WorldWideScience

Sample records for managing sleep apnoea

  1. Mild obstructive sleep apnoea: clinical relevance and approaches to management.

    Science.gov (United States)

    McNicholas, Walter T; Bonsignore, Maria R; Lévy, Patrick; Ryan, Silke

    2016-10-01

    Obstructive sleep apnoea is highly prevalent in the general population worldwide, especially in its mild form. Clinical manifestations correlate poorly with disease severity measured by the apnoea-hypopnoea index (AHI), which complicates diagnosis. Full polysomnography might be more appropriate to assess suspected mild cases because limited ambulatory diagnostic systems are least accurate in mild disease. Treatment options in mild obstructive sleep apnoea include continuous positive airway pressure (CPAP) and oral appliance therapy, in addition to positional therapy and weight reduction when appropriate. The superior efficacy of CPAP in reducing AHI is offset by greater tolerance of oral appliances, especially in mild disease. Although severe obstructive sleep apnoea is associated with adverse health consequences, including cardiometabolic comorbidities, the association with mild disease is unclear, and reports differ regarding the clinical relevance of mild obstructive sleep apnoea. Improved diagnostic techniques and evidence-based approaches to management in mild obstructive sleep apnoea require further research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Obstructive Sleep Apnoea

    African Journals Online (AJOL)

    Cheyne-Stokes respiration), obstructive sleep apnoea and mixed or complex sleep apnoea.1. Obstructive sleep apnoea (OSA) is the most common of these three disorders and is defined as airway obstruction during sleep, accompanied by at least ...

  3. Office management of obstructive sleep apnoea: appliances.

    Science.gov (United States)

    Johnson, Matthew D

    2015-08-01

    Oral appliances are becoming increasingly common in the treatment of obstructive sleep apnoea (OSA). They work by advancing the mandible and opening the pharynx. There are several types of devices available for use. Many patients intolerant to continuous positive airway pressure (CPAP) are using oral appliances for OSA. Oral appliances have been shown to improve polysomnography, quality of life and health measures associated with OSA. There is current work to better identify patients who are ideal candidates. Development of titratable devices and monitoring are optimizing usage. They have been compared with CPAP, with both showing improvement in OSA; however, CPAP remains superior overall. Oral appliances are becoming first-line therapy for mild and moderate OSA. They provide a meaningful alternative in severe OSA for patients unable to use CPAP. Device titration and usage monitoring are beginning to hone oral appliances as a therapeutic option.

  4. SLEEP APNOEA!!! : SNORING & BEYOND

    Indian Academy of Sciences (India)

    SLEEP APNOEA!!! : SNORING & BEYOND · Slide 2 · Snoring · Introduction · Identifiable causes of hypertension · Crucial areas for Snoring & Obstructive Sleep Apnea · Slide 7 · Slide 8 · Slide 9 · Slide 10 · Slide 11 · Slide 12 · Slide 13 · Slide 14 · Slide 15 · Slide 16 · Epidemiology (contd.) Slide 18 · Am I at risk??? Slide 20.

  5. Obstructive sleep apnoea syndrome in children

    Directory of Open Access Journals (Sweden)

    Anna Włodarska

    2016-09-01

    Full Text Available Sleep-related breathing disorders in children are a clinical problem which is more and more often diagnosed by doctors nowadays. They can be the basis for diagnosing obstructive sleep apnoea syndrome that causes a number of complications: lowering the quality of life, behavioural problems, complications involving cardiovascular system. The incidence of obstructive sleep apnoea syndrome in the paediatric population is estimated to be at the level of 2%. The symptoms of obstructive sleep apnoea syndrome can be divided into daytime and night ones. Night symptoms in children include: snoring, apnoea, breathing with open mouth (both during the day and at night, dry tongue and mouth during sleep, agitated sleep in unnatural positions. Among daytime symptoms of obstructive sleep apnoea syndrome there are: irritability, aggressiveness, hyperactivity, attention deficit disorder, delayed development and growth pattern (mainly failure to thrive, learning problems, morning headaches. Parents often do not connect the night and daytime symptoms with the possible development of obstructive sleep apnoea syndrome in their children. The main predisposing factor of obstructive sleep apnoea syndrome in children is adenotonsillar hypertrophy. Effective and in most cases preferred treatment for the management of obstructive sleep apnoea syndrome in children is adenotonsillectomy. Polysomnography and polygraphy are diagnostic tools helpful in the study of sleep-related disorders. The objective of this study was to systematise the knowledge on the epidemiology, aetiology, clinical image and prevention of obstructive sleep apnoea syndrome in children.

  6. Management of the obstructive sleep apnoea syndrome: More knowledge required for an optimal choice of treatment modality

    NARCIS (Netherlands)

    Hoekema, A

    2006-01-01

    In the management of the obstructive sleep apnoea syndrome (OSAS), clinicians may consider various conservative, non-invasive and surgical treatment modalities. Continuous positive airway pressure (CPAP) is regarded as the treatment of choice for, especially, moderate to severe OSAS. However, due to

  7. Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study.

    Science.gov (United States)

    Wu, Xu; Liu, Zilong; Chang, Su Chi; Fu, Cuiping; Li, Wenjing; Jiang, Hong; Jiang, Liyan; Li, Shanqun

    2016-02-16

    Nocturnal heart block often occurs in patients with obstructive sleep apnoea (OSA). It is more likely to be undiagnosed in heart block patients who are ignorant of the symptoms of sleep disorder. Berlin Questionnaire (BQ) is a highly reliable way to discover the risk factors of OSA, whereas the validity in sleep-related heart block patients is uncertain. We performed an observational study to address these issues and confirmed the potential protective effect of continuous positive airway pressure (CPAP). Patients who were previously diagnosed with nocturnal heart block with R-R pauses exceeding 2 seconds were retrospective screened from the ECG centre of Zhongshan hospital. These recruited participants completed Berlin Questionnaire and underwent polysomnography synchronously with 24-hour Holter monitoring. A cross-sectional analysis was performed to confirm the association between nocturnal arrhythmia and OSA, as well as to assess the diagnostic accuracy of the BQ. Subsequently, subjects diagnosed with OSA (apnoea-hypopnoea index > 5) underwent 3 consecutive days of CPAP therapy. On the third day, patients repeated 24-hour Holter monitoring within the institution of CPAP. The symptoms of disruptive snoring and hypersomnolence in 72 enrolled patients were more related to the occurrence of nocturnal heart block (r = 0.306, 0.226, respectively, p = 0.015, 0.019) than syncope (r = 0.134, p = 0.282) and palpitations (r = 0.106, p = 0.119), which were prominent trait of our study population. The sensitivity, specificity, positive and negative predictive value of the BQ at a cut-off point of 5 of AHI for detecting OSA in heart block patients was 81.0 %, 44.4 %, 91.07 % and 25 %. Nocturnal heart block does not appear to occur exclusively in severe sleep apnoea. The frequent occurrence of arrhythmias in prominent oxygen desaturation supports the correlation between them. CPAP therapy resulted in significant decrease in the average number of

  8. Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    Jaime Corral-Peñafiel

    2013-09-01

    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG, at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.

  9. Snoring and obstructive sleep apnoea syndrome among ...

    African Journals Online (AJOL)

    Background: Obstructive sleep apnoea (OSA) syndrome is a common disorder in the community. Association between hypertension and sleep apnoea and /or snoring has been described. The Berlin questionnaire is a validated instrument that is used to identify individuals who are at risk for OSA. The study aim to describe ...

  10. Obstructive Sleep Apnoea

    African Journals Online (AJOL)

    listed below; any history of excessive snoring, restless sleep, headaches ... 2014; 56(5):29-32. Open Access article distributed under the terms of the ..... contains 11 different forms of carotenes and 5 different forms of vitamin e. It contains no ...

  11. Mandibular advancement appliance for obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Petri, Niels; Svanholt, Palle; Solow, Beni

    2008-01-01

    The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non...

  12. Lifestyle modification for obstructive sleep apnoea.

    Science.gov (United States)

    Shneerson, J; Wright, J

    2001-01-01

    Obstructive sleep apnoeas are due to transient closure of the upper airway during sleep and merge into hypopnoeas in which the airway narrows, but some airflow continues. They are due to the forces compressing the airway overcoming those which stabilise its patency. The commonest association is obesity in which fatty tissue is deposited around the airway. Exercise has been recommended as a method of losing weight, but other techniques which achieve this are also thought to improve symptoms due to sleep apnoeas. Sleep hygiene may alter the sleep structure and the control of the upper airway during sleep and thus promote its patency. The objectives of this review are to determine whether weight loss, sleep hygiene and exercise are effective in the treatment of obstructive sleep apnoeas. The Cochrane Airways Group Trials Register, MEDLINE, EMBASE, CINAHL and reference lists of review articles have been searched. Randomised, single or double blind placebo controlled, either parallel group or crossover design studies of any of these interventions were to have been included. No completed trials have been identified. No randomised trial data were available for analysis. There is a need for randomised controlled trials of these commonly used treatments in obstructive sleep apnoeas. These should identify which sub groups of patients with sleep apnoeas benefit most from each type of treatment and they should have clear and standardised outcome measures.

  13. The Management of Co-Morbidities in Patients with Heart Failure – Obstructive Sleep Apnoea

    Directory of Open Access Journals (Sweden)

    Andrew J Stewart Coats

    2017-01-01

    Full Text Available Heart failure (HF patients are older and frequently present with multiple co-morbidities. Co- morbidities worsen patient symptoms and may contribute to the progression of heart failure, increase mortality or limit the therapeutic response to treatment. Obstructive sleep apnoea (OSA affects 2–4% of the adult population world-wide and is associated with similar risk factors to HF, meaning it is a frequent finding in HF patients, including HFrEF, HFmrEF and HFpEF. OSA has consistently been shown to be associated with hypertension, coronary artery disease, arrhythmias, heart failure, and stroke. A thorough understanding of the diagnosis and treatment options of OSA is of paramount importance to the practising HF clinician. Patients may present to the HF specialist having been diagnosed by a formal sleep study or may be suspected of OSA because of symptoms of snoring, reports of obstructed breathing by the sleep partner or day-time sleepiness. The mainstay of treatment for OSA is a positive airway pressure mask which can be used in mild moderate and severe OSA. The need for therapy should be discussed with the patient and if the AHI is above 15/ hr then treatment is indicated to reduce this to below 15. This is a consensus recommendation and no adequately powered clinical trials have shown this improves either mortality or the risk of disease progression. Other options are discussed

  14. Sleep apnoea in patients with quadriplegia.

    Science.gov (United States)

    McEvoy, R. D.; Mykytyn, I.; Sajkov, D.; Flavell, H.; Marshall, R.; Antic, R.; Thornton, A. T.

    1995-01-01

    BACKGROUND--This study was undertaken to establish the prevalence of, and the factors contributing towards, sleep disordered breathing in patients with quadriplegia. METHODS--Forty representative quadriplegic patients (time since injury > 6 months, injury level C8 and above, Frankel category A, B, or C; mean (SE) age 35.0 (1.7) years) had home sleep studies in which EEG, EOG, submental EMG, body movement, nasal airflow, respiratory effort, and pulse oximetry (SpO2) were measured. Patients reporting post traumatic amnesia of > 24 hours, drug or alcohol abuse or other major medical illness were excluded from the study. A questionnaire on medications and sleep was administered and supine blood pressure, awake SpO2, spirometric values, height, and neck circumference were measured. RESULTS--A pattern of sustained hypoventilation was not observed in any of the patients. Sleep apnoeas and hypopnoeas were, however, common. Eleven patients (27.5%) had a respiratory disturbance index (RDI, apnoeas plus hypopnoeas per hour of sleep) of > or = 15, with nadir SpO2 ranging from 49% to 95%. Twelve of the 40 (30%) had an apnoea index (AI) of > or = 5 and, of these, nine (75%) had predominantly obstructive apnoeas-that is, > 80% of apnoeas were obstructive or mixed. This represents a prevalence of sleep disordered breathing more than twice that observed in normal populations. For the study population RDI correlated with systolic and diastolic blood pressure and neck circumference. RDI was higher in patients who slept supine compared with those in other postures. Daytime sleepiness was a common complaint in the study population and sleep architecture was considerably disturbed with decreased REM sleep and increased stage 1 non-REM sleep. CONCLUSIONS--Sleep disordered breathing is common in quadriplegic patients and sleep disturbance is significant. The predominant type of apnoea is obstructive. As with non-quadriplegic patients with sleep apnoea, sleep disordered breathing in

  15. The obstructive sleep apnoea syndrome in adolescents.

    Science.gov (United States)

    Marcus, Carole L; Keenan, Brendan T; Huang, Jingtao; Yuan, Haibo; Pinto, Swaroop; Bradford, Ruth M; Kim, Christopher; Bagchi, Sheila; Comyn, Francois-Louis; Wang, Stephen; Tapia, Ignacio E; Maislin, Greg; Cielo, Christopher M; Traylor, Joel; Torigian, Drew A; Schwab, Richard J

    2017-08-01

    The obstructive sleep apnoea syndrome (OSAS) results from a combination of structural and neuromotor factors; however, the relative contributions of these factors have not been studied during the important developmental phase of adolescence. We hypothesised that adenotonsillar volume (ATV), nasopharyngeal airway volume (NPAV), upper airway critical closing pressure (Pcrit) in the hypotonic and activated neuromotor states, upper airway electromyographic response to subatmospheric pressure and the ventilatory response to CO 2 during sleep would be major predictors of OSAS risk. 42 obese adolescents with OSAS and 37 weight-matched controls underwent upper airway MRI, measurements of Pcrit, genioglossal electromyography and ventilatory response to CO 2 during wakefulness and sleep. ATV, NPAV, activated and hypotonic Pcrit, genioglossal electromyography and ventilatory response to CO 2 during sleep were all associated with OSAS risk. Multivariate models adjusted for age, gender, body mass index and race indicated that ATV, NPAV and activated Pcrit each independently affected apnoea risk in adolescents; genioglossal electromyography was independently associated in a reduced sample. There was significant interaction between NPAV and activated Pcrit (p=0.021), with activated Pcrit more strongly associated with OSAS in adolescents with larger NPAVs and NPAV more strongly associated with OSAS in adolescents with more negative activated closing pressure. OSAS in adolescents is mediated by a combination of anatomic (ATV, NPAV) and neuromotor factors (activated Pcrit). This may have important implications for the management of OSAS in adolescents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk.

    Science.gov (United States)

    Dobrosielski, Devon A; Papandreou, Christopher; Patil, Susheel P; Salas-Salvadó, Jordi

    2017-06-30

    Obstructive sleep apnoea (OSA) is associated with increased cardiovascular disease (CVD) morbidity and mortality. It is accepted that OSA and obesity commonly coexist. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA. However, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of calorie-restricted, often low-fat diets for improving OSA severity, whereas less attention has been given to the means through which weight loss is achieved ( e.g. altered dietary quality) or whether diet or exercise mediates the associations between reduced weight, improved OSA severity and the CVD substrate. The current evidence suggests that the benefits of a low-carbohydrate or Mediterranean diet in overweight and obese individuals go beyond the recognised benefits of weight reduction. In addition, exercise has an independent protective effect on vascular health, which may counter the increased oxidative stress, inflammation and sympathetic activation that occur in OSA patients. This review aims to expand our understanding of the effects of diet and exercise on OSA and associated CVD complications, and sets the stage for continued research designed to explore optimal lifestyle strategies for reducing the CVD burden in OSA patients. Copyright ©ERS 2017.

  17. Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk

    Directory of Open Access Journals (Sweden)

    Devon A. Dobrosielski

    2017-06-01

    Full Text Available Obstructive sleep apnoea (OSA is associated with increased cardiovascular disease (CVD morbidity and mortality. It is accepted that OSA and obesity commonly coexist. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA. However, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of calorie-restricted, often low-fat diets for improving OSA severity, whereas less attention has been given to the means through which weight loss is achieved (e.g. altered dietary quality or whether diet or exercise mediates the associations between reduced weight, improved OSA severity and the CVD substrate. The current evidence suggests that the benefits of a low-carbohydrate or Mediterranean diet in overweight and obese individuals go beyond the recognised benefits of weight reduction. In addition, exercise has an independent protective effect on vascular health, which may counter the increased oxidative stress, inflammation and sympathetic activation that occur in OSA patients. This review aims to expand our understanding of the effects of diet and exercise on OSA and associated CVD complications, and sets the stage for continued research designed to explore optimal lifestyle strategies for reducing the CVD burden in OSA patients.

  18. Expiratory timing in obstructive sleep apnoeas.

    Science.gov (United States)

    Cibella, F; Marrone, O; Sanci, S; Bellia, V; Bonsignore, G

    1990-03-01

    Diaphragmatic electromyogram was recorded during NREM sleep in 4 patients affected by obstructive sleep apnoea (OSA) syndrome in order to evaluate the behaviour of expiratory time (TE) in the course of the obstructive apnoea-ventilation cycle. The two components of TE, i.e. time of post-inspiratory inspiratory activity (TPIIA) and time of expiratory phase 2 (TE2) were separately analysed. TPIIA showed a short duration, with only minor variations, within the apnoea, while its duration was more variable and longer in the interapnoeic periods: the longest TPIIA values were associated with the highest inspiratory volumes in the same breaths. This behaviour seemed regulated according to the need of a more or less effective expiratory flow braking, probably as a result of pulmonary stretch receptors discharge. Conversely TE2 showed a continuous gradual modulation, progressively increasing in the pre-apnoeic period, decreasing during the apnoea and increasing in the post-apnoeic period: these TE2 variations seemed related to oscillations in chemical drive. These data show that TE in the obstructive apnoea-ventilation cycle results from a different modulation in its two components and suggest that both mechanical and chemical influences play a role in its overall duration.

  19. Identifying patients at high risk for obstructive sleep apnoea ...

    African Journals Online (AJOL)

    Background: Obstructive sleep apnoea is associated with significant health consequences. A significant proportion of hospitalized patients at risk for obstructive sleep apnoea were never identified and referred for polysomnography for diagnosis. The objective of this study was to determine the factors associated with high ...

  20. Recommendations for the management of patients with obstructive sleep apnoea and hypertension

    DEFF Research Database (Denmark)

    Parati, Gianfranco; Lombardi, Carolina; Hedner, Jan

    2013-01-01

    Respiratory Society and the European Society of Hypertension. In particular, these recommendations are aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are also aimed at reminding respiration experts...

  1. Long-term screening for sleep apnoea in paced patients: preliminary assessment of a novel patient management flowchart by using automatic pacemaker indexes and sleep lab polygraphy.

    Science.gov (United States)

    Aimé, Ezio; Rovida, Marina; Contardi, Danilo; Ricci, Cristian; Gaeta, Maddalena; Innocenti, Ester; Cabral Tantchou-Tchoumi, Jacques

    2014-10-01

    The primary aim of this pilot study was to prospectively assess a flowchart to screen and diagnose paced patients (pts) affected by sleep apnoeas, by crosschecking indexes derived from pacemakers (minute ventilation sensor on-board) with Sleep-Lab Polygraphy (PG) outcomes. Secondarily, "smoothed" long-term pacemaker indexes (all the information between two consecutive follow-up visits) have been retrospectively compared vs. standard short-term pacemaker indexes (last 24h) at each follow-up (FU) visit, to test their correlation and diagnostic concordance. Data from long-term FU of 61 paced pts were collected. At each visit, the standard short-term apnoea+hypopnoea (PM_AHI) index was retrieved from the pacemaker memory. Patients showing PM_AHI ≥ 30 at least once during FU were proposed to undergo a PG for diagnostic confirmation. Smoothed pacemaker (PM_SAHI) indexes were calculated by averaging the overall number of apnoeas/hypopnoeas over the period between two FU visits, and retrospectively compared with standard PM_AHI. Data were available from 609 consecutive visits (overall 4.64 ± 1.78 years FU). PM_AHI indexes were positive during FU in 40/61 pts (65.6%); 26/40 pts (65%) accepted to undergo a PG recording; Sleep-Lab confirmed positivity in 22/26 pts (84.6% positive predictive value for PM_AHI). A strong correlation (r=0.73) and a high level of concordance were found between smoothed and standard indexes (multivariate analysis, Cohen's-k and Z-score tests). Pacemaker-derived indexes may help in screening paced pts potentially affected by sleep apnoeas. Long-term "smoothed" apnoea indexes could improve the accuracy of pacemaker screening capability, even though this hypothesis must be prospectively confirmed by larger studies. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  2. Patient's experience of treatment for sleep apnoea with a mandibular advancement splint.

    Science.gov (United States)

    Bhamrah, Gurprit; Dhir, Arti; Cash, Alex; Ahmad, Sofia; Winchester, Lindsay J

    2015-10-01

    Obstructive sleep apnoea (OSA) is a well recognised clinical disorder in which there is narrowing and repeated collapse of the upper airway during sleep resulting in the cessation of breathing. Patients with mild to moderate sleep apnoea are often provided with mandibular advancement splint (MAS) therapy as a form of first line or definitive treatment. The aims of this audit were to evaluate patient satisfaction and success of MAS therapy. 93 patients diagnosed with sleep apnoea and suitable for a splint were recruited prospectively at Queen Victoria Hospital, East Grinstead between January 2009 and October 2010. A patient satisfaction questionnaire was developed by health professionals involved in the care of patients with sleep apnoea and assessed for face and content validity and reliability. Participants completed the questionnaire six weeks after the splint was fitted. 44% who previously experienced snoring now reported no snoring and 47% reported less snoring since wearing the MAS appliance. 69% reported complete resolution of sleep apnoea symptoms. 37% experienced aching teeth and 33% experienced having a dry throat when wearing the appliance. 86% of sleeping partners felt that their quality of sleep was improved following their partners treatment. The standards set for each criteria in this audit were met. MAS treatment has a key role to play in the management of obstructive sleep apnoea with high rates of patient satisfaction and the majority of patients partners reporting a significant improvement in their own and their partners sleep quality. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  3. The genetics of obstructive sleep apnoea.

    LENUS (Irish Health Repository)

    Kent, Brian D

    2012-02-01

    PURPOSE OF REVIEW: Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder associated with reduced quality of life and adverse cardiovascular and metabolic sequelae. Recent years have seen an intensification of the research effort to establish the genetic contribution to the development of OSAS and its sequelae. This review explores emerging evidence in this field. RECENT FINDINGS: A genetic basis for sleep-disordered breathing has been demonstrated for discrete disorders such as Treacher-Collins and Down syndromes, but the picture is less clear in so-called idiopathic OSAS. A degree of heritability appears likely in some of the intermediate phenotypes that lead to OSAS, particularly craniofacial morphology. However, only sparse and often contradictory evidence exists regarding the role of specific polymorphisms in causing OSAS in the general population. Similarly, investigations of the cardiovascular sequelae of OSAS have in general failed to consistently find single causative genetic mutations. Nonetheless, evidence suggests a role for tumour necrosis factor-alpha polymorphisms in particular, and large-scale family studies have suggested shared pathogenetic pathways for the development of obesity and OSAS. SUMMARY: As with other common disorders, OSAS is likely to result from multiple gene-gene interactions occurring in a suitable environment. The application of modern genetic investigative techniques, such as genome-wide association studies, may facilitate new discoveries in this field.

  4. Metabolic aspects of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    M. R. Bonsignore

    2009-06-01

    Full Text Available Insulin resistance is often associated with obstructive sleep apnoea syndrome (OSAS and could contribute to cardiovascular risk in OSAS. Sleep loss and intermittent hypoxia could contribute to the pathogenesis of the metabolic alterations associated with obesity, a common feature of OSAS. The biology of the adipocyte is being increasingly studied, and it has been found that hypoxia negatively affects adipocyte function. In November 2007, the European Respiratory Society and two EU COST Actions (Cardiovascular risk in OSAS (B26 and Adipose tissue and the metabolic syndrome (BM0602, held a Research Seminar in Düsseldorf, Germany, to discuss the following: 1 the effects of hypoxia on glucose metabolism and adipocyte function; 2 the role of inflammatory activation in OSAS and obesity; 3 the alarming rates of obesity and OSAS in children; 4 the harmful effects of the metabolic syndrome in OSAS; 5 the effects of OSAS treatment on metabolic variables; and 6 the relationship between daytime sleepiness and hormonal and inflammatory responses. Insulin resistance in skeletal muscle, the role of the endocannabinoid system and novel pharmacological approaches to treat insulin resistance were also discussed. As obesity and hypoxia could be the basic links between OSAS and adipocyte dysfunction, further research is needed to translate these new data into clinical practice.

  5. Arterial stiffness in people with Type 2 diabetes and obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Hvelplund Kristiansen, M; Banghøj, A M; Laugesen, E

    2018-01-01

    AIMS: To examine whether people with Type 2 diabetes with concurrent obstructive sleep apnoea have increased arterial stiffness as compared with people with Type 2 diabetes without obstructive sleep apnoea. METHODS: In a study with a case-control design, 40 people with Type 2 diabetes and treatment......-naïve moderate to severe obstructive sleep apnoea (Apnoea-Hypopnoea Index ≥15) and a control group of 31 people with Type 2 diabetes without obstructive sleep apnoea (Apnoea-Hypopnoea Index ... was not significantly different between participants with Type 2 diabetes with obstructive sleep apnoea and those without obstructive sleep apnoea (10.7±2.2 m/s vs 10.3±2.1 m/s; P=0.513), whereas oscillometric pulse wave velocity was significantly higher in participants with Type 2 diabetes with obstructive sleep...

  6. Positional therapy in sleep apnoea - one fits all? What determines success in positional therapy in sleep apnoea syndrome.

    Directory of Open Access Journals (Sweden)

    Natascha Troester

    Full Text Available Positional therapy is a simple means of therapy in sleep apnoea syndrome, but due to controversial or lacking evidence, it is not widely accepted as appropriate treatment. In this study, we analysed data to positional therapy with regard to successful reduction of AHI and predictors of success.All consecutive patients undergoing polysomnography between 2007 and 2011 were analysed. We used a strict definition of positional sleep apnoea syndrome (supine-exclusive sleep apnoea syndrome and of therapy used. Patients underwent polysomnography initially and during follow-up.1275 patients were evaluated, 112 of which had supine-exclusive sleep apnoea syndrome (AHI 5-66/h, median 13/h, 105 received positional therapy. With this treatment alone 75% (70/105 reached an AHI <5/h, in the follow-up 1 year later 37% (37/105 of these still had AHI<5/h, 46% (43/105 yielded an AHI between 5 and 10/h. Nine patient switched to APAP due to deterioration, 3 wanted to try APAP due to comfort reasons. At the last follow-up, 32% patients (34/105 were still on positional therapy with AHI <5/h. BMI was a predictor for successful reduction of AHI, but success was independent of sex, the presence of obstructive versus central sleep apnoea, severity of sleep apnoea syndrome or co-morbidities.Positional therapy may be a promising therapy option for patients with positional sleep apnoea. With appropriate adherence it yields a reasonable success rate in the clinical routine.

  7. Obstructive sleep apnoea among older patients attending the ...

    African Journals Online (AJOL)

    Aim: To determine the risk of obstructive sleep apnoea and sleep difficulties among older patients attending the geriatric clinic at the University College Hospital (UCH), Ibadan, Nigeria. Methods: The Berlin questionnaires was used to assess the risk of OSA in 843 older patients aged 60 years and above at geriatric clinic, ...

  8. Screening for Sleep Apnoea in Mild Cognitive Impairment: The Utility of the Multivariable Apnoea Prediction Index

    Directory of Open Access Journals (Sweden)

    Georgina Wilson

    2014-01-01

    Full Text Available Purpose. Mild cognitive impairment (MCI is considered an “at risk” state for dementia and efforts are needed to target modifiable risk factors, of which Obstructive sleep apnoea (OSA is one. This study aims to evaluate the predictive utility of the multivariate apnoea prediction index (MAPI, a patient self-report survey, to assess OSA in MCI. Methods. Thirty-seven participants with MCI and 37 age-matched controls completed the MAPI and underwent polysomnography (PSG. Correlations were used to compare the MAPI and PSG measures including oxygen desaturation index and apnoea-hypopnoea index (AHI. Receiver-operating characteristics (ROC curve analyses were performed using various cut-off scores for apnoea severity. Results. In controls, there was a significant moderate correlation between higher MAPI scores and more severe apnoea (AHI: r=0.47, P=0.017. However, this relationship was not significant in the MCI sample. ROC curve analysis indicated much lower area under the curve (AUC in the MCI sample compared to the controls across all AHI severity cut-off scores. Conclusions. In older people, the MAPI moderately correlates with AHI severity but only in those who are cognitively intact. Development of further screening tools is required in order to accurately screen for OSA in MCI.

  9. Obstructive Sleep Apnoea | Gardner | South African Family Practice

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 56, No 2 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Obstructive Sleep Apnoea. BM Gardner. Abstract.

  10. Follow-up of conservatively treated sleep apnoea patients

    African Journals Online (AJOL)

    Health of School Children: Treatment of /ntestinal. Helminths and Schistosomiasis (WHO/GDS/IPI/GTD 92.1). Geneva: WHO, 1992. Accepted 17 June 1994. Follow-up of conservatively treated sleep apnoea patients. P. R. Bartel, J. Verster, P. J. Becker. Polysomnograms have been recorded at our laboratory since 1985 for ...

  11. High-intensity interval training improves obstructive sleep apnoea.

    Science.gov (United States)

    Karlsen, Trine; Nes, Bjarne Martens; Tjønna, Arnt Erik; Engstrøm, Morten; Støylen, Asbjørn; Steinshamn, Sigurd

    2016-01-01

    Three hours per week of vigorous physical activity is found to be associated with reduced odds of sleep-disordered breathing. To investigate whether 12 weeks of high-intensity interval training (HIIT) reduced the apnoea-hypopnea index (AHI) in obese subjects with moderate-to-severe obstructive sleep apnoea. In a prospective randomised controlled exercise study, 30 (body mass index 37±6 kg/m 2 , age 51±9 years) patients with sleep apnoea (AHI 41.5±25.3 events/hour) were randomised 1:1 to control or 12 weeks of supervised HIIT (4×4 min of treadmill running or walking at 90%-95% of maximal heart rate two times per week). In the HIIT group, the AHI was reduced by 7.5±11.6 events/hour (within-group pHIIT improved the AHI and self-reported daytime sleepiness in subjects with obese sleep apnoea without any change in the desaturation index and body weight.

  12. The diagnosis of obstructive sleep apnoea (Pickwickian syndrome)

    International Nuclear Information System (INIS)

    Stark, P.; Aguilar, E.A. Jr.; Robbins, K.T.

    1984-01-01

    Two patients with obstructive sleep apnoea are described and the value of computer tomography in the diagnosis and follow-up is stressed. Narrowing of the oro-pharynx is a major feature in the diagnosis of this condition and is best demonstrated by CT. (orig.) [de

  13. Obstructive Sleep Apnoea | Gardner | South African Family Practice

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 56, No 5 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Obstructive Sleep Apnoea. BM Gardner. Abstract.

  14. Radiofrequency vs laser in the management of mild to moderate obstructive sleep apnoea: does the number of treatment sessions matter?

    Science.gov (United States)

    Atef, Ahmed; Mosleh, Mohammed; Hesham, Mohammed; Fathi, Ahmed; Hassan, Mohammed; Fawzy, Mahmoud

    2005-11-01

    Obstructive sleep apnea (OSA) is a relatively common and serious problem with many medical and social consequences. Laser and radiofrequency are two recent techniques used to treat OSA and they can be carried out under local anaesthesia, but they need multiple sessions to achieve satisfactory outcome and are associated with better short-term than long-term outcomes. In this work we compare the two modalities as regards the optimal number of treatment sessions needed to achieve a favourable outcome in the short and long term. A total of 150 patients with apnoea hypopnoea index (AHI) between 5 and 30 events per hour, no morbid obesity and retropalatal site of obstruction were included in this prospective study. Patients were randomly and equally divided into two groups, each comprising 75 patients. The first group was treated with bipolar radiofrequency volumetric tissue reduction of the palate (BRVTR) and the second group was treated with laser-assisted uvulopalatoplasty (LAUP). Each group was further subdivided into five subgroups each consisting of 15 patients. The first group received one treatment session, the second received two sessions, the third received three sessions, the fourth received four sessions and the fifth group received five treatment sessions. Evaluation of efficiency of both techniques in treating OSA was assessed objectively by polysomnography. In those treated with BRVTR; at least three sessions were needed to achieve a favourable outcome in OSA in the short and long term. In those treated with LAUP, a single treatment session was enough to achieve a favourable outcome on OSA in the short term, while two sessions were needed to achieve the same long-term outcome. In OSA, fewer treatment sessions are needed with LAUP (one session) than with BRVTR (three sessions) to achieve a favourable outcome. In LAUP more treatment sessions (two) are needed to maintain a longer-term favourable outcome than those needed to achieve short-term favourable

  15. Obstructive sleep apnoea syndrome in children and anaesthesia

    Directory of Open Access Journals (Sweden)

    A Rudra

    2010-01-01

    Full Text Available Obstructive sleep apnoea syndrome (OSAS is a common medical disorder among adults, which is increasingly being recognized in children too. It is a breathing disorder characterized by upper airway obstruction with or without intermittent complete obstruction that disrupts normal breathing during sleep. Anatomical and neuromuscular disorders are mainly responsible for this disorder. This disorder leads to a state of chronic hypoxemia, which has significant cardiac, pulmonary and central nervous system implications. Diagnosis of OSAS is based on thorough history and clinical examination along with appropriate sleep studies including polysomnography. The mainstay of treatment of paediatric OSAS is adenotonsillectomy. Good anaesthetic practice in Paediatric patients with OSAS revolves around good and ideal airway management. Early detection of airway obstruction, intense monitoring to warn of impending airway problems and appropriate and early intervention of airway compromise are good anaesthetic practices. Coexisting medical problems should be adequately addressed and safe analgesic techniques in the perioperative period go towards improving outcomes in patients with paediatric OSAS.

  16. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial.

    Science.gov (United States)

    Isetta, Valentina; Negrín, Miguel A; Monasterio, Carmen; Masa, Juan F; Feu, Nuria; Álvarez, Ainhoa; Campos-Rodriguez, Francisco; Ruiz, Concepción; Abad, Jorge; Vázquez-Polo, Francisco J; Farré, Ramon; Galdeano, Marina; Lloberes, Patricia; Embid, Cristina; de la Peña, Mónica; Puertas, Javier; Dalmases, Mireia; Salord, Neus; Corral, Jaime; Jurado, Bernabé; León, Carmen; Egea, Carlos; Muñoz, Aida; Parra, Olga; Cambrodi, Roser; Martel-Escobar, María; Arqué, Meritxell; Montserrat, Josep M

    2015-11-01

    Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). NCT01716676. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go

  17. Obstructive Sleep Apnoea Syndrome and Weight Loss: Review

    Directory of Open Access Journals (Sweden)

    Douglas C. Cowan

    2012-01-01

    Full Text Available Obstructive sleep apnoea (OSA syndrome is common, and obesity is a major risk factor. Increased peripharyngeal and central adiposity result in increased pharyngeal collapsibility, through increased mechanical loading around the upper airway, reduced tracheal traction on the pharynx, and reduced neuromuscular activity, particularly during sleep. Significant and sustained weight loss, if achieved, is likely to be a useful therapeutic option in the management of OSA and may be attempted by behavioural, pharmacological, and surgical approaches. Behavioural therapy programs that focus on aspects such as dietary intervention, exercise prescription patients and general lifestyle counselling have been tested. Bariatric surgery is an option in the severely obese when nonsurgical measures have failed, and laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass are the most commonly employed techniques in the United Kingdom. Most evidence for efficacy of surgery comes from cohort studies. The role of sibutramine in OSA in the obese patients has been investigated, however, there are concerns regarding associated cardiovascular risk. In this paper the links between obesity and OSA are discussed, and the recent studies evaluating the behavioural, pharmacological and surgical approaches to weight loss in OSA are reviewed.

  18. Novel method for detection of Sleep Apnoea using respiration signals

    DEFF Research Database (Denmark)

    Nielsen, Kristine Carmes; Kempfner, Lykke; Sørensen, Helge Bjarup Dissing

    2014-01-01

    desaturations > 3%, extracted from the thorax and abdomen respiration effort belts, and the oxyhemoglobin saturation (SaO2), fed to an Elastic Net classifier and validated according to American Academy of Sleep Medicine (AASM) using the patients' AHI value. The method was applied to 109 patient recordings......Polysomnography (PSG) studies are considered the “gold standard” for the diagnosis of Sleep Apnoea (SA). Identifying cessations of breathing from long-lasting PSG recordings manually is a labour-intensive and time-consuming task for sleep specialist, associated with inter-scorer variability...

  19. Sexual function in male patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Petersen, Marian; Kristensen, Ellids; Berg, Søren

    2010-01-01

    OBJECTIVE: Our objective was to investigate general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA) and compare the results with normative data. MATERIALS AND METHODS: We investigated 308 male patients (age 30-69) admitted to a sleep...... of sexuality were worse in patients with (untreated) OSA when compared with normative data. Both aspects were dependent on age, obesity, social factors and concomitant medication but not on the severity of OSA as reflected by the apnoea-hypopnoea index or subjective sleepiness. CONCLUSION: We conclude...... that although sexual dysfunction is more prevalent in OSA patients than in the general population, it is a complex problem relating more to age, obesity, social factors and comorbidity than to the severity of OSA....

  20. Ventilatory support and pharmacological treatment of patients with central apnoea or hypoventilation during sleep

    Directory of Open Access Journals (Sweden)

    D. Pevernagie

    2007-12-01

    Full Text Available The concept of central sleep apnoea or hypoventilation encompasses hypercapnic central hypoventilation, such as obesity hypoventilation syndrome and eucapnic or hypocapnic central sleep apnoea. Among subjects with eucapnic or hypocapnic central sleep apnoea, several therapeutic options are available for those with Cheyne–Stokes respiration (CSR. CSR is frequent in patients with New York Heart Association stage III and IV chronic heart failure, and in various neurological disorders. In these patients, treatment modalities include optimising cardiac condition and drugs, such as theophylline, acetazolamide and/or oxygen. Ventilatory support, such as nasal continuous positive airway pressure (CPAP, bi-level pressure support, or adaptive servo-ventilation (ASV, has been shown to improve CSR in patients with cardiac failure; however, convincing evidence that nasal CPAP improves life expectancy in these patients is lacking. Nevertheless, the treatment of associated obstructive sleep-disordered breathing is indicated per se, as it may improve cardiac function. There is currently no proof that bi-level ventilation is superior to nasal CPAP. The few available studies that have focused on ASV have shown satisfactory control of CSR in cardiac failure patients. While ASV is not a first-line treatment choice, it appears to be superior to oxygen, CPAP and bi-level pressure ventilation in controlling the apnoea/hypopnea index and probably sleep fragmentation. As yet there are no data on mortality and, as such, firm conclusions cannot be drawn as to the role of ASV in the management of cardiac failure patients suffering from CSR. Obesity-related hypoventilation has increased dramatically over recent decades due to the epidemic increase in obesity in the developed countries. Obesity hypoventilation syndrome predisposes to the development of pulmonary hypertension and cor pulmonale. Noninvasive home ventilation is increasingly applied in obese patients with

  1. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy

    DEFF Research Database (Denmark)

    Lamberts, Morten; Nielsen, O W; Lip, G Y H

    2014-01-01

    BACKGROUND: The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously. METHODS: Using nationwide databases, the entire Danish population was followed from 2000 until 2011. First......-time sleep apnoea diagnoses and use of CPAP therapy were determined. Incidence rate ratios (IRRs) of ischaemic stroke and myocardial infarction (MI) were analysed using Poisson regression models. RESULTS: Amongst 4.5 million individuals included in the study, 33 274 developed sleep apnoea (mean age 53, 79......% men) of whom 44% received persistent CPAP therapy. Median time to initiation of CPAP therapy was 88 days (interquartile range 34-346). Patients with sleep apnoea had more comorbidities compared to the general population. Crude rates of MI and ischaemic stroke were increased for sleep apnoea patients...

  2. Sleep apnoea and driving: how can this be dealt with?

    Directory of Open Access Journals (Sweden)

    J. Krieger

    2007-12-01

    Full Text Available Excessive daytime sleepiness has long been known to be associated with an increased risk of often particularly severe traffic accidents. Obstructive sleep apnoea (OSA is among the most prevalent conditions leading to excessive daytime sleepiness, in addition to impaired cognitive function, both of which are likely to impair driving ability. An increased risk of traffic accidents has been demonstrated repeatedly, in association with OSA, as well its normalisation with effective treatment. However, it seems that not all patients are at equal risk, but it is not clear how to identify when and how at-risk patients can be identified. Nevertheless, some European countries have made specific regulations concerning OSA and/or excessive daytime sleepiness and the capacity to obtain or to keep a driving license. Most countries have the general rule that "a driving license should not be given or renewed to any candidate or license holder suffering from a disorder ... likely to compromise safety on the road", without a specific mention of sleepiness and/or sleep apnoea. However, the way in which such a statement is applied and the measures taken to identify unfit drivers vary greatly from country to country. In addition, in those countries that have made specific regulations, no evaluation of their efficacy in reducing sleepiness-related accidents is available. In practice, it is the physician's responsibility to inform the untreated obstructive sleep apnoea patient about the risk associated with their condition, and about the regulations that prevail in their country, if relevant; only in a few countries, is the physician allowed (or compelled to report the unfit patient to the licensing authorities. Although it is generally accepted that the treated patient may be allowed to drive, the specific treatment conditions that eliminate the risk are not clearly established.

  3. Arterial alterations in severely obese children with obstructive sleep apnoea.

    Science.gov (United States)

    Dubern, Beatrice; Aggoun, Yacine; Boulé, Michèle; Fauroux, Brigitte; Bonnet, Damien; Tounian, Patrick

    2010-05-03

    Obstructive sleep apnoea (OSA) in obese adults is associated with cardiovascular disease independently of obesity. Vascular alterations exist in children with obesity and may constitute the first stage in the development of adulthood cardiovascular disease. To investigate the relationship between OSA and early arterial alterations in obese children. Cross-sectional study of a prospective cohort. A total of 51 children with severe obesity managed at a teaching hospital outpatient clinic. Polysomnography was performed. We measured the intima-media thickness and incremental elastic modulus (Einc) to assess the mechanical characteristics of the common carotid artery. Arterial endothelial function was evaluated by measuring flow-mediated dilation and glyceryl trinitrate-mediated dilation (GTNMD) of the brachial artery. A total of 24 (47%) children had a desaturation index (DI) >10/h and 7 (14%) had a respiratory event index >10/h. DI >10/h was associated with significantly higher values of Einc (4.0 + or - 0.5 vs. 2.4 + or - 0.4 mm Hg(-1) x 10(3), p=0.003) and GTNMD (18.0 + or - 1.1 vs. 14.1 + or - 1.0 %, p=0.02) after adjustment for age, sex, body mass index, fasting insulin, and leptin. In the univariate analysis, GTNMD correlated positively with DI (r=0.14, p=0.02) after adjustment for age, sex, fasting insulin and leptin. By multivariate analysis with BMI as an additional independent variable, both GTNMD and Einc correlated significantly with DI (beta=0.4, p=0.02 and beta=0.27, p=0.04, respectively). OSA in children is associated with arterial alterations independently from obesity. The increased vasodilation in response to glyceryl trinitrate reflects pre-existing vasoconstriction probably induced by intermittent hypoxia. OSA should be detected early in children with severe obesity.

  4. Pink Masks: Obstructive Sleep Apnoea and the Sociology of Diagnosis

    Directory of Open Access Journals (Sweden)

    SHARON HANCOCK

    2013-01-01

    Full Text Available The sociology of diagnosis takes a new look at diagnostic categories, the means by which they are delivered, and the social consequences of diagnosis for patient and professional alike. Considering the social elements which contribute to the recognition of disease categories and their consequences highlights important phenomena which can enrich the thinking of nurses regardless of whether or not they diagnose as part of their practice. However, the principles of the sociology of diagnosis, while widely debated in academe, have yet to penetrate nursing literature. In this discussion article, we use obstructive sleep apnoea in women as an exemplar to illustrate how a clearly material, pathophysiological disorder has, nonetheless, significant social “content.” We demonstrate the social structures and interests which shape obstructive sleep apnoea as a male disease, and the risks, paradoxically, of both under- and over-diagnosis that arise from this social construction. We use this example to exhort nurses to consider how the social and the biological intermesh and shape how we perceive disease and its impact. This should open the door for more responsive and responsible health care.

  5. Apnoeic-hypopnoeic episodes during obstructive sleep apnoea are associated with histological nonalcoholic steatohepatitis.

    Science.gov (United States)

    Mishra, Poonam; Nugent, Clarke; Afendy, Arian; Bai, Chunhong; Bhatia, Priya; Afendy, Mariam; Fang, Yun; Elariny, Hazem; Goodman, Zachary; Younossi, Zobair M

    2008-09-01

    Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnoea are associated with metabolic syndrome and atherosclerotic heart disease. This study evaluates the potential association between the NAFLD subtypes and a number of polysomnographical (PSG) parameters. This study included patients undergoing bariatric surgery with extensive clinical and histological data for whom complete PSG data before surgery were also available. Excess alcohol intake and other causes of liver disease were excluded. Apnoea, hypopnoea and apnoea-hypopnoea index (AHI) were calculated as described previously. In this study, a total of 101 patients [77 nonalcoholic steatohepatitis (NASH) and 22 non-NASH controls] with PSG data were included (age 42.9 +/- 11.4 years, body mass index 51.6 +/- 9.5 kg/m(2), fasting serum glucose 117.4 +/- 53.4 mg/dl, fasting serum triglycerides 171.3 +/- 82.9 mg/dl, 58% hypertension and 33% diabetes mellitus). Subjects with histological NASH had significantly lower lowest desaturation (77 vs. 85%, P=0.006), lower mean nocturnal oxygen saturation (91 vs. 93%, P=0.05), higher AHI (35 vs. 22, P=0.03), higher respiratory disturbance index (46 vs. 21, P=0.02) and higher alanine aminotransferase/aspartate aminotransferase ratio (1.4 vs. 1.3, P=0.05) compared with non-NASH controls. In multivariate analysis, the lowest desaturation (P=0.04) was independently associated with histological NASH. Lowest desaturation and mean nocturnal oxygen saturation were significantly lower in subjects with fibrosis (76 vs. 85%, P=0.004 and 90.4 vs. 93.0%, P=0.02). Our results suggest that the frequent nocturnal hypoxic episodes in NAFLD patients may be a risk factor for developing NASH. Additional studies are needed to study the effect of optimizing sleep apnoea management on the outcomes of patients with NAFLD.

  6. Sleep apnoea syndromes and the cardiovascular system.

    Science.gov (United States)

    Pepperell, Justin C

    2011-06-01

    Management of SAS and cardiovascular disease risk should be closely linked. It is important to screen for cardiovascular disease risk in patients with SAS and vice versa. CSA/CSR may be improved by ventilation strategies in heart failure, but benefit remains to be proven. For OSA, although CPAP may reduce cardiovascular disease risk, its main benefit is symptom control. In the longer-term, CPAP should be used alongside standard cardiovascular risk reduction strategies including robust weight management programmes, with referral for bariatric surgery in appropriate cases. CPAP and NIV should be considered for acute admissions with decompensated cardiac failure.

  7. A simple procedure for measuring pharyngeal sensitivity: a contribution to the diagnosis of sleep apnoea

    OpenAIRE

    Dematteis, M; Levy, P; Pepin, J

    2005-01-01

    Background: Patients with severe apnoea may have an impaired pharyngeal dilating reflex related to decreased pharyngeal sensitivity. The accuracy of a simple new procedure to measure pharyngeal sensitivity and to diagnose sleep disordered breathing (SDB) was investigated.

  8. Risk of obstructive sleep apnoea syndrome among in-patients at a ...

    African Journals Online (AJOL)

    We screened for risk of OSA among in-patients with severe mental illness to determine its prevalence ... Keywords: obstructive sleep apnoea; severe mental illness; Nigeria, in-patients .... a physical co-morbidity which was hypertension, none.

  9. Pharyngeal shape and dimensions in healthy subjects, snorers, and patients with obstructive sleep apnoea.

    OpenAIRE

    Rodenstein, D O; Dooms, G; Thomas, Y; Liistro, G; Stanescu, D C; Culée, C; Aubert-Tulkens, G

    1990-01-01

    To characterise the relation between pharyngeal anatomy and sleep related disordered breathing, 17 men with complaints of snoring were studied by all night polysomnography. Ten of them had obstructive sleep apnoea (mean (SD) apnoea-hypopnoea index 56.3 (41.7), age 52 (10) years, body mass index 31.4 (5.3) kg/m2); whereas seven were simple snorers (apnoea-hypopnoea index 6.7 (4.6), age 40 (17) years, body mass index 25.9 (4.3) kg/m2). The pharynx was studied by magnetic resonance imaging in al...

  10. Compliance with CPAP therapy in patients with the sleep apnoea/hypopnoea syndrome.

    OpenAIRE

    Engleman, H. M.; Martin, S. E.; Douglas, N. J.

    1994-01-01

    BACKGROUND--Continuous positive airway pressure (CPAP) therapy is the treatment of choice for the sleep apnoea/hypopnoea syndrome. Compliance with this relatively obtrusive therapy has not been well studied. METHODS--Usage of CPAP was investigated in 54 patients with sleep apnoea/hypopnoea syndrome (median 36 (range 7-129) apnoeas + hypopnoeas/hour slept) over the first 1-3 months after starting CPAP therapy. In all cases CPAP usage was monitored by hidden time clocks that indicated for how l...

  11. Can you die from obstructive sleep apnoea syndrome (OSAS)?

    LENUS (Irish Health Repository)

    O'Carroll, G

    2015-02-01

    Studies suggest an independent association between Obstructive Sleep Apnoea Syndrome (OSAS) and cardiovascular death. The purpose of our study is to examine doctors\\' awareness of this association and to determine whether this correlates with recording of OSAS on death certificates. We contacted the Central Statistics Office (CSO) and obtained relevant mention of OSAS on death certificates. We surveyed doctors on their view of OSAS-related deaths, CSO data from 2008-2011 reveal two deaths with OSAS documented as a direct cause and 52 deaths with OSAS as a contributory cause. Seventy-five doctors\\' surveyed (41%) believe OSAS can be a direct cause of death and 177 (96%) believe OSAS can be an indirect cause of death. Only 22 (12%) had putdown OSAS as a cause of death. OSAS is seldom recorded on death certificates. This is at odds with epidemiological forecasts and contrary to an opinion poll from a selection of doctors.

  12. Intermittent hypoxia, cardiovascular disease and obstructive sleep apnoea.

    Science.gov (United States)

    Turnbull, Chris D

    2018-01-01

    Obstructive sleep apnoea (OSA) is a common disorder and is associated with cardiovascular disease. Continuous positive airway pressure (CPAP), whilst reducing blood pressure, has not been shown to reduce cardiovascular events when used as a treatment solely for this purpose in patients with previous cardiovascular disease. Developing a better understanding of the mechanisms underlying cardiovascular disease in OSA is important to develop new treatments. Potential causative mechanisms for cardiovascular disease in OSA include arousal induced sympathetic activation, large intrathoracic pressure swings leading to shear stress on the heart and great vessels, and intermittent hypoxia (IH). This review discusses the role of IH, as a major physiological consequence of OSA, in the development of cardiovascular disease.

  13. Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study.

    Science.gov (United States)

    Elhennawi, D M; Ahmed, M R; Abou-Halawa, A S

    2016-12-01

    To study the correlation of obstructive sleep apnoea (OSA) and laryngopharyngeal reflux (LPR). A descriptive study. Suez Canal University Hospital, Ismailia, Egypt. 62 patients with polysomnography confirmed OSA. Patients were evaluated with ambulatory 24-h double channel pH monitoring. Mean reflux symptom index in the study group was 9 ± 5.5, and it was > 13 in all patients with severe OSA. Signs of LPR reflux were present in 34 (55%) patients. Abnormal reflux was detected in the distal oesophagus in 41 patients (66%) and in the proximal oesophagus in 21 patients (34%). Patients with severe OSA had significantly higher nocturnal LPR reflux episodes compared to patients with mild disease (P .05). LPR is common in patients with OSA. Patients with severe OSA have significantly higher nocturnal LPR. This should be considered when treating this group of patients. © 2016 John Wiley & Sons Ltd.

  14. Sleep apnoea during upper respiratory infection and metabolic alkalosis in infancy.

    Science.gov (United States)

    Abreu e Silva, F A; MacFadyen, U M; Williams, A; Simpson, H

    1986-01-01

    Three to four hour polygraphic sleep studies were carried out in 10 infants, five with upper respiratory infection and five with metabolic alkalosis secondary to vomiting during and after recovery from illness. During upper respiratory infection, the main abnormality detected was brief (greater than 3 less than 6 seconds) or prolonged (greater than 6 seconds) attacks of obstructive apnoea. Other indices of apnoea were similar to recovery data. Gross body movements were also increased. In infants with metabolic alkalosis indices of central apnoea were significantly increased when compared with recovery or case control data. Prolonged (greater than 15 seconds) attacks of central apnoea and obstructive apnoea (greater than 6 seconds) were only observed during illness. Gross body movements and periodic breathing were also increased. These findings suggest that the functional consequences of apparently 'mild' illnesses in young infants may be greater than is generally suspected and perhaps relevant to mechanism(s) of death in sudden infant death syndrome. PMID:3789786

  15. Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012.

    Science.gov (United States)

    Laitinen, L A; Anttalainen, U; Pietinalho, A; Hämäläinen, P; Koskela, K

    2003-04-01

    (1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients

  16. Quantifying the ventilatory control contribution to sleep apnoea using polysomnography.

    Science.gov (United States)

    Terrill, Philip I; Edwards, Bradley A; Nemati, Shamim; Butler, James P; Owens, Robert L; Eckert, Danny J; White, David P; Malhotra, Atul; Wellman, Andrew; Sands, Scott A

    2015-02-01

    Elevated loop gain, consequent to hypersensitive ventilatory control, is a primary nonanatomical cause of obstructive sleep apnoea (OSA) but it is not possible to quantify this in the clinic. Here we provide a novel method to estimate loop gain in OSA patients using routine clinical polysomnography alone. We use the concept that spontaneous ventilatory fluctuations due to apnoeas/hypopnoeas (disturbance) result in opposing changes in ventilatory drive (response) as determined by loop gain (response/disturbance). Fitting a simple ventilatory control model (including chemical and arousal contributions to ventilatory drive) to the ventilatory pattern of OSA reveals the underlying loop gain. Following mathematical-model validation, we critically tested our method in patients with OSA by comparison with a standard (continuous positive airway pressure (CPAP) drop method), and by assessing its ability to detect the known reduction in loop gain with oxygen and acetazolamide. Our method quantified loop gain from baseline polysomnography (correlation versus CPAP-estimated loop gain: n=28; r=0.63, p<0.001), detected the known reduction in loop gain with oxygen (n=11; mean±sem change in loop gain (ΔLG) -0.23±0.08, p=0.02) and acetazolamide (n=11; ΔLG -0.20±0.06, p=0.005), and predicted the OSA response to loop gain-lowering therapy. We validated a means to quantify the ventilatory control contribution to OSA pathogenesis using clinical polysomnography, enabling identification of likely responders to therapies targeting ventilatory control. Copyright ©ERS 2015.

  17. [The Overlap Syndrome: association of COPD and Obstructive Sleep Apnoea].

    Science.gov (United States)

    Weitzenblum, E; Chaouat, A; Kessler, R; Canuet, M; Hirschi, S

    2010-04-01

    Chronic obstructive pulmonary disease (COPD) and the obstructive sleep apnoea-hypopnoea syndrome (OSAHS) are both common diseases affecting respectively 10 and 5% of the adult population over 40 years of age. Their coexistence, which is denominated "Overlap Syndrome", can be expected to occur in about 0.5% of this population. Two recent epidemiologic studies have shown that the prevalence of OSAHS is not higher in COPD than in the general population, and that the coexistence of the two conditions is due to chance and not through a pathophysiological linkage. Patients with "overlap" have a higher risk of sleep-related O(2) desaturation than do patients with COPD alone and the same degree of bronchial obstruction. They have an increased risk of developing hypercapnic respiratory failure and pulmonary hypertension when compared with patients with OSAHS alone and with patients with "usual" COPD. In patients with overlap, hypoxaemia, hypercapnia, and pulmonary hypertension can be observed in the presence of mild to moderate bronchial obstruction, which is different from "usual" COPD. Treatment of the overlap syndrome consists of nasal continuous positive airway pressure or nocturnal non-invasive ventilation (NIV), with or without nocturnal O(2). Patients who are markedly hypoxaemic during the daytime (PaO(2)<55-60 mmHg) should be given conventional long-term O(2) therapy in addition to nocturnal ventilation. Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  18. Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates.

    Science.gov (United States)

    Vizzardi, Enrico; Sciatti, Edoardo; Bonadei, Ivano; D'Aloia, Antonio; Curnis, Antonio; Metra, Marco

    2017-07-01

    Obstructive sleep apnoea-hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately. We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias', 'OSAH arrhythmias' and 'OSA arrhythmias'. We analyse 1298 articles and meta-analyses, excluding already edited reviews. Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH. Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients.

  19. Sleep. 5: Driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoea syndrome.

    Science.gov (United States)

    George, C F P

    2004-09-01

    Driving is a complex task involving distinct cognitive, perceptual, motor, and decision making skills. After placing the vehicle on the road, the driver must constantly survey the ever changing roadway environment to keep the vehicle in the lane and moving at an appropriate safe speed. This surveillance involves two distinct visual tasks: estimating and responding to the oncoming curvature and controlling lane position. Driving is therefore a divided attention task involving speed and lane control as well as monitoring. To do this in a safe manner requires careful attention and alertness which can be problematic for patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) or other sleep disorders.

  20. Effect of CPAP on arterial stiffness in severely obese patients with obstructive sleep apnoea.

    Science.gov (United States)

    Seetho, Ian W; Asher, Rebecca; Parker, Robert J; Craig, Sonya; Duffy, Nick; Hardy, Kevin J; Wilding, John P H

    2015-12-01

    Obstructive sleep apnoea (OSA) may independently increase cardiovascular risk in obesity. Although there is evidence that arterial stiffness is altered in OSA, knowledge of these effects with continuous positive airway pressure (CPAP) in severe obesity (body mass index (BMI) ≥ 35 kg/m(2)) is limited. This study aimed to explore how arterial stiffness, as measured by the augmentation index (Aix), changed in severely obese patients with OSA who were treated with CPAP and in patients without OSA. Forty-two patients with severe obesity-22 with OSA, 20 without OSA-were recruited at baseline and followed-up after a median of 13.5 months. Pulse wave analysis (PWA) was performed using applanation tonometry at the radial artery to measure augmentation index (Aix), augmentation pressure (AP) and subendocardial viability ratio (SEVR). Cardiovascular parameters and body composition were also measured. There were significant improvements in Aix, AP (both P CPAP compared with subjects without OSA. Epworth scores (P CPAP. Regression showed that CPAP was significantly associated with change in arterial stiffness from baseline. However, patients with OSA on CPAP continued to have increased arterial stiffness (Aix) (P CPAP in severe obesity, CPAP alone is not sufficient to modify PWA measures to levels comparable with non-OSA patients. This supports a need for a multifaceted approach when managing cardiovascular risk in patients with severe obesity and obstructive sleep apnoea receiving CPAP therapy.

  1. Severe obstructive sleep apnoea syndrome in an adult patient with Laron syndrome.

    Science.gov (United States)

    Dagan, Y; Abadi, J; Lifschitz, A; Laron, Z

    2001-08-01

    A 68 year old patient with Laron syndrome (primary growth hormone (GH) resistance-insensitivity due to a molecular defect of the GH receptor) and severe obstructive sleep apnoea syndrome is described. Treatment with continuous positive air pressure therapy resulted in improved nocturnal sleep, daytime alertness and cognitive functions. Copyright 2001 Harcourt Publishers Ltd.

  2. Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe

    DEFF Research Database (Denmark)

    Alonderis, A.; Barbee, F.; Bonsignore, M.

    2008-01-01

    Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulati......Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license...... sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries...... it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea...

  3. Sleep apnoea and driving risk: the need for regulation

    Directory of Open Access Journals (Sweden)

    Walter T. McNicholas

    2015-12-01

    Full Text Available Obstructive sleep apnoea syndrome (OSAS is a highly prevalent chronic respiratory disorder with prevalence among adult males of ≥10%. The most common daytime symptom associated with OSAS is excessive sleepiness, which in more severe manifestations can result in sleepiness at the wheel while driving and probably contributes to the substantial increase in accident risk among patients with OSAS. Fortunately, current evidence indicates that successful therapy of OSAS, particularly with continuous positive airway pressure, can bring the accident risk down to levels similar to an equivalent general population. The recognition of the increased driving accident risk in OSAS prompted the Transport and Mobility Directorate of the European Commission to establish a working group on this topic in 2012, which ultimately led to a revision of Annex III of the EU Driving Licence Directive, which is subject to mandatory implementation by European Union member states by December 2015. This directive specifies that patients with moderate or severe OSAS associated with significant daytime sleepiness should be prohibited from driving until effective therapy is established. These new regulations are designed to balance the legitimate objective of public safety with not penalising OSAS patients who are complying with effective therapy. Successful implementation of regulations on driving in OSAS patients must also include measures to educate relevant stakeholders including patients, medical personnel, traffic police and employers in the transport industry. The key objective is to encourage patients with possible OSAS to seek diagnosis and treatment and not to inhibit OSAS patients from coming forward.

  4. Sleep apnoea and driving risk: the need for regulation.

    Science.gov (United States)

    McNicholas, Walter T; Rodenstein, Daniel

    2015-12-01

    Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent chronic respiratory disorder with prevalence among adult males of ≥10%. The most common daytime symptom associated with OSAS is excessive sleepiness, which in more severe manifestations can result in sleepiness at the wheel while driving and probably contributes to the substantial increase in accident risk among patients with OSAS. Fortunately, current evidence indicates that successful therapy of OSAS, particularly with continuous positive airway pressure, can bring the accident risk down to levels similar to an equivalent general population. The recognition of the increased driving accident risk in OSAS prompted the Transport and Mobility Directorate of the European Commission to establish a working group on this topic in 2012, which ultimately led to a revision of Annex III of the EU Driving Licence Directive, which is subject to mandatory implementation by European Union member states by December 2015. This directive specifies that patients with moderate or severe OSAS associated with significant daytime sleepiness should be prohibited from driving until effective therapy is established. These new regulations are designed to balance the legitimate objective of public safety with not penalising OSAS patients who are complying with effective therapy. Successful implementation of regulations on driving in OSAS patients must also include measures to educate relevant stakeholders including patients, medical personnel, traffic police and employers in the transport industry. The key objective is to encourage patients with possible OSAS to seek diagnosis and treatment and not to inhibit OSAS patients from coming forward. Copyright ©ERS 2015.

  5. EVALUATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA - OVERLAP SYNDROME

    Directory of Open Access Journals (Sweden)

    Vaddadi Sailendra

    2016-09-01

    Full Text Available BACKGROUND The drop in oxygen saturation during sleep is more than during exercise and patients of COPD who spend more time in sleeping. Significant sleep desaturation and the sleep disturbances are greater in overlap syndrome than in OSA alone. The present study is conducted in Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, to find the prevalence of obstructive sleep apnoea in the patients with COPD. AIMS The present study was a cross-sectional study prospectively carried out with an aim to evaluate the breathing disorders during sleep in patients with COPD and to correlate these disorders with the stage of the disease. SETTINGS AND DESIGN The study Cohort was constituted by patients of COPD registered into Chest OPD or admitted in Indoor units of Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, from July 2014 to May 2016. A total of thirty six consecutive COPD patients who consented to be enrolled into the study were classified into Mild, Moderate and Severe stages based on the Indian Guidelines for the management of COPD. METHODS AND MATERIAL Spirometric evaluation and bronchial reversibility testing was conducted in all the patients. Arterial Blood Gas Analysis was done using ABL3 arterial blood gas analyser (Radiometer, Copenhagen. POLYSOMNOGRAPHY Patients were hooked to Compumedics ProFusion Polysomnographic Machine (Compumedics Private Limited 2001, USA, by standard gold cups/electrodes. Thereafter, the patients were subjected to a full night sleep study (Overnight polysomnography. The electrode and sensor connection system utilises E-series EEG/PSG system in order to record the PSG study. The impedance of electrodes was checked and set to <10. A total of 20 leads were utilised for the study. The various parameters monitored included Electroencephalogram (EEG, Electro-oculogram (EOG, Electrocardiogram (ECG, chin and leg Electromyogram (EMG

  6. Neurocognitive function in obstructive sleep apnoea: a meta-review.

    Science.gov (United States)

    Bucks, Romola S; Olaithe, Michelle; Eastwood, Peter

    2013-01-01

    Adult obstructive sleep apnoea (OSA) is associated with cognitive dysfunction. While many review articles have attempted to summarize the evidence for this association, it remains difficult to determine which domains of cognition are affected by OSA. This is because of marked differences in the nature of these reviews (e.g. many are unsystematic) and the many different tasks and domains assessed. This paper addresses this issue by comparing the results of only systematic reviews or meta-analyses assessing the effects of OSA on cognition, the relationship between OSA severity and cognition, and/or the effects of treatment on cognition in OSA. Electronic databases and hand-searching were undertaken to select reviews that reported on these areas. We found 33 reviews; five reviews met predetermined, stringent selection criteria. The majority of reviews supported deficits in attention/vigilance, delayed long-term visual and verbal memory, visuospatial/constructional abilities, and executive function in individuals with OSA. There is also general agreement that language ability and psychomotor function are unaffected by OSA. Data are equivocal for the effects of OSA on working memory, short-term memory and global cognitive functioning. Attention/vigilance dysfunction appears to be associated with sleep fragmentation and global cognitive function with hypoxaemia. Continuous positive airway pressure treatment of OSA appears to improve executive dysfunction, delayed long-term verbal and visual memory, attention/vigilance and global cognitive functioning. In order to improve our understanding of cognitive dysfunction in OSA, future research should pay particular attention to participant characteristics, measures of disease severity and choice of neuropsychological tests. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

  7. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis.

