Sleepwalking (also called noctambulism or somnambulism), under the larger category of Parasomnias, is a sleep disorder where the sufferer engages in activities that are normally associated with wakefulness while asleep or in a sleeplike state. Sleepwalking can affect people of any age. It generally occurs when an individual awakes suddenly from Slow Wave Sleep (SWS or sometimes referred to as "deep sleep"), causing the sleepwalking episode. In children and young adults, up to 25% of the night is spent in SWS. However this decreases as the person ages until none can be measured in the geriatric individual. For this reason, children and young adults (or anyone else with high amount of SWS), are more likely to be woken up and, for the same reasons, they are witnessed to have many more episodes than the older individuals.

Statistics

• Somewhere between 1% and 17% of U.S. children sleepwalk, and juveniles are seen to be those more prone to the activity.
• Some 18% of Americans are prone to the act, roughly 2 in 11 of the US population
• One study showed that the highest prevalence of sleepwalking was 16.7% for children of 11 to 12 years of age.
• Boys are seen to be more likely to sleepwalk than girls.

Activities such as eating, dressing or even driving cars have also been recorded as taking place while the subjects are technically asleep. Contrary to popular belief, most cases of sleepwalking do not consist of walking around (without the conscious knowledge of the subject). Most cases of somnambulism occur when the person is woken up (something or someone disturbs their SWS), the person may sit up, look around and immediately go back to sleep. But these kinds of incidence are rarely noticed or reported unless recorded in a sleep clinic.

More on [ Sleepwalking ]

UPHS - Penn Sleep Centers Newsletter

Asleep at the Wheel?
Truck drivers who routinely get too little sleep or suffer from sleep apnea show signs of fatigue and impaired performance that can make them a hazard on the road, according to a major new study by Penn Sleep Centers researchers. The study results, entitled “Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration,” were published in the August 15th issue of the American Journal of Respiratory and Critical Care Medicine.
Sleep Apnea and Heart Disease
Along with the epidemic of obesity, the incidence of sleep apnea has risen at an alarming rate. The most common form, known as obstructive sleep apnea (OSA), is caused by extra tissue in the upper airway that collapses and literally blocks the airflow to the lungs. The risk factors for OSA include male sex (women’s risk increases after menopause), obesity, and neck size greater than 17 inches. The symptoms of sleep apnea include fatigue, early morning headaches, snoring, falling asleep during the daytime, depression and witnessed episodes of irregular breathing while sleeping.
Cognitive-Behavioral Treatment of Insomnia
Insomnia is the most prevalent sleep disorder, representing one of the most common complaints reported to doctors by their patients. In an effort to provide non-pharmacologic treatment options for insomnia, research and clinical practice have focused on developing cognitive- behavior treatments as an alternative.
Do Flies and Worms Sleep?
Can you tell if a fly is asleep? This is precisely the question asked seven years ago by Dr. Joan Hendricks, who is now the Dean of the School of Veterinary Medicine at the University of Pennsylvania. In collaboration with Dr. Amita Sehgal and Dr. Allan Pack of the Penn Center for Sleep and Respiratory Neurobiology (CSRN), Dr. Hendricks wanted to determine if the fruit fly Drosophila melanogaster, an animal used since the early 1900s for genetic studies in biology, has a sleeplike state much as we do. But unlike human studies, where one can measure brain electrical activity to distinguish sleep from the waking state, one cannot easily measure fly brain waves. Instead, Dr. Hendricks used behavioral measures.
Advice for Sleepy Students
Each fall, Grace Pien, MD in the University of Pennsylvania Division of Sleep Medicine sees teenagers being brought into her office by parents. The teens complain about difficulty falling asleep at night. After several follow-up questions, Pien often determines that these patients suffer from a sleep disorder called delayed sleep phase syndrome (DSPS) - when the body's circadian rhythm delays the urge to sleep until much later than what is considered to be a normal bedtime.
New Headquarters for Penn Sleep
In April of this year, the practices and sleep laboratory facilities of the Penn Sleep Centers at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center were merged into a single new site at 3624 Market St. which serves as headquarters for the Penn Sleep Centers. This newly renovated facility provides pleasant and spacious areas for both patients and staff.

