Nocturnal panic: Response to hyperventilation and carbon dioxide challenges.

To examine the role of ventilatory response in nocturnal panic, subjects experiencing nocturnal panic were compared with those who experienced daytime panic attacks only. In particular, measures of chronic hyperventilation (baseline pCO?) and CO? hypersensitivity (response to ventilatory challenges) were assessed. Subjective and psychophysiological measures were obtained during baseline, forced hyperventilation, and carbon dioxide inhalation phases of a standardized laboratory-based assessment. The groups did not differ with respect to subjective or physiological measures or to the frequency with which panic occurred during the assessment. The results do not lend support to models that emphasize central CO? hypersensitivity and chronic hyperventilation as primary mechanisms underlying nocturnal panic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional characterization of a novel type of 1 alpha,25-dihydroxyvitamin D3 response element identified in the mouse c-fos promoter

The measurement characteristics of two asthma symptom diary scales developed for use as health outcome measures in clinical trials of asthma therapy were investigated. A daytime diary scale was designed to capture the frequency and inconvenience of daytime asthma symptoms and their effects on activities, and a nocturnal asthma symptom diary scale was designed to capture awakenings with asthma symptoms. The internal consistency, reliability, validity and responsiveness of both asthma diary scales were assessed in 346 adult asthma patients in two placebo-controlled clinical trials of an investigational asthma therapy, a leukotriene biosynthesis inhibitor. The daytime symptom scale showed sufficient internal consistency (0.90-0.92), and the daytime and nocturnal symptom scales showed sufficient test retest reliability (0.69-0.87). Construct validity was demonstrated by generally moderate-to-strong correlations for changes in the diary scales with changes in other measures of asthma status, such as forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and puffs of beta-agonist inhaler. Both scales demonstrated significant responsiveness to change in asthma due to therapy in one of the clinical trials. Based on these results, the daytime and nocturnal asthma symptom diary scales show measurement characteristics appropriate for use as asthma outcome measures in clinical trials of asthma therapy.     

The hypnotic dream: Its relation to nocturnal dreams and waking fantasies.

A review of the literature in the area of hypnotic dreams suggests that physiological correlates of hypnotic dreams are better established than content characteristics. A study is also reported that examined the content of hypnotic dreams in relation to that of nocturnal dreams and daydreams from the same Ss. Ss were 16 undergraduates divided into deep-trance and medium-trance groups. Deep trance Ss' hypnotic dreams were similar to their nocturnal dreams and different from daydreams on a wide variety of characteristics including length, emotional themes, characters, setting, and amount of distortion. Medium trance Ss' hypnotic dreams were found to fall between their nocturnal dreams and daydreams on most of these measures. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of nocturnal hypoglycemia on hypoglycemic cognitive dysfunction in type 1 diabetes

To test the hypothesis that glycemic thresholds for cognitive dysfunction during hypoglycemia, like those for autonomic and symptomatic responses, shift to lower plasma glucose concentrations after recent antecedent hypoglycemia in patients with type 1 diabetes mellitus (T1DM), 15 patients were studied on two occasions. Cognitive functions were assessed during morning hyperinsulinemic stepped hypoglycemic clamps (85, 75, 65, 55, and 45 mg/dl steps) after, in random sequence, nocturnal (2330-0300) hypoglycemia (48 +/- 2 mg/dl) on one occasion and nocturnal euglycemia (109 +/- 1 mg/dl) on the other. Compared with nondiabetic control subjects (n = 12), patients with T1DM had absent glucagon (P = 0.0009) and reduced epinephrine (P = 0.0010), norepinephrine (P = 0.0001), and neurogenic symptom (P = 0.0480) responses to hypoglycemia; the epinephrine (P = 0.0460) and neurogenic symptom (P = 0.0480) responses were reduced further after nocturnal hypoglycemia. After nocturnal hypoglycemia, in contrast to nocturnal euglycemia, there was less deterioration of cognitive function overall (P = 0.0065) during hypoglycemia based on analysis of the sum of standardized scores (z-scores). There was relative preservation of measures of pattern recognition and memory (the delayed non-match to sample task, P = 0.0371) and of attention (the Stroop arrow-word task, P = 0.0395), but not of measures of information processing (the paced serial addition task) or declarative memory (the delayed paragraph recall task), after nocturnal hypoglycemia. Thus, glycemic thresholds for hypoglycemic cognitive dysfunction, like those for autonomic and symptomatic responses to hypoglycemia, shift to lower plasma glucose concentrations after recent antecedent hypoglycemia in patients with T1DM.     

