Science.gov

Sample records for article managing sleep

  1. [Sleep physiology and its relevance for the management of behavioral sleep disorders in children].

    PubMed

    Jenni, Oskar; Benz, Caroline; Hunkeler, Peter; Werner, Helene

    2014-11-01

    Sleep problems are among the most frequent behavioural issues during childhood. This article highlights some of the most important aspects of children's sleep physiology and presents a clinical approach for the management of behavioural sleep disorders in children. Our concept is based on developmental aspects of sleep physiology and also uses behavioural strategies for the parents and their child to handle maladaptive sleep behaviour.

  2. Text Mining of Journal Articles for Sleep Disorder Terminologies.

    PubMed

    Lam, Calvin; Lai, Fu-Chih; Wang, Chia-Hui; Lai, Mei-Hsin; Hsu, Nanly; Chung, Min-Huey

    2016-01-01

    Research on publication trends in journal articles on sleep disorders (SDs) and the associated methodologies by using text mining has been limited. The present study involved text mining for terms to determine the publication trends in sleep-related journal articles published during 2000-2013 and to identify associations between SD and methodology terms as well as conducting statistical analyses of the text mining findings. SD and methodology terms were extracted from 3,720 sleep-related journal articles in the PubMed database by using MetaMap. The extracted data set was analyzed using hierarchical cluster analyses and adjusted logistic regression models to investigate publication trends and associations between SD and methodology terms. MetaMap had a text mining precision, recall, and false positive rate of 0.70, 0.77, and 11.51%, respectively. The most common SD term was breathing-related sleep disorder, whereas narcolepsy was the least common. Cluster analyses showed similar methodology clusters for each SD term, except narcolepsy. The logistic regression models showed an increasing prevalence of insomnia, parasomnia, and other sleep disorders but a decreasing prevalence of breathing-related sleep disorder during 2000-2013. Different SD terms were positively associated with different methodology terms regarding research design terms, measure terms, and analysis terms. Insomnia-, parasomnia-, and other sleep disorder-related articles showed an increasing publication trend, whereas those related to breathing-related sleep disorder showed a decreasing trend. Furthermore, experimental studies more commonly focused on hypersomnia and other SDs and less commonly on insomnia, breathing-related sleep disorder, narcolepsy, and parasomnia. Thus, text mining may facilitate the exploration of the publication trends in SDs and the associated methodologies.

  3. Text Mining of Journal Articles for Sleep Disorder Terminologies

    PubMed Central

    Lam, Calvin; Lai, Fu-Chih; Wang, Chia-Hui; Lai, Mei-Hsin; Hsu, Nanly; Chung, Min-Huey

    2016-01-01

    Objective Research on publication trends in journal articles on sleep disorders (SDs) and the associated methodologies by using text mining has been limited. The present study involved text mining for terms to determine the publication trends in sleep-related journal articles published during 2000–2013 and to identify associations between SD and methodology terms as well as conducting statistical analyses of the text mining findings. Methods SD and methodology terms were extracted from 3,720 sleep-related journal articles in the PubMed database by using MetaMap. The extracted data set was analyzed using hierarchical cluster analyses and adjusted logistic regression models to investigate publication trends and associations between SD and methodology terms. Results MetaMap had a text mining precision, recall, and false positive rate of 0.70, 0.77, and 11.51%, respectively. The most common SD term was breathing-related sleep disorder, whereas narcolepsy was the least common. Cluster analyses showed similar methodology clusters for each SD term, except narcolepsy. The logistic regression models showed an increasing prevalence of insomnia, parasomnia, and other sleep disorders but a decreasing prevalence of breathing-related sleep disorder during 2000–2013. Different SD terms were positively associated with different methodology terms regarding research design terms, measure terms, and analysis terms. Conclusion Insomnia-, parasomnia-, and other sleep disorder-related articles showed an increasing publication trend, whereas those related to breathing-related sleep disorder showed a decreasing trend. Furthermore, experimental studies more commonly focused on hypersomnia and other SDs and less commonly on insomnia, breathing-related sleep disorder, narcolepsy, and parasomnia. Thus, text mining may facilitate the exploration of the publication trends in SDs and the associated methodologies. PMID:27203858

  4. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    PubMed

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

  5. Sleep disturbances and their management in patients with brain injury.

    PubMed

    Thaxton, Lora; Myers, Mary Ann

    2002-08-01

    Sleep disturbances in people with brain injuries, although quite common, remain a problematic management issue for caregivers. This article will review the architecture of sleep, the assessment of insomnia, and discussion of common medications that may exacerbate the problem. Nonpharmacological management techniques, including stimulus control, sleep restriction, and relaxation therapy, will also be discussed. An intensive analysis of pharmacological agents used in treatment, including descriptions of the positive and negative effects of the various classes of drugs (e.g., sedative/hypnotics, antihistamines, dopamine agonists, and stimulants) will be provided. These discussions will hopefully assist in the decision-making processes of caregivers managing this unique group of persons with sleep difficulties.

  6. Importance of sleep in the management of pediatric pain.

    PubMed

    Lewin, D S; Dahl, R E

    1999-08-01

    This article outlines several aspects of sleep regulation relevant to pediatric pain management. A broad range of connections between sleep and pain are described: (1) pain can interfere with the quality and quantity of children's sleep; (2) insufficient sleep (quality or quantity) can cause daytime sequelae (behavioral and emotional changes) that interfere with the coping skills necessary for effective pain management; (3) fear and anxiety often have a negative impact on both pain and sleep; (4) feelings of safety and control frequently have a positive effect on both sleep and pain symptoms; (5) adequate sleep seems to promote both physiological (tissue repair) and psychological (transient cessation of the perception of pain signals) processes relevant to recovery from pain, injury, and illness; and (6) treatment approaches to pediatric sleep and pain problems show considerable overlap with respect to many pharmacological as well as cognitive-behavioral interventions. Given these multiple links, a better understanding of sleep--and its importance in physical and mental health--is likely to be of value to clinicians and researchers working in areas of pediatric pain management. One specific hypothesis to be addressed is the possible contribution of sleep disruption as a step in the progression to some chronic pain syndromes.

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

    PubMed Central

    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. PMID:23957268

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

    PubMed

    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.

  9. Managing fatigue: It really is about sleep.

    PubMed

    Darwent, David; Dawson, Drew; Paterson, Jessica L; Roach, Gregory D; Ferguson, Sally A

    2015-09-01

    Biomathematical models of fatigue can assist organisations to estimate the fatigue consequences of a roster before operations commence. These estimates do not account for the diversity of sleep behaviours exhibited by employees. The purpose of this study was to develop sleep transfer functions describing the likely distributions of sleep around fatigue level estimates produced by a commercial biomathematical model of fatigue. Participants included 347 (18 females, 329 males) train drivers working commercial railway operations in Australia. They provided detailed information about their sleep behaviours using sleep diaries and wrist activity monitors. On average, drivers slept for 7.7 (±1.7)h in the 24h before work and 15.1 (±2.5)h in the 48h before work. The amount of sleep obtained by drivers before shifts differed only marginally across morning, afternoon and night shifts. Shifts were also classified into one of seven ranked categories using estimated fatigue level scores. Higher fatigue score categories were associated with significant reductions in the amount of sleep obtained before shifts, but there was substantial within-category variation. The study findings demonstrate that biomathematical models of fatigue have utility for designing round-the-clock rosters that provide sufficient sleep opportunities for the average employee. Robust variability in the amount of sleep obtained by drivers indicate that models are relatively poor tools for ensuring that all employees obtain sufficient sleep. These findings demonstrate the importance of developing approaches for managing the sleep behaviour of individual employees. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Hypnosis in the Management of Sleep Disorders.

    PubMed

    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.

  11. Sleep Disorders and Therapeutic Management.

    PubMed

    Goudard, Anaïs; Lalande, Laure; Bertin, Camille; Sautereau, Marie; Le Borgne, Marc; Cabelguenne, Delphine

    2017-01-01

    In a French prison, most inmates reported not being satisfied with their sleep. Life habits between good and bad sleepers were not significantly different except for television and smoking. The most frequently reported symptom of insomnia was several awakenings at night, and the most frequently cited etiologies were rumination of thoughts and noise. Most patients reported that their sleeping problems began or worsened after incarceration. A quarter of the inmates were following a hypnotic treatment, and most of these treatments began in prison. Only 42% of patients were satisfied with its effectiveness. These observations enabled us to make recommendations for healthy sleep patterns such as respecting normal night-and-day cycles, encouraging to stop smoking, and promoting appropriate use of hypnotic treatments.

  12. The challenge of sleep management in military operations.

    PubMed

    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.

  13. Obstructive sleep apnea syndrome: diagnosis and management.

    PubMed

    Goodday, R H; Percious, D S; Morrison, A D; Robertson, C G

    2001-12-01

    Increased awareness that changes in sleeping habits and daytime behaviour may be attributable to obstructive sleep apnea syndrome (OSAS) has led many patients to seek both information and definitive treatment. The purpose of this article is to provide information to dentists that will enable them to identify patients who may have OSAS and to assist these patients in making informed decisions regarding treatment options. In patients who have identifiable anatomic abnormalities of the maxilla and mandible resulting in a narrow pharyngeal airway, orthognathic surgery appears to be an excellent treatment option.

  14. The Role of Sleep and Sleep Disorders in the Development, Diagnosis, and Management of Neurocognitive Disorders

    PubMed Central

    Miller, Michelle A.

    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 neuronal pathways and have an impact on neurological diseases. Sleep deprivation studies in normal subjects demonstrate that a lack of sleep can cause attention and working memory impairment. Moreover, untreated sleep disturbances and sleep disorders such as obstructive sleep apnoe (OSA) can also lead to cognitive impairment. Poor sleep and sleep disorders may present a significant risk factor for the development of dementia. In this review, the underlying mechanisms and the role of sleep and sleep disorders in the development of neurocognitive disorders [dementia and mild cognitive impairment (MCI)] and how the presence of sleep disorders could direct the process of diagnosis and management of neurocognitive disorders will be discussed. PMID:26557104

  15. Disaster waste management: A review article

    SciTech Connect

    Brown, Charlotte; Milke, Mark; Seville, Erica

    2011-06-15

    Depending on their nature and severity, disasters can create large volumes of debris and waste. The waste can overwhelm existing solid waste management facilities and impact on other emergency response and recovery activities. If poorly managed, the waste can have significant environmental and public health impacts and can affect the overall recovery process. This paper presents a system overview of disaster waste management based on existing literature. The main literature available to date comprises disaster waste management plans or guidelines and isolated case studies. There is ample discussion on technical management options such as temporary storage sites, recycling, disposal, etc.; however, there is little or no guidance on how these various management options are selected post-disaster. The literature does not specifically address the impact or appropriateness of existing legislation, organisational structures and funding mechanisms on disaster waste management programmes, nor does it satisfactorily cover the social impact of disaster waste management programmes. It is envisaged that the discussion presented in this paper, and the literature gaps identified, will form a basis for future comprehensive and cohesive research on disaster waste management. In turn, research will lead to better preparedness and response to disaster waste management problems.

  16. Disaster waste management: a review article.

    PubMed

    Brown, Charlotte; Milke, Mark; Seville, Erica

    2011-06-01

    Depending on their nature and severity, disasters can create large volumes of debris and waste. The waste can overwhelm existing solid waste management facilities and impact on other emergency response and recovery activities. If poorly managed, the waste can have significant environmental and public health impacts and can affect the overall recovery process. This paper presents a system overview of disaster waste management based on existing literature. The main literature available to date comprises disaster waste management plans or guidelines and isolated case studies. There is ample discussion on technical management options such as temporary storage sites, recycling, disposal, etc.; however, there is little or no guidance on how these various management options are selected post-disaster. The literature does not specifically address the impact or appropriateness of existing legislation, organisational structures and funding mechanisms on disaster waste management programmes, nor does it satisfactorily cover the social impact of disaster waste management programmes. It is envisaged that the discussion presented in this paper, and the literature gaps identified, will form a basis for future comprehensive and cohesive research on disaster waste management. In turn, research will lead to better preparedness and response to disaster waste management problems. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Effectiveness of Three Sleep Apnea Management Alternatives

    PubMed Central

    Masa, Juan F.; Corral, Jaime; Sanchez de Cos, Julio; Duran-Cantolla, Joaquin; Cabello, Marta; Hernández-Blasco, Luis; Monasterio, Carmen; Alonso, Alberto; Chiner, Eusebi; Aizpuru, Felipe; Vázquez-Polo, Francisco-José; Zamorano, Jose; Montserrat, Jose M.; Garcia-Ledesma, Estefania; Pereira, Ricardo; Cancelo, Laura; Martinez, Angeles; Sacristan, Lirios; Salord, Neus; Carrera, Miguel; Sancho-Chust, José N.; Negrín, Miguel A.; Embid, Cristina

    2013-01-01

    Rationale: Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography (PSG) for diagnosis and treatment election in patients with high clinical probability of obstructive sleep apnea (OSA), but there is conflicting evidence on its use for a wider spectrum of patients. Objectives: To determine the efficacy and cost of OSA management (diagnosis and therapeutic decision making) using (1) PSG for all patients (PSG arm); (2) HRP for all patients (HRP arm); and (3) HRP for a subsample of patients with high clinical probability of being treated with continuous positive airway pressure (CPAP) and PSG for the remainder (elective HRP arm). Methods: Multicentric study of 366 patients with intermediate-high clinical probability of OSA, randomly subjected to HRP and PSG. We explored the diagnostic and therapeutic decision agreements between the PSG and both HRP arms for several HRP cutoff points and calculated costs for equal diagnostic and/or therapeutic decision efficacy. Results: For equal diagnostic and therapeutic decision efficacy, PSG arm costs were 18% higher than HRP arm costs and 20% higher than elective HRP arm costs. HRP arm costs tended to be lower than elective HRP arm costs, and both tended to be lower than PSG arm costs if patient costs were omitted. Conclusion: Home respiratory polygraphy is a less costly alternative than polysomnography for the diagnosis and therapeutic decision making for patients with suspected obstructive sleep apnea. We found no advantage in cost terms, however, in using home respiratory polygraphy for all patients or home respiratory polygraphy for the most symptomatic patients and polysomnography for the rest. Citation: Masa JF; Corral J; Sanchez de Cos J; Duran-Cantolla J; Cabello M; Hernández-Blasco L; Monasterio C; Alonso A; Chiner E; Aizpuru F; Vázquez-Polo FJ; Zamorano J; Montserrat JM. Effectiveness of three sleep apnea management alternatives. SLEEP 2013;36(12):1799-1807. PMID:24293754

  18. Review article: oesophageal spasm - diagnosis and management.

    PubMed

    Tutuian, R; Castell, D O

    2006-05-15

    Oesophageal spasm is a common empiric diagnosis clinically applied to patients with unexplained chest pain. In contrast it is an uncommon manometric abnormality found in patients presenting with chest pain and/or dysphagia and diagnosed by >or=20% simultaneous oesophageal contractions during standardized motility testing. Using Medline we searched for diagnostic criteria and treatment options for oesophageal spasm. While the aetiology of this condition is unclear, studies suggest the culprit being a defect in the nitric oxide pathway. Well-known radiographic patterns have low sensitivities and specificities to identify intermittent simultaneous contractions. Recognizing that simultaneous contractions may result from gastro-oesophageal reflux this diagnosis should be investigated or treated first. Studies have documented improvements with proton-pump inhibitors, nitrates, calcium-channel blockers and tricyclic antidepressants or serotonin reuptake inhibitors. Small case series reported benefits after botulinium toxin injections, dilatations and myotomies. Uncertainties persist regarding the optimal management of oesophageal spasm and recommendations are based on controlled studies with small numbers of patients or on case series. Acid suppression, muscle relaxants and visceral analgetics should be tried first. Botulinium toxin injections should be reserved for patients who do not respond. Pneumatic dilatations or myotomies represent rather heroic approaches for non-responding patients.

  19. Management of Sleep-Wake Disturbances Comorbid With Cancer.

    PubMed

    Berger, Ann M; Matthews, Ellyn E; Kenkel, Ashley M

    2017-08-15

    It is critical that clinicians and healthcare systems adopt routine screening and affordable interventions to reduce chronic insomnia and improve the quality of life in cancer patients and survivors. We provide expert clinical advice on how to manage sleep-wake disturbances that occur comorbidly with cancer. Our discussion focuses on the etiology, screening, and assessment of sleep-wake disturbances, and on both nonpharmacologic and pharmacologic interventions to manage sleep disturbances, insomnia, and sleep-related breathing disorders. We share a simplified sleep management algorithm based on evidence-based guidelines and resources from the National Cancer Institute, National Comprehensive Cancer Network, and Oncology Nursing Society, as well as case studies that illustrate how oncology professionals can use the algorithm. Finally, we describe ways to strengthen the partnership between clinicians and patients in the management of sleep-wake disorders and related symptoms.

  20. 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

    PubMed Central

    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; Sullivan, Glendon

    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. PMID:23061075

  1. Diagnosis and Management of Sleep Disorders in Posttraumatic Stress Disorder:A Review of the Literature

    PubMed Central

    Mohsenin, Shahla

    2014-01-01

    Objective: International and societal conflicts and natural disasters can leave physical and mental scars in people who are directly affected by these traumatic experiences. Posttraumatic stress disorder (PTSD) is the clinical manifestation of these experiences in the form of re-experiencing the trauma, avoidance of trauma-related stimuli, and persistent symptoms of hyperarousal. There is growing evidence that sleep disruption that occurs following trauma exposure may in fact contribute to the pathophysiology of PTSD and poor clinical outcomes. The purpose of this review is to highlight the importance of recognition and management of sleep disorders in patients with PTSD. Data Sources: English-language, adult research studies published between 1985 and April 2014 were identified via the PubMed database. The search terms used were PTSD AND sleep disorders. Study Selection: The search identified 792 original and review articles. Of these, 53 articles that discussed or researched sleep disorders in PTSD were selected. Fourteen randomized controlled trials of therapy for PTSD are included in this review. Results: Impaired sleep is a common complaint mainly in the form of nightmares and insomnia among people with PTSD. Sleep apnea and periodic limb movement disorder are particularly prevalent in patients with PTSD and, yet, remain unrecognized. Although selective serotonin reuptake inhibitors are effective in improving PTSD global symptoms, they have a variable and modest effect on sleep disorder symptoms. Cognitive-behavioral treatment targeted to sleep and/or the use of the centrally acting selective α1 antagonist prazosin have been more successful in treating insomnia and nightmares in PTSD than other classes of medications. In view of the high occurrence of sleep apnea and periodic leg movement disorder, a thorough sleep evaluation and treatment are warranted. Conclusions: Patients with PTSD have a high prevalence of sleep disorders and should be queried for

  2. Obstructive sleep apnoea syndrome and its management

    PubMed Central

    Caruso, Daniela; Di Maria, Giuseppe

    2015-01-01

    Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. OSA causes severe symptoms, such as excessive daytime somnolence, and is associated with a significant cardiovascular morbidity and mortality. Different treatment options are now available for an effective management of this disease. After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment. Nasal CPAP (nCPAP) is highly effective in controlling symptoms, improving quality of life and reducing the clinical sequelae of sleep apnoea. Other positive airway pressure modalities are available for patients intolerant to CPAP or requiring high levels of positive pressure. Mandibular advancement devices, particularly if custom made, are effective in mild to moderate OSA and provide a viable alternative for patients intolerant to CPAP therapy. The role of surgery remains controversial. Uvulopalatopharyngoplasty is a well established procedure and can be considered when treatment with CPAP has failed, whereas maxillar-mandibular surgery can be suggested to patients with a craniofacial malformation. A number of minimally invasive procedures to treat snoring are currently under evaluation. Weight loss improves symptoms and morbidity in all patients with obesity and bariatric surgery is an option in severe obesity. A multidisciplinary approach is necessary for an accurate management of the disease. PMID:26336596

  3. Sleep bruxism: Current knowledge and contemporary management.

    PubMed

    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.

  4. Sleep bruxism: Current knowledge and contemporary management

    PubMed Central

    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

  5. Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities.

    PubMed

    Almoznino, Galit; Benoliel, Rafael; Sharav, Yair; Haviv, Yaron

    2017-06-01

    Chronic craniofacial pain involves the head, face and oral cavity and is associated with significant morbidity and high levels of health care utilization. A bidirectional relationship is suggested in the literature for poor sleep and pain, and craniofacial pain and sleep are reciprocally related. We review this relationship and discuss management options. Part I reviews the relationship between pain and sleep disorders in the context of four diagnostic categories of chronic craniofacial pain: 1) primary headaches: migraines, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs) and hypnic headache, 2) secondary headaches: sleep apnea headache, 3) temporomandibular joint disorders (TMD) and 4) painful cranial neuropathies: trigeminal neuralgia, post-herpetic trigeminal neuropathy, painful post-traumatic trigeminal neuropathy (PTTN) and burning mouth syndrome (BMS). Part II discusses the management of patients with chronic craniofacial pain and sleep disorders addressing the factors that modulate the pain experience as well as sleep disorders and including both non-pharmacological and pharmacological modalities.

  6. Management of sleep disturbance associated with atopic dermatitis.

    PubMed

    Kelsay, Kim

    2006-07-01

    Atopic dermatitis (AD) is a common childhood skin disease that also affects adults. Sleep problems are frequently associated with AD and negatively affect both patients and their families. Although this problem is well recognized, there are currently limited studies of patients with AD to guide clinical management of sleep disturbances. This targeted review will inform clinicians of the potential therapeutic agents available to manage sleep disturbances and will review literature relevant to improving the sleep of children and adults with AD. On the basis of our clinical experience and the limited data available, we provide a suggested algorithm for clinicians treating sleep problems associated with AD, but clearly more studies are needed to both further characterize the sleep of patients with AD and to test the efficacy and effectiveness of candidate agents in clinical trials.

  7. The Athlete Sleep Screening Questionnaire: a new tool for assessing and managing sleep in elite athletes.

    PubMed

    Samuels, Charles; James, Lois; Lawson, Doug; Meeuwisse, Willem

    2016-04-01

    The purpose of this study was to develop a subjective, self-report, sleep-screening questionnaire for elite athletes. This paper describes the development of the Athlete Sleep Screening Questionnaire (ASSQ). A convenience sample of 60 elite athletes was randomly distributed into two groups; 30 athletes completed a survey composed of current psychometric tools, and 30 athletes completed a revised survey and a sleep specialist structured clinical interview. An item analysis was performed on the revised survey with comparison to clinical decisions regarding appropriate intervention based on a sleep specialist assessment. A comparison of existing sleep-screening tools with determination of clinical need from a sleep specialist showed low consistency, indicating that current sleep-screening tools are unsuitable for assessing athlete sleep. A new 15-item tool was developed (ASSQ) by selecting items from existing tools that more closely associated with the sleep specialist's reviews. Based on test-retest percentage agreement and the κ-statistic, we found good internal consistency and reliability of the ASSQ. To date, 349 athletes have been screened, and 46 (13.2%) identified as requiring follow-up consultation with a sleep specialist. Results from the follow-up consultations demonstrated that those athletes identified by the ASSQ as abnormal sleepers have required intervention. The research developed a new athlete-specific sleep-screening questionnaire. Our findings suggest that existing sleep-screening tools are unsuitable for assessing sleep in elite athletes. The ASSQ appears to be more accurate in assessing athlete sleep (based on comparison with expert clinical assessment). The ASSQ can be deployed online and provides clinical cut-off scores associated with specific clinical interventions to guide management of athletes' sleep disturbance. The next phase of the research is to conduct a series of studies comparing results from the ASSQ to blinded clinical reviews and

  8. Crisis Management Aspects of Bam Catastrophic Earthquake: Review Article

    PubMed Central

    Sadeghi-Bazargani, Homayoun; Azami-Aghdash, Saber; Kazemi, Abdolhassan; Ziapour, Behrad

    2015-01-01

    Background: Bam earthquake was the most catastrophic natural disasters in recent years. The aim of this study was to review different aspects of crisis management during and after the catastrophic earthquake in Bam City, Iran. Methods: Data needed for this systematic review were collected through searching PubMed, EMBASE and SID databases, for the period from 2003 to 2011. Keywords included earthquake, Iran and Bam earthquake. The data were summarized and were analyzed using Content Analysis. Results: Out of 422 articles, 25 articles were included in the study. Crisis Management aspects and existing pitfalls were classified into seven categories including planning and organization, human resource management, management of logistics, international humanitarian aids, field performance of the military and security forces, health and medical service provision, and information management. Positive aspects and major pitfalls of crisis management have been introduced in all the mentioned categories. Conclusion: The available evidence indicated poor crisis management during Bam earthquake that resulted in aggravating the losses as well as diminishing the effect of interventions. Thus, concerning the importance of different aspects of the crisis management and the high prevalence of disasters in Iran, the observed vulnerability in disaster management process should be addressed. PMID:26000241

  9. Behavioral Management of Sleep Problems in Infants Under 6 Months--What Works?

    PubMed

    Crichton, Georgina E; Symon, Brian

    2016-01-01

    Crying and unsettled behavior in infancy is common. Prolonged disturbed infant sleep can have significant negative effects on the development of the child, and on the psychological well-being of the mother. Compared to studies examining the effects of behavioral sleep programs such as extinction-based techniques in infants over 6 months of age, fewer studies have looked at such strategies in infants under 6 months of age. The aim of this article is to summarize the literature examining the effects of behavioral techniques on infant sleep outcomes in the first 6 months of life and provide evidence based recommendations for the management of infant sleep disturbance. An electronic search of the literature was performed to identify studies which examined the effects of a behavioral intervention aimed at improving sleep in infants under 6 months of age. Eleven studies were identified, of which 8 demonstrated improvements in infant sleep outcomes subsequent to the implementation of an educational behavioral program. Education directed to parents about the use of simple, prescriptive, behavioral techniques is effective in improving infant sleep. Long term follow-up studies have failed to find any negative effects on the child, either from a psychological or physical perspective.

  10. Sleep management training for cancer patients with insomnia.

    PubMed

    Simeit, Rainer; Deck, Ruth; Conta-Marx, Beate

    2004-03-01

    Insomnia is a common phenomenon in cancer patients; nevertheless, there are only a few intervention results published covering this topic. We examined the effects of a multi-modal psychological sleep management programme combining relaxation techniques, sleep hygiene, cognitive techniques and advice in stimulus control technique on various sleep and quality-of-life variables. We compared two intervention groups up to 6 months after treatment, one with progressive muscle relaxation (n=80), the other with autogenic training (n=71). A control group (n=78) received only a standard rehabilitation programme. It was a heterogeneous sample of adult patients (mean age 58 years) predominantly with breast, kidney or prostate cancer staying for 3 or 4 weeks in an oncological rehabilitation clinic. In comparison to the control group, the analysis of variance for repeated measures (R-MANOVA) showed significant improvements over time, indicating that intervention group participants benefited with moderate- or large-scale effects on sleep latency (p<0.001), sleep duration (p<0.001), sleep efficiency (p<0.001), sleep quality (p<0.001), sleep medication (p<0.05) and daytime dysfunction (p<0.05). In quality-of-life subscales, there was mainly improvement over time. This may indicate a benefit of the rehabilitation treatment in general. No evidence was found for any differences between the two intervention groups. The results suggest that the use of a multi-modal psychological sleep intervention could enhance various sleep parameters and well being of patients. The efficacy on quality of life is still under review.

  11. Investigation and management of childhood sleep apnoea

    PubMed Central

    Urquhart, DS

    2013-01-01

    Sleep-disordered breathing includes disorders of breathing that affect airway patency, e.g. obstructive sleep apnoea syndrome, and also conditions that affect respiratory drive (central sleep disorders) or cause hypoventilation, either as a direct central effect or due to peripheral muscle weakness. Obstructive sleep apnoea syndrome (OSAS) is an increasingly-recognised clinical entity affecting up to 5.7% of children, which, if left untreated, is associated with adverse effects on growth and development including deleterious cognitive and behavioural outcomes. Evidence exists also that untreated OSAS impacts on cardiovascular risk. Close attention should be paid to assessment and investigation of this relatively common condition, instigating early and appropriate treatment to children with OSAS. First-line treatment in younger children is adenotonsillectomy, although other treatment options available include continuous positive airways pressure (CPAP), anti-inflammatory therapies (nasal corticosteroids and anti-leukotrienes), airway adjuncts and orthodontic appliances. Central sleep-disordered breathing may be related to immaturity of respiratory control and can be associated with prematurity as well as disorders such as Prader-Willi syndrome. In some cases, central apnoeas occur as part of a central hypoventilation disorder, which may be inherited, e.g. Congenital Central hypoventilation Syndrome, or acquired, e.g. Arnold-Chiari malformation, brain tumour, or spinal injury. The treatments of central breathing problems depend upon the underlying aetiology. PMID:24470727

  12. Novel sleep management method in a toddler displaying fear and trauma: the Boss of My Sleep Book.

    PubMed

    Blunden, Sarah

    2017-01-06

    Sleep problems in toddlers occur in ∼40% of children and increase the likelihood of postnatal depression. Most sleep training in toddlers requires contact with a trained professional, and requires a parent to ignore their child's cries, causing distress to many children and parents, increasing attrition and leaving families untreated and at risk. This case study reports success in significantly ameliorating sleep reluctance and bedtime fears in a sleep disturbed toddler with a history of trauma. It uses a novel use of bedtime behaviour management with some positive reinforcement techniques, called the Boss of My Sleep book: a non-cry, online (thus readily and cheaply available without a trained professional) sleep intervention. The system was successful immediately and was sustained after 6 months. The Boss of My Sleep book shows promise as a sleep intervention in toddlers, particularly for those parents who do not want to use cry intensive methods.

  13. Obstructive sleep apnea: management considerations in psychiatric patients

    PubMed Central

    Heck, Taryn; Zolezzi, Monica

    2015-01-01

    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. PMID:26508864

  14. Recognizing and Managing Obstructive Sleep Apnea in Primary Care

    PubMed Central

    Roth, Thomas

    2009-01-01

    Objective: This review aims to impart information regarding recognition of obstructive sleep apnea (OSA) and associated excessive sleepiness (ES) in the primary care setting in order to provide optimal care to patients with this common but serious condition. This review will also discuss the prevalence and treatment of depression in patients with OSA. Data Sources: A MEDLINE search of articles published between 1990 and 2008 was conducted using the search terms obstructive sleep apnea AND excessive sleepiness, obstructive sleep apnea AND depression, and obstructive sleep apnea AND primary care. Searches were limited to articles in English concerned with adult patients. Study Selection: In total, 239 articles were identified. Articles concerning other sleep disorders and forms of apnea were excluded. The reference lists of identified articles were searched manually to find additional articles of interest. Data Synthesis: Primary care physicians can aid in the diagnosis of OSA and associated ES by being vigilant for lifestyle and physical risk factors associated with this condition. In addition, primary care physicians should maintain a high level of clinical suspicion when presented with illnesses that are commonly comorbid with OSA, such as psychiatric disorders and depression, in particular. Conversely, assessment of patients with OSA for common comorbidities may also improve a patient's prognosis and quality of life. Conclusions: Primary care physicians play a vital role in recognizing OSA and ES. These clinicians are crucial in supporting their patients during treatment by ensuring that they have clear, concise information regarding available therapies and the correct application and maintenance of prescribed devices. PMID:20098525

  15. Nutrition, Exercise, and Sleep: Physiological Considerations in the Classroom for Alternative Certification Teachers. Editor's Perspective Article

    ERIC Educational Resources Information Center

    Evans, Brian R.

    2012-01-01

    Proper nutrition, adequate amounts of physical activity, and sufficient amounts of sleep are three important variables for healthy children. Alternative certification teachers quickly enter the classroom at the beginning of their programs and may encounter disengaged students who lack the energy needed for quality learning and achievement.…

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

    PubMed

    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.

  17. A Preliminary Investigation into the Effectiveness of a Group-Delivered Sleep Management Intervention for Parents of Children with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Stuttard, Lucy; Beresford, Bryony; Clarke, Sue; Beecham, Jeni; Curtis, Julie

    2015-01-01

    Sleep problems are more prevalent and severe among children with intellectual disabilities and autism compared to typically developing children. Training parents in behavioural approaches to manage sleep problems is advocated. However, delivering such interventions via groups is novel. This article reports the findings from a preliminary…

  18. A Preliminary Investigation into the Effectiveness of a Group-Delivered Sleep Management Intervention for Parents of Children with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Stuttard, Lucy; Beresford, Bryony; Clarke, Sue; Beecham, Jeni; Curtis, Julie

    2015-01-01

    Sleep problems are more prevalent and severe among children with intellectual disabilities and autism compared to typically developing children. Training parents in behavioural approaches to manage sleep problems is advocated. However, delivering such interventions via groups is novel. This article reports the findings from a preliminary…

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

    PubMed

    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 < 0.0001) and negatively correlated with the number participations in this race (P = 0.0039). Runners who adopted a 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.

  20. Parasomnias. Managing bizarre sleep-related behavior disorders.

    PubMed

    Schenck, C H; Mahowald, M W

    2000-03-01

    Sleep can be a troubling experience for persons plagued by nocturnal disorders known as parasomnias. While they are "asleep," such persons may be walking, screaming in terror, rearranging furniture, eating odd food concoctions, or wielding weapons. Or they may be unable to fall asleep because of the unpleasant sensations of restless legs syndrome. Although these disorders are indeed bizarre, effective treatments are available. In this article, Drs Schenck and Mahowald discuss the evaluation and treatment of parasomnias and provide illustrative patient vignettes from their extensive experience at a sleep disorders center.

  1. Enrollment Management's Sleeping Giant: The Net Price Calculator Mandate

    ERIC Educational Resources Information Center

    Fallon, Mary A. C.

    2011-01-01

    Enrollment managers will be watching to see how recruitment strategies change when higher education's sleeping giant--net price calculators (NPCs)--wakes in the fall of 2011. Some predict yield projections may be more difficult and reputations will be challenged as prospective students, their families, high school counselors, and independent…

  2. Sleep

    MedlinePlus

    ... NICHD Research Information Clinical Trials Resources and Publications Sleep: Condition Information Skip sharing on social media links Share this: Page Content What is sleep? Sleep is a period of unconsciousness during which ...

  3. Alertness management in aviation operations: enhancing performance and sleep.

    PubMed

    Rosekind, Mark R; Gregory, Kevin B; Mallis, Melissa M

    2006-12-01

    Fatigue is an acknowledged safety risk in diverse operational settings. As a result, there has been growing interest in developing and implementing activities to improve alertness, performance, and safety in real-world operations where fatigue is a factor. A comprehensive Alertness Management Program (AMP) that included education, alertness strategies, scheduling, and healthy sleep was implemented in a commercial airline. An operational evaluation was conducted with 29 flight crewmembers, first when flying a standard schedule without AMP components (i.e., standard condition) compared with full AMP implementation, which included flying an innovative schedule that incorporated physiological sleep and alertness principles (i.e., intervention condition). The evaluation included objective measures of sleep quantity (actigraphy), psychomotor vigilance task (PVT) performance, and subjective reports of daily activities and sleep. The results showed that the 3.5-h educational CD improved pre-education test scores from an average 74% correct to a post-education average of 98%. Alertness strategies showed minimal changes, though the daily diary did not allow for refined evaluation of duration, frequency, and timing of use. The intervention condition was associated with significantly more sleep (1 h, 9 min; p < 0.01) during the trip period compared with the standard schedule. All performance metrics showed significantly better performance during the intervention condition trip schedule (p < 0.01) compared with the standard condition. This first-ever evaluation of a comprehensive AMP showed significantly improved knowledge, support for the use of alertness strategies, and increased sleep and performance during actual operations. The robust and consistent findings support the use of an AMP approach to effectively manage fatigue in operational settings.

  4. Evaluation of oxidative stress markers in obstructive sleep apnea syndrome and additional antioxidant therapy: a review article.

    PubMed

    Lira, Amanda Bastos; de Sousa Rodrigues, Célio Fernando

    2016-12-01

    The hypoxia and reoxygenation cycles in obstructive sleep apnea syndrome (OSAS) cause a change in the oxidative balance, leading to the formation of reactive oxygen species capable of reacting with other organic molecules impairing their functions. This study aimed to determine the best markers of oxidative stress in OSAS and what better antioxidant agent to be used to treat the disease. Searches were conducted in three different databases (PubMed, LILACS, SCIELO), using as descriptors the terms obstructive sleep apnea, oxidative stress, and antioxidant therapy. A total of 120 articles were found but only those considered of interest to the research were selected. Thus, 10 articles were included for further analysis regarding the biomarkers of oxidative stress in OSAS, and 6 articles to evaluate the antioxidant most often used for demonstration of efficacy. The thioredoxin, malondialdehyde, superoxide dysmutase, and reduced iron were the most commonly used biomarkers and showed a more consistent relationship between increased oxidative stress and OSAS. As antioxidant therapy, vitamin C and N-acetylcysteine (NAC) presented interesting results as a reduction of oxidative stress, which may become an alternative to the complementary treatment of OSAS. This review's findings agree mostly to measure that the markers of oxidative stress in OSAS may be a contributing aspect to assessment and monitoring of patient, and the antioxidant therapy appears to be beneficial in the treatment of OSAS.

  5. Sleep in Adolescents and Young Adults with Type 1 Diabetes: Associations with Diabetes Management and Glycemic Control

    PubMed Central

    Jaser, Sarah S.; Ellis, Deborah

    2016-01-01

    Objective To describe sleep in adolescents and young adults with type 1 diabetes and explore the association between sleep disturbances, diabetes management and glycemic control. Methods Adolescents with type 1 diabetes (n = 159, mean age = 16.4, 43% female, 69% white, mean A1C = 9.3%) completed the Pittsburgh Sleep Quality Index to assess sleep quantity and quality and sleep disturbances. Frequency of blood glucose monitoring (meter downloads) was used as a measure of diabetes management. Results Average sleep duration was 7.4 hours, below the recommended duration for this age. Adolescents using insulin pumps reported fewer sleep disturbances and longer sleep duration than those on injections, and older adolescents reported less sleep than younger adolescents. Poorer sleep duration was related to poorer diabetes management and better self-reported sleep quality was associated with better glycemic control for males but not for females. Conclusions Assessing for and treating sleep disturbances in adolescents may improve diabetes management. PMID:27081578

  6. Remote Ambulatory Management of Veterans with Obstructive Sleep Apnea

    PubMed Central

    Fields, Barry G.; Behari, Pratima Pathak; McCloskey, Susan; True, Gala; Richardson, Diane; Thomasson, Arwin; Korom-Djakovic, Danijela; Davies, Keith; Kuna, Samuel T.

    2016-01-01

    Study Objectives: Despite significant medical sequelae of obstructive sleep apnea (OSA), the condition remains undiagnosed and untreated in many affected individuals. We explored the feasibility of a comprehensive, telemedicine-based OSA management pathway in a community-based Veteran cohort. Methods: This prospective, parallel-group randomized pilot study assessed feasibility of a telemedicine-based pathway for OSA evaluation and management in comparison to a more traditional, in-person care model. The study included 60 Veterans at the Philadelphia Veterans Affairs Medical Center and two affiliated community-based outpatient clinics. Telemedicine pathway feasibility, acceptability, and outcomes were assessed through a variety of quantitative (Functional Outcomes of Sleep Questionnaire, dropout rates, positive airway pressure [PAP] adherence rates, participant satisfaction ratings) and qualitative (verbal feedback) metrics. Results: There was no significant difference in functional outcome changes, patient satisfaction, dropout rates, or objectively measured PAP adherence between groups after 3 months of treatment. Telemedicine participants showed greater improvement in mental health scores, and their feedback was overwhelmingly positive. Conclusions: Our pilot study suggests that telemedicine-based management of OSA patients is feasible in terms of patient functional outcomes and overall satisfaction with care. Future studies should include larger populations to further elucidate these findings while assessing provider- and patient-related cost effectiveness. Citation: Fields BG, Behari PP, McCloskey S, True G, Richardson D, Thomasson A, Korom-Djakovic D, Davies K, Kuna ST. Remote ambulatory management of veterans with obstructive sleep apnea. SLEEP 2016;39(3):501–509. PMID:26446115

  7. Remote Ambulatory Management of Veterans with Obstructive Sleep Apnea.

    PubMed

    Fields, Barry G; Behari, Pratima Pathak; McCloskey, Susan; True, Gala; Richardson, Diane; Thomasson, Arwin; Korom-Djakovic, Danijela; Davies, Keith; Kuna, Samuel T

    2016-03-01

    Despite significant medical sequelae of obstructive sleep apnea (OSA), the condition remains undiagnosed and untreated in many affected individuals. We explored the feasibility of a comprehensive, telemedicine-based OSA management pathway in a community-based Veteran cohort. This prospective, parallel-group randomized pilot study assessed feasibility of a telemedicine-based pathway for OSA evaluation and management in comparison to a more traditional, in-person care model. The study included 60 Veterans at the Philadelphia Veterans Affairs Medical Center and two affiliated community-based outpatient clinics. Telemedicine pathway feasibility, acceptability, and outcomes were assessed through a variety of quantitative (Functional Outcomes of Sleep Questionnaire, dropout rates, positive airway pressure [PAP] adherence rates, participant satisfaction ratings) and qualitative (verbal feedback) metrics. There was no significant difference in functional outcome changes, patient satisfaction, dropout rates, or objectively measured PAP adherence between groups after 3 months of treatment. Telemedicine participants showed greater improvement in mental health scores, and their feedback was overwhelmingly positive. Our pilot study suggests that telemedicine-based management of OSA patients is feasible in terms of patient functional outcomes and overall satisfaction with care. Future studies should include larger populations to further elucidate these findings while assessing provider- and patient-related cost effectiveness. © 2016 Associated Professional Sleep Societies, LLC.

  8. Home-Based Diagnosis and Management of Sleep-Related Breathing Disorders in Spinal Cord Injury

    DTIC Science & Technology

    2012-10-01

    form of sleep -disordered breathing in SCI is nocturnal hypoventilation (NH) due to respiratory muscle paralysis and/or reduced ventilatory drive...DATES COVERED 2011 – 29 2012 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-11-1-0826 Home-Based Diagnosis and Management of Sleep ...with spinal cord injury (SCI) commonly have sleep -disordered breathing due to obstructive sleep apnea (OSA) and/or nocturnal hypoventilation (NH) due to

  9. A guide to journal articles on strategic management in nonprofit organizations, 1977 to 1992.

    PubMed

    Stone, M M; Crittenden, W

    1993-01-01

    This article is a guide to over a hundred journal articles on strategic management in nonprofit organizations, published from 1977 to 1992 in nineteen leading general management or nonprofit journals. The guide provides brief summaries of articles, organized into widely accepted strategic management topic areas and research categories. The article indicates areas where substantial foundations of knowledge exist and where such bases are lacking. It distinguishes between works on general nonprofit management and those on empirical research.

  10. The prevalence, cost implications, and management of sleep disorders: an overview.

    PubMed

    Hossain, Jamil L; Shapiro, Colin M

    2002-06-01

    The International Classification of Sleep Disorders distinguishes more than 80 different disorders, which can be effectively treated. Problems with falling asleep or daytime sleepiness affect approximately 35 to 40% of the U.S. adult population annually and are a significant cause of morbidity and mortality. However, the prevalence, burden, and management of sleep disorders are often ignored or overlooked by individuals and society in general. This leads to an underappreciation and undertreatment of sleep disorders, making this group of illnesses a serious health concern. Sleep medicine is a young discipline, and as such the full implications of treating sleep disorders and the extent of sleep-related problems are not well delineated. As a result of high prevalence, severe complications, and concomitant illnesses in untreated cases, the cost implications are immense. The costs can be direct, indirect, related, and intangible. However, relatively little has been published on the economic implications of sleep disorders. Economic analysis can help evaluate available resources to set priorities and maximize management strategies for cost control without sacrificing safety, efficacy, or effectiveness. There has been considerable evidence of the cost-effectiveness of treating patients with obstructive sleep apnea, especially considering its high prevalence, morbidity, mortality, and concomitant health care consumption. We review the economic balance sheet of sleep disorders and conclude that sleep medicine education (among general population and health care professionals) and the availability of diagnostic and therapeutic facilities to treat sleep disorders will reduce the profound socioeconomic implications of untreated sleep disorders.

  11. Managing the Interactive Classroom: A Collection of Articles. K-12.

    ERIC Educational Resources Information Center

    Burke, Kay, Ed.

    Intended for teachers, this book is a compilation of articles on effectively creating and maintaining an interactive classroom, one in which the teacher uses a wide repertoire of teaching strategies, organizational tools, problem-solving techniques, and consensus building methods. Section 1 discusses improving schools and schooling's role in…

  12. Sleep apnoea.

    PubMed

    Jun, Jonathan C; Chopra, Swati; Schwartz, Alan R

    2016-03-01

    Sleep apnoea is a disorder characterised by repetitive pauses in breathing during sleep caused by airway occlusion (obstructive sleep apnoea) or altered control of breathing (central sleep apnoea). In this Clinical Year in Review, we summarise high-impact research from the past year pertaining to management, diagnosis and cardio-metabolic consequences of sleep apnoea.

  13. Sleep/Wakefulness Management in Continuous/Sustained Operations

    DTIC Science & Technology

    2002-11-01

    4321P) was used with time constants and high filter settings of 0.3 sec. and 35 Hz, respectively. Sleep architecture of naps. Polysomnograms during...condition factor). To maintain brevity, only effects which involve the condition factor will be discussed. Sleep architecture of naps Nap data were...zolpidem nap was superior in several instances. Sleep architecture of naps The more rapid sleep onset and longer sleep duration in the zolpidem nap compared

  14. Sleep America: managing the crisis of adult chronic insomnia and associated conditions.

    PubMed

    Kraus, Stefanie S; Rabin, Laura A

    2012-05-01

    Chronic insomnia, a public health crisis affecting 10-15% of the U.S. population and costing billions of dollars annually, typically presents with one or more comorbid psychiatric or organic conditions. Historical classification of chronic insomnia as "secondary" to a presenting comorbid condition has resulted in under-recognition and under-treatment of both the insomnia and comorbid condition(s). Though critical in any model of comorbid disease management, chronic insomnia receives little, if any, public policy attention. We conducted a systematic review of recent empirical studies, review papers, books, government documents, press releases, advertisements, and articles pertaining to the classification, epidemiology, treatment, and physiology of sleep, insomnia, and comorbid conditions. Data were located primarily through MEDLINE, PsycINFO, SCOPUS, and PUBMED databases. Our goal was to provide an overview of the systems for classifying insomnia and available epidemiological data, and to review theoretical models regarding the etiology and maintaining factors of chronic insomnia along with research on the complex, bidirectional associations between chronic insomnia and various affective (and other) conditions. After thorough review of the literature, we propose several public policy measures as an initial step in managing chronic insomnia in the United States. These include introducing a nation-wide multi-modal educational and awareness campaign titled "Sleep America;" increasing the availability and demand for behavioral sleep medicine - the initially preferred treatment approach; and increasing the use of monitoring and enforcement activities by regulatory authorities to curtail false and misleading claims by sponsors of supplements or treatments for insomnia. Through the adoption of such measures, we hope to galvanize a national interest in healthy sleep and the evidence-based treatment of chronic insomnia. Copyright © 2011 Elsevier B.V. All rights reserved.

  15. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: A systematic review and meta-analysis.

    PubMed

    Huynh, Nelly T; Desplats, Eve; Almeida, Fernanda R

    2016-02-01

    A small maxilla and/or mandible may predispose children to sleep-disordered breathing, which is a continuum of severity from snoring to obstructive sleep apnea. Preliminary studies have suggested that orthodontic treatments, such as orthopedic mandibular advancement or rapid maxillary expansion, may be effective treatments. The aim is to investigate the efficacy of orthopedic mandibular advancement and/or rapid maxillary expansion in the treatment of pediatric obstructive sleep apnea. Pubmed, Medline, Embase, and Internet were searched for eligible studies published until April 2014. Articles with adequate data were selected for the meta-analysis; other articles were reported in the qualitative assessment. Data extraction was conducted by two independent authors. A total of 58 studies were identified. Only eight studies were included in the review; of these, six were included in the meta-analysis. The research yielded only a small number of studies. Consequently, any conclusions from the pooled diagnostic parameters and their interpretation should be treated carefully. Although the included studies were limited, these orthodontic treatments may be effective in managing pediatric snoring and obstructive sleep apnea. Other related health outcomes, such as neurocognitive and cardiovascular functions have not yet been systematically addressed. More studies are needed with larger sample size, specific inclusion and exclusion criteria and standardized data reporting to help establish guidelines for the orthodontic treatment of pediatric obstructive sleep apnea. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    PubMed Central

    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

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

    PubMed Central

    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. PMID:25745301

  18. Review article: Crisis resource management in emergency medicine.

    PubMed

    Carne, Belinda; Kennedy, Marcus; Gray, Tim

    2012-02-01

    Effective team management is a core element of expert practice in emergency medicine. Thus far, training in emergency medicine has focussed predominantly on proficiency in medical and technical skills, with emergency physicians acquiring these 'non-technical' skills in an ad hoc manner or by trial and error with varying levels of success. This paper describes a set of behaviours that, when practised in conjunction with medical and technical expertise, can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of an ED. Teaching and practice of these behaviours is now a core element of training and skills maintenance in other high-risk areas, such as aviation, and is becoming part of the routine training for anaesthetists. They address areas, such as communication, leadership, knowledge of environment, anticipation and planning, obtaining timely assistance, attention allocation and workload distribution. We outline the application of these behaviours in the speciality of emergency medicine, and suggest that the teaching and practice of crisis resource management principles should become part of the curriculum for training and credentialing of emergency medicine specialists. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Review article: the current management of acute liver failure.

    PubMed

    Craig, D G N; Lee, A; Hayes, P C; Simpson, K J

    2010-02-01

    Acute liver failure is a devastating clinical syndrome with a persistently high mortality rate despite critical care advances. Orthotopic liver transplantation (OLT) is a life-saving treatment in selected cases, but effective use of this limited resource requires accurate prognostication because of surgical risks and the requirement for subsequent life-long immunosuppression. To review the aetiology of acute liver failure, discuss the evidence behind critical care management strategies and examine potential treatment alternatives to OLT. Literature review using Ovid, PubMed and recent conference abstracts. Paracetamol remains the most common aetiology of acute liver failure in developed countries, whereas acute viral aetiologies predominate elsewhere. Cerebral oedema is a major cause of death, and its prevention and prompt recognition are vital components of critical care support, which strives to provide multiorgan support and 'buy time' to permit either organ regeneration or psychological and physical assessment prior to acquisition of a donor organ. Artificial liver support systems do not improve mortality in acute liver failure, whilst most other interventions have limited evidence bases to support their use. Acute liver failure remains a truly challenging condition to manage, and requires early recognition and transfer of patients to specialist centres providing intensive, multidisciplinary input and, in some cases, OLT.

