Volume 9 ● Number 4 ● October 2011SLEEP ANDBIOLOGICALRHYTHMS
Accepted into the Science Citation Index Expanded!

Worldsleep2011

New Horizons of Sleep Research for Our Planet
October 16 (Sun)-20 (Thu) 2011
Kyoto International Conference Center (ICC Kyoto)

http://www.worldsleep2011.jp/

KYOTO, JAPANSLEEP AND BIOLOGICAL RHYTHMS
Volume 9 ● Number 4 ● October 2011

Preface
Welcome to Kyoto, Worldsleep2011/JSSR

193

Plenary Sessions
Presidential lectures
Opening lecture
Plenary lectures
Plenary symposia
Educational lectures
Educational symposia
Industrial symposia
Abstract symposia

194
194
195
198
216
218
224
232

Poster Presentations
Poster presentations 1
Poster presentations 2

254
342

Author Index

417

Submit your articles online at
http://mc.manuscriptcentral.com/sbr

Worldsleep2011– International Organizing Committee
World Sleep Federation
Masako Okawa
Australasian Sleep Association
Naomi Rogers
European Sleep Research Societies
Dieter Riemann
Canadian Sleep Society
Celyne Bastien
American Academy of Sleep Medicine
Geraldo Lorenzi-Filho
Sleep Research Society USA
Joel Dimsdale
Federation of Latin American Sleep Societies
Sergio Tufik
Asian Sleep Research Society
H. N. Mallick– International Program Committee
World Sleep Federation
Daniel Caridinali
Australian Sleep Association
Cameron Van Den Heuvel
European Sleep Research Societies
Claudio Bassetti
Canadian Sleep Society
Gilles Lavigne
American Academy of Sleep Medicine
Mary Morrell
Sleep Research Society USA
Chiara Cirelli
Federation of Latin American Sleep Societies
Ricardo A Velluti
Asian Sleep Research Society
Ken-ichi Honma– Local Organizing Committee
Chair
Masako Okawa
Vice Chair Tetsuo Shimizu
Do-Un Jeong
Ning-hung Chen
Secretary General
Ken-ichi Honma
Vice Secretary General Takashi Ohida
MemberToshiaki Shiomi
Soichiro Miyazaki
Koichi Hirata
H. N. Mallick
Naiphinich Kotchabhakdi– Local Program Committee
Chair
Ken-ichi Honma
Vice Chair Yoshihiro Urade
Makoto Uchiyama
H. N. Mallick
Member
Tadao Hori
Toshinori Kobayashi
Kazuki Honda
Jun Kohyama
Yuichi Inoue
Tsuneto Akashiba
Kazuo Mishima
Hiroshi Kadotani– Active Financial Committee
Chair
Makoto Uchiyama
Vice Chair Koichi Hirata
Naoto Yamada
MemberTetsuo Shimizu
Naohisa Uchimura
Yuichi Inoue
Tsuneto Akashiba
Kuniaki Otsuka
Jun Ishigouoka– Active Publicity Committee
Chair
Yu-hei Kayukawa
Member Shuichiro Shirakawa
Shigeru Chiba
Taneyoshi Nozawa
Kazuhiko Fukuda
Hirokuni Tagaya– Active Liaison Committee
Chair
Toshinori Kobayashi
MemberKazuki Honda
Yoshirou Sugita
Kazuo Mishima– Active Congress Committee
Chair
Hiroshi Kadotani
Member Yoshihiro Urade
Naoto Yamada
Ichiro Komada– Active Registration Committee
Chair
Soichiro Miyazaki
Vice Chair Ichiro Komada
MemberShintaro Chiba
Masa-aki Suzuki
Makoto Imai
– Refrees
Toshiki Akahoshi
Tsuneto Akashiba
Kazuo Chin
Yuriko Doi
Kazuhiko Fukuda
Shigekazu Higuchi
Koichi Hirata
Kazuki Honda
Makoto Honda
Sato Honma
Ken-ichi Honma
Tadao Hori
Masayuki Ikeda
Makoto Imai
Yuichi Inoue
Hiroshi Kadotani
Takashi Kanbayashi
Yuhei Kayukawa
Mayumi Kimura
Hiroshi Kimura
Tsuyoshi Kitajima
Toshinori Kobayashi
Toru Kodama

Masako Okawa
Makoto Kikuchi
Kazue Suenaga
Takashi Kanemura
Tomoko Yagi
Hiroshi Kimura
Jun Kohyama
Yoshimasa Koyama
Emi Koyama
Ken-ichi Kuriyama
Kazuo Mishima
Masayuki Miyamoto
Soichiro Miyazaki
Mitsuyuki Nakao
Masaki Nishida
Kyoko Nishihara
Yasunori Oka
Masako Okawa
Hiroki Sakakibara
Makoto Sato
Hiroyoshi Sei
Tetsuo Shimizu
Toshiaki Shiomi
Shuichiro Shirakawa
Masaya Takahashi
Yuji Takasaki
Sunao Uchida
Makoto Uchiyama
Yoshihiro Urade
Wataru Yamadera

Worldsleep2011
NEW HORIZONS OF SLEEP RESEARCHFOR OUR PLANET
Kyoto International Conference Centre(ICC Kyoto)
16–20 October 2011
Kyoto, Japan
ABSTRACTS

Sleep and Biological Rhythms 2011; 9: 193

doi:10.1111/j.1479-8425.2011.00520.x

PREFACE

sbr_520193

Welcome to Kyoto,
Worldsleep2011/JSSR
Masako OKAWA1 and Tetsuo SHIMIZU2
Vice President of World Sleep Federation (WSF), President of
Asian Sleep Research Society (ASRS) and Chair of Local
Organizing Committee, Worldsleep2011, and 2President ofJapanese Society of Sleep Research (JSSR), President of 36th
Annual Meeting of Japanese Society of Sleep Research andVice Chair of Local Organizing Committee, Worldsleep2011
1

Welcome to Kyoto, a city full of World Heritage Sites in
the heart of Japan, and to Worldsleep2011. This congress aims to explore new horizons of sleep research forour planet, by building bridges between Asia and theworld in the field of somnology. Kyoto was selected as
the venue for Worldsleep2011 at Worldsleep07 in
Cairns, Australia. Ever since, we have devoted ourselvesto preparation for this meeting.
As you may know, an unimaginable disaster hit
eastern Japan on 11 March and Fukushima is still struggling with the accident response. We would like toexpress our deepest condolences to those who have losttheir lives and those who are still suffering from theGreat East Japan Earthquake.
While affected areas are recovering, we believe thatscience should continue to advance. The Local Organizing Committee, the Executive Council of the World Sleep
Federation (WSF) and the Japanese Society of Sleep
Research (JSSR) jointly decided that Worldsleep2011
should be held as planned in October of this year.
In response to the current situation in Japan, anumber of special programs focusing on “disaster andsleep” and “problems related to daylight savings/energy
consumption” have been added to the original program.
A wide variety of joint symposia are scheduled with therelevant societies. We also have opportunities to hearfrom senior researchers who have contributed to theadvancement of somnology in Japan and overseas. They
are expected to provide valuable developmental insights
to the young scientists attending.
Furthermore, we are pleased to offer an exciting
plenary symposium, entitled “The Future Direction of
Global Sleep Medicine,” in collaboration with WSF, JSSR
and the World Health Organization (WHO). The symposium will provide participants with up-to-date talks
on sleep and health, public health policy, and a global
picture of policy development and resources for mental
health. The impact of sleep health will be revisited fromthe viewpoint of WHO, which we expect will open up
new horizons for our sleep research.
Sleep researchers must keep moving forward andworking at any time and any place, even in the face ofdisaster. We look forward to welcoming our colleagues
from around the globe.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

193

Sleep and Biological Rhythms 2011; 9: 194–253

doi:10.1111/j.1479-8425.2011.00521.x

Plenary Sessions
Presidential lectures
Pr-1-1SLEEP, HEALTH AND SOCIETY

RR GRUNSTEIN1
Sleep, Sydney University/RPA Hospital, Missenden Road, Australia

1More than 20% of the population in developed nations suffer the consequences of inadequate sleep or a sleep disorder (sleep loss). These
sleep health problems are much more common in those at social andeconomic disadvantage. In Australia, over 30% of truck crashes involve
falling asleep often at night and we know that 45% of Australian truck
drivers have sleep apnea, one of the most common sleep disorders.
Although catastrophic events due to sleep loss such as marine oil spills
or nuclear meltdown have obvious public impact, it is the pervasiveloss of alertness and widespread occurrence of human error thatseverely compromises productivity and public safety. The effects of sleep
loss are compounded when there is disruption to our internal biologicalclock (circadian system), which regulates when we sleep and wake andis exquisitely sensitive to light. Biological clock disorders affect 16% ofAustralians who work shifts, 30% who travel (jet lag) and 10% of
patients with chronic insomnia. Sleep loss and biological clock disruption also have clear effects on general health – weight gain, diabetes,
hypertension, depression, accelerated dementia, resulting in major
health costs and reduced survival. Indeed the WHO has classified
shiftwork as a probable carcinogen. The effects of sleep loss vary widelyfrom individual to individual. Failure to recognise may limit efforts tominimise the consequences of sleep loss for our workers, our industries
and our community. As the global impact of chronic disease is being
increasingly recognised, there are challenges in emphasising the importance of sleep health. Firstly, there is a poor understanding of sleep
health issues amongst national and international policymakers. Secondly, there is little international co-ordination for the promotion ofhealthy sleep. Finally, we need better scientific evidence to support ourarguments. As a field we need to overcome “silos” in our thinking andapproach. There are opportunities for better international efforts toaddress challenges in evidence and translation to policy for healthier
sleep.

Pr-2-1NEW HORIZONS OF SLEEP RESEARCH FOR OUR
PLANET-SLEEP AND CHRONOBIOLOGYM OKAWA1
1
Sleep Medicine, Shiga University of Medical Science, Otsu, Shiga, JapanThe study of sleep and circadian rhythms in humans has provided us
with an extensive base of knowledge as to normal behaviour and pathophysiology. In particular, looking at biological rhythms in children withbrain damage has provided useful information on development of thecircadian system. These children manifest various types of circadiansleep-wake disorders, and blind children tend to show a higher rate of194

rhythm disorders than sighted children. On the other hand, sleep inold age can best be characterized by a reduced tendency to sleep atnight and difficulty in remaining awake during the daytime. Especiallyelderly patients with dementia are likely to show reversed or irregularday-night sleep-wake rhythms. Several factors have been implicated: 1)
sensory deprivation during the day (particularly low light levels); 2)
absence of social stimulation; 3) lack of daytime physical and mental
exercise; and 4) organic factors such as the degeneration of the suprachiasmatic nuclei (biological clock) in the brain of dementia.
The prevalence of circadian rhythm sleep disorders are increasing inour 24-hour-7 day society. Delayed sleep phase syndrome and evennon-24-h sleep-wake syndrome seem to be common and underrecognized in society, typically emerging during adolescence. Psychiatric problems are also common in both syndromes. DSPS and non-24-h
sleep-wake syndrome may share common circadian rhythm pathology
in terms of clinical progression and biological underpinnings (dysfunctions at the behavioral, physiological and genetic levels). Given theincreasing number of patients in modern society suffering from these
disorders, treatment and prevention procedures require further attention using behavioral, environmental, and psychiatric approaches.
In our society, where at least a third of the work force must be available
for shifts across the 24-h day and 7 days a week, maintaining healthand quality of life has become more difficult. Society’s sleep problems
need to be addressed from 3 perspectives of “somnology” – sleep
science, medicine and sleep sociology.

Opening lectureOL-1-1EVOLUTION OF LIFE HISTORY STRATEGY IN
HUMAN AND NON-HUMAN PRIMATESJ YAMAGIWA1,2
1
Dean, Graduate School and Faculty of Science, Kyoto University, Japan,
2
President, International Primatological Society
Primates show slow life history traits, such as small litter size, longgestation, long lactation, and long life span. The low growth rate ofprimates may be caused by a negative association between mortality
rates and growth rates, and the juveniles’ vulnerability to food shortage
and predation may shape their life history traits. Primates may be
adapted to the low mortality rates prevalent in their ancestral habitat(tropical forests), since other arboreal mammals such as bats also have
low mortality rates. Primates living in the more unpredictable habitats
have higher birth rates and earlier age at first reproduction. The great
apes (Hominidae: orangutans, gorillas and chimpanzees) that arestrictly distributed in and around the tropical forests have the slowest
life history traits among mammals. Modern humans also exhibit slow
life history traits, while having high birth rate and short inter-birthinterval. The presence of childhood, adolescent sterile, and menopause
are unique to human life history. High predation pressure, bipedal walk,and encephalization may have promoted such human specific traits
outside the tropical forests. Not hunting abilities, but hunted situations(increased mortality), increased human fecundity by reducing the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

period of lactation. Establishment of bipedalism prior to encephalization shaped the patterns of somatic and brain development. Brain uses
a lot of energy for maintenance and development. Human children
attain a large brain by decreasing body growth rate until puberty. High
expenditure of brain development may cause the adolescent spurt inbody growth. Such situations may have increased dependency ofhuman children on their parents and led the human ancestors to communal breeding. Social adaptations to open lands may have resulted in
the creation of human family and the unique patterns of human sleep.
From the common feature of sleeping in individual beds among thegreat apes, human ancestors established communal sleeping without
individual beds, which guarantees cooperation and security.

Plenary lectures
PL-1-1NEUROIMAGING STUDY ON BRAIN
PATHOPHYSIOLOGY OF SLEEP DISORDERSSB HONG1
Department of Neurology, Samsung Medical Center, Sungkyunkwan
University, Seoul, Republic of Korea
1

Sleep is not a simple rest. Active processes occur in brain during sleep.
Brain acts differently in different sleep stages. Normal physiologic brain
conditions are affected by many sleep disorders. There are many
imaging techniques for the evaluation of brain state. Brain MRI shows
anatomical structures whereas brain SPECT and FDG-PET reflect thepatterns of cerebral blood flow and cerebral glucose metabolism at thetime of radiotracer injection. Insomnia patients showed increased global
cerebral glucose metabolic rate during the transition from waking tosleep onset, suggesting that there is an overall hyperarousal in insomnia.
The CBF patterns were improved after cognitive behavioral therapy inother study. Brain MRI studies in narcolepsy did not show consistentfindings. But two studies similarly reported significant decrease of graymatter concentration in bilateral hypothalamus and nucleus accumbens
in narcolepsy patients. FDG-PET study showed reduced glucose metabolism in hypothalamus and thalamus in narcoleptics compared tonormal controls. A subsequent brain SPECT study revealed hypoperfusion in bilateral anterior hypothalami. These two studies indicate lower
waking baseline brain activity in narcolepsy. In a brain SPECT study,
cerebral perfusion increased in limbic areas and basal ganglia, thalami,
premotor cortex, sensorimotor cortex and brainstem during cataplectic
attacks. Obstructive sleep apnea syndrome (OSAS) are usually associated with a reduction in blood oxygen saturation, blood pressure/heart
rate changes, decreased of cerebral blood flow, increased intracranialpressure and increased sympathetic tone. We found significant graymatter reduction in bilateral temporal lobe and anterior cingulated gyri,caudate nuclei, thalamus and other brain structures which suggest brain
damage induced by chronic sleep apneas. Neuroimaging studies may
be useful to elucidate the etiology and consequences in brain of sleep
disorders and contribute to the better understanding of cerebral pathophysiology of sleep disorders.

PL-2-1SLEEP DISTURBANCES, OBESITY AND
DIABETES: INTERACTING EPIDEMICS

E VAN CAUTER1
1
Department of Medicine, University of Chicago, Chicago, Illinois, UnitedStates of America
During the past few decades, sleep curtailment and sleep disorders havebecome increasingly prevalent. The epidemic of obesity has been associated with an epidemic of obstructive sleep apnea (OSA). Insomnia isalso on the rise. These trends for shorter sleep duration and poorer
sleep quality have developed over the same time period as the epidemics of obesity and diabetes. There is good evidence that chronic partial
sleep loss and decreased sleep quality may increase the risk of obesityand diabetes. Laboratory studies in healthy volunteers have shown thatsleep restriction is associated with an adverse impact on glucose homeostasis. Insulin sensitivity decreases markedly without adequate compensation in beta cell function, resulting in an elevated risk of diabetes.
Reduced sleep quality, without change in sleep duration, is also associated with an increased risk of diabetes. Prospective epidemiologic
studies are consistent with a causative role of sleep disturbances in theincreased risk of insulin resistance and diabetes. Sleep curtailment isalso associated with a dysregulation of the neuroendocrine control ofappetite. Several studies have observed a decrease in leptin levels and/or an increase in ghrelin levels following sleep restriction. Thus, sleep
loss may alter the ability of leptin and ghrelin to accurately signal caloric
need. Consistent with the laboratory evidence, more than 60 epidemiologic studies in both children and adults have shown an association
between short sleep and higher BMI after controlling for a variety ofpossible confounders. Multiple studies have shown that OSA is a risk
factor for insulin resistance and diabetes, independently of BMI andother confounders. The prevalence of OSA in type 2 diabetes is exceptionally high, averaging 68% across five independent studies. The severity of OSA is an independent predictor of glycemic control. Taken
together, the current evidence suggest that chronic partial sleep curtailment and reduced sleep quality may be involved in the current epidemics of obesity, insulin resistance and type 2 diabetes.

PL-3-1PHENOTYPING IN THE PATHOGENESIS OF
OBSTRUCTIVE SLEEP APNEA: IMPLICATIONSFOR FUTURE THERAPIES

DP WHITE1
Sleep Medicine/Medicine, Harvard Medical School, Brigham and Women’s
Hospital, Boston, MA, United States of America
1

Obstructive sleep apnea is a common disorder with important adverse
consequences for afflicted individuals. A better understanding of apnea
pathophysiology could lead to improved therapies with the potential
to individualize treatment. Deficient pharyngeal anatomy is a common
characteristic in patients with obstructive sleep apnea. However, measures of anatomy, generally Pcrt, predict little of the variability in apnea
presence and severity. Thus other traits are important as well and likely
include: 1. Upper airway muscle responsiveness and effectivenessduring sleep: the upper airway response. 2. Arousal threshold to a
respiratory stimulus. 3. Loop Gain, a measure of ventilator control
stability or instability. We have developed a graphical, mathematicalmodel that incorporates these four traits which can predict who does
and does not have obstructive sleep apnea based on these physiologic
characteristics. Manipulation of individual traits can affect apnea severity© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

195

Sleep, Science and Researchbased on predictions from the model. Examples include decreasing
loop gain with oxygen or acetazolamide, increasing arousal thresholdwith a hypnotic or changes in upper airway anatomy i.e. surgery or
mandibular advancement. Although not fully tested, several otherobservations have resulted from the model: 1. REM predominant apnea
occurs in individuals with reasonably poor anatomy, but a substantial
upper airway response during NREM sleep. Loss or reduction in theupper airway response during REM sleep likely leads to airway collapse.
2. Some patients have a negative upper airway response i.e. increasing
respiratory drives leads to decreased airway patency. Unless this trait
can be altered, such patients will likely be difficult to treat withapproaches other than CPAP or major manipulation of anatomy. Bymeasuring these traits and utilizing the graphical model, apnea pathophysiology can be better understood and new therapeutic strategies
designed.

PL-4-1
THE ADAPTIVE FUNCTION OF SLEEPJ SIEGEL1
UCLA Brain Reserch Institute, United States of America

1Sleep is not a maladaptive state that needs to be explained by undiscovered functions (which nevertheless undoubtedly exist). Rather, themajor function of sleep is to increase behavioral efficiency. Greaterwaking activity does not necessarily lead to increased numbers of viable
offspring and, hence, genetic success. Rather, genetic success is closely
linked to the efficient use of resources and to the avoidance of risk.
Thus, inactivity can reduce predation and injury. It also reduces brain
and body energy consumption. Evidence bearing on this hypothesis will
be presented.

PL-5-1
UNANSWERED QUESTIONS ABOUTADOLESCENT SLEEPMA CARSKADON1
1
Department of Psychiatry & Human Behavior, Brown University,
Providence, RI, United States of America
Several decades of research with teenagers in the developed world show
a convergence of findings about trends in the developmental pattern ofadolescent sleep: the timing of sleep delays and becomes variable andthe duration of sleep declines. Several maturational features of the CNS
and sleep regulatory processes underlying these changes will be
described. In addition, the talk reviews studies indicating that certain
sleep teen patterns are associated with negative outcomes for academic
achievement, mood and behavior disorders, substance use and abuse,and health. Unanswered questions remain. Progress on these issues may
be enhanced if reframe our aproach in a way that better examines
individual differences, sleep over extended time frames, and variationin outcomes. Experimental studies are needed as well as studies that
may require global cooperation to examine these processes not only indeveloped countries, but also in developing, undeveloped, and deprived
regions. Examining sleep exposures in broader contexts can extend ourunderstanding of adolescent sleep and the roles it plays in brain development, behavior, and health.

196

PL-6-1
RBD RESEARCH IN JAPAN: PAST, PRESENTAND FUTURET SHIMIZU1
1
Department of Neuropsychiatry, Akita University Graduate School of
Medicine, Akita-City, Akita, JapanIn 1986, Schenck et al proposed a new category of parasomnia which
is now called as REM sleep behavior disorder (RBD). Since then, nearlya thousand papers have been published on RBD. However, its animalmodel, cats with bilateral lesions in their pontine tegmentum showing
oneiric behaviors during REM sleep, was reported in 1960th by Jouvet
et al. Also before 1986, Japanese researchers had reported similar phenomena in patients with diverse etiologies such as delirium tremens(DT) and other withdrawal delirium, experimental delirium by anticholinergic agents, nocturnal delirium in patients with chronic brain
damage, neurodegenerative diseases involving the brain stem, brain
tumor, and an elderly without obvious etiology which would be thefirst report of idiopathic RBD. Hishikawa et al (1975) coined the term
stage 1-REM without muscle atonia (1-REM) to describe polygraphic
pattern seen in patients with DT. The possible mechanism underlying
1-REM would be not only REM sleep without muscle atonia but also
stage 1 with REMs by intrusion of REMs and dream content to stage 1of NREM sleep or by disinhibition of REMs during NREM sleep. After
1986, Uchiyama (1995) reported an incidental Lewy body diseaseconfirmed by autopsy in a patient with idiopathic RBD. Miyamoto(2006) et al reported markedly reduced cardiac 123I-MBIG uptake,consistent with the loss of sympathetic terminals, in idiopathic RBD.
These reports indicate that idiopathic RBD would be the latent Lewy
body disease. Further study is needed to elucidate this possibility. Japanese researchers are willing to participate in the international study onthat topic.

PL-7-1SLEEP, FATIGUE AND CIRCADIAN RHYTHMS
IN CANCER

S ANCOLI-ISRAEL1
1
Department of Psychiatry, University of California San Diego, La Jolla,
Ca, United States of America
Women with breast cancer report poor sleep and fatigue, occasionally
before, and frequently during chemotherapy. These symptoms often lastfor months and even years after the end of primary cancer treatment,
significantly burdening quality of life, decreasing their overall functional
level, lowering adherence to adjuvant cancer treatment, and potentiallyaffecting survival. Sleep complaints in cancer patients consist of difficulty falling asleep, difficulty staying asleep and frequent and prolongednight time awakenings. Risk factors for insomnia in cancer patients
include the cancer itself, treatment, medications, environment, psychosocial disturbances and physical disorders. Women with breast cancer
with a symptom cluster of poor sleep, fatigue and depressive symptoms
before chemotherapy are more likely to manifest an increase in severityof these symptoms during chemotherapy. In addition, circadian activity
rhythms and cognitive function deteriorate during chemotherapy.
Objective measures of sleep in cancer confirm fragmented sleep andlow sleep efficiency, more restlessness at night during treatment, longer
sleep latency, increased wake time during the night, and more prevalent
sleep disorders such as sleep apnea and periodic limb movements.
Because insomnia in this patient population may be due to a variety of© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

causes and comorbidities, treatment must be multimodal and may
include both pharmacologic, such as hypnotics and behavioral
therapies.

PL-8-1
OBSTRUCTIVE SLEEP APNEA ANDATHEROSCLEROSIS – EXPLORING THE LINKSMSM IP1
1
Department of Medicine, University of Hong Kong, Hong Kong, China
Growing evidence support that obstructive sleep apnea (OSA) may exerta causal role in its strong association with cardiovascular disease (CVD).
OSA is postulated to initiate or promote atherosclerosis, the vascularpathology underlying majority of CVD. Atherosclerosis is a process ofchronic low grade vascular inflammation, involving interplay of endothelial cells and various circulating cells, and an array of vasoactive
mediators. Clinical studies have shown that OSA is independently
associated with endothelial dysfunction, arterial stiffness, and early
imaging features of carotid atherosclerosis. Mechanistically, neutrophils,
monocytes and lymphocytes from OSA subjects, compared to that from
non-OSA, were found to be more activated and produced more reactive
oxygen species, proinflammatory cytokines, leukotrienes, cell adhesion
molecules and other pro-atherogenic factors. Systemic increase in oxidative stress and inflammation have been reported in OSA, although
results were conflicting. The role of adipocytokines and biomolecules
which regulate vascular inflammation have been studied. There areconflicting results of enhanced or impaired repair capacity in OSA asreflected by circulating endothelial progenitor cells. Intermittent
hypoxia (IH) exposure is a commonly employed experimental modelof sleep apnea. In rodents exposed to IH, development of atherosclerotic
plagues appeared to be more definitive in the presence of concomitant
high-cholesterol diet or other predisposing factors. IH may exert proatherogenic effects via increasing blood pressure, insulin resistance ordyslipidemia. Many in-vitro or in-vivo studies have reported that IH
may produce pro-atherogenic effects at cellular level. A lot remains tobe learnt regarding end organ/tissue specificity and the change withduration or intensity of IH. Other biologic effects in sleep apnea,
notably sleep fragmentation and shear stress to vessel wall, are relatively
unexplored. Tissue vibrations from snoring is recently suggested tocontribute to carotid artery endothelial dysfunction.

PL-9-1CIRCADIAN CLOCK AND SLEEP-WAKE CYCLEK HONMA1
1Department of Physiology, Graduate School of Medicine, Hokkaido
University, Sapporo, JapanThe circadian system in mammals including humans is consisted of thecentral pacemaker located in the suprachiasmatic nucleus (SCN) andthe peripheral clocks in a variety of organs. The SCN circadian pacemaker entrains to the day-night alternation and conveys the informationof local time to the peripheral clocks which express overt circadianrhythms. A unique feature of the human circadian system is internal
desynchrony between the circadian rhythms and sleep-wake cycle. Theinternal desynchrony occurs spontaneously under temporal isolation oris induced by an abrupt shift of time cues. When the routine sleep
schedule was shifted by 8 hours, the sleep-wake cycle was entrained by
the shifted schedule in 4 days on average, whereas the circadian rhythmin plasma melatonin was not entrained but showed a free-run rhythm
under dim light conditions. The circadian system was internally desyn-

chronized. Under following free-run session where there was no timecue, the sleep-wake cycle either phase-advanced or delayed to reestablish
the normal phase-relation with the circadian melatonin rhythm inseveral days. The direction and the amount of phase-shift of the sleepwake cycle depended on the phase-relation with the circadian rhythm
immediately before the phase-shift. These findings strongly suggest that
two independent but mutually coupled pacemakers are involved in thehuman circadian system.The circadian melatonin rhythm in humans isprobably regulated by the SCN, but neither the site nor the nature of
the sleep-wake cycle is known. There are two animal models, where
the behavior rhythms are desynchronized from the SCN circadian pacemaker; one is food-entrainable oscillation (FEO) and the other methamphetamine-induced oscillation (MAO). Both oscillations are
independent of the SCN circadian pacemaker. Taking advantage ofinternal desynchrony, the site of SCN-independent oscillation was
explored in the mouse and rat brains. As a result, the dopaminergic
system in the brain stem was found to be the most likely site of oscillation, but other brain areas were not completely excluded.

PL-10-1
SLEEP AND STROKE

CF BASSETTI1
1
Neurology, Neurocentro della Svizzera Italiana, Ospedale Civico, Lugano,
Switzerland
A causal link between sleep and stroke has been postulated since the 19th
centuries. Despite the frequency of both, sleep disturbances and stroke,
this area of research was generally neglected until very recently. For different reasons this area is, however, of clinical and neurobiological interest.
First, sleep disordered breathing (SDB) has been shown to represent an
independent risk factor for stroke1. Recent data raise the possibility that
also other sleep disorders (such as restless legs syndrome, periodic limb
disorder in sleep, and insomnia) may increase the cardio- and cerebrovascular risk1–3. Second, sleep-wake disorders (SWD) such as hypersomnia, insomnia and parasomnias (e.g. restless legs syndrome, REM
sleep behavior disorder) can arise from focal brain damage (stroke)1.
The analysis of this secondary SWD offer unique insights into theneurobiology of sleep-wake mechanisms1,4. Third, clinical data support
the hypothesis that SDB, SWD and their treatment may affect the shortterm and long-term outcome after stroke1,2,4–6. Fourth, experimental
and clinical data suggest a fundamental role of sleep in neuroplasticity
and learning processes. As a consequence, sleep and its modulation(disturbance or enhancement) are expected to affect the recovery after
stroke. Also, recovery after stroke may be accompanied by specificchanges of sleep microstructure. Few clinical and experimental observation give support this hypothesis7–10.
References
1) Bassetti CL and Hermann D. Handbook of Neurology 2011; 99:1051–72.
2) Hermann D and Bassetti CL. Neurology 2009; 73: 1313–22.
3) Walter AS and Rye DB. Sleep 2009; 32: 589–97.
4) Hermann D et al. Stroke 2008; 39: 62–8.
5) Ryan CM et al. Stroke 2011; 42: 1062–7.
6) Martinez Garcia MA et al. Am J Respir Crit Care Med 2009; 180:
36–41.
7) Siengsukon CF and Boyd L. 2009; Neurosci Lett 451; 1–5.
8) van Meer MP et al. J Neurosci 2010; 30: 3964–72.
9) Gao B et al. Sleep 2010; 33: 879–87.
10) Zunzunegui C et al. Sleep 2011 (in press).

© 2011 The Authors
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Sleep, Science and Research

PL-11-1

PL-13-1

ALARM CLOCKS ARE MORE COSTLY THAN
WE THINK

BRAIN CIRCUITRY FOR CIRCADIANREGULATION OF SLEEPT ROENNEBERG1
1
Institute for Medical Psychology, Ludwig-Maximilians-University Munich,
Munich, Germany

CB SAPER1
1
Dept of Neurology, Beth Israel Deaconess Med Ctr/Harvard Med School,
Boston, MA, United States of America

Since the circadian clock controls sleep timing, sleeping at the ‘wrong’time has consequences. In a large-scale, on-going epidemiological study
on sleep behaviour, we find that the disparity between biological andsocial timing (social jet-lag) affects health. The higher an individual’ssocial jetlag, the more likely he/she is a smoker and the higher his/her
alcohol and caffeine consumption. But social jetlag also affects bodymass index (BMI), which has been shown to correlate with sleep duration. Although shift-work elicits the most extreme form of social jetlag,
the number of people whose body clocks are not aligned to the life they
have to lead for social reasons (e.g., work and school times) has
increased over the past years. 85% of the population uses alarm clocks
to wake up in time on workdays. To quantify social jetlag in real life
and to develop counter measures against social jetlag, we have developed algorithms that predict the progression of internal time based onlight exposure. These algorithms do not only promote an understandingof the daily relationship between internal and external time in everyday
life but also allows us to simulate the effects of alternative social schedules and life-styles based on daily light profiles. Modelling circadiantime in real life is of key importance in pending discussions on artificial
manipulations of clock time, such as Daylight Saving Time, over-proportioned time zones, or inappropriately early work and school times.
Improving the correspondence between biological and social clocks willlead to improved health on a population-wide level.

The basic outline of the circadian timing system in the mammalian brain
has been known for decades, but the specific circuitry, including cell
types and neurotransmitters involved in timing wake-sleep and activity
cycles, has only recently emerged. In this lecture, we will review recent
advances in understanding the pathways that link the external lightdark cycle, through the suprachiasmatic nucleus (SCN) to the circadian
control of wake-sleep, with particular emphasis on recent studies using
manipulation of gene expression to dissect this system. First, we will
examine the retinal input to the SCN from a specific class of melanopsin-containing retinal ganglion cells, and the neurotransmitters thosecells may use in resetting circadian phase. We will then review thepathways from the SCN, via a series of relays in the subparaventricularzone and the dorsomedial nucleus of the hypothalamus (DMH), thatallow it to influence the wake-sleep circuitry, and the neurotransmittersused in those pathways. Finally, we will discuss the ways in which suchsignals as food availability and drug delivery can converge on the DMH,
and how the DMH can override the SCN, and reshape circadianrhythms. These studies not only help us to understand the circadianbasis of normal wake-sleep states, but give us insight into possible
approaches to therapies for sleep and circadian disorders.

Plenary symposia

PL-12-1
FROM THE CLINIC TO THE LABORATORY ANDBACK AGAIN: NEW INSIGHTS ON INSOMNIA1DJ BUYSSE
1
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, UnitedStates of America
Chronic insomnia is the most prevalent sleep disorder, and accumulating evidence demonstrates the morbidity and functional impairment
associated with this condition. Insomnia research has made rapid progress in some areas, such as epidemiology and behavioral treatment, but
slower progress in other areas, such as genetics and pathophysiology. A
translational approach to insomnia research–moving from the clinic to
the laboratory and back again–may help to accelerate progress. This
talk with provide examples of how listening to insomnia patients’ symptoms can lead to improved assessment methods, and how basic andclinical neuroscience findings can be understood in the context ofpatient symptoms. The talk will also illustrate how the effects of insomnia treatments can be understood from the perspective of patient symptoms and sleep regulatory mechanisms. Specific data will be presented
from studies at the University of Pittsburgh that deal with qualitative
research in insomnia, epidemiological and clinical studies, the development of sleep-focused patient-related outcomes (PROs), treatment
studies, and functional imaging studies.

198

PS-1-1SLEEP, HEALTH, AND SOCIETY: AN OVERVIEW

RR GRUNSTEIN1,2
CIRUS, NHMRC Centre for Sleep Health, University of Sydney,
Australia,2President, World Sleep Federation
1

More than 20% of the population in developed nations suffer theconsequences of inadequate sleep or a sleep disorder (sleep loss).
These sleep health problems are much more common in those at socialand economic disadvantage. In Australia, over 30% of truck crashes
involve falling asleep often at night and we know that 45% of Australian truck drivers have sleep apnea, one of the most common sleep
disorders. Although catastrophic events due to sleep loss such as
marine oil spills or nuclear meltdown have obvious public impact, itis the pervasive loss of alertness and widespread occurrence of humanerror that severely compromises productivity and public safety. The
effects of sleep loss are compounded when there is disruption to ourinternal biological clock (circadian system), which regulates when we
sleep and wake and is exquisitely sensitive to light. Biological clock
disorders affect 16% of Australians who work shifts, 30% of Australians who travel internationally each year (jet lag) and 10% of patientswith chronic insomnia.
Sleep loss and biological clock disruption also have clear effects on
general health – weight gain, diabetes, hypertension, depression, accelerated dementia, resulting in major health costs and reduced survival.
Indeed the World Health Organisation has classified shiftwork as aprobable carcinogen. The effects of sleep loss vary widely from individual to individual. Failure to recognise may limit efforts to minimise© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

the consequences of sleep loss for our workers, our industries and ourcommunity.
As the global impact of chronic disease is being increasingly recognised,
there are challenges in emphasising the importance of sleep health.
Firstly, there is a poor understanding of sleep health issues amongst
national and international policymakers. Secondly, there is little international co-ordination for the promotion of healthy sleep. Finally, weneed better scientific evidence to support our arguments.
As a field we need to overcome “silos” in our thinking and approach.
There are opportunities for better international efforts to address challenges in evidence and translation to policy for healthier sleep in society.

PS-1-2SLEEP AND MENTAL HEALTH: WHAT WE KNOWAND STILL NEED TO KNOWDJ BUYSSE1
1
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, UnitedStates of America
Sleep problems share complex bidirectional relationships with mental
health disorders. These relationships have been most carefully exploredfor insomnia and depression. Cross-sectionally, depression is the strongest risk factor for insomnia, and insomnia is a nearly universal
symptom in patients with depression. Increasing evidence has also
demonstrated that insomnia is a risk factor for incident depression, forpoor treatment outcome in comorbid depression, and for recurrence ofdepression following treatment. More recent studies have shown thatpharmacologic or behavioral treatment of comorbid insomnia improves
outcomes in depressed patients. However, a number of important questions remain. Most important is the mechanism by which insomnia
increases depression risk. Future studies should examine the neuralcircuitry of affect regulation in patients with chronic insomnia to determine similarities and differences compared to patients with depression.
Treatment of insomnia could potentially reduce the risk of subsequent
depression. However, before widely advocating such treatment, it isimportant to determine whether insomnia treatment significantly alters
affective neural circuits. The relationship between bipolar disorder andsleep also warrants further investigation. Patients with bipolar disorder
have significantly disturbed sleep, even between episodes. Developing
sleep and circadian interventions to address these sleep disturbances
could potentially improve outcomes. Finally, patients with mental
health disorders have increased risk for cardiovascular and metabolic
disorders. It is important to examine whether sleep disturbances andsleep disorders (such as obstructive sleep apnea) contribute to this risk,
and whether appropriate treatment can mitigate the risk.

PS-1-3
PUBLIC HEALTH POLICY AND SERVICES FORSLEEP AND HEALTHH SHINOZAKI1
1
National Institute of Public Health, Japan, Wako, Saitama, Japan

In the past half-century, the Ministry of Health, Labour and Welfare,Japan, has focused on improving the health of our citizens. Over thelast three decades, the ministry has taken specific actions aimed at
reducing premature deaths and enhancing quality of life by implementing a series of measures termed the Nation’s Health Promotions: the first
period was 1978–1987, the second period 1988–1999 and the third
period 2000–2012. Life expectancy and healthy life expectancy at birth

for Japan in 2001 were estimated to be 77.9 years and 71.4 years formen and 84.7 years and 75.8 years for women, respectively. With thegoal of helping people to live longer lives in better health, the third
Nation’s Health Promotion, referred to as Healthy Japan 21, is being
carried out to achieve 70 goals in the nine fields of non-communicablediseases (e.g., cardiovascular disease, cancer, diabetes mellitus, mental
health and oral health), lifestyles (e.g., diet, physical activity and sleep)and behaviors (e.g. tobacco and alcohol use). The accumulated knowledge of sleep in biology, medicine and sociology shows that sleep
deprivation or disorders increase the risks for hypertension, diabetes
mellitus and depression. It is noteworthy that sleep is included in
Healthy Japan 21 as one of the important factors contributing to noncommunicable diseases. Good sleep ensured by appropriate interventions might contribute to reducing national afflictions and prolonging
healthy life expectancy in the future. My presentation will focus on thefollowing topics: 1) the history of the nation’s health promotion in
Japan, 2) Healthy Japan 21, and 3) the coming 10 years for our nation’s
health.

PS-2-1SLEEP IN YOUNG CHILDREN IN OCEANIAAND ASIADYT GOH1
1
Department of Paediatrics, National University of Singapore, Singapore
Sleep is a vital part of every growing child and significantly impacts thehealth of the child and the family. Variability in sleep practices occur
around the world. Understanding the sleep patterns and problems in
different populations would aid in appreciating the impact of thesedifferences. This paper describes the first large scale study on sleep in
Asian and Oceania infants less than 36 months old.
Methods: Parents of 23,479 infants and toddlers in Australia, New
Zealand, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia,
Philippines, Singapore, Taiwan, Thailand and Vietnam completed an
expanded version of the Brief Infant Sleep Questionnaire. Sleep inChinese infants (n = 10,856, from countries with substantial ethnic
Chinese – China, Hong Kong, Indonesia, Malaysia, Singapore andTaiwan) in the region was also compared.
Results: Significant variability in bedtime was seen across the region,
ranging from 19:27 (New Zealand) to 22:17 (Hong Kong), p < .0001.
Total sleep time ranged from 11.6 (Japan) to 13.3 hrs (New Zealand),p < .0001. Daytime sleep was less variable. Co-sleeping, room-sharing
and bed-sharing varied from 5.8% in New Zealand to 83.2% in Vietnam.
Sleep was perceived to be a problem in wide ranging levels across theregion (11% in Thailand to 76% in China). Australia and New Zealandinfants generally slept earlier, had longer night time sleep, was less likely
to co-sleep, more likely to have bedtime routines and had less bedtime
difficulties compared to Asian infants. Ethnic Chinese infants from different countries in the region also show variability in sleep. North Asia
compared to South-east Asia had little difference in infant sleep but
reported more sleep problems.
Conclusions: This study describes the substantial differences in sleep
practices and problems across the Oceania and Asian region and also
amongst chinese infants across the region. This information will
enhance our understanding of sleep practices and problems as well asserve as a baseline for future comparative studies over time, across age
groups and between different regions.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

199

Sleep, Science and ResearchPS-2-2SLEEP IN YOUNG CHILDREN IN THE USA AND
AROUND THE WORLDJA MINDELL1
1
Sleep Center, Children’s Hospital of Philadelphia/Saint Joseph’s University,
Philadelphia, PA, United States of America
Few broad scale studies have been conducted on sleep in young children. Results will be presented from two large scale global studies,
which focused on sleep patterns and sleep problems in children ages 0
to 3 years from the United States, as well as from predominantly Caucasian and predominantly Asian countries. Results from the UnitedStates reflected clear sleep related developmental changes, including adecrease in daytime sleep and total sleep time, as well as consolidationof sleep during the night, which was manifested in a decrease in frequency and duration of night wakings. Sleep ecology and parental
behaviors significantly explained a portion of the variance in the sleep
patterns of young children. Parental interventions that encourage independence and self soothing were associated with extended and more
consolidated sleep, especially in comparison to more active interactions
that were associated with shorter and more fragmented sleep. Furthermore, findings indicated that children from predominantly Asian countries have significantly later bedtimes, shorter total sleep times, increased
parental perception of sleep problems, and are more likely to room
share than children from predominantly Caucasian countries. These
results indicate substantial differences in sleep patterns in young children across culturally diverse countries. In addition, across all countries, three primary factors, that is an early bedtime, a consistentbedtime routine, and falling asleep without parental presence, weremost predictive of sleep consolidation and sleep problems. Implicationsof these results will be discussed.

PS-2-3
CROSS-CULTURAL DIFFERENCES IN SLEEP ANDSLEEP DISTURBANCES IN YOUNG CHILDREN.
SLEEP IN YOUNG CHILDREN IN SOUTH
AMERICARS ALVES1
Neurology, University of Sao Paulo, Sao Paulo, Brazil

1

Sleep in Young Children in South America.The way children sleep critically affects their ability to think and behave during daytime hours.
Most of important studies concerning prevalence of sleep disturbances
are based on self-administered sleep habit questionnaires which parents
take home or answer by internet. Unfortunately there are few comprehensive studies of sleep patterns and sleep problems among children in
South America. There are few studies about the prevalence of bed
sharing and factors associated with this sleeping environment. One
study from Brazil showed that at 3 and 6 months about 30% of infants
slept with their mothers at night. Prevalence of bed-sharing at 3 months
was high and associated with single mothers and sharing the home with
the infant’s maternal grandmother. Another study from Brazil showeda prevalence of co-sleeping at 12 months of 45% and co-sleeping wasmore common among mothers with low socioeconomic status, lesseducation, younger mothers, mothers with previous births and amongchildren who used to wake at night. In another study the prevalence ofbreastfeeding at age 12 months was about 60% in the children who bed
shared at 3 months and 44% in those who did not; bed sharing at
3 months protected against weaning up to age 12 months. Sleep disorders were highly prevailing in some studies, similar to other studies:200

bruxism: 12 to 35%, sleep enuresis: 5%, habitual snoring: 15 to 27%
and arousal disorders: 10%. A recent study shows that both short sleep
duration and increased television viewing were associated with greater
body fatness, obesity and higher blood pressure, independently ofphysical activity level.

PS-2-4SLEEP IN YOUNG CHILDREN IN EUROPEP FRANCO1, S FLORI2, E MONTEMITRO1, H PATURAL2
1
Pediatric Sleep Unit, Hpital Femme Mre Enfant & INSERM U1068,
University of Lyon 1, Lyon, France, 2Department of Pediatrics, Physiology
and Exercise, University Hospital of Saint-Etienne France
Infant sleep problems are among the most prevalent problems presented
to pediatricians and other child-care professionals. The consolidationof sleep during the night, which is referred to as sleeping through thenight, is a rapid maturational process during the first year of life.
However, surveys show that as many as 20% to 30% of all infants andtoddlers do not succeed in achieving this goal and their sleep continues
to be fragmented, as manifested by multiple and/or prolonged night
wakings, which are considered to be the most prevalent sleep problems
during early childhood. If not treated, these night-waking problems are
persistent and can last well into adulthood. Other studies indicate thatchildhood sleep disturbance may have effects that linger into adulthood,such as increased risk for depression. This last decade, numerous
studies have been done in Europe to gather normative data on parentreported child sleep and investigate what factors could influences it,
such as, foreign origin, family situation, parents age and education,
prenatal and perinatal factors, night feedings, child temperament andpsychological trauma. These studies have been done with structured
interviews, questionnaires, sleep diary logs, internet surveys but alsowith objective actigraphy sleep measures. Longitudinal studies havegiven normative data for sleep characteristics in children in Western
societies. Cross-sectional survey have pointed the disparities between
the different countries in Europe due to sociocultural and climate differences. The sleep disturbances induce repercussions on children
behavioral symptoms but also on physical growth already in infants lessthan 6 months. Maternal sleep-related cognitions during pregnancy
have also a great influence on the infant sleep. During this presentation,
we will also report our experience on 500 newborns followed from birth
to 2 years of life with questionnaires and polysomnographic recordings
every 6 months. Their sleep was evaluated according to the infants
characteristics but also to maternal sleep during pregnancy.

PS-3-1MECHANISMS UNDERLYING OVARIAN
HORMONE MODULATION OF SLEEP: WHATRODENT STUDIES TELL US ABOUT THE
IMPLICATIONS ON WOMEN’S HEALTH

JA MONG1, S VIECHWEG1, M SCHWARTZ1, D CUSMANO1,2
Department of Pharmacology, University of Maryland, School of Medicine,
Baltimore, United States of America, 2Program in Neuroscience, Universityof Maryland, United States of America
1Sleep complaints like insufficient sleep and insomnia are twice as prevalent in women. As quality sleep is imperative for the maintenance ofgood health, women suffering from sleep disturbances are at risk for
affective mood disorders, impaired cognitive function, and increased
stress and anxiety. Data from a number of different species, including© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

humans, strongly implicate a role for gonadal hormones (estrogens,progestins and androgens) in the modulation of sleep. Symptoms of
sleep disruption are often coincident with marked changes in the
gonadal hormone profile across the female lifespan. What is less clear
are the mechanisms underlying such effects. Using the laboratory rat,
our group has made inroads into where and how gonadal hormones
influence sleep. We have found that (1) estradiol (E2; endogenous orexogenous) attenuates rapid eye movement (REM) sleep with no significant effect on non-REM sleep in the quiescent phase, (2) theE2-induced suppression of REM sleep is NOT followed by a homeostatic rebound and under conditions of induced sleep loss (i.e., sleep
deprivation) E2 significantly attenuates the REM sleep rebound, and (3)the suppression of REM sleep correlates with attenuation of neuronal
activity (measured via fos expression) in the ventrolateral preoptic area
(VLPO) and median preoptic nucleus (MnPN). More recent results
demonstrate that both estrogen receptor alpha and beta isoforms arenecessary for the attenuation of REM sleep by E2. However, an estrogen
receptor antagonist infused directly into the VLPO does not return REM
sleep to the non-hormonal baseline suggesting that E2 is not acting
directly in the VLPO to suppress REM sleep. Currently, we are investigating E2 actions in other brain regions involved in the modulation
REM sleep. The significance of advancing our understanding of themechanisms underlying ovarian hormone modulation of sleep is thepotential to uncover new perspectives on the origins of sleep disturbance in the female brain, which may uncover novel drug targets forthe treatment of sleep disorders in women.

PS-3-2
MODULATION OF SLEEP AND RESPONSE TOSLEEP LOSS BY OVARIAN HORMONES IN RATS

K SEMBA1
Department of Anatomy & Neurobiology, Dalhousie University, Halifax,
NS, Canada
1

Hormonal changes that occur naturally in women or as a result of
medical treatments are associated with changes in sleep patterns. To
understand these phenomena and their underlying mechanisms, weused ovariectomized rats with subcutaneous steroid implants. We foundthat physiological levels of ovarian hormones modulate sleep architecture differently at baseline (24 h) and during recovery (18 or 24 h) after
sleep loss. Specifically, estradiol (E), either alone or combined withprogesterone (P), promoted arousal in the animal’s active (dark) phaseby consolidating wake and fragmenting sleep, resulting in an increased
light : dark ratio of NREM and REM sleep. A different picture emerged
after acute sleep deprivation by gentle handing for 6 h during thesecond half of the light phase. As expected, all animals showed reboundsleep. However, hormonally treated rats showed greater consolidationof sleep; nevertheless, the total time spent in rebound NREM sleep did
not change and sleep intensity, as assessed by NREM EEG delta power,
increased for a shorter period of time than in vehicle-treated rats. Possibly as a result of NREM sleep consolidation, individual REM sleep
episodes lasted longer in hormonally treated rats, leading to greater
REM sleep rebound.
We repeated the same experiments using middle-aged (10–12 months)
female rats, and found that sleep-modulatory effects of E and P in theserats are largely similar to those observed in young females, although
there are several minor differences that may be attributable to age differences. We also asked whether the modulation of sleep regulation by
E is dependent on the female sex of the animal. The results with young
castrated male rats indicated that E’s effects on baseline and recovery

sleep are similar between males and females, but that E’s effects on EEG
measures associated with sleep and wake states are sex-dependent.
In conclusion, ovarian hormones modulate baseline sleep and recovery
sleep differently in both young and middle-aged female rats as well as
in male rats.

PS-3-3
SEX DIFFERENCES AND MENSTRUAL-RELATEDEFFECTS ON SLEEPFC BAKER1,2Center for Health Sciences, SRI International, Menlo Park, California,
United States of America, 2Brain Function Research Group, University of
the Witwatersrand, South Africa
1

There are sex differences in sleep behavior with women reporting more
sleep problems and a poorer sleep quality than men across a wide age
range. Women are at 40% greater risk than men for developing insomnia. The poorer self-reported sleep quality in women appears to relate
in part to psychosocial factors, such as depression and anxiety, which
are more common in women. In contrast to subjective reports, polysomnographic recordings show that women have better sleep efficiency,with less Stage 1 sleep and fewer awakenings than men across a wide
age range, suggesting that objective and subjective assessments aretapping into different constructs of sleep. Women also have more slow
wave sleep (SWS) and slow wave activity (SWA, delta, 0.5-4Hz) within
the sleep electroencephalograph (EEG) as well as larger amplitude
evoked K-complexes than men. This sex difference in slow waves seems
to be driven by more than just anatomical differences affecting signal
conduction, since women have thicker skulls, smaller intracranial
volumes, and smaller absolute volume of cortical gray matter than men.
Within women, fluctuating sex steroids during the menstrual cycle,
pregnancy, and menopause transition, impact sleep architecture. The
most dramatic change in sleep across the menstrual cycle is increased
spindle frequency EEG activity in the luteal phase, when progesterone
is high, compared with the follicular phase. SWS and SWA, however,
do not change across the menstrual cycle. The menstrual cycle influences REM sleep, which is marginally reduced in the luteal phase.
Higher progesterone and estrogen levels correlate with a longer latency
to REM sleep and less REM sleep, implying a role of these hormonesin the REM sleep changes. Women with premenstrual syndrome reporta poorer subjective sleep quality in the symptomatic luteal phase yetshow similar menstrual-related changes in sleep architecture as controls
suggesting that sleep-independent factors such as mood impact theirperception of sleep quality. Sleep in women, therefore, is impacted byboth biological and psychosocial factors.

PS-3-4
AGE- AND SEX-RELATED DIFFERENCES IN
SLOW-WAVE ACTIVITY IN HEALTHY AND
DEPRESSED CHILDREN AND ADOLESCENTS

R ARMITAGE1
Department of Psychiatry, Sleep & Chronophysiology Laboratory,
University of Michigan, Ann Arbor, MI, United States of America
1Major depressive disorders (MDD) are associated with a number ofsubjective and objective sleep disturbances both in adults and in childhood and adolescence. Prolonged latency to sleep onset and alterationsin the timing of the REM and NREM sleep cycles are among the mostrobust findings. Few studies focus on the sleep regulatory differences© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

201

Sleep, Science and Research

between depressed patients and healthy controls and the moderating
influence of age and sex are rarely explored. This presentation will focus
on sleep homeostasis and slow-wave EEG activity (SWA) regulation in
MDD and discuss how age and sex moderate response to a sleep regulatory challenge, including several large scale studies from the UM sleep
research group. The clinical significance and treatment relevance of
these findings will also be addressed. Finally, we will also discuss therole of homeostatic impairment as a risk factor for onset of the first
episode of depression, presenting recent data on SWA regulation andresponse to homeostatic challenge in adolescents who are at high-risk
for MDD, based on parental history, but who are not yet depressed.

PS-3-5GENDER DIFFERENCES IN HUMANPEPTIDERGIC SLEEP REGULATIONA STEIGER1, I ANTONIJEVIC1, M KLUGE1, S MATHIAS1,P SCHUESSLER1, J WEIKEL1
1
Department of Psychiatry, Max Planck Institute of Psychiatry, Munich,Germany
It is well established that certain peptides play a key role in sleep regulation. This knowledge derived from studies which were performed inmale animals and humans only. We performed a series of studies toclarify whether gender differences exist peptidergic effects on sleep EEG
and nocturnal hormone secretion.
Sleep EEG (23:00 to 07:00) and the nocturnal secretion of growth
hormone (GH), cortisol and in some studies of ACTH (22:00 to 07:00)
were investigated simultaneously after one night of adaptation after
pulstile intravenous injections of peptides or placebo. In detail we
examined vs placebo the effects of four bolus injections of 50 ug GHreleasing hormone in 7 young healthy men, and in healthy volunteers(20 m, 20 f) and in drug-free patients with depression (18 m, 16 f, age
range 19–76 years), of 25 ug and 50 ug GHRH in 11 young male
female volunteers, of 50 ug corticotropin-releasing hormone (CRH) in
7 young male and in 10 young female volunteers, and of 50 ug ghrelinin 10 young and 10 elder healthy male and 10 young and 10 elder
healthy female volunteers and in drug-free patients with depression(7 m, 7 f, mean age 41 ± 7 and 37 ± 5 respectively.
Major findings were opposite effects of GHRH between gender as
NonREM sleep was promoted and ACTH and cortisol were blunted inmale patients and healthy subjects, whereas NonREM sleep was
impaired and ACTH and cortisol increased in women regardlesswhether they were healthy or depressed. Also in the young women sleep
was impaired after GHRH, but cortisol remained unchanged. After CRH
slow-wave sleep and GH decreased in men. In women the sleep-EEGchanges ware more distinct as the time spent in REM sleep increased
during the first third of the night, wakefulness increased and stage 3
sleep decreased. Ghrelin promoted NonREM sleep in young and elder
healthy men, but not in women. In both sexes GH and cortisol increased
after ghrelin. In female, but not in male depressed patients REM sleep
was suppressed after this peptide.
Our data show distinct differences in the effects of GHRH, CRH andghrelin on human sleep and sleep related hormone secretion.

202

PS-4-1
THE SLEEP HEART HEALTH STUDY: A LOOKBACK AT LESSONS LEARNEDNM PUNJABI1
Division of Pulmonary and Critical Care Medicine, Johns Hopkins
University, Columbia, Maryland, United States of America
1Sleep-disordered breathing (SDB) or obstructive sleep apnea is a chronic
condition that is characterized by partial or complete collapse of theupper airway during sleep. The resulting apneas and hypopneas often
lead to reduction in oxyhemoglobin saturation and recurrent arousals
from sleep. Although the clinical syndrome of SDB has been known for
decades, it was not until 1988 that the National Commission of Sleep
Disorders Research (NCSDR) was established by Congress to address
the public health importance of SDB and other sleep-related disorders.
In 1993, the NCSDR issued a comprehensive report which set forth key
research priorities for the field of sleep medicine with the specificacknowledgment that coordinated efforts were needed to define thehealth-related effects of SDB. At about the same time, the potential
morbidity and mortality associated with even moderate degrees of SDB
was being increasingly recognized, and the means to efficiently diagnose
the condition were becoming readily available. Shortly thereafter, newly
available data on the population prevalence of SDB revealed that millions of Americans were affected with this condition with a majority ofthem being undiagnosed. Given the rising epidemic of obesity and its
strong association with SDB, a major initiative was set forth by the
National Institutes of Health to define the public health impact of SDB.
The Sleep Heart Health Study (SHHS), a product of that initiative, wasestablished to answer many of the pressing questions regarding theclinical consequences of SDB, particularly its effects on hypertension
and cardiovascular disease. The primary objective of this presentation
is to review the scientific progress made by the SHHS over the last
20 years. Within the context of this presentation, some of the mostpivotal findings available to date will be highlighted including theassociations between SDB and incident hypertension, cardiovasculardisease, stroke, and all-cause mortality.

PS-4-2
PUBLIC HEALTH IMPLICATIONS OF THE
BUSSELTON HEALTH STUDYNS MARSHALL1
1
Sleep Research Group, Woolcock Institute, University of Sydney,
Camperdown, Sydney, Australia
There are very few community-based cohorts anywhere in the world
with objective quantification of sleep apnea and snoring and sufficient
follow-up time to determine whether sleep disordered breathing is arisk factor for cardiovascular disease and premature mortality. Four
hundred residents (n = 102 women) of the Western Australian town ofBusselton underwent investigation with a home sleep apnea monitoring
device in 1990 (MESAM IV). Sleep apnea and snoring were quantified
via the respiratory disturbance index (RDI) and percentage of the night
spent snoring quantified via a microphone and spectral analyses. Allcause mortality and cardiovascular and stroke hospitalisation status wasdetermined in 397/400 participants (99.3%) after up to 17 years (meanfollow-up 16.2 years) by data matching. Diabetic status was also ascertained at baseline and 4 years follow-up. People with a respiratory
disturbance index >15/hr in 1990 (n = 18) had a marked independent
increased risk of all-cause mortality after 17 years after control for all
leading risk factors and snoring (Hazard Ratio 6.0; 2.0–17.6) and may© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

in time prove to be at increased risk for cardiovascular events (univariate p = 0.055) and stroke events (univariate p < 0.01) compared topeople without sleep apnea (RDI < 5/hr). People with moderate-severe
OSA at baseline were also at increased risk for developing diabetes
inside 4 years after controlling for both BMI and waist circumference(Multivariate Odds Ratio 13.5; 1.6–114.1). In no analyses was any
definition of snoring in either univariate or multivariate models associated with mortality, cardiovascular events or stroke events after 17 years.
Snoring may however act as an amplifier of for the effect of sleep apnea
on mortality as there was a significant effect modification. We are awaiting ethical approval to match and analyse 20 year outcome data. The
Busselton Health Study is one of the small number of community-based
cohorts in the world helping to define the public health implicationsof sleep apnea, who it affects and at what severity should we be worried
about it.

PS-4-3
HYPERTENSION AND ATHEROSCLEROSIS INSLEEP APNEAG LORENZI-FILHO1
1
Pulmonary Division, University of São Paulo, São Paulo, SP, Brazil

obtained from the company’s periodical inspection data. Average sleep
duration was 6.0 h/day. Severe OSA was 7.8 times as likely to be present
in subjects with Mets (16.2% of all 68 Mets subjects) as those without(2.4% of 207 non-Mets) (p < 0.001). Subject with severe OSA had
significantly short sleep duration (p < 0.05). Sleep duration in Mets
subjects was also significantly shorter than in those without (p < 0.05).
Respiratory disturbance index (RDI) was related negatively significantly
to sleep duration in hypertensive subjects. Multiple regression analyses
showed that only in the diabetic subjects, the RDI was independently
related to fasting plasma glucose even after adjustment for the confounders. The total cholesterol level was correlated negatively with sleep
duration and positively with age and the waist/hip ratio, and that thetriglyceride level correlated positively with the RDI, body mass index
and alcohol consumption. Sleep duration should be taken into consideration as an important factor in studies investigating the prevalence of
OSA and several risk factors for cardiovascular diseases including Mets.

PS-5-1CORTICAL ACTIVATION CHANGES DURINGSLEEP FOR VISUAL PERCEPTUAL LEARNINGY SASAKI1,2
Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts
General Hospital, Arlington, United States of America, 2Radiology, Harvard
Medical School, United States of America
1

Obstructive sleep apnea (OSA) is independently associated with deathfrom cardiovascular diseases, including myocardial infarction andstroke. Myocardial infarction and stroke are complications of atherosclerosis; therefore, over the last decade investigators have tried tounravel relationships between OSA and atherosclerosis. OSA may accelerate atherosclerosis by exacerbating key atherogenic risk factors. For
instance, OSA is a recognized secondary cause of hypertension and may
contribute to insulin resistance, diabetes, and dyslipidemia. In addition,clinical data and experimental evidence in animal models suggest that
OSA can have direct proatherogenic effects inducing systemic inflammation, oxidative stress, vascular smooth cell activation, increased
adhesion molecule expression, monocyte/lymphocyte activation,
increased lipid loading in macrophages, lipid peroxidation, and endothelial dysfunction. Several cross-sectional studies have shown consistently that OSA is independently associated with surrogate markers ofpremature atherosclerosis, most of them in the carotid bed. Moreover,
OSA treatment with continuous positive airway pressure (CPAP) may
attenuate carotid atherosclerosis, as has been shown in a randomized
clinical trial.

PS-4-4METABOLIC SYNDROME, HYPERTENSION,DIABETES MELLITUS AND SLEEP APNEAIN JAPAN

K CHIN1
Department of Respiratory Care and Sleep Control Medicine, Graduate
School of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
1

Obstructive sleep apnea (OSA), metabolic syndrome (Mets) and shortsleep duration are all risk factors for cardiovascular events. There has
been no report which has investigated this relationship in an age- andBMI-matched population-based study. An individual who has 3 of 5
risk factors for cardiovascular disease is diagnosed as Mets. Five risk
factors usually contain increased waist circumference, high blood pressure, increased fasting glucose, increased triglycerides, and decreased
HDL cholesterol. This home cardiorespiratory (type 3) sleep study,
using an actigraph, was conducted in 275 males working for an urban
company. Retrospective measurements of fasting blood parameters were

While a growing body of evidence suggests that sleep is beneficial for
visual learning, the underlying neural mechanisms are not clear. Here,
we investigated consolidation-related brain activation during sleep subsequent to training of a visual task using fMRI concurrently with measurements of EEG, EOG and EMG to obtain polysomnogram.
We employed a texture discrimination task (Karni & Sagi, 1992,
Nature). Perceptual learning of this task activates only the region in the
primary cortex (V1) corresponding to the trained location (Yotsumoto,
Watanabe & Sasaki, 2008, Neuron). The experiment consisted of 2
sleep adaptation sessions, the pre-training sleep session for 90 min on
the 3rd night, intensive training of the texture discrimination task
6 hours prior to the post-training sleep session for 90 min, followed by
the re-test session of the task. To estimate brain activation in the preand post-training sleep, we contrasted BOLD signals during NREM
sleep before and after training to during wakefulness before each sleep.
NREM sleep periods were identified by the standard sleep scoring criteria on the obtained polysomnogram.
The results indicate that brain activation in the trained region of V1 wassignificantly higher than in the untrained region of V1 in the posttraining sleep, but not in the pre-training sleep. Significant performance
improvement was obtained in the re-test session after the post-training
sleep and was highly correlated with the brain activation in the trained
region of V1 in the post-training sleep. Furthermore, the left dorsolateral prefrontal cortex (DLPFC) was significantly more highly activatedthan the right DLPFC in the post-training sleep and was correlated withactivation of the trained region in V1.
These results suggest that during early NREM sleep after training, consolidation of learning occurs in the trained region of V1 under a control
by the prefrontal cortex.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research203

Sleep, Science and ResearchPS-5-2MEMORY PROCESSING DURING SLEEP:IMPLICATIONS FOR HEALTHY AND
DYSFUNCTIONAL MEMORY

KA PALLER1, CE WESTERBERG1, JD CREERY1, JW ANTONY1
1
Department of Psychology, Northwestern University, Evanston, IL, UnitedStates of America
Two approaches will be used to show that sleep is important for
memory. First, sleep can enhance memory accuracy, and second,
memory difficulties can be exacerbated by poor sleep. In keeping withcorrelative evidence linking sleep and memory, we used novel auditory
stimulation methods to demonstrate selective memory reactivation
during slow-wave sleep. Sounds were uniquely associated with specificinformation learned prior to sleep. Presenting these sounds at a low
intensity during sleep led to selective memory improvement for thecorresponding information. By extension, memory fidelity in generalmay depend on the same sorts of memory processing during sleep,
particularly during slow-wave sleep. In other experiments, we explored
deficits in declarative memory (recall and recognition of facts andevents); memory abilities commonly decline in older adults and canbe especially problematic in patients with amnestic mild cognitive
impairment (aMCI) or Alzheimer’s disease. These difficulties areusually ascribed to deficient memory acquisition, but they may also
reflect memory stability. That is, if memory processing during sleep isnormally operative in the service of stabilizing memory storage andcreating new connections among memories (i.e., memory consolidation), then deficient memory access during sleep may contribute topoor memory function during the day. Polysomnographic findings inpatients diagnosed with aMCI were consistent with this suggestion.
Patients spent less time in slow-wave sleep and showed lower delta
and theta power compared to age-matched healthy adults. These sleep
disruptions were also implicated in memory consolidation, as eveningto-morning change in memory correlated with delta and theta power
during intervening sleep in both groups. In a subsequent study, electrical stimulation delivered during sleep at a frequency in the delta range
resulted in larger pre- to post-sleep memory improvements compared
to sham stimulation. These results suggest that deficiencies in sleepdependent memory consolidation can contribute to memory
impairment.

PS-5-3
SHIFT IN THE NEURAL NETWORK ASSOCIATED
WITH DECLARATIVE MEMORY CONSOLIDATION

A TAKASHIMA1,2
Donders Institute for Brain, Cognition and Behaviour, Radboud University
Nijmegen, Nijmegen, Netherlands, 2Behavioural Science Institute, Radboud
University, Nijmegen, Netherlands
1

We learn through experiences that we encounter during the wakeful
period. Not all information, however, is successfully stored for later
retrieval. Memory consolidation pertains to stabilization of the memory
trace such that it becomes resistant to forgetting. One theory of memory
consolidation posits that initial episodic memory trace is captured in
the medial temporal lobe structures including the hippocampus. Overtime, the memory trace transforms itself to a more neocortical network
based trace. The hippocampus is an ideal brain structure that can
encode ongoing episodes very rapidly, but at the same time, is vulnerable to interference and erasure. On the other hand, neocortical memory
network is slow in binding distributed elements that comprise a204

memory, but is more resistant from decay. How this transformation
occurs over time is yet unclear, however, evidence for the role of sleepin the consolidation of memories is steadily increasing. If sleep isdeprived, we tend to remember less, or the performance improvement
is not observed. With sleep, there is a better chance that memory is
stabilized and even more, if the brain is stimulated during sleep,
memory retention seems to be enhanced. In this talk, I would like topresent some data showing the changes in the retrieval network before
and after sleep and how functional connectivity during sleep might havean influence on the consolidation process. Furthermore, I would liketo show brain responses to the stimulation during sleep which could
result in strengthening of the memory.

PS-6-1SLEEP IN CHILDREN WITH AUTISM SPECTRUM
DISORDERSJ OWENS1
Division of Pulmonology and Sleep Medicine, Children’s National Medical
Center, Washington DC, United States of America
1Sleep disturbances in children with autism spectrum disorders such aspervasive developmental disorder and Asperger syndrome are extremelycommon. The etiology of sleep problems in these children is varied andmay be linked to homeostatic and circadian dysregulation as well as tofeatures associated with the underlying neurodevelopmental disorder(ie, anxiety, self-injurious behavior, sensory integration deficits). This
presentation will focus on the etiology, clinical presentation, differential
diagnosis and intervention strategies for children with ASD and sleep
problems, using a case-based approach.

PS-6-2SLEEP IN CHILDREN WITH ATTENTION
DEFICIT HYPERACTIVITY DISORDERJ OWENS1
Division of Pulmonology and Sleep Medicine, Children’s National Medical
Center, Washington DC, United States of America
1Sleep disturbances are a significant clinical problem in children withattention deficit hyperactivity disorder (ADHD) and may impact on
daytime functioning. There are many potential causes of sleep problems
in these children and these range from psychostimulant-related sleep
onset delay to bedtime resistance related to comorbid oppositionality
to circadian-mediated sleep phase delays. This presentation will outline
a comprehensive clinical approach to the diagnosis and management of
sleep problems in children with ADHD.

PS-6-3
BEHAVIORAL INTERVENTIONS IN CHILDRENWITH NEURODEVELOPMENTAL DISABILITIESJA MINDELL1
1
Sleep Center, Children’s Hospital of Philadelphia/Saint Joseph’s University,
Philadelphia, PA, United States of America
Sleep disturbances are highly prevalent in children with neurodevelopmental disabilities. For example, studies have indicated that between
50 to 80% of parents of children with ADHD report sleep problems,with similar percentages reported by parents of children with Autism
Spectrum Disorders. The most common sleep disturbance reported is© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

pediatric insomnia, including bedtime problems and night wakings.
Studies have found that behavioral interventions can be highly effectivein treating behaviorally based sleep disturbances in these populations.
Interventions include implementing positive sleep hygiene practices,developing consistent bedtime routines and reward systems for appropriate sleep related behaviors, and encouraging the ability to fall asleep
independently. Behavioral interventions are found to not only improve
sleep in children and their parents, but can also reduce parental stressand improve a sense of control and ability to cope in parents. Behavioral
interventions are also preferred by parents to pharmacological management, however these interventions can be more difficult to implement
than in typically developing children.

(Montplaisir J, et al. Mov Disord 2010;25:2044–51). Automated scoringof the submental EMG in REM sleep is being investigated (Ferri R, etal.), with the development of a REM-atonia-index that can be usedclinically & for research. RBD screening and severity questionnaires
have been developed. New brain imaging techniques are being used in
RBD studies. Research into the strong link between RBD-parkinsonism,
RBD-narcolepsy, RBD-PLMs continues on multiple fronts. RBD linked
with NREM parasomnias (Parasomnia Overlap Disorder) now also
includes sexsomnia and sleep related eating disorder. The brain mechanisms subserving REM atonia, and its loss in RBD, and phasic motor
overactivity in RBD are being further elucidated.

PS-7-2PS-6-4
POLYSOMNOGRAPHY IN CHILDREN WITH
NEURODEVELOPMENTAL DISORDERS

M WITMANS1
Pediatric Respiratory, University of Alberta Stollery Childrens Hospital,
Canada1Children with neurodevelopmental disabilities have significant sleep
disturbances. The use of polysomnography in these children can bechallenging given the complexity of their disorders, the medication,
regimen, and their ability to tolerate the sleep laboratory. This symposium will summarize the findings on polysomnography that are associated with various disorders such as autism spectrum disorders, Tourette’s
syndrome and Attention deficit hyperactivity disorders. The challenges
and methodological issues related to these disorders will be discussed.
Future directions with respect to clinical and research involving thesechildren with neurodevelopmental disabilities will also be discussed.

PS-7-1
RBD: UPDATE ON RECENT STUDIES AND NEW
DEVELOPMENTSCH SCHENCK1
1
Minnesota Regional Sleep Disorders Center, University of Minnesota
Medical School, Dept. of Psychiatry, Minneapolis, MN, United States ofAmerica

Recent studies and the cumulative clinical & basic science literature on
RBD indicate that RBD is situated at a strategic crossroads of the neurosciences and sleep medicine. The formation of the International RBD
Study Group in 2009 in Marburg, Germany underscores this assertion.
The IRBDSG has sponsored 4 RBD symposia, with the 5th symposium
to be held in Japan after the Worldsleep2011 congress. Topics being
addressed at these RBD symposia consist of devising research protocolsi) for studying primary & secondary endpoints in double-blind, placebo-controlled prospective therapeutic trials utilizing clonazepam andmelatonin; ii) for studying the efficacy of putative neuroprotective
agents in prolonging the latency period (or preventing the progression)from idiopathic RBD to the emergence of parkinsonism (PD, MSA,
DLB). Of relevance to the latter study design are 2 studies that identified
risk factors for predicting imminent parkinsonism in iRBD: decreased
striatal dopamine transporters uptake together with substantia nigra
hyperechogenicity (Iranzo A, et al. Lancet Neurol 2010;11:1070–7);
olfaction/color vision abnormalities (Postuma RB, et al. Ann Neurol
2011;69:811–8). The PSG diagnosis of RBD has been clarified, with
cut-off scores for tonic & phasic EMG activity identified with highspecificity & sensitivity that can be used clinically and for research.

COMBINATION NEUROIMAGING MARKERSPROVIDE CLUES TO THE UNDERLYINGNEURODEGENERATIVE DISORDER IN
IDIOPATHIC REM SLEEP BEHAVIOR DISORDERT MIYAMOTO1, M MIYAMOTO2
Department of Neurology, Dokkyo Medicial University, Koshigaya-city,
Saitama, Japan, 2Department of Neurology, Dokkyo Medical University,Japan
1

Idiopathic REM sleep behavior disorder (iRBD) is a parasomnia related
to REM sleep that is characterized by nocturnal behaviors in which
patients appear to act out their dreams. RBD in PD occurs in 46–50%
of PD patients. In about 20% of cases it occurs before the onset of classic
walking motor symptoms. Several longitudinal studies have reported
the natural course of iRBD. Several procedures such as positron emission tomography (PET), SPECT studies, transcranial ultrasound imagingof the substantia nigra, and cardiac MIBG scintigraphy have been proposed to identify subjects in early stage of Parkinson disease (PD) or
dementia with Lewy bodies (DLB). In our study, 6-[18F]-fluorometa-tyrosine PET (FMT/PET) template superimposed onto the eachindividual brain MRI in PD, iRBD, and controls. Regions of interests(ROIs) for striatum and cerebellum were placed over each individual
brain template. ROIs were manually drawn on the FMT/PET after
overlapping with each individual brain MRI, and striatal ROI was
divided into the putamen and caudate. We performed FMT-PET
imaging can assess the level of presynaptic dopaminergic nerve for
iRBD, PD, and controls. IRBD patients have no signs of parkinsonism
and have neuroimaging evidence of almost intact striatal dopaminergic
innervations such as controls. Whereas PD patients have parkinsonism
by definition and have loss of striatal dopaminergic innervation, as
evidenced by decreased striatal uptake. Reduced 123I-MIBG uptake bypostganglionic cardiac sympathetic neurons in patients with early stage
PD has made this technique a useful early marker of this disease. We
determined that these same 123I-MIBG findings were present inpatients with iRBD. H/M ratio was significantly lower in RBD, PD and
DLB subjects compared to essential tremor and multiple system atrophy(MSA) and PSP. It has been speculated that iRBD might represent a
prodromal form of neurodegenerative diseases referred to as synucleinopathies such as PD, MSA, and DLB.

© 2011 The Authors
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205

Sleep, Science and ResearchPS-7-3SIGNIFICANCE OF REM SLEEP BEHAVIORDISORDERS IN SYNUCLEINOPATHIES SUCH
AS PARKINSON DISEASET NOMURA1, Y INOUE2
1
Department of Neurology, Tottori University, Yonago, Japan, 2Department
of Somnology, Tokyo Medical University, JapanREM sleep behavior disorder (RBD) has been reported to occur insynucleinopathies, such as Parkinson disease (PD) and multiple system
atrophy (MSA). We conducted clinical interviews examining RBD
symptoms in 49 patients with PD and 16 patients with MSA, and performed polysomnography (PSG) on all the subject patients. Twentyseven patients with PD (55.1%) and 11 patients with MSA (68.8%) had
REM sleep without atonia (RWA) on PSG, a essential physiologicalmarker for RBD. The life time prevalence of RBD symptoms in PD was
38.8% (19/49) and that in MSA was 50.0% (8/16). These findings supported that RBD is frequently co-morbid with synucleinopathies.
Uptake of 123I-labeled meta-iodobenzylguanidine (MIBG) in myocardial scintigrams has been shown to be as low in patients with idiopathic
RBD as in PD patients. We performed MIBG scintigrams on the above
indicated 49 PD patients. The patients were divided into three groups(PD with clinical RBD, PD with subclinical RBD, and PD with normal
REM sleep). PD patients with clinical RBD had reduced MIBG uptake
compared to those with subclinical RBD and those with normal REM
sleep. Multiple linear regression analysis revealed that only the existenceof RBD symptoms was significantly associated with reduced MIBG
uptake among PD patients. This result suggests that PD patients withclinical RBD have a wider synuclein pathology. Convenient screening
tool for RBD in PD patients has been desirable. We evaluated the usefulness of the RBD screening questionnaire (RBDSQ) among 45 patientswith PD. We compared RBDSQ scores among the following groups: PD
with RBD, PD without RBD, and idiopathic RBD, and estimated thecut-off score for an RBD diagnosis. RBDSQ scores in PD with RBD and
idiopathic RBD groups were similar, and the scores were higher thanthose in the PD without RBD group. A receiver-operator characteristics
curve revealed that a total score of 6 points (1 point higher than idiopathic RBD) on the RBDSQ represented the best cut-off value for detecting RBD. RBDSQ could be a useful tool for the screening of RBD in PD
patients.

PS-7-4
RBD – PRECLINICAL PD, LBD, OR BOTH?

RB POSTUMA1
1
Department of Neurology, McGill University, Montreal, Quebec, Canada
Idiopathic RBD is an important risk factor for neurodegenerative
disease, in particular, those diseases characterized by deposition ofalpha synuclein; Parkinson disease (PD), Lewy body dementia (LBD),
and multiple system atrophy. Prospective cohort studies have estimatedthat between 40 to 65 percent of patients with idiopathic RBD willdevelop a defined synucleinopathy over 10 years. Systematic follow-up
of patients with idiopathic RBD provides an unprecedented opportunity
to directly observe the development of a neurodegenerative disease.
With observation of early disease, it has become increasingly clear thatthese conditions overlap. Patients with PD who also have RBD are athigher risk of mild cognitive impairment, develop dementia faster, andhave more autonomic dysfunction than those without. Patients with
idiopathic RBD who go on to develop Lewy body dementia usually haveprominent parkinsonism at onset, and are equivalent to PD patients on

206

quantitative motor testing, autonomic dysfunction, and olfactory dysfunction (hallucinations and cognitive fluctuations appear to develop
later). Although there are exceptions (in particular patients with tremorpredominant PD) for most patients with idiopathic RBD and newly
defined neurodegenerative disease there is considerable difficulty indeciding which is the appropriate diagnosis. The clinical impression isthat of a generally advancing global synucleinopathy, the diagnosis ofwhich depends on whether it is first parkinsonism or cognitive impairment that crosses diagnostic threshold. The implications of these findings for understanding development of neurodegenerative disease inprediagnostic stages and classification of synucleinopathies will be
discussed.

PS-8-1CIRCADIAN RHYTHM DISRUPTION IN
PATIENTS WITH SCHIZOPHRENIA AND SNAP-25
MUTANT MICERG FOSTER1, K WULFF1, PL OLIVER2, MV SOBCZYK1, D-J DIJK3,
ES MAYWOOD4, MH HASTINGS4, E JOYCE5, KE DAVIES2
1
Nuffield Laboratory of Ophthalmology, University of Oxford, John
Radcliffe Hosp, Oxford, United Kingdom of Great Britain and Northern
Ireland, 2MRC Functional Genomics Unit, Department of Physiology,
Anatomy and Genetics, University of Oxford, United Kingdom, 3Surrey
Sleep Research Centre, University of Surrey, United Kingdom, 4MRC
Laboratory of Molecular Biology/Division of Neurobiology, University ofCambridge, United Kingdom, 5Institute of Neurology, University College
London, United Kingdom

Sleep disturbances comparable to insomnia occur in up to 80% ofschizophrenia patients, but very little is known about the contributionof the circadian system to these prevalent disruptions. We have undertaken a systematic exploration of circadian time patterns in 20 schizophrenia patients and 21 healthy control individuals matched for age,sex and being unemployed. Significant sleep/circadian disruption
occurred in all patients. Half the patients showed severe circadianmisalignment ranging from phase-advance/delay to non-24-hour
periods in sleep-wake and melatonin cycles, and the other half showedpatterns from excessive sleep to highly irregular and fragmented sleep
epochs but normally timed melatonin production. We show that severe
circadian sleep/wake disruptions exist irrespective of mood, mental
state and antipsychotic treatment regimes. In parallel with our work on
human subjects, we have examined both rest/activity behaviour and theexpression of molecular elements of the circadian system in Snap-25
mutant mice, blind-drunk (Bdr). Bdr mice are known to display endophenotypes associated with schizophrenia. Our studies show that thesemice also show abnormal sleep/wake behaviours that mirror thosefound in patients with schizophrenia. Further, critical outputs of themolecular clock shows disrupted expression in the suprachiasmatic
nuclei (SCN) of mutant mice. These data suggest that the Bdr sleep/
wake phenotype arises from a disruption of synaptic connectivity within
the SCN that alters the neuropeptide output of the master circadianpacemaker. Collectively these data provide the first direct evidence foroverlapping mechanistic pathways between circadian timing andschizophrenia.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

PS-8-2
LIGHT-INDUCED IMPAIRMENT OF MOOD
AND LEARNING REQUIRES MELANOPSINEXPRESSING GANGLION CELLSS HATTAR1
Biology, Johns Hopkins University, Baltimore/MD, United States ofAmerica1

Aberrant light conditions experienced in shift-work and transmeridian
travel, as well asseasonal changes in day length, cause mood and cognitive deficits. These are thought toarise from disruptions in sleep andcircadian rhythms. However, using an aberrant lightcycle that neither
changes the amount of sleep nor abolishes circadian rhythmicity,
weshow that light directly regulates mood-related behaviors and cognitive functions in mice.In these animals, depression-like behavior andserum corticosterone levels are increased,while hippocampal long-term
potentiation and learning are impaired. Administration oftwo differentially acting antidepressant drugs, fluoxetine and desipramine, restoreslearning in mice exposed to the aberrant light cycle. Furthermore,melanopsin-expressingintrinsically photosensitive retinal ganglion cells
are necessary for this disruptive lightenvironment to directly influencemood and learning.

term, inescapable stress of being suspended by their tail or being forced
to swim in a water-filled cylinder. In such situations, the animals rapidly
adopt a characteristic immobile posture that has been named “behavioral despair” on the assumption that the animals have given up hopeof escaping. These tests have been widely used for assessing antidepressant activity and depression-like behavior. Quantitative trait locus(QTL) mapping using CS and C57BL/6J mice revealed significant QTLs
on chromosomes (Chrs) 4 (FST) and 5 (TST and FST). To identify thequantitative trait gene on Chr 5, we narrowed the QTL interval to
0.5 Mb using several congenic and subcongenic strains. Ubiquitinspecific peptidase 46 (Usp46) with a lysine codon deletion was locatedin this region. This deletion affected nest-building, nursing behavior,alcohol preference, muscimol-induced righting reflex etc. The muscimol-induced current in the hippocampal CA1 pyramidal neurons andhippocampal expression of the 67-kDa isoform of glutamic acid decarboxylase significantly decreased in the Usp46 mutant mice compared
to control mice. All these phenotypes were rescued in transgenic micewith bacterial artificial chromosomes containing wild-type Usp46. In
addition, Usp46 KO mice exhibited low immobility time in TST. Thus,
Usp46 affects “behavioral despair” and it is implicated in the regulationof GABA action.

PS-9-1
MORPHOLOGICAL AND FUNCTIONALNEUROIMAGING OF HUMAN NARCOLEPSY

PS-8-3
RHYTHM AND THE BLUES
1

T TAKUMI
Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima,Japan
1

Our biological clock counts daily rhythms with approximately 24 hours
called circadian rhythm in our body. The mammalian circadian system
consists of three components: input, pacemaker, and output. Almost allphysiological phenomena including mental states, in addition to sleepwake cycles, can be considered as circadian outputs. The recent molecular advances revealed that molecular clocks were located not only inthe central oscillator, suprachiasmatic nuclei (SCN), but also in peripheral tissues, even in cultured cells. We established both in vivo and invitro rhythm monitoring system. To understand molecular interaction
between circadian rhythm and depression or mood disorders, we investigated circadian rhythm of the learned helplessness (LH) rat, an animalmodel of depression, at the behavioral and cellular level. The locomotor
activity rhythm in vivo and circadian transcriptional rhythm in vitro
seemed to be correlated with each other. The phosphorylated glycogensynthase kinase 3beta (pGSK3beta) was likely to be the key moleculethat connects behavioral rhythm with cellular ones. Clock genes were
included in the downstream targets of GSK3beta. The phenotypes
including circadian rhythm in fibroblasts correlate to those in vivo,
suggesting that the fibroblasts from the patients can be used as a diagnostic material and a therapeutic tool.

PS-8-4
DEUBIQUITINATION AND BEHAVIORS EBIHARA1
School of Bioagricultural Sciences, Nagoya University, Nagoya, Japan1

We found that CS mice exhibit an extremely low immobility time
(almost no immobility) in both the tail suspension test (TST) and forced
swimming test (FST). In these tests, animals are subjected to the short-

CF BASSETTI1
1
Neurology, Neurocentro della Svizzera Italiana, Ospedale Civico, Lugano,
Switzerland
Human narcolepsy is due to a deficiency of the hypothalamic hypocretin system and presents with a pleomorphic clinical phenotype including sleep-wake, motor, vegetative, psychiatric and cognitive disturbances.
Neuroimaging studies have expanded our knowledge of narcolepsy as
a complex brain disorder arising from the dysfunction of multiple brain
areas in addition to the hypothalamus.
1) Conventional brain MR studies have shown that the brain is grossly
intact in primary (idiopathic) narcolepsy1, whereas in secondary narcolepsy, hypothalamic and brainstem lesions were mostly found2.
2) Voxel-based brain MR studies provided inconsistent results3.
3) Proton brain MR spectroscopic studies have also been contradictory.
Some authors reported alterations in hypothalamus and brainstem4–5.
4) Functional brain MR studies documented abnormalities in hypothalamo-amygdala-brainstem-limbic interactions in both aversive andappetitive (reward) experiments, suggesting a dysfunction of the emotional processing in narcolepsy6–9. 5) Brain PET studies found both ahypo- and hyper-metametabolism of cortico-subcortical areas during
the awake state, and an hypothalamic hypometabolism during cataplexy10–11. 6) Brain SPECT studies have shown the activation of anamygdalo-cortico-basal ganglia-brainstem circuit during cataplexy12.
7) Brain neurotransmission (ligand) studies suggested changes in serotoninergic and dopaminergic transmission, the nature of which remains
unclear3.
References
1) Bassetti CL et al. Sleep 1997; 20: 630–1.
2) Nishino S and Kanbayashi. Sleep Med Rev 2005.
3) Desseilles et al. Sleep 2008; 31: 777–94.
4) Tonon C et al. Brain Res Bull 2009; 80: 147–50.
5) Poryazova R et al. Sleep 2009; 10: 812–3.
6) Schwartz S et al. Brain 2008; 131: 514–22.
7) Ponz A et al. Ann Neurol 2010; 67: 190–200.
8) Ponz A et al. Ann Neurol 2010; 67: 394–8.

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Sleep, Science and Research9) Delazer M et al. Neuropsychology 2011; 25: 477–87.
10) Joo EY et al. Neuroimage 2005; 28: 410–6.
11) Dauvilliers Y et al. J Neurol Neurosurg Psychiatry 2010; 81: 344–8.
12) Hong SB et al. Neurology 2006; 66: 1747–9.

PS-9-2
DECIPHERING THE GENETIC PREDISPOSITIONTO HUMAN NARCOLEPSYK TOKUNAGA1
Department of Human Genetics, University of Tokyo, Graduate School of
Medicine, Tokyo, Japan1

Human narcolepsy is affected by multiple genetic and environmental
factors. In 1984, two independent groups reported the very strong
association of HLA-DR2 with narcolepsy (Juji, Honda et al. Tissue
Antigens; Langdon et al. Lancet), and the high-risk type is now defined
to be HLA DRB1*1501-DQB1*0602 haplotype. Since then, a numberof candidate genes have been studied for possible associations, but few
common susceptibility polymorphisms have been confirmed. Recent
technological development in large-scale SNP (single nucleotide polymorphism) typing has enabled genome-wide association studies(GWAS), and provided opportunities to identify novel susceptibility lociwithout any prior knowledge of position or function. Our first SNPbased GWAS confirmed the strong association with HLA-DQ region andidentified a new susceptibility locus, CPT1B/CHKB (Miyagawa et al. Nat
Genet 2008). GWAS by Mignot and international collaborators haveidentified new susceptibility genes, T cell receptor alpha (TCRA) (Hallmayer et al. Nat Genet 2009) and P2RY11 (Kornum et al. Nat Genet2011). Another GWAS by Tafti and collaborators reported a new protective HLA haplotypes (Hor et al. Nat Genet 2010). Associations with
HLA, TCRA, and P2RY11, as well as elevated autoantibodies against
TRIB2 in narcoleptic patients (Cvetkovic-Lopes et al. J Clin Invest 2010)strongly suggest the involvement of autoimmunity in the disease pathogenesis. In addition, association with CPT1B/CHKB and some othergenes as well as abnormal serum acylcarnitine levels (Miyagawa et al.
Sleep 2011) suggest alteration of fatty acid beta-oxidation in the disease.
New technological developments including massive parallel sequencing
will contribute to our understanding of the genetic basis of humannarcolepsy.

PS-9-3
MOVEMENT DISORDERS IN NARCOLEPSYYA DAUVILLIERS1
1
Department of Neurology, Gui de Chauliac Hospital, Montpellier
University, Montpellier, France
Narcolepsy with cataplexy (NC) is a chronic disease characterized byexcessive daytime sleepiness, striking transitions from wakefulness into
rapid eye movement (REM) sleep, typically associated with cataplexy
and other phenomena due to the abnormal occurrence of REM sleep
elements during wakefulness (sleep paralysis and hallucinations) andfrequent sleep/wake transitions. Nocturnal sleep in NC is usually disturbed by a large cohort of phenomena: vivid frightening dreams,
several nocturnal awakenings, REM sleep behavior disorder (RBD),
periodic leg movement (PLM), obstructive sleep apnea (OSA), sleeprelated eating disorders and other parasomnias. Frequent abnormalities
in both NREM and REM sleep motor regulation result in dissociatedsleep/wake states. Higher abnormalities in REM sleep motor regulation
were reported with an increased frequency of REM sleep without atonia,
phasic EMG events and PLMS in narcoleptic patients when compared208

to controls. A higher prevalence of RLS was found in NC but with amoderate severity, together with a higher frequency of PLMS and PLMW
with an association between the presence of PLMS and measures of
REM sleep and daytime functioning disruption. PLMS displayed specific features in idiopathic restless legs syndrome and narcolepsy-cataplexy respectively, with narcolepsy-cataplexy with restless legs showing
an intermediate pattern. Motor dyscontrol in narcolepsy is not restricted
to sleep, involving also wakefulness with the presence of cataplexy andthe increase in periodic leg movements index. Moreover, recently pediatric cases of NC have been reported with a co-occurence with acomplex movement disorder at disease onset, a phenomenon that may
vanish later in the course of the disease. The coexistence of NC andseveral motor dysfunctions suggest a common neurobiological defect ofmotor inhibition. Further studies are warranted to assess clinical course
and whether the associated movement disorder is also caused by hypocretin deficiency or by additional neurochemical abnormalities.

PS-9-4SPECTRUM CONCEPT OF NARCOLEPSY AND ITS
CLINICAL SIGNIFICANCEY INOUE1,2
Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo,
Japan, 2Department of Somnology, Tokyo Medical University, Japan1

In the 2nd edition of International Classification of Sleep Disorders(ICSD 2nd), narcolepsy was separated into the cases with and without
cataplexy, and idiopathic hypersomnia into the cases with and without
long sleep time. Among these, idiopathic hypersomnia with long sleep
time is clearly different in symptomatology with more than 10 h ofnocturnal sleep time and a major difficulty to wake up in the morning.
However, the other three categories are common in that they havefrequent short naps in daytime and show almost normal length of
nocturnal sleep time. Based on this, narcolepsy spectrum encompasses
idiopathic hypersomnia without long sleep time. Although all the disorders in this spectrum show marked daytime sleepiness, score of
Epworth sleepiness scale (ESS) is highest and sleep latency on multiple
sleep latency test (MSLT) is lowest in narcolepsy with cataplexy among
the disorders. Of note, when dividing the cases with narcolepsy without
cataplexy into the group with HLA-DRB1*1501/DQB1*0602 positivity
and that without, the latter group shows a lower frequency of sleep
onset REM period and longer sleep latency on MSLT compared withthe former group, and the sleep latency in this group is quite similar
with that in idiopathic hypersomnia without long sleep time. The fragmentation of nocturnal sleep is observed in narcolepsy with cataplexy,but this phenomenon is not observed in HLA negative narcolepsy
without cataplexy as well as in idiopathic hypersomnia without long
sleep time. In addition, the deficiency of orexin secretion does not exist
in HLA negative narcolepsy without cataplexy. These findings suggestthat HLA negative narcolepsy without cataplexy is a milder variant of
narcolepsy and symptomatic characteristics is not so different from
idiopathic hypersomnia except for the increased REM propensity.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

PS-9-5
WORK OF DR. YUTAKA HONDA ONNARCOLEPSY AND ITS SUBSEQUENTDEVELOPMENTM HONDA1
Psychiatry and Behavioral Sciences, Sleep Research Project, Tokyo
Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
1

Dr. Yutaka Honda started his passionate interest in narcolepsy while heengaged in the study of his doctoral thesis entitled Clinical studies on
the Diencephalon-related Psychic Symptoms published in 1959. He
reported 24 patients with psychiatric symptoms associated with vegetative dysfunction and found that somatic/autonomic symptoms andpsychic symptoms progress simultaneously and closely connected.
Among 24 patients, 16 were narcolepsy and he evaluated their psychic
symptoms such as changes in activity, mood and character as well as
autonomic functions.
He extended his interests in narcolepsy to various directions, including
neuroendocrinological abnormality (disappearance of GH surge), tendency towards obesity and diabetes mellitus, and the HLA associationin narcolepsy. The discovery of genetic contribution to narcolepsy triggered subsequent studies, resulting in the identification of novel narcolepsy-related genes. IGFBP3 and CPT1B are among those, identified byexpressional gene profiling and genome wide association study, which
could be associated with endocrine and metabolic abnormalities foundin narcolepsy patients.
He noticed the serious QOL impairment of narcolepsy patients andfounded the Japan Narcolepsy Association (JNA) in order to cultivate
mutual friendship and facilitate self-help activities among the members.
Now JNA developed into an authorized NPO with more than 200
members, fulfilling his one more aim to enhance a better public understanding of narcolepsy. JNA activity was also effective to form a goodtherapeutic relationship and provided the opportunity for long-term
prognosis study of narcolepsy, elucidating the existence of spontaneous
remission in narcolepsy.
We are still on the way to understand narcolepsy as a whole from theviewpoint of current knowledge about hypothalamic sleep wake regulation. His observations remain to be addressed how psychic and somatic
symptoms are interacted and what neural system contribute psychic toform narcoleptoid personality and occasional psychotic symptoms
observed in narcolepsy patients.

PS-10-1
COMBINED CHRONOTHERAPY IN DRUGRESISTANT DEPRESSIONM ECHIZENYA1
1
Department of Neuropsychiatry, Bioregulatory Medicine, Akita University
Graduate School of Medicine, Akita-City, Japan
There are several advantages to using sleep deprivation for treatment
of depression, including early response, a high efficacy rate (approximately 60%), few side effects, and efficacy for drug-resistant depression. On the other hand, its clinical efficacy seems to be hampered byhigh relapse rates after recovery sleep. Therefore, it has not been
widely used to date in many countries. However, methods for increasing and sustaining the efficacy of sleep deprivation have beenreported. It is possible to increase and sustain the efficacy of sleep
deprivation in combination with medication (antidepressant drug,
lithium, etc.), repeated sleep deprivation, bright light therapy, and/or
sleep phase advance. In Akita University Hospital, we tried combined

chronotherapy, which is total sleep deprivation followed by sleep
phase advance (3 days) and bright light therapy (5 days), in drugresistant depression patients (N = 13, male/female = 8/5, unipolar/
bipolar = 10/3). They took ongoing medication without change before
and after the chronotherapy. Changes in the depressive state over time
were rated using the Hamilton Rating Scale for Depression (HAM-D),
the Visual Analogue Scale (VAS), and the Zung Self-Rating Depression
Scale (SDS) for 3 weeks. Significant improvements were observedwith the chronotherapy in HAM-D, VAS, and SDS. Finally, 8 patientsof 13 kept treatment response (50% or more changes in HAM-D).
Because we sometimes encounter patients who are resistant to generaldrug treatment, adding sleep deprivation to the treatment choices may
overcome drug-resistant depression and shorten treatment duration.

PS-10-2
RAPID AND SUSTAINED ANTIDEPRESSANTRESPONSE WITH SLEEP DEPRIVATION AND
CHRONOTHERAPY IN BIPOLAR DISORDERJC WU1, JR KELSOE2, CS SCHACHAT1, BG BUNNEY1,
A DEMODENA2, S GOLSHAN2, JC GILLIN2, SG POTKIN1,WE BUNNEY1
1
Psychiatry, University of California Irvine College of Medicine, Irvine,
California, United States of America, 2Psychiatry Department, Universityof California, San Diego, United States of America
Objectives: The development of a rapid-acting and sustainable treatment for bipolar disorder (BPD) has been a goal for decades. The mostwidely-documented rapid-onset antidepressant therapy is sleep deprivation (SD) which acts within 24–48 hours in 40–60% of depressed
patients. Conventional antidepressants usually require 2–8 weeks tomeet response criteria. The delay prolongs suffering, may increase suicidal risk and underlines the urgency of alternative treatment strategies.
This the first study to evaluate the combined efficacy of three established circadian-related treatments (SD, bright light, sleep phaseadvance) as adjunctive treatment to lithium and antidepressants.
Methods: Forty-nine BPD patients were randomly assigned to a chronotherapeutic augmentation (CAT) (SD+BL+SPA) or to a medicationonly (MED) group. Clinical outcome was assessed using the Hamilton
Rating Scale for Depression (HRSD).
Results: Significant decreases in depression in the CAT versus MED
patients were seen within 48 hours of SD.
Conclusions: This is the first study to demonstrate the benefit of adding
three non-invasive circadian-related interventions to SD in medicatedpatients to accelerate and sustain antidepressant responses and provides
a strategy for the safe, fast-acting and sustainable treatment of BPD.
Keywords: Sleep deprivation, depression, light therapy

PS-10-3
NEUROIMAGING AND GENETICS OF SLEEP
DEPRIVATION IN DEPRESSION: FROMMONOAMINES AND GLUTAMATE TONEUROPLASTICITY

F BENEDETTI1
1
Department of Clinical Neurosciences, Scientific Institute and University
Vita-Salute San Raffaele, Milano, Italy
Accumulating evidence suggests that plastic processes occurring during
wakefulness result in a net increase in synaptic strength in many brain
circuits, and that synaptic strength is downscaled to baseline levels© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

209

Sleep, Science and Researchduring sleep, when effective cortico-cortical connectivity is broken
down. According to this synaptic homeostasis hypothesis of sleep, SD
should cause marked changes in neuronal connectivity resulting inmajor changes of brain metabolism and function which could be related
to its antidepressant action.The mechanisms by which prolonged wakeincreases synaptic strength involve glutamatergic neurotransmission.
Glutamate agonists, such as ketamine, cause rapid antidepressant effects
similar to SD, and increase mTOR dependent synaptic formation. Someauthors speculated that increased AMPA-to-NMDA glutamate receptor
throughput in critical neuronal circuits would be a key component of
antidepressant mechanisms, indirectly and gradually obtained bymonoaminergic compunds and directly caused by drugs influencing
Glu neurotransmission.We showed that Glu metabolism is altered by
SD, the changes being proportional to both perceived and observedmood amelioration. The effects are well evident in dorsal ACC cortex,
where changes in 5-HT function as a function of 5-HTTLPR polymorphism influence neural responses after successful SD. The finding suggests then a role for Glu neurotransmission, and its interaction withmonoamines, in the rapid antidepressant effects of SD.

PS-11-1

PS-11-3

BRAINSTEM AND SPINAL CORD NEURALCIRCUITRY OF REM SLEEP AND ATONIAJ LU1
1Department of Neurology, Beth Israel Deaconess Medical Center andHarvard Medical School, United States of America
REM sleep (or paradoxical sleep) is characterized by cortical and hippocampal activation and muscle atonia. Atonia can be better understood by dividing it into tonic and phasic component, which displays
differently in cranial muscles with prominent phasic actvitiy (such as
rapid eye movements) and postural muscles with almost no phasic
activity. In this talk, I will review the lesion, behavioral and genetic
works leading to identify the brainstem and spinal neural circuitry regulating phasic activity atonia, cortical activation and REM sleep timing.
I will also review our recent work of the neural circuitry of phasic eventsof trigeminal motor nucleus (Mo5). Finally, I will discuss how theanimal model can help us to understand human REM sleep behavior
disorder (RBD).

PS-11-2
COMMON GROUNDS AND DIFFICULT TO
RECONCILE DIFFERENCES BETWEEN THE
DISFACILITATION AND ACTIVE INHIBITIONCONCEPTS OF THE ATONIA OF REM SLEEPL KUBIN1
Department of Animal Biology, University of Pennsylvania, Philadelphia,
PA, United States of America
1When rapid eye movement (REM) sleep was discovered, a combinationof characteristic motor events was noted: REMs, phasic twitches of facialand distal muscles, irregular breathing, and a flaccid paralysis of axial/
postural muscles (atonia). Subsequent observations revealed that, when
the atonia occurs, motoneurons are hyperpolarized and receive postsynaptic, glycinergic inhibitiory potentials. Additional experiments led
to the concept of a REM sleep-specific descending inhibitory pathway
that: (1) originates in the dorsomedial pons; (2) has a synaptic relay
in the medial medulla; and (3) includes glycinergic inhibitory premotor
neurons that cause the atonia. Evidence supports parts of this concept,

210

some parts still need critical examination, and some have been disproved. Specifically, REM sleep-related depression of activity in hypoglossal (XII) and trigeminal (V) motoneurons is not diminished byantagonism of glycine receptors in the corresponding motor nuclei. This
does not disprove the presence of active inhibition but indicates that it
is not the main cause of depression of XII or V motoneuronal activity
during REM sleep. Similar studies need to be conducted with spinal
motoneurons. Forthermore, some orofacial motoneurons become silent
during non-REM sleep (atonia). Any additional depression of theiractivity during REM sleep is not strong enough to suppress the phasic
excitations that elicit the frequent and large phasic twitches in orofacialmuscles. In the carbachol model of the atonia of REM sleep in which
phasic twitches do not occur, the REM sleep-like depression of XII
motoneuronal activity can be sufficiently explained as resulting from a
combined withdrawal of serotonin- and norepinephrine-mediated,endogenous excitation (disfacilitation). Thus, a one-size-fits-all concept
cannot explain the atonia of REM sleep in all muscles. Rather, the atonia
is caused by a combination of disfacilitation and active inhibition, withthe two mechanisms having different magnitudes in motoneurons
innervating axial, distal limb, orofacial and other muscle groups.

PONTOMEDULLARY REGULATION OF REMSLEEP ATONIA

Y-Y LAI1
1
Psychiatry and Biobehavioral Sciences, University of California, Los
Angeles, North Hills, California, United States of America
The medial pontomedullary reticular formation has been implicated in
the control of motor activity. Electrical activation of the medial pons
and medulla suppresses motor activity in the decerebrate animal. In the
behaving animal, the magnitude of the medial medulla stimulationinduced motor suppression has been shown to be state-dependent, withlarger suppression of muscle tone in SWS than waking. Pharmacologicalstudies showed that the medial pons, the pontine inhibitory area (PIA),
responded to glutamate and acetylcholine, with suppression of muscle
tone being induced by these chemicals. On the other hand, injectionof glutamate but not acetylcholine into the nucleus magnocellularis(NMC) of the rostroventral medulla induced muscle atonia. The PIA
stimulation induced suppression of muscle tone has been suggested tobe mediated through the NMC. Anatomical and physiological studies
demonstrated that the PIA contains glutamatergic neurons, which
project to the NMC and elicit muscle atonia. In vivo microdialysis and
HPLC analysis studies revealed that activation of both the PIA and NMC
increases glycine and GABA release and decreases norepinephrine andserotonin release into the spinal ventral horn. Our recent study foundthat an area rostral to the PIA, located at the ventral portion of thejunction of the pons and midbrain including the caudal substantia
nigra, the ventral mesopontine junction (VMPJ), is also involved in thecontrol of muscle activity in sleep. Sleep pattern was not changed byneurotoxic lesion of the VMPJ. However, this lesion produced periodic
leg movements in SWS and increased phasic and tonic muscle activity
in REM sleep in the cat, symptoms resembling human REM sleep
behavior disorder (RBD). Clinical evidences have shown that RBD and
Parkinson’s disease are highly correlated. Patients may be diagnosed
simultaneously with Parkinson’s disease and RBD, or diagnosed with
Parkinson’s disease and then develop RBD, or vice versa. The anatomical
proximity of the VMPJ to the substantia nigra may provide a link
between RBD and Parkinson’s disease.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

PS-11-4
ATONIA MEDIATING MECHANISMS FROM THE
FOREBRAIN STRUCTURES TO SPINAL CORD

K TAKAKUSAKI1
1
Research Center for Brain Function and Medical Engineering, Asahikawa
Medical University, Asahikawa, Japan
Postural muscle tone is defined as tonic muscular tension that permits
standing. Although appropriate level of postural muscle tone is regulated in conjunction with any types of movements during wakefulness,
it is completely abolished during rapid eye movement (REM) sleep.
Abnormality in postural muscle tone may exist behind a variety of
movement disorders and sleep-relating disorders. We have identifiedmuscle tone inhibitory system in the cat. This inhibitory system arises
from the midbrain cholinergic neurons in located the pedunculopontine
tegmental nucleus (PPN). The PPN cholinergic neurons activate cholinoceptive neurons in the medial pontine reticular formation (PRF),
which consecutively excite medullary reticulospinal neurons and spinal
inhibitory interneurons. At the level of lumbosacral spinal segments, anactivation of the inhibitory system exerted postsynaptic inhibition inalpha- and gamma-motoneurons and interneurons mediating reflex
pathways, and presynaptic inhibition in primary afferents. These inhibitory effects are possibly mediated by a group of lamina VII interneurons.
Microinjections of carbachol (a long-acting cholinergic agonist) andserotonin into the medial PRF altered the level of muscle tone of thedecerebrate cats by increasing and decreasing the excitability of
the inhibitory system, respectively. The PPN receives efferents from theforebrain structures such as the basal ganglia and the hypothalamus.
GABAergic efferents from the substantia nigra pars reticulata (SNr), an
output nucleus of the basal ganglia, to the PPN reduced the activity of
the inhibitory system. In addition, orexinergic efferents from the prefornical lateral hypothalamus to the SNr and the PPN also reduced theactivity of this system via GABAergic neurons. Based on these findings,
it is possible that the inhibitory system contributes to muscular atonia
during REM sleep. We propose that the dysfunction of this inhibitory
system may underlie pathophysiological mechanisms of neurologicaldisorders such as Parkinson disease and narcolepsy.

PS-12-1
HOW INDIVIDUAL GENETIC DIFFERENCES
AFFECT DAILY BEHAVIOR

SA BROWN1
1Institute of Pharmacology and Toxicology, University of Zurich, Zurich,
Switzerland
All facets of human behavior display wide inter-individual variations.
In every aspect studied so far, a portion of this difference has been
genetically determined, and a portion by environment. Twin studies
have shown that interindividual differences in both the circadian clock
determining diurnal behavior and the homeostatic one regulating sleep
need are likely about 50% heritable – i.e. half is controlled genetically,and half by environmental factors. Using human primary fibroblasts asa model, our laboratory has studied the origins of these differences at
a molecular level. Even if the intercellular interactions that determine
diurnal behavior are neuronal, the intracellular pathways that control acell’s response to external signals are conserved in most cell types. For
example, there exist slave circadian oscillators in most cells of the bodythat are similar or identical in mechanism to those in the suprachiasmatic nuclei (SCN) of the hypothalamus that regulate circadian behavior. Thus, the molecular period length of human fibroblasts in culture

is proportional to the behavioral period of the subjects from whom they
were taken.Thus, we can conclude that some circadian variation can be
ascribed to direct genetic changes in the circadian clockwork that are
visible in peripheral cells: changes in period and amplitude of the circadian clock, for example. Other changes, however, can be ascribed toepigenetic mechanisms. In particular, we show that early in life, circadian properties are plastic, and can be stably modified by environmental
light patterns that modify genome-wide methylation patterns. Together,
these genetic and epigenetic mechanisms probably account for the wide
diversity of human daily behavior.

PS-12-2
POTENTIAL THERAPEUTIC AND DIAGNOSTICTARGETS FOR CIRCADIAN RHYTHM SLEEPDISORDERSS SHIBATA1
School of Advanced Science and Engineering, Waseda University,
Shinjuku-ku, Tokyo, Japan1

We prepared two different topics for this symposium. When clock
mutant mice were reared under constant lighting conditions in theirearly stage, they showed the delay of onset of locomotor activity rhythm
under light-dark conditions, similar to delayed sleep-phase syndrome(DSPS) in humans. This result suggests that environmental lighting
condition in early life stage may be an important factor for normal
circadian rhythm in adults. Administration of melatonin at light-off time
could attenuate the DSPS, and mouse activity onset was advanced
during administration period. In addition, opioid receptor-like 1(ORL1) receptor agonist, W-212393 could also rescue the DSPS of clock
mutant mice. Thus, this model mouse is helpful to understand the DSPS
and also develop potential therapeutic drugs for DSPS. For the purposeof sleep and wakefulness, benzodiazepines and caffeine is used forhumans, respectively. Brotizolam administration during late afternoon
caused a phase-advance of hamster circadian rhythm with reduction of
expression of Per1 and Per2 genes, suggesting that brotizolam may
affect circadian rhythm system. Caffeine lengthens the locomotor activity rhythm and bioluminescence rhythm of suprachiasmatic nucleus in
Per2-luc KI mouse. Caffeine also lengthens the bioluminescence rhythmof MEF from Per2-luc KI mouse, and decreased the phosphorylation of
GSK and increased the phosphorylation of AMPK. Thus, caffeineinduced lengthen of circadian rhythm may be involved in the activation
and /or inactivation of various protein kinases. Taken together it is suggested that chemicals induce sleep or wakefulness may have a potential
activity to affect the circadian rhythms.

PS-12-3
CIRCADIAN AND HOMEOSTATIC EVALUATIONOF SLEEP-WAKE DISTURBANCES INHUMANS

D-J DIJK1
1
Surrey Sleep Research Centre, University of Surrey, Guildford, United
Kingdom of Great Britain and Northern Ireland

Circadian and homeostatic processes are key regulatory components ofsleep-wake regulation. Quantification of these processes in humans canbe accomplished by a variety of protocols, including total sleep-deprivation, partial sleep deprivation and circadian displacement. Relevant
outcome variables are numerous and range from waking performance,
waking and sleep EEG measures to analyses of the transcriptome inperipheral tissues. Individual differences in these processes are prominent and may be informative of the mechanisms underlying commonly© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

211

Sleep, Science and Researchobserved sleep-wake disturbances. Recent data related to the circadianand homeostatic evaluation of sleep-wake disturbances will bepresented.

PS-12-4
GENETIC AND PHYSIOLOGIC PHENOTYPING OF
CIRCADIAN RHYTHM SLEEP DISORDERS

A HIDA1
Department of Psychophysiology, National Institute of Mental Health,National Center of Neurology and Psychiatry, Tokyo, Japan
1

Metabolic, physiological, and behavioral processes exhibit 24-hour (h)rhythms in most organisms including humans. These rhythms are
driven by a system of self-sustained clocks and are entrained by environmental cues such as cycles of light and dark and food intake. In
mammals, the circadian clock system is hierarchically organized suchthat the master clock in the suprachiasmatic nuclei of the hypothalamus
integrates environmental information and synchronizes the phase of
oscillators in peripheral tissues. The transcription and translation feedback loops of multiple clock genes are involved in the molecular mechanism of the circadian system. Disorganization of the circadian system
is known to be closely related to many diseases including sleep, moodand metabolic disorders. Advanced sleep phase type, delayed sleep
phase type and non-entrained type of circadian rhythm sleep disorders(CRSD) are thought to result from malfunction/maladaptation of thecircadian system. Dissection of human circadian clock system is indispensable to understand the pathophysiology of CRSD. In this study, weevaluated rhythmic characteristics of physiological functions (core bodytemperature, plasma melatonin and plasma cortisol levels) from healthy
subjects and CRSD patients under a 28-h forced desynchrony protocol
in a laboratory environment free from external cues and masking effects
for several weeks. Furthermore, we measured clock gene expression inprimary fibroblast cells established from individual skin biopsies using
a luminescence reporter assay system. Our results demonstrate that
there was a significant correlation between the period length of physiological and fibroblast rhythms in the same subjects and suggest thatsurrogate measurements using fibroblast cells derived from individual
biopsies would be a useful tool for assessing individual circadian properties. Here, we have examined and will discuss the phenotypes of
CRSD at both the physiologic and molecular levels.

PS-12-5
SOCIAL APPLICATION OF HUMAN SLEEP AND
CIRCADIAN PHENOTYPING FOR SHIFTWORKERSDB BOIVIN1, P BOUDREAU2
1
Faculty of Medicine/Psychiatry, McGill University, Montreal, Canada,
2
Integrated Program in Neuroscience, McGill University, Canada

Introduction: Individuals vary greatly in their tolerance to circadian
disruption. The results of two field studies are presented to illustrate
the impact of circadian rhythms and sleep-wake disturbances for theshift worker population.
Methods: Experiment 1: 15 shift nurses (mean (S.D.): 41.8(7.9) years;
9 controls and 10 intervention) worked about 12 non-consecutive 8 hnights. The intervention consisted of bright white light exposure andmorning neutral grey density goggles. Diurnal sleep was measured athome by Nightcap or PSG. Circadian rhythm of salivary melatonin wasassessed before and after night shifts by 36-h constant routines. Experi-

212

ment 2: 15 police officers (30.1 (5.2) years; 9 controls and 8 interventions) worked 7 consecutive 8-h nights. The intervention consisted ofbright white light and orange-tinted goggles at sunrise. Diurnal sleep
was measured at home by wrist actigraphy. The amount of UaMT6s
excreted during diurnal sleep was assessed at home after night shifts.
Circadian rhythm of salivary melatonin and UaMT6s was assessed
before and after night shifts during 48-h laboratory visits.
Results: Experiment 1: Intervention group nurses had longer mean
(SEM) diurnal TST of 7h20 (0h10) compared to 6h35 (0h08) in controls (Mann-Whitney, p = 0.05). The 11.31 (1.13h) phase delay of
melatonin was greater in intervention group nurses than the 5.08 (2.32)
h delay in controls (ANOVA: p = 0.03). Experiment 2: The rate of
UaMT6s excreted during diurnal sleep increased faster over the week
in intervention versus control group officers (mixed linear model: p =.0323), although circadian phase delay was not significantly different.
Following night shifts, treatment group officers had greater mean
diurnal TST of 6h31 (0h15) compared to the 6h21 (0h28) of control
group officers (mixed linear model: p = 0.0238).
Discussion: Parameters such as circadian phase and the phase angle ofentrainment are useful indexes of sleep-wake disturbances in shift
workers. The degree of exposure to light and darkness contribute to
the level of circadian adjustment in both studies.

PS-13-1
TURNING AROUND DAYTIME IMPACT OF
INSOMNIA IN THE DAILY LIFE OF PATIENTSD LÉGER1
1
Centre du Sommeil et de la Vigilance de l’Hôtel Dieu de Paris, Université
Paris Descartes, APHP, Paris, France
Insomnia is not only defined by a non satisfiyng sleep, but also by
daytime consequences of poor sleep on the daily life of patients.
However this daytime impact is poorly understood.
Based on two recent studies made in national and international samples,
we try to better understand determinants of deleterious daytime life inchronic insomniacs.
– In a Cross-sectional telephone survey in a representative sample of1004 French young adults (25–45 years old), we assess insomnia,
short sleep (total sleep time < 5 hours) and sleep debt. We foundsignificantly more short sleepers in the group of insomniacs than in
the non-insomniac group (24.6% vs 17.2%; p < 0.0001). Insomniacs
with short sleep have significantly more complaints on daytime
functionning that those who are non short sleepers (1).
– In an international cross-sectional survey was conducted in 5293
outpatients complaining of sleep disturbances in primary care practice. A sleep questionnaire addressing daytime consequences, insomnia symptoms, socio-demographic characteristics, and daytime
impairment was administered by 647 physicians in 10 countries.
Overall, 20% to 33% of subjects reported a “severe” daytime impairment associated with sleep disturbances. Patients with several andcombined complaints of insomnia showed a higher percentage ofsevere daytime consequences compared with those suffering fromsingle type of insomnia (initiation or maintenance). Non-restorative
sleep insomniacs had less severe daytime impact compared to theother subgroups (2).
Ref:
1) LEGER D du ROSCOAT E, BAYON V, GUIGNARD J, PAQUEREAUJ, BECK F. Short sleep in young adults: Insomnia or sleep debt?
Prevalence and clinical description of short sleep in a representative
sample of 1004 young adults from France. Sleep Med. 2011
12:454–62.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

2) LEGER D, PARTINEN M, HIRSHKOWITZ M, CHOCROVERTY S,
J. HEDNER on behalf of the EQUINOX survey investigators Daytime
consequences of insomnia symptoms among outpatients in primarycare practice: EQUINOX international survey. Sleep Med. 2010;
11:999–1009.

PS-13-2
LONGITUDINAL OUTCOME OF INSOMNIA –PSYCHIATRIC & MEDICAL CONSEQUENCESYK WING1
1
Psychiatry, The Chinese University of Hong Kong, 33 A Kung Kok Street,
NT, China
Insomnia is defined as a complaint about sleep continuity and qualitythat has daytime repercussions. It is a common sleep disorder affecting
all age groups across the globe, and carries significant health careburden and morbidities including reduced daytime alertness, fatigue,
increased health care utilization, accident risk, reduced productivity
and subjective quality of life.
Insomnia is much more common among patients of psychiatric disorders. Over past decade, there is a paradigm shift to conceptualize
insomnia as a co-morbidity disorder rather than merely as a symptomof the mental disorders. Prospective studies found that insomnia predisposed to future development of depression, anxiety disorders, andalcoholism abuse. Persistent insomniac symptom was associated with
future risk of relapse of depression. Apart from mental adversity,
increasing attention has been recently focused on the medical consequences of insomnia. Medical illnesses, such as chronic pain, hypertension, impaired glucose tolerance and diabetes mellitus, and upper
respiratory tract infections, were found to be associated with insomnia
in both cross sectional surveys and longitudinal studies.
In this lecture, the current literature on the longitudinal psychiatric andmedical outcome of insomnia will be discussed especially with reference
to the adult and children insomnia longitudinal data from our Hong
Kong studies.

PS-13-3
SLEEP AND SUICIDAL BEHAVIORSAMONG YOUTHS

X LIU1
School of Public Health, Shandong University, New York, United States ofAmerica1

Suicide risk begins to increase during adolescence. Sleep in adolescenceis characterized by delay in the sleep/wake schedule, sleep insufficiency,
daytime sleepiness and fatigue, and increased risk for sleep disturbances. Sleep disturbances are likely to lead to suicidal behaviors, sincemental disorders are a strong risk factor for suicidal behaviors, and sleep
disturbances are, in turn, linked to mental disorders. This presentation
will review recent clinical, epidemiological, and biological studies on
the relationship between sleep and suicidal behavior and propose
potential psychological and biological pathways and future research
directions. Clinical studies have shown that suicidal psychiatric patients
have more sleep disturbances including insomnia, hypersomnia, ornightmares than nonsuicidal patients. Shorter rapid eye movement
latency and increased rapid eye movement activity have been noted to
be a marker of suicidality in psychiatric patients. A number of crosssectional and several longitudinal epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associatedwith elevated risk for suicide. Inadequate sleep increases suicide risk
possibly by 1) impairing cognitive judgment or impulse control; 2)
increasing irritability, lowering threshold for negative emotional
responses; 3) increasing the individual’s susceptibility to psychopathology or exacerbating preexisting psychopathology; or 4) by interactingwith a number of underlying vulnerable moderators (such as hopelessness, impulsivity). Inadequate sleep or sleep disturbances and suicidal
behavior may share neurobiological mechanism, particularly in regard
to decreased serotonin functioning. Future studies need to examine thecausal relationship neurobiological mechanisms between sleep, psychopathology, and youth suicidal behavior.

PS-13-4
NATURAL HISTORY OF INSOMNIA: FACTORSMODERATING THE COURSE OF INSOMNIAOVER TIME
CM MORIN,1 M LEBLANC,2 H IVERS,3 C MERETTE4
Psychology, Laval University, Canada, 2Laval University, Psychology,
Canada, 3Laval University, Psychology, Canada, 4Laval University,
Psychiatry, Canada

1

Despite the high prevalence and significant burden of insomnia, there
is little information about its natural history, risk factors, course, andfactors moderating its trajectory over time. This presentation will
outline preliminary findings of an ongoing longitudinal study of insomnia in a population-based sample in Canada. A sample of 3464 adults(62% women, mean age of 48 years old) with and without insomnia
complaints completed several questionnaires about their sleep, physicaland mental health, and several psychological and behavioral characteristics hypothesized to be related to the onset and course of insomnia.
These evaluations were completed at baseline, 6 months, and at yearly
follow ups for five consecutive years. Data from the first three evaluations (baseline, 6 and 12 months) will be used for this presentation.
Among good sleepers, 20.3% developed either insomnia symptoms(17.3%) or an insomnia disorder (3%) during the 1-year follow-up
period. Conversely, of those with insomnia symptoms or an insomnia
syndrome, the majority reported persistent insomnia (63.5 for symptoms and 90.1% for syndrome) over the course of the one year follow
up, whereas 36.8% and 9.9% remitted during the same period. Of all
psychological variables examined, depression, anxiety, arousability,
emotion-oriented coping style, and stress-related vulnerability toinsomnia were associated with (predisposed to) new onset insomnia;
conversely, improvements on these variables between any two assessment periods were also associated with remission of insomnia. Of thehealth-related variables, only general health and pain were associatedwith new onset insomnia. These findings suggest that several psychological and health-related variables can moderate the course of insomnia
over time.

PS-13-5
LIFE STYLE AND GENESIS OF INSOMNIAM KONNO1, M UCHIYAMA1
Department of Psychiatry, Nihon University School of Medicine, Toshima,
Tokyo, Japan
1

Insomnia is defined as a sleep difficulty that occurs despite adequate
opportunity and circumstances for sleep and is associated with various
daytime impairments related to the difficulty. Prior studies have indicated that factors having an influence on its genesis are multiple, including gender, age, physical and psychological conditions, life style, etc.

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Sleep, Science and Research

Among these variables, life style or sleep habits has been a target of
non-pharmacological therapeutic interventions. Bed time restriction, a
cognitive behavior therapy, in which time spent in bed (TIB) is properly
shortened has a favorable therapeutic effect on insomnia, suggesting thatthe length of TIB may have a robust pathogenetic influence on thedevelopment of insomnia. However, none of the studies have examined
the pathogenetic importance of long TIB in a large sample from thegeneral population. Therefore we conducted an epidemiological survey
on sleep problems and habits among the general adult population ofJapan and examined the relation between insomnia and sleep habits.
Describing prevalence for insomnia subtypes as a function of TIB wasof our particular interest. The Nihon University Sleep and Mind Epidemiology Project (NUSMEP) was conducted in 2009, using face-to-faceinterviews. People aged 20 years or older were selected randomly fromall areas of Japan, by using a three-stage-stratified sampling method.
Finally 2,559 people (response rate 54.0%) indicated the presence ofdifficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), earlymorning awakenings (EMA) and habitual TIB. Multiple logistic regression analyses after adjusting possible confounding effects of age andgender revealed that long TIB (9 hours or longer) was associated with ahigher prevalence of all the subtypes of insomnia and that a short TIB(shorter than 6 hours) was associated with a higher prevalence of DIS
and EMA. These results suggest that one’s setting of TIB may have playeda pathogenetic role in the natural history of insomnia and that its
detailed mechanism may be different among the subtypes of insomnia.

PS-14-1
HOW ANIMAL KNOWS THE DAYLENGTHT YOSHIMURA1
1
Graduate School of Bioagricultural Sciences, Nagoya University, Nagoya,Japan
Animals living outside the tropics use changes in daylength to adapt toseasonal changes in environment, but the molecular and endocrine
mechanisms underlying photoperiodic time measurement are not fully
understood. The Japanese quail is a robust model for the study of thesemechanisms because of its rapid and dramatic response to changes inphotoperiod. In the previous study, we have demonstrated that local
thyroid hormone catabolism within the mediobasal hypothalamus(MBH) by thyroid hormone-activating enzyme (type 2 deiodinase:DIO2) regulates photoperiodism. Recent functional genomics analysis
in quail demonstrated that long days induce thyrotropin (TSH) production in the pars tuberalis (PT) of the pituitary gland, which triggers
DIO2 expression in the ependymal cells (EC) of the MBH. In mammals,
nocturnal melatonin secretion provides an endocrine signal of the photoperiod to the PT that contains melatonin receptors in high density.
We have also demonstrated the involvement of TSH signalling pathway
in mammals by using the TSH receptor null mice. It has been know formany decades that non-mammalian vertebrates detect light by deepbrain photoreceptors that lie outside the retina and pineal gland to
regulate photoperiodism. We identified expression of a novel opsin(Opsin 5) in the paraventricular organ (PVO), an area long believed tobe capable of phototransduction in quail. Functional analysis revealed
that Opsin 5 detects short-wavelength light to regulate photoperiodism.
I would like to review the current understanding of the mechanism
underlying photoperiodism in vertebrates.

214

PS-14-2
MAMMALIAN CIRCADIAN CLOCKS DETECTING
MORNING LIGHT AND EVENING LIGHTSS HONMA1, T YOSHIKAWA2, K HONMA3
Department of Physiology, Hokkaido University Graduate School of
Medicine, Sapporo, Japan, 2Research Center for Cooperative Projects,
Hokkaido University Graduate School of Medicine, Japan, 3Department ofChronomedicine, Hokkaido University Graduate School of Medicine, Japan1

Seasonal changes in day-length (photoperiod) and climates affecthuman circadian rhythms including sleep length and quality. The
mechanisms how mammals, especially non-seasonal breeders, know theseasonal changes to alter their physiology and behavior are still poorly
understood. Long-lasting hypothesis for measuring day length in nocturnal rodents is the two independent but mutually coupled oscillators,
Morning (M) and Evening (E) oscillators, which track dawn and dusk
separately and regulate behavioral offset and onset, respectively. By
using transgenic mice carrying a firefly luciferase reporter gene for clock
genes Per1 expression and PER2, we explored the mechanisms and siteof the photoperiodic clock.
Per1-luc or PER2:LUC knock-in mice which were kept in LD12:12 were
exposed to either LD6:18 or 18:6 for 3 weeks. After measuring behavioral rhythms, they were decapitated and serial coronal SCN slices were
cultured for recording bioluminescence with a photomultiplier (PMT).
In addition, horizontal as well as serial coronal slices were cultured forbioluminescent imaging with a CCD camera, and circadian rhythms insingle SCN cells were analyzed.
Irrespective of photoperiods, Per1 expression rhythms in the anterior
and posterior SCN were phase-locked to the onset and offset of behavioral rhythms, respectively, suggesting the localization of E and M
oscillators. In addition, the third oscillatory cell group with an earlymorning peak was detected in the anterior SCN of mice that were
exposed LD18:6. No laterality was detected in the cells with earlymorning or late evening peaks, suggesting that an oscillatory mechanism for photoperiodic regulation of behavioral rhythms may be different from that for behavioral splitting of hamsters in constant light.
PER2::LUC rhythms in single SCN cells did not show large phase differences even in LD18:6. Different roles are suggested between Per1 andPer2 especially in photoperiodic responses of behavioral rhythms.

PS-14-3
NATURE AND NURTURE IN THE SEASONALITY
OF CIRCADIAN RHYTHMSDG MCMAHON1, C CIARLEGLIO2, K GAMBLE3
1
Department of Biological Sciences, Vanderbilt University, Nashville, TN,
United States of America, 2Neuroscience Graduate Program, Vanderbilt
University, United States of America, 3Department of Psychiatry,
University of Alabama Birmingham, United States of America

The mammalian central biological clock, that times sleep/wake cycles
and mediates seasonal responses to light, is composed of ca. 20,000
neurons that express a network of clock genes which generate 24 hourrhythms. Much is known about how clock genes and their variants
determine the characteristics of the circadian timing system, but less isknown about how environmental influences on the clock during development may affect the clock through epigenetic means. Recently, ourlaboratory has examined whether exposure to seasonal light cycles
during perinatal development can have lasting influence on the characteristics of the brain’s biological clock. During the perinatal period
mice were exposed to either a short-day winter-like LD 8:16 light cycle,© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

an equinox LD 12:12 cycle, or a long-day summer-like LD 16:8 lightcycle. At weaning, mice were placed into individual cages with running
wheels and either continued on the same seasonal light cycle, or
switched to the opposing cycle (long to short; short to long) for 4
additional weeks of maturation. At 7 weeks of age either the molecularrhythms of the suprachismatic nucleus (SCN) biological clock, or
running wheel behavior in constant darkness was assayed. We tested
for i) persistent effects of perinatal photoperiod by testing for main
effects of developmental photoperiod across both the maintained andreversed continuation groups, and for ii) interactions of perinatal photoperiod with subsequent changes in seasonal photoperiod by comparing across all groups. We found that i) there are persistent changes in
the waveform and period of individual clock neurons induced by perinatal seasonal light cycles that are also evident as altered circadianbehaviors, and ii) that changes in clock neurons induced by perinatal
exposure to seasonal light resulted in altered circadian responses tosubsequent seasonal change. These results show that in addition to thegenetic determination of clock properties by clock genes that can belasting epigenetic influence of environmental signals to the clock during
development.

PS-14-4
SEASONALITY IN HUMAN SLEEP AND MOOD INHEALTH AND DISEASE

A WIRZ-JUSTICE1
1
Centre for Chronobiology, Psychiatric University Clinics, Basel,
Switzerland

Seasonality used once to pervade our lives. The change in daylength
throughout the seasons was as important for human physiology as forother organisms that needed to adapt to survive and reproduce. Until
the widespread use of electric light (and indoor work) and heating/air
conditioning, there is evidence for a spring peak in conception rates.
Epidemiological studies indicate some remnant of seasonality in sleep
under daily entrained conditions – longer in autumn/winter than inspring/summer (by ca. 15 mins), whereas the changes in sleep underfreerun during temporal isolation are much greater (by ca. 1 h). Women
sleep longer than men at all times of year. A wide range of behaviours
and illnesses still show seasonal variations – from physical activity tometabolic syndrome, from sympathetic outflow to schizophrenia birthrate to suicide. At the neurotransmitter level, serotonin function changes
with season. Seasonal affective disorder is one example of a mooddisorder related to shifts in the circadian system (lower amplitude,
phase delay). More generally a winter lowering of mood is associatedwith a shift towards eveningness, and evening chronotypes have ahigher prevalence of depressive disorders.

PS-15-1
DISCOVERY AND HISTORY OF OREXINT SAKURAI1
1
Faculty of Medicine, Kanazawa University, Kanazawa-city, Japan
Orexin A and orexin B (also known as hypocretin 1 and hypocretin 2)
are hypothalamic neuropeptides that were discovered thirteen years ago.
Orexin producing neurons are localized exclusively in the lateral hypothalamus, the classical feeding center. Subsequently, several studies
suggested that orexin deficiency causes narcolepsy in humans and othermammalian species, highlighting roles of this hypothalamic neuropeptide in the regulation of sleep and wakefulness. Studies of efferent andafferent systems of orexin-producing neurons have shown that the orexin
neuronal system has close interactions with systems that the regulateemotion, energy homeostasis, reward, and arousal. Orexin neurons
receive abundant input from the limbic system, which might be important for increasing arousal during emotional stimuli. We found thatorexin neurons are also regulated by sleep active neurons in the ventrolateral preoptic area. These cells also have been also thought to be
regulated by peripheral metabolic cues, including ghrelin, leptin andglucose, suggesting that orexin neurons might provide a link between
energy homeostasis and vigilance states. Orexin neurons project tonumerous brain regions, with especially strong inennevation to themonoaminergic/cholinergic nuclei, suggesting that orexin neurons affectthe activity of these nuclei to regulate sleep/wakefulness states. Theseobservations suggest that orexin neurons are involved in sensing the
body’s external and internal environments, and regulate vigilance statesaccordingly. In this symposium, we will discuss the input and output
systems of orexin neurons and their roles in sleep/wake regulation.

PS-15-2
AFFERENT AND EFFERENT CONTROL OF THE
OREXIN SYSTEMTE SCAMMELL1
Depart of Neurology, Harvard Medical School, Boston, MA, United Statesof America
1

The orexin/hypocretin neurons play key roles in the maintenance of
wakefulness and the regulation of REM sleep. The importance of thesecells is clear in mice lacking the orexin neurons that have narcolepsy
and fail to rouse in response to hunger. Over the last few years, muchhas been learned about the factors that drive activity in the orexin
neurons and the key projections of the orexin neurons that ultimately
affect wakefulness and sleep.
As expected, inputs to the orexin neurons arise from brain regions
implicated in the control of sleep/wake behavior, but they also originate
from areas that govern emotions, stress, hunger, and circadian rhythms.
The orexin neurons receive inputs from state-regulating regions such as
the preoptic area, basal forebrain, lateral and posterior hypothalamus,
periaqueductal gray matter, raphe nuclei, and lateral parabrachial
nucleus. Inputs also arise from limbic regions including the allocortex,
lateral septum, bed nucleus, amygdala and CRF neurons. Signals related
to circadian rhythms are relayed via the subparaventricular zone anddorsomedial nucleus.
The orexin neurons innervate a wide variety of brain regions from thecortex to the spinal cord, and some of these projections are especially
important for normal state control. We produced mice in which a loxPflanked gene cassette disrupts production of the OX1 and OX2 orexin
receptors, but Cre recombinase can globally or focally restore normal
orexin receptor signaling. At baseline, mice lacking OX2R show signsof moderate sleepiness, and expression of OX2R only in the tuberomammillary region completely rescues their ability to produce long
wake bouts. Restoration of OX1R and OX2R signaling in the basal
forebrain also improves the maintenance of wakefulness, demonstratingthat signaling through these regions is sufficient to improve sleep/wakebehavior.
These anatomic connections show that the orexin neurons are uniquely
positioned to integrate a variety of interoceptive and homeostatic signals
to increase behavioral arousal under basal condition and in response toa variety of challenges.

© 2011 The Authors
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Sleep, Science and Research

PS-15-3

Educational lectures

OREXIN NEURONS AS SENSORS OF
EXTRACELLULAR NUTRIENTS

EL-1-1

D BURDAKOV1
1
Department of Pharmacology, University of Cambridge, Cambridge,
United Kingdom of Great Britain and Northern Ireland
In order to maintain body energy balance through regulation of foodintake and energy expenditure, the brain has to measure body energy
levels. A key direct strategy for doing this was discovered by Yutaka
Oomura and co-workers in the 1970s, who found that there are specialized glucose-sensing neurons in the lateral hypothalamus (LH). Theiridentity remained unclear until 2003, when Takeshi Sakurai and coworkers showed that glucose-inhibited neurons in the LH containorexin. Our recent work indicates that inhibition of orexin cells by
glucose is mechanistically unusual in that it may not require conventional glucose metabolism. Moreover, our data suggest that glucose
inhibition of orexin cells is subject to paradoxical negative modulation
by increased background energy levels. We also investigated the effects
of other macronutrients on orexin cells, and show that nutritionallyrelevant mixtures of dietary amino acids alter the orexin cell activity inthe opposite direction to glucose. This suggests that orexin neurons are
not simple energy sensors, but may detect the balance between different
macronutrient in the diet. We propose a hypothesis for how nutrientspecific modulation of orexin cells may promote consumption of abalanced diet.

PS-15-4
NEUROCHEMISTRY OF HYPERSOMNIAS NISHINO1
1
Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA,
United States of America
Our recent progress in understanding the pathophysiology of hypersomnia is particularly indebted to the 1999 discovery of narcolepsy
genes (i.e., hypocretin receptor and peptide genes) in animals and thesubsequent discovery (in 2000) of hypocretin ligand deficiency in idiopathic cases of human narcolepsy-cataplexy. This discovery in humannarcolepsy lead to (A) the establishment of a new diagnostic test (i.e.,
low CSF hypocretin levels) and (B) development of hypocretin replacements to be used in the treatment of hypocretin deficient narcolepsy.
In contrast, the pathophysiology of hypocretin non-deficient narcolepsy
is still debated. Similarly, the pathophysiology of idiopathic hypersomnia, another defined primary hypersomnia, is largely unknown.Anatomical and functional studies demonstrate that the hypocretin systems
integrate and coordinate multiple wake-promoting systems (such as
monoamine and acetylcholine systems) to keep subjects fully alert.
Among theses wake-promoting systems, we are particularly interested
in the hypocretin-histamine interactions since hypocretins excite histaminergic neurons in the posterior hypothalamus through hypocretin
receptor-2, one of two hypocretin receptors that play critical roles increating the narcolepsy phenotype.In this talk, the roles of hypocretinhitsmaine interaction in primary hypersomnia will be discussed.
Further knowledge of the neurochemistry of hypersomnia will most
likely lead to the development of new treatments and management
strategies for patients with hypersomnia of various etiologies.

216

NEUROBEHAVIORAL DYNAMICS OF SLEEPRESTRICTION AND RECOVERYDF DINGES1
Department of Psychiatry, University of Pennsylvania School of Medicine,Philadelphia, Pennsylvania, United States of America
1This talk will review the effects of sleep loss on human neurobehavioral
functions over periods longer than the typical acute sleep deprivation
study. Although acute total sleep loss experiments suggest the effects arequickly recovered by intensification of sleep as manifest in EEG slow
wave energy, more chronic experiments reveal longer time constants indegradation and recovery of neurobehavioral functions. Studies havefound that chronic reduction of sleep can result in waking neurobehavioral deficits that become progressively worse over days, and that the rateof accumulation of waking deficits is a function of the magnitude of thesleep restriction. Thus, chronic sleep restriction induces slow changes(days to weeks) in neural processes mediating alertness, attention andaspects of cognitive functioning. A recent experiment suggests extended
recovery sleep duration is critical to liquidation of these slow (cumulative) changes. If this is the case, time off work during and following
consecutive days of chronic sleep restriction must receive more scrutiny
for the extent to which it provides adequate recovery sleep duration andthereby reverses the (slow) cumulative neurobehavioral effects of sleep
restriction. A related issue is the length of the recovery period required
between multi-day work periods. Although recovery time is often
allowed to be minimized in duration in work regulations, based on theassumption that people will utilize the majority of the off-work time forsleep, it appears this may not be the case. A failure to understand thecriticality of chronic sleep restriction and recovery sleep duration in thehealth and safety of people appears to be the greatest challenge to preventing fatigue-related accidents and adverse outcomes.

EL-2-1
GENETICS OF SLEEP DISORDERS

M TAFTI1
1
Center for Integrative Genomics, University of Lausanne, Lausanne,
Switzerland
Enormous efforts have been undertaken in the last decade to identify
genes for complex diseases and traits. Sleep, as a behavior, is from thegenetic point of view a highly complex trait and sleep disorders ingeneral are complex diseases. Narcolepsy and Restless Legs Syndrome(RLS) are two emblematic disorders of sleep and recent advances intheir molecular genetics opened new avenues. RLS is a common disorder affecting up 10% while narcolepsy is rare and affects less than
0.05% of the general population. RLS is familial in up to 60% andnarcolepsy in less than 10% of cases. Although single genes with autosomal dominant inheritance are evidenced by linkage studies in bothconditions, no causative gene has yet been identified. The extraordinary
success of genome-wide association studies (GWAS) led to recent suchattempts in RLS and narcolepsy. Identified variants (except one) revealed
small effect sizes and even when several such variants were identified
in RLS, the added effect size remains negligible in regards to the overall
heritability. Obviously, as in many other complex disorders, GWAS
are of limited help in discovering a substantial genetic contribution
to complex traits such as sleep disorders. Other strategies such as© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

large-scale, high-resolution comparative genomic hybridization andnext generation sequencing technologies combined with linkage analysis in families might help identifying causative genes.

EL-3-1
THE NEURONAL NETWORK RESPONSIBLE FOR
PARADOXICAL (REM) SLEEP AND ITS
DYSFUNCTIONS CAUSING NARCOLEPSY AND
REM BEHAVIOR DISORDER

P-H LUPPI1
1
team “Physiopathology of the neuronal network of the sleep-waking cycle”
of the CRNL, UMR 5292 CNRS/U1028 INSERM, Lyon, France
Since the discovery of rapid eye movement (REM) sleep (also known
as paradoxical sleep; PS), it is accepted that sleep is an active process.
PS is characterized by EEG rhythmic activity resembling that of waking
with a disappearance of muscle tone and the occurrence of REMs, incontrast to slow-wave sleep (SWS, also known as non-REM sleep)
identified by the presence of delta waves. I will describe an updated
integrated model of the mechanisms responsible for the sleepwake
cycle. This model introduces the notion that the entrance and exit of
PS are induced by different mechanisms. I will hypothesize that theentrance from SWS to PS is due to the intrinsic activation of PS-on
GABAergic neurons. These populations of neurons would inhibit during
PS all waking systems and a population of PS-off GABAergic neurons.
This population of PS-off GABAergic neurons tonically inhibits during
waking and SWS the glutamatergic neurons triggering the state of PS
localized in the pontine sublaterodorsal tegmental nucleus (SLD). The
exit from PS would be induced by the inhibition of the PS-on GABAergic neurons by waking systems such as the pontine and medullary
noradrenergic neurons and the hypothalamic hypocretin. Finally, I willpropose hypotheses on the mechanisms responsible for two main sleep
pathologies, REM sleep behavior disorder and narcolepsy.

EL-4-1EPIDEMIOLOGY, INSOMNIA, MENTALDISORDERS
MM OHAYON
Stanford Sleep Epidemiology Research Center, School of Medicine, Stanford
University, USA
Abstract not arrived.

EL-5-1
VIOLENT PARASOMNIAS- FORENSICIMPLICATIONS

MA CRAMER BORNEMANN1, MW MAHOWALD1,2
Department of Neurology, Minnesota Regional Sleep Disorders Center,
Hennepin County Medical Ctr, Minneapolis, Minnesota, United States ofAmerica, 2Department of Neurology, University of Minnesota School of
Medicine, United States of America
1

All brain states are now recognized as permeable, dynamic, and interactive. Additionally, the various components of sleep may dissociate oroscillate rapidly which may result in State Dissociation. In such situations transitions from wake to sleep or from NREM to REM may proceed
until switching errors arise resulting in states that are not stable and not
yet fully declared. As each state is an entity which is physiologically andexperientially distinct, an overlapping of states transpire whereby thephysiologic and experiential remnant of each state can be dissected,
studied, and understood. A salient example of State Dissociation would
be the Parasomnias, specifically REM Behavior Disorder whose condition can be understood as an overlap between wake and REM sleep.
SLEEP FORENSICS was first formally defined at the 5th Congress ofthe WFSRSMS (WorldSleep07) in Cairns, Australia. SLEEP FORENSICS
is defined as the application of the principles and tools of neuroscience
as applied to Somnology and Sleep Medicine that have been widely
accepted under international peer-review to the investigation in understanding unusual, irrational, and/or bizarre human behaviors associatedwith alleged criminal behavior which is to undergo further examination
in a conflict resolution legal atmosphere and/or courtroom. This lecture
will develop a current and up-to-date neuroscientific approach tounderstanding violent behaviors arising from sleep while contrasting
the often conflicting paradigms of LAW vs. SCIENCE. Upon defining
the new and developing field of SLEEP FORENSICS the speakers willproceed to review the broad spectrum of criminal and civil allegations
associated with SLEEP FORENSICS based upon their extensive medicolegal experience from their formal international forensics program withboth the law enforcement and legal communities involving over 230
case referrals from 2006–2011.

EL-6-1CIRCADIAN RHYTHM, HUMAN, SLEEP-WAKE
CA CZEISLER
Harvard Medical School, USA
Abstract not arrived.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

217

Sleep, Science and ResearchEL-7-1SLEEP APNEA SYNDROMESKP STROHL1
1
Medicine, Case Western Reserve University, Shaker Heights, OH, UnitedStates of America
Sleep Apnea is a complex disease, its pathogenesis and management
derived from genetic and environmental factors. An apnea occurs
through a reduction in ventilatory drive, and recurrent apnea resultsfrom longer-term influences such as loop gain. Patients could have a
pre-determined susceptibility for breathing instability and the appearance of recurrent apneas. Mathematical models predict an association
between recurrent apneas and chemosensitivity, and a post-hypoxic
response could promote ventilatory stability or recurrent apnea. The
trait of post-hypoxic frequency decline (Han, Subramanian et al. 2001)
as well as periodic and unstable breathing is present in the C57BL/6J(B6) mouse during wakefulness (Han, Subramanian et al. 2002) andunder anesthesia (Gonsenhauser, Wilson et al. 2004). The finding of
periodic breathing in B6xA/J recombinant inbred mice (Han, Subramanian et al. 2002) and chromosomal substitution strains confirm an
inherited basis, but also indicate that the expression of post-hypoxic
ventilatory decline is not necessary for its expression. To date, we knowthat that buspirone (Yamauchi et al, 2008), acetazolamide (Yamauchi
et al 2007), and inhibition of hydrogen sulfite production (Donovan etal, in press) will reduce or eliminate post-hypoxic apnea, and pharmacologic inhibition of neural nitric oxide synthase will lengthen events(Price, Han et al. 2003). Chromosome 1 from the A/J strain protects theB6 from the expression of recurrent apneas, not only in the setting of
reoxygenation but also spontaneous sighs during resting breathing(Yamauchi et al 2008). Such a pre-clinical model is a starting point forunderstanding mechanisms and treatments that sensitize (or desensitize) the control system in regard to ventilatory stability, and is broadly
applicable to breathing instability in several medical and neurologicalconditions.

EL-8-1
MOLECULAR CHARACTERIZATION OF HUMANSLEEP VARIANTS

Y-H FU1
Department of Neurology, University of California, San Francisco, CA,
United States of America
1Sleep disruption and duration has been shown to have significant
impact on human health, quality of life, and life expectancy. Among
humans, it is clear that the biological need for sleep varies dramatically.
Natural short sleepers have a lifelong tendency to sleep only 4–5 hours
per night and to awaken refreshed and energetic. Natural long sleepers
biologically require 9–10 hours/night to feel well rested. The reason forthese differences is not known and no genetic forms of either phenotype
have been described. In contrast to sleep (where almost nothing is
known), there is a wealth of information on the genetics of clock function across species. Sleep and circadian function are distinct processes
that interact in living organisms. Although these two systems canoperate independently, recent studies indicate a more intimate relationship. Despite the exciting developments in the last decade on theneuronal pathways involved in wakefulness, sleep induction/maintenance, and molecular characterization of the circadian clock, the mechanism that controls how much sleep we need is entirely unknown.
We’ve undertaken a Human Genetic approach to identify genes/pathways involved in sleep. We’ve identified families with autosomal domi-

218

nant transmission of Natural Short Sleep (NSS) and Natural Long Sleep(NLS) phenotypes and identified a mutation causing familial NSS(FNSS). The mutation is in Dec2 a gene encoding a transcription factor.
Mice engineered to carry the human FNSS mutation also sleep less. It
is interesting that they also have a metabolic syndrome. Identificationof mutations that give rise to alterations in sleep requirement represents
a unique opportunity for delving into the molecular regulatory mechanisms of sleep homeostasis. Understanding of human sleep homeostasis
has the potential to produce an enormous impact on our understandingof many biological pathways including brain functions (vigilance, shortterm and long-term memory, executive function, math processing, cognitive speed, and spatial orientation), behavior, health, and longevity.

Educational symposia
ES-1-1
HUMORAL AND NEURAL REGULATION OFSLEEP – LESSON FROM PROSTAGLANDIN
D2-INDUCED SLEEPY URADE1
Department of Molecular Behavioral Biology, Osaka Bioscience Institute,
Suita-city, Osaka, Japan
1

Prostaglandin (PG) D2 is the most potent endogenous sleep-promoting
substance thus far reported. PGD2 is produced by lipocalin-type PGD
synthase localized in the leptomeninges, choroid plexus, and oligodendrocytes in the brain, and is secreted into the cerebrospinal fluid as asleep hormone. PGD2- stimulates DP1 receptors localized in the leptomeninges of the basal forebrain and the hypothalamus, and increases
the local concentration of extracellular adenosine. Adenosine acts as aparacrine sleep-promoting molecule to activate adenosine A2A receptorexpressing sleep-promoting neurons in the basal forebrain and/or
ventrolateral preoptic area (VLPO) and to inhibit adenosine A1 receptorpossessing arousal neurons. An intracerebroventricular infusion of
PGD2 or adenosine A2A receptor-agonists induces non-REM sleep andincreases the expression of fos protein in VLPO. The activation of VLPO
neurons is associated with a decrease in the fos expression in the histaminergic tuberomammillary nucleus (TMN), one of the arousal
centers. The neural network between VLPO and TMN is considered toplay a key role in the regulation of vigilance states. The i.p. injection of
SeCl4, a selective inhibitor of L-PGDS into mice decreased the PGD2
content in the brain and inhibited sleep in a dose-dependent manner,
during the light period when mice normally sleep. The SeCl4-induced
insomnia was not observed at all in gene-knockout (KO) mice of
L-PGDS or DP1 receptor. A novel DP1 antagonist ONO-4127Na reduced
sleep of rats by 30% during infusion at 200 pmol/min into the subarachnoid space under the rostral basal forebrain. Caffeine, a nonselective antagonist of adenosine A1 and A2A receptors, inhibited sleep
in wild-type mice in a dose-dependent manner and induced complete
insomnia for several hours after an i.p. injection at 15 mg/kg. The
caffeine-induced insomnia was also observed in A1 receptor KO micebut not at all in A2A receptor KO mice. These results indicate that theDP1 and A2A receptor system is critical for physiological sleep.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

ES-1-2
KEY ROLES OF THE HISTAMINERGIC SYSTEMFOR THE SOMNOGENIC EFFECT OF
PROSTAGLANDIN D2 AND ADENOSINE

Z-L HUANG1, W-M QU1, Y URADE2, H OSAMU2
1
Department of Pharmacology, Shanghai Medical College, Fudan
University, Shanghai, China, 2Department of Molecular Behavioral Biology,
Osaka Bioscience Institute, Japan
This talk presents an overview of the current knowledge about the roleof histamine in mediating wakefulness in mammals with a focus on thesomnogenic effects of prostaglandin (PG) D2 and adenosine, and on thearousal effects of PGE2 and orexin. PGD2 activates DP1 receptors (R) to
promote sleep by stimulating them to release adenosine. The released
adenosine activates adenosine A2AR and subsequently excites the ventrolateral preoptic area (VLPO), one of the sleep centers in the anterior
hypothalamus. VLPO neurons then send inhibitory signals to downregulate the histaminergic tuberomammillary nucleus (TMN), which
contributes to arousal. A1R is expressed in histaminergic neurons of the
rat TMN. Adenosine in the TMN inhibits the histaminergic system via
A1R and promotes NREM sleep. Conversely, both endogenous PGE2 andorexin activate the histaminergic system through EP4R and OX2R,
respectively, to promote wakefulness via histamine H1R. Furthermore,
the arousal effect of ciproxifan, H3R antagonist, depends on the activation of histaminergic systems. These findings indicate that VLPO andTMN regulate sleep and wakefulness by means of a “flip-flop” mechanism during sleep-wake state transitions.

ES-1-3
DIURNAL VARIATION OF PROSTAGLANDINMETABOITES D AND LIPOCALIN TYPE
PROSTAGLANDIN D SYNTHASE IN
HEALTHY VOLUNTEERSJM MULLINGTON1, M HAACK1, K ARITAKE2, M LASARUS2,
Y URADE2
1
Sleep and Inflammatory Systems Laboratory, Department of Neurology,
Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA, United States of America, 2Department of Molecular
Behavioral Biology, Osaka Bioscience Institute, Japan
Introduction: There is a bi-directional relationship between sleep andinflammation. Insufficient sleep leads to increased inflammatory mediators, and activation of the host defense system leads to sleepiness andsleep. The prostaglandins (PGs) are mediators of inflammation, and
PGD synthase in serum is elevated in association with sleepiness. PGE2
is associated with pain sensitivity and increases with sleep loss. For
these reasons, we explored the diurnal and sleep-loss associated changes
in the urinary metabolites of PGD, PGE (PGDm and PGEm, respectively) and lipocalin type prostaglandin D synthase (l-PGDs) in healthy
volunteers undergoing 63 hrs of sleep deprivation (SD).
Methods: Twenty-three subjects were randomized (1:2) to sleep or SD
conditions, respectively. Twenty-three subjects (10f/13m) between 23
and 56 years were included. Following extensive screening (habitual
sleep time, healthy profile based on blood chemistry and medical
history, ECG, overnight PSG and exercise stress tests), volunteers stayedin the clinical research center for 7 days, and six nights. The first 2nights were adaptation and baseline (BL), followed by 2 nights of SD
or normal control sleep of 9 hrs, followed by recovery sleep of 2 nights.
Urinary in- and output was measured for the second BL, last 24 h of

SD and the first 24 h recovery. Urine from the 9 h bed period waspooled and analyzed for nighttime samples; urine was pooled for 15 h
wake periods and made up the daytime samples. Data were analyzed
using SPSS mixed model analysis, with condition (deprivation/control
sleep); day of protocol, and diurnal (day/night), as fixed factors(repeated).
Results: PGDm and l-PGDs showed significant diurnal rhythms in theabsence of sleep deprivation effects (p > 0.04 for the metabolite and p< 0.001 for the synthase, respectively). PGEm showed a trend (p < 0.06)
towards higher levels in the SD condition at night during SD.
Conclusion: The PGD system shows diurnal variation in the absenceof SD changes. Daytime levels were higher than nighttime, despite
continuous wakefulness.

ES-1-4
HUMORAL REGULATION OF SLEEP: PAST,PRESENT AND FUTURE

MR OPP1
Anesthesiology & Pain Medicine, University of Washington, Seattle, WA,
United States of America
1Studies conducted by Ishimori at the beginning of the 20th century
demonstrated that factors accumulated in brain during wakefulness thatinduced subsequent sleep. These initial studies were forgotten as sleep
research during the mid-20th century was dominated by neuroanatomists. In the 1960 s, investigations in the laboratories of Kornmuller,
Monnier, Pappenheimer and Uchizono focused on humoral sleep regulatory mechanisms. Pappenheimer and Krueger demonstrated thatduring prolonged wakefulness factor S, subsequently determined to be
muramyl peptide, increased in brain and could induce deep sleep.
Subsequent studies of sleep factors demonstrated that interleukin-1,
tumor necrosis factor, and prostaglandin D2 were immunomodulatorsthat also were powerful inducers sleep. During the period from 1983
to present, much has been learned of mechanisms by which immunomodulators contribute to the regulation / modulation of physiologicalsleep and in the alterations in sleep during immune challenge. Epidemiological studies demonstrate that chronic insufficient sleep is a risk
factor for hypertension, cardiovascular disease, metabolic syndrome,obesity, insulin resistance and diabetes. Each of these pathologies ischaracterized by inflammation, suggesting that immunomodulators
may be a mechanistic link between chronic insufficient sleep and multiple diseases that plague society today.

ES-2-1OVERVIEW OF STUDIES UTILIZING ANALYSISOF THE TRANSCRIPTOMEAI PACK1
Medicine/Sleep Division, University of Pennsylvania, Philadelphia, PA,
United States of America
1Analysis of changes in the transcriptome with sleep/wake and sleep
deprivation has proven to be a powerful strategy. Knowledge of genes
changing expression with behavioral state has led to hypotheses about
the functions of sleep-synaptic homeostasis, macromolecular synthesisin brain-as well as identifying that sleep deprivation leads to theunfolded protein response in brain. Recently our group has extended
these studies to ask the question whether sleep/wake and sleep deprivation affects gene expression in peripheral organs controlling for diurnal
time (heart and lung), i.e., is sleep only for the brain? There were genesthat increased expression in specific molecular pathways in both organs© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research219

Sleep, Science and Researchwith sleep and different genes in both organs that increased expression
with sleep deprivation. Thus, at a molecular level, sleep is not only forthe brain. Genes changing expression in brain with behavioral state
could do so as a consequence of the state and/or be involved in its
control. High throughput video-based phenotyping strategies to assess
sleep, combined with new mouse resources, can quickly address thisquestion. Currently transcriptome analysis is moving in two new directions. First, RNA seq is being used to assess changes in all genes in the
genome, including small RNAs. About 25% of all genes are not represented in current microarray chips. Second, analysis is moving to studyof identified neuronal populations as well as glia based on novel transgenic animals and utilizing techniques such as manual plucking. Application of these new approaches to the study of changes in thetranscriptome with sleep/wake and sleep deprivation will be described.

ES-2-2
MOLECULAR AND NEUROANATOMICALSIGNATURES OF SLEEP DEPRIVATION

TS KILDUFF1
Center for Neuroscience, SRI International, Menlo Park, CA, UnitedStates of America
1Sleep deprivation (SD) leads to a suite of cognitive and behavioral
impairments, although the molecular consequences of SD in the brain
are poorly understood. Using systematic immediate-early gene (IEG)
mapping to detect neuronal activation, the consequences of SD were
mapped in forebrain regions. SD both induced and suppressed IEG
expression in subregions of neocortex, striatum, and other brain
regions. Laser microdissection and cDNA microarrays were used to
identify the molecular consequences of SD in 7 brain regions. In situ
hybridization (ISH) for 222 genes selected from the microarray data andother sources confirmed that robust molecular changes were largely
restricted to the forebrain. In the neocortex, SD activated gene expression in an areal, layer-, and cell type-specific manner and preferentially
activated excitatory neurons. The neocortex and suprachiasmatic nuclei(SCN) exhibited differential regulation of the same genes such that SD
and Waking-related effects were evident in the neocortex whereas timeof-day effects were evident only in the SCN. Analysis of the ISH datafor 222 genes (publicly accessible at http://sleep.alleninstitute.org) provided a molecular and anatomic signature of the effects of SD. In a
separate set of studies, we identified a population of cortical GABAergic
neurons that express neuronal nitric oxide synthase (nNOS) and also
express FOS specifically during sleep in three different species. FOS
expression in cortical nNOS neurons varies across the diurnal cycle inconjunction with the natural occurrence of sleep; SD experiments
further demonstrate that the extent of activation of these cells is proportional to homeostatic sleep drive. Cortical nNOS neurons receive
subcortical inputs from serotonergic and cholinergic neurons and haveintracortical efferent projections. We propose that cortical nNOS
neurons are critical integrators that link state-dependent afferent inputs
to cortical slow wave activity and the homeostatic response to SD.
[Supported by NIH R01 HL059658].

ES-2-3
INTEGRATIVE ANALYSIS OF GENOME WIDEDATA SETS FOR SLEEP AND CIRCADIANRHYTHMSRC ANAFI1, TK SATO1, J KIM1, AC LIU1, JB HOGENESCH1
1
Division of Sleep Medicine, University of Pennsylvania, Narberth,Pennyslvania, United States of America

The analysis of high throughput data sets requires analytical techniquesthat can highlight important results in a specific biological context.
Understanding of the relevant physiology, and a proper selection of
relevant features and data, can greatly influence the utility of the results.
Our recent work on identifying novel core clock genes through the
integrative analysis of diverse genome-wide data sets provides an illustrative example of one such computational approach. Using naive
Bayesian integration we enumerated key features that characterize corecircadian genes. For each feature we then developed a simple, quantifiable metric that encapsulates it. We combined our own data with previously published data sets to determine how those metrics were
distributed among known clock genes and within the genome at large.
These distributions were used to quantify the total evidentiary support
that a given gene was a core clock component. The output of thisanalysis is a ranking of genes by the probability that they play a role inthe clock. This list, was, as expected, greatly enriched for known coreclock genes. However several novel candidates were identified. In orderto demonstrate the utility of this approach we then experimentally
characterized one novel candidate. Gm129, which we have dubbed
Chrono, demonstrates many features of a core clock gene. Over-expression studies demonstrate that it functions as a Cry1/Cry2 independent
repressor of Clock/Bmal1 mediated transcription. Additional data froma mammalian 2 hybrid screen shows direct physical interactions
between Gm129 and the clock genes Bmal1 and Per2. Knockdown
experiments in the NIH3T3 cellular model system demonstrate a shortperiod phenotype.
Additional examples from the analysis of microarray results relating tosleep deprivation will be used to illustrate the use of unsupervisedmachine learning algorithms and, in particular, the value of looking
beyond standard metrics of differential gene expression.

ES-2-4
USING MICROARRAYS TO IDENTIFY NOVELBIOMARKERS

ES ARNARDOTTIR1, EV NIKONOVA4, KR SHOCKLEY5,
AA PODTELEZHNIKOV4, KQ TANIS4, DJ STONE4, G MAISLIN3,
T GISLASON1,2, J RENGER4, CJ WINROW4, AI PACK2,3
1
Dept of Resp Medicine and Sleep, Landspitali University Hospital, Reykjavik,
Iceland, 2Faculty of Medicine, University of Iceland, Iceland, 3Center for Sleep
and Circadian Neurobiology, University of Pennsylvania, United States ofAmerica, 4Merck Research Laboratories, Westpoint, PA, United States ofAmerica, 5Biostatistics Branch, National Institute of Environmental Health
Science, National Institutes of Health, United States of America
Introduction: The aim of this study was to find changes in gene expression in human blood in response to sleep deprivation and recovery
sleep.
Methods: Fourteen healthy subjects that were relatively resistant tosleep deprivation (low responders) and markedly impaired (highresponders), based on performance in a psychomotor vigilance task
(PVT), were chosen for the study. Blood mRNA expression was measured using microarrays in a normal sleep-wake cycle, 24 hours of sleep220© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

deprivation and 8 hours of recovery sleep. Significance of differencesin gene expression was assessed by multivariate ANOVA model. Selectedcandidate genes were confirmed by qRT-PCR. Biological pathway
enrichment analyses were performed using Target and Gene Identification system (TGI) with correction for multiple comparisons.
Results: 7976 gene transcripts had a circadian rhythm in normal sleepwake cycle (false discovery rate, FDR < 5%). A much higher numberof biological pathways peaked during the day than the night. Only 2
genes changed expression significantly during sleep deprivation (FDR
< 5%), both significantly involved in lipid metabolism. 28 known genes
were suggestive at a less stringent threshold (p < 0.001). Again, thesegenes were involved significantly in lipid metabolism. 31 known genes
could separate high and low responders in sleep deprivation (p <0.001). Further differences were observed in recovery sleep with 131
genes found to differ significantly between normal sleep and recovery
sleep in high responders and two genes in low responders.
Discussion: This is the first study to use peripheral tissue to identify
different human behavioural states. Despite profound circadian signature observed in normal sleep-wake, a small number of genes change
expression in response to sleep deprivation and recovery sleep in blood.
Importantly, individuals resistant to sleep deprivation have some differences in molecular signatures compared to those markedly impaired.
These findings may help further blood biomarker development to successfully monitor healthy or diseased sleep homeostasis.

ES-3-1
ON THE NEURONAL REGULATION OFSLEEP-WAKEFULNESS-NEUROPHYSIOLOGICALAPPROACHES-

tion during waking, and release from the inhibition of these GABAergic
neurons would be a powerful trigger for initiation of REM sleep.

ES-3-2
PHYSIOLOGICALLY BASED QUANTITATIVEMODELING OF SLEEP DYNAMICS
PA ROBINSON1
1
School of Physics, University of Sydney, Camperdown, Australia

Arousal state is largely controlled by the ascending arousal systemof the brainstem, which projects to the corticothalamic system that
produces the commonly observed EEG signatures of arousal state.
Quantitative modeling of sleep-wake dynamics is described, using aphysiologically based model of the brainstem and hypothalamus withrealistic parameters that describe the properties and couplings of neural
populations, accumulation and clearance of homeostatic sleep drive,
circadian and pharmacological influences, and stimuli. After calibration
against a small set of experiments, predictions and analyses of a muchwider variety of phenomena are made. Verifications against numerous
experimental data are described, including normal arousal dynamics,
sleep deprivation and recovery, shiftwork, pharmacological influences,
arousal threshold, sleep latency, and subjective fatigue, some of whichenable quantification of what have previously been subjective measures.
Links to arousal-related EEG changes are then made by coupling theoutput of the ascending arousal system to a physiologically based modelof the cortex and thalamus. Successful prediction of sleep patterns in avariety of terrestrial and aquatic mammals using the same model is also
briefly discussed.

Y KOYAMA1
Department of Science and Technology, Fukushima University, Fukushimacity, Fukushima, Japan

ES-3-3Sleep and wakefulness are controlled by a sophisticated orchestrationof a variety of neural populations. Based upon the clinical studies andclassical brain lesion or stimulation studies in animals, the hypothalamus has been considered to contain sleep and waking centers. Slow
wave sleep is prompted in the proptic area, especially in the ventrolateralpreoptic area (VLPO). Neurons in and around the VLPO become active
during slow wave sleep and with an inhibitory neurotransmitter, GABA,
affect inhibitory influences on the waking active neurons in the waking
centers. For the regulation of wakefulness, the neurons in the hypothalamus and brainstem play a crucial role, including the orexinergic
neurons in the perifornical hypothalamus, histaminergic neurons in theposterior hypothalamus (tuberomammilary nucleus), noradrenergic
neuron in the locus coeruleus and serotonetgic neurons in the dorsal
raphe nucleus. These neurons are most active during waking, decrees
firing during slow wave sleep and completely cease from firing during
REM sleep. In addition, some of the cholinergic neurons in the laterodorsal tegmental nucleus (LDT) and pedunculopontine tegmental
nucleus (PPT) become active during waking as well as during REM
sleep. They would also some roles in the regulation of waking. A pileof evidence, showing that the cholinergic agonist (carbachol) injectedin the mesopontine tegmental area induces REM sleep, have suggested
that the cholinergic neurons in the LDT/PPT have a role in the regulationof REM sleep. Some of the cholinergic neurons in the LDT/PPT are mostactive during REM sleep, least active or almost silent during waking. In
addition to the cholinergic neuron, gulutamatergic neurons ventral to
the LDT are also important for REM sleep. They receive cholinergic
excitation to keep higher firing during REM sleep. These cholinergic
and glutamatergic REM sleep active neurons receive GABAergic inhibi-

CG DINIZ BEHN1
1
Department of Mathematics, Gettysburg College, Gettysburg, PA, UnitedStates of America

1

INSIGHTS FROM MATHEMATICAL MODELINGOF SLEEP-WAKE BEHAVIOR

Mathematical modeling has a rich history of helping to shape the way wethink about sleep. In recent years, advances in experimental investigations have enabled mathematical models of sleep-wake behavior to
become increasingly grounded in the physiology of the system. Thisstrong physiological basis links models to existing data and has thepotential to enhance the impact and utility of these models by allowing
them to generate precise, experimentally testable predictions. Furthermore, mathematical models can provide detailed, dynamic descriptionsof system physiology over time to complement experimental data inwhich the spatial and temporal scope is often necessarily limited byexperimental methodology. In this talk, I will review some of the modeling approaches we have developed to investigate sleep-wake behavior.
Using a modeling formalism based on neurotransmitter-mediated interactions among neuronal populations involved in sleep-wake regulation,
we have examined mechanisms of state transitions, simulated the effectsof localized microinjection of neurotransmitters on sleep-wake behavior,probed interactions between circadian and sleep-wake regulatory
systems, and explored the role of orexin/hypocretin in the production
and maintenance of sleep. I will summarize these results while focusing
on both the ways in which experimental data has been incorporated into
the formulation of these mathematical models and the symbiotic relationship that exists between model predictions and future experiments.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

221

Sleep, Science and ResearchES-3-4FROM FLIP-FLOP TO CYCLES: NEURALREGULATION MECHANISM OF SLEEP-WAKE
STATESM NAKAO1, A KARASHIMA1, N KATAYAMA1
Graduate School of Information Sciences, Tohoku University, Sendai, Japan1

So far, many hypotheses have been proposed on regulatory mechanismof sleep-wake states. They are roughly classified into the following
categories, although their objectives are more or less different from eachother.
(1) Prey-predator dynamics: The reciprocal interaction between cholinergic and aminergic systems is considered to regulate nonREMREM cycle (McCarley and Massaquoi, 1986).
(2) Multiple flip-flops: The regulatory mechanism of sleep-wake states isinterpreted as a multiple flip-flops involving the nuclei in the preoptic hypothalamic area, the aminergic neurons, and the glutamatergic
and GABAergic neurons in the brainstems (Saper et al., 2001).
(3) Neural diagram: The glutamatergic and GABAergic systems in thebrainstem interacting with each other or their cascade are considered to regulate REM generation (Sakai et al., 2001; Luppi et al.,2006). Because (2) and (3) are rather conceptual, their realization
and resulting dynamics are not given. Actually, there have been
many mathematical models produced based on these idea. Mathematical modeling of regulatory mechanism of sleep-wake states
tends to be more focused on circuit implementation to reproduce
physiological phenomena rather than the time scale of state alternation. However, for biological reality what kind of actual process
determines the time scale is essential. A flip-flop or bistable system
is realized by self-excited systems mutually coupled by inhibitory
connections, where excitation may come from external systems.
Formation of flip-flop is not a sufficient condition for alternationof multiple states, but an unstabilizing mechanism of each state is
essential to determine the time scale of state alternation, i.e.,
minutes in rodents and hours in human. Actual determinant factors
for such a slow dynamics are not identified, which have not been
seriously concerned so far. This situation is the same as in (1) and(3). Such slow dynamics cannot be attributed only to neural synaptic interactions. Possible biological processes are discussed fromthe modeling viewpoint.

ES-4-1
AROUSAL-RELATED LAPSES OFRESPONSIVENESS: CHARACTERISTICS,
DETECTION, AND UNDERLYING MECHANISMS

RD JONES1
Neurotechnology Research Programme, Van der Veer Brain ResearchInstitute, Christchurch, New Zealand1

Lapses of responsiveness (‘lapses’) are complete transient disruptions insensory-motor performance. They are a surprisingly frequent phenomenon in healthy subjects – even when not sleep-deprived – and particularly so when engaged in extended monotonous tasks. They are ofparticular importance in the transport, military, and medical sectors inwhich there is a need to maintain sustained attention for extended
periods and in which lapses can lead to multiple-fatality accidents.
Lapses can be broadly divided into four main types:• Sleep events (>15 s) – Extended loss of consciousness.
• Behavioural microsleeps (∼0.5–15 s) – Brief loss of consciousness,with clear behavioural indications of drowsiness.

222• Lapses of sustained attention – Not directly related to level of arousaland can occur when alert, fatigued, or drowsy.
• Lapses of task-orientated attention – Diverted attention.
Our primary focus is on microsleeps, with contributions covering
aspects of behavioural detection and characterization, EEG-based characterization and detection, and determination of the underlying mechanisms in the brain via simultaneous recordings of whole-brain BOLD
fMRI, 64-ch. EEG, eye video, and EOG, while performing a continuous
2-D visuomotor tracking task. In addition to improving our understanding of what happens in the brain during microsleeps, it is hopedthat improved knowledge of the spatiotemporal dynamics of microsleeps
will allow us to substantially improve the early detection, and evenprediction, of microsleeps and to use this as the basis for a non-invasive
early-warning systems with the potential to save many lives.
My talk will (i) provide an introduction to lapses, (ii) overview theirimportance in the real world, (iii) overview what several researchstudies have revealed about microsleeps, and (iv) summarize some of
the remaining challenges in this fascinating and important area.

ES-4-2
CAPACITY LIMITS OF INFORMATIONPROCESSING WHEN SLEEP DEPRIVED

MWL CHEE1
1
Research/NBD, Duke-NUS Graduate Medical School Singapore, Singapore
Our capacity to process information declines when sleep deprived.
Perceptual processing capacity refers to our residual capacity to process
peripheral distractors after processing a central task. Visual short term
memory capacity refers to the number of visual items we can perceiveand remember over a few seconds.
Perceptual processing capacity limitations may not be evident at lower
perceptual load but can be uncovered at higher load using functional
magnetic resonance adaptation. Indeed our ability to allocate attention
to a specific visual category may be compromised during sleep deprivation but the extent to which this occurs relates to the temporal predictability of target appearance. Imaging visual cortex provides a means of
uncovering loss of attentional selectivity, which in turn is a contributor
to impaired cognition in the setting of sleep deprivation.
Visual short term memory is indeed affected by sleep deprivation but
for reasons not obvious from observing behavior. We found deficits inengagement of fronto-parietal activation usually engaged in task performance that suggests a memoranda independent effect on neural activation that can be remedied in vulnerable persons by pharmacologic
means.

ES-4-3
A MOBILE EEG DEVICE FOR ON-LINE
ASSESSMENT OF SLEEP QUALITY

C-T LIN1, L-W KO2,4, H-Y TSAI3, T-P JUNG3,4
1
Department of Electrical Engineering/Brain Research Center, National
Chiao Tung University, Hsinchu, Taiwan, 2Department of Biological Scienceand Technology/Brain Research Center, National Chiao Tung University,
Taiwan, 3Department of Computer Science/Brain Research Center, National
Chiao Tung University, Taiwan, 4Swartz Center for Computational
Neuroscience, University of California San Diego, United States of America
The polysomnography (PSG) which senses multiple physiologicalsignals including EEG, ECG, EMG and EOG signals is a traditional andcommon device used to diagnose the participants sleep problems inclinic. People who have the sleep problem will pre-register to do the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

sleep quality experiment in clinical sleep laboratory. However, longwaiting process and sleep environment adaption are the major challenges for performing the sleep experiment. Even the participant canproceed the sleep experiment in clinic, he/she should wear the traditional PSG system with many cables of the multiple physiologicalsignals and paste of conductive gels on each sensor. These preparation
procedures are quite complicated and time consuming. Also, the participant will feel uncomfortable and not easy to sleep in clinic which
will cause low efficiency of data acquisition and low accuracy of sleep
stage classification. In this study, a mobile and wireless EEG system
which consists of innovative foam-based dry EEG sensors, miniaturizedcircuits and the novel form factor had been developed for EEG signals
acquisition in an arbitrary environment. We further developed an intelligent sleep-stage classification system based on the EEG signals
acquired only through a few forehead EEG sensors. Experimental
results show that the classification accuracy of the proposed system isclose to the performance of the clinical PSG system. The best advantageof the developed sleep-stage classification system using the mobile andwireless EEG is that people can easily don and doff the EEG device withgreat comfort to do the self-evaluation of sleep quality at home.

ES-5-1NARCOLEPSY AND IDIOPATHIC HYPERSOMNIAM HONDA1
Psychiatry and Behavioral Sciences, Sleep Research Project, Tokyo
Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
1

Narcolepsy and Idiopathic Hypersomnia are main sleep disorders categorized in Hypersomnia of Central Origin, in which the primary causeof daytime sleepiness is not disturbed nocturnal sleep or misaligned
circadian rhythms. The fundamental symptom is excessive daytime
sleepiness (EDS) defined as the inability to stay awake and alert during
daytime, resulting in unintended drowsiness or lapses into sleep.
Typical narcolepsy (with cataplexy) and typical idiopathic hypersomnia(with long sleep time) have their characteristic symptoms not only in
EDS (short refreshing naps and long nap with awakening difficulty) but
in the other features such as cataplexy in narcolepsy and sleep drunkenness in idiopathic hypersomnia.
The pathologic mechanism underlying peculiar narcolepsy symptoms(summarized as sleep wake phase fragmentations and dissociated REM
sleep manifestations) are now explained well as the instability of sleep
state switching model based on the hypocretin/orexin deficiency innarcolepsy, which is used as a diagnostic biomarker of narcolepsy withcataplexy. Various clinical characteristics of idiopathic hyperosomnia aredescribed, such as autonomic dysfunction, frequent fatigue and preference of evening chronotype. But none of them are pathognomonic nor
explain the disease pathophysiology. Idiopathic hypersomnia remains
to be a diagnosis of exclusion.
There exist similar but not typical hypersomnia patients and ICSD2
employ operational diagnostic procedures on these cases, defining narcolepsy without cataplexy and idiopathic hypersomnia without long
sleep time according to the number of sleep onset REM periods during
MSLT. Whether these criteria form independent clinical entities or not
awaits further validation study.
Treatments include pharmacological and non pharmacological intervention, such as an instruction for daily life style. Stimulant is effective inmost narcolepsy patients but not predictable in idiopathic hypersomnia
patients. Clinical course (onset and prognosis) is studied in narcolepsy
but not well known in idiopathic hypersomnia.

