Yoyogi Sleep Disorder Center

Tokyo, Japan

Yoyogi Sleep Disorder Center

Tokyo, Japan
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Sasai T.,Neuropsychiatric Research Institute | Sasai T.,Yoyogi Sleep Disorder Center | Sasai T.,Tokyo Medical University | Sasai T.,Tokyo Medical and Dental University | And 5 more authors.
Sleep Medicine | Year: 2012

Background: The rapid eye movement (REM) sleep behavior disorder (RBD) questionnaire (RBDQ)- Hong Kong was the first tool developed for quantifying the severity of RBD. This study was conducted to validate the Japanese version of the questionnaire and to investigate its reliability, validity, and responsiveness. Methods: Patients with idiopathic RBD and sex and age-matched healthy controls completed the Japanese version of the questionnaire (RBDQ-JP). In addition to the evaluation of its reliability and validity, the questionnaire scores were compared between those earned before and those earned after pharmaceutical treatment to assess the questionnaire's responsiveness. Results: The questionnaire demonstrated high test-retest reliability and moderate internal consistency. The best cut-off score was 19/20 with a sensitivity of 97.2% and a specificity of 97.5%. Exploratory factor analysis revealed that the questionnaire consists of the following two factors: Factor 1, Dream and dream-related behaviors and Factor 2, Violent/complex behaviors. Among the patients, significant correlation was found between the rate of change of questionnaire score and the clinical global impression improvement score with pharmaceutical treatment (rs= -0.829, p< 0.01). Conclusions: The RBDQ-JP provides satisfactory reliability, validity, and responsiveness. The questionnaire is suitable for severity assessment and for assessing the RBD treatment outcome. © 2012 Elsevier B.V.


Inoue Y.,Neuropsychiatric Research Institute | Inoue Y.,Tokyo Medical University | Inoue Y.,Yoyogi Sleep Disorder Center | Takasaki Y.,Ohta Nishinouchi Hospital | Yamashiro Y.,Ota General Hospital
Journal of Clinical Sleep Medicine | Year: 2013

Study Objectives: This double-blind study evaluated the efficacy and safety of modafinil for treating excessive daytime sleepiness in Japanese patients with obstructive sleep apnea syndrome (OSAS). Methods: Patients with residual excessive sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11) on optimal nasal continuous positive airway pressure (nCPAP) therapy (apnea-hypopnea index ≤ 10) were randomized to either 200 mg modafinil (n = 52) or placebo (n = 62) once daily for 4 weeks. Outcomes included baseline-week 4 changes in ESS total score, sleep latency on maintenance of wakefulness test (SL-MWT), nocturnal polysomnography, Pittsburgh Sleep Quality Index (PSQI), and safety. Results: All 114 randomized patients completed the study. Mean change in ESS total score (-6.6 vs -2.4, p < 0.001) and SL-MWT (+2.8 vs -0.4 minutes, p = 0.009) were significantly greater with modafinil than with placebo. ESS total score decreased from > 11 to < 11 at the final assessment in 69.2% of modafinil-treated patients and 30.6% of placebo-treated patients (p < 0.001). Corresponding rates at week 1 were 57.7% and 33.9% (p = 0.014). Changes in nocturnal polysomnography, PSQI, and apnea-hypopnea index from baseline to the final assessment were similar in both groups. Adverse drug reactions occurred in 36.5% and 22.6% of patients in the modafinil and placebo groups, respectively (p = 0.146). Conclusions: Once-daily modafinil was effective and well tolerated for managing residual daytime sleepiness in Japanese OSAS patients with residual excessive daytime sleepiness on optimal nCPAP therapy. Clinical Trial Registration: JapicCTI-No.090777.