    Science.gov (United States)

    Simou, Evangelia; Britton, John; Leonardi-Bee, Jo

    2018-02-01

    A systematic review and meta-analysis of the association between alcohol consumption and risk of sleep apnoea in adults. We searched Medline, EMBASE and Web of Science databases from 1985 to 2015 for comparative epidemiological studies assessing the relation between alcohol consumption and sleep apnoea. Two authors independently screened and extracted data. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was quantified using I 2 and explored using subgroup analyses based on study exposure and outcome measures, quality, design, adjustment for confounders and geographical location. Publication bias was assessed using a funnel plot and Egger's test. We identified 21 studies from which estimates of relative risk could be obtained. Meta-analysis of these estimates demonstrated that higher levels of alcohol consumption increased the risk of sleep apnoea by 25% (RR 1.25, 95%CI 1.13-1.38, I 2  = 82%, p Country locations. We detected evidence of publication bias (p = 0.001). A further eight included studies reported average alcohol consumption in people with and without sleep apnoea. Meta-analysis revealed that mean alcohol intake was two units/week higher in those with sleep apnoea, but this difference was not statistically significant (p = 0.41). These findings suggest that alcohol consumption is associated with a higher risk of sleep apnoea, further supporting evidence that reducing alcohol intake is of potential therapeutic and preventive value in this condition. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Flextube reflectometry and pressure recordings for level diagnosis in obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Faber, C E; Grymer, L; Hilberg, O

    2002-01-01

    The objective of this study was to compare sound reflections in a flexible tube (flextube reflectometry) with pressure-catheter recordings (ApneaGraph) for identifying the predominant obstructive level of the upper airway during sleep. Seventeen males with suspected obstructive sleep apnoea...... results were found in flextube reflectometry studies and pressure-recordings performed on different nights regarding the level distribution of obstructions during sleep. Possible explanations of this discrepancy are discussed....

  9. How to assess, diagnose, refer and treat adult obstructive sleep apnoea: a commentary on the choices.

    Science.gov (United States)

    Mansfield, Darren R; Antic, Nicholas A; McEvoy, R Doug

    2013-10-21

    Obstructive sleep apnoea (OSA) determined by polysomnography is highly prevalent, affecting about 25% of men and 10% of women in the United States, although most have few or no symptoms. Symptomatic moderate to severe OSA has major health implications related to daytime sleepiness, such as increased accidents, altered mood and loss of productivity in the workplace. Severe OSA may increase the risk of cardiovascular disease independent of daytime sleepiness. A major challenge is to correctly identify, from the large community pool of disease, people with symptoms and those at risk of long-term complications. For treatment plans to achieve quality patient outcomes, clinicians must have a clear understanding of patients' symptoms and their motivations for presentation, and be knowledgeable about the evidence surrounding the health risks of OSA and the relative merits of the various diagnostic and treatment options available. The diagnosis of OSA represents a teachable moment to target adverse lifestyle factors such as excessive weight, excessive alcohol consumption and smoking, which may be contributing to OSA and long-term cardiometabolic risk. OSA assessment and management has traditionally involved specialist referral and in-laboratory polysomnography. However, these services may not always be easy to access. Controlled studies have shown that patients with a high pretest probability of symptomatic, moderate to severe OSA can be managed well in primary care, or by skilled nurses with appropriate medical backup, using simplified ambulatory models of care. The future of sleep apnoea assessment and management will likely include models of care that involve early referral to specialists of patients with complex or atypical presentations, and an upskilled and supported primary care workforce to manage symptomatic, uncomplicated, high pretest probability disease.

  10. Inflammatory cardiovascular risk markers in obstructive sleep apnoea syndrome.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    Obstructive sleep apnoea syndrome (OSAS) represents a highly prevalent disease and is recognized as a major public health burden. Large-scale epidemiological studies have demonstrated an independent relationship between OSAS and various cardiovascular disorders. The pathogenesis of cardiovascular complications in OSAS is not completely understood, but given the complexity of the disorder, a multifactorial etiology is likely. Inflammatory processes have emerged as critical in the pathogenesis of atherosclerosis in general and they mediate many of the stages of atheroma formation. Circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These markers include cell adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) and selectins, cytokines such as tumour necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6), chemokines such as IL-8, and C-reactive protein (CRP). There is increasing evidence that inflammatory processes also play a central role in the cardiovascular pathophysiology of OSAS. This is supported by cell culture and animal studies identifying a preferential activation of inflammatory pathways by intermittent hypoxia (IH), the hallmark of OSAS. A number of studies have selectively examined the expression of inflammatory factors in OSAS patients with different conclusions. These different findings may have been contributed to by a number of methodological factors such as small subject numbers, inadequately matched study populations, particularly in terms of body mass index (BMI), and inclusion of patients with pre-existing cardiovascular or metabolic diseases. This review will focus on the potential role of various inflammatory markers in OSAS with a critical analysis of the current literature.

  11. Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea.

    Science.gov (United States)

    Kauppi, Paula; Bachour, Patrick; Maasilta, Paula; Bachour, Adel

    2016-12-01

    Both asthma and obstructive sleep apnoea cause sleep disturbance, daytime sleepiness and diminished quality of life. Continuous positive airway pressure (CPAP) is efficient in reducing symptoms related to sleep apnoea. Here we report the impact of long-term use of CPAP on asthma symptoms. A survey questionnaire was distributed to all of our obstructive sleep apnoea patients with CPAP therapy in 2013. We used the Finnish version of the Asthma Control Test™ (ACT) and a visual analogue scale (0 = no symptoms, 100 = severe asthma symptoms). Asthma was defined as self-reported physician-diagnosed disease and a special reimbursement for asthma medication by the Social Insurance Institution. We sent 2577 questionnaires and received 1586 answers (61 %). One hundred ninety-seven patients were asthmatics with a prevalence of asthma among CPAP users of 13 %. We studied 152 patients (58 females) whose CPAP therapy was initiated after starting asthma medication. Their mean (SD) age was 62 (10) years, duration of CPAP 5.7 (4.7) years and their CPAP daily use was 6.3 (2.4) h. Self-reported asthma severity decreased significantly from 48.3 (29.6) to 33.1 (27.4) (p CPAP (P CPAP in patients with both asthma and obstructive sleep apnoea.

  12. Developing a successful treatment for co-morbid insomnia and sleep apnoea.

    Science.gov (United States)

    Sweetman, Alexander M; Lack, Leon C; Catcheside, Peter G; Antic, Nick A; Chai-Coetzer, Ching Li; Smith, Simon S; Douglas, James A; McEvoy, R Doug

    2017-06-01

    Insomnia and sleep apnoea are the two most common sleep disorders, found in 6% and 23-50% of the general population respectively. These disorders also frequently co-occur, with 39-58% of sleep apnoea patients reporting symptoms indicative of co-morbid insomnia. When these disorders co-occur, clinicians are faced with difficult treatment decisions, patients experience the additive detrimental impacts of both disorders, and the effectiveness of discrete treatments for each disorder may be impaired. A common finding is that co-morbid insomnia and sleep apnoea (COMISA) is more difficult to treat than either disorder presenting alone. Co-morbid insomnia reduces the initial acceptance of, and later adherence to, continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea. This has resulted in recent recommendations that treatment approaches should initially target COMISA patients' insomnia to remove this barrier to CPAP treatment, and improve patient outcomes. However, no randomised controlled trial outcomes investigating this treatment approach currently exist. The current article aims to review and integrate recent research examining the prevalence, characteristics, and theoretical mechanistic relationships between co-occurring insomnia and OSA, and discuss previous treatment attempts. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Pattern recognition of obstructive sleep apnoea and Cheyne–Stokes respiration

    International Nuclear Information System (INIS)

    Weinreich, Gerhard; Teschler, Helmut; Armitstead, Jeff

    2008-01-01

    The aim of this study was to assess the validity of an artificial neural network based on flow-related spectral entropy as a diagnostic test for obstructive sleep apnoea and Cheyne–Stokes respiration. A data set of 37 subjects was used for spectral analysis of the airflow by performing a fast Fourier transform. The examined intervals were divided into epochs of 3 min. Spectral entropy S was applied as a measure for the spread of the related power spectrum. The spectrum was divided into several frequency areas with various subsets of spectral entropy. We studied 11 subjects with obstructive apnoeas (n = 267 epochs), 10 subjects with obstructive hypopnoeas (n = 80 epochs), 11 subjects with Cheyne–Stokes respiration (n = 253 epochs) and 5 subjects with normal breathing in non-REM sleep (n = 174 epochs). Based on spectral entropy an artificial neural network was built, and we obtained a sensitivity of 90.2% and a specificity of 90.9% for distinguishing between obstructive apnoeas and Cheyne–Stokes respiration, and a sensitivity of 91.3% and a specificity of 94.6% for discriminating between obstructive hypopnoeas and normal breathing in non-REM sleep. This resulted in an accuracy of 91.5% for identifying flow patterns of obstructive sleep apnoea, Cheyne–Stokes respiration and normal breathing in non-REM sleep. It is concluded that the use of an artificial neural network relying on spectral analysis of the airflow could be a useful method as a diagnostic test for obstructive sleep apnoea and Cheyne–Stokes respiration

  14. Reduced Inspiratory Muscle Strength in Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnoea

    DEFF Research Database (Denmark)

    Rehling, Thomas; Banghoj, Anne Margareta; Kristiansen, Marie Hvelplund

    2017-01-01

    Background: Obstructive sleep apnoea (OSA) is related to type 2 diabetes (T2DM), and it may be associated with reduced inspiratory muscle strength (IMS). The aim of this study was to investigate the IMS in patients with T2DM, with or without OSA. Methods: Patients with T2DM with OSA (n = 33...

  15. Outcomes in coronary artery disease patients with sleepy obstructive sleep apnoea on CPAP

    NARCIS (Netherlands)

    Peker, Yuksel; Thunstrom, Erik; Glantz, Helena; Wegscheider, Karl; Eulenburg, Christine

    2017-01-01

    Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA) have increased risk for major adverse cardiovascular and cerebrovascular events (MACCEs) compared with CAD patients without OSA. We aimed to address if the risk is similar in both groups when OSA patients are treated. This

  16. Sleep apnoea syndrome and 10-year cardiovascular risk in females with type 2 diabetes: relationship with insulin secretion and insulin resistance.

    Science.gov (United States)

    Hermans, Michel P; Ahn, Sylvie A; Mahadeb, Yovan P; Rousseau, Michel F

    2013-03-01

    Obstructive sleep apnoea syndrome (OSAS) is a risk factor for type 2 diabetes mellitus (T2DM) and promotes cardiovascular events, especially in men. The prevalence of sleep apnoea and its association with microvascular and macrovascular diseases and glycaemic control are poorly documented in T2DM women. A total of 305 T2DM women were sleep apnoea diagnosed through (hetero)anamnesis, Epworth's score, oximetry and polysomnography. Sleep apnoea[+] (n = 25) were compared with sleep apnoea[-] (n = 280) regarding cardiovascular risk factors, glucose homeostasis, micro/macrovascular complications and the United Kingdom Prospective Diabetes Study (UKPDS) 10-year risk. Mean (1 SD) age was 66 (12) years, diabetes duration 15 (9) years, sleep apnoea prevalence 8.2% and metabolic syndrome 86%. There were no differences in age, diabetes duration, education, smoking and blood pressure between groups. Sleep apnoea[+] had significantly higher values of body mass index, waist, relative/absolute fat, conicity, visceral fat (all p Women with sleep apnoea had higher UKPDS risk of CAD: 18 (11)% versus 12 (10)% (p = 0.0136). Prevalent micro/macrovascular complications were not different between groups. Sleep apnoea, a frequent comorbidity of T2DM women, is associated with central fat, atherogenic dyslipidaemia, inflammation, worsening β-cell function, poorer glycaemic control and coronary artery disease risk. Sleep apnoea may increase residual vascular risk for microvascular and macrovascular events in T2DM women. Copyright © 2013 John Wiley & Sons, Ltd.

  17. Body Fat Distribution, Serum Leptin, And Insulin Resistance In Obese Subjects With Obstructive Sleep Apnoea

    OpenAIRE

    Hassan ZA*,Attia MF**, Ahmed AH**;Hassan HA***,

    2006-01-01

    Obstructive sleep apnoea (OS A) is strongly associated with obesity and is characterized by endocrine and metabolic changes. The aim of the present study is to clarify whether there is interrelationship between body fat, serum leptin, glucose-insulin metabolism and OSA. Subjects and measurements: we studied 23 obese subjects with OSA (13 males,& 10 females; age mean 36 ± 4.4 years; BMI: 31.7 ± 3.6 kg/m2; WHR: 1.2 ± .25 in males and 0.81+.5 in females ;Apnoea Index "AI"( 9.2 ±6.1) event/hour o...

  18. Relationship between obstructive sleep apnoea syndrome and sleep bruxism: a systematic review.

    Science.gov (United States)

    Jokubauskas, L; Baltrušaitytė, A

    2017-02-01

    Obstructive sleep apnoea syndrome (OSAS) is a clinical risk factor for sleep bruxism (SB). Both OSAS and SB are reported to be associated with sleep-related arousal reactions, although no clear causative link has been established. An electronic literature search was conducted of the MEDLINE, ScienceDirect, Wiley Online Library, SAGE Journals and EBSCOhost databases covering the period January 2006 and September 2016. Sequential screenings at the title, abstract and full-text levels were performed. The review included observational studies in the English language with a clearly established aim to assess the relationship between OSAS and SB using full-night PSG. The seven-item quality-assessment tool for experimental bruxism studies was used to assess the methodology across the studies. After a comprehensive screening of titles, abstracts and full texts, only three studies that met the pre-defined criteria were finally included in this systematic review. Two studies gave evidence that OSAS is associated with the occurrence of SB events: (i) SB events frequently occur during micro-arousal events consequent on apnoea-hypopnoea (AH) events and (ii) most SB events occur in temporal conjunction with AH events termination. However, one study did not report a strong association between AH and SB events. It can be concluded that there are not enough scientific data to define a clear causative link between OSAS and SB. However, they appear to share common clinical features. Further studies should focus on the intermediate mechanisms between respiratory and SB events. © 2016 John Wiley & Sons Ltd.

  19. Sleeping Well Trial: Increasing the effectiveness of treatment with continuous positive airway pressure using a weight management program in overweight adults with obstructive sleep apnoea-A stepped wedge randomised trial protocol.

    Science.gov (United States)

    Truby, Helen; Edwards, Bradley A; O'Driscoll, Denise M; Young, Alan; Ghazi, Ladan; Bristow, Claire; Roem, Kerryn; Bonham, Maxine P; Murgia, Chiara; Day, Kaitlin; Haines, Terry P; Hamilton, Garun S

    2018-05-24

    The majority of adults diagnosed with obstructive sleep apnoea (OSA) are overweight or obese. Continuous positive airway pressure (CPAP) is the most common effective therapy for OSA. However, adherence declines over time with only 50% of patients prescribed CPAP continuing to use it long term. Furthermore, a recent prospective analysis indicated that those more adherent with CPAP therapy have enhanced weight gain trajectories which in turn may negatively impact their OSA. The Sleeping Well Trial aims to establish whether the timing of starting a lifestyle weight loss intervention impacts on weight trajectory in those with moderate-severe OSA treated at home with CPAP, while testing the potential for smart phone technology to improve adherence with lifestyle interventions. A stepped wedge design with randomisation of individuals from 1 to 6 months post-enrolment, with 5 months of additional prospective follow up after completion of the stepped wedge. This design will investigate the effect of the 6-month lifestyle intervention on people undergoing CPAP on body weight, body composition and health-related quality of life. This trial tests whether the timing of supporting the patient through a weight loss intervention is important in obtaining the maximum benefit of a lifestyle change and CPAP usage, and identify how best to support patients through this critical period. The protocol (v1) is registered prospectively with the International Clinical Trials Registry (CTR) ACTRN12616000203459 (public access). Any amendments to protocol will be documented via the CTR. Recruitment commenced in March 2016 with data collection scheduled to finish by May 2018. © 2018 Dietitians Association of Australia.

  20. Surgery for adult patients with obstructive sleep apnoea: A review for general practitioners.

    Science.gov (United States)

    Phan, Nga T; Wallwork, Benjamin; Panizza, Benedict

    2016-08-01

    Obstructive sleep apnoea (OSA) is a complex disease process that involves collapse of the upper airway during sleep and subsequent reduction or cessation of airflow. Continuous positive airway pressure (CPAP) is the primary treatment for OSA and is the recommended first-line treatment for patients with moderate-to-severe forms of the disease. However, some patients are unable to tolerate CPAP or are unwilling to accept it as a form of permanent management. In these cases, surgical management aimed at addressing anatomical obstruction may be useful and warranted. This article presents an overview of the surgical options available for OSA. The review also describes a useful approach for selecting appropriate patients for surgery. On the basis of an OSA model that accounts for observed increased risk of stroke, cardiovascular disease and motor vehicle accidents, there is evidence to support that surgery is beneficial and cost-effective for patients with severe OSA who are intolerant of CPAP. There are many surgical options available for OSA.

  1. At least one in three people with Type 2 diabetes mellitus referred to a diabetes centre has symptomatic obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Storgaard, H; Mortensen, B; Almdal, T

    2014-01-01

    , diabetic complications or medication use. In multiple regression analyses, age, BMI and HDL cholesterol levels were all significant, independent predictors of obstructive sleep apnoea. CONCLUSIONS: At least one third of people with Type 2 diabetes referred to a diabetes clinic in Denmark has symptomatic......AIMS: To investigate the prevalence of symptomatic obstructive sleep apnoea in unselected patients with Type 2 diabetes referred to a tertiary diabetes clinic. METHODS: In a cross-sectional design, all newly referred patients were offered a stepwise screening for obstructive sleep apnoea with: (1...... obstructive sleep apnoea. Our data suggest higher age, a compromised plasma lipid profile and a more obese phenotype in patients with Type 2 diabetes who have obstructive sleep apnoea, highlighting the need to focus on screening and treatment of obstructive sleep apnoea in these patients....

  2. Automated processing of the single-lead electrocardiogram for the detection of obstructive sleep apnoea.

    Science.gov (United States)

    de Chazal, Philip; Heneghan, Conor; Sheridan, Elaine; Reilly, Richard; Nolan, Philip; O'Malley, Mark

    2003-06-01

    A method for the automatic processing of the electrocardiogram (ECG) for the detection of obstructive apnoea is presented. The method screens nighttime single-lead ECG recordings for the presence of major sleep apnoea and provides a minute-by-minute analysis of disordered breathing. A large independently validated database of 70 ECG recordings acquired from normal subjects and subjects with obstructive and mixed sleep apnoea, each of approximately eight hours in duration, was used throughout the study. Thirty-five of these recordings were used for training and 35 retained for independent testing. A wide variety of features based on heartbeat intervals and an ECG-derived respiratory signal were considered. Classifiers based on linear and quadratic discriminants were compared. Feature selection and regularization of classifier parameters were used to optimize classifier performance. Results show that the normal recordings could be separated from the apnoea recordings with a 100% success rate and a minute-by-minute classification accuracy of over 90% is achievable.

  3. Predicting uptake of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnoea (OSA)

    DEFF Research Database (Denmark)

    Skinner, Timothy; McNeil, Lindsay; Olaithe, Michelle

    2013-01-01

    diagnosed with OSA. Epworth sleepiness scale (ESS), Fatigue Severity Scale, Depression Anxiety Stress Scale and Illness Perception Questionnaire-Revised (IPQ-R) were administered at time of sleep study. These, patient demographics and sleep study variables were used to determine factors predicting patient......Purpose: Obstructive sleep apnoea (OSA) is a common disorder, for which continuous positive airway pressure (CPAP) therapy is a standard treatment. Despite its well-established efficacy, many patients choose not to initiate CPAP treatment. The present study investigated the degree to which...

  4. Efficacy of daytime continuous positive airway pressure titration in severe obstructive sleep apnoea.

    Science.gov (United States)

    Rudkowski, J C; Verschelden, P; Kimoff, R J

    2001-09-01

    The aim of this study was to evaluate manual nasal continuous positive airway pressure (nCPAP) titration during daytime polysomnography compared with conventional overnight titration for patients with severe obstructive sleep apnoea. Thirty-two patients who underwent daytime titration were retrospectively matched (for age, sex, body mass index and apnoea/hypopnoea index (AHI)) to a group titrated overnight during the same period. Successful titration was defined as the identification of the nCPAP level (effective nCPAP (Peff)) required to eliminate respiratory events during all sleep stages. After 3 months of therapy on nCPAP at Peff, nCPAP utilization history was obtained and a group of patients underwent a repeat polysomnogram (PSG) and completed a follow-up Epworth Sleepiness Scale (ESS) score. Initial titration was successful in 91% of daytime patients and 91% of overnight patients. The success of daytime titration was not related to diagnostic AHI or ESS score. Subjective nCPAP utilization was statistically similar in both groups. On the follow-up PSG, there were no significant differences between daytime (n=11) and overnight (n=11) patients in measures of sleep quality or respiratory disturbance. Both groups demonstrated similar and significant improvements in ESS score. These findings suggest that the effective nasal continuous positive airway pressure can be accurately established during daytime titration in a substantial proportion of severe, symptomatic obstructive sleep apnoea patients.

  5. Examining uptake of online education on obstructive sleep apnoea in general practitioners: a randomised trial.

    Science.gov (United States)

    Paul, Christine; Rose, Shiho; Hensley, Michael; Pretto, Jeffrey; Hardy, Margaret; Henskens, Frans; Clinton-McHarg, Tara; Carey, Mariko

    2016-07-19

    Obstructive sleep apnoea (OSA) affects up to 28 % of the adult population in Western countries. The detection and management of OSA by general practitioners (GPs) can be poor. The study aimed to examine what influence enhanced invitations had on uptake of on-line learning modules for OSA by GPs, and whether recent referrals of patients to sleep specialists influenced uptake. Practicing GPs in regional Australia were identified and randomised to receive either an enhanced or standard invitation letter to a new on-line education module for OSA. The enhanced letter included indication that the module was eligible for professional accreditation and described the prevalence and burden of sleep disorders. Some included extra emphasis if the GP had recently referred a patient for diagnostic investigation of OSA. Two reminder letters were sent. Of 796 eligible GPs who received the letters, sixteen (2 %) accessed the website and four completed the modules over the four-month study period. GPs who received an enhanced invitation letter were not significantly more likely to access the website compared to GPs who received the standard invitation letter. Recent referral of a patient for diagnostic investigation was also not a significant factor in influencing use of the module. GP interest in on-line education about OSA appears low, and emphasis of relevant recent past patient(s) and the opportunity for professional education points was not successful in increasing engagement. There is a need to identify effective approaches to improving the detection and management of OSA in general practice.

  6. Proportional positive airway pressure: a new concept to treat obstructive sleep apnoea.

    Science.gov (United States)

    Juhász, J; Becker, H; Cassel, W; Rostig, S; Peter, J H

    2001-03-01

    Proportional positive airway pressure (PPAP) was designed to optimize airway pressure for the therapy of obstructive sleep apnoea (OSA). In a randomized crossover prospective study, the clinical feasibility of PPAP and its immediate effects on the breathing disorder and sleep in comparison with continuous positive airway pressure (CPAP) was evaluated. Twelve patients requiring CPAP therapy underwent CPAP and PPAP titration in a random order. Obstructive and mixed respiratory events could be completely abolished with both forms of treatment. This efficacy could be achieved at a significantly lower mean mask pressure during PPAP titration (8.45+/-2.42 cmH2O) compared to CPAP (9.96+/-2.7 cmH2O) (p=0.002). The mean minimal arterial oxygen saturation (Sa,O2) (82.8+/-6.5%) on the diagnostic night increased significantly (pPPAP titration. Total sleep time, slow wave sleep and rapid eye movement (REM) sleep increased significantly by the same amount during both CPAP and PPAP titration (pPPAP titration night, four patients did not have a preference, and two patients preferred CPAP. The present data show that proportional positive airway pressure is as effective as continuous positive airway pressure in eliminating obstructive events and has the same immediate effect on sleep. The lower average mask pressure during proportional positive airway pressure implies potential advantages compared to continuous positive airway pressure. Proportional positive airway pressure presents a new effective therapeutic approach to obstructive sleep apnoea.

  7. Management of obstructive sleep apnea in Europe

    DEFF Research Database (Denmark)

    Fietze, I; Penzel, T; Alonderis, A

    2011-01-01

    In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA...

  8. The influence of the lateral pharyngeal wall anatomy on snoring and sleep apnoea.

    Science.gov (United States)

    Korhan, Ibrahim; Gode, Sercan; Midilli, Rasit; Basoglu, Ozen Kacmaz

    2015-02-01

    To elucidate the variations of the lateral pharyngeal wall anatomy on physical examination and to assess the clinical importance of the examination of the lateral pharyngeal wall on the presence and severity of obstructive sleep apnoea syndrome. The cross-sectional study was conducted at Ege University Medical School, Izmir, Turkey, between May 2010 and April 2011. The patients were divided into four equal groups: Group 1--snoring without apnoea (age 20-40); Group 2--snoring without apnoea (age 40-60); Group 3--apnoea-hypopnoea index 30/hr. Calibrated oropharynx pictures were taken. Distance between palatoglossal and palatopharyngeal arches, height of palatoglossal and palatopharyngeal arches, uvula width, uvula length and distance between tonsils were measured. SPSS 17 was used for statistical analysis. Of the 80 patients in the study, 44 (55%) were men. Mean distance between palatopharyngeal and palatoglossal arches were 1.55 ± 0.34 cm and 2.70 ± 0.43 cm respectively. Mean height of palatopharyngeal and palatoglossal arches were 0.60 ± 0.21 cm and 1.37 ± 0.36 cm respectively (p > 0.05). Mean uvula width and uvula length were 0.80 ± 0.12cm and 1.25 ± 0.27 cm respectively (p > 0.05). Mean distance between tonsils was 2.24 ± 0.56 cm (p > 0.05). Distance between palatopharyngeal arches was significantly different between groups 3 and 4 (p < 0.05). Palatopharyngeal arch anatomy was found to be significantly associated with obstructive sleep apnoea syndrome severity, especially in patients with normal or small tonsil size. Patients with the palatopharyngeal arches, which narrow the oropharyngeal inlet more than the tonsils, should further be investigated with polysomnography.

  9. Obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome

    OpenAIRE

    Hill, Elizabeth A.

    2016-01-01

    Key points Adults with Down syndrome are predisposed to obstructive sleep apnoea/hypopnoea syndrome (OSAHS) due to overlap between the Down syndrome phenotype and OSAHS risk factors. The prevalence of OSAHS in adults with Down syndrome is estimated at 35?42%. This is up to ten-times higher than in the general adult population. Symptoms of OSAHS, including behavioural and emotional disturbances as well as standard symptoms such as sleepiness, should be monitored as part of regular health surve...

  10. Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

    Directory of Open Access Journals (Sweden)

    Jaroslava Hybášková

    2016-01-01

    Full Text Available The present study evaluated whether drug-induced sleep endoscopy (DISE helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA. A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%. The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n=17, 33.3%, followed by palatal and oropharyngeal collapse (n=12, 23.5%. Pathology of the larynx (epiglottis was observed in 16 patients (31.4%. The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3% patients. After DISE, the surgical plan was changed in 31 patients (60.8%. The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

  11. Sleep bruxism associated with obstructive sleep apnoea syndrome - A pilot study using a new portable device.

    Science.gov (United States)

    Winck, M; Drummond, M; Viana, P; Pinho, J C; Winck, J C

    Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways. We aimed to study the presence and relationship of SB in a OSAS population. Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles. From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3±11.3 years, and apnea hypopnea index of 11.1±5.7/h. Through specific questionnaire 55.6% had SB criteria. Orofacial examination (only feasible in 3) confirmed tooth wear in all. 77.8% had polygraphic SB criteria (SB index>2/h). Mean SB index was 5.12±3.6/h, phasic events predominated (72.7%). Concerning tooth grinding episodes, we found a mean of 10.7±9.2 per night. All OSAS patients except two (77.8%) had more than two audible tooth-grinding episodes. These two patients were the ones with the lowest SB index (1.0 and 1.4 per hour). Only in one patient could we not detect tooth grinding episodes. There was a statistically significant positive correlation between tooth grinding episodes and SB index and phasic event index (R=0.755, p=0.019 and R=0.737, p=0.023 respectively, Pearson correlation). Mean apnoea to bruxism index was 0.4/h, meaning that only a minority of SB events were not secondary to OSAS. We could not find any significant correlation between AHI and bruxism index or phasic bruxism index (R=-0.632 and R=-0.611, p>0.05, Pearson correlation). This pilot study shows that SB is a very common phenomenon in a group of mild OSAS patients, probably being secondary to it in the majority of cases. The new portable device used may add diagnostic accuracy and help to tailor therapy in this setting. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  12. The development of a screening questionnaire for obstructive sleep apnoea in children with Down syndrome

    Directory of Open Access Journals (Sweden)

    Emma eSanders

    2015-10-01

    Full Text Available Obstructive sleep apnoea is a condition which affects an estimated 50% of children with Down syndrome, particularly in their early years. It can cause serious sequelae in affected children but may not be recognised by parents or health professionals. Routine screening has been recommended in some countries but is not standard practice. There are no validated questionnaire based tools available to screen this population of children for this particular sleep-related disorder. Using existing validated sleep questionnaire items, we have developed a questionnaire to screen children with Down syndrome up to 6 years of age for obstructive sleep apnoea, which corresponds with the recommendations made in UK national guidelines. This paper describes these first steps in demonstrating content validity for a new questionnaire which will be subject to further in-depth psychometric analysis. Relevance, clarity and age-appropriateness was rated for 33 items using a content review questionnaire by a group of 18 health professionals with expertise in respiratory paediatrics, neurodevelopmental paediatrics and sleep physiology. The content validity index was calculated for individual items and contributed to decisions about item inclusion. Scale level content validity index for the modified questionnaire of 14 items was at an accepted level of 0.78. Two parents of children with Down syndrome took part in cognitive interviews after completing the modified questionnaire. We describe the development of this 14 item questionnaire to screen for OSA in children with DS from infancy to 6 years.

  13. Sibutramine versus continuous positive airway pressure in obese obstructive sleep apnoea patients.

    Science.gov (United States)

    Ferland, A; Poirier, P; Sériès, F

    2009-09-01

    The aim of the present study was to compare the efficacy of 1 yr of sibutramine-induced weight loss versus continuous positive airway pressure (CPAP) treatment on sleep-disordered breathing, cardiac autonomic function and systemic blood pressure in obese patients with obstructive sleep apnoea. Subjects with a body mass index of > or =30 kg.m(-2) without previous treatment for obstructive sleep apnoea underwent either sibutramine (n = 22) or CPAP (n = 18) treatment for 1 yr. Sibutramine induced a 5.4+/-1.4 kg decrease in body weight compared to the CPAP group, in which no changes in anthropometric variables were observed. The CPAP treatment improved all sleep and respiratory variables, whereas sibutramine-induced weight loss improved only nocturnal arterial oxygen saturation profile. Only CPAP treatment improved night-time systolic and diastolic blood pressure and 24-h and daytime ambulatory diastolic blood pressure. Sibutramine-induced weight loss had no impact on indices of heart rate variability, whereas CPAP treatment increased daytime time domain indices. CPAP treatment for 1 yr had beneficial impacts on nocturnal breathing disturbances, and improved nocturnal oxygenation, night-time systolic and diastolic blood pressure, and daytime cardiac parasympathetic modulation. Sibutramine did not improve sleep-disordered breathing, systemic blood pressure or heart rate variability. There were no adverse effects, such as increment in blood pressure or arrhythmias, associated with this treatment regimen.

  14. A Surgical Treatment of Obstructive Sleep Apnoea (OSA)

    African Journals Online (AJOL)

    Snoring is now seen as one end of sleep-related breathing disorder resulting ultimately in obstructive sleep apnea. Uvulopalatopharyngoplasty (UPPP) is the first surgical procedure specifically designed to alleviate the abnormalities, although the use of laser appears to be the new trend. We present a case of Obstructive ...

  15. Obstructive sleep apnoea and atopy among middle aged chronic obstructive pulmonary disease and bronchial asthma patients.

    Science.gov (United States)

    Kumar, Raj; Nagar, Devender; Mallick, Adeeb; Kumar, Manoj; Tarke, Chandrakant R; Goel, Nitin

    2013-09-01

    Obstructive sleep apnoea syndrome is associated with significant morbidity. A high prevalence of obstructive sleep apnoea (OSA) symptoms has been reported in patients with asthma and chronic obstructive pulmonary disease (COPD). There are limited studies regarding relationship between atopy and OSA. To study the risk of obstructive sleep apnoea among middle aged chronic obstructive pulmonary disease and asthma patients by a home based sleep study and its association with atopy. Patients with asthma and COPD were evaluated for OSA symptoms by Epworth sleepiness scale (ESS) and Berlin questionnaire (BQ). ESS score > or = 9 was considered as high risk for OSA. Patients having high risk for OSA by ESS and BQ were further evaluated for OSA by home based sleep study. Skin prick test against common allergens was done to diagnose atopy in these patients. Among 400 patients (229, 57.25% male and 171, 42.75% female) 328 were asthmatics and 72 were COPD patients. ESS and BQ was positive in 11.25% (45/400) and 18.25% (73/400) patients respectively. ESS was positive in 10.67% (35/328) of asthma and 13.88% (10/72) of COPD patients. BQ was positive in 18.29% (60/328) of asthmatic and 18.05% (13/72) of COPD patients. Skin prick test was positive in 74.16% patients. The maximum positivity was found in asthmatics (139/155, 89.68%) compared to COPD patients (16/155, 10.32%). Skin prick test was done for 40 patients out of 73 of Asthma and COPD patients who were found positive by ESS and BQ. 72.5% patients were found to be atopic. Out of 19 patients in whom home polysomnography was done, 13 patients consented for skin prick test with common aeroallergens and 9 (69.23%) patients were found to be atopic. There is an increased risk of obstructive sleep apnoea among middle aged chronic obstructive pulmonary disease and asthma patients. Atopy could be associated with OSA. The association needs to be proved in a larger study.

  16. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children.

    Science.gov (United States)

    Carvalho, Fernando R; Lentini-Oliveira, Débora A; Prado, Lucila Bf; Prado, Gilmar F; Carvalho, Luciane Bc

    2016-10-05

    Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adeno-tonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbidities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they hold the lower jaw (mandible) forwards which potentially enlarges the upper airway and increases the upper airspace, improving the respiratory function. To assess the effects of oral appliances or functional orthopaedic appliances for obstructive sleep apnoea in children. We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 7 April 2016); Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3) in the Cochrane Library (searched 7 April 2016); MEDLINE Ovid (1946 to 7 April 2016); Embase Ovid (1980 to 7 April 2016); LILACS BIREME (from 1982 to 7 April 2016); BBO BIREME (from 1986 to 7 April 2016) and SciELO Web of Science (from 1997 to 7 April 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials on 7 April 2016. We placed no restrictions on the language or date of publication when searching the electronic databases. All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. reduction of apnoea to less than one episode per hour. dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiological function, behavioural problems, quality of life, side effects

  17. Obstructive sleep apnoea (OSA) - a silent killer in anaesthesia ...

    African Journals Online (AJOL)

    Sleep-disordered breathing (SDB) encompasses a wide range of disorders that afflict both adults and children. These disorders are often unrecognised preoperatively and the pathophysiological consequences may impact severely on the patient in the peri-operative period.

  18. Temporal associations between arousal and body/limb movement in children with suspected obstructed sleep apnoea.

    Science.gov (United States)

    Lamprecht, Marnie L; Bradley, Andrew P; Williams, Gordon; Terrill, Philip I

    2016-01-01

    The inter-relationship between arousal events and body and/or limb movements during sleep may significantly impact the performance and clinical interpretation of actigraphy. As such, the objective of this study was to quantify the temporal association between arousals and body/limb movement. From this, we aim to determine whether actigraphy can predict arousal events in children, and identify the impact of arousal-related movements on estimates of sleep/wake periods. Thirty otherwise healthy children (5-16 years, median 9 years, 21 male) with suspected sleep apnoea were studied using full polysomnography and customised raw tri-axial accelerometry measured at the left fingertip, left wrist, upper thorax, left ankle and left great toe. Raw data were synchronised to within 0.1 s of the polysomnogram. Movements were then identified using a custom algorithm. On average 67.5% of arousals were associated with wrist movement. Arousals associated with movement were longer than those without movement (mean duration: 12.2 s versus 7.9 s respectively, p  <  0.01); movements during wake and arousal were longer than other sleep movements (wrist duration: 6.26 s and 9.89 s versus 2.35 s respectively, p  <  0.01); and the movement index (movements/h) did not predict apnoea-hypopnoea index (ρ  =  -0.11). Movements associated with arousals are likely to unavoidably contribute to actigraphy's poor sensitivity for wake. However, as sleep-related movements tend to be shorter than those during wake or arousal, incorporating movement duration into the actigraphy scoring algorithm may improve sleep staging performance. Although actigraphy-based measurements cannot reliably predict all arousal events, actigraphy can likely identify longer events that may have the greatest impact on sleep quality.

  19. Circulating cell-derived microparticles in patients with minimally symptomatic obstructive sleep apnoea.

    Science.gov (United States)

    Ayers, L; Ferry, B; Craig, S; Nicoll, D; Stradling, J R; Kohler, M

    2009-03-01

    Moderate-severe obstructive sleep apnoea (OSA) has been associated with several pro-atherogenic mechanisms and increased cardiovascular risk, but it is not known if minimally symptomatic OSA has similar effects. Circulating cell-derived microparticles have been shown to have pro-inflammatory, pro-coagulant and endothelial function-impairing effects, as well as to predict subclinical atherosclerosis and cardiovascular risk. In 57 patients with minimally symptomatic OSA, and 15 closely matched control subjects without OSA, AnnexinV-positive, platelet-, leukocyte- and endothelial cell-derived microparticles were measured by flow cytometry. In patients with OSA, median (interquartile range) levels of AnnexinV-positive microparticles were significantly elevated compared with control subjects: 2,586 (1,566-3,964) microL(-1) versus 1,206 (474-2,501) microL(-1), respectively. Levels of platelet-derived and leukocyte-derived microparticles were also significantly higher in patients with OSA (2,267 (1,102-3,592) microL(-1) and 20 (14-31) microL(-1), respectively) compared with control subjects (925 (328-2,068) microL(-1) and 15 (5-23) microL(-1), respectively). Endothelial cell-derived microparticle levels were similar in patients with OSA compared with control subjects (13 (8-25) microL(-1) versus 11 (6-17) microL(-1)). In patients with minimally symptomatic obstructive sleep apnoea, levels of AnnexinV-positive, platelet- and leukocyte-derived microparticles are elevated when compared with closely matched control subjects without obstructive sleep apnoea. These findings suggest that these patients may be at increased cardiovascular risk, despite being minimally symptomatic.

  20. Genetic aspects of hypertension and metabolic disease in the obstructive sleep apnoea-hypopnoea syndrome

    DEFF Research Database (Denmark)

    Riha, R.L.; Diefenbach, K.; Jennum, P.

    2008-01-01

    Though it has long been recognised that there is a hereditary component to the obstructive steep apnoea/hypopnoea syndrome (OSAHS), identifying its genetic basis remains elusive. Hypertension and metabolic syndrome, Like OSAHS, are polygenic disorders, physiologically complex and the product...... phenotyping, which has hampered genetic dissection of these diseases; in addition, sleep-disordered breathing has not been factored into most studies dealing with essential hypertension or metabolic syndrome. Genome-wide scans have yielded inconsistent results in all three disorders under discussion...... for the expression of cardiovascular disease and metabolic syndrome in the context of OSAHS. (C) 2007 Elsevier Ltd. All rights reserved Udgivelsesdato: 2008/2...

  1. Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge

    Directory of Open Access Journals (Sweden)

    Shruti Redhu

    2016-01-01

    Full Text Available Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.

  2. Obstructive sleep apnoea syndrome as a cause of road traffic accidents.

    Science.gov (United States)

    Aguiar, M; Valença, J; Felizardo, M; Caeiro, F; Moreira, S; Staats, R; Bugalho de Almeida, A A

    2009-01-01

    Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. We studied 163 patients with OSAS (apnoea- hypopnoea index (AHI)>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 TDAH) (T test). Group I (no road traffic accidents) No=89 patients; group II (road traffic accidents) No=74 patients. Age (years) was 57.6+/-11.8 vs. 54.7+/-10.9 (ns); male gender, 75% vs. 78.4%; ESS, 12.3+/-5.4 vs. 17.6+/-4.3 (pTDAH (minutes), 98.5+/-63.7 vs. 133.3+/-83.2 (p=0,005). In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.

  3. The role of nasal CPAP in obstructive sleep apnoea syndrome due to mandibular hypoplasia.

    LENUS (Irish Health Repository)

    Miller, Stanley D W

    2012-02-01

    Melnick Needles syndrome (MNS), Treacher Collins syndrome (TCS) and Pierre Robin syndrome (PRS) are congenital abnormalities with characteristic facial appearances that include micrognathia. A 20-year-old girl with MNS, a 16-year-old boy with TCS and a 12-year-old girl with PRS attended the sleep apnoea clinic at our institution at different times. Diagnostic sleep studies were initially performed on all three patients to confirm the diagnosis of obstructive sleep apnoea syndrome (OSAS). They subsequently commenced nasal CPAP (nCPAP) treatment and their progress was followed. A limited sleep study on the patient with MNS demonstrated moderate\\/severe OSAS with an AHI of 33 events\\/h. Commencement of nCPAP resulted in symptomatic improvement. Overnight oximetry in the patient with TCS showed repeated desaturation to SpO2<90%. Subsequent treatment by nCPAP almost completely abolished the desaturation events. Overnight polysomnography in the patient with PRS demonstrated severe OSAS with an AHI of 49 events\\/h. After 3 years of nCPAP therapy, this patient requested discontinuation of treatment. Subsequent polysomnography without nCPAP revealed an AHI of <5 events\\/h. The use of nCPAP in the patients with MNS and TCS resulted in effective control of their sleep abnormalities. Mandibular growth and enlargement of the posterior airway space led to resolution of OSAS in the patient with PRS. There is a definite role for nCPAP therapy in patients with congenital micrognathia and OSAS. The use of nCPAP may obviate the need for more invasive corrective surgery for OSAS and is not necessarily a life-long requirement.

  4. Are We overestimating the prevalence of depression in chronic illness using questionnaires? Meta-analytic evidence in obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Nanthakumar, Shenooka; Bucks, Romola S.; Skinner, Timothy C.

    2016-01-01

    Depression is common in chronic illness, albeit prevalence can be highly variable. This variability may be a function of symptom overlap between depression and chronic illness. Using Obstructive Sleep Apnoea (OSA) as an exemplar, this meta-analysis explored whether the proportion of overlapping s...

  5. Simulated driving in obstructive sleep apnoea-hypopnoea : effects of oral appliances and continuous positive airway pressure

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stegenga, Boudewijn; Bakker, Marije; Brouwer, Wiebo H.; de Bont, Lambert G. M.; Wijkstra, Peter J.; van der Hoeven, Johannes H.

    Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients. Although continuous positive airway pressure (CPAP) generally improves simulated driving performance, the effects of oral-appliance (OA) therapy are unknown. The aims of this

  6. Adaptive servo ventilation for central sleep apnoea in heart failure : SERVE-HF on-treatment analysis

    NARCIS (Netherlands)

    Woehrle, Holger; Cowie, Martin R.; Eulenburg, Christine; Suling, Anna; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K.; Somers, Virend K.; Zannad, Faiez; Teschler, Helmut; Wegscheider, Karl

    2017-01-01

    This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the

  7. Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea : An inter-ethnic comparison

    NARCIS (Netherlands)

    Wong, M.L.; Sandham, John; Ang, PK; Wong, DC; Tan, WC; Huggare, J

    The aim of this study was to measure craniofacial morphology and nasal respiratory resistance (NRR) in Malay, Indian and Chinese subjects with obstructive sleep apnoea (OSA). The sample consisted of 34 male subjects, 27-52 years of age (Malay n = 11, which included five mild and six moderate-severe

  8. Behavioural hyperventilation as a novel clinical condition associated with central sleep apnoea: A report of three cases

    NARCIS (Netherlands)

    Pevernagie, D.; Mariman, A.; Vandenbussche, N.; Tobback, E.; Overeem, S.; Delesie, L.; Janssen, H.; Vogelaers, D.

    2012-01-01

    Central sleep apnoea (CSA) is a disorder characterised by repetitive episodes of decreased ventilation due to complete or partial reduction in the central neural outflow to the respiratory muscles. Hyperventilation plays a prime role in the pathogenesis of CSA. Chronic heart failure and dwelling at

  9. Flextube reflectometry for level diagnosis in patients with obstructive sleep apnoea and snoring

    DEFF Research Database (Denmark)

    Faber, C E; Hilberg, O; Grymer, L

    2002-01-01

    The aim of this study was to use sound reflections in a flexible tube (flextube reflectometry) for identifying the predominant obstructive level of the upper airway in a series of patients referred to a sleep clinic. We also wished to study the relationship between the number of flextube narrowings...... per hour recording and the RDI (respiratory disturbance index = apnoeas and hypopneas per hour recording) by ResMed AutoSet (AS), which is a device based on nasal pressure variations. We performed sleep studies on 54 patients referred for snoring or OSA; 1) at home with AS; 2) in hospital using...... flextube reflectometry and AS simultaneously. The predominant obstructive level of the upper airway was retropalatal in 15 of the patients and retrolingual in 25 of the patients determined by flextube reflectometry. In 14 there was no predominant level of narrowing. We found a statistically significant...

  10. Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health

    Directory of Open Access Journals (Sweden)

    Chamara Visanka Senaratna

    2016-10-01

    Full Text Available Abstract Background Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors. Methods We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18–55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI. Results Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18–25 years to 7.8 % in the age 45–55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all. Sleep apnoea was significantly associated with older age (p < 0.001, unemployment (p < 0.001, asthma (p = 0.011, chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002, diabetes (p < 0.001, hypercholesterolemia (p < 0.001, hypertension (p < 0.001, heart attack (p < 0.001, heart failure (p < 0.001, angina (p < 0.001, depression (p < 0.001, post-traumatic stress disorder (p

  11. Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children.

    Science.gov (United States)

    Carvalho, F R; Lentini-Oliveira, D; Machado, M A C; Prado, G F; Prado, L B F; Saconato, H

    2007-04-18

    Apnoea is a breathing disorder marked by the absence of airflow at the nose or mouth. In children, risk factors include adenotonsillar hypertrophy, obesity, neuromuscular disorders and craniofacial anomalies. The most common treatment for obstructive sleep apnoea syndrome (OSAS) in childhood is adenotonsillectomy. This approach is limited by its surgical risks, mostly in children with comorbities and, in some patients, by recurrence that can be associated with craniofacial problems. Oral appliances and functional orthopaedic appliances have been used for patients who have OSAS and craniofacial anomalies because they change the mandible posture forwards and potentially enlarge the upper airway and increase the upper airspace, improving the respiratory function. To assess the effectiveness of oral appliances or functional orthopaedic appliances for OSAS in children. A sensitive search was developed for the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); PubMed (January 1966 to September 2005); EMBASE (1980 to September 2005); Lilacs (1982 to September 2005); BBO-Bibliografia Brasileira de Odontologia (1986 to September 2005); and SciELO (1997 to September 2005). There was no restriction of language or source of information. All randomised or quasi-randomised controlled trials comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children 15 years old or younger. reduction of apnoea to less than one episode per hour. dental and skeletal relationship, sleep parameters improvement, cognitive and phonoaudiologic function, behavioural problems, drop outs and withdrawals, quality of life, side effects (tolerability), economic evaluation. Data were independently extracted by two review authors. Authors were contacted for additional information. Risk ratios with 95% confidence intervals were calculated for all important dichotomous outcomes. The initial search identified 384 trials

  12. Sleeping over a sleep disorder - Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students

    OpenAIRE

    Sharma, Sushma; Srijithesh, P. R.

    2013-01-01

    Background: Obstructive sleep apnoea (OSA) syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension. Objective: To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension. Methods: Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19. Results: 180 participant...

  13. Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design

    DEFF Research Database (Denmark)

    Petri, N.; Svanholt, P.; Solow, B.

    2008-01-01

    The aim of this trial was to evaluate the efficacy of a mandibular advancement appliance (MAA) for obstructive sleep apnoea (OSA). Ninety-three patients with OSA and a mean apnoea-hypopnoea index (AHI) of 34.7 were centrally randomised into three, parallel groups: (a) MAA; (b) mandibular non......). Eighty-one patients (87%) completed the trial. The MAA group achieved mean AHI and Epworth scores significantly lower (P group and the no-intervention group. No significant differences were found between the MNA group and the no-intervention group. The MAA group had...

  14. Comparison of Standard and Novel Signal Analysis Approaches to Obstructive Sleep Apnoea Classification

    Directory of Open Access Journals (Sweden)

    Aoife eRoebuck

    2015-08-01

    Full Text Available Obstructive sleep apnoea (OSA is a disorder characterised by repeated pauses in breathing during sleep, which leads to deoxygenation and voiced chokes at the end of each episode. OSA is associated by daytime sleepiness and an increased risk of serious conditions such as cardiovascular disease, diabetes and stroke. Between 2-7% of the adult population globally has OSA, but it is estimated that up to 90% of those are undiagnosed and untreated. Diagnosis of OSA requires expensive and cumbersome screening. Audio offers a potential non-contact alternative, particularly with the ubiquity of excellent signal processing on every phone.Previous studies have focused on the classification of snoring and apnoeic chokes. However, such approaches require accurate identification of events. This leads to limited accuracy and small study populations. In this work we propose an alternative approach which uses multiscale entropy (MSE coefficients presented to a classifier to identify disorder in vocal patterns indicative of sleep apnoea. A database of 858 patients was used, the largest reported in this domain. Apnoeic choke, snore, and noise events encoded with speech analysis features were input into a linear classifier. Coefficients of MSE derived from the first 4 hours of each recording were used to train and test a random forest to classify patients as apnoeic or not.Standard speech analysis approaches for event classification achieved an out of sample accuracy (Ac of 76.9% with a sensitivity (Se of 29.2% and a specificity (Sp of 88.7% but high variance. For OSA severity classification, MSE provided an out of sample Ac of 79.9%, Se of 66.0% and Sp = 88.8%. Including demographic information improved the MSE-based classification performance to Ac = 80.5%, Se = 69.2%, Sp = 87.9%. These results indicate that audio recordings could be used in screening for OSA, but are generally under-sensitive.

  15. Prevalence of metabolic syndrome in a north Indian hospital-based population with obstructive sleep apnoea

    Science.gov (United States)

    Agrawal, Swastik; Sharma, Surendra K.; Sreenivas, Vishnubhatla; Lakshmy, Ramakrishnan

    2011-01-01

    Background & objectives: Obstructive sleep apnoea (OSA) is known to be associated with cardiovascular risk factors and metabolic syndrome (MS). The burden of MS in patients with OSA in India is unknown. We investigated the prevalence of MS and its components in a cross-sectional study in patients with and without OSA in a hospital-based population of a tertiary health care centre in New Delhi, India. Methods: Consecutive patients undergoing overnight polysomnography in the Sleep Laboratory of the Department of Internal Medicine of All India Institute of Medical Sciences (AIIMS) hospital, New Delhi, were studied. Anthropometry and body composition analysis, blood pressure (BP), fasting blood glucose, insulin resistance by homeostasis model assessment (HOMA-IR) and fasting blood lipid profile were measured. MS was defined using the National Cholesterol Education Program Adult treatment panel III criteria, with Asian cut-off values for abdominal obesity. Results: Of the 272 subjects recruited, 187 (82%) had OSA [apnoea-hypopnoea index (AHI)>5 events/h] while 40 (18%) had a normal sleep study. Prevalence of MS in OSA patients was 79 per cent compared to 48 per cent in non-OSA individuals [OR 4.15, (2.05-8.56), P<0.001]. Prevalence of OSA in mild, moderate and severe OSA was 66, 72 and 86 per cent, respectively (P<0.001). Patients with OSA were more likely to have higher BP [OR: 1.06 (1.02-1.11)], fasting insulin [OR: 1.18 (1.05-1.32)], HOMA-IR [OR: 1.61 (1.11-2.33)] and waist circumference [OR: 1.20 (1.13-1.27)]. Interpretation & conclusions: Our findings suggest that OSA is associated with a 4-fold higher occurrence of MS than patients without OSA. The prevalence of MS increases with increasing severity of OSA, therefore, early detection will be beneficial. PMID:22199102

  16. Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement.

    Science.gov (United States)

    de Ruiter, M H T; Apperloo, R C; Milstein, D M J; de Lange, J

    2017-11-01

    Maxillomandibular advancement (MMA) is an alternative therapeutic option that is highly effective for treating obstructive sleep apnoea (OSA). MMA provides a solution for OSA patients that have difficulty accepting lifelong treatments with continuous positive airway pressure or mandibular advancement devices. The goal of this study was to investigate the different characteristics that determine OSA treatment success/failure after MMA. The apnoea-hypopnoea index (AHI) was used to determine the success or failure of OSA treatment after MMA. Sixty-two patients underwent MMA for moderate and severe OSA. A 71% success rate was observed with a mean AHI reduction of 69%. A statistically significant larger neck circumference was measured in patients with failed OSA treatments following MMA (P=0.008), and older patients had failed OSA treatments with MMA: 58 vs. 53 years respectively (P=0.037). Cephalometric analysis revealed no differences between successful and failed OSA treatment outcomes. There was no difference in maxillary and mandibular advancements between success and failed MMA-treated OSA patients. The complications most frequently reported following MMA were sensory disturbances in the inferior alveolar nerve (60%) and malocclusion (24%). The results suggest that age and neck girth may be important factors that could predict susceptibility to OSA treatment failures by MMA. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Cholesterol Metabolism and Weight Reduction in Subjects with Mild Obstructive Sleep Apnoea: A Randomised, Controlled Study

    Directory of Open Access Journals (Sweden)

    Maarit Hallikainen

    2013-01-01

    Full Text Available To evaluate whether parameters of obstructive sleep apnoea (OSA associate with cholesterol metabolism before and after weight reduction, 42 middle-aged overweight subjects with mild OSA were randomised to intensive lifestyle intervention (N=23 or to control group (N=18 with routine lifestyle counselling only. Cholesterol metabolism was evaluated with serum noncholesterol sterol ratios to cholesterol, surrogate markers of cholesterol absorption (cholestanol and plant sterols and synthesis (cholestenol, desmosterol, and lathosterol at baseline and after 1-year intervention. At baseline, arterial oxygen saturation (SaO2 was associated with serum campesterol (P<0.05 and inversely with desmosterol ratios (P<0.001 independently of gender, BMI, and homeostasis model assessment index of insulin resistance (HOMA-IR. Apnoea-hypopnoea index (AHI was not associated with cholesterol metabolism. Weight reduction significantly increased SaO2and serum cholestanol and decreased AHI and serum cholestenol ratios. In the groups combined, the changes in AHI were inversely associated with changes of cholestanol and positively with cholestenol ratios independent of gender and the changes of BMI and HOMA-IR (P<0.05. In conclusion, mild OSA seemed to be associated with cholesterol metabolism independent of BMI and HOMA-IR. Weight reduction increased the markers of cholesterol absorption and decreased those of cholesterol synthesis in the overweight subjects with mild OSA.

  18. The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea versus controls

    Science.gov (United States)

    Fogel, Robert B; Trinder, John; White, David P; Malhotra, Atul; Raneri, Jill; Schory, Karen; Kleverlaan, Darci; Pierce, Robert J

    2005-01-01

    Pharyngeal dilator muscles are important in the pathophysiology of obstructive sleep apnoea syndrome (OSA). We have previously shown that during wakefulness, the activity of both the genioglossus (GGEMG) and tensor palatini (TPEMG) is greater in patients with OSA compared with controls. Further, EMG activity decreases at sleep onset, and the decrement is greater in apnoea patients than in healthy controls. In addition, it is known that the prevalence of OSA is greater in middle-aged compared with younger men. Thus, we had two goals in this study. First we compared upper airway muscle activity between young and middle-aged healthy men compared with men with OSA. We also explored the mechanisms responsible for the decrement in muscle activity at sleep onset in these groups. We investigated muscle activity, ventilation , and upper airway resistance (UAR) during wakefulness and sleep onset (transition from α to θ EEG activity) in all three groups. Measurements were obtained during basal breathing (BB) and nasal continuous positive airway pressure (CPAP) was applied to reduce negative pressure-mediated muscle activation). We found that during wakefulness there was a gradation of GGEMG and UAR (younger < older < OSA) and that muscle activity was reduced by the application of nasal CPAP (to a greater degree in the OSA patients). Although CPAP eliminated differences in UAR during wakefulness and sleep, GGEMG remained greater in the OSA patients. During sleep onset, a greater initial fall in GGEMG was seen in the OSA patients followed by subsequent muscle recruitment in the third to fifth breaths following the α to θ transition. On the CPAP night, and GGEMG still fell further in the OSA patients compared with control subjects. CPAP prevented the rise in UAR at sleep onset along with the associated recruitment in GGEMG. Differences in TPEMG among the groups were not significant. These data suggest that the middle-aged men had upper airway function midway between that of

  19. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnoea syndrome: a randomised, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems

    NARCIS (Netherlands)

    Nikolopoulou, M.; Byraki, A.; Ahlberg, J.; Heymans, M. W.; Hamburger, H. L.; de Lange, J.; Lobbezoo, F.; Aarab, G.

    2017-01-01

    Obstructive sleep apnoea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported

  20. The neuropharmacology of upper airway motor control in the awake and asleep states: implications for obstructive sleep apnoea

    Directory of Open Access Journals (Sweden)

    Horner Richard L

    2001-08-01

    Full Text Available Abstract Obstructive sleep apnoea is a common and serious breathing problem that is caused by effects of sleep on pharyngeal muscle tone in individuals with narrow upper airways. There has been increasing focus on delineating the brain mechanisms that modulate pharyngeal muscle activity in the awake and asleep states in order to understand the pathogenesis of obstructive apnoeas and to develop novel neurochemical treatments. Although initial clinical studies have met with only limited success, it is proposed that more rational and realistic approaches may be devised for neurochemical modulation of pharyngeal muscle tone as the relevant neurotransmitters and receptors that are involved in sleep-dependent modulation are identified following basic experiments.

  1. Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation.

    LENUS (Irish Health Repository)

    Garvey, J F

    2012-02-01

    There is increasing evidence that intermittent hypoxia plays a role in the development of cardiovascular risk in obstructive sleep apnoea syndrome (OSAS) through the activation of inflammatory pathways. The development of translational models of intermittent hypoxia has allowed investigation of its role in the activation of inflammatory mechanisms and promotion of cardiovascular disease in OSAS. There are noticeable differences in the response to intermittent hypoxia between body tissues but the hypoxia-sensitive transcription factors hypoxia-inducible factor-1 and nuclear factor-kappaB appear to play a key role in mediating the inflammatory and cardiovascular consequences of OSAS. Expanding our understanding of these pathways, the cross-talk between them and the activation of inflammatory mechanisms by intermittent hypoxia in OSAS will provide new avenues of therapeutic opportunity for the disease.

  2. Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment

    DEFF Research Database (Denmark)

    Petersen, Marian Christin; Kristensen, Ellids; Berg, Søren

    2012-01-01

    OBJECTIVE: Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA). METHODS: Before and after 1...... year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26-77) received a survey with questions drawn from two self-administered questionnaires on sexuality - Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used...... of CPAP treatment. ESS score decreased significantly after 1 year of CPAP treatment. CONCLUSION: One year of CPAP treatment improves all aspects of sexual function in male patients with OSA. Our data indirectly suggest that organic factors are the most likely explanation to these improvements....

  3. Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key?

    Science.gov (United States)

    Rubio-Bueno, P; Landete, P; Ardanza, B; Vázquez, L; Soriano, J B; Wix, R; Capote, A; Zamora, E; Ancochea, J; Naval-Gías, L

    2017-11-01

    Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea-hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41±14years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4±5.4 and AHI was 38.3±10.7 per hour before surgery. Postoperative AHI was 6.5±4.3 per hour (P<0.001) with 52.94% of the patients considered as cured, and 47.06% suffering from a mild residual OSA with ESS 0.8±1.4 (P<0.001). 3D changes revealed a volume increase of 106.3±38.8%. The mandible was advanced 10.4±3.9mm and maxilla 4.9±3.2mm. MOP postoperative value was concluded to be the best predictor variable. Treatment planning should include MOP normalization and a mandibular advancement between 6 and 10mm. The maxillary advancement would depend on the desired aesthetic changes and final occlusion. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Polymorphism of the ACE gene and the risk of obstructive sleep apnoea.

    Science.gov (United States)

    Chmielewska, Izabela; Mlak, Radosław; Krawczyk, Paweł; Czukiewska, Ewa; Milanowski, Janusz

    2013-01-01

    Obstructive sleep apnoea/hypopnea syndrome (OSA) is characterized by obstruction of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen desaturation and arousal from sleep. Among the candidate genes affecting the risk of OSA, genes whose polymorphisms influence the development of diseases with similar pathogenesis such as OSA could be listed: APOE, genes for leptin and leptin receptor, TNFA1, ADRB2 and ACE (gene for angiotensin-converting enzyme). Until now there has been a confirmed relationship between ACE gene polymorphism and cardiovascular diseases, but its effect on the incidence of OSA is debatable. The aim of this study was to investigate the effect of ACE gene insertion/deletion (I/D) polymorphism on the risk of OSA. Fifty-five patients with confirmed diagnose of OSA and qualified to CPAP therapy entered the study. The control group included 50 subjects who did not complain of any sleep related symptoms. Diagnose of OSA was set on the basis of full overnight polysomnography together with Epworth Sleepiness Scale according to American Academy of Sleep Medicine guidelines. DNA was isolated from peripheral blood leukocytes with Qiagen DNA mini Kit. ACE gene polymorphism was determined in genomic DNA using allele specific polymerase chain reaction. Different sizes of PCR products were observed on agarose gel electrophoresis. There were non-significant differences in the frequency of ACE genotypes. However, allele D had significantly lower prevalence in the study group than in the control group. (χ(2) = 4.25 p = 0.04). Moreover, I allele carriers had a threefold greater risk of developing OSA (HR = 2.748, 95% CI = 1.029-7.340, p gene polymorphism might be useful to determine the risk of developing OSA in clinically predisposed patients.

  5. Is there a difference between the STOP-BANG and the Berlin Obstructive Sleep Apnoea Syndrome questionnaires for determining respiratory complications during the perioperative period?