ES-5-2SYMPTOMATIC NARCOLEPSY AND
HYPERSOMNIAS NISHINO1, K TAKASHI2
1
Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA,
United States of America, 2Department of Neuropsychiatry, Akita
Univesity, Japan
Narcolepsy symptoms can also occur during the course of other neurological conditions (i.e., symptomatic narcolepsy). In our recent meta
analysis, 116 symptomatic narcolepsy cases reported were analyzed. As
several authors have previously reported, inherited disorders (n = 38),
tumors (n = 33), and head trauma (n = 19) are the three most frequentcauses of symptomatic narcolepsy. Although it is difficult to rule out
the comorbidity of idiopathic narcolepsy in some cases, literature
review reveals numerous unquestionable cases of symptomatic narcolepsy. These include cases with HLA negative and/or late onset andcases where the occurrence of narcoleptic symptoms runs parallel withthe rise and fall of the causative disease. Notably, the review of thesecases (particularly those with brain tumors) clearly illustrates that the
hypothalamus is most often involved.The same review also lists about
70 symptomatic excessive daytime sleepiness (EDS) cases associatedwith these neurological conditions. Prevalence of symptomatic EDS is
likely much higher. For example, several million USA subjects suffered
chronic brain injury, 75% experienced sleep problems, and about 50%
among them reported sleepiness. In the current talk, involvements of
the hypocretin system in symptomatic narcolepsy and EDS will be
discussed. We will also report unique EDS cases occurring in the courseof MS patients with symmetrical hypothalamic inflammatory lesions,which together with hypocretin ligand deficiency, contrasts with thecharacteristics of classic MS cases, but share the clinical characteristicsof neuromyelitis optica.

ES-5-3KLEINE-LEVIN SYNDROME

I ARNULF1
Sleep Disorder Unit, Pitie-Salpetriere Hospital, Paris, France

1

Kleine Levin syndrome (KLS) is a rare encephalitis (1 per million)
characterized by relapsing-remitting episodes of hypersomnia plus cognitive and behavioral disturbances. Patients are mostly male (68%) andadolescents (81%), with mean onset at 15 years. The first episode istriggered by an infection in 72% of patients. Patients experience anaverage of 7 to 19 episodes of 10 to 13 days each, relapsing every 0.5
to 12 months. Episodes recur more quickly in patients with childhood
onset. The median disease course is 8–14 years, with longer course inmen, in patients with hypersexuality, and when onset is after age 20.
During episodes, all patients have hypersomnia and heavy fatigue (withsleep lasting 15 to 21 h per day), cognitive impairment (apathy, confusion, slowness, amnesia) and a specific feeling of derealization (dreamy
state, altered perception). Less frequently, they experience megaphagia(66%), hypersexuality (53%), depressed mood (53%), hallucinations
and photo/phonophobia. Patients have normal sleep, vigilance, mood,and eating attitude between episodes, but may have increased bodymass index and mild attention problems. Structural brain imaging, CSF
and serological inflammatory markers are normal. EEG slowing is
notable in 70% of cases during episodes. Sleep structure varies fromhypersomnia with initial decrease in slow wave sleep then in REM sleep,
to hypo-arousal with low sleep efficiency. The brain scintigraphy may
show hypoperfusion of the frontal, temporal internal and angular gyrus© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

223

Sleep, Science and Researchareas during and between episodes. Factors of vulnerability include
birth and developmental problems, Jewish heritage and genetics (5%multiplex families). The association of KLS with HLA DRB1*201, foundin a small series, is not replicated in a larger independent sample. Thereis no increased family history for neuropsychiatric disorders. Somestimulants (amantadine, but rarely modafinil and amphetamines) andmood stabilizers (lithium, valproate) have a moderate efficacy.

3) Light’s acute alerting response depends on its capacity to suppress
endogenous melatonin levels during the biological night.
Thus, melatonin’s soporific and chronobiotic properties make it an
optimal candidate for treating sleep, in addition to circadian rhythm
disorders.

ES-5-4

EFFECTS OF RAMELTEON ON TEMPERATURE
AND SLEEP PHYSIOLOGY DURING CIRCADIANMISALIGNMENTHYPERSOMNIA ASSOCIATED WITH
MOOD DISORDERS

N YAMADA1
1
Department of Psychiatry, Shiga University of Medical Science, Otsu,
Shiga, Japan
Insomnia is recognized as an essential aspect of mood disorders. Insomnia is included in diagnostic criteria for major depressive episode in
DSM-IV-TR. Many reports have suggested the potential causal role ofinsomnia in the development of depression in patients who have noprevious history of depression and in predicting relapse in patients withdepression in remission. Decreased need for sleep (e.g., feels rested after
only 3 hours of sleep) is one of the criteria for manic episode in bipolar
disorders. On the other hand, epidemiologic data suggest hypersomnia
is present in 10–14% of patients with various mood disorders. Some
research reported that hypersomnia is more indicative of bipolar thanunipolar depression. Particularly, hypersomnia is one of the importantcriteria for seasonal affective disorder. In this lecture, we focus primaryon the observable sleep-wake disturbance in the manic and depressed
phases in patients with bipolar disorder and secondary on the fundamental etiological agent in mania. From the observation, total sleep timeand early morning awaking are thought to be important predictors of
future manic episodes.

Industrial symposia
IS-1-1
INTERACTION OF MELATONIN AND LIGHT ON
WAKE & SLEEP EEG AND THERMOREGULATIONC CAJOCHEN1
Psychiatric University Clinics, Centre for Chronobiology, University ofBasel, Switzerland
1

Pineal melatonin is primarily a neuroendocrine transducer of external
time (i.e. light dark cycle) promoting an increased propensity for “darkappropriate” behavior. The most unequivocal characteristic of endogenous melatonin is its utility to be used alone or in combination withcore body temperature as a phase marker of the endogenous circadianpacemaker located in the suprachiasmatic nuclei. However, there arethree major reasons, which imply that melatonin could also play animportant role in the regulation human sleep-wake behavior:
1) The endogenous melatonin rhythm exhibits a close temporal association with the endogenous circadian component of the sleep propensity rhythm and thermoregulation.
2) There is evidence that exogenous melatonin is able to induce sleep
when the homeostatic drive to sleep is insufficient, to inhibit thedrive for wakefulness emanating from the circadian pacemaker andto induce phase shifts in the circadian clock such that the circadianphase of increased sleep propensity occurs at a new desired time.

224

IS-1-2

KP WRIGHT JR.
Department of Integrative Physiology, University of Colorado, Boulder,
United States of America
Abstract not arrived.

IS-1-3
MELATONIN AND MELATONIN RECEPTORAGONIST IN THE TREATMENT OF CIRCADIANRHYTHM SLEEP DISORDERS

M UCHIYAMA1
1
Department of Psychiatry, Nihon University School of Medicine, Tokyo,
Japan

Circadian rhythm sleep disorders (CRSD) are conditions in which sleep
timing fails to be synchronized with the internal or external environment. While CRSD associated with shift work or jet lag is a consequenceof socially evoked acute sleep misalignment relative to the circadianpacemaker, chronic CRSDs including delayed or advanced sleep phasetype (ASPT or DSPT), and non-entrained type (NET) are featured bychronic sleep misalignment caused by an improper entrainment of thecircadian pacemaker. In the chronic CRSD, entraining the patient’s circadian pacemaker properly relative to the external environment is thegoal of the treatment, i.e., a timed bright light exposure, or a timed
administration of melatonin or its receptor agonists (MRA). Melatonin’s
efficacy on CSRD is based on its phase-resetting property as a functionof a phase response curve (PRC). In healthy subjects a melatonin administration in the early evening induces a phase advance and that in theearly morning produces a phase delay. Since the initial demonstrations
that a 5-mg or 10-mg dose of melatonin reset circadian rhythms inpatients having DSPT or NET, many case reports as well as a few placebocontrolled trials have confirmed its efficacy administered in the early
evening. Recently, lower doses (0.5 mg) of melatonin administered daily
in the early evening was reported to be equally or even more effectivein entraining the blind patients with NET. After the recent introductionof ramelteon, a MRA, in the medical practice of insomnia, a significant
phase-shifting effect in forced bedtime-advance experiments has beenreported when a smaller dose (a half or quarter tablet) was administered.
The greater efficacy of melatonin and MRA in relatively smaller doses inthe treatment of CRSD may be interpreted as providing a more discreet
temporal signal to the circadian pacemaker than higher doses. In addition to the systematic review mainly on DSPT and NET, I propose theuse of MRA in the treatment of other types of CRSD.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

IS-1-4RAMELTEON’S EFFECTS ON INSOMNIAG MAYER1
Department of Neurology, Hephata Klinik, Philipps-Universität, Marburg,
Germany1

Hypnotic effects of melatonin and melatoninergic drugs are mediatedvia MT1 and MT2 receptors. They differ fundamentally from GABAergic
hypnotics. Melatoninergic agonists enhance sleep initiation and resetthe circadian clock to phases allowing persistent sleep. Ramelteon is
rapidly taken up, reaching Tmax between 0.75 and 0.94 h. Its half-lifein the circulation amounts to about 1 to 2 h which is much longer thanthat of melatonin (20–30 min). The metabolite M-II has a half-life 2 to
5 h longer can reach concentrations that are 20- to 100-fold higher thanramelteon.
Ramelteons effects on sleep in insomnia patients has been shown insubjective and objective sleep parameters (polysomnography) in shortand long term studies. At doses of 4 or 8 mg it reduces sleep onset
latency, improves total sleep time and sleep efficiency/sleep quality. Thishas been demonstrated in several double-blind, placebo controlled
studies on a total of more than a thousand adult or elderly subjects withprimary chronic insomnia. All the effects were statistically significant,but the improvements of sleep maintenance remained moderate. No
further improvements are obtained with 16 and 32 mg. However, due
to the high affinity for both receptors, higher long life, and the longterm effect of the M-II metabolite, the effect on sleep maintenance isbetter than that of other melatonergic drugs.
Ramelteon does not cause next-day hangover, sedation, withdrawal
effects, insomnia rebound, tolerance or dependence, and cognitive
impairment. It does not induce behavioural changes, as sometimes
observed with non-benzodiazepine receptor antagonists. Taken during
the daytime it causes drowsiness and therefore should be taken at theright circadian time at evening/night. In COPD patients with insomnia
it does not affect respiratory parameters and improves sleep efficiency
and number of nocturnal awakenings.
Despite otherwise good tolerability, its use in children, adolescents, andduring pregnancy has not been studied enough, and should be avoided.
It should not be applied in patients with immunological diseases. Inhibitors of CYP1A2 may raise ramelteon levels.

IS-2-1AN INTERNATIONAL SURVEY ON QUALITYOF-LIFE AND UTILITY SCORES IN CHRONICINSOMNIACS COMPARED TO GOOD SLEEPERS
OF JAPAN, FRANCE AND UNITED STATESOF AMERICAD LÉGER1
1
Centre du Sommeil et de la Vigilance de l’Hôtel Dieu de Paris, Université
Paris Descartes. APHP., PARIS, France
Context: Chronic insomnia has a recognized impact on health-related
quality-of-life (HRQoL) but data on utility scores across countries arelacking.
Objective: To assess HRQoL and utility scores in people with chronic
insomnia compared to good sleepers in three countries (USA, France,
and Japan).
Design: Cross-sectional survey (SLEEPI-i) of 4067 persons in the US(n = 1298; 478 good sleepers and 820 patients with insomnias), France(n = 1858; 998 good sleepers and 860 patients with insomnias) andJapan (n = 911; 506 good sleepers and 405 patients with insomnias).

Enrollment and data collection using consumer panels were web-basedin the US and France, and via a postal survey in Japan. People withchronic insomnia (>6 months) were selected based on Insomnia Severity Index scores (ISI).
Method: Severity of insomnia was assessed using the ISI score and
HRQoL was assessed using the self-administered Short-Form SF-36
Health Survey. Utility scores were derived using the algorithm developed by Brazier et al. Multivariate analyses were used to adjust forpotential confounding factors.
Results: In all countries, people with chronic insomnia (40% treated)
reported lower SF-36 scores in each of eight domains compared withgood sleepers (P < .0001). Chronic insomnia was associated with significantly lower utility scores compared with good sleepers (meanscores 0.63 versus 0.72 in the US, 0.57 versus 0.67 in France and 0.67
versus 0.77 in Japan, P < .0001).
Conclusion: This survey suggests that chronic insomnia is associatedwith significant impairment of HRQoL and decreased utilities whichwere similar across the different geographical regions studied.

IS-2-2GUIDELINE FOR THE EVALUATION AND
MANAGEMENT OF CHRONIC INSOMNIA:
USA PERSPECTIVE

P Zee1
Neurology and Sleep Medicine, Northwestern University, Chicago, Illinois,
United States of America
1

Insomnia is a highly prevalent health problem, with nearly 50% of the
US adult population reporting symptoms of insomnia and 10–15%
having chronic insomnia. Insomnia is often co-morbid with a myriadof medical and psychiatric disorders. Insomnia is also associated withdecreased productivity and increased risk of accidents. A recent study
on insomnia and work performance of US workers concluded that
insomnia is associated with substantial workplace costs, equivalent toannualized population-level estimates of 252.7 days and $63.2 billion.
The personal, clinical and socioeconomic implications of untreatedinsomnia are substantial.
There is undoubtedly a need for practical clinical guidelines to assist
health care professionals, particularly in primary care to diagnose andtreat patients with insomnia. In 2008, an evidence and consensus based
clinical guideline for the evaluation and management of chronic insomnia in adults was published in the US. An innovative aspect of thisguideline is the multiple tiered approach to both the evaluation andmanagement that considers the chronic nature of insomnia, the fact that
biological and behavioral/environmental factors are involved, and thatpatients may have several concurrent insomnia diagnoses.
How these approaches can be tailored for special populations such as
the elderly and those with co-morbid disorders is an important area fordevelopment. The recent advances in the understanding of the neurobiology and behavioral mechanisms underlying insomnia disorders canidentify specific insomnia phenotypes, which in turn will lead to more
precise diagnosis and personalized approaches for the management of
insomnia to improve global health.
Kessler RC et al. Insomnia and the performance of US workers: resultsfrom the America Insomnia Survey. SLEEP 2011;34(9):1161–1171
Schutte-Rodin S et al. Clinical guideline for the evaluation and man­agement of chronic insomnia in adults. J Clin Sleep Med
2008;4(5):487–504
Bloom HG, et al. Evidence based assessment and management of sleep
disorders in older persons. JAGS 2009 May;57(5):761–89© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

225

Sleep, Science and ResearchIS-2-3
IMPORTANCE OF SLEEP TO SUPPRESSCARDIOVASCULAR EVENTS AFTER THE
GREAT EAST JAPAN EARTHQUAKEK KARIO1
Division of Cardiovascular Medicine/School of Medicine, Jichi Medical
University, Shimotsuke,Tochigi, Japan
1

The magnitude 9.0 Great East Japan Earthquake that hit Tohoku in thenortheast region of the main island, Honshu, on March 11, 2011, wasfollowed by a devastating tsunami that has taken lives of 20,000 or
more people. After the earthquake, cardiovascular diseases (CVD) wereobserved about twice much, particularly during sleep period. The 2
major mechanisms of the earthquake-induced CVD are hypertension
and thrombotic tendency caused by stress, poor sleep quality, and highsalt intake. Poor sleep and disrupted circadian rhythm increase salt
sensitivity through sympathetic activation and increased aldosterone
synthesis. High salt intake as well as increased salt sensitivity causes
new-onset of hypertension after the earthquake.
To better assess and reduce risks for disaster-associated CVD, we developed the web-based Disaster Cardiovascular Prevention (DCAP)
network on the basis of previous evidences of The Great Hanshin Awaji
Earthquake occurred 16 years ago (Kario, et al. J Am Coll Cardiol
1997;29:926–33. Hypertens Res 2003;26:355–67) and have begun to
implement it in the survivors of the Great East Japan Earthquake (Kario,
Nishizawa, et al. Lancet 2011, Sept 1). Rapid assessment by the DCAP
network demonstrated that insomnia and unrecognized hypertension
were the most frequent diseases among the suffered people.
Recent studies demonstrated that insomnia (both reduced sleep duration and poor sleep quality) is a new risk factor of hypertension and
CVD. Poor sleep quality is particularly important leading cause of
nocturnal hypertension with disrupted circadian rhythm of blood pressure (BP) (non-dipper and riser patterns). Treatment of insomnia
reduces high BP and restores disrupted circadian rhythm of BP particularly in patients with uncontrolled morning hypertension.
To control hypertension is essentially important for effective preventionof CVD in forthcoming winter season. The “Good sleep”, defined byadequate sleep period and improved sleep quality, and salt restriction
are especially important for synergistic protection against CVD in stressful conditions.

IS-2-4
MAKING JAPANESE CONSENSUS REPORT ON
THE MANAGEMENT OF INSOMNIA IN GENERAL
PRACTICEM UCHIYAMA1, Y INOUE2, N UCHIMURA3, R KAWAHARA4,
M KURABAYASHI5, K KARIO6
1
Department of Psychiatry, Nihon University School of Medicine, Tokyo,
Japan, 2Department of Somnology, Tokyo Medical University, Japan,
3
Department of Neuropsychiatry, Kurume University School of Medicine,Japan, 4Sportology Center, Juntendo University Graduate School of
Medicine, Japan, 5Department of Medicine and Biological Science, Gunma
University, Japan, 6Division of Cardiovascular Medicine, Department ofMedicine, Jichi Medical University School of Medicine, Japan

It has been widely documented that most patients with insomnia first
consult a general practitioner. Thus, various kinds of hypnotics areprescribed mainly by general practitioners or non-sleep-medicine expert
physicians. A study using Japanese insurance data revealed that about
70% of hypnotic prescriptions were made by non-specialists. However,226

most general physicians seem to be unaware of both the potential morbidity associated with insomnia and the importance of sleep health. In
addition, most people having sleep problems do not tell their primary
physicians about the problems. Thus, we carried out a project to establish a comprehensive consensus report on the management of insomnia
aiming at standardization of optimal treatments in general practice. In
2009, board members (BMs), consisting of 3 sleep medicine experts and3 other non-sleep medicine expert physicians, conducted a survey to
explore the information that clinicians actually need in the clinical practice of insomnia. Based on the survey, the board members selected the
10 most important topics and asked 11 expert clinicians (topic investigators: TIs) with different specialties to review and establish the statement
for each topic. In December 2009, the BMs, the TIs and other specialists
gathered to discuss and determine the contents of the consensus report.
Professor Phyllis C. Zee joined the meeting as an advisor. After a peer
review by specialists outside the panel, the consensus report was finallyconfirmed by the BMs in July 2010 and submitted to a journal. A comprehensive index summary as a synopsis of the final statements is asfollows: 1) Significance of insomnia treatment, 2) Insomnia to be treated,
3) Goal of the insomnia treatment, 4) Appropriate sleep hygiene education, 5) Strategy for hypnotics treatment, 6) Drug therapy for insomnia
in the elderly, pregnant women and children/adolescents, and 7) Diagnostic and therapeutic strategy of insomnia in general practice. We
expect that this review paper will contribute to the advancement of the
management of insomnia in general practice.

IS-3-1SLEEPINESS AND SAFETY: WHERE BIOLOGYNEEDS TECHNOLOGYDF DINGES1
Department of Psychiatry, University of Pennsylvania Scvhool of Medicine,Philadelphia, Pennsylvania, United States of America
1

Humans remain the root cause of 50% to 90% of all operational failuresand disasters. Sleepiness and the neurobehavioral consequences of
inadequate sleep contribute to this human error rate, because modern
industrialized economies use time as an expendable commodity, requiring more people to be awake more of the time, and thereby frequently
exceeding the biological limits on safe human performance. Time use
studies indicate that time for compensated work and travel are two
major reasons people sleep less. This trend is likely to continue toincrease in modern societies as the global population expands to 7
billion and beyond. Although the biological dynamics of human sleepiness and its effects on performance are increasingly understood, the useof technology to predict, prevent, detect and intervene before humanerror occurs is a relatively new area, but one of great promise for managing sleep/fatigue-related risk. This talk will review the growth of humanactivity relative to biological limits on safe human performance; thenature of human performance deficits as sleepiness increases; andrecent technology development initiatives from the transportation,
security and aerospace domains designed to help humans avoid sleepiness/fatigue-related catastrophic errors. These technologies range from
(1) prediction of vulnerability to sleepiness and of the timing of sleepiness; (2) brief objective probed assessments of sleepiness; and (3)online, real time continuous evaluations of sleepiness-alertness. Promising examples of these approaches for rapidly detecting sleepiness in theworkplace and will be discussed, along with the challenges to bringing
these technologies forward relative to individual behaviors and social
policies and attitudes.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

IS-3-2
NIGHT WORK SLEEPINESSTG Akerstedt1
1
Stress Research, Stockholm University, Stockholm, Sweden
Night work is associated with an increased accident risk often attributed
to sleepiness. This attribution is based on inference in the sense thatsleepiness normally results from activity at the circadian trough or fromreduced sleep or, frequently, from both. Rarely, however, is sleepinessactually measured in relation to accidents, near accidents, or corresponding situations. Here we present data showing physiological indications of physiological sleepiness during night work in, as well as
subjective reports of sleepiness. Sleep intrusions is seen during work atnight and subjective reports reach very high levels. Sleepiness seems tobe the major problem in shift or night work (much more so than sleep
problems). Night shift levels at the end of the night shift reach levels
like those after one night of total sleep loss. Morning shift levels of
sleepiness are similar to those of mid-night shift levels or those after aweek of 4 h sleep per day or those seen in burnout patients. In a seriesof studies of driving on rural roads and motorways we have described
the levels of sleepiness reached and related this to measures such as
unintentional line crossings and driving interrupted because of dangerous sleepiness. The results indicate that shortly before driving is interrupted reported sleepiness is increased to very high levels (corresponding
to those seen just before driving off the road in a simulator) and sleepiness intrusions in the EEG and EOG increase., as well as blink duration.
About 40% of normal drivers reach high danger levels. Finally, night or
morning work are seen as major overall problems by around 14% of
those exposed in a national representative sample (N = 4000), but thatis only in the middle of the ranking list of problem prevalence (lowinfluence on work hours, short leadway, short time off between shifts
are the worst factors). However, night work is seen as the leading riskin terms of health, sleepiness and impaired risk.

IS-3-3children under the age of four or among adults over the age of 19. A
somewhat weaker increase has occurred in Sweden. In China an
increase of childhood narcolepsy in 2010 has been related to H1N1
infection contrary to Finland where the link seems to be with the adjuvanted vaccine and not with the H1N1 infection. No link has beenfound with vaccines without adjuvants. Recent findings about thechanges in incidence of narcolepsy will be discussed during thecongress.

IS-3-4
ACCIDENTS RISK IN SLEEP DISORDERSY INOUE1, Y KOMADA1,2
Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo,
Tokyo, Japan, 2Department of Somnology, Tokyo Medical University, Japan1

Sleep disorders are not uncommon and have been widely reported
throughout the world. They have a profound impact on industrialized
24-h societies. Consequences of sleep problems include impaired socialand recreational activities, increased human errors, loss of productivity,and elevated risk of accidents. Conditions such as behaviorally induced
insufficient sleep syndrome, CNS hypersomnias, shift-work, jet lag, andsleep apnea warrant public health attention, since daytime sleepinessdue to these sleep disorders may affect performance of daily activities
such as driving a car. The increased risk seems to relate with thesymptom severity of excessive daytime sleepiness, and many studies
have shown a clear dose-response relationship with respect to the severity of respiratory disorder indices in OSAS to the driving risk. Treatmentof sleep apnea with nasal continuous positive airway pressure appears
to reduce the risk of traffic accidents to the one of the general population, but the effects of wakefulness-promoting drugs on driving ability
is limited. The countermeasures for excessive daytime sleepiness are
effective only in the cases with acute sleep loss. There is a need for asocial awareness program to educate the public about the potential
consequences of various sleep disorders in order to reduce the numberof sleep-related traffic accidents.

EPIDEMIOLOGY OF DAYTIME SLEEPINESSM Partinen1
Helsinki Sleep Clinic, Vitalmed Research Centre & University of Helsinki,
Helsinki, Finland
1

Excessive daytime sleepiness (EDS) is a frequent complain in modern
society. As an average the prevalence is between 5% and 15%. In sleep
clinic populations sleep apnea is the most common cause followed bynarcolepsy. An increase has been noted recently in some countries. The
prevalence of narcolepsy varies between 20 and 50/ 100,000 persons.
The highest figures are from Japan (160 to 590/ 100,000) and the lowest
from Israel. Using the Ullanlinna Narcolepsy Scale (UNS) the prevalence
is between 15 and 34/ 100,000. The incidence of narcolepsy is estimated to be 0.74/ 100,000 person-years for narcolepsy with cataplexy
and 1.37/ 100 000 for narcolepsy with or without cataplexy. In Finland,
during 2002 to 2009 the annual incidence has been around 0.8/
100,000 inhabitants (95% confidence interval 0.6–1). The averageannual incidence among subjects under 17 years of age has been 0.3/
100,000. In 2010 in subjects aged 4 to 16 years there was an increasein the incidence to 5/ 100,000. Among adults over 20 years of age theincidence rate in 2010 was 0.9/100,000, which equals the average
incidence figure in 2002–2009. The increased risk associated with vaccination amounted to 6/ 100,000 vaccinated persons in the 4 to 19 age
group during 8 months after vaccination. The risk of a vaccinatedperson, aged 4 to 19, was 12.7 times the risk of an unvaccinated person(www.thl.fi). No increased incidence of narcolepsy was observed among

IS-3-5
MOVEMENT DISORDERS IN NARCOLEPSYYA DAUVILLIERS
Department of Neurology, Gui de Chauliac Hospital, Montpellier
University, Montpellier, France
Narcolepsy with cataplexy (NC) is a chronic disease characterized byexcessive daytime sleepiness, striking transitions from wakefulness into
rapid eye movement (REM) sleep, typically associated with cataplexy
and other phenomena due to the abnormal occurrence of REM sleep
elements during wakefulness (sleep paralysis and hallucinations) andfrequent sleep/wake transitions. Nocturnal sleep in NC is usually disturbed by a large cohort of phenomena: vivid frightening dreams,
several nocturnal awakenings, REM sleep behavior disorder (RBD),
periodic leg movement (PLM), obstructive sleep apnea (OSA), sleeprelated eating disorders and other parasomnias. Frequent abnormalities
in both NREM and REM sleep motor regulation result in dissociatedsleep/wake states. Higher abnormalities in REM sleep motor regulation
were reported with an increased frequency of REM sleep without
atonia, phasic EMG events and PLMS in narcoleptic patients whencompared to controls. A higher prevalence of RLS was found in NC
but with a moderate severity, together with a higher frequency of PLMS
and PLMW with an association between the presence of PLMS andmeasures of REM sleep and daytime functioning disruption. PLMS

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

227

Sleep, Science and Researchdisplayed specific features in idiopathic restless legs syndrome and narcolepsycataplexy respectively, with narcolepsy-cataplexy with restless legs
showing an intermediate pattern. Motor dyscontrol in narcolepsy is not
restricted to sleep, involving also wakefulness with the presence of
cataplexy and the increase in periodic leg movements index. Moreover,recently pediatric cases of NC have been reported with a co-occurencewith a complex movement disorder at disease onset, a phenomenon
that may vanish later in the course of the disease. The coexistence ofNC and several motor dysfunctions suggest a common neurobiologicaldefect of motor inhibition. Further studies are warranted to assess
clinical course and whether the associated movement disorder isalso caused by hypocretin deficiency or by additional neurochemical
abnormalities.

of desaturation rather than AHI or ODI. Plasma thioredoxin (a biomarker of oxidative stress) and plasma adiponectin (an adipokine)
correlated with both IH and SH. These findings suggest that IH and SH
can affect different pathways and biomarkers that are related with cardiovascular complications in patients with OSA. We would discussdifferent aspects of IH and SH in OSA, based on our clinical studies.
In addition, we would also show some of our cellular experiments ofhypoxia exposure.

IS-4-1VY Polotsky1
Division of Pulmonary and Critical Care Medicine/Department ofMedicine, Johns Hopkins University School of Medicine, Baltimore, MD,
United States of America

IS-4-3
MOLECULAR EFFECTS OF OBSTRUCTIVE SLEEPAPNEA: SUMMARY AND PERSPECTIVES

1

METABOLIC RISK OF SLEEP APNEANM Punjabi1
Division of Pulmonary and Critical Care Medicine, Johns Hopkins
University, Columbia, Maryland, United States of America
1

Abstract not arrived.

IS-4-2
EFFECTS OF INTERMITTENT HYPOXIA ON
SEVERAL PARAMETERS FOR CARDIOVASCULARRISK FACTORSK Tanizawa1, K Chin2
1
Graduate School of Medicine, Department of Respiratory Medicine, Kyoto
University, Kyoto-city, Kyoto, Japan, 2Graduate School of Medicine,
Department of Respiratory Care and Sleep Control Medicine, Kyoto
University, Japan
Pathophysiology of obstructive sleep apnea (OSA) is characterized byrepeated events of intermittent hypoxia (IH), sleep fragmentation andarousals. Chronic IH consists of ischemia and reperfusion periods, andischemia/reperfusion injury can produce oxidative stress. IH is a pathologic phenomenon that is characteristic of OSA, while sustained hypoxia(SH) is observed in normal physiological processes. In vitro, IH causes
different effects on cells, compared to SH. In mice, chronic IH increases
atherosclerotic changes in combination with high cholesterol diet, andcauses insulin resistance in lean mice, independent from autonomic
nervous system. Among clinical parameters of OSA, apnea hypopnea
index (AHI) and oxygen desaturation index (ODI) represent IH, while% time of desaturation SH. We have investigated the relationshipbetween these OSA parameters and several cardiovascular and metabolic biomarkers in OSA patients, and compared between the effects of
IH and those of SH. We revealed that plasma ghrelin, a biomarker ofobesity was associated with AHI or ODI rather than % time of desaturation. Platelet aggregability was also related with IH but not SH. In
contrast, the heme oxygenase-1/bilirubin pathway, which can be
induced by various stresses including hypoxia was related with % time

228

Obstructive Sleep Apnea (OSA) causes intermittent hypoxia (IH), sleep
fragmentation, hypercapnea, and intrathoracic pressure swings. Most of
the molecular effects of OSA have been attributed to IH. Moleculareffects of IH can be classified as systemic and tissue-specific. Systemic
effects to large extent are governed by activation of sympathetic nervous
system resulting in hypertension, exuberant hepatic gluconeogenesis
and adipose tissue lipolysis with ensuing increases in free fatty acids(FFA). Excess of free fatty acids impairs insulin signaling resulting ininsulin resistance and activates NF-kappa B resulting in systemic
inflammation. Tissue specific effects of IH have been described in the
different areas of the brain, heart, pancreas, liver, arterial wall andadipose tissue and attributable to oxidative stress with activation of
NADPH oxidase and hypoxia inducible factor 1 (HIF-1). Of note,
HIF-2, which is up-regulated by sustained hypoxia, is inactivated by
IH. Oxidative stress in different areas of the brain induces hypersomnolence and memory deficit. Excessive production of reactive oxygen
species up-regulates NF-kappa B increasing synthesis of pro-inflammatory cytokines TNF alpha, IL-6, IL-8, adhesion molecules and leukotrienes, and activating renin-angiotensin system and secretion ofendotheline. IH up-regulates a transcription factor of liver lipid biosynthesis sterol regulatory element binding protein 1 and a downstream
enzyme stearoyl coenzyme A desaturase 1, which causes hepatic steatosis and hyperlipidemia. In adipose tissue, IH increases biosynthesis of
leptin and angiopoietin-like protein 4 (Angptl4), while insulin sensitizer
adiponectin is decreased. Angptl4 inactivates a key enzyme of lipoprotein clearance, lipoprotein lipase which also leads to dyslipidemia.
Finally, up-regulation of HIF-1 in the liver and adipose tissue may leadto tissue fibrosis. Thus, multidimensional effects of IH may cause a
cognitive dysfunction, atherosclerosis, non-alcoholic steatohepatitis,
insulin resistance and type 2 diabetes.

IS-4-4
CARDIOVASCULAR AND METABOLICCONSEQUENCES OF OBSTRUCTIVE SLEEPAPNEA: MECHANISMS
P Levy1
Physiology, Grenoble University, Grenoble, France

1

In the past two decades, obstructive sleep apnea (OSA) has been identified as a common clinical condition. Epidemiological studies have confirmed a high prevalence of the disease in middle-aged adults.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

OSA is associated with marked cardiovascular and metabolic morbidities, leading to a significant increase in mortality. Sympathetic activation, oxidative stress and systemic inflammation have been shown tobe the main intermediary mechanisms associated with sleep apnea andintermittent hypoxia. There are now convincing data regarding theassociation between hypertension, arrhythmias, stroke, coronary heartdisease, increased cardiovascular mortality and OSA. Data in OSAmodels and animal models are now available that support the link
between sleep apnea and atherosclerosis and dysmetabolism. The desaturation-reoxygenation sequence is a typical pattern that is coupled witha majority of respiratory events and thought to be responsible for mostof the associated cardiovascular morbidity. This sequence leads to oxidative stress and the production of reactive oxygen species (ROS).
Numerous studies have reported increased oxidative stress using
various biological markers, although comorbidities such as diabetes,
hypertension or obesity may account for part of these results. The
increased levels of ROS contribute to generation of adhesion molecules,
activation of leukocytes and production of vascular and systemic
inflammation. All these mechanisms are presumably responsible for
vascular endothelium damage. They have been extensively studied inintermittent hypoxia model in rodents and more recently in normal
volunteers.

IS-5-1
GENETIC UNDERPINNINGS OF VENTILATORYCONTROLKP STROHL
Professor of Medicine, Department of Medicine, Division of Pulmonary,Critical Care and Sleep Medicine, University Hospitals of Cleveland, Case
Western Reserve University, Cleveland, OH, United States of America
Abstract not arrived.

IS-5-2OSA PHENOTYPE AND BREATHING
IRREGULARITYM YAMAUCHI1, H KIMURA1
Department of Respiratory Medicine, Nara Medical University, Kashihara,
Nara, Japan1

In polysomnography, each single apnea is classified into three groups,
obstructive apnea, central apnea, and mixed apnea according to thepresence of respiratory effort. Sometimes we see these three types of
apnea coexisting during a night; however we diagnose by which typeof apnea is predominant. Thus, if most of the respiratory events are
obstructive apnea and/or mixed apnea, it would be OSAS, and if central
apnea can be seen frequently we diagnose it as CSAS. Cherniack hassuggested in 1979 that the interaction of respiratory output to the upper
airway and diaphragm may determine the expression of apnea types,
such as central and obstructive. Thus, individuals may manifest apneas
with both obstructive and central components. The relative proportionof these components would depend on individual factors, which may
be genetic or secondary to a medical condition. With this concept, wehave been focusing on resting breathing pattern variability during wakefulness since we consider resting breathing might be not only a window
to explore the central respiratory control system, but also a new tool todistinguish clinically important OSAS phenotypes. In this session, first,
we will present that irregular breathing during wakefulness and poor
adherence to CPAP were seen in mixed apnea dominant OSAS which
is one of the particular phenotypes of OSAS. Second, we will introduce
the possibility of breathing irregularity as a marker for CPAP acceptancein patients with obstructive apnea dominant OSAS (pure OSAS).

IS-5-3MECHANICAL PROPERTIES AND COMPENSATORYNEUROMUSCULAR RESPONSES OF THE UPPER
AIRWAY IN OBSTRUCTIVE SLEEP APNEA

T Ayuse1
1
Department of Clinical Physiology, Nagasaki University Graduate Schoolof Biomedical Sciences, Nagasaki, Japan

Obstructive sleep apnea (OSA) is characterized by repetitive obstructionof the upper airway that results in recurrent hypoxemia and arousal
from sleep and increases in cardiovascular morbidity and mortality.
Upper airway obstruction during sleep can result from alterations ineither the passive structural pharyngeal properties or from disturbancesin neuromuscular control. When the neural mechanisms are depressed
under sleep, the sequential interaction between anatomical balance andcompensatory neuromuscular response against upper airway obstruction become the key factors controlling upper airway patency during
sleep.When the upper airway first obstructs, the upper airway musculature remains in a relatively hypotonic or passive state. Initially, mechanoreceptor activity in airway pressure receptors and pulmonary stretch
receptors can produce immediate alterations in respiratory timing inexperimental animals and sleeping humans. Recent evidence suggeststhat a prolongation of the inspiratory duty cycle can help stabilize
ventilation during periods of upper airway obstruction. Thereafter,
upper airway obstruction can elicit compensatory neuromuscularresponses that can mitigate the obstruction during spontaneous breathing in sleeping and anesthetized subjects. As upper airway obstruction
persists, disturbances in gas exchange ensue, leading to increases inupper airway neuromuscular activity, improvements in airway patency
and greater ventilatory stability (active state). When compensatory
mechanisms are inadequate to stabilize ventilation, upper airway
obstruction often terminates in an arousal from sleep and the prompt
restoration of upper airway patency. The main issue of this presentation
is to summarize the current understanding of mechanisms for maintaining upper airway patency during sleep and anesthesia and discusses thedevelopmental aspects of the mechanisms, based on the quantitative
analysis of upper airway collapsibility using the concept of inspiratory
flow limitation.

IS-5-4
THE NEUROBIOLOGY OF OBSTRUCTIVESLEEP APNEAL KUBIN1
Department of Animal Biology, University of Pennsylvania, Philadelphia,
PA, United States of America
1Structural features of the upper airway are the root cause of the obstructive sleep apnea (OSA) syndrome but the interaction between the neuralmechanisms that promote sleep with those that control breathing isultimately responsible for the perturbed breathing because OSA patients© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research229

Sleep, Science and Research

generate adequate ventilation when awake. During wakefulness, OSA
patients have elevated upper airway muscle tone when compared tohealthy individuals. This elevation is likely caused by: (1) reflex activation by more negative than in healthy persons inspiratory airway pressure; and (2) enhanced tonic, wake-related drive relayed to upper
airway motoneurons from a host of sources that are collectively referred
to as the wakefulness stimulus for breathing. To date, excitatory effectmediated by norepinephrine and serotonin have been positively identified in animal studies as major mediators of the wake-related drive toupper airway motoneurons. In animals with fully patent upper airway,these drives decline gradually from a maximal level during active waketo total abolition during rapid eye movement sleep. In cats, endogenous
serotonergic drive predominates, whereas in rats, norepinephrine has astronger endogenous excitatory effect. Other state-dependent neurochemicals that excite upper airway motoneurons include histamine,
acetylcholine and orexin, but their endogenous effects remain to be
characterized. In rats subjected to moderate chronic-intermittent
hypoxia (CIH) for 35 days, sprouting of noradrenergic terminals occurs
in the hypoglossal (XII) motor nucleus which innervates the genioglossus muscle, a major upper airway dilator, and XII motoneurons exhibit
enhanced immunoreactivity for alpha1-adrenergic receptors. In anesthetized rats pre-treated with CIH, antagonism of these receptors reveals
an enhanced endogenous noradrenergic drive to inspiratory-modulated
XII motoneurons. Collectively, these findings suggest that CIH contributes to the adaptive increase in wakefulness of upper airway muscle
tone in OSA patients. [Support: HL47600, HL-71097.]

IS-6-1RESTLESS LEGS SYNDROME: CLINICALASPECTS, COMORBIDITY AND TREATMENTOPTIONSL FERINI-STRAMBI
Associate Professor, Director Sleep Disorders Center, Department of
Neuroscience, Università? Vita-Salute San Raffaele, Italy
Abstract not arrived.

IS-7-1
AUGMENTATION AND COMPLICATIONS DUETO DOPAMINE THERAPYB HOGL1
Department of Neurology, Schlaflabor und Spezialambulanz fur
Schlafstorungen University, Innsbruck, Austria
1

The most relevant complication of dopamine therapy in RLS is augmentation. It is characterized as an overall worsening of symptoms despite
therapy. According to current augmentation criteria, RLS is paradoxically worsened or improved (sometimes) despite increasing or reducingof dopaminergic drug dose respectively. Alternative criteria for augmentation include earlier temporal onset of symptoms by four hours
without / or by two hours with additional occurrence of other features.
Augmentation has been observed around 15 years ago, but early reports
used different definitions, were based on case reports or retrospective
case series only. Later, augmentation was described in up to 60% of
l-dopa treated patients (Hogl B, 2010), and in up to 30% of dopamineagonist treated patients. Only recently, prospective double-blind trials
were performed with appropriate testing for augmentation. Results are
difficult to compare because of varying durations of the studies, different methods to assess augmentation, etc. The longest available controlled trial of RLS therapy with (retrospective) assessment ofaugmentation by experts was performed with rotigotine. It showed a
low augmentation rate of 13.2% over 5 years (Oertel W, Lancet Neurol2011). Reports from clinical populations treated for up to 10 years
showed that during ongoing treatment with persistent response, nevertheless in the majority of patients, some more or less subtle signs ofevolving augmentation can be present (Allen R, Sleep Med 2011). Clinicians should carefully evaluate dopaminergically treated RLS patientsfor evolving signs of augmentation, and try to reduce the risk for augmentation by keeping the dose low and iron body stores non-depleted.
Other complications of dopaminergic treatment, such as gambling havebeen observed also in RLS. Patients should be warned and regularly
questioned for any symptoms of impulse control disorders. Daytime
sleepiness and involuntary sleep onset may occur rarely in RLS, but
overall ESS improved with dopaminergic treatment due to the improvement of sleep (Kallweit 2009).

IS-7-2PATHOPHYSIOLOGY OF RLS FROM GENETICRESEARCH PERSPECTIVE

IS-6-2CURRENT DIAGNOSTIC AND MANAGEMENTSTRATEGIES OF RESTLESS LEGS SYNDROME IN
UNITED STATESCA KUSHIDA
Professor, Med Center Line, Psychiatry & Behavioral Science, Stanford
Sleep Medicine Center, United States of America
Abstract not arrived.

230

J MONTPLAISIR1
Centre d’Etude du Sommeil, Hopital du Sacre-Coeur de Montreal,Montreal, Quebec, Canada
1

There are major controversies with regard to the localization of theneural structures and the nature of neurotransmitters involved in thephysiopathology of RLS. Neuroimaging studies and therapeutic results
obtained with opioids and L-dopa and the detrimental effect of antihistamine have led to neuropharmacological hypotheses regarding thephysiopathology of RLS PLMS. Studies of brain iron and RLS consistently found significant abnormalities supporting the putative conceptthat a brain iron deficiency causes RLS in many patients.
On the other hand, there are substantial evidences for a genetic contribution to RLS. Twin studies showing higher concordance rate in monozygotic than dizygotic twins, familial aggregation of RLS with strong
percentage of positive family histories, multigenerational pedigrees withmultiple affected individuals and increased sibling risk for RLS support
genetic contribution. The significant familial aggregation of RLS has© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

encouraged linkage analyses of large multiplex families. Several loci for
RLS have been mapped in RLS families supporting the view that RLS
is a genetically heterogenous complex trait, but no causative genes andmutations have been identified in the linked families. Association
studies have also looked at candidate genes for RLS. Genes related to
dopaminergic transmission (D1 to D5 receptors, tyrosine hydroxylase,
dopamine-B-hydroxylase) were first investigated but no association was
found. Genome-wide association study of RLS provided robust evidenceof the presence of common sequence variants in four candidate loci/genes strongly associated with unrelated RLS cases: MEIS1, BTBD9,MAP2K5 and PTPRD on chromosomes 2p, 6p and 15q, respectively,
associated with a more than 50% increase in risk for RLS. The link
between these genetic mutations and the physiopathology
of RLS is largely unknown but a recent study has shown that RLSassociated MEIS1 risk variant influences iron metabolism.

IS-7-3OVERVIEW OF CURRENT RLS THERAPY WITH
DOPAMINE AGONISTSW OERTEL1, D VADASZ1, K STIASNY-KOLSTER1, K EGGERT1,V RIES1
1
Department of Neurology, Philipps University Marburg, Marburg,
Germany

Restless legs syndrome (RLS) is a “sleep-movement-pain”-disorder witha prevalence of 2%–10(caucasian)%. The diagnosis is clinically achievedby asking 4 specific questions. The severity of RLS is assessed by theInternational RLS Study Group Severity Scale (IRLS). It consists of 10questions each with a numerical value of 0–4 (4 = worst). For intermediate (IRLS > 15) to severe (IRLS = 20–30) RLS, the internationallyrecognized first line pharmacotherapy for RLS are dopamine agonists– and according to expert opinion also for mildly affected RLS patients.
3 non-ergot dopamine agonists-pramipexole, ropinirole and rotigotine– are approved in various markets for RLS-based on numerous “Evidence based Medicine class I” trials – with an effect size of at least 6
points in the IRLS. These clinical efficacy data are supported by objective measures (i.e. reduction in PLM – or arousal index) obtained indouble blind placebo controlled polysomnographic studies. In comparison to their use in Parkinson’s disease, in RLS non-ergot dopamineagonists are employed at a dosage of a factor of 3 to 4 times less. They
are well tolerated in RLS. Augmentation, a long term complication in
RLS and considered to be occur under short acting dopaminergic
therapy such as L-dopa, appears to occur less with long acting dopamine agonists (Trenkwalder et al., 2008). This statement has received
support from a recently published study of 295 patients with severe
RLS, who received transdermal (24 hour patch delivery) rotigotine overa 5 year open label follow up period. 126 patients completed the trial.
39% of patients who completed the trial were classified as “symptom
free (RLS remitter − IRLS = 0)”. Clinically significant augmentation
under a therapy of 1–3 mg rotigotine/day was reported to be 5.1%
during the 5 years (Oertel et al., 2011). In summary, non-ergot dopamine agonists are the pharmacotherapy of choice for RLS. (Trenkwalder
et al. Mov. Disord 2008; Oertel et al Lancet Neurol 2011).

IS-7-4RESTLESS LEGS SYNDROME IN ENDSTAGE
RENAL DISEASEY INOUE1,2
Japan Somnology Center, Neuropsychiatric Research Institute, Japan,
2
Department of Somnology, Tokyo Medical University, Tokyo, Japan

1

Undoubtedly, restless legs syndrome (RLS) is one of the common symptoms in patients with endstage renal disease (ERSD), and the prevalenceof the disorder has been estimated at 20 to 60% of ESRD population.
Of note, although the prevalence of RLS in general population is clearlylower in Asia compared with Western countries, the rate is quite similar
between the countries, suggesting that RLS in ESDRD occurs beyond
racial difference. When evaluating the prevalence of RLS among eachrenal dysfunction category, the rate becomes higher among the cases ingrade 3 or above, and sharply rises in grade 5 (=ERSD). Moreover, it
has been known that RLS symptoms in most of ERSD patients disappear
shortly after renal transplantation. Considering these, accumulation of
uremic toxin to a certain amount can be hypothesized to be responsible
for the occurrence of RLS, but a candidate toxic substance has not beenfound to date. In clinical settings, severity of RLS symptom and consequent nocturnal insomnia in ERSD patients is likely to be higher thanthose in patients with idiopathic RLS, and the former group accompanies larger amount of periodic limb movements during sleep comparedwith the latter group. As for treatment, dopaminergic drugs are thought
to be the first line in uremic RLS similar with idiopathic RLS. However,the drugs which are eliminated from kidney should be contraindicatedin ESRD patients. In addition, we should consider the drug which can
suppress RLS symptom both in nocturnal period and periods while
undergoing haemodialysis when the symptom is likely to become
worse.

IS-7-5
RLS-RELATED NEUROPATHY

K HIRATA1
1
Department of Neurology, Dokkyo Medical University, Shimotsuga-gun,
Japan
Restless legs syndrome (RLS) is characterized by a desire to move theextremities, often associated with paresthesias or dysesthesias, motor
restlessness, worsening of symptoms with rest with relief by activity,
and worsening of symptoms in the evening or night. Numerous formsof neuropathy, including hereditary, diabetic, alcoholic, amyloid, motor
neuron disease, poliomyelitis, and radiculopathy, have been associatedwith RLS.
Investigating the association between RLS and neuropathy, however, theassociation between RLS and peripheral neuropathy remains
controversial.
On the other hand, aging deeply influences several morphologic andfunctional features of the peripheral nervous system. Morphologic
studies have reported a loss of myelinated and unmyelinated nerve
fibers in elderly subjects, and several abnormalities involving myelinated fibers.
Polydefkis et al reported that 36% of RLS patients neuropathy was
identified. Three patients had pure large-fiber neuropathy (LFN), two
had mixed LFN and small sensory fiber loss (SSFL) and three had
isolated SSFL. The SSFL group had a later onset of RLS (p < 0.009),
reported pain in their feet with RLS more frequently (p < 0.001), andtended to have no family history of RLS (p < 0.078). Patients with LFN
did not have similar associations with age at onset, family history status,© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

231

Sleep, Science and Researchor presence of pain. They conclude that the results suggest that two
forms of RLS exist. Thus in some case of a later onset or aged RLS may
have neuropathy as a co morbidity due to aging. Therefore, for later
onset or aged RLS not only dopaminergic drugs but also drugs forneuropathy such as pregabaline should be considered as a therapeutic
drug.

Abstract symposia
AS-1-1COGNITIVE BEHAVIOR THERAPY FOR
INSOMNIA IMPROVES SLEEP AND DECREASESPAIN IN OLDER ADULTS WITH CO-MORBIDINSOMNIA AND OSTEOARTHRITISMV VITIELLO1
1
Psychiatry and Behavioral Sciences, University of Washington, Seattle,
WA, United States of America

Fully a quarter of older adults experience significant and chronic osteoarthritis (OA) pain and co-morbid insomnia. This co-morbid pain andinsomnia has significant negative impact on physical function and on
quality of life and can result in depression, impaired cognitive function
and increased healthcare utilization and related costs. Chronic pain
initiates and exacerbates sleep disturbance, and disturbed sleep in turn
maintains and exacerbates chronic pain and related dysfunction. Sinceboth OA pain and sleep disturbance are common among older adults,
and adversely affect physical function, quality of life, and health carecosts, there is a compelling rationale for integrated management of bothpain and sleep in OA. The likely reciprocal effects of pain dysfunction
and sleep disturbance suggest potential benefits of such an integrated
approach. In a secondary analysis of a well conducted CBT for insomnia(CBT-I) trail in older adults with co-morbid OA and insomnia we demonstrated that CBT-I treated OA subjects had both significantly improved
sleep and reduced pain both post treatment and at one year follow-up
relative to attention control OA subjects; despite neither treatment
condition including any pain management information. This preliminary finding as well as our ongoing randomized clinical trial, Cognitive
Behavioral Therapy for Arthritis Pain and Insomnia in Older Adults(LIFESTYLES) testing the effectiveness of an integrated cognitive behavioral therapy for pain and insomnia (CBT-PI) intervention versus a
cognitive behavioral therapy for pain (CBT-P) intervention and an education only attention control (EOC) in a large sample of older adults
with co-morbid OA and insomnia drawn from a primary care population will be discussed.

AS-1-2
THE ROLE OF SELF-HELP CBT-I IN THE
MANAGEMENT OF INSOMNIA SYMPTOMSASSOCIATED WITH CHRONIC DISEASE

could offer a low-cost, first-line treatment option within a stepped caremodel. This presentation examines the utility and limitations of selfhelp approaches to insomnia management among older people withinsomnia associated with long-term conditions.
Method: In a single centre, pragmatic, 2-arm randomized controlled
trial, 98 participants who received a manualized program of supported
self-help cognitive behavioral therapy for insomnia (CBT-I) were compared with 95 participants receiving treatment as usual (TAU). Participants were: aged 55–87; diagnosed with a chronic condition; andreporting insomnia symptoms (as defined by DSM-IV-TR). The primary
outcome was sleep quality, measured by the Pittsburgh Sleep Quality
Index (PSQI). Secondary outcomes were the Insomnia Severity Index(ISI), the subjective sleep efficiency index, the Fatigue Severity Scale(FSS), and the Brief Pain Inventory.
Results: Self-help CBT-I improved sleep quality and sleep efficiency,
and reduced insomnia severity and sleep medication use; it did not,however, impact fatigue or pain severity.
Conclusion: This trial supports the use of simple, manualized self-help
in a stepped-care model for patients with comorbid insomnia
symptoms.

AS-2-1SEASONAL CHANGES OF OBSTRUCTIVE SLEEPAPNEA SYNDROME (OSAS) IN CHILDREN
M Nakayama1
Good Sleep Center, Nagoya City University, Nagoya-city, Japan

1

Pediatric obstructive sleep apnea syndrome (OSAS) is a disorder inchildren characterized by recurring episodes of upper airway complete
and/or partial obstruction during sleep, resulting in intermittent hypoxemia and hypercapnia, frequent awaking and sleep pattern breaks.
At present, polysomnography provides the gold-standard tool forevaluating the presence and severity of OSAS in children The pathophysiology of pediatric OSAS is multifactorial, with enlargement of thelymphoid tissues of Waldeyer’s ring contributing to abnormalities of
craniofacial/pharyngeal structure and coordination of upper airway
tone. In addition, pediatric OSAS may be implicated pathophysiologically by allergies and respiratory viruses. However, its seasonal distribution has been rarely reported. This study population, 554 cases
comprised children from the Good Sleep Center, Nagoya City University Hospital and the Toyohashi Mtes Sleep Disorder Center, during theperiod January 2003 to June 2011 for an assessment of their need fortreatment because of nighttime snoring, apneas, or difficult breathing.
Children with known genetic syndromes, craniofacial anomalies, neurologic disease, upper airway anomalies, any underlying disease predisposing to upper airway obstruction, asthma, or perennial allergy were
excluded. All cases received polysomnography, and the rusults diveded
to the months of the day when they received examination. Significant
differences of seasonal changes were found in children under six years
old. Since adenotonsillectomy is the most common treatment for theage children, careful diagnosis should be accomplished with consideration of seasonal distribution.

K MORGAN1
1
Sleep Research Centre, SSEHS, Loughborough University, Loughborough,Leics, LE11 3TU, United Kingdom of Great Britain and Northern Ireland
Introduction: Aging-related increases in sleep symptoms are closely
associated with chronic diseases which both increase with age andsubstantially elevate the odds of persistent insomnia symptoms. Selfhelp approaches, based on the principles of CBT for insomnia (CBT-I),

232© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

AS-2-2AS-3-2

VASCULAR DYSFUNCTION IN CHILDRENWITH OBSTRUCTIVE SLEEP APNOEA: IS IT
ONLY OBESITY?

NON-VISUAL EFFECT OF LIGHT AND SLEEP:NEW FINDINGS FROM THE STUDIES IN
CHILDREN AND MELANOPSIN GENEPOLYMORPHISM

AM LI1,2
Department of Paediatrics, Prince of Wales Hospital, The Chinese
University of Hongkong, Midview City, Singapore, 2Department ofPaediatrics, The Chinese University of Hong Kong, China
1

Obstructive sleep apnoea (OSA) is a common condition in children,and is characterized by repeated episodes of complete and or partial
upper airway obstruction during sleep resulting in gas exchange disturbances, frequent arousals and distortion of sleep architecture. There isrobust scientific literature to suggest that if the condition is left
untreated, significant complications like neurocognitive dysfunction,
insulin resistance and hypertension could result. Of particular interest
and clinical importance are the cardiovascular sequelae that may
develop in children with OSA. These sequelae not only exert an immediately significant effect on cardiovascular health during childhood, but
may also affect cardiovascular outcomes later during adult life. With therecent global epidemic of childhood obesity, the association between
obesity, OSA and risk for cardiovascular diseases is even more difficult
to ascertain, since subjects with either of these disorders often havecommon risk factors for cardiovascular complications. In this lecture,
the author will share with you research on the association between
childhood OSA and cardiovascular complications that have thus far
been described with reference to the confounding factor of obesity.

AS-3-1NON-VISUAL LIGHT RESPONSES IN HUMANS

JJ GOOLEY1
1
Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical
School, Singapore
Exposure to light at night resets circadian rhythms and inhibits synthesis of the sleep-promoting hormone melatonin. These non-visual light
responses are mediated by melanopsin-containing retinal ganglion cells.
Melanopsin cells are most sensitive to short-wavelength blue light but
also receive input from rod and cone photoreceptors. In the first partof my talk, I will present evidence that visual photoreceptors contribute
substantially to non-visual light responses at the beginning of light
exposure and at low irradiances, whereas melanopsin is the primarycircadian photopigment in response to long-duration light exposureand at high irradiances. In the second part of my talk, I will discuss theimpact of exposure to room light at night on melatonin regulation. In
a series of laboratory studies, we found that exposure to room light
before bedtime suppressed melatonin strongly, resulting in a later melatonin onset in about 99% of individuals. Hence, chronically exposing
oneself to electrical lighting in the late evening disrupts melatoninsignaling and could therefore potentially impact sleep. Our findings alsosuggest, however, that appropriately timed exposure to room light, orlight therapy that optimizes stimulation of melanopsin and visual photoreceptors, could potentially be used to treat circadian disruption, witheffects similar to exposure to bright polychromatic white light.

S HIGUCHI1
Department of Human Science, Kyushu University, Fukuoka, Japan1

Human in modern society are surrounded by many factors which
disturb circadian rhythm and sleep. Light is the most powerful synchronizer of the human circadian clock. Although exposure to morning lightreset human circadian rhythm to 24 hours, light at night delays circadian rhythm. Other than the effect on circadian rhythm, light hasvarious effects such as effects on melatonin secretion, alertness, andpupillary light response. These effects are called “non-visual effects” or“non-image forming effects”, are induced by light signals projecting to
the hypothalamus in the brain. It is known that there are large individual differences in these physiological responses to light. The researchers have shown that the light-induced melatonin suppression might beinfluenced by many factors such as age, light history, season, andethnics. In recent our study, we found that children was more sensitive
to light-induced melatonin suppression than adults. In modern society,sleep time in children has been decreasing and sleep timing has been
also delaying. Although it is unclear that the causal relationship between
light at night and delayed bed time in children, we should pay more
attention to the lighting environment for children. As another new
finding, we found that single nucleotide polymorphism of melanopsin
gene (OPN4) was associated with pupillary light response and sleep
timing. This finding suggests that individual difference in non-visual
response to light affects human circadian rhythm and sleep timing. We
might have to consider lighting environments for individuals.

AS-4-1
A CROSS-NATIONAL COMPARISON OF TEENSLEEP BETWEEN AUSTRALIA AND THE U.S.:
THE ROLE OF SCHOOL START TIME, PARENTAL
LIMIT-SETTING AND EXTRA-CURRICULAR
ACTIVITIESMA SHORT1, MS GRADISAR1, HR WRIGHT1, LC LACK1,
MA CARSKADON2
1
School of Psychology, Flinders University, O’Halloran Hill, Australia,
2
Department of Psychiatry and Human Behavior, E. P. Bradley Hospital,
United States of America

Study aims: To test whether cultural differences in school start times,
parental involvement in setting bedtimes and extra-curricular commitments explain the difference in total sleep time on school nights
between adolescents in Australia and the U.S.
Participants: 385 adolescents aged 13–18 years (X = 15.6, SD = 0.95;
60% male) from Australia and 302 adolescents aged 13–19 years (X =16.03, SD = 1.19; 35% male) from the United States.
Methods: Adolescents completed the School Sleep Habits Survey
during class time, followed by an 8-day Sleep Diary.
Results: After controlling for age and sex, culture explained a significant 12.1% of the variance in sleep duration. Australian adolescents
obtained an average of 47 minutes more sleep per school night thanthose in the U.S. There were significant differences between the twocountries on all mediator variables. Australian adolescents were more
likely to have a parent-set bedtime (17.5% vs 6.8%), start school later© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research233

Sleep, Science and Research(8:32am vs 7:45am) and spend less time on extra-curricular activities(1h37m vs 2h41m) than their U.S. peers. These mediators were significantly associated with sleep duration, with parent-set bedtimes, laterschool start times and less hours spent on extra-curricular activities
being associated with more total sleep. After controlling for mediatorvariables, culture still explained a significant, but smaller 5.5% of thevariance in school night sleep duration, consistent with partial
mediation.
Conclusions: In addition to biological factors, extrinsic cultural factors
significantly impact upon the sleep of adolescents. The present study
highlights the importance of considering a comprehensive, ecologicalapproach to adolescent sleep.

AS-4-2
A CROSS-CULTURAL COMPARISON BETWEEN
AUSTRALIAN AND DUTCH ADOLESCENTS,
THAT RELATES CHRONIC SLEEP REDUCTION
TO SLEEP MEASURES AS WELL AS TO SCHOOLPERFORMANCEJF DEWALD1, M SHORT2, M GRADISAR2, AM MEIJER1
Research Institute of Child Development and Education, University of
Amsterdam, Amsterdam, Netherlands, 2Department of Psychology, Finders
University, Australia
1Sleep problems and its severe negative consequences on daytime functioning have worldwide been reported. Still, very little research is donethat compares these relationships in cross-cultural studies. Althoughadolescents often experience insufficient and poor sleep, sleep variables
such as total sleep time do not account for individuals sleep need andsleep debt and may be an inadequate representation of adolescents’sleep problems and its daytime consequences. This problem can beovercome by measuring chronic sleep reduction. Besides, by measuring
symptoms of chronic sleep reduction, individual sleep need and sleep
debt can be taken into consideration. We aim to investigate whether
chronic sleep reduction and its relationship to subjective (surveys, sleep
diaries) and objective (actigraphy) sleep variables as well as to school
performance are comparable in Dutch and Australian adolescents. Subjective sleep variables were measured with surveys and sleep diaries offive school nights. Sleep of the same five nights was monitored withactigraphy. School performance was assessed with self-reports. Similar
relationships between chronic sleep reduction, sleep variables andschool performance were found in both samples, indicating that these
relationships are culturally independent. Chronic sleep reduction was
associated with a higher sleep need, less time spent in bed, shorter sleep
durations (diary), and longer sleep onset latencies. Interestingly, total
sleep time and sleep efficiency (actigraphy) were not related to chronic
sleep reduction in both samples. School performance was related tochronic sleep reduction, whereas the relationship between grades andother sleep variables was weak or absent. This cross-cultural comparison shows that sleep problems and their relationship with school performance seem to be culturally independent phenomena. Furthermore,
our results highlight the idea that chronic sleep reduction may be agood indicator of adolescents’ insufficient and poor sleep than othersleep variables such as total sleep time.

234

AS-5-1
CLINICAL SIGNIFICANCE OF PHASE
DETERMINATION OF MELATONIN RHYTHMSFOR THE TREATMENT OF CIRCADIAN RHYTHMSLEEP DISORDERS

M ENOMOTO1, K SHINGO1, H AKIKO1, N KENTARO1, K YUICHI1,
K YASUKO1, M KAZUO1
1
Department of Psychophysiology, National Institute of Mental Health,National Center of Neurology & Psychiatry, Kodaira, Tokyo, Japan
Both the circadian and homeostatic processes contribute to sleep timing
and sleep structure in humans. Circadian rhythm sleep disorders(CRSD) are characterized by misalignment of endogenous circadianrhythms with the desired or required time for sleep. Reliable estimateof circadian rhythm phase is essential for effective diagnosis and treatment of circadian rhythm sleep disorders. The onset of melatoninsecretion under dim light conditions (dim light onset melatonin;
DLMO) is one of the most reliable and feasible markers for assessing
the circadian pacemaker and determination of most favorable timing
for exogenous melatonin administration in the treatment of CRSD.
According to the phase response curve (PRC) to melatonin, which
nearly forms a mirror image of the PRC to light, exogenously administered melatonin in the early evening could induce circadian phaseadvance and contribute to the treatment of CRSD with delayed sleep
phase type or non-entrained type. Sleep phase per se can’t be a reliable
alternative marker to DLMO due to large inter-individual variation ofinterval between sleep onset and DLMO as well as presence of internal
desynchronization. Using saliva for assessing melatonin levels is relatively non-invasive and acceptable diagnostic method even for childpatients. An additional advantage of salivary DLMO determination isthat patients can collect saliva samples at home setting by themselves.
In this study, we applied salivary DLMO monitoring at home startingat 6 hours before usual sleep onset time for patients with CRSD, andestimated the efficacy of DLMO-based melatonin therapy for them. We
discuss the usability of salivary DLMO monitoring in the clinical settings and the favorable timing of exogenous melatonin administration
for the treatment of CRSD.

AS-5-2
CLINICAL PRACTICE OF CIRCADIAN RHYTHMSLEEP DISORDERST KITAJIMA1
Department of Pychiatry, School of Medicine, Fujita Health University,
Toyoake, Aichi, Japan
1

Circadian rhythm sleep disorders (CRSDs) are serious conditions,which are consist of being unable to adapt internal circadian rhythms
to socially determined light-dark schedules, and are often linked tophysical and psychological disturbances and social maladaptation.
Especially, delayed sleep phase disorder (DSPD) brings major clinicalproblems to many adolescents and young adults. Weitzman and colleagues firstly described this condition in 1981, and so far various
clinical methodologies have developed as assessments and treatments
for endogenous CRSDs; however, they still have much to be evolved.
Firstly, there are some assessment tools such as sleep diary, actigraphy,
the Morningness-Eveningness Questionnaire, endogenous melatoninmeasurement, and core body temperature measurement; however eachof them has substantial limitations in the clinical use. Secondly, thetreatments such as exogenous melatonin administration, bright light
exposure and chronotherapy have been applied for CRSDs, but they

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

have still insufficient evidences except for melatonin. Additionally, otherinterventions that strengthen the social cues, such as behavioral therapy
or environmental therapy with temporal hospitalization, have scarcely
studied. Thirdly, there are some other problems with the comorbid
psychiatric disorders. Many psychiatric patients show sleep-wakerhythm disturbance, and it has been considered that the remission of
the primary psychiatric condition should also lead to the resolution of
the secondary sleep problems. However, residual sleep-wake rhythm
disturbance often seems to affect the course of the comorbid psychiatricdisorders conversely, and also prevents the patients from returning tosocial activities; therefore, some chronobiological interventions may
also be needed for this condition. In this symposium, I would like topresent the overview of these clinical practices of CRSDs, and thendiscuss their future directions.

AS-6-1CRANIOFACIAL COMPARISONS BETWEENASIAN AND CAUCASIAN PATIENTSWITH
OBSTRUCTIVE SLEEP APNEAAA LOWE1, YH LIU1
1
Department of Oral Health Sciences, Faculty of Dentistry, The Universityof British Columbia, Vancouver, BC, CanadaThis study was designed to compare two groups of adult men from Asianand Caucasian ethnic backgrounds with obstructive sleep apnea who
were selected by matching age, gender, skeletal pattern, body massindex, and respiratory disturbance index. Pretreatment cephalometricradiographs and overnight polysomnograms of 30 Chinese and 43 Caucasian patients with Class II, Division 1 malocclusions were analyzed toinvestigate if there were craniofacial and upper airway structural differences between the two ethnic groups. The Chinese group, when compared with the group of Caucasian patients, revealed more severe
underlying craniofacial skeletal discrepancies with significantly smaller
maxilla and mandibles, more severe mandibular retrognathism, proclined lower incisors, increased total and upper facial heights, andsteeper and shorter anterior cranial bases. However, no significant differences were found between the two groups in posterior facial height,
ratio of upper to lower anterior facial height, and the position of hyoidbone, maxilla, and upper incisors. With regard to soft tissue and upper
airway measurements, there were no significant ethnic differences intongue and soft palate size, vertical length of oropharynx, and anteroposterior dimensions of the upper airway at most of the levels except fora larger super-posterior airway space, a larger nasopharynx and oropharynx cross-sectional area, and a smaller tongue height in the Chinesegroup. There appear to be a number of craniofacial and upper airway
structures that differ between the two groups that may be relevant to thetreatment of obstructive sleep apnea in various ethnic populations.

size of the craniofacial rigid enclosure (formed by the dentitions, cervicalvertebrae, maxilla, and mandible) and the amount of soft tissue (e.g.
tongue) influences the upper airway space and is involved in the pathogenesis of OSA (Tsuiki et al. 2008, Isono 2009). In this study, we investigated whether this anatomical balance was different between races in
OSA people. Blind measurements of tongue cross-sectional area and craniofacial dimensions were performed two dimensionally through lateralcephalograms in 78 Japanese patients with OSA and 63 Caucasian OSA
subjects after matching gender (male), age, and apnea hypopnea index.
Sagittal tongue size, sagittal maxillomandibular dimensions, and bodymass index (BMI) were compared between the groups. While BMI was
significantly higher in Caucasians than in Japanese patients (p < 0.001),
tongue size (p = 0.27) and maxillomandibular dimensions (p = 0.46)
were not different between the races. These findings suggest that anatomical balance does not differ between Japanese OSA people and Caucasian OSA persons under the same OSA severity. [Support: JSPS
21406033].

AS-7-1
INTERACTION OF SEXUAL AND SLEEPPROBLEMS RELATED TO EPILEPSY ABSTRACTSYMPOSIA: EPILEPSY RESEARCH: OVERALLOUTCOMES RELATED TO SLEEPML Andersen1, AA Tathiana1, SA Fulvio2, CA Esper2,
T Sergio2
1
Department of Psychobiology, Universidade Federal de Sao Paulo, Sao
Paulo, SP, Brazil, 2Department of Neurologia Experimental, Universidade
Federal de So Paulo, Brazil
Epilepsy affects approximately 1–3% of the global population, including men and women of all ages, with different levels of severity. Sexual
life is particularly impaired in patients with epilepsy. However, it isdifficult to clearly differentiate the specific impacts of the disease fromthe impact of antiepileptic drugs on sexual function. The aim of thisstudy was to evaluate sexual behavior of adult male rats in an experimental model of epilepsy. Initially, the animals were exposed to nine
training sessions to acquire sexual experience. After this training period,
the same rats were given pilocarpine to induce seizures (350 mg/kg i.p).
Once the animals had a stable seizure frequency, sexual behavior were
evaluated during three sessions. The results showed that both sexualmotivation and sexual performance were markedly impaired during thesessions compared with the baseline response. These findings will aid
in understanding the interaction between sexual behavior and epilepsy
as well as translate possible human clinical questions involved in thisrelationship into experimental contexts.

AS-8-1

ANATOMICAL BALANCE OF THE UPPER AIRWAY
IN JAPANESE AND CAUCASIAN PATIENTS WITH
OBSTRUCTIVE SLEEP APNEAPOLICY IMPLICATIONS OF SOCIOECONOMIC
INEQUALITIES IN SLEEP: RESULTS FROMINTERNATIONAL COMPARATIVE STUDIESON BRITISH, FINNISH AND JAPANESECIVIL SERVANTS

1

1

Obesity and craniofacial abnormalities are common features of patientswith Obstructive Sleep Apnea (OSA). Anatomical balance between the

Introduction: In general, the lower the socioeconomic status (SES), thepoorer the sleep. In Japanese civil servants, low grade employees hadpoor sleep, and the sleep inequalities reduced after adjustment
for psychosocial stress at work, work hours, and work-family

AS-6-2

S TSUIKI1, FR ALMEIDA2Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo,
Japan, 2Department of Oral Health Sciences, The University of British
Columbia, Canada

M SEKINE1
Department of Epidemiology, University of Toyama, Toyama, Japan© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

235

Sleep, Science and Research

conflicts. These results suggest that sleep inequalities are generated fromsocioeconomic inequalities in work and family characteristics. International comparisons may provide further understanding of sleep inequalities and their international variations.
Methods: The participants were 3 civil servants populations fromBritain, Finland, and Japan. We evaluated whether the magnitude andpatterns of sleep inequalities differed among employees from 3 different
countries, and whether sleep inequalities and their international variations were explained by work and family characteristics.
Results: In men, low grade employees had difficulty falling asleep. After
adjustment for work characteristics, the sleep inequalities decreased in
all populations. After adjustment for family characteristics, while thesleep inequalities further decreased in the Japanese population,
the inequalities remained unchanged or rather slightly increased in the
British and Finnish populations. In women, while low grade employees
had difficulty falling asleep in the British and Finnish populations, thereverse was true for the Japanese population. In the British and Finnish
populations, the sleep inequalities slightly decreased when work characteristics were adjusted for, but slightly increased when family characteristics were adjusted for. In the Japanese population, the sleep
inequalities remained unchanged after adjustment for work and family
characteristics.
Conclusions: Work and family characteristics more or less explained
SES inequalities in sleep and their international variations. Understanding SES inequalities in work and family characteristics and their international variations provide more effective and efficient health policies
for reducing SES inequalities in sleep.

AS-8-2
EXAMINING A PATHWAY BETWEEN SOCIALINEQUALITY IN SLEEP AND HEALTH RELATEDBEHAVIORS USING THE NATIONAL CHILD
DEVELOPMENT STUDYN CABLE1, M SEKINE2, T LALLUKA3
Epidemiology and Public Health, University Collge London, Leighton
Buzzard, Bedfordshire, United Kingdom of Great Britain and Northern
Ireland, 2Department of Welfare Promotion Epidemiology, Toyama
University, Japan, 3Department of Public Health, University of Helsinki,
Finland1

Previous studies showed a detrimental effect of adult alcohol misuse on
sleep; however, little is known in relation to sleep and with other healthrelated behaviours across lifecourse.
We used the data from the National Childhood Development Study forthis study (born in Great Britain, 1958, Men = 5937, Women = 5718)
to examine early social determinants for sleep inequalities and thelifecourse pathways of alcohol use and smoking. We also examined theeffect of lifecourse alcohol use on sleep quality in middle adulthood.
Path analysis was used to identify significant paths between variables.
Men and women were analyzed separately.
Findings of path analysis showed gender specific patterns in sleep
inequalities. Men with socially disadvantaged background had problems with duration of sleep, while the same background contributed to
women’s difficulties in falling asleep. Men’s smoking status at age 42
directly contributed their difficulties in falling asleep; this was partially
due to accumulation of the habit stemming through disadvantagedsocial upbringing and poor cognition and psychosocial mal-adjustment
in childhood. On the other hand, women’s alcohol use at age 42 directly
contributed to their experiences of waking up during sleep. Their drinking habit accumulated over time stemming through affluent social
upbringing. However, smoking at age 16 which endorsed by poor social

236

upbringing, cognition and psychosocial adjustment, contributed totheir alcohol use at age 33, which led to their difficulties in staying
sleep.
In sum, social inequality in sleep is prevalent in men observed in a
direct path from their social background and through the pathway ofsocially patterned smoking habit.

AS-8-3
ECONOMIC DIFFICULTIES AND POOR SLEEP:LONGITUDINAL ASSOCIATIONS AND
INTERNATIONAL COMPARISONSTM LALLUKKA1
1
Hjelt Institute, Department of Public Health, University of Helsinki,
Helsinki, Finland

Background: Sleep problems tend to be socioeconomically patterned,
but contribution of economic difficulties to sleep over and above socioeconomic position, is poorly understood. Childhood and current economic difficulties have been associated with sleep problems incross-sectional studies. However, impact of changes in economic difficulties on subsequent sleep problems has not been addressed. In thispresentation, childhood and current economic difficulties and theirassociations with adult sleep problems are reviewed. Additionally, novel
findings from ongoing international comparative prospective study arepresented. Furthermore, in addition to changes in economic difficulties,
multiple socioeconomic circumstances are simultaneously taken into
account.
Methods: In addition to a literature review, prospective cohort datafrom Finnish (n = 6328) and British (=5002) public sector employees
were analyzed. Childhood and current economic difficulties, and otherindicators of socioeconomic position, were assessed at baseline andfollow-up. Sleep problems referred to difficulties initiating and maintaining sleep as well as nonrestorative sleep.
Results: Sleep problems were prevalent and increased over time inageing employees. Persistent and increasing economic difficulties
remained associated with subsequent sleep problems after multiple
adjustments, although less consistently in the British cohort. Sleep
problems were also associated with income and housing. Althoughfindings vary between studies, material situation shows more consistentassociations with sleep than other indicators of socioeconomic
position.
Conclusion: Supporting people to cope with their economic situation
might prevent sleep problems and their adverse health consequences.

AS-9-1OSA AND INTERMITTENT HYPOXIA: FROM
CLINICAL RESEARCH TO HYPOXIC
EXPERIMENTS AND VICE-VERSAP LEVY1
Physiology, Grenoble University, Grenoble, France

1

Obstructive Sleep Apnea (OSA) is a disorder combining intermittent
hypoxia (IH), sleep fragmentation and respiratory efforts. OSA is frequently associated with Excessive Daytime Sleepiness (EDS) and excess
in traffic accidents. It also leads to frequent cardiovascular and metabolic consequences. However, obesity and visceral adiposity represent
major confounding factors in OSA. Thus both the complexity of thedisease and the limited access to the evaluation of intermittent hypoxia
consequences at the tissue level in patients, have limited our under-© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

standing of sleep apnea pathophysiology and the development ofspecific treatments. The intermittent hypoxia model was developed
both in normal volunteers and in rodents, in order to study the cardiovascular and metabolic consequences of OSA, without the confounding
factors met in humans. IH is associated with increased blood pressure,
impaired vasoreactivity and structural arterial remodeling leading toatherosclerosis, cardiac remodeling, and myocardial infarction. For
instance, there is now substantial evidence that intermittent hypoxia inrodents, as a partial model of sleep apnea, triggers atherogenesis. Bloodpressure alterations and hemodynamic strains on the vascular wall,
impairment in vascular reactivity, lipid metabolism dysregulation, activation of pro-inflammatory transcription factors at the vascular walllevel are among the key-factors promoting vascular remodeling. Also,
several biological markers potentially linked with early atherosclerosis
development have been evidenced as involved in OSA patients. Further
studies are needed to identify at-risk subjects prone to develop vascularchanges since OSA treatment may either be initiated earlier or combined with specific drug treatments.

AS-9-2
INTERMITTENT HYPOXIA IN RODENTS:
EVIDENCE FOR A ROLE OF HYPOXIA IN
METABOLIC CHANGES AND ATHEROSCLEROSISVY POLOTSKY1
Division of Pulmonary and Critical Care Medicine/Department ofMedicine, Johns Hopkins University School of Medicine, Baltimore, MD,
United States of America
1

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia(IH) during sleep. OSA leads to high cardiovascular morbidity andmortality attributable to metabolic abnormalities induced by chronic
IH, including dyslipidemia, atherosclerosis, insulin resistance, glucose
intolerance and non-alcoholic steatohepatitis (NASH). We have developed a mouse model of IH, which mimics the oxygen profile in patientswith OSA, and have shown that chronic IH induces VLDL secretion,
dyslipidemia, atherosclerosis, insulin resistance and steatohepatitis inmice. Our findings suggest that chronic IH increases hepatic lipid biosynthesis and VLDL secretion up-regulating a key enzyme of hepatic
lipid biosynthesis stearoyl coenzyme A desaturase 1 (SCD-1) via
hypoxia inducible factor 1 (HIF-1). Chronic IH also inhibits clearanceof chylomicrons (CM) and VLDL contributing to postprandial hyperlipidemia, which may lead to atherosclerosis. IH decreases CM and
VLDL clearance by inactivating lipoprotein lipase (LPL) in adipose
tissue. In turn, LPL inactivation is likely mediated by HIF-1 induced
up-regulation of angiopoietin like protein 4, a powerful LPL inhibitor.
Finally, sleep apnea in humans and IH in rodents raise circulating freefatty acid (FFA) levels in proportion to the severity of hypoxia suggesting that IH leads to exuberant lipolysis in adipose tissue. The FFA influx
into the liver may accelerate assembly of pro-atherogenic VLDL, induce
insulin resistance, hepatic steatosis and inflammation leading to NASH.
Sympathetic nervous system (SNS) is a major regulator of lipolysis. We
propose that IH of OSA causes metabolic dysfunction by augmenting
adipose tissue lipolysis, which is induced by SNS through the carotid
bodies. In summary, our data suggest that IH of OSA may induce metabolic dysfunction and atherosclerosis by 3 major mechanisms: 1) upregulation of hepatic lipid biosynthesis; 2) down-regulation of
lipoprotein clearance; 3) exuberant adipose tissue lipolysis.

AS-9-3
CLINICAL TRIALS ADDRESSING OSAASSOCIATED CARDIOVASCULAR AND
METABOLIC OUTCOMES: PAST, PRESENTAND FUTURE

J-L PEPIN1
INSERM U1042, HP2 laboratory and Locomotion, Rehabilitation andPhysiology Department, University Joseph Fourier and Grenoble University
Hospital, BP 217, GRENOBLE 09, France
1

Intermittent hypoxia (IH) is inducing oxidative stress and consequently
promotes inflammation, endothelial dysfunction and cardiovascularmorbidity. Effective treatment of OSA may represent an important target
for improving cardiovascular risk. Large-scale randomized controlled
trials (RCTs) demonstrating the benefits of OSA treatment with respect
to hard cardiovascular outcomes (e.g., cardiac events and death) arethen necessary. An alternative is to design shorter-term RCTs using surrogate cardiovascular end points such as endothelial function, carotid
intima-media thickness or arterial stiffness. Research efforts should also
be directed at identifying novel treatment interventions that affect the
specific pathophysiology of cardiovascular consequences of OSA. The
most effective strategy for reducing OSA-induced hypertension remains
to be delineated. In OSA patients, the blockade of angiotensin II receptors reduces blood pressure fourfold more than CPAP. Recent studies
suggest that spontaneous overnight fluid shift from the legs to the upper
body is associated with obstructive sleep apnea. Spironolactone ispotentially interesting for reducing this overnight fluid shift and thenimproving both blood pressure and the severity of OSA. This hypothesis
remains to be validated in RCTs. Our group has demonstrated that theleukotrienes pathway is activated in OSA-induced atherosclerosis. We
have also described a specific inflammatory profile in aortic walls ofmice exposed to IH with a key role of the chemokine RANTES. A
5-lipoxygenase inhibitor or anti-inflammatory drugs like statins need
to be evaluated as able to prevent atherosclerosis progression in OSA.
Response to CPAP therapy in terms of cardiovascular and metabolic
outcomes differs in non-obese and obese patients. The failure of CPAP
to alter metabolic or inflammatory markers in obese OSA emphasizes
the need to offer a combination of multiple modalities of treatment
including weight loss and physical activity.

AS-10-1
CAN A COMPOSITE ANALYSIS OF AUTONOMIC
AND VASCULAR SIGNALS PREDICTCARDIOVASCULAR RISK? THE ASI APPROACH

L Grote1, D Sommermeyer1,2, D Zou1, D Eder1, J Ficker3,
W Randerath4, T Penzel5, B Sanner6, J Hedner1
1
Department of Pulmonary Medicine, Sahgrenska University Hospital,
Gothenburg, Sweden, 2Karlsruhe Institute of Technology, Karlsruhe,
Germany, 3Department of Pulmonary Medicine, Clinic Nuenberg Nord,
Germany, 4Department of Pulmonary Medicine, Bethanien Hospital,
Solingen, Germany, 5Department of Cardiology, University Hospital
Charite, Berlin, Germany, 6Department of Pulmonary Medicine, Bethesda,
Hospital, Wuppertal, Germany
Introduction: Analysis of multiple continuous physiological signals
obtained during sleep may provide a novel method to assess cardiovascular (CV) risk. The novel autonomic state indicator (ASI) algorithm
combines information from arterial oxygen saturation (SpO2) and aphotoplethysmographic pulse wave signal and computes a CV risk
index.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research237

Sleep, Science and Research

Methods: Subjects (n = 327, 227 male, age 55.1 ± 13.6 yrs, BMI 30.1
± 6.4 kg/m2) referred to five sleep centers in Germany and Sweden
were studied. The occurrence of CV risk factors was assessed and subjects were classified by four established CV risk matrixes (Framingham,
EU-SCORE, PROCAM and ESC/ESH). Peripheral pulse wave was measured by overnight digital photoplethysmography. The ASI algorithm
extracted patterns of the peripheral pulse wave and SpO2 signal by
amplitude and time/frequency analysis. Five derived parameters(hypoxic variation, vascular augmentation, cardio acceleration, cardiorespiratory coupling and pulse wave amplitude) were used to determine
the final ASI score (range 0–1).
Results: The computed ASI CV risk index was significantly associatedwith the ESH/ESC risk matrix (r = 0.48, p < 0.0001), the Framingham
risk score (r = 0.42, p < 0.001, the PROCAM score (r = 0.45, p < 0.001)
and the EU-SCORE (r = 0.36, p < 0.001). Moreover, the ASI CV risk
index was elevated in patients with an already established CV endpoint(MI and/or stroke, n = 29) compared with the remaining patients (0.72± 0.43 vs. 0.47 ± 0.38, p = 0.002).
Conclusions: The ASI technique appears to provide a possibility torecognize subjects with increased CV risk based on recording of physiological signals. Interestingly, the sleep period appears to be a particularly useful window for assessment. This technique, based on a modified
pulse oximeter, may be useful in both sleep and cardiovascular medicine. [The study was supported by Weinmann GMBH, the Swedish
Heart and Lung Foundation and the University of Gothenburg].

AS-10-2NOCTURNAL TRANSCUTANEOUS CARBONDIOXIDE MONITORING: A NEW MESSAGE
FROM AN OLD TECHNIQUEOJ Polo1
Department of Respiratory Medicine, Tampere University Hospital,
Tampere, Finland1

The transcutaneous carbon dioxide measuring technique was developed in the 1970ies. As non-invasive estimate of the arterial pCO2, themethod is considered unreliable, since the signal is affected by vasoconstriction and vasodilatation.
Falling asleep is characterized by gradual vasodilatation whereas arousal
from sleep is associated with temporary vasoconstriction. We havepreviously shown that the transcutaneous carbon dioxide signal can beused to monitor these sleep-induced autonomic events in the peripheral
vascular bed.
Fully relaxed parasympathetic state during sleep is indicated by levelling-off of the tcCO2 signal at higher level than what occurs during
wakefulness. Partial upper airway obstruction with flow limitation is aparasympathetic event, during which the tcCO2 increased further
above the plateau level. Repetitive episodes of obstructive sleep apnea
result in lowering the tcCO2 below the nocturnal plateau but above thelevel during wakefulness.
Endothelial dysfunction (failure of vasodilatation during sleep) is
detected as difficulties in reaching or maintaining the nocturnal tcCO2
plateau. In 103 women aged 46 the nocturnal transcutaneous CO2parameters were the best predictors of the endothelial function estimated during wakefulness with ultrasound measurements of the brachial artery (Aittokallio et al. 2009). The nocturnal transcutaneous CO2
signal can also predict metabolic abnormalities including low HDL
concentration in the serum (Virkki et al 2008).
The peripheral CO2 is a product of ventilation and perfusion, which iscontrolled by the autonomic nervous system. The old transcutaneous
CO2 measured during sleep is a new tool to study the interactions
between sleep, metabolism and endothelial function.

238

AS-11-1
TO LAPSE OR NOT TO LAPSE: A QUESTION OF
PRIOR SLEEP, CIRCADIAN TIMING AND
ENVIONMENTAL DISTRACTERS

C ANDERSON1
School of Psychology and Psychiatry, Monash University, Clayton,
Australia
1

Introduction: Well controlled laboratory studies reveal attention lapses
increase due to both acute and chronic sleep restriction. Here, we lookat the lapse outside the confines of a controlled laboratory setting, anddescribe the incidence of an attention lapses as a function of prior wake,circadian timing, and environmental distracters.
Methods: Study 1 involved participants completing psychomotor vigilance tests (PVTs), with and without extraneous distractions, at 10pm
and 4am. Distraction comprised a TV (with sound) operating in the
periphery. Time synchronized video footage was obtained simultaneously. Here, lapses were categorized as occurring with the eyes
open (EO), eyes closed (EC) and due to distraction (DIS). For study 2,
participants (trainee physicians) completed PVTs while working an
extended duration work shift in the hospital (acute sleep loss). This was
repeated on six successive occasions (chronic sleep loss).
Results: For study 1, lapses increased significantly due to time awake/time of day. This impairment was further exacerbated by the presenceof a distracter. While lapses increased in incidence as a function of timeawake/time of day, only lapses due EC increased in duration. Lapses
due to DIS increased when the distractor was present ONLY at 4am(time*distraction interaction). For study 2, lapses significantly increased
due to acute and chronic sleep loss, with a significant acute*chronic
sleep loss interaction.
Conclusions: Field and laboratory data indicate PVT lapses change asa function of prior wake and time of day, with lapses due to an eye
closure being the most vulnerable to these factors. When sleepy, an
external distractor exacerbates PVT lapses attributed to looking away,ostensibly as the sleep brain seeks stimulation.

AS-11-2
A PARADOXICAL RELATIONSHIP BETWEENUSUAL SLEEP EFFICIENCY AND BEHAVIOURALMICROSLEEP PROPENSITY FOLLOWING A
SINGLE NIGHT OF SLEEP RESTRICTION

CRH INNES1, GR POUDEL1,2, RD JONES1,2,3,4,5,6
1
Department of Medical Physics and Bioengineering, Van der Veer Institutefor Parkinson’s and Brain Research, Christchurch, New Zealand,
2
Department of Medical Physics and Bioengineering, Canterbury District
Health Board, New Zealand, 3Department of Medicine, University ofOtago, Christchurch, New Zealand, 4Department of Electrical & Computer
Engineering, University of Canterbury, New Zealand, 5Department of
Psychology, University of Canterbury, New Zealand, 6Department ofCommunication Disorders, University of Canterbury, New Zealand
Sleep-deprived people, or those performing extended monotonous
tasks, can exhibit brief episodes when performance is suspended andthey appear to fall asleep momentarily – behavioural microsleeps (BMs).
BM rates have been shown to be highly variable between normallyrested people but relatively stable between sessions. This study aimed
to determine whether there is a relationship between BM propensity
when normally-rested or after a night of sleep restriction (4 h time-inbed) and measures of sleep (i.e., wrist actigraphy, Epworth Sleepiness© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

Scale, Pittsburgh Sleep Quality Index, and Horne-Ostberg MorningEveningness Questionnaire). BMs were identified based on eye-video
and tracking response characteristics during a continuous 20-min
tracking task undertaken during the afternoon (1.30 or 2.30pm). Analysis was completed on data from n = 8 healthy people (age 26.3 ± 5.6 y(mean ± SD) [5 F, 3 M]). Mean actual sleep was 8.1 ± 1.0 h for thenight prior to the normally-rested session and 3.5 ± 0.2 h for the nightprior to the restricted session. Sessions were 1 week apart and counterbalanced. There was an increase in the number of BMs from the normally-rested to restricted session (mean 2.5 vs 33.0, p = .047, range
0–10 vs 0–100). There was a strong correlation between BM propensity
in the restricted session and sleep efficiency during the week prior to
the sleep restricted night (r = 0.85, p = .007). There were also trends
for correlations between BM propensity in the restricted session andsleep efficiency (r = 0.61, p = .10) and sleep onset latency (r = −0.64,
p = .09) during the sleep restricted night. High sleep efficiency isequivalent to a low proportion of arousal time during the sleep period.
Unexpectedly, the correlations and trends were in the direction thatpeople who had higher sleep efficiency and shorter sleep onset latencies
had more BMs. These findings may indicate that, paradoxically, highsleep efficiency and, perhaps, short sleep onset latency are related togreater vulnerability to sleep restriction. While intriguing, these findings will need to be confirmed in a larger group.

AS-12-1
SLEEP AND CIRCADIAN GENES: PREDICTORSFOR RESPONSE TO SLEEP RESTRICTION

N GOEL1
Department of Psychiatry, University of Pennsylvania School of Medicine,Philadelphia, PA, United States of America

AS-12-2
THE PER3 VNTR AND SLEEP AND CIRCADIANINTERACTION IN HUMANS AND ANIMAL
MODELSSN ARCHER1
Faculty of Health & Medical Sciences, University of Surrey, Guildford,
Surrey, United Kingdom of Great Britain and Northern Ireland
1

Sleep and circadian systems are independent but interact to modulate
their function. This is demonstrated in everyday life by jet lag andexperimentally in forced desynchrony protocols. A distinct set of interacting clock genes forms the molecular basis for circadian rhythmicity,
but much less is known concerning the genetic basis for sleep. However,there is growing evidence showing that a number of clock genes also
have significant roles in the regulation of sleep architecture and homeostasis. Period3 (Per3) plays a redundant role within the mouse central
circadian clock, but a variable number tandem repeat (VNTR) polymorphism within human PER3 is associated with diurnal preference, sleep
homeostasis, cognitive vulnerability to sleep loss, and fMRI-assessed
brain activity in response to sleep loss. We have investigated subjects
genotyped for this polymorphism in sleep manipulation and forced
desynchrony protocols. We have made multiple measures of circadianmarkers, sleep, cognition, and peripheral gene expression. We have alsomeasured sleep, circadian activity rhythms, and gene expression in
animal models either lacking PER3, or with the human VNTR polymorphism knocked-in. From these experiments, we further demonstrate
the important interaction between sleep and circadian systems, andconfirm the role for PER3 within this interaction.

1

Sleep loss causes sleepiness and fatigue, as well as errors and accidents
that are due to its adverse neurobehavioral effects on alertness, cognitive
functions and mood. Recent evidence, however, indicates that healthy
adults show significant, trait-like (phenotypic) differences in the extent
to which they experience such neurobehavioral deficits when exposed
to either acute total sleep deprivation or chronic sleep restriction. Thusfar, such differences have not been explained by individuals’ baselinefunctioning or by a number of other potential predictors including priorsleep history, circadian chronotype, and demographic factors. Data collected in carefully controlled laboratory experiments suggest that
common genetic variations involved in sleep-wake and circadianrhythm regulation–including those found in the human leukocyte
antigen (HLA) DQB1*0602 gene, the PERIOD 3 (PER3) gene, and the
CLOCK gene–may underlie these large phenotypic differences in neurobehavioral vulnerability to chronic sleep restriction in healthy adults
and may thus serve as putative biomarkers. Determination of biomarkers of individual differences to sleep loss will help identify those individuals who are most in need of prevention of sleep debt and in needof countermeasures for sleep loss; further our understanding and management of vulnerability to excessive sleepiness due to common sleep
and medical disorders; and help inform public policies pertaining to
the need for adequate sleep.

AS-13-3
TIME TRENDS IN SLEEP DISTURBANCE AND
DURATION – AN INTERNATIONAL REVIEWN Glozier1
BMRI Sydney Medical School, University of Sydney, Camperdown,
Australia
1

Background: Despite the enormous growth of sleep research over the
past four decades, little is known about secular trends in sleep disturbance. Concerns over decreasing sleep durations, technology that may
limiot sleep and the “24/7” lifestyle dominate the public, and to soem
extent scientific discourse as progressively more research points to sleep
disturbance as a health risk factor.
Methods: This presentation will cover(i) The background and development of these ideas(ii) Recent data on time trends in a number of aspectsof sleep – adolescent sleep duration and insomnia(iii) Present the resultsof a systematic review of all published studies evaluating temporal
trends in adult sleep duration.
Results: Self-reported adult average sleep duration had increased in 7
countries and had decreased in 6 countries. Inconsistent results were
found for the United States and Sweden.
Conclusion: Data from less biased nationally representative studies
does not support the thesis that sleep durations are decreasing globally.
Measurement and reporting issues for future use will be identified.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research239

Sleep, Science and Research

AS-14-1

AS-14-6

MRI STRUCTURAL AND SPECTROSCOPIC
MARKERS OF DISTURBED SLEEP IN
POSTTRAUMATIC STRESS DISORDERSTRUCTURAL AND FUNCTIONALNEUROIMAGING STUDIES IN PRIMARYINSOMNIA AND GOOD SLEEPER CONTROLST Neylan1, D Meyerhoff2, M Weiner2, S Mueller2,
N Schuff2
1
Psychiatry, University of California, San Francisco, San Francisco, CA,
United States of America, 2Radiology, University of California, San
Francisco, United States of America
High field strength MR structural and spectroscopic imaging techniques
now have the sensitivity to detect markers associated with sleep quality.
This presentation will provide an overview of sleep and imaging for the
symposium, “Advances in Neuroimaging of insomnia.” This presentation will present data linking sleep quality in subjects with Posttraumatic Stress Disorder to the volume of CA3/dentate gyrus hippocampal
subfield, and to concentrations of GABA, glutamate, and N-acetylaspartate in cortical brain regions. These findings indicate that poor sleep
quality is associated with volume loss of the CA3/dentate subfields andlow concentrations of GABA. The discussion will highlight converging
evidence that impaired sleep may adversely affect adult neurogenesis.

AS-14-3
IMAGING IN PRIMARY INSOMNIA: STRUCTURE,
FUNCTION, SLEEP, WAKE

PL Franzen1, GJ Siegle1, SR Graham1, HJ Aizenstein1,
DJ Buysse1
1
Department of Psychiatry, University of Pittsburgh, PITTSBURGH, PA,
United States of America

D RIEMANN1
1
Department of Psychiatry and Psychotherapy, Freiburg Univesrity Medical
Center, Feiburg, Germany
Primary insomnia afflicts approximately 3–5% of the adult populationand is characterized by problems to fall asleep, to maintain sleep or theexperience of non-restorative sleep. Additionally, patients with insomnia suffer from daytime consequences like tiredness or deficits in concentration or attention. In recent years several studies using
neuroimaging methods have been published investigating primary
insomnia. Own work is focussing on structural and functional neuroimaging studies with MR. In a pilot study with 8 patients we were able
to demonstrate reduced bilateral hippocampal volumes in chronic
insomnia compared to good sleepers. Another functional study revealed
that the alpha rhythm is instigated by the same neuronal centers ininsomnia and good sleepers. Ongoing work includes a structural
approach and several paradigms looking at emotions and attentional
bias in insomnia. 24 patients and 30 good sleepers were included inthese studies. These new results will be presented at the meeting.

AS-15-1
NEW WAYS TO UNDERSTAND INSOMNIA: BRAINIMAGING AND WEB-BASED PHENOTYPINGEJW VAN SOMEREN1
Sleep & Cognition, Netherlands Institute for Neuroscience, Amsterdam,
Netherlands
1

Primary insomnia is a prevalent sleep disorder that frequently andsignificantly impairs waking function. Insomnia confers significant risk
the development of a new onset or recurrent major depressive disorder,
as well as other psychiatric disorders, such as anxiety and substanceabuse disorders. Complaints regarding daytime function across bothcognitive and affective domains are common in insomnia, such as tiredness, difficulty concentrating, and impairments in affective function,such as low mood, and difficulty with interpersonal relationships. Yet,
our understanding of the neural mechanisms that contribute to suchcomplaints is not well understood. Using Positron Emission Topography studies, we have previously found higher global cerebral glucose
metabolism during NREM sleep in wake-promoting regions, as well as
reduced glucose metabolism during wakefulness in both cortical andsubcortical regions in primary insomniacs compared to good sleeper
controls. We will present findings from both structural and functional
magnetic resonance imaging studies focusing on the neural circuitry
underlying emotion regulation in individuals with primary insomnia.
Such research into sleep disturbances, their consequences for waking
function, and their distinct neuroanatomic basis can provide important
insights regarding the potent risk relationship between primary insomnia and mood disorders.

240

Affecting about 10 percent of the population, insomnia is the mostcommon health complaint in general practice. While insomnia hasserious consequences, e.g. being the major risk factor for the development of psychiatric disorders, our understanding of its brain mechanisms is very limited. Investigations into the causes and consequencesof insomnia have to a large extent applied theoretical frameworks andmethods that are rooted in psychology. The present lecture provides
examples that illustrate the value of application of the arsenal of brain
imaging tools that have been developed in human cognitive neuroscience, to tackle the underlying mechanisms of insomnia. While somedeviations recover after therapy, others do not, in the very same patientsassessed on the same day. The unchanging abnormalities may be heritable traits involved in the risk of developing insomnia. For example,
while attenuated prefrontal fMRI BOLD activation during word fluency
recovered, attenuated activation of the head of the caudate nucleus
during a planning task did not. Also, abnormal intracortical excitability
demonstrated using transcranial magnetic stimulation did not recoverafter treatment. Voxel-based morphometry showed a lower volume ofgray matter in areas that are part of the default mode network including
the orbitofrontal cortex, where volume showed a strong negative correlation with insomnia severity. This area seems involved in disturbed
hedonic evaluation, which we indeed found to be compromized ininsomniacs. Concertedly, we found new angles on mechanisms of vulnerability. We now look for volunteers for extensive web-based characterization of phenotypes of good and poor sleepers on www.sleepregistry.
eu.
1. Van Someren EJW et al, 2009, Frontiers in Neuroscience 3:436
2. Van Der Werf YD et al, 2010, Biol Psychiatry 68:950–955© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

3. Altena E et al, 2010, Biol Psychiatry 67:182–185
4. Altena E et al, 2008, Sleep 31:1271–1276
5. Raymann R et al, 2008, Sleep 31:1301–1309

AS-16-2

AS-15-2

H Frohnhofen1,2, N Netzer3
1
Zentrum für Altersmedizin, Kliniken Essen Mitte, Essen, Germany,
2
Fakultät für Gesundheit, Department Humanmedizin, Universität
Witten-Herdecke, Witten, Germany, 3Klinik Ghersburg, Bad Aibling,
Germany

PHENOTYPING COGNITIVE FACTORS
ANDCORTICAL AROUSAL IN
PSYCHOPHYSIOLOGICALINSOMNIACA ESPIE1, SD KYLE1, KM MACMAHON1, H WOODS1, S BIELLO1
Institute of Neuroscience & Psychology, College of Medical, Veterinary &Life Sciences, University of Glasgow Sleep Centre, Kilmacolm, United
Kingdom of Great Britain and Northern Ireland
1

Although insomnia is very common, exactly how it develops and what
are its crucial maintaining factors remain unclear. There is some evidence for phenotypical features that are behavioural (e.g. conditioned
arousal, sleep-incompatible behaviour), and cognitive (e.g. sleep preoccupation, dysfunctional beliefs). However, the insomnia phenotype
lacks objective markers, not least for the central phenomena of cognitive
arousal. This paper reviews a range of cognitive perspectives on insomnia (e.g. dysfunctional thinking, performance anxiety, cortical arousal,
sleep misperception, automaticity, attentional processing). Emphasis isplaced upon models that yield testable hypotheses about putative cognitive processes in its aetiology and perpetuation. Experimental studies
that have adapted methods from other fields of adult psychopathology
research are highlighted because they yield valuable conceptual insights
and offer novel measurement paradigms. An argument is made that
because sleep normalcy is a relatively automatic process, it is vulnerable
to inhibition (in insomnia) by selective attention upon sleep and bydirect attempts to control its expression. Computerized tests of information-processing bias may offer one objective means of appraisingmental processes in insomnia. Studying the interplay between subjective experience, cognitive performance and cortical arousal in insomnia
may be a fruitful line of future research.

AS-16-1

FRAILTY AND INTERMITTENT HYOPEMIA IN A
SAMPLE OF OLDER SUBJECTS

Background: Frailty and sleep apnea are common entities in the elderly.
Frailty causes dependency and need of care. The prevention of frailty
is a major topic in geriatrics. However, the relationship between sleep
apnea and frailty is hardly studied.
Methods: In a prospective pilot study, we examined the relationshipbetween the presence of at least one of the five Frailty criteria proposedby Fried and sleep apnea. Patients were eligible, if they able to communicate and had no dementia. Sleep apnea was diagnosed by overnight pulse oximetry. Sleepiness was obtained by the questionnaire ofSiegrist and the Pittsburgh Sleep Quality Index [PSQI].
Results: 42 patients with a mean age of 82 ± 7 years were enrolled.
Fifteen (36%) patients were male, 27 (64%) were female. Twenty-eight(67%) patients had at least one frailty criterion. Patients with Frailty
criteria had significantly more often daytime sleepiness (1/14 vs. 17/28,
p < 0.001), had a significantly higher incidence of severe sleep apnea
with an oxigen desaturation index >30/h (p < 0.04) and had a lower
mean nocturnal oxygen saturation (95 ± 2% vs. 91 ± 4%, p < 0.02).
Conclusion: Our small pilot study shows an association between thepresence of at least one frailty criterion, daytime sleepiness and severe
sleep apnea. Given the high frequency of both phenomena and regarding the clinical relevance of frailty, prospective studies are warranted toproof of a causal relationship between sleep apnea and Frailty.

AS-17-1
EVALUATION OF THE HUMAN CIRCADIAN
CLOCK USING HAIR FOLLICLE CELLSM AKASHI1The Research Institute for Time Studies, Yamaguchi University, Yamaguchi,
Japan
1

NIGHTLY HYPOXEMIA IN THE ELDERLY AND ITSPOSSIBLE LINK TO DEMENTIA

D Dupre1
1
Department of Psychiatry, University of California, San Diego, San Diego,
California, United States of America

Hypoxemia in elderly persons is a known phenomenon based on physiologic and pathophysiologic developments with growing age. However
the prevalence of especially nightly hypoxemia and its influence on
frailty and cognitive impairment of geriatric patients might be underestimated. Recently a Norwegian study showed that more than 30% of
all elderly inpatient patients had a nightly hypoxemia with a SaO2
<90% more than 30% of total sleep time.
The studies on sleep disordered breathing and brain damage throughepisodes of short intermittent hypoxia have highlighted the topic tosome account and nurtured speculations on a link between dementia
and hypoxemia in elderly patients with cognitive impairment.
In a multicenter international study in Asia and Europe running sinceNovember 2010 we study the correlation between the prevalence forcognitive impairment assessed through the Mini Mental Status Examand various other cognitive function tests and the prevalence of nightly
hypoxemia measured via continuous pulse oximetry in elderly hospitalized patients aged over 75 years.

Circadian behavioral and physiological rhythms are driven by autonomous oscillation of clock gene expression. Thus, a clear understandingof the circadian core clock requires a thorough examination of therhythmic expression of clock genes. Although more than ten years havepast since the first mammalian clock gene was identified, there are still
only a handful of reports on in vivo observation of circadian expressionof human clock genes. The lack of an established method for evaluating
circadian clock gene expression has markedly impeded the progress forstudying human circadian rhythms. Here we report a convenient andless invasive method for detecting human clock gene expression using
biopsy samples of hair follicle cells from the head or chin. We show thatthe circadian phase of clock gene expression in hair follicle cells reflectsthat of individual behavioral rhythms, demonstrating that this strategy
is appropriate for evaluating the human peripheral circadian clock.
Furthermore, using this method, we indicate that rotating shift workers
suffer from a serious time lag between circadian gene expression rhythms
and lifestyle. Researchers in the field of circadian rhythms can easily
adopt our experimental strategy using hair follicle cells, without specialized experimental techniques. Qualitative evaluation of clock gene
expression in hair follicle cells, therefore, may be an effective approachfor studying the human circadian clock even in the clinical setting.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research241

Sleep, Science and Research

AS-17-2

AS-18-2

LIGHT EXERTS POWERFUL NON-VISUAL
EFFECTS IN HUMANS

NEUROBIOLOGICAL MECHANISMS OF
THERAPEUTIC SLEEP DEPRIVATION
IN DEPRESSIONC CAJOCHEN1
Psychiatric University Clinics, Centre for Chronobiology, University ofBasel, Switzerland, Basel, Switzerland
1

Environmental conditions such as light, sound, temperature, etc. play
an important role in the control of sleep and wakefulness. Light is certainly the most regularly occurring stimulus in the environment. The
challenge of a daily change of the lightdark cycle has profound impact
on a wide range of biological functions and behavior. In humans, lightis intuitively linked with an alert or wakeful state. On the other hand,closing the eyelids or dimming or turning off the lights has a very powerful soporific effect. Compared to the effects of light on human circadianrhythms, little attention has been paid to its acute alerting action. The
influence of illuminance level, exposure duration, timing and wavelength of light needed to evoke alerting responses in humans, as well as
their temporal relationship to light-induced changes in endocrinologicaland electrophysiological sequelae of alertness, clock gene expression,
sleep and cognition will be summarized. Furthermore, our new data on
low intensity blue-enriched and backlit LED screen light will be presented, which give evidence for light impacting on higher cognitive
function, such as declarative memory and for individual differences in
the response to short-wavelength light. We hope that our results will
help to create optimized lighting conditions for work places and homes.

AS-18-1
SLEEP PHENOTYPING VALIDATES NEW MOUSE
MODELS OF AFFECTIVE DISORDERS

M KIMURA1
1
Neurogenetics of Sleep, Max Planck Institute of Psychiatry, Munich, Germany
Impaired sleep is a key premorbid symptom that is often accompanied
by affective disorders, e.g., major depression. However, its mechanism
is rather complex, and differentiating its causalities from those ofdepression undergoes hardships. Depressed patients demonstrate characteristic changes in sleep architecture even before symptoms fully
develop. Therefore, EEG activity must embrace a specific facet thatpossibly serves as a susceptibility marker for depression. In our institute, several animal models have been generated to investigate stressrelated disorders. Monitoring EEGs in those animals can be used to
select the most appropriate study model. Upon my presentation, sleep
phenotypes in three different lines of mouse models will be compared;
a conditional mouse mutant that chronically overexpresses corticotropin-releasing hormone (CRH) in the entire central nervous system(CRH-COE-Nes) or only in the forebrain including limbic structures(CRH-COE-Cam), a humanized mouse mutant in which the murine
P2RX7 gene was substituted by the disease-associated variants ofhuman P2RX7, and a bi-directionally bred mouse model of trait anxiety
showing high and low anxiety-related behavior. All these mouse lines
demonstrated sleep alterations, particularly fragmented sleep episodes
and enhanced REM sleep. Sleep analysis highlighted significance of
CRH-COE-Cam and heterozygous P2RX7 mutant mice that failed toshow any particular changes in behavior. Measuring sleep is an only
behavioral test applicable similarly both in humans and animals andcan be a powerful tool to detect genetic influences on psychiatric diseases. Sleep phenotyping is thus requisite to validate new animalmodels of depression and supports discovery of close correlations
between sleep and mental dysregulation.

242

UM HEMMETER1, E HOLSBOER-TRACHSLER3, JC KRIEG2
1
Center of Education and Research (COEUR), Psychiatric Service of the
Canton of St.Gallen, Wil / SG, Switzerland, 2Department of Psychiatry andPsychotherapy, University of Marburg, Germany, 3Department ofDepression Desearch Sleep Medicine, Clinical Neurophysiology, Psychiatric
University Clinic Basel, Switzerland
Sleep deprivation (SD) is powerful antidepressant treatment whichshows antidepressent responses within hours in 40 to 60 % of depressed
patients. In more than 80% of the responders to SD a relapse into
depression occurred after the recovery night. In addition, SD serves as
an excellent tool to examine the neurobiological disturbance of depression and may profoundly contribute to the development of new specificand more rapidly acting antidepressant strategies.The reason why sleep
deprivation works and relapses occur is still unclear. A key to solve thisproblem is to include the current knowledge about the neurobiologicaldisturbance of depression into research with a focus on neurobiologicalaspects of sleep and SD (sleep EEG, neuroendocrinology, neurochemistry, chronobiology). Based on findings from these different areas different strategies to stabilize the antidepressant effect of SD have been
applied. The lecture addresses these above mentioned topics including
own studies in which neurobiological mechanisms of SD have been
examined and an augmentation and stabilization of the effects of sleep
deprivation has been performed by different neurochemical approaches.

AS-19-1
ETHNIC DISPARITIES IN CPAP USAGE:QUANTITATIVE EFFECTS OF SOCIOECONOMIC
STATUS, HEALTH LITERACY AND
SELF-EFFICACYAJ CAMPBELL1, JP BAKKER1, KM O’KEEFFE1, AM NEILL1
1
WellSleep, Otago University Wellington, Wellington, New ZealandWe performed a prospective study of patients referred for CPAP treatment, quantitatively investigating usage, socioeconomic status, healthliteracy and self-efficacy, and gathering qualitative data through focus
groups.
Consecutive CPAP-naive patients ≥18 years of age referred for treatment
were included. After one month of CPAP, objective use was comparedby ethnicity, Epworth Sleepiness Scale, Self-Efficacy Measurefor Sleep Apnea, Rapid Estimate of Adult Literacy in Medicine, thearea-based New Zealand Deprivation Index, New Zealand Individual
Deprivation Index, educational history, income and employment data.
Multivariate logistic regression was undertaken using univariate predictors of CPAP compliance ≥4 hours per night, as well as ethnicity (Maori/
non-Maori). A sub-set of patients attended standardised ethnic-based
focus groups, where they were encouraged to share their experienceswith CPAP.
Usage data were available for 126 patients (mean ± SD apneahypopnea index 57.8 ± 38.8 events/hour). Maori (n = 25) used CPAP
less than non-Maori (median 4.68 IQR 2.24 hours/night versus median
5.33 IQR 2.61 hours/night; p = 0.05), and were over-represented inareas of low socioeconomic status (p = 0.05). There were no significant
relationships between use and subjective sleepiness, self-efficacy orhealth literacy. After controlling for ethnicity, not completing higher
education and high individual deprivation were significant independent© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

predictors of not reaching ≥ 4 hours/night compliance (odds ratio 0.25,
95% CI 0.08–0.83, p = 0.02; odds ratio 0.10, 95% CI 0.02–0.86, p =0.04 respectively). Focus groups of Maori, Pacific and European patientsemphasised the importance of role models.
The disparity in CPAP usage and compliance demonstrated between
Maori and non-Maori can be explained in part by lower education levels
and socioeconomic status. An intervention to address the disparity
should encompass these factors, as well as drawing on suggestions frompatients of different backgrounds.

generated, in association with cortical arousal, increased cardiovascular
activity and increased respiratory amplitude. The animal models allows
for a controlled manipulation of stress, catecholamine concentrations
and muscle activity. However, the complete pathophysiology and causes
are still unknown; thus multidisciplinary research spanning from bench
to bedside is relevant to help open new prevention/treatment avenues
and managing concomitant orofacial pain. The intention of this symposium is to present the status of the current multidisciplinary knowledge on sleep bruxism and to highlight the future research needs. The
targeted audiences are physicians and dentists.

AS-19-2
THE IMPACT OF SLEEP CONSULTATION PRIOR
TO A DIAGNOSTIC POLYSOMNOGRAM ON
CPAP ADHERENCEB MOKHLESI1, S PAMIDI1, K KNUTSON1, F GHODS1, AJ CAMPBELL1
1
Medicine/Pulmonary and Critical Care, University of Chicago, Chicago,
IL, United States of America
Background: Polysomnograms (PSGs) are routinely ordered by nonsleep specialists. However, it is unknown whether a sleep specialist
consultation prior to a diagnostic PSG influences adherence to continuous positive airway pressure (CPAP) therapy.
Methods: CPAP was set up at home and objective adherence wasremotely monitored during the first 30 days of therapy. Physicians whoordered PSGs were divided into 2 groups: sleep specialists and nonsleep specialists. This study was done at the University of Chicago Sleep
Disorders Center and included 403 patients with obstructive sleep
apnea who had CPAP adherence data available.
Results: Mean (± standard deviation) age was 52.5 ± 14 years; 47%
were men and 54% were African American. Mean daily CPAP use wasgreater in patients who were referred by sleep specialists (n = 105; 279± 179 min/day) compared to patients referred by non-sleep specialists(n = 298; 219 ± 152 min/day, p = 0.005). In the linear regression model
adjusting for several covariates, only two predictors were significantly
associated with CPAP adherence. A sleep specialist consultation prior
to the diagnostic PSG was associated with 58.2 minutes more per day(p = 0.002) and African American race was associated with 56.0
minutes less per day (p = 0.002) of CPAP use.
Conclusions: In this cohort study, CPAP adherence was significantly
higher with a sleep specialist consultation prior to the diagnostic PSG.
In addition, African American race was associated with worse adherence
to therapy. A better understanding of predictors of CPAP adherence may
be useful in identifying patients that may benefit from a sleep specialist
consultation prior to ordering a diagnostic PSG.

AS-20-1
SLEEP BRUXISM FROM BENCHSIDETO CHAIRSIDEN HUYNH1
Faculty of Dentistry, University of Montreal, QC, Canada

1

Sleep bruxism is the third most common parasomnia, with a reported
prevalence in childhood of 14–46% to 6–8% in the adult population.
Various risk factors have been associated to sleep bruxism, such as otherparasomnias (i.e., sleep walking), some medical/psychological conditions (i.e., sleep-disordered breathing, ADHD, headaches), various medications (i.e., methylphenidate, SSRIs), and concomitant oral habits.
Persistent sleep bruxism is often associated with orofacial pain, headache,dental injury and bed partner complaints. Relatively recent studies inanimal models and in humans have shown that sleep bruxism is centrally

AS-20-2
SLEEP BRUXISM: FROM HUMAN RESEARCH TO
CLINICAL PERSPECTIVE
MC CARRA1
1
Faculty of Dentistry, University of Montreal, Montreal, Canada

Sleep bruxism (SB) is a sleep-related motor disorder reported by
14–38% of pediatric and 6–8% of adult populations. SB episodes arecharacterized by tonic or phasic activities (rhythmic masticatory muscle
activity) of the masseter and temporalis muscles that can be observedon electromyographic recordings performed during sleep. SB has beenfrequently associated with other disorsers, such as other parasomnias(i.e., sleep walking), sleep-disordered breathing (i.e., snoring andobstructive sleep apnea), some medical/psychological conditions (i.e.,
ADHD, headaches), orofacial pain, temporomandibular disorders,various medications (i.e., methylphenidate, SSRIs), and other concomitant oral habits (i.e., wake-time tooth clenching). Although the etiologyof SB remains unknown, its physiopathology during sleep is partly
explained by a re-activation of cerebral and autonomic nervous systems
occurring during periods of sleep instability (a process called sleep
arousal). In facts, recent polysomnographic studies in humans haveshown that SB is more likely centrally generated, and often associatedwith increased in sympathetic tone, blood pressure and respiratory
amplitude. Moreover, genetic predisposing factors and psychosocial
components (such as anxiety and stress sensitivity) seem to play a rolein the mechanisms that regulate the occurrence of SB. Probably, SB
genesis could not be explained by a single cause and causative factors
are most likely variable between patients. Thus, further research inexperimental and clinical settings is needed to elucidate the etiologic
and risk factors of SB, and its possible impact on the overall health of
SB patients.

AS-20-5
SLEEP BRUXISM: TRANSFER KNOWLEDGE
BETWEEN HUMAN RESEARCH AND
BASIC SCIENCET KATO1, Y MASUDA2, T MORIMOTO2, A YOSHIDA1
Department of Oral Anatomy and Neurobiology, Osaka University
Graduate School of Dentistry, Suita, Osaka, Japan2
Department of Oral and Maxillofacial Biology, Matsumoto Dental
University Graduate School of Oral Medicine, Japan
1

There are various oromotor events during sleep. Sleep bruxism (SB)patients exhibit the increased number of oromotor events during sleep
compared to normal subjects, and a frequent occurrence of rhythmic
masticatory muscle activity is characteristic to SB patients. Polysomnographic studies in humans have revealed that SB is centrally generated
in association with sleep states, cortical arousal fluctuation and increased© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research243

Sleep, Science and Researchcardiovascular activity. However, neurophysiological mechanisms
underlying the jaw motor activation in SB patients are still unknown.
For studying such mechanisms, animal models with oromotor activity
similar to SB are indispensable. Ideally, they should present physiological and pathological signs that are observed for SB in humans. Initialstudy done in the naturally sleeping animals for developing animalmodels has provided several findings regarding: 1) the differential
modulation of motor activities in masticatory and neck muscles; 2) the
association between jaw muscle activity and arousal/autonomic activities; 3) the effects of pharmacologic agents on sleep and jaw muscle
activity; and 4) the characteristics of jaw muscle EMG bursts in association with jaw movement kinesiology. These findings, combined withthe results from human studies, suggest that jaw motor activity during
sleep reflects a variety of interactions between trigeminal motor andsleep regulatory systems and can not be recognized as a consequenceof a single neural process. Further efforts are needed to develop adequate animal model relevant to translational research that addresses
clinical and biological questions.

AS-21-1
DECOUPLING OF SLEEPINESS FROM SLEEPTIME AND INTENSITY DURING CHRONIC SLEEPRESTRICTION: THE ROLE OF ADENOSINE AND
NOREPINEPHRINE SYSTEMY KIM1, L CHEN1, R BASHEER1, RW MCCARLEY1, RE STRECKER1
1
Department of Psychiatry, Harvard Medical School, Brockton, UnitedStates of America

The sleep responses to chronic sleep restriction (CSR) are fundamentally different from those to short-term total sleep deprivation. Specifically, when CSR continues for several consecutive days, animals fail toexpress homeostatic increases in sleep time and sleep intensity. These
allostatic responses of sleep to CSR have been shown in both humans
and rats. Here, we measured: 1) sleep latency to assess sleepiness during
CSR, and 2) brain adenosine receptor and adrenergic receptor mRNAlevels to determine neurochemical mechanisms underlying different
sleep responses to CSR. Rats underwent 18h sleep deprivation (SD) and6h sleep opportunity (SO) each day for 5 days, followed by 3 days offull recovery sleep (R1-R3). The 6h SO was given during the first halfof the 12h light period. Another group of rats underwent the same
protocol but their brains were collected at the end of each SD period
to measure receptor mRNA levels. After 18h SD on the first sleep restriction (SR) day, the total sleep time and NREM delta power were significantly increased during the 6h SO, compared to the corresponding
baseline level. However, those compensatory increases were absent from
SR days 2 to 5. However, sleep latencies during 6h SO were significantly
reduced to 3 min or less from SR1 through SR4, compared to 9.1 minon baseline day. Throughout the 5 days of SR and recovery day 1,
adenosine A1 receptor (A1R) mRNA level was increased in the basal
forebrain while adenosine A2a receptor (A2aR) was decreased in thefrontal cortex. Beta-adrenergic receptor mRNA levels were significantly
decreased in the anterior cingulate cortex only on SR1. Rats exposed tochronic sleep restriction do not sleep longer or deeper even though they
continue to experience elevated sleepiness. We propose that there areat least two different sleep regulatory systems in the brain: one mediating sleepiness and the other mediating sleep amount. Our findings
suggest that changes in the basal forebrain A1R and the cortical A2aR
tone may mediate sleepiness, whereas the cortical beta-adrenergic
receptor tone may mediate sleep time and intensity.

244

AS-21-2
TIME-OF-DAY MODULATION OF SLEEPHOMEOSTASIS AND ADAPTATION IN A RATMODEL OF CHRONIC SLEEP RESTRICTION

S DEURVEILHER1, B RUSAK2, K SEMBA1
Anatomy and Neurobiology, Dalhousie University, Halifax, Nova Scotia,
Canada, 2Psychology, Dalhousie University, Canada
1

Chronic sleep restriction (CSR) is a common condition in modern
societies. It impairs cognitive performance, and is associated withincreased risks for various health problems, such as cardiovasculardisease, diabetes and obesity. To understand the neurobehaviouralimpacts of CSR, we studied changes in sleep patterns during and following CSR, using a rat model of CSR (‘3/1 model’). In this model,
cycles of 3 h of sleep deprivation (SD) and 1 h of sleep opportunity(SO) are continuously imposed for 4 days (i.e., totaling 18 h of SD and6 h of SO per day), followed by 2 recovery days. Sleep propensity is
known to be modulated by both circadian and homeostatic processes,
and this model permits analysis of time-of-day effects on responses to
CSR. The 3/1 model is also consistent with the polyphasic sleep/wakecycles of rats. EEG and EMG were recorded in adult male rats before,
during, and following the 4-day 3/1 CSR starting at lights on under a12/12 h light/dark (L/D) cycle. During CSR, total sleep time was
reduced by ∼60%. During the SO periods, increases (above baseline
levels) in both non-rapid eye movement sleep (NREMS) and REMS were
sustained over the 4 days, while initial increases in NREMS EEG delta
power (a measure of sleep intensity/drive) gradually declined. Normal
daily rhythms in NREMS and REMS amounts persisted during SO,
whereas daily rhythms in NREMS delta power were reduced in amplitude. Despite significant cumulative sleep loss, compensatory responses
during the post-CSR recovery period were modest, and gated by timeof day. Specifically, NREMS rebound was delayed until the late D phaseon the first, as well as the second, recovery day, while REMS reboundoccurred in the early L, as well as the late D, phase of the first recovery
day; NREMS delta power was below baseline levels during the L phaseof both recovery days. The amounts of NREMS, REMS, and EEG deltaenergy lost during CSR had not been recovered at the end of the second
recovery day. These results suggest that the 4-day 3/1 CSR protocol may
trigger both homeostatic and other regulatory (allostatic?) processes thatare modulated by time of day.

AS-22-1
REMOTE CONTROL OF SLEEP-WAKE STATESUSING VIRAL VECTORSPM FULLER
Department of Neurology, Beth Israel Deaconess Medical Center andHarvard Medical School, United States of America
Over the past 10 years, researchers have developed an impressive armamentarium of molecular and electro-physiological techniques forprobing the neural circuitry subserving sleep-wake regulation. Whilethese tools and techniques have provided significant insight into the
CNS circuitry and neurotransmitter systems regulating sleep, each has
non-trivial limitations.
For example, both pharmacological and global knockout approaches
have limited temporal and spatial resolution, whereas lesion approaches
can produce collateral damage to adjacent brain structures that may inturn produce effects on sleep behavior and the cortical electroencephalogram beyond those due to the lesion of the target site. Importantly,
however, these technical and interpretational concerns are largely© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

obviated in newer conditional genomics models. The newer conditional
technologies encompass a wide range of approaches, from conditionaldeletion of genes based on the Cre/loxP technology to RNA interference
to the modulation of neuronal activity using genetically engineered
optical switches to the in vivo reversible silencing and activation ofneurons in freely behaving animals. In this symposium, we will highlight some of these more recent and advanced molecular biological
techniques for investigation of mechanisms of sleep-wake regulation,with a particular emphasis on the use of viral vectors for genetic manipulation of the circuitry governing sleep-wake regulation.

AS-22-2
THE ROLE OF ADENOSINE A2A RECEPTORS IN
THE NUCLEUS ACCUMBENS FOR SLEEP-WAKE
REGULATIONM LAZARUS1, Y URADE1, O HAYAISHI1
Molecular Behavioral Biology, Osaka Bioscience Institute, Suita, Japan

has not been completely understood. To reveal this, we generated
transgenic mice in which orexin neurons specifically express tetracycline transactivator protein (tTA) (orexin-tTA mice). These mice enable
to control the expression of specific gene in the orexin neurons in vivo
since tTA induces gene expression to bind tetracycline response element(TetO). To confirm specific regulation of gene expression in the orexin
neurons by tTA, orexin-tTA mice were bred with TetO red fluorescentprotein (RFP) mice. In orexin-tTA; TetO RFP double transgenic micebrain, 85% of orexin-immunoreactive (ir) neurons expressed RFP. No
ectopic expression of RFP other than orexin-ir neurons was observed
throughout the brain. This result suggested that orexin-tTA mice enable
to control the expression of gene in the orexin neurons just to breedwith various TetO mice. Additionally gene expression could be temporally controlled since tTA lost its function to induce gene expression in
the presence of doxycycline (DOX). Therefore, application of DOX inchow inhibits gene expression induced by tTA, but remove DOX fromchow induces gene expression. These results suggest that orexin-tTA
mice are useful tool to study its physiological role in vivo.

1

Adenosine promotes sleep through the activation of A2A receptors. A2A
receptors are densely expressed on striatopallidal neurons of the basal
ganglia, where dopamine D2 receptors are co-expressed with A2A receptors and contribute to the control of locomotion, motivation, and addiction, all activities that require wakefulness. Abilities to maintain arousal
are compromised under low dopamine conditions such as Parkinson’s
disease, but the extent to which A2A receptors in the basal ganglia contribute to the regulation of wakefulness is not known. We generated
striatopallidal-specific A2A receptor knockout mice, based on the Cre/lox technology, and focal A2A receptor knockdown rats, by using local
infection with adeno-associated virus carrying short-hairpin RNA of A2A
receptors to silence the expression of A2A receptors. By using thesepowerful tools for site-specific gene manipulations, we investigated therole of A2A receptors in the basal ganglia for wakefulness in response to
arousing stimuli, such as caffeine and light transition. We found thatthe deletion of the A2A receptors selectively in the nucleus accumbens
shell results in abrogation of the effect of caffeine on wakefulness, but
did not change the amount of basal wakefulness during the sleep
period. However, enhanced wakefulness can be observed in the waking
period when A2A receptors are focally removed from the nucleus accumbens. These observations demonstrate that A2A receptors in the nucleus
accumbens are required for the arousal effect of caffeine by activating
pathways that have traditionally been associated with locomotion andmotivational behaviors in the basal ganglia. We therefore propose thatthe adenosine/A2A system in the nucleus accumbens acts as an accessory
nucleus to a putative flip-flop arrangement between arousal-promoting
regions and sleep-promoting neurons of the preoptic area for sleep/
wake regulation.

AS-22-3
OREXIN/HYPOCRETIN NEURONS SPECIFICCONTROL OF GENE EXPRESSION REVEALS ITSPHYSIOLOGICAL ROLE IN VIVO

A YAMANAKA1, T TSUNEMATSU1, S TABUCHI1
1
Cell Signaling, National Institute for Physiological Sciences, Okazaki,
Japan, 2PRESTO, JST, Japan

AS-23-1
ADENOSINE, HOMEOSTASIS AND BRAIN
ENERGYRW MCCARLEY1, R BASHEER1, A KALINCHUK1, M DWORAK1,T KIM1, R BROWN1, T MCKENNA1, R STRECKER1
1
Psychiatry, Harvard Medical School-VA Boston Healthcare System,
Brockton, MA, United States of America
Adenosine is a ubiquitous nucleoside that links the two central processes controlling sleep homeostasis and brain cellular energy metabolism. Recent research from our group has provided extensive evidence
on the somnogenic role of extracellular adenosine on the wakefulness
active neurons of the basal forebrain. Compared to sleep, extracellularlevels of adenosine in the basal forebrain are higher during wakefulness,and increase further with prolonged wakefulness. Acting via A1 receptors, adenosine inhibits cortically projecting and wakefulness active
cholinergic neurons, as well as GABAergic and other noncholinergic
neurons, and thus induces a homeostatic sleep response. Moreover, theaction of adenosine on the A1 adenosine receptor activates a second
messenger pathway leading to a positive feedback regulation of the A1
receptor, and increasing the sensitivity of wakefulness active neurons to
the inhibitory effects of adenosine. More recent work from our laboratory shows that a delayed increase in extracellular adenosine and its
receptor also occurs in cortex. Thus adenosine serves as an inhibitory
neuromodulator and promotes homeostatic sleep response in brain.
The changes in the levels of adenosine largely reflect the breakdown of
the cellular high energy molecule, adenosine triphosphate, when energy
consumption associated with cellular activity is increased, as during
wakefulness. Thus, our theory about how adenosine functions during
sleep and wakefulness derives from the fact that it is a byproduct ofenergy metabolism, and its negative feedback on cellular activity serves
as a homeostatic regulator of energy in the brain. This is in accord withthe hypothesis that energy restoration is one of the functions of sleep.
In this talk I will present data in support of an interrelationship between
adenosine and its roles in sleep and brain energy homeostasis.

Orexin/hypocretin is a neuropeptide produced in neurons which aresparsely distributed in the lateral hypothalamic area (orexin neurons).
Although specific ablation of orexin neurons results in sleep disordernarcolepsy, its physiological role on the regulation of sleep/wakefulness© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research245

Sleep, Science and Research

AS-23-2
SLEEP IS FOR A SURGE IN BRAIN ENERGY

R BASHEER1, D MARKUS1, T KIM1, AV KALINCHUK1,RW MCCARLEY1
1
Psychiatry, Harvard University and VA Boston Healthcare System, West
Roxbury, United States of America
An often postulated function of sleep is that it restores energy expended
by the brain during active waking. While the brain comprises only 2%of the body weight, it receives 15% of cardiac output and uses 20% of
total body oxygen consumption and 25% of total body glucose utilization. The extensive energy needs of the brain are met by continualsupply of blood oxygen and glucose, because the brain is unique in thatit cannot store large amounts of energy–yielding lipids or glycogen.
Consequently, adenosine triphosphate (ATP), derived from the metabolism of blood glucose and oxygen, is the primary currency of energy inbrain. This leads to the important question – Does sleep restore or regulate brain ATP levels, which have been depleted during wakefulness?
No direct metrics exist about changing levels of brain ATP during sleep
and waking, therefore we propose here a series of experiments toaddress this fundamental, but unanswered question of the interrelationship between sleep–wakefulness and brain energy balance. Data will bepresented in support of the hypothesis that the states of sleep andwakefulness are closely interrelated with brain energy status. The ATPlevels in wake-active brain regions will show a surge during sleep thatis prevented if sleep is prevented. Here we will present data to showthat while sleep–wake state changes regulate the intra– and extra–cellular levels of the regional ATP, and of its metabolite, adenosine, thesecompounds, in turn, regulate sleep and wakefulness. The data from ourexperiments also strive to understand the feedback regulatory role of
ATP and adenosine in sleep – wake–regulation. The knowledge ofthe molecular and biochemical processes occurring during sleep–
wakefulness that contribute to ATP regulation, and the relationshipof ATP levels with the cellular catabolic/anabolic activity, will provide
insight into the restorative role of sleep.

AS-24-1
PREOPTIC HYPOTHALAMIC NEURONS ARE
ACTIVATED BY HOMEOSTATIC SLEEP PRESSURER SZYMUSIAK1
Departments of Medicine and Neurobiology, University of California, Los
Angeles, Granada Hills, CA, United States of America
1

The preoptic hypothalamus (POH) is a functionally important sleep
regulatory region of the brain, as evidenced by results of lesion, stimulation and unit recording studies. Within the POH of rats, the ventrolateral preoptic nucleus (VLPO) and the median preoptic nucleus (MnPN)
contain numerous sleep-active neurons, confirmed by unit recording
and by sleep-related c-Fos protein expression. While the relationshipof neuronal activity in these nuclei to alterations in wake and sleep isestablished, effects of changing levels of homeostatic sleep pressure on
MnPN and VLPO neurons is unknown. We have shown that Fos+ cellcounts in the MnPN are elevated after 2 hours of sleep deprivation (SD)compared to 2 hours of spontaneous sleep-waking and 2 hours ofrecovery sleep (RS). We have also recorded MnPN single unit activity
sequentially across periods of baseline sleep-wake, SD and RS. Activityof MnPN units increases progressively during SD such that after
2 hours, waking discharge rates are approximately double baseline
waking rates. During early RS, discharge rates are >60% higher thanrates during baseline sleep, but return to baseline levels after 90 min of246

RS. In the VLPO, Fos+ cell counts are significantly elevated after periodsof RS compared to SD. Waking discharge of VLPO neurons increase
moderately during SD, but VLPO units display sustained increases indischarge during RS compared to baseline sleep. These findings demonstrate that activity of MnPN and VLPO neurons reflects changes inhomeostatic sleep pressure. Injections of A2A adenosine receptor antagonist into the subarachnoid space rostroventral to the POH promotes
sleep and activates c-Fos expression in MnPN and VLPO neurons.
Hence, increases in extracellular adenosine levels in and adjacent to the
POH is one mechanism by which sustained waking can alter MnPN and
VLPO neuronal activity.

AS-24-2
OPTOGENETIC MANIPULATION OF THE
ACTIVITY OF OREXIN NEURONS CONTROLSSLEEP/WAKEFULNESS STATE IN MICET TSUNEMATSU1
Section of Cell Signaling, National Institute for Physiological Sciences,
Okazaki, Aichi, Japan1

Orexin/hypocretin is a neuropeptide produced in the neurons, which
are sparsely distributed in the lateral hypothalamic area. The micelacking prepro-orexin gene or orexin-producing neurons (orexin
neurons) show narcolepsy-like phenotypes, a fragmentation of sleep/
wakefulness and sudden attack of muscle weakness, cataplexy. Althoughthese facts suggest that the orexin neurons play critical role in the regulation of sleep/wakefulness, it is not clear that how the activity of orexin
neurons maintain wakefulness. To study this in vivo, a hot technology
optogenetics was incorporated. Optogenetics enables to control theactivity of neurons by illuminating light. A light-activated neuronalsilencer, halorhodopsin or arcaerhodopsin-3, is expressed in the orexin
neurons in the transgenic mice. Slice patch clamp recordings of orexin
neurons demonstrated that photic illumination silenced orexin neuron.
In the light period, acute silencing of orexin neurons in vivo synchronized the electroencephalogram and reduced in amplitude of the electromyogram. These are characteristic in slow wave sleep (SWS). This
result indicates that activation of orexin neurons is necessary forkeeping wakefulness during the light period. Acute photic inhibition oforexin neurons reduced discharge rate of serotonergic neurons in thedorsal raphe (DR) nucleus. Taken together, this study revealed that
optogenetics modulation of orexin neuronal activity enabled us tocontrol the transition from wakefulness to SWS in mice. Furthermore,
the silencing of orexin neurons and transition to SWS was accompanied
by a reduction of the activity of serotonergic neurons in the DR.

AS-24-3
ACTIVATION OF CORTICAL INTERNEURONS
DURING SLOW WAVE SLEEP: AN ANATOMICALLINK TO SLEEP HOMEOSTASIS?

TS KILDUFF1
Center for Neuroscience, SRI International, Menlo Park, CA, UnitedStates of America
1

The Two Process model of homeostatic sleep regulation posits that thetiming of sleep results from an interaction between a circadian process(Process C) and a homeostatically-regulated sleep process (Process S).
Whereas Process C is linked to neural systems that generate circadianrhythms, the neural basis of Process S is currently unknown. We haveidentified a population of GABAergic cells in the cerebral cortex that© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

express neuronal nitric oxide synthase (nNOS) and also express thetranscription factor FOS specifically during sleep in three different
species. FOS expression in cortical nNOS neurons varies across thediurnal cycle in conjunction with the natural occurrence of sleep;
sleep deprivation (SD) experiments further demonstrate that theextent of activation of these cells is proportional to homeostatic sleep
drive. Cortical nNOS neurons receive inputs from subcortical sleeprelated neurotransmitter systems such as serotonergic and cholinergic
neurons. nNOS cells are unique among cortical GABAergic interneurons because they have intracortical efferent projections. nNOS knockout (KO) mice exhibit disrupted sleep architecture and are sleepierthan WT mice yet have an impaired ability to respond to SD. CorticalnNOS neurons express the receptor NK1, which enables identificationof the sleep-active neurons (SANs) in nNOS KO mice; SANs are activated by SD in the absence of nNOS. Since cortical nNOS/NK1
neurons receive monoaminergic and cholinergic inputs, are active
during sleep in proportion to homeostatic sleep drive, and project
intracortically, we propose that cortical nNOS/NK1 neurons are critical integrators in the neuronal network that links state-dependentafferent inputs to the generation of cortical slow wave activity and thehomeostatic response to SD. Supported by NIH R01 HL059658.

AS-25-1
HOW CHOLINERGIC, GABAERGIC AND
GLUTAMATERGIC BASAL FOREBRAIN NEURONSREGULATE SLEEP-WAKE STATESBE JONES1
1
Montreal Neurological Institute, McGill University, Montreal, Canada

Using juxtacellular recording and labeling with Neurobiotin (Nb) of
neurons in naturally sleeping-waking, head-fixed rats, we have identified and characterized the discharge properties of cholinergic, GABAergic and glutamatergic basal forebrain neurons across the sleep-wakecycle (Lee et al., JN, 2005; Hassani et al., JN, 2009). We distinguishedfour pairs or sets of functionally distinct cell groups, each comprised ofsimilarly discharging glutamatergic and GABAergic cells together withcholinergic cells in one group that discharged maximally in W, SWS
and/or PS in association with either EEG activity or EMG activity. They
represent: 1) W/PS-max active cells (47%), which include cholinergic
cells, whose discharge is positively correlated with EEG gamma activity,2) SWS-max active cells (20%), whose discharge is negatively correlatedwith EEG gamma activity, 3) W-max active cells (8%), whose discharge
is positively correlated with EMG and 4) PS-max active cells (23%),
whose discharge is negatively correlated with EMG. Together with ourfindings from neuroanatomical studies, we conclude that the EEG
related W/PS-max and SWS-max cell set/pairs project to the cortex andreciprocally modulate EEG gamma activity, whereas the EMG related
W-max and PS-max cell pairs project to the hypothalamus, brainstemor spinal cord and reciprocally modulate muscle tone across the sleepwake cycle. Following from these findings and conclusions, we created
a computational model with inhibitory interconnections between reciprocally related EEG or EMG cell set/pairs and excitatory coupling
between similarly related EEG and EMG cell set/pairs. This basal forebrain network has the capacity to generate oscillatory discharge profilesof the intrinsic neurons, cyclic modulation of cortical activation andmuscle tone and the cyclic succession of the three states of W, SWS andPS (Cordova et al., SfN Abstracts, 2010).

AS-25-2
ROLES OF PREOPTIC AND ADJACENT BASALFOREBRAIN NEURONS IN THE CONTROL OFSLEEP-WAKING SWITCHK SAKAI1
1
Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon,
FranceThe preoptic area (POA) and adjacent basal forebrain (BFB) play animportant role in the control of sleep and wakefulness. According to aprevailing current hypothesis, the sleep process starts and ends withthe beginning or cessation, respectively, of firing of POA/BFB sleeppromoting neurons. Using the c-fos immunostaining method, two clusters of neurons that exhibit Fos protein expression after sustained sleep,
but not after waking, were reported in the rat, first in the ventrolateralpreoptic area (VLPO), then in the median preoptic nucleus (MnPO),
and have been proposed to be the principal sleep-promoting cell groups
within the POA/BFB. However, the sleep/waking-related neuronal activity of the POA/BFB neurons can be known only by recording their unit
activity during the sleep-waking cycle. Using extracellular single unit
recordings in unanesthetized, head-restrained mice, we therefore
recorded a large number (>1500) of single units in the POA/BFB anddetermined their activity profiles during all sleep-waking states and atstate transitions in an attempt to identify sleep-promoting and wakingpromoting neurons and determine their anatomical distribution. In
order to elucidate the mechanisms of sleep-waking switch, we also
recorded a large number of single units in the posterior hypothalamus(n > 500) and mesopontine structures (n > 1500) deeply involved in
the regulation of sleep and wakefulness. Our study showed that sleeppromoting neurons are found throughout the POA/BFB, rather than in
specific sites within the POA/BFB and that contrary to the current
hypothesis, the sleep process does not start with the activation of forebrain sleep-promoting neurons, but with a cascade of disfacilitation offorebrain and brainstem waking-promoting neurons.

AS-25-3
HOW PROJECTION AND INTER-NEURONS IN
THE THALAMUS AND CORTEX MODULATE EEG
ACTIVITY ACROSS SLEEP-WAKE STATESI TIMOFEEV1
Psychiatry and Neuroscience, Laval University, Quebec, Canada

1During slow-wave sleep the field potentials reveal large amplitude slowwaves and during waking state and REM sleep cortical field potentials
show activated pattern, composed of fast and low amplitude oscillations.
Cortical field potential recordings reflect intracellular activities of neuronal populations. The objective of the present study was to understandhow neuronal activities contribute to the generation of field potentials.
During slow-wave sleep the membrane potential of cortical neurons
undergoes large amplitude fluctuations. The hyperpolarizing phase of
membrane potential correspond to depth-positive local field potential
components. The depth-negative components of field potentials as wellas during waking state and REM sleep the membrane potential of majority of cortical neurons is depolarized and the neurons fire action potentials. During depolarizing components of all these states, the fast-spiking(inhibitory) neurons fired at higher frequencies than other neurons.
Conductance measurements demonstrate that inhibitory activities dominate active cortical states. In quiet wakefulness, due to intense firingof inhibitory interneurons, a half of cortical pyramidal neurons isrelatively hyperpolarized and these neurons either do not fire action© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research247

Sleep, Science and Researchpotentials or fire at very low rates. Intracellular activities of thalamocortical neurons were less investigated during natural states of vigilance. Ourcurrent study demonstrates that thalamus contributes to the generationof cortical slow oscillation, although cortical networks are able toproduce slow oscillation without any other structure.

AS-26-1
TREATMENT OPTIONS FOR MILD TO
MODERATE SLEEP APNEA PATIENTSFR ALMEIDA1
Department of Oral Health Sciences, Faculty of Dentistry, The Universityof British Columbia, Vancouver, BC, Canada
1

Obstructive Sleep Apnea (OSA) primary health consequences include
sleepiness and serious neurocognitive and cardiovascular sequelae. The
primary mechanisms by which OSA triggers cardiovascular disease
include intermittent hypoxia, generation of negative intrathoracic pressure during occluded breaths and arousals from sleep. Cardiovascularsequelae may include pulmonary and systemic hypertension, congestive
heart failure, arrhythmia, myocardial infarction, and stroke. Still, controversy remains as to how much impact the severity of OSA has on
cardiovascular consequences, independent of other confounding factors
such as obesity, gender and age. Busselton Health Study reported anincrease in all-cause mortality amongst moderate to severe OSA patients,
while the Wisconsin Sleep Cohort Study reported an increase in allcause mortality only in untreated severe OSA patients. The effect of
CPAP or mandibular advancement splints (MAS) treatment in objective
cardiovascular measurements in patients with mild OSA is less clear.
Studies evaluating milder OSA cases and cardiovascular consequences
will be discussed. Barnes et al. have identified four of 24 mild OSA
patients who became normotensive under CPAP therapy, but did not
find differences derived from 24 hour blood pressure recordings after
CPAP or placebo compared with baseline. While in another study, MAS
improved the nocturnal diastolic blood pressure and increased the
proportion of subjects with a normal night-time dip in blood pressure
only in the MAS group when compared to CPAP. Compliance andcomplexities of treatment are especially important in milder cases,
where subjective improvement may be small and not be perceived asimportant by the patients. OSA seems to progress from snoring to sleep
apnea. Even simple snoring could cause local nervous lesions in theupper airway, and this trauma could be responsible for the progressive
nature of the disease. OSA treatment should be considered for primaryand secondary cardiovascular prevention, even in milder OSA.

AS-27-1
CENTRAL ROLE OF SLEEP DISORDERS IN
MENTAL DISORDERS / DISEASESA BUETTNER(-TELEAGA)1
Institute of Sleep Research, Woosuk University, Samnye-up, Republic of
Korea
1

The number of permanently increasing sleep disturbed and neurological patients is alarming in the industrial countries, caused in eastern
and western social structures: specially the number of patients with
Insomnia, OSAS and with Stroke, TIA, AD and Dementia is increasing.
Mostly the causes of the disorders and/or diseases are unkown. Bothsleep disorders and neurological diseases leads to a lot of physical,(neuro)cognitive, emotional and social changes and comorbidities.
Possibility there is a strong relationship between both kinds of diseases– some sleep disorders could be a predictor for special acute and248

chronic neurological diseases and could be used as prognosis for it.
Particularly the degree of severity of the disease and the length of thetherapy having been carried out till now could play an important rolein this.Altogether, in Western Europe already suffer more than 10
percent of the population from Sleep-Awake-Disturbances which has tobe treated urgently; 800,000 from Sleep Apnea Syndromes and 25,000
from Narcolepsy.Not diagnosed and untreatedly among others these
diseases cause on the one hand frequently subjective sorrow with thepersons affected and on the other hand accident danger frequently also
increased one due to the increased daytime sleepiness or doziness inthe traffic and at work.The aim of this symposium is to analyse thephysical, cognitive and emotional impairments as well as the quality oflife before and after any therapeutical measures from peoples who sufferfrom sleep disorders or neurological diseases. The necessary therapy
time and the degree of severity shall be analysed too. Although thetherapeutical effect of some of the therapeutical interventions is confessed, greater, particularly systematic examinations are almost completely missing, however. It comes added to that that in the existingexaminations the case numbers are frequently very low and do notwithstand a statistical proof.

AS-27-2
POSSIBLE MECHANISM OFCYTOMORPHOLOGICAL AND APOPTOTICCHANGES IN RAT BRAIN NEURONS INDUCEDBY RAPID EYE MOVEMENT SLEEP DEPRIVATION
BN MALLICK1
School of Life Sciences, Jawaharlal Nehru University, New Delhi, India

1

Rapid eye movement sleep (REMS) is a complex but unique phenomenon expressed at least in higher vertebrates, including humans. It ispresent throughout life although its quantity varies with progress in age
and maturity and its duration varies with depth of sleep. Its proportion
varies in species and it is affected in most of the diseases. Its role has
been implicated with almost all psycho-somatic and patho-physiological processes and in severe cases its loss may cause death. As a unified
hypothesis it has been proposed that “REMS maintains brain excitability
and it serves as House Keeping Function of the Brain” (Mallick andSingh 2011). I will present evidence showing REMS deprivation(REMSD) modulates neuronal cytomorphology and biochemical properties suggesting apoptotic changes and noradrenaline (NA) is a key
factor in mediating such effects in rats.
Studies on male wistar rats revealed that REMSD by classical flower pot
method caused changes in neuronal size in different brain areas andthese changes could be prevented by alpha-adrenergic antagonist, prazosin. The REMSD on one hand caused fragmentation of cellular structural proteins leading to apoptotic changes in neurons, on the other
hand, it induced loss of synaptic boutons. As mechanism of action we
have found in vivo that experimentally non-cessation of NA-ergic
REM-OFF neurons in the locus coeruleus, which is likely to increase
NA-level in the brain, induced REMS loss and in vitro, NA indeed
affected neuronal membrane properties, oxidation-reduction levels,
calcium influx, growth and development and all these effects are dependent on duration of REMSD and NA concentration.
The findings advance our knowledge on the functions of REMS, REMSD
associated changes in neuronal properties, its possible mechanism ofaction, which help us better understand and attempt to counter REMS
loss associated disorders.
Acknowledgement: My students for carrying out the experiments.
Funding from Indian agencies CSIR, DBT, DST, ICMR and UGC.
Mallick and Singh, Sleep Med Rev, 2011.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

AS-27-3

AS-28-2

LINKS BETWEEN RBD, RLS, PLM AND M.
PARKINSON & LINKS BETWEEN OSAS AND
DEMENTIA, DEPRESSION, ANXIETYSLEEP SHAPES SMALL-WORLD PROPERTIES OFSUBSEQUENT SPONTANEOUS WAKING BRAIN
ACTIVITY

H FANG
Department of Respiratory Sleep Center, Peking University People’s
Hospital, China

YD VAN DER WERF1,2
Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam,
Netherlands, 2Dept Anatomy and Neurosciences, VU University medical
center, Netherlands
1

Abstract not arrived.

AS-28-1
LARGE-SCALE FUNCTIONAL BRAIN NETWORKSIN HUMAN SLEEP; INSIGHTS FROM EEG/FMRISTUDIESVI SPOORMAKER1, MS SCHROETER1, PG SAEMANN1, M CZISCH1RG Neuroimaging, Max Planck Institute of Psychiatry, Munich, Germany

1

Ultraslow spontaneous fluctuations of the blood oxygen level dependent (BOLD) signal as measured with fMRI show temporal correlations
in functionally related networks. Previous EEG/fMRI studies have examined these resting networks during sleep and reported that, in general,
functional connectivity was maintained in light sleep. These results arelargely in line with EEG studies, which reported increased neocorticalconnectivity (EEG synchronization) in specific frequency bands during
sleep. The breakdown in functional connectivity in deep NREM sleep
is in accord with the fading of consciousness and deepening of sleep,
but the preservation or even increase in functional connectivity in light
NREM sleep stages appears more puzzling and counterintuitive. We
applied graph theoretical analysis on wavelet correlations of extracted
BOLD signal time-courses of atlas-defined cortical and subcorticalregions in wakefulness, light sleep stages and slow wave sleep, and we
confirmed the widespread increase in cortico-cortical connectivity inlight sleep stages and a strong reduction of cortico-cortical connectivity
in slow wave sleep. Moreover, thalamo-cortical correlation values
sharply decreased in light sleep stage 1 and were partially restored indeeper sleep stages. There was also a significant effect of sleep on
network topology, in particular on local clustering values, which were
lowest in light sleep when compared to values of randomly rewired
networks. This randomization process can be contrasted with network
reconfiguration in different states of unconsciousness. A network
approach to the sleeping brain may be helpful for our understandingof potential brain plasticity/maintenance functions of sleep.

The role of sleep for waking brain activity remains poorly understood.
As a model for investigating this role, we studied sleep deprivation andits effects on brain function, described in terms of functional networkorganization measured with high-density EEG. We found that sleep
deprivation selectively affects the network parameters of frontal regions.
After sleep deprivation, local connectivity was lower for the alpha frequency band and pathlength was higher in the theta band compared
to after normal sleep. These changes could not be explained by power
differences. Thus, frontal connectivity was decreased locally after sleep
deprivation, indexed by both reduced local integration, and reduced
global integration of the frontal cluster. A homeostatic restorative function of sleep would therefore be most prominent for the frontal regions
and its connections. It remains to be investigated how task-related
neural network activity responds to sleep deprivation: the findings fit
well with the notion that specifically functions associated with thefrontal cortex suffer from sleep deprivation, such as executive control
and higher-order cognitive processes.

AS-29-1
GIFT OF SLEEP: HOW TODAY’S EXPERIENCES
BECOME TOMORROW’S MEMORIESS DATTA1
1
Psychiatry/Sleep and Cognitive Neuroscience, Boston University School of
Medicine, Boston, United States of America
Sleep in mammals is not a homogenous behavioral state, rather it is acontinuum of mixed states that differ in their physiology, chemistry, andphenomenological experiences. Like sleep, long-term memory formation is also not a single step, rather it is a multistep process. Over thelast four decades, an impressive number of studies have shown thatsleep confers a beneficial effect on learning and memory. There is now
strong evidence in both humans and animals to support the hypothesisthat separate sleep states are differentially involved in different steps ofmemory consolidation. This presentation will explain the cellular andmolecular mechanisms, as well as the beneficial effects, of each sleep
stage in the memory consolidation process.

AS-29-2
THETA WAVE PHASE SPECIFIC HIPPOCAMPALREACTIVATION DURING REM SLEEPINFLUENCES SYNAPTIC PLASTICITY
AND LEARNINGGR POE1
Department of Anesthesiology, University of Michigan, Ann Arbor, MI,
United States of America
1

Hippocampal place cell activity encodes one of the associative memory
functions of the hippocampus necessary for learning and consolidation
to the neocortex. During exploration, place cells fire primarily at the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research249

Sleep, Science and Researchpeaks of the ongoing hippocampal theta EEG activity (4–9 Hz) associated with potentiating synapses between cells which underlies longterm memory. During times of learning in wakefulness theta activity isessential for memory formation. REM sleep (REMS) also shows sustained theta activity in the hippocampus and associated structures. We
found that hippocampal place cells encoding a recently learned environment reactivate during REMS theta at primarily the peaks of the theta
waves. Cellular measures also indicate strengthened synapses, consistent with the proposed REMS memory consolidation process. However,place cells encoding familiar, already consolidated environments reactivate primarily at the troughs of REMS theta, which is associated withweakening previously potentiated synapses of those consolidated memories in the temporary memory assembly place of the hippocampus.
Cellular and place field activity measures show synaptic weakening after
REMS theta trough activity episodes, as would be expected for clearing
unnecessary memory networks during REMS. Further, auditory stimuli
such as loud clicks increase REMS duration and/or the density of REM
phasic activity, including P waves. We found that auditory stimuli
delivered during REMS following learning increased the efficiency ofthe memory consolidation process, rescued the detrimental effects ofshort term REMS deprivation on learning, and influenced REMS reactivation profiles of hippocampal cells during theta. These results further
reveal the physiological mechanisms underlying REMS memory
consolidation.

AS-29-3
PONTINE-WAVE ASSOCIATEDSYNCHRONIZATION BETWEEN HIPPOCAMPALAND AMYGDALA THETA WAVES: A
PHYSIOLOGICAL PROCESS FOR SLEEPDEPENDENT MEMORY PROCESSINGA KARASHIMA1, N KATAYAMA1, M NAKAO1
Graduate School of Information Sciences, Tohoku University,
Sendai, Japan1

The pontine reticular formation (PRF) nuclei are involved in the generation of hippocampal theta wave, which is recorded during particularbehavioral activities and REM sleep. A group of PRF neurons begins tofire and/or increase their discharge rate coincident with ponto-geniculooccipital (PGO) wave in cats during REM sleep. In rats, a PGO-like
phasic potential called pontine (P) wave can be recorded in the subcoeruleus region (SubC), which has mutual connections with the other PRF
nuclei. We have shown a close time-relationship between theta and P
waves. Theta wave appears not only in the hippocampus but also in
the amygdala. One of the intriguing features of amygdala theta wave isthe synchronization with hippocampal theta. We examined correlations
between the dynamics of the two theta and P waves and found thatfrequency of both hippocampal and amygdala theta waves increased
with an increase in P wave, synchronization between hippocampal andamygdala theta waves was enhanced in association with increased P
wave density, lesion of the SubC decreased the theta frequency anddegraded theta synchronization. These indicate that SubC enhancessynchronization between hippocampal and amygdala theta waves.
The immediate early gene leading to the formation of LTP is highly
expressed in the hippocampus and amygdala during REM sleep justafter a learning task. This supports the hypothesis that REM sleep servesto consolidate memories. The function of synchronization of hippocampal-amygdala theta wave is not yet clear, but the theta activity is considered to be important for the synaptic plasticity in the hippocampus
and amygdala. Theta-frequency stimulation facilitates synaptic plasticity, such as LTP in the hippocampus and long-term depression in the250

amygdala. Recently, it was found that activation of the SubC enhances
memory consolidation and increases synaptic plasticity-related gene
expression in the hippocampus and amygdala. These suggest that theclose time relation between theta wave dynamics and P wave density
contributes to memory functions during REM sleep.

AS-30-0
UNDERSTANDING THE MECHANISMS FOR THE
SUDDEN INFANT DEATH SYNDROME: WHAT WE
CAN LEARN FROM INFANT SLEEP STUDIESRSC HORNE1
1
The Ritchie Centre, Monash Institute of Medical Research, Monash
University, Melbourne, Victoria, Australia

During infancy sleep is at a life time maximum and the developmentof sleep is one of the major physiological processes which occurs during
the first year of life. Sleep has a marked effect on cardio-respiratory
physiology and control in adults. During infancy cardio-respiratory
control also undergoes significant maturation, and until this is mature
the cardio-respiratory system is unstable, and this is particularly soduring sleep. Sudden Infant Death Syndrome (SIDS) is the sudden
death of an infant less than 1 year of age that remains unexplained after
a complete autopsy, death scene investigation, and a review of the clinical history, and is presumed to occur during sleep. Although the underlying mechanisms involved in SIDS remain unclear, impaired
cardiovascular control during sleep together with an impairment inarousal from sleep are thought to be a likely mechanisms. In supportof this hypothesis, future SIDS victims have been found to have alteredor impaired cardiovascular control and reduced arousability in the
weeks to months before death. In addition, the major risk factors for
SIDS such as the prone sleeping position, maternal smoking and prematurity all have significant negative effects on both cardiovascular
control and arousability from sleep. Polysomnography studies in
infants, both at low and high risk for SIDS, have provided important
insights into the mechanisms underlying SIDS and can provide important information to further reduce the occurrence of SIDS. This symposium will focus on the studies which have examined deficits in
cardiovascular control and arousal from sleep.

AS-30-1
CARDIOVASCULAR CONTROL AND THE RISKFACTORS FOR SIDSSR YIALLOUROU1Ritchie Centre, Monash Institute of Medical Research, Monash University,
Clayton, Australia
1

Sudden Infant Death Syndrome (SIDS) is the most common cause ofdeath in infants aged 1–12 months in developed countries and isbelieved to occur during sleep. Epidemiological studies have identified
that prone sleeping is one of the major risk factors for SIDS and thatSIDS peaks between 2–3 months of age. Despite the identification ofmajor risk factors, the actual underlying mechanism(s) involved in SIDS
remain unclear. However, it has been suggested that the fatal event may
occur due to an impaired ability to mount an appropriate compensatory
response to a profound loss of blood pressure. Thus, understanding thedevelopment of cardiovascular control during sleep in infancy may
provide vital clues into the pathology of SIDS. Until recently, there has
been limited information regarding cardiovascular control in healthy
full-term infants. The paucity of cardiovascular data has been largely© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

due to the inability to measure blood pressure continuously and noninvasively in infants. However, advances in blood pressure measurement, has allowed the recent validation of a new non-invasive beat-beatmeasurement in infants. Using these techniques in longitudinal studies,
we have identified that within the first 6 months of life, blood pressure
dips at 2–3 months postnatal age, when the risk of SIDS is greatest.
Importantly, we have identified that prone sleeping, which is the major
SIDS risk factor, reduces blood pressure, impairs the response to a
cardiovascular challenge, and reduces baroreflex sensitivity and theseeffects are most marked during quiet sleep at 2–3 months. In summary,these studies provide evidence that impaired cardiovascular control
during sleep in the prone position may dampen protective responses tohypotensive events and play a vital role in pathogenesis of SIDS.

AS-30-2
THE IMPORTANCE OF AROUSAL FROM SLEEPIN SIDS

RSC HORNE1, HL RICHARDSON2The Ritchie Centre, Monash Institute of Medical Research, Monash
University, Melbourne, Victoria, Australia, 2Department of Neurobiology,
David Geffen School of Medicine, UCLA, United States of America
1

Sudden Infant Death Syndrome (SIDS) is one of the leading causes of
infant mortality in western countries and is commonly thought to occur
during sleep. Although the exact underlying mechanism(s) remain tobe elucidated, there is compelling evidence for the involvement of an
impaired ability to arouse from sleep in response to a life threatening
challenge. In infants, arousal is a hierarchical response, whereby fullcortical arousal and awakening is preceded by a stereotypical sequenceof sub-cortical events. When compared with age-matched controls, a
decrease in cortical arousal frequency has been identified in infants who
subsequently died of SIDS. These findings suggest that future SIDS
victims may have subtle pre-existing abnormalities in their arousal
pathways inhibiting progression from sub-cortical activation to corticalarousal. Previous studies identified that infant arousability from sleep
is reduced by major risk factors for SIDS, including the prone position
and maternal smoking, and increased by protective factors. Morerecently, however, studies have focused on the progression from subcortical activation to full cortical arousal. Our studies showed that
this arousal process in otherwise healthy, term infants is modified byexposure to prone sleeping and maternal smoking, particularly at 2 to
3 months, the peak risk age for SIDS. Furthermore, we have found thatfactors that have been suggested to protect against SIDS, swaddling andpacifier use, also modify both total arousability and the arousal processitself; however, the effects of swaddling were dependent on the infants
previous experience with the technique. An inhibited progression of
sub-cortical activation to full cortical arousal may prove to be a clinicallysignificant marker of infants who have an increased likelihood of succumbing to SIDS. Our findings highlight the importance of continued
education of the known risk factors for SIDS for both parents andadditional caregivers, to avoid complacency.

AS-31-1
RE EMERGENCE OF THE PREOPTIC AREA INSLEEP REGULATION

HN MALLICK1
1
Department of Physiology, All India Institute of Medical Sciences, New
Delhi, India
Over the last 80 years the basic mechanisms of sleep-wakefulness havebeen studied with an interdisciplinary approach embracing neurophysiology, neuroanatomy and neurochemistry. The existence of asleep-promoting area in the brain was first implied from the postmortem findings in Encephalitis lethargica patients by von Economoin 1930. The patients having lesion in the anterior hypothalamic preoptic area (POA) had insomnia. On the other hand hypersomnolence
was correlated with lesion in the posterior hypothalamus. Later in
1946, Nauta showed lesions of the POA resulted in decrease in sleep
and disruption of sleep cycle. In 1962, electrical stimulation of basal
forebrain and the POA by Sterman and Clemente showed drowsinessfollowed by behavioural and electroencephalographic sleep. In theintervening years, the role of the POA in sleep regulation was eclipsed
by the rising popularity of ascending reticular activating system
hypothesis. During 1965–85 the chemical signatures of ARAS werediscovered. However over last 25 years, in our laboratory, the role of
POA in sleep regulation has been confirmed by several lines of animal
experiments including stimulation, neurotoxic lesion, single unit
recording, neural transplantation, and functional magnetic resonanceimaging. More recently sleep active neurons have been found to beconcentrated exclusively in the ventrolateral POA (VLPOA) and median
POA (MnPOA). The importance of these cell groups is evident fromc-fos expression particularly during sleep and not during wake. The
results of few studies suggest that small lesions in the VLPOA and
MnPOA effectively suppress sleep. Compared to VLPOA a number ofstudies employing variety of techniques have shown that, the medial
POA is equally important if not less in regulating sleep. Together thesefindings suggest that the sleep promoting areas within the POA are
multiple and intermingled. The POA also takes part in homeostatic
control of sleep-wakefulness at adverse environmental temperature andsituation.

AS-31-2
SLEEP TO SURVIVAL: EMERGING ROLE OF THE
PREOPTIC AREA NETWORKINGKK GULIA1
Comprehensive Centre for Sleep Disorders, Sree Chitra Tirunal Institutefor Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
1

Preoptic area (POA) harbors neurons involved in varied functions
including sleep initiation and maintenance, thermoregulation, malesexual behavior, maternal behavior etc. Some of these vital functions
are closely interrelated that alteration in one behavior gets reflected inup or down regulation of the other function for energy homeostasis. It
has been challenging to examine the neuronal networking involved incentral processing and control of these functions, especially when it
involves understanding the mechanism for integration of functionality
in the in-vivo systems. On the basis of modern and classical techniques
in animal models, roles of various nuclei in the preoptic area are redefined for regulation of sleep. The original studies demonstrated the roleof medial preoptic neurons in promotion of sleep. The presence ofabundant warm sensitive neurons in this area were functionally correlated with the generation of slow wave sleep as the brain temperature© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research251

Sleep, Science and Researchshowed significant alteration with respect to change in the vigilant
state. In the late nineties, after identification of neuropeptide orexin/
hypocretin, regulation of sleep-wakefulness was restructured via thelateral-POA. The modulation of arousal states and sleep by various
established neurotransmitters were routed through orexin/hypocretin.
The optogenetic methods provided important insights into the state
dependent variation in the neuronal activity in the POA. The ventrolateral-POA and the median preoptic nuclei for sleep initiation also gained
momentum. However, the medial-POA continued to be important for
maintenance of sleep. The strong inputs from the adjoining nuclei inthe basal forebrain, like septum needs attention for a comprehensive
understanding of neuronal networking in the multimodal POA. In thecurrent decade, wherein sleep disturbances are more frequently
encountered that are causing serious health implications, the study ofregulation of sleep deserves a new prospective.

ponents of the cortical slow oscillations that occur during sleep andanesthesia. Thus, subtypes of cholinergic neurons show distinct discharge properties, express different molecular markers and are distinctly
modulated by their afferents. Similarly, GABAergic and glutamatergic
neurons are composed of subsets of functionally distinct neurons with
distinct dynamics across brain states. The analysis of these neuronal
populations at the single cell level has revealed evidence of a local
synaptic network primarily maintained by cholinergic neurons. The
activation of such a network produces phasic increases in cortical fastfrequency oscillations that are constrained to the temporal dynamics ofthe slow oscillations. These results, along with recent evidence revealing
similar mechanisms in other subcortical structures, suggest that theorchestrated activation of midbrain/brainstem networks during the slow
oscillations that are characteristic of sleep and anesthesia, plays a rolein shaping global neuronal activity, possibly by modulating the phasic
events occurring during slow wave activity.

AS-31-3
SLEEP IS AUTO-REGULATED: BASAL FOREBRAIN AREAS MODIFY SLEEP AS PERHOMEOSTATIC NEEDSVM KUMAR1
Comprehensive Centre for Sleep Disorders, Sree Chitra Tirunal Institutefor Medical Sciences & Technology, Jagathy, Trivandrum, India
1

Sleep is an auto-regulatory global phenomenon as almost all the brain
segments have an inherent tendency for sleep-wake oscillation. Thistendency is derived from a collective response of the several hundredsof neurons with oscillating membrane potential. In an intact animal,
the prior activity in the network determines the probability of its entering the sleep-like state or awake-like state. Normal alteration andexpression of sleep-wakefulness are influenced by several factors
including external input and internal feedback. There are several internal signals, including sleep-inducing substances, which are sleep facilitating. Basal fore-brain and hypothalamus should be considered as partof the neural mechanism through which many of these internal signals
act. There is enough evidence to suggest that the basal fore-brain andthe hypothalamus integrate sleep with body temperature, hunger, thirst,
circadian cycles, neuroendocrine outputs, autonomic responses andstereotyped behaviors as per homeostatic needs.

AS-32-1
SPIKE TIMING OF PEDUNCULOPONTINENEURONS DURING SLOW OSCILLATIONS AND
THEIR INVOLVEMENT IN THE MODULATION OF
PHASIC EVENTS DURING SLEEPJ MENA-SEGOVIA1
1
Department of Pharmacology, MRC Anatomical Neuropharmacology Unit,
University of Oxford, Oxford, United Kingdom of Great Britain andNorthern Ireland
The pedunculopontine nucleus (PPN) constitutes one of the main components of the reticular activating system. Along with other neuronalsystems in the brainstem and midbrain, it influences the occurrence ofspecific brain states and contributes to their cyclic alternation. The PPN
is composed of three main types of neurons, cholinergic, GABAergic
and glutamatergic, but it is the cholinergic population that has been
traditionally associated with its function as part of the reticular activating system. Recent results show that specific firing patterns of different
PPN neuronal subtypes are distinctively correlated with discrete com-252

AS-32-2
NORADRENERGIC NEURONS OF THE LOCUS
COERULEUS ARE PHASE-LOCKED TO CORTICAL
UP-DOWN STATES DURING SLEEPSJ SARA1
CNRS-LPPA, College de France, Paris, France

1

Slow wave, or non rapid eye movement sleep (nREM) is known to bebeneficial for memory in humans and other species, although theunderlying mechanisms are just beginning to be understood. NREM
sleep is characterized by periodic changes of cortical excitability,reflected in the EEG as high-amplitude slow oscillations (UP/DOWN
states). Discovery of a learning-dependent increase in activity of thenoradrenergic nucleus Locus Coeruleus (LC) during slow wave sleep
prompted us to investigate the timing of LC spikes as a function of
sleep-associated cortical oscillations. We monitored these slow oscillations, along with extracellularly recorded unit activity of LC neurons
and neurons of the prefrontal cortex, in non-anesthetized freely sleeping
rats. Spike-triggered averaging of EEG, together with phase-locking
analysis, confirmed that cortical neurons fired around the peak of theslow oscillation. These analyses further revealed preferential firing of
LC neurons along the ascending edge of the slow oscillation, correlatingwith Down-to-Up state transition. LC neurons were locked best when
spikes were shifted forward ∼50 ms in time with respect to the EEG
slow oscillation. This precise timing of LC activity with the transitional
state of cortical excitability provides neuromodulatory input which
could facilitate the transition by making cortical neurons more excitable. Moreover, plasticity processes ocurring during this phase of sleep
would be reinforced by release of noradrenaline by the LC neurons.

AS-33-1
AWAKE AT NIGHT – HOW EXTREME DOESSLEEPINESS GET?
TG AKERSTEDT1
1
Stress Research, Stockholm University, Stockholm, Sweden

Night work is associated with an increased accident risk often attributed
to sleepiness. This attribution is based on inference in the sense thatsleepiness normally results from activity at the circadian through orfrom reduced sleep or, frequently, from both. Rarely, however, is sleepiness actually measured in relation to accidents, near accidents, or corresponding situations. Here we present data showing that physiological© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPlenary Sessions

indications of sleepiness during night work in general, as well as subjective reports of sleepiness. Sleep intrusions is seen during work at nightand subjective reports reach high levels. In a series of studies of driving
on rural roads and motorways we have described the levels of sleepinessreached and related this to measures such as unintentional line crossings and driving interrupted because of dangerous sleepiness. The
results indicate that shortly before driving is interrupted reported sleepiness is increased to very high levels (corresponding to those seen justbefore driving off the road in a simulator) and sleepiness intrusions in
the EEG and EOG increase., as well as blink duration.

AS-33-2
RECOVERY SLEEP AND NAPPING AS
COUNTERMEASURES TO FATIGUE:
BENEFITS AND CONSEQUENCES IN
INDUSTRIAL SETTINGS

T KUBO1
1
Health Administration and Psychosocial Factor Research Group, National
Institute of Occupational Safety and Health, Japan, Kawasaki-city,
Kanagawa, Japan
Sleep plays an essential role in recovery from work-related fatigue. The
management of sleep is linked to practical strategies for occupationalsafety and health. Recently, much attention has been directed toward
the effects of chronic sleep loss and the subsequent recovery process.
This research interest may be inspired by the effects of long working
times on health and safety among daytime workers.
A great deal of previous research has focused on alertness and performance in response to manipulated sleep times (e.g., Van Dongen et al.,2003). However, very little is known about the influences of daytime
activities during the period of sleep restriction on subsequent sleep anddaytime function the next day. Examining the interaction between sleep
and social (i.e., work) or individual (i.e., leisure) activity is crucial tounderstanding fatigue recovery among workers. In short, the recovery
power of sleep may change based on the type of daytime activities, eventhough the same sleep times are provided (Kubo et al., 2008).
Also, since shift workers take a daytime sleep after night shift at theexpense of individual time, their daytime activity would be limited
compared to daytime workers. According to previous research (Sasaki
et al. 1992, Takeyama et al., 2005), night-shift napping is expected as
an effective strategy for enhancing the quality of daytime activities afternight shift in addition to reducing fatigue and sleepiness during night
shift.

Taken together, fruitful time for social or individual activity is considered to be a key factor to high quality of sleep for facilitating fatigue
recovery among workers. The presentation will highlight findings as tofatigue recovery among workers in terms of the interaction between
sleep and daytime activities.

AS-33-3
THE EFFECTIVENESS OF A RESTART BREAKTO SUSTAIN PERFORMANCE ACROSSCONSECUTIVE WORK SHIFTS DEPENDS ON
THE CIRCADIAN TIMING OF THE SHIFTSHPA VAN DONGEN1
Sleep and Performance Research Center, Washington State University,
Spokane, WA, United States of America
1

U.S. truck drivers are allowed to accumulate 60 h/70 h on duty in awork period of 7/8 consecutive days, and to begin another work period
after a 34 h restart break. We investigated the effectiveness of this breakfor sustaining performance in daytime and nighttime schedules. N = 27
healthy subjects (22–39 y; 14 f) participated in a 14-day in-residence
laboratory study, which included a 5-day work period, a 34 h restart
break, and another 5-day work period. 14 subjects were randomized
to a daytime condition, involving nocturnal sleep (22:00–08:00) daily
during the two 5-day work periods and the restart. 13 subjects wererandomized to a nighttime condition, involving nocturnal wake anddiurnal sleep (10:00–20:00) daily during the two 5-day work periods,
while reverting to diurnal wake and nocturnal sleep during the restart.
Performance on cognitive tasks and on a high-fidelity driving simulator
was tested four times per day, except during the restart. Mixed-effects
ANOVA revealed significant interactions of work period (before versus
after the restart) by condition (daytime versus nighttime) for lapses (RTs
> 500 ms) on a psychomotor vigilance test (PVT; F = 20.1, p < 0.001),
for ability to orient a map in a cardinal direction decision task (CDDT;
F = 17.8, p < 0.001), and for lane deviation on the driving simulator(F = 9.2, p = 0.003). In the daytime condition, performance after therestart was the same or better than before the restart. In the nighttime
condition, performance after the restart was degraded (PVT lapses) or
showed less improvement from practice than in the daytime condition(CDDT, driving) relative to before the restart. Thus, the 34 h restart
break was adequate to sustain performance in subjects scheduled to
daytime shifts, but not in subjects scheduled to nighttime shifts. This
stresses the importance of circadian effects on sleep and performancefor effective hours-of-service regulations.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

253

Sleep and Biological Rhythms 2011; 9: 254–416

doi:10.1111/j.1479-8425.2011.00518.x

Poster Presentations
PO-1-002 / AS-15 Presenter

Poster presentations 1

POOR SLEEP AND EEG SLEEP SPINDLEACTIVITY IN CHILDREN AND ADULTS
WITH AUTISM

PO-1-001
BIDIRECTIONAL ASSOCIATIONS BETWEENSLEEP PROBLEMS AND BEHAVIOURALRISK FACTORSP LYYTIKINEN, O RAHKONEN, M LAAKSONEN, E LAHELMA,T LALLUKKA
Department of Public Health, University of Helsinki, Helsinki, FinlandObjective: It has been hypothesized that sleep problems may induce
adverse health behaviours and health behaviours may negatively affectsleep. The aim of this study was to examine whether there are bidirectional associations between sleep problems and behavioural risk factors.
Method: The data were derived from the Helsinki Health Study prospective cohort study. The baseline data were collected in 2000–2002(n = 8960, response rate 67%) among 40–60-year old employees of theCity Helsinki and follow up data in 2007 (n = 7332, response rate83%). Logistic regression analysis was used to examine associations
among sleep problems and behavioural risk factors, including heavy
and binge drinking, smoking, leisure-time physical inactivity, unhealthy
food habits and obesity (BMI > 30 kg/m2).
Results: At baseline, 17% of men and 21% of women reported frequent
sleep problems. At follow-up, these figures were 20% for men and 27%
for women. Among women, frequent sleep problems at baseline predicted heavy drinking (OR 1.30; CI 1.02–1.66), physical inactivity (OR1.37; 95% CI 1.16–1.63) and obesity (OR 1.28; 95% CI 1.01–1.63) atfollow-up after adjusting for baseline behavioural risk factors, occupational class and sleep duration. Additionally, among women heavy
drinking (OR 1.56; 95% CI 1.26–1.92), binge drinking (OR 1.29; 95%
CI 1.09–1.53), physical inactivity (OR 1.17; 95% CI 1.00–1.39) andobesity (OR 1.31; 95% CI 1.09–1.58) reported at baseline predictedsubsequent sleep problems at follow-up. Obesity at baseline was associated with frequent sleep problems at follow-up also in men (OR 1.66;
95% CI 1.09–2.55).
Conclusion: Sleep problems are associated with subsequent behavioural risk factors and also behavioural risk factors are associated withsubsequent sleep problems in women.