Inoue Y.,Tokyo Medical University | Inoue Y.,Neuropsychiatric Research Institute | Inoue Y.,Yoyogi Sleep Disorder Center | Hirata K.,Dokkyo Medical University | And 4 more authors.
Current Medical Research and Opinion | Year: 2013

Objective Gabapentin enacarbil (GEn) was effective and well-tolerated for the treatment of restless legs syndrome (RLS) in North American studies. However, no placebo-controlled studies of GEn have been performed in Asian patients with RLS. Therefore, we investigated the efficacy and safety of GEn in Japanese patients with RLS to determine the optimal dosage. Research design and methods Outpatients with RLS (International Restless Legs Syndrome Rating Scale (IRLS) scores ≥15) were randomized (n=474) and treated (n=469) in a double-blind manner with once-daily placebo (n=116), 600 (n=120), 900 (n=119) or 1200 (n=114)mg GEn for 12 weeks. Clinical trial registration NCT00530530 (ClinicalTrials.gov) Main outcome measure The primary outcome was the change in IRLS score. Secondary outcomes included Investigator (ICGI)-And Patient (PCGI)-rated Clinical Global Impression and adverse events. Results The mean change in IRLS score from baseline to the final observation was-8.96 for placebo versus-11.10,-10.28 and-11.38 for 600, 900 and 1200mg GEn. Williams' multiple comparison test showed that only 1200mg GEn was superior to placebo (p=0.011). However, in post hoc mixed-effects models with repeated measures, which accounted for the time-course of changes in IRLS, the placebo-Adjusted changes were-2.31,-1.92 and-2.31 for 600, 900 and 1200mg GEn. ICGI and PCGI response rates were significantly greater for all three GEn doses versus placebo (all p≤0.014). Adverse events, including somnolence, dizziness and nasopharyngitis, were frequent but of mild-to-moderate severity. However, there was a tendency toward a dose-dependent increase in the incidence of adverse events. Conclusions GEn is effective and well-tolerated for the treatment of RLS in Japanese patients. All three doses produced improvements in IRLS compared with placebo; 600mg GEn is a suitable target dose. However, our analysis possibly introduced positive bias by assuming that symptoms improve after discontinuation. © 2013 Informa UK Ltd All rights reserved.


Nakajima S.,Tokyo Medical University | Nakajima S.,Neuropsychiatric Research Institute | Nakajima S.,Yoyogi Sleep Disorder Center | Okajima I.,Tokyo Medical University | And 14 more authors.
Sleep Medicine | Year: 2014

Objective: Our study was conducted to validate the Japanese version of the Ford Insomnia Response to Stress Test (FIRST-J) and to clarify the association of the measure with trait anxiety and insomnia in healthy subjects and insomnia patients. Methods: We studied 161 healthy subjects and 177 insomnia patients who completed the FIRST-J, Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), and State-Trait Anxiety Inventory-Trait (STAI). The healthy subjects and the insomnia patients were classified, respectively, into two groups with high FIRST-J and low FIRST-J scores (divided by the median value of healthy subjects). Results: Cronbach α coefficients of the FIRST-J in the insomnia patients and healthy subjects were 0.89 and 0.87, respectively. Factor analysis revealed that the FIRST-J had a single-factor structure. The FIRST-J score significantly correlated with all other measures in the healthy subjects, though the score only correlated with the score of the STAI in the insomnia patients. The healthy subjects with high FIRST-J scores showed higher scores of the AIS and STAI than those with low FIRST-J scores. Furthermore, insomnia patients had a higher total score of the FIRST-J than the healthy subjects. Conclusions: The FIRST-J is an important tool for assessing vulnerability to insomnia. © 2013 Elsevier B.V.


Hida A.,National Institute of Mental Health | Kitamura S.,National Institute of Mental Health | Katayose Y.,National Institute of Mental Health | Kato M.,National Institute of Mental Health | And 10 more authors.
Scientific Reports | Year: 2014