Journal SLEEP Articles

Does Untreated Obstructive Sleep Apnea Lead to Death?
A commentary on Young et al. Sleep 2008;31:1071-8 and Marshall et al. Sleep 2008;31:1079-85.
COMMENTARY - Does Untreated Obstructive Sleep Apnea Lead to Death?
Response to Restless Legs Syndrome and Diabetic Neuropathy–Commentary by Gemignani, et al.
LETTER TO THE EDITOR - Response to Restless Legs Syndrome and Diabetic Neuropathy–Commentary by Gemignani, et al.
Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort
Background: Sleep-disordered breathing (SDB) is a treatable but markedly under-diagnosed condition of frequent breathing pauses during sleep. SDB is linked to incident cardiovascular disease, stroke, and other morbidity. However, the risk of mortality with untreated SDB, determined by polysomnography screening, in the general population has not been established. Methods: An 18-year mortality follow-up was conducted on the population- based Wisconsin Sleep Cohort sample (n = 1522), assessed at baseline for SDB with polysomnography, the clinical diagnostic standard. SDB was described by the number of apnea and hypopnea episodes/hour of sleep; cutpoints at 5, 15 and 30 identified mild, moderate, and severe SDB, respectively. Cox proportional hazards regression was used to estimate all-cause and cardiovascular mortality risks, adjusted for potential confounding factors, associated with SDB severity levels. Results: All-cause mortality risk, adjusted for age, sex, BMI, and other factors was significantly increased with SDB severity. The adjusted hazard ratio (HR, 95% CI) for all-cause mortality with severe versus no SDB was 3.0 (1.4,6.3). After excluding persons who had used CPAP treatment (n = 126), the adjusted HR (95% CI) for all-cause mortality with severe versus no SDB was 3.8 (1.6,9.0); the adjusted HR (95% CI) for cardiovascular mortality was 5.2 (1.4,19.2). Results were unchanged after accounting for daytime sleepiness. Conclusions: Our findings of a significant, high mortality risk with untreated SDB, independent of age, sex, and BMI underscore the need for heightened clinical recognition and treatment of SDB, indicated by frequent episodes of apnea and hypopnea, irrespective of symptoms of sleepiness.
Sleep Apnea as an Independent Risk Factor for All-Cause Mortality: The Busselton Health Study
Background: Previously published cohort studies in clinical populations have suggested that obstructive sleep apnea (OSA) is a risk factor for mortality associated with cardiovascular disease. However, it is unknown whether sleep apnea is an independent risk factor for all-cause mortality in a community-based sample free from clinical referral bias. Methods: Residents of the Western Australian town of Busselton underwent investigation with a home sleep apnea monitoring device (MESAM IV). OSA was quantified via the respiratory disturbance index (RDI). Mortality status was determined in 397/400 participants (99.3%) after up to 14 years (mean follow-up 13.4 years) by data matching with the Australian National Death Index and the Western Australian Death Register. Univariate analyses and multivariate Cox proportional hazards modelling were used to ascertain the association between sleep apnea and mortality after adjustment for age, gender, body mass index, mean arterial pressure, total cholesterol, high-density lipoprotein cholesterol, diabetes, and medically diagnosed angina in those free from heart attack or stroke at baseline (n = 380). Results: Among the 380 participants, 18 had moderate-severe OSA (RDI ≥15/hr, 6 deaths) and 77 had mild OSA (RDI 5 to <15/hr, 5 deaths). Moderate-to-severe OSA was independently associated with greater risk of all-cause mortality (fully adjusted hazard ratio [HR] = 6.24, 95% CL 2.01, 19.39) than non-OSA (n = 285, 22 deaths). Mild OSA (RDI 5 to <15/hr) was not an independent risk factor for higher mortality (HR = 0.47, 95% CL 0.17, 1.29). Conclusions: Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality in this community-based sample.