R GODBOUT1, M CHICOINE2,4, J DUFRESNE-BASTIEN2,4,
A LAMBERT2,4, S TESSIER2,4, A-C ROCHETTE2,4, L MOTTRON3,4,
E CHEVRIER2,4
1
Psychiatry – Sleep Laboratory & Clinic, Université de Montréal,
Montréal, Canada, 2Sleep Laboratory & Clinic, Hop. Riviere-des-Prairies,
Canada, 3Autism Clinic, Hop. Riviere-des-Prairies, Canada, 4Centre derecherche Fernand-Seguin, Hop. Riviere-des-Prairies, Canada
Introduction: Autism is characterized with poor sleep maintenance.
EEG sleep spindles represent a sleep protective process by whichaccess of inputs to the brain is diminished via a thalamo-cortical loop
inhibition. In typically developed individuals, sleep spindle density
decreases with age. In adults with an Autism Spectrum Disorder (ASD)
the density of left central (C3) sleep spindles, not left prefrontal (Fp1),
is significantly lower than controls (Limoges et al., 2005). The goalsof the present study were to: 1) See whether SS density is also low
in children with ASD; 2) Compare the results in children and adults.
Methods: Twenty-eight individuals with ASD (15 adults: 14M, 1F, 22.3
± 3.6 yrs; 13 boys, 10.7 ± 1.9 yrs) and 29 controls (16 adults: 15M,
1F, 24.4 ± 4.0 yrs; 13 boys, 9.8 ± 2.2 yrs) were recorded for two consecutive nights. Sleep stages were determined for night 2 according to
Rechtschaffen and Kales (1968) using 20 sec. epochs. Stage 2 sleep
spindles were visually identified at the Fp1 and C3 electrodes. Results
were compared using t-tests (p < .05).
Results: Children and adults with ASD showed longer sleep latencies
and more awakenings than controls. Sleep spindle density was not different between ASD and control children; adults with ASD had significantly less spindles than controls, at C3 only. Children with ASD hadsignificantly more sleep spindles than adults with ASD at Fp1 and C3
while the control children had significantly more spindles that adultcontrols at Fp1.
Discussion: These results could suggest that sleep protective mechanisms are intact in children with ASD but other EEG markers (K-complexes and EEG power) and more recording sites should be investigated.
Moreover, other age-dependant sources of poor sleep could affect children with autism, including an impaired circadian timing system andbehavioral issues. The present EEG results also show an atypical corticalmaturation way along the antero-posterior axis in autistics that will
require further investigation using a full EEG montage.

PO-1-003 / AS-27 Presenter
RESIDUAL SLEEP DISTURBANCES AFTERREMISSION OF MAJOR DEPRESSIVE DISORDER– A 4-YEAR NATURALISTIC FOLLOW-UP STUDYXS LI, SP LAM, JWY CHAN, MWM YU, YK WING
Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
Objectives: A substantial portion of depressed patients continued
to experience residual symptoms despite optimized antidepressant254© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

treatment. The aim of the current study was to investigate the prevalence, clinical, psychosocial as well as quality of life correlates of residual sleep disturbances in a cohort of psychiatric outpatients with MDD.
Methods: A total of 421 depressed outpatients were assessed in 2006
and 2010, which consisted of a standardized diagnostic psychiatricinterview and a packet of self-reported questionnaires, including ageneral sleep questionnaire, Hospital Anxiety and Depression Scale(HADS), NEO-Five Factor Inventory (NEO-FRI), and Short-Form-12
Health Survey (SF-12v2).
Results: A total of 371 patients (mean age: 44.6 ± 10.4 years, female:
81.8%; response rate 88.5%) completed the reassessments, in which
41% were classified as remitted cases. One-year prevalence of frequent
insomnia at baseline and follow-up was 38.0% and 19.3%, respectively. One-year prevalence of frequent nightmares at baseline andfollow-up was 24.0% and 9.3%, respectively. Remitted participants
with residual insomnia were more likely to be divorced (p < .05), andscored higher on anxiety subscale (p < .05). Additionally, remitted
participants with residual nightmares were younger (p < .05), andscored higher on neuroticism (p < .05) and anxiety subscale (p < .01).
Residual insomnia was associated with lower physical functioning (p< .05) and role-emotional (p < .01); residual nightmares was associated with bodily pain (p < .05) and lower vitality (p < .05). Suicidal
ideation was significantly associated with residual nightmares (OR =8.40, 95% C.I. 1.79–39.33) after controlling for potential confounding
factors.
Conclusion: Residual sleep disturbances were associated with a constellation of psychosocial factors, impaired quality of life and suicidal
ideation in remitted depressed patients. Future prospective studies
should be conducted to examine the prognostic significance of residual
sleep disturbances in relation to the recurrence of depression.

PO-1-004 / AS-14 Presenter
GRAY MATTER CHANGES IN BRAINS OFPRIMARY INSOMNIAY WAN JOONG, EY JOO, SB HONG
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
Introduction & Objective: To investigate differences in brain graymatter concentrations (GMC) in patients with primary insomnia (psychophysiological insomnia, PI) and good sleepers (GS).
Methods: The study consisted of 27 female PI and 27 GS matched
for age (mean age, 47.5 years). All subjects underwent night polysomnography to exclude other sleep disorders and then optimized voxelbased morphometry, an automated processing technique for MRI wasapplied.
Results: On visual inspection of brain MRIs, there were no structuralabnormalities. Compared to GS, GMCs of PI were significantly decreasedin the superior and inferior frontal gyri, superior temporal gyrus, andpostcentral gyrus in right hemisphere middle and inferior frontal gyriand postcentral gyrus in left hemisphere (uncorrected P < 0.001). Gray
matter volume was not different between PI and GS. Also there were
no brain areas showing increased GMCs in PI than GS.
Conclusions: These findings suggest that attention and affective disturbances and executive dysfunction frequently found in PI patientsmight be related to morphological differences in the brain gray matterareas.

PO-1-005 / AS-1 Presenter
NIGHT-TO-NIGHT SLEEP VARIABILITY IN
INSOMNIA PATIENTS PARTICIPATING IN
GROUP CBTIS SUH1, S NOWAKOWSKI1, R BERNERT1, J ONG3, A SIEBERN1,C DOWDLE2, E WILLETT2, R MANBER1
1
Department of Psychiatry, Department of Sleep Medicine, Stanford
University, San Francisco, CA, United States of America, 2Stanford Psy. D.
Consortium, Pacific Graduate School of Psychology, United States ofAmerica, 3Department of Behavioral Sciences, Rush University Medical
Center, United States of America
INTRO: Regularizing sleep-wake times is a target for cognitive-behavioral therapy for insomnia (CBT-I), yet little is known about determinants of variability in sleep behaviors and insomnia symptoms.
METHODS: 455 participants (57.6% female; M = 48.12 ± 14.38 years)
participated in a 7-session CBTI group. Participants completed the Beck
Depression Inventory (BDI), the Morningness-Eveningness Composite
Scale (MECS), and one week of sleep diaries at baseline and end oftreatment. Participants were categorized into Evening and Non-evening
chronotypes based on the 20th percentile MECS score. The weeklymeans of successive squared differences of bed time, lights out, waketime, out of bed, and time in bed were computed, converted to z-scores
and averaged, yielding behavioral composite scores (BCS). The sameprocedure was used to derive an insomnia composite score (ICS) basedon variability of sleep onset latency, time awake after sleep onset, andtotal sleep time.
RESULTS: Pre- to post-treatment reductions were found on all BCS
and ICS variables (p < 0.01). Multiple regressions with age as a covariate
were employed to examine the effects of depression and chronotype on
BCS and ICS. For BCS, the model (Adjusted R2 = .19) had significant
effects for depression (B = .30, p < .001), chronotype (B = .27, p <.001) and their interaction (B = .02, p = .003). Among those with higher
depression severity (BDI > 14), evening chronotypes exhibited significantly greater variability in sleep behaviors than non-evening chronotypes (t = −2.44, p = 0.03). Among those with low depressive symptoms,
there was no significant difference in BCS. For ICS, the model (Adjusted
R2 = .03) had a significant effect for depression (B = .12, p = .001), but
not chronotype or interaction.
CONCLUSION: Elevations in depressive symptoms and evening chronotype status is associated with high levels of sleep variability, suggesting that regularizing sleep may be an especially important treatment
target. In addition, elevations in depressive symptoms predicted morevariable insomnia symptoms, which stabilized following group CBTI.

PO-1-006
WITHDRAWN© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research255

Sleep, Science and Research

PO-1-007
THE DAYTIME IMPACT OF DSM-V INSOMNIADISORDER: COMPARATIVE ANALYSIS OF
INSOMNIA SUBTYPE FROM THE GREAT BRITISHSLEEP SURVEY (N = 11,129)

CA ESPIE1, SD KYLE1, P HAMES2
Institute of Neuroscience & Psychology, College of Medical, Veterinary &Life Sciences, University of Glasgow Sleep Centre, Kilmacolm, United
Kingdom of Great Britain and Northern Ireland, 2Sleepio Ltd., London,
United Kingdom
1

The DSM-V work group for sleep-wake disorders propose moving awayfrom the notion of primary and secondary insomnia, and instead advocate the view that, whenever present, insomnia disorder (ID) should be
coded and treated as a substantive psychiatric disorder in its own right,
regardless of the presence of co-morbid illness. Here, we report datafrom the Great British Sleep Survey (GBSS) on the daytime impact of
DSM-V defined ID and its diagnostic subtypes. The GBSS is an online
population survey, based upon proposed DSM-V criteria, covering bothnight-time and daytime symptoms, physical- and mental-health, andsymptoms of additional sleep disorders. We compared those with ID
and those with NO-ID, in terms of daytime impact in the following areas:
energy, concentration, relationships, ability to stay awake, mood andability to get through work. ID subtypes (difficulty initiating sleep {DIS};
difficulty maintaining sleep {DMS}; early morning awakening {EMA};
mixed; non-restorative sleep {NRS}) and ID presentations (ID and poor
mental health; ID and poor physical health; ID and additional sleeprelated symptoms; ID on its own) were also compared in terms daytime
impact. A total of 11,129 surveys (72% female; mean age = 39 yrs) werecompleted in a 12-month period. Using DSM-V criteria, 5,713 participants screened as having a possible ID. The ID group, compared with
the NO-ID group, reported significantly greater impairments in all six
areas of impact (Cohen’s d > .70). In terms of ID subtypes, EMA andmixed groups reported significantly greater impairment in all areas offunctioning compared with DIS, DMS, and NRS. The ID and poor
mental health group were found to be consistently more impaired in fiveout of six areas of daytime dysfunction (excluding ability to stay awake)
relative to ID on its own, ID and poor physical health, and ID in addition
to other sleep-disordered symptoms. The GBSS provides some of thefirst data on the proposed new DSM-V ID criteria, revealing differential
subtype profiles in terms of daytime impact, which may shed light on
differing underlying pathogenic mechanisms.

PO-1-008 / AS-1 Presenter
EFFECTS OF COGNITIVE BEHAVIORAL THERAPYON PATIENTS WITH PHARMACOLOGICALTREATMENT-RESISTANT INSOMNIAI OKAJIMA1, K HAYASHIDA1,3, M NAKAMURA1,2, M KANNO1,3,
U AKIRA1,4, S NAKAJIMA1,2, Y INOUE1,2
1
Japan Somnology Center, Neuropsychatric Research Institute, Tokyo,
Japan, 2Development of Somnology, Tokyo Medical University, Japan,
3
Sleep and Stress Clinic, Japan, 4The Faculty of Health Science Technology,
Bunkyo Gakuin University, Japan

This study examined whether cognitive behavioral therapy (CBT-I)
improves insomnia symptom and whether CBT-I contribute to the
reduction of the dose of hypnotics medication among patients withpharmacological treatment-resistant chronic insomnia. Sixty three
insomniac outpatients with pharmacological treatment-resistant chronic

256

insomnia (42 Female (67%), Mean age: 46.5 ± 15.5 years, self-reported
morbidity of the disorder: 7.5 years; mean duration of hypnotics medication: 3.9 years, mean score of the PSQI was 13.1 ± 3.0) were assigned
to a biweekly six-session CBT-I (n = 34) or to treatment as usual by sleep
disorder specialist physicians (TAU; n = 29). CBT-I included psychoeducation, sleep hygiene, relaxation, stimulus control, sleep restriction,
contingency management, and coping for worry. Subjective measures
including the following variables were evaluated at the baseline and at
the end of the treatment; the Pittsburgh Sleep Quality Index (PSQI), theAthens Insomnia Scale (AIS; a cut-off score is 6), and the Self-rating
Depression Scale (SDS). Descriptive variables (e.g., gender) and thescores of these subjective measures did not differ between CBT-I groupand TAU group at the baseline. The scores of the PSQI and the AIS
decreased significantly at the end of the treatment in both groups andbetween groups at the end of the treatment. Significant decrease in thescore of the SDS was observed only in CBT-I group. The rates of change
after the treatment of CBT-I were larger than that of TAU. As for daily
lormetazepam equivalent dose of hypnotics. the doses of hypnotics
decreased significantly in CBT-I compared to those in TAU group at theend of the treatment. In addition, 24 participants (71%) in CBT-I groupand 7 (24%) in TAU group had the AIS score of 6 points or lower at theend of treatment. Our result strongly supported the assumption that
CBT-I improves the nocturnal and daytime symptoms of pharmacological treatment-resistant chronic insomnia, and that the treatment is
helpful for the discontinuation or reduction of the medication usage.

PO-1-009
BRIEF BEHAVIORAL THERAPY FOR REFRACTORYINSOMNIA IN RESIDUAL DEPRESSION:ASSESSOR-BLIND, RANDOMIZEDCONTROLLED TRIAL

N WATANABE1, T FURUKAWA2, S SHIMODERA3, I MOROKUMA3,F KATSUKI4, H FUJITA3, M SASAKI5, C KAWAMURA3, M PERLIS6
1
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya
City University Graduate School of Medical Sciences, Nagoya, Japan,
2
Department of Cognitive-Behavioral Medicine, Kyoto University Graduate
School of Medicine / School of Public Health, Japan, 3Department of
Neuropsychiatry, Kochi Medical School, Japan, 4Department of Psychiatricand Mental Health Nursing, Nagoya City University School of Nursing,Japan, 5Center for Education and Research on the Science of Preventive
Education, Naruto University of Education, Japan, 6Behavioral Sleep
Medicine Program, Department of Psychiatry, University of Pennsylvania,
United States of America

Objective: Insomnia often persists despite pharmacotherapy in depression and represents an obstacle to its full remission. This study aimed
to investigate the added value of brief Behavioural Therapy for insomnia(bBTi) over treatment as usual (TAU) for residual depression and refractory insomnia.
Method: Thirty-seven outpatients (average age of 50.5 years) wererandomly assigned to TAU alone or TAU plus bBTi, consisting of 4
weekly 1-hour individual sessions. The Insomnia Severity Index (ISI)
scores (primary outcome), sleep parameters, the Hamilton Rating Scalefor Depression (HAMD) scores assessed by blind raters, and remission
rates for both insomnia and depression were collected at 4- and 8-weekfollow-ups.
Results: bBTi plus TAU resulted in significantly lower ISI scores thanTAU alone at 8 weeks (P < .0005). The sleep efficiency for the combination was also significantly better than that for TAU alone (P = .015).
Significant differences were observed in favour of the combinationgroup on both the total HAMD scores (P = .013) and the HAMD scores© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

after removing the three sleep items (P = .008). The combination treatment produced higher rates of remission than TAU alone, both in termsof insomnia (50% vs 0%) with a number-needed-to-treat (NNT) of 2
(95% confidence intervals, 1 to 4), and in terms of depression (50% vs
6%) with an NNT of 2 (1 to 5).
Conclusions: In patients with residual depression and treatment refractory insomnia, adding bBTi to usual clinical care produced statisticallysignificant and clinically substantive added benefits.
Reference:
Watanabe N, Furukawa TA, Shimodera S, Morokuma I, Katsuki F, Fujita
H, Sasaki M, Kawamura C, Perlis ML. Brief behavioral therapy forrefractory insomnia in residual depression: an assessor-blind, randomized controlled trial. J Clin Psychiatry. 2011. Online ahead of print.

PO-1-010
EFFICACY OF CO-MORBID COGNITIVEBEHAVIORAL THERAPY FOR INSOMNIACOMBINED WITH DEPRESSION PREVENTIONPROGRAM IN PATIENTS WITH REMIT
DEPRESSIONK AOKI, M OZONE, H FURUKAWA, T TSUMURA, M MORITA,T MANABE, K NUKARIYA, H ITOH, K NAKAYAMA
Department of Psychiatry, Jikei University School of Medicine, Tokyo-city,
Tokyo, Japan
Backgrounds: The rate of patients having sleep problems is approximately 27–65% in remit depression. Insomnia deteriorates the efficacyof therapy for depression and increases the risk for relapse. We carriedout the depression prevention program (DPP) from 1994 in our hospital. DPP is group psychotherapy which is combination of cognitive
behavioral therapy and social learning theory for remit depressed
patients. A course is consisted of 8 sessions held weekly, which takes
60–90 min per session. According to our previous study, DPP hadsignificant effects on residual depressive symptoms, but did not haveenough effects for insomnia. Therefore, we put focus on clarifying theefficacy of co-morbid cognitive behavioral therapy for insomnia (CBT-I)
combined with DPP for insomnia and other symptoms in remit depressive patients.
Subjects and Methods:
1) Subjects:a) DPP + CBT-I group 8 (M/F 4/4, mean age 43.1 ± 12.1y) and DPPgroup 16 (M/F 8/8, mean age 44.6 ± 11.9y)b) Inclusion criteria: 1) Depressive episode or Recurrent depressive
disorder in ICD-10 2) Less than 15 points in HAMD-24 (theHamilton Rating Scale for Depression-24) before DPP.
2) Measurements:a) HAMD-24b) Profile of Mood States (POMS)c) Automatic Thoughts Questionnaire Revised (ATQ-R)d) Pittsburgh Sleep Quality Index (PSQI)
These items were assessed before and after DPP.
Results:
1) There was no difference in HAMD total score between DDP and DPP+ CBT-I group before first session (Two-sided Mann-Whitney’s Utest).
2) In both of DPP and DPP + CBT-I group, HAMD total score and
ATQ-R score significantly decreased after treatment of either DPP or
DPP + CBT-I (P < 0.05; two-sided Wilcoxon’s signed rank test).
3) Compared with DDP group, the sub score of early morning awakening in HAMD tended to decrease more in DPP + CBT-I group (P <0.1; ANOVA).

4) Compared with DDP group, the sub score of general somatic symptoms in HAMD was significantly lower in DPP + CBT-I group (P =0.035; ANOVA).
Conclusions: From our results, it was suggested that addition of CBT-I
to DPP was effective for not only insomnia but also general somatic
symptoms in remit depressed patients.

PO-1-011
SELF-HELP TREATMENT FOR INSOMNIASYMPTOMS ASSOCIATED WITH CHRONICCONDITIONS IN OLDER ADULTS: A
RANDOMISED CONTROLLED TRIAL
K MORGAN, P GREGORY, M TOMENY, B DAVID
Sleep Research Centre, SSEHS, Loughborough University, Loughborough,Leics, LE11 3TU, United Kingdom of Great Britain and Northern Ireland
Introduction: While the benefits of self-management approaches tochronic conditions are widely recognised, self-help CBT-I strategies
have not been evaluated for use among older people with comorbid
insomnia symptoms. In a randomised controlled trial patients with
DSM-IV insomnia symptoms associated with long-term health problems received either treatment as usual (TAU) or self-help CBT-I. The
self-help comprised six consecutive booklets, mailed at weekly intervals, providing structured advice on self-monitoring, sleep hygiene,
sleep restriction, stimulus control procedures, and cognitive strategies.
In addition, a telephone helpline was provided to support the implementation of the self-help advice. Outcomes (PSQI, Insomnia Severity
Index, the Fatigue Severity Scale, and medication use) were assessed atbaseline, on completion of the self-help programme (post-treatment),
and then 3 and 6 months later.
Results: 193 patients (aged 55–87) were randomly allocated to theintervention (n = 98) or TAU (n = 95) groups. In models controllingfor age, gender and baseline values patients in the self-help arm showed:
significantly improved sleep quality, and significantly reduced insomnia
symptom severity at post-treatment, 3 and 6 month follow-ups (all p <0.001); and significantly reduced sleep medication use at the posttreatment follow-up (p < 0.05). Effect sizes were low, and treatment
had no effect on levels of daytime fatigue. Most treated patients (73%)
said they would recommend the self-help programme to others.
Conclusion: Self-help CBT-I offers a practical, low-cost, first-line
response to insomnia symptoms associated with chronic disease in
primary care settings. Among these patients, however, symptoms ofdaytime fatigue appear to be more closely associated with disease processes than to sleep quality.

PO-1-012
SUBJECTIVE SLEEP QUALITY, DEPRESSION AND
ANXIETY IN AUSTRALIAN ADOLESCENTS

JM WALOSZEK1, B BEI1, M BYRNE1, CL NICHOLAS1, M RANITI1,
G MURRAY1,2, N ALLEN1, J TRINDER1, M WOODS1
1
Psychological Sciences, University of Melbourne, Parkville, Australia,
2
Psychological Sciences and Statistics, Swinburne University of Technology,
Australia

Introduction: Poor sleep is widely observed in adolescence and is acommon symptom of psychological disturbances. This study examined
the relationship between depression and anxiety symptoms, and subjective sleep quality in an adolescent sample.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research257

Sleep, Science and Research

Method: 213 (38 boys) 12 to 18 year olds in Australian secondary
colleges completed the Centre for Epidemiological Studies Depression
Scale (CES-D), the Spence Children’s Anxiety Scale (SCAS), and
the Pittsburgh Sleep Quality Index (PSQI). Questionnaires produced
Total Scores with cut offs reflecting overall high or low levels of depression, anxiety and sleep quality. The PSQI also assessed sleep disturbance, onset latency (SOL), total sleep time (TST) and daytime
dysfunction.
Results: The groups average total PSQI score (7.58) indicated substantially disturbed sleep with 37.5% of participants reporting poor sleep
quality. Average TST was 7.58 (SD = 3.7) hrs and SOL 30 (SD =20.2) min. SCAS and CES-D scores were significantly correlated withtotal PSQI score (p < 0.01), TST (p < 0.01) and sleep disturbance (p <0.01). Adolescents scoring above CES-D clinical cut off, indicating possible major depression (n = 55), reported significantly less TST, higher
sleep disturbance and daytime dysfunction, lower sleep quality andlonger SOL compared to those below the cut off. Sleep disturbance washigher with increasing symptoms, i.e. those with comorbid anxiety anddepressive symptoms reporting the highest sleep disturbance comparedto those who scored highly on either alone. Interestingly, regression
analyses indicated sleep disturbance was more strongly associated withscores of depression than anxiety.
Conclusion: Poor sleep is common and highly correlated with anxiety
and depressive symptoms in adolescents, and was more strongly associated with depression than anxiety symptoms.

PO-1-013
EVENING STATE ANXIETY AND AUTONOMIC
MODULATION OF HEART AMONG GOODSLEEPERS AND CHRONIC PRIMARY INSOMNIAG SCAVONE1, M-J FAUCHER1,3, A-A BARIL1,3, M-H PENNESTRI1,2,
PA LANFRANCHI1,4
1
Center for advanced research in sleep medicine, Hôpital du Sacré-Coeurde Montréal, Montréal, Qubec, Canada, 2Department of Psychology,
Université de Montréal, Canada, 3Sciences Biomedicales, Université deMontréal, Canada, 4Department of Medicine, Division of Cardiology,
Hôpital du Sacré-Coeur de Montréal and Université de Montréal, Canada
Introduction & Objectives: Physiologic hyperactivation is a correlateof anxiety. Insomnia is associated with both of this factors. The question
remains as whether anxiety is the mediator of physiological hyperactivation in insomniacs. In this study we assessed the relationship between
evening anxiety state and autonomic arousal in subjects with insomnia
compared to good sleepers. Materials & Methods We studied 19 subjects with a diagnosis of chronic primary insomnia (15w; 44y sd = 8)
and 10 good sleepers (6w; 41y sd = 8). All subjects were free of any
medical or psychiatric co-morbidity and other sleep disorders. Subjects
underwent 2 week sleep diary and 2 night of polysomnographic recording including non-invasive beat-to-beat BP recordings. Analysis wasmade with variables evaluated and recording on pre-sleep wakefulness
and during subsequent sleep. Mean heart rate (HR), systolic bloodpressure (SBP) and diastolic blood pressure (DBP) were calculated forboth state. An estimate of nocturnal dipping was provided by the delta(d) between wake and sleep. Anxiety was measured by the STATE
anxiety inventory (STAI), administrated immediately before sleep.
Pearson correlation coefficients were calculated between STAI and autonomic cardiovascular variables.
Results: Insomniacs STAI was negatively correlate with sleep HR(−0.48, p < 0.05). No difference for wake HR, SBP, DBP; night HR, SBP,
DBP and for dHR, dSBP and dDBP. Control good sleeper STAI was
positively correlate with wake HR (+0.85, p < 0.01) and negatively

258

correlate with dHR (−0.66, p < 0.05). No significative difference wasfound for night HR, SBP and DBP; night HR, SBP, DBP and dSBP anddDBP.
Conclusion: Our results showed different pattern of activation in thetwo groups about response to evening anxiety state. Anxious good
sleeper show an activation response in evening and an effective recovery
after a night normal sleep. Anxious insomniac wasn’t correlated withevening activation but they’re was with decrease HR activation during
night, which may suggesting somatisation mechanisms for insomniac
who doesn’t auto-report anxiety.

PO-1-014
THE COURSE OF INSOMNIA AND HEALTHRELATED QUALITY OF LIFE OVER TWO YEARS:A LONGITUDINAL STUDY IN THE GENERALPOPULATION IN JAPANY KOMADA1, T NOMURA3, I OKAJIMA1,2, T SASAI1,2, Y INOUE1,2
Department of Somnology, Tokyo Medical University, Tokyo, Japan, 2Japan
Somnology Center, Neuropsychiatric Research Institute, Japan, 3Departmentof Neurology, Institute of the Neurological Sciences, Tottori University
Faculty of Medicine, Japan
1

Objectives: Only a few reports are available about the longitudinalcourse of insomnia in the general population. This study was designed
to investigate the two years natural course of insomnia symptom and
QOL on the rural cohort.
Methods: The Ethics Committee of Tottori University approved thisstudy, and all participants provided written informed consent. Twopoint epidemiological surveys with a two-year interval were performedon the same adult cohort in a rural town in Japan. 1,577 people bothsurveys (responder rate: 56%, 683 males, mean age [SD]: 58.6 [16.1])
answered the questionnaires consisted of demographic variables, theJapanese version of the Pittsburgh Sleep Quality Index (PSQI), thestandardized 8-items Short Form Health Survey of the Medical Outcomes Study (SF-8), twelve-item version of the Center for Epidemiological Studies Depression Scale (CES-D). Responders with PSQI scoresof 5.5 or higher were considered as insomniacs.
Results: The prevalence rates of chronic insomnia (PSQI score >5.5 atboth surveys) were 18.7%, and morbidity of insomnia was significantly
associated with existence of depression at either survey, PCS and MCS
deterioration at both surveys. There were no significant differences overthe course of two year in CES-D, PCS and MCS scores among chronic
insomnia as a whole, although there was a significant but small increase
in PSQI total score. On the other hand, chronic insomnia with mild tomoderate severity (5.5 < PSQI < 8.5 at the baseline) of showed significant deterioration in PSQI total score and MCS at the follow up,
whereas there was no significant deterioration among those with severe
disturbance (PSQI > 8.5).
Conclusions: This investigation showed that chronic insomnia is aprevalent condition. Appropriate treatment is necessary for not only
sever insomnia but also mild to moderate insomnia, since the insomnia
symptoms and QOL become worse even among the mild to moderate
insomnia over the two years course.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-015 / AS-15 Presenter
EFFICACY OF INTERNET AND GROUPADMINISTERED COGNITIVE BEHAVIORALTHERAPY FOR INSOMNIA IN ADOLESCENTS;
A PILOT STUDY
EJ DE BRUIN, AM MEIJER, FJ OORT, SM BGELS
Department of Education, University of Amsterdam, Amsterdam,
Netherlands
Introduction: Literature shows a high prevalence of insomnia in adolescents. Cognitive behavioral therapy for insomnia (CBT-I) is proveneffective in adults. Adolescents however are not inclined to seek help
for their sleep problems. Therefore we developed a CBT-I protocol foradolescents of 6 weekly consults administered through an internet-site(N = 13) and compared results to CBT-I in a group setting (N = 7). We
expected shorter sleep onset latency (SOL), less wake after sleep onset(WASO), longer total sleep time (TST) and higher sleep efficiency (SE)after treatment for both groups.
Methods: Subjects were recruited through the media. After screening
with online questionnaires and an interview for further diagnosis subjects without other primary psychological or medical disorders interfering with sleep were included in the trial. A baseline measurement withwrist-actigraphy for a 7 day period was obtained registering SOL,
WASO, TST and SE, followed by the CBT-I treatment. Directly after thelast consult follow up measurements were obtained for another 7 consecutive days.
Results: Mixed model analysis showed a significant decrease of SOL
after treatment for both groups (F(1, 186.79) = 35.76, p < .01) although
at baseline SOL in the internet condition was significantly lower compared to the group condition (F(1, 25.92) = 27.92, p < .01). There wasalso a significant improvement of SE for both groups (F(1, 178.85) =24.89, p < .01) with a significant interaction for treatment and condition showing more improvement for the group condition (F(1, 180.27)= 6.84, p < .05). There was no significant effect on WASO and TST for
either group.
Conclusion: Internet and group administered CBT-I is effective for
improvement of sleep in adolescents. SOL decreased and SE improved.
TST did not show an increase which we attribute to restriction of timein bed that still is applied after the last consult. Differences in SOL
before treatment could be caused by holidays during baseline for theinternet condition. Further studies with a larger sample, a waiting list
control group and long term follow up are needed.

PO-1-016 / AS-1 Presenter
THE CLINICAL TRIAL OF GROUP COGNITIVEBEHAVIOR THERAPY FOR PRIMARY INSOMNIAIN OUTPATIENTSW YAMADERA
Department of Psychiatry, Jikei University School of Medicine, Minato-ku,
Tokyo, Japan
Psychophysiological insomnia (PPI), as defined in ICSD-II is the almost
the same as primary insomnia as defined in DSM-IV-TR. It is wellknown that cognitive behavior therapy (CBT) for insomnia is useful for
PPI patients. Therefore we conducted group CBT for primary insomnia
outpatients and investigated its clinical efficacy. Nineteen patients (10of them woman) suffering from primary insomnia were enrolled to CBT.
The mean patient age was 62.4 years, and the mean duration of insomnia was 8.8 years. Each received group combined CBT treatments thatconsisted of stimulus control, sleep reduction, cognitive therapy andsleep hygiene education 60–90 min sessions twice in a month. As
booster sessions, the author gave consultations to each subject, andsupervised the contents of the CBT. Just before the CBT, and after its
completion, we conducted sleep measurements that involved 1) subjective evaluation of sleep: sleep logs, Dysfunctional Beliefs and Attitudes
about Sleep Scale (DBAS), the Pittsburgh Sleep Quality Index (PSQI),2) objective evaluation of sleep: actigraphy, 3) dissociation between
subjective and objective evaluation of sleep. Just after the CBT, wefound 1) decrease of dissociation between subjective and objective
evaluation of sleep, 2) improvement of patients` incorrect cognition
about sleep (DBAS), and 3) improvement in both the subjective andobjective evaluation of sleep. Result1) was especially noteworthy
because the primary aim of CBT was to change patients` incorrect cognition about sleep. The author defined result1) as the primary outcomeof the study. The present results suggest that group CBT for primary
insomnia is able to modify incorrect cognition about sleep.

PO-1-017
INTERNET ADDICTION AND ITS RELATION TOSLEEP AND DEPRESSION IN KOREAN
ADOLESCENTS

J-S LEE1, H-K SONG2
1
Department of Psychiatry, Pusan National University Yangsan Hospital,
Yangsan, Gyeongnam, Republic of Korea, 2Department of Psychiatry, Seoul
Medical Center, Republic of Korea
Introduction: Internet-addiction came into common use not only inclinical setting but also in everyday life. The objectives of this study
were to investigate the characteristics of internet addiction and its
association with sleep pattern and depression in Korean adolescence.
Methods: Subjects were 799 middle and high school students in Seoul,
Korea. We administered a self reported questionnaire including sociodemographic data, Korean versions of Young’s Internet Addiction Scale(YIAS), Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies for Depression Scale (CES-D) and questions about
internet using patterns. Data of 696 subjects were included inanalysis.
Results: Of the 696 participants, 2.0% (n = 14) were internet-addicted(IA), 27.7% (n = 193) were over-using (OU) and 70.3% (n = 489) were
not-addicted (NA). Comparing variables among IA, OU and NA groups,
computer using time not for study (96.36 ± 63.31 min. vs. 134.92 ±
86.79 min. vs. 213.57 ± 136.87 min., F = 34.287, p < 0.001) andportable device using time not for study (84.22 ± 79.11 min. vs. 96.97± 91.89 min. vs. 152.31 ± 93.64 min., F = 5.400, p = 0.005) weredifferent among groups. PSQI (5.26 ± 2.97 vs. 6.08 ± 2.97 vs. 7.50 ±
4.41, F = 8.218, p < 0.001) and CES-D scores (15.40 ± 8.08 vs. 19.05± 8.42 vs. 30.43 ± 13.43, F = 32.692, p < 0.001) were also different
among groups. YIAS score were correlated with computer using time
not for study (r = 0.356, p < 0.001) and portable device using time notfor study (r = 0.136, p < 0.001). PSQI score (r = 0.237, p < 0.001) and
CES-D score (r = 0.332, p < 0.001). YIAS score and PSQI score (r =0.131, p = 0.001), YIAS and CES-D score (r = 0.265, p < 0.001), PSQI
score and CES-D score (r = 0.357, p < 0.001) were correlated eachother.
Conclusion: These results suggested that adolescents’ internetaddiction was correlated with not only computer and portable device
using time not for study but also depression and sleep-related problems.
We should pay attention to depression and sleep-related problems,
when evaluating internet-addiction in adolescents.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research259

Sleep, Science and Research

PO-1-018 / AS-4 Presenter

Conclusion: PPI patients showed sleep fragmentation although they
had no definite sleep disorders. Depression and anxiety level were highand well associated with insomnia severity. It seems that certain personality predisposed to the patients with PPI.

SLEEP DISTURBANCE AND ATTENTION
DEFICIT/HYPERACTIVITY SYMPTOMS IN
YOUNG ADULTS

BI VOINESCU1, A SZENTAGOTAI1, J THOME2
Department of Psychology, Babes Bolyai University, Cluj-Napoca,
Romania, 2Department of Psychiatry and Psychotherapy, Rostock
University, Germany

PO-1-020

1

We aimed to determine the prevalence of sleep disturbance and symptoms of attention deficit/ hyperkinetic disorder in young adults and theirrelationship. Students, attending the Faculty of Psychology from two
major cities, received a battery of tests containing the Sleep Disorders
Questionnaire, the Sleep Timing Questionnaire, the Sleep Condition
Index, as well as the Adult ADHD Self-Report Scale 1.1 and the Barkley
Adult ADHD Rating Scale IV. To date, most of the respondents werefemales (N = 121, 85%), aged 21.1 ± 3.8 years. Preliminary data showthat 13% (N = 18) of the surveyed complained of chronic insomnia and
20–29% were likely of having adult ADHD. Chronic insomnia was significantly more severe (p = 0.007) and more frequently reported (28%; p= 0.003) by those with symptoms of ADHD. As both insomnia and
ADHD symptoms seem to be common among young adults, we are tofurther investigate them through clinical interview, as well as actigraphy.

PO-1-019
PERSONALITY AND MOOD CHARACTERISTICS
IN PATIENTS WITH PSYCHOPHYSIOLOGICALINSOMNIAJH CHAE, EY JOO, SB HONG
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
Purpose: To investigate the mood status in patients with PPI who were
underwent polysomnography (PSG) to exclude the co morbidity ofother sleep disorders.
Methods: we recruited 185 patients (M : F = 71:114, mean age 56.8 yr)
who visited our sleep center complaining sleep onset or maintenanceinsomnia. By detail history taking, overnight PSG, we excluded thepatients who had obstructive sleep apnea syndrome (OSA), restless leg
syndrome (RLS), periodic leg movement disorder (PLMD) or otherproblems that disturb sleep. The patients diagnosed as depression werealso excluded. Included PPI patients completed the Insomnia Severity
Index (ISI), Beck depression inventory (BDI), Beck anxiety inventory(BAI), Minnesota Multiphasic Personality Inventory (MMPI), Pittsburgh
Sleep Quality Index (PSQI), and Profiles of Mood States (POMS).
Results: Mean duration of insomnia was 10.5 yrs and they had taken
more than one kind of hypnotics. Seventy-nine patients (42.7%) underwent PSG, which showed alterations of sleep architecture (increased
light sleep and decreased deep sleep) and increased REM latency(125.6 min). Sleep fragmentation was noted as increased arousal index(18.9 ± 9.6/hour), waking after sleep onset (23.1 ± 18.4%), anddecreased sleep efficiency (77.6 ± 13.5%). BDI (15.5 ± 13.2) and BAI(13.4 ± 9.4) showed the abnormally high scores in PPI patients andwere correlated with ISI (p = 0.018 in BDI; p = 0.02 in BAI) significantly.
PPI patients complaint of poor sleep qualities (PSQI score 17.5 ± 7.6)
although. PSQI score was not correlated with ISI. MMPI was obtained
from 105 out of 185 patients (56.5%). Absolutely high scores wereobserved in personality with hypochondriasis (57.9 ± 10.3), depression(61.5 ± 11.2), hysteria (57.9 ± 10.1) and pyscoasthenia (56.7 ± 9.9) inthe patients.

260

INSOMNIA AND HEALTH-RELATED QUALITY OF
LIFE IN HOSPITALIZED DIABETIC PATIENTSH KONDO1, K MORI1,3, T DEGUCHI2, M NAKAO2,
A SHIMOHARA2, K SAKAI2, M FUKUJU1, C NISHI1, T YOSHIDA1,
A KAWASAKI1, C JINNOUCHI3, K ASHIZAWA3, M IZUMI1,3
1
Center for Sleep Medicine, Saiseikai Nagasaki Hospital, Nagasaki-city,
Nagasaki, Japan, 2Department of Nursing, Saiseikai Nagasaki Hospital,
Japan, 3Department of Internal Medicine, Saiseikai Nagasaki Hospital,
Japan

Background: Some epidemiological studies reported that approximately 40% of diabetic patients suffered from insomnia. This study
reports the relationship between insomnia and health-related quality oflife (QOL) in hospitalized diabetic patients.
Method: Data were obtained from 39 diabetic patients who admitted
to our hospital to receive diabetes treatment (26 males, aged 57.3 ±16.4 years, and 13 females, aged 61.4 ± 15.6 years). Pittsburg Sleep
Quality Index (PSQI) and the Japanese version of the Insomnia Severity
Index (ISI-J) were used to evaluate their sleep. Japanese version of SF36
v2 was used to evaluate health-related QOL. The patients were asked
to answer the questionnaires based on their conditions prior to admission to the hospital. The t- test and the Mann-Whitney U-test were used
for comparing two groups with significance level of 0.05.
Result: Mean PSQI global score was 6.7 ± 4.2. The histogram of PSQI
global score exhibited a bimodal distribution. Nineteen patients (50%)
had PSQI global score of 6 points or higher, a level in which individual
is considered to be a poor sleeper. The group had lower SF36 subscalescores in Bodily Pain (P = 0.017). Mean ISI-J score was 9.6 ± 6.1.
Eighteen patients (46.2%) had total ISI-J score of 10 points or higher,a level in which individual is considered suffering from insomnia.
Insomnia group had lower Mental Component Summary, Bodily Pain,
Vitality, and Mental Health scales (P = 0.006, 0.047, 0.013, 0.034,
respectively). 41.0% of the patients had difficulty initiating sleep (DIS),
43.6% had difficulty maintaining sleep (DMS) and 33.3% had nonrestorative sleep. The DIS group had lower Mental Component
Summary and Vitality scale (P = 0.014, 0.049, respectively). The DMSgroup had lower Mental Component Summary, Bodily Pain, Vitality,
Social Functioning and Mental Health scales (P = 0.001, 0.026, 0.004,
0.026, 0.005, respectively).
Conclusion: The study suggests that hospitalized diabetic patients who
suffer from insomnia, especially with DMS, have poor mental health.

PO-1-021
RELATIONSHIP BETWEEN INSOMNIA AND
FUTURE DEVELOPMENT OF DEPRESSIONN NISHITANI1, H SAKAKIBARA2
Department of Nursing, Sugiyama Jogakuen University, Nagoya-city,
Aichi, Japan, 2School of Health Sciences, Nagoya University, Japan
1

Objective: We conducted to examine the relationship between insomnia and future incidence of depression through a 2-year cohort studyof male Japanese workers.
Method: A self-completed questionnaire survey was conducted in conjunction with annual health checkups for male employees at a synthetic© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

fiber manufacturing plant. The questionnaire survey of job stress, sleep
conditions, and depression was conducted in 2007 and 2009. Sleep
quality and depression were examined with the Athens Insomnia Scale(AIS-5) and the Job Stress Questionnaire, respectively. Sleep quality was
surveyed utilizing the AIS, an instrument for assessing insomnia that isused worldwide.
Results: Of the 158 respondents over the 2-year, 108 without depression at baseline were analyzed (mean age 38.2 ± 12.8 year; range
20–63 years). The incidence of new depression was 10.2% (11 of the
108 subjects) over the 2-year. None of the subjects without insomnia
in 2007 suffered symptoms of depression in 2009, while 15.7% of thesubjects with insomnia did so. In the subjects having insomnia with
AIS-5 scores of 3 or more, 20.0% experienced depression in 2009.
Logistic regression analysis showed a significant association between
depression and the AIS score (OR 1.40; 95% CI 1.09–1.81, p < 0.05).
The total AIS scores were also associated with increased scores for
qualitative workload (p < 0.05), and decreased scores for appropriateness of work (p < 0.01).
Conclusions: Insomnia can be a risk factor for developing depression
or, at least, an important marker for the later development of depression
and workers’ mental health. Measures to counter insomnia will serve
to reduce the incidence of depression.

PO-1-022
SLEEP COMPLAINTS AMONG FINNISH
ADOLESCENTS WITH MAJOR DEPRESSIVEDISORDER

AS URRILA1, L KARLSSON2,3, M MARTTUNEN1,2
1
Department of Adolescent Psychiatry, Helsinki University Central
Hospital, Helsinki, Finland, 2Helsinki, National Institute for Health andWelfare, Finland, 3Department of Child Psychiatry, Turku University
Central Hospital, Finland
BACKGROUND: Studies assessing the prevalence and nature of sleep
disturbances in adolescents diagnosed with major depressive disorder(MDD) are significantly few in number.1 Whether depressed adolescents
manifest different clinical features according to the absence or presence,
and according to the nature of the sleep disturbances remains poorly
understood. In particular, to our knowledge, depressed adolescents
have not been previously studied separately from prepubertal children
despite the fact that the association between sleep problems and depression may change when children mature into adolescence andadulthood.2
AIM OF THE STUDY: The aim of our study was to 1) examine theprevalence rates of different sleep disturbances in a sample of Finnish
adolescents with MDD, 2) examine whether the adolescents without
and with sleep disturbances differ in severity of depression and thepresence of comorbid psychiatric disorders, 3) examine whether thedifferent sleep disturbances in adolescents can be associated with different symptom profiles of depression.
METHODS: A total of 169 Finnish adolescents (age 13–19; mean
16,5 years old; 17% boys) diagnosed with MDD (as defined by DSM-IV
criteria) were included in the study. Their sleep complaints were assessedwith self-rating scales and interviews as a part of their clinical assessment.
RESULTS: In our preliminary analysis, the prevalence rate of subjective
sleep complaints in Finnish adolescents with MDD was high: 74% of
the depressed adolescents experienced significantly disturbed sleep,
while the minority (13%) did not have any sleep problems. The mostcommon type of insomnia was initial insomnia (41%), while middle(26%) and late-night (10%) insomnia were less frequent. 30% of theadolescents reported having much more nightmares than usual.

CONCLUSIONS: These findings suggest a need for the assessment ofand attention to sleep problems among depressed adolescents inresearch and clinical settings.
1. Ivanenko et al. Sleep Med Rev 2005;9:115–29.
2. Knowles et al. Neuropsychopharmacology 1990;3:251–9.

PO-1-023
HYPERAROUSAL AMONG CHRONIC INSOMNIAPATIENTS AND INDIVIDUALS PRONE TO
STRESS-RELATED SLEEP DISTURBANCES
C-M YANG, Y-H LIN, Y-S LIN
Department of Psychology, National Chengchi University, Taipei City,
Taiwan, 2Research Center for Mind, Brain, & Learning, National Chengchi
University, Taiwan
Many physiological and behavioral/psychological factors have beenshown to be associated with chronic insomnia. However, the roles thatthe factors play along the development of chronic insomnia are still
unclear. Previous studies have demonstrated that patients with insomnia showed increased levels of arousal in autonomic nervous system(e.g. heart rate, metabolic rate, cortisol level), central nervous system(e.g. EEG, event-related potential [ERP]), and subjective ratings ofarousal level. However, it is not clear if the hyperarousal is a predisposing condition that exists before the development of persistent insomnia
or a perpetuating factor that developed after a longer term of insomnia.
The present study aims to clarify the role of hyperarousal in the development of insomnia. The study included 9 chronic insomnia patients,
14 non-insomniac subjects with high vulnerability to stress-relatedtransient sleep disturbance as measured by the Ford Insomnia Responseto Stress Test (FIRST), and 13 good sleepers with low vulnerability.
Their ERP to tones during NREM sleep, R-R interval of EKGs andsubjective arousal on the Pre-Sleep Arousal Scale (PSAS) were measured. In addition to a baseline condition, a stress-eliciting condition
by anticipating giving a speech was introduced for the two non-insomniac groups. The results showed that chronic insomnia patients manifested higher level of arousal in ERP latency and R-R interval than theother two groups under no stress elicitation. However, while understress condition, high vulnerable group showed increased level of subjective cognitive arousal similar to insomnia group that is higher thanlow vulnerable group. The findings suggest that the hyperarousal may
be more a product of long-term experiences of poor sleep rather thana predisposing trait. The psychological reactivity to stress, however, may
prone individuals to react to stress and that may prolong the sleep
disturbance into a chronic condition.

PO-1-024
INSOMNIA AND QUALITY OF LIFE OF
PATIENTS WITH DEMENTIA IN LONG-TERM
CARE FACILITIESS TERADA1, C IKEDA1, S NAGAO1, N TAKEDA1, Y KISHIMOTO1,
H YOSHIDA2, E OSHIMA1, O YOKOTA1, K SASAKI2, Y UCHITOMI1
1
Department of Neuropsychiatry, Okayama University Graduatet School,
Okayama-city, Okayama, Japan, 2Department of Psychiatry, Kinoko Espoir
Hospital, Japan
Quality of life (QOL) is an important target of dementia care andinsomnia is very frequent symptoms among dementia patients.
However, there have been few studies on the relationship of insomnia© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

261

Sleep, Science and Research

to QOL of dementia patients in long-term care facilities. We performed
a questionnaire survey of QOL assessment and clinical characteristics
in elderly patients with dementia in Japan, using QOL questionnaire
for dementia (QOL-D). Insomnia is significantly correlated with low
QOL scores in the field of negative affect&actions and restlessness, but
not correlated with QOL scores in the fields of positive affect, communication ability, attachment to others and sponteneity. Logistic
regression analysis revealed that insomnia is significantly related withlow QOL scores in the fields of negative affect&actions and restlessnee,
independently of age, sex, cognitive function and activity of dailylivings. QOL of dementia patients might be influenced by insomnia.
We should more attention to insomnia among dementia.

PO-1-025
THE RELATIONSHIP BETWEEN SLEEP PATTERNSAND MENTAL HEALTH IN ELDERLY PEOPLE
SUFFERING MINOR DEPRESSIONY KITABATAKE1, T NAGAMATSU2, H YOSHIDA3, H IIDA4,Y SUZUKI5, K TANAKA6, H ISHIJIMA7, C HASEGAWA8, K IHARA9
1
Academic Institution, Meiji Yasuda Life Foundation of Health and Welfare,Shinjuku-ku, Tokyo, Japan, 2Physical Fitness Research Institute, Meiji Yasuda
Life Foundation of Health and Welfare, Japan, 3Research Team for Promoting
Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology,
Japan, 4Izu Hospital NTT EC, Japan, 5Department of Adult Mental Health,National Institute of Mental Health, NCNP, Japan, 6Department ofOccupational Mental Health, Kitasato University Graduate School of
Medical Sciences, Japan, 7Department of Public Health, Faculty of Medicine,
Saitama Medical School, Japan, 8Tokyo Musashino Hospital, Japan,
9Department of Public Health, Toho University School of Medicine, Japan
Depression is increasing in Japan prompting the need to find ways toprevent and combat depression. We have created a program to combat
and prevent depression as well as a program to improve sleep patterns
using physical exercise. Our studies indicate that exercise reduces
depression symptoms and improves sleep patterns in communitydwelling elderly (CDE) people. Exacerbation of depression symptoms
worsens sleep patterns, while poor sleep patterns worsen symptoms ofdepression. This condition results in a vicious cycle of worsening
depression and sleep patterns. Our hypothesis is that exercise is a way
to break this cycle. To test our hypothesis, we did research among CDE
people who have the highest number of sleep related complaints andexhibit higher depression rates.
PURPOSE: This study explored the relationship between sleep patterns
and mental health in elderly people suffering minor depression.
METHODS: This was a cross-sectional study. Subjects were elderly
people diagnosed with symptoms of minor depression by a psychiatrist(n = 20, 76 ± 4 yr: mean±SD male = 1, Female = 19). The Pittsburgh
Sleep Quality Index (PSQI-J) measured sleep quality. The Profile ofMood States (POMS) was the mental health index. Correlation analysis
was used for statistical analysis.
RESULTS: The average PSQI-J score was 7.6 points. 65% of participants had sleep disorders. There is a significant relationship between
the PSQI-J scores and the Tension-Anxiety, Depression-Dejection, andAnger-Hostility scores through correlation analysis (r = 0.545, P < 0.05,
r = 0.634 P < 0.01, r = 0.558 P < 0.05).
CONCLUSION: People with sleep related problems had higher levelsof depression. This doesn’t necessarily indicate a causal relationship,
however this does lend credence to studies showing that poor sleep
patterns are a risk factor leading to depression. This study intimatesthat exercise is effective in breaking the vicious cycle of depression andpoor sleep patterns.

262

PO-1-026
ASSOCIATION BETWEEN DEPRESSIONSYMPTOMS AND INSOMNIA IN SMALL OFFICESH ISHII1, Y HIDA2, Y YAMADA3, I FUJIMARU4, Y TANAKA5
School of Nursing, Sugiyama Jogakuen University, Nagaoya, Aichi, Japan,
2
School of Nursing, Sugiyama Jogakuen University, Japan, 3College ofNursing, Japan Red Cross, Japan, 4College of Life and Health Sciences,
Chubu University, Japan, 5School of Nursing, Sugiyama Jogakuen
University, Japan
1

Background of the study: The prevalence of depression is increasingin the Methods.
Subjects: Small-to-medium-sized business offices with 50 or lessemployees joining local chambers of commerce within an area of
600,000 people under the district K public health center.
Survey method: Questionnaires were mailed to 700 offices by random
sampling requesting a response by mail.
Contents: Sixteen items concerning depression symptoms.
Analysis: Statistics software SPSS 17.0J for Windows was used toanalyze and compare values by descriptive statistics and the Wilcoxon
rank-sum test. workplace every year. Ethical consideration. Each registrant of chambers of commerce was asked to participate in the study
after an explanation of the purpose of the study in writing. Submissionof a completed questionnaire was considered acceptance of study participation. Submitted data were handled appropriately and used withthe promise of them being used only for study purposes so that individual subjects could not be identified.
Conflicts of interest: None.
Results: Three hundred and thirteen offices submitted effective
responses, of which 39.6% were manufacturers, 16.9% were builders,
12.5% service industry, and 8.3% transportation industry. There was apositive correlation between insomnia and depression symptoms:
people with a sense of responsibility are likely to have depression (P <0.01); depression can develop in about 1 out of 15 persons during life
(P < 0.05); it is difficult to recover from depression once it develops (P< 0.01); people with depression should change jobs or resign because
they do not fit in the current workplace (P < 0.01); I want them towork a little harder because we are busy (P < 0.05); it is difficult to visit
psychiatric clinics (P < 0.01).

PO-1-027
ANALYSIS OF GENETIC EXPRESSION IN THE
SOFT PALATE OF PATIENTS WITH
OBSTRUCTIVE SLEEP APNEA
J-W KIM, W-H LEE, MS CHANG, CH LEE
Otorhinolaryngology, Seoul National University Bundang Hospital,
Seongnam, Republic of Korea
To evaluate the biomolecular characteristics of the tissue where airway
obstruction actually occurs, the genetic expression was investigated in
the soft palate of patients with obstructive sleep apnea (OSA). The soft
palate mucosa was obtained during uvulopalatal flap surgery. Threepatients with apnea/hypopnea index (AHI) over 60 were enrolled for
an OSA group, and 3 simple snoring patients with AHI less than 5 fora control group. After total RNA was extracted and amplified into
microarray, gene expression levels were calculated, and relative signal
intensities for each gene were evaluated. Of the 45,034 genes analyzed,
232 genes were statistically different between the OSA group and simple
snoring group and genes involved in metabolism were the mostcommon. Our results suggest that there may be changes of gene
expression in soft palate as OSA proceeds.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-028 / AS-12 Presenter
A GENOME-WIDE LINKAGE STUDY IN
OBSTRUCTIVE SLEEP APNEA PHENOTYPESAND SUB-PHENOTYPESA FEDSON1, AI PACK1,2, T GISLASON3,4
Center for Sleep and Circadian Neurobiology, University of Pennsylvania,
Philadelphia, PA, United States of America, 2Division of Sleep Medicine,
Department of Medicine, University of Pennsylvania, United States ofAmerica, 3Department of Respiratory Medicine and Sleep, Landspitali
University Hospital, Iceland, 4Faculty of Medicine, University of Iceland,
Iceland1

Background: Familial aggregation of obstructive sleep apnea (OSA) has
been identified in several populations. Whilst the few OSA genomewide linkage studies conducted have demonstrated suggestive linkage
regions, they have failed to show significant linkage. The aim was toconduct a genome-wide linkage study in a well-characterized population to further investigate OSA susceptibility genes.
Methods: Subjects were from the Iceland Sleep Apnea Cohort Study.
OSA diagnosis was defined from overnight polysomnography. Linkage
analysis was conducted for OSA phenotypes using 4–6 meiotic clustering (MC) for dichotomous outcomes, and quantitative trait loci (QTL)
analysis for the apnea-hypopnea index (AHI) and oxygen desaturationindex (ODI). Parametric and non-parametric analyses were performed
using an affected-only approach. Fine mapping of linkage regions was
conducted via the 300 K Illumina Bead Chip.
Results: There were 2,250 OSA subjects included. Eleven linkage peaks
were observed (2q36, 5p14, 7p14, 7p21, 10q26, 11p14, 11q13, 11q25,
12q24, 18q12, 19p13). The highest LOD scores were demonstrated for
5p14 and 11q25. The linkage peak at 5p14 was found in subjects with
AHI and/or ODI more than or equal to 5, and in subjects with AHI and/or ODI more than or equal to 15. The linkage peak at 11q25 was shared
between OSA and obese OSA phenotypes. Most linkage peaks wereconfined to obese OSA phenotypes (2q36, 7p21, 10q26, 11p14). QTL
analysis yielded one linkage peak for AHI (3q29) and four for ODI(2p14, 4q13, 4q31 10p15). Fine mapping of these linkage regions did
not detect any significant associations with OSA phenotypes.
Conclusions: Several peaks for suggestive linkage regions were identified, with most limited to obese OSA phenotypes, some of whichcontain known obesity genes. None of the linkage peaks identified inthis study reached genome-wide significance. These findings suggest
there may not be any common variants with large effects which contribute to OSA risk, however further investigation is required.

PO-1-029
THE INFLUENCE OF AGE ON AROUSALDENSITY FOR OBSTRUCTIVE SLEEPAPNEA SYNDROME

L-W HANG1, C-L LIN3, C-N HUANG3
Sleep Medicine, China Medical University Hospital, Taichung, Taiwan,
2
Department of Healthcare Administration, Asia University, Taiwan,
3
Biomedical Technology and Device Research laboratories, Industrial
Technology Research Institute, Taiwan
1

Objectives: Obstructive sleep apnea syndrome (OSAS) is a common
syndrome afflicting millions. OSAS is a sleep breathing disorder characterized by recurrent airflow obstruction caused by total or partial
collapse of the upper airway. Cardiovascular and neuropsychologicalmorbidity has been demonstrated in untreated sleep apnea. At present
polysomnography (PSG) remains the golden standard for the diagnosis

of OSAS. The arousals are transient and generally do not result in
behavioral awakening, and recur in some conditions as often as once
per minute. EEG arousal is the important parameter of sleep fragmentation. Previous study reported respiratory effort decreases with increasing age. The objective of this study was to evaluate the effect of age on
arousal for OSAS.
Methods: Five-hundred forty-two male patients with a diagnosis of
OSAS by standard PSG were recruited from China Medical University
Hospital Centre and obtained the EEG arousal index (ArI). The presenceof OSAS was defined as AHI > 5/h. This study divided subjects into
groups based on age > 40, 40 ≦ age < 60 and age ≧ 60. To avoid theeffect of the severity of OSAS, this study also separated patients into
three levels of severity of OSAS included the AHI < 15, 15 ≦ AHI <30, and AHI ≧ 30, respectively.
Results: When the severity of OSAS is AHI < 15, the ArI between different age groups is not significant (age < 40: 18.4 ± 10.3, 40 ≦ age <60: 23.7 ± 14.3, age ≧ 60: 19.4 ± 7.8, NS). Moreover, when the severityof OSAS is 15 ≦ AHI < 30 and AHI ≧ 30, the ArI between different
age groups is still not significant (15 ≦ AHI < 30, age < 40: 25.2 ±
10.4, 40 ≦ age < 60: 28.2 ± 10.4, age ≧ 60: 33.6 ± 15.3, NS; AHI ≧30, age < 40: 43.8 ± 22.7, 40 ≦ age < 60: 47.4 ± 19.6, age ≧ 60: 46.2
± 23.2, NS).
Conclusions: This study evaluated the influence of age on arousal inmale patients with OSAS. The results revealed the aging has no effecton arousal density and the arousal density increased as the severity of
OSAS increased.

PO-1-030
FREQUENTLY USED SLEEP QUESTIONNAIRES IN
GENETIC AND EPIDEMIOLOGICAL RESEARCHFOR OBSTRUCTIVE SLEEP APNEA: A REVIEWA FEDSON1, AI PACK1,2, T GISLASON3,4
Center for Sleep and Circadian Neurobiology, University of Pennsylvania,
Philadelphia, PA, United States of America, 2Division of Sleep Medicine,
Department of Medicine, University of Pennsylvania, United States ofAmerica, 3Department of Respiratory Medicine and Sleep, Landspitali
University Hospital, Iceland, 4Faculty of Medicine, University of Iceland,
Iceland1

Background: Many sleep questionnaires are utilized by the epidemiological and genetic research communities. This paper will review andcompare sleep-related questions and answers commonly used in epidemiological studies, with a particular emphasis on the utility of the
response options available.
Methods: A literature search was conducted to identify sleep questionnaires meeting the inclusion criteria. Questionnaires were limited to theEnglish language and had to include questions specific to snoring or
stop breathing during sleep. Questionnaires also had to demonstrate acitation count > 10 through Web of Science. Questions and answers
from eligible questionnaires were compared.
Results: There were fourteen questionnaires meeting the inclusion
criteria for final review. These questionnaires were very heterogeneous,with only some (n = 6) allowing a don’t know alternative. Altogether six
specified the time period referred to as past month, one referred to last
three months and the remaining questionnaires had no specific timeframe. The response alternatives to specific questions were Yes or No(n = 5), wording only like never, seldom, often (n = 4), or a frequency
scale indicating times per week (n = 8).
Conclusions: There is a need for improved standardized instruments
not only to capture relevant sleep information but also to allow greatercomparability between studies.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research263

Sleep, Science and Research

PO-1-031
THE PREVALENCE OF SLEEP APNEA INPOMERANIA / GERMANY – PRELIMINARYRESULTS FROM THE SHIP-TREND STUDYT PENZEL1, A BLAU1, I VON MENGDEN1, S ZIMMERMANN1,B DIECKER1, C BIRO1, I RIEGER1, K LAU2, A OBST2, H VOELZKE2,R EWERT2, M GLOS1, I FIETZE1
1Interdisciplinary Center For Sleep Medicine, Charité University Clinic,
Berlin, Germany, 2Center of Internal Medicine, Depart. of Cardiology andPulmonology, Ernst-Moritz Arndt University Greifswald, Germany
The SHIP-TREND study (Study of Health in Pomerania) is the first
German population based study which implemented attended cardiorespiratory polysomnography (PSG) with a one night recording as oneof the key parameters. The method in the main focus of this epidemiological study is a full body MRI to evaluate the health status of thepomeranian population. A high cardiovascular risk, specifically arterial
hypertension, has been reported earlier for this region of Germany.
As one part of the SHIP- Trend study cardiorespiratory PSG is offered
to all subjects between 20 and 79 years of age when they are drawn toparticipate. As part of the sleep study module subjects completed theInsomnia Severity Index (ISI scale), Epworth Sleepiness Scale (ESS),
Pittsburgh Sleep Quality Index (PSQI), and Restless- Legs Syndrome
Diagnostic Index (RLS-DI). Additionally all participants answered somespecific questions about sleep duration and quality.
Until December 2010 2769 volunteers entered the study and 966 ofthem underwent PSG. In a preliminary analysis 805 subjects wereanalyzed (370 female, 435 male). The mean age was 53 years. 208 of
805 subjects (25.8%) showed an apnea-hypopnea index (AHI) greaterthan 15 per hour sleep. There was a significant difference in gender
related prevalence of obstructive and central apnoeas. Mean AHI inwomen was 7.6 per hour sleep and in men 15.1 per hour sleep. Independent of gender the AHI increases with BMI and age significantly.
Prevalence of obstructive sleep apnea in pomeranian population is high.
PSG was done only in those subjects who agreed to participate
in this module. Men showed more nocturnal breathing events than
women. We detected in both groups a progression of breathing eventswith age. In the influence of concomitant disorders has to be analyzed.

PO-1-032 / AS-2 Presenter
ASSOCIATION BETWEEN SYMPTOMS OF SLEEPDISORDERED BREATHING AND DAYTIMESLEEPINESS WITH SCHOOL-AGED CHILDREN IN
JAPAN: A LARGE-SCALE CROSS-SECTIONALSURVEYE TSUKADA1, S KITAMURA1, M ENOMOTO1, Y KAMEI1,
T KOYAMA2, T ASADA3, Y KAMIO2, K MISHIMA1
1
Department of Psychophysiology, National Institute of Mental Health,National Center of Neurology and Psychiatry, Kodaira-city, Tokyo, Japan,
2
Department of Child and Adolescent Mental Health, National Institute of
Mental health, National Center of Neurology and Psychiatry, Japan,
3
Department of Neuropsychiatry, University of Tsukuba, Japan

Objective: Children with sleep-disordered breathing (SDB) have beenshown to be vulnerable to significant daytime sleepiness and consecutive cognitive impairment and behavioral symptoms. This study aimed
to investigate the prevalence rate of SDB-related symptoms in the Japanese school-aged children, and confirm the association between SDBrelated symptoms and daytime sleepiness.

264

Subjects & Methods: Cross-sectional survey was performed for 6 to
15 year-old-children (n = 25,211, average age = 10.8 ± 2.5) in 148
elementary schools and 71 junior high schools in 10 areas across thecountry. Parents answered a newly prepared questionnaire based on A
Brief Screening Questionnaire for Infant Sleep Problems (Sadeh et al.)and Children’s Sleep Habits Questionnaire (Owens et al.). This questionnaire consisted of thirty-one items to evaluate sleep habits and sleep
problems including four items to detect SDB (snoring, SN; snorts andgasps, SG; stop breathing, SB) and daytime sleepiness.
Result: Among 25,211 children whose parents completed questionnaire, the prevalence rate of SN, SG, SB and daytime sleepiness withthe frequency of five or more times a week were 378(1.4%), 47(0.18%),52(0.2%) and 226(0.89%), respectively. The prevalence rate of daytime
sleepiness in children with SN, SG and SB was 5.0%, 14.8% and 21.2%.
The prevalence rate of daytime sleepiness in children with all the three
SDB-related symptoms was 26.0%. Logistic regression analysis revealed
that SN (OR = 3.824, 95% CI 2.038 to 7.176) and “SG or SB” (OR =13.378, 95% CI 6.002 to 29.816) significantly correlated with the presence of daytime sleepiness even after adjusting age, gender and total
sleep time.
Conclusion: This large-scale cross-sectional survey has revealed
the prevalence rate of SDB-related symptoms among the Japanese
school-aged children and that they could be independent risk factorsof severe daytime sleepiness in these children.

PO-1-033
PREVALENCE OF RESTLESS LEG SYNDROME
AMONG ADOLESCENT CHILDREN IN THE
TUCSON CHILDRENS ASSESSMENT OF SLEEPAPNEA STUDY TUCASAJL GOODWIN1, MM VASQUEZ2, SF QUAN3
1
College of Medicine, University of Arizona, Tucson, Arizona, United Statesof America, 2Arizona Respiratory Center, University of Arizona, UnitedStates of America, 3Division of Sleep Medicine, Harvard University, UnitedStates of America
Introduction: Restless Leg Syndrome (RLS) and its association withsleep problems in normal children has been understudied. This analysis
aims to describe the prevalence of RLS, and its association with sleep
problems, in the adolescent age group.
Methods: TuCASA study is a prospective, cohort study that initiallyenrolled Hispanic and Caucasian children between the ages of 6 and11 years (Time 1) and subsequently re-studied them about 5 years laterat approximately 10–18 years of age (Time 2). At both time points,
in-home polysomnography as well as comprehensive sleep habits
surveys were completed. RLS was present if the subject met 4 essential
adult RLS criteria described by Allen (2003). Habitual snoring (SN),excessive daytime sleepiness (EDS), difficulty initiating or maintaining
sleep (DIMS), and learning problems (LP) were present if symptoms
were present frequently or almost always. Enuresis (EN), sleep terrors(TR), sleep walking (SW) and sleep talking (ST) were also assessed.
Results: Assessments were obtained in 348 children (49% girls; 36%
Hispanic) at both time points with a mean interval between assessmentsof 4.6 years. The prevalence of RLS was 4.3%. RLS was associated withthe presence of EDS (p < 0.006), DIMS (p < 0.013), and SN (p < 0.029).
There was no significant association between RLS and gender or ethnicity.
There was no association between RLS and LP, EN, SW, or ST, however, ingeneral we lacked the power to demonstrate a statistically relevant result.
Conclusions: The prevalence of RLS in a community based sample ofadolescents is approximately 4.3%. RLS in adolescents is associatedwith EDS, DIMS, and habitual snoring. The prevalence of RLS was© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

higher in girls than boys (5.3% vs 3.4%) but this difference was notstatistically significant. HL 62373

PO-1-034 / AS-9 Presenter
THE ROLE OF OBESITY, DIFFERENT FATCOMPARTMENTS AND SLEEP APNEASEVERITY IN CIRCULATING LEPTIN LEVELS:THE ISAC STUDYES ARNARDOTTIR1, G MAISLIN3, N JACKSON3, RJ SCHWAB3,B BENEDIKTSDOTTIR1,2, K TEFF4,5, S JULIUSSON6, B STALEY3,
AI PACK3, T GISLASON1,2
1
Dept of Resp Medicine and Sleep, Landspitali University Hospital,
Reykjavik, Iceland, 2Faculty of Medicine, University of Iceland, Iceland,
3
Center for Sleep and Circadian Neurobiology, Division of Sleep Medicine/
Department of Medicine, University of Pennsylvania School of Medicine,
United States of America, 4Monell Chemical Senses Center, Philadelphia,
PA, United States of America, 5Institute for Diabetes, Obesity andMetabolism, University of Pennsylvania, United States of America, 6Deptof Otalaryngology, Landspitali University Hospital, Iceland
Aim: To assess the relative role of OSA and obesity on leptin levels.
Methods: 452 untreated OSA patients in the Icelandic Sleep Apnea
Cohort (ISAC) study were assessed. They underwent a sleep study,
magnetic resonance imaging of the abdomen to measure visceral andsubcutaneous fat volume and fasting morning leptin levels were measured in serum.
Results: BMI, subcutaneous and total fat volume were more highly
correlated with leptin levels than visceral fat volume (bootstrapped
analysis, r = 0.58–0.67 vs. r = 0.24, p < 0.001). A multiple linear
regression model with quadratics and interactions was used to assess
the effects of obesity and OSA severity on leptin levels adjusting for
gender (main effects only). The model involving BMI, AHI and gender
explained 60.6% of the variance in leptin levels. Terms involving BMI
explained 38.7%, gender 21.2% but AHI had no significant effect. The
same was found for hypoxia severity. No interaction was found between
different measures of OSA severity and BMI on leptin levels. The presence of hypertension had, however, a significant effect on the interaction between AHI and BMI (p = 0.04). For subjects without hypertension(n = 249), there was a significant but minor effect of OSA severity(explaining 2.1–3.2%) and an interaction between OSA severity and
BMI (explaining 1.5–1.7%). For nonhypertensive subjects, the effect ofincreased OSA severity was the greatest for nonobese subjects andsmaller for obese subjects. However, these associations where not foundfor hypertensive subjects (n = 199).
Conclusion: OSA severity does not affect leptin levels, except in nonobese nonhypertensive OSA subjects. Total fat and subcutaneous fat
volume is more important in determining leptin levels than visceral fat
volume.

PO-1-035
MORBIDITY PRIOR AND AFTER A DIAGNOSISOF SLEEP DISORDERED BREATHING.
A CONTROLLED NATIONAL STUDYPP JENNUM, J KJELLBERG
Danish Centre for Sleep Medicine, Glostrup Hospital, 2600 Glostrup,
Faculty of Health, University of Copenhagen, Glostrup, Denmarkof sleep apnea (SA) or obesity hypoventilation syndrome (OHS) but theoverall morbidity prior to a SDB diagnose is incompletely evaluated.
Using data from the Danish National Patient Registry (1998–2006), we
identified all national patients with a diagnosis of SA (19438), or OHS(755). For every patient, we randomly selected 4 age-, sex- and socioeconomic-matched citizens from the Danish Civil Registration System
Statistics. We further extracted information from the Danish Ministryof Health, Danish Medicines Agency, and National Health Security. Pts
with SA and OHS presented increased morbidity (p lt 0.01) up to morethan eight years prior to a SDB diagnose of SA the most common contacts were diseases of the endocrine, nutritional and metabolic diseases((Odds Ratio (OR) SA/OHS 4.5/4.8), nervous system: OR 4.4/5.5),
respiratory system (OR: 2.9/4.0), skin and subcutaneous tissue (OR2.5/1–3), infections (OR 1.8/3.0), CVD (OR 1.7/1.3), genito-urinary
system (OR 1.3), ear-nose and throat (OR 1.3), psychiatric diseases (OR1.1/1.4). After a SDB diagnose, patients also presented significant morbidities and mortality. CPAP treatment reduced mortality 6.6% versus
5.5 in SA pts, 4.0% in control subjects.
Conclusion: Patients with SDB shows significant morbidities several
years prior to a diagnose of SA or OHS. As early detection of SA/OHS
is important for improving prognosis, SDB should be considered inpatients with endocrine, nutritional, metabolic, neurological, and pulmonary and CVD disorders.

PO-1-036
ASSOCIATION OF WORSE GLYCEMIC CONTROLAND HYPOXEMIA IN MIDDLE-AGED CHINESE
PATIENTS WITH TYPE II DIABETES AND
OBSTRUCTIVE SLEEP APNEAJ LAM1, A LAI1, DC LAM1, LY ONG2, MM LUI1, KS LAM2, MS IP1
1Division of Respiratory Medicine, Department of Medicine, The Universityof Hong Kong, Queen Mary Hospital, Hong Kong, China, 2Division of
Endocrinology, Department of Medicine, The University of Hong Kong,
Queen Mary Hospital, China
Introduction: Accumulating data suggest that obstructive sleep apnea(OSA) is highly associated with glucose dysmetabolism, but the association between OSA and glycemic control in established diabetes is notwell understood. This study investigated the relationship between OSA
and glucose control in type II diabetic Chinese patients.
Methods: Patients with type II diabetes and age <65 were recruitedfrom our outpatient clinic. They were all invited to undergo overnightin-laboratory polysomnography. Clinical data and fasting biochemicalmarkers were collected on waking the next morning. HbA1C wasmeasured as the glycemic control index.
Results: 112 diabetic patients were evaluated. Their mean (±SD) age
was 53.0 ± 6.7 years, body mass index (BMI) was 27.2 ± 4.5 kg/m2,
HbA1C was 8.6 ± 1.5% and median (±interquartile range) apnea
hypopnea index was 6.1 (1.7, 19.8) events/hour. When they weredivided into 3 groups according to HbA1C level (Group 1: <8% (n =38),Group 2: 8–8.9% (n = 32), Group 3: >= 9% (n = 42)), there wasno significant difference in age, BMI, Epworth sleepiness scale, bloodpressure, smoking and drinking history. However, minimum oxygen
saturation was significantly lower in group 3 (p = 0.006) compared togroups 1 and 2, after adjusting for gender, duration of diabetes andnumber of diabetic drugs.
Conclusion: In this clinic-based population, hypoxemia is significantly
associated with worse glycemic control in middle-aged Chinese patientswith type II diabetes and OSA.

Sleep disordered breathing (SDB) causes significant burden. Former
studies have focused on cardiovascular diseases (CVD) after diagnose© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research265

Sleep, Science and Research

PO-1-037
QUALITY OF LIFE IN SLEEP APNEA COMPAREDTO CONTROLSS JULIUSSON1, B EYSTEINSDOTTIR2, ES ARNARDOTTIR2,B BENEDIKSTDOTTIR2, G MAISLIN3, B HALLDORSDOTTIR2,AI PACK3, T GISLASON2
1
Department of ENT, Landspitali University Hospital, Reykjavik, Iceland,2
Faculty of Medicine, University of Iceland, Iceland, 3Center for Sleep andRespiratory Neurobiology, University of Pennsylvania, United States ofAmerica
Introduction: The quality of life is intrinsically linked to sleep quality.
Patients suffering from obstructive sleep apnea (OSA) have disturbed
sleep which may in some patients lead to severe impairment. The aimof this study was to measure health-related quality of life with standardized measurements in a large group of OSA patients and compares theresults to the general population.
Material and Methods: The OSA subjects (n = 822) were a part of the
Icelandic Sleep Apnea Cohort. They were newly diagnosed with moderate or severe OSA (665 males, 157 females). The control subjects (n =742) were randomly chosen Icelanders (394 males, 348 females) who
participated in another epidemiological study (www.boldcopd.org). To
measure Quality of life, SF-12 was administered to controls and OSA
patients before CPAP treatment was started. A 2 year follow-up is
ongoing.
Results: The mean ± SD unadjusted SF-12 Physical Component
Summary Score (PCS) was 40.3 ± 10.9 for OSA patients but 50.7 ± 8.0
for controls. The mean ± SD SF-12 Mental Health Component Summary
Score (MCS) was 48.3 ± 10.9 for OSA patients compared 51.4 ± 4.8
for controls. Multiple linear regression analysis for the pooled materialof OSA and controls showed that PCS was strongly related to presenceof OSA, male gender, age and obesity (R2 adjusted = 33.5%) whilemuch less of the variation in MCS could be explained (R2 adjusted =5.4%). OSA severity by itself was, however, neither related to PCS nor
MCS. Altogether 497 OSA patients have been evaluated in the two year
follow-up (80% of invited). Of these, 179 were no longer CPAP users.
Preliminary results among CPAP users show that CPAP use is associatedwith an increase in PCS by 3.3 ± 9.4 (compared to 2.1 ± 10 among
non-users). MSC increased by 3.1 ± 10.4 among CPAP users (compared
to1.7 ± 11.3 among non-users).
Conclusion: OSA patients report severely impaired quality life compared to controls, especially in the physical component.

PO-1-038
GENDER DIFFERENCES IN THE RELATIONSHIPSBETWEEN POLYSOMNOGRAPHY AND PHYSICAL
FACTORS IN PATIENTS WITH OBSTRUCTIVESLEEP APNEA-HYPOPNEA SYNDROME
H TOYOSHIMA, Y YAMAGUCHI
Sleep Medicine, Fukuoka Urasoe Clinic, Fukuoka-city, Japan

who attended our clinic. Sixty eight patients presented by the otherhospital were excluded from the study. The patients were divided
according to sex and age (over or below 60 y.o.). Apnea-hypopnea index(AHI) and lowest SpO2 were included in the results of PSG. The patients
who indicated the lowest SpO2 below 50% were excluded for the analysis. Physical characteristics measured were BMI and NC.
Result: The patients were divided into male <60 y.o., male.≧60 y.o.,female <60 y.o. and female.≧60 y.o. Their number was 756, 194, 32
and 44 respectively. BMI and NC correlated with AHI significantly ineach of the 4 subgroups. In males, BMI and NC correlated with thelowest SpO2 negatively irrespective of age, but not in females.
Conclusion: These results suggest that obesity and neck circumference
are not related to severe hypoxemia during sleep in females with OSAHS
in Japan.

PO-1-039
ASSOCIATION BETWEEN SLEEP DISORDERED
BREATHING (SDB) AND PSYCHOMOTOR
VIGILANCE TASK (PVT) IN GENERALPOPULATION: A CROSS-SECTIONAL STUDYS TANNO1, T TANIGAWA1, Y OKA2, S SAKURAI1, I SAITO1
Department of Public Health, Ehime University, Shitsukawa, Toon-city,
Ehime, Japan, 2Department of Sleep Medicine, Ehime University, Japan
1

Introduction: Sleep disordered breathing (SDB) is known to be associated with increased risk of car accidents. To evaluate sleepiness associated with impaired performance, the multiple sleep latency test is
considered a valuable objective measure, although it is too complex tobe performed widely. The Epworth Sleepiness Scale (ESS) is commonlyused to evaluate sleepiness because of its simplicity, but it does notnecessarily correlate with objective measures. We hypothesized inpatients with SDB, their performance is impaired regardless of their ESS
scores, and it could be detected by psychomotor vigilance task (PVT).
Methods: 642 local residents aged 30–79 years from Toon City, Japan
participated. They completed 10 minutes PVT in a morning at local
health center and underwent SDB screening test at their home using
single-channel airflow monitor on the subsequent night. SDB was indicated by the respiratory disturbance index (RDI); PVT variables
included mean reciprocal of reaction time (RT)s, number of lapses,mean reciprocal of fastest 10% RTs, mean reciprocal of slowest 10%
RTs, slope of linear regression line across the 10 minutes of the task fit
to reciprocal of RTs, and number of false responses. Also, detailed
questionnaire including ESS, sleep duration, and ethanol intake wereobtained.
Results: A linear trend of the PVT variables with RDI levels showedsignificant negative association between RDI and mean of the slowest
10%, number of lapses, and the slope in participants aged <= 60, evenafter adjusted for age, sex, BMI, ethanol intake, and sleep duration. The
ESS score did not differ significantly among each RDI levels.
Conclusion: Our finding indicated that in patients with SDB, the PVT
may be useful in evaluating impaired vigilance which could not be
detected by the ESS.

Purpose: To determine whether apnea severity between men andwomen is related to physical characteristics such as body mass index(BMI), neck circumference (NC) and age.
Material and Method: A total of 1094 patients with obstructive sleep
apnea-hypopnea syndrome (OSAHS) were referred to our sleep clinic.
Each patient’s BMI, NC and age were recorded during one month period
in April, 2011. Polysomnography (PSG) was performed on all patients266© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-040
LONGITUDINAL STUDY OF SLEEP BREATHINGDISORDER (SBD) IN THE GENERALPOPULATION OF KOREASC HONG1, SP LEE1, CS PARK2, BH PARK1, YO CHO1, JT LEE3,DW KANG1, J KIM1
1
Department of Psychiatry, The catholic of University, Suwon,Gyeonggi-do,
Republic of Korea, 2Departments of Otolaryngology-Head and Neck
Surgery, The Catholic University, Republic of Korea, 3Department of
Psychiatry, The Catholic University, Republic of Korea
Objective: Evolution of SBD has been little documented in general
population. Longitudinal information can be gathered by interviewing
the same individuals at different times but it can also be obtained bymeasuring a population at different occasions. This study presents theresults related to SBD in South Korea assessed in a 7-year interval.
Methods: The first study was carried on in 2001 with 3719 individuals
aged 15 years or older representative of the general population of South
Korea. The second study was performed in 2008 using a representative
sample of 2537 individuals in the same age range. The methodology
was the same for both studies. The participants were interviewed by
telephone using the Sleep-EVAL system. The interviews covered sleep
habits, sleep symptomatology, physical and psychiatric illnesses.
DSM-IV sleep and psychiatric disorder diagnoses were also assessed.
Results:
1) MenIn 2001; 8.1% of the sample reported having snoring; theprevalence was increased to 13.7% in 2008. In 2001; 2.9% of thesample reported having OSAS; the prevalence was increased to 4.7%
in 2008.
2) WomenIn 2001; 2.8% of the sample reported having snoring; theprevalence was increased to 6.2% in 2008. In 2001; 1.7% of thesample reported having OSAS; the prevalence was increased to 2.6%
in 2008.
Conclusions: Overall, prevalence of SBD has increased over a 7-year
period mainly in the young adult individuals. The increase of SBD isstrongly correlated with weight gain among the young adult in korean
population.

PO-1-041
A SURVEY ON THE MANAGEMENT OF SLEEPAPNEA IN EUROPE

I FIETZE1, T PENZEL1, M BONSIGNORE2, WT MCNICHOLAS3
Dept. of Cardiology, Charite - Universittsmedizin Berlin, Berlin, Germany,
2
Department of Medicine, Pneumology, Physiology and Nutrition,
University of Palermo, Italy, 3Pulmonary and Sleep Disorders Unit,
University College Dublin, St. Vincent’s University Hospital, Ireland
1

Introduction: Even within Europe, the services provided for the investigation and management of sleep disordered breathing (SDB) vary fromcountry to country. To study this variation a questionnaire-based study
was initiated to investigate the status of diagnostic pathways and therapeutic methods currently used. In the management of SDB in Europe
personal qualification requirements for physicians involved in the diagnosis and treatment of SDB are assessed and reimbursement of sleep
medicine services in different European countries are specified.MethodsTwo questionnaires were sent to 39 physicians in 22 European
countries. In order to standardize the answers, the questionnaires wereaccompanied by completed examples.ResultsSleep centers from 21
countries (38 physicians) participated. A broad consistency among
countries with respect to the following was found: clinical pathways

included referral to sleep physicians, sleep laboratories, requirement ofan objective diagnosis (primarily by polysomnography), indications for
positive airway pressure (PAP) therapy, application of standard PAP
therapy (100% with an CPAP/APAP ratio of 2.24:1), and the need forsome form of treatment follow-up study (90.5%). Differences between
countries were apparent for reimbursement of the diagnostic procedures, reimbursement for follow-up studies, in the procedures for PAP
titration which ranged from home APAP titration with portable sleep
apnoea monitoring (38.1%) up to titration with hospital based attended
polysomnography and APAP (85.7%), as well as the personal qualification requirements for sleep physicians.DiscussionManagement of OSA
in different European countries is similar but there are differences inreimbursement rules, qualification of sleep specialists and procedures
applied for titration of CPAP treatment. A European network can help
to implement a better unified health-service for sleep medicine in sleep
disordered breathing in order to standardize management in a costeffective way. Key words: Public health services; sleep disorderedbreathing.

PO-1-042
SERUM FERRITIN LEVELS IN PATIENTS WITH
OBSTRUCTIVE SLEEP APNOEA (OSA),COMPARED TO THE GENERAL POPULATION. –AN EPIDEMIOLOGICAL CASE-CONTROL STUDY-

B BENEDIKTSDOTTIR1, EH THORARINSDOTTIR1, T GISLASON1,2,
I OLAFSSON3, C JANSON5, AI PACK4
1
Medical Faculty, University of Iceland, Gardabaer, Iceland, 2Departmentof Allergy, Respiratory Medicine and Sleep, Landspitali University Hospital,
Iceland, 3Department of Clinical Biochemistry, Landspitali University
Hospital, Iceland, 4School of Medicine, University of Pennsylvania, UnitedStates of America, 5Department of Medical Sciences: Respiratory Medicine
and Allergology, Uppsala University, Sweden
Background: Ferritin is an intracellular iron storage protein but also amarker of acute and chronic inflammation. Previous studies have shownthat subjects with sleep apnea (OSA) have higher levels of circulating
pro-inflammatory cytokines but little is known about the association
between ferritin, OSA and its comorbitities.
Objective: The aim of the study was to evaluate S-ferritin levels in OSA
patients before and after CPAP treatment and compare it to S-ferritin
levels in the general population. Also to study if there were correlationof S-ferritin levels to OSA comorbiditis.
Methods: The OSA subjects (n = 822) were a part of the Icelandic Sleep
Apnea Cohort. They were newly diagnosed with moderate or severe
OSA (665 males,157 females). The control subjects (n = 742) wererandomly chosen Icelanders (394 males, 348 females) who participatedin another epidemiological study (www.boldcopd.org). S-ferritin levels
were measured, participants answeared a detailed questionnaire withquestions about sleep, health and the Epworth Sleepiness scale. The
OSA patients underwent a sleep study. The change with CPAP treatment
was assessed after 2 years (n = 538).
Results: S-ferritin was significantly higher in OSA patients than controls, both in men (p = 0.007) and women (p = 0.0006) but after
adjusting for body mass index (BMI), age, smoking status and comorbidities, S-ferritin was only found to be significantly elevated in
OSA women (p = 0.032). S-ferritin did not show any significant correlation with severity of OSA, daytime-sleepiness or level of CPAP usage at
the two-year follow up.
Conclusions: Women with OSA had significantly higher S-ferritin
levels than controls after adjusting for BMI, age, smoking status andco-morbidities.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

267

Sleep, Science and Research

PO-1-043
PREVALENCE OF HYPERTENSION IN
INDONESIAN SLEEP APNEA PATIENTSR TEDJASUKMANA
Departement of Neurology, RS MEDISTRA, JAKARTA, Indonesia
Introduction: Sleep-disordered breathing (SDB) and sleep apnea havebeen linked to hypertension in many studies. Apnea and hypopnea
cause temporary elevations in blood pressure in association with blood
oxygen desaturation, arousal, and sympathetic activation and may cause
elevated blood pressure during the daytime and, ultimately,sustained
hypertension. There is no data on prevalence of hypertension in Indonesian Sleep Apnea patients. Should the diagnosis of apnea be actively
sought with sleep studies in hypertensive populations?
Methodology: This is a cross-sectional study of more than 200 Indonesian patients attending a sleep clinic. All patients were diagnosed as
Obstructive Sleep Apnea by undergoing attended in hospital overnightpolysomnography. We analyzed data of hypertension, body mass index,
diabetes, ischemic heart disease and stroke in these patients. Severityof Sleep Apnea and oxygen desaturations was examined in conjunction
to hypertension.
Results: Patients age range from 21 to 79 years. All patients present
with snoring, 40% present with snoring and hypertension. Most
patients had moderate to severe Sleep Apnea with Apnea-Hypopnea
Index of more than 15 per hour.
Conclusions: Prevalence of hypertension is very high in Indonesian
Sleep Apnea patients. The presence of hypertension in snoring patientsshould alert physicians to investigate with sleep studies.

PO-1-044
ASSOCIATIONS BETWEEN SLEEP APNEASYNDROME AND GASTROESOPHAGEAL REFLUXDISEASE (GERD)

A UEMATSU1, T AKASHIBA1, T AKAHOSHI1, K NAGAOKA1,
N OKAMOTO1, K IGEI1, Y KOHZU1, N NOMURA1, K KATSURA1,
T YOSHIZAWA2, S HASHIMOTO1
1
Respiratory Internalmedicine, Nihon University School of Medicne,
Itabashi-ku, Tokyo, Japan, 2Sleep Disorder-Clinic, Kanamechou Hospital,Japan

A link between obstructive sleep apnea syndrome (OSAS) and gastroesphageal reflux disease (GERD) has been suggested, with patients
being predisposed to both conditions, with similar etiologic risk factors
such as obesity and alcohol use. Although a high prevalence of GERD
in patients with OSAS is noted even in Japan, no studies have showna clear association and therefore a cause and effect relationship is not
unknown. We aim to investigate the direct associations between GERD
and OSAS in relatively large number of the patients. Eight hundreds
thirty eight consecutive men who referred to the Sleep Center of Nihon
University and Sleep Clinic of Kanamecyo Hospital were included inthis study. Before diagnostic polysomnography (PSG), subjects completed a brief 12 item questionnaire that is called the frequency scale
for the symptoms of GERD (FSSG) and is the sole tool used to diagnose
GERD in this study. More than 8 of 48 points was evaluated positive(+) in GERD. A full night PSG was performed in all subjects. The
patients with apnea-hypopnea index (AHI) > 5 received a diagnosis ofOSAS. OSAS was found in 781 (93.1%) and GERD (+) (FSSG > 8) was
detected in 316 (37.7%) out of 838 cases. GERD (+) group were significantly younger than GERD (-) group. On PSG data, although AHI
was not different among groups, the lowest SpO2 was significantly

268

lower in GERD (+) group than that in GERD (-) group. Subjects weredivided to 5 groups according to AHI, non, mild, moderate, severe, andvery severe OSAS and were examined the relationships between severityof SAS and GERD. FSSG and prevalence of GERD (+) were significantly
increased as AHI was elevated. However FSSG was also significantly
higher in obese subjects than in nonobese subjects. These results
suggest that OSAS was clearly associated with occurrence of GERD
although the influence of body habitus was not ruled out even in large
scale study.

PO-1-045
PREVALENCE OF RISK FACTORS FOR
UNDIAGNOSED OBSTRUCTIVE SLEEP APNOEAIS HIGH IN TRUCK DRIVERS ON UK ROADSAJ FILTNESS1, LA REYNER1, JA HORNE1
1
Sleep Research Centre, Loughborough University, Oakleigh, Australia,
2
Accident Research Centre, Monash University, Australia

Objectives: To determine the prevalence of symptoms and risk factorsof obstructive sleep apnoea (OSA) in truck drivers at a UK large truckstop.
Methods: Over a 5 day period, truck drivers completed a short questionnaire at a major UK ‘truck stop’. The questionnaire asked about
OSA rist factors and symptoms, and included the Epworth Sleepiness
Scale (ESS). Additionally, measurements of height, weight and collar
size were taken. 148 truck drivers participated and within this random
group the risk factors of OSA that were looked for were:men age over
40 y, obesity, parge neck circumference, smoking, high ESS and bed
partner reporting snoring with witnessed apnoeas.
Results: Our sample were all men, with 82% aged over 40 y. 47% wereobese (compared with 23% for UK men in general) and average neckcircumference was 42 cm (compared with 38 cm for UK men in general– Martin et al 1997). 31% smoked (vs 21% for general population),and ESS averaged 2.1 points higher than expected for a healthy population (Johns et al 1997). Snoring was quite evident at 57% (compared
wth 40% for men in general) and witnessed apnoeas were almost
double (7%) compared with 3.8% given by Ohayon et al (1997) generally for men.
Conclusion: 8 key symptoms and risk factors of OSA have been foundto be prevalent in a sample of truck drivers on UK roads, and to greater
extent that for estimates in the general male population. Bed partnersof truck drivers reporting witnessed apnoeas strongly suggests thisgroup has a high potential for undiagnosed OSA. OSA sufferers are
known to be at high risk of causing road traffic accidents. This, together
with the large size of trucks, then the potential for serious road crashes
is great. Truck drivers, especially those who are obese, ought to be ahigh priority population for OSA screening.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-046
WHICH FACTOR RELATES TO SUBJECTIVESLEEPINESS IN JAPANESE SNORERS? A
PROSPECTIVE STUDY BASED ON DATACOLLECTED FROM THE INTERNETT TANAHASHI1, H NAKANO2, T FURUKAWA1,2,3, K HIRAYAMA2,N SUDO1,3
1
Department of Psychosomatic Medicine, Kyushu University Hospital,
Fukuoka-city, Fukuoka, Japan, 2Sleep Center, Fukuoka National Hospital,
Japan, 3Department of Psychosomatic Medicine, Graduate School of
Medical Sciences, Kyushu University, Japan
Background: Subjective excessive daytime sleepiness (EDS) is very
weakly associated with the severity of sleep disordered breathing.
However, EDS has been reported to be associated with snoring variables
as well as apnea/hypopnea index. We investigated EDS determinant invisitors of our homepage on snoring.
Methods: The subjects answered a questionnaire between December 1,
2009 and November 30, 2010. The inclusion criteria were habitual(greater than or equal to 3 nights a week) snorers and age greater thanor equal to 20 years. The exclusion criteria were sedative hypnotic use,
antiallergic agents use, and previous diagnosis of sleep apnea. Multiple
regression analysis was performed using Epworth sleepiness scale (ESS)
as the dependent variable.
Results: We included 1,425 subjects (956 men, 469 women) of averageage, 39.2 years (20–79); BMI, 24.0 ± 4.0 (mean ± SD); daily time inbed, 6.4 ± 1.3 h; nocturia frequency, 0.3 ± 0.7 (0–5); and ESS, 8.1 ±4.8. Among these, 733 (51%) had witnessed apnea, 1,148 (81%) had
dry feeling in the pharynx at waking, 906 (64%) had night-time nasal
obstruction, and 277 (19%) had hypertension. Subjects whose daily
time in bed was less than 3 h or greater than or equal to 9 h were
excluded, and multiple regression analysis was performed in theremaining 1,387 subjects (931 men, 456 women). Daily time in bed (β= −0.162), witnessed apnea frequency (β = 0.116), frequency of dry
feeling in the pharynx at waking (β = 0.099), age (β = −0.059), andsex (β = −0.059) were significantly related to ESS (R2 = 0.065; P < 0.05).
Excluding the frequency of dry feeling in the pharynx at waking, significant factors in the multiple regression model were daily time in bed(β = −0.163), witnessed apnea frequency (β = 0.125), age (β = −0.074),
frequency of night-time nasal obstruction (β = 0.064), and sex (β =−0.064) (R2 = 0.057; P < 0.05).
Conclusions: EDS in Japanese snorers was related to less sleep time,
witnessed apnea frequency, frequency of dry feeling in the pharynx at
waking, less age, and female sex. Furthermore, nasal obstruction might
be related to EDS.

PO-1-047
ASSOCIATION BETWEEN SNORING AND
CAROTID ATHEROSCLEROSIS IN
NON-OBESE WOMENJ KIM1, KC RICHARDS1, C SHIN2, SH KIM2, AI PACK3
School of Nursing, University of Pennsylvania, Philadelphia, United Statesof America, 2School of Medicine, Korea University, Republic of Korea,
3
School of Medicine, University of Pennsylvania, United States of America
1

Background: Recent animal studies have suggested that snoringinduced vibration might have an impact on cardiovascular and subclinical atherosclerotic changes, due to increased local inflammatory
responses and adjunct vessel damage in carotid arteries by transmissionof vibration energy. The purpose of the present study was to examine
whether snoring is associated with intima-media thickness (IMT) on
carotid arteries, independent of obesity and sleep apnea.
Methods: Subjects were derived from the Korean Genome Epidemiology Study, an ongoing cohort study of Korean adults. The final sample
comprised 1,096 men and 1,014 women who were free of known
cardio/cerebrovascular disease, who did not take any medication due
to hypertension, diabetes, and dyslipidemia, and who had a body massindex (BMI) less than 27.5 kg/m2. IMT at the far and near wall ofcommon carotid arteries was measured by B-mode ultrasonogram on
both sides. Averaged mean and maximal values of IMT from the four
segments were used for analysis. Individuals were grouped into habitualsnorers (snoring ≧ 4 days/week), occasional snorers (<4 days/ week),
and non-snorers. All participants were asked about a witnessed sleep
apnea as follows: “Have you ever heard that you stopped breathing
during sleep?”Results: After adjusting for witnessed sleep apnea and other covariates,
both occasional and habitual snorers had significantly higher mean andmaximal values of carotid IMT than non-snorers in women (p = 0.0156
and p = 0.0146 for mean and maximal IMT, respectively), but not inmen. In the multivariate logistic regression analyses, odds ratios (95%
confidence interval) of mean carotid IMT greater than 0.8 mm were 2.60
(1.10–6.19) for habitual snorers, compared with non-snorers. Odds
ratios for maximal carotid IMT greater than 1.0 mm were 1.94 (1.07–
3.51) and 3.00 (1.50–6.02) for both occasional and habitual snorers,
respectively.
Conclusions: The findings indicate that snoring is positively associatedwith the early process of atherosclerosis on carotid arteries in non-obese
women, independent of sleep apnea.

PO-1-048 / AS-10 Presenter
THE EFFECTS OF BODY MASS INDEX (BMI)ON GENIOGLOSSUS MOTION IN AWAKEHEALTHY SUBJECTSS CHENG1, A MCDOUGALL1, J BUTLER1, S GANDEVIA1,
L BILSTON1
1
Neuroscience Research Australia, University of New South Wales,
Randiwck, Sydney, Australia

Obstructive sleep apneoa (OSA) is a respiratory disorder characterized
by the repetitive collapse of the upper airway during sleep and is commonly associated with obesity. EMG of the upper airway muscles iscommonly studied to understand OSA. However, EMG cannot be translated into tissue motion and how upper airway patency is maintained
in individuals remain unclear. By using a novel MR imaging technique(CSPAMM), we mapped the EMG of the tongue and showed that genioglossus moves anteriorly to dilate the upper airway during inspirationin awake healthy subjects [1]. The effects of BMI on genioglossus
motion remains unclear and understanding this is important to elucidate the pathophysiology of OSA. 10 healthy subjects with normal (n= 7) and high BMI (n = 7) were recruited. CSPAMM was used to image
respiratory-related tissue motion around the upper airway using a 3T
scanner. Genioglossus motion was tracked during inspiration. Cross
sectional area at the level of the soft palate (CSAsp) was also measured
in 10 subjects (5 with normal BMI and 5 with high BMI). The BMI of
the two groups of subjects is significantly different (p < 0.05). While
the average genioglossus motion is anterior for the group with normal
BMI, it is posterior for the high BMI group. The average anteroposteriormotion of genioglossus for the normal and high BMI subjects is–0.26 mm and 1.22 mm respectively and is significantly higher in thehigh BMI group (p < 0.05). There is a linear relationship between© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research269

Sleep, Science and Research

genioglossus motion and CSAsp (R = 0.78) such that posterior motionof genioglossus is greater for smaller CSAsp. This study shows thatgenioglossus is less effective in dilating the upper airway in healthy
subjects with high BMI despite this cohort having a likely higher EMG
in the muscle than the normal BMI group during inspiration. This study
together with our work on genioglossus motion in OSA patients present
a novel and potential assessment for OSA. [1. S. Cheng, J.E. Butler, S.
Gandevia, L.E.Bilston, Movement of the human tongue during normal
breathing in awake healthy subjects. Journal of Physiology (2008),586,
pg. 4283–94.]

PO-1-049
THE ASSOCIATION OF OBSTRUCTIVE SLEEPAPNEA WITH SINGLE NUCLEOTIDEPOLYMORPHISMS LOCATED NEAR THE
CDKN2A/2B LOCI ON CHROMOSOME 9P21

A FEDSON1, S MUKHERJEE3, J HUNG4, JD LEE2, L SIMPSON2,
KL WARD2, AL JAMES3,4, DR HILLMAN3, LJ PALMER5
1
Center for Sleep and Circadian Neurobiology, University of Pennsylvania,
Philadelphia, PA, United States of America, 2Centre for Genetic
Epidemiology and Biostatistics, University of Western Australia, Australia,
3
Western Australian Sleep Disorders Research Institute, QEII Medical
Centre, Australia, 4School of Medicine and Pharmacology, University ofWestern Australia, Australia, 5Ontario Institute for Cancer Research,
University of Toronto, Australia
Background: Genetic variants located near CDKN2A/2B loci are associated with insulin resistance and cardiovascular disease (CVD) risk. It is
unknown whether these polymorphisms are independently associatedwith obstructive sleep apnea (OSA). The aim of this study was to investigate CDKN2A/2B variant associations with OSA risk and severity,
adjusting for conventional confounders.
Methods: Four single nucleotide polymorphisms (SNPs) were genotyped and analyzed in an OSA case population (Western Australian
Sleep Health Study) and compared with two general population control
groups (Busselton Health Surveys). Sleep clinic cases were defined by
AHI more than or equal to 5 from overnight polysomnography. Community controls included: (a) unselected participants and (b) those with
low OSA probability as determined by sleep questionnaire. Subjects
were assessed for hypertension, diabetes, CVD and metabolic syndrome. Sex-stratified generalized linear modelling characterized multivariate associations adjusted for age, body mass index (BMI), smoking
and other co-morbidities.
Results: There were 973 cases, 4,772 unselected controls, and 1,526
controls with low OSA probability. Case-control analysis indicated significant interactions between diabetes and the rs10811661 andrs564398 SNPs on OSA risk in women. Within OSA cases, multivariate
analyses indicated significant SNP associations with OSA and CVD
associated phenotypes independently of BMI and other confounders (Pless than 0.05). Variant rs10757278 was significantly associated withdiabetes, and a SNP:diabetes interaction was significantly associatedwith loge(AHI) (P less than 0.05).
Conclusions: These results suggest pleiotropic loci near the CDKN2A/2B
region are associated with OSA both in association with and independently of cardiovascular and metabolic factors. Replication analyses andfunctional genetic investigations are required to determine causality.

270

PO-1-050
INTERACTION BETWEEN CO2 AND
DORSOMEDIAL MEDULLARY 5-HT2
RECEPTOR ACTIVITY IN HYPOXICVENTILATORY AIRWAY RESPONSESM KANAMARU, I HOMMA
Department of Physiology, Showa University School of Medicine, Tokyo,
Japan
In obstructive sleep apnea (OSA) patients, it is suggested that the
number and sensitivity of central 5-HT receptors are possibly increased
during sleep due to an enhanced cortisol increase by 5-HT precursor
ingestion. Genioglossus muscle contraction is mediated via 5-HT2
receptors in the nXII. 5-HT neurons in the nXII originate from the raphe
nuclei (nR), related with CO2 /pH-sensitive central chemoreceptors andwakefulness. Those in the solitary tract nucleus (nTS) also originate
from the nR. In the present study, the influence of 5-HT2 receptors in
the dorsomedial medulla oblongata (DMM), including the nXII and thenTS, on hypoxic ventilatory airway responses was investigated with andwithout hypercapnia.Adult male mice (C57BL/6N) were anesthetized
intraperitoneally with sodium pentobarbital and locally with Xylocaine
or Marcaine. Microdialysis probes were inserted into the DMM. The
mice in the double-chamber plethysmograph were recovered from anesthesia, became acclimatized to the chamber, and were inhaled air for
25 min. They were then exposed to hypoxic gas (7% O2 in N2) or
hypercapnic hypoxic gas (7% O2 and 5% CO2 in N2) with and withouta 5-HT2 receptor antagonist (10-5 M LY-53857). Under these conditions, two respiratory curves through the head and body chambers wererecorded, and concomitantly, extracellular fluid was collected throughthe microdialysis probe in the DMM.5-HT release in the DMM wasincreased by hypoxia and hypercapnic hypoxia. 5-HT2 activity in the
DMM elicited immediate airway dilation and immediate hyperventilation in hypoxia condition and enhanced polypnea, stable airway dilation, and no different ventilatory facilitation in hypercapnic hypoxia.
Hypercapnia compensated for the hypoxic responses mediated via
5-HT2 receptors in the DMM. Maintenance of pCO2 and/or CO2
responsiveness is important for ventilatory airway control during sleep.

PO-1-051
BRAIN FUNCTIONS IN RESPONSE TO ORAL AND
COGNITIVE TASKS ASSESSED BY NEARINFRARED SPECTROSCOPY IN OBSTRUCTIVESLEEP APNEA SYNDROMEK YOSHIDA
Department of Oral and Maxillofacial Surgery, National Hospital
Organization, Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
Aim: Nocturnal respiratory disturbances and disrupted sleep architecture due to obstructive sleep apnea syndrome (OSAS) cause daytime
sleepiness and cognitive deficits. The aim of this study was to evaluate
the functional brain imaging of OSAS patients during oral and cognitive
tasks.
Methods: Ten Japanese patients with OSAS (mean age: 52.5 years,
mean AHI: 18.9) and ten normal subjects (mean age: 50.8 years) were
examined. We recorded the activity of brain tissue in response to oral
function tasks (mouth opening, tongue protrusion, phonation) and acognitive function task (word fluency task) using near-infrared spectroscopy (ETG-4000 Optical Topography, Hitachi Medical, Tokyo,
Japan). In the word fluency task, the subjects were requested to generate© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

as many words of which the initial syllables were /a/, /ka/, or /sa/ asthey could. Fifty-two measurement points were placed on subjects’
frontal and bilateral temporal regions. During measurements of the oral
function tasks, the subjects repeated 30 s’ rest and 10 s’ tasks for 5 times.
The cognitive activation consisted of a 30 s’ pretask baseline, a 60 s’word fluency task, and a 60 s’ posttask baseline.
Results: In response to the oral function tasks, an event-related increase
in total hemoglobin (Hb) was evident, and all subjects showed significant (p < 0.01) changes in total Hb over the bilateral temporal cortex.
No significant differences were observed between the two groups.
During the word fluency task, clear oxy-Hb increases were observed in
the lower frontal and anterior lower channels. The increases in the Hbduring the word fluency task were significantly (p < 0.05) reduced in
the patients compared to the controls.
Conclusion: The results may be related to prefrontal lobe dysfunctionin OSAS patients.

PO-1-052
PREVALENCE OF PATENT FORAMEN OVALE
AND ITS IMPACT ON OXYGEN DESATURATION
IN OBSTRUCTIVE SLEEP APNEAEMT LAU1, SK JAIJEE3, K MELEHAN1,2, K WONG1,2, BJ YEE1,2,
DS CELERMAJER3, RR GRUNSTEIN1,2
1
Woolcock Institute of Medical Research, University of Sydney, Connells
Point, NSW, Australia, 2Department of Respiratory and Sleep Medicine,Royal Prince Alfred Hospital, Australia, 3Department of Cardiology, RoyalPrince Alfred Hospital, Australia
A possible association between patent foramen ovale (PFO) andobstructive sleep apnea has been suggested (OSA), whereby right-to-leftshunting may exacerbate the severity of nocturnal oxygen desaturation.
However, the interaction between these two conditions has not been
well characterised.
Methods: A case-control study was conducted to evaluate the epidemiological association between PFO and OSA. Subjects were recruited
prospectively from a sleep laboratory population, and 102 OSA subjects(mean age 51.5 ± 13 years) were compared to 50 controls without OSA(mean age 49.9 ± 12.4). The presence and size of right-to-left shunting
were determined by contrast transcranial Doppler ultrasonography with
Valsalva provocation. Using the 21,749 obstructive breathing events
recorded at polysomnography from the OSA group, a mixed-effects
linear regression model was developed to evaluate the impact of rightto-left shunting on nocturnal oxygen desaturation (deltaSpO2).
Results: A higher prevalence of PFO was present in the OSA groupcompared to the control group (47.1% versus 26.0%, OR 2.53, CI 1.20
to 5.31, p = 0.014). From the regression model, right-to-left shunt size
did not exert a significant influence on the severity of deltaSpO2 (coefficient 0.85, CI −0.62 to 2.32, p = 0.254); whereas sleep state, event
type, sleep position, event duration, awake oxygen saturation, apneahypopnea index and body mass index were all independent predictorsof deltaSpO2.
Conclusion: A higher prevalence of PFO is found in OSA subjects.
However, the degree of right-to-left shunting, characterised by Valsalva
provocation, is not associated with an increased severity of nocturnal
oxygen desaturation.

PO-1-053
ASSOCIATION BETWEEN OBSTRUCTIVE SLEEPAPNEA AND ELEVATED LEVELS OF B-TYPE
NATRIURETIC PEPTIDE IN A COMMUNITYBASED SAMPLE OF WOMENE LINDBERG1, M LJUNGGREN1, J THEORELL-HAGLW1,
B LINDAHL2
1
Dept of Medical Sciences, Respiratory Medicine and Allergology, Uppsala
University, Uppsala, Sweden, 2Uppsala Clinical Research Center and
Department of Medical Sciences, Uppsala University Hospital, Sweden
Background: Obstructive sleep apnea (OSA) is associated with anincreased risk of cardiovascular disease and mortality. One contributory
factor may be hemodynamic stress due to the negative intrathoracic
pressure during each apnea. Type-B Natriuretic Peptide (BNP) is
secreted by the cardiac ventricles in response to volume expansion andpressure load and we hypothesized that there would be an association
between indices of obstructive sleep apnea in the night and levels of
BNP in the morning.
Methods: From a community-based sample, 349 women underwent
full-night polysomnography, anthropometric measurements andanswered a questionnaire about medical conditions and current medication. The morning following the polysomnography, blood samples
were drawn for analysis of plasma BNP, C-reactive protein, creatinineand hemoglobin.
Results: There was an increase in mean BNP as the severity of sleep
apnea increased, increasing from a mean value of 8.5 ng/L among
women with an AHI of <5 to 18.0 ng/L in women with an AHI of >30.
Elevated BNP levels (>20 ng/L) were found in 29.8% of the women,
while 70.2% had normal levels. The odds ratio was 2.2 for elevated
BNP levels for women with an AHI of 5-<15 in relation to women with
an AHI of <5, 3.1 for women with an AHI of 15-<30 and 4.5 for womenwith an AHI of >30 after adjustment for age, BMI, systolic blood pressure, antihypertensive drugs and creatinine.
Conclusions: We conclude that there is a dose-response relationshipbetween the severity of sleep apnea during the night in women and thelevels of BNP in the morning.

PO-1-054
COMMON PRE-MOTOR DRIVE TO
GENIOGLOSSUS AND TENSOR PALATINIMOTOR NEURONSJ TRINDER1, CL NICHOLAS1, L HECKEL1, AS JORDAN1,MJ WOODS1, JM WALOSEK1, C WORSNOP1, JG SEMMLER2
1
School of Psychological Science, University of Melbourne, Melbourne, VIC,
Australia, 2Department of Physiology, University of Adelaide, Australia
Introduction: Upper Airway Muscles (UAM) are critical in maintaining
airway patency, with deficits in the control of these muscles being
implicated in airway collapse during sleep. Thus, it is important tounderstand motor control of UAMs. A powerful method of understanding pre-motor inputs to motor nuclei is to analyze the correlated activityof pairs of Motor Units (MU). We analyzed pairs of MUs from two
UAMs, Genioglossus (GG) and Tensor Palatini (TP) during relaxed
wakefulness and quantified the levels of Common Drive and MU synchronization in the frequency domain.
Methods: GG and TP EMG activities were recorded from 2 fine wire
electrodes inserted bilaterally into each muscle. Sleep-wake state andrespiratory activity were recorded. The discharge characteristics of MUs© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research271

Sleep, Science and Researchwere identified over 30 to 60 second epochs. Pairs of MUs recorded
within the same epoch were identified and classified according towhether the two MUs: 1) came from the same or different muscles and;2) had the same or different discharge patterns.
Results: 141 pairs of MUs were identified: 47 GG; 39 TP and 55 mixed.
CD was quantified as the maximum coherence value from 0 to 5 Hzsuch that 0.60 to 1.00 indicated strong; 0.30 to 0.60 moderate and 0.30
to 0.00 weak CD. For both muscles, MU pairs with the same patternand either an inspiratory or expiratory phasic component had strong
CD (mean = .75). MU pairs that had the same pattern and a tonic
component had moderate CD in both muscles (mean = .57). Pairs that
had different patterns, but had a tonic component and were from thesame muscle (e.g. Tonic & Inspiratory Tonic pairs), had moderate CD(mean = .39). However, MUs from different muscles where both units
had a Tonic component had weak CD (mean = .20). Synchronization(maximum coherence from 10 to 30 Hz) was weak in all pair combinations in both muscles (range = .10 to .26).
Conclusions: Coherence analysis of MU pairs identified a strong phasic
component in both GG and TP and inspiratory and expiratory MUs.
Tonic MU pairs exhibited moderately strong CD, but the drive wasidiosyncratic to each muscle.

PO-1-055
EFFECT OF DEEP SLEEP ON THE REGULATION
OF THE REPRODUCTIVE FUNCTIONASSESSMENT OF PLASMA KISSPEPTINLEVELS IN OSAS-

T NISHIJIMA1, T KIZAWA1, K HOSOKAWA1, S TAKAHASHI1,J TOKUNAGA2, T KANBAYASHI2, T SHIMIZU2, A SUWABE1,S SAKURAI1
1
Department of Laboratory Medicine, Division of Sleep Medicine, Iwate
Medical University, Morioka, Iwate, Japan, 2Department of
Neuropsychiatry, Akita University, School of Medicine, Japan

Secretion of gonadotropins, such as of the LH and FSH, is affected by
the sex and age, and particularly in women, is closely correlated withthe menstrual cycle. In healthy individuals, both males and females,
gonadotropin secretion is slight before puberty and increases in theearly stage of puberty, being known to reach high levels particularly
during sleep. Recently, studies on kisspeptins, a kind of gonadotropin,
have clarified that Kisspeptin-GPR54 signaling plays a crucial role in
the regulation of gonadal function, and that kisspeptins strongly
promote the secretion of LH and FSH.Meanwhile, plasma LH and total
testosterone levels are reported to be low and the frequencies of erectile
dysfunction (ED) and hyposexuality is known to be increased inpatients with OSAS. On the assumption that positive feedback by kisspeptins is not relayed to the hypothalamus despite the low level of LH
and total testosterone secretion in severe OSAS, we measured theplasma kisspeptin concentrations by RIA in patients with OSAS (122males, 27 females) and a healthy control group without sleep disturbances (7 males, 7 females). The results revealed reduced plasma kisspeptin concentrations in the OSAS group as compared with those in
the healthy control group in both sexes (OSAS group: 2.9 ± 0.1 pg/L
for males, 3.5 ± 0.3 pg/L for females; Healthy control group: 4.2 ±0.8 pg/L for males, 5.1 ± 0.7 pg/L for females). Furthermore, the plasma
kisspeptin concentrations were significantly correlated with the percentage of slow-wave sleep (p < 0.005, r = 0.451).The above results
suggest that the onset of gonadal dysfunction in patients with severe
OSAS is likely mediated by the suppression of kisspeptin secretioninduced by sleep disturbances.

272

PO-1-056
THE CARDIOVASCULAR RISKS ACCORDING TO
THE FRAMINGHAM HEART STUDY IN PATIENTSWITH SLEEP APNEAY MORITSUCHI1, H TSUDA2, C HADANO1, N MURAOKA1,
S NAGATA1, T GUNJIGAKE1, K ICHIKI1, T JIMI1, Y SUZUKI1,
T TSUDA1
1
Sleep Respiratory center, Kirigaoka Tsuda Hospital, Kitakyusyu-shi,
Fukuoka, Japan, 2General Oral Care, Kyushu University Hospital, Japan

Many recent reports suggest the relationship between sleep apnea andcardiovascular disease (CVD) and it is required to be clear the mechanism of these associations. This study was designed to estimate the CVD
risks of sleep apnea patients according to the Framingham Risk Scores(FRSs) and evaluate the relationship between FRSs and sleep related
variables.
Methods: Subjects were 429 male patients diagnosed with OSA at the
Sleep Center, Tsuda Hospital in Japan (age 57.1 ± 12.2 years, BMI 25.8
± 3.8, AHI 31.5 ± 20.9). The evaluated sleep related variables included
AHI, arousal index, slow wave sleep% (%SWS), minimum and average
SpO2, SpO2 less than 90% time, Epworth Sleepiness Scale (ESS). FRSs
for general cardiovascular disease (GCD), stroke and coronary heartdisease (CHD) were calculated based on blood pressure, medication
history, diabetes mellitus, previous CVD, drinking, smoking, and lipid
related measurements. Statistical analyses were performed with significance defined as a 2-tailed P value less than 0.05. Spearman rank correlations were applied between the FRSs and sleep related variables.
One-way ANOVA tests compared continuous variables between thegroups divided by AHI severity.
Results: From FRSs, probabilities of a GCD, stroke and CHD within
10 years were 16.7 ± 9.9%, 10.8 ± 7.0% and 12.4 ± 8.7% respectively.
There is no significant correlations between FRSs and evaluated variables except between GCD risk score and%SWS (p < 0.01, r = −0.223).
There was no significant difference between groups classified with AHI
severity except BMI (p < 0.01). Some 35.1% subjects had higher CHD
risk score than age-matched general population. Especially CHD risk
score in age group 30 to 34, 85.7% subjects exceeded the average.
Conclusion: Lower SWS% subjects had higher cardiovascular risks insleep apnea patients. More than 30% of subjects had high CHD risks
compared with the age-matched control. As there is no significant
cardiovascular risk differences in groups classified with AHI severity,
considerations for the cardiovascular risk would be required for all sleep
apnea patients.

PO-1-057
LIPOCALIN-TYPE PROSTAGLANDIN D SYNTHASE(L-PGDS) IS ASSOCIATED WITH OBSTRUCTIVESLEEP APNEAY CHIHARA1, K ARITAKE2, Y HARADA1, M AZUMA1, Y TOYAMA1,
K MURASE1, K AIHARA1, K TANIZAWA1, T HANDA3,C YOSHIMURA4, T HITOMI4, T OGA4, M MISHIMA1,O HAYAISHI2, K CHIN4
1
Department of Respiratory Medicine, Kyoto University Hospital,
Kyoto-city,Kyoto, Japan, 2Departments of Molecular and Behavioral Biology,
Osaka Bioscience Institute, Japan, 3Department of Rehabilitation, Kyoto
University Hospital, Japan, 4Departments of Respiratory Care and Sleep
Control Medicine, Kyoto University Graduate School of Medicine, Japan

Background: Obstructive sleep apnea (OSA) is associated with excessive daytime sleepiness, neurocognitive impairment, and cardiovascular© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

mortality. The prostaglandin D2 (PGD2) system is a physiological regulator of sleep. However, the relation between the PGD2 system and OSA
is not exactly known.
Methods: Forty adult patients with suspected OSA were enrolled andunderwent polysomnography. The median apnea-hypopnea index(AHI) was 26.7}17.5 events per hour. Urine samples were collected atnight and the morning following overnight polysomnography, andurinary concentrations of lipocalin-type prostaglandin D synthase(L-PGDS) were measured. Additionally, in the OSA patients who wereusing continuous positive airway pressure (CPAP), urinary L-PGDS was
also measured after 2 days of CPAP treatment.
Results: Morning urinary L-PGDS concentrations correlated positively
with AHI (r = 0.422, p = 0.008), arousal index (r = 0.328, p = 0.04),
plasma fibrinogen (r = 0.484, p = 0.002), and plasma noradrenaline(r = 0.471, p = 0.002). Morning urinary L-PGDS was higher in patientswith severe OSA (n = 15, 939.9 ± 215.6 ng/mgCreatinine) than inpatients with mild-to-moderate OSA (n = 21, 487.8 ± 68.7 ng/mgCreatinine, p = 0.02). After 2 days of CPAP treatment, urinary L-PGDS
concentrations decreased significantly (n = 12, p = 0.04).
Conclusions: Through the data from urinary L-PGDS, OSA might havesignificant effects on the PGD2 system, which is thought to be a powerful sleep-related factor. The urinary L-PGDS may be a novel parameterthat is useful for managing patients with OSA.

PO-1-058 / AS-20 Presenter
SLEEP BRUXISM, SLEEP APNEA AND CPAPCOMPLIANCE: THE ICELANDIC SLEEPAPNEA COHORTT GISLASON1, B BENEDIKTSDOTTIR2, ES ARNARDOTTIR3,
N JACKSON4, AI PACK5, S JULIUSSON6, R SCHWAB7
1Faculty of Medicine, University of Iceland, Reykjavik, Iceland, 2Faculty of
Medicine, University of Iceland, Iceland, 3Faculty of Medicine, Universityof Iceland, Iceland, 4Center for Sleep and Respiratory Neurobiology,
University of Pennsylvania, United States of America, 5Center for Sleep
and Respiratory Neurobiology, University of Pennsylvania, United States ofAmerica, 6Faculty of Medicine, University of Iceland, Iceland, 7Center for
Sleep and Respiratory Neurobiology, University of Pennsylvania, UnitedStates of America
Objectives: To analyze the clinical characteristics of sleep bruxism (SB)among subjects with obstructive sleep apnea (OSA) and upper airway
morphology based on MRI. Also the effect of CPAP treatment on subjects reporting bruxism.
Materials and Methods: The OSA subjects (n = 590) were newly
diagnosed with moderate/severe OSA (479 males/111 females). SB was
defined as yes to the question: Do you grind or clench your teeth during
sleep. The prevalence of SB with CPAP treatment was assessed after
2 years (n = 538).
Results: Among OSA patients 18.8% reported SB. There was no genderdifference. SB was more common in younger age groups (p < 0.001).
Subjects with SB had lower sleep apnea severity than those without SB.
SB was not related to hypertension, respiratory diseases or the metabolic
syndrome. SB was not related to insomnia, nocturnal sweating, RLS orexcessive daytime sleepiness.
Subjects with SB had based on SF-12, a lower mental quality of life
than those without SB (p = 0.002) but no difference was found inphysical quality of life. MRI of upper airway in those subjects with SB
had significantly smaller volumes of the retropalatal airway (p = 0.042)
and tongue (p = 0.0145) compared to non-SB.
Subjects using CPAP full-time had a decreased prevalence of SB from
15.8% to 10.8% while no change in SB prevalence was observed inthose subjects not using CPAP. Noncompliant CPAP subjects were more
likely to report SB at baseline (27.2% vs 15.8% for fully treated and12.6% for partially treated, p = 0.007).
Conclusions: SB is most prevalent among young OSA patients with alower OSA severity. Subjects with SB had smaller volumes of the retropalatal airway and tongue compared to non-SB and lower mental
quality of life. CPAP treatment of OSA decreases SB symptoms significantly but subjects with bruxism are also less likely to adhere totreatment.

PO-1-059 / AS-6 Presenter
THE SEVERITY OF OSA IS RELATED TO THE
COLLAPSIBILITY OF UPPER AIRWAY IN
EXPIRATORY PHASE

N-H CHEN1, C-C YU2, H-D HSIAO2, L-C LEE2, C-M YAO2,
C-J WANG3, S-W LIN1, L-P CHUANG1, Y-T CHOU1, C-D YANG1,
K-C KAO1, C-C HUANG1
1
Sleep Center, Pulmonary and Critical Care Medicine, Chang Gung
Memorial Hospital, Taoyuan, Taiwan, 2National Applied ResearchLaboratories, National Center for High-performance Computing, Taiwan,
3
Department of Radiology, Chang Gung Memorial Hospital, Taiwan
Introduction: Collapsibility of upper airway is related to the severityof obstructive sleep apnea (OSA). Asymmetric dynamic changes of theupper airway throughout the whole respiratory phase was reported by
Schwabs et al. The collapsibility of upper airway is different during
expiration and inspiration. We hypothesized that the collapsibility ofupper airway during expiration but not inspiration correlated with theseverity of OSA.
Methods: Overnight Polysomnography (PSG) was done in every subjects. Gender, age, and body mass index (BMI) were recorded. Upper
airway image by ultrafast Computed Tomography (CT) simultaneouslywith flow measurement were performed in these subjects at quiet respiration. Upper airway area changes over the narrowest portion and thesimultaneous flow were measured for at least 3 smooth respiration.
Upper airway collapsibility is defined as the variation of upper airway
area divided by simultaneous flow changes. Resistance, as a reciprocal ofcollapsibility, was also calculated and correlated with the severity of OSA.
Results: From 2008 July to 2009 June, 36 subjects were invited tojoin the study. 14 subjects were normal (AHI < 5, mean AHI = 1.04 ±1.37/hr) as control. 10 patients were mild to moderate group(AHI
between 5 and 30, mean AHI = 18.3 ± 8.06/hr) and 12 patients weresevere cases (AHI > 30, mean AHI = 65.89 ± 22.44/hr). The airway
changes correlated better with the flow changes in severe cases. The collapsibility of the upper airway (area changes/ flow changes ) of all cases
is correlated well with the severity of OSA (AHI) in expiratory phases(R2 = 0.372, p < 0.01), where as in inspiratory phases, there show nocorrelation (R2 = 0.009, p = 0.89). The resistance also show negative
correlation with AHI in expiratory phases (R2 = 0.634, p < 0.001), in
inspiratory phase, there is no correlation (R2 = 0.020, p = 0.47).
Conclusion: The upper airway changes are correlated with the severityof OSA in expiratory phase only. The measurement of upper airway forthe pathogenesis of OSA has to consider the phase changes throughout
the respiration.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research273

Sleep, Science and Research

PO-1-060
ROLE OF CARBON DIOXIDE MONITORING
DURING POLYSOMNOGRAPHY IN PAEDIATRIC
OBSTRUCTIVE SLEEP APNOEA (OSA)
CL PARSLEY, P WALES, M-A HARRIS, C DAKIN, S SURESH
Respiratory and Sleep Medicine, Mater Children’s Hospital, Alderley,
Australia
Polysomnography (PSG) is the gold standard for diagnosing paediatric
OSA. Carbon dioxide (CO2) monitoring is included in the paediatric
PSG. In congenital airway disorders it is known that CO2 can be elevated with minimal symptoms in infants. In severe OSA, CO2 iselevated but in less severe disease its value is poorly understood.
Aim: To assess if CO2 monitoring assists in categorising the severity of
OSA.
Methods: An audit of 256 diagnostic sleep studies from a tertiary
paediatric sleep service was conducted over a four year period. The
primary clinical diagnosis was OSA. Studies were divided into three
diagnostic groups: normal, mild and moderate-severe. Studies were
included if the minimum transcutaneous CO2 was >35 mmHg and there
was an increase of >10 mmHg during REM epochs. A two-by-two table
analysis was performed to ascertain odds ratio, sensitivity and specificity for each of the diagnostic groups.
Results: A total of 256 studies were audited. The number of studies ineach diagnostic group are: normal (N = 106, M : F 2:1), mild (96, 1.9:1)
and moderate-severe (54, 1.25:1). CO2 rise in REM was noted in 37 of
the mild group and 37 of the moderate-severe group. The odds ratio(CI) of diagnosis of OSA with increase in CO2 was 0.96 (0.52–1.75) forthe mild group and 3.32 (1.57–7.06). Sensitivity and specificity for themild group were 38% and 60%, respectively, for the moderate-severegroup were 69% and 60%.
Conclusion: These results demonstrate that classification of the severityof OSA can be assisted by a rise in REM of >10 mmHg using transcutaneous carbon dioxide in a patient group referred to a sleep disorders
clinic. Transcutaneous carbon dioxide is a useful adjunct for diagnosis
of OSA. CO2 within a limited channel acquisition profile may aid in thetriage of patients.

PO-1-061
PREDICTIVE FACTORS TO DEPRESSION
IN PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA SYNDROME
MJ KIM, KH LEE, JH HWANG, C-S KIM, S-A LEE
Department of Neurology, Ulsan University, Songpa-gu, Seoul, Republic of
Korea
Inctroduction: Depression is a major risk factor to decrease quality oflife in patients with obstructive sleep apnea. We tried to figure out thecharacteristics of patients with depression and investigate the predictive
factors for the severity of depressive mood in OSA patients.
Methods: All patients complain of snoring and sleep apnea from September 2009 to august 2010 performed overnight polysomnography.
We obtained demographic, socioeconomic and medical data with variable questionnaires include Epworth Sleepiness Scale, MultiDementional Fatigue Inventory, Sleep Trait Anxiety Inventory, Medical
Outcomes Study sleep scale with sleep problems index, Sleep related
Breathing Disorder. To evaluate depressive mood, Beck Depression
Inventory were used. We compared variables include PSG parameters
between depression group and non-depression group based on BDI and274

investigated factors to predict the depression score by multivariate
linear regression analysis.
Results: Total 604 patients diagnosed as to have obstructive sleep apnea
Male were 516 and female were 88. Mean age was 49.2 years, and mean
apnea-hypopnea inde was 29.4. Mean BDI score was 10.4. Total 286
patients classified as depression group. Women had more frequent
depression than men. Depression is significantly related with diabetes,
stroke, low educational status, unemployed status, and negatively influenced all questionnaire score. Scores of MFI, sleep problems index,
educational status, sex, and total sleep time were significant predictfactors to depression. MFI was the most predictive factor. R2 was 0.337.
Subgroup by gender presented also MFI was the most predictive factor
in men and women.
Conclusions: Depression was more frequent in women, patientswith low educational status, unemployed status, diabetes, and stroke.
MFI is the most powerful predictor to BDI score in both men andwomen.

PO-1-062
DESATURATION AT HIGH ALTITUDE IN
PATIENTS WITH MILD OBSTRUCTIVE SLEEPAPNEA SYNDROMET FUKUTOME
The director, Fukuoka Sleep Clinic, Fukutsu-city, Fukuoka, Japan
Obstructive sleep apnea syndrome (OSAS) is a common condition andhas been reported to be exacerbated at high altitudes. In this study, we
determined the reduction in saturation of arterial blood oxygen (SpO2)
values during sleep at a high altitude in patients with asymptomatic
OSAS and compared the values with those obtained at a low altitude.
Methods and subjects: Four healthy male adult volunteers were
included in the study. All of them had asymptomatic snoring. Standard
all-night polysomnography (PSG) was performed in a hotel near sea
level (Nagoya) and in a hotel at an altitude of 2612 m (Senjyoujiki
Hotel: S-hotel) on subsequent days. All sleep parameters, as recommended by the AASM Manual, were scored visually. The desaturation
speed (%/s) was calculated by dividing the difference between the initial
SpO2 value and the lowest value recorded during apnea by intervalfrom the beginning to the point of lowest SpO2 of apnea. All values arereported as means} standard deviation.
Result: The SpO2 values in awake supine patients before PSG at Nagoya
and S-hotel were 98 ± 0% and 87.5 ± 3.1%, respectively, with a difference of 10.5%, while the lowest SpO2 values during apnea were 81.2
± 6.1% and 54.5 ± 12.8%, respectively, with a difference of 27.2 ± 8.6%.
The desaturation speed was 0.19 ± 0.02%/s at Nagoya and 0.75 ±
0.22%/s at S-hotel. The apnea-hypopnea index (AHI) and arousal index
values at S-hotel were greater than those at Nagoya, with the values
respectively being 39.7 ± 10 vs. 9.48 ± 4.2 and 57.1 ± 11.7 vs. 43.8 ±9.8.
Discussion: At S-hotel, which is located at an altitude of 2612 m, theSpO2 in the awake condition was 10.5% lower than that at Nagoya.
However, the lowest SpO2 during apnea at the S-hotel was as much as
26.7% lower than that at Nagoya. Because desaturation speed at highaltitude was far greater than that at lower altitude, severe hypoxemia
during apnea was observed at high altitudes. As a result, the sleep
quality at high altitudes seemed to be poor.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-063
PROBING THE DYNAMICS OF INTERACTIONSBETWEEN AUTONOMIC SYSTEMS DURING
OBSTRUCTIVE SLEEP APNEACC CHEN1, C LIN2,3,4, M-T LO2,3, C-M LIN1
Sleep Center, Shin Kong Wu Ho-Su Memorial Hospital, Shih Lin District,Taipei, Taiwan, 2Center for Dynamical Biomarkers and Translational
Medicine, National Central University, Taiwan, 3Center for Adaptive Data
Analysis, National Central University, Taiwan, 4Institute of Systems Biology
and Bioinformatics, National Central University, Taiwan
1

Background: Patients with obstructive sleep apnea (OSA) are sufferedfrom frequent interruptions of normal sleep cycle and will cause abnormal autonomic neural functions in daytime and during sleep. Evaluation of autonomic functions in patients with OSA may provide useful
information about the severity of OSA. However, the prominent featuresof automomic nervous system dysfunction are most likely occurred
during OSA. The inconsistent period of each episode or the intermittent
occurrences of OSA present a methodological challenge since evidence
showed that traditional analytic techniques are not suitable for such
nonlinear and nonstationary physiological signals. Therefore, in thisstudy, we applied an adaptive nonlinear method called Hilbert-Huang
Transform (HHT) to probe the complex dynamics of interactions
between autonomic systems during OSA.
Method: 99 patients with mild to severe OSA were enrolled in thisstudy and underwent overnight polysomnogram examinations. Heartrate fluctuations (HRF) of patients during sleep were extracted andanalyzed by HHT to adaptively decompose complex nonstationary HRF
to multiple empirical modes corresponding to different physiologic
processes. Then, the empirical mode functions correlated to oscillations
originated from the periodic breathing of OSA as well as the parasympathetic-mediated respiratory sinus arrhythmia were identified. Furthermore, the interactions between the two empirical mode functions
can be quantified by pearson’s correlation.
Results: The correlation of two derived empirical mode functions (Rhht)
were significantly higher in patients with severe OSA than that inpatients with mild OSA (p < 0.05) and that in patients with moderate
OSA (p < 0.05). A moderate correlation was found between AHI index
and Rhht (r = 0.423, p < 10−4).
Concusion: Although AHI index remains the gold standard in evaluating the severity of OSA, quantifying the interactions between two different control mechanisms may be an alternative indicator to theseverity of OSA by assessing the abnormal interactions between autonomic systems.

PO-1-064
CENTRAL SLEEP APNEA INFLUENCED BY
POSITION CHANGES HWANG, JW CHO, DJ KIM, SM LEE, DS KIM
Department of Neurology, Pusan National University Yangsan Hospital,
Yangsan, Republic of Korea
Background: It has been established that obstructive sleep apnea
hypopnea syndrome (OSAHS) severity as measured by the apnea
hypopnea index (AHI) usually increase in supine position due to upper
airway anatomy leading to increased upper airway collapsibility.
However, the influence of body position on central sleep apneas has
not been studied systematically. We report a case of central sleep apnea
after medullary infarction showing improvement by position change.
Case: A 62 year old male was requested for the evaluation of sleep
apnea. He was diagnosed as bilateral medullary infarction about 16 daysago. He complained of snoring, awakening during sleep and witnessedapneas after medullary infarction. On physical examination, mild weakness (MRC grade 4+) and dysmetria in right upper and lower limbs
were identified. Soft palate elevation and gag reflex were sluggish bilaterally. His medical history included confirmed coronary artery occlusive
disease with failure of stent insertion, and hypertension. Echocardiography revealed akinesis of apical septum and basal inferior wall of left
ventricle, but ejection fraction was 49%, which meant mild left ventricular dysfunction. 24 hour Holter monitoring showed frequent premature ventricular contractions. Whole night polysomnography (PSG)
was performed. Sleep efficacy was 50%. Total 43 apneas, which were
all central type, were observed and maximal length was up to
23.1 seconds with desaturations to 88.9%. The AHI was 43.2/hr andsupine index was 60/hr. All central apnea were seen with supine position, therefore lateral index was zero. CPAP (Continuous positive airway
pressure) trial was failed due to discomfortness.
Conclusions: Sleeping with supine body position increases AHI in ourpatient, even though his apneas were all central type. It could be suggested that changes of lung volume and ventilatory instability depending on body position may be responsible for the change of the respiration
drive threshold. Further studies are required to identify precise
mechanism.

PO-1-065
EVALUATION OF QUALITY OF LIFE AND MOOD
STATUS IN PATIENTS WITH OBSTRUCTIVESLEEP APNEA SYNDROMEK HYE JUNG, EY JOO, SB HONG
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
Background: There are many studies showing obstructive sleep apnea
syndrome (OSAS) may deteriorate the quality of life (QOL) and moodstatus. The object of study was to evaluate the QOL and mood status
in patients with untreated OSA and its relationship with the severity of
OSA.
Method: We enrolled the patients who were diagnosed with OSA(apnea-hypopnea index 5 per hr) by overnight polysomnography(PSG). All patients were instructed to fill out the questionnaires on the
study night of PSG; the Medical Outcomes Study Short-Form 36(SF-36) for QOL, and the Symptom Checklist-90-Revision (SCL-90-R),
the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory(BAI) for mood status. Subjects who had a history of psychiatric disorders or of taking antidepressant or anxiolytics were excluded. QOL and
Mood scales were analyzed with various parameters such as clinicaldemographics (age, gender, ESS, BMI) and PSG data.
Result: Two hundred fifty five OSA patients (269 male, mean age
50.6 yrs) were included (mean AHI, 29.4 per hr). The number ofpatients with mild OSA (AHI, 5–15) was 118, moderate (AHI, 15–30)
was 78, and severe (AHI more than 30) was 123. Mean BDI and BAI
were definitely higher in women than men although their mean
AHI was not different. Six of eight domains on the SF-36 and 3 scales(hostility, phobic anxiety, and psychoticism) of the SCL-90-R showed
lower scores in women than men. BDI and BAI were correlatedwith all items of the SF-36 and SCL-90-R. ESS was significantly correlated with BDI, BAI, one of SF-36 (physical health), and all domainsof the SCL-90-R in all patients. There were significant differences
in mood status (SCL-90-R, obsessive-compulsive, anxiety, and phobic
anxiety) among groups (mild vs. mod. vs. Severe OSA, One-way
ANOVA). The severity of OSA (AHI) was correlated with mood(obsessive-compulsive).

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research275

Sleep, Science and Research

Conclusion: This study showed that daytime sleepiness may influenceon the mood and QOL and, depression and anxiety themselves arestrongly correlated with QOL. Severer sleep apneas seemed to be related
to be less obsessive compulsive trait than mild or moderate severity.

PO-1-066
IS IT IMPORTANT TO IDENTIFY NOCTURNAL
WHEEZE IN THE SLEEP LABORATORY?
JM GOLDIN, N KHOLI, J ERITAIA, P DIONYSOPOULOS, L IRVING
Department of Respiratory & Sleep Medicine, Royal Melbourne Hospital,
Newport, Australia
AIM: To assess for nocturnal wheeze using acoustic respiratory monitoring (ARM) in patients undergoing overnight polysomnography (PSG)
and to determine its effect on PSG parameters of sleep.
METHODS: Retrospective analysis of 85 unselected patients undergoing PSG together with ARM (Pulmotrack device, Karmelsonix inc.) ina tertiary referral centre. Clinical data including patient demographics,
co-morbidities, medications, Epworth Sleepiness Score (ESS) and spirometry were reviewed. PSG data was analysed by a sleep scientist andreported by a sleep physician both of whom were blinded to ARM data
which was sent to the manufacturer (Karmelsonix inc.) for independentand accurate analysis and to determine the WheezeRATE. Correlations
between PSG and ARM data where analysed using standard statisticalmethods.
RESULTS: The prevalence of wheeze in the study population was 25/85(29%). There was a significant correlation between the average
WheezeRATE and the Apnoea Hypopnoea Index (r = 0.40, p < 0.001),
the average WheezeRATE and the Cortical Arousal Index (r = 0.61, p= 0.001) and the average WheezeRATE and total time with SpO2 <90% (r = 0.44, p = 0.03). Wheezers tended to have less REM than
non-wheezers (r = 0.42, p = 0.002). There was no significant differencein ESS between wheezers and non wheezers.
CONCLUSION: Nocturnal wheeze is prevalent in patients undergoing
PSG. There is a relationship between the presence of nocturnal wheeze
and Apnoea Hypopnoea Index (AHI). Nocturnal wheeze appears toincrease cortical arousals independent of AHI and therefore may be acause for sleep fragmentation.

PO-1-067
NEW SIGNIFICANCE OF MEASURING PLASMAVASPIN CONCENTRATIONS IN OBSTRUCTIVESLEEP APNEA SYNDROMEK HOSOKAWA, T NISHIJIMA, T KIZAWA, S TAKAHASHI,
K SUZUKI, A SUWABE, S SAKURAI
Department of Laboratory, Division of Sleep Medicine, Iwate Medical
University, Morioka, Japan
OSAS is suggested to be associated with factors common to the development and pathophysiology of metabolic syndrome, such as leptin andinsulin resistance. Vaspin is a protein identified within a gene cluster
increasingly expressed in visceral fat of obese OLETF rats, an animalmodel of obesity with visceral fat accumulation or type 2 DM. However,factors affecting and mechanisms regulating plasma vaspin concentrations (Pvas) remain unclear. Thus, we investigated, in OSAS patients
considered to have leptin and insulin resistance, whether Pvas are asassociated with the severity of sleep-disordered breathing as is leptin.
The study enrolled 22 OSAS patients and 6 controls. Moreover, the276

subjects consisted of 7 patients without DM and respiratory disease who
had been diagnosed as having OSAS by PSG. All the patients hadreceived the nCPAP treatment for a period of 6 months. The Pvas in the
22 OSAS patients was 0.9 ± 0.2 ng/ml and concentration in the OSAS
group was significantly higher than that in the control group (0.3 ±0.02 ng/ml). The Pvas in the 7 OSAS patients before the nCPAP treatment was 0.6 ± 0.2 ng/ml and after the nCPAP treatment was 0.3 ±0.1 ng/ml. Pvas were significantly lower after the nCPAP treatment than
before the nCPAP treatment.While past reports have suggested a correlation between vaspin and BMI, this investigation limited to OSAS
patients found no correlation between vaspin and BMI. However, strong
correlations were recognized between vaspin and AHI, a respiratory
disorder index, and the arousal index. Thus, vaspin, considered to bea new biomarker of visceral fat, is associated with respiratory and sleep
disorders rather than BMI in OSAS patients, suggesting that Pvas is apotential biomarker of the pathophysiology associated with OSAS.

PO-1-068
THE ROLE OF SLEEP POSITION IN
OBSTRUCTIVE SLEEP APNEA SYNDROME IN
KOREAN PEOPLE

TW KIM1, B YOO2, J CHOI3, H-K LIM4, S-P LEE5, S-C HONG6
Department of Psychiatry, St.Vincent Hospital, The Catholic University of
Korea, songpa gu, Seoul, Korea, Republic of Korea, 2Department of
Psychiatry, St.Vincent Hospital, The Catholic University of Korea, Republicof Korea, 3Department of Psychiatry, St.Vincent Hospital, The Catholic
University of Korea, Republic of Korea, 4Department of Psychiatry,
St. Vincent Hospital, The Catholic University of Korea, Republic of Korea,
5Department of Psychiatry, St.Vincent Hospital, The Catholic University of
Korea, Republic of Korea, 6Department of Psychiatry, St.Vincent Hospital,
The Catholic University of Korea, Republic of Korea
1

Objectives: The aim of this study is to analyze the role of sleep positionin obstructive sleep apnea syndrome (OSAS) in Korean people.
Methods: The subjects were 75 obstructive sleep apnea syndrome
patients suffering excessive daytime sleepiness or snoring. Patients withco-morbidities of other sleep disorders such as narcolepsy or periodic
limb movement syndrome were excluded. All subjects underwent polysomnography. Patients were stratified in a group of position dependentpatients (PP) and a group of non-position dependent patients (NPP).
We associated the apnea hypopnea index (AHI) of the supine position
with the AHI of the other positions.
Results: We identified that a non-supine position was related with thedecrease in AHI, especially in the PP group. BMI and AHI were higher
in the NPP group. In our study, 61.3% were PP (AHI in supine 2 times
greater than AHI in other positions). In polysomnography tests, bothgroup showed no significant difference in AHI in supine position, but
NPP group had significantly higher AHI in non-supine position. NPP
group showed significantly higher total wake time and respiratory
arousal index. PP group had higher average oxygen saturation andhigher lowest oxygen saturation.
Conclusion: This study confirms the finding that OSAS is position
dependent in more than 50% of patients and non-supine position
would lower the AHI of OSAS patients. AHI in non-supine position of
PP group was significantly lower than AHI in supine position. Even in
NPP group, AHI in non-supine position was lower than AHI in supine
position. We may need more comprehensive and in-depth studies tofind the efficacy and effectiveness of positional therapy for OSAS
patients.
Key words: Obstructive sleep apnea syndrom, Body position, Polysomnography, Positional therapy, Apnea-hypopnea Index© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-069

PO-1-070

RELATIONSHIP BETWEEN REDUCED LUNGFUNCTION AND METABOLIC SYNDROME IN AN
URBAN MALE WORKING POPULATION IN JAPANEFFECTS OF SLEEP DURATION AND
OBSTRUCTIVE SLEEP APNEA ON SERUM LIPIDPROFILES IN WORKING AGE MALES IN JAPANC YOSHIMURA1, T OGA1, H KADOTANI2, M TAKEGAMI3,Y NAKAYAMA-ASHIDA4, I MINAMI4, S HORITA5, Y OKA6,
T WAKAMURA7, S FUKUHARA3, M MISHIMA8, K CHIN1
1
Department of Respiratory Care and Sleep Control Medicine, Kyoto
University, Kyoto-city, Kyoto, Japan, 2Center for Genomic Medicine,
Graduate School of Medicine, Kyoto University, Japan, 3Department of
Epidemiology and Healthcare Research, Graduate School of Medicine andPublic Health, Kyoto University, Japan, 4Horizontal Medical Research
Organization, Graduate School of Medicine, Kyoto University, Japan,
5
Department of Human Nursing, Faculty of Human Health, Sonoda
Women’s University, Japan, 6Department of Sleep Medicine, Graduate
School of Medicine, Ehime University, Japan, 7Department ofEnvironmental Health Nursing, Graduate School of Medicine, Human
Health Science, Kyoto University, Japan, 8Department of Respiratory
Medicine, Graduate School of Medicine, Kyoto University, Japan

Background: Increased risk for metabolic syndrome is reported to be
associated with reduced lung function and obstructive sleep apnea(OSA). However, simultaneous analysis of the relationship of metabolic
syndrome with lung function and OSA has not been performed.
Objective: To investigate the risk for metabolic syndrome according to
the level of lung function and the severity of OSA.
Methods: We previously analyzed the relationships between metabolic
syndrome and OSA from a cross-sectional epidemiological healthsurvey conducted in middle-aged male employees at a wholesalecompany (Chin K, et al. Sleep 2010). In this secondary analysis, we
reviewed data from a home cardiorespiratory (type 3) sleep study, metabolic syndrome, and, in addition, spirometry in 273 subjects.
Results: Univariate logistic regression analyses revealed that the percentages of predicted forced expiratory volume in one second (%FEV1),
predicted vital capacity (%VC) and predicted forced vital capacity(%FVC), and the respiratory disturbance index (RDI) were significantly
related to the presence of metabolic syndrome (p = 0.0067, 0.015,
0.0072 and p < 0.001, respectively). Multivariate logistic regression
analyses revealed that, after adjustment for age, body mass index andsmoking,%FEV1,%VC and%FVC were significantly related to the presence of metabolic syndrome (p = 0.021, 0.050 and 0.045, respectively),
but RDI was not.
Conclusions: We showed epidemiologic evidence to indicate a positive
relationship between metabolic syndrome and reduced lung function
independent of age, obesity, smoking and OSA.

Y TOYAMA1, H KADOTANI2, M TAKEGAMI3, Y NAKAYAMAASHIDA4, I MINAMI4, S HORITA5, Y OKA6, T OGA7,
T WAKAMURA8, S-I FUKUHARA3, M MISHIMA1, K CHIN7
1
Department of Respiratory Medicine, Kyoto University Graduate School of
Medicine, Kyoto, Japan, 2Center for Genomic Medicine, Kyoto University
Graduate School of Medicine, Japan, 3Department of Epidemiology and
Healthcare Research, Kyoto University Graduate School of Medicine andPublic Health, Japan, 4Horizontal Medical Research Organization, Kyoto
University Graduate School of Medicine, Japan, 5Department of Human
Nursing, Faculty of Human Health, Sonoda Women’s University, Japan,
6Japan Somnology Center, Neuropsychiatric Research Institute, Japan,
7
Department of Respiratory Care and Sleep Control Medicine, Kyoto
University Graduate School of Medicine, Japan, 8Environmental HealthNursing, Kyoto University Graduate School of Medicine, Japan
Sleep duration is associated with hypertension, diabetes and metabolic
syndrome, but the relationship between sleep duration and dyslipidemia(DL) is not well known. The prevalence of DL is higher in patients withthan without obstructive sleep apnea (OSA), but few population-based
studies have investigated this relationship. In addition, no study has
evaluated the associations among sleep duration, OSA and DL simultaneously. We investigated the relationships among sleep duration, OSA
and lipid profiles in a population-based study. We analyzed data on 275
male employees of a company in Japan. We measured blood pressure,anthropometric parameters, sleep duration with an actigraph for 7 days
and the respiratory disturbance index (RDI) with a type 3 portabledevice for 2 nights. Fasting blood parameters were obtained from periodic inspection data. Average sleep duration was 6.0 h/day. Of the 275
subjects, 143 (52%) had DL. The RDI, prevalence of severe OSA and asleep duration <5 h were greater and the mean SpO2 was lower in thegroup with than without DL. When subjects were divided into 4 groups
according to sleep duration, the total cholesterol (TC), RDI, mean
SpO2,%Time of SpO2 < 90%, prevalence of no and severe OSA, andEpworth sleepiness scale differed significantly among groups. Multiple
regression analysis showed that the TC level was correlated negatively
with sleep duration and positively with age and the waist/hip ratio, andthat the triglyceride (TG) level correlated positively with the RDI, bodymass index and alcohol consumption. Short sleep and OSA was a risk
factor for elevation of the TC level and TG level, respectively, in aworking-age male population. Correction of sleep status might improvelipid profiles and subsequently decrease cardiovascular risks.

PO-1-071
SLEEP-DISORDERED BREATHING IN PATIENTSWITH MOTOR NEURON DISEASEKK KIM
Department of Neurology, Dongguk University Ilsan Hospital, Goyang-shi/
Kyeonggi-do, Republic of Korea
Background and objective: Patients with motor neuron disease may
have sleep-disordered breathing even in the early stage. The objectiveof this study is to evaluate the disturbances of breathing during sleepin patients with motor neuron disease.
Methods: Seven patients (M: F = 2:7, mean age 65 (47–79)) who werediagnosed as motor neuron disease were enrolled. We checked thedaytime symptoms such as fatigue that may be caused by sleep-disordered breathing in all patients. All patients underwent pulmonary© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research277

Sleep, Science and Researchfunction test and routine polysomnography (PSG) accompanied byarterial blood gas analysis (ABGA) before and after PSG to evaluate thesleep apnea or nocturnal hypoventilation.
Results: All patients had daytime symptoms of nocturnal sleep-disordered breathing. To look on the PSG results, two patients showed mild
obstructive sleep apnea and the other patients did not have significant
sleep apnea. But ABGA showed significant retention of carbon dioxide
and reduction of oxygen in all patients.
Conclusion: Even the patients without significant sleep apnea, nocturnal hypoventilation can exist and it causes the daytime symptoms. Evenin the early stage patients of motor neuron disease, detailed history
taking should be obtained and PSG has to be considered if needed.

PO-1-072
THE RELATIONSHIP BETWEEN OBSTRUCTIVESLEEP APNEA AND CARTOTID ARTERYATHEROSCLEROSISJW CHO1, DJ KIM1, SM LEE1, C KIM2, KH KANG1, DS KIM1
1
Department of Neurology, Pusan National University Yangsan Hospital,
Yangsan, Other, 2Office of public health service, Pusan National University
Hospital, Republic of Korea
Background: Obstructive sleep apnea (OSA) is associated with several
cardiovascular diseases. However, the mechanisms are not completely
understood. The measure of common carotid artery intima-media thickness (IMT) has been extensively used as an early marker of atherosclerosis.
The aim of this study was to test the hypothesis that early signs of atherosclerosis are present in patients with OSA and correlate with OSA severity.
Method: Thirty male patients with OSA were studied by using fullstandard overnight polysomnography and high-definition echo-tracking device to measure intima-media thickness and carotid artery diameter. Twenty Eight healthy volunteers matched for age and sex werestudied by portable respiratory monitoring device. All participants were
free of hypertension, diabetes, and were not on any medications.
Patients with OSA were naive to treatment.
Result: All patients and normal controls were male. There was no
significant difference of age between patients and controls (48.4 ± 8.85
and 48.0 ± 9.77). Significant differences existed between control subjects and patients with mild to moderate and severe OSA (apnea hypopnea index, 1.51 ± 1.15 and 38.51 ± 19.13 respectively) in intima media
thickness (0.59 ± 0.064 and 0.93 ± 0.16; p = 0.0023), and carotid
diameter (5.79 ± 0.44 and 6.47 ± 0.51; p = 0.0227). Multivariate
analyses showed that the apnea hypopnea index correlated independently with intima media thickness and carotid diameter (r = 0.79, p= 0.0008, and r = 0.47, p = 0.0482).
Conclusion: Middle aged patients with OSA who are free of overt
cardiovascular diseases have early signs of atherosclerosis, which further
supports the hypothesis that OSA plays an independent role in atherosclerosis progression.

PO-1-073
DOES INCREASING THE VENTILATORYRESPONSE TO AROUSAL INDUCEGENIOGLOSSUS MUSCLE HYPOTONIA ON
THE RESUMPTION OF SLEEP?

AS JORDAN1, J CORI1, CL NICHOLAS1, S BAPTISTA1,P ROCHFORD2, FJ O’DONOGHUE2, JA TRINDER1
1
Psychological Sciences, University of Melbourne, Parkville, Australia,
2
Sleep Medicine, Institute for Breathing and Sleep, Australia
Arousals from sleep are thought to predispose to obstructive sleep apnea(OSA) by causing hyperventilation and hypocapnia, which reduces278

airway dilator muscle activity on the return to sleep. Despite this suggestion, studies of brief auditory arousals in patients with and without OSA
have not induced hypotonia of the genioglossus (GG) airway dilator
muscle. This may have occurred because airway resistance was low prior
to arousal in these studies, resulting in a small ventilatory response to
arousal (VRA) and minimal hypocapnia. Thus we aimed to increase the
VRA in healthy subjects by resistive loading prior to auditory arousal inorder to determine whether GG hypotonia on return to sleep then occurs.
Methods: Healthy men and women were instrumented with sleep
staging and GG muscle electrodes, an epiglottic pressure catheter anda mask/pneumotachograph. Auditory tones (45–100 dB, 0.5 s, 1000 Hz)
were played to induce brief (3–15 s) ASDA arousal following either
resting breathing or 5 breaths through an inspiratory resistive load
(5–15 cmH2O/l/s, which was removed as the tone was played).
Results: Adequate data have been obtained in 4 of 7 subjects studied
to date. Subjects were normal weight (BMI = 20.5 ± 1.2 kg/m2) andwere aged 21 ± 0.4 years. Prior to arousal, ventilation (VI) was lower inthe loaded condition than resting breathing (4.0 ± 0.5 vs 5.3 ± 0.4 L/min) but GG did not differ between conditions (1.0 ± 0.1 vs 0.9 ±
0.1%max). The peak of VI and GG during arousal tended to be higher
in the loaded condition compared to resting breathing (7.4 ± 0.4 vs 6.8± 0.7 L/min and 3.7 ± 1.8 vs 2.1 ± 1.1%max respectively). However,
the minimum VI and GG on the return to sleep did not differ between
loaded and resting breathing conditions (4.7 ± 0.3 vs 4.6 ± 0.3 L/min
and 1.1 ± 0.1 vs 1.2 ± 0.1%max).
Discussion: Although the increase in VRA after loading was small, no
period of GG hypotonia was observed in either condition in thesepreliminary data. Data collection is ongoing.

PO-1-074
TRANSCUTANEOUS CO2 DECREASESDURING REPETITIVE EPISODES OF APNEAAND HYPOPNEAVPO RIMPILA1, R SARIOLA2, MA JOKINEN2, JOT NUPPONEN2,3,
O POLO1,2
1
Department of Pulmonology, Tampere University Hospital, Tampere,
Finland, 2Sleep Research Unit, Unesta Research Centre, Finland,
3
Department of Software Systems, Tampere University of Technology, Finland
Introduction: It has been previously suggested that the transcutaneous
CO2 (tcCO2) increases during repeated episodes of sleep apnea. On theother hand, sympathetic intrusion during sleep (eg. during arousal)
decreases the tcCO2. We compared the tcCO2 levels during presleep
wakefulness (sympathetic state), episodes of repetitive apnea with intermittent hypoxemia (sympathetic intrusion) and episodes of non-apneic
breathing without hypoxemia (parasympathetic state).
Methods: 154 consecutive cardiorespiratory sleep studies including
tcCO2 monitoring were retrospectively analyzed in patient who had
been referred to Tampere University Hospital because of suspected
obstructive sleep apnea syndrome. Patients were included if 1) theypresented with episodes of repetitive arterial oxyhemoglobin desaturation for a minimum amplitude of 4%, repeating during a minimum
duration of four minutes and 2) they also had episodes of high (>90%)
and stable (±1%) SaO2. The tcCO2 values (kPa) during the above mentioned episodes and presleep wakefulness were compared in 27 patients
who fulfilled these criteria.
Results: TcCO2 increased from presleep wakefulness to episodes of
non-apneic breathing (5.26 (SEM 0.17) to 5.87 (SEM 0.20) kPa) (p =1.0 × 10E-11). The tcCO2 during apneic events was 5.63 kPa (SEM
0.21). This was higher than during presleep wakefulness (p = 2.4 ×
10E-6) but lower than during non-apneic breathing (p = 1.4 × 10E-6).

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

Conclusions: The tcCO2 increase from wakefulness to stable sleep is aphysiologic shift between sympathetic and parasympathetic states. This
increase is disturbed by sympathetic intrusion associated with repetitive
episodes of sleep apnea.

PO-1-075
RELATIONSHIP BETWEEN ARTERIAL STIFFNESSAND INSULIN RESISTANCE IN OBSTRUCIVESLEEP APNEA SYNDROME WITH METABOLICSYNDROME PATIENTSH MITSUBAYASHI, M OOTSU, I HASEGAWA, T ISHII, S UZUKA,
Y KAMEI, Y YOSHIDA, A SUZUKI, Y NAKAHARA, H MITSUYASU,M NAKAUMA, T OCHIAI, Y KOMORI, A KOMORI, Y YAJIMA
Division of sleep disorders, NIPPON DENTAL UNIVERSITY HOSPITAL,Tokyo, Japan
Purpose: The aim of this study was to evaluate the relationship between
the effect of continuous positive airway pressure (CPAP) and the changeof arterial stiffness in obstrucive sleep apnea hypopnea syndrome(OSAHS) with metabolic syndrome (MS).
Methods: Fifty OSAHS males with MS as experimental groups andThirty five OSAHS males without MS as controls were enrolled andwere evaluated by polysomnography(PSG) during sleep. Alll subjects
were 30–70 years old in hospital from April. 2005 to September. 2010.
Cardio-ankle vasucular index(CAVI) is superior to estimate the extent
of atherosclerosis in large arteries. Therefore, We measured CAVI asarterial stiffness and insulin resistance in all subjects before and after
CPAP treatment.
Result: Apnea-hypopnea index(AHI) in OSAHS males with MS grouphigher than that in control group. CAVI in OSAHS males with MS groupwere similar to that in control group. After CPAP treatment, AHI
decreased in both groups. CAVI in OSAHS males with MS groupstrongly decresed compare to control group.
Conclusion: To conclude,these findings suggest the improvements of
CAVI in OSAHS males with MS group by CPAP that may contribute toimprovements of insulin resistance.

PO-1-076
IMPACT OF INSOMNIA AND DEPRESSION
IN PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA SYNDROMEH OTAKE1, A NODA2, M OKUDA1, T NAKASHIMA1
Department of Otorhinolaryngology, Nagoya University Graduate Schoolof Medicine, Nagoya-city, Aichi, Japan, 2Department of Biomedical Science,
College of Life and Health Science, Chubu University, Japan
1

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent
episodes of sleep apnea that are associated with hypoxia, arousal, andconsequent fragmented sleep. The most common neuropsychiatricmanifestation of OSAS is excessive daytime sleepiness that is secondary
to the sleep fragmentation and loss of slow-wave sleep. We investigatedinsomnia and depression in OSAS.
Methods: We studied 16 OSAS patients (mean 62.9 ± 9.6 years).
Polysomnography for sleep analysis was performed during natural
sleep in all patients and moderate to severe OSAS patients were randomly assigned to receive nasal CPAP treatment. Subjective sleep
symptoms, disturbances, and patterns were assessed with the Pittsburgh Sleep Quality Index (PSQI). The total global score ranges from0 to 21, and greater scores indicate higher levels of sleep symptoms.
Subjects with PSQI > 6 were defined as insomnia. Depression was

evaluated using two-question case-finding instrument. Daytime sleepiness was quantified using the Epworth Sleepiness Scale (ESS). All
patients underwent an otolaryngological evaluation. Deviation of thenasal septum and inferior turbinate hypertrophy were evaluated withnasopharyngoscopy, palate position and tonsil size evaluated by Friedman’s classification.
Results: The prevalence of insomnia and depression was 75% and43.8%, and daytime somnolence was 50% in OSAS patients. About theevaluation in the form of nasal cavity and the pharynx, Deflected nasal
septum were 12 cases, the hypertrophic rhinitis were 10 cases. Regarding the scores of tonsillar hypertrophy, 1 patient was classed in grade0, 9 in grade 1, 3 in grade 2, 2 in grade 3, and 1 in grade 4.
Conclusions: The OSAS patients with depression, the insomnia
symptom were recognized frequently. For early detection of depressionin OSAS, evaluating two-question case-finding instrument in addition
to PSQI would be a useful. Grasp of the OSAS pathophysiology by theevaluation of not only the OSAS severity (or AHI) but also the otolaryngology was indicated to provide beneficial information for the
improvement of the depression symptom.

PO-1-077
DAYTIME HYPERCAPNIA IN PATIENTS WITHSLEEP APNEA HYPOPNEA SYNDROME

WH LING1, H FANG2
Department of Respiratory Medicine, Handan Central Hospital, Han
Dan-city, He Bei, China, 2Department of Respiratory Medicine, Peking
University People’s Hospital, China
1

Objectives: To evaluate the incidence and factors related to daytime
hypercapnia in Chinese patients withsleep apnea hypopnea
syndrome(SAHS).
Methods: To assess the prevalence of daytime hypercapnia(PaCO2 >45 mmHg) in Chinese patients with OSAHS, 1441 patients with SAHS
had daytime arterial blood gas analysis were recruited from 2007 to2009 in Peking University People’s Hospital.145 patients underwent
pulmonary function test and had FEV1/FVC ratio over 70% were underfurther analysis sex, BMI, pulmonary function, poly somnogram andblood gas analysis results were recorded. Linear regression analysis wereused to evaluate the relationship between PaCO2 levels and relatedparameters. Comparison was done between hypercanpnic and eucapnic
patients.Finally, we evaluated the treatment effect of noninvasive
ventilation(CPAP or BiPAP) on 49 patients with OSAHS(20 with hypercapnia and 29 eucapnia).
Results: Daytime hypercapnia occurs in 25.2% of 1441 patients withOSAHS. 26.9% in the 145 with FEV1/FVC ratio over 70% and OSAHS.
PaCO2 was correlated with BMI, PaO2 and the severity of nocturnal
hypoxemia as reflected by the mean SpO2 and SIT90.This was also
confirmed by the comparison between the hypercapnic and eucapnic
patients. One week of noninvasive ventilation treatment induced significant improvement of sleep breathing disorder in both hypercapnic
and eucapnic patients, however, daytime PaO2 and PaCO2 only
improved in the hypercapnic group(P < 0.05), but not in the eucapnic
patients. PaCO2 level in 13 of the 20 hypercapnic patients returned tonormal level (<45 mmHg).
Conclusions: Hypercapnia occurred in a large part of patients withSAHS and normal FEV1/FVC value. BMI, nocturnal hypoxemia anddaytime PaO2 level are all contributed to the development of daytime
CO2 retention in SAHS. Short term treatment using noninvasive ventilation can effectively decrease CO2 level, and may correct daytime CO2
retention. [Key words] Obstructive sleep apnea hypopnea syndrome;Daytime hypercapnia; Continuous positive airway pressure.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research279

Sleep, Science and Research

PO-1-078
DIFFERENTIAL CONTRIBUTION OF REM- AND
NREM-RELATED ABNORMAL BREATHING TO
DAYTIME SLEEPINESS IN PATIENTS WITH OSAK YAMAGUCHI1, S ONIZAWA1,2, Y MAEDA2,3, H TOMOE4,
M SUZUKI2, M KAWANA5, T TSUJI1, K AOSHIBA1, A NAGAI1
1
The First Department of Medicine (Respiratory Medicine), Tokyo Women’s
Medical University Medical Center East, Tokyo, Japan, 2Comprehensive Sleep
Medicine Center, Aoyama Hospital, Tokyo Women’s Medical University,
Japan, 3Department of Urology, Aoyama Hospital, Tokyo Women’s Medical
University, Japan, 4Department of Pelvic Reconstructive Surgery, Medical
Center East, Tokyo Women’s Medical University, Japan, 5Department of
Cardiology, Aoyama Hospital, Tokyo Women’s Medical University, JapanThe excessive daytime sleepiness is the fundamental symptom in patientswith OSA, and is estimated by asking the patients about the self-administered questionnaire of ESS. Although ESS is approved for association
with some of PSG parameters such as minimum SO2 and AHI, detailed
relations between ESS and specific parameters of sleep-disorderedbreathing (SDB) during REM and NREM phases have not been systematically analyzed. We, therefore, attempted to examine the influence of
SDB-related parameters in REM and NREM on the ESS of OSA patients.
Forty patients with morbid OSA were recruited. They were evaluated forovernight PSG monitoring, and their leukocyte counts as well as NTproBNP concentrations in the blood harvested within 3 hours after
awakening were measured, as well. Taking the ESS as dependent variable,
its correlation with 18 independent variables including age, BMI, neutrophil number, NT-proBNP concentration, times of nocturnal urination,and 13 PSG parameters were estimated with multivariate analysis bypartial correlation coefficient allowing evaluation of true relation between
independent and dependent variables. Distribution of sleep stage (N1,
N2, N3, and REM), arousal index, heart rate, minimum SO2, AHI (REM
and NREM), hypoxic time (REM and NREM), and hypocapnic time
(REM and NREM) were used as the PSG parameters. We found that,
although the daytime sleepiness estimated by ESS became better withage, it was aggravated by overweight, nocturia, increased heart rateduring night, and prolonged N2 time. The daytime sleepiness was evidently worsen along with decrease in minimum SO2, and increase in
REM-related hypoxic time and NREM-related hypocapnic time, while it
was improved by increase in REM-associated AHI. In conclusion, thedaytime sleepiness is underestimated by the elderly. Hypoxia during
REM and hypercapnia during NREM function as the factor aggravating
the daytime sleepiness. Although we found that REM-related AHI
restrains the excessive daytime sleepiness, further study warrants elucidation of the mechanism explaining this peculiar phenomenon.

PO-1-079
ASSOCIATION OF OREXIN GENES MUTATIONSAND OBSTRUCTIVE SLEEP APNEA A MULTISTAGES SEQUENTIAL STUDY

WA AHMED1, K SUZUKI1, S NAKATA1, Y NISHIMURA1,
T FUJISAWA1, I KATO1, M NAKASHIMA1, H KURAHASHI2
1
School of Medicine,Second Hospital, Department of Otolaryngology, Fujita
Health University, Nagoya-city, Aichi, Japan, 2Division of Molecular
Genetics, Institute for Comprehensive Medical Science, Fujita Healthuniversity, Japan, 3Department of Otolaryngology, Sohag University, Egypt
Background: Obstructive sleep apnea (OSA) is considered a complex
genetic disease. Several candidate genes have been studied for association with OSA. In our current study we investigated the association of280

orexin genes and obstructive sleep apnea in a cohort of Japanese subjects.MethodsOur study group included 50 patients with laboratory
confirmed OSA through full night polysomnography where only moderate and severe cases of OSA were chosen. Another group included 50
control subjects without OSA. Genetic studies included genotyping
assay, gene sequencing followed by functional gene expression assay
and quantitative phenotyping assessment for orexin concentration inplasma. The study was approved by the Ethics Review Board for Human
Genome Studies at Fujita Health University
Results: A novel single nucleotide deletion in the orexin gene was foundin one patient in heterozygote form.Two single nucleotide mutations in
the orexin gene were identified in the study group with significant difference between patients and controls.By using Spicing Site Prediction
Programs, one of these mutations showed change of the Spice Donorsite in some of them or change of the score in others.In vitro assessmentof the splicing pattern followed by in vitro functional study for thetranscriptional activity revealed significant findings as regard one of thesemutations.Furthermore, quantitative phenotyping assessment for theplasma orexin level supported our in vitro functional results.
Conclusions: This genetic association, case-control study identified
two single nucleotide mutations in the orexin genes showed significant
differences between patients and control. Furthermore, functional
assessment supported our association study. Orexin genes could be
involved in the pathogenesis of OSA.

PO-1-080
QUALITY AND QUANTITY OF SLEEP IN
PATIENTS WITH COPD ADMITTED TO AN
ACUTE RESPIRATORY WARDKL AMBROGETTI1, P LEUNG1, S ROBB1, G CLAYTON1,
D TIPPETT1, P PERONA1, J DONAGHUE1, M HENSLEY1,A AMBROGETTI1
1
Department of Respiratory & Sleep Disorder, John Hunter Hospital,
Charlestown, Australia
Aims of the study: To measure length, continuity and quality of sleepin patients with chronic obstructive pulmonary disease admitted to anacute respiratory ward.
Method: A prospective observational study involving 36 quasiconsecutive patients (20 males, mean age 72 yrs, range 51–91), withsevere airway obstruction (FEV1/FVC 45% SD±10) during 41 admissions. Usual sleep at home and daily sleep in hospital was assessed byuse of questionnaires, Likert scale for quality of sleep, nurse observations and actigraphy.
Results: There were 140 admission days, 40 in single room and 100
in 4 bed cubicles. Average length of stay was 5 days (range 1 to 30).
There was no significant difference in age and severity of airway
obstruction between men and women. Bed time and wake up time were
earlier in hospital by 33 min (95%CI 5–72 min) and 21 min (95% CI
1.5–44 min) respectively. Latency to sleep was significantly longer in
hospital (mean difference 43 minutes, 95%CI 29–58 minutes). Total
sleep time (TST) assessed subjectively was significantly reduced compared to home by 2 hours and 26 minutes (95%CI 2.4–2 hrs). Subjects
overestimated TST by 54 min (95%CI 22–87 min) compared to actigraphy TST. There was no difference in sleep latency and TST between
sleep in single room compared to 4 bed cubicles.
There was no correlation between severity of airway obstruction
measure (FEV1/ FVC) and total sleep time. Perceived sleep quality did
not improve between the first day of admission and up to 10 days stay.
The number of awakenings through the night was higher in hospitalthan at home (mean difference 1.2, 95% CI 0.8–1.5) and in 4 bed© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

cubicles than in single room (4 and 2 respectively). The most common
reasons for sleep fragmentation were voiding, nurse intervention andnoise. Lunch and dinner were earlier in hospital by 1.30 and 1 hour
respectively.
Conclusion: In patients with severe COPD, admission to hospital isassociated with severe disruption of sleep continuity, length and daily
routine. Attention and modification of some of the identified factors
associated with sleep disruption may be beneficial to patients’ care.

PO-1-081
CLINICAL FEATURES OF RESPIRATORY FAILURE
AND HEART FAILURE IN PATIENTS WITH SLEEPDISORDERED BREATHINGDX SONG1, GY HUI2, H FANG3
1
Department of Respiratory Medicine, Peking University People’s Hospital,
Beijing, China, 2Department of Respiratory Medicine, Peking University
People’s Hospital, China, 3Department of Respiratory Medicine, Peking
University People’s Hospital, China

Objective: To assess clinical characteristics of heart failure and respiratory failure in patients with sleep disordered breathing (SDB).
Methods: Symptoms, signs, laboratory tests, clinical courses, bloodgases responses to voluntary hyperventilation test were analyzed in 29
patients with SDB. All were diagnosed as right or left heart failure andrespiratory failure from 1994 to 2009 in Peking University People’s
Hospital.
Results: 13 were male and 16 female. 14(48.3%) were diagnosed as
obstructive sleep apnea syndrome at first visit. Chief complains includes
dyspnea, edema, cough, snoring, hypersomnolence, oliguria and alteredmental status. Common signs include obesity, narrow upper airway,
cyanosis, moist rales at the base of lungs, enlarged border of cardiac
dullness, edema. Polycythemia was seen in 13(44.80%), among 26
patients who had underwent pulmonary function tests, 14 had FEV1/FVC =>70%, the others were FEV1/FVC < 70%, with 6 patients had
50% predict value <= FEV1 < 80% predict value and 6 patients had
30% predict value <= FEV1 < 50% predict value. After positive airway
pressure treatment, symptoms and arterial blood gases test results
improved. Chest X-ray, CT scan and UCG show pulmonary vascularcongestion and edema with cardiomegaly and possible pleural effusion,
pulmonary hypertension, left ventricular diastolic dysfunction. In 11
patients, voluntary hyperventilation induced significant improvementof SpO2, PaCO2 and PaO2, and most of the parameters returned fromtype II respiratory failure to normal level.
Conclusion: The mobidity of SDB remained to be recognized. Thiscases report indicated that obese patients complaining of severe dyspnea
and edema may have respiratory failure and bilateral heart failure secodary to SDB. The respiratory failure can be completely reversed byvoluntary hyperventilation, and noninvasive treatments only could
achieve good outcomes in most of the patients.
Key words: sleep disordered breathing, heart failure, respiratory failure,voluntary hyperventilation, noninvasive ventilation

PO-1-082
RELATIONSHIP BETWEEN AIRWAY VOLUMEAND SLEEP-DISORDERED BREATHING

H NAKANO1, K MISHIMA1, A MATSUSHITA1, H SUGA1,M MATSUMURA1, Y MIYAWAKI2, T MANO1, Y MORI3, Y UEYAMA1
1
Department of Oral and Maxillofacial Surgery, Yamaguchi University,
Ube-city, Yamaguchi, Japan, 2Miyawaki orthodontic Clinic, Japan,
3
Department of Oral and Maxillofacial Surgery II, Kyushu University, Japan
Introduction: Early detection and prevention of OSAS is very important, because several reported the relationship of OSAS and cerebrovascular disorder, or cardiac disorder recently. The purpose of this study
is to clarify the relation between airway volume and sleep-disorderedbreathing (SDB).
Materials and Methods: Thirty five Japanese female patients, who werediagnosed as jaw deformity. The average age and BMI were 24.0 years
and 20.2 kg/m2, respectively. Based on the angle of ANB, these patientswere divided into three groups; skeletal 1, 2 and 3. Using polysomnography, AHI, 3% ODI an arousal index were measured. 3D images of the
airway were reconstructed using a CT analyzing computer software. The
upper and lower boundary were defineded as be at the level of the hardpalate and the base of the epiglottis, respectively. From the 3D reconstructed models, the following parameters on the airway were obtained:
the volume of upper airway (total volume), the volume between thelevel of the hard palate and the top of uvula (volume of HP-TU),
the volume between the top of uvula and the base of the epiglottis (thevolume of TP-BE).
Results: The average of total volume in the skeletal 1, 2 and 3 groupwas 15.4 cm3, 13.7 cm3 and 11.2 cm3, respectively. The average of
HP-TU volume was 8.6 cm3, 6.2 cm3 and 5.6 cm3 in the skeletal 1, 2
and 3 group, respectively. The average of TP-BE volume was 6.6 cm3,
7.3 cm3 and 5.5 cm3 in the skeletal 1, 2 and 3 group, respectively. The
average of AHI was 1.5/hr, 1.7/hr and 2.3/hr in the skeletal 1, 2 and 3group, respectively. The average of 3% ODI was 0.4/hr, 0.6/hr and 1.0/
hr in the skeletal 1, 2 and 3 group, respectively. The average of arousal
index was 8.3/hr, 10.2/hr and 13.7/hr in the skeletal 1, 2 and 3 group,
respectively. There were no significant differences. The Spearmans correlation coefficient by rank test was found to be a negative correlation
between the HP-TU airway volume and 3% ODI (p < 0.05).
Discussion: If oral appliance will be treated for OSAS, it is importantto the measurement of HP-TU airway volume using CT scan when themandible was displaced anteriorly at pre-treatment.

