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Insalaco G, Dal Farra F, Braghiroli A, Salvaggio A. Sleep Breathing Disorders in the COVID-19 Era: Italian Thoracic Society Organizational Models for a Correct Approach to Diagnosis and Treatment. Respiration 2020; 99:690-694. [PMID: 32854106 PMCID: PMC7490486 DOI: 10.1159/000510825] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/12/2020] [Indexed: 01/08/2023] Open
Abstract
The attenuation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, at least in Italy, allows a gradual resumption of diagnostic and therapeutic activities for sleep respiratory disorders. The knowledge on this new disorder is growing fast, but our experience is still limited and when a physician cannot rely on evidence-based medicine, the experience of his peers can support the decision-making and operational process of reopening sleep laboratories. The aim of this paper is to focus on the safety of patients and operators accessing hospitals and the practice of diagnosing and treating sleep-related respiratory disorders. The whole process requires a careful plan, starting with a triage preceding the access to the facility, to minimize the risk of infection. Preparation of the medical record can be performed through standard questionnaires administered over the phone or by e-mail, including an assessment of the COVID-19 risk. The home sleep test should include single-patient sensors or easy-to-sanitize material. The use of nasal cannulas is discouraged in view of the risk of the virus colonizing the internal reading chamber, since no filter has been tested and certified to be used extensively for coronavirus due to its small size. The adaptation to positive airway pressure (PAP) treatment can also be performed mainly using telemedicine procedures. In the adaptation session, the mask should be new or correctly sanitized and the PAP device, without a humidifier, should be protected by an antibacterial/antiviral filter, then sanitized and reassigned after at least 4 days since SARS-CoV-2 was detected on some surfaces up to 72 h after. Identification of pressure should preferably be performed by telemedicine. The patient should be informed of the risk of spreading the disease in the family environment through droplets and how to reduce this risk. The follow-up phase can again be performed mainly by telemedicine both for problem solving and the collection of data. Public access to hospital should be minimized and granted to patients only. Constant monitoring of institutional communications will help in implementing the necessary recommendations.
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Affiliation(s)
- Giuseppe Insalaco
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy,
| | | | - Alberto Braghiroli
- Sleep Laboratory, Department of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy
| | - Adriana Salvaggio
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
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Abstract
Sleep medicine is a rapidly developing field of medicine that is well-suited to initiatives such as Telehealth to provide safe, effective clinical care to an expanding group of patients. The increasing prevalence of sleep disorders has resulted in long waiting lists and lack of specialist availability. Telemedicine has potential to facilitate a move toward an integrated care model, which involves professionals from different disciplines and different organizations working together in a team-oriented way toward a shared goal of delivering all of a person's care requirements. Issues around consumer health technology and nonphysician sleep providers are discussed further in the article.
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Affiliation(s)
- Cliona O'Donnell
- UCD School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland; Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Silke Ryan
- UCD School of Medicine, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland; Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, School of Medicine, University College Dublin, St. Vincent's University Hospital, St. Vincent's Hospital Group, Elm Park, Dublin 4, Ireland.
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Gupta R, Kumar VM, Tripathi M, Datta K, Narayana M, Ranjan Sarmah K, Bhatia M, Devnani P, Das S, Shrivastava D, Gourineni RD, Singh TD, Jindal A, Mallick HN. Guidelines of the Indian Society for Sleep Research (ISSR) for Practice of Sleep Medicine during COVID-19. ACTA ACUST UNITED AC 2020;:1-12. [PMID: 32838116 DOI: 10.1007/s41782-020-00097-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Sleep services are assigned a non-essential status during COVID-19. The American Academy of Sleep Medicine strongly urges sleep clinicians to continue postponing non-urgent care until a later date, if such a recommendation is made by state officials due to local conditions. At the same time, one cannot ignore the fact that sleep is important for people’s health and wellbeing. Therefore, to protect the health of the population, it is essential to find ways and means to continue the practice of sleep medicine even during the COVID-19 pandemic. Method Social environment and work ethics in sleep clinics and sleep laboratories in Asia, Africa, and Latin America are different from those in the US. Under these circumstances, the Indian Society for Sleep Research (ISSR) created a task force to develop guidelines for the practice of sleep medicine, not only for the Indian environment but also for other countries that are affected by the COVID-19 pandemic. The task force examined documents regarding practice of sleep medicine and associated specialities during COVID-19 by various professional organizations and governmental authorities. The recommendations were examined for their applicability. Wherever gaps were identified, consensus was reached keeping in view the available evidences. Outcome and Recommendations The emphasis of the guidelines is on avoiding doctor to patient contact during the pandemic. Teleconsultation and other modes of audio-visuals can be used as modes for medical practice during the COVID-19 pandemic. However, in addition to the patient, the presence of a family member, or a reliable informant is recommended. Patients of most sleep disorders can be provided tele-aftercare service. ISSR guidelines also give a list of medications allowed to be prescribed during the first and the follow-up teleconsultation. Hospitals and clinics are slowly opening in India and many other countries. As sleep services resume operations, there is a need to find innovative ways to reduce contact with COVID-19 patients, follow personal protection guidelines, as well as social distancing. This article does discuss strategies for the safe conduct of Level 1 sleep studies. Home sleep testing, which had greater acceptance during the last few years, should be given more attention during the COVID-19 period. Once the decision to reopen the sleep laboratory and resume operations is made, the safety of the patients and office staff should become the major priority. The ISSR recommendation is to postpone and reschedule in-laboratory positive pressure therapy, but it mentions the considerations to be followed in emergency situations. At the same time, high clinical risk patients may be diagnosed on the basis of clinical findings, and without performing polysomnography or home sleep testing. However, at some point, there is a need to reinitiate the in-lab testing. In addition, daily assessment of the COVID-19 situation in the community, along with a review of the situation with local public health and the state health department is advised.