  20. Review article: the clinical management of congenital chloride diarrhoea.

    PubMed

    Wedenoja, S; Höglund, P; Holmberg, C

    2010-02-15

    Congenital chloride diarrhoea in a newborn is a medical emergency, requiring early diagnostics and treatment to prevent severe dehydration and infant mortality. While most of the 250 cases reported arise from Finland, Poland and Arab countries, single cases with this autosomal recessive disorder appear worldwide. Such congenital chloride diarrhoea rarity makes diagnosis difficult. Life-long salt substitution with NaCl and KCl stabilizes fluid, electrolyte and acid-base balance diagnosis. When properly treated, the long-term outcome is favourable. To summarize data on congenital chloride diarrhoea diagnosis, pathophysiology and treatment, and to provide guidelines for both acute and long-term management of congenital chloride diarrhoea. Data are based on MEDLINE search for 'chloride diarrhoea', in addition to clinical experience in the treatment of the largest known series of patients. Treatment of congenital chloride diarrhoea involves (i) life-long salt substitution; (ii) management of acute dehydration and hypokalaemia during gastroenteritis or other infections; and (iii) recognition and treatment of other manifestations of the disease, such as intestinal inflammation, renal impairment and male subfertility. This review summarizes data on congenital chloride diarrhoea and provides guidelines for treatment. After being a mostly paediatric problem, adult patients constitute a rare challenge for gastroenterologists worldwide.

  1. Sleep, epilepsy, and autism.

    PubMed

    Accardo, Jennifer A; Malow, Beth A

    2015-06-01

    The purpose of this review article is to explore the links between sleep and epilepsy and the treatment of sleep problems in children with autism spectrum disorder (ASD). Epilepsy and sleep have bidirectional relationships, and problems with both are highly prevalent in children with ASD. Literature is reviewed to support the view that sleep is particularly important to address in the context of ASD. Identification and management of sleep disorders may improve seizure control and challenging behaviors. In closing, special considerations for evaluating and treating sleep disorders in children with ASD and epilepsy are reviewed. This article is part of a Special Issue entitled "Autism and Epilepsy". Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Review article: the management of heartburn in pregnancy.

    PubMed

    Richter, J E

    2005-11-01

    Heartburn is a normal consequence of pregnancy. The predominant aetiology is a decrease in lower oesophageal sphincter pressure caused by female sex hormones, especially progesterone. Serious reflux complications during pregnancy are rare; hence upper endoscopy and other diagnostic tests are infrequently needed. Gastro-oesophageal reflux disease during pregnancy should be managed with a step-up algorithm beginning with lifestyle modifications and dietary changes. Antacids or sucralfate are considered the first-line drug therapy. If symptoms persist, any of the histamine2-receptor antagonists can be used. Proton pump inhibitors are reserved for women with intractable symptoms or complicated reflux disease. All but omeprazole are FDA category B drugs during pregnancy. Most drugs are excreted in breast milk. Of systemic agents, only the histamine2-receptor antagonists, with the exception of nizatidine, are safe to use during lactation.

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

    PubMed Central

    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

  4. Gender differences in approaches to self-management of poor sleep in later life.

    PubMed

    Venn, Susan; Meadows, Robert; Arber, Sara

    2013-02-01

    In this paper we seek to understand the influence of gender on the different approaches to managing poor sleep by older men and women through the conceptual framework of existing theoretical debates on medicalization, healthicization and 'personalization'. In-depth interviews undertaken between January and July 2008 with 62 people aged 65-95 who were experiencing poor sleep, revealed that the majority of older men and women resisted the medicalization of poor sleep, as they perceived sleep problems in later life were an inevitable consequence of ageing. However, older men and women engaged differently with the healthicization of poor sleep, with women far more likely than men to explore a range of alternative sleep remedies, such as herbal supplements, and were also much more likely than men to engage in behavioural practices to promote good sleep, and to avoid practices which prevented sleep. Women situated 'sleep' alongside more abstract discussions of 'diet' and health behaviours and drew on the discourses of the media, friends, family and their own experiences to create 'personalized' strategies, drawn from a paradigm of healthicization. Men, however, solely relied on the 'body' to indicate when sleep was needed and gauged their sleep needs largely by how they felt, and were able to function the following day. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    PubMed

    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.

  6. Management of Sleep Problems in Pre-school Children.

    ERIC Educational Resources Information Center

    Pritchard, Alison-Ann; Appleton, Peter

    1988-01-01

    Assesses a behavioral intervention program for 31 children aged nine months to 3 1/2 years who had sleep problems. The children's sleep showed rapid improvement following the intervention, and similar changes were observed in other measures. (RJC)

  7. Management of Sleep Apnea without High Pretest Probability or with Comorbidities by Three Nights of Portable Sleep Monitoring

    PubMed Central

    Guerrero, Arnoldo; Embid, Cristina; Isetta, Valentina; Farre, Ramón; Duran-Cantolla, Joaquin; Parra, Olga; Barbé, Ferran; Montserrat, Josep M.; Masa, Juan F.

    2014-01-01

    Study Objectives: Obstructive sleep apnea (OSA) diagnosis using simplified methods such as portable sleep monitoring (PM) is only recommended in patients with a high pretest probability. The aim is to determine the diagnostic efficacy, consequent therapeutic decision-making, and costs of OSA diagnosis using polysomnography (PSG) versus three consecutive studies of PM in patients with mild to moderate suspicion of sleep apnea or with comorbidity that can mask OSA symptoms. Design and Setting: Randomized, blinded, crossover study of 3 nights of PM (3N-PM) versus PSG. The diagnostic efficacy was evaluated with receiver operating characteristic (ROC) curves. Therapeutic decisions to assess concordance between the two different approaches were performed by sleep physicians and respiratory physicians (staff and residents) using agreement level and kappa coefficient. The costs of each diagnostic strategy were considered. Patients and Results: Fifty-six patients were selected. Epworth Sleepiness Scale was 10.1 (5.3) points. Bland-Altman plot for apnea-hypopnea index (AHI) showed good agreement. ROC curves showed the best area under the curve in patients with PSG AHI ≥ 5 [0.955 (confidence interval = 0.862–0.993)]. For a PSG AHI ≥ 5, a PM AHI of 5 would effectively exclude and confirm OSA diagnosis. For a PSG AHI ≥ 15, a PM AHI ≥ 22 would confirm and PM AHI < 7 would exclude OSA. The best agreement of therapeutic decisions was achieved by the sleep medicine specialists (81.8%). The best cost-diagnostic efficacy was obtained by the 3N-PM. Conclusions: Three consecutive nights of portable monitoring at home evaluated by a qualified sleep specialist is useful for the management of patients without high pretest probability of obstructive sleep apnea or with comorbidities. Clinical Trial Registration: http://www.clinicaltrials.gov, registration number: NCT01820156 Citation: Guerrero A, Embid C, Isetta V, Farre R, Duran-Cantolla J, Parra O, Barbé F, Montserrat JM, Masa

  8. Overview of Sleep and Sleep Disorders in Infancy and Childhood.

    PubMed

    Carter, John C; Wrede, Joanna E

    2017-04-01

    Sleep in children is an important and dynamic process, affecting numerous aspects of health and development. Problems with sleep are relatively common but often can be challenging to recognize. This article reviews the fundamental aspects of sleep in children from infancy to adolescence, and the most common and relevant sleep disorders likely to be encountered in a general pediatric practice. Where available, current evidence-based recommendations for management are discussed, including indications for referral to a sleep specialist. [Pediatr Ann. 2017;46(4):e133-e138.]. Copyright 2017, SLACK Incorporated.

  9. Health related management plans improve sleep disorders of patients with chronic liver disease

    PubMed Central

    Liu, Chunzi; Xie, Hui; Zhang, Xin; Yu, Yanbo; Zhang, Xiaoning; Sun, Yanyan; Zhou, Lin; Su, Beibei; Wang, Huaming

    2015-01-01

    Backgrounds: Sleep disorders (SDs) are commonly occurred in patients with chronic liver disease (CLD) and always bring with uncomfortable experience Lavender hot-bathing, foot-soaking, or progressive relaxation have been widely used to provide comfortable feeling for CLD patients and promote their sleep quality. Aims: Thus, the aim of present study is to investigate effective intervention from above mentioned in the managements of SD and promote sleep quality for CLD patients. Methods: This study was conducted in People's Liberation Army No. 302 Hospital. A total of 317 subjects joined in our research. Initially, 197 CLD patients were enrolled and divided randomly into four groups for receiving lavender hot-bathing and foot-soaking, progressive relaxation, or the combination of both methods, and controls. After that, all of enrolled subjects were given sleep state questionnaires to assess their sleep qualities and other associated factors. Self-rating scores of sleep (SRSS) was sued to assess sleep disorder. Furthermore, another cohort with 120 CLD patients were also investigated for further confirming related findings. Results: The SRSS scores were significantly higher in the patients with CLD (62.94%) than those of domestic common model and internal medicine inpatients. However, all three methods of intervention were effectively decreased SRSS scores. The four mostly influencing factors of sleep states were short sleep, difficulty falling asleep, staying asleep and early morning awakening. Besides, age was identified as one of associating with sleep states. 44.67% of patients suffered from polyuria, abdominal distention or itch of skin. And those factors contributed to major risk factors of sleep disorder. Furthermore, sleep states also influenced by environmental interference (37.06%). Conclusion: The health managements of health education could reduce risk factors and implement intervention strategies, effectively decreased occurrence of sleep disorder related

  10. A practical approach to the diagnosis and management of sleep disorders in patients with multiple sclerosis

    PubMed Central

    Braley, Tiffany J.; Chervin, Ronald D.

    2015-01-01

    Patients with multiple sclerosis (MS) are at increased risk for comorbid sleep disturbances, which can profoundly contribute to poor functional status and fatigue. Insomnia, sleep-disordered breathing, and restless legs syndrome are among the most common sleep disorders experienced by patients with MS. Despite their impact, these underlying sleep disorders may escape routine clinical evaluations in persons with MS, thereby leading to missed opportunities to optimize functional status and quality of life in patients with MS. A practical, systematic approach to the evaluation and treatment of sleep disorders in MS, in the context of MS-specific variables that may influence risk for these conditions or response to therapy, is recommended to facilitate early diagnosis and successful treatment. This review summarizes the most common sleep disorders experienced by persons with MS, and offers a practical approach to diagnosis and management of these conditions. PMID:26600873

  11. Sleep disturbances in Parkinson’s disease patients and management options

    PubMed Central

    Claassen, Daniel O; Kutscher, Scott J

    2011-01-01

    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. PMID:23616723

  12. Management of sleep apnea without high pretest probability or with comorbidities by three nights of portable sleep monitoring.

    PubMed

    Guerrero, Arnoldo; Embid, Cristina; Isetta, Valentina; Farre, Ramón; Duran-Cantolla, Joaquin; Parra, Olga; Barbé, Ferran; Montserrat, Josep M; Masa, Juan F

    2014-08-01

    Obstructive sleep apnea (OSA) diagnosis using simplified methods such as portable sleep monitoring (PM) is only recommended in patients with a high pretest probability. The aim is to determine the diagnostic efficacy, consequent therapeutic decision-making, and costs of OSA diagnosis using polysomnography (PSG) versus three consecutive studies of PM in patients with mild to moderate suspicion of sleep apnea or with comorbidity that can mask OSA symptoms. Randomized, blinded, crossover study of 3 nights of PM (3N-PM) versus PSG. The diagnostic efficacy was evaluated with receiver operating characteristic (ROC) curves. Therapeutic decisions to assess concordance between the two different approaches were performed by sleep physicians and respiratory physicians (staff and residents) using agreement level and kappa coefficient. The costs of each diagnostic strategy were considered. Fifty-six patients were selected. Epworth Sleepiness Scale was 10.1 (5.3) points. Bland-Altman plot for apnea-hypopnea index (AHI) showed good agreement. ROC curves showed the best area under the curve in patients with PSG AHI ≥ 5 [0.955 (confidence interval = 0.862-0.993)]. For a PSG AHI ≥ 5, a PM AHI of 5 would effectively exclude and confirm OSA diagnosis. For a PSG AHI ≥ 15, a PM AHI ≥ 22 would confirm and PM AHI < 7 would exclude OSA. The best agreement of therapeutic decisions was achieved by the sleep medicine specialists (81.8%). The best cost-diagnostic efficacy was obtained by the 3N-PM. Three consecutive nights of portable monitoring at home evaluated by a qualified sleep specialist is useful for the management of patients without high pretest probability of obstructive sleep apnea or with comorbidities. http://www.clinicaltrials.gov, registration number: NCT01820156. Guerrero A, Embid C, Isetta V, Farre R, Duran-Cantolla J, Parra O, Barbé F, Montserrat JM, Masa JF. Management of sleep apnea without high pretest probability or with comorbidities by three nights of portable

  13. Sleep Apnea Detection

    MedlinePlus

    ... Young Adult Healthy Children > Ages & Stages > Baby > Sleep > Sleep Apnea Detection Ages & Stages Listen Español Text Size Email Print Share Sleep Apnea Detection Page Content Article Body Sleep apnea ...

  14. Managing snoring and obstructive sleep apnoea in childhood.

    PubMed

    Fitzgerald, Nicholas M; Fitzgerald, Dominic A

    2013-10-01

    Snoring assessment and its differentiation from obstructive sleep apnoea are difficult based upon a parent history and physical examination of the size of the tonsils. Not only is the presence of obstructive sleep apnoea important to diagnose, but confirming its severity is the key determinant in prioritising treatment in a resource-limited setting. This review provides current knowledge on the utility of common diagnostic tests, results of treatment options available and implications of treatment and unrecognised or untreated obstructive sleep apnoea.

  15. Sleep Management User’s Guide for Special Operations Personnel

    DTIC Science & Technology

    1992-07-01

    attention work against effective communication. Sleep loss can cause a listener to forget what was recently said in a conversation. A listener may fill the...to uncontrollable lapses in attention and poor memory. Sleep logistics has been proposed as a means of preventing these problems by way of work/rest...unit members will pass from increased irritability and negativism to a sense of dullness and weariness. Impaired Attention . With progressive sleep loss

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

    PubMed

    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.

  17. Effect of diabetes mellitus on sleep quality

    PubMed Central

    Surani, Salim; Brito, Veronica; Surani, Asif; Ghamande, Shekhar

    2015-01-01

    Diabetes mellitus (DM) is a highly prevalent condition affecting about 347 million people worldwide. In addition to its numerous clinical implications, DM also exerts a negative effect on patient’s sleep quality. Impaired sleep quality disrupts the adequate glycemic control regarded as corner stone in DM management and also lead to many deleterious effects causing a profound impact on health related quality of life. This article outlines various factors leading to impaired sleep quality among diabetics and delineates how individual factor influences sleep. The article also discusses potential interventions and lifestyle changes to promote healthy sleep among diabetics. PMID:26131327

  18. Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review.

    PubMed

    Blackmer, Allison Beck; Feinstein, James A

    2016-01-01

    Neurodevelopmental disorders (NDDs) are defined as a group of disorders caused by changes in early brain development, resulting in behavioral and cognitive alterations in sensory and motor systems, speech, and language. NDDs affect approximately 1-2% of the general population. Up to 80% of children with NDDs are reported to have disrupted sleep; subsequent deleterious effects on daytime behaviors, cognition, growth, and overall development of the child are commonly reported. Examples of NDDs discussed in this review include autism spectrum disorder, cerebral palsy, Rett syndrome, Angelman syndrome, Williams syndrome, and Smith-Magenis syndrome. The etiology of sleep disorders in children with NDDs is largely heterogeneous and disease specific. The diagnosis and management of sleep disorders in this population are complex, and little high-quality data exist to guide a consistent approach to therapy. Managing sleep disorders in children with NDDs is critical both for the child and for the family but is often frustrating due to the refractory nature of the problem. Sleep hygiene must be implemented as first-line therapy; if sleep hygiene alone fails, it should be combined with pharmacologic management. The available evidence for the use of common pharmacologic interventions, such as iron supplementation and melatonin, as well as less common interventions, such as melatonin receptor agonists, clonidine, gabapentin, hypnotics, trazodone, and atypical antipsychotics is reviewed. Further, parents and caregivers should be provided with appropriate education on the nature of the sleep disorders and the expectation for modest pharmacologic benefit, at best. Additional data from well-designed trials in children with NDDs are desperately needed to gain a better understanding of sleep pharmacotherapy including efficacy and safety implications. Until then, clinicians must rely on the limited available data, as well as clinical expertise, when managing sleep disorders in the

  19. American Academy of Dental Sleep Medicine

    MedlinePlus

    ... Sleep Solutions Nierman Practice Management ProSomnus Sleep Technologies Space Maintainers Laboratory ... © American Academy of Dental Sleep Medicine, All Rights Reserved. American Academy of Dental Sleep ...

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

    PubMed

    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.

  1. Managing sleep disorders in children: which is the best strategy?

    PubMed

    Bellini, Benedetta; Bruni, Oliviero; Cescut, Alessandra; De Martino, Silvia; Lucchese, Franco; Guidetti, Vincenzo

    2011-01-01

    This review aims to critically analyze the literature studies showing the effectiveness of cognitive-behavioral strategies in the treatment of sleep disorder during the developmental age. About 15-35% of children suffer from sleep disorder. If they are not treated right away, it can persist into adulthood. Recent studies demonstrate an effective cognitive-behavior treatment for these disturbances. In this regard, the most effective method seems to be extinction (standard, with parental presence, graduated), the bedtime routine, scheduled awakenings, and preventive parent education. The procedures of extinction, not only its effectiveness, have limited application for the difficulty that compares to the parents following the procedure of the intervention. They are not able to ignore their children when they are crying for long prolonged period of time. Bedtime routine is relevant in the prevention and treatment of sleep disorders. The scheduled awakenings are a useful technique that teaches parents to change the way they interact with the child's disturbed sleep, allowing recovery. Finally, preventive parental education depends on the parents or caregivers and aims to educate them; during the prenatal or postnatal period with their child's sleep it seems useful in preventing irregular pattern formation and temporal regulation of sleep. The vast majority of children's sleep disruptions seem to resolve only with the cognitive-behavioral intervention, while in some psychopathologic disruptions it is necessary to combine cognitive-behavioral and drug therapy. Literature reviews show that clinical research concerning sleep disruptions is still very limited. In current reviews, there have been diverse investigations on efficacy of cognitive-behavioral interventions and sleep disruptions, highlighting both the strong points and weak points. Therefore, this analysis could be a starting point for developing further research since there is a lack of studies in relation to

  2. Updates on definition, consequences, and management of obstructive sleep apnea.

    PubMed

    Park, John G; Ramar, Kannan; Olson, Eric J

    2011-06-01

    Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field.

  3. Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea

    PubMed Central

    Park, John G.; Ramar, Kannan; Olson, Eric J.

    2011-01-01

    Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field. PMID:21628617

  4. Sleep disturbances and quality of life in postoperative management after esophagectomy for esophageal cancer

    PubMed Central

    2014-01-01

    Background The aims of this prospective study were to analyze the predictors of postoperative sleep disturbance after esophagectomy for cancer and to identify patients at risk for postoperative hypnotic administration. Methods Sixty two consecutive patients who underwent cancer-related esophagectomy were enrolled in this study from May 2011 to February 2012. Data about perioperative management, postoperative complications, ICU stay, and vasopressor, hypnotic, and painkiller administration were retrieved. The EORTC QLQ-C30 was used and global quality of life (QL2 item) and sleep disturbance (SL item) were the primary endpoints. Univariate and multivariate analyses were performed. Results Postoperative request of hypnotics independently predicted bad quality of life outcome. Sleep disturbance after esophagectomy was independently predicted by the duration of dopamine infusion in the ICU and the daily request of benzodiazepines. Even in this case, only sleep disturbance at diagnosis revealed to be an independent predictor of hypnotic administration need. ROC curve analysis showed that sleep disturbance at diagnosis was a good predictor of benzodiazepine request (AUC = 73%, P = 0.02). Conclusions The use of vasopressors in the ICU affects sleep in the following postoperative period and the use of hypnotics is neither completely successful nor lacking in possible consequences. Sleep disturbance at diagnosis can successfully predict patients who can develop sleep disturbance during the postoperative period. PMID:24886219

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

    PubMed Central

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

    2016-01-01

    Objectives: To test a collaborative care model for interfacing sleep specialists with primary care providers to enhance patients' sleep disorders management. Methods: 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. Results: 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 < 0.001) and mental health clinic referrals (19% versus 6%; P = 0.02). At the 10-mo follow up, INT recipients showed greater estimated mean reductions in diary total wake time (−17.0 min; 95% confidence interval [CI]: −30.9, −3.1; P = 0.02) and greater increases in 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). Conclusions: A one-time sleep consultation significantly increased healthcare providers' attention to sleep problems and

  6. A developmental approach to the management of children with sleep disturbances in the first three years of life.

    PubMed

    Largo, R H; Hunziker, U A

    1984-08-01

    A developmental approach to the management of sleep disturbances was successful in 85% (44/52) of the children (aged 2-36 months) within 2-6 weeks. No drugs were used. The approach was based on the following two principles: taking into account the characteristics of sleep behavior in infants and young children by setting up seven rules of normal sleep behavior, and dealing with the expectations and anxieties of the parents by means of a sleep chart.

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

    PubMed

    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.

  8. Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder.

    PubMed

    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.

  9. Managing Comorbid Illness in Obstructive Sleep Apnea: What Can We Learn from Other Diseases?

    PubMed

    Conwell, Walter D; Tsai, Sheila C

    2016-09-01

    Obstructive sleep apnea (OSA) is associated with numerous comorbid medical conditions. Symptoms of OSA may mimic those of comorbid conditions. The presence of OSA may worsen outcomes from the primary condition. Conversely, OSA treatment may benefit both sleep symptomatology and comorbid illness. Because of potential significant benefit, it is important to screen for sleep apnea symptoms, to have a low threshold to perform diagnostic testing, to treat OSA if present, and to closely monitor symptoms. OSA management does not necessarily replace, but rather, should be performed in conjunction with primary therapy for comorbid conditions.

  10. Extending Human Effectiveness during Sustained Operations through Sleep Management

    DTIC Science & Technology

    1983-08-01

    HASE MONDAY TUESDAY WEDNESDAY THURSDAY FRiDAY _’, ,•_PFTL PWA -SE Training Baseline CW11 CW2 Recovery LTIME WA WB WA W WA We WA WB WA WB 01-02 02-03 03-04...recovery sleep. IP Table 2. Summary of Results Task/Measure Sleep/hours Mean CWii Mean CW2 % Change÷ Direction of Change SRT*(l0?i slow: msec) 8** 509 524

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

    PubMed Central

    Lougheed, Scott; Rowe, R Kerry; Kuyvenhoven, Cassandra

    2014-01-01

    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. PMID:25051590

  12. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management.

    PubMed

    Kaditis, Athanasios G; Alonso Alvarez, Maria Luz; Boudewyns, An; Alexopoulos, Emmanouel I; Ersu, Refika; Joosten, Koen; Larramona, Helena; Miano, Silvia; Narang, Indra; Trang, Ha; Tsaoussoglou, Marina; Vandenbussche, Nele; Villa, Maria Pia; Van Waardenburg, Dick; Weber, Silke; Verhulst, Stijn

    2016-01-01

    This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).

  13. Clinical management of sleep disturbances in Alzheimer’s disease: current and emerging strategies

    PubMed Central

    Urrestarazu, Elena; Iriarte, Jorge

    2016-01-01

    Sleep and circadian disorders in Alzheimer’s disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock. PMID:26834500

  14. Clinical management of sleep disturbances in Alzheimer's disease: current and emerging strategies.

    PubMed

    Urrestarazu, Elena; Iriarte, Jorge

    2016-01-01

    Sleep and circadian disorders in Alzheimer's disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock.

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

    PubMed

    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 < 0.001) and mental health clinic referrals (19% versus 6%; P = 0.02). At the 10-mo follow up, INT recipients showed greater estimated mean reductions in diary total wake time (-17.0 min; 95% confidence interval [CI]: -30.9, -3.1; P = 0.02) and greater increases in 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

  16. Chronic obstructive pulmonary disease and sleep related disorders.

    PubMed

    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. Latest trends in the assessment and management of paediatric snoring and sleep apnoea.

    PubMed

    Sharma, S D; Kanona, H; Kumar, G; Kotecha, B

    2016-05-01

    To investigate the assessment and management of paediatric snoring and obstructive sleep apnoea in UK otolaryngology departments. A telephone questionnaire survey of UK otolaryngology departments was conducted over a 16-week period. The response rate was 61 per cent (85 out of 139 trusts). Use of pre-operative pulse oximetry was reported by 84 per cent of respondents, mainly to diagnose obstructive sleep apnoea (73 per cent) or stratify post-operative risk (46 per cent). Thirty-one per cent of respondents reported using post-operative pulse oximetry. Twenty-five per cent of respondents have a dedicated management protocol for paediatric obstructive sleep apnoea and snoring. Thirty-four per cent require prior clinical commissioning group approval before performing surgery. Fifty-eight per cent of respondents reported following up their obstructive sleep apnoea patients after surgery. The mean follow-up period (±standard deviation) was 6.8 ± 1.2 weeks. There is variation in the assessment and management of paediatric snoring and obstructive sleep apnoea across the UK, particularly in the use of pre- and post-operative pulse oximetry monitoring, and further guidelines regarding this are necessary.

  18. Overview of sleep & sleep disorders.

    PubMed

    Chokroverty, S

    2010-02-01

    disturbance and vigorously treat the co-morbid conditions causing the sleep disturbance. If a satisfactory treatment is not available for the primary condition or does not resolve the problem, the treatment should be directed at the specific sleep disturbance. Most sleep disorders, once diagnosed, can be managed with limited consultations. The treatment of primary sleep disorders, however, is best handled by a sleep specialist. An overview of sleep and sleep disorders viz., Basic science; international classification and approach; and phenomenology of common sleep disorders are presented.

  19. [Sleep disorders and work: guidelines for health surveillance, risk management and prevention].

    PubMed

    Costa, G; Accattoli, Maria Patrizia; Garbarino, S; Magnavita, N; Roscelli, F

    2013-01-01

    Sleep disorders and related diseases are becoming increasingly relevant for the health and wellbeing of the general and working populations. Sleep disorders affect all aspects of health, showing a bi-directionality with health conditions and comorbidity with several diseases. Consequently, sleep disorders may have severe negative consequences both for the individual and the enterprise, as well as for society on the whole, in terms of health, productivity and social costs. When considering the disturbances of the sleep/wake cycle, it is important to distinguish between those connected with endogenous biological factors from those related to socio-environmental conditions, including work, and those associated with mental and physical diseases, that are often associated and interact with each other. Many sleep disorders are still underestimated and under-valued in clinical practice and, to a much greater extent, in workers' health surveillance. The present paper is aimed at drawing the attention of the occupational health physician to some key issues, particularly regarding excessive daytime sleepiness, obstructive sleep apnea syndrome and shift and night work, as well as their implications in terms of health and occupational consequences. Information on the main aspects of clinical diagnosis and health surveillance, as well as risk management and prevention at the workplace, are provided.

  20. Sleep Disturbances in Acutely Ill Patients with Cancer.

    PubMed

    Matthews, Ellyn E; Tanner, J Mark; Dumont, Natalie A

    2016-06-01

    Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. How to interpret the results of a sleep study

    PubMed Central

    Shrivastava, Deepak; Jung, Syung; Saadat, Mohsen; Sirohi, Roopa; Crewson, Keri

    2014-01-01

    With an increased level of awareness of sleep disorders among the public, there has been an increase in requests for sleep studies, and consequently, more referrals made to sleep specialists by primary care physicians and other health care providers. Understanding technical and clinical information provided in the sleep study report is crucial. It offers significant insight in to sleep pathophysiology in relation to patient symptoms. The purpose of this article is to provide a simple and easy method to interpret the reported results of polysomnography for primary care physicians. This will facilitate better understanding and management of patients with sleep disorders and related complications. PMID:25432643

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

    PubMed Central

    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

  3. Communication platform for biosensor-based sleep management applications.

    PubMed

    Fernanda Cabrera-Umpiérrez, María; Fico, Giuseppe; Arredondo, María Teresa; Blasco, José Manuel; Hernández, José F; Montón, Eduardo; Guillén, Sergio; Vazão, Teresa; Valadas, Jorge

    2006-01-01

    This paper presents the architecture of a complete communications platform for biosensor-based applications in the domain of sleep disorders. It covers from the direct communication with the sensors themselves to the most remote application modules. It has been divided into three levels: BAN (Body Area Network), LAN (Local Area Network) and WAN (Wide Area Network), and it uses wireless communications at all levels of the architecture.

  4. Dentists should participate in the management of patients with obstructive sleep apnea and socially disruptive snoring-findings from a survey of Scottish sleep specialists.

    PubMed

    John, Mike T

    2010-06-01

    The attitudes of general dental practitioners and medical specialists to the provision of intra-oral appliances for the management of snoring and sleep apnoea Jauhar S, Lyons MF, Banham SW, Orchardson R, Livingston E. Br Dent J 2008;205(12):653-7. Mike T. John, DDS, PhD. Should dentists have a role in helping patients with either socially disruptive snoring or obstructive sleep apnea? Information not available. Survey. Level 2: Limited quality, patient-oriented evidence. Not applicable.

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

    PubMed

    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.

  6. Parasomnias and movement disorders of sleep.

    PubMed

    Avidan, Alon Y

    2009-09-01

    Neurologists are often enlisted to help diagnose, evaluate, and manage a spectrum of abnormal spells during the night ranging from parasomnias to motor disturbance that span the sleep-wake cycle. Parasomnias are undesirable emotional or physical events that accompany sleep. These events typically occur during entry into sleep from wakefulness, or during arousals from sleep, and are often augmented by the sleep state. Some parasomnias, such as the rapid eye movement (REM) sleep behavior disorder may be extremely undesirable, while others such as somniloquy are often of little concern. The parasomnias include a spectrum of abnormal emotions, movements, behaviors, sensory perceptions, dream mentation, and autonomic activity. Basic physiologic drives, such as sex, hunger, and aggression, may manifest as sleep-related eating, sleep-related sexual behaviors, and sleep-related violence. Parasomnias have a very bizarre nature, but are readily explainable, diagnosable, and treatable. They are hypothesized to be due to changes in brain organization across multiple states of being, and are particularly apt to occur during the incomplete transition or oscillation from one sleep state to another. Parasomnias are often explained on the basis that wakefulness and sleep are not mutually exclusive states, and abnormal intrusion of wakefulness into non-REM (NREM) sleep produces arousal disorders, and intrusion of wakefulness into REM sleep produces REM sleep parasomnias and REM sleep behavior disorder (RBD). Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD), two closely related conditions that often result in disturbed sleep onset and sleep maintenance, are also reviewed in this article. Although the mechanisms that underlie idiopathic RLS or PLMD are not fully understood, there is currently substantial evidence that dopaminergic dysfunction is likely involved in both conditions. The discussion will conclude with the "other parasomnias" and sleep

  7. Carbon capture and sequestration: identifying and managing risks - article no. 1

    SciTech Connect

    Alexandra B. Klass; Elizabeth J. Wilson

    2009-07-01

    Carbon capture and geologic sequestration (CCS) technology promises to provide deep emissions cuts, particularly from coal power generation, but deploying CCS creates risks of its own. This article first considers the risks associated with CCS, which involves capturing CO{sub 2} emissions from industrial sources and power plants, transporting the CO{sub 2} by pipeline, and injecting it underground for permanent sequestration. The article then suggests ways in which these risks can be minimized and managed and considers more broadly when or if CCS should be deployed or whether its use should be limited or rejected in favor of other solutions.

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

    PubMed

    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.

  9. Surgical management of maxillomandibular advancement in sleep apnea patients: specific technical considerations.

    PubMed

    Gilon, Y; Raskin, S; Heymans, O; Poirrier, R

    2001-01-01

    Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.

  10. Side Effects: Sleep Problems

    Cancer.gov

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

  11. Review of survey articles regarding medication therapy management (MTM) services/programs in the United States.

    PubMed

    Oladapo, Abiola O; Rascati, Karen L

    2012-08-01

    To provide a summary of published survey articles regarding the provision of medication therapy management (MTM) services in the United States. A literature search was conducted to identify original articles on MTM-related surveys conducted in the United States, involving community and outpatient pharmacists, physicians, patients, or pharmacy students and published by the primary researchers who conducted the study. Search engines used included PubMed, Medline, and International Pharmaceutical Abstracts (IPA). If MTM was in the keyword list, mesh heading, title, or abstract, the article was reviewed. References from these articles were searched to determine whether other relevant articles were available. A total of 405 articles were initially reviewed; however, only 32 articles met the study requirements. Of the 32 articles, 17 surveyed community/outpatient pharmacists, 3 surveyed pharmacy students, 4 surveyed physicians, and 8 surveyed patients. The survey periods varied across the different studies, with the earliest survey conducted in 2004 and the most recent survey conducted in 2009. The surveys were conducted via the telephone, US mail, interoffice mail, e-mails, Internet/Web sites, hand-delivered questionnaires, and focus groups. Despite the identified barriers to the provision of MTM services, pharmacists reportedly found it professionally rewarding to provide these services. Pharmacists claimed to have adequate clinical knowledge, experience, and access to information required to provide MTM services. Pharmacy students were of the opinion that the provision of MTM services was important to the advancement of the pharmacy profession and in providing patients with a higher level of care. Physicians supported having pharmacists adjust patients’ drug therapy and educate patients on general drug information but not in selecting patients’ drug therapy. Finally, patients suggested that alternative ways need to be explored in describing and marketing MTM

  12. Selected surgical managements in snoring and obstructive sleep apnea patients

    PubMed Central

    Olszewska, Ewa; Rutkowska, Justyna; Czajkowska, Aneta; Rogowski, Marek

    2012-01-01

    Summary Background The diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients. Material/Methods A precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires. Results In most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days. Conclusions Surgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery. PMID:22207114

  13. Are chemicals in articles an obstacle for reaching environmental goals? - Missing links in EU chemical management.

    PubMed

    Molander, Linda; Breitholtz, Magnus; Andersson, Patrik L; Rybacka, Aleksandra; Rudén, Christina

    2012-10-01

    It is widely acknowledged that the management of risks associated with chemicals in articles needs to be improved. The EU environmental policy states that environmental damage should be rectified at source. It is therefore motivated that the risk management of substances in articles also takes particular consideration to those substances identified as posing a risk in different environmental compartments. The primary aim of the present study was to empirically analyze to what extent the regulation of chemicals in articles under REACH is coherent with the rules concerning chemicals in the Sewage Sludge Directive (SSD) and the Water Framework Directive (WFD). We also analyzed the chemical variation of the organic substances regulated under these legislations in relation to the most heavily used chemicals. The results show that 16 of 24 substances used in or potentially present in articles and regulated by the SSD or the WFD are also identified under REACH either as a substance of very high concern (SVHC) or subject to some restrictions. However, for these substances we conclude that there is limited coherence between the legislations, since the identification as an SVHC does not in itself encompass any use restrictions, and the restrictions in REACH are in many cases limited to a particular use, and thus all other uses are allowed. Only a minor part of chemicals in commerce is regulated and these show a chemical variation that deviates from classical legacy pollutants. This warrants new tools to identify potentially hazardous chemicals in articles. We also noted that chemicals monitored in the environment under the WFD deviate in their chemistry from the ones regulated by REACH. In summary, we argue that to obtain improved resource efficiency and a sustainable development it is necessary to minimize the input of chemicals identified as hazardous to health or the environment into articles. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. Drug-induced sleep endoscopy changes snoring management plan very significantly compared to standard clinical evaluation.

    PubMed

    Pilaete, Karen; De Medts, Joris; Delsupehe, Kathelijne Godelieve

    2014-05-01

    Drug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospital. A consecutive series of 100 snoring patients prospectively underwent a standardised questionnaire, clinical examination, rhinomanometry, allergy skin prick testing, DISE and polysomnography. Management plan before and after DISE evaluation was compared. In 61 patients (excluding 16 patients sent for continuous positive airway pressure, three patients refused sleep endoscopy and 20 were lost to follow-up), we compared the treatment plans. DISE showed single level airway collapse in 13 and multilevel collapse in 48 patients. The site of flutter did not add additional information as compared to the pattern and the location of the collapse. After DISE, the initial management plan changed in 41% of patients irrespective of the type of initial management plan. The only somewhat accurate initial treatment plan was uvulopalatopharyngoplasty (unchanged in 11/13 patients). Excluding moderate to severe obstructive sleep apnea patients DISE is an indispensable tool in treatment decision in all SDB patients. We suggest to simplify the protocol for DISE reporting.

  15. A trial of drug-induced sleep endoscopy in the surgical management of sleep-disordered breathing.

    PubMed

    Gillespie, M Boyd; Reddy, Ryan P; White, David R; Discolo, Christopher M; Overdyk, Frank J; Nguyen, Shaun A

    2013-01-01

    To determine the reliability and validity of drug-induced sleep endoscopy (DISE) for patients undergoing surgery for sleep-disordered breathing (SDB). Non-randomized, prospective clinical trial. Patients with sleep-disordered breathing were evaluated for multi-level upper airway surgery by awake and drug-induced sleep endoscopy to identify levels and degree of airway collapse. The reliability of a drug-induced sleep endoscopy rating index was assessed by comparing scores of three blinded investigators. The validity was assessed by comparison of drug-induced sleep endoscopy index scores from awake and drug-induced sleep endoscopy; correlation between drug-induced sleep endoscopy scores and Apnea-Hypopnea Index; and determination whether drug-induced sleep endoscopy affected the original surgical plan. Thirty-eight patients (22 M, 16 F) underwent preoperative assessment with awake and drug-induced sleep endoscopy. Drug-induced sleep endoscopy was successfully performed in all but one patient (97%) who became combative during propofol infusion. Using an internal airway grading scale, drug-induced sleep endoscopy demonstrated more severity of collapse than awake endoscopy (P = 0.0001). The surgical plan was changed after drug-induced sleep endoscopy in 23 (62%) cases and unchanged in 14 (38%). The majority (73%) had multi-segmental airway collapse with fewer having single-level palatal (16%) or tongue base (11%) collapse. Scoring of drug-induced sleep endoscopy videos demonstrated good intrarater (κ 0.61) and interrater (κ 0.65) correlation. Drug-induced sleep endoscopy provides more clinical information to assess airway function and collapse than awake endoscopy alone and assists in the surgical planning. Additional investigation is needed to standardize drug-induced sleep endoscopy techniques, training, and interpretation. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  16. 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)

    DTIC Science & Technology

    2006-10-01

    II: Effects on F +31 15 284 39 91 sleep pattern and sleep quality in marmosets Info-DenV@tno.nf Date October 2006 Author(s) Dr I.l1.C.H.M. Philippens...5126 Summary In this study, the marmoset monkey model was validated using nocturnal electroencephalogram measurements for evaluating effects on sleep...the effects of the short acting hypnotic drugs temazepam, zolpidem and zaleplon on sleep were determined in the marmoset monkey. The results showed

  17. Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis.

    PubMed

    Meccariello, Giuseppe; Cammaroto, Giovanni; Montevecchi, Filippo; Hoff, Paut T; Spector, Matthew E; Negm, Hesham; Shams, Medhat; Bellini, Chiara; Zeccardo, Ermelinda; Vicini, Claudio

    2017-02-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a serious social health problem with significant implications on quality of life. Surgery for OSAHS has been criticized due to a lack of evidence to support its efficacy as well as the heterogeneous reporting of published outcomes. Moreover, the transoral robotic surgery (TORS) in the management of OSAHS is still in a relative infancy. Nevertheless, a review and meta-analysis of the published articles may be helpful. Among 195 articles, eight studies were included in the analysis. The mean of enrolled patients was 102.5 ± 107.9 (range 6-289) comprising a total of 820 cases. The mean age was 49 ± 3.27 and 285 patients underwent a previous sleep apnea surgery. The uvulopalatopharyngoplasty (UPPP) was the most common palatal procedure. The mean rate of failure was 34.4 % (29.5-46.2 %). Complications occurred in 21.3 % of the patients included in the analysis, most of them were classified as minor. Transient dysphagia represented the most common complication (7.2 %) followed by bleeding (4.2 %). TORS for the treatment of OSAHS appears to be a promising and safe procedure for selected patients seeking an alternative to continuous positive airway pressure (CPAP), although further researches are urgently needed.

  18. Obstructive sleep apnoea and anaesthesia

    PubMed Central

    Rudra, A.; Chatterjee, S.; Das, T.; Sengupta, S.; Maitra, G.; Kumar, P.

    2008-01-01

    Obstructive sleep apnoea (OSA) correlates positively with obesity and age, both of which are becoming increasingly prevalent. Obstructive sleep apnoea occurs much more frequently in clinical practice than formerly diagnosed, and that this condition represents complex challenges for difficulty in mask ventilation, laryngoscopic intubation, accelerated arterial desaturation, postoperative monitoring and discharge status. In this review article pathophysiology, diagnosis, and perioperative management of this group of patients have been discussed in detail. PMID:19742249

  19. Validity of claims made in weight management research: a narrative review of dietetic articles

    PubMed Central

    2010-01-01

    Background The best available evidence demonstrates that conventional weight management has a high long-term failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored. Methods A narrative literature review of journal articles in The Journal of Human Nutrition and Dietetics from 2004 to 2008. Results Although the energy deficit approach to weight management has a high long-term failure rate it continues to dominate research in the field. In the current research agenda, controversies and complexities in the evidence base are inadequately discussed, and claims about the likely success of weight management misrepresent available evidence. Conclusions Dietetic literature on weight management fails to meet the standards of evidence based medicine. Research in the field is characterised by speculative claims that fail to accurately represent the available data. There is a corresponding lack of debate on the ethical implications of continuing to promote ineffective treatment regimes and little research into alternative non-weight centred approaches. An alternative health at every size approach is recommended. PMID:20646282

  20. Sleep and performance--recent trends.

    PubMed

    Himashree, Gidugu; Banerjee, P K; Selvamurthy, W

    2002-01-01

    Sleep and sleep deprivation are intimately related to performance. Sleep management of people working in different sectors of the society like multi shift workers, nurses, doctors, students in professional schools and the armed forces has a great bearing on performance, health and safety of the subject population. The detrimental effects of sleep deprivation on psychological performance are indicated as increased lapsing, cognitive slowing, memory impairment, decrease in vigilance and sustained attention and shift in optimum response capability. Its effects on physical performance are manifested as decline in ability to perform maximal exercise, self-selected walking pace and increase in perceived exertion. Sleep deprivation appears to have no effect in respect of muscle contractile properties and maximum anaerobic power. At high altitude (HA), there is a reduction in NREM sleep with frequent awakening due to hypoxia as a physiological adaptive measure to prevent accentuation of hypoxemia due to sleep-hypoventilation. Total sleep deprivation for 48 hours at high altitude can affect the acclimatization status, thermoregulation efficiency and cognitive functions. The concept of 'sleepiness' has also been studied, as it is an emerging concept for better understanding of the effects of sleep deprivation and its effects on performance. A special mention of sustained operations in the armed forces has been made keeping in mind its uniqueness in challenging the normal sleep-work schedule and its deployment in extreme environment and operational condition. This article reviews in detail the functions of sleep, its requirement and the effects of sleep deprivation on human performance.

  1. [Arrhythmia and sleep apnea syndrome].

    PubMed

    Marrakchi, S; Kammoun, I; Kachboura, S

    2015-10-01

    Arrhythmia is a major cause of morbidity and mortality in Europe and in the United States. The aim of this review article was to assess the results of the prospective studies that evaluated the risk of arrhythmia in patients with sleep apnea syndrome and discuss the management of this arrhythmia. Reports published with the following search terms were searched: sleep apnea syndrome, atrial flutter, supraventricular arrhythmia, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation, torsade de pointe, atrial fibrillation and sudden death. The investigation was restricted to reports published in English and French. The outcome of this analysis suggests that patients with untreated overt sleep apnea syndrome are at increased risk of arrhythmia. The timely recognition and effective treatment of sleep apnea syndrome in patients with arrhythmia are mandatory because the prognosis of arrhythmia may be improved with the appropriate treatment of sleep apnea syndrome. Copyright © 2015. Published by Elsevier Masson SAS.

  2. A study protocol: a community pharmacy-based intervention for improving the management of sleep disorders in the community settings

    PubMed Central

    2014-01-01

    Background Sleep disorders are very common in the community and are estimated to affect up to 45% of the world’s population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are– (1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders, (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders and (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow. Trial registration Australian New Zealand Clinical Trial Registry: ACTRN12612000825853 PMID:24533916

  3. Management of sleep/wake cycles improves cognitive function in a transgenic mouse model of Huntington's disease.

    PubMed

    Pallier, Patrick N; Morton, A Jennifer

    2009-07-07

    Normally, mice sleep during the day and are active at night. In Huntington's disease mice (R6/2 line) this circadian pattern disintegrates progressively over the course of their illness. Cognitive decline and apathy in R6/2 mice can be improved with sleeping drugs, suggesting that sleep disruption contributes to their neurological decline. We wondered if wakefulness was equally important. Here, we used two drugs to manage sleep/wake cycles in R6/2 mice, Alprazolam (to put them to sleep) and Modafinil (to wake them up). We found that both drugs improved cognitive function and apathy, but had a stronger effect when used in combination. Remarkably, beneficial effects on cognitive performance were also seen in vehicle-treated cage-mates of Alprazolam/Modafinil-treated mice, suggesting that behavioral intervention to regularize sleep/wake activity might be therapeutically useful. We suggest that focused management of sleep and wakefulness will slow the progression of cognitive decline and apathy in neurological conditions where sleep is disordered.

  4. A Classification and Analysis of National Contract Management Journal Articles from 1990 to 1999 and Journal of Supply Chain Management Articles from 1987 to 2000

    DTIC Science & Technology

    2001-12-01

    take, then the article was categorized as positive. For example, in Richard Germain’s article “The Context, Organizational Design and...Other Factors Affecting the Commercialization of Air Force Technology,” Maj. Richard M. Franza, USAF, and Capt. Robert S. Widman, USAF, pp. 51-71...24] “Corporate Environmental Responsibility: An Examination of Incentivization,” Maj. Richard A. L’Heureux, USAF, Ph.D., CPCM, and 1Lt. Jennifer A

  5. The Neurobiology of Orofacial Pain and Sleep and Their Interactions.

    PubMed

    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.

  6. Research article: Watershed management councils and scientific models: Using diffusion literature to explain adoption

    USGS Publications Warehouse

    King, M.D.; Burkardt, N.; Clark, B.T.

    2006-01-01

    Recent literature on the diffusion of innovations concentrates either specifically on public adoption of policy, where social or environmental conditions are the dependent variables for adoption, or on private adoption of an innovation, where emphasis is placed on the characteristics of the innovation itself. This article uses both the policy diffusion literature and the diffusion of innovation literature to assess watershed management councils' decisions to adopt, or not adopt, scientific models. Watershed management councils are a relevant case study because they possess both public and private attributes. We report on a survey of councils in the United States that was conducted to determine the criteria used when selecting scientific models for studying watershed conditions. We found that specific variables from each body of literature play a role in explaining the choice to adopt scientific models by these quasi-public organizations. The diffusion of innovation literature contributes to an understanding of how organizations select models by confirming the importance of a model's ability to provide better data. Variables from the policy diffusion literature showed that watershed management councils that employ consultants are more likely to use scientific models. We found a gap between those who create scientific models and those who use these models. We recommend shrinking this gap through more communication between these actors and advancing the need for developers to provide more technical assistance.

  7. Sleep Disturbance in People with Diabetes: A Concept Analysis.

    PubMed

    Zhu, Bingqian; Vincent, Catherine; Kapella, Mary C; Quinn, Laurie; Collins, Eileen G; Ruggiero, Laurie; Park, Chang; Fritschi, Cynthia

    2017-08-09

    To clarify the meaning of sleep disturbance in people with diabetes and examine its antecedents, attributes, and consequences through concept analysis. Sleep is crucial for health, and people with diabetes are frequently beset with disturbances in their sleep. The concept of sleep disturbance in people with diabetes has not been clearly defined. The inconsistent use of sleep disturbance has created confusion and impeded our understanding of the sleep in people with diabetes. This analysis will provide a conceptual foundation of sleep disturbance in diabetes, thereby facilitating more effective means for assessment and treatment. Concept analysis. A systematic search without time restriction on the publication year was carried out using PubMed, CINAHL, PsycINFO, Web of Science, and ProQuest Dissertations and Theses. Rodgers's method of evolutionary concept analysis guided the analysis. Inductive thematic analysis was conducted to identify the attributes, antecedents, and consequences. Based on the 26 eligible studies, two major attributes are that sleep disturbance is a symptom and is characterized by impaired sleep quality and/or abnormal sleep duration. Two antecedents are diabetes-related physiological change and psychological well-being. Sleep disturbance can result in impaired daytime functioning, glucose regulation, and quality of life. Defining the concept of sleep disturbance in people with diabetes facilitates consistent use and effective communication in both practice and research. Sleep disturbance in people with diabetes is a complex symptom that includes impaired sleep quality and/or abnormal sleep duration. This paper contributes to the current knowledge of sleep in people with diabetes. Future research on antecedents and consequences of sleep disturbance are necessary for further clarifications. Findings from this paper underscore the need for nursing education, clinical assessment and effective management of sleep disturbance in people with diabetes

  8. SMART DOCS: a new patient-centered outcomes and coordinated-care management approach for the future practice of sleep medicine.

    PubMed

    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.

  9. Sleep Applications to Assess Sleep Quality.

    PubMed

    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.

  10. [Sleep: regulation and phenomenology].

    PubMed

    Vecchierini, M-F

    2013-12-01

    This article describes the two-process model of sleep regulation. The 24-hour sleep-wake cycle is regulated by a homeostatic process and an endogenous, 2 oscillators, circadian process, under the influence of external synchronisers. These two processes are partially independent but influence each other, as shown in the two-sleep-process auto-regulation model. A reciprocal inhibition model of two interconnected neuronal groups, "SP on" and "SP off", explains the regular recurrence of paradoxical sleep. Sleep studies have primarily depended on observation of the subject and have determined the optimal conditions for sleep (position, external conditions, sleep duration and need) and have studied the consequences of sleep deprivation or modifications of sleep schedules. Then, electrophysiological recordings permitted the classification of sleep stages according to the observed EEG patterns. The course of a night's sleep is reported on a "hypnogram". The adult subject falls asleep in non-REM sleep (N1), then sleep deepens progressively to stages N2 and N3 with the appearance of spindles and slow waves (N2). Slow waves become more numerous in stage N3. Every 90minutes REM sleep recurs, with muscle atonia and rapid eye movements. These adult sleep patterns develop progressively during the 2 first years of life as total sleep duration decreases, with the reduction of diurnal sleep and of REM sleep. Around 2 to 4 months, spindles and K complexes appear on the EEG, with the differentiation of light and deep sleep with, however, a predominance of slow wave sleep.

  11. 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

    PubMed Central

    Kyle, Simon D.; Miller, Christopher B.; Rogers, Zoe; Siriwardena, A. Niroshan; MacMahon, Kenneth M.; Espie, Colin A.

    2014-01-01

    objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia. Citation: Kyle SD; Miller CB; Rogers Z; Siriwardena AN; MacMahon KM; Espie CA. 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. SLEEP 2014;37(2):229-237. PMID:24497651

  12. Management protocols for status epilepticus in the pediatric emergency room: systematic review article.

    PubMed

    Au, Cheuk C; Branco, Ricardo G; Tasker, Robert C

    2017-09-20

    This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department (ED) treatment of status epilepticus. Systematic search of national or regional guidelines (January 2000 to February 2017) contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 ED guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11) guidelines recommended phenytoin, but other options were phenobarbital (nine/11), valproic acid (six/11), and either fosphenytoin or levetiracetam (each four/11); third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital). All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery. Copyright © 2017. Published by Elsevier Editora Ltda.

