Sleep Blog

Neuroscience researchers at the Duke-NUS Graduate Medical School, located in Singapore, have shown for the first time what happens to the visual perceptions of healthy but sleep-deprived volunteers who fight to stay awake, like people who try to drive through the night.

The scientists found that even after sleep deprivation, people had periods of near-normal brain function in which they could finish tasks quickly. This normalcy mixed with periods of slow response and severe drops in visual processing and attention, according to their paper, published in the May 21, 2008 edition of Journal of Neuroscience.

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In an effort to better define and ultimately address fatigue more effectively, a qualitative study from the University of Texas’ M.D. Anderson Cancer Center has identified three primary themes loss of strength or energy, major effects of fatigue and associated sensations - among patients being treated with standard radiation therapy.

Presenting at the 33rd Annual Congress of the Oncology Nursing Society (ONS), Loretta A. Williams, Ph.D., RN, AOCN, OCN, an instructor in the Department of Symptom Research at M.D. Anderson, detailed commonalities of 21 patients who shared personal stories of dealing with cancer’s most distressing and common symptom.

"While fatigue is a well-recognized symptom of cancer and its treatment, the measurement of fatigue has been based on many different ideas and definitions. Few of these definitions have included patient input. We’re trying to define fatigue based on patient experience," said Williams.

"Once we’re able to determine the critical elements of fatigue, we’ll be better equipped to ask the right questions of patients to assess fatigue. Healthcare professionals — including nurses — will be in a much better position to intervene with patients to manage or prevent fatigue," Williams added.

The study included open-ended, audio-taped interviews with 21 patients, all who were receiving radiation therapy at M.D. Anderson. The patients were evenly divided with diagnoses of breast, prostate and head and neck cancer. Of the 21 patients who were interviewed during the fifth week of radiation therapy, 57 percent were women and the average patient was 54 years old.

In the study, patients reported a loss of strength or energy that included feelings of tiredness or weakness, which may progress to exhaustion, and lack of energy and stamina.

Because of the qualitative technique that Williams and her team used, their dialogues with patients revealed comments such as, "I don’t have a body part that is tired. My whole body is tired", "I just have a weak feeling … pretty well all over", and "Fatigue to me is just a feeling of no energy."

More than 85 percent of the patients in Williams’ study used the terms, "tiredness" and "lack of energy" to describe fatigue.

According to the researchers, these may be good terms for patients to use when speaking with health care providers about fatigue and terms that should alert the providers to patients experiencing it.

The team also reported that the effects of fatigue included a lack of motivation or inability to perform usual activities, decreased interest in social activities, and an overwhelming need to rest at times.

"Among the patients that we talked to, they often expressed an inability to do things that they could easily do before their treatment or before their diagnosis," said Williams. "They frequently reported that they didn’t want to be around others, that it took too much out of them to keep up a conversation or be cordial."

Williams and her team also pinpointed physical sensations associated with fatigue that included, "malaise, aching, feelings of heaviness or weight, slowness of movement, lack of appetite, and mental sensations of psychological distress and difficulty thinking or concentrating."

One patient described the physical sensations as "a feeling of heaviness," while another said, "I just felt myself dragged out, just tired, and it was distressing to me because that’s not my norm. I don’t like to feel like that."

"Defining the patient’s experience with a symptom is critical to assessing and managing that symptom," said Williams. "Assessing and managing symptoms, certainly fatigue, is a primary role of oncology nurses."

Collaborating with Williams on the study were Shannon Burkett, Ph.D.; Margaret H. White, B.A.; Ibrahima Gning, Ph.D.; and Charles Cleeland, Ph.D., and funding for the study was provided through a research grant from Cephalon, Inc.

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Stroke victims who have obstructive sleep apnea die sooner than stroke victims who do not have sleep apnea or who have central sleep apnea, according to Swedish researchers who presented their findings at the American Thoracic Society’s 2008 International Conference on Monday.

The researchers followed 132 stroke patients over 10 years. Twenty-three of those patients had obstructive sleep apnea; 28 of those patients had central sleep apnea.

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Obstructive sleep apnea (OSA) in very young children may cause some of the adverse cardiovascular health consequences seen in older children and adults with the condition, according to Israeli-based researchers, who presented their findings this morning at the American Thoracic Society’s 2008 International Conference in Toronto.

"OSA starts from the first year of life," said Aviv Goldbart, M.D., the pediatric pulmonologist and sleep specialist who led the study at Ben-Gurion University’s Soroka Medical Center, located in Beersheba, Israel, "yet very little is known regarding the cognitive, cardiovascular and other medical consequences."

The study is the first to look at the relationship between systemic inflammation and cardiovascular morbidity in children with OSA. Researchers assessed 70 young children, ages 12 to 26 months, whose OSA was confirmed by polysomnography. The children were scheduled to undergo adenotonsillectomy (T&A) to remove enlarged tonsils and adenoids.

On the morning of their surgery, the children were tested to determine levels of N Terminal pro B type Natriuretic Peptide (NTproBNP), a peptide marker of ventricular strain and C Reactive Protein (CRP), a marker for inflammation.

Compared to matched controls, 46 children with OSA had significantly higher levels of NTproBNP and of CRP. Three months after surgery, 20 children were evaluated. The average levels of NTproBNP and CRP dropped below that of the control group.

"Increased levels of CRP in children with OSA may require cardiovascular assessment," said Goldbart. "Further studies are needed first to determine the need to diagnose and treat OSA at a very young age."

He and his colleagues plan to conduct a follow-up study to determine if abnormal cardiovascular function in these children puts them at greater risk for cardiovascular morbidity as adults.

The team’s research was funded by the Israel Science Foundation.

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