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Rattray NA, Khaw A, McGrath M, Damush TM, Miech EJ, Lenet A, Stahl S, Ferguson J, Myers J, Guenther D, Homoya BJ, Bravata DM. Evaluating the feasibility of implementing a Telesleep pilot program using two-tiered external facilitation. BMC Health Serv Res 2020; 20:357. [PMID: 32336284 PMCID: PMC7183618 DOI: 10.1186/s12913-020-05164-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) can negatively impact patients' health status and outcomes. Positive airway pressure (PAP) reverses airway obstruction and may reduce the risk of adverse outcomes. Remote monitoring of PAP (as opposed to in-person visits) may improve access to sleep medicine services. This study aimed to evaluate the feasibility of implementing a clinical program that delivers treatment for OSA through PAP remote monitoring using external facilitation as an implementation strategy. METHODS Participants included patients with OSA at a Veteran Affairs Medical Center (VAMC). PAP adherence and clinical disease severity on treatment (measured by the apnea hypopnea index [AHI]) were the preliminary effectiveness outcomes across two delivery models: usual care (in-person) and Telehealth nurse-delivered remote monitoring. We also assessed visit duration and travel distance. A prospective, mixed-methods evaluation examined the two-tiered external facilitation implementation strategy. RESULTS The pilot project included N = 52 usual care patients and N = 38 Telehealth nurse-delivered remote monitoring patients. PAP adherence and disease severity were similar across the delivery modalities. However, remote monitoring visits were 50% shorter than in-person visits and saved a mean of 72 miles of travel (median = 45.6, SD = 59.0, mode = 17.8, range 5.4-220). A total of 62 interviews were conducted during implementation with a purposive sample of 12 clinical staff involved in program implementation. Weekly external facilitation delivered to both front-line staff and supervisory physicians was necessary to ensure patient enrollment and treatment. Synchronized, "two-tiered" facilitation at the executive and coordinator levels proved crucial to developing the clinical and administrative infrastructure to support a PAP remote monitoring program and to overcome implementation barriers. CONCLUSIONS Remote PAP monitoring had similar efficacy to in-person PAP services in this Veteran population. Although external facilitation is a widely-recognized implementation strategy in quality improvement projects, less is known about how multiple facilitators work together to help implement complex programs. Two-tiered facilitation offers a model well-suited to programs where innovations span disciplines, disrupt professional hierarchies (such as those between service chiefs, clinicians, and technicians) and bring together providers who do not know each other, yet must collaborate to improve access to care.
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Affiliation(s)
- Nicholas A. Rattray
- grid.280828.80000 0000 9681 3540VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana USA ,grid.448342.d0000 0001 2287 2027William M. Tierney Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana USA ,VA Precision Monitoring (PRIS-M) QUERI, Veterans Health Indiana, Indianapolis, Indiana USA ,grid.257413.60000 0001 2287 3919Department of Anthropology, Indiana University-Purdue University, Indianapolis, Indiana USA ,grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, Indiana USA
| | - Andrew Khaw
- grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, Indiana USA
| | - Mackenzie McGrath
- grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, Indiana USA
| | - Teresa M. Damush
- grid.280828.80000 0000 9681 3540VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana USA ,grid.448342.d0000 0001 2287 2027William M. Tierney Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana USA ,VA Precision Monitoring (PRIS-M) QUERI, Veterans Health Indiana, Indianapolis, Indiana USA ,grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, Indiana USA
| | - Edward J. Miech
- grid.280828.80000 0000 9681 3540VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana USA ,grid.448342.d0000 0001 2287 2027William M. Tierney Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana USA ,VA Precision Monitoring (PRIS-M) QUERI, Veterans Health Indiana, Indianapolis, Indiana USA ,grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, Indiana USA
| | - Adam Lenet
- Internal Medicine and Sleep Services, Veterans Health Indiana, Indianapolis, IN USA
| | - Stephanie Stahl
- Internal Medicine and Sleep Services, Veterans Health Indiana, Indianapolis, IN USA ,grid.257413.60000 0001 2287 3919Department of Neurology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Jared Ferguson
- grid.280828.80000 0000 9681 3540VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana USA ,VA Precision Monitoring (PRIS-M) QUERI, Veterans Health Indiana, Indianapolis, Indiana USA
| | - Jennifer Myers
- grid.280828.80000 0000 9681 3540VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana USA ,VA Precision Monitoring (PRIS-M) QUERI, Veterans Health Indiana, Indianapolis, Indiana USA
| | - David Guenther
- Nursing Service, Veterans Health Indiana, Indianapolis, IN USA
| | - Barbara J. Homoya
- grid.280828.80000 0000 9681 3540VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana USA ,VA Precision Monitoring (PRIS-M) QUERI, Veterans Health Indiana, Indianapolis, Indiana USA