  13. Management of Synkinesis and Asymmetry in Facial Nerve Palsy: A Review Article

    PubMed Central

    Pourmomeny, Abbas Ali; Asadi, Sahar

    2014-01-01

    Introduction: The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy. Materials and Methods: Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013. Results: Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education. Conclusion: Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy. PMID:25320703

  14. [Role of the EFSA in risk management system regarding food contact materials and articles].

    PubMed

    Cwiek-Ludwicka, Kazimiera; Półtorak, Hanna; Pawlicka, Marzena

    2009-01-01

    The role of the European Food Safety Authority (EFSA) in the risk management system regarding food contact materials and articles is related with the risk assessment of the substances for the European Commission. General rules for the authorisation of substances used in materials and articles intended to contact with food is established in the Regulation (EC) no 1935/2004. For the evaluation of substances their toxicological properties and magnitude of migration into food simulants is taken into account. Toxicological studies include the mutagenicity tests, oral toxicity studies, carcinogenicity, reproduction and also studies on absorption, distribution, metabolism and excretion of the substance and other studies when needed. The set of the relevant toxicological data for substance depends on the magnitude of migration. In the case of positive opinion by EFSA the substance appears on the Community list of authorised substances. Sometimes, the earlier evaluated and authorized substances must undergo re-evaluation due to their new toxicological properties or as a result of a presence in the food of their earlier unknown decomposition products. Examples of the selected substances which underwent re-evaluation by EFSA in the light of the current toxicological knowledge and the relevant activities undertaken by the European Commission have been presented.

  15. Consumer sleep tracking devices: a critical review.

    PubMed

    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.

  16. Improved Sleep, Diet, and Exercise in Adults with Serious Mental Illness: Results from a Pilot Self-Management Intervention.

    PubMed

    Schmutte, Timothy; Davidson, Larry; O'Connell, Maria

    2017-04-29

    Compared to the general population, adults with serious mental illnesses have elevated rates of medical morbidity resulting in a reduced life expectancy of approximately 15 years. Chronic disease self-management programs for adults with serious mental and chronic medical illnesses show some promise in improving physical health-related outcomes, yet none of them address sleep quality. Poor sleep affects a majority of adults with serious mental illness and is robust risk factor for physical morbidity and premature mortality. This pilot project examined the impact of a 14-week educational and support group that included sleep quality as a cornerstone in promoting wellness and self-management in 78 adults with serious mental illness and poor health. Results provide preliminary data that the self-management program was associated with significant improvements in self-reported sleep quality at post-intervention. At 3-month follow-up, participants reported additional increases in sleep quality as well as in healthy diet and exercise frequency. Addressing sleep quality as part of self-management and wellness programs may be a viable approach to assist adults with chronic mental and physical illnesses to adopt health-promoting changes.

  17. Monitoring and Managing Cabin Crew Sleep and Fatigue During an Ultra-Long Range Trip.

    PubMed

    van den Berg, Margo J; Signal, T Leigh; Mulrine, Hannah M; Smith, Alexander A T; Gander, Philippa H; Serfontein, Wynand

    2015-08-01

    The aims of this study were to monitor cabin crew fatigue, sleep, and performance on an ultra-long range (ULR) trip and to evaluate the appropriateness of applying data collection methods developed for flight crew to cabin crew operations under a fatigue risk management system (FRMS). Prior to, throughout, and following the ULR trip (outbound flight ULR; mean layover duration=52.6 h; inbound flight long range), 55 cabin crew (29 women; mean age 36.5 yr; 25 men; mean age 36.6 yr; one missing data) completed a sleep/duty diary and wore an actigraph. Across each flight, crewmembers rated their fatigue (Samn-Perelli Crew Status Check) and sleepiness (Karolinska Sleepiness Scale) and completed a 5-min Psychomotor Vigilance Task (PVT) at key times. Of crewmembers approached, 73% (N=134) agreed to participate and 41% (N=55) provided data of suitable quality for analysis. In the 24 h before departure, sleep averaged 7.0 h and 40% took a preflight nap. All crewmembers slept in flight (mean total sleep time=3.6 h outbound, 2.9 h inbound). Sleepiness and fatigue were lower, and performance better, on the longer outbound flight than on the inbound flight. Post-trip, crewmembers slept more on day 1 (mean=7.9 h) compared to baseline days, but there was no difference from day 2 onwards. The present study demonstrates that cabin crew fatigue can be managed effectively on a ULR flight and that FRMS data collection is feasible for cabin crew, but operational differences between cabin crew and flight crew need to be considered.

  18. The Influence of Sleep Disordered Breathing on Weight Loss in a National Weight Management Program

    PubMed Central

    Janney, Carol A.; Kilbourne, Amy M.; Germain, Anne; Lai, Zongshan; Hoerster, Katherine D.; Goodrich, David E.; Klingaman, Elizabeth A.; Verchinina, Lilia; Richardson, Caroline R.

    2016-01-01

    Study Objective: To investigate the influence of sleep disordered breathing (SDB) on weight loss in overweight/obese veterans enrolled in MOVE!, a nationally implemented behavioral weight management program delivered by the National Veterans Health Administration health system. Methods: This observational study evaluated weight loss by SDB status in overweight/obese veterans enrolled in MOVE! from May 2008–February 2012 who had at least two MOVE! visits, baseline weight, and at least one follow-up weight (n = 84,770). SDB was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was weight change (lb) from MOVE! enrollment to 6- and 12-mo assessments. Weight change over time was modeled with repeated-measures analyses. Results: SDB was diagnosed in one-third of the cohort (n = 28,269). At baseline, veterans with SDB weighed 29 [48] lb more than those without SDB (P < 0.001). On average, veterans attended eight MOVE! visits. Weight loss patterns over time were statistically different between veterans with and without SDB (P < 0.001); veterans with SDB lost less weight (−2.5 [0.1] lb) compared to those without SDB (−3.3 [0.1] lb; P = 0.001) at 6 months. At 12 mo, veterans with SDB continued to lose weight whereas veterans without SDB started to re-gain weight. Conclusions: Veterans with sleep disordered breathing (SDB) had significantly less weight loss over time than veterans without SDB. SDB should be considered in the development and implementation of weight loss programs due to its high prevalence and negative effect on health. Citation: Janney CA, Kilbourne AM, Germain A, Lai Z, Hoerster KD, Goodrich DE, Klingaman EA, Verchinina L, Richardson CR. The influence of sleep disordered breathing on weight loss in a national weight management program. SLEEP 2016;39(1):59–65. PMID:26350475

  19. Perioperative management of obstructive sleep apnea: a survey of Puerto Rico anesthesia providers.

    PubMed

    Del Olmo-Arroyo, Francisco; Hernandez-Castillo, Ricardo; Soto, Antonio; Martínez, Juancarlo; Rodríguez-Cintrón, William

    2015-12-01

    Obstructive sleep apnea (OSA) prevalence has been increasing in the past years adding significant morbidity. Perioperative management is controversial and few studies have addressed this matter. The American Society of Anesthesiology (ASA) and the American Academy of Sleep Medicine (AASM) have developed clinical practice guidelines for the perioperative management of patients with OSA. Existing evidence suggest an increase in early postoperative complications in patients with OSA. Nevertheless, data about perioperative management of OSA is limited. To our knowledge, only two studies that address this matter, none in Puerto Rico. A questionnaire was given to participants at the annual meeting of anesthesiology in Puerto Rico. The document was then anonymously deposited into sealed box. The response rate was 80 %. The awareness about written postoperative policy in patients with diagnosed (23 %) and suspected (11 %) OSA was low. If a written policy were available, 46 % of patients would have gone to ICU. The most important factor for final disposition was the degree of OSA, which was decided by surgery and anesthesia (69 %). In the last year, at least one complication related to OSA was observed in 20 % of respondents. The most common preoperative screening tool was the ASA guidelines. Seventy-two percent of respondents suggested a lack of institutional policies as the main reason for disparity. There is a significant heterogeneity in the current clinical practice. The main barriers identified to achieve current recommendations were lack of institutional policies, awareness of current guideline, formal training in management of OSA, and access to a sleep specialist.

  20. ROLE OF TRANSCRANIAL COLOUR-CODED DUPLEX SONOGRAPHY IN STROKE MANAGEMENT - REVIEW ARTICLE

    PubMed Central

    Olatunji, Richard B.; Ogbole, Godwin I.; Atalabi, Omolola M.; Adeyinka, Abiodun O.; Lagunju, Ikeola; Oyinlade, Alexander; Ogun, Olufunmilola; Owolabi, Mayowa O.; Ogunseyinde, Oluremi A; Ogunniyi, Adesola

    2015-01-01

    The development of transcranial colour-coded duplex sonography (TCCS) has resurrected the hope of safe, real time bedside brain imaging beyond childhood. This review article provides an overview of the role of TCCS in the management of patients with stroke. The objective is to stimulate interest in the field of neurosonology as a potential means of improving neurological outcome for stroke patients and a area for stroke research endeavors in Africa. Literature search was done on MEDLINE, Cochrane library, and Google Scholar databases with the following keywords: transcranial colour Doppler, Transcranial duplex sonography, transcranial colour-coded Doppler sonography, stroke, infarct and haemorrhage. We also identified relevant articles from the references section of studies produced by our literature search. We discussed the roles of TCCS to discriminate ischaemic from haemorrhagic forms; unravel the mechanism of stroke; monitor temporal evolution of stroke and predictors of stroke outcome; and promote better understanding of the epidemiology of stroke. Its emerging role as a potent point-of-care imaging modality for definitive treatment in ischaemic stroke within and outside the hospital setting is also highlighted. Comparison of TCCS with alternative modalities for neuroimaging in stroke is also discussed. A root cause analysis of the untenable high cost of neuroimaging for stroke patients in Africa is presented vis-à-vis the potential economic relief which widespread adoption of TCCS may provide. We advocate capacity building for TCCS and suggest some action plans required to achieve safe, cheap, affordable and reliable ultrasound based neuroimaging for stroke patients in resource limited areas of Africa. PMID:27077136

  1. How Postpartum Women With Depressive Symptoms Manage Sleep Disruption and Fatigue.

    PubMed

    Doering, Jennifer J; Sims, Dauphne A; Miller, Donald D

    2017-04-01

    Postpartum sleep and fatigue have bidirectional relationships with depressive symptoms and challenge women's everyday functioning. The everyday process of managing postpartum sleep and fatigue in the context of depressive symptoms remains unexplored. We conducted a grounded theory study with a sample of 19 women who screened positive on the Postpartum Depression Screening Scale (PDSS™) Short Form at 3 weeks postpartum. Women completed semi-structured in-home interviews and the full PDSS and Modified Fatigue Symptoms Checklist at 1, 3, and 6 months postpartum. The sample was on average 27 years old, with 2.8 children, and 63% were African-American. They described a basic social process of Finding a Routine Together, during which women's experiences with their infants progressed from Retreating at month 1 toward Finding a New Normal at month 6. In their work to Find a Routine Together, mothers' patterns of change over time were continuous, gradual, or prolonged. Their progress was influenced by depressive symptoms, social support, work and daycare, stability in social circumstances, and underlying stressors. This study's findings suggest the need to allocate resources and tailor interventions to meet the needs of women who are most vulnerable to the health effects of ongoing persistent severe fatigue, disordered sleep, and sub-clinical and clinical levels of depressive symptoms. © 2017 Wiley Periodicals, Inc.

  2. Neuroimmunologic aspects of sleep and sleep loss

    NASA Technical Reports Server (NTRS)

    Rogers, N. L.; Szuba, M. P.; Staab, J. P.; Evans, D. L.; Dinges, D. F.

    2001-01-01

    The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans. Copyright 2001 by W.B. Saunders Company.

  3. Neuroimmunologic aspects of sleep and sleep loss

    NASA Technical Reports Server (NTRS)

    Rogers, N. L.; Szuba, M. P.; Staab, J. P.; Evans, D. L.; Dinges, D. F.

    2001-01-01

    The complex and intimate interactions between the sleep and immune systems have been the focus of study for several years. Immune factors, particularly the interleukins, regulate sleep and in turn are altered by sleep and sleep deprivation. The sleep-wake cycle likewise regulates normal functioning of the immune system. Although a large number of studies have focused on the relationship between the immune system and sleep, relatively few studies have examined the effects of sleep deprivation on immune parameters. Studies of sleep deprivation's effects are important for several reasons. First, in the 21st century, various societal pressures require humans to work longer and sleep less. Sleep deprivation is becoming an occupational hazard in many industries. Second, to garner a greater understanding of the regulatory effects of sleep on the immune system, one must understand the consequences of sleep deprivation on the immune system. Significant detrimental effects on immune functioning can be seen after a few days of total sleep deprivation or even several days of partial sleep deprivation. Interestingly, not all of the changes in immune physiology that occur as a result of sleep deprivation appear to be negative. Numerous medical disorders involving the immune system are associated with changes in the sleep-wake physiology--either being caused by sleep dysfunction or being exacerbated by sleep disruption. These disorders include infectious diseases, fibromyalgia, cancers, and major depressive disorder. In this article, we will describe the relationships between sleep physiology and the immune system, in states of health and disease. Interspersed will be proposals for future research that may illuminate the clinical relevance of the relationships between sleeping, sleep loss and immune function in humans. Copyright 2001 by W.B. Saunders Company.

  4. Review article: management of chronic hepatitis C in patients with contraindications to anti-viral therapy.

    PubMed

    Carreño, V

    2014-01-01

    There are patients with chronic hepatitis C who are not eligible for the current interferon-based therapies or refuse to be treated due to secondary effects. To provide information on alternative treatments for the management of these patients. A PubMed search was performed to identify relevant literature. Search terms included hepatitis C virus, anti-inflammatory treatment, antioxidant, natural products and alternative treatment, alone or in combination. Additional publications were identified using the references cited by primary and review articles. Several approaches, such as iron depletion (phlebotomy), treatment with ursodeoxycholic acid or glycyrrhizin, have anti-inflammatory and/or anti-fibrotic effects. Life interventions like weight loss, exercise and coffee consumption are associated with a biochemical improvement. Other alternatives (ribavirin monotherapy, amantadine, silibinin, vitamin supplementation, etc.) do not have any beneficial effect or need to be tested in larger clinical studies. There are therapeutic strategies and lifestyle interventions that can be used to improve liver damage in patients with chronic hepatitis C who cannot receive or refuse interferon-based treatments. © 2013 John Wiley & Sons Ltd.

  5. Review article: the management of Crohn's disease and ulcerative colitis during pregnancy and lactation.

    PubMed

    Schulze, H; Esters, P; Dignass, A

    2014-11-01

    Inflammatory bowel diseases (IBD) commonly affect young patients in the reproductive phase of their lives. The chronic and relapsing nature of IBD and the potential need for medical or surgical interventions raise concerns about family planning issues. To review the current knowledge on IBD management in pregnant and nursing IBD patients. A PubMed literature search was performed using the search terms 'reproduction' and 'inflammatory bowel disease' and using the headers and main subjects of each section of this article as search terms. Male and female fertility are not impaired in the majority of IBD patients. In IBD patients with quiescent disease pregnancy outcomes are not impaired in comparison to the general population, however, an increased incidence of pregnancy complications is observed in active IBD patients. As methotrexate (MTX) has been demonstrated to be teratogenic, the use of MTX is contraindicated in patients, who wish to conceive, throughout pregnancy and when nursing. However, normal pregnancies following MTX treatment at conception and later have been reported. Most of the other currently approved IBD medications are not associated with adverse pregnancy outcomes and may be used to maintain quiescent disease or to induce a rapid remission in patients with flares and active disease. Breast-feeding in IBD patients is possible and recommended. The overall outcome of pregnancies in IBD patients is favourable and not different to healthy controls, thus patients with IBD should not be discouraged from having children. © 2014 John Wiley & Sons Ltd.

  6. Management of severe obstructive sleep apnea using mandibular advancement devices with auto continuous positive airway pressures

    PubMed Central

    Upadhyay, Rashmi; Dubey, Abhishek; Kant, Surya; Singh, Balendra Pratap

    2015-01-01

    The use of continuous positive airway pressures (CPAP) is considered standard treatment of moderate to severe obstructive sleep apnea (OSA). Treatment of the disease poses a great challenge not only for its diagnostic purpose but also for its treatment part. In about 29-83% of the patients, treatment is difficult because of non-compliance resulting due to high pressures, air leaks and other related issues. In such situations, alternative methods of treatment need to be looked for so as to ascertain better management. Mandibular advancement devices along with CPAP may show better treatment outcome in specific situations. PMID:25814802

  7. Sleep problems in children.

    PubMed

    Baweja, R; Calhoun, S; Baweja, R; Singareddy, R

    2013-10-01

    Sleep complaints and sleep disorders are common during childhood and adolescence. The impact of not getting enough sleep may affect children's' physical health as well emotional, cognitive and social development. Insomnia, sleep-disordered breathing, parasomnias and sleep disturbances associated with medical and psychiatric disorders are some of the commonly encountered sleep disorders in this age group. Changes in sleep architecture and the amount of sleep requirement associated with each stage of development should be considered during an evaluation of sleep disorders in children. Behavioral treatments should be used initially wherever possible especially considering that most pharmacologic agents used to treat pediatric sleep disorders are off-label. In this review we address the most common sleep problems in children/adolescents as they relate to prevalence, presentation and symptoms, evaluation and management.

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

    PubMed

    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.

  9. Sleep Quality and Fatigue After A Stress Management Intervention For Women With Early-Stage Breast Cancer in Southern Florida

    PubMed Central

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

    2015-01-01

    Background Sleep disruption and fatigue are ubiquitous among cancer patients and is a source 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. Purpose 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). Methods Patients were randomized to CBSM (n = 120) or a one-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. Results 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. Conclusions Future work may consider integrating sleep and fatigue content into stress management interventions for women with early-stage breast cancer. PMID:24318654

  10. Promoting healthy sleep.

    PubMed

    Price, Bob

    2016-03-09

    Nurses are accustomed to helping others with their sleep problems and dealing with issues such as pain that may delay or interrupt sleep. However, they may be less familiar with what constitutes a healthy night's sleep. This article examines what is known about the process and purpose of sleep, and examines the ways in which factors that promote wakefulness and sleep combine to help establish a normal circadian rhythm. Theories relating to the function of sleep are discussed and research is considered that suggests that sleep deficit may lead to metabolic risks, including heart disease, obesity, type 2 diabetes mellitus and several types of cancer.

  11. Movement disorders and sleep.

    PubMed

    Driver-Dunckley, Erika D; Adler, Charles H

    2012-11-01

    This article summarizes what is currently known about sleep disturbances in several movement disorders including Parkinson disease, essential tremor, parkinsonism, dystonia, Huntington disease, myoclonus, and ataxias. There is an association between movement disorders and sleep. In some cases the prevalence of sleep disorders is much higher in patients with movement disorder, such as rapid eye movement sleep behavior disorder in Parkinson disease. In other cases, sleep difficulties worsen the involuntary movements. In many cases the medications used to treat patients with movement disorder disturb sleep or cause daytime sleepiness. The importance of discussing sleep issues in patients with movement disorders cannot be underestimated.

  12. Sleep disorders in pregnancy.

    PubMed

    Oyiengo, Dennis; Louis, Mariam; Hott, Beth; Bourjeily, Ghada

    2014-09-01

    Sleep disturbances are common in pregnancy and may be influenced by a multitude of factors. Pregnancy physiology may predispose to sleep disruption but may also result in worsening of some underlying sleep disorders, and the de novo development of others. Apart from sleep disordered breathing, the impact of sleep disorders on pregnancy, fetal, and neonatal outcomes is poorly understood. In this article, we review the literature and discuss available data pertaining to the most common sleep disorders in perinatal women. These include restless legs syndrome, insomnia, circadian pattern disturbances, narcolepsy, and sleep-disordered breathing.

  13. Occupational Sleep Medicine.

    PubMed

    Cheng, Philip; Drake, Christopher

    2016-03-01

    Sleep and circadian rhythms significantly impact almost all aspects of human behavior and are therefore relevant to occupational sleep medicine, which is focused predominantly around workplace productivity, safety, and health. In this article, 5 main factors that influence occupational functioning are reviewed: (1) sleep deprivation, (2) disordered sleep, (3) circadian rhythms, (4) common medical illnesses that affect sleep and sleepiness, and (5) medications that affect sleep and sleepiness. Consequences of disturbed sleep and sleepiness are also reviewed, including cognitive, emotional, and psychomotor functioning and drowsy driving. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Sleep abnormalities during abstinence in alcohol-dependent patients. Aetiology and management.

    PubMed

    Landolt, H P; Gillin, J C

    2001-01-01

    Virtually every type of sleep problem occurs in alcohol-dependent patients. Typically, these individuals take a longer time to fall asleep and show decreased sleep efficiency, shorter sleep duration and reduced amounts of slow wave sleep when compared with healthy controls. Their sleep patterns are fragmented, and the typical time course of electroencephalogram (EEG) delta wave activity is severely disrupted. The amount of rapid eye movement (REM) sleep may be reduced or increased. Sleep changes can persist during months or years of abstinence, and recent studies indicate that certain alterations in sleep architecture, as well as subjective sleep complaints, predict relapse to alcoholism. The mechanisms of action of short and long term alcohol administration on sleep are incompletely understood. They may arise from an interaction with gamma-aminobutyric acid (GABA), serotonin (5-hydroxytryptamine; 5-HT), adenosine or other neurotransmitter systems. While only a few pharmacological and nonpharmacological strategies to improve or normalise disturbed sleep in individuals who have recovered from alcoholism have been studied, the use of benzodiazepines, other hypnosedatives or selective serotonin reuptake inhibitors is not recommended. Therapies include sleep hygiene, bright light therapy, meditation, relaxation methods, and other nonpharmacological approaches. Further studies are needed to clarify the relationship between sleep, sleep abnormalities and alcoholism, and to establish new approaches to improve sleep in alcohol-dependent patients and to prevent withdrawal reactions that affect sleep during abstinence.

  15. Counting Sheep: Sleep Disorders in Children With Autism Spectrum Disorders.

    PubMed

    Herrmann, Shoshana

    2016-01-01

    This article will discuss the prevalence and types of sleep disorders experienced by children with autism spectrum disorders (ASDs), the risk factors for the development of sleep disorders among children with ASDs, the impact of sleep disorders on children with ASDs, and the role of the primary care provider (PCP) in diagnosing and treating sleep disorders among children with ASDs. Review of published literature on the topic. Children with ASDs are at risk for the development of chronic sleep disorders, which can have a negative impact on behavior. Both behavioral and pharmacological interventions exist for the treatment of sleep disorders among children with ASDs, with supplemental melatonin being the most widely studied and proven treatment. PCPs will care for children with ASDs. Therefore, it is vital for PCPs to be knowledgeable about this topic and to promptly assess for and manage sleep disorders among children with ASDs. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  16. Sleep disorders during pregnancy.

    PubMed

    Pien, Grace W; Schwab, Richard J

    2004-11-01

    This paper reviews the topic of sleep disorders in pregnant women. We describe changes in sleep architecture and sleep pattern during pregnancy, discuss the impact of the physical and biochemical changes of pregnancy on sleep in pregnant women and examine whether maternal-fetal outcomes may be adversely affected in women with disordered sleep. The literature on common sleep disorders affecting pregnant women, including insomnia, sleep-disordered breathing and restless legs syndrome, is reviewed and recommendations are made for the management of these disorders during pregnancy.

  17. Sleep-related movement disorders.

    PubMed

    Silber, Michael H

    2013-02-01

    This article reviews the sleep-related movement disorders, including restless legs syndrome (RLS; Willis-Ekbom disease), periodic limb movement disorder, rhythmic movement disorders, sleep-related bruxism, and sleep-related leg cramps. The prevalence of clinically significant RLS is 1.5% to 3.0%. The pathophysiology of RLS may involve abnormal iron transport across the blood-brain barrier and down-regulation of putaminal D2 receptors. The availability of the rotigotine patch provides an additional form of dopaminergic therapy for RLS. Calcium channel alpha-2-delta ligands (gabapentin, gabapentin enacarbil, and pregabalin) provide alternative therapies for RLS especially in patients with augmentation, impulse control disorders, or hypersomnia induced by dopamine agonists. Long-term use of opioid medication is safe and effective for refractory cases of RLS. RLS is a common disorder causing considerable morbidity. Accurate diagnosis and appropriate investigations are essential. Many effective therapies are available, but the side effects of each class of medication should be considered in determining optimal treatment. Periodic limb movements of sleep, bruxism, and rhythmic movement disorders are sleep-related phenomena often accompanying other sleep disorders and only sometimes requiring primary therapy. Sleep-related leg cramps are generally idiopathic. Management is challenging with few effective therapies.

  18. THE ESSENTIAL ROLE OF THE COM IN THE MANAGEMENT OF SLEEP-DISORDERED BREATHING: A LITERATURE REVIEW AND DISCUSSION.

    PubMed

    Frey, Lorraine; Green, Shari; Fabbie, Paula; Hockenbury, Dana; Foran, Marge; Elder, Kathleen

    2014-11-01

    The origins of Orofacial Myofunctional Therapy began in the early 1960's by orthodontists who recognized the importance of functional nasal breathing, proper swallowing, and more ideal oral rest postures. Re-patterning these functions through myofunctional therapy assisted with better orthodontic outcomes and improved stability. Experts in orofacial myology have concluded that improper oral rest postures and tongue thrusting may be the result of hypertrophy of the lymphatic tissues in the upper airway. Orthodontists are aware of the deleterious effects these habits have on the developing face and dentition. Sleep disordered breathing is a major health concern that affects people from infancy into adulthood. Physicians who treat sleep disorders are now referring patients for orofacial myofunctional therapy. Researchers have concluded that removal of tonsils and adenoids, along with expansion orthodontics, may not fully resolve the upper airway issues that continue to plague patients' health. Sleep researchers report that the presence of mouth breathing, along with hypotonia of the orofacial muscular complex, has been a persistent problem in the treatment of sleep disordered breathing. Orofacial myofunctional disorders (OMDs) coexist in a large population of people with sleep disordered breathing and sleep apnea. Advances in 3D Cone Beam Computed Tomography (CBCT) imaging offer the dental and medical communities the opportunity to identify, assess, and treat patients with abnormal growth patterns. These undesirable changes in oral structures can involve the upper airway, as well as functional breathing, chewing and swallowing. Leading researchers have advocated a multidisciplinary team approach. Sleep physicians, otolaryngologists, dentists, myofunctional therapists, and other healthcare professionals are working together to achieve these goals. The authors have compiled research articles that support incorporating the necessary education on sleep disordered

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

    PubMed

    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.

  20. Active Management of Integrated Geothermal-CO2 Storage Reservoirs in Sedimentary Formations: Data used in Geosphere Journal Article

    DOE Data Explorer

    Thomas A. Buscheck

    2015-06-01

    This data submission is for Phase 2 of Active Management of Integrated Geothermal-CO2 Storage Reservoirs in Sedimentary Formations, which focuses on multi-fluid (CO2 and brine) geothermal energy production and diurnal bulk energy storage in geologic settings that are suitable for geologic CO2 storage. This data submission includes all data used in the Geosphere Journal article by Buscheck et al (2016). All assumptions are discussed in that article.

  1. Influence of Data and Formulas on Trust in Information from Journal Articles in an Operating Room Management Course.

    PubMed

    Dexter, Franklin; Van Swol, Lyn M

    2016-06-01

    To make good decisions, operating room (OR) managers often act autocratically after obtaining expert advice. When such advice is provided by e-mail, attachments of research articles can be included. We performed a quasi-experimental study using an evaluation of 4 articles used in a 50-hour OR management course to assess how their content influences trust in the article's content, including its quality, usefulness, and reliability. There were (a) 2 articles containing data with specific examples of application for health systems and 2 without and (b) 2 articles containing appendices of formulas and 2 without. Some of the formulas in the readings were relatively complicated (e.g., stochastic optimization using the Lagrange method) and unlikely to be used by the subjects (i.e., they show what does not need to be done). Content complexity (±data, ±formulas) served both as sources of limitation in understanding the content and potentially as peripheral cues influencing perception of the content. The 2-page evaluation forms were generated with random sequences of articles and response items. The N = 17 subjects each completed 9 items about each of the 4 articles (i.e., answered 36 questions). The 9-item assessment of trust provided a unidimensional construct (Cronbach α, 0.94). Formulas in the articles significantly increased trust in the information (P = 0.0019). Presence of data did not significantly influence trust (P = 0.15). Therefore, when an expert sends e-mail to a manager who has completed this basic OR management science and asks a question, choosing a paper with formulas has no disadvantage.

  2. Moisture Management in an Active Sportswear: Techniques and Evaluation—A Review Article

    NASA Astrophysics Data System (ADS)

    Senthilkumar, Mani; Sampath, M. B.; Ramachandran, T.

    2013-07-01

    Moisture management property is an important aspect of any fabric meant for active sportswear, which decides the comfort level of that fabric. Every human being sweats during different kinds of activities. An important feature of any fabric is how it transports this water out of the body, so as to make the wearer feel comfortable. This paper reports the concept of moisture management, various production techniques and evaluation of the moisture management characteristics on fabrics for active sportswear.

  3. Sleep outcomes in youth with chronic pain participating in a randomized controlled trial of online cognitive-behavioral therapy for pain management

    PubMed Central

    Fales, Jessica; Palermo, Tonya M.; Law, Emily F.; Wilson, Anna C.

    2013-01-01

    Sleep disturbances are commonly reported in youth with chronic pain. We examined whether online cognitive-behavioral therapy (CBT) for pain management would impact youth’s sleep. Subjective sleep quality and actigraphic sleep were evaluated in 33 youth (M=14.8 years; 70% female) with chronic pain participating in a larger randomized controlled trial of online-CBT. The Internet treatment condition (n=17) received 8-10 weeks of online-CBT + standard care and the wait-list control condition (n=16) continued with standard care. Although pain improved with online-CBT, no changes were observed in sleep outcomes. Shorter pre-treatment sleep duration was associated with less improvement in post-treatment functioning. Findings underscore the need for further development in psychological therapies to more intensively target sleep loss in youth with chronic pain. PMID:24484373

  4. Sleep outcomes in youth with chronic pain participating in a randomized controlled trial of online cognitive-behavioral therapy for pain management.

    PubMed

    Fales, Jessica; Palermo, Tonya M; Law, Emily F; Wilson, Anna C

    2015-01-01

    Sleep disturbances are commonly reported in youth with chronic pain. We examined whether online cognitive-behavioral therapy (CBT) for pain management would impact youth's sleep. Subjective sleep quality and actigraphic sleep were evaluated in 33 youth (M = 14.8 years; 70% female) with chronic pain participating in a larger randomized controlled trial of online-CBT. The Internet treatment condition (n = 17) received 8-10 weeks of online-CBT + standard care, and the wait-list control condition (n = 16) continued with standard care. Although pain improved with online-CBT, no changes were observed in sleep outcomes. Shorter pretreatment sleep duration was associated with less improvement in posttreatment functioning. Findings underscore the need for further development in psychological therapies to more intensively target sleep loss in youth with chronic pain.

  5. Clinical characteristics, management and long-term outcome of suspected rapid eye movement sleep behaviour disorder in 14 dogs.

    PubMed

    Schubert, T A; Chidester, R M; Chrisman, C L

    2011-02-01

    To describe the clinical characteristics, management and long-term outcome in dogs with suspected rapid eye movement sleep behaviour disorder. Medical records and video recordings of 14 dogs with suspected rapid eye movement sleep behaviour disorder were reviewed and the owners were contacted via telephone or email for further information. Clinical signs included episodes of violent limb movements, howling, barking, growling, chewing, or biting during sleep. Episodes occurred at night and during daytime naps. The age at onset ranged from 8 weeks to 7·5 years with a median of 6 years but 64% of dogs were one year or less. There was no apparent sex or breed predisposition. Rapid eye movement sleep behaviour disorder events were reduced in severity and frequency in 78% of the dogs treated with 40 mg/kg/day oral potassium bromide. One dog was euthanized within 3 months of the onset of signs because of their severity. The duration of the disorder in the 13 surviving dogs ranged from 1·5 to 9 years. None of the dogs spontaneously recovered. Rapid eye movement sleep behaviour disorder is suspected to occur in dogs, as it does in human beings. It causes concern to the owners and disrupts the home environment. Unlike human beings, rapid eye movement sleep behaviour disorder of dogs often has a juvenile onset. © 2011 British Small Animal Veterinary Association.

  6. Taking care of business: self-help and sleep medicine in american corporate culture.

    PubMed

    Brown, Megan

    2004-01-01

    This article argues that corporate management in the United States has expanded its scope beyond office walls and encompasses many aspects of workers' daily lives. One new element of corporate training is the micromanagement of sleep; self-help books, newspaper reports, magazine articles, and consulting firms currently advise workers and supervisors on optimizing productivity by cultivating certain sleep habits. Although consultants and self-help books make specific recommendations about sleep, most medical research is inconclusive about sleep's benefits for human performance. Using the ideas of Michel Foucault and Gilles Deleuze as a philosophical backdrop, this article examines the complex and often contradictory links between self-help, medicine, and corporate governance.

  7. [What are the effects and management of short sleep duration in adolescents?].

    PubMed

    Bat-Pitault, F; Da Fonseca, D

    2012-10-01

    Sleep deprivation is highly prevalent in the general population and related to lifestyle in industrialized countries. There has been an increase in this reduction of sleep for half a century and adolescents are particularly affected. Given the magnitude of this sleep restriction, it seems important to focus its mechanisms and its neurocognitive, endocrine, metabolic, weight, psychological and school consequences on adolescents. This sleep deprivation is described and the solutions that can be proposed to adolescents and their family or school environment to increase sleep duration and decrease the negative consequences of their current sleep deprivation are reviewed. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  8. Operations Management: Is There a Disconnect between Journal Article Content and Employer Needs?

    ERIC Educational Resources Information Center

    Singer, Marc G.; Welborn, Cliff A.

    2014-01-01

    The authors sought to determine whether topics researched by academicians in the field of operations management were aligned with the knowledge, skills, and abilities (KSAs) employers were seeking from potential employees. Twenty-eight research topics were identified in the operations management literature and were compared to the KSAs derived…

  9. Ethical challenges for medical professionals in middle manager positions: a debate article.

    PubMed

    Schnoor, Joerg; Heyde, Christoph-Eckhard; Ghanem, Mohamed

    2015-01-01

    Demographic changes increase the financing needs of all social services. This change also generates new and complex demands on the medical staff. Accordingly, medical professionals in middle management positions hold a characteristic sandwich position between top management and the operational core. This sandwich position often constitutes new challenges. In the industrial field, the growing importance of the middle management for the company's success has already been recognized. Accordingly, the growing demand on economy urges an analysis for the medical field. While there are nearly no differences in the nature of the tasks of medical middle manager in the areas of strategy, role function, performance pressure and qualifications compared to those tasks of the industrial sector, there are basic differences as well. Especially the character of "independence" of the medical profession and its ethical values justifies these differences. Consequently, qualification of medical professionals may not be solely based on medical academic career. It is also based on the personal ability or potential to lead and to manage. Above all, the character of "independence" of the medical profession and its ethical values justifies medical action that is based on the patient's well-being and not exclusively on economic outcomes. In the future, medical middle managers are supposed to achieve an optimized balance between a patient-centered medicine and economic measures. It will be a basic requirement that middle managers accept their position and the resultant tasks putting themselves in a more active position. Because of that, middle managers can become "value-added bridge-builders".

  10. Operations Management: Is There a Disconnect between Journal Article Content and Employer Needs?

    ERIC Educational Resources Information Center

    Singer, Marc G.; Welborn, Cliff A.

    2014-01-01

    The authors sought to determine whether topics researched by academicians in the field of operations management were aligned with the knowledge, skills, and abilities (KSAs) employers were seeking from potential employees. Twenty-eight research topics were identified in the operations management literature and were compared to the KSAs derived…

  11. [Non-surgical management after blunt traumatic liver injuries: A review article].

    PubMed

    Noyola-Villalobos, Héctor Faustino; Loera-Torres, Marco Antonio; Jiménez-Chavarría, Enrique; Núñez-Cantú, Olliver; García-Núñez, Luis Manuel; Arcaute-Velázquez, Fernando Federico

    2016-01-01

    Hepatic trauma is a common cause for admissions in the Emergency Room. Currently, non-surgical management is the standard treatment in haemodynamically stable patients with a success rate of around 85 to 98%. This haemodynamic stability is the most important factor in selecting the appropriate patient. Adjuncts in non-surgical management are angioembolisation, image-guided drainage and endoscopic retrograde cholangiopancreatography. Failure in non-surgical management is relatively rare but potentially fatal, and needs to be recognised and aggressively treated as early as possible. The main cause of failure in non-surgical management is persistent haemorrhage. The aim of this paper is to describe current evidence and guidelines that support non-surgical management of liver injuries in blunt trauma. Copyright © 2016 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  12. Sleep-Wake Disorders of Childhood.

    PubMed

    Kotagal, Suresh

    2017-08-01

    Sleep-wake disorders occur in 10% to 28% of children and differ somewhat in pathophysiology and management from sleep-wake disorders in adults. This article discusses the diagnosis and management of key childhood sleep disorders. The role of sleep in memory consolidation and in the facilitation of learning has been increasingly recognized, even at the toddler stage. Cataplexy, a key feature of narcolepsy type 1, may be subtle in childhood and characterized by transient muscle weakness isolated to the face. Children with obstructive sleep apnea and restless legs syndrome display prominent neurobehavioral symptoms such as daytime inattentiveness and hyperactivity, so it is important to elicit a sleep history when these symptoms are encountered. Systemic iron deficiency occurs in about two-thirds of children with restless legs syndrome and is easily treatable. Parasomnias arising out of non-rapid eye movement (REM) sleep, such as confusional arousals and sleepwalking, may be difficult to distinguish from nocturnal seizures, and, in many cases, video-EEG polysomnography is required to differentiate between causes. Clinicians should routinely integrate the assessment of sleep-wake function into their practices of neurology and child neurology because of the opportunity to improve the quality of life of their patients.

  13. Pharmacology of sleep disorders in children and adolescents.

    PubMed

    Chhangani, Bantu; Greydanus, Donald E; Patel, Dilip R; Feucht, Cynthia

    2011-02-01

    There is a high prevalence of sleep disorders in children and an apparent increasing need for pharmacologic management. However, because of the paucity of data available with regards to dosing, efficacy, tolerability, and safety profiles of medications as well as a lack of adequate well-designed clinical trials, medications are currently not approved for the pediatric population by the US Food and Drug Administration. There are no pharmacologic guidelines for the specific sleep disorders or the different pediatric age ranges. Additional research is needed for evidence-based pediatric sleep pharmacotherapy. This article reviews pediatric sleep disorders and the pharmacologic therapeutic options.

  14. Gaps in evidence: Management of pediatric obstructive sleep apnea without tonsillar hypertrophy.

    PubMed

    Tang, Alice; Gropler, Matthew; Duggins, Angela L; Amin, Raouf S; Shott, Sally R; Chini, Barbara; Ishman, Stacey L

    2016-03-01

    Persistent obstructive sleep apnea (OSA) is demonstrated in 40% of children after adenotonsillectomy. We previously evaluated the basis of management decisions in children with OSA without tonsillar hypertrophy and found that 61% of decisions were non-evidence based. The aim of this study was to identify gaps in evidence for the management of children with OSA without tonsillar hypertrophy. Case series. We recorded all real-time decisions made by pediatric subspecialists from eight disciplines that participated in an upper airway clinic and management conferences. Practitioners were immediately queried regarding the basis of their decisions, and non-evidence-based decisions were categorized. During 10 case conferences and five clinics, 507 decisions were made for 63 children (43% with Down syndrome, 20% with Pierre Robin sequence). The 309 non-evidence-based decisions most commonly pertained to follow-up timing and appropriate subspecialty clinic location (116/309, 38%) as well as timing for repeat polysomnography (35/309, 11%), especially in children at high risk for persistent OSA after treatment. Additional gaps identified included the likelihood of OSA improvement from weight loss, and effectiveness of sleep surgical procedures (i.e., lingual tonsillectomy, posterior midline glossectomy, and craniofacial surgery) alone or in combination. Identified gaps in evidence included timing and location of follow-up, appropriate use of polysomnography for surveillance, effectiveness of specific surgical procedures performed alone and in combination, and the use of oral appliances and continuous positive airway pressure therapy in children with Down syndrome. We also found a need for studies to compare the effectiveness of these treatment options in diverse patient populations. 4 Laryngoscope, 126:758-762, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

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

    PubMed

    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.

  16. The literature on inhibitors: articles that influence my management of patients with hemophilia A and high-titer inhibitors.

    PubMed

    Leissinger, Cindy A

    2012-05-01

    High-titer inhibitors represent the greatest management challenge faced by clinicians who treat patients with hemophilia A, as bleeding episodes no longer respond to standard factor VIII replacement therapy. Over the last seven decades, major strides have been made in inhibitor treatment. This article focuses on the seminal clinical observations and studies that provided the foundation for these advances in hemophilia care.

  17. [Management of sleep-related abnormal breathing by cardiologists and hospital departments of cardiology].

    PubMed

    Fietze, I; Penzel, T; Baumann, G; Bönner, G; Kamke, W; Podszus, T

    2010-02-01

    In the general population there is a high prevalence of sleep-related disorders of breathing (sleep apnea). In addition to being leading symptom of excessive day-time sleepiness they are also important predictors are cardiovascular disease such as arterial hypertension, heart failure, cardiac arrhythmias and stroke. Are the cardiologists the specialists who recognize such patients and refer them to diagnostic procedures and treatment? We sent out a questionnaires to cardiologists in private practice, to hospitals with cardiology departments and to cardiology rehabilitation units in Germany in order to assess the knowledge about sleep apnea and of the current diagnostic and therapeutic procedures in patients with suspected sleep apnea. All cardiology rehabilitation units and every other practice and cardiology department listed in the reference book 'Medführer' were approached. 98% of 388 cardiologists with private practice were found to know about the disorder sleep apnea. 94.3% routinely asked their patients about any sleep disorder and specifically about excessive day-time sleepiness. More than half of the cardiologists (59.3%) questioned patients about possible sleep apnea as part of their interview, but only 32.7% carried out tests with a portable sleep apnea monitor. Most patients were referred to a sleep center. In 60% of the cardiology departments a portable sleep apnea monitor was used. Further diagnostic investigation followed in collaborating sleep centers (66.4%), because only 22.4% of the departments had a sleep laboratories. The main focus was on the diagnosis of abnormal sleep due to central or obstructive disorders of breathing. More than two thirds of the cardiology departments initiate nocturnal ventilation treatment. Cardiologists in private practice and cardiologists in hospital departments know about sleep-related abnormal breathing. The use of portable sleep apnea monitors and of polysomnography in special as parts of sleep centers within

  18. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults

    PubMed Central

    2009-01-01

    Background: Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence-based recommendations for addressing aspects of care. Objective: This guideline is designed to assist primary care providers as well as sleep medicine specialists, surgeons, and dentists who care for patients with OSA by providing a comprehensive strategy for the evaluation, management and long-term care of adult patients with OSA. Methods: The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) was assembled to produce a clinical guideline from a review of existing practice parameters and available literature. All existing evidence-based AASM practice parameters relevant to the evaluation and management of OSA in adults were incorporated into this guideline. For areas not covered by the practice parameters, the task force performed a literature review and made consensus recommendations using a modified nominal group technique. Recommendations: Questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment. Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments. OSA should be approached as a chronic disease requiring long-term, multidisciplinary management. For each treatment option, appropriate outcome

  19. The Management of Iatrogenic Obstructive Sleep Apnoea Syndrome Following Bimaxillary Surgery in a Patient with Cleft Lip and Palate.

    PubMed

    Gerbino, Giovanni; Gervasio, Fernando Carmine; Blythe, John; Bianchi, Francesca Antonella

    2016-07-01

    A 26-year-old man presented with a 6-year history of severe obstructive sleep apnoea syndrome followed a bimaxillary osteotomy procedure for a class III skeletal pattern. The patient was born with a unilateral cleft lip and palate and underwent primary lip and palate repair and later a pharyngeal flap for severe velopharyngeal insufficiency. Surgical management of obstructive sleep apnoea syndrome with conventional osteotomy, in cleft lip and palate patients, is a difficult problem. Distraction osteogenesis may provide a safer alternative. The authors describe and discuss the indications and the technical challenge of a multistage treatment protocol with distraction osteogenesis.

  20. [Insomnia and sleep apnea].

    PubMed

    Bayon, V; Léger, D

    2014-02-01

    The presence of insomnia in patients with sleep apnea seems paradoxical as excessive sleepiness is one of the major symptoms of sleep apnea. However, recent research has shown that about half of patients with sleep disorder breathing experience insomnia. Moreover, patients complaining of insomnia or non-restorative sleep may also present with moderate to severe sleep apnea syndromes. Thus, in recent years, clinicians have become more aware of the possible association between insomnia and sleep apnea. This article reviews data published on different aspects of this co-occurrence. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  1. Physiology of Sleep.

    PubMed

    Carley, David W; Farabi, Sarah S

    2016-02-01

    IN BRIEF Far from a simple absence of wakefulness, sleep is an active, regulated, and metabolically distinct state, essential for health and well-being. In this article, the authors review the fundamental anatomy and physiology of sleep and its regulation, with an eye toward interactions between sleep and metabolism.

  2. Promoting healthy sleep.

    PubMed

    O'Reilly-Foley, Georgina

    2016-08-31

    What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The CPD article discussed strategies to promote healthy sleep. It considered theories related to the function of sleep and the potential consequences of sleep deficit.

  3. Pediatric sleep pharmacology.

    PubMed

    Pelayo, Rafael; Yuen, Kin

    2012-10-01

    This article reviews common sleep disorders in children and pharmacologic options for them. Discussions of pediatric sleep pharmacology typically focus on treatment of insomnia. Although insomnia is a major concern in this population, other conditions of concern in children are presented, such as narcolepsy, parasomnias, restless legs syndrome, and sleep apnea.

  4. Special article: airway management in reconstructive surgery for noma (cancrum oris).

    PubMed

    Coupe, Michael Howard; Johnson, Doug; Seigne, Patrick; Hamlin, Bill

    2013-07-01

    Noma (cancrum oris) is a disease of poverty and malnutrition, which predominantly affects children younger than 10 years in developing countries. Although the majority of sufferers die of sepsis at the time of the initial infection, or of subsequent starvation due to severe trismus and an inability to eat, a small minority of patients survive and require reconstructive surgery for severe facial scarring and deformity. These patients present significant problems to the anesthesiologist with regard to airway management. We present a series of 26 patients undergoing primary and subsequent reconstructive surgery, with particular focus on airway management. We show that airway management, while challenging, can be performed safely and successfully by using individualized airway plans but may require advanced techniques and equipment. Traditional tests focusing on the anterior/superior airway are helpful in assessing patients with facial deformity due to noma.

  5. What is New in the Management of Acute Preterm Labor?: Best Articles From the Past Year.

    PubMed

    Malone, Fergal D

    2016-02-01

    This month we focus on current research in the management of acute preterm labor. Dr. Malone discusses four recent publications, which are concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.

  6. [Sleep-wake transition disorders].

    PubMed

    Honma, H; Kobayashi, R; Koyama, T

    1998-02-01

    The term sleep-wake transition disorders refers to a group of parasomnias that occur during the transition from wakefulness to sleep or from one sleep stage to another. Rhythmic movement disorder, sleep starts, sleep talking, and nocturnal leg cramps--these four disorders belong to sleep-wake transition disorders in the International Classification of Sleep Disorders. Although these are common disorders, little attention is given to them and their mechanisms are remain unclear. The majority of patients are not so severe as to require any treatment. Their prognosis are usually well. This article describes sleep-wake transition disorders concerning the clinical features, differential diagnosis, treatment, etc.

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

    PubMed

    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.

  8. Oral appliances and the management of sleep bruxism in adults: a century of clinical applications and search for mechanisms.

    PubMed

    Klasser, Gary D; Greene, Charles S; Lavigne, Gilles J

    2010-01-01

    The phenomenon of sleep bruxism (SB) has been recognized and described for centuries, including literary references to the gnashing of teeth. Early etiologic explanations were generally focused on mechanistic factors, but later, attention was focused on psychologic issues such as stress and anxiety; by the end of the 20th century, most opinions combined these two ideas. However, recently, the study of the SB phenomena has occurred primarily in sleep laboratories in which patients could be observed and monitored over several nights. Various other physiologic systems were also studied in sleep laboratories, including brain activity, muscle activity, cardiac function, and breathing. As a result of these studies, most authorities now consider SB to be a primarily sleep-related movement disorder, and specific diagnostic criteria have been established for the formal diagnosis of that condition. All of these changes in the understanding of the SB phenomena have led to a corresponding change in thinking about how oral appliances (OAs) might be used in the management of SB. Originally, they were thought to be a temporary measure that could help dentists analyze improper dental relationships. Unfortunately, this often led to dental procedures to "improve" these relationships, including equilibrations, orthodontics, bite opening, or even major restorative dentistry. However, it is now understood that the proper role for OAs is to protect the teeth and hopefully to diminish muscle activity during sleep. This paper reviews these evolutionary changes in the understanding of SB and how this affects concepts of designing and using OAs.

  9. Changes in self-reported sleep and cognitive failures: a randomized controlled trial of a stress management intervention.

    PubMed

    Dalgaard, Ligaya; Eskildsen, Anita; Carstensen, Ole; Willert, Morten Vejs; Andersen, Johan Hviid; Glasscock, David J

    2014-11-01

    This study evaluated the effectiveness of a stress management intervention combining individual cognitive behavioral therapy (CBT) with a brief workplace intervention on self-reported measures of sleep and cognitive functioning among patients on sick leave due to work-related stress complaints. Participants were patients referred to the regional Department of Occupational Medicine. Inclusion criteria were (i) sick leave due to work-related stress complaints and (ii) a diagnosis of adjustment disorder/reactions to stress or mild depression. Participants (N=137) were randomized to either an intervention (N=57) or control (N=80) group. The intervention comprised six sessions with a psychologist and the offer of a small workplace intervention. Questionnaires were answered at baseline and after 4, and 10 months. Symptoms were significantly reduced over time in both groups but there was no significant treatment effect on sleep or cognitive outcomes at any time point. From 0-4 months, there was a tendency for larger improvements in the intervention group with regards to sleep and cognitive failures in distraction. Although neither was significant, the results came close to significance depicting a small effect size (Cohen's d) on sleep complaints and distractions (but not memory). The specific intervention was not superior to the control condition in reducing symptoms of sleep problems and cognitive difficulties at any time point during the 10-month follow-up period. Substantial improvements in symptoms over time were seen in both groups.

  10. [Perioperative management in children with sleep apnea syndrome (SAS) undergoing adenoidotonsillectomy].

    PubMed

    Mizuno, Ju; Nemoto, Mikiko; Sato, Tomoko; Yokoyama, Takeshi; Hanaoka, Kazuo

    2013-02-01

    We should take care of the occurrences of apnea and hypopnea after emergence from general anesthesia in the children with sleep apnea syndrome (SAS) due to an increase in sensitivity to opioid agonists given for previous recurrent hypoxia. Preoperative assessment for SAS with apnea hypopnea index (AHI), oxygen desaturation index (ODI), and minimum artery oxygen saturation by pulse oxymetry (lowest SpO2) obtained from polysomnography (PSG) test could help to predict the postoperative respiratory depression. In perioperative management in the children with SAS who are candidates for adenotonsillectomy, the dose of opioid agonists during anesthesia maintenance for purpose of postoperative analgesia and sedation should be reduced; postoperative respiratory and circulatory management with monitoring of respiratory movement of the thoracoabdominal part, and electrographic (ECG) and SpO2 monitoring should be continued intensively under long-term oxygen administration; and airway management, nasal continuous positive airway pressure (nCPAP), and artificial ventilation should be prepared for the occurrence of postoperative respiratory depression.