Neuroendocrine aspects of primary endogenous depression--XIV. Gonadotropin secretion in female patients and their matched controls

To determine the extent of dysregulation of gonadotropin secretion in depressed women, we measured nocturnal and diurnal serum luteinizing hormone (LH) and follicle stimulating hormone (FSH) concentrations and the responses of these hormones to gonadotropin releasing hormone (LHRH) in 20 Research Diagnostic Criteria primary, definite endogenous female depressives and in 20 individually matched female normal controls. Fourteen patients and 14 controls were premenopausal, and six patients and six controls were peri/postmenopausal or panhysterectomized. None of the latter was receiving estrogen replacement therapy. The premenopausal patients showed no significant differences in basal nocturnal or diurnal gonadotropin concentrations and no significant differences in hormone concentrations post-LHRH compared to their premenopausal matched controls. In contrast, in the postmenopausal subjects there were (1) significantly increased diurnal vs. nocturnal serum FSH concentrations in the depressives; (2) marginally increased nocturnal, diurnal, and LHRH-stimulated LH concentrations and highly significantly increased LHRH-stimulated FSH concentrations in the depressives compared to their controls; and (3) positive correlations between the LH measures and ratings of depression severity in the patients. These results suggest a dysregulation of the HPG axis in peri/postmenopausal and panhysterectomized female endogenous depressives.     

Sleeping and waking-state measurement of erectile function in an aging male population.

Sleeping and waking-state erectile ability and sexual adjustment in 58 men aged 50 to 79 years were evaluated using the "Snap Gauge" measure of nocturnal penile tumescence (NPT). The data indicated that 50% of the sample failed to demonstrate nocturnal erections of sufficient rigidity to activate the Snap-Gauge. Nevertheless, these men did not differ from those who did activate the device on 11 out of 13 self-report measures of daytime sexual functioning. The two exceptions to the negative findings were significant differences in frequency of morning erections and sexual desire. The findings cast further doubt on the neurophysiological equivalence of sleep and waking-state erections and on the clinical utility of NPT monitoring for differentiating psychogenic from organically based erectile dysfunction in aging men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between nocturnal activity, parental ratings of daytime activity and measues from the Children's Sleep Behaviour Scale.

Monitored the nocturnal activity levels of 20 boys and 20 girls (mean age 10.46 yrs) from 12:00 AM to 6:00 AM over 2 consecutive nights in their homes. Frequency of sleep-related behaviors based on retrospective parental ratings was assessed by the Children's Sleep Behavior Scale (CSBS). Children who were rated high on sleep behaviors with an observable motor component were also more active during the night, thereby validating the motor subscale of the CSBS. Nocturnal activity was associated with another CSBS-derived sleep score that included items with positive affective content, such as laughing and smiling while asleep. Children who showed bedtime resistance behaviors and complained of difficulty going to sleep were not more active during the night. Gender, age, and parental perception of daytime activity levels were not related to objective measures of nocturnal activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Desmopressin for the treatment of nocturnal polyuria in the elderly: a dose titration study

OBJECTIVE: To evaluate the decrease in nocturnal polyuria and the tolerability of three different doses of oral desmopressin in elderly subjects. SUBJECTS AND METHODS: Subjects were included in the study if they; (i) were healthy and free from medication with possible influence on their diuresis or voiding pattern: (ii) had an increased nocturnal frequency (> or = 2 nocturnal voids, as reported in the pre-screening period); and (iii) had a nocturnal urinary output of > or = 0.9 mL/min. Seventeen men and six women (mean age 68.1, SD 4.7 years) met these criteria and were treated with 0.1, 0.2 and 0.4 mg oral desmopressin given at bedtime, each dose taken for one week on three consecutive weeks. RESULTS: The mean (SD) nocturnal diuresis before treatment was 1.6 (0.7) mL/min, which decreased significantly to 1.1 (0.4) mL/min when 0.1 mg desmopressin was given. A dose of 0.2 mg desmopressin resulted in a further small decrease in the nocturnal diuresis to 0.9 (0.4) mL/min, whereas the 0.4 mg dose produced no additional effect. The reduction in nocturnal diuresis occurred almost exclusively in the group with a nocturnal urinary output of > or =1.3 mL/min. After treatment, diuresis returned to pretreatment levels. There was no change in body weight or in ankle circumference during desmopressin treatment and no serious adverse effects were observed. CONCLUSION: Desmopressin reduces nocturnal diuresis in polyuric elderly subjects and this reduction, occurring with doses of 0.1 mg given at bedtime, does not increase in a dose-dependent way.     

