R L Manfredi

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Besides sleep apnea, the main disorders of excessive daytime sleepiness include narcolepsy and hypersomnia. Narcolepsy is characterized by periods of irresistible sleepiness and sleep attacks of brief duration and, most often, by one or more of the auxiliary symptoms: cataplexy, sleep paralysis, and hypnogogic hallucinations. Generally, sleepiness and sleep(More)
The sensitivity, specificity, and positive predictive value of two proposed sleep laboratory criteria for the diagnosis of insomnia were evaluated in 375 adults with a primary complaint of insomnia and 150 noninsomniac controls. The two criteria used results in either low sensitivity and moderately strong specificity or high sensitivity and low specificity(More)
Nocturnal sleep and wakefulness patterns of 50 patients with narcolepsy and cataplexy were compared to those of 50 control subjects. A sleep onset REM period (SOREM) occurred in 22 (44%) of the patients but in none of the controls. Comparisons among patients showing a SOREM, patients without this abnormality, and controls demonstrated that the timing,(More)
OBJECTIVE Primary insomnia and insomnia related to mental disorders are the two most common DSM-IV insomnia diagnoses, but distinguishing between them is difficult in clinical practice. This analysis was performed to identify clinical factors used by sleep specialists to distinguish primary insomnia from insomnia related to mental disorders. METHOD(More)
OBJECTIVE The frequency and ranking of DSM-IV sleep disorder diagnoses of clinical patients with complaints of insomnia, as well as rates of diagnostic agreement and disagreement between two types of interviewers, were investigated. METHOD Interviewers at five clinical sites assessed 216 patients referred for insomnia complaints. One sleep specialist and(More)
The prevalence of sleep apnea, sleep apneic activity, nocturnal myoclonus, and nocturnal myoclonic activity was assessed in 375 outpatient insomniacs and 150 normal controls. Only a small percentage of insomniacs (n = 8, 2.3%) and normal controls (n = 2, 1.3%) presented > or = 30 apneic events per night. Only one of these subjects, an insomniac, met the(More)
Sleep and wakefulness patterns in daytime naps of 50 patients with narcolepsy/cataplexy were compared with those of 50 controls. Each subject was monitored polygraphically during 2 one-hour nap periods. A sleep-onset REM period in either of the 2 daytime naps was observed to have a higher diagnostic sensitivity (78%) than an abnormally shortened sleep(More)
The prevalence, rate, and degree of memory impairment for next-day activities during a short, intermittent course of bedtime doses of triazolam, temazepam, and placebo were assessed in a double-blind parallel-group study. 5 of the 6 subjects in the triazolam group reported at least one episode of next-day memory impairment/amnesia, with a total of 12(More)
In three parallel groups, brief and intermittent administration and withdrawal of triazolam, 0.5 mg, temazepam, 30 mg, and placebo were assessed in a 12-night sleep laboratory study of 18 subjects with insomnia. With this intermittent schedule both drugs improved sleep, with about one-third reduction in total wake time; this reduction was significant for(More)