الفهرس 
Physiology of Normal SleepOnly 14 pages are availabe for public view
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Abstract
People with psychiatric illness commonly complain of sleep problems, and sleep disruption is a part of the diagnostic criteria of many psychiatric disorders. The relationship between sleep and mood is bidirectional: sleep complaints are more common in people with mood disorders than in the general population, and mood disorders are more common in those with sleep complaints.
Current understanding of the relationship between sleep and bipolar mania involves the following aspects: 1) decreased need for sleep is a fundamental marker of the manic state; 2) sleep deprivation is one cause of mania and may in fact be a fundamental etiological agent in mania; 3) total sleep time is a predictor of future manic episodes; and 4) total sleep time may be a marker of response as well as a target of treatment in mania.
Depression is associated with sleep disturbances in the elderly general and clinical populations, with insomnia in the primary care setting showing a stronger association to depression than any other medical condition.
Based on that, this study was conducted aiming to study the profile of sleep in mood disorders patients, determining the nature of the sleep disturbance in them if present and highlighting the factors related to this disturbance.
Forty (40) patients were included in this study, 20 patients diagnosed as major depressive disorders and 20 patients presented with hypomania, and compared with 20 age and six matched healthy controls. Their age ranges between 18-45 years and they have episode of mood disorder.
The study took place from first of January 2010 till 31 of December 2011. All subjects of the study were assessed by using: Structured Clinical Interview for DSM-IV (SCID I) diagnostic tool to diagnose mood disorders and to exclude other Axis I diagnosis according to DSM VI classification; Young Mania Rating Scale (YMRS): to assess the severity of manic state; Hamilton Rating Scale for Depression (HRSD): to assess the severity of depression state; Comprehensive Sleep Disorder Questionnaire: To assess Personal sleep rituals as well as Sleep disorders which are insomnia, hypersomnia, parasomnias, or dyssomnias; and All Night Polysomnography (PSG): to analyze the sleep architecture of the subjects including General sleep aspects NREM and REM sleep characteristics as well as assessment of respiratory variables during sleep.
Sleep assessment was performed when the participants were medication free for at least 7 days prior to study to exclude the effect of any psychotropic medication on their polysomnography.
The main findings in the study were highly significant differences between the three groups in most of sleep architecture variables (sleep efficiency, latency, stages percentages and REM sleep variables). No significant differences were detected regarding respiratory distress index, desaturation index, and periodic leg movement index.
Post Hoc analysis of values of polysomnogram parameters between subgroups revealed highly significant differences. Patients with MDD and also patients with hypomania had highly significantly decreased sleep efficiency, increased latency, increased percentage of stages I & II, decreased percentage of stage III – IV, increased REM density, density of first (1st) REM , decreased REM latency and increased apnea appendix, compared with age –sex matched controls. REM sleep percentage was significantly increased in patients with MDD compared to controls, and non-significantly differed in hypomanic patients compared to controls.
Comparison between patients with hypomania and MDD, using polysomnogram parameters, showed that hypomanic patients had highly significantly increased sleep efficiency, decreased sleep latency, decreased stage I and REM percentages, increased stage III-IV percentage, increased REM latency, and increased apnea index. Other parameters showed no significant differences. In patients with MDD group, age was positively and significantly correlated with stage III-IV percentage (r=0.513, p=0.021) and density of 1st REM (r=0.461, p=0.041), while negatively correlated with stage II percentage(r= -.588, p=0.006), and sleep changes were more prominent in moderate depression compared to mild forms
Using SSDQ, there were highly significant differences regarding difficultly falling asleep (100% with MDD, 90% with hypomania, and 10% in controls), difficulty on Maintaining of sleep (85 % with MDD, 70 % with hypomania, and 0 % in controls), early morning awakening (85 % with MDD, 80% with hypomania, and 0% in controls), and Disorder of Excessive Somnolence (15 % with MDD, 0% with hypomania, and 0% in controls), but not parasomnias, between patients with MDD, hypomania, and healthy controls.
Comparing controls with patients with MDD, and hypomania separately showed same significant results, while comparing patients with MDD with hypomanic patients showed no significant differences.
The findings of this study are similar to previous literature, emphasizing sleep changes in MDD, and its correlates; explores sleep pattern in hypomania that was similar to depression pattern compared to controls. This similarity is in line with comparison between mania and depression in previous studies, supporting the same underlying mechanisms.