ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00219.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY After the advent of polygraphic recordings in the 1960s a great deal of interest focused on cardiocirculatory and respiratory activity during sleep.The Bologna sleep laboratory was the first to make direct recordings of systemic arterial pressure, pulmonary arterial pressure and alveolar ventilation in normal subjects, measuring gas‐blood values during different sleep stages. In the 1960s, neurophysiologists rediscovered a syndrome known to pneumologists for a decade as Pickwickian Syndrome. Polygraphic studies performed in sleep laboratoires all over Europe (Germany, France and Italy) led to a major discovery: the syndrome was not caused by respiratory overload due to obesity, but usually by the presence of obstructive apnoeas arising during sleep. By means of continuous sleep recordings, our laboratory documented the severe repercussions of apnoeas on ventilatory and cardiocirculatory functions. Hypnologists pointed to tracheostomy as the logical effective treatment for the syndrome. Surgery was first performed in Germany by Kuhlo and coworkers and then in Bologna.In the early 1970s, following the Bologna group's research, there emerged the now accepted concept that obstruction of the upper airways is a continuum stretching from snoring to full‐blown sleep apnoea syndrome. The Bologna team was also the first to conduct epidemiological surveys that indicated that snoring is a relevant risk factor for the cardiocirculatory system.Here the trends of haemodynamic and ventilatory parameters during sleep are investigated in syndromes of obstructive respiratory failure. The conclusion is that sleep, particularly REM‐sleep, exacerbates all these disorders, and the topic provides a basis for a wider look at how cardiocirculatory activity varies during sleep under normal and pathological con

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00178.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY This paper reviews the association between neurobiologically‐based sleepiness/fatigue and human‐error related accidents. It concludes that fatigue contributes to human error and accidents in technology‐rich, industrialized societies in terms of human, environmental and economic impacts. The cultural utilization of time as expressed in 24‐h work operations, combined with the widespread use of automation, will continue to escalate in the next century, further increasing the risks of fatigue‐related accidents, as more people conduct vigilance‐based activities at times other than the traditional daytime work hours. Fatigue management and prevention of fatigue‐related catastrophes need to become a sustained priority for government, industries, labour, and the public. Scientific data are urgently needed on the most likely areas in which sleepiness‐related performance failures contribute to accidents, and on the effectiveness of a wide range of potentially usefu

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00220.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY H.‐P. Koepchen's presence at this symposium on cardiocirculatory function during sleep would have given us an inspiring impetus. His death has meant a severe loss for all of us. Koepchen's integrated view on cardiorespiratory control and rhythmicity has been the content of his late work. His considerations as documented in various papers are used for this contribution. They are based on earlier experimental studies of spontaneous coordinations of rhythmic activities in anaesthetized dogs, conscious men, and microelectrode recordings and local cooling experiments in the brain stem of anaesthetized dogs and cats, which he had worked on together with his stude

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00179.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY Neuropsychological methods have been applied by different authors to investigate cognitive processes such as attention, information processing, memory and psychomotor performance in narcoleptic patients. A review of the results strongly suggests that cognitive processes in narcoleptic patients are not impaired on a functional but only on a temporal level. Providing that short and challenging tasks were used, the performance of narcoleptic patient did not differ significantly from that of healthy subjects. Performance was impaired mainly when a low and monotonous information input had to be processed, a situation which is typical for tests of vigilance. This was supported by this study measuring critical flicker fusion (CFF) at 15‐min intervals for 10 hours in 10 narcoleptic patients and matched healthy controls. While peak performance did not differ between groups, narcoleptic patients were unable to perform at a steady level through the day. Tiredness and episodes of sleepiness seem to be the main reason for cognitive impairments in narcole

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00144.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY Severe subjective and physiological sleepiness occur in night work, afflict almost all individuals and are associated with a performance impairment severe enough to explain night‐work accident data. The alertness deficit is caused by the displacement of work to the circadian phase which is least conducive to alert behaviour, by extension of the time spent awake and by the reduction of sleep length (due to circadian interference with sleep). Sleepiness will be extreme when the three causes are operative simultaneously. The three factors may be used quantitatively to predict sleepin

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00221.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY This paper describes several different methods for the analysis of blood pressure and heart rate variability over the 24 hours, both in the time and in the frequency domain. The mechanisms possibly involved in the genesis of the variations in blood pressure and heart rate which occur over a 24‐hour period are also discussed. Finally, new approaches to the dynamic evaluation of the sensitivity of baroreflex control of heart rate and of its changes over the 24 hours in daily life conditions, based on computer analysis of the interaction between fluctuations in blood pressure and heart rate, are described. Data obtained by applying these methods in different clinical conditions (normotensive vs. hypertensive subjects, young vs. elderly individuals and pure autonomic failure patients) are presen

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00181.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY Falling asleep at the wheel accounts for a sizeable number of vehicle accidents under monotonous driving conditions. The risk of driver death and serious injury is high. Circadian factors are profound and seem to be of equal (if not more) importance to the duration of the drive. Unfortunately, only the latter tends to be built into legislation. Young adults are the most likely to have these accidents, especially in the early morning, whereas older adults may be more vulnerable in the early afternoon. Drivers falling asleep are unlikely to recollect having done so, but they are aware of the precursory state of feeling sleepy, as normal sleep does not occur spontaneously without warning. Self‐awareness of sleepiness is a better method for alerting the driver than in‐car automatic devices. Car simulator studies show high inter‐correlations between driving performance, EEG measures of drowsiness and self‐assessments of sleepiness. Putative countermeasures to sleepiness during continued driving (for example cold air, playing car radio) have to be substantiated. The only safe countermeasure is to stop driving. At this point, a nap and/or coffee (caffeine) can be effective. Exercise is of little use. More driver education is needed about the dangers of driving whil

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00222.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY Jet‐lag and day‐time sleepiness cannot be avoided in transmeridian operations, because work hours of aircrews interfere with the circadian system through irregular work‐rest schedules and rapid time‐zone transitions. Although the primary cause of accidents is usually the human factor, jet lag and sleepiness have seldom been officially identified as causes of inadequate functioning in the cockpit. However, research clearly indicates that flights at night and/or across time zones will impair performance and reduce safety. Research on countermeasures have focused on on‐board napping, crew augmentation, behavioural strategies against jet‐lag, light treatment and melatonin administration. Regrettably, scientific knowledge has been successfully transmitted to only a very few national authorities responsible for work hour

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00223.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SUMMARY Epidemiological data indicate a link between sleep‐disordered breathing and elevation of arterial pressure. Previous studies suggest increased activity of the sympathetic nervous system in patients with sleep apnoea. The response of muscle sympathetic nerve activity was further investigated in normal, awake subjects following exposure to 20 minutes of asphyxia. Sympathetic nerve traffic increased during exposure and remained elevated even after the return to room air breathing. These findings raise the possibility that this sustained elevation of sympathetic nerve traffic could play a role in the development of daytime hypertension in patients with sleep‐disordered brea

ISSN:0962-1105    

DOI:10.1111/j.1365-2869.1995.tb00183.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY