from REM sleep. DESIGN: Two blocks of 3 polysomnographies (separated by at least 1 week) were performed randomly. An inspiratory-loaded night followed either 2 undisturbed control nights (LN(C)) or 2 acoustically fragmented nights (LN(F)) SETTING: Sleep laboratory. PARTICIPANTS: Sixteen healthy men aged 20 to 29 years. INTERVENTIONS: In both loaded nights, an inspiratory resistive load was added via a valved facemask every 2 minutes during sleep and turned off either when arousal occurred or after 2 minutes. MEASUREMENTS AND RESULTS: During LN(F), arousability remained significantly greater in REM sleep (71% aroused within 2 minutes) compared with stage 2 (29%) or stage 3/4 (16%) sleep. After sleep fragmentation, arousability was decreased in stage 2 sleep (LN(F): 29%; LN(C): 38%; p < .05) and low in early REM sleep, increasing across the night (p < .01). In stage 3/4 sleep, neither an attenuation nor a change across the night was seen after sleep fragmentation. CONCLUSIONS: Mild sleep fragmentation is already sufficient to attenuate arousability in stage 2 sleep and to decrease arousability in early, compared with late, REM sleep. This means that sleep fragmentation affects the arousal response to increasing resistance and that the effects are different in stage 2 and REM sleep. The biologic reason for this increase in the arousal response in REM sleep across the night is not clear.

Endothelial function and sleep: associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep.

Endothelial function typically precedes clinical manifestations of cardiovascular disease and provides a potential mechanism for the associations observed between cardiovascular disease and sleep quality. This study examined how subjective and objective indicators of sleep quality relate to endothelial function, as measured by brachial artery flow-mediated dilation (FMD). In a clinical research centre, 100 non-shift working adults (mean age: 36 years) completed FMD testing and the Pittsburgh Sleep Quality Index, along with a polysomnography assessment to obtain the following measures: slow wave sleep, percentage rapid eye movement (REM) sleep, REM sleep latency, total arousal index, total sleep time, wake after sleep onset, sleep efficiency and apnea-hypopnea index. Bivariate correlations and follow-up multiple regressions examined how FMD related to subjective (i.e., Pittsburgh Sleep Quality Index scores) and objective (i.e., polysomnography-derived) indicators of sleep quality. After FMD showed bivariate correlations with Pittsburgh Sleep Quality Index scores, percentage REM sleep and REM latency, further examination with separate regression models indicated that these associations remained significant after adjustments for sex, age, race, hypertension, body mass index, apnea-hypopnea index, smoking and income (Ps < 0.05). Specifically, as FMD decreased, scores on the Pittsburgh Sleep Quality Index increased (indicating decreased subjective sleep quality) and percentage REM sleep decreased, while REM sleep latency increased (Ps < 0.05). Poorer subjective sleep quality and adverse changes in REM sleep were associated with diminished vasodilation, which could link sleep disturbances to cardiovascular disease.

Sleepwalking, REM sleep behaviour disorder and overlap parasomnia in patients with Parkinson's disease

BACKGROUND/AIMS In a questionnaire survey, we identified 36 (9%) of 417 Parkinson's disease (PD) patients with sleepwalking (SW); 72% of them also had a history of REM sleep behaviour disorder (RBD). We aimed to assess the clinical and polysomnographic characteristics of SW in PD and to compare them to patients with PD with and without a history of RBD. METHODS We performed video-polysomnography and detailed clinical examination in 30 PD patients from the above-mentioned survey: 10 patients with a history of SW, 10 patients with a history of RBD, and 10 patients with no history of either SW or RBD. RESULTS PD patients with SW had higher depression, anxiety and Hoehn & Yahr scores and lower activities of daily living scores than patients without a history of RBD but did not differ from patients with RBD. Patients with SW and RBD also had more often dyskinesia and hallucinations. By polysomnography, RBD was observed in 8 patients with SW and in all patients with a history of RBD. A total of 5 patients without a history of either SW or RBD had REM sleep without atonia without behavioural peculiarities. CONCLUSION SW in PD is associated with depression, higher disease severity and functional disability. The simultaneous occurrence of SW and RBD (overlap parasomnia) in most patients suggests a common underlying disturbance of motor control during sleep in PD, with variable manifestations in different sleep stages.