  11. Review article: Role of magnesium sulphate in the management of Irukandji syndrome: A systematic review.

    PubMed

    Rathbone, John; Franklin, Richard; Gibbs, Clinton; Williams, David

    2017-02-01

    Signs of Irukandji syndrome (IS) suggest an underlying catecholamine storm with research demonstrating that Carukia barnesi venom causes a significant rise in adrenaline/noradrenaline serum levels. A systematic review was undertaken to ascertain the current evidence in treating IS with magnesium salts. A literature search was conducted using Scopus, Medline and ScienceDirect. Further articles were discarded via title description and/or abstract details. The remaining were read in full, and those identified as not having sufficient information regarding magnesium and patient outcomes were removed. Nine articles were identified. One article was a randomised controlled trial, which concluded that there appears to be no beneficial difference between those patients who received the magnesium sulphate (MgSO4 ) and those who received the placebo and recommended against the use of MgSO4 in IS. Of the remaining eight, one reported the failure of MgSO4 and the remaining seven were case series reporting varying success in its use. This systematic review found insufficient evidence to support any clear recommendation regarding the use of magnesium, but nor was there clear evidence to recommend against its use in IS. Two case series describe significant reduction in key symptoms and hypertension but are a non-randomised albeit prospective series with the limitations accompanying this. The reporting of recrudescence of symptoms with reduction of dose does suggest a dose-response relationship. The evidence for the use of MgSO4 is at best anecdotal, and further research is required to either confirm its benefit or confirm the randomised controlled trial.

  12. [Neurological sleep disorders].

    PubMed

    Khatami, Ramin

    2014-11-01

    Neurological sleep disorders are common in the general population and may have a strong impact on quality of life. General practitioners play a key role in recognizing and managing sleep disorders in the general population. They should therefore be familiar with the most important neurological sleep disorders. This review provides a comprehensive overview of the most prevalent and important neurological sleep disorders, including Restless legs syndrome (with and without periodic limb movements in sleep), narcolepsy, NREM- and REM-sleep parasomnias and the complex relationship between sleep and epilepsies. Although narcolepsy is considered as a rare disease, recent discoveries in narcolepsy research provided insight in the function of brain circuitries involved in sleep wake regulation. REM sleep behavioral parasomnia (RBD) is increasingly recognized to represent an early manifestation of neurodegenerative disorders, in particular evolving synucleinopathies. Early diagnosis may thus open new perspectives for developing novel treatment options by targeting neuroprotective substances.

  13. The Management of Bone Defects in Periarticular Knee Injuries: A Review Article.

    PubMed

    Buck, Brian; Murtha, Yvonne M

    2017-03-01

    Traumatic bone defects of the distal femur and proximal tibia present treatment challenges for the orthopaedic traumatologist. In addition to bone loss, significant soft tissue compromise and cartilage defects leave the patient and surgeon with few reconstructive options for proper long-term joint function. These injuries are often complicated by delayed healing, nonunion, malunion, infection, and poor subjective patient outcomes. There are a variety of clinical problems associated with the treatment of periarticular fractures about the knee. This article will describe the surgical options for these difficult problems.

  14. A Classification and Analysis of National Contract Management Journal Articles from 1966 Through 1989

    DTIC Science & Technology

    1991-06-01

    THEORETICAL, POSITIVE, NON-EMPIRICAL, INDUCTIVE [64] "The DOD’s ’Rights in Technical Data and Computer Software’ Clause," Maj. Jerome S. Gabig and Roger J...DOD’ s Rights in Technical Data and Computer Software Clause--Part II," Maj. Jerome S. Gabig and Roger J. XcAvoy, pp. 37-44. This article was written...NON-EMPIRICAL, NO PARTICULAR LOGIC [54] "A Guide to Interpreting Contracts," Jerome S. Gabig and Charles L. Cook, pp. 55-61. Many disputes involving

  15. Sleep and the Endocrine System.

    PubMed

    Morgan, Dionne; Tsai, Sheila C

    2016-03-01

    In this article, the effect of sleep and sleep disorders on endocrine function and the influence of endocrine abnormalities on sleep are discussed. Sleep disruption and its associated endocrine consequences in the critically ill patient are also reviewed. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Sleep and the endocrine system.

    PubMed

    Morgan, Dionne; Tsai, Sheila C

    2015-07-01

    In this article, the effect of sleep and sleep disorders on endocrine function and the influence of endocrine abnormalities on sleep are discussed. Sleep disruption and its associated endocrine consequences in the critically ill patient are also reviewed. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Sleep bruxism: a comprehensive overview for the dental clinician interested in sleep medicine.

    PubMed

    Carra, Maria Clotilde; Huynh, Nelly; Lavigne, Gilles

    2012-04-01

    Sleep bruxism (SB) is a common sleep-related motor disorder characterized by tooth grinding and clenching. SB diagnosis is made on history of tooth grinding and confirmed by polysomnographic recording of electromyographic (EMG) episodes in the masseter and temporalis muscles. The typical EMG activity pattern in patients with SB is known as rhythmic masticatory muscle activity (RMMA). The authors observed that most RMMA episodes occur in association with sleep arousal and are preceded by physiologic activation of the central nervous and sympathetic cardiac systems. This article provides a comprehensive review of the cause, pathophysiology, assessment, and management of SB.

  18. Surgical Management of the Forefoot in Patients with Rheumatoid Arthritis - A Review Article

    PubMed Central

    Nash, W.J.; Al-Nammari, S.; Khan, W.S.; Pengas, I.P.

    2015-01-01

    Foot and ankle pathologies cause a significant disease burden on rheumatoid patients. Forefoot pathologies causes pain, callosities and possibly ulceration, and can cause problems with footwear. Forefoot correction in rheumatoid patients has historically comprised of excision of diseased joints. While satisfaction was high with this procedure, complications, changing expectations and improvement in medical therapy have raised expectation of patients, physicians and surgeons alike. This review assesses the role of joint preserving osteotomies and arthrodesis, as well as associated complications. It also describes the role of the multidisciplinary team in the management of these patients. PMID:25861409

  19. Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer.

    PubMed

    Skipworth, J R A; Olde Damink, S W M; Imber, C; Bridgewater, J; Pereira, S P; Malagó, M

    2011-11-01

    The majority of patients with cholangiocarcinoma present with advanced, irresectable tumours associated with poor prognosis. The incidence and mortality rates associated with cholangiocarcinoma continue to rise, mandating the development of novel strategies for early detection, improved resection and treatment of residual lesions. To review the current evidence base for surgical, adjuvant and neo-adjuvant techniques in the management of cholangiocarcinoma. A search strategy incorporating PubMed/Medline search engines and utilising the key words biliary tract carcinoma; cholangiocarcinoma; management; surgery; chemotherapy; radiotherapy; photodynamic therapy; and radiofrequency ablation, in various combinations, was employed. Data on neo-adjuvant and adjuvant techniques remain limited, and much of the literature concerns palliation of inoperable disease. The only opportunity for long-term survival remains surgical resection with negative pathological margins or liver transplantation, both of which remain possible in only a minority of selected patients. Neo-adjuvant and adjuvant techniques currently provide only limited success in improving survival. The development of novel strategies and treatment techniques is crucial. However, the shortage of randomised controlled trials is compounded by the low feasibility of conducting adequately powered trials in liver surgery, due to the large sample sizes that are required. © 2011 Blackwell Publishing Ltd.

  20. Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome.

    PubMed

    Abdelghany, Mahmoud; Subedi, Rogin; Shah, Siddharth; Kozman, Hani

    2017-04-01

    Kounis syndrome (KS) is a hypersensitivity coronary disorder induced by exposure to drugs, food, environmental and other triggers. Vasospastic allergic angina, allergic myocardial infarction (MI) and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute the three main variants of this syndrome. We reviewed 175 patients who fulfilled the definition of one of the three types of KS. The epidemiology, diagnostic findings, management and complications were reviewed in this article.

  1. Update on the role of melatonin in the prevention of cancer tumorigenesis and in the management of cancer correlates, such as sleep-wake and mood disturbances: review and remarks.

    PubMed

    Rondanelli, Mariangela; Faliva, Milena Anna; Perna, Simone; Antoniello, Neldo

    2013-10-01

    The aim of this article was to perform a systematic review on the role of melatonin in the prevention of cancer tumorigenesis--in vivo and in vitro--as well as in the management of cancer correlates, such as sleep-wake and mood disturbances. The International Agency for Research on Cancer recently classified "shift-work that involves circadian disruption" as "probably carcinogenic to humans" (Group 2A) based on "limited evidence in humans for the carcinogenicity of shift-work that involves night-work", and "sufficient evidence in experimental animals for the carcinogenicity of light during the daily dark period (biological night)". The clinical implications and the potential uses of melatonin in terms of biologic clock influence (e.g. sleep and mood), immune function, cancer initiation and growth, as well as the correlation between melatonin levels and cancer risk, are hereinafter recorded and summarized. Additionally, this paper includes a description of the newly discovered effects that melatonin has on the management of sleep-wake and mood disturbances as well as with regard to cancer patients' life quality. In cancer patients depression and insomnia are frequent and serious comorbid conditions which definitely require a special attention. The data presented in this review encourage the performance of new clinical trials to investigate the possible use of melatonin in cancer patients suffering from sleep-wake and mood disturbances, also considering that melatonin registered a low toxicity in cancer patients.

  2. Recent advances in management of alkaptonuria (invited review; best practice article).

    PubMed

    Ranganath, Lakshminarayan R; Jarvis, Jonathan C; Gallagher, James A

    2013-05-01

    Alkaptonuria (AKU) is an autosomal recessive condition arising as a result of a genetic deficiency of the enzyme homogentisate 1,2 dioxygenase and characterised by accumulation of homogentisic acid (HGA). Oxidative conversion of HGA leads to production of a melanin-like polymer in a process termed ochronosis. The binding of ochronotic pigment to the connective tissues of the body leads to multisystem disorder dominated by premature severe spondylo-arthropathy. Other systemic features include stones (renal, prostatic, salivary, gall bladder), renal damage/failure, osteopenia/fractures, ruptures of tendons/muscle/ligaments, respiratory compromise, hearing loss and aortic valve disease. Detection of these features requires systematic investigation. Treatment in AKU patients is palliative and unsatisfactory. Ascorbic acid, low protein diet and physiotherapy have been tried but do not alter the underlying metabolic defect. Regular surveillance to detect and treat complications early is important. Palliative pain management is a crucial issue in AKU. Timely spinal surgery and arthroplasty are the major treatment approaches at present. A potential disease modifying drug, nitisinone, inhibits 4-hydroxy-phenyl-pyruvate-dioxygenase and decreases formation of HGA and could prevent or slow the progression of disease in AKU. If nitisinone therapy is able to complement the biochemical 'cure' with improved outcomes, it will completely alter the way we approach the management of this disease. Greater efforts to improve recognition and registration of the disease will be worthwhile. Improved laboratory diagnostics to monitor the tyrosine metabolic pathway that includes plasma metabolites including tyrosine to monitor efficacy, toxicity and safety postnitisinone will also be required.

  3. The Effect of Physician Continuing Medical Education on Patient-Reported Outcomes for Identifying and Optimally Managing Obstructive Sleep Apnea

    PubMed Central

    Johnson, Sara S.; Castle, Patricia H.; Van Marter, Deborah; Roc, Anne; Neubauer, David; Auerbach, Sanford; DeAguiar, Emma

    2015-01-01

    Study Objective: To evaluate the effect of continuing medical education (CME) activities on patient reported outcomes with regard to (1) screening for excessive sleepiness (ES) and obstructive sleep apnea (OSA) and (2) appropriate referral and treatment. Methods: A total of 725 patients were recruited from 75 providers who either participated or did not participate in Transtheoretical Model (TTM)-based OSA CME activities. Patient reported outcomes from participating (n = 36) and non-participating providers (n = 39) were compared using generalized estimating equations examining random effects of provider as unit of assignment. Results: Patients' reports demonstrate that participating physicians were 1.7 times more likely to initiate discussion of sleep problems than non-participating physicians (t1,411 = 3.71, p = 0.05) and 2.25–2.86 times more likely to administer validated measures for OSA (Epworth Sleepiness Scale and STOP-BANG). Patient reports also indicated that participating clinicians (79.9%) were significantly more likely to recommend seeing a sleep specialist compared to non-participating clinicians (60.7%; t1,348 = 9.1, p < 0.01, OR = 2.6). Furthermore, while 89.4% of participating clinicians recommended a sleep study, only 73.2% of the non-participating physicians recommended one (t1,363 = 11.46, p < 0.001, OR = 3.1). Conclusions: Participation in TTM-based OSA CME activities was associated with improved patient reported outcomes compared to the non-participating clinicians. Citation: Johnson SS, Castle PH, Van Marter D, Roc A, Neubauer D, Auerbach S, DeAguiar E. The effect of physician continuing medical education on patient-reported outcomes for identifying and optimally managing obstructive sleep apnea. J Clin Sleep Med 2015;11(3):197–204. PMID:25845903

  4. Strategies for nurses to prevent sleep-related injuries and errors.

    PubMed

    Caruso, Claire C; Hitchcock, Edward M

    2010-01-01

    Rehabilitation nurses work shift schedules or long hours to provide essential patient services around the clock. These demanding hours can lead to sleep difficulties, declines in performance, and increased worker errors. This article gives an overview of selected declines in cognitive performance that are associated with inadequate sleep and several factors that increase riskforfatigue-related errors. Selected strategies for nurses and managers to reduce these risks are discussed, such as better sleep practices, improved work schedule design, naps, caffeine, exposure to light, and rest breaks. Both nurses and managers share responsibility for implementing strategies to reduce risks from inadequate sleep.

  5. Sleep and sleep disordered breathing in hospitalized patients.

    PubMed

    Knauert, Melissa P; Malik, Vipin; Kamdar, Biren B

    2014-10-01

    Sleep is a fundamental physiological process necessary for recovery from acute illness. Unfortunately for hospitalized patients, sleep is often short, fragmented, and poor in quality, and may be associated with adverse outcomes including inpatient delirium. Many factors contribute to poor sleep in the hospital setting, including preexisting sleep deprivation, sleep disordered breathing, environmental noise and light, patient care activities, and medications. Sleep disordered breathing increases the risk of potentially life-threatening cardiovascular, respiratory, and metabolic consequences, and therefore should be diagnosed and treated in hospitalized patients. Mitigating the sequelae associated with poor sleep quality and sleep disordered breathing requires early identification of modifiable factors impacting a patient's sleep, including engagement of a multidisciplinary team. In this article, we review the current knowledge of sleep in hospitalized patients with a detailed focus on patients with sleep disordered breathing. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Effective management and intrauterine treatment of congenital cytomegalovirus infection: review article and case series.

    PubMed

    Wagner, Norbert; Kagan, Karl Oliver; Haen, Susanne; Schmidt, Sybille; Yerlikaya, Gülen; Maden, Zerrin; Jahn, Gerhard; Hamprecht, Klaus

    2014-01-01

    Human Cytomegalovirus (CMV) infection during pregnancy is the most frequent viral cause of intrauterine infection and responsible for various cerebral and other ultrasound abnormalities of the fetus. It is the leading infectious cause of mental retardation and sensorineural deafness in affected newborns and infants. We present three cases of primary cytomegalovirus infection in pregnancy and demonstrate three different scenarios of the disease with regard to clinical outcome and therapy options. We first report on CMV related phospho- and glycoprotein-specific antibody reactivities in amnion fluid that have not been reported earlier in literature. Case 1: A 33-year-old Gravida II Para I was referred for primary CMV infection at 15 weeks gestation presenting with a history of fever. HIG therapy was performed resulting in good neonatal outcome. Case 2: A 23-year-old Gravida I was referred for targeted ultrasound at 23 weeks of gestation presenting with intrauterine growth retardation, multiple fetal hepatic echodensities and thickened placenta. Termination of pregnancy was initiated. Case 3: A 29-year-old Gravida II Para I was referred for primary CMV infection at 16 weeks gestation presenting with no clinical symptoms of CMV. HIG therapy was performed, resulting in good neonatal outcome. We want to stress the potential benefit of an off label use of CMV-specific hyperimmune globulin (HIG) therapy, present an algorithm for the management of affected pregnancies and review current literature on this issue.

  7. Review article: anesthetic management of patients undergoing deep brain stimulator insertion.

    PubMed

    Venkatraghavan, Lashmi; Luciano, Michelle; Manninen, Pirjo

    2010-04-01

    Deep brain stimulation is used for the treatment of patients with neurologic disorders who have an alteration of function, such as movement disorders and other chronic illnesses. The insertion of the deep brain stimulator (DBS) is a minimally invasive procedure that includes the placement of electrodes into deep brain structures for microelectrode recordings and intraoperative clinical testing and connection of the DBS to an implanted pacemaker. The anesthetic technique varies depending on the traditions and requirements of each institution performing these procedures and has included monitored anesthesia with local anesthesia, conscious sedation, and general anesthesia. The challenges and demands for the anesthesiologist in the care of these patients relate to the specific concerns of the patients with functional neurologic disorders, the effects of anesthetic drugs on microelectrode recordings, and the requirements of the surgical procedure, which often include an awake and cooperative patient. The purpose of this review is to familiarize anesthesiologists with deep brain stimulation by discussing the mechanism, the effects of anesthetic drugs, and the surgical procedure of DBS insertion, and the perioperative assessment, preparation, intraoperative anesthetic management, and complications in patients with functional neurologic disorders.

  8. Review article: the potential mechanisms of action of rifaximin in the management of inflammatory bowel diseases.

    PubMed

    Sartor, R B

    2016-01-01

    Gut microbiota dysbiosis contributes to the pathogenesis of inflammatory bowel diseases (IBD). Although the microbiota's role in IBD pathogenesis, specifically Crohn's disease (CD), provides a rationale for antibiotic treatment, antibiotic use in CD remains controversial. Rifaximin, traditionally identified as a nonsystemic bactericidal antibiotic, may be therapeutically beneficial for inducing CD remission. To examine the role of rifaximin in the management of IBD and its potential mechanisms of action. A literature search using the following strategy: ('inflammatory bowel disease' OR 'Crohn's' OR 'ulcerative'), 'rifaximin' AND ('barrier' OR 'translocation' OR 'adhesion' OR 'internalization' OR 'pregnane X'), AND 'pregnane X' AND ('Crohn's' OR 'ulcerative colitis' OR 'inflammatory bowel disease'). In vitro data suggest rifaximin mediates changes in epithelial cell physiology and reduces bacterial attachment and internalisation. In experimental colitis models, rifaximin antagonised the effects of tumour necrosis factor-α on intestinal epithelial cells by activating pregnane X receptor, which inhibits nuclear factor-κB-mediated proinflammatory mediators and induces detoxification genes (e.g. multidrug resistance 1 and cytochrome P450 3A4). Rifaximin also inhibits bacterial translocation into the mesenteric lymph nodes. Accumulating evidence suggests that mechanisms of action of rifaximin in IBD may not be limited to direct bactericidal activity; therefore, rifaximin could potentially be redefined as a gut environment modulator. © 2015 John Wiley & Sons Ltd.

  9. Review article: the diagnosis and management of food allergy and food intolerances.

    PubMed

    Turnbull, J L; Adams, H N; Gorard, D A

    2015-01-01

    Adverse reactions to food include immune mediated food allergies and non-immune mediated food intolerances. Food allergies and intolerances are often confused by health professionals, patients and the public. To critically review the data relating to diagnosis and management of food allergy and food intolerance in adults and children. MEDLINE, EMBASE and the Cochrane Database were searched up until May 2014, using search terms related to food allergy and intolerance. An estimated one-fifth of the population believe that they have adverse reactions to food. Estimates of true IgE-mediated food allergy vary, but in some countries it may be as prevalent as 4-7% of preschool children. The most common food allergens are cow's milk, egg, peanut, tree nuts, soy, shellfish and finned fish. Reactions vary from urticaria to anaphylaxis and death. Tolerance for many foods including milk and egg develops with age, but is far less likely with peanut allergy. Estimates of IgE-mediated food allergy in adults are closer to 1-2%. Non-IgE-mediated food allergies such as Food Protein-Induced Enterocolitis Syndrome are rarer and predominantly recognised in childhood. Eosinophilic gastrointestinal disorders including eosinophilic oesophagitis are mixed IgE- and non-IgE-mediated food allergic conditions, and are improved by dietary exclusions. By contrast food intolerances are nonspecific, and the resultant symptoms resemble other common medically unexplained complaints, often overlapping with symptoms found in functional disorders such as irritable bowel syndrome. Improved dietary treatments for the irritable bowel syndrome have recently been described. Food allergies are more common in children, can be life-threatening and are distinct from food intolerances. Food intolerances may pose little risk but since functional disorders are so prevalent, greater efforts to understand adverse effects of foods in functional disorders are warranted. © 2014 John Wiley & Sons Ltd.

  10. Review article: new drug formulations, chemical entities and therapeutic approaches for the management of ulcerative colitis.

    PubMed

    Ng, S C; Kamm, M A

    2008-10-01

    Treatment options for ulcerative colitis (UC) are expanding with the development of novel drug formulations and dosing regimens and new chemical entities. Although the goals of medical therapy for UC remain unchanged, that is to induce and to maintain remission, focus has also centred on improving patient compliance, modifying the natural course of disease and healing the mucosa. To examine novel formulations, new chemical entities and novel therapeutic approaches to the management of UC. Searches for all studies related to UC treatment in Medline and abstracts from major national and international meetings published in the last 10 years. 5-Aminosalicylic acids (5-ASA) remain the standard first-line treatment for patients with mild to moderately active UC. New formulations with altered delivery, and new dosing regimens have demonstrated possible improvements in efficacy compared with historically available preparations and dosing patterns. Once-daily dosing, micropellet formulations,and high-dose tablets offer enhanced efficacy and improved compliance. 5-ASA is now recognized as a ligand for peroxisome proliferator activated receptor-gamma (PPAR-gamma) and it has a role as a chemo-preventive agent in long-standing UC. New colonic release corticosteroid formulations help to limit systemic toxicity; turmeric, tacrolimus and infliximab have shown promising results. New anti-inflammatory targeted therapies include an anti-CD3 antibody, selective integrin blockers, anti-IL-2 antibody and PPAR-gamma agonists. The evolution of novel oral 5-ASA formulations and dosage regimens,and recent development of new molecules have expanded the therapeutic armamentarium of UC.

  11. Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice.

    PubMed

    Howell, D; Oliver, T K; Keller-Olaman, S; Davidson, J R; Garland, S; Samuels, C; Savard, J; Harris, C; Aubin, M; Olson, K; Sussman, J; MacFarlane, J; Taylor, C

    2014-04-01

    Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.

  12. Sleep in the Pediatric Population.

    PubMed

    Hintze, Jonathan P; Paruthi, Shalini

    2016-03-01

    This article provides an overview of common pediatric sleep disorders encountered in the neurology clinic, including restless legs syndrome, narcolepsy, parasomnias, sleep-related epilepsy, and sleep and headaches. An overview of each is provided, with an emphasis on accurate diagnosis and treatment. It is important in comprehensive neurologic care to also obtain a sleep history, because treating the underlying sleep condition may improve the neurologic disorder. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    PubMed

    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 < 0·05). No significant difference was observed in 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.

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

    PubMed Central

    Shell, William E.; May, Lawrence A.; Bullias, Debora H.; Pavlik, Stephanie L.; Silver, David S.

    2012-01-01

    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. PMID:23650468

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

    PubMed

    Shell, William E; May, Lawrence A; Bullias, Debora H; Pavlik, Stephanie L; Silver, David S

    2012-01-01

    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.

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

    PubMed

    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.

  17. Sleep, Health, and Society.

    PubMed

    Grandner, Michael A

    2017-03-01

    Biological needs for sleep are met by engaging in behaviors that are largely influenced by the environment, social norms and demands, and societal influences and pressures. Insufficient sleep duration and sleep disorders such as insomnia and sleep apnea are highly prevalent in the US population. This article outlines some of these downstream factors, including cardiovascular and metabolic disease risk, neurocognitive dysfunction, and mortality, as well as societal factors such as age, sex, race/ethnicity, and socioeconomics. This review also discusses societal factors related to sleep, such as globalization, health disparities, public policy, public safety, and changing patterns of use of technology.

  18. Sleep Disturbances in Mood Disorders.

    PubMed

    Rumble, Meredith E; White, Kaitlin Hanley; Benca, Ruth M

    2015-12-01

    The article provides an overview of common and differentiating self-reported and objective sleep disturbances seen in mood-disordered populations. The importance of considering sleep disturbances in the context of mood disorders is emphasized, because a large body of evidence supports the notion that sleep disturbances are a risk factor for onset, exacerbation, and relapse of mood disorders. In addition, potential mechanisms for sleep disturbance in depression, other primary sleep disorders that often occur with mood disorders, effects of antidepressant and mood-stabilizing drugs on sleep, and the adjunctive effect of treating sleep in patients with mood disorders are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Sleep medicine in Taiwan.

    PubMed

    Chen, Ning-Hung; Hang, Liang-Wen; Lin, Chia-Mo

    The sleep medicine is a young medical science in Taiwan. It began from less than 10 sleep beds 20 years ago in four hospitals all over Taiwan. By the organization of sleep team in Chang Gung Memorial Hospital and the initiation of Taiwan Society of Sleep Medicine, sleep medicine becomes a popular medicine in the past decades. The setting of Sleep Society in 2002 is the milestone to promote the sleep medicine, educate the public and professionals, and control of the quality of clinical practice. Epidemiologic study in Taiwan shows many Taiwanese suffer from sleep disorders and hence more sleep institutes are needed. Accreditation has become a mission of the Taiwan Society of Sleep Medicine. Technicians, sleep centers, sleep specialists and sleep phycologists are gradually certified by the society. 215 sleep technicians, 307 sleep physicians, 31 iCBT therapists and 21 sleep centers are certified by the society till 2015. The first sleep related medical courses are initiated in the Department of Respiratory Therapy in Chang Gung University from 2003. For the following years, eight medical courses are set in six Universities now. Given the fact that the Asian accounts for the largest proportion of population in the world, investigation on the OSA in Asian population is essential. In this article, we aimed to demonstrate the outcomes of OSA-related research in Asia. In particular, the progress driven by the studies in Taiwan will be discussed. Data were obtained online from the Science Citation Index Expanded database of the Thomson Reuters' Web of Science Core Collection. Keywords including "apnea" and "hyponea" were used to search by applying the filters of the title and the publication years between 1991 and 2014. In total, 2623 articles were hit, subject to the criteria for data search. Among the 2623 articles, sleep and breathing related articles (128, 4.95 %) were the most frequently reported. Japan is the country that published the highest amount of OSA

  20. Sleep disturbances in Parkinsonism.

    PubMed

    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

  1. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome.

    PubMed

    2002-04-01

    This clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of obstructive sleep apnea syndrome (OSAS). The Section on Pediatric Pulmonology of the American Academy of Pediatrics selected a subcommittee composed of pediatricians and other experts in the fields of pulmonology and otolaryngology as well as experts from epidemiology and pediatric practice to develop an evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for the diagnosis and management of childhood OSAS. The guideline contains the following recommendations for the diagnosis of OSAS: 1) all children should be screened for snoring; 2) complex high-risk patients should be referred to a specialist; 3) patients with cardiorespiratory failure cannot await elective evaluation; 4) diagnostic evaluation is useful in discriminating between primary snoring and OSAS, the gold standard being polysomnography; 5) adenotonsillectomy is the first line of treatment for most children, and continuous positive airway pressure is an option for those who are not candidates for surgery or do not respond to surgery; 6) high-risk patients should be monitored as inpatients postoperatively; 7) patients should be reevaluated postoperatively to determine whether additional treatment is required. This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OSAS. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decision-making. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.

  2. The effects of mindfulness-based stress reduction on sleep disturbance: a systematic review.

    PubMed

    Winbush, Nicole Y; Gross, Cynthia R; Kreitzer, Mary Jo

    2007-01-01

    Sleep disturbance is common and associated with compromised health status. Cognitive processes characterized by stress and worry can cause, or contribute to, sleep complaints. This study systematically evaluated the evidence that sleep can be improved by mindfulness-based stress reduction (MBSR), a formalized psychoeducational intervention that helps individuals self-manage and reframe worrisome and intrusive thoughts. Articles were identified from searches of Medline, Allied and Complementary Medicine Database, CINAHL, PsycINFO, Digital Dissertations, and the Cochrane Central Register of Controlled Trials. Eligible for inclusion were English language clinical trials of MBSR that reported preintervention and postintervention measures of sleep quality or duration. Studies employing multicomponent interventions were excluded. Studies were reviewed independently by the first and second authors. Thirty-eight articles were identified for review. Seven met inclusion criteria. Lack of standardized outcome measures precluded pooling of results for quantitative data analysis. Sleep report measures varied (standardized scales, single item, sleep diaries). Four studies (all uncontrolled) found that MBSR significantly improved measures of sleep quality or duration. The remaining studies found no statistically significant difference between treatment and control conditions. To date, controlled studies have not clearly demonstrated the positive effects of MBSR on sleep quality and duration. However, there is some evidence to suggest that increased practice of mindfulness techniques is associated with improved sleep and that MBSR participants experience a decrease in sleep-interfering cognitive processes (eg, worry). More research is needed using standardized sleep scales and methods, with particular attention to the importance of MBSR home practice.

  3. Weighing the balance: how analgesics used in chronic pain influence sleep?

    PubMed Central

    Kaushik, Chhavi; Temple, Daniel; Chung, Sharon A; Shapiro, Colin M

    2014-01-01

    Pain and sleep share a bidirectional relationship, with each influencing the other. Several excellent reviews have explored this relationship. In this article, we revisit the evidence and explore existing research on this complex inter-relationship. The primary focus of the article is on the pharmacological treatment of chronic non-malignant pain and the main purpose is to review the effect of various pharmacological agents used in the management of chronic pain on sleep. This has not been comprehensively done before. We explore the clinical use of these agents, their impact on sleep architecture and sleep physiology, the mechanism of action on sleep parameters and sleep disorders associated with these agents. Pharmacological classes reviewed include antidepressants, opioid analgesics, anti-epileptics, cannabinoids and non-steroidal anti-inflammatory agents, drugs most commonly used to manage chronic pain. The objective is to help health professionals gain better insight into the complex effect that commonly used analgesics have on an individual’s sleep and how this could impact on the effectiveness of the drug as an analgesic. We conclude that antidepressants have both positive and negative effects on sleep, so do opioids, but in the latter case the evidence shifts towards the counterproductive side. Some anticonvulsants are sleep sparing and non-steroidal anti-inflammatory drugs (NSAIDs) are sleep neutral. Cannabinoids remain an underexplored and researched group. PMID:26516542

  4. Melatonin for the management of sleep disorders in children and adolescents.

    PubMed

    Cummings, Carl

    2012-06-01

    Problems of sleep initiation and maintenance occur in 15% to 25% of children and adolescents. Studies of the benefits of melatonin for sleep disorders have been published for healthy populations, for children and adolescents with attention-deficit hyperactivity disorder, for children and youth with autism, and for several other special populations. These studies demonstrate benefit with minimal side effects. However, all studies have involved small numbers of subjects and address only short-term use of melatonin. There are no good data concerning the safety and efficacy of long-term melatonin use. Further studies are needed to confirm the usefulness and safety of melatonin for sleep disorders in children and adolescents.

  5. Managing obstructive sleep apnoea in children: the role of craniofacial morphology.

    PubMed

    Bozzini, Maria Fernanda Rabelo; Di Francesco, Renata Cantisani

    2016-11-01

    Obstructive sleep apnoea syndrome is a type of sleep-disordered breathing that affects 1 to 5% of all children. Pharyngeal and palatine tonsil hypertrophy is the main predisposing factor. Various abnormalities are predisposing factors for obstructive sleep apnoea, such as decreased mandibular and maxillary lengths, skeletal retrusion, increased lower facial height and, consequently, increased total anterior facial height, a larger cranio-cervical angle, small posterior airway space and an inferiorly positioned hyoid bone. The diagnosis is based on the clinical history, a physical examination and tests confirming the presence and severity of upper airway obstruction. The gold standard test for diagnosis is overnight polysomnography. Attention must be paid to identify the craniofacial characteristics. When necessary, children should be referred to orthodontists and/or sleep medicine specialists for adequate treatment in addition to undergoing an adenotonsillectomy.

  6. Managing obstructive sleep apnoea in children: the role of craniofacial morphology

    PubMed Central

    Bozzini, Maria Fernanda Rabelo; Di Francesco, Renata Cantisani

    2016-01-01

    Obstructive sleep apnoea syndrome is a type of sleep-disordered breathing that affects 1 to 5% of all children. Pharyngeal and palatine tonsil hypertrophy is the main predisposing factor. Various abnormalities are predisposing factors for obstructive sleep apnoea, such as decreased mandibular and maxillary lengths, skeletal retrusion, increased lower facial height and, consequently, increased total anterior facial height, a larger cranio-cervical angle, small posterior airway space and an inferiorly positioned hyoid bone. The diagnosis is based on the clinical history, a physical examination and tests confirming the presence and severity of upper airway obstruction. The gold standard test for diagnosis is overnight polysomnography. Attention must be paid to identify the craniofacial characteristics. When necessary, children should be referred to orthodontists and/or sleep medicine specialists for adequate treatment in addition to undergoing an adenotonsillectomy. PMID:27982168

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

    PubMed

    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.

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

    PubMed

    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).

  9. Sleep apnoea and stroke

    PubMed Central

    Sharma, Sameer; Culebras, Antonio

    2016-01-01

    Sleep disorders have been known to physicians for a long time. In his famous aphorisms, Hippocrates said “Sleep or watchfulness exceeding that which is customary, augurs unfavorably”. Modern medicine has been able to disentangle some of the phenomena that disturb sleep. Among the most notable offenders is sleep apnoea that has gained prominence in the past few decades. It is being proposed as one of the potentially modifiable risk factors for vascular diseases including stroke. The pathological mechanisms linking sleep apnoea to vascular risk factors include hypoxia, cardiac arrhythmias, dysautonomia, impaired glucose tolerance, hypertension, dyslipidaemia and inflammation. In this article, we review literature linking sleep apnoea and stroke, including sleep apnoea as a risk factor for primary prevention with the potential to improve outcome after acute stroke and as a secondary risk factor, amenable to modification and hence vascular risk reduction. PMID:28959482

  10. PSYCHIATRIC DISORDERS AND SLEEP

    PubMed Central

    Krystal, Andrew D.

    2012-01-01

    SYNOPSIS Psychiatric disorders and sleep are related in important ways. In contrast to the longstanding view of this relationship which viewed sleep problems as symptoms of psychiatric disorders, there is growing experimental evidence that the relationship between psychiatric disorders and sleep is complex and includes bi-directional causation. In this article we provide the evidence that supports this point of view, reviewing the data on the sleep disturbances seen in patients with psychiatric disorders but also reviewing the data on the impact of sleep disturbances on psychiatric conditions. Although much has been learned about the psychiatric disorders-sleep relationship, additional research is needed to better understand these relationships. This work promises to improve our ability to understand both of these phenomena and to allow us to better treat the many patients with sleep disorders and with psychiatric disorders. PMID:23099143

  11. Sleep physiology and sleep disorders in childhood

    PubMed Central

    El Shakankiry, Hanan M

    2011-01-01

    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. PMID:23616721

  12. Sleep in the Intensive Care Unit: A Review.

    PubMed

    Pulak, Lisa M; Jensen, Louise

    2016-01-01

    Patients in the intensive care unit (ICU) are susceptible to sleep deprivation. Disrupted sleep is associated with increased morbidity and mortality in the critically ill patients. The etiology of sleep disruption is multifactorial. The article reviews the literature on sleep in the ICU, the effects of sleep deprivation, and strategies to promote sleep in the ICU. Until the impact of disrupted sleep is better explained, it is appropriate to provide critically ill patients with consolidated, restorative sleep. © The Author(s) 2014.

  13. Disrupted Nighttime Sleep in Narcolepsy

    PubMed Central

    Roth, Thomas; Dauvilliers, Yves; Mignot, Emmanuel; Montplaisir, Jacques; Paul, Josh; Swick, Todd; Zee, Phyllis

    2013-01-01

    Study Objectives: Characterize disrupted nighttime sleep (DNS) in narcolepsy, an important symptom of narcolepsy. Methods: A panel of international narcolepsy experts was convened in 2011 to build a consensus characterization of DNS in patients with narcolepsy. A literature search of the Medline (1965 to date), Medline In-Process (latest weeks), Embase (1974 to date), Embase Alert (latest 8 weeks), and Biosis (1965 to date) databases was conducted using the following search terms: narcolepsy and disrupted nighttime sleep, disturbed nighttime sleep, fragmented sleep, consolidated sleep, sleep disruption, and narcolepsy questionnaire. The purpose of the literature search was to identify publications characterizing the nighttime sleep of patients with narcolepsy. The panel reviewed the literature. Nocturnal sleep can also be disturbed by REM sleep abnormalities such as vivid dreaming and REM sleep behavior disorder; however, these were not reviewed in the current paper, as we were evaluating for idiopathic sleep disturbances. Results: The literature reviewed provide a consistent characterization of nighttime sleep in patients with narcolepsy as fragmented, with reports of frequent, brief nightly awakenings with difficulties returning to sleep and associated reports of poor sleep quality. Polysomnographic studies consistently report frequent awakenings/arousals after sleep onset, more stage 1 (S1) sleep, and more frequent shifts to S1 sleep or wake from deeper stages of sleep. The consensus of the International Experts' Panel on Narcolepsy was that DNS can be distressing for patients with narcolepsy and that treatment of DNS warrants consideration. Conclusions: Clinicians involved in the management of patients with narcolepsy should investigate patients' quality of nighttime sleep, give weight and consideration to patient reports of nighttime sleep experience, and consider DNS a target for treatment. Citation: Roth T; Dauvilliers Y; Mignot E; Montplaisir J; Paul J

  14. Adenotonsillectomy vs observation for management of mild obstructive sleep apnea in children.

    PubMed

    Volsky, Peter G; Woughter, Meghan A; Beydoun, Hind A; Derkay, Craig S; Baldassari, Cristina M

    2014-01-01

    To determine the impact of adenotonsillectomy vs observation on quality of life (QOL) in children with mild obstructive sleep apnea (OSA). Prospective, nonrandomized trial. Tertiary children's hospital. Sixty-four children (ages 3-16 years) with mild OSA (apnea hypopnea index between 1 and 5 on polysomnogram) completed the study. Caregivers chose between management options of adenotonsillectomy and observation and completed validated QOL instruments (OSA-18 and Children's Health Questionnaire) at baseline, early, and late follow-ups. The primary outcome measure was QOL. Thirty patients chose adenotonsillectomy, while 34 were observed. Total OSA-18 scores at baseline were significantly poorer (P = .01) in the surgery group (72.3) compared with the observation group (58.5). Four months following surgery, OSA-18 scores improved by 39.1 points over baseline (P = .0001), while there was no change for the observation group (P = .69). After 8 months, OSA-18 scores remained improved in the surgery group, and observation group scores improved by 13.4 points over baseline (P = .005). While OSA-18 scores at the late follow-up visit were poorer in the observation group, the difference was not statistically significant (P = .05). Six observation patients opted for adenotonsillectomy during the study. Quality of life significantly improves in children with mild OSA after adenotonsillectomy. In children with mild OSA who are observed, QOL improvements at early follow-up are less pronounced, but significant improvements in QOL are evident after 8 months. QOL instruments may be useful tools to help providers determine which children with mild OSA may benefit from early intervention.

  15. Key articles and guidelines in the management of acute coronary syndromes and in percutaneous coronary intervention: 2007 update.

    PubMed

    Dobesh, Paul P; Brouse, Sara D; Dager, William E; Spinler, Sarah A; Stacy, Zachary; Wiggins, Barbara S

    2007-12-01

    Clinical evidence in the management of acute coronary syndromes (ACS) and in percutaneous coronary intervention (PCI) continues to evolve at a rapid pace. For clinicians to provide optimal care for these patients, it is important to keep up with new information as it becomes available. With the existence of numerous pharmacologic agents, abundance of major clinical trials, and several nationally recognized clinical guidelines, compiling the needed reference material to make evidence-based decisions on the care of patients with ACS or those undergoing PCI can be difficult for clinicians. Therefore, we provide an update to the first compiled bibliography of key articles and guidelines relative to patients with ACS published in Pharmacotherapy in 2004. A number of guidelines and practice-changing literature have been published since the initial 2004 document. We hope that this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with coronary heart disease.

  16. Use of intranasal corticosteroids in the management of congestion and sleep disturbance in pediatric patients with allergic rhinitis.

    PubMed

    Lanier, Bob Q

    2008-06-01

    Allergic rhinitis affects a large number of children and exerts a considerable socioeconomic impact. It is underdiagnosed and inadequately treated, which predisposes children to potentially serious comorbidities. Allergic rhinitis symptoms may create nighttime breathing problems and sleep disturbances and have a negative effect on a child's ability to learn in the classroom. Although antihistamines have shown efficacy in relieving many symptoms, they have little effect on nasal congestion. This article summarizes the advantages of intranasal corticosteroids, including their effectiveness against congestion and excellent safety profile. Intranasal corticosteroids with minimal systemic bioavailability provide topical drug delivery that minimizes the potential for systemic side-effects.

  17. Sleep Disorders

    MedlinePlus

    ... 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 - ...

  18. Sleep Problems

    MedlinePlus

    ... For Consumers Consumer Information by Audience For Women Sleep Problems Share Tweet Linkedin Pin it More sharing ... PDF 474KB) En Español Medicines to Help You Sleep Tips for Better Sleep Basic Facts about Sleep ...

  19. Sleep disorders in Parkinson's disease.

    PubMed

    Schrempf, Wiebke; Brandt, Moritz D; Storch, Alexander; Reichmann, Heinz

    2014-01-01

    Sleep disorders in patients with Parkinson's disease (PD) are very common and have an immense negative impact on their quality of life. Insomnia, daytime sleepiness with sleep attacks, restless-legs syndrome (RLS) and REM-sleep behaviour disorder (RBD) are the most frequent sleep disorders in PD. Neurodegenerative processes within sleep regulatory brain circuitries, antiparkinsonian (e.g., levodopa and dopamine agonists) and concomitant medication (e.g., antidepressants) as well as comorbidities or other non-motor symptoms (such as depression) are discussed as causative factors. For the diagnosis of sleep disturbances we recommend regular screening using validated questionnaires such as the Pittsburgh Sleep Quality Index (PSQI) or the Medical Outcomes Study Sleep Scale (MOS), for evaluating daytime sleepiness we would suggest to use the Epworth Sleepiness Scale (ESS), the inappropriate sleep composite score (ISCS) or the Stanford sleepiness scale (SSS). All of these questionnaires should be used in combination with a detailed medical history focusing on common sleep disorders and medication. If necessary, patients should be referred to sleep specialists or sleep laboratories for further investigations. Management of sleep disorders in PD patients usually starts with optimization of (dopaminergic) antiparkinsonian therapy followed by specific treatment of the sleep disturbances. Aside from these clinical issues of sleep disorders in PD, the concept of REM-sleep behaviour disorder (RBD) as an early sign for emerging neurodegenerative diseases is of pivotal interest for future research on biomarkers and neuroprotective treatment strategies of neurodegenerative diseases, and particularly PD.

  20. Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure.

    PubMed Central

    Malone, M; Harris, A L; Luscombe, D K

    1994-01-01

    A general health status measure (the UK Sickness Impact Profile) was used to assess health-related quality of life in 212 cancer patients [143 women, mean (SD-standard deviation) age 55.3 (11.7) years] compared to 105 age-sex matched control subjects [71 women, mean (SD) age 54.7 (12.2) years]. The four main areas of impairment in the cancer patient group were work, recreation and pastimes, home management and sleep and rest. The majority of patients were unable to work or working shorter hours due to their disease. A diagnosis of cancer was likewise found to have a major impact on active leisure pursuits and led to reduced participation in social and community activities. Patients had particular problems in carrying out household chores and maintenance or repair work in the house. Many patients had difficulty sleeping at night and tended to sleep during the day or rest for much of the day. The majority of studies of quality of life in oncology patients concentrate upon alterations in symptoms, such measures would fail to detect impairment in the aspects described above. Greater attention should be directed towards addressing issues such as changes in employment status and the need for help in the home to improve the overall care of cancer patients. PMID:8046723

  1. Review article: the role of anticonvulsant drugs in postoperative pain management: a bench-to-bedside perspective.

    PubMed

    Gilron, Ian

    2006-06-01

    Anticonvulsant drugs are effective in the treatment of chronic neuropathic pain but were not, until recently, thought to be useful in more acute conditions such as postoperative pain. However, similar to nerve injury, surgical tissue injury is known to produce neuroplastic changes leading to spinal sensitization and the expression of stimulus-evoked hyperalgesia and allodynia. Pharmacological effects of anticonvulsant drugs which may be important in the modulation of these postoperative neural changes include suppression of sodium channel, calcium channel and glutamate receptor activity at peripheral, spinal and supraspinal sites. The purpose of this article is to review preclinical evidence and clinical trial data describing the efficacy and safety of anticonvulsant drugs in the setting of postoperative pain management. A Medline search was performed to retrieve available literature on the basic and clinical pharmacology of anticonvulsant drugs as they pertain to postoperative pain management. Numerous laboratory studies have described analgesic effects of different anticonvulsant drugs in experimental pain models. Furthermore, several recent clinical trials have shown that anticonvulsants may reduce spontaneous and movement-evoked pain, as well as decrease opioid requirements postoperatively. Some early findings suggest further that anticonvulsant drugs may alleviate postoperative anxiety, accelerate postoperative functional recovery and reduce chronic postsurgical pain. Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia. Further research in this field is warranted.

  2. Key articles and guidelines in the management of acute coronary syndrome and in percutaneous coronary intervention: 2012 update.

    PubMed

    Dobesh, Paul P; Beavers, Craig J; Herring, Holly R; Spinler, Sarah A; Stacy, Zachary A; Trujillo, Toby C

    2012-12-01

    More than 1 million people in the United States experience an acute coronary syndrome (ACS) every year, and almost 600,000 undergo percutaneous coronary intervention (PCI) for treatment of cardiovascular disease. There is a large amount of evidence-based literature to guide appropriate management of these patients. There have been a number of advances in the treatment of these patients over the last several years. Due to the large amount of rapidly available literature concerning the care of patients with ACS or undergoing PCI, clinicians can often find it difficult to keep up with the information needed for optimizing care of these patients. Therefore, we provide the second update to the first compiled bibliography of key articles and guidelines relative to patients with ACS published in Pharmacotherapy in 2004. The initial update was published in Pharmacotherapy in 2007 and also included bibliographies concerning management of patients undergoing PCI. A number of guidelines and practice-changing literature have been published since the update in 2007. Specific areas included in this review are updated summaries of clinical practice guidelines and clinical trials of anticoagulants, antiplatelets, platelet aggregation testing, pharmacogenomics testing in patients taking clopidogrel, clopidogrel loading dose comparisons, clopidogrel and proton pump inhibitor drug interactions, the impact of bleeding in ACS, and statins. As with previous versions of this document, we hope that this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with coronary heart disease. © 2012 Pharmacotherapy Publications, Inc.

  3. Sleep disorders in psychiatry.

    PubMed

    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

  4. REM sleep behaviour disorder in older individuals: epidemiology, pathophysiology and management.

    PubMed

    Trotti, Lynn Marie

    2010-06-01

    Rapid eye movement (REM) sleep behaviour disorder (RBD) is a sleep disorder in which patients appear to be enacting their dreams while in REM sleep. The behaviours are typically violent, in association with violent dream content, so serious harm can be done to the patient or the bed partner. The disorder predominantly affects older adults, and has an estimated prevalence in adults of 0.4-0.5%. However, the frequency is much higher in certain neurodegenerative diseases, especially Parkinson's disease, dementia with Lewy bodies and multiple systems atrophy. RBD can occur in the absence of diagnosed neurological diseases (the 'idiopathic' form), although patients with this form of RBD may have subtle neurological abnormalities and often ultimately develop a neurodegenerative disorder. Data from animal models and cases of RBD developing after brainstem (pontine tegmentum, medulla) lesions have led to the understanding that RBD is caused by a lack of normal REM muscle atonia and a lack of normal suppression of locomotor generators during REM sleep. Clonazepam is used as first-line therapy for RBD and melatonin as second-line therapy, although evidence for both of these interventions comes from uncontrolled case series. Because the risk of injury to the patient or the bed partner is high, interventions to improve the safety of the sleep environment are also often necessary. This review describes the epidemiology, pathophysiology and treatment of RBD.

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

    PubMed Central

    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

  6. The end of sleep: 'sleep debt' versus biological adaptation of human sleep to waking needs.

    PubMed

    Horne, Jim

    2011-04-01

    It is argued that the latter part of usual human sleep is phenotypically adaptable (without 'sleep debt') to habitual shortening or lengthening, according to environmental influences of light, safety, food availability and socio-economic factors, but without increasing daytime sleepiness. Pluripotent brain mechanisms linking sleep, hunger, foraging, locomotion and alertness, facilitate this time management, with REM acting as a 'buffer' between wakefulness and nonREM ('true') sleep. The adaptive sleep range is approximately 6-9h, although, a timely short (<20 min) nap can equate to 1h 'extra' nighttime sleep. Appraisal of recent epidemiological findings linking habitual sleep duration to mortality and morbidity points to nominal causal effects of sleep within this range. Statistical significance, here, may not equate to real clinical significance. Sleep durations outside 6-9h are usually surrogates of common underlying causes, with sleep associations taking years to develop. Manipulation of sleep, alone, is unlikely to overcome these health effects, and there are effective, rapid, non-sleep, behavioural countermeasures. Sleep can be taken for pleasure, with minimal sleepiness; such 'sleepability' is 'unmasked' by sleep-conducive situations. Sleep is not the only anodyne to sleepiness, but so is wakefulness, inasmuch that some sleepiness disappears when wakefulness becomes more challenging and eventful. A more ecological approach to sleep and sleepiness is advocated.

  7. Sleep Disorders, Epilepsy, and Autism

    ERIC Educational Resources Information Center

    Malow, Beth A.

    2004-01-01

    The purpose of this review article is to describe the clinical data linking autism with sleep and epilepsy and to discuss the impact of treating sleep disorders in children with autism either with or without coexisting epileptic seizures. Studies are presented to support the view that sleep is abnormal in individuals with autistic spectrum…

  8. Sleep Disorders, Epilepsy, and Autism

    ERIC Educational Resources Information Center

    Malow, Beth A.

    2004-01-01

    The purpose of this review article is to describe the clinical data linking autism with sleep and epilepsy and to discuss the impact of treating sleep disorders in children with autism either with or without coexisting epileptic seizures. Studies are presented to support the view that sleep is abnormal in individuals with autistic spectrum…

  9. Obstructive sleep apnoea in adults: a common chronic condition in need of a comprehensive chronic condition management approach.