Sleep Duration Associated with Mortality in Elderly, but not Middle-Aged, Adults in a Large US Sample
Study Objectives: To explore age differences in the relationship between sleep duration and mortality by conducting analyses stratified by age. Both short and long sleep durations have been found to be associated with mortality. Short sleep duration is associated with negative health outcomes, but there is little evidence that long sleep duration has adverse health effects. No epidemiologic studies have published multivariate analyses stratified by age, even though life expectancy is 75 years and the majority of deaths occur in the elderly. Design: Multivariate longitudinal analyses of the first National Health and Nutrition Examination Survey using Cox proportional hazards models. Setting: Probability sample (n = 9789) of the civilian noninstitutionalized population of the United States between 1982 and 1992. Participants: Subjects aged 32 to 86 years. Measurements and Results: In multivariate analyses controlling for many covariates, no relationship was found in middle-aged subjects between short sleep of 5 hours or less and mortality (hazards ratio [HR] = 0.67, 95% confidence interval [CI] 0.43-1.05) or long sleep of 9 hours or more and mortality (HR = 1.04, 95% CI 0.66-1.65). A U-shaped relationship was found only in elderly subjects, with both short sleep duration (HR = 1.27, 95% CI 1.06-1.53) and long sleep duration (HR = 1.36, 95% CI 1.15-1.60) having significantly higher HRs. Conclusions: The relationship between sleep duration and mortality is largely influenced by deaths in elderly subjects and by the measurement of sleep durations closely before death. Long sleep duration is unlikely to contribute toward mortality but, rather, is a consequence of medical conditions and age-related sleep changes.
Association Between Short Sleep and Suicidal Ideation and Suicide Attempt Among Adults in the General Population
Objective: To determine the association between sleep, mental disorders, and suicidal ideation (SI) and suicide attempt (SA) among adults in the community. Design: Cross-sectional. Setting: National Comorbidity Survey (n = 8098). Participants: A representative sample of adults in the United States. Measurements and Results: Multiple logistic regression analyses were used to determine the association between usual number of hours of sleep during a 24-h period and SI and SA (past 12 months and lifetime). Analyses were adjusted for differences in demographic characteristics and comorbid mental disorders. Additional analyses examined the relationship between hours of sleep and the odds of SA among adults with SI, compared with SI without SA. Short sleep was associated with significantly increased odds of SI (OR 2.5, 95% CI: 1.6-3.9) and SA (OR 3.0, 95% CI: 1.4-6.4), and with SA among those with SI (past 12 months). These associations persisted after adjusting for differences in demographic characteristics and mental disorders, though the links between short sleep and SA among those with SI were no longer statistically significant after adjusting for panic, mood, and substance use disorders. Conclusions: Short sleep appears to be associated with increased likelihood of SI and SA, independent of the effects of comorbid mental disorders, among adults in the community. Among adults with SI, short sleep is associated with increased odds of SA, and this association seems largely related to the presence of panic attacks, mood, and substance use disorders. Future studies should investigate the nature of these relationships, and whether and how mental health problems may play a role.