| | - Dawn M. Bravata
- grid.280828.80000 0000 9681 3540VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana USA ,grid.448342.d0000 0001 2287 2027William M. Tierney Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana USA ,VA Precision Monitoring (PRIS-M) QUERI, Veterans Health Indiana, Indianapolis, Indiana USA ,grid.257413.60000 0001 2287 3919Department of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana USA
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Stowe RC, Afolabi-Brown O. Pediatric polysomnography-A review of indications, technical aspects, and interpretation. Paediatr Respir Rev 2020; 34:9-17. [PMID: 31761560 DOI: 10.1016/j.prrv.2019.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
Polysomnography is an elaborate diagnostic test composed of numerous data-collecting sensors working concomitantly to aid in the evaluation of varied sleep disorders in all age groups. Polysomnography is the study of choice for the assessment of pediatric sleep-disordered breathing, including obstructive sleep apnea syndrome, central apnea, and hypoventilation disorders, and is used to help determine treatment efficacy. Beyond the purview of snoring and breathing pauses, polysomnography can elucidate the etiology of hypersomnolence, when associated with a multiple sleep latency test, and abnormal movements or events, whether nocturnal seizure or complex parasomnia, when a thorough patient history cannot provide clear answers. This review will highlight the multitudinous indications for pediatric polysomnography and detail its technical aspects by describing the multiple neurophysiologic and respiratory parametric sources. Knowledge of these technical aspects will provide the practitioner with a thoughtful means to understand the limitations and interpretation of polysomnography.
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Affiliation(s)
- Robert C Stowe
- Division of Neurology, Children's Hospital of Philadelphia, United States; Children's Hospital of Philadelphia Sleep Center, United States.
| | - Olufunke Afolabi-Brown
- Children's Hospital of Philadelphia Sleep Center, United States; Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, United States.
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Chorney SR, Dailey JF, Zur KB. Pediatric adenoidectomy in the very young child and indications for postoperative inpatient admission. Int J Pediatr Otorhinolaryngol 2020; 130:109796. [PMID: 31794902 DOI: 10.1016/j.ijporl.2019.109796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the rate of significant respiratory events following adenoidectomy in young patients and to identify factors that would prompt inpatient admission postoperatively. METHODS A retrospective chart review was performed of consecutive adenoidectomy surgeries at a high-volume, tertiary-care children's hospital between 2016 and 2018. Children under 3.5 years of age who had surgery for obstructive symptoms were included. Patients were grouped by age (youngest ≤1.5 years, middle 1.6-2.5 years, and oldest 2.6-3.5 years). We excluded patients having revision surgery, a concomitant tonsillectomy, or additional major surgical procedure. RESULTS There were 353 patients that met inclusion criteria. The three age groups were similar with respect to all characteristics except age (p < .001), body mass index (p < .001), and percentage of Black or African American children (p = .02). Patients under 1.5 years more often had preoperative polysomnography (p = .02) with a lower oxygen saturation nadir (p = .04), and were more likely to have surgery for obstructive sleep apnea (p < .001). No differences were found between age groups with respect to recovery room issues, nurse triage calls, or readmissions within 30 days of surgery. An elective admission rate in the cohort was 35.1%, and this was age-group dependent with 79.5% of the youngest group being admitted (p < .001). On admission, 16.9% of all patients had admission events requiring positive pressure support, intensive care unit admission, or prolonged hospitalization, which was similar across all age groups (p = .67). Events were more common in younger patients (17 mos. vs 20 mos., p = .07), those with more comorbidities (74.8% vs 51.5%, p = .06) and significantly higher in those with severe preoperative polysomnogram variables (p < .001). Based on multivariate regression analysis, younger children (OR: 13.7, 95% CI: 6.5 - 29.0, p < .001) or children with an AHI over 5 events/hr (OR: 32.3, 95% CI: 3.4 - 303.2, p = .005) were more likely to have significant events on admission. CONCLUSIONS Significant respiratory events are uncommon after adenoidectomy for obstructive symptoms, even in very young children. However, for children under 1.5 years of age or those with AHI scores above 5 events/hr, postoperative admission for monitoring is recommended. Clinical judgement should be used when considering outpatient surgery for older children or those with comorbidities.
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Affiliation(s)
- Stephen R Chorney
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA; Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA.
| | - Julia F Dailey
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA.
| | - Karen B Zur
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA; Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA.