A system of self-sustained biological clocks controls the 24-h rhythms of behavioral and physiological processes such as the sleep-wake cycle. The circadian clock system is regulated by transcriptional and translational negative feedback loops of multiple clock genes. Polymorphisms in circadian clock genes have been associated with morningness-eveningness (diurnal) preference, familial advanced sleep phase type (ASPT), and delayed sleep phase type (DSPT). We genotyped single-nucleotide polymorphisms in circadian clock genes in 182 DSPT individuals, 67 free-running type (FRT) individuals, and 925 controls. The clock gene polymorphisms were tested for associations with diurnal preference and circadian rhythm sleep disorder (CRSD) phenotypes. The PER3 polymorphism (rs228697) was significantly associated with diurnal preference and the FRT phenotype. The minor allele of rs228697 was more prevalent in evening types than in morning types (sex-adjusted odds ratio (OR), 2.483, Bonferroni-corrected P = 0.012) and in FRT individuals compared with the controls (age- and sex-adjusted OR, 2.021, permutated P = 0.017). Our findings support the notion that PER3 polymorphisms could be a potential genetic marker for an individual's circadian and sleep phenotypes.


Nakamura M.,Yoyogi Sleep Disorder Center
Nihon rinsho. Japanese journal of clinical medicine | Year: 2013

Comorbidity of sleep disturbances in dementia may lead to aggravation of cognitive and behavioral problems such as agitation, delirium and wandering in night time. Especially, Alzheimer's disease (AD) and frontotemporal dementia (FTD) frequently showed a disturbance of the sleep-wake circadian rhythm, on the other hand, dementia with Lewy bodies showed REM sleep behavior disorder. This disturbance of circadian rhythm is associated with degeneration of responsible area for sleep-wake regulation (i.e. suprachiasmatic nucleus: SCN, tuberomammillary nucleus: TMN etc.) and decreased melatonin secretion. To prevent or treat sleep disturbance in dementia, mixed modality approach with pharmacological, physical and social intervention and sleep-wake scheduling is needed. Management of the symptom is important for maintaining QOL of not only patients themselves but alsotheir caregivers.


Okajima I.,Tokyo Medical University | Okajima I.,Neuropsychiatric Research Institute | Okajima I.,Yoyogi Sleep Disorder Center | Nakajima S.,Tokyo Medical University | And 8 more authors.
Psychiatry and Clinical Neurosciences | Year: 2013

Aim The aim of this study was to develop and validate a Japanese version of the Athens Insomnia Scale (AIS-J). Methods The AIS-J was created using a back-translation design. A total of 477 outpatients with chronic insomnia and 163 individuals from the general community were recruited. Participants were asked to complete the AIS-J along with two other insomnia scales - Japanese versions of the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. Results The AIS-J consisted of a two-factor structure: 'nocturnal sleep problem' (items 1-5) and 'daytime dysfunction' (items 6-8). Internal consistencycoefficients ranged from 0.78 to 0.88. Correlations between the AIS-J and the aforementioned authorized scales were 0.81 and 0.85, respectively. Scores on the AIS-J were significantly higher for the insomnia group than for the control group. The AIS-J cut-off value for identifying pathological insomnia was estimated at 6 points or more, and the AIS-J-nocturnal cut-off value was estimated at 4 points or more. Conclusions The AIS-J has sufficient validity and diagnostic utility. © 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.


Tsuiki S.,Neuropsychiatric Research Institute | Tsuiki S.,Yoyogi Sleep Disorder Center | Tsuiki S.,Tokyo Medical University | Ito E.,Yoyogi Sleep Disorder Center | And 9 more authors.
Chest | Year: 2013

Background: Oral appliances are increasingly prescribed for patients with moderate obstructive sleep apnea (OSA) instead of nasal CPAP. However, the effi cacy of oral appliances varies greatly. We hypothesized that oral appliances were not effi cacious in patients with moderate OSA who were obese with oropharyngeal crowding. Methods: Japanese patients with moderate OSA were prospectively and consecutively recruited. The Mallampati score (MS) was used as an estimate of oropharyngeal crowding. Follow-up polysomnography was performed with the adjusted oral appliance in place. Responders were defi ned as subjects who showed a follow-up apnea-hypopnea index (AHI) of < 5 with . 50% reduction in baseline AHI. Results: The mean baseline AHI was reduced with an oral appliance from 21 ± 4 to 9.8 ± 8 in 95 subjects. Thirty-fi ve patients were regarded as responders. Logistic regression analyses revealed that both MS and BMI could individually predict the treatment outcome. When the cutoff value of BMI was determined to be 24 kg/m2 based on a receiver operating characteristic curve, 53 obese patients (ie, BMI > 24 kg/m 2) with an MS of class 4 were indicative of treatment failure with a high negative predictive value (92) and a low negative likelihood ratio (0.28). Conclusions: We conclude that patients with moderate OSA who are obese with oropharyngeal crowding are unlikely to respond to oral appliance treatment. This simple prediction can be applied without the need for any cumbersome tools immediately after the diagnosis of OSA. © 2013 American College of Chest Physicians.