PO-1-083
COMPLICATED EFFECTS OF REM- AND NREMRELATED VENTILATORY IMPEDIMENTS ON
MINIMUM SO2 IN OSA PATIENTSS ONIZAWA1, K YAMAGUCHI1,2, Y MAEDA3, H TOMOE4,
M SUZUKI2, M KAWANA5, T TSUJI1, K AOSHIBA1, A NAGAI1
1
The First Department of Medicine, Tokyo Women’s Medical University,
Tokyo, Japan, 2Comprehensive Sleep Medicine Center, Aoyama Hospital,
Tokyo Women’s Medical University, Japan, 3Department of Urology,
Aoyama Hospital, Tokyo Women’s Medical University, Japan, 4Departmentof Pelvic Reconstructive Surgery, Medical Center East, Tokyo Women’s
Medical University, Japan, 5Department of Cardiology, Aoyama Hospital,
Tokyo Women’s Medical University, JapanThe severity of OSA is generally diagnosed by the number of apnea/
hypopnea events (AHI), but minimum SO2 (minSO2) and the period of
hypoxic time during sleep are equally important for judging it, as well.
About 10 years ago, Bixler et al. demonstrated that minSO2 in patients© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research281

Sleep, Science and Researchwith sleep disordered breathing (SDB) was improved with age, indicating that the clinical severity of SDB decreased along with age. However,this important finding has not been reliably reexamined so far. We,
therefore, attempted to investigate the impact of age on minSO2 in OSA
patients by considering the interactions of various SDB-related parameters in REM and NREM phases. Forty patients with morbid OSA(overall AHI: more than 5) were enrolled and evaluated for overnightlaboratory PSG. In addition, neutrophil counts as well as NT-proBNP
concentrations in their blood samples harvested within three hours aftergetting up were measured. The correlations between minSO2 (dependent variable) and 18 independent variables including age, BMI, neutrophil count, NT-proBNP concentration, daytime sleepiness (ESS), numberof nocturnal urination times, and 12 PSG parameters were estimatedwith multivariate analysis by partial correlation coefficient allowing
evaluation of true relation between dependent and independent variables. Distribution of sleep stage (N1, N2, N3, and REM), arousal index,
heart rate, AHI (REM and NREM), hypoxic time (REM and NREM), andhypocapnic time (REM and NREM) were introduced as the PSG parameters. Partial correlation analysis revealed that, opposed to Bixlers
finding, minSO2 decreased with age. Furthermore, MinSO2 decreased
with REM-related AHI, but increased with increased heart rate during
sleep and prolonged hypocapnic time in NREM. Interestingly, minSO2
decreased with enhanced NT-proBNP concentration in the blood, suggesting that a transient pulmonary edema induced by apnea-evoked
cardiac failure worsened gas exchange in the lung. These findings indicate that minSO2 is worsened by aging in a complicated combination
with REM- and NREM-associated ventilatory impediments.

PO-1-084
PATHOGENESIS OF OBSTRUCTIVE SLEEPAPNOEA IN QUADRIPLEGIALL GAINCHE1, M LE GUEN2, J TRINDER1, P ROCHFORD2,W RUEHLAND2, M BARNES2, F O’DONOGHUE2, D BERLOWITZ2,AS JORDAN1,2
1
Department of Psychology, University of Melbourne, VICTORIA,
Australia, 2Institute for Breathing and Sleep, Austin Hospital, Australia
Introduction: Obstructive sleep apnoea (OSA) is estimated to be 2 to
5 times higher in patients with quadriplegia than in able-bodied (AB)individuals. In order to better understand the causes of OSA in quadriplegia we aim to investigate upper airway function in quadriplegia.
High nasal resistance predisposes to OSA in AB individuals. In patientswith quadriplegia, the spinal sympathetic circuits lose tonic control andinduce vascular engorgement of the airway causing the nasal mucosa
to thicken. We therefore hypothesized that nasal (Rna) and pharyngeal(Rph) resistance will be 1) elevated in patients with quadriplegia and
OSA compared to AB individuals with and without OSA, and 2)
reduced to AB levels with decongestant.
Methods: AB and patients with quadriplegia both with and without
OSA are being recruited. Subjects are instrumented with epiglottic andchoanal pressure catheters, a nasal mask and pneumotachograph. All
measurements are performed while subjects are supine during wakefulness. Rna and Rph (in cmH2O/l/s, calculated from mask, choanal andepiglottic pressures at a flow rate of 200 ml/s), were determined for 5
minutes, before and 5–10 minutes after application of decongestant(0.5 ml of phenylephrine 0.5%).
Results: One patient with quadriplegia (20 years old) and one healthy
AB individual (45 years old) have been studied to date. The patient withquadriplegia showed elevated resistance at baseline (Rna = 6.26, andRph = 5.29, compared to Rna = 2.43, Rph = 1.05 in the AB). Afterdecongestion, the Rna was 1.51 in the patient with quadriplegia and0.80 in the AB. The Rph was similar to baseline after phenylephrine.

282

Discussion: Although very preliminary, these data suggest that after
quadriplegia the Rna is particularly elevated. This is probably due tothe partial loss of function of the autonomic nervous system. The highRna in patients with quadriplegia appears to be significantly reducedby the application of decongestant. The high Rna and Rph observed arepotentially one of the risk factors for OSA in quadriplegia but further
data are required.

PO-1-085
IMPACT OF MASKED HYPERTENSION/MORNING
BP SURGE IN OBSTRUCTIVE SLEEP APNEASYNDROMES MIYATA1, A NODA1, Y YASUDA2, M OKUDA3, H OTAKE3,N OZAKI4, T NAKASHIMA3
1
Department of Biomedical Sciences, Chubu University, Kasugai-city, Aichi,
Japan, 2Department of Nephrology, Nagoya University Graduate School of
Medicine, Japan, 3Department of Otorhinolaryngology, Nagoya University
Graduate School of Medicine, Japan, 4Department of Psychiatry, Nagoya
University Graduate School of Medicine, Japan
Background: The frequent hypoxic episodes and arousal during sleepin obstructive sleep apnea syndrome (OSAS) result in an increase innocturnal blood pressure, and may lead to sustained hypertension. The
aim of this study was to investigate the relationship between OSAS andabnormal circadian rhythm in blood pressure.
Methods: We studied 26 patients with OSAS (age 49.3 yrs). Twenty four
hour ambulatory BP monitoring (ABPM) was performed in all patients
without taking antihypertensive medication. Masked hypertension was
defined as clinic BP < or = 140/90 mmHg and 24-hour ambulatory BP> or = 130/80 mmHg. The following ABPM-related prognostic features
were studied absence of nocturnal dip (< or = 10% fall in night time
systolic BP) and morning surge (> or = 20 mmHg rise in the first fourmorning readings from wake-up as compared to average night time BP).
OSAS severity was evaluated using standard polysomnography.
Results: Three patients (12%) were normotensive, six patients (23%)
exhibited masked hypertension, and 17 hypertension (65%). Apneahypopnea index was significantly lower in masked hypertension thanthat in hypertension. Morning BP surge was observed in 12 patients(46%). All moderate OSAS (6 patients) showed morning BP surge.
Apnea-hypopnea index in morning BP surge group was significantly
lower than that in non-morning BP surge group. Thirteen patients (50%)
showed nondipping pattern. Of 10 nondippers were severe OSAS.
Apnea-hypopnea index and lowest SpO2 were worse in nondippers
compared with those in dippers, but did not reach significant level.
Conclusion: Masked hypertension/morning BP surge may relate withpre-hypertensive status in patients with OSAS.

PO-1-086
DIFFERENTIAL EXPRESSION OF HEMI-CHOREAIN INTRA-SLEEP AWAKENINGS: EVIDENCE
FROM ONE CASE OF DIABETIC STRIATOPATHY
WITH SLEEP APNEA SYNDROME

AM COEYTAUX1, I CONSTANTINESCU1, R GRAVE2, R IANCUFERFOGLIA1, I MOMJIAN1, H EMOND1, S PERRIG2
1
Department of clinical neurosciences-Division of neurology, Geneva
University Hospitals-1211 Geneva 14, Switzerland, 2Sleep laboratory,
Division of neuropsychiatry, Department of psychiatry, Geneva University
Hospitals, Switzerland
Background: Unilateral chorea and corresponding neuroimaging
abnormalities of the striatum have been recently described as a rare

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

syndrome associated with uncontrolled diabetes mellitus. Despite specific clinical manifestations and imaging findings, the pathogenic mechanisms underlying this syndrome are still not fully understood.
Moreover, sleep data and movement analysis across sleep related awakenings are lacking in these patients.
Methods: We report the case of one patient diagnosed with diabetic
striatopathy and subjected to video-polysomnographical recordings.
Results: Sleep recordings revealed a severe obstructive sleep apnea
syndrome with fragmented sleep. Video recordings showed that the
involuntary movements ceased during sleep and were re-initiatedduring intra-sleep awakenings. Interestingly, the movements duringslow wave sleep (SWS) awakenings seemed to have a more similar
pattern with the diurnal movements as compared to the ones expressed
during rapid eye movement (REM) sleep awakenings.
Conclusions: Our patient presented sleep disturbances related to severe
sleep apnea syndrome. We bring evidence, for the first time to ourknowledge, of different characteristics of the involuntary movements
expressed during REM awakenings versus NREM awakenings in striatopathy. This confirms the differential motor control across biochemicallyand physiologically distinct sleep stages. Furthermore, we qualitatively
analyzed the involuntary movements expressed during REM awakenings
versus SWS awakenings. Our observations are in line with evidence
coming from patients with Parkinson disease and REM sleep behavior
disorder, who show a differential motor control during REM sleep ascompared to diurnal time. We suggest that the diabetic striatopathy
entity can be used as a neurological model to study motor control andunderlying biochemical changes related to different stages of sleep

PO-1-087
INSOMNIA AMONG SLEEP APNEA PATIENTSAND CONTROLSE BJORNSDOTTIR1, B BENEDIKTSDOTTIR1,2, C JANSON3,
JF SIGURDSSON4, P GEHRMAN5, AI PACK5, T GISLASON1,2
1
Faculty of Medicine, University of Iceland, Reykjavk, Iceland,
2
Department of Respiratory Medicine and Sleep, Landspitali University
Hospital, Iceland, 3Department of Medical Sciences: Respiratory Medicine
and Allergology, Uppsala University, Sweden, 4Department of psychiatry,Landspitali University Hospital, Iceland, 5Center for Sleep and Respiratory
Neurobiology and Division of Sleep Medicine/Department of Medicine,
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania,
United States of America
Background: Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of thisstudy were to compare the prevalence of initial and middle insomnia
between OSA patients and controls as well as to study the influence ofinsomnia on sleepiness and quality of life in OSA patients.
Material and methods: Two groups were compared, untreated OSA
patients (n = 824) and controls 40+ years from the general populationin Iceland (n = 762). Controls were sub-divided into OSA high and low
risk based on the multivariable apnea index (MAP). All subjects
answered the same questionnaires on health and sleep and OSA patients
underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients.
Results: Difficulties maintaining sleep (DMS) were more common
among men and women with OSA compared to the general population(52 vs. 31% and 62 vs. 31%, respectively, p < 0.0001). Difficulties
initiating sleep (DIS) and DIS+DMS were more common among womenwith OSA compared to women without OSA. OSA patients with DMS
were sleepier than patients without DMS (Epworth Sleepiness Scale:12.2 vs. 10.9, <0.001) while both DMS and DIS were related to lower

quality of life in OSA patients as measured by the Short Form 12 (physical score 39 vs. 42 and mental score 36 vs. 41, p < 0.001). DIS andDMS were not related to OSA severity. Altogether, 12% of the controls
were in high risk for OSA based on the MAP index and they were more
likely to be suffering from DIS than low risk controls.
Conclusion: DMS is almost twice as common among OSA patientscompared to controls while the prevalence of DIS is similar between
the groups. Insomnia has an additional negative influence on quality oflife and sleepiness in this patient group. It is relevant to screen for
insomnia among OSA patients and treat both conditions when theyco-occur.

PO-1-088
DETECTION OF SLEEP APNEA IN PATIENTSWITH ATRIAL FIBRILLATION USING BERLINQUESTIONNAIRE AND PORTABLE MONITORINGC SCHOEBEL1, M SEBERT2, C GARCIA3, D BUCK4, I FIETZE5,G BAUMANN6, T VOGTMANN7, T PENZEL8
1
Department for Cardiology, Center for Sleep Medicine, Charité –Universitaetsmedizin Berlin, Berlin-Mitte, Berlin, Germany, 2Department
for Cardiology, Center for Sleep Medicine, Charité – Universitaetsmedizin
Berlin, Germany, 3Department for Cardiology, Center for Sleep Medicine,
Charité – Universitaetsmedizin Berlin, Germany, 4Department for
Cardiology, Center for Sleep Medicine, Charité – Universitaetsmedizin
Berlin, Germany, 5Department for Cardiology, Center for Sleep Medicine,
Charité – Universitaetsmedizin Berlin, Germany, 6Department for
Cardiology, Center for Sleep Medicine, Charité – Universitaetsmedizin
Berlin, Germany, 7Department for Cardiology, Center for Sleep Medicine,
Charité – Universitaetsmedizin Berlin, Germany, 8Department for
Cardiology, Center for Sleep Medicine, Charité – Universitaetsmedizin
Berlin, Germany

Introduction: Atrial fibrillation (AF) is one of the most common
arrhythmia. Sleep Disordered Breathing (SDB) is supposed to correlatewith AF according to recent studies. In field of cardiology, Berlin Questionnaire (BQ) is widely used to estimate risk for co-existing SDB. In
our study we used unattended Portable Monitoring (PM) to detect SDB
in AF patients to compare both diagnostic approaches.
Methods: We included 81 patients (51 males, 30 females, mean age:
63 ± 9,6 years, BMI: 29,2 ± 5 kg/sqm) with a documented AF in thismonocentric prospective study. All patients had an indication forrhythm control therapy as recommended in actual guidelines (antiarrythmic medication, electrical cardioversion, catheter ablation of pulmonary veins). Before treatment BQ was completed by all patients toestimate risk for SDB. In addition all patients got PM, recording nasal
flow, respiratory movements, oxygen saturation and ECG.
Results: PM detected SDB in 49 of 81 subjects (AHI = 12,2 ± 6,9 perhour, cut off 5 per hour).
29 subjects showed mild, 14 moderate and 4 patients severe levels of
SDB.
BQ classified 43 of 81 subjects to be at high risk for SDB (53%). PM
confirmed SDB in only 31 of these 43 patients (BQ: sensitivity 63%,
specificity 62%).
Conclusion: A remarkable prevalence of SDB was detected in patientswith AF and an indication for rhythm control therapy by both BQ andPM.
Screening for SDB should be part of routine examination of AF patients,
as treatment of SDB is supposed to reduce relapse rate of AF after
rhythm control therapy.
Further investigation is needed for outlining the best screening method
for SDB in AF patients. Therefore all limited methods should be compared with polysomnography which is the gold standard.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research283

Sleep, Science and Research

PO-1-089 / AS-10 Presenter
AN INDEX BASED ON THE HILBERTTRANSFORM OF THE AIRFLOW SIGNAL THATASSESS REGULARITY AND QUANTIFIESDISTURBED BREATHING DURING SLEEPEA VIVALDI1, J DIAZ1, A BASSI1, J ARANCIBIA1
1
Programa de Fisiologia y Biofisica, Universidad de Chile, Santiago, Chile
An essential part of polysomnographic reports derives from the visualor automated detection of apneas and hipopneas, summarized as events
per hour, a widely used index (AHI) of the severity of sleep breathing
disorders. Here we propose a mathematical technique that analyses the
airflow as a continuous signal and provides an index that varies fromnormal, regular patterns, to severely disturbed breathing.The Hilberttransform provides the envelope or instant amplitude of a given signal.
The coefficient of variation (CV = standard deviation/mean) of theenvelope is a dimensionless constant invariant to signal scale. The
envelope of a signal generated by a population of asynchronous oscillators is described by the Rayleigh distribution whose CV equals thesquare root of (4/pi-1), approximately 0.523. The CV can be used as
an index to discriminate signals produced by synchronous or asynchronous neuronal populations (Diaz et al. J Neurosci. 27:9238–45, 2007).
The envelope CV is 0.523 for signals produced by asynchronous oscillators and less than 0.523 when produced by synchronous oscillators,
with smaller CVs indicating higher synchrony and envelope regularity.
Envelopes with a CV higher than 0.523 correspond to a pulsating timecourse. Thus, the CV index for the respiratory signal would provide avalue in a range going from regular respiration to high incidence of
apneas.The method was applied to the PTAF signal in 90-second
windows sliding over 30-second epochs. Time course of the CVs correlates remarkably with state transitions. Frequency distributions of CVs
for eupneic subjects typically concentrate in the 0.1–0.3 range and forseverely apneic subjects in the 1.0–1.4 range. State or position dependency of apneas is readily assessed by overlaying the CV time course.

PO-1-090
CLINICAL PERFORMANCE OF THE SD-101 FOR
THE DIAGNOSIS OF OBSTRUCTIVE SLEEPAPNEA SYNDROME

T KANEMURA1, H NAKAMURA2, S KOIKE3, M IMAI4, S CHIBA5,R YOSHIDA6, T TANAKA7, M OKAWA1, N YAMADA1,4, S MIYAZAKI1
1
Sleep Medicine, Shiga University of Medical Science, Otsu-city, Shiga,
Japan, 2Nakamura Clinic, Japan, 3Toyohashi Mates Clinic, Japan,
4
Psychiatry, Shiga University of Medical Science, Japan, 5Ota Sleep Science
Center, Japan, 6Yoshida Sleep Clinic, Japan, 7Tanaka Sleep Clinic, Japan
Study Objectives: The SD-101 is a non-restrictive, sheet-type portable
monitoring device with a built-in pressure sensor used to detect respiratory events based on pressure changes corresponding to respiratory
movements. This study evaluated the clinical performance of the
SD-101 as a screening device for obstructive sleep apnea syndrome(OSAS).
Design: Cross-sectional and multi-center study.
Setting: Sleep laboratory.
Participants: 192 subjects with suspected OSAS.
Interventions: N/AMeasurement and Results: One hundred ninety-two
subjects with suspected OSAS underwent overnight polysomnography(PSG) and SD-101 simultaneously at 5 sleep centers; data from 188
subjects were analyzed. The correlation of respiratory disturbance index

284(RDI) between polysomnography and the SD-101 was 0.901 (p < 0.05).
The sensitivity and specificity of the SD-101 were 0.817 and 0.903
respectively for AHI cutoff of >15 events/hour and the SD-101 RDI
cutoff value of 16.9. The positive and negative likelihood ratios were
8.447 and 0.202, respectively. The areas under the curve (AUC) were0.918 for apnea/hypopnea index (AHI) cut offs of >15 events/hour. The
optimal cut off value of the SD-101 was 16.9 for the same AHI cutoff
value.
Conclusion: The present study revealed that the SD-101 was less discomfort, is easy to use compared with other devices and had a relatively
high ability to detect OSAS.

PO-1-091
COMPARISON OF FACIAL PHOTOGRAPHICDIMENSIONS AND BONY MEASUREMENTS
FROM MRI IN OSA PATIENTSK SUTHERLAND1, R SCHWAB3, S JULIUSSON4, R LEE1,2,
B BENEDIKSTDSOTTIR4, T GISLASON4, A PACK3, P CISTULLI1,2
1
Centre for Sleep Health and Research, Royal North Shore Hospital, Pacific
Highway, St Leonards, Australia, 2Woolcock Institute of Medical Research,
University of Sydney, Australia, 3Penn Sleep Center, University ofPennsylvania, United States of America, 4Landspitali University Hospital,
University of Iceland, Iceland
Facial photography is potentially a very useful anatomical phenotyping
tool in obstructive sleep apnoea (OSA). We hypothesize that facial
photographs relate to OSA because they capture aspects of general andvisceral obesity as well as upper airway soft tissue and craniofacial
structure. We have previously shown relationships between facial
photographic dimensions and obesity and upper airway soft tissue
structures. We aimed to assess the relationship between facial photographic measurements and measurements of skeletal structures in subjects with OSA.
Methods: Patients from the Icelandic Sleep Apnea Cohort (ISAC) had
magnetic resonance imaging (MRI) and calibrated facial photographs
performed. Facial dimensions derived from photographic analysis werecompared to those obtained by three-dimensional MRI cephalometry
using Bland-Altman plots and correlation.
Results: Preliminary analysis was conducted in 73 (61 male, 12 female)
OSA patients (mean [±SD] age 55.6 ± 10.2 years, AHI 41.7 ± 19.9/hr,
BMI 32.7 ± 4.9). There was agreement between craniofacial dimensions(SNA, SNB, facial heights) obtained from photographed surface landmarks and bony landmarks. Surface measurements produced generally
larger measures of mandibular length (Go-Gn) however the two measures were correlated (r = 0.53, p < 0.001). The difference between
surface and skeletal mandibular width (Go-Go) measurements correlated with measures of obesity (neck circumference r = 0.38, p = 0.001;
body mass index r = 0.41, p < 0.001).
Conclusions: These preliminary data suggest there are relationships
between surface and skeletal measurements of the face and mandible
in subjects with OSA, which incorporate measures of obesity. The data
support the use of facial photography as a tool for large scale phenotyping studies. Work is ongoing to verify these findings and to further
evaluate the influence of obesity, gender and ethnicity.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-092
SLEEP PERCEPTION IN CHRONIC PRIMARYINSOMNIACS, OBSTRUCTIVE SLEEP APNEASYNDROME PATIENTS, AND HEALTHY
VOLUNTEERSSJ CHOI1, EY JOO1, SB HONG1
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
1

Background: The mechanisms of sleep perception by the patient arelargely unknown. Moreover, sleep perception might be divers depending on each sleep disorder. The aim of this study was to investigate thedifferences in sleep perception over patients with chronic primary
insomnia(PI) or obstructive sleep apnea syndrome (OSA) with orwithout insomnia symptoms.
Methods: We enrolled the consecutive 430 patients(age 20–79) who
underwent polysomnography(PSG) and sleep questionnaire including
depression scale(BDI) and daytime sleepiness(ESS). We divided into 4groups: Group I(n, 63) with normal controls, Group II(90) with thepatients with PI[apneahypopnea index lower than 5 and DSM-IV criteria], Group III (83) with OSA patients (AHI more than 5 per hr) who
have a difficulty of sleep onset and maintenance , and Group IV(194)with OSA patients without subjective insomnia symptoms. We compared the differences of sleep parameters obtained from polysomnography among 4 groups and investigated the discrepancy between
objective and subjective total sleep time and sleep latency in each group.
Results: Sleep perception was defined as the percentage of the ratio
between the total sleep time perceived by the patient and the total sleep
time obtained by PSG. Mean Sleep perception of 4 groups were 87.4%,
76.6%, 80.9%, and 93.6%, respectively. Group IV showed the highest
and group II had the lowest sleep perception. Group III showed definitely lower sleep perception than group IV and were more depressive.
Patients who complaint insomnia tended to report longer sleep latency(67.1 min in group II and 70.7 min in III) than others (29.4 min ingroup I and 29.5 min in IV) subjectively, but the discrepancy ratio(subjective/objective sleep latency) did not reach to statistical significance among groups.
Conclusion: Patients with insomnia (with or without OSA) appear tounderestimate their sleep time as compared with normal controls or
patients with OSA. This sleep misperception may be related to higher
N2 sleep, WASO, and lower REM sleep (%).

PO-1-093
APPLICATION OF 3D-CT EVALUATION OF UPPER
AIRWAY MORPHOLOGY OF OSAS PATIENTS FOR
SELECTION OF SURGICAL TREATMENTCANDIDATESH HARA1, S YOSHIDA1, H TOYOTA1, H YAMASHITA1
1
Department of Otolaryngology, Yamaguchi University Graduate School of
Medicine, Ube-city, Yamaguchi, Japan

Obstructive sleep apnea (OSA) is a common form of sleep-disorderedbreathing characterized by repetitive episodes of partial or complete
upper airway obstruction. It usually causes sleep fragmentation,
reduced blood oxygen levels, and excessive daytime somnolence. Cognitive deficits, impaired psychosocial wellbeing, reduced driving competence, cardiovascular morbidity, and mortality have been reported.
Because the clinical significance of OSA is increasing, more exact diagnosis for successful treatment is required.

Multiple factors like enlarged tonsils, nasal disease, body weight, age
and craniofacial morphology causes OSAS. But it is well known thatthe breathing route affects the upper airway morphology. It has beensuggested that patients with OSA have narrower pharyngeal airways
than normal persons, therefore breathing with mouth open affect theupper airway morphology of OSA patients significantly compared to
non-OSA patients.
To assess the relationship between pattern of breathing and upper
airway morphology in OSA patients, we perform 3D-CT examinationand evaluate the changes of upper airway morphology with mouth open
and close with DICOM viewer (Osirix) .
Eleven patients were examined 3D-CT with both oral breathing andnasal breathing. The results showed that even in awake, upper airway
became narrow with oral breathing.
It has been reported that the imaging results while awake do not necessarily reflect conditions during sleep, when tone of the upper airway
dilating muscles is decreased. But on the standpoint of relationshipbetween breathing routes and upper airway morphology, 3D-CT while
awake can be a useful tool for selection of surgical treatment candidate,especially predict the effects of nasal surgery because it can improve thenasal breathing.

PO-1-094
DETECTION OF SPECIFIC OBSTRUCTION SITESUSING FLUID-STRUCTURE INTERACTIONANALYSIS IN CHILDREN WITH OBSTRUCTIVESLEEP APNEA SYNDROME.

T IWASAKI1, I SAITOH1, M HARADA2, K MIYASHITA2, S MATSUNE3,
Y TAKEMOTO1, E INADA1, R KANOMI4, H HAYASAKI5, Y KURONO2,
Y YAMASAKI1
1
Department of Pediatric Dentistry, Kagoshima University Medical and
Dental Hospital, Kagoshima-city, Kagoshima, Japan, 2Department ofOtolaryngology-Head and Neck Surgery, Kagoshima University, Japan,
3
Department of Otolaryngology-Head and Neck Surgery, Nippon Medical
School Musashi Kosugi Hospital, Japan, 4Department of Orthodontics,
Kanomi orthodontic Office, Japan, 5Department of Pediatric Dentistry,Niigata University, JapanINTRODUCTION: Obstructive sleep apnea syndrome (OSAS) in children is not rare and is a major health problem. Unfortunately, surgery’s
success rate is relatively low because obstruction sites of the upper
airway vary considerably. Morphological findings from computedtomography (CT) do not always coincide precisely with the functional
obstruction sites in the upper airway. Consequently, establishing amethod to detect the specific obstruction sites of the whole upper
airway is indispensable to successful treatment of OSAS.
MATERIALS and METHODS: From CT data the constructed 3-D
whole upper airway model of a OSAS child with a stopped breath
condition was exported to fluid-dynamic software in STL format. Fluid
mechanical simulation (FMS) of the airway model was performed for
inspiration and exhalation to obtain each pressure value for structural
analysis of these airway models. Airway deformation models were
manufactured from the analysis results. Finally, FMS of these deformation models during inspiration and exhalation were performed, and the
dynamic ventilation conditions of each model were evaluated.
RESULTS: The ventilation condition was presented in the upper airway
models as pressure and velocity. Fluid structural interaction analysis(FSI) detected obstruction sites during inspiration and exhalation thatwere not detected in the airway model alone.
DISCUSSION: We describe a new method combining an airway modelwith FSI. This method can locate the obstruction sites and simulate© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research285

Sleep, Science and Research

the magnitude of air pressure and velocity, evaluating the ventilation
condition more precisely than with a morphological evaluation alone.
And it may be more reliable when applied to the clinical diagnosis
of OSAS.

PO-1-095
A PRELIMINARY STUDY OF ESTIMATING
SEVERITY FOR SLEEP APNEA SYNDROME USINGA NONWEAR DEVICE (NEMURI SCAN)

T KOGURE1, M SHIMOKAWA2, T INOUE1, S SHIRAKAWA3
1
Paramount Bed Sleep Research Laboratory, PARAMOUNT BED CO.
LTD., Tokyo, Japan, 2Research and Engineering Department,
PARAMOUNT BED CO. LTD., Japan, 3National Institute of Mental
Health, National Center of Neurology and Psychiatry, JapanOBJECTIVE: Existing portable devices for the diagnosis of sleep apnea
syndrome (SAS) are recognized as unreliable methods. Polysomnography (PSG) is the gold standard for the diagnosis of SAS. However, PSG
is costly and requires the patients to wear the many sensors. The development of a simplified, low-cost, accurate portable device has been
anticipated. A nonwear actigraphy (NWA: NEMURI SCAN, Kogure etal., J Physiol Anthropol 2011) device placed under a mattress that canscore sleep/wake and in-bed/out-of-bed from body motion in bed wasrecently developed. The NWA device is low cost and requires no sensor
placed on the body. The objective of this study is to explore the capability of estimating severity for SAS from respiratory movements measured
by the NWA device.
METHODS: Simultaneous PSG and NWA recordings were made for 13
participants (2 women, 11 men), aged 40–78 (average 56.6 ± 12.5
years). The participants were admitted to hospitals for PSG in diagnosis
of SAS. The apnea hypopnea index (AHI), defined as the number of
apneas and hypopneas per hour of sleep, was calculated by PSG and
NWA for each participant. Ethical approval was obtained prior to thestudy.
RESULTS: The AHI was 2.0–73.1 (average 32.9 ± 24.1) in PSG and
5.7–56.8 (average 26.2 ± 17.6) in NWA. Pearson correlation coefficients
between PSG and NWA were 0.86 (P < 0.001) in AHI.
CONCLUSION: Although further study is required to address thevalidity of estimating severity for SAS, it is indicated that the estimationfrom respiratory movements measured by the NWA device is a possible
method.

PO-1-096
NEUROCOGNITIVE FUNCTION IN
OBSTRUCTIVE SLEEP APNEA: A CASE
CONTROL STUDYA RAGUPARAN1, K WONG1, N MARSHALL1, D PALMER2,
M WANG2, D BARTLETT1, A DENOTTI1, R GRUNSTEIN1
1
Sleep and Circadian, Woolcock Institute of Medical Research, Strathfield,
NSW, Australia, 2Brain Resource, Brain Resource, Australia
Introduction: Previous studies in obstructive sleep apnea (OSA)showing cognitive dysfunction have often employed small groups,
drawing controls from clinical populations, and using tests with sparse
normative data. We aim to characterize the neurocognitive dysfunctionin OSA using a comprehensive battery of tests including event-related
potentials (ERPs) and using non-clinical controls.
Methods: We compared 106 cases with OSA (PSG AHI > 5), with
controls matched by age, gender and years of education, on a 1:4 ratio,from the Brain Resource International Database. All subjects underwent

286

a standard cognitive test battery and EEG recording concurrent withworking memory, Go-No Go and auditory oddball tasks, from which
ERP responses were derived. OSA cases were compared with the controls for all outcomes of interest, using mixed effects models.
Results: Tests for verbal memory, working memory, language skill, andbehavior control (verbal interference total score) and attention wereimpaired in OSA subjects (p <= 0.001). Analysis of ERP by area under
the curve during the working memory and Go-No Go tasks showed
OSA subjects to have a significantly increased activation near 100 ms(p < 0.05) and beyond 200 ms (p < 0.01), corresponding to the N1
and N2 components of the ERP waveform, while having worse performance (p < 0.001). However there were no between-group differencesin ERP components found in the oddball task (p > 0.5). Within cases
there was no relationship found between severity of OSA and cognitive
function affected or magnitude of amplitude in ERP.
Conclusion: Using a comprehensive assessment battery, we demonstrate impairments related to memory, language skill, behavioral control
and attention in OSA patients. Evidence of greater neural processing as
observed in ERP responses, associated with poorer performance, may
indicate requirement for greater mental effort or focus in OSA subjects.

PO-1-097
DEVELOPMENT OF A DIAGNOSTIC MODEL FORSLEEP APNEA IN PRIMARY CAREKKH WONG1, MP JONES3, P CISTULLI2, G MARKS2, N ZWAR4,
RR GRUNSTEIN1,2
1
Department of Respiratory and Sleep Medicine, Royal Prince Alfred
Hospital, Missenden Road NSW, Australia, 2NHMRC CCRE in
Interdisciplinary Sleep Health, Woolcock Institute of Medical Research,
Australia, 3Psychology Department, Macquarie University, Australia,
4
School of Public Health and Community Medicine, University of New
South Wales, Australia

Introduction: As a means to diagnose obstructive sleep apnea, inlaboratory polysomnography is costly and resource-intensive. Questionnaires, physical measurements and home monitors have beenstudied as potential simpler alternatives to in-laboratory polysomnography (PSG) for diagnosis of obstructive sleep apnea (OSA). This study
aims to develop a diagnostic model for OSA for use in primary care.
Methods: Participating general practitioners were trained to recognise
symptoms of sleep apnea, and recruited patients based on clinical needto establish or exclude the presence of OSA. Assessment was bysymptom questionnaires, anthropomorphic measurements, digital
photography of the face and profile, and a single channel nasal flow
monitor (Flow Wizard, DiagnoseIT, Sydney, Australia) worn at homefor 3 nights. Patients also underwent in-laboratory PSG as the reference
test, with OSA defined as AHI >= 10.
Results: In the model development sample 25 general practitioners
studied 360 patients: 64% male, with mean(SD) age 50.3(12.5) years,
BMI 29.8(6.6) kg/m2, ESS 9.6(4.8). Mean PSG apnea-hypopnea index(AHI) was 19.6(19.6)/hour, with 58% having PSG AHI >= 10 and 21%
having AHI >= 30. The nasal flow monitor alone yields high accuracy
for predicting OSA with area under receiver operating curve (AUC)
0.87. Sensitivity was 0.87 (0.80–0.91) and specificity 0.77 (0.69–0.83)
at a threshold of 18 events/hr on the flow monitor. A six-element model
adding symptoms, BMI, hip circumference, and nasal width from photography to the flow monitor modestly improved OSA prediction (AUC0.88).
Discussion: The results suggest that testing with a portable monitor
may be appropriately applied at the primary care setting in concert withclinical assessment and knowledge of test characteristics.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-098
PREDICTORS OF WEIGHT GAIN IN PATIENTSWITH SUSPECTED SLEEP APNEAT SAARESRANTA1, U ANTTALAINEN1,2, K IRJALA3, O POLO1,4
1
Pulmonary Diseases, Turku University Hospital, Littoinen, Finland, 2Sleep
Research Unit, University of Turku, Finland, 3Clinical Chemistry, Universityof Turku, Finland, 4Pulmonary Diseases, University of Tampere, Finland
Background: Obesity is the main risk factor for obstructive sleep apnea.
According to clinical experience, patients frequently continue to gain
weight also after the sleep apnea diagnosis and successful treatment.
We hypothesised that higher level of sleepiness, shorter habitual sleep
duration, higher depression scores, graving for high-fat, high-carbohydrate type of food, low plasma insulin-like growth factor-1 and leptin
levels would correlate with weight gain.
Materials and methods: Consecutive patients (n = 223; M 123, F 100)
referred for a sleep study because of suspected sleep apnea wererecruited. Of this cohort, 59.6% (n = 133; M 75, F 58) participated inthe 3-year follow-up. In the evening prior the overnight in-hospital
sleep study, patients were weighed and the height was measured. Aftera standard hospital dinner, patients completed a questionnaire battery
including the Epworth Sleepiness Scale (ESS), habitual sleep duration,
depression scale (DEPS), and VAS of graving for various food categories.
Blood for plasma IGF-1 and leptin concentration assessments was
drawn after an overnight fast in the morning after the sleep study.
Results: Median BMI at baseline was 31.1 (range from 19.9 to 56.5)
kg/m2. After a 3-year follow-up, median change in BMI was +0.33(range from −13.4 to +7.5) kg/m2 and did not differ between CPAPusers and non-users. Change in BMI correlated positively with thescores in the baseline depression score (Spearman r = 0.19, p = 0.346)
but not with the plasma IGF-1 or leptin levels, ESS score, habitual selfreported sleep duration or graving for various food categories.
Conclusions: Depressive symptoms at baseline were associated withweight gain during a 3-year follow-up in patients with suspected sleep
apnea. Prospective studies are warranted whether weight gain is related
to depression per se or the antidepressive medication and whether adietician consultation should be focused particularly in depressive sleep
apnea patients.

PO-1-100
CORRELATION ANALYSIS BETWEEN SLEEPVIDEOFLUOROSCOPY AND POLYSOMNOGRAPHY

W-H LEE1, W-S SUNWOO1, T-B WON1, DH HAN1, J-W KIM1,
CH LEE1, C-S RHEE1,2
1
Department of Rhinology, Seoul national university, SEONGNAM-SI,
GYEONGGI-DO, Republic of Korea, 2Department of Sensory organ
institute, Seoul national university, Republic of Korea

desaturation – MOA normosaturation) and obstruction site, were evaluated as SVF variables.
Results: The severer OSAS patients showed the smaller MOA difference. Soft palate (SP) obstruction group was more likely to have PD
than tongue base (TB) obstruction group and PD was inversely related
to OSAS severity. When adjusted for OSAS severity, patients with SP
obstruction alone tended to have PD more than those with TB obstruction only in the severe group (P = .025 by Chi square test).
Conclusion: It is suggested that knowledge of these SVF variables canimprove our understanding of PSG results. The data also reinforce thenecessity of not only monitoring PSG evaluation of every suspected
OSAS patient, but also SVF reporting the localizing obstruction site.

PO-1-101
THE STUDY OF GEOMETRIC PARAMETRIC FOR
THE UPPER AIRWAY OF OSA

T-I TSENG1, H-T HSIAO1, L-C LEE1, C-M YAO1, C-C YU2,
L-P CHUANG3, N-H CHEN3
1
Applied Computational Engineering, National Center for Highperformance Computing, Hsinchu, Taiwan, 2Department of Plastic andReconstructive Surgery, Chang Gung Memorial Hospital, Taiwan,
3
Department of Chest Medicine, Chang Gung Memorial Hospital, Taiwan
Purpose: In this study, we hypothesized that the Obstructive sleep
apnea syndrome (OSA) patients with a narrow upper airway. Therefore,
used 3D CT scanning provides a stable and thorough presentation of
upper airway morphology, and tried to understand the relation between
the geometry of upper airway and OSA.
Methods: Participants were grouped to be normal control and OSA by
results of overnight polysomnography (PSG). 3D geometry model ofupper airway was generated by segmentation from CT images on NCHC
OSAMed platform. The statistical relation of geometry parameters, i.e.
the area of the hard palate, minimum cross-section of upper airway andstenosis ratio, with AHI are established via parametric studies and theanalysis of receiver operating characteristic (ROC) and the optimal
diagnostic cut-off point has been determined.ResultThere are 10 normal
subjects (AHI < 5, mean AHI = 0.96?1.56 /hr) as control, and 14 (AHI
> 5, mean AHI = 51.55?22.31 /hr) patients with OSA in this study. The
minimum cross-section area of upper airway correlated better with theflow changes in severe cases. The stenosis ratio of the upper airway of
OSA group is correlated well with the AHI even in all cases (R = 0.767,
p < 0.01), but no correlation between area of choana and AHI (R =0.362, p = 0.08). From the analysis of receiver operating characteristic,
the optimal stenosis ratio is 84% (Sensitivity = 0.931, Specificity = 1.0,
Accuracy = 0.954, AROC (area under the ROC curve) = 0.947).
Conclusion: The geometry parameter correlations with AHI of upper
airway are investigated in this study. Using CT or MRI image scanningwith stenosis ratio can be rapidly sieving the patient with or without OSA.

Background: The treatment of obstructive sleep apnea syndrome(OSAS) is focused on the way how to improve the upper airway
obstruction. Sleep videofluoroscopy (SVF) is a kind of localization
technique combining fluoroscopy and video recording and enabling
direct visualization of dynamic airway change. The purpose of thisstudy is to find correlations between SVF and PSG.
Methods: Retrospective review was made of 112 OSAS patients who
underwent PSG and SVF from August 2009 through June 2010. PSG
variables include respiratory disturbance index (RDI), supine apneahypopnea index (AHI), non-supine AHI, longest apnea time & lowest
O2 saturation and positional dependency (PD), Mouth-opening angle(MOA) at normosaturation and desaturation, MOA difference (MOA

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research287

Sleep, Science and Research

PO-1-102

PO-1-103

EVALUATION OF NEUROMUSCULAR ACTIVITYIN PATIENTS WITH OBSTRUCTIVE SLEEP APNEAUSING CHIN SURFACE ELECTROMYOGRAPHY
OF POLYSOMNOGRAPHYSLEEP-APNEA ANALYSIS WITH A NEWNONINVASIVE PIEZOELECTRIC SENSORJY YE1, GP YIN2, XY WANG3, LM WANG4, YH ZHANG5, YR LI6,
JY WANG7, X DING8
1
Otolaryngology Head and Neck Surgery, Affiliated Beijing Tongren Hospital,
Capital Medical University, Beijing, China, 2Otolaryngology Head and Neck
Surgery, Affiliated Beijing Tongren Hospital, Capital Medical University,
China, 3Otolaryngology Head and Neck Surgery, Affiliated Beijing Tongren
Hospital, Capital Medical University, China, 4Otolaryngology Head andNeck Surgery, Affiliated Beijing Tongren Hospital, Capital Medical
University, China, 5Otolaryngology Head and Neck Surgery, AffiliatedBeijing Tongren Hospital, Capital Medical University, China,
6
Otolaryngology Head and Neck Surgery, Affiliated Beijing Tongren Hospital,
Capital Medical University, China, 7Otolaryngology Head and Neck Surgery,
Affiliated Beijing Tongren Hospital, Capital Medical University, China,
8
Otolaryngology Head and Neck Surgery, Affiliated Beijing Tongren Hospital,
Capital Medical University, China

Objectives: This study was designed to assess the validity of chin surface
electromyography of routine polysomnograph in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of obstructive sleep apnea.
Methods: This was a randomized cases study in sleep laboratory. The
chin surface electromyography of routine Polysomnograph during
normal breath and obstructive apnea were quantified in 36 male adultobstructive sleep apnea subjects who have similar cross section area ofpharynx at the level of uvular root and upper edge of epiglottis evaluated by computer-assistant fibrolaryngoscope. The chin surface electromyography change from normal breath to obstructive apnea wasexpressed as percent compensated electromyography value, percent
compensated electromyography value = (normal breath surface electromyography-apnea surface electromyography)/ normal breath surface
electromyography, and the percent compensated electromyography
value between subjects was compared and analysed.
Results: Percent compensated electromyography value of the subjects
varied from 1% to 90% and had significant positive correlation withapnea hypopnea index (R2 = 0.382, P = 0.000). Nevertheless, the bodymass index and lowest oxygen saturation did not show statistic correlation with percent compensated electromyography value.
Conclusions: Recording and analyzing of chin surface electromyography of routine Polysomnograph is a good way for survey study ofneuromuscular activity in obstructive sleep apnea patient population.
The neuromuscular contribution is different between subjects in thepathogenesis of obstructive sleep apnea and percent compensated electromyography value can reflect this difference.

S SATO1, T KOYAMA2, T KANBAYASHI3, G IGARASHI2,J TOKUNAGA3, M SATO3, T OHBA1, Y OKAMOTO1,
H WATANABE2, K ONO1, H ITO2, T SHIMIZU3
1
Department of Cell Physiology, Akita University Graduate School of
Medicine, Akita, Japan, 2Department of Cardiovascular and Respiratory
Medicine, Akita University Graduate School of Medicine, Japan, 3Departmentof Neuropsychiatry, Akita University Graduate School of Medicine, Japan
Introduction: Fastening belt sensors to their chest/abdomen and setting
a flow sensor to nose and many other sensors/electrodes to patients arecumbersome to both the patients and physicians at the preparation forpolysomnography (PSG) for monitoring sleep and sleep apnea. Furthermore, the uncomfortable sensor attachment may cause a stress thatmight affect the quality of sleep and the result of PSG. A new piezoelectric sensor is noninvasive because it neither contacts to their skinnor binds their body but has a comparable performance for cardiorespiratory monitoring to that of PSG, and therefore, it is suitable forsleep-apnea monitoring.
Methods: Ten healthy volunteers and forty-three cardiology inpatients
underwent PSG simultaneously with respiratory monitoring by a thinpiezoelectric sensor, which was placed under a towel spread on patients’bed. They were diagnosed as having sleep disordered breathing (SDB)
when they exhibited apneas more than 10 times in total during cheynestokes-like breathings appeared in the respiratory signal. In addition,
at most 5 representative episodes of OSA/CSA were collected from eachpatient to evaluate the accuracy rate in determining OSA and CSA by
the observatory analysis of the respiratory signal obtained by the piezoelectric sensor.
Results: By the analysis of apneic events during cheyne-stokes-likebreathings, we found SDB in 97% (31/32) of the patients with apnea
hypopnea index (AHI, judged by PSG) of >15 and no one in 21 patients(including 10 healthy volunteers) with AHI < 15 (sensitivity 97%,
specificity 100%). Selected 107 obstructive and 88 central apnea eventsin the piezoelectric-sensor signal of 43 patients were verified by PSG
analysis; 86 and 89% of them were correct, respectively; 10 and 5% ofthem were inversely scored; remaining 4 and 7% of them were notaccompanied by a decrease in SpO2 (>= 4%).
Conclusion: In the present study, we propose a simple but effective
method for the screening of SDB, in which we do observatory analysisof the cheyne-stokes-like breathing signal obtained by a new noninvasive piezoelectric sensor.

PO-1-104 / AS-7 Presenter
EPILEPSY AND DEMENTIA COEXISTFREQUENTLY IN OBSTRUCTIVE SLEEPAPNEA SYNDROME

M WAKAI1, A HONDA1,2, M AKAHORI2
1
Department of Neurology, Kakegawa Municipal General Hospital,
Kakegawa, Shizuoka, Japan, 2Center for Sleep Medicine, Kakegawa
Municipal General Hospital, Japan
Introduction: Obstructive sleep apnea syndrome (OSAS) is a disorderassociated with frequent awakening and repeated hypoxia during sleep.
Therefore, it is reasonable to assume that OSAS potentially causes brain
damage so that it might be a risk of brain diseases. However, there isan inevitable difficulty in dealing with the issue because OSAS is oneof the common diseases in adults. It means that even if OSAS and a288© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

brain disease coexist, the two diseases do not necessarily have etiological relationship. In this study, we present our patients with adult-onset
epilepsy or with dementia who also have OSAS and then try to find aclue to the issue.
Cases: The subjects who met all of the followings were selected in thisstudy: 1) ones who came to our department because of the first-time
episode of epilepsy or dementia; 2) the age was over thirty; 3) no apparent causes of epilepsy such as cerebral apoplexy, encephalitis, brain
tumor and brain contusion were revealed; 4) presence of sleep related
breathing disorders was suggested by interview and PSG was performed.
Results: From Feb 2004 through Feb 2011, 16 patients (14 men and2 women) met the above conditions. The average age at the onset of
epilepsy or dementia was 54.8 ± 15.7 years (30–74). The averageapnea-hypopnea index (AHI) was 35.72 ± 15.16/h (10.7–62.2). The
median AHI was 32.2/h. The average lowest SpO2 was 81.1 ± 9.5%. 9
patients showed only epilepsy and 2 had only dementia. 5 patients
presented both epilepsy and dementia. The average age at the onset of
epilepsy and dementia was 53.6 ± 16.5 and 68.4 ± 5.3 years, respectively. 5 of 8 patients aged over 60 have both the diseases.
Conclusions: Epilepsy and dementia coexist frequently in OSAS, especially in aged patients with OSAS. It suggests that OSAS might be a risk
factor of brain diseases.

PO-1-105
ACOUSTIC RHINOMETRY IN OSA PATIENTSH MORIWAKI1, A MUROTA2, S CHIBA3, Y INOUE4
1
Deprtment of Otorhinolaryngology, Asahi General Hospital, Asahi-city,
Chiba, Japan, 2Depatment, Japan Somnology Center, Japan, 3Department
of Otorhinolaryngology, The Jikei University School of Medicine, Japan,
4
Depatment of Psychiatry, Japan Somnology Center, Japan
Background: Obstructive sleep apnea syndrome (OSAS) is caused byvarious factors, and it is still unclear how nasal breathing disorderaffects OSAS severity. The aim of this study was to evaluate the relationship between apnea hypopnea index (AHI) and upper airway variables(nasal resistance, minimal cross-sectional area and cavity volume).
Subjects: A retrospective clinical survey was conducted on 334 consecutive adult subjects suspected to have OSAS. All of them underwent
polysomnographic diagnosis, acoustic rhinometry (AR), rhinomanometer (RM) and cephalometry (298 males and 36 females; age 44 y, bodymass index (BMI) 26.2 kg/m2, AHI 24.1/hr, respectively median).
Methods: Polysomnography (PSG) was performed using Alice4 system(Respironics Murrysville, PA, USA) and AR was performed using
SRE2100 (RhinoMetrics; Lynge, Denmark). The following measures
were recorded: minimal cross-sectional area (MCA) in centimeterssquared between 0 and 1.5 cm (MCA1), between 1.6 cm to 5.4 cm(MCA2) behind the nostril; nasal cavity volume (VOL) in centimeters
cubed between 0 and 2 cm (VOL2), between 0 and 4 cm (VOL4),
between 0 and 6 cm (VOL6) behind the nostril; nasal resistance. Subjects were divided into 2 groups from the PSG results, i.e., controls and
OSAS group. We analyzed the relationships between the two groups interms of the parameters of PSG, AR, RM and cephalometry by using
logistic regression analysis. As for comparison of the above indicatedvariables, OSAS group was divided into 4 groups by obesity and age(cut off 25 kg/ m2, 50 y respectively).
Results: 1) When comparing the controls (n = 37) and OSAS group(n = 297), there were significant differences in BMI, age and MPH.
2) When comparing the controls (n = 37) and non-obese and younger(n = 71), there was a significant difference in MCA1 (p = 0.032).
Discussion: The difference in MCA1 between the two groups may
suggest that nasal breathing disorder influence on OSAS. Therefore
nasal therapy should be considered as one of the OSAS therapies.

PO-1-106 / AS-10 Presenter
ORAL FLOW MEASUREMENT FOR ACCURATE
RECOGNITION OF RESPIRATORY EVENTSM SUZUKI1, K SHIBASAKI3, Y ITO3, H HASHIDA3, A ITO3,
M HONMA3, R HORIGUCHI3, T ISHIGURO3, T YOSHIZAWA3,
T FURUKAWA2
1
Dept. of Otolarygology, Teikyo University, Tokyo, Japan, 2Dept. ofLaboratory Medicine, Teikyo University, Japan, 3Dept. of Sleep Medicine,
Kaname Sleep Clinic, Japan
Objective: The purpose of this study is to elucidate the usefulness oforal flow (OF) measurement during sleep.
Methods: We conducted a prospective study on Japanese adults. The
nasal flow and oral flow were measured separately under polysomnography. The nasal flow was measured with a nasal mask using a pneumothacometer or pressure sensor, and the OF was measured in 2 cm
in front of lips using a pressure sensor. Nasal resistance was measured
with the anterior method of rhinomanometry in the supine position.
Results: The OFs were basically divided into three patterns, postapneic
OF, OF during snoring, spontaneous arousal-induced OF (SpArinduced OF), and others. The postapneic OF began apnea, hypopnea,
and snoring, accompanied by respiratory arousals and postapneic
hyperventilation. The OF during snoring refers to OFs occurring duringsnoring. Many of repeated flow limitations were associated with OF
during snoring. SpAr-induced OF began during stable breathing preceded by spontaneous arousals, accompanied by an EMG activation anda reduction of nasal flow, but was not accompanied by apnea/hypopnea.
Multivariate regression analyses showed that the determinant that mostsignificantly predicted SpAr-induced OF was nasal obstruction.
Conclusions: Respiratory events such as flow limitation, snoring,
hypopnea, or apnea could be scored accurately by introducing oral flow
measurement. Clinicians and technologists should be aware of “OFshidden in respiratory events”.

PO-1-107
DETECTION FOR JUDGING METHOD TO MOVE
MANDIBLE FORWARD IN THE MIDDLE
MF HUANG
Department of Orthodontics, People’s Hospital of Guangxi Zhuang
Autonomous Region, Nanning-city, Nanning, China
Objective: To detect a judging method moving mandible forward in
the middle.
Method: 110 Obstructive Sleep Apnea cases were treated with mandibular advancement aplliances. Moving mandible in the middle wasjudged by general method that upper and lower midline of incisor area
keep the same line before and after advancing and advancing distanceof bilateral posterior teeth was equal. The digital film imaging of temporomandibular joint by transcranial projection was taken. Bilateralcondyle position at the closing occlusion, maximum open bite positionand occlusion with reconstructing occlusal wax wafer in place werecompared.
Results: 100 cases had the same medline of incisor area before andafter mandibular advancement,the same advancing distance of bilateralposterior teeth in the same cast and of condyle in the digital film
imaging of the temporomandibular joint by transcranial projection.
Only 10 cases had different advancing distance of condyle in the digital
film imaging of temporomandibular joint by transcranial projection.
Conclusion: The same advancing distance of bilateral posterior teeth
and permanent midline of incisor area before and after mandibular© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research289

Sleep, Science and Researchadvancement could not conclude the advancing distance of bilateralcondyle in the digital film imaging of the temporomandibular joint bytranscranial projection after mandibular advancement was equal,but it
was an important judging proof.

PO-1-108
EFFECTS OF BREATHING ADJUSTMENT ONSLEEPINESS AND SLEEP LATENCYH TSUGAWA1, S ONO2
1
Department of Psychology, Kibi International University, Takahashi-city,
Okayama, Japan, 2Group of Psychology, Asaka Hospital, Japan
Objective: The breathing pattern during sleep stages 1 and 2 is different
from that observed in other stages. Ono et al. (2010) reported that the(expiratory):(pause + inspiratory) time ratio was approximately 1:3
during S1 and S2. This study examined whether it would be easier tofall asleep when performing this breathing pattern intentionally.
Methods: Twenty-six university students with a tendency for insomnia
participated in the study. They were divided into two groups: experimental (n = 14) and control (n = 12). Sleepiness was measured using
the Stanford Sleepiness Scale (Hoddes et al., 1973). Sleep latency wasmeasured using the TMIN-LHI (Miyashita, 1994). Participants in bothgroups were asked to perform calculation tasks in order to regulate theirarousal levels. Participants in the experimental group were then asked
to adjust their breathing pattern keeping (expiratory):(pause + inspiratory) at 1:3 for 10 min, while those in the control group continued
breathing normally. The second session was conducted using the sameprocedure in the following week.
Results: Sleepiness: A three-way ANOVA of Groups (experimental,
control) × Time (before and after intervention) × Sessions (1, 2) was
conducted. SSS scores obtained after intervention were higher thanthose obtained before intervention in both groups (p < .01). In particular, the after intervention scores of the experimental group were higher
than that of the control group (p < .01). Sleep latency: The mean sleep
latencies were as follows: before the experiment (M = 42.14), during
the experiment (M = 23.86), and during follow-up (M = 26.07). The
results of one-way ANOVA and multiple comparison tests indicated thatsleep latencies during the experiment and follow-up were shorter thanthat before the experiment (p < .01).
Discussion: Breathing adjustment elicited a higher level of sleepinessthan normal breathing. Sleep latencies during the experiment and follow-up were shorter than that before the experiment. These results
suggest that breathing adjustment is an effective procedure for people
who have a tendency toward insomnia.

PO-1-109UTILITY OF PORTABLE DEVICE WITH
AIRFLOW,OXYGEN SATURATION ANDRESPIRATORY EFFORT IN THE DIAGNOSISOF SLEEP APNEA HYPOPNEA SYNDROME

Y HAN1, H FANG2
1
Department of Respiratory Medicine, Peking University People’s Hospital,
Beijing, China, 2Department of Respiratory Medicine, Peking University
People’s Hospital, China
Objective: To validate the usage of monitoring airflow, oxygen saturation and respiratory effort in the diagnosis of sleep apnea hypopnea
syndrome(SAHS).
Methods: Seventy subjects suspected with SAHS diagnosis underwent
PSG and portable monitoring testing sepatately in the sleep lab. The

290

portable monitoring device records nasal airflow, oxygen saturation andrespiratory effort. Apnea hypopnea index(AHI), lowest oxygen
saturation(LSaO2), oxygen desaturation index(ODI4) and percentage ofdifferent type of sleep breathing events(central, obstructive, mixed
and hypopnea) accounting for the total numbers of sleep disorderedbreathing were also analyzed. Pair t test was used for the comparisonsof different parameters, and linear regression was used to describe thecorelationship by the two methods. The agreement between the two
measures was analyzed using Bland-Altman plot.
Results: 58 of the 70 subjects were diagnosed as SAHS with an AHI
over 5 by PSG testing. Mean AHI[27.4(24.9) vs 28. 6(26.6), p = 0.205],
ODI[22.5(24.9) vs 20.6(24.3), p = 0.199] and LSaO2[78.8(12.6) vs79.4(11.5), p = 0.550] values derived from PMD and PSG did not show
significant differences respectively. Bland-Altman plot also showed highagreement between PMD and PSG in regard to AHI, but not to ODI4and LSaO2. The PMD device can also identify major part of the different
events which may be helpful to clinical decision making.
Conclusion: Portable monitoring device recording airflow, oxygen
saturation and respiratory effort shows great agreement with PSG inregard to AHI, and the identification of different types of respiratory
events.
Key words: Obstructive sleep apnea hypopnea syndrome; diagnosis;
AHI; portable monitoring device

PO-1-110
PSG SPECTRAL ANALYSIS IN OSA PARTICIPANTS
FROM A BRAZILIAN POPULATION BASEDSTUDY: CLINICAL IMPLICATIONS AND
NEURAL CONECTIVITY USING PARTIAL
DIRECTED COHERENCEAA LINO DE SOUZA1, JR SATO2, R SANTOS-SILVA3,
LRA BITENCOURT4, S TUFIK5
1
Department of Psychobiology, Universidade Federal de São Paulo, Brazil,
2
Center of Cognition and Mathematics, Universidade Federal do ABC,
Brazil, 3Department of Psychobiology, Universidade Federal de São Paulo,
Brazil, 4Department of Psychobiology, Universidade Federal deSão Paulo, Brazil, 5Department of Psychobiology, Universidade Federal deSão Paulo, Brazil

Obstructive Sleep Apnea Syndrome is a common sleep disorder withneurocognitive impairments. The pathophysiological mechanisms
underlying the side effects of OSA are not completely understood andtheir effects in brain activity are not completely clear. In order to accessthe dynamic of electroencephalographic (EEG) power bands (delta,
theta, alfa1, alfa2, beta1 and beta2) in participants with OSA, we
compare them in relation with participants without OSA (control group)
inside a population-based study from Sao Paulo(Brazil) called EPISONO.
Fast Fourier Transformation was spectral analysis technique choosed
and Partial Directed Coherence (PDC) was also calculated to evaluate
the brain information connectivity based on Granger Causality.
938 valid full night polissonography (PSG) EEG were analyzed from a
total base of 1101 participants of EPISONO study. Patients with OSA(evaluated using PSG criteria) showed higher levels of alpha frequencies
during the REM stage (p = 0.003) in C3 and C4 electrodes. Delta frequencies were found during the slow wave (S3-S4) sleep in O1 (p =0.02)and C4 electrodes (p = 0.03). These findings can be explained by
the presence of arousals during these sleep stages. Related to PDC, asmaller correlation between C3-C4 electrodes and O1-O2 electrodes
were found only in severe OSA participants in comparison with control
group only during the REM stage. This finding presents the lack of© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

information shared between brain hemispheres during REM probably
caused by hypoxia for long periods related with severity of OSA.
EPISONO study is a population based study designed to access theprevalence of several disorders related with sleep and other population
aspects. Because of this design we cannot estimate the participants
length of time with OSA syndrome. This is the main limitation of ourstudy. Our research should be especially useful to sleep health professionals or professionals interested in analysis of biomedical signals.

PO-1-111
A CASE OF CENTRAL SLEEP APNEA IN CHIARIMALFORMATION TYPE I SYNDROMET KITAMURA1, S MIYAZAKI1, T TANAKA2, I KOMADA3, M IMAI4,
T HATANO5, T KANEMURA1, M OKAWA1
1
Department of Sleep Medicine, Shiga University, Otsu, Shiga, Japan,
2
Sleep Division, Tnaka Sleep Clinic, Japan, 3Department ofOtorhinolaryngology, Social Insurance Shiga Hospital, Japan, 4Departmentof Neuropsychiatry, Shiga University, Japan, 5Department of Neurosurgery,
Fukui Red Cross Hospital, Japan
Chiari Malformation (CM) Type I is characterized by cerebellar tonsil
herniation through the foramen magnum. Among the CM patients,
Central sleep apnea (CSA) is often present but it is rare without otherneurologic symptoms. We report on a child with only clinical signs ofcentral sleep apnea who, on imaging, was found to exhibit Chiari type
I malformation.
Case presentation: A 10-year-old girl was admitted to our affiliatedsleep clinic because of nocturnal sleep apnea and excessive daytime
sleepiness. No neurologic abnormality was apparent by physical examination. A polysomnography revealed a severe CSA. The AHI was 41.7
events /hr and the minimal oxygen saturation reached was 84%. Administration of acetazolamide resulted temporary improvement of sleep
respiratory disturbance, but the symptom became worsen again bydiscontinuation of the medication. Magnetic resonance imaging (MRI)
revealed a cerebellar tonsillar herniation below the foramen magnum.
Neither syringomyelia nor bulbar were noted. These findings wereconsistent with Chiari type I malformation. She underwent a posterior
fossa and superior cervical spine decompression. Initially, her symptoms diminished dramatically after decompression. Physiologic
improvement was confirmed by further polysomnographic studies. She
remained asymptomatic 12 months after surgery.
Discussion: Recently some researchers described that decompressive
surgery in patients with craniovertebral junction malformations resulted
in decreased respiratory events during sleep and the effect was more
pronounced in patients with central apnea. Craniocervical sagittal
section MRI is recommended when central sleep apnea without anobvious cause is discovered in a young patient.

PO-1-112
POLYSOMNOGRAPHIC FINDINGS IN PATIENTSWITH OBSTRUCTIVE SLEEP APNEA WITH ANDWITHOUT EXCESSIVE DAYTIME SLEEPINESSK SADEGHNIIAT-HAGHIGHI1, Z YAZDI2
Center for Research on Occupational Diseases, Tehran University of
Medical Sciences, Tehran, Iran, 2Occupational Health, Qazvin Universityof Medical Sciences, Iran
1

Obstructive sleep apnea syndrome (OSAS) is a common disorder inthe general population. Excessive daytime sleepiness (EDS) is afrequent symptom of patients with OSA. Obstructive sleep apnea and
EDS lead to an increased risk of motor vehicle accidents throughmultiple pathways. We investigate correlation between EDS with
polysomnography(PSG) variables. This is a retrospective study of 126
consecutive patients with OSA who underwent sleep PSG. Subjective
sleepiness was assessed using the Epworth Sleepiness Scale. Absence of
EDS was defined as having an ESS score of <10. Polysomnographic
recordings were compared in patients with and without excessive
daytime sleepiness. 71 patients with EDS and 55 patients without EDS
were studied. Patients with EDS had lower saturation of oxygen longer
total sleep time shorter sleep latency more total Respiratory DisturbanceIndex and more total limb movement than patients without EDS. EDS
and non-EDS patients did not differ in the sleep efficiency sleep stage
distribution and number of awakening. Our results suggest that there
is correlation between excessive daytime sleepiness and respiratory
sleep variables in PSG and desaturation of oxygen at night. Patients withmore severe daytime sleepiness are characterized by more severe nocturnal hypoxemia.

PO-1-113
PRESUMPTIVE DIAGNOSIS OF SLEEP APNEA VIASKYPE, COST-EFFECTIVE ACCESS TO SLEEPMEDICINE PHYSICIANAQ CHAN1, EL CHAN1, MP CHAN1
1
Chanwell Clinic Institute for Heart & Sleep Disorders, Stanford University
School of Medicine, Milpitas, California, United States of America
Background: Obstructive sleep apnea (OSA) affects 24% of American
adult population and a much higher percentage of Asians. Geneticallydetermined craniofacial features of Asians make them at risk for OSA.
Sleep medicine specialists are predominantly in America and Europe
and much less in Asia. It has been postulated that metabolic syndromeand cardio-cerebral-renal diseases so prevalent among Asians are largely
due to long standing OSA that remain undiagnosed. The advent ofbroadband Skype allows patient in Asia to consult with sleep specialist
in the U.S.
Method: Three patients from Asia (Singapore 2, Taiwan 1), one patientfrom Florida initiated remote online consultations with sleep specialist
at Chanwell Clinic in Silicon Valley, California. These involved threepart process; first by telephone where history, Epworth Sleepiness Scale(ESS) were taken, then a date and time was set for Skype video examination of the upper airway Mallampati Score (MS), craniofacial features
for micrognathia (M), retrognathia (R), mid-facial hypoplasia (FH) andfinally onsite physical examinations, cardiac non-invasive studies andpolysomnogram (PSG) were done at the Cardiac Sleep Lab.
Result: Singapore 1 (BMI 26, ESS 9, MS 4, M+), Taiwan (BMI 25, ESS
12, MS 4), Florida (BMI 27, ESS 14, M 4, M+, R+, FH+), Singapore 2(BMI 22, ESS 10, MS 2). Index of OSA suspicion for Singapore 1,
Taiwan and Florida were high, PSG confirms unusually severe OSA(Singapore 1 AHI 83, Florida AHI 69) and moderate OSA (Taiwan AHI
17). Singapore 2 was tested with overnight pulse oximeter, PSG was
deemed unnecessary since OSA suspicion was low.
Conclusion: The presence of MS 3 or 4, M, R or FH seen in Skypepredict the presence and severity of OSA. Sleep Medicine physicians
could extend their reach to potential patients all over the world in thepresumptive diagnosis of OSA via Skype video examinations and conferencing. Patient could have access to world class sleep medicine
specialist through cost-effective adaptation of Skype which is widely
present in mobile phones, tablet and desktop computers in homes,
schools and the workplace.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research291

Sleep, Science and Research

PO-1-114
CAN A SMALL CHANGE IN OXIMETERAVERAGING TIME AFFECT THE RESPIRATORYDISTURBANCE INDEX?

JT ERITAIA1, A MATTHEWS1, J GOLDIN1
1
Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville,
VICTORIA, Australia

Introduction: AASM 2007 guidelines recommend that polysomnography (PSG) procedures use oximeters with averaging time (aT) of 3
seconds or less. This is to ensure rapid changes in SpO2 associated withrespiratory events are detected. Recent studies have shown conflicting
results, some proving no significant difference in Respiratory Disturbance Index (RDI) when investigating averaging times between 2 to 6
seconds. We hypothesize that the same oximeter, set on 2 different aTvalues (3 and 4 seconds) will generate RDIs that are significantly
different.
Method: 39 patients undergoing full PSG were simultaneously monitored with 2 Masimo oximeters, Alice 5 in-built Masimo SET and
Masimo Radical 7. The same oximeter algorithm is used (Masimo SET)and finger probes were placed on the same hand. One oximeter was set
to an aT of 3 seconds (Alice 5 in-built Masimo). The Radical 7 was set
to 4 seconds aT. RDI was calculated twice using one oximeter signal ata time. Same scorer analyzed both set of oximetry data. Analysis of datausing the 2nd oximeter signal was conducted a month later after data
was blindly renamed and assigned to the same scorer. The AASM criteria for PSG data analysis were used and the AASM alternative hypopnea definition was adopted. Paired t-test was used to calculate how
significantly different the two methods means of RDIs.
Results: There is a significant difference in RDI generated from oximeters set with 2 different averaging times (p < .001). In the 39 simultaneously recordings of SpO2, the mean RDI was lower using the 4secaT oximeter (RDI_aT3secs = 31.29 ± 29.32 versus RDI_aT4secs = 28.63± 28.95, p =< .001). The Mean difference was 2.67 (95% IC 1.45 to3.88). There is a high correlation of 0.992 between the two methods.
Conclusion: There is a significant difference in RDI values calculated
from same oximeter set to 2 different averaging times of 3 and 4seconds. Thus, when interpreting RDI values, one should note theaveraging time used in the acquiring of the SpO2 signal. A differenceof 1 second in averaging time can significantly alter an RDI value of thesame patient.

PO-1-115POSITIVE EFFECT OF NASAL CONTINUOUS
POSITIVE AIRWAY PRESSURE ON CEREBRALPERFUSION IN PATIENTS WITH OBSTRUCTIVESLEEP APNEA SYNDROME

K JEONG SIK1, J EUN YEON1, H SEUNG BONG1
1
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea

Objectives: To investigate the cerebral perfusion changes after nasal
continuous positive airway pressure (CPAP) in patients with obstructive
sleep apnea (OSA),
Methods: we enrolled 30 patients with severe OSA (apnea-hypopnea
index 30/hr). 99 mTc-ethyl cysteinate dimer (99 mTc-ECD) brain single-photon emission computed tomography (SPECT) scans were performed before and after usage of nasal CPAP for more than 6 months.
in.

292

Results: After long-term -CPAP usage, cerebral blood flow increased in
the left fusiform gyrus, right inferior parietal lobule, bilateral inferior
frontal gyrus, and middle frontal gyrus. Regional CBF of left superior
temporal gyrus and right insula was negatively correlated with Epworth
sleepiness scale. Positive correlation was found between rCBF in theright superior frontal gyrus, bilateral cingulate gyri, right parahippocampal gyrus, and left precentral gyrus and mean duration of the CPAP
usage a day and between rCBF in the right parahippocampal gyrus andright superior frontal gyrus and the mean frequency of CPAP usage per
week.
Conclusions: These findings suggested that increased rCBF and positive correlation of rCBF changes in prefrontal cortices and temporal area
after long-term CPAP treatment may explain positive effect of CPAP on
OSA and cognitive improvement by CPAP.
Key words: OSA, SPECT, cerebral blood flow, continuous positive
airway pressure.

PO-1-116
WHAT SHORT-TERM ADHERENCE OF CPAP
THERAPY SHOULD BE USED TO DETERMINE ITSEFFECTIVENESS ON MORTALITY IN PATIENTSWITH OBSTRUCTIVE/CENTRAL SLEEP APNEA(OSA/CSA)?

H NAKAMURA1, K TOHYAMA1, C TAKARA1, K YAMASHIRO1,
T NAKAMURA1, R MORII1, T OKADA1, T MATSUMOTO2
1
Sleep Respiratory Center, Nakamura Clinic, Urasoe-city, Okinawa, Japan,
2
Puimonary Department, Tomishiro Chuou Hospital, Japan

Background: The long term adherence of CPAP in patients with OSA/
CSA has significantly lowered the mortality rate.The minimal length ofadherence to CPAP in determining mortality among OSA patients is
unclear.
Methods and Results: We retrospectively examined the causes ofdeaths in 4,056 patients with OSA or CSA in a long-term study of 13
years follow-up from December 1990 to December 2003 based on
ONSLEEP registry database that features 4,056 patients(OSA 4,000 and
CSA 56), male 3,259(80.3%), age 51.2 ± 13.3 years, BMI 27.9 ± 4.7 kg/
m2, AHI 39.7 ± 32.7 events/h. And we compared the CPAP users, nonusers in relation to the duration of CPAP use and mortality within one
year. The number of deaths 144 (121 male and 23 female). The major
causes of deaths were cardiovascular events including cardiac disorders,sudden death and stroke,34.7%. The number of CPAP users were2,298, 73 died (mortality rate 3.2%, 6.9 /1000 persons/year) in 13
years; and 39 (39/73 = 53%) within one year; 31 within half a year
(31/39 = 79.5%). The CPAP non-users were 1,758, 71 died (mortality
rate 4.0%, 10.4/1000 persons/year) in 13 years, and 15 patients (15/71= 21%) within one year. Patients’ characteristics on gender, age, BMI,
AHI between the two cohorts, only AHI is statistically significant forusers and non-users, with 60 and 66.4 events/h, respectively. Major
causes of deaths within one year among the CPAP users were 15 cardiovascular events, 5 COPD, 4 infections, 10 unknown; and in the
non-users,7 cardiovascular events, 2 infections, 3 unknown. In the
Kaplan-Meier survival analysis, significant difference was not foundbetween the CPAP users and non-users at one year. The CPAP users
compared with non-users, early deaths due to pulmonary disorders
were more prevalent and might result in compromising the effectivenessof CPAP.
Conclusion: CPAP should be used at least longer than one year toevaluate the effectiveness on mortality. The preexisting co-morbidities
would be the confounding factors to early mortality among OSA/CSA
patients.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-117
IMPROVEMENT IN NEUROCOGNITIVEFUNCTION IN COMPLIANT CONTINUOUS
POSITIVE AIRWAY PRESSURE (CPAP) USERS

CJ FIELD1, DJ BARTLETT1, AL DENOTTI1, K WONG1,2,
R GRUNSTEIN1,2
1
Centre for Integrated Research and Understanding of Sleep, Woolcock
Institute of Medical Research, Missenden Road, Australia, 2Department ofRespiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
Introduction: Daytime sleepiness and neurocognitive dysfunction arecommon symptoms of obstructive sleep apnea (OSA). It is unclear
whether CPAP fully reverses the neurocognitive dysfunction associatedwith untreated OSA. We explored the effects of 6 months CPAP therapy
on neurocognitive function in compliant users.
Methods: In this prospective trial, OSA patients performed a computerised, neurocognitive test battery at baseline and after 6 months ofcompliant CPAP therapy (>6 hrs use per night). The test battery
assessed sensori-motor function, attention, working memory, executivefunction and motivation. Performance at baseline and after CPAP
therapy were assessed, and compared to a normative dataset of performance variables previously collected from healthy controls.
Results: Performance data from 202 OSA patients (age 49.2 ± 12.6,
range 20–70 yrs; body mass index (BMI) 33.5 ± 8.0; Epworth sleepinessscale (ESS) 12 ± 5) and 60 controls (age 32.3 ± 12.6, range 19–76 yrs;
BMI 25.5 ± 4.3, ESS 4 ± 2) were analysed. At baseline, the OSA groupdemonstrated impaired performance compared to controls in Stroop
Colour (p =< 0.001), Stroop Text (p =< 0.02), Letter Cancellation Task
(LCT) hits (p =< 0.001) and commissions (p =< 0.05), n-back (p =<0.001) and Psychomotor Vigilance Task reaction time (p =< 0.001). In
the OSA group, compliant CPAP users at 6 months (n = 49) showed
improved performance in Stroop Colour (p =< 0.001), LCT hits (p =<0.02) and n-back (p =< 0.017) compared to baseline. Despite these
improvements over time, performance in this group of compliant CPAP
users remained impaired when compared to controls in Stroop Text
(p =< 0.01), n-back (p =< 0.01) and LCT hits (p =< 0.001) and commissions (p =< 0.03).
Discussion: Improvements in executive function at 6 months in compliant CPAP users implies that some degree of specific neurocognitive
function may be regained with continued usage. The test battery effectively identified the neurocognitive dysfunction associated with OSA
and subsequent improvement of some cognitive domains with adherent
CPAP therapy.

PO-1-118
ONE NIGHT CPAP WITHDRAWAL IMPAIRSPERFORMANCE AT A DRIVING SIMULATORTASK FASTER THAN SLEEP RESTRICTION TO 5
HOURS WITH TREATMENT IN OSA PATIENTSAJ FILTNESS1, LL REYNER1, JA HORNE1
1
Sleep Research Centre, Loughborough University, Oakleigh, Australia,
2
Accident Research Centre, Monash University, Australia

Introduction: Sleep restriction and missing 1 night’s continuous positive air pressure (CPAP) treatment are scenarios faced by obstructive
sleep apnoea (OSA) patients, who must then assess their own fitness todrive. This study aims to assess the impact of this on driving
performance.

Method: 11 CPAP treated participants (50–75 yrs), drove an interactive
car simulator under monotonous motorway conditions for 2 hours on
3 afternoons, following;(i)normal night’s sleep (average 8.2 h) with
CPAP (ii) sleep restriction (5 h), with CPAP (iii)normal length of sleep,
without CPAP. Driving incidents were noted if the car came out of thedesignated driving lane. EEG was recorded continually and KSS
reported every 200 seconds.
Results: Driving incidents: Incidents were more prevalent following
CPAP withdrawal during hour 1, demonstrating a significant condition
time interaction [F(6,60) = 3.40, p = 0.006]. KSS: At the start of driving
participants felt sleepiest following CPAP withdrawal, by the end of thetask KSS levels were similar following CPAP withdrawal and sleep
restriction, demonstrating a significant condition, time interaction[F(3.94,39.41) = 3.39, p = 0.018]. EEG: There was a non significant
trend for combined alpha and theta activity to be highest throughout
the drive following CPAP withdrawal.
Discussion: CPAP withdrawal impairs driving simulator performancesooner than restricting sleep to 5 h with CPAP. Participants had insight
into this increased sleepiness reflected by the higher KSS reported following CPAP withdrawal. In the practical terms of driving any one
incident could be fatal. The earlier impairment reported here demonstrates the potential danger of missing CPAP treatment and highlights
the benefit of CPAP treatment even when sleep time is short.

PO-1-119 / AS-9 Presenter
CARDIOMETABOLIC AND NEUROBEHAVIOURALCHANGES AFTER CONTINUOUS POSITIVE
AIRWAY PRESSURE (CPAP) TREATMENT FOR
OSA: A 12-WEEK RANDOMISED SHAMCONTROLLED STUDY.

CM HOYOS1, R KILLICK1,3, BJ YEE1,2,3,4, CL PHILLIPS1,3,
RR GRUNSTEIN2,3,4, PY LIU1,3,4,5
1
Endocrine and Cardiometabolic Group, Woolcock Institute of Medical
Research, Sydney, NSW, Australia, 2Sleep and Circadian Group, Woolcock
Institute of Medical Research, Australia, 3Central Clinical School,
University of Sydney, Australia, 4Respiratory and Sleep Department, RoyalPrince Alfred Hospital, Australia, 5Endocrinology Department, RoyalPrince Alfred Hospital, Australia
Introduction: Visceral abdominal adiposity (VAA), insulin resistance(IR) and OSA often co-exist. However the role of OSA in impaired
metabolic health is poorly understood because there are no randomised
trials of the effect of CPAP on VAA and the data on CPAP and IR are
inconsistent. The aim of this study was to assess the effect of CPAP on
important intermediate markers of cardio-metabolic health and neurobehavioural function in men with OSA without type II diabetes (DM).
Methods: Sixty-five men with moderate to severe OSA (mean ± SD, age= 49 ± 12 y, apnea hypopnea index (AHI) = 39.9 ± 17.7 events/h, bodymass index = 31.3 ± 5.2 kg/m2, ESS = 10 ± 4.4), who were CPAP naive,
without DM, were randomised in a 12-week double blind shamcontrolled parallel group study, to receive either active (n = 34) or sham(n = 31) CPAP. The primary outcome was VAA change (CT scan) frombaseline to week 12. Secondary outcomes were IR and disposition index(minimal model), liver fat, total fat and lean muscle (DEXA), arterial
stiffness, objective and subjective sleepiness (modified MWT and ESS),
and driving ability (AusEd).
Results: CPAP, compared to placebo, significantly decreased AHI by 33
events/h (mean difference −33.0 events/h; 95%CI, −43.9 to −22.2, p <0.0001) There were no between group differences in the change in VAA(−13.0 cm3 −42.4 to 16.2, p = 0.37) or IR (−0.13 [min−1][fÊU/mL])−1;© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

293

Sleep, Science and Research−0.40 to 0.14, p = 0.33) after 12 weeks. Objective and subjective sleepiness improved in both groups (both p < 0.05). The changes in all othersecondary outcomes were not significantly different between groups.
There were no correlations between the change in VAA or IR with CPAP
use, OSA severity, BMI or sleepiness.
Conclusion: Twelve weeks of therapeutic CPAP did not significantly
improve VAA or IR in men with moderate to severe OSA without DM.

PO-1-120 / AS-19 Presenter
THE EFFECT OF CONTINUOUS POSITIVE
AIRWAY PRESSURE USAGE ON SYMPTOMS OF
OBSTRUCTIVE SLEEP APNEA: REAL EFFECTS OREXPECTATION OF BENEFIT?

NS MARSHALL1, MR CRAWFORD2, DJ BARTLETT1, CL PHILLIPS1,
AM NEILL3, CA ESPIE2, GC DUNGAN1, RR GRUNSTEIN1
1
Sleep Research Group, Woolcock Institute, University of Sydney,
Camperdown, Sydney, Australia, 2University of Glasgow Sleep Centre,
University of Glasgow, United Kingdom, 3WellSleep, Department ofMedicine, University of Otago at Wellington, New Zealand

Background: Poor compliance with medical treatments is a major limitation to healthcare effectiveness. Continuous Positive Airway Pressure(CPAP) is the standard treatment for Obstructive Sleep Apnea (OSA) withthe level of pressure individually titrated for each patient. As such, theeffective dose of treatment is a function of the amount of time patientsuse the device. We explored whether symptom improvement associatedwith high device usage may be related to a placebo-like expectation of
benefit using data from two placebo-controlled crossover trials.
Methods: Patient-level meta-analysis of two trials using two sleepinessrelated symptom questionnaires (ESS, Epworth Sleepinss Score and
FOSQ, Functional Outcomes of Sleepiness Questionaire). Mixed model
analysis of variance was used to quantify the effects of real vs. placebodevice treatment, compliance, interaction of treatment and complianceand regression to the mean.
Results: Compliance between real and placebo-device treatment wasclosely related (r = 0.74, p < 0.001). High compliance with either realor placebo CPAP was associated with greater improvement in sleepiness(mean = 2.2 points; 95%CI = 1.0–3.3, p < 0.001) and functioning (mean= 1.1 points, 0.5–1.7, p < 0.01). High use of real CPAP (4+ hrs/night)
reduced ESS to a greater degree than high use of placebo. In the FOSQ
the same trend was evident but not statistically significant. The association between symptomatic benefit and hours of use of CPAP may not belinear as improvements beyond 6 hours of use were not discernable.
Conclusions: As expected, higher hours of real CPAP use resulted ingreater improvements in symptoms. However, some of this effect wasalso seen in higher users of placebo CPAP. Compliance with real andplacebo therapy was highly correlated, so this effect may arise fromexpectations of benefit or from other unidentified patient-specific factors.

294

PO-1-121 / AS-26 Presenter
A COMPARATIVE EFFECTIVENESS TRIAL OF
CONTINUOUS POSITIVE AIRWAY PRESSURE(CPAP) VERSUS ORAL APPLIANCE (OA)
THERAPY IN OBSTRUCTIVE SLEEP APNEA (OSA)

CL PHILLIPS1, RR GRUNSTEIN2,3,6, A DARENDELILER4,A MIHAILIDOU5, BJ YEE2,3,6, PA CISTULLI1,2,6
1
Department of Respiratory & Sleep Medicine, Royal North Shore Hospital,
NSW, Australia, 2NHMRC Centre for Integrated Research and Understandingof Sleep (CIRUS), Woolcock Institute of Medical Research, Australia,
3
Department of Respiratory & Sleep Medicine, Royal Prince Alfred Hospital,
Australia, 4Department of Orthodontics, Faculty of Dentistry, University ofSydney, Sydney Dental Hospital, Australia, 5Department of Cardiology, RoyalNorth Shore Hospital, Royal North Shore Hospital, Australia, 6Discipline ofSleep Medicine, Sydney Medical School, University of Sydney, Australia
Objectives: To compare the effects of OSA treatment with CPAP andOA therapies on cardiovascular and neurobehavioural healthoutcomes.
Methods: In this randomised crossover trial, we compared the effect of
1-month treatment with CPAP versus mandibular advancement splint(MAS) therapy on blood pressure (24-hr and central), sleepiness (ESS),
simulated driving performance (AusEd) and quality of life (FOSQ andSF36) in 108 patients with OSA (AHI >= 10). Patients were first titrated
and acclimatised to both devices (~6 weeks each) before commencing
treatment on each device for 1 month. 2-week washouts occurred after
acclimatisation and between treatments and the order of each was
randomised.
Results: Patients were middle aged (49 ± 11 yrs) and overweight (BMI
29.5 kg/m2) and most were male (n = 102/126). Mean AHI was 25.4 ±
12.5/hr and 82% had moderate or severe OSA (AHI > 15/hr). Clinic
BP was 123 ± 14/80.6 ± 9 mmHg with 38% on BP medication. Patients
did not report excessive sleepiness (ESS 9.1 ± 4.2) however quality oflife scores (FOSQ and SF36) were below normal. The AHI fell to 4.5 ±
0.7/hr on CPAP and 11.1 ± 1.2/hr on MAS (both p < 0.05 vs baseline
and p < 0.05 CPAP vs MAS). In contrast, self reported compliance on
MAS was higher (CPAP 5.2 ± 2 hrs, MAS 6.5 ± 1.3 hrs, p < 0.0001)
and more than twice as many patients preferred MAS to CPAP (44 vs20%). Overall, 24 hr BP variables were not reduced by CPAP or MAS
however in hypertensive patients BP did fall, albeit by a similar amount(~2–4 mmHg) on both treatments. ESS improved by 1.6 ± 0.3 on CPAP
and 1.9 ± 0.3 on MAS and FOSQ by 1 ± 0.2 on both CPAP and MAS,(all p < 0.001 versus baseline). Similarly, most SF36 domains improved
on both treatments however in 4 domains they were greater on MAS
than CPAP. There were also improvements in aspects of driving performance with both treatments.
Conclusions: This randomised trial showed that treatment of moderate-severe OSA with either CPAP or MAS has similar effects on healthoutcomes. The results are most likely explained by a greater efficacy
with CPAP being offset by a greater compliance with MAS. Patient
preference favoured MAS.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-122
LONG-TERM COMPLIANCE OF CPAP IN
PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA SYNDROME
MS KIM, EY JOO, SB HONG
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
Background: Although nasal positive airway pressure therapy (CPAP)
is the most widely accepted and effective therapy available for the treatment of obstructive sleep apnea syndrome (OSA), short-term and longterm compliance was not so longer than expected.
Methods: We enrolled consecutively 1260 OSA patients who wererecommended to use the nasal CPAP in the outpatient clinic of Samsung
Medical Center from Jan. 2005 to Dec. 2010. After the instruction of
CPAP, 935 patients (74.2%) had agreed to use CPAP, but 325 patients(25.8%) declined it. We investigated the overall compliance of nasal
CPAP use and discomfort from CPAP and compared the clinical characteristics between patients with CPAP maintenance and those with
CPAP discontinuance.
Results: Among 935 patients, 53.4% (n = 500) had continued CPAP
use (<2 yrs, n = 240; 2–3 yrs, n = 133; 4–5 yrs, n = 3) and 46.5% (n= 435) discontinued it. Seventy-three% (n = 319) had stopped the CPAP
within 1 month and 25.2% (n = 110) were within 6 months. In patientswith CPAP maintenance, 48.5% of patients had used CPAP > 90% ofnights and 62% slept with CPAP > 6 hrs of nocturnal sleep time.
Patients with CPAP maintenance showed significantly higher AHI (47.3/
hr vs. 25.5/hr) and larger BMI (27.3 vs. 24.1 kg/m2) than patients with
CPAP discontinuance (p < 0.05). Most common discomfort from CPAP
use was the mask-fitting problem (45.1%).
Conclusions: Over 70% of patients stopped the CPAP use within
1 month and the main problem was mask-fitting. When patients continued to CPAP use more than 6 months, they appeared to maintain the
CPAP for a long-time than expected. Severe OSA and overweight seems
to be the important factors to maintain the CPAP in the OSA patients.

PO-1-123 / AS-19 Presenter
THE ROLE OF SOCIAL COGNITIVE THEORY(SCT) IN CPAP ADHERENCE: DATA FROM TWORANDOMISED CONTROLLED STUDIESDJ BARTLETT1, CM HOYOS2,3, KK WONG1,3,4, R DIANNE1,
GR RONALD1,3,4, LY PETER2,3,4,5
1
Sleep & Circadian Research group, Woolcock Institute of Medical Research,
Sydney NSW, Australia, 2Cardiometbolic and Endocrine Research Group,
Woolcock Institute of Medical Research, Australia, 3Central Clinical School,
University of Sydney, Australia, 4Respiratory and Sleep, Royal Prince Alfred
Hospital, Australia, 5Endocrinology, Royal Prince Alfred Hospital, Australia
Background: Social cognitive theory (SCT) relates to how humans
make choices. Previous data has shown how it may underpin CPAP
adherence.
Methods: The first study (S1) was an RCT of 206 males and females(age range: 22–80) with OSA (mean AHI = 35 ± 26.5) who were randomised to receive either cognitive behaviour therapy (n = 109) orsocial reciprocity (afternoon tea) (n = 97) to improve CPAP adherence
over a 26 week period. The second study (S2) included 65 men with
OSA (age = 49 ± 12 y, AHI = 39.9 ± 17.7) who were randomly assigned
to receive either therapeutic (n = 34) or sham (n = 31) CPAP therapy
for 12 weeks. SCT (self-efficacy, outcome expectation, social support)

was measured in both studies before and after treatment. CPAP adherence was recorded as average nightly use.
Results: SI found CPAP use increased by 1.5 hours (95%CI 1.03–1.96,
r = 0.41, p < 0.00001) for every 1 unit increase in the self-efficacy scale
at baseline. No component of SCT changed with either intervention.
S2 found that for every 1 unit increase in baseline self-efficacy, CPAP
adherence improved by 0.78 hours, however this was not significant (p= 0.12). Change in self-efficacy was positively correlated with adherence(r2 = 0.55, p < 0.0001). In S2, outcome expectation significantly worsened with sham compared to therapeutic CPAP after 12 weeks (meandiff 1.0; 95%CI 0.38–1.62, p = 0.0023). No other group differenceswere found.
Conclusions: Self-efficacy predicted CPAP use in both studies. In S2,
those individuals who reported the greatest fall in self-efficacy scores
were more likely to be non-users. The experience of sham CPAP
resulted in reduced outcome expectation. Previous successful underlying experiences are likely to be driving adherence regardless of educational intervention or treatment modality.

PO-1-124
TRANSVENOUS PHRENIC NERVE STIMULATIONIMPROVES CHEYNE-STOKES RESPIRATION IN
PATIENTS WITH CHRONIC HEART FAILUREZ XILONG
Department of Respirology, The First Affiliated Hospital of Nanjing
Medical University, Nanjing, Jiangsu, China
Background: Cheyne-Stokes respiration (CSR) may accelerate progression of congestive heart failure (CHF) and is associated with poor
survival. Phrenic nerve stimulation (PNS) may interrupt CSR and
improve CHF outcomes. We report the first clinical use of transvenous
PNS in CHF patients with central sleep apnea and CSR.
Methods: Twenty-three CHF patients with central sleep apnea and CSR
were enrolled. A single stimulation lead was placed at the junction
between the superior vena cava and brachiocephalic vein or in the left
pericardiophrenic vein. PNS stimulation was performed using the
Eupnea System software (Cardiac Concepts Inc., Minnetonka, MN).
Respiratory properties were assessed prior to and post-PNS. PNS wasassessed at a maximum of 10 mA.
Results: No adverse events were seen under maximum normal stimulation parameters for a maximum single 12 hour sleep cycle. Phrenic
nerve stimulation was able to reproducibly slow the rate of breathing
in a predictable manner and raise end-tidal expiratory CO2. When PNS
was applied following a series of central sleep apneic events, a trend
towards stabilization of breathing and heart rate, as well as improvement in oxygen saturation, was seen. There was a significant improvement in indices of apnea/hypopnea, central apnea, oxygen saturationand sleep efficiency after PNS versus pre-PNS (all P < 0.01).
Conclusion: Unilateral transvenous PNS proved to be a safe and feasible treatment and by effectively improving CSR, it will be a promisingtreatment for CHF patient with CSR.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research295

Sleep, Science and Research

PO-1-125
EFFECT OF CPAP THERAPY ON
NEUROPSYCHOLOGICAL FUNCTIONS FORPATIENTS WITH SLEEP APNEA SYNDROME
T YAMANAKA
Department of Medicine, NHO Minami Okayama Medical Center,
Tsukubo-gun, Okayama, Japan
Over 20 years, numerous studies have assessed a wide range of cognitive deficits associated with obstructive sleep apnea syndrome (OSAS).
With functional magnetic resonance imaging (fMRI), a few report said
that the deficits persist after CPAP therapy. We should run back over
Neuropsychological functions, referring the outcome of fMRI of OSAS.
Neuropsychological functions in 26 patients with OSAS were evaluatedbefore and at least 6 month after continuous CPAP therapy. Neuropsychological examinations using 3 batteries Kana pick out test (KPT), Trailmaking test (TMT), and, Miyake’s retention Test (MRT) were performed.
The patients included 24 men and 2 women with a mean AHI 45.7
SD21.4 (range 20 to 114), mean age 54.3 SD14 (range, 30 to 74 years).
After 6 month CPAP therapy, CPAP titlation was performed (mean AHI
4.5 SD 2.98).
KPT and MRT for irrelevance for words of meaning represented significant difference between before CPAP therapy and after one were found.
No significantly differences on TMT and KPT for relevance for wordsof meaning among them.
The KPT is a popular test of attention in Japan. This task requires parallel processing of reading and picking Kana (Japanese syllabogram), anddemands an appropriate allocation of attentional resources to the two
activities. The KPT is a suitable test of working memory and executivefunction. TMT is thought to be two part neuropsychological test, inwhich visuospatial ability and executive function are evaluated, and toreflect frontal area function. MRT is neuropsychological test of shortterm memory test regarding to relevance or irrelevance for words ofmeaning.
These results suggested that the neuropsychological outcomes after
CPAP therapy were effective not only for attention ability but also forshort time memory.

PO-1-126
HOURS OF NIGHTLY NASAL CONTINUOUS
POSITIVE AIRWAY PRESSURE USE IS
ASSOCIATED WITH WEIGHT CHANGE IN
PATIENTS WITH OSAHST NISHIJIMA1, S ISHIDOYA2, T MIKASA2, T KIZAWA1, K HOSOKAWA1,
S TAKAHASHI1, H KAGAMI2, A SUWABE1, S SAKURAI1
1
Department of Laboratory Medicine, Division of Sleep Medicine, Iwate
Medical University, Morioka, Iwate, Japan, 2Department of Respirology,
Hachinohe Red Cross Hospital, Japan
Obesity is one of the strongest risk factors for obstructive sleep apneahypopnea syndrome (OSAHS). People of Asian origin, such as theJapanese, are likely to develop OSAHS even with mild degrees ofobesity, suggesting that, in addition to obesity, cranio-facial morphology is also an important contributor for the development of OSAHS.
Nasal continuous positive airway pressure (nCPAP) is known to alleviate sleep-related disturbances and may reduce the risk of hypertension
and cardiovascular disease. A number of previous studies have shownthat habitual sleep duration may be an important determinant of bodyweight with short sleep duration being an independent risk factor forobesity. Using an electronic database of number of hours of nightly

296

CPAP use, we estimated the habitual sleep time of patients during
nCPAP and examined its relationship to association with changes inbody weight. In obese patients with OSAHS, percent weight gain over
9 years displayed a U-shaped relationship with the minimal weightgain in patients with 5 to 6 hours of habitual sleep. In contrast, weightgain was the largest in patients with sleep time of less than 4 hours
per night or more than 8 hours per night. These results suggest thatchanges in body weight in patients with OSAHS are associated morewith habitual sleep time.

PO-1-127 / AS-19 PRESENTERMASK DESENSITIZATION IMPROVES NASAL PAPCOMPLIANCE IN NON-ADHERENT PATIENTSWITH SLEEP APNEARC WEI1, A WANG2, L JIANG4, R CABE4, R CENTILLAS4,MP CHAN5, EL CHAN4, AQ CHAN3
1
Chanwell Clinic Institute for Heart & Sleep Disorders, University ofCalifornia L.A., San Jose, CA, United States of America, 2Chanwell Clinic
Institute for Heart & Sleep Disorders, Keck School of Medicine, UnitedStates of America, 3Chanwell Clinic Institute for Heart & Sleep Disorders,
Stanford University School of Medicine, United States of America,
4
Chanwell Clinic Institute for Heart & Sleep Disorders, United States ofAmerica, 5Chanwell Clinic Institute for Heart & Sleep Disorders, Stanford
University School of Medicine, Chicago Medical School – Rosalind Franklin
University, United States of America
Background: 31 patients, M : F 12:19, ages 46 to 99, with obstructive
sleep apnea (OSA), who were either positive airway pressure (PAP)
non-adherent (PAPNA) or PAP intolerant (PAPI), underwent a nasal
mask desensitization program (NMD) to increase patient compliancewith PAP therapy. Untreated OSA drives the progression of cardio
cerebral-renal diseases (CCR) and leads to a 300% increased risk ofstroke, myocardial infarction, and sudden cardiac death, as well as a
700% increased risk of auto accidents. The implications on morbidity,
mortality and healthcare costs are considerable.
Method: NMD includes 2–5 weekly/biweekly visits to the PAP Clinic;
sleep technicians (RPSGTs) encourage patients to achieve consistent
PAP usage. PAP usage, mask leak, & apnea hypopnea index (AHI)
data were analyzed. Interviews were conducted to address treatmentcompliance concerns. After RPSGTs optimize mask fit, air pressure,humidity, and device cleanliness, patients undergo 30-minutes of NMD,
a nap in the lab with the new treatment adjustments.
Results: PAP adherence (PAPA) is defined as = or >4 hours usage pernight, at least 70% of the time. 65% of patients (20/31) achieved PAPA.
52% of patients (16/31) already achieved PAPA by their second NMD
visit. 67% maintained PAPA even 3 months after NMD, and patients
who relapsed were recalled for a second round of NMD.
Conclusion: Achieving PAPA is one of the major challenges of effective
treatment of OSA. Our NMD program improved PAPA in a majority of
PAPNA/PAPI patients. Treating OSA prevents cardio-cerebral-renal deterioration, improves quality of life, and reduces health care costs. We
recommend sleep medicine physicians continue PAP Clinic every threemonths to monitor compliance and implement NMD if patients fall
below PAPA.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-128 / AS-26 Presenter

PO-1-130

WITHDRAWN

TRANSIENT INCREASE IN INTERICTAL SPIKES
AFTER INTRODUCTION OF NASALCONTINUOUS POSITIVE AIRWAY PRESSURE FOR
OBSTRUCTIVE SLEEP APNEA AND EPILEPSY

PO-1-129
INSOMNIA AMONG SLEEP APNEA PATIENTSBEFORE AND AFTER TREATMENT WITHCONTINUOUS POSITIVE AIRWAYPRESSURE (CPAP)E BJORNSDOTTIR1, C JANSON2, P GEHRMAN3, JF SIGURDSSON5,
M PERLIS3, T GISLASON1,4 AI PACK3, B BENEDIKTSDOTTIR1,4
1
Faculty of Medicine, University of Iceland, Reykjavk, Iceland, 2Department ofMedical Sciences: Respiratory Medicine and Allergology, Uppsala University,
Sweden, 3Center for Sleep and Respiratory Neurobiology and Division of Sleep
Medicine/Department of Medicine, University of Pennsylvania School of
Medicine, Philadelphia, Pennsylvania, United States of America, 4Departmentof Respiratory Medicine and Sleep, Landspitali University Hospital, Iceland,
5
Department of psychiatry, Landspitali University Hospital, Iceland
Background: Insomnia and obstructive sleep apnea (OSA) are bothcommon problems with high co-morbidity. However, the nature of theirrelationship is unclear. The aim of this study was to assess insomnia
prevalence among OSA patients before starting treatment with continuous positive airway pressure (CPAP) and at a two year follow up.
Material and methods: Altogether 824 untreated OSA patients underwent a medical examination and answered questionnaires on health andsleep at baseline and follow up. This is an ongoing study and to date
650 patients have finished the follow up.
Results: When untreated, the majority of OSA patients (57.6%) reported
difficulties maintaining sleep (DMS). OSA patients with DMS were older,
sleepier during the day, more obese and reported poorer mental andphysical health compared to other OSA patients. Furthermore, 15% of
untreated OSA patients reported difficulties initiating sleep (DIS) and
28% reported early morning awakening (EMA). At the two year follow
up, complaints of DMS were reported among 43.9% of non CPAP users,
40.6% of partial users and 25.1% of full CPAP users (p < 0.0001).
Complaints of DIS were reported among 15.2% of non CPAP users,
11.9% of partial users and 7% of full CPAP users (p < 0.0001). Complaints of EMA were reported among 27.8% of non CPAP users, 26.3%
of partial users and 16.3% of full CPAP users (p = 0.01). Complaintsof DIS and EMA were negatively associated with CPAP compliance.
Conclusion: The prevalence of insomnia, especially DMS, is highamong untreated OSA patients but these symptoms improve with successful CPAP treatment. OSA patients with symptoms of DIS and EMA
might benefit from additional treatment for insomnia in order toimprove CPAP compliance.

T HITOMI1, T OGA1, T TSUBOI1, C YOSHIMURA1, T KATO2,
A IKEDA3, R TAKAHASHI3, K CHIN1
1
Respiratory Care and Sleep Control Medicine, Graduate School of
medicine, Kyoto University, Kyoto, Japan, 2Pediatrics, Graduate Schoolof medicine, Kyoto University, Japan, 3Neurology, Graduate School of
medicine, Kyoto University, Japan

Introduction: In patients with epilepsy and obstructive sleep apnea(OSA), seizure frequency and interictal epileptiform discharges usually
decrease after introduction of nasal continuous positive airway pressure(nCPAP). However, we reported 1 patient showing transient increase ininterictal spikes immediately following nCPAP treatment.
Case report: An Eighteen-year-old obese woman started to havecomplex partial seizures at the age of 13. Her seizures sometimes evolved
into generalized. Her seizures were well controlled by Carbamazepine(CBZ) and she was seizure free for the last 2 years. She felt excessive
daytime sleepiness and had witnessed loud snoring and was referred toour clinic. She underwent polysomnography (PSG), which showed
severe OSA with apnea and hypopnea index (AHI) of 59.5 and generalized spike and wave complex (GSWC) (33 times per night). She wasintroduced nCPAP 2 weeks later, and PSG on nCPAP showed normalized
AHI of less than 5. However, GSWC increased to almost 4 times as
many as those of previous study (142 times per night). Follow-up PSG
was taken again following 4 months of nCPAP treatment and GSWC
frequency went back to her baseline level (36 times per night). She was
seizure free for 1 year after nCPAP introduction. The dosage of CBZ wasalmost same and its serum concentration was also quite consistent.
Discussion: We reported one case showing transient increase ininterictal spikes after nCPAP introduction. New onset seizure after
nCPAP introduction was also reported in previous study. These findings
suggested that acute drastic defragmentation in sleep architecture in
OSA by nCPAP could sometimes increase epileptiform discharges, even
if the change itself improved the sleep quality. Acute change in arterial
blood gas by acute release of airway collapse may also contribute theincrease in epileptiform discharges. We should be cautious about theincrease in epileptiform discharge or new appearance of seizure immediately after nCPAP introduction.

PO-1-131
EARLY EFFECTS OF CONTINUOUS POSITIVE
AIRWAY PRESSURE (CPAP) IN A RODENTMODEL OF ALLERGIC RHINITIS

JM MONTSERRAT1, A GUERRERO1, B MARTNEZ1,I ALMENDROS1,2, M TORRES1,2, C EMBID1, I VILASECA1,2
1
Respiratory Medicine, Hospital Clinic Barcelona-University of Barcelona,
Barcelona, Spain, 2Group 11, CIBERES, Spain
Background: Continuous positive airway pressure (CPAP) is the mostused treatment in obstructive sleep apnea. In a previous study, wedemonstrated that nasal CPAP induces an early local inflammation
which results in neutrophil extravasation in the nasal mucosa of a rat
model. The impact of nasal CPAP on a previously inflamade nasal
mucosa may be even greater.
Objectives: To evaluate the early nasal CPAP effects in a rat model ofallergic rhinitis (AR).

© 2011 The Authors
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Sleep, Science and Research

Study design: Twenty Sprague-Dawley rats were sensitized with intraperiotoneal ovoalbumina (OVA). Nasal inflammation was induced by
the administration of OVA intranasal drops during consecutive days.
The same procedure was performed in 20 control rats treated withsaline solution. Then, the allergic and non allergic rats were randomized
to nasal CPAP at 10 cm H2O pressure for 5 hours or to sham CPAP.
Degree of nasal inflammation was assessed by directly evaluating thepercentage of neutrophils, eosinophils, basophils and lymphocytes in
the nasal mucosa. Un-paired Mann Withney test was used to analyse
differences between groups.
Results: The highest inflammation (percentage of neutrophils) was
observed in the group of AR without CPAP (1.24 ± 0.94%), followedby non allergic (NA) with CPAP (0.64 ± 0.30), AR with CPAP (0.64 ±0.40), and NA without CPAP (0.21 ± 0.29).
Conclusions: Acute administration of nasal CPAP or allergy sensitization can produce, individually, neutrophil extravasation on the nasal
mucosa of a rat model. The application of a second source stimulus(nasal CPAP on a previously allergic mucosa) is not responsible of anincreased inflammation.

PO-1-132
WEB-BASED FOLLOW-UP OF CPAP COMPLIANCE
IN OBSTRUCTIVE SLEEP APNEA SYNDROME

JM MONTSERRAT1, V ISETTA2, M FERNANDO5, J SARROCA4,J DONADEU4, R FARRE2,3
1
Respiratory Medicine, Hospital Clinic Barcelona-University of Barcelona,
Barcelona, Spain, 2Unit of Biophysics and Bioengineering, Faculty of
Medicine, University of Barcelona, Spain, 3CIBER de Enfermedades
Respiratorias, CIBERES, Spain, 4Esteve-Teijin, Spain, 5Hospital San Pedrode Alcantara, Caceres, Spain

Introduction: Despite its fast penetration in many fields, the application of information and communication technologies in the clinicalpractice is still very limited, especially in respiratory medicine. The
availability of tools such as the Internet has grown rapidly and, although
the web-based information is easily accessible on various aspects ofhealth, it is rarely considered as an option for management of the
Obstructive Sleep Apnea Syndrome (OSAS).
Objective: To develop and to assess the feasibility of a web-based follow-up of continuous positive pressure airway pressure (CPAP) therapy
in patients with OSAS.
Methods: A personal easy-structured web site was created for this study
and each patient was given access to his/her own data exclusively. By visiting the web site, patients could answer to a weekly questionnaire about
symptoms, sleep quality, potential CPAP side effects, physical activity andbody weight, having the patient access to continuously updated temporal
trends in graphical format. Moreover, informative documents about
OSAS and CPAP therapy were available to free download.
Results: On a total of 163 consecutive patients of the Sleep Clinic, 66
reported minimum knowledge of the Internet and agreed to participate.
After 12 weeks of monitoring, the participation rate was high (82%).
In addition, patients responded to a satisfaction survey through thewebsite itself, showing a level of agreement to the statement “Overall I
am satisfied with the web service” of 4.3 ± 0.58 points (1 = I strongly
disagree, 5 = I strongly agree) and their potential interest in participating in a long-term web-based monitoring.
Conclusions: The results of this pilot study show the potential usefulness of the Internet as a tool to support home monitoring of CPAP
treatment in OSAS. Other options, such as videoconference calls,
should be necessary to be integrated in this web tool in the near future.

298

PO-1-133
TREATMENT EFFECT OF CONTINUOUS
POSITIVE AIRWAY PRESSURE ON ATTENTION IN
UNTREATED PATIENTS WITH OBSTRUCTIVESLEEP APNEA SYNDROME
SH KIM, EY JOO, SB HONG
Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
Background & Objectives: To evaluate the changes of attention before
and after therapeutic continuous positive airway pressure (CPAP), we
measured the P300 and Continuous Performance Tests (CPT) in OSA
patients before and after CPAP treatment.
Method: Auditory & visual P300 studies and CPT were performed in
47 patients with (45 males, mean age 42.3 years) with OSA (meanapnea-hypopea index, 53.7 per hr) and 35 healthy control (22 males,mean age 40.6 years). The diagnosis of OSA was based on standard
criteria using nocturnal polysomnography. OSA patients had repeatedauditory and visual P300 studies after 6 months of therapeutic CPAP.
Result: The auditory P300 was significantly prolonged mean latency
and decreased mean amplitude at fronto-centro-parietal areas in OSA
patients compared to those of normal controls (p less than 0.05). The
visual P300 was significantly prolonged mean latency and nonsignificantly decreased mean amplitude at fronto-centro-parietal areasin OSA patients. In all three steps of CPT, mean correction rate was
non-significantly lower in OSA patients than that in control group. After
CPAP treatment, the auditory P300 latency was shortened at all electrodes although it did not reach statistical significance. The visual P300
latency, amplitudes of auditory and visual P300 was not changed bytherapeutic CPAP for 6 months.
Conclusion: Our findings in ERP and CPT may support that untreated
OSA patients had significantly impaired attention deficits. Successful
CPAP treatment induced a shorter latency of auditory P300 but not invisual P300 latency, amplitudes of auditory and visual P300.

PO-1-134
AN AUDIT OF CPAP TITRATION STUDIESPERFORMED IN A SINGAPORE TEACHING
HOSPITAL SLEEP LABORATORYS VENKATESWARAN
Respiratory, Changi General Hospital, Singapore, Singapore
Introduction: With the advent of autotitrating PAP (APAP) machines.
There has been a general reduction in the number of CPAP titration
studies worldwide. An audit was done to determine the numbers andvarious characteristics of patients undergoing titration studies in ourlaboratory.
Methods: A retrospective case review was done on patients who underwent CPAP titration studies between January and December 2010.
Results: There were 36 patients in total of which there were 24 males
and 12 females. Of these 20(55.6%) were Chinese, 12(33.3%) Malay,
and 3(8.33%) of Indian ethnicity and 1 other. The mean age of thecohort was 52.6 ± 15.1 years. Their mean BMI was 36.9 ± 9.3 kg/m2.
The mean ESS score was 10.7. Their mean RDI pre-treatment was 52.1
± 30.0 compared to the mean post-titration RDI which was 12.2 ± 17.9
(p < 0.05). The mean titrated CPAP pressure was 11.1 ± 3.3 cmH2O.
Twenty two patients (61.1%) were adherent to CPAP at the last clinic
visit. TYhe majority (72.2%) had either hypertension, hyperlipidaemia
or diabetes mellitus.
Conclusions: The number of CPAP titration studies that were performed is small. There may be more than one reason for this. The© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

patients who underwent these studies were predominantly male,
middle aged, obese, had severe OSA and were borderline hypersomnolent. The mean CPAP pressure that was determined for the group was
not high. The mean post-titration RDI’s while significantly improved
were however not within normal limits.

PO-1-135
THE DEGREE OF SLEEP DISTURBED BREATHING
AFFECTS THE CARDIAC SUPPORTING EFFECTS
OF BI-LEVEL POSITIVE AIRWAY PRESSURE
VENTILATION IN PATIENTS WITH HEARTFAILUREM YOSHIDA, S ANDO, A IDE, S NARITA, H MOMII, T KADOKAMI
Department of Cardiology, Saiseikai Futsukaichi Hospital, Chikushino city,
Fukuoka, Japan
Introduction: Noninvasive positive airway pressure ventilation including adaptive servo ventilation has been widely used in the treatment ofpatients with congestive heart failure (CHF) in both acute and chronic
phase. Major concern in this treatment is possible deterioration ofcardiac function by PAP itself. We, therefore, conducted a study about
the effects of bi-level PAP to cardiac function and its relation to degreeof sleep disturbed breathing (SDB).
Methods: In 10 stable CHF patients, apnea-hypoxia index (AHI) is
obtained by portable polysomnography (ASA2100, Nihon Kohden,
Japan). We performed fixed level of positive airway pressure (CPAP)(PEEP 4 cmH2O) followed by bi-level PAP (EPAP/IPAP 4/9 cmH2O) for
five minutes each while continuously monitoring intra-cardiac pressures and cardiac index (CI) using Swan-Ganz catheter.
Results: AHI was 26.5 ± 19.9/hr. CPAP tended to decrease CI, but Bilevel PAP has no significant change compared with control (control 1.93
± 0.53 L/min/m2, CPAP 1.76 ± 0.39 L/min/m2, Bi-level PAP 1.93 ±0.46 L/min/m2). The difference of CI after application of CPAP or Bilevel PAP (f.⩾CI = CIBi-levelPAP-CICPAP) showed significant inverse linear
relationship against AHI (f.⩾CI = −0.007 +0.348 R2 = 0.64). When thepatients are divided into two groups (milder SDB with AHI < 30/hr andmore severe SDB with AHI >= 30/hr), the f.⩾CI in the former patients
is significantly larger than the latter patients 0.29 ± 0.13 vs 0.03 ±0.08 L/min/m2, p = 0.008).
Conclusion: Our result showed that bi-level ventilation was more effective than CPAP in the patients with milder SDB and this implies that
there may be several different mechanisms in the favorable effect ofpositive airway ventilation in the treatment of heart failure patients.

PO-1-136
CONTINUOUS POSITIVE AIRWAY PRESSURE
EFFECT ON ADIPOSE TISSUE IN OBSTRUCTIVESLEEP APNEAS SIVAM1, CL PHILLIPS1,2,3, MI TRENELL5, BJ YEE1,2,4, PY LIU1,2,4,
KK WONG1,2,4, RR GRUNSTEIN1,2,4
1Respiratory and Sleep Medicine, Woolcock Institute of Medical Research,Glebe, Australia, 2Sleep Medicine, Sydney Medical School, Australia,
3
Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia,
4
Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia,
5Institute of Cellular Medicine, Newcastle University, United Kingdom
Objectives: To investigate the effect of Continuous Positive Airway
Pressure (CPAP) treatment on regional adipose tissue distribution inpatients with moderate or severe range OSA.

Methods: We compared the 2 months of therapeutic and sham CPAP
(in random order) on abdominal subcutaneous, visceral and liver fat,liver enzymes and plasma glucose. Magnetic resonance imaging (MRI)and spectroscopy (MRS) were used to quantify abdominal and liver fat
respectively using validated techniques. Measurements were obtained
at baseline and at the end of both treatment arms. Statistical analysis
was performed using paired t-tests or Wilcoxon signed rank tests.
Results: 38 eligible patients were randomly assigned to a treatment
order with 27 patients having complete MRI/MRS data. No significant
difference was observed in subcutaneous (SCAT) and visceral adipose
tissue (VAT), liver fat and serial glucose measurements between treatment modalities. Alkaline phosphatase (ALP) decreased while on therapeutic CPAP but other liver enzymes (AST, ALT, Gamma GT) remained
unchanged.
Conclusions: In this randomized placebo controlled trial, there was nochange in adipose tissue distribution after 8 weeks of therapeutic CPAP
compared with 8 weeks of sham CPAP. Longer treatment duration may
be necessary for VAT, SCAT and liver fat reduction in patients with OSA.

PO-1-137
THE RESULTS OF TWO-PIECEPALATOPHARYNGOPLASTY (TWO-P4: MODIFIEDUVULOPALATOPHARYNGOPLASTY) FOR
SEVERE OSAS

I KOMADA1, S MIYAZAKI2, M OKAWA2, M NISHIKAWA3,
T TANAKA4, T KITAMURA2, T SHIMIZU5
1
Otorhynolaryngology, Social Insurance Shiga Hospital, Otsu-si, Shiga,
Japan, 2Sleep Medicine, Shiga University of Medical Science, Japan,
3
Otorhynolaryngology, Ohomi Kusatsu Tokusyukai Hospital, Japan,
4
Otorhynolaryngology, Tanaka Sleep Clinic, Japan, 5Otorhynolaryngology,
Shiga University of Medical Science, Japan

Two-piece palatopharyngoplasty (Two-P4) for OSAS is a new surgery
modified uvulopalatopharyngoplasty (UPPP). Two-P4 makes two
separated scars on both sides of soft palate and reserving middle soft
tissue intact. These scars pull the reserved middle soft palate to eachside and pharyngeal space becomes wide and deep after several weeks.
We guess that middle soft palate including uvula becomes buffer zone
against separated scars.
Fifty-two patients of OSAS received Two-P4 during 2002 and 2010.
Forty-four patients out of 52 patients underwent polysomnography
before and after surgery. We recruited 35 patients with severe OSAS
(AHI > 30) who received polysomnography before and after surgery.
The age ranged from 17 to 74, average 40.5 ± 12.1 years old, including
34 men and 1 woman. Their average BMI is 28.0 ± 4.3 kg/m2 and 27.6
± 4.1 kg/m2 three months after surgery.
The average AHI of the 35 patients decreased from 62.3 ± 22.0 to 18,
2 ± 20.1 after surgery. The total success rate is 77.1% (27/35) by 50%
AHI decrement and AHI under 20 after surgery. Epworth Sleepiness
Scale (ESS) score improved 12.2 ± 5.0 to 7.2 ± 3.8. According to theFriedman’s anatomical stage, the success rate of the 16 patients withstage 1 was 93.8%, 16 patients with stage 2 was 75%, 7 patients withstage 3 was 57.1%. None of 35 cases complaint permanent soft palate
insufficiency, or stenosis of the nasopharynx.
Classical UPPP makes single line scar, which makes pharyngeal space
narrow. Two-P4 makes two separated scars, and two scars makes
pharynx wide. Another important point is the indication of the surgery.
Friedman’s anatomical stage 1 is most suitable for the soft palate surgery.
But even with the stage 3, the success rate of Two-P4 is 57.1%. Two-P4
is a successful surgical procedure for severe OSAS (AHI > 30), which
could establish high success rate (77.1%).

© 2011 The Authors
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Sleep, Science and Research

PO-1-138
EFFECTS OF ORTHOGNATHIC SURGERY ON
AIRWAY AND SLEEP DISORDERED BREATHING

A MATSUSHITA1, K MISHIMA1, H NAKANO1, H SUGA1,M MATSUMURA1, Y MIYAWAKI2, T MANO1, Y MORI3, Y UEYAMA1
1
Department of Oral and Maxillofacial Surgrey, Yamaguchi University,
Ube-city, Yamaguchi, Japan, 2Miyawaki orthodontic Clinic, Japan,
3
Department of Oral and Maxillofacial Surgery II, Kyushu University, Japan
Background: In 1985, Guilleminault reported a case of Sleep Disordered Breathing (SDB) that developed after orthognathic surgery.
However, orthognathic surgery has been widely accepted as one of theoptions for treating SDB. Thus, respiratory status after orthognathic
surgery is controversial. This study investigated the effects of orthognathic surgery on SDB.
Method: Seventeen patients with jaw deformity, who underwent
two-jaw surgery (Le Fort I osteotomy and sagittal split ramus osteotomy; SSRO) in our hospital, were enrolled. Seven patients underwent
mandibular setback surgeries and five of these patients underwent
two-jaw surgery; the other ten patients underwent mandibular setforward surgeries and eight of these patients underwent two-jaw surgery.
Using polysomnography (Alice 5; Respironics; Murrysville, PA), Apnea
Hypopnea index (AHI), 3% oxygen drop index (ODI), and arousal
index were measured. Then 3D images of the airway were reconstructedfrom CT data using Mimics Version 13.1. The upper and lower boundaries were defined as the level of the hard plate and the base of theepiglottis, respectively. From the 3D reconstruction models, the following volumes of the airway were measured: the volume of the upper
airway (total volume), the volume between the level of the hard palate
and the tip of the uvula (volume of HP-TU), and the volume between
the tip of uvula and the base of the epiglottis (the volume of TP-BE).
Result: Mean AHIs were 2.94/hr and 1.07/hr before and after surgery,respectively (P < 0.01). Total volumes were 10.4 cm3 and 15.6 cm3
before and after surgery, respectively (P < 0.01). Especially, the volumeof HP-TU was significantly increased after surgery (P < 0.035).
Discussion: It was suggested that mandibular setforward surgeries
increase the airway space and improve SDB. However, mandibular
setback surgeries did not significantly change respiratory status.

Results:
1. Success rate of nasal surgery is 11.1% (50% reduction & AHI < 20).
2. There were no statistical difference with AHI between preope andpostope state. (43.2 vs 36.5 p = 0.057).
3. Some parameter such as sleep efficiency, oxygen saturation improved,
but almost parameter did not change.
4. In 7 case, no parameter improve but CAP rate after surgery.
Conclusion: It is difficult to improve OSA severity with nasal surgery
alone. But nasal surgery is useful for OSA patients because of improvement of sleep stabilization.

PO-1-140
THE EFFECT OF TONSILLECTOMY OR
ADENOTONSILLECTOMY ON QUALITY OF
LIFE IN PEDIATRIC SLEEP-DISORDERED
BREATHING PATIENTSS YOSHIDA, H TOYOTA, H HARA, H YAMASHITA
Department of Otolaryngology, Yamaguchi University Graduate School of
Medicine, Ube-city, Yamaguchi, Japan
It is well known that the general population of children with Sleepdisordered breathing (SDB) shows dramatic improvements in the physiological parameters of sleep after those surgeries. However, there are
few report related to the evaluation of the changes of the quality of life
for children with SDB after tonsillectomy or adenotonsillectomy inJapan.
We evaluated the effect of tonsillectomy or adenotonsillectomy onquality of life (QOL) in 24 pediatric SDB patients (age range, 3 to
12 years; median age, 4.6 years) with the translated version of OSA-18,
an 18-item QOL survey. Twenty three children who underwent tonsillectomy or adenotonsillectomy showed improvement in physiologicalparameters of sleep and quality of life after those surgeries. One childwith worsened physiological parameters of sleep after surgery due tore-enlargement of adenoid did not show enough improvement inquality of life after surgery. Even in Japan, the OSA-18 can be usefulfor the evaluation of the effect of surgical treatment on QOL in SDB
children.

PO-1-139

PO-1-141

EFFECT OF NASAL SURGERY ON JAPANESEOSA PATIENTSROLE OF THE DENTISTRY AND ORALMAXILLOFACIAL SURGERY IN MANAGEMENT
OF PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA SYNDROME BY A PANEL OF DOCTORSS WATANABE1, T YAGI1, S CHIBA3, A KIMURA2, Y ANDO2,
H MORIWAKI2, F OTA1, M OTA1
1
Otorhinolaryngology, Ota sleep disorder center, Ota general hospital,
Kawasaki-city, Kanagawa, Japan, 2Otorhinolaryngology, Jikei University
school of medicine, Japan, 3Sleep & Circadian Neurobiology Laboratory
Center for Narcolepsy, Stanford Sleep Research Center Stanford University
School of Medicine, United States of America
Back ground: Japanese OSA have multifactor and we have to evaluate
and select treatment methods case by case. We considered that nasal
respiratory function is as one of the factors related to sleep quality.
Objective: To compare a severity of OSA and sleep structure pre andpost nasal surgery.
Subjects and methods: Retrospectively, we enrolled 30 OSA patients
who received nasal surgery. And compare PSG parameter pre and post
operatively. In 7 case out of 30, we rescored including CAP (cyclic
alternating pattern) parameters as sleep stabilization.

300

T NAKAI1, A MATSUO2, E KAWASHIMA2, Y TAKADA3, Y USUI3,
T KITAMURA4, D CHIKAZU2
1
Dentistry oral – maxillofacial surgery, Tokyo Medical University Hospital,
Musashino-city, Tokyo, Japan, 2Oral-maxillofacial Surgery, Tokyo Medical
University, Japan, 3Internal medicine, Tokyo Medical University, Japan,
4
Otorhinolaryngology, Tokyo Medical University, Japan
Patients with obstructive sleep apnea syndrome (OSAS) are generally
referred to dentistry or oral-maxillofacial (OMF) surgeons by their
physicians. Treatment options include the use of corrective oral appliances (OA) or maxillomandibular advancement (MMA) in some cases;
however the treatment decision is made by physicians and not bydentists. Given this fact, Tokyo Medical University Hospital has set up
a panel of doctors with expertise in relevant fields (circulatory internal
medicine, otorhinolaryngology, OMF surgery), who function as a team© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

to collectively examine OSAS patients. This panel, which has been
evaluating 1148 OSAS patients since November 2004, then reaches aconsensus on an optimal treatment plan. In the present study, we evaluated the efficacy of such team-mediated management by retrospective
examination of the patients clinical records. The following treatment
regiments were employed by the different specialists : continuous positive airway pressure (CPAP) by internists, uvulopalatopharyngoplasty(UPPP) by ENT doctors, and OA and MMA by DOMF surgeons. Somepatients received combined treatments (CPAP/OA, OA/CPAP, CPAP or
OA/MMA) and others were followed up without any of the above
therapies. The average apnea-hypopnea indices (AHI; times/h) of
patients (total number) before treatment were 50.1 for CPAP (n = 760),
40.2 for UPPP (19), 19.7 for OA (245), 32.6 for MMA (5), 35.1 for
CPAP/OA (5), 24.7 for OA/CPAP (1), 51.9 for CPAP or OA/MMA (2),and 15.8 for follow-up only (111). Post-operative, mean AHI scores
were 7.9 for OA and 9.8 for MMA, a remarkable improvement. Thesefindings suggest that the treatment of OSAS by OMF surgeons as a teamwith internists and ENT doctors provides much better efficacy and more
efficient management for the affected patients.

PO-1-142
PERIOPERATIVE MANAGEMENT IN THE
SURGICAL TREATMENT OF OSAS IN
OUR HOSPITALH OOKA1, M ASAKO1, H MURATA1, M YAGI1, K TOMODA1,K NISHI2, N HAMANO2, K SHINGU2
1
Department of Otorhinolaryngology, Kansai Medical School, Hirakata-city,
Osaka, Japan, 2Department of Anesthesiology, Kansai Medical University,
Japan
It is known that nasal respiration disorders at night affect sleep disordered breathing. In our hospital, the patients of obstructive sleep apnea
syndrome (OSAS) are treated at both cardiovascular internal medicine
and otorhinolaryngology. When the patients in OSAS complainednight-time nasal obstruct, night-time mouth-breathing or night-time
dry mouse, more treated with operation. Operation has a lot of risks,
which are OSAS, obesity, general anesthesia, airway edema, bleeding
and oral breathing makes high risk in the perioperative management ofOSAS. Otorhinolaryngologists have difficulty with these management.
So, this is the case of the nasal surgical treatment of OSA by otorhinolaryngologist in our hospital, so that nCPAP failures with night-timenasal obstruct could restart nCPAP because of nasal cavity reform byoperation. They have had deviation and allergic rhinitis and hypertrophic rhinitis. At the last of operation, we would insert the hand-madenasal airway (18Fr Nelaton catheter) through the bilateral common
nasal meatus, and hand-made nasal packs at nasal cavity by and pressing on the several surgical point. After operation, the patient would
enter the ICU by Anesthesiologist and use the biPAP by airway control
one day. The patient of of the nasal surgical treatment of OSA could
spent a perioperative period on lower lisks.

PO-1-143
GLYCATED HEMOGLOBIN IMPROVEMENT BY
ORAL APPLIANCE THERAPY IN OBSTRUCTIVESLEEP APNEA SYNDROME PATIENTS WITH
DIABETES MELLITUS
K YOSHIDA
Department of Oral and Maxillofacial Surgery, National Hospital
Organization, Kyoto Medical Center, Fushimi-ku, Kyoto, Japan
Aim: It has been indicated that obstructive sleep apnea syndrome(OSAS) is independently associated with glucose intolerance andinsulin resistance. The effects of treatment with CPAP on glycemic
control has remained controversial. The aim of this study was to evaluate the influence of oral appliance (OA) therapy on glycated hemoglobin(HbA1c) of OSAS patients with diabetes mellitus.
Methods: Ninety-eight diabetes mellitus patients (mean age: 54.3 years)
diagnosed with OSAS (mean AHI: 18.5) were studied before and after
the insertion of an OA with an average interval of 90 days. The patientswere randomly assigned to periodontal treatment and control groups.
Patients in the periodontal treatment group were divided into threegroups (normal, mild and moderate, and severe) according to the severity of periodontal disease.
Results: AHI showed a significant (p < 0.01) fall to 5.3 in all patients.
HbA1c reduced significantly (p < 0.01) from 6.9 to 6.5%. Both theperiodontal treatment (n = 50) and control (n = 48) groups showed asignificant reduction of HbA1c. The severe periodontal (n = 22) showeda significant reduction in HbA1c. Otherwise, normal (n = 10) and mildand moderate (n = 18) groups showed no significant reduction. Insulin
sensitivity is influenced by chronic inflammation in periodontal disease.
Most OSAS patients breathe through their mouth during sleep. An OA
can prevent the drying of patients’ oral cavities due to nocturnal mouth
breathing. This could result in the amelioration of periodontal disease
and inflammation, and, consequently, a significant reduction of HbA1c.
Conclusion: This data suggest that dental treatment such as OA therapy
and periodontal treatment for OSAS patients with diabetes mellitus canlead to a substantial reduction in HbA1c.

PO-1-144
DENTAL AND SKELETAL CHANGES AFTERLONG-TIME ORAL THERAPY OF OBSTRUCTIVESLEEP APNEA

X-M GAO1, X GONG2
1
Department of Orthodontics, Stomatology school and hospital, Peking
University, Beijing, China, 2Department of Orthodontics, Stomatology
school and hospital, Peking University, China

Objective: Oral appliances (OA) have been established as an alternative
treatment option for obstructive sleep apnea and hypopnea syndrome(OSAHS). Although the short-term therapeutic effect of OA has been
proven through various studies, there are very few follow-up examinations concerning long-term dental or skeletal side effects caused by theappliances.
Methods: 25 OSAHS patients had been treated with OA for a mean
duration of 5 years. Their cephalometric films before and after 5 years
wearing were used to investigate the dental, skeletal and airway changes.
13 OSAHS patients also kept the dental study models, which were used
to investigate the dental side effects.
Results: After 5 years wearing, retroclination of the maxillary incisors(3.3 degree) and proclination of the mandibular incisors (1.8 degree)© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research301

Sleep, Science and Research

could be found, accompanied by reductions in overbite (1.4 mm) andoverjet (1.1 mm). The MP-FH, MP-SN angles increased 1.3 degree,
and the face height increased 2.5 mm. The distance between the hyoid
and FH plane increased 2.3 mm. In the three-dimensional (3D) dental
study, the arch width between each pair of upper molars increased by
1.24+1.83 mm and 0.33+0.53 mm, respectively, while for lower firstmolars it increased by 0.78+0.823 mm. The upper incisors were overerupted about 0.3 mm while the upper molars were depressed about
0.3 mm.
Conclusions: Long-term OA use can cause dental and skeletal changes.
But most of the changes were too minor to imperil the security of OA
therapy.

PO-1-145
TREATMENT OF OBSTRUCTIVE SLEEP APNEAAND HYPOPNEA SYNDROME WITH ORALAPPLIANCE : LONG-TERM FOLLOW-UP

X GONG1, Y ZHAO2, X GAO1
Department of Orthodontics, Peking university school and hospital ofstomatology, Beijing, China, 2Department of stomatology, Xuanwu Hospital
Capital Medical University, China
1

Objective: To investigate the long-term efficacy of oral appliance treating of obstructive sleep apnea and hypopnea syndrome in long-term
treatment.
Methods: A total of 55 patients were included in the study. They weredivided into four groups by the period of treatment, including control
group, 1–2 years group, 2–6 years group and 6–9 years group. The
polysomnographic study was used to investigate the efficacy of fourgroups.
Results: The apnea-hypopnea index (AHI) decreased significantly in allgroups. The control group decreased from 24.50(14.65, 54.05) to
7.40(2.12, 10.00) events per hour (p < 0.001), The 1~2 years groupdecreased from 19.50(12.15, 39.23) to 1.80(0.70, 6.58) events perhour (p = 0.001), The 2–6 years group decreased from 25.00(11.41,
42.60) to 4.50(1.35, 7.90) events per hour (p = 0.001), The 6–9 years
group decreased from 26.2(16.95, 47.45) to 4.00(1.90, 26.70) events
per hour (p = 0.043). There was no significant difference between thefour groups. The longest apnea decreased significantly in control group,
1–2 years group and 2–6 years group. The lowest SaO2 increased significantly in control group and 2–6 years group.
Conclusions: The oral appliance is an effective therapy for patients withOSAHS in long-term treatment. However, it’s recommend to makeappointments with patients as a follow-up supervision if there is any
efficacy decrease.

PO-1-146
COMPARISON BETWEEN MONOBLOCK AND
DUALBLOCK TYPE OA (SOMNODENT MAS) FOR
THE SAME OSA PATIENTSM FURUHATA1, A IKEMATSU2, A FURUHATA3
1
Dentistry, Furuhata Sleep-disordered Breathing Research Institute, Tokyo,
Japan, 2Physiology, Ikematsu Takenosuke Memorial Clinic, Japan,
3
Dentistry, Nippon Dental University, Japan

Introduction: There are 2 main non-invasive treatments for OSA
patients, CPAP and OAT (Oral Appliance Therapy). To this point intime OAT has been indicated for mild to moderate cases. However OAT

302

usage expands to those severe patients who cannot tolerate, are notappropriate for, or do not continue to use CPAP, or use OA whilst travelling. Combined CPAP and OAT is another emerging option.
Efficient and simple structured Monoblock type OA are widely used inJapan given the Governmental insurance coverage which began in April,
2004. However, Monoblock type OA take more time and are complicated to re-titrate, adjust and also prevent jaw movement, limiting
patient adherence.
The principle and preferred treatment choice for OAT is Dualblock type
OA both in Europe and North America due to comfort, ease of titrationand optimized patient adherence.
We made an investigation as a comparison between the Monoblock type
OA and the Dualblock type OA (SomnoDent MAS) which is now usedby over 70,000 patients (2010. December).
Aim: Efficacy Comparison between Monoblock type OA and the Dualblock type OA (SomnoDent MAS).
Object: Patient selection was based on OSA patients who are treatedwith OAT and agreed to participate in the research.
Method: The patients first used Monoblock type OA and subsequently
used the Dualblock type OA (SomnoDent MAS). An Alice5 PSG and
LS-100 were used to compare results. We conducted a survey by questionnaire to compare comfort.
Result: Objective results were almost equivalent, however Dualblock
type OA (SomnoDent MAS) compliance was significantly superior.
Mouth opening in Dualblock type OA (SomnoDent MAS) was shownto have no effect.

PO-1-147
OPTIMAL CPAP PRESSURE AS A PREDICTOR
OF ORAL APPLIANCE TREATMENT OUTCOME
IN OSAK SUTHERLAND1, C PHILLIPS1,2, A GREENWOOD1,2,
V SRINIVASAN3, O DALCI3, B YEE2,4, A DARENDELILER3,
R GRUNSTEIN2,4, P CISTULLI1,2
1
Centre for Sleep Health and Research, Royal North Shore Hospital, Pacific
Highway, St Leonards, Australia, 2NHMRC Centre for Sleep Health(CIRUS), Woolcock Institute of Medical Research, University of Sydney,
Australia, 3Department of Orthodontics, Faculty of Dentistry, Sydney
Dental Hospital, University of Sydney, Australia, 4Department ofRespiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
CPAP is the standard treatment for OSA however oral appliances (OA)
are an alternative treatment often preferred by patients. This simpler
and more portable treatment may be a viable replacement or temporary
treatment solution for some patients. However not all patients will
experience equal efficacy with OA compared to CPAP. It has been proposed that CPAP pressure may predict OA treatment response, withpatients with higher CPAP pressure requirements likely to fail OA
treatment.
Methods: Optimal CPAP pressure, based on 95th percentile pressureon autoset CPAP, was compared between OA treatment responders(>50% AHI reduction) and non-responders (<50% AHI reduction) in
participants in a randomised cross-over trial comparing both treatments. Logistic regression analyses were used to assess if CPAP pressure
was useful as a predictor of OA treatment outcome.
Results: OA treatment responders (N = 79) compared to non-responders (N = 24) were younger (47.6 ± 11.3 vs. 55.4 ± 10.3 years, p =0.003), with smaller neck circumference (40.4 ± 7.3 vs. 42.1 ± 2.8 cm,
p = 0.003) and lower BMI (28.9 ± 5.6 vs. 31.1 ± 5.3 kg/m2, p = 0.059).
However baseline AHI did not differ between groups. There was a trend
for OA responders to have a lower CPAP pressure requirement than

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

non-responders (10.3 ± 1.9, range 4–18 cmH2O vs. 11.2 ± 2.3, range
7–17, p = 0.057). Logistic regression showed that the addition of CPAP
pressure as a predictor variable slightly enhanced prediction of OA
treatment outcome (OR 0.79, 0.63–1.00 95%CI, p = 0.05). Area under
the ROC curve was 0.63. A CPAP pressure threshold of 11.5 cmH2O
yielded 89.9% sensitivity and 41.7% specificity in classifying patients.
Conclusions: Although there was a trend for OA treatment nonresponders to require higher CPAP pressures, this alone was not adequate
to reliably predict OA treatment outcome in this patient population.

PO-1-148
DIFFERENCES BETWEEN A RIGID ORALAPPLIANCE AND A SEMI-RIGID APPLIANCE FOR
THE TREATMENT OF OBSTRUCTIVE SLEEPAPNEA SYNDROME

H SUGA1, K MISHIMA1, H NAKANO1, A MATSUSHITA1,M MATSUMURA1, T MANO1, H HARA2, H YAMASHITA2, Y UEYAMA1
1
Department of Oral and Maxillofacial Surgery, Yamaguchi University,
Ube-city, Yamaguchi, Japan, 2Department of Otolaryngology, Yamaguchi
University, Japan
Background: Over seventy types of oral appliances for the treatment of
obstructive sleep apnea syndrome have been reported. Among theseappliances, a rigid oral appliance (rigid OA) or a semi-rigid appliance(Silensor) are mainly used in clinical settings. However, the mechanisms
underlying the effectiveness of these oral appliances remain unclear.
This study investigated the efficacy and mechanism of a rigid OA anda silensor for the treatment for OSAS.
Materials and Methods: Fourteen patients, 12 males and 2 females,with OSAS, were enrolled. Six patients were treated with a rigid OA,
and eight patients were treated with a silensor. The average age andbody mass index were 58.2 years (49~68 years) and 25.6 kg/m2(23.0~30.7 kg/m2) in the rigid OA group, 54.5 years (36~62 years) and23.5 kg/m2 (20.6~27.2 kg/m2) in the silensor group, respectively. Polysomnography and CT examination were performed twice in eachpatient: at the initial consultation and after improvement of subjective
symptoms. Using CT analyzing computer software (Mimics Version
13.1), 3D images of the airway were reconstructed. The upper andlower boundaries were defined at the level of the hard palate and thebase of the epiglottis, respectively. Using these reconstructed 3D models,the airway parameters were measured. These data were analyzed statistically using Wilcoxon singed-rank test.
Results: The apnea-hypopnea index (AHI) significantly improved from
23.4/hr to 8.1/hr in the rigid OA group (p < 0.05) and from 20.3/hr to
9.7/hr in the silensor group (p < 0.01). CT images, demonstrated thatthe area of the tongue base and the area posterior to the PNS wereincreased in the rigid OA group and in the silencer group, respectively.
Conclusions: It was suggested that both the rigid OA appliance and thesilensor appliance improved respiratory status, but that there were differences in the positions of the airway affected by these two appliances.

PO-1-149
MULTIPLE ASSESSMENTS IMPROVE
PREDICTION OF ORAL APPLIANCE TREATMENTOUTCOME IN OSA: POTENTIAL IMPORTANCE
OF PATIENT PHENOTYPINGK SUTHERLAND1, P PETOCZ3, A CHAN1,2, A DARENDELILER4,J QIAN5, A NG5, P CISTULLI1,2
1
Centre for Sleep Health and Research, Royal North Shore Hospital, Pacific
Highway, St Leonards, Australia, 2NHMRC Centre for Sleep Health(CIRUS), Woolcock Institute of Medical Research, University of Sydney,
Australia, 3Department of Statistics, Macquarie University, Australia,
4
Department of Orthodontics, Faculty of Dentistry, Sydney Dental Hospital,
University of Sydney, Australia, 5Department of Respiratory and Sleep
Medicine, St George Hospital, University of New South Wales, Australia

Oral appliances (OA) can effectively treat OSA however not all patients
respond to treatment. The ability to pre-identify such patients using
simple clinical assessments is highly desirable. Spirometry, nasal resistance and cephalometry have individually shown some initial predictive
utility but not on prospective validation. We hypothesise that single
assessments are inadequate due to the complex upper airway response
to OA and inter-individual differences in mechanisms of response.
Combining results from structural and functional tests into a single
prediction model may provide more accuracy.
Methods: 29 OSA patients underwent 3 assessments before using an
OA. Prediction models to classify patients as responders (AHI reduction> 50%) or non-responders (AHI reduction < 50%) were developed
using logistic regression and classification and regression tree (CART)
analyses. Key measures from each test, SNA angle (cephalometry), nasal
resistance and MEF50/MIF50 ratio (spirometry), were used singly or
combined as independent predictors.
Results: Logistic regression showed each test variable individually hadsome predictive value (area under ROC curve [AUC] 0.7). Combing
variables further enhanced prediction (AUC 0.81–0.88). However thebest model incorporated variables from each of the 3 assessments (AUC0.94). A CART analysis model allowing patients to be classified basedon all 3 results performed substantially better than those with only
single variables.
Conclusion: Prediction of OA treatment outcome improved when predictor variables from different assessments were incorporated into theprediction model. Multiple assessments that phenotype different aspectsof patient upper airway function and craniofacial structure may beneeded to accurately predict OA treatment outcome.

PO-1-150
A MANDIBULAR ADVANCEMENT APPLIANCE
THERAPY FOR A CASE WITH COMORBIDITY OF
SLEEP BRUXISM AND MILD OBSTRUCTIVESLEEP APNEAG UMEMOTO1, N AOYAGI1, H TOYOSHIMA2, Y YAMAGUCHI2,T KIKUTA1
1
Department of Oral and Maxillofacial Surgery, Faculty of Medicine,
Fukuoka University, Fukuoka-city, Fukuoka, Japan, 2Center for Sleep
Disorders, Fukuoka Urasoe Clinic, Japan

Introduction: Previous studies reported that respiratory sleep disorders
were observed concomitantly with sleep bruxism (SB). However, there
is little reliable evidence in efficiency of a mandibular advancement
appliance (MAA) for patients with comorbidity of SB and obstructive© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research303

Sleep, Science and Research

sleep apnea (OSA). We experienced a case with these two disorders whowore a MAA and showed improvement in quality of sleep.
Methods: A 52-year-old office worker was referred by his family dentist
to our department due to frequent stomatitis. He wore a dental soft splint
for the maxilla because sleep bruxism was suspected as a cause of thefrequent stomatitis, and many deficits were detected in the splint in only
a few days. He also complained daytime sleepiness and his Epworth
Sleepiness Scale (ESS) was 11 out of a maximum of 24. His past medical
history was unremarkable during the past 3 years. His body mass index(BMI) is 21.3. A MAA was fixedly set to advance the mandible 3 mm.
Results: Before the MAA therapy, the diagnostic polysomnography(PSG) recording showed that the patient suffered from mild OSA and SB(AHI, 10.5/hr; bruxism episodes per hour: bruxism index, 5.1/hr; lowest
SpO2, 88.6%; arousal index, 16.5/hr; snoring index, 144/hr; periodic leg
movement index, 3/hr; sleep efficiency, 62.8%; stage 1 NREM sleep,
41.4%; stage 2 NREM sleep, 29.0%; slow wave sleep, 0%; REM sleep,
29.6%). Most of the bruxism events were accompanied by arousing
events and leg movements. Six months after the start of MAA therapy,
his daytime sleepiness and frequency of snores were subjectively reducedand ESS decreased to 6. The frequent stomatitis also disappeared.
Discussion: These results suggest the possibility that a MAA therapy
improve quality of sleep for patients with comorbidity of SB and OSA.

PO-1-151
EFFECTS OF THE SILENSOR TREATMENT FOR
THE OBSTRUCTIVE SLEEP APNEA SYNDROMECASES

M MATSUMURA1, K MISHIMA1, H NAKANO1, A MATSUSHITA1,H SUGA1, T MANO1, H HARA2, T FUKUDA1, H YAMASHITA2,Y UEYAMA1
1
Department of Oral and Maxillofacial Suregry, Yamaguchi University,
Ube-city, Yamaguchi, Japan, 2Department of Otolaryngology, Yamaguchi
University, Japan
Background: Although a mandibular repositioning device (MRD) in
treating obstructive sleep apnea (OSAS) is very effective, this device may
generate side effects such as temporomandibular joint disorder anddeviation of occlusion. A semi-rigid silensor (Erkodent Gmbh, Tuttlingen, Germany) has been reported with a low frequency of side effects
in the previous report. The purpose of this study is to determine
whether the silensor is effective or not in treatment of OSAS.
Materials and Methods: Thirty-five patients (27 males and 8 females)with OSAS, who were treated with the silensor, were enrolled. The
average age and body mass index (BMI) were 52.2 years (23~72 years)
and 24.5 kg/m2 (19.3~31.6 kg/m2), respectively. These patients wereclassified into two groups based on the length of the connector of theapparatus; 0–2 mm and 3–4 mm. A polysomnography test was performed in two times; at first visit and often improvement of subjective
symptoms. These datas were analyzed statistically using a Wilcoxon
singed-rank test.
Results: The apnea-hypopnea index (AHI) improvement significantly
in all OSAS patients, mild to moderate OSAS patients, severe OSAS
patients, 0 to 2 mm group patients, 3 to 4 mm group patients (91.4 %:p < 0.01, 88.9%: p < 0.01, 100%: p < 0.05, 86.4%: p < 0.01, 100%:p < 0.01, respectively). The side effects of silensor consisted only of
broken the apparatus and damaged to buccal mucosa.
Conclusions: The silensor was useful in treatment of the patients with
OSAS. Especially, silencer was suitable for first phase of treatment withoral appliances for OSAS, because the effect of silensor was equal tothat of another oral appliance, and had few side effects.

304

PO-1-152
INCREASED SEXUAL DESIRE WITHTESTOSTERONE ADMINISTRATION IN MEN
WITH OBSTRUCTIVE SLEEP APNEA: AN
18-WEEK RANDOMIZED DOUBLE-BLIND
PLACEBO CONTROLLED STUDYKL MELEHAN1, CM HOYOS1,4, BJ YEE1,2, PR BUCHANAN1,
RR GRUNSTEIN1,2, PY LIU1,3,5
1
Sleep Group, Woolcock Institute of Medical Research, Glebe, Australia,
2
Department of Respiratory and Sleep Medicine, Royal Prince Alfred
Hospital, Australia, 3Department of Andrology, Concord General
Repatriation Hospital, Australia, 4Faculty of Medicine, University ofSydney, Australia, 5Department of Endocronlogy, Royal Prince Alfred
Hospital, Australia
Background: Sexual dysfunction, biochemical testosterone (T) deficiency, obesity and OSA coexist. Large studies show that half of all men
with OSA have erectile dysfunction, and that sexual dysfunction iscommon. Nevertheless, sexual dysfunction often remains undiagnosed
due to patient or doctor embarrassment despite the existence of therapies which are effective in other contexts. Here we comprehensively
assess the impact of T administration on sexual desire, erectile function
and general and disease specific quality of life and cognitive function
in obese men with OSA.
Methods: 67 middle aged (age 49 ± 1.1, mean ± SEM), obese (BMI
35.8 ± 0.57) men with moderate-severe OSA (AHI 31.8 ± 2.4) received
3 intramuscular injections of 1000 mg T undecanoate or placebo at
6 weekly intervals. SF36, FOSQ, sexual function by visual analogue
scales and computerised cognitive testing were assessed at 0, 6, 12 and18 weeks. Polysomnography (PSG) occurred at 0, 7 and 18 weeks.
Results: T administration, compared with placebo, significantly
increased blood T and suppressed gonadotrophins (P < 0.001). T
increased sexual desire by 16% (mean difference between groups, 5.4–
26.8% 95%CI, p = 0.004), but did not alter erectile or orgasmic function, quality of life (FOSQ, SF-36), reaction time (PVT), spatial cognition(Tower of London) or executive memory (Stroop), irrespective ofbaseline T. T therapy increased vitality (p = 0.004), ‘feeling down’(p = 0.002), and orgasmic ability (p = 0.016) and reduced nervousness(p = 0.032), but only in those with low baseline T. These effects did
not correlate with any changes in AHI or ODI.
Conclusions: 18 weeks of T therapy improves sexual desire in obese
men with OSA, and improves orgasmic function only in those with low
baseline T. T therapy variably controls different facets of sexual function.
However, the decision to use T therapy to improve sexual function inobese men with OSA requires consideration of both risks and benefits.

PO-1-153
SLEEP DISORDERED BREATHING AND LONGACTING HYPNOTIC USE AFFECT DAYTIMEPHYSICAL ACTIVITY AMONG INPATIENTSWITH SCHIZOPHRENIAJ MURAKAMI1, M IMAI2, N YAMADA2
Department of Psychiatry, Biwako Hospital, Otsu-city, Shiga, Japan,
2
Department of Psychiatry, Shiga University of Medical Science, Japan

1

Objective: This study evaluated factors influencing daytime activity
among inpatients with schizophrenia.
Method: This study enrolled 546 inpatients with schizophrenia (300
men and 246 women, mean age 57.6 years old). Activity among© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

participants was assessed by 3-axis accelerometer with pulse oximeterfor 24-hours. Mean activity per hour on lighting-up time at each hospital ward was analyzed as daytime activity index. After simple regression analyses, multiple linear regression was performed to explore
determinants of daytime activity index.
Results: 3% oxygen desaturation index, dose of long-acting hypnotics(half-life period above 24 hours) and age had significant statistical negative correlation with daytime activity index in simple regression model.
3%ODI, dose of long-acting hypnotics, age and biologically plausible
predictors (sex, body mass index) were included in the original multiple
linear regression model. The final linear regression model included
3%ODI (p < 0.001), long-acting hypnotics (p < 0.001), sex (p = 0.045),
age (p = 0.006) (R2 = 0.08, F = 11.6, ANOVA p < 0.001).
Conclusion: In this study, sleep disordered breathing and long-acting
hypnotics use were risk factors for reduction of daytime activity among
inpatients with schizophrenia. Screening for sleep disordered breathingis necessary to identify with negative symptom. Furthermore, attention
to activity change among patients using long-acting hypnotics might beneeded.

PO-1-154 / AS-26 PRESENTER
EFFECTIVENESS OF A NASAL AIRWAY STENT
ON OBSTRUCTIVE SLEEP APNEAM SATOH1, K HIOKI2, H YAMADA2, S SAKANE2, I KOMADA3,K KADONO4, M YANAGIHARA1, Y KOSHINO1, S MIYAZAKI5,
S ISONO6
1
Sleep Medicine, Tsukuba University, Tsukuba, Ibaraki, Japan, 2Sleep
Labo., Seven Dreamers Laboratories, Inc., United States of America,
3
Otorhinolaryngology, Shiga Hospital of Social Insurance, Japan, 4Sleep
Medicine, Moriya Sleep Clinic, Japan, 5Sleep Medicine, Shiga University of
Medical Science, Japan, 6Anesthesiology, Chiba University School of
Medicine, Japan
We report promising preliminary findings regarding the clinical effectiveness of a novel nasal airway stent (NAS) that was developed for thetreatment of obstructive sleep apnea (OSA). The device is constructedusing resilient semi-rigid silicone rubber and was designed to be safely
and comfortably inserted into the upper airway. The NAS contains an
expandable distal end, located within the nasopharynx and retropalataloropharinx, that is encapsulated by a nontoxic water-soluble material.
Following device placement, the distal end of the device is released andexpands to maintain an air flow passageway of 5–10 mm in diameter.
Effectiveness of the NAS on sleep disordered breathing was assessed bypolysomnographic studies before and during placement of the device
in five patients with OSA. The NAS did not normalize the disorderedbreathing, but significantly improved the apnea hypopnea index (from31.9 ± 22.6 to 16.2 ± 15.7), 3% oxygen desaturation index (from 30.3
± 27.4 to 13.5 ± 14.6) and arousal index (from 28.4 ± 18.3 to 17.5 ±10.8). None of the patients experienced traumatic side effects such as
nasal bleeding, pain, or discomfort following placement of the device.
The NAS appears to be a useful alternative or additive treatment forpatients with OSA. The device may be used as an immediate therapeutic
tool while a patient undertakes a weight loss program or as an alternative for patients who cannot tolerate a nasal continuous positive airway
pressure treatment. The NAS affects obstruction of nasopharynx andpartly oropharynx but not of hypopharynx, therefore the combinationof the NAS and an oral appliance may provide additional benefits.
Further studies are necessary to confirm our preliminary results.

PO-1-155
THE EFFECTS OF TESTOSTERONE ON
VENTILATORY RESPONSES IN MEN WITH
OBSTRUCTIVE SLEEP APNOEA – A
RANDOMISED, PLACEBO CONTROLLED TRIAL

R KILLICK1, D WANG1,3,4, CM HOYOS2,3, BJ YEE2,3,4, KK WONG1,3,4,
RR GRUNSTEIN1,3,4, PY LIU2,3,4,5
1
Endocrine and Metabolic Group, Woolcock Institute of Medical Research,
Wodonga, Victoria, Australia, 2Endocrine and Metabolic Group, Woolcock
Institute of Medical Research, Australia, 3Central Clinical School,
University of Sydney, Australia, 4Department of Respiratory and Sleep
Medicine, Royal Prince Alfred Hospital, Sydney, Australia, 5Department ofEndocrinology, Royal Prince Alfred Hospital, Sydney, Australia
Introduction: We recently presented in abstract form that testosterone(T) worsens sleep disordered breathing at 7 but not after 18 weeks inmen with OSA. Whether these effects are mediated by changes in ventilatory responses (VR) is not known. To our knowledge the effect of T
on VR in men with significant OSA has not been studied before.
Methods: 21 obese men with OSA were randomised in a 18 week
double-blind placebo controlled parallel group study to 3 intramuscular
injections (0, 6, 12 weeks) of either 1000 mg T undecanoate or placebo(mean body mass index (BMI) = 37.7 ± 0.9 kg/m2, apnea hypopnea
index (AHI) = 32.6 ± 2.2 events/hr). VR testing was performed using
Duffin’s modified rebreathing method before (week 0), during (week6), and at the end of treatment (week 18) in hyperoxic (pO2 150 mmHg)
and hypoxic (pO2 50 mmHg) conditions to determine the ventilatory
recruitment threshold (VRT) and chemosensitivity (CS), alongside overnight polysomnography. Data were analysed by mixed models and aredescribed as overall mean differences between groups (95%CI).
Results: A significant increase in blood T levels (5.65 nmol/L, 0.51 to
10.8, p = 0.03), and lean muscle mass (2.36 kg, 0.8 to 3.9, p = 0.007)
between the two groups was observed. There were no significant differences following T treatment overall at 6 weeks or at 18 weeks in:
hyperoxic VRT (1.39 mmHg, −3.16 to 5.93), hyperoxic CS (−0.22 L/
min/mmHg, −1.11 to 0.67), hypoxic VRT (0.9 mmHg, −5.16 to 6.96)
or hypoxic CS (−0.73 L/min/mmHg, −3.2 to 1.74); all p > 0.05. Positive
correlations were found at week 6, but not week 18, between changes
in: blood T levels and hyperoxic VRT (r = +0.55, p = 0.03) and hyperoxic VRT and time spent below 90% (r = +0.57, p = 0.03).
Conclusion: T treatment did not significantly change VR in these menwith moderate-severe OSA. However T levels correlated with hyperoxic
VRT, and then with overnight hypoxia. Whether testosterone mediates
acute, but not chronic, worsening of OSA through alterations in hyperoxic VRT requires further evaluation.

PO-1-156SLEEP DISTURBANCE IN PRE-SCHOOLCHILDREN WITH OBSTRUCTIVE SLEEPAPNOEA SYNDROME

RSC HORNE1, LM WALTER1, GM NIXON1, MJ DAVEY2,
DM O’DRISCOLL1, J TRINDER3
1
The Ritchie Centre, Monash Institute of Medical Research, Monash
University, Melbourne, Victoria, Australia, 2Melbourne Children’s Sleep
Centre, Monash Medical Centre, Australia, 3Discipline of Pyschology,
University of Melbourne, Australia
Backgrond: Sleep disordered breathing in children is most prevalent in
the pre-school years and has been associated with sleep fragmentationand hypoxia. We aimed to compare the sleep and spontaneous arousal© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research305

Sleep, Science and Researchcharacteristics of 3–5 y old children with obstructive sleep apnea to thatof non-snoring control children, and to further characterize the arousal
responses to obstructive respiratory events.
Methods: 73 children (48 male) underwent overnight polysomnography; 51 for assessment of snoring who were subsequently diagnosed
with OSA (obstructive apnea hypopnea index (OAHI) > 1 events/h),and 22 control children recruited from the community (OAHI < = 1
and no history of snoring).
Results: The OSA group had poorer sleep efficiency (p < 0.05), spenta smaller proportion of their sleep period time in REM (p < 0.05) andhad significantly fewer spontaneous arousals (p < 0.001) compared with
controls. 25% of the children with OSA had a Sleep Pressure Score
above the cut-off point for increased sleep pressure. In children with
OSA, 62% of obstructive respiratory events terminated in a corticalarousal, and 21% in a sub-cortical arousal. A significantly higher proportion of obstructive respiratory events terminated in a cortical arousal
during NREM compared to REM (p < 0.001).
Conclusions: These findings suggest that in pre-school children, OSA
has an effect on sleep and arousal patterns. Given that these children
are in a critical period for brain development, the impact of OSA may
have more severe consequences than in older children.

PO-1-158
POLYSOMNOGRAPHIC ASSESSMENT OF SLEEPBRUXISM IN CHILDREN WITH SLEEP RELATEDBREATHING DISORDER
K-Y CHAE, S-J CHANG, S-H LEE
Dept. of Pediatrics, CHA Bundang Medical Center, CHA University,
Seongnam-city, Republic of Korea
Background: To investigate incidence of bruxism in children with sleep
related breathing disorder and the relevance between sleep stage, position and bruxism.
Methods: Total 66 children and adolescents who visited sleep clinic at
CHA Bundang Medical Center were subjects of our study and pediatricsleep questionnaire and PSG were done. Aspects of bruxism with regard
to sleep stage and position using additional masseter electrodes according to 2007 AASM bruxism criteria were studied.
Results: Of total 66 patients, PSQ respondents were 62 and mean value
was 0.38, 34 patients (52%) scored over 0.33 at PSQ and was corresponded to risk group of obstructive sleep apnea. Their mean AHI was
5.5 and mean RDI was 11.3 and children with AHI score over 1.0 who
correspond to SRBD was 41 which was 62.1% of total patients. Patientsand parents who answered having bruxism was 24 and occupied 36.4%of the patients. On the PSG assessment of bruxism, surprisingly, allsubjects had bruxism that frequently occurred after brief arousal withrespiratory events or movements. Bruxism index for each corresponding sleep stage N1, N2, N3 and REM sleep were 13.1, 1.9, 0.7 and 3.1.
Bruxism occurred more frequently on N1 sleep and decreased at slow
wave sleep. Bruxism index increased with arousal index and show
statistical significance (P = 0.033). Also comparing frequency of bruxism
on supine and non-supine sleep position, frequency increased onsupine position with statistical significance.
Conclusion: On the PSG assessment of bruxism according to 2007
AASM criteria in children with sleep related breathing disorder, sleep
bruxism occurred in every patient related with arousal. Frequency ofbruxism significantly increased at stage N1 sleep and supine position
as respiratory events or arousals were usually aggravated in same supine
position during N1 or N2 sleep stage in patients with sleep related
breathing disorders. It is assumed that PSG based bruxism is common
movement phenomenon related with arousal in children with sleep
related breathing disorder.

306

PO-1-159 / AS-06 Presenter
UNUSUALLY SEVERE REM SLEEP APNEAHYPOPNEA IN A CHILD, STRENGTHENSGENETIC LINKAGE WITH PARENTS
AQ CHAN, MP CHAN, EL CHAN, R WEI, L JIANG, R CABE
Chanwell Clinic Institute for Heart & Sleep Disorders, Stanford University
School of Medicine, Milpitas, California, United States of America
Background: Obstructive sleep apnea hypopnea (OSAH) in children
has health implications such as behavior disorders, attention deficit,
learning difficulty and growth retardation. Most common cause of
OSAH in age group 3 to 6 years is often attributed to adenoid tonsillar
hypertrophy. REM OSAH in children may have specific, unique genetic
linkage with parents.
History: Child 3.5 years, 39 inches, BMI 17 seen with snoring, attention deficit disorder, growth retardation, Mallampati 4, micrognathia,
normal looking tonsils. Father age 35, 67 inches, BMI 41 has loudsnoring, short neck, hypertension, diabetes, cardiomegaly, and diastolic
dysfunction. Mother has Mallampati 4, micrognathia, and short neck.
Method: Both father and child underwent polysomnography (PSG).
Result: Child: RDI non-REM 19, RDI REM 98, Lowest Sa02 83%.
Father: RDI non-REM 10, RDI REM 73, Lowest Sa02 87%.
Discussion: Asian’s craniofacial features predispose to the developmentof OSAH. Both father and child have almost similar PSG pattern of
unusually severe REM OSAH in contrast to moderate OSAH during
non-REM sleep. There are reports that in children the correction of
respiratory disorders was more complete in non-REM sleep, so thatadenotonsillectomy can be considered a more effective treatment thanfor REM obstructive disorders. Children with OSAH do not keep adequate airflow when upper-airway inspiratory-pressure drops during
REM sleep, hence a more collapsible upper airway, compared with thatof control subjects during REM sleep.
Conclusion: REM OSAH in children may have specific, and uniquegenetic linkage within the larger universe of genetically link craniofacial
features among Asians with OSAH. Further clinical study is needed tovalidate this conclusion.

PO-1-160
ARE CHILDREN EASILY PREDISPOSED TO
OBSTRUCTIVE SLEEP APNEA?

K MAEDA1, S TSUIKI1,2, S NAKATA3,4, Y OKAWARA1, Y INOUE1,2
1
Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo,
Japan, 2Department of Somnology, Tokyo Medical University, Japan,
3
Department of Otorhinolaryngology, Nagoya University, Japan,
4
Department of Otorhinolaryngology, Fujita Health University School of
Medicine, Japan
An excessive volume of soft tissue relative to the size of the craniofacial
hard tissue, which is an indicator for disharmony of the anatomicalbalance in the upper airway, is a risk factor for obstructive sleep apnea(OSA) in adult patients since it increases the collapsibility of the upper
airway. In contrast, the contribution of maxillofacial morphology to thepathogenesis of OSA in a pediatric population has not been examined.
We hypothesized that the disharmony of the anatomical balance seenin adult OSA patients can also be observed in pediatric OSA patients.
The study protocol was approved by the ethics committee of the Neuropsychiatric Research Institute. A total of 7 pediatric OSA patients (5.3
± 2.0 yrs.) with an apnea-hypopnea index (AHI) above 1/hour after
adenotonsillectomy and 31 adult OSA patients (43.8 ± 10.2 yrs.) witha matching skeletal pattern according to the cephalometric parameters© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

SNA, SNB and ANB were recruited to this study. All subjects were male
Japanese. Using upright lateral cephalograms, we compared the Lower
Face Cage size (LFC), tongue size (TG), and the anatomical balance
determined as the ratio of TG/LFC between pediatric and adult OSA
patients. LFC (p < 0.05) and TG (p < 0.05) in the pediatric patientswere significantly smaller than those in the adult patients. Moreover,
TG/LFC in the pediatric patients was smaller than that in adult patients(p < 0.05). These findings suggest that pediatric patients are structurally
predisposed to OSA due to a smaller amount of soft tissue comparedto adult patients. The increased vulnerability to collapsibility of theupper airway may be offset by some neurophysiological mechanism inpediatric OSA patients.

PO-1-161
A REVIEW OF INDICATIONS FOR
POLYSOMNOGRAPHY IN CHILDREN IN AN
AUSTRALIAN SLEEP LABORATORY –COMPARISON TO AASM RECOMMENDATIONSA BOYNTON, L GAULD, A PUGALENTHI, C DAKIN, M HARRIS,S SURESH
Respiratory and Sleep Medicine, Mater Children’s Hospital, Queensland,
Australia
Background: Polysomnography (PSG) testing is an essential part ofinvestigation for a child with sleep problems. Recently American
Academy of Sleep Medicine (AASM) has published practice parameters
for respiratory indications for polysomnography in children. This isbased on literature review and classifies the indications into threegroups standard, guideline and option.
Aim: To describe the indication for PSGs in the last 5 years in a tertiary
paediatric sleep medicine service and to stratify them to the diagnostic
groups as per AASM. Further review of the guideline and option groups
to ascertain the role of PSG in clinical management.
Methods: Retrospective review of our database and studies stratified
according to three categories, standard, guideline and options. Qualitative assessment of the guideline and option groups to derive themes
regarding clinical management decisions. A department specific practice parameter was derived.
Results and discussion: Total number of studies during 5 years Jan
2006 to Dec 2010; 3871 studies. Study indications were Standard 1935
(49.9.%); Guideline 560 (14.4%); Option 1340 (34.6%); Non classifiable 36 (.9%). Diagnostic studies for suspected OSA formed the largest
group with 49.9% of the studies. 50% of studies were assigned to theguideline and option group; these were review studies for home ventilatory support on either CPAP of Bi level support. PSGs for titration of
supplemental oxygen and assessing central breathing control in infancy
are widely used in this facility. Further evaluation is needed whether
less intensive monitoring techniques may be appropriate for somepatient groups.
Conclusion: The AASM practice parameters are a useful guide against
which local practices could be audited and unit specific guidelines
written.

PO-1-162 / AS-2 Presenter
A COMPARISON BETWEEN PRE AND POSTOPERATIVE SLEEP STRUCTURES IN PEDIATRIC
OBSTRUCTIVE SLEEP APNEA PATIENTSY NISHIMURA, S NAKATA, T KOJIMA, WA AHMED, K SUZUKI
Department of Otorhinolaryngology, Fujita Health University, Nagoya-city,
Japan, Japan
Objective: Adenotonsillectomy is a common procedure in children
with OSA. After adenotonsillectomy children grow and become stablein their psychological condition. The objective of this study is tocompare the results of pre and post operative Polysomnographic datain terms of sleep structure for each sleep stage in pediatric OSA patients.
Method: Standard overnight multi channel polysomnographically evaluation was performed preoperatively and 1 to 3 months after operation
based on the diagnostic criteria of International Classification of Sleep
Disorders second edition. This is a retrospective study of sleep structuresof pediatric OSA patients. Aged 3 to 6 years, mean 4.5 years, n equal 25.
Results: Children who underwent adenotonsillectomy had significant
improvement in the mean AHI from 17.1 to 3.5 1.8. P less than 0.001.
Sleep stage 1 and arousals decreased significantly. Stage 1 from 6.8 to
3.9. P less than 0.01 and arousal index from 23.0 to 11.9. P less than
0.001. Changes in slow wave stages were not statistically significant.
Conclusion: We compared sleep structures between pre and post operatively children who underwent adenotonsillectomy. We predicted
increase of slow wave stages but identified changes in the sleep structuresin the form of reduction of sleep stage 1 and arousal index. We concluded
that the changes of these PSG parameters after adenotonsillectomy might
gradually improve their physical and psychological conditions.

PO-1-163
THE CIRCADIAN RHYTHM OF PLASMAMELATONIN CONCENTRATIONS IS ALTEREDIN HYPOCRETIN DEFICIENT MEN

CEHM DONJACOUR1, NA AZIZ1, S OVEREEM2,3, GJ LAMMERS1,B BOTHOREL4, A KALSBEEK5,6, H PIJL7
1
Neurology, Leiden University Medical Center, Leiden, Netherlands,
2
Neurology, Donders Institute for Neuroscience, Nijmegen, Netherlands,
3
Sleep Medicine, Sleep Medicine Center ‘Kempenhaeghe, Netherlands,
4
Département de Neurobiologie des Rythmes, Institut des Neurosciences
Intégratives et Cellulaires, Strasbourg, France, 5Department ofEndocrinology and Metabolism, Academic Medical Centre of the Universityof Amsterdam, Netherlands, 6Netherlands Institute for Neuroscience,
Hypothalamic Integration Mechanisms, Amsterdam, Netherlands,
7
Endocrinology, Leiden University Medical Centre, Netherlands
Objective: Hypocretin deficiency causes narcolepsy, a condition characterized by excessive daytime sleepiness, cataplexy, and fragmented
nocturnal sleep. Recently, it was shown that in various vertebrates
hypocretin fibers project to the pineal gland. Moreover in zebrafish
hypocretin was suggested to affect diurnal melatonin synthesis. Therefore, this study was performed to assess whether melatonin secretion
differs between narcolepsy patients and matched controls.
Methods: Seven male hypocretin deficient narcolepsy patients withcataplexy and seven controls matched for sex, age and body mass index
were enrolled. Blood was sampled at hourly intervals for 24-h tomeasure melatonin concentrations. Sleep was continuously assessed bypolysomnography.
Results: Mean 24-h melatonin concentrations did not differ between
narcolepsy patients and controls (39.2 ± 16.4 vs. 28.6 ± 4.6 pg/ml, P© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research307

Sleep, Science and Research= 0.56). However, the percentage of 24-h melatonin that was secreted
during daytime was significantly higher in narcolepsy patients (46.6 ±4.1 vs. 32.5 ± 5.8%) (P = 0.007 for group effect). Moreover, the crosscorrelations between melatonin levels with the percentage of time spentin either slow wave sleep, phase I/II non-REM sleep, or time awake
were significantly weaker in narcolepsy patients (all P < 0.023).
Conclusion: Hypocretin is not only involved in the regulation of sleep
but also in the regulation of the daily rhythm of melatonin secretion.
As sleep and melatonin release are normally entrained, the weakercross-correlation between sleep and plasma melatonin levels in narcoleptic patients indicates that hypocretin deficiency differently affects thecircadian distribution of sleep and melatonin release.

PO-1-164 / AS-11 Presenter
AMBULANT SKIN TEMPERATURE REGULATION
AND SLEEP ATTACKS IN NARCOLEPTIC
PATIENTSR FRONCZEK1, C BAUMANN2, A VAN DE HEIDE1, E WERTH2,
BL CLAUDIO2, EJW VAN SOMEREN3, GJ LAMMERS1
1
Neurology, Leiden University Medical Centre, 2215 NE Voorhout,Netherlands, 2Neurology, University Hospital of Zurich, Switzerland,
3
Sleep And Cognition, Netherlands Institute for Neurosciences, Netherlands
Introduction: In healthy subjects, sleep propensity increases when the
distal skin temperature increases relative to the proximal skin temperature. This increase results from increased blood flow in the skin of theextremities and is controlled by the hypothalamic circadian clock, as issleep. Narcolepsy is characterized by hypothalamic alterations. Previously, we studied skin temperature in narcoleptic patients in relation totheir characteristically increased sleep propensity during the day. Awake
narcoleptic patients showed higher distal and lower proximal skintemperatures then controls. This increased distal skin temperature wasrelated to shorter subsequent sleep-onset latency during a multiple
sleep latency test protocol.
Methods: In this 24-hour ambulatory polysomnography study, we continuously measured core body, distal and proximal skin temperature in
relation to daytime sleep attacks and nighttime sleep, while subjects
were outside the hospital and underwent their normal activities. Subjects were 14 medication-free narcolepsy with cataplexy patients, fulfilling the ICSD-2 criteria.
Results: The mean (±SD) number of daytime sleep attacks for eachpatient was 2.6 ± 1.0. When each individual sleep attack was analyzed
separately, a higher mean distal and proximal skin temperature and ahigher distal-to-proximal skin temperature gradient (DPG) was seen in
the 5-minute window before a sleep attack, compared to the 5-minutewindow 30 minutes before a sleep attack in 70% of sleep attacks. Mean
increases were 0.5 ± 0.3 in distal and 0.3 ± 0.2 degrees Celcius inproximal skin temperature.
Conclusion: In narcolepsy with cataplexy, an increase in distal skintemperature heralds 70% of sleep attacks in daily life outside of thecontrolled hospital conditions. This is in line with previous findings
under controlled MSLT conditions in narcolepsy with cataplexy; andwith the increase in distal skin temperature before normal nocturnal
sleep in healthy subjects.

308

PO-1-165
ASSESSMENT OF HIPPOCAMPAL VOLUMEIN PATIENTS WITH NARCOLEPSYWITH CATAPLEXYK SUN HWA, EY JOO, SB HONG
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
Background: To investigate the differences in hippocampal volume(HV) between narcoleptics and normal controls and determine if HV isassociated with memory function in narcoleptics, left and right HV andintracranial volumes (ICV) were manually measured and compared
between two groups.
Methods: The study consisted of 36 drug-naive narcoleptics with cataplexy and 36 age- and sex-matched controls (mean age, 29.0 years). All
subjects underwent 1.6-mm-thick spoiled gradient recalled magnetic
resonance imaging and took the Korean California Verbal Learning Test
and the Rey Complex Figure Test to assess verbal and visual memory.
Results: The mean ICV was not different between groups (1,599.2 cm3in narcoleptics vs. 1,623.5 cm3 in controls). Bilateral HV was significantly smaller in narcoleptics (left, 2,907.2 mm3 in narcoleptics vs.
3,092.3 mm3 in controls, P = 0.005; right, 2,990.8 mm3 in narcoleptics
vs. 3,184.3 mm3 in controls). Significance of HV differences between
groups remained after corrections were made for gender, age, and ICV.
In narcoleptics, bilateral HV was positively correlated with mean sleep
and REM sleep latencies in multiple sleep latency test. Absolute memory
scores were not different between groups and were not correlated with
HV in narcoleptics.
Conclusions: Narcoleptics had smaller bilateral HVs compared to controls. HV had a significant relationship with sleep and REM sleep latencies. This study provides supportive evidence of the functional andanatomical deficits in medial temporal areas that are related to theseverity of narcolepsy.

PO-1-166
24-HOUR AMBULATORY MONITORING OFSLEEP-WAKEFULNESS PATTERNS IN
NARCOLEPSYM KOHSAKA1, N FUKUDA2, T ISHIKANE1
1
Department of Psychiatry, Ishikane Hospital, Sapporo-city, Hokkaido,
Japan, 2Department of Health Sciences, Hokkaido University, Japan
Introduction: Narcolepsy is characterized by excessive daytime sleepiness (EDS), cataplexy and other dissociated manifestations of rapid eye
movement sleep (hypnagogic hallucinations and sleep paralysis). EDS
is common and associated with a broad range of medical, sleep andpsychiatric disorders. The diagnosis of narcolepsy should be confirmed
by a whole night polysomnographyic recording followed by a Multiple
Sleep Latency Test (ICSD-2). However, MSLT is designed to provide
information about the sleep tendency when the patients lie down. We
try to detect SOREMPs by 24-hour ambulatory monitoring and diagnose more precisely.
Methods: Twenty-four narcolepsy patients (age range: 15–78 years)
and 25 non-narcoleptic patients (age range: 15–68 years). Out of 24
narcoleptics, 22 patients presented typical clinical picture of cataplexy.
The primary complaint in non-narcoleptic patients is daytime sleepiness. 24-hour polygraphic recordings were performed with ambulatory
monitoring system. Patients were instructed to maintain wakefulness intheir rooms, reading books, listening to the radio. Sleep stages were

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

visually scored for 20-second epochs according to Rechtschahffen andKales criteria.
Results: 1) Daytime sleep: Two or more sleep-onset REM periods(SOREMPs) during the diurnal monitoring were observed in 92% of
narcoleptic patients and 4% of non-narcoleptic patients. 2) Nighttime
sleep: The nocturnal SOREMP was observed 77% of narcolepsy patientsand 12% of non-narcoleptics. Short sleep latency of less than 8 minutes
was also observed in 64% of narcoleptics, vs. 24% of nonnarcoleptics.
Conclusion: 24-hour ambulatory monitoring appears to be a usefulprocedure for diagnosis of narcolepsy. It provides information about the
number, duration and types of daytime sleep episodes, as well as documenting nocturnal sleep disturbance.

PO-1-167
STATE SPACE ANALYSIS OF SLEEP STAGE
TRANSITIONS IN NARCOLEPTIC PATIENTS AND
HEALTHY VOLUNTEERS

CR BAUMANN1, LL IMBACH1, U KALLWEIT1, J SARNTHEIN2,
E WERTH1
1
Neurology, University of Zurich, Zurich, Switzerland, 2Neurosurgery,
University of Zurich, Switzerland

Background: Behavioral states in human sleep are conventionallydescribed by subsequent analysis of characteristic EEG-patterns, representing the static sleep architecture. In this approach, the dynamic
properties of sleep, e.g. transitions between different behavioral states,
are not represented. Behavioral state instability is believed to be a key
feature in narcolepsy with cataplexy, but the dynamic aspect of changes
between behavioral states and the underlying pathology in sleep-wake
dynamics are poorly understood.
Methods: We analyzed polysomnography recordings of 7 narcoleptic
patients and 7 age-, gender- and BMI-matched healthy volunteers in a
2 dimensional state space, which was optimized by statistical modellingfor best differentiation of sleep behavioral states. Further dataevaluation was performed for cluster analysis, density estimates andvelocity calculations between behavioral states using various biostatistical approaches.
Results: We observed a uniform characteristic distribution of stableclusters in a reproducible 2-dimensional sleep state space for all patientsand volunteers. The presented data is focused on cluster appearance
and velocity calculations in 2 dimensions. We find qualitative changes
in cluster arrangement, e.g. a reduction in distance between clusters
representing WAKE and REM-sleep for narcoleptic patients as compared to the control group. Analysis of velocity distribution (as ameasure of EEG-frequency instability) shows higher overall velocities
in state space for narcoleptic patients in all EEG derivations, mostpronounced in frontal electrodes.
Conclusions: The highly conserved topography of the 2-dimensional
state space shows the potential general usefulness of this analysis technique not only in normal, but also in disordered sleep. In narcolepsy,
the higher proximity of clusters indicates behavioral state instability.
Furthermore, velocity analysis reveals differences between the twogroups, as a novel potentially diagnostic criterion not accessible byconventional polysomnography.