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Lu M, Yee BJ, Fitzgerald DA. Transition to adult care in sleep medicine. Paediatr Respir Rev 2020; 33:9-15. [PMID: 31806562 DOI: 10.1016/j.prrv.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022]
Abstract
More children with chronic and complex care needs are transitioned to adulthood due to advancements in medical technology including the use of non-invasive ventilation [NIV] at home and innovative medical therapies. Sleep medicine is becoming a common and at times vital component of the management plan. Various challenges are experienced in transitioning sleep patients depending on the underlying condition. These include the direct conflict between the desires of a young person for independence and their declining ability to provide self-care in neuromuscular patients, the behavioural challenges inherent in the management of children with various syndromes and the funding of equipment, care needs and multidisciplinary team input in an already resource limited adult setting. These patients should be transitioned in an early and coordinated approach following core principles of transition. Ongoing advocacy is required to raise awareness of the increased trend for technology supported young people being transitioned. Further research is required to track and assess the transition process in patients with various sleep conditions.
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Affiliation(s)
- Mimi Lu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Brendon J Yee
- Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Abstract
INTRODUCTION The American Academy of Sleep Medicine recommends patients attending for bariatric surgery (BS) to be evaluated for obstructive sleep apnoea (OSA) as untreated OSA is associated with a greater risk of post-operative complications. Not all bariatric patients have symptoms of OSA and their phenotype may be at less risk than the typical sleep clinic phenotype. Therefore, all patients may not require pre-operative sleep studies. This study aimed to establish whether screened and unscreened BS patients are at increased risk of post-operative complications. METHODS A retrospective review of BS patients at a single centre, June 2008-May 2017. Demographic data, sleep study outcomes, post-operative complications, length of stay (LOS), intensive care unit (ICU) admission, and readmission rates were reviewed. RESULTS A total of 510 patients underwent gastric bypass, sleeve gastrectomy, or gastric banding. 385/510 (75.5%) were female. Mean age was 46 ± 11.27 years, mean BMI was 49 kg/m2 ± 7.42. OSA was diagnosed in 300/510 (58.8%) and normal sleep in 57/510 (11.2%). OSA was not associated with increased post-operative complications. No significant difference between screened and unscreened patients for the development of post-operative pulmonary or cardiac complications, (p = 0.607, p = 0.827, respectively). Increasing age was a predictor for pulmonary (p = 0.011) and cardiac (p = 0.018) complications. CONCLUSION OSA is very prevalent in morbidly obese patients. The lack of association between patients diagnosed with OSA and unscreened patients, and post-operative complications suggests that not all patients require pre-operative sleep studies. Further studies may help identify which patients can safely avoid OSA screening.
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Affiliation(s)
- Emily O'Reilly
- Bon Secours Hospital, Bon Secours Health System , College Road, Cork, Ireland. .,University College Cork , College Road, Cork, Ireland.
| | - Liam Doherty
- Bon Secours Hospital, Bon Secours Health System , College Road, Cork, Ireland
| | - Colm O'Boyle
- Bon Secours Hospital, Bon Secours Health System , College Road, Cork, Ireland
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Kumar AT, Vasconcellos A, Boon M, Huntley C. Inclusion of the first cervical nerve does not influence outcomes in upper airway stimulation for treatment of obstructive sleep apnea. Laryngoscope 2019; 130:E382-E385. [PMID: 31461160 DOI: 10.1002/lary.28256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Upper airway stimulation (UAS) has demonstrated efficacy in the management of obstructive sleep apnea (OSA). Branches of the hypoglossal nerve that selectively activate tongue protrusor and stiffener muscles are included within the stimulation cuff electrode. The first cervical nerve (C1) is often also included to stimulate additional muscles contributing to tongue protrusion and stabilization. The purpose of this study was to determine whether inclusion of the C1 translates into treatment efficacy, decreased voltage requirement, and improved outcomes in patients utilizing UAS. STUDY DESIGN Single-center, retrospective cohort study. METHODS One hundred fourteen patients who received a UAS implant at our institution and underwent posttreatment polysomnography were evaluated. Stimulation cuff electrodes in 87 patients included the C1; those in the remaining 27 patients did not include the C1. Demographic data, voltage data, and pre- and posttreatment apnea-hypopnea index (AHI), O2 nadir, and Epworth Sleepiness Scale (ESS) data were collected for all patients. RESULTS There was no significant difference in stimulation voltage, or posttreatment AHI, O2 nadir, and ESS between the two cohorts. Treatment success, as measured by posttreatment AHI < 20 with a 50% reduction, was similar regardless of C1 inclusion. The same was seen for the percent of patients with AHI < 15 and AHI < 5 after treatment. The distributions of age and body mass index, as well as pre-treatment AHI, O2 nadir, and ESS were also not significantly different between treatment groups. CONCLUSIONS The current study has demonstrated that inclusion of the C1 in the stimulation cuff electrode of the upper airway stimulator may not provide any additional benefit in therapy for OSA. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E382-E385, 2020.