    PubMed

    Heatley, Emer M; Harris, Melanie; Battersby, Malcolm; McEvoy, R Doug; Chai-Coetzer, Ching Li; Antic, Nicholas A

    2013-10-01

    Obstructive sleep apnoea (OSA) is a common disorder that has all the characteristics of a chronic condition. As with other chronic conditions, OSA requires ongoing management of treatments and problems, such as residual symptoms, deficits and co-morbidities. Also, many OSA patients have modifiable lifestyle factors that contribute to their disease, which could be improved with intervention. As health systems are in the process of developing more comprehensive chronic care structures and supports, tools such as chronic condition management programs are available to enable OSA patients and their health care providers to further engage and collaborate in health management. This review explains why the OSA patient group requires a more comprehensive approach to disease management, describes the chronic care model as a platform for management of chronic conditions, and assesses the suitability of particular chronic disease management programs in relation to the needs of the OSA population. Implementation of an evidence-based health-professional-led chronic condition management program into OSA patient care is likely to provide a context in which health risks are properly acknowledged and addressed. Such programs present an important opportunity to enable more optimal health outcomes than is possible by device-focused management alone. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Empirical research evaluating non-traditional approaches to managing sleep problems in children with autism.

    PubMed

    McLay, Laura-Lee Kathleen; France, Karyn

    2016-01-01

    This paper examines the efficacy of non-behavioural and non-pharmacological approaches to the treatment of sleep disturbance in individuals with autism spectrum disorder. A systematic search of electronic databases and reference lists identified eight studies that met inclusion criteria. Studies were evaluated according to (a) treatment used, (b) participants, (c) experimental design, (d) baseline measures, (e) dependent variables, (f) follow-up measures, (g) reliability and treatment integrity, (h) results and certainty of evidence and (i) implications for treatment. Positive outcomes were reported for the use of massage therapy and vitamin supplements. Aromatherapy was reported to have no effect on sleep. No studies were found that examined other non-traditional treatment approaches, nor did any of the studies provide conclusive evidence. The limited corpus of evidence and the methodological limitations suggests that the efficacy of non-traditional approaches to treatment of sleep problems in individuals with autism is yet to be demonstrated.

  11. Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial.

    PubMed

    Nakamura, Yoshio; Lipschitz, David L; Kuhn, Renee; Kinney, Anita Y; Donaldson, Gary W

    2013-06-01

    reducing sleep disturbance and one of them further improved other psychosocial aspects of the cancer survivors' life. Management of sleep problems in survivors is a high priority issue that demands more attention in cancer survivorship.

  12. Medical management with diazepam for electrical status epilepticus during slow wave sleep in children.

    PubMed

    Francois, Densley; Roberts, Jessica; Hess, Stephany; Probst, Luke; Eksioglu, Yaman

    2014-03-01

    Oral diazepam, administered in varying doses, is among the few proposed treatment options for electrical status epilepticus during slow wave sleep in children. We sought to retrospectively evaluate the long-term efficacy of high-dose oral diazepam in reducing electrographic and clinical evidence of electrical status epilepticus during slow wave sleep in children. Additionally, we surveyed caregivers to assess safety and behavioral outcomes related to ongoing therapy. We collected demographic and clinical data on children treated for electrical status epilepticus during slow wave sleep between October 2010 and March 2013. We sought to identify the number of patients who achieved at least a 50% reduction in spike wave index on electroencephalograph after receiving high-dose oral diazepam. We also administered a questionnaire to caregivers to assess for behavioral problems and side effects. We identified 42 evaluable patients who received high-dose diazepam (range 0.23-2.02 mg/kg per day) to treat electrical status epilepticus during slow wave sleep. Twenty-six patients had spike reduction data and 18/26 (69.2%) children achieved a greater than 50% reduction in spike wave count from an average of 15.54 to 5.05 (P = 0.001). We received 28 responses to the questionnaire. Some patients experienced new onset of difficulties with problem-solving and speech and writing development. Sleep disturbances (50%) and irritability (57.1%) were the most frequent side effects reported. There did not appear to be a dose-related effect with electroencephalograph changes, behavioral effects, or side effects. High-dose oral diazepam significantly reduces the spike wave count on electroencephalograph in children with electrical status epilepticus during slow wave sleep. Although this therapy improves electroencephalograph-related findings, it can be associated with concerning neurological and behavioral side effects in some individuals, so further study is warranted. Copyright © 2014

  13. The epileptic syndromes with continuous spikes and waves during slow sleep: definition and management guidelines.

    PubMed

    Van Bogaert, P; Aeby, A; De Borchgrave, V; De Cocq, C; Deprez, M; De Tiège, X; de Tourtchaninoff, M; Dubru, J M; Foulon, M; Ghariani, S; Grisar, T; Legros, B; Ossemann, M; Tugendhaft, P; van Rijckevorsel, K; Verheulpen, D

    2006-06-01

    The authors propose to define the epileptic syndromes with continuous spikes and waves during slow sleep (CSWS) as a cognitive or behavioral impairment acquired during childhood, associated with a strong activation of the interictal epileptiform discharges during NREM sleep--whatever focal or generalized--and not related to another factor than the presence of CSWS. The type of syndrome will be defined according to the neurological and neuropsychological deficit. These syndromes have to be classified among the localization-related epileptic syndromes. Some cases are idiopathic and others are symptomatic. Guidelines for work-up and treatment are proposed.

  14. Sleep in athletes and the effects of Ramadan.

    PubMed

    Roky, Rachida; Herrera, Christopher Paul; Ahmed, Qanta

    2012-01-01

    Sleep is now considered as a new frontier in performance enhancement. This article presents background content on sleep function, sleep needs and methods of sleep investigation along with data on the potential effects of Ramadan fasting on sleep in normal individuals and athletes. Accumulated sleep loss has negative impacts on cognitive function, mood, daytime sleepiness and performance. Sleep studies in athletes fasting during Ramadan are very rare. Most of them have demonstrated that during this month, sleep duration decreased and sleep timing shifted. But the direct relation between sleep changes and performance during Ramadan is not yet elucidated. Objective sleep patterns can be investigated using polysomnography, actigraphy, and standardised questionnaires and recorded in daily journals or sleep logs. The available data on sleep indicate that team doctors and coaches should consider planning sleep schedule and napping; implementing educational programmes focusing on the need for healthy sleep; and consider routine screening for sleep loss in athletes of all age groups and genders.

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

    PubMed

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

    2017-09-04

    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.

  16. Sleep and sleep disorders in menopausal women.

    PubMed

    Guidozzi, F

    2013-04-01

    Sleep disorders in the menopause are common. Although these disorders may be due to the menopause itself and/or the associated vasomotor symptoms, the etiology is multifactorial and includes a number of other associated conditions. They may simply arise as part of the aging process and not be specifically related to the decrease in estrogen levels or, alternatively, because of breathing or limb movement syndromes, depression, anxiety, co-morbid medical diseases, medication, pain and/or psychosocial factors. The most commonly encountered sleep disorders in menopausal women include insomnia, nocturnal breathing disturbances and the associated sleep disorders that accompany the restless leg syndrome, periodic leg movement syndrome, depression and anxiety. This review article addresses sleep and the sleep disorders associated with menopause and briefly the role that hormone therapy may play in alleviating these disorders.

  17. Headache and sleep in children.

    PubMed

    Bellini, Benedetta; Panunzi, Sara; Bruni, Oliviero; Guidetti, Vincenzo

    2013-06-01

    Several scientific studies report a close relationship between sleep and headache: sleep changes may reflect the onset and increase of both duration and frequency of headache attacks. Variations in sleep architecture, together with a poor sleep hygiene in children, may indeed be responsible for the onset of headache and its development into a chronic disease. For a correct clinical management of children with headache, it is therefore fundamental to investigate their sleep habits, architecture and potential disturbances, in order to develop adequate therapeutic plans for both sleep and headache.

  18. Wake-Sleep Cycle Management during SUSOPS and CONOPS in French Military Forces: Policy and Ethics

    DTIC Science & Technology

    2009-10-01

    therapeutics against the excessive daytime sleepiness encountered in narcolepsia, idiopathic hypersomnia , and sometimes in treated obstructive sleep...Policy and Ethics RTO-MP-HFM-181 29 - 9 Nevertheless, a few patients suffering of hypersomnia and treated with modafinil sometimes complain of

  19. Management of sleep apnea: a critical look at intra-oral appliances.

    PubMed

    Conley, R S

    2015-04-01

    With so many disciplines of both medicine and dentistry involved in the treatment of obstructive sleep apnea (OSA), several forms of therapy are available. The orthodontist is rarely considered when the diagnosis of chronic obstructive sleep apnea (OSA) is delivered. However, the scope of orthodontic care today is much broader than the mere alignment of teeth. While the current gold standard for OSA care remains continuous positive air pressure (CPAP), the patient may be given a prescription for an intra-oral sleep appliance. When orthodontists work in concert with their medical colleagues to provide a sleep appliance, several considerations must be made including the evidence regarding oral appliance efficacy. For some patients, oral appliances are highly successful; however, even for responsive patients, there are risks associated with oral appliance therapy. The aim of the paper was to present a critical review of the current level of evidence for the use of oral appliances in the treatment of OSA. A substantial number of publications ranging from case reports, uncontrolled and controlled case series, prospective randomized studies, and even a small number of systematic reviews were available. The existing systematic reviews were based on either a limited number of prospective studies with limited numbers of patients or in some cases were based on subjective data only. As a result, a narrative review of the literature was performed that discusses objective clinically testable criteria and recent developments that may aid future research investigations. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Manipulating the sleep-wake cycle and circadian rhythms to improve clinical management of major depression

    PubMed Central

    2013-01-01

    Background Clinical psychiatry has always been limited by the lack of objective tests to substantiate diagnoses and a lack of specific treatments that target underlying pathophysiology. One area in which these twin failures has been most frustrating is major depression. Due to very considerable progress in the basic and clinical neurosciences of sleep-wake cycles and underlying circadian systems this situation is now rapidly changing. Discussion The development of specific behavioral or pharmacological strategies that target these basic regulatory systems is driving renewed clinical interest. Here, we explore the extent to which objective tests of sleep-wake cycles and circadian function - namely, those that measure timing or synchrony of circadian-dependent physiology as well as daytime activity and nighttime sleep patterns - can be used to identify a sub-class of patients with major depression who have disturbed circadian profiles. Summary Once this unique pathophysiology is characterized, a highly personalized treatment plan can be proposed and monitored. New treatments will now be designed and old treatments re-evaluated on the basis of their effects on objective measures of sleep-wake cycles, circadian rhythms and related metabolic systems. PMID:23521808

  1. REM Sleep Behaviour Disorder in Older Individuals: Epidemiology, Pathophysiology, and Management

    PubMed Central

    Trotti, Lynn Marie

    2010-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disorder that predominantly affects older adults, in which patients appear to be enacting their dreams while in REM sleep. The behaviors are typically violent, in association with violent dream content, so serious harm can be done to the patient or the bed-partner. The estimated prevalence in adults is 0.4–0.5%, but the frequency is much higher in certain neurodegenerative diseases, especially Parkinson's disease, Dementia with Lewy bodies, and multiple systems atrophy. RBD can occur in the absence of diagnosed neurologic diseases (the “idiopathic” form), although patients with this form of RBD may have subtle neurologic abnormalities and often ultimately develop a neurodegenerative disorder. Animal models and cases of RBD developing after brainstem lesions (pontine tegmentum, medulla) have led to the understanding that RBD is caused by a lack of normal REM muscle atonia and a lack of normal suppression of locomotor generators during REM. Clonazepam is used as first-line therapy for RBD and melatonin for second-line therapy, although evidence for both of these interventions comes from uncontrolled case series. Because the risk of injury to the patient or the bed-partner is high, interventions to improve the safety of the sleep environment are also often necessary. This review describes the epidemiology, pathophysiology, and treatment of RBD. PMID:20524706

  2. Sleep: The E-ZZZ Intervention

    ERIC Educational Resources Information Center

    Bergin, Christi A.; Bergin, David A.

    2009-01-01

    Research has shown that students who do not get enough sleep are more likely to misbehave in school and have lower academic achievement than their peers with healthy sleeping habits. In this article, Christi A. Bergin and David A. Bergin share research into students' sleep habits and conclude that helping students get adequate sleep has potential…

  3. Sleep: The E-ZZZ Intervention

    ERIC Educational Resources Information Center

    Bergin, Christi A.; Bergin, David A.

    2009-01-01

    Research has shown that students who do not get enough sleep are more likely to misbehave in school and have lower academic achievement than their peers with healthy sleeping habits. In this article, Christi A. Bergin and David A. Bergin share research into students' sleep habits and conclude that helping students get adequate sleep has potential…

  4. Type 1 Diabetes and Sleep.

    PubMed

    Farabi, Sarah S

    2016-02-01

    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.

  5. ENN-ICS--implementation and evaluation of a multilingual learning management system for sleep medicine in Europe.

    PubMed

    Knobl, Brigitte; Paiva, Teresa; Jungmann, Dieter; Böhme, Rico; Penzel, Thomas

    2006-01-01

    A new web based network aims at the improvement of health care in Europe by integrating advanced e-learning and e-publishing technologies for the training of medical doctors, nurses, and students. The field of application is sleep physiology and sleep medicine. Based on a multilingual, multimedia communication system, ENN-ICS Centre offers direct access to medical information for users, i.e healthcare professionals and citizens, in Europe and worldwide. The use of XML supports the development of media independent contents for multiple target groups. 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 online questionnaires based on the DISCERN questionnaire for evaluating patient information, the HON principles for health-related websites and 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.

  6. Sleep Physiology, Abnormal States, and Therapeutic Interventions

    PubMed Central

    Wickboldt, Alvah T.; Bowen, Alex F.; Kaye, Aaron J.; Kaye, Adam M.; Rivera Bueno, Franklin; Kaye, Alan D.

    2012-01-01

    Sleep is essential. Unfortunately, a significant portion of the population experiences altered sleep states that often result in a multitude of health-related issues. The regulation of sleep and sleep-wake cycles is an area of intense research, and many options for treatment are available. The following review summarizes the current understanding of normal and abnormal sleep-related conditions and the available treatment options. All clinicians managing patients must recommend appropriate therapeutic interventions for abnormal sleep states. Clinicians' solid understanding of sleep physiology, abnormal sleep states, and treatments will greatly benefit patients regardless of their disease process. PMID:22778676

  7. Headache, drugs and sleep.

    PubMed

    Nesbitt, Alexander D; Leschziner, Guy D; Peatfield, Richard C

    2014-09-01

    Headache and sleep mechanisms share multiple levels of physiological interaction. Pharmacological treatment of headache syndromes may be associated with a broad range of sleep disturbances, either as a direct result of the pharmacology of the drug used, or by unmasking physiological alterations in sleep propensity seen as part of the headache symptom complex. This review summarises known sleep and circadian effects of various drugs commonly used in the management of headache disorders, with particular attention paid to abnormal sleep function emerging as a result of treatment. Literature searches were performed using MEDLINE, PubMed, and the Cochrane database using search terms and strings relating to generic drug names of commonly used compounds in the treatment of headache and their effect on sleep in humans with review of additional pre-clinical evidence where theoretically appropriate. Medications used to treat headache disorders may have a considerable impact on sleep physiology. However, greater attention is needed to characterise the direction of the changes of these effects on sleep, particularly to avoid exacerbating detrimental sleep complaints, but also to potentially capitalise on homeostatically useful properties of sleep which may reduce the individual burden of headache disorders on patients. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Recognising sleep apnoea.

    PubMed

    How, C H; Hsu, P P; Tan, K L

    2015-03-01

    Most people spend a third of their lives sleeping, and thus, sleep has a major impact on all of us. As sleep is a function and not a structure, it is challenging to treat and prevent its complications. Sleep apnoea is one such complication, with serious and potentially life-threatening consequences. Local studies estimate that about 15% of Singapore's population is afflicted with sleep apnoea. The resulting sleep fragmentation may result in poor quality of sleep, leading to daytime sleepiness. Sleep apnoea may also be the underlying cause of high blood pressure, memory loss, poor concentration and work performance, motor vehicle accidents, and marital problems. Evaluation involves a sleep study, followed by patient education, and an individualised step-wise management approach should be explored. Many patients will require follow-up for a long period of time, as management options may not offer a permanent cure; other contributory causes may arise at different phases of their lives, compounded by genetic and hormonal issues, ethnicity and the modern hazards of a fast-paced society.

  9. [Sleep talking].

    PubMed

    Challamel, M J

    2001-11-01

    Sleep talking is very common in the general population. Its prevalence remains stable from childhood through adulthood. Sleep talking is often associated with other parasomnias: sleep walking, sleep terrors or REM sleep behavior disorders. It may arise from either REM or non REM sleep, when associated with REM sleep it is more comprehensible and often associated with clear sentences and recall of sleep mentation. Sleep talking is a benign entity and does not require any treatment; however an exceptional organic cause or psychopathology should be suspected if the onset is late (after 25 years); if the mental content is too violent or too emotional.

  10. Sleep Regulation, Physiology and Development, Sleep Duration and Patterns, and Sleep Hygiene in Infants, Toddlers, and Preschool-Age Children.

    PubMed

    Bathory, Eleanor; Tomopoulos, Suzy

    2017-02-01

    Sleep problems are common, reported by a quarter of parents with children under the age of 5 years, and have been associated with poor behavior, worse school performance, and obesity, in addition to negative secondary effects on maternal and family well-being. Yet, it has been shown that pediatricians do not adequately address sleep in routine well-child visits, and underdiagnose sleep issues. Pediatricians receive little formal training in medical school or in residency regarding sleep medicine. An understanding of the physiology of sleep is critical to a pediatrician׳s ability to effectively and confidently counsel patients about sleep. The biological rhythm of sleep and waking is regulated through both circadian and homeostatic processes. Sleep also has an internal rhythmic organization, or sleep architecture, which includes sleep cycles of REM and NREM sleep. Arousal and sleep (REM and NREM) are active and complex neurophysiologic processes, involving both neural pathway activation and suppression. These physiologic processes change over the life course, especially in the first 5 years. Adequate sleep is often difficult to achieve, yet is considered very important to optimal daily function and behavior in children; thus, understanding optimal sleep duration and patterns is critical for pediatricians. There is little experimental evidence that guides sleep recommendations, rather normative data and expert recommendations. Effective counseling on child sleep must account for the child and parent factors (child temperament, parent-child interaction, and parental affect) and the environmental factors (cultural, geographic, and home environment, especially media exposure) that influence sleep. To promote health and to prevent and manage sleep problems, the American Academy of Pediatrics (AAP) recommends that parents start promoting good sleep hygiene, with a sleep-promoting environment and a bedtime routine in infancy, and throughout childhood. Thus, counseling

  11. Orthognathic surgery in the management of obstructive sleep apnoea: experience from maxillofacial surgery unit in the United Kingdom.

    PubMed

    Islam, Shofiq; Uwadiae, Nosa; Ormiston, Ian W

    2014-07-01

    In the United Kingdom, maxillofacial techniques are underused in the treatment of obstructive sleep apnoea (OSA). We retrospectively analysed the details and relevant clinical data of consecutive patients who had operations for OSA at the maxillofacial unit in Leicester between 2002 and 2012. They had been referred from the local sleep clinic after investigation and diagnosis, and in all cases treatment with continuous positive airway pressure (CPAP) had failed. We compared preoperative and postoperative apnoea/hypopnoea indices (AHI), scores for the Epworth sleepiness scale (ESS), and lowest oxygen saturation to measure surgical success (AHI of less than 15 and a 50% reduction in the number of apnoeas or hypopnoea/hour) and surgical cure (AHI of less than 5). We identified 51 patients (mean age 44 years, range 21-60) with a mean (SD) body mass index (BMI) of 29 (3.4). Most patients had bimaxillary advancement with genioplasty (n=42). Differences in mean (SD) preoperative and postoperative values were significant for all 3 outcome measures (AHI: 42 (17) to 8 (7) p<0.001; ESS: 14 (4) to 5 (4) p<0.001; lowest oxygen saturation: 76% (11%) to 83% (7%); p=0.006). On the postoperative sleep study 85% of patients met the criteria for surgical success. Our experience has confirmed that bimaxillary advancement results in a high rate of success in patients with OSA. The operation has a role in the management of selected patients in the UK who do not adhere to CPAP. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Distraction osteogenesis for management of obstructive sleep apnoea in temporomandibular joint ankylosis patients before the release of joint.

    PubMed

    Yadav, Rahul; Bhutia, Ongkila; Shukla, Garima; Roychoudhury, Ajoy

    2014-07-01

    To evaluate the effects of distraction osteogenesis in management of obstructive sleep apnoea patients secondary to temporomandibular joints ankylosis. Fifteen patients were included in study. Preoperatively the patients were worked up for polysomnography and CT scans. Only those patients with Apnoea-hypopnoea index >15 events/h denoting moderate to severe obstructive sleep apnoea were included in the study. Distraction osteogenesis was followed with 5 days latency period in adult patients and 0 days for children. Rate of distraction was 1 mm/day for adults and 2 mm/day for children till the mandibular incisors were in reverse overjet. After 3 months post distraction assessment was done using polysomnography and CT scan. TMJ ankylosis was released by doing gap arthroplasty after distraction osteogenesis. Post distraction improvement was seen in clinical features of OSA like daytime sleepiness and snoring. Epworth sleepiness scale improved from a mean of 10.25 to 2.25. Polysomnographic analysis also showed improvement in all cases with apnoea-hypopnoea index from 57.03 to 6.67 per hour. Lowest oxygen saturation improved from 64.47% to 81.20% and average minimum oxygen saturation improved from 92.17% to 98.19%. Body mass index improved from a mean of 18.26 to 21.39 kg/m2. Distraction osteogenesis is a stable and beneficial treatment option for temporomandibular joint ankylosis patients with obstructive sleep apnoea. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. Diagnosis, disease notification, and management of rapid eye movement (REM) sleep behavior disorder.

    PubMed

    Shimohata, Takayoshi; Inoue, Yuichi; Hirata, Koichi

    2017-02-25

    Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment behavior during REM sleep. It has been demonstrated that patients with idiopathic RBD are at a significantly increased risk of developing one of the α-synucleinopathies later in life, and this is called "phenoconversion". Although some physicians argue against disclosing information that could cause patients psychological stress, the patients also have a "right to know" about their own disease. Therefore, determining when and how to disclose this information, in addition to appropriate follow-up, is important. Clonazepam is the first choice of treatment for RBD associated with α-synucleinopathies. Since RBD is one of the premotor symptoms of α-synucleinopathies, and enables its early diagnosis, a combination of RBD and other examinations may contribute to the realization of a disease-modifying therapy. It is hoped that the early establishment of biomarkers could help predict the phenoconversion from RBD to α-synucleinopathies.

  14. Sleep and Alertness Management During Military Operations: Questions To Be Answered

    DTIC Science & Technology

    2000-03-01

    to 6 chronobiotic effects are more important than its hours after the last dose of 10 or 20 mg zaleplon. These hypnotic properties. There is sufficient...1998; 1999. p. 441446 7(S2):191. 16. Dinges DF. Adult napping and its effects on ability to 32. Lavie P. Melatonin : role in gating nocturnal rise in... effectiveness and safety. issues: Therefore, when recommending the cockpit nap, it was emphasized that those pilots, for whom such a nap will Short sleep

  15. Sleep disorders in pregnancy.

    PubMed

    Sahota, Pradeep K; Jain, Sanjay S; Dhand, Rajiv

    2003-11-01

    if lower thresholds for management of OSA should be used in pregnant women to prevent harm to the fetus. In conclusion, sleep disturbances are common during pregnancy though the full extent of this relation remains undefined. Large, multi-center, prospective studies are needed for better understanding.

  16. Cognitive-behavioral therapy for sleep abnormalities of chronic pain patients.

    PubMed

    Tang, Nicole K Y

    2009-12-01

    Chronic pain and insomnia often occur simultaneously, with the vast majority of chronic pain patients complaining of interrupted or poor quality sleep. The need to improve sleep in these patients is clear, given increasing evidence that sleep disturbance is associated with heightened pain sensitivity and elevated disability. This article evaluates the efficacy of pain management programs (PMPs) based on cognitive-behavioral therapy (CBT) principles and CBT for primary insomnia (CBT-I) in treating pain-related insomnia. Although PMPs effectively enhance pain management skills in patients, they do not adequately address insomnia. CBT-I has demonstrated strong efficacy in treating pain-related insomnia, but sleep improvement is not followed by pain reduction. As both CBT approaches involve strengths and limitations, a hybrid form of treatment is needed that simultaneously addresses pain and sleep.

  17. Sleep Disturbances

    MedlinePlus

    ... PD / Coping with Symptoms & Side Effects / Sleep Disturbances Sleep Disturbances Many people with Parkinson’s disease (PD) have ... stay awake during the day. Tips for Better Sleep People with PD — and their care partners too — ...

  18. [Sleep and movement disorders].

    PubMed

    Poryazova, R; Bassetti, C L

    2007-01-01

    The three different states of being (wakefulness, NREM and REM sleep) are associated with profound neurophysiological and neurochemical changes in the brain. These changes explain the existence of movement disorders appearing only or preferentially during sleep, and the effects of sleep on movement disorders. Sleep-related movement disorders are of clinical relevance for multiple reasons: 1) high frequency (e.g. restless legs syndrome (RLS)); 2) diagnostic relevance (e.g. REM sleep behavior disorder (RBD) as first manifestation of Parkinson disorder); 3) diagnostic uncertainty (e.g. parasomnias vs nocturnal epilepsy); 4) association with injuries (e.g. RBD, sleepwalking), sleep disruption/daytime sleepiness (e.g. RLS), and psycho-social burden (e.g. enuresis); 5) requirement of specific treatments (e.g. nocturnal epilepsy, stridor, RBD). This article gives an overview on clinical manifestations, pathophysiology, work-up and treatment of sleep-related movement disorders (e.g. RLS, bruxism), parasomnias (e.g. sleepwalking, RBD), sleep-related epilepsies, and on sleep-associated manifestations of movement disorders (e.g. Parkinson disease, multiple system atrophy).

  19. Experiences of Sleep and Benzodiazepine Use among Older Women

    PubMed Central

    Rubinstein, Robert L.

    2015-01-01

    Sleep disturbances are common among older women; however, little is known about sleep experiences among chronic benzodiazepine users. The experience of sleep, sleep troubles, and management of sleep problems were explored through semi-structured interviews with 12 women aged 65 to 92 who had used a benzodiazepine for three months or longer to treat a sleep disturbance. Themes that emerged from an interpretive phenomenological analysis included multiple reasons for sleep disruptions (health problems, mental disturbances, and sleeping arrangements); opposing effects of benzodiazepines on sleep (helps or does not work); and several supplemental sleep strategies (modification of the environment, distraction, and consumption). PMID:25581296

  20. Three Articles

    ERIC Educational Resources Information Center

    Renwick, E. M.

    1976-01-01

    These three brief articles concern problems students encounter in solving simple linear equations, children's conceptions of number, and the distinction between adding objects and adding numbers as illustrated by students' problems with Euler's formula. (SD)

  1. Neuromuscular Disorders and Sleep in Critically Ill Patients

    PubMed Central

    Irfan, Muna; Selim, Bernardo; Rabinstein, Alejandro A.

    2016-01-01

    Synopsis Sleep-disordered breathing (SDB) is a frequent presenting manifestation of neuromuscular disorders and can lead to significant morbidity and mortality. If not promptly recognized and addressed early in the clinical course, SDB can lead to clinical deterioration with respiratory failure. In this article, we review the pathophysiologic basis of SDB in neuromuscular disorders, clinical features encountered in specific neuromuscular diseases, and diagnostic and management strategies for SDB in neuromuscular patients in the critical care setting. Non-invasive positive pressure ventilation (NIPV) has been a crucial advance in critical care management, improving sleep quality and often preventing or delaying mechanical ventilation and improving survival in neuromuscular patients. PMID:26118919

  2. Nonepileptic paroxysmal sleep disorders.

    PubMed

    Frenette, Eric; Guilleminault, Christian

    2013-01-01

    Events occurring during nighttime sleep in children can be easily mislabeled, as witnesses are usually not immediately available. Even when observers are present, description of the events can be sketchy, as these individuals are frequently aroused from their own sleep. Errors of perception are thus common and can lead to diagnosis of epilepsy where other sleep-related conditions are present, sometimes initiating unnecessary therapeutic interventions, especially with antiepileptic drugs. Often not acknowledged, paroxysmal nonepileptic behavioral and motor episodes in sleep are encountered much more frequently than their epileptic counterpart. The International Classification of Sleep Disorders (ICSD) 2nd edition displays an extensive list of such conditions that can be readily mistaken for epilepsy. The most prevalent ones are reviewed, such as nonrapid eye movement (NREM) sleep parasomnias, comprised of sleepwalking, confusional arousals and sleep terrors, periodic leg movements of sleep, repetitive movement disorders, benign neonatal myoclonus, and sleep starts. Apnea of prematurity is also briefly reviewed. Specific issues regarding management of these selected disorders, both for diagnostic consideration and for therapeutic intervention, are addressed.

  3. Sleep disorders - overview

    MedlinePlus

    ... Hypersomina; Daytime sleepiness; Sleep rhythm; Sleep disruptive behaviors; Jet lag ... disrupted sleep schedule include: Irregular sleep-wake syndrome Jet lag syndrome Paradoxical insomnia (the person sleeps a ...

  4. Sleep, Clocks and Synaptic Plasticity

    PubMed Central

    2014-01-01

    Sleep is widely believed to play an essential role in synaptic plasticity. However, the precise mechanisms governing this presumptive function are largely unknown. There is also evidence for independent circadian oscillations in synaptic strength and morphology. Therefore, synaptic changes observed after sleep reflect interactions between state-dependent (e.g. wake vs. sleep) and state-independent (circadian) processes. In this article we review how sleep and biological clocks influence synaptic plasticity. We discuss these findings in the context of current plasticity-based theories of sleep function and propose a new model that integrates circadian and brain state influences on synaptic plasticity. PMID:25087980

  5. Sleep quality subtypes and obesity.

    PubMed

    Magee, Christopher A; Reddy, Prasuna; Robinson, Laura; McGregor, Alisha

    2016-12-01

    Poor sleep quality could be a risk factor for obesity. This article utilized a person-centered approach to investigate whether distinct sleep quality subtypes were associated with obesity directly, and indirectly via physical activity. The sample included 8,932 Australian employees who participated in the Household, Income and Labor Dynamics in Australia Survey. Structured interviews and self-report questionnaires collected information on sleep quality, obesity, and relevant demographic, health, and work-related variables. Latent class analysis identified distinct subtypes of sleep quality. General linear modeling examined the associations of sleep quality subtypes with body mass index (BMI) and waist circumference. Multicategorical mediation models examined indirect paths linking sleep quality classes with obesity via physical activity. Five distinct sleep quality subtypes were identified: Poor Sleepers (20.0%), Frequent Sleep Disturbances (19.2%), Minor Sleep Disturbances (24.5%), Long Sleepers (9.6%), and Good Sleepers (26.7%). BMI, waist circumference, and physical activity differed among the sleep quality subtypes, with similar results observed for males and females. For example, Poor Sleepers had the highest BMIs, followed by Frequent Sleep Disturbances and Minor Sleep Disturbances; Long Sleepers and Good Sleepers had the lowest BMIs. Mediation analyses indicated that low levels of physical activity linked the Poor Sleep, Frequent Sleep Disturbance, and Long Sleep classes with higher BMI. These results provide new insights into the nature of sleep quality in employees. In particular, distinct sleep quality patterns had differing associations with measures of obesity, suggesting the need for tailored workplace interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  6. Shift work sleep disorder: burden of illness and approaches to management.

    PubMed

    Schwartz, Jonathan R L; Roth, Thomas

    2006-01-01

    More than 6 million Americans work night shifts on a regular or rotating basis. The negative consequences of shift work have been established, and recent evidence suggests that patients with shift work sleep disorder (SWSD) are at increased risk of these consequences and co-morbidities. SWSD is a relatively common but under-recognised, and hence undertreated, condition with potentially serious medical, social, economic and quality-of-life consequences. In addition to increased risk of gastrointestinal and cardiovascular disease, patients with SWSD experience clinically significant excessive sleepiness or insomnia associated with work during normal sleep times, which has important safety implications. A number of studies have evaluated countermeasures or interventions in shift workers; proposed treatments include chronobiotic interventions, such as light exposure, melatonin, hypnotic agents, caffeine and CNS stimulants (amphetamine), and the wake-promoting agents modafinil and armodafinil. However, most studies evaluating pharmacological therapies and nonpharmacological interventions simulate night-shift work under conditions that may not accurately reflect real-world activities. Pharmacological and nonpharmacological countermeasures evaluated mostly in simulated laboratory conditions have been shown to improve alertness or sleep in shift workers but have not yet been evaluated in patients with SWSD. To date, three randomised, double-blind clinical studies have evaluated pharmacological therapies in patients with SWSD. These studies showed that modafinil and armodafinil significantly improve the ability to sustain wakefulness during waking activities (e.g. working, driving), overall clinical condition, and sustained attention or memory in patients with SWSD. In conclusion, SWSD is a common condition that remains under-recognised and undertreated. Further research is needed to evaluate different treatment approaches for this condition, to clarify the substantial

  7. Association between sleep behavior and sleep-related factors among university students in Hong Kong.

    PubMed

    Suen, Lorna K P; Hon, K L Ellis; Tam, Wilson W S

    2008-09-01

    Sleep problems among university students are common; however, the association between many sleep-related factors and sleep behaviors is still unclear. The purpose of this study is to examine different sleep behaviors and sleep-related factors influencing such behaviors in university students. A descriptive survey was conducted on 400 university students in Hong Kong. The instruments for data collection consisted of the Pittsburgh Sleep Quality Index (PSQI), a sleep hygiene practice questionnaire, demographic data, and other sleep-related factors. The results reveal that 57.5% of the 400 university students are poor sleepers. Sex, year of study, sleep hygiene practice, and perceived adequate sleep in the past month all demonstrate significant associations with poor sleepers. A high prevalence of sleep-related problems among college students is confirmed and associated factors are identified. Students should be encouraged to follow sleep hygiene practice, adequate time management for academic and social activities, and suitable stress-relieving measures.

  8. Sleep debt and obesity.

    PubMed

    Bayon, Virginie; Leger, Damien; Gomez-Merino, Danielle; Vecchierini, Marie-Françoise; Chennaoui, Mounir

    2014-08-01

    Short sleep duration has been shown to be associated with elevated body mass index (BMI) in many epidemiological studies. Several pathways could link sleep deprivation to weight gain and obesity, including increased food intake, decreased energy expenditure, and changes in levels of appetite-regulating hormones, such as leptin and ghrelin. A relatively new factor that is contributing to sleep deprivation is the use of multimedia (e.g. television viewing, computer, and internet), which may aggravate sedentary behavior and increase caloric intake. In addition, shift-work, long working hours, and increased time commuting to and from work have also been hypothesized to favor weight gain and obesity-related metabolic disorders, because of their strong link to shorter sleep times. This article reviews the epidemiological, biological, and behavioral evidence linking sleep debt and obesity.

  9. [Develpment of sleep stages in childhood].

    PubMed

    Geib, Lorena Teresinha Consalter

    2007-01-01

    With the perspective of describing some aspects of the ontogenesis and organization of the sleep stages during the first year of life, a literature review was carried out to assess the physiological and behavioral alterations controlled by changes occurring during sleep at this developmental stage. In addition, based on the sleep preceding theory the stages of differentiation, classification and time organization of sleep stages are presented, aiming at the favorable management of environmental events that affect the organization of infant sleep.

  10. [Postoperative management following rhinosurgery interventions in severe obstructive sleep apnea. A pilot study].

    PubMed

    Dorn, M; Pirsig, W; Verse, T

    2001-08-01

    Patients with severe obstructive sleep apnea (OSA) treated by nasal continuous positive airway pressure (CPAP) often undergo rhinosurgery to improve nasal ventilation and comply with CPAP therapy. The use of nasal packing postoperatively may worsen the severity of their sleep-related breathing disorders, even leading to death. For this reason, postoperative surveillance with CPAP ventilation is recommended. An oral connection piece offers the possibility to continue CPAP therapy. Five patients with OSA were enrolled in this pilot study. All patients underwent a septorhinoplasty with nasal packing for 2 days. CPAP ventilation was guaranteed postoperatively by using an oral connection piece. The object of the study was to evaluate the feasibility, effectiveness, and acceptance of CPAP ventilation with this oral connection piece in patients with nasal packing. Therefore, the blood oxygenation of the patients was observed by pulse oximetry pre- and postoperatively. None of the patients with nasal packing showed apneas or hypopneas with arterial blood oxygen saturation below 92%. Application of oxygen was not necessary. Cardiorespiratory or neurological complications were not observed. The oral connection piece offers a feasible and effective opportunity to continue CPAP ventilation therapy after rhinosurgery in patients with OSA. The acceptance of the method is satisfactory.

  11. An expert system for fault management assistance on a space sleep experiment.

    PubMed

    Atamer, A; Delaney, M; Young, L R

    2002-10-01

    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.

  12. An expert system for fault management assistance on a space sleep experiment

    NASA Technical Reports Server (NTRS)

    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.

  13. Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea.

    PubMed

    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.

  14. Controlling the vector of distraction osteogenesis in the management of obstructive sleep apnea

    PubMed Central

    Shilo, Dekel; Emodi, Omri; Aizenbud, Dror; Rachmiel, Adi

    2016-01-01

    Background: 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. Materials and Methods: 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. 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. Conclusions: 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. PMID:28299260

  15. Rapid Eye Movement Sleep Behavior Disorder and Other Rapid Eye Movement Sleep Parasomnias.

    PubMed

    Högl, Birgit; Iranzo, Alex

    2017-08-01

    The most common rapid eye movement (REM) parasomnia encountered by neurologists is REM sleep behavior disorder (RBD), and nightmares are so frequent that every neurologist should be able to differentiate them from the dream enactment of RBD. Isolated sleep paralysis is relatively common and is often mistaken for other neurologic disorders. This article summarizes the current state of the art in the diagnosis of RBD, discusses the role of specific questionnaires and polysomnography in the diagnosis of RBD, and reviews recent studies on idiopathic RBD as an early feature of a synucleinopathy, secondary RBD, and its management. Recent diagnostic criteria and implications of nightmares and isolated sleep paralysis are also reviewed. Idiopathic RBD can now be considered as part of the prodromal stage of a synucleinopathy. Therefore, an accurate diagnosis is mandatory, and this implies detection of REM sleep without atonia. The polysomnography montage, including EMG of the submentalis and flexor digitorum superficialis muscles, provides a high sensitivity and specificity for the diagnosis. The exact diagnosis is important for patient counseling and for future neuroprotective trials. REM parasomnias include RBD, sleep paralysis, and nightmares, which have distinct clinical characteristics and different implications regarding diagnostic procedures, management, and prognosis.

  16. Sleep, alertness and alertness management among commercial airline pilots on short-haul and long-haul flights.

    PubMed

    Sallinen, Mikael; Sihvola, Maria; Puttonen, Sampsa; Ketola, Kimmo; Tuori, Antti; Härmä, Mikko; Kecklund, Göran; Åkerstedt, Torbjörn

    2017-01-01

    Airline pilots' sleep and on-duty alertness are important focus areas in commercial aviation. Until now, studies pertaining to this topic have mainly focused on specific characteristics of flights and thus a comprehensive picture of the matter is not well established. In addition, research knowledge of what airline pilots actually do to maintain their alertness while being on duty is scarce. To address these gaps in research knowledge, we conducted a field study on a representative sample of the airline pilots of a medium-sized airline. The sample consisted of 90 pilots, of whom 30 flew long-haul (LH) routes, 30 short-haul (SH) routes, and 30 flew both. A total of 86 pilots completed the measurements that lasted for almost two months per pilot. The measurements resulted in a total of 965 flight duty periods (FDPs) including SH flights and 627 FDPs including LH flights. During the measurement periods, sleep was measured by a diary and actigraphs, on-duty alertness by the Karolinska Sleepiness Scale (KSS) in all flight phases, and on-duty alertness management strategies by the diary. Results showed that SH and LH FDPs covering the whole domicile night (00:00-06:00 at home base) were most consistently associated with reduced sleep-wake ratio and subjective alertness. Approximately every 3rd FDP falling into this category involved a reduced sleep-wake ratio (1:3 or lower) and every 2nd a reduced level of subjective alertness (KSS rating 8-9 in at least one flight phase). The corresponding frequencies for the SH and LH FDPs that partly covered the domicile night were every 10th and every 5th FDP and for the pure non-night FDPs every 30th and every 36th FDP, respectively. The results also showed that the pilots tended to increase the use of effective on-duty alertness management strategies (consuming alertness-promoting products and taking strategic naps) in connection with the FDPs that overlapped the domicile night. Finally, the results showed that the frequency of

  17. Sleeping like a baby? Infant sleep: impact on caregivers and current controversies.

    PubMed

    Hiscock, Harriet; Fisher, Jane

    2015-04-01

    This annotation discusses definitions of 'sleep problems', the impacts of infant sleep on maternal and paternal well-being, and the evidence behind two areas of current controversy - the role of attachment versus behaviourally based parenting in infant sleep and management strategies for sleep problems in infants aged less than 6 months.

  18. Laminate article

    DOEpatents

    Williams, Robert K.; Paranthaman, Mariappan; Chirayil, Thomas G.; Lee, Dominic F.; Goyal, Amit; Feenstra, Roeland

    2002-01-01

    A laminate article comprises a substrate and a biaxially textured (RE.sub.x A.sub.(1-x)).sub.2 O.sub.2-(x/2) buffer layer over the substrate, wherein 0article can include a layer of YBCO over the (RE.sub.x A.sub.(1-x)).sub.2 O.sub.2-(x/2) buffer layer. A layer of CeO.sub.2 between the YBCO layer and the (RE.sub.x A.sub.(1-x)).sub.2 O.sub.2-(x/2) buffer layer can also be include. Further included can be a layer of YSZ between the CeO.sub.2 layer and the (RE.sub.x A.sub.(1-x)).sub.2 O.sub.2-(x/2) buffer layer. The substrate can be a biaxially textured metal, such as nickel. A method of forming the laminate article is also disclosed.

  19. Sleep Apnea

    MedlinePlus

    ... that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is ... obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. CPAP may eliminate snoring and prevent sleep apnea. ...

  20. Sleep duration, sleep quality and body weight: parallel developments.

    PubMed

    Gonnissen, Hanne K J; Adam, Tanja C; Hursel, Rick; Rutters, Femke; Verhoef, Sanne P M; Westerterp-Plantenga, Margriet S

    2013-09-10

    The increase in obesity, including childhood obesity, has developed over the same time period as the progressive decrease in self-reported sleep duration. Since epidemiological studies showed an inverse relationship between short or disturbed sleep and obesity, the question arose, how sleep duration and sleep quality are associated with the development of obesity. In this review, the current literature on these topics has been evaluated. During puberty, changes in body mass index (BMI) are inversely correlated to changes in sleep duration. During adulthood, this relationship remains and at the same time unfavorable metabolic and neuro-endocrinological changes develop, that promote a positive energy balance, coinciding with sleep disturbance. Furthermore, during excessive weight loss BMI and fat mass decrease, in parallel, and related with an increase in sleep duration. In order to shed light on the association between sleep duration, sleep quality and obesity, until now it only has been shown that diet-induced body-weight loss and successive body-weight maintenance contribute to sleep improvement. It remains to be demonstrated whether body-weight management and body composition improve during an intervention concomitantly with spontaneous sleep improvement compared with the same intervention without spontaneous sleep improvement.

  1. Sleep and metabolic function

    PubMed Central

    Morselli, Lisa L.; Guyon, Aurore; Spiegel, Karine

    2012-01-01

    Evidence for the role of sleep on metabolic and endocrine function has been reported more than four decades ago. In the past 30 years, the prevalence of obesity and diabetes has greatly increased in industrialized countries, and self-imposed sleep curtailment, now very common, is starting to be recognized as a contributing factor, alongside with increased caloric intake and decreased physical activity. Furthermore, obstructive sleep apnea, a chronic condition characterized by recurrent upper airway obstruction leading to intermittent hypoxemia and sleep fragmentation, has also become highly prevalent as a consequence of the epidemic of obesity and has been shown to contribute, in a vicious circle, to the metabolic disturbances observed in obese patients. In this article, we summarize the current data supporting the role of sleep in the regulation of glucose homeostasis and the hormones involved in the regulation of appetite. We also review the results of the epidemiologic and laboratory studies that investigated the impact of sleep duration and quality on the risk of developing diabetes and obesity, as well as the mechanisms underlying this increased risk. Finally, we discuss how obstructive sleep apnea affects glucose metabolism and the beneficial impact of its treatment, the continuous positive airway pressure. In conclusion, the data available in the literature highlight the importance of getting enough good sleep for metabolic health. PMID:22101912

  2. 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.

    PubMed

    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 < 0.001; effect size range = 1.60-1.80). During SRT, PVT lapses were significantly increased from baseline (at three of five assessment points, all P < 0.05; effect size range = 0.69-0.78), returning to baseline levels by 3 mo (P = 0.43). A similar pattern was observed for RT, with RTs slowing during acute treatment (at four of five assessment points, all P < 0.05; effect size range = 0.57-0.89) and returning to pretreatment levels at 3 mo (P = 0.78). ESS scores were increased at w 1, 2, and 3 (relative to baseline; all P < 0.05); by 3 mo, sleepiness had returned to baseline (normative) levels (P = 0.65). For the first time we show that acute sleep restriction therapy is associated with reduced objective total sleep time, increased daytime sleepiness, and objective performance impairment. Our data have important implications for implementation guidelines

  3. Site-Based Management and the School Business Administrator: A Compilation of Articles from "School Business Affairs." The Professional Development Series.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    The Association of School Business Officials International compiled the 12 best articles on site-based management from its journal "School Business Affairs." The first section covers budgeting: "School-Site Budgeting," David S. Honeyman and Richard Jensen; "Involving the Principal in the Budget Making Process," Leonard L. Gregory and Roger R.…

  4. [Sleep disorders and dementia].

    PubMed

    Hess, C W

    1997-08-27

    A clinically relevant sleep-wake disturbance is found in up to half the patients with dementia, and the sundowning agitation is a common cause of institutionalisation of demented geriatric patients. The circadian rhythm of demented patients is levelled off with increased daytime sleep and disrupted night sleep. Particularly in vascular dementia, Korsakow syndrome, Parkinson's disease, and depression the alteration of sleep architecture may be pronounced, whereas in Alzheimer's disease prominent hypersomnolence or insomnia is typically only found in later stages of the diseases. Greatly increased daytime sleepiness or striking insomnia at the very beginning of suspected dementia should thus prompt the search for other, possibly treatable causes of dementia. Neuropathological and neurophysiological studies support the hypothesis of a deteriorated hypothalamic suprachiasmatic nucleus (harbouring the biological clock) as a cause for the deranged circadian sleep-wake system in dementia. Management of sundowning behaviour includes restriction of daytime sleep, exposure to bright lights, and social interaction schedules during the day. The benzodiazepines and analogues usually not being sufficiently effectual, low doses of mild neuroleptics are often needed. Whether recent reports on efficacy of melatonin in elderly insomniacs also apply to demented patients is yet uncertain. The careful search and treatment of possible extracerebral physiologic factors causing reversible hypersomnia or insomnia is an important requisite. Polysomnographic studies are needed to recognise treatable sleep disturbance which could deteriorate or mimic dementia and sundowning. Particularly, a sleep-apnea-hypopnea syndrome must be searched for at the beginning of a suspected dementia, when successful treatment is still possible. Sleep studies should also identify periodic leg movements of sleep with restless legs and/or increased daytime sleepiness, and hyperkinetic parasomnias such as REM sleep

  5. Management of severe sleep apnea secondary to juvenile arthritis with temporomandibular joint replacement and mandibular advancement

    PubMed Central

    Paul, S. Arun; Simon, S. Sibu; Issac, Barney; Kumar, Saurav

    2015-01-01

    Variations affecting the growth centers can severely affect the normal formation and subsequent function of vital musculoskeletal structures. We report a case of bilateral condylar atrophy with a history of juvenile arthritis (JA) resulting in progressive obstructive sleep apnea (OSA) in adulthood. In addition to this, the case report emphasizes the role of temporomandibular joint replacement and advancement of the mandible to correct progressive OSA secondary to idiopathic JA. Computed tomography revealed micrognathia, condylar hypoplasia, and decreased pharyngeal airway space. The resultant increase in the retrolingual-pharyngeal airway space following the surgery, helped to completely resolve the presenting symptoms. It is hoped that the described technique could be used in similar cases with a predictable outcome. PMID:26538944

  6. Sleep and psychoneuroimmunology.

    PubMed

    Opp, Mark R

    2009-05-01

    The brain uses a variety of mechanisms to survey the immune system constantly. Responses of the immune system to invading pathogens are detected by the central nervous system, which responds by orchestrating complex changes in behavior and physiology. Sleep is one of the behaviors altered in response to immune challenge. The role of cytokines as mediators of responses to infectious challenge and regulators and modulators of sleep is the focus of this article.

  7. Sleep Dysfunction and Gastrointestinal Diseases.

    PubMed

    Khanijow, Vikesh; Prakash, Pia; Emsellem, Helene A; Borum, Marie L; Doman, David B

    2015-12-01

    Sleep deprivation and impaired sleep quality have been associated with poor health outcomes. Many patients experience sleep disturbances, which can increase the risk of medical conditions such as hypertension, obesity, stroke, and heart disease as well as increase overall mortality. Recent studies have suggested that there is a strong association between sleep disturbances and gastrointestinal diseases. Proinflammatory cytokines, such as tumor necrosis factor, interleukin-1, and interleukin-6, have been associated with sleep dysfunction. Alterations in these cytokines have been seen in certain gastrointestinal diseases, such as gastroesophageal reflux disease, inflammatory bowel disease, liver disorders, and colorectal cancer. It is important for gastroenterologists to be aware of the relationship between sleep disorders and gastrointestinal illnesses to ensure good care for patients. This article reviews the current research on the interplay between sleep disorders, immune function, and gastrointestinal diseases.

  8. Sleep Dysfunction and Gastrointestinal Diseases

    PubMed Central

    Khanijow, Vikesh; Prakash, Pia; Emsellem, Helene A.; Borum, Marie L.

    2015-01-01

    Sleep deprivation and impaired sleep quality have been associated with poor health outcomes. Many patients experience sleep disturbances, which can increase the risk of medical conditions such as hypertension, obesity, stroke, and heart disease as well as increase overall mortality. Recent studies have suggested that there is a strong association between sleep disturbances and gastrointestinal diseases. Proinflammatory cytokines, such as tumor necrosis factor, interleukin-1, and interleukin-6, have been associated with sleep dysfunction. Alterations in these cytokines have been seen in certain gastrointestinal diseases, such as gastroesophageal reflux disease, inflammatory bowel disease, liver disorders, and colorectal cancer. It is important for gastroenterologists to be aware of the relationship between sleep disorders and gastrointestinal illnesses to ensure good care for patients. This article reviews the current research on the interplay between sleep disorders, immune function, and gastrointestinal diseases. PMID:27134599

  9. [Obstructive sleep-apnoea syndrome in adult and its perioperative management].