PubMed | Kokubunji Sakura Clinic, Sleep & Stress Clinic, Dokkyo Medical University and Yoyogi Sleep Disorder Center
Type: Journal Article | Journal: PloS one | Year: 2015

Because the prevalence and characteristics of primary headache have yet to be thoroughly studied in patients with hypersomnia disorders, including narcolepsy and idiopathic hypersomnia, we examined these parameters in the Japanese population.In a multicentre cross-sectional survey, among 576 consecutive outpatients with sleep disorders, 68 narcolepsy patients and 35 idiopathic hypersomnia patients were included. Additionally, 61 healthy control subjects participated. Semi-structured headache questionnaires were administered to all participants.The patients with narcolepsy (52.9%) and idiopathic hypersomnia (77.1%) more frequently experienced headache than the healthy controls (24.6%; p<0.0001). The prevalence rates were 23.5%, 41.2% and 4.9% for migraine (p<0.0001) and 16.2%, 23.5% and 14.8% (p = 0.58) for tension-type headache among the narcolepsy patients, the idiopathic hypersomnia patients and the control subjects, respectively. Those who experienced migraine more frequently experienced excessive daytime sleepiness, defined as an Epworth Sleepiness Scale score of 10, than those who did not experience headache among the patients with narcolepsy (93.8% vs. 65.6%, p = 0.040) and idiopathic hypersomnia (86.7% vs. 37.5%, p = 0.026). Dream-enacting behaviour (DEB), as evaluated by the rapid eye movement sleep disorders questionnaire, was more frequently observed in the narcolepsy patients than in the idiopathic hypersomnia patients and the control subjects. An increased DEB frequency was observed in the narcolepsy patients with migraines compared to those without headache.Migraines were frequently observed in patients with narcolepsy and idiopathic hypersomnia. DEB is a characteristic of narcolepsy patients. Further studies are required to assess the factors that contribute to migraines in narcolepsy and idiopathic hypersomnia patients.


PubMed | Tokyo Medical University and Yoyogi Sleep Disorder Center
Type: Journal Article | Journal: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine | Year: 2014

The aim of this study was to examine whether the upper airway anatomical balance, as reflected by tongue size relative to maxillomandibular size, is related to optimal nasal continuous positive airway pressure (PnCPAP).Sixty-six male Japanese obstructive sleep apnea syndrome (OSAS) patients (median apnea-hypopnea index [AHI] = 33.9 episodes/h [10th/90th percentile = 19.5/59.9], median body mass index [BMI] = 25.1 kg/m(2) [10th/90th percentile = 21.2/30.4]) were recruited. All patients underwent standard polysomnography (PSG), and PnCPAP was determined by nasal continuous positive airway pressure (nCPAP) titration. The anatomical balance was defined as the tongue area (TG) divided by the lower face cage (LFC) measured on cephalometry. A predictive equation of PnCPAP was created using demographic, polysomnographic, and cephalometric variables.Significant correlations were found between PnCPAP and descriptive variables, including BMI, AHI, lowest SpO2, distance from the anterosuperior point of the hyoid bone to the mandibular plane (MP-H), and TG/LFC. Stepwise multiple regression analysis revealed that AHI and TG/LFC were independent predictors of PnCPAP. The predictive equation was: PnCPAP = 1.000 + 0.043 AHI + 9.699 TG / LFC, which accounted for 28.0% of the total variance in PnCPAP (R(2) = 0.280, p < 0.01).Anatomical balance of upper airway in addition to the severity of OSAS is an important contributing factor for PnCPAP in Japanese OSAS patients.

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