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Affiliation(s)
- Ayan T Kumar
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Adam Vasconcellos
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Colin Huntley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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Robbins R, Grandner MA, Buxton OM, Hale L, Buysse DJ, Knutson KL, Patel SR, Troxel WM, Youngstedt SD, Czeisler CA, Jean-Louis G. Sleep myths: an expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices. Sleep Health 2019; 5:409-417. [PMID: 31003950 PMCID: PMC6689426 DOI: 10.1016/j.sleh.2019.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/08/2019] [Accepted: 02/16/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION False beliefs about sleep can persist despite contradicting scientific evidence, potentially impairing population health. Identifying commonly held false beliefs lacking an evidence base ("myths") can inform efforts to promote population sleep health. METHOD We compiled a list of potential myths using Internet searches of popular press and scientific literature. We used a Delphi process with sleep experts (n = 10) from the fields of sleep medicine and research. Selection and refinement of myths by sleep experts proceeded in 3 phases, including focus groups (Phase 1); email-based feedback to edit, add, or remove myths (Phase 2); and closed-ended questionnaires (Phase 3) where experts rated myths on 2 dimensions, falseness and public health significance, using 5-point Likert scale from 1 ("not at all") to 5 ("extremely false"). RESULTS The current study identified 20 sleep myths. Mean expert ratings of falseness ranged from 5.00 (SD = 0.00) for the statement "during sleep the brain is not active" to 2.50 (SD = 1.07) for the statement "sleeping in during the weekends is a good way to ensure you get adequate sleep." Mean responses to public health significance ranged from 4.63 (SD = 0.74) for debunking the statement that "many adults need only 5 or less hours of sleep for general health" to 1.71 (SD = 0.49) for the statement that "remembering your dreams is a sign of a good night's sleep." CONCLUSION The current study identified commonly held sleep myths that have a limited or questionable evidence base. Ratings provided by experts suggest areas that may benefit from public health education to correct myths and promote healthy sleep.
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Affiliation(s)
- Rebecca Robbins
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health.
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine
| | - Orfeu M Buxton
- Department of Biobehavioral Health, Pennsylvania State University; Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital; Division of Sleep Medicine, Harvard Medical School; Department of Social and Behavioral Sciences, Harvard Chan School of Public Health
| | - Lauren Hale
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook Medicine
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Kristen L Knutson
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh School of Medicine
| | | | | | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital; Division of Sleep Medicine, Harvard Medical School
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health
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Bishop TM, Walsh PG, Ashrafioun L, Lavigne JE, Pigeon WR. Sleep, suicide behaviors, and the protective role of sleep medicine. Sleep Med 2020; 66:264-70. [PMID: 31727433 DOI: 10.1016/j.sleep.2019.07.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep disturbance is associated with suicidal thoughts and behaviors. The relationship of specific sleep disorders to suicide attempts is less well established. Whether treating sleep disorders reduces suicide attempts remains controversial. METHODS Suicide attempts, treatment utilization, and psychiatric diagnoses were extracted from electronic medical records and a suicide attempt database from the U.S. Department of Veterans Affairs. The sample (N = 60,102) consisted of patients with any record of suicide attempt in FY13-14 and a 1:1 case-control of patients with no record of attempt, who were propensity score-matched based on age, gender, and prior year mental health treatment utilization. Associations among sleep disorders and suicide attempt were examined via logistic regression. Covariates included depression, anxiety, posttraumatic stress disorder (PTSD), bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity. RESULTS Insomnia (OR = 5.62; 95% CI, 5.39-5.86), nightmares (odds ratio, OR = 2.49; 95% confidence interval, CI, 2.23-2.77), and sleep-related breathing disorders (OR = 1.37; 95% CI, 1.27-1.48) were positively associated with suicide attempt after accounting for age, gender, treatment utilization, and comorbid sleep disorders. Furthermore, when controlling for depression, anxiety, PTSD, bipolar, schizophrenia, substance use disorder (SUD), medical comorbidity, and obesity, insomnia (OR = 1.51, 95% CI, 1.43-1.59) remained positively associated with suicide attempt nightmares (OR = 0.96; 95% CI, 0.85-1.09) nor sleep-related breathing disorders (OR = 0.87, 95% CI = 0.79-0.94). Additionally, sleep medicine visits 180 days prior to index date were associated with decreased likelihood of suicide attempt for individuals with sleep disorders (OR = 0.86; 95% CI, 0.79-0.94). CONCLUSION Insomnia is associated with suicide attempt among veterans. Sleep medicine visits were associated with a reduced risk of suicide attempt in sleep disordered patients. The assessment and treatment of sleep disorders should be considered in context of strategies to augment suicide prevention efforts.
