BACKGROUND: Volumetric MRI surrogate markers of disease progression are lacking. OBJECTIVE: To establish cut-off values of brain volume loss able to discriminate between healthy controls and MS patients. METHODS: In total, 386 patients after first demyelinating event suggestive of MS (CIS), 964 relapsing-remitting MS (RRMS) patients, 63 secondary-progressive MS (SPMS) patients and 58 healthy controls were included in this longitudinal study. A total of 11,438 MRI scans performed on the same MRI scanner with the same protocol were analysed. Annualised percentage changes of whole brain, grey matter, thalamus and corpus callosum volumes were estimated. We investigated cut-offs able to discriminate between healthy controls and MS patients. RESULTS: At a predefined specificity of 90%, the annualised percentage change cut-off of corpus callosum volume (-0.57%) was able to distinguish between healthy controls and patients with the highest sensitivity (51% in CIS, 48% in RRMS and 42% in SPMS patients). Lower sensitivities (22%-49%) were found for cut-offs of whole brain, grey matter and thalamic volume loss. Among CIS and RRMS patients, cut-offs were associated with greater accumulation of disability. CONCLUSION: We identified cut-offs of annualised global and regional brain volume loss rates able to discriminate between healthy controls and MS patients.
- MeSH
- atrofie patologie MeSH
- corpus callosum diagnostické zobrazování patologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- magnetická rezonanční tomografie normy MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mozek diagnostické zobrazování patologie MeSH
- progrese nemoci * MeSH
- roztroušená skleróza diagnóza diagnostické zobrazování patologie MeSH
- šedá hmota diagnostické zobrazování patologie MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- thalamus diagnostické zobrazování patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
Cíl: Narkolepsii objektivizuje test mnohočetné latence usnutí (Multiple Sleep Latency Test, MSLT) nálezem průměrné latence usnutí ≤ 8 min a ≥ 2 spánky s časným nástupem REM spánku. Cílem studie bylo zhodnotit přínos opakování MSLT při podezření na narkolepsii, když první MSLT narkolepsii nepotvrdilo. Soubor a metodika: Jedná se o retrospektivní studii výsledků MSLT u nemocných vyšetřených pro narkolepsii v Centru pro poruchy spánku a bdění Neurologické kliniky 1. LF UK a VFN za sledované období 13 let. Studie analyzuje 39 dospělých nemocných s podezřením na narkolepsii, kterým bylo v průběhu roku provedeno dvakrát MSLT a u nichž první výsledek nesplňoval kritéria narkolepsie, a 42 nemocných, jejichž první MSLT odpovídalo narkolepsii. Výsledky: Devatenáct nemocných mělo první MSLT negativní a druhé pozitivní a u 20 nemocných první i opakované MSLT nesplnilo diagnostická kritéria narkolepsie. Tyto skupiny se navzájem a také vzhledem k nemocným se stanovenou diagnózou při prvním MSLT lišily v latenci REM spánku během noční polysomnografie. Latence usnutí prvního MSLT předpovídá výsledek opakovaného MSLT (p < 0,001). Senzitivita jednoho vyšetření MSLT proti dvěma MSLT je 82,4 % a negativní prediktivní hodnota prvního nepotvrzujícího MSLT je 48,7 %. Závěry: Při podezření na narkolepsii a neprůkazném nálezu při vyšetření MSLT je přínosné toto vyšetření opakovat.
Aim:Narcolepsy is confirmed if the MSLT (Multiple Sleep Latency Test) shows the mean sleep latency of ≤8 min and ≥2 episodes of sleep with early onset of REM sleep. The aim was to assess the value of repeated MSLT in subjects with suspected narcolepsy after the first MSLT failed to confirm narcolepsy. Patients and methods: This is a retrospective study of the MSLT results in adult patients examined for narcolepsy at the Sleep and Wake Disorders Center of the Department of Neurology, First Faculty of Medicine and General University Hospital in Prague during a 13-year period. The study analysed 39 adults with suspected narcolepsy who underwent second MSLT in a course of one year after their first MSLT results failed to meet the criteria for narcolepsy, and 42 patients whose initial MSLT was consistent with narcolepsy. Results: In 19 patients, the first MSLT was negative, while the second was positive. In 20 patients, both the first and repeated MSLT failed to meet the diagnostic criteria for narcolepsy. These groups differed from one another and from patients diagnosed with the first MSLT in REM sleep latency during nocturnal polysomnography. Sleep latency in the first test is predictive of the outcome of the repeated MSLT (p < 0.001). Sensitivity of one MSLT compared to two is 82.4%, and negative predictive value of the first non-confirmatory test is 48%. Conclusions: It is useful to repeat testing in patients with suspected narcolepsy and inconclusive MSLT.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- narkolepsie * diagnóza MeSH