Sleep and Breathing

Obstructive sleep apnea presenting as recurrent cardiopulmonary arrest
Wed, 06 Aug 2008 05:50:01 -0000
Abstract  A non-obese patient who was admitted initially with hypoglycemia had multiple episodes of cardiopulmonary arrests requiring resuscitations and a short period of mechanical ventilation. A subsequent sleep study confirmed the diagnosis of severe obstructive sleep apnea (OSA) and documented an episode of near-arrest with cerebral hypoxia during rapid eye movement sleep. We suggest that OSA coupled with impairment of arousal response and other apnea termination mechanisms had resulted in prolonged apnea, life-threatening hypoxemia, and cardiopulmonary arrest in this patient. We review the current understanding of the mechanisms of apnea termination in OSA and suggest that further studies are needed to investigate these mechanisms and their roles in sudden death during sleeping hours in patients with OSA. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11325-008-0209-3Authors See Meng Khoo, National University Hospital Division of Respiratory, Critical Care and Sleep Medicine, Department of Medicine 5 Lower Kent Ridge Road Singapore Singapore 119074J. J. Mukherjee, National University Hospital Division of Endocrinology, Department of Medicine 5 Lower Kent Ridge Road Singapore Singapore 119074Jason Phua, National University Hospital Division of Respiratory, Critical Care and Sleep Medicine, Department of Medicine 5 Lower Kent Ridge Road Singapore Singapore 119074Dong Xia Shi, National University Hospital Division of Respiratory, Critical Care and Sleep Medicine, Department of Medicine 5 Lower Kent Ridge Road Singapore Singapore 119074 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
Hypoxemia in patients on chronic opiate therapy with and without sleep apnea
Wed, 06 Aug 2008 05:50:00 -0000
Abstract Objective  Animal models have shown a quantal slowing of respiratory pattern when exposed to opioid agonist, in a pattern similar to that observed in central sleep apnea. We postulated that opioid-induced hypoventilation is more likely to be associated with sleep apnea rather than hypoventilation alone. Since we did not have a direct measure of hypoventilation we used hypoxemia as an indirect measure reasoning that significant hypoventilation would not occur in the absence of hypoxemia. Methods  We conducted a retrospective analysis of 98 consecutive patients on chronic opioid medications who were referred for overnight polysomnography. All patients on chronic opioids seen in the chronic pain clinic were referred for a sleep study regardless of whether they had sleep symptoms or not. Sleep-related hypoxemia was defined as arterial oxyhemoglobin saturation of less than 90% for more than 5 min with a nadir of ≤85%, or greater than 30% of total sleep time at an oxyhemoglobin saturation of less than 90%. Results  Of the 98 patients, 36% (95% CI 26–46%) had obstructive sleep apnea, 24%, (95% CI 16–33%) had central sleep apnea, 21% (95% CI 14–31%) had combined obstructive and central sleep apnea, in 4% (95% CI 0–10%) sleep apnea was classified as indeterminate, and 15% (95% CI 9–24%) had no sleep apnea. Opioids were potentially responsible for hypoxemia during wakefulness in 10% of patients (95% CI 5–18%) and for hypoxemia during sleep not clearly associated with apneas/hypopneas in 8% of patients (95% CI 4–15%). Two patients (2%, 95% CI 0–7%) had sleep-related hypoxemia in the absence of sleep apnea or hypoxemia during wakefulness. Conclusions  Patients on chronic opiate therapy for chronic pain have an extremely high prevalence of sleep apnea and nocturnal hypoxemia. Hypoxemia can occur during quiet wakefulness in patients on chronic opioid medications with and without sleep apnea. In patients on chronic opioid therapy, isolated nocturnal hypoxemia without coexisting sleep apnea or daytime hypoxemia is very uncommon. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-008-0208-4Authors Mohammed Mogri, State University of New York at Buffalo Department of Medicine Buffalo NY USAHimanshu Desai, State University of New York at Buffalo Division of Pulmonary, Critical Care and Sleep Medicine Section 111S, 3495 Bailey Avenue Buffalo NY 14215 USALynn Webster, Lifetree Clinical Research and Pain Clinic Salt Lake City UT USABrydon J. B. Grant, State University of New York at Buffalo Division of Pulmonary, Critical Care and Sleep Medicine Section 111S, 3495 Bailey Avenue Buffalo NY 14215 USAM. Jeffery Mador, State University of New York at Buffalo Division of Pulmonary, Critical Care and Sleep Medicine Section 111S, 3495 Bailey Avenue Buffalo NY 14215 USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
American Academy of Dental Sleep Medicine Continuing Education Offerings
Fri, 11 Jul 2008 07:20:01 -0000
American Academy of Dental Sleep Medicine Continuing Education Offerings Content Type Journal ArticleCategory CMEDOI 10.1007/s11325-008-0204-8 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 12 Journal Issue Volume 12, Number 3 / August, 2008