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Catella C, Micoulaud-Franchi JA, Monteyrol PJ, Cuny E, Vanderveken OM, d'Incau E, Philip P. Development of a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination. Eur Arch Otorhinolaryngol 2019; 276:901-9. [PMID: 30689040 DOI: 10.1007/s00405-019-05298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A new approach to treat obstructive sleep apnea (OSA) is upper airway stimulation therapy (UAS). Electrical pulses applied to the hypoglossal nerve induce tongue protrusion, increase airway patency and decrease the frequency of apneic and hypopneic events. Thus, the main objective of this study was to design a standardized evaluation of endobuccal adverse events induced by repeated tongue protrusion with both a dedicated questionnaire and an endobuccal examination. METHOD This study has designed the Tongue Adverse Event and Satisfaction Questionnaire (TAESQ) and an endobuccal examinations divided into an endobuccal lesion examination (ELE) and an endobuccal risk factor examination (ERFE). Evaluations were conducted at month 6 post-implantation. RESULTS The study population after implantation of UAS device consisted of ten Caucasian males with a mean age of 51.9 ± 11.8 years, and a mean BMI of 28.6 ± 3.3. The AHI of the ten participants ranged from 46.7 ± 12.2/h at baseline to 14.5 ± 8.9/h with the Inspire therapy at the 6-month follow-up. The TAESQ revealed pain (30%), followed by less tongue sensitivity (20%) and tongue weakness (10%). The ELE did not reveal any lesions. The ERFE revealed that some participants had tissue and dental risk factors but not associated to more adverse events. CONCLUSION The TAESQ, ELE and ERFE have been designed and studied on a small number of participants. These evaluations could systematically be included in the care pathway of patients treated by UAS to better investigate tongue discomfort and tongue lesion for patients treated with this technology.
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Kompelli AR, Ni JS, Nguyen SA, Lentsch EJ, Neskey DM, Meyer TA. The outcomes of hypoglossal nerve stimulation in the management of OSA: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg 2018; 5:41-48. [PMID: 30775701 PMCID: PMC6364516 DOI: 10.1016/j.wjorl.2018.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/08/2018] [Accepted: 04/02/2018] [Indexed: 01/14/2023] Open
Abstract
Objectives Obstructive sleep apnea (OSA) is a prevalent disease with significant health impacts. While first line therapy is CPAP, long-term compliance is low and device misuse is common, highlighting the need for alternative therapies. Upper airway surgery is one alternative, but substantial side effects hamper efficacy. A new alternative is an implantable hypoglossal nerve stimulator (HNS). These devices utilize neuromodulation to dilate/reinforce the airway and reduce side effects associated with traditional surgery. Several recent trials investigated the efficacy of these devices. The purpose of this study was to perform meta-analysis of available HNS studies investigating treatment of OSA to analyze objective and subjective outcomes and side effects. Methods A comprehensive literature search of PubMed and Scopus was performed. Two independent reviewers examined clinical trials investigating HNS in treatment of sleep apnea in adults. Studies with objective and subjective endpoints in sleep were included for analysis. Adverse events from trials were also recorded. Results Across 16 studies, 381 patients were analyzed. At 6 months (p = 0.008), mean SAQLI improved by 3.1 (95%CI, 2.6-3.7). At 12 months (p < 0.0001), mean AHI was reduced by 21.1 (95%CI, 16.9-25.3), mean ODI was reduced by 15.0 (95%CI, 12.7-17.4), mean ESS was reduced by 5.0 (95%CI, 4.2-5.8), mean FOSQ improved by 3.1 (95%CI, 2.6-3.4). Pain (6.2%:0.7-16.6), tongue abrasion (11.0%:1.2-28.7), and internal (3.0%:0.3-8.4)/external device (5.8%:0.3-17.4) malfunction were common adverse events. Conclusions HNS is a safe and effective treatment for CPAP refractory OSA. Further study comparing HNS to other therapies is required.
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Affiliation(s)
- Anvesh R Kompelli
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan S Ni
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Eric J Lentsch
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David M Neskey
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ted A Meyer
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Affiliation(s)
- Daniel Ruivo Marques
- University of Aveiro, Department of Education and Psychology, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal; CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal.
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Abstract
Economic analyses, and cost-effectiveness studies in particular, are increasingly used in medicine and population health to inform policy making and resource allocation. Health economic models have successfully captured sleep medicine outcomes. This study provides an overview of the growth of the use of cost-effectiveness analyses to quantify the outcomes of sleep related interventions. It also identifies highly prevalent sleep disorders, which despite having a high burden of disease, lack basic utility studies.
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Behr M, Acker J, Cohrs S, Deuschle M, Danker-Hopfe H, Göder R, Norra C, Richter K, Riemann D, Schilling C, Weeß HG, Wetter TC, Wollenburg LM, Pollmächer T. [Prevalence of sleep-related breathing disorders of inpatients with psychiatric disorders]. Nervenarzt 2018; 89:807-813. [PMID: 29876601 DOI: 10.1007/s00115-018-0545-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep-related breathing disorders seriously impair well-being and increase the risk for relevant somatic and psychiatric disorders. Moreover, risk factors for sleep-related breathing disorders are highly prevalent in psychiatric patients. The aim of this study was for the first time in Germany to study the prevalence of obstructive sleep apnea syndrome (OSAS) as the most common form of sleep-related breathing disorder in patients with psychiatric disorders. METHODS In 10 psychiatric hospitals in Germany and 1 hospital in Switzerland, a total of 249 inpatients underwent an 8‑channel sleep polygraphy to investigate the prevalence of sleep apnea in this group of patients. RESULTS With a conspicuous screening result of 23.7% of the subjects, a high prevalence of sleep-related breathing disorders was found to occur among this group of patients. Male gender, higher age and high body mass index (BMI) were identified as positive risk factors for the detection of OSAS. DISCUSSION The high prevalence indicates that sleep apnea is a common sleep disorder among psychiatric patients. Although OSAS can lead to substantial disorders of the mental state and when untreated is accompanied by serious somatic health problems, screening procedures are not part of the routine work-up in psychiatric hospitals; therefore, sleep apnea is presumably underdiagnosed in psychiatric patients. In view of the results of this and previous studies, this topic complex should be the subject of further research studies.