    PubMed

    Payen, J-F; Jaber, S; Levy, P; Pepin, J-L; Fischler, M

    2010-11-01

    Obstructive sleep apnoea (OSA) syndrome in adult is defined as an Apnoea-Hypopnoea Index (AHI) of 5 or more per hour of sleep in a context of excessive daytime sleepiness and snoring. OSA is considered as mild with an AHI of 5-15, moderate with an AHI of 15-30, and severe with an AHI greater than 30. OSA is a highly prevalent disease since it should affect 7-15% of the middle-aged population, but most patients are not yet diagnosed for OSA. Middle age, male gender, obesity and arterial hypertension are main risk factors for OSA in adults. OSA patients are exposed to higher neurological and cardiovascular morbidity, including stroke, depression, hypertension, coronary artery disease, heart failure, arrhythmias. Because OSA may lead to life-threatening problems if undiagnosed, anaesthesiologists should be aware of their screening role in the preoperative period. In that way, the STOP-BANG questionnaire is a well-adapted instrument to screen patients for OSA during the preoperative visit. OSA patients are exposed to higher preoperative morbidity in relation with OSA severity, particularly difficult manual ventilation with mask, difficult tracheal intubation and postoperative upper airway obstruction. The unknown diagnosis of OSA is one major contributor to facilitate the occurrence of those events. In the postoperative period, early resuming continuous positive airway pressure and installing the OSA patient in a nonsupine position could be effective in preventing pharyngeal obstruction. Considering the timing of postoperative complications, a careful monitoring in the post-anesthesia care unit for three hours is an appropriate strategy for a majority of OSA patients. Alternatives to opioids should be promoted for postoperative pain control.

  10. The bidirectional relationship between exercise and sleep: Implications for exercise adherence and sleep improvement.

    PubMed

    Kline, Christopher E

    2014-01-01

    Exercise has long been associated with better sleep, and evidence is accumulating on the efficacy of exercise as a nonpharmacologic treatment option for disturbed sleep. Recent research, however, has noted that poor sleep may contribute to low physical activity levels, emphasizing a robust bidirectional relationship between exercise and sleep. This article will briefly review the evidence supporting the use of exercise as a nonpharmacologic treatment for sleep disturbance, outline future research that is needed to establish the viability of exercise as a behavioral sleep treatment, describe recent research that has emphasized the potential influence of poor sleep on daytime activity levels, and discuss whether improving sleep may facilitate adoption and/or better adherence to a physically active lifestyle. With poor sleep and physical inactivity each recognized as key public health priorities, additional research into the bidirectional relationship between exercise and sleep has significant implications for facilitating greater exercise adherence and improving sleep in society.

  11. Children's Sleep Needs: Is There Sufficient Evidence to Recommend Optimal Sleep for Children?

    PubMed Central

    Matricciani, Lisa; Blunden, Sarah; Rigney, Gabrielle; Williams, Marie T.; Olds, Tim S.

    2013-01-01

    It is widely recognized that sleep is important for children's health and well-being and that short sleep duration is associated with a wide range of negative health outcomes. Recently, there has been much interest in whether or not there are sufficient data to support the specific recommendations made for how much sleep children need. In this article we explore concepts related to children's sleep need, discuss the theory, rationale, and empirical evidence for contemporary sleep recommendations, and outline future research directions for sleep recommendations. If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children. Citation: Matricciani L; Blunden S; Rigney G; Williams MT; Olds TS. Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children? SLEEP 2013;36(4):527-534. PMID:23564999

  12. Research Article Abstracts in Two Subdisciplines of Business--Move Structure and Hedging between Management and Marketing

    ERIC Educational Resources Information Center

    Li, Qian; Pramoolsook, Issra

    2015-01-01

    The importance of RA abstracts lies in their influence on the readers' decision about whether the accompanying article is worth reading. A number of studies have investigated the move structure of abstracts and have generated several influential models. However, little research has been conducted on subdisciplinary variations in move structure of…

  13. Diagnostic and treatment implications of nasal obstruction in snoring and obstructive sleep apnea.

    PubMed

    Scharf, M B; Cohen, A P

    1998-10-01

    The purpose of this review is to highlight fundamental aspects of obstructive sleep apnea (OSA), and to present an overview of the medical literature that pertains to the clinical interplay between various allergy-related disorders, nasal patency, and OSA. This should enable the reader to play a more proactive role in the diagnosis, management, and prevention of OSA. Relevant reviews, texts, and articles. The MEDLINE database was used to find related literature. In predisposed individuals, OSA, sleep fragmentation, and the sequelae of disturbed sleep often result from nasal obstruction. Since breathing through the nose appears to be the preferred route during sleep, nasal obstruction frequently leads to nocturnal mouth breathing, snoring, and ultimately to OSA. Allergists can thus play a vital role in assessing sleep problems in their patients with allergic rhinitis and other upper respiratory disorders, in treating these problems more aggressively, and in some instances, in preventing them.

  14. Survivorship: Sleep Disorders, Version 1.2014

    PubMed Central

    Denlinger, Crystal S.; Ligibel, Jennifer A.; Are, Madhuri; Baker, K. Scott; Demark-Wahnefried, Wendy; Friedman, Debra L.; Goldman, Mindy; Jones, Lee; King, Allison; Ku, Grace H.; Kvale, Elizabeth; Langbaum, Terry S.; Leonardi-Warren, Kristin; McCabe, Mary S.; Melisko, Michelle; Montoya, Jose G.; Mooney, Kathi; Morgan, Mary Ann; Moslehi, Javid J.; O’Connor, Tracey; Overholser, Linda; Paskett, Electra D.; Raza, Muhammad; Syrjala, Karen L.; Urba, Susan G; Wakabayashi, Mark T.; Zee, Phyllis; McMillian, Nicole; Freedman-Cass, Deborah

    2015-01-01

    Sleep disorders, including insomnia and excessive sleepiness, affect a significant proportion of patients with cancer and survivors, often in combination with fatigue, anxiety, and depression. Improvements in sleep lead to improvements in fatigue, mood, and quality of life. This section of the NCCN Guidelines for Survivorship provides screening, diagnosis, and management recommendations for sleep disorders in survivors. Management includes combinations of sleep hygiene education, physical activity, psychosocial interventions, and pharmacologic treatments. PMID:24812132

  15. Management and outcomes of obstructive sleep apnea in children with Robin sequence, a cross-sectional study.

    PubMed

    van Lieshout, Manouk J S; Joosten, Koen F M; Koudstaal, Maarten J; van der Schroeff, Marc P; Dulfer, Karolijn; Mathijssen, Irene M J; Wolvius, Eppo B

    2017-07-01

    The objective of this cross-sectional study is to assess the prevalence, course, and management of obstructive sleep apnea (OSA) in children with Robin sequence (RS) aged 1-18 years. A cross-sectional study was conducted in 63 children aged 1 to18 years with RS. Patient data were collected on baseline characteristics and management. OSA was evaluated by polysomnography. Sixty-three children with RS were included (median age 8.0 years) and divided into two groups based on the initial treatment: prone positioning or respiratory support. Respiratory support was more often indicated in children with a non-isolated RS (p < 0.05). At cross section, in the prone positioning group (n = 32), one child was diagnosed with OSA. In the respiratory support group (n = 31), 13 children (42 %) had respiratory problems of whom 10 needed respiratory support. Between the age of 1 and 18 years, almost one out of four children with RS still has respiratory problems. Children with RS, who can be treated with prone positioning only as an infant, are not likely to develop obstructive airway problems at a later age. In contrast, children who need respiratory support early after birth are at risk of continuing or re-developing OSA after the age of 1 year. This study shows that those who need respiratory support at an early age need careful monitoring until adulthood.

  16. [Sleep genes].

    PubMed

    Prospéro-García, O; Guzmán, K; Méndez-Diaz, M; Herrera-Solís, A; Ruiz-Contreras, A

    Sleep is a non-learned adaptive strategy that depends on the expression of several neurotransmitters and other molecules. The expression of some of these molecules depends on a number of different genes. Sleep disorders are associated with an inadequate expression of some molecules, which therefore indicates that these genes that code for these molecules participate in the regulation of normal sleep. To discuss the evidence on gene regulation over the occurrence of sleep and its architecture, as well as of sleep disorders, which supports the participation of specific genes. We describe the evidence on sleep in mammals, particularly in humans, in addition to studies with twins that demonstrate the influence of genes on sleep regulation. We also discuss several sleep disorders, which in this study only serves to emphasise how certain specific genes, under normal conditions, participate in the expression of sleep. Furthermore, evidence is also provided for other molecules, such as endocannibinoids, involved in sleep regulation. Lastly, we report on studies conducted with different strains of mice that show differences in the amount of sleep they express, possibly as an epiphenomenon of their different genetic loads. A number of different genes have been described as those responsible for making us sleep, although sleeping also depends on our interaction with the environment. This interaction is what makes us express sleep at times that are best suited to favouring our survival.

  17. Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force.

    PubMed

    Gurubhagavatula, Indira; Sullivan, Shannon; Meoli, Amy; Patil, Susheel; Olson, Ryan; Berneking, Michael; Watson, Nathaniel F

    2017-05-15

    The American Academy of Sleep Medicine Sleep and Transportation Safety Awareness Task Force responded to the Federal Motor Carrier Safety Administration and Federal Railroad Administration Advance Notice of Proposed Rulemaking and request for public comments regarding the evaluation of safety-sensitive personnel for moderate-to-severe obstructive sleep apnea (OSA). The following document represents this response. The most salient points provided in our comments are that (1) moderate-to-severe OSA is common among commercial motor vehicle operators (CMVOs) and contributes to an increased risk of crashes; (2) objective screening methods are available and preferred for identifying at-risk drivers, with the most commonly used indicator being body mass index; (3) treatment in the form of continuous positive airway pressure (CPAP) is effective and reduces crashes; (4) CPAP is economically viable; (5) guidelines are available to assist medical examiners in determining whether CMVOs with moderate-to-severe OSA should continue to work without restrictions, with conditional certification, or be disqualified from operating commercial motor vehicles.

  18. "Grammar Nazis Never Sleep": Facebook Humor and the Management of Standard Written Language

    ERIC Educational Resources Information Center

    Sherman, Tamah; Švelch, Jaroslav

    2015-01-01

    This paper uses Language Management Theory (Nekvapil and Sherman, "Language management in contact situations. Perspectives from three continents". Peter Lang, Frankfurt/Main, 2009) to investigate Facebook pages as a site and instrument of behavior-toward-language, focusing specifically on the use of humor. The language in question is…

  19. "Grammar Nazis Never Sleep": Facebook Humor and the Management of Standard Written Language

    ERIC Educational Resources Information Center

    Sherman, Tamah; Švelch, Jaroslav

    2015-01-01

    This paper uses Language Management Theory (Nekvapil and Sherman, "Language management in contact situations. Perspectives from three continents". Peter Lang, Frankfurt/Main, 2009) to investigate Facebook pages as a site and instrument of behavior-toward-language, focusing specifically on the use of humor. The language in question is…

  20. [Sleep and sleep difficulties in Danish children aged 6-11 years].

    PubMed

    Hvolby, Allan; Jørgensen, Jan; Bilenberg, Niels

    2008-02-04

    Sleeping difficulties in children can affect learning and behaviour. Parental understanding of sleep can differ from what clinicians define as a sleep problem. It is therefore important to have information on sleep in Danish children in order to be able to advice parents on normal and deviant sleep. The purpose of this article is to describe the sleep in Danish healthy children. We examined 211 healthy children aged 6-11 years, recruited in a public school. Their sleep was evaluated objectively with actigraphy. Sleep patterns and sleep problems were examined by means of a questionnaire completed by parents. The objective and subjective measurements were compared. The most frequently reported sleep problem was fear of falling asleep in the dark, which 19.4% reported. Unwillingness to go to bed was reported in 7.1% and 7.5% had difficulties falling asleep. Actigraphic-measured sleep onset latency was on average 13.5 minutes, while parents reported an average of 21.5 minutes. The results comply with other findings. As in other sleep studies we found that parents estimate the child's sleep to be poorer than it actually is, although the discrepancy is less than seen in clinical populations. Detailed sleep history, possibly in combination with a sleep diary, can usually identify sleep problems and might be the first step in an effective treatment. Furthermore, actigraphy can be an effective supplement in the unravelling of sleep difficulties.

  1. Insufficient sleep: Enhanced risk-seeking relates to low local sleep intensity.

    PubMed

    Maric, Angelina; Montvai, Eszter; Werth, Esther; Storz, Matthias; Leemann, Janina; Weissengruber, Sebastian; Ruff, Christian C; Huber, Reto; Poryazova, Rositsa; Baumann, Christian R

    2017-08-21

    Chronic sleep restriction is highly prevalent in modern society and is in its clinical form, insufficient sleep syndrome, one of the most prevalent diagnoses in clinical sleep laboratories, with substantial negative impact on health and community burden. It reflects every-day sleep loss better than acute sleep deprivation, but its effects and particularly the underlying mechanisms remain largely unknown for a variety of critical cognitive domains, as for example risky decision-making. We assessed financial risk-taking behavior after 7 consecutive nights of sleep restriction and after one night of acute sleep deprivation compared to a regular sleep condition in a within-subject design. We further investigated potential underlying mechanisms of sleep loss induced changes in behavior by high-density electroencephalography recordings during restricted sleep. We show that chronic sleep restriction increases risk-seeking, while this was not observed after acute sleep deprivation. This increase was subjectively not noticed and was related to locally lower values of slow wave energy during preceding sleep, an electrophysiological marker of sleep intensity and restoration, in electrodes over the right prefrontal cortex. This study provides for the first time evidence that insufficient sleep restoration over circumscribed cortical areas leads to aberrant behavior. In chronically sleep restricted subjects, low slow wave sleep intensity over the right prefrontal cortex - which has been shown to be linked to risk behavior - may lead to increased and subjectively unnoticed risk-seeking. This article is protected by copyright. All rights reserved. © 2017 American Neurological Association.

  2. The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000–2010

    PubMed Central

    Alexander, Melannie; Ray, Meredith A.; Hébert, James R.; Youngstedt, Shawn D.; Zhang, Hongmei; Steck, Susan E.; Bogan, Richard K.; Burch, James B.

    2016-01-01

    Study Objectives: A large proportion of individuals affected by sleep disorders are untreated and susceptible to accidents, injuries, long-term sequelae (e.g., risk of cardiovascular disease, cancer, psychiatric disorders), and increased mortality risk. Few studies have examined the scope and magnitude of sleep disorder diagnoses in the United States (US) or factors influencing them. Veterans are particularly vulnerable to factors that elicit or exacerbate sleep disorders. Methods: This serial cross-sectional study characterized secular trends in diagnosed sleep disorders among veterans seeking care in US Veterans Health Administration facilities over an eleven-year span (FY2000–2010, n = 9,786,778). Electronic medical records from the national Veterans Administration Informatics and Computing Infrastructure database were accessed. Cases were defined using diagnostic codes specified by the American Academy of Sleep Medicine. Age-adjusted annual prevalence was summarized by sex, race, combat exposure, body mass index, and comorbid diagnoses (cardiovascular disease, cancer, mental disorders). Results: Sleep apnea (47%) and insomnia (26%) were the most common diagnoses among patients with any sleep disorder. There was a six-fold relative increase in total sleep disorder prevalence over the study period. Posttraumatic stress disorder, which tripled over the same time period, was associated with the highest prevalence of sleep disorders (16%) among the comorbid conditions evaluated. Conclusions: The results indicate a growing need for integration of sleep disorder management with patient care and health care planning among US veterans. Commentary: A commentary on this article appears in this issue on page 1331. Citation: Alexander M, Ray MA, Hébert JR, Youngstedt SD, Zhang H, Steck SE, Bogan RK, Burch JB. The National Veteran Sleep Disorder Study: descriptive epidemiology and secular trends, 2000–2010. SLEEP 2016;39(7):1399–1410. PMID:27091538

  3. Healthy Sleep Habits

    MedlinePlus

    ... 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 ...

  4. What Are Sleep Studies?

    MedlinePlus

    ... Share this page from the NHLBI on Twitter. Sleep Studies Also known as polysomnography. Sleep studies are ... Sleep Rate This Content: Updated: December 9, 2016 Sleep Infographic Sleep Disorders & Insufficient Sleep: Improving Health through ...

  5. Obstructive Sleep Apnea

    MedlinePlus

    ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ...

  6. Sleep Talking (Somniloquy)

    MedlinePlus

    ... Benefits Side Effects Variations Tips Healthy Sleep Habits Sleep Disorders by Category Insomnias Insomnia Child Insomnia Short Sleeper Hypersomnias Narcolepsy Insufficient Sleep Syndrome Long Sleeper Sleep Breathing Disorders Sleep Apnea Snoring Central Sleep Apnea Overview & Facts ...

  7. Pilot Randomized Controlled Trial of Auricular Point Acupressure to Manage Symptom Clusters of Pain, Fatigue, and Disturbed Sleep in Breast Cancer Patients.

    PubMed

    Yeh, Chao Hsing; Chien, Lung-Chang; Lin, Wei-Chun; Bovbjerg, Dana Howard; van Londen, G J

    2016-01-01

    Current management for a symptom cluster of pain, fatigue, and disturbed sleep in breast cancer patients has limited effects. The purposes of this prospective, randomized controlled pilot study were to (1) assess the feasibility and tolerability of auricular point acupressure (APA) intervention to manage pain, fatigue, and sleep disturbance in breast cancer patients and (2) provide an initial appraisal of effect size as compared with a control intervention. Thirty-one participants were randomized into either an active APA group (n = 16) or a control APA group (n = 15), which included the sham APA treatment not related to the symptoms. All participants received the APA once a week for 4 weeks. Self-report measures were obtained at baseline, weekly during intervention, at end of intervention, and at a 1-month follow-up. For the 4-week of APA treatment, the retention rate was 88% for the active APA group and 73% for the control APA group. After 4 weeks of APA, participants in the active APA treatment had reported a reduction of 71% in pain, 44% in fatigue, 31% in sleep disturbance, and 61% in interference with daily activities. The control APA group experienced some moderate reduction in these symptoms. Given that this was a pilot study with a small sample size, results must be interpreted with caution. Our results suggest that APA may provide an inexpensive and effective complementary approach for the management of symptom clusters for breast cancer patients, and further study is warranted.

  8. Sleep and hormonal changes in aging.

    PubMed

    Copinschi, Georges; Caufriez, Anne

    2013-06-01

    Age-related sleep and endocrinometabolic alterations frequently interact with each other. For many hormones, sleep curtailment in young healthy subjects results in alterations strikingly similar to those observed in healthy old subjects not submitted to sleep restriction. Thus, recurrent sleep restriction, which is currently experienced by a substantial and rapidly growing proportion of children and young adults, might contribute to accelerate the senescence of endocrine and metabolic function. The mechanisms of sleep-hormonal interactions, and therefore the endocrinometabolic consequences of age-related sleep alterations, which markedly differ from one hormone to another, are reviewed in this article.

  9. Children's Sleep and School Psychology Practice

    ERIC Educational Resources Information Center

    Buckhalt, Joseph A.; Wolfson, Amy R.; El-Sheikh, Mona

    2009-01-01

    Much contemporary research has demonstrated the multiple ways that sleep is important for child and adolescent development. This article reviews that research with an emphasis on how sleep parameters are related to school adjustment and achievement. Five areas of sleep research are reviewed to discern implications for practice with children using…

  10. Types and Treatment of Pediatric Sleep Disturbances

    ERIC Educational Resources Information Center

    Hamilton, Gloria J.

    2009-01-01

    This article provides an overview of pediatric sleep disturbances with emphases on types and treatments. Relationships between sleep disorders and comorbid conditions function to exacerbate and maintain both disorders. An estimated 20% of teenagers experience chronic partial sleep deprivation, resulting in problems with memory, attention, and…

  11. Children's Sleep and School Psychology Practice

    ERIC Educational Resources Information Center

    Buckhalt, Joseph A.; Wolfson, Amy R.; El-Sheikh, Mona

    2009-01-01

    Much contemporary research has demonstrated the multiple ways that sleep is important for child and adolescent development. This article reviews that research with an emphasis on how sleep parameters are related to school adjustment and achievement. Five areas of sleep research are reviewed to discern implications for practice with children using…

  12. Types and Treatment of Pediatric Sleep Disturbances

    ERIC Educational Resources Information Center

    Hamilton, Gloria J.

    2009-01-01

    This article provides an overview of pediatric sleep disturbances with emphases on types and treatments. Relationships between sleep disorders and comorbid conditions function to exacerbate and maintain both disorders. An estimated 20% of teenagers experience chronic partial sleep deprivation, resulting in problems with memory, attention, and…

  13. Snoring and obstructive sleep apnea.

    PubMed

    Krug, P

    1999-04-01

    The most common form of sleep apnea is obstructive sleep apnea (OSA). It is characterized by the cessation of nasal airflow with persistence of ventilatory effort, as shown by paradoxical chest and abdominal movement, and varying degrees of oxygen desaturation. This article describes current methods of diagnosing OSA and available treatment for OSA and snoring.

  14. Sleeping sickness.

    PubMed

    Malvy, D; Chappuis, F

    2011-07-01

    Human African trypanosomiasis (HAT), or sleeping sickness, is a vector-borne disease that flourishes in impoverished, rural parts of sub-Saharan Africa. It is caused by infection with the protozoan parasite Trypanosoma brucei and is transmitted by tsetse flies of the genus Glossina. The majority of cases are caused by T. b. gambiense, which gives rise to the chronic, anthroponotic endemic disease in Western and Central Africa. Infection with T. b. rhodesiense leads to the acute, zoonotic form of Eastern and Southern Africa. The parasites live and multiply extracellularly in the blood and tissue fluids of their human host. They have elaborated a variety of strategies for invading hosts, to escape the immune system and to take advantage of host growth factors. HAT is a challenging and deadly disease owing to its complex epidemiology and clinical presentation and, if left untreated, can result in high death rates. As one of the most neglected tropical diseases, HAT is characterized by the limited availability of safe and cost-effective control tools. No vaccine against HAT is available, and the toxicity of existing old and cumbersome drugs precludes the adoption of control strategies based on preventive chemotherapy. As a result, the keystones of interventions against sleeping sickness are active and passive case-finding for early detection of cases followed by treatment, vector control and animal reservoir management. New methods to diagnose and treat patients and to control transmission by the tsetse fly are needed to achieve the goal of global elimination of the disease.

  15. Management of obstructive sleep apnea in a Treacher Collins syndrome patient using distraction osteogenesis of the mandible.

    PubMed

    Damlar, İbrahim; Altan, Ahmet; Turgay, Berk; Kiliç, Soydan

    2016-12-01

    In this study, we present the surgical treatment of obstructive sleep apnea in a child with Treacher Collins syndrome. A 10-year-old girl with a past history of Treacher Collins syndrome presented to our clinic with her parents for respiratory distress and insomnia. The patient was referred to a sleep laboratory where she was diagnosed with obstructive sleep apnea, which was a consequence of her Treacher Collins syndrome. The patient underwent mandibular distraction osteogenesis under general anesthesia. The mandible was expanded by 15 mm using internal bilateral distractors. After distraction osteogenesis, the patient's respiratory problems resolved, and she was able to sleep comfortably. Distraction osteogenesis was an effective method of advancing the mandible, increasing the upper airway space and ultimately preventing obstructive sleep apnea syndrome in patients with Treacher Collins syndrome.

  16. Management of obstructive sleep apnea in a Treacher Collins syndrome patient using distraction osteogenesis of the mandible

    PubMed Central

    2016-01-01

    In this study, we present the surgical treatment of obstructive sleep apnea in a child with Treacher Collins syndrome. A 10-year-old girl with a past history of Treacher Collins syndrome presented to our clinic with her parents for respiratory distress and insomnia. The patient was referred to a sleep laboratory where she was diagnosed with obstructive sleep apnea, which was a consequence of her Treacher Collins syndrome. The patient underwent mandibular distraction osteogenesis under general anesthesia. The mandible was expanded by 15 mm using internal bilateral distractors. After distraction osteogenesis, the patient’s respiratory problems resolved, and she was able to sleep comfortably. Distraction osteogenesis was an effective method of advancing the mandible, increasing the upper airway space and ultimately preventing obstructive sleep apnea syndrome in patients with Treacher Collins syndrome. PMID:28053912

  17. Sleep Apnea

    MedlinePlus

    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 ...

  18. Sleep disorders in Machado-Joseph disease.

    PubMed

    Pedroso, José Luiz; Braga-Neto, Pedro; Martinez, Alberto R M; Martins, Carlos R; Rezende Filho, Flávio M; Sobreira-Neto, Manoel A; Prado, Lucila B F; do Prado, Gilmar F; França, Marcondes C; Barsottini, Orlando G P

    2016-11-01

    This article provides a description on clinical features and pathophysiology of the main sleep disorders observed in Machado-Joseph disease (MJD). Pathological studies have clearly demonstrated that degenerative process in MJD is widespread in the nervous system, and not restricted to the cerebellum. Nonmotor manifestations are frequent and may include pain, cramps, dysautonomia, cognitive deficits, psychiatric manifestations, olfactory deficits, fatigue, nutritional issues, and sleep disorders. Sleep disorders are frequent in MJD, and include restless legs syndrome, rapid eye movement sleep behavior disorder, excessive daytime sleepiness, insomnia, sleep apnea, periodic limb movements during sleep, parasomnia, and others. Pathophysiological mechanisms related to sleep disorders in Machado-Joseph are complex and poorly understood. Considering that sleep complaints are a treatable condition, recognizing sleep disorders in MJD is relevant.

  19. Social jet lag: Sleep-corrected formula.

    PubMed

    Jankowski, Konrad S

    2017-03-20

    Social jet lag is a term describing misalignment between social and biological times. In this article, it is argued that the currently used formula for social jet lag captures not only this misalignment, but also sleep debt resulting from sleep deprivation during workdays. It is proposed to adopt the sleep-corrected formula for social jet lag, which takes the form of the difference between the sleep onset on free days and workdays in the case of subjects with longer sleep and later (or equal) sleep onset on free days compared to workdays; it takes the form of the difference between the sleep offset on free days and workdays for subjects with longer sleep and earlier (or equal) sleep offset on workdays compared to free days.

  20. Reducing health disparities: the role of sleep deficiency and sleep disorders.

    PubMed

    Laposky, Aaron D; Van Cauter, Eve; Diez-Roux, Ana V

    2016-02-01

    Decrements in sleep health, including insufficient sleep duration, irregular timing of sleep, poor sleep quality, and sleep/circadian disorders, are widespread in modern society and are associated with an array of disease risks and outcomes, including those contributing to health disparities (eg, cardiovascular disease, obesity and diabetes, psychiatric illness, and cancer). Recent findings have uncovered racial/ethnic and socioeconomic position differences in sleep health; however, the contribution of sleep deficiency to health disparities remains largely unexplored, and understanding the underlying causes of disparities in sleep health is only beginning to emerge. In 2011, the National Heart, Lung, and Blood Institute (NHLBI) convened a workshop, bringing together sleep and health disparities investigators, to identify research gaps and opportunities to advance sleep and health disparities science. This article provides a brief background and rationale for the workshop, and it disseminates the research recommendations and priorities resulting from the working group discussions. Published by Elsevier B.V.

  1. The relation among sleep duration, homework burden, and sleep hygiene in chinese school-aged children.

    PubMed

    Sun, Wan-Qi; Spruyt, Karen; Chen, Wen-Juan; Jiang, Yan-Rui; Schonfeld, David; Adams, Ryan; Tseng, Chia-Huei; Shen, Xiao-Ming; Jiang, Fan

    2014-09-03

    Insufficient sleep in school-aged children is common in modern society, with homework burden being a potential risk factor. The aim of this article is to explore the effect of sleep hygiene on the association between homework and sleep duration. Children filled out the Chinese version of the Adolescent Sleep Hygiene Scale, and parents filled out a sociodemographic questionnaire. The final sample included 363 boys and 371 girls with a mean age of 10.82 ± 0.38 years. Children with more homework went to bed later and slept less. Better sleep hygiene was associated with earlier bedtimes and longer sleep duration. Findings suggest that homework burden had a larger effect on sleep duration than sleep hygiene. Fifth-grade children in Shanghai have an excessive homework burden, which overwrites the benefit of sleep hygiene on sleep duration.

  2. 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.

    PubMed

    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.

  3. The role of drug-induced sleep endoscopy in the diagnosis and management of obstructive sleep apnoea syndrome: our personal experience.

    PubMed

    DE Corso, E; Fiorita, A; Rizzotto, G; Mennuni, G F; Meucci, D; Giuliani, M; Marchese, M R; Levantesi, L; Della Marca, G; Paludetti, G; Scarano, E

    2013-12-01

    Nowadays, drug-induced sleep endoscopy (DISE) is performed widely and its validity and reliability has been demonstrated by several studies; in fact, it provides clinical information not available by routine clinical inspection alone. Its safety and utility are promising, but still needs to be improved to reach the level of excellence expected of gold standard tests used in clinical practice. Our study compares the results of clinical and diagnostic evaluation with those of sleep endoscopy, evaluating the correlation between clinical indexes of routine clinical diagnosis and sites of obstruction in terms of number of sites involved, entity of obstruction and pattern of closure. This study consists in a longitudinal prospective evaluation of 138 patients who successfully underwent sleep endoscopy at our institution. Patients were induced to sleep with a low dose of midazolam followed by titration with propofol. Sedation level was monitored using bispectral index monitoring. Our results suggest that the multilevel complete collapse was statistically significantly associated with higher apnoea hypopnea index values. By including partial sites of obstruction greater than 50%, our results also suggest that multilevel collapse remains statistically and significantly associated with higher apnoea hypopnoea index values. Analyzing BMI distribution based on number of sites with complete and partial obstruction there was no significant difference. Finally, analyzing Epworth Sleepiness Score distribution based on number of sites with complete obstruction, there was a statistically significant difference between patients with 3-4 sites of obstruction compared to those with two sites or uni-level obstruction. In conclusion, our data suggest that DISE is safe, easy to perform, valid and reliable, as previously reported. Furthermore, we found a good correlation between DISE findings and clinical characteristics such as AHI and EPS. Consequently, adequate assessment by DISE of all

  4. Associations between preschoolers' daytime and nighttime sleep parameters.

    PubMed

    El-Sheikh, Mona; Arsiwalla, Dilbur D; Staton, Lori; Dyer, W Justin; Vaughn, Brian E

    2013-04-01

    This article examined associations between preschoolers' daytime and nighttime sleep parameters. A total of 63 preschoolers (65% boys; age: M = 4.15, SD = 0.62) participated. Sleep was assessed via actigraphy for 4 days and nights. Results are among the first to demonstrate significant associations between sleep parameters (especially sleep quality indexes) examined actigraphically at home and in child care contexts. Findings indicate that poor sleep quality indexed by greater sleep activity and awakenings, as well as less efficient sleep, were associated across nighttime sleep at home and daytime sleep in child care. Understanding connections between sleep across contexts has important implications for child care providers and parents as they attempt to facilitate child sleep during a developmental period of rapidly changing sleep patterns.

  5. Sleep physiology and sleep-disordered breathing: the essentials.

    PubMed

    Primhak, Robert; Kingshott, Ruth

    2012-01-01

    Sleep is essential, but poses a risk to breathing in some children. We have outlined the developmental changes in sleep patterns and physiology, and the evidence of deleterious effects of sleep deprivation and of sleep-related breathing disorder (SRBD). Some factors increase the risk of adenotonsillar surgery and should be excluded before contemplating surgery in a secondary care setting. Screening for SRBD is indicated in some conditions, which are discussed. Although simple studies may suffice for many patients, there are a few who need more detailed assessment with polysomnography. A managed clinical network would be the most appropriate model to ensure appropriate organisation and utilisation of scarce resources in this area.

  6. Review article: potential mechanisms of action of rifaximin in the management of hepatic encephalopathy and other complications of cirrhosis.

    PubMed

    Bajaj, J S

    2016-01-01

    Progressive gut milieu (microbiota) changes occur in patients with cirrhosis and are associated with complications [e.g. hepatic encephalopathy (HE)]. To examine the role of rifaximin in the management of HE and other complications of cirrhosis, including potential mechanisms of action and the need for future studies. A literature search was conducted using the keywords 'rifaximin', 'hepatic encephalopathy', 'ascites', 'variceal bleeding', 'peritonitis', 'portal hypertension', 'portopulmonary hypertension' and 'hepatorenal syndrome'. The nonsystemic agent rifaximin reduces the risk of HE recurrence and HE-related hospitalisations in cirrhosis. In patients with cirrhosis, rifaximin modulates the bacterial composition of the gut microbiota without a consistent effect on overall faecal microbiota composition. However, rifaximin can impact the function or activities of the gut microbiota. For example, rifaximin significantly increased serum levels of long-chain fatty acids and carbohydrate metabolism intermediates in patients with minimal HE. Rifaximin also favourably affects serum proinflammatory cytokine and faecal secondary bile acid levels. The gut microenvironment and associated microbiota play an important role in the pathogenesis of HE and other cirrhosis-related complications. Rifaximin's clinical activity may be attributed to effects on metabolic function of the gut microbiota, rather than a change in the relative bacterial abundance. © 2015 John Wiley & Sons Ltd.

  7. Sleep apnoea in the child.

    PubMed

    Nixon, Gillian M; Davey, Margot

    2015-06-01

    Obstructive sleep apnoea (OSA) is a condition causing repetitive episodes of upper airway obstruction during sleep, leading to hypoxia and/or sleep disturbance. OSA affects 1-5% of children and has important implications for learning, behaviour and cardiovascular health. The aim of this article is to provide a suggested approach to case finding and treatment of OSA for general practitioners. Snoring or noisy breathing during sleep is the cardinal symptom of OSA, and should be specifically sought in children with disturbed sleep, nasal obstruction and large tonsils. Multi-channel physiological recording in a paediatric sleep laboratory is available to formally define the condition. Treatment with adenotonsillectomy usually leads to improvements in key domains. Milder disease may respond to intranasal steroids or anti-inflammatory agents.

  8. Physician Education in Sleep Disorders.

    ERIC Educational Resources Information Center

    Orr, William C.; And Others

    1980-01-01

    The lack of physician knowledge in the diagnosis and management of sleep disorders is discussed. An examination of physicians demonstrated knowledge deficiencies and a survey of medical schools showed that 46 percent offered no training in the area of sleep physiology or disorders. Recommendations for addressing the situation are offered. (JMD)

  9. A retrospective analysis of airway management in patients with obstructive sleep apnea and its effects on postanesthesia care unit length of stay.

    PubMed

    Brousseau, Claire A; Dobson, Gregory R; Milne, Andrew D

    2014-01-01

    Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing characterized by periods of partial or complete obstruction of the upper airway during sleep, resulting in oxygen desaturations. Symptoms and risk factors for OSA are of particular importance in the management of OSA patients in the perioperative setting. The present study collected data regarding the intraoperative airway management of OSA patients and their course in the postanesthesia care unit (PACU) over a six-month period. A total of 86 patients underwent general anesthesia, 63 of whom were intubated by direct laryngoscopy. Of these, 43% were classified as a grade 1 view by direct laryngoscopy, 43% were grade 2 and 14% were classified as grade 3. Apnea events or periods of desaturation in the PACU were observed in 27% of cases. Length of stay was significantly longer for cases in which PACU nurses had indicated that OSA had affected the individuals' postoperative course of treatment. Overall, OSA patients had an increased frequency of grade 3 views compared with the general population, and adjuncts were commonly used to help secure the airway in OSA patients. Symptomatic OSA patients placed increased demands on the PACU in terms of length of stay and hospital resources.

  10. Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies.

    PubMed

    Linz, Dominik; Fox, Henrik; Bitter, Thomas; Spießhöfer, Jens; Schöbel, Christoph; Skobel, Erik; Türoff, Anke; Böhm, Michael; Cowie, Martin R; Arzt, Michael; Oldenburg, Olaf

    2016-07-01

    Sleep disordered breathing (SDB) (obstructive sleep apnea, central sleep apnea/Cheyne-Stokes respiration or the combination of both) is highly prevalent in patients with a wide variety of cardiovascular diseases including hypertension, arrhythmia, coronary artery disease, myocardial infarction and stroke (reviewed previously in the September issue of this journal). Its close association with outcomes in chronic heart failure with reduced ejection fraction (HF-REF) suggests that it may be a potential treatment target. Herein, we provide an update on SDB and its treatment in HF-REF.

  11. Sleep Deprivation.

    PubMed

    Abrams, Robert M

    2015-09-01

    Sleep deprivation occurs when inadequate sleep leads to decreased performance, inadequate alertness, and deterioration in health. It is incompletely understood why humans need sleep, although some theories include energy conservation, restoration, and information processing. Sleep deprivation has many deleterious health effects. Residency programs have enacted strict work restrictions because of medically related errors due to sleep deprivation. Because obstetrics is an unpredictable specialty with long irregular hours, enacting a hospitalist program enhances patient safety, decreases malpractice risk, and improves the physician's quality of life by allowing obstetricians to get sufficient rest.

  12. Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

    PubMed Central

    Vasu, Tajender S.; Grewal, Ritu; Doghramji, Karl

    2012-01-01

    Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. Citation: Vasu TS; Grewal R; Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 2012;8(2):199-207. PMID:22505868

  13. Understanding older peoples' decisions about the use of sleeping medication: issues of control and autonomy.

    PubMed

    Venn, Susan; Arber, Sara

    2012-11-01

    Poor sleep is known to impact on health and wellbeing in later life and has implications for the ability of older people to remain active during the day. Medical treatments for chronic poor sleep have primarily included the regular, long-term prescribing of hypnotics, which are known to impact on older people's health, cognitive function and quality of life. Therefore, recent policy and practice has focused on reducing such prescribing, on encouraging older people to stop taking long-term hypnotics and on finding alternative, non-pharmacological ways to manage poor sleep. However, little research has been undertaken to understand the perspectives of older people who choose not to seek professional help for their poor sleep, despite the potential impact of poor sleep on their health and ability to remain active. Through in-depth interviews with 62 older men and women living in their own homes in England, this article explores the factors that deter older people from seeking professional help for their poor sleep. We argue that these are located in their perceptions of the normativity of poor sleep in later life, their beliefs about prescription sleeping medications and their desire to maintain control and autonomy over their everyday and night lives.

  14. The significance of intraocular pressure elevation during sleep-related postures.

    PubMed

    McMonnies, Charles W

    2014-05-01

    Intraocular pressure and its fluctuations are associated with the development and progression of glaucoma. This review examines the potential for sleep-related intraocular pressure elevations to contribute to the onset and progression of glaucoma. Also considered is the potential for patient education and appropriate changes in behaviour as a means of reducing exposure to elevated intraocular pressure. A PubMed search using the combination key words 'glaucoma and sleep' was conducted. Information was taken from representative articles from the 187 yielded from the search. Additional papers were found after accessing references in selected papers. Several studies have indicated an association between the progression of glaucoma and both lateral decubitus (side sleep) and supine sleep positions. Evidence that prone sleep positions could raise intraocular pressure to high levels suggests a similar if not stronger association. Intraocular pressure elevation and progression of glaucoma associated with sleep positions suggest that there are similar risks of progression associated with sleep-related body postures adopted during non-sleep activities, such as reading, watching television and sun-bathing. Posture-related management of patients with glaucoma, which is intended to reduce the risk or degree of progression may include the use of specially designed pillows, bed-head elevation and recommendations to avoid postures which induce higher intraocular pressure.

  15. Sleep As A Strategy For Optimizing Performance.

    PubMed

    Yarnell, Angela M; Deuster, Patricia

    2016-01-01

    Recovery is an essential component of maintaining, sustaining, and optimizing cognitive and physical performance during and after demanding training and strenuous missions. Getting sufficient amounts of rest and sleep is key to recovery. This article focuses on sleep and discusses (1) why getting sufficient sleep is important, (2) how to optimize sleep, and (3) tools available to help maximize sleep-related performance. Insufficient sleep negatively impacts safety and readiness through reduced cognitive function, more accidents, and increased military friendly-fire incidents. Sufficient sleep is linked to better cognitive performance outcomes, increased vigor, and better physical and athletic performance as well as improved emotional and social functioning. Because Special Operations missions do not always allow for optimal rest or sleep, the impact of reduced rest and sleep on readiness and mission success should be minimized through appropriate preparation and planning. Preparation includes periods of "banking" or extending sleep opportunities before periods of loss, monitoring sleep by using tools like actigraphy to measure sleep and activity, assessing mental effectiveness, exploiting strategic sleep opportunities, and consuming caffeine at recommended doses to reduce fatigue during periods of loss. Together, these efforts may decrease the impact of sleep loss on mission and performance. 2016.

  16. Maternal and infant sleep postpartum.

    PubMed

    McGuire, Elizabeth

    2013-07-01

    New parents should be aware that infants' sleep is unlike that of adults and that meeting their infant's needs is likely to disrupt their own sleep. They will need to adjust their routine to manage their own sleep needs. Parental sleep patterns in the postpartum period are tied to the infant's development of a circadian sleep-wake rhythm, and the infant's feeds. Close contact with the mother and exposure to light/dark cues appear to assist in the development of the infant's circadian rhythm. The composition of breastmilk varies over the course of 24 hours and some components produced at night are likely to contribute to the infant's day/night entrainment. There is no clear evidence that using artificial feeds improves maternal sleep. Most infants need night feeds but requirements for nighttime feeds vary with the individual.

  17. Sleep Monitoring Experiment - Skylab Experiment M133

    NASA Technical Reports Server (NTRS)

    1970-01-01

    This 1970 photograph shows equipment for the Skylab's Sleep Monitoring Experiment (M133), a medical evaluation designed to objectively determine the amount and quality of crewmembers' inflight sleep. The experiment monitored and recorded electroencephalographic (EEG) and electrooculographic (EOG) activity during astronauts' sleep periods. One of the astronauts was selected for this experiment and wore a fitted cap during his sleep periods. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

  18. [Sleep disorder and pain: the good hypnotic].

    PubMed

    Perrig, S; Espa-Cervena, K; Pépin, J L

    2011-06-29

    Chronic pain and sleep disorder can put the patient in a vicious circle (bidirectional relation between those two morbid entities). Clinical management must be global. The physiopathology includes chronic sleep deficit, mainly in deep sleep (the "restoring" sleep) generated principally by the prefrontal regions. These areas are also implicated in the modulation of pain. To break this "loops", we advocate an approach based on three main components: hygiene principles, cognitive and behavioral therapy, medications with analgesic and hypnotic proprieties.

  19. A randomized controlled trial of an ambulatory approach versus the hospital-based approach in managing suspected obstructive sleep apnea syndrome

    PubMed Central

    Hui, David S.; Ng, Susanna S.; To, Kin-Wang; Ko, Fanny W.; Ngai, Jenny; Chan, Ken K. P.; Yip, Wing-Ho; Chan, Tat-On; Yiu, Karen; Tam, Wilson W. S.

    2017-01-01

    Comparisons of home-based versus hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome(OSAS). A prospective, controlled CPAP parallel study of new referrals with suspected OSAS randomized into group A) home-based or B) hospital-based approach. Following detection of AHI ≥ 15/hr by Embletta sleep study (group A) or polysomnography (group B), patients received CPAP for 3 months after an overnight autoCPAP titration at home or in hospital respectively. Modified intention-to-treat analysis of those with AHI ≥ 15/hr on CPAP (n = 86 vs 86) showed no difference in Epworth sleepiness score, the primary endpoint, but greater improvement in Sleep-Apnoea-Quality-of-Life-Index[difference 0.3,(95%CI 0.02, 0.6), p = 0.033] at 3 months in group A. The mean costs for the patients in group A and group B were HK$8479(989) and HK$22,248(2407) respectively. The mean difference between groups was HK$-13,769(USD 1770 equivalent) per patient with 95% CI. (−14324, −13213), p < 0.001. The waiting time of patients with AHI ≥ 15/hr who were started on CPAP treatment from the first clinic consultation to the diagnostic sleep test, autoCPAP titration, and CPAP treatment was 189.6, 148.8 and 145.0 days shorter in group A than group B respectively. Home-based approach is non-inferior to hospital-based approach in managing patients with suspected OSAS, with shorter waiting time, and substantial cost savings. PMID:28374832

  20. The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010.

    PubMed

    Alexander, Melannie; Ray, Meredith A; Hébert, James R; Youngstedt, Shawn D; Zhang, Hongmei; Steck, Susan E; Bogan, Richard K; Burch, James B

    2016-07-01

    A large proportion of individuals affected by sleep disorders are untreated and susceptible to accidents, injuries, long-term sequelae (e.g., risk of cardiovascular disease, cancer, psychiatric disorders), and increased mortality risk. Few studies have examined the scope and magnitude of sleep disorder diagnoses in the United States (US) or factors influencing them. Veterans are particularly vulnerable to factors that elicit or exacerbate sleep disorders. This serial cross-sectional study characterized secular trends in diagnosed sleep disorders among veterans seeking care in US Veterans Health Administration facilities over an eleven-year span (FY2000-2010, n = 9,786,778). Electronic medical records from the national Veterans Administration Informatics and Computing Infrastructure database were accessed. Cases were defined using diagnostic codes specified by the American Academy of Sleep Medicine. Age-adjusted annual prevalence was summarized by sex, race, combat exposure, body mass index, and comorbid diagnoses (cardiovascular disease, cancer, mental disorders). Sleep apnea (47%) and insomnia (26%) were the most common diagnoses among patients with any sleep disorder. There was a six-fold relative increase in total sleep disorder prevalence over the study period. Posttraumatic stress disorder, which tripled over the same time period, was associated with the highest prevalence of sleep disorders (16%) among the comorbid conditions evaluated. The results indicate a growing need for integration of sleep disorder management with patient care and health care planning among US veterans. A commentary on this article appears in this issue on page 1331. © 2016 Associated Professional Sleep Societies, LLC.

  1. Sleep disordered breathing in pregnancy

    PubMed Central

    2015-01-01

    Key points Sleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses. Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m−2) could be reliable indicators for SDB in early pregnancy. SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy. Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations. There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain. Educational aims To highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population. To inform readers about risk factors for SDB in pregnancy. To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes. To introduce current management options for SDB in pregnancy, including medical and behavioural approaches. Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the

  2. Excessive Daytime Sleepiness and Unintended Sleep Episodes Associated with Parkinson’s Disease

    PubMed Central

    Salawu, Fatai; Olokoba, Abdulfatai

    2015-01-01

    This article looks at the issues of excessive daytime sleepiness and unintended sleep episodes in patients with Parkinson’s disease (PD) and explores the reasons why patients might suffer from these symptoms, and what steps could be taken to manage them. During the last decade, understanding of sleep/wake regulation has increased. Several brainstem nuclei and their communication pathways in the ascending arousing system through the hypothalamus and thalamus to the cortex play key roles in sleep disorders. Insomnia is the most common sleep disorder in PD patients, and excessive daytime sleepiness is also common. Excessive daytime sleepiness affects up to 50% of PD patients and a growing body of research has established this sleep disturbance as a marker of preclinical and premotor PD. It is a frequent and highly persistent feature in PD, with multifactorial underlying pathophysiology. Both age and disease-related disturbances of sleep-wake regulation contribute to hypersomnia in PD. Treatment with dopamine agonists also contribute to excessive daytime sleepiness. Effective management of sleep disturbances and excessive daytime sleepiness can greatly improve the quality of life for patients with PD. PMID:25829994

  3. [Physicians see both pros and cons of health care financial management. Questionnaire study provides more insights--with starting point in controversial DN-article series].

    PubMed

    Björk, Joar; Petersson, Christer

    2015-05-12

    In the spring of 2013, the Swedish journalist Maciej Zaremba wrote a series of articles criticizing the impact of NPM (New Public Management) on Swedish health care. The present study examines the views of experienced Swedish physicians (general practitioners and internal medicine speclialists) on the problems focused in Mr Zaremba's article series. The respondents (51 general practitioners and 61 internal medicine specialists) mention advantages as well as disadvantages with NPM in Swedish health care. The majority agrees that with NPM, physicians loose influence over health care governance to other professional groups. The majority disagree with the charge made by Mr Zaremba that NPM has had the effect of manipulating Swedish physicians away from the standards of good medical care.

  4. Mammalian sleep

    NASA Astrophysics Data System (ADS)

    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.

  5. Gifted Students and Sleep

    ERIC Educational Resources Information Center

    Harsh, John; Karnes, Frances; Eiers, Patrick

    2012-01-01

    In this article, the authors emphasize that good sleep health is essential if gifted children are to gain the greatest benefit from opportunities to grow intellectually, socially, and spiritually while maintaining good psychological and physical health. The outstanding abilities that characterize these children and enable high levels of…

  6. Gifted Students and Sleep

    ERIC Educational Resources Information Center

    Harsh, John; Karnes, Frances; Eiers, Patrick

    2012-01-01

    In this article, the authors emphasize that good sleep health is essential if gifted children are to gain the greatest benefit from opportunities to grow intellectually, socially, and spiritually while maintaining good psychological and physical health. The outstanding abilities that characterize these children and enable high levels of…

  7. Sleeping in fits and starts: a practical guide to distinguishing nocturnal epilepsy from sleep disorders.

    PubMed

    Derry, Christopher P

    2014-12-01

    Accurately diagnosing sleep-related events, and particularly distinguishing nocturnal frontal lobe seizures from other sleep disorders such as parasomnias, can be challenging. This article reviews the differential diagnosis of paroxysmal events from sleep, epileptic and non-epileptic, considers important diagnostic points in the history, and evaluates the role of investigations in this setting.

  8. Obstructive sleep apnea.

    PubMed

    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.

  9. Obstructive sleep apnea

    PubMed Central

    Ho, Matthew L.; Brass, Steven D.

    2011-01-01

    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. PMID:22368774

  10. Sleep: A 'Wake-up' Call.

    PubMed

    Dhamangaonkar, A C

    2013-11-01

    This report aims to attract attention toward the importance of sleep in medical students and young resident doctors. With growing stress levels among students, sleep problems have become a common affair. Concepts like sleep disorders, chronotypes, indicators of sleep deprivation are worth knowing. As found in a questionnaire-based review, significant gaps in sleep education exist today among medical students. There are many health hazards of sleep deprivation like anxiety, depression, hypertension, obesity, diabetes, increased error rate at work, breast malignancy, decreased dexterity and adverse impact on academic performance that are dealt with in this article. These issues are not covered well in the conventional didactic lectures on 'sleep' in the medical curriculum. The medical profession demands health caregivers to stay up all night and keep working. Hence, the current medical education curriculum should lay special emphasis on sleep education.

  11. Development of a Five-Dimensional Measure of Adult Sleep Quality

    ERIC Educational Resources Information Center

    Fortunato, Vincent J.; LeBourgeois, Monique K.; Harsh, John

    2008-01-01

    This article describes the development of a measure of adult sleep quality: the Adult Sleep-Wake Scale (ADSWS). The ADSWS is a self-report pencil-and-paper measure of sleep quality consisting of five behavioral dimensions (Going to Bed, Falling Asleep, Maintaining Sleep, Reinitiating Sleep, and Returning to Wakefulness). Data were collected from…

  12. Development of a Five-Dimensional Measure of Adult Sleep Quality

    ERIC Educational Resources Information Center

    Fortunato, Vincent J.; LeBourgeois, Monique K.; Harsh, John

    2008-01-01

    This article describes the development of a measure of adult sleep quality: the Adult Sleep-Wake Scale (ADSWS). The ADSWS is a self-report pencil-and-paper measure of sleep quality consisting of five behavioral dimensions (Going to Bed, Falling Asleep, Maintaining Sleep, Reinitiating Sleep, and Returning to Wakefulness). Data were collected from…

  13. American Sleep Association

    MedlinePlus

    ... Sleep Disorders Book Join ASA Press Room American Sleep Association Improving public health by increasing awareness about ... Members Username or Email Password Remember Me Register Sleep Blog Changing Bad Sleep Habits Asthma and Sleep ...