PubMed: 1389-9457

Sleep Disturbance Scale for Children: Translation, cultural adaptation, and validation.
Ferreira VR, Carvalho LB, Ruotolo F, de Morais JF, Prado LB, Prado GF Related Articles Sleep Disturbance Scale for Children: Translation, cultural adaptation, and validation. Sleep Med. 2008 Aug 13; Authors: Ferreira VR, Carvalho LB, Ruotolo F, de Morais JF, Prado LB, Prado GF INTRODUCTION: The Sleep Disturbance Scale for Children (SDSC) is a 26-item instrument for evaluating sleep among children aged 3-18 years. It differentiates among conditions such as disorders of initiating and maintaining sleep, sleep breathing disorders, disorders of arousal, sleep-wake transition disorders, excessive somnolence, and sleep hyperhydrosis. The aim of this study was to translate, culturally adapt, and validate it for Brazilian Portuguese. METHOD: The study was carried out in two phases: (1) forward translation, back translation, pretesting, and calculation of sample size; (2) validation: reliability (Chronbach's alpha), convergent analysis (Pearson correlation), and discriminatory validity (comparing the scores of the test with the results of polysomnography). One hundred children, aged 3-18 years, accompanied by their parents and/or guardians participated in the phases. PSG studies have been done to calculate the sample size and validation. RESULTS: The scale instructions and items were adapted regarding semantic, experiential, conceptual, and cultural equivalence validation. The scale structure related to visual communication was also adapted to Brazilian population preference and habits, and this resulted in a chart with clear instructions and easy recognition of the statements and possible responses. Reliability analysis showed values greater than 0.55. There has been reasonable convergent validity. Discriminatory validity using the PSG study for positive sleep-disordered breathing (SDB) was 8.9, attesting discriminatory validity only for SDB. The three questions of the scale can screen SDB. CONCLUSION: The SDSC was translated, adapted and validated for Brazilian Portuguese, and it presented internal consistency and convergent and discriminatory validity. It can be used in population-based studies in order to screen for sleep-disordered breathing in children. PMID: 18706856 [PubMed - as supplied by publisher]
Cardiorespiratory response to exercise in men and women with obstructive sleep apnea.
Cintra F, Poyares D, Rizzi CF, Risso TT, Skomro R, Montuori E, Mello-Fujita L, de Paola A, Tufik S Related Articles Cardiorespiratory response to exercise in men and women with obstructive sleep apnea. Sleep Med. 2008 Aug 13; Authors: Cintra F, Poyares D, Rizzi CF, Risso TT, Skomro R, Montuori E, Mello-Fujita L, de Paola A, Tufik S BACKGROUND: OSA severity has been associated with self-reported lack of exercise. Most of the research has been done with men recruited from sleep clinics. There is limited data on the exercise performance of women with OSA. Therefore, the aim of this study was to assess exercise performance in a prospective, consecutive sample of men and women with OSA to compare their cardio respiratory parameters, arterial blood pressure and heart rate responses during and after exercise. METHODS: Sixty-two subjects (32 men) completed the protocol. Men had a higher peak VO(2), percent predicted peak VO(2), VCO(2), heart rate, systolic BP, and oxygen pulse than women. RESULTS: There were no differences between men and women for peak oxygen saturation, peak Borg scales for dyspnea and leg fatigue and diastolic BP. A significant negative correlation was found between severity of OSA as measured by AHI, and peak VO(2) (r=-0.4) in women, but not in men. CONCLUSION: Men with OSA have higher peak VO(2) and higher peak exercise heart rate than women with OSA; they also have higher end-exercise systolic BP than women and higher SBP during recovery from exercise; although this difference is not significant when adjusted for peak systolic BP. In men with OSA, there is no correlation between peak VO(2) and AHI, but there is a significant correlation between these variables in women. Heart rate and blood pressure behaved similarly during exercise in both groups. PMID: 18706855 [PubMed - as supplied by publisher]
Quiescegenic nocturnal dyskinesia: A restless legs syndrome (RLS) variant or a new syndrome?
Salas RE, Gamaldo CE, Allen RP, Earley CJ Related Articles Quiescegenic nocturnal dyskinesia: A restless legs syndrome (RLS) variant or a new syndrome? Sleep Med. 2008 Aug 13; Authors: Salas RE, Gamaldo CE, Allen RP, Earley CJ PMID: 18706854 [PubMed - as supplied by publisher]

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