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Affiliation(s)
- M Behr
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - J Acker
- Klinik für Schlafmedizin, Bad Zurzach, Schweiz
| | - S Cohrs
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Rostock, Rostock, Deutschland
| | - M Deuschle
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - H Danker-Hopfe
- Kompetenzzentrum Schlafmedizin, Klinik für Psychiatrie und Psychotherapie der Charité, Berlin, Deutschland
| | - R Göder
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - C Norra
- LWL-Klinik Paderborn, Paderborn, Deutschland
| | - K Richter
- Klinik für Psychiatrie und Psychotherapie, Klinikum Nürnberg Nord, Nürnberg, Deutschland
| | - D Riemann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Schilling
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - H-G Weeß
- Schlafzentrum am Pfalzklinikum Klingenmünster, Klingenmünster, Deutschland
| | - T C Wetter
- Schlafmedizinisches Zentrum, Klinik für Psychiatrie und Psychotherapie, Universität Regensburg am Bezirksklinikum, Regensburg, Deutschland
| | - L M Wollenburg
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - T Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland.
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Hata T, Kanazawa T, Hamada T, Nishihara M, Bush AI, Yoneda H, Nakajima M, Katsumata T. What can predict and prevent the long-term use of benzodiazepines? J Psychiatr Res 2018; 97:94-100. [PMID: 29223863 DOI: 10.1016/j.jpsychires.2017.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/14/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022]
Abstract
Although benzodiazepines (BZDs) are commonly prescribed for insomnia or anxiety, long-term use of BZDs causes serious adverse effects such as daytime drowsiness and cognitive decline. In the current study, we evaluated the predictors and preventers of long-term usage of BZDs from a retrospective survey by utilizing the 12-year prescription record of a university hospital. From the prescription data of 92,005 people, users of BZDs (n = 3,470, male = 39.2%, mean age = 60 ± 17.5) were analyzed. During this period, both the number of prescriptions (2722 in 2004 to 1019 in 2016) and the number of BZDs (1.73 in 2004 to 1.36 in 2016) gradually decreased, although more than half of the patients continued to take BZDs for over three years. High risk factors for long-term use of BZDs include elderly patients (>65 years old), high dosage (>5 mg diazepam per day), psychiatrist-prescribers, and users with polytherapy. Discontinuation is significantly found in users of hypnotic BZDs and alternative psychotropic medical drugs (including antipsychotics, serotonergic drugs, or newer types of sleep medicine). Future studies should focus on elucidating interventions that are more effective against long-term usage of BZDs.
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Affiliation(s)
- Takeo Hata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa 920-1192, Japan.
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Department of Psychiatry, The University of Melbourne, VIC 3010, Australia; Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC 3052, Australia
| | - Takeshi Hamada
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Masami Nishihara
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Ashley Ian Bush
- Department of Psychiatry, The University of Melbourne, VIC 3010, Australia; Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC 3052, Australia
| | - Hiroshi Yoneda
- Department of Neuropsychiatry, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Miki Nakajima
- Drug Metabolism and Toxicology, Faculty of Pharmaceutical Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa 920-1192, Japan
| | - Takahiro Katsumata
- Department of Pharmacy, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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Abstract
OBJECTIVES Sleep difficulties are a serious health problem in children, and interest in using complementary and alternative medicine (CAM) therapies to treat sleep is growing. In this study, we aimed to identify: the prevalence of sleep difficulties in children, and the prevalence and patterns of CAM use among children with trouble sleeping. METHODS We used the 2012 National Health Interview Survey (NHIS) dataset to estimate the prevalence of sleep difficulties and CAM use in children ages 6-17 years. Prevalence estimates were weighted to reflect the survey's sampling design. We used logistic regression to explore associations between sleep difficulties, psychosocial factors, comorbidities and CAM use. RESULTS 6.4% of children in the 2012 NHIS dataset reported regular difficulty sleeping in the last year, corresponding to an estimated 1.5 million children in the US. Older age, poorer health status, more missed school days, and multiple comorbidities were all associated with sleep difficulties (p ≤ 0.001). Among children with sleep difficulties, 29% used at least one CAM therapy. Of the CAM therapies surveyed, non-vitamin, non-mineral supplements were the most commonly used (14.6%), followed by manipulation therapies (9.2%) and mind-body techniques (8.8%). Parental education and CAM use were most strongly associated with child CAM use (p ≤ 0.001). CONCLUSIONS CAM therapies, particularly non-vitamin, non-mineral supplements, are commonly used among children with sleeping problems. More research is needed to characterize the safety and efficacy of CAM therapies for sleep in this population.