    Science.gov (United States)

    Gokay, Pervin; Tastan, Sevinc; Orhan, Mehmet Emin

    2016-05-01

    This study aimed to compare the efficiency of the STOP-BANG and Berlin Obstructive Sleep Apnoea Syndrome questionnaires for evaluating potential respiratory complications during the perioperative period. Questionnaires that are used to determine obstructive sleep apnoea risk are not widely used for surgical patients. Among the questionnaires that are commonly used for obstructive sleep apnoea screening, it remains unclear whether the STOP-BANG or Berlin Obstructive Sleep Apnoea Syndrome questionnaire is more effective in terms of ease of use, usage period and diagnosis of surgical patients with obstructive sleep apnoea risk. This study was designed as a descriptive and prospective study. The study included 126 patients over 18 years of age who were American Society of Anesthesiologists classification class I-II and underwent laparoscopic cholecystectomy. To determine the potential obstructive sleep apnoea syndrome risk, the STOP-BANG and Berlin questionnaires were administered. Respiratory complications were then observed during the perioperative period. During intubation and extubation, we observed statistically significant differences in difficult intubation, difficult facemask ventilation and desaturation frequency between the high- and low-risk groups for obstructive sleep apnoea syndrome, as determined by the STOP-BANG questionnaire. During extubation, statistically significant differences in coughing, breath-holding and desaturation frequency were observed between the high-risk and low-risk groups, according to the Berlin questionnaire. In the post-anaesthesia care unit, both questionnaires found statistically significant differences between the low- and high-risk groups. Obstructive sleep apnoea syndrome screening questionnaires administered during the preoperative period are useful for predicting perioperative respiratory complications. It may be most useful to administer the STOP-BANG questionnaire as the initial evaluation. Questionnaires may be used to

  6. Neurobehavioural correlates in older children and adolescents with obesity and obstructive sleep apnoea.

    Science.gov (United States)

    Tan, Evan; Healey, Dione; Schaughency, Elizabeth; Dawes, Patrick; Galland, Barbara

    2014-01-01

    The relationship between obstructive sleep apnoea (OSA) and poorer neurobehavioural outcomes in school-age children is well established, but the relationship in obese children and adolescents, in whom OSA is more common, is not so well established. We aimed to investigate this relationship in 10-18-year-olds. Thirty-one participants with a mean body mass index (BMI) of 32.3 ± 4.9 enrolled. BMI-for-age cut-offs were used to define obesity. Participants underwent polysomnography and were classified into OSA (apnoea-hypopnoea index (AHI) > 2 per hour) and non-OSA (AHI ≤ 2) groups. Intelligence, memory and learning, academic achievement, behaviour and executive functioning were assessed using the Wechsler Abbreviated Scale of Intelligence, Wide Range Assessment of Memory and Learning 2, Wechsler Individual Achievement Test II (WIAT-II), Behavioural Assessment System for Children 2 and Behaviour Rating Inventory of Executive Function, respectively. Forty-eight per cent (15/31) were classified as having OSA, and 52% (16/31) as non-OSA. The obese cohort performed below the average of normative data on several neurobehavioural measures. WIAT-II maths scores were significantly lower (P = 0.034) in the OSA group than in the non-OSA group (means 84.5 vs. 94.6, respectively), losing significance after adjustment for IQ, age and gender. Self-reported school problems were significantly worse in the OSA group before and after multivariate adjustment (P = 0.010, Cohen's d = 1.02). No other significant differences were found. Results suggest that OSA may increase risk for some poorer educational and behavioural outcomes. The findings are reasonably consistent with and add to the evidence base of the few studies that have explored this relationship. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  7. Obstructive sleep apnoea syndrome, endothelial function and markers of endothelialization. Changes after CPAP.

    Science.gov (United States)

    Muñoz-Hernandez, Rocio; Vallejo-Vaz, Antonio J; Sanchez Armengol, Angeles; Moreno-Luna, Rafael; Caballero-Eraso, Candela; Macher, Hada C; Villar, Jose; Merino, Ana M; Castell, Javier; Capote, Francisco; Stiefel, Pablo

    2015-01-01

    This study tries to assess the endothelial function in vivo using flow-mediated dilatation (FMD) and several biomarkers of endothelium formation/restoration and damage in patients with obstructive sleep apnoea (OSA) syndrome at baseline and after three months with CPAP therapy. Observational study, before and after CPAP therapy. We studied 30 patients with apnoea/hypopnoea index (AHI) >15/h that were compared with themselves after three months of CPAP therapy. FMD was assessed non-invasively in vivo using the Laser-Doppler flowmetry. Circulating cell-free DNA (cf-DNA) and microparticles (MPs) were measured as markers of endothelial damage and the vascular endothelial growth factor (VEGF) was determined as a marker of endothelial restoration process. After three month with CPAP, FMD significantly increased (1072.26 ± 483.21 vs. 1604.38 ± 915.69 PU, pDNA and MPs significantly decreased (187.93 ± 115.81 vs. 121.28 ± 78.98 pg/ml, p<0.01, and 69.60 ± 62.60 vs. 39.82 ± 22.14 U/μL, p<0.05, respectively) and VEGF levels increased (585.02 ± 246.06 vs. 641.11 ± 212.69 pg/ml, p<0.05). These changes were higher in patients with more severe disease. There was a relationship between markers of damage (r = -0.53, p<0.005) but not between markers of damage and restoration, thus suggesting that both types of markers should be measured together. CPAP therapy improves FMD. This improvement may be related to an increase of endothelial restoration process and a decrease of endothelial damage.

  8. Obstructive sleep apnoea syndrome, endothelial function and markers of endothelialization. Changes after CPAP.

    Directory of Open Access Journals (Sweden)

    Rocio Muñoz-Hernandez

    Full Text Available This study tries to assess the endothelial function in vivo using flow-mediated dilatation (FMD and several biomarkers of endothelium formation/restoration and damage in patients with obstructive sleep apnoea (OSA syndrome at baseline and after three months with CPAP therapy.Observational study, before and after CPAP therapy.We studied 30 patients with apnoea/hypopnoea index (AHI >15/h that were compared with themselves after three months of CPAP therapy. FMD was assessed non-invasively in vivo using the Laser-Doppler flowmetry. Circulating cell-free DNA (cf-DNA and microparticles (MPs were measured as markers of endothelial damage and the vascular endothelial growth factor (VEGF was determined as a marker of endothelial restoration process.After three month with CPAP, FMD significantly increased (1072.26 ± 483.21 vs. 1604.38 ± 915.69 PU, p< 0.005 cf-DNA and MPs significantly decreased (187.93 ± 115.81 vs. 121.28 ± 78.98 pg/ml, p<0.01, and 69.60 ± 62.60 vs. 39.82 ± 22.14 U/μL, p<0.05, respectively and VEGF levels increased (585.02 ± 246.06 vs. 641.11 ± 212.69 pg/ml, p<0.05. These changes were higher in patients with more severe disease. There was a relationship between markers of damage (r = -0.53, p<0.005 but not between markers of damage and restoration, thus suggesting that both types of markers should be measured together.CPAP therapy improves FMD. This improvement may be related to an increase of endothelial restoration process and a decrease of endothelial damage.

  9. Continuous positive airway pressure improves gait control in severe obstructive sleep apnoea: A prospective study.

    Directory of Open Access Journals (Sweden)

    Sébastien Baillieul

    Full Text Available Severe obstructive sleep apnoea (OSA can lead to neurocognitive alterations, including gait impairments. The beneficial effects of continuous positive airway pressure (CPAP on improving excessive daytime sleepiness and daily functioning have been documented. However, a demonstration of CPAP treatment efficacy on gait control is still lacking. This study aims to test the hypothesis that CPAP improves gait control in severe OSA patients.In this prospective controlled study, twelve severe OSA patients (age = 57.2±8.9 years, body mass index = 27.4±3.1 kg·m-2, apnoea-hypopnoea index = 46.3±11.7 events·h-1 and 10 healthy matched subjects were included. Overground gait parameters were recorded at spontaneous speed and stride time variability, a clinical marker of gait control, was calculated. To assess the role of executive functions in gait and postural control, a dual-task paradigm was applied using a Stroop test as secondary cognitive task. All assessments were performed before and after 8 weeks of CPAP treatment.Before CPAP treatment, OSA patients had significantly larger stride time variability (3.1±1.1% vs 2.1±0.5% and lower cognitive performances under dual task compared to controls. After CPAP treatment, stride time variability was significantly improved and no longer different compared to controls. Cognitive performance under dual task also improved after CPAP treatment.Eight weeks of CPAP treatment improves gait control of severe OSA patients, suggesting morphological and functional cerebral improvements. Our data provide a rationale for further mechanistic studies and the use of gait as a biomarker of OSA brain consequences.

  10. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing

    DEFF Research Database (Denmark)

    Jennum, P; Riha, R L

    2009-01-01

    Epidemiological studies have revealed a high prevalence of sleep-disordered breathing in the community (up to 20%). A subset of these patients has concurrent symptoms of excessive daytime sleepiness attributable to their nocturnal breathing disorder and is classified as having obstructive sleep a...

  11. Three-dimensional photography for the evaluation of facial profiles in obstructive sleep apnoea.

    Science.gov (United States)

    Lin, Shih-Wei; Sutherland, Kate; Liao, Yu-Fang; Cistulli, Peter A; Chuang, Li-Pang; Chou, Yu-Ting; Chang, Chih-Hao; Lee, Chung-Shu; Li, Li-Fu; Chen, Ning-Hung

    2018-06-01

    Craniofacial structure is an important determinant of obstructive sleep apnoea (OSA) syndrome risk. Three-dimensional stereo-photogrammetry (3dMD) is a novel technique which allows quantification of the craniofacial profile. This study compares the facial images of OSA patients captured by 3dMD to three-dimensional computed tomography (3-D CT) and two-dimensional (2-D) digital photogrammetry. Measurements were correlated with indices of OSA severity. Thirty-eight patients diagnosed with OSA were included, and digital photogrammetry, 3dMD and 3-D CT were performed. Distances, areas, angles and volumes from the images captured by three methods were analysed. Almost all measurements captured by 3dMD showed strong agreement with 3-D CT measurements. Results from 2-D digital photogrammetry showed poor agreement with 3-D CT. Mandibular width, neck perimeter size and maxillary volume measurements correlated well with the severity of OSA using all three imaging methods. Mandibular length, facial width, binocular width, neck width, cranial base triangle area, cranial base area 1 and middle cranial fossa volume correlated well with OSA severity using 3dMD and 3-D CT, but not with 2-D digital photogrammetry. 3dMD provided accurate craniofacial measurements of OSA patients, which were highly concordant with those obtained by CT, while avoiding the radiation associated with CT. © 2018 Asian Pacific Society of Respirology.

  12. Computed tomographic cephalometric analysis of chinese patients with obstructive sleep apnoea

    International Nuclear Information System (INIS)

    Peh, W.C.G.; Chu, F.S.K.; Ip, M.S.M.; Chung, K.-F.

    2000-01-01

    Variations of craniofacial and upper airway structures are recognized to contribute to the phenomenon of obstructive sleep apnoea (OSA). Most previous cephalometric studies were performed using erect lateral radiographs in Caucasian patients. The present project aims to determine cephalometric measurements, utilizing CT, in normal Chinese subjects and in Chinese patients with OSA. Computed tomography of 25 patients with OSA (proven using overnight polysomnography), and of 25 age-, sex-, height-, bodyweight- and body mass index (BMI)-matched control subjects were prospectively performed. Thirteen standard bony and soft-tissue measurements were obtained from the CT lateral scout view of the head and neck, taken with each subject in the neutral supine position. The cross-sectional area was calculated at two axial levels (velopharynx and hypopharynx). The measurements in the two groups, OSA and control subjects, were compared. The measurements for hyoid position (P=0.00), nasal cavity length (P=0.01), mandibular prognathism (P = 0.05), tongue size (P = 0.02), oropharyngeal airway space (P = 0.02), posterior tongue airway space (P = 0.04) and cross-sectional areas at the level of the velopharynx (P = 0.00) and hypopharynx (P = 0.01) differed significantly between the two groups. In conclusion, CT cephalometric measurements show that certain anatomical variations in the head and neck are likely to contribute to the pathogenesis of OSA in Chinese patients. Copyright (1999) Blackwell Science Pty Ltd

  13. Impact of testosterone replacement therapy on thromboembolism, heart disease and obstructive sleep apnoea in men.

    Science.gov (United States)

    Cole, Alexander P; Hanske, Julian; Jiang, Wei; Kwon, Nicollette K; Lipsitz, Stuart R; Kathrins, Martin; Learn, Peter A; Sun, Maxine; Haider, Adil H; Basaria, Shehzad; Trinh, Quoc-Dien

    2018-05-01

    To assess the association of testosterone replacement therapy (TRT) with thromboembolism, cardiovascular disease (stroke, coronary artery disease and heart failure) and obstructive sleep apnoea (OSA). A cohort of 3 422 male US military service members, retirees and their dependents, aged 40-64 years, was identified, who were prescribed TRT between 2006 and 2010 for low testosterone levels. The men in this cohort were matched on a 1:1 basis for age and comorbidities to men without a prescription for TRT. Event-free survival and rates of thromboembolism, cardiovascular events and OSA were compared between men using TRT and the control group, with a median follow-up of 17 months. There was no difference in event-free survival with regard to thromboembolism (P = 0.239). Relative to controls, men using TRT had improved cardiovascular event-free survival (P = 0.004), mainly as a result of lower incidence of coronary artery disease (P = 0.008). The risk of OSA was higher in TRT users (2-year risk 16.5% [95% confidence interval 15.1-18.1] in the TRT group vs 12.7% [11.4-14.1] in the control group. This study adds to growing evidence that the cardiovascular risk associated with TRT may be lower than once feared. The elevated risk of OSA in men using TRT is noteworthy. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

  14. Obstructive sleep apnoea is frequent in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Banghoej, Anne Margareta; Nerild, Henriette Holst; Kristensen, Peter Lommer

    2017-01-01

    mild OSA (60 patients (69%)). OSA was present in 32% of the patients with normal BMI, in 60% of overweight patients, and in 61% of obese patients. Patients with type 1 diabetes and OSA were largely asymptomatic and did not report more sleepiness than patients without OSA. At multivariate analysis, age......AIM: Obstructive Sleep Apnoea (OSA) is frequent in patients with type 2 diabetes. The aim of this study is to evaluate prevalence of OSA in patients with type 1 diabetes. METHODS: In a cross-sectional design, all patients with type 1 diabetes attending the outpatient clinic were offered screening...... of 200 of 518 eligible patients with type 1 diabetes (39%) participated (68% men; age 52±15years (mean±SD), diabetes duration 24±14years and BMI 25.3±3.3kg/m(2)). OSA was diagnosed in 92 patients (46% (95% CI: 40-53)). Five patients had known OSA, and OSA was newly diagnosed in 87 patients, predominantly...

  15. Continuous Positive Airway Pressure: Is it a route for infection in those with Obstructive Sleep Apnoea?

    Directory of Open Access Journals (Sweden)

    Liam Mercieca

    Full Text Available Introduction: Continuous positive airway pressure (CPAP is the standard treatment for obstructive sleep apnoea (OSA, with limited data about the prevalence of respiratory infections and microbial colonization in these patients. Objectives: The aim of this study was to determine if CPAP use is associated with respiratory infections and to identify the organisms that colonize or infect these patients. Method: A retrospective, case-controlled study in patients diagnosed with OSA was carried out. 137 patients were recruited and interviewed using a questionnaire. A nasal swab was taken from each patient. Patients using CPAP machines had swabs taken from masks and humidifiers. Results: 66 (48.2% patients received CPAP treatment with 60.6% of them having a heated humidifier. 78.8% were male, with the majority using a full face mask (63.6%. No significant difference was seen in the prevalence of rhinosinusitis, lower respiratory tract infections and hospital admissions for pneumonia between CPAP and non-CPAP treated patients. The presence of a humidifier did not influence the prevalence of infections. Commensal flora was predominantly cultured from nasal swabs from both patient groups. Coagulase Negative Staphylococci and Diphtheroids were the main organisms cultured from masks and humidifiers respectively. Conclusions: This study shows that the use of CPAP, choice of mask and humidifier have no significant impact on the prevalence of infections and micro-organisms isolated. This is very reassuring to the physician prescribing CPAP therapy and users.

  16. Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification.

    Science.gov (United States)

    Koutsourelakis, I; Vagiakis, E; Perraki, E; Karatza, M; Magkou, C; Kopaka, M; Roussos, C; Zakynthinos, S

    2011-03-01

    Nasal continuous positive airway pressure (CPAP) can cause undesirable nasal symptoms, such as congestion to obstructive sleep apnoea (OSA) patients, whose symptoms can be attenuated by the addition of heated humidification. However, neither the nature of nasal symptoms nor the effect of heated humidification on nasal pathophysiology and pathology are convincingly known. 20 patients with OSA on nasal CPAP who exhibited symptomatic nasal obstruction were randomised to receive either 3 weeks of CPAP treatment with heated humidification or 3 weeks of CPAP treatment with sham-heated humidification, followed by 3 weeks of the opposite treatment, respectively. Nasal symptom score, nasal resistance, nasal lavage interleukin-6, interleukin-12 and tumour necrosis factor-α and nasal mucosa histopathology were assessed at baseline and after each treatment arm. Heated humidification in comparison with sham-heated humidification was associated with decrease in nasal symptomatology, resistance and lavage cytokines, and attenuation of inflammatory cell infiltration and fibrosis of the nasal mucosa. In conclusion, nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin and the addition of heated humidification decreases nasal resistance and mucosal inflammation.

  17. Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome.

    Science.gov (United States)

    Martinez-Beneyto, Paz; Soria Checa, Cristina E; Botella-Rocamora, Paloma; Rincon-Piedrahita, Inés; Garcia Callejo, Francisco J; Algarra, Jaime Marco

    Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2") RESULTS: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (Pde Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  18. Dynamic loop gain increases upon adopting the supine body position during sleep in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Joosten, Simon A; Landry, Shane A; Sands, Scott A; Terrill, Philip I; Mann, Dwayne; Andara, Christopher; Skuza, Elizabeth; Turton, Anthony; Berger, Philip; Hamilton, Garun S; Edwards, Bradley A

    2017-11-01

    Obstructive sleep apnoea (OSA) is typically worse in the supine versus lateral sleeping position. One potential factor driving this observation is a decrease in lung volume in the supine position which is expected by theory to increase a key OSA pathogenic factor: dynamic ventilatory control instability (i.e. loop gain). We aimed to quantify dynamic loop gain in OSA patients in the lateral and supine positions, and to explore the relationship between change in dynamic loop gain and change in lung volume with position. Data from 20 patients enrolled in previous studies on the effect of body position on OSA pathogenesis were retrospectively analysed. Dynamic loop gain was calculated from routinely collected polysomnographic signals using a previously validated mathematical model. Lung volumes were measured in the awake state with a nitrogen washout technique. Dynamic loop gain was significantly higher in the supine than in the lateral position (0.77 ± 0.15 vs 0.68 ± 0.14, P = 0.012). Supine functional residual capacity (FRC) was significantly lower than lateral FRC (81.0 ± 15.4% vs 87.3 ± 18.4% of the seated FRC, P = 0.021). The reduced FRC we observed on moving to the supine position was predicted by theory to increase loop gain by 10.2 (0.6, 17.1)%, a value similar to the observed increase of 8.4 (-1.5, 31.0)%. Dynamic loop gain increased by a small but statistically significant amount when moving from the lateral to supine position and this may, in part, contribute to the worsening of OSA in the supine sleeping position. © 2017 Asian Pacific Society of Respirology.

  19. Behavioural hyperventilation as a novel clinical condition associated with central sleep apnoea: a report of three cases.

    Science.gov (United States)

    Pevernagie, Dirk; Mariman, An; Vandenbussche, Nele; Tobback, Els; Overeem, Sebastiaan; Delesie, Liesbeth; Janssen, Hennie; Vogelaers, Dirk

    2012-12-01

    Central sleep apnoea (CSA) is a disorder characterised by repetitive episodes of decreased ventilation due to complete or partial reduction in the central neural outflow to the respiratory muscles. Hyperventilation plays a prime role in the pathogenesis of CSA. Chronic heart failure and dwelling at high altitude are classical conditions in which CSA is induced by hyperventilation. Hyperventilation syndrome (HVS) is a prevalent behavioural condition in which minute ventilation exceeds metabolic demands, resulting in haemodynamic and chemical changes that produce characteristic dysphoric symptoms. HVS is frequently caused by anxiety disorders and panic attacks. Until now, medical literature has focussed primarily on daytime symptoms of behavioural hyperventilation. It is currently unknown how this condition may affect sleep. Three cases are reported in which behavioural hyperventilation was associated with occurrence of significant central sleep apnoea, which was not present during normal tidal breathing in steady sleep. Therefore, behavioural hyperventilation should be added to the list of known clinical conditions associated with CSA. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Obstructive sleep apnoea syndrome in a patient with retrosternal goiter: a case report

    International Nuclear Information System (INIS)

    Sevketbeyoglu, H.; Kara, K.; Ince, M.; Karaagac, H.

    2012-01-01

    Full text: Introduction: Obstructive sleep apnoea syndrome (OSAS) is associated with a large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia etc.). In addition to these factors goiter and hypothyroidism have been reported to be associated with OSAS. Objectives and tasks: In our case with retrosternal goiter, values of OSAS before and after thyroidectomy were shown. Materials and methods: Seventy-two years old, BMI: 26,8 kg/m 2 , female patient was admitted our hospital because of complaints to stop breathing during sleep, snoring, morning headache and daytime drowsiness. Results: Thorax CT and ultrasonography of thyroid shown retrosternal goiter and left tracheal deviation. Severe OSAS was diagnosed by polysomnography (PSG). Thyroid function tests were normal. Apneahypopnea index (AHI) was 63,1/h. Patients was performed 7 cm H 2 O nasal continuous positive airway pressure (gvrnCPAP). AHI was 11,4/h under nCPAP. One month after OSAS diagnosis the patient underwent thyroidectomy operation. Pathological examination was reported as multinodular GOITER. In postoperative period CPAP treatment couldn't continue, because patient was not compliant. In postoperative 8-th weeks, PSG was performed; AHI was 34,8/h. The patient's weight and BMI didn't change. Conclusion: In our case, despite absence of continued CPAP treatment after thyroidectomy, symptoms and PSG values improved partially. As a result of these findings, especially, compression of upper airway and deterioration of venous circulation of patients with large goiter may lead to an increase in OSAS symptoms. During patients with OSAS are treated with CPAP, goiter needs to be investigated

  1. Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification.

    Science.gov (United States)

    Cavusoglu, M; Ciloglu, T; Serinagaoglu, Y; Kamasak, M; Erogul, O; Akcam, T

    2008-08-01

    In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

  2. Investigation of sequential properties of snoring episodes for obstructive sleep apnoea identification

    International Nuclear Information System (INIS)

    Cavusoglu, M; Ciloglu, T; Serinagaoglu, Y; Kamasak, M; Erogul, O; Akcam, T

    2008-01-01

    In this paper, 'snore regularity' is studied in terms of the variations of snoring sound episode durations, separations and average powers in simple snorers and in obstructive sleep apnoea (OSA) patients. The goal was to explore the possibility of distinguishing among simple snorers and OSA patients using only sleep sound recordings of individuals and to ultimately eliminate the need for spending a whole night in the clinic for polysomnographic recording. Sequences that contain snoring episode durations (SED), snoring episode separations (SES) and average snoring episode powers (SEP) were constructed from snoring sound recordings of 30 individuals (18 simple snorers and 12 OSA patients) who were also under polysomnographic recording in Gülhane Military Medical Academy Sleep Studies Laboratory (GMMA-SSL), Ankara, Turkey. Snore regularity is quantified in terms of mean, standard deviation and coefficient of variation values for the SED, SES and SEP sequences. In all three of these sequences, OSA patients' data displayed a higher variation than those of simple snorers. To exclude the effects of slow variations in the base-line of these sequences, new sequences that contain the coefficient of variation of the sample values in a 'short' signal frame, i.e., short time coefficient of variation (STCV) sequences, were defined. The mean, the standard deviation and the coefficient of variation values calculated from the STCV sequences displayed a stronger potential to distinguish among simple snorers and OSA patients than those obtained from the SED, SES and SEP sequences themselves. Spider charts were used to jointly visualize the three parameters, i.e., the mean, the standard deviation and the coefficient of variation values of the SED, SES and SEP sequences, and the corresponding STCV sequences as two-dimensional plots. Our observations showed that the statistical parameters obtained from the SED and SES sequences, and the corresponding STCV sequences, possessed a strong

  3. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome?

    LENUS (Irish Health Repository)

    Ryan, S

    2012-02-01

    Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disease and is recognised as a major public health burden. Large-scale epidemiological studies have demonstrated an independent relationship between OSAS and various cardiovascular disorders. The pathogenesis of cardiovascular complications in OSAS is not completely understood but a multifactorial aetiology is likely. Inflammatory processes have emerged as critical in the pathogenesis of atherosclerosis at all stages of atheroma formation. Increased levels of various circulating markers of inflammation including tumour necrosis factor alpha (TNFalpha), interleukin 6 (IL6), IL-8 and C-reactive protein (CRP) have been reported as associated with future cardiovascular risk. There is increasing evidence of elevated inflammatory markers in OSAS with a significant fall after effective treatment with continuous positive airway pressure. This evidence is particularly strong for TNFalpha, whereas studies on IL6 and CRP have yielded conflicting results possibly due to the confounding effects of obesity. Cell culture and animal studies have significantly contributed to our understanding of the underlying mechanisms of the association between OSAS and inflammation. Intermittent hypoxia, the hallmark of OSAS, results in activation of pro-inflammatory transcription factors such as nuclear factor kappa B (NF-kappaB) and activator protein (AP)-1. These promote activation of various inflammatory cells, particularly lymphocytes and monocytes, with the downstream consequence of expression of pro-inflammatory mediators that may lead to endothelial dysfunction. This review provides a critical analysis of the current evidence for an association between OSAS, inflammation and cardiovascular disease, discusses basic mechanisms that may be responsible for this association and proposes future research possibilities.

  4. A resource of potential drug targets and strategic decision-making for obstructive sleep apnoea pharmacotherapy.

    Science.gov (United States)

    Horner, Richard L; Grace, Kevin P; Wellman, Andrew

    2017-07-01

    There is currently no pharmacotherapy for obstructive sleep apnoea (OSA) but there is no principled a priori reason why there should not be one. This review identifies a rational decision-making strategy with the necessary logical underpinnings that any reasonable approach would be expected to navigate to develop a viable pharmacotherapy for OSA. The process first involves phenotyping an individual to quantify and characterize the critical predisposing factor(s) to their OSA pathogenesis and identify, a priori, if the patient is likely to benefit from a pharmacotherapy that targets those factors. We then identify rational strategies to manipulate those critical predisposing factor(s), and the barriers that have to be overcome for success of any OSA pharmacotherapy. A new analysis then identifies candidate drug targets to manipulate the upper airway motor circuitry for OSA pharmacotherapy. The first conclusion is that there are two general pharmacological approaches for OSA treatment that are of the most potential benefit and are practically realistic, one being fairly intuitive but the second perhaps less so. The second conclusion is that after identifying the critical physiological obstacles to OSA pharmacotherapy, there are current therapeutic targets of high interest for future development. The final analysis provides a tabulated resource of 'druggable' targets that are relatively restricted to the circuitry controlling the upper airway musculature, with these candidate targets being of high priority for screening and further study. We also emphasize that a pharmacotherapy may not cure OSA per se, but may still be a useful adjunct to improve the effectiveness of, and adherence to, other treatment mainstays. © 2017 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.

  5. Qualitative assessment of awake nasopharyngoscopy for prediction of oral appliance treatment response in obstructive sleep apnoea.

    Science.gov (United States)

    Sutherland, Kate; Chan, Andrew S L; Ngiam, Joachim; Darendeliler, M Ali; Cistulli, Peter A

    2018-01-23

    Clinical methods to identify responders to oral appliance (OA) therapy for obstructive sleep apnoea (OSA) are needed. Awake nasopharyngoscopy during mandibular advancement, with image capture and subsequent processing and analysis, may predict treatment response. A qualitative assessment of awake nasopharyngoscopy would be simpler for clinical practice. We aimed to determine if a qualitative classification system of nasopharyngoscopic observations reflects treatment response. OSA patients were recruited for treatment with a customised two-piece OA. A custom scoring sheet was used to record observations of the pharyngeal airway (velopharynx, oropharynx, hypopharynx) during supine nasopharyngoscopy in response to mandibular advancement and performance of the Müller manoeuvre. Qualitative scores for degree ( 75%), collapse pattern (concentric, anteroposterior, lateral) and diameter change (uniform, anteroposterior, lateral) were recorded. Treatment outcome was confirmed by polysomnography after a titration period of 14.6 ± 9.8 weeks. Treatment response was defined as (1) Treatment AHI  50% AHI reduction and (3) > 50% AHI reduction. Eighty OSA patients (53.8% male) underwent nasopharyngoscopy. The most common naspharyngoscopic observation with mandibular advancement was a small ( 75% velopharyngeal collapse on performance of the Müller manoeuvre. Mandibular advancement reduced the observed level of pharyngeal collapse at all three pharyngeal regions (p < 0.001). None of the nasopharyngoscopic qualitative scores differed between responder and non-responder groups. Qualitative assessment of awake nasopharyngoscopy appears useful for assessing the effect of mandibular advancement on upper airway collapsibility. However, it is not sensitive enough to predict oral appliance treatment outcome.

  6. Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state

    Directory of Open Access Journals (Sweden)

    Sithole J

    2006-11-01

    Full Text Available Abstract Obstructive sleep apnoea (OSA is a cardio-metabolic disorder. Whether metabolic syndrome (MS, insulin resistance (IR and albuminuria are independently associated with OSA is unclear, but defining the interactions between OSA and various cardiovascular (CV risk factors independent of obesity facilitates the development of therapeutic strategies to mitigate their increased CV risks. We prospectively recruited 38 subjects with OSA and 41 controls. Anthropometric measurements, glucose, lipids, insulin and blood pressure (BP were measured after an overnight fast. IR state was defined as homeostasis model assessment (HOMA value >3.99 and MS diagnosed according to the International Diabetes Federation (IDF criteria. Subjects with OSA were more obese, more insulin resistant, more hyperglycaemic, had higher Epworth score (measure of day time somnolence and systolic blood pressure levels. The prevalence of MS was higher in OSA compared with non-OSA subjects (74% vs 24%, p 103 cm would predict MS in patients with OSA at 75–78% sensitivity and 61–64% specificity. The agreement between MS and IR state in this cohort is poor. Thus, OSA is associated with MS independent of obesity predominantly due to increased triglyceride, glucose and Epworth score values but not IR or microalbuminuria status. This observation suggests an alternative pathogenic factor mediating the increased cardiovascular risk in patients with OSA and MS, other than that due to IR. The independent link between Epworth score and MS in patients with OSA implicates the role of daytime sleepiness and chronic hypoxia as a potential mediator. Given the discordant between MS and IR state, measurement of waist is useful for predicting mainly MS but not insulin resistance status in patients with OSA. Appropriate pharmacological intervention targeting these independent factors is important in reducing the increased CV risks among patients with OSA.

  7. Sleeping over a sleep disorder - Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students.

    Science.gov (United States)

    Sharma, Sushma; Srijithesh, P R

    2013-04-01

    Obstructive sleep apnoea (OSA) syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension. To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension. Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19. 180 participants completed the survey questionnaire. Only 24 (13.3%) identified OSA as a reversible risk factor for ischemic stroke. 11 (6%) participants only could answer OSA as an identified risk factor for hypertension as per Seventh Joint National Committee report. This study reveals dismal level of awareness, among health professionals and medical students, about OSA being an established and modifiable risk factor for hypertension and ischemic stroke.

  8. Sleeping over a sleep disorder - Awareness of obstructive sleep apnoea as a modifiable risk factor for hypertension and stroke: A survey among health care professionals and medical students

    Directory of Open Access Journals (Sweden)

    Sushma Sharma

    2013-01-01

    Full Text Available Background: Obstructive sleep apnoea (OSA syndrome is an established and modifiable but under recognized risk factor for common disorders like stroke and hypertension. Objective: To assess awareness level of health care practitioners and medical students about OSA as a risk factor for stroke and hypertension. Methods: Questionnaire based survey with multiple response type and fill in the blanks type questions. The data was compiled and analyzed using SPSS version 19. Results: 180 participants completed the survey questionnaire. Only 24 (13.3% identified OSA as a reversible risk factor for ischemic stroke. 11 (6% participants only could answer OSA as an identified risk factor for hypertension as per Seventh Joint National Committee report. Poor awareness extended over all categories of participants (medical students, trained doctors and nursing staff . Conclusion: This study reveals dismal level of awareness, among health professionals and medical students, about OSA being an established and modifiable risk factor for hypertension and ischemic stroke.

  9. Auto-titrating continuous positive airway pressure treatment for obstructive sleep apnoea after acute quadriplegia (COSAQ): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Berlowitz, David J; Ayas, Najib; Barnes, Maree; Brown, Douglas J; Cistulli, Peter A; Geraghty, Tim; Graham, Alison; Lee, Bonsan Bonne; Morris, Meg; O'Donoghue, Fergal; Rochford, Peter D; Ross, Jack; Singhal, Balraj; Spong, Jo; Wadsworth, Brooke; Pierce, Robert J

    2013-06-19

    Quadriplegia is a severe, catastrophic injury that predominantly affects people early in life, resulting in lifelong physical disability. Obstructive sleep apnoea is a direct consequence of quadriplegia and is associated with neurocognitive deficits, sleepiness and reduced quality of life. The usual treatment for sleep apnoea is nasal continuous positive airway pressure (CPAP); however, this is poorly tolerated in quadriplegia. To encourage patients to use this therapy, we have to demonstrate that the benefits outweigh the inconvenience. We therefore propose a prospective, multinational randomized controlled trial of three months of CPAP for obstructive sleep apnoea after acute quadriplegia. Specialist spinal cord injury centres across Australia, New Zealand, the UK and Canada will recruit medically stable individuals who have sustained a (new) traumatic quadriplegia (complete or incomplete second cervical to first thoracic level lesions). Participants will be screened for obstructive sleep apnoea using full, portable sleep studies. Those with an apnoea hypopnoea index greater than 10 per hour will proceed to an initial three-night trial of CPAP. Those who can tolerate CPAP for at least 4 hours on at least one night of the initial trial will be randomized to either usual care or a 3-month period of auto-titrating CPAP. The primary hypothesis is that nocturnal CPAP will improve neuropsychological functioning more than usual care alone. The secondary hypothesis is that the magnitude of improvement of neuropsychological function will be predicted by the severity of baseline sleepiness measures, sleep fragmentation and sleep apnoea. Neuropsychological tests and full polysomnography will be performed at baseline and 3 months with interim measures of sleepiness and symptoms of autonomic dysfunction measured weekly. Spirometry will be performed monthly. Neuropsychological tests will be administered by blinded assessors. Recruitment commenced in July 2009. The results of

  10. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform.

    Science.gov (United States)

    Mazza, S; Pépin, J-L; Naëgelé, B; Rauch, E; Deschaux, C; Ficheux, P; Lévy, P

    2006-11-01

    Sleepiness is considered to be the major cause of increased traffic accidents in patients with obstructive sleep apnoea syndrome (OSAS). Until now, OSAS patients' driving ability has been assessed using driving simulators, but no assessment in a more natural driving environment has been carried out to date. The aim of the present study was to evaluate driving parameters in OSAS and in controls on a road safety platform, and to compare them with attentional in-laboratory measures before and after continuous positive airway pressure treatment. The parameters measured were: reaction time; distance to stop and number of collisions on the platform; maintenance of wakefulness; and sustained, selective and divided attention in laboratory. Patients exhibited much longer reaction times than controls, leading to a lengthening of the vehicle's stopping distance of 8.8 m at 40 km.h(-1) and to twice the number of collisions. Patients did not demonstrate objective sleepiness or selective and sustained attention deficits. Divided attention deficits were found. However, they did not allow the prediction of real driving impairment. After CPAP treatment, there was no longer any difference between patients and controls regarding driving and attention performances. Driving abilities are significantly impaired in obstructive sleep apnoea syndrome. After continuous positive airway pressure treatment, deficits were normalised. This stresses the importance of evaluating attentional parameters in apnoeic patients and of offering continuous positive airway pressure treatment even to non-sleepy subjects.

  11. Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis.

    Science.gov (United States)

    Woehrle, Holger; Cowie, Martin R; Eulenburg, Christine; Suling, Anna; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K; Somers, Virend K; Zannad, Faiez; Teschler, Helmut; Wegscheider, Karl

    2017-08-01

    This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the control group in the SERVE-HF trial.Time-dependent on-treatment analyses were conducted (unadjusted and adjusted for predictive covariates). A comprehensive, time-dependent model was developed to correct for asymmetric selection effects (to minimise bias).The comprehensive model showed increased cardiovascular death hazard ratios during adaptive servo ventilation usage periods, slightly lower than those in the SERVE-HF intention-to-treat analysis. Self-selection bias was evident. Patients randomised to adaptive servo ventilation who crossed over to the control group were at higher risk of cardiovascular death than controls, while control patients with crossover to adaptive servo ventilation showed a trend towards lower risk of cardiovascular death than patients randomised to adaptive servo ventilation. Cardiovascular risk did not increase as nightly adaptive servo ventilation usage increased.On-treatment analysis showed similar results to the SERVE-HF intention-to-treat analysis, with an increased risk of cardiovascular death in heart failure with reduced ejection fraction patients with predominant central sleep apnoea treated with adaptive servo ventilation. Bias is inevitable and needs to be taken into account in any kind of on-treatment analysis in positive airway pressure studies. Copyright ©ERS 2017.

  12. The role of nocturnal oximetry in obstructive sleep apnoea-hypopnoea syndrome screening

    Directory of Open Access Journals (Sweden)

    Celestina Ventura

    2007-07-01

    Full Text Available Aim: The aim of our study was to evaluate the sensitivity and specificity of Nocturnal Oximetry (NO as a diagnostic screening tool for obstructive sleep apnoea hypopnoea syndrome (OSAHS, compared with polysomnography (PSG as the gold standard. Methodology: 63 patients with clinical suspicion of OSAHS and exclusion of respiratory disease underwent PSG and NO. We then determined NO sensitivity, specificity, positive (PPV and negative predictive values (NPV. Results: OSAHS was diagnosed in 47 patients with a mean age of 54 years. In the evaluation of the percentage of Total Sleep Time (TST with oxygen desaturation below 90%, we found significant differences between patients with OSAHS (25.4 ± 29.7% and without OSAHS (1 ± 1.5%, p<0,001. We used two cutoff points to evaluate sensitivity, specificity, positive (PPV and negative predictive values (NPV, based on the severity of O2 desaturation (StO2<90%. Using the first cutoff point we diagnosed with NO as positive all the patients with TST desaturation values ≥1% of the TST. Under these circumstances we found a sensitivity of 76.6%, a specificity of 75%, a PPV of 90% and an NPV value of 52.2% for our screening test (NO. Using the second cutoff point, we diagnosed with NO as positive all the patients with TST desaturation values ≥5% of the TST. With this method we found a sensitivity of 65.9%, a specificity of 100%, a PPV of 100% and an NPV of 50%. Conclusion: NO is a useful screening test for the diagnosis of OSAHS in patients without respiratory disease. Resumo: Objectivo: Foi objectivo deste estudo determinar a sensibilidade e a especificidade da oximetria nocturna (ON como método de screening diagnóstico para a síndroma de apneia-hipopneia obstrutiva do sono (SAHOS, utilizando como método de referência a polissonografia (PSG. Metodologia: Foram incluídos 63 doentes com suspeita clínica de SAHOS e exclusão de doença respiratória, sendo

  13. Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study.

    Science.gov (United States)

    Alonso-Álvarez, María Luz; Terán-Santos, Joaquin; Navazo-Egüia, Ana Isabel; Martinez, Mónica Gonzalez; Jurado-Luque, María José; Corral-Peñafiel, Jaime; Duran-Cantolla, Joaquin; Cordero-Guevara, José Aurelio; Kheirandish-Gozal, Leila; Gozal, David

    2015-09-01

    The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ≥3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (p<0.03) and OR 8.71, 95% CI 1.24-61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up. Copyright ©ERS 2015.

  14. Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly

    Czech Academy of Sciences Publication Activity Database

    Dostálová, S.; Šonka, K.; Šmahel, Zbyněk; Weiss, V.; Marek, J.; Hořínek, D.

    2001-01-01

    Roč. 144, - (2001), s. 491-497 ISSN 0804-4643 R&D Projects: GA MZd IZ3575 Institutional research plan: CEZ:AV0Z5039906 Keywords : apnoea syndrome Subject RIV: AC - Archeology, Anthropology, Ethnology Impact factor: 2.133, year: 2001

  15. Interaction of obstructive sleep apnoea and cognitive impairment with slow gait speed in middle-aged and older adults.

    Science.gov (United States)

    Lee, Sunghee; Shin, Chol

    2017-07-01

    to investigate whether slow gait speed is associated with cognitive impairment and further whether the association is modified by obstructive sleep apnoea (OSA). in total, 2,222 adults aged 49-80 years, free from dementia, stroke and head injury were asked to walk a 4-m course at fast and usual gait speeds. The time taken to walk was measured. All participants completed the Korean Mini-Mental State Examination, which was validated in the Korean language, to assess cognitive function. Additionally, the participants completed a polysomnography test to ascertain OSA (defined as an apnoea-hypopnoea index ≥15). Multivariable linear regression models were utilised to test the associations. time taken to walk 4 m showed significant inverse associations with cognitive scores (P value = 0.001 at fast gait speed and P = 0.002 at usual gait speed). Furthermore, a significant interaction according to OSA on the association between time to walk and cognitive impairment was found (P value for interaction = 0.003 at fast gait speed and P value for interaction = 0.007 at usual gait speed). we found that the inverse association between the time taken to walk 4 m and a cognitive score became significantly stronger, if an individual had OSA. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  16. Insufficient evidence to confirm effectiveness of oral appliances in treatment of obstructive sleep apnoea syndrome in children.

    Science.gov (United States)

    Fox, Nigel A

    2007-01-01

    Searches were made using the Cochrane Central Register of Controlled Trials, Medline, Embase, Latin American and Caribbean Health Sciences Literature, Bibliografia Brasileira de Odontologia and SciELO (the Scientific Electronic Library Online). Studies chosen were randomised controlled trials (RCT) or quasi-RCT comparing all types of oral and functional orthopaedic appliances with placebo or no treatment, in children of 15 years old or younger. Data were independently extracted by two review authors. Authors were contacted for additional information. Risk ratios with 95% confidence intervals were calculated for all important dichotomous outcomes. A total of 384 trials were identified, of which only one, reporting results from a total of 23 patients, was suitable for inclusion in the review. Data provided in the published report did not answer all the questions from this review, but did answer some: the results presented favour treatment. At present there is not sufficient evidence to state that oral appliances or functional orthopaedic appliances are effective in the treatment of obstructive sleep apnoea (OSA) syndrome in children. Oral appliances or functional orthopaedic appliances may be helpful in the treatment of children with craniofacial anomalies which are risk factors for apnoea.

  17. Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

    International Nuclear Information System (INIS)

    Oezdemir, Hueseyin; Mahmutyaziciglu, Kamran; Davsancimath, Halit; Guendogdu, Sadi; Altin, Remzi; Kart, Levent; Soeguet, Ayhan; Tomac, Nazan; Cinar, Fikret; Uzun, Lokman

    2004-01-01

    Cephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS). To evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity. The study population consisted of 39 children, aged 4-12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded. Cranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P 0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=-0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH. (orig.)

  18. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnoea syndrome: a randomised, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems.

    Science.gov (United States)

    Nikolopoulou, M; Byraki, A; Ahlberg, J; Heymans, M W; Hamburger, H L; De Lange, J; Lobbezoo, F; Aarab, G

    2017-06-01

    Obstructive sleep apnoea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. In this randomised placebo-controlled trial, sixty-four OSAS patients (52·0 ± 9·6 years) were randomly assigned to an MAD, nCPAP or an intra-oral placebo appliance in a parallel design. All participants filled out the validated Dutch Sleep Disorders Questionnaire (SDQ) twice: one before treatment and one after six months of treatment. With 88 questions, thirteen scales were constructed, representing common sleep disorders and sleep-related problems. Linear mixed model analyses were performed to study differences between the groups for the different SDQ scales over time. The MAD group showed significant improvements over time in symptoms corresponding with 'insomnia', 'excessive daytime sleepiness', 'psychiatric sleep disorder', 'periodic limb movements', 'sleep apnoea', 'sleep paralysis', 'daytime dysfunction', 'hypnagogic hallucinations/dreaming', 'restless sleep', 'negative conditioning' and 'automatic behaviour' (range of P values: 0·000-0·014). These improvements in symptoms were, however, not significantly different from the improvements in symptoms observed in the nCPAP and placebo groups (range of P values: 0·090-0·897). It can be concluded that there is no significant difference between MAD and nCPAP in their positive effects on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. These beneficial effects may be a result of placebo effects. © 2017 John Wiley & Sons Ltd.

  19. Titration effectiveness of two autoadjustable continuous positive airway pressure devices driven by different algorithms in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Damiani, Mario Francesco; Quaranta, Vitaliano Nicola; Tedeschi, Ersilia; Drigo, Riccardo; Ranieri, Teresa; Carratù, Pierluigi; Resta, Onofrio

    2013-08-01

    Nocturnal application of continuous positive airway pressure (CPAP) is the standard treatment for patients with obstructive sleep apnoea (OSA). Determination of the therapeutic pressure (CPAP titration) is usually performed by a technician in the sleep laboratory during attended polysomnography. One possible alternative to manual titration is automated titration. Indeed, during the last 15 years, devices have been developed that deliver autoadjustable CPAP (A-CPAP). The aim of the present study was to compare the titration effectiveness of two A-CPAP devices using different flow-based algorithms in patients with OSA. This is a randomized study; 79 subjects underwent two consecutive unattended home A-CPAP titration nights with two different devices (Autoset Resmed; Remstar Auto Respironics); during the third and the fourth night, patients underwent portable monitoring in the sleep laboratory during fixed CPAP at the A-CPAP recommended pressure. Bland Altman plots showed good agreement between the recommended median and maximal pressure levels obtained with the two devices. A significant improvement was observed in all the sleep parameters by both A-CPAP machines to a similar degree. It was observed that the two A-CPAP devices using different algorithms are equally effective in initial titration of CPAP. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  20. Influence of craniofacial and upper spine morphology on mandibular advancement device treatment outcome in patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Svanholt, Palle; Petri, Niels; Wildschiødtz, Gordon

    2015-01-01

    Summary BACKGROUND/OBJECTIVES: The aim of the study was to assess cephalometric predictive markers in terms of craniofacial morphology including posterior cranial fossa and upper spine morphology for mandibular advancement device (MAD) treatment outcome in patients with obstructive sleep apnoea...... patients and the no success treatment group of 19 patients. Before MAD treatment lateral cephalograms were taken and analyses of the craniofacial morphology including the posterior cranial fossa and upper spine morphology were performed. Differences between the groups were analysed by Fisher's exact test......, t-test, and multiple regression analysis. RESULTS: Upper spine morphological deviations occurred non-significantly in 25 per cent in the success treatment group and in 42.1 per cent in the no success treatment group. Body mass index (BMI; P

  1. Physiological consequences of CPAP therapy withdrawal in patients with obstructive sleep apnoea-an opportunity for an efficient experimental model.

    Science.gov (United States)

    Schwarz, Esther I; Stradling, John R; Kohler, Malcolm

    2018-01-01

    Randomised controlled trials (RCTs) of continuous positive airway pressure (CPAP) in obstructive sleep apnoea (OSA) are time consuming, and their findings often inconclusive or limited due to suboptimal CPAP adherence in CPAP-naïve patients with OSA. Short-term CPAP withdrawal in patients with prior optimal CPAP adherence results in recurrence of OSA and its consequences. Thus, this experimental model serves as an efficient tool to investigate both the consequences of untreated OSA, and potential treatment alternatives to CPAP. The CPAP withdrawal protocol has been thoroughly validated, and applied in several RCTs focusing on cardiovascular and metabolic consequences of untreated OSA, as well as the assessment of treatment alternatives to CPAP.

  2. Paradoxical reaction of blood pressure on sleep apnoea patients treated with Positive Airway Pressure

    Directory of Open Access Journals (Sweden)

    C. Chaves Loureiro

    2011-03-01

    Full Text Available Introduction: Obstructive Sleep Apnoea Syndrome (OSAS patients may develop hypertension and Positive Airway Pressure (PAP is an effective treatment in blood pressure (BP control. Objectives: Analyse a hypertensive OSAS population with unexpected BP rise after PAP usage and verify correlations between BP rise, either with OSAS severity index or nocturnal ventilatory support compliance. Methods: Descriptive, retrospective analysis of 30 patients with PAP treated OSA, for one year, on average, and with previous controlled hypertension, who developed a rise in BP, defined as augmentation of > 5 mmHg in systolic (SBP and/or diastolic BP (DBP, after PAP usage. Co-relational analysis of BP increase, with OSAS severity indexes and therapy compliance, using Pearson coefficient. Results: Of 508 consecutive patients followed in our Department, treated with nocturnal ventilatory support, 30 evolved with BP rise after initiating treatment (age 58 ± 10.8 years; Apnoea-Hypopnoea Index [AHI], 46.1 ± 18.68. After PAP usage, mean blood pressure (MBP, Systolic BP (SBP and Diastolic BP (DBP variation was 16 ± 15 mmHg, 20 ± 25 mmHg and 6 ± 19.4 mmHg, respectively. No patient showed significant BMI increase. Epworth Sleepiness Scale (ESS value decreased 8.9 ± 5.48 points. MBP, SBP and DBP variations were not correlated with P90/P95, residual AHI, leaks or PAP compliance. Conclusions: No specific characteristics were identified in the group who developed a rise in BP with PAP usage. No correlations were found between rises in BP and OSAS severity indexes or PAP compliance. Neither BMI nor variation in wakefulness status explained the rise in BP. Studies relate polymorphisms of b1-adrenoreceptors with different BP responses to ventilatory support. More studies are needed to clarify the cause of this paradoxical response. Resumo: Introdução: Doentes com síndrome de Apneia Obstrutiva do Sono (SAOS podem desenvolver hipertensão arterial (HTA sendo a

  3. Sex, stress and sleep apnoea: Decreased susceptibility to upper airway muscle dysfunction following intermittent hypoxia in females.

    Science.gov (United States)

    O'Halloran, Ken D; Lewis, Philip; McDonald, Fiona

    2017-11-01

    Obstructive sleep apnoea syndrome (OSAS) is a devastating respiratory control disorder more common in men than women. The reasons for the sex difference in prevalence are multifactorial, but are partly attributable to protective effects of oestrogen. Indeed, OSAS prevalence increases in post-menopausal women. OSAS is characterized by repeated occlusions of the pharyngeal airway during sleep. Dysfunction of the upper airway muscles controlling airway calibre and collapsibility is implicated in the pathophysiology of OSAS, and sex differences in the neuro-mechanical control of upper airway patency are described. It is widely recognized that chronic intermittent hypoxia (CIH), a cardinal feature of OSAS due to recurrent apnoea, drives many of the morbid consequences characteristic of the disorder. In rodents, exposure to CIH-related redox stress causes upper airway muscle weakness and fatigue, associated with mitochondrial dysfunction. Of interest, in adults, there is female resilience to CIH-induced muscle dysfunction. Conversely, exposure to CIH in early life, results in upper airway muscle weakness equivalent between the two sexes at 3 and 6 weeks of age. Ovariectomy exacerbates the deleterious effects of exposure to CIH in adult female upper airway muscle, an effect partially restored by oestrogen replacement therapy. Intriguingly, female advantage intrinsic to upper airway muscle exists with evidence of substantially greater loss of performance in male muscle during acute exposure to severe hypoxic stress. Sex differences in upper airway muscle physiology may have relevance to human OSAS. The oestrogen-oestrogen receptor α axis represents a potential therapeutic target in OSAS, particularly in post-menopausal women. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Impact of sacubitril-valsartan combination in patients with chronic heart failure and sleep apnoea syndrome: the ENTRESTO-SAS study design.

    Science.gov (United States)

    Jaffuel, Dany; Molinari, Nicolas; Berdague, Philippe; Pathak, Atul; Galinier, Michel; Dupuis, Marion; Ricci, Jean-Etienne; Mallet, Jean-Pierre; Bourdin, Arnaud; Roubille, François

    2018-06-01

    Sleep-disordered breathing (SDB) is a highly prevalent co-morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril-valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin-converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. The ENTRESTO-SAS trial is a 3-month, multicentric, prospective, open-label real-life cohort study. Patients eligible for sacubitril-valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin-converting enzyme inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea-Hypopnoea Index with a power of 90% at an alpha risk of 5%. In the context of the SERVE-HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO-SAS trial whether sacubitril-valsartan could improve the outcome of SDB in CHF patients. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

  5. Morbidity and mortality in children with obstructive sleep apnoea: a controlled national study.

    Science.gov (United States)

    Jennum, Poul; Ibsen, Rikke; Kjellberg, Jakob

    2013-10-01

    Little is known about the diagnostic patterns of obstructive sleep apnoea (OSA) in children. A study was undertaken to evaluate morbidity and mortality in childhood OSA. 2998 patients aged 0-19 years with a diagnosis of OSA were identified from the Danish National Patient Registry. For each patient we randomly selected four citizens matched for age, sex and socioeconomic status, thus providing 11 974 controls. Patients with OSA had greater morbidity at least 3 years before their diagnosis. The most common contacts with the health system arose from infections (OR 1.19, 95% CI 1.01 to 1.40); endocrine, nutritional and metabolic diseases (OR 1.30, 95% CI 0.94 to 1.80); nervous conditions (OR 2.12, 95% CI 1.65 to 2.73); eye conditions (OR 1.43, 95% CI 1.07 to 1.90); ear, nose and throat (ENT) diseases (OR 1.61, 95% CI 1.33 to 1.94); respiratory system diseases (OR 1.78, 95% CI 1.60 to 1.98); gastrointestinal diseases (OR 1.34, 95% CI 1.09 to 1.66); skin conditions (OR 1.32, 95% CI 1.02 to 1.71); congenital malformations (OR 1.56, 95% CI 1.31 to 1.85); abnormal clinical or laboratory findings (OR 1.21, 95% CI 1.06 to 1.39); and other factors influencing health status (OR 1.29, 95% CI 1.16 to 1.43). After diagnosis, OSA was associated with incidences of endocrine, nutritional and metabolic diseases (OR 1.78, 95% CI 1.29 to 2.45), nervous conditions (OR 3.16, 95% CI 2.58 to 3.89), ENT diseases (OR 1.45, 95% CI 1.14 to 1.84), respiratory system diseases (OR 1.94, 95% CI 1.70 to 2.22), skin conditions (OR 1.42, 95% CI 1.06 to 1.89), musculoskeletal diseases (OR 1.29, 95% CI 1.01 to 1.64), congenital malformations (OR 1.83, 95% CI 1.51 to 2.22), abnormal clinical or laboratory findings (OR 1.16, 95% CI 1.06 to 1.27) and other factors influencing health status (OR 1.35, 95% CI 1.20 to 1.51). The 5-year death rate was 70 per 10 000 for patients and 11 per 10 000 for controls. The HR for cases compared with controls was 6.58 (95% CI 3.39 to 12.79; p<0.001). Children with OSA

  6. Long-term side effects on the temporomandibular joints and oro-facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device

    DEFF Research Database (Denmark)

    Knappe, S W; Bakke, M; Svanholt, P

    2017-01-01

    Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to inv......Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim...... was to investigate the influence of long-term MAD treatment on the TMJs, oro-facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea-Hypopnoea Index (AHI): 7-57]. They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic...... changes in the TMJs, the oro-facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups....

  7. Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    Side-effects directly due to the nasal mask are common in patients with obstructive sleep apnoea syndrome (OSAS) commencing continuous positive airway pressure (CPAP). Recently, nasal pillows have been designed to overcome these issues. Limited evidence exists of the benefits and effectiveness of these devices. Twenty-one patients (19 male, 49+\\/-10years) with the established diagnosis of OSAS [apnoea\\/hypopnoea index (AHI): 52+\\/-22] and who had a successful CPAP titration were commenced on CPAP therapy (10+\\/-2cmH2O), and randomized to 4weeks of a nasal pillow (P) and a standard nasal mask (M) in a crossover design. Outcome measures were objective compliance, AHI, quality of life, Epworth Sleepiness Score (ESS) and CPAP side-effects. There was no difference in compliance (M versus P: 5.1+\\/-1.9h versus 5.0+\\/-1.7h; P=0.701) and AHI (2.6+\\/-2.7 versus 3.0+\\/-2.9; P=0.509). Quality of life and ESS improved with CPAP, but there was no difference in the extent of improvement between both devices. Usage of nasal pillows resulted in less reported pressure on the face and more subjects found the nasal pillow the more comfortable device. However, there was no clear overall preference for either device at the end of the study (mask=57%, pillow=43%; P=0.513). The applied CPAP pressure did not correlate with compliance, AHI and ESS. Furthermore, no differences in outcome parameters were noted comparing groups with CPAP pressure <10 and >\\/=10cm H(2) O. Nasal pillows are equally effective in CPAP therapy, but do not generally lead to improved compliance.

  8. Sleep Apnoea Detection in Single Channel ECGs by Analyzing Heart Rate Dynamics

    National Research Council Canada - National Science Library

    Zywietz, C

    2001-01-01

    .... Sleep disorders are typically investigated by means of polysomnographic recordings. We have analyzed 70 eight-hour single-channel ECG recordings to find out to which extent sleep apneas may be detected from the ECG alone...

  9. Study into the use of continuous positive airway pressure in obstructive sleep apnoea-hypopnoea syndrome patients with daytime drowsiness

    Directory of Open Access Journals (Sweden)

    Clélia Maria Ribeiro Franco

    2009-03-01

    Full Text Available Background: Obstructive sleep apnoea-hypopnoea syndrome (OSAHS is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications. Aims: To evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness. Method: A sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use. Results: There was a significant decrease in the level of daytime sleepiness of the patients users of nasal CPAP (p=0.017; patients not using nasal CPAP experienced a decrease without statistical significance (p=0.162. 100% of CPAP users reported benefits and 50% of these reported related discomforts. Conclusions: Patients with OSAHS that use CPAP have a greater reduced level of sleepiness than those who do not use it. Resumo: Introdução: A síndroma da apneia-hipopneia obstrutiva do sono (SAHOS é um distúrbio respiratório de elevada morbimortalidade. A terapia com pressão positiva contínua das vias aéreas (CPAP representa o tratamento conservador mais prescrito para a SAHOS e tem o intuito de restabelecer a patência das vias aéreas, normalizando o índice de eventos respiratórios obstrutivos, corrigindo os sintomas. Objectivo: Avaliar o impacto do uso do CPAP nasal sobre a hipersonia diurna em portadores de SAHOS. Método: Amostra de vinte doentes portadores de SAHOS diagnosticados por estudo de polissonografia de noite inteira, usuários ou não de CPAP nasal, todos avaliados quanto à hipersonia diurna através da escala de sonolência de Epworth. Resultados: O decréscimo do nível de sonolência diurna dos usuários de CPAP nasal foi significante (p=0,017, enquanto para não usuários de CPAP nasal a m

  10. Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men.

    Science.gov (United States)

    Adams, Robert J; Appleton, Sarah L; Vakulin, Andrew; Lang, Carol; Martin, Sean A; Taylor, Anne W; McEvoy, R Doug; Antic, Nick A; Catcheside, Peter G; Wittert, Gary A

    2016-10-01

    To determine correlates of excessive daytime sleepiness (EDS) identified with the Epworth Sleepiness Scale (ESS) and a more broad definition, while accounting for obstructive sleep apnoea (OSA) in community dwelling men. Participants of the Men Androgens Inflammation Lifestyle Environment and Stress (MAILES) Study (n = 837, ≥ 40 years) without a prior OSA diagnosis, underwent in-home full unattended polysomnography (PSG, Embletta X100), completed the ESS, STOP questionnaire and Pittsburgh Sleep Quality Index in 2010-2011. In 2007-2010, questionnaires and biomedical assessment (in South Australian public hospital-based clinics) identified medical conditions. An alternate EDS definition (EDSAlt ) consisted of ≥ 2 of 3 problems (feeling sleepy sitting quietly; feeling tired/fatigued/sleepy; trouble staying awake). EDSAlt (30.4%, n = 253), but not ESS ≥ 11 (EDSESS , 12.6%, n = 104), increased significantly across OSA severity and body mass index categories. In adjusted analyses, EDSESS was significantly associated with depression: odds ratio (OR), 95%CI: 2.2 (1.3-3.8) and nocturia: 2.0 (1.3-3.2). EDSAlt was associated with depression, financial stress, relationship, work-life balance problems and associations with nocturia and diabetes were borderline. After excluding men with EDSESS , EDSAlt was associated with oxygen desaturation index (3%) ≥ 16 and the highest arousal index quartile but not with comorbidities. Sleepiness not necessarily leading to dozing, but not ESS ≥ 11, was related to sleep disordered breathing. Clinicians should be alert to (1) differing perspectives of sleepiness for investigation and treatment of OSA, and (2) the presence of depression and nocturia in men presenting with significant Epworth sleepiness regardless of the presence of OSA. © 2016 Asian Pacific Society of Respirology.

  11. Transvenous stimulation of the phrenic nerve for the treatment of central sleep apnoea: 12 months' experience with the remedē® System.

    Science.gov (United States)

    Jagielski, Dariusz; Ponikowski, Piotr; Augostini, Ralph; Kolodziej, Adam; Khayat, Rami; Abraham, William T

    2016-11-01

    Patients with central sleep apnoea (CSA) often have poor quality of life and are at increased risk of morbidity and mortality. This study sought to evaluate the 12-month clinical outcomes of patients with CSA treated with unilateral transvenous phrenic nerve stimulation in the prospective, multicentre, non-randomized remedē ® System pilot study. Forty-seven patients with CSA were treated with the remedē ® System (Respicardia Inc., Minnetonka, MN, USA) for a minimum of 3 months. Sleep-disordered breathing parameters were evaluated by polysomnography (PSG) at 3, 6, and 12-month follow-up. Sleep symptoms and quality of life were also evaluated. Forty-one patients completed all follow-up PSGs and were included in the analysis. At 12 months, there was sustained improvement compared with baseline in the apnoea-hypopnoea index (49.9 ± 15.1 vs. 27.5 ± 18.3 events/h, P phrenic nerve stimulation is associated with sustained improvement in key sleep parameters, sleep symptoms, and quality of life over 12 months of follow-up. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  12. Maximal exercise capacity in patients with obstructive sleep apnoea syndrome: A systematic review and meta-analysis.

    Science.gov (United States)

    Mendelson, Monique; Marillier, Mathieu; Bailly, Sébastien; Flore, Patrice; Borel, Jean-Christian; Vivodtzev, Isabelle; Doutreleau, Stéphane; Tamisier, Renaud; Pépin, Jean-Louis; Verges, Samuel

    2018-04-26

    Maximal aerobic capacity is a strong health predictor and peak oxygen consumption (VO 2peak ) is considered a reflection of total body health. No systematic reviews or meta-analysis' to date have synthesised the existing data regarding VO 2peak in patients with obstructive sleep apnoea (OSA).A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing VO 2peak of OSA patients in mL·kg -1 ·min -1 compared with controls or in % predicted. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence.Mean VO 2peak expressed in mL·kg -1 ·min -1 was significantly lower in patients with OSA when compared with controls (mean difference=-2.7 mL·kg -1 ·min -1 ; p<0.001; n=850). This reduction in VO 2peak was found to be larger in non-obese patients (BMI<30 kg·m -2 ). Mean VO 2peak in % predicted was 90.7±21.0% in OSA patients (n=643).OSA patients present reduced maximal aerobic capacity, which can be associated with increased cardiovascular risks and reduced survival in certain patient subgroups. Maximal exercise testing can be useful to characterise functional limitation and to evaluate health status in OSA patients. Registration # CRD42017057319. Copyright ©ERS 2018.

  13. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment

    Directory of Open Access Journals (Sweden)

    Del Ben Maria

    2012-07-01

    Full Text Available Abstract Background Several studies suggest an increase of oxidative stress and a reduction of endothelial function in obstructive sleep apnoea syndrome (OSAS. We assessed the association between OSAS, endothelial dysfunction and oxidative stress. Further aim was to evaluate the effect of nasal continuous positive airway pressure (nCPAP on oxidative stress and arterial dysfunction. Methods We studied 138 consecutive patients with heavy snoring and possible OSAS. Patients underwent unattended overnight home polysomnography. Ten patients with severe OSAS were revaluated after 6 months of nCPAP therapy. To assess oxidative stress in vivo, we measured urinary 8-iso-PGF2α and serum levels of soluble NOX2-derived peptide (sNOX2-dp. Serum levels of nitrite/nitrate (NOx were also determined. Flow-mediated brachial artery dilation (FMD was measured to asses endothelial function. Results Patients with severe OSAS had higher urinary 8-iso-PGF2α (p Conclusions The results of our study indicate that patients with OSAS and cardiometabolic comorbidities have increased oxidative stress and arterial dysfunction that are partially reversed by nCPAP treatment.

  14. Use of bibloc and monobloc oral appliances in obstructive sleep apnoea: a multicentre, randomized, blinded, parallel-group equivalence trial.

