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Psychological well-being of patients with insomnia and its relationship with anxiety and depression
No full textThe aims of the present study are to evaluate the impact of insomnia on psychological well-being and to examine the associations of insomnia and psychological well-being with anxiety and depression. Forty-one patients attending our hospital-based Centre for sleep medicine were administered scales for the evaluation of insomnia (ISI), anxiety (STAI-Y), depression (BDI-II) and psychological well-being (PWB). The scores were compared to those of a control group of 68 subjects attending the hospital for routine examinations or as accompanying persons. Significant differences between patients and controls were detected for anxiety and depression, as well as for psychological well-being. Even if subclinical on average, anxiety and depression symptoms were significantly related to poor psychological well-being, whereas insomnia per se was not. These findings suggest that patients with insomnia report a relevant impact on their psychological well-being, and that such an impact seems to be strongly associated with concomitant subthreshold symptoms of anxiety and depression. The implications for diagnosis and treatment are discussed
Partial sleep deprivation in patients with focal epilepsy: effect on sleep macrostructure and cyclic alternating pattern
No full textObjectives: The potential mechanisms underlining the promoting
role of sleep deprivation (SD) for epileptic seizures and interictal
epileptiform abnormalities have been extensively studied, but some
issues have not been completely addressed. Epileptic phenomena
are deeply sensitive to fluctuations of arousal and sleep instability,
that may be related to SD. Aim of our study was to evaluate the role
of cyclic alternating pattern (CAP) as a potential mechanism through
which SD may exert its activating effect.
Methods: Eight patients with focal epilepsy (mean age 39 19 yy;
5F, 4M) underwent in-lab polysomnography (PSG) and sleep
deprived diurnal PSG after partial SD, being awake from 2 AM,
performed within 7 days. Sleep macrostructural and microstructural
parameters were evaluated according to standard guidelines.
Results: One subject had an epileptic attack recorded during the
diurnal polysomnogram and was excluded from the analysis.
Macrostructural analysis showed a decreased first REM latency for
diurnal sleep (night vs. diurnal sleep: 207.0 + 158.3 vs.
59.2 + 42.4 min), although with a decreased REM percentage
(18.0 + 7.8 vs. 10.6 + 10.3) and a trend in increased SWS.
Microstructural analysis suggests a greater sleep instability for
diurnal sleep, with significantly increased CAP rate (53.5 + 8.2 vs.
66.0 + 9.9), particularly for N2 (44.2 + 9.7 vs. 57.6 + 15.3) and
CAP slow components, as reported by increased A1 index
(46.0 + 10.0 vs. 57.7 + 17.7).
Conclusions: In diurnal sleep after partial SD of subjects with focal
epilepsy, CAP and its slow components, are increased and may thus
offer a favorable framework through which SD modulates interictal
and ictal epileptic activit
Controversial issues on EEG after sleep deprivation for the diagnosis of epilepsy
Full text linkEEG after sleep deprivation (SD-EEG) is widely used in many epilepsy centers as an important tool in the epilepsy diagnosis process. However, after more than 40 years of use, there are a number of issues which still need to be clarified concerning its features and role. In particular, the many scientific papers addressing its role in epilepsy diagnosis often differ remarkably from each other in terms of the type of patients assessed, their description and study design. Furthermore, also the length and the type of EEG performed after SD, as well as the length of SD itself, vary dramatically from one study to another. In this paper we shortly underscore the abovementioned differences among the different reports, as well as some interpretations of the findings obtained in the different studies. This analysis emphasizes, if needed, how SD-EEG still represents a crucial step in epilepsy diagnosis, and how additional, controlled studies might further shape its precise diagnostic/prognostic role
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