Association of sleep-wake habits in older people with changes in output of circadian pacemaker

Czeisler, Charles A.; Dumont, Marie; Duffy, Jeanne F.; Steinberg, J.; Richardson, Gary S.; Brown, Emery N.; Sánchez, Raymond E A; Ríos, C.D; Ronda, Joseph M.

doi:10.1016/0140-6736(92)92817-y

Cited by 400 publications

(232 citation statements)

References 21 publications

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“…31 Likewise, sleep abnormalities may be secondary to malfunctioning circadian timekeeping systems, 32 such as sleep disturbance, that develop with aging. 33 Analysis of sleep patterns in FIG. 3.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of sleep disturbance in cirrhosis

et al. 1998

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Sleep disturbance is a classic sign of hepatic encephalopathy. However, there are limited data regarding its prevalence in cirrhotic patients without overt hepatic encephalopathy. We assessed the characteristics of sleep in cirrhosis using a sleep questionnaire (n ‫؍‬ 44) and actigraphy (n ‫؍‬ 20). The results were compared with those of subjects with chronic renal failure and those of healthy controls. Presence of subclinical hepatic encephalopathy, chronotypology profile, and individual's affective state were also analyzed. The questionnaire indicated an elevated number of cirrhotic patients (47.7%) and patients with chronic renal failure (38.6%) who complained of unsatisfactory sleep compared with healthy controls (4.5%, P F .01). Actigraphy corroborated the deterioration of sleep parameters in cirrhotic patients with unsatisfactory sleep. The sleep disturbance in cirrhosis was not associated with clinical parameters nor with cognitive impairment. Cirrhotic subjects and patients with chronic renal failure with unsatisfactory sleep showed higher scores for depression and anxiety, raising the possibility that the effects of chronic disease may underlie the pathogenesis of sleep disturbance. However, in contrast to chronic renal failure, unsatisfactory sleep in cirrhosis was associated with delayed bedtime, delayed wake-up time, and evening chronotypology. In conclusion, a sleep disturbance is frequent in cirrhotic patients without hepatic encephalopathy and may be related to abnormalities of the circadian timekeeping system. (HEPATOLOGY 1998;27:339-345.)A disturbance of sleep is recognized as one of the early signs of hepatic encephalopathy. 1 However, there are limited data regarding its prevalence in patients with cirrhosis without signs of overt hepatic encephalopathy. Results from a quality of life questionnaire indicated that disturbance in sleep was significantly higher in nonalcoholic cirrhotic patients compared with subjects with another chronic illness, such as Crohn' s disease. 2 In this survey and subsequent data, 3 up to 35% of cirrhotic individuals had difficulties in the area of sleep and rest.The mechanisms responsible for these findings are poorly understood. One possibility is that abnormalities in circadian function may underlie its pathogenesis. The sleep-wake cycle is one of the functions regulated by the circadian clock, the suprachiasmatic nucleus of the anterior hypothalamus, 4 which has efferent connections that influence a large array of biological functions including the secretion of melatonin from the pineal gland. Previous studies from our laboratory have shown that rats subjected to a portacaval anastomosis experience an alteration in the rhythm of circadian locomotor activity as well as the rhythm of pineal melatonin content. 5 In patients with cirrhosis, the diurnal plasma melatonin profile showed a significant delay in the onset of plasma melatonin increase and in its peak nocturnal level. 6 This displacement of the melatonin profile could be a reflection of an alteration in the ...

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Section: Discussionmentioning

confidence: 99%

High prevalence of sleep disturbance in cirrhosis

et al. 1998

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“…The cumulative effects of FLU may be important in elderly patients who are generally subject to more disturbed sleep and reduced daytime wakefulness than are younger adults (Czeisler et al 1992;Bliwise 1993). The elderly are sensitive to cumulative effects of drugs, particularly when multiple drugs are administered for concomitant systemic illnesses.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Fluoxetine on the Polysomnogram of Depressed Outpatients: A Pilot Study

