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Abstract
A group of 22 psychotics (19 schizophrenics) was recorded in acute and/or chronic phase by series of 3 consecutive nights. Our main purposes were to study correlations between subgroups and sleep patterns and to follow the clinical evolution of these patients in looking at the quantitative and/or qualitative modifications of the various sleep states. Schizoaffective psychotics showed a lack of the "first night effect". The patients recorded in acute and in remission phases differ from unmedicated normal subjects: the former had less deep sleep and more "intermediate phases": the later presented an increase, sometimes very high, of REM total duration. Finally, within each subgroup, the analysis of individuals pointed out, for some of them, an evolution opposite to the general tendency.
... Environ 3 à 4% de la population d'adultes sains rapportent manquer de sommeil et de 10 à 25% rapportent qu'il leur arrive de se sentir somnolents le jour (Basner et al., 2007; Roehrs et al., 2005). Ces habitudes de sommeil dépendent beaucoup du travail, des déplacements, des obligations familiales et des loisirs (Basner et al., 2007; Hale, 2005; Hurst, 2008)Julien et al., 1980; Kupfer et al. 1970;). Les traitements pharmacologiques ont aussi une influence marquée sur le sommeil des personnes atteintes de schizophrénie () profond et un délai d'apparition du sommeil paradoxal plus court (Benson et al., , 1996 Feinberg and Hiatt 1978; Ganguli er al., 1987; Hudson et al., 1993; Jus et al., 1973; Kupfer et al., 1970; Lauer et al., 1997; Nishino et al., 1998; Poulin et al., 2003; van Cauter et al., 1991). ...
Les personnes atteintes de schizophrénie peuvent présenter un sommeil anormal même lorsqu’elles sont stables cliniquement sous traitements pharmacologiques. Les études présentées dans cette thèse ont pour but de mesurer le sommeil afin de mieux comprendre les dysfonctions des mécanismes cérébraux pouvant être impliqués dans la physiopathologie de la schizophrénie. Les trois études présentées dans cette thèse rapportent des résultats sur le sommeil dans la schizophrénie à trois niveaux d’analyse chez trois groupes différents de patients. Le premier niveau est subjectif et décrit le sommeil à l’aide d’un questionnaire administré chez des personnes atteintes de schizophrénie cliniquement stables sous traitements pharmacologiques. Le deuxième niveau est objectif et évalue le sommeil par une méta-analyse des études polysomnographiques chez des patients atteints de schizophrénie ne recevant pas de traitement pharmacologique. Le troisième niveau est micro-structurel et utilise l’analyse spectrale de l’électroencéphalogramme (EEG) afin de caractériser le sommeil paradoxal de patients en premier épisode aigu de schizophrénie avant le début du traitement pharmacologique. La première étude montre que, lorsqu’évaluées par un questionnaire de sommeil, les personnes atteintes de schizophrénie cliniquement stables sous traitements pharmacologiques rapportent prendre plus de temps à s’endormir, se coucher plus tôt et se lever plus tard, passer plus de temps au lit et faire plus de siestes comparativement aux participants sains. Aussi, tout comme les participants sains, les personnes atteintes de schizophrénie rapportent un nombre normal d’éveils nocturnes, se disent normalement satisfaites de leur sommeil et se sentent normalement reposées au réveil. La deuxième étude révèle qu’objectivement, lorsque les études polysomnographiques effectuées chez des patients non traités sont soumises à une méta-analyse, les personnes atteintes de schizophrénie montrent une augmentation du délai d’endormissement, une diminution du temps total en sommeil, une diminution de l’efficacité du sommeil et une augmentation de la durée des éveils nocturnes comparativement aux participants sains. Les patients en arrêt aigu de traitement ont des désordres plus sévères au niveau de ces variables que les patients jamais traités. Seulement les patients jamais traités ont une diminution du pourcentage de stade 2 comparativement aux participants sains. La méta-analyse ne révèle pas de différence significative entre les groupes en ce qui concerne le sommeil lent profond et le sommeil paradoxal. La troisième étude, portant sur l’analyse spectrale de l’EEG en sommeil paradoxal, montre une diminution de l’amplitude relative de la bande de fréquence alpha dans les régions frontales, centrales et temporales et montre une augmentation de l’amplitude relative de la bande de fréquence bêta2 dans la région occipitale chez les personnes en premier épisode de schizophrénie jamais traitées comparativement aux participants sains. L’activité alpha absolue est positivement corrélée aux symptômes négatifs dans les régions frontales, centrales et temporales et négativement corrélée aux symptômes positifs dans la région occipitale. L’activité beta2 absolue ne montre pas de corrélation significative avec les symptômes positifs et négatifs de la schizophrénie. Ces résultats sont discutés suivant la possibilité que des dysfonctions au niveau des mécanismes de la vigilance seraient impliquées dans la physiopathologie de la schizophrénie. Patients with schizophrenia may have an abnormal sleep even when clinically stable under pharmacological treatments. In the present thesis, sleep studies aim at measuring central nervous system dysfunctions that can be involved in the pathophysiology of schizophrenia. The present thesis includes three studies. These studies report results on sleep in patients with schizophrenia in a three levels analysis with three different groups of patients. The first level is subjective and describes sleep habits using a questionnaire administered to outpatients with schizophrenia clinically stable under pharmacological treatments. The second level of analysis is objective and evaluates sleep architecture using a meta-analysis of polysomnographic studies in untreated patients with schizophrenia. The third level is microstructural and uses electroencephalogram (EEG) spectral analysis to characterize REM sleep in never-treated patients with first-episode schizophrenia. The first study shows that, when evaluated using a sleep habits