PO-1-168
THE BRAIN MICROSTRUCTURALABNORMALITIES IN NARCOLEPSY THOSE
CAUSE DAYTIME SLEEPINESS AND CATAPLEXYM NAKAMURA1, S NISHIDA1,2, Y UEKI2,3, K HAYASHIDA1,3,
Y INOUE1,2
1
Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo,
Japan, 2Department of Somnology, Tokyo Medical University, Japan,
3
Clinical psychiatry & somnology, Sleep & Stress Clinic, Japan

Introduction: Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are two major indices of diffusion tensor imaging (DTI)
which can detect microscopic axonal change by the diffusivity of watermolecules. In this study, we applied the voxel-based statistic approachfor FA/ADC map and conventional voxel-based morphometory (VBM)
technique to estimate the brain microstructural change in narcolepsy
and to ascertain its relationship to the mechanism of excessive daytime
sleepiness and cataplexy.
Method: The study included 12 narcolepsy with cataplexy (NA/CA),
12 narcolepsy without cataplexy (NA w/o CA) and 12 age-matchedhealthy normal controls (NC). FA/ADC images and gray/white matter
images obtained on a 1.5T MRI were statistically compared using voxelbased statistic technique. Furthermore, we investigated the correlation
between morphometric changes and sleep indices.
Results: NA group (NA/CA and NA w/o CA) showed higher ADC in
bilateral amygdala and left anterior cingulate, lower FA in left medial
frontal area, reduced gray matter of left temporal area and left caudate
and reduced white matter of midbrain and right precentral area thanNC. In comparison with NA w/o CA, NA/CA showed higher ADC inright frontal area, higher FA in right parietal area, higher white mattervolume in left cerebellum. In narcolepsy, sleep efficiency (SE) showednegative correlation with ADC and FA in mainly right limbic area, graymatter volume in left precentral area and white matter volume in left
cingulate, and positive correlation with white matter volume in left
precentral area and bilateral posterior cingulate.
Discussion: The volume reduction in midbrain may reflect the essential
abnormality of wake-sleep promoting system in narcolepsy. Higher
ADC in right inferior frontal area and higher white matter volume inleft cerebellum in NA/CA might be associated with the occurrence of
cataplexy. The correlation between SE and many brain area may suggestthat the degree of axonal change is related with the disturbance insleep-wake promoting system originating from brain stem.

PO-1-169SLEEP, SLEEPINESS AND VIGILANCE IN
DOPAMINE- AND HYPOCRETIN DEFICIENTDISORDERS

CR BAUMANN1, M WIENECKE1, E WERTH1, R PORYAZOVA1,
H VOGEL1, CL BASSETTI2, D WALDVOGEL1
1
Neurology, University of Zurich, Zurich, Switzerland, 2Neurology,
Ospedale Civico Lugano, Switzerland
Background: Parkinson disease (PD) and narcolepsy with cataplexy(NC) are caused by disturbed neurotransmitter signaling, particularly
dopamine and hypocretin (orexin). To better understand sleep-wakedisturbances against the background of these differential neurotransmitter deficiencies, we aimed at examining nocturnal sleep, excessive
daytime sleepiness, and vigilance in consecutive PD and NC patients,
and in matched healthy controls.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research309

Sleep, Science and Research

Methods: We prospectively included 10 patients with early PD, 10
patients with advanced PD, 10 NC patients, and 10 controls. All participants were examined with nocturnal polysomnography (PSG), multiple sleep latency tests (MSLT), and vigilance tests. Cerebrospinal fluid
hypocretin levels were assessed in all patients.
Results: Hypocretin levels were lower in patients with advanced compared to those with early PD, and undetectable in most NC patients.
Linear regression revealed that sleep efficiency on PSG was lower inpatients with deficient dopaminergic signaling (p = 0.008). The amountof deep sleep stage NREM3 and latency to REM sleep was also related to
dopaminergic signaling (p = 0.01 and p < 0.001). Otherwise we could
not identify influences of dopaminergic and hypocretinergic signaling on
PSG parameters. On the other hand, decreased hypocretin signaling was
associated both with decreased mean sleep latencies and increased
number of sleep onset REM periods on MSLT (both: p < 0.001). Vigilance
tests were not influenced by neurotransmitter signaling.
Conclusion: Nocturnal sleep is most altered in patients with advanced
PD, i.e. in patients with marked loss of dopamine neurons and partial
loss of hypocretin cells. On the other hand, excessive daytime sleepiness
was most pronounced in NC patients, i.e. in patients with subtotal lossof hypocretin neurons.

PO-1-170
DIFFERENCES IN FINDINGS OF NOCTURNAL
POLYSOMNOGRAPHY AND MULTIPLE SLEEPLATENCY TEST BETWEEN NARCOLEPSY ANDIDIOPATHIC HYPERSOMNIAY TAKEI1, Y KOMADA1,2, K NAMBA1, T SASAI1,2, M NAKAMURA1,2,
T SUGIURA1, K HAYASHIDA1,3, Y INOUE1,2
1
Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo,
Japan, 2Department of Somnology, Tokyo Medical University, Japan,
3
Sleep and Stress Clinic, Japan
Objectives: In order to clarify the difference in the characteristics ofdaytime sleepiness among narcolepsy with cataplexy (NA with CA),
narcolepsy without cataplexy (NA without CA), and idiopathic hypersomnia without long sleep time (IHS without LST), we compared thefindings of nocturnal polysomnography (N-PSG) and diurnal variations
in multiple sleep latency test (MSLT) parameters among patients withthese disorders.
Methods: The patients with NA with CA (n = 52, M : F = 24:28, 27.2 ±8.9 years), NA without CA (n = 62, M : F = 30:32, 26.7 ± 7.4 years), andIHS without LST (n = 50, M : F = 27:23, 29.5 ± 9.7 years) were enrolled
to this study. The polysomnographic findings were compared by using
One-way analysis of variance (ANOVA). Diurnal variations in MSLT
parameters were also compared with among three groups by Two-way
repeated measurements ANOVA (disease group × time period).
Results: The NA with CA group had significantly more disrupted andshallower nocturnal sleep than the other groups. On MSLT, the IHS
without LST group had significantly longer sleep latency (SL) comparedwith the two NA groups. The latter two groups did not show statisticaldifferences in diurnal variation of SL.
Conclusions: The IHS without LST group had milder objective daytime
sleepiness compared with the NA groups. In patients with NA, nocturnal sleep disturbances appeared only in cases with CA, despite a similar
trend in diurnal changes in sleep propensity between the two NAgroups. Our result suggested that objective nocturnal sleep disturbances
are specific to NA patients with CA, whereas diurnal variations of sleep
propensity are observed irrespective of the presence of CA among NA
patients. These findings could be helpful for making treatment plansfor patients with these disorder categories.

310

PO-1-171
THE EFFECT OF STEROID THERAPY FOR 2
PATIENTS WITH NARCOLEPSYR MIYATA1, M HONDA2, J KOHYAMA3
Department of Pediatrics, Tokyo-kita Social Insurance Hospital, Tokyo,
Japan, 2Department of Sleep Research Project, Tokyo Metropolitan Instituteof Medical Science, Japan, 3Department of Pediatrics, Tokyo Bay Urayasu/
Ichikawa Medical Center, Japan
1

Introduction: The relation of autoimmune system with narcolepsy wassuggested. We used streroid for 2 patients with narcolepsy who had
suffered about 1 month before. It was effective for thier symptoms with
narcolepsy.
Case 1: An 11 years-old girl could not walk with cataplexy suddenly.
At the same time, she became to wake in early morning and not to beable to maintain the night sleep. Somniloquence and myoclonus in falling
asleep appeared remarkably. She could not walk without help becauseof cataplexy. Daytime sleepiness was very strong and she could not keep
awake more than 15 minutes. In electroencephalography, time for falling
asleep was 0 minute, sleep onset rapid eye movements was demonstrated, and she had seven sleep cycles. The orexin level in cerebrospinal
fluid (CSF) was decreased remarkably. She was diagnosed as narcolepsy.
About one month after the onset, she was treated with oral prednisolone
1 mg/kg/day. She was medicated with full dose of predonisolone for
2 weeks and decreased gradually. She became to be suffered from cataplexy only in laughing, to be able to walk alone and maintain awakening
time in daytime 1 week after the start of treatment.
Case 2: A 13 years-old boy could not walk with cataplexy, suddenly.
At the same time, he became to sleep in daytime and not to be able tomaintain the night sleep. The orexin level in CSF was decreased remarkably. He was diagnosed as narcolepsy. One month after the onset, he
was treated with oral prednisolone 1 mg/kg/day. He was medicated withfull dose of predonisolone for 2 weeks and decreased gradually. His
cataplexy and daytime sleepiness improved remarkably 2 days after
oral prednisolone. Mild sleepiness reappeared with decrease of
prednisolone.
Discussion: Steroid therapy revealed thier cataplexy and daytime sleepiness slightly, though cytokines and orexin levels in CSF were notchanged from before to after treatment. It seemed that the steroid
therapy was effective partly for the symptoms of narcolepsy.
Conclusion: Steroid therapy could be one of the therapies for narcolepsy in early period of suffering.

PO-1-172
INVESTIGATION OF BINGE EATINGBEHAVIOURS IN NARCOLEPSYDM GATTI1, D BRUCK2
1
Psychology, Victoria University, Hoppers Crossing, Victoria, Australia,
2
Psychology, Victoria University, Australia
Previous work has suggested that eating behaviours in narcolepsy may
be abnormal. Binge eating behaviours of individuals with and without
narcolepsy were investigated as part of a larger study. Of particularinterest was the hypothesised difference in self reported binge eating
across the two groups and possible relationships within the narcolepsy
group between eating patterns and sleepiness and mood. Our sample
consisted of 73 individuals with unambiguous narcolepsy (M = 58.4 yrs,
SD = 18.5) and 74 controls (M = 57.2 yrs, SD = 15.4). Groups werematched on age and gender. Controls with a sleep disorder or a disorderthat restricted food intake were excluded. Measures used were the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

Bulimia Test, Depression Anxiety Stress Scale and Epworth Sleepiness
Scale (ESS) and analyses used the Mann Whitney U Test. It was foundthat individuals with narcolepsy were significantly more likely to reportbinge eating than controls (p = .001). A derived ‘binge eating factor’ fromthe Bulimia Test was used (Cronbach’s alpha = 0.88). Using this binge
factor as the dependent variable it was found that individuals with
narcolepsy who had ‘moderate to high’ anxiety and/or stress (comparedto ‘no to mild’) scored significantly higher on the binge factor (p = .001
and p = .000 respectively). No significant differences on the binge factor
were found between individuals with narcolepsy who had severe andless severe daytime sleepiness (ESS rated both on and off medication) or
depression. In sum, individuals with narcolepsy were found to be more
likely to report binge eating than controls, and those with moderate tohigh anxiety and stress were more at risk. Understanding such risk
factors will aide health professionals in preventing and treating eating
disordered behaviours in narcolepsy.

PO-1-173
NEW INSIGHTS IN UNDERSTANDING
AUTOMATIC BEHAVIOUR
D BRUCK, M MORANDIN
Social Sciences and Psychology, Victoria University, Yarraville, Australia
Automatic behaviours are stereotyped, repetitive behaviours performed
without awareness. Descriptors include “highway hypnosis” and “automatic pilot”, portrayed in both non-clinical (sleep deprived) and clinical(hypersomnia) populations. At present little is known about thiscomplex phenomenon, and research in the area is minimal. The highprevalence of automatic behaviour in some individuals with narcolepsy
provided the opportunity for new insights on such behaviours. The
study was based on an in-depth, phenomenological analysis of theexperiences of ten individuals with narcolepsy (with self-reported moderate to severe automatic behaviour). Procedures included two interviews, a family member interview, a one week journal and a one day
minimal medication journal. Prominent issues discussed by participants
and presented include behaviours associated with automatic behaviour(including errors), internal states of sleepiness and cognitive load, as
well as ways of controlling automatic behaviour. Different types ofautomatic behaviour were identified; Type 1 (sleepiness with low cognitive load), Type 2 (sleepiness with high cognitive load) and Type 3 (highcognitive load without sleepiness). New contributions include; thenotion of cognitive load, the Type 3 phenomena, the possible progression of Type 1 to sleep, a new classification of errors (sequencing errors,
item/environment intrusions, perseverative action leading to nonsense,
context inappropriate behaviours), the importance of adequate medication, as well as a discussion of the key roles of vigilance and feedbackin the cognitive mechanism of automatic behaviour. Further research isneeded to determine whether these findings in narcolepsy have implications for understanding automatic behaviour in sleep deprived individuals (e.g. shift workers).

PO-1-174QUALITY OF LIFE IN PATIENTS WITH
NARCOLEPSY WITH CATAPLEXY, NARCOLEPSYWITHOUT CATAPLEXY, AND IDIOPATHIC
HYPERSOMNIA WITHOUT LONG SLEEP TIMEA OZAKI1, Y INOUE2,3, K HAYASHIDA2, T NAKAJIMA2,4,
M HONDA2,5, A USUI2,6, Y KOMADA2,3, M KOBAYASHI2,
K TAKAHASHI2,7
1
School of Nursing, Toho University, Tokyo, Japan, 2NeuropsychiatricResearch Institute, Japan Somnology Center, Japan, 3Department of
Psychiatry, Tokyo Medical University, Japan, 4Department of
Neuropsychiatry, Kyorin University, Japan, 5Sleep Disorder Research
Project, Tokyo Institute of Psychiatry, Japan, 6Faculty of Health Science
Technology, Bunkyo Gakuin University, Japan, 7Japan Foundation for
Neuroscience and Mental Health, Japan

Objective: To assess quality of life (OQL) in patients with narcolepsy
with cataplexy (NA-CA), narcolepsy without cataplexy (NA w/o CA)
and idiopathic hypersomnia without long sleep time (IHS w/o LST) who
were taking psychostimulant medication, and to ascertain which factors(including psychosocial and environmental variables) influence QOL inthis population.
Methods: A total of 185 patients who had received regular treatment
were enrolled (NA-CA, n = 83; NA w/o CA, n = 48; IHS w/o LST, n =54). Patients were asked to complete questionnaires including the Short
Form-36 Health Survey (SF-36), the Epworth Sleepiness Scale (ESS),
and items concerning psychosocial and environmental variables.
Results: All 3 diagnostic groups had significantly lower scores in most
SF-36 domains compared with Japanese normative data, although the
ESS score was significantly reduced with the treatment. Multiple logistic
regression analyses revealed that several SF-36 domains were associatedwith the ESS score, having automony in controlling one’s job schedule,
having the experience of a divorce or breakup with a partner due tosymptoms, having the experience of being forced to relocate or dismiss,and perception of support from others.
Conclusions: Not only severity of subjective sleepiness but also psychological and environmental variables influenced QOL in patients withthese hypersomnias of central origin.

PO-1-175
INJURIES AND PROPERTY DAMAGE DUE TO
SMOKING IN NARCOLEPTIC PATIENTSL KRAHN1, N SLOCUMB2, M SILBER3
Sleep Medicine/Psychiatry and Psychology, Mayo Clinic, Scottsdale AZ,
United States of America, 2Sleep Medicine, Mayo Clinic, United States ofAmerica, 3Sleep Medicine/Neurology, Mayo Clinic, United States ofAmerica
1

Objectives: Most fires related to lighted smoking materials occur whena smoker falls asleep, representing a leading cause of death, injury andproperty damage in the U.S. Smokers with sleep disorders associatedwith excessive daytime sleepiness (EDS) are expected to be at increased
risk. A previous study of attendees of a Narcolepsy Network meeting
reported adverse consequences including burns and injuries associatedwith smoked tobacco. This project seeks to re-examine these findings
in a larger sample of narcolepsy patients seen at an academic medical
center.
Methods: After being approved by the I.R.B., a questionnaire concerning nicotine use was mailed to a registry of narcolepsy patients© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research311

Sleep, Science and Research

maintained by a U.S. medical center. 110 questionnaires were returnedin the postage paid envelope.
Results: The respondents were 60% female and ranged in age from 18
to 87. A lifetime point prevalence of smoking tobacco was describedby 54% of respondents. Current cigarettes and cigar use was reported
by 16%. Median usage was 1 pack of cigarettes per day. Burns anddamage related to smoking was reported by 19 respondents (17%).
Reported consequences included clothing burns (15), furniture (12),skin burns (10), and other property (4). These incidents were frequently
associated with being asleep. Perceived effect of nicotine on sleepiness
was a reduction for 44%, neutral for 40% and increase for 4%.
Conclusions: Persons with narcolepsy who smoke experience injury
and property damage due to lighted smoking materials. Even though asignificant percentage of respondents perceive nicotine to reduce EDS,
smoking cessation should be strongly advised. Effective nicotine cessation strategies need to be identified and specifically studied in patientswith narcolepsy.

PO-1-176
DELAY OF GRATIFICATION IN NARCOLEPSYPA BEITINGER, M-E BEITINGER, R WEHRLE, A STEIGER
Sleep Lab, Max Planck Institute of Psychiatry, Mnchen, Germany
Orexins are involved in the regulation of food intake and sleep. Narcolepsy is characterized by a central orexin deficiency. Studies report anincreased body weight in narcolepsy. The inability to delay gratificationis related to obesity. This study investigates the delay of gratification inpatients with narcolepsy. Nine patients organized in the German Narcolepsy Self-help Group (DNG) with polysomnographically verified
narcolepsy (F/M 7/2: mean age 37.9 ± 18 years; mean BMI 25.0 ±4.9 kg/m2) were included in the study. We designed a board game toassess the delay of gratification. On designated fields patients had todecide whether they choose an immediate small gratification consistingof a small piece of sweetie or whether they continue playing and get
double of the amount in the end of the game. The outcome measure is
the percentage of decisions in favor of delay. The percentage was calculated for the total game and for the three thirds of the fields. The
sleepiness was assed with the Karolinska Sleepiness Scale (KSS) before
and after the game. Nine control subjects were individually matched
for gender, age and BMI (mean age: 38 ± 18 years; mean BMI 25.3 ±4.8 kg/m2). The percentage of decisions in favor of delaying did not
differ between patients with narcolepsy (89 ± 10%) and individuallymatched controls (83 ± 19%, p = 0.40). The percentage of decisions infavor of delayed gratification across the time hardly increased little in
the narcoleptic group (80%, 91%, 93%) across the 3 thirds. It showeda steep increase in the control group (65%, 86%, 92%). KSS dropped
or remained stable in all but one narcoleptic individuals. These preliminary results suggest no obvious peculiarities concerning the delay ofgratification in narcoleptic patients. Subtle differences in favor of stronger inhibition may be possible. Remarkably the decisions made induced
preferentially the intake of a higher amount of sweeties. The board gameparadigm emerged as valuable tool that takes into account the sleepinessof narcoleptic patients. Investigating a larger sample will help control
for the large standard deviation.

312

PO-1-177
TOLERANCE AND EFFICACY OF SODIUMOXYBATE IN CHILDHOOD NARCOLEPSYWITH CATAPLEXY

ML LECENDREUX1, F POLI2, D OUDIETTE3, F BENAZZOUZ1,C DONJACOUR4, C FRANCESCHINI2, E FINOTTI2, F PIZZA2,O BRUNI5, G PLAZZI2
1
Pediatric Sleep Center, Hospital Robert Debre, Paris, France, 2Departmentof Neurological Sciences, University of Bologna, Italy, 3Sleep Disorders
Unit, Pitié-Salpétrière Hospital, Paris VI University, Paris, France,
4
Department of Neurology and Clinical Neurophysiology, Leiden University
Medical Center, Netherlands, 5Dept. of Developmental Neurology andPsychiatry, Pediatric Sleep Center, Sapienza, Italy
Narcolepsy with cataplexy is a disabling lifelong disorder frequently
arising during childhood.
Pediatric narcolepsy often results in severe learning and social impairment. Improving awareness about this condition increases early diagnosis and may allow patients to rapidly access adequate treatments
including pharmacotherapy and/or non-medication-based approaches.
Even though children currently undergo pharmacotherapy, data about
safety and efficacy in the paediatric population are scarce.
The present study brings preliminary data on the efficacy of Sodium
Oxybate in a childhood and adolescent population of 27 patients suffering from narcolepsy with cataplexy, also confirming a previous reporton 8 children. Sodium Oxybate has been shown to be efficacious andwell tolerated by the majority of subjects, during a long-term
follow-up.
Sodium Oxybate may therefore constitute a very valuable treatment inchildhood narcolepsy with cataplexy.

PO-1-178
INTRAVENOUS HIGH DOSE IMMUNOGLOBULIN
TREATMENT IN LATE-ONSET NARCOLEPSYWITH CATAPLEXYJY JEONG, DJ KIM, SM LEE, JW CHO, DS KIM
Department of Neurology, Pusan National University Yangsan Hospitol,
Yangsan, Republic of Korea
Background: Narcolepsy with cataplexy (NC) is associated with thedegeneration of the posterolateral hypothalamic neurons containing
hypocretin. Because of the close HLA association, the disorder has beensuggested to be autoimmune in nature. We report an outcome of intravenous high-dose immunoglobulin (IVIg) treatment in late-onset narcolepsy and cataplexy patient.
Case: A 55-year-old man presented a 5 months history of sudden sleep
attack during wakefulness and intermittent muscle weakness inducedby emotions. His Epworth Sleepiness Scale score was 23, which meant
severe excessive daytime sleepiness (EDS). Nocturnal polysomnography
and multiple sleep latency test findings revealed short sleep latency and2 SOREM, which were competent with narcolepsy. His HLA DQB1*0602
was positive, and CSF hypocretin level was below 40 pg/ml. Therefore,
his initial diagnosis was narcolepsy with cataplexy. A diagnosis of idiopathic narcolepsy-cataplexy was finally made. He has been treated withmodafinil and methylphenidate for his excessive sleepiness, and clomipramine for cataplexy. After 5 months, IVIg were administered at thewidely used dosage in autoimmune diseases, also suggested in NC:
0.4 g/kg per day for five days, repeated monthly for three months andfollowed by the same single day dose every. After the entire IVIg cycle,© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

no effects of EDS and cataplexy were observed during or after the entire
IVIg treatment. CSF hypocretin level was still below 40 pg/ml.
Conclusion: Several factors may account for the lack of significant
effects of IVIg in our patients. First, CSF hypocretin-1 was alreadyundetectable, suggesting thatautoimmune destruction of hypocretin
neurons was already complete when IVIg therapy was started. Second,
the treatment protocol might be not sufficient. At last, our patients wereolder at disease onset. Further efforts on a well selected large group of
NC patients are needed to assess their spectrum of efficacy in thisdisease.

PO-1-179
MOOD, ACTIVITY, AND QOL IN PATIENTS WITH
BEHAVIORALLY INDUCED INSUFFICIENT SLEEPSYNDROME AND NARCOLEPSY AS DETERMINEDBY POMS AND QOL26Y HASHIZUME, N UCHIMURA
Neuropsychiatry, Kurume University, Kurume, Japan
Introduction: The sleeping time of Japanese adults has been decreasing
every year, and is now estimated to be less than 6 hours per night on
average. Insufficient sleep may cause excessive daytime sleepiness,
which in turn influences mood, daytime activity, and quolity of life
(QOL). And we have seen an increasing number of patients with behaviorally induced insufficient sleep syndrome (BIISS) at our sleep disorders outpatient clinic. This study sought to determine the incidence ofsleep disorders among medical college students.
Subjects and Methods: We investigated the mood, daytime activity,
and QOL of 93 medical college students by using the Profile of Mood
States (POMS), the Quality of Life 26 (QOL26) scale, the Pittsburg Sleep
Quality Index (PSQI), and Epworth score. For those subjects who were
found to have BIISS and narcolepsy on assessment, we additionallyconducted the multiple sleep latency test (MSLT).
Results: Among the 93 subjects, 38 were found to have BIISS (male:22, female: 16; mean age: 21.8 years), 20 had narcolepsy (male: 10,
female: 10; mean age: 24.3 years), and 35 had no sleep disorders (male:24, female: 11; mean age: 24.1 years). For subjects found to have BIISS
and narcolepsy, the respective MSLT results were 60.2% and 81.3% forsleep efficiency, 453.2 s and 206.5 s for sleep latency, and 1 and 2.7 for
number of REM periods. The Epworth score was markedly higher
among the groups with sleep disorders than the healthy group, andlikewise scores on the POMS indicated poorer mood profiles for thosewith sleep disorders.

PO-1-180
FALSE-POSITIVE CASES IN MSLT BY
ACCUMULATED SLEEP DEFICIENCYT KIZAWA1, K HOSOKAWA1, M SATO2, J TOKUNAGA2, W ITO2,M ECHIZENYA2, T NISHIJIMA1, S TAKAHASHI1, S SAKURAI1,
T KANBAYASHI2, A SUWABE1, T SHIMIZU2
1
Department of Laboratory & Sleep Medicine, Iwate Medical University
School of Medicine, Morioka, Iwate, Japan, 2Department of
Neuropsychiatry, Akita University School of Medicine, Japan
Introduction: MSLT is usually performed as objective assessment of
sleepiness. It is performed on the following day after PSG. In mostclinics and hospitals, patients are required to stay for a couple of days.
However, if patients have chronic insufficient sleep, the accumulationof their sleep insufficiencies may affect MSLT results. Even if they getenough nocturnal sleep during the PSG, their sleep insufficiencies
would not be fully recovered (Janjua T. 2003). In the present study, we
compared each sleep latency by examining it with MSLT twice. First
session is 0 or one hospitalized night with the following MSLT, andsecond session is three or more hospitalized nights with the following
MSLT.
Methods: Ten males and one female (31.8 ± 14.2 yrs) who performed
MSLT twice were enrolled in our study. They complained about sleepwake disorders in our hospital from 2004 to 2010. Initially, we examined these cases using standard PSG and MSLT procedure, however,their results were doubtful compared with sleep logs and other symptoms. Therefore, we examined these doubtful cases for the second
examination with two or more previous hospitalized nights and following PSG and MSLT procedure (total three or more hospitalized nights).
Result: Mean sleep latency was 6.4 min in ‘0 or one night’ group and14.8 min in ‘three or more nights’ group. There was a significant difference between these two groups (p < 0.001).
Conclusion: Sleep latencies of ‘0 or one night’ group were shorter thanthose of ‘three or more nights’ group. This may produce false-positive
results at diagnosis when patients were examined by standard PSG and
MSLT procedures. It is thought that the effects of insufficient sleep affectthese procedures, consequently, shorten sleep latencies. Therefore, weneed to consider the hospitalized durations before PSG and MSLT
procedures.
Reference:
Janjua T. et al. Clinical caveat: prior sleep deprivation can affect the
MSLT for days. Sleep Med. 2003; 4(1): 69–72.

PO-1-181
NOCTURAL ASPECT OF CENTRALHYPERSOMNIA PATIENTS. ANALYSIS OF
SELF-COMPLETED QUESTIONNAIREM HONDA1, Y HONDA2
1
Psychiatry and Behavioral Sciences, Sleep Research Project, Tokyo
Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan,
2
Japan Somnology Center, Neuropsychiatric Institute, Japan
Introduction: Symptoms other than excessive daytime sleepiness are
not always evaluated well in patients with hypersomnia of central
origin. In order to elucidate the nocturnal characteristics of hypersomnia, we performed questionnaire-based survey to study the prevalenceof nocturnal sleep problems and their correlates.
Methods: Subjects are 358 hypersomnia patients (216 narcolepsy withcataplexy; NA, 31 idiopathic hypersomnia with long sleep time; IHS,
111 essential hypersomnia; EHS) recruited in Japan Somnology Centerand 292 non-hypersomnia controls. Self-completed questionnaireasking the frequency of nocturnal sleep problems and related symptoms
were collected.
Results: Most hypersomnia patients tend to fall asleep in a short time,
but the percentage of sleep initiating problems are similar amonggroups. Number of nocturnal awakenings is frequent in NA. Dreaming
at nocturnal awaking is frequent in NA (44%) compared to Control(23%). 15% of NA experience difficulty in resuming sleep at nocturnal
awakenings. Time required to be fully awake in the morning is characteristically longer in IHS. NA can wake up more easily than Control.
Prevalence of hypnagogic hallucination is high in NA (78%), EHS &IHS (40%) compared to Control (7%). Note that REM sleep related
phenomena are not rare in IHS. Modality of hypnagogic hallucination
content shows similar pattern across groups; more visual than auditory
hallucination. Tactile hallucination is common in NA and feeling of© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research313

Sleep, Science and Researchfloating/flying is common in all the subjects with the experience. Frequent nocturnal eating with half asleep condition is reported from 7%of NA. Body temperature dysregulation is common among hypersomnia
patients: Raynaud phenomena in IHS (25%) and excessive sweating inNA (53%). Two thirds of IHS suffered from fatigue.
Conclusion: Nocturnal sleep of hypersomina patients shows characteristic pattern, especially in the process of waking up in the morning,which could be partly REM-related. It is clinically important to ask
hypersomnia patients for nocturnal sleep problems besides daytime
sleepiness.

PO-1-182
POST INFLUENZA A/H1N1 HYPERSOMNOLENCE:REPORT OF 2 CASES AND REVIEW OF THE
LITERATURE
K DOONG WOO
Department of Psychiatry, St. Vincent’s Hospital, Su won, Republic of
Korea
We present 2 patients who complained for excessive daytime sleepinessafter Influenza A/H1N1 infection. First case is a 42 year old woman
who experienced excessive daytime sleepiness and cataplexy 10 days
after the remission of suspected acute Influenza A/H1N1 infection.
HLA-DQB1*0602 was negative. The diagnosis of narcolepsy with cataplexy was confirmed following extensive investigations including polysomnography and multiple sleep latency test (MSLT). Second case is a
16 year old male adolescent who had Influenza A/H1N1 confirmed by
RT-PCR. Three months after his recovery, the patient developed monthly
hypersomnolent attack with 5 days of mean duration. He was also
accompanied by memory loss and hyperphagia. Polysomnographic
recordings in between attacks showed relatively normal sleep structure.
2 SOREMPs appeared and sleep latency was 5.8 min in MSLT. Thesefindings provide support for association of Influenza A/H1N1 infection
with hypersomnolence.

PO-1-183 / AS-31 Presenter
PITOLISANT, AN INVERSE AGONIST OF THE
HISTAMINE H3 RECEPTOR: AN ALTERNATIVETREATMENT FOR SEVERE EXCESSIVE DAYTIMESLEEPINESS IN CHILDREN WITH NARCOLEPSYCI INOCENTE1, I ARNULF2, H BASTUJI3, A THIBAULT-STOLL4,
MJ CHALLAMEL5, A RAOUX6, R RUBENS7, J-S LIN8, P FRANCO9
1
Pediatric Sleep Unit, Integrative Physiology of Brain Arousal System,
CRNL, INSERM-U1028, CNRS-UMR52, Hôpital Femme Mère Enfant,
University Lyon 1, Lyon, France, 22AP-HP, Groupe Hospitalier PitiéSalpêtrière, Unité des Pathologies du Sommeil & Pierre et Marie Curie –Paris 6 University, Centre de Recherche de l’Institut du Cerveau et de la
Moelle épinière, UMR-S975, CNRS UMR7225 & Inserm, U975;
National reference centre for orphan diseases, narcolepsy, idiopathic
hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie);
Groupe Hospitalier Pitié-Salpêtrière; Pierre et Marie Curie – Paris 6
University; UMR-S975, CNRS UMR7225 & Inserm, U975, France,
3
Service d’hypnologie, Hôpital Neurologique Central Integrative Physiology
of Pain, CRNL, INSERM U1028 – CNRS UMR5292, University Lyon1,
Hôpital Neurologique Central Integrative Physiology of Pain, CRNL,
INSERM U1028 – CNRS UMR5292, University Lyon1, France, 4Centre dusommeil-épilepsie, clinique Sainte BARBE, Strasbourg; Clinique Sainte
BARBE, France, 5Integrative Physiology of Brain Arousal System; CRNL,
INSERM-U1028, CNRS-UMR5292, University Lyon1; Pediatric Sleep Unit,
Hôpital Femme Mère Enfant, University Lyon1; CRNL, INSERM-U1028,
CNRS-UMR5292, University Lyon1; Hôspital Femme Mère Enfant, France,
6
Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028,
CNRS-UMR5292, University Lyon1; Pediatric Sleep Unit, Hôpital Femme
Mère Enfant, University Lyon1; National reference centre for orphan
diseases, narcolepsy, idiopathic hypersomnia and Kleine-Levin Syndrome(CNR narcolepsie-hypersomnie); CRNL, INSERM-U1028, CNRSUMR5292, University Lyon1, France, 7Sleep Medicine Advanced ResearchGroup, Division of Clinical Neurology, Hospital das Clinicas, University ofSão Paulo Medical School; Hospital das Clinicas, University of São Paulo
Medical School, Brazil, 8Integrative Physiology of Brain Arousal System,
CRNL, INSERM-U1028, CNRS-UMR5292, University Lyon1; CRNL,
INSERM-U1028, CNRS-UMR5292, University Lyon1, France, 9Integrative
Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRSUMR5292, University Lyon1; Pediatric Sleep Unit, Hôpital Femme Mère
Enfant, University Lyon1; National reference centre for orphan diseases,
narcolepsy, idiopathic hypersomnia and Kleine-Levin Syndrome (CNR
narcolepsie-hypersomnie); CRNL, INSERM-U1028, CNRS-UMR5292,
University Lyon1, France
Narcolepsy is linked to a deficiency of orexins. Its clinical manifestations are often more severe in children than in adults. Narcoleptic cataplectic, NC, patients also show a deficit of histamine, HA, anotherhypothalamic arousal system. We have identified brain HA H3 receptor
as new cerebral target for the therapy of sleep wake disorders andproposed Pitolisant, inverse agonist of H3 receptor, as a new class ofanti narcoleptic drugs. In this work, we report retrospectively ourexperience of the off label use of Pitolisant in children followed in our
sleep disorders center with severe NC with a refractory sleepiness tohabitual therapy at recommended doses: modafinil, methylphenidate,mazindol, sodium oxybate. All these patients developed their diseasein childhood, 12.5 plus and minus 3 years, 50 per cent boy. These
treatments have been stopped for side effects, 4; and lack or partial
efficacy; 2. The adolescents were 17.35 plus and minus 0.8 years old.
Pitolisant treatment has been progressively increased from 10 to 40 mg.
All the patients except one received the maximum dose. The treatment
was rarely efficient alone; other treatment was required in association:
ritaline, mazindol, sodium oxybate. In these conditions, subjective and314© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

objective sleepiness decreased. ESS decreased from 14.35 plus andminus 1.1 to 9.25 plus and minus 2.5 and the sleep latency at Maintenance Wakefulness Test increased from 27.95 plus and minus 14.9 to34.95 plus and minus 8.8 min. There was no habituation during thefollow up, 13.55 plus and minus 7.1 months. The side effects were mild
and transitory. Insomnia was the only long term side effects in 2
patients. Indeed, the polygraphic results showed a decrease in total
sleep time, in percent of sleep efficiency, in percent of 3 and 4 NREM
sleep and REM sleep and an increased in arousals during sleep. Pitolisant
had not repercussions on blood analyses and the cardiologic evaluation.
Pitolisant could be an alternative treatment with few side effects forsevere excessive daytime sleepiness in children with narcolepsy.
However long term follow up is required.

PO-1-184
SUSTAINED ATTENTION TO RESPONSE TASK(SART) SHOWS IMPAIRED VIGILANCE IN A
SPECTRUM OF DISORDERS OF EXCESSIVEDAYTIME SLEEPINESSMKM VAN SCHIE1, RD THIJS2, R FRONCZEK3,
HAM MIDDELKOOP4, GJ LAMMERS5, JG VAN DIJK6
1
Clinical Neurophysiology, Leiden University Medical Centre, Leiden,
Netherlands, 2Neurology and Clinical Neurophysiology, Leiden University
Medical Centre, Netherlands, 3Neurology, Leiden University Medical
Centre, Netherlands, 4Neuropsychology, Leiden University Medical Centre,
Netherlands, 5Neurology, Leiden University Medical Centre, Netherlands,
6
Neurology and Clinical Neurophysiology, Leiden University Medical
Centre, Netherlands
The Sustained Attention to Response Task (SART) comprises withholding key presses to 1 in 9 of 225 target stimuli; it proved to be a sensitive
measure of vigilance in a small group of narcoleptics. We studied SART
results in a 96 patients from a tertiary narcolepsy referral centre. Diagnoses according to ICSD-2 criteria were narcolepsy with (n = 42) andwithout cataplexy (n = 5), idiopathic hypersomnia (n = 37), andobstructive sleep apnea syndrome (n = 12). The SART was administeredprior to each of 5 MSLT sessions. Analysis concerned error rates, mean
reaction time (RT), RT variability and post-error slowing, as well as thecorrelation of SART results with mean latency of the Multiple Sleep
Latency Test (MSLT) and possible time of day influences. Median SART
error scores ranged from 8.4 to 11.1, and mean RTs from 332 to
366 ms. SART error score and mean RT did not differ significantly
between patient groups. SART error score did not correlate with MSLT
sleep latency. RT was more variable as the error score was higher. SART
error score was highest for the first session. We conclude that a high
SART error rate reflects vigilance impairment in excessive daytime
sleepiness irrespective of its cause. The SART and the MSLT reflect different aspects of sleep/wakefulness and are complementary.

PO-1-185
DAYTIME SLEEPINESS AND SLEEP DISORDERS
IN PATIENTS WITH ALLERGIC RHINITISS CHIBA1, T YAGI2, S WATANABE3, S NISHINO1
Sleep & Circadian Neurobiology Lab, Stanford University School of
Medicine, Palo Alto, United States of America, 2Sleep Center, Ota General
Hospital, Japan, 3Depertment of Otorhinolaryngology, Jikei University
School of Medicine, Japan

with severe symptoms during season (just 2–3 mth). In clinically, there
is a big problem about QOL including daytime sleepiness and sleep
problems, and the medical expenses are estimated 150 billion yen.
(⩽1.5 billion) Recently, There are some clinical reports about correlation between allergic rhinitis and sleep disturbance. But we are not sure
how to influence to Sleep or Daytime sleepiness?
Methods: Objective Study: 22 patients with hey fever caused by cedar
Pollen were enrolled. We evaluated sleep architecture and objective
sleepiness between before the season & on season using PSG and MSLT.
Results: WASO (wake time after sleep on set) showed significantly
increase during on season rather than before season: (from 16.4 to
29.7 min). AHI does not change for the worse during on season. (total
nasal resistance >0.3 pa/cm3/sec) The highest accuracy rate is 72.7%
using this statistical model. In 10 patients with nasal obstruction (total
nasal resistance >0.3 pa/cm3/sec) out of 22, REM-sleep decreased (from24.4 to 21.1%) and mean MSLT decreased (from 12.9 to 8.4 min)significantly. Especially 4 out of 11 showed severe sleepiness that wasrecognized as disease (MSLT < 5 min) on season. Three following
hypotheses are considered as likelihood, however, Pathology of allergic
rhinitis affecting sleep is still not known. 1, Nasal obstruction will cause
sleep disordered breathing. 2, Nasal obstruction will directly affect on
sleep. 3, Chemical mediators in allergic diseases will affect on Sleep/
Wake Center. Further studies are needed.
Conclusion: There are strong associations between nasal symptom
especially nasal obstruction, sleepiness and sleep quality. But cause andeffect is unknown. We need further study about allergic rhnitis andsleep disorders.

PO-1-186
MONOZYGOTIC TWINS CONCORDANT FOR
RECURRENT HYPERSOMNIAT UENO1, A FUKUHARA2, A IKEGAMI2, F OHISHI2, K KUME1
Department of Stem Cell Biology, Institute of Molecular Embryology andGenetics, Kumamoto University, Kumamoto, Japan, 2Department ofInternal Medicine, Kuwamizu Hospital, Japan
1

Recurrent hypersomnia is a rare sleep disorder occuring during adolescence. It is characterized by intermittent periods of excessive sleepiness,cognitive disturbances and behavioral abnormalities. The pathogenesisof recurrent hypersomnia is not yet known. Although most cases ofrecurrent hypersomnia are sporadic, there may be a genetic predisposition, since nine familial cases have been described. However, no caseof twins affected with recurrent hypersomnia has been reported.
Here we describe monozygotic twins who both affected with recurrent
hypersomnia. In both cases, infection of influenza virus was followedby the onset of the first episode. Actimetry recording showed thatduring attacks, activity in day was decreased compared to asymptomatic
periods, on the other hand, the activity during night was significantly
higher in symptomatic periods. Polysomnography (PSG) revealed
decreased slow wave sleep and frequent awakenings during symptomatic period. Human leukocyte antigen (HLA) typing revealed there are
no existence of DQB1*02 loci. Our observations suggest that the possible presence of genetic and autoimmune processes, although association with HLA remains controversial.

1

Background: Today, in Japan, over 20 million peoples are suffered fromHay fever caused by cedar pollen, and every year, they are disturbed© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

315

Sleep, Science and Research

PO-1-187
SLEEPY AND AGITATED-KLEINE-LEVINSYNDROME MISDIAGNOSED AS BIPOLARDISORDER: A CASE REPORTY LIN1, C-C YAO1, H-C LIU1
Department of Psychiatry, Mackay Memorial Hospital, New Taipei City
25160, Taiwan, Taiwan, 2Center for Dynamical Biomarkers andTranslational Medicine, National Central University, Taiwan
1Case report: The patient, a 16 year-old Taiwanese teenager, had thedisease onset when he was 11. He had regressive behavior, bursts ofcrying and irritability after flu-like symptoms. Post-infectious encephalitis was initially impressed. After steroid pulse therapy, the condition
remitted. But condition recurred and he was hospitalized for steroid
pulse therapy three times within 3 months. Each episode lasts for
1–2 weeks. He manifested visual hallucinations, emotional lability, irritability, increased activity, excessive talking, distractibility, drowsinessand hyperphagia. Then he was brought to another hospital and wasdiagnosed as bipolar disorder. No more steroids was given. He washospitalized in psychiatric ward twice during a 18 month period withpoor adherence to lithium treatment. Due to lithium intoxication, his
medications were shifted to valproic acid and lorazapam. He still had
episodes of sleepiness and agitation. A typical episode which happened
once to twice per year included intermittent hypersomnolence, behavioral and cognitive disturbances which resulted in 8–10 days of hospitalization. His brain imaging results, biochemistry data and thyroid
function were normal during these episodes. No epilepsy was seen. He
was drowsy with a total sleep time of 13 hours a day, but when he got
off bed, he would become argumentative, agitated, shouted and had
many goal-directed behaviors. Between episodes, he had normal daily
activities with almost no symptoms. There were episodes with abrupt
onset despite fair drug compliance and with-in drug level, which is notoften seen in bipolar patients. The recurrences were mainly in winterand autumn, and none of them were in summer. After exclusion anddiscussion, diagnosis of Kleine-Levine syndrome was established. We
keep treatment with anticonvulsants with no antipsychotics. There werelonger interspersed lucid periods within the recurring episode.
Conclusion: KLS can have typical manifestations of bipolar disorder.
However, the disease course pattern and hypersomnic symptoms help
differentiate the two disorders.

PO-1-188
UNUSUAL CIRCADIAN RHYTHM AND DIABETESMELLITUS IN MUTANT CRYPTOCHROME1
TRANSGENIC MICES OKANO1, K HAYASAKA2, M IGARASHI3, Y TOGASHI1,O NAKAJIMA1
1
Research Laboratory for Molecular Genetics, Yamagata University Schoolof Medicine, Yamagata, Japan, 2Department of Pediatrics, Yamagata
University School of Medicine, Japan, 3Division of Internal Medicine, Zao
Miyuki Hospital, Japan

Cryptochrome proteins (CRYs) play indispensable roles as inhibitive
components of the transcriptional-translational negative feedback loop
in the molecular model underlying mammalian circadian rhythm. We
generated transgenic (Tg) mice ubiquitously expressing CRY1 having amutation in the dipeptide motif of cysteine and proline that is conserved
beyond evolutional divergence among animal CRYs: cystein 414 of the
motif was replaced with alanine (CRY1-AP protein). Mice overexpressing CRY1-AP (CRY1-AP Tg) showed anomalous circadian behavior, and316

also symptoms of diabetes mellitus characterized by early onset, nonobese, and beta cell dysfunction (Neurosci Lett. 451, 246–251, 2009;
Eur J Clin invest., 40, 1011–1017, 2010). In order to clarify yet uncovered pathogenesis of diabetes mellitus, in which the mutant CRY1 isinvolved, we examined the characteristic aspects of islets in CRY1-AP
Tg mice. In the mature stage of the Tg mice (about 20 weeks of age),glucagon-positive cells were distributed throughout the islets, indicating abnormal islet architecture. Massive apoptosis was induced in theislets of the mature Tg mice. Also at this stage the size of the islet wassignificantly smaller than that of wild-type mice. In accordance withthese results, expression levels of some transcription factors, which are
known to play important roles in the function of islet, decreased in theislets of the mature Tg mice. These results suggest that CRY1 is crucial
to the maintenance of the function of pancreatic islet.

PO-1-189
LOW BIRTH WEIGHT BY UNDERNUTRITION
DURING PREGNANCY ELICITS ANXIETY AND
DEPRESSION IN MALE OFFSPRING MICEN SHIMIZU1, S CHIKAHISA1, Y IWAKI1, K KITAOKA2, H SEI1
Department of Integrative Physiology, The University of Tokushima
Graduate School, Tokushima-city, Tokushima, Japan, 2Department of
Physiology, The University of Tokushima Graduate School, Japan
1

Undernutrition during pregnancy is known as one of the crucial risk
factors of low birth weight (LBW) caused in infants. LBW accompanied
by catch-up growth (CUG) are increased risk for type 2 diabetes andmetabolic syndrome. Type 2 diabates elicit various of sleep disorders
caused by alternation of sleep architecture and quality. However, itremains unclear whether the LBW accompanied by CUG would affecthigher brain function including sleep, anxiety and/or depression. We
developed a mouse model of LBW with CUG by caloric restriction (CR)to pregnant female mice. We selected the CR rate for 0% (control), 20%
and 50%. Pregnancy was dated with vaginal plugs (day 0.5), thenpregnant female mice were performed CR from days 12.5 to 18.5. Afterthe parturition, dams were assigned to ad libitum chow. We performed
sleep recording, behavioral test to evaluate anxiety and depression in
the LBW model and control mice (8–14 weeks of old). In this study,
we found that 50% CR mice showed LBW and a marked increase inanxiety and depression compared with control mice. Meanwhile, 50%
and 20% CR mice showed a remarkably low activity compared with
control mice during dark period. Furthermore, in 50% CR mice, NREM
sleep during dark period tended to be increased. These results indicatethat LBW with CUG by CR during pregnancy would be a crucial risk
factor of anxiety, depression and other behavioral abnormality.

PO-1-190
THE RELATIONSHIP BETWEEN CIRCADIANRHYTHM SLEEP DISORDER AND MELATONIN
SECRETION IN ANGELMAN SYNDROME

Y TAKAESU1, Y KOMADA2,3, Y INOUE1,2,3
Department of Psychiatry, Tokyo Medical University, Shinjyuku-ku, Tokyo,
Japan, 2Department of somnology, Tokyo Medical University, Japan, 3Japan
Somnology Center, Neuropsychiatric Research Institute, Japan
1

Angelman syndrome (AS) is characterized by mental retardation, seizures and gait ataxia, and is associated with abnormalities of chromosome 15q11-q13 region. In AS, sleep problems have been reported tofrequently occur. However, characteristics of sleep problems in AS still© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

remain unclear. The aim of this study was to investigate the sleep-wakepatterns of patients with AS and its relation to melatonin secretion
pattern.
This study was approved by the ethics committee of NeuropsychiatricResearch Institute. Fifteen consecutive AS patients having abnormalityof chromosome 15q11-q13 (5 males and 10 females aged 16.3 ±7.1 years) participated in the study. Age-matched controls who had
been diagnosed as nonspecific mental retardation were selected fromthe same facilities where subject AS patients lived. Eight of the AS
patients had circadian rhythm sleep disorder, which was confirmed bytheir sleep logs (irregular sleep-wake type; n = 4, delayed sleep phasetype; n = 2, free-running type; n = 2). Serum melatonin levels in AS
patients were measured every four hours throughout twenty-four hours,
and the values were compared to the controls. Six AS patients having
circadian rhythm sleep disorders took a daily dose of 1 mg melatonin
at 8 PM for three months.
As a result of two way repeated ANOVA, secretion level of melatoninof AS patients was significantly lower than that of controls (F (1, 27) =12.6, p < 0.01). However, there was no significant difference in secretionof melatonin between AS patients with and without circadian rhythm
sleep disorder. The post hoc test showed that during night times (at 8
PM to 4 AM) secretion of melatonin of the AS patients were significantly
higher than that of the controls. After the treatment with melatonin,
nocturnal sleep patterns were improved in four of the AS patient.
The results of this study suggest that sleep problem, especially circadianrhythm sleep disorder, is highly frequent among AS patients. Low secretion levels of melatonin was thought to underlie the mechanism of
circadian rhythm sleep disorder in the AS patients.

PO-1-191 / AS-27 Presenter
NOT CURRENT, BUT RECENT WEATHER IS
ASSOCIATED WITH SUICIDAL ATTEMPTS IN
TRAINS IN JAPANH KADOTANI, Y NAGAI
Center for Genomic Medicine, Kyoto University, Kyoto-city, Kyoto, Japan
Introduction: Seasonal affective disorder (SAD) is closely associatedwith circadian rhythm disorder and classified into depression in the
DMS-IV. Blight light is the most effective therapy for SAD, and also
effective for non-seasonal depression. Clinical response to the blight
light therapy is usually observed within 1 to 2 weeks. Suicides are
known to be committed not at the worst time of the depressive
symptom, but during the recovery from the worst. We hypothesizedthat recent weather condition, especially hours of sunlight during theseveral days before, may affect suicidal attempts.
Methods: Three prefectures (Tokyo, Kanagawa and Osaka) were chosen
as the target areas, because the numbers of suicide by train were largest
in them. Databases of railway delay and of weather from 2001/10/01
to 2007/11/30 were analyzed (6816 day.prefecture).
Results: 1220 suicidal attempts were reported in the database. More than
two suicides were attempted in the 108 day.prefecture. Multiple suicidal
attempts were not associated with seasons (p = 0.592), day of the week
(p = 0.107) nor weather condition of the attempted day (such as hours
of sunlight (p = 0.461), cloud cover (p = 0.388), precipitation (p = 0.465)
and humidity (p = 0.112)). There was a significant association between
average of hours of sunlight among one to five days before the suicidal attempts
and multiple suicidal attempts, even after adjustment of season, hours ofsunlight and day of the week of the attempted day (p = 0.005).
Conclusion: Suicide by train is associated with the recent weather condition (average of hours of sunlight among several days before the suicidal
attempts), and not with the weather conditions of the attempted day.

PO-1-192
MELATONIN AND SLEEP EFFECTS ON HEALTH,BEHAVIOR PROBLEMS AND PARENTING STRESSA VAN MAANEN1, AM MEIJER1, MG SMITS2, FJ OORT1
Department of Child Development and Education, University of
Amsterdam, Uitgeest, Netherlands, 2Centre for Sleep-Wake disorders andChronobiology, Hospital Gelderse Vallei, Netherlands
1

In children with sleep onset insomnia and delayed Dim Light Melatonin
Onset (DLMO), melatonin treatment not only improves sleep but
also health, behavior and parenting stress1. An important question concerning the effectiveness of melatonin is whether melatonin has a direct
effect on these outcomes or whether the effect of melatonin is dependenton (improved) sleep. To our knowledge this is the first study addressing
this question. 41 Children (24 boys, 17 girls; mean age = 9.43 years;
mean DLMO = 20:57 h.) entered melatonin treatment (1–maximum
5 mg) for three weeks and then discontinued treatment by first taking ahalf dose for one week and then stopping completely for another week.
Sleep was measured with sleep diaries filled in by parents and withactometers. There was a positive effect of sleep duration on health. Immediately after three weeks treatment health was better for children withlonger sleep durations. This effect disappeared at the end of the stop
week. In general, health decreased from directly after treatment to theend of the stop week. Behavior problems decreased from baseline to theend of the stop week and this decrease was stronger for children with anearlier DLMO. These results show that the effects of melatonin on healthand behavior problems may partly be dependent on improved sleep.
Reference:
Maanen A van, Meijer AM, Smits MG, Oort FJ. Termination of shortterm melatonin treatment in children with Delayed Dim Light Melatonin Onset: Effects on sleep, health, behavior problems and parenting
stress. Sleep Med. In press 2011.

PO-1-193 / AS-30 Presenter
SLEEP IN CHILDREN WITH ASTHMA: RESULTS
OF THE PIAMA STUDY

A VAN MAANEN1, A WIJGA2, J DE JONGSTE3, R RODENBURG1,
AM MEIJER1
1
Department of Child Development and Education, University of
Amsterdam, Uitgeest, Netherlands, 2Centre for Prevention and HealthServices Research, National Institute for Public Health and theEnvironment, Bilthoven, Netherlands, 3Department of Pediatrics, Erasmus
University Medical Center – Sophia Children’s Hospital, Rotterdam,
Netherlands
Asthma is a chronic inflammatory disorder of the airways, affecting
approximately 5–15% of children (Sadeh, Horowitz, Wolach-Benodis,& Wolach, 1998). From the children between 2–15 years, 4–12%
suffers from shortness of breath and 5–20% suffers from wheezy breathing (Smit, Boezen, & Poos, 2010).
Children with asthma have worse general health and a lower quality oflife than children without asthma. Studies investigating sleep in children with asthma have not yielded clear results. More information isneeded concerning the question whether sleep problems are moreprevalent in children with asthma and to what extent children with lessserious asthma differ from children with more serious asthma withregard to sleep.
In the present study we investigated frequency of sleep problems in
Dutch children (10–12 years old) with asthma and we examined relations between asthma symptoms and different aspects of sleep (time in© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research317

Sleep, Science and Researchbed, sleep latency, nighttime awakenings, sleepiness, tiredness). Bothchildren and parents reported about sleep and asthma, and different
diagnostic groups (doctor diagnosis, parental-reported asthma symptoms, and parental-reported frequent asthma symptoms) were distinguished and compared with healthy children.
Results of 2735 children, participating in the PIAMA (Prevention and
Incidence of Asthma and Mite Allergy) birth cohort showed that children with frequent asthma symptoms reported more sleepiness or tiredness during the day (x2 (4) = 10.218, p = .037). For all other sleep
aspects, children with asthma in all diagnostic groups did not differ
from healthy children. Implications for clinical practice will be
discussed.

PO-1-194
LONG-TERM SLEEPINESS AND FATIGUESYMPTOMS FOLLOWING MODERATE/SEVERE
TRAUMATIC BRAIN INJURYS BEAULIEU-BONNEAU, CM MORIN
School of Psychology, Universite Laval, Quebec City, Canada
Daytime sleepiness and fatigue are often cited among the most prevalentconsequences after traumatic brain injury (TBI). Despite a recent
increase in scientific interest, the literature is still limited as most studies
have focused on the acute recovery phase and/or have been conductedin heterogeneous samples in terms of injury severity. The aim of thisstudy was to document long-term sleepiness and fatigue after moderate/
severe TBI.
Participants were 22 adults with moderate/severe TBI (mean age =37.5 years, 22.7% women, mean time since injury = 53 months) and22 matched healthy controls (CTL; mean age = 37.0 years, 22.7%
women). They underwent four 40-minute Maintenance of Wakefulness
Tests (MWT), and completed the Epworth Sleepiness Scale (ESS), Functional Outcome of Sleepiness Questionnaire (FOSQ), Multidimensional
Fatigue Inventory (MFI) and a 14-day sleep diary (SD). Groups werecompared using t tests.
Groups did not differ on mean sleep onset latency on the MWT (TBI =31.6 min vs. CTL = 35.1 min). Sleep onset REM periods were observedin two TBI participants. Subjective sleepiness was similar between
groups (ESS total score: TBI = 7.8 vs. CTL = 7.6) but TBI participants
reported greater consequences of sleepiness on daily life compared to
CTL (FOSQ total score: 17.6 vs. 18.7; p = .04). Subjective fatigue washigher in TBI participants on the MFI composite score (49.4 vs. 38.0;
p = .003). Sleep diary data revealed that TBI participants spent moretime in bed at night (514.5 vs. 484.2 min; p = .03), and napped more
frequently (3.3 vs. 1.3 naps/week; p = .006) and for a longer time (213.1
vs. 72.0 min/week; p = .009) during the day.
As a group, individuals with moderate/severe TBI do not seem to bepathologically sleepy when assessed at least one year after the injury.
On the other hand, TBI patients could be more vulnerable to detrimental effects of sleepiness on daytime functioning. Additionally, they
appear to use compensatory strategies such as increasing nighttime anddaytime sleep opportunities.
This study was supported by the Canadian Institutes of Health Research.

PO-1-195 / AS-5 Presenter
TIMING NON-ADHERENCE IS ASSOCIATED
WITH CHRONOTYPE IN RENAL TRANSPLANT
RECIPIENTSH BURKHALTER1, A WIRZ-JUSTICE2, C CAJOCHEN2, T WEAVER3,J STEIGER4, T FEHR5, R VENZIN6, S DE GEEST1,7
1
Institute of Nursing Science, Basel University, Basel, Switzerland, 2Centerfor Chronobiology, University Clinics Basel, Switzerland, 3Department of
Biobehavioral and Health Sciences, University of Illinois Chicago, UnitedStates of America, 4Division of Transplant Immunology and Nephrology,
University Hospital Basel, Switzerland, 5Division of Nephrology, University
Hospital Zürich, Switzerland, 6Division of Nephrology, University HospitalBern, Switzerland, 7Center for Health Services and Nursing Research,
Katholieke Universiteit Leuven, Belgium
Background: Chronotype refers to an individual’s preferred sleep-wakecycle timing within the 24-hour day. The aims of this study were todescribe chronotype distribution in adult renal transplant (RTx) recipients and to explore associations with sleep quality, sleepiness, anxiety,depression, stress and medication adherence.
Methods: Using a cross-sectional design, we included a conveniencesample of 423 RTx outpatients (37.6% women; time since RTx: 9.33 ±7.15 years; mean age: 58 ± 12.36 years) transplanted at a single European transplant centre. Chronotype was assessed with the modified
Horne-Oestberg morningness-eveningness questionnaire; medication
adherence with the BAASIS, sleep quality with the PSQI, and sleepinesswith the ESS; psychological symptomatology with the DASS-21.
Descriptive statistics and Spearman’s correlation were used.
Results: The prevalence of timing non-adherence (NA) (deviation fromdosing schedule >2 h) was 43.3%, poor sleep quality 48.9% (PSQI >5) and daytime sleepiness 43.3% (ESS > 6); 19.9% reported depressive
symptomatology, 25.1% anxiety and 17.7% stress. Patients were classified into five chronotype groups (morning type 13.9%, moderate
morning type 42.1%, middle type 40.9%, moderate evening type 2.4%
and evening type 0.7%). There were no significant gender differences
between groups (Chi2: 52, 66 (df:47); p: 0.264). Eveningness was significantly correlated with younger age (Spearman’s rho: 0.27; p < 0.01)
and higher frequency of not taking the medication on time (timing NA)(Spearman’s rho: −0.11; p: 0.03), while other variables such as NA itself,
sleep quality, daytime sleepiness, anxiety, stress and depression did not
significantly correlate with chronotype in our cohort.
Conclusion: Morningness is highly prevalent in RTx recipients. Eveningness is rare, but is associated with higher timing NA and younger
age, suggesting that the assessment of chronotype could help counselingto enhance adherence. RTx could be instructed to take their drugs laterand consequently come away from the 8 am–8 pm schedule.

PO-1-196
A CROSS-CULTURAL META-ANALYSIS OFSLEEP PATTERNS AND PROBLEMS DURING
ADOLESCENCEM GRADISAR1, G GARDNER1, H DOHNT1, M SHORT1,J ROBINSON1, FZ ELWAN2, A WOLFSON3, M CARSKADON4
1
School of Psychology, Flinders University, Adelaide, South Australia,
Australia, 2Department of Psychology, Cairo University, Egypt, 3Departmentof Psychology, College of the Holy Cross, United States of America,
4
Department of Psychology, Brown University, United States of America
Introduction: Many adolescent sleep surveys have been performed
within countries over the past decade. However, direct comparisons are
rare. The present study conducted direct statistical comparisons of318© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

adolescent sleep patterns and problems (ie, insomnia, daytime sleepiness) across 5 continents.
Method: Adolescent sleep surveys were included if they sampled 300+
participants aged 11–18 yrs, and were recently published (1999–2011).
To increase the number of statistical comparisons, the authors’ unpublished Australian (N = 385) and African (N = 426) data were included.
Using these criteria, 41 published studies and 2 unpublished datasets
were included. Sleep patterns were related to age (p < .0001), thus
meta-analyses involved ANCOVAs with age as a covariate. Age-adjusted
means are presented, with the exception of African data (N = 1, mean
age = 16.5 yrs). Differences are reported if significance was detected oreffect sizes were moderate-to-large.
Results: School-night sleep data showed variability between continents.
Asian adolescents went to bed later (11:20 pm) than other adolescents(Europe = 10:40 pm; Australia = 10:19 pm; North America = 10:09pm) except Africa (1:25 am), yet it was North American adolescents
who obtained significantly less sleep (7.4 hrs) than their European andAustralian peers (both 8.4 hrs). This was partly due to North Americanadolescents having earlier rise times (6:34 am) compared to their peers(Europe = 6:58 am; Australia = 7:05 am; Africa = 9:33 am). Weekend
sleep data showed a similar pattern of differences, albeit a systematicallylater sleep scheduling across all continents (p < .0001). Difficulty falling
asleep was commonly reported across samples, being experienced by
16% of teens. However, slightly more teens report a sleep latency>30 mins (25%). Daytime sleepiness was also common, with variableprevalence (5–53%) due to variations in measures used.
Conclusion: Culture is an influential extrinsic factor on adolescents’sleep. Considerable work is needed to conduct simultaneous comparisons to understand such cultural influences.

PO-1-197
MULTI-FOCUSED STUDY OF SLEEP DISORDERIN FUNCTIONAL DYSPEPSIAM OZONE1, A KURODA1, K AOKI1, T MORIYA1, M IWASHITA1,S OKINO1, K NAKATA2, H ITOH1
1
Psychiatry, The Jikei university school of medicine, Tokyo, Japan,
2Surgery, The Jikei university school of medicine, Japan

Backgrounds: Patients suffering from Functional Gastrointestinal Disorders often have complaints of sleep problems. According to the previous study, it has been reported that 20% of general population withsleep disturbance have gastric symptoms like functional dyspepsia (FD)(Santhi et al., 2000).
However, the pathological relationship between FD’s symptoms and its
sleep disturbances is so complicated that it has not been clarified at thistime. Therefore, we performed multi-focused study to clarify the considerable clinical factors impacting on development of sleep disordersin FD.
Subjects and Methods:
1) Subjects:
FD group 30 (M/F 17/13, mean age 32.9 ± 8.9 y), who met the criteriaof FD in Rome II.
Control group (CL) 45 (M/F 38/7, mean age 31.4 ± 6.3 y)
2) Measurements:a) Pittsburgh Sleep Quality Index (PSQI)b) Gastro-intestinal symptom rating scale (GSRS)c) Gastric emptying study (GE; 13C-acetate breathe test)d) Drink test (DT; Visceral hypersensitivity test; drink 10 ml/kg ofwater for 5 minutes at equal rate)e) Psychological test (STAI, SDS, SCL90R, MMPI, SF36)
Results
1) Thirteen cases (43.3%) had over 5.5 points in total PSQI score in FD.

2) The sub items of PSQI were significantly higher than those of CL insleep quality, sleep latency, and sleep difficulty in FD.
3) In terms of the correlation between total PSQI score and each items
in FD group,a) The value of Tmax (the time to the maximum concentration of
13
C in breathe) in GE was not correlated.
b) The DT score was not correlated.
c) STAI-1 score (r = 0.457) and SDS score (r = 0.487) weresignificantly correlated.
d) The scores of hypochondriasis, paranoid, and hypomania in
MMPI were significantly correlated.
e) Constipation score of GSRS was significantly correlated (r =0.418). The abdominal pain score was correlated with sleep
quality.
Conclusions: From our results, it was suggested that the gastric symptoms such as constipation and abdominal pain and mental condition
may be responsible for the sleep disorder in functional dyspepsia.

PO-1-198
ASSOCIATIONS BETWEEN SLEEP AND
AFFECTIVE LABILITY IN ADOLESCENTS WITH
A BORDERLINE PERSONALITY DISORDER

H CHRISTOPHE1, G JEAN-MARC1, B JEAN-JACQUES1,3, G ROGER2,3
1
Mood Disorders Clinic (Clinique des troubles de l’humeur), Riviere-desPrairies Hospital, Montreal, Quebec, Canada, 2Sleep Laboratory andClinic, Riviere-des-Prairies Hospital, and Department of Psychiatry,
Université de Montréal, Canada, 3Centre de recherche Fernand-Seguin,Riviere-des-Prairies Hospital, Canada
Introduction: A bidirectional association exists between sleep quality
and mood regulation. Many recent adult studies have shown sleep
abnormalities in Borderline Personality Disorder (BPD), which is characterised by hostility and severe affective lability, including depressive
mood. However, little is known about sleep in adolescent BPD. This
study had two objectives: to characterise sleep patterns in an adolescenteuthymic BPD group and to determine whether these characteristics
were associated with dimensional measures of mood.
Methods: Fourteen euthymic BPD adolescents (13–17 years old; 12
girls/2 boys) wore an actigraph and filled out a sleep diary (in order tovalidate actigraphy data) for at least nine days, including two weekends.
They also completed self-reported questionnaires assessing mood instability (Affective Lability Scales; ALS), depressive state (Beck Depression
Inventory), and hostility (Buss-Durkee Hostility Inventory) on the firstday of actigraphy recording. Non parametric correlation analyses(Spearman Rank Correlation Coefficient) were performed to examine
the association between sleep and mood.
Results: Preliminary results show that BPD adolescents without concurrent DSM-IV Depressive Disorders experience poor sleep efficiency(weekdays: 77.92 ± 7.67%; weekends: 76.55 ± 9.27%), and shorter
total sleep time (weekdays: 430.67 ± 57.80 minutes; weekends: 459.16± 101.15 minutes) compared to published norms (i.e., 540–600 minutes
per night). Percentage of time scored as sleep during the sleeping period
was negatively correlated with ALS total raw score (r = −0.53): mood
was less stable as total sleep time got shorter. Duration of wakefulness(in minutes) was also correlated with ALS total score (r = 0.56) during
the sleep period.
Discussion: These results suggest that sleep quality and affective instability are interrelated in euthymic adolescent BPD. To confirm thesepreliminary findings, a greater sample size and a comparison control
group (healthy adolescents) are needed.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research319

Sleep, Science and Research

PO-1-199

PO-1-200

PROSPECTIVE ANALYSIS OF SLEEP PROBLEMSIN CHRONIC RHINOSINUSITIS

THE ROLE OF SLEEP DISTURBANCE AND
DEPRESSION IN PATIENTS WITH TYPE
2 DIABETESY ANDO, T ORUSHI, D ASAKA, T NAKAYAMA, E MORI,Y MATSUWAKI, M YOSHIKAWA, M IIDA, S CHIBA, N OTORI,K YANAGI, H MORIYAMA
Department of Otorhinolaryngology, The Jikei University School of
Medicine, Minato-ku, Tokyo, Japan
Objectives: Chronic rhinosinusitis (CRS) is commonly encountered by
ENT doctors. In recent years, various studies have been conducted
regarding the effects of CRS on the patient’s quality of life (QOL).
However, few reports of its effects on the quality of sleep have beenreported. The purpose of this study was to investigate the incidence ofsleep problems associated with CRS and examine which factors are
involved in sleep problems.
Study design: Multicenter prospective study
Subjects: 685 patients who were diagnosed with CRS between April
2007 and March 2008 were analyzed.
Methods: All of patients completed a QOL questionnaire using ascoring system 0~6 that included items regarding nasal symptoms andsleep. In addition, data were compiled for various background parameters; for example, the peripheral eosinophil count and the presence/
absence of allergic rhinitis. The patients were stratified into two groups
on the basis of sleep score results: 4 and over, and less than 4. Thenthe two groups were compared in regard to the data for above-describedparameters. Logistic regression analysis was performed using the highsleep score group (4 and over) as explanatory variable and backgroundparameters as dependent variables.
Results: The high sleep score was seen in 148 patients (21.6%). The
scores for each of the nasal symptoms were significantly higher inthe high sleep score group. The sleep score was significantly higher inthe patients with a complication of allergic rhinitis and high peripheral
and tissue eosinophil counts. Logistic regression analysis found thatnasal congestion, cough and ear fullness were nasal symptoms that
contributed to a high sleep score.
Conclusions: Some patients who have CRS experience sleep problems.
In addition to nasal symptoms, inflammatory conditions such as allergic
rhinitis and eosinophilic inflammation also have the potential to directly
affect sleep problems. Subjective symptoms such as nasal congestion,
cough, etc., are closely related to sleep problems.

A YAGI1, Y NISHIO2, S UGI3, H KAWAI4, T UZU5, M IMAI6,
N YAMADA7, M OKAWA8, A KASHIWAGI9, H MAEGAWA10
1Division of Endocrinology and Metabolism, Department of Medicine, Shiga
university of Medical Science, Otsu city, Shiga prefecture, Japan, 2Division
of Endocrinology and Metabolism,Department of Medicine, Shiga
University of Medical Science, Japan, 3Division of Endocrinology andMetabolism, Department of Medicine, Shiga University of Medical Science,
Japan, 4Division of Endocrinology and Metabolism, Department ofMedicine, Shiga University of Medical Science, Japan, 5Division of
Endocrinology and Metabolism, Department of Medicine, Shiga Universityof Medical Science, Japan, 6Department of Psychiatry, Shiga University of
Medical Science, Japan, 7Department of Psychiatry, Shiga University of
Medical Science, Japan, 8Department of Sleep medicine, Shiga Universityof Medical Science, Japan, 9Division of Endocrinology and Metabolism,
Department of Medicine, Shiga University of Medical Science, Japan,
10
Division of Endocrinology and Metabolism, Department of Medicine,
Shiga University of Medical Science, Japan
Little is known about the relationship among sleep disturbance, depression and type 2 diabetes. The goal was to evaluate the role of these
indices for the quality of life (QOL) in patients with type 2 diabetes. In
the present study, 270 patients were recruited from the Shiga Prospective Observational Follow-up Study for Diabetic Complications.
Depressive symptoms, sleep disturbance, and QOL were assessed using
Zung Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality
Index (PSQI), SF-8, respectively, following evaluation of their metabolic
control and complications. Furthermore, 141 patients were completed
the same study after 6–12 (mean 7.3) months. Significant correlations
were found among sleep disturbance, depression and QOL in thepatients with type 2 diabetes. The patients with insulin therapy showedsignificantly higher SDS scores, meaning more depressive symptoms,
than that of the patients without insulin therapy. The patients withpainful neuropathy had higher PSQI and SDS scores and lower physicalcomponent of the QOL score than those of the patients without painful
neuropathy. In the follow-up observation, it was found that the presenceof neuropathy and elevated HbA1c level were predicting factors forincreasing PSQI score and SDS score, respectively. Furthermore, presence of painful neuropathy became the risk factor for sleep disturbanceof type 2 diabetic patients. Sleep disturbance or depressive symptoms
were significantly correlated with the QOL scores in the patients with
type 2 diabetes, suggesting the importance of these indices for the better
management of the diabetic patients.

PO-1-201
THE RELATIONSHIP BETWEEN DIGESTIVESYMPTOMS AND SLEEP DISORDERS INOUTPATIENTS OF PSYCHIATRIC CLINICS

A KURODA1, M OZONE1, K AOKI1, T MORIYA1, M IWASHITA1,H ITOH1, K NAKAYAMA1
1
Department of Psychiatry, The Jikei University School of Medicine,
Minato-ku, Tokyo, Japan
Aim: Sleep disorders is very common in psychiatric patients. Most ofthem also have several complaints of digestive symptoms, such as
abdominal pain, nausea, constipation, and diarrhea.Concerning mechanisms of these abdominal symptoms, they may be influenced by

320© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

psychiatric symptoms, pharmacological treatments, and eating behavior
based on primary mental disorders.However, little epidemiologicalstudy clarified the frequency of digestive symptoms in patients withmental disorders. Therefore, the aim of this study was to reveal the rateof patients having digestive symptoms and the correlation with sleep
disorders in psychiatric patients.
This study was conducted with the approval of the Ethical Committeeof Jikei university school of Medicine.
Subjects and methods:
1) Subjects: 128 outpatients (mean age 50.2 ± 12.5 y, M/F 73/55, ICD10:F2/F3/F4/F5/others 22/45/41/18/2) who attended the Jikei university hospital and its three related facilities.
Control group (CL) 45 (mean age 31.4 ± 6.3 y, M/F 38/7)
Measurements:(1) The rating scale for digestive symptoms
a. Gastro-intestinal symptom rating scale (GSRS)
b. Questionnaire for the diagnosis of reflux disease (QUEST)
c. Frequency scale for the system of GERD (gastroesophageal reflux
disease) (FSSG)(2) The rating scale for Sleep, psychiatric symptoms, and QOL
a. PSQI
b. SCL-90-R
c. SF-8TM
Results:(1) GSRS total score (1.9}0.8 points) was higher than that of normals(1.5}0.5). Concerning sub items of GSRS score, constipation score
was significantly higher.
(2) 48 patients (37.5%) got 4 and above in QUEST.
(3) GSRS score was significantly correlated with PSQI score (r = 0.396,
p < 0.01). In terms of the sub items of GSRS, all scores except
diarrhea score had significant correlations with PSQI score (p <0.01), and constipation score had the most striking correlation withit (r = 0.387, p < 0.01).
Conclusions: From our results, it was suggested that 40% of outpatients in psychiatric clinics might have GERD. Moreover, various digestive symptoms might be associated with the development of sleep
disturbance, especially in constipation.

PO-1-202
THE INTERRELATIONSHIP BETWEENHEADACHE AND SLEEPYJ SHIM1, SH YOON2, JS KWON3, ST KIM4, JH CHOI5, HJ AHN6
Department of orofacial pain clinic, Yonsei University, Dental college,
Seodaemun-gu, Seoul, Republic of Korea, 2Department of orofacial pain
clinic, Yonsei University, Dental college, Republic of Korea, 3Department of
orofacial pain clinic, Yonsei University, Dental college, Republic of Korea,
4
Department of orofacial pain clinic, Yonsei University, Dental college,
Republic of Korea, 5Department of orofacial pain clinic, Yonsei University,
Dental college, Republic of Korea, 6Department of orofacial pain clinic,
Yonsei University, Dental college, Republic of Korea
1

Objectives: This study investigated the relationship between headacheand sleep by evaluating sleep quality, daytime sleepiness, and specificfeatures related to sleep breathing disorders(SBD).
Method: 101 subjects suffering from headache, and 128 healthy controls without headache were enrolled. Headache group were diagnosed
by using ICHD-II criteria and completed MIDAS questionnaire. All
subjects were evaluated for the subjective quality of sleep by using PSQI
and ESS. In addition, randomly selected 28 subjects of each group were
evaluated of sleep features(including AHI, prevalence of SBD, nocturnal
SaO2, ODI) by portable sleep monitoring device.

Results
1. PSQI and ESS scores were significantly higher in headache groupthan control (p < 0.0001). Also, the prevalence of poor sleeper(Global PSQI > 5) and daytime sleepiness (ESS > 10) were significantly higher in headache group (p < 0.0001).
2. The severity of headache, which was estimated by using NRS (p =0.03) and MIDAS (p = 0.001), showed significant association withsleep quality. Chronicity of headache also showed significant association with sleep quality (p = 0.003) and prevalence of daytime sleepiness (p = 0.03). But, presence of morning headache did not show
significant association with sleep quality and daytime sleepiness.
3. There were no significant differences in AHI, ODI, prevalence of SBD
and nocturnal SaO2 between headache group and control. Also,
there were no significant differences according to presence ofmorning headache.
Conclusion: There is a significant association between headache andsleep. Among various characteristics of headache, severity and chronicity were significantly associated with sleep quality and daytime sleepiness, while no statistically significant association was evident between
headache and nocturnal hypoxia or SBD. A limitation of this study wasthat it was not based on polysomnography (PSG), but based on selfreported subject information about headache and sleep. Therefore,
further study applying PSG will be needed.

PO-1-203SLEEP, DEPRESSIVE BEHAVIOR AND
INFLAMMATION IN A POST MYOCARDIAL
INFARCT MODEL IN THE RAT

R GODBOUT1, TM BAH1,2, G ROUSSEAU1,3
Psychiatry – Sleep Laboratory & Clinic, Universite de Montreal,Montreal, Canada, 2Department of Psychiatry, Universite de Montreal,
Canada, 3Department of Pharmacology, Universite de Montreal, Canada
1

Introduction: Myocardial infarction (MI) in humans is followed bydepression in 15–30% of cases. Here we report the data obtained in a
rat model upon chronic sleep recordings and biochemical analyses,
before and after antidepressant treatment.
Methods: Sleep was recorded for 24 h in 40 rats. MI was then induced
in 20 rats while the 20 others were sham controls. Escitalopram (10 mg/
kg/day, i.p.) was administered to 10 MI rats and 10 controls while allother rats received saline; sleep was recorded again after 14 days. In 19
other MI rats and 20 sham rats, escitalopram was followed by tests ofsocial Interaction, forced swimming sucrose preference; circulatinglevels of proinflammatory cytokines were measured after sacrifice.
Results: MI rats showed signs of impaired social interaction, behavioral
despair and anhedonia; this was blocked by escitalopram. MI rats displayed prolonged sleep latency, short total sleep time, short latency to
but short duration of Paradoxical Sleep (PS); escitalopram did not affectsleep in MI rats but decreased PS in controls. We found less choline
acetyltransferase (ChAT)-positive neurons in the pedunculopontine tegmentum (PPT) area of MI rats compared to controls while the laterodorsal tegmentum (LDT) was intact. TNF-alpha, PGE2 and corticosterone
plasma levels were higher in saline-treated MI rats compared to controls; escitalopram decreased TNF-alpha, IL-beta, and PGE2 levels inboth groups of rats while IL-6 showed no differences whatsoever.
Conclusion: MI induces a behavioral syndrome compatible with signsof depression in humans. These behavioral impairments are reversedby the antidepressant escitalopram through a mechanism that could
involve a reduction of pro-inflammatory cytokines. Sleep disorders of
MI rats are compatible with depression in humans, paralleled bydecreased brainstem cholinergic neurons, but not affected by escitalopram; this could suggest alternate pathophysiological pathways.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

321

Sleep, Science and Research

PO-1-204SLEEP/WAKE REGULATION IN PPARƒ¿KNOCKOUT MICES CHIKAHISA1, N SHIMIZU1, K KITAOKA2, I YOHEI1, F HIROAKI1,S TETSUYA1, S HIROYOSHI1
1
Department of Integrative Physiology, Institute of Health Biosciences, The
University of Tokushima Graduate School, Tokushima-shi, Tokushima,
Japan, 2Department of Physiology, Institute of Health Biosciences, The
University of Tokushima Graduate School, Japan
Peroxisome proliferator-activated receptor alpha (PPARƒ¿) is a transcriptional factors belonging to the nuclear receptor family that has animportant role in controlling gene expression related to glucose/lipid
metabolism. PPARƒ¿ is known for its role in promoting hepatic fatty acidoxidation and ketogenesis in response to fasting. Recent studies haveshown that energy metabolism affects sleep regulation and sleep loss isalso associated with impairments in glucose/lipid metabolism. Therefore,
manipulations changing PPARƒ¿ likely affect sleep and other physiological phenotypes. In the current study, we examined the role of PPARƒ¿in sleep/wake regulation using PPARƒ¿-knockout (KO) mice. Sleep, bodytemperature, locomotor activities, blood pressure and heart rate wererecorded in PPARƒ¿-KO mice and their wild-type littermates (WT) fed
ad lib at baseline, with 5-hr sleep deprivation (SD) and fasting for 24 hrs
starting at light-phase onset. PPARƒ¿-KO and WT mice were identicalin basal amount of wake/sleep, body temperature, blood pressure andheart rate. PPARƒ¿-KO mice showed decreased the amount of NREM
sleep in the latter half of dark period and tended to have decreased
locomotor activity. In addition, PPARƒ¿-KO mice demonstrated muchhigher EEG delta power in NREM sleep compared with WT. However,
5-hr SD induced similar rebound response of delta power in bothPPARƒ¿-KO and WT mice. In response to fasting, during hours 17–24
of the fasting day, the amount of wake and blood pressure of PPARƒ¿-KO
mice were suppressed in comparison to the WT. During that period,
heart rate and body temperature decreased by fasting in both WT andPPARƒ¿-KO mice. These results suggest that PPARƒ¿ gene is required forthe normal integration of sleep and blood pressure regulation in mice.

PO-1-205
LOWER THETA AND ALPHA
ELECTROENCEPHALOGRAPHIC ACTIVITY IN
YOUNG ADULT FEMALE SUBJECTS WITH SLEEPBRUXISM: A CASE CONTROL ANALYSISS ABE1, NT HUYNH2, PH ROMPRÉ3, JY MONTPLAISIR4, MCCARRA5, GJ LAVIGNE6, F KAWANO7
1
Department of Oral Care and Clinical Education, The Tokushima
University Hospital, Tokushima-City, Tokushima, Japan, 2Faculty of dental
medicine, Université de Montréal, Canada, 3Faculty of dental medicine,
Université de Montréal, Canada, 4Facluty of medicine, Université deMontréal, Hôpital du Sacré-Coeur, Centre d’étude du sommeil, Canada,
5
Faculties of dental medicine and medicine, Université de Montréal,
Hôpital du Sacré-Coeur, Centre d’étude du sommeil, Canada, 6Faculties ofdental medicine and medicine, Université de Montréal, Hôpital duSacré-Coeur, Centre d’étude du sommeil, Canada, 7Department of Oral
Care and Clinical Education, Tokushima University Hospital, Japan
Aims: Sleep bruxism subjects often report transient morning pain in
the first hours after an awakening. Jaw muscle pain has been observed
to be gender specific with a higher prevalence in females. Middle-aged
female patients with chronic widespread musculoskeletal pain (e.g.
fibromyalgia) have been reported to present a gender specific reduction322

of sleep electroencephalographic (EEG) slow wave activity. The objective of this study was to compare sleep EEG activity of young healthy
subjects and SB subjects with or without transient morning pain toassess if any gender specificity could explain female susceptibility toreport pain.
Methods: A retrospective analysis on sleep laboratory data (secondnight) collected from 62 sleep bruxism-tooth grinding (SB) subjects and19 age- and gender-matched control individuals (CTRL) was performed. Prevalence and intensity of morning jaw muscle pain, orofacialpain, and sleep disruption were assessed by questionnaires. EEG delta
to beta power activities were quantitatively analyzed across four consecutive non-REM and REM sleep cycles. Statistical comparisons
between CTRL and SB subjects with or without transient morning pain
were conducted according to gender distribution.
Results: 71% of SB subjects reported transient morning jaw muscle
pain. Among them, no gender difference was noted in pain reports.
From the quantitative analysis, the EEG power for each frequency bands
were not different between CTRL and SB, whether or not transientmorning pain was present. However, female SB subjects, with andwithout morning pain, had a lower power of theta and alpha EEG
activities in comparison to female CTRL subjects (p = 0.03).
Conclusion: Young SB female subjects had a lower power of theta andalpha EEG activity during sleep, whether or not they presented morningtransient muscle pain. Sleep of SB patients does not seem to be influenced by the onset of muscle pain. (Supported by CIHR)

PO-1-206
TREATMENT OF BIPOLAR DEPRESSIONASSOCIATED WITH COMORBID
DEVELOPMENTAL DISORDER IN ADULTS.
EFFECTS OF THE LIFE RHYTHM THERAPYTARGETED AT SLEEP DISTURBANCESK OOGA1, Y ABE2, T OKUDAIRA3, E SHIBA4, Y FURUKAWA5,
N WATANABE6
1
Department of Psychiatry, Nihon University School of Medicine,
Chiyoda-ku, Tokyo, Japan, 2Department of Psychophysiology, National
Institute of Mental Health, Japan, 3Department of Medicine Division ofIntegrated Herbal Medicine, Nihon University School of Medicine, Japan,
4
Department of Psychiatry, Yamaguchi Hospital, Japan, 5Department of
Psychology, California State University Fullerton, United States ofAmerica, 6Department of Psychiatry, Nihon University School of Medicine,Japan
Introduction: Bipolar depression tends to be refractory to treatment
and takes a prolonged course. Its atypical symptoms such as hypersomnia or hypersensitivity to rejection makes patients difficult to go out,
preventing their rework. We have already stressed that certain vulnerability of sleep-wake rhythm associated with developmental disorder isinvolved in prolongation of disease phases of mood disorder.
Subjects and Methods: The subjects were five adults with developmental disorders who had comorbid bipolar disorder (age 30–40 Malen = 1 Female n = 4). All the subjects showed irregular sleep-wakerhythm disturbances corresponding to episodes. The subjects had more
episodes of irritability, impulse, dissociative symptoms, personalitychange, and criminal behaviors during the periods of manic-depressive
mixed state. Combined administration of mood stabilizers and atypicalantipsychotic agents relieved these symptoms. Sleep disturbances weretreated with co-administration of modafinil, melatonin, and Chinese
herbal medicines such as TJ-35 and TJ-83. Meanwhile, the subjects
were instructed to keep sleep logs to monitor their daily sleep-wakerhythm. Furthermore, structurization of lifestyle cycle was attempted© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

by setting daily routines referring to SPELL developed by the National
Autistic Society in the UK and the therapeutic concept based on treatment methods of patients with affective psychosis at Sanatorium Bellevue in Switzerland at the end of 19th century.
Results: The five adults with developmental disorder tended to show
sleep-wake rhythm disturbances induced by interpersonal stress or thelost of daily routine. As the patients became to do daily routines efficiently, their depressive mood and malaise were improved. Furthermore, it was suggested that stabilization of sleep-wake rhythm may playa role in preventing recurrence of episodes.
Discussion: Both SPELL and traditional Bellevue methods may be
useful for stabilizing sleep-wake rhythm by structuring lifestyle cycle ofpatients with developmental disorder.

PO-1-207
THE CLINICAL PRESENTATION OFADOLESCENTS WITH DELAYED SLEEPPHASE DISORDER

M GRADISAR1, H DOHNT1, G GARDNER1, S PAINE1, K STARKEY1,
M BILLOWS1, S TRENOWDEN1
1
School of Psychology, Flinders University, Adelaide, South Australia,
Australia
Introduction: Adolescents typically display a pattern of delayed sleep
timing, but in extreme cases this develops into Delayed Sleep Phase
Disorder (DSPD). Few data exist regarding the clinical characteristics ofadolescents who present for treatment for their DSPD. The objective of
the present study was to provide information on the clinical presentation of adolescents with DSPD.
Methods: Data were obtained from 49 adolescents (14.6}1.0 yrs, 53%
males) diagnosed with DSPD. Diagnosis was made via a 1-hr clinicalsleep history interview with the adolescent and at least one parent, as
well as a 7-day sleep diary and simultaneous wrist actigraphy recording.
Adolescents also completed sleepiness, fatigue and depression
questionnaires.
Results: 100% of adolescents reported a gradual onset of their sleep
problem, occurring at ~10 yrs. 100% reported their schooling wasaffected by their sleep disorder, with 16% not attending school. All
reported insomnia symptoms, including difficulty falling asleep andwaking, as well as cognitive arousal in bed (eg, mind racing). Interestingly, adolescents misperceived their sleep onset time by 14 min,however this difference was driven by gender with females misperceiving more than males. Once asleep though, no misperception of sleep
time occurred. In terms of sleep hygiene, 89% possessed electronic
media in their bedroom (eg, cell phone), 35% consumed caffeine in theafternoon, 33% took frequent longs naps, and 14% used social substances (ie, alcohol, THC). In terms of emotional functioning, 5% had
a diagnosis of a mood disorder, however overall, the frequency ofdepression symptoms was surprisingly low. In contrast, daytime sleepiness and fatigue were moderate-to-high.
Conclusions: Adolescents presenting with DSPD possess a number ofclinical characteristics that may factor into the maintenance of their
sleep disorder. These include poor sleep hygiene and insomnia symptoms. Consideration of these factors is warranted when treating adolescents for their DSPD.

PO-1-208SLEEP QUALITY IN THE ELDERLY POPULATIONWITH DIABETES MELLITUS, HYPERTENSION
AND HYPERLIPIDAEMIA

BLH SIM1, GSH CHIANG1, JHM QUAH2, JJM LEE3
Yong Loo Lin School of Medicine, National University of Singapore,
Singapore, Singapore, 2Outram Polyclinic, Singhealth, Singapore,3
Department of Epidemiology and Public Health, National University ofSingapore, Singapore
1Introduction and objective: The elderly are known to have poor
quality sleep. In individuals with diabetes mellitus, hypertension andhyperlipidaemia, this might be a result of obstructive sleep apnoea,
which they are more susceptible to developing. The objective of thisstudy was to evaluate the various demographic factors, co-morbidities(other than diabetes, hypertension and hyperlipidaemia), and lifestylefactors so as to identify risk factors and protective factors of poor sleep
quality.
Materials and methods: This cross-sectional study was conducted in
the primary healthcare setting (Outram Polyclinic) in Singapore. bidities were identified. The responders’ sleep quality were then assessedwith the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Additional information on demographics, co-morbidities and lifestyle practices were collected. The study population was then divided into thosewith good quality sleep and those with poor quality sleep, based on the
PSQI score. We then applied univariate, bivariate and multivariate
analyses on the risk factors and protective factors studied.
Results: 199 patients out of the 226 patients identified responded tothe questionnaire, obtaining a response rate of 88.1%. Using cox regression analysis, nocturia (prevalence rate ratio 1.542, 95% confidence
interval 1.056–2.251) was found to be associated with an increased riskof poor sleep quality.
Conclusion: Nocturia is a prevalent problem in the geriatric populationand it has been found to be associated with poor sleep quality in ourstudy. Hence it is imperative to address this issue, whether by meansof lifestyle modification or good control of co-morbidities, especiallydiabetes.
Acknowledgement: We would like to thank Dr Daniel J. Buysse for
permission to use the Pittsburgh Sleep Quality Index questionnaire in
our study.

PO-1-209
QUANTITATIVE EEG ABNORMALITIES INIDIOPATHIC REM SLEEP BEHAVIOUR DISORDERJ RODRIGUES BRAZÉTE1, J-F GAGNON2,3, J CARRIER1,2,
J MONTPLAISIR2,4
1
Department of psychology, Université de Montéral, Montréal, Qubec,
Canada, 2Center for Advanced Research in Sleep Medicine, Hôpital duSacré-Coeur de Montréal, Canada, 3Department of psychology, Universitédu Québec à Montréal, Canada, 4Department of psychiatry, Université deMontréal, Canada

Idiopathic REM sleep behaviour disorder (iRBD) is considered as a risk
factor for synucleinopathies, such as Lewy body dementia (LBD) andParkinson’s disease (PD). A slowing of the electroencephalogram (EEG)
during wakefulness has already been reported in LBD and PD. The
objective of the study was to compare the EEG during a resting state
between a relatively large group of iRBD patients and healthy
controls.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research323

Sleep, Science and Research

A total of 45 iRBD patients (mean age, 66.7} 9.0 years) and 45 healthy
subjects (mean age, 63.8} 10.9 years) were studied. Quantitative analyses of the absolute and relative spectral power were performed for fivefrequency bands, namely delta (0.75–4.0 Hz), theta (4.0–8.0 Hz), alpha(8.0–13.0 Hz), beta1 (13.0–22.0 Hz) and beta2 (22.0–32.0 Hz) in fivecortical regions: frontal, central, parietal, occipital and temporal. The
ratio of the absolute power of delta and theta over beta1 and beta2(D+T)/(B1+B2) was calculated as a specific index of cortical slowing.
Between-group differences on absolute and relative power were assessedby mixed ANOVAs (Group by Band) for each region while betweengroup differences on the ratio was assessed by a mixed ANOVA (Groupby Region).
iRBD patients showed a higher delta and theta absolute power incentral, parietal, occipital and temporal regions, a higher theta andlower beta1 relative power in parietal, occipital and temporal regions,in addition to a lower alpha relative power in the occipital region incomparison with control subjects. The analyses also showed that iRBD
patients had a higher (D+T)/(B1+B2) ratio than controls in the fivecortical regions.
This study indicates the presence of a diffuse slowing of the EEG during
wakefulness in iRBD patients similar to that reported in some neurodegenerative diseases like PD and DLB.

PO-1-210
REM SLEEP BEHAVIOR DISORDER INPSYCHIATRIC PATIENT: A CASE-CONTROLSTUDYJ LAM1, J ZHANG1, J TSOH1, SX LI1, KWC HO1, V MOK2,AYY CHAN2, YK WING1
1
Department of Psychiatry, The Chinese University of Hong Kong, Shatin,
Hong Kong, Other, 2Medicine and Therapeutics, The Chinese University ofHong Kong, China
Objective: REM sleep behavior disorder (RBD), a parasomnia commonly occur in elderly population, has been increasingly reported inpatients taking antidepressants, and was commonly regarded as “secondary RBD”. However, there was limited literature to document its
clinical and polysomnographic features.
Method: A case-control study consisting clinical and polysomnographic
assessments. We recruited 21 psychiatric RBD patients and matchedthem with two control arms: 1) age, sex and psychiatric diagnosis
matched control subjects from psychiatric clinic, 2) Typical idiopathic
RBD of elderly population from sleep clinic.
Result: Psychiatric RBD patients were found to have comparable clinical features and degree of sleep-related injuries to that of typical RBDof elderly population. Comparing to the matched psychiatric controls,
who were also prescribed with antidepressants, psychiatric RBD subjects had significantly more nightmares, dream enactment and resultant
sleep-related injuries. They also had higher REM related EMG activities
compared to psychiatric controls. A dosing effect was observed in REM
EMG tonic activities across typical RBD, psychiatric RBD and psychiatric controls.
Conclusion: Psychiatric RBD is comparable to typical RBD in terms of
the high prevalence of sleep-related injuries and personal distress. Our
study suggests that RBD in psychiatric patients is not solely contributedby antidepressant. The presence of excessive REM-related tonic EMG
activities may suggest a potential early neurodegenerative process as anaetiological component in psychiatric RBD. Further neuropsychiatricassessment and prospective follow-up is needed to clarify the relationship between RBD among psychiatric patients and typical elderly population, also its neurodegenerative outcomes.

324

PO-1-211
PRECLINICAL SUBSTANTIA NIGRA
DYSFUNCTION IN IDIOPATHIC RAPID
EYE MOVEMENT SLEEP BEHAVIORDISORDER PATIENTSM MIYAMOTO1, T MIYAMOTO2, M IWANAMI2, S MURAMATSU3,S ASARI3, I NAKANO3, K HIRATA1
1
Department of Neurology, Dokkyo Medical University School of Medicine,Mibu, Tochigi, Japan, 2Department of Neurology, Dokkyo Medical
University Koshigaya Hospital, Japan, 3Division of Neurology, Departmentof Medicine, Jichi Medical University, Japan
Introduction: REM sleep behavior disorder (RBD) is a parasomnia
characterized by dream-enacting behaviors, unpleasant dreams and lackof muscle atonia during REM sleep. RBD may be idiopathic or related
to neurological diseases. An increased risk of developing Parkinson’s
disease (PD) in patients with idiopathic RBD (iRBD) was reported.
Transcranial sonography (TCS) has been shown to reveal hyperechogenicity of the substantial nigra (SN) in PD and in about 10% of healthy
subjects. It is hypothesized that SN hyperechogenicity in healthy subjects and iRBD patients is a vulnerability marker for PD.
Methods: To assess nigrostriatal function in iRBD, TCS and 6-[18F]
FMT-PET were performed in 19 males with polysomnography-(PSG)
confirmed iRBD (mean 66.4 years of age; mean estimated RBD duration
3.5 years).
Results: Nine of the iRBD patients were found to have SN hyperechogenicity (SN+), but the remaining 10 iRBD patients did not have SN
hyperechogenicity (SN-). FMT uptake at the putamen and caudate wassignificantly lower in patients with iRBD (SN+) than in patients with
iRBD (SN-). However, no correlation was found between SN echogenicity and FMT uptake.
Conclusions: Pathological hyperechogenic alterations in the area of the
SN in iRBD may suggest the existence of preclinical substantia nigra
dysfunction as determined by FMT-PET.

PO-1-212PERSONALITY TRAIT IS NOT RELATED WITH
THE OCCURRENCE OF REM SLEEP BEHAVIORDISORDER

T SASAI1, Y INOUE1,2
Japan Somnology Center, 2Department of Somnology, Tokyo Medical
University, Japan, 3Department of Life Sciences and Bio-informatics, Tokyo
Medical and Dental University, Japan
1

Rapid eye movement sleep behavior disorder (RBD) occurs idiopathically (iRBD) and frequently represents a prodromal phase of Parkinson’s
disease (PD). Previous reports have suggested that patients with PD
premorbidly show personality traits such as industriousness, inflexibility, cautiousness, and lack of novelty seeking. Additionally, psychological stress often causes aggravation of RBD symptoms. These phenomena
encouraged us to investigate personality traits in iRBD patients.
53 patients with iRBD (M : F = 41 : 12, age 65.5 ± 6.3) and 49 age andsex matched healthy controls (HC) (M : F = 33 : 16, age 64.7 ± 4.6) wereenrolled in this study. The new revision of the NEO Personality Inventory (NEO-PIR) were used to measure personality of these subjects, andthe 5 domains and the 30 facets of the NEO-PIR were compared
between the two groups. Among iRBD group, association between RBD
variables; e.g. proportion of REM sleep without atonia (RWA/REM),
length of RBD morbidity, frequency of vocalization or abnormal behavior, and the variables of NEO-PIR was investigated.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

Domain level analyses revealed that no significant differences were foundbetween the two groups. Facet-level analyses revealed that only the
Fantasy facet was significantly higher in iRBD group than the HC group;
however, the scores of this facet in both of the two groups were within
normal level. In iRBD group, neither the domains nor the facets showed
differences between the patients with and without stress related aggravation of RBD symptoms. Among the clinical descriptive RBD variables,
RWA/REM showed significant but weak correlations with frequency of
vocalization (r = .289, p < 0.05), the score of Neuroticism (r = .338, p <0.05) and its subscales; Angry Hostility (r = .299, p < 0.05), Self-Consciousness (r = .290, p < 0.05), and Vulnerability (r = .272, p < 0.05).
The present result suggests that patients with RBD have no noticeable
personality traits, which may underlie the development of PD.

PO-1-213
COMPARISON OF POLYSOMNOGRAPHICFINDINGS AND REM SLEEP BEHAVIORDISORDER BETWEEN PATIENTS WITH
PROGRESSIVE SUPRANUCLEAR PALSY AND
THOSE WITH PARKINSON DISEASET NOMURA1, Y INOUE2, H TAKIGAWA1, K NAKASHIMA1
Department of Neurology, Tottori University, Yonago, Japan, 2Department
of Somnology, Tokyo Medical University, Japan1

Purpose: REM sleep behavior disorder is a strong indicator of underlying synucleinopathies. However, the frequency of REM sleep behavior
disorder in tauopathies such as progressive supranuclear palsy remains
unclear. In this study, we compared REM sleep behavior disorder related
symptoms and polysomnographic findings between patients with progressive supranuclear palsy and Parkinson disease.
Methods: We conducted clinical interviews on 20 patients with progressive supranuclear palsy, 93 patients with Parkinson disease andtheir caregivers regarding REM sleep behavior disorder related symptoms. In addition, we made polysomnographic recordings on all thesubject patients. We then compared the patients clinical backgrounds,
parameters of Polysmnographies, and frequency of REM sleep behavior
disorder related symptoms between the two groups.
Results: Patients with progressive supranuclear palsy had more severely
disturbed nocturnal sleep than those with Parkinson disease. progressive supranuclear palsy group showed a significantly smaller numberof patients with REM sleep without atonia than in those with Parkinson
disease group. None of the progressive supranuclear palsy patients wereexperiencing REM sleep behavior disorder related symptoms, while 20
Parkinson disease patients had REM sleep behavior disorder related
symptoms.
Conclusion: The existence of REM sleep wihtout atonia on polysomnographic findings and REM sleep behavior disorder related symptoms
on interviews were less frequent in patients with progressive supranuclear palsy than in those with Parkinson disease.

PO-1-214EVALUATION OF CONTRIBUTING FACTORS TORESTLESS LEGS SYNDROME IN MIGRAINEPATIENTSS SUZUKI1, K SUZUKI1, M MIYAMOTO1, T MIYAMOTO1,Y WATANABE1, R TAKASHIMA1, K HIRATA1
1
Department of Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
Backgrounds: Recent studies have provided evidence for a positive
association between migraine and restless legs syndrome, although theexact mechanisms and factors remain unclear.

Methods: A cross-sectional, case-control study was conducted, including patients with migraine (n = 262) and headache-free control subjects(n = 163). Restless legs syndrome was diagnosed based on four essential
criteria as described by the International Restless Legs Syndrome Study
Group. A total of 210 blood samples were collected to correlate various
parameters with restless legs syndrome.
Results: Frequency of restless legs syndrome was significantly greaterin patients with migraine than in controls (13.7% vs. 1.8%). Migraine
patients with restless legs syndrome had high scores for Migraine Disability Assessment questionnaire, Beck Depression Inventory-II, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale comparedwith those without restless legs syndrome. In addition, migraine
patients with restless legs syndrome had a high rate of smoking andfamily history of restless legs syndrome, as well as increased levels of
serum phosphorus and urea nitrogen compared with those without
restless legs syndrome. In migraine patients, logistic regression analysis
revealed that positive family history of restless legs syndrome, depressive symptoms, daytime sleepiness, and increased serum phosphorus
levels were significant predictors for restless legs syndrome.
Conclusion: Our study confirmed a positive association between restless legs syndrome and migraine. Comorbidity of restless legs syndromein migraine patients was associated with insomnia, daytime sleepiness,depressive symptoms, headache-related disability, and increased serum
phosphorus levels. These findings may provide a better understandingof restless legs syndrome pathogenesis in migraine.

PO-1-215
APPEARANCE OF PERIODIC LIMB MOVEMENTS
DURING SLEEP ON THE NIGHT OFCONTINUOUS POSITIVE AIRWAY PRESSURE
IN OBSTRUCTIVE APNEA SYNDROMES OKADA-ARITAKE1, K NAMBA3, N HIDANO6, S ASAOKA1,
Y KOMADA1, A USUI7, M MATSUURA5, Y INOUE1,3,4
1
Department of Somnology, Tokyo Medical University, Tokyo, Japan,
2
Research Fellow, Japan Society for the Promotion of Science, Japan, 3Japan
Somnology Center, Neuropsychiatric Research Institute, Japan, 4Departmentof Psychiatry, Tokyo Medical University, Japan, 5Department of Life
Sciences and Bio-informatics, Tokyo Medical and Dental University, Japan,
6
Itabashi Hospital, Nihon University, Japan, 7Faculty of Health Science
Technology, Bunkyo Gakuin University, Japan
Objectives: Periodic limb movements during sleep (PLMs) sometimes
newly appear on the night of continuous positive airway pressure (CPAP)
titration in patients with obstructive sleep apnea syndrome (OSAS). To
ascertain the incidence of and causative factors for this phenomenon,
we investigated differences in the prevalence and associated factors for
new appearing and persistence of PLMs on CPAP titration night.
Method: We retrospectively analyzed 997 consecutive OSAS outpatients who received CPAP titration. On the basis of changes in periodic
limb movements index (PLMI) values (cut off level <= 15/h) frombaseline PSG to CPAP titration PSG, patients were assigned to the persistent, CPAP emergent, CPAP disappearance, or non-PLMs group.
Results: The rate of the number of the patients was 6.7% in the persistent group, 8.0% in the CPAP emergent group, 4.0% in the CPAP
disappearance group, and 81.2% in the non-PLM group. Multiple logistic regression analysis revealed that CPAP emergent PLMs were associated with a higher apnea-hypopnea index score (<= 30/h) on baseline
PSG and aged <= 47 years and that persistent PLMs were associatedwith being female and aged <= 47 years.
Conclusion: A significant number of OSAS patients may develop CPAP
emergent PLMs. Both CPAP emergent PLMs and persistent PLMs appear© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

325

Sleep, Science and Research

to be age-dependent phenomena. Additionally, CPAP emergent PLMs
were associated with OSAS severity. These findings provide some clues
for predicting the occurrence of PLMs during CPAP titration.

PO-1-216
SEASONAL OR TEMPERATURE CHANGE COULD
AFFECT SENSORY SYMPTOMS OF RESTLESSLEGS SYNDROME (RLS)Y OKA1, S TOMINAGA3, Y WATARI3
1
Department of Sleep Medicine, Ehime University Graduate School of
Medicine, Toon-city, Ehime, Japan, 2Department of Neurology, Hiroshima
Sleep Center, Japan, 3Sleep Disorders Laboratory, Hiroshima Sleep Center,Japan

Background: Restless legs syndrome (RLS) is a neurological disordercharacterized by an urge to move of the legs and most RLS patients
experience uncomfortable sensation of the legs. Change of the severityof RLS symptoms related to seasonal or temperature change is clinicallyexperienced, however, this phenomenon has not been analyzed indetail.
Objectives: The aim of the study was to elucidate whether the seasonalor temperature change could affect the severity of RLS symptoms.
Methods: Fifty-two consecutive RLS patients (21 males and 31 females,mean age: 59.1 SD 16.0) who consulted Hiroshima Sleep Center were
included in the study. Difference in sensory symptoms of RLS related
to season or temperature conditions, and dose of medical treatment for
RLS related to the seasonal change were investigated.
Results: Sensory symptoms worsened at summer in 19% of the RLS
patients and worsened at winter in 17% of the patients. Patients withsummertime worsening experience relief of the symptom in cooler
condition in 60% and worsening of the symptom in warmer conditionin 40%. Patients with wintertime worsening experience relief of thesymptom by bathing in 33% and worsening of the symptom in warmer
condition in 44%. Among the 14 patients with seasonal worsening
under medication followed up for at least one year, increased dose of
medication was required in 8 patients when their symptoms were worse
due to seasonal change.
Conclusions: Severity of RLS symptom could be affected by seasonalor temperature difference. Seasonal worsening of the symptoms may
mimic augmentation and should be differentiated.

PO-1-217SLEEP AND LIFE QUALITY IN UNTREATEDPATIENTS WITH PRIMARY RLSY SU HWA1, EY JOO1, SB HONG1
1
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
This study investigates the sleep architectures by polysomnography(PSG) and the quality of life in untreated patients with symptoms of
RLS. We enrolled consecutively 69 untreated RLS patients that met the
RLS criteria of ICSD2. All patients completed the overnight polysomnography (PSG), Restless Leg syndrome Quality of Life questionnaire(RLSQOL), International RLS scale (IRLSS), Beck Depression Inventory(BDI), Epworth Sleepiness Score (ESS), Stanford Sleepiness Score (SSS),
and Suggested Immobilization Test (SIT). According to RLS severity,
patients were divided to 3 groups (mild, moderate and severe).We
excluded the 14 comorbid patients with obstructive sleep apnea (OSA)(AHI more than 10 per hr) because of considerable effects on sleep
architectures and daytime consequences and the 13 patients with326

incorrect or incomplete data. Total 42 patients were analyzed (meanage, 54.6 yrs, 26 females). The mean duration of RLS was 12.7 years.
Mean ESS was 8.1 and SSS was 2.8. Mean IRLSS for severity was 22.7
and mean SIT score was 25.7. Mean RLSQOL was 65.8 and BDI score
was 11.3. All patients complained the sleep onset insomnia due to RLS
symptoms, but their mean sleep latency was within normal range(17.7 min). But, they showed sleep maintenance problem (increased
wakefulness after sleep onset, mean 79.2 min). Also twenty sevenpatients had periodic limb movement during sleep (mean PLMS index,
24.1 per hr, movement arousal index, 4.1 per hr). The RLSQOL, SITscore, and BDI score were significantly different between mild, moderate, or severe RLS group. RLSQOL and SIT score were significantly
correlated RLS severity (p less than 0.01). Total sleep time and arousal
index were significant correlated with RLS severity. RLS patients hadpoor quality of sleep and RLS severity was well correlated with RLSQOL,
SIT, and BDI scores.

PO-1-218
ASSOCIATION BETWEEN IRRITABLE BOWELSYNDROME AND RESTLESS LEGS SYNDROME
IN GENERAL POPULATIONC-H YUN1, SK LEE2, H KIM2, H-K PARK5, SH LEE3, C SHIN4
Department of Neurology, Inha University Hospital, Incheon, Republic ofKorea, 2Institute of Human Genomic Study, Korea University College ofMedicine, Republic of Korea, 3Department of Otorhinolaryngology-Headand Neck Surgery, Korea University College of Medicne, Republic of Korea,
4
Division of Pulmonary, Sleep and Critical Care Medicine, Korea
University College of Medicne, Republic of Korea, 5Department of
Neurology, Inha University Hospital, Republic of Korea
1

Background and Objectives: The association of restless legs syndrome(RLS) with gastrointestinal disorders has been reported. The aim of thisstudy is to document the association of RLS with irritable bowel syndrome in general population.
Methods: We recruited 3,425 Korean adult population aged 44 to
73 years who participated in a comprehensive health examination andon-site interviews as the third stage of evaluation of Korean Genome
and Epidemiology Study performed from March 2005 and November
2006. The diagnosis of RLS was based on the criteria proposed byInternational RLS Study Group and IBS was defined according to theRome II criteria. The prevalence of each condition was defined and theirassociation was checked by multiple logistic regression analysis. Age,
gender, renal function, depressive mood, use of RLS provocating drugs
and iron or vitamin supplements, and alcohol drinking and smoking
status were adjusted.
Results: The prevalence of RLS and IBS was 4.5% and 10.9%, respectively. RLS subjects had shorter nocturnal sleep (6.5 ± 1.4 vs. 6.8 ± 1.4,
p = 0.04), lower hemoglobin concentration (13.7 ± 1.5 vs.14.1 ± 1.6,
p = 0.003), more insomnia (44.4% vs. 28.3%), higher Epworth Sleepiness Scale (6.5 ± 3.8 vs. 5.8 ± 3.4, p = 0.01) and depression (27.5%
vs. 12.6%, p < 0.001) than subjects without RLS. There was no difference in renal function, cardiometabolic status, and use of iron orvitamin supplement between two groups. IBS was significantly prevalent in the RLS group compared with subjects without RLS (23.5% vs.
1.4%, p < 0.001). The adjusted odds ratio of RLS in relation to IBS was
2.56 [1.72, 3.80; p < 0.001].
Conclusions: This study broadens the spectrum of RLS associatedconditions and indicates that RLS needs to be screened in all patientswith IBS.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-219
PREVALENCE OF RESTLESS LEGS SYNDROME
AMONG PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA BEFORE AND AFTER CPAP TREATMENT,COMPARED TO THE GENERAL POPULATIONB BENEDIKTSDOTTIR1, ES ARNARDOTTIR1,2, C JANSON4,AI PACK3, S JULIUSSON2, T GISLASON1,2
1
Medical Faculty, University of Iceland, Gardabaer, Iceland, 2Department ofRespiratory Medicine and Sleep, Landspitali University Hospital, Iceland,
3
Center for Sleep and Respiratory Neurobiology, University of Pennsylvania
School, United States of America, 4Department of Medical Sciences:
Respiratory Medicine and Allergology, Uppsala University, Sweden
Objectives: To compare the prevalence of reported restless legs syndrome (RLS) between subjects with obstructive sleep apnea (OSA) anda randomly chosen sample from the general population as well as possible changes with CPAP treatment.
Materials and Methods: The OSA subjects (n = 822) were a part of
the Icelandic Sleep Apnea Cohort. They were newly diagnosed withmoderate or severe OSA (665 males, 157 females). The control subjects(n = 742) were randomly chosen Icelanders (394 males, 348 females)
who participated in another epidemiological study (www.boldcopd.
org). Measurements included a standardized RLS rating scale, questions
about sleep and the Epworth Sleepiness scale. The change with CPAP
treatment was assessed after 2 years (n = 538).
Results: Among OSA males 23.3% reported RLS but 12.9% of control
males (p < 0.001). 35.8% of OSA females reported RLS but 24.4% of
control females (p = 0.03). Both among OSA patients and controls thosewith RLS more commonly reported insomnia, daytime sleepiness, nocturnal sweating, snoring and gastro esophageal reflux (p < 0.05). They
were more likely to be females and to have a smoking history. No
relationship was found between RLS and age, BMI, hypertension or
respiratory disease in a logistic regression adjusting for the presence of
OSA and the other factors mentioned. No relationship was foundbetween RLS and sleep apnea severity. Subjects using CPAP had adecreased prevalence of RLS from 25.7% to 13.8% while no change wasobserved in those subjects not using CPAP (p = 0.04 for difference
between groups). Subjects that had persistent RLS were older on
average and had a lower physical quality of life at baseline.
Conclusions: RLS is more prevalent among OSA patients than controls.
No relationship was found with sleep apnea severity or BMI. CPAP
treatment of OSA decreases RLS symptoms significantly. RLS symptoms
are significantly related with insomnia and daytime sleepiness in both
OSA subjects and controls.

PO-1-220
DAYTIME SOMNOLENCE IN PATIENTS WITHRESTLESS LEG SYNDROMES DONG SEOG1, EY JOO1, SB HONG1
Department of Neurology, Samsung Medical Center, Seoul, Republic of
Korea
1

Background: Restless legs syndrome (RLS) is known to induce sleep fragmentation. However, subjective daytime sleepiness scale was reported
lower in RLS patients compared to patients with other sleep disorders. To
investigate the daytime sleepiness in RLS patients, we performed thepolysomnography (PSG) and Multiple Sleep Latency Test (MSLT).
Methods: We enrolled consecutively 125 untreated RLS patients who
met the RLS criteria of ICSD-II. But we excluded 29 co-morbid patientswith obstructive sleep apnea (OSA) or two or more sleep onset REM

periods because of the possibility of having co-morbid narcolepsy. Total
96 patients were analyzed (mean age 55.1 years, 66 females). We performed Epworth Sleepiness Score (ESS), Stanford Sleepiness Score(SSS), and Suggested Immobilization Test (SIT) in all patients. International RLS scale (IRLSS) was performed in 86, PSG in 71, and MSLT
in 45.
Results: Mean ESS was 7.2 and SSS was 3.0. Most of RLS patients
have moderate to severe symptoms on IRLSS (more than 5). Of them
only 17 patients reported moderate to severe daytime sleepiness (ESS
more than 11). Mean IRLS score for severity was 23.1 and mean SITscore was 26.7. SIT scores were not significantly correlated with ESS
but were correlated with RLS severity (p less than 0.01). On MSLT,
their mean sleep latency was 9.8 min and less than or equal to 8 min
in 15 patients.
Conclusions: Although most RLS patients did not report daytime
sleepiness, their mean sleep latency on MSLT was definitely shorter inabout half of them. These findings suggest that daytime sleepiness ofthem may be related to the concentration and memory deficit and mood
disturbances, which were frequently found in RLS patients.

PO-1-221
TRANSCUTANEOUS CARBON DIOXIDE LEVELSDURING NOCTURNAL PERIODIC LEG
MOVEMENTS

AV SALMINEN1, JOT NUPPONEN3, VPO RIMPILA1,4, VV ARHO5,O POLO1,4
1
Sleep Research Unit, Unesta Research Centre, Tampere, Finland,
2
Department of Chemistry and Bioengineering, Tampere University ofTechnology, Finland, 3Department of Software Systems, Tampere Universityof Technology, Finland, 4Department of Respiratory Medicine, Tampere
University Hospital, Finland, 5Medical Biotechnology, VTT TechnicalResearch Centre of Finland, Finland
Correspondence*: Olli Polo, professor of Respiratory Medicine, Unesta
Research Centre, Finn-Medi 3, Biokatu 10, 33520 Tampere, Finland,tel: +358 50 3054 739, fax: +358 3 261 7778, email: olli.polo@pshp.fi
Conflicts of Interests: None
Keywords: Transcutaneous carbon dioxide, periodic leg movements,
sleep, autonomic nervous system, vascular function, sympathetic activity
Objective: Periodic leg movements are associated with sympathetic
activation. The purpose of the study was to compare the characteristicsof those periodic leg movements (PLM) that do associate or do not
associate with phasic or tonic sympathetic outflow to the skin.
Methods: The sympathetic outflow to the skin was detected as variabletranscutaneous carbon dioxide partial pressure below the nocturnal
tcCO2 plateau level, resulting from vasoconstriction of the cutaneous
vessels. The high and stable tcCO2 plateau indicated a parasympathetic
state with absence of vasoconstriction or sympathetic influence. The
PLM characteristics and their ECG responses were analyzed during
periods of either low and unstable or high and stable tcCO2 levels in
111 cardiorespiratory sleep recordings.
Results: PLM with high intensity appeared during periods on low andunstable tcCO2, whereas PLM with lower intensity occurred, when the
tcCO2 had reached high and stable levels, characteristic for slow-wave
sleep. Heart rate responses were associated with majority of the PLM,
irrespective of the tcCO2 conditions.
Conclusions: High intensity PLMs are associated with tonic and phasic
vasoconstriction of the skin arteries indicating increased sympathetic
outflow to the cutaneous vascular bed. PLM with lower intensity
appeared during the vasodilated state, suggesting less sympathetic
intrusion and sleep disturbance.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research327

Sleep, Science and Research

PO-1-222

PO-1-224

ACTIGRAPHIC ASSESSMENT OF PERIODIC LEG
MOVEMENTS FOR PATIENTS WITH RESTLESSLEGS SYNDROMENOCTURNAL DISTURBANCES IN PARKINSON’SDISEASE: A VALIDATION STUDY OF
PARKINSON’S DISEASE SLEEP SCALE-2
JAPANESE VERSION

CR BAUMANN1, M PONCINI1, R PORYAZOVA1, E WERTH1,
CL BASSETTI2, MM SICCOLI3
1
Neurology, University of Zurich, Zurich, Switzerland, 2Neurology,
Ospedale Civico Lugano, Switzerland, 3Neurology, Neurozentrum Bellevue
Zurich, Switzerland
Background: The diagnosis of restless legs syndrome relies on theessential diagnostic criteria. Supportive criteria including response to
dopaminergic treatment and periodic leg movements on polysomnography enhance diagnostic sensitivity. Restless legs patients who do not
fulfill the supportive criteria may need an alternative treatment.
Methods: We retrospectively included 25 consecutive patients fulfillingthe essential criteria for restless legs and 17 healthy controls. All subjects
underwent actigraphy over three nights, and patients started treatment
with dopaminergic drugs thereafter. We examined the association
between the response to dopaminergic treatment and the periodic limb
movement index as assessed with actigraphy.
Results: Responders had significantly higher periodic limb movement
index than non-responders. Periodic limb movement was significantly
lower in control subjects.
Conclusions: Periodic limb movement as assessed with actigraphy overthree nights may predict the response to dopaminergic treatment inpatients who fulfill the four essential criteria of restless legs.

PO-1-223
HYPOCRETIN (OREXIN) LOSS IN ALZHEIMER’SDISEASER FRONCZEK1, S VAN GEEST1, M FRLICH1, S OVEREEM2,FWC ROELANDSE1, GJ LAMMERS1, DF SWAAB3
1
Neurology, Leiden University Medical Centre, 2215 NE Voorhout,Netherlands, 2Neurology, Radboud University Nijmegen Medical
Centre, Netherlands, 3Hypothalamus, Netherlands Institute for
Neuroscience, Netherlands

Sleep disturbances in Alzheimer’s Disease (AD) patients are associatedwith the severity of dementia and are often the primary reason for
institutionalization. These sleep problems partly resemble core symptoms of narcolepsy, a sleep disorder caused by a general loss of theneurotransmitter hypocretin. AD is a neurodegenerative disorder targeting different brain areas and types of neurons. In this study, we assessed
whether the neurodegenerative process of AD also affects hypothalamic
hypocretin/orexin neurons. The total number of hypocretin-1 immunoreactive neurons was quantified in post-mortem hypothalami of AD
patients (N = 10) and matched controls (N = 10). In addition, thehypocretin-1 concentration was measured in post-mortem ventricular
cerebrospinal fluid of 24 AD patients and 25 controls (including the 10
patients and 8 controls in which the hypothalamic cell counts were
performed). The number of hypocretin-1 immunoreactive neurons was
significantly decreased by 40% in AD patients (median (25th-75th
percentiles); AD 12,935 neurons (9,972–19,051); controls 21,002
neurons (16,439–25,765); p = 0.049). Lower CSF hypocretin-1 levels
were found in 24 AD patients compared to 25 controls (AD: 275 pg/ml(197–317); controls: 320 pg/ml (262–363); p = 0.038). Two AD patientswith documented excessive daytime sleepiness showed the lowest CSF
hypocretin-1 concentrations (55 pg/ml and 76 pg/ml). We conclude thatthe hypocretin system is affected in advanced AD. This is reflected in a
40% decreased cell number, and in 14% lower CSF hypocretin-1 levels.

328

K SUZUKI1, M MIYAMOTO1, M TATSUMOTO1, T MIYAMOTO1,Y WATANABE1, S SUZUKI1, M IWANAMI1, T SADA1,T KADOWAKI1, K HIRATA1, C TRENKWALDER2
1
Department of Neurology, Dokkyo Medical University, Mibu, Tochigi,
Japan, 2Department of Clinical Neurophysiology, University of Goettingen
and Paracelsus-Elena Klinik, Germany
Backgrounds: Sleep disturbances are common, but often difficult to beevaluated in Parkinson’s disease. Very recently, revised version of Parkinson’s disease sleep scale, Parkinson’s disease sleep scale-2, has beendeveloped for assessing nocturnal disturbances. The aim of this study
was to assess a validity and reliability of the Japanese version of Parkinson’s disease sleep scale-2 and to evaluate nocturnal disabilities by thisnew scale.
Methods: A cross-sectional, case-control study was carried out consisting of patients with Parkinson’s disease (n = 90) and age- and gendermatched control subjects (n = 90). Parkinson’s disease sleep scale-2
Japanese version was used for evaluation of nocturnal disturbances,
Pittsburgh Sleep Quality Index for insomnia and Epworth Sleepiness
Scale for daytime sleepiness. Motor function and complication of treatment were rated with the Unified Parkinson’s Disease Rating Scale part3 and 4, respectively. Quality of life was evaluated with the Parkinson’s
Disease Quality of Life questionnaire and depressive symptoms wasassessed with Beck Depression Inventory-II, respectively.
Results: Parkinson’s disease patients had significantly impaired scoresof Parkinson’s disease sleep scale-2 compared with control subjects. A
satisfactory internal consistency and test-retest reliability were demonstrated. Parkinson’s disease sleep scale-2 was correlated with Pittsburgh
Sleep Quality Index and Epworth Sleepiness Scale. Also, a significant
correlation was found with depressive symptoms, quality of life andmotor function.
Conclusion: Our study confirmed a usefulness of new version of thescale, Parkinson’s disease sleep scale-2 Japanese version, that enables
comprehensive assessment in nocturnal disturbances in Parkinson’s
disease.

PO-1-225SLEEP ALTERATIONS IN LONGITUDINALLYASSESSED ALZHEIMER’S DISEASE PATIENTSEJ CUSSANS1, G WILCOCK2, RG FOSTER1, K WULFF1
1
Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford,
United Kingdom of Great Britain and Northern Ireland, 2Nuffield
Department of Clinical Medicine, University of Oxford, United Kingdom
Sleep disturbances are commonly found in Alzheimer’s disease (AD)patients as well as in the elderly population. The most common disturbances are reduced sleep maintenance and longer sleep latencies.
Despite common misperception, the amount of sleep is rarely affectedby old age. Cholinergic medication [cholinesterase inhibitors or ChEIs]
is available to delay memory degradation in AD patients however there
are reports of sleep also being affected. Here the longitudinal assessmentof sleep in ChEI-naive healthy elderly controls, mild cognitive impairment (MCI), early AD and moderate AD patients is presented. On
commencement of the study baseline observations were made using© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

actigraphy and polysomnography (PSG) to assess sleep. These assessments were repeated 6 weeks after ChEI initiation.
Pre-medication significant differences in sleep characteristics between
the controls and the AD patients were found, including time spent inbed, with patients staying in bed nearly three hours longer [p < 0.05].
Furthermore total activity levels were much lower for the AD patients[p < 0.05]. Activity levels were also found to be reduced in early AD
patients in comparison to controls [p < 0.05] and differences in baseline
PSG were found between all groups. Post-medication, in comparison
to controls, the moderate AD patients spent more time in bed, had lesssleep efficiency and more fragmentation of sleep [p < 0.05]. Alterations
in PSG were also found with changes in rapid eye-movement and slow
wave sleep most noticeable.
This is the first study to longitudinally assess the sleep and circadianrhythmicity of healthy controls, MCI, early AD and moderate AD
patients. The moderate AD patients showed distinct sleep alterations
after six weeks of ChEI treatment. This is important as sleep disturbances
are a common reason for terminating ChEI treatment and the primaryreason for institutionalisation. A better understanding of the alterationsof sleep in AD patients could prolong the use of ChEI medication andconsequently increase time spent at home before institutionalisation.

PO-1-226SLEEP CHARACTERISTICS IN MILD TRAUMATIC
BRAIN INJURY PATIENTSS KHOURY1, F AMZICA1,2, J-F GIGUÈRE5, R DENIS5,GA ROULEAU1,2,3, GJ LAVIGNE1,2,3,4,5
1
Department of physiology/Neurosciences, Université de Montréal, Montréal,
Canada, 2Faculty of Medicine and Dentistry, Université de Montréal,
Canada, 3Center of Excellence in Neuroscience of the Université de Montréal,
Université de Montréal, Canada, 4Center for Advanced Research in Sleep
Medicine, Hôpital du Sacré-Coeur de Montréal, Canada, 5Department of
trauma and surgery, Hôpital du Sacré-Coeur de Montréal, Canada
Introduction: Sleep disturbance, along with fatigue and pain, is one of
the top three complaints following Mild Traumatic Brain Injury (MTBI).
Earlier reports aimed at studying sleep in MTBI, yet no consensual results
were found to describe and understand sleep disruption. Many reasons
may explain these discrepancies, including sample heterogeneity, multiple traumas, confounding factors . . . In this study, we aim to look at sleep
self quality report, macrostructure and spectral analysis in a homogeneous MTBI patients sample in comparison to healthy control subjects.
Methods: The diagnostic of MTBI was confirmed by a trauma neurosurgeon. 33 MTBI and 16 healthy subjects slept for two nights in a
hospital based laboratory. 9 MTBI were excluded from the study for
failure to comply with protocol. The final sample consisted of 24 MTBI
(15M/9F; mean age = 38,3 y.o. SD = 11,4) and 16 healthy subjects(6M/12F; mean age = 31,9 y.o. SD = 9,4). The first night is for habituation and the second night is used for analysis. The Pittsburgh Sleep
Quality Index (PSQI) was administered. Visual Scoring was performed
according to the R&K scoring rules. Off-line spectral analysis was performed using Wavemetrics (IgorPro 6.12) on an artefact free signal.
Results: The global score on the PSQI was higher in the MTBI (mean= 8,9 SD = 4,9) than the healthy subjects (mean = 2,8 SD = 1,7) as
well as for all the subscores. There were no significant differences insleep macrostructures between the two groups for the following sleep
parameters: latency (min), duration (min), efficiency (%), stages
1,2,3&4, REM (%), REM latency (min) and REM efficiency. Spectral
EEG analysis is still underway.
Conclusion: The PSQI, which measures subjective sleep quality for the
past month showed that the MTBI group do report a worst sleep quality

than healthy subjects. Even though sleep disorders are the major complaint following a MTBI, no significant difference is observed in sleep
macrostructure. FFT spectral results may provide the answer to thesleep disturbance reported by this population. Supported by: QPRN,FRSQ and CIHR

PO-1-227
RELATIONSHIP BETWEEN POLYSOMNOGRAPHIC
AND ACTIGRAPHIC ASSESSMENT OF SLEEPVARIABLES IN ADULTS WITH LATE-LIFE
NEUROPSYCHIATRIC OR NEURODEGENERATIVEDISORDERSIKC TONY1, NL SHARON1, LJG SIMON1, P STERGOS1, RL NAOMI2
1
Chronobiology & Sleep, Brain & Mind Research Institute, Camperdown,
Australia, 2School of Management and Marketing, Central Queensland
University, Australia

Introduction: Although actigraphically determined sleep-wake variables provide robust sleep-wake differentiation in healthy subjects, theconcordance between actigraphy and polysomnographic assessment of
sleep have not been conducted in older clinical samples. Such studies
are required given the increasing use of actigraphy in clinical samples.
Method: Fifty-nine patients with mild cognitive impairment (19M,
age = 64.7 ± 11.1) and Parkinson’s disease (23M, age = 64.0 ± 7.2) and17 age-matched controls (7M, age = 63.4 ± 8.0) completed 2-weeks ofactigraphy and 2 consecutive in-lab overnight PSG studies. Variablesfrom the second night of PSG assessment were analysed. Agreement
between the two measures was analysed using t-tests and regression.
Results: There were no significant differences in sleep-wake variables
between the two groups. Average rest onset and rest offset times determined by actigraphy were significantly later than PSG determined sleep
onset (mean difference = 21.3 ± 56 min, t = 3.3, p < 0.05) and offset
times (mean difference = 20.5 ± 50.0 min, t = 3.6, p < 0.05). Actigraphy
underestimated wake duration compared to PSG wake duration (WASO)(mean difference = –67.2 ± 60.2 min, t = –9.7, p < 0.05). Greater duration of PSG WASO was associated with greater underestimation of
actigraphically defined wake time (b = -0.869, r = –0.893, p < 0.05).
Discussion: Although sleep-wake parameters from the two procedures
were not equivalent, the differences were not profound. The underestimation of actigraphically determined wake time is consistent withprevious findings where quiet wakefulness is typically scored as sleep.
In this older sample, we have demonstrated that actigraphically defined
wake time corresponded to 87% of PSG WASO consistently. Thesefindings suggest that actigraphy is of significant clinical utility in some
aspects of sleep-wake monitoring, and initial determination of sleepwake disturbances that may subsequently require further, more detailed
investigation in these groups.

PO-1-228
NEW EEG MARKERS OF ALZHEIMER’S DISEASEFOR THE ELDERLY

C-F LIN1, P-L LIU2, P-Y CHIANG3
Department of Applied Mechanics, National Taiwan University, Taipei
City, Taiwan, Taiwan, 2Department of Applied Mechanics, National Taiwan
University, Taiwan, 3Department of Otolaryngology, School of Medicine, Fu
Jen Catholic University, Taiwan
1This study develops new markers of the Alzheimer’s disease for theelderly based on the all-night EEG of a single channel. The sleep EEG© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research329

Sleep, Science and Researchis transformed into 5 power time series corresponding to the delta,
theta, alpha, sigma and beta frequency bands. Then, the mutual information and wavelet coherence are adopted to develop a measurement
for the similarity between the power time series of a frequency band
pair, denoted as the half phase variance (PV). The PV values are usedas markers of the Alzheimer’s disease for the elderly.
In this study, the sleep EEG from electrodes C3, C4, O1 and O2 havebeen recorded for 7 dementia’s patients (including AD patients andnon-AD type patients), 19 age-matched normal controls, and 5 normal
young people as baseline. It is found that the PV of theta and alphaband power time series prominently increases in dementia’s patients ascompared with the controls in the C3 and O1 channels with p-value <0.001, especially for AD patients. In addition, it also increases significantly in dementia’s patients in the C4 channel with p-value < 0.01.
These PV values seem to be able to reflect neurophysiological degeneration and thus may serve as a marker to identify AD patients. Comparedwith conventional approach, this method is advantageous because only
one channel measurement is required.

PO-1-229
COMPARISON OF SLEEP ARCHITECTURE
AMONG ALZHEIMER’S DISEASE, DEMENTIA
WITH LEWY BODIES AND MILD COGNITIVE
IMPAIRMENTH SHINNO1, I ISHIKAWA1, M YAMANAKA1, A USUI1, Y INAMI2,J HORIGUCHI2, Y NAKAMURA1
1
Department of Neuropsychiatry, Kagawa University School of Medicine,
Kagawa, Japan, 2Department of Psychiatry, Shimane University Faculty of
Medicine, Japan
Objective: Previous studies have suggested that sleep quality of patientswith dementia may be poorer than that of the elderly subjects without
cognitive impairment. This study aims to compare sleep architecture
among Alzheimer’s disease (AD), dementia with Lewy bodies (DLB),
mild cognitive impairment (MCI) and age-matched controls.
Methods: Clinical evaluation, cognitive screening test and polysomnography were carried out. Diagnoses of MCI, AD and MCI were madewith standard guidelines. Polysomnography variables such as total sleep
time (TST), sleep efficiency, sleep latency, time spent in stages slow wave
sleep (SWS) and REM sleep and periodic limb movement during sleep(PLMs) were compared among MCI, AD, DLB and control groups. All
subjects gave informed consent according to institutional guidelines
and tenets of the Declaration of Helsinki. This study was approved by
local Institutional Research Board.
Results: TST and time spent in the stages of SWS and REM sleep in
the AD and DLB groups were decreased compared to those in MCI andthe control group. There were significant differences in the amount oftime spent in stage REM sleep among these groups. The rank order oftime spent in REM sleep was control group > MCI, DLB, > AD group.
PLMs index in DLB was increased compared with those in the othergroups.
Conclusion: Subjects with dementia had significantly shorter TST, SWS
and REM sleep. An increase in PLMs was significant in patients with
DLB. Time spent in stage REM sleep was shortest in the AD group.
Subjects with MCI demonstrated a significantly shorter time spent instage REM sleep compared with the control, yet they do not meet currently accepted criteria for dementia.
Acknowledgement: This study was supported by a Grant-in-Aid for
Scientific Research.

330

PO-1-230
PRECIPITATING FACTORS FOR
SOMNMABULISM: A VIEW FROM PATIENTS’PERSPECTIVE

M-A LABELLE1, M PILON1,2, J MONTPLAISIR2,3, A ZADRA1,2
1
Department of Psychology, Universite de Montreal, Montreal, Qc, Canada,
2
Centre d’etude du sommeil et des rythmes biologiques, Hopital du
Sacre-Coeur de Montreal, Canada, 3Department of Psychiatry, Universite
de Montreal, Canada
Sleepwalking is a common arousal parasomnia affecting up to 4% of
adults. Underlying pathophysiological mechanisms remain unclear, but
factors that intensify or disrupt sleep can facilitate episode occurrencein predisposed individuals. Other variables have been described as
facilitating episodes, but supporting evidence is scarce. Surprisingly,
sleepwalkers’ views on such factors have not been systematically investigated. Participants were 70 consecutive patients referred to our Sleep
Disorders Clinic and diagnosed with sleepwalking. All participants
underwent a clinical interview, overnight polysomnography, and completed a questionnaire assessing various aspects of their sleepwalking.
One section covered a wide range of precipitating factors, including
stress (3 items), dreams (2 items), sleep schedule and habits (4 items),
use of psychoactive substances (4 items), and various endogenous (5items) and environmental (6 items) factors. Each item was rated for the
degree to which it contributed to their experiencing episodes using ascale from 1 (never) to 5 (always). We present the percentage of patients
who responded with often or always to highlight their most salient
factors.Consistent with previous literature, most sleepwalkers (68.5%
of patients) considered stress to be a significant precipitating factor for
their episodes. Dreams were the second most frequently reported factor(45.7%), a finding that underscores the importance of assessing phenomenological experiences in arousal parasomnias. Sleep deprivation
was third with 31.4%. Surprisingly, endogenous and environmental
stimuli were identified as significant factors by less than 10% of sleepwalkers. This contrasts with reports suggesting that alcohol, caffeine,sudden sounds or being touched constitute important contributing
factors. These data reveal that sleepwalkers consider stress, sleep mentation, and sleep deprivation as the factors most susceptible of increasing
their likelihood of experiencing episodes of somnambulism.

PO-1-231
DISCRIMINATING BETWEEN VIOLENT AND
NON-VIOLENT SLEEPWALKERS: SENSITIVITY
AND SPECIFICITY OF STAGE 4 SLEEPA ZADRA1, A DESAUTELS2, M-A LABELLE1,2, J MONTPLAISIR2,3
Psychology, Université de Montréal, Beaconsfield, Qc, Canada, 2Center for
Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur deMontréal, Canada, 3Psychiatry, Université de Montréal, Canada

1

Introduction: Somnambulism (sleepwalking) is considered a disorderof arousal characterized by motor activity, impaired judgment, misperception and relative unresponsiveness to environmental stimuli, andvariable retrograde amnesia. Although somnambulism can give rise toviolent sleep related behaviors, little is known about why some sleepwalkers repeatedly experience violent episodes. Having less than 2% ofstage 4 sleep has been identified as one potential marker of violent
somnambulism. We report a follow-up study of this polysomnographic
marker.
Method: All sleepwalkers were referred to our Sleep Disorders
Clinic by a physician. Overnight polysomnographic recordings were

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

performed on 7 adult sleepwalkers (4 Men, 3 Women) reporting ahistory of violent episodes of somnambulism and on 54 sleepwalkers(20 Men, 34 Women) without violent episodes. The two groups did not
differ significantly in terms of their age (33.3 vs 32.7 years).
Results: Violent sleepwalkers had significantly less stage 4 sleep thannon-violent sleepwalkers (1.53% vs 4.65%, p = .008) and six out ofseven violent sleepwalkers (86%) had less that 2% of stage 4 sleep
compared to 25 of the 54 non-violent sleepwalkers (46%). A Chi square
test indicated that these group proportions were significantly different(p = .036). No other polysomnographic measure differed significantly
between the two groups.
Conclusion: Our findings indicate that although having less than 2%of stage 4 sleep shows good sensitivity for violent sleepwalkers, its
specificity is relatively low as it also occurs in almost 50% of non-violent
sleepwalkers.

PO-1-232SLEEP AND EXECUTIVE FUNCTIONING IN
CHILDREN WITH EPILEPSY

CM HILL1, K FENELLA1, W ANDREA2, S HOLLEY1
1
Division of Clinical Neuroscience, University of Southampton, Eastleigh,Hampshire, United Kingdom of Great Britain and Northern Ireland,
2
Department of Paediatric Neurology, Southampton University Hospitals
NHS Trust, United Kingdom
Background: Sleep disturbance is commonly reported in childhood
epilepsy, although few studies have quantified this using objective sleep
measures. We have previously demonstrated in typically developing(TD) children that less sleep time is associated with poorer neuropsychological performance, particularly tasks measuring Executive Functioning (EF). To our knowledge, no studies have examined whether
children with epilepsy are at risk of neurocognitive deficits associatedwith sleep disturbance.
Method: The sample consisted of 23 children diagnosed with idiopathic
epilepsy (with no significant learning difficulties) and 53 TD children.
Children were aged 6–13 years, with no significant differences between
the two groups in age or gender. Sleep was measured for one week
using wrist-worn actigraphs (AMI). Neuropsychological tests wereadministered measuring attention, working memory, planning, verbal
fluency, inhibition, and processing speed (PSI). An aggregate score of
EF (AEF) was calculated from standardised residuals (not including PSI)
to measure the overall effect of sleep disturbances on EF.
Results: Although children with epilepsy slept (M = 459.91 minutes,
SD = 64.62), on average, for 20 minutes less compared to TD children(M = 479.42 minutes, SD = 57.06), this difference failed to reach statis­
tical significance (F = 2.52, p = .087). Sleep efficiency was similar
between the groups: M = 84.92 (SD = 8.12) in the TD group, M = 82.38(SD = 10.53) in the Epilepsy group. However, children with epilepsy
had significantly poorer AEF compared to TD children (F = 11.86, p <.01). Furthermore, PSI was significantly lower in children with epilepsy(t = 2.82, p < .01). Conclusion: These results need further investigation
but in this study are not apparently related to measures of sleep quality.
Funded by a grant from Epilepsy Action UK.

PO-1-233
ASSOCIATION BETWEEN SHORT TOTAL SLEEPTIME AND HYPERTENSION- THE SKARASLEEP COHORTD ZOU1, DN EDER2, D ESKANDARI2, U LINDBLAD3, L GROTE1,2,
J HEDNER1,2
1
Sleep Disorders Center/Department of Pulmonary Medicine, Sahlgrenska
University Hospital, Gothenburg, Sweden, 2Center for Sleep and Vigilance
Disorders/Institute of Medicine, University of Gothenburg, Sweden, 3Skara
Institute, Skvde, Sweden
Objective: To investigate the relationship between total sleep time(TST) and hypertension in a gender-balanced community-dwellingcohort of hypertensive patients and normotensive controls (Skara Sleep
Cohort).
Methods: All participants (n = 344, males 173, age 61[7] years, bodymass index [BMI] 29[5] kg/m2) underwent ambulatory home polysomnography. Hypertension was defined as supine systolic BP >= 140 mmHg
and/or diastolic BP >= 90 mmHg or with ongoing hypertensive medication. A multivariate logistic regression model was used to address theassociation between hypertension status and anthropomorphic/sleep
variables. Odds ratios (ORs) are expressed as the relative risk over theinterquartile range [25% vs. 75%] of the predictor with 95% confidence
intervals.
Results: The mean age, BMI, apnea/hypopnea index and TST in hypertension (n = 224, males 109) and control (n = 120, males 64) groups
were 63(6) vs. 59(7) years, 29(5) vs. 27(4) kg/m2, 29(24) vs. 20(23)n/h and 360(76) vs. 395(67) minutes, respectively (p < 0.01). Logistic
regression analysis demonstrated that the number of apnea/hypopnea
events (47 vs. 218 events), TST (331 vs. 426 minutes), BMI (25 vs.
31 kg/m2) and age (56 vs. 67 years) all independently contributed to
hypertension (OR 1.89 [1.1 : 3.2], 0.58 [0.4 : 0.8], 1.96 [1.4 : 2.8] and2.25 [1.7 : 3.9], respectively).
Conclusion: Short sleep time is associated with hypertension independent of age, BMI and apnea/hypopnea events in this population-based
cohort.

PO-1-234
SLEEP-RELATED EATING DISORDER: A SLEEPDISORDER OR MENTAL DISORDER? A CASEREPORT EXPLORING SRED AND THE
IMPORTANCE OF SUCH DISTINCTION

EJ BRITTON1
Medical School, St George’s Medical School, University of London, London,
United Kingdom of Great Britain and Northern Ireland
1

This is the case of a 32 year old woman who has been living with SleepRelated Eating Disorder (SRED) for 25 years. She experiences the typical
picture of recurrent arousals from sleep associated with compulsive
ingestion of food, impaired levels of consciousness and amnesia. Currently, 50% of her nights are affected by the disorder, with 2–3 episodes
each night. Until recently this disorder was considered distinct from
Nocturnal Eating Syndrome (NES), where subjects are fully aware of
their feeding, much of which may take place before the patient goes tosleep. However, the 2005 revision of the International Classification of
Sleep Disorders has blurred the boundaries between the two conditions
by in effect subsuming NES into SRED. This report describes some ofthe difficulties a young mother has experienced in living with andmanaging the disorder. It raises specific issues in three areas: the clinical© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

331

Sleep, Science and Researchand psychosocial importance of understanding and maintaining thedistinction between SRED and NES; the prevalence and problems associated with increased weight in SRED patients; the limited options andefficacy of treatment in SRED.

PO-1-235
THE SINGLE DOSE PHARMACOKINETIC AND
PHARMACODYNAMIC PROFILES OF
SUVOREXANT (MK-4305), A DUAL OREXIN
RECEPTOR ANTAGONIST, IN HEALTHY
MALE SUBJECTSH SUN1, WD KENNEDY2, N LEWIS3, T LAETHEM4, K TEE5, XD LI6,J HOON7, L VAN BORTEL8, L ROSEN9, J CHODAKEWITZ10,
JA WAGNER10, MG MURPHY101
Clinical Research/Clinical Pharmacology, Merck Research Laboratories,
Merck & Co., Inc., North Wales/PA, United States of America, 2Medical
Director, Genetech Research and Early Development, William Dexter
Kennedy, United States of America, 3Early Clincal Specialist, Merck
Research Laboratories, Merck & Co., Inc., United States of America,
4
Clinical Pharmacology, MSD Europe, United Kingdom, 5Reserch Fellow,
Merck Research Laboratories, Merck & Co., Inc., United States ofAmerica, 6Biometrician Biostatistics, Early Development Statistics, Merck
Research Laboratories, Merck & Co., Inc., United States of America,
7
Center for Clinical Pharmacology, U.Z. Gashuisberg, United Kingdom,
8
Drug Research Development, U.Z. Gent, Belgium, 9Sr. Project Ld,
Cardiovascular, Merck Research Laboratories, Merck & Co., Inc., UnitedStates of America, 10VP Clinical Research, Clinical Pharmacology, Merck
Research Laboratories, Merck & Co., Inc., United States of America
Introduction: Orexin neuropeptides play a critical role in regulating
the transition between wake and sleep. Suvorexant (MK-4305), a potent
dual orexin receptor antagonist, represents a potentially new approach
to treating insomnia.
Methods: This first-in-human study of suvorexant was a multi-part
pharmacokinetic and pharmacodynamic study in healthy young men.
Part I was a randomized, double-blind, single rising-dose study toevaluate the safety, tolerability, and pharmacokinetics of suvorexant(n = 16). Part II was a 4-period crossover study to evaluate the effectsof suvorexant on quantitative EEG (qEEG) (n = 12).
Results: Suvorexant was generally well tolerated in healthy young men
up to 120 mg with the most frequently reported adverse experience
being somnolence. Following AM administration, suvorexant was
rapidly absorbed with a median Tmax of 1.0–2.0-hour and apparent
terminal T1/2 of 8.5–15-hours. Night-time administration did not affect
AUC0-, but slightly decreased Cmax and median Tmax was delayed by
1-hour. The increases on AUC0- and Cmax appeared less than dose
proportional from 4 to 120 mg. There was a dose-dependent and timelimited increase in sleepiness on Karolinska sleepiness scale anddecrease in alertness on Bond-Lader VAS, which were consistent withthe desired pharmacodynamic effects. Following AM administration,
single doses of 20 and 80 mg produced a dose-dependent increase indelta band power spectral density on qEEG suggesting sleep promoting
effects. The effect of suvorexant on qEEG disappeared at 8 and 12-hour
post-dose indicating no long-lasting effect which may cause next-day
residual effects.
Conclusions: Suvorexant was well tolerated and demonstrated pharmacokinetic and pharmacodynamic profiles that supported its development as a hypnotic.

332

PO-1-236
A DUAL OREXIN RECEPTOR ANTAGONIST,
MK-6096, IN PATIENTS WITH PRIMARYINSOMNIA: RANDOMIZED, CONTROLLED,
CROSSOVER POLYSOMNOGRAPHY STUDYKM CONNOR1, E MAHONEY1, S JACKSON1, J HUTZELMANN1,X ZHAO2, E SNYDER2, D SNAVELY2, D MICHELSON1, T ROTH3,WJ HERRING1
1
Clinical Research, Neuroscience and Ophthalmology, Merck Reserach
Laboratories, North Wales, PA, United States of America, 2Late Stage
Statistics, Merck Research Laboratories, United States of America, 3Sleep
Medicine Research, Henry Ford Hospital, United States of America
Objectives: Orexinergic activity originating in the lateral hypothalamus
plays a critical role in sleep/wake regulation. Drugs that influence orexinergic tone may be useful in the treatment of sleep disorders. We
evaluated MK-6096, a potent and selective dual orexin receptor antagonist (DORA), for the treatment of primary insomnia in adults.
Methods: A randomized, double-blind, placebo-controlled, adaptive,
2-period (4-weeks per treatment period, separated by a 2-weekwashout) cross-over polysomnography (PSG) global study was performed to assess the efficacy and tolerability of MK 6096 (2.5, 5, 10,
and 20 mg) orally-administered 30 minutes before bed time in the treatment of primary insomnia. PSG was performed on Night 1 and at theend of Week 4 of each period. The primary outcome measure was sleep
efficiency.
Results: 324 patients were randomized and administered at least one
dose of study medication: 318 received MK-6096 (2.5 mg N = 79, 5 mg
N = 78, 10 mg N = 80, 20 mg N = 81) and 315 received placebo. All
doses of MK-6096 were superior to placebo (p-values < 0.002) for the
co-primary endpoints of difference from placebo in change from baseline sleep efficiency at Night 1 (LS mean [95% CI]: 2.5 mg = 8.4%
[5.3,11.6], 5 mg = 10.0% [6.9,13.2], 10 mg = 10.7% [7.7,13.8], 20 mg= 13.4% [10.3,16.4]) and end of week 4 (2.5 mg = 4.6% [1.8,7.4], 5 mg
= 4.5% [1.7,7.3], 10 mg = 9.7% [6.9,12.5], 20 mg = 8.6% [5.8,11.4]).
Significant dose-related effects were also observed for sleep induction
and maintenance parameters. MK-6096 was generally safe andwell-tolerated.
Conclusions: Treatment for 4-weeks with the DORA MK-6096 is efficacious and well-tolerated in adults with primary insomnia. Support:
Merck Research Laboratories.

PO-1-237
PRECLINICAL EFFICACY OF SUVOREXANT AND
OTHER OREXIN RECEPTOR ANTAGONISTSCJ WINROW1, S KUDUK2, SM DORAN1, MH PAUSCH1,J USLANER1, PL TANNENBAUM1, DR REISS1, J MAJERCAK1,
MJ BRESLIN2, AL GOTTER1, D COLUSSI1, D CUI3, CM HARRELL1,
PJ COLEMAN2, JJ RENGER1
1
Neuroscience Department, Merck Research Laboratories, West Point, PA,
United States of America, 2Medicinal Chemistry Department, Merck
Research Laboratories, United States of America, 3Drug Metabolism andPharmacokinetics, Merck Research Laboratories, United States of America

Introduction: Orexins are neuropeptides which promote wakefulness
by activation of two G-protein coupled receptors, Orexin 1 Receptor(OX1R) and Orexin 2 Receptor (OX2R). Antagonism of Orexin Receptors provides a novel therapeutic approach for primary insomnia and© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

is supported by both genetic and pharmacological data. Merck has led
the discovery and development of Dual Orexin Receptor Antagonists(DORAs) as a novel treatment for primary insomnia, with the leadcompound Suvorexant (MK-4305) currently in Phase III clinicalstudies.
Methods: The detailed pharmacological characterization of Suvorexant
and a series of other small molecule DORAs will be presented. Studies
included in vitro binding and functional assays, ex vivo receptor occupancy studies, as well as in vivo locomotor assessment, multi-species
PSG and quantitative EEG in wild-type and transgenic animals.
Comparisons with other sleep-promoting medications were also
conducted.
Results: Equivalent in vitro binding affinities and potencies for orexin
receptors from mice, rats, rabbits, dogs, rhesus and humans wereobserved. In vivo studies with Suvorexant and DORAs from distinct
structural classes showed dose-dependent receptor occupancy, reduced
homecage locomotor activity and proportionally increased REM and
NREM sleep in multiple species. These sleep effects fundamentally differ
from sedating GABAergic drugs, and unlike zolpidem and diazepam,
DORAs do not impair rotarod performance even when administered at>10-fold above sleep-promoting doses. Examination of sleep architecture and qEEG patterns showed consistency and dose-dependence inmice, rats, and dogs, with modulation of low and high frequency spectral power bands.
Conclusion: Suvorexant and other dual orexin receptor antagonists
effectively promote sleep across species and provide a novel approachfor the treatment of primary insomnia.
Support: This project was supported by Merck.

PO-1-238
CHARACTERIZATION OF MK-6096: A NOVELDUAL OREXIN RECEPTOR ANTAGONIST FOR
THE TREATMENT OF INSOMNIACJ WINROW1, CD COX2, PL TANNENBAUM1, MJ BRESLIN2,
AL GOTTER1, CM HARRELL1, SV FOX1, SL GARSON1, J STEVENS1,
D CUI3, DR REISS1, SM DORAN1, J SCHREIER2, PJ COLEMAN2,
JJ RENGER1
1
Neuroscience Department, Merck Research Laboratories, West Point, PA,
United States of America, 2Medicinal Chemistry Department, Merck
Research Laboratories, United States of America, 3Drug Metabolism andPharmacokinetics Department, Merck Research Laboratories, United Statesof America
Introduction: Orexin/Hypocretin is a neuropeptide responsible forregulating arousal in mammals, acting through Orexin 1 Receptor(OX1R) and Orexin 2 Receptor (OX2R) to promote wakefulness.
Genetic and pharmacological studies demonstrate that blockade oforexin receptor signaling reduces wakefulness and could provide
benefit for insomnia. MK-6096 is a potent and selective Dual Orexin
Receptor Antagonist (DORA) developed by Merck Research Laboratories, and has recently completed PhIIb studies as a treatment for
primary insomnia.
Methods: This presentation will focus on the preclinical characterization of MK-6096, including data from in vitro receptor binding, calcium
release and specificity assays, and in vivo receptor occupancy, locomotor, sleep and quantitative EEG (qEEG) assays. MK-6096 in vitro andin vivo activities were examined across species including mice, rats anddogs.
Results: MK-6096 and other DORA compounds effectively blockorexin-induced locomotor activity, demonstrate receptor engagement inan ex vivo occupancy assay and dose-proportionally promote sleep in

multiple species. MK-6096 and other DORAs reduce wake activity andproportionally increase both slow wave sleep (SWS) and rapid eye
movement (REM) sleep to increase total sleep time. Dose-dependentand translational qEEG effects were observed across preclinical species.
Sleep architecture and qEEG patterns were consistent and dose-dependent across DORAs from distinct structural classes, and differ fromstudies using GABA modulators. Orexin receptor antagonists modify
sleep architecture by consistently increasing deep sleep states at theexpense of wakefulness.
Conclusion: MK-6096 is a potent and selective DORA that effectively
promotes sleep in multiple species, and provides a new therapeutic
approach for the treatment of insomnia.
Support: This project was supported by Merck.

PO-1-239 / AS-22 Presenter
RELATIVE CONTRIBUTION OF OREXIN-1 AND
OREXIN-2 RECEPTORS TO THE SLEEP EFFECTS
INDUCED BY A DUAL OX1/2R ANTAGONISTC DUGOVIC1, S YUN1, J SHELTON1, P BONAVENTURE1,
M RIZZOLIO1, B SHIREMAN1, T LOVENBERG1
1
Neuroscience, Johnson & Johnson PRD, San Diego, United States ofAmerica

Introduction: In accordance with the prominent role of orexins in themaintenance of wakefulness via activation of orexin-1 (OX1R) andorexin-2 (OX2R) receptors, various dual OX1/2R antagonists have beenshown to promote sleep. We have demonstrated that blockade of OX2R
is sufficient to initiate and prolong sleep, and that simultaneous blockade of OX1R attenuates the NREM but enhances the REM sleep promoting effects of a selective OX2R antagonist in rats. The differential roleof these receptors in sleep-wake modulation was further investigatedusing mice deficient for either the OX1R or the OX2R treated with adual OX1/2R antagonist.
Methods: Four separate groups of mice (OX1R KO and WT; OX2R KO
and WT) were implanted with telemetric devices for recording EEG/
EMG signals, locomotor activity and body temperature. Following 24 hbaseline sleep evaluation, animals were orally dosed with a dual OX1/2R
antagonist (compound A, 30 mg/kg) or vehicle at dark onset andrecordings were analyzed during the 12-h dark phase.
Results: In baseline conditions, sleep-wake parameters were similar in
OX1R KO and WT mice. OX2R KO mice displayed elevated sleep
fragmentation and more NREM sleep time than WT mice during thedark phase. The OX1/2R antagonist produced an increase in NREM andREM sleep time in WT mice. The REM sleep promoting effect, concomitant with SOREM, was more pronounced in OX1R KO than in WT
mice. In contrast, NREM but not REM sleep was rather decreased anddirect wake to REM transitions (DREM) were observed in OX2R KO
mice.
Conclusion: The data indicate that sleep patterns can be differently
affected by simultaneous transient (pharmacological) and permanent(knockout) inhibition of either OX1R or OX2R in mice. These results
further extend our investigation on the relative contribution of eachorexin receptor to the sleep effects induced by a dual OX1/2R antagonist, and reinforce the view that selective OX2R antagonists are moresuitable for the treatment of insomnia.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

333

Sleep, Science and Research

PO-1-240
MK-6096, A DUAL OREXIN RECEPTORANTAGONIST, ENHANCES SLEEP ONSET AND
MAINTENANCE AS MEASURED BY PSG IN
HEALTHY MALE SUBJECTSH SUN1, K BROWN1, N CALDER2, X LI1, K YEE1, I PERLSTEIN1,
D WILBRAHAM2, L ROSEN1, J CHODAKEWITZ1, J WAGNER1,
MG MURPHY1
1
Clinical Research/Clinical Pharmacology, Merck Research Laboratories,
Merck & Co., Inc., North Wales/PA, United States of America, 2Quintiles
Guy’s Drug Research Unit, United Kingdom
Introduction: Orexin neuropeptides play a critical role in regulating
the transition between awake and sleep. MK-6096, a potent orexin
receptor antagonism, represents a potentially new approach to treating
insomnia.
Methods: Double-blind, placebo-controlled 5-period cross-over study
to evaluate the effect of MK-6096 on sleep parameters via polysomnography (PSG) in healthy male subjects. EFollowing a habituation nightin the sleep lab, each subject received 3 doses of MK-6096 (5, 20 and
60 mg) and placebo in Periods 1–4. PSG recording started 1-hr postdoseafter dosing and lasted for 8 hours. Pharmacokinetic samples werecollected in a 5th period.
Results: All 3 doses of MK-6096 significantly decreased latency topersistent sleep (LPS) and wake after sleep onset (WASO) (p < 0.05).
The effects were dose-dependent. Mean LPS was decreased by 63%,85% and 94% at 5, 20 and 60 mg of MK-6096, respectively. MeanWASO was reduced by 39%, 45% and 51% at 5, 20 and 60 mg of
MK-6096, respectively. A corresponding significant increase in sleep
efficiency was observed (p < 0.05). While no statistically significant
change in percentage of non-REM sleep was detected, a small increasein percentage of REM sleep occurred. MK-6096 did not show evidenceof clinically significant residual effects at 5 and 20 mg, as assessed bysubjective (e.g. Leed’s Sleep Evaluation Questionnaire) and objective(e.g. reaction time and digit symbol substitution test) measurements.
The most frequently reported adverse event was headache.
Conclusions: Single doses of MK-6096 at 5–60 mg demonstrated significant enhancement of sleep onset, maintenance and efficiency inhealthy male volunteers. MK-6096 was safe and well tolerated at all
doses tested.

PO-1-241 / AS-25 Presenter
ESSENTIAL ROLES OF GABA TRANSPORTER-1 IN
CONTROLLING RAPID EYE MOVEMENT SLEEPAND INCREASED SLOW WAVE ACTIVITY AFTERSLEEP DEPRIVATIONX XU1, W QU2, Y URADE3, Z HUANG4
Department of Pharmacology, Shanghai Medical College, Fudan Universi,
Shanghai, China, 2Department of Pharmacology, Fudan University, China,
3
Department of Molecular Behavioral Biology, Osaka Bioscience Institute,Japan, 4Department of Pharmacology, Fudan University, China
1

Under baseline conditions, GAT1 KO mice exhibited dominanttheta-activity across all vigilance stages, including wakefulness, rapid
eye movement (REM), and non-REM (NREM) sleep. During the lightperiod, the KO mice spent longer time in REM sleep and shorter timein NREM sleep. They also showed more state transitions from NREM
to REM sleep, more numbers of longer REM bouts, and less numbersof longer NREM bouts than the WT mice. During the dark period, theKO mice exhibited fragmented REM sleep, although no difference wasobserved in the amount of each stage between these two genotypes.
After the mice were subjected to 6-h sleep deprivation, both NREM andREM sleep rebounds were found in both genotypes. However, compared to the baseline, the slow wave activity of NREM sleep was briefly
elevated in the WT mice but remained completely unchanged in the
KO mice for 6 h after sleep deprivation. These results indicate that
GAT1 plays a critical role in the regulation of REM sleep and homeostasis of NREM sleep. On the other hand, NO-711, a selective GAT1
inhibitor could mimic the major phenotypes of GAT1 KO mice. These
results indicated that GAT1 plays an essential role in sleep-wakeregulation.

PO-1-242
RESIDUAL SEDATIVE EFFECTS ON NEXT-DAY
ALERTNESS AND PSYCHOMOTORPERFORMANCE OF BEDTIME ADMINISTEREDANTIHISTAMINE-RANDOMIZEDCONTROLLEDTRIAL-Y KATAYOSE1, S KITAMURA1, M ENOMOTO1, S ARITAKE2, K
NOZAKI1, M HIDA1, Y MORIGUCHI1, Y KAMEI1, K MISHIMA1
1
Department of Psychophysiology, National Institute of Mental Health,National Center of Neurology and Psychiatry, Kodaira-city, Tokyo, Japan,
2
Department of Somnology, Tokyo Medical University, Japan

Antihistamines are frequently used in various clinical settings for reliving symptoms of allergic diseases. Sedation is a most common side effectof the antihistamines, which effect was frequently utilized for the treatment of insomnia caused by allergic symptoms such as skin itching.
The main aim of the present study is to examine the feature and impactof residual sedative effect of antihistamines and zolpidem administeredat bedtime. The study considered of 4 experimental sessions with atleast 7-day intervals conducted by a double-blind, placebo-controlled,
crossover study design. In each period, 22 healthy male young volunteers (mean age±SE: 22.2 ± 0.8 years) took either zolpidem 10 mg,
diphenhydramine 50 mg, ketotifen 1 mg or placebo orally at bedtime
and underwent polysomnography. Next-day residual sedative effects
were evaluated by the multiple sleep latency test, alpha attenuation test,
visual analog scale, and several psychomotor performance tests conducted in both the morning and afternoon. No significant difference
was observed in the sleep architecture among 4 experimental sessions.
Both the subjective/objective sleepiness and psychomotor deterioration
were significantly enhanced in the order of ketotifen and diphenhydramine sessions. Contrastingly, zolpidem showed no significant next-day
residual effects. These results strongly disapprove of the alternative useof sedative antihistamines for insomnia in patients with allergic
diseases.

GABA transporter subtype 1 (GAT1) constructs high affinity reuptake
sites for GABA in the CNS and regulates GABAergic transmission.
Compounds that inhibit GAT1 are targets for epilepsy treatment. Sedation has been reported as a side effect of these agents, indicating possible
sedative or hypnotic potential. To elucidate the role of GAT1 in sleepwake regulation, we characterized the spontaneous sleep-wake cycle
and responses to sleep deprivation in GAT1 knock-out (KO) mice.

334© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-1-243 / AS-11 Presenter
EFFECTS OF TRIAZOLAM WERE INFLUENCED
BY CIRCADIAN TIMING OF ADMINISTRATIONH TAGAYA1, M UCHIYAMA2, H SUZUKI3, S OKADA-ARITAKE4
1
Department of Health Science, Kitasato University, School of Allied Health
Sciences, Sagamihara, Japan, 2Department of Psychiatry, Nihon University,
School of Medicine, Japan, 3Forth Department of Forensic Science,
National Research Institute of Police Science, Japan, 4Department ofSomnology, Tokyo Medical University, School of Medicine, JapanTo determine whether effects of triazolam are influenced by circadiantiming of administration, chronopharmacological study have done.
Fourteen healthy young Japanese volunteers participated, and they
repeated 40 min nap trials and 80 min enforced wakefulness for
50 hours from 1400 hours on day 1 to 1600 hours on day 3, to minimize effects of sleep debt. Polysomnogram was recorded during nap
trials, and was scored manually according to international criteria.
Saliva melatonin concentrations, simple reaction time, equilibrium ofbody were measured during enforced wakefulness. Subjective sleep
duration, subjective sleep latency and subjective sleep depth during
prior nap trial, and subjective sleepiness during enforced wakefulness
were obtained by questionnaire and visual analogue scale. Opaquecapsules were administered 30 min before every nap trial. One capsulecontained 0.25 mg of triazolam, and the others contained placebo.
Subjects were separated into two groups, and administered triazolam
1730 hours or 2330 hours on day 2 by double-blind randomized
manner.
In both groups, triazolam enhanced objective sleep for 5 hours
after administration. Subjective sleep parameters were deteriorated
8–13 hours after administration possibly due to acute withdrawal effect.
Different effects of triazolam by administration time were observed insubjective and objective sleep parameters at 0.5 and 4.5–8.5 hours afteradministration. Hypnotic effects and withdrawal effects were stronger
when administered at 1730 hours.
Insomniacs may regard their symptoms have become more serious
when they had taken ultra-short acting hypnotics at early evening due
to stronger acute withdrawal effects.

PO-1-244
THE RISE AND FALL OF ZOLPIDEM IN
AUSTRALIA

NS MARSHALL1, Y PAN2, B SAINI3, R FOIS3, C HARRISON2,
H BRITT2, R GRUNSTEIN1
1
Sleep Research Group, Woolcock Institute, University of Sydney,
Camperdown, Sydney, Australia, 2Family Medicine Research Centre,
University of Sydney, Australia, 3Faculty of Pharmacy, University ofSydney, Australia
Background: The hypnotic zolpidem is marketed in Australia as Stilnox
and as Ambien in the United States. During 2007–8 zolpidem was
subject to sustained negative media attention causing a large stimulated
reporting event (SRE) in spontaneously reported adverse effects datacollected by the Therapeutic Goods Administration. We aimed to quantify the prescription rates for zolpidem for insomnia in Australia since
2000, the size of the fall in popularity following the 2007–8 SRE, andwhat drugs might have replaced it.
Methods: Analysis of the BEACH study (Bettering the Evaluation And
Care of Health), a continuous representative cross-sectional samplingof primary care activity across Australia (9,842 GPs recording 984,200
patient-encounters). We quantified weighted average prescription rates

associated with insomnia problems for the leading hypnotics (temazepam, nitrazepam, oxazepam, diazepam and zopiclone) for each
12 month period from April 2000 to March 2010.
Results: Across the years, between 93–99 medications per 100 insomnia problems were prescribed, supplied or advised for over-the-counterpurchase. Zolpidem prescription per 100 insomnia problems rose from0.04 in 2000–01 to a peak of 15.4 in 2006–07 before falling to 7.3 by
2009–10. Throughout this period temazepam has been by far theleading hypnotic and the fall in prescriptions for zolpidem has largely
been associated with an increase in temazepam prescriptions which had
previously dropped as zolpidem popularity rose in 2001–05.
Conclusions: A stimulated reporting event associated with zolpidemin Australia has resulted in about a halving of prescribing of zolpidem.
Prescribing of temazepam has largely replaced the vacated market share.

PO-1-245
THE EFFECTS OF ZOLPIDEM AND TRIAZOLAM,RAMELTEON THE PHYSICAL AND COGNITIVEFUNCTIONS IN HEALTHY, ELDERLY PERSONSS UEMURA–ITO1, M WAKASA1, A SAITO1, W ITO2, K SHIMIZU2,T KANBAYASHI2, T SHIMIZU2
1
Graduate School of Health Sciences, Akita University, Akita-city, Akita,Japan, 2Graduate School of Medicine, Akita University, Japan

Introduction: Many problems have been reported on the use of hypnotics on the elderly, such as balance disorders, falling, and memory disorders. A safer use of hypnotics is being anticipated. We investigate theeffects of a single dose of Zolpidem and Triazolam, Ramelteon on thephysical and cognitive function in healthy, elderly persons.
Methods: We performed a double-blind crossover trial on 14 healthyelderly subjects (mean age 64.5 years) in order to investigate the residual effect of a single administration of Zolpidem (5 mg) and Triazolam(0.125 g), Ramelteon(1 mg). The subjects were given either
hypnotics or a placebo at 23 o’clock before going to bed. Objective
assessments Critical Flicker Fusion Test (CFF), Total Sway pass, Functional Reach Test (FRT), Timed Up and Go test (TUG), Simply Discriminatory Reaction test (SDR), Short-Term Memory test (STM) wereconducted at 22 o’clock before the subjects took the hypnotic, and at
4, 6, 10, and 14 o’clock the next day. This experiment protocol wasapproved by Akita University Ethical Committee. The ANCOVA with agrouping factor (placebo vs. drug sessions) for objective assessments
was conducted to verify main effects and interactions of time and/or
drug. A p-value less than 0.05 was considered significant.
Results: The CFF and FRT, the result of Zolpidem were significantly
better than those of placebo(p = 0.02) or Ramelteon(p = 0.02). And,
the SDR, the results of Ramelteon and Triazolam were significantly
better than those of placeb(p = 0.01).
Discussion: It is known that clinical parameters FRT, TUG, which focus
on the dynamic balance are more useful rather than those which focus
on statistic balance in order to evaluate the accidental falls in the elderly.
This study suggests that Zolpidem may decrease the risk of falling downbecause this hypnotic keep the dynamic balance. Triazolam and Ramelteon showed effects on the cognitive functions on the following day
when given to healthy elders.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research335

Sleep, Science and Research

PO-1-246
LONG-TERM USE OF HYPNOTICS IN JAPANM ENOMOTO1, S KITAMURA1, H TACHIMORI2, K MISHIMA1
Department of Psychophysiology, National Institute of Mental Health,National Center of Neurology & Psychiatry, Kodaira, Tokyo, Japan,
2
Department of Mental Health Policy and Evaluation, National Institute of
Mental Health, National Center for Neurology & Psychiatry, Japan
1

Objectives: The occurrences of long-term benzodiazepines use in thegeneral population were approximately 2–7.4%. Prior research generally indicated that there appears to be a strong relationship between age
and the occurrence of benzodiazepines use. This study aimed at revealing the current status of long-term hypnotics use and the risk factor
accounting for long-term use among Japanese, with the use of largesized health insurance data.
Methods: Data were derived from medical fee receipts of approximately
330,000 people enrolled in multiple health insurance associations inJapan. We selected adult patients who were prescribed at least one
hypnotic for the first time between April 2005 and March 2008. Followup period was extended to March 2009. To reveal the risk factor of
long-term use of hypnotics, we performed Cox regression analyses with
time-dependent variables in those patients who were followed up for
up to 12 months, considering discontinuing prescription hypnotics as
event, while patients who withdrew from health insurance associations
during the study period were defined as censored cases.
Results: A total of 3,981 patients (M: 2,382 F: 1,579, 40.3 ± 12.4) wereprescribed hypnotics first time during the study period. Each of thefollowing variables had significant association with lower risk of discontinuing prescription hypnotics in univariate time-dependent analysis: combined use of another psychotropic drug (anxiolytics,
antidepressants or antipsychotics); prescribed hypnotics at the department of psychiatry in the first month; high dosage of hypnotics; female;and high age. All variables were taken as candidates in multiple timedependent Cox regression analyses.
Conclusion: The present results showed that combined use of antidepressants, high dosage of hypnotics and high age were each associatedwith higher risk of long-term benzodiazepines use in the Japanese
population.

PO-1-247
HYPNOTIC DRUGS IMPROVE THE FIRST-NIGHT
EFFECT” OF MICE AFTER CAGE CHANGE”

Q XU1, X-H XU3, W-M QU3,4, M LAZARUS2, Y URADE2,
Z-L HUANG1,3,4
1State Key Laboratory of Medical Neurobiology, Fudan University,
shanghai-city, China, 2Department of Molecular Behavioral Biology, Osaka
Bioscience Institute, Japan, 3Department of Pharmacology, Shanghai
Medical College, Fudan University, China, 4Institutes of Brain Science,
Shanghai Medical College, Fudan University, China
First night effect (FNE) is a well-known phenomenon in human sleep
research, which is characterized by decreased total sleep time andlonger sleep latency. We established an animal FNE model and used
this model to evaluate the hypnotic effects drugs, i.e., zolpidem, diazepam, dopamine D1 receptor antagonist SCH 23390, dopamine D2
receptor antagonist raclopride, or histamine H1R antagonist pyrilamine.
After C57BL/6 mice were surgically implanted with sleep recording
electrodes, we investigated spontaneous sleep and the effect of cagechanges on sleep. When mice were moved to clean or dirty cages, thesleep latency was longer for clean cages than for dirty cages. Therefore,336

the pharmacological studies were performed under clean cage-change
conditions. When mice were pretreated with zolpidem, raclopride,
diazepam, and pyrilamine, non-rapid eye movement (NREM) sleep
latency was decreased, whereby zolpidem, raclopride, and diazepam
were most effective in our FNE model. Zolpidem, raclopride, or diazepam significantly increased NREM and REM sleep, but diazepampretreated mice showed a drastic decrease in the delta power(1.25–3.75 Hz) for NREM sleep in the electroencephalogram between
1 and 6 h after cage change. Our results suggest that a mouse modelwith cage change is suitable to mimic human FNE and that zolpidem
and raclopride are potential drugs to prevent FNE.

PO-1-248
TRENDS IN THE USE OF SLEEP MEDICATIONSBY AUSTRALIAN ADULTS
YS BIN
Discipline of Psychiatry / CIRUS, University of Sydney, Camperdown NSW,
Australia
Objective: People report achieving less sleep than in previous years,
although the time allocated to sleep appears unchanged over recent
decades. Changes in sleep quality may be responsible for subjective
reports of lack of sleep. The prevalence of sleep medication use wasinvestigated in Australian adults as a proxy for secular changes in sleep
quality.
Design: Secondary analysis of data from Australian National Health
Surveys conducted from 1977 to 2007.
Participants: Community-dwelling individuals aged 15 to 65 and over.
Measurements and Results: Self-reported use of sleep medications in
the previous 2 weeks was the main variable of interest. Unadjusted rates
of sleep medication use was 3.3% in 1977, 4.8% in 1983, 6.1% in 1989,
1.7% in 1995, 4.3% in 2001, 5.3% in 2004, and 1.2% in 2007. Logistic
regression models with age and gender as the covariates show that theodds of sleep medication use fluctuate considerably over time. Compared to 1977, use of sleep medication was more likely in 2007 (AOR
1.43; 95% CI 0.79–2.57). Across all years, women (2.11; 1.56–2.85)
and the elderly (23.67; 6.97–33.00) were more likely use sleep medications. However, there appeared to be a trend of decreasing medication
use by middle-aged and elderly groups over time.
Conclusions: Likelihood of sleep medication use appears to haveincreased in the Australian population and supports a trend of decreasing sleep quality over recent years. However this increase seems limited
to younger age groups. It was not possible to explore the influence ofavailability and access to medications but the findings contribute to thegrowing literature on secular changes in population sleep.

PO-1-249
SLEEP PROBLEMS AND SUBSEQUENTPSYCHOTROPIC MEDICATION: A REGISTERLINKED STUDY WITH 5-YEAR FOLLOW-UPP HAARAMO1, T LALLUKKA1, E LAHELMA1, C HUBLIN2,O RAHKONEN1
1
Hjelt Institute, Department of Public Health, University of Helsinki,
University of Helsinki, Finland, 2Finnish Institute of Occupational Health,FinlandIntroduction: Sleep problems and mental disorders are associated.
Studies examining the association between sleep problems and psychotropic mediation using register-based data are lacking.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

Data and methods: Participants were 40–60-year-old employees of theCity of Helsinki, Finland (77% women). Data on sleep problems –difficulties in initiating and maintaining sleep and non-restorative
sleep – and covariates were derived from surveys conducted in 2000–
2002 (response rate 67%). Follow-up data were derived from the Social
Insurance Institution’s registers of prescribed medication (consent toregister linkages 74%, data analysed N = 5336). All purchased psychotropic medication (ATC-coded, mainly antidepressants, hypnotics, andsedatives) 5–7 years prior to and 5 years after baseline were included.
Sleep problems were assessed with the Jenkins Sleep Questionnaire.
Logistic regression analysis was used to calculate odds ratios (OR) with
95% confidence intervals (CI), adjusting for a large number ofcovariates.
Results: Frequent sleep problems were reported by 19% and no sleep
problems by 14%. During the follow-up 22% of the participants purchased psychotropic medication. Adjusted for age, gender, and priorpsychotropic medication, the ORs for psychotropic medication were1.39 (95%CI 1.05–1.83) among those with rare sleep problems, 2.10
(95%CI 1.60–2.75) among those with occasional problems, and 3.49
(95%CI 2.63–4.63) among those with frequent problems, compared tothose with no sleep problems. The associations were similar in bothgenders, as well as for groups of psychotropic medication examined.
Adjusting for other covariates had a negligible effect on theassociations.
Conclusion: Sleep problems are associated with subsequent psychotropic medication, with a clear gradient.

PO-1-250
THE RELATIONSHIP BETWEEN SELECTIVESEROTONIN REUPTAKE INHIBITOR AND
PERIODIC LIMB MOVEMENT SYNDROME IN
DEPRESSIVE PATIENT
Z BIN
Sleep Medicine Unit, Guang Dong Provincial Mental Health Institute,
Guang Zhou, Guang Dong, China
Objective: To investigate the relationship between Selective Serotonin
Reuptake Inhibitor (SSRI) and Periodic Limb Movement Syndrome(PLMS) in depressive patients.
Methods: 31 depressive patients in SSRI treatment were recruited fromthe polysomnography database. Two comparing groups were recruited
at the same time: 27 depressive without any pharmacological treatment
and 31 normal controls. According to the AASM Manual, we evaluatedthe stage of sleep, events in sleep and PLMS.
Results: compared to no treatment group (5.3 ± 1.4) and normal
control group (4.1 ± 1.1), SSRI group (13.7 ± 2.6) experienced more
Periodic Limb Movement Index (PLMI) (p < 0.001). The prevalence of
PLMS in SSRI group (41.9%) was much higher than no treatment group(11.1%) and normal control group (6.5%) (p < 0.001). Furthermore,
the logistic regression revealed that higher SSRI dosage, longer REM
latency, and higher arousal index were risk factors for PLMS in SSRI
group.
Conclusion: SSRI could increase the risk of PLMS in the depressive
patients. It could make a lot of arousals in sleep, and these arousal could
make sleep fragment and reduce the slow wave sleep. All in all, thisphenomenon was an very important side effect in SSRI treatment.

