S50 Abstracts of 3rd International Congress of the Association of Sleep Medicine (WASM) / Sleep Medicine 10, Suppl.
ep Medicine 10, Suppl. 2 (2009) S1–S83
Conclusion: The prevalence of insomnia among Georgian epilepsy patients
seems to be much higher than previously suggested. However, whether the
side effects of antiepileptic drugs are more important for the development
of insomnia as opposed to chronic stress due to the stigma of epilepsy still
remains unclear.
182 LANGUAGE FUNCTION RELATED TO SLEEP QUALITY AND SLEEP
APNEA IN THE ELDERLY
J. Lee 1 , S. Kim 2 , D. Lee 3 , J. Woo 3 . 1 Kangwon National University Hospital;
2 184
Hyosung General Hospital; 3 Seoul National University Hospital
Objectives: Sleep apnea syndrome (SAS) is considered a risk factor for cogni-
tive decline in the elderly. The specific neurocognitive decline was suggested
as a predictive factor for dementia in mild cognitive impairment (MCI) pa-
tients. We aimed to illustrate the sleep characteristics related to the specific
neurocognitive decline in the community-dwelling elderly including MCI pa-
tients.
Methods: Thirty MCI patients and 30 age- and sex-matched normal elderly
subjects were selected. Seven tests in the Korean version of the Consortium
to Establish A Registry of Alzheimer’s Disease (CERAD-K) neuropsychologi-
cal battery were administered and nocturnal polysomnographies were con-
ducted. P-values below 0.05 were considered statistically significant.
Results: There was no significant difference in the sleep parameters between
the MCI and normal groups. The amount of stage 1 sleep was negatively cor-
related with scores from the Boston Naming Test (BNT), Word List Recall and
construction recall (CR) in the combined group (r=-0.351, -0.304, -0.333). The
slow wave sleep amount (SWS) was significantly correlated with BNT scores
(r=0.322), and the REM sleep amount (REMS) with CR scores (r=0.388). The
apnea index was negatively correlated with the BNT scores (r=-0.320). Step-
wise multiple regression analysis showed that SWS and sleep efficiency were
significant predictive sleep variables explaining the increased BNT and CR
scores for 11.4% and 16.6%, respectively.
Conclusions: Our results showed that the more severe cases of SAS were
associated with impaired language function reflecting frontal-subcortical
pathology in the community-dwelling elderly including MCI patients. It sug-
gested that vulnerability of a specific brain region related to SAS could in-
crease the risk for dementia.
183 PREDICTING DEATH FROM STROKE AFTER ONE YEAR – CLINICAL
FACTORS AND SLEEP DISTURBANCES
C.A.M. Medeiros, V.M.S. de Bruin, T.R. Paiva, W.M. Coutinho, P.F.C. de Bruin.
Department of Clinical Medicine, Federal University of Ceará, Brazil
Background: Identifying predictors of stroke outcome is important for ther-
apeutic guidance. Sleep disturbances are known to affect survival and quality
of life. Obstructive sleep apnea (OSA) has been recognized an independent
factor that predicts functional recovery and death after stroke. Hypertension
and metabolic syndrome, which are two important determinants of stroke,
are intimately associated with OSA, which reinforced the importance of iden-
tifying and treating OSA in connection with stroke.
Objectives: The aim of this prospective study was to evaluate the effects of
clinical measures and sleep disturbances in the outcome of stroke in a long-
term observation.
Methods: This was a prospective study that involved 62 consecutive patients
(mean age of 63.9±8.9) of both genders with acute ischemic stroke. The
risk of OSA was evaluated by the Berlin questionnaire, excessive daytime
somnolence by the Epworth Sleepiness Scale and subjective sleep quality
by the Pittsburgh Sleep Quality Index. Body mass index, hip-waist measure-
ments, neck circumference and the results of ancillary examinations were
obtained from both physical examination and a review of medical charts.
Stroke severity was estimated by the Barthel Index and the Modified Rankin
Score. The end-point was death from any causes, after assessment at a 12-
months follow-up.