- obstrukční spánková apnoe * diagnóza patofyziologie MeSH
- polysomnografie MeSH
- poruchy nadměrné spavosti diagnóza MeSH
- retrospektivní studie MeSH
- senzitivita a specificita MeSH
- spánek REM MeSH
- stadia spánku fyziologie MeSH
- statistika jako téma MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
BACKGROUND: Obstructive sleep apnea (OSA) is a condition contributing to oxidative stress. The aim of this study was to ascertain if there is any connection between OSA and novel oxidative stress-related markers. Matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), high sensitive C-reactive protein (hsCRP), pregnancy-associated plasma protein-A (PAPP-A), soluble receptors for advanced glycation end-products (sRAGE), zinc (Zn) and copper (Cu) were measured. Further biochemical markers were evaluated. MATERIAL/METHODS: Fifty-one men suspected for OSA indicated for night polygraphy were included. Apnea/hypopnea index (AHI), oxygen desaturation index (ODI), mean blood hemoglobin oxygen saturation (SpO2) and time of blood hemoglobin oxygen saturation below 90% (SpO2 <90%) were measured. Morning venous blood samples were taken. RESULTS: For body mass index (BMI) we found strong positive correlation with levels of Cu, MMP-9, hsCRP and fibrinogen, and negative correlation with sRAGE. Concerning ventilation parameters, we found positive correlation of ODI and SpO2 <90% with markers MMP-9 and hsCRP. sRAGE level correlated with AHI and ODI negatively. SpO2 correlated negatively with Cu, MMP-9, hsCRP and fibrinogen. There was no correlation between ventilation parameters and markers MMP-2, PAPP-A and Zn. Compared to severity of OSA, there was significant difference in levels of hsCRP and Cu between patients with AHI ≤5 and AHI ≥30 independent of BMI. CONCLUSIONS: MMP-9, hsCRP, sRAGE and Cu seem to be strong predictors of oxidative stress in OSA patients. The strong correlation between oxidative stress-related markers and OSA is elucidated by connection of these to BMI, which is probably a primary condition of oxidative stress, but OSA is an additive condition.
- MeSH
- biologické markery metabolismus MeSH
- C-reaktivní protein metabolismus MeSH
- dospělí MeSH
- kyslík metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- matrixová metaloproteinasa 9 metabolismus MeSH
- měď metabolismus MeSH
- obstrukční spánková apnoe enzymologie metabolismus patologie MeSH
- oxidační stres MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Shift work is associated with increased risk of health problems. We chose to test the parameters of wakefulness at shift-working nurses using the Performance Vigilance Task (PVT-192). The visual analogue scale of sleepiness (VAS) and selected sleep history data were included in the investigation. 20 nurses working in a 12-hour rotating shift regimen were included. Exclusion criteria comprised the use of sleep-modulating drugs, the presence of history-based sleep disorders, morbidity. Each of the nurses underwent a total of four PVT tests, before and then after her (day or night) duty. The reaction time (RT) mean value before the day shift was 261.3ms (SD±38.7), after the day shift 260.1ms (SD±33.1), before the night shift 251.3ms (SD±23.5), after the night shift 260.5ms (SD±26.1). There were significant differences in RT before and after the night duty, and between the RT of both evening measurements. The difference in RT before and after duty was significantly greater after night shifts. There was a significant difference between the rate of PVT test errors before the day shift and after the night shift. VAS-based subjective rating of daytime sleepiness was 3.3 (SD±2.2) before and 3.5 (SD±2.8) after the day shift, 3.1 (SD±2.4) before and 5.9 (SD±2.3) after the night shift. There was a significant difference between VAS before and after night shifts, and a significant difference in the VAS difference between the beginning and end of the night shift in comparison with the day shift. Clearly enough, the circadian aspect has a major role to play in the testing.