PO-1-251
THE EFFECT OF SELECTIVE SEROTONIN
REUPTAKE INHIBITOR ON THE MUSCLE TONE
OF RAPID EYE MOVEMENT SLEEP IN
DEPRESSIVE PATIENT
Z BIN
Sleep Medicine Unit, Guang Dong Provincial Mental Health Institute,
Guang Zhou, Guang Dong, China
Objective: To investigate the effects of Selective Serotonin Reuptake
Inhibitor (SSRI) on the muscle tone in depressive patients.
Methods: 21 depressive patients in SSRI treatment were recruited fromthe polysomnography database. Two age- and sex-matched comparing
groups were recruited at the same time: 21 depressive without any
pharmacological treatment and 21 normal controls. According to Lapierre & Montplaisir criteria, we reevaluated the tonic and phasic electromyogram (EMG) in every Rapid Eye Movement (REM) sleep.
Results: compared to no treatment group and normal control group,
SSRI group experienced more tonic EMG (10.1 ± 9.4% VS 3.3 ± 3.7%
& 2.8 ± 3.4%, P < 0.001) and phasic EMG (submental: 11.5 ± 6.8%
VS 6.3 ± 4.1% & 5.0 ± 3.7%, P < 0.05; Anterior tibialis: 18.8 ± 13.2%
VS 10.3 ± 7.2% & 9.8 ± 5.5%, P < 0.05) in REM sleep. In SSRI group,
both tonic and phasic EMG in REM sleep correlated with REM latency
positively and correlated with percentage of REM sleep negatively.
Conclusion: SSRI could increase EMG activity in REM sleep, and might
produce some symptomatic REM sleep behavioral disorder (RSBD).
Because it do not have neurological basis, so it could be cured by quitting SSRI.

PO-1-252
THE CHANGE OF COGNITIVE FUNCTION
ON THE NEXT MORNING AFTER TAKINGMIRTAZAPINE 15 MG IN NORMAL
MALE VOLUNTEERSM OKAYASU1, T NAKAZIMA2, Y KOGA2
Department of Psychiatry, Fudougaoka Hospital, Kazo-city,Saitama,
Japan, 2Department of NeuroPsychiatry, Kyorin University Hospital, Japan1

Mirtazapine (MIR) sometimes induces sleepiness. We have examinedthe characteristics of the sleepiness induced by MIR employing placebo
controlled double blind cross over design. 14 male right-handed normal
volunteers participated in the study. This study was approved by Kyorin
University Ethical Committee and all gave informed consents. The sleep
wake patterns of volunteers were observed actigraphically for more than
one week before examination to exclude the irregular sleep wake patterns. MIR 15 mg or placebo was in a white capsule not to discriminate
visually. 7 volunteers took MIR 15 mg first followed by more than one
week washout interval, then they took placebo secondly. Another 7
volunteers took drugs using inverse schedule. The order of taking drugs
was controlled by envelope method. On the day when taking drugs,
volunteers gathered at 1800 h, eating dinner at 1900 h, taking bath at2000 h. They took drugs just at 2300 h and went to bed under lessthan 5 lx illumination. On the next day, they woke up at 0700 h. Afterdaily morning habit, examinations started from 0900 h. Attachment theelectrodes for electrophysiological examinations and flicker test werecarried out at 0900 h. Assessment of subjective feeling with visual
analogue scale and sleep latency test were performed at 0940 h. Acquisition of electroencephalogram (EEG) at waking state for examining
power spectral analysis and event related potential (ERP) were done at© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research337

Sleep, Science and Research

1020 h. At last Kreapelin test was examined before 1200 h. In ERP,
visual P300 was examined. Red circle (target) and yellow circle (nontarget) were randomly showed (stimulus time 100msec, visual angle 2
degree, target 20%/ non-target 80%, inter stimulus interval 1sec). EEG(from Fz, Cz, Pz, C3, C4, O1, and O2, A1+A2 as reference by 10–20
method) was acquired when target emerged up to 30 times. The P300
latency in MIR showed significant increase compared with placebo. Thechanges in P300 amplitude and the result of Kreapelin test did not reachthe significance level. MIR may decrease the processing speed, which
does not have effect on performance representing Kreapelin test.

PO-1-253
THE CHANGE OF SLEEPINESS AND SLEEPLATENCY ON THE NEXT MORNING AFTER
TAKING MIRTAZAPINE 15 MG IN NORMAL
MALE VOLUNTEERST NAKAJIMA1, M OKAYASU2, Y KOGA1
Department of Neuropsychiatry, Kyorin University, Mitaka-City, Tokyo,
Japan, 2Fudogaoka Hospital, Japan1

Mirtazapine (MIR) sometimes induces sleepiness. We have examinedthe characteristics of the sleepiness induced by MIR employing placebo
controlled double blind cross over design. 14 male right-handed normal
volunteers participated in the study. This study was approved by Kyorin
University Ethical Committee and all gave informed consents. The sleep
wake patterns of volunteers were observed actigraphically for more than
one week before examination to exclude the volunteers having irregularsleep wake patterns. MIR 15 mg or placebo was in a white capsule not
to discriminate visually. 7 volunteers took MIR 15 mg first followed bymore than one week washout interval, then they took placebo secondly.
Another 7 volunteers took drugs using inverse schedule. The orderof taking drugs was controlled by envelope method. On the day when
taking drugs, volunteers gathered at 1800 h, eating dinner at 1900 h,
taking bath at 2000 h. They took drugs just at 2300 h and went to bed
under less than 5 lx illumination. On the next day, they woke up at
0700 h. After daily morning habit, examinations started from 0900 h.
Attachment the electrodes for electrophysiological examinations andflicker test were carried out between 0900 h and 0940 h. Assessmentof subjective feeling including sleepiness with visual analogue scale(VAS) and sleep latency test (SLT) were performed between 0940 h and1020 h. Acquisition of electroencephalogram at waking state for examining power spectral analysis and event related potential were done
between 1020 h and 1100 h. At last Kreapelin test was examined before
1200 h. In SLT, sleep onset was defined by following criteria: a. thetime when sleep stages except for stage 1 or stage wake is observed. b.
the initial time when consecutive 150 sec stage 1 sleep was observed.
SLT did not show the significance. On the contrary, sleepiness by VAS
and alertness by Flicker test showed the significant sleepiness and thesignificant decrease in MIR compared with placebo. The sleepinessinduced by MIR may have different characteristics from other sleepinessbecause SLT did not reflect the subjective sleepiness.

338

PO-1-254
DOPAMINE D2 RECEPTORS ARE ESSENTIAL IN
THE MAINTENANCE OF WAKEFULNESSW-M QU1, Z-L HUANG1,2, Y URADE2
1
Department of pharmacology, Shanghai Medical College, Fudan
University, Shanghai, China, 2Department of Molecular Behavioral Biology,
Osaka Bioscience Institute, Japan
Dopamine (DA) is critically involved in regulating processes responsible
for the generation of complex movements and emotions, cognition,
reward processing, and drug addiction. In contrast, the role assigned to
DA in sleep-wake cycle has been relatively limited, because the activityof DA neurons in the ventral tegmental area and substantia nigra pars
compacta is not significantly modulated by the sleep-wake state. The
main DA receptors (R) in the brain are D1R and D2R. To clarify the rolesof DA receptors in the sleep-wake regulation, we used D2R knockout(KO) mice and pharmacological manipulation. We found that the D2R
blockade could reduce the sleep latency and increase amounts of nonrapid eye movement (non-REM, NREM) sleep. Modafinil is the mostpotent wake-promoting medicine for enhancing the extracellular DA
level in the nucleus accumbens and the prefrontal cortex, and forincreasing wakefulness. By using D2R KO mice and D1R antagonist, wedemonstrated that D1R and D2R are essential for the arousal effect ofmodafinil, with D2R being the receptor of primary importance. Compared with wild-type (WT) mice, D2R KO mice exhibited a significant
decrease in wakefulness, with a concomitant increase in NREM andREM sleep, especially during the first 4 h after lights off. When the KO
mice were subjected to a cage change, the latency to sleep in the KO
mice decreased to half of the level for WT mice. The D2R antagonist
raclopride mimicked these effects in WT mice. When GBR12909, a DA
transport inhibitor, was administered intraperitoneally, it induced wakefulness in WT mice, but its arousal effect was attenuated to one-third
in the D2R KO mice. These results indicate that D2R plays an essential
role in the maintenance of wakefulness.

PO-1-255
KETAMINE MODIFIED MELANINCONCENTRATING HORMONE IN RAT BRAIN

T KUSHIKATA1, M SAWADA1, M OISHI1, K MORIYA3, H YOSHIDA2,
K HIROTA3
1
Department of Anesthesiology, Hirosaki University, Hirosaki, Japan,
2
Department of Emergency and Disaster Medicine, Hirosaki University,
Japan, 3Department of Anesthesiology, Hirosaki University Graduate Schoolof Medicine, Japan
Anesthesia disturbs sleep. Ketamine, a NMDA antagonist, is a widelyused intravenous anesthetics. Ketamine is a dissociated anesthetics
that depresses cerebral cortical activity but activates subcortical structures. Therefore, unpleasant dreaming or hallucination could be developed with ketamine. We previously reported that endogenous
sleep-wakefulness related substance such as orexin1) and neuropeptide-S2) decreased ketamine anesthesia time. These results suggest
various sleep-related endogenous substances could be involved in anesthetic process of ketamine. Melanin-Concentrating Hormone (MCH) is
one of them that potentiates REM sleep. We tested if ketamine would
affect MCH level in several brain regions responsible for sleep process.
After obtaining approval from ethical committee of Hirosaki University,
a total 4 male SD rats were used. They are housed with 12 h light-darkcycle (lights on at 08:00) and could access food and water freely. The
rats received 100 mg/kg ketamine ip. Anesthesia time was defined a© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

duration from loss of righting reflex through regain it. Mean anesthesia
time was 32 ± 5 min. Measurement of MCH levels of the cerebral cortex,
hypothalamus, pons, hippocampus, and serum are done with ELIZA at
pre-anesthesia, 20, 60 and 120 minutes after ketamine administration.
Pre-anesthesia values of MCH in each regions are 5.057 ± 1.506 pg/mg
tissue (pons), 7.632 ± 0.001 (hypothalamus) pg/mg tissue, 3.446 ±0.001 (hippocampus) pg/mg tissue, 2.048 ± 0.001 (cerebral cortex) pg/
mg tissue, 233.125 ± 53.771 pg/ml (serum).Ketamine increased MCHlevel of the hypothalamus (17.485 ± 6.565 pg/mg tissue) at 20 minutes
after ketamine anesthesia (p < 0.01). This increase was continued
throughout all time point after ketamine administration. At 120 minutes
after ketamine administration, MCH levels were increased in hippocampus (7.123 ± 0.001; p < 0.01) and cerebral cortex (6.190 ± 0.896; p <0.05)Ketamine had different effect on the MCH levels. These effects
would be involved in process of unique property of ketamine
anesthesia.

PO-1-256 / AS-24 Presenter
DIFFERENTIAL ROLES OF OREXIN RECEPTOR-1
AND -2 IN THE REGULATION OF NON-REM AND
REM SLEEP

M MIEDA1, E HASEGAWA1, YY KISANUKI2,4, CM SINTON3,
M YANAGISAWA2, T SAKURAI1
1
Department of Molecular Neuroscience and Integrative Physiology,
Kanazawa University, Kanazawa-city, Ishikawa, Japan, 2Department of
Molecular Genetics, University of Texas Southwestern Medical Center,
United States of America, 3Department of Pathology, University of Texas
Southwestern Medical Center, United States of America, 4Department of
Neurology, The Ohio State University Medical Center, United States ofAmerica

Orexin-A and orexin-B are hypothalamic neuropeptides that play critical roles in the maintenance of wakefulness. Intracerebroventricular(ICV) administration of orexin-A has been shown to promote wakefulness and suppress both rapid eye movement (REM) sleep and non-REM(NREM) sleep through the orexin receptor-1 (OX1R) and orexin receptor-2 (OX2R). Here, we elucidated the differential roles of orexin receptors in the regulation of sleep and wakefulness by comparing the effects
of ICV orexin-A administration in wild-type, OX1R-/- and OX2R-/mice. The effects of orexin-A on wakefulness and NREM sleep weresignificantly attenuated in both knockout mice as compared to wildtype mice, with substantially larger attenuation in OX2R-/- mice thanin OX1R-/- mice. These results suggest that although the OX2R-mediated pathway has a pivotal role in the promotion of wakefulness, OX1R
also plays additional roles in promoting arousal. In contrast, suppression of REM sleep by orexin-A administration was slightly and similarly
attenuated in both OX1R-/- and OX2R-/- mice, suggesting a comparable
contribution of the two receptors to REM sleep suppression. Histological studies demonstrated differential distributions of each receptor
subtype in distinct neuronal populations with specific neurotransmitter
identities in brainstem cholinergic/monoaminergic neurons. In the laterodorsal tegmental and pedunculopontine tegmental nuclei especially,cholinergic neurons exclusively expressed OX1R mRNA, but OX2RmRNA was expressed mainly in GABAergic putative interneurons.
Thus, each orexin receptor subtype plays differential roles in gating
NREM and REM sleep, through distinct neuronal pathways.

PO-1-257
SLEEP FORENSICS- A WALK ON THE WILD
SIDE . . . OR AN AVENUE FOR POST-MARKETINGANALYSIS OF ZOLPIDEM?”

MA CRAMER BORNEMANN1, MW MAHOWALD1,2,
CH SCHENCK1,3
1
Department of Neurology, Minnesota Regional Sleep Disorders Center,
Hennepin County Medical Ctr, Minneapolis, Minnesota, United States ofAmerica, 2Department of Neurology, University of Minnesota School of
Medicine, United States of America, 2Department of Psychiatry, Universityof Minnesota School of Medicine, United States of America
First defined at WorldSleep07, Sleep Forensics is a growing investigative
field most often associated with the sleepwalking defense. For 5 years(8/1/06 to 6/1/11), the sleep forensics team at the Minnesota Regional
Sleep Disorders Center were contacted by attorneys to place their cases(Total ⋕ Cases = 210) in consideration for a formal review to assess
whether a sleep disorder may have been involved. As anticipated, Parasomnias were the most prevalent sleep disorder subtype implicated(N = 97). Surprisingly, Pharmaceutical Toxicity was the second mostcommon subtype (N = 82) with Zolpidem accounting for the majority(N = 79) for which DWI was the most common associated criminal
complaint (N = 43). We learned there was an unmet need to review
medico-legal cases perhaps involving sleep disorders or altered levelsof awareness. We found that Sleep Forensics was much more than awalk alongside Parasomnias and for many in the legal community it
was a call for an investigation into the adverse consequences of Zolpidem. The high prevalence of Zolpidem legal cases in our experienceraises several questions. Are such adverse consequences unique to Zolpidem or is this reflective of the popularity of the medication given its
widespread use? Our case review reveals that the possible adverse effectof Zolpidem is most often associated with the criminal complaint of
DWI. Is this indicative of an unusual and rare side effect (i.e. sleepdriving) or is this reflective of inadequate counseling concerning appropriate use of a seemingly-safe non-benzodiazepine medication? Conceivably,
investigative pursuits in the emergent field of Sleep Forensics canprovide insight into medications such as Zolpidem- for if the adverse
effect is one that involves a behavior that takes the individual out of the
bedroom, then the adverse effect has now become a public safetyconcern for which we all share in this responsibility.

PO-1-258
CAN MINOCYCLINE REVERSE MORPHINEINDUCED RESPIRATORY DEPRESSION IN
OBSTRUCTIVE SLEEP APNEA PATIENTS?

D WANG1, A SOMOGYI4, BJ YEE1,2,3, KK WONG1,2,3, J SINGH2,
P WRIGLEY5, RR GRUNSTEIN1,2,3
1
Sleep Group, Woolcock Institute of Medical Research, Sydney University,
Marsfield, NSW, Australia, 2Department of Respiratory and Sleep Medicine,Royal Prince Alfred Hospital, Australia, 3CIRUS, Sydney University,
Australia, 4Discipline of Pharmacology, University of Adelaide, Australia,
5
Pain Management Research Institute, Sydney University, Australia
Background: Recent animal studies suggest that the antibiotic minocycline reverses morphine-induced respiratory depression, while enhancing morphine-induced analgesia. We conducted a proof of concept
double-blind, cross-over, placebo-controlled clinical trial, testing thiscombination of drugs on mild to moderate obstructive sleep apnea(OSA) patients.
Methods: After a screening polysomnography (PSG) study, 10 OSA
patients underwent 2 overnight PSG sleep studies separated by an© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research339

Sleep, Science and Researchinterval of at least 1 week. The patients took a 3 day course of either
active or placebo minocycline (100 mg twice a day), in random order,
before the two PSG studies. They also took 30 mg oral control-releasemorphine 4 hrs before the start of each PSG study. Ventilatory chemoreflexes were tested just before sleep.
Results: Compared to baseline, the administration of 30 mg morphine
alone did not cause significant respiratory depression in all key PSG
parameters (all p > 0.05). However, compared to the use of morphine
alone, the combination use of morphine and minocycline tended tohave worse mean SpO2 nadir (83.5 ± 7.3 vs 78.9 ± 8.6 SD%, p = 0.13)
and sleep time with SpO2 < 90% (6.5 ± 6.9 vs 13.7 ± 16.3 SD mins,
p = 0.12). Mean heart rate was also reduced during awake (73.0 ± 16.4
vs 62.9 ± 15.4 SD/min, p = 0.06), during non-REM sleep (57.6 ± 9.1
vs 53.2 ± 8.1 SD/min, p = 0.088) and during REM sleep (62.1 ±9.6 vs 57.1 ± 8.0 SD/min, p = 0.1). Compared to baseline, mean central
chemosensitivity was reduced either using morphine alone or in combination with minocycline (2.2 ± 1.3 vs 1.5 ± 0.8 SD, 2.2 ± 1.3 vs 1.4± 0.5 SD, l/min/mmHg; p = 0.18, p = 0.09). Basal minute ventilation
was particularly reduced with the combination minocycline (10.4 ± 3.6
vs 12.6 ± 5.3 SD l/min baseline, p = 0.02; 10.4 ± 3.6 vs 12.1 ± 4.3 SDl/min morphine alone, p = 0.1).
Conclusion: A clinically significant protective effect of minocycline on
opiate-induced respiratory depression is unlikely. Conversely, themajority of outcomes tested show a trend towards greater respiratory
depression with the addition of minocycline.

PO-1-259
THE EFFECT OF LOW-DOSE ORAL QUETIAPINE
ON SLEEP AND COGNITIVE IN ADULTS

Y SAGARA1, M IMAI2, S OGAWA3, M OKAWA4, N YAMADA2,4
Department of Local Psychiatric Practice, Shiga University of Medical
Science, Shiga-city, Japan, 2Department of Physiology, Shiga University of
Medical Science, Japan, 3Medicine graduate course molecules oncology
lecture, Kyoto University, Japan, 4Department of sleep medicine, Shiga
University of Medical Science, Japan1

To clarify the effects of quetiapine(QUE), an atypical antipsychotic drug,on sleep, we investigated polysomnographic sleep structure, subjective
sleep quality and side effect. The double-blind, placebo-controlled,
randomized cross-over study was carried out for 10 adult volunteers(mean age23,1 years) after one night for adaptation. Placebo or QUE
25 mg was administered orally at 10 pm every one week interval.
The efficacy and side effects were judged by Saint Mary’s Hospital Sleep
Questionnaire (SMH), Karolinska Sleepiness Scale (KSS), tapping test(TT), cognitive reaction test (CRT) and stabilometry. Nearly 40% of
shortening of sleep stage1 (p < 0,05) and 10% of extention of sleep stage2(p < 0,05) were observed after QUE intake compared with placebo.
Moreover, improvement of the sleep structure was remarkably observedin the subjects with higher score in Pittsburgh Sleep Quality Index(PSQI) than in those with lower score and the number of awakenings
decreased in SMH and alertness in the following morning worsend in
SMH and KSS in the QUE session.
Also the aggravation of the cognitive function was observed in the QUE
session: the number of error and the mean latency of reaction wasincreased, and the amount of reaction decreased in CRT. In particular,
the longer latency of reaction, the longer the duration of slow-wave
sleep (p < 0,05).
Although, 25 mg of QUE lengthened sleep stage2 in healthy adults, theaggravation of cognitive function is a problem as side effect. The application of QUE to a large number of insomniacs would be necessary in
the future.

340

PO-1-260
CROCIN PROMOTES NON-RAPID EYE
MOVEMENT SLEEP IN MICEK ARITAKE1, M MASAKI1, H TANAKA2, M LAZARUS1, Z-L HUANG1,Y SHOYAMA3, Y URADE1
1
Molecular Behavioral Biology, Osaka Bioscience Institute, Suita-city,
Osaka, Japan, 2Department of Pharmacognosy, Graduate School of
Pharmaceutical Sciences, Kyushu University, Japan, 3Department ofPharmacognosy, Faculty of Pharmaceutical Sciences, Nagasaki
International University, Japan
Crocus sativus L.Crocus sativus L. (saffron) has been traditionally used
for the treatment of insomnia and other diseases of the nervous systems.
Crocetin and crocin are major carotenoid pigment of saffron and anumber of pharmacological studies have demonstrated that crocin andalso crocetin have a wide range of neuroprotective activities against
Alzheimer’s disease, depression, and memory impairment. On the other
hand, the effects of crocin and crocetin on sleep still remain unknown.
In this study, we examined the sleep-promoting activity of crocin andcrocetin by monitoring the locomotor activity and electroencephalogram after administration of these components to mice. Orally administered crocin (80 and 160 mg/kg of body weight) significantly
suppressed the total amount of locomotor activity during the 12 hr by
33% and 20%, respectively, as compared with the vehicle control.
Crocin (30 and 100 mg/kg of body weight) increased the total time ofnon-rapid eye movement (non-REM) sleep by 60% and 170%, respectively, during a 4-hr period from 20:00 to 24:00 after its intraperitoneal
administration at a lights-off time of 20:00. Crocetin (100 mg/kg) also
increased the total time of non-REM sleep by 50% after the administration. Compared with the vehicle-treated control, the number of
non-REM sleep bouts increased by 2.2-fold and also those of wakebouts by 2.0-fold for 4 hr after the crocin treatment. Crocin increased
the number of stage transitions from wakefulness to non-REM sleep andfrom non-REM sleep to wakefulness by 110% and 190%, respectively.
There was no significant difference in EEG power density of non-REM
sleep between the crocin treatment and the vehicle control, indicating
crocin did not affect the EEG power density of NREM sleep. Crocin isconsidered to induce non-REM sleep that is very similar to physiologicalsleep, suggesting its potential use for the treatment of insomnia.

PO-1-261
CLINICAL TRIAL ON HERBAL TREATMENT OF
PRIMARY INSOMNIA – A RANDOMIZEDPLACEBO-CONTROLLED STUDYWMM YU1, YK Wing1, KF Chung2, KF Cheung3, PC Leung3
1
Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR,
China, 2Psychiatry, The University of Hong Kong, China, 3Institute ofChinese Medicine, The Chinese University of Hong Kong, China

Objective: To evaluate the efficacy of a Traditional Chinese Medicine(TCM) herbal formula composed of Semen ziziphi spinosae, Caulis
polygoni multiflori, Poria cum radix pini, Fructus tritici levis, Rhizoma
anemarrhenae and Radix polygalae in subjects with primary insomnia.
Methods: This double-blind, randomized, placebo-controlled trial(RCT) enrolled 162 primary insomniac subjects who received either
4 weeks’ TCM herbal formula or placebo. Efficiacy was evaluated byboth subjective and objective sleep measurements (polysomnography
and actiwatch).
Results: The TCM group had a nearly significant reduction in sleep
latency as measured by polysomnography as compared to the placebogroup (p = 0.074). In addition, when the adaptation night data was© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

excluded, there was a trend of better sleep, in terms of shorter time in
bed and higher sleep efficiency in the TCM group. The subjective sleep
quality improved in both groups at the end of 4 weeks’ treatment but
a higher percentage of the TCM group reproted “improvement of theirinsomnia” than the placebo group (66.2% vs. 49.3%, p = 0.04) as well
as a marginal non-significance in the “improvement of sleep quality”
item (63% vs. 47.3%, p = 0.055). Multivariate analysis suggested that
the TCM group had a much less temporal night-to-night instability insleep efficency as measured by actiwatch compare to the placebo group(p < 0.05). In addition, the TCM group had slightly more improvements
in subjective sleep quality related to depth, peacefulness and refreshness
when compared to that of the placebo group. The TCM herbal productwas well tolerated.
Conclusion: To our knowledge, this is the first randomized placebocontrolled trial of TCM herbal formula for primary insomnia using astringent screening process and both subjective and objective sleep
measurements. Our study suggested that the TCM herbal formula provided a significant improvement of sleep in insomniac subjects whencompared to the placebo group.

PO-1-262
ANTI-NMDA RECEPTOR ANTIBODY POSITIVEPATIENTS WITH VARIOUS PSYCHIATRIC ANDSLEEP SYMPTOMST KANBAYASHI1, K TSUTSUI1, K TANAKA2, W ITO1, S BOKU3,
Y SAGAWA1,4, J TOKUNAGA1, M SATO1, S NISHINO4, T SHIMIZU1
1
Neuropsychiatry, Akita University, Akita, Japan, 2Neurology, Kanazawa
Medical University, Japan, 3Neuropsychiatry, Hokkaido University, Japan,
4Sleep and Circadian Neurobiology Laboratory, Stanford University, UnitedStates of America
Recently, causative roles of encephalitis (EN) in major psychiatric features have been emphasized. These symptoms are often in young
females with ovarian teratomas with good responses to tumor surgery
and immunotherapy, and with autoantibodies to the NMDA receptor(NMDAR). We have experienced 10 these patients (pts) with various
psychiatric and sleep symptoms. These pts exhibited 3 distinct clinicalpictures, and we believe that the report of our cases will bring further
discussions on the autoimmune-mediated atypical psychosis.The first
3 cases had typical clinical pictures of anti-NMDAR EN, beginning withpsychiatric symptoms, and then seizures and disturbances of consciousness occurring. In order to examine the specificity of the anti-NMDAR
Ab involvements, we also examined the Ab in other psychotic pts withhypersomnia. Narcolepsy (NA) with severe psychosis was included,
because auto-Ab (Ma2, AQP4) mediated mechanisms are suspected insome secondary NA cases.We found that 3 narcolepsy pts (among 5),
who had severe psychotic symptoms, were positive for the Ab. These
cases were hypocretin deficient, but no significant neurological signs
were noted. They were under stimulant medications, and their symptoms were unchanged when the stimulants were withdrawn. Antipsychotics and modified electro-convulsion treatment (ECT) were required
to manage the psychotic symptoms. In addition, we also found 4 Ab
positive pts with schizophrenia or schizo-affective disorders among
51 pts examined. The neurological symptoms were mild in these cases,
and mECT was effective for 3 cases.Our results showed a high incidenceof anti-NMDAR Ab positivity in a broader range of psychiatric disorders, including sleep and schizophrenia pts. Although the causative
relationship between anti-NMDAR Ab positivity and psychiatric symptoms in these pts are not known, they exhibit unique demographic andclinical characteristics: Eight are female, and ovarian tumors are associated with 2 pts. Most of their symptoms are resistant to the pharmacological treatments, but responded relatively well to mECT.

PO-1-263
THE NEUROPROTECTIVE EFFECT OF
MINOCYCLINE FOR ISCHEMIC INJURY IN
NEURONAL CELLK KIKUCHI1, H UCHIKADO1, N MIYAGI2, Y MORIMOTO3,N MIURA4, T ITO5, S TANCHAROEN6, T KURAMOTO7,K KAWAHARA8
1
Department of Neurosurgery, Kurume University, Kurume, Fukuoka, Japan,
2
Department of Neurosurgery, Yame Public General Hospital, Japan,
3
Department of Restorative Dentistry and Endodontology, Kagoshima
University Graduate School of Medical and Dental Sciences, Japan,
4
Veterinary Teaching Hospital and Laboratory of Veterinary Diagnostic
Imaging, Kagoshima University, Japan, 5Division of Laboratory and Vascular
Medicine, Kagoshima University Graduate School of Medical and Dental
Sciences, Japan, 6Department of Pharmacology, Mahidol University,
Thailand, 7Department of Neurosurgery, Omuta City General Hospital,
Japan, 8Laboratory of Functional Foods, Osaka Institute of Technology, Japan
Obstructive sleep apnea (OSA) may increase this risk of transient ischemic attacks (TIA) and minor stroke.High mobil ity group box-1(HMGB1), a nonhistone DNA-binding protein, is massively released
into the extracellular space from neuronal cells after ischemic insult andexacerbates brain tissue damage in rats. Minocycline is a semi synthetic
second-generation tetracycline antibiotic which has recently beenshown to be a promising neuroprotective agent. In this study, we foundthat minocycline inhibited HMGB1 release in oxygen-glucose deprivation (OGD)-treated PC12 cells and triggered the activation of p38mitogen-activated protein kinase (MAPK) and extracellular signal-regulated
kinases (ERK1/2). The ERK kinase (MEK)1/2 inhibitor U-0126 andp38MAPK inhibitor SB203580 blocked HMGB1 release in response to
OGD. Furthermore, HMGB1 triggered apoptosis in a dose-de pendent
fashion. Minocycline significantly rescued HMGB1-induced apoptosis
in a dose-dependent manner. In light of recent observations as well as
the good safety profile of minocycline in humans, we propose that
minocycline might play a potent neuroprotective role through the inhibition of HMGB1-induced neuronal apoptosis in OSA.

PO-1-264
RAMELTEON INDUCES ACUTE SLEEPINESS ON
THE PATIENTS WHO HAVE THE TENDENCY OF
SEASONAL AFFECTIVE DISORDER
T NAKAJIMA
Department of Neuropsychiatry, Kyorin University, Mitaka-City, Tokyo,
Japan
Ramelteon, an agonist of melatonin-1 receptor, which is used for treatment of insomnia, sometimes induces the acute sleepiness. We foundthat the patients who complain the acute sleepiness show the seasonalpatterns. Fourteen outpatients (7 males, 7 females, age 14–74 years old)
who consulted our clinic and have taken Ramelteon for their insomnia
participated in the present study after informed consents orally foranonymous presentation. They are comprised one schizophrenia, fivemood disorders (one atypical depression, two seasonal affective disorders, two other type mood disorders), two neurosis, four insomniacs,
and two sleep wake rhythm disorders. We examined their seasonality
with Seasonal Pattern Assessment Questionnaire (SPAQ) (Rosenthal,1984). To judge the intensity for seasonality by assessing the questionnaire 11. ‘To what degree do the following change with the seasons?’
which assess the intensity of the seasonality for following items: A. Sleep
length, B. Social activity, C. Mood (overall feeling of well-being), D.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research341

Sleep, Science and Research

Weight, E. Appetite, and F. Energy level. Additionally, we defined theanchor point after following criteria: 4. Extremely marked change:
Immediate answer for the items by the open question, ‘Do you haveany seasonal change about physical or mental state?’ 3. Immediateanswer after reading the item. 2. Spending time for answer after reading.
1. Seasonal change is uncovered in other part of the questionnaire, thenconfirming the seasonality. 6 patients complained the acute sleepinessafter Ramelteon, the points of the seasonality was 6.67, which is significantly higher than the patients without acute sleepiness, whose
seasonality points was 1.25. Ramelteon may induce acute sleepiness inthe patients who have seasonal features.

PO-1-265
EFFECTS OF SYNTHETIC CANNABINOIDS,CANNABICYCLOHEXANOL AND JWH-018, ON
ELECTROENCEPHALOGRAM POWER SPECTRA
AND LOCOMOTOR ACTIVITY IN RATS

N UCHIYAMA1, R KIKURA-HANAJIRI1, N MATSUMOTO2,
Z-L HUANG2, Y GODA1, Y URADE2
1
Division of Pharmacognosy, Phytochemistry and Narcotics, National
Institute of Health Sciences, Tokyo, Japan, 2Department of Molecular
Behavioral Biology, Osaka Bioscience Institute, Japan

Objectives: Several synthetic cannabinoids (SCs) have recently been
distributed as adulterants in many herbal products on the illegal drug
market around the world, on behalf of marijuana which contains psychoactive cannabinoids such as Δ9-tetrahydrocannabinol (Δ9-THC).
However, there is a little information on pharmacology of those SCs. In
this study following our previous report [Uchiyama, N. et al., Forensic
Sci. Int., 2011, in press, doi:10.1016/j.forsciint.2011.05.005], we
examined the pharmacological activities of two SCs, cannabicyclohexanol (CCH) and JWH-018, and Δ9-THC by analyzing electroencephalograms (EEG) power spectra and the locomotor activity afteradministration to rats.
Methods: Sprague-Dawley male rats (8 weeks old) were implanted with
EEG electrodes for polygraphic recording. After 10-days recovery, theEEG of each rat was recorded for 48 h. The first 24 h recording wasused as a control with the vehicle-treatment. The second 24 h recording
was obtained after an intraperitoneal (i.p.) administration of the above
drugs at 3 doses of 1, 2.5 and 5 mg/kg. The cortical EEG signal was
amplified, filtered (0.5–35 Hz), and recorded by using the analysis
software SLEEPSIGN. EEG spectrum was analyzed after fast Fouriertransformation. Locomotor activity of each rat was measured after thei.p. injection of each drug by monitoring with an infrared device.
Results: CCH and JWH-018 significantly increased EEG power in afrequency range of 4.5–6.0 Hz for the first 3 h in each dose. Δ9-THC
showed EEG pattern similar to those of SCs only at the dose of 5 mg/
kg. In addition, CCH significantly decreased the locomotor activity ina dose-dependent manner for a longer duration than that of Δ9-THC.
JWH-018 decreased the locomotor activity for longer duration than thatof Δ9-THC at the dose of 2.5 mg/kg, but the shorter duration than thatof Δ9-THC at the dose of 5 mg/kg. However, JWH-018 had more rapid
onset of the actions than CCH and Δ9-THC.
Conclusion: These SCs significantly changed the EEG power spectraand suppressed the locomotor activity in rats.

PO-1-266
ADHERENCE AND EFFECTIVENESS OFPOSITIONAL THERAPY FOR OBSTRUCTIVESLEEP APNEA SYNDROMEKW FRIDEL1, C MOSTI2, RR BOOTZIN3
Department of Psychology, University of Arizona, Grayslake, Illinois, UnitedStates of America, 2Gainesville, FL, University of Florida, United States ofAmerica, 3Tucson, AZ, University of Arizona, United States of America
1

The purpose of this investigation was to explore how adherence toapositional therapy intervention affected therapeutic outcome inparticipants with positional-related obstructive sleep apnea syndrome. Eighteen adult participants identified as having positional-related obstructive
sleep apnea by an initial overnight polysomnography study wererecruited. Participants were instructed to use a “tennis balltechnique”
positional device for three weeks at home and record their sleep habits
and adherence before a final post-treatment polysomnography evaluation. A repeated measures MANOVA found significant effects of treatment between pre- and post-test on the objective polysomnography
variables of Total Recording Time [F(1,17) = 5.21, p < .05, η2 = .24],
Total Sleep Time [F(1,17) = 8.59, p < .01, η2 = .34], Sleep Efficiency[F(1,17)= 5.42, p < .05, η2 = .24], Total REM sleep time [F(1,17) = 9.91, p <.01, η2 = .37], and the Apnea-Hypopnea Index [F(1,17) = 14.28,p <.001, η2 = .46]. Sleep onset latency was not statisticallysignificant. There
were significant effects of treatment on the subjective measures of the
Functional Outcome of Sleep QualityF(1,17) = 8.92, p < .01, η2 = .35],
Pittsburgh Sleep Quality Index[F(1,17) = 11.2, p < .01, η2 = .39],
Epworth Sleepiness Scale[F(1,17) = 6.69, p < .05, η2 = .28], and theBrief Symptom Inventory[F(1,17) = 5.14, p < .05, η2 = .23]. No significant interaction effects were found between treatment and adherence
when participants were grouped post-hoc into an adherent or nonadherent categories based on their self-reported daily log data. In
summary, the results of this study indicated that the positional device
was efficacious for significantly improving both objective polysomnography variables and subjective variables of sleep. The results also indicated that even partially adherent participants reported significant
improvements in nighttime sleep quality and quality of life after the three
weektreatment period. This study found very acceptable adherence rates
with this traditional positional device design.

Poster presentations 2
PO-2-001 / AS-28 Presenter
PARVALBUMIN-POSITIVE BASAL FOREBRAIN
NEURONS ENTRAINS CORTICAL GAMMAOSCILLATIONS AND PROMOTES WAKEFULNESS:
AN OPTOGENETIC STUDYT KIM1, JT MCKENNA1, JM MCNALLY1, S WINSTON1, C YANG1,
L CHEN1, B KOCSIS2, K DEISSEROTH3, RE STRECKER1,RW MCCARLEY1, RE BROWN1, R BASHEER1
1
Department of Psychiatry, Harvard Medical School & VA Boston
Healthcare System, Newton, MA, United States of America, 2Departmentof Psychiatry, Harvard Medical School-Beth Israel Deaconess Medical
Center, United States of America, 3Department of Psychiatry and
Behavioral Science, Stanford University, United States of America

The basal forebrain (BF) plays a crucial role in the modulation of corticalactivity across sleep-wake cycles via cortically projecting cholinergic

342© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

and non-cholinergic neurons. Among non-cholinergic neurons, an
important component consists of parvalbumin (PARV)-containing,
gamma-aminobutyric acid (GABA)ergic neurons whose firing rates
increase during electroencephalographic (EEG) low-voltage fast activity.
However, their precise contribution to cortical activation and sleepwake regulation is not well understood. Therefore, we sought to activate
the PARV-positive BF neurons using optogenetic stimulation and determine the effect on the EEG and sleep-wake behavior. Adeno-associatedviral vectors with double-floxed Channelrhodopsin2 (ChR2)-eYFP were
injected stereotactically into the BF of transgenic mice expressing Cre
recombinase under the control of the PARV promoter (PARV-Cre mice).
Post-hoc immunohistochemistry confirmed high levels of double labeling of ChR2-eYFP (green) and PARV protein (red) (n = 2). Opticalstimulation was performed through an optical fiber inserted into a guidecannula targeting the BF. Entrainment of the cortical EEG was particularly pronounced when the BF stimulation was at the gamma oscillation
frequency (40 Hz) (n = 5). Notably, this entrainment could be reproducibly elicited over the course of an hour of stimulation. 20 Hz stimulation
elicited a clear 40 Hz harmonic. We believe this PARV- specific solicitation of cortical gamma oscillation has not been previously reported, andmay represent an important but unsuspected feature of BF activation.
The effect on the sleep-wake cycle was investigated by comparing one
hour of baseline EEG with that of same time of day of one hour ofphasic stimulation at 40 Hz. Excluding the 5 s of stimulation, opticalstimulation increased wakefulness from 9.2% to 45.2% and decreased
NREM sleep from 75.3% to 43.5% (n = 1). We conclude that optogenetic stimulation of PARV-positive BF neurons entrains cortical rhythms,
particularly those in the gamma range, and enhances wakefulness.

PO-2-002 / AS-28 Presenter
BOTH OREXIN AND GHRELIN DEPOLARIZE
THE RAT LATERODORSAL AND
PEDUNCULOPONTINE TEGMENTAL NEURONSVIA PHOSPHOLIPASE C SIGNALING PATHWAY:AN IN VITRO STUDYJ KIM1, Y IKARI2, K SASAKI2
1
Department of Anatomy and Neurobiology, The University of Tennessee
College of Medicine, Memphis, Tennessee, United States of America,
2
Division of Bio-Information Engineering, University of Toyama, Japan
Orexin and ghrelin are newly identified neuropeptides that stimulate
food intake. Orexin is produced in the lateral hypothalamus, whereas
ghrelin is produced in the medial hypothalamus and peripheral organs,such as the stomach. Recent studies demonstrate that these peptides
are also involved in the regulation of sleep-wakefulness. Cholinergic
neurons in the laterodorsal (LDT) and pedunculopontine (PPT) tegmental nuclei play a potential role in the control of wakefulness and rapid
eye movement (REM) sleep. Interestingly, both LDT and PPT neurons
express receptors for orexin and/or ghrelin. Therefore, we examined theelectrophysiological effects of orexin and ghrelin on LDT and PPTneurons using rat brain slice preparations. whole-cell patch clamp
recording revealed that approximately 55% of LDT and PPT neurons
were depolarized by both orexin and ghrelin. The percentage of neurons
that were depolarized by orexin alone was 13% in the LDT and 23%
in the PPT, whereas 24% of LDT neurons and 9% of PPT neurons weredepolarized by ghrelin alone, indicating that LDT neurons are more
responsive to ghrelin than orexin and PPT neurons are more responsive
to orexin than ghrelin. When orexin and ghrelin were simultaneously
applied to LDT and PPT neurons that were depolarized by each of both
peptides, a depolarization that was almost equal to the addition oforexin- and ghrelin-induced depolarizations was induced. The depolar-

ization of LDT and PPT neurons induced by orexin and ghrelin was
significantly suppressed by D609, an inhibitor of phosphatidylcholinespecific phosphplipase C (PC-PLC). In addition, most of LDT and PPTneurons that responded to orexin and ghrelin were characterized by
low threshold spikes and A-currents and they were cholinergic. These
results suggest that orexin and ghrelin additively depolarize LDT and
PPT neurons via the common PC-PLC signaling pathway, and that orexin
and ghrelin may act as effective modulators on LDT and PPT neurons
to mediate the hypothalamic and peripheral influences on brainstem
machinery to regulate both wakefulness and REM sleep.

PO-2-003 / AS-31 Presenter
FIRING PROPERTIES OF THE NEURONS IN THE
AMYGDALA DURING SLEEP AND WAKEFULNESSIN RATST AOYAGI1, S TOYOMAKI1, K TAKAHASHI2, Y KOYAMA1
Faculty of Science and Technology, Fukushima University, Fukushima-city,
Fukushima, Japan, 2Department of Neurophysiology, Fukushima Medical
University, Japan1

Amygdala is known to be a center of emotion and is closely involvedin the regulation of autonomic nervous system associating with emotional behavior. During REM sleep, in addition to desynchronization of
EEG and rapid eye movement (REM), large fluctuation of autonomic
signs such as blood pressure, hart rate or body temperature occur. It
has been reported that, in human, activity of amygdale increases during
REM sleep. However, little is known about the single neuronal activity
in the amygdale during sleep and waking. Single neuronal activity wasrecorded from the amygdale in non-anesthetized, head restrained rats.
About half of the neurons (9 of 19) in the basolateral nucleus of amygdala displayed the most active firing during REM sleep. Of them, fiveincreased the firing in advance of the onset of REM sleep. In the central
nucleus of amygdala, neurons active both during waking and REM sleep
were recorded. Most of the amyddala neurons displayed phasic firing
during REM sleep, while during slow wave sleep, neurons frequently
showed burstic firing. These results suggest that the amygdale is closely
related with the phasic events during REM sleep.

PO-2-004 / AS-25 Presenter
PHYSIOLOGICAL SIGNIFICANCE OF
SEROTONERGIC INHIBITORY INPUTS TO
OREXIN NEURONSS TABUCHI1, T TSUNEMATSU1, S SUGIO2,3, K TANAKA2,3,
M TOMINAGA1,3, A YAMANAKA1,3
1
Cell Signaling, NIPS, Okazaki, Aichi, Japan, 2Neurobiology andBioinformatics, NIPS, Japan, 3Physiological Science, SOKENDAI, JapanThe neurons producing neuropeptide orexin/hypocretin (orexin
neurons) have an important role in the maintenance of arousal. It isreported that serotonergic neurons in the raphe nucleus are densely
innervated by orexin neurons. These serotonergic neurons express bothorexin receptors, OX1R and OX2R, and are activated by orexin. On theother hand, orexin neurons are innervated by serotonergic neurons in
the raphe nucleus, and are inhibited by serotonin through the serotonin
1A receptor (Htr1a). Although these results suggest that serotonergic
input forms a negative feedback circuit, its physiological role has notbeen completely understood.
To reveal this, expression of Htr1a mRNA is reversibly regulated in theorexin neurons by applying or removing doxycycline (DOX) from chow.
Electrophysiological analysis of orexin neurons revealed that inhibitory© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research343

Sleep, Science and Researcheffect of serotonin was approximately 2-hold prolonged in Htr1a overexpression mice compared with control mice. EEG and EMG recordingfrom Htr1a over expression mice revealed that these mice showedfragmentation of wakefulness in the early dark period. DOX applicationfor 5 days cancelled Htr1a mRNA over expression in the orexin neurons
and consolidated wakefulness in the early dark period. DOX removing
for 14 days over expressed Htr1a mRNA, and wakefulness was fragmented again. However, sleep/wakefulness pattern in the light period
was not significantly different from control mice. These results suggestthat inhibitory inputs from serotonergic neurons to orexin neurons
function as negative feedback circuitry to preserve the activity of orexin
neurons in moderate range in the early dark period.

PO-2-005
EXPLORING THE THALAMUS ACROSS THE
NATURAL SLEEP-WAKE CYCLE AND ITS ROLE
IN SOMATOSENSORY PROCESSINGN URBAIN, C PETERSEN
Laboratory of Sensory Processing, Ecole Polytechnique Fdrale de Lausanne,
Lausanne, Switzerland
Little is known about thalamic cell activity across the natural sleep-wakecycle, especially during REM sleep (REMS), nor its correlates withneocortical activity in non-anesthetised animals. We therefore developed a new technical approach to perform intra- and extracellular
single-unit recordings in the mouse somatosensory thalamus coupledwith local field potentials (LFP) recordings in its cortical target, polygraphic monitoring of vigilance states and video-tracking of whisker
movements. While tonically active during whisking, thalamic cells of
the ventroposteromedial nucleus strongly decrease their firing during
quiet wakefulness. In slow wave sleep, thalamic cells exhibit robust
bursts correlated with the cortical waves, and their membrane potential
is more hyperpolarised than in wakefulness and characterised by
1–10 mV membrane potential oscillations correlated with cortical slow
waves and spindles. When the mouse enters REMS, thalamic neurons
are suddenly depolarised and increase their firing rate. Most cells
further increase their activity simultaneously with the REMS associatedwhisker movements and cortical desynchronisation. Between two episodes of REMS whisking, cortical LFP exhibits a low frequency oscillating activity. This study is the first characterisation of rodent thalamic
membrane dynamics across physiological sleep and wakefulness. Furthermore, although cortical response to whisking behaviour has been
described, our results bridge the gap between periphery and cortex.
Our data reveal that thalamic membrane potential and/or firing isstrongly responsive to peripheral inputs, but also tightly linked withcortical activity in each vigilance state. These original data are therefore
crucial for the understanding of information processing throughout thesomatosensory system.

PO-2-006 / AS-32 Presenter
ELECTROPHYSIOLOGICAL EFFECTS OF OREXIN
ON LATERODORSAL AND PEDUNCULOPONTINETEGEMENTAL NEURONS IN RATS IN VITRO
T HIRAO, Y IKARI, J KIM, K SASAKIDivision of Bio-Information Engineering, University of Toyama, Toyama,Japan
Orexin-A (ORX-A) and orexin-B (ORX-B) act upon ORX receptor-1(OX1-R) and -2 (OX2-R) in the brain, and participate in the regulation
sleep-wakefulness and feeding. Although ORX-containing neurons

344

project to the laterodorsal (LDT) and pedunculopontine (PPT) tegmental nuclei that control wakefulness and rapid eye movement sleep, theactions of ORX on LDT and PPT neurons are not thoroughly understood. Thus, we examined the electrophysiological effects of ORX on
LDT and PPT neurons using rat brain slice preparations. whole-cellrecording revealed that ORX depolarized LDT and PPT neurons postsynaptically and dose-dependently. The dose-response curve for ORX-A
was almost overlapped to that for ORX-B in LDT neurons, whereas in
PPT neurons the dose-response curve for ORX-A was shifted to the leftof that for ORX-B with the EC50 values for these ORXs being 66 nM
and 536 nM, respectively. The ORX-induced depolarization was partly
suppressed in high-K+ solution with extracellular K+ concentration of
13.25 mM or in low-Na+ solution in which NaCl was replaced with
N-methyl-D-glucamine-Cl. Finally, the depolarization was completely
abolished in high-K+/low-Na+ solution. Inhibitors of the Na+/Ca2+
exchanger had no effect on the ORX-induced depolarization. In both
LDT and PPT neurons, the reversal potential obtained from currentvoltage relationships in low-Na+ solution was approximately −90 mV.
When the standard pipette solution was changed to the Cs+-containing
solution to block K+ channels, the reversal potential was approximately−40 mV in standard external solution. Most LDT and PPT neurons that
responded to ORX were characterized by low threshold spikes andA-currents and they were cholinergic. These results suggest that ORX
depolarizes LDT and PPT neurons via OX2-R and OX1-R, respectively,
and via a dual ionic mechanism including an increase of nonselective
cationic conductance and a decrease of K+ conductance. The present
results also suggest that LDT and PPT neurons are involved in the cellular process through which ORX participates in the regulation of
sleep-wakefulness.

PO-2-007
BURSTIC EYE MOVEMENTS DURING
PALADOXICAL SLEEP WERE NOT UNDER THE
CONTROL OF SUPERIOR COLLICULUS

K OGAWA1, K TAKAHASHI2, N SAITO3, K KITAHAMA4,K YAMAZAKI5, Y KOYAMA3
1
Faculty of integrated sciences and arts, Hiroshima University, HiagshiHiroshima, Hiroshima, Japan, 2Department of Physiology, Fukushima
Medical University, Japan, 3Faculty of Symbiotec System Science,
Fukushima University, Japan, 4Tokyo Metropolitan Institute of Medical
Science, Tokyo Metropolitan Institute of Medical Science, Japan, 5Faculty ofSport Sciences, Waseda University, Japan
Rapid eye movements (REMs) are the most prominent physiologicalfeatures of paradoxical sleep (PS). Although REMs during PS are analogous in shape to REMs during wakefulness (saccades), the neuralmechanisms regulating REMs during PS are still unknown. In human
EEG study, during PS, we have found the positive cerebral potentials
following REMs over the occipital visual areas. This potential is known
to represent cortical visual information processing after saccades. These
results suggest that, during PS, there are voluntary driven REMs under
the control of forebrain mechanism. However, it is well known that
REMs during PS persist in midbrain-transected cats (without forebrain
structures). In this study, we addressed the question whether REMs
during PS are, like saccades, influenced by the forebrain structures. In
un-anesthetized, head-restrained 7 rats, we examined the effect on theeye movements during PS of electrical lesions to the superior colliculus(SC) that is known to regulate saccade. During PS, two types of eye
movements, burstic eye movements and isolated ones occurred. Burstic
eye movements were observed more frequently than isolated eye movements but were not observed during wakefulness. After successful© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

lesion to the SC, the number of burstic eye movements during PS did
not change (1.4 ± 0.9 /min in pre lesion and 1.5 ± 0.9 /min in post
lesion). In addition, the duration of PS also had no clear difference (44.4± 15.9 min in pre lesion and 43.3 ± 12.4 min in post lesion). Ourfindings suggest that burstic eye movements during PS are regulated by
the mechanism not under the control of SC.

PO-2-008 / AS-24 Presenter
SUBSTANCE P DEPOLARIZES SLEEP-ACTIVE
CORTICAL NEURONS AND INDUCES EEGSYNCHRONIZATIONJE HEISS1, L DITTRICH1, D WARRIER1, T-M CHEN1, X PEREZ2,M QUIK2, KS THOMAS1
1
Biosciences Division, SRI International, MENLO PARK, California, UnitedStates of America, 2Center for Health Sciences, SRI International, UnitedStates of America
We recently described a population of sleep-active neurons in the cerebral cortex of rodents that present Fos expression during sleep but not
wake. These cells express NPY, nNOS and NK1, the receptor for substance P (SP).
To test the hypothesis that SP can modulate the activity of corticalsleep-active neurons and enhance EEG synchronization, we performedin vitro patch clamp recordings of cortical NK1 neurons in slices from
Npy-hrGFP mice and from squirrel monkey while delivering SP andother sleep-wake related compounds to the bath. To determine theeffects of cortical infusion of SP in vivo, we also performed multi-site
cortical injections of SP in freely-behaving mice while recording EEG
and EMG. Putative sleep-active neurons were identified in layers 5–6
of coronal cortical slices after 10 min of incubation in 35 nM of fluorescent TMR-SP, a ligand that is internalized by NK1-expressing
neurons. The effects of SP (1–100 nM), ACh, 5-HT, NE and otherneuromodulators on membrane potential were determined with andwithout TTX.
SP strongly depolarized all the recorded neurons that were positive fornNOS in both mice and monkeys, suggesting that SP can modulate
cortical activity in vivo. 5-HT and NE also depolarized these cells. To
characterize the effects of cortical injection of SP in vivo, mice were
implanted with a telemetry device (DSI, Inc.) that enabled measurementof EEG and EMG in freely-behaving mice. Animals were administered
600 nl of either vehicle or SP diluted in ACSF in 8 cortical sites simultaneously via 4 pairs of bilateral cannulae (Plastics One). Cortical injection of SP evoked a strong increase in delta activity in the EEG that was
not observed with vehicle injections.
Our results indicate that SP can modulate the activity of cortical nNOS
neurons in vitro and EEG activity in vivo. The depolarization evoked by
NE and 5-HT (which are associated with wakefulness) suggests that
there must be an additional mechanism to suppress the activity of nNOS
neurons during wakefulness.

PO-2-009
SLEEP DEPRIVATION AND EFFECT OF NITRICOXIDE, ENDOGENOUS OPIOID LIGANDS, AND
MELATONIN ON GASTRIC MUCOSAL DAMAGE
IN RATSK SADEGHNIIAT-HAGHIGHI1, E NOORI2, G HASANZADEH3,
A DEHPOUR4
1
Center for Research on Occupational Diseases, Tehran University of
Medical Sciences, Tehran, Iran, 2Occupational Medicine Department,
Tehran University of Medical Sciences, Iran, 3Anatomy Department,
Tehran University of Medical Sciences, Iran, 4pharmacology
Department, Tehran University of Medical Sciences, Iran

Partial sleep deprivation has been shown to induce gastric mucosal
damage in rats and this effect could be due to stress responses. There
were some relations among nitric oxide, endogenous opioid ligands,
and melatonin with different models of stress. The aim of this study
was determining the role of nitric oxide, endogenous opioid ligands,
and the possible role of melatonin in gastric mucosal damage inducedby partial sleep deprivation. So, 84 male rats assigned in 7 subgroups(n = 12): 3 control subgroups which slept normally and received saline,
L-NAME (a non-selective nitric oxide synthase inhibitor), and naltrexone respectively; 3 subgroups had disturbed sleep and received thesame drugs as control; and the last one had disturbed sleep and received
naltrexone and L-NAME. Partial sleep deprivation was induced by
specially designed rotating cages for 14 days. Serum melatonin wasmeasured by ELISA technique. Gastric mucosa damage was assessed
macroscopically and microscopically. The results indicated that partial
sleep deprived animals have significantly more severe gastric damages
than normally slept animals (P < 0.001), and inhibition of nitric oxide
synthase or blockage of opioids did not have a significant effect on thisdamage. Furthermore, it was found that serum melatonin was significantly lower (P < 0.001) in partial sleep deprived animals than normal
slept animals. In conclusion, melatonin might have a protective role inpreventing gastric mucosal damage induced by partial sleep deprivation
in a way other than nitrergic or opioid pathways.

PO-2-010
EFFECTS OF STIMULATION OF MEDIAN RAPHENUCLEUS ON STRESS AND STRESS-INDUCEDSLEEP ALTERATIONS
Y-T HSIAO, F-C CHANG
School of Veterinary Medicine, National Taiwan University, Taipei city,
Taipei, Taiwan
The hippocampal theta waves (4–7 Hz) are dominant in the electroencephalograms (EEGs) during rapid eye movement (REM) sleep, exploration, orientation and anxiety. Theta oscillations has been considered
as an index for anxiety level, since anxiolytics suppress the reticularformation-induced hippocampal theta oscillation. The projections frommedian raphe nucleus (MR) to the medial septum desynchronize thegeneration of hippocampal theta waves. Current study was designed toinvestigate whether the MR involves in the enhancement of stressinduced hippocampal theta waves and in the following sleep disturbances. Twelve times of randomized and inescapable foot electroshocks,
performed within 10 minutes prior to the light period of the light : darkcycle, increased theta oscillations. After foot electroshocks, the amountof REM sleep was significantly decreased. Application of a train of
100 Hz, 40 fÊA electrical stimuli or microinjection of glutamate into

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research345

Sleep, Science and Research

the MR alleviated the enhancement of footshock-induced theta oscillations and increased the time for rats spending in the open arms ofelevated-plus maze (EPM), indicating the role of MR in anxiety.
However, the footshock-induced reduction of REM sleep was notaltered by MR stimuli. These results suggest that the underlying neuronal circuits for the theta oscillations under stress and for the stressinduced decrease of REM sleep may differ.

PO-2-011
THE MYELIN MUTANT TAIEP RAT AS A MODEL
OF NARCOLEPSY-CATAPLEXY

JR EGUIBAR1, MA. DEL CARMEN CORTES2, ML ITA3,M LARA-LOZANO2
1
Provost Office and Institute of Physiology, B. Universidad autónoma dePuebla, Puebla, Pue., Mexico, 2Institute of Physiology, B. Universidad
Autónoma De Puebla, Mexico, Faculty of Medicine, UPAEP, Mexico

During the process to obtain a high-yawning subline of Sprague-Dawley
rats, we obtained a myelin mutant rat with a syndrome characterized
by tremor, ataxia, immobilities, epilepsy and paralysis. The acronym ofthese symptoms given its name taiep. The rats showed an initial hypomyelination followed by a progressive demyelination. During theimmobility episodes (IEs) the cortex had a disorganized activity in thebeta band, associated with theta rhythm in the hippocampus that is a
REM-like sleep pattern. In the present work, we analyze the electrophysiological characteristics of IEs and its relationship with the sleepwake cycle under basal conditions and after total sleep deprivation. The
animals we maintained under standard conditions with a 12:12 lightdark schedule and free access to rodent pellets and tap water. All procedures were approved by the IACUC. The animals were implanted inthree different regions of the cortex, hippocampus, nuchal muscles andright orbit with standard techniques and recording signals with Harmonie System. Our results showed that during IEs taiep rats showed threecharacteristic patterns of muscle tone changes. In type A there is an
initial increase in the muscle tone followed by diminution until reachatonia; type B is characterized by an increase of the muscle tone in the
middle of IEs and type C showed changes of muscle tone along IEs
duration. Importantly all IEs showed a REM-like sleep pattern suggesting a REM sleep disorder similar to narcolepsy. Total sleep deprivation(TSD) performed manually by gently touching technique, waking rats
each time they showed polygraphic signs of sleep by 3, 6, 12 and 24 h,
and recording during a recovery period showed an increase in the
power of SWS rebound after 24 h TSD, but not with other times used.
However, a linear increased of IEs are tightly correlated with the time
the rats were sleep deprivated (r2 = 0.85). In conclusion, IEs in taieprats are the expression of REM sleep and are controled by homeostatic
process. So, myelin mutant taiep rat is an adequate model of narcolepsy
cataplexy.

PO-2-012
SHORT-TERM HOMEOSTASIS AND THE
NREM/REM ALTERNATION WITHIN SLEEPARCHITECTURE IN THE RAT
EA. VIVALDI, A BASSI, J DIAZ
Programa de Fisiologia y Biofisica, Universidad de Chile, Santiago, Chile
The time course of the likelihood of entering or ending a REM sleep
episode (R) can be described, respectively, as its Propensity and Volatility. Propensity is the instantaneous rate of into-REM transition throughout the interval going from the end of one R to the start of the next R.

346

Volatility is the instantaneous rate of out-of-REM transition throughout
R. In this report, we describe those two processes through the alternating sequence of NREM/REM bouts within sleep episodes. Episodes ofwake (W), NREM (N) and R were detected with 5-second resolution
by an automated system in the 12-hour light-phase from 43 days ofrecordings of Sprague-Dawley rats. Operationally, episodes within sleep
were defined as lasting at least 2 epochs and intervening episodes of W,
at least 6 epochs. A total of 2,228 W/sleep alternations were detected.
A total of 4,732 N and of 3,056 R episodes were counted. There was amuch higher probability of going out to W from the first N in a sleep
episode (N1) than from later Ns (47% VS. 24%). In the first 90 secondsof N1 the rate of transiting to W was more than two-fold that of transiting to R (a W inertial effect), a relationship that was later reversed. Earlytransitions from N1 to W were significantly more frequent the longer
the preceding W. N1s that transit to W are significantly shorter that N1s
that transit to R (N priming effect). Additionally, the following R1s thattransit to W are significantly longer than those that go back to N. In all
Rs, the likelihood of going from R to N follows a sharp U curve with anadir at 1.5–2.0 minutes (N inertial effect and R saturation effect);whereas that of going from R to W increases monotonically through R.
Rs that transit to W are significantly longer that those that transit to N
and then to W, and these, again, longer that those that transit to N andthe go back to R. This suggests that R fulfillment facilitates ending asleep episode. Characterizing the overt dynamics of sleep-wake alternation may contribute to understanding the time course of the underlying
processes that are responsible for sleep architecture.

PO-2-013 / AS-18 Presenter
LOWER BRAIN ACTIVITY DURING SLEEP AND
WAKEFULNESS; INDUCED BY EXPOSURE TO
LONG MATERNAL SEPARATION AND CHRONICMILD STRESS IN RATS

J MRDALJ1, S PALLESEN2,5, AM MILDE1, FK JELLESTAD1,
R MURISON1, R URSIN4,5, B BJORVATN3,5, J GRNLI1,5
1
Department of Biological and Medical Psychology, University of Bergen,
Bergen, Norway, 2Department of Psychosocial Science, University ofBergen, Norway, 3Department of Public Health and Primary Health Care,
University of Bergen, Norway, 4Department of Biomedicine, University ofBergen, Norway, 5Norwegian Competence Center for Sleep Disorders,Haukeland University Hospital, Norway
Adverse events in early life can induce vulnerability to handle stressful
situations later in life. Sleep disturbances and depression are widespreadin victims of negative childhood experiences.
In male rats, we investigated the effects of 180 minutes (long maternal
separation; LMS) early separation from the mother during the postnataldays 2–14, compared to 10 minutes (brief maternal separation; BMS).
As adults, the animals were exposed to unpredictable chronic mild
stress (CMS). Twelve hour EEG/EMG recording, sleep staging and EEG
power spectrum analyses were performed before and after CMS
exposure.
There were no differences in sleep stages between LMS and BMS offspring. Exposure to chronic mild stress increased total sleep time andtime in REM sleep in LMS compared to BMS rats (p < 0.05). Within
the LMS group, all sleep parameters were affected by CMS except for
REM sleep, while CMS affected all sleep parameters in BMS group.
During wakefulness, CMS reduced EEG power in two higher frequency
ranges (19.5–35 Hz p < 0.001; 35–60 Hz p < 0.01), in the theta(6–9 Hz) and in the delta (0.5–4 Hz) range (p < 0.001 in both) in the
LMS group. Only power in 35–60 Hz frequency range was reduced(p < 0.05) in the BMS group.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

During slow wave sleep, in both LMS and BMS group chronic stress
reduced the EEG power in delta (p < 0.001) and theta range (p < 0.01).
Power was also reduced in 19.5–35 Hz frequency range in BMS (p <0.05), however more strongly in the LMS group (p < 0.001). In addition
LMS group showed lower power in 35–60 Hz range (p < 0.05).
During REM sleep, CMS affected both groups; theta power was reduced
in BMS group (p < 0.05), and more strongly in LMS group (p < 0.01),
in addition to a lower power in high frequency ranges (p < 0.001 inall). In the BMS group there was an increase in delta power (p < 0.05).
Long- and brief maternal separated rats responded differently to chronic
mild stress. LMS showed more REM sleep. The characteristic EEG
power for REM sleep and wakefulness were more strongly reduced in
LMS rats. The results indicate that LMS animals are more vulnerable tostress as adults.

PO-2-014
REM SLEEP RECOGNITION BASED ON
NEURONAL SYNCHRONY USING TIMEFREQUENCY INTERFERENCE ANALYSIS OF
EEG RECORDINGS IN THE RAT

EA. VIVALDI1, J DIAZ1, J-C LETELIER2, A BASSI1, A COOLEN3
1
Programa de Fisiologia y Biofisica, Universidad de Chile, Santiago, Chile,
2
Biology of cognition laboratory, Biology Department, Faculty of Sciences.,
Universidad de Chile, Chile, 3Department of Behavioral Physiology, Center
for Behavior and Neurosciences, University of Groningen, Netherlands
REM sleep is characterized by a highly predominant, uniform, theta
rhythm. During NREM sleep the characteristic large amplitude, irregular, delta-rich activity encompasses a broad spectrum that includes theta
band. Since theta activity may be high in both states, EEG analysis basedon FFT must additionally compute the delta to theta ratio. Here we
present an alternative approach for REM sleep detection based on the
direct identification of synchronous rhythms. It has been shown that,through analysis of the envelope of neuronal signals, the degree ofsynchrony of the underlying neuronal oscillators can be inferred (Diazet al., J Neurosci 4512-06, 2007). It was demonstrated that combinations of asynchronous oscillators produce a signal whose envelope
exhibits a characteristic interference modulation. The coefficient ofvariation of such signals envelopes (ECV) corresponds to the CV of theRayleigh probability density function and it approaches sqrt (4/pi-1) or
0.523. When signals are instead produced by a population of synchronized oscillators their ECV is significantly lower. Twenty five days fromfive chronically implanted Sprague Dawley rats were used to obtain
continuous epidural EEG and EMG recordings. States were scored witha 10-second epoch resolution, both visually and by a computer algorithm. After filtering, the theta band ECV per epoch was calculated.
Theta ECV for NREM epochs approximated the 0.523 fingerprint value,indicating asynchronous activity of the involved oscillators. In contrast,
the theta ECV was markedly lower during REM-sleep, in consonancewith their high degree of synchrony. Plotting theta ECV versus EMG
power, three very well-defined clusters corresponding to REM, NREM
and W are distinguished. Since this method focuses on the signal
structure, independently of the signal power, it can directly recognize
REM sleep based on the remarkable synchrony of its theta rhythm.

PO-2-015
COMMON CARDIAC RESPONSE TO RESTRAINT
STIMULI IN RAT AND MOUSE DURING EARLYPOSTNATAL PERIODJ TOKUNAGA1, S SATO2, M SATO1, Y SAGAWA4, T KIZAWA3,
K HOSOKAWA3, W ITO1, T KANBAYASHI1, K ONO2, T SHIMIZU1
1
Department of Neuropsychiatry, Akita University, Akita-city, Akita, Japan,
2
Department of Physiology, Akita University, Japan, 3Department of Sleep
medicine and Laboratory Medicine, Iwate Medical University, Japan, 4Sleep& Circadian Neurobiology Laboratory, Stanford University, United Statesof America
Introduction: Using a piezoelectric-transducer (PZT) sensor that enabled
us to measure heart rate (HR) of small newborn animals noninvasively, we
compared the development of HR and the HR response to restraint stressduring the first two postnatal weeks between rats and mice.
Methods: Basal HRs of rats and mice were measured by the PZT sensor
at postnatal day (P) 0-P14 by simply put them on the sensor for 5 min.
Then, HR response to restraint stress was measured for 5 min by
restraining them with ECG electrodes which were fixed on the PZT
sensor. Additionally, the same protocol was performed after autonomic
blockade with atropine, metoprolol or both to evaluate the relevance
between the HR response and autonomic nervous system regulation.
Results: Basal HR measured by PZT sensor (PZT-HR) in rats(mice) was
220(323) b/m at P0, which steeply increased to 330(598) b/m at P2(P5)and almost linearly increased thereafter until P14 to 470(692) b/m. In
contrast to stable PZT-HR, the stress by attaching ECG electrodes significantly decreased HR of rats(mice) during 5 min at P0 [181(319) to171(302) b/m, P < 0.05] through P10(P3) [427(468) to 364(436) b/m,
P < 0.05] after an initial HR drop at 0 min, while it induced transient
bradycardia at P11(P9) -P14. The transient bradycardia was abolishedby parasympathetic blockade with atropine.
Conclusion: Basal HR in both newborn rats and mice increased almost
linearly with changing its slope in the first postnatal week but not in
S-shape curve as described in the earlier studies. The development ofparasympathetic nervous system may be also similar between thembecause the both exhibited transient bradycardia in response to restraint
stress during the second postnatal week. These similar developmentsof HR and autonomic nervous system seem to be a heritable trait
common in rodents at least in rats and mice.

PO-2-016
PRETERM BIRTH ALTERS AUTONOMICBLOOD PRESSURE CONTROL DURING SLEEPIN INFANCYSR YIALLOUROU, NB WITCOMBE, SA SANDS, AM WALKER,
RSC HORNE
Ritchie Centre, Monash Institute of Medical Research, Monash University,
Clayton, Australia
Background: Preterm infants have increased risk for Sudden Infant
Death Syndrome (SIDS). Impaired autonomic blood pressure (BP)control leading to an uncompensated hypotension is thought to be
involved in SIDS. Assessment of BP variability (BPV) can be used toassess autonomic BP control, however, there are no data concerning
BPV during sleep in preterm infants. We aimed to investigate the effects
of preterm birth, sleep state and age on BPV across the first 6 monthsof term-corrected age (CA).
Method: Preterm (n = 25) and term (n = 31) infants were studied at
2–4 wks, 2–3 mo and 5–6 mo CA using daytime polysomnography. BP© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research347

Sleep, Science and Research

was recorded during quiet (QS) and active (AS) sleep using a photoplethysmographic cuff (FinometerTM). Using spectral analysis, 2 min BP
epochs were used to establish BPV indices: Low frequency power (LF,reflects baroreflex changes and sympathetic modulation), high frequency power (HF, reflects respiratory changes and parasympathetic
activity) LF/HF (reflects sympathovagal balance).
Results: Compared to term infants, preterm infants had lower LF/HF
at 2–4 wks and 2–3 mo during QS (p < 0.05) and at 2–3 mo and
5–6 mo during AS (p < 0.05); lower LF power at 2–4 wks during QS(p < 0.05); and higher HF power during both QS and AS at all ages
studied (p < 0.05).
Within the preterm group, LF/HF and LF power were increased in AS
compared with QS at 2–4 wks CA (p < 0.05), and HF power was
decreased in AS compared with QS at both 2–4 wks and 2–3 mo CA (p <0.05). Between the ages of 2–4 wks and 5–6 mo CA, LF power decreased
and HF power increased with age in AS in the preterm group (p < 0.05).
Conclusions: Preterm infants exhibit a profoundly altered BPV, whichsuggests that preterm birth provides for reduced sympathetic vascular
modulation compared to term infants. Sleep state and age also havemarked effects on BPV in preterm infants, suggesting heightened sympathetic vascular modulation in AS, which drops away with age.
Overall, lower sympathetic modulation in preterm infants may lead toan impaired ability to appropriately respond to hypo/hypertensive challenges during sleep and may potentially lead to SIDS.

PO-2-017
POOR SLEEP AND CARDIOVASCULARFUNCTION IN CHILDREN

S MARTIKAINEN1, A-K PESONEN1, K FELDT1, A JONES2, J LAHTI1,
R PYHÄLÄ1, K HEINONEN1, E KAJANTIE3,4, J ERIKSSON3,5,6,7,8,
K RÄIKKÖNEN1
1
Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland,
2Institute of Cardiovascular Science, University College London, United
Kingdom, 3Department of Chronic Disease Prevention, National Institutefor Health and Welfare, Finland, 4Institute of Clinical Medicine, Hospitalfor Children and Adolescents, University of Helsinki, Finland, 5Departmentof General Practice and Primary Health Care, University of Helsinki,
Finland, 6Unit of General Practice, Helsinki University Central
Hospital, Finland, 7Folhälsan Research Center, Helsinki University Central
Hospital, Finland, 8Vasa Central Hospital, Vasa, Finland
Background: Poor sleep in adults is associated with increased risk ofhypertension and cardiovascular (CV) disease, but associations with CV
function in children are little studied and the results are contradictory.
We investigated whether actigraphic sleep quantity and quality wererelated to 24-hour ambulatory blood pressure (ABP) and CV reactivity
to a standardized psychosocial stress test in children.
Methods and results: We studied term-born, healthy 8-year-olds (SD= 1.4 years) without sleep disordered breathing (n = 321 with 231 and265 providing valid data for analyses on ABP and CV reactivity, respectively). Sleep was registered with an actigraph for six nights on average(SD = 1.2, Range = 3–13 nights). ABP was measured for 24-hours (41%non-school days) with an oscillometric device. The children underwent
the Trier Social Stress Test for Children during which blood pressure(BP), electrocardiogram and thoracic impedance were recorded andprocessed offline to give measures of cardiovascular and autonomic
function. Neither quantity nor quality of sleep were related to 24-hour
ABP or CV reactivity after accounting for major covariates (sex, age,height, body mass index and parental education).
Conclusions: These findings in healthy 8-year-old children do notsupport the mainstream of epidemiological findings, derived from348

samples more heterogeneous in age, sociodemographic characteristics
and health, suggesting that poor sleep is associated with an unhealthy
CV phenotype.

PO-2-018
FRACTAL HEART RATE DYNAMICS DURINGSLEEP IN PATIENTS WITH CHRONICFATIGUE SYNDROMEF TOGO1, BH NATELSON2
Educational Physiology Laboratory, The University of Tokyo, Tokyo,
Japan, 2Pain and Fatigue Study Center, Beth Israel Medical Center andAlbert Einstein Medical Center, United States of America
1

We determined whether feelings of unrefreshing sleep in patients withchronic fatigue syndrome (CFS) were associated with differences inheart rate dynamics during sleep from normal.
Beat-to-beat RR intervals during nocturnal sleep and subjective scoreson visual analog scale for sleepiness were collected from 18 healthy and
17 CFS female study participants aged 25–55. Age did not differ
between the groups. A short-term fractal scaling exponent of heart rate
dynamics, analyzed by the detrended fluctuation analysis (DFA) method
was assessed during wakefulness after sleep onset, non-rapid eye movement sleep (stage 1, stage 2, stage 3 or 4), rapid eye movement (REM)
sleep (stage REM), and arousal. CFS patients were stratified into those
who reported more or less sleepiness after a night’s sleep (a.m. sleepieror a.m. less sleepy, respectively).
The fractal scaling index during stage 1, stage 2, and stage 3 or 4 wassignificantly (p < 0.05) higher for patients in the a.m. sleepier groupthan healthy controls, although standard polysomnographic measure
did not differ between the groups. The fractal scaling index during stage
2 and stage 3 or 4 was significantly (p < 0.05) lower than that during
wakefulness after sleep onset and arousal for healthy controls andpatients in the a.m. less sleepy group, but did not differ between sleep
stages for patients in the a.m. sleepier group.
These results suggest that autonomic nervous system activity during
sleep might relate with unrefreshing sleep in patients with CFS.

PO-2-019
ALTERATION IN THE AUTONOMIC NERVOUS
SYSTEM ACTIVITY OF EXTREMELY PREMATURE
INFANTS DURING EARLY NEONATAL PERIODEA BEGUM1, M BONNO1,2, Y OMORI2, K MATSUDA2, AI NAGATA2,J HIRAYAMA2, N SASAKI2, W YAMAMOTO2, N SUGINO2,S TANAKA2, H YAMAMOTO1, M IDO2
1
Clinical Research Institute, National Hospital Organization, Miechuo
Medical Center, Tsu, Mie, Japan, 2Department of Pediatrics, National
Hospital Organization, Miechuo Medical Center, Japan
Background: Although a major deficit in autonomic nervous system(ANS) activity has been reported in extremely premature infants during
early neonatal period, evidences on the alteration in the ANS activity
during this period is not widely available. The aim of this study was toinvestigate the alteration in the ANS activity in extremely prematureinfants from birth to 7 days of postnatal age (PNA).
Methods: Electrocardiographic recording was performed from birth to
7-days of PNA in 15-infants born within 25–27 weeks of gestational
age. Time-domain and frequency-domain analysis of heart rate variability was performed using R-R intervals. As ANS activity indices,
standard deviation of normal to normal R-R intervals (SDNN) and root
mean square of successive R-R differences (RMSSD) were computed by© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

time-domain and total power (TP: 0.0–0.50 Hz), the power of low
frequency (LF: 0.04–0.15 Hz), the power of high frequency (HF: 0.15–
0.50 Hz) and LF/HF ratio were computed by frequency-domain analysis. Data were analyzed in various session from 3-hour (hr) to 7-daysof PNA.
Results: Significant changes were not observed in SDNN and RMSSD
computed by time-domain analysis until 7-days of PNA(p < 0.05).
Indices from frequency-domain analysis, TP, LF and HF were gradually
but significantly increased over the week in the time-dependent manner(TP, 3-hrs: 1053.8 ± 789.4 ms2, 7-days: 3552.2 ± 1360.9, p < 0.01; LF,
3-hr: 553.5 ± 412.7, 7-day: 1698.5 ± 570.3, p < 0.01; HF, 3-hr: 259.4± 248.2, 7-days: 1077 ± 456.9, p < 0.01) with a significant decrease in
LF/HF ratio (3-hr: 2.4 ± 1.5, 7-days: 1.6 ± 0.4, p < 0.05). LF, indicating
sympathetic nervous system (SNS) activity, was significantly higher
compared to HF, a marker of parasympathetic nervous system activity,in each session (LF × HF, < 0.001, respectively), however, the increasein HF was greater than the increase in LF power.
Conclusion: The increase in the TP, LF and HF with the increase of
PNA suggests a progressive development of the ANS activity after birthand LF × HF indicates the dominance of SNS in the extremely premature infants during early neonatal period.

PO-2-020
HEART RATE VARIABILITY CAN BE USED TO
ESTIMATE SLEEPINESS-RELATED DECREMENTS
IN PSYCHOMOTOR VIGILANCEECP CHUA1, W-Q TAN2, S-C YEO3, P LAU1, I LEE1, IH MIEN4,K PUVANENDRAN3, JJ GOOLEY1
1Program in Neuroscience and Behavioral Disorders, Duke-NUS Graduate
Medical School, Singapore, Singapore, 2Division of Bioengineering, National
University of Singapore, Singapore, 3National Neuroscience Institute,Singapore, 4Graduate School for Integrative Sciences and Engineering,
National University of Singapore, Singapore
Study Objectives: To assess whether heart rate variability (HRV) canbe used to estimate decrements in psychomotor vigilance caused bysleepiness.
Design: In a within-subjects design, HRV measures were comparedwith validated measures of sleepiness derived from eyelid closures andthe electroencephalogram (EEG).
Setting: Chronobiology and Sleep Laboratory, Duke-NUS Graduate
Medical School Singapore.
Participants: Twenty four healthy Chinese men (mean age±SD = 25.9
± 2.8 years).
Interventions: Subjects were kept awake continuously for 40 hours
under constant environmental conditions. Every two hours, subjects
completed a 10-min Psychomotor Vigilance Test (PVT) to assess sustained visual attention.
Measurements and Results: During each PVT, we examined the electrocardiogram (ECG), EEG, and percentage of time that the eyes wereclosed (PERCLOS). Similar to EEG power density and PERCLOS measures, the time course of ECG RR-interval power density (0.02–0.08 Hz)
correlated with the 40-h profile of PVT lapses (reaction time × 500 ms).
Based on receiver operating characteristic (ROC) curves, RR-interval
power density performed as well as EEG power density at identifying
a sleepiness-related increase in PVT lapses above threshold. RR-interval
power density also classified subject performance with sensitivity andspecificity similar to PERCLOS.
Conclusions: The ECG carries information about a person’s vigilancestate. Hence, HRV measures could potentially be used to predict when
an individual is at increased risk of attentional failure. Our results

suggest that HRV monitoring, either alone or in combination with otherphysiologic measures, could be incorporated into safety devices to warn
drowsy operators when their performance is impaired.

PO-2-021
CORRELATION OF BRAIN ACTIVITY AND HEARTRATE TIME COURSES DURING NOCTURNALSLEEP: A PILOT STUDYJW KIM1, AL DENOTTI3, KKH WONG3,4, PA ROBINSON1,2,3,
RR GRUNSTEIN3,4
1
School of Physics, The University of Sydney, Sydney, New South Wales,
Australia, 2Brain Dynamics Centre, The University of Sydney, Australia,
3
Centre for Integrated Research and Understanding of Sleep, Woolcock
Institute of Medical Research, Australia, 4Dept. of Respiratory and Sleep
Medicine, Royal Prince Alfred Hospital, Australia

Introduction: Sleep is an active process with dynamic changes in theelectrophysiology of the brain and other organs, such as the heart, invarious time scales. Having “sound” sleep, consequently, is important
not only to patients with sleep-related disorders but also to others withcomorbidities, e.g., cardiac dysfunction. Electroencephalograms (EEG)and electrocardiogram (ECG), routinely used to monitor patients during
sleep studies, enable us to explore simultaneous, dynamic changes inthe brain and heart. The purpose of this study is to introduce a method
to examine correlations of brain and heart activity, and demonstrate its
potential application in a clinical setting.
Methods: Full polysomnography (including six-channel EEG, ECG,
EOG, etc) was recorded for 17 patients (8 obstructive apnea and 9
healthy controls). Each 5 s epoch of the EEG and ECG signals was
examined for non-physiological artefact. Artefact-free EEG epochs wereanalyzed using the power spectral method and detrended fluctuation
analysis (DFA), while a QRS detection algorithm was applied to 5 s ECG
epochs. These values were calculated for each sleep stage. In particular,
correlations between DFA scaling exponents (SE) and the RR interval(RRI) of the heart beat were explored.
Results: We found two distinct patterns of correlations between DFA
SE and RRI. 15 of the 17 patients showed significant positive correlations (i.e., higher DFA SE occurs with slower heart rate, mean correlation coefficient, r = 0.30, p < 0.001), while 2 patients (one from OSA
and one from controls) show significant negative correlations (r =−0.27, p < 0.001). No inter-group differences were found.
Discussion: The strong correlation between brain and heart activity
suggest that our method could be a potential measure to study the comorbidity of sleep and heart-related disorders. The clinical conditions associated with the positive and negative correlations require further study.
Support: Australian Research Council, Australian National Health andMedical Research Council.

PO-2-022
HAEMODYNAMIC COUPLING OF
ELECTROGRAPHIC TRANSIENTS DURING
NON-REM SLEEPDT ROLLINGS1, AP BAGSHAW2
Dept of Neurophysiology & Birmingham University Imaging Centre,
University of Birmingham, West Midlands, United Kingdom of GreatBritain and Northern Ireland, 2School of Psychology & Birmingham
University Imaging Centre, University of Birmingham, United Kingdom
1

Introduction: The transit between the state of wakefulness and thestages of sleep can be assessed by way of various electrographic© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research349

Sleep, Science and Researchphenomena. The K-complex, sleep spindles and vertex sharp waves arelandmarks in the staging of sleep (Rechtschaffen and Kales., 1968). The
neurophysiological origin of these sleep transients are fairly well understood, due in part to the work of Steriade and colleagues (Amzica &Steriade., 1997; Steriade et al., 1987), though their functional role isless clear. Combined EEG-fMRI is a potential tool for elucidating thefunctional role of these electrographic transients.
Method: The EEG-fMRI data were obtained from 14 control subjects
who had undergone a night of sleep deprivation prior to scanning (3TPhilips Achieva, TR = 2000 ms, 64 channel EEG, Brain Products,
Munich, Germany). GLM analysis was performed using SPM5 (Wellcome Department of Imaging Neuroscience, UCL, UK).
Results: Of the 14 subjects, 4 failed to reach a sufficient state of sleep.
The 10 subjects who fell asleep had one or more of the sleep transients
present in the EEG, with all showing fMRI activation. Vertex sharp
waves demonstrated activation in the primary somatosensory, primaryvisual and auditory cortex, with additional involvement of inferior
frontal regions. Common activation patterns for K-complexes included
superior frontal, post central regions, as well as temporal and posterior
cingulate areas. Sleeps spindles showed differing activation patterns
dependent on their frequency and topographical distribution.
Discussion: These findings suggest vertex sharp waves may act aspriming mechanism of primary sensory systems in response to exogenous stimuli; such as sound. Robust activation was identified with
K-complexes, despite previous EEG-fMRI studies concluding that, due
to no associated fMRI changes, there was little metabolic demand intheir generation (Czisch et al., 2009). Our findings support the observations made by Schabus et al. (2007), of the notion of two spindle types
though there is some discrepancy. The potential role of these sleep
transients are discussed.

PO-2-023
EFFECTS OF INTENSIVE EXERCISE ON
PHYSIOLOGICAL RESPONSES DURING SLEEPK SHIODA1, Y UEDA1, Y NAKAMURA1, K GOTO2, S UCHIDA3
1
Graduate School of Sport Sciences, Waseda University, Tokorozawa-city,
Saitama, Japan, 2Faculty of Sport and Health Science, Ritsumeikan
University, Japan, 3Faculty of Sport Sciences, Waseda University, Japan
Introduction: There have been various researches on the relationshipbetween sleep and exercise. However, few researches have been conducted in relation to physiological responses during sleep after intensive
exercise. The purpose of the present study is to examine the effect ofintensive exercise on sleep electroencephalogram (EEG), heart rate variability (HRV) and rectal temperature (RT).
Method: Seven young males participated in the experimental condition
consisting of three consecutive days. The first night was set for acclimatization. Subsequent two nights were set as “no exercise day (secondnight, control condition)” and “exercise day (third night, exercise condition)”. On the exercise day, the participants performed ten sets of
5 seconds maximal pedaling exercise with 25 seconds rest periods
between sets. An applied load for maximal intermittent exercise was
equivalent to 7.5% of each participant’s body weight. The exercise wasthen repeated after 30 minutes. Respiratory parameters and blood
lactate concentration were measured before and after exercise. During
sleep (bedtime from 23:30 to 07:30), polysomnography (PSG), HRV(heart rate: HR, low frequency: LF, high frequency: HF and LF/HF), andRT were continuously recorded.
Results: There were no significant differences in sleep variables andEEG power spectrum. However, HR, LF/HF and RT were significantly
higher in the exercise condition than in the control condition (P < 0.05).

350

In addition, HF was significantly lower in the exercise condition thanin the control condition (P < 0.05).
Conclusion: Although sleep variables and EEG power spectrum did
not differ between conditions, HR, LF/HF, HF and RT showed significant differences between conditions. These results suggest that intensive
exercise has a strong effect on autonomic systems such as HRV and RT,
but not on EEG during sleep.

PO-2-024
EFFECT OF SINGLE BOUT MODERATEINTENSITY 1-HR AEROBIC EXERCISE AT NIGHT
ON FOLLOWING NIGHT SLEEPM GANEKO1, K SHIODA1, T KOJIMA1, J SUMITOMO1, S UCHIDA2
Graduate School of Sport Sciences, Waseda University, Tkorozawa-city,
Saitama, Japan, 2Faculty of Sport Sciences, Waseda University, Japan
1

Although, there have been studies to investigate the effect of exercise on
sleep, most of the results indicate the exercise has only little effect on
sleep. However, Walker et al. (1978) reported an interesting result thatexercise has strong effect on heart rate during sleep. This result may
indicate that physical exercise has more effect on autonomic parameters
during sleep than EEG sleep. Therefore, in this study, we aim to examine
not only EEG sleep, but also other physiological parameters such asheart rate (HR), respiratory rate (RR) or core body temperature (CBT).
Healthy young male subjects, who are sedentary nonsmokers, participated in the experiment consisting of two sets of two consecutive nights.
The first night was adaptation night in the both sets. The second night
was exercise condition in the first set and control condition in the second
set. Two sets were separated by one week. Sleep time was 8 hours from
11pm to 7am. On the exercise condition, subjects performed 60-minutes
cycle ergometer exercise at 60%VO2max 3.5 hours before bedtime. On
the control condition, subjects relaxed by watching TV and readingbooks at the same time period. We recorded PSG including EEG, HR,
RR, and CBT. Newly developed sheet type sensor was also used. This
device was inserted under bed mattress and measured HR and RR. In
addition, cortisol, blood glucose level, blood lactate level, and subjective
sleep quality. We have finished a part of subjects. The results up to now
indicate that WASO, HR and CBT increased exercise condition. Furthermore, heart rate variability analysis revealed that parasympathetic
nervous system during exercise condition decreased. Complete resultswith statistical analysis will be presented at the meeting.

PO-2-025 / AS-28 Presenter
DECREASES IN CONNECTIVITY BETWEEN THE
CENTROMEDIAN NUCLEUS OF THE THALAMUS
AND THE NEOCORTEX DURING HUMAN
SLOW-WAVE SLEEPD PICCHIONI1, ML PIXA1,2, M FUKUNAGA3, WS CARR4,
SG HOROVITZ3, JH DUYN3, AR BRAUN4, TJ BALKIN1
1
Department of Behavioral Biology, Walter Reed Army Institute of
Research, Silver Spring, MD, United States of America, 2Computer Systems
Laboratory, Thomas Jefferson High School for Science and Technology,
United States of America, 3National Institute of Neurological Disorders andStroke, National Institutes of Health, United States of America, 4National
Institute on Deafness and Other Communication Disorders, National
Institutes of Health, United States of America
The objective of this study was to extend, into humans, the finding fromanimal studies of a functional deafferentation between non-specific© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

thalamic nuclei and the neocortex during slow-wave sleep. Simultaneously collected EEG and fMRI were used in this regard. A functional
connectivity analysis was conducted by calculating the correlation
between fMRI activity in the centromedian nucleus of the thalamus andthe rest of the brain during wakefulness and slow-wave sleep. Significant
differences between wake and sleep were calculated on a voxelwise basis
using Fisher’s z transformation. The absolute value for each transformed
correlation was used in this calculation because if a strong positive correlation during wakefulness became a strong negative correlation during
sleep, this would still indicate the same magnitude of connectivity andthus the difference between the conditions would be and should be zero.
Based on previous animal work, it was hypothesized that a majority of
neocortical regions would show a significant decrease in the magnitudeof their correlation with the centromedian nucleus during sleep. Thishypothesis was supported. The neocortical regions that displayed
decreased connectivity were mostly heteromodal regions (e.g., posterior
cingulate/precuneus), but there were also decreases in unimodal regions(e.g., lingual gyrus). This study provides evidence of a functional deafferentation between non-specific nuclei of the thalamus and the neocortex during slow-wave sleep using a non-invasive technique in humans.
The results represent a plausible mechanism that might correlate withsensory thresholds in future sleep studies and explain them based on
known neurophysiological phenomena. For example, the thalamus may
act like a gate where sensory signals are essentially blocked from beingtransmitted to the neocortex during sleep. These data may also lead toa better understanding of disorders of consciousness such as coma,
which exhibit similar changes in thalamocortical connectivity.

PO-2-026
ASSOCIATION BETWEEN JAW POSITION AND
MASSETER TONE DURING SLEEPY SUZUKI1, K OKURA1, S SHIGEMOTO1, S ABE2, T KATO3
1
Department of Fixed Prosthodontics, Tokushima University, Tokusima,
Tokushima, Japan, 2Department of Comprehensive Dentistry, Tokushima
University, Japan, 3Department of Oral Anatomy and Neurobiology, Osaka
University Graduate School, Japan
Objectives: Muscle tone of orofacial muscles as well as other skeletal
muscles is decreased during sleep. Since masseter muscle is responsible
for the jaw-closing movements, the changes in masseter tone can becorrelated to the amount of jaw opening during sleep. Thus, we investigated the association between masseter tone and the amount of thejaw opening during sleep.
Methods: Twelve healthy adult subjects (7M; 5F, 25.5 ± 5.7 years) wereparticipated. They had normal occlusion and were free from sleep
disorders and stomatognathic dysfunction. Masseter EMG activity andjaw movements were recorded simultaneously with video-polysomnography for two nights. Jaw movements were recorded by the six-degreeof-freedom jaw tracking device that can detect the positions of intraoral
sensors attached to upper and lower teeth. The data from the secondnight were analyzed. Sleep stages were scored according to the R&K
method. For every one second during quiet sleep period without masseter contraction and jaw movement, masseter tone and the jaw opening
length were analyzed.
Results: Masseter tone significantly differed between sleep stages(Friedman test, P < 0.001). It was lower during Stage REM than Stages
1, 2 and 3&4 (post hoc Wilcoxon tests, P < 0.05). The jaw opening
length was smaller during Stgae1 than other sleep stages (Friedman
test, P < 0.001; post hoc Wilcoxon tests, p < 0.05). In all subjects, noobvious correlations were found between masseter muscle tone and thejaw opening length in the night (Pearson correlation coefficient < 0.3).

Conclusion: The results suggest that the changes in masseter tone areunlikely associated with the amount of the jaw opening during sleep.

PO-2-027 / AS-20 Presenter
THE PATTERNS OF CLOSE-OPEN JAW
MOVEMENT DURING SLEEP IN NORMALSUBJECTSK OKURA1, S SHIGEMOTO1, S ABE2, Y SUZUKI1, T KATO3
1
Department of Fixed Prosthodontics, The University of Tokushima
Graduate School, Tokushima-city, Tokushima, Japan, 2Department ofComprehensive Dentistry, The University of Tokushima Graduate School,
Japan, 3Department of Oral Anatomy and Neurobiology, Osaka University
Graduate School of Dentistry, Japan
Objectives: Increased jaw motor activities associated with tooth grinding are thought to be a cause of dental problems in sleep bruxism
patients. Although mechanical impacts to teeth during jaw motor activities can vary with the patterns of jaw movements, there is little information on jaw movements during sleep. This study was aimed tocharacterize the patterns of close-open jaw movement during sleep.
Methods: Video-polysomnographic recordings with masseter EMGs
were made in 8 young healthy volunteers (6M; 2F, 23.8 ± 2.2 yrs old)
for two nights. Jaw movements were simulataneously recorded by thesix-degree-of-freedom jaw tracking system. The data from the secondnight were analyzed. Masseter EMG bursts with the amplitude × 5% of
maximal voluntary tooth clenching were detected. Jaw motor episodes
were scored when the successive bursts were separated by × 2 seconds.
Then, cycles of close-open jaw movements were selected. For eachcycle, jaw movement trajectories on the frontal view were analyzed.
Results: Among 231 episodes scored (mean±SD: 28.9 ± 11.4), 121
episodes (15.1 ± 6.5) contained 371 (46.4 ± 35.4) close-open jaw
movements: 33.2% of cycles were more likely vertical (Lateral jaw
shift: 0.81 ± 0.70 mm) while the other cycles (66.8%) were characterized by jaw sliding movements against the upper dentition with alarger lateral jaw shift (3.42 ± 1.68 mm). Lateral jaw sliding was
found to occur either during jaw-closing, jaw-opening phase, or bothphases of a close-open cycle. An inter-individual difference was found
for the percentage of the occurrence for the jaw movement patterns.
Conclusion: In normal subjects, jaw motor episodes were occasionallyassociated with close-open jaw movements. The patterns of close-open
jaw movements can vary. Variations of the jaw movements during jaw
motor activity suggest that teeth are exposed to a variety of mechanicalload during sleep.

PO-2-028
BRAIN ACTIVITY MARKERS OF SLEEPCORRELATE WITH PERFORMANCE DURING A
SUBSEQUENT EXTENDED WAKEFULNESSCHALLENGE

AL DENOTTI1, JW KIM1,2,3, KKH WONG1,4, RR GRUNSTEIN1,4
Sleep and Circadian Research Group / CIRUS, Woolcock Institute ofMedical Research, Sydney, NSW, Australia, 2School of Physics, The
University of Sydney, Australia, 3Brain Dynamics Centre, Sydney Medical
School-Western, The University of Sydney, Australia, 4Department ofRespiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
1

Introduction: Vigilance failure due to sleep loss has a major impact on
health and the economy. It is important to identify individuals at riskof vigilance failure but this is difficult in a clinical setting. Better© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research351

Sleep, Science and Researchbiomarkers of neurobehavioural dysfunction e.g. impaired driving are
required. We explored the relationship between brain activity biomarkers of sleep and neurobehavioural dysfunction during a subsequent
extended wakefulness challenge.
Methods: Healthy subjects completed a 3-day/night protocol with twonights of polysomnography (night 1 = baseline; night 3 = recovery) and
40 h of extended wakefulness in between. Performance testing on a
psychomotor vigilance task (PVT) and driving simulator (AusEd)
occurred every 2 h during wake. Baseline sleep EEG (Cz/A1) was analysed using power spectral analysis and detrended fluctuation analysis(DFA) following artefact exclusion. We explored correlations of power
spectra and DFA scaling exponents (ScE) of sleep with performancemeasures. ScE increases with deeper sleep, is lower in REM and wake,and correlates with slow wave sleep (SWS).
Results: We assessed 9 healthy subjects (8 male) without sleep disorders (age 28 yrs, BMI 23 kg/m2). A greater low-delta power (0.5–1 Hz)
of SWS correlated with poorer vigilance (PVT mean reciprocal reaction
time r = −0.83, p = 0.005; lapses r = 0.76, p = 0.02) and impaired
driving (AusEd steering deviation r = 0.73, p = 0.02; crashes r = 0.79,
p = 0.01) following one night of sleep deprivation (×28 h awake). The
DFA ScE of SWS also positively correlated with vigilance and driving
ability. Conversely, sigma power (12–15 Hz) of NREM (stages 2, 3 &4) negatively correlated with driving ability.
Discussion: Strong relationships between brain biomarkers of baseline
sleep and neurobehavioural dysfunction during extended wakefulness
exist in these subjects. Increased low-delta power and ScE of SWS
significantly correlated with worse performance, and increased sigma
power with better performance. These biomarkers may be useful toidentify those at risk of vigilance failure or monitor treatment
effectiveness.

PO-2-029
FRONTAL BRAIN NETWORK ACTIVITY DEPENDSON SLEEPYD VAN DER WERF1, IM VERWEIJ1, N ROMEIJN1, DJA SMIT3,
G PIANTONI1, EJW VAN SOMEREN1,4
1
Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam,
Netherlands, 2Dept Anatomy and Neurosciences, VU University medical
center, Netherlands, 3Dept Psychology, VU University, Netherlands, 4Dept
Integrative Neurophysiology, Center for Neurogenomics and Cognitive
Research, Neuroscience Campus Amsterdam, VU University, Netherlands

The restorative effects of sleep or conversely, the effects of sleep loss on
waking brain activity remain poorly understood. An example of sleep
deprivation-induced effects is the loss of functions mediated by theprefrontal cortex. We here investigate the relationship between sleep
and subsequent awake brain activity high-density EEG. We hypothesize
firstly: that a night of sleep deprivation (SD) leads to less optimal functional network, described with graph theory, as compared to after
normal sleep; and secondly, that the functional network changes are notuniform across the brain but show regional specificity. We obtained
resting state eyes-close EEG measurements of 8 healthy subjects both
after a night of normal sleep and after a night of sleep deprivation.
Synchronization between the 61 electrodes was determined using synchronization likelihood, a measure of linear and non-linear coupling.
From the synchronization matrix, small world network characteristics,
i.e. the cluster coefficient (C) and the path length (L), were calculated
for different frequency bands. A permutation analysis with a cluster
correction for multiple comparisons was applied to assess significant
local changes in C and L. We found that SD selectively affects the
network characteristics of frontal regions. After SD, C was lower for the352

alpha band and L was higher in the beta and theta band compared toafter sleep. These changes could not be explained by power differences.
Frontal connectivity, as determined by small-world network analysis,
was decreased locally after sleep deprivation in the alpha and theta
band. A homeostatic restorative function of sleep would therefore be
most prominent in the frontal regions. It remains to be investigated how
task-related neural network activity responds to sleep deprivation: thefindings fit well with the notion that specifically functions associatedwith the frontal cortex suffer from sleep deprivation, such as executive
control and higher-order cognitive processes.

PO-2-030
THE RELATIONSHIP BETWEEN THE
POLYSOMNOGRAPHIC SLEEP STATE AND THE
SUBJECTIVE QUALITY OF WAKEFULNESSK HATTA1, A HASEGAWA2, A MATSUBARA2, K UENO2,N OKAMOTO3, S NAKAYAMA3, W OKADA3, H NOGUCHI4,E KOYAMA2
1
Department of Design Engineering and Management, Graduate School of
Science and Technology, Kyoto Institute of Technology, presently PanasonicElectric Works, Osaka-city, Osaka, Japan, 2Department of Design
Engineering and Management, Graduate School of Science and Technology,
Kyoto Institute of Technology, Japan, 3School of Science and Technology,
Kyoto Institute of Technology, Japan, 4Lighting R&D Center, PanasonicElectric Works, JapanThe relationship between the objective sleep state and the subjective
quality of wakefulness after waking up was investigated in the normal
sleep.
Subjects were twenty healthy males. PSG and the subjective feelingscores of VAS (visual analog scale) were recorded for eight consecutive
nights. First two days were adaptation nights. Subjects were awakened
by alarm after seven hour sleep. Sleep stages were scored by the R&K’s
manual every 20 seconds. EEG frequency analysis immediately before
awakening for less than three minutes was made with the complex
demodulation method. Spearman’s correlation was calculated to analyze
the relationship (*; p < 0.05).
In the VAS scores immediately after awakening, results showed thenegative correlation (r = −0.49*, −0.51*) between the amount of Stage2
in the last quarter of sleep and the scores of energy and the total activity(average score of wakefulness, mood, energy and fatigue), and the positive correlation (r = 0.49*, 0.59*) between EEG alpha power 30 sec
before awakening and the scores of wakefulness and refreshment, andthe positive correlation (r = 0.52*, 0.59*) between EEG beta power
30 sec before awakening and the scores of wakefulness andrefreshment.
In the VAS scores 1 hour after awakening, results showed the negative
correlation (r = −0.55*) between the amount of Stage2 in the lastquarter of sleep and the scores of mood, and the negative correlation(r = −0.50*, −0.50*, −0.46*) between the number of spindles in thelast quarter and the scores of mood, fatigue and the total activity.
However, there were no significant correlations between EEG power
30 sec before awakening and VAS scores.
It is suggested that the quality of wakefulness immediately after awakening showed stronger correlation with the sleep state immediately before
awakening. On the other hand, the quality of wakefulness 1 hour after
awakening showed the correlation with the sleep state in the last quarteror longer period of sleep.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-031
TOPOGRAPHICALLY ENHANCED SLOWSPINDLES IN MEDICATED DEPRESSIVE
PATIENTSY NAKASHIMA1, M NISHIDA2, T TOMITA1, T YAMAMOTO1,A YASUDA1
1
Advanced Material Laboratory, Sony Corperation, Bukyo-ward, Tokyo,
Japan, 2Section of Psychiatry and Behavioral Sciences, Tokyo Medical and
Dental University, Japan
Introduction: Accumulated researches have demonstrated that sleep
spindles were generated within thalamo-reticular formation and thatfrontal spindles observed in parietal region consisted of slower frequency, compared with those in centro-parietal region. The differenceof propensities between slow spindles and fast spindles have been still
under debate.
Objectives: To clarify the properties of sleep spindles between healthy
subjects and medicated depressive patients, including frequency range,
spectra power and the pattern of propagation.
Methods: Healthy comparison subjects (n = 20)and medicated depressive patients(n = 14)were recruited. Subjects were recorded during allnight with 16 channels EEG. Recordings were analyzed for changes in
EEG power spectra, power topography. In addition, we graphicallydemonstrated the pattern of propagation of each type of spindle,
divided into fast spindle(12.5–16 Hz)and slow spindle(10.5–12.5 Hz).
Ethical committee of Tokyo Medical and Dental University approved
this study and written informed consent was obtained from eachsubject.
Results: As a result of ANOVA and multiple comparison, sleep EEG of
depressive subjects exhibited statistically the highest amplitude of slow
spindle in frontal pole region, compared with the other regions. On theother hand, sleep EEG of normal subjects exhibited the highest amplitude in frontal region. Slow spindles were generally dominant in whole
cerebral regions in depressive patients, while fast spindles were prominent within frontal region in normal groups.
Conclusions: Sleep spindles are generated by the thalamic reticular
nucleus and are modulated by corticothalamic and thalamocorticalconnections. The alteration in sleep spindles in medicated depressive
subjects may reflect dysregulation in thalamic-reticular and thalamocortical mechanisms and could represent a recovery process onneural network, involving pharmacological modulation on synaptic
function.

PO-2-032
SENSORY INPUT AND SLEEP, REVISITEDRA VELLUTI1, M PEDEMONTE2
1
Hospital De Clinicas, Universidad De La Repblica, Montrvideo, Uruguay,
2
Facultad de Medicina CLAEH, Punta del Este, Uruguay
The passive sleep theory was proposed by Bremer (1935) i.e., the lackof sensory input would be the origin of sleep. Beside, the surgicalsection of the olfactory, optic, statoacoustic, and trigeminal nerves, one
vagus nerve and the spinal cord posterior paths in cats -quasi total
deafferentation-, carried out by Vital-Durand et Michel (1971) showedthat diminishing the contact with the external world. The sphinx behavior observed was associated with a peculiar occipital EEG, and a “somnolence” state.
Later became clear that sleep was depending on brain active
processes.

The auditory is a special sense continuously open during wakefulness
and also in sleep1. In a recent study (based on previously demonstrations in guinea pigs reported results) four implanted deaf patients wererecorded during 4 nights each one; 2 nights with the implant OFF, with
no auditory input, and 2 nights with the implant ON, i.e., with normal
auditory input, being only the common night sounds present, without
any additional auditory stimuli delivered. All of them with the implant
OFF showed normal sleep patterns. When compared the night recordings with the implant ON and OFF, a new sleep organization wasobserved for the recordings with the implant ON, suggesting that brain
plasticity may produce changes in the sleep stage percentages while
maintaining the ultradian rhythm. During sleep with the implant ON,
the analysis of the electroencephalographic delta, theta and alpha bands
in the frequency domain, Fast Fourier Transform, revealed a diversityof changes in the power originated in the contralateral cortical temporal
region2. Conclusions, it was showed that the auditory input in humans
can introduce changes in CNS activity leading to shifts in sleep phases
percentages characteristics emphasizing the relevance of the sensory
input on sleep.
[1] Velluti, R.A. Ricardo A. Velluti. The auditory system in sleep. (2008)
Elsevier-Academic Press. Amsterdam[2] Velluti R.A., et al. (2010) J. Sleep Res, 19(4): 585–590.

PO-2-033 / AS-31 Presenter
OPTOGENETIC ACTIVATION OF PREOPTIC
AREA GABAERGIC NEURONS INHIBITED
ACTIVITY OF OREXIN NEURONSY SAITO1, N TSUJINO1, M MIEDA1, K SAKIMURA2, T SAKURAI1
Department of molecular neuroscience and integrative physiology,
Kanazawa University, Kanazawa, Ishikawa, Japan, 2Departmaent of
Cellular Neurobiology, Niigata University, Japan1

Neurons in the preoptic area (POA), especially the ventral lateral preopticarea and the median preoptic nucleus, fire rapidly during sleepand cease firing during wakefulness. These neurons carry GABA, andthought to play an important role in initiation and maintenance of sleep
by sending inhibitory projections to the arousal systems that reside in
the brain stem. Recently, several evidence have suggested that orexinergic neurons in the hypothalamus,which play a critical role in maintaining arousal, are also influenced by these neurons. To elucidate theroles of these neurons in regulation of orexin neurons, we optogenetically stimulate these sleep-active neurons. We used Gad1-Cre knock-in
mice, in which Cre recombinase is exclusively expressed inGABAergic
neurons. We used an adeno-associated viral vector to deliver channelrhodopsin-2-YFP to Cre-expressing neurons in the POA. The axonal
projection of the GABAegic neurons of the POA was visualized withdouble-label immunohistochemistry used anti orexin antiserum combined with an anti-GFP antiserum. Rich immunoreactivities of GFP-ir
projections were observed in arousal region including the LHA. Optogenetic stimulation of POA GABAergic neurons resulted in increase of
NREM sleep accompanied by inhibition of activity of orexin neurons.
These observations suggest that the POA GABAergic neurons are important ininhibition of arousal regions including hypothalamic orexin
neurons.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research353

Sleep, Science and Research

PO-2-034 / AS-23 Presenter

PO-2-036

FEEDING-INDUCED CATAPLEXY AND C-FOS
EXPRESSION IN BRAIN AREAS PROJECTING TO
THE BRAINSTEM IN OREXIN KNOCKOUT MICEOREXIN CHANGES IN EXPERIMENTALLYIMMUNIZED RATS BY TRIB2Y OISHI1, T MOCHIZUKI2, CB SAPER3, TE SCAMMELL4
1
Department of Neurology, E/CLS-717, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, MA, United States ofAmerica, 2Department of Neurology, E/CLS-717, Beth Israel Deaconess
Medical Center and Harvard Medical School, United States of America,
3
Department of Neurology, E/CLS-717, Beth Israel Deaconess Medical
Center and Harvard Medical School, United States of America,
4
Department of Neurology, E/CLS-717, Beth Israel Deaconess Medical
Center and Harvard Medical School, United States of America

Cataplexy is a sudden loss of muscle tone induced by strong emotions
that occurs in people with narcolepsy. About 90% of narcoleptics withcataplexy have low or undetectable orexin/hypocretin levels, and micelacking orexin signaling have atonia and paralysis episodes strongly
resembling human cataplexy. Although orexin has an essential role in
the regulation of cataplexy, the neural mechanisms that trigger cataplexy
are poorly understood. To better understand these mechanisms, we firstsought a stimulus to produce high levels of cataplexy. We found thatchocolate markedly increases cataplexy in orexin knockout (KO) mice.
Next, we microinjected the retrograde tracer cholera toxin subunit B(CTB) into ventrolateral periaqueductal gray and lateral pontine tegmentum – an area that receives orexin projections and is thought tosuppress rapid eye movement sleep and cataplexy. We then mapped the
distribution of neurons double immunolabeled for CTB and c-Fos, amarker of neuronal activation. Compared with orexin KO mice thatreceived normal chow, orexin KO mice that received chocolate hadhigher numbers of neurons showing double labeled cells in the medial
prefrontal cortex, parasubthalamic nucleus, and prerubral field.
Increased activity in some of these regions may trigger cataplexy
induced by highly palatable food or emotionally positive stimuli.

PO-2-035
NR6A1 REGULATES HYPOCRETIN/OREXIN
TRANSCRIPTIONS TANAKA1, M HONDA1, T KODAMA1, M EMMANUEL2
1
Department of Psychiatry and Behavioral Science, Sleep Control Project,Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo,
Japan, 2Center for Narcolepsy, Stanford University School of Medicine,
United States of America
Hypocretin (also called as orexin) coordinates the regulation of sleep/
wakefulness and energy homeostasis. The reduction in nuclear receptor
subfamily 6, group A, member 1 (Nr6a1) expression was shown in
hypocretin neuron-ablating transgenic mice. Using a database analysis
in silico, we identified a putative NR6A1 target sequence within hypocretin promoter. To evidence prepro-hypocretin transcription isfunctionally modulated by NR6A1, we performed chromatin immunoprecipitation (ChIP)-PCR, double-immunostaining, luciferase reporter
assay, and in utero electroporation study. ChIP-PCR showed the endogenous NR6A1 binds to DNA containing putative NR6A1-binding site.
Double-immunostaining indicated almost all hypocretin neurons werepositive for NR6A1 immunoreactivity. Transfection with NR6A1 into
SH-SY5Y cells modulated hypocretin promoter activity, an effect thatwas countered by using a mutated prepro-hypocretin promoter lacking
a putative NR6A1-binding site. In utero electroporation with Nr6a1 into
the fetal hypothalamus activated in hypocretin transcription comparedwith that of GFP-electroporation. These studies confirmed that NR6A1
works as a regulator for hypocretin transcription.

354

T KODAMA1, S TANAKA2, Y HONDA1,2, S USUI1, K MIZUNO3,
M HONDA2
1
Department Psychophysiology, Tokyo Metroolitan Insititute of Medical
Science, Tokyo, Japan, 2Sleep Research Project, Tokyo Metropolitan Instituteof Medical Science, Japan, 3Department of Immunology and Signal
Transduction, Tokyo Metropolitan Insititute of Medical Science, Japan
Narcolepsy is thought to be caused by loss of orexin neurons in the
hypothalamus. The allele of the HLA (DQB1*0602 as susceptible,
DQB1*0603 as protective) and the polymorphisms in T-cell receptorf¿
loci are strongly associated with the morbidity. It is also reported
improvement of cataplexy and normalization of CSF Orexin-A by the
intravenous administration of IgG. These evidences indicate the contribution of autoimmune mechanism, however, the details remain
unknown. Recently, Cvetkovic-Lopes et al reported about 30% narcolepsy patients have autoantibodies to TRIB2 protein, which is highly
expressed in orexin neurons. We also have confirmed the autoantibodies to TRIB2 (anti-TRIB2) in the serum of Japanese narcolepsy patients.
To clarify whether 1) orexin neurons are degenerated by the attack ofanti-TRIB2 or 2) anti-TRIB2 increases in the serum due to loss of orexin
neurons, we investigated the changes in orexin of rats experimentallyimmunized with TRIB2.
Twenty-five 6 week-old female SD rats were given every other week the
subcutaneous injection of keyhole limpet hemocyanin (KLH), 30fÊG
TRIB2 conjugated to KLH (TRIB2), or saline (control). The IgG titers
were also checked every other week by ELISA. After the IgG titers rose,
orexin concentrations in CSF were measured by ELISA kit. The rat
brains were stained immunohistochemically to investigate the changeof orexin neurons.
The percent ratio to the average orexin level of age matched control
group was calculated. Orexin in both KLH and TRIB2 group decreased
significantly compared to the initial value. Orexin levels of 16, 18, and20 week-old rats in KLH group are 114.16%±14.05, 61.96%±4.90, and81.18%±10.67 (mean±SEM), respectively. Similarly, these in TRIB2
group of 16, 18, and 20 week are 97.75%±8.38, 77.56%±8.12, and73.84%±8.65, respectively. There was no significant difference between
KLH and TRIB2 group. Contrary to expectation, there was no change
in orexin neurons of either group in histological study. This result may
suggest that the general activation in immune system has the effect on
the regulation of orexin synthesis.

PO-2-037
DOPAMINERGIC SLEEP REGULATION IN
DROSOPHILA MELANOGASTER
T UENO, S KUME, K KUME
Department of Stem Cell Biology, Institute of Molecular Embryology andGenetics, Kumamoto University, Kumamoto, Japan
In mammals, dopamine regulates different kinds of cognition andbehavior, such as reward, attention, motivation, sleep, working memory
and learning. Neural circuit of dopamine system and dopamine receptors dissociate these functions.
Since identification of sleep in Drosophila melanogaster, the mostsophisticated genetic model organism, there have been significant
advances in the understanding of molecular basis of sleep. In Drosophila melanogaster, dopamine also regulates sleep, learning andmemory. Dopamine transporter (DAT) mutant, fumin, shows short© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

sleep phenotype and poor memory retention. However, little is known
about how these different functions are achieved by dopamine. Here
we show that specific neural circuit and dopamine receptor regulates
fly sleep. Double knock out of DAT and dDA1 receptor rescued shortsleep phenotype in fumin mutant. Tissue specific knock down of dDA1
receptor in fumin background revealed the brain locus important forsleep regulation by dopamine. Activation of subsets of dopamine
neuron which contribute to the formation of aversive memory showed
little effect on fly sleep. We further searched sleep regulating subset of
dopamine neuron by expressing thermosensitive dTrpA1 channel usingmosaic analysis with a repressible cell marker (MARCM) system. The
direct activation of dopamine neuron subset with dTrpA1 channel identified specific neural circuit. These results suggest that specific subsetsof dopamine neuron regulates fly sleep.

PO-2-038
SLEEP ALTERATIONS IN HUMANIZED P2RX7MICE – VALIDATING A SUSCEPTIBILITY
MARKER FOR DEPRESSIONV JAKUBCAKOVA, C FLACHSKAMM, F HOLSBOER,
JM DEUSSING, M KIMURA
Neurogenetics of Sleep, Max Planck Institute of Psychiatry, Munich,Germany
Introduction: Biological markers for depression are of great interest due
to their potential to indicate the presence of the condition. Recently, asingle nucleotide polymorphism (SNP) identified in the purinergic
receptor P2X, ligand-gated ion channel, 7 (P2rx7) gene has been foundto be associated with depression. In search for the functional relevanceof this polymorphism as a susceptibility marker for depression, weinvestigated sleep-wake patterns and sleep architecture in humanizedmouse mutants in which the murine P2rx7 gene was substituted by
the wild-type or the disease-associated variants of human P2rx7(P2rx7h).
Methods: All mouse lines (wild-type P2rx7hWT, heterozygote,
P2rx7hWT/hMT and homozygote P2rx7hMT; n = 11 each group) habituatedinto 12:12-h light-dark cycles were implanted with EEG-EMG electrodes for polygraphic sleep recordings. Spontaneous sleep-wake states
were monitored for a 24-h light-dark cycle starting with the onset ofthe light period.
Results: All mouse lines exhibited a diurnal rhythm in the distributionof sleep and wakefulness, with increased amounts of sleep during thelight than the dark period. The amount of wake, NREM or REM sleep
did not differ between genotypes across the 24-h recording period.
However, during the light period, significantly less amount of SWS2
and more frequent entries into the REM sleep episodes were demonstrated in heterozygous P2rx7hWT/hMT mice. Compared with two otherlines, dramatic suppression of the EEG power in lower frequency bands
was observed in the P2rx7hWT/hMT strain. In particular, the activity ofslow waves during NREM sleep was decreased in P2rx7hWT/hMT mice
during the normal resting phase.
Conclusion: In summary, only heterozygous mice carrying the humanized variant of P2rx7 gene show a reduced quality of sleep. Strong drives
toward REM sleep and altered homeostasis of sleep regulation are quite
unique sleep characteristics observed in heterozygous P2rx7hWT/hMT
mice. We suggest the feasibility of this mouse line as a new depression
model to study sleep disorders caused by the same variation in humans.

PO-2-039
THE INVOLVEMENT OF CRH-R1 IN STRESSINDUCED REM SLEEP REBOUND
CPN ROMANOWSKI, C FLACHSKAMM, JM DEUSSING,
M KIMURA
Neurogenetics of Sleep, Max Planck Institute of Psychiatry, Munich,Germany
Severe stress is thought to underlie the development of many psychiatric disorders such as depression. A cardinal symptom of depression
is impaired sleep including changes in sleep architecture (e.g. REM
sleep disinhibition). A contribution of corticotropin-releasing hormone(CRH) as a major activator of the stress axis to these sleep changes was
suggested. Our study showed that a lack of the central CRH receptor
type 1 (CRH-R1) prevents REM sleep rebound after a mild stressor (i.e.
sleep deprivation). In this study we investigated whether these results
could be replicated by applying a stronger stressor (i.e. restraint stress)
to our animals. Conditional CRH-R1 knockout (CRH-R1 CKO) miceand their wildtype littermates (CL) were implanted with EEG and EMG
electrodes. After recovering from surgery mice were restrained for one
hour at the beginning of the light period by placing them into falcon
tubes. One week later, restraint was repeated to collect blood samples
to assess plasma corticosterone levels (CORT) in response to thestressor. EEG and EMG recordings were performed for 23 h one day
before, during, and one day after the first restraint experiment. Under
baseline conditions, no differences in vigilance states were detected
between the genotypes. After the stressor, both groups showed increases
in CORT levels, as well as decreased wakefulness and increased NREM
sleep at the beginning of the dark period. However, in CRH-R1 CKO
unlike CL animals no REM sleep rebound occurred. Previous studies
report that the rebound of REM sleep induced after certain stressors isblocked by unspecific CRH receptor antagonists. Our results are in linewith these observations and point towards a crucial involvement ofcentral CRH-R1 pathways in REM sleep regulation.

PO-2-040
LACKING PURINERGIC P2X7 RECEPTOR (P2X7R)
INFLUENCES BASELINE SLEEP BUT NOTRESPONSES TO SLEEP LOSS AND AN IMMUNE
CHALLENGE IN MICE

M KIMURA1, V JAKUBCAKOVA1, C FLACHSKAMM1,
JM DEUSSING2
1
Neurogenetics of Sleep, Max Planck Institute of Psychiatry, Munich,Germany, 2Molecular Neurogenetics, Max Planck Institute of Psychiatry,Germany

The purinergic P2X7 receptor (P2X7R) is a ligand-gated ion channel
and locates on macrophages and microglia, involved in the maturation
and release of inflammatory mediators such as interleukin-1β (IL-1β ).
Cytokines like IL-1β trigger many physiological and behaviouralchanges in depression. Further, many reports support that those cytokines possess sleep regulatory properties. Since sleep-wake behaviour
is often altered in depressed patients, it is of our interest to know a roleof P2X7R in sleep regulation. Therefore, we employed P2X7R knockout(KO) mice and analyzed sleep patterns under baseline and stress conditions. P2X7R KO mice and wild-type littermates were implanted with
EEG and EMG electrodes. Baseline recordings were initiated 2 weeks
after surgery, and 6-h sleep deprivation (SD) was subjected at the beginning of the light period on a following day. In a different group ofanimals, 10 μg of lipopolysaccharide (LPS) was i.p. injected at dark

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research355

Sleep, Science and Research

onset, and sleep responses to this immune challenge were compared
between genotypes. During the light period, P2X7R KO mice spentslightly more non-REM sleep at the beginning, whereas during the dark
period they showed a reduced amount of non-REM sleep, compared towild type animals. Regarding REM sleep, attenuated levels were mostly
consistent throughout the baseline day in P2X7R KO mice. In contrast,
they were more awake during the dark period than wild type mice. In
response to SD, however, both genotypes demonstrated similar sleep
recovery. As reported in previous studies, LPS challenge increased
non-REM sleep and suppressed REM sleep, but these sleep responses
were similarly observed in both genotypes. Although the release of
somnogenic IL-1β elicited by SD and LPS seems to be attenuated in
P2X7R KO mice, the magnitude of their sleep responses, in which IL-1β
should be involved, were not lower than that in wild type mice. The
results suggest that lack of P2X7R influences spontaneous sleep-wakestructures. Sleep responses to some stress stimuli in P2X7R KO mice,
however, may be compensated by other factors.

PO-2-041
IS ENHANCED REM SLEEP IN CONDITIONAL
CRH-OVEREXPRESSING MICE DUE TO
CHOLINERGIC ACTIVATION?
ML CURZI, C FLACHSKAMM, JM DEUSSING, M KIMURA
Neurogenetics of Sleep, Max Planck Institute of Psychiatry, Munich,Germany
Objectives: Impaired sleep often associates with depression. Especially,
reduced slow-wave sleep and disinhibition of rapid eye movement(REM) sleep are characteristic in those patients. Recently, we demonstrated upregulated REM sleep in two different types of conditional
CRH-overexpressing mouse models suggesting that overexpressed CRH
in the forebrain including limbic structures (CRH-COE-Cam) contributes to enhanced REM sleep. The present study examined a possible
involvement of altered cholinergic activity by limbic CRH in REM sleep
regulation.
Methods: CRH-COE-Cam mice were implanted with a guide cannula
for in vivo microdialysis probe targeting the right central nucleus of
amygdala (CeA). Extracellular levels of acethylcholine (ACh) and spontaneous locomotor activity were determined across 2 days. In anotherexperiment using C57BL/6J mice, we analyzed c-fos expression after
CRH (1.0 ng and 10 ng) microinjected into the right CeA.
Results: Compared with controls, homozygous CRH-COE-Cam mice
showed constantly elevated ACh levels throughout 48 h whereas spontaneous locomotor activity was similarly observed in both genotypes.
Microinjections of CRH at either dose increased the number of c-fos
positive cells in the brainstem including the locus coeruleus and thelaterodorsal tegmental nucleus but none of them were identified ascholinergic.
Conclusion: The results suggest that cholinergic activity is higher in
CRH-COE-Cam mice than controls. In this model, overexpressed CRH
in the amygdala may contribute to intensifying the cholinergic system,that may lead to upregulated REM sleep, although where the outcomeof this stimulation ends up to elicit REM sleep still needs to beclarified.

PO-2-042
CHRONIC MILD STRESS AND ACUTE SLEEP
DEPRIVATION: INTERACTIVE AND BRAINREGION SPECIFIC EFFECTS ON REGULATION
OF TRANSLATION FACTOR AND CPEB
PHOSPHORYLATIONJ GRONLI1, G DAGESTAD2, AM MILDE1, R MURISON1,
CM PORTAS2, C BRAMHAM2
1
Department of Biological and Medical Psychology, Univeristy of Bergen,
Bergen, Norway, 2Department of Biomedicine, University of Bergen,
Norway, 3Norwegian Competence Center for Sleep Disorders, Haukeland
University Hospital, Norway
Restricted/disrupted sleep and/or stress trigger adaptive responses inthe brain at the level of gene transcription. Here, we investigated thepossible impact of chronic mild stress (CMS) and acute sleep deprivation in rats on post-transcriptional mechanisms important for memory
formation and synaptic plasticity. Thirty six adult male rats were
implanted with EEG and EMG electrodes. After postoperative recovery
the animals were randomly separated into one CMS (4 weeks of daily
exposure to mild stressors) group and one control group. Further, they
were subdivided into one group of 8 h EEG/EMG controlled sleep
deprivation (gentle handling) or non-sleep deprivation. Sleep wasrecorded prior to and after termination of CMS/control condition.
Decapitation was performed immediately after sleep recording or sleep
deprivation. The brain regions dentate gyrus, hippocampus and prefrontal cortex (PFC) were analysed for post-transcriptional effects. CMS
exposure enhanced phosphorylation of two key translation factors,
eukaryotic initiation factor 4E (eIF4E) and elongation factor 2 (eEF2)
in the PFC, but not in the hippocampus and dentate gyrus. Acute sleep
deprivation alone increased phospho-eIF4E expression in the PFC
while decreasing phosphorylation in the dentate gyrus. In contrast,eEF2 phosphorylation was elevated in all brain regions after sleep
deprivation. Thus, CMS and sleep deprivation, when separate administered, have distinct region-specific effects. The combined treatment
revealed striking interactions in which prior CMS modulates the effects
of sleep deprivation on translation specifically in the hippocampus
proper. CMS strongly enhanced sleep deprivation-induced eEF2 phosphorylation while preventing dephosphorylation of a major regulatory
RNA-binding protein, cytoplasmic polyadenylation element-binding
protein (CPEB) in hippocampus. We conclude that CMS and acute sleep
deprivation have interactive and brain region-specific effects on translational control of relevance to mechanisms of stress responsiveness andsleep homeostasis.

PO-2-043 / AS-23 Presenter
VESICULAR NUCLEOTIDE TRANSPORTER IS
DOMINANTLY EXPRESS IN SLEEP-WAKE
CENTERS OF THE CENTRAL NERVOUS SYSTEMEK MITAMURA1, M LAZARUS1, M YOSHINORI2, U YOSHIHIRO1
1
Department of Molecular Behavioral Biology, Osaka Bioscience Institute,
Suita City,Osaka, Japan, 2Dentistry and Pharmaceutical Sciences,
Graduate School of Medicine, Okayama University, JapanThe vesicular nucleotide transporter (VNUT, SLC17A9) was recently
shown to partake in the vesicular storage of ATP in ATP-secreting cells.
ATP is crucial as a neurotransmitter and a transmitter of signals between
glial cells. Considering that VNUT may influence the availability of ATP
that is released in the central nervous systems (CNS) by exocytosis,356© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

understanding the distribution of VNUT in the brain is deemed essential. We, therefore, performed mRNA and protein profiling of VNUT in
the mouse and rat CNS.VNUT was abundantly expressed in different
cell groups as well as cell types throughout the CNS. VNUT was highly
expressed in neurons and glial cells, particularly astrocytes. Cell groups
expressing high levels of VNUT extends from the fore brain to hindbrain, such as the glomerular and mitral cell layers of the olfactory bulb,
different layers of the cerebral cortex, the hypothalamus, the supraoptic
and paraventricular hypothalamic nuclei, substantia innominata of thebasal forebrain, ventrolateral preoptic nucleus, thalamic relay nuclei,
tuberomammillary nucleus, red nucleus and substantia nigra, dorsal
and median raphe nuclei, and Purkinje cells of cerebellum. Interestingly, many of these cell groups are involved in sleep-wake regulation.
These results imply that VNUT may control the availability of extracellular ATP acting both as a fast excitatory neurotransmitter and as aneuromodulator, both directly and via its conversion to somnogenadenosine. Considering that ATP interacts with other neurotransmitters
via different receptor subtypes and that it is also released from astrocytes
and mediates interactions with surrounding neurons and other glial
cells, our results further implicate that VNUT may influence the orchestration of cell groups involved in sleep-wake regulation.

PO-2-044
A NOVEL SOX5 SPLICING ISOFORM EXPRESSEDIN MOUSE BRAIN DURING SLEEPN NAGATA1, K KASHIWAGI1, T YAMAMOTO1, E MITAMURA1,
M LAZARUS1, Z-L HUANG1, K FUJIMORI1,2, Y URADE1
1
Department of Molecular Behavioral Biology, Osaka Bioscience Institute,
Suita-City, Osaka, Japan, 2Laboratory of Biodefense and Regulation, Osaka
University of Pharmacological Science, Japan
In this study, we elucidated the transcriptional network involved insleep-wake regulation in the mouse brain by the GeneChip cDNA
microarray analysis with mRNAs obtained from cortexes of sleeping (at10:00) or waking (at 22:00) mice. After discrimination of circadianrhythm-related genes from the gene pool, GeneChip and quantitative
PCR analyses revealed that mRNAs for 55 genes were up-regulated
during sleep. The mRNAs of 38 genes including the transcription factor
SOX5 increased in a time-dependent manner during the first 4 h of thelight period where mice are mostly asleep. Database analysis of ciselement indicated that a SOX5 -binding site can be found with a highfrequency in the promoter region of those 38 genes. Among various
SOX genes, we found that only SOX5 was up-regulated during sleep
and identified a novel splicing isoform of SOX5 with partially truncatedexon 2, SOX5-t2. Immunofluorescence staining revealed that SOX5-t2
was highly expressed in the nucleus of neurons of the adult mousecortex. In gel shift assays, SOX5-t2 bound to the SOX-binding elementsin the promoter regions of those up-regulated genes. Over expressionof SOX5-t2 induced neurite branching in cultured neuroblastoma.
These results suggest that SOX5 is an important regulator of sleeprelated function of neurons.

PO-2-045 / AS-7 Presenter
THE ROLE OF PROSTAGLANDIN D2 IN CAUSING
POST-ICTAL SLEEP FOLLOWING SEIZURESMK KAUSHIK1, M LAZARUS1, T MORIYAMA1, Y CHERASSE1,
WM QU2, K ARITAKE1, MA RAHMAN1, ZL HUANG1, O HAYAISHI1,Y URADE1
1
Department of Molecular Behavioral Biology, Osaka Bioscience Institute,
Suita-Shi, Osaka, Japan, 2State Key Laboratory of Medical Neurobiology,
Shanghai Medical College of Fudan University, Shanghai, China

Prostaglandin D2 (PGD2) synthesized by the lipocalin type prostaglandin (PG) D synthase (L-PGDS) is the major prostanoid in the brain.
During the last decades, experiments have led to the conclusion thatPGD2 is one of the most dominant components of the humoral sleep
drive. A femtomolar continuous infusion of PGD2 into the third cerebral ventricle induces rapid eye movement (REM) and non-REM(NREM) sleep in rodents and monkeys and by using knockout (KO)mice for L-PGDS and PGD2 receptor, subtype 1 (DP1R), our group has
previously demonstrated that PGD2 is involved in the regulation ofphysiological sleep. It is well known that sleep follows seizures during
epilepsy, but the molecular mechanism by which post-ictal sleep is
induced has remained unclear. In recent experiments, we found thatpentylenetetrazole (PTZ)-induced seizures significantly increased the
PGD2 content of the brain and the amount of NREM sleep in wild-type
mice. The PTZ-induced increase of PGD2 was attenuated in the brainsof L-PGDS and hematopoietic PGDS (H-PGDS) KO mice and abolishedin H-PGDS/L-PGDS double KO mouse brains. We are currently investing the sleep behaviour of L-PGDS, H-PGDS/L-PGDS double KO, DP1R
or CRTH2 receptor KO mice to establish a role of PGD2 in seizureinduced sleep.

PO-2-046
CHOLINERGIC SIGNALING REGULATESARC/ARG3.1 PROTEIN EXPRESSION AND
DEGRADATION IN SH-SH5Y CELLS AND
CULTURED HIPPOCAMPAL SLICESJ SOULE, MN ALME, CL MYRUM, M SCHUBERT, T KANHEMA,
CR BRAMHAM
Department for Biomedicine, University of Bergen, Bergen, Norway
Cholinergic signaling is crucial for learning and memory during wakeand sleep. Rapid-eye movement (REM) sleep is associated with highcholinergic tone in the hippocampus. Blockade of muscarinic acetylcholine receptors (mAchR) during REM-sleep results in impairment inlong-term memory formation. Arc/Arg3.1 (hereafter Arc) is an immediate early gene involved in consolidation of long-term synaptic plasticity
and homeostatic synaptic scaling. Absence of hippocampal Arc expression leads to deficits in long-term potentiation and long-term memory
formation. Conversely, low degradation rates of Arc protein also alter
synaptic plasticity as observed in the mouse model for Angelman syndrome. Carbachol, a mAchR agonist, induces Arc expression in human
SH-SY5Y cells and rat hippocampal neurons. Here we investigated the
dynamics of Arc synthesis resulting from stimulation of SH-SY5Y cells
and cultured hippocampal slices with carbachol. We show that the
duration of mAchR activation temporally and quantitatively modulated
Arc transcription and that expression of both Arc mRNA and protein is
rapid, but transient. We determined that carbachol-induced Arc protein
expression is MEK-dependent. In addition, mAchR-induced intracellular release of calcium from IP3-sensitive stores was found to play an© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research357

Sleep, Science and Research

important role in Arc expression. Finally, we observed that the transient
aspect of Arc protein expression originates in its rapid targeting toproteasomal degradation.
In summary, our study provides evidence for tight regulation of Arc
expression both in time and magnitude during cholinergic activity.
While duration of mAchR activation essentially influences the levels of
Arc protein, Arc half-life is controlled by a process which combinestranslation and degradation. The data support the hypothesis that Arc
expression participate in sleep-related consolidation of synaptic plasticity through the occurrence of brief periods of REM sleep-associatedcholinergic activity.

PO-2-047 / AS-29 Presenter
SLEEP-DEPENDENT MRNA TRANSLATIONCONSOLIDATES CORTICAL PLASTICITY
IN VIVOJ SEIBT1, MC DUMOULIN2, SJ ATON2, T COLEMAN2, A WATSON2,
N NAIDOO3, MG FRANK2
1
Department of Physiology, University of Bern, Bern, Switzerland,
2
Department of Neuroscience, University of Pennsylvania, United States ofAmerica, 3Center for Sleep and Respiratory Neurobiology, University ofPennsylvania, United States of America
Sleep consolidates experience-dependent brain plasticity but the underlying mechanisms are poorly understood. Persistent forms of synaptic
plasticity are known to require local production of new synaptic proteins to grow new synaptic structures. Therefore one mechanism promoted by sleep may be translation of mRNAs necessary for synaptic
remodeling. We investigated this process in a classic form of corticalplasticity in vivo (ocular dominance plasticity: ODP) known to beconsolidated by sleep. Using qPCR and Western blotting, we looked at
the influence of sleep on 1) synaptic plasticity-related genes (ARC,
BDNF, αCamKII, GLUR1) expression at the mRNA and protein level,and 2) translation regulation (initiation and elongation step). In parallel,
we inhibit the mTOR pathway (important in local translation regulation) in the sleeping and awake visual cortex and assess ODP using
single-unit recordings.We show that decreased transcription of ARC and
BDNF during sleep is an indirect effect of reduced visual input and that
their translation at the synapse requires sleep. We found in the same
cortical samples a net increase in synaptic translation initiation (4E-BP1
phosphorylation) during sleep. All those molecular events are generally
induced during sleep and are further promoted if the brain is triggered
to remodel. Finally, we show that local inhibition of mTOR-dependent
protein synthesis abolishes sleep-dependent ODP consolidation but has
no effect on the induction of ODP during wake. Collectively, thesefindings suggest that sleep generally promotes cortical mRNA translation, but when the brain is stimulated to remodel, this process is shift
toward more translation initiation. Interruption of this process during
sleep has functional consequences, as it abolishes the consolidation ofexperience in the cerebral cortex. To further investigate the role of sleepin synaptic plasticity, we are currently developing a method to image
dendritic calcium activity during wake and sleep in freely behaving
animals.

358

PO-2-048
REM SLEEP PLAYS A ROLE IN OCULAR
DOMINANCE PLASTICITY CONSOLIDATIONMC DUMOULIN, J SEIBT, SJ ATON, T COLEMAN, AJ WATSON,MG FRANK
Department of Neuroscience, University of Pennsylvania, Philadelphia, PA,
United States of America
Introduction: Sleep is thought to consolidate plasticity, but the mechanisms underlying this process are unclear. Ocular dominance plasticity(ODP) in the cat primary visual cortex (V1) is a canonical form of invivo plasticity induced by monocular deprivation (MD), and is consolidated by sleep. However, the relative contributions of NREM and REM
sleep to ODP consolidation are unknown. This study aims to determine
whether REM is necessary for ODP consolidation and identify REMdependent mechanisms that underlie this process.
Methods: Cats were implanted with electrodes for polysomnography
recording, and then underwent MD for 6 hours to induce cortical
remodeling. MD was followed by normal, REM sleep deprived (RSD),or NREM-fragmented (NF) sleep. NF controlled for the nonspecificeffects (e.g. increased wake time, decreased sleep continuity, anddecreased delta power) of RSD. A fourth group received intracorticalinfusions of U0126, an upstream blocker of ERK phosphorylation, or
vehicle into V1 during post-MD sleep. Immediately following thesemanipulations, ODP was assessed using optical imaging of intrinsic
cortical signals and single-unit recording in V1. Another set of animals
underwent the same sleep-wake manipulations, after which V1 tissue
was collected for Western blot analysis of GluR1, ERK and CaMKII,
proteins that are phosphorylated during post-MD sleep.
Results: RSD animals had impaired ODP consolidation compared toanimals that received normal or NF sleep, indicating that REM isrequired for ODP consolidation. RSD also reduced ERK, but not GluR1
or CaMKII, phosphorylation in V1 compared to sleeping and NF
animals, suggesting that ERK is activated during post-MD REM sleep.
Furthermore, blocking ERK activation with U0126 during post-MD
sleep impaired ODP consolidation compared to vehicle. Together, thesedata suggest that ERK phosphorylation during REM is required for ODP
consolidation.
Conclusion: These results support a model in which ERK activation
during REM may interact with other molecular events during NREM toconsolidate ODP.

PO-2-049 / AS-25 Presenter
BASAL FOREBRAIN HISTAMINE: INCREASESDURING WAKEFULNESS, INDUCES
WAKEFULNESS AND ACTIVATES THE CORTEXJC ZANT1, S ROZOV2, P PANULA2, T PORKKA-HEISKANEN1
1
Institute of Biomedicine/Physiology, University of Helsinki, Helsinki,
Finland, 2Institute of Biomedicine/Anatomy, University of Helsinki, Finland
Introduction & Objectives: The basal forebrain (BF) participates in
the control of vigilance state. The build-up of adenosine in the BF
during sleep deprivation (SD) inhibits wake-promoting neurons andthereby promotes sleep. However, the animals are able to stay awake,suggesting increased activity of the ascending arousal systems counteracting sleep pressure. Histamine (HA) excites BF neurons and histamine
infusion into the BF induces wake. Therefore we hypothesize that thehistaminergic system may be involved in counteracting the effect of
sleep pressure in the BF.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

Materials & Methods: Male Han-Wistar rats were subjected to a
6 hour SD by ‘gentle handling’. In vivo microdialysis was used to sample
the BF extracellular space before, during and after SD and samples wereanalysed using HPLC. The effect of HA on vigilance state and the power
spectrum of the electroencephalogram (EEG) was examined by infusing
HA or HA antagonists into the BF for 3 hours by means of reversed invivo microdialyses.
Results: HA levels increased immediately and remained constantthroughout the SD period (n = 8, ANOVA repeated measures P < 0.05),
returning to baseline instantly after SD. Infusion of HA into the BF
increased wakefulness and altered the EEG power spectrum. Acrossvigilance states EEG delta power (0.5–4 Hz) was decreased and EEG
theta power (4–7 Hz) was increased. Infusion of HA 1 receptor antagonist or HA 3 receptor agonist decreased both wakefulness and EEG theta
power.
Conclusions: HA levels do not change due to increased sleep pressure
and thus do not appear to be involved in counteracting the effect ofenhanced sleep pressure. However, these results do further indicate
the BF as a key site for HA to promote cortical activation andwakefulness.

PO-2-050
GLUTAMATE MICROINJECTION IN THE MEDIALSEPTUM ENHANCES SLOW WAVE SLEEP AND
DECREASES PARADOXICAL SLEEP IN RATSD MUKHERJEE1, AK JARYAL2, HN MALLICK3
Department of Physiology, All India Institute of Medical Sciences, Kolkata,West Bengal, India, 2Department of Physiology, All India Institute ofMedical Sciences, India, 3Department of Physiology, All India Institute ofMedical Sciences, India
1

Medial septum (MS) has connection with various sleep and wake promoting areas. Various studies have shown its involvement in sleepwakefulness (S-W). Local glutamatergic neuronal network andfunctional glutamate receptors are present in the MS. Although glutamate microinjections in brain areas regulating S-W have been shown
to modulate S-W, the exact role of glutamate in the MS on S-W is not
yet known. We studied the effect of L-glutamate microinjection in the
MS on S-W in adult male Wistar rats. Under sodium pentobarbital
anesthesia, EEG, EMG and EOG electrodes were implanted for recording S-W parameters. For microinjection of glutamate, a guide canulawith indwelling stylet was implanted above the MS, as per the atlas of
DeGroot. Two baseline polysomnographic recording S-W were taken
for 6 hours, after post surgery recovery. L-glutamate (dose 40 ng/200 nl,
volume: 200 nl) or equal volume of normal saline (control group) was
injected at 12:00 h on the third day following first two hours of preinjection recordings. Post-injection recording was continued from12:15–16:15 h. Injection sites in the brain were confirmed histologically. Data were analyzed in 15 seconds epoch by visual scoring. When
compared with data from time-matched and vehicle injected controls,significant decrease in the paradoxical sleep during post injection firsthour (p = 0.0317 and 0.016 respectively) and significant increase in
the slow wave sleep during post injection second hour (p = 0.0159 forboth) were observed. The later resulted in significant increase in total
sleep time (p = 0.0159 for both) during the same time window. Our
study suggests that microinjection of L-glutamate in the MS increases
slow wave sleep and decreases paradoxical sleep in rats.

PO-2-051
BASAL FOREBRAIN CHOLINERGIC NEURONSAND NITRIC OXIDE-MEDIATED REGULATIONOF SLEEP HOMEOSTASISA KALINCHUK1, T PORKKA-HEISKANEN2, RW MCCARLEY1,
R BASHEER1
1Harvard Medical School, Harvard University, Boston/MA, United States ofAmerica, 2Institute of Biomedicine, University of Helsinki, Finland
The levels of adenosine (AD) and inducible nitric oxide (NO) synthase(iNOS)-mediated NO increase during sleep deprivation (SD) in thebasal forebrain (BF), and, with prolongation of SD, in the frontal cortex(FC). NO donor infusion increases AD and NREM sleep (NREMS),
while iNOS/NO inhibition prevents SD-induced AD increase and recovery NREMS (Kalinchuk et al., 2006). iNOS induction occurs in wakeactive neurons in BF and FC (Kalinchuk et al., 2010, 2011), however,the neurotransmitter specificity of these cells is not known. Lesion of
BF cholinergic cells attenuates both SD-induced AD increase and recovery NREMS (Kalinchuk et al., 2008). Hence in this study, we tested therole of wake-active-cholinergic neurons in iNOS/NO release in BF and
FC as well as in iNOS/NO-mediated homeostatic sleep response.
Methods: Experiment.⋕1. The effects of SD on iNOS/NO production
and the effect of NO donor on sleep were compared in the same animals
before and 2 weeks after the lesion of BF cholinergic neurons using
immunotoxin 192 IgG-saporin. Experiment ⋕2. Neurotransmitter
specificity of cells inducing iNOS during SD was identified using immunohistochemistry and double-labeling with specific markers for iNOS,
acetylcholinetransferase (ChAT), vesicular glutamate transporters(VGlut) and glutamatic acid decarboxylase (GAD67).
Results: 1. Before saporin lesioning, SD induced significant increases
in NO levels, intensity of waking theta power and in subsequent
NREMS/NREMS delta power (by 35/47%). NO donor infusion increased
NREMS/NREMS delta power by 39/41%. After saporin lesioning, allthese increases were significantly attenuated or totally blocked. 2. The
numbers of iNOS+ cells in the BF and FC were significantly increased
after SD. In the BF, 96% of ChAT+ cells were iNOS+ after SD, and 85%
of iNOS+ cells were ChAT+. Numbers of iNOS+/ChAT+ cells positively
correlated with SD-induced increase in theta power.
Conclusion: Data suggest that cholinergic BF cells play an importantrole in iNOS/NO production during SD that contributes to the generation of homeostatic sleep pressure.

PO-2-052
NOVEL MOUSE MODELS FOR THE
INVESTIGATION OF NEURONAL-GLIALIMMUNE INTERACTIONSMR OPP1, AM TALSMA1,3, RM RAYMOND1,2
Anesthesiology & Pain Medicine, University of Washington, Seattle, WA,
United States of America, 2Graduate Program in Neurobiology and
Behavior, University of Washington, United States of America,3
Neuroscience Graduate Program, University of Michigan, United States ofAmerica1

Immune challenge alters CNS-mediated processes and complex behaviors. These changes in physiology and behavior are collectively referred
to as sickness behavior. Sickness behavior is believed to contribute tosurvival from infection by facilitating fever, thereby upregulating innate
immune cell activity and creating a less hospitable environment
for pathogens. Pro-inflammatory cytokines such as interleukin-1β(IL-1) and tumor necrosis factor α (TNF) are well characterized© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research359

Sleep, Science and Research

immunomodulators that mediate multiple aspects of the innate immune
response. The brain, long thought to be an immune privileged site,
contains cytokines and their receptors. IL-1 and TNF respectively bindto IL-1 receptor 1 (IL-1R1) and TNF p55 receptor 1 (TNFR1) present
on neurons and glia. Administration of IL-1 or TNF elicits sickness
behaviors, such as alterations in sleep, decreased food and water intake,and social withdrawal. It is known that glia and, to a lesser extent,
neurons produce these pro-inflammatory cytokines in response to an
immune challenge. Collectively, these observations suggest that neuronal-glial interactions involving cytokines are crucial to the manifestationof sickness behavior. Nevertheless, the relative contribution of neurons
and glia to the modulation of complex behavior and physiology during
immune challenge is not known. To address this knowledge gap, we
have engineered four transgenic mouse strains that express IL-1R1 or
TNFR1 only in the CNS and selectively on neurons or astrocytes. Thesetransgenic mice express either IL-1R1 or TNFR1 cDNA under thetranscriptional control of the neuron-specific enolase (NSE) or thehuman glial fibrillary acidic protein (gfa2) promoters. These animals
provide a novel and unique tool to study CNS responses to systemic
immune challenge independent from peripheral actions of IL-1 or TNF.
The systematic and selective examination of neuronal-glial cytokine
interactions will further our understanding of the central response to
immune activation that are relevant to a broad spectrum of pathologies
characterized by inflammation.

PO-2-053 / AS-12 Presenter
DEPRESSED MOOD, CHRONIC SHORT SLEEP,
AND 5HTTLPR POLYMORPHISM: PRELIMINARYREPORT OF A GENE X ENVIRONMENT
INTERACTION

MA CARSKADON1, KM SHARKEY1,5, T RAFFRAY2, BM ROANE1,4,
T BOND6, V KNOPIK1,3, J MCGEARY1,3
1
Department of Psychiatry & Human Behavior, Brown University,
Providence, RI, United States of America, 2Department of Adult Psychiatry,
Lausanne University Hospital, Switzerland, 3Division of Behavioral
Genetics, Alpert Medical School of Brown University, United States ofAmerica, 4Sleep for Science Research Laboratory, Alpert Medical School ofBrown University, United States of America, 5Department of Medicine,
Alpert Medical School of Brown University, United States of America,
6
Department of Psychology, Iona College, United States of America
Introduction: A polymorphism of the serotonin transporter gene
(5HTTLPR) is implicated in depressed mood, anxiety, and insomnia.
This study examines whether a 5HTTLPR polymorphism is associatedwith depressed mood in young adults with a chronic pattern of shortsleep.
Methods: First-year university students (ages 18–20 y) completed daily
online sleep diaries for the first 9 weeks of term (21 to 63 days; median= 58) and Center for Epidemiologic Studies-Depression (CES-D) moodscale at the end of week 9. DNA acquired from buccal cell samples
was genotyped for 5HTTLPR and SNP rs25531 A/G polymorphisms.
Low-expressing S and LG polymorphisms were designated S’; highexpressing LA was designated L’. Three genotypes were identified (S’S’,
S’L’, L’L’). CES-D was assessed using median split (high >12; low <13).
Mean total sleep time (TST) from diaries was short if <7.01 h (n = 49,
20 male; mean TST = 6.5 h, SD = .4) or long if >7.49 h (n = 40, 17
male; mean TST = 7.9, SD = .3 h). CES-D scores did not differ between
those with short (mean = 15.6, SD = 9.9) and long (mean = 15.6, SD= 11.5) TST.
Results: Four phenotype groups were compared: 28 participants had
a pattern of short TST and high CES-D; 21 had shortTST/lowCES-D;

360

19 had longTST/highCES-D; 21 had longTST/lowCES-D. Female : male
distribution did not vary across phenotype groups (chi-sq = 0.66(3);p = ns). The genotype distribution showed an overrepresentation of S’S’(n = 20) in the short TST/high CES-D group (chi-sq(6) = 20.88; p <.01) compared to other phenotypes. The association was sustained(chi-sq(6) = 16.91; p < .01) after omitting those (n = 19) whose CES-D
was high 3 mo before starting university.
Conclusion: These preliminary data indicate a significant vulnerability
to high depressed mood in young adults who report short nocturnal
sleep and carry a variant of the 5 HT promoter gene associated withlow expression of the serotonin transporter. A larger sample size andfurther analyses are planned to confirm this observation.
Support: National Institute of Mental Health (MH079179); Sleep
Research Society Foundation Elliot D. Weitzman, M.D., Research Grant.

PO-2-054
GENOME-WIDE ASSOCIATION STUDY OF SLEEPDURATION OR SELF-PERCEIVED INSUFFICIENTSLEEP IN JAPANESE POPULATIONSE MORITA1, K MATSUO2, H TANAKA2, F MATSUDA3, M NAITO1,
N HAMAJIMA1, K WAKAI, J-MICC STUDY GROUP1
1
Department of Preventive Medicine, Nagoya University Graduate Schoolof Medicine, Nagoya, Japan, 2Division of Epidemiology and Prevention,
Aichi Cancer Center Research Institute, Japan, 3Center for Genomic
Medicine, Kyoto University Graduate School of Medicine, Japan

Background: Duration of self-perceived insufficient sleep may differ
among individuals, and the difference may be based on genetic factors.
The aim of this study was to identify single nucleotide polymorphisms(SNPs) related to sleep duration or self-perceived insufficient sleep.
Methods: Sleep duration and self-perceived insufficient sleep were
evaluated by a self-administered questionnaire. In phase 1, candidate
SNPs related to sleep duration or perceived-insufficient sleep wereidentified by genome-wide association study (GWAS). Subjects
were 421 healthy volunteers recruited from Aichi Cancer Hospital inwhom suspected cancer had been ruled out by diagnostic tests. Illumina
610 Quad containing >0.5 million SNPs was used for GWAS. The
association of SNPs with sleep duration and self-perceived insufficient
sleep was screened. Inclusion criteria for candidate SNPs were p < 10−5
and minor allele frequency >0.1. Then, to confirm candidate SNPs
identified in phase 1 in other populations, confirmation phase 2 was
performed. Phase 2 subjects were 4519 individuals participating in theJapan Multi-Instructional Collaborative Cohort (J-MICC) Study fromten study areas. The inclusion criterion for participation in the J-MICC
Study was age 35–69 years. The candidate SNPs were genotyped bymultiplex polymerase chain reaction (PCR)-based Invader assay. Associations of candidate SNPs with sleep duration or self-perceived insufficient sleep were examined for conformation.
Results and Conclusion: In total, 14 candidate SNPs related to sleep
duration or insufficient sleep were identified in phase 1. Among them,
five SNPs were located on NLRP3, PTPN5, SGCZ, and SPOCK1. Associations between these genes and sleep have not been reported so far. The
other identified SNPs were not located on any genes. Genotyping inphase 2 is ongoing; the results of phase 2 will be presented at theconference.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-055
ASSOCIATION OF SLC6A4 AND 5-HTR2A GENEPOLYMORPHISMS WITH DIFFERENTPHENOTYPE OBSTRUCTIVE SLEEP APNEA IN
CHINESE HAN POPULATIONJ YE1, D HAN2, G YIN3, W ZENG4, Y ZHANG5
1
Otolaryngology Head and Neck Surgery, Affiliated Beijing Tongren
Hospital, Capital Medical University, Beijing, China, 2Otolaryngology Headand Neck Surgery, Affiliated Beijing Tongren Hospital, Capital Medical
University, China, 3Otolaryngology Head and Neck Surgery, AffiliatedBeijing Tongren Hospital, Capital Medical University, China, 4Molecular
Genetics Lab, North Centre of National Genome Project, China,
5
Otolaryngology Head and Neck Surgery, Affiliated Beijing Tongren
Hospital, Capital Medical University, China
Objective: To investigate the association of SLC6A4 and 5-HTR2A gene
polymorphisms with different phenotype obstructive sleep apnea(OSA).
Methods: All the exons and promoter regions of SLC6A4 and 5-HTR2A
gene first underwent genetic analysis in 49 OSA and 47 controls in
Chinese Han population. According to the primary results, 40705T/G,
40912T/G of SLC6A4 and −1438G/A of 5-HTR2A were chosen forfurther genetic analysis in 365 OSA and 110 controls. Chin surface
electromyography (sEMG) of routine Polysomnograph during normal
breath and obstructive apnea were quantified in all the OSA subjects.
The sEMG change from normal breath to obstructive apnea wasexpressed as percent compensated electromyography value (PCEV),PCEV = (normal breath sEMG-apnea sEMG)/ normal breath sEMG. The
OSA subjects were divided into three subgroups based on the PCEV.
The frequency of genetype and allele was compared between different
subgroups.
Results: The PCEV of OSA patients varied from 1% to 92% in thisstudy, which implies the neuromuscular defect is different between OSA
subjects and the PCEV can reflect this kind of difference. The genetypeand allele frequency of −1438G/A showed statistic difference between
OSA patients and controls (P < 0.001), but no significant difference wasfound between different PCEV OSA subgroups. On the contrary, thegenetype and allele frequency of 40705T/G and 40912T/G showedstatistic difference between different PCEV OSA subgroups (P < 0.01,
0.05 respectively), while no statistic difference was found between OSA
patients and controls.
Conclusions: The polymorphism of 40705T/G and 40912T/G may be
involved in susceptibility to OSA through neuromuscular pathway,
while the −1438G/A polymorphism may through other ways affect theincidence of OSA.

PO-2-056
THE RELATIONSHIP BETWEEN CHRONOTYPE
AND SLEEP IN CHINESE STUDENTS AT
ELEMENTARY AND SENIOR HIGH SCHOOLSJ LIU1, Y NAKASHIMA2, T MORITA1,2
1
Graduate School of Human Environmental Science, Fukuoka Women’s
University, Fukuoka-city,Fukuoka, Japan, 2Faculty of Human
Environmental Science, Fukuoka Women’s University, Japan

study, 16students were recruited from Chinese elementary and seniorhigh schools, and the set of students from each school was divided
into two groups (“morning” and “evening” types) according to theirchronotype (assessed by a morningness-eveningness questionnaire).
That is there were four groups (each comprising 4 students): elementary
school-morning type, elementary school-evening type, senior highschool-morning type and senior high school-evening type. Light exposure, activity, the sleep pattern and meal habits of each subject were
measured over the course of four days. Furthermore, the melatoninlevels during sleep were measured by urine and awakening levels were
measured on the morning of the fifth day. Sleep latency of the seniorhigh school students who were morning types was significantly shorter
than that of the evening types from the same school. Exposure to lightduring the period from 20:00 to 04:00 h was significantly lower inelementary school students than senior high school students, regardlessof their chronotype.

PO-2-057
DO D-NEURONS PRODUCEPSYCHOSTIMULANTS?

K IKEMOTO1, A WADA1, K NISHIURA1, N TERAI1, A JOUVET4,
A TAKAYA3, K KATSUJI3, K KITAHAMA5,6
1
Department of Neuropsychiatry, Fukushima Medical University School of
Medicine, Fukushima, Japan, 2Department of Psychiatry, Iwaki Kyoritsu
General Hospital, Japan, 3Department of Legal Medicine, Shiga Universityof Medical Science, Japan, 4Department of Neuropathology, l’ Hopital
Neurologique, Lyon, France, 5Division of Sleep Disorders, Tokyo
Metropolitan Institute of Psychiatry, Japan, 6Laboratory of Cellular andMolecular Physiology, CNRS UMR5123, France
When Jaeger et al. originally described D-cells in the rat brains in 1983,
these cells were defined as aromatic L-amino acid decarboxylase-containing cells that are not dopaminergic nor serotonergic cells. These cells
were regarded as trace amine-synthesizing cells, and the localizationsof which were specified from D1 (the spinal cord) to D14 (the bed
nucleus of stria terminalis) in the rat central nervous system (Jaeger etal. 1984). Since the cloning of the trace amine receptor in 2001
(Borowski et al. 2001, Bunzow et al. 2001), numerous studies havebeen performed to elucidate the functions of the trace amine receptor.
The trace amine receptors are localized monoamine-related areas, andmodulate the functions of monoamines. In the human, D-neurons,
presumable trace amine-synthesizing neurons, preferably localized in
the forebrain structures rather than the hindbrain, including the midbrain, pons, and medulla oblongata (Kitahama et al. 2009). We also
reported the number reduction of D-neurons in the striatum of postmortem brains of schizophrenia (Ikemoto et al. 2003). In the human,
the ligands of trace amine-associated receptor, type 1 (TAAR1) are
known as phenylethylamine, tryptamine, metamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), or 3-iodothyronamine, a delivative of thyroid hormone, etc., and some of which may act as
psychostimulants. D-neurons might be waking-active neurons(Sakai2011). TAAR1 knockout mice showed schizophrenia-like behaviours(Wolinski et al. 2007), and a selective TAAR1 agonist has been shown
to be a promising neuroleptics (Revel et al. 2011). However, due to thepaucity of quantity of the trace amines in vivo, in situ visualization of
the trace amines has hardly been successful.

Entraining factors for biological rhythms (i.e. lighting, activity, meal
habits, and so on) have been considered to affect the sleep of humans,
and understanding the relationships between these factors and sleep isbecoming more important in the present-day environment. In this© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research361

Sleep, Science and Research

PO-2-058
CIRCADIAN CLOCK T3111C POLYMORPHISM
ASSOCIATED WITH INDIVIDUAL DIFFERENCES
IN EXECUTIVE FUNCTIONING, SLEEPINESSAND MOOD DURING SLEEP RESTRICTION

N GOEL1, S BANKS1,2, L LIN3, E MIGNOT3, DF DINGES1
1
Department of Psychiatry, University of Pennsylvania School of Medicine,Philadelphia, PA, United States of America, 2Centre for Sleep Research,
University of South Australia, Australia, 3Department of Psychiatry and
Behavioral Sciences, Stanford University, United States of America
The CLOCK T3111C polymorphism is associated with aspects of sleep,
sleepiness, and morningness-eveningness in healthy adults, and withinsomnia in bipolar disorder and major depressive disorder. We evaluated the CLOCK T3111C polymorphism’s role in cognitive, sleepiness,sleep homeostatic and mood responses during baseline and chronic
partial sleep deprivation (PSD). 6 C/C, 45 C/T and 78 T/T healthy adults(29.9 ± 6.9 y;63females) completed 2 baseline (10 h TIB) nights, followed by 5 consecutive PSD nights (4 h TIB) in a laboratory experimentassessing neurobehavioral measures (cognitive and executive function
tests, subjective sleepiness, mood and fatigue, MWT) and physiologicalsleep responses. The C/C and C/T groups did not differ in outcomes
and were combined; comparisons were conducted between C allele
carriers (C/C+C/T;N = 51) and the T/T genotype (N = 78). T/T genotypic and T allelic frequencies were higher in African Americans than
Caucasians; results were significant after controlling for ethnicity.
During PSD, C allele carriers showed poorer executive functioning
performance on the Tower of London (p’s < 0.05), which assesses planning and problem solving abilities. This group also showed greater total
mood disturbance (TMD) and greater subjective sleepiness and fatigue
during PSD (p’s < 0.05). At baseline, C allele carriers showed greater
TMD and confusion (p’s < 0.05), but did not differ in circadian phasetypology, physiological sleep characteristics, physiological or subjective
sleepiness, or cognitive performance. Both groups demonstrated similarcognitive performance (PVT, Digit Span) decreases, and increases in
SWE and subjective and physiological sleepiness (KSS, MWT) in
response to PSD. This is the first report of the CLOCK T3111C polymorphism predicting performance on a measure of executive functioning, and sleepiness and mood during chronic PSD. The CLOCK T3111C
polymorphism may be a genetic marker for a cognitive-mood diathesis
more so than a sleep-circadian diathesis, since it did not predict sleep
homeostatic or circadian measures relative to PSD.

PO-2-059 / AS-5 Presenter
ANIMAL MODELS OF HUMAN SLEEP-WAKE
CYCLE: NON-SCN CIRCADIAN BEHAVIORRHYTHMS IN RODENTS

A KAMEYAMA1, K HONMA2, S HONMA1,2
Department of Physiology, Hokkaido University, Sapporo-city, Hokkaido,
Japan, 2Department of Chronomedicine, Hokkaido University, Japan1

One of the characteristics of human sleep-wake cycle is a spontaneousdesynchronization from the circadian rhythms in core body temperatureand plasma melatonin, which are regulated by the circadian pacemakerin the suprachiasmatic nucleus (SCN). In rodents such as rats and mice,it has been known that behavioral rhythms are dissociated from the
SCN pacemaker by chronic Methamphetamine (MAP) treatment or
restricted daily feeding (RF). The rhythms induced by MAP and RF
suggested to be based on the same oscillatory mechanism because of
the similarity of these characteristics. These oscillators are called as a

362

MAP-induced oscillator (MAO) and food-entrainable oscillator (FEO).
Neither the site nor the mechanism of these oscillators is uncovered.
In this study, we analyzed the molecular mechanisms of MAO and FEO
in terms of clock gene, per2 expression. We treated Period2luciferase transgenic rats either to daily MAP injection (2 mg/kg b.w.)
or RF (2 hours) starting from ZT4 for 14 days under light-dark cyclesof 12 h lights. Wheel-running and spontaneous activities were measured simultaneously. Following the treatment, we made brain slices
including the Olfactory bulb (OB), Caudate-Putamen (CPU), Parietal
cortex (PC), Substantia Nigra (SN), and SCN for the measurement of
Per2-luc bioluminescence rhythms in culture. Both groups of rats
treated by MAP and RF exhibited the enhancement of activity before
the time of treatments and persisted after the termination of treatments.
We found that circadian phases of Per2-luc rhythms were significantly
different between MAP and RF treated groups in the OB, CPU, PC, and
SN. The circadian Per2-luc rhythm in the SCN was not affected by either
treatment. These results strongly suggest that the molecular mechanisms of MAO and FEO are different.

PO-2-060 / AS-22 Presenter
NON-CIRCADIAN DIRECT EFFECTS OF LIGHT
ON SLEEP AND ALERTNESS ARE MEDIATED VIA
SEVERAL HYPOTHALAMIC PATHWAYSINCLUDING THE SCN AND THE VLPOP BOURGIN1, J HUBBARD1, E RUPPERT1, J TSAI2, L CALVEL1,CH HELLER2, P FRANKEN3
1
Sleep clinic and Neuroscience Institute, CNRS and University ofStrasbourg, Strasbourg, France, 2Department of Biological Sciences,
Stanford University, United States of America, 3Center for Integrative
genomics, University of Lausanne, Switzerland

Light is known to influence sleep and alertness indirectly through awell-defined circadian pathway (suprachiasmatic nucleus, SCN), or
directly through mechanisms that remain to be further understood.
Retinal ganglion cells expressing melanopsin (Opn4, photopigment)
convey non-visual light information to the brain. Our recent work
looking at c-Fos induction in response to light suggests that the sleep
promoting (i.e., galanin-positive) neurons of the ventrolateral preoptic(VLPO) or the SCN may act as possible relays mediating the direct
effects of light on vigilance states. To test this hypothesis, we performed
SCN lesion and analyzed sleep under various light dark regimen(12 hL : 12 hD, single 1 hL or D-pulses, and 24 hours of 1 h : 1 h LD
cycles) in Opn4−/− and WT mice, in arrhythmic (verified with actimetry) lesioned (SCNx) and rhythmic sham mice. The SCN lesion wasverified by VIP and AVP staining. Retinohypothalamic fibers to the
VLPO and other areas were conserved in lesioned animals (staining ofcholera toxin B previously injected into the posterior chamber of theeye). Under LD12 h : 12 h, SCNx mice (WT and −/−) showed an abolished sleep-wake rhythm and slept longer during the 12-hr dark period
as compared to sham animals (p < 0.001). Sleep induction in response
to a 1 hr light pulse was attenuated in Opn4−/− (p < 0.05) but not in
SCNx animals. The wake-promoting effect of a dark pulse was decreasedin lesioned and in KO animals (p < 0.05). Under ultradian 1 h : 1 h LD
cycle the reactivity to light and dark was reduced in KO sham (−58.7± 8.5%, p < 0.05) and WT SCNx mice (−59.3 ± 9.2%, p < 0.05). In
the absence of both the SCN and melanopsin the reactivity to light anddark (−87.1 ± 11.2%, p < 0.01) was abolished. These results suggest
that, in nocturnal animals, the direct sleep promoting effect of light rely,at least in part, on the VLPO and the wake facilitating effect of darkness
on the SCN. These direct effects are mainly, but not only, based on
melanopsin photoreception. The SCN, beyond its function as circadian© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

master clock, play a role to mediate the direct effects of light and darkness on sleep and alertness.

PO-2-061
CHRONIC LIGHT AS A POTENTIAL REGULATOROF SLEEP: DIRECT PERTURBATION OF SLEEPHOMEOSTASIS IN ARRHYTHMIC MICE
G SUNAGAWA, HR UEDA
Laboratory for Systems Biology, RIKEN Center for Developmental Biology,
Chuou-ku, Kobe-shi, Hyogo, Japan
Mammalian sleep is under control of both circadian clock and sleep
homeostasis. The circadian clock is known to be a strong regulator ofsleep homeostasis and this makes it difficult to assess the sleep homeostasis system in mammals. To evaluate the dynamics of sleep homeostatic system, removing the circadian clock is necessary. Geneticallyarrhythmic mice, which have no circadian clock, could solve thisproblem by enabling direct perturbation of sleep homeostatic system.
Generally, analyzing a dynamics of a biological system, quantitative andnoninvasive method is ideal. Light is a perfect method that meets these
conditions. Using CB57BL/6 J mice (WT) and two arrhythmic strains,
Cry1−/−, Cry2−/− mice (CRY) and Bmal1−/− mice (BMAL), we first showthat daily locomotor can be regulated by chronic light not only in WT
but also in arrhythmic strains (CRY and BMAL). Second, we showchronic light can transiently increase sleep time in BMAL. Thus, chronic
light is a candidate to perturb sleep in arrhythmic mice. However, thelack of reproducibility of previous locomotor studies while recording
electroencephalograms and electromyograms, we are now seeking for aless invasive method to evaluate sleep/wake status in mice.

PO-2-062 / AS-22 Presenter
PROSTAGLANDIN D2 PRODUCED BY
LIPOCALIN-TYPE PROSTAGLANDIN D SYNTHASEIN THE LEPTOMENINGES OF THE BRAIN IS
INVOLVED IN SLEEP REGULATIONY CHRASSE1, M LAZARUS1, Y OISHI2, Y URADE1, O HAYAISHI1
1
Department of Molecular Behavioral Biology, Osaka Bioscience Institute,
Suita-shi, Osaka, Japan, 2Neurology, Beth Israel Deaconess Medical Center,
United States of America

Prostaglandin D2(PGD2) is the most abundant prostaglandin producedin the brain. Injections of nano-molar PGD2 in rat brains induce sleep
in a dose -and time- dependent manner. The PGD2-induced sleep is
indistinguishable from physiological sleep.
PGD2 is produced by two distinct types of PGD2 synthase (PGDS),
lipocalin-type PGDS (LPGDS) and hematopoietic PGDS (HPGDS), but
only LPGDS is related to the sleep regulation. Three potential sites of
PGD2 synthesis have been identified in the brain: LPGDS is localized
into oligodendrocytes (OD), epithelial cells of the choroid plexus (CP),and arachnoid trabecular cells of the leptomeninges (LM).
We attempted to identify the site of synthesis of somnogenic PGD2 andgenerated a transgenic mouse line with the LPGDS gene amenable toconditional deletion using Cre recombinase.
To identify the tissue or cells responsible for the production of somnogenic PGD2, we engineered animals lacking LPGDS specifically in:– OD by cross-breeding flox-LPGDS mice with Nestin-Cre mice toinduce a complete KO of LPGDS in the neural but not the leptomeningeal cells (OD-LPGDS KO mice)– CP by injecting adeno-associated virus (AAV), serotype 5, expressing
Cre recombinase (AAV5-Cre) into the lateral third ventricle (CP-LPGDS
KO mice)– LM by injecting AAV, serotype 8, expressing Cre recombinase (AAV8Cre) into the ventricle of new born mice (LM-LPGDS KO mice)
We recorded electroencephalogram, electromyogram and locomotor
activity to measure sleep of 10 weeks old animals without LPGDS in
one of the 3 target tissues and demonstrated that selenium tetrachloride,a specific PGDS inhibitor, inhibited sleep in OD-LPGDS and CP-LPGDS
KO mice, but not in LM-LPGDS KO mice.
These results indicate that leptomeningeal cells, but not OD or CP, arethe source of somnogenic PGD2.

PO-2-063
MICE LACKING HEAT SHOCK FACTOR 1 SHOWEVENING-TYPE SLEEP/WAKE RHYTHM

H SEI1, K KITAOKA1, N FUJIKI1, N SHIMIZU1, S CHIKAHISA1,F HIROAKI1, T SHIUCHI1, A NAKAI2
1
Department of Integrative Physiology, Tokushima University, Tokushima,
Japan, 2Departments of Biochemistry and Molecular Biology, Yamaguchi
University, Japan

Body temperature is considered to work as a resetting cue for internal
circadian synchronization [Buhr et al., Science (2010) 330:379–85].
Block of the function of heat shock factor 1 (HSF1), a transcription factorof heat shock proteins, suppresses the ability of heat pulses to shift thecircadian phase and lengthen the free-running period. We hypothesized
and tested that mice lacking HSF1 would show the evening-type of sleep/
wake pattern because of its longer circadian period. We measured EEG,
EMG and body temperature in HSF1 knockout and wild-type mice for24 hours under 12 h-light and 12 h-dark condition. The acrophase in
the rhythm of wake and non-rapid eye movement sleep in HSF1 knockout mice was significantly delayed for about 3 hours in comparison to
the wild-type mice, while that in body temperature was not affected.
The HSF1 knockout did not change the total sleep/wake durations for
24 hours and averaged body temperature. Present results indicate that
HSF1 may be involved in the circadian sleep control.

PO-2-064 / AS-7 Presenter
KINDLING STIMULI DELIVERED AT DISTINCTZEITGEBER TIME POINTS ALTER HOMEOSTATICFACTOR AND CIRCADIAN RHYTHM
DIFFERENTLY

F-C CHANG1, P-L YI1,2
1
Department of Veterinary Medicine, National Taiwan University, Taipei,
Taiwan, 2Department of Sports, Health & Leisure, Aletheia University, Taiwan
Introduction: Sleep is regulated by homeostastic factor and circadian
process. Disturbances in the sleep-wake continuum in epilepsy patientsare common but often overlooked. We herein employed kindlingstimuli delivered at different zeitgeber time (ZT) points to elucidate theeffect of epilepsy on the alterations of sleep homeostasis.
Methods: Amygdala kindling protocol was delivered at different ZT
points (ZT0, ZT6 and ZT13) to induced temporal lobe epilepsy (TLE)
in rats. EEGs and sleep activities were recorded after reaching fullblown epilepsy. ELISA, ribonuclease protection assay and immunocytochemistry were employed to measure corticosterone, interleukin(IL)-1 and Per1 protein expression, respectively.
Results: SWS and REM sleep decreased during ZT0-12 when rats werekindled at ZT0. When ZT13 kindling was given, SWS increased but
REM sleep was not altered during ZT13-24. However, the 12:12 h
sleep-wake circadian rhythm was not altered. Corticosterone concentrations were increased after ZT0 kindling and the expression of IL-1 was© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research363

Sleep, Science and Researchenhanced after ZT13 kindling. Furthermore, corticotrophin-releasing
hormone (CRH) receptor antagonist and IL-1 receptor antagonist (IL1ra) respectively blocked ZT0- and ZT13-induced sleep alterations.
Furthermore, the expression of Per1 protein in the suprachiasmatic
nucleus (SCN) was shifted 6 hours in advance and sleep circadian wasadvanced 2 hours when kindling stimuli was given at ZT6. Microinjection of hypocretin receptor antagonist, SB 334867, directly into the
SCN significantly blocked ZT6-kindling induced advance shifting ofPer1 expression in SCN and the alteration of sleep circadian.
Conclusion: Amygdala-kindling stimuli delivered at different ZT points
may alter the circadian and/or homeostatic factors, indicating theunderlying mechanisms for the sleep disturbances in epilepsy patients.

PO-2-065
ULTRADIAN SLEEP-WAKE RHYTHM INDROSOPHILAY SEKI, T TANIMURA
Department of Biology, Kyushu University, Fukuoka-city, Fukuoka, Japan
Rhythmic activities are found in a wide range of organisms from unicellular organisms to mammals. Biological rhythms are classified by thelength of periods. Rhythms with periodicity shorter than 1 day arereferred to as ultradian rhythms. Ultradian rhythms are complicated, asvarious period lengths are observed. A well-known ultradian rhythm isthe neuronal activity of the human brain during sleep. Human sleep
consists of two stages, REM and non-REM, which appears alternately
with a cycle of about 90 min between sleep phases. Several ultradianrhythms have also been reported in invertebrates. However, nothing is
yet known about the biological meaning of ultradian rhythms and thatsuch oscillations can be influenced by external or internal signals. We
used Drosophila melanogaster to study the behavioral aspect of ultradianrhythms and employed a video-recording system to analyze fly movements and sleep states. Time series data were analyzed by the maximum-entropy method of the MemCalc software package. Ultradianrhythmicity of sleep wake-cycle was detected in circadian rhythm
mutant strains. Moreover, ultradian rhythmicity was also detected in awild-type strain placed under constant dark or light conditions. Notably,robust and precise ultradian rhythmicity was detected in a clock output
mutant, Pigment-dispersing factor (Pdf01). The ultradian rhythmicity wefound in Drosophila is not temperature-compensated and has different
properties from those of the circadian system.

PO-2-066
NON-REM SLEEP STAGE TRANSITIONSCONTROL ULTRADIAN REM SLEEP RHYTHM

A KISHI1, H YASUDA2, T MATSUMOTO3, Y INAMI4,J HORIGUCHI2, M TAMAKI5, ZR STRUZIK6, Y YAMAMOTO6
1
Department of Medicine, New York University School of Medicine, Jersey
City, NJ, United States of America, 2Department of Psychiatry, Shimane
University School of Medicine, Japan, 3Department of Psychiatry, Seiwakai
Nishikawa Hospital, Japan, 4Department of Psychiatry, Ehime Rosai
Hospital, Japan, Computational Neuroscience Laboratories, Advanced
Telecommunications Research Institute International (ATR), Japan,
5
Graduate School of Education, The University of Tokyo, Japan
Study Objectives: The cyclic sequence of non-rapid-eye-movement(non-REM) and REM sleep, the so-called ultradian rhythm, is a highly
characteristic feature of sleep. However, the mechanisms responsible forthe ultradian REM sleep rhythm, particularly in humans, have not to datebeen fully elucidated. We hypothesize that a stage transition mechanism
is involved in the determination of the ultradian REM sleep rhythm.

364

Participants: Ten healthy young male volunteers (age: 22 ± 3.7 years,
range 19–31 years) spent three nights in a sleep laboratory. The firstwas the adaptation night, and the second was the baseline night. On
the third night, the subjects received risperidone (1 mg tablet), a central
serotonergic and dopaminergic antagonist, 30 min before the polysomnography recording.
Measurements and Results: We measured and investigated transition
probabilities between Awake, REM and non-REM sleep stages (N1, N2
and N3) within the REM-onset intervals, defined as the intervals
between the onset of one REM period and the beginning of the next,
altered by risperidone. We also calculated the transition intensity (i.e.,
instantaneous transition rate) and examined the temporal pattern oftransitions within the altered REM-onset intervals. We found that when
the REM-onset interval was prolonged by risperidone, the probabilityof transitions from N2 to N3 was significantly increased within the same
prolonged interval, with a significant delay and/or recurrences of thepeak intensity of transitions from N2 to N3.
Conclusions: These results suggest that the mechanism governing
non-REM sleep stage transitions (from light to deep sleep) plays animportant role in determining ultradian REM sleep rhythms.