Characterization of [11C]tetrabenazine as an in vivo radioligand for the vesicular monoamine transporter

The erythrocytes of paroxysmal nocturnal hemoglobinuria are abnormally sensitive to complement-mediated lysis because they are deficient in membrane proteins that regulate the functional activity of complement. All the deficient proteins in paroxysmal nocturnal hemoglobinuria share the common structural feature of being anchored to the cell surface by a glycosyl phosphatidylinositol moiety. Recent studies showed that the first intermediate in the pathway of the glycosyl phosphatidylinositol anchor synthesis is not formed in paroxysmal nocturnal hemoglobinuria cells. This observation suggests that the molecular basis of paroxysmal nocturnal hemoglobinuria is due to an abnormality involving a gene that encodes a protein essential for the normal biosynthesis of the first intermediate. By using expression cloning, the complementary DNA (called phosphatidylinositol glycan class A [PIG-A]) that corrects the abnormality in glycosyl phosphatidylinositol-anchor synthesis in paroxysmal nocturnal hemoglobinuria cells was identified. Subsequent studies showed that the PIG-A gene is located on the X chromosome. Together, these studies provided a molecular explanation for paroxysmal nocturnal hemoglobinuria.     

Day and night pain measurement in rheumatoid arthritis

OBJECTIVE: An attempt was made to see if rheumatoid arthritis (RA) patients can use visual analogue scales (VAS) to distinguish and grade the severity of pain at night, during rest, and on joint movement and to determine if discriminate measurement of these three pain components enhances the value of VAS estimation. METHODS: Two hundred and fifty two consecutive RA patients were evaluated by a single observer using 10 cm VAS for pain at night, at rest during the day, and on movement. Values were correlated against age, disease duration, joint tenderness, swollen joint count, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and Larsen x ray scores. RESULTS: Night pain was recorded by 71 (28%) and this component of pain was lower than VAS scores for daytime rest and movement. However, those with nocturnal pain had significantly more joint tenderness (p < 0.0001), swollen joints (p < 0.0001), and higher ESR and CRP. Age, disease duration, and radiographic scores were similar in those with and without night pain. Correlations of joint tenderness were apparent for all three pain scores but only nocturnal pain correlated with swollen joints (p < 0.001) and CRP (p < 0.005). Age, disease duration, and radiographic severity correlated with daytime rest or movement scores but not nocturnal pain. CONCLUSION: Patients were able to distinguish and estimate the severity of pain at rest, on movement, and at night. The occurrence of night pain characterised those with more active disease and night pain VAS measurement correlated best with measures of joint inflammation whereas daytime pain scores, both at rest and on movement, seemed influenced by the degree of permanent joint damage. Thus, discrete measurement of rest, movement, and nocturnal pain may provide useful information about RA disease status.     

Factors affecting the nocturnal decrease in blood pressure: a community-based study in Ohasama

OBJECTIVE: To investigate factors affecting the nocturnal decrease in blood pressure. DESIGN: A cross-sectional study of 823 community-based untreated subjects aged > 20 years. Screening and ambulatory blood pressures were measured and the effects of age and the ambulatory blood pressure on the nocturnal decrease were examined. RESULTS: The magnitude of the decrease and the percentage decrease in the nocturnal blood pressure increased with increasing daytime ambulatory blood pressure and decreased with increasing night-time ambulatory blood pressure. Although the magnitude of the nocturnal decrease in blood pressure increased with increasing daytime blood pressure, the nocturnal blood pressure levels in hypertensives were still higher than those in normotensive subjects. The magnitude decreased with increasing age for men but not for women, whereas the percentage decrease decreased with increasing age both for men and for women. The SD of the 24 h blood pressure correlated strongly to the magnitude of the nocturnal decrease (systolic blood pressure r = 0.62, P < 0.0001; diastolic blood pressure r = 0.52, P < 0.0001), suggesting that the SD of the 24 h blood pressure is representative of the nocturnal decrease. A minimal nocturnal decrease was observed frequently in elderly normotensive men but infrequently in hypertensive individuals from the general population. A marked nocturnal decrease was observed frequently in hypertensive women aged > 70 years. CONCLUSION: Although the magnitude of the nocturnal decrease in blood pressure increased with increasing daytime blood pressure, the nocturnal blood pressure levels increased with increasing daytime ambulatory blood pressure. Therefore, the blood pressure in hypertensive subjects should essentially be lowered throughout the 24 h period. A marked nocturnal decrease in blood pressure in some elderly hypertensive women was observed without treatment. The nocturnal blood pressure levels of such subjects should be considered during treatment.     