    Science.gov (United States)

    Isacsson, Göran; Nohlert, Eva; Fransson, Anette M C; Bornefalk-Hermansson, Anna; Wiman Eriksson, Eva; Ortlieb, Eva; Trepp, Livia; Avdelius, Anna; Sturebrand, Magnus; Fodor, Clara; List, Thomas; Schumann, Mohamad; Tegelberg, Åke

    2018-05-16

    The clinical benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that the two types of appliances are equally effective in treating OSA. To compare the efficacy of monobloc versus bibloc appliances in a short-term perspective. In this multicentre, randomized, blinded, controlled, parallel-group equivalence trial, patients with OSA were randomly assigned to use either a bibloc or a monobloc appliance. One-night respiratory polygraphy without respiratory support was performed at baseline, and participants were re-examined with the appliance in place at short-term follow-up. The primary outcome was the change in the apnoea-hypopnea index (AHI). An independent person prepared a randomization list and sealed envelopes. Evaluating dentist and the biomedical analysts who evaluated the polygraphy were blinded to the choice of therapy. Of 302 patients, 146 were randomly assigned to use the bibloc and 156 the monobloc device; 123 and 139 patients, respectively, were analysed as per protocol. The mean changes in AHI were -13.8 (95% confidence interval -16.1 to -11.5) in the bibloc group and -12.5 (-14.8 to -10.3) in the monobloc group. The difference of -1.3 (-4.5 to 1.9) was significant within the equivalence interval (P = 0.011; the greater of the two P values) and was confirmed by the intention-to-treat analysis (P = 0.001). The adverse events were of mild character and were experienced by similar percentages of patients in both groups (39 and 40 per cent for the bibloc and monobloc group, respectively). The study shows short-term results with a median time from commencing treatment to the evaluation visit of 56 days and long-term data on efficacy and harm are needed to be fully conclusive. In a short-term perspective, both appliances were equivalent in terms of their positive effects for treating OSA and caused adverse events of similar magnitude. Registered with Clinical

  15. Computed tomographic angiography study of the relationship between the lingual artery and lingual markers in patients with obstructive sleep apnoea

    Energy Technology Data Exchange (ETDEWEB)

    Hou, T.-N., E-mail: dr-htn@hotmail.co [Department of Otolaryngology Head and Neck Surgery, Affiliated SIR RUN RUN SHAW Hospital, Zhejiang University, Hangzhou 310016 (China); Zhou, L.-N.; Hu, H.-J. [Department of Otolaryngology Head and Neck Surgery, Affiliated SIR RUN RUN SHAW Hospital, Zhejiang University, Hangzhou 310016 (China)

    2011-06-15

    Aim: To determine the relationship between the lingual artery and lingual markers for preoperative evaluation of the lingual artery in patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Methods: A 16-section computed tomographic angiography (CTA) of the lingual artery was performed in 87 inpatient cases with OSAHS, from December 2007 to May 2009. The course of the lingual artery and the anatomic relationship between the lingual artery and the lingual markers were analyzed using CTA imaging. Results: The course of the lingual artery with the tongue in a resting position was similar to that of the Big Dipper constellation (Plough) in the sagittal view of CTA imaging. The first segment of the lingual artery declined approximately 19.27 {+-} 5.24 mm, the middle segment of the lingual artery was forward approximately 19.30 {+-} 6.79 mm, and the ascending segment of the lingual artery rose approximately 52.49 {+-} 10.98 mm. The entry point where the lingual artery entered into the tongue was adjacent to the tip of the greater horn of the hyoid bone. The relationship between the second segment of the lingual artery and the greater horn of the hyoid bone was relatively steady with the tongue in whatever position. The interval between the bilateral greater horn of the hyoid bone equalled that between the bilateral lingual arteries. Conclusions: Recognizing some lingual markers in the patients with OSAHS, such as the greater horn of the hyoid bone, foramen cecum, circumvallate papilla, lingual vein and tongue midline, may facilitate the surgeon's ability to define the course of the lingual artery accurately in the treatment of OSAHS.

  16. Effect of continuous positive airway pressure treatment for obstructive sleep apnoea on visual processing of degraded words.

    Science.gov (United States)

    Proudlove, Katie; Manuel, Ari; Hall, Rachel; Rieu, Romelie; Villarroel, Mauricio; Stradling, John

    2014-01-01

    In a previous uncontrolled study, continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) improved vision in patients with diabetic macular oedema. We investigated whether the above improvement in vision (or visual processing) might have been due to reduced sleepiness, rather than a true improvement in retinal function. Twelve normal control subjects and 20 patients with OSA were tested for their ability to recognise degraded words, by means of a computer programme displaying 5-letter words every 4 s for 10 min, with variable amounts of the bottom half of the word missing; the percentage of the word necessary to achieve correct identification on average half the time was 'hunted' (the test score). All subjects were tested twice, 2-3 weeks apart; the OSA group after the commencement of CPAP. The Epworth Sleepiness Score (ESS) in patients was measured at the same visit. The test score at visit 1 was 26.7% for normal subjects and 31.6% for patients with OSA. At visit 2, the test score was 25.0% for normal subjects and 29.9% for patients with OSA. The groups showed a small and identical improvement over the trial period in the test score, of 1.7% (p = 0.01 and p = 0.03 for the normal and OSA groups, respectively). The group with OSA experienced a drop in ESS of 7.5 (SD 5.5) points following treatment. The small and identical improvement in both groups suggests only a similar learning effect rather than any improvement due to reduced sleepiness.

  17. A single qualitative study can show same findings as years of quantitative research: Obstructive sleep apnoea as an example

    Directory of Open Access Journals (Sweden)

    Howard Tandeter

    2016-06-01

    Full Text Available Background Many years of quantitative research led to our present knowledge of the symptoms and associated features (S&AF of the obstructive sleep apnoea (OSA syndrome. Aims 1. To prove that a qualitative research approach may identify symptoms and associated features of OSA in less time/effort than that used in a quantitative approach; 2. To describe the experience of patients with OSA and the effects of the syndrome on their quality of life and that of their spouses and families (issues that quantitative methods fail to recognize. Methods We used a narrative inquiry methodology (qualitative research. The sample was selected using the “snowball sampling technique". The sample included 10 patients with moderate to severe OSA who had good adherence to CPAP and significant clinical improvement after treatment, and 3 of the patient’s spouses. Results The following issues were identified: A long pre-diagnosis phase of OSA (20 years in one of the patients; Characteristic S&AF of the syndrome as experienced by patients and their spouses; The need for increased awareness of both the public and the medical establishment in regards to this disorder; Premature ejaculation (not reported previously and nightmares (non-conclusive in the literature were identified and improved with CPAP therapy. Conclusion With the use of quantitative research methods it took decades to discover things that we found in one simple qualitative study. We therefore urge scientists to use more often these qualitative methods when looking for S&AF of diseases and syndromes.

  18. Adherence to CPAP therapy: comparing the effect of three educational approaches in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Delanote, Isabelle; Borzée, Pascal; Belge, Catharina; Buyse, Bertien; Testelmans, Dries

    2018-01-01

    Continuous positive airway pressure (CPAP)-therapy is the first-line treatment for moderate to severe obstructive sleep apnoea (OSA). A significant limitation of CPAP treatment is the poor therapy adherence, compromising the beneficial effects. This study evaluates three different educational approaches and their effect on therapy adherence. This single-center, retrospective study compared three groups of 100 consecutive, CPAP-naive patients with moderate to severe OSA who were started on CPAP therapy. Group 1 and 2 received the same individual structured education on two consecutive days with an extra phone call 7 to 10 days after CPAP start in group 2. Group 3 received individual structured education on the first day and participated in a group education using a slide presentation open for discussion on the second day. Re-evaluation was performed after 24 weeks. Baseline characteristics did not differ significantly between groups. During the 24 weeks follow-up there was a drop-out rate of 16% (group 1), 12% (group 2) and 5% (group 3). In the patients still on CPAP after 24 weeks, the mean nightly CPAP usage was, respectively, 4.7 ± 1.8, 5.2 ± 2.3 and 5.7 ± 2.1 h/night. In group 3 both the drop-out rate and mean CPAP usage were significantly different (P values, respectively, P CPAP adherence is an ongoing challenge. This study shows that a multi-modality approach, using a combination of individual and group education using a slide presentation open for discussion resulted in improved therapy adherence. © 2016 John Wiley & Sons Ltd.

  19. Adaptive servo-ventilation for central sleep apnoea in systolic heart failure: results of the major substudy of SERVE-HF.

    Science.gov (United States)

    Cowie, Martin R; Woehrle, Holger; Wegscheider, Karl; Vettorazzi, Eik; Lezius, Susanne; Koenig, Wolfgang; Weidemann, Frank; Smith, Gillian; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita K; Somers, Virend K; Zannad, Faiez; Teschler, Helmut

    2018-03-01

    The SERVE-HF trial investigated the impact of treating central sleep apnoea (CSA) with adaptive servo-ventilation (ASV) in patients with systolic heart failure. A preplanned substudy was conducted to provide insight into mechanistic changes underlying the observed effects of ASV, including assessment of changes in left ventricular function, ventricular remodelling, and cardiac, renal and inflammatory biomarkers. In a subset of the 1325 randomised patients, echocardiography, cardiac magnetic resonance imaging (cMRI) and biomarker analysis were performed at baseline, and 3 and 12 months. In secondary analyses, data for patients with baseline and 12-month values were evaluated; 312 patients participated in the substudy. The primary endpoint, change in echocardiographically determined left ventricular ejection fraction from baseline to 12 months, did not differ significantly between the ASV and the control groups. There were also no significant between-group differences for changes in left ventricular dimensions, wall thickness, diastolic function or right ventricular dimensions and ejection fraction (echocardiography), and on cMRI (in small patient numbers). Plasma N-terminal pro B-type natriuretic peptide concentration decreased in both groups, and values were similar at 12 months. There were no significant between-group differences in changes in cardiac, renal and systemic inflammation biomarkers. In patients with systolic heart failure and CSA, addition of ASV to guideline-based medical management had no statistically significant effect on cardiac structure and function, or on cardiac biomarkers, renal function and systemic inflammation over 12 months. The increased cardiovascular mortality reported in SERVE-HF may not be related to adverse remodelling or worsening heart failure. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  20. Reversal of functional changes in the brain associated with obstructive sleep apnoea following 6 months of CPAP

    Directory of Open Access Journals (Sweden)

    Rania H. Fatouleh

    2015-01-01

    Full Text Available Obstructive sleep apnoea (OSA is associated with an increase in the number of bursts of muscle sympathetic nerve activity (MSNA, leading to neurogenic hypertension. Continuous positive airway pressure (CPAP is the most effective and widely used treatment for preventing collapse of the upper airway in OSA. In addition to improving sleep, CPAP decreases daytime MSNA towards control levels. It remains unknown how this restoration of MSNA occurs, in particular whether CPAP treatment results in a simple readjustment in activity of those brain regions responsible for the initial increase in MSNA or whether other brain regions are recruited to over-ride aberrant brain activity. By recording MSNA concurrently with functional Magnetic Resonance Imaging (fMRI, we aimed to assess brain activity associated with each individual subject's patterns of MSNA prior to and following 6 months of CPAP treatment. Spontaneous fluctuations in MSNA were recorded via tungsten microelectrodes inserted into the common peroneal nerve in 13 newly diagnosed patients with OSA before and after 6 months of treatment with CPAP and in 15 healthy control subjects while lying in a 3 T MRI scanner. Blood Oxygen Level Dependent (BOLD contrast gradient echo, echo-planar images were continuously collected in a 4 s ON, 4 s OFF (200 volumes sampling protocol. MSNA was significantly elevated in newly diagnosed OSA patients compared to control subjects (55 ± 4 vs 26 ± 2 bursts/min. Fluctuations in BOLD signal intensity in multiple regions covaried with the intensity of the concurrently recorded bursts of MSNA. There was a significant fall in MSNA after 6 months of CPAP (39 ± 2 bursts/min. The reduction in resting MSNA was coupled with significant falls in signal intensity in precuneus bilaterally, the left and right insula, right medial prefrontal cortex, right anterior cingulate cortex, right parahippocampus and the left and right retrosplenial cortices. These data support

  1. Reversal of functional changes in the brain associated with obstructive sleep apnoea following 6 months of CPAP.

    Science.gov (United States)

    Fatouleh, Rania H; Lundblad, Linda C; Macey, Paul M; McKenzie, David K; Henderson, Luke A; Macefield, Vaughan G

    2015-01-01

    Obstructive sleep apnoea (OSA) is associated with an increase in the number of bursts of muscle sympathetic nerve activity (MSNA), leading to neurogenic hypertension. Continuous positive airway pressure (CPAP) is the most effective and widely used treatment for preventing collapse of the upper airway in OSA. In addition to improving sleep, CPAP decreases daytime MSNA towards control levels. It remains unknown how this restoration of MSNA occurs, in particular whether CPAP treatment results in a simple readjustment in activity of those brain regions responsible for the initial increase in MSNA or whether other brain regions are recruited to over-ride aberrant brain activity. By recording MSNA concurrently with functional Magnetic Resonance Imaging (fMRI), we aimed to assess brain activity associated with each individual subject's patterns of MSNA prior to and following 6 months of CPAP treatment. Spontaneous fluctuations in MSNA were recorded via tungsten microelectrodes inserted into the common peroneal nerve in 13 newly diagnosed patients with OSA before and after 6 months of treatment with CPAP and in 15 healthy control subjects while lying in a 3 T MRI scanner. Blood Oxygen Level Dependent (BOLD) contrast gradient echo, echo-planar images were continuously collected in a 4 s ON, 4 s OFF (200 volumes) sampling protocol. MSNA was significantly elevated in newly diagnosed OSA patients compared to control subjects (55 ± 4 vs 26 ± 2 bursts/min). Fluctuations in BOLD signal intensity in multiple regions covaried with the intensity of the concurrently recorded bursts of MSNA. There was a significant fall in MSNA after 6 months of CPAP (39 ± 2 bursts/min). The reduction in resting MSNA was coupled with significant falls in signal intensity in precuneus bilaterally, the left and right insula, right medial prefrontal cortex, right anterior cingulate cortex, right parahippocampus and the left and right retrosplenial cortices. These data support our contention that

  2. Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial.

    Science.gov (United States)

    Guralnick, Amy S; Balachandran, Jay S; Szutenbach, Shane; Adley, Kevin; Emami, Leila; Mohammadi, Meelad; Farnan, Jeanne M; Arora, Vineet M; Mokhlesi, Babak

    2017-12-01

    Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. ClinicalTrials.gov Identifier: NCT02553694. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy.

    Science.gov (United States)

    Bosi, Marcello; De Vito, Andrea; Gobbi, Riccardo; Poletti, Venerino; Vicini, Claudio

    2017-03-01

    The objective of this study is to highlight the importance of anatomical and not-anatomical factors' identification for customized therapy in OSAHS patients. The data sources are: MEDLINE, The Cochrane Library and EMBASE. A systematic review was performed to identify studies that analyze the role of multiple interacting factors involved in the OSAHS pathophysiology. 85 out of 1242 abstracts were selected for full-text review. A variable combinations pathophysiological factors contribute to realize differentiated OSAHS phenotypes: a small pharyngeal airway with a low resistance to collapse (increased critical closing pressure), an inadequate responses of pharyngeal dilator muscles (wakefulness drive to breathe), an unstable ventilator responsiveness to hypercapnia (high loop gain), and an increased propensity to wake related to upper airway obstruction (low arousal threshold). Identifying if the anatomical or not-anatomical factors are predominant in each OSAHS patient represents the current challenge in clinical practice, moreover for the treatment decision-making. In the future, if a reliable and accurate pathophysiological pattern for each OSAHS patient can be identified, a customized therapy will be feasible, with a significant improvement of surgical success in sleep surgery and a better understanding of surgical failure.

  4. Blood pressure response to CPAP treatment in subjects with obstructive sleep apnoea: the predictive value of 24-h ambulatory blood pressure monitoring.

    Science.gov (United States)

    Castro-Grattoni, Anabel L; Torres, Gerard; Martínez-Alonso, Montserrat; Barbé, Ferran; Turino, Cecilia; Sánchez-de-la-Torre, Alicia; Cortijo, Anunciacion; Duran-Cantolla, Joaquin; Egea, Carlos; Cao, Gonzalo; Sánchez-de-la-Torre, Manuel

    2017-10-01

    The reduction in blood pressure (BP) with continuous positive airway pressure (CPAP) is modest and highly variable. In this study, we identified the variables that predict BP response to CPAP.24-h ambulatory BP monitoring (ABPM), C-reactive protein (CRP), leptin, adiponectin and 24-h urinary catecholamine were measured before and after 6 months of CPAP in obstructive sleep apnoea (OSA) patients.Overall, 88 middle-aged, obese male patients with severe OSA (median apnoea-hypopnoea index 42 events·h -1 ) were included; 28.4% had hypertension. 62 patients finished the study, and 60 were analysed. The daytime diastolic BP (-2 mmHg) and norepinephrine (-109.5 nmol·day -1 ) were reduced after CPAP, but no changes in the 24-h BP, night-time BP, dopamine, epinephrine, CRP, leptin or adiponectin were detected. The nocturnal normotension was associated with an increased night-time-BP (+4 mmHg) after CPAP, whereas nocturnal hypertension was associated with a reduction of 24-h BP (-3 mmHg). A multivariate linear regression model showed differential night-time BP changes after CPAP. Specifically, low night-time heart rate (CPAP and support the usefulness of 24-h ABPM for OSA patients before treatment initiation. These results need to be confirmed in further studies. Copyright ©ERS 2017.

  5. Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure.

    Science.gov (United States)

    Cowie, Martin R; Woehrle, Holger; Wegscheider, Karl; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita; Somers, Virend K; Zannad, Faiez; Teschler, Helmut

    2013-08-01

    Central sleep apnoea/Cheyne-Stokes respiration (CSA/CSR) is a risk factor for increased mortality and morbidity in heart failure (HF). Adaptive servo-ventilation (ASV) is a non-invasive ventilation modality for the treatment of CSA/CSR in patients with HF. SERVE-HF is a multinational, multicentre, randomized, parallel trial designed to assess the effects of addition of ASV (PaceWave, AutoSet CS; ResMed) to optimal medical management compared with medical management alone (control group) in patients with symptomatic chronic HF, LVEF ≤45%, and predominant CSA. The trial is based on an event-driven group sequential design, and the final analysis will be performed when 651 events have been observed or the study is terminated at one of the two interim analyses. The aim is to randomize ∼1200 patients to be followed for a minimum of 2 years. Patients are to stay in the trial up to study termination. The first patient was randomized in February 2008 and the study is expected to end mid 2015. The primary combined endpoint is the time to first event of all-cause death, unplanned hospitalization (or unplanned prolongation of a planned hospitalization) for worsening (chronic) HF, cardiac transplantation, resuscitation of sudden cardiac arrest, or appropriate life-saving shock for ventricular fibrillation or fast ventricular tachycardia in implantable cardioverter defibrillator patients. The SERVE-HF study is a randomized study that will provide important data on the effect of treatment with ASV on morbidity and mortality, as well as the cost-effectiveness of this therapy, in patients with chronic HF and predominantly CSA/CSR. ISRCTN19572887.

  6. Diagnostic approaches to respiratory sleep disorders

    OpenAIRE

    Riha, Renata L.

    2015-01-01

    Sleep disordered breathing (SDB) comprises a number of breathing disturbances occurring during sleep including snoring, the obstructive sleep apnoea/hypopnea syndrome (OSAHS), central sleep apnoea (CSA) and hypoventilation syndromes. This review focuses on sleep disordered breathing and diagnostic approaches in adults, in particular clinical assessment and overnight assessment during sleep. Although diagnostic approaches to respiratory sleep disorders are reasonably straightforward, they do r...

  7. Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial.

    Science.gov (United States)

    Pépin, J L; Tamisier, R; Baguet, J P; Lepaulle, B; Arbib, F; Arnol, N; Timsit, J F; Lévy, P

    2016-08-01

    Millions of individuals with obstructive sleep apnoea (OSA) are treated by CPAP aimed at reducing blood pressure (BP) and thus cardiovascular risk. However, evidence is scarce concerning the impact of different CPAP modalities on BP evolution. This double-blind, randomised clinical trial of parallel groups of patients with OSA indicated for CPAP treatment compared the efficacy of fixed-pressure CPAP (FP-CPAP) with auto-adjusting CPAP (AutoCPAP) in reducing BP. The primary endpoint was the change in office systolic BP after 4 months. Secondary endpoints included 24 h BP measurements. Patients (322) were randomised to FP-CPAP (n=161) or AutoCPAP (n=161). The mean apnoea+hypopnoea index (AHI) was 43/h (SD, 21); mean age was 57 (SD, 11), with 70% of males; mean body mass index was 31.3 kg/m(2) (SD, 6.6) and median device use was 5.1 h/night. In the intention-to-treat analysis, office systolic blood pressure decreased by 2.2 mm Hg (95% CI -5.8 to 1.4) and 0.4 mm Hg (-4.3 to 3.4) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.3 mm Hg (95% CI -4.1 to 1.5); p=0.37, adjusted for baseline BP values). 24 h diastolic BP (DBP) decreased by 1.7 mm Hg (95% CI -3.9 to 0.5) and 0.5 mm Hg (95% CI -2.3 to 1.3) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.4 mm Hg (95% CI -2.7 to -0.01); p=0.048, adjusted for baseline BP values). The result was negative regarding the primary outcome of office BP, while FP-CPAP was more effective in reducing 24 h DBP (a secondary outcome). NCT01090297. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Response to a combination of oxygen and a hypnotic as treatment for obstructive sleep apnoea is predicted by a patient's therapeutic CPAP requirement.

    Science.gov (United States)

    Landry, Shane A; Joosten, Simon A; Sands, Scott A; White, David P; Malhotra, Atul; Wellman, Andrew; Hamilton, Garun S; Edwards, Bradley A

    2017-08-01

    Upper airway collapsibility predicts the response to several non-continuous positive airway pressure (CPAP) interventions for obstructive sleep apnoea (OSA). Measures of upper airway collapsibility cannot be easily performed in a clinical context; however, a patient's therapeutic CPAP requirement may serve as a surrogate measure of collapsibility. The present work aimed to compare the predictive use of CPAP level with detailed physiological measures of collapsibility. Therapeutic CPAP levels and gold-standard pharyngeal collapsibility measures (passive pharyngeal critical closing pressure (P crit ) and ventilation at CPAP level of 0 cmH 2 O (V passive )) were retrospectively analysed from a randomized controlled trial (n = 20) comparing the combination of oxygen and eszopiclone (treatment) versus placebo/air control. Responders (9/20) to treatment were defined as those who exhibited a 50% reduction in apnoea/hypopnoea index (AHI) plus an AHICPAP requirement compared with non-responders (6.6 (5.4-8.1)  cmH 2 O vs 8.9 (8.4-10.4) cmH 2 O, P = 0.007), consistent with their reduced collapsibility (lower P crit , P = 0.017, higher V passive P = 0.025). Therapeutic CPAP level provided the highest predictive accuracy for differentiating responders from non-responders (area under the curve (AUC) = 0.86 ± 0.9, 95% CI: 0.68-1.00, P = 0.007). However, both P crit (AUC = 0.83 ± 0.11, 95% CI: 0.62-1.00, P = 0.017) and V passive (AUC = 0.77 ± 0.12, 95% CI: 0.53-1.00, P = 0.44) performed well, and the difference in AUC for these three metrics was not statistically different. A therapeutic CPAP level ≤8 cmH 2 O provided 78% sensitivity and 82% specificity (positive predictive value = 78%, negative predictive value = 82%) for predicting a response to these therapies. Therapeutic CPAP requirement, as a surrogate measure of pharyngeal collapsibility, predicts the response to non-anatomical therapy (oxygen and

  9. Effects of CPAP therapy on visceral fat thickness, carotid intima-media thickness and adipokines in patients with obstructive sleep apnoea.

    Science.gov (United States)

    Ng, Susanna S S; Liu, Eric K H; Ma, Ronald C W; Chan, Tat-On; To, Kin-Wang; Chan, Ken K P; Ngai, Jenny; Yip, Wing-Ho; Ko, Fanny W S; Wong, Chun-Kwok; Hui, David S C

    2017-05-01

    Obstructive sleep apnoea (OSA) is associated with an increased prevalence of metabolic syndrome. This study explores the effects of continuous positive airway pressure (CPAP) for patients with OSA on visceral and mesenteric fat thickness, carotid intima-media thickness (IMT) and adipokines. A randomized controlled study was conducted at a teaching hospital on 90 patients newly diagnosed with OSA to receive either therapeutic CPAP or subtherapeutic CPAP for 3 months. Visceral fat thickness and carotid IMT were measured with B-mode ultrasound; adipokine levels were assessed at baseline and 3 months. Altogether, 45 patients received therapeutic CPAP and 45 received subtherapeutic CPAP without significant differences in age 50.3 (10.1) versus 48.7 (9.0) years, BMI 28.2 (3.9) versus 28.2 (4.5) kg/m 2 , Epworth Sleepiness Scale (ESS) 12.4 (5.9) versus 11.3 (4.7), apnoea-hypopnoea index (AHI) 30.6 (21.4) versus 35.2 (25.5) /h, minimum SaO 2 79.6 (10.8) versus 76.7 (12.4) % and existing co-morbidities. CPAP usage was therapeutic 4.2 (2.1) versus subtherapeutic 4.1 (2.0) h/night over 3 months. Adiponectin and irisin levels changed significantly following therapeutic CPAP for 3 months versus subtherapeutic CPAP (-1.6 vs 7.3, P = 0.042; 0.1 vs -0.1, P = 0.028 respectively) while only serum level of monocyte chemotactic protein 1 (MCP-1) at baseline was positively correlated with AHI (r = 0.278). No significant changes were observed in other adipokines, visceral fat thickness and IMT. Short-term therapeutic CPAP versus subtherapeutic CPAP does not significantly reduce visceral fat thickness and IMT, although it reduces adiponectin and increases irisin. © 2016 Asian Pacific Society of Respirology.

  10. Quality of sleep and risk for obstructive sleep apnoea in ambulant individuals with type 2 diabetes mellitus at a tertiary referral hospital in Kenya: a cross-sectional, comparative study.

    Science.gov (United States)

    Sokwalla, Sairabanu Mohammed Rashid; Joshi, Mark David; Amayo, Erastus Olonde; Acharya, Kirtida; Mecha, Jared Ongechi; Mutai, Kenneth Kipyegon

    2017-02-06

    Sleep disorders are common and associated with multiple metabolic and psychological derangements. Obstructive sleep apnoea (OSA) is among the most common sleep disorders and an inter-relationship between OSA, insulin resistance, obesity, type 2 diabetes (T2DM) and cardiovascular diseases has been established. Prevalence of sleep disorders in Kenyans, particularly in individuals with T2DM is unknown. We thus aimed to determine prevalence of poor quality of sleep (QOS) and high risk for OSA, among persons with T2DM and determine their associations with socio-demographic and anthropometric variables. Utilising a Cross- Sectional Descriptive design, QOS and risk for OSA were determined in a randomly selected sample of patients with T2DM (cases) and an age and sex matched comparison group. The validated Pittsburgh Sleep Quality Index (PSQI) and Berlin Questionnaire (BQ) were used to measure QOS and risk for OSA respectively. Associations between poor QOS, high risk for OSA, and socio-demographic and anthropometric variables in cases were evaluated. From 245 randomly selected persons with T2DM attending outpatient clinics, aged over 18 years, 22 were excluded due to ineligibility thus 223 were included in the analysis; 53.8% were females, mean age was 56.8 (SD 12.2) years and mean BMI was 28.8 kg/m 2 (SD 4.4). Among them, 119 (53%, CI 95% 46.5-60.2) had poor QOS and 99 (44% CI 95% 37.8-50.9) were at high risk for OSA. Among 112 individuals in comparison group, 33 (29.5%, CI 95% 20.9-38.3) had poor QOS and 9 (8%, CI 95% 3.3-13.4) had high risk for OSA. Cases had a significantly higher probability for poor QOS [OR 2.76 (95% CI 1.7-4.4))] and high risk for OSA [OR 9.1 (95% CI 4.4-19.0)]. Higher waist circumference was independently associated with a high risk for OSA in cases. We demonstrate a high burden of sleep disturbances in patients with T2DM. Our findings may have implications for clinicians to screen for sleep disorders when assessing patients with T2DM and

  11. The relationship between driving simulation performance and obstructive sleep apnoea risk, daytime sleepiness, obesity and road traffic accident history of commercial drivers in Turkey.

    Science.gov (United States)

    Demirdöğen Çetinoğlu, Ezgi; Görek Dilektaşlı, Aslı; Demir, Nefise Ateş; Özkaya, Güven; Acet, Nilüfer Aylin; Durmuş, Eda; Ursavaş, Ahmet; Karadağ, Mehmet; Ege, Ercüment

    2015-09-01

    Driving performance is known to be very sensitive to cognitive-psychomotor impairment. The aim of the study was to determine the relationship between obesity, risk of obstructive sleep apnoea (OSA), daytime sleepiness, history of road traffic accident (RTA) and performance on a driving simulator, among commercial drivers. We examined commercial vehicle drivers admitted to Psycho-Technical Assessment System (PTAS), which is a computer-aided system that includes a driving simulator test and tests assessing psychomotor-cognitive skills required for driving. Risk of OSA and daytime sleepiness were assessed by the Berlin Questionnaire and the Epworth Sleepiness Scale (ESS), respectively. A total of 282 commercial vehicle drivers were consecutively enrolled. The age range was 29-76 years. Thirty drivers were at high risk of OSA. Median ESS of the group was 2 (0-20). Forty-seven percent of the subjects at high risk of OSA failed in early reaction time test, while 28% of the drivers with low risk of OSA failed (p = 0.03). The obese drivers failed the peripheral vision test when compared with non-obese drivers (p = 0.02). ESS was higher for drivers with a history of RTA when compared to those without RTA (p = 0.02). Cognitive-psychomotor functions can be impaired in obese and high risk of OSA patients. In our opinion, requiring obese and/or high risk of OSA drivers to take PTAS tests that assess driving skills and psychomotor-cognitive functions crucial to those skills would significantly improve road traffic safety, which is of considerable importance to public health.

  12. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure.

    Science.gov (United States)

    Sharples, Linda; Glover, Matthew; Clutterbuck-James, Abigail; Bennett, Maxine; Jordan, Jake; Chadwick, Rebecca; Pittman, Marcus; East, Clare; Cameron, Malcolm; Davies, Mike; Oscroft, Nick; Smith, Ian; Morrell, Mary; Fox-Rushby, Julia; Quinnell, Timothy

    2014-01-01

    BACKGROUND Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. OBJECTIVES (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. TOMADO A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p < 0.001). Differences between MADs were not significant. Sleepiness [as measured by the Epworth Sleepiness Scale (ESS)] was scored 1.51 [95% CI 0.73 to 2.29 (SP1)] to 2.37 [95% CI 1.53 to 3.22 (bMAD)] lower than no treatment (p < 0.001), with SP2 and bMAD significantly better than SP1

  13. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children

    NARCIS (Netherlands)

    Venekamp, Roderick P; Hearne, Benjamin J; Chandrasekharan, Deepak; Blackshaw, Helen; Lim, Jerome; Schilder, Anne G M

    2015-01-01

    BACKGROUND: Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children,

  14. Evaluation of the upper airway measurements by multi-slice CT before and after operations in obstructive sleep apnoea syndrome patients

    International Nuclear Information System (INIS)

    Tao Ping; Dang Yuqing; Chang Bei; Wang Xiao; Jin Zhengyu; Li Wuyi; Huo Hong

    2009-01-01

    Objective: To evaluate the changes of the upper airway of the patients with obstructive sleep apnoea syndrome (OSAS) before and after operations and to know the effects of operations by MSCT. Methods: The upper airway dimensions of 26 patients with OSAS were measured on multiplanar reformatted (MPR), curved-planar reformatted (CPR), volume rendering (VR) images of 16-slice spiral CT. The measurements include the anteroposterior calibres and the areas on the reformatted axial images on the pharyngeal cavity levels, the calibres and the minimum areas in retropalatal and retroglossal regions, the areas of the soft palate and uvula on the reformatted sagittal view with maximum thickness, the maximum wall thickness of the right and left the upper airway on the coronary images, the volume of the upper airway before and after the operations. The measurements were correlated with the polysomnography (PSG) records. The data were analyzed paired-samples t-test and Pearson correlations. Results: By comparison, the anteroposterior calibres and the cross-sectional areas on the reformatted axial view of the lower retropalatal region (slice 4) of the upper airway increased significantly after operations. The anteroposterior diameter increased from 5.9 mm before operations to 12.8 mm after operations, where t=-5.506, P 2 before operations to 275.0 mm 2 after operations, where t=-5.011, P 2 before operations to 128.0 mm 2 after operations, where t=3.087, P 2 before operation to 10.9 mm, 76.0 mm 2 after operation, where t=-3.413, -2.216, respectively and P 2 before operations to 76.0 mm 2 after operations, were t=-4.932, P<0.05. The anteroposterior calibres increased from 4.6 mm before operations to 6.6 mm after operations, where t=-7.308, P<0.05. The L-R calibres increased from 8.3 mm before operations to 13.6 mm after operations, where t=-4.320, P<0.05. Conclusions: MPR, CPR, VR of MSCT can evaluate the not only the morphology but the function changes of the upper airways on the

  15. A multicentre randomised controlled trial and economic evaluation of continuous positive airway pressure for the treatment of obstructive sleep apnoea syndrome in older people: PREDICT.

    Science.gov (United States)

    McMillan, Alison; Bratton, Daniel J; Faria, Rita; Laskawiec-Szkonter, Magda; Griffin, Susan; Davies, Robert J; Nunn, Andrew J; Stradling, John R; Riha, Renata L; Morrell, Mary J

    2015-06-01

    The therapeutic and economic benefits of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnoea syndrome (OSAS) have been established in middle-aged people. In older people there is a lack of evidence. To determine the clinical efficacy of CPAP in older people with OSAS and to establish its cost-effectiveness. A randomised, parallel, investigator-blinded multicentre trial with within-trial and model-based cost-effectiveness analysis. Two hundred and seventy-eight patients, aged ≥ 65 years with newly diagnosed OSAS [defined as oxygen desaturation index at ≥ 4% desaturation threshold level for > 7.5 events/hour and Epworth Sleepiness Scale (ESS) score of ≥ 9] recruited from 14 hospital-based sleep services across the UK. CPAP with best supportive care (BSC) or BSC alone. Autotitrating CPAP was initiated using standard clinical practice. BSC was structured advice on minimising sleepiness. Subjective sleepiness at 3 months, as measured by the ESS (ESS mean score: months 3 and 4) and cost-effectiveness over 12 months, as measured in quality-adjusted life-years (QALYs) calculated using the European Quality of Life-5 Dimensions (EQ-5D) and health-care resource use, information on which was collected monthly from patient diaries. Subjective sleepiness at 12 months (ESS mean score: months 10, 11 and 12) and objective sleepiness, disease-specific and generic quality of life, mood, functionality, nocturia, mobility, accidents, cognitive function, cardiovascular risk factors and events at 3 and 12 months. Two hundred and seventy-eight patients were randomised to CPAP (n = 140) or BSC (n = 138) over 27 months and 231 (83%) patients completed the trial. Baseline ESS score was similar in both groups [mean (standard deviation; SD) CPAP 11.5 (3.3), BSC 11.4 (4.2)]; groups were well balanced for other characteristics. The mean (SD) in ESS score at 3 months was -3.8 (0.4) in the CPAP group and -1.6 (0.3) in the BSC group. The

  16. Sleep loss and circadian disruption in shift work: health burden and management.

    Science.gov (United States)

    Rajaratnam, Shantha M W; Howard, Mark E; Grunstein, Ronald R

    2013-10-21

    About 1.5 million Australians are shift workers. Shift work is associated with adverse health, safety and performance outcomes. Circadian rhythm misalignment, inadequate and poor-quality sleep, and sleep disorders such as sleep apnoea, insomnia and shift work disorder (excessive sleepiness and/or insomnia temporally associated with the work schedule) contribute to these associations. Falling asleep at work at least once a week occurs in 32%-36% of shift workers. Risk of occupational accidents is at least 60% higher for non-day shift workers. Shift workers also have higher rates of cardiometabolic diseases and mood disturbances. Road and workplace accidents related to excessive sleepiness, to which shift work is a significant contributor, are estimated to cost $71-$93 billion per annum in the United States. There is growing evidence that understanding the interindividual variability in sleep-wake responses to shift work will help detect and manage workers vulnerable to the health consequences of shift work. A range of approaches can be used to enhance alertness in shift workers, including screening and treating sleep disorders, melatonin treatment to promote sleep during the daytime, and avoidance of inappropriate use of sedatives and wakefulness-promoters such as modafinil and caffeine. Short naps, which minimise sleep inertia, are generally effective. Shifting the circadian pacemaker with appropriately timed melatonin and/or bright light may be used to facilitate adjustment to a shift work schedule in some situations, such as a long sequence of night work. It is important to manage the health risk of shift workers by minimising vascular risk factors through dietary and other lifestyle approaches.

  17. Managing Sleep Disturbances in Cirrhosis

    Directory of Open Access Journals (Sweden)

    Xun Zhao

    2016-01-01

    Full Text Available Sleep disturbances, particularly daytime sleepiness and insomnia, are common problems reported by patients suffering from liver cirrhosis. Poor sleep negatively impacts patients’ quality of life and cognitive functions and increases mortality. Although sleep disturbances can be an early sign of hepatic encephalopathy (HE, many patients without HE still complain of poor quality sleep. The pathophysiology of these disturbances is not fully understood but is believed to be linked to impaired hepatic melatonin metabolism. This paper provides an overview for the clinician of common comorbidities contributing to poor sleep in patients with liver disease, mainly restless leg syndrome and obstructive sleep apnea. It discusses nondrug and pharmacologic treatment options in these patients, such as the use of light therapy and histamine (H1 blockers.

  18. Sleep-related headache and its management.

    Science.gov (United States)

    Singh, Niranjan N; Sahota, Pradeep

    2013-12-01

    apnea, which includes cluster headache, hypnic headache, and headache related to obstructive sleep apnea; and (2) headaches with high prevalence of insomnia, medication overuse, and psychiatric comorbidity including chronic migraine and chronic tension-type headache. The initial step in the management of sleep related headache is proper diagnosis with exclusion of secondary headaches. Screening for sleep disorders with the use of proper tests including polysomnography and referral to sleep clinic, when appropriate is very helpful. Control of individual episode in less than 2 hours should be the initial goal using measures to abort and prevent a relapse. Cluster headache responds very well to injectable Imitrex and oxygen. Verapamil, steroids and lithium are used for preventive treatment of cluster headache. Intractable cluster headache patients have responded to hypothalamic deep brain stimulation. Hypnic headache patients respond to nightly caffeine, indomethacin, and lithium. Paroxysmal hemicrania responds very well to indomethacin. Early morning headaches associated with obstructive sleep apnea respond to CPAP or BiPAP with complete resolution of headache within a month. Patient education and lifestyle modification play a significant role in overall success of the treatment. Chronic tension-type headache and chronic migraine have high prevalence of insomnia and comorbid psychiatric disorders, which require behavioral insomnia treatment and medication if needed along with psychiatric evaluation. Apart from the abortive treatment tailored to the headache types, - such as triptans and DHE 45 for migraine and nonsteroidal anti-inflammatory medication for chronic tension-type headache, preventive treatment with different class of medications including antiepileptics (Topamax and Depakote), calcium channel blockers (verapamil), beta blockers (propranolol), antidepressants (amitriptyline), and Botox may be used depending upon the comorbid conditions.

  19. Severe obstructive sleep disorders in Prader-Willi syndrome patients in southern Italy.

    Science.gov (United States)

    Canora, Angelo; Franzese, Adriana; Mozzillo, Enza; Fattorusso, Valentina; Bocchino, Marialuisa; Sanduzzi, Alessandro

    2018-01-09

    Sleep-related disordered breathing (SDB) is very common in paediatric patients affected by Prader-Willi Syndrome (PWS). However, data addressing SBD patterns and their management are lacking. The aim of the present study was to analyse SDB features in 14 PWS patients (age range, 8 months-17 years). Polygraphic registration (PG) during a 12-h nocturnal sleep was performed in all patients. Obstructive and central apnoea indices and oxygen saturation (SpO 2 ) were recorded along with demographic and clinical data. Obstructive sleep apnoea (OSA) was diagnosed in 13/14 patients (92.9%); the mean obstructive apnoea-hypopnea index (OAHI) was 7.6 ± 4.2 events/h with a mean central apnoea index (CAI) of 0.7 ± 1.04 events/h. Time spent with SpO 2 Prader-Willi syndrome. What is New: • Severe obstructive sleep apnoea is the most frequent sleep-related disorder in our case series.

  20. Obstructive sleep apnoea and obesity

    African Journals Online (AJOL)

    aDepartment of Internal Medicine, Steve Biko Academic Hospital, Faculty of Health Sciences .... a significant number have an alternative predisposing factor, such ... to atherosclerosis, ischaemic heart disease, strokes, and peripheral vascular disease. ... tumour necrosis factor-alpha (TNF-a) and interleukin-1 (IL-1), the so.

  1. Hypnosis in the Management of Sleep Disorders.

    Science.gov (United States)

    Becker, Philip M

    2015-03-01

    Hypnosis has been used to manage insomnia and disorders of arousal. The alteration in the state of consciousness produced during hypnotic trance is more similar to relaxed reverie than sleep. Hypnosis typically occurs in a state of repose and the accomplished subject may have no recollection of the experience during a trance, 2 commonalities with sleep. Because hypnosis allows for relaxation, increased suggestibility, posthypnotic suggestion, imagery rehearsal, access to preconscious cognitions and emotions, and cognitive restructuring, disorders of sleep such as the insomnias, parasomnias, and related mood or anxiety disorders can be amenable to this therapeutic intervention. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Comparison of manual versus automatic continuous positive airway pressure titration and the development of a predictive equation for therapeutic continuous positive airway pressure in Chinese patients with obstructive sleep apnoea.

    Science.gov (United States)

    Luo, Jiaying; Xiao, Sichang; Qiu, Zhihui; Song, Ning; Luo, Yuanming

    2013-04-01

    Whether the therapeutic nasal continuous positive airway pressure (CPAP) derived from manual titration is the same as derived from automatic titration is controversial. The purpose of this study was to compare the therapeutic pressure derived from manual titration with automatic titration. Fifty-one patients with obstructive sleep apnoea (OSA) (mean apnoea/hypopnoea index (AHI) = 50.6 ± 18.6 events/h) who were newly diagnosed after an overnight full polysomnography and who were willing to accept CPAP as a long-term treatment were recruited for the study. Manual titration during full polysomnography monitoring and unattended automatic titration with an automatic CPAP device (REMstar Auto) were performed. A separate cohort study of one hundred patients with OSA (AHI = 54.3 ± 18.9 events/h) was also performed by observing the efficacy of CPAP derived from manual titration. The treatment pressure derived from automatic titration (9.8 ± 2.2 cmH(2)O) was significantly higher than that derived from manual titration (7.3 ± 1.5 cmH(2)O; P titration (54.3 ± 18.9 events/h before treatment and 3.3 ± 1.7 events/h after treatment; P titration pressure derived from REMstar Auto is usually higher than the pressure derived from manual titration. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  3. Health, social and economical consequences of sleep-disordered breathing

    DEFF Research Database (Denmark)

    Jennum, Poul; Kjellberg, Jakob

    2011-01-01

    The objective direct and indirect costs of sleep-disordered breathing (snoring, sleep apnoea (SA) and obesity hypoventilation syndrome (OHS)) and the treatment are incompletely described.......The objective direct and indirect costs of sleep-disordered breathing (snoring, sleep apnoea (SA) and obesity hypoventilation syndrome (OHS)) and the treatment are incompletely described....

  4. The challenge of sleep management in military operations.

    Science.gov (United States)

    Wesensten, Nancy J; Balkin, Thomas J

    2013-01-01

    It has long been known that short-term (days) insufficient sleep causes decrements in mental effectiveness that put individuals at increased risk of committing errors and causing accidents. More recently, it has been discovered that chronic poor sleep (over years) is associated with a variety of negative health outcomes (metabolic syndrome, obesity, degraded behavioral health). Implementing an effective sleep health program is, therefore, in the best interests of active duty personnel and their families both in the short- and long-term. Like managing physical activity or nutrition, effectively managing sleep health comes with its unique set of challenges arising from the fact that individuals who routinely do not obtain sufficient sleep are generally desensitized to feeling sleepy and are poor at judging their own performance capabilities--and individuals cannot be compelled to sleep. For these reasons, an optimally effective sleep health program requires 3 components: (1) a rigorous, evidence-based sleep education component to impart actionable knowledge about optimal sleep amounts, healthy sleep behaviors, the known benefits of sleep, the short- and long-term consequences of insufficient sleep, and to dispel myths about sleep; (2) a nonintrusive device that objectively and accurately measures sleep to empower the individual to track his/her own sleep/wake habits; and (3) a meaningful, actionable metric reflecting sleep/wake impact on daily effectiveness so that the individual sees the consequences of his/her sleep behavior and, therefore, can make informed sleep health choices.

  5. Síndroma de apneia obstrutiva do sono como causa de acidentes de viação Obstructive sleep apnoea syndrome as a cause of road traffic accidents

    Directory of Open Access Journals (Sweden)

    M Aguiar

    2009-05-01

    Full Text Available Vários estudos demonstram que os doentes com síndroma de apneia obstrutiva do sono (SAOS têm um risco aumentado de acidentes de viação. O objectivo do presente trabalho consistiu em analisar, nestes doentes, se há diferenças nos que referem acidentes e/ /ou quase acidentes e aqueles que o não fazem. Material e métodos: Estudaram-se prospectivamente 163 doentes com SAOS (índice apneia/hipopneia (IAH>10/h diagnosticados por polissonografia nocturna (PSG, todos condutores de veículos, 18,4% do quais profissionais. Na altura da entrevista clínica foi inquirido se tinham tido, nos três anos antes acidentes e/ou quase acidentes devido a hipersonia diurna (Grupo II = 74 ou não (Grupo I = 89. Estes dois grupos foram comparados quanto a: idade, índice de massa corporal (IMC, escala de sonolência de Epworth (ESE, PaO2 e PaCO2 diurnas, avaliação da qualidade de vida pelo inquérito Functional Outcomes of Sleep Questionnaire (FOSQ teste e dados da polissonografia - tempo total de sono (TTS, eficiência do sono, estádios do sono, índice de microdespertares (IMD, índice de apneia/hipopneia (IAH, SaO2 mínima e média, % tempo SaO2Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. Methods: We studied 163 patients with OSAS (apnoea-hypopnoea index (AHI>10/h diagnosed using nocturnal polysomnography (NPSG, all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age

  6. Accuracy and reliability of the sensory test performed using the laryngopharyngeal endoscopic esthesiometer and rangefinder in patients with suspected obstructive sleep apnoea hypopnoea: protocol for a prospective double-blinded, randomised, exploratory study.

    Science.gov (United States)

    Giraldo-Cadavid, Luis Fernando; Bastidas, Alirio Rodrigo; Padilla-Ortiz, Diana Marcela; Concha-Galan, Diana Carolina; Bazurto, María Angelica; Vargas, Leslie

    2017-08-21

    Patients with obstructive sleep apnoea hypopnoea syndrome (OSA) might have varying degrees of laryngopharyngeal mechanical hyposensitivity that might impair the brain's capacity to prevent airway collapse during sleep. However, this knowledge about sensory compromises in OSA comes from studies performed using methods with little evidence of their validity. Hence, the purpose of this study is to assess the reliability and accuracy of the measurement of laryngopharyngeal mechanosensitivity in patients with OSA using a recently developed laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER). The study will be prospective and double blinded, with a randomised crossover assignment of raters performing the sensory tests. Subjects will be recruited from patients with suspected OSA referred for baseline polysomnography to a university hospital sleep laboratory. Intra-rater and inter-rater reliability will be evaluated using the Bland-Altman's limits of agreement plot, the intraclass correlation coefficient, and the Pearson or Spearman correlation coefficient, depending on the distribution of the variables. Diagnostic accuracy will be evaluated plotting ROC curves using standard baseline polysomnography as a reference. The sensory threshold values ​​for patients with mild, moderate and severe OSA will be determined and compared using ANOVA or the Kruskal-Wallis test, depending on the distribution of the variables. The LPEER could be a new tool for evaluating and monitoring laryngopharyngeal sensory impairment in patients with OSA. If it is shown to be valid, it could help to increase our understanding of the pathophysiological mechanisms of this condition and potentially help in finding new therapeutic interventions for OSA. The protocol has been approved by the Institutional Review Board of Fundacion Neumologica Colombiana. The results will be disseminated through conference presentations and peer-reviewed publication. This trial was registered at Clinical

  7. Management of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    V K Vijayan

    2014-03-01

    Full Text Available Obstructive Sleep Apnea (OSA is an important public health problem and is associatedwith considerable morbidity and mortality. Therefore, treatment of this condition is ofparamount importance. The treatment of OSA includes general and behaviouralmeasures, mechanical measures including continuous positive airway pressure(CPAP, Bilevel positive airway pressure (BiPAP and Oral Appliances (OA,pharmacological treatment and surgical procedures. Continuous positive airwaypressure (CPAP treatment reverses the repetitive upper airway obstruction of sleepapnea and associated daytime sleepiness and is the most effective treatment for OSA.However maintaining patient adherence to CPAP therapy is a challenge. Weight lossshould be recommended to overweight patients with OSA, as it has been shown thatweight reduction has additional health benefits. Treatment of underlying medicalconditions such as hypothyroidism or acromegaly has profound effect onapnea/hypopnea index. A subset of patients with OSA may benefit from supplementaloxygen and positional therapy. Presently, there are no effective pharmacotherapeuticagents for treatment of patients with OSA and the role of surgical treatment in OSA iscontroversial. However, pharmacological treatment of persisting residual sleepiness,despite adequate positive airway pressure therapy delivery and adherence, is indicatedand may improve daytime sleepiness.Key words : CPAP, Oral appliances, Modafinil, CPAP complianceUvulopalatopharyngoplasty, positional therapy

  8. Impact of Sleep Telemedicine Protocol in Management of Sleep Apnea: A 5-Year VA Experience.

    Science.gov (United States)

    Baig, Mirza M; Antonescu-Turcu, Andrea; Ratarasarn, Kavita

    2016-05-01

    protocol at the Milwaukee VAMC was associated with increased efficiency of sleep services. Timeliness of sleep management interventions for sleep apnea improved in spite of the increased volume of service.

  9. The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease.

    Science.gov (United States)

    Johansson, Peter; Svensson, Erland; Alehagen, Urban; Jaarsma, Tiny; Broström, Anders

    2015-06-01

    This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality. A total of 331 community-dwelling elderly aged 71-87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years. In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (pinsomnia (pinsomnia. Hypoxia of more than 1.5% of sleep time with SaO2causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002). In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis. © The European Society of Cardiology 2014.

  10. Sleep bruxism: Current knowledge and contemporary management

    Science.gov (United States)

    Yap, Adrian U.; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief. PMID:27656052

  11. Sleep bruxism: Current knowledge and contemporary management.

    Science.gov (United States)

    Yap, Adrian U; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that "cures" or "stops" SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

  12. Sleep disturbances in Parkinson's disease patients and management options

    Directory of Open Access Journals (Sweden)

    Claassen DO

    2011-12-01

    Full Text Available Daniel O Claassen, Scott J KutscherDepartment of Neurology, Vanderbilt University, Nashville, TN, USAAbstract: Sleep disturbances are among the most common nonmotor complaints of patients with Parkinson's disease (PD, and can have a great impact on quality of life. These disturbances manifest in a variety of ways; for instance, insomnia, sleep fragmentation, and excessive daytime sleepiness. Sleep-related movement disorders such as restless legs syndrome and periodic leg movements may share a common pathophysiology, and occurrence of rapid eye movement behavior disorder may predate the onset of PD or other synucleinopathies by several years. Medications for PD can have a significant impact on sleep, representing a great challenge to the treating physician. Awareness of the complex relationship between PD and sleep disorders, as well as the varied way in which sleep disturbances appear, is imperative for successful long-term management.Keywords: sleep disorders, insomnia, restless legs syndrome, Parkinson disease, fatigue, REM behavior disorder

  13. Sleep Disorders and Their Management in Children With Ehlers-Danlos Syndrome Referred to Sleep Clinics.

    Science.gov (United States)

    Domany, Keren Armoni; Hantragool, Sumalee; Smith, David F; Xu, Yuanfang; Hossain, Monir; Simakajornboon, Narong

    2018-04-15

    The nature of sleep disorders in children with Ehlers-Danlos syndrome (EDS) is unknown. We aimed to describe the type, the management, and the short-term outcome of sleep disorders in children with EDS referred to sleep clinics. This is a retrospective review of medical records and polysomnography tests of children with EDS younger than 18 years who were referred to the sleep clinic. Demographic information and medical history were collected, and polysomnography tests were reviewed. Questionnaires completed during previous clinic visits, including the Pediatrics Sleep Questionnaire (PSQ), Epworth Sleepiness Scale (ESS), and Pediatric Quality of Life Inventory (PedsQL), were also evaluated. Sixty-five patients with EDS-hypermobility type were included. The mean age was 13.15 ± 3.9 years. There were 68% of patients who were female, and 91% of patients were Caucasian. The mean follow-up period was 1.14 ± 1.55 years. Common sleep diagnoses included insomnia (n = 14, 22%), obstructive sleep apnea (OSA) (n = 17, 26%), periodic limb movement disorder (PLMD) (n = 11, 17%), and hypersomnia (n = 10, 15%). In addition, 65% required pharmacologic treatment and 29% were referred to behavioral sleep medicine. For OSA, two patients required continuous positive airway pressure. A significant improvement was observed in the PSQ, ESS, and PedsQL scores during follow-up visits after treatment (n = 34; P = .0004, 0.03, and 0.01, respectively). There is a high prevalence of sleep disorders, including OSA, insomnia, PLMD, and hypersomnia in children with EDS referred to sleep clinics. Specific management can improve quality of life and questionnaire scores of this patient population. Our study emphasizes the importance of screening for sleep disorders in children with EDS. © 2018 American Academy of Sleep Medicine.

  14. Suicidality in sleep disorders: prevalence, impact, and management strategies

    Directory of Open Access Journals (Sweden)

    Drapeau CW

    2017-09-01

    Full Text Available Christopher W Drapeau, Michael R Nadorff Department of Psychology, Mississippi State University, Mississippi State, MS, USA Abstract: Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep–suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep–suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders. Keywords: sleep, suicide, suicidality, insomnia, nightmares, treatment

  15. Managing sleep and wakefulness in a 24-hour world.

    Science.gov (United States)

    Coveney, Catherine M

    2014-01-01

    This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi-structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24-hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work-social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self-regulate our sleeping patterns. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  16. [The NHG guideline 'Sleep problems and sleeping pills'].

    Science.gov (United States)

    Damen-van Beek, Zamire; Lucassen, Peter L B J; Gorgels, Wim; Smelt, Antonette F H; Knuistingh Neven, Arie; Bouma, Margriet

    2015-01-01

    The Dutch College of General Practitioners' (NHG) guideline 'Sleep problems and sleeping pills' provides recommendations for the diagnosis and treatment of the most prevalent sleep problems and for the management of chronic users of sleeping pills. The preferred approach for sleeplessness is not to prescribe medication but to give information and behavioural advice. Practice assistants of the Dutch Association of Mental Health and Addiction Care are also expected to be able to undertake this management. The GP may consider prescribing sleeping pills for a short period only in cases of severe insomnia with considerable distress. Chronic users of sleeping pills should be advised by the GP to stop using them or to reduce the dose gradually (controlled dose reduction). The GP may refer patients with suspected obstructive sleep apnoea (OSA) to a pulmonary or ear, nose and throat specialist or neurologist for further diagnosis depending on the regional arrangements. The GP may then consider the cardiovascular risk factors commonly present with OSA. In patients with restless legs syndrome (RLS) who continue to experience major distress despite being given advice without the prescription of medication, the GP may consider prescribing a dopamine agonist.

  17. Sleep/Wakefulness Management in Continuous/Sustained Operations

    National Research Council Canada - National Science Library

    2002-01-01

    ......There is an antinomy between the physiological requirement and the operational requirement. To be able to continue the mission but also to preserve our security and the security of the crew we need an appropriate sleep-wakefulness management...

  18. Sleep in trigeminal autonomic cephalagias

    DEFF Research Database (Denmark)

    Barløse, Mads; Lund, Nunu; Jensen, Rigmor Højland

    2014-01-01

    and eventually to more effective therapeutic regimens. This review aims to evaluate the existing literature on the subject of TACs and sleep. An association between episodic CH and distinct macrostructural sleep phases, especially the relation to rapid eye movement (REM) sleep, has been described in some older...... studies but could not be confirmed in other, more recent studies. Investigations into the microstructure of sleep in these patients are lacking. Only a few case reports exist on the relation between sleep and other TACs. SUMMARY: Recent studies do not find an association between CH and REM sleep. One...... older study suggests chronic paroxysmal hemicranias may be locked to REM sleep but otherwise the relation is unknown. Reports indicate that CH and obstructive sleep apnoea are associated in some individuals but results are diverging. Single cases show improvement of CH upon treatment of sleep apnoea...

  19. Any sleep is a dream far away: a nominal group study assessing how gout affects sleep.

    Science.gov (United States)

    Singh, Jasvinder A

    2018-02-23

    There are no qualitative studies of sleep in gout; the aim of this study was to examine the impact of gout on sleep. Nine nominal groups were conducted, oversampling for African-Americans and women with gout. Patients discussed and rank-ordered their concerns. Nine nominal groups with 46 gout patients were conducted with mean age, 61 years (s.d. 10.6) and gout duration, 14.9 years (s.d. 12); 63% were men, 46% African-American, 52% married, 46% retired and 63% were allopurinol users. The most frequently cited highly ranked concerns could be divided into three categories. The first category, character of sleep interruption, included the concerns: severe and complete sleep interruption by gout flare pain (nine groups); and inability to get rapid eye movement sleep (one group). The second category, causes of sleep interruption, included: inability to get into a comfortable position during sleep (six groups); anxiety and depression associated with severe gout pain (seven groups); sleep interruption by moderate chronic joint pain (three groups); frequent trips to the bathroom interfering with sleep (two groups); gout medication side effects (four groups); frequent trips to the emergency room (one group); joint swelling with physical/functional deficit interfering with sleep (two groups); and flare pain interfering with sleep apnoea management (two groups). The final category, consequences of sleep interruption, included: effect on daily functioning (two groups); worsens other health conditions, which then affect sleep (four groups); and cumulative effect on sleep (one group). Gout has significant impact on sleep quantity, quality and architecture. Sleep disruption due to gout has several pathways and significant consequences.

  20. Management of REM sleep behavior disorder: An evidence based review

    OpenAIRE

    Preeti Devnani; Racheal Fernandes

    2015-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, ...

  1. Management of sleep disorders in neurodevelopmental disorders and genetic syndromes.

    Science.gov (United States)

    Heussler, Helen S

    2016-03-01

    Sleep disorders in individuals with developmental difficulties continue to be a significant challenge for families, carers, and therapists with a major impact on individuals and carers alike. This review is designed to update the reader on recent developments in this area. A systematic search identified a variety of studies illustrating advances in the regulation of circadian rhythm and sleep disturbance in neurodevelopmental disorders. Specific advances are likely to lead in some disorders to targeted therapies. There is strong evidence that behavioural and sleep hygiene measures should be first line therapy; however, studies are still limited in this area. Nonpharmacological measures such as exercise, sensory interventions, and behavioural are reported. Behavioural regulation and sleep hygiene demonstrate the best evidence for improved sleep parameters in individuals with neurodisability. Although the mainstay of management of children with sleep problems and neurodevelopmental disability is similar to that of typically developing children, there is emerging evidence of behavioural strategies being successful in large-scale trials and the promise of more targeted therapies for more specific resistant disorders.

  2. Sleep Management Strategy and Performance in an Extreme Mountain Ultra-marathon.

    Science.gov (United States)

    Poussel, Mathias; Laroppe, Julien; Hurdiel, Rémy; Girard, Julien; Poletti, Laurence; Thil, Catherine; Didelot, Antoine; Chenuel, Bruno

    2015-01-01

    We intended to assess the relationship between sleep strategies and performance during the North-Face Ultra-Trail du Mont-Blanc 2013, to test the hypothesis that sleep management can influence athletic performance. Almost all runners specifically adopted sleep management strategies before the race. Among the finishers 72% didn't sleep at all during the race and 28% took a least one break for sleep. Non-sleepers completed the race faster than the sleepers (P = 0.0008). Race time was positively correlated with drowsiness (P sleep management strategy based on increased sleep time before the race completed the race faster (P = 0.0258). Most finishers seemed to be aware of the importance of developing sleep management strategies and increasing sleep time some nights before the race appeared to be the most relevant strategy to improve performance.

  3. Sleep

    Science.gov (United States)

    ... Institute (NHLBI). 1 Mood. Sleep affects your mood. Insufficient sleep can cause irritability that can lead to trouble with relationships, ... basics/understanding_sleep.htm#dynamic_activity Centers for Disease ... insufficient rest or sleep among adults—United States, 2008. MMWR, 58 (42), ...

  4. Dynamic cycling in atrial size and flow during obstructive apnoea.

    Science.gov (United States)

    Pressman, Gregg S; Cepeda-Valery, Beatriz; Codolosa, Nicolas; Orban, Marek; Samuel, Solomon P; Somers, Virend K

    2016-01-01

    Obstructive sleep apnoea (OSA) is strongly associated with cardiovascular disease. However, acute cardiovascular effects of repetitive airway obstruction are poorly understood. While past research used a sustained Mueller manoeuver to simulate OSA we employed a series of gasping efforts to better simulate true obstructive apnoeas. This report describes acute changes in cardiac anatomy and flow related to sudden changes in intrathoracic pressure. 26 healthy, normal weight participants performed 5-6 gasping efforts (target intrathoracic pressure -40 mm Hg) while undergoing Doppler echocardiography. 14 participants had sufficient echocardiographic images to allow comparison of atrial areas during the manoeuver with baseline measurements. Mitral and tricuspid E-wave and A-wave velocities postmanoeuver were compared with baseline in all participants. Average atrial areas changed little during the manoeuver, but variance in both atrial areas was significantly greater than baseline. Further, an inverse relationship was noted with left atrial collapse and right atrial enlargement at onset of inspiratory effort. Significant inverse changes were noted in Doppler flow when comparing the first beat postmanoeuver (pMM1) with baseline. Mitral E-wave velocity increased 9.1 cm/s while tricuspid E-wave velocity decreased 7.0 cm/s; by the eighth beat postmanoeuver (pMM8) values were not different from baseline. Mitral and tricuspid A-wave velocities were not different from baseline at pMM1, but both were significantly higher by pMM8. Repetitive obstructive apnoeas produce dynamic, inverse changes in atrial size and Doppler flow across the atrioventricular valves. These observations have important implications for understanding the pathophysiology of OSA.

  5. The role of sleep and sleep disorders in the development, diagnosis, and management of neurocognitive disorders.

    OpenAIRE

    Michelle A Miller

    2015-01-01

    It is becoming increasingly apparent that sleep plays an important role in the maintenance, disease prevention, repair and restoration of both mind and body. The sleep and wake cycles are controlled by the pacemaker activity of the superchiasmic nucleus in the hypothalamus but can be disrupted by diseases of the nervous system causing disordered sleep. A lack of sleep has been associated with an increase in all–cause mortality. Likewise, sleep disturbances and sleep disorders may disrupt neu...

  6. Management of obstructive sleep apnea: A dental perspective

    Directory of Open Access Journals (Sweden)

    Padma Ariga

    2007-01-01

    Full Text Available Sleep disordered breathing is a term which includes simple snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA. Simple snoring is a common complaint affecting 45% of adults occasionally and 25% of adults habitually and is a sign of upper airway obstruction. Snoring has also been identified as a possible risk factor for hypertension, ischemic heart disease, and stroke. The role of dentistry in sleep disorders is becoming more significant, especially in co-managing patients with simple snoring and mild to moderate OSA. The practicing dental professional has the opportunity to assist patients at a variety of levels, starting with the recognition of a sleep-related disorder, referring patients to a physician for evaluation, and assisting in the management of sleep disorders. Obesity is the main predisposing factor for OSA. In nonobese patients, craniofacial anomalies like micrognathia and retrognathia may also predispose to OSA. Diagnosis of OSA is made on the basis of the history and physical examination and investigations such as polysomnography, limited channel testing, split-night testing, and oximetry. Nocturnal attended polysomnography, which requires an overnight stay in a sleep facility, is the standard diagnostic modality in determining if a patient has OSA. As far as treatment is concerned, the less invasive procedures are to be preferred to the more invasive options. The first and simplest option would be behavior modification, followed by insertion of oral devices suited to the patient, especially in those with mild to moderate OSA. Continuous positive airway pressure (CPAP and surgical options are chosen for patients with moderate to severe OSA. The American Academy of Sleep Medicine (AAOSM has recommended oral appliances for use in patients with primary snoring and mild to moderate OSA. It can also be used in patients with a lesser degree of oxygen saturation, relatively less day time sleepiness, lower frequency

  7. THE SUFFERING OF PATIENTS WITH RESPIRATORY DISORDERS DURING SLEEP

    Directory of Open Access Journals (Sweden)

    Jacek Lech

    2013-11-01

    Full Text Available Assumption : Respiratory disorders during sleep involving the occurrence of sleep apnoea leading to a reduction in arterial oxygen saturation are classified as: obstructive sleep apnoea, central sleep apnoea and sleep-related hypoventilation with hypoxaemia. A close correlation has been proved between the occurrence of apnoea and obesity. This problem concerns 2–4% of the population, and is more likely to affect men. Aim : Presentation of the problem of respiratory disorders during sleep as a chronic disease causing much suffering. Its symptoms may lead to sleep fragmentation and somatic consequences (such as dysfunction of the cardiovascular system as well as mental consequences (personality changes. Method : An analysis of literature concerning the subject-matter from the perspective of a doctor conducting ventilation therapy of patients with respiratory sleep disorders. Summary : The problem of sleep apnoea is most often diagnosed and treated too late due to the number of symptoms with a simultaneous absence of pathognomonic symptoms. Despite its commonness, recognition of this disease is still insufficient.