PO-2-067 / AS-17 Presenter
HUMAN CIRCADIAN RHYTHM POLYMORPHISMS
ARE CORRELATED WITH CLIMATEBE CADE1, SN ARCHER2, M VON SCHANTZ2
Sleep Medicine, Brigham and Women’s Hospital / Harvard Medical School,
Boston, MA, United States of America, 2Faculty of Health and Medical
Science, University of Surrey, United Kingdom
1

Introduction: Numerous studies have reported associations between
polymorphisms in human circadian genes and phenotypes describing
diurnal preference (DP). However, findings often have not been replicated across populations. There are multiple reasons for lack of replication, including poor linkage disequilibrium (LD) between the reported
single nucleotide polymorphisms (SNPs) and the causative allele, anddiffering LD across populations. An alternate explanation for poor replication could be population-specific effects, given latitudinal clines
reported in prior non-human circadian studies. Climate, as opposed tolatitude, exacts direct physiological challenges (e.g. temperature
extremes) that may reflect any ultimate forces responsible for the possible spatial selection of circadian phenotypes.
Methods: Summer and winter climate principal components were constructed using 13 climate variables (New, Clim Res 2002) and NASAinsolation data for 45 Human Genome Diversity Project populations (n= 975) (Li, Science 2008). Climate SNPs were defined as Spearman’s
Rho principal components 1/2 ± 1% outliers relative to 644,192 autosomal SNP allele frequencies. HapMap LD (r2> 0.8) between climate
SNPs and a) SNPs within 35 circadian-associated genes (20 kbp flank)
and b) known DP variants was measured for possible correlation.
Results: 13 genes had >10% SNPs tagged by 1% climate SNP outliers,
including 4 genes (BTRC, CRY1, FBXL3, and SIRT1) with >50% SNPs
tagged within a single HapMap population. Near-exact relationships
between climate and diurnal preference polymorphisms in multiple
populations were found for PER1 and PER2 (linking British morningness [Carpen, J Sleep Res 2005] and Japanese eveningness [Matsuo,
Sleep Biol Rhythms 2007]), while an extrapolated haplotype relationship affected PER3.
Conclusion: These results suggest that human circadian phenotypes
may be altered by the environment. This raises the importance of future
multiple-population studies, but predicts increased complexity in theirinterpretation.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-068
CIRCADIAN DISTRIBUTION OF CSF INOSINEAND HISTAMINE LEVELS IN HUMANSU KALLWEIT1, K ARITAKE2, S BLUMENTHAL3, O HAYAISHI2,
CL BASSETTI1,4, CR BAUMANN1, Y URADE2
1
Department of Neurology, University Hospital Zurich, Zurich,
Switzerland, 2Department of Molecular Behavioral Biology, Osaka
Bioscience Institute, Japan, 3Department of Anaesthesiology and Intensive
Medicine, Triemli Hospital Zurich, Switzerland, 4Neurocenter of Southern
Switzerland, Ente Ospedaliero Cantonale Lugano, Switzerland
Background and Aims: There is evidence for adenosine being an
endogenous sleep substance based on results of various experiments.
In contrast, histamine is an important wake-mediator. In animals, cerebrospinal fluid (CSF) histamine levels are increased during wakefulness
and decreased during sleep. In humans, there is little information on
the circadian distribution of adenosine or histamine in CSF. Limited
data indicate for lower CSF histamine levels in human narcolepsy.
Adenosine is an unstable substance and therefore difficult to measure.
Adenosine is converted into the more stable metabolite inosine. We
aimed at investigating the circadian course of inosine, hypocretin, betatrace and histamine in human CSF and to find potential correlations.
Methods: We prospectively studied a series of 184 consecutive patientsand healthy controls. 164 patients suffered from different sleep orneurological disorders. There were 110 women (ratio 1.5:1), mean age
was 51 years (range 20–85). Lumbar puncture was performed between
6 am and 1am. The study was approved by the institutional ethicalcommittee. The concentrations of hypocretin or beta-trace were measured by specific ELISA for respective protein. The concentration ofhistamine was measured by using HPLC-fluorometry. The amount of
inosine was measured by using HPLC- tandem mass spectrometry.
Results: There was a continuous increase of inosine during the day (8am to 6 pm, r = 0.35, p < 0.001). This was also the case for histamine(r = 0.2, p < 0.001). In addition, there was a positive correlation
between inosine and histamine (r = 0.34, p < 0.001). Subgroup analysis(gender, age, diagnosis, healthy controls) all confirmed positive correlations. Levels of hypocretin and beta-trace during the day varied (n.s.).
Discussion: In our study, the increase of inosine concentrations in thecourse of day support previous animal data of inosine (adenosine) being
an endogenous sleep substance. Histamine increase points to its importance in maintenance of wakefulness and antagonistic role to inosine inhuman sleep wake regulation.

PO-2-069 / AS-3 Presenter
EFFECT OF SCHEDULED PHYSICAL EXERCISEON RE-ENTRAINMENT OF HUMAN CIRCADIANRHYTHMS TO 8 H ADVANCED SLEEP SCHEDULE
IN ISOLATION FACILITYY YAMANAKA1, S HASHIMOTO2, S MASUBUCHI2, S-Y NISHIDE1,
A KAMEYAMA1, S HONMA1,3, K HONMA3
1
Department of Physiology, Hokkaido University Graduate School of
Medicine, Sapporo-city, Hokkaido, Japan, 2Research center of Photonic
bioimaging section, Hokkaido University, Japan, 3Department ofChronomedicine, Hokkaido University, Japan

Bright light is known as a primary zeitgeber for human circadianrhythms. Timed bright light has been reported to produce phase shifts
and to accelerate the re-entrainment of circadian melatonin rhythm.
Recently, we observed that scheduled physical exercise significantly
accelerated re-entrainment of the sleep-wake cycle to 8-h advanced

sleep schedule but not the circadian melatonin rhythm under dim
light conditions(<10 lx). These results were not consistent with several
previous studies which demonstrated timed physical exercise phaseshifted the circadian melatonin rhythms. One possible explanation forthis discrepancy is the effects of exercise on light perception for rhythm
entrainment. To examine this possibility, effects of physical exercise
were assessed under bright light condition. Subjects spent for 14 daysin an isolation unit without knowing the time of day. For the first threenights, the subjects kept in their habitual sleep time for 8 h. The lightintensity in the wake period was fixed to 5000–8000 lx. All illuminations were turned off during the sleep period. The baseline circadianphase of plasma melatonin rhythm was measured on the third night.
Afterward, the subjects were not permitted to sleep until the time when
the sleep schedule was set at 8 h earlier than the habitual sleep time.
They were required to follow the advanced schedule for 4 days. Physicalexercise with bicycle ergometer was imposed on the exercise group
twice a day during waking period. The 2nd circadian melatonin rhythm
was measured on the last day of schedule. Then the subjects werereleased into free-run condition for 6 days with dim light conditions(<10 lx). On the last day of free-run, the 3rd circadian melatoninrhythm was measured. From the preliminary data of two control subjects, their sleep onsets were fully re-entrained to the shifted scheduleby bright lights, whereas the peak phases of plasma melatonin rhythms
were still on the way of re-entrainment (transient). We will discuss apossibility whether the timed physical exercise could accelerate there-entrainment of circadian melatonin rhythm.

PO-2-070 / AS-3 Presenter
EFFECTS OF SINGLE EXPOSURE TO EVENING
BLUE LIGHT ON LATENCY TO PERSISTENTSLEEP, SLOW WAVE ACTIVITY, MELATONINPRODUCTION AND COGNITIVE PERFORMANCECI GARCIA1, W WILKENING1, L FRANKE2, R UEBELHACK2,D FROHBERG1, I FIETZE1, T PENZEL1
1
Department of Interdisciplinary Sleep Medicine, Charité
Universitätsmedizin Berlin, Berlin, Germany, 2Department of Psychiatry
and Psychotherapy, Charité Universitätsmedizin Berlin Germany

Introduction: In former studies it has been shown that light with awavelength from 446 to 477 nm suppresses melatonin, decreases sleepiness and slow wave activity in the EEG and also shortens Rapid Eye
Movement (REM) phase at least for the first cycles after exposure.
Method: 40 healthy subjects have been included in this trial, 17 maleand 23 female with a mean age of 25 years. 2 subjects dropped out
after night 1. Chronotype was determined by the German Morningness Eveningness Questionaire (D-MEQ). Evening types had been
excluded. Participants stayed 2 consecutive nights at the sleep laboratory to undergo polysomnography. Subjects had been randomized to
2 groups. Group 1 went to bed one hour earlier than group 2 andreceived blue light one hour earlier. In the second night participantsreceived light with a length of 460 nm for one hour. Philips goLite
BLU with a lamp colour temperature of 5500 K was used. 23 subjects
received light with an intensity of 25%, 7 subjects with 50% and 8
subjects with 75%. To asses subjective sleepiness at different time
points Karolinska Sleepiness Scale was used. Cognitive performance
was measured by psychomotor vigilance test and Osler test sitting ina dark room for 1 hour in the first night and directly after light exposure in the second night. Melatonin was determined in blood andsaliva at different time points.
Results: Analysis of the data is still outstanding. Of special interest are
analysis to investigate the effect, on sleep in general, especially on© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research365

Sleep, Science and Researchlatency to persistent sleep, slow waves and REM sleep. By increasing
light intensity a greater suppression of melatonin production is
expected. The correlation between grade of melatonin suppression andsleep EEG activity changes are investigated.
Conclusion: This study has been conducted to clarify if a single exposure to blue light by Philips goLite BLU in the evening can lead to adecrease in sleepiness and enhance cognitive performance compared tono light condition. It has to be clarified if the expected effects provokechanges on sleep parameters in EEG by single exposure.

PO-2-071
DIURNAL VARIATION IN POSITIVE AND
NEGATIVE AFFECT SCALEM TANAKA1, M GOTO1, E MASUTANI1, R TAKENOUCHI1,
S NAGASHIMA1, M ADAMSSON2, T LAIKE2, T WAKAMURA1,
T MORITA3, M TOICHI1
1
Human Health Sciences, Graduate School of Medicine, Kyoto University,
Kyoto, Japan, 2Environmental Psychology, Graduate School of Engineering,
Lund University, Sweden, 3Living Environmental Science, Graduate Schoolof Human Environmental Sciences, Fukuoka Women’s University, Japan
Background and Objective: The positive (PA) and negative (NA) affectscale (PANAS) is used in many studies as a facilitative and reliable
questionnaire. In PANAS used globally as a questionnaire consisting ofeach 10-item mood scale (Watson et al. 1998). The Japanese version of
PANAS was developed by Sato and Yasuda in 2001, consists of each
8-item. PA has been separated from NA, as independent components
in opposite admittedly subjective directions. Each item of both questionnaires is rated on a 5-point scale. Circadian changes in mood by
PANAS have been described in a little of studies, but not enough. This
study aims to observe the diurnal change of mood in daily life by meansof PANAS in Japan and Sweden.
Participants and Method: All of 25 Japanese (18 males and 7 females
aged 23–60) and 15 Swedish (3 males and 12 females aged 28–60)
participants were daytime office workers, and their working times were
almost fixed throughout the year. PANAS was administered to theparticipants 4 times of day (8:00, 12:00, 15:00 and 20:00) in continuous 4 days every month during the course of a year. The used questionnaires were the Japanese version of PANAS in Japan and the PANAS
developed by Watson et al. in Sweden.
Results and Conclusion: The result showed that score of PA and NA
were low in evening of all months both countries. It is considered that
PA score may relate with photoperiod, because the result on seasonality
in this study showed that PA score during summer in Sweden didn’t
decline at evening, when sun maintains to rise. Consequently, when weused the PANAS in researches, we must consider the timing of the datacollection.

PO-2-072
EVALUATION OF HEART RATE VARIABILITY
AND RESPIRATORY VARIABILITY DURING SLEEPUSING A LORENZ PLOTA DEGUCHI1, H HAGIWARA2
1
Graduate School of Science and Engineering, Ritsumeikan University,
Kusatsu-city, Shiga, Japan, 2College of Information Science andEngineering, Ritsumeikan University, Japan

As part of the 24-hour, highly networked information society in Japan,
workers have increasingly complained of a lack of sleep or insomnia
from working long hours and late at night.

366

In general, assessing the stage of sleep based on the electrical patternsof the brain, or electroencephalogram (EEG), requires that the subject
wear numerous electrodes. This, however, makes sleep measurements
in daily life very impractical. Thus, we focused on the Peak-to-Peakintervals (PPIs) of the respiratory waveform (RESP) as an instantaneousand noninvasive method. Sleep is deeply linked to PPIs by the autonomic nervous system, and can change markedly within a few seconds.
We had proposed a method using evaluation indexes from the Lorenz
plot (LP). To evaluate the changes in these distributions, we projectedthe LP on a y = x axis, y = −x axis, and analyzed the shifting of themean (center C) and standard deviation (area S) for each sleep stage.
In the present study, the relationship between sleep stage based on EEG
and evaluation indexes from the LP during all-night sleep was examined. Sleep stages were found to be related to the stability of evaluationindexes from the LP. We weighed the estimation values from RESP
against the measurement values from EEG, and found that the method
using LP can estimate the depth of sleep in real time. The mean concordance rate between the measurement and estimation indexes was
73.8% (SD = ±6.5) in all subjects. These results indicate that the sleep
level can be evaluated based on RESP using the LP.
In the present study, as a simple method for analyzing the variation in
RESP during all-night sleep, the distribution of points on the LP was
regarded as an ellipse on the LP. To quantitatively determine the changes
in distribution on LP, center M, area S, eccentricity E and flattening F
were calculated as evaluation indexes. The characteristic features offluctuations related to transitions between sleep levels were subsequently obtained. Using these features, the state of sleep can be inferredfrom the change in shape of the ellipse on the LP. It will be found tohelp improve people’s quality of sleep.

PO-2-073
SEASONAL DIFFERENCES OF SLEEP AND
MELATONIN CONCENTRATION IN OBESESUBJECTS IN JAPANM SATO, D KANIKOWSKA, S IWASE, Y SHIMIZU, N NISHIMURA,Y INUKAI, J SUGENOYA
Department of Physiology, Aichi Medical University, Aichi, Japan
Obesity has become a major health challenge worldwide. In Japan,
28.6% men and 20.6% women is more than BMI 25 kg/m2. Sleep-wakeregulation might be altered with body fatness in different seasons. We
investigated seasonal differences of sleep and melatonin concentrationin obese subjects in Japan. 5 healthy and 5 obese men participated inthis experiment in summer and winter. EEG and ECG were measured
continuously during overnight in the climatic chamber at 26°C and
50%RH. Saliva for melatonin was collected at 23:00, 2:00 and 6:00 ineach season. Melatonin concentration showed the seasonal changes inobese and control, higher in summer. Obese subjects did not show alower level of melatonin concentration compared to healthy subjects.

PO-2-074
EFFECTS OF 1-OLEOYL-2-DOCOSAHEXAENOYLPHOSPHATIDYLCHOLINE (PC-DHA) UPON REM
SLEEP IN HUMAN STUDYT KOBAYASHI1, T OHKUBO2
Ashikaga Sleep Research Center, Ashikaga Institute of Technology,
Ashikaga-city, Tochigi, Japan, 2Functional Food Research Lab., NOF
Corporation, Japan1

We are interested in effects of daily foods, particularly fish oil, on sleep.
It is well known that REM sleep was manipulated by the cholinergic© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

system. 1000 mg/day Salmon roe’s oil containing of 5.37% of PC-DHA,
which is DHA combined with phosphatidylchoilne, was orally administrated every day during three months for nine human healthy malesubjects (aged:45 ± 15 years). Their night sleep was recorded by polysomunography (PSG) with the pace of once in a week during theadministration session with three consecutive months, and during thewash out session with one week. The relevant local ethical committee
approved this study protocol.
It was found that% REM sleep, the relative amount of REM sleep to thetotal sleep time, was significantly increased to 25%–35% at the 3rdmonth of the administration session in compared with the base line
nights. This increment of% REM sleep disappeared in the wash out
session. And the periodicity of REM cycle is higher in the 3rd month of
the administration session than the 1st month. REM cycle became gradually regular in proportion to the length of PC-DHA administration
period.
These results suggest that PC-DHA increases REM sleep to the optimal
amount of REM sleep, and may be contributed to stabilize sleep
structure.

PO-2-075
THE RELATIONSHIP BETWEEN CHRONOTYPE
AND DIURNAL VARIATION OF TASTE
THRESHOLD
A YAMASHINA, T MORITA
Graduate School of Human Environmental Science, Fukuoka Women’s
University, Fukuoka-city, Fukuoka, Japan
Although many studies have considered nutrition and food intake, few
have discussed changes in these variable due to the environment, especially light conditions, and chronotype (timing of biological rhythms).
It is possible that these two factors might cause an individual’s taste
threshold to change, in accord with altered nutritional needs. This study
investigated the diurnal variation of taste threshold in subjects of different chronotype in response to living in different lighting conditions.
The subjects were 12 female college students and their chronotypes(M-E scores) were estimated by a morningness-eveningness questionnaire. For one week prior to the two experimental days, subjects were
instructed to maintain a regular daily lifestyle, getting up at 07:00 hand going to bed at midnight, and not to drink alcohol. On the firstexperimental day, they entered the experimental room at 10:00 h andstayed under 1200 lux till noon, then remaining sedentary under dim
light (50 lux) until retiring and sleeping in the dark. Their taste thresholds (to sweet, salty, sour and bitter stimuli) were examined at 16:00,
20:00 and 24:00 h. On the second experimental day, they got up at
07:00 h and remained in dim light, their taste thresholds being examined at 08:00 and 12:00 h. They were allowed to eat a meal after eachexamination. The threshold to a salty stimulus tended to be higher at
08:00 h than at the other times in those subjects whose M-E scores
were 51–63 (indicating that they were “morning” types). By contrast,
those subjects whose M-E scores were 38–47 (“evening” types) showed
higher thresholds to a salty stimulus at 20:00 h. However, there were
no diurnal variations and no differences between morning and evening
types in the taste thresholds to sweetness, sourness, or bitterness.

PO-2-076
DIURNAL VARIATION IN RESPONSES OFMELANOPSIN-EXPRESSING RETINAL GANGLIONCELLS TO LIGHT IN THE HUMAN RETINAY FUKUDA1, S-I TSUJIMURA2, S HIGUCHI3, A YASUKOUCHI3,
T MORITA1
1
Department of Living Environmental Science, Fukuoka Women’s
University, Fukuoka-city, Fukuoka, Japan, 2Department of Information
Science and Biomedical Engineering, Kagoshima University, Japan,
3
Department of Human Science, Kyushu University, JapanThe mechanisms by which melanopsin-expressing retinal ganglion cells(mRGCs) regulate circadian rhythms in humans have not been established. To understand mRGC characteristics and their role, mRGC
responses should be induced or measured independent of cone and rod
responses. In a prior study (Fukuda et al., 2010), we successfully
investigated mRGC responses independent of rods and cones by using
our innovative method, which induces responses in only the mRGCs
as measured by the electroretinogram (ERG). In the present study, we
have attempted to use the ERG to measure changed responses of themRGCs over the course of the day.
Two healthy female Japanese subjects (22 years old) joined this study.
Sleep-wake cycle by using an Actiwatch-L (Mini Mitter Co. Inc., USA)and a sleep diary, salivary melatonin and tympanic temperature were
measured as markers of biological rhythms. The subjects undertook test
sessions – to investigate changes in mRGC responses to light stimuli asmeasured by the ERG – at 9 pm on the first day and 9 am and 3 pmon the second. For each test session, the subject’s pupil on the left eye
was dilated by a mydriatic agent and they wore an ERG electrode while
they gazed at the center of circular light stimulus on a diffuser in frontof them. The diffuser was at a distance of 300 mm from the subject andthe circle subtended an angle 18.9 degrees at the eyes. After 5-min
adaptation, in order to saturate rod responses, the light stimuli were
given for 250 msec and repeated 30 times at intervals of 5 sec.
The hormone and body temperature rhythms were normal in bothsubjects. The mRGC and overall amplitudes in the ERG were higher inthe evening (9 pm) than in the other time (9 am and 3 pm), indicating
the possibility that the sensitivity of the cones as well as of the mRGCs
would be heightened in the evening. Therefore, in a modern society,people should take more care with exposure to bright light in theevening, since their light sensitivity might be higher at this time. The
results also suggest that light might more easily disrupt human circadianrhythms in the evening.

PO-2-077
WITHDRAWN
PO-2-078
CHRONIC SLEEP RESTRICTION ALTERSSLEEPINESS, SLEEP AMOUNT,NEUROCHEMISTRY, AND SPATIALMEMORY IN RATS
RE STRECKER, Y KIM, M ALI, MA CHRISTIE, LB SHIFFLETT,P MEERLO, JG MCCOY, L CHEN, R BASHEER, RW MCCARLEY
Research Service and Psychiatry, VABHS & Havard Medical School,
Brookline/Massachusetts, United States of America
The sleep responses to chronic sleep restriction (CSR) are different fromthose to short-term total sleep deprivation. When CSR continues for© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research367

Sleep, Science and Researchseveral consecutive days, humans and rats fail to express homeostaticincreases in sleep amount, which includes sleep time and sleep intensity(as measured by NREM delta power). Rats exposed to CSR were allowed
6 h of sleep opportunity (SO) per day during the first 6 h of the 12 h
light period for at least 5 days, followed by recovery days. Measurements included: 1) sleep latency to assess sleepiness, 2) brain adenosine
receptor and adrenergic receptor mRNA, and, 3) spatial reference
memory using the water maze. After 18 h sleep deprivation on the firstsleep restriction (SR) day, the total sleep time and NREM delta power
were significantly increased during the 6 h SO, compared to the corresponding baseline level (BL). However, these compensatory increases
in sleep time and intensity were absent from SR days 2 to 5. Sleep onset
latencies were significantly reduced from SR1 through SR4 compared
to BL day. Adenosine A1 receptor mRNA levels were increased in thebasal forebrain throughout the CSR and recovery days, while adenosine
A2a receptor was decreased in the frontal cortex throughout the CSR
period. Beta-adrenergic receptor mRNA levels were significantly
decreased in the anterior cingulate cortex only on SR1. The spatial
learning of CSR rats was similar to movement control rats. However,spatial memory recall was impaired compared to the movement control
rats. In conclusion, rats exposed to chronic sleep restriction do not sleep
longer or deeper even though they continue to experience elevatedsleepiness and memory impairments. The data suggest at least two different sleep regulatory systems in the brain: one mediating sleepinessand memory consolidation, and the other mediating sleep amount.
Based on the similar time course changes, our findings support thepossibility that changes in A1R and the cortical A2aR tone may mediate
sleepiness and memory consolidation; whereas the cortical beta-adrenergic receptor tone may mediate sleep time and intensity.

PO-2-079 / AS-29 Presenter
SEX AND MENSTRUAL CYCLE EFFECTS ONSLEEP DEPENDENT MEMORY CONSOLIDATION

L GENZEL1, L RENNER1, T KIEFER1, M DRESLER1, R WEHRLE1,
M GRZINGER2, A STEIGER1
1
Sleependocrinology, Max Planck Institute of Psychiatry, Munich, Germany,
2
Department of Psychiatry, University of Aachen, Germany
There is growing amount of evidence that memory is consolidated byshort midday naps. But until now it remains unclear, which sleep phases
or EEG activities are relevant for different tasks and which hormonal
influences may play a role in memory consolidation. Effects of short,
midday naps on declarative and procedural memory consolidation were
investigated in healthy adults, ages 18 to 30 years. A female group wastested during different phases of the menstrual cycle. The subjects wereallowed a nap after learning or watched a movie. Memory performance
was tested by verbal paired associate task and finger tapping task. In
addition the subjects underwent one nap without a previous learning
experience. The mens memory benefited significantly from the NREM
nap in comparison to wake, and the increase in motor performancecorrelated with the increase in sleep spindles through learning. The
womens performance only increased through a nap during the luteal
phase and not during the follicular phase of their menstrual cycle. Only
the men and women in their luteal phase experienced an increase inspindle activity after learning matching the learning behavior. Further,in women estrogen correlated with the offline change in declarative
learning and progesterone with motor learning. Interestingly the ratioof the 2nd and 4th digit, which has been associated to fetal sex hormones and cognitive sex differences, predicted the average performanceof the female subjects in the learning tasks. We are the first to show
a gender and menstrual cycle effect on sleep dependent memory368

consolidation during a nap. Further, we could demonstrate that declarative and procedural memory consolidation cannot be REM sleep dependent as previously assumed, but most likely is connected to sleep
spindles.

PO-2-080
NMDA RECEPTOR AGONIST FACILITATESSLEEP-INDEPENDENT SYNAPTIC PLASTICITYASSOCIATED WITH ENHANCEMENT OF
WORKING MEMORY CAPACITYT YOSHIIKE1, K KURIYAMA1, M HONMA1, M SHIMAZAKI1, Y KIM1,T NISHIKAWA2
1
Department of Adult Mental Health, National Institute of Mental Health,National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan,
2
Section of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental
University Graduate School, Japan
Currently, although N-methyl-D-aspartate (NMDA) receptor antagonists suppress sleep-dependent memory processing, it is not wellknown how sleep and NMDA receptor agonists affect working memory(WM) performance improvement, respectively. In order to investigate
the neural basis underlying relationships between WM skill learningand sleep, D-cycloserine (DCS), which is a NMDA receptor partial
agonist, and both sleep and DCS together, we evaluated training-retest
performance of n-back task in healthy subjects who were given eitherwith wakefulness or sleep. All subjects showed improved WM capacity
over successive n-back test trials. Among subjects retested 24 hours
after the training session, greater WM capacity improvements occurred
when individuals were treated with DCS rather than placebo. Amongsubjects retested 12 hours after the training session, who received only
a placebo, greater improvements in task performance were observed
when training session was followed by sleep rather than a period of
wakefulness. However, among those who received DCS, greater
improvements in task performance were observed only when the training session was followed by a period of wakefulness. These results
indicate that WM capacity enhancement is affected by disparity insynaptic plasticity between sleep and wakefulness. Further, these findings suggest potential methods for improvement general fluid intelligence, which is necessary in human for problem-solving activities, andmay also influence learning, anti-aging processes, and rehabilitation ofhigher cognition.

PO-2-081 / AS-32 Presenter
MEG CORTICAL ACTIVITY DURING NREMSLEEP CORRELATED WITH IMPROVEMENT OF
A MOTOR SEQUENCE LEARNING

M TAMAKI1, TR HUANG2, FH LIN3, M HMLINEN3,Y YOTSUMOTO4, T WATANABE2, Y SASAKI3,5
1
Department of Neuroinformatics, Advanced Telecommunications ResearchInstitute International, Soraku-gun, Kyoto, Japan, 2Boston University,
United States of America, 3Massachusetts General Hospital, United Statesof America, 4Keio University, Japan, 5Harvard Medical School, UnitedStates of America
A growing body of evidence suggests that brain oscillatory activity
during sleep plays a key role in facilitatory action of memory and learning. However, the underlying neural mechanisms remain unclear. Here,
we used a multimodal neuroimaging technique in combination of MEG
and MRI, which allows us to measure brain activation in high spatial
and temporal resolution, to test whether such facilitatory effect occurs© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentationsin the brain region known to involve with better performance. Healthy
participants underwent 4 nightly MEG sessions (2 adaptation nights,
pre-training sleep, and post-training sleep) as well as 1 MRI session.
Before and after the post-training sleep, a finger-tapping task was conducted, which was previously shown to involve the primary motor area(M1) contralateral to the trained hand, but not other motor-related areas
including the supplementary motor area (SMA), for its improvement.
MEG data was wavelet-transformed and combined with MRI to constrain the current locations to the cortical mantle individually. Based on
the individual MRI, we localized motor related cortical areas including
the M1, the SMA and the pre-supplementary motor area (pre-SMA),
premotor area, superior parietal gyrus, as well as the primary visualcortex (V1) as a non-motor related area. We found increase in several
bands of spontaneous oscillations including the sigma and delta bands
during the post-training sleep compared to the pre-training sleep inmotor-memory regions such as the supplementary motor area (SMA),
and pre-SMA in high correlation with performance improvement after
sleep, but not in M1. These results suggest that there is a distinct neuralnetwork strongly correlated with the sleep facilitatory effect during
post-training NREM sleep, separately from the network involved in the
better execution of the task during the subsequent wakefulness.

sensations) plays is important for adaptation to different environmental
conditions (Stein, 1998), it remains unclear whether or how sleep
affects learning of cross-modal integration. To explore this issue wecompared delayed learning properties of visual-tactile integration
during sleep and wakefulness. All subjects initially acquired the newly
formed visual-tactile integration by using the rubber hand illusion paradigm (Botvinick & Cohen, 1998) to provide false visuospatial perception. Twelve hours later, following continuous normal daytime waking(Wake group: N = 20) or an equal interval containing a normal night’s
sleep (Sleep group: N = 20), we measured visuospatial false perception
and habituation as represented by the skin conductance response. The
false perception rate in the delayed test decreased in both groups. A
greater decrement in the visuospatial false perception rate was observedin the sleep group than in the wake group. In contrast, a greater decrement in the skin conductance response was observed in the wake groupthan in the sleep group. Here we show that sleep reduces the learningof visuo-tactile integration. Sleep may discriminate inappropriate learning from beneficial learning, facilitating beneficial learning while extinguishing inappropriate learning based on successful adaptation.

PO-2-082 / AS-29 Presenter

IMPLICIT LEARNING IS PERSISTENT EVEN IN A
DROWSY CONDITIONSLEEP AND MEMORY CONSOLIDATION IN
MEMORY CHAMPIONS
1

2

2

2

M DRESLER , BN KONRAD , VI SPOORMAKER , M CZISCH ,L GENZEL1, A STEIGER1
1
Sleep Research, Max Planck Institute of Psychiatry, Munich, Germany,
2
Neuroimaging, Max Planck Institute of Psychiatry, Germany
Increasing evidence suggests a supportive role of sleep in memory
consolidation. However, the details of the sleep-memory relation are
still under debate. While there is a wide consensus on a general beneficial effect of sleep on memory consolidation, in contrast the effects ofintense memorizing periods on sleep are much less clear. In addition,
little is known about the influence of individual differences (e.g. cognitive capabilities) on the sleep-memory relationship. We are addressingthese points in an ongoing study including 15 world-class memory
athletes out of the top-50 of the memory championships world ranking
list. As a control group served 15 subjects matched for age, gender andintelligence. All subjects underwent three nights of polysomnography
and a battery of declarative learning tasks. In a crossover-designed
manner, subjects spent a night in the sleep lab either after an intense
learning session of four consecutive hours, memorizing 1000+ information chunks, or after a day without active memorizing activity. Sleep
data of the test and control nights are presented and their relation tomemory consolidation discussed.

PO-2-083
SLEEP EXTINGUISHES FALSE PERCEPTIONACQUIRED BY LEARNING OF VISUAL-TACTILE
INTEGRATIONM HONMA, T YOSHIIKE, M SHIMAZAKI, S KOYAMA, M KIMURA,Y KIM, K KURIYAMA
Department of Adult Mental Health, National Center of Neurology andPsychiatry, Kodaira-city Tokyo, Japan

PO-2-084

K KAIDA, Y TAKEDA, K TSUZUKI
Human life technology research institute, National Institute of Advanced
Industrial Science and Technology, Tsukuba-city, Ibaraki, JapanThe aim of the study was to investigate whether implicit learning would
be improved by a short afternoon nap or bright light exposure. Seventeen partial sleep deprived participants (8 women; 30.4 ± 7.69 years
old; 20% reduction from normal nocturnal sleep time) carried out the
implicit learning task and subjective sleepiness rating twice a day(1145–1300h, 1415–1530h) before and after an afternoon short nap(20 min) or rest. During the second task, bright light treatment (2000
lux) was applied, so that the participants took part in a total of four
experimental conditions (control, short nap, bright light, and short nap+ bright light conditions). In the implicit learning task, participants
searched a 90 degrees rotated character “T” (target) among randomly
rotated and deployed characters “L” (distracter) on a computer display.
In the task, participants were required to indicate the direction of “T”(either right or left) by pressing a button as quickly as possible. Twelve
blocks (24 pictures for each block) were performed in total. In the first
block, all the pictures were new (NEW) for the participants, but in thesubsequent blocks, half of them (12 pictures) were the same pictures
as they responded in the first block (OLD). The experiment was
designed so that participants did not notice that OLD pictures wereshown amongst NEW pictures in the subsequent blocks. In the result,the search time was significantly shorter against OLD than NEW pictures (p < .05), which means that implicit learning was occurred during
the task. This factor interacted with neither nap nor light treatments.
The search time was significantly shorter in the nap condition comparedto the control condition (p < .05). Subjective sleepiness was significantly
reduced in the short nap, bright light, and short nap + bright light
conditions compared to the control condition (p < .05). In conclusion,
implicit learning per se occurred regardless of a short nap and bright
light exposure. A short nap improves cognitive performance to searcha target from distractive stimuli, though it has no significant effect on
implicit learning amount.

It is well known that delayed learning of various perceptual skills isfacilitated by sleep following repetitive skill training (Stickgold &Walker, 2005). Although cross-modal integration (e.g. visual and tactile© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research369

Sleep, Science and Research

PO-2-085
ALTERATION OF EEG SPECTRAL POWER
DURING SLEEP AFTER MOTOR LEARNINGY MORITA1, K OGAWA3, S UCHIDA4
Graduate School of Sport Sciences, Waseda University, Tokorozawa,
Saitama, Japan, 2Research Fellow of the Japan Society for the Promotion,
Japan Society for the Promotion of Science, Japan, 3Faculty of Integrated
Arts and Sciences, Hiroshima University, Japan, 4Faculty of Sport Sciences,
Waseda University, Japan1

The beneficial role of sleep in motor memory consolidation is now well
documented. However, there has been only insufficient evidence todocument neurophysiological mechanism of sleep on memory
consolidation.
PURPOSE: We examined the effects of 2h daytime nap on three-ballcascade juggling. In addition, in order to elucidate neurophysiologicalmechanism of sleep related to the memory consolidation, sleep EEG
spectral analysis was performed in addition to sleep stage scoring.
METHODS: Subjects were 18 female college students. They weredivided into nap group and control group. All subject practiced juggling
for 15min, and juggling technique was evaluated at 10:30. Subsequently, nap group took a 2h nap from 14:00 while control group stayedawake. Both groups retested juggling at 17:30. One week before theseexperiments, nap group had taken 2h nap in the same environment as
a baseline nap condition. These EEG were recorded at 7 scalp sites.
EEG was subjected to fast Fourier transform analysis (FFT).
RESULT: Nap group improve the juggling performance after 2h nap (p< .001). Control group did not show the improvement. Compared tothe baseline nap, increasing time of slow wave sleep (SWS) was marginally significant (p = .09). FFT revealed that slow oscillation (0.3~1.0Hz)
power and delta EEG (1.0~4.0Hz) power showed increasing trends(slow oscillation: p = .08, delta: p = .06), theta EEG (4.0~8.0Hz) andsigma EEG (12.0~16.0Hz) power was significantly increased (theta: p< .05, sigma: p < .05) during NREM sleep in after learning nap. During
REM sleep, only 23–25Hz showed an increasing trend (p = .07).
CONCLUSION: Sleep facilitate memory consolidation in three-ballcascade juggling. Slow and delta showed increasing trend, and thetaand sigma showed significant increment during NREM. These results
may indicate that SWS related the motor memory consolidation process.
Increasing sigma EEG power may suggest that sleep spindle activities
are involved in procedural memory consolidation process during sleep.
Increasing trend of 23–25Hz during REM may suggest that REM sleep
is also involved.

PO-2-086
CONTRIBUTION OF A NAP TO THE
CONSOLIDATION OF DECLARATIVE AND
PROCEDURAL MEMORIESK TAO, M HAYASHI
Graduate School of Integrated Arts and Sciences, Hiroshima University,
Higashihiroshima-city, Japan
A number of studies have demonstrated that declarative and procedural
memories improve across nocturnal sleep. The relationship between
memory consolidation and sleep stages has been under discussion.
Nocturnal sleep contains all of the sleep stages so that it is difficult toeliminate the influences of each sleep stage. Then we focused on a
daytime nap to examine the influence of sleep stage 2 and slow wave
sleep for memory consolidation. At 2 pm., 22 participants took a nap
including sleep stage 2 (n = 10) or slow wave sleep (n = 12), while the370

other participants remained awake (n = 11). All participants trained
paired association and finger tapping sequence task at noon and were
tested at 5 pm. The participants who took a nap containing slow wave
sleep tended to improve the performance of paired association task
than those who stayed awake. In addition, improvement of this task
positively correlated with the amount of sleep stage 2 for the participants who took a nap including slow wave sleep (r = 87, p < .05). These
results suggest that a certain amount of sleep stage 2 is necessary toconsolidate the memory trace of declarative memory.

PO-2-087
THE RELATIONSHIP BETWEEN SCHOOLACHIEVEMENT AND SLEEP AMONGELEMENTARY AND JUNIOR HIGH SCHOOLSTUDENTS IN OKINAWA

Y SASAZAWA1, K KOHAMA2
1
Faculty of Education, University of Ryukyus, Nakagami-gun, Okinawa,
Japan, 2Faculty of Education, University of Ryukyus, JapanTo clarify the relationship between school achievement and sleep andlife-style among 6 th. grade elementary school students (ESS) and 3 rd.
grade junior high school students (JHSS) in Okinawa, the authors
conducted a survey. The questionnaire consisted of self-rated school
achievement for Japanese language, mathematics, science, social studies,
English and physical education, sleep indexes such as total sleep time,
sleep quality, regular sleep, attitude and value of sleep and sleep satisfaction, life-style indexes such as physical activity, regular breakfast,
reading time, studying time and television viewing time, and mental
health indexes such as self-esteem and depression. Subjects were 981
ESS and 1,051 JHSS. We received 948 (97%) and 962 (92%) valid
responses, respectively. Results showed that 13% of ESS and 33% of
JHSS suffered from insomnia. Moreover, 5% of ESS and 20% of JHSS
were “short sleepers who slept less than 6 hours” and 5% of ESS and
6% of JHSS were “poor quality sleepers”. Furthermore, 2% of ESS and
3% of JHSS were “not satisfied sleepers” and “irregular sleepers” numbered 5% for ESS and 8% for JHSS. Short sleepers had a lower achievement for mathematics, social studies, humanities and natural science.
Poor quality sleepers had a lower achievement for Japanese language,
science, humanities and natural science. Concerning life-style, students
who had regular physical activities, ate breakfast regularly, who did nothave depress moods, and studied longer, had a higher school achievement. This study suggested that students’ sleep quality and quantity
may effect school achievement.

PO-2-088
EFFECTS OF NAPS, AND HEAD MASSAGES ON
IMPROVING MEMORY AND REDUCING FALSEMEMORY IN YOUNG ADULTS

T RASEEKUL1, M PHOTHISONOTHAI2, LR NELSON3,
S KORNPETPANEE4
1
College of Research Methodology and Cognitive Science, Burapha University,
Chonburi, Thailand, 2College of Research Methodology and Cognitive Science,
Burapha University, Thailand, 3College of Research Methodology andCognitive Science, Burapha University, Thailand, 4College of Research
Methodology and Cognitive Science, Burapha University, Thailand
Research has shown that naps and head massages can improve memory.
However, their effects on false memory, often found among young
people, are a matter yet to be soundly addressed.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

The present study focuses specifically on young adults, comparing therelative efficiency of naps and head massages on improving memory,and on reducing false memory. Thirty undergraduate university students have volunteered to participate in the study. They are all righthanded, with demonstrated regular word memory, and having nohistory of neurological disease or mental illness.
A pre-post with control group quasi experimental design will be used.
The Deese-Roediger-McDermott paradigm (DRM) test will serve as the
pre-test. One experimental group will nap for 60 to 90 minutes; anotherwill receive a traditional Thai head massage for 30 minutes. The DRM
will be administered again as a post-test.
Other research instruments to be used include the Thai General Health
Questionnaire (for screening), the Wechsler Adult Intelligence ScaleThird edition (WAIS-III) verbal comprehension (as a covariate), withelectroencephalograms (EEG) used in the nap group to measure andrecord electrical activity in the left anterior temporal lobe (LATL),
known to be vital for semantic processing.
Hypotheses to be tested: naps and head massages will both improve
memory; head massages will be more effective than naps in reducing
false memory.

PO-2-089
IMPAIRED SLEEP-DEPENDENT PROCEDURALMEMORY CONSOLIDATION WAS ASSOCIATED
WITH FAST SPINDLE ACTIVITY IN MEDICATED
DEPRESSIVE PATIENTSM NISHIDA1, T TOMITA2, Y NAKASHIMA2, T YAMAMOTO2,A YASUDA2
1
Section of Psychiatry and Behavioral Science, Tokyo Medical and Dental
University, Tokyo, Japan, 2Life Science Laboratory, Sony Corporation, Japan
Introduction: A growing corpus of evidence demonstrates that sleep
enhances consolidation process of memory, ranging from declarative
memory to other kinds of memory system. Although procedural
memory was consolidated in normal human subjects, whether the
sleep-dependent procedural memory consolidation occurs in medicateddepressive patients is still unclear, with pharmacological and physiological mechanism in neural network.
Methods: Healthy comparison subjects (n = 19) and medicated depressive patients (n = 9) were recruited. We used motor sequential tapping
test (MST test) paradigm, comparing the archived score between preand post-learning sleep. In MST test subjects were offered to use theirleft non-dominant hand. Subjects were recorded during all night with
16 channels EEG between MST test. Sleep scoring and frequency analysis were performed in recorded EEG. In addition, we detected sleep
spindle by using automatic algorithm, dividing into fast spindle (12.5–
16Hz) and slow spindle (10.5–12.5Hz).
Results: Motor memory consolidation was significantly impaired inpatients compared with normal controls. In normal controls, theamount of stage 2 NREM sleep was correlated with the magnitude of
motor memory consolidation. In patients, the ratio of fast spindle forslow spindle in left centro-parietal region, which was opposite side ofthe left hand, was correlated with improvement.
Conclusions: These data suggest that spindle activity has the potential of
regulate offline procedural memory consolidation. In medicated depressive patients, the activity of fast spindle within the right motor cortex
showed decreased correlation with motor memory improvement. Benzodiazepines may inhibit underlying brain plasticity of the area where
offline consolidation take place, modulating the propensities of fast andslow spindle activities. Further studies are needed regarding cerebral
connectivity of physiological biomarker, linked with cognitive process.

PO-2-090
WHICH CEREBRAL ACTIVITY DIFFERENTIATESDREAMERS FROM NON-DREAMERS?

P RUBY1, D MORLET1,2, J-B EICHENLAUB1,2
1
Brain Dynamics and Cognition Team, Lyon Neuroscience Research Center,
Bron cedex, France, 2University, of Lyon, France
Dreaming is still a mystery of human cognition. In the fifties, dreaming
has been associated with rapid eye movement sleep (Dement & Kleitman 1957; Sastre & Jouvet 1979) but this hypothesis which cannot
explain all the characteristics of dream reports has been challenged(Solms 1997; Nir & Tononi 2010). The neurophysiological correlatesof dreaming remain thus unclear. We used event-related potentials
during wakefulness and sleep to measure brain activity in subjects whoreport dreams frequently (Dreamers) versus rarely (Non-Dreamers).
During data acquisition participants passively listened to sounds while
they were (1) watching a silent movie (2) sleeping. Here we show thatthe primary steps of auditory processing (N1, Naatanen et al. 1978,
1987) match in Dreamers and Non-Dreamers. However, latter brain
responses, reflecting higher cognitive processing, dramatically differ inthe two groups both during pre-sleep wakefulness and during sleep.
Our results support the idea that the ability to recall dream is associatedwith a particular cerebral functional organisation independent of thestate of vigilance.

PO-2-092
ASSOCIATION BETWEEN FREQUENCY OF BAD
DREAMS AND DEPRESSIVE SYMPTOM AMONG
MIDDLE-AGED AND ELDERLY ADULTS IN THE
COMMUNITY

M TAKEGAMI1, S YAMAZAKI2, Y HAYASHINO2, R ONO3, K OTANI4,M SEKIGUCHI4, Y ONISHI5, S-I KONNO4, S FUKUHARA2
1
Department of Preventive Medicine and Epidemiology, National Cerebral
and Cardiovascular Center, Suita, Osaka, Japan, 2Department of
Epidemiology and Health Care Research, Kyoto University, Japan,
3
Department of Community Health Sciences, Kobe University, Japan,
4
Department of Orthopaedic Surgery, Fukushima Medical University
School of Medicine, Japan, 5Department of Clinical research, Institute for
Health Outcomes and Process Evaluation Research (iHope International),Japan
AIMS: Frequency of bad dreams has been related to depression inadolescent, this association among middle-aged and elder remains
unknown. This study aims to examine the association between frequency of bad dreams and depressive symptom among middle-aged
and elderly adults in the community.
METHODS: A cross-sectional analyses were performed using residents
who participated in a prospective cohort study which is Locomotive
Syndrome and Health outcome in Aizu Cohort Study (LOHAS), in
Tadami and Minami Aizu, Fukushima Prefecture, Japan. We administrated a questionnaire consisting of dreams, sleep variables and sleep
quality (Pittsburgh Sleep Quality Index), depressive symptoms (Thefive-item Mental Health Index), physical activity (International Physical
Activity Questionnaire), and demographic factors. Presence of bad
dreams was defined as experiencing a bad dream at least once a week.
Logistic regression models were used to examine the association
between bad dreams and depressive symptom.
RESULTS: 3400 subjects were included in the analyses (39.4% male,mean age = 66.3 years). The prevalence of bad dreams was 2.9%. Sleep
characteristics differentiating subjects with bad dreams from those© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research371

Sleep, Science and Researchwithout were significantly longer sleep latency, decreased sleep efficacy,
and poorer sleep quality. Bad dreams were significantly associated withdepressive symptoms (p < 0.001).
CONCLUSIONS: Depression symptoms and sleep quality are independently associated with bad dreams. Interventions for improving bad
dreams and sleep quality may therefore decrease depressive symptoms.
The further studies need to determine directions of causality for thosecorrelations.

PO-2-093
RECURRENT DREAMS AND BAD DREAMS IN
CHILDREN: A LONGITUDINAL INVESTIGATIONA GAUCHAT1, JR SGUIN2,5, RE TREMBLAY2,3,4, A ZADRA1
Psychology, University of Montreal, Montreal, Canada, 2Research Center,
Ste-Justine Hospital, Canada, 3International Laboratory for Child andAdolescent Mental Health Development, INSERM U669, France, 4University
College, Dublin, Ireland, 5Psychiatry, University of Montreal, Canada
1

Bad dreams and recurrent dreams are two types of oneiric experiencesthat have long interested researchers and clinicians alike. In adults, thepresence of recurrent dreams is associated with lowered psychologicalwell-being and bad dream frequency with increased scores on measuresof anxiety and depression. However, little is known about the concurrent and longitudinal psychological correlates of bad dreams and recurrent dreams in children. We present findings from an ongoing
longitudinal study focusing on the social, psychological, and cognitive
development of children in the province of Quebec, Canada.
Participants were 172 children (50% of each gender) studied yearly
between the ages 11 and 13 years. As part of their assessment, children
provided information about their dreams and various aspects of their
psychosocial adjustment. The incidence of bad dreams as well as ofrecurrent dreams was found to decrease between the ages 11 and 13(from 82.7% to 63.8% for bad dreams; from 35.3% to 12.2% for recurrent dreams). At age 11, presence of bad dreams or recurrent dreams
was associated with greater emotional difficulties. Emotional problems
as well as anxiety at age 11 did not predict subsequent occurrence ofbad dreams or recurrent dreams at age 12 or 13. However, the presenceof bad dreams or recurrent dreams at age 11 predicted the occurrenceof bad dreams and recurrent dreams at ages 12 and 13. These results
suggests that the presence of recurrent or bad dreams at age 11 is
associated with concurrent emotional difficulties but that the presenceof negative oneiric experiences in older children is better predicted bypast negative oneiric experiences than by previous emotional problems.
How relations between repetitive or negative dream content and waking
adjustment jointly evolve over time from childhood through adolescence remains to be determined.

PO-2-094
SEXUAL CONTENT OF MEN AND WOMEN’S
DREAMSA ZADRA, J GERVAIS
Psychology, Universit de Montral, Beaconsfield, Qc, Canada
Introduction: Given the longstanding interest in dreams with sexual
content, it is surprising to note the paucity of empirical literature on
this topic. The aim of the present study was to investigate the content
of sexual dreams across a large sample of everyday dream reports collected prospectively from both student and non-student men andwomen.

372

Methods: Participants were 220 women (30.3 ± 14 years) and 60 men(29.9 ± 14.4 years), who recorded their dreams in a daily sleep log for
2 to 4 weeks. Since the evaluation of sexual experiences in dreams was
not the focus of the original investigation, they were not asked to takespecial note of these elements. Dream reports were scored on a varietyof scales including type of sexual content, characters, and setting.
Results: Participants reported a total of 5521 dreams, including 323
sexual dreams representing 6.7% of men’s (M) and 5.6% of women’s(W) dreams. Sexual propositions were the most common type of sexual
dream content (M = 35%; W = 26%), followed by intercourse (M =26%, W = 27%), kissing (M = 21%, W = 27%) and fantasies (M = 21%,F = 24%). Irrespective of gender, sex dreams were more likely to takeplace in an unknown setting rather than in a familiar one. Men more
often described themselves as having initiated sexual contact (M = 39%,
W = 28%) but women were more likely to describe at least part of thesexual activity as being unwanted (17% versus 11%). Current or past
partners were identified in 30% of women’s sex dreams compared to
11% for men. Older adults were more likely than students to havesexual dreams containing one’s current partner (24% vs 14%) and older
males were almost 2.5 times more likely than student males to describe
themselves as the initiators of erotic activities.
Discussion: To our knowledge, this is the first study to have investigated sex-related dream content variables in a large sample of log-based
dreams. The findings reveal multiple gender and age based differences.
In line with the continuity hypothesis of dreaming, these variations may
be indicative of different waking needs, experiences, desires and attitudes with respect to sexuality.

PO-2-095
SLEEP ARCHITECTURE IN SYNOMOLOGUS
MACAQUE ACROSS A 24-H LIGHT ANDDARK PERIODK HONDA
Sleep Science Laboratories, Hamri Co., Ltd., Koga-city, Ibaraki, Japan
Basic sleep research typically involves the use of animal models such as
mouse, rat, rabbit, cat and dog. The non-human primate synomologus
macaque (Macaca fascicularis) is widely used for research on humandiseases, including neurological disorders; however, little is known
about this animal’s sleep architecture. Thus, we investigated the sleepwake patterns of synomologus macaque in 24-h polysomnographic
recordings using telemetry.
Five male synomologus macaques, weighing 3–5 kg each, were chronically implanted with cortical EEG, orbit EOG and neck EMG electrodes.
All electrodes were connected to wires that passed subcutaneously andterminated at the telemeter transmitter in the abdomen. EEG, EOG, and
EMG were continuously recorded by the telemetry system across circadian dark (19:00–07:00) and light (07:00–19:00) periods. Polysomnographic data were visually scored using criteria based on the standards
for staging human sleep.
In synomologus macaque, non-REM sleep accounts for 90.5 ± 2.5%
(n = 5) of total sleep time while REM sleep accounts for 11.1 ± 1.9%
(n = 5) of total sleep time during the dark period. Most of the slow
wave sleep states appeared during the first few hours of the dark period.
These results clearly demonstrate that synomologus macaques are
diurnal animals with mono-phasic sleep-wake circadian patterns. Furthermore, the sleep architecture of synomologus macaques is closely
related to that of humans.
In conclusion, our results suggest that synomologus macaque, a diurnal
non-human primate, may be a promising experimental animal model
for studying sleep disorders and newly developed drugs.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-096
NONINVASIVE DETECTION OF SLEEP/WAKE
CHANGES IN OREXIN/ATAXIN-3 TRANSGENICMICE ACROSS THE DISEASE ONSETY SAGAWA1, N HIRAI2, S SATO3, T KANBAYASHI1, T SHIMIZU1,S NISHINO2
1
Department of Neuropsychiatry, Akita University, Akita-city, Akita, Japan,
2
Department of Psychiatry and Behavior, Stanford University, United Statesof America, 3Department of Cell Physiology, Akita University, Japan
Introduction: Narcolepsy is characterized by excessive daytime sleepiness, a fragmented sleep/wake pattern, cataplexy and other dissociatedmanifestations of REM sleep. The hypocretin/ataxin-3 transgenic (TG)mice exhibit a phenotype similar to human narcolepsy. Hypocretincontaining neurons in TG mice are selectively ablated postnatally andlost over 99% by 84 days postnatal age. No sleep recordings were,
however, conducted at the disease onset. This is partially due to themethodological limitation; implantations of an EEG headstage in
growing young mice and a long term monitoring are difficult. In thisstudy, we evaluated the sleep/wake changes of narcoleptic mice from
2 weeks old and across the disease onset using the piezoelectric (PZT)
system as a noninvasive sleep monitoring system.
Method: Sleep recordings of 6 TG mice and 6 respective wild type (WT)
littermates were performed. PZT sensor can detect the movements andthe heart rate and respiratory variation. Mice were simply placed on the
PZT-sensor for 3 hours during the light period, and the recordings wererepeated on 14, 28, 56, 84, and 98 days after the birth. The amount of
sleep and the sleep/wake bouts of TG and WT mice were analyzed using
our original software.
Result: The sleep amounts in TG mice over 28 days old become larger
than those of WT mice, but the differences did not reach to the significant levels. There were no changes in wake bout length nor any differences between the genotypes during the study period. In WT mice,
there was also no change in sleep bout length. In contrast, sleep boutlength in TG mice decreased over the age. As a result, significant differences in sleep bout length between the genotypes were observed over
56 days old.
Conclusion: The sleep fragmentation in narcoleptic mice progresses
during the period of progressive loss of hypocretin neurons. Our results
confirm that the piezoelectric sensor is useful as a noninvasive sleepand behavior monitoring system, especially in the developmental
period. Analysis of other sleep behavioral changes using the piezosignals obtained is also in progress.

PO-2-097
CATECHOLAMINERGIC DRUGS MODIFY THE
NARCOLEPSY-CATAPLEXY EPISODES IN
MUTANT TAIEP RATMDC CORTES1, M LARA-LOZANO1, JR EGUIBAR2
Institute of Physiology, B. Universidad Autnoma de Puebla, Puebla,
Mexico, 2Provost Office and Institute of Physiology, B. Universidad
Autónoma de Puebla, Mexico
1

In 1989 Holmgren et al. described a new mutant rat which develops a
progressive motor syndrome during its lifespan. The syndrome is characterized by a tremor in the hindlimbs followed by ataxia, immobility
episodes (IEs), epilepsy, and paralysis. The acronym of these symptoms
named this autosomic recessive mutant trait as taiep. In this study, we
analyzed the effects of systemic administration of several catecholamin-

ergic drugs in the expression of gripping-induced IEs in 8-month-old
male taiep rats. The animals were housed under a 12:12 light-dark cycle(lights on at 0700) with controlled conditions around 21 Celsius
degrees and 30%-45% relative humidity all the time. The administration of drugs was done by i.p. route with an increasing dose scheme
every 48 h. We recorded the frequency, total duration of each IEs andthe latency of the first IEs. The drugs used were: yohimbine, clonidine,prazosin, D-amphetamine and modafinil. All experimental procedures
were approved by the IACUC and the experiments start at 0800 andlasted 90 min. Systemic administration of clonidine or prazosin produced an increase in the frequency and mean duration of grippinginduced IEs, while D-amphetamine modafinil, two dopamine reuptake
blockers, are very effective to decrease a diminution in the frequency
and duration of IEs. On the other hand, yohimbine, an alpha 2 antagonist, is capable to abolished IEs with the higher dose tested (1 mg/Kg).
These findings correlate with the pharmacological observations madein narcoleptic dogs and humans, in which chatecholaminergic including dopaminergic and adrenergic mechanisms are involved in themodulation of cataplexy. So, taiep, a myelin mutant rat with a severe
demyelination is an adequate model to study cataplexies and then anadequate option to study the new therapeutic options available to treat
cataplexy.

PO-2-098
SEX-SPECIFIC ASSOCIATIONS BETWEEN SLEEPPROBLEMS AND HYPOTHALAMIC-PITUITARYADRENOCORTICAL AXIS ACTIVITY IN
CHILDREN

A-K PESONEN1, E KAJANTIE2, K HEINONEN3, R PYHL4, J LAHTI5,A JONES6, K MATTHEWS7, J ERIKSSON8, T STRANDBERG9,K RIKKNEN10
1
Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland,2
Hospital for children and adolescents, University of Helsinki, Finland,
3
Institute of Behavioral Sciences, University of Helsinki, Finland, 4Instituteof Behavioral Sciences, University of Helsinki, Finland, 5Institute of
Behavioral Sciences, University of Helsinki, Finland, 6Centre for
Cardiovascular MR, Institute of Child Health, United Kingdom, 7Universityof Pittsburgh, University of Pittsburgh, United States of America, 8Instituteof clinical medicine, University of Helsinki, Finland, 9Faculty of medicine,
University of Oulu, Finland, 10Institute of Behavioral Sciences, University
of Helsinki, Finland
Study objectives: Sleep problems are associated with reduced physicaland mental health. Altered function of the hypothalamic-pituitaryadrenocortical axis (HPAA) may be one underlying mechanism. We
studied the associations between sleep problems and HPAA activity inchildren.
Design: A cross-sectional epidemiological cohort study.
Setting: Salivary cortisol was sampled throughout one day at home andduring the Trier Social Stress Test for Children (TSST-C) in clinic. Sleep
disorders were measured with a parent-rated Sleep Disturbance Scale
for Children, and sleep duration measured by actigraphy for one week.
Participants: 284 (51 percent girls) 8-year-old children.
Results: Boys with sleep problems (85th percentile in any of the sleepwake transition, arousal, excessive daytime somnolence or sleep hyperhydrosis subscales) had lower diurnal salivary cortisol levels andsalivary cortisol responses to TSST-C stress in comparison to boys
without sleep problems. Girls with sleep problems (85th percentile indisorders of initiating and maintaining sleep) displayed a higher overalllevel of salivary cortisol during the TSST-C. Salivary cortisol responses© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research373

Sleep, Science and Research

to stress were lower in boys and higher in girls with more than one
sleep problem.
Conclusions: Sleep problems in children are associated with altered
HPAA function, after controlling for actual sleep quantity measured by
actigraphy. Boys with sleep problems had lower HPAA activity and girls
with sleep problems had higher HPAA activity, compared to children
without sleep problems.

PO-2-099
CLINICAL SIGNIFICANCE OF LONG-TERM
HOME MONITORING OF FETAL MOVEMENTDURING SLEEP IN TWO HIGH-RISK PREGNANTWOMENK NISHIHARA1, S HORIUCHI2, H ETO2, N OKI3
Fatigue and Working Life Research Group, Institute for Science of Labour,
Fuchu-shi, Japan, 2Maternal Infant Nursing and Midwifery, St.Luke’s
College of Nursing, Japan, 3R & D, NoruPro Light Systems, Inc, Japan
1

Fetal movement is an index of fetal well-being. We have developed arecord-analysis system for fetal movement during maternal sleep athome using a new sensor (FMAM: Fetal Movement Acceleration Measurement).* Pregnant women who previously experienced stillbirth orneonatal death have high anxiety when facing another pregnancy. This
study looked at the use of long-term home monitoring of fetal movement in high-risk pregnant women in order to reduce their anxiety.
Methods: Subjects were ten normal pregnant women (range:
29 yr–39 yr) and two high-risk pregnant women (33 yr and 38 yr) who
previously experienced stillbirth or neonatal death. All subjects gave
written informed consent to the study. We provided FMAM recorders
to the subjects. In addition, midwives visited the homes of the two
women at risk to check their health. All subjects used the FMAM
recorder once every four weeks. One sensor was placed on the abdomen
to record fetal movement, and the other was placed on the thigh torecord their own movement. All women recorded fetal movement
during sleep by themselves.
Results: Median (and range) numbers for fetal movement per hour
during sleep for the normal pregnant women were 116 (56–206), 110(42–173), 108 (68–152), and 99 (31–146) at 24, 28, 32, and 36 gestation weeks respectively. There were large individual differences in fetal
movement. The numbers for fetal movement for the woman who previously experienced stillbirth were 53 and 47 at 34 and 36 weeks respectively. The numbers for fetal movement for the woman who previously
experienced neonatal death were 52, 81, 94, and 93 at 24, 29, 34, and37 weeks respectively.
Conclusion: The number of fetal movements per hour during sleep forthe two women who experienced stillbirth or neonatal death was similar
to those for the normal pregnant women. Knowing weekly variation of
fetal movement at night contributed to reducing anxiety in the pregnant
women at risk. Interviews were also useful for reducing their anxiety.
*K. Nishihara, S. Horiuchi, H. Eto, M. Honda.Early Human Dev.
84:595–603, 2008

374

PO-2-100
THE DISCREPANCY BETWEEN ACTIGRAPHIC
AND SLEEP DIARY MEASURES OF SLEEPIN ADOLESCENTS

MA SHORT1, MS GRADISAR1, LC LACK1, H WRIGHT1,
MA CARSKADON2
1
School of Psychology, Flinders University, O’Halloran Hill, Australia,
2
Department of Psychiatry and Human Behavior, E.P. Bradley Hospital,
United States of America
STUDY AIMS: To explore the discrepancy between sleep diary andactigraphic measures of sleep in adolescents and to ascertain whether
these discrepancies may vary according to characteristics of theparticipant.
PARTICIPANTS: 385 adolescents aged 13–18 years (X = 15.6, SD =0.95; 60% male) from eight high schools in South Australia.
MEASUREMENTS & METHODS: Adolescents completed the School
Sleep Habits Survey and Paediatric Daytime Sleepiness Scale during classtime, followed by an 8-day Sleep Diary and wrist actigraphy. The Flinders
Fatigue Scale was completed on the final day of the study. Parents completed a Sleep, Medical, Education and Family History survey.
RESULTS: Actigraphic estimates of wake after sleep onset (WASO)
were substantially greater than sleep diary estimates (74m actigraphy
vs. 7m sleep diary) and conversely actigraphic estimates of sleep were
substantially less than both sleep diary and parent-report (6h51m actigraphy vs. 8h16m sleep diary vs. 8h51m parent-report). Sleep diaryestimates, but not actigraphy, displayed significant relationships withdaytime functioning. Actigraphy showed weak relationships with concomitantly recorded sleep diary variables. Sex and puberty-related differences were found in actigraphic scoring. Actigraphy scored more
WASO and less sleep in boys compared to girls, and more WASO
amongst pubertally-mature boys than boys of less advanced pubertal
development.
CONCLUSIONS: There may be differences in the sleep of adolescentsthat result in less actigraphic total sleep scored than perceived, particularly in boys, possibly because of increased sleep motor activity inadolescents that actigraphic algorithms score as wake. This is a significant concern that requires further examination with PSG.

PO-2-101SLEEP LATENCY ON MSLT IN HEALTHY YOUNG
ADULT-COMPARISON BETWEEN 7-HOUR SLEEPAND 3-HOUR SLEEPYF NAKABAYASHI1, H SUZUKI1, A SHIMADU2, R MASHYAMA3,A USUI3
1
Graduate School of Health Care Science, Bunkyo Gakuin University,
Tokyo, Japan, 2Former Ota Sleep Center, Ota General Hospital, Japan,
3
Faculty of Health Science Technology, Bunkyo Gakuin University, Japan

Purpose: Japanese young adults have insufficient sleep. We studied theinfluence of subacute partial sleep deprivation on their sleep latencies(SL) and frequency of sleep onset REM periods (SOREMPs) on multiple
sleep latency test (MSLT).
Methods: Subjects were healthy seven females and three males (meanage: 21.4 ± 0.7 years). We obtained written informed consents from allof them. The study schedule was as follows: in the control (C)condition, the subjects were allowed seven-hour sleep for the baseline
week (BW) and the following experimental week (EW); in the partial
sleep deprivation (SD) condition, they were allowed seven-hour sleepfor BW and three-hour sleep for EW. The wakeup time was the same

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

clock time. C and SD conditions were done in crossover design for eachsubject. The subjects’ wrist activity was measured by using Actiwatch(Mini-Mitter Co., Inc., Bend, Ore) for both two weeks and actigraphic
sleep-wake state was calculated by the recommended method. On both
final days on EWs, polysomnography (PSG) and MSLT were
performed.
Results: Nighttime actigraphic sleep was approximately five hours on
both BWs, and those of C and SD conditions on EWs were about 5.5
and 3.5 hours, respectively. Total sleep time on PSG was about six hours
in C condition and about three hours in SD condition, respectively. The
mean SL (mSL) on MSLT was 6.3 minutes in C condition and 3.9
minutes in SD condition. The frequency of SOREMPs was higher in SD
condition than C condition.
Conclusion: Even in C condition, mSL of the subjects was less thaneight minutes. In SD condition, mSL was shorter and the frequency of
SOREMPs was higher than in C condition. When we examine young
adults, we should exclude insufficient sleep syndrome carefully fromother hypersomnias as narcolepsy.

PO-2-102
VIGILANT ATTENTION IN SLEEP WAKEDISORDERS: NORM VALUES ON THE
PSYCHOMOTOR VIGILANCE TASK (PVT)E WERTH, J THOMANN, J MEIER, S WEBER, CR BAUMANN
Department of Neurology, University Hospital Zrich, Zurich, Switzerland
The Psychomotor Vigilance Test (PVT) is one of the leading assays ofvigilant attention in sleep research and highly sensitive to the effects ofsleep loss. Rather little is known about PVT performance in patients
suffering from sleep-wake disorders. With the present study, we aimed
at evaluating the use of PVT in clinical routine in a sleep laboratory.
The objective was to examine the patterns of PVT outcomes in patientswith different sleep-wake disorders and in healthy control subjects, andinterpret these patterns in relation to other tests of sleep andwakefulness.
We compared PVT data of 356 patients and 67 healthy control subjects.
Patients were diagnosed with one of the following sleep-wake disorders:narcolepsy with cataplexy, behaviorally induced insufficient sleep syndrome (BIISS), hypersomnia, fatigue, sleep related movement disorder(SRMD), central and obstructive sleep apnea, REM-sleep parasomnia
and insomnia. The following PVT outcomes were analysed: medianreaction time, lapses (>500 ms), false starts (<100 ms) and variability(interpercentile range between 10th and 90th percentile). PVT performance was significantly better in healthy controls than in patients withsleep-wake disorders. Furthermore, we found additional differences
between specific sleep-wake disorders. Based on the comparison
between patients and healthy controls we suggest cut-offs of 270 ms
for median reaction time, 1 for lapses and 120 ms for variability. There
was a correlation between PVT and Steer Clear, but correlations between
PVT and MSLT/MWT were weak to absent. As there were influences ofage, sex, major depression and Parkinson disease on PVT results, theymust be interpreted in combination with other clinical findings andsleepiness tests.
In conclusion, our study quantified the differences in vigilance performance between patients with sleep-wake disorders and healthy controls. It is the first to publish cut-offs for the distinction between normal
and impaired vigilant attention measured with PVT.

PO-2-103
DETECTING DETERIORATED PERFORMANCEUSING PERCENTAGE OF EYELID CLOSURE TIME
DURING OXFORD SLEEP RESISTANCE TESTST ABE1, T NONOMURA3, Y KOMADA1,2, S ASAOKA1,2, T SASAI1,2,
A UENO3, Y INOUE1,2
1
Japan Somnology Center, Neuropsychiatric Research Institute, Sanda,
Hyogo, Japan, 2Department of Somnology, Tokyo Medical University,
Japan, 3Graduate School of Engineering, Tokyo Denki University, Japan

Several researchers have investigated the relation between vigilance andocular variables such as saccade, slow eye movement, pupil, blink, oreyelid closure. This study was undertaken to find the most effective
indicator among these ocular variables for evaluating short-term (1 min)fluctuation of vigilance, and to investigate the ability of the most effective ocular variable for predicting deteriorated vigilance during behavioral maintenance of the wakefulness test (Oxford sleep resistance test:
OSLER test). Nine healthy volunteers (two women, 19–30 years old,
23.4 ± 3.9 years old) participated in this study. Ocular variables wererecorded during the OSLER test at 10 A.M. and 2 P.M. before and afterpartial sleep deprivation (4 hr sleep). The periods during the OSLER
test were divided into 1 min epochs. Each epoch was classified according to the number of consecutive missed responses. Decreased blink
frequency and pupil diameter as well as increased PERCLOS (percentage of eyelid closure time) and slow eye movement were observed as
the consecutive missed responses increased. Among these variables,
PERCLOS showed the highest ability to detect occurrences of any
missed responses and three or more consecutive missed responses. Our
study also found that a missed response seldom occurred (0.2 ± 0.2 /20 trial / min) when the PERCLOS was lower than 11.5% per 1 min.
Our research has added a new finding: PERCLOS is the most effective
indicator for detecting deteriorated vigilance among the ocular variables. Maintaining PERCLOS below 11.5% might be effective for preventing deteriorated vigilance.

PO-2-104
ELECTROCARDIOGRAM-BASED MEASURE OFSLEEP STATE INSTABILITY PREDICTS SLOWER
REACTION TIME IN PSYCHOMOTOR VIGILANCETASK: A PRELIMINARY STUDY

H KIM1, C-H YUN2, RJ THOMAS4, SK LEE1, ER CHO1, S KIM1,C SHIN1,3,5
1
Institute of Human Genomic Study, Korea University Medical Center
Ansan Hospital, Ansan-si, Gyeonggi-Do, Republic of Korea, 2Department of
Neurology, Inha University Hospital, Republic of Korea, 3BK21 Programfor Biomedical Science, Korea University College of Medicine, Republic ofKorea, 4Division of Pulmonary, Critical Care and Sleep Medicine, BethIsrael Deaconess Medical Center, Boston, United States of America,
5
Department of Pulmonary, Sleep and Critical Care Medicine, Korea
University Medical Center Ansan Hospital, Republic of Korea
Introduction: Numerous clinical and experimental data have demonstrated that disrupted or diminished sleep leads to the impairment incognition and psychomotor vigilance. Therefore, good quality andadequate amount of sleep is essential to the waking cognitive performance. Early attempts to understand the effect of sleep quality on cognition were based on subjective scales such as Pittsburgh Sleep Quality
index or insomnia symptoms. In this study, we adopted the electrocardiogram (ECG)-based cardiopulmonary coupling (CPC) analysis as© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research375

Sleep, Science and Research

an objective index of sleep quality, and its effect on the psychomotor
vigilance were investigated.
Methods: We performed CPC analysis on ECG signal derived fromhome portable sleep study of 401 participants (aged 56.3 ± 7.1, 69%male) of ongoing Korean Genome and Epidemiology Study (KoGES).
Sleep state stability was determined in terms of high-, low-, and very
low frequency coupling between the heart rate and the respiration(frequency, Hz.), and namely, spectrographic measure of very frequency
coupling (VLFC) was used as an index of wakeful/REM sleep slate.
Psychomotor vigilant task (PVT) was administered in the morning (8:00
AM to noon) as a measure of daytime cognitive function, and the effectof CPC parameters and conventional sleep structures on psychomotor
vigilance was investigated.
Results: Reversed PVT mean reaction time (1/mean reaction time,msec-1), was negatively associated with VLFC (p = 0.005). With age,sex, body mass index, education, apnea-hypopnea index, sleep duration, Becks Depression Index, and Epworth Sleepiness Scale (ESS)
adjusted, VLFC remained an independent predictor of slower mean
reaction time (p = 0.003) in a step-wise multiple linear regression
analysis (R2 = 0.18, p =< .0001).
Conclusion: CPC parameters as the objective metrics of sleep quality
were closely related to the psychomotor vigilance. In particular, VLFC
(REM/wakeful state) has a prominent impact on vigilant attention.

PO-2-105
THE PATTERN OF BREAST BREATH DURINGSLEEP ONSET PERIODM FURUTANI1, N KANAMORI2, Y FUJIWARA2, H TANAKA3
1
The Graduate School of Human Life Sciences, Notre Dame Seishin
University, Higashihiroshima, Hiroshima, Japan, 2Technology R&D
Headquarters, SANYO Electric Co., Ltd., Japan, 3Department of Clinicalpsychology, Hiroshima International University, Japan
Respiratory movements during wakefulness is predominant abdominal,
however that changes to a pattern of breast dominance in sleep. The
purpose of the present study was to investigate the pattern of breast
breath in sleep onset period with a sheet sleep sensor.
Sleep was recorded in 8 healthy college students (mean age = 21.0 yr.,
SD = 0.76) who slept for 4 consecutive nights in their home. Subjects
were given a thorough explanation of the protocol and provided written
informed consent prior to participation in the study. Sleep latency
was calculated using a sheet sleep sensor (SANYO Electric Co., Ltd.)and Actigraph (A. M. I). Both measuring devices are nonconstraining
and noninvasive. A short sleep latency day (mean = 20.9 minutes) andlong sleep latency day (mean = 63.0 minutes) were comparedwith the quality of sleep, subjective sleep and number of breast
respiration.
Result of the present study demonstrated that a short sleep latency day
led to a significantly increased total sleep time. On a short sleep latency
day, subjects experienced easily with falling asleep and displayed maintaining sleep, according to the Oguri – Shirakawa – Azumi (OSA) sleep
feeling questionnaire. The number of breast breath during sleep onset
in the short sleep latency day was many than that of long sleep latency
day. An increased number of breast breath was also shown 30 minutes
after sleep onset. These results suggest that measuring the number ofbreast breaths may constitute a new way to assess sleep quality.

376

PO-2-106NORMALIZATION AND CASE-SPECIFIC
DEFINITION OF EEG BANDS IN SPECTROGRAMSFOR IMPROVING VISUALIZATION AND
AUTOMATED SCORING OF SLEEP STUDIESEA VIVALDI, A BASSI, J DIAZ
Programa de Fisiologia y Biofisica, Universidad de Chile, Santiago, Chile
EEG spectrograms display a grid where columns represent time epochs
and rows represent frequency bins. The intensity of each cell in the grid
denotes the FFT amplitude of the EEG signal at given time and frequency. These graphs are useful for all-night recording visualization andare remarkably helpful as a first step for automating state and stage
assignments. We propose here a mathematical treatment based on spectrogram normalization to improve visualization and on subject-specificfrequency band definition to improve automated scoring. A single EEG
channel, typically C3M1, undergoes FFT processing according to Welch
method using 4 s Hanning tapered windows with 50% overlapping.
Frequencies over 30 Hz are discarded. The resulting spectrogram is log
scaled, aggregated in 30-second epoch averages and normalized for zeromean and unitary variance in each frequency bin. Spectrogram normalization emphasizes the relative distribution of bands throughout sleep
time and enhances particularly the descriptive value of higher frequency
bands. From the normalized spectrograms, a frequency covariancematrix is computed and displayed. Four bands corresponding to delta,alpha, sigma and beta become evident. The highly contrasted limits
between these bands are obtained by locating the extremes of a standard
central-difference-derivative estimation method. Theta band is operationally defined in rapport to the lower alpha band. Band activities arecalculated by averaging the normalized spectrogram over each band
range for each epoch, and then normalizing the results in turn. Activities are used, by themselves or in combinations such as the theta-alphadifference, as the key features that optimize clustering for state segregation (Vivaldi EA et al., Conf Proc IEEE Eng Med Biol Soc 2010:280–3,
2010). Spectrogram normalization provides a compactly informative
all-encompassing view of sleep states and their transitions, employing
one-channel EEG data. The frequency covariance matrix allows tailoring the band limits to each case.

PO-2-107
THE DETECTION OF EEG FEATURE OF SLEEPSTAGE 2 BY A NEW SCORING SYSTEM

M HAYASHI1, A FUSHIMI1, H IIZUKA2
Graduate School of Integrated Arts and Sciences, Hiroshima University,
Higashi-Hiroshima, Hiroshima, Japan, 2Future Project, TOYOTA Motor
Corporation, Japan1

We have reported that the recuperative power of a daytime short nap
depends on the length of sleep stage 2 (Hayashi et al., 2005). However,
it is not clear what the quality of the nap has recuperative power. Then,
we tried to make a new scoring system to classify the quality of sleep
stage 2, referred to the 5s-EEG stages of hypnagogic state (Hori et al.,1994) and REM sleep (Takahara et al., 2006). Eleven healthy university
students (9 female and 3male; 21 to 24 yr.) participated in the study.
They took a nap for 1 hour from 14:00 in a bed (n = 3) or in a reclining
seat (n = 9). Sleep stages were scored every 20s by the standard procedure, and then C3-EEG during sleep stage 2 was divided into 5s andwas rescored. EEG stages of sleep stage 2 could be scored as the
5s-epochs composed of more than 50% of the following EEG wave
forms. 1) Flattening: suppressed waves with the amplitudes of less than

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

20 μV. 2) Theta: theta waves with the frequencies of 4 to 7 Hz andamplitudes of more than 20 μV. 3) Spindle: spindles with duration of
more than 0.5s or with composed of more than 6 consecutive waves.
4) K-complex: the appearance of delta waves with frequency of less than
4 Hz followed by positive peak of which amplitude of negative andpositive peak is more than 200 μV. 5) Small delta: delta waves of 2 to
4 Hz with the amplitudes of more than 20 μV or those of 0.5 to 2 Hz
with the amplitudes of less than 75 μV. 6) Large delta: delta waves of
0.5 to 2Hz with the amplitudes of more than 75 μV. And 7) Mixed: theepoch with no more than 50% of any EEG waves listed above.

PO-2-108AN ATTEMPT OF SLEEP MONITORING USINGA NON-INVASIVE AND AMBULATORY CARDIAC
MEASUREMENT ON A BEAT-BY-BEAT BASIS
1

1

2

1

M OGAWA , K MOTOI , T YAMAKOSHI , M NOGAWA ,K-I YAMAKOSHI1
1
Graduate School of Schience and Engineering, Kanazawa University,
Kanazawa, Japan, 2Graduate School of Natural Science and Technology,
Kanazawa University, Japan
Sleep monitoring has been drastically advanced in these two or three
decades. Especially, importance of screening and evaluation of sleep
apnea syndrome (SAS) has enhanced polysomnography. Besides ofthem, we have been developed a non-invasive cardiovascular measurement. In this abstract, we would like to report our newly developed awearable cardiovascular monitoring monitor and its application tophysiological measurement during sleep.
The developed non-invasive wearable cardiovascular monitor includes
beat-by-beat continuous and non-invasive blood pressure (BP) andcardiac output (CO) simultaneous measurement whose measurement
methodologies are based on volume-compensation method and transthoracic admittance plethysmograph method. And ambulatory monitoring during daily life using the monitor has been reported [1]. In thistime, continuous monitoring during sleep was attempted. Continuous
cardiovascular measurements were done on seven healthy male subjects(yrs. 22–24). In the measurement, the subject was attached the cardiovascular monitor and asked to work at his desk and sleep after the work.
The five of seven subjects were slept during the experiment. The study
was approved by a local ethical committee.
As results, BP and CO were able to be measured during the measurement(including their sleep period) and total peripheral resistance was derived
from BP and CO then found that BP was clearly decreased in sleep period
but fluctuated as wakefulness period.Moreover, hemodynamics parameters HP (hemodynamic profile) and CO (compensation deficit) proposedby Gregg [2] were obtained and information of relative myocardial-andvascular balance during sleep was evaluated. After this, we’ll try toanalyze baroreflex sensitivity during sleep using measured data.
Acknowledgements: This research was partially supported by Health
Labour Sciences Research Grant (H21-Trans-General-013), Japanesse
Ministry of Health, Labour and Welfare, 2010–2011.
References[1] Ogawa M. et al., Adv. Nat.Sci., 2010, 3, 17–21[2] Gregg M E. et al., Psychophysiology, 2002, 39, 64–72

PO-2-109INVESTIGATION OF SLEEP STAGE IDENTIFYINGALGORITHM FOR SLEEP MONITORING SYSTEMBY DETECTING HUMAN ORIGINATED LOWFREQUENCY SIGNAL IN UNRESTRAINT WAY

T ATSUMI1, Y NAGATSU1, H IWAMI1, Y INAGAKI1, K NAKAYAMA1,S KOJIMA2, K SUENAGA3, T ENDOH4, S UCHIDA5
1
New Business Planning Dept., AISIN SEIKI Co., Ltd, Kariya-city, Aichi,
Japan, 2Information & Electronics Research Division, Toyota Central R&D
Labs., Inc., Japan, 3Inspection Section, Aoki Hospital, Japan, 4Hospital
Director, Sleep Clinic Chofu, Japan, 5Faculty of Sport Sciences, Waseda
University, JapanWe are developing sleep state monitoring system detecting human originated low-frequency signals in unrestraint way. We have been aiming toestablish quantitative sleep evaluation by means of the signal processingof human originated low-frequency vibration signals including heartbeat, breathing and body movement which are detected by using asheet-like vibratory sensor, however the improvement of the accuracy toidentify the sleep stages is one of the challenges of the system. In thisstudy, we used the signals which were recorded by Polysomnography(PSG) and attempted linear discriminant analysis using several pre-calculated characteristics derived from time and spectrum analysis of heartbeat fluctuations, variability of abdominal breathing and frequency ofbody movement. Then we evaluated concordance rate between our
results and clinical diagnostic solutions by R&K method. Furthermore,
we tried SVM which is one of nonlinear discriminant analyses, andcompared the result with that of linear analysis. As the result, under agiving condition and in the case of stage recongnition in four stages, we
obtained the concordance rate of around 50% by linear method. In
contrast, by nonlinear method, we obtained above 70%. It suggested
that the derived algorithm is useful for improvement of accuracy.

PO-2-110
RELATIONS BETWEEN SLEEP ACTIVITY
INDICES AND VERRAN AND SNYDER-HALPERN(VSH) SLEEP SCALE USING STATISTICALANALYSIS

Y-TC YANG1, J-S WANG2, C-W LIN2, W-C CHIANG2Institute of Education & Center for Teacher Education, National Cheng
Kung University, Tainan, Taiwan, 2Department of Electrical Engineering,
National Cheng Kung University, Taiwan
1

Sleep activity indices derived from wearable activity sensors such as
actigraphy are regarded as reliable indicators to represent objective sleep
quality, whereas the Verran and Snyder-Halpern (VSH) sleep scale are
regarded as a reliable tool to represent subjective sleep quality. The
relations between the sleep activity indices and the VSH sleep scalescore using statistical analysis are investigated in this study. The participants are instructed to wear an actigraphy for measuring the acceleration signals produced by body activities during their sleep. The sleep
activity indices derived from the acceleration signals include: 1) theamount of activity during all night sleep, 2) the average amount ofactivity of each hour during sleep, 3) the amount of activity in the firstninety minutes after lying on the bed, and 4) the amount of activity
whose counts are larger than 50. The VSH sleep scale employed in ourstudy includes three subscales: 1) disturbance, 2) effectiveness, and 3)
supplementation of sleep. Several items are included in each subscale
and the score of each item ranges from 0 to 100. The Spearman rankorder correlation is utilized in the relationship analysis between the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research377

Sleep, Science and Research

sleep activity indices and the VSH sleep scale. The statistical analysis
results show that three of the sleep activity indices have negative correlation to that of the disturbance and effectiveness of sleep (p < 0.05).
These three sleep activity indices are: 1) the amount of activity during
all night sleep, 2) the average amount of activity of each hour during
sleep, and 3) the amount of activity whose counts are larger than 50.

PO-2-111
USING A WEARABLE PHYSICAL ACTIVITYSENSOR SYSTEM FOR SLEEP/WAKE
STATES DETECTION

J-S WANG1, Y-TC YANG2, W-C CHIANG1, C-W LIN1Electrical Engineering, National Cheng Kung University, Tainan, Taiwan,
2
Institute of Education & Center for Teacher Education, National Cheng
Kung University, Taiwan
1

Low activity levels and prolonged motionlessness are two main featuresof sleep. In clinical practice, polysomnographic (PSG) recordings are agold standard for sleep assessment. However, the PSG is expansive andnot suitable for use in home environment. This paper introduces awearable physical activity sensor system for monitoring physical activity
during sleep. The portable watch-type sensor modules are placed on
wrist and ankle simultaneously and the epoch-by-epoch comparison of
sleep/wake states to PSG is made. In our validation test, a total of seventeen normal subjects (13 males and 4 females) aged between 19 and30 years are included. The subjects are asked to sleep in our sleep laboratory for two consecutive nights and the first night is for environment
adaptation to avoid the first night effect caused by the laboratory environment. The all-night PSG recordings are scored visually according to
the AASM rule by experienced sleep scorers. The experiment results
show that the overall sensitivity and specificity for sleep detection are
90.9% and 64.4%, and the overall accuracy is 88.9% when we only use
the wrist data for analysis. However, when we use both the data fromthe wrist and ankle sensors, the overall sensitivity and specificity to forsleep detection are 89.4% and 69.7%, and the overall accuracy is
88.0%. The specificity can be improved for more than 5.3% if the datafrom both wrist and ankle are used for detecting sleep/wakefulness. We
conclude that the wearable physical activity sensor system provides agood accurate detection of sleep/ wakefulness on an epoch-by-epochbasis.

PO-2-112
CAN HANDHELD DEVICE ACCURATELYMEASURE SLEEP PARAMETERS? COMPARISON
OF ACTIGRAPH, SLEEP DIARY AND
ELECTRONIC SLEEP DIARY APPLICATION
R HURDIEL, J VANHELST, T PEZE, D THEUNYNCK
Departement of Sport Science, Universit du Littoral Cte d’Opale,
Dunkerque, France
Introduction: Development and validation of user-friendly portable
sleep recording devices have important implications in sleep researchand education. The aim of the study was to report rates of agreement
between actigraphy (ACT), manuscript sleep diary (SD) and an electronic sleep diary (ESD) application for handheld device.
Method: 38 healthy adults (29 ± 9 yrs; 45% women) recorded sleep
data for 6 to 7 days. Participants wore wrist actigraph and used an
application for handheld device (Scextan) set on one-minute intervals.
For each one-minute epoch, Sadeh’s algorithm was used to score acti-

378

graph recordings as wake or sleep. Nineteen participants also recorded
data from a manuscript sleep diary at 15-minute intervals. Total sleep
time (TST), wake after sleep onset (WASO), and sleep efficiency (SE)were derived from the three methods. Sleep onset latency (SOL) was
determined from ESD bedtime information to ACT and ESD sleep
onset.
Results: Inter-group deviation analysis between ACT and ESD did notshow statistical differences (t test). TST analysis revealed better correlation (Spearman) and agreement rate (using the Bland and Altman
method) for ACT vs ESD (bias = −6.2 min; SD = 10.9; rho = 0.93; p <0.0001), than for ACT vs SD (bias = −5.1 min; SD = 30.1; rho = 0,70;
p < 0.0001). SOL analysis showed high correlation and good agreement
between ACT and ESD (bias = 3.7 min; SD = 10.1; rho = 0.80; p <0.0001). WASO correlation coefficient was low for ACT vs ESD (rho =0.14) as for ACT vs SD (rho = 0,32). SE analysis also revealed poorcorrelation for ACT vs ESD (rho = 0,18) and for ACT vs SD (rho =0,25).
Conclusion: Electronic sleep diary is a valid method to measure TST
in healthy subjects and is more accurate than a manuscript sleep diary.
SOL measurement appears to be the most efficient for short latencies.
We agree that subjective assessments need to be supplemented by theuse of an accelerometer to detect awakenings during sleep. Nevertheless, electronic sleep diary application on handheld device could offer
more educational facilities than manuscript sleep diary and remains
cheaper than the actigraph.

PO-2-113
A LONG-TERM SLEEP MONITORING OF THE
ELDERLY WITH DEMENTIA USING A NONWEARACTIGRAPHY DEVICE (NEMURI SCAN)T INOUE1, T KOGURE1, T KAWAMOTO1, S SHIRAKAWA2
1
Paramount Bed Sleep Research Laboratory, PARAMOUNT BED CO.
LTD., Tokyo, Japan, 2National Institute of Mental Health, National Centerof Neurology and Psychiatry, JapanOBJECTIVE: Considering day-to-day and week-to-week variability, it
is reported that a valuable improvement in the reliability of actigraphic
sleep evaluation can be obtained by increasing the number of recordingnights. However, few studies record sleep of persons with dementia using
wrist acitgarphy (WA) devices over several weeks. Nonwear devices are
better suited for a long-term sleep monitoring of the elderly with dementia (ED) than wear-type devices such as WA. A nonwear actigraphy(NWA: NEMURI SCAN, Kogure et al., J Physiol Anthropol 2011) device
placed under a mattress that can score sleep/wake and in-bed/out-of-bed
from body motion in bed was recently developed. We conducted a longterm sleep monitoring of ED using the NWA device.
METHODS: NWA recordings for 12–14 days were made for 62 ED
participants (18 men, 44 women), aged 70–95 years (average 84.2 ±5.6). We calculated sleep parameters by NWA and investigated thein-bed/out-of-bed regularities. Ethical approval was obtained prior to
the study.
RESULTS: The data containing unidentified into-bed-time or arise-time(5 participants) were excluded. As a result, we analyzed data of 57 ED
participants (17 men, 40 women), aged 70–95 years (84.3 ± 5.7). Meanvalues of total sleep time, sleep latency, sleep efficiency, and wake timeafter sleep onset were 488 min (range, 305–692), 20.9 min (8.1–133),
77.5% (51.9–94.4), 114 min (20–270). Mean values of time in bed,
into-bed-time, and arise-time were 630 min (472–742), 20:14 (19:10–
22:08), and 6:42 (5:02–8:10). Mean values of total out-of-bed time andnumber of out-of-bed were 15.4 min (0–76.8) and 2.9 (0–17.1). Eachparticipant’s range of total sleep time was 69–541 min (219 ± 110). The© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

in-bed/out-of-bed regularities were observed in 41.7% of participants
who go out of bed at least once a sleep time.
CONCLUSION: Sleep of ED differed greatly in individuals and sleep
parameters of ED varied greatly from day to day. It is expected that theNWA device, a non-wear device for scoring sleep/wake and in-bed/
out-of-bed, enables the convenient sleep-related evaluation over several
months or years.

PO-2-114
DEVELOPMENT OF A NETWORK SYSTEM FOR
LONG-TERM SLEEP MONITORING AT HOME
AND ITS APPLICATION TO MEDICAL CARE FOR
CARDIOVASCULAR DISEASEK MOTOI1, M OGAWA1, I MITO2, N TANAKA1, K HATA1,K MATSUMURA1, T YAMAKOSHI1, S TANAKA1, H ASANOI2,
K-I YAMAKOSHI1
1
Graduate School of Natural Science and Technology, Kanazawa
University, Kanazawa, Ishikawa, Japan, 2Department of Internal Medicine,
Imizu City Hospital, JapanThe demand for less-burdensome daily sleep monitoring at home has
been increasingly raised as an effective scheme for early diagnosis andtreatment of sleep apnea syndrome: SAS. Moreover, there is a need tomonitor such sleep status of patients having chronic cardiovasculardisease requiring acute life support or chronic therapies. Commerciallyavailable devices for sleep monitoring at hospital are cumbersome interms of attachments of biological sensors and operations of the devices.
From these view points, we developed the under-pillow type and the
sheet-type sleep monitoring systems without any attachment of biological sensors and operations of devices, showing its usefulness for simple
screening of SAS. Furthermore in this study, we have newly developed
a fully automated network system for long-term sleep monitoring at
home combined with the under-pillow type and the sheet-type pressure
sensors. The system can monitor the pulse and the respiration in bed
during daily living, using the pillow-type sensor. Moreover, the contactpressure distribution can be also detected to evaluate not only sleep
condition such as the body position, but also the risk of the bedsore,using the sheet-type multipoint pressure sensor. These data are fully
automatically transferred to the server located at hospital and the
medical staff can check the daily sleep status of the patients using a web
application in real time. In six patients with chronic cardiovasculardisease, the daily sleep statuses such as the pulse rate, respiration rate
and the body position were successfully measured in the home ofpatients using the system. The results demonstrated that the systemappears useful for less-burdensome monitor of daily sleep condition in
the patient with chronic cardiovascular disease.

PO-2-115
HIGH RECALL ACTIGRAPHIC SLEEP/WAKE
DETECTION BASED ON STATISTICAL
CLASSIFICATIONK KAWAMOTO1, S TAJIMA2
1
Central Research Lab., Hitachi, Ltd., Tokyo, Japan, 2Hyogo Rehabilitation
Central Hospital, Children’s Sleep and Development Medical ResearchCenter, Japan
Introduction: Many existing algorithms for actigraphic sleep/wakedetection are based on single feature regression, yet various research(de Souza, 2003) find that such methods successfully identify only 34%

of all wake epoches. We propose using a statistical classifier to combinea larger set of features to improve sleep/wake detection, and evaluate
this using PSG-generated labels.
Methods: 15 healthy adults underwent a night of full PSG while
wearing a triaxial accelerometer (“Life Microscope” life recorder, HitachiLtd.) on their left wrist. The PSG data was scored in 30 second epoches
according to the R&K sleep stage scale. Our proposed method has twostages:(1) Training: periods of body movement during sleep are identified byan acceleration threshold. A feature vector is calculated for eachperiod from a set of 115 features, such as zero-crossing count andmaximum scalar power. The period is associated with a target class“Wake” or “Sleep” depending on its cooccurrence with a wake stage,
to which a Random Forest classifier is trained on.
(2) Prediction: the classifier is applied against all movement periods,
and any 1 minute epoche that clips a “Wake” period is predicted
as a “Wake” epoche.
Results and Discussion: Per-epoche sensitivity and specificity of sleep
detection was evaluated by cross validation. The proposed method
maintained similar sensitivity to Cole (Cole: 99%, Proposed: 96%), butwith higher specificity (Cole: 34%, Proposed: 59%). We thus conclude
that usage of a larger feature set is effective in sleep/wake detection.
We observe that the most important feature was the average power, incontrast to the zero-crossing count usually used as per Cole. This suggests that single feature regression can also benefit from a more informed
choice of features.

PO-2-116
AGREEMENT OF ACTIGRAPHIC SLEEP/WAKE
STATES BETWEEN ACTIWATCH AND
ACTIGRAPH

HF SUZUKI1, Y NAKABAYASHI1, A SHIMADU2, R MASHIYAMA3,A USUI3
1
Graduate School of Health Care Science, Bunkyo Gakuin University,
Tokyo, Japan, 2(former) Ota Sleep Center, Ota General Hospital, Japan,
3
Faculty of Health Science Technology, Bunkyo Gakuin University, Japan
Purpose: The activity monitoring is used to help sleep study. However,
the methods of measurements and algorisms used to evaluate sleep/
wake state are various. Those are different from polysomnography(PSG). Then, in this study, agreement of actigraphic sleep/wake states
between Actiwatch (AW, Mini-Mitter Co., Inc., Bend, Ore) and Actigraph (AG, Ambulatory Monitoring Inc., Ardsley, NY), and agreement
between each equipment and PSG were examined.
Methods: Subjects were healthy four females and three males (meanage: 21.7 years). Their wrist-activity was monitored by AW and AG
simultaneously for 48 hours in two conditions that were control (sevenhour sleep) and partial sleep deprivation (three-hour sleep). And PSG
were conducted on each second night. For each minute, actigraphic
sleep/wake state was calculated by each recommended method andpolysomnographic sleep stage was scored by the standard method. In
each method, sleep/wake state was assumed as 0/1. Then for eachminute, AW-PSG, AG-PSG and AW-AG were calculated (“0” means thejudgement was agreed).
Results:(1) The agreement rate between AW and AG sleep/wake states was low
when their activity was moderate range.
(2) In the partial sleep deprivation, the agreement rate between AW
and PSG was significantly lower than that between AG and PSG.
As compared with AG, AW more overestimated sleep during sleep
deprivation and wake during sleep after the deprivation.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research379

Sleep, Science and Research

Conclusion:(1) The agreement rate between the two devices’ sleep/wake states was
low when activity is moderate. There is no help for it because
actigraphic sleep/wake state is based on the amount of activity.
(2) Misjudgments by AW were more than that by AG. To solve thisproblem, improvements of sensitivity and algorism for sleep/wakestate should be done for AW.

than the actual suppression values. We focused on the pupil constriction and its correction factor to interpret the action spectrum for theproperties of the melatonin suppression model. When the correction
factor was used to modify the model, actual suppression values were
almost completely predictable. These factors suggest that it might bepossible to explain the indescribable results.

PO-2-119PO-2-117ESTIMATING SLEEP CYCLE USING
OCCURRENCE RATE OF BODY MOVEMENTS

Y KAMBAYASHI1, H HAGIWARA2
Advanced Information Science and Engineering Major, Ritsumeikan
University, Kusatsu, Shiga, Japan, 2Department of Human & ComputerIntelligence, Japan
1

Polysomnography (PSG) is an objective means of evaluating sleep andwaking states that uses brain waves, eye movements, and electromyograms. However, because this method requires the subject to wear alarge number of electrodes, at-home measurements of sleep and waking
states remain difficult. Several studies have shown that the occurrence
rate of body movement closely relates to sleep stage, and that thisoccurrence rate decreases as the sleep stage deepens. Thus, we devised
a new method for estimating the sleep cycle that uses the occurrence
rate of body movement. To make measurements less cumbersome forsubjects, body movement was measured using an infrared motion
sensor. In the present study, sleep stage determined by PSG as the main
physiology index was compared to the values estimated by measuring
body movement. The stages of sleep follow the international standardsof Rechtschaffen & Kales for sleep stage. Sixteen healthy, non-medicatedsubjects (13 males, 3 females; 20–23 years old) participated in thepresent study. All subjects provided written informed consent prior toparticipation in the study.
The occurrence rate of body movement is an important element in theestimation of sleep stages. Thus, in the present study, body movement
density (BMD) is defined as the number of body movements that occurin 30-min intervals and is used as a value for evaluating body movement. Results show that BMD did not directly correlate with sleep
stages. However, transitions between sleep stages within the sleep cycle
and BMD were synchronous. Therefore, estimating the changes in sleep
stage is possible using BMD. Moreover, using BMD in this manner, thesleep cycle can be estimated without any additional information.
The quality of sleep is related to the sleep cycle, and the present resultsshows that the sleep cycle can be estimated using BMD. While there isa trade-off between accuracy and convenience using this method, thelong-term goal of this study is to develop a method to easily measure
sleep stage at home. From this perspective, measurements of BMD areboth convenient and sufficiently accurate.

SLEEP EDUCATION BY USING SELF-HELP
TREATMENT FOR JUNIOR HIGH SCHOOLSTUDENTS IN JAPAN.
H TANAKA, M FURUTANI, G ONISHI, K IDESHITA, N TAMURA,M SAKAI, N KADOSAWA, T HIRATA
Department of Clinical Psychology, Hiroshima International University,
Higashihiroshima city, Hiroshi, JapanINTRODUCTION: knowledge of sleep related to modification of lifestyle (Gallasch et al., 2007). Brief cognitive-behavioral method (selfchecking and sleep diary for 2 week) is effective on sleep in high school
students (Tanaka, 2008). The purpose of this study was to examine theeffects of sleep education by using brief cognitive-behavioral method(knowledge, self help treatment) for Junior high school students. Additionally, examine effective behaviors for ensuring of sleep, preventing
night type lifestyle.
METHODS: Sleep education by using self-help treatment carried out
for 10 days for 318 (age 13, 14, 15) students who gave informed
consent. Sleep instructors lecture them about sleep hygiene using text,
10 questions relation to sleep carried out pre and post lecture. In thisprogram the self-checking for daily life-habits, goal setting for behavioral changes and self-monitoring were used by sleep diary. Instructor
asked student to check their own life-habits and to select one target
behavior from it. The questionnaire involving lifestyle was used toassess the effects of program.
RESULTS& DISCUSSION: After ten days of the sleep education byusing self-help treatment bed time changed to earlier. The difference of
bed time between weekday and holiday changed to shorten, significantly (p < 0.05). Sleep latency, sleepiness of day significantly improved.
These show that treatment is effective to prevent night type lifestyle andto reduce irregular sleep-wake patterns. Lifestyle, regular sleep-wakepatterns, such as reduce the difference of wake up time of weekday andholiday below 2hour, exposing sunlight in the morning, having every
morning breakfast, not taking the nap after evening, relaxation before
bed times occupy important position to improvement of ensuring of
sleep times, preventing night type lifestyle. Especially, not taking thenap after evening effected on initiating sleep, preventing night type
lifestyle, feelings of wakening. Present results suggest sleep educationby using self-help treatment improve sleep, arousal levels of daytime
for students.

PO-2-118
PREDICTION MODEL OF LIGHT-INDUCEDMELATONIN SUPPRESSION
Y TAKAHASHI, T KATSUURA, Y SHIMOMURA, K IWANAGA
Department of Design, Chiba University, Chiba-city, Chiba, Japan
The prediction method of melatonin suppression values was based on
previous studies related to melatonin suppression and pupil constriction. Estimated values that considered pupil constriction were larger

380© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-120
THERAPEUTIC OUTCOME BY TWO-MONTHSINTENSIVE CIRCADIAN RHYTHM TREATMENTS
IN JAPANESE CHILDREN AND ADOLESCENTS
WITH CHRONIC FATIGUES TAJIMA, S MATSUZAWA, K TAKAI, M KAWAKAMI,M NAKASHIMA, T MIIKE
Children’s sleep and development medical research center, Hyogo
rehabilitation central hospital, Kobe, Japan
Objectives: We have started to treat patients with chronic fatigue at
new pediatric medical research center for sleep and developmental
disorder since April 2009. Here we show the therapeutic outcome of
our first year trial.
Methods: 30 patients (15 boys and 15 girls, age 11 to 25) with chronic
fatigue induced by sleep deprivation were admitted in the first year of
our center. All patients were treated for 8 weeks with bright lighttherapy, thermal therapy, medication, cognitive behavioral therapy andlifestyle teaching. Self-sleep-logs (S-log) have been recorded duringhospitalization. 48 hr core body temperature (CBT) monitoring was
performed at the beginning and the end of therapy. Delay of circadianrhythm (D-CBT; >= 60 min.), poor daily variation (CBT amplitude <1.0
degree centigrade) and totally high CBT (1.0 degree centigrade higher
than control) were detected in CBT recordings. Long total sleep time
(L-TST; >= 10 hr), delayed sleep phase (D-SP; sleep onset later than
24:00), irregularity of sleep onset and offset (I-SOs; larger variation than
90 min.) and sleep segmentation (segmented more than 7 days per
2 weeks) were also detected in S-log recordings. With or without thesefactors were compared between the beginning and the end of therapy
using fisher’s exact test.
Results: D-CBT (p < 0.01), L-TST (p < 0.0001), D-SP (p < 0.05) andI-SOs (p < 0.0001) were significantly improved at the end of therapy.
Conclusion: Our intensive treatments were effective to improve circadian rhythm. However, recoveries of other chronic fatigue related symptoms and poor performances were insufficient at the time of discharge.
Recovery from sleep disturbance is not the goal but the first stage ofimprovement for the patients with chronic fatigue. From this point ofview, more clinical trials will be needed.

PO-2-121
ASSOCIATION BETWEEN MORNINGNESSEVENINGNESS CHRONOTYPE, SLEEPDISTURBANCES AND MENTAL HEALTH IN THE
UNIVERSITY FRESHMEN IN HONG KONG

WYJ CHAN1, SX LI2, SP LAM1, MWM YU2, RNY CHAN2, YK WING2
Psychiatry, Shatin Hospital, Hong Kong SAR, China, 2Psychiatry, The
Chinese University of Hong Kong, China

1

Objective: There has been a close link between circadian disruption
and a vulnerability to psychopathology. The aim of the current study
was to explore the relationships among morningness-eveningness, nocturnal sleep disturbances and mental health in first-year university
students in Hong Kong.
Methods: A battery of questionnaires was distributed to all the first-year
university students. Study inventories included a sleep questionnaire,
Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI),
Morningness and Eveningness Questionnaire (r-MEQ) and General
Health Questionnaires (GHQ-12).
Results: In total, 1207 students (response rate: 58.5%, mean age: 18.9
± 1.1 years; male 57.9%) completed the questionnaires. The prevalenceof morning-, intermediate-, and evening-type was 8.5%, 63.7% and27.8%, respectively. As compared to the subjects of intermediate-type,those evening-type had shorter sleep duration during weekdays (7.2 ±1.2 vs. 6.5 ± 1.5 hours, p < 0.001), and scored significantly higher on
PSQI (5.5 ± 2.1 vs. 6.3 ± 2.1, p < 0.001) and ESS (8.4 ± 3.6 vs. 9.4 ±
3.9, p < 0.001). More subjects of evening-type reported insomnia disturbances (15.4% vs. 14.9% vs. 9.5%, p < 0.01) and alcohol drinking(27.2% vs. 18.6% vs. 13.9%, p < 0.01) than their peers of intermediate- and morning-type. Eveningness was associated with minor psychiatric disturbances after adjusting for age, gender, frequent insomnia andnightmares [Odds ratio = 1.5 (95% C.I. 1.1–2.1)].
Conclusion: Eveningness was associated with insomnia, mental disturbances and alcohol use in university students. Interventional program
should address circadian disruption in relation to psychiatric disturbances in university students. Future prospective studies should be
conducted to investigate the stability of chronotypes and its association
with future development of sleep disturbances and psychopathology.

PO-2-122
COMPARATIVE STUDY ON SLEEP SATISFACTION
AND QUALITY OF LIFE IN HEALTHY STUDENTS
BETWEEN JAPAN AND THAILAND

M SAITO1, J SUCHINDA2, M EIKO1, P NOPPOWAN2,N SHUNSUKE1, Y MAKOTO1, O RINA1, W TOMOKO1
1
Graduate School of Medicine anf Faculty of Medicine Kyoto University,
Kyoto University, kyoto-city, Kyoto, Japan, 2Ramathibodi Hospital, Facultyof Medicine, Mahidol University, Thailand

Study objective: The 24 hours-commercialization is accelerated in theJapanese modern society. Some reports have shown that the quality oflife (QOL) is positively correlated with the quality of sleep. QOL is
influenced from whether the quality of sleep is enough. There have been
several reports on the relationship between QOL and sleep quality for
hospitalized patients. There are few reports in healthy population. This
study aims to compare the QOL and sleep quality between Japan and
Thailand in healthy students.
Participants and Method: The integrated questionnaire was administered to 424 students (Japan 198, Thailand 226) and included 10-items
Pittsburgh sleep quality index (PSQI) and 26-items WHOQOL-BREF(WHOQOL). A cross sectional statistical analysis was performed.
Result: The average sleep hours were 6.35 h in Japan and 6.55 h in
Thailand. The average PSQI score was significantly higher in Thailand
than in Japan (p < 0.001). Several scores as follows were significantly
worse in Thailand than in Japan: longer sleep latency, worse habitual
sleep efficiency, more frequent sleep-onset and -offset disturbance andmore frequent daytime dysfunction (respectively p < 0.05). Additionally, participants in Thailand tended to use sleeping pills more frequently than Japanese ones (p = 0.05). On the other hand, the averagescore of QOL was higher in Thailand than in Japan (p < 0.001). In all
domains including physical health, psychological, social relationship,environment and global, scores were higher in Thailand than in Japan(p < 0.001). It meant that QOL in Thailand was better than in Japan.
Discussion and Conclusion: PSQI was better in Japan, whereas QOL
was worse in Japan than in Thailand. This suggests that Japanese sleep
quality is better than Thailand participants, although Japanese students
are little satisfied in their life. This replicates the difference between Japanand Thailand in the relationship between sleep quality and QOL. Furthermore, some difference in life style might be related the relationship.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research381

Sleep, Science and Research

PO-2-123SLEEP BEHAVIOR AND RISK FACTORS FOR
DETERIORATION OF SLEEP PATTERNS AMONG
JAPANESE MIDDLE-SCHOOL STUDENTS

M SHIGETA1, A NAKAZAWA1,2, M UEDA2, M KADONO2,I WATANABE1, D MATSUI1, E OZAKI1, N KURIYAMA1,Y WATANABE1
1
Epidemiology for community health and medicine, Kyoto
Prefecturalniversity of Medicine, Kyoto-city, Kyoto, Japan, 2Health check-up
and promotion, Kyoto first red cross hospital, Japan
Background: Many studies have shown that sleep deprivation of may
promote both lifestyle-related diseases and mental illness. To a large
extent sleep behavior is affected by the environment in childhood andadolescence.
Purpose: To determine the current sleep behavior of teenagers and toclarify risk factors, we investigated sleep patterns and patterns of spending time in various activities among middle-school students in Kyoto
city.
Subjects and methods: Subjects were 1545 students at 13 public
middle-schools in Kyoto city. The questionnaire included sleep pattern,smoking experience, drinking experience, diet pattern, study habits,
watching TV, Internet usage and frequency of visiting convenience stores(CS). We analyzed how these behaviors were related to sleep patterns.
Results: Valid responses were obtained from 818 boys and 721 girls.
Mean lights-off time, wake-up time and sleep duration were 7:30 AM,
11:13 PM, 6.9 hr. 4.2% of subjects slept less than 6 hours. Boys slept
significantly longer than girls (p < 0.01): 6.9 hr versus 6.8 hr, because
boys turned off the lights earlier than girls (11:06 PM versus 23:19 PM)
and woke up later (7:39 AM versus 7:21 AM). Subjects who skippedbreakfast, ate late at night, spent long hours to use the Internet, did notstudy, had experience with drinking and visited convenience stores
frequently, slept for shorter periods (p < 0.01). Watching TV for longer
periods, reading books, experience with smoking and belonging toschool clubs did not show any association with sleep patterns.
Discussion: Sleep deprivation among middle-school students in Kyoto
city was extremely serious. The situation is likely to influence not only
current health problems but also promote health problems in future.
Skipping breakfast might be due to sleep deprivation because eating at
midnight or short sleep contribute to reducing hunger in the morning.
Unlike skipping breakfast, visiting CSs and long periods of Internet use
have the potential to deteriorate sleep patterns because these activities
are accessible 24 hr a day and are attractive to adolescents.

PO-2-124SLEEP EDUCATION BY USING COGNITIVEBEHAVIORAL METHOD FOR TEACHERS OF
JUNIOR HIGH SCHOOL IN JAPANN TAMURA, N KADOSAWA, H TANAKA
Department of Clinical Psychology, Hiroshima International University,
Hiroshima, Aki-gun, JapanINTRODUCTION: Recently, the deterioration of teacher’s health, volition is serious relation with the aggravation of an educational problem.
Brief cognitive-behavioral method (self-checking for target-behavior
and sleep diary for 2 week) is effective in improving sleep quality for
local residents or high school students (Tanaka, 2007). The purpose ofthis study was to examine the effects of sleep education by using Brief
Cognitive-behavioral method (knowledge of sleep, self-checking for382

target-behavior and sleep diary for two weeks), self-help treatment.
METOD: Sleep education or sleep education by using self-help treatment carried out for the 22 teachers in junior high schools who gave
informed consent. In this program the self-checking for daily life-habits,
goal setting for behavioral changes and self-monitoring were used as
behavioral modification techniques, it ran for each 2 week in 4 week.
Each teacher practiced two conditions (only sleep education condition,
sleep education with self-help treatment condition) with crossoverdesign. They were lectured about sleep hygiene. And then, asked participants to check their own life-habits and to select three target behaviors from it. The questionnaire involving lifestyle and sleep health wasused to assess the effects of program. Furthermore, compliance oftargets behavioral habits was assessed.
RESULTS & DISCUSSION: After the sleep management for two
weeks, sleep and fatigue significantly improved. Furthermore, feelingsof wakening, volition improved (p < 0.05). Sleep education with selfhelp treatment condition was effective compared to only sleep education condition, significantly. Sleep and volition are related to the life
habits such as 1) Getting up in the every morning approximately
decided time, 2) Don’t take a nap after go home, 3) Going to bed by
0:00 a.m., 4) Having a regular sleeping time, 5) Relaxing before bed
time, 6) Getting to bed after becoming sleepy, 7) Don’t worry in bed.
Present results suggest sleep education by using brief cognitive-behavioral method improve sleep, fatigue, volition for teachers.

PO-2-127
A NOVEL CHILD SLEEP SCREENINGQUESTIONNAIRE: CHILD AND ADOLESCENTSLEEP CHECKLIST (CASC)Y OKA1, F HORIUCHI2
Department of Sleep Medicine, Ehime University Graduate School of
Medicine, Toon-city, Ehime, Japan, 2Department of Neuropsychiatry, Ehime
University Graduate School of Medicine, Japan
1

Background: As characteristics of sleep changes dramatically both inquality and in quantity during childhood, assessment of sleep using
a single questionnaire for wide range of ages requires special
considerations.
Objectives: The aim of this study was to develop and validate a sleep
questionnaire for the screening of sleep problems among children andadolescents.
Methods: Child and Adolescent Sleep Checklist (CASC) is consisted of
36 questions commonly used from infants up to high-school students.
CASC has three versions; for caregivers (common for all age groups),
for elementary school children (6–12 years of age), and for high-school
students (12–18 years of age). 53 children (29 community sample and
24 clinical sample) were recruited for the validation study. CASC sleep
problem scores were compared with other sleep questionnaires; parental reports (preschoolers and elementary school children, n = 26) werecompared with Childrens’ Sleep Habits Questionnaire (CSHQ) and theself reports (high school students, n = 19) were compared with Pittsburgh Sleep Quality Index (PSQI). Subjects were also asked to answer
CASC twice with 2 weeks interval, and the responses were compared.
Results: CASC sleep problem scores of the parental reports showed
good correlation with CSHQ total scores (r = 0.770, p < 0.001). CASC
sleep problem scores of the self reports showed good correlation withPSQI scores (r = 0.599, p = 0.007). CASC sleep problem score showed
good correlation between the first and second responses (r = 0.787,
p < 0.001).
Conclusion: CASC has its advantage in making cross sectional screening of sleep problems in wide range of ages by using both parental and© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

self report. In addition, CASC is especially useful in interventional orcohort study as this questionnaire allows to use same questionnairethroughout the study period.

PO-2-128 / AS-13 Presenter
SLEEP HABITS AND SLEEP PROBLEMS INSCHOOL-AGED CHILDREN IN JAPAN: A CROSSSECTIONAL STUDYS KITAMURA1, M ENOMOTO1, E TSUKADA1, Y KAMEI1,
T KOYAMA2, A MORIWAKI2, Y KAMIO2, KAZUO MISHIMA1
1
Department of Psychophysiolosy, Natl Ctr of Neurol and Psychiatry NatlInst of Mental Health, Kodaira-city, Tokyo, Japan, 2Department of Childand Adolescent Mental Health, Natl Ctr of Neurol and Psychiatry Natl Instof Mental Health, JapanINTRODUCTION: Although it is known that low sleep qualities orsleep disturbances are common in children and are associated withexcessive daytime sleepiness, impaired daytime neurocognitive performance, obesity, incidence of psychiatric disorders or development disorders, there is an insufficient data of large sample of school-aged
children. In this study, we conducted a population survey to characterize sleep habits and sleep problems among school-aged children in
Japan.
METHODS: The participants were parents who raised children aged 6
to 15 belong to 148 elementary schools and 71 junior high schools in
10 areas across the country. They were requested to answer a newly
prepared questionnaire based on A Brief Screening Questionnaire for
Infant Sleep Problems (Sadeh et al.) and Children’s Sleep Habits Questionnaire (Owens et al.). This questionnaire consisted of thirty-one
items to evaluate sleep habits and sleep problems of their children forthe past one month.
RESULTS: Of the 25,211 children, mean bedtime and rise time were
21.9 h and 6.6 h, respectively. Approximately half of children(12,700/25,211) went to bed after 22 p.m. or later and 20.4%(5,144/25,211) went to bed after 23 p.m. or later. As grade shifted
higher, bed time was significantly delayed, while rise time minimallychanged across all grades. Consequently, a significant shortening in total
sleep time for the higher grades relative to the lower grades wasobserved. The highest grade children slept an average of 126.5 min lessthan the lowest grades. Similarly, the prevalence of daytime sleepinessand sleep problems related to awakening behaviors were greater inhigher grades. On the other hand, sleep problems related to initiating
sleep and behaviors during sleep showed higher prevalence in lower
grades compared to higher grades.
CONCLUSION: The present study has clearly shown that delayed bed
time, short sleep duration, excessive daytime sleepiness and various
difficulties in initiating, maintaining and terminating sleep were highly
prevalent in school-aged children in Japan.

PO-2-129RISK FACTORS OF SLEEP DISTURBANCEAMONG SCHOOL CHILDREN IN JAPAN:
THE 2-YEAR FOLLOW-UP STUDYE YAMANO1, S FUKUDA1, K MIZUNO2, M TANAKA1, T JOUDOI3,
J KAWATANI3, M TAKANO3, A TOMODA3, K MATSUMURA-IMAI4,T MIIKE5, Y WATANABE1,2
1
Department of Physiology, Osaka Cicty University of Graduate School of
Medicine, Osaka-city, Osaka, Japan, 2Center for Molecular Imaging
Science, RIKEN, Japan, 3Faculty of Medical and Pharmaceutical Sciences,
Kumamoto University of Graduate School, Japan, 4Department of Clinical,
Health and Special Needs Education Needs, Hyogo University of Teacher
Education Graduate School of Education, Japan, 5Hyogo Children’s Sleep
and Development Medical Research Center, (HCSDMRC) Japan
Objective: To examine the association between life-style habit including
school life and newonset of sleep disturbance among school children
in Japan.
Methods: A follow-up survey was conducted in December 2006 (T1) and2008 (T2) among 844 school children from 4 elementary and 4 juniorhigh schools in Japan. Multivariate logistic regression analyses were performed to examine the associated factors with sleep disturbance assessedby self-reported questionnaire. The study protocol was approved by the
Ethical Committee of Osaka City University Graduate School of Medicine.
Results: The prevalence of morning fatigue, difficulty initiating sleep,
arousal during sleep, and excessive daytime sleepiness at T2 was 9.4%,
9.5%, 7.1%, and 27.2%, respectively. Sleep disturbance was found tobe significantly associated with eating regularly, frequency of exercise,computer time, relationships with family and friends.
Conclusions: The risk factors for sleep disturbance were having an
unhealthy life-style and poor interpersonal relationship at school andhome. Insufficient sleep has been reported to cause poor mental healthand decreased motivation for learning among school children. Confirmation of the correlates of sleep disturbance has implications for screening susceptible students and may help prevent the occurrence of such
disturbance at an early stage.
Ackowledgements: This study was supported by Japan Science andTechnology Agency / Research Institute of Science and Technology forSociety.

PO-2-130 / AS-30 Presenter
CULTURE AND SLEEP: HOW DO SLEEP HABITSCOMPARE BETWEEN HIGH AND LOW ALTITUDE
DWELLING BOLIVIAN CHILDREN AND A LOWLAND NORTHERN EUROPEAN POPULATION?

CM HILL1, A BAYA2, D ANNAZ3, SL HOLLEY1, R BUCKS4
1
Division of Clinical Neuroscience, University of Southampton, Eastleigh,Hampshire, United Kingdom of Great Britain and Northern Ireland,
2
Department of Psychology, Universidad Privada de Santa Cruz de la Sierra,
Bolivia, 3Department of Psychology, University of Middlesex, London, United
Kingdom, 4School of Psychology, University of Western Australia, Australia

Background: Sleep is important for child development and should beconserved across populations. However, sleep habits are culturally
determined both within and between countries. Bolivia has distinct
urban populations in low altitude (LA) and high altitude (HA) locations.
We studied the sleep habits of LA and HA dwelling children and compared them to a UK population.
Method: Healthy Bolivian children aged 4–10 yrs were recruited, 39(23 male) from Santa Cruz (altitude 500 m), and 52 (22 male) from La© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research383

Sleep, Science and Research

Paz (3700 m). Parents completed the Child Sleep Habits questionnaire(CSHQ); questions about infant swaddling and siesta practices andestimated their child’s total 24 hour sleep time. Children aged 6–12 yrs
in Hampshire, UK, recruited to a sleep and behavioural study completed a CSHQ.
Results: There were no age differences between HA and LA children(6.7 yrs SD 1.9; 7.0 SD 1.9). As infants, 86% slept in the parents’bedroom, (35% in parents’ bed). Before 6 months, 62% slept supine
and 33% prone, 13% were swaddled. Most 4 yr olds had siestas as did
25% of 5–6 yr olds and 19% of 7–10 yr olds. There were no altitudedifferences in these practices. HA children had more sleep/24 hrs than
LA children (9 hrs 56 mins v. 9 hrs 05 mins) and had earlier bedtimes.
Bedtimes across altitudes were late: weekdays 21.07 for 4–6 yr olds and21.25 for 7–10 yr olds (range 20:00 to 23:00 hrs). LA children had
more bedtime resistance and sleep anxiety than those at HA. Comparing
45 Bolivian children, 7–10 yrs, (8.6 SD 1.0 yrs, 25 male), age-matched,with 55 (8.6 SD 1.0, 25 male) from the UK, adjusting for multiple
comparisons (p < .002), sig. differences in specific sleep habits emerged.
Bolivian children were more likely to need a parent in the room to fallasleep; be afraid to sleep alone; have irregular bedtimes, take >20 minutes
to fall asleep and have difficulty waking spontaneously in the morning.
Conclusion: Bolivian children, particularly those in the hot lowlands,
had more sleep problems than British children. Multiple factors may
contribute including later bedtimes driven by warm evenings and theloss of regular siestas.

PO-2-131SLEEP HABIT, CIRCADIAN TYPOLOGY, MENTALHEALTH, AND TV GAME PLAYING OF CZECHAND JAPANESE INFANTS AGED 5–6 YRS

T HARADA1, A KOBAYASHI1, M KREJCI2, K WADA1,R NISHIHARA1, O AKIMITSU1, T NOJI3, M NAKADE4, H TAKEUCHI1
1
Laboratory of Environmental Physiology, Faculty of Education, Kochi
University, Kochi-city, Kochi Prefecture, Japan, 2Department of Health
Education, Faculty of Education, University of South Bohemia, Czech
Republic, 3Laboratory of Health & Physical Education, Faculty of
Education, Kochi University, Japan, 4Deparment of Nutritional Education,
Tokai Gakuen University, Japan
Objective: This study attempts to compare sleep habit, circadian typology, mental health, and TV game playing between “winter” Czech and“summer” Japanese infants aged 5~6 yrs (both severe seasons) from anepidemiological point of view.
Participants and Methods: 79 Czech (Ceske Budejovice at 49 degree
north) and 269 Japanese (Kochi at 33 degree north) infants (70~80%
response rate) answered an integrated questionnaire in January 2011
and in July 2010, respectively. The questionnaire included MEQ of
Torsvall and Akerstedt (1980), questions on sleep habits (such as
wake-up and bed times and sleep quality and quantity), meal habits,
mental health (such as anger and depression) and TV game use.
Results: Japanese infants were significantly more evening-typed (p <0.001), showed later bedtime (p < 0.001), were depressed less frequently (p < 0.001), showed anger more frequently (p = 0.004), took
sweet drink (p = 0.018) and sweet stuff (p = 0.032) less frequently, took
well balanced breakfast less frequently (p < 0.001), played TV game
more frequently (p < 0.001) and were exposed to morning sunlight for
longer minutes (p < 0.001) than Czech infants. Only 13% of Japanese
infants woke up once or twice during the night sleep and lower than
33% of Czech ones (p < 0.001).
Discussion and Conclusion: Frequent depression and lower sleep
quality shown by “winter” Czech infants might be related to the short-384

age of morning sunlight. Evening typology shown by Japanese infants
even in summer is hypothesized to be partially related to TV gameplaying after the sunset.

PO-2-132
EFFECT OF PSYCHOLOGICAL STRESS ON
NIGHTTIME SLEEP AND CORTISOL RESPONSE
DURING MORNING IN CHILDREN

M TAKAHARA1, S SUWA2,3, J SARUTA2, S SHIRAKAWA4
1
Faculty of Symbiotic Systems Science, Fukushima University, Fukushimacity, Fukushima, Japan, 2Research Center of Brain and Oral Science,
Kanagawa Dental College, Japan, 3Orthodontics, Emita Dental Clinic,
Japan, 4Department of Psychogeriatrics, National Institute of Mental
Health, NCNP, Japan
To investigate the effect of some stressful activities just before bedtimeon the following sleep in children, we conducted psychological tasks
and examined the sleep quality by means of PSG and HRV. In addition,
we investigated salivary cortisol levels before and after the experimentalnight sleep. The participants were 8 children (6–8 years old). In the
Task night, they had to engage in two tasks with a computer about anhour before their own bedtimes. One was the Stroop Task, and the otherwas a continuous detection task. Each task lasted 10 minutes. On the
No-task night, they spent an equal amount of time reading a book of
their choice and seeing a video of their choice. All the children experienced the Task night and the No-task night (the order was counter­balanced). A polysomnogram, including electroencephalogram,
electrooculogram, electromyogram was recorded each night. The heartrate variability, as determined by the MemCalc method, was also
obtained each night. Furthermore, saliva samplings were obtained
before and after the both experimental manipulations, and after thenight sleep. All recordings of all children were made at their own
houses. We quantitatively analyzed sleep parameters and measures ofheart-rate variability, including heart rate (HR),%LF and HF. Amount ofcortisol in each saliva were measured by ELISA method. Sympathetic
nerve activities which evaluated with HRV were higher for the Task
night than for the No-task night during both the waking state and thesleeping state. There was less amount of REM sleep especially in thefirst and fourth 2-hour periods on the Task night than on the No-tasknight. Amounts of slow wave sleep, wake time after sleep onset andmovement time were not different between the two conditions. Thismight be related with small arousals which were so brief that they did
not affect on the sleep architecture. Amount of change in saliva cortisol
before and after the experimental night sleep was smaller for the Task
night. The present study revealed that all-night sleep quality in children
can be affected by some exciting activities 1 hour before bedtime.

PO-2-133
IMPACT OF OBLIGATORY DAYTIME NAP IN
JAPANESE NURSERY SCHOOLS ON CHILDREN’SNIGHTTIME SLEEP AND MORNING MOODINESSK FUKUDA1, S ASAOKA2
1
Department of Psychology, Edogawa University, Nagareyama, Chiba,
Japan, 2Department of Somnology, Tokyo Medical University, Japan

Newborn infants show scarce evidence of circadian rhythmicity of sleep
and wakefulness. Around the 7th week after the birth, the first evidenceof sleep circadian rhythm is found in full-term infants (Fukuda& Ishihara, 1997). Recently preterm infants are found to show the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

emergence of sleep circadian rhythm exactly at the same timing as thefull-term infants, if the timing is counted from their conception, notfrom their birth. In the both groups, the sleep circadian rhythm emergedat the 46th week from the conception (Takaya et al., 2009). During 2
to 5 years of age, percentage of the children who take an afternoon nap
gradually decreases. At the age of 3, about 60% of children take naps,
then the percentage decreased to about 30% at the age of 4, about 15%
at the age of 5, then almost none at the age of 6. However, In many
Japanese nursery schools, obligatory lengthy daytime nap was taken bychildren of all ages, i.e., before the entrance to primary schools. The
obligatory daytime nap for about 90 min was found to cause the delayof nocturnal sleep onset, morning moodiness, and reluctance to go topreschools. The authors conducted surveys on children attend preschools. Informed consent was given by the parents of the children. In
Japan, the obligatory nap was taken only in nursery schools, not inkindergartens, because these two preschools are regulated under different laws, and supervised by the different ministries, i.e., ministry ofhealth and labor, and ministry of education and science, respectively.
Nursery school children showed significantly later bedtime, severer
morning moodiness, and more frequent reluctance to go to preschools
than kindergartners. Children’s bedtime was not associated with parents’bedtime. The authors recorded children’s activity with an actographic
monitoring device to estimate their sleep wake patterns. Preschool
children with long obligatory naps showed significantly delayed onset
of nocturnal sleep (over one hour) than the children without naps. The
impact of unnecessary lengthy daytime naps on nighttime sleep was
confirmed also by the objective measurements.

PO-2-134 / AS-16 Presenter
THE EFFECT OF INCREASING ARTIFICIAL
LIGHT LEVELS ON REST-ACTIVITY RHYTHMS
OF OLDER PEOPLE LIVING IN CARE HOMESDJ SKENE1, B MIDDLETON1, PL MORGAN1, SL HOPKINS1,
LJM SCHLANGEN2
1
Centre for Chronobiology, University of Surrey, Guildford, United Kingdomof Great Britain and Northern Ireland, 2Philips Lighting, Eindhoven,
Netherlands
Introduction: As people age ocular changes occur reducing the amountof light, in particular short wavelength blue light, reaching the retina.
This, coupled with age-related changes to the circadian and homeostatic
regulation of the sleep-wake cycle, may contribute to sleep problems
and reduced circadian amplitude in older people. Lighting in carehomes is of poor quality and low intensity. The aim of this study was
to investigate the effect of blue-enriched white light compared to control
white light on actigraphic rest-activity rhythms.
Methods: The study was conducted over 12-week periods (autumn/
winter 2008–2010) in a randomised, crossover design in communal
rooms of 7 care homes in south-east England. After a baseline week(original care home lighting), each light intervention period (4000 K,
200 lux or 17 000 K, 1000 lux) lasted for 4 weeks with a 3-weekwashout period (original care home lighting, <100 lux) in between.
Rest-activity data were collected continuously using Actiwatch-L monitors. Cosinor analysis and non-parametric circadian rhythm analysis(NPCRA) were used to quantify each participant’s 24-hour rest-activity
rhythm for each week and for light condition (5 males, 43 females,
MMSE range 6–24, age 85 ± 8 years). RMANOVA fixed effect model(SAS 9.1), adjusted for medication, sex, age, MMSE score, mobility,%time spent in light rooms .
Results: No significant differences were found in the rest-activity
rhythms between light conditions. Higher cosinor mesor, IS (interdaily

stability) and M10 (average activity for 10 most active hours) was
associated with increasing% time spent in the rooms with lights (p <0.05). Medication use (hypnotics, anti-depressants, anti-psychotics)
was associated with a delay in the timing of the activity rhythm (acrophase, L5 onset, M10 onset) and a reduction in amplitude.
Discussion: The light intervention did not affect the amplitude or
timing of rest-activity rhythm. Time spent in the rooms with lights andmedication were shown to influence the strength and timing of theactivity rhythm.

PO-2-135
CORRELATION BETWEEN SLEEP AND
LIFESTYLE PATTERNS AND STRESS HORMONE
DYNAMICS IN THE ELDERLY
M KOMATSU, M MITSUHASHI, E MANABE, E YAMAGATA,M KIMURA, Y OKAYAMA
School of nursing, Kyoto prefectural university of medicine, Kyoto, JapanThe dynamics of stress hormones are said to exhibit elevated values
when waking up, and these values are said to be elevated before going
to bed in elderly persons with dementia disturbed sleep patterns. The
purpose of this study is to identify the correlation between sleep andlifestyle patterns and stress hormone levels in saliva in normal elderly
persons before bed and when waking up in the morning. The subjects
consisted of 25 elderly persons participating in classes for preventing
the need for long-term care and the like (average age: 75.8 years), andthe subjects were surveyed using a questionnaire relating to sleep andlifestyle patterns, and tested for stress hormone: human chromogranin
A, levels before going to bed and when waking up in the morning. The
data was analyzed using the t-test and the Mann-Whitney U-test after
dividing the subjects into 14 members of a bedtime elevated hormone
and 11 members of a wakeup hormone group. Ethical considerations
consisted of acquiring approval of the ethics committee of the participating health care institution and obtaining the consent of the subjects.
The subjects were generally healthy, demonstrated an average sleep timeof 6.6 hours, spent a total of 7.0 hours in bed, and exhibited sleep
efficiency of 89.2%. Among subjects in the bedtime elevated hormone
group, time spent in bed was significantly longer (p < .05) and sleep
efficiency was poor (p < .05). Values were low when these subjects wokeup, thereby confirming the effects of this hormone on sleep even in
normal elderly persons, and indicating that alleviation of psychologicalstress prior to going to bed is an important key in support of promoting
sleep. There were no correlations observed between stress levels andlifestyle patterns.

PO-2-136
ASSOCIATION OF LEISURE-TIME, HOUSEHOLDAND WORK-RELATED PHYSICAL ACTIVITY
WITH SLEEP CONDITION IN OLDER ADULTS
N KITANO, K TSUNODA, T TSUJI, Y MITSUISHI, JY YOON,JE YOON, O TOMOHIRO
Graduate School of Comprehensive Human Sciences, University ofTsukuba, Amakubo3-5-6, Tsukuba, Ibaraki, JapanBACKGROUND: Although many investigators have been reported thatdaily exercise is related to good sleep condition, little information is
known on relationships of each physical activity excepting for exercise(e.g. household, working) with sleep condition in older adults.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research385

Sleep, Science and Research

PURPOSE: This study was conducted to reveal which type of physicalactivity would be strongly relevant to sleep condition in older Japanese
adults.
METHODS: Three hundreds and fifty-five community-dwelling older
Japanese adults, aged 65 to 85 years (average 73.4 ± 5.3 years), wererandomly drawn from Basic Resident Register as subjects. Pittsburgh
Sleep Quality Index was used to evaluate mean sleep duration, sleep
latency and daytime nap time. Physical activity was assessed by Physical
Activity Scale for the Elderly, consisted of five kinds of leisure-time
activity (e.g. walking, low intensity exercise), six kinds of household
activity (e.g. light housework, lawn work), and a work-related activity.
We evaluated the association of the leisure-time, household and work
related physical activity with sleep condition using logistic regression
analysis with an adjustment for age, sex, and Geriatric Depression Scalescore. Each sleep condition was used as a dependent variable (good =0, poor = 1) and each physical activity score was used as an independent
one (high = 0, low = 1).
RESULTS: Logistic regression analysis showed that inappropriate sleep
duration was associated with lower scores of light housework (OR =2.15, 95%CI = 1.02–4.50) and heavy housework (OR = 1.85, 95%CI= 1.03–3.33). Those who had long sleep latency were less likely topractice light recreational activity (OR = 1.56, 95%CI = 1.01–2.41) andmuscle strength exercise (OR = 2.74, 95%CI = 1.41–5.29). Long
daytime napping was associated with low score of heavy house housework (OR = 1.95, 95%CI = 1.05–3.45).
CONCLUSIONS: These findings suggest that increasing leisure-time
activity is associated with shorter sleep latency. To obtain good qualityof sleep may be necessary for older Japanese adults to practice not only
exercise but also household activity.

PO-2-137 / AS-13 Presenter
THE SLEEP AND TECHNOLOGY USE OF
AMERICANS: RESULTS FROM THE 2011
NATIONAL SLEEP FOUNDATION’S SLEEP IN
AMERICA POLL

M GRADISAR1, AR WOLFSON2, AG HARVEY3, L HALE4,
R ROSENBERG5, CA CZEISLER6, D CLOUD7
1
School of Psychology, Flinders University, Adelaide, South Australia,
Australia, 2Psychology Department, College of the Holy Cross, UnitedStates of America, 3Psychology Department, University of California,
United States of America, 4Division of Evaluative Sciences, Stony Brook
University Medical Center, United States of America, 5Director, Atlanta
School of Sleep and Medicine Technology, United States of America,
6
Division of Sleep Medicine, Harvard Medical School, United States ofAmerica, 7CEO, National Sleep Foundation, United States of America
Introduction: Advances in the accessibility and portability of technology has led to claims that technology use is impacting Americans’ sleep.
However, nationally representative surveys have been lacking. The
primary aim of the present work was to measure the presence and useof technology on sleep and compare them across age groups.
Methods: 1,508 respondents, representative of the USA population
between 13–64 yrs of age, completed the survey either via telephoneinterview (N = 750) or the web (N = 758). The survey contained questions about sleep, technology use, daytime functioning and coping withsleeplessness. The sample was categorized into different age groups:
Gen Z’ers (13–18 yrs), Gen Y’ers (19–29 yrs), Gen X’ers (30–45 yrs),
Baby Boomers (46–64 yrs) to contrast the diverse use of technology bydifferent age cohorts. Each age group was weighted to 2009 USA Census
data. The maximum sampling error was±2.5% at the 95% confidence
level.

386

Results: 95% of the total sample used technology in the hour before
bed. Several distinctions were found between the under 30 s (Gen Z
and Y’ers) and over 30 s (Gen X’ers and Baby Boomers). Younger groups
were higher users of cell phones (67–72%), laptops/computer (60%),
music devices (34–64)%, and video game consoles (18–23%) in the
bedroom in the hour before bed than the over 30 s. Further, respondents
under 30, had later bedtimes, were more likely to report difficulty
falling asleep, and took longer to fall asleep than those respondents over
30. Once asleep, under 30 s were more likely to be awakened by theircell phone at least a few nights a week (18–20% vs 3–11%). Whenawakened, under 30 s were more likely to text, listen to music, talk on
the phone, and surf the internet than over 30 s. Despite under 30 sgetting more sleep, they were nonetheless more likely to report daytime
sleepiness and napping.
Conclusions: Technology use prior to bed and during the night isprevalent in the USA, especially in adolescents and emerging adults.
The pervasive use of this technology demands we learn causal links
between technology use and sleep.

PO-2-138
ASSOCIATION BETWEEN SLEEP DURATION AND
LIFESTYLE-RELATED DISEASES IN NAGAHAMA
0-DEGREE COHORT STUDY

H KADOTANI1, M YAMAGUCHI1,2,6, Y NAGAI1,6, A SEKINE3,6,
S KOSUGI4,6, T NAKAYAMA5,6, F MATSUDA1,6
1
Center for Genomic Medicine, Kyoto University, Kyoto-city, Kyoto, Japan,
2CEO, Amelief Co. Ltd., Japan, 3EBM Research Center, Kyoto University,
Japan, 4Department of Medical Ethics and Clinical Genetics, Kyoto
University, Japan, 5Department of Health Informatics, Kyoto University,
Japan, 6Nagahama 0-degree Cohort Study group, Kyoto University, Japan

Introduction: Nagahama city (Shiga prefecture, Japan) and Kyoto University made a contract to perform a genome-cohort study and biobanking (Nagahama 0-degree cohort study).
Method: The first cross-sectional survey with questionnaire and physical examination was conducted between 2008 and 2010. 9853 residents (30–74 years, 32.8% male) participated in the study. Sleep
duration and current medical condition were asked in the questionnaire. Arterial stiffness was measured by CAVI (Cardio-ankle vascularindex). Logistic regression models were constructed to examine theindependent associations of important covariates (age, gender and BMI)
with lifestyle-related diseases (hypertension, diabetes mellitus, lipidemia, depression, insomnia and arterial stiffness).
Results: Mode of sleep duration was 6 hrs (6–7 hrs). Compared to
7–8 hrs of sleep, shorter sleep (−5, 5–6, 6–7 hrs) was related to a significantly increased risk for insomnia. Sleep shorter than 5 hrs andlonger than 8 hrs were both significantly associated with depression.
Hypertension and arterial stiffness were both significantly associatedonly with sleep longer than 8 hrs. We could not find any association
between sleep duration and lipidemia. Diabetes mellitus showed a
U-shape, but not reached a statistical significance with sleep duration.
Unlike the previous reports in US, our population did not showed
U-shape with sleep duration in hypertension.
Conclusion: Sleep duration is associated with insomnia, depression,
hypertension and arterial stiffness. Sleep duration might affect differently on Japanese and Caucasians.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-139
DIFFICULTY MAINTAINING SLEEP AND EARLY
WAKE-UP TIMES ARE ASSOCIATED WITH
VASCULAR DYSFUNCTION IN JAPANESEHEALTHY INDIVIDUALSM KADONO1, M SHIGETA1,2,4, A NAKAZAWA3,4, M UEDA4,M ASANO1, M YAMAZAKI1, M FUKUI1, G HASEGAWA1, N
NAKAMURA1
1
Endocrinology, Kyoto Prefectural University of Medicine, Kyoto-city,
Kyoto, Japan, 2Division of Epidemiology for Community health andMedicine, Kyoto Prefectural University of Medicine, Japan, 3Health Center,
Doshisya University, Japan, 4Division of Medical Check-up, Kyoto FirstRed Cross Hospital, Japan
Introduction: Previous investigations have shown that sleep loss causes
hypertension and atherosclerosis. Sleep fragmentation and earlier
wake-up times characterize sleep patterns of older adults in relation to
age-related circadian phase advance. These findings raise the question ofwhether vascular dysfunction with aging is associated with the agerelated changes of circadian phase and sleep-wake patterns. In the present
study, wehave cross-sectionally investigated whether self- reported difficulty sleep maintaining, habitual wake-uptimes, and sleep timing areassociated with higher blood pressure and vascular dysfunction.
Methods: The study included 3066 apparently healthy individuals(mean aged 57.2 ± 10.1,1634 male) who underwent a human doc
program in a general hospital. Habitual patterns concerning sleep ((bedtimes, wake-up times (WT), and symptoms of difficulty initiating ormaintaining sleep (DMS)) were recorded from answers on the questionnaire. Vascular condition was assessed by blood pressure andbrachialankle pulse-wave velocity (PWV) value. Hypertension (HT) was defined
as blood pressure ≥130/85 mmHg, and Atherosclerosis (AT) was determined as the highest tertile of baPWV values. Logistic regression model,
adjusted for variables including gender, age, sex, body mass index,
blood pressure, sleep duration were applied.
Results: DMS was associated with increased prevalence of HT withadjusted ORs of 1.23 (1.01–1.50). WT 5:00 a.m or before were associated with increased prevalence of HT and AT with an adjusted ORs of
1.48 (1.06–2.07) and 1.83 (1.12–2.99), respectively, compared to WT
after 5:00 a.m. Sleep timing (ST) (midpoint of BT and WT) advancedby 1 hour was associated with higher prevalence of AT, with adjusted
ORs of 1.18 (1.05–1.33). Sleep duration did not contribute to theassociation between the sleep parameters and vascular condition.
Conclusion: DMS , early WT, and advanced ST were strongly associated with vascular dysfunction. Age- associated changes of circadiantiming and sleep forms might influence vascular condition.

PO-2-140
COMPARISON OF SLEEP ON PUBLIC BATHING
AND BATHING AT HOME

K SUNAGA1, H KONDO2, T TATSUSE1
1
Graduate School of Medicine and Pharmaceutical Science, University of
Toyama, Toyama city, Toyama prefecture, Japan, 2Company, Limited,
Magnet, JapanOBJECTIVE: The purpose of this study is to evaluate core temperature
difference between taking Public Bathing (with hot spring ingredients)(PB) and Bathing At Home (BAH) and analy1zed its effect on sleep.
METHODS:
Settings and Subjects: Subjects are 22 to 25 years old 6 male and 1
female who has no record of psychiatric disease including sleep disorder.

All subjects marked high score by Morningness-eveningness questionnaire (mean score 36.3 ± 8.2) and regular time in bed tended to be late.
Condition: Subjects chose two certain days out of 6 consecutive days
and they took BAH on the first day and took PB on the second day. On
both two days subjects took bath two hours prior to their regular in
bed time. Bathing time was 10 minutes and water temperature at home
was approximately 41 degrees (38–42), at public bathing was 38–42
degrees. Subjects spent regular school days in day time and went to bed
on regular time.
MEASUREMENTS: Wireless core temperature sensor (Mini-MitterCo.), was used to measure core temperature. The consecutive coretemperature data was taken from 12:00 pm on the first day to thesecond day 12:00 pm. Sleep diary was recorded on Time In Bed, Get
Up Time and bathing time.
ANALYSIS: We compared sleep latency and total sleep time of twogroups. Core temperature was picked up at 5 points of “Before Bathing”,“After Bathing”, “Time in Bed”, “The lowest temperature “, and “At wakeup” and analyzed difference by one-way ANOVA. We set combinationof “Before and After Bathing”, “After Bathing-Time In Bed”, “Time In
Bed-The Lowest Temperature”, “The Lowest Temperature-At Wake Up”
for both PB and BAH and compared data by two-way ANOVA.
RESULTS: Mean time of TST was 1.97 ± 0.67 for BAH and 1.88 ± 0.55
for HSB and there was not significant difference. Core temperature of
PB at After bathing temperature was higher than BAH but rest threepoints showed the same temperature. PB showed significant decreasingof core temperature before sleep. PB showed higher rate of decreasing
with core temperature and might help to fall asleep promptly.

PO-2-141SLEEP FACILITATION BY JAPANESE HOTSPRING; EEG, CORE, PROXIMAL, AND DISTALTEMPERATURE EVALUATIONSS UEMURA-ITO1, M WAKASA1, A SAITO1, W ITO2, K SHIMIZU2,M YOSHIDA3, M ECHIZENYA2, T KANBAYASHI2, S NISHINO4,
T SHIMIZU2
1
Graduate School of Health Sciences, Akita University, Akita-city, Akita,Japan, 2Graduate School of Health Sciences, Department of Physical
Therapy, Akita University, Japan, 3SleepWell CO., Ltd, Japan, 4Psychiatry
and Behavioral Sciences – Sleep Disorder/Sleep Center, Stanford University,
United States of America
Background: Bathing, especially with hot spring with various mineralcompositions, is known to facilitate/improve sleep by warming thebody. It is postulated that the heat dissipation decreases the elevatedcore body temperature, facilitates sleep. It was also reported that sleep
is more easily induced when the DPG (Distal-proximal temperature
gradient) exhibit the most positive values (Krauchi1999). In this study,
we thus evaluated the effects of usual (plain hot water; PH) and hot
spring bathing (HS) on sleep using clinical thermometers and EEG.
Methods: Eight healthy men (average age 20.1 years) were divided into
3 groups and each group received the HS (Akita-Onsen Satomi), PH
bath and no bathing (NB) a week interval. The temperature of thebathwater was set to be 40 C degrees. Subjects soaked in the bath deep
enough their chests touched the water at 22:00 for 15 min. From thetime they finished bathing to the next morning, we measured their core
body temperature (CT: rectum), distal skin temperature (DT: top sideof the foot), proximal skin temperature (PT: lower part of the clavicle)
and EEG using a single channel portable device (Moomin-kei, SleepWell). Subjects were told to sleep from 24:00–7:00.
Results: The amount of delta power per min in the first sleep cycle
significantly increased in the bath groups (p < 0.04, ANOVA), and the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research387

Sleep, Science and Researchhighest power was observed in HS group. Sleep latency also decreasedin the same order but the difference did not reach to the significant
level. Total sleep time increased in the order of PH, HS, and NB groups(p < 0.05). Bathing significantly increased CT and the subsequentdeclines during initial 40 minutes (p < 0.05). Changes in the DPG wereassociated with significant decrease in PT, and the larger decline in PT
was seen in the HS group.
Conclusion: These sleep changes are associated with large decline in
the elevated CT, increased heat dissipation and positive DPG values.
Hot spring bathing had the larger effects on these parameters. It is
proposed that some mineral compositions of hot spring likely produced
larger temperature changes and subsequent sleep facilitations.

PO-2-143 / AS-8 Presenter
PROMOTING SLEEP QUALITY THROUGHMEDITATION
JP NARAIN MISHRA, PS Shekhawat, YS Khangarot
Department of Science of Living, p.m. and Yoga, Jain Vishva Bharati
University, Ladnun / Rajasthan, India
Meditation techniques are claimed to enhance the quality of sleep. Veryfew studies are available on the objective assessment of sleep following
various yogic practices. Changes in theta rhythm during slow wave
sleep along with significant alteration in EMG and enhanced REM duration were observed following TM. The purpose of this study was to seek
evidence of EEG and EMG alteration to determine whether Preksha
Meditation (PM) practice causes any positive impact on the quality andquantity of sleep. The study was carried out on randomly selected 16
experimental subjects (8 long term and 8 short term PM practitioners)
and a group of 16 matched control subjects. EEG and EMG recordingsof all 32 subjects conducted in a sound proof room, dimly lit and inlie-down position consecutively at different occasions as per availabilityof the subjects. EEG records was taken from surface electrodes by using
32 channel digital EEG machine with brain mapping and EMG wasrecorded from a surface electrode applied at wrist by using RMS Aleron
401 (4 channel). Recordings were analyzed for the alpha rhythm, total
sleep duration, sleep efficiency index, spindle amplitude, spindle duration, intra-spindle frequency, S1, S2 and REM percentage. The findings
indicate prominent appearance of theta rhythms during slow wave sleep
along with low EMG and also enhanced REM duration in long term
practitioners of PM. Spindle amplitude, spindle duration, intra spindle
frequency were found to be insignificantly increased in short term
practitioners where as they increase significantly in long term practitioners and alpha rhythm dominance was significant in both groups. Outof the results obtained it may be inferred that PM helps in improving
the quality of sleep and bringing in the state of relaxation. The detailed
pathway of possible mechanism involved in the process will be
discussed.

PO-2-144 / AS-4 Presenter
MEDIA USAGE AS A PREDICTOR OF IRREGULARSLEEPING PATTERNSV TEIJA1, C RAY1,2, E ROOS1,2
1
Health promotion, Folkhlsan Research Center, HELSINKI, Finland,
2
Department of Public Health, University of Helsinki, Finland

sumption and media presence in the bedroom at baseline predict irregular sleeping patterns 1,5 years later.
Methods: The baseline sample, from 2006, consisted of 10- to 11-yearold children from 27 Swedish-speaking schools in Helsinki region insouthern Finland. A follow-up was made in 2008. Only subjects (n =677, response rates 74% and 93%, 2006 and 2008 respectively) who
answered in both years are included in the analyses. Media consumption was assessed as watching television, using computer and total
screen time (h/day). Irregular sleeping patterns were defined as later
bedtimes at weekends than school nights and as difference in sleep
duration between school and weekend nights. Linear regression analyses were used. Model 1 was adjusted for gender, grade, living withmother and father and model 2 further by baseline sleep irregularity.
Results: More frequent computer use, screen time and media presence
in bedrooms at baseline predicted later bedtimes at weekends thanschool nights. Adjusting for baseline irregularity in sleep patterns, computer use and computer in bedroom predicted later bedtimes. Computer use and screen time predicted sleeping more at weekends thanschool nights. Adjusting for baseline sleep irregularity, screen time andwatching television predicted sleeping more at weekends.
Conclusion: Media consumption at baseline predicted irregular sleeping patterns. Media presence in bedrooms predicted later bedtimes atweekends.

PO-2-145
BETTER SLEEP PROPOSAL FOR THE FUTURE:
LEARNING THE HUMAN ASPECTS FROMSLEEPING POSTURES DEPICTED ON PICTURE
SCROLLS DURING THE MEDIEVAL TIMESM HAYAMA
Department of Beauty Culture, Kamakura Hayami institute of Art,
Yokohama-city, Kanagawa, Japan
People sleep. There is no exception to it at any time any place. Since
the ancient glory times of Japan we have a lexis, Oki-fushi, which
describes our daily lives as cycles of getting up and going to sleep.
Production of picture rolls was flourished during 12th to 14th centuries
in Japan and they were exactly presenting the world of Oki-Fushi.
Scenes in picture scrolls are marvelously color-painted and intriguingstorylines are inserted next. Themes vary in scrolls to scrolls – they
could be dynasty themes, Buddhist narratives, or they could be scandalous incidents happened in the Capitol City. The movement of people
inside of residences in picture scrolls was introduced as knees, crawls,
and lies down instead of walk and sit. Eshi, the scroll painters, depicted
fear of the people for the night. Night was the time when people
believed vengeance and apparition surrender their world. Frightening
the dark, yet all they could do was to sleep with complexity of weirdness
and confusion. Nowadays science and technology are what we believe
which have contributed and transformed the sleeping customs andhabits revolutionary. At the same time it has led people to lose the senseof having night and day. People find themselves mislay the rhythm ofsleep and some of us struggle to sleep at night with the stress produced
from the day time. Evaluating both depiction of sleeping habits andepisodes from Medieval Times and sleep problems in nowadays, what
can we propose for the better sleep in the future?

Introduction: Regularity in sleep schedules is important part of good
sleep hygiene, enabling good sleep quality and sufficient amount of
sleep. The aim of this study was to examine do frequent media con-388

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-146
EFFECTS OF VIEWING NEGATIVE AFFECTIVEPICTURES ON NIGHTTIME SLEEP: LATENCY TOSLEEP STAGES, THE TOTAL AMOUNT OF SLEEPSTAGES, AND RAPID EYE MOVEMENT DENSITYT SATO
Health and Social Services, Tohoku Bunka Gakuen University, Sendai,Japan
This study investigated the effects of a certain kind of emotion elicitation on the latency to rapid eye movement (REM) and non-REM sleep
stages, on the total amount of these stages, and on REM density inhealthy participants, by using polysomnographic recordings. The study
included 5 women and 4 men. Sixty different pictures drawn from theInternational Affective Picture System (IAPS; Lang, Bradley, & Cuthbert,2005) were used to elicit emotions, and included 20 pleasant, 20
neutral, and 20 unpleasant pictures. The participants underwent fullnight polysomnography on 4 nights in a sleep laboratory. After themeasurements were obtained on the first night, i.e., the adaptationnight, 1 of the 3 picture-viewing tasks–i.e., viewing and rating pleasant(task 1), neutral (task 2), or unpleasant (task 3) pictures–was randomly
assigned for the second, third, or fourth night. The participants engaged
in 1 of the 3 tasks before bedtime on these 3 nights. The 8-hour polysomnographic recordings commenced at 2400, at which time all thelights, except for an emergency fluorescent light bulb, were switched
off. REM density was calculated as a percentage ratio of the number of
30-s epochs in which one or more REMs were observed and the total
number of epochs evaluated as REM stages. In this report, the author
presents the results of the effects of the unpleasant picture-viewing
tasks, compared to the neutral. The polysomnographic measurements
obtained after the unpleasant picture- and neutral picture-viewing tasks
were compared by one-way repeated measures analysis of variance.
These analyses showed that the latency from the time when the lights
were switched off to sleep stage 3 after the unpleasant picture-viewing
task was significantly longer than that after the neutral picture-viewing
task (p < 0.05). No significant differences were found between the total
amount of any of the sleep stages or in the REM density after these 2
types of tasks were performed on the measurement nights. These data
indicate that using unpleasant affective stimuli before bedtime extends
latency to deep sleep stages.

PO-2-147 / AS-3 Presenter
MULTI-COLORED EFFECTS OF LED LIGHT ON
COGNITIVE FUNCTION AND PSYCHOLOGICALPARAMETER IN THE EVENING

M GOTO1, M TANAKA1, T WAKAMURA1, M FUKUHARA2,
M TANAKA2, K NODA1, E MASUTANI1, H YOKOUCHI3,
T HIROYASU3, ATSUSHI MAKI41
Department of Medicine, Kyoto University, Kyoto-city, Kyoto, Japan,
2
Department of Engineering, Doshisha University, Japan, 3Department ofLife and Medical Sciences, Doshisha University, Japan, 4Total Solution
Department Business Incubation Division, Hitachi, Japan

Objective: This study aimed to examine the multi-colored effects of
LED light on cognitive and psychological parameters in evening.
Participants and Method: All of 20 participants were male student(age: 18–19). They conducted GO/NOGO task, Kwansei-gakuin Sleepiness Scale (KSS) and Positive and Negative Scale (PANAS) at every 30
minutes from 18:30 to 23:30 under three light conditions. From 18:30

to 21:00, participants were in dim light condition in all settings. From
21:00 to 23:00, the light conditions were in Dim (a), the Blue LED light(7000K, 30lx) (b) and the Red LED light (3000K, 20lx) (c). From 23:00
to 23:30, the light was again in dim condition.
Results: In GO/NOGO task, on error rate compared to the average rate
of before lighting, the average rate of after lighting decreased in setting(b) and (c) (b p = 0.018, c p = 0.062). On reaction time the score at
21:30 was significantly faster than the average score before lighting insetting (c) (p = 0.005). In KSS, the score at 21:30 and 22:00 weresignificantly lower than the average score of before lighting in setting(c) (21:30 p = 0.09, 22:00 p = 0.02). At the same time in setting (b)and (c) the PA score (PANAS) at 21:30 and at 22:00 were significantly
higher than the average score of before lighting (b: 21:30 p = 0.000,
22:00 p = 0.006, c: 21:30 p = 0.009, 22:00 p = 0.026, respectively).
There was a significant decrease on PA score at 22:00 compared to thatat 21:30 in setting (b) (p = 0.045). However in setting (c), between thescore at 21:30 and at 22:00 there was no significant difference (p =0.901).
Conclusion: Our data suggest that we should consider how to use the
LED light for depending on a purpose by its multi-coloristic in theevening.

PO-2-148
CHANGE IN SLEEP QUALITY BY OUTDOOR AIRTEMPERATURE RISE

T IHARA1, Y SHIGETA2, Y OHASHI3, Y GENCHI1
1
Research Institute of Science for Safety and Sustainability, Advanced LCA
Research Group, National Institute of Advanced Industrial Science andTechnology (AIST), Tsukuba-city, Ibaraki, Japan, 2Department ofEnvironment Systems, Rissho University, Japan, 3Department of BiosphereGeosphere System Science, Okayama University of Science, Japan
Background: Air temperature rise worsens sleep quality. Okano et al(2008) conducted the survey on a total of 838 subjects living in Tokyo
in summers of 2006 and 2007. They found that about 2% more subjects
become “poor” sleepers for each 1 degree C increase in outdoor air
temperature at 0000 LST over 25.3 degree C. However, there was a
problem that the rate of “poor” sleepers under 25.3 degree C in thesurvey was 48.8% and it was significantly higher than 26.4% for maleand 31.1% for female by Doi et al (2001) surveyed on Japanese residents in October. Both of the surveys used the Japanese version of thePittsburgh Sleep Quality Index (PSQI-J) and the cutoff value, 5.5. Inorder to apply Okano et al to Japanese residents, influence by somefactors which are different among these two surveys should be evaluated. This study focuses on difference of season.
Subjects & Methods: We conducted a survey via the Internet on a
total of 2,421 adults living in Tokyo during four seasons from 2009 to
2010. The survey days were 20 April, 8 September, 17 November, and22 January. Questionnaire for each day was consisted of four sections;personal attributes, housing and bedroom environments, subjective
sleep quality using PSQI-J, and bedclothing.
Results: A total of 1,263 male and 1,163 female are included in the
responders. The response rate was 100% because of the Internet survey.
The PSQI-J global scores among the four seasons are 4.2 ± 2.7, 4.8 ±
2.9, 4.3 ± 2.9 and 3.9 ± 2.4 for male and 4.4 ± 2.6, 5.2 ± 2.8, 4.5 ±2.6 and 4.4 ± 2.6 for female. There is a significant difference among
the seasons for both sexes (p < 0.005). Using the cutoff value, the ratesof “poor” sleepers are 28.3%, 31.8%, 23.1% and 18.4% for male and28.7%, 38.6%, 29.3% and 25.4% for female.
Conclusion: The rate of “poor” sleepers is changed in season. It can
explain a part of the difference between Okano et al (2008) and Doi et© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research389

Sleep, Science and Researchal (2001). Additionally, there is a correlation between monthly air
temperature at 0000 LST of the survey day and the PSQI-J global score.
Seasonal change in sleep quality can include air temperature change.

PO-2-149
EFFECT OF USING AIR CONDITIONER ON
FATIGUE AND SLEEP QUALITYH FUJII1, S FUKUDA1,4, D NARUMI2, T IHARA3, Y WATANABE1,4
1
Dept of Physiology, Osaka City University Graduate School of Medicine,
Osaka city, Osaka, Japan, 2Environment and Information Science,
Yokohama National University, Graduate School, Japan, 3Research Instituteof Science for Safety and Sustainability, National Institute of Advanced
Industrial Science and Technology (AIST), Japan, 4Center for Molecular
Imaging Science, RIKEN, Japan
Background: It is common senses that there is a relationship between
poor sleep quality and fatigue status. However their relationship wasneither well studied nor characterized. We examined the follow-up
studies by questionnaire for about 200 healthy subjects in Osaka every
one month for three terms to estimate impact of air conditioner use on
hot days and/or nights.
Subjects & Methods: We administered about a total of 662 subjects
for the study. The subjects answered the questionnaire for 6 days at
every term (from July to October in 2010; T1-T3). Questionnaire wasconsisted of four sections; demographic variables, lifestyle, fatigue, andsleep quality. We used Chalder’s fatigue scale for assessment of fatigue
and Pittsburgh sleep quality index for assessment of sleep quality.
Results: The response rate is 95.6%. Increase of fatigue score are shownin the subjects who are at over 30 degree of the outside air temperature
Taking deep sleep induces low fatigue score. However even if taking
deep sleep, subjects who use air conditioner at night shows high fatigue
score. Even in the hot days, some subjects show low fatigue score.
Therefore we divided subjects into two groups , high group (CS = >17) and low group (CS < 17), and examined the effect of living environment on fatigue score between the two groups. There are significant
differences on air conditioner use daytime and/or during sleep between
two groups.
Conclusions: Good sleep quality may contribute low fatigue score.
Using air conditioner is recommended as a good method for keeping
good sleep quality, but our data suggested it might induce fatigue on
the next day.
Acknowledgment: This study was conducted by research project for
creation of housing that promotes health and well-being.

PO-2-150
EFFECTS OF BED MATTRESS MATERIAL ONSLEEP ONSET UNDER MILD HUMID HEATEXPOSURE

K OKAMOTO-MIZUNO1, K MIZUNO2, M YAMAMOTO1,N MATSUURA3, A MATSUO4, A IWATA4, S SHIRAKAWA3,5
1
Kansei Fukushi Research Center, Tohoku Fukushi University, Sendai-city,
Miyagi, Japan, 2Faculty of Child and Family Studies, 1) Tohoku Fukushi
University, Japan, 3None, Sleep Assessment and Research Institute, Japan,
4None, IWATA Co. Ltd, Japan, 5None, National Institute of Mental Health,
N.C.N.P., Japan
The purpose of this study was to investigate the effects of bed mattressmaterial on sleep onset during naps taken under mild humid heat
exposure that simulated Japanese summers. The study included 11390

healthy male subjects who wore short-sleeved pajamas and shorts andslept from 1330 to 1530 wearing a cotton blanket on a bed covered
with a sheet. Two types of bed mattresses containing different materials
were compared: polyurethane foam mattress (U) and camel mattress(C). Ambient climate conditions were maintained, with the temperature
at 29°C and relative humidity at 70%. Electroencephalogram (EEG),
electrooculogram (EOG), and mental electromyogram (EMG) recordings; and the skin temperature (Tsk), microclimate temperature, andhumidity measurement for the waist and chest areas of the subjects were
continuously obtained. The subjective sensation was asked before andafter sleep. The protocols for this study were approved by the ethics
committee of Tohoku Fukushi University. No significant differenceswere observed in the amount of sleep stages and in sleep onset latency.
However, the rapid eye movement (REM) sleep in the first hour for the
U was significantly increased than that for the C. The leg, arm, andmean Tsks for the U were significantly increased than those for the C
at the sleep onset. The microclimate temperature and humidity of thechest area for the U were significantly increased than those for the C at
40 min after the lights were switched off. The subjective sensation of
humidity for the bed mattresses was significantly high, and the requirement for decreasing the mattress temperature in for the U was significantly higher than that for the C. These results suggest that bed mattressproperties can affect an increase in the subjective sensation of humidity
and the requirement for decreasing mattress temperature during sleepby (1) increasing the mean Tsk at the onset of sleep and microclimate
temperature and humidity of the chest area in the later segment of sleepand (2) changing the REM sleep distribution pattern.

PO-2-151
CONSUMPTION EFFECT OF TYROSINE AND
PHENYLALANINE AS PRECURSORS OF
CATECHOLAMINE ON MENTAL HEALTH EXISTSNOT AT SUPPER BUT AT BREAKFAST IN
JAPANESE INFANTSO AKIMITSU1, K WADA1,2, R NISHIHARA1,2, T NOJI3,N TANIWAKI4, M NAKADE5, H TAKEUCHI2, T HARADA2
1
Graduate school of integrated art and science, Kochi University,
Kochi-city, Japan, 2Laboratory of Environmental Physiology, Kochi
University, Japan, 3Laboratory of Health & Physical Education,
Kochi University, Japan, 4Affiliated Kindergarten, Faculty of Education,
Kochi University, Japan, 5Deparment of Nutritional Education, Tokai
Gkuen University, Japan

Objective: This study challenges to examine the effects of tyrosine andphenylalanine intake at breakfast and supper as precursors of dopamineon Morningness-Eveningness (M-E) scores and mental health in Japanese young children aged 2–6 yrs from epidemiological point of view.
Participants and Methods: An integrated questionnaire was administered to 1367 infants attending 10 nursery schools governed by Kochi
City and affiliated kindergarten of Faculty of Education in June-July
2008. The questionnaire included M-E questionnaire, questions on
sleep habits (wake-up and bed times, sleep quality and quantity and soon), meal habits (regularity of timing and contents), mental health(anger and depression). Intake amount of tyrosine and phenylalanine
were calculated based on contents questionnaire, and tables on thecomponents of amino acids in foods (Gomyo and Hasegawa, 1993).
Results: Infants who took more than 800 mg (per meal) of tyrosine or
phenylalanine at breakfast were more morning-typed than those taking
less than 800 mg (One-Way ANOVA: df = 1, F-value = 7.997, p =0.005). However, this effect disappeared in the Two-Way ANOVA(deleting effect of covariance as tryptophan intake: df = 1, F-value =© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

0.018, p = 0.894). Infants who took more than 800 mg of the twoamino-acids at breakfast showed significantly higher scores of mental
health (lower frequency of depression and anger) than those taking lessthan 800 mg (One-Way ANOVA: df = 1, F-value = 8.302, p = 0.004),
and this effect remained significant even after deleting covariance =tryptophan effect (Two-Way ANOVA: df = 1, F-value = 5.773, p =0.017). However, infants who took more than 1600 mg of tyrosine or
phenylalanine at supper showed similar scores of M-E and also mental
health (One-Way ANOVA, M-E: df = 1, F-value = 0.018, p = 0.894;
Mental health: df = 1, F-value = 0.058, p = 0.810).
Discussion and Conclusion: Activity of dopamine synthesis in infant
brain might be hypothesized to be higher in the morning than in theevening. Tyrosine and phenylalanine taken not at supper but at breakfast could affect mental health in infants.

PO-2-152
EFFECT OF AROMA OIL ON AUTONOMICNERVOUS SYSTEM IN THE MORNING UNDERDIFFERENT LIGHT CONDITIONST WAKAMURA, R TAKENOUCHI, M MURAKAMI, C TANAKA,
M TANAKA
Graduate school of medicine, Kyoto Univesity, Kyoto, Japan
Aromatherapy is popular in modern life in the world; it has been particularly accepted as nursing care recently. However, the efficacy data
are scant, and potential mechanisms are disputable. As the experimentenvironment, the light condition is important, because the bright lights
in daytime is effective in promoting the sympathetic nervous system.
The purpose of this study is to investigate the effect of aroma oil onhuman physiological parameters in bright and dim conditions.
Seventeen healthy male volunteers aged between 18 and 31 years (meanage: 22.4 years) participated in this experiment. The experiments werecarried out in October 2010. Participants were experienced in sitting
position with essential oil (Boswelliacarterii; sedative aroma) on bright(500lux) or dark (50lux) condition in the morning. Four essential oils
were previously tested by these participants and this oil was selected forthis experiment, because the number of persons preferring this oil equal
to un-preferring number. Autonomic nervous function was evaluatedbased on heart rate variability using Lorenz plot method (Map1060).
Heart rate variability was analyzed by paired t-test in this study. In brightcondition, CSI index, the activity of sympathetic nervous system, shownby preferred group tended to be higher in comparison with that by unpreferred group during aroma inhalation (p = 0.10). Furthermore, also
after the aroma application, CSI index by the preferred group was higher
than that by un-preferred group (p = 0.01). However, in the preferredgroup, the aroma oil effect on the CSI index tended to be reduced underthe bright condition than under the dim condition (p = 0.065).
In conclusion, brightness and the preference are possible to affect theactivity of sympathetic nervous system when exposed to this aroma.
Further studies are also required to clarify the significant effect of aroma
under light condition and preferred level.

PO-2-153
EFFECTS OF ONE MONTH INTERVENTIONPROGRAM ON MEAL HABIT, SLEEP-WAKE CYCLE
AND MENTAL HEALTH OF JAPANESE
UNIVERSITY SPORT CLUB MEMBERS

K WADA1, S YATA2, O AKIMITSU1, M KREICI3, T NOJI2,M NAKADE4, H TAKEUCHI1, S HIGUCHI5, T HARADA1
1
Laboratory of environmental physiology, Graduate School of Integrated
Arts and Science, Kochi University, Kochi-city, Kochi, Japan, 2Laboratory of
Health & Physical Education, Faculty of Education, Kochi University,
Japan, 3Department of Health Education, Faculty of Education, Universityof South Bohemia, Czech Republic, 4Deparment of Nutritional Education,
Tokai Gakuen University, Japan, 5Department of Human Science, Facultyof Design, Kyushu University, Japan

Objective: This study aims to estimate effects of intervention which isasking Japanese university students to take breakfast including protein
and Vitamin B6, followed by the exposure to sun-light and to be
exposed to incandescent lights (“low temperature” light) at night (Oct–Nov, 2010) on meal habit, sleep-wake cycle and mental health.
Participants and Methods: 94 male attendants of university footballclub were divided to 3 groups (G1: no intervention; G2: asking themto have protein resources like as fermented soybeans and VB6 resources
like as banana at breakfast and to be exposed to sun-light after breakfast;
G3: asking them to do as G2 plus to use incandescent lamp at night).
To estimate the effects of the 1 month intervention, an integrated questionnaire was administered to all participants three times, first justbefore the intervention and second just after that and third one month
later. The questionnaire included MEQ and questions on sleep habit,
GHQ and SOC. Just after the intervention, questions on “implementation rate” and the satisfaction on their implementation were administered to G2 and G3. Salivary melatonin was measured around 23:00 at
mid-point and just after 1 month period.
Results: Just after the intervention, participants satisfied with theirimplementation of breakfast took their breakfast more frequently andregularly (p = 0.069, p = 0.038) and showed more morning-typed (p= 0.006) than those with lower satisfaction. Participants who took theirbreakfast more frequently have less mid-night snacks (p = 0.003) thanthose with less frequency. Participants who implemented the contents
of both morning and night intervention in more days showed higher
conc. of salivary melatonin at the midday of the intervention than thosewith lower implementation rate (p = 0.025). The frequency of irritation
was lower just after intervention than that before intervention in G3(p < 0.001).
Discussion and conclusion: These may indicate that the one monthintervention program is effective to promote the morning-typed sleepwake cycle and to improve mental health, and meal habits.

PO-2-154
THE EFFECTS OF DIFFERENT TIMING OF THE
EVENING MEAL ON SLEEP EEG AND
SUBJECTIVE SLEEP AMONG YOUNG ATHLETESK KOHAMA1, Y SASAZAWA2
1
Graduate School of Education, Ryukyu University, Naha-city, Okinawa,
Japan, 2Faculty of Education, Ryukyu University, Japan

Subjects: Subjects were 5 college students aged 19 to 20 years old who
exercise regularly.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research391

Sleep, Science and Research

Methods: The experiments took place from November to January inthe sleep laboratory. This study compared four conditions: [C1] undernourishment after exercise, [C2] a meal just after exercise (within anhour after exercise), [C3] a meal just before sleep and after exercise(within an hour before sleep), [C4] only a meal (meal time was sameas [C2] condition. The experiments were conducted once a week. The
subjects exercised by bicycle ergometer for an hour between 17:00 and
19:00, after that they executed each condition, then slept between
23:00 to 24:00. Sleep was evaluated with the OSA questionnaire andby polysomnography.
Results: According to the OSA questionnaire, Condition [C2] had asignificantly higher score for sleep maintenance (p = 0.005) and forsleep initiation (p = 0.021) than [C1]. Condition [C2] also had a significantly higher score (p = 0.029) for sleep maintenance than that of[C3]. Condition [C2] also had a significantly higher (p = 0.028) scoreof sleep initiation than that of [C4]. According to the results of thepolysomnography, Condition [C1] had a significantly higher score of
sleep efficiency (p = 0.005) and significantly lower number of awakenings (p = 0.037) than that of [C3]. In this study subjective indicators
were inconsistent with objective indicators, therefore deeper investigation is necessary.
Conclusions: This study suggests that exercise may improve sleep
initiation and a meal just after exercise may improve subjective sleep
when compared to conditions of undernourishment after exercise, anda meal after exercise just before sleep.

PO-2-155
INFLUENCE OF ACUTE MODERATE AEROBICINTENSITY EXERCISE ON QUALITY OF SLEEPESTIMATED BY MAT-BASED SLEEP MONITOR

H PARK1, F TOGO2, T KOMATSU3, Y KASAHARA4, T SASAKI5
1
Aging Regulation, Tokyo Metropolitan Institute of Gerontology, Tokyo,
Japan, 2Educational Physiology Laboratory, The University ofTokyo, Japan, 3Department of Physical Therapy, Tokyo University ofTechnology, Japan, 4Tanita Body Weight Scientific Institute, Tanita, Japan,
5
Tanita Body Weight Scientific Institute, Tanita, Japan
This study was to examine the influence of moderate intensity of aerobic
exercise during early evening and late night on sleep. Twenty young
adults aged 26–35 participated. From 8 days before the experiment day,usual sleep time was obtained by standardized questionnaire for 7 days.
In addition, we measured total durations of sedentary, light-intensity
activity, and moderate- to vigorous-intensity activity during the 7 daysby accelerometer. The participants were randomly allocated, matchedage, sex, objectively measured daily total physical activity and daily total
sleep time, to early evening exercise group (exercise I, n = 9), late night
exercise group (exercise I, n = 9) and control group (n = 9). Subjects
in the exercise I group attended an exercise program of 120-min duration (1500–1700) which started with warming up stretching for
15 min, followed by 60 min of aerobic exercise at intensity between
60–70% of the heart rate reserve. Subjects in the exercise II groupattended the same exercise program at late night (2100–2300), while
the control group performed book reading at the same time (1500–
1700). On the experiment night, we estimated total sleep time and total
duration of each sleep stage during sleep at home by using mat-based
sleep monitor with body movement sensor. Sleep stages were estimatedby using pulse wave, respiration, and body movement measured by thesensor. Analysis of covariance showed that total duration (or ratio) of
the estimated sleep stages 3 or 4 and the estimated rapid eye movement
sleep were significantly longer (or higher) and shorter (or lower),
respectively, for both exercise groups (I and II) than the control group.

392

In addition, the total duration (or ratio) of stages 3 or 4 was significantly
longer (or higher) for exercise I group than exercise II group (p = 0.04).
As expected, our results indicate that acute moderate intensity exercise
during early evening or late night might improve quality of sleep athome estimated by mat-based sleep monitor with body movement
sensor. Mat-based sleep monitor might be useful for self-monitoring of
quality of daily sleep at home.

PO-2-156
MODERATE INTENSITY EXERCISE PERFORMED
IN THE EARLY EVENING ELICITS A POSITIVE
EFFECT ON SLEEP FOR YOUNG PEOPLE WHO
DO NOT SLEEP WELLS ODA1, K SHIRAKAWA2, C HARASAKI3
1
Department of Lifelong Sport, Hokusho University, Ebetsu-city, Hokkaido,
Japan, 2The Northern Regions Lifelong Sports Research Center, Hokusho
University, Japan, 3Graduate School of Lifelong Learning Studies, Hokusho
University, Japan
Many studies pointed out a methodological limitation that good sleepers have little room to achieve improvements in sleep by exercise. So
in this study, we examined the effects of early evening exercise on sleep
for people who do not sleep well. 19 male college students completed
a sleep-monitoring by actigraph on more than three non-exercise days,
and seven subjects (mean (SD) age of 20.6 (1.1) years) were selected,
who showed less than 90% of sleep efficiency (SE; total sleep time /time in bed). After an adaptation day, the subjects completed threeexperimental treatments, consisting of baseline non-exercise (NE) and2 exercise timing conditions, in which subjects completed 60% of heart
rate reserve at 3 h (3HE) or 5 h (5HE) before bedtime. The subjects
maintained a sedentary condition except for the exercise period, going
to bed at 23:30 and getting up at 07:30. Total sleep time, sleep onset
latency, wake time after sleep onset, and SE were assessed by actigraph.
In addition, subjective physical fatigue and sleepiness were assessed bya set of visual analog 100 mm scale administered before retiring on eachexperimental night. Results did not show any significant difference
among the three experimental treatments. However, significantly higher
value of SE was observed for the exercise day (mean of 3HE and 5HE)
than NE (88.5% > 81.2%). Also, higher scores of physical fatigue andsleepiness were observed for the exercise day compared with NE (52 >24, 66 > 53, respectively). These results indicate that early evening
exercise, without difference in specific exercise timing, might enhance
subjective sleepiness to improve sleep for young people who do not
sleep well. This work was supported by KAKENHI (20700542).