Expectations about arousal and nocturnal panic.

Expectations about arousal were examined in relation to nocturnal panic (NP). Eighteen panic disorder patients suffering from NP attacks and 18 control individuals were assigned randomly to conditions in which they were informed that audio feedback signals reflected heightened arousal that was either (a) expected and harmless or (b) unexpected. Participants relaxed and slept for 45 to 60 min, followed by presentation of periodic audio feedback signals. Physiological recording was continuous while subjective measures were collected at completion of the signals phase. NP patients in the unexpected-no reassurance condition were significantly more anxious and symptomatic than their counterparts in the expected reassurance condition, whereas control individuals did not differ across the 2 conditions. Physiological and behavioral data were less consistent than subjective measures. The results are interpreted as supportive of a cognitive–behavioral model of NP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beneficial effect of intranasal desmopressin for nocturnal polyuria in Parkinson's disease

Patients with Parkinson's disease (PD) are known to experience autonomic nervous system dysfunction: this disruptive symptomatology includes urinary urgency, frequency, and nocturnal polyuria. Anticholinergic and tricyclic medications can be beneficial in controlling these urinary symptoms, but have unpleasant side effects in some patients. Desmopressin has been used to treat nocturnal polyuria successfully in a number of conditions, such as central diabetes insipidus, enuresis, and autonomic failure. The purpose of the present study was to assess the efficacy of desmopressin in patients with PD with significant nocturia. Eight patients were recruited into the study. They were first asked to establish a baseline of number of nocturnal voids; the patients were then prescribed the intranasal form of desmopressin and asked to continue to record the number of nocturnal voids. The five patients who completed the trial demonstrated clinically and statistically significant reductions in the frequency of nocturnal voids. One patient became hyponatremic and confused during desmopressin administration; his symptoms resolved soon after the desmopressin was discontinued. Two patients failed to complete the trial due to compliance problems. Thus, desmopressin appears to be a safe and effective medication for nocturnal polyuria in PD.     

Short-duration nocturnal hypoxemia and persistent pulmonary hypertension

Can daily short-duration hypoxemia (4-8 hours) induce pulmonary hypertension and right ventricular hypertrophy? A clinical model of this type of hypoxemia does exist: isolated nocturnal hypoxemia in patients with obstructive sleep apnea syndrome (OSAS) or chronic obstructive pulmonary disease (COPD). By investigating the pulmonary hemodynamics of these patients, it should be possible to determine whether nocturnal hypoxemia alone can induce pulmonary hypertension. Although nocturnal hypoxemia (in OSAS as well as in COPD) can induce acute episodes of pulmonary hypertension, it would not appear that nocturnal hypoxemia alone would be sufficient to provoke permanent diurnal pulmonary hypertension. This is the conclusion of recent studies concerning diurnal pulmonary hemodynamics in OSAS and COPD patients exhibiting minimal hypoxemia during the day but significant nocturnal desaturation. The therapeutic consequences of these data, particularly in COPD are important: current evidence is insufficient to treat with nocturnal oxygen therapy COPD patients who have minimal diurnal hypoxemia but significant nocturnal desaturation.     

Association of relative nocturnal hypertension and autonomic neuropathy in insulin-dependent diabetic children

Twenty-four hour BP and heart rate measurements were carried out in fourteen newly diagnosed-, and in twenty-eight diabetics with 5-13 years of duration; and in eight healthy control children. Mean arterial BP rose at night in five-, fell slightly (less than 10%) in five- and fall markedly (more than 10%) in eighteen diabetics with longer duration of the disease. The diurnal-nocturnal difference of mean arterial pressure was significantly lower in the groups with nocturnal BP rise and slight nocturnal BP fall, compared to the control group (< 0.001; p < 0.01, respectively). The diurnal-nocturnal differences of heart rates were significantly lower in diabetics with relative "nocturnal hypertension" compared to the control group (p < 0.05). The presence of subclinical signs of diabetic autonomic neuropathy was significantly higher in patients with nocturnal BP rise and slight nocturnal BP fall compared to patients with marked nocturnal BP fall and newly diagnosed diabetics (chi squared p = 0.02 and p = 0.01, respectively). In conclusion, the prevalence of autonomic symptoms in diabetic children could be related to change in diurnal/nocturnal arterial BP, however longitudinal studies of ABPM are needed to define, whether patients with abnormal BP profiles are candidates for the development of diabetic vascular disease.     