  8. Management of Sleep Disordered Breathing in Patients with Heart Failure.

    Science.gov (United States)

    Oates, Connor P; Ananthram, Manjula; Gottlieb, Stephen S

    2018-04-03

    This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor? Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm. Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient's heart failure management should remain the priority of medical care.

  9. Sleep Management on Multiple Machines for Energy and Flow Time

    DEFF Research Database (Denmark)

    Chan, Sze-Hang; Lam, Tak-Wah; Lee, Lap Kei

    2011-01-01

    In large data centers, determining the right number of operating machines is often non-trivial, especially when the workload is unpredictable. Using too many machines would waste energy, while using too few would affect the performance. This paper extends the traditional study of online flow-time...... scheduling on multiple machines to take sleep management and energy into consideration. Specifically, we study online algorithms that can determine dynamically when and which subset of machines should wake up (or sleep), and how jobs are dispatched and scheduled. We consider schedules whose objective...... is to minimize the sum of flow time and energy, and obtain O(1)-competitive algorithms for two settings: one assumes machines running at a fixed speed, and the other allows dynamic speed scaling to further optimize energy usage. Like the previous work on the tradeoff between flow time and energy, the analysis...

  10. Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children.

    Science.gov (United States)

    Venekamp, Roderick P; Hearne, Benjamin J; Chandrasekharan, Deepak; Blackshaw, Helen; Lim, Jerome; Schilder, Anne G M

    2015-10-14

    Obstructive sleep-disordered breathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructive sleep apnoea syndrome (OSAS). It affects both children and adults. In children, hypertrophy of the tonsils and adenoid tissue is thought to be the commonest cause of oSDB. As such, tonsillectomy - with or without adenoidectomy - is considered an appropriate first-line treatment for most cases of paediatric oSDB. To assess the benefits and harms of tonsillectomy with or without adenoidectomy compared with non-surgical management of children with oSDB. We searched the Cochrane Register of Studies Online, PubMed, EMBASE, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the search was 5 March 2015. Randomised controlled trials comparing the effectiveness and safety of (adeno)tonsillectomy with non-surgical management in children with oSDB aged 2 to 16 years. We used the standard methodological procedures expected by The Cochrane Collaboration. Three trials (562 children) met our inclusion criteria. Two were at moderate to high risk of bias and one at low risk of bias. We did not pool the results because of substantial clinical heterogeneity. They evaluated three different groups of children: those diagnosed with mild to moderate OSAS by polysomnography (PSG) (453 children aged five to nine years; low risk of bias; CHAT trial), those with a clinical diagnosis of oSDB but with negative PSG recordings (29 children aged two to 14 years; moderate to high risk of bias; Goldstein) and children with Down syndrome or mucopolysaccharidosis (MPS) diagnosed with mild to moderate OSAS by PSG (80 children aged six to 12 years; moderate to high risk of bias; Sudarsan). Moreover, the trials included two different comparisons: adenotonsillectomy versus no surgery (CHAT trial and Goldstein) or versus

  11. Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

    Science.gov (United States)

    Budhiraja, Rohit; Siddiqi, Tauseef A.; Quan, Stuart F.

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors—some of them unique to COPD—can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPD— an association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifically in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259–270. PMID:25700872

  12. Management of REM sleep behavior disorder: An evidence based review.

    Science.gov (United States)

    Devnani, Preeti; Fernandes, Racheal

    2015-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG) while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms.

  13. Management of REM sleep behavior disorder: An evidence based review

    Directory of Open Access Journals (Sweden)

    Preeti Devnani

    2015-01-01

    Full Text Available Rapid eye movement (REM sleep behavior disorder (RBD is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms.

  14. Obstructive sleep apnea: management considerations in psychiatric patients

    Directory of Open Access Journals (Sweden)

    Heck T

    2015-10-01

    Full Text Available Taryn Heck,1 Monica Zolezzi21Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada; 2Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, QatarAbstract: Psychiatric disorders and obstructive sleep apnea (OSA are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.Keywords: obstructive sleep apnea, psychiatric disorders, comorbidity, psychotropic medications

  15. Sleep Disruption in Hematopoietic Cell Transplant Recipients: Prevalence, Severity, and Clinical Management

    Science.gov (United States)

    Jim, Heather S.L.; Evans, Bryan; Jeong, Jiyeon M.; Gonzalez, Brian D.; Johnston, Laura; Nelson, Ashley M.; Kesler, Shelli; Phillips, Kristin M.; Barata, Anna; Pidala, Joseph; Palesh, Oxana

    2014-01-01

    Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of patients experiencing sleep disruption pre-transplant, up to 82% experiencing moderate to severe sleep disruption during hospitalization for transplant, and up to 43% in the post-transplant period. These rates of sleep disruption are substantially higher than the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption as a clinical problem in HCT in order to facilitate patient education, intervention, and research. The review opens with a discussion of sleep disruption measurement and clinical diagnosis of sleep disorders. An overview of the prevalence, severity, and chronicity of sleep disruption and disorders in patients receiving HCT follows. Current evidence regarding sociodemographic and clinical predictors of sleep disruption and disorders is summarized. The review concludes with suggestions for behavioral and pharmacologic management of sleep disruption and disorders as well as directions for future research. PMID:24747335

  16. The role of telemedicine in obstructive sleep apnea management.

    Science.gov (United States)

    Lugo, Vera; Villanueva, Jair Asir; Garmendia, Onintza; Montserrat, Josep M

    2017-09-01

    Obstructive sleep apnea (OSA) is a common disease that leads in notorious symptoms and comorbidities. Although general measures are important, continuous positive airway pressure (CPAP) is the best treatment option. However, compliance can be suboptimal and telemedicine may play a role to improve it. Areas covered: Review authors searched EMBASE, PubMed and Cochrane data bases using the following keywords: continuous positive airway pressure, Obstructive sleep apnea, telemedicine, respiratory telemedicine, information and communication technology. Papers published between 2000 and 2016 in English language were considered. Expert commentary: To improve OSA management, there is a pressing need to develop new cost-effective strategies, particularly those related to OSA treatment, from measures such as lifestyle changes to CPAP use. Two broad strategies should be implemented: 1) adequate pre-, peri-, and post-titration measures to ensure correct diagnosis, adequate training, and appropriate support during follow up; and 2) the use of technological advances including both the optimization of CPAP devices and the use of telemedicine, specially focused on the first days or weeks of treatment. Telemedicine can help with these processes, especially when it is personalized to the needs of each patient group.

  17. Management of obstructive sleep apnea in the indigent population: a deviation of standard of care?

    Science.gov (United States)

    Hamblin, John S; Sandulache, Vlad C; Alapat, Philip M; Takashima, Masayoshi

    2014-03-01

    Comprehensive management of patients with obstructive sleep apnea (OSA) typically is managed best via a multidisciplinary approach, involving otolaryngologists, sleep psychologists/psychiatrists, pulmonologists, neurologists, oral surgeons, and sleep trained dentists. By utilizing these resources, one could fashion a treatment individualized to the patient, giving rise to the holistic phrase of "personalized medicine." Unfortunately, in situations and environments with limited resources, the treatment options in an otolaryngologist's armamentarium are restricted--typically to continuous positive airway pressure (CPAP) versus sleep surgery. However, a recent patient encounter highlighted here shows how a hospital's reimbursement policy effectively dictated a patient's medical management to sleep surgery. This occurred although the current gold standard for the initial treatment of OSA is CPAP. Changing the course of medical/surgical management by selectively restricting funding is a cause of concern, especially when it promotes patients to choose a treatment option that is not considered the current standard of care.

  18. Sleep disorders of Whipple's disease of the brain.

    Science.gov (United States)

    Panegyres, P K; Goh, J

    2015-02-01

    To understand the effects of Whipple's disease (WD) of the brain on sleep function. Clinical and polysomnographic studies of two patients with severe disruption of sleep due to WD: a 48-year-old female with primary WD of the brain and a 41-year-old male with secondary WD of the brain. The patient with primary WD had hypersomnolence with severe obstructive sleep apnoea, reduced sleep efficiency, frequent waking and sleep fragmentation. The patient with secondary WD was also hypersomnolent with oculomastictory myorhythmia. He was shown to have severe sleep initiation insomnia with poor sleep efficiency, severe obstructive sleep apnoea/hypopnoea and oculomasticatory myorhythmia at sleep-wake transitions. WD of the brain may affect sleep biology in its primary and secondary forms leading to hypersomnolence from obstructive sleep apnoea, sleep fragmentation, reduced sleep efficiency, sleep initiation insomnia and intrusive oculomasticatory myorhythmia. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management.

    Science.gov (United States)

    Budhiraja, Rohit; Siddiqi, Tauseef A; Quan, Stuart F

    2015-03-15

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors--some of them unique to COPD--can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPD--an association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifically in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. © 2015 American Academy of Sleep Medicine.

  20. Perioperative management of children with obstructive sleep apnea.

    Science.gov (United States)

    Schwengel, Deborah A; Sterni, Laura M; Tunkel, David E; Heitmiller, Eugenie S

    2009-07-01

    Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.

  1. A Collaborative Paradigm for Improving Management of Sleep Disorders in Primary Care: A Randomized Clinical Trial.

    Science.gov (United States)

    Edinger, Jack D; Grubber, Janet; Ulmer, Christi; Zervakis, Jennifer; Olsen, Maren

    2016-01-01

    To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management. This study used a randomized, parallel group, clinical intervention trial design. A total of 137 adult (29 women) VA outpatients with sleep complaints were enrolled and randomly assigned to (1) an intervention (INT) consisting of a one-time consultation with a sleep specialist who provided diagnostic feedback and treatment recommendations to the patient and the patient's primary care provider; or (2) a control condition consisting of their usual primary care (UPC). Provider-focused outcomes included rates of adherence to recommended diagnostic procedures and sleep-focused interventions. Patient-focused outcomes included measures taken from sleep diaries and actigraphy; Pittsburgh Sleep Quality Index (PSQI) scores; and self-report measures of sleepiness, fatigue, mood, quality of life, and satisfaction with health care. The proportions of provider-initiated sleep-focused interventions were significantly higher in the INT group than in the UPC group for polysomnography referrals (49% versus 6%; P sleep efficiency (+3.7%; 95% CI: 0.8, 6.5; P = 0.01) than did UPC participants. A greater proportion of the INT group showed ≥ 1 standard deviation decline on the PSQI from baseline to the 10-mo follow-up (41% versus 21%; P = 0.02). Moreover, 69% of the INT group had normal (≤ 10) Epworth Sleepiness Scale scores at the 10-mo follow-up, whereas only 50% of the UPC group fell below this clinical cutoff (P = 0.03). A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and resulted in benefits to patients' sleep/wake symptoms. This study is registered with clinicaltrials.gov with identifier # NCT00390572. © 2016 Associated Professional Sleep Societies, LLC.

  2. PALLIATIVE CARE ELDERLY PATIENTS WITH SLEEPING DISORDERS ARE POORLY TREATED

    OpenAIRE

    Bellido-Estevez, Inmaculada

    2015-01-01

    Background: Sleep disorders are frequent in patients with advanced cancer receiving palliative-care, especially in elderly patients (1). Sleep disorders during palliative-care may be related with anxiety, opioids related central-sleep apnoea or corticoids therapy between others (2). Our aim was to quantify the effectiveness of hypnotic medication in the sleep quality in advanced cancer receiving palliative-care elderly patients. Material and methods: A descriptive cross-sectional study was...

  3. The impact on sleep of a multidisciplinary cognitive behavioural pain management programme: a pilot study.

    Science.gov (United States)

    Cunningham, Jennifer M; Blake, Catherine; Power, Camillus K; O'Keeffe, Declan; Kelly, Valerie; Horan, Sheila; Spencer, Orla; Fullen, Brona M

    2011-01-10

    Reduced sleep quality is a common complaint among patients with chronic pain, with 50-80% of patients reporting sleep disturbance. Improvements in pain and quality of life measures have been achieved using a multidisciplinary cognitive behavioural therapy pain management programme (CBT-PMP) that aims to recondition attitudes to pain, and improve patients' self-management of their condition. Despite its high prevalence in patients with chronic pain, there is very limited objective evidence for the effect of this intervention on sleep quality. The primary research objective is to investigate the short-term effect of a multidisciplinary CBT-PMP on subjective (measured by Pittsburg Sleep Quality Index) and objective sleep quality (measured by Actigraphy) in patients with chronic pain by comparison with a control group. The secondary objectives will investigate changes in function and mood, and then explore the relationship between objective and subjective sleep quality and physical and psychological outcome measures. Patients who fulfil the inclusion criteria for attendance on the multidisciplinary CBT-PMP in the Adelaide and Meath Hospital, Tallaght, Dublin and are currently listed on the PMP waiting list will be invited to participate in this pilot study. Potential patients will be screened for sleep disturbance [determined by the Pittsburgh Sleep Quality Index (PSQI)]. Those patients with a sleep disturbance (PSQI >5) will be assigned to either the intervention group (immediate treatment), or control group (deferred treatment, i.e. the PMP they are listed for is more than six months away) based on where they appear on the waiting list. Baseline measures of sleep, function, and mood will be obtained using a combination of self-report questionnaires (the Hospital Anxiety and Depression Scale, the Short Form 36 health survey, the Pittsburgh Sleep Quality Index, the Tampa Scale for Kinesiophobia), and functional outcome measures. Sleep will be measured for seven days

  4. Sleep disturbances and cognitive decline: recommendations on clinical assessment and the management.

    Science.gov (United States)

    Guarnieri, Biancamaria; Cerroni, Gianluigi; Sorbi, Sandro

    2015-01-01

    In 2004, in Genoa (Italy), the Italian Dementia Research Association (SINDem) was born. The first congress of this new scientific society took place in Rome in 2006. SINDem soon recognized the importance to investigate sleep problems in cognitive decline and created a national "sleep study group "composed by neurologists and sleep specialists. In 2012, The SINDem study group, in close relationship with the Italian Association of sleep medicine (AIMS), published the study "Prevalence of sleep disturbances in mild cognitive impairment and dementing disorders: a multicenter Italian clinical cross-sectional study on 431 patients ", confirming the high prevalence of sleep disturbances in a wide Italian population of persons with cognitive decline. The study was supported by a grant from the Italian Minister of Health and was conducted with the fundamental contribution of the Italian National Research Center (CNR). In 2014, the same group published the paper "Recommendations of the Sleep Study Group of the Italian Dementia Research Association (SINDem) on clinical assessment and management of sleep disorders in individuals with mild cognitive impairment and dementia: a clinical review". The recommendations are wide and directed to professionals (neurologists but not exclusively) to try to establish uniform levels of care, promote collaborative studies into areas of uncertainty, and define the qualitative characteristics of Dementia Reference Centers about sleep disturbances.

  5. Economic implications of sleep disorders.

    Science.gov (United States)

    Skaer, Tracy L; Sclar, David A

    2010-01-01

    Sleep disorders such as insomnia, obstructive sleep apnoea (OSA), excessive daytime sleepiness (EDS) and fatigue, sleep deprivation and restless legs syndrome (RLS) are increasingly seen in clinical practice. Sleep is considered vital for preserving daytime cognitive function and physiological well-being. Sleep insufficiency may have deleterious effects on work-life balance, overall health and safety. The consequential economic burden at both the individual and societal levels is significant. Moreover, sleep disorders are commonly associated with other major medical problems such as chronic pain, cardiovascular disease, mental illness, dementias, gastrointestinal disorders and diabetes mellitus. Thus, in order to properly care for patients presenting with sleep-related morbidity, and to reduce the consequential economic burden, accurate screening efforts and efficacious/cost-effective treatments need to be developed and employed.

  6. AASM standards of practice compliant validation of actigraphic sleep analysis from SOMNOwatch(TM) versus polysomnographic sleep diagnostics shows high conformity also among subjects with sleep disordered breathing

    International Nuclear Information System (INIS)

    Dick, R; Schulz, J; Penzel, T; Fietze, I; Partinen, M; Hein, H

    2010-01-01

    In recent AASM practice, parameter actimetry is cited to measure total sleep time in obstructive sleep apnoea patients, when polysomnography is not available. An actigraph was therefore compared to polysomnographic data in 28 subjects with known sleep disordered breathing. Total sleep time (TST), sleep period time (SPT), sleep efficiency (SE), sustained sleep efficiency (SSE), sleep onset latency (SL) and sleep/wake pattern were compared to gold standard polysomnography. The results of an epoch-by-epoch comparison of sleep/wake from actigraphy to sleep stages from polysomnography gave a sensitivity of 90.2%, a specificity of 95.2% and an overall accuracy of 85.9%. Correlations were moderately strong for SE (0.71, p < 0.001) and SSE (0.65, p < 0.001) and high for TST (0.89, p < 0.001), SPT (0.91, p < 0.001) and SL (0.89, p < 0.001). It was concluded that actigraphy is not identical with PSG recording but gives good results in sleep/wake patterns and predicting TST, SPT, SSE, SE and SL also in sleep apnoea patients not suffering from other sleep disorders. The difficult detection of correct sleep onset causes SSE and SL to be less predictable. Therefore a 15-epoch criterion was introduced and resulted in high correlation of 0.89 for sleep latency, but has to be tested on a bigger population

  7. Real Time Apnoea Monitoring of Children Using the Microsoft Kinect Sensor: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ali Al-Naji

    2017-02-01

    Full Text Available The objective of this study was to design a non-invasive system for the observation of respiratory rates and detection of apnoea using analysis of real time image sequences captured in any given sleep position and under any light conditions (even in dark environments. A Microsoft Kinect sensor was used to visualize the variations in the thorax and abdomen from the respiratory rhythm. These variations were magnified, analyzed and detected at a distance of 2.5 m from the subject. A modified motion magnification system and frame subtraction technique were used to identify breathing movements by detecting rapid motion areas in the magnified frame sequences. The experimental results on a set of video data from five subjects (3 h for each subject showed that our monitoring system can accurately measure respiratory rate and therefore detect apnoea in infants and young children. The proposed system is feasible, accurate, safe and low computational complexity, making it an efficient alternative for non-contact home sleep monitoring systems and advancing health care applications.

  8. Position paper by Canadian dental sleep medicine professionals on the role of different health care professionals in managing obstructive sleep apnea and snoring with oral appliances.

    Science.gov (United States)

    Gauthier, Luc; Almeida, Fernanda; Arcache, Jean-Patrick; Ashton-McGregor, Catherine; Coté, David; Driver, Helen S; Ferguson, Kathleen A; Lavigne, Gilles J; Martin, Philippe; Masse, Jean-François; Morisson, Florence; Pancer, Jeffrey; Samuels, Charles Harry; Schachter, Maurice; Sériès, Frédéric; Sullivan, Glendon Edward

    2012-01-01

    The present Canadian position paper contains recommendations for the management by dentists of sleep-disordered breathing in adults with the use of oral appliances (OAs) as a treatment option for snoring and obstructive sleep apnea (OSA). The recommendations are based on literature reviews and expert panel consensus. OAs offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe OSA patients who cannot tolerate CPAP, are inappropriate candidates for CPAP or who have failed CPAP treatment attempts. The purpose of the present position paper is to guide interdisciplinary teamwork (sleep physicians and sleep dentists) and to clarify the role of each professional in the management of OA therapy. The diagnosis of OSA should always be made by a physician, and OAs should be fitted by a qualified dentist who is trained and experienced in dental sleep medicine. Follow-up assessment by the referring physician and polysomnography or sleep studies are required to verify treatment efficacy. The present article emphasizes the need for a team approach to OA therapy and provides treatment guidelines for dentists trained in dental sleep medicine. Many of the dentists and sleep physicians who contributed to the preparation of the present article are members of the Canadian Sleep Society and the authors reached a consensus based on the current literature.

  9. Challenges in the diagnosis and management of sleeping sickness in Tanzania: a case report.

    Science.gov (United States)

    Sindato, C; Kibona, S N; Nkya, G M; Mbilu, T J N K; Manga, C; Kaboya, J S; Rawille, F

    2008-07-01

    In Tanzania sleeping sickness presents a serious threat to human health with a country-wide average of 400 cases reported annually. Both wild and domestic animals have been found to play a significant role in the epidemiology of sleeping sickness. Serengeti National Park in northern Tanzania, has experienced a number of sleeping sickness epidemics since 1922. The epidemics were associated with abundant game animals in the areas and Glossina swynnertoni was incriminated as the main vector. However since 2001 there has been no case of sleeping sickness reported from the park. This case report highlights on the possibility of resurgence and challenges in the diagnosis and management of sleeping sickness in Serengeti. A 38 years old Tanzanian man working in the Serengeti National Park who had experienced various tsetse bites was presented with a febrile condition and history of unsuccessful case management at different health facilities. Blood and cerebrospinal fluid (CSF) samples were examined for the presence oftrypanosomes using wet film, Field's stain and concentration techniques. Typanosoma brucei rhodesiense were detected in both the blood and CSF samples. The patient was treated successfully with melarsoprol. The results of this case study highlight the possibility of resurgence of sleeping sickness in the park hence calls for the need to create more awareness among the community and clinicians. There is need for early reporting to health facility and strengthening the diagnostic capacity of healthcare facilities in and around national parks endemic for sleeping sickness.

  10. Hipersonolência diurna e variáveis polissonográficas em doentes com síndroma de apneia do sono Daytime sleepiness and polysomnographic variables in sleep apnoea patients

    Directory of Open Access Journals (Sweden)

    O Mediano

    2007-12-01

    indivíduos sofria de doença crónica, nomeadamente DPOC, cirrose hepática, disfunção tiroideia, artrite reumatóide, insuficiência renal crónica ou fazia qualquer tipo de medicação. O diagnóstico de SAOS foi estabelecido por polissonografia nocturna com registo de múltiplas variáveis, como sejam electroencefalograma (EEG, electromiograma (EMG mentoniano, electrooculograma, fluxo oronasal, movimentos toracoabdominais e oximetria de fluxo. Apneia foi definida como a interrupção de fluxo oronasal >10s e hipopneia como uma redução >50% do fluxo por um período >10s associado a uma descida >4% da SaO2 ou despertar. O índice de apneia/hipopneia (IAH consiste no somatório do número de apneias e hipopneias por hora de sono. Os estádios do sono foram classificados de acordo com os critérios de Rechtschoffen e Kales. A latência do sono foi definida como o período compreendido entre o acto de deitar e os primeiros 30s do estádio I e a eficiência do sono como a duração do sono nocturno expressa como percentagem do tempo total de permanência no leito. De acordo com os critérios da American Sleep Disorders Association Task Force, os despertares foram definidos como despertares de origem respiratória quando ocorriam 3s após uma apneia, hipopneia ou ressonar, sabendo que existem outros tipos de despertares (espontâneos, relacionados com os movimentos periódicos dos membros e técnicos. O total de despertares foi determinado pela soma de cada tipo dos mesmos. A hipersonolência subjectiva foi avaliada utilizando a ESE constituída por 8 itens a que são atribuídos um score de 0 a 3. A avaliação objectiva é obtida através do teste de latência múltipla de acordo com as guidelines internacionais. Um score 10 min a sua ausência. Foram estudados, no total, 23 indivíduos do sexo masculino com hipersonolência diurna (ESE: 17±3; teste latência múltipla: 4±1 min e 17 sem sonolência excessiva (ESE: 5±2 e teste latência: 16±3 min. Ambos os grupos

  11. Managing sleep problems using non-prescription medications and the role of community pharmacists: older adults' perspectives.

    Science.gov (United States)

    Abraham, Olufunmilola; Schleiden, Loren J; Brothers, Amanda L; Albert, Steven M

    2017-12-01

    To examine older adults' perspectives regarding managing sleep problems through selection and use of non-prescription sleep aids, and the role of pharmacists. Telephone interviews were conducted from May to June 2015 with 116 individuals aged ≥60 years in Pittsburgh, Pennsylvania. Participants reported in a previous survey to have used at least one non-prescription sleep aid in the past 30 days and were willing to participate in a follow-up interview. Interview guides were designed to elicit perspectives of sleep problems, selection and use of non-prescription sleep aids, and consultation with healthcare professionals. Interview transcripts underwent content analysis. Four themes emerged as follows: experiences with sleep problems, selection of non-prescription sleep aids, non-prescription sleep aid use and interactions with healthcare professionals. Over half of participants reported using a non-prescription sleep aid for >1 year, were satisfied with its use and perceived it improved sleep quality. Participants commonly used an antihistamine-only sleep aid; 36% of participants self-recommended their sleep aid; and 16% of participants consulted healthcare professionals. Few participants read medication dosage labels (22%), side effects or warnings (19%), and many reported they disregarded directions. Participants did not typically consult pharmacists about sleep problems (65%) but perceived that they could assist with medication concerns. Although most participants had favourable perceptions of non-prescription sleep aids, older adults may be inappropriately using non-prescription sleep aids to self-manage sleep problems by frequently disregarding medication labels and directions for safe use. Also, few older adults are discussing their sleep aid selection and use with pharmacists. © 2017 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.

  12. Position paper on the management of patients with obstructive sleep apnea and hypertension

    DEFF Research Database (Denmark)

    Parati, Gianfranco; Lombardi, Carolina; Hedner, Jan

    2012-01-01

    This article is aimed at addressing the current state of the art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnea (OSA) in cardiovascular (particularly hypertensive) patients, as well as for the management of cardi...... respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night....

  13. Management of sleep bruxism in adults: a qualitative systematic literature review

    NARCIS (Netherlands)

    Manfredini, D.; Ahlberg, J.; Winocur, E.; Lobbezoo, F.

    2015-01-01

    This paper updates the bruxism management review published by Lobbezoo et al. in 2008 (J Oral Rehabil 2008; 35: 509-23). The review focuses on the most recent literature on management of sleep bruxism (SB) in adults, as diagnosed with polysomnography (PSG) with audio-video (AV) recordings, or with

  14. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer

    Directory of Open Access Journals (Sweden)

    Palesh O

    2012-12-01

    Full Text Available Oxana Palesh,1 Luke Peppone,2 Pasquale F Innominato,3–5 Michelle Janelsins,2 Monica Jeong,1 Lisa Sprod,7 Josee Savard,6 Max Rotatori,1 Shelli Kesler,1 Melinda Telli,1 Karen Mustian21Stanford University School of Medicine, Stanford, CA, USA; 2University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; 3INSERM, UMRS 776, Biological Rhythms and Cancers, Villejuif, France; 4Faculty of Medicine, Universite Paris Sud, le Kremlin-Bicêtre, France; 5APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse Hospital, Villejuif, France; 6Laval University, Quebec, Canada; 7University of North Carolina, Wilmington, NC, USAAbstract: Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients

  15. Management of sleep disorders in Parkinson's disease and multiple system atrophy.

    Science.gov (United States)

    Videnovic, Aleksandar

    2017-05-01

    Parkinson's disease (PD) and multiple system atrophy (MSA) are disorders associated with α synuclein-related neurodegeneration. Nonmotor symptoms are common hallmarks of these disorders, and disturbances of the sleep-wake cycle are among the most common nonmotor symptoms. It is only recently that sleep disturbances have received the attention of the medical and research community. Significant progress has been made in understanding the pathophysiology of sleep and wake disruption in alphasynucleinopathies during the past few decades. Despite these advancements, treatment options are limited and frequently associated with problematic side effects. Further studies that center on the development of novel treatment approaches are very much needed. In this article, the author discusses the current state of the management of disturbed sleep and alertness in PD and MSA. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  16. Obstructive sleep apnoea in pregnancy and its association with pre ...

    African Journals Online (AJOL)

    Results: The median gestational age in this sample was 28 weeks; 80.3% (CI ... The association between the hypertensive disorders and OSA must be ... and mortality for mother and baby.1–3 Continuous positive airway ... During pregnancy weight gain can be attributed to oedema, ..... Maternal and neonatal morbidities.

  17. Sleep-dependent memory consolidation in patients with sleep disorders.

    Science.gov (United States)

    Cipolli, Carlo; Mazzetti, Michela; Plazzi, Giuseppe

    2013-04-01

    Sleep can improve the off-line memory consolidation of new items of declarative and non-declarative information in healthy subjects, whereas acute sleep loss, as well as sleep restriction and fragmentation, impair consolidation. This suggests that, by modifying the amount and/or architecture of sleep, chronic sleep disorders may also lead to a lower gain in off-line consolidation, which in turn may be responsible for the varying levels of impaired performance at memory tasks usually observed in sleep-disordered patients. The experimental studies conducted to date have shown specific impairments of sleep-dependent consolidation overall for verbal and visual declarative information in patients with primary insomnia, for verbal declarative information in patients with obstructive sleep apnoeas, and for visual procedural skills in patients with narcolepsy-cataplexy. These findings corroborate the hypothesis that impaired consolidation is a consequence of the chronically altered organization of sleep. Moreover, they raise several novel questions as to: a) the reversibility of consolidation impairment in the case of effective treatment, b) the possible negative influence of altered prior sleep also on the encoding of new information, and c) the relationships between altered sleep and memory impairment in patients with other (medical, psychiatric or neurological) diseases associated with quantitative and/or qualitative changes of sleep architecture. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

    Directory of Open Access Journals (Sweden)

    Fernandez RC

    2018-02-01

    pituitary–adrenal function. Psychological and behavioral pathways are also likely to play a role, as anxiety and depression, smoking, alcohol use and lack of physical activity are also common among women with PCOS, partly in response to the distressing symptoms they experience. The specific impact of sleep disturbances on the health of women with PCOS is not yet clear; however, both PCOS and sleep disturbances are associated with deterioration in cardiometabolic health in the longer term and increased risk of type 2 diabetes. Both immediate quality of life and longer-term health of women with PCOS are likely to benefit from diagnosis and management of sleep disorders as part of interdisciplinary health care. Keywords: polycystic ovary syndrome, sleep, sleep disturbance, hypothalamic-pituitary-adrenal, cardiometabolic health

  19. Sleep disturbance relates to neuropsychological functioning in late-life depression.

    Science.gov (United States)

    Naismith, Sharon L; Rogers, Naomi L; Lewis, Simon J G; Terpening, Zoë; Ip, Tony; Diamond, Keri; Norrie, Louisa; Hickie, Ian B

    2011-07-01

    Sleep-wake disturbance in older people is a risk factor for depression onset and recurrence. The aim of this study was to determine if objective sleep-wake disturbance in late-life depression relates to neuropsychological functioning. Forty-four older patients with a lifetime history of major depression and 22 control participants underwent psychiatric, medical and neuropsychological assessments. Participants completed self-report sleep measures, sleep diaries and wore wrist actigraphy for two weeks. Outcome measures included sleep latency, the number and duration of nocturnal awakenings and the overall sleep efficiency. Patients with depression had a greater duration of nocturnal awakenings and poorer sleep efficiency, in comparison to control participants. Sleep disturbance in patients was associated with greater depression severity and later ages of depression onset. It also related to poorer psychomotor speed, poorer verbal and visual learning, poorer semantic fluency as well as poorer performance on tests of executive functioning. These relationships largely remained significant after controlling for depression and estimated apnoea severity. This sample had only mild levels of depression severity and results require replication in patients with moderate to severe depression. The inclusion of polysomnography and circadian markers would be useful to delineate the specific features of sleep-wake disturbance that are critical to cognitive performance. Sleep-wake disturbance in older patients with depression is related to neuropsychological functioning and to later ages of illness onset. This study suggests that common neurobiological changes may underpin these disease features, which may, in turn, warrant early identification and management. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. High versus standard dose caffeine for apnoea: a systematic review

    NARCIS (Netherlands)

    Vliegenthart, Roos; Miedema, Martijn; Hutten, Gerard J.; van Kaam, Anton H.; Onland, Wes

    2018-01-01

    Placebo-controlled trials have shown that caffeine is highly effective in treating apnoea of prematurity and reduces the risk of bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI). To identify, appraise and summarise studies investigating the modulating effect of different

  1. The impact on sleep of a multidisciplinary cognitive behavioural pain management programme: a pilot study

    Directory of Open Access Journals (Sweden)

    Horan Sheila

    2011-01-01

    Full Text Available Abstract Background Reduced sleep quality is a common complaint among patients with chronic pain, with 50-80% of patients reporting sleep disturbance. Improvements in pain and quality of life measures have been achieved using a multidisciplinary cognitive behavioural therapy pain management programme (CBT-PMP that aims to recondition attitudes to pain, and improve patients' self-management of their condition. Despite its high prevalence in patients with chronic pain, there is very limited objective evidence for the effect of this intervention on sleep quality. The primary research objective is to investigate the short-term effect of a multidisciplinary CBT-PMP on subjective (measured by Pittsburg Sleep Quality Index and objective sleep quality (measured by Actigraphy in patients with chronic pain by comparison with a control group. The secondary objectives will investigate changes in function and mood, and then explore the relationship between objective and subjective sleep quality and physical and psychological outcome measures. Methods/Design Patients who fulfil the inclusion criteria for attendance on the multidisciplinary CBT-PMP in the Adelaide and Meath Hospital, Tallaght, Dublin and are currently listed on the PMP waiting list will be invited to participate in this pilot study. Potential patients will be screened for sleep disturbance [determined by the Pittsburgh Sleep Quality Index (PSQI]. Those patients with a sleep disturbance (PSQI >5 will be assigned to either the intervention group (immediate treatment, or control group (deferred treatment, i.e. the PMP they are listed for is more than six months away based on where they appear on the waiting list. Baseline measures of sleep, function, and mood will be obtained using a combination of self-report questionnaires (the Hospital Anxiety and Depression Scale, the Short Form 36 health survey, the Pittsburgh Sleep Quality Index, the Tampa Scale for Kinesiophobia, and functional outcome

  2. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

    Science.gov (United States)

    Moore, Vivienne M; Van Ryswyk, Emer M; Varcoe, Tamara J; Rodgers, Raymond J; March, Wendy A; Moran, Lisa J; Avery, Jodie C; McEvoy, R Doug; Davies, Michael J

    2018-01-01

    Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting the reproductive, metabolic and psychological health of women. Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome. Evidence from the few available population-based studies is supportive. Women with PCOS tend to be overweight/obese, but this only partly accounts for their sleep problems as associations are generally upheld after adjustment for body mass index; sleep problems also occur in women with PCOS of normal weight. There are several, possibly bidirectional, pathways through which PCOS is associated with sleep disturbances. The pathophysiology of PCOS involves hyperandrogenemia, a form of insulin resistance unique to affected women, and possible changes in cortisol and melatonin secretion, arguably reflecting altered hypothalamic–pituitary–adrenal function. Psychological and behavioral pathways are also likely to play a role, as anxiety and depression, smoking, alcohol use and lack of physical activity are also common among women with PCOS, partly in response to the distressing symptoms they experience. The specific impact of sleep disturbances on the health of women with PCOS is not yet clear; however, both PCOS and sleep disturbances are associated with deterioration in cardiometabolic health in the longer term and increased risk of type 2 diabetes. Both immediate quality of life and longer-term health of women with PCOS are likely to benefit from diagnosis and management of sleep disorders as part of interdisciplinary health care. PMID:29440941

  3. Position paper by Canadian dental sleep medicine professionals regarding the role of different health care professionals in managing obstructive sleep apnea and snoring with oral appliances

    OpenAIRE

    Gauthier, Luc; Almeida, Fernanda; Arcache, Patrick; Ashton-McGregor, Catherine; Côté, David; Driver, Helen; Ferguson, Kathleen; Lavigne, Gilles; Martin, Philippe; Masse, Jean-François; Morisson, Florence; Pancer, Jeffrey; Samuels, Charles; Schachter, Maurice; Sériès, Frédéric

    2012-01-01

    The present Canadian position paper contains recommendations for the management by dentists of sleep-disordered breathing in adults with the use of oral appliances (OAs) as a treatment option for snoring and obstructive sleep apnea (OSA). The recommendations are based on literature reviews and expert panel consensus. OAs offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe O...

  4. Sleep problems during the menopausal transition: prevalence, impact, and management challenges

    Directory of Open Access Journals (Sweden)

    Baker FC

    2018-02-01

    Full Text Available Fiona C Baker,1,2 Massimiliano de Zambotti,1 Ian M Colrain,1,3 Bei Bei4,5 1Center for Health Sciences, SRI International, Menlo Park, CA, USA; 2Brain Function Research Group, University of the Witwatersrand, Johannesburg, South Africa; 3Melbourne School of Psychological Sciences, University of Melbourne, 4Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 5Centre for Women’s Mental Health, Department of Psychiatry, University of Melbourne, Royal Women’s Hospital, Melbourne, VIC, Australia Abstract: A substantial number of women experience sleep difficulties in the approach to menopause and beyond, with 26% experiencing severe symptoms that impact daytime functioning, qualifying them for a diagnosis of insomnia. Here, we review both self-report and polysomnographic evidence for sleep difficulties in the context of the menopausal transition, considering severity of sleep complaints and links between hot flashes (HFs and depression with poor sleep. Longitudinal population-based studies show that sleep difficulties are uniquely linked with menopausal stage and changes in follicle-stimulating hormone and estradiol, over and above the effects of age. A major contributor to sleep complaints in the context of the menopausal transition is HFs, and many, although not all, HFs are linked with polysomnographic-defined awakenings, with HF-associated wake time contributing significantly to overall wakefulness after sleep onset. Some sleep complaints may be comorbid with depressive disorders or attributed to sleep-related breathing or movement disorders, which increase in prevalence especially after menopause, and for some women, menopause, age, and environmental/behavioral factors may interact to disrupt sleep. Considering the unique and multifactorial basis for sleep difficulties in women transitioning menopause, we describe clinical assessment

  5. Sleep management and the performance of eight sailors in the Tour de France à la voile yacht race.

    Science.gov (United States)

    Léger, D; Elbaz, M; Raffray, T; Metlaine, A; Bayon, V; Duforez, F

    2008-01-01

    We observed how sailors manage their sleep and alertness before and during competition in a long-haul yacht race. Global performance of the teams was also recorded. We assessed eight sailors aged 21-30 years, split into four teams, who competed in the Tour de France à la Voile 2002 yacht race. Two phases of the race were examined: two legs in both the Atlantic Ocean and Mediterranean Sea. Sleep length, sleep debt, and sleepiness before competition and on board during the race were assessed using ambulatory polysomnography. Intermediate and final rankings were considered as a reflection of performance. A significant correlation was observed between the sleep debt before competition and the total sleep time on board during the Atlantic legs. The greater the sleep debt, the more sleepy the participants were. During the Mediterranean legs, almost all the sailors were deprived of sleep and slept during the daytime competitions. We observed that the final ranking in the race related to the sleep management strategy of the participants. In extreme competitive conditions, the effect of a good night's sleep before competition on performance is important. The strategy of the winners was to get sufficient sleep before each leg so as to be the most alert and efficient during the race.

  6. Side Effects: Sleep Problems

    Science.gov (United States)

    Sleep problems are a common side effect during cancer treatment. Learn how a polysomnogram can assess sleep problems. Learn about the benefits of managing sleep disorders in men and women with cancer.

  7. Sleep and Alertness Management II: Effects on Sleep Pattern and Sleep Quality in Marmosets (slaap- en alertheidsmanagement II: effecten op slaapritme en slaapkwaliteit in marmosetapen)

    Science.gov (United States)

    2006-10-01

    beleidsondersteuning Commando Luchtstrijdkrachten/Hoofd Auteur (s) Afdeling Gezondheidszorg operaties dr. I.H.C.H.M. Philippens, R.A.P. Vanwersob, ing. M.J... Theory .......................................................................................................................... 9 2.1 Sleep as an...2 Theory 2.1 Sleep as an active and rhythmical process Till the 50s the research on sleep was dominated by a passive theory of sleep. This theory

  8. Improvement in Obstructive Sleep Apnea Diagnosis and Management Wait Times: A Retrospective Analysis of a Home Management Pathway for Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Samuel Alan Stewart

    2015-01-01

    Full Text Available Obstructive sleep apnea is a common condition within the Canadian population. The current gold standard for diagnosis and management of patients is in-laboratory (in-lab polysomnography; however, the limited availability of testing options for patients has led to long wait times and increased disease burden within the population. The Sleep Research Laboratory in Saskatoon (Saskatchewan implemented a home management program to run in parallel with the in-lab system several years ago in an effort to increase their capacity and reduce wait times. The present study was a retrospective analysis of all patients referred to the program between 2009 and 2012. The home management system has improved wait times by diagnosing and managing up to one-half of the referred patient population, reducing the wait for in-lab treatment from a median of 152 days in 2009 to 92 days in 2012 (P<0.0001. Moving forward, home management can provide a viable alternative to in-lab testing for patients who meet strict entry criteria, reducing the in-lab workload and, ultimately, reducing wait times.

  9. Respiratory and sleep disorders in female children with atypical Rett syndrome caused by mutations in the CDKL5 gene.

    Science.gov (United States)

    Hagebeuk, Eveline E O; van den Bossche, Renilde A S; de Weerd, Al W

    2013-05-01

    In female children with drug-resistant seizures and developmental delay from birth, atypical Rett syndrome caused by mutations in the CDKL5 gene should be considered. Several clinical features resemble classic Rett syndrome. Respiratory and sleep abnormalities are frequently present in Rett syndrome, whereas little is known in patients with CDKL5 mutations. In four genetically confirmed female patients with CDKL5 mutations (age range 2-15 y), the presence of breathing and sleep abnormalities was evaluated using the validated Sleep Disturbance Scale for Children and polysomnography (PSG). The Sleep Disturbance Scale for Children indicated disorders of initiating and maintaining sleep, daytime somnolence, and sleep breathing disorders. In one patient, PSG showed central apnoeas during sleep: her total apnoea-hypopnoea index (AHI) was 4.9, of which the central AHI was 3.4/h. When awake, central apnoeas were present in two of the four female children (central AHI 28/h and 41/h respectively), all preceded by hyperventilation. PSG showed low rapid eye movement (REM) sleep (9.7-18.3%), frequent awakenings, and low sleep efficiency (range 59-78%). Episodic hyperventilation followed by central apnoeas was present while awake in two of four patients. This may indicate failure of brainstem respiratory centres. In addition, low REM sleep, frequent arousals (not caused by apnoeas/seizures), and low sleep efficiency were present. Similar to Rett syndrome, in patients with CDKL5 mutations PSG seems warranted to evaluate breathing and sleep disturbances. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

  10. How do I best manage insomnia and other sleep disorders in older adults with cancer?

    Science.gov (United States)

    Loh, Kah Poh; Burhenn, Peggy; Hurria, Arti; Zachariah, Finly; Mohile, Supriya Gupta

    2016-11-01

    Insomnia is common in older adults with cancer, with a reported prevalence of 19-60% in prior studies. Cancer treatments are associated with increased risk of insomnia or aggravation of pre-existing insomnia symptoms, and patients who are receiving active cancer treatments are more likely to report insomnia. Insomnia can lead to significant physical and psychological consequences with increased mortality. We discuss physiological sleep changes in older adults, and illustrated the various sleep disorders. We present a literature review on the prevalence and the effects of insomnia on the quality of life in older adults with cancer. We discuss the risk factors and presented a theoretical framework of insomnia in older adults with cancer. We present a case study to illustrate the assessment and management of insomnia in older adults with cancer, comparing and contrasting a number of tools for sleep assessment. There are currently no guidelines on the treatment of sleep disorders in older adults with cancer. We present an algorithm developed at the City of Hope Comprehensive Cancer Center by a multidisciplinary team for managing insomnia, using evidence-based pharmacologic and non-pharmacologic interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Integrated orofacial therapy in chronic rhinosinusitis management for children with sleep bruxism

    Directory of Open Access Journals (Sweden)

    Haryono Utomo

    2010-06-01

    Full Text Available Background: The prevalence of rhinosinusitis was 20% in ambulatory patients and was mostly affected by viral infections and allergy. If conservative treatments of rhinosinusitis failed, surgical procedure is an alternative choice. Previous case report revealed that the rhinosinusitis symptoms were successfully relieved by the "assisted drainage" therapy only. Nevertheless, this therapy was less successful in children with sleep bruxism (SB. Purpose: To report an integrated orofacial therapy for management of rhinosinusitis children with sleep bruxism (SB which consisted of the assisted drainage, night-guard and masseter muscle massage therapies. Case: Two boys who suffered from rhinosinusitis with bruxism were unsuccessfully treated with conventional treatment. Case management: Patients was subjected to the assisted drainage therapy that was scaling and root planning combined with gingival massage, and masseter muscle massage; night guard was worn in night sleep. They successfully relieved the rhinosinusitis symptoms. Conclusion: Based on the successful result, this integrated therapy could be suggested as an adjuvant in rhinosinusitis management.Latar belakang: Prevalensi rinosinusitis adalah 20% pasien rawat jalan dan umumnya disebabkan oleh infeksi virus dan alergi. Apabila terapi konservatif rinosinusitis mengalami kegagalan maka pilihan terakhir adalah operasi. Pada laporan kasus yang ada telah terjadi perbaikan gejala rinosinusitis setelah dilakukan terapi “assisted drainage” saja. Akan tetapi, terapi ini kurang berhasil pada anak dengan sleep bruxism (SB. Tujuan: Melaporkan suatu terapi orofasial terintegrasi untuk tatalaksana rinosinusitis pada anak dengan sleep bruxism (SB yang terdiri dari terapi assisted drainage, night guard dan masase otot masseter. Kasus: Dua anak laki-laki yang menderita rinosinusitis dengan bruxism telah mengalami kegagalan pada perawatan konsvensional. Tatalaksana kasus: Pasien dilakukan terapi assisted

  12. Influence of arousal threshold and depth of sleep on respiratory stability in man: analysis using a mathematical model.

    Science.gov (United States)

    Longobardo, G S; Evangelisti, C J; Cherniack, N S

    2009-12-01

    We examined the effect of arousals (shifts from sleep to wakefulness) on breathing during sleep using a mathematical model. The model consisted of a description of the fluid dynamics and mechanical properties of the upper airways and lungs, as well as a controller sensitive to arterial and brain changes in CO(2), changes in arterial oxygen, and a neural input, alertness. The body was divided into multiple gas store compartments connected by the circulation. Cardiac output was constant, and cerebral blood flows were sensitive to changes in O(2) and CO(2) levels. Arousal was considered to occur instantaneously when afferent respiratory chemical and neural stimulation reached a threshold value, while sleep occurred when stimulation fell below that value. In the case of rigid and nearly incompressible upper airways, lowering arousal threshold decreased the stability of breathing and led to the occurrence of repeated apnoeas. In more compressible upper airways, to maintain stability, increasing arousal thresholds and decreasing elasticity were linked approximately linearly, until at low elastances arousal thresholds had no effect on stability. Increased controller gain promoted instability. The architecture of apnoeas during unstable sleep changed with the arousal threshold and decreases in elasticity. With rigid airways, apnoeas were central. With lower elastances, apnoeas were mixed even with higher arousal thresholds. With very low elastances and still higher arousal thresholds, sleep consisted totally of obstructed apnoeas. Cycle lengths shortened as the sleep architecture changed from mixed apnoeas to total obstruction. Deeper sleep also tended to promote instability by increasing plant gain. These instabilities could be countered by arousal threshold increases which were tied to deeper sleep or accumulated aroused time, or by decreased controller gains.

  13. [A 14-day-old boy with jaundice and apnoea].

    Science.gov (United States)

    Smerud, Ole-Jørgen Olsøy; Solevåg, Anne Lee; Hansen, Thor Willy Ruud; Grønn, Morten

    2015-12-15

    We describe an infant who was readmitted from home at 14 days of age with jaundice and a history of apnoea and episodes of retrocollis/opisthotonos. He had been only mildly jaundiced on discharge from the maternity clinic at 2 days of age. The total serum bilirubin (TSB) on admission was 542 µmol/L, and the infant was treated intensively with triple phototherapy and exchange transfusion. In contrast to what is recommended in Norwegian national guidelines for management of neonatal jaundice, the parents had apparently neither received oral nor written information about jaundice and its follow-up at the time of discharge from maternity. They therefore contacted their child healthcare centre when they had questions about jaundice, though the national guidelines specifically state that follow-up for neonatal jaundice during the first 2 weeks of life is the responsibility of the birth hospital. Inappropriate advice resulted in delayed referral, and the child has been diagnosed with chronic kernicterus, probably the first such case in Norway since national guidelines were formalised in 2006. Genetic work-up disclosed compound heterozygosity for Crigler-Najjar syndrome type I, to the best of our knowledge the first instance of this disorder ever to have been diagnosed in Norway. The incidence of kernicterus is Norway is much lower than in other industrialised countries. This is most likely due to national guidelines for management of neonatal jaundice, which place the responsibility for management and follow-up of jaundice with the birth hospital during the crucial first 2 weeks of life. This case report reminds us that tragedies may occur when guidelines are disregarded.

  14. Sleep Sleeping Patch

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The Sleep Sleeping Patch is a new kind of external patch based on modern sleep medicine research achievements, which uses the internationally advanced transdermal therapeutic system (TTS). The Sleep Sleeping Patch transmits natural sleep inducers such as peppermint and liquorice extracts and melatonin through the skin to induce sleep. Clinical research proves that the Sleep Sleeping Patch can effectively improve insomnia and the quality of sleep. Highly effective: With the modern TTS therapy,

  15. Afternoon serum-melatonin in sleep disordered breathing.

    Science.gov (United States)

    Ulfberg, J; Micic, S; Strøm, J

    1998-08-01

    To study afternoon serum-melatonin values in patients with sleep disordered breathing. Melatonin has a strong circadian rhythm with high values during the night-time and low values in the afternoon. Sleep disordered breathing may change the circadian rhythm of melatonin which may have diagnostic implications. The Sleep Laboratory, The Department of Internal Medicine, Avesta Hospital, Sweden, and the Department of Anaesthesiology, Glostrup University Hospital, Copenhagen, Denmark. We examined 60 consecutive patients admitted for sleep disordered breathing and 10 healthy non snoring controls. The patients underwent a sleep apnoea screening test having a specificity of 100% for the obstructive sleep apnoea syndrome (OSAS) using a combination of static charge sensitive bed and oximetry. Obstructive sleep apnoea syndrome was found in 49 patients, eight patients had borderline sleep disordered breathing (BSDB) and three patients were excluded due to interfering disease. Patients and controls had an afternoon determination of serum-melatonin. The Epworth Sleepiness Scale was used to score day-time sleepiness. In comparison with normal controls patients suffering from OSAS had significantly higher serum-melatonin levels in the afternoon. However, as a diagnostic test for OSAS in patients with sleep disordered breathing serum-melatonin showed a low sensitivity but a high specificity. The results indicate that breathing disorders during sleep in general affect pineal function. Sleep disordered breathing seems to disturb pineal function. Determination of afternoon serum-melatonin alone or together with a scoring of daytime sleepiness does not identify OSAS-patients in a heterogeneous population of patients complaining of heavy snoring and excessive daytime sleepiness.

  16. Making waste management public (or falling back to sleep).

    Science.gov (United States)

    Hird, Myra J; Lougheed, Scott; Rowe, R Kerry; Kuyvenhoven, Cassandra

    2014-06-01

    Human-produced waste is a major environmental concern, with communities considering various waste management practices, such as increased recycling, landfilling, incineration, and waste-to-energy technologies. This article is concerned with how and why publics assemble around waste management issues. In particular, we explore Noortje Marres and Bruno Latour's theory that publics do not exist prior to issues but rather assemble around objects, and through these assemblages, objects become matters of concern that sometimes become political. The article addresses this theory of making things public through a study of a small city in Ontario, Canada, whose landfill is closed and waste diversion options are saturated, and that faces unsustainable costs in shipping its waste to the United States, China, and other regions. The city's officials are undertaking a cost-benefit assessment to determine the efficacy of siting a new landfill or other waste management facility. We are interested in emphasizing the complexity of making (or not making) landfills public, by exploring an object in action, where members of the public may or may not assemble, waste may or may not be made into an issue, and waste is sufficiently routinized that it is not typically transformed from an object to an issue. We hope to demonstrate Latour's third and fifth senses of politics best account for waste management's trajectory as a persistent yet inconsistent matter of public concern.

  17. Sleep and Cognitive Decline: A Strong Bidirectional Relationship. It Is Time for Specific Recommendations on Routine Assessment and the Management of Sleep Disorders in Patients with Mild Cognitive Impairment and Dementia.

    Science.gov (United States)

    Guarnieri, Biancamaria; Sorbi, Sandro

    2015-01-01

    Sleep disturbances and disruption of the neural regulation of the sleep-wake rhythm appear to be involved in the cellular and molecular mechanisms of cognitive decline. Although sleep problems are highly prevalent in mild cognitive impairment (MCI) and many types of dementia, they have not been systematically investigated in the clinical setting and are often only investigated by sleep specialists upon individual request. This review discusses sleep disorders in the context of cognitive decline and provides an overview of the clinical diagnosis and management of these disorders in patients with dementia and MCI. Key Messages: Sleep disorders are largely underestimated and do not receive sufficient attention in the global management of dementia patients. Sleep disturbances have a significant impact on cognitive and physical functions in individuals with cognitive decline and may be associated with important psychological distress and depression. They are positively associated with the severity of behavioral problems and cognitive impairment. The recent recommendations by the Sleep Study Group of the Italian Dementia Research Association can be used as a guideline for the clinical assessment and management of sleep disorders in MCI and dementia patients. Sleep disorders should be carefully investigated using an in-depth sleep history, physical examination, questionnaires and clinical scales and should be validated with the support of a direct caregiver. The recommendations for older adults can be used as a framework to guide the diagnosis and treatment of sleep disorders in individuals with dementia and MCI. The management strategy should be based on the choice of different treatments for each sleep problem present in the same patient, while avoiding adverse interactions between treatments. © 2015 S. Karger AG, Basel.

  18. Perioperative management and complications in patients with obstructive sleep apnea undergoing transsphenoidal surgery: Our institutional experience.

    Science.gov (United States)

    Rahimi, Eiman; Mariappan, Ramamani; Tharmaradinam, Suresh; Manninen, Pirjo; Venkatraghavan, Lashmi

    2014-07-01

    Patients with endocrine diseases such as acromegaly and Cushing's disease have a high prevalence of obstructive sleep apnea (OSA). There is controversy regarding the use of continuous positive airway pressure (CPAP) following transsphenoidal surgery. The aim of this study was to compare the perioperative management and complications, in patients with or without OSA undergoing transsphenoidal surgery. After Research Ethics Board approval, we retrospectively reviewed the charts of all patients who underwent transsphenoidal surgery in our institution from 2006 to 2011. Information collected included patients' demographics, pathology of lesion, history of OSA, anesthetic and perioperative management and incidence of perioperative complications. Patients with sleep study proven OSA were compared with a control group, matched for age, sex and pathology of patients without OSA. Statistical analysis was performed using t-test and Chi-square test and the P transsphenoidal surgery, 105 patients were found to be at risk for OSA by a positive STOP-BANG scoring assessment. Preoperative sleep study testing was positive for OSA in 38 patients. Post-operative hypoxemia (SpO2 transsphenoidal surgery can be treated in most but not all patients with high flow oxygen using the face mask. We were able to safely use CPAP in a very small number of patients but caution is needed to prevent complications. Further prospective studies are needed to determine the safe use of CPAP in patients after transsphenoidal surgery.

  19. Apnoea of prematurity – discontinuation of methylxanthines in a ...

    African Journals Online (AJOL)

    Background. Methylxanthines such as caffeine have been proven to reduce apnoea of prematurity and are often discontinued at 35 weeks' corrected gestational age (GA). Objective. To ascertain whether a caffeine protocol based on international guidelines is applicable in our setting, where GA is often uncertain. Methods.

  20. Sleep health and its assessment and management in physical therapy practice: the evidence.

    Science.gov (United States)

    Coren, Stanley

    2009-07-01

    Sleep and sleep deprivation have become major health issues in our modern society. Impaired sleep can negatively affect physical and psychological well-being, and conversely, certain common conditions can impair sleep. Furthermore, insufficient or disrupted sleep can contribute to functional impairments. As health care professionals, physical therapists are singularly concerned with function and well-being. To understand the role of sleep and sleep deprivation on health, this article describes sleep, our contemporary culture of sleeplessness, insomnia, sleep needs, the physical cost of inadequate sleep, the psychological cost of sleep deprivation, and the effects of sleep debt on safety. How to assess an individual's sleep debt is then described, and a sleep inventory questionnaire and scoring scale are presented. Evidence-based recommendations for optimizing sleep are outlined, and these can be readily implemented by the busy clinician. The sleep inventory questionnaire can be used to evaluate the outcome of these recommendations or other interventions as well as serve as an assessment tool. Based on the literature, the assessment and evaluation of sleep and basic sleep recommendations need to be considered as fundamental clinical competencies in contemporary physical therapy care.

  1. Sleep-related laryngospasm.

    Science.gov (United States)

    Thurnheer, R; Henz, S; Knoblauch, A

    1997-09-01

    The term "sleep-related laryngospasm" refers to episodic, abrupt interruption of sleep accompanied by feelings of acute suffocation followed by stridor. The condition is included in the diagnostic and coding manual of the American Sleep Disorders Association (ASDA), but there are few references in the peer-reviewed literature. Our description of the distinct clinical picture associated with this condition is based on an analysis of the histories of a series of 10 patients. The patients and their families gave precise, uniform accounts of the dramatic attacks. Diagnostic work-up included pulmonary and gastroenterological assessment. All patients reported sudden awakening from sleep due to feelings of acute suffocation, accompanied by intense fear. Apnoea lasting 5-45 s was followed by stridor. Breathing returned to normal within minutes. Patients were left exhausted by the attacks. Nine of our 10 patients had evidence of gastro-oesophageal reflux and six responded to antireflux therapy. We conclude that the nocturnal choking attacks (and the occasional daytime attacks experienced by some of the patients) are caused by laryngospasm. The pathogenesis of the apparent underlying laryngeal irritability is unknown. The condition may be related to a gastro-oesophageal reflux.

  2. Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida.

    Science.gov (United States)

    Vargas, Sara; Antoni, Michael H; Carver, Charles S; Lechner, Suzanne C; Wohlgemuth, William; Llabre, Maria; Blomberg, Bonnie B; Glück, Stefan; DerHagopian, Robert P

    2014-12-01

    Sleep disruption and fatigue are ubiquitous among cancer patients and are sources of stress that may compromise treatment outcomes. Previously, we showed that a cognitive behavioral stress management (CBSM) intervention reduced anxiety and other stress-related processes in women undergoing primary treatment for breast cancer. This study examined secondary outcomes from a CBSM intervention trial for women with early-stage breast cancer to test if CBSM would improve sleep quality and fatigue among these patients at a single site in southern Florida. CBSM-related effects have already been demonstrated for indicators of psychosocial adaptation (e.g., general and cancer-related anxiety). Patients were randomized to CBSM (n= 120) or a 1-day psychoeducation control group (n= 120). The Pittsburgh Sleep Quality Index (PSQI) and Fatigue Symptom Inventory were completed prior to randomization and 6 and 12 months after the baseline assignment. In latent growth analyses, women in CBSM reported greater improvements in PSQI sleep quality scores than controls, although there were no significant differences between conditions on PSQI total scores. Women in CBSM also reported greater reductions in fatigue-related daytime interference than controls, though there were no significant differences in changes in fatigue intensity. Changes in sleep quality were associated with changes in fatigue. Future work may consider integrating sleep and fatigue content into stress management interventions for women with early-stage breast cancer.

  3. Gastro-Oesophageal Reflux and Apnoea: Is There a Temporal Relationship?

    Science.gov (United States)

    Rossor, Thomas; Andradi, Gwendolyn; Ali, Kamal; Bhat, Ravindra; Greenough, Anne

    2018-01-01

    Gastro-oesophageal reflux (GOR) and apnoea are common in infants; whether there is a causal relationship is controversial. To determine whether there was a temporal relationship between GOR and apnoea, in particular, the frequency of obstructive apnoeas and if the frequency of GOR episodes correlated with apnoea frequency when maturity at testing was taken into account. Polysomnography and pH/multichannel intraluminal impedance (MII) studies were performed. Apnoeas were classified as central, obstructive, or mixed. MII events were classified as acidic (pH reflux event was compared to that in the 5-min period preceding the event and that in a 5-min reflux-free period (control period). Forty infants (median gestational age 29 [range 24-42] weeks) were assessed at a post-conceptional age of 37 (30-54) weeks. Obstructive (n = 580), central (n = 900), and mixed (n = 452) apnoeas were identified; 381 acid reflux events were detected by MII and 153 by the pH probe only. Apnoeas were not more frequent following GOR than during control periods. Both the frequency of apnoeas (p = 0.002) and GOR episodes (p = 0.01) were inversely related to post-conceptional age at testing, but were not significantly correlated with each other when controlled for post-conceptional age. These results suggest that GOR does not cause apnoea. © 2017 S. Karger AG, Basel.

  4. Obstructive sleep apnea - adults

    Science.gov (United States)

    ... SM. Obstructive sleep apnea: clinical features, evaluation, and principles of management. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine . 6th ed. Philadelphia, ...

  5. Tracheobronchomegaly associated tracheomalacia: analysis by sleep study.

    Science.gov (United States)

    Sundaram, P; Joshi, J M

    2004-01-01

    Tracheobronchomegaly (TBM) occasionally may progress to extensive tracheomalacia which leads to respiratory failure. Spirometry, dynamic expiratory multidetector computed tomography (CT), bronchoscopy are used to diagnose patients of suspected tracheobronchomalacia. We used the technique of night-time monitoring of respiratory variables to show the presence of respiratory abnormalities during sleep and which was corrected by applying nasal continuous positive airway pressure (CPAP). The study showed the presence of both apnoea and hypopnoeas, which were obstructive in nature with an apnoea-hypopnoea index (AHI) of 11, no snoring and associated oxygen desaturation of 75 per cent. A second overnight study with nasal continuous positive airway pressure at a critical pressure of 8 cm, the AHI decreased to 3 along with no drop in oxygen saturation. This non-invasive technique should be considered as a diagnostic tool in tracheobronchomalacia and to know the outcome of CPAP, surgical or stent therapy in this condition.

  6. Understanding and managing sleep disruption in children with fetal alcohol spectrum disorder.

    Science.gov (United States)

    Hanlon-Dearman, Ana; Chen, Maida Lynn; Olson, Heather Carmichael

    2018-04-01

    Accumulating evidence has revealed high rates of sleep disruption among children with fetal alcohol spectrum disorder (FASD). Multiple animal and clinical studies have found a clear association between sleep problems and prenatal alcohol exposure, and recent research is beginning to characterize the types and extent of sleep disruption in FASD. Nevertheless, sleep disruption in children with FASD often goes unrecognized or is treated without referring to an evidence base. Children's disrupted sleep interferes with parental sleep and increases caregiver burden, which is of particular importance for families raising children with FASD, a group with very high levels of caregiving stress. The literature supporting an association between sleep problems and deficits in emotional, behavioral, and cognitive function in children is compelling, but needs further investigation in children with FASD. This paper will review the current state of knowledge on sleep in FASD and recommend a rational approach to sleep interventions for affected children and their families.