Hendrickse

Roffwarg

Grannemann

et al. 1994

Neuropsychopharmacol

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The effects of fluoxetine (FLU) and its active metabolite, norfluoxetine (NFLU), on the polysomnogram (PSG) of nine depressed outpatients (eight with major depression; one with bipolar II, depressed phase disorder) were investigated by contrasting PSG values prior to treatment and during administration of FLU. The PSG changes were correlated with daily dose, cumulative dosage, single serum concentrations, and the total area under the serum concentration curve (AUC) of both FLU and NFLU.KEY WORDS: Fluoxetine; Norfluoxetine; Polysomnography; Serotonin; Depression Fluoxetine (FLU)-a potent, specifIc, serotonin reup take inhibitor-is an effective treatment for major depression (for a review, see Depression Guideline Panel, 1993). Serotonin affects the regulation of the sleep-wake cycle. It plays a role in the induction and maintenance of sleep as well as the character of sleep stage macro architecture and rapid-eye-movement (REM) sleep expression Oouvet et al. 1989).Fluoxetine reportedly causes a shift toward lighter Fluoxetine clearly increased both stage 1 sleep time and rapid-eye-movement (REM) latency and decreased both percent REM and REM density. With a few exceptions, the cumulative dosage of FLU and the AUC of FLU and NFLU were better predictors of the changes in awake and movement time in the PSG than single-sample concentrations of FLU and NFLU taken at the time of PSG assessment. fNeuropsychopharmacology 10: 85-91, 1994J sleep that is reflected in increases in sleep latency and percentage of non-REM stage 1 sleep and decreases in total sleep time, sleep efficiency, and percentage of non REM stages 3 and 4 sleep (Nicholson and Pascoe 1986;Pastel and Fernstrom 1987;Kerkhofs et al. 1990;Keck et al. 1991;Keck and McElroy 1992). The duration of REM sleep and REM latency, as well as REM density, may also be affected by FLU (Nicholson and Pascoe 1988;von Bardeleben et al. 1989;Nicholson et al. 1989; Bakalian and Fernstrom 1990;Hanzel et al. 1991;Saletu et al. 1991). These effects likely depend upon both the dose and duration of FLU treatment.Changes in polysomnogram (PSG) measures as sociated with chronic FLU treatment in depressed sub jects have been incompletely studied (Schenck et al. 1992). Relationships among PSG measures and serum concentrations of FLU and its active metabolite norflu oxetine (NFLU) have not been previously reported in depressed patients. This pilot study evaluated the effect of FLU and NFLU on PSG measures in a group of medication-responsive depressed outpatients.

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“…However, changes in circadian parameters with aging are less consistent than age-related changes of sleep parameters, and SWS in particular. Thus, some (Czeisler et al, 1992;Münch et al, 2005;Van Coevorden et al, 1991;Weitzman et al, 1982), but not all, studies report a decline in the amplitude of CBT, melatonin, and cortisol (Monk, 2005;Niggemyer et al, 2004;Zeitzer et al, 1999). The disparity of these findings points to rather large interindividual differences in sleep and circadian rhythmicity with age and leaves the question open as to what is driving these individual differences (Van Cauter et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Interindividual differences in circadian rhythmicity and sleep homeostasis in older people: effect of a PER3 polymorphism

Viola

Chellappa

Archer

et al. 2012

Neurobiology of Aging

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Aging is associated with marked changes in the timing, consolidation and structure of sleep. Older people wake up frequently, get up earlier and have less slow wave sleep than young people, although the extent of these age-related changes differs considerably between individuals. Interindividual differences in homeostatic sleep regulation in young volunteers are associated with the variable-number, tandem-repeat (VNTR) polymorphism (rs57875989) in the coding region of the circadian clock gene PERIOD3 (PER3). However, predictors of these interindividual differences have yet to be identified in older people. Sleep electroencephalographic (EEG) characteristics and circadian rhythms were assessed in 26 healthy older volunteers (55-75 years) selected on the basis of homozygosity for either the long or short allele of the PER3 polymorphism. Homozygosity for the longer allele (PER3 5/5 ) associated with a phase-advance in the circadian melatonin profile and an earlier occurrence of the melatonin peak within the sleep episode. Furthermore, older PER3 5/5 participants accumulated more nocturnal wakefulness, had increased EEG frontal delta activity (0.75-1.50 Hz), and decreased EEG frontal sigma activity (11-13 Hz) during non-rapid eye movement (REM) sleep compared with PER3 4/4 participants. Our results indicate that the polymorphism in the clock gene PER3 may contribute to interindividual differences in sleep and circadian physiology in older people.

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Association of sleep-wake habits in older people with changes in output of circadian pacemaker

Cited by 400 publications

References 21 publications

High prevalence of sleep disturbance in cirrhosis

High prevalence of sleep disturbance in cirrhosis

The Effects of Fluoxetine on the Polysomnogram of Depressed Outpatients: A Pilot Study

Interindividual differences in circadian rhythmicity and sleep homeostasis in older people: effect of a PER3 polymorphism

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