  14. Sleep Terrors (Night Terrors)

    MedlinePlus

    ... can contribute to sleep terrors, such as: Sleep deprivation and extreme tiredness Stress Sleep schedule disruptions, travel ... Risk factors Sleep terrors are more common if family members have a history of sleep terrors or ...

  15. Sleep Deprivation and Deficiency

    MedlinePlus

    ... page from the NHLBI on Twitter. What Are Sleep Deprivation and Deficiency? Sleep deprivation (DEP-rih-VA- ... Rate This Content: NEXT >> Updated: June 7, 2017 Sleep Infographic Sleep Disorders & Insufficient Sleep: Improving Health through ...

  16. Sleep and hypnotic drugs.

    PubMed

    Johns, M W

    1975-01-01

    In recent years the effectiveness of hypnotic drugs has had to be assessed in terms of a greatly increased knowledge of the physiology and pathology of sleep. The normal pattern of sleep and wakefulness involves a cyclic alternation between three rather than two basically dissimilar states of the brain and body - alert wakefulness, rapid-eye-movement (REM) sleep and non-rapid-eye-movement (NREM) sleep. The pattern of this alternation in individual people results from the interaction of many influences - biological (including genetic, early developmental and later degenerative influences), psychological, social and environmental factors, various physical and psychiatric disorders, and most drugs which affect the central nervous system. The quality of sleep is not related in any simple or constant manner either to its duration or to the proprotions of time spent in each stage of sleep. Among the disorders of sleep, insomnia is a far more common problem of medical management than are enuresis, narcolepsy, somnambulism or nightmares. With a few exceptions, most hypnotic drugs now in widespread use cease to be effective in treating insomnia after the first few nights. However, the ineffective treatment is often continued because insomnia will be even worse during the initial period of drug withdrawal. These factors and the toxicity of hypnotic drugs when taken in overdose make the long-term treatment of insomnia more difficult than was previously supposed. Barbiturates should no longer be prescribed. Some of the non-barbiturates, such as glutethimide and methaqualone, have no advantage over the barbiturates. The benzodiazepine hypnotics, nitrazepam and flurazepam, are less toxic in overdose and are relatively effective in treating insomnia. Chloral hydrate and its derivates are useful alternative drugs for short-term use. Measures to improve sleep without drugs deserve greater emphasis than they have had in the past.

  17. Sleep in the intensive care unit.

    PubMed

    Beltrami, Flávia Gabe; Nguyen, Xuân-Lan; Pichereau, Claire; Maury, Eric; Fleury, Bernard; Fagondes, Simone

    2015-01-01

    Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.

  18. Sleep in the intensive care unit

    PubMed Central

    Beltrami, Flávia Gabe; Nguyen, Xuân-Lan; Pichereau, Claire; Maury, Eric; Fleury, Bernard; Fagondes, Simone

    2015-01-01

    ABSTRACT Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion. PMID:26785964

  19. SLEEP DEPRIVATION,

    DTIC Science & Technology

    This report was confined to considering the effects of sleep deprivation , in man, with particular reference to studies of the resulting biochemical...have a limited value when taken separately: the biochemical and physiological changes that occur in response to sleep deprivation may depend...three separate heads: first, the biochemical changes resulting from sleep deprivation ; secondly, the physiological ones; and last, the changes in performance and behaviour. (Author)

  20. [Perioperative management of an obese patient complicated with sleep apnea syndrome (SAS) undergoing awake craniotomy].

    PubMed

    Komayama, Noriaki; Kamata, Kotoe; Maruyama, Takashi; Nitta, Masayuki; Muragaki, Yoshihiro; Ozaki, Makoto

    2014-10-01

    Both obesity (BMI over 30) and SAS are risks for Supper airway maintenance. We report an obese patient (BMI 33.5) with SAS who underwent awake craniotomy. Weight reduction was instructed 1 month before the operation, and the patient lost enough weight to use intraoperative MRI. Under general anesthesia, surgical pads containing 2% lidocaine with adrenaline were inserted into the nasal cavities. The patient's airway S was secured by i-gel® until dura was opened. A nasal airway was then inserted to confirm the upper airway patency and anesthetics were terminated The patient regained consciousness and started respiration. The i-gel® was removed. The nasal airway was changed to an RAE tracheal tube ; the tube was fixed above the vocal cords under bronchofiberscopic observation. Continuous positive airway pressure (CPAP) via RAE tube was started. Neither coughing nor epistaxis was observed.The RAE tube prevented glossoptosis and did not disturb speech mapping. Emergent endotracheal intubation was easily managed because the tube was close to the glottis. The RAE tube was removed and nasal CP AP was applied overnight Carefully prepared CP AP support via nasal RAE tube was practical in keeping upper airway patency for an obese patient complicated with SAS undergoing awake craniotomy.

  1. Relationships between parental sleep quality, fatigue, cognitions about infant sleep, and parental depression pre and post-intervention for infant behavioral sleep problems.

    PubMed

    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

  2. Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation

    PubMed Central

    Irwin, Michael R.; Olmstead, Richard; Carroll, Judith E.

    2015-01-01

    Background Sleep disturbance is associated with inflammatory disease risk and all-cause mortality. Here, we assess global evidence linking sleep disturbance, sleep duration, and inflammation in adult humans. Methods A systematic search of English language publications was performed, with inclusion of primary research articles that characterized sleep disturbance and/or sleep duration or performed experimental sleep deprivation, and assessed inflammation by levels of circulating markers. Effect sizes (ES) and 95% confidence intervals (CI) were extracted and pooled using a random effect model. Results A total of 72 studies (n>50000) were analyzed with assessment of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF). Sleep disturbance was associated with higher levels of CRP (ES 0.12; 95% CI 0.05 – 0.19) and IL-6 (ES 0.20; 95% CI 0.08 – 0.31). Shorter sleep duration, but not the extreme of short sleep, was associated with higher levels of CRP (ES 0.09; 95% CI 0.01 – 0.17) but not IL-6 (ES 0.03; 95% CI −0.09 – 0.14). The extreme of long sleep duration was associated with higher levels of CRP (ES 0.17; 95% CI 0.01 – 0.34) and IL-6 (ES 0.11; 95% CI 0.02 – 0.20). Neither sleep disturbances nor sleep duration was associated with TNF. Neither experimental sleep deprivation nor sleep restriction was associated with CRP, IL-6, or TNF. Some heterogeneity among studies was found, but no evidence of publication bias. Conclusions Sleep disturbance and long sleep duration, but not short sleep duration, are associated with increases in markers of systemic inflammation. PMID:26140821

  3. Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation.

    PubMed

    Irwin, Michael R; Olmstead, Richard; Carroll, Judith E

    2016-07-01

    Sleep disturbance is associated with inflammatory disease risk and all-cause mortality. Here, we assess global evidence linking sleep disturbance, sleep duration, and inflammation in adult humans. A systematic search of English language publications was performed, with inclusion of primary research articles that characterized sleep disturbance and/or sleep duration or performed experimental sleep deprivation and assessed inflammation by levels of circulating markers. Effect sizes (ES) and 95% confidence intervals (CI) were extracted and pooled using a random effect model. A total of 72 studies (n > 50,000) were analyzed with assessment of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNFα). Sleep disturbance was associated with higher levels of CRP (ES .12; 95% CI = .05-.19) and IL-6 (ES .20; 95% CI = .08-.31). Shorter sleep duration, but not the extreme of short sleep, was associated with higher levels of CRP (ES .09; 95% CI = .01-.17) but not IL-6 (ES .03; 95% CI: -.09 to .14). The extreme of long sleep duration was associated with higher levels of CRP (ES .17; 95% CI = .01-.34) and IL-6 (ES .11; 95% CI = .02-20). Neither sleep disturbances nor sleep duration was associated with TNFα. Neither experimental sleep deprivation nor sleep restriction was associated with CRP, IL-6, or TNFα. Some heterogeneity among studies was found, but there was no evidence of publication bias. Sleep disturbance and long sleep duration, but not short sleep duration, are associated with increases in markers of systemic inflammation. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  4. Yoga for the management of pain and sleep in rheumatoid arthritis: a pilot randomized controlled trial.

    PubMed

    Ward, Lesley; Stebbings, Simon; Athens, Josie; Cherkin, Daniel; David Baxter, G

    2017-06-16

    The aim of the present study was to determine the feasibility of a relaxation-based yoga intervention for rheumatoid arthritis, designed and reported in accordance with Delphi recommendations for yoga interventions for musculoskeletal conditions. Participants were recruited from a hospital database, and randomized to either eight weekly 75-min yoga classes or a usual care control. Feasibility was determined by recruitment rates, retention, protocol adherence, participant satisfaction and adverse events. Secondary physical and psychosocial outcomes were assessed using self-reported questionnaires at baseline (week 0), week 9 (primary time point) and week 12 (follow-up). Over a 3-month period, 26 participants with mild pain, mild to moderate functional disability and moderate disease activity were recruited into the study (25% recruitment rate). Retention rates were 100% for yoga participants and 92% for usual care participants at both weeks 9 and 12. Protocol adherence and participant satisfaction were high. Yoga participants attended a median of seven classes; additionally, seven of the yoga participants (54%) reported continuing yoga at home during the follow-up period. No serious adverse events were related to the study. Secondary outcomes showed no group effects of yoga compared with usual care. A relaxation-based yoga programme was found to be feasible and safe for participants with rheumatoid arthritis-related pain and functional disability. Adverse events were minor, and not unexpected from an intervention including physical components. This pilot provides a framework for larger intervention studies, and supports further exploration of yoga as a complex intervention to assist with the management of rheumatoid arthritis. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Sleep paralysis as spiritual experience.

    PubMed

    Hufford, David J

    2005-03-01

    This article presents an overview of the sleep paralysis experience from both a cultural and a historical perspective. The robust, complex phenomenological pattern that represents the subjective experience of sleep paralysis is documented and illustrated. Examples are given showing that, for a majority of subjects, sleep paralysis is taken to be a kind of spiritual experience. This is, in part, because of the very common perception of a non-physical 'threatening presence' that is part of the event. Examples from various cultures, including mainstream contemporary America which has no widely known tradition about sleep paralysis, are used to show that the complex pattern and spiritual interpretation are not dependent on cultural models or prior learning. This is dramatically contrary to conventional explanations of apparently 'direct' spiritual experiences, explanations that are summed up as the 'Cultural Source Hypothesis.' This aspect of sleep paralysis was not recognized through most of the twentieth century. The article examines the way that conventional modern views of spiritual experience, combined with medical ideas that labeled 'direct' spiritual experiences as psychopathological, and mainstream religious views of such experiences as heretical if not pathological, suppressed the report and discussion of these experiences in modern society. These views have resulted in confusion in the scientific literature on sleep paralysis with regard to its prevalence and core features. The article also places sleep paralysis in the context of other 'direct' spiritual experiences and offers an 'Experiential Theory' of cross-culturally distributed spiritual experiences.

  6. Sleep Quality in Family Caregivers of Individuals With Dementia: A Concept Analysis.

    PubMed

    Peng, Hsi-Ling; Lorenz, Rebecca A; Chang, Yu-Ping

    2016-08-01

    Poor sleep quality in family caregivers may impact their health status and cause quality of life to decline. Nurses are conducting an increasing number of studies that use sleep quality or related concepts as a main indicator to assess caregiver's sleep. Therefore, a clear understanding of sleep quality and how it is different from other relevant sleep domains is essential. This article aimed to analyze the concept of sleep quality using the steps outlined by Walker and Avant. Findings include (a) attributes of sleep quality including subjective perception of sleep, sleep hours, and evaluation of activity after awaking; (b) antecedents of sleep quality including the ability to get naturally into the sleep cycle and status of conscious state; and (c) consequences of sleep quality including bio-psycho-social and global dimensions of health. This article intends to help clinicians and researchers better understand and define sleep quality in dementia caregivers. © The Author(s) 2015.

  7. Monetary value of undisturbed sleep.

    PubMed

    Riethmüller, Sebastian; Müller-Wenk, Ruedi; Knoblauch, Andreas; Schoch, Otto D

    2008-01-01

    To design a national antinoise policy, we need to know the monetary value that people attach to the reduction of sleep disturbance due to road traffic noise. Patients with obstructive sleep apnea syndrome (OSAS) controlled by nasal continuous positive airway pressure (nCPAP) underwent one-to-one structured interviews to determine the monetary value of their resultant undisturbed sleep. This was then converted into a value for sleep undisturbed by noise, using a severity ratio. Outpatient interviews in 67 OSAS patients (54 males, 28 to 73 years old) managed by the Center for Sleep Medicine, Kantonsspital, St. Gallen, Switzerland. The interview questions addressed the outcome and difficulties of nCPAP therapy, the self-rated severity of pretreatment sleep disturbance and self-rated monetary value of sleep improvement. Thirteen OSAS patients who had also experienced noise-related sleep disturbance rated its severity on a visual analogue scale (VAS). The mean monetary value of nCPAP-controlled sleep disturbance was Swiss francs (CHF) 70/night (CHF1 = US$ 0.877, year end 2004; 25th and 75th percentiles: CHF 35 and CHF 100). Interviewees maintained this high estimate after learning that the actual treatment costs were only approximately 6 CHF/night. A severity ratio ranging from 2.3:1 to 4.7:1 for sleep disturbance resulting from OSAS or from noise was derived from patients' responses and literature. The value of noise-free sleep was CHF 7.45-23.81 per night. Sleep undisturbed by noise has a remarkably high monetary value for people, which should be considered in political decision-making.

  8. Sleep and Mood During Pregnancy and the Postpartum Period.

    PubMed

    Bei, Bei; Coo, Soledad; Trinder, John

    2015-03-01

    During the perinatal period, compromises in sleep duration and quality are commonly reported by women and confirmed by objective measurements of sleep. Self-reported poor sleep has been associated with concurrent mood disturbance and with increased risk for future mood problems during pregnancy and the postpartum period. Findings on the relationship between objectively measured sleep and mood in perinatal women have been mixed. This article reviews the literature on the nature of and contributing factors to perinatal sleep disturbance, the relationship between sleep and mood, and intervention studies that aim to improve maternal sleep.

  9. Instruments to study sleep disorders in climacteric women.

    PubMed

    Monterrosa-Castro, Álvaro; Portela-Buelvas, Katherin; Salguedo-Madrid, Marlon; Mo-Carrascal, Joulen; Duran-Méndez Leidy, Carolina

    2016-01-01

    To identify the scales to assess sleep disorders applied to women with climacteric stage. Bibliographical research without intervention, the available information in scientific databases. Performed in PubMed, ScienceDirect, Scopus, Ebscohos OvidSP and Health Library. The words used in this article: insomnia, adjustment sleep disorder, questionnaires, studies and menopause. Publications of all types were included. Seven scales were identified: Insomnia Severity Index, Athens Insomnia Scale, Pittsburgh Quality of sleep Index, Epworth Sleepiness Scale, Jenkins Sleep Scale, Basic Nordic Sleep Questionnaire and The St Mary's Hospital Sleep Questionnaire. There are validated scales in multiple languages and considered appropriate for studying sleep disorders.

  10. Risk management by labelling 26 fragrances? Evaluation of Article 10 (1) of the seventh Amendment (Guideline 2003/15/EC) of the Cosmetic Directive.

    PubMed

    Klaschka, Ursula

    2010-07-01

    Some fragrance compounds are severe contact allergens. According to the so-called "26 allergens rule" (Article 1 (10) of Directive 2003/15/EC) (EC, 2003), 26 supposedly allergenic fragrances must be listed on the containers of cosmetics products if they are present above certain mass percentages in the product. This declaration is meant to inform the consumer of potential risks of skin sensitizers in the products. The objective of this paper is to validate whether "the 26 allergens rule" meets the expectations to improve consumer protection. The method used for this validation was on one hand a reflection on the elements of the approach used in "the 26 allergens rule" and on the other hand a product analysis of 742 products by 4 large producers of cosmetic products on the German market. It was found that more than 50% of these cosmetic and washing and cleansing products contain at least one of the 26 substances above the thresholds for labelling and that there are 14% of all products which contain strong allergens. Many consumers apparently still buy these products. The indirect effect that producers reduce the amounts of these fragrances to avoid declaration seems to be small. Several arguments were assembled which show that other instruments are needed to ensure consumer protection or protection of the environment. This paper recommends different approaches. The use of a list of single substances in such a directive is not in line with scientific standards. It is recommended to base decision making on comprehensive risk assessments or at least on valid and strong criteria. More parameters need to be involved, not only contact allergy. As illustrated in this article, the roles taken over by authorities and manufacturers in risk management of the "26 allergens" are relatively small compared with the responsibility carried by consumers. However, consumers are only able to take over their part properly if they are sufficiently trained and have the necessary

  11. Sleep and menopause: a narrative review.

    PubMed

    Shaver, Joan L; Woods, Nancy F

    2015-08-01

    Our overall aim-through a narrative review-is to critically profile key extant evidence of menopause-related sleep, mostly from studies published in the last decade. We searched the database PubMed using selected Medical Subject Headings for sleep and menopause (n = 588 articles). Using similar headings, we also searched the Cochrane Library (n = 1), Embase (n = 449), Cumulative Index to Nursing and Allied Health Literature (n = 163), Web of Science (n = 506), and PsycINFO (n = 58). Articles deemed most related to the purpose were reviewed. Results were articulated with interpretive comments according to evidence of sleep quality (self-reported) and sleep patterns (polysomnography and actigraphy) impact as related to reproductive aging and in the context of vasomotor symptoms (VMS; self-reported), vasomotor activity (VMA) events (recorded skin conductance), depressed mood, and ovarian hormones. Predominantly, the menopausal transition conveys poor sleep beyond anticipated age effects. Perceptions of sleep are not necessarily translatable from detectable physical sleep changes and are probably affected by an emotional overlay on symptoms reporting. Sleep quality and pattern changes are mostly manifest in wakefulness indicators, but sleep pattern changes are not striking. Likely contributing are VMS of sufficient frequency/severity and bothersomeness, probably with a sweating component. VMA events influence physical sleep fragmentation but not necessarily extensive sleep loss or sleep architecture changes. Lack of robust connections between perceived and recorded sleep (and VMA) could be influenced by inadequate detection. There is a need for studies of women in well-defined menopausal transition stages who have no sleep problems, accounting for sleep-related disorders, mood, and other symptoms, with attention to VMS dimensions, distribution of VMS during night and day, and advanced measurement of symptoms and physiologic manifestations.

  12. Ancestral sleep.

    PubMed

    de la Iglesia, Horacio O; Moreno, Claudia; Lowden, Arne; Louzada, Fernando; Marqueze, Elaine; Levandovski, Rosa; Pilz, Luisa K; Valeggia, Claudia; Fernandez-Duque, Eduardo; Golombek, Diego A; Czeisler, Charles A; Skene, Debra J; Duffy, Jeanne F; Roenneberg, Till

    2016-04-04

    While we do not yet understand all the functions of sleep, its critical role for normal physiology and behaviour is evident. Its amount and temporal pattern depend on species and condition. Humans sleep about a third of the day with the longest, consolidated episode during the night. The change in lifestyle from hunter-gatherers via agricultural communities to densely populated industrialized centres has certainly affected sleep, and a major concern in the medical community is the impact of insufficient sleep on health [1,2]. One of the causal mechanisms leading to insufficient sleep is altered exposure to the natural light-dark cycle. This includes the wide availability of electric light, attenuated exposure to daylight within buildings, and evening use of light-emitting devices, all of which decrease the strength of natural light-dark signals that entrain circadian systems [3]. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. 'M-apping' sleep? Trends and transformations in the digital age.

    PubMed

    Williams, Simon J; Coveney, Catherine; Meadows, Robert

    2015-09-01

    This article critically explores recent trends and transformations in the monitoring and management of sleep in the digital age, taking as its focus the advent of new digital technologies to trace and track the 'sleep of ourselves' far away from the conventional sleep laboratory or clinic. Our argument is situated dually in the history of sleep science and medicine on the one hand, and the rise of new digital forms of so-called self-tracking and mobile health (m-Health) on the other hand. While the recent history of sleep science and medicine may rightly we suggest, in Kroker's terms, be characterised as a concern with the 'sleep of others', a new chapter in this story may well be dawning through the advent of these smart new mobile tools and technologies for mapping, or 'm-apping' as we term it, the 'sleep of ourselves' in the digital age. The problems and prospects this holds are then critically considered - through the interrelated themes of selfhood, sociality and governance - and some preliminary conclusions ventured in this new digital domain.

  14. Multinight Recording and Analysis of Continuous Positive Airway Pressure Airflow in the Home for Titration and Management of Sleep Disordered Breathing

    PubMed Central

    Callahan, Cynthia Y.; Norman, Robert G.; Taxin, Zachary; Mooney, Anne M.; Rapoport, David M.; Ayappa, Indu

    2013-01-01

    physiologic variability of SDB. Citation: Callahan CY; Norman RG; Taxin Z; Mooney AM; Rapoport DM; Ayappa I. Multinight recording and analysis of continuous positive airway pressure airflow in the home for titration and management of sleep disordered breathing. SLEEP 2013;36(4):535-545. PMID:23543909

  15. Commentary on the management of type II odontoid process fractures in octogenarians: Article by Graffeo et al. and Editorial by Falavigna (J Neurosurgery Spine August 19, 2016)

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: Establishing a clear treatment paradigm for octogenarians with type II odontoid fractures in hampered by a literature replete with level III articles. Methods: In the study by Graffeo et al., the authors evaluated 111 patients over the age of 79 (average age: 87) with type II odontoid fractures undergoing nonoperative (94 patients) vs. operative intervention (17 total; 15 posterior and 2 anterior). They studied multiple variables and utilized several scales [abbreviated injury scale (AIS), injury severity score (ISS), and the Glasgow coma scale (GCS)] to determine the outcomes of nonoperative vs. operative management. Results: Graffeo et al. concluded that there were no significant differences between nonoperative and operative management for type II odontoid fractures in octogenarians. They found similar frequencies of additional cervical fractures, mechanisms of injury, GCS of 8 or under, AIS/ISS scores, and disposition to “nonhome” facilities. Furthermore, both appeared to have increased mortality rates at 1-year post injury; 13% during hospitalization, 26% within the first post-injury month, and 41% at 1 year. Conclusions: In the editorial by Falavigna, his major criticism of Graffeo's article was the marked disparity in the number of patients in the operative (17 patients) vs. the nonoperative group (94 patients), making it difficult to accept any conclusions as “significant”. He further noted that few prior studies provided level I evidence, and that most, like this one, were level III analyses that did not “significantly” advance our knowledge as to whether to treat octogenarians with type II odontoid fractures operatively vs. nonoperatively. PMID:28028444

  16. Sleep Disturbance in Children and Adolescents with Disorders of Development: Its Significance and Management. Clinics in Developmental Medicine.

    ERIC Educational Resources Information Center

    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"…

  17. Sleep Disturbance in Children and Adolescents with Disorders of Development: Its Significance and Management. Clinics in Developmental Medicine.

    ERIC Educational Resources Information Center

    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"…

  18. Brain Circuitry Controlling Sleep and Wakefulness.

    PubMed

    Horner, Richard L; Peever, John H

    2017-08-01

    This article outlines the fundamental brain mechanisms that control sleep-wake patterns and reviews how pathologic changes in these control mechanisms contribute to common sleep disorders. Discrete but interconnected clusters of cells located within the brainstem and hypothalamus comprise the circuits that generate wakefulness, non-rapid eye movement (non-REM) sleep, and REM sleep. These clusters of cells use specific neurotransmitters, or collections of neurotransmitters, to inhibit or excite their respective sleep- and wake-promoting target sites. These excitatory and inhibitory connections modulate not only the presence of wakefulness or sleep, but also the levels of arousal within those states, including the depth of sleep, degree of vigilance, and motor activity. Dysfunction or degeneration of wake- and sleep-promoting circuits is associated with narcolepsy, REM sleep behavior disorder, and age-related sleep disturbances. Research has made significant headway in identifying the brain circuits that control wakefulness, non-REM, and REM sleep and has led to a deeper understanding of common sleep disorders and disturbances.

  19. Sleep, recovery, and performance: the new frontier in high-performance athletics.

    PubMed

    Samuels, Charles

    2008-02-01

    The relationship of sleep to post-exercise recovery (PER) and athletic performance is a topic of great interest because of the growing body of scientific evidence confirming a link between critical sleep factors, cognitive processes, and metabolic function. Sleep restriction (sleep deprivation), sleep disturbance (poor sleep quality), and circadian rhythm disturbance (jet lag) are the key sleep factors that affect the overall restorative quality of the sleep state. This article discusses these theoretic concepts, presents relevant clinical cases, and reviews pilot data exploring the prevalence of sleep disturbance in two groups of high-performance athletes.

  20. Effectiveness of sleep education programs to improve sleep hygiene and/or sleep quality in college students: a systematic review.

    PubMed

    Dietrich, Shellene K; Francis-Jimenez, Coleen M; Knibbs, Melida Delcina; Umali, Ismael L; Truglio-Londrigan, Marie

    2016-09-01

    -analysis was not possible due to limited studies and variability of design and interventions; therefore, results are presented in narrative form. This systematic review yielded three RCTs and one quasi-experimental study for inclusion. Two studies reported outcomes on sleep hygiene knowledge; one showing a statistically significant improvement (P = 0.025) and the other reported no difference (test of significance not provided). Two studies reported on sleep hygiene behavior; one showing no difference (P > 0.05) and the other reporting a statistically significant improvement (P = 0.0001). Four studies reported on sleep quality; three reporting no difference (P > 0.05) and the other reporting a statistically significant improvement (P = 0.017). This reviewed article identified insufficient evidence to determine the effectiveness of sleep education on sleep hygiene knowledge, sleep hygiene behavior or sleep quality in this population.

  1. Starting a sleep center.

    PubMed

    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.

  2. Review Article: Multi-criteria decision making for flood risk management: a survey of the current state-of-the-art

    NASA Astrophysics Data System (ADS)

    de Brito, M. M.; Evers, M.

    2015-11-01

    This paper provides a review of Multi-Criteria Decision Making (MCDM) applications to flood risk management, seeking to highlight trends and identify research gaps. Totally, 128 peer-reviewed papers published from 1995 to June 2015 were systematically analysed and classified into the following application areas: (1) ranking of alternatives for flood mitigation, (2) reservoir flood control, (3) susceptibility, (4) hazard, (5) vulnerability, (6) risk, (7) coping capacity, and (8) emergency management. Additionally, the articles were categorized based on the publication year, MCDM method, whether they were or were not carried out in a participatory process, and if uncertainty and sensitivity analysis were performed. Results showed that the number of flood MCDM publications has exponentially grown during this period, with over 82 % of all papers published since 2009. The Analytical Hierarchy Process (AHP) was the most popular technique, followed by Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS), and Simple Additive Weighting (SAW). Although there is greater interest on MCDM, uncertainty analysis remains an issue and is seldom applied in flood-related studies. In addition, participation of multiple stakeholders has been generally fragmented, focusing on particular stages of the decision-making process, especially on the definition of criteria weights. Based on the survey, some suggestions for further investigation are provided.

  3. Medicines for sleep

    MedlinePlus

    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 ...

  4. Sleep in the ICU: potential mechanisms and clinical implications.

    PubMed

    Hardin, Kimberly A

    2009-07-01

    Patients in the ICU are known to have severely disrupted sleep with disturbed circadian pattern, decreased nocturnal sleep time, abnormally increased stages 1 and 2 sleep, and reduced or absent deep sleep. Recent data reveal that a subpopulation of critically ill patients manifests unique EEG sleep patterns. The etiology of sleep disruption in the ICU includes the inherent nature of the environment, medications, ventilator-patient interaction, and the effect of acute illness. How sleep disruption contributes to outcomes in critically ill patients, such as recovery time and weaning from mechanical ventilation, is unknown. This article reviews the literature describing sleep in ICU patients, including recent investigations in patients who require mechanical ventilation, factors that affect sleep in critically ill patients, and the potential mechanisms and clinical implications of disturbed sleep in the ICU setting with directions to consider for future investigations.

  5. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article.

    PubMed

    Machado, Norman Oneil

    2012-01-10

    Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool to primarily therapeutic procedure. With this, the complexity of the procedure and risk of complication including duodenal perforation have increased. In this article, the recent literature is reviewed to identify the optimal management and factors influencing the clinical outcome. Recent literature in English language from the year 2000 onwards, containing major studies of 9 or more cases on duodenal perforation post ERCP were analyzed. Literature review revealed a total of 251 cases of duodenal perforation reported in 10 major reports presenting 9 or more cases each. The mean age of these patients was 58.5 years with nearly two third (62.9%) being female patients. The predominant location of the perforation was: duodenal wall (34.5%), perivaterian (31.3%), common bile duct (23.0%), and unknown in 7.9%.Early diagnosis within 24 hours was made in 78.5%, with 55.8% of these being diagnosed during or immediately after ERCP. CT scan was the most useful investigations in detecting perforations missed during ERCP (44.6%). Conservative management was employed in 62.2%, which was successful in 92.9% of these cases. Ten of these who failed conservative management required salvage surgery (6.4%) and one died of pneumothorax (0.6%). The predominant surgical intervention was closure of perforation (49.0%) with or without other procedures, retroperitoneal drainage (39.0%), duodenal exclusion (24.0%) and common bile duct exploration and T tube insertion (13.0%). The overall mortality was 8.0% which appears to be better than previously reported (16-18%). Among the 20 patients who died, six (30.0%) had salvage surgery, five (25.0%) had delay in diagnosis/intervention beyond 3 days and 3 (15.0%) required multiple operations. While the patients with duodenal perforation invariably require surgical intervention, most of the patients with perivaterian injuries can be successfully managed

  6. Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children?

    PubMed

    Matricciani, Lisa; Blunden, Sarah; Rigney, Gabrielle; Williams, Marie T; Olds, Tim S

    2013-04-01

    It is widely recognized that sleep is important for children's health and well-being and that short sleep duration is associated with a wide range of negative health outcomes. Recently, there has been much interest in whether or not there are sufficient data to support the specific recommendations made for how much sleep children need. In this article we explore concepts related to children's sleep need, discuss the theory, rationale, and empirical evidence for contemporary sleep recommendations, and outline future research directions for sleep recommendations. If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.

  7. Effect of sedative-hypnotics, anesthetics and analgesics on sleep architecture in obstructive sleep apnea.

    PubMed

    McEntire, Dan M; Kirkpatrick, Daniel R; Kerfeld, Mitchell J; Hambsch, Zakary J; Reisbig, Mark D; Agrawal, Devendra K; Youngblood, Charles F

    2014-11-01

    The perioperative care of obstructive sleep apnea (OSA) patients is currently receiving much attention due to an increased risk for complications. It is established that postoperative changes in sleep architecture occur and this may have pathophysiological implications for OSA patients. Upper airway muscle activity decreases during rapid eye movement sleep (REMS). Severe OSA patients exhibit exaggerated chemoreceptor-driven ventilation during non-rapid eye movement sleep (NREMS), which leads to central and obstructive apnea. This article critically reviewed the literature relevant to preoperative screening for OSA, prevalence of OSA in surgical populations and changes in postoperative sleep architecture relevant to OSA patients. In particular, we addressed three questions in regard to the effects of sedative-hypnotics, anesthetics and analgesics on sleep architecture, the underlying mechanisms and the relevance to OSA. Indeed, these classes of drugs alter sleep architecture, which likely significantly contributes to abnormal postoperative sleep architecture, exacerbation of OSA and postoperative complications.

  8. SLEEP - Williams wearing sleep net

    NASA Image and Video Library

    1998-05-12

    STS090-377-011 (17 APRIL-3 MAY 1998) --- Astronaut Dafydd R. (Dave) Williams, mission specialist representing the Canadian Space Agency (CSA), accomplishes more than one purpose when he sleeps in this bunk aboard the Earth-orbiting Space Shuttle Columbia. Conducting a Neurolab sleep experiment, Williams wears equipment which includes a sleep net (mesh cap that monitors and records brain waves); a Respiratory Inductance Plethysmograph (RIP) suit for monitoring respiration; and an activity monitor -- a device (out of view) worn on the wrist to detect and record body movement. Data on brain waves, eye movements, respiration, heart rate, and oxygen concentration are routed to a portable data recorder. The entire system has capabilities similar to a fully equipped sleep laboratory on Earth. The sleeping bag is conventional Shuttle ware and not part of the experiment.

  9. Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained?

    PubMed

    Otte, Julie L; Carpenter, Janet S; Manchanda, Shalini; Rand, Kevin L; Skaar, Todd C; Weaver, Michael; Chernyak, Yelena; Zhong, Xin; Igega, Christele; Landis, Carol

    2015-02-01

    Although sleep is vital to all human functioning and poor sleep is a known problem in cancer, it is unclear whether the overall prevalence of the various types of sleep disorders in cancer is known. The purpose of this systematic literature review was to evaluate if the prevalence of sleep disorders could be ascertained from the current body of literature regarding sleep in cancer. This was a critical and systematic review of peer-reviewed, English-language, original articles published from 1980 through 15 October 2013, identified using electronic search engines, a set of key words, and prespecified inclusion and exclusion criteria. Information from 254 full-text, English-language articles was abstracted onto a paper checklist by one reviewer, with a second reviewer randomly verifying 50% (k = 99%). All abstracted data were entered into an electronic database, verified for accuracy, and analyzed using descriptive statistics and frequencies in SPSS (v.20) (North Castle, NY). Studies of sleep and cancer focus on specific types of symptoms of poor sleep, and there are no published prevalence studies that focus on underlying sleep disorders. Challenging the current paradigm of the way sleep is studied in cancer could produce better clinical screening tools for use in oncology clinics leading to better triaging of patients with sleep complaints to sleep specialists, and overall improvement in sleep quality. © 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  10. Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained?

    PubMed Central

    Otte, Julie L; Carpenter, Janet S; Manchanda, Shalini; Rand, Kevin L; Skaar, Todd C; Weaver, Michael; Chernyak, Yelena; Zhong, Xin; Igega, Christele; Landis, Carol

    2015-01-01

    Although sleep is vital to all human functioning and poor sleep is a known problem in cancer, it is unclear whether the overall prevalence of the various types of sleep disorders in cancer is known. The purpose of this systematic literature review was to evaluate if the prevalence of sleep disorders could be ascertained from the current body of literature regarding sleep in cancer. This was a critical and systematic review of peer-reviewed, English-language, original articles published from 1980 through 15 October 2013, identified using electronic search engines, a set of key words, and prespecified inclusion and exclusion criteria. Information from 254 full-text, English-language articles was abstracted onto a paper checklist by one reviewer, with a second reviewer randomly verifying 50% (k = 99%). All abstracted data were entered into an electronic database, verified for accuracy, and analyzed using descriptive statistics and frequencies in SPSS (v.20) (North Castle, NY). Studies of sleep and cancer focus on specific types of symptoms of poor sleep, and there are no published prevalence studies that focus on underlying sleep disorders. Challenging the current paradigm of the way sleep is studied in cancer could produce better clinical screening tools for use in oncology clinics leading to better triaging of patients with sleep complaints to sleep specialists, and overall improvement in sleep quality. PMID:25449319

  11. Subjective Sleep Measures in Children: Self-Report

    PubMed Central

    Erwin, Andrea M.; Bashore, Lisa

    2017-01-01

    The American Academy of Sleep Medicine (AASM) recently published a consensus statement on the recommended number of hours of sleep in infants and children. The AASM expert panel identified seven health categories in children influenced by sleep duration, a component of sleep quality. For optimal health and general function, children require a certain number of hours of sleep each night. Limited data exist to subjectively assess sleep in this population. Practitioners must evaluate overall sleep quality not simply sleep duration. The purpose of this article is to provide a mini-review of the self-report sleep measures used in children. The authors individually completed a review of the literature for this article via an independent review followed by collaborative discussion. The subjective measures included in this mini-review have been used in children, but not all measures have reported psychometrics. Several tools included in this mini-review measure subjective sleep in children but with limited reliabilities or only preliminary psychometrics. Accurate measurement of self-reported sleep in children is critical to identify sleep problems in this population and further detect associated health problems. Ongoing studies are warranted to establish reliable and valid measures of self-reported sleep in children to accurately detect health problems associated with poor sleep quality. This mini-review of the literature is an important first step to identify the most reliable subjective sleep measures in children. PMID:28243584

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

    PubMed

    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.

  13. Evaluation and Management of Behavioral Health Disorders in Women: An Overview of Major Depression, Bipolar Disorder, Anxiety Disorders, and Sleep in the Primary Care Setting.

    PubMed

    Fitelson, Elizabeth; McGibbon, Cheryl

    2016-06-01

    Providers of obstetric and gynecologic care are often the most commonly seen medical providers for adult women, providing primary and reproductive care. Even where psychiatric care is readily available, obstetricians/gynecologists are frequently the front line for recognition, education, and initial management of many mental health problems. In settings where psychiatric treatment is a more scarce resource, obstetricians/gynecologists often are responsible for ongoing treatment of these disorders. This review focuses on the impact of the female reproductive life cycle on the presentation and management of some of the most common behavioral health problems in women: major depression, bipolar disorder, anxiety disorders, and primary sleep disorders. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Assessment of the awareness and management of sleep apnea syndrome in acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group.

    PubMed

    De Menis, E; Giustina, A; Colao, A; Degli Uberti, E; Ghigo, E; Minuto, F; Bogazzi, F; Drigo, R; Cattaneo, A; Aimaretti, G

    2011-01-01

    In 2007 the Italian COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) study group started to assess the application in a clinical setting of the Versailles criteria for management of acromegaly complications by a first questionnaire focusing on cardiovascular co-morbidities. A further questionnaire on sleep apnea syndrome (SAS) was delivered by the COM.E.T.A. study group to 107 endocrine centers in Italy. The results of our survey suggest that SAS is a well-known comorbidity even if its estimated prevalence is lower than in the literature. Polysomnography is the preferred tool for diagnosis. Control of SAS is considered relevant both for quality of life and co-morbidities. Continuous positive airway pressure is the cornerstone of therapy, but patients' acceptance may be critical. Control of GH/IGF-I secretion is important to improve SAS. Management of SAS requires cooperation between specialists.

  15. Sleep in Children With Psychiatric Disorders.

    PubMed

    Ramtekkar, Ujjwal; Ivanenko, Anna

    2015-06-01

    Sleep disturbances are common in pediatric psychiatric disorders and constitute key elements in diagnostic symptomatology of various primary psychiatric disorders including bipolar disorder, depression, and anxiety disorder. Although sleep is not included in key defining criteria of some impairing illnesses such as obsessive-compulsive disorder and schizophrenia, these disorders present with a very high prevalence of sleep disturbances. The interaction between sleep and psychopathology is very complex with significant interrelationship in development, severity, and prognosis of psychiatric disorders and comorbid sleep disturbances. The research ranging from small intervention case series to large epidemiologic studies have demonstrated the role of specific sleep complaints in specific psychiatric diagnoses. However, the research using objective instruments such as polysomnography and actigraphy remains limited in youth with psychiatric disorders. The intervention studies using pharmaceutical treatment specifically focusing on sleep disturbances in psychiatric disorders are also sparse in the pediatric literature. Early identification of sleep disturbances and behavioral management using cognitive behavior therapy-based tools appear to be the most effective approach for treatment. The use of psychotropic medications such as selective serotonin reuptake inhibitors for the treatment of primary psychiatric disorder often alleviate the psychological barriers for sleep but may lead to emergence of other sleep issues such as restless leg syndrome. The safety and efficacy data of hypnotics for primary sleep disorders are limited in pediatrics and should be avoided or used with extreme caution in children with comorbid sleep and psychiatric problems. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Diagnostic approaches to respiratory sleep disorders

    PubMed Central

    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 require a degree of clinical acumen when it comes to assessing severity and management options. Diagnosing respiratory sleep disorders on clinical features alone has limitations. Monitoring and measuring respiration during sleep has undergone many advances in the last 40 years in respect of quality and validity, largely regarding OSAHS. Despite the improvement in our diagnostic standards and recognition of sleep disordered breathing, many limitations still need to be overcome. Apart from assessing the individual patient, population screening for sleep disorders continues to preoccupy health professionals and policy makers in many countries. Research in the field is pushing current boundaries in terms of simplifying diagnosis and enhancing screening for sleep disordered breathing in large populations. At present, a number of these newer approaches require further validation. PMID:26380763

  17. Sleep disorders and chronic kidney disease

    PubMed Central

    Maung, Stephanie C; El Sara, Ammar; Chapman, Cherylle; Cohen, Danielle; Cukor, Daniel

    2016-01-01

    Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease (CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD. PMID:27152260

  18. Future Directions in Sleep and Developmental Psychopathology.

    PubMed

    Meltzer, Lisa J

    2017-01-01

    It is critical for psychologists to gain a better understanding about the intersection between sleep and developmental psychopathology. However, while many strive to answer the question of whether sleep causes developmental psychopathology, or vice versa, ultimately the relationship between sleep and developmental psychopathology is complex and dynamic. This article considers future directions in the field of clinical child and adolescent psychology that go beyond this mechanistic question, highlighting areas important to address for clinicians and researchers who strive to better understand how best to serve children and adolescents with developmental psychopathology. Questions are presented about what is normal in terms of sleep across development, the role of individual variability in terms of sleep needs and vulnerability to sleep loss, and how sleep may serve as a risk or resilience factor for developmental psychopathology, concluding with considerations for interventions.

  19. Sleep disorders and chronic kidney disease.

    PubMed

    Maung, Stephanie C; El Sara, Ammar; Chapman, Cherylle; Cohen, Danielle; Cukor, Daniel

    2016-05-06

    Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease (CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.

  20. A randomized crossover efficacy trial of oral CPAP (Oracle) compared with nasal CPAP in the management of obstructive sleep apnea.

    PubMed

    Anderson, Fiona E; Kingshott, Ruth N; Taylor, D Robin; Jones, David R; Kline, Lewis R; Whyte, Kenneth F

    2003-09-01

    To determine the therapeutic efficacy and viability of a novel oral interface for continuous positive airway pressure (CPAP) compared with conventional nasal interfaces. A randomized single-blind crossover study. Hospital-based sleep laboratory. 21 CPAP-naïve patients with obstructive sleep apnea (baseline apnea-hypopnea index, 85 +/- 36) INTERVENTIONS: Nasal CPAP and oral CPAP MEASUREMENTS AND RESULTS: Patients were each treated for two 4-week periods using nasal CPAP and oral CPAP. The CPAP titrations were undertaken at the start of each treatment arm. Outcome measures were recorded at baseline and at the end of each treatment arm. These included polysomnography variables, CPAP compliance, subjective sleepiness, obstructive sleep apnea symptom ratings, and adverse effects. There were no significant differences between oral and nasal interfaces for the on-CPAP frequency of apneas and hypopneas (mean difference, nasal-oral [95%CI] = -4.6[-10.1-1.0]/h; P = 0.06) or arousals (-3.0 [-7.8-1.8]/h; P = 0.23). There were also no statistically significant differences between interfaces for scores on the Epworth Sleepiness Scale (-0.7 [-3.1-1.7]; P = 0.20), obstructive sleep apnea symptoms (-7.7 [-17.7-2.4]; P = 0.052), CPAP compliance (0.3 [-0.5-1.1] h/night; P = 0.50), CPAP pressure (0.05 [-0.66-0.76] cmH20; P = 0.73), CPAP side effects scores (-2.0 [-5.3-1.4]; P = 0.23), or mask preference (P = 0.407). In addition, both nasal and oral interfaces significantly improved polysomnographic variables, Epworth Sleepiness Scale scores, obstructive sleep apnea symptoms, and CPAP compliance from baseline (all P < 0.05). This preliminary study indicates that oral CPAP has similar efficacy to traditionally applied nasal CPAP in treating obstructive sleep apnea. Additional large studies are required to determine the range of clinical situations where oral CPAP is indicated.

  1. Troubled sleep

    PubMed Central

    Haig, David

    2014-01-01

    Disrupted sleep is probably the most common complaint of parents with a new baby. Night waking increases in the second half of the first year of infant life and is more pronounced for breastfed infants. Sleep-related phenotypes of infants with Prader-Willi and Angelman syndromes suggest that imprinted genes of paternal origin promote greater wakefulness whereas imprinted genes of maternal origin favor more consolidated sleep. All these observations are consistent with a hypothesis that waking at night to suckle is an adaptation of infants to extend their mothers’ lactational amenorrhea, thus delaying the birth of a younger sib and enhancing infant survival. PMID:24610432

  2. An Integrative Review of Sleep for Nutrition Professionals12

    PubMed Central

    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

  3. An integrative review of sleep for nutrition professionals.

    PubMed

    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.

  4. The role of upper airway stimulation therapy in the multidisciplinary management approach of obstructive sleep apnea in the adult patient.

    PubMed

    Doghramji, Karl; Boon, Maurits

    2016-09-01

    Upper airway stimulation therapy (UAS) is a novel and effective treatment modality for obstructive sleep apnea (OSA). It is indicated for patients who are intolerant to traditional forms of therapy such as CPAP, and who have moderate to severe disease. Its success also relies upon the absence of certain upper airway structural and functional abnormalities. Therefore, the implementation of UAS necessitates a comprehensive evaluation with the coordinated efforts of otolaryngologist and sleep specialist, utilizing the consultative input of various other specialists. This same collaborative process also underlies the successful long-term followup care of patients following implantation surgery. Laryngoscope, 126:S9-S11, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Sleep apnea syndrome: implications on cardiovascular diseases.

    PubMed

    Bhadriraju, Satish; Kemp, Carlton R; Cheruvu, Mani; Bhadriraju, Srinivas

    2008-12-01

    Global risk assessment is the standard of care for coronary artery disease management. In this setting, sleep apnea syndrome, which includes obstructive sleep apnea and central sleep apnea, is being increasingly recognized as a potentially modifiable risk factor for coronary artery disease. Emerging evidence points toward a cause and effect relationship between sleep apnea syndrome and medical conditions like insulin resistance, hypertension, heart failure, and myocardial ischemia. The effects of sleep apnea on coronary artery disease can be independent of many traditional risk factors. Continuous positive airway pressure has been shown to decrease inflammatory markers that are elevated in sleep apnea syndrome. Well-designed randomized controlled clinical trials are needed to better establish the role of sleep apnea in the genesis and progression of coronary artery disease.

  6. Sleep Disturbance Implications for Modern Military Operations

    DTIC Science & Technology

    2012-01-01

    Academy (USMA) and the United States Air Force Academy (USAFA). Using a combination of sleep diaries, self report, and actigraphy (wrist worn devices that...comprehensive examination of sleep at USAFA has been initiated. Using both surveys and actigraphy , several studies have indicated that cadets are receiving from...Journal of Human Performance in Extreme Environments Volume 10 | Issue 1 Article 2 Published online: 10-11-2012 Sleep Disturbance Implications for

  7. Sleep Fragmentation Does Not Explain Misperception of Latency or Total Sleep Time

    PubMed Central

    Saline, Austin; Goparaju, Balaji; Bianchi, Matt T.

    2016-01-01

    Study Objectives: Perception of sleep-wake times may differ from objective measures, although the mechanisms remain elusive. Quantifying the misperception phenotype involves two operational challenges: defining objective sleep latency and treating sleep latency and total sleep time as independent factors. We evaluated a novel approach to address these challenges and test the hypothesis that sleep fragmentation underlies misperception. Methods: We performed a retrospective analysis on patients with or without obstructive sleep apnea during overnight diagnostic polysomnography in our laboratory (n = 391; n = 252). We compared subjective and objective sleep-wake durations to characterize misperception. We introduce a new metric, sleep during subjective latency (SDSL), which captures latency misperception without defining objective sleep latency and allows correction for latency misperception when assessing total sleep time (TST) misperception. Results: The stage content of SDSL is related to latency misperception, but in the opposite manner as our hypothesis: those with > 20 minutes of SDSL had less N1%, more N3%, and lower transition frequency. After adjusting for misperceived sleep during subjective sleep latency, TST misperception was greater in those with longer bouts of REM and N2 stages (OSA patients) as well as N3 (non-OSA patients), which also did not support our hypothesis. Conclusions: Despite the advantages of SDSL as a phenotyping tool to overcome operational issues with quantifying misperception, our results argue against the hypothesis that light or fragmented sleep underlies misperception. Further investigation of sleep physiology utilizing alternative methods than that captured by conventional stages may yield additional mechanistic insights into misperception. Commentary: A commentary on this article appears in this issue on page 1211. Citation: Saline A, Goparaju B, Bianchi MT. Sleep fragmentation does not explain misperception of latency or total

  8. Sleep Quiz

    MedlinePlus

    ... body and brain shut down for rest and relaxation True False Correct! Incorrect! Although it is a time when your body rests and restores its energy levels, sleep is an active state that affects both your physical and mental ...

  9. Sleep Quiz

    MedlinePlus

    ... body and brain shut down for rest and relaxation. _____2 . If you regularly doze off unintentionally during ... and restores its energy levels, sleep is an active state that affects both your physical and mental ...

  10. Exercise & Sleep

    MedlinePlus

    ... on. Feature: Back to School, the Healthy Way Exercise & Sleep Past Issues / Fall 2012 Table of Contents ... helps kids. Photo: iStock 6 "Bests" About Kids' Exercise At least one hour of physical activity a ...

  11. Sleep Disorders (PDQ)

    MedlinePlus

    ... anxiety and the patient's age. Stress caused by learning the cancer diagnosis often causes sleeping problems. Stress, ... control and sleep restriction to work for you. Learning good sleep habits is important. Good sleep habits ...

  12. Sleeping during Pregnancy

    MedlinePlus

    ... Old Feeding Your 1- to 2-Year-Old Sleeping During Pregnancy KidsHealth > For Parents > Sleeping During Pregnancy ... have trouble getting enough deep, uninterrupted sleep. Why Sleeping Can Be Difficult The first and most pressing ...

  13. Polysomnography (Sleep Study)

    MedlinePlus

    ... diagnosed with a sleep disorder. Polysomnography monitors your sleep stages and cycles to identify if or when your ... normal process of falling asleep begins with a sleep stage called non-rapid eye movement (NREM) sleep. During ...

  14. Sleep Apnea (For Parents)

    MedlinePlus

    ... for TV, Video Games, and the Internet Obstructive Sleep Apnea KidsHealth > For Parents > Obstructive Sleep Apnea Print ... kids and teens can develop it, too. About Sleep Apnea Sleep apnea happens when a person stops ...

  15. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  16. Pediatric sleep apnea

    MedlinePlus

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  17. Sleep and Aging

    MedlinePlus

    ... version of this page please turn Javascript on. Sleep and Aging About Sleep We all look forward to a good night's ... health and quality of life. Two Types of Sleep There are two types of sleep: non-rapid ...

  18. Sleep Terrors (Night Terrors)

    MedlinePlus

    ... factors can contribute to sleep terrors, such as: Sleep deprivation and extreme tiredness Stress Fever (in children) Sleeping in unfamiliar surroundings Lights or noise An overfull bladder Sleep terrors sometimes are associated with underlying conditions that ...

