Synthetic Biology as it relates to Frontiers in Translational Medicine, prepared for the 150th Anniversary of Thayer School of Engineering, Dartmouth College, Hanover, NH, 16 Feb 2017
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5. จาก polysomnography สามารถแยกการช่วงของการนอนหลับได้เป็น
◦ non-rapid eye movement (NREM) sleepA state of sleep characterized by slowing of the
EEG rhythms, high muscle tone, absence of eye movements, and thoughtlike mental
activity. In this state the brain is inactive while the body is active. NREM is made up of 4
stages:
แบ่งย่อยออกได้เป็น 4 ระยะ (stage I - IV) ตามระดับความลึกของการนอนหลับ
เมื่อหลับลึกลักษณะคลื่นEEGมีขนาดใหญ่ขึ้นและความถี่ลดลง
◦ rapid eye movement (REM) sleep
8. rapid eye movement (REM)
◦ REM Sleep
เป็นระยะที่ยังคงหลับอยู่แต่คลื่นไฟฟ้าฟ้าสมองมีขนาดเล็กและความถี่สูงคล้าย beta wave
อาจเรียกอีกชื่อหนึ่งว่า paradoxical sleep
มีการกลอกตาเป็นจังหวะอย่างรวดเร็ว
ความตึงตัวของกล้ามเนื้อหายไป ยกเว้นกล้ามเนื้อextra ocular muscle และ middle ear
sympathetic activity จะสูงขึ้น
อาจพบการแข็งตัวของอวัยวะเพศเกิดขึ้นในช่วง REM sleep
เป็นภาวะที่มีการฝัน
9.
10.
11. Stage EEG Findings Distribution
Stage 1
Disappearance of alpha wave
and appearance of theta wave
5%
Stage 2 k compelexes and sleep spindles 45%
Stage 3 Appearance of delta wave 12%
Stage 4 Continuation of delta wave 13%
REM Bursts of sawtooth waves 25%
56. ◦ Parasomnias - Risk Factors
Age
◦ Childhood: sleepwalking bedwetting
Genetics
◦ If sleepwalking, night terrors or certain other parasomnias run in your family, you are more likely to have them.
Stress
◦ Some people are more likely to sleepwalk or have other parasomnias when they are under stress
Post-Traumatic Stress Disorder
◦ Nightmare disorder and trauma-related nightmares are frequently associated with PTSD.
◦ Nearly 80 percent of patients with PTSD have nightmares within three months of the trauma.
57. Medications
Some medications may cause other parasomnias.
◦ Sleepwalking disorder:, thioridazine, fluphenazine, perphenazine, desipramine, chloral hydrate, and lithium
◦ Sleep terror disorder:CNS depressant medications(alcohol,SSRI, TCA, hypnotics)
◦ Nightmare disorder: levodopa, beta-adrenergic drugs, and withdrawal of REM-suppressing medications
Drug or Alcohol Abuse
◦ may also worsen the symptoms of some parasomnias.
Other Disorders
◦ Some parasomnias are linked to other disorders.
◦ bedwetting is linked to obstructive sleep apnea and congestive heart failure.
◦ REM sleep behavior disorder is often associated with Parkinson’s disease.
58. ◦ Non-REM (NREM) Sleep Parasomnias
Sleepwalking(somnambulism)
◦ Sleepwalking involves getting up from bed and walking around when you are still asleep.
◦ sometimes involves a series of other complex actions
◦ eyes are usually open
◦ . Being woken up will not harm a sleepwalker
◦ Trying to restrain a sleepwalker may result in
◦ aggressive behavior such as kicking or biting.
59. Confusional Arousals
◦ common in children.
◦ They result from partial or incomplete arousal from deep sleep,
◦ typically during the first third of the night.
◦ can last from a few minutes to a few hours.
◦ no memory of these episodes.
◦ In general, confusional arousals are benign
and require no treatment.
60. ◦ Sleep terrors (parvor nocturnus, incubus attacks).
◦ The individual sits up with an expression of terror
◦ displays autonomic arousal with rapid breathing, tachycardia, sweating, dilated pupils, and increased muscle tone
◦ The typical duration is between 30 seconds and 3 minutes
◦ the end of an attack, usually returns to sleep.
61. ◦ Treatment of NREM parasomnias.
◦ For most children, treatment of parasomnias is not necessary
◦ reassured that events are not harmful
◦ Treatment may be needed if episodes are frequent, severe, and impose danger
◦ benzodiazepines, such as diazepam, oxazepam, and especially clonazepam usually help
62. REM Sleep Parasomnias
REM Sleep Behavior Disorder
◦ more common in the elderly.
◦ men are affected more frequently than women
◦ This potentially dangerous sleep disorder causes act out dreams
◦ There is a strong association between RBD
and Lewy body-involving neurodegenerative disorders
of Parkinson's disease,
Treatment Clonazepam 0.5 to 1mg
Melatonin at doses of 3 to 12mg
tricyclic antidepressants, levodopa, and dopamine agonists, may also be effective.
63. Nightmare Disorder
◦ Nightmares are frightening dreams
◦ usually awaken the sleeper from REM sleep
◦ fear and/or anxiety are the most frequent emotions
◦ Up to 40 percent have been diagnosed with schizotypal,
borderline, or schizoid personality disorders.
◦ Treatment
◦ of nightmares includes psychotherapy, minimizing or avoiding stress, and minimizing the use of drugs
◦ cyproheptadine at doses of 4 to 16mg
◦ prazosin at doses of 5 to 10mg
64. reference
◦ http://med-stud.narod.ru/med/misc/sleep.html
◦ http://www.sciencedirect.com/topics/page/Ventrolateral_preoptic_nucleus
◦ http://neurowiki2013.wikidot.com/individual:neurotransmitter-system-and-neural-circuits-gover
◦ http://www.dr-survival.com/academic/academic_detail.php?ac_id=&subacid=&acm_id=427
◦ http://www.psychiatry.or.th/JOURNAL/v4518.html
◦ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021925/
◦ https://www.doctor.or.th/clinic/detail/6923
◦ http://www.sleepeducation.org/essentials-in-sleep/parasomnias/symptoms
◦ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958868/
◦ Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong’ s review of medicalphysiology. 23rd ed. Boston:McGraw-Hill; 2010. P. 229-240.
◦ Benarroch EE. Basic neuroscienceswith clinicalapplication.Philadelphia:Butterworth Heinemann/Elsevier; 2006. p. 771-805.
◦ Conn PM. Neuroscience in Medicine. 3rd ed. New Jersey: Humana; 2008. p. 623-649.
◦ Kandel ER, Schwartz JH, JessellTM, Siegelbaum SA, Hudspeth AJ. Principlesof neural science. 5th ed. New York: McGraw-Hill; 2013.
◦ Nolte J. Elsevier’s Integrated Neuroscience. Philadelphia:Mosby/Elsevier; 2007. p. 201-205.