  7. Automated detection of sleep apnea from electrocardiogram signals using nonlinear parameters

    International Nuclear Information System (INIS)

    Acharya, U Rajendra; Faust, Oliver; Chua, Eric Chern-Pin; Lim, Teik-Cheng; Lim, Liang Feng Benjamin

    2011-01-01

    Sleep apnoea is a very common sleep disorder which can cause symptoms such as daytime sleepiness, irritability and poor concentration. To monitor patients with this sleeping disorder we measured the electrical activity of the heart. The resulting electrocardiography (ECG) signals are both non-stationary and nonlinear. Therefore, we used nonlinear parameters such as approximate entropy, fractal dimension, correlation dimension, largest Lyapunov exponent and Hurst exponent to extract physiological information. This information was used to train an artificial neural network (ANN) classifier to categorize ECG signal segments into one of the following groups: apnoea, hypopnoea and normal breathing. ANN classification tests produced an average classification accuracy of 90%; specificity and sensitivity were 100% and 95%, respectively. We have also proposed unique recurrence plots for the normal, hypopnea and apnea classes. Detecting sleep apnea with this level of accuracy can potentially reduce the need of polysomnography (PSG). This brings advantages to patients, because the proposed system is less cumbersome when compared to PSG

  8. Sleep and metabolic control: waking to a problem?

    Science.gov (United States)

    Trenell, Michael I; Marshall, Nathaniel S; Rogers, Naomi L

    2007-01-01

    1. The aim of the present review is to outline: (i) the association between sleep and metabolism; (ii) how sleep duration influences the development of disease; and (iii) how sex differences, ageing and obesity may potentially influence the relationship between sleep, metabolic control and subsequent disease. 2. Sleep is associated with a number of endocrine changes, including a change in insulin action in healthy young individuals. Sleep duration shows a prospective U-shaped relationship with all-cause mortality, cardiovascular disease and Type 2 diabetes. 3. Chronic sleep restriction is becoming more common. Experimental sleep restriction impedes daytime glucose control and increases appetite. 4. The sex hormones oestrogen and testosterone influence sleep duration and quality and may account for sex differences in the prevalence of sleep-related disorders. 5. Ageing is associated with a decreased sleep duration, decreased muscle mass and impaired insulin action. 6. Obesity impairs insulin action and is associated with the incidence and severity of obstructive sleep apnoea. 7. Sleep plays an integral role in metabolic control. Consequently, insufficient sleep may represent a modifiable risk factor for the development of Type 2 diabetes. The challenge ahead is to identify how sex differences, ageing and obesity could potentially influence the relationship between sleep and metabolism.

  9. Good stress management capability is associated with lower body mass index and restful sleep in the elderly.

    Science.gov (United States)

    Teraoka, Seitaro; Hayashida, Naomi; Shinkawa, Tetsuko; Taira, Yasuyuki; Nagai-Sekitani, Yui; Irie, Sumiko; Kamasaki, Toshihiko; Nakashima-Hashiguchi, Kanami; Yoshida, Koji; Orita, Makiko; Morishita, Michiko; Clancey, Gregory; Takamura, Noboru

    2013-01-01

    Psychosocial stress is generally associated with adverse health behaviors and has been linked to the development of cardiovascular diseases (CVD). Recently, an individual's sense of coherence (SOC), which is a concept that reflects the ability to cope with psychosocial stress, has been recognized as an essential component of long-term health and stress management. The association between SOC and traditional and alternative atherosclerotic markers in a community sample, however, has not been thoroughly investigated. In the present study, we evaluated stress management capability and psychological conditions using the Japanese version of the Sense of Coherence-13 (SOC-13) Scale, supplemented by the General Health Questionnaire-12 (GHQ-12) that screens for minor psychiatric disorders. The study subjects were 511 adults, median age 64 years (range 48-70), who participated in a regular medical screening program in Nagasaki Prefecture, Japan. We then correlated our findings with atherosclerotic risk factors in the same community sample, such as body mass index (BMI) and proper and regular sleeping habits. We found that close association between good stress management capability and lower BMI and/or regular sleeping habits in elderly Japanese. This provides strong evidence that BMI and sleep management are contributory to SOC. If the ability to cope with psychosocial stress is important to the prevention of CVD, then weight control and proper sleep habits must be emphasized from a psychosocial stress-management perspective as well as a physical one.

  10. Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings.

    Science.gov (United States)

    Berkman, Lisa F; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

    2010-07-01

    An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work-family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work-family balance score of manager openness and creativity in dealing with employee work-family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work-family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work-family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work-family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk.

  11. Sleep physiology and sleep disorders in childhood

    Directory of Open Access Journals (Sweden)

    El Shakankiry HM

    2011-09-01

    Full Text Available Hanan M El ShakankiryKing Fahd University Hospital, Al Dammam University, Al Khobar, Kingdom of Saudi ArabiaAbstract: Sleep has long been considered as a passive phenomenon, but it is now clear that it is a period of intense brain activity involving higher cortical functions. Overall, sleep affects every aspect of a child's development, particularly higher cognitive functions. Sleep concerns are ranked as the fifth leading concern of parents. Close to one third of all children suffer from sleep disorders, the prevalence of which is increased in certain pediatric populations, such as children with special needs, children with psychiatric or medical diagnoses and children with autism or pervasive developmental disorders. The paper reviews sleep physiology and the impact, classification, and management of sleep disorders in the pediatric age group.Keywords: sleep physiology, sleep disorders, childhood, epilepsy

  12. Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults.

    Science.gov (United States)

    Chong, Mei Sian; Tan, Keng Teng; Tay, Laura; Wong, Yoke Moi; Ancoli-Israel, Sonia

    2013-01-01

    Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000-3000 lux; 6-10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients. A total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini-Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient's GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed. The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P hours) (P hours) (P bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies.

  13. Management of sleep bruxism in adults: a qualitative systematic literature review.

    Science.gov (United States)

    Manfredini, Daniele; Ahlberg, Jari; Winocur, Ephraim; Lobbezoo, Frank

    2015-11-01

    This paper updates the bruxism management review published by Lobbezoo et al. in 2008 (J Oral Rehabil 2008; 35: 509-23). The review focuses on the most recent literature on management of sleep bruxism (SB) in adults, as diagnosed with polysomnography (PSG) with audio-video (AV) recordings, or with any other approach measuring the sleep-time masticatory muscles' activity, viz., PSG without AV recordings or electromyography (EMG) recorded with portable devices. Fourteen (N = 14) papers were included in the review, of which 12 were randomised controlled trials (RCTs) and 2 were uncontrolled before-after studies. Structured reading of the included articles showed a high variability of topics, designs and findings. On average, the risk of bias for RCTs was low-to-unclear, whilst the before-after studies had several methodological limitations. The studies' results suggest that (i) almost every type of oral appliance (OA) (seven papers) is somehow effective to reduce SB activity, with a potentially higher decrease for devices providing large extent of mandibular advancement; (ii) all tested pharmacological approaches [i.e. botulinum toxin (two papers), clonazepam (one paper) and clonidine (one paper)] may reduce SB with respect to placebo; (iii) the potential benefit of biofeedback (BF) and cognitive-behavioural (CB) approaches to SB management is not fully supported (two papers); and (iv) the only investigation providing an electrical stimulus to the masseter muscle supports its effectiveness to reduce SB. It can be concluded that there is not enough evidence to define a standard of reference approach for SB treatment, except for the use of OA. Future studies on the indications for SB treatment are recommended. © 2015 John Wiley & Sons Ltd.

  14. The Impact of a Cognitive Behavioral Pain Management Program on Sleep in Patients with Chronic Pain: Results of a Pilot Study.

    Science.gov (United States)

    Blake, Catherine; Cunningham, Jennifer; Power, Camillus K; Horan, Sheila; Spencer, Orla; Fullen, Brona M

    2016-02-01

    To determine the impact of a cognitive behavioral pain management program on sleep in patients with chronic pain. Prospective nonrandomized controlled pilot study with evaluations at baseline and 12 weeks. Out-patient multidisciplinary cognitive behavioral pain management program in a university teaching hospital. Patients with chronic pain who fulfilled the criteria for participation in a cognitive behavioral pain management program. Patients assigned to the intervention group (n = 24) completed a 4 week cognitive behavioral pain management program, and were compared with a waiting list control group (n = 22). Assessments for both groups occurred at baseline and two months post cognitive behavioral pain management program. Outcome measures included self-report (Pittsburgh Sleep Quality Index) and objective (actigraphy) sleep measures, pain and quality of life measures. Both groups were comparable at baseline, and all had sleep disturbance. The Pittsburgh Sleep Quality Index correlated with only two of the seven objective sleep measures (fragmentation index r = 0.34, P = 0.02, and sleep efficiency percentage r = -0.31, P = 0.04). There was a large treatment effect for cognitive behavioral pain management program group in mean number of wake bouts (d = 0.76), where a significant group*time interaction was also found (P = 0.016), showing that the CBT-PMP group improved significantly more than controls in this sleep variable. Patients attending a cognitive behavioral pain management program have high prevalence of sleep disturbance, and actigraphy technology was well tolerated by the patients. Preliminary analysis of the impact of a cognitive behavioral pain management program on sleep is promising, and warrants further investigation.

  15. Effects of body mass index on sleep patterns during pregnancy.

    LENUS (Irish Health Repository)

    Kennelly, M M

    2011-01-01

    The purpose of this study was to profile sleep patterns during pregnancy according to body mass index (BMI) and to correlate labour outcomes with both BMI and hours sleep. Data were collected from 200 postpartum women detailing sleep characteristics before and during pregnancy. A validated sleep questionnaire was employed, which comprised of questions about sleep apnoea, snoring, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication and daytime dysfunction. Descriptive analyses were used. With advancing gestation, the mean (SD) number of hours sleep per night declined: pre-pregnancy 8.1 (SD 1.4); 1st trimester 8.3 (SD 1.8); 2nd trimester 7.7 (SD 1.7) and 3rd trimester 6.7 (SD 2.2). In the 18.5-24.9 BMI group, there was a marked difference in hours sleep per night from pre-pregnancy to 1st (8.6 h, p = 0.007), 2nd (7.9 h, p = 0.023) and 3rd (6.4 h, p = 0.000) trimesters in primiparous women. In the 25-29.9 BMI group, there was a difference from pre-pregnancy to 3rd trimester (p = 0.000). These changes were not reflected in a clinically significant difference in birth weight or mode of delivery.

  16. Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults

    Directory of Open Access Journals (Sweden)

    Chong MS

    2013-05-01

    Full Text Available Mei Sian Chong,1 Keng Teng Tan,2 Laura Tay,1 Yoke Moi Wong,1 Sonia Ancoli-Israel3,41Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; 2Department of Pharmacy, Tan Tock Seng Hospital, Singapore; 3Departments of Psychiatry and Medicine, University of California, San Diego, CA, USA; 4VA Center of Excellence for Stress and Mental Health (CESAMH, San Diego, CA, USAObjective: Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU, was established. Evening bright light therapy (2000–3000 lux; 6–10 pm daily was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients.Method: A total of 228 patients (mean age = 84.2 years were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS, cognitive status (Chinese Mini–Mental State Examination, functional status (modified Barthel Index [MBI], and chemical restraint use during the initial and predischarge phase of the patient’s GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB were computed.Results: The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05. Significant improvements were noted on the DRS sleep–wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours (P < 0.05 and length of first SB (6.0 compared with 5.3 hours (P < 0.05 improved, with decreased mean number of SBs and awakenings. The

  17. Sleep disruption in hematopoietic cell transplantation recipients: prevalence, severity, and clinical management.

    Science.gov (United States)

    Jim, Heather S L; Evans, Bryan; Jeong, Jiyeon M; Gonzalez, Brian D; Johnston, Laura; Nelson, Ashley M; Kesler, Shelli; Phillips, Kristin M; Barata, Anna; Pidala, Joseph; Palesh, Oxana

    2014-10-01

    Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of recipients experiencing sleep disruption pre-transplant, with up to 82% of patients experiencing moderate to severe sleep disruption during hospitalization for transplant and up to 43% after transplant. These rates of sleep disruption are substantially higher than what we see in the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption and disorders (ie, insomnia, obstructive sleep apnea, restless legs syndrome) as a clinical problem in HCT in order to facilitate patient education, intervention, and research. We identified 35 observational studies published in the past decade that examined sleep disruption or disorders in HCT. Most studies utilized a single item measure of sleep, had small sample size, and included heterogeneous samples of patients. Six studies of the effects of psychosocial and exercise interventions on sleep in HCT have reported no significant improvements. These results highlight the need for rigorous observational and interventional studies of sleep disruption and disorders in HCT recipients.. Copyright © 2014 American Society for Blood and Marrow Transplantation. All rights reserved.

  18. Nocturnal motor activity in fibromyalgia patients with poor sleep quality.

    Science.gov (United States)

    Hyyppä, M T; Kronholm, E

    1995-01-01

    Nocturnal motor activity was examined in long-term rehabilitation patients complaining of poor sleep and having fibromyalgia syndrome (N = 24) or other musculoskeletal disorders (N = 60) and compared with that in 91 healthy controls drawn from a random community sample. Self-reports on sleep complaints and habits were collected. The frequency of nocturnal body movements, the "apnoea" index and ratio of "quiet sleep" to total time in bed were measured using the Static Charge Sensitive Bed (SCSB) (BioMatt). As a group, patients with fibromyalgia syndrome did not differ from patients with other musculoskeletal disorders or from healthy controls in their nocturnal motor activity. The "apnoea" index was a little higher in the fibromyalgia group than in the healthy control group but did not differ from that of the group of other musculoskeletal patients. Further multivariate analyses adjusted for age, BMI, medication and "apnoea" index did not support the assumption that an increased nocturnal motor activity characterizes patients with fibromyalgia syndrome.

  19. [Postoperative management of patients with BMI > 40 kg / m2].

    Science.gov (United States)

    Kaffarnik, M; Utzolino, S

    2009-02-01

    Bariatric surgery, especially in the morbidly obese, can be associated with serious postoperative problems. Apart from surgical complications requiring reoperation, pre-existing disease can worsen during the postoperative period. Bariatric patients require particular therapeutic approaches such as adapted fluid and pain management, management of obstructive sleep apnoea-hypopnea, early ambulation and measures for preventing pressure ulcers. Another challenging issue is the early identification and management of postoperative intraabdominal sepsis (IAS) before the onset of organ dysfunction. Early and frequent ambulation is thought to reduce risk of pressure ulcers, deep vein thrombosis, resedation, pain, pneumonia and atelectasis. To prevent spine injury of health care workers it is necessary to provide appropriate support with special beds, lifting and transfer devices.

  20. The Impact of Le Fort I Advancement and Bilateral Sagittal Split Osteotomy Setback on Ventilation during Sleep

    Czech Academy of Sciences Publication Activity Database

    Foltán, R.; Hoffmannová, J.; Doněv, F.; Vlk, M.; Šedý, Jiří; Kufa, R.; Bulík, O.

    2009-01-01

    Roč. 38, č. 10 (2009), s. 1036-1040 ISSN 0901-5027 Grant - others:GA MZd(CZ) NR8038 Institutional research plan: CEZ:AV0Z50390512 Keywords : orthognathic surgery * sleep apnoea * ventilation Subject RIV: FH - Neurology Impact factor: 1.444, year: 2009

  1. [The NHG guideline 'Sleep problems and sleeping pills'

    NARCIS (Netherlands)

    Damen-van Beek, Z.; Lucassen, P.L.; Gorgels, W.J.M.J.; Smelt, A.F.; Knuistingh Neven, A.; Bouma, M.

    2015-01-01

    - The Dutch College of General Practitioners' (NHG) guideline 'Sleep problems and sleeping pills' provides recommendations for the diagnosis and treatment of the most prevalent sleep problems and for the management of chronic users of sleeping pills.- The preferred approach for sleeplessness is not

  2. REM sleep respiratory behaviours mental content in narcoleptic lucid dreamers.

    Science.gov (United States)

    Oudiette, Delphine; Dodet, Pauline; Ledard, Nahema; Artru, Emilie; Rachidi, Inès; Similowski, Thomas; Arnulf, Isabelle

    2018-02-08

    Breathing is irregular during rapid eye-movement (REM) sleep, whereas it is stable during non-REM sleep. Why this is so remains a mystery. We propose that irregular breathing has a cortical origin and reflects the mental content of dreams, which often accompany REM sleep. We tested 21 patients with narcolepsy who had the exceptional ability to lucid dream in REM sleep, a condition in which one is conscious of dreaming during the dream and can signal lucidity with an ocular code. Sleep and respiration were monitored during multiple naps. Participants were instructed to modify their dream scenario so that it involved vocalizations or an apnoea, -two behaviours that require a cortical control of ventilation when executed during wakefulness. Most participants (86%) were able to signal lucidity in at least one nap. In 50% of the lucid naps, we found a clear congruence between the dream report (e.g., diving under water) and the observed respiratory behaviour (e.g., central apnoea) and, in several cases, a preparatory breath before the respiratory behaviour. This suggests that the cortico-subcortical networks involved in voluntary respiratory movements are preserved during REM sleep and that breathing irregularities during this stage have a cortical/subcortical origin that reflects dream content.

  3. National patterns of physician management of sleep apnea and treatment among patients with hypertension.

    Directory of Open Access Journals (Sweden)

    Rebecca Robbins

    Full Text Available Sleep apnea is associated with hypertension, and treatment may improve outcomes. We examine national burden of sleep apnea, rates of sleep apnea treatment, and whether racial/ethnic disparities exist among patients with hypertension.Data from the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS, 2005-2012, were analyzed (N = 417,950. We identified hypertension patient visits where sleep apnea diagnosis or complaint was recorded. Primary outcome measures were sleep study, medication, or behavioral therapy (diet, weight loss, or exercise counseling. We used multivariate logistic regression to examine treatment by demographic/clinical factors.Among patients with hypertension, sleep apnea was identified in 11.2-per-1,000 visits. Overall, patients with hypertension and a sleep disorder were referred for sleep study in 14.4% of visits, prescribed sleep medication in 11.2% of visits, and offered behavioral therapy in 34.8% of visits. Adjusted analyses show behavioral therapy more likely to be provided to obese patients than normal/overweight (OR = 4.96, 95%CI[2.93-8.38], but less likely to be provided to smokers than nonsmokers (OR = 0.54, 95%CI[0.32-0.93]. Non-Hispanic blacks were less likely to receive medications than non-Hispanic whites (OR = 0.19, 95% CI[0.06-0.65].In the U.S., sleep apnea were observed in a small proportion of hypertension visits, a population at high-risk for the disorder. One explanation for the low prevalence of sleep apnea observed in this patient population at high risk for the disorder is under-diagnosis of sleep related breathing disorders. Behavioral therapy was underutilized, and non-Hispanic Blacks were less likely to receive medications than non-Hispanic Whites.

  4. Social consequences of sleep disordered breathing on patients and their partners

    DEFF Research Database (Denmark)

    Jennum, Poul; Ibsen, Rikke Falkner; Kjellberg, Jakob

    2014-01-01

    We aimed to evaluate the total costs to patients and their partners of sleep apnoea and obesity hypoventilation syndrome (OHS) and their treatment, as this is poorly described in families. Using data from the Danish National Patient Registry and other public databases, all patients and their part......, and increased as the disease advanced. Sleep-disordered breathing has major socioeconomic consequences for patients and their spouses years before and after diagnosis.......We aimed to evaluate the total costs to patients and their partners of sleep apnoea and obesity hypoventilation syndrome (OHS) and their treatment, as this is poorly described in families. Using data from the Danish National Patient Registry and other public databases, all patients...... and their partners with a diagnosis of sleep apnoea (n=30,278) or OHS (n=1562) were included. They were compared with age-, sex- and community location-matched citizens at a ratio 1:4 (120,506 and 6241 control subjects, respectively). Direct and indirect costs were evaluated for patients and their partners. Sleep...

  5. Sentra PM (a Medical Food and Trazodone in the Management of Sleep Disorders

    Directory of Open Access Journals (Sweden)

    William E. Shell Md

    2012-04-01

    Full Text Available Sleep disorders are a common and poorly treated disease state. This double blind, four arm placebo-controlled, randomized trial compared (1 low dose trazodone, (2 Sentra PM, a neurotransmitter based medical food, (3 the joint administration of trazodone and the medical food Sentra PM and (4 placebo. There were 111 subjects studied in 12 independent sites. Subjects underwent baseline screening, informed consent and an initial sleep questionnaire. After 14 days subjects underwent a second evaluation by questionnaire. At baseline and Day 14 the subjects underwent 24 hour ECG recordings that were analyzed in the frequency domain of heart rate variability. The specific high frequency parasympathetic autonomic nervous system activity was analyzed. The primary endpoints were sleep latency and parasympathetic autonomic nervous system improvement in sleeping hours. The results showed improvement in sleep latency for the Sentra PM and combination of Sentra PM and trazodone (−41 and −56 minutes P < 0.001. There was an improvement in quality of sleep for the amino acid formulation Sentra PM and the combination (3.86 and 6.48 Likert units on a 10 point scale P < 0.001. There was an activation of circadian activity percent at night in the medical food and combination groups while there was no change in parasympathetic activity in either the placebo or trazodone group. These data indicate that Sentra PM can improve the quality of sleep, the response to trazodone as a sleep medication and parasympathetic autonomic nervous system activity.

  6. Management of sleep-time masticatory muscle activity using stabilisation splints affects psychological stress.

    Science.gov (United States)

    Takahashi, H; Masaki, C; Makino, M; Yoshida, M; Mukaibo, T; Kondo, Y; Nakamoto, T; Hosokawa, R

    2013-12-01

    To treat sleep bruxism (SB), symptomatic therapy using stabilisation splints (SS) is frequently used. However, their effects on psychological stress and sleep quality have not yet been examined fully. The objective of this study was to clarify the effects of SS use on psychological stress and sleep quality. The subjects (11 men, 12 women) were healthy volunteers. A crossover design was used. Sleep measurements were performed for three consecutive days or longer without (baseline) or with an SS or palatal splint (PS), and data for the final day were evaluated. We measured masseter muscle activity during sleep using portable electromyography to evaluate SB. Furthermore, to compare psychological stress before and after sleep, assessments were made based on STAI-JYZ and the measurement of salivary chromogranin A. To compare each parameter among the three groups (baseline, SS and PS), Friedman's and Dunn's tests were used. From the results of the baseline measurements, eight subjects were identified as high group and 15 as low group. Among the high group, a marked decrease in the number of bruxism events per hour and an increase in the difference in the total STAI Y-1 scores were observed in the SS group compared with those at baseline (P sleep stages. SS use may be effective in reducing the number of SB events, while it may increase psychological stress levels, and SS use did not apparently influence sleep stages. © 2013 John Wiley & Sons Ltd.

  7. Sleep fragmentation: comparison of two definitions of short arousals during sleep in OSAS patients.

    Science.gov (United States)

    Smurra, M V; Dury, M; Aubert, G; Rodenstein, D O; Liistro, G

    2001-04-01

    The measurement of arousals during sleep is useful to quantify sleep fragmentation. The criteria for electroencephalography (EEG) arousals defined by the American Sleep Disorders Association (ASDA) have recently been criticized because of lack of interobserver agreement. The authors have adopted a scoring method that associates the increase in chin electromyography (EMG) with the occurrence of an alpha-rhythm in all sleep stages (Université Catholique de Louvain (UCL) definition of arousals). The aim of the present study was to compare the two scoring definitions in terms of agreement and repeatability and the time taken for scoring in patients with obstructive sleep apnoea syndrome (OSAS) of varying severity. Two readers using both ASDA and UCL definitions scored twenty polysomnographies (PSGs) each on two occasions. The PSGs were chosen retrospectively to represent a wide range of arousal index (from 6-82) in OSAS patients. There was no difference in the arousal indices between readers and between scoring methods. The mean+/-SD difference between the two definitions (the bias) was 1.1+/-3.76 (95% confidence interval: -0.66-2.86). There was a strong linear relationship between the arousal index scored with the two definitions (r=0.981, pASDA definitions (18.5+/-5.4 versus 25.3+/-6.6 min, p<0.001). In conclusion, it has been found that in obstructive sleep apnoea syndrome patients, the American Sleep Disorders Association and Université Catholique de Louvain definitions were comparable in terms of agreement and repeatability.

  8. Management of Obstructive Sleep Apnea and Comorbid Insomnia: A Mixed-Methods Evaluation.

    Science.gov (United States)

    Ong, Jason C; Crawford, Megan R; Kong, Allison; Park, Margaret; Cvengros, Jamie A; Crisostomo, M Isabel; Alexander, Ewa I; Wyatt, James K

    2017-01-01

    The purpose of this study was to examine the process of care in an interdisciplinary sleep clinic for patients with obstructive sleep apnea (OSA) and comorbid insomnia. A mixed-methods approach was used to examine clinical and patient-centered measures for 34 patients who received positive-airway pressure for OSA or cognitive-behavior therapy for insomnia. The results revealed baseline-to-follow-up improvements on several self-reported sleep parameters and measures of daytime functioning. Qualitative analyses from patient interviews revealed three themes: conceptual distinctions about each sleep disorder, importance of treating both sleep disorders, and preferences with regard to the sequence of treatment. These findings indicate that patients with OSA and comorbid insomnia encounter unique challenges. A dimensional approach to assessment and treatment is proposed for future research.

  9. Sleep quality, sleep duration and physical activity in obese adolescents: effects of exercise training.

    Science.gov (United States)

    Mendelson, M; Borowik, A; Michallet, A-S; Perrin, C; Monneret, D; Faure, P; Levy, P; Pépin, J-L; Wuyam, B; Flore, P

    2016-02-01

    Decreased sleep duration and altered sleep quality are risk factors for obesity in youth. Structured exercise training has been shown to increase sleep duration and improve sleep quality. This study aimed at evaluating the impact of exercise training for improving sleep duration, sleep quality and physical activity in obese adolescents (OB). Twenty OB (age: 14.5 ± 1.5 years; body mass index: 34.0 ± 4.7 kg m(-2) ) and 20 healthy-weight adolescents (HW) completed an overnight polysomnography and wore an accelerometer (SenseWear Bodymedia) for 7 days. OB participated in a 12-week supervised exercise-training programme consisting of 180 min of exercise weekly. Exercise training was a combination of aerobic exercise and resistance training. Sleep duration was greater in HW compared with OB (P < 0.05). OB presented higher apnoea-hypopnoea index than HW (P < 0.05). Physical activity (average daily metabolic equivalent of tasks [METs]) by accelerometer was lower in OB (P < 0.05). After exercise training, obese adolescents increased their sleep duration (+64.4 min; effect size: 0.88; P = 0.025) and sleep efficiency (+7.6%; effect size: 0.76; P = 0.028). Physical activity levels were increased in OB as evidenced by increased steps per day and average daily METs (P < 0.05). Improved sleep duration was associated with improved average daily METs (r = 0.48, P = 0.04). The present study confirms altered sleep duration and quality in OB. Exercise training improves sleep duration, sleep quality and physical activity. © 2015 World Obesity.

  10. Interactions between sleep disorders and oral diseases.

    Science.gov (United States)

    Huynh, N T; Emami, E; Helman, J I; Chervin, R D

    2014-04-01

    Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Perioperative management of obstructive sleep apnea: a survey of Veterans Affairs health care providers.

    Science.gov (United States)

    Dhanda Patil, Reena; Patil, Yash J

    2012-01-01

    (1) To determine the presence of Veterans Affairs (VA) institutional guidelines for the perioperative management of obstructive sleep apnea (OSA); (2) to examine current use of preoperative screening tools for OSA in the VA; and (3) to understand current VA practice patterns regarding postoperative disposition of patients with OSA. Survey study. Veterans Affairs hospitals with surgical services; sample size 102 facilities. Veterans Affairs health care providers. The authors surveyed health care providers at VA hospitals using a survey tool developed by the authors. The response rate was 80%. A variety of preoperative screening tools for OSA were used by respondents, most commonly American Society of Anesthesiologists guidelines (53%). A policy for postoperative disposition of known and presumed OSA was present in 26% and 19% of responses, respectively. Of those respondents reporting a formal postoperative care policy, 48% and 30% admitted patients to a monitored ward bed and surgical intensive care unit, respectively. Of the 74% of respondents unaware of an institutional policy, Anesthesia and Surgery worked together to dictate postoperative disposition of patients with known OSA 73% of the time. The degree of OSA was ranked as the most important factor (58%) influencing postoperative disposition. Ten percent of respondents reported a major perioperative complication attributable to OSA in the past year. This survey study elucidates the heterogeneity of preoperative screening for and postoperative care of veterans with OSA. Future investigators may use these data to formalize institutional policies with regard to patients with OSA, with potentially significant impacts on patient care and usage of financial resources.

  12. Sleep Disorders

    Science.gov (United States)

    ... the day, even if you have had enough sleep? You might have a sleep disorder. The most common kinds are Insomnia - a hard time falling or staying asleep Sleep apnea - breathing interruptions during sleep Restless legs syndrome - ...

  13. Sleep Problems

    Science.gov (United States)

    ... For Consumers Consumer Information by Audience For Women Sleep Problems Share Tweet Linkedin Pin it More sharing ... 101 KB) En Español Medicines to Help You Sleep Tips for Better Sleep Basic Facts about Sleep ...

  14. Creating technological boundaries to protect bedtime: examining work-home boundary management, psychological detachment and sleep.

    Science.gov (United States)

    Barber, Larissa K; Jenkins, Jade S

    2014-08-01

    This study examined the mechanism by which information and communication technology (ICT) use at home for work purposes may affect sleep. In this investigation, data from 315 employees were used to examine the indirect effect of ICT use at home on sleep outcomes through psychological detachment, and how boundary creation may moderate this effect. Results revealed the indirect effect of increased work-home boundary crossing on sleep (quantity, quality and consistency) through psychological detachment occurred only among individuals with low boundaries around ICT use and not among those with high boundaries. These results suggest that creating boundaries around work-relevant ICT use while at home is beneficial to sleep as a recovery process through being able to psychologically disengage from work. Copyright © 2013 John Wiley & Sons, Ltd.

  15. Association between sleep stages and hunger scores in 36 children.

    Science.gov (United States)

    Arun, R; Pina, P; Rubin, D; Erichsen, D

    2016-10-01

    Childhood obesity is a growing health challenge. Recent studies show that children with late bedtime and late awakening are more obese independent of total sleep time. In adolescents and adults, a delayed sleep phase has been associated with higher caloric intake. Furthermore, an adult study showed a positive correlation between REM sleep and energy balance. This relationship has not been demonstrated in children. However, it may be important as a delayed sleep phase would increase the proportion of REM sleep. This study investigated the relationship between hunger score and sleep physiology in a paediatric population. Thirty-six patients referred for a polysomnogram for suspected obstructive sleep apnoea were enrolled in the study. Sleep stages were recorded as part of the polysomnogram. Hunger scores were obtained using a visual analogue scale. Mean age was 9.6 ± 3.5 years. Mean hunger scores were 2.07 ± 2.78. Hunger scores were positively correlated with percentage of total rapid eye movement (REM) sleep (r = 0.438, P hunger score (r = -0.360, P hunger scores. These findings suggest that delayed bedtime, which increases the proportion of REM sleep and decreases the proportion of SWS, results in higher hunger levels in children. © 2015 World Obesity.

  16. Sleep and circadian rhythm disturbance in bipolar disorder.

    Science.gov (United States)

    Bradley, A J; Webb-Mitchell, R; Hazu, A; Slater, N; Middleton, B; Gallagher, P; McAllister-Williams, H; Anderson, K N

    2017-07-01

    Subjective reports of insomnia and hypersomnia are common in bipolar disorder (BD). It is unclear to what extent these relate to underlying circadian rhythm disturbance (CRD). In this study we aimed to objectively assess sleep and circadian rhythm in a cohort of patients with BD compared to matched controls. Forty-six patients with BD and 42 controls had comprehensive sleep/circadian rhythm assessment with respiratory sleep studies, prolonged accelerometry over 3 weeks, sleep questionnaires and diaries, melatonin levels, alongside mood, psychosocial functioning and quality of life (QoL) questionnaires. Twenty-three (50%) patients with BD had abnormal sleep, of whom 12 (52%) had CRD and 29% had obstructive sleep apnoea. Patients with abnormal sleep had lower 24-h melatonin secretion compared to controls and patients with normal sleep. Abnormal sleep/CRD in BD was associated with impaired functioning and worse QoL. BD is associated with high rates of abnormal sleep and CRD. The association between these disorders, mood and functioning, and the direction of causality, warrants further investigation.

  17. Use of an evidence-based protocol to screen for sleep-disordered breathing in a heart failure disease management clinic.

    Science.gov (United States)

    Garner, Shelby L; Traverse, Ramona D

    2014-01-01

    Undiagnosed and untreated sleep-disordered breathing can lead to negative health outcomes and increased utilization of health resources among patients with heart failure. The purpose of this evidence-based practice project was to implement and evaluate a new multifaceted sleep-disordered breathing screening protocol in a heart failure disease management clinic. The combined use of a symptoms questionnaire, the Epworth sleepiness scale, and overnight pulse oximetry was significantly more effective in identifying patients with a positive diagnosis of sleep-disordered breathing than using the Epworth sleepiness scale alone (P < .05).

  18. Primary sleep disorders can cause long-term sleep disturbance in patients with autoimmune mediated limbic encephalitis.

    Science.gov (United States)

    Anderson, Kirstie N; Kelly, Thomas P; Griffiths, Timothy D

    2013-07-01

    Antibody mediated limbic encephalitis causes a sub acute encephalopathy with an amnestic syndrome, seizures and often an affective prodrome. Sleep disturbance including abnormal dream sleep and insomnia are described in a percentage of long-term survivors but there are very few detailed assessments of sleep disturbance in patients beyond the acute phase of illness. The objectives of this study were to understand the causes of sleep disturbance in the long-term survivors of antibody mediated limbic encephalitis. We screened twelve patients under long-term follow up with sleep questionnaires and went on to perform detailed sleep studies (polysomnography) in those who reported sleep disturbance. Two were found to have persistent, severe central and obstructive sleep apnoea and two others to have restless legs and periodic limb movements of sleep. This highlights the need to investigate sleep disturbance in this group of patients. Effective treatments may be available to improve quality of life and daytime function. Copyright © 2012 Elsevier B.V. All rights reserved.

  19. Sleep disorders in psychiatry.

    Science.gov (United States)

    Costa e Silva, Jorge Alberto

    2006-10-01

    Sleep is an active state that is critical for our physical, mental, and emotional well-being. Sleep is also important for optimal cognitive functioning, and sleep disruption results in functional impairment. Insomnia is the most common sleep disorder in psychiatry. At any given time, 50% of adults are affected with 1 or more sleep problems such as difficulty in falling or staying asleep, in staying awake, or in adhering to a consistent sleep/wake schedule. Narcolepsy affects as many individuals as does multiple sclerosis or Parkinson disease. Sleep problems are especially prevalent in schizophrenia, depression, and other mental illnesses, and every year, sleep disorders, sleep deprivation, and sleepiness add billions to the national health care bill in industrialized countries. Although psychiatrists often treat patients with insomnia secondary to depression, most patients discuss their insomnia with general care physicians, making it important to provide this group with clear guidelines for the diagnosis and management of insomnia. Once the specific medical, behavioral, or psychiatric causes of the sleep problem have been identified, appropriate treatment can be undertaken. Chronic insomnia has multiple causes arising from medical disorders, psychiatric disorders, primary sleep disorders, circadian rhythm disorders, social or therapeutic use of drugs, or maladaptive behaviors. The emerging concepts of sleep neurophysiology are consistent with the cholinergic-aminergic imbalance hypothesis of mood disorders, which proposes that depression is associated with an increased ratio of central cholinergic to aminergic neurotransmission. The characteristic sleep abnormalities of depression may reflect a relative predominance of cholinergic activity. Antidepressant medications presumably reduce rapid eye movement (REM) sleep either by their anticholinergic properties or by enhancing aminergic neurotransmission. Intense and prolonged dreams often accompany abrupt withdrawal

  20. The More the Merrier? Working Towards Multidisciplinary Management of Obstructive Sleep Apnea and Comorbid Insomnia

    Science.gov (United States)

    Ong, Jason C.; Crisostomo, M. Isabel

    2013-01-01

    Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is associated with negative cardiovascular consequences and adverse events from excessive daytime sleepiness. Insomnia is the inability to initiate or maintain sleep accompanied by daytime dysfunction. OSA and insomnia co-occur at a high rate, and such patients appear to have distinct clinical features of both disorders. Although empirically supported treatments are now available for OSA and insomnia independently, there are currently no standards or guidelines for how to combine or initiate these treatments for patients who suffer from both sleep disorders. Our goal was to review the literature on current diagnostic considerations, clinical features, pathophysiology, and treatment approaches for patients with OSA and comorbid insomnia. In particular, the potential benefits and challenges of using a multidisciplinary treatment model are discussed, including a research strategy that could inform implementation of pulmonary and behavioral sleep medicine treatments. The research, clinical, and policy implications of treating both OSA and insomnia are discussed with the hope that further activity will establish standards or guidelines for patients with OSA and insomnia. PMID:23382086

  1. Depression and obstructive sleep apnea.

    Science.gov (United States)

    Hobzova, Milada; Prasko, Jan; Vanek, Jakub; Ociskova, Marie; Genzor, Samuel; Holubova, Michaela; Grambal, Ales; Latalova, Klara

    2017-10-01

    Obstructive sleep apnea (OSA), is described as intermittent interruptions or reductions in airflow which are initiated by an incomplete or complete collapse of the upper airways despite respiratory effort. When left untreated, OSA is connected with comorbid conditions, such as cardiovascular and metabolic illnesses. The PubMed database was used to examine papers published until April 2017 using the subsequent terms: "obstructive sleep apnea" or "obstructive sleep apnoea" and "depression" in successive combination with "CPAP (continuous positive airway pressure)", "therapy", "pharmacotherapy", "psychotherapy", "cognitive behavioral therapy" or "quality of life". After assessment for the suitability, 126 articles were chosen. The numerous evidence of a connection between OSA and depressive symptoms, as well as depressive disorder, were found. This connection may be directly or indirectly linked due to the participation of some OSA mediators consequences such as obesity, hypertension, and the decreased quality of life. Patients with the comorbid major depression and OSA reported more severe and longer episodes of depression. Nevertheless, the information on the effect of the treatment of OSA using CPAP on the depressive symptoms was limited. Still, the current state of the art suggests that this treatment decreases the severity of the comorbid depressive symptoms. It is important to evaluate the symptoms of depression in the patients with OSA. On the other side, a psychiatrist should not just treat the depression, as it is also important to screen individuals at high risk of OSA when assessing patients for depressive disorder, especially those with depression resistant to treatment.

  2. [How to characterize and treat sleep complaints in bipolar disorders?

    Science.gov (United States)

    Geoffroy, P A; Micoulaud Franchi, J-A; Lopez, R; Poirot, I; Brion, A; Royant-Parola, S; Etain, B

    2017-08-01

    Sleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD. We examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: "bipolar disorder" and ("sleep" or "insomnia" or "hypersomnia" or "circadian" or "apnoea" or "apnea" or "restless legs"). Patients with BD suffer from sleep and circadian rhythm abnormalities during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal and/or early awakenings, non-restorative sleep) and manic episodes (insomnia, decreased need for sleep without fatigue), but also some of these abnormalities may persist during remission. These remission phases are characterized by a reduced quality and quantity of sleep, with a longer sleep duration, increased sleep latency, a lengthening of the wake time after sleep onset (WASO), a decrease of sleep efficiency, and greater variability in sleep/wake rhythms. Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness, sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS), and restless legs syndrome (RLS). These disorders are insufficiently diagnosed and treated whereas they are associated with mood relapses, treatment resistance, affect cognitive global functioning, reduce the quality of life, and contribute to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities have been also associated with suicidal behaviors. Therefore, a clinical exploration with characterization of these abnormalities and disorders is essential. This exploration should be

  3. Effects of sleep management with self-help treatment for the Japanese elderly with chronic insomnia: a quasi-experimental study.

    Science.gov (United States)

    Tamura, Norihisa; Tanaka, Hideki

    2017-08-01

    This study aimed to determine whether sleep management with self-help treatment is more effective in improving insomnia, compared to a waiting-list control. A total of 51 participants with insomnia, aged ≥60 years, were assigned to two groups: the treatment group or waiting-list control group. Intervention included sleep education, group work, moderately intense exercise, and self-help treatment using a sleep diary for 2 weeks. Participants completed the Insomnia Severity Index (ISI-J) and sleep diaries wearing an activity recorder pre- and post-treatment. The treatment group showed a significant improvement in the ISI-J with a fairly large effect size (Cohen's d: within = 0.78, between = 0.70), whereas the waiting-list control group did not. Sleep diary and activity recorder data showed small to moderate effect sizes in the treatment group. Thus, sleep management with self-help treatment was superior to a waiting-list control for insomnia severity in the targeted elderly population.

  4. Sleep Disorders

    DEFF Research Database (Denmark)

    Rahbek Kornum, Birgitte; Mignot, Emmanuel

    2014-01-01

    mediates circadian regulation of sleep. Misalignment with the rhythm of the sun results in circadian disorders and jet lag. The molecular basis of homeostatic sleep regulation is mostly unknown. A network of mutually inhibitory brain nuclei regulates sleep states and sleep-wake transitions. Abnormalities...... in these networks create sleep disorders, including rapid eye movement sleep behavior disorder, sleep walking, and narcolepsy. Physiological changes associated with sleep can be imbalanced, resulting in excess movements such as periodic leg movements during sleep or abnormal breathing in obstructive sleep apneas....... As every organ in the body is affected by sleep directly or indirectly, sleep and sleep-associated disorders are frequent and only now starting to be understood....

  5. Effect of sleep deprivation after a night shift duty on simulated crisis management by residents in anaesthesia. A randomised crossover study.

    Science.gov (United States)

    Arzalier-Daret, Ségolène; Buléon, Clément; Bocca, Marie-Laure; Denise, Pierre; Gérard, Jean-Louis; Hanouz, Jean-Luc

    2018-04-01

    Sleep deprivation has been associated with an increased incidence of medical errors and can jeopardise patients' safety during medical crisis management. The aim of the study was to assess the effect of sleep deprivation on the management of simulated anaesthesia crisis by residents in anaesthesiology. A randomised, comparative, monocentric crossover study involving 48 residents in anaesthesia was performed on a high fidelity patient simulator. Each resident was evaluated in a sleep-deprived state (deprived group, after a night shift duty) and control state (control group, after a night of sleep). Performance was assessed through points obtained during crisis scenario 1 (oesophageal intubation followed by anaphylactic shock) and scenario 2 (anaesthesia-related bronchospasm followed by ventricular tachycardia). Sleep periods were recorded by actigraphy. Two independent observers assessed the performances. The primary endpoint of the study was the score obtained for each scenario. Resident's crisis management performance is associated with sleep deprivation (scenario 1: control=39 [33-42] points vs. deprived=26 [19-40] points, P=0.02; scenario 2: control=21 [17-24] vs. deprived=14 [12-19], P=0.01). The main errors observed were: error in drug administration and dose, delay in identification of hypotension, and missing communication with the surgical team about situation. The present study showed that sleep deprivation is associated with impairment of performance to manage crisis situations by residents in anaesthesia. Copyright © 2017 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  6. Type 1 Diabetes and Sleep

    OpenAIRE

    Farabi, Sarah S.

    2016-01-01

    IN BRIEF In people with type 1 diabetes, sleep may be disrupted as a result of both behavioral and physiological aspects of diabetes and its management. This sleep disruption may negatively affect disease progression and development of complications. This review highlights key research findings regarding sleep in people with type 1 diabetes.

  7. ENN-ICS - quality assurance and online evaluation of a multilingual learning management system for sleep medicine

    Directory of Open Access Journals (Sweden)

    Knobl, Brigitte

    2006-11-01

    Full Text Available With the development and implementation of a multilingual interactive communication system the e-health project ENN-ICS, funded by the European Union, aims at the improvement of health care in Europe. The field of application is sleep physiology and sleep medicine. ENN-ICS Centre offers direct access to medical information for multiple users, i.e. health authorities, health care professionals, patients and citizen. Using XML technologies the new web based network integrates advanced e-learning and e-publishing methods for the training of healthcare professionals. Editorial and distributive processes are supported by customized central editorial, content management and learning management systems (CMS, LMS. ENN-ICS e-health services are evaluated by selected user groups in North, Middle and Southern Europe using reliable and scientifically accepted validation instruments. The compliance with essential quality requirements and criteria is tested and verified by using adapted online questionnaires based on the DISCERN questionnaire for evaluating patient information, on the HON principles for evaluating health-related websites and on the GMDS catalogue of quality criteria for electronic publications in medicine. The system architecture and its exemplary applications can be used as a model for future e-health services dealing with neurological and other medical topics.

  8. Robust classification of neonatal apnoea-related desaturations

    International Nuclear Information System (INIS)

    Monasterio, Violeta; Burgess, Fred; Clifford, Gari D

    2012-01-01

    Respiratory signals monitored in the neonatal intensive care units are usually ignored due to the high prevalence of noise and false alarms (FA). Apneic events are generally therefore indicated by a pulse oximeter alarm reacting to the subsequent desaturation. However, the high FA rate in the photoplethysmogram may desensitize staff, reducing the reaction speed. The main reason for the high FA rates of critical care monitors is the unimodal analysis behaviour. In this work, we propose a multimodal analysis framework to reduce the FA rate in neonatal apnoea monitoring. Information about oxygen saturation, heart rate, respiratory rate and signal quality was extracted from electrocardiogram, impedance pneumogram and photoplethysmographic signals for a total of 20 features in the 5 min interval before a desaturation event. 1616 desaturation events from 27 neonatal admissions were annotated by two independent reviewers as true (physiologically relevant) or false (noise-related). Patients were divided into two independent groups for training and validation, and a support vector machine was trained to classify the events as true or false. The best classification performance was achieved on a combination of 13 features with sensitivity, specificity and accuracy of 100% in the training set, and a sensitivity of 86%, a specificity of 91% and an accuracy of 90% in the validation set. (paper)

  9. Sleep Quiz

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Sleep Quiz Past Issues / Summer 2007 Table of Contents ... on. Photo: iStock Take the National Center on Sleep Disorders Research Sleep Quiz TRUE OR FALSE ? _____1. ...

  10. Sleep quality in children: questionnaires available in Brazil

    Directory of Open Access Journals (Sweden)

    Maria Gabriela Cavalheiro

    Full Text Available Introduction: The purpose of this paper was to evaluate and compare the questionnaires regarding sleep quality among children aged up to 12 years old, used in the Portuguese language in Brazil. Material and methods: A search at the literature databases of Lilacs, Scielo and Pubmed was performed using keywords “sleep quality” and “children”. Selected Articles were analysed for age of the studied population, the number of questions and the issues addressed thereby, who realized the application, the analysis of the results, and content. Results: Out of 9377 titles, 11 studies were included, performing 7 different questionnaires: Questionnaire to measure quality of life among children with enlarged palatine and pharyngeal tonsils (translation of OSD-6 (1; Inventory of Sleep Habits for Preschool Children (2; the Questionnaire on Obstructive Sleep Apnoea-18 (OSA-18 (3, Sleep Questionnaire by Reimão and Lefévre - QRL (4; the Questionnaire on Sleep Behaviour Patterns (5 and the translation of the Sleep Disturbance Scale for Children (6; Brief Infant Sleep Questionnaire - BISQ (7 . Six of the questionnaires have covered the following issues: snoring and daytime sleepiness. Conclusions: A total of 7 protocols were found to be available in Brazil, the most commonly mentioned being OSA-18 and OSD-6. The use of protocols as a guided interview helps to define diagnosis and treatment among the paediatric population, but its large variability makes it difficult to compare a standardised monitoring process.

  11. Sleep-disordered breathing and its management in children with achondroplasia.

    Science.gov (United States)

    Tenconi, Rossana; Khirani, Sonia; Amaddeo, Alessandro; Michot, Caroline; Baujat, Geneviève; Couloigner, Vincent; De Sanctis, Livio; James, Syril; Zerah, Michel; Cormier-Daire, Valérie; Fauroux, Brigitte

    2017-04-01

    Sleep-disordered breathing is a common feature in children with achondroplasia. The aim of our study was to review the poly(somno)graphic (P(S)G) findings and consequent treatments in children with achondroplasia followed in the national reference center for skeletal dysplasia. A retrospective review of the clinical charts and P(S)G of 43 consecutive children (mean age 3.9 ± 3.5 years) with achondroplasia seen over a period of 2 years was performed. Twenty four (59%) children had obstructive sleep apnea (OSA). Thirteen children had an obstructive apnea-hypopnea index (OAHI) achondroplasia. The observation of a reduced prevalence of OSA after (adeno-)tonsillectomy is in favor of this type of surgery when possible. © 2017 Wiley Periodicals, Inc.

  12. Association between sleep-disordered breathing, sleep-wake pattern, and cognitive impairment among patients with chronic heart failure.

    Science.gov (United States)

    Hjelm, Carina; Strömberg, Anna; Arestedt, Kristofer; Broström, Anders

    2013-05-01

    Chronic heart failure (CHF) and sleep-disordered breathing (SDB) are often co-existing problems among the elderly. Apnoeic events may cause cognitive impairment. The aim of the study was to compare sleep and wake patterns, insomnia, daytime sleepiness, and cognitive function in community-dwelling CHF patients, with and without SDB, and to investigate the association between sleep-related factors and cognitive dysfunction. In this cross-sectional observational study, SDB was measured with an ApneaLink device and defined as an apnoea-hypopnoea index (AHI) ≥15/h of sleep. Sleep and wake patterns were measured with actigraphy for 1 week. Insomnia was measured with the Minimal Insomnia Symptom Scale, daytime sleepiness with the Epworth Sleepiness Scale, and cognitive function with a neuropsychological test battery. A total of 137 patients (68% male, median age 72 years, 58% NYHA functional class II) were consecutively included. Forty-four per cent had SDB (AHI ≥15). The SDB group had significantly higher saturation time below 90%, more difficulties maintaining sleep, and lower levels of daytime sleepiness compared with the non-SDB group. Cognitive function and sleep and wake patterns did not differ between the SDB and the non-SDB group. Insomnia was associated with decreased global cognition. The prevalence of cognitive dysfunction was low in this population with predominantly mild to moderate CHF. This might have influenced the lack of associations between cognitive function and SDB. Insomnia was the only sleep-related factor significantly influencing cognition.

  13. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  14. Sleep Disorders: Insomnia.

    Science.gov (United States)

    Burman, Deepa

    2017-09-01

    Insomnia is the most common type of sleep disorder in the family medicine population. It is defined as a persistent difficulty initiating or maintaining sleep, or a report of nonrestorative sleep, accompanied by related daytime impairment. Insomnia is a significant public health problem because of its high prevalence and management challenges. There is increasing evidence of a strong association between insomnia and various medical and psychiatric comorbidities. Diagnosis of insomnia and treatment planning rely on a thorough sleep history to address contributing and precipitating factors as well as maladaptive behaviors resulting in poor sleep. Using a sleep diary or sleep log is more accurate than patient recall to determine sleep patterns. A sleep study is not routinely indicated for evaluation of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the mainstay of treatment and is a safe and effective approach. The key challenge of CBT-I is the lack of clinicians to implement it. The newer generation nonbenzodiazepines (eg, zolpidem, zaleplon) are used as first-line pharmacotherapy for chronic insomnia. Newer drugs active on targets other than the gamma-aminobutyric acid receptor are now available, but clear treatment guidelines are needed. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  15. SMART DOCS: A New Patient-Centered Outcomes and Coordinated-Care Management Approach for the Future Practice of Sleep Medicine

    Science.gov (United States)

    Kushida, Clete A.; Nichols, Deborah A.; Holmes, Tyson H.; Miller, Ric; Griffin, Kara; Cardell, Chia-Yu; Hyde, Pamela R.; Cohen, Elyse; Manber, Rachel; Walsh, James K.

    2015-01-01

    The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT02037438. Citation: Kushida CA, Nichols DA, Holmes TH, Miller R, Griffin K, Cardell CY, Hyde PR, Cohen E, Manber R, Walsh JK. SMART DOCS: a new patient-centered outcomes and coordinated

  16. Long-Term Effectiveness of Stress Management at Work: Effects of the Changes in Perceived Stress Reactivity on Mental Health and Sleep Problems Seven Years Later.

    Science.gov (United States)

    Herr, Raphael M; Barrech, Amira; Riedel, Natalie; Gündel, Harald; Angerer, Peter; Li, Jian

    2018-02-03

    The reduction of stress reactivity resulting from stress management interventions prevents disorders and improves mental health, however, its long-term sustainability has been little examined. The objective of this study was, therefore, to determine the effectiveness of a stress management intervention, designed to improve stress reactivity, for mental health and sleep problems seven years later, using longitudinal data from 101 male industrial workers. Linear regressions estimated the adjusted effects of the changes in stress reactivity in general as well as in its six subdimensions (work overload, social conflict, social stress, failure at work, and anticipatory and prolonged reactivity) on depression, anxiety, and sleep problems seven years later. The improvement of the prolonged reactivity had positive effects on depression, anxiety, and sleep problems (unstandardized regression coefficients [ Bs ] ≥ 0.35, all p -values ≤ 0.01). Depression and sleep problems were further improved by a reduction of the reactivity to social conflicts ( Bs ≥ 0.29, p -values stress reactivity resulting from a work stress intervention was effective and generally long-lasting in preventing mental health and sleep problems. The reduction of the prolonged reactivity seems of particular importance and efficient in inhibiting negative stress manifestations.

  17. X-ray upper airway changes in individuals suffering from obstructive respiratory disorders during sleep

    International Nuclear Information System (INIS)

    Shakhov, A.A.; Rabukhina, N.A.; Nerobeev, A.I.; Vasil'ev, A.Yu.

    2000-01-01

    Obstructive respiratory disorders during sleep present an important medical and social problem. Serious dysfunctions of cardiovascular, nervous, endocrine and other vital systems of the body reduce longevity and life quality. On the other hand, load nocturnal snore and abnormal during sleepiness cause great damage to family life, reduce working capacity and induce accidents. X-ray visualization of the upper airways is essential in diagnosing obstructive upper airway states and selecting patients for surgical treatment. The paper presents the author's own experience in using various X-ray diagnostic methods in patients with chronic snore and obstructive sleep apnoea-hypopnoea syndrome [ru

  18. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder.

    Science.gov (United States)

    Kyle, Simon D; Miller, Christopher B; Rogers, Zoe; Siriwardena, A Niroshan; Macmahon, Kenneth M; Espie, Colin A

    2014-02-01

    To investigate whether sleep restriction therapy (SRT) is associated with reduced objective total sleep time (TST), increased daytime somnolence, and impaired vigilance. Within-subject, noncontrolled treatment investigation. Sleep research laboratory. Sixteen patients [10 female, mean age = 47.1 (10.8) y] with well-defined psychophysiological insomnia (PI), reporting TST ≤ 6 h. Patients were treated with single-component SRT over a 4-w protocol, sleeping in the laboratory for 2 nights prior to treatment initiation and for 3 nights (SRT night 1, 8, 22) during the acute interventional phase. The psychomotor vigilance task (PVT) was completed at seven defined time points [day 0 (baseline), day 1,7,8,21,22 (acute treatment) and day 84 (3 mo)]. The Epworth Sleepiness Scale (ESS) was completed at baseline, w 1-4, and 3 mo. Subjective sleep outcomes and global insomnia severity significantly improved before and after SRT. There was, however, a robust decrease in PSG-defined TST during acute implementation of SRT, by an average of 91 min on night 1, 78 min on night 8, and 69 min on night 22, relative to baseline (P insomnia.

  19. Prevalence and risk factors for obstructive sleep apnoea in Dar es ...

    African Journals Online (AJOL)

    Epworth scores of 11 or more and experiencing sleepiness during work or driving are regarded as ... sectors while 23.4% of the residents were self-employed, and 34.6% were involved in petty business, ... passenger in a car for > 1hour, lying down to rest in the afternoon when circumstances permit, ... briefly in heavy traffic.

  20. Plasma natriuretic peptides in children and adolescents with obstructive sleep apnoea and their changes following intervention

    Directory of Open Access Journals (Sweden)

    Albert Martin Li

    2014-03-01

    Full Text Available Objective: This study aimed to evaluate circulating natriuretic peptides (NP concentration in obese and non-obese children and adolescents with and without OSA, and their levels following OSA treatment.Methods: Subjects with habitual snoring and symptoms suggestive of OSA were recruited. They underwent physical examination and overnight polysomnography (PSG. OSA was diagnosed if obstructive apnea hypopnea index (OAHI ≥1/h. Fasting serum atrial natriuretic peptide (ANP and brain natriuretic peptide (BNP were taken after overnight PSG. The subjects were divided into obese, non-obese, with and without OSA groups for comparisons.Results: 114 children (77 were boys with a median (IQR age of 10.8 (8.3-12.7 years (range: 2.4-11.8 years were recruited. Sixty-eight subjects were found to have OSA. Natriuretic peptide levels did not differ between subjects with and without OSA in both obese and non-obese groups. . Stepwise multiple linear regressions revealed that body mass index (BMI z-score was the only independent factor associated with NP concentrations. Fifteen children with moderate-to-severe OSA (OAHI >5/h underwent treatment and there were no significant changes in both ANP and BNP levels after intervention.Conclusion: BMI rather than OSA was the main determinant of natriuretic peptide levels in school-aged children and adolescents.

  1. Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Steinke, E; Palm Johansen, P; Fridlund, B

    2016-01-01

    -analysis. RESULTS: Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 ... literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool...

  2. Sleep Apnoea Detection in Single Channel ECGs by Analyzing Heart Rate Dynamics

    National Research Council Canada - National Science Library

    Zywietz, C

    2001-01-01

    .... Our analysis is based on spectral components of heart rate variability. Frequency analysis was performed using Fourier and wavelet transformation with appropriate application of the Hilbert transform...

  3. Sleep Disorders (PDQ®)—Health Professional Version

    Science.gov (United States)

    Sleep disorders (e.g., insomnias, sleep apnea, hypersomnias, parasomnias, and problems with circadian rhythm) are common in people with cancer. Get detailed information about the causes and management of the major sleep disorders in this summary for clinicians.

  4. November 2012 sleep journal club

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-11-01

    Full Text Available No abstract available. Article truncated at 150 words. Crawford MR, Bartlett DJ, Coughlin SR, et al. The effect of continuous positive airway pressure usage on sleepiness in obstructive sleep apnoea: real effects or expectation of benefit? Thorax. 2012;67:920-4. Abstract With continuous positive airway pressure (CPAP treatment of obstructive sleep apnea, greater hours of CPAP use are associated with reduced sleepiness. However, these open-label studies have not controlled for patient expectation of benefit. The authors performed a meta-analysis combining data on sleepiness measured by the Epworth Sleepiness Scale from three randomized placebo-controlled crossover trials including use of low dose CPAP. High use of CPAP reduced sleepiness more than placebo and more than low use. The authors calculated that 29% of the effect of high usage of CPAP was explained by the expectation of benefit with CPAP. In retrospect it should not be surprising that there was a significant placebo effect. The primary end point used, improvement in the Epworth …

  5. Physiological consequences of CPAP therapy withdrawal in patients with obstructive sleep apnoea—an opportunity for an efficient experimental model

    OpenAIRE

    Schwarz, Esther I.; Stradling, John R.; Kohler, Malcolm

    2018-01-01

    Randomised controlled trials (RCTs) of continuous positive airway pressure (CPAP) in obstructive sleep apnoea (OSA) are time consuming, and their findings often inconclusive or limited due to suboptimal CPAP adherence in CPAP-naïve patients with OSA. Short-term CPAP withdrawal in patients with prior optimal CPAP adherence results in recurrence of OSA and its consequences. Thus, this experimental model serves as an efficient tool to investigate both the consequences of untreated OSA, and poten...

  6. Sleep education in college: a preliminary study.

    Science.gov (United States)

    Tsai, Ling-Ling; Li, Sheng-Ping

    2004-12-01

    In this study we evaluated the effect of a two-credit (100 min./week) "Sleep Management" course on the sleep patterns of college students as the course progressed over an 18-wk. semester. Curricular activity included lectures, group discussions, and practice of self-evaluation of sleep. Instead of giving the students the whole list of sleep hygiene at the outset of the course, each concept of sleep hygiene was introduced and discussed under related lecture topics. A total of 241 students (131 men and 110 women) took the course and kept 7-day sleep logs three times. Concurrently, sleep-log data were collected from 65 students (32 men and 33 women) who were not taking the course. Both groups showed similar varieties of academic backgrounds and characteristics of sleep patterns at the beginning. Similarly, their sleep patterns, namely, rise time, nighttime awakenings, time asleep, time in bed, sleep efficiency, and rise time regularity, changed over the semester. Women in both groups had more nighttime awakenings. In contrast, sleep quality was progressively better for the group in the course but not for the control group. Only women in the course decreased their nap time in the second and third months. Thus, the course of "Sleep Management" only had a mild and limited effect on sleep patterns. The course content needs refinement to maximize influence on students' sleep patterns and habits, particularly, on reduction of insufficient sleep and daytime sleepiness which are the highest ranking sleep problems among college students.

  7. Recent advances in the management of obstructive sleep apnea: The dental perspective.

    Science.gov (United States)

    Prabhat, K C; Goyal, Lata; Bey, Afshan; Maheshwari, Sandhya

    2012-07-01

    Obstructive sleep apnea (OSA) is common in adult population. OSA shows detrimental effects on health, neuropsychological development, quality-of-life, and economic potential and now it is recognized as a public health problem. Despite the availability of expanded therapeutic options, polysomnography and nasal continuous positive airway pressure (CPAP) are the gold standards for the diagnosis and treatment for OSA. Recently, American Academy of Sleep Medicine has recommended oral appliances for OSA. Hence the therapeutic interventions that are directed at the site of airway obstruction in the maxillofacial region are within the scope of dentistry. Treatment of OSA can improve vitality, social and daytime functioning, family life and mental health of a person and hence the quality-of-life. Obesity is the main predisposing factor for OSA. Other than obesity, craniofacial abnormalities such as micrognathia and retrognathia, age, ethnic background and genetic predisposition, consumption of alcohol, smoking, and sedatives may also predispose to OSA. Treatment modalities for OSA are behavior modification, diet and medication, CPAP devices, surgical (maxillo-mandibular advancement surgery), and oral appliances. Treatment of a patient with OSA not only improves the physical health of the patients but also the mental and social well-being.

  8. An expert system for fault management assistance on a space sleep experiment

    Science.gov (United States)

    Atamer, A.; Delaney, M.; Young, L. R.

    2002-01-01

    The expert system, Principal Investigator-in-a-box, or [PI], was designed to assist astronauts or other operators in performing experiments outside their expertise. Currently, the software helps astronauts calibrate instruments for a Sleep and Respiration Experiment without contact with the investigator on the ground. It flew on the Space Shuttle missions STS-90 and STS-95. [PI] displays electrophysiological signals in real time, alerts astronauts via the indicator lights when a poor signal quality is detected, and advises astronauts how to restore good signal quality. Thirty subjects received training on the sleep instrumentation and the [PI] interface. A beneficial effects of [PI] and training reduced troubleshooting time. [PI] benefited subjects on the most difficult scenarios, even though its lights were not 100% accurate. Further, questionnaires showed that most subjects preferred monitoring waveforms with [PI] assistance rather than monitoring waveforms alone. This study addresses problems of complex troubleshooting and the extended time between training and execution that is common to many human operator situations on earth such as in power plant operation, and marine exploration.

  9. Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea.

    Science.gov (United States)

    Shilo, Dekel; Emodi, Omri; Aizenbud, Dror; Rachmiel, Adi

    2016-01-01

    Obstructive sleep apnea (OSA) in individuals with craniofacial anomalies can compromise airway and is a serious life-threatening condition. In many cases, tracheostomy is carried out as the treatment of choice. Distraction osteogenesis of the mandible as a treatment modality for OSA is very useful and may spare the need for tracheostomy or allow decannulation, yet controlling the vector of distraction is still a major challenge. We present a method for controlling the vector of distraction. Eight patients with severe respiratory distress secondary to a micrognathic mandible were treated by mandibular distraction osteogenesis using either external or internal devices. Temporary anchorage devices (TADs) and orthodontic elastics were used to control the vector of distraction. Cephalometric X-rays, computed tomography, and polysomnographic sleep studies were used to analyze the results. A mean distraction of 22 mm using the internal devices and a mean of 30 mm using the external devices were achieved. Increase in the pharyngeal airway and hyoid bone advancement was also observed. Anterior-posterior advancement of the mandible was noted with no clockwise rotation. Most importantly, clinical improvement in symptoms of OSA, respiratory distress, and feeding was noted. We describe a method for controlling the vector of distraction used as a treatment for OSA. In these cases, TADs were used as an anchorage unit to control the vector of distraction. Our results show excellent clinical and radiographical results. TADs are a simple and nonexpensive method to control the vector of distraction.