- MeSH
- arousal MeSH
- chybná zdravotní péče statistika a číselné údaje MeSH
- cirkadiánní rytmus MeSH
- financování organizované MeSH
- kohortové studie MeSH
- lidé MeSH
- noční péče o pacienty pracovní síly MeSH
- personál sesterský nemocniční MeSH
- poruchy cirkadiánního rytmu (spánek) epidemiologie etiologie komplikace MeSH
- poruchy spánku a bdění etiologie komplikace MeSH
- reakční čas MeSH
- vliv směnného provozu na zdraví fyziologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
BACKGROUND AND OBJECTIVE: Nocturnal groaning (catathrenia) is a chronic sleep disorder classified as parasomnia with unclear effects on sleep and life quality. It is characterized by repeated episodes of monotonous vocalization in prolonged expiration (episodes of bradypnea) occurring mostly in REM sleep. We sought to assess its impact on sleep microstructure, i.e., the frequency of arousals relative to the groaning episodes. The frequency, duration and sleep-stage distribution of the groaning episodes were also studied. METHODS: Eight patients with nocturnal groaning (5 male, 3 female, age range 11-32 years, mean age 23+/-7.1) were evaluated. All underwent standard neurologic examination and nocturnal videopolysomnography for two consecutive nights. The second night polysomnography data were used to evaluate sleep parameters. The groaning episodes (bradypneic events) were counted separately, not as clusters. RESULTS: Sleep macrostructure revealed no specific changes. The number of groaning episodes/bradypneic events during the night varied from 40 to 182 (total number 725). The duration of bradypnea was from 2 to 46s (mean duration 12.5s). Groaning episodes prevailed in REM sleep (76.5%). The rate for NREM 2 was 21.5%, and only sporadic episodes were noted in delta sleep (1.9%); 63.3% of the events were associated with arousals, and in 94% of them an arousal occurred before or together with the onset of bradypnea. The arousal index was increased in 5 patients (mean 20.4). Bruxism was present in 4 cases, in 1 patient appearing in close association with groaning episodes. Ronchopathy was noted in 4 cases. CONCLUSION: Almost two-thirds of the groaning episodes were connected with arousals. Hypothetically, nocturnal groaning may well be a source of sleep disruption (mainly REM) in some cases. Because an arousal mostly preceded or coincided with groaning we believe that arousal mechanisms may be involved in the pathogenesis of nocturnal groaning.
- MeSH
- dítě MeSH
- dospělí MeSH
- fonace fyziologie MeSH
- hlas fyziologie MeSH
- kohortové studie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- polysomnografie MeSH
- poruchy probouzení ze spánku diagnóza etiologie patofyziologie MeSH
- rizikové faktory MeSH
- stadia spánku fyziologie MeSH
- syndromy spánkové apnoe diagnóza komplikace patofyziologie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- ateroskleróza etiologie komplikace metabolismus MeSH
- dospělí MeSH
- financování organizované MeSH
- kardiovaskulární nemoci etiologie patofyziologie MeSH
- klinické laboratorní techniky využití MeSH
- lidé MeSH
- obstrukční spánková apnoe diagnóza komplikace patofyziologie MeSH
- oxidační stres MeSH
- polysomnografie metody využití MeSH
- poruchy dýchání etiologie komplikace metabolismus MeSH
- poruchy spánku a bdění MeSH
- produkty pokročilé glykace MeSH
- proteiny izolace a purifikace škodlivé účinky MeSH
- spektrofotometrie metody využití MeSH
- statistika jako téma metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
OBJECTIVE: Responsible for sleep brain perfusion changes, obstructive sleep apnea (OSA) constitutes a cardiovascular risk. To find out about any diffuse damage to the brain tissue, we studied the S100B protein, whose serum level is known to rise in stroke and craniocerebral trauma. METHODS: 60 men (mean age 51.7+/-11.8 years) referred to us for OSA without any major comorbidity were examined polygraphically. S100B was determined with electrochemiluminiscence immunoassay (ECLIA) from evening and morning blood samples. RESULTS: All sixty men were diagnosed with OSA. The difference between the evening level of S100B 0.068+/-0.030 microg/l and the morning level 0.059+/-0.029 microg/l was significant (p=0.0004). Patients with mild OSA were found to have the evening S100B 0.063+/-0.023 microg/l, the morning level 0.042+/-0.012 microg/l, the difference being significant (p=0.00051). In moderate OSA the difference between the evening -0.070+/-0.017 microg/l and morning levels -0.055+/-0.025 microg/l was less significant (p=0.043). In severe OSA no difference was found between the evening and morning concentrations of S100B (0.070+/-0.036 microg/l and 0.070+/-0.031 microg/l respectively). The difference between the evening and morning S100B levels correlated negatively with AHI and ODI and positively with basal saturation and average minimal oxygen saturation. CONCLUSIONS: Sleep with signs of severe OSA influences S100B protein release.
- MeSH
- cirkadiánní rytmus fyziologie MeSH
- dospělí MeSH
- financování organizované MeSH
- kyslík krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- neparametrická statistika MeSH
- neurotrofní faktory krev MeSH
- obstrukční spánková apnoe krev MeSH
- polysomnografie MeSH
- proteiny S100 krev MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- srovnávací studie MeSH
Syndrom neklidných nohou (RLS) je běžná choroba, jejíž diagnóza spočívá na anamnéze. Protože mnoho nemocných s RLS není diagnostikováno, bylo by užitečné mít screeningovou otázku na vyhledání nemocných, kteří mají být následně podrobněji vyšetřeni z hlediska RLS. International Restless Legs Syndrome Study Group (IRLSSG) vytvořila skríninkovou otázku, která byla přeložena do čestiny a testována na skupině nemocných přicházejících do centra pro poruchy spánku. U 29 ze 133 nemocných byl po kompletním vyšetření diagnostikován RLS. Screeningová otázka identifikovala 28 z nemocných s RLS (sensitivita 96,6 %). Falešně pozitivní byly odpovědi 6 nemocných bez RLS (specificita 94,2 %).