PO-2-157SLEEP IN MIDDLE-AGED AND ELDERLY WOMENAND ITS RELATED FACTORSY HIDA1, H ISHII2, T KAWAKAMI3, M OSHIMA4, H IWAKAWA5
School of Nursing, Sugiyama Jogakuen University, Nagoya-city, Aichi,
Japan, 2School of Nursing, Sugiyama Jogakuen University, Japan, 3School of
Nursing, Sugiyama Jogakuen University, Japan, 4School of Nursing,Sugiyama Jogakuen University, Japan, 5Region inclusive support center,
Tokoname-city Region inclusive support center, Japan1

Aim of the study: To analyze factors that impact on sleep in middleaged and elderly women for health consultation.
Subjects: Two-hundred and twenty-one middle-aged and elderly
women who belong to the JA Women’s Group of A Peninsula in Japan;© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

34.9% were middle-aged, 48.4% early elderly, and 16.7% late elderly.
Survey method: An anonymous self-administered questionnaire wasadministered and body height was measured. We investigated the sleep
status in terms of achievement of sufficient sleep, difficulty in falling
asleep, use of hypnotics, early morning awakening, and daytime
sleepiness.
Contents: Basic attributes, physical factors, psychological factors, andlife environment factors.
Analysis: Statistical analysis were performed using PASW statistics17.0,
descriptive statistics, and Spearman’s rank correlation coefficient. A
level of 5% was considered statistically significant.
Ethical consideration: This study was approved by the Institutional
Review Board of Sugiyama Jogakuen University School of Nursing(no.11). The nature of the study and the privacy protection wereexplained to the subjects, they were asked to participate in the study,
and informed consent was obtained.
Conflicts of interest: Not applicable.
Conclusion: Women living with family fell asleep more easily (p <0.01); those living alone had more difficulty in falling asleep (p < 0.01)
and felt a lack of sleep (p < 0.01). Those with lower weight (p < 0.01)
and a stronger tendency to feeling depressed had more sleep disturbances (p < 0.01), and those who consumed more meat (p < 0.01) andreported higher subjective well-being experienced better sleep (p <0.01). This study identified several factors related to sleep status in
middle-aged and elderly women.

PO-2-158
CORRELATION BETWEEN SLEEP AND MINORSYMPTOMS DURING PREGNANCYS UEMATSU, E MANABE
Department of Nursing, School of Nursing, Kyoto Prefectural University of
Medicine, Kyoto-city, Kyoto, Japan
Sleep is involved in apprehension and depression, and has both physical and psychologocal effects. Thus, sleep is thought to be useful inimproving minor symptoms during pregnancy. This study was therefore
conducted for the purpose of identifying the correlation between sleep
and minor symptoms during pregnancy.
Methods: Aquestionnaire survey was conducted on 239 complicationfree pregnant women. The contents of the survey consisted of the frequency at which the time of going to bed or waking up varying by morethan 2 hours during pregnancy and the occurrence of minor symptoms(including constipation, stiff shoulders, drowsiness, lower back pain,
lazy, easily, fatigued, irritability, light sleep, depression and stomach
discomfort). These minor symptoms were scored by determining the
product of the frequency and degree of each symptom. The total ofthese scores was defined as overall minor symptom score. The subjects
were analyzed by categorizing into a regular bedtime/wakeup group, in
which changes in bedtime/wakeup time did not vary or only varied 1
or 2 times a month, and an irregular bedtime/wakeup group, in whichchanges varied daily or 1 to 2 times a week, and the two groups werecompared for the occurrence of minor symptoms during pregnancy.
Results: As a result of comparing the two groups, with respect tobedtime, the regular group demonstrated significantly lower overallminor symptom scores as well as scores for stiff shoulders, lazy, easily
fatigued, irritability, light sleep and depression (p < .05). With respect
to wakeup time, the regular group demonstrated significantly lower
overall minor symptom scores as well as scores for easily fatigued anddepression (p < .05).
Conclusion: A definite correlation was observed between sleep regularity and the occurrence of minor symptoms during pregnancy.

PO-2-159 / AS-16 Presenter
SLEEP RELATED OCCUPATIONAL IMPAIRMENTDECREASES WITH AGE IN MALE WORKERS IN
THE UKE KUCHARCZYK1, K MORGAN1, S CLEMES2, M DUNCAN2,C HASLAM2, A KAZI2, L KERR2
1
Sleep Research Centre, SSEHS, Loughborough University, Loughborough,Leics. LE11 3TU, United Kingdom of Great Britain and Northern Ireland,
2
Work and Health Research Centre, Loughborough University, United
Kingdom
While ‘sleep-related occupational impairment’ is widely utilized as adiagnostic criterion in sleep medicine, the construct itself has been poorly
operationalized and under-researched. Using the ‘Loughborough Occupational Impact of Sleep Scale (LOISS)’, these analyses explore sleeprelated aspects of occupational performance within the UK workforce.
1054 workers (54% male) aged 18–65, from a range of occupationalsettings, completed a questionnaire including the 19-item LOISS which
captures sleep related occupational impairment over the previous
4 weeks. The mean LOISS score was 12.2(range 0–61, SD 10.9). 20%of all respondents scored in the range 21–61, indicative of moderate tosevere occupational impairment.
While reported sleep durations for work days showed no significant age
effects, sleep durations for non-work days showed a significant age
gradient, declining by 62 minutes from the age group 18–24 (meanestimated TST = 516.3 minutes; SD = 69.4) to the age group 54–65(mean estimated TST = 453.68 minutes; SD = 56.7; main effect F(1,4)= 17.93, p < 0.001). Despite the evidence of an age related decline insleep quantity, LOISS scores showed a reduction in sleep-related occupational impairment with increasing age. This trend was mainly due tothe male respondents (LOISS scores as age increased: (rp = −.156, r2 =0.02, p < 0.01) while scores remained stable, below the mean forfemales. The relationship between increased age and decreased occupational impairment in males remained significant after controlling forsleep duration, perceived workability, health indicators and work hours.
Two different hypotheses, alone or in combination, could explain thesefindings. First, age related increases in attention to detail, risk management, accident avoidance and role autonomy may account for theageing-related decrease in sleep-related occupational impairment
among men. Second, poorer sleep management among younger workers
may result in sleep-related workplace underperformance, which
declines with age and experience. Both hypotheses will be addressed infuture research.

PO-2-160
SLEEP QUANTITY AND QUALITY OF WORKERS
LIVING IN BIG CITIES IN JAPANK KASHIWAGI1, M YOSHIDA1, Y URADE2
1
Dept of Planning and Development, SleepWell co., ltd, Osaka-city, Osaka,
Japan, 2Molecular Behavioral Biology, Osaka Bioscience Institute, JapanAn accurate tool for the objective collection of sleep data over manynights in a wide population could have important implications in sleep
research and clinical practice. The ability to discriminate between sleep
stages beyond subjective sleep/wake measures by a questionnaire may
be especially useful in the objective assessment of sleep quantity andquality. We investigated actual sleep situation of over 300 working
Japanese living in big cities from 2009 to 2011 using a simple, smalland easy-to-use portable electroencephalogram (EEG) acquisition
device and analyzed sleep stages based on the Rechtschaffen and Kales1© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research393

Sleep, Science and Researchmethod. Participants were healthy 318 adult volunteers living in theTokyo metropolitan or Kansai area. Average age was 37.8 years old(10.7, SD) and no sleep complaints. They measured EEG by themselveswith the portable EEG at home. Average of total sleep time: 6 h 06 min(all, 1.4 h, SD), 6 h 20 min (male, 1.4 h, SD), 5 h 40 min (female,
10 min, SD). Sleep latency: 10.5 min (all, 9.6 min, SD), 11.3 min (male,
8.2 min, SD), 8.8 min (female, 3.2 min, SD). Total time in bed for male
was increased age dependently, but not for female. Total wake time
during sleep: 16.4 min (all, 12 min, SD), 19.4 min (male, 18 min, SD),
14.5 min (female, 10.2 min, SD). Our results of sleep quantity was over
1 h shorter than the results by questionnaire recently conducted by
NHK (Japan Broadcasting Corporation, 2010) or OECD (Organization
for Economic Cooperation and Development, 2009), were reported that
total sleep time was 7 h 14 min and 7 h 50 min, respectively. EEG based
home monitoring could reflect the present precise sleep situation ofworkers living in Japan.

PO-2-161
THE EFFECT OF NAP IN AN
ENVIRONMENTALLY-CONTROLLED VEHICLE
ON PSYCHOLOGICAL CONDITION, AND
WORK ABILITY

T KURIHARA1, Y NAKAGAWA1, M TATSUTA2, H TANAKA3
1
Advanced Technologies development Laboratory, Panasonic Electric WorksCo., Ltd., Kadoma-shi, Japan, 2Panasonic Electric Works Analysis Center
Co.,Ltd, Japan, 3Psychological Science department, Hiroshima International
University, Japan
Purpose: We operated in-house and outside experiments to verify thatthe nap during which the environment is appropriately controlled does
not cause the sleep inertia easily even immediately after the nap, andthe work result improves too.
Method:[laboratory experiment]
The car room sized space was made in the soundproof room, and theenvironment control equipment was arranged in that space. We experimented by “System nap condition” and “Control nap condition” inconsideration of the counterbalance. In “System nap condition”, participants took a 20 minute nap in an environment where massage,
intense illumination lighting, angle of the seat, sound, and image, etc.
were controlled. In “Control nap condition”, the massage and theintense illumination lighting were deleted.
On the experiment day, we evaluated the effect and the sleep inertia
before/immediately after/30 minutes after the nap by the subjective
measures (VAS) and performance test.
[Field experiment]
We made the same environment as the laboratory experiment in the carand experimented in “System nap condition” and “Free break condition” in consideration of the counterbalance.
Operation similar to the laboratory experiment was done in “Systemnap condition”, and TV whose volume was controlled was appreciatedin “Free break condition”.
Conclusion: A similar tendency to both experiments was seen, and“System nap condition” was able to confirmed in 30 minutes after ittakes a nap and to confirm awake the level and concentration risesignificantly compared with “Free break condition”. In addition, theexperiments showed that the work result increased significantly bymaking it to “System nap condition” immediately/30 minutes after thenap. Moreover, it demonstrated that the illuminance of the lighting had
greatly influenced subjective awake actually feeling.

394

Therefore, by the present study we suggest that “System nap,” even forthe massage and the intense illumination lighting to control the environment, suppresses the sleep inertia and it has effect on taking an effective
nap while running.

PO-2-162
RESEARCH ON SLEEP PATTERN OF
INFORMATION TECHNOLOGY ENGINEERS

H SUNAHARA1, A NISHIHARA2, E KAWAZOE3, K TAKASHI4,S TETSUO4, A RIKA3
1
Graduate School of Media Design, Keio University, Yokohama, Japan,2
Hospital, National Cerebral and Cardiovascular Center, Japan, 3Faculty of
Nursing and Rehabilitation, Aino University, Japan, 4School of Medicine,
Akita University, Japan
Purpose: Recent years, Information Technology infrastructures such as
the Internet become important. IT (Information Technology/Computer)engineers work hard to keep IT infrastructures as 24 hours 7 days.
Working style of IT engineers would be different from others. We study
sleep patterns of IT engineers to know life style of them.
Method and Subject: We selected six males IT engineers.
Six IT engineers: Male/24.4 years old (Average)
Six healthy adults (Control): Male/22 years old (Average)
All of subjects ware actigraph on their wrist during two weeks. Actigraph records activity in every minute. Engineers also keep a sleep diaryin same two weeks.
Result: We found two typical sleep patterns. One is irregular sleep-wakerhythm. In this pattern, subject works very irregular working style.
Someday, he works normally. But, he wake up midnight then works until
morning. Another pattern is “night owl” style. This pattern shows that
subject wakes up in the evening or night. He works until early morning
via midnight. He basically works as same pattern in everyday.
We compare average total sleep time per day between subjects andcontrols. Following is result.
Total sleep time (min.): 539.61 (subject) / 644.20 (control)
According to t test of average total sleep time per day, result is P <0.018484. This means that a significant difference between subject andcontrol is exist.
Conclusion: Average sleep time for Japanese adult male of 20–24 years
old is 7.54 hours. Subject and control show enough sleep time. According to sleep diary, subjects are doing basketball or tennis. But, they
complain headache, eyestrain fatigue of the eyes and neck stiffness. Thismeans that IT engineers working style cause several stress to subjects.
Currently, all of subjects don’t show significant problems in their life.
But, there is a possibility of causing significant problems after a longterm experience.
IT engineers are new jobs in current new age. We should track them tokeep health, since IT infrastructure is important social infrastructure.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-163SLEEP DURATION AND SLEEP SURROUNDINGSIN OFFICE WORKERS-COMPARATIVE ANALYSISIN TOKYO, NEW YORK, SHANGHAI, PARIS
AND STOCKHOLM

M BANNAI1, M KANEKO2, S NISHINO3
1
Institute for Innovation, Ajinomoto Co., Inc., Kawasaki-shi, Kanagawa,Japan, 2Wellness Business Division, Ajinomoto Co., Inc., Japan, 3Sleep andCircadian Neurobiology Laboratory, Stanford University, United States ofAmerica
The importance of sleep has recently been emphasized, and many
epidemiologic investigations about the relationship between sleep andlife-style diseases have been performed. Based on the results of theinvestigations, several countries have made guidelines for beneficial
sleep. However, most questionnaire surveys of sleep were done in asingle country, while comparisons among different countries have been
investigated less thoroughly. The objective of this study was to compare
the sleep and sleep surroundings in five large cities through a questionnaire survey. The subjects were chosen from office workers living inTokyo, New York, Shanghai, Paris and Stockholm by internet screening;
90 males and 90 females were included in each area. Sixty subjects were
included in their 30’s, 40’s and 50’s, respectively. The questionnaire
contained 10 main questions about sleep duration and surroundings.
The effects of gender and age on sleep duration were not significantly
different among the cities. Average sleep duration on weekdays in Tokyo(5.99 h) was the shortest (6.58–7.47, for the other 4 cities) and thedifferences between actual and ideal sleep duration in Tokyo was thelargest (1.36 h, 0.77–1.32 for other 4 cities). The National Sleep Foundation suggests that healthy adults need 7–9 h sleep per day, the percentage of the people within the range was the lowest in Tokyo (22.8).
Sleep surroundings also differed among the countries; subjects in Tokyoand Paris gave sleep the highest priority over other activities, such as
meals and work, but they were willing to cover the least cost for improving their sleep. It is important to perform further studies on how thedifferences in sleep and sleep surroundings among different cities affecttheir health and diseases.

PO-2-164
THE NUMBER OF CONCURRENT NONCOMMUNICABLE DISEASES AND POORSLEEP QUALITY: THE JAPANESE CIVILSERVANTS STUDYM SEKINE, T TATSUSE, H MINEMURA
Department of Epidemiology, University of Toyama, Toyama, Japan
Introduction: The elderly often suffer from several non-communicablediseases simultaneously. Non-communicable diseases cause poor sleep
quality, and the reverse is also true. This study aims to evaluate whether
individual and combined non-communicable diseases is independently
associated with poor sleep quality.
Methods: The subjects were 2799 public sector employees (1818 men
and 981 women) aged 20–65. Questionnaire survey was conducted in
2003. The subjects answered whether they had doctor-diagnosed heartdisease, stroke, hypertension, dyslipidemia, diabetes, obesity, bronchialasthma, gastroduodenal ulcer, and back pain. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index.
Results: Although subjects who had any non-communicable diseasetended to have poor sleep quality, the associations were not necessarily

statistically significant. The larger the number of concurrent non-communicable diseases, the poorer the sleep. In men, the prevalence of poor
sleep quality was 19.7% for those without any non-communicabledisease, 19.7% for those with 1 disease, 21.9% for those with 2 diseases,
22.1% for those with 3 disease, and 29.4% for those with 4 diseases ormore. In women, the prevalence of poor sleep quality was 26.9% for
those without any non-communicable disease, 38.1% for those with 1
disease, 32.9% for those with 2 diseases, 36.7% for those with 3 disease,and 66.7% for those with 4 diseases or more. The associations of thenumber of concurrent non-communicable disease with poor sleep
quality remain significant after adjustment for age and mental disorders.
Conclusions: A dose-response relationship between the number ofconcurrent non-communicable diseases and poor sleep quality wasobserved. Reducing the number of concurrent non-communicable diseases may have beneficial effects on sleep.

PO-2-165
POOR SLEEP STATUS INCREASES THE RISKOF FATIGUES FUKUDA1, H FUJII1, D NARUMI2, T IHARA3, Y WATANABE1,4
1
Graduate School of Medicine, Osaka City University, Osaka-City, Osaka,
Japan, 2Graduate School of Environment and Information Science,
Yokohama National University, Japan, 3Research Insititute of Science for
Sacety and Sustainability, National Insitute of Advanced Industrial Scienceand Technology (AIST), Japan, 4Center for Molecular Imaging Science,
RIKEN, Japan
Background: It is a common sense that there is a relationship between
poor sleep quality and fatigue status. However their relationship wasneither well studied nor characterized. Therefore we examined thefollow-up studies by questionnaire for about 200 healthy subjects in
Osaka every one month.
Subjects & Methods: We administered about a total of 662 subjects
for the study. The subjects answered the questionnaire for 6 days at
every term (from July to October in 2010; T1–T3). Questionnaire wasconsisted of four sections; demographic variables, lifestyle, fatigue, andsleep quality. We used Chalder’s fatigue scale for assessment of fatigue
and Pittsburgh sleep quality index for assessment of sleep quality.
Results: The response rate is 95.6%. A total of 267 males and 366
females are included in the responders. There is a significantly positive
relationship between fatigue score and sleep score (r = 0.51). The mean
sleep score is higher in females than that in males. (p < 0.001). The
166 subjects out of those completed all questionnaire through the threeterms. We divided them into two groups with a sleep score by the statedcutoff value, 5.5, and are re-categorized into poor (over 6) and good(under 5) sleep status. Those who show poor sleep status at T1 significantly increasing fatigue status at T3 as compared with those who show
good sleep status at T1.
Conclusions: Poor sleep status might be one of the risk factors forincreasing fatigue even in the short term.
Acknowledgment: This study was conducted by research project for
creation of housing that promotes health and well-being.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research395

Sleep, Science and Research

PO-2-166

PO-2-168

A COMPARATIVE STUDY OF THE SLEEP-WAKE
SCHEDULE AND THE LIGHT ENVIRONMENTBEFORE ONE THOUSAND YEARS WITH THE
MODERN SOCIETY; FOR THE NEXT
GENERATION LIGHTINGSUBJECTIVE SLEEPING PROBLEMS AND SELFREPORTED SLEEP LENGTH DURING FOURSEASONS IN ARCTIC NORTHERN NORWAYE KOYAMA1, E MATSUDA2, H SAWAI3
1
Department of Design Engineering and Management, Graduate School of
Science and Technology, Kyoto Institute of Technology, Kyoto-city, Kyoto,
Japan, 2School of Science and Technology, Kyoto Institute of Technology,
Japan, 3Graduate School of Science and Technology, Kyoto Institute ofTechnology, Japan
In modern Japanese society, sleep time shortening caused by a phasedelay becomes social problems. Changes of light environment are supposed to affect the sleep-wake schedule. It is necessary to evaluate thehistorical changes of sleep-wake schedules and artificial lighting. In thisstudy, we inferred the sleep customs and the artificial light in the Heianera, before approximately one thousand years in Japan, and try toconsider how the sleep-wake cycle had been entrained by lightenvironment.
In order to infer the sleep-wake schedules in the Heian era, we analyzed
the expressions about the timing of awakening and social life in “theTale of Genji” and “the Diary of Lady Murasaki”. As a characteristic of
the sleep custom, we found the many descriptions in which the people
wake up and start activity on the astronomical twilight, several hours
earlier than modern society. However, bedtime is indistinct and thepeople may not always go to sleep immediately after sunset, and especially in the court service, shift work was sometimes assigned.
Artificial lighting in the Heian era was the lamplight using vegetal oil.
We reproduced an illumination tool of those days and measured theoptical characteristics. The luminous flux of the flame light was lessthan quarter of a present incandescent 5W miniature bulb. Therefore,
it is supposed that there was not the possibility of increasing vigilancelevel or circadian phase delay in the nighttime. On the other hand, also
in the daytime, indoor illuminance was much lower than in the modernroom.
In the Heian era, it is suggested that the sleep-wake cycle can beentrained by the astronomical twilight before sunrise. Regardless ofwhether people of those days were able to get regularity of bedtime,
periodical awakening schedules would be maintained because the parametrical photic entrainment was not disturbed by excessive nocturnal
light everywhere in the modern society. For the next generation lighting,it is considered necessary to secure gradually increasing dawn light withbalanced spectral distribution after stable nocturnal darkness.

PO-2-167
WITHDRAWN

396

IB SKRE1, V HANSEN2, T BRAATEN3, E LUND3
1
Department of Psychology, University of Tromsoe, Troms, Norway,
2
Department of Clinical Medicine, University of Tromsoe, Norway,
3
Department of Community Medicine, University of Tromsoe, Norway

Introduction: Arctic Northern is a natural laboratory for the study ofseasonality of sleep. During two midwinter months the sun is below
the horizon, and during two summer months the sun is above thehorizon 24 hours a day, while at spring and autumn equinox, day andnight are of equal length. If there were any effect of length of daylighton sleep, the population of Northern Norway, should experience this.
Material and methods: The study was part of a screening for cardiovascular disease, done by the National Screening Institute of Norway.
All persons aged 23–71, living in Gamvik municipality, 460 persons,
were asked to participate. Of 312 persons attending, 250 were invited
to answer a questionnaire in January, March, June and September. The
questionnaire asked about sleep length, subjective seasonal complaints,
seasonal sleep complaints, and the actual time they woke up on the
day of completion of the questionnaire. In December, the Centre for
Epidemiologic Studies Depression Scale (CES-D) was added to thequestionnaire.
Results: The sample was 196 persons, 108 (55%) women, mean age
50.7 (SD 10.7). Eighty-one persons (41%) reported subjective seasonal
complaints, and 49 persons (21%) reported specific midwinter sleeping
problems. Persons with midwinter sleeping problems slept more in allseasons, compared to persons reporting other problems, but only significantly more in spring (ANOVA, df = 3, F = 3.158, p < .03). Persons
reporting midwinter sleeping complaints reported waking up later thanpersons with other complaints, but only significantly later in autumn(ANOVA, df = 3, F = 5.313, p < .002). Subjective seasonal complaints
was significantly related to depressive symptoms (CES-D) (Beta −.092,
p < .000) in a logistic regression modell controlling for age and gender.

PO-2-169 / AS-33 Presenter
SLEEP AND FATIGUE MANAGEMENT IN
EXTREME ENVIRONMENT: CASE OF
SOLO SAILORSR HURDIEL1, F LE SAUSSE2, G ZUNQUIN1, P MASSON1,J MIKULOVIC1, G BUI-XUAN1, J-F ROBIN2, D THEUNYNCK1
1
Departement of Sport Science, Universit du Littoral Cte d’Opale,
Dunkerque, France, 2Departement of Sports Sciences, Laboratoire Circeft,
EA 4384/PRES EST, France
Introduction: Solo offshore sailboat racing require skippers to face24-hour/day readiness to perform under sleep loss. The objective wasto measure the effectiveness of an Individual Fatigue Management
Program (IFMP) during a solo-transatlantic race.
Method: Before a 3542 nm race, 15 sailors (men; 39 ± 9 yrs) completed
a self-questionnaire about their sleep management in race. Following
that, a 45-minute individual course about sleep regulation and consequences of sleep loss was given. In addition, they were offered to use
an interactive sleep diary (software Scextan) that we designed to help
users to manage fatigue during sleep restriction. Within 48 hours after
arrival, sailors were asked to answer an interview based on a preestablished grid. A fatigue management feedback of the race was© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentationsindividually made after the interview and sailors were re-tested with thesame questionnaire. Interviews were transcribed by double-blind
method. Results from self-questionnaire and interviews gave for eachsailor Fatigue Management Scores (FMS).
Results: Variance analysis showed a light effect of the FMP (p = .08)
by reducing the variance of the FMS between before and after the race.
Interviews analysis revealed the difficulties that skippers had to adapt
their fatigue management to what they thought to be the best for the
performance. In particular, to rationally anticipate fatigue periods seems
the most difficult to achieve. The winner of the race (18 days at sea)also had the best FMS in both questionnaires and interview. Analysis
showed that he managed his fatigue in anticipation of the environment,
more than other sailors. He was also the only one to almost constantly
use the software to monitor his “sleep consumption” along the race. For
4 years, he systematically took into account fatigue management in the
preparation of his races with a sleep specialist.
Conclusion: An IFMP associated to a dedicated tool is effective forbetter sleep management and helps to improve performance in solo
sailing races. A tool which predicts individual alertness might reduce
the gap between knowledge and behavior.

PO-2-170SLEEP IN WINTERING EXPEDITION MEMBERS
IN ANTARCTICA

K MIZUNO1, N YAMAMOTO2,10, M YOSHIDA3, M INOKUCHI4,9,
K MORIKAWA5,9, T YOSHIDA6,9, Y OKADA7,9, K OHTSUKA2,Y URADE8, K WATANABE9, G OHNO9, H OHSHIMA2,10, C MUKAI2,10
1
Faculty of Child and Family Studies, Tohoku Fukushi University,
Sendai-city, Miyagi, Japan, 2Department of Medicine, Tokyo Women’s
Medical University Medical Center East, Japan, 3None, SleepWell co ltd,
Japan, 4None, Miyagi Children’s Hospital, Japan, 5None, Tokyo
Metropolitan Tama Medical Center, Japan, 6None, Kanagawaken
Yobouigakukyoukai Inc, Japan, 7None, Tsubasa Clinic, Japan,
8
Molecular Behavioral Biology Department, Osaka Bioscience Institute,Japan, 9Bioscience Group, National Institute of Polar Research, Japan,
10Space Biomedical Research Office, Japan Aerospace Exploration Agency,
Japan
Antarctic environment is characterized by extremely low ambient temperature and seasonal variation in daylight time. In addition to thosenatural characteristics, psychological factors related to isolation withsmall number of members in the Antarctic base may have some influences on physiological and psychological functions. As previous studies
have reported abnormalities in human circadian rhythms and deteriorated sleep in Antarctica, we evaluated sleep in the wintering members
in Antarctica by using subjective and objective measurements. The
subjects were ten males and two females recruited from the membersof the 50th and 51st Japanese Antarctic Research Expedition (age: 39.7
± 10.0 years; BMI: 25.2 ± 3.3). During their 13 months sojourn in the
Antarctic base, data collection was conducted every 3 months (March,June, September, and December). The data collection was consisted ofstandardized sleep questionnaire answering past one month of sleep
and wrist actigraphy for one week to evaluate sleep/wake rhythm. In 6
members of 51st expedition, instead of wrist actigraphy, the other typeof activity monitoring device was attached to the waist of the subjects
to evaluate sleep/wake rhythm and daily energy expenditure. Subjectively evaluated sleep maintenance showed mostly above the standard
value throughout the sojourn. The results of objective sleep evaluationsuch as sleep efficiency, sleep period time and regularity of sleep time
were individually differed, which might be associated with type of work

and/or subjects’ trait. On the other hand, sleep phase in June was significantly delayed from those in March for approximate one hour, which
was accompanied by a decrease in daily energy expenditure of approximate 200 kcal. As the delayed sleep phase in June was thought to berelated to lack of sunlight in winter, decreased physical activity might
have adverse influences on sleep quality.

PO-2-171SLEEP AFTER TOHOKU-PACIFIC OCEAN
EARTHQUAKE IN 2011

K MIZUNO1, K OKAMOTO-MIZUNO2, K IWATA3, H YAMAMOTO4
Faculty of Child and Family Studies, Tohoku Fukushi University,
Sendai-city, Miyagi, Japan, 2Kansei Fukushi Research Center, Tohoku
Fukushi University, Japan, 3Faculty of Comprehensive Welfare,Tohoku Fukushi University, Japan, 4none, Fukushikai of medical
corporation, Japan1

At 2:46 PM on March 11th, 2011, devastating earthquake shook northern part of Japan, which induced widespread severe damage. Wrist
actigraphy and bed room temperature were accidentally measured for
one week from March 9th. As the primarily objective of the data collection was a follow-up measurement examining the effect of sleep
hygiene education for elderly, 6 of the 8 subjects completed one week
actigraphy and the other two subject worn actigraph for 4 and 5 days
including the night of earthquake. One to three weeks after retrieving
the actigraphic data, the situation related to sleep was asked withinforming of the individual results of actigraphy. The subjects were 3
men and 5 women (mean age, 73.1 ± 4.3 years) who were living in
Sendai-city where the intensity of earthquake was registered as 6-lower.
This intensity is defined by Japanese Meteorological Agency as degreeof shaking as “Difficult to keep standing” and “A lot of heavy andunfixed furniture moves and falls”. The area where the subjects were
living did not suffer from Tsunami attacks. While some of the subjects’house suffered slight damage by the earthquake, two subjects moved
to an asylum or her relative’s house after the earthquake.
In the night of the earthquake, mean value of sleep efficiency was 72± 19%, and 5 out of 8 subjects showed the lowest value in the datacollection period. A subject who showed the lowest value of 40%
among the subjects slept in an asylum which was a school gymnasium
without heating system. In the second night after the earthquake, timeto go to bed tended to become earlier probably due to poor sleep inthe last night and blackout caused by earthquake. Unusual situation
possibly affecting nocturnal sleep reported by the subjects were aftershock earthquake, coldness, tight clothing able to go out, changing the
bedroom for security. These results should be taken into account forconsidering future provision in case of disaster.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research397

Sleep, Science and Research

PO-2-172
ANNUAL CHANGE OF CIRCADIAN RHYTHM
IN WINTERING EXPEDITION MEMBERS
IN ANTARCTICA

N YAMAMOTO1, K MIZUNO2,10, M YOSHIDA3, M INOKUCHI4,9,
K MORIKAWA5,9, T YOSHIDA6,9, Y OKADA7,9, K OTSUKA2, Y
URADE8, K WATANABE9, G OHNO9, H OHSHIMA10, C MUKAI10
1
Department of Medicine, Tokyo Women’s Medical University Medical
Center East, Arakawa, Tokyo, Japan, 2Faculty of Child and Family Studies,
Tohoku Fukushi University, Japan, 3None, SleepWell co ltd, Japan, 4None,
Miyagi Children’s Hospital, Japan, 5None, Tokyo Metropolitan Tama
Medical Center, Japan, 6None, Kanagawaken Yobouigakukyoukai Inc,
Japan, 7None, Tsubasa Clinic, Japan, 8Molecular Behavioral Biology
Department, Osaka Bioscience Institute, Japan, 9Bioscience Group,
National Institute of Polar Research, Japan, 10Space Biomedical Research
Office, Japan Aerospace Exploration Agency, Japan
Background: Biological clocks synchronize and modulate circadianrhythms of systemic organs. Disruption of circadian rhythm are not only
associated with an enhanced risk of insomnia, but also induce variety
of other disease, such as metabolic disorder. Circadian rhythms are
known to be affected by external stimulation, such as short sunlightand long darkness. However, it is uncertain how impact dose external
environment gives the circadian rhythm. Antarctic environment is characterized by extremely low ambient temperature and seasonal variationin daylight time. To clarify the change of an accurate circadian rhythm
from extreme circumstance, we evaluated continuous 24-hour RR intervals measurement in Antarctica.
Subjects and methods: The subjects were ten males and one female
recruited from the members of the 50th and 51st Japanese Antarctic
Research Expedition (Mean age: 40.6 years). Assessment of circadianrhythm using RR intervals obtained from Holter ECG under free living.
During their 13 months sojourn in the Antarctic base, data collection
was conducted every 3 months (March, June, September, andDecember).
Results: The mean annual circadian rhythm of HF and L/H were significantly different every season (P < 0.0001, ANOVA). Circadianrhythm of HF significantly prolonged in June than in September (Junevs. September = 25.1 hour [20.4–27.0] vs. 30.2 hour [24.1–36.3], P =0.028). And circadian rhythm of HF in June tended to prolonged thanin March. Circadian rhythm of L/H significantly prolonged in June thanin March (June vs. March = 26.1 hour [23.8–28.5] vs. 23.2 hour [20.8–
25.6], P = 0.046). Sleep evaluation was delayed sleep phase from March
to June for approximate one hour (P < 0.05).
Conclusion: The circadian rhythm prolonged in June in Antarctica andit might be related to the delayed sleep phase due to lack of sunlightin winter.

PO-2-173
CHANGES IN BLOOD AMINO ACID LEVELASSOCIATED WITH SLEEP DEPRIVATIONIN RATSN SAKAI1, M BANNAI2, S NISHINO1
1
Department of Psychiatry, Stanford University, Palo alto, California, UnitedStates of America, 2Institute for Innovation, Ajinomoto Co., Inc., Japan
Introduction: Since some of critical neurotransmitters that control
sleep/wake status are amino acids per se (i.e., GABA, glutamate, glycine)or synthesized from amino acids (i.e., monoamines), it is possible thatan altered balance and quantity of amino acids can cause sleep distur-398

bances. Similarly, sleep disturbances may induce changes in amino acidbalances. In addition, since sleep disturbances are associated withchanges in blood leptin and ghrelin levels, sleep disturbances may also
cause metabolic changes in blood amino acids. However, there are noreports to directly address these questions. We therefore evaluated anychanges in blood amino acid level associated with sleep changes usingrodents.
Methods: Adult male Sprague-Dawley rats (n = 6) were acutely sleep
deprived with gentle handling from ZT 0 (light on) to ZT 6 and thenrecovery sleep was allowed from ZT 6. The blood samples were collected from the tail vein every 3 hours from ZT 0 to ZT 12 in these rats.
The same rats were used in a control test, and blood was also collected
at each time point. Plasma amino acid concentrations were measured
by an automatic amino acid analyzer.
Results: We could reliably measure more than 40 amino acids, including essential amino acids from small amount of plasma (7 ul). Most of
the amino acids measured declined across time in both the baseline andsleep-deprived groups. Noticeable changes between the baseline andsleep-deprived groups were for glutamic acid (Glu), but no differenceswere seen in a large majority of amino acid measured. Of interest
however, changes in Glu may have been due to the sleep deprivation,
since the increase in Glu in the sleep-deprived rats was reduced when
the rats were allowed to have recovery sleep.
Conclusion: Our results showed that acute sleep deprivation for
6 hours induced small changes in blood amino acid levels. Therefore,
further investigations of chronic sleep restriction or sleep and circadiandisease-oriented experiments will be required to substantiate the relationship between changes in amino acids and sleep.

PO-2-174
PHYSIOLOGICALLY BASED MODELING IN
EXPLORATION AND PREDICTION OFSLEEPINESS ON ATYPICAL WORK SCHEDULESS POSTNOVA1, PA ROBINSON1,2,3
1School of Physics, University of Sydney, Sydney, NSW, Australia, 2Centre
for Integrated Research and Understanding of Sleep, University of Sydney,
Australia, 3Brain Dynamics Centre, University of Sydney, Australia
The effects of shift work on circadian entrainment and sleepiness are
examined using a physiologically based mathematical model. The modelaccounts for the dynamics of the sleep-related brain nuclei in hypothalamus and brainstem according to Phillips & Robinson model (2007)
and for entrainment of the circadian pacemaker to light as per St. Hilaire
et al. model (2007). This approach allows studying entrainment to shiftschedules in the long term and to probe the biological mechanisms
underlying changes of sleepiness. In contrast to most of the earlier
studies the present model accounts for the dynamic interactions between
the circadian and homeostatic processes along with changes in externalcues that are affected by the state of the model (sleep, wake-rest, wakework), allowing a broader range of applications.
Here this model is applied to the simplest case of permanent shiftschedules in order to understand the basic mechanisms and to lay thefoundation for examining more complicated schedules and conditions,such as rotating shifts and natural light input. The results demonstrate
that, in good agreement with experimental data, average sleepinessincreases during the first days on the evening, night, and early morning
shifts, but is unchanged for normal daytime work. This is explained byan inability to sleep enough during the active circadian phase and theresulting increase of homeostatic pressure. After this initial increase,
sleepiness decreases and stabilizes due to circadian entrainment to the
new external cues provided by the shifts. The simulations reveal the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

presence of a critical shift onset time which depends on light conditions
and circadian parameters, and separates the shifts leading to phaseadvance and those leading to phase delay of the circadian pacemaker.
The shifts starting around this time take longest to entrain, and are
expected to be the worst for the long term performance and well-beingof the workers. The results are very robust to the presence of noise
which was simulated as either random changes in ambient lighting orin mean potentials of the neuronal populations.

PO-2-175SLEEP AND VIGILANCE OF ON-CALL
PHYSICIANS IN JAPANN KIRIYAMA1, K FUKUNAGA2, Y OGUMA1,3, K ASANO2
Graduate School of Health Management, Keio University, Uehara
Shibuya-ku, Japan, 2Pulmonary Division, Department of Medicine, Keio
University of Medicine, Japan, 3Sports Medicine Research Center, Keio
University, Japan
1

Objectives: Long work hours and work schedules may have a negative
impact on vigilance. It is possible to raise drowsiness and lead poor
work performance under insufficient sleep condition. In Japan, there isa custom to work on day duty after on-call. We examined sleep status
and vigilance of physicians in Japan to investigate how these states
would change before and after on-call duty.
Methods: A total of 28 physicians (13 at a university hospital and 15
at a municipal hospital, 20 men and 8 women) aged 26–43 years were
followed by the wake-sleep study at before and after on-call duty. Total
Sleep Time (TST) was obtained by wrist actigraphy. Vigilance was calculated from visual response time to random light signals for 10 minutes,
measured using the Psychomotor Vigilance Task (PVT) monitor. PVT
tests were conducted right before and after on-call duty. At the sametime, subjective sleepiness was asked by Karolinska Sleepiness Scale(KSS).
Results: TST of the night during on-call duty was significantly shortened than the night before the on-call duty (273 ± 100 to 404 ± 80 min,p < 0.001). Compared with the morning before on-call duty, the subjective sleepiness was raised significantly after on-call duty (3.12 ± 1.1.21
to 5.15 ± 1.87, p < 0.001). The vigilance, the median reaction time by
PVT, also showed a significant drop after the on-call duty (223 ± 30 to
249 ± 44 ms, p = 0.039).
Discussion and Conclusions: The results showed that on-call duty
may affect on vigilance of the next day duty as the sleep restriction by
on-call which would lead sleepiness. The day duty straight after on-callunder the lower vigilance state could increase social risks which should
be managed from sleep hygiene perspective.

PO-2-176
ASSOCIATED FACTORS OF POSSIBLE SHIFTWORK DISORDER IN NURSES WORKING WITH
RAPID ROTATION SCHEDULE IN JAPANS ASAOKA1, S ARITAKE1,2, Y KOMADA1,2, Y INOUE1,2
Department of Somnology, Tokyo Medical University, Tokyo, Japan, 2Japan
Somnology Center, Neuropsychiatric Research Institute, Japan

1

Previous studies showed that the workers who meet the criteria of shiftwork disorder (SWD) are at a risk for health and behavioral problems,possibly leading to social and economic burden. We explored the associated factor of possible SWD in nurses working with rapid rotation
shift-work schedule in Japan using a cross-sectional questionnaire

survey. The eligible participants were 1493, and responses wereobtained from 1202 nurses, including 727 two-shift workers and 315
three-shift workers. Questionnaire were consisted of the items relevant
to demographic variables, family structure, household duties, job position, working schedule, existence of illness, food and physical exercise
habits, and sleep problems. The participants with reported insomnia
and/or excessive sleepiness subjectively related to their shift-workschedule for at least one month were categorized as possible SWD. The
percentage of possible SWD participants in shift-worker was 24.4%.
The result of multivariate logistic regression analysis to explore theassociated factors for the existence of possible SWD in shift-worker
showed that nurses who were younger, frequently missed a meal, andhad eveningness-chronotype were likely to be associated with possible
SWD. The result of this study was inconsistent with that of previous
studies which suggested that eveningess-type individuals can tolerate
shift-work. This inconsistency might be partly attributed to the rapid
rotation schedule in which 87.5% of the subject shift-workers reported
that night work shift was not inconsecutive. This result suggests thatminimizing the delay of circadian rhythms might play a key role on theprevention of SWD in the shift-workers with rapid rotation schedule.

PO-2-177
ONE DAY OFF FOLLOWING CONSECUTIVENIGHT SHIFTS IS ENOUGH TO MAINTAIN
WAKEFULNESS AND COGNITIVE FUNCTION IN
NURSES WORKING ON FAST AND FORWARD
ROTATING SHIFTYS CHANG1, CY LIN2, CY HSU3, YH WU2, SH TANG2, LL YANG2
Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung,Taiwan, 2Department of Neuropsychiatry, Kai-Suan Psychiatric Hospital,
Taiwan, 3Department of Neurology, Kaohsiung Medical University
Hospital, Taiwan
1

Objective: The three-shift working schedule with fast and forward rotation is common in the medical field in Taiwan. Nurses have one day off
between the end of consecutive night shifts and the beginning of thenext day shifts. During the off-day, one would be expected to overcome
the feeling of physical and mental tiredness and to keep awake during
the daytime for readjustment of their circadian rhythm. We explored thechange of cognitive function and objectively measured sleep propensity
in the daytime after three consecutive night shifts. Sleep-related hormones (growth hormone; cortisol; prolactin; thyrotropin, TSH) werealso detected during the daytime. We further investigated the factors
associated with mean sleep latency (MSL) of Multiple Sleep Latency Test
(MSLT) and Maintenance of Wakefulness Test (MWT).
Methods: The study recruited 20 nurses (mean age 26.0 ± 2.0 years)
from the acute psychiatric ward. We evaluated the changes on sleepinessvigilance, and performance on the day after three night shifts, using
MWT, MSLT, Stanford Sleepiness Scale (SSS), Wisconsin Card Sorting
Test (WCST), Digit Symbol Substitution Test, Symbol Searching Test,
Taiwan University Attention Test, and collected sleep related endocrine.
All of the tests were administered four times at 2 h intervals.
Results: The subjects had no increase in sleep propensity measured by
MWT or MSLT despite of increased self-reported sleepiness by SSS.
There was no time of day effect on the neuropsychological tasks. Age
was negatively associated with the MSL of MWT and positively associated with the MSL of MSLT. The perseverative errors in WCST were
negatively associated with the MSL of MWT. TSH level was significantly
elevated during the daytime and positively associated with the MSL of
MWT.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research399

Sleep, Science and Research

Conclusions: We conclude that nurses did not have increased sleep
propensity and impaired neuropsychological performance in thedaytime after three consecutive night shifts when they were trying toreadjust circadian rhythm. This ability might be modulated by TSH andcompromised by ageing and tasks which require a high attentive load.

PO-2-178
NURSES WORKING ON FAST ROTATING SHIFTSHAVE MORE IMPAIRED PERCEPTUAL AND
MOTOR ABILITIES DURING THE END OF A
NIGHT SHIFTYS CHANG1, YH WU2, CY HSU3, SH TANG2, LL YANG2, SF SU2
1
Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung,Taiwan, 2Department of Psychiatry, Kai-Suan Psychiatric Hospital, Taiwan,
3
Department of Neurology, Kaohsiung Medical University Hospital, Taiwan
Objective: A three-shift working schedule with faster rotation iscommon in the medical field in Taiwan. The aim of this study was tocompare cognitive performance among three groups working two, threeand four consecutive night shifts, respectively, at the end of the night
shift and at the time of maximum fatigue (3–4 a.m.).
Methods: Sixty-two nurses (mean age 26.4 ± 2.0 years) were recruitedfrom the acute psychiatric ward and randomly assigned into threegroups. The exclusion criteria were current use of hypnotics, regularcoffee drinker, psychiatric illness, major systemic disease, and sleep
disorders. Cognitive performance included the State-Trait Anxiety
Inventory, Stanford Sleepiness Scale, Wisconsin Card Sorting Test,
Taiwan University Attention Test, Digit Symbol Substitution Test andSymbol Searching Test.
Results: The subjects working on consecutive two-night shifts had
poorer performances in perceptual and motor abilities than thoseworking on consecutive four-night shifts. There were no differences indemographic data, executive function, or attention among the threegroups.
Conclusions: The routine duty of night shift nurses in our hospital ischecking medical orders and prescriptions, which requires perceptualand motor abilities. Thus we suggest that rotating night shifts too fast
may carry a risk of medical errors occurring.

PO-2-179SLEEPINESS IN NURSES AND CARE WORKERSENGAGED IN SHIFT WORK DURING CHILDREARING YEARSY YAMADA1, K SUGIYAMA2, T NAGASAKA1, H ISHII3
1
Public Heaith Nursing, Japanese Red Cross Toyota College of Nursing,Toyota-city, Aichi, Japan, 2Faculty of Nursing, Fujita Health University,
Japan, 3Fuculty of Nursing, Sugiyama jogakuen University, Japan

Objective and background of the study: Night shift can have a significant impact on the physical well-being of workers, mainly sleepiness, because this shift can last from 12 to 17 hours. Especially, working
mothers rearing young children may suffer great physical effects,
because they have a lot to do even after returning home. The objectiveof this study was to assess the sleepiness in nurses and care workers
engaged in shift work during child rearing years.
Method: A self-administered questionnaire was administered to 19
nurses and care workers who worked in a chronic disease unit at Hospital A. The questionnaire included subject characteristics, PSQI, KSS,

400

and the revised “Questionnaire of Subjective Symptoms” score, and wasadministered over 3 consecutive days. The KSS was completed 3 times
per task before work, during breaks, and after work, and the revised“Questionnaire of Subjective Symptoms” was completed before andafter work.
Results and Discussion: The mean KSS score for night shift was 2.77
before work, 4.21 during breaks, and 4.98 after work, with no difference between subjects rearing young children and those not. The corresponding score for day shift was 4.06 Before Work, 2.51 During
breaks, and 3.59 After Work in subjects rearing young children and
3.11, 4.03, and 3.24 in those not. For day shift, there was no significant
difference in the KSS during work between the subjects rearing children
and those not. However, the mean score on the “Questionnaire of
Subjective Symptoms” for day shift differed significantly between thoserearing children and those not. Notably, the score before work was not
related to whether or not they were rearing children, but there was asignificant difference in the score after work between those rearing
children (Factors I, 1.80, II, 6.40, III, 8.20, IV, 9.20, and V, 8.40) andthose not (Factors I, 11.86, II, 12.00, III, 10.86, IV, 14.86, and V, 9.14),
those not rearing children reported significantly more intense feelingsof instability (Factor II) and local pain or dullness (Factor IV).

PO-2-180
IMPACT OF EXTENDED DURATION WORKSHIFTS ON DROWSY DRIVING, SUBJECTIVESLEEPINESS AND DISTRACTIBILITY
WHEN DRIVING

C ANDERSON1, CA CHARLES2,3, LW STEVEN2,3
1
School of Psychology and Psychiatry, Monash University, Clayton,
Australia, 2Division of Sleep Medicine, Brigham and Women’s Hospital,
United States of America, 3Division of Sleep Medicine, Harvard Medical
School, United States of America
Background: Acute and chronic sleep deficiency is an inherent part of
medical training in the US due to the repeated exposure to extended
duration work shifts, and is associated with increased medical errors
and attentional failures, and increased incidence of crashes on the drive
home. Here, we assess self-reported drowsy driving in trainee physicians on the commute to and from work.
Methods: A prospective, repeated measures design, whereby 16 trainee
physicians (age 24–29 y) completed daily sleep diaries and drive diaries
for each drive to and from the hospital over 3–6 weeks. For each
commute to and from the hospital, participants completed the Karolinska Sleepiness Scale (KSS) ratings at the beginning and end of eachdrive, and reported sleep-related incidents (i.e. falling asleep at a stop
light, hitting the rumble strip) and sleepiness-alleviating actions (i.e.
winding down the window, using a cell phone).
Results: In comparison to the intervening day shifts, KSS levels werehigher at the start and end of the drive on the commute home following
an extended duration work shift (p < 0.005), with drowsiness levels
increasing over the course of the drive (p < 0.05). More trainee physicians
reported a drowsiness-related event on the journey home (98.2% vs.
50%), and were significantly more likely to report falling asleep at a stop
light, being distracted having a lack of awareness and shouting aggressively (p < 0.01). They were also more likely change the music often,
become mentally occupied, open the window, read and use the cell
phone while driving their vehicle (p < 0.05). Finally, drowsiness levels
at the beginning of the drive predicted the number and severity of incidence trainee physicians encountered in a dose-dependent manner.
Conclusions: Extended duration work shifts inherent in US physician
schedules result in elevated levels of drowsiness while driving, which© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

in turn, leads to an increased likelihood of incident risk on the commute
home. Sleepiness ratings prior to commencing the drive were predictiveof the number and severity of sleepiness-related adverse driving
incidents.

PO-2-181
SLEEP QUALITY AND ASSOCIATED FACTORS OF
RADAR MONITORING WORKERS
C-H LAI, H-Y LIN, C-C LIN, F-G LIN
Department of Public Health, National Defense Medical Center, Taipei,
TaiwanBackground: Radar monitoring workers play an important role in aviation safety and military combat readiness. Sleeping quality and shift
work may disturb the normal circadian rhythm and affect the decreased
alertness and responsiveness of their duty. Furthermore, poor sleep
quality may be associated with cardiovascular and neurological diseases
in the long-term. The purpose of this study was to explore the correlation between sleep quality status and its associated factors (including
job strain, fatigue, personal characteristic factors as well as environmental factors) among radar monitoring workers.
Design: A cross-sectional study of 242 radar monitoring workers and431 office workers as a reference group were recruited. The Swedish
occupational fatigue inventory (SOFI) was used to evaluate fatigue.
While Demand-control-support model (JCQ), Effort-reward imbalance(ERI), and Stress-Satification Offset Score (SSOS) were used to evaluate
job strain. Pittsburg Sleep Quality Index was used to measure the sleep
quality. Questionnaire was used to collect personal characteristics,
working types and duration, and disease history.
Results: There were significant sleep quality differences between these
two groups. The multivariate analysis indicated that age (≥30 vs. <30)
(OR 1.75, 95% CI 1.01 to 3.01), shift work (OR 1.67, 95% CI 1.05 to2.67), current smoking habit (OR 1.88, 95% CI 1.11 to 3.17), coffee
consumption habit (OR 1.82, 95% CI 1.13 to 2.9), high strain (vs. low
strain) (OR 2.30, 95% CI 1.16 to 4.55), fatigue (OR 1.42, 95% CI 1.24
to 1.63), noisy environment (OR 2.16, 95% CI 1.28 to 3.65), and hightemperature environment (OR 2.85, 95% 1.73 to 4.69) may be theinfluencing factors of poor sleep.
Conclusion: The poor sleep quality of radar monitoring workers may
be associated with shift work, job strain, current life style factors, andsleeping environmental factors.

PO-2-182 / AS-33 Presenter
SLEEPING ABOARD AIRPLANES: UNKNOWN
RISKS
E-M ELMENHORST, D ROONEY, M WITTKOWSKI, J WENZEL
Institute of Aerospace Medicine, German Aerospace Center, Cologne,
Germany
Little is known about the physiological effects for crew and passenger
when sleeping in airplanes under hypobaric conditions. At cruising
altitude the cabin pressure equals an altitude of 8000 ft. At the DLRInstitute of Aerospace Medicine, 16 healthy subjects (8 female, averageage 28 years±4 SD), slept in a pressure chamber furnished as crew-restcompartment during a realistic flight simulation concerning atmospheric conditions and noise. Blood oxygen saturation (SpO2), heartrate, and Sleep-EEG were recorded during the 4 h sleep period. Morning
performance was tested using an unstable tracking task reflecting
typical operator demands. A control group of 16 subjects (8 female,average age 26 years±6 SD), slept 4 h in private sleeping rooms of the
DLR-isolation unit in normobaric conditions. SpO2 and heart rate differed significantly between groups (p < 0.0001). During sleep period
time (SPT) a mean SpO2 level of 96% (±1 SD) and a mean heart rateof 62 bpm (±8 SD) were measured in normobaric conditions, whereas
mean SpO2 level in the pressure chamber was 88% (±1 SD) with amean heart rate of 73 bpm (±7 SD). In hypobaric conditions for 83%(±5%) of SPT the average SpO2 dropped below 90% and for 4% of SPTeven below 85% SpO2. The mean minimum SpO2-level was 81% (±3SD). SPT and sleep efficiency did not differ between groups, but deep
sleep (p < 0.05) and REM sleep (p < 0.01) were significantly reduced
in hypobaric conditions in favor of the light sleep phases (N1 p < 0.05,
N2 p < 0.01). Performance was significantly impaired in the experimental group (p < 0.05). The recuperative function for crew members
sleeping in a crew-rest-compartment during flight seems limited since
performance and sleep are impaired, and SpO2 drops considerably.
Sleep aboard an airplane induced hypobaric hypoxia in young, healthy
subjects. To date, the degree of arterial hypoxemia that should be considered as being harmful remains unclear. However, passengers with a
SpO2 below 85% in the hypoxic challenge test are recommended toreceive supplemental oxygen during flight. For risk groups sleep during
flight should be regarded with care.

PO-2-183
FOOD INTAKE BEHAVIORS OF IRREGULARSHIFT WORKERS AFFECTED THE CHRONOTYPE(MORNINGNESS-EVENINGNESS TYPE)S NAGASHIMA, E MASUTANI, T WAKAMURA
Nursing Science, Human Health Sciences, Faculty of Medicine, Kyoto
University, Kyoto-city, Kyoto, Japan
Background: In modern society, shiftwork has many advantages, forexample improvement of productivity and safety. So shiftwork is essential for our life. However, shiftwork hasn’t only advantages but also
many disadvantages. Previous studies suggested that shiftwork disturbed lifework, increased risks of various diseases as problems. As oneof their problems, some previous studies showed that shiftwork affected
shiftworker’s food intake behaviors.
Purpose: The aim of this study investigates the affects of shiftwork tofood intake behavior on chronotype (morningness-eveningness type) as
chronobiological aspect.
Method: Participants were 225 irregular shift work nurses. This study
was investigated by Questionnaire structured demographics of participants, the Morningness (M-type)-Eveningness (E-type) Questionnaire
and the Food Intake Questionnaire. It was compared about food intake
behaviors (food style, reason of selection, hunger before food intake,enjoyment during food intake, and satiety after food intake.) on breakfast and dinner with M-type and E type. On analysis, it was tested bychi-square test and Mann-Whitney test.
Result: Before day-work, there was a tendency difference by type offood among M-types and E-type (p = 0.079). E-type after night-workbecame significantly higher in the score of satiety afterward in comparison with M-type (p = 0.016). Sense of hungry before meal of E-typeafter day-work compared with M-type tended to be high (p = 0.077).
Conclusion: Therefore, it was suggested that M-type is more susceptible to the effect of shiftwork in food intake behavior than E-type.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research401

Sleep, Science and Research

PO-2-184
COMPARISON OF SLEEP HABIT IN JAPANESEMEN STUDENTS BEFORE, DURING AND AFTERSCIENCE CRUISES

H TAKEUCHI1, K WADA1, O AKIMITSU1, M KREJCI3, T NOJI2,M NAKADE4, T HARADA1
1
Department of Environmental Physiology, Kochi University, Kochi-city,
Kochi, Japan, 2Laboratory of Health & Physical Education, Kochi
University, Japan, 3Department of Health Education, University of South
Bohemia, Czech Republic, 4Deparment of Nutritional Education, Tokai
Gakuen University, Japan

Objective: This study aims to estimate effects of the life on the ship on
sleep habit and diurnal rhythm during the cruise and the following
period in Japanese university students.
Participants and Methods: Four men participants (22–28 yrs) continued to note the sleep diary and also to answer the questions on daily
mood, falling in sleep, sleep quality, mood at waking up from one
month before cruise(s) (Participant = P-A: Sep 1–15, P-B: May 5–Jun
28, Sep 1–15, P-C & P-D: May 5–Jun 28, Sep 1–Oct 15, Oct 21–Nov21), during the cruise and till one month after the cruise. An integrated
questionnaire including sleep habit and MEQ was also administered tothem just before the cruise and one month later from the cruise.
Results: The regularity of sleep-wake rhythms were extremely higher
during the cruise than that before or after the cruise in all four participants (p < 0.01). Sleep-wake schedule was more regular in two weeks
after the cruise than that in two weeks before the cruise (p = 0.016) in
P-A. Daily mood was significantly higher after the cruise than that
before the cruise (p = 0.002) in P-B. In P-C, average wake-up time inweek-end was 9:00 before the cruise, whereas the average value became
earlier and 7:20. After the cruise, the wake up time was fixed for one
week and then gradually delayed in P-D.
Discussion and conclusion: Fixed times of meals and works during
the cruise might promote, in some extent, the regularity of sleep wakecycle and mental health at least in one or two weeks after the cruise.

PO-2-185
THE ASSOCIATION BETWEEN SLEEP PROBLEMSAND PERCEIVED HEALTH STATUS: A JAPANESENATIONWIDE GENERAL POPULATION SURVEYR FURIHATA1, M UCHIYAMA1, S TAKAHASHI1, C KONNO1,
M SUZUKI1, K OSAKI1, M KONNO1, Y KANEITA2, T OHIDA2,
T AKAHOSHI3, S HASHIMOTO3, T AKASHIBA3,4
1
Department of Psychiatry, Nihon University, Itabashi-ku, Tokyo, Japan,
2
Division of Public Health, Department of Social Medicine, Nihon
University, Japan, 3Division of Respiratory Medicine, Department ofInternal Medicine, Nihon University, Japan, 4Division of Sleep Medicine,
Department of Internal Medicine, Nihon University, Japan

Objective: Sleep problems have been reported to have a serious impact
on daily functioning and to have an association with human well-being.
To see the contribution of individual sleep problems on physical andmental health, we conducted a nationwide epidemiological survey andinvestigated the relation between sleep problems and perceived healthstatus.
Method: The Nihon University Sleep and Mind Epidemiology Project(NUSMEP) was conducted in August and September, 2009, using faceto-face interviews. People aged 20 years or older were selected randomly from all areas of Japan, by using a three-stage stratified sampling
method. Finally 2,559 people (response rate 54.0%) completed a ques-402

tionnaire on perceived physical and mental health status, and sleep
problems, including the presence or absence of insomnia symptoms(i.e., difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS),
and early-morning awakening (EMA)), excessive daytime sleepiness(EDS), short sleep duration (SSD), and insufficient rest by sleep (IRS).
Results: Poor perceived physical and mental health status were foundin 16.9% and 11.4% of the participants. The prevalence of DIS, DMS,
and EMA was 14.8%, 26.6%, and 11.7%. Subject having at least anyof the three insomnia subtypes were 32.7%. The prevalence of EDS,
SSD, and IRS was 1.4%, 4.0%, and 21.7%. Multiple logistic regression
analyses revealed that DMS, SSD, and IRS were negatively associatedwith poor perceived physical health status, while DIS, EDS, and IRS
were negatively associated with poor perceived mental health status.
Conclusion: These results suggest that individual sleep problems havetheir own significance with regard to perceived physical and/or mental
health status.

PO-2-186
GENETIC ASSOCIATIONS BETWEEN SHORTSLEEP DURATION AND INCIDENCE OF
HYPERTENSION: A SIX-YEAR FOLLOW-UP
KOREAN GENOME EPIDEMIOLOGY STUDYK SE JOONG, S CHOL
Division of Pulmonary, Sleep and Critical Care Medicine, Korea University,
Ansan city, Republic of Korea
Objectives: Hypertension is caused by complex interactions between
genetic and environmental factors. Despite evidence for an association
between short sleep duration and the development of hypertension,
genetic factors associated with this effect have not been defined. Here
we prospectively investigated the incidence of hypertension in subjects
with short sleep duration over a 6 year follow up period, and identified
associated genetic variants in a genome wide association study.
Methods: Hypertension was defined by systolic or diastolic blood pressure of >140 or >90 mmHg, respectively, or when participants reported
using anti hypertensive medications. Sleep duration was determined byquestionnaire. Three categories of sleep duration were established:<5 hours, 5–7 hours, and >7 hours. Genotyping was carried out using
the Affymetrix Genome-Wide Human Single Nucleotide Polymorphism(SNP) Array 5.0.
Results: Of the 4,965 individuals included in our study, 1,071 (543 of
2,330 men and 528 of 2,635 women) developed hypertension. The
cumulative incidence of hypertension during the 6 year study period
was 21.6%. Sleep duration of <5 hours was associated with an increased
risk of incident hypertension only in premenopausal women (adjusted
hazard ratio 2.34, 95% confidence interval 1.30–4.21). The diplotypesof LRRC7, MYO1D, AUTS2, TGFBR3, JMJD2A, THSD4, SNTG2 and
ACPL2 were associated with this increased risk.
Conclusion: This prospective population-based study showed that premenopausal women with short sleep durations had an increased risk ofincident hypertension, and found associations with specific genomic
markers.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-187
SOCIODEMOGRAPHIC AND SOCIOECONOMIC
DIFFERENCES IN SLEEP DURATION AND
INSOMNIA-RELATED SYMPTOMS IN THE
FINNISH ADULT POPULATIONOJ RAHKONEN1, TM LALLUKKA1, L SARES-JSKE2, E KRONHOLM2,K SKSJRVI2, A LUNDQVIST2, T PARTONEN2, P KNEKT2
1
Department of Public Health, University of Helsinki, University of
Helsinki, Finland, 2National Institute for Health and Welfare, Finland
Background: Poor sleep tends to be patterned by sociodemographic
and socioeconomic circumstances. However, we lack nationally representative studies. The aim of this study was to examine the associationsof sociodemographic and socioeconomic factors with sleep durationand insomnia-related symptoms.
Methods: Data were derived from the cross-sectional Health 2000
survey (2000–2001) representative of the adult Finnish general population (n = 5578, aged 30+ years). Sociodemographic and socioeconomic
circumstances comprised gender, age, marital status, number of children, parental and own education, household income, employment
status, and residential area. Insomnia-related symptoms over the previous month and average sleep duration were based on self-reports.
Multinomial logistic regression models were adjusted first for genderand age, second for sociodemographic factors, and third for all covariates simultaneously.
Results: On average 71% of adult Finnish men and women slept
7–8 hours a day. Frequent insomnia-related symptoms were moreprevalent among women (14%) than men (10%). Not being married,
not having children, having low education, having low income, being
unemployed, and on old age or disability retirement were associatedwith frequent insomnia-related symptoms. Short and long sleep duration were associated with similar factors. Additionally, living outside
urban areas was associated with long sleep duration and low parental
education with short sleep duration.
Discussion: Disadvantaged socioeconomic position in adulthood areassociated with poor sleep. In promoting optimal sleep duration andbetter sleep quality, families with low income level, unemployed people
and those on disability retirement should be targeted.

PO-2-188
DOES SLEEP POSITION AFFECT AROUSAL FROMSLEEP PATHWAYS IN INFANTS BORN PRETERM?
RSC HORNE, HL RICHARDSON, AM WALKER
The Ritchie Centre, Monash Institute of Medical Research, Monash
University, Melbourne, Victoria, Australia
Previous studies have shown that infants born preterm are more likely
to succumb to SIDS, and also exhibit depressed total arousability whencompared with term infants. As the final cortical element of the arousal
process may be the most critical for survival, we hypothesised that theincreased vulnerability of preterm infants to SIDS could be explainedby depressed cortical arousal responses. We aimed to evaluate the effects
of preterm birth on stimulus-induced arousal processes in both prone
and supine sleeping positions. Ten healthy ex-preterm infants werestudied with daytime polysomnography, in both supine and prone
sleeping positions, at 2–4 wk, 2–3 mo and 5–6 mo post-term. Arousal
from sleep was induced using a pulsatile jet of air at increasing pressures
to the nostrils. Sub-cortical activations and cortical arousals (CA) werescored using standard criteria and expressed as proportions of totalarousal responses. Data were then compared with data from 13 healthy
term infants. In term infants at 2–3 mo of age, prone sleeping was
associated with increased CA when compared to the supine position
and the other ages studied. By contrast, in preterm infants this positional effect of increased CA when prone was evident at all three ages
studied. We showed that prone sleeping promoted cortical arousal
responses in healthy preterm infants throughout the first six months of
post-term age. We have previously suggested that enhanced CA represents a critical protection against a potentially harmful situation; we
speculate that such protection may be absent in SIDS victims.

PO-2-189
ALTERATION OF CHILD SLEEP IN JAPAN FROM
2000 TO 2010
J KOHYAMA
Pediatrics, Tokyo Bay Urayasu/Ichikawa Medical Center, Urayasu, Japan
Introduction: In 2000, 49% of children in Japan aged 18 to 83 months
fell into sleep 10 pm or later. The rate in 2010 was 30%. I am thefounding member of web site named hayaoki site opened in 2002.
Hayaoki means “wake up early in the morning” in Japanese. Hayaoki
site is undoubtedly the first runner for the promotion to keep bedtime
early, to wake up early, and to secure enough sleep duration for children
in Japan. In this paper, I will look back these almost 10 years and viewthe next several years regarding child sleep in Japan.
Beginning of the campaign: Our campaign is consistent with recent
scientific findings of the importance of sleep health practices (1.
Increase exposure to morning light. 2. Engage in physical activity
during daytime. 3. Sleep in the dark during the night. 4. Eat regularmeals. + Avoid substances that disturb sleep (e.g., caffeine, alcohol,
nicotine) and excessive media exposure.). We, members of hayaoki site,
have had more than 100 lectures a year all around Japan. Since our
promotion has been based on the scientific issues, many parents, healthcare takers, nursery school teachers and nurses have listened to our
explanation.
Spread of the campaign: In 2006, we were asked to join the nationalwide promotion to keep bedtime early, to wake up early and to takebreakfast, organized by the Ministry of Education, Culture, Sports,
Science and Technology. Tokyo Metropolitan has also begun promotion
to keep bedtime early, to wake up early, and to secure enough sleep
duration for children in 2008. Finally, 30% of children in Japan aged
18 to 83 months was found to fall into sleep 10 pm or later in 2010.
It seems that our promotion have reached a goal.
Prospects: In spite of obtaining the goal, I am not satisfied on the sleep
situation of children in Japan. I will indicate four points. 1. Short sleep
duration. 2. Short nap duration. 3. Education on sleep. 4. Side effects
of national-wide campaign.
Conclusion: We should keep spreading the basic knowledge on sleep
to parents, pediatricians, family doctors, health care takers, nurseryschool teachers, nurses and policymakers.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research403

Sleep, Science and Research

PO-2-190
SIGNIFICANT RELATIONSHIP BETWEEN SLEEPCHARACTERISTICS AND BEHAVIORALATTRIBUTES IN JAPANESE SCHOOL CHILDREN

M MATSUOKA1, S NAGAMITU1, M IWASAKI1, A IEMURA1,
Y YAMASHITA1, M MAEDA2, N UCHIMURA2, T MATSUISHI1
1
Department of Pediatrics and Child Health, Department of
Neuropsychiatry, Kurume University, Kurume-city, Fukuoka, Japan,
2
Department of Neuropsychiatry, Kurume University, Japan

Objectives: The total sleep duration of Japanese children is the shortest
in the world. Sleep disturbance in children may be linked to daily
school and cognitive performance. To clarify the relationship amongchildren’s sleep characteristics, behavioral attributes, school records,
and their parents’sleep quality, we administered a questionnaire survey.
Methods: A total of 415 children(age range, 6–12 years; 221 boys and
194 girls) from one elementary school in Kurume city, Japan, participated in this study. We used the Japanese version of the Children’s Sleep
Habits Questionnaire (CSHQ-J), the Strengths and Difficulties Questionnaire (SDQ), and, for the parents, the Japanese version of thePittsburgh Sleep Quality Index (PSQI-J), as well as each child’s bodyweight, height, medication, school records and family history. The SDQ
is a short screening instrument which addresses “Emotional symptoms”,“Hyperactivity/inattention”, “Conduct” and “Peer problems”.
Results: The average values for the children’s sleep duration, CSHQ-J,
and SDQ, and the parents’PSQI-J were 9.1 hours, 44.7, 9.3, and 5.4,
respectively. CSHQ-J showed a significant positive correlation with SDQ(P < 0.01) and the parents’PSQI-J (P < 0.01). However, CSHQ-J showed
no correlation with body mass index or school records. School records
showed a significant negative correlation with SDQ (P < 0.01). Children
diagnosed with developmental disorders (n = 43) showed significantly
higher CSHQ-J and subscales than other children. The collection rate
was 95.2%.
Conclusion: The significant relationship between the children’s CSHQ-J
and SDQ and the parents’PSQI-J indicates that children’s negative
behavioral attributes may adversely affect children’s and theirparents’sleep quality. The poor sleep quality in children with developmental disorders suggests that behavioral attributes may play an important role in sleep quality.

PO-2-191
DEVELOPMENT & FEASIBILITY TRIAL OF AMINDFULNESS-BASED MULTI-COMPONENT
IN-SCHOOL GROUP SLEEP INTERVENTION FOR
POOR SLEEP & ANXIETY SYMPTOMS IN
ADOLESCENT GIRLS
B BEI, J WALOSZEK, M BYRNE, M WOODS, C IVENS,C NICHOLAS, G MURRAY, N ALLEN, T JOHN
Psychological Sciences, University of Melbourne, University of Melbourne,
Australia
Introduction: Existing literature links poor sleep, bedtime cognitive/
physical arousal, and anxiety symptoms in adolescents. This pilot study
examined the feasibility of a mindfulness-based, multi-component, inschool group intervention targeting poor sleep, using sleep and anxiety
as outcome measures.
Methods: 62 Year 9 students (age 13–15) at a girl’s college completed
screening scales: Pittsburgh Sleep Quality Index (PSQI) and Spence
Children’s Anxiety Scale (SCAS). Self-reported poor sleepers wereinvited to a home interview for past/current psychopathology and suit-404

ability for the program, yielding a total of 10 participants. The 6-session
program was based on Bootzin & Stevens (2005) with added stress/
anxiety-specific components. Sessions ran weekly after school covering
key aspects of: basic mindfulness concepts and practice, sleep hygiene,
sleep scheduling, evening/daytime habits, stimulus control, skills for
bedtime worries, and healthy attitudes to sleep. Treatment-relatedchanges were measured by pre-post scores on the PSQI, SCAS, andobjectively measured sleep on 7-day actigraphy.
Results: Mean (SD) baseline global PSQI and SCAS scores for group
participants were 10.9 (2.5) and 38.3 (16) compared to 7.3 (3.7) and27.9 (14.2) for the remaining screening sample. Based on effect-size
analyses, participants who completed the program (90%) showed significant improvement on objective sleep onset latency (SOL), sleep
efficiency, and total sleep time; actigraph data also showed significantly
earlier bedtime, rise-time, and smaller daily bedtime variation. Postintervention global PSQI and SCAS scores were 6.2 (3.6) and 27.3
(18.5), significantly lower than at baseline, and there was significant
improvement on subjective SOL, sleep quality, sleep-related daytime
dysfunction, and the SCAS Panic Agoraphobia subscale.
Conclusion: A mindfulness-based, multi-component, in-school groupsleep intervention following brief screening is feasible, and has thepotential to improve sleep and anxiety symptoms.

PO-2-192
WITHDRAWN
PO-2-193
SURVEY OF ACTUAL SLEEPING CONDITIONSIN MEDICAL UNIVERSITY STUDENTS:
COMPARISON OF NURSING STUDENTS WITH
THOSE OF OTHER FACULTIEST TAGUCHI, A HAYASHI, M NAKAMORI
Acute and Critical Care in Adult Nursing, Meiji University of Integrative
Medicine, Nantan, Japan
Objective: To investigate sleep quality on awakening in medical university students and clarify the characteristics of sleeping.
Methods: We surveyed medical university students using the MA
version of the OSA sleep questionnaire. The survey was conducted withthe approval of the ethics review in an affiliated university. Subjects
were provided with sufficient information, and those who consented
were asked to complete the questionnaire and deposit it into a lockedbox. The standardized score of the OSA was compared.
Results: We surveyed 49 nursing students about one month after
admission, and noted that they slept for about 5.3 hours on average.
Eighty percent of the students felt drowsiness on awakening, and 45%of them felt difficulty in initiating and maintaining sleep, which suggested a tendency whereby they could not secure sufficient sleeping
hours. Regarding dreams, they were divided into two groups (good orbad). Eighty percent of the students could not recover from fatigue.
Meanwhile, 42 non-nursing students slept for 5 hours on average.
Regarding evaluation of the OSA every five factors, 71% of the students
felt drowsiness on awakening. Seventy-one percent of them felt difficulty in initiating and maintaining sleep, suggesting a tendency whereby
they could not secure sufficient sleeping hours. Regarding dreams, they
were divided into two groups (good or bad). Sixty-two percent of them
could not recover from fatigue. Regarding nursing students, the rate of
the total score for five factors being below and above 50% was 0 and
14%, respectively. However, regarding non-nursing students, that of
below and above 50% was 14 and 12%, respectively. When performing© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

t-tests for both students, the rate for factor II was likely to be significantly lower in non-nursing students (p = 0.01).
Discussion: Both types of university student showed poor results concerning drowsiness on awakening, recovery from fatigue, and sleeping
hours; therefore, it may be necessary for them to improve their lifestyle
habits.

PO-2-194 / AS-16 Presenter
RECOMMENDED LEVELS OF WALKING PREDICTSLEEP AND HEALTH OUTCOMES AMONG
OLDER PEOPLEI HARTESCU1, K MORGAN2, C STEVINSON3
1
Sleep Research Centre, SSEHS, Loughborough University, Loughborough,Leics. LE11 3TU, United Kingdom of Great Britain and Northern Ireland,
2
Sleep Research Centre, SSEHS, Loughborough University, United Kingdom,
3
School of Sports, Exercise and Health Sciences, Loughborough University,
United Kingdom
The minimum level of physical activity likely to improve or maintainboth health and sleep outcomes among older people has not been
explored. The present analyses assess the contribution of physical activity, above and below the 150 minute international guidelines, to sleep
and health outcomes reported at baseline.
Methods: Sleep, health, and physical activity data were obtained froma random community sample of 1042 people aged 65+ interviewed in1985 for the Nottingham Longitudinal Study of Activity and Ageing.
Baseline walking was categorized as below (<150 minutes/week) or
above (=>150 minutes/week) international guidelines. In models
adjusted for age, sex and health status at baseline, predictive relationships
were examined between these activity categories and: 21-year all cause
mortality (Cox regression); the prevalence of baseline insomnia (logistic
regression);and subjectively reported time in bed (multiple regression).
Mortality (cause/date of death) was monitored from baseline.
Results: At baseline 441 (48%) and 485 (52%) respondents were categorised as walking below and equal to/above the guidelines thresholdrespectively. During 1985–2006 the project was notified of 919 deaths.
In the adjusted multivariate models, the higher level of walking was
significantly associated with increased longevity (HR = 0.78, 95% CI =0.67–0.89, p < 0.01), lower levels of reported insomnia (OR = 0.65,
95% CI = 0.46–0.92, p < 0.05) and shorter durations of ‘time in bed’
(r2 = .04, F(4,908) = 10.25, p < 0.01).
Conclusion: Internationally recommended levels of physical activity
appear to provide a common threshold for superior health and sleep
outcomes among older people. Results also suggest that time spent in
bed may be an under-researched proxy for inactivity.

PO-2-195
THE JOINT ASSOCIATION OF SLEEP DURATION
AND SLEEP PROBLEMS WITH DISABILITY
RETIREMENT: A LONGITUDINAL REGISTERLINKED STUDYP HAARAMO, O RAHKONEN, E LAHELMA, T LALLUKKA
Hjelt Institute, Department of Public Health, University of Helsinki,
University of Helsinki, FinlandObjective: To examine the joint association of sleep duration and sleep
problems with subsequent disability retirement.
Methods: Baseline survey data were collected in 2000–2002 from
40–60-year-old employees of the City of Helsinki, Finland. Baseline

data were linked with disability retirement data until the end of 2010,
obtained from the Finnish Centre for Pensions registers (N = 6042).
Sleep duration and sleep problems (Jenkins Sleep Questionnaire, assessing difficulties in initiating and maintaining sleep and non-restorative
sleep) were derived from the baseline surveys. All-cause disability retirement (N = 561) and the most prevalent diagnostic groups, musculoskeletal diseases (43%) and mental disorders (26%), were examined.
Cox regression analysis was used to yield hazard ratios (HR) with 95%
confidence intervals (CI).
Results: A joint association of sleep duration and sleep problems withdisability retirement was found, implying a higher risk for those withfrequent sleep problems. HRs for all-cause disability retirement ranged
among those with frequent sleep problems from 2.02 (95% CI 1.53–
2.68, sleeping 7 h) to 3.92 (95% CI 2.57–5.97, sleeping 5 h or less).
Adjusting for sociodemographic, work-related factors, and health attenuated the associations, which nevertheless remained. The associations
were similar for the two diagnostic groups, although stronger for thosewith mental disorders.
Conclusions: Sleep problems dominate the joint association of sleep
duration and sleep problems with subsequent disability retirement.
Examining exclusively sleep duration would provide an incomplete
understanding of the consequences of poor sleep.

PO-2-196
SLEEP AND ACTIVITY STATUS OF PSYCHIATRICDAY CARE USERS IN JAPAN – A SURVEY OF
A SLEEP AND ACTIVITY LEVEL USINGACTIGRAPHYM MITSUHASHI, M KOMATSU, E MANABE, Y OKAYAMA,K KITAJIMA
School of Nursing, Kyoto Prefectual University of Medicine, Kyoto-city,
Kyoto, Japan
Purpose: We conducted a study of a support program to enable homebound psychiatric patients to self-manage their sleep through the useof non-pharmacotherapy. The purpose of this study is to identify thesleep and activity status of homebound psychiatric patients as the firststep of that program.
Method: The subjects of the study consisted of homebound psychiatricpatients age 20 or older who were users of day care centers. Sleep andactivity status was measured using sleep log, actigraph and self-administered questionnaires. Spearman’s rho were determined between age,
sleep indices and activity level. Data was collected during the period
from September to December, 2009.
The survey was approved by the medical ethics committee of the facility
with which the researchers are affiliated and by the day care centers.
Results: The subjects consisted of 9 psychiatric day care users comprised of 3 men and 6 women.
The majority of the subjects generally reported waking up and going
to bed at regular times, but some of the subjects exhibited serious sleep
disorders in which they repeatedly slept for short periods of time on an
irregular basis. With respect to sleep health, all of the subjects weresuspected of having at least one sleep problem. With respect to correlations among age, sleep indices, activity level and light exposure, significant correlations were observed between sleepiness scale and sense of
having slept, and between activity level and daytime light exposure.
Discussion: Although many of the users of psychiatric day care centers
in Japan generally exhibited regular sleep and biorhythms, all of thesubjects were suspected of having some sleep disorders, thus suggesting
the need to provide support for these subjects relating to improving
their sleep. There were no significant correlations observed between© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research405

Sleep, Science and Research

sleep indices and daytime activity levels or light exposure levels. We
intend to conduct a study on a specific support program for thispurpose by increasing the number of subjects.

PO-2-197
ASSESSING THE RELIABILITY OF AQUESTIONNAIRE TO ASSESS LIFETIME SLEEPQUALITY IN A CASE-CONTROL STUDY OF
BREAST CANCER

J GIRSCHIK1, J HEYWORTH2, L FRITSCHI1
1
Cancer Epidemiology, Western Australian Institute for Medical Research,
Nedlands, Western Australia, Australia; 2School of Population Health, The
University of Western Australia, Australia
Sleep diaries and/or questionnaires are the most cost-effective and realistic option for measuring sleep in large population based studies. There
have been a number of formal questionnaires designed for the detailed
assessment of sleep quality. However, these instruments have been
designed predominantly to assess recent exposures and short term
outcomes. The Breast Cancer Environment and Employment Study(BCEES) team has developed a sleep questionnaire that addresses someof the limitations of previous sleep quality questionnaires in assessing
lifetime sleep quality. The aim of this study is to assess the reliability of
the BCEES sleep questionnaire. Women participating as controls in the
BCEES study were invited to participate in the sleep reliability study
once they had completed the lifestyle questionnaire, which included
the sleep questions. Consenting participants completed the BCEES
sleep questions again at least two weeks later. Categorical responses tothe two questionnaires were compared using weighted kappa statistics.
Preliminary results were based on 189 people who had data available
for analysis from both the test and re-test questionnaires. Of these 189
people, 3 had missing data on hours of sleep duration and 8 had data
missing on subjective sleep quality. Kappa values for usual duration of
sleep on work days was 0.71 (p-value < 0.001) and for usual sleep
duration on non-work days was 0.70 (p < 0.001). Kappa values for
subjective usual sleep quality was 0.75 (p < 0.001). Our study foundgood test-retest reliability on individual items of the BCEES sleep questionnaire. The reliable and valid assessment of sleep quality is criticalin providing an accurate assessment of the relationship between sleep
quality and health outcomes.

PO-2-198
DIFFERENCES IN OBJECTIVE AND SUBJECTIVESLEEP IN FIRST-TIME AND EXPERIENCED
MOTHERSS COO CALCAGNI1, B BEI1, J MILGROM1,2, JA TRINDER1
1
Psychology Department, University of Melbourne, Carlton, Melbourne,
Australia, 2Parent-Infant Research Institute, Department of Clinical &Health Psychology, Austin Health, Victoria, Australia

Introduction: Changes in sleep are common across pregnancy and the
postpartum period, with poor sleep potentially contributing to postnatal distress. Previous findings have reported differences between objective and subjective measures of sleep, subjective sleep being a better
predictor of postpartum mood in healthy women than objective sleep,
thus suggesting that subjective sleep is an indicator of overall wellbeing.
Sleep differences have also been observed in first-time (FM) and experienced mothers (EM), however subjective and objective measures of
sleep have not been compared as a function of parity.

406

Methods: During the third trimester of pregnancy (Time-1) 36 FM and
35 EM completed measures on mood and sleep, and wore actigraphs
for 7 days. Among these participants, 30 FM and 31 EM completed thesame procedure within 2 weeks postpartum (Time-2). Mood scales
included the Edinburgh Postnatal Depression Scale, the Depression
Anxiety Stress Scale, and the Hospital Anxiety Depression Scale. Subjective sleep was assessed using the Pittsburgh Sleep Quality Index.
Results: Analyses confirmed previous findings that both objective andsubjective sleep worsen from late pregnancy to the postpartum period.
During T-2 both Mood and objective sleep were significantly better in
EM than in FM; however, no differences were observed in subjective
sleep. Regression analyses revealed an overall significant association
between subjective sleep and mood. Comparisons of regression coefficients between FM and EM showed a significantly stronger relationship of subjective sleep and postpartum stress in FM, no significant
differences were observed in other variables.
Conclusion: Discrepancy between FM and EM in objective sleep may
indicate more effective strategies to cope with sleep disruption in EM.
Results support the notion that subjective sleep might reflect psychological wellbeing rather than actual sleep, especially in the case of
postnatal stress levels in FMs.

PO-2-200 / AS-13 Presenter
WORK-FAMILY CONFLICTS AND SLEEPMEDICATION: A LONGITUDINAL REGISTERBASED STUDYOJ RAHKONEN1, MT LAAKSONEN1, S ARBER2, ET LAHELMA1,TM LALLUKKA1,2
1
Department of Public Health, University of Helsinki, University of
Helsinki, Finland, 2Department of Sociology, University of Surrey, United
Kingdom
Background and aims: Work-family conflicts are prevalent among
employees and potentially detrimental to health and well-being, including sleep problems. However, longitudinal studies using objective measures on sleep are lacking. This study examined the longitudinalassociation of work-family conflicts with subsequent sleep medication
adjusting for covariates.
Methods: Data were derived from the Helsinki Health Study baseline
mail surveys in 2001–2002 (3137 women, 849 men). Data concerning
sleep and other psychotropic medication were derived from the Finnish
Social Insurance Institution’s registers covering all reimbursed prescribed medication in 1995–2007 (ATC-codes). Those currently using
sleep or other psychotropic medication at baseline were excluded fromall analyses (n = 319). Previous sleep medication five years before
baseline was adjusted for in the analyses. Four work to family items
measured whether job responsibilities interfered with family life, andfour family to work items measured whether family responsibilities
interfered with work. Cox proportional hazard models were fitted,
adjusting for age, sleep medication five years before baseline, and social,family-, and work-related covariates.
Results: During a five year follow-up, 16% of participants had at least
one purchase of prescribed sleep medication. Strong conflicts between
family and work were reported by 8%, whereas 16% of participants
reported strong conflicts between work and family. Strong family towork conflicts were associated with subsequent sleep medication after
full adjustment for social, family- and work-related covariates association (HR = 1.77, 95% CI 1.34–2.33). Strong work to family conflicts
were also associated with subsequent sleep medication after full adjustment (HR = 1.37, 95% CI 1.01–1.85). Control analyses excluding thosewith prior sleep medication (16%) produced slightly stronger results.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

Conclusion: Better balance between work and family likely helps
prevent sleep medication and underlying sleep problems.

PO-2-201SLEEP DEPRIVATION RELATED SMOKING,DRINKING AND FATIGUE AMONG MIDDLEAGED JAPANESE MENA NAKAZAWA1, M SHIGETA2, I WATANABE2, D MATSUI2,Y WATANABE2, M UEDA3, M KADONO3, E OZAKI2, N KURIYAMA2
1
Health Center, Doshisha University Kyoto-city, Kyoto, Japan, 2Division of
Epidemiology for Community health and Medicine, Kyoto Prefectural
University of Medicine, Japan, 3Medical Check-up, Kyoto First Red Cross
Hospital, Japan
Background: Sleep deprivation is one of the biggest health problems
in Japan. According to the Japanese National survey in 2006, mean
sleeping hours of Japanese male worker was 7.5 hr that was 40 min
shorter than in 1976. We are concerned with aggravation of the problem
because the 24-hour society is progressing very rapidly.
Purpose: This study investigates the sleep habits of healthy middleaged men. We focused on smoking, drinking and fatigue which are
related to sleep deprivation.
Subjects and Methods: The subjects were 3256 middle-class male
employees aged 30 to 59 years old. They attended medical check ups
in our clinic from January to December in 2007. The data were gatheredfrom a self-administered questionnaire that investigated lights-out time,
getting up time, and the number of awakening times. The relationshipbetween these data and symptoms such as fatigue and not having energy
was evaluated. Moreover, the influence of smoking and drinking on
sleeping hours and the quality of sleep was investigated.
Results: The mean [±SD] sleeping hours were 6.87 ± 0.02 hours. The
younger subjects slept shorter [6.57 ± 0.05 hours in their thirties].
Significant relationship was observed between lights-out time and fatigability [p < 0.01], but there was no apparent relationship between
getting up time, sleeping hours and fatigability. The number of cigarettes and amount of alcohol consumptions were significantly related
to the data on sleep. Particularly, there was an apparent relationshipbetween smoking and getting up time [p < 0.01]. The amount of alcohol
consumption is significantly related to sleeping hours [p < 0.01], lightsout time [p < 0.01] and interruption of sleep. Drinking and smoking
were also related to fatigue.
Discussion: In our study, sleeping hours were shorter than that in theearlier study. Middle-aged Japanese males may have been cutting down
on sleep because of changes in society. Sleep deprivation among middleaged men in Japan should be considered seriously.

PO-2-202
THE CONTRIBUTION OF SLEEP QUALITY TO
SELF-RATED HEALTH AND PHYSICAL AND
MENTAL FUNCTIONING: THE JAPANESE CIVILSERVANTS STUDYM SEKINE, T TATSUSE1, H MINEMURA
Department of Epidemiology, University of Toyama, Toyama, Japan

Introduction: While it is well-known that poor sleep quantity (i.e. shortsleep duration) is associated with the development of various diseases,
research on the associations of sleep quality with physical and mental
health is relatively few.

Methods: The subjects were 3684 public sector employees (2471 men
and 1213 women: Mean age 42.8) aged 20–65. Questionnaire survey
was conducted in 2003. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) which generates 7 components ofsleep quality and one overall sleep quality. Physical and mental healthwas evaluated using Short Form 36 (SF-36) and subjects with a scorebelow 25 percentile were considered to have poor physical and mental
functioning. Self-rated health was evaluated using one item in SF-36.
Logistic regression analysis was used to evaluate whether poor sleep
quality is associated with poor self-rated health and poor physical andmental functioning. In multivariate analysis, age, socioeconomic status,and personality (affect balance) were adjusted for.
Results: In general, the poorer the overall sleep quality, the poorer the
self-rated health and physical and, in particular, mental functioning. Allof the subscales of the PSQI (i.e. subjective sleep quality, sleep latency,
sleep duration, sleep efficiency, sleep disturbance, use of sleep drug,
daytime dysfunction) was independently associated with poor self-rated
health and poor physical and mental functioning.
Conclusions: Self-rated health and physical and mental functioning are
affected by sleep quality. Improvement in sleep quality may have beneficial effects on physical and mental health.

PO-2-203
ASSOCIATIONS OF SLEEP QUANTITY WITHSLEEP QUALITY: THE JAPANESE CIVILSERVANTS STUDYM SEKINE, T TATSUSE, H MINEMURA
Department of Epidemiology, University of Toyama, Toyama, Japan
Introduction: This study aims to evaluate the associations of sleep
quantity with sleep quality and evaluate whether characteristics of poor
sleep quality differ between short and long sleepers.
Methods: The subjects were 3769 public sector employees (2517 men
and 1242 women: mean age: 42.6) aged 20–65 working in a local
government in Japan. Questionnaire survey was conducted in 2003.
Sleep hours was defined as hours between bedtime and rising time anddivided into 6 groups, ranging from less than 5 hours to 9 hours or
longer. Sleep quality was evaluated using the Pittsburgh Sleep Quality
Index (PSQI). Analysis of covariance (ANCOVA) was used to evaluate
the associations of sleep quantity (i.e. sleep hours) with poor sleep
quality.
Results: Average sleep hours was 7:03 for men and 6:39 for women.
The prevalence of poor sleep quality was, in average, 21.5% for men
and 31.6%. The lowest prevalence of poor sleep quality was observed
for men taking 7–8 hours sleep and women taking 8–9 hours
sleep(15.6% and 17.1%, respectively). Both short and long sleepers had
poorer sleep quality than average sleepers. While 77.8% of men and68.6% of women taking less than 5 hours sleep (i.e. short sleepers) had
poor sleep quality, 23.6% of men and 29.4% of women taking 9 hours
sleep or more (i.e. long sleepers) had poor sleep quality. The reasons ofpoor sleep quality differed between short and long sleepers. While poor
sleep quality among short sleepers was mainly attributable to poor
subjective sleep quality and daytime dysfunction, poor sleep quality
among long sleepers was mainly attributable to long sleep latency, poor
sleep efficiency and sleep disturbance.
Conclusions: The lowest prevalence of poor sleep quality was observed
among men and women taking around 8 hours sleep. Both short andlong sleepers had poor sleep quality but the underlying causes differed
between short and long sleepers.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research407

Sleep, Science and Research

PO-2-204
EFFECT OF FIVE DAYS SLEEP SHORTAGE ON
SPORT RELATED PERFORMANCESC KUBOTA1, K SHIODA1, T KOJIMA1, J SUMITOMO1, M GANEKO1,
S UCHIDA2
1
Graduate school of Sport Sciences, Waseda University, Tokorozawa-city,
Saitama, Japan, 2Faculty of Sport Sciences, Waseda University, Japan
Introduction: Sports related activities need not only physical but neuraland psychological abilities. It has been studies that sleep shortage deteriorate cognitive performances. However, there have not been studies
examining how sleep shortage affect sports related activities. In thisstudy, we examined physical and cognitive performances on healthy
young subjects to investigate how sleep shortage affect sleep sports
related activities.
Methods: Subjects were six healthy young students. In order to measure
regular sleep length, subjects wore wrist actigram for 14 days. Experiment was performed on two conditions (regular sleep condition: RSC,
sleep deprivation condition: SDC). Subjects took normal sleep in the
RSC first two days. On the second day after regular sleep, exercise
performances (EX) (aerobic and anaerobic) and cognitive tests (COG)(PVT and dexterity test) were examined. In the SDC, sleep was
shortened to 50% of regular sleep length for each subject. EX wasmeasured at 18:00 of the 1, 3, 5 day, and COG was measured at 9:00
every day. Standard PSG was done on the second regular sleep nightand 1, 3, 5 shortened sleep nights.
Results: There were no significant differences in exercise performancesand cognitive performances between regular sleep and sleep deprivation
condition. However number of PVT-false (RT × 500 ms, RT < 150 ms)
have an increasing trend. However, sleep variables were significantly
different in the sleep consecutive deprivation conditions. Percentage ofsleep stage 1 decreased and percentage of slow wave sleep increased in
the sleep deprivation conditions (p < 0.05).
Conclusion: Results of experiment suggested that five days shortened
sleep didn’t affect exercise performances and cognitive performances. It
may be because improved sleep quality (increased SWS) substituteinsufficient sleep to time.

PO-2-205
INDIVIDUAL DIFFERENCES INFLUENCE ON THE
EFFECTS OF SLEEP DEPRIVATION DURING
FACE RECOGNITIONM TAMURA1, S HIGUCHI2,3, A HIDA2, M ENOMOTO2,Y MORIGUCHI2, K MISHIMA2
1
Faculty of Human Arts and Sciences, University of Human Arts andSciences, Saitama-city, Saitama, Japan, 2Department of Psychophysiology,
National Institute of Mental Health, National Center of Neurology andPsychiatry, Japan, 3Faculty of Design, Kyushu University, Japan

Sleep deprivation affects a range of cognitive functions, including thoserelated to social interaction. However, it is currently unclear whether
sleep deprivation specifically affects the neural basis of understanding
others’ emotional states, an essential component of effective social functioning. We used fMRI to examine subjects in sleep-deprived and wellrested states to examine the effects of sleep deprivation on neuralactivity related to emotional facial expression processing, predicting that
activity in empathy-related brain areas would be significantly affected.
Taken together, the present study thus aimed to investigate the influenceof interindividual psychological differences on patterns of activation in408

the neural network associated with the perception of facial expression,under conditions of sleep deprivation and normal sleep.
Well-slept participants exhibited significantly greater activation
increases in the fusiform gyrus (FG) and insula while observing happy
faces. In contrast, neural responses to fearful faces in the inferior frontal
gyrus and insula were significantly greater following sleep deprivation.
Moreover, higher levels of depression were associated with higher FG
responses to happy faces under normal sleep conditions. However, alower mental health state was associated with higher insula activationin response to fearful faces under sleep-deprived conditions. Our findings suggest that individual differences in mental health (and levels ofdepression in particular) in healthy individuals can impact on the effects
of sleep deprivation on face processing.
These results provide novel evidence supporting the hypothesis that
empathy-related brain areas involved in emotion processing are affectedby sleep deprivation, consistent with the notion that sleep deprivation
affects the processing underlying emotion understanding.

PO-2-206 / AS-11 Presenter
CAN RELATIVE VULNERABILITY TO THE
EFFECTS OF SLEEP DEPRIVATION ON
PSYCHOMOTOR VIGILANCE BE ESTIMATED
USING FEATURES OF DAYTIME PERFORMANCE?
JJ GOOLEY, C-P CHUA
Neuroscience and Behavioral Disorders, Duke-NUS Graduate Medical
School, Singapore, Singapore
Some individuals show severe cognitive impairments during sleep
deprivation, whereas others are able to maintain high levels of performance. At present, there is no reliable method for predicting how wella person will cope with sleep loss. Here, we examined whether daytime
performance on the psychomotor vigilance test (PVT) can be used toestimate a person’s relative vulnerability to the effects of sleep deprivation on sustained visual attention. Healthy volunteers (n = 48, ages
21–30) were kept awake for at least 26 hours in a controlled laboratoryenvironment. Every two hours, participants completed a 10-minute
PVT. In a retrospective analysis, we stratified participants into top,intermediate, and bottom performance groups based on number of PVT
lapses during the usual hours of sleep (i.e., between 16–24 hours afterwake). Compared to the top tertile of performers, subjects in the bottom
tertile exhibited an earlier wake-dependent decline in PVT performanceand had about twice as many lapses during sleep deprivation. Chronotype, circadian phase, and actigraphy-based sleep measures were similar
between groups, despite differences in performance vulnerability tosleep loss. We found that some measures of PVT performance variability
during the day correlated with lapses during sleep deprivation (Spearman’s rho > 0.70; P < 0.05). Participants with the highest number oflapses during sleep deprivation had the most variable PVT response
times during rested wake, whereas subjects with the fewest number oflapses during the usual hours of sleep showed relatively lower variability in daytime PVT performance. Our findings raise the possibility
that it may be possible to estimate a person’s relative vulnerability tosleep loss by assessing features of his/her daytime performance.Research
was supported by the Duke-NUS Signature Research Program fundedby A*STAR and the Ministry of Health, Singapore; National Medical
Research Council, NIG09may007; SingHealth Foundation, SHF/
FG410P/2009.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-207 / AS-15 Presenter
EFFECT OF SLEEP DEPRIVATION ON SLEEP,
MOOD AND EMOTIONAL PROCESSING

K PORCHERET1, E HOLMES2, G GOODWIN2, C KENNARD3,
R FOSTER1, K WULFF1
1
Nuffield Laboratory of Opthtalmology, University of Oxford, Oxford,
United Kingdom of Great Britain and Northern Ireland, 2Department of
Psychiatry, University of Oxford, United Kingdom, 3Clinical Neurology,
University of Oxford, United Kingdom
Objectives: To investigate the effect of total sleep deprivation on the
response to an analogue depressing event in terms of mood and emotional processing, in healthy young subjects.
Methods: Subjects (aged 18–25 yrs) where shown a depressive film
followed by either 24 hrs total sleep deprivation or normal sleep. Subjects were screened to ensure no personal history of psychiatric conditions, no smoking and no illicit drug intake. Before watching the film
all subjects underwent a two-week screening period of actigraphy,
including melatonin and cortisol profiling. Polysomnographic recordings were done before and after watching the film. Mood was assessedby a visual analogue scale (VAS), state anxiety scale and positive andnegative affect scale. Emotional processing was measured by participants reporting the number of intrusive memories relating to the film
experienced.
Results: This study is ongoing. The two groups, sleep deprived (n =17) and non sleep deprived (n = 20) show no difference in age, sex,
caffeine or alcohol intake, subjectively rated sleep quality, morningness/eveningness, or type of personality. All participants were found to havea significant decrease in mood after watching the film, reflected inincreased anxiety and sadness, feelings of being horrified, decreased
happiness and calmness. A poison distributed generalized linear modelshows that group (sleep versus sleep deprived) has a significant effecton the number of intrusions generated, with the sleep deprived grouphaving fewer intrusions than the non sleep deprived group (p = 0.003).
To date no significant effect of the film has been found on sleep over
the anticipated effects of sleep deprivation.
Conclusion: We have found that within a homogenous young healthy
population, sleep deprivation causes fewer intrusive memories to ananalogue depressive event, than sleeping normally. This correlated withclinical data suggesting that sedation after trauma can lead to an increasein post traumatic stress disorder, which is characterized by the presenceof intrusive memories (Matar et al 08).

PO-2-208
BEHAVIOURALLY INDUCED INSUFFICIENTSLEEP SYNDROME AND ITS BORDERLAND
E WERTH, N MICHAEL, CR BAUMANN, CL BASSETTI
Department of Neurology, University Hospital Zrich, Zurich, Switzerland
Behaviourally induced insufficient sleep syndrome (BIISS) occurs when
an individual chonically fails to obtain the amount of sleep required tomaintain normal levels of alertness and wakefulness. Its significance ismostly unappreciated by the patient. Some patients may develop secondary symptoms which may even become the main focus of the patients,
serving to obscure the primary cause of the difficulties. This study presents the results of the post hoc evaluation of 47 consecutive patients who
received the diagnosis of BIISS in our Center of Sleep Disorders.
Mean age of the BIISS patient was 40 ± 12 years (mean ± SD). Only
30% were females. Patients mostly complain symptoms of hypersomnia

with excessive daytime sleepiness, however, many individuals reported
other symptoms as sleep attacks without general daytime sleepiness,fatigue, sleep drunkenness, concentration and attention deficits or cognitive impairment. Mean ESS was 14.1 ± 3.6. Time in bed (TIB) estimation based on the SQ revealed TIB of 7:10 h ± 1:03 h during weekdays
and 8:29 h ± 1:16 h on weekend. TIB estimation based on actigraphy
recordings revealed significantly shorter TIB on weekdays and on weekends (weekday: 6:25 h ± 0:57 h, weekend: 7:56 h ± 1:13 h) compared
to TIB taken from the SQ. In this population the PSG recording revealed
short sleep latency 8.4 ± 7.9 minutes and high sleep efficiency (91.5± 16.7%). Mean sleep latency of MSLT was 5.5 ± 3.3 minutes. Sleep
onset REM (SOREM) episodes with 2 and more SOREM were present
in 8 patients. Mean sleep latency of MWT was very variable. A clear
reduced ability to maintain wakefulness (sleep latency <12 min) waspresent in 34% of patients.
To conclude, the results of this case series indicate that there are a
noticeable large number of patients who were not aware that their sleep
duration was insufficient and that there is a substantial clinical overlap
between BIISS, narcolepsy without cataplexy and idiopatic hypersomnia without long sleep. A positive response to increased sleep time isdiagnostic of BIISS and an important feature to differentiate between
these three entities.

PO-2-209
THE EFFECT OF SLOW WAVE ACTIVITYDEPRIVATION DURING AN AFTERNOON SHORTNAP ON PERFORMANCEH IIZUKA1, K KAIDA2
Future Project, TOYOTA Motor Corporation, Susono, Shizuoka, Japan,
2
Human Life Technology Research Institute, National Institute of Advanced
Industrial Science and Technology (AIST), Japan1

Purpose: To take an advantage of recuperative effects of short nap, slow
wave sleep (i.e., slow wave activity, SWA; ×2.0 Hz) would be necessary.
However, it has also been reported that SWA would worsen performance immediately after awakening. The aim of the present study is toinvestigate whether SWA deprivation during a short nap can improve
performance and subjective sleepiness.
Method: Ten healthy men (28.7 &plusmn; 6.4 years old) took part in
the five experimental conditions, which were (1) control condition (reston the chair for 30 min), (2) 15 min nap condition, (3) 20 min nap
condition, (4) SWA condition (the participants slept for 30 min), and(5) SWA deprived condition (SWA-DEP). In the SWA-DEP condition,
participants were stimulated by tactile vibrations immediately after theexperimenters confirm the sleep stage 3 during a 20 min nap. The
vibration devices were installed in the chair in the location of back area
(around L2). Before and after the nap or rest, participants carried out
a simple reaction time (RT) task and answered questionnaires (sleepiness, fatigue, tension and relax). The order of the conditions was counterbalanced among the participants. All the participants were explained
the procedures of the experiment and signed for participation.
Result: It was confirmed that SWA was suppressed by the vibration in
the SWA-DEP condition. RT was shorter in the SWA-DEP condition
than in the other conditions. Subjective sleepiness was lower in the
SWA-DEP condition than in the 20 min nap condition. These results
suggest that the technique of SWA deprivation using tactile vibration
was effective on increasing the effect of afternoon short nap on performance and subjective sleepiness.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research409

Sleep, Science and Research

PO-2-210
SELF-AWAKENING PREVENTS SLEEP INERTIAUNDER THE PERIOD OF PARTIAL SLEEP
DEPRIVATION

H IKEDA1, T KUBO2, T MASAYA2
1
Exploratory Research for Advanced Technology, Okanoya Emotional
Information Project, Japan Science and Technology Agency, Nagoya city,
Aichi, Japan, 2Health Administration and Psychosocial Factor ResearchGroup, National Institute of Occupational Safety and Health, JapanThe ability to awaken at a predetermined time without an alarm is
known as self-awakening. Self-awakening has been reported to prevent
sleep inertia after undisturbed normal sleep (Ikeda & Hayashi, 2010),
but whether it can improve sleep inertia after partial sleep deprivationis unknown. The aim of this study was to examine the effects of selfawakening on sleep inertia after partial sleep deprivation. This study
included 15 healthy workers (age, 27–49 years) without the habit ofself-awakening. Two conditions were employed in this study: the forcedawakening and self-awakening condition. In each condition, participants slept in their homes for 5 h for 4 consecutive nights.
Nocturnal sleep was monitored using Actiwatch (Actiwatch AW64,
Mini-Mitter Co. Inc., Bend, Ore.). Vigilance performance was analyzed
using a psychomotor vigilance task (PVT-192, Ambulatory Monitoring,
Ardsley, New York, USA) and subjective sleepiness, motivation, fatigue,and feeling were rated using the 5-point Likert scale before bedtime andimmediately after awakening. The order of the conditions was counterbalanced across the participants. There were no significant differencesin the sleep variables without body movement time. PVT reaction times
were significantly shorter in the self-awakening condition than in theforced awakening condition. In addition, motivation was significantly
improved in the self-awakening condition than in the forced awakening
condition. These data indicate that self-awakening can prevent sleep
inertia under the period of partial sleep deprivation.

PO-2-211
SCENT REDUCES THE DELETERIOUS EFFECTOF SLEEP INTERRUPTION ON CIRCADIANRHYTHM AND SKIN CONDITIONSY GOZU, S HAZE, K SAKAI, A JOICHI
Research Center, Shiseido Co., LTD, Yokohama-city, Kanagawa, JapanOBJECTS: This study investigated (1) the deleterious effect of briefinterruption of sleep on circadian rhythms, and on mental, physical andskin conditions, and (2) the reduction of deleterious effect by scent.
SUBJECTS: Twenty females in their thirties were equally divided into
two groups; scent using and control groups.
METHODS: A newly developed fragrance which depresses sympathetic
nervous activity was used at bedtime every night over one menstrual
cycle by scent using group. As brief interruption of sleep, the subjects
were asked to wake up temporarily at 2:00 and to answer some quiz
questions for approx. 5 min under a light condition, and allowed tosleep again. This procedure was repeated continuously 2 nights. Psychological stress level was evaluated by STAI, and the sleep quality wasmeasured by sleep questionnaires. Diurnal changes of clock gene
expression and salivary cortisol level were measured by QPCR using
salivary total RNA and by ELISA respectively. Autonomic nervous activity was measured by heart rate fluctuation analysis under orthostatic
stress. The skin conditions were evaluated by sebum-secretion level,skin moisture value, skin barrier recovery and cold stress response.

410

RESULTS: In spite of no change in the score of STAI, the brief interruption of sleep reduced the score of sleep quality, and disturbed thediurnal change of clock gene expression and salivary cortisol level. Also
it stimulated the sympathetic nervous activity. The interruption was
found to decrease the sebum secretion and moisture levels of the skin,and disturb the recovery of skin barrier and cold stress response. In
contrast to the control group, the deleterious effect of sleep interruption
on the scent using group was significantly mitigated by inhalation of
the fragrance.
CONCLUSION: Environmental change in daily life such as brief-interruption of sleep causes the deleterious effect on mental, physical andskin conditions, and scent inhalation reduces the deleterious effect andleads to good conditions.

PO-2-212
PREPROHYPOCRETIN/PREPRO-OREXINPOLYMORPHISM PREDICTS INDIVIDUAL
DIFFERENCES IN MWT LATENCY, SLEEPPHYSIOLOGY AND HOMEOSTASIS DURINGSLEEP RESTRICTION

N GOEL1, S BANKS1,2, L LIN3, E MIGNOT3, DF DINGES1
1
Department of Psychiatry, University of Pennsylvania School of Medicine,Philadelphia, PA, United States of America, 2Centre for Sleep Research,
University of South Australia, Australia, 3Department of Psychiatry and
Behavioral Sciences, Stanford University, United States of America
The orexin-hypocretin system is involved in normal regulation of sleep
and wakefulness and is disturbed in narcolepsy. The −909 C/T polymorphism of the prepro-hypocretin/prepro-orexin (HCRT) gene is associated with an increased risk of sudden onset of sleep (SOS)/sleep
attacks in Parkinson’s patients, though it is not associated with narcolepsy. We evaluated the role of this polymorphism in mediating sleep
and wake responses during baseline and chronic partial sleep deprivation (PSD). 16 C/C, 59 C/T and 54 T/T healthy adults (29.9 ± 6.9 y;
63 females) completed 2 baseline (10 h TIB) nights, followed by 5consecutive PSD nights (4 h TIB) in a laboratory experiment assessing
physiological sleep responses (including NREM slow-wave energy[SWE]) and neurobehavioral outcomes (i.e., cognitive tests, subjective
sleepiness and fatigue, and sleep propensity as measured by MWT).
Comparisons were made across the 3 genotypes. T/T genotypic and T
allelic frequencies were higher in Caucasians than African Americans;results were significant after controlling for ethnicity. At baseline, theC/C group showed decreased sleep homeostatic pressure (SWE) during
the night (p < 0.05), but comparable SWE elevation to PSD. Relative
to T allele carriers, C/C subjects also had more stage 2 sleep and less
SWS during baseline (p’s < 0.05) and during PSD (p’s < 0.05) andgreater REM latency reductions (p < 0.05) during PSD. C/C subjects
showed longer MWT latencies during PSD (p < 0.05) but not at baseline. No differences were found for circadian phase typology, habitual
sleep, demographics, subjective sleepiness, or cognitive performance.
All genotypes demonstrated similar cognitive performance (PVT, Digit
Span) decreases, and increases in subjective sleepiness (KSS) in response
to PSD. The HCRT −909 C/T polymorphism is associated with differences in sleep homeostasis during fully-rested conditions, as well as inphysiological sleepiness and sleep structure during PSD. The C/C genotype appears particularly buffered from the physiological, but not thecognitive performance effects of sleep restriction.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-213 / AS-14 Presenter
SLEEP DEPRIVATION INCREASES SEROTONIN
2A RECEPTOR DENSITY IN THE HUMAN BRAIN:
A [18F]ALTANSERIN PET STUDY

D ELMENHORST1, T KROLL1, A MATUSCH1, A BAUER1,2
1
Institute for Neuroscience and Medicine, Forschungszentrum JuelichGmbH, Juelich, Germany, 2Department of Neurology, Heinrich-HeineUniversity Duesseldorf, Germany

When wakefulness is extended beyond the usual in animal models, anelevation of the serotonin level is observed. It is an open question
whether this difference in neurotransmitter release is accompanied bychanges in the respective serotonin receptor (5-HT2AR) densities. The
aim of the present study was to investigate the effect of prolonged
wakefulness on 5-HT2AR availability in the human brain and its linkage
to EEG measures of sleep deprivation (SD) and substrates of cognitive
performance impairment. 18 healthy subjects (39–58 years) without
sleep disorders participated in two subsequent dynamic [18 F]altanserin bolus/infusions positron emission tomography (PET) scans before
and after 24 hours of SD. The binding potential relative to the plasma
concentration corrected for metabolism (BPP), proportional to the
5-HT2AR density, was chosen as outcome parameter. Subjects performance was screened with the psychomotor vigilance task (PVT). Wake
EEG was recorded. SD significantly increased the specific binding of[18 F]altanserin in the following ROIs (ranging from 8 to 11%, p <0.05): anterior and posterior cingulate cortex, insula, parietal cortex,
medial inferior temporal gyrus, sensomotoric cortex, and ventrolateralprefrontal cortex. Correlation of the relative change of PVT performanceand BPP showed a significant linear relation for several cortical regions(e.g. insula: r = 0.59, p = 0.01). We found no correlation of wake EEG
power and receptor binding changes. The findings point to an upregulation of 5-HT2AR density caused by a single night of prolonged wakefulness. Furthermore 5-HT2AR density and psychomotor performancecorrelate. These results suggest that SD may trigger plastic changes incortical 5-HT2AR density. These and our previous findings of increased
A1-adenosine receptor density after SD in humans and rodents support
the general hypothesis of an increase in synaptic strength during wakefulness and downscaling during normal sleep as a maintenance mechanism of synaptic functionality.

PO-2-214SLEEP DEPRIVATION ALTERS VALUATION
SIGNALS IN THE VENTROMEDIAL PREFRONTALCORTEXCD LIBEDINSKY1, DV SMITH2, CS TENG1, P NAMBURI1,
VW CHEN1, SA HUETTEL2, MWL CHEE1
1
Neurobehavioral disorders, Duke-NUS Graduate Medical School,
Singapore, Singapore, 2Center for Cognitive Neuroscience, Duke University,
United States of America
Sleep-deprivation (SD) has long been known to impair vigilance andattention, factors that can contribute to poor decision making. Yet themost insidious effects of SD might be on preferences themselves, suchthat deprivation changes the very values that underlie our decisions.
Here we employed functional magnetic resonance imaging (fMRI) in
human participants to examine how SD affects the neural mechanisms
underlying economic decision making. We identified decision value(DV) signals predictive of each participant’s willingness to exchangemoney for brief views of attractive faces in a separate task. SD alteredthese DV signals in VMPFC in proportion to the corresponding change

in economic preference. To explore the neural mechanisms underlying
this SD-related change in DV we analyzed value signals related to monetary and social rewards independently, which presumably correspondto a stage prior to integration in VMPFC. We observed changes in
response to social rewards in the amygdala, frontal pole, striatum andinsula that correlated with changes in DV signals in VMPFC. No suchchanges were observed in response to monetary rewards. These results
provide evidence that SD can have selective effects on valuation of
specific reward types, which may in turn alter economic decision
making. In addition, these changes in preference were uncorrelatedwith altered vigilance after a night of SD, which warns us that attempts
to ameliorate the cognitive effects of SD may leave unaffected importantchanges in neural signals for value.

PO-2-215 / AS-14 Presenter
CEREBRAL BLOOD FLOW FOLLOWING ACUTESLEEP RESTRICTION MEASURED USING
ARTERIAL SPIN LABELINGG POUDEL1, C INNES1,2, R JONES1,2,3,4,5
Medical Physics and Bioengineering, Van der Veer Institute for Parkinson’sand Brain Research, Christchurch, New Zealand, 2Medical Physics andBioengineering, Canterbury District Health Board, New Zealand,
3
Medicine, University of Otago, Christchurch, New Zealand, 4Electrical andComputer Engineering, University of Canterbury, Christchurch, New
Zealand, 5Psychology, University of Canterbury, Christchurch, New
Zealand1

Sleep restriction is common due to shift work and extended work
hours. Sleep restriction can substantially increase sleepiness during
monotonous situations. In this study, we investigated changes in cerebral blood flow (CBF) after a night restricted to 4 hours time-in-bed(actual sleep 3.6 ± 0.26 h (mean±SD)) compared to after a normallyrested night (actual sleep 7.9 ± 0.94 h) using a relatively new perfusion
measurement technique called arterial spin labeling (ASL).CBF was
measured in 18 individuals after both rested and sleep-restricted nights
using ASL in a GE 3 T MRI scanner. Individuals were asked to keep
their eyes open during the 5-min ASL scans. The CBF images wereco-registered with anatomical scans, normalized to a standard MNI
template, and smoothed using a 10-mm FWHM Gaussian window. CBF
following sleep restriction was compared with rested CBF using a voxelwise paired t-test. There was no difference in global CBF values between
rested (43.1 ± 7.2 mL/100 g/min) and sleep-restricted (43.0 ±6.7 mL/100 g/min) sessions. Regional CBF decreased (p < 0.05, Z ×
2.3, Cluster-based correction) in the right inferior/middle gyri andintra-parietal sulcus, and bilaterally in the superior frontal, precentral,paracentral, and superior parietal lobules. Increased CBF (p < 0.01,
uncorrected, extent threshold of 100 voxels) after sleep restriction wasobserved in the right occipital gyrus, left inferior lateral occipital gyrus,
left middle temporal gyrus, and bilateral frontal pole.We have shownthat the ASL-based perfusion imaging can be used to detect changes in
CBF following acute sleep restriction. We observed decreased CBF in
the right parietal and frontal areas important for alertness and attention.
The decreased CBF in these areas reflects the reduced alertness andcognitive deficits observed after sleep loss.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research411

Sleep, Science and Research

PO-2-216 / AS-4 Presenter
PREDICTORS OF SLEEPING DIFFICULTIES IN
YOUNG WOMEND BRUCK, J ASTBURY
Social Sciences and Psychology, Victoria University, Yarraville, Australia
Some studies have concluded that the gender disparity in sleep difficulties in young adults may be driven by higher rates of affective disorders
in women. Other have argued that sleep related gender disparities arelargely due to socio economic inequalities. This paper investigated arange of factors as potential predictors of “difficulty sleeping” in 9061
Australian women aged from 24 to 30 years, using survey data. Variables that covered socio-economic status (SES); lifestyle; abuse history
and affective issues (depression and anxiety) were investigated. Odds
ratio (OR) analyses showed that symptoms of depression and intenseanxiety were more significant predictors of difficulty sleeping than SES
variables, with ORs at least 5 times larger. Regression analyses wereconsistent with this, with depression and anxiety symptoms being
strong predictors of difficulty sleeping. However, four other variables(binge drinking, lower qualifications, dissatisfaction with excessive
weight and a history of abuse) also made significant contributions tosleep difficulty in this sample, even when depression and anxiety
symptoms were statistically controlled. On the other hand, analyses
suggested that having a lower household income, a recent major illness,and ever having combined alcohol and drugs only predict sleeping
difficulty in this sample via a co-existing relationship with depression
and anxiety. The current findings argue for the primacy of affective
problems in predicting sleep disruption in young women, althoughseveral other predictors are also independently important.

PO-2-217 / AS-12 Presenter
CELLULAR EFFECTS OF SLEEP RESTRICTION IN
HEALTHY YOUNG MEN

HM OLLILA1, V AHO2, V RANTANEN3, W VAN LEEUWEN2,4,
M LEHTO5, S MATIKAINEN5, I SURAKKA1, S RIPATTI1, M HRM4,M SALLINEN4, M JAUHIAINEN1, H ALENIUS5, T PAUNIO1,6,
T PORKKA-HEISKANEN1
1
Medical genetics, National Insitute for Health and Welfare, University of
Helsinki, Helsinki, Finland, 2Department of Physiology, University of
Helsinki, Finland, 3Computational Systems Biology Laboratory, University
of Helsinki, Finland, 4Brain and Work Research Centre, Finnish Institute ofOccupational Health, Finland, 5Unit of Excellence for Immunotoxicology,
Finnish Institute of Occupational Health, Finland, 6Department of
Psychiatry, Helsinki University Central Hospital, Finland

To elucidate the detriments of cumulative sleep restriction at cellularlevel. Find pathways and single genes that react to sleep restriction incontrolled environment.
Study participants (N = 13) spent one week in laboratory conditions.
The experiment consisted of two nights of baseline sleep (8 h/night),
sleep restriction for five nights (4 h/night) and two nights of recovery(8 h/night). The control subjects (N = 6) spent the time in laboratory
sleeping normally (8 h/night). Blood samples were collected and totalcholesterol was measured after baseline, sleep restriction and recovery
phases. Total RNA was extracted from blood mononuclear leukocytes.
RNA expression was analyzed using Affymetrix whole genome microarrays complemented with pathway and transcription factor analysis ofdifferentially expressed genes.
We saw significant increase of immune response pathways after sleep
restriction. The significant up-regulated pathways included T-cell acti-

412

vation, NF-kappaB signaling and IL-8 production pathways (P < 0.001).
Known immunological transcription factor binding site was enrichedin up-regulated transcripts and its transcription was shown to increasein sleep restriction (P < 0.05). Circadian rhythm and lipid transportand synthesis pathways were down-regulated. Several expression
changes did not return back to baseline after recovery phase.
Our data suggest that sleep restriction has a strong pathophysiologicaleffect on signaling pathways related to the immune system and energy
metabolism. Sleep restriction disrupted the function of molecular clock,and recovery from sleep deprivation was a long-term process also at
cellular level. The findings may explain why prolonged sleep deprivation may predispose to cardiovascular diseases and obesity.

PO-2-218 / AS-21 Presenter
THE EFFECTS OF SLEEP DEPRIVATION ON
SYMPATHOADRENAL SYSTEM AND
HYPOTHALAMIC-PITUITARY-ADRENOCORTICAL
AXIS USING SALIVARY STRESS MARKERS

M KONISHI1, M TAKAHASHI1, HK KIM1, H TABATA1, N ENDO1,S NUMAO2, S TAKAGI3, Y YAMADA4, M MIYASHITA2,
T MIDORIKAWA5, K SUZUKI2, S SAKAMOTO2
1
Graduate School of Sport Sciences, Waseda University, Tokorozawa-city,
Saitama, Japan, 2Faculty of Sport Sciences, Waseda University, Japan,
3
Department of Sports Medicine for Health Promotion, Tokyo Medical
University, Japan, 4Sport Science Research Center, Waseda University,
Japan, 5College of Health and Welfare, J.F. Oberlin University, Japan

Introduction: People often experience sleep deprivation due to ourmodern around-the-clock lifestyle, increased work load and various
other challenges. It is reported that sleep deprivation-induced stress cannegatively influence on human health. However, it is unknown potential mechanisms underlying the impact of sleep deprivation on stresssystem. The saliva sample testing can evaluate stress responses accurately with a non-invasive sampling method. The purpose of this study
was to investigate the effects of sleep deprivation on sympathoadrenal
system (SAS) and hypothalamic-pituitary-adrenocortical axis using salivary stress markers.
Methods: Ten healthy young males completed two, 2-day trials (i.e.
control and sleep deprivation trials) separated by more than five days
each. For the control trial, participants were allowed normal sleep from23:00 to 7:00; for the sleep deprivation trial, they did not sleep for
34 hours. These experimental trials were performed under supervisionby the investigators. On both trials, saliva samples were collected at
9:00, 13:00 and 16:00 before each meal on both days. Salivary samples
were analysed for f¿-amylase, secretory immunoglobulin A (sIgA), chromogranin A (CgA) and cortisol concentrations.
Results: Changes in salivary f¿-amylase, sIgA and cortisol concentrations were not significantly different between trials on both days.
Changes in salivary CgA concentrations on the first-day were not significantly different between trials, but changes in CgA concentrations
on the second-day were significantly higher in the sleep deprivation
trial than the sleep trial (P < 0.05).
Discussion: CgA co-released with catecholamines from the adrenal
medulla and sympathetic nerve endings seem to be a better index of
sympathetic activity. Increased salivary CgA concentrations in the sleep
deprivation trial suggest the activation of SAS. Sleep deprivation may
represent as an index of psychosomatic stress response and mediate thestress system.

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

PO-2-219 / AS-21 Presenter
ENDOTHELIAL FUNCTION IN HEALTHY ADULTS
WITH INSUFFICIENT SLEEPA NODA1, S MIYATA1, M KATO1, K IWAMOTO2, N OZAKI2
1
Department of Biomedical Sciences, Chubu University, Kasugai, Aichi,
Japan, 2Department of Psychiatry, Nagoya University Graduate School of
Medicine, Japan

Background: Many community-based studies have shown that shortsleep duration is linked to an increased risk of hypertension and allcause mortality, but its effects on atherosclerosis are not well characterized. Endothelial dysfunction may contribute to the progression andcomplication of atherosclerosis. Flow-mediated dilation (FMD) has
been used as a noninvasive tool to evaluate endothelial function. We
assessed endothelial function in healthy adults with insufficient sleepby FMD.
Methods: Seven healthy subjects (26.2 ± 4.2 years) were studied. Brachial-ankle pulsed wave velocity (baPWV), systolic blood pressure(SBP), and diastolic blood pressure (DBP) were measured using a plethysmography (form PWV/ABI; OMRON COLIN Co., Ltd., Japan). Highresolution ultrasound (Prosound α10; ALOKA, Co., Ltd., Japan) witha 7.5 MHz linear array transducer was used to measure the diameter ofthe right brachial artery after the subject had rested for at least 10 min
in the supine position. We evaluated the maximum intima-media thickness (maxIMT). Heart rate variability (HRV) is used as an index toevaluate the autonomic activity. The power spectra were quantified at
0.04∼0.15 Hz (low frequency power; LF) and 0.15∼0.40 Hz (high frequency power; HF). On natural sleep nights, the subjects were in bed
for 8 hours (sufficient sleep), while on the controlled sleep nights, thesubjects were allowed to be in bed between 3 am and 7 am, and their
total sleep time was limited to <4 h (insufficient sleep).
Results: FMD was found to be significantly lower after insufficient sleep
than after sufficient sleep. No significant differences were observed in
baPWV, SBP, DBP and maxIMT between insufficient sleep and sufficient
sleep. HF was significantly lower, while LF/HF was significantly greater
after insufficient sleep than after sufficient sleep.
Conclusion: Insufficient sleep is considered to negatively affect theendothelial function as a consequence of an elevated sympathetic
activity.

PO-2-220 / AS-18 Presenter
MELATONIN CHANGES IN THE PINEAL GLAND
OF SLEEP DEPRIVED RATS FOLLOWINGHABENULAR NUCLEUS LESIONH ZHAO
Department of Physiology, Norman Bethune College of Medicine, Ji Lin
University, Changchun, China
Melatonin changes in the pineal gland of sleep deprived rats following
habenular nucleus lesion Huijuan Jin, Meiying Song, Min Huang, ManliWang, Hua Zhao*Department of Physiology, Norman Bethune Collegeof Medicine, Jilin University, Changchun 130021, ChinaSleep deprivation (SD) is considered a risk factor for various disorders involving
behavior, emotion, attention, learning ability, and immunological functions. It has been reported that SD-induced physiological functional
disturbances are associated with reduction of melatonin. Animal experiments unequivocally show that SD can lead to melatonin reduction in
the pineal gland of rats. However, the underlying mechanism remains
unknown. The habenular nucleus (Hb) is an important structure that
regulates the function of the pineal gland, which may affect melatonin

content in the pineal gland after SD. The experiment aim is to investigate that the reduction of melatonin in pineal gland after SD is related
to the changed activity of the Hb, revealing a central mechanism of
sleeping regulation. In the present study, high performance liquid chromatography showed that the melatonin content in the pineal gland wassignificantly reduced, and fÁ-aminobutyric acid content in the Hb wassignificantly increased after SD. Furthermore, the melatonin content in
the pineal gland was markedly reduced after Hb lesion under normal
sleep and SD conditions. Immunohistochemistry showed that the
number of Fos-positive neurons was significantly decreased in thelateral and medial Hb after SD. The results demonstrate that the reduction of melatonin in the pineal gland after SD is related to decreased
activity of Hb neurons, and that the Hb can regulate sleep-wake rhythm
by influencing melatonin secretion in the pineal gland.
Key Words: Habenular nucleus; melatonin; pineal gland; sleep deprivation; rat*Email to zhua@jlu.edu.cn

PO-2-221
ACUTE SLEEP DEPRIVATION AFFECTS DIURNAL
RHYTHMICITY IN GRANULOCYTESDJ SKENE1, K ACKERMANN2, VL REVELL3, OL LAO2,EJ ROMBOUTS4, M KAYSER2
1
Centre for Chronobiology, University of Surrey, Guildford, United Kingdomof Great Britain and Northern Ireland, 2Department of Forensic Molecular
Biology, Erasmus MC University Medical Centre, Rotterdam, Netherlands,
3
Centre for Chronobiology, Faculty of Health and Medical Sciences,
University of Surrey, Guildford, GU2 7XH, United Kingdom, 4Departmentof Haematology, Erasmus MC University Medical Centre, Rotterdam,
Netherlands
The sleep/wake cycle and circadian timing system affect circulating
numbers of immune cells, with highest lymphocyte levels being
observed at night. The aim of this study was to provide an in-depthcharacterisation of diurnal rhythms in the levels of different humanblood cell populations obtained under strictly controlled laboratory
conditions and to investigate the impact of acute total sleep deprivation
on any observed rhythmicity.
Eleven healthy male subjects (25.0 ± 5.8 (SD) years) participated in a
72 h laboratory session which included an 8 h sleep episode followed
by 29 h of continuous wakefulness. Blood samples (every 3 h over a
48 h period) were taken for flow cytometry to determine circulating
numbers of different blood cell subsets. The impact of condition (sleep
versus sleep deprivation) on peak time and amplitude of the blood cellrhythms was investigated. Inter-individual variation of, and correlation
between, the different cell populations was also assessed.
Cosinor analysis revealed significant diurnal rhythmicity for 3–9 (outof 11) subjects per cell population (B cells, T cells (and subsets), granulocytes, monocytes). Non-linear curve fitting of normalised data fromall individuals showed significant diurnal rhythmicity in circulatinglevels of all the blood cell types investigated. Both methods found thatnaive-CD4 cells exhibited the most robust rhythms independent of
sleep condition (sleep versus sleep deprivation). Furthermore, granulocytes showed the lowest correlations with any other cell type while
exhibiting the largest inter-individual variation in abundance. Granulocyte levels and their diurnal rhythmicity were severely affected by acutesleep deprivation and likely reflect the body’s immediate immune
response to the stress of sleep loss.
Support: Netherlands Forensic Institute (NFI), and the Netherlands
Genomics Initiative (NGI) / Netherlands Organization for Scientific
Research (NWO) within the framework of the Forensic Genomics Consortium Netherlands (FGCN).

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research413

Sleep, Science and Research

PO-2-222
PER3 AND ADORA2A POLYMORPHISMS IMPACT
NEUROBEHAVIORAL PERFORMANCE DURINGCHRONIC SLEEP RESTRICTION
TL RUPP, NJ WESENSTEN, TJ BALKIN
Behavioral Biology, Walter Reed Army Institute of Research, Silver Spring,
MD, United States of America
We examined the contribution of PER3 and ADORA2A polymorphisms
to individual vulnerability to chronic sleep restriction. Nineteen healthy
adults (ages 18–39, 11 men, 7 women) underwent 7 nights of sleep
restricted to 3 hours nightly time in bed (TIB), preceded by 7 in-laboratory nights of 10 hours nightly TIB and followed by 3 nights of
8 hours nightly TIB. Volunteers performed the psychomotor vigilance
test (PVT) throughout and were genotyped for PER3 VNTR and
ADORA2A polymorphisms (PER34/4 n = 7; PER34/5 n = 10 [PER35/5
n = 2, not included in the analyses]; ADORA2AC/T n = 9; ADORA2AT/T
n = 9 [ADORA2AC/C n = 1, not included in analyses]). Mixed-model
ANOVAs with repeated factors day and time of day and between-subjects factor PER3 or ADORA2A genotype were performed for PVT lapses(reaction time [RT] 500 msecs) and reciprocal RT (1/RT *1000). PER34/4
individuals presented with significantly fewer lapses on SR4 – SR7 (DAYX PER3, p < 0.05). During recovery (R), PER34/4 individuals presented
with significantly fewer lapses on R1 and R2 (DAY X PER3, p < 0.05)
compared to PER34/5 individuals. For reciprocal RT, PER34/4 individuals
displayed significantly faster RTs compared to PER34/5 individuals
overall. Compared to ADORA2AC/T individuals, ADORA2AT/T individuals displayed faster RTs on SR6 (Day X ADORA2A interaction, p < 0.05).
Our results indicate that individuals expressing PER34/4 and ADORA2AC/T
polymorphisms are less vulnerable to chronic sleep restriction than are
individuals expressing PER4/5 and ADORA2AT/T polymorphisms. In lightof previous failure to show that these polymorphisms impact performance during chronic sleep loss, we suggest that PER3 and ADORA2A
polymorphism only become behaviorally relevant only under conditions of more persistent sleep restriction.

PO-2-223
HEART RATE VARIABILITY AND ENDOTHELIALFUNCTION AFTER SLEEP DEPRIVATION ANDRECOVERY SLEEP IN SHIFT WORKERS AND
NON-SHIFT WORKERSDJ SKENE1, SMT WEHRENS2, SM HAMPTON2
1
Centre for Chronobiology, University of Surrey, Guildford, United Kingdomof Great Britain and Northern Ireland, 2Centre for Chronobiology, Facultyof Health and Medical Sciences, University of Surrey, Guildford, GU2
7XH, United Kingdom
Sleep deprivation, shift work, endothelial dysfunction and changes inheart rate variability (HRV) have all been associated with cardiovasculardisease. The aim of this study was to compare the effect of total sleep
deprivation (TSD) and recovery sleep on HRV and endothelial function
in experienced shift workers and matched non-shift workers underidentical laboratory settings.
Eleven male shift workers (shift work > 5 years) and 14 non-shift
workers were matched for age, BMI and cholesterol. Endothelial function was assessed by flow-mediated dilatation (FMD) using ultrasoundat 0.75 and 10.75 h after habitual wake up time, following baseline
sleep, TSD and recovery sleep (controlled posture, lighting and foodintake). HRV parameters (e.g. HR variance and low frequency/high414

frequency (LF/HF) ratio) were derived from 5-min electrocardiogram
bins at 0.25, 4.25, 11.5, 12.5 and 13.5 h after habitual wake up time.
Circadian phase was assessed before baseline sleep by salivary dim lightmelatonin onset (DLMO).
There was no difference in circadian phase between both groups. HR
variance was greatest at 0.25 h following TSD and lowest after recovery
sleep. A significantly higher LF/HF ratio, significantly lower HR variance and a trend for a lower%FMD (P = 0.08) were observed in theshift workers compared to the non-shift workers.
These differences in endothelial function and HRV observed in the shift
workers may reflect higher sympathetic and/or lower parasympathetic
activity, and may explain the increased cardiovascular risk reported in
the shift workers.

PO-2-224
THE EFFECT OF A SLEEP RESTRICTION ON THE
PUPILLARY LIGHT REFLEXK YAMAMOTO, R HORI, F KOBAYASHI
Department of Health and Psychosocial medicine, Aichi medical university,
Nagoya-city, Aichi, Japan
Purpose: We indicated the effects of the mild sleep restriction for aweek on the amplitude of the central neural system by the light reflex.
The amplitude on the pupillary light reflex was seem to relate to theserotonin neuron (Koudas, 2009). However, it’s not detected the relation between the subjective sleepiness of the people with sleep loss andthe pupillary reflex.
Methods: The subjects were 7 healthy males (age 21 ± 1.0, range
20–23), who have no medical histories. All the subjects were nonsmokers. They had two sleep schedules, 8 h and 5 h, for each 7 days.
They were assigned the schedules randomly. The sleep durations wereidentified by the sleep diary and the actigraph using the wrist-watch
type action monitor (AMI, Micro Mini Actigraph). They wrote the valuesof the sleepiness by the visual analogue scales each 3 h for 14 days,
9:00, 12:00, 15:00, 18:00, 21:00. We measured their pupils on the lastday each the schedules by the machine with the CCD camera using theinfra-red radiation (Hamamatsu, C7364). According to the ShapiroWilks test, we used the non-parametric statistical test.
Results: The average of the VAS scores of the sleepiness on 8 h was
134.6 ± 36.3, the average of 5 h was 215.3 ± 38.3. The VAS scores of
the 5 h sleep restriction was significantly higher (p < 0.04, Wilcoxon
signed rank test). The average of the amplitudes on 8 h was 3.3 ±0.3 mm, the average of 5 h was 2.9 ± 0.7 mm. The difference of theamplitudes between the sleep schedules was not significant (p > 0.1,
Wilcoxon signed rank test). The correlation between the amplitudes
and the VAS scores was not reached the level of significance in statistics(r = −0.71, p > 0.07, spearman rank correlation).

PO-2-225 / AS-8 Presenter
TIRED AND INSIGNIFICANT

T SUNDELIN1, A OLSSON2, M LEKANDER2,3, J AXELSSON2
Department of Psychology, Stockholm University, Stockholm, Sweden,
2
Department of Clinical Neuroscience, Karolinska Institutet, Sweden,
3
Stress Research Institute, Stockholm University, Sweden

1

Introduction: Sleep affects a variety of subjective measures of moodand affect, such as sociability, optimism, irritability, and general mood.
fMRI-data suggests a neural foundation for less rational social judgements in sleep-deprived individuals, with an amplified amygdala© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchPoster Presentations

response to negative emotional stimuli as well as a loss of functional
connectivity with the medial prefrontal cortex. But what happens when
the negative emotional stimuli is of a social nature? Social exclusion is
known to have a powerful negative effect on people, and based on therelationship between sleep deprivation and emotional reactivity wehypothesized that being excluded affects a sleep-deprived person evenmore negatively than someone who has had a good night’s sleep.
Method: 24 healthy individuals (11 males) with a habitual sleep needbetween 7 and 8.5 h/night were randomly divided into a sleep restriction group (4 h/night for 2 nights) or a control group. After the secondnight they played a computerized ball tossing game, ostensibly with
two other people over a network, but the participant was, in reality, theonly player. The game consisted of two sessions, one where the participant was included and one where the other two “players” excluded theparticipant by not tossing them the ball. A questionnaire was completed
after both sessions assessing participants’ feelings of belongingness,meaningfulness, control, and self esteem.
Results: Compared to the control group, the sleep-restricted group was
more negatively affected by exclusion in terms of meaningfulness (p =0.001). The sleep-restricted and the control group did not differ significantly in belongingness, control, or self-esteem.
Conclusion: When sleep restricted, people are more sensitive to social
exclusion, at least in terms of feeling more meaningless. These findings
suggest that sleep restriction may have an important impact on how weinteract with other people. The relation between suboptimal sleep andfeelings of meaninglessness may be of relevance to understand the link
between disturbed sleep and depression.

PO-2-226 / AS-21 Presenter
CONSISTENT INCREASES OF DELTA SLEEP IN
INDIVIDUALS EXPOSED TO CHRONIC SLEEPRESTRICTIONJ AXELSSON1, G KECKLUND2, T KERSTEDT2, M INGRE2
1
Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden, 2Stressresearch institute, Stockholm University, Sweden
There is still a debate whether chronic sleep restriction results in anallostatic or homeostatic responses of deep sleep. An animal study
showed a striking allostatic response among rodents exposed to chronic
sleep restriction (1), although we could later confirm that humans
increase their deep sleep in a homeostatic manner (2). A possible
explanation for the different findings could be large individual differences in the response to restricted sleep. Thus, we investigated whether
the increase of delta sleep (in response to repeated sleep restriction) is
consistent across individuals or whether some individuals fail to
respond with an increase of delta power.
Nine healthy males (age range 23–28 yrs) went though a laboratory
protocol including 2 baseline days (sleep 23–07 h) and 5 days withsleep restriction (03–07 h). The first 3.8 h hours of NREM-sleep EEG
was analysed with respect to spectral analysis. The first step included
observation of raw data. However, since raw data are contaminated bymeasurement errors a model based approach was also used to produce
empirical Bayes estimates of individual response patterns (in the
0.75–32 Hz band) to restricted sleep across five days with restricted
sleep. A linear mixed effect model was used with (polynomial) fixed
effects for days of sleep deprivation and frequency response profiles.
The final model included 8 fixed and 8 random effects, the latteraccounting for individual differences.
Results: The raw data indicate that sleep restriction resulted in increased
delta sleep in 52 out of 54 sleep episodes occurring after restricted sleep.
The empirical Bayes estimates suggested that all participants reactedwith an increase of the delta band after 2 days of restricted sleep with
continued increased delta sleep power until recovery (p’s < .01 for all
fixed effects).
To conclude, the uniform increase of delta sleep amongst individuals
supports the notion of a very robust and stable homeostatic responseto restricted sleep.
1) Kim et al., (2007) PNAS 104:10697–702
2) Akerstedt et al., (2009) Sleep Feb 1;32(2):217–22

PO-2-227
FEATURES OF TIREDNESSJ AXELSSON1, T SUNDELIN1,2, M LEKANDER1,3
1
Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden, 2Dept of
Psychology, Stockholm University, Sweden, 3Stress reseasrch institute,
Stockholm University, Sweden
Objectives: It is generally believed that looking tired entails a numberof characteristics such as dark circles under the eyes, pale skin anddroopy eyelids. Since this has never been scientifically studied, we set
out to investigate how sleep affects facial traits and what it is about aface that makes it look tired.
Methods: The faces of 10 participants (5 women), mean age of 23 yr,
were photographed between 14.00–15.00 h during two conditions ina balanced design: after normal sleep (23.00–07.00 h and 7 hours of
wakefulness) and following sleep deprivation (sleep 02.00–07.00 h and
31 hours of wakefulness). These photographs were then presented in arandomised order to 40 naive observers (20 women, mean age 25 yr)
who rated the faces (on VAS scales) with respect to dark circles underthe eyes, red eyes, glazed eyes, hanging eyelids, swollen eyes, pale skin,wrinkles/fine lines, rash/eczema, corners of the mouth pointing down,tense lips, inclination of the head, and tiredness.
Results: During sleep deprivation the participants were judged to havemore dark circles under the eyes, redder eyes, more hanging eyelids,
more swollen eyes, paler skin, more wrinkles/fine lines, and corners ofthe mouth pointing more downwards (p’s < 0.01), compared to after anight of good sleep. Sleep deprivation did not affect glazed eyes, rash/eczema, tense lips or inclination of the head significantly (p’s > .05).
Looking tired was positively correlated with the factors affected by sleep
deprivation, but also with glazed eyes (p’s < 0.01).
Conclusions: Our findings show that there are facial features reliably
correlated with sleep deprivation and looking tired, hence adding torecent findings on sleep and judged appearance (1). Further studies are
warranted to understand if these factors affect situations such as matechoice, clinical decision making, and other social interactions.
1) Axelsson et al. Beauty Sleep: Experimental study on the perceived
health and attractiveness of sleep deprived people BMJ 2010,
341:c6614

PO-2-228
SLEEP IN ANTARCTICA
M YOSHIDA
Representative Director, SleepWell co., ltd., Osaka-city, Osaka, Japan
Sleep in Antarctica Antarctic environment is characterized by extremely
low ambient temperature and seasonal variation in daylight time. In
addition to those natural characteristics, psychological factors related
to isolation with small number of members in the Antarctic base may
have some influences on physiological and psychological functions. As
previous studies have reported abnormalities in human circadianrhythms and deteriorated sleep in Antarctica, we evaluated sleep in the© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research415

Sleep, Science and Research

wintering members in Antarctica by using subjective and objective
measurements. The subjects were ten males and two females recruitedfrom the members of the 50th and 51st Japanese Antarctic Research
Expedition (age: 39.7 ± 10.0 years; BMI: 25.2 ± 3.3). During their 13
months sojourn in the Antarctic base, data collection was conducted
every 3 months (March, June, September, and December). The datacollection was consisted of sleep EEG by portable EEG device, fromobtained electroencephalographic data, we analyzed it and considered
all sleep variables. The sleep state was associated with environment
outside the seasonal daylight hours or temperature change, we formed
an initial hypothesis. The quality of the sleep was good quality in starting for March. However, the quality of the sleep worsened over time,
it became good quality in December. By the questionnaire survey, themotivation of the member gradually worsens after peaking in Marchand corrects it and increases just before return home again. This sleep
electroencephalogram analysis results were similar to the questionnaire
results, too. The stress that could not meet a family and had much work
may have an influence on the sleep from external environment.

Results: Of 366 randomized patients, 348 completed the protocol. The
impossible decision case was not observed with either polysomnography or home respiratory polygraphy. Therapeutic decisions using home
respiratory polygraphy had a sensitivity of 73%, a specificity of 77%,
and an agreement (sum of true positives and negatives) of 76%. Patientswith higher home respiratory polygraphy apnea and hypopnea index
scores (major or equal than 30)(40% of the total sample) had a sensitivity of 94%, a specificity of 44%, and agreement was 91%.
Conclusion: The home respiratory polygraphy-based therapeutic decision was adequate when apnea and hypopnea index was high, but
deficient in the large population of patients with mild to moderateapnea and hypopnea index. Therefore, both selecting patients with ahigh suspicion/severity of sleep apnea-hypopnea syndrome and future
prospective cost-effectiveness studies are necessary.

PO-2-229
THERAPEUTIC DECISION-MAKING FOR SLEEPAPNEA AND HYPOPNEA SYNDROME USINGHOME RESPIRATORY POLYGRAPHY

J-M PETIT1, X LIU2, C GIAUME3, PJ MAGISTRETTI1,2
NeuroEnergetic and Cellular Dynamic Laboratory, CHUV – EPFL,
Lausanne, Switzerland, 2Center for Psychiatric Neuroscience, Psychiatry
Dep., CHUV, Switzerland, 3CIRB, UMR CNRS 7241/ INSERM U1050,
Collge de France, France

Rationale: Home respiratory polygraphy is an alternative to polysomnography for sleep apnea-hypopnea syndrome diagnosis. However,therapeutic decision-making is a different process than diagnosis. This
study aimed to determine the efficacy of home respiratory polygraphy
compared to in-hospital polysomnography for therapeutic decisionmaking in a large sample.
Methods: Patients with an intermediate or high sleep apnea-hypopnea
syndrome suspicion were included in a multicenter study (eight sleep
centers) and assigned to home and hospital protocols in a random order.
Therapeutic decisions (continuos positive airway pressure, no continuos positive airway pressure or impossible decision) were made by aninvestigator in each center, based on using either home respiratory
polygraphy or polysomnography and a single set of auxiliary clinicalvariables. Patients and diagnostic methods (home respiratory polygraphy and polysomnography) were assessed in a random order using anelectronic database. After a month the same therapeutic decision-making procedure was repeated with the same method.

During sleep-wake cycle, cortical neuronal firing pattern changes
rapidly and considerably. This implies that adaptations in brain energy
metabolism are likely to occur throughout the sleep-wake cycle tomatch such variations. Astrocytes are ideally suited to play a key rolein neuro-metabolic coupling since they present two main metabolic
features: their ability to store glucose under the form of glycogen andthe possibility to produce lactate as an energy substrate to neurons
through the “Astrocyte-Neuron Lactate Shuttle”(ANLS). Moreover,astrocytes form connexin-mediated networks through gap junctions(GJs) and energy metabolites can diffuse across GJs thus contributing
to neuronal activity. Therefore, we tested the involvement of astrocytes
in the metabolic adaptation during sleep deprivation (SD) induced by
the “gentle-SD” method (GSD) and by administration of Modafinil(MOD), in mice. Moreover, functionality of GJs after MOD application
was studied using diffusion of gap-junction channel-permeable dyes inacute cortical slices. We also performed instrumental SD on transgenic
mice expressing GFP in astrocytes (Tg(GFAP-GFP)) to determine astroglial regulation of ANLS-related genes expression.
We founded that glycogen metabolism was directed towards a “synthesis mode” to maintain glycogen levels in spite of the wakefulness continuation. Moreover, increase in mRNA encoding specific astroglial
connexin, in SD mice and enhanced GJ-mediated intercellular communication in astrocytes treated with MOD, suggest a dynamic effectof wakefulness on astroglial networking. Finally, mRNA encoding proteins related to ANLS in cortical astrocytes from (Tg(GFAP-GFP)) displayed a significant induction after SD.
Altogether, these results indicate that metabolism and GJ-mediatednetworking in cortical astrocytes are dynamically regulated when wakefulness is prolonged.
Supported by FNRS grant 3100AO-108336/1 to PJM and ENP to XL.

JF MASA1, J CORRAL2, R PEREIRA3, J DURN-CANTOLLA4,
M CABELLO5, L HERNNDEZ-BLASCO6, C MONASTERIO7,
A ALONSO8, E CHINER9, J ZAMORANO10
1
Department of pulmonology, San Pedro de Alcntara Hospital, Cceres,
Extremadura, Spain, 2Department of pulmonology, San Pedro de Alcntara
Hospital, Spain, 3Department of pulmonology, San Pedro de Alcntara
Hospital, Spain, 4Department of pulmonology, Txagorritxu Hospital, Spain,
5
Department of pulmonology, Valdecillas Hospital, Spain, 6Department of
pulmonology, General Universitario Hospital Alicante, Spain, 7Departmentof pulmonology, Bellvitge Hospital, Spain, 8Department of pulmonology, Son
Dureta Hospital, Spain, 9Department of pulmonology, Txagorritxu
Hospital, Spain, 10Department of research, San Pedro de Alcntara Hospital,
Spain

416

PO-2-230
NEUROGLIAL METABOLIC COUPLING DURING
THE SLEEP-WAKE CYCLE

1© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep ResearchSleep and Biological Rhythms 2011; 9: 417–421

doi:10.1111/j.1479-8425.2011.00522.x

Author Index

Abe S PO-1-205 p322
Abe T PO-2-103 p375
Ahmed WA PO-1-079 p280
Akashi M AS-17-1 p241
Akerstedt TG IS-3-2 p227;
AS-33-1 p252
Akimitsu O PO-2-151 p390
Almeida FR AS-26-1 p248
Alves RS PS-2-3 p200
Ambrogetti KL PO-1-080
p280
Anafi RC ES-2-3 p220
Ancoli-Israel S PL-7-1 p196
Andersen ML AS-7-1 p235
Anderson C AS-11-1 p238;
PO-2-180 p400
Ando Y PO-1-199 p320
Aoki K PO-1-010 p257
Aoyagi T PO-2-003 / AS-31
Presenter p343
Archer SN AS-12-2 p239
Aritake K PO-1-260 p340
Armitage R PS-3-4 p201
Arnardottir ES ES-2-4 p220;
PO-1-034 / AS-9
Presenter p265
Arnulf I ES-5-3 p223
Asaoka S PO-2-176 p399
Atsumi T PO-2-109 p377
Axelsson J PO-2-226 /AS-21 Presenter p415;
PO-2-227 p415
Ayuse T IS-5-3 p229
Baker FC PS-3-3 p201
Bannai M PO-2-163 p395
Bartlett DJ PO-1-123 /AS-19 Presenter p295
Basheer R AS-23-2 p246
Bassetti CF PL-10-1 p197;
PS-9-1 p207
Baumann CR PO-1-167
p309; PO-1-169 p309;
PO-1-222 p328
Beaulieu-Bonneau S PO-1194 p318

Begum EA PO-2-019 p348
Bei B PO-2-191 p404
Beitinger PA PO-1-176
p312
Benedetti F PS-10-3 p209
Benediktsdottir B PO-1-042
p267; PO-1-219 p327
Bin YS PO-1-248 p336
Bin Z PO-1-250 p337;
PO-1-251 p337
Bjornsdottir E PO-1-087
p283; PO-1-129 p297
Boivin DB PS-12-5 p212
Bornemann MAC EL-5-1
p217; PO-1-257 p339
Bourgin P PO-2-060 /AS-22 Presenter p362
Boynton A PO-1-161 p307
Brazéte JR PO-1-209 p323
Britton EJ PO-1-234 p331
Brown SA PS-12-1 p211
Bruck D PO-1-173 p311;
PO-2-216 / AS-4
Presenter p412
Buettner(-Teleaga) A
AS-27-1 p248
Burdakov D PS-15-3 p216
Burkhalter H PO-1-195 /AS-5 Presenter p318
Buysse DJ PL-12-1 p198;
PS-1-2 p199
Cable N AS-8-2 p236
Cade BE PO-2-067 / AS-17
Presenter p364
Cajochen C IS-1-1 p224;
AS-17-2 p242
Calcagni SC PO-2-198
p406
Campbell AJ AS-19-1 p242
Carra MC AS-20-2 p243
Carskadon MA PL-5-1
p196; PO-2-053 / AS-12
Presenter p360
Chae JH PO-1-019 p260
Chae K-Y PO-1-158 p306

Chan AQ PO-1-113 p291;
PO-1-159 / AS-06
Presenter p306
Chan WYJ PO-2-121 p381
Chang F-C PO-2-064 /AS-7 Presenter p363
Chang YS PO-2-177 p399;
PO-2-178 p400
Chee MWL ES-4-2 p222
Chen CC PO-1-063 p275
Chen N-H PO-1-059 / AS-6
Presenter p273
Cheng S PO-1-048 / AS-10
Presenter p269
Chiba S PO-1-185 p315
Chihara Y PO-1-057 p272
Chikahisa S PO-1-204 p322
Chin K PS-4-4 p203
Cho JW PO-1-072 p278
Choi SJ PO-1-092 p285
Chrasse Y PO-2-062 /AS-22 Presenter p363
Christophe H PO-1-198
p319
Chua ECP PO-2-020 p349
Coeytaux AM PO-1-086
p282
Connor KM PO-1-236 p332
Cortes MDC PO-2-097
p373
Curzi ML PO-2-041 p356
Cussans EJ PO-1-225 p328
Czeisler CA EL-6-1 p217
Datta S AS-29-1 p249
Dauvilliers YA PS-9-3 p208;
IS-3-5 p227
De Bruin EJ PO-1-015 /AS-15 Presenter p259
De Souza AAL PO-1-110
p290
Deguchi A PO-2-072 p366
Denotti AL PO-2-028 p351
Deurveilher S AS-21-2 p244
Dewald JF AS-4-2 p234
Dijk D-J PS-12-3 p211

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

Dinges DF EL-1-1 p216;
IS-3-1 p226
Diniz Behn CG ES-3-3
p221
Donjacour CEHM PO-1163 p307
Dresler M PO-2-082 /AS-29 Presenter p369
Dugovic C PO-1-239 /AS-22 Presenter p333
Dumoulin MC PO-2-048
p358
Dupre D AS-16-1 p241
Ebihara S PS-8-4 p207
Echizenya M PS-10-1
p209
Eguibar JR PO-2-011
p346
Elmenhorst D PO-2-213 /AS-14 Presenter p411
Elmenhorst E-M PO-2-182 /AS-33 Presenter p401
Enomoto M AS-5-1 p234;
PO-1-246 p336
Eritaia JT PO-1-114 p292
Espie CA AS-15-2 p241;
PO-1-007 p256
Fang H AS-27-3 p249
Fedson A PO-1-028 / AS-12
Presenter p263; PO-1030 p263; PO-1-049
p270
Ferini-Strambi L IS-6-1
p230
Field CJ PO-1-117 p293
Fietze I PO-1-041 p267
Filtness AJ PO-1-045 p268;
PO-1-118 p293
Foster RG PS-8-1 p206
Franco P PS-2-4 p200
Franzen PL AS-14-3 p240
Fridel KW PO-1-266 p342
Frohnhofen H AS-16-2
p241

417

Author Index

Fronczek R PO-1-164 /AS-11 Presenter p308;
PO-1-223 p328
Fu Y-H EL-8-1 p218
Fujii H PO-2-149 p390
Fukuda K PO-2-133 p384
Fukuda S PO-2-165 p395
Fukuda Y PO-2-076 p367
Fukutome T PO-1-062
p274
Fuller PM AS-22-1 p244
Furihata R PO-2-185 p402
Furuhata M PO-1-146
p302
Furutani M PO-2-105 p376
Gainche LL PO-1-084 p282
Ganeko M PO-2-024 p350
Gao X-M PO-1-144 p301
Garcia CI PO-2-070 / AS-3
Presenter p365
Gatti DM PO-1-172 p310
Gauchat A PO-2-093 p372
Genzel L PO-2-079 / AS-29
Presenter p368
Girschik J PO-2-197 p406
Gislason T PO-1-058 /AS-20 Presenter p273
Glozier N AS-13-3 p239
Godbout R PO-1-002 /AS-15 Presenter p254;
PO-1-203 p321
Goel N AS-12-1 p239;
PO-2-058 p362; PO-2212 p410
Goh DYT PS-2-1 p199
Goldin JM PO-1-066 p276
Gong X PO-1-145 p302
Goodwin JL PO-1-033 p264
Gooley JJ AS-3-1 p233;
PO-2-206 / AS-11
Presenter p408
Goto M PO-2-147 / AS-3
Presenter p389
Gozu Y PO-2-211 p410
Gradisar M PO-1-196 p318;
PO-1-207 p323; PO-2137 / AS-13 Presenter
p386
Gronli J PO-2-042 p356
Grote L AS-10-1 p237
Grunstein RR Pr-1-1 p194;
PS-1-1 p198
Gulia KK AS-31-2 p251

418

Haaramo P PO-1-249 p336;
PO-2-195 p405
Han Y PO-1-109 p290
Hang L-W PO-1-029 p263
Hara H PO-1-093 p285
Harada T PO-2-131 p384
Hartescu I PO-2-194 /AS-32 Presenter p405
Hashizume Y PO-1-179
p313
Hatta K PO-2-030 p352
Hattar S PS-8-2 p207
Hayama M PO-2-145
p388
Hayashi M PO-2-107 p376
Heiss JE PO-2-008 / AS-24
Presenter p345
Hemmeter UM AS-18-2
p242
Hida A PS-12-4 p212
Hida Y PO-2-157 p392
Higuchi S AS-3-2 p233
Hill CM PO-1-232 p331;
PO-2-130 / AS-30
Presenter p383
Hirao T PO-2-006 / AS-32
Presenter p344
Hirata K IS-7-5 p231
Hitomi T PO-1-130 p297
Hogl B IS-7-1 p230
Honda K PO-2-095 p372
Honda M PS-9-5 p209;
ES-5-1 p223; PO-1-181
p313
Hong SB PL-1-1 p195
Hong SC PO-1-040 p267
Honma K PL-9-1 p197
Honma M PO-2-083 p369
Honma S PS-14-2 p214
Horne RSC AS-30-0 p250;
AS-30-2 p251; PO-1-156
p305; PO-2-188 p403
Hosokawa K PO-1-067
p276
Hoyos CM PO-1-119 / AS-9
Presenter p293
Hsiao Y-T PO-2-010 p345
Huang MF PO-1-107 p289
Huang Z-L ES-1-2 p219
Hurdiel R PO-2-112 p378;
PO-2-169 / AS-33
Presenter p396
Huynh N AS-20-1 p243
Hwa KS PO-1-165 p308

Hwa YS PO-1-217 p326
Hwang S PO-1-064 p275
Ihara T PO-2-148 p389
Iizuka H PO-2-209 p409
Ikeda H PO-2-210 p410
Ikemoto K PO-2-057 p361
Innes CRH AS-11-2 p238
Inocente CI PO-1-183 /AS-31 Presenter p314
Inoue T PO-2-113 p378
Inoue Y PS-9-4 p208;
IS-3-4 p227; IS-7-4 p231
Ip MSM PL-8-1 p197
Ishii H PO-1-026 p262
Iwasaki T PO-1-094 p285
Jakubcakova V PO-2-038
p355
Jennum PP PO-1-035 p265
Jeong JY PO-1-178 p312
Jones BE AS-25-1 p247
Jones RD ES-4-1 p222
Joong KS PO-2-186 p402
Joong YW PO-1-004 /AS-14 Presenter p255
Jordan AS PO-1-073 p278
Juliusson S PO-1-037 p266
Jung KH PO-1-065 p275
Kadono M PO-2-139 p387
Kadotani H PO-1-191 /AS-27 Presenter p317;
PO-2-138 p386
Kaida K PO-2-084 p369
Kalinchuk A PO-2-051
p359
Kallweit U PO-2-068 p365
Kambayashi Y PO-2-117
p380
Kameyama A PO-2-059 /AS-5 Presenter p362
Kanamaru M PO-1-050
p270
Kanbayashi T PO-1-262
p341
Kanemura T PO-1-090
p284
Karashima A AS-29-3 p250
Kario K IS-2-3 p226
Kashiwagi K PO-2-160
p393
Katayose Y PO-1-242 p334
Kato T AS-20-5 p243

Kaushik MK PO-2-045 /AS-7 Presenter p357
Kawamoto K PO-2-115
p379
Khoury S PO-1-226 p329
Kikuchi K PO-1-263 p341
Kilduff TS ES-2-2 p220;
AS-24-3 p246
Killick R PO-1-155 p305
Kim H PO-2-104 p375
Kim J PO-1-047 p269;
PO-2-002 / AS-28
Presenter p343
Kim JW PO-2-021 p349
Kim J-W PO-1-027 p262
Kim KK PO-1-071 p277
Kim MJ PO-1-061 p274
Kim MS PO-1-122 p295
Kim SH PO-1-133 p298
Kim T PO-2-001 / AS-28
Presenter p342
Kim TW PO-1-068 p276
Kim Y AS-21-1 p244
Kimura M AS-18-1 p242;
PO-2-040 p355
Kiriyama N PO-2-175 p399
Kishi A PO-2-066 p364
Kitabatake Y PO-1-025
p262
Kitajima T AS-5-2 p234
Kitamura S PO-2-128 /AS-13 Presenter p383
Kitamura T PO-1-111 p291
Kitano N PO-2-136 p385
Kizawa T PO-1-180 p313
Kobayashi T PO-2-074
p366
Kodama T PO-2-036 p354
Kogure T PO-1-095 p286
Kohama K PO-2-154 p391
Kohsaka M PO-1-166 p308
Kohyama J PO-2-189 p403
Komada I PO-1-137 p299
Komada Y PO-1-014 p258
Komatsu M PO-2-135 p385
Kondo H PO-1-020 p260
Konishi M PO-2-218 /AS-21 Presenter p412
Konno M PS-13-5 p213
Koyama E PO-2-166 p396
Koyama Y ES-3-1 p221
Krahn L PO-1-175 p311
Kubin L PS-11-2 p210;
IS-5-4 p229

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

Author Index

Kubo T AS-33-2 p253
Kubota C PO-2-204 p408
Kucharczyk E PO-2-159 /AS-16 Presenter p393
Kumar VM AS-31-3 p252
Kurihara T PO-2-161 p394
Kuroda A PO-1-201 p320
Kushida CA IS-6-2 p230
Kushikata T PO-1-255 p338
Labelle M-A PO-1-230
p330
Lai C-H PO-2-181 p401
Lai Y-Y PS-11-3 p210
Lallukka TM AS-8-3 p236
Lam J PO-1-036 p265;
PO-1-210 p324
Lau EMT PO-1-052 p271
Lazarus M AS-22-2 p245
Lecendreux ML PO-1-177
p312
Lee J-S PO-1-017 p259
Lee W-H PO-1-100 p287
Léger D PS-13-1 p212;
IS-2-1 p225
Levy P IS-4-4 p228; AS-9-1
p236
Li AM AS-2-2 p233
Li XS PO-1-003 / AS-27
Presenter p254
Libedinsky CD PO-2-214
p411
Lin C-F PO-1-228 p329
Lin C-T ES-4-3 p222
Lin Y PO-1-187 p316
Lindberg E PO-1-053 p271
Ling WH PO-1-077 p279
Liu J PO-2-056 p361
Liu X PS-13-3 p213
Lorenzi-Filho G PS-4-3
p203
Lowe AA AS-6-1 p235
Lu J PS-11-1 p210
Luppi P-H EL-3-1 p217
Lyytikinen P PO-1-001
p254
Maeda K PO-1-160 p306
Mallick BN AS-27-2 p248
Mallick HN AS-31-1 p251
Marshall NS PS-4-2 p202;
PO-1-120 / AS-19
Presenter p294; PO-1244 p335

Martikainen S PO-2-017
p348
Masa JF PO-2-229 p416
Matsumura M PO-1-151
p304
Matsuoka M PO-2-190
p404
Matsushita A PO-1-138
p300
Mayer G IS-1-4 p225
Mccarley RW AS-23-1 p245
Mcmahon DG PS-14-3
p214
Melehan KL PO-1-152
p304
Mena-Segovia J AS-32-1
p252
Mieda M PO-1-256 / AS-24
Presenter p339
Mindell JA PS-2-2 p200;
PS-6-3 p204
Mishra JPN PO-2-143 /AS-8 Presenter p388
Mitamura EK PO-2-043 /AS-23 Presenter p356
Mitsubayashi H PO-1-075
p279
Mitsuhashi M PO-2-196
p405
Miyamoto M PO-1-211
p324
Miyamoto T PS-7-2 p205
Miyata R PO-1-171 p310
Miyata S PO-1-085 p282
Mizuno K PO-2-170 p397;
PO-2-171 p397
Mokhlesi B AS-19-2 p243
Mong JA PS-3-1 p200
Montplaisir J IS-7-2 p230
Montserrat JM PO-1-131
p297; PO-1-132 p298
Morgan K AS-1-2 p232;
PO-1-011 p257
Morin CM PS-13-4 p213
Morita E PO-2-054 p360
Morita Y PO-2-085 p370
Moritsuchi Y PO-1-056
p272
Moriwaki H PO-1-105 p289
Motoi K PO-2-114 p379
Mrdalj J PO-2-013 / AS-18
Presenter p346
Mukherjee D PO-2-050
p359

Mullington JM ES-1-3 p219
Murakami J PO-1-153 p304
Nagashima S PO-2-183
p401
Nagata N PO-2-044 p357
Nakabayashi YF PO-2-101
p374
Nakai T PO-1-141 p300
Nakajima T PO-1-253
p338; PO-1-264 p341
Nakamura H PO-1-116
p292
Nakamura M PO-1-168
p309
Nakano H PO-1-082 p281
Nakao M ES-3-4 p222
Nakashima Y PO-2-031
p353
Nakayama M AS-2-1 p232
Nakazawa A PO-2-201
p407
Neylan T AS-14-1 p240
Nishida M PO-2-089 p371
Nishihara K PO-2-099 p374
Nishijima T PO-1-055
p272; PO-1-126 p296
Nishimura Y PO-1-162 /AS-2 Presenter p307
Nishino S PS-15-4 p216;
ES-5-2 p223
Nishitani N PO-1-021 p260
Noda A PO-2-219 / AS-21
Presenter p413
Nomura T PS-7-3 p206;
PO-1-213 p325
Oda S PO-2-156 p392
Oertel W IS-7-3 p231
Ogawa K PO-2-007 p344
Ogawa M PO-2-108 p377
Ohayon MM EL-4-1 p217
Oishi Y PO-2-034 / AS-23
Presenter p354
Oka Y PO-1-216 p326;
PO-2-127 p382
Okada-Aritake S PO-1-215
p325
Okajima I PO-1-008 / AS-1
Presenter p256
Okamoto-Mizuno K PO-2150 p390
Okano S PO-1-188 p316
Okawa M Pr-2-1 p194

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

Okayasu M PO-1-252 p337
Okura K PO-2-027 / AS-20
Presenter p351
Ollila HM PO-2-217 /AS-12 Presenter p412
Onizawa S PO-1-083 p281
Ooga K PO-1-206 p322
Ooka H PO-1-142 p301
Opp MR ES-1-4 p219;
PO-2-052 p359
Otake H PO-1-076 p279
Owens J PS-6-1 p204;
PS-6-2 p204
Ozaki A PO-1-174 p311
Ozone M PO-1-197 p319
Pack AI ES-2-1 p219
Paller KA PS-5-2 p204
Park H PO-2-155 p392
Parsley CL PO-1-060 p274
Partinen M IS-3-3 p227
Penzel T PO-1-031 p264
Pepin J-L AS-9-3 p237
Pesonen A-K PO-2-098
p373
Petit J-M PO-2-230 p416
Phillips CL PO-1-121 /AS-26 Presenter p294
Picchioni D PO-2-025 /AS-28 Presenter p350
Poe GR AS-29-2 p249
Polo OJ AS-10-2 p238
Polotsky VY IS-4-3 p228;
AS-9-2 p237
Porcheret K PO-2-207 /AS-15 Presenter p409
Postnova S PO-2-174 p398
Postuma RB PS-7-4 p206
Poudel G PO-2-215 / AS-14
Presenter p411
Punjabi NM PS-4-1 p202;
IS-4-1 p228
Qu W-M PO-1-254 p338
Raguparan A PO-1-096
p286
Rahkonen OJ PO-2-187
p403; PO-2-200 / AS-13
Presenter p406
Raseekul T PO-2-088 p370
Riemann D AS-14-6 p240
Rimpila VPO PO-1-074
p278

419

Author Index

Robinson PA ES-3-2 p221
Roenneberg T PL-11-1
p198
Rollings DT PO-2-022 p349
Romanowski CPN PO-2039 p355
Ruby P PO-2-090 p371
Rupp TL PO-2-222 p414
Saaresranta T PO-1-098
p287
Sadeghniiat-Haghighi K
PO-1-112 p291; PO-2009 p345
Sagara Y PO-1-259 p340
Sagawa Y PO-2-096 p373
Saito M PO-2-122 p381
Saito Y PO-2-033 / AS-31
Presenter p353
Sakai K AS-25-2 p247
Sakai N PO-2-173 p398
Sakurai T PS-15-1 p215
Salminen AV PO-1-221
p327
Saper CB PL-13-1 p198
Sara SJ AS-32-2 p252
Sasai T PO-1-212 p324
Sasaki Y PS-5-1 p203
Sasazawa Y PO-2-087 p370
Sato M PO-2-073 p366
Sato S PO-1-103 p288
Sato T PO-2-146 p389
Satoh M PO-1-154 / AS-26
Presenter p305
Scammell TE PS-15-2 p215
Scavone G PO-1-013 p258
Schenck CH PS-7-1 p205
Schoebel C PO-1-088 p283
Sei H PO-2-063 p363
Seibt J PO-2-047 / AS-29
Presenter p358
Seki Y PO-2-065 p364
Sekine M AS-8-1 p235;
PO-2-164 p395; PO-2202 p407; PO-2-203
p407
Semba K PS-3-2 p201
Seog SD PO-1-220 p327
Shibata S PS-12-2 p211
Shigeta M PO-2-123 p382
Shim YJ PO-1-202 p321
Shimizu N PO-1-189 p316
Shimizu T PL-6-1 p196
Shinno H PO-1-229 p330

420

Shinozaki H PS-1-3 p199
Shioda K PO-2-023 p350
Short MA AS-4-1 p233;
PO-2-100 p374
Siegel J PL-4-1 p196
Sik KJ PO-1-115 p292
Sim BLH PO-1-208 p323
Sivam S PO-1-136 p299
Skene DJ PO-2-134 / AS-16
Presenter p385; PO-2221 p413; PO-2-223
p414
Skre IB PO-2-168 p396
Song DX PO-1-081 p281
Soule J PO-2-046 p357
Spoormaker VI AS-28-1
p249
Steiger A PS-3-5 p202
Strecker RE PO-2-078 p367
Strohl KP EL-7-1 p218;
IS-5-1 p229
Suga H PO-1-148 p303
Suh S PO-1-005 / AS-1
Presenter p255
Sun H PO-1-235 p332;
PO-1-240 p334
Sunaga K PO-2-140 p387
Sunagawa G PO-2-061
p363
Sunahara H PO-2-162 p394
Sundelin T PO-2-225 /AS-8 Presenter p414
Sutherland K PO-1-091
p284; PO-1-147 p302;
PO-1-149 p303
Suzuki HF PO-2-116 p379
Suzuki K PO-1-224 p328
Suzuki M PO-1-106 / AS-10
Presenter p289
Suzuki S PO-1-214 p325
Suzuki Y PO-2-026 p351
Szymusiak R AS-24-1 p246
Tabuchi S PO-2-004 /AS-25 Presenter p343
Tafti M EL-2-1 p216
Tagaya H PO-1-243 / AS-11
Presenter p335
Taguchi T PO-2-193 p404
Tajima S PO-2-120 p381
Takaesu Y PO-1-190 p316
Takahara M PO-2-132 p384
Takahashi Y PO-2-118 p380
Takakusaki K PS-11-4 p211

Takashima A PS-5-3 p204
Takegami M PO-2-092
p371
Takei Y PO-1-170 p310
Takeuchi H PO-2-184 p402
Takumi T PS-8-3 p207
Tamaki M PO-2-081 /AS-32 Presenter p368
Tamura M PO-2-205 p408
Tamura N PO-2-124 p382
Tanahashi T PO-1-046
p269
Tanaka H PO-2-119 p380
Tanaka M PO-2-071 p366
Tanaka S PO-2-035 p354
Tanizawa K IS-4-2 p228
Tanno S PO-1-039 p266
Tao K PO-2-086 p370
Tedjasukmana R PO-1-043
p268
Teija V PO-2-144 / AS-4
Presenter p388
Terada S PO-1-024 p261
Timofeev I AS-25-3 p247
Togo F PO-2-018 p348
Tokunaga J PO-2-015 p347
Tokunaga K PS-9-2 p208
Tony IKC PO-1-227 p329
Toyama Y PO-1-070 p277
Toyoshima H PO-1-038
p266
Trinder J PO-1-054 p271
Tseng T-I PO-1-101 p287
Tsugawa H PO-1-108 p290
Tsuiki S AS-6-2 p235
Tsukada E PO-1-032 / AS-2
Presenter p264
Tsunematsu T AS-24-2
p246
Uchiyama M IS-1-3 p224;
IS-2-4 p226
Uchiyama N PO-1-265
p342
Uematsu A PO-1-044 p268
Uematsu S PO-2-158 p393
Uemura-Ito S PO-2-141
p387
Uemura–Ito S PO-1-245
p335
Ueno T PO-1-186 p315;
PO-2-037 p354
Umemoto G PO-1-150
p303

Urade Y ES-1-1 p218
Urbain N PO-2-005 p344
Urrila AS PO-1-022 p261
Van Cauter E PL-2-1 p195
Van Der Werf YD AS-28-2
p249
Van Dongen HPA AS-33-3
p253
Van Maanen A PO-1-193 /AS-30 Presenter p317;
PO-1-192 p317
Van Schie MKM PO-1-184
p315
Van Someren EJW AS-15-1
p240
Velluti RA PO-2-032 p353
Venkateswaran S PO-1-134
p298
Vitiello MV AS-1-1 p232
Vivaldi EA PO-1-089 /AS-10 Presenter p284;
PO-2-106 p376
Vivaldi EA. PO-2-012 p346
Vivaldi EA. PO-2-014 p347
Voinescu BI PO-1-018 /AS-4 Presenter p260
Wada K PO-2-153 p391
Wakai M PO-1-104 / AS-7
Presenter p288
Wakamura T PO-2-152
p391
Waloszek JM PO-1-012
p257
Wang D PO-1-258 p339
Wang J-S PO-2-111 p378
Watanabe N PO-1-009
p256
Watanabe S PO-1-139
p300
Wei RC PO-1-127 / AS-19
Presenter p296
Werf VanDer YD PO-2-029
p352
Werth E PO-2-102 p375;
PO-2-208 p409
White DP PL-3-1 p195
Wing YK PS-13-2 p213
Winrow CJ PO-1-237 p332;
PO-1-238 p333
Wirz-Justice A PS-14-4
p215
Witmans M PS-6-4 p205

© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

Author Index

Wong KKH PO-1-097 p286
Woo KD PO-1-182 p314
Wright KP IS-1-2 p224
Wu JC PS-10-2 p209
Xilong Z PO-1-124 p295
Xu Q PO-1-247 p336
Xu X PO-1-241 / AS-25
Presenter p334
Yagi A PO-1-200 p320
Yamada N ES-5-4 p224
Yamada Y PO-2-179 p400
Yamadera W PO-1-016 /AS-1 Presenter p259

Yamagiwa J OL-1-1 p194
Yamaguchi K PO-1-078
p280
Yamamoto K PO-2-224
p414
Yamamoto N PO-2-172
p398
Yamanaka A AS-22-3 p245
Yamanaka T PO-1-125
p296
Yamanaka Y PO-2-069 /AS-3 Presenter p365
Yamano E PO-2-129 p383
Yamashina A PO-2-075
p367

Yamauchi M IS-5-2 p229
Yang C-M PO-1-023
p261
Yang Y-TC PO-2-110 p377
Ye J PO-2-055 p361
Ye JY PO-1-102 p288
Yiallourou SR AS-30-1
p250; PO-2-016 p347
Yoshida K PO-1-051 p270;
PO-1-143 p301
Yoshida M PO-1-135 p299;
PO-2-228 p415
Yoshida S PO-1-140 p300
Yoshiike T PO-2-080
p368© 2011 The Authors
Sleep and Biological Rhythms © 2011 Japanese Society of Sleep Research

Yoshimura C PO-1-069
p277
Yoshimura T PS-14-1
p214
Yu WMM PO-1-261 p340
Yun C-H PO-1-218 p326
Zadra A PO-1-231 p330;
PO-2-094 p372
Zant JC PO-2-049 / AS-25
Presenter p358
Zee P IS-2-2 p225
Zhao H PO-2-220 / AS-18
Presenter p413
Zou D PO-1-233 p331

421

SPONSORSNSORSPLATINUM SPONSORM SPONSORGOLD SPONSOR
中心位置

PONSOR

Takeda Pharmaceutical Company Limited

rmaceutical Company Limited

SILVER SPONSORSPONSOR
基本シグネチャー

情報概要、広告用

in alphabetical sequenceAcknowledgements
Acti GraphAISIN SEIKI CO., LTD.
Astellas Pharma Inc.
Chest M.I., Inc.
COSMO SOUND Co., Ltd., Tokai Office
Eisai Co., Ltd.
Fisher & Paykel Healthcare Limited
Fukuda Denshi Co., Ltd.
GE Healthcare Asia Pacific
HSINER CO., LTD
INTERVOICE, Inc.
ITC Ltd.
KINOKUNIYA COMPANY LTD.
KISSEI COMTEC CO., LTD.
Kitaoji Shobo Co., Ltd.
KOIKE MEDICAL CO., LTD.
Kyorin Pharmaceutical Co., Ltd.
LOTTE Health Products Co., Ltd.
Macros Japan Co., Ltd.
MAGnet co., ltd.
Medi-Sys Inc.
Merci Co., Ltd.
Merck & Co., Inc./ MSD K. K.
NIHON KOUDEN CORPORATION
Nippon Boehringer Ingelheim Co., Ltd.
NoruPro Light Systems, Inc.

(as of September 30, 2011)
NTT DOCOMO, INC.
OMRON HEALTHCARE Co., Ltd.
OTSUKA PHARMACEUTICAL CO., LTD.
Brightlight Store
Pacific Medico Co., Ltd.
PARAMOUNT BED CO., LTD.
Pegasus Wing Co., Ltd.
Pfizer Japan Inc.
Philips Respironics
RESMED LIMITEDRUSHRUN, Co., Ltd.
SANITA TRADING CO., LTD.
sanofi-aventis K.K.
Shinryobunco
SleepWell Co., Ltd.
SomnoMedSUPER HOTEL, Co., Ltd.
SUZUKEN CO., LTD./KENZMEDICO CO., LTD.
Takeda Pharmaceutical Company Limited
TANITA Corporation
TEIJIN HOME HEALTHCARE LIMITEDThe Federation of Pharmaceutical Manufacturers’
Associations of JAPANVitalAire Japan K.K.
Weinmann Geräte für Medizin GmbH + Co.
Wiley-Blackwell

Listed in the NHI drug price list.

Psychotropic drug, Habit-forming drug(Caution: Habit-forming.)
Prescription drug(Caution: Use only pursuant to the prescription of a physician, etc.)• Please refer to package inserts for ‘‘Indication’’, ‘‘Dosage and Administration’’ and ‘‘Precautions’’.

Manufactured and Distributed by:

Co-Distributed by:

Licensed by:Tokyo, JapanTokyo, Japan

Trademark holder Sanofi-Aventis group

JP.ZOL.11.08.08

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