  19. American Sleep Apnea Association

    MedlinePlus

    American Sleep Apnea Association Learn About the CPAP Assistance Program About ASAA News about ASAA Who we are Leadership Team Supporting the ASAA Financials Learn Healthy sleep Sleep apnea Other sleep disorders Personal stories Treat Test Yourself ...

  20. A review of the surgical treatment options for the obstructive sleep apnea/hypopnea syndrome patient.

    PubMed

    Powers, David B; Allan, Patrick F; Hayes, Curtis J; Michaelson, Peter G

    2010-09-01

    Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a medical condition that has received significant attention within the medical community and mainstream media due to its potentially serious physiological consequences and relatively frequent occurrence within the general population. From the military perspective, the impact on individual readiness for deployment, and the potential degradation of performance in critically important military duties, often results in tremendous expenditures of training resources, time, and expertise to replace the military member with a suitable substitute or release of the individual from active duty. This article reviews common surgical techniques for clinical management of OSAHS patients in a presentation format for primary care and sleep medicine specialists, as well as surgeons interested in the philosophies of surgical management of sleep disordered breathing. Presentation of risks and benefits of surgical treatment are discussed in a manner to facilitate communication between patient and health care provider.

  1. Sleep complaints and sleep breathing disorders in upper and lower obstructive lung diseases

    PubMed Central

    Ferrando, Matteo; Bagnasco, Diego; Roustan, Valeria; Canonica, Giorgio Walter; Braido, Fulvio

    2016-01-01

    Upper and lower obstructive lung diseases can induce sleep complaints and can be part of the pathogenesis of sleep breathing disorders. In fact, the physiological changes of the pattern of respiration during sleep, added to the airways disease can lead to symptomatic worsening of rhinitis, asthma and chronic obstructive pulmonary diseases (COPD); moreover, their functional and anatomical features can lead to sleep breathing disorders such as obstructive sleep apnea syndrome (OSAS). This review highlights the above-mentioned relationships and the effect of disease management on its comorbidities and the patient’s quality of life. Rhinitis, asthma and COPD represent causes of sleep complaints that may be reduced with optimal management of these obstructive airways diseases. Continuous positive airway pressure (CPAP) treatment of sleep apnea needs to be tailored after optimization of the therapy of concomitant diseases, but it can often ameliorate comorbid disease. PMID:27621908

  2. 9. Common causes of sleep disruption and daytime sleepiness: childhood sleep disorders II.

    PubMed

    Heussler, Helen S

    2005-05-02

    There are strong associations between childhood sleep disorders and behavioural, concentration and mood problems. Sleep disorders caused and maintained by behavioural factors (eg, sleep-onset association disorder) are common in young children, and have a significant impact on families. Evaluation should include a medical history, a physical, neurological and developmental examination, a description of any nocturnal events or daytime effects of the child's disturbed sleep, and a good understanding of the family situation and parental management of the child. Management involves recognising the developmental age of the child and the family dynamics, and educating and supporting families in applying behavioural techniques to establish good sleep hygiene. Children with parasomnias (eg, night terrors) also benefit from good sleep hygiene, while those with respiratory or neurological causes of sleep disturbance should be referred for specialist treatment.

  3. Electroencephalographic studies of sleep

    NASA Technical Reports Server (NTRS)

    Webb, W. B.; Agnew, H. W., Jr.

    1975-01-01

    Various experimental studies on sleep are described. The following areas are discussed: (1) effect of altered day length on sleep, (2) effect of a partial loss of sleep on subsequent nocturnal sleep; (3) effect of rigid control over sleep-wake-up times; (4) sleep and wakefulness in a time-free environment; (5) distribution of spindles during a full night of sleep; and (6) effect on sleep and performance of swiftly changing shifts of work.

  4. Sleep in Othello

    PubMed Central

    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

  5. Sleep Tips: 7 Steps to Better Sleep

    MedlinePlus

    ... 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 ...

  6. Management and Risk Reduction of Rheumatoid Arthritis in Individuals with Obstructive Sleep Apnea: A Nationwide Population-Based Study in Taiwan

    PubMed Central

    Chen, Wei-Sheng; Chang, Yu-Sheng; Chang, Chi-Ching; Chang, Deh-Ming; Chen, Yi-Hsuan; Tsai, Chang-Youh; Chen, Jin-Hua

    2016-01-01

    Study Objectives: To explore associations between obstructive sleep apnea (OSA) and autoimmune diseases and evaluate whether OSA management reduces the incidence of autoimmune diseases. Methods: This was a retrospective cohort study using nationwide database research. The data was from 105,846 adult patients in whom OSA was diagnosed and recorded in the Taiwan National Health Insurance Research Database between 2002 and 2011 were the patients were analyzed retrospectively. Patients with antecedent autoimmune diseases were excluded. A comparison cohort of 423,384 participants without OSA served as age- and sex-matched controls. Multivariable Cox regression analysis was performed on both cohorts to compute risk of autoimmune diseases during follow-up. Time-dependent OSA treatment effect was analyzed among patients with OSA. There were no interventions. Results: Among patients with OSA, overall risk for incident autoimmune diseases was significantly higher than that in controls (adjusted hazard ratio [HR] = 1.95, 95% confidence interval [CI] = 1.66–2.27). Risk for individual autoimmune diseases, including rheumatoid arthritis (RA), Sjögren syndrome (SS), and Behçet disease, was significantly higher in patients with OSA than in controls (HRs [95% CI]: RA 1.33 [1.03–1.72, SS 3.45 [2.67–4.45] and Behçet disease 5.33 [2.45–12.66]). Increased risk for systemic lupus erythematosus (HR 1.00 [0.54–1.84]) and systemic sclerosis (HR 1.43 [0.51–3.96]) did not reach statistical significance. Patients with OSA receiving treatment had an overall reduced risk of RA and other autoimmune diseases (time-dependent HRs [95% CI]: 0.22 [0.05–0.94] and 0.51 [0.28–0.92], respectively). Conclusions: Patients with OSA are associated with higher risk for developing RA, SS, and Behçet disease. OSA management is associated with reduced risk of RA. Citation: Chen WS, Chang YS, Chang CC, Chang DM, Chen YH, Tsai CY, Chen JH. Management and risk reduction of rheumatoid arthritis

  7. ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations.

    PubMed

    Allen, Stephanie L; Howlett, Melissa D; Coulombe, J Aimée; Corkum, Penny V

    2016-10-01

    The ABCs of SLEEPING mnemonic was developed to serve as an organizing framework for common pediatric sleep recommendations. The mnemonic stands for 1) age appropriate bedtimes and wake-times with consistency, 2) schedules and routines, 3) location, 4) exercise and diet, 5) no electronics in the bedroom or before bed, 6) positivity 7) independence when falling asleep and 8) needs of child met during the day, 9) equal great sleep. This review examines the empirical evidence behind the practices and recommendations captured by the ABCs of SLEEPING mnemonic for children aged 1 to 12. A search was conducted of key electronic databases (PubMed, PsycINFO, CINAHL, & EMBASE) to identify English articles that included the concepts of sleep, insomnia, and/or bedtime. 77 articles were eligible for inclusion and were coded to extract key details and findings regarding the relations between sleep practices identified in the ABCs of SLEEPING mnemonic and sleep outcomes. Findings provided preliminary support for many of the recommendations that are commonly made to families regarding healthy sleep practices. However, more robust investigations are needed to better understand the causal contributions of healthy sleep practices to the onset and maintenance of children's sleep problems.

  8. Childhood sleep disorders: diagnostic and therapeutic approaches.

    PubMed

    Pearl, Phillip L

    2002-03-01

    Pediatric sleep physiology begins with development of the sleep/wake cycle, and the origins of active versus quiet sleep. The 24-hour circadian cycle becomes established at 3 to 6 months. Sleep disorders are rationally approached in pediatrics as age-related. Disorders during infancy commonly include mild, usually self-limited conditions such as sleep-onset association disorder, excessive nighttime feedings, and poor limit-setting. These require behavioral management to avoid long-term deleterious sleep habits. In contrast, other sleep disorders are more ominous, including sudden infant death syndrome (SIDS), central congenital hypoventilation syndrome, and sleep apnea. Childhood is generally the golden age of sleep, with brief latency, high efficiency, and easy awakening. Parasomnias, sometimes stage specific, are manifest here. Adolescents have sleep requirements similar to preteens, posing a challenge for them to adapt to school schedules and lifestyles. Narcolepsy, usually diagnosed in adolescence or early adulthood, is a lifelong sleep disorder that has led to the identification of the hypocretin/orexin neurotransmitter system. This will lead to enhanced understanding of what regulates stage rapid eye movement, and to novel therapeutic advances for hypersomnolence.

  9. The delivery of behavioral sleep medicine to college students.

    PubMed

    Kloss, Jacqueline D; Nash, Christina O; Horsey, Sarah E; Taylor, Daniel J

    2011-06-01

    College students are vulnerable to a variety of sleep disorders, which can result in sleep deprivation and a variety of other consequences. The delivery of behavioral sleep medicine is particularly relevant for the college student population, as the early intervention on their sleep problems might prevent lifelong consequences. This article critically reviews the efficacy of relevant behavioral sleep medicine interventions and discusses special considerations for using them with college students who have unique sleep patterns and lifestyles. Recommendations are also given regarding ways to disseminate these empirically supported treatments into this environment. Finally, recommendations regarding future research directions are discussed in the present study.

  10. Diagnosis and assessment of sleep and circadian rhythm disorders.

    PubMed

    Buysse, Daniel J

    2005-03-01

    Sleep and wakefulness are fundamental behavioral and neurobiological states that characterize all higher animals, including human beings. This article presents an overview of the current state of our knowledge concerning the function of sleep and sleep-wake rhythms, the neurobiology of circadian rhythms, how wakefulness and sleep are studied, and the clinical assessment and diagnosis of sleep and circadian rhythm disorders. Major theories of the function of sleep and sleep-wake rhythms are reviewed, including ecological or environmental advantage, physical restoration, optimizing waking function, learning and integration of experience, and survival. The author then reviews what is known about the neurobiology of endogenous circadian rhythms and how they are affected by environmental time cues. How sleep is studied using polysomnography (PSG) is explained, and the PSG characteristics of the three major neurobehavioral states, wakefulness, rapid eye movement (REM) sleep, and non-rapid eye movement (NREM) sleep, are described. Systems of classifying sleep disorders are reviewed, including those of the DSM-IV-TR, the International Classification of Sleep Disorders, and the ICD-10. Methods of assessing sleep complaints are then described, including taking an accurate history from the patient and bed partner, use of sleep history questionnaires and sleep-wake diaries, use of actigraphy, and use of PSG.

  11. Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review.

    PubMed

    Shin, Jong Cheol; Kim, Julia; Grigsby-Toussaint, Diana

    2017-09-07

    Although mobile health technologies have been developed for interventions to improve sleep disorders and sleep quality, evidence of their effectiveness remains limited. A systematic literature review was performed to determine the effectiveness of mobile technology interventions for improving sleep disorders and sleep quality. Four electronic databases (EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for articles on mobile technology and sleep interventions published between January 1983 and December 2016. Studies were eligible for inclusion if they met the following criteria: (1) written in English, (2) adequate details on study design, (3) focus on sleep intervention research, (4) sleep index measurement outcome provided, and (5) publication in peer-reviewed journals. An initial sample of 2679 English-language papers were retrieved from five electronic databases. After screening and review, 16 eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders and sleep quality. These included one case study, three pre-post studies, and 12 randomized controlled trials. The studies were categorized as (1) conventional mobile phone support and (2) utilizing mobile phone apps. Based on the results of sleep outcome measurements, 88% (14/16) studies showed that mobile phone interventions have the capability to attenuate sleep disorders and to enhance sleep quality, regardless of intervention type. In addition, mobile phone intervention methods (either alternatively or as an auxiliary) provide better sleep solutions in comparison with other recognized treatments (eg, cognitive behavioral therapy for insomnia). We found evidence to support the use of mobile phone interventions to address sleep disorders and to improve sleep quality. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research.

  12. Sleep behaviors in children with different frequencies of parental-reported sleep bruxism.

    PubMed

    Restrepo, Claudia; Manfredini, Daniele; Lobbezoo, Frank

    2017-08-12

    Knowledge on the relationship between sleep bruxism (SB) and sleep behaviors in children is still fragmental, especially when socioeconomic factors are concerned. To assess sleep behaviors in children with different frequencies of proxy-reported SB. Parents of 1475 Colombian children, aged 9.8±1.6years, belonging to 3 different social layers, filled out a questionnaire on their childreńs sleep (Childreńs Sleep Habits Questionnaire [CSHQ]). Differences in sleep behaviors were assessed for the total sample and the three socioeconomic layers, using one-way ANOVA and Bonferroni post-hoc tests or Kruskal-Wallis and Dunn's post-hoc tests, based on the normality of outcome variables. Most sleep patterns and daytime sleepiness were similar for children with different frequencies of proxy-reported SB, without differences among socioeconomic layers, whilst sleep disorders and parasomnias increased with the frequency of proxy-reported SB, independently on the socioeconomic layer (Bonferroni post-hoc<0.001). The association between sleep-related habits and the frequency of proxy-reported SB was different for each socioeconomic layer. Among the various sleep behaviors under investigation, some sleep disorders and parasomnias seem to be associated with parental-reported SB in children. The influence of socioeconomic conditions on sleep behaviors seems not relevant. Based on these results, more specific studies on the association between different sleep behaviors are needed. Sleep behaviors, sociodemographic and socioeconomic features are correlated with SB in adults. However, in children, good evidence about this topic is lacking. This article give information to help clinicians evaluating sleep behaviors, sociodemographic and socioeconomic characteristics, when assessing sleep bruxism, based on evidence. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Sleep and Development in Genetically Tractable Model Organisms

    PubMed Central

    Kayser, Matthew S.; Biron, David

    2016-01-01

    Sleep is widely recognized as essential, but without a clear singular function. Inadequate sleep impairs cognition, metabolism, immune function, and many other processes. Work in genetic model systems has greatly expanded our understanding of basic sleep neurobiology as well as introduced new concepts for why we sleep. Among these is an idea with its roots in human work nearly 50 years old: sleep in early life is crucial for normal brain maturation. Nearly all known species that sleep do so more while immature, and this increased sleep coincides with a period of exuberant synaptogenesis and massive neural circuit remodeling. Adequate sleep also appears critical for normal neurodevelopmental progression. This article describes recent findings regarding molecular and circuit mechanisms of sleep, with a focus on development and the insights garnered from models amenable to detailed genetic analyses. PMID:27183564

  14. Sleep and Development in Genetically Tractable Model Organisms.

    PubMed

    Kayser, Matthew S; Biron, David

    2016-05-01

    Sleep is widely recognized as essential, but without a clear singular function. Inadequate sleep impairs cognition, metabolism, immune function, and many other processes. Work in genetic model systems has greatly expanded our understanding of basic sleep neurobiology as well as introduced new concepts for why we sleep. Among these is an idea with its roots in human work nearly 50 years old: sleep in early life is crucial for normal brain maturation. Nearly all known species that sleep do so more while immature, and this increased sleep coincides with a period of exuberant synaptogenesis and massive neural circuit remodeling. Adequate sleep also appears critical for normal neurodevelopmental progression. This article describes recent findings regarding molecular and circuit mechanisms of sleep, with a focus on development and the insights garnered from models amenable to detailed genetic analyses. Copyright © 2016 by the Genetics Society of America.

  15. Sleep Health Issues for Children with FASD: Clinical Considerations

    PubMed Central

    Jan, James E.; Asante, Kwadwo O.; Conry, Julianne L.; Fast, Diane K.; Bax, Martin C. O.; Ipsiroglu, Osman S.; Bredberg, Elizabeth; Loock, Christine A.; Wasdell, Michael B.

    2010-01-01

    This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research. PMID:20706655

  16. Differences in sleep complaints in adults with varying levels of bed days residing in extended care facilities for chronic disease management.

    PubMed

    Fox, Mary T; Sidani, Souraya; Brooks, Dina

    2010-05-01

    This cohort study examined differences in perceived insomnia and daytime sleepiness in 67 adults residing in extended care facilities for chronic disease management who had varying levels of bed days. One bed day was defined as spending 24 hours in bed. Planned pairwise comparisons, using Bonferroni adjustment, were made between participants who spent 0 (n = 21), 2 to 4 (n = 23), and 5 to 7 (n = 23) days in bed during 1 week of monitoring. Participants who spent 5 to 7 days in bed had significantly greater insomnia than those who spent 2 to 4 days in bed. No group differences were found in daytime sleepiness. Based on the findings, nurses may assess subjective insomnia and explore sleep hygiene strategies, such as increasing time out of bed with patients who have high levels of 5 to 7 bed days.

  17. Effects of Sleep Deprivation on U.S. Navy Surface Ship Watchstander Performance using Alternative Watch Schedules

    DTIC Science & Technology

    2012-09-01

    preferred by the crew, but was shown to have actual measurable benefit in performance. 14. SUBJECT TERMS: Sleep , Fatigue, Actigraphy , Fatigue Management...The Five Stages of an Eight-Hour Sleep Cycle (From Miller & Firehammer, 2007...with a loss of sleep (Dorian et al., 2003). The human sleep cycle is divided into five stages of sleep that are further divided into the two

  18. Subjective Sleep Complaints in Pediatric Depression: A Controlled Study and Comparison with EEG Measures of Sleep and Waking

    ERIC Educational Resources Information Center

    Bertocci, Michele A.; Dahl, Ronald E.; Williamson, Douglas E.; Iosif, Ana-Maria; Birmaher, Boris; Axelson, David; Ryan, Neal D.

    2005-01-01

    Objective: Children with major depressive disorder (MDD) often complain of sleep disturbances; however, polysomnographic studies have failed to find objective evidence of these disturbances. This article examines subjective sleep reports of children with MDD and healthy controls focusing on comparing subjective and objective sleep measures.…

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

    PubMed

    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

  20. Hypnotherapy for sleep disorders.

    PubMed

    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.

  1. Sleep Apnea Cardiovascular Clinical Trials-Current Status and Steps Forward: The International Collaboration of Sleep Apnea Cardiovascular Trialists.

    PubMed

    Gottlieb, Daniel J; Craig, Sonya E; Lorenzi-Filho, Geraldo; Heeley, Emma; Redline, Susan; McEvoy, R Doug; Durán-Cantolla, Joaquín

    2013-07-01

    Sleep apnea is a common chronic disease that is associated with coronary heart disease, stroke, heart failure and mortality, although the ability of sleep apnea treatment to reduce cardiovascular morbidity and mortality has not been demonstrated. In contrast to patients seeking treatment in sleep disorders centers, as many as half of individuals with moderate to severe sleep apnea in the general population do not report excessive sleepiness; however, if treatment of sleep apnea were shown to reduce cardiovascular disease risk, this would provide a strong rationale for treatment of sleep apnea even in the absence of daytime sleepiness. This article summarizes the status of clinical trials evaluating the potential cardiovascular benefits of sleep apnea treatment and discusses the challenges of conducting such trials, and introduces the International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT), a clinical research collaboration formed to foster cardiovascular sleep research.

  2. Disturbing sleep and sleepfulness during recovery from substance dependence in residential rehabilitation settings.

    PubMed

    Nettleton, Sarah; Meadows, Robert; Neale, Joanne

    2016-12-05

    There is evidence that poor sleep mitigates recovery from substance dependence and increases risk of relapse. However, to date research literature is located within biomedical, clinical and psychological paradigms. To complement the extant work, this article offers a sociological exploration of sleep in the context of recovery from dependence on alcohol and/or other drugs. Drawing on qualitative data generated through interviews with 28 men and women living in residential rehabilitation settings in England, we provide a detailed exploration of sleep practices focusing on how these are enacted throughout the night. We offer the concept of 'sleepfulness' to suggest that sleep should not be understood simply as being other than awake; rather it involves a myriad of associations between diverse actants - human and non-human - that come to 'fill up', enable and assemble sleep. Together these empirical insights and conceptualisations disturb the ontology of sleep and point to the fulsome dimensions of the category.

  3. Short- and long-term health consequences of sleep disruption

    PubMed Central

    Medic, Goran; Wille, Micheline; Hemels, Michiel EH

    2017-01-01

    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. PMID:28579842

  4. Inflammation, sleep, obesity and cardiovascular disease.

    PubMed

    Miller, Michelle A; Cappuccio, Francesco P

    2007-04-01

    Evidence is emerging that disturbances in sleep and sleep disorders play a role in the morbidity of chronic conditions. However, the relationship between sleep processes, disease development, disease progression and disease management is often unclear or understudied. Numerous common medical conditions can have an affect on sleep. For example, diabetes or inflammatory conditions such as arthritis can lead to poor sleep quality and induce symptoms of excessive daytime sleepiness and fatigue. It has also been suggested that poor sleep may lead to the development of cardiovascular disease for which an underlying inflammatory component has been proposed. It is therefore important that the development and progression of such disease states are studied to determine whether the sleep effect merely reflects disease progression or whether it may be in some way causally related. Sleep loss can also have consequences on safety related behaviours both for the individuals and for the society, for example the increased risk of accidents when driving while drowsy. Sleep is a complex phenotype and as such it is possible that there are numerous genes which may each have a number of effects that control an individual's sleep pattern. This review examines the interaction between sleep (both quantity and quality) and parameters of cardiovascular risk. We also explore the hypothesis that inflammation plays an essential role in cardiovascular disease and that a lack of sleep may play a key role in this inflammatory process. To review current evidence regarding the endocrine, metabolic, cardiovascular and immune functions and their interactions with regard to sleep, given the current evidence that sleep disturbances may affect each of these areas.

  5. A community-oriented framework to increase screening and treatment of obstructive sleep apnea among blacks

    PubMed Central

    Williams, Natasha J; Jean-Louis, Girardin; Ravenell, Joeseph; Seixas, Azizi; Islam, Nadia; Trinh-Shevrin, Chau; Ogedegbe, Gbenga

    2016-01-01

    Objective Obstructive sleep apnea (OSA); is a leading sleep disorder that is disproportionately more prevalent in minority populations and is a major risk factor for cardiovascular disease (CVD) morbidity and mortality. OSA is associated with many chronic conditions including hypertension, diabetes, and obesity, all of which disproportionately burden blacks (i.e., peoples of African American, Caribbean, or African descent). Methods This article will review studies conducted in the U.S. that examined sleep screenings and adherence to treatment for obstructive sleep apnea among blacks. In addition, we provide guidelines for implementing a practical framework to increase OSA screening and management among blacks. Results Several studies have documented racial/ethnic disparities in adherence to treatment for obstructive sleep apnea. However, despite its public health significance, there is a paucity of studies addressing these disparities. Further, there is a lack of health programs and policies to increase screening and treatment of OSA among blacks and other minority populations. A practical framework to increase the number of blacks who are screened for OSA and treated appropriately is warranted. Such a framework is timely and is of major importance, as early identification of OSA in this high-risk population could potentially lead to early treatment and prevention of CVD, thereby reducing racial and ethnic disparities in sleep-related CVD morbidity and mortality. PMID:26652238

  6. Sleep apnea and cardiovascular disease.

    PubMed

    Logan, Alexander G; Bradley, T Douglas

    2010-06-01

    Cardiovascular disease is still the leading cause of death in North America. To improve outcomes, it will likely be necessary to identify new potentially treatable conditions. Sleep apnea affects approximately 50% of patients with cardiovascular disease and is associated with increased cardiovascular risk. Continuous positive airway pressure is currently the treatment of choice and has many short-term favorable effects. The long-term benefits, however, remain elusive. Further, it may not be the ideal treatment for central sleep apnea, and the benefits of alternatives such adaptive servo-ventilation are currently being tested. Randomized controlled trials are now needed to determine whether treating sleep apnea will improve survival and reduce cardiovascular disease risk. Until better evidence becomes available, testing for sleep apnea cannot be recommended as part of the routine cardiovascular disease risk assessment, nor can its treatment be recommended for the prevention or management of cardiovascular disease in asymptomatic patients.

  7. Sleep deprivation and neurobehavioral functioning in children.

    PubMed

    Maski, Kiran P; Kothare, Sanjeev V

    2013-08-01

    Sleep deprivation can result in significant impairments in daytime neurobehavioral functioning in children. Neural substrates impacted by sleep deprivation include the prefrontal cortex, basal ganglia and amygdala and result in difficulties with executive functioning, reward anticipation and emotional reactivity respectively. In everyday life, such difficulties contribute to academic struggles, challenging behaviors and public health concerns of substance abuse and suicidality. In this article, we aim to review 1) core neural structures impacted by sleep deprivation; 2) neurobehavioral problems associated with sleep deprivation; 3) specific mechanisms that may explain the relationship between sleep disturbances and neurobehavioral dysfunction; and 4) sleep problems reported in common neurodevelopmental disorders including attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders (ASDs).

  8. The impact of drugs for multiple sclerosis on sleep.

    PubMed

    Lanza, Giuseppe; Ferri, Raffaele; Bella, Rita; Ferini-Strambi, Luigi

    2017-01-01

    Although there is a growing literature on the presence of sleep disorders in multiple sclerosis (MS), few studies have specifically addressed the impact of drugs on sleep of these patients. Moreover, even when sleep is considered, quantitative assessment by standardized questionnaires or polysomnography is lacking. The studies that have been done highlight that interferon-beta and some symptomatic medications may affect sleep, thus contributing to fatigue, depression, and poor quality of life; conversely, natalizumab and cannabinoids may improve sleep. Common limitations of the literature reviewed here are small sample size, selection bias, and often a lack of objective outcome measures. Clinicians need to remember to ask about sleep in all MS patients and intervene when appropriate. A systematic approach that takes sleep into account is recommended to enhance recognition and appropriate management of sleep disruption, including disorders related to medication. Consideration of the impact on sleep should also be part of the design of trials of new therapies.

  9. Sleep Problems in Children and Adolescents with Common Medical Conditions

    PubMed Central

    Lewandowski, Amy S.; Ward, Teresa M.; Palermo, Tonya M.

    2011-01-01

    Synopsis Sleep is critically important to children’s health and well-being. Untreated sleep disturbances and sleep disorders pose significant adverse daytime consequences and place children at considerable risk for poor health outcomes. Sleep disturbances occur at a greater frequency in children with acute and chronic medical conditions compared to otherwise healthy peers. Sleep disturbances in medically ill children can be associated with sleep disorders (e.g., sleep disordered breathing, restless leg syndrome), co-morbid with acute and chronic conditions (e.g., asthma, arthritis, cancer), or secondary to underlying disease-related mechanisms (e.g. airway restriction, inflammation) treatment regimens, or hospitalization. Clinical management should include a multidisciplinary approach with particular emphasis on routine, regular sleep assessments and prevention of daytime consequences and promotion of healthy sleep habits and health outcomes. PMID:21600350

  10. Use of Melatonin in Young Children for Sleep Disorders.

    ERIC Educational Resources Information Center

    Lin-Dyken, Deborah C.; Dyken, Mark Eric

    2002-01-01

    Sleep problems may occur in up to 88% of children with visual impairments who have developmental disabilities. The use of oral melatonin has recently been used for the management of sleep difficulties in children with and without disabilities. Sustained-release melatonin may reduce nighttime awakenings and increase total sleep time. (Contains…

  11. Use of Melatonin in Young Children for Sleep Disorders.

    ERIC Educational Resources Information Center

    Lin-Dyken, Deborah C.; Dyken, Mark Eric

    2002-01-01

    Sleep problems may occur in up to 88% of children with visual impairments who have developmental disabilities. The use of oral melatonin has recently been used for the management of sleep difficulties in children with and without disabilities. Sustained-release melatonin may reduce nighttime awakenings and increase total sleep time. (Contains…

  12. Sleep and immune function.

    PubMed

    Ganz, Freda DeKeyser

    2012-04-01

    Scientists are only beginning to fully understand the purpose of sleep and its underlying mechanisms. Lack of sleep is associated with many diseases, including infection, and with increased mortality. Lack of proper sleep is an important problem in the intensive care unit, and interventions have been designed to improve it. Sleep is associated with immune function, and this relationship is partially based on the physiological basis of sleep, sleep architecture, the sleep-wake cycle, cytokines and the hypothalamic-pituitary axis.

  13. WWC Quick Review of the Article "Impact of For-Profit and Nonprofit Management on Student Achievement: The Philadelphia Intervention, 2002-2008"

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2010

    2010-01-01

    "Impact of For-Profit and Nonprofit Management on Student Achievement: The Philadelphia Intervention, 2002-2008" examined whether shifting from traditional district management to management by a for-profit or nonprofit organization improves student achievement. The study analyzed data on six cohorts of elementary and middle school…

  14. Weight Management

    MedlinePlus

    ... 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 ...

  15. Sexsomnia: sleep sex research and its legal implications.

    PubMed

    Organ, Alexandria; Fedoroff, J Paul

    2015-05-01

    "Sleep sex," also known as sexsomnia, is a sleep disorder characterized by sexual behaviors committed while asleep. There has recently been increased interest in sexsomnia due to controversies arising in legal trials that have been widely publicized in the social and public media. This article attempts to marshal the current information about sexsomnia from the forensic literature and provides an overview of sexsomnia including common features, precipitating factors, prevalence rates, diagnostic procedures, and treatment. As sexsomnia represents a condition in which sexual acts are committed without awareness or intention, this paper also reviews the development of sexsomnia as a legal defense and summarizes Canadian case law on the topic. It provides an overview of the hurdles presented to defense attorneys attempting to utilize the defense and examines popular public notions surrounding the legitimacy of sexsomnia and the possibility of malingering. We conclude that sexsomnia is a legitimate sleep disorder for which case law now exists to support its use in legal defenses based on automatism. The question of whether it is an example of "sane" or "insane" automatism remains to be determined by the courts. Regardless of whether or not sexsomnia is determined to be a mental disorder by the courts, it is now a recognized and well-described sleep disorder that can be safely treated and managed by knowledgeable clinicians.

  16. Discrimination and sleep: a systematic review

    PubMed Central

    Slopen, Natalie; Lewis, Tené T.; Williams, David R.

    2015-01-01

    An increasing body of literature indicates that discrimination has a negative impact on health; poor sleep may be an underlying mechanism. The primary objective of this review was to examine existing studies on the relationship between discrimination and sleep to clarify (a) the potential role of discrimination in shaping population patterns of sleep and sleep disparities, and (b) research needed to develop interventions at individual and institutional levels. We identified articles from English-language publications in Pubmed and Ebsco databases from inception through July 2014. We employed a broad definition of discrimination to include any form of unfair treatment and all self-reported and objectively-assessed sleep outcomes, including duration, difficulties, and sleep architecture. Seventeen studies were identified: four prospective, twelve cross-sectional, and one that utilized a daily-diary design. Fifteen of the 17 studies evaluated interpersonal discrimination as the exposure and the majority of studies included self-reported sleep as the outcome. Only four studies incorporated objective sleep assessments. All 17 studies identified at least one association between discrimination and a measure of poorer sleep, although studies with more detailed consideration of either discrimination or sleep architecture revealed some inconsistencies. Taken together, existing studies demonstrate consistent evidence that discrimination is associated with poorer sleep outcomes. This evidence base can be strengthened with additional prospective studies that incorporate objectively-measured aspects of sleep. We outline important extensions for this field of inquiry that can inform the development of interventions to improve sleep outcomes, and consequently promote wellbeing and reduce health inequities across the life course. PMID:25770043

  17. Discrimination and sleep: a systematic review.

    PubMed

    Slopen, Natalie; Lewis, Tené T; Williams, David R

    2016-02-01

    An increasing body of literature indicates that discrimination has a negative impact on health; poor sleep may be an underlying mechanism. The primary objective of this review was to examine existing studies on the relationship between discrimination and sleep to clarify (a) the potential role of discrimination in shaping population patterns of sleep and sleep disparities, and (b) the research needed to develop interventions at individual and institutional levels. We identified articles from English-language publications in PubMed and EBSCO databases from inception through July 2014. We employed a broad definition of discrimination to include any form of unfair treatment and all self-reported and objectively assessed sleep outcomes, including duration, difficulties, and sleep architecture. Seventeen studies were identified: four prospective, 12 cross-sectional, and one that utilized a daily-diary design. Fifteen of the 17 studies evaluated interpersonal discrimination as the exposure and the majority of studies included self-reported sleep as the outcome. Only four studies incorporated objective sleep assessments. All 17 studies identified at least one association between discrimination and a measure of poorer sleep, although studies with more detailed consideration of either discrimination or sleep architecture revealed some inconsistencies. Taken together, existing studies demonstrate consistent evidence that discrimination is associated with poorer sleep outcomes. This evidence base can be strengthened with additional prospective studies that incorporate objectively measured aspects of sleep. We outline important extensions for this field of inquiry that can inform the development of interventions to improve sleep outcomes, and consequently promote well-being and reduce health inequities across the life course.

  18. Promoting Sleep: Adapting to Shiftwork and Time Zone Change

    DTIC Science & Technology

    2000-03-01

    in an emergency Improvements in sleep continuity with situation (35) or on arrival at the destination 5-6 actigraphy (42). There have, however, been...be measured by actigraphy (63). effective in some middle-aged individuals (47,53,54). CONCLUSION In summary, management of sleep disturbance arising...Use of melatonin to adapt to phase shifts: effects on sleep architecture . J Sleep Res, 1996;5(Suppl 1):221. 5-11 45. Walsh JK, Muehlbach MJ, 55. Baird

  19. Safe sleep, day and night: mothers' experiences regarding infant sleep safety.

    PubMed

    Lau, Annie; Hall, Wendy

    2016-10-01

    To explore Canadian mothers' experiences with infant sleep safety. Parents decide when, how and where to place their infants to sleep. It is anticipated that they will follow international Sudden Infant Death Syndrome prevention sleep safety guidelines. Limited evidence is available for how parents take up guidelines; no studies have explored Canadian mothers' experiences regarding infant sleep safety. An inductive qualitative descriptive study using some elements of grounded theory, including concurrent data collection and analysis and memoing. Semi-structured interviews and constant comparative analysis were employed to explore infant sleep safety experiences of 14 Canadian mothers residing in Metro Vancouver. Data collection commenced in December 2012 and ended in July 2013. The core theme, Infant Sleep Safety Cycle, represents a cyclical process encompassing sleep safety from the prenatal period to the first six months of infants' lives. The cyclical process includes five segments: mothers' expectations of sleep safety, their struggles with reality as opposed to maternal visions, modifications of expectations, provision of rationale for choices and shifts in mothers' views of infants' developmental capabilities. Mothers' experiences were influenced by four factors: perceptions of everyone's needs, familial influences, attitudes and judgments from outsiders and resource availability and accessibility. To manage infants' sleep, mothers reframed sleep safety guidelines and downplayed the risk of Sudden Infant Death Syndrome for all forms of sleep at all times. Healthcare providers can support mothers' efforts to manage their infants' sleep challenges. During prenatal and postpartum periods, providers' interventions can influence mothers' efforts to adhere to sleep safety principles. The study findings support healthcare providers' efforts to assist mothers to modify expectations and develop strategies to support sleep safety principles while acknowledging their

  20. Obese Veterans Enrolled in a Veterans Affairs Medical Center Outpatient Weight Loss Clinic Are Likely to Experience Disordered Sleep and Posttraumatic Stress

    PubMed Central

    Mayer, Stephanie B.; Levy, James R.; Farrell-Carnahan, Leah; Nichols, Michelle G.; Raman, Shekar

    2016-01-01

    Study Objectives: This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic. Methods: Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith's Measure of Morningness/Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist – Civilian Version (PCL-C). Results: Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (standard deviation [SD] 10.6) years, and mean body mass index (BMI) 38.4 kg/m2 (SD 8.4). By PSQI, 89% rated sleep quality as “poor” (mean = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI. Conclusions: Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD. Commentary: A commentary on this article appears in this issue on page 943. Citation: Mayer SB

  1. Circadian Rhythm Sleep-Wake Disorders.

    PubMed

    Pavlova, Milena

    2017-08-01

    The endogenous circadian rhythms are one of the cardinal processes that control sleep. They are self-sustaining biological rhythms with a periodicity of approximately 24 hours that may be entrained by external zeitgebers (German for time givers), such as light, exercise, and meal times. This article discusses the physiology of the circadian rhythms, their relationship to neurologic disease, and the presentation and treatment of circadian rhythm sleep-wake disorders. Classic examples of circadian rhythms include cortisol and melatonin secretion, body temperature, and urine volume. More recently, the impact of circadian rhythm on several neurologic disorders has been investigated, such as the timing of occurrence of epileptic seizures as well as neurobehavioral functioning in dementia. Further updates include a more in-depth understanding of the symptoms, consequences, and treatment of circadian sleep-wake disorders, which may occur because of extrinsic misalignment with clock time or because of intrinsic dysfunction of the brain. An example of extrinsic misalignment occurs with jet lag during transmeridian travel or with intrinsic circadian rhythm sleep-wake disorders such as advanced or delayed sleep-wake phase disorders. In advanced sleep-wake phase disorder, which is most common in elderly individuals, sleep onset and morning arousal are undesirably early, leading to impaired evening function with excessive sleepiness and sleep-maintenance insomnia with early morning awakening. By contrast, delayed sleep-wake phase disorder is characterized by an inability to initiate sleep before the early morning hours, with subsequent delayed rise time, leading to clinical symptoms of severe sleep-onset insomnia coupled with excessive daytime sleepiness in the morning hours, as patients are unable to "sleep in" to attain sufficient sleep quantity. Irregular sleep-wake rhythm disorder is misentrainment with patches of brief sleep and wakefulness spread throughout the day

  2. Sleep, Mood, and Quality of Life in Patients Receiving Treatment for Lung Cancer

    PubMed Central

    Dean, Grace E.; Redeker, Nancy S.; Wang, Ya-Jung; Rogers, Ann E.; Dickerson, Suzanne S.; Steinbrenner, Lynn M.; Gooneratne, Nalaka S.

    2014-01-01

    Purpose/Objectives To distinguish relationships among subjective and objective characteristics of sleep, mood, and quality of life (QOL) in patients receiving treatment for lung cancer. Design Descriptive, correlational study. Setting Two ambulatory oncology clinics. Sample 35 patients with lung cancer. Methods The following instruments were used to measure the variables of interest: Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Treatment–Lung (FACT-L), a sleep diary, and a motionlogger actigraph. Main Research Variables Sleep, mood, and QOL. Findings Significant differences were found between sleep diary and actigraph measures of sleep efficiency (p = 0.002), sleep latency (p = 0.014), sleep duration (p < 0.001), and wake after sleep onset (p < 0.001). Poor sleepers (PSQI score greater than 5) were significantly different from good sleepers (PSQI score of 5 or lower) on sleep diary measures of sleep efficiency and sleep latency and the FACT-L lung cancer symptom subscale, but not on mood or actigraphy sleep measures. Conclusions Although patients with lung cancer may report an overall acceptable sleep quality when assessed by a single question, those same patients may still have markedly increased sleep latencies or reduced total sleep time. The findings indicate the complexity of sleep disturbances in patients with lung cancer. Lung cancer symptoms had a stronger association with sleep than mood. Research using prospective methods will help to elucidate their clinical significance. Implications for Nursing Patients receiving treatment for lung cancer are at an increased risk for sleep disturbances and would benefit from routine sleep assessment and management. In addition, assessment and management of common symptoms may improve sleep and, ultimately, QOL. Knowledge Translation A high frequency of sleep disturbances in patients receiving treatment for lung cancer was evident, and poor sleepers had

  3. The relationship of health behaviors with sleep and fatigue in transplant caregivers.

    PubMed

    Ross, A; Yang, L; Klagholz, S D; Wehrlen, L; Bevans, M F

    2016-05-01

    The burden and psychological impact of providing care to a loved one with cancer is significant and associated with a number of problems including sleep disturbance and fatigue. While engaging in healthy behaviors such as proper nutrition, exercise, and stress reduction may improve sleep and fatigue, few studies have focused on this relationship. The objective of this study is to examine the relationship of health behaviors with sleep quality and fatigue in transplant caregivers. Data were analyzed from a cross-sectional survey of 78 caregivers of patients undergoing allogeneic hematopoietic stem cell transplantation. Measures included: Health-Promoting Lifestyle Profile II (HPLP-II), Brief Symptom Inventory (Distress), Caregiver Reaction Assessment (Caregiver Burden), Pittsburgh Sleep Quality Index, and the Multidimensional Fatigue Symptom Inventory Short-Form. Controlling for age, gender, BMI, burden and distress, health behaviors predicted sleep quality (B = -0.408, p = 0.021) and fatigue (B = -0.966, p < 0.001). Stress management (B = -0.450, p = 0.001), nutrition (B = -0.249, p = 0.048), and interpersonal relationships (B = -0.319, p = 0.049) were the HPLP-II subscales that significantly predicted sleep quality; nearly every HPLP-II subscale predicted fatigue. Despite the burden and distress associated with caregiving, engaging in healthy behaviors may help to improve sleep and fatigue in transplant caregivers. Published 2015. This article is a U.S. Government work and is in the public domain in the USA. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

  4. Sleep in Schizophrenia: Exploring Subjective Experiences of Sleep Problems, and Implications for Treatment.

    PubMed

    Chiu, Vivian W; Ree, Melissa; Janca, Aleksandar; Waters, Flavie

    2016-12-01

    Sleep dysfunction is a pervasive issue in schizophrenia and psychosis. Current knowledge is drawn almost exclusively from studies using quantitative research methodologies that include measures and tools developed in healthy population groups. Qualitative studies investigating the first-person perspectives of sleep problems are therefore important for designing better assessment and treatment tools to meet consumer needs. Focus groups were conducted to elicit detailed information regarding the personal experience of sleep problems, their antecedents and impact, in 14 individuals with schizophrenia-spectrum disorder who experienced insomnia during their illness. Thematic analysis was applied to examine the data and draw treatment implications for sleep management. Insomnia was ubiquitous and frequently co-occurred with other sleep difficulties (nightmares, sleep walking, acting out dreams, etc.) in this group. Discussions revealed themes common across insomnia populations (role of negative mood states and cognitive intrusions) and also new themes on factors contributing to sleep problems in schizophrenia: (1) beliefs that sleep problems cannot be changed; (2) trauma and adversity; (3) lifestyle choices and lack of motivation; and (4) medication side effects. Sleep problems also had profound impact on daytime dysfunctions and disability. The findings point to novel issues that may benefit from consideration in the treatment of sleep problems in schizophrenia. Unhelpful cognitions and behaviours about sleep can be addressed with psychological interventions, activity scheduling and motivational interviewing techniques. Seeking a first-person perspective is vital for identifying issues that will impact on treatment success and recovery.

  5. Effects of sleep manipulation on cognitive functioning of adolescents: A systematic review.

    PubMed

    de Bruin, Eduard J; van Run, Chris; Staaks, Janneke; Meijer, Anne Marie

    2017-04-01

    Adolescents are considered to be at risk for deteriorated cognitive functioning due to insufficient sleep. This systematic review examined the effects of experimental sleep manipulation on adolescent cognitive functioning. Sleep manipulations consisted of total or partial sleep restriction, sleep extension, and sleep improvement. Only articles written in English, with participants' mean age between 10 and 19 y, using objective sleep measures and cognitive performance as outcomes were included. Based on these criteria 16 articles were included. The results showed that the sleep manipulations were successful. Partial sleep restriction had small or no effects on adolescent cognitive functioning. Sleep deprivation studies showed decrements in the psychomotor vigilance task as most consistent finding. Sleep extension and sleep improvement contributed to improvement of working memory. Sleep directly after learning improved memory consolidation. Due to the great diversity of tests and lack of coherent results, decisive conclusions could not be drawn about which domains in particular were influenced by sleep manipulation. Small number of participants, not accounting for the role of sleep quality, individual differences in sleep need, compensatory mechanisms in adolescent sleep and cognitive functioning, and the impurity problem of cognitive tests might explain the absence of more distinct results.

  6. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan.

    PubMed

    Ohayon, Maurice M; Carskadon, Mary A; Guilleminault, Christian; Vitiello, Michael V

    2004-11-01

    The purposes of this study were to identify age-related changes in objectively recorded sleep patterns across the human life span in healthy individuals and to clarify whether sleep latency and percentages of stage 1, stage 2, and rapid eye movement (REM) sleep significantly change with age. Review of literature of articles published between 1960 and 2003 in peer-reviewed journals and meta-analysis. 65 studies representing 3,577 subjects aged 5 years to 102 years. The research reports included in this meta-analysis met the following criteria: (1) included nonclinical participants aged 5 years or older; (2) included measures of sleep characteristics by "all night" polysomnography or actigraphy on sleep latency, sleep efficiency, total sleep time, stage 1 sleep, stage 2 sleep, slow-wave sleep, REM sleep, REM latency, or minutes awake after sleep onset; (3) included numeric presentation of the data; and (4) were published between 1960 and 2003 in peer-reviewed journals. In children and adolescents, total sleep time decreased with age only in studies performed on school days. Percentage of slow-wave sleep was significantly negatively correlated with age. Percentages of stage 2 and REM sleep significantly changed with age. In adults, total sleep time, sleep efficiency, percentage of slow-wave sleep, percentage of REM sleep, and REM latency all significantly decreased with age, while sleep latency, percentage of stage 1 sleep, percentage of stage 2 sleep, and wake after sleep onset significantly increased with age. However, only sleep efficiency continued to significantly decrease after 60 years of age. The magnitudes of the effect sizes noted changed depending on whether or not studied participants were screened for mental disorders, organic diseases, use of drug or alcohol, obstructive sleep apnea syndrome, or other sleep disorders. In adults, it appeared that sleep latency, percentages of stage 1 and stage 2 significantly increased with age while percentage of REM

  7. [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].

    PubMed

    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.

  8. 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.

    PubMed

    Mendoza, M E; Capafons, A; Gralow, J R; Syrjala, K L; Suárez-Rodríguez, J M; Fann, J R; Jensen, M P

    2016-07-28

    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.

  9. Applying Sleep Research to University Students: Recommendations for Developing a Student Sleep Education Program.

    ERIC Educational Resources Information Center

    Brown, Franklin C.; Buboltz, Walter C., Jr.

    2002-01-01

    Many students are unaware that academic difficulties may be related to their sleep habits. This article introduces key elements of a student sleep education program that can be easily incorporated into many universities first-year orientation classes or as part of residential housing programs. (Author)

  10. Crewmembers sleeping in sleep restraints

    NASA Image and Video Library

    1997-08-29

    STS085-327-026 (7 - 19 August 1997) --- Payload specialist Bjarni V. Tryggvason, representing the Canadian Space Agency (CSA), sleeps on the Space Shuttle Discovery's mid-deck floor. Tryggvason elected to not use a pillow, allowing his head to float freely in the Microgravity environment.

  11. Temporal Relationships Between Napping and Nocturnal Sleep in Healthy Adolescents.

    PubMed

    Jakubowski, Karen P; Hall, Martica H; Lee, Laisze; Matthews, Karen A

    2017-01-01

    Many adolescents do not achieve the recommended 9 hr of sleep per night and report daytime napping, perhaps because it makes up for short nocturnal sleep. This article tests temporal relationships between daytime naps and nighttime sleep as measured by actigraphy and diary among 236 healthy high school students during one school week. Mixed model analyses adjusted for age, race, and gender demonstrated that shorter actigraphy-assessed nocturnal sleep duration predicted longer napping (measured by actigraphy and diary) the next day. Napping (by actigraphy and diary) predicted shorter nocturnal sleep duration and worse sleep efficiency that night measured by actigraphy. Diary-reported napping also predicted poorer self-reported sleep quality that night. Frequent napping may interfere with nocturnal sleep during adolescence.

  12. Sleep and Culture in Children with Medical Conditions

    PubMed Central

    Koinis-Mitchell, Daphne

    2010-01-01

    Objectives To provide an integrative review of the existing literature on the interrelationships among sleep, culture, and medical conditions in children. Methods A comprehensive literature search was conducted using PubMed, Medline, and PsychINFO computerized databases and bibliographies of relevant articles. Results Children with chronic illnesses experience more sleep problems than healthy children. Cultural beliefs and practices are likely to impact the sleep of children with chronic illnesses. Few studies have examined cultural factors affecting the relationship between sleep and illness, but existing evidence suggests the relationship between sleep and illness is exacerbated for diverse groups. Conclusions Sleep is of critical importance to children with chronic illnesses. Cultural factors can predispose children both to sleep problems and to certain medical conditions. Additional research is needed to address the limitations of the existing literature, and to develop culturally sensitive interventions to treat sleep problems in children with chronic illnesses. PMID:20332222

  13. Cardiorespiratory fitness and sleep-related breathing disorders.

    PubMed

    Vanhecke, Thomas E; Franklin, Barry A; Ajluni, Steven C; Sangal, R Bart; McCullough, Peter A

    2008-06-01

    Obstructive sleep apnea and central sleep apnea are burgeoning sleep-related breathing disorders within the general population. Most of the associated comorbidities and causes of these sleep disorders are known to negatively impact cardiorespiratory fitness; however, little is known about the direct relationships between cardiorespiratory fitness, obstructive sleep apnea and central sleep apnea. This article provides a systematic analysis of existing peer reviewed, published clinical studies pertaining to the relationship between cardiorespiratory fitness and sleep-related breathing disorders in adults. A brief description of each sleep disorder, the pathophysiology, its epidemiology and its implications for cardiorespiratory fitness are provided. Finally, we discuss therapy for each disorder and its effect on the cardiovascular system.

  14. How Much Sleep Is Enough

    MedlinePlus

    ... page from the NHLBI on Twitter. How Much Sleep Is Enough? The amount of sleep you need ... Rate This Content: NEXT >> Updated: June 7, 2017 Sleep Infographic Sleep Disorders & Insufficient Sleep: Improving Health through ...

  15. What Is Sleep Apnea?

    MedlinePlus

    ... CPAP High Blood Pressure Overweight and Obesity Sleep Deprivation and Deficiency Sleep Studies Send a link to ... it because it only occurs during sleep. A family member or bed partner might be the first ...

  16. Changing your sleep habits

    MedlinePlus

    ... sleep over a 24-hour period. Remember, the quality of sleep and how rested you feel afterward is as ... expect to start your day. Avoid beverages with caffeine or alcohol ... sleep. Find calming, relaxing activities to do before bedtime. ...

  17. Sleep studies (image)

    MedlinePlus

    During a sleep study the sleep cycles and stages of sleep are monitored. Electrodes are placed to monitor continuous recordings of brain waves, electrical activity of muscles, eye movement, respiratory ...

  18. Obstructive Sleep Apnea

    MedlinePlus

    ... sleep apnea increase blood pressure and strain the cardiovascular system. Many people with obstructive sleep apnea develop high blood pressure (hypertension), which can increase the risk of heart disease. The more severe the obstructive sleep apnea, the ...

  19. Sleep and Chronic Disease

    MedlinePlus

    ... Search The CDC Cancel Submit Search The CDC Sleep and Sleep Disorders Note: Javascript is disabled or is not ... Data Source Projects and Partners Resources For Clinicians Sleep and Chronic Disease Recommend on Facebook Tweet Share ...

  20. Brain Basics: Understanding Sleep

    MedlinePlus

    ... Home » Disorders » Patient & Caregiver Education Brain Basics: Understanding Sleep Do you ever feel sleepy or "zone out" ... The Future Tips for a Good Night's Sleep Sleep: A Dynamic Activity Until the 1950s, most people ...