  10. Use of thoracic impedance sensors to screen for sleep-disordered breathing in patients with cardiovascular disease

    International Nuclear Information System (INIS)

    Poupard, L; Mathieu, M; Sartène, R; Goldman, M

    2008-01-01

    Screening patients for the possibility of sleep apnoea, one of the most common forms of sleep-disordered breathing, requires measurement of respiration. We propose a simple method to estimate the amplitude modulation of a respiratory tidal volume, using a semi-quantitative measure of respiration based on thoracic impedance (TI). Because respiratory volume changes may be accommodated by varying displacements of the rib cage (RC) and abdomen (AB), the latter produced by outward motion of the diaphragm, it is necessary for any useful measure of respiration to be closely related to both RC and AB displacements. Because the relative contributions of RC and AB displacements to respiratory tidal volume vary in different body positions, the present measurements were recorded from subjects in supine, and right and left lateral decubitus postures. We observed a clear linear relationship between TI and both RC and AB signals in all three body positions. There were no statistically significant differences between observed relationships between TI and AB and between TI and RC, and these relationships were independent of the body position. TI sensors appear to be a useful candidate for a simple method of screening for sleep apnoea, especially in a cardiology clinical setting. Further investigation is warranted for the refinement of algorithms to detect changes in amplitude modulation occurring with apnoeas and to remove artefacts due to gross body movements

  11. Recognition and Management of Sleep-Disordered Breathing in Chronic Heart Failure

    Science.gov (United States)

    Kikta, Donald; Khayat, Rami

    2013-01-01

    It is increasingly recognized that sleep-disordered breathing (SDB) is a common modifiable risk factor for cardiovascular disease with significant impact on morbidity and potentially mortality. SDB is highly prevalent in patients with systolic or diastolic heart failure. A high index of suspicion is necessary to diagnose SDB in patients with heart failure because the vast majority of affected patients do not report daytime symptoms. Recent clinical trials have demonstrated improvement in heart function, exercise tolerance, and quality of life after treatment of SDB in patients with heart failure. Accumulating evidence suggests that treatment of SDB should complement the established pharmacologic therapy for chronic heart failure. However, mortality benefit has yet to be demonstrated. PMID:21086079

  12. Sleep less and bite more: sleep disorders associated with occlusal loads during sleep.

    Science.gov (United States)

    Kato, Takafumi; Yamaguchi, Taihiko; Okura, Kazuo; Abe, Susumu; Lavigne, Gilles J

    2013-04-01

    Occlusal overload during sleep is a significant clinical issue that has negative impacts on the maintenance of teeth and the longevity of dental prostheses. Sleep is usually viewed as an 'out-of-functional' mode for masticatory muscles. However, orodental structures and prostheses are not free from occlusal loads during sleep since masticatory muscles can be activated at a low level within normal sleep continuity. Thus, an increase in masticatory muscle contractions, by whatever the cause, can be associated with a risk of increased occlusal loads during sleep. Among such conditions, sleep bruxism (SB) is a type of sleep-related movement disorders with potential load challenge to the tooth and orofacial structures. Patients with SB usually report frequent tooth grinding noises during sleep and there is a consecutive increase in number and strength of rhythmic masticatory muscle activity (RMMA). Other types of masticatory muscle contractions can be non-specifically activated during sleep, such as brief contractions with tooth tapping, sleep talking, non-rhythmic contractions related to non-specific body movements, etc.; these occur more frequently in sleep disorders. Studies have shown that clinical signs and symptoms of SB can be found in patients with sleep disorders. In addition, sleep becomes compromised with aging process, and a prevalence of most sleep disorders is high in the elderly populations, in which prosthodontic rehabilitations are more required. Therefore, the recognition and understanding of the role of sleep disorders can provide a comprehensive vision for prosthodontic rehabilitations when prosthodontists manage complex orodental cases needing interdisciplinary collaborations between dentistry and sleep medicine. Copyright © 2013 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  13. Sleep habits and strategies of ultramarathon runners

    Science.gov (United States)

    Martin, Tristan; Arnal, Pierrick J.; Hoffman, Martin D.; Millet, Guillaume Y.

    2018-01-01

    Among factors impacting performance during an ultramarathon, sleep is an underappreciated factor that has received little attention. The aims of this study were to characterize habitual sleep behaviors in ultramarathon runners and to examine strategies they use to manage sleep before and during ultramarathons. Responses from 636 participants to a questionnaire were considered. This population was found to sleep more on weekends and holidays (7–8 h to 8–9 h) than during weekdays (6–7 h to 7–8 h; p sleep disorders, with more women (38.9%) reporting sleep problems than men (22.0%; p sleep preceding an ultramarathon, with 54.7% trying to increase their opportunities for sleep. Only 21% of participants reported that they had a strategy to manage sleep during ultramarathons, with micronaps being the most common strategy specified. Sub-analyses from 221 responses indicated that sleep duration during an ultramarathon was correlated with finish time for races lasting 36–60 h (r = 0.48; p 60 h (r = 0.44; p sleep duration among ultramarathon runners was comparable to the general population and other athletic populations, yet they reported a lower prevalence of sleep disorders. Daytime sleepiness was among the lowest rates encountered in athletic populations, which may be related to the high percentage of nappers in our population. Sleep extension, by increasing sleep time at night and daytime napping, was the main sleep strategy to prepare for ultramarathons. PMID:29742118

  14. Assessing sleep in adolescents through a better understanding of sleep physiology.

    Science.gov (United States)

    George, Nancy M; Davis, Jean E

    2013-06-01

    Adolescents need about nine hours of sleep per night, yet most teens get far less. Inadequate sleep has consequences not only for academic performance but also for mental and physical health; it has been linked to lowered resilience and an increased risk of cardiovascular and metabolic diseases. It's imperative that assessment of sleep become a routine part of adolescent health care. An understanding of sleep physiology is essential to helping nurses better assess and manage sleep deprivation in this population. Sleep assessment involves evaluating the three main aspects of sleep: amount, quality, and architecture. The authors provide an overview of sleep physiology, describe sleep changes that occur during adolescence, and discuss the influence of these changes on adolescent health. They also provide simple questions that nurses can use to assess sleep and risk factors for disrupted sleep, and discuss patient education and other interventions.

  15. Polysomnography for the management of oxygen supplementation therapy in infants with chronic lung disease of prematurity.

    Science.gov (United States)

    Kulkarni, Gaurav; de Waal, Koert; Grahame, Sally; Collison, Adam; Roddick, Laurence; Hilton, Jodi; Gulliver, Tanya; Whitehead, Bruce; Mattes, Joerg

    2018-04-25

    Some infants with bronchopulmonary dysplasia (BPD) may require oxygen supplementation at home but a role for overnight polysomnography (PSG) in the management of home oxygen therapy has been rarely described. Forty-one infants with BPD born at less than 30 weeks gestational age were discharged with continuous home oxygen supplementation therapy between 2010 and 2013. PSG data were recorded on oxygen supplementation versus room air at median post conceptual age of 2 months (range 1-5.5 months) (first PSG after discharge to home). Those infants who continued oxygen supplementation therapy at home had at least one more PSG before oxygen therapy was discontinued (last PSG). We also collected PSG data in 10 healthy term infants (median age 3.5 months; range 2-4 months). In infants with BPD in room air, increased numbers of central apnoeas, hypopnoeas and SaO 2 desaturations were the predominant PSG features with a median apnoea-hypopnoea index (AHI) of 16.8 events per hour (range 0-155). On oxygen supplementation therapy, median AHI dramatically improved (2.2, range 0-22; p < 0.001) and was not different from control infants (2.0, range 0-3.9; p = 0.31). AHI on room air at the last PSG when home oxygen was ceased was 4.1 per hour (range 0-13.8) slightly higher than in healthy infants. Central sleep disordered breathing in infants with BPD dramatically normalises with low flow nasal cannula home oxygen therapy and improves with age. Mild central sleep disordered breathing remains detectable, although much improved, when compared to healthy infants at the time when the decision to cease home oxygen therapy was made by the physician.

  16. Healthy Sleep Habits

    Science.gov (United States)

    ... Sleep Apnea Testing CPAP Healthy Sleep Habits Healthy Sleep Habits Your behaviors during the day, and especially ... team at an AASM accredited sleep center . Quick Sleep Tips Follow these tips to establish healthy sleep ...

  17. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ...

  18. Obstructive Sleep Apnea

    Science.gov (United States)

    ... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ... find out more. Obstructive Sleep Apnea (OSA) Obstructive Sleep Apnea (OSA) Obstructive sleep apnea (OSA) is a ...

  19. SMART DOCS: a new patient-centered outcomes and coordinated-care management approach for the future practice of sleep medicine.

    Science.gov (United States)

    Kushida, Clete A; Nichols, Deborah A; Holmes, Tyson H; Miller, Ric; Griffin, Kara; Cardell, Chia-Yu; Hyde, Pamela R; Cohen, Elyse; Manber, Rachel; Walsh, James K

    2015-02-01

    The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. http://www.clinicaltrials.gov, NCT02037438. © 2015 Associated Professional Sleep Societies, LLC.

  20. Sleep Apnea

    Science.gov (United States)

    Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing ... an hour. The most common type is obstructive sleep apnea. It causes your airway to collapse or ...

  1. Subjective sleep quality in sarcoidosis.

    Science.gov (United States)

    Bosse-Henck, Andrea; Wirtz, Hubert; Hinz, Andreas

    2015-05-01

    Poor sleep is common among patients with medical disorders. Sleep disturbances can be a cause of fatigue and poor quality of life for patients suffering from sarcoidosis. Studies on subjective sleep quality or prevalence of insomnia have not been reported so far. The aim of this study was to investigate the subjectively reported sleep quality and its relation to psychological and physical factors in sarcoidosis patients. 1197 patients from Germany diagnosed with sarcoidosis were examined using the Pittsburgh Sleep Quality Index (PSQI), the Medical Research Council (MRC) dyspnea scale, the Hospital Anxiety and Depression Scale (HADS) and the Multidimensional Fatigue Inventory (MFI). 802 patients (67%) had PSQI global scores >5, indicating subjectively poor quality of sleep. The mean PSQI score was 7.79 ± 4.00. Women reported a significantly inferior individual quality of sleep than men. The subjective quality of sleep was lowered significantly with increasing dyspnea for men and women. 294 patients (25%) had PSQI global scores >10 usually found in patients with clinically relevant insomnia. In this group 86% had high values for fatigue, 69% for anxiety, and 59% for depression. The prevalence of known sleep apnea was 8.7% and 15.7% for restless legs. Poor subjective sleep quality in sarcoidosis patients is about twice as common as in the general population and is associated with fatigue, anxiety, depression and dyspnea. Questions about sleep complaints should therefore be included in the management of sarcoidosis. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Sleep problems and internet addiction among children and adolescents: a longitudinal study.

    Science.gov (United States)

    Chen, Yi-Lung; Gau, Susan Shur-Fen

    2016-08-01

    Although the literature has documented associations between sleep problems and internet addiction, the temporal direction of these relationships has not been established. The purpose of this study is to evaluate the bidirectional relationships between sleep problems and internet addiction among children and adolescents longitudinally. A four-wave longitudinal study was conducted with 1253 children and adolescents in grades 3, 5 and 8 from March 2013 to January 2014. The sleep problems of the student participants were measured by parental reports on the Sleep Habit Questionnaire, which catalogues early insomnia, middle insomnia, disturbed circadian rhythm, periodic leg movements, sleep terrors, sleepwalking, sleep talking, nightmares, bruxism, snoring and sleep apnoea. The severity of internet addiction was measured by students' self-reports on the Chen Internet Addiction Scale. Based on the results of time-lag models, dyssomnias (odds ratio = 1.31), especially early and middle insomnias (odds ratio = 1.74 and 2.24), sequentially predicted internet addiction, and internet addiction sequentially predicted disturbed circadian rhythm (odds ratio = 2.40), regardless of adjustment for gender and age. This is the first study to demonstrate the temporal relationship of early and middle insomnia predicting internet addiction, which subsequently predicts disturbed circadian rhythm. These findings imply that treatment strategies for sleep problems and internet addiction should vary according to the order of their occurrence. © 2016 European Sleep Research Society.

  3. Convergent validity of actigraphy with polysomnography and parent reports when measuring sleep in children with Down syndrome.

    Science.gov (United States)

    Esbensen, A J; Hoffman, E K; Stansberry, E; Shaffer, R

    2018-04-01

    There is a need for rigorous measures of sleep in children with Down syndrome as sleep is a substantial problem in this population and there are barriers to obtaining the gold standard polysomnography (PSG). PSG is cost-prohibitive when measuring treatment effects in some clinical trials, and children with Down syndrome may not cooperate with undergoing a PSG. Minimal information is available on the validity of alternative methods of assessing sleep in children with Down syndrome, such as actigraphy and parent ratings. Our study examined the concurrent and convergent validity of different measures of sleep, including PSG, actigraphy and parent reports of sleep among children with Down syndrome. A clinic (n = 27) and a community (n = 47) sample of children with Down syndrome were examined. In clinic, children with Down syndrome wore an actigraph watch during a routine PSG. In the community, children with Down syndrome wore an actigraph watch for a week at home at night as part of a larger study on sleep and behaviour. Their parent completed ratings of the child's sleep during that same week. Actigraph watches demonstrated convergent validity with PSG when measuring a child with Down syndrome's total amount of sleep time, total wake time after sleep onset and sleep period efficiency. In contrast, actigraph watches demonstrated poor correlations with parent reports of sleep, and with PSG when measuring the total time in bed and total wake episodes. Actigraphy, PSG and parent ratings of sleep demonstrated poor concurrent validity with clinical diagnosis of obstructive sleep apnoea. Our current data suggest that actigraph watches demonstrate convergent validity and are sensitive to measuring certain sleep constructs (duration, efficiency) in children with Down syndrome. However, parent reports, such as the Children's Sleep Habits Questionnaire, may be measuring other sleep constructs. These findings highlight the importance of selecting measures of sleep related to

  4. Sleep architecture, insulin resistance and the nasal cycle: Implications for positive airway pressure therapy

    Directory of Open Access Journals (Sweden)

    Catherine A.P. Crofts

    2018-03-01

    Full Text Available Background: The global pandemic of metabolic disease is worsening. The metabolic theory of obesity proposes that hormonal changes, especially hyperinsulinaemia, precede metabolic disease development. Although quality sleep is recognised as a key factor for good health, less is known about disrupted sleep as a risk factor for hyperinsulinaemia.   Aim: To explore the relationship between sleep, especially sleep architecture and the nasal cycle, on insulin secretion in obstructive sleep apnoea (OSA with comorbid metabolic disease. This review includes a discussion of the potential role of Rest-Activity-Cycler positive airway pressure (RACer-PAP, a novel non-pharmacological OSA treatment strategy.   Methods: A narrative review of all the relevant papers known to the authors was conducted. This review also included results from a polysomnographic sleep clinic pilot study (n = 3 comparing sleep efficiency of RACer-PAP to nasal continuous positive airways pressure (n-CPAP in OSA patients.   Results: Metabolic disease is strongly associated with disturbed sleep. Sleep architecture influences cerebral hormonal secretion, lateral shifts in the autonomic nervous system and nasal airflow dominance. Disturbed sleep shortens short-wave sleep periods, decreasing insulin sensitivity and glucose tolerance. Improvements to metabolic function during n-CPAP treatment are inconsistent. If RACer-PAP demonstrates superior effects on sleep architecture and autonomic function, it may offer advantages in OSA patients with comorbid metabolic disease.   Conclusion: Improving sleep architecture by maintaining the nasal cycle proposes a novel non-pharmacological treatment paradigm for treating OSA with comorbid metabolic disease. Research is required to demonstrate if RACer-PAP therapy influences whole night sleep architecture, sympathovagal balance and markers of metabolic disease.

  5. Topical review: sleep bruxism, headaches, and sleep-disordered breathing in children and adolescents.

    Science.gov (United States)

    Carra, Maria Clotilde; Bruni, Olivero; Huynh, Nelly

    2012-01-01

    Sleep bruxism, a well-known burden for dentists, is commonly observed in pediatric populations. Dentists are responsible for the detection and prevention of the detrimental consequences on the stomatognathic system that may occur in some patients with sleep bruxism. However, sleep bruxism is much more than tooth wear, since it is frequently associated with orofacial pain, headaches, and other more severe sleep disorders, such as sleep-disordered breathing. Although the mechanisms underlying the possible interactions among sleep bruxism, headaches, and sleep-disordered breathing need further research, these conditions are often concomitant. A literature search was performed to identify relevant publications related to the topic, which have been integrated in this topical review. The aim of this article was to provide a brief overview on sleep bruxism, headaches, and sleep-disordered breathing in pediatric patients and to promote a multispecialist approach (including dentists, sleep specialist physicians, and psychologists) in the diagnosis and management of these frequently associated disorders.

  6. Australasian Sleep Association position statement regarding the use of psychological/behavioral treatments in the management of insomnia in adults.

    Science.gov (United States)

    Ree, Melissa; Junge, Moira; Cunnington, David

    2017-08-01

    Insomnia disorder is a high prevalence condition with a high disease burden, which, left untreated, can increase risk of poorer health outcomes. Due to Insomnia's tendency towards having a chronic course, long-term treatment approaches are required to reduce the impact of Insomnia over time. After reviewing the available literature, The Australasian Sleep Association (ASA) recommends Cognitive Behavior Therapy for Insomnia (CBT-I) as a first line treatment in the management of Insomnia. The ASA notes that in addition to CBT-I, there is emerging evidence for the use of Mindfulness Based Therapy for Insomnia when used in combination with behavioural techniques (MBT-I). CBT-I should be used whenever possible, and medications should be limited to the lowest necessary dose and shortest necessary duration. CBT-I, whilst the most effective long-term treatment, does not work for everybody across all circumstances, so there will be circumstances in which other treatments are required (e.g., pharmacotherapy). Improving access to CBT-I is an important issue which will involve raising awareness of the effectiveness of CBT-I, increasing the number of trained practitioners, and the development of effective low intensity treatments that can be offered in the first instance. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Mammalian sleep

    Science.gov (United States)

    Staunton, Hugh

    2005-05-01

    This review examines the biological background to the development of ideas on rapid eye movement sleep (REM sleep), so-called paradoxical sleep (PS), and its relation to dreaming. Aspects of the phenomenon which are discussed include physiological changes and their anatomical location, the effects of total and selective sleep deprivation in the human and animal, and REM sleep behavior disorder, the latter with its clinical manifestations in the human. Although dreaming also occurs in other sleep phases (non-REM or NREM sleep), in the human, there is a contingent relation between REM sleep and dreaming. Thus, REM is taken as a marker for dreaming and as REM is distributed ubiquitously throughout the mammalian class, it is suggested that other mammals also dream. It is suggested that the overall function of REM sleep/dreaming is more important than the content of the individual dream; its function is to place the dreamer protagonist/observer on the topographical world. This has importance for the developing infant who needs to develop a sense of self and separateness from the world which it requires to navigate and from which it is separated for long periods in sleep. Dreaming may also serve to maintain a sense of ‘I’ness or “self” in the adult, in whom a fragility of this faculty is revealed in neurological disorders.

  8. Positive pressure ventilation in the management of acute and chronic cardiac failure: a systematic review and meta-analysis.

    Science.gov (United States)

    Nadar, Sunil; Prasad, Neeraj; Taylor, Rod S; Lip, Gregory Y H

    2005-03-18

    Chronic heart failure (CHF) is a common condition and is associated with excess morbidity and mortality, in spite of the many advances in its treatment. Chronic stable heart failure is also associated with an increased incidence of sleep-related breathing disorders, such as central sleep apnoea (CSA) and Cheyne Stokes respiration (CSR). Continuous positive airways pressure (CPAP) has been shown to alleviate the symptoms of CHF, improve left ventricular function and oxygenation. To a certain extent, CPAP also abolishes sleep-related breathing disorders in patients with chronic heart failure. In patients with acute pulmonary oedema, the use of positive pressure ventilation improves cardiac haemodynamic indices, as well as symptoms and oxygenation, and is associated with a lower need for intubation. However, some studies have cast doubts about its safety and suggest a higher rate of myocardial infarction associated with its use. In our opinion, non-invasive positive pressure ventilation and CPAP offers an adjunctive mode of therapy in patients with acute pulmonary oedema and chronic heart failure, who may not be suitable for intubation and in those not responsive to conventional therapies. Non-invasive ventilation also helps to improve oxygenation in those patients with exhaustion and respiratory acidosis. Many trials are still ongoing and the results of these studies would throw more light on the present role of non-invasive ventilation in the management of CHF.

  9. [Sleep disorders in Parkinson's disease: insomnia and sleep fragmentation, daytime hypersomnia, alterations to the circadian rhythm and sleep apnea syndrome].

    Science.gov (United States)

    Mondragón-Rezola, E; Arratíbel-Echarren, I; Ruiz-Martínez, J; Martí-Massó, J F

    2010-02-08

    Sleep disorders in Parkinson's disease are present in 60-98% of patients and reduce their quality of life. To review the pathophysiology, diagnostic approach and management of the different sleep disorders. We describe the pathophysiology associated with neurodegeneration, due to symptoms (motor and nonmotor) and drug therapies. This article reviews insomnia, excessive daytime sleepiness, circadian sleep disorders and sleep apnea. Subjective or objective sleepiness assessment should routinely be performed by physicians looking after Parkinson's disease patients. Management is difficult and should be targeted to the specific sleep disorder and its likely cause.

  10. Sleep in Patients with Chronic Migraine.

    Science.gov (United States)

    Yang, Chun-Pai; Wang, Shuu-Jiun

    2017-09-01

    The biological and pathophysiological interaction between sleep and chronic migraine (CM) remains to be fully elucidated. In this article, we provide a narrative review of the literature on sleep disturbance and CM, highlighting recent advances in sleep research and insights into mechanisms that could mediate a role of sleep disturbances in migraine chronification. We discuss the potential for cognitive-behavioral insomnia therapy (CBTi) as an intervention for CM with comorbid insomnia. Finally, we propose a model of the mechanisms underlying the interactions among sleep physiology, maladaptive migraine-coping behaviors, and coexisting factors which contribute to sleep disturbances in CM based on conceptual models used in sleep research. Insomnia is the most common sleep complaint among patients with CM. CM patients experience more frequent and severe insomnia symptoms than patients with episodic migraine (EM). It has been suggested that sleep disturbances may predispose individuals to migraine attacks, which may affect the pain-processing trigeminovascular system and thus play a role in migraine progression. Encouraging but limited evidence suggests that management of insomnia via behavioral sleep therapy may reverse CM to EM and possibly prevent migraine chronification. Migraine has a complex relationship with sleep. The use of objective sleep study such as polysomnographic microstructural sleep analysis and actigraphy could help connect sleep disturbances and processes related to CM. Future longitudinal studies should examine whether effective behavioral treatments such as CBTi can reverse migraine chronification.

  11. Sleep disorders - overview

    Science.gov (United States)

    Insomnia; Narcolepsy; Hypersomina; Daytime sleepiness; Sleep rhythm; Sleep disruptive behaviors; Jet lag ... excessive daytime sleepiness) Problems sticking to a regular sleep schedule (sleep rhythm problem) Unusual behaviors during sleep ( ...

  12. Central sleep apnea

    Science.gov (United States)

    Sleep apnea - central; Obesity - central sleep apnea; Cheyne-Stokes - central sleep apnea; Heart failure - central sleep apnea ... Central sleep apnea results when the brain temporarily stops sending signals to the muscles that control breathing. The condition ...

  13. Sleep Apnea (For Parents)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Obstructive Sleep Apnea KidsHealth / For Parents / Obstructive Sleep Apnea What's ... How Is Sleep Apnea Treated? Print What Is Sleep Apnea? Brief pauses in breathing during sleep are ...

  14. Obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Steven D. Brass

    2011-11-01

    Full Text Available Obstructive sleep apnea (OSA affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual’s risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  15. Obstructive sleep apnea.

    Science.gov (United States)

    Ho, Matthew L; Brass, Steven D

    2011-11-29

    Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  16. Relationships between parental sleep quality, fatigue, cognitions about infant sleep, and parental depression pre and post-intervention for infant behavioral sleep problems.

    Science.gov (United States)

    Hall, Wendy A; Moynihan, Melissa; Bhagat, Radhika; Wooldridge, Joanne

    2017-04-04

    Maternal and paternal depression has been associated with infants' behavioral sleep problems. Behavioral sleep interventions, which alter parental cognitions about infant sleep, have improved infant sleep problems. This study reports relationships between parental depression, fatigue, sleep quality, and cognitions about infant sleep pre and post-intervention for a behavioral sleep problem. This secondary analysis of data from Canadian parents (n = 455), with healthy infants aged 6-to-8-months exposed to a behavioral sleep intervention, examined baseline data and follow-up data from 18 or 24 weeks post intervention (group teaching or printed material) exposure. Parents reported on sleep quality, fatigue, depression, and cognitions about infant sleep. Data were analyzed using Pearson's r and stepwise regression analysis. Parents' fatigue, sleep quality, sleep cognitions, and depression scores were correlated at baseline and follow-up. At baseline, sleep quality (b = .52, 95% CI .19-.85), fatigue (b = .48, 95% CI .33-.63), doubt about managing infant sleep (b = .44, 95% CI .19-.69), and anger about infant sleep (b = .69, 95% CI .44-.94) were associated with mothers' depression. At baseline, fathers' depression related to sleep quality (b = .42, 95% CI .01-.83), fatigue (b = .47, 95% CI .32-.63), and doubt about managing infant sleep (b = .50, 95% CI .24-.76). At follow-up, mothers' depression was associated with sleep quality (b = .76, 95% CI .41-1.12), fatigue (b = .25, 95% CI .14-.37), doubt about managing infant sleep (b = .44, 95% CI .16-.73), sleep anger (b = .31, 95% CI .02-.59), and setting sleep limits (b = -.22, 95% CI -.41-[-.03]). At follow-up, fathers' depression related to sleep quality (b = .84, 95% CI .46-1.22), fatigue (b = .31, 95% CI .17-.45), sleep doubt (b = .34, 95% CI .05-.62), and setting sleep limits (b = .25, 95% CI .01-.49). Mothers' and fathers' cognitions about infant

  17. The effects of exercise on self-rated sleep among adults with chronic sleep complaints

    Directory of Open Access Journals (Sweden)

    Carmen Erlacher

    2015-09-01

    Conclusion: Improvements on subjective sleep quality after a combined intervention cannot be attributed to the cognitive component alone, but PA has an independent effect. Adults with chronic sleep complaints benefit from exercise. Therefore structured PA should be implemented in any sleep management programs.

  18. [Obstructive sleep apnea syndrome. Analytical study of 63 cases].

    Science.gov (United States)

    Battikh, Mohamed H; Joobeur, Sameh; Ben Sayeh, Mohamed M; Rouetbi, Naceur; Maatallah, Anis; Daami, Monia; el Kamel, Ali

    2004-02-01

    Obstructive sleep apnoea (OSA) is a relatively common disorder, in developed country with prevalence estimated to lie between 2 and 4% in adult population. The diagnosis of this syndrome is made on the basis of characteristic clinical features and the results of nocturnal polysomnography. There is no data concerning the OSA in developing country. It is therefore of interest to determine the clinic and polysomnographic profile of this disease and to landmark factors correlated with severity in our country. This was achieved by studying a set of 63 OSA. The mean of age was 53 + 13 years with sex ratio 1. The means of Epworth sleepiness scale score, BMI and Apnoea/Hypopnoea index (AHI) were respectively 16 + 4, 38.8 + 7 kg/m2 and 51.7 + 28.6. 44% of patients have OSA severe with IAH > 50/h. Arousal index and desaturation index were respectively 36.4 + 21.7 and 49 + 26. Trial of continuous positive airway pressure (CPAP) therapy was proposed first to 40 patients, 17 were able to use CPAP.

  19. Sleep disorders and the dental patient: an overview.

    Science.gov (United States)

    Lavigne, G J; Goulet, J P; Zuconni, M; Morrison, F; Lobbezoo, F

    1999-09-01

    This article is intended to briefly describe common sleep disorders of interest to the dental profession and to render general management guidelines. Topics include sleep-related bruxism, xerostomia, hypersalivation, gastroesophageal reflux, apnea, and the effect of orofacial pain on sleep quality. The term sleep-related is used instead of the term nocturnal because some of the activities described can occur with daytime sleep.

  20. Medicines for sleep

    Science.gov (United States)

    Benzodiazepines; Sedatives; Hypnotics; Sleeping pills; Insomnia - medicines; Sleep disorder - medicines ... are commonly used to treat allergies. While these sleep aids are not addictive, your body becomes used ...

  1. Diaphragm pacing improves sleep in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Gonzalez-Bermejo, Jesus; Morélot-Panzini, Capucine; Salachas, François; Redolfi, Stefania; Straus, Christian; Becquemin, Marie-Hélène; Arnulf, Isabelle; Pradat, Pierre-François; Bruneteau, Gaëlle; Ignagni, Anthony R; Diop, Moustapha; Onders, Raymond; Nelson, Teresa; Menegaux, Fabrice; Meininger, Vincent; Similowski, Thomas

    2012-01-01

    In amyotrophic lateral sclerosis (ALS) patients, respiratory insufficiency is a major burden. Diaphragm conditioning by electrical stimulation could interfere with lung function decline by promoting the development of type 1 muscle fibres. We describe an ancillary study to a prospective, non-randomized trial (NCT00420719) assessing the effects of diaphragm pacing on forced vital capacity (FVC). Sleep-related disturbances being early clues to diaphragmatic dysfunction, we postulated that they would provide a sensitive marker. Stimulators were implanted laparoscopically in the diaphragm close to the phrenic motor point in 18 ALS patients for daily conditioning. ALS functioning score (ALSFRS), FVC, sniff nasal inspiratory pressure (SNIP), and polysomnographic recordings (PSG, performed with the stimulator turned off) were assessed before implantation and after four months of conditioning (n = 14). Sleep efficiency improved (69 ± 15% to 75 ± 11%, p = 0.0394) with fewer arousals and micro-arousals. This occurred against a background of deterioration as ALSFRS-R, FVC, and SNIP declined. There was, however, no change in NIV status or the ALSFRS respiratory subscore, and the FVC decline was mostly due to impaired expiration. Supporting a better diaphragm function, apnoeas and hypopnoeas during REM sleep decreased. In conclusion, in these severe patients not expected to experience spontaneous improvements, diaphragm conditioning improved sleep and there were hints at diaphragm function changes.

  2. Starting a sleep center.

    Science.gov (United States)

    Epstein, Lawrence J; Valentine, Paul S

    2010-05-01

    The demand for sleep medicine services has grown tremendously during the last decade and will likely continue. To date, growth in demand has been met by growth in the number of new sleep centers. The need for more new centers will be dependent on market drivers that include increasing regulatory requirements, personnel shortages, integration of home sleep testing, changes in reimbursement, a shift in emphasis from diagnostics to treatment, and an increased consumer focus on sleep. The decision to open a new center should be based on understanding the market dynamics, completing a market analysis, and developing a business plan. The business plan should include an overview of the facility, a personnel and organizational structure, an evaluation of the business environment, a financial plan, a description of services provided, and a strategy for obtaining, managing, and extending a referral base. Implementation of the business plan and successful operation require ongoing planning and monitoring of operational parameters. The need for new sleep centers will likely continue, but the shifting market dynamics indicate a greater need for understanding the marketplace and careful planning.

  3. The management, privacy and medico-legal issues of electronic CPAP data in Australia and New Zealand: Electronic CPAP data management in Australia and New Zealand.

    Science.gov (United States)

    Swieca, John; Hamilton, Garun S; Meaklim, Hailey

    2017-08-01

    Continuous Positive Airway Pressure (CPAP) is considered to be the gold standard treatment for obstructive sleep apnoea (OSA). CPAP monitoring systems allow tracking of patient CPAP adherence and treatment efficacy, by measuring residual sleep-disordered breathing, hours of CPAP use, and mask leak etc. The American Thoracic Society (ATS) published a position paper in 2013 highlighting issues of interpreting CPAP data such as a lack of consistency between CPAP manufacturers data algorithms, legal implications of CPAP data and implications for CPAP adherence. This paper extends on this work by investigating these issues in an Australasian context. A review of current literature on CPAP monitoring systems, privacy and security of CPAP data for major Australasian CPAP providers, and CPAP adherence was undertaken. A legal review was also commissioned for issues related to privacy and security of CPAP data. CPAP manufacturers' utilize different algorithms for respiratory event detection and clinicians need to be aware the implications for interpreting CPAP data. Australasian CPAP manufacturers have created security/privacy policies with the intent to follow relevant legislation to protect patients' CPAP data, however they do need to be constantly reviewed and updated to avoid data breaches and changes to agreements. No guarantees can be provided by the Australasian Sleep Association on CPAP manufacturers' compliance with these policies and there is the potential for some degree of liability for physicians and CPAP providers associated with CPAP data. Lastly, providing patients with feedback on their CPAP usage and OSA management appears to have positive influence CPAP adherence. CPAP data provides many opportunities to increase OSA patient care and to help patients self-manage this chronic condition. However, issues relating to lack of standardization of CPAP parameters, privacy, security, and legal implications will need to be managed in this changing technologic and

  4. Sleep Disturbance in Children and Adolescents with Disorders of Development: Its Significance and Management. Clinics in Developmental Medicine.

    Science.gov (United States)

    Stores, Gregory, Ed.; Wiggs, Luci, Ed.

    The 30 papers in this collection are arranged in five sections which address general issues, neurodevelopmental disorders, other neurological conditions, non-neurological pediatric disorders, and psychiatric disorders. The papers are: (1) "Sleep Disturbance: A Serious, Widespread, Yet Neglected Problem in Disorders of Development"…

  5. Healthy Sleep

    Science.gov (United States)

    ... quality sleep, ask yourself Do you have trouble getting up in the morning? Do you have trouble focusing during the day? Do you doze off during the day? If you answered yes to these three questions, you should work on ...

  6. Pediatric sleep apnea

    Science.gov (United States)

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... Untreated pediatric sleep apnea may lead to: High blood pressure Heart or lung problems Slow growth and development

  7. Changing your sleep habits

    Science.gov (United States)

    ... falling asleep; Sleep hygiene References American Academy of Sleep Medicine. Insomnia. Updated March 4, 2015. SleepEducation.org. sleepeducation. ... T, Dement WC, eds. Principles and Practice of Sleep Medicine . 6th ed. Philadelphia, PA: Elsevier; 2017:chap 86. ...

  8. Snoring and Sleep Apnea

    Science.gov (United States)

    ... Find an ENT Doctor Near You Snoring and Sleep Apnea Snoring and Sleep Apnea Patient Health Information ... newsroom@entnet.org . Insight into sleeping disorders and sleep apnea Forty-five percent of normal adults snore ...

  9. [Sleep paroxysmal events in children in video/polysomnography].

    Science.gov (United States)

    Zajac, Anna; Skowronek-Bała, Barbara; Wesołowska, Ewa; Kaciński, Marek

    2010-01-01

    personnel. It is crucial in gathering objective data about sleep disorders. Correct diagnosis of paroxysmal disorders during sleep in children is possible thanks to video/polysomnography, and enables proper management and pharmacotherpy. It enables improvement or cure disorders during the sleep and moreover enables the obtainment of positive changes in child's every day life.

  10. Transnasal humidified rapid insufflation ventilatory exchange for oxygenation of children during apnoea: a prospective randomised controlled trial.

    Science.gov (United States)

    Riva, T; Pedersen, T H; Seiler, S; Kasper, N; Theiler, L; Greif, R; Kleine-Brueggeney, M

    2018-03-01

    Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) comprises the administration of heated, humidified, and blended air/oxygen mixtures via nasal cannula at rates of ≥2 litres kg -1  min -1 . The aim of this randomized controlled study was to evaluate the length of the safe apnoea time using THRIVE with two different oxygen concentrations (100% vs 30% oxygen) compared with standard low-flow 100% oxygen administration. Sixty patients, aged 1-6 yr, weighing 10-20 kg, undergoing general anaesthesia for elective surgery, were randomly allocated to receive one of the following oxygen administration methods during apnoea: 1) low-flow 100% oxygen at 0.2 litres kg -1  min -1 ; 2) THRIVE 100% oxygen at 2 litres kg -1  min -1 ; and 3) THRIVE 30% oxygen at 2 litres kg -1  min -1 . Primary outcome was time to desaturation to 95%. Termination criteria included SpO 2 decreased to 95%, transcutaneous CO 2 increased to 65 mmHg, or apnoea time of 10 min. The median (interquartile range) [range] apnoea time was 6.9 (5.7-7.8) [2.8-10.0] min for low-flow 100% oxygen, 7.6 (6.2-9.1) [5.2-10.0] min for THRIVE 100% oxygen, and 3.0 (2.4-3.7) [0.2-5.3] min for THRIVE 30% oxygen. No significant difference was detected between apnoea times with low-flow and THRIVE 100% oxygen administration (P=0.15). THRIVE with 30% oxygen demonstrated significantly shorter apnoea times (Prate of transcutaneous CO 2 increase was 0.57 (0.49-0.63) [0.29-8.92] kPa min -1 without differences between the 3 groups (P=0.25). High-flow 100% oxygen (2 litres kg -1  min -1 ) administered via nasal cannulas did not extend the safe apnoea time for children weighing 10-20 kg compared with low-flow nasal cannula oxygen (0.2 litres kg -1  min -1 ). No ventilatory effect was observed with THRIVE at 2.0 litres kg -1  min -1 . NCT02979067. Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

  11. An Integrative Review of Sleep for Nutrition Professionals12

    Science.gov (United States)

    Golem, Devon L.; Martin-Biggers, Jennifer T.; Koenings, Mallory M.; Davis, Katherine Finn; Byrd-Bredbenner, Carol

    2014-01-01

    Sleep is an essential lifestyle factor that contributes to overall health. The inverse relation between sleep duration and weight status has revealed the importance of sleep in nutritional health. This integrative review builds foundational knowledge with regard to sleep vis-à-vis nutrition by summarizing the importance and process of sleep, current sleep recommendations and trends, as well as lifestyle contributors to poor sleep. Additionally, it details the association between sleep and obesity and potential mechanisms for this association. Furthermore, guidance is offered regarding the incorporation of sleep considerations in nutrition counseling, communication, and research. Like many other lifestyle factors that contribute to nutritional health, sleep needs to be considered when examining weight management and health promotion. PMID:25398735

  12. An integrative review of sleep for nutrition professionals.

    Science.gov (United States)

    Golem, Devon L; Martin-Biggers, Jennifer T; Koenings, Mallory M; Davis, Katherine Finn; Byrd-Bredbenner, Carol

    2014-11-01

    Sleep is an essential lifestyle factor that contributes to overall health. The inverse relation between sleep duration and weight status has revealed the importance of sleep in nutritional health. This integrative review builds foundational knowledge with regard to sleep vis-à-vis nutrition by summarizing the importance and process of sleep, current sleep recommendations and trends, as well as lifestyle contributors to poor sleep. Additionally, it details the association between sleep and obesity and potential mechanisms for this association. Furthermore, guidance is offered regarding the incorporation of sleep considerations in nutrition counseling, communication, and research. Like many other lifestyle factors that contribute to nutritional health, sleep needs to be considered when examining weight management and health promotion. © 2014 American Society for Nutrition.

  13. Sleep in Othello

    Science.gov (United States)

    Dimsdale, Joel E.

    2009-01-01

    Some of our best descriptions of sleep disorders come from literature. While Shakespeare is well known for his references to insomnia and sleep walking, his works also demonstrate a keen awareness of many other sleep disorders. This paper examines sleep themes in Shakespeare's play Othello. The play indicates Shakespeare's astute eye for sleep deprivation, sexual parasomnias, and effects of stress and drugs on sleep. Citation: Dimsdale JE. Sleep in Othello. J Clin Sleep Med 2009;5(3):280-281. PMID:19960651

  14. Sleep Tips: 7 Steps to Better Sleep

    Science.gov (United States)

    ... turn every night. Consider simple tips for better sleep, from setting a sleep schedule to including physical activity in your daily ... factors that can interfere with a good night's sleep — from work stress and family responsibilities to unexpected ...

  15. Sleep in Othello

    OpenAIRE

    Dimsdale, Joel E.

    2009-01-01

    Some of our best descriptions of sleep disorders come from literature. While Shakespeare is well known for his references to insomnia and sleep walking, his works also demonstrate a keen awareness of many other sleep disorders. This paper examines sleep themes in Shakespeare's play Othello. The play indicates Shakespeare's astute eye for sleep deprivation, sexual parasomnias, and effects of stress and drugs on sleep.

  16. Chronic obstructive pulmonary disease and sleep related disorders.

    Science.gov (United States)

    Tsai, Sheila C

    2017-03-01

    Sleep related disorders are common and under-recognized in the chronic obstructive pulmonary disease (COPD) population. COPD symptoms can disrupt sleep. Similarly, sleep disorders can affect COPD. This review highlights the common sleep disorders seen in COPD patients, their impact, and potential management. Treatment of sleep disorders may improve quality of life in COPD patients. Optimizing inhaler therapy improves sleep quality. Increased inflammatory markers are noted in patients with the overlap syndrome of COPD and obstructive sleep apnea versus COPD alone. There are potential benefits of noninvasive positive pressure ventilation therapy for overlap syndrome patients with hypercapnia. Nocturnal supplemental oxygen may be beneficial in certain COPD subtypes. Nonbenzodiazepine hypnotic therapy for insomnia has shown benefit without associated respiratory failure or worsening respiratory symptoms. Melatonin may provide mild hypnotic and antioxidant benefits. This article discusses the impact of sleep disorders on COPD patients and the potential benefits of managing sleep disorders on respiratory disease control and quality of life.

  17. Sleep, Stress & Relaxation: Rejuvenate Body & Mind

    Science.gov (United States)

    Sleep, Stress & Relaxation: Rejuvenate Body & Mind; Relieve Stress; best ways to relieve stress; best way to relieve stress; different ways to relieve stress; does smoking relieve stress; does tobacco relieve stress; how can I relieve stress; how can you relieve stress; how do I relieve stress; reduce stress; does smoking reduce stress; how can I reduce stress; how to reduce stress; reduce stress; reduce stress levels; reducing stress; smoking reduce stress; smoking reduces stress; stress reducing techniques; techniques to reduce stress; stress relief; best stress relief; natural stress relief; need stress relief; relief for stress; relief from stress; relief of stress; smoking and stress relief; smoking for stress relief; smoking stress relief; deal with stress; dealing with stress; dealing with anger; dealing with stress; different ways of dealing with stress; help dealing with stress; how to deal with anger; how to deal with stress; how to deal with stress when quitting smoking; stress management; free stress management; how can you manage stress; how do you manage stress; how to manage stress; manage stress; management of stress; management stress; managing stress; strategies for managing stress; coping with stress; cope with stress; copeing with stress; coping and stress; coping skills for stress; coping strategies for stress; coping strategies with stress; coping strategy for stress; coping with stress; coping with stress and anxiety; emotional health; emotional health; emotional health article; emotional health articles; deep relaxation; deep breathing relaxation techniques; deep muscle relaxation; deep relaxation; deep relaxation meditation; deep relaxation technique; deep relaxation techniques; meditation exercises; mindful exercises; mindful meditation exercises; online relaxation exercises; relaxation breathing exercises; relaxation exercise; relaxation exercises; stress relaxation; methods of relaxation for stress; relax stress; relax techniques stress

  18. Targeting autophagy in obesity: from pathophysiology to management.

    Science.gov (United States)

    Zhang, Yingmei; Sowers, James R; Ren, Jun

    2018-04-23

    Obesity poses a severe threat to human health, including the increased prevalence of hypertension, insulin resistance, diabetes mellitus, cancer, inflammation, sleep apnoea and other chronic diseases. Current therapies focus mainly on suppressing caloric intake, but the efficacy of this approach remains poor. A better understanding of the pathophysiology of obesity will be essential for the management of obesity and its complications. Knowledge gained over the past three decades regarding the aetiological mechanisms underpinning obesity has provided a framework that emphasizes energy imbalance and neurohormonal dysregulation, which are tightly regulated by autophagy. Accordingly, there is an emerging interest in the role of autophagy, a conserved homeostatic process for cellular quality control through the disposal and recycling of cellular components, in the maintenance of cellular homeostasis and organ function by selectively ridding cells of potentially toxic proteins, lipids and organelles. Indeed, defects in autophagy homeostasis are implicated in metabolic disorders, including obesity, insulin resistance, diabetes mellitus and atherosclerosis. In this Review, the alterations in autophagy that occur in response to nutrient stress, and how these changes alter the course of obesogenesis and obesity-related complications, are discussed. The potential of pharmacological modulation of autophagy for the management of obesity is also addressed.

  19. Diagnosis and treatment of sleep related breathing disorders in children: 2007 to 2011.

    LENUS (Irish Health Repository)

    Walsh, A

    2015-03-01

    Sleep related breathing disorders (SRBD) have historically been under-recognised and under-treated. Obstructive sleep apnoea (OSA) affects approximately 3% of children. In line with the increased recognition of SRBD there has been an increase in demand for diagnostic services. We determined the awareness of SRBD amongst Irish paediatricians, examined the provision of sleep services to children throughout the country between 2007 and 2011 and audited diagnostic sleep services in a tertiary centre in 2011. Amongst respondents there was an awareness of SRBD but a poor understanding of diagnostic evaluation with 31\\/46 (67) referring to inappropriate services. There has been a sharp increase in both diagnostic sleep tests (433-1793 [414]) and in the use of non-invasive ventilation (NIV) (31-186 [627]) for treatment of SRBD between 2007 and 2011. Paediatric sleep services are organized in an ad-hoc manner nationally with significant service variation. The use of domiciliary overnight oximetry reduced the requirement for more formal polysomnography by 70%.

  20. A Contribution for the Automatic Sleep Classification Based on the Itakura-Saito Spectral Distance

    Science.gov (United States)

    Cardoso, Eduardo; Batista, Arnaldo; Rodrigues, Rui; Ortigueira, Manuel; Bárbara, Cristina; Martinho, Cristina; Rato, Raul

    Sleep staging is a crucial step before the scoring the sleep apnoea, in subjects that are tested for this condition. These patients undergo a whole night polysomnography recording that includes EEG, EOG, ECG, EMG and respiratory signals. Sleep staging refers to the quantification of its depth. Despite the commercial sleep software being able to stage the sleep, there is a general lack of confidence amongst health practitioners of these machine results. Generally the sleep scoring is done over the visual inspection of the overnight patient EEG recording, which takes the attention of an expert medical practitioner over a couple of hours. This contributes to a waiting list of two years for patients of the Portuguese Health Service. In this work we have used a spectral comparison method called Itakura distance to be able to make a distinction between sleepy and awake epochs in a night EEG recording, therefore automatically doing the staging. We have used the data from 20 patients of Hospital Pulido Valente, which had been previously visually expert scored. Our technique results were promising, in a way that Itakura distance can, by itself, distinguish with a good degree of certainty the N2, N3 and awake states. Pre-processing stages for artefact reduction and baseline removal using Wavelets were applied.

  1. Effectiveness of transnasal humidified rapid-insufflation ventilatory exchange versus traditional preoxygenation followed by apnoeic oxygenation in delaying desaturation during apnoea: A preliminary study

    Directory of Open Access Journals (Sweden)

    Sunil Rajan

    2018-01-01

    Full Text Available Background and Aims: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE during apnoea has shown to delay desaturation. The primary objective was to compare time to desaturate to 200 mmHg even at 12 min of apnoea with a significant rise in PaCO2along with fall in pH after 6 min. Conclusion: During apnoeic periods time to desaturate to <90% was significantly prolonged with use of THRIVE.

  2. Hypnotherapy for sleep disorders.

    Science.gov (United States)

    Ng, Beng-Yeong; Lee, Tih Shih

    2008-08-01

    Hypnosis can be defined as a procedure during which changes in sensations, perceptions, thoughts, feelings or behaviour are suggested. Hypnosis can be used to amplify whatever it is about therapy that makes it therapeutic. It permits a wide range of choices regarding where and how to intervene in the patient's problems. In this paper, we set out to examine the rationale of using hypnotherapy to manage various types of sleep disorders, and to explore the techniques, strategies and hypnotic scripts employed by various hypnotherapists. We also examine the research data available on the efficacy of hypnosis in the treatment of sleep disorders. Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions. Hypnotherapy has also helped with nightmares and sleep terrors. There are several reports of successful use of hypnotherapy for parasomnias, specifically for head and body rocking, bedwetting and sleepwalking. Hypnosis is a specialised technique, not a therapy itself, and should be used as an adjunctive intervention within a complete psychological and medical treatment package. Most of the literature is limited to case reports or studies with such a small sample that at times it is very difficult to interpret the results. There is a major placebo effect, so uncontrolled trials are of limited value. It is hard to perform a randomised, double-blind, controlled trial to evaluate hypnotherapy given that cooperation and rapport between patient and therapist is needed to achieve a receptive trance state.

  3. Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night

    Directory of Open Access Journals (Sweden)

    Sophia Schiza

    2015-06-01

    Full Text Available The prevalence of obstructive sleep apnoea (OSA is continuously increasing in patients with idiopathic pulmonary fibrosis (IPF and, for the first time, the recent IPF guidelines recognise OSA as an important associated comorbidity that can affect patient's survival. Thus, it becomes conceivable that clinicians should refer patients with newly diagnosed IPF to sleep centres for the diagnosis and treatment of OSA as well as for addressing issues regarding the reduced compliance of patients with continuous positive airway pressure therapy. The discovery of biomarkers common to both disorders may help early diagnosis, institution of the most appropriate treatment and follow-up of patients. Better understanding of epigenetic changes may provide useful information about pathogenesis and, possibly, development of new drugs for a dismal disease like IPF.

  4. Sleep Disturbances in Newborns

    OpenAIRE

    Yasova Barbeau, Daphna; Weiss, Michael D.

    2017-01-01

    The purpose of this review is to serve as an introduction to understanding sleep in the fetus, the preterm neonate and the term neonate. Sleep appears to have numerous important roles, particularly in the consolidation of new information. The sleep cycle changes over time, neonates spend the most time in active sleep and have a progressive shortening of active sleep and lengthening of quiet sleep. Additionally, the sleep cycle is disrupted by many things including disease state and environmen...

  5. Sleep disorders in Charcot-Marie-Tooth disease type 1.

    Science.gov (United States)

    Boentert, Matthias; Knop, Katharina; Schuhmacher, Christine; Gess, Burkhard; Okegwo, Angelika; Young, Peter

    2014-03-01

    Obstructive sleep apnoea (OSA) and restless legs syndrome (RLS) have been reported in Charcot-Marie-Tooth disease (CMT) type 1A and axonal subtypes of CMT, respectively. The aim of this case-control study was to investigate both prevalence and severity of OSA, RLS and periodic limb movements in sleep (PLMS) in adult patients with genetically proven CMT1. 61 patients with CMT1 and 61 insomnic control subjects were matched for age, sex, and Body Mass Index. Neurological disability in patients with CMT was assessed using the Functional Disability Scale (FDS). RLS diagnosis was based on a screening questionnaire and structured clinical interviews. All participants underwent overnight polysomnography. OSA was present in 37.7% of patients with CMT1 and 4.9% of controls (psleep quality. In addition to known risk factors, CMT may predispose to OSA. RLS is highly prevalent not only in axonal subtypes of CMT but also in primarily demyelinating subforms of CMT. PLMS are common in CMT1, but do not significantly impair sleep quality.

  6. Short- and long-term health consequences of sleep disruption.

    Science.gov (United States)

    Medic, Goran; Wille, Micheline; Hemels, Michiel Eh

    2017-01-01

    professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption.

  7. Sleep Applications to Assess Sleep Quality.

    Science.gov (United States)

    Fietze, Ingo

    2016-12-01

    This article highlights the potential uses that smartphone applications may have for helping those with sleep problems. Applications in smartphones offer the promised possibility of detection of sleep. From the author's own experience, one can also conclude that sleep applications are approximately as good as polysomnography in detection of sleep time, similar to the conventional wearable actimeters. In the future, sleep applications will help to further enhance awareness of sleep health and to distinguish those who actually poorly and only briefly sleep from those who suffer more likely from paradox insomnia. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Medical comorbidity of sleep disorders.

    Science.gov (United States)

    Dikeos, Dimitris; Georgantopoulos, Georgios

    2011-07-01

    Recently published literature indicates that sleep disorders present with medical comorbidities quite frequently. The coexistence of a sleep disorder with a medical disorder has a substantial impact for both the patient and the health system. Insomnia and hypersomnia are highly comorbid with medical conditions, such as chronic pain and diabetes, as well as with various cardiovascular, respiratory, gastrointestinal, urinary and neurological disorders. Restless legs syndrome and periodic leg movement syndrome have been associated with iron deficiency, kidney disease, diabetes, and neurological, autoimmune, cardiovascular and respiratory disorders. Rapid eye movement behaviour disorder has been described as an early manifestation of serious central nervous system diseases; thus, close neurological monitoring of patients referring with this complaint is indicated. Identification and management of any sleep disorder in medical patients is important for optimizing the course and prognosis. Of equal importance is the search for undetected medical disorder in patients presenting with sleep disorders.

  9. The Use of Precision Medicine to Manage Obstructive Sleep Apnea Treatment in Patients with Resistant Hypertension: Current Evidence and Future Directions.

    Science.gov (United States)

    Sapiña, Esther; Torres, Gerard; Barbé, Ferran; Sánchez-de-la-Torre, Manuel

    2018-06-08

    The significant prevalence of resistant hypertension (RH) and the high cardiovascular risk of the population of patients with RH have indicated the necessity to identify its main causes. Among these, obstructive sleep apnea (OSA) is considered the most well-established cause. In recent years, several studies have shown a beneficial effect of continuous positive airway pressure (CPAP) treatment on blood pressure (BP), but this effect exhibits great variability. The diagnosis and management of OSA in patients with RH suggest a clinical option for a phenotype of patients for whom therapeutic strategies are limited to pharmaceutical therapy and renal denervation. However, the great variability in the CPAP response has increased the necessity to develop instruments to identify patients who could benefit from a treatment that reduces BP. Application of precision medicine to these patients should be considered as a first-line intervention to avoid the prescription of ineffective treatments and excessive consumption of pharmacological drugs that do not ameliorate the cardiovascular risk.

  10. Sleep walking

    Science.gov (United States)

    ... Sleepwalking. In: Chokroverty S, Thomas RJ, eds. Atlas of Sleep Medicine . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2014:380- ... of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare ... NIH MedlinePlus Magazine Read more ...

  11. Sleep behaviors in older African American females reporting nonmalignant chronic pain: understanding the psychosocial implications of general sleep disturbance.

    Science.gov (United States)

    Baker, Tamara A; Whitfield, Keith E

    2014-01-01

    This study examined factors that influence sleep quality in older African American women (N = 181) reporting chronic pain. Participants completed a series of questions assessing demographic and behavioral characteristics, health status, pain intensity, and sleep disturbance. Findings indicated that younger participants and those experiencing poorer physical functioning reported more difficulty sleeping due to pain. Similarly, participants who reported being awakened from sleep due to pain were younger and experienced greater pain intensity. Understanding the relationship between sleep and pain in this group of women may be useful in promoting effective disease management and sleep awareness among patients, caregivers, and healthcare professionals.

  12. Development of Home-Based Sleep Monitoring System for Obstructive Sleep Apnea.

    Science.gov (United States)

    Wu, Peirong; Chen, Guan-Ting; Cui, Yanyan; Li, Jin-Wei; Kuo, Terry B J; Chang, Polun

    2017-01-01

    Obstructive Sleep Apnea (OSA) has been proven to increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes. If people would like to know whether they are suffering from this sleep disorder, they need to go to particular hospital with which a sleep center that could perform polysomnography (PSG); however, for most people, this is not convenient. Consequently, the goal of this study is to develop a convenient, lower priced, and easy-to-use home-based sleep monitoring system. The researchers have developed the "Sleep Healthcare Management System" for OSA patients and healthcare providers. It combines smartphone and wearable devices that can perform real-time sleep monitoring. Healthcare providers could apply their professional knowledge to provide customized feedback via a web application. When the patient is diagnosed with an abnormal sleep health condition, healthcare providers may be able to provide appropriate and timely care.

  13. Recurrent acute pulmonary oedema after aortic and mitral valve surgery due to trachea malacia and obstructive sleep apnoea syndrome

    NARCIS (Netherlands)

    Sankatsing, S. U. C.; Hanselaar, W. E. J. J.; van Steenwijk, R. P.; Van der Sloot, J. A. P.; Broekhuis, E.; Kok, W. E. M.

    2008-01-01

    In this report we describe a patient with recurrent episodes of acute pulmonary oedema after aortic and mitral valve surgery. The first episode of pulmonary oedema was caused by mitral valve dysfunction. The second episode of pulmonary oedema was not clearly associated with a mitral valve problem,

  14. Optimizing Prophylactic CPAP in Patients Without Obstructive Sleep Apnoea for High-Risk Abdominal Surgeries: A Meta-regression Analysis.

    Science.gov (United States)

    Singh, Preet Mohinder; Borle, Anuradha; Shah, Dipal; Sinha, Ashish; Makkar, Jeetinder Kaur; Trikha, Anjan; Goudra, Basavana Gouda

    2016-04-01

    Prophylactic continuous positive airway pressure (CPAP) can prevent pulmonary adverse events following upper abdominal surgeries. The present meta-regression evaluates and quantifies the effect of degree/duration of (CPAP) on the incidence of postoperative pulmonary events. Medical databases were searched for randomized controlled trials involving adult patients, comparing the outcome in those receiving prophylactic postoperative CPAP versus no CPAP, undergoing high-risk abdominal surgeries. Our meta-analysis evaluated the relationship between the postoperative pulmonary complications and the use of CPAP. Furthermore, meta-regression was used to quantify the effect of cumulative duration and degree of CPAP on the measured outcomes. Seventy-three potentially relevant studies were identified, of which 11 had appropriate data, allowing us to compare a total of 362 and 363 patients in CPAP and control groups, respectively. Qualitatively, Odds ratio for CPAP showed protective effect for pneumonia [0.39 (0.19-0.78)], atelectasis [0.51 (0.32-0.80)] and pulmonary complications [0.37 (0.24-0.56)] with zero heterogeneity. For prevention of pulmonary complications, odds ratio was better for continuous than intermittent CPAP. Meta-regression demonstrated a positive correlation between the degree of CPAP and the incidence of pneumonia with a regression coefficient of +0.61 (95 % CI 0.02-1.21, P = 0.048, τ (2) = 0.078, r (2) = 7.87 %). Overall, adverse effects were similar with or without the use of CPAP. Prophylactic postoperative use of continuous CPAP significantly reduces the incidence of postoperative pneumonia, atelectasis and pulmonary complications in patients undergoing high-risk abdominal surgeries. Quantitatively, increasing the CPAP levels does not necessarily enhance the protective effect against pneumonia. Instead, protective effect diminishes with increasing degree of CPAP.

  15. Clinical practices to promote sleep in the ICU

    DEFF Research Database (Denmark)

    Hofhuis, José G M; Rose, Louise; Blackwood, Bronagh

    2018-01-01

    PURPOSE: To describe sleep assessment and strategies to promote sleep in adult ICUs in ten countries. METHODS: Multicenter, self-administered survey sent to nurse managers. RESULTS: Response rate was 66% with 522 ICUs providing data. 'Lying quietly with closed eyes' was the characteristic most...... frequently perceived as indicative of sleep by >60% of responding ICUs in all countries except Italy. Few ICUs (9%) had a protocol for sleep management or used sleep questionnaires (1%). Compared to ICUs in Northern Europe, those in central Europe were more likely to have a sleep promoting protocol (p ....001), and to want to implement a protocol (p 80% of responding ICUs, the most common non-pharmacological sleep-promoting interventions were reducing ICU staff noise, light, and nurse interventions at night; only 18% used earplugs frequently. Approximately 50% of ICUs reported sleep medication...

  16. Sleep disorders as core symptoms of depression.

    Science.gov (United States)

    Nutt, David; Wilson, Sue; Paterson, Louise

    2008-01-01

    Links between sleep and depression are strong. About three quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults and 10% of older patients, with a preponderance in females. The symptoms cause huge distress, have a major impact on quality of life, and are a strong risk factor for suicide. As well as the subjective experience of sleep symptoms, there are well-documented changes in objective sleep architecture in depression. Mechanisms of sleep regulation and how they might be disturbed in depression are discussed. The sleep symptoms are often unresolved by treatment, and confer a greater risk of relapse and recurrence. Epidemiological studies have pointed out that insomnia in nondepressed subjects is a risk factor for later development of depression. There is therefore a need for more successful management of sleep disturbance in depression, in order to improve quality of life in these patients and reduce an important factor in depressive relapse and recurrence.

  17. Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party.

    Science.gov (United States)

    Robb, P J; Bew, S; Kubba, H; Murphy, N; Primhak, R; Rollin, A-M; Tremlett, M

    2009-07-01

    During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not available, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominated expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limited evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decision-making at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endorsing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a 'concise, accurate and helpful document'. The consensus statement is an interim working tool, based on level-five evidence. It

  18. Are baby hammocks safe for sleeping babies? A randomised controlled trial.

    Science.gov (United States)

    Chiu, Karen; Tonkin, Shirley L; Gunn, Alistair J; McIntosh, Christine C

    2014-07-01

    Two reports of infants found dead after sleeping in baby hammocks have raised international concern about the safety of infant hammocks. We therefore tested whether hammock sleep affected oxygenation in infants, when they were at an age of high risk of sudden, unexpected infant death. Healthy, full-term 4- to 8-week-old infants were randomised to sleep either in a commercially available hammock (n = 14) or a standard bassinet (n = 9), and sleep state, oxygen desaturation (a fall in peripheral haemoglobin oxygen saturation (SpO2 ) ≥ 4%, for ≥ 4 sec from baseline to nadir), apnoea and hypopnoea, and mean SpO2 were analysed. There was no significant difference in mean SpO2 (both 98.5%) or rate of oxygen desaturation events between the hammock and the bassinet cot (mean ± SD, 24 ± 20 vs. 28 ± 23 events per hour), but infants slept less in the hammock (59 ± 31 vs. 81 ± 34 min, p baby hammocks, nor to older babies, particularly once the infant can roll. Given that it is not possible to predict when an infant will be able to roll, we strongly recommend that hammocks should not be used for unsupervised sleep. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  19. Sleep-related Issues for Recovery and Performance in Athletes.

    Science.gov (United States)

    Kölling, Sarah; Duffield, Rob; Erlacher, Daniel; Venter, Ranel; Halson, Shona L

    2018-04-13

    The body of research that reports the relevance of sleep in high-performance sports is growing steadily. While the identification of sleep cycles and diagnosis of sleep disorders is limited to lab-based assessment via polysomnography, the development of activity-based devices estimating sleep patterns provides greater insight into the sleep behaviour of athletes in ecological settings. Overall, small sleep quantity and/or poor quality appears to exist in many athletic populations, though this may be related to training and competition context. Typical sleep-affecting factors are the scheduling of training sessions and competitions as well as impaired sleep-onset as a result of increased arousal prior to competition or due to the use of electronic devices before bedtime. Further challenges are travel demands which may be accompanied by jet-lag symptoms and disruption of sleep habits. Promotion of sleep may be approached via behavioural strategies, such as sleep hygiene, extending night-time sleep or daytime napping. Pharmacological interventions should be limited to clinically-induced treatments as evidence among healthy and athletic populations is lacking. To optimise and manage sleep in athletes, it is recommended to implement routine sleep monitoring on an individual basis.

  20. Sleep and Newborns

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Sleep and Newborns KidsHealth / For Parents / Sleep and Newborns ... night it is. How Long Will My Newborn Sleep? Newborns should get 14 to 17 hours of ...

  1. Sleep Apnea Information Page

    Science.gov (United States)

    ... Page You are here Home » Disorders » All Disorders Sleep Apnea Information Page Sleep Apnea Information Page What research is being done? ... Institutes of Health (NIH) conduct research related to sleep apnea in laboratories at the NIH, and also ...

  2. Sleep Eduction: Treatment & Therapy

    Science.gov (United States)

    Find a Sleep Center Use the following fields to locate sleep centers in your area. Search radius (in miles): 10 25 50 Share: Essentials in Sleep Insomnia Overview & Facts Symptoms & Causes Diagnosis & Self Tests ...

  3. Sleep Disorders (PDQ)

    Science.gov (United States)

    ... Types of Cancer Treatment Surgery Radiation Therapy External Beam Radiation Internal Radiation Therapy Side Effects Chemotherapy Immunotherapy ... asleep, sleeping, or waking from sleep, such as walking, talking, or eating. Sleep disorders keep you from ...

  4. Brain Basics: Understanding Sleep

    Science.gov (United States)

    ... You are here Home » Disorders » Patient & Caregiver Education Brain Basics: Understanding Sleep Anatomy of Sleep Sleep Stages ... t form or maintain the pathways in your brain that let you learn and create new memories, ...

  5. Consumer sleep tracking devices: a critical review.

    Science.gov (United States)

    Lee, Jeon; Finkelstein, Joseph

    2015-01-01

    Consumer sleep tracking devices are widely advertised as effective means to monitor and manage sleep quality and to provide positive effects on overall heath. However objective evidence supporting these claims is not always readily available. The goal of this study was to perform a comprehensive review of available information on six representative sleep tracking devices: BodyMedia FIT, Fitbit Flex, Jawbone UP, Basis Band, Innovative Sleep Solutions SleepTracker, and Zeo Sleep Manager Pro. The review was conducted along the following dimensions: output metrics, theoretical frameworks, systematic evaluation, and FDA clearance. The review identified a critical lack of basic information about the devices: five out of six devices provided no supporting information on their sensor accuracy and four out of six devices provided no information on their output metrics accuracy. Only three devices were found to have related peer-reviewed articles. However in these articles wake detection accuracy was revealed to be quite low and to vary widely (BodyMedia, 49.9±3.6%; Fitbit, 19.8%; Zeo, 78.9% to 83.5%). No supporting evidence on how well tracking devices can help mitigate sleep loss and manage sleep disturbances in practical life was provided.