questionnaire, outpatients with schizophrenia clinically stable under pharmacological treatments report increased time to fall asleep, have earlier bedtime, later risetime, spend more time in bed and do more naps compared to healthy participants. Also, similarly to healthy participants, most patients with schizophrenia report normal wake time after sleep onset, are normally satisfied about their sleep and feel normally refreshed in the morning. The second study reveals that, objectively, when polysomnographic studies evaluating untreated patients with schizophrenia are submitted to a meta-analysis, patients with schizophrenia have increased sleep latency, reduced total sleep time, reduced sleep efficiency and increased wake time after sleep onset compared to healthy participants. Patients in acute drug withdrawal show more severe sleep disturbances in these variables compared to never treated patients. Only never treated patients show decreased stage 2 sleep duration compared to healthy participants. The meta-analysis does not reveal significant differences between groups in regards to slow wave sleep and paradoxical sleep variables. The third study about REM sleep EEG spectral analysis shows decreased relative alpha spectral amplitude in frontal, central and temporal cortical regions and increased relative beta2 spectral amplitude in the occipital region in never treated patients with first-episode schizophrenia compared to healthy participants. Absolute alpha spectral amplitude correlates positively with negative symptoms in the frontal, central and temporal regions and negatively with positive symptoms in the occipital region. No significant correlation has been observed between beta2 spectral amplitude and clinical symptoms of schizophrenia. These results are discussed following the possibility that dysfunctions in the mechanisms of vigilance would be involved in the pathophysiology of schizophrenia.
... Environ 3 à 4% de la population d'adultes sains rapportent manquer de sommeil et de 10 à 25% rapportent qu'il leur arrive de se sentir somnolents le jour (Basner et al., 2007; Roehrs et al., 2005). Ces habitudes de sommeil dépendent beaucoup du travail, des déplacements, des obligations familiales et des loisirs (Basner et al., 2007; Hale, 2005; Hurst, 2008)Julien et al., 1980; Kupfer et al. 1970;). Les traitements pharmacologiques ont aussi une influence marquée sur le sommeil des personnes atteintes de schizophrénie () profond et un délai d'apparition du sommeil paradoxal plus court (Benson et al., , 1996 Feinberg and Hiatt 1978; Ganguli er al., 1987; Hudson et al., 1993; Jus et al., 1973; Kupfer et al., 1970; Lauer et al., 1997; Nishino et al., 1998; Poulin et al., 2003; van Cauter et al., 1991). ...
The pathophysiology of schizophrenia includes abnormalities in subcortical-cortical transfer of information that can be studied using REM sleep EEG spectral analysis, a measure that reflects spontaneous and endogenous thalamocortical activity. We recorded 10 patients with first-episode schizophrenia and 30 healthy controls for two consecutive nights in a sleep laboratory, using a 10-electrode EEG montage. Sixty seconds of REM sleep EEG without artifact were analyzed using FFT spectral analysis. Absolute and relative spectral amplitudes of five frequency bands (delta, theta, alpha, beta1 and beta2) were extracted and compared between the two groups. Frequency bands with significant differences were correlated with BPRS positive and negative symptoms scores. Patients with schizophrenia showed lower relative alpha and higher relative beta2 spectral amplitudes compared to healthy controls over the averaged total scalp. Analysis using cortical regions showed lower relative alpha over frontal, central and temporal regions and higher relative beta2 over the occipital region. Absolute spectral amplitude was not different between groups for any given EEG band. However, absolute alpha activity correlated negatively with BPRS positive symptoms scores and correlated positively with negative symptoms scores. Since similar results have been reported following EEG spectral analysis during the waking state, we conclude that abnormalities of subcortical-cortical transfer of information in schizophrenia could be generated by mechanisms common to REM sleep and waking.
Samples consisting of 10 patients out of each of the following diagnostic groups are compared to each other, as well as to a selected control group, with regard to their sleep polygram: narcisssistic depression resp. MDD, schizophrenia, psychosomatic and borderline disease and anorexia nervosa. The different and common aspects of the standard parameters of sleep (quantitative proportions of the sleep stages) and the parameters of structure (segmentation of time) are illustrated in a synopsis. Furthermore the authors attempt to compare the sleep structure of individual diseases with those of other diseases and with those of the selected control group in terms of delimitative entities. On the background of sleep sturctures, which also entails comparisons of ectreme groups with regard to the allocation of NREM 3 and the length of REM latency, the attempt is made to investigate how far aspects of sleep structure coincide with aspects of human-structure as described by Ammon, on the basis of his human-structural concept with respect to the various psychiatric diseases.
Polysomnograhpy was performed during two consecutive nights in 20 schizophrenic patients and in 10 healthy controls. »First night effect« (the increase of REM sleep latency on the first night by at least 30 minutes in comparison to the second night) was present in 35% of schizophrenic patients and in 80% of healthy subjects. The increase of REM sleep latency in schizophrenic patients was accompanied by the decreased sleep efficiency in the same night as well as by the increased number of awakenings in comparison to healthy subjects. The mean age of subjects and the mean data of positive symptoms were higher in schizophrenic patients with the »first night effect« than in patients without »first night effect«. Search activity concept is used for the explanation of these data.
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