Luḥot 20 Hoc Est, Tabulae Viginti, Institutiones In Linguam Sanctam Absolutas Complectentes : Ex Selectissimis Hebrae̜orum Grãmaticis, prœsertim ex libris, quos de re Grammatica scripsit Elias Leuites Iudæus Germanus, collectœ, ut facilè is, qui uiua prœceptoris uoce destituitur, suo ipsius ductu rem Grammaticam discere possit

Autore Antonio Reuchlino

J. C. Brucheri E. E. Isagoge grammatica, seu brevis & analytica methodo disposita delineatio syntaxeos, phraseologiæ, ut et accentuationis linguæ hebrææ : manuducens philebræos ad fusiora & ad rem grammaticam spectantia scripta, Buxtorfii, Glassii, Ouseelii, aliorumque philologorum; accedit appendix, de usu grammaticæ alatingianæ aliarumve ratiocinativo

J. C. Brucherus

Programm: Die reißende Gewalt, mit welcher sich die Revolution in uns'rem Vaterlande Bahn gebrochen ...

Welsch (Projektbearbeiter): Gründungsmanifest der 'Neuen Preußischen Zeitung', nach der Eisernen Kreuz-Vignette im Titelkopf auch 'Kreuzzeitung' genannt, des Organs der evangelischen Hochkonservativen, die sich zum Ziel setzen, "den entfesselten Geistern der Empörung mit Kraft und Nachdruck entgegen zu treten"

Petri Tatareti Parisiensis, subtilium omnium facile principis, in triplicem Aristotelis philosophiam : physicam, metaphysicam, [et] ethicam, castigatissimae lucubrationes / post longas vigilias, post diutinos labores, ae sumptus eò rem hac noua nostra ed

Sign.: *8, 2*4, A-Z8, 2A-2Z8, 3A-3D8

Bandas programáticas: Variaciones de una estructura organizativa en la obra de Rem Koolhaas/ OMA.

Resulta posible extraer una constante en los proyectos de Rem Koolhaas / OMA, un sistema de bandas, al que a menudo recurre, como estructura de organización programática. Su germen en "The Berlin Wall as Architecture", su conexión con Delirious New York, y la persistencia hasta los grandes propuestas desarrolladas en los últimos años como el LACMA (2001), la Biblioteca de Seattle(1999-04) o el CCTV(2002-8). El presente trabajo se desarrolla bajo una doble hipótesis: La primera es que este esquema de organización se pone en valor originalmente en la aproximación a “The Berlin Wall as Architecture" que Koolhaas realiza en el 1971 como estudiante en la A.A. Y la segunda, que este sistema de bandas programáticas, va transformándose, desde su concepción como esquema organizativo en la Spear House (1974), a diagrama operativo en proyectos como la Villette (1982), Melun- Sénart (1987), ZKM (1989), hasta un sistema de bandas con connotaciones más figurativas que estratégicas en la Biblioteca de Seattle, y al que Peter Eisenman se referirá como diagrama icónico. Para realizar este estudio, se opera con una selección de obras representativas, a partir de esta constante (sistema de bandas) para analizar en qué medida aparece y se transforma. EN It is possible to extract extract a constant in Rem Koolhaas / OMA´s projects, a system of bands, which often resorts such as programmatic organization structure. The germ in "The Berlin Wall as Architecture"(1971), his connection with Delirious New York(1972-78), and persistence to large proposals developed in recent years as the LACMA (2001), the Seattle Library (1999- 1904) or the CCTV (2002-8). This work was conducted under a double hypothesis: The first is that this organizational scheme is put in value approach originally in "The Berlin Wall as Architecture" Koolhaas made in 1971 as a student at the AA.Tthe second, which this band program system, is transformed, from its conception as organizational scheme in Spear House (1974), a chart operating in projects such as Villette (1982), Melun sénart (1987), ZKM (1989), to a system bands with figurative connotations strategic Seattle Library, and Peter Eisenman referred as iconic diagram. For this study, it operates with a selection of representative works from this constant (band system) to analyze to what extent appears and transforms.