Sociodemographic factors associated with nocturnal enuresis

This study examined the school nursing/medical examination records of 6206 national school children for sociodemographic factors associated with reported nocturnal enuresis. A point prevalence of 10.7% (n = 666) for nocturnal enuresis was reported by parents during 1970-1993 in children aged 4-14 years. Although a downward linear trend (from 11.5% to 10.7%) was seen for the reported prevalence of nocturnal enuresis over the 23-year period, this trend was not statistically significant. Age, as expected, large family size and low ordinal position in the family were all statistically associated with reported nocturnal enuresis. Gender was statistically associated with reported nocturnal enuresis only in the 6-14 years age group. Paternal social class was not statistically associated with reported nocturnal enuresis, although 15% of children in families where the father was absent were reported enuretic compared with only 10% of children whose father was in social class 1. These findings contribute to an understanding of the relationship between sociodemographic factors and enuresis as reported at school medical examinations and have implications for the planning and development of health services at local levels.     

Pathophysiology and impact of nocturnal enuresis

Nocturnal enuresis in children is not a psychogenic disorder. It is caused by a hereditary delay in maturation of the somatic mechanisms (reduction of nocturnal urine production and a normal arousal to a full bladder) which prevent the child from wetting the bed. Traditionally, doctors treating bedwetting children have used an expectant attitude, because nocturnal enuresis has been looked upon as self-limiting and harmless. According to recent research this is not true. More than 5% of children and 0.5% of the adult population report nocturnal enuresis, meaning that 10% of enuretic children will remain bedwetters for life if left untreated, and nocturnal enuresis is perceived as a shameful condition, giving a significant impairment of self-esteem at an age when an intact self-image is extremely important for an optimal development of the child's personality. Treatment should be given when the enuretic child wants to sleep dry.     

Exhaled nitric oxide is higher both at day and night in subjects with nocturnal asthma

Nitric oxide in exhaled air is thought to reflect airway inflammation. No data have been reported so far on circadian changes in NO in subjects with nocturnal asthma. To determine whether exhaled NO shows a circadian rhythm inverse to the circadian rhythm in airway obstruction in subjects with nocturnal asthma, we conducted a study involving six healthy controls, eight individuals without nocturnal asthma (4-h to 16-h variation in peak expiratory flow [PEF] <= 15%), and six individuals with nocturnal asthma (4-h to 16-h PEF variation > 15%). Smoking, use of corticosteroids, and recent respiratory infections were excluded. NO concentrations were measured at 12, 16, 20, and 24 h, and at 4, 8, and 12 h of the next day, using the single-breath method. At the same times, FEV1 and PEF were also measured. Mean NO concentrations were significantly higher in subjects with nocturnal asthma than in subjects without nocturnal asthma, and higher in both groups than in healthy controls at all time points. Mean exhaled NO levels over 24 h correlated with the 4-h to 16-h variation in PEF (r = 0.61, p < 0.01). Exhaled NO did not show a significant circadian variation in any of the three groups as assessed with cosinor analysis, in contrast to the FEV1 in both asthma groups (p < 0.05). At 4 h, mean +/- SD NO levels were higher than at 16 h in subjects with nocturnal asthma; at 50 +/- 20 ppb versus 42 +/- 15 ppb (p < 0.05); other measurements at all time points were similar. Differences in NO and FEV1 from 4 h to 16 h did not correlate with one another. We conclude that subjects with nocturnal asthma exhale NO at higher levels both at night and during the day, which may reflect more severe diurnal airway-wall inflammation. A circadian rhythm in exhaled NO was not observed. NO levels did not correspond to the circadian rhythm in airway obstruction. The small increase in NO at 4 h may indicate an aspect of inflammation, but it is not associated with increased nocturnal airway obstruction.     

Fréquence de l'énurésie chez les enfants agés de 4 à 7 ans.

Studied the incidence of diurnal and nocturnal enuresis in children and the age at which children stop exhibiting enuresis during the day and through the night. Human subjects: 2,007 male and female French children (4–7 yrs) (nursery school and kindergarten students). Data on diurnal and nocturnal enuresis and age at which a child stopped exhibiting enuresis were obtained via a questionnaire administered to the Ss' parents. The incidence and frequency of nocturnal and diurnal enuresis were compared between male and female Ss. (English abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)