Results: Family history of stroke (79%), obesity (19%), diabetes (37%) and hy-
pertension (74%) were frequent in this population. Common sleep distur-
bances were excessive daytime sleepiness (42%), poor sleep quality (69%)
and risk of OSA (57%). Individuals who did not survive tended to be older
(p=0.02) and have a greater neck circumference (p=0.005). After multiple re-
gression analysis, both age (p=0.03) and neck circumference (p=0.01) were
associated with death after one year. Neck circumference remained associ-
ated with death after controlling for age and gender [p=0.01, OR=1.59 CI:
1.10-2.28]. Neck circumference ≥43 served as a strong predictor of death af-
ter the one-year follow-up (p=0.02; Sensitivity 70%, Specificity 82%; Positive
Predictive Value = 80%; Negative Predictive Value= 75%).
Conclusion: A neck circumference of 43 cm or more could be used to pre-
dict death after a one-year follow-up after stroke with good sensitivity and
specificity. This criterion should be used as a strong indicator to send stroke
patients for follow-up OSA investigation and treatment.
SOUND STIMULATION DURING SLEEP: A THERAPEUTIC TOOL TO
IMPROVE TINNITUS
M. Pedemonte, D. Drexler, S. Rodio, V. Bernhardt. Centro de Medicina del
Sueño, Facultad de Medicina, Instituto Universitario CLAEH, Punta del Este,
Uruguay
Idiopathic subjective tinnitus is a sound perception created by the central
nervous system in the absence of either an external sound stimulation or
a detectable anatomical lesion. During wakefulness, various sound stimu-
lation treatments have been used (music, white noise, pure tones) with no
clear results. Since previous research demonstrated that the auditory system
functions during sleep, i.e., incoming information is processed and some kind
of learning may occur, we propose that the brain could learn, during sleep,
to mask tinnitus perception. Usually, tinnitus is a disturbing condition and
may provoke sleep alterations (insomnia) and psychological disorders such
as anxiety and depression. Thus, this study was approached on an interdisci-
plinary basis: otolaryngology, psychology and sleep medicine. Seventeen pa-
tients with idiopathic subjective tinnitus were studied. The sound selected
for stimulation during sleep had the same characteristics in frequency and
intensity than that reported by each patient, and was delivered through an
iPod. Patients could regulate the intensity by fixing it at the level at which
they were not able to identify the source of the sound (internal or exter-
nal). Four patients were initially studied with polysomnography (PSG) to as-
sess their personal sleep characteristics. After 15 days of nightly stimulation
adaptation, another PSG was performed during sound stimulation overnight.
The resulting hypnograms were analyzed and compared with those of con-
trol subjects. In two patients, the PSGs were performed with sound stim-
ulation during half of the night in order to compare the power spectra of
EEG bands in the different sleep stages with and without sound stimuli.
The results showed that sound stimulation during sleep: 1) did not alter
sleep architecture 2) increased delta waves power spectra and 3) induced
a decrement in tinnitus intensity perception with periods of total silence.
This treatment would be advantageous since the stimulation time was longer
than that which might occur during any possible daytime stimulation. Night
treatment-stimulation may help the patients adhere to the treatment and,
by provoking a tinnitus masking, may improve sleep quality.
185 MORVAN CHOREA AND AGRYPNIA EXCITATA: WHEN
VIDEO-POLYSOMNOGRAPHIC RECORDING GUIDES THE
DIAGNOSIS
F. Provini, S. Marconi, M. Amadori, P. Guaraldi, G. Pierangeli, P. Cortelli,
E. Lugaresi, P. Montagna, P. Tinuper. Department of Neurological Sciences,
University of Bologna
Introduction: Morvan chorea (MC) is characterized by neuromyotonia, se-
vere insomnia and dream enactment. Antibodies to voltage-gated K+ chan-
nels (VGKCs) are sometimes present in patients with MC. We describe a pa-
tient in whom the observation of enacted dreams during a video-PSG record-
ing was the decisive finding to establish the diagnosis.
Clinical and Laboratory Findings: A retired electrician, aged 78, started pre-
senting episodes characterized by staring and manual automatisms. Later he
developed unusual aggressive behavior, apathy, spatial disorientation, visual
daytime hallucinations, complex motor behavior during sleep (i.e., dissem-
bling the bedroom electrical equipment) and progressive insomnia. On ad-
mission, the patient appeared confused. When left alone, he lapsed in an
“oneiric state”. On examination, he had an upper limb postural tremor, my-
oclonic jerks and muscle twitches. Routine investigations, including a search
for paraneoplastic antibodies and tumor markers, were normal. In the CSF,
the 14-3-3 protein was absent, and total tau protein was within normal
range. Anti-neural antibodies were absent both from the CSF and blood. Brain
MRI showed age-associated diffuse intensity lesions in the white matter. As-