  6. The impact of altitude on the sleep of young elite soccer players (ISA3600)

    Science.gov (United States)

    Sargent, Charli; Schmidt, Walter F; Aughey, Robert J; Bourdon, Pitre C; Soria, Rudy; Claros, Jesus C Jimenez; Garvican-Lewis, Laura A; Buchheit, Martin; Simpson, Ben M; Hammond, Kristal; Kley, Marlen; Wachsmuth, Nadine; Gore, Christopher J; Roach, Gregory D

    2013-01-01

    Background Altitude training is used by elite athletes to improve sports performance, but it may also disrupt sleep. The aim of this study was to examine the effects of 2 weeks at high altitude on the sleep of young elite athletes. Methods Participants (n=10) were members of the Australian under-17 soccer team on an 18-day (19-night) training camp in Bolivia, with six nights at near sea level in Santa Cruz (430 m) and 13 nights at high altitude in La Paz (3600 m). Sleep was monitored using polysomnography during a baseline night at 430 m and three nights at 3600 m (immediately after ascent, 1 week after ascent and 2 weeks after ascent). Data were analysed using effect size statistics. Results All results are reported as comparisons with baseline. Rapid eye movement (REM) sleep was likely lower immediately upon ascent to altitude, possibly lower after 1 week and similar after 2 weeks. On all three nights at altitude, hypopneas and desaturations were almost certainly higher; oxygen saturation was almost certainly lower; and central apnoeas, respiratory arousals and periodic breathing were very likely higher. The effects on REM sleep were common to all but one participant, but the effects on breathing were specific to only half the participants. Conclusions The immediate effects of terrestrial altitude of 3600 m are to reduce the amount of REM sleep obtained by young elite athletes, and to cause 50% of them to have impaired breathing during sleep. REM sleep returns to normal after 2 weeks at altitude, but impaired breathing does not improve. PMID:24282215

  7. Beyond factor analysis: Multidimensionality and the Parkinson's Disease Sleep Scale-Revised.

    Directory of Open Access Journals (Sweden)

    Maria E Pushpanathan

    Full Text Available Many studies have sought to describe the relationship between sleep disturbance and cognition in Parkinson's disease (PD. The Parkinson's Disease Sleep Scale (PDSS and its variants (the Parkinson's disease Sleep Scale-Revised; PDSS-R, and the Parkinson's Disease Sleep Scale-2; PDSS-2 quantify a range of symptoms impacting sleep in only 15 items. However, data from these scales may be problematic as included items have considerable conceptual breadth, and there may be overlap in the constructs assessed. Multidimensional measurement models, accounting for the tendency for items to measure multiple constructs, may be useful more accurately to model variance than traditional confirmatory factor analysis. In the present study, we tested the hypothesis that a multidimensional model (a bifactor model is more appropriate than traditional factor analysis for data generated by these types of scales, using data collected using the PDSS-R as an exemplar. 166 participants diagnosed with idiopathic PD participated in this study. Using PDSS-R data, we compared three models: a unidimensional model; a 3-factor model consisting of sub-factors measuring insomnia, motor symptoms and obstructive sleep apnoea (OSA and REM sleep behaviour disorder (RBD symptoms; and, a confirmatory bifactor model with both a general factor and the same three sub-factors. Only the confirmatory bifactor model achieved satisfactory model fit, suggesting that PDSS-R data are multidimensional. There were differential associations between factor scores and patient characteristics, suggesting that some PDSS-R items, but not others, are influenced by mood and personality in addition to sleep symptoms. Multidimensional measurement models may also be a helpful tool in the PDSS and the PDSS-2 scales and may improve the sensitivity of these instruments.

  8. Sleep disordered breathing, insomnia, and health related quality of life -- a comparison between age and gender matched elderly with heart failure or without cardiovascular disease.

    Science.gov (United States)

    Johansson, Peter; Arestedt, Kristoffer; Alehagen, Urban; Svanborg, Eva; Dahlström, Ulf; Broström, Anders

    2010-06-01

    The aims of this study are (I) to compare the prevalence of sleep disordered breathing (SDB) and insomnia between elderly with heart failure (HF) and age and gender matched elderly without cardiovascular disease (CVD), and (II) to examine the association between HF, SDB and insomnia, as well as their impact on health related quality of life (Hr-QoL). Three hundred and thirty-one elderly (71-87 years) community-living individuals underwent sleep recordings and echocardiography. Questionnaires assessed insomnia and Hr-QoL. Comparisons were made between age and gender matched individuals with HF (n=36) and without CVD (n=36). The HF group had higher mean apnoea-hypopnoea index (17.6 vs. 6.3, pinsomnia or EDS. SDB, DMS and EDS are more common in elderly with HF. SDB is not an obvious cause for sleep complaints or poor Hr-QoL in elderly. Copyright (c) 2009. Published by Elsevier B.V.

  9. On-call work: To sleep or not to sleep? It depends.

    Science.gov (United States)

    Ferguson, Sally A; Paterson, Jessica L; Hall, Sarah J; Jay, Sarah M; Aisbett, Brad

    On-call working time arrangements are increasingly common, involve work only in the event of an unpredictable incident and exist primarily outside of standard hours. Like other non-standard working time arrangements, on-call work disrupts sleep and can therefore have negative effects on health, safety and performance. Unlike other non-standard working time arrangements, on-call work often allows sleep opportunities between calls. Any sleep obtained during on-call periods will be beneficial for waking performance. However, there is evidence that sleep while on call may be of substantially reduced restorative value because of the expectation of receiving the call and apprehension about missing the call. In turn, waking from sleep to respond to a call may be associated with temporary increases in performance impairment. This is dependent on characteristics of both the preceding sleep, the tasks required upon waking and the availability and utility of any countermeasures to support the transition from sleep to wake. In this paper, we critically evaluate the evidence both for and against sleeping during on-call periods and conclude that some sleep, even if it is of reduced quality and broken by repeated calls, is a good strategy. We also note, however, that organisations utilising on-call working time arrangements need to systematically manage the likelihood that on-call sleep can be associated with temporary performance impairments upon waking. Given that the majority of work in this area has been laboratory-based, there is a significant need for field-based investigations of the magnitude of sleep inertia, in addition to the utility of sleep inertia countermeasures. Field studies should include working with subject matter experts to identify the real-world impacts of changes in performance associated with sleeping, or not sleeping, whilst on call.

  10. Fiber and Saturated Fat Are Associated with Sleep Arousals and Slow Wave Sleep.

    Science.gov (United States)

    St-Onge, Marie-Pierre; Roberts, Amy; Shechter, Ari; Choudhury, Arindam Roy

    2016-01-01

    Sleep restriction alters food intake, but less is known about how dietary patterns affect sleep. Current goals were to determine whether: (1) sleep is different after consumption of a controlled diet vs. an ad libitum diet, and (2) dietary intake during ad libitum feeding is related to nocturnal sleep. Twenty-six normal weight adults (30-45 y), habitually sleeping 7-9 h/night, participated in a randomized-crossover inpatient study with 2 phases of 5 nights: short (4 h in bed) or habitual (9 h in bed) sleep. Only data from the habitual sleep phase were used for the present analyses. During the first 4 days, participants consumed a controlled diet; on day 5, food intake was self-selected. Linear regression was used to determine relations between daytime food intake and nighttime sleep on day 5. Sleep duration did not differ after 3 days of controlled feeding vs. a day of ad libitum intake. However, sleep after ad libitum eating had less slow wave sleep (SWS, P = 0.0430) and longer onset latency (P = 0.0085). Greater fiber intake predicted less stage 1 (P = 0.0198) and more SWS (P = 0.0286). Percent of energy from saturated fat predicted less SWS (P = 0.0422). Higher percent of energy from sugar and other carbohydrates not considered sugar or fiber was associated with arousals (P = 0.0320 and 0.0481, respectively). Low fiber and high saturated fat and sugar intake is associated with lighter, less restorative sleep with more arousals. Diet could be useful in the management of sleep disorders but this needs to be tested. http://www.clinicaltrials.gov, #NCT00935402. © 2016 American Academy of Sleep Medicine.

  11. Randomized controlled trial of the Valencia model of waking hypnosis plus CBT for pain, fatigue, and sleep management in patients with cancer and cancer survivors.

    Science.gov (United States)

    Mendoza, M E; Capafons, A; Gralow, J R; Syrjala, K L; Suárez-Rodríguez, J M; Fann, J R; Jensen, M P

    2017-11-01

    This study evaluated the efficacy of an intervention combining the Valencia model of waking hypnosis with cognitive-behavioral therapy (VMWH-CBT) in managing cancer-related pain, fatigue, and sleep problems in individuals with active cancer or who were post-treatment survivors. We hypothesized that four sessions of VMWH-CBT would result in greater improvement in participants' symptoms than four sessions of an education control intervention. Additionally, we examined the effects on several secondary outcome domains that are associated with increases in these symptoms (depression, pain interference, pain catastrophizing, and cancer treatment distress). The study design was a randomized controlled crossover clinical trial comparing the VMWH-CBT intervention with education control. Participants (N = 44) received four sessions of both treatments, in a counterbalanced order (n = 22 per order condition). Participants were 89% female (N = 39) with mean age of 61 years (SD = 12.2). They reported significantly greater improvement after receiving the active treatment relative to the control condition in all the outcome measures. Treatment gains were maintained at 3-month follow-up. This study supports the beneficial effects of the VMWH-CBT intervention relative to a control condition and that treatment gains remain stable. VMWH-CBT-trained clinicians should be accessible for managing symptoms both during and after cancer treatment, though the findings need to be replicated in larger samples of cancer survivors. Copyright © 2016 John Wiley & Sons, Ltd.

  12. [Analysis and management of postoperative hemorrhage in surgery of obstructive sleep apnea hypopnea syndrome in children using plasma-mediated radio-frequency ablation at low temperature].

    Science.gov (United States)

    Wang, Jun; Chen, Jie; Yang, Jun

    2013-09-01

    To analyze retrospectively cause, prevention and management of postoperative hemorrhage in surgery of obstructive sleep apnea hypopnea syndrome (OSAHS) in children using plasma-mediated radio-frequency (pmRF) ablation at low temperature. Tonsil and adenoid ablation were carried out in 4028 cases diagnosed with OSAHS, using ENTColator lI plasma system of Arthocare company under general anesthesia. Postoperative hemorrhage occurred in 37 cases of 4028 cases, among which 1 case occurred after tonsil ablation and other 36 cases occurred after adenoid ablation. Primary hemorrhage was in 7 cases, while secondary hemorrhage in other 30 cases. Cessation of bleeding was achieved by using different methods of hemostasis in all cases. Tonsil and adenoid ablation were performed by pmRF at low temperature with advantages of less trauma, less bleeding. However, postoperative hemorrhage might occur in a few cases (accounting for 0.92%). Postoperative hemorrhage in these patients was related with preoperatively incomplete control of inflammation of tonsil or adenoid, surgeon's experience, intraoperatively incomplete hemostasis, postoperative crying and restlessness, eating improperly in two weeks after surgery, coagulation factor deficiency. In case of postoperative hemorrhage, good outcome could be achieved by management of compression, pmRF at low temperature, bipolar coagulation.

  13. Sleep: A Health Imperative

    Science.gov (United States)

    Luyster, Faith S.; Strollo, Patrick J.; Zee, Phyllis C.; Walsh, James K.

    2012-01-01

    Chronic sleep deficiency, defined as a state of inadequate or mistimed sleep, is a growing and underappreciated determinant of health status. Sleep deprivation contributes to a number of molecular, immune, and neural changes that play a role in disease development, independent of primary sleep disorders. These changes in biological processes in response to chronic sleep deficiency may serve as etiological factors for the development and exacerbation of cardiovascular and metabolic diseases and, ultimately, a shortened lifespan. Sleep deprivation also results in significant impairments in cognitive and motor performance which increase the risk of motor vehicle crashes and work-related injuries and fatal accidents. The American Academy of Sleep Medicine and the Sleep Research Society have developed this statement to communicate to national health stakeholders the current knowledge which ties sufficient sleep and circadian alignment in adults to health. Citation: Luyster FS; Strollo PJ; Zee PC; Walsh JK. Sleep: a health imperative. SLEEP 2012;35(6):727-734. PMID:22654183

  14. Sleep for cognitive enhancement

    Directory of Open Access Journals (Sweden)

    Susanne eDiekelmann

    2014-04-01

    Full Text Available Sleep is essential for effective cognitive functioning. Loosing even a few hours of sleep can have detrimental effects on a wide variety of cognitive processes such as attention, language, reasoning, decision making, learning and memory. While sleep is necessary to ensure normal healthy cognitive functioning, it can also enhance performance beyond the boundaries of the normal condition. This article discusses the enhancing potential of sleep, mainly focusing on the domain of learning and memory. Sleep is known to facilitate the consolidation of memories learned before sleep as well as the acquisition of new memories to be learned after sleep. According to a widely held model this beneficial effect of sleep relies on the neuronal reactivation of memories during sleep that is associated with sleep-specific brain oscillations (slow oscillations, spindles, ripples as well as a characteristic neurotransmitter milieu. Recent research indicates that memory processing during sleep can be boosted by (i cueing memory reactivation during sleep, (ii stimulating sleep-specific brain oscillations, and (iii targeting specific neurotransmitter systems pharmacologically. Olfactory and auditory cues can be used, for example, to increase reactivation of associated memories during post-learning sleep. Intensifying neocortical slow oscillations (the hallmark of slow wave sleep by electrical or auditory stimulation and modulating specific neurotransmitters such as noradrenaline and glutamate likewise facilitates memory processing during sleep. With this evidence in mind, this article concludes by discussing different methodological caveats and ethical issues that should be considered when thinking about using sleep for cognitive enhancement in everyday applications.

  15. Adolescents' Sleep Behaviors and Perceptions of Sleep

    Science.gov (United States)

    Noland, Heather; Price, James H.; Dake, Joseph; Telljohann, Susan K.

    2009-01-01

    Background: Sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents. This study extends our understanding of how adolescents perceive and deal with their sleep issues. Methods: General education classes were…

  16. Weight Management

    Science.gov (United States)

    ... Health Information Weight Management English English Español Weight Management Obesity is a chronic condition that affects more ... Liver (NASH) Heart Disease & Stroke Sleep Apnea Weight Management Topics About Food Portions Bariatric Surgery for Severe ...

  17. Sleep problems in children with attention-deficit hyperactivity disorder: associations with parenting style and sleep hygiene.

    Science.gov (United States)

    Sciberras, Emma; Song, Jie Cheng; Mulraney, Melissa; Schuster, Tibor; Hiscock, Harriet

    2017-09-01

    We aimed to examine the association between sleep problems and parenting and sleep hygiene in children with attention-deficit/hyperactivity disorder (ADHD). Participants included 5-13-year-old children with DSM 5 defined ADHD and a parent-reported moderate-to-severe sleep problem (N = 361). Sleep was assessed using the parent-reported Children's Sleep Habits Questionnaire. Parents also completed checklists assessing sleep hygiene, parenting consistency, and parenting warmth. Linear regression established prediction models controlling for confounding variables including child age and sex, ADHD symptom severity, comorbidities, medication use, and socio-demographic factors. More consistent parenting was associated with decreased bedtime resistance (β = -0.16) and decreased sleep anxiety (β = -0.14), while greater parental warmth was associated with increased parasomnias (β = +0.18) and sleep anxiety (β = +0.13). Poorer sleep hygiene was associated with increased bedtime resistance (β = +0.20), increased daytime sleepiness (β = +0.12), and increased sleep duration problems (β = +0.13). In conclusion, sleep hygiene and parenting are important modifiable factors independently associated with sleep problems in children with ADHD. These factors should be considered in the management of sleep problems in children with ADHD.

  18. Are You Sleep Deprived?

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Sleep Disorders Are You Sleep Deprived? Past Issues / Summer 2015 Table of Contents ... even if you think you've had enough sleep? You might have a sleep disorder. There are ...

  19. The Sleeping Cerebellum

    NARCIS (Netherlands)

    Canto, Cathrin B; Onuki, Yoshiyuki; Bruinsma, Bastiaan; van der Werf, Ysbrand D; De Zeeuw, Chris I

    2017-01-01

    We sleep almost one-third of our lives and sleep plays an important role in critical brain functions like memory formation and consolidation. The role of sleep in cerebellar processing, however, constitutes an enigma in the field of neuroscience; we know little about cerebellar sleep-physiology,

  20. Sleep education during pregnancy for new mothers

    Directory of Open Access Journals (Sweden)

    Kempler Liora

    2012-12-01

    Full Text Available Abstract Background There is a high association between disturbed (poor quality sleep and depression, which has lead to a consensus that there is a bidirectional relationship between sleep and mood. One time in a woman’s life when sleep is commonly disturbed is during pregnancy and following childbirth. It has been suggested that sleep disturbance is another factor that may contribute to the propensity for women to become depressed in the postpartum period compared to other periods in their life. Post Natal Depression (PND is common (15.5% and associated with sleep disturbance, however, no studies have attempted to provide a sleep-focused intervention to pregnant women and assess whether this can improve sleep, and consequently maternal mood post-partum. The primary aim of this research is to determine the efficacy of a brief psychoeducational sleep intervention compared with a control group to improve sleep management, with a view to reduce depressive symptoms in first time mothers. Method This randomised controlled trial will recruit 214 first time mothers during the last trimester of their pregnancy. Participants will be randomised to receive either a set of booklets (control group or a 3hour psychoeducational intervention that focuses on sleep. The primary outcomes of this study are sleep-related, that is sleep quality and sleepiness for ten months following the birth of the baby. The secondary outcome is depressive symptoms. It is hypothesised that participants in the intervention group will have better sleep quality and sleepiness in the postpartum period than women in the control condition. Further, we predict that women who receive the sleep intervention will have lower depression scores postpartum compared with the control group. Discussion This study aims to provide an intervention that will improve maternal sleep in the postpartum period. If sleep can be effectively improved through a brief psychoeducational program, then it may

  1. [Natural factors influencing sleep].

    Science.gov (United States)

    Jurkowski, Marek K; Bobek-Billewicz, Barbara

    2007-01-01

    Sleep is a universal phenomenon of human and animal lives, although the importance of sleep for homeo-stasis is still unknown. Sleep disturbances influence many behavioral and physiologic processes, leading to health complications including death. On the other hand, sleep improvement can beneficially influence the course of healing of many disorders and can be a prognostic of health recovery. The factors influencing sleep have different biological and chemical origins. They are classical hormones, hypothalamic releasing and inhibitory hormones, neuropeptides, peptides and others as cytokines, prostaglandins, oleamid, adenosine, nitric oxide. These factors regulate most physiologic processes and are likely elements integrating sleep with physiology and physiology with sleep in health and disorders.

  2. Sleep and cognition.

    Science.gov (United States)

    Deak, Maryann C; Stickgold, Robert

    2010-07-01

    Sleep is a complex physiologic state, the importance of which has long been recognized. Lack of sleep is detrimental to humans and animals. Over the past decade, an important link between sleep and cognitive processing has been established. Sleep plays an important role in consolidation of different types of memory and contributes to insightful, inferential thinking. While the mechanism by which memories are processed in sleep remains unknown, several experimental models have been proposed. This article explores the link between sleep and cognition by reviewing (1) the effects of sleep deprivation on cognition, (2) the influence of sleep on consolidation of declarative and non-declarative memory, and (3) some proposed models of how sleep facilitates memory consolidation in sleep. Copyright © 2010 John Wiley & Sons, Ltd. For further resources related to this article, please visit the WIREs website. Copyright © 2010 John Wiley & Sons, Ltd.

  3. Sleep disorders in children

    OpenAIRE

    Montgomery, Paul; Dunne, Danielle

    2007-01-01

    Sleep disorders may affect 20-30% of young children, and include excessive daytime sleepiness, problems getting to sleep (dysomnias), or undesirable phenomena during sleep (parasomnias), such as sleep terrors, and sleepwalking. Children with physical or learning disabilities are at increased risk of sleep disorders. Other risk factors include the child being the first born, having a difficult temperament or having had colic, and increased maternal responsiveness.

  4. Sleep disorders in children

    OpenAIRE

    Bruni, Oliveiero; Novelli, Luana

    2010-01-01

    Sleep disorders may affect between 20% and 30% of young children, and include problems getting to sleep (dyssomnias) or undesirable phenomena during sleep (parasomnias), such as sleep terrors and sleepwalking. Children with physical or learning disabilities are at increased risk of sleep disorders. Other risk factors include the child being the first born, having a difficult temperament or having had colic, and increased maternal responsiveness.

  5. Ostriches sleep like platypuses.

    Directory of Open Access Journals (Sweden)

    John A Lesku

    Full Text Available Mammals and birds engage in two distinct states of sleep, slow wave sleep (SWS and rapid eye movement (REM sleep. SWS is characterized by slow, high amplitude brain waves, while REM sleep is characterized by fast, low amplitude waves, known as activation, occurring with rapid eye movements and reduced muscle tone. However, monotremes (platypuses and echidnas, the most basal (or 'ancient' group of living mammals, show only a single sleep state that combines elements of SWS and REM sleep, suggesting that these states became temporally segregated in the common ancestor to marsupial and eutherian mammals. Whether sleep in basal birds resembles that of monotremes or other mammals and birds is unknown. Here, we provide the first description of brain activity during sleep in ostriches (Struthio camelus, a member of the most basal group of living birds. We found that the brain activity of sleeping ostriches is unique. Episodes of REM sleep were delineated by rapid eye movements, reduced muscle tone, and head movements, similar to those observed in other birds and mammals engaged in REM sleep; however, during REM sleep in ostriches, forebrain activity would flip between REM sleep-like activation and SWS-like slow waves, the latter reminiscent of sleep in the platypus. Moreover, the amount of REM sleep in ostriches is greater than in any other bird, just as in platypuses, which have more REM sleep than other mammals. These findings reveal a recurring sequence of steps in the evolution of sleep in which SWS and REM sleep arose from a single heterogeneous state that became temporally segregated into two distinct states. This common trajectory suggests that forebrain activation during REM sleep is an evolutionarily new feature, presumably involved in performing new sleep functions not found in more basal animals.

  6. Sleep and cognitive dysfunctions. Therapeutic approach

    Directory of Open Access Journals (Sweden)

    M.G. Poluektov

    2014-01-01

    Full Text Available This review focuses on the possible mechanisms of sleep disorders in patients with cognitive impairment (CI of different severity. The interrelation between CI, emotional disorders and insomnia, as well as the dependence of CI severity on the degree of sleep disorders, are discussed. The issues related to treatment of sleep disorders in patients with CI, the advantages and disadvantages of modern somnogenic medications are studied. Recommendations on management of patients with a combination of sleep disorders and CI are provided. Data on the use of Egb 761 to treat CI no dementia and melatonin-based drugs to treat sleep disorders in patients with CI are presented. 

  7. Sleep quality under mild hypoxia in men with low hypoxic ventilatory response.

    Science.gov (United States)

    Hoshikawa, Masako; Uchida, Sunao; Ganeko, Masashi; Sumitomo, Junya; Totoki, Masatsugu; Kojima, Takuto; Nakamura, Yukiko; Kawahara, Takashi

    2014-01-01

    The present study evaluated whether slow-wave sleep and whole-night delta power of the non-rapid eye movement (NREM) sleep electroencephalogram (EEG) decrease during sleep at a simulated altitude of 2000 m, and whether such changes related to measures of hypoxic ventilatory response (HVR). This study consisted of two parts; in the first, HVR was measured in 41 subjects and each seven subjects with the lowest or the highest HVR were selected for the subsequent sleep study. In the second part, polysomnogram, arterial oxygen saturation (SpO2) and respiratory events are recorded on the selected subjects under normoxic and hypoxic conditions. Hypoxia decreased SpO2 and increased respiratory disturbances for both groups. The low HVR group, but not the high HVR group, showed decreases in the whole-night delta power of NREM sleep EEG under hypoxia. On the other hand, two subjects in the high HVR group, who showed relatively high apnoea indices, also showed lower SpO2 nadirs and decreases in the whole-night delta power under hypoxia. These results suggest that acute hypoxia equivalent to that at a 2000 m altitude decreases slow-wave sleep in individuals that show low HVR. However, low HVR may not be the only, but one of some factors that decrease the whole-night delta power under hypoxia. Therefore, it was not sufficient to identify individuals likely to be susceptible to deteriorated sleep quality at a simulated altitude of 2000 m only using the HVR test. Other factors, which relate to respiratory instabilities, should be taken into consideration to identify them.

  8. Rhythm disturbances in childhood obstructive sleep apnea during apnea-hypopnea episodes

    International Nuclear Information System (INIS)

    Khositseth, Anant; Chokechuleekorn, Jittamas; Kuptanon, Teeradej; Leejakpai, Anchalee

    2013-01-01

    Obstructive sleep apnoea (OSA) can result in cardiovascular complications. Nocturnal arrhythmias are reported up to 50% of adult OSA patients. Arrhythmias and heart rate variability in children with OSA have not been well studied. We sought to study rhythm disturbances in childhood OSA and also to analyze the relationship of heart rate variability to the severity of OSA in children. In a retrospective cross sectional study, records of children aged < 15 years with history of snoring and suspected OSA, who had undergone polysomnography (PSG) for first time were analyzed. The cardiac rhythm and heart rate variability were studied during PSG. A total of 124 patients diagnosed with OSA were grouped into mild (n = 52), moderate (n = 30), and severe (n = 42) OSA. During PSG, all had sinus arrhythmias and only three patients had premature atrial contractions (PACs). The standard deviation of heart rate (SD-HR) during rapid eye movement (REM) sleep in severe OSA (9.1 ± 2.4) was significantly higher than SD-HR in mild OSA (7.5 ± 1.3, P < 0.0001). The maximum heart rate (max-HR) during REM-sleep in severe OSA (132.1 ± 22.1) was significantly higher than the max-HR in mild OSA (121.3 ± 12.6 bpm, P = 0.016). There was no significant arrhythmia in children with OSA during their sleep. Heart rate variability correlated with the severity of OSA

  9. Adolescents' sleep behaviors and perceptions of sleep.

    Science.gov (United States)

    Noland, Heather; Price, James H; Dake, Joseph; Telljohann, Susan K

    2009-05-01

    Sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents. This study extends our understanding of how adolescents perceive and deal with their sleep issues. General education classes were randomly selected from a convenience sample of three high schools in the Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviors and perceptions of sleep. Most respondents (91.9%) obtained inadequate sleep (sleep each week night. The majority indicated that not getting enough sleep had the following effects on them: being more tired during the day (93.7%), having difficulty paying attention (83.6%), lower grades (60.8%), increase in stress (59.0%), and having difficulty getting along with others (57.7%). Some students reported engaging in harmful behaviors to help them sleep: taking sleeping pills (6.0%), smoking a cigarette to relax (5.7%), and drinking alcohol in the evening (2.9%). Students who received fewer hours of sleep were significantly more likely to report being stressed (p = .02) and were more likely to be overweight (p = .04). Inadequate sleep time may be contributing to adolescent health problems such as increased stress and obesity. Findings indicate a need for sleep hygiene education for adolescents and their parents. A long-term solution to chronic sleep deprivation among high school students could include delaying high school start times, such as was done successfully in the Minneapolis Public School District.

  10. Control of upper airway muscle activity in younger versus older men during sleep onset

    Science.gov (United States)

    Fogel, Robert B; White, David P; Pierce, Robert J; Malhotra, Atul; Edwards, Jill K; Dunai, Judy; Kleverlaan, Darci; Trinder, John

    2003-01-01

    Pharyngeal dilator muscles are clearly important in the pathophysiology of obstructive sleep apnoea syndrome (OSA). We have previously shown that the activity of both the genioglossus (GGEMG) and tensor palatini (TPEMG) are decreased at sleep onset, and that this decrement in muscle activity is greater in the apnoea patient than in healthy controls. We have also previously shown this decrement to be greater in older men when compared with younger ones. In order to explore the mechanisms responsible for this decrement in muscle activity nasal continuous positive airway pressure (CPAP) was applied to reduce negative pressure mediated muscle activation. We then investigated the effect of sleep onset (transition from predominantly α to predominantly θ EEG activity) on ventilation, upper airway muscle activation and upper airway resistance (UAR) in middle-aged and younger healthy men. We found that both GGEMG and TPEMG were reduced by the application of nasal CPAP during wakefulness, but that CPAP did not alter the decrement in activity in either muscle seen in the first two breaths following an α to θ transition. However, CPAP prevented both the rise in UAR at sleep onset that occurred on the control night, and the recruitment in GGEMG seen in the third to fifth breaths following the α to θ transition. Further, GGEMG was higher in the middle-aged men than in the younger men during wakefulness and was decreased more in the middle-aged men with the application of nasal CPAP. No differences were seen in TPEMG between the two age groups. These data suggest that the initial sleep onset reduction in upper airway muscle activity is due to loss of a ‘wakefulness’ stimulus, rather than to loss of responsiveness to negative pressure. In addition, it suggests that in older men, higher wakeful muscle activity is due to an anatomically more collapsible upper airway with more negative pressure driven muscle activation. Sleep onset per se does not appear to have a greater

  11. The role of sleep hygiene in promoting public health: A review of empirical evidence.

    Science.gov (United States)

    Irish, Leah A; Kline, Christopher E; Gunn, Heather E; Buysse, Daniel J; Hall, Martica H

    2015-08-01

    The ineffectiveness of sleep hygiene as a treatment in clinical sleep medicine has raised some interesting questions. If it is known that, individually, each specific component of sleep hygiene is related to sleep, why wouldn't addressing multiple individual components (i.e., sleep hygiene education) improve sleep? Is there still a use for sleep hygiene? Global public health concern over sleep has increased demand for sleep promotion strategies accessible to the population. However, the extent to which sleep hygiene strategies apply outside clinical settings is not well known. The present review sought to evaluate the empirical evidence for sleep hygiene recommendations regarding exercise, stress management, noise, sleep timing, and avoidance of caffeine, nicotine, alcohol, and daytime napping, with a particular emphasis on their public health utility. Thus, our review is not intended to be exhaustive regarding the clinical application of these techniques, but rather to focus on broader applications. Overall, though epidemiologic and experimental research generally supported an association between individual sleep hygiene recommendations and nocturnal sleep, the direct effects of individual recommendations on sleep remains largely untested in the general population. Suggestions for clarification of sleep hygiene recommendations and considerations for the use of sleep hygiene in nonclinical populations are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Shift work, night work and sleep disorders among pastry cookers and shopkeepers in France: a cross-sectional survey.

    Science.gov (United States)

    Pepin, Emilie; Gillet, Pascal; Sauvet, Fabien; Gomez-Merino, Danielle; Thaon, Isabelle; Chennaoui, Mounir; Leger, Damien

    2018-05-09

    Most research on night and shift work focuses on employee health in large companies, primarily in the healthcare and transportation sectors. However, many night workers work on their own or in small businesses related to services or food. This survey focuses on sleep habits and disorders concerning night work in pastry production and sales. An epidemiological telephone cross-sectional survey of night shift workers and their sleep habits was proposed to all employers and employees in the French pastry industry via their insurance health prevention company. Sleep logs allow us to estimate the total sleep time (TST) on workdays and enquire on napping episodes and length. In order to estimate the ideal TST, we added a question on the ideal amount of sleep the subjects need to be in good shape in the morning. We also define sleep debt as the difference between the ideal TST and TST on workdays, and considered a sleep debt when the difference was above 60 min and severe sleep debt above 90 min. Finally we retained subjects as long sleepers for those with a TSTof more than 7 hours and short sleepers when TST was under 5 hours. Insomnia, sleepiness and sleep apnoea have been defined based on the International Classification of Sleep Disorders-Third Edition and the classification of mental disorders (Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition). Bivariate and multivariate logistic regression models were applied to investigate the association with short TST, long TST, sleep debt and napping. We analysed 2622 complete questionnaires from 1313 men and 1309 women aged 22-50 years old. 1397 workers began work before 07:00, whereas 1225 began later. The 24-hour TST was 6.7±1.4 hours, whereas the ideal TST was 7.0±1.2 hours. Severe sleep debt (>90 min) was reported by 6% women versus 5% men, whereas moderate sleep debt (>60 min) was reported by 11.5% women versus 9.3% men. Napping is one way to improve 24-hour TST for 58% of pastry

  13. Anaesthetic management of a paediatric patient with congenital fibre type disproportion myopathy.

    Science.gov (United States)

    Buisán, F; de la Varga, O; Flores, M; Sánchez-Ruano, J

    2018-04-23

    Congenital fibre type disproportion (CFTD) is a rare type of myopathy that is characterised by muscle weakness and hypotonia during childhood. Clinical features include motor delay, feeding difficulties, limb weakness, joint contractures, and scoliosis. A report is presented of the anaesthetic management of a 3-year-old girl with CFTD myopathy associated with a mutation of the TPM3 gene, scheduled for adenotonsillectomy because of obstructive sleep apnoea hypopnoea syndrome (OSAHS). The main concerns were the possible susceptibility to malignant hyperthermia, the risk of anaesthesia-induced rhabdomyolysis, a greater sensitivity to non-depolarising muscle relaxants, and the presence of OSAHS. Total intravenous anaesthesia with propofol and the use of rocuronium/sugammadex appear to be safe options. Given the high risk of respiratory compromise and other complications, patients should be closely monitored in the post-operative period. Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Sleep disorders among high school students in New Zealand.

    Science.gov (United States)

    Fernando, Antonio T; Samaranayake, Chinthaka B; Blank, Christopher J; Roberts, Gareth; Arroll, Bruce

    2013-12-01

    Adolescents are known to have high risk factors for sleep disorders, yet the youth rates of sleep disturbances are unknown. This study aimed to determine the prevalence of sleep disorders among New Zealand high school students. The Auckland Sleep Questionnaire (ASQ) was administered to high school students at six schools in the North Island. Schools were chosen to reflect a range of ethnicities and school deciles, which identify the socioeconomic status of households in the school catchment area. A total of 1388 students completed the ASQ. The median age was 17 years (range 14-23) and females represented 43.5% (n=604) of the total group. A total of 37.2% of the students surveyed reported having significant sleep symptoms lasting longer than one month. Depression and anxiety were present in 51.7% and 44.8% of students reporting a sleep problem, respectively. A moderate correlation was observed between sleep problems and depression (r=0.34, psleep problems and anxiety (r=0.31, pstudents with sleep symptoms (12.2% and 5.5% respectively). No difference was found in the rate of sleep problems reported by different ethnic groups. A considerable proportion of students surveyed reported significant sleep symptoms. This study has the potential to aid physicians within New Zealand in better appreciating the burden of sleep disorders faced by young people and in effectively assessing and managing different causes of sleep symptoms in this demographic.

  15. The Neurobiology of Orofacial Pain and Sleep and Their Interactions.

    Science.gov (United States)

    Lavigne, G J; Sessle, B J

    2016-09-01

    This article provides an overview of the neurobiology of orofacial pain as well as the neural processes underlying sleep, with a particular focus on the mechanisms that underlie pain and sleep interactions including sleep disorders. Acute pain is part of a hypervigilance system that alerts the individual to injury or potential injury of tissues. It can also disturb sleep. Disrupted sleep is often associated with chronic pain states, including those that occur in the orofacial region. The article presents many insights that have been gained in the last few decades into the peripheral and central mechanisms involved in orofacial pain and its modulation, as well as the circuits and processes in the central nervous system that underlie sleep. Although it has become clear that sleep is essential to preserve and maintain health, it has also been found that pain, particularly chronic pain, is commonly associated with disturbed sleep. In the presence of chronic pain, a circular relationship may prevail, with mutual deleterious influences causing an increase in pain and a disruption of sleep. This article also reviews findings that indicate that reducing orofacial pain and improving sleep need to be targeted together in the management of acute to chronic orofacial pain states in order to improve an orofacial pain patient's quality of life, to prevent mood alterations or exacerbation of sleep disorder (e.g., insomnia, sleep-disordered breathing) that can negatively affect their pain, and to promote healing and optimize their health. © International & American Associations for Dental Research 2016.

  16. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways.

    Science.gov (United States)

    Patel, A; Nouraei, S A R

    2015-03-01

    Emergency and difficult tracheal intubations are hazardous undertakings where successive laryngoscopy-hypoxaemia-re-oxygenation cycles can escalate to airway loss and the 'can't intubate, can't ventilate' scenario. Between 2013 and 2014, we extended the apnoea times of 25 patients with difficult airways who were undergoing general anaesthesia for hypopharyngeal or laryngotracheal surgery. This was achieved through continuous delivery of transnasal high-flow humidified oxygen, initially to provide pre-oxygenation, and continuing as post-oxygenation during intravenous induction of anaesthesia and neuromuscular blockade until a definitive airway was secured. Apnoea time commenced at administration of neuromuscular blockade and ended with commencement of jet ventilation, positive-pressure ventilation or recommencement of spontaneous ventilation. During this time, upper airway patency was maintained with jaw-thrust. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) was used in 15 males and 10 females. Mean (SD [range]) age at treatment was 49 (15 [25-81]) years. The median (IQR [range]) Mallampati grade was 3 (2-3 [2-4]) and direct laryngoscopy grade was 3 (3-3 [2-4]). There were 12 obese patients and nine patients were stridulous. The median (IQR [range]) apnoea time was 14 (9-19 [5-65]) min. No patient experienced arterial desaturation gaseous exchange through flow-dependent deadspace flushing. It has the potential to transform the practice of anaesthesia by changing the nature of securing a definitive airway in emergency and difficult intubations from a pressured stop-start process to a smooth and unhurried undertaking. © 2014 The Authors Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

  17. The Sleeping Cerebellum.

    Science.gov (United States)

    Canto, Cathrin B; Onuki, Yoshiyuki; Bruinsma, Bastiaan; van der Werf, Ysbrand D; De Zeeuw, Chris I

    2017-05-01

    We sleep almost one-third of our lives and sleep plays an important role in critical brain functions like memory formation and consolidation. The role of sleep in cerebellar processing, however, constitutes an enigma in the field of neuroscience; we know little about cerebellar sleep-physiology, cerebro-cerebellar interactions during sleep, or the contributions of sleep to cerebellum-dependent memory consolidation. Likewise, we do not understand why cerebellar malfunction can lead to changes in the sleep-wake cycle and sleep disorders. In this review, we evaluate how sleep and cerebellar processing may influence one another and highlight which scientific routes and technical approaches could be taken to uncover the mechanisms underlying these interactions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Short- and long-term health consequences of sleep disruption

    Directory of Open Access Journals (Sweden)

    Medic G

    2017-05-01

    underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption. Keywords: sleep, sleep disorders, children, adolescents, adults, health status

  19. Predictability decomposition detects the impairment of brain-heart dynamical networks during sleep disorders and their recovery with treatment

    Science.gov (United States)

    Faes, Luca; Marinazzo, Daniele; Stramaglia, Sebastiano; Jurysta, Fabrice; Porta, Alberto; Giandomenico, Nollo

    2016-05-01

    This work introduces a framework to study the network formed by the autonomic component of heart rate variability (cardiac process η) and the amplitude of the different electroencephalographic waves (brain processes δ, θ, α, σ, β) during sleep. The framework exploits multivariate linear models to decompose the predictability of any given target process into measures of self-, causal and interaction predictability reflecting respectively the information retained in the process and related to its physiological complexity, the information transferred from the other source processes, and the information modified during the transfer according to redundant or synergistic interaction between the sources. The framework is here applied to the η, δ, θ, α, σ, β time series measured from the sleep recordings of eight severe sleep apnoea-hypopnoea syndrome (SAHS) patients studied before and after long-term treatment with continuous positive airway pressure (CPAP) therapy, and 14 healthy controls. Results show that the full and self-predictability of η, δ and θ decreased significantly in SAHS compared with controls, and were restored with CPAP for δ and θ but not for η. The causal predictability of η and δ occurred through significantly redundant source interaction during healthy sleep, which was lost in SAHS and recovered after CPAP. These results indicate that predictability analysis is a viable tool to assess the modifications of complexity and causality of the cerebral and cardiac processes induced by sleep disorders, and to monitor the restoration of the neuroautonomic control of these processes during long-term treatment.

  20. A novel non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder associated with antibodies to IgLON5: a case series, characterisation of the antigen, and post-mortem study.

    Science.gov (United States)

    Sabater, Lidia; Gaig, Carles; Gelpi, Ellen; Bataller, Luis; Lewerenz, Jan; Torres-Vega, Estefanía; Contreras, Angeles; Giometto, Bruno; Compta, Yaroslau; Embid, Cristina; Vilaseca, Isabel; Iranzo, Alex; Santamaría, Joan; Dalmau, Josep; Graus, Francesc

    2014-06-01

    Autoimmunity might be associated with or implicated in sleep and neurodegenerative disorders. We aimed to describe the features of a novel neurological syndrome associated with prominent sleep dysfunction and antibodies to a neuronal antigen. In this observational study, we used clinical and video polysomnography to identify a novel sleep disorder in three patients referred to the Sleep Unit of Hospital Clinic, University of Barcelona, Spain, for abnormal sleep behaviours and obstructive sleep apnoea. These patients had antibodies against a neuronal surface antigen, which were also present in five additional patients referred to our laboratory for antibody studies. These five patients had been assessed with polysomnography, which was done in our sleep unit in one patient and the recording reviewed in a second patient. Two patients underwent post-mortem brain examination. Immunoprecipitation and mass spectrometry were used to characterise the antigen and develop an assay for antibody testing. Serum or CSF from 298 patients with neurodegenerative, sleep, or autoimmune disorders served as control samples. All eight patients (five women; median age at disease onset 59 years [range 52-76]) had abnormal sleep movements and behaviours and obstructive sleep apnoea, as confirmed by polysomnography. Six patients had chronic progression with a median duration from symptom onset to death or last visit of 5 years (range 2-12); in four the sleep disorder was the initial and most prominent feature, and in two it was preceded by gait instability followed by dysarthria, dysphagia, ataxia, or chorea. Two patients had a rapid progression with disequilibrium, dysarthria, dysphagia, and central hypoventilation, and died 2 months and 6 months, respectively, after symptom onset. In five of five patients, video polysomnography showed features of obstructive sleep apnoea, stridor, and abnormal sleep architecture (undifferentiated non-rapid-eye-movement [non-REM] sleep or poorly structured

  1. Sleep from an islamic perspective

    OpenAIRE

    Ahmed S BaHammam

    2011-01-01

    Sleep medicine is a relatively new scientific specialty. Sleep is an important topic in Islamic literature, and the Quran and Hadith discuss types of sleep, the importance of sleep, and good sleep practices. Islam considers sleep as one of the signs of the greatness of All?h (God) and encourages followers to explore this important sign. The Quran describes different types of sleep, and these correspond with sleep stages identified by modern science. The Quran discusses the beneficial effects ...

  2. Sleep and sleep disorders in Don Quixote.

    Science.gov (United States)

    Iranzo, Alex; Santamaria, Joan; de Riquer, Martín

    2004-01-01

    In Don Quijote de la Mancha, Miguel de Cervantes presents Don Quixote as an amazing character of the 17th century who suffers from delusions and illusions, believing himself to be a medieval knight errant. Besides this neuropsychiatric condition, Cervantes included masterful descriptions of several sleep disorders such as insomnia, sleep deprivation, disruptive loud snoring and rapid eye movement sleep behaviour disorder. In addition, he described the occurrence of physiological, vivid dreams and habitual, post-prandial sleepiness--the siesta. Cervantes' concept of sleep as a passive state where all cerebral activities are almost absent is in conflict with his description of abnormal behaviours during sleep and vivid, fantastic dreams. His concept of sleep was shared by his contemporary, Shakespeare, and could have been influenced by the reading of the classical Spanish book of psychiatry Examen de Ingenios (1575).

  3. SLEEP AND CIRCADIAN RHYTHM DISORDERS IN PARKINSON'S DISEASE.

    Science.gov (United States)

    Gros, Priti; Videnovic, Aleksandar

    2017-09-01

    Sleep disorders are among the most challenging non-motor features of Parkinson's disease (PD) and significantly affect quality of life. Research in this field has gained recent interest among clinicians and scientists and is rapidly evolving. This review is dedicated to sleep and circadian dysfunction associated with PD. Most primary sleep disorders may co-exist with PD; majority of these disorders have unique features when expressed in the PD population. We discuss the specific considerations related to the common sleep problems in Parkinson's disease including insomnia, rapid eye movement sleep behavior disorder, restless legs syndrome, sleep disordered breathing, excessive daytime sleepiness and circadian rhythm disorders. Within each of these sleep disorders, we present updated definitions, epidemiology, etiology, diagnosis, clinical implications and management. Furthermore, areas of potential interest for further research are outlined.

  4. Ultrafast contrast-enhanced 3D MR angiography of the aorta and renal arteries in apnoea

    International Nuclear Information System (INIS)

    Hany, T.F.; Pfammatter, T.; Schmidt, M.; Leung, D.A.; Debatin, J.F.

    1997-01-01

    Purpose: To determine the value of ultrafast, gadolinium-enhanced, three-dimensional breathhold magnetic resonance angiography (MRA) in the assessment of the aorta and renal arteries in comparison to conventional arteriography (CA). Patients and methods: 49 patients (31 m, 18 f) were evaluated with both CA and 3D MRA. The 3D MRA data set consisted of 44 continuous sections, acquired in apnoea (23-28 s) using the following parameters: T R /T E 3.9/1.5 ms, flip angle 40 , 3/4 k-space acquisition. 0.3 mmol/kg BW gadolinium-DTPA were administered intravenously in a bolus, using an automated injector. A test bolus method was used for timing of the bolus and beginning of the data acquisition. Intraarterial CA was used as the gold standard in 47 patients; in two patients the intraoperative findings were employed as the standard of reference. CA and MRA were interpreted separately by two different radiologists, who were blinded to the results of the other examine. Results: All 11 accessory renal arteries were visualised on MRA. MRA-based assessment of renal artery stenosis was identical with CA in 31 of 41 (75%) stenoses. Sensitivity and specificity values for assessment of renal arterial disease were 84,4% and 96,1%, for haemodynamically significant lesions they amounted to 90% and 98,9%, respectively. Conclusion: The presented ultrafast contrast-enhanced 3D MRA technique allows for the reliable assessment of aortic and renal arterial morphology and pathology. (orig.) [de

  5. Effects of sleep deprivation with reference to military operations.

    Science.gov (United States)

    Giam, G C

    1997-01-01

    This review discusses the need for sleep, effects of sleep deprivation on behaviour and performance in the military, and sleep management recommendations to optimise combat effectiveness. Most people, regardless of sex or race, prefer 7 to 8 hours of sleep each night. Sleeping during the day is less recuperative. Continuous sleep is more effective than multiple short naps-even when the total hours for naps is more. Ten to 20 minute naps are useful when continuous sleep is not possible. Sleep inertia is the 5 to 30 minute period of sluggishness after awakening and important military tasks should be avoided. Previously, continuous work episodes (CWEs) duration was restricted by limited night vision, unreliable equipment and reduced endurance of military personnel. With improved technology, CWEs are now restricted primarily by endurance which is affected by sleep deprivation. This was one of the experiences noted in recent conflicts (e.g. Desert Storm) by personnel in the air force, army and navy. Since there will be changes in operational requirements, several work-rest-sleep plans must be prepared. Sleeping the preferred 7 to 8 hours per 24 hours the week before an operation may help prepare for optimal performance. Personnel should be familiarised with conditions under which they may sleep. During combat, sleep management should ideally avoid situations where all personnel are exhausted at the same time. As sleep debt accumulates, a person's mood, motivation, attention, alertness, short-term memory, ability to complete routines, task performance (errors of omission more than errors of commission) and physical performance will become more negatively affected. Counter measures must then be taken (e.g. time for sleep or naps, changing routines or rotating jobs). Drugs like caffeine and amphetamine can help personnel stay awake. However, they may also keep them awake when they need to sleep- and on awakening, they could suffer from "hang-overs" and are less efficient

  6. Obstructive Sleep Apnea Due To Extrathoracic Tracheomalacia

    OpenAIRE

    Muzumdar, Hiren; Nandalike, K.; Bent, J.; Arens, Raanan

    2013-01-01

    We report obstructive sleep apnea in a 3-year-old boy with tracheomalacia secondary to tracheotomy that resolved after placement of a metallic stent in the region of tracheomalacia. The tracheal location of obstruction during sleep in this case contrasts with the usual location in the pharynx or, less often, the larynx. This case also demonstrates the utility of polysomnography in managing decannulation of tracheostomies.

  7. Obstructive sleep apnea due to extrathoracic tracheomalacia.

    Science.gov (United States)

    Muzumdar, Hiren; Nandalike, K; Bent, J; Arens, Raanan

    2013-02-01

    We report obstructive sleep apnea in a 3-year-old boy with tracheomalacia secondary to tracheotomy that resolved after placement of a metallic stent in the region of tracheomalacia. The tracheal location of obstruction during sleep in this case contrasts with the usual location in the pharynx or, less often, the larynx. This case also demonstrates the utility of polysomnography in managing decannulation of tracheostomies.

  8. Sleep disturbances in Parkinsonism.

    Science.gov (United States)

    Askenasy, J J M

    2003-02-01

    The present article is meant to suggest an approach to the guidelines for the therapy of sleep disturbances in Parkinson's Disease (PD) patients.The factors affecting the quality of life in PD patients are depression, sleep disturbances and dependence. A large review of the literature on sleep disturbances in PD patients, provided the basis for the following classification of the sleep-arousal disturbances in PD patients. We suggest a model based on 3 steps in the treatment of sleep disturbances in PD patients. This model allowing the patient, the spouse or the caregiver a quiet sleep at night, may postpone the retirement and the institutionalization of the PD patient. I. Correct diagnosis of sleep disorders based on detailed anamnesis of the patient and of the spouse or of the caregiver. One week recording on a symptom diary (log) by the patient or the caregiver. Correct diagnosis of sleep disorders co morbidities. Selection of the most appropriate sleep test among: polysomnography (PSG), multiple sleep latency test (MSLT), multiple wake latency test (MWLT), Epworth Sleepiness Scale, actigraphy or video-PSG. II. The nonspecific therapeutic approach consists in: a) Checking the sleep effect on motor performance, is it beneficial, worse or neutral. b) Psycho-physical assistance. c) Dopaminergic adjustment is necessary owing to the progression of the nigrostriatal degeneration and the increased sensitivity of the terminals, which alter the normal modulator mechanisms of the motor centers in PD patients. Among the many neurotransmitters of the nigro-striatal pathway one can distinguish two with a major influence on REM and NonREM sleep. REM sleep corresponds to an increased cholinergic receptor activity and a decreased dopaminergic activity. This is the reason why REM sleep deprivation by suppressing cholinergic receptor activity ameliorates PD motor symptoms. L-Dopa and its agonists by suppressing cholinergic receptors suppress REM sleep. The permanent adjustment

  9. Sleep Bruxism in Respiratory Medicine Practice.

    Science.gov (United States)

    Mayer, Pierre; Heinzer, Raphael; Lavigne, Gilles

    2016-01-01

    Sleep bruxism (SB) consists of involuntary episodic and repetitive jaw muscle activity characterized by occasional tooth grinding or jaw clenching during sleep. Prevalence decreases from 20% to 14% in childhood to 8% to 3% in adulthood. Although the causes and mechanisms of idiopathic primary SB are unknown, putative candidates include psychologic risk factors (eg, anxiety, stress due to life events, hypervigilance) and sleep physiologic reactivity (eg, sleep arousals with autonomic activity, breathing events). Although certain neurotransmitters (serotonin, dopamine, noradrenalin, histamine) have been proposed to play an indirect role in SB, their exact contribution to rhythmic masticatory muscle activity (RMMA) (the electromyography marker of SB) genesis remains undetermined. No specific gene is associated with SB; familial environmental influence plays a significant role. To date, no single explanation can account for the SB mechanism. Secondary SB with sleep comorbidities that should be clinically assessed are insomnia, periodic limb movements during sleep, sleep-disordered breathing (eg, apnea-hypopnea), gastroesophageal reflux disease, and neurologic disorders (eg, sleep epilepsy, rapid eye movement behavior disorder). SB is currently quantified by scoring RMMA recordings in parallel with brain, respiratory, and heart activity recordings in a sleep laboratory or home setting. RMMA confirmation with audio-video recordings is recommended for better diagnostic accuracy in the presence of neurologic conditions. Management strategies (diagnostic tests, treatment) should be tailored to the patient's phenotype and comorbidities. In the presence of sleep-disordered breathing, a mandibular advancement appliance or CPAP treatment is preferred over single occlusal splint therapy on the upper jaw. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  10. Feasibilty of a sleep intervention during adjuvant breast cancer chemotherapy.

    Science.gov (United States)

    Berger, Ann M; VonEssen, Susanna; Khun, Brett R; Piper, Barbara F; Farr, Lynne; Agrawal, Sangeeta; Lynch, James C; Higginbotham, Patti

    2002-01-01

    To evaluate the feasibility of an intervention designed to promote sleep and modify fatigue during four cycles of adjuvant breast cancer chemotherapy. Prospective, repeated measures, quasi-experimental feasibility study. Midwestern urban oncology clinics. 25 women between the ages of 40-65 (mean = 54.3) with stage I-II breast cancer receiving doxorubicin-based chemotherapy. Each woman developed, reinforced, and revised an individualized sleep promotion plan (ISPP) with four components: sleep hygiene, relaxation therapy, stimulus control, and sleep restriction techniques. A daily diary, the Pittsburgh Sleep Quality Index, a wrist actigraph, and the Piper Fatigue Scale were used to collect data two days before and seven days after each treatment. Adherence, sleep and wake outcomes, and fatigue. Adherence rates with the components of the ISPP varied during treatments one through four: sleep hygiene (68%-78%), relaxation therapy (57%-67%), stimulus control (46%-67%), and sleep restriction (76%-80%). Mean sleep and wake outcomes at baseline, peak, and rebound times were that (a) sleep latency remained brief (less than 30 minutes per night), (b) time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores remained stable at 85%-90%, (d) total rest time remained stable at 8-10 hours per night, (e) subjective ratings of feelings on arising were stable, and (f) nighttime awakenings were 8-10 per night. Fatigue outcomes were that fatigue was stable two days after each treatment and mean daily fatigue intensity was lower at treatment three than at treatment one but rebounded at treatment four. The intervention was feasible, adherence rates improved over time, and most sleep and wake patterns were consistent with normal values. Revisions will focus on decreasing nighttime awakenings. Adopting behaviors to promote sleep may assist in maintaining sleep and managing fatigue during chemotherapy.

  11. Impact of sleep disturbances in inflammatory bowel disease.

    Science.gov (United States)

    Ranjbaran, Ziba; Keefer, Laurie; Farhadi, Ashkan; Stepanski, Edward; Sedghi, Shahriar; Keshavarzian, Ali

    2007-11-01

    Normal sleep is paramount for a healthy lifestyle and high quality of life. Sleep modulates the immune system and thus affects the course of several chronic inflammatory conditions. There are no reported studies that address the role of sleep disturbance in the course of inflammatory bowel disease (IBD). The aim of this study was to characterize sleep disturbance in IBD using validated measures of sleep and quality of life. A self-administered, mail-in questionnaire package was sent to 205 subjects after a brief instruction. The questionnaire package was composed of the Pittsburgh Sleep Quality Index (PSQI), a measure of disease severity and the IBD-Quality of Life Questionnaire. A total of 119 subjects were recruited (58% response rate): 80 with inactive IBD, 24 with irritable bowel syndrome (IBS) and 15 healthy controls. The IBD subjects reported significantly prolonged sleep latency, frequent sleep fragmentation, higher rate of using sleeping pills, decreased day-time energy, increased tiredness and poor overall sleep quality compared to healthy controls. The abnormal sleep patterns in IBD subjects were similar to IBS subjects. The reported sleep quality was correlated with IBD disease severity score (r(2) = 0.55, P = 0.02). Both IBD and IBS subjects thought that sleep and their disease status were correlated. The results show that IBD patients have significant sleep disturbance even when their disease is not active. This problem might affect quality of life, gastrointestinal symptoms and coping ability, and might potentially modify disease severity or increase risk of flare-up. Regardless of the primary or secondary origin of this problem, sleep disturbance should be addressed in the clinical management of patients with IBD.

  12. Nocturnal serum melatonin levels in sulfur mustard exposed patients with sleep disorders.

    Science.gov (United States)

    Mousavi, Seyyedeh Soghra; Vahedi, E; Shohrati, M; Panahi, Y; Parvin, S

    2017-12-01

    Sulfur mustard (SM) exposure causes respiratory disorders, progressive deterioration in lung function and mortality in injured victims and poor sleep quality is one of the most common problems among SM-exposed patients. Since melatonin has a critical role in regulation of sleep and awareness, this study aimed to evaluate the serum melatonin levels in SM-injured subjects. A total of 30 SM-exposed male patients and 10 controls was evaluated. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was measured by the Epworth Sleepiness Scale (ESS), and the risk of obstructive sleep apnoea was determined by the STOP-Bang questionnaire. Polysomnography (PSG) and pulmonary function tests (PFTs) were also available. Nocturnal serum melatonin levels were measured using an ELISA kit. The mean of PSQI, ESS and STOP-Bang scores in patients (11.76±3.56, 12.6±3.03 and 5.03±1.09, respectively) were significantly (pmelatonin levels in patients (29.78±19.31 pg/mL) was significantly (p=0.005) lower than that in the controls (78.53±34.41 pg/mL). Reduced nocturnal serum melatonin and respiratory disorders can be the reasons for poor sleep quality among these patients. IRCT2015092924267N1, Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Safe Sleep for Babies

    Science.gov (United States)

    ... 5 MB] Read the MMWR Science Clips Safe Sleep for Babies Eliminating hazards Recommend on Facebook Tweet ... Page Problem Every year, there are thousands of sleep-related deaths among babies. View large image and ...

  14. Teenagers and sleep

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000872.htm Teenagers and sleep To use the sharing features on this page, ... need. What Makes it Hard for Teens to Sleep? Several factors make it hard for teens to ...

  15. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... OSA causes daytime drowsiness that can result in accidents, lost productivity and relationship problems. The National Sleep ... 30 apneas during a seven-hour sleep. In severe cases, periods of not breathing may last for ...

  16. Isolated sleep paralysis

    Science.gov (United States)

    ... T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 103. ... Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant ...

  17. Problems sleeping during pregnancy

    Science.gov (United States)

    ... T, Dement WC, eds. Principles and Practice of Sleep Medicine . 6th ed. Philadelphia, PA: Elsevier; 2017:chap 156. Ibrahim S, Foldvary-Shaefer N. Sleep disorders in pregnancy: implications, evaluation, and treatment. Neurologic ...

  18. Sleep Apnea Facts

    Science.gov (United States)

    ... include being overweight and having a large neck. Losing even 10 percent of body weight can help reduce the number of times a person with sleep apnea stops breathing during sleep. African-Americans, Pacific ...

  19. Sleep and Eating Disorders.

    Science.gov (United States)

    Allison, Kelly C; Spaeth, Andrea; Hopkins, Christina M

    2016-10-01

    Insomnia is related to an increased risk of eating disorders, while eating disorders are related to more disrupted sleep. Insomnia is also linked to poorer treatment outcomes for eating disorders. However, over the last decade, studies examining sleep and eating disorders have relied on surveys, with no objective measures of sleep for anorexia nervosa or bulimia nervosa, and only actigraphy data for binge eating disorder. Sleep disturbance is better defined for night eating syndrome, where sleep efficiency is reduced and melatonin release is delayed. Studies that include objectively measured sleep and metabolic parameters combined with psychiatric comorbidity data would help identify under what circumstances eating disorders and sleep disturbance produce an additive effect for symptom severity and for whom poor sleep would increase risk for an eating disorder. Cognitive behavior therapy for insomnia may be a helpful addition to treatment of those with both eating disorder and insomnia.

  20. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... The National Sleep Foundation estimates that 18 million adults have obstructive sleep apnea and it is likely ... Maxillofacial Surgeon (OMS). An estimated 18-20 million adults in the US suffer from OSA. What Is ...

  1. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... sleep apnea (OSA) is a serious and even life-threatening condition. The risks of undiagnosed OSA are ... sleep apnea (OSA) is a serious and even life-threatening condition. The risks of undiagnosed OSA are ...

  2. Sleeping during Pregnancy

    Science.gov (United States)

    ... Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Sleeping During Pregnancy KidsHealth / For Parents / Sleeping During Pregnancy What's in ...

  3. Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder.

    Science.gov (United States)

    Singh, Kanwaljit; Zimmerman, Andrew W

    2015-06-01

    Sleep problems are common in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Sleep problems in these disorders may not only worsen daytime behaviors and core symptoms of ASD and ADHD but also contribute to parental stress levels. Therefore, the presence of sleep problems in ASD and ADHD requires prompt attention and management. This article is presented in 2 sections, one each for ASD and ADHD. First, a detailed literature review about the burden and prevalence of different types of sleep disorders is presented, followed by the pathophysiology and etiology of the sleep problems and evaluation and management of sleep disorders in ASD and ADHD. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Original Research Identifying patients at high risk for obstructive ...

    African Journals Online (AJOL)

    determine the factors associated with high risk for obstructive sleep apnoea and use it to identify patients at risk for the condition in ... mainstay of management is CPAP in addition to behavioral ..... the present study has some potential limitations which ... consequences of obstructive sleep apnea and short sleep duration.

  5. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Science.gov (United States)

    Chouchou, Florian; Chauny, Jean-Marc; Rainville, Pierre; Lavigne, Gilles J

    2015-01-01

    The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM) sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers). Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1) placebo analgesia improved with REM sleep deprivation; 2) pain relief expectations did not differ between REM sleep deprivation and control groups; and 3) REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

  6. Sleep and Metabolism: An Overview

    Directory of Open Access Journals (Sweden)

    Sunil Sharma

    2010-01-01

    Full Text Available Sleep and its disorders are increasingly becoming important in our sleep deprived society. Sleep is intricately connected to various hormonal and metabolic processes in the body and is important in maintaining metabolic homeostasis. Research shows that sleep deprivation and sleep disorders may have profound metabolic and cardiovascular implications. Sleep deprivation, sleep disordered breathing, and circadian misalignment are believed to cause metabolic dysregulation through myriad pathways involving sympathetic overstimulation, hormonal imbalance, and subclinical inflammation. This paper reviews sleep and metabolism, and how sleep deprivation and sleep disorders may be altering human metabolism.

  7. The Functions of Sleep

    Directory of Open Access Journals (Sweden)

    Samson Z Assefa

    2015-08-01

    Full Text Available Sleep is a ubiquitous component of animal life including birds and mammals. The exact function of sleep has been one of the mysteries of biology. A considerable number of theories have been put forward to explain the reason(s for the necessity of sleep. To date, while a great deal is known about what happens when animals sleep, there is no definitive comprehensive explanation as to the reason that sleep is an inevitable part of animal functioning. It is well known that sleep is a homeostatically regulated body process, and that prolonged sleep deprivation is fatal in animals. In this paper, we present some of the theories as to the functions of sleep and provide a review of some hypotheses as to the overall physiologic function of sleep. To better understand the purpose for sleeping, we review the effects of sleep deprivation on physical, neurocognitive and psychic function. A better understanding of the purpose for sleeping will be a great advance in our understanding of the nature of the animal kingdom, including our own.

  8. Treatments for Sleep Changes

    Science.gov (United States)

    ... Contributing medical factors Non-drug strategies Medications Common sleep changes Many people with Alzheimer’s experience changes in ... at night. Subscribe now Non-drug treatments for sleep changes Non-drug treatments aim to improve sleep ...

  9. Sleep Talking (Somniloquy)

    Science.gov (United States)

    ... radius (in miles): 10 25 50 Share: Essentials in Sleep Insomnia Overview & Facts Symptoms & Causes Diagnosis & Self Tests Treatment ... Sleep talking is very common. It is reported in 50% of young children. About 5% of adults are reported to talk in their sleep. It ...

  10. The relationship between patient data and pooled clinical management decisions.

    Science.gov (United States)

    Ludbrook, G I; O'Loughlin, E J; Corcoran, T B; Grant, C

    2013-01-01

    A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management. In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. In the current study, the relationship between patient data and these decisions was examined using binomial logistic regression analysis. Backward stepwise regression was used to identify independent predictors of each decision (at P >0.15), which were then incorporated into a predictive model. The number of factors related to each decision varied: blood picture (four factors), biochemistry (six factors), coagulation studies (three factors), electrocardiography (eight factors), chest X-ray (seven factors), preoperative outpatient assessment (17 factors), intensive care unit requirement (eight factors) and aspiration prophylaxis (one factor). The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics in the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient

  11. Sleep and Metabolism: An Overview

    OpenAIRE

    Sharma, Sunil; Kavuru, Mani

    2010-01-01

    Sleep and its disorders are increasingly becoming important in our sleep deprived society. Sleep is intricately connected to various hormonal