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Affiliation(s)
- Ezra M Cohen
- Division of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Michelle L Dossett
- Benson-Henry Institute for Mind-Body Medicine, 151 Merrimac St, Boston, MA 02114, USA; Division of General Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
| | - Darshan H Mehta
- Benson-Henry Institute for Mind-Body Medicine, 151 Merrimac St, Boston, MA 02114, USA; Division of General Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
| | - Roger B Davis
- Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115, USA.
| | - Yvonne C Lee
- Department of Rheumatology, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA.
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Baptista P, Garaycochea O, Álvarez-Gómez L, Alcalde J, Alegre M, Urrestarazu E. Hypoglossal nerve stimulation surgery for obstructive sleep apnoea: Our preliminary experience. Acta Otorrinolaringol Esp (Engl Ed) 2017; 69:42-47. [PMID: 28755767 DOI: 10.1016/j.otorri.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
The objective of this communication is to describe our preliminary results in upper airway stimulation surgery via hypoglossal nerve stimulation implantation for obstructive sleep apnoea. We describe 4 cases and the outcomes of the surgery were analysed using the Epworth scale, apnoea-hypopnoea index, minimal O2 Sat, average O2 Sat and snoring intensity. In all cases a significant reduction in Epworth scale values and apnoea-hypopnoea index were obtained (P<.05). The minimum and average oxygen saturation had better values after the surgery, however, there was no statistically significant difference. The snoring severity measured subjectively changed from «intense» to «absent» in all cases. The preliminary results obtained with the upper airway stimulation surgery via hypoglossal nerve stimulation showed objective and subjective improvement after the implant activation.
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Affiliation(s)
- Peter Baptista
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España.
| | - Octavio Garaycochea
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Laura Álvarez-Gómez
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Juan Alcalde
- Servicio de Otorrinolaringología, Clínica Universidad de Navarra, Pamplona, España
| | - Manuel Alegre
- Servicio de Neurofisiología, Clínica Universidad de Navarra, Pamplona, España
| | - Elena Urrestarazu
- Servicio de Neurofisiología, Clínica Universidad de Navarra, Pamplona, España
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Araslanova R, Paradis J, Rotenberg BW. Publication trends in obstructive sleep apnea: Evidence of need for more evidence. World J Otorhinolaryngol Head Neck Surg 2017; 3:72-78. [PMID: 29204582 PMCID: PMC5683624 DOI: 10.1016/j.wjorl.2017.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Published research in obstructive sleep apnea (OSA) appears limited despite OSA being a highly prevalent adult and pediatric disease leading to many adverse outcomes if left untreated. We aimed to quantify the deficit in OSA scientific literature in order to provide a novel way of identifying gaps in knowledge and a need for further research inquiry. Methods This was a Bibliometric analysis study. Using Ovid Medline database we analyzed and compared research output (medical and surgical) between adult OSA and similarly prevalent chronic conditions (Type II diabetes (T2DM), coronary artery disease (CAD) and osteoarthritis (OA)) from December 2016 up to fifty years prior. Linear graphs were utilized to trend collected data. Utilizing same strategy, we compared publication trends for pediatric OSA to asthma and gastroesophageal reflux (GER). Results Adult OSA publications (n = 9314) were significantly underrepresented when compared to T2DM (n = 66,023), CAD (n = 31,526) and OA (n = 34,123). Linear plots demonstrated that despite increasing number of publications this disparity persisted annually. Surgical literature composed 10.4% (n = 972) of adult OSA publications and reached a plateau in the last ten years. Pediatric OSA (n = 2994) had less research output when compared to asthma (n = 47,442) and GER (n = 6705). However, over past five years pediatric OSA surpassed GER in annual number of publications. Surgical literature represented 23.1% (n = 693) of pediatric OSA publications and continued increasing over past ten years. Study methodologies for both adult and pediatric OSA showed a lack of randomized controlled trials and meta-analyses in comparison to other diseases. Conclusion Our review shows substantial deficit in total, annual and surgical adult OSA published research compared to similarly prevalent diseases. This trend is not entirely observed in pediatric OSA literature.
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Affiliation(s)
- R Araslanova
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - J Paradis
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - B W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
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Camacho M, Riley RW, Capasso R, O'Connor P, Chang ET, Reckley LK, Guilleminault C. Sleep surgery tool: A medical checklist to review prior to operating. J Craniomaxillofac Surg 2017; 45:381-386. [PMID: 28169045 DOI: 10.1016/j.jcms.2017.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to systematically review the international literature for studies providing a preoperative checklist for medical disorders to be evaluated or treated before performing sleep surgery. If no checklist exists, then studies providing recommendations would be used to develop a checklist de novo. STUDY DESIGN Systematic review combined with expert opinion. METHODS Four databases, including PubMed/Medline were searched through August 10, 2016. RESULTS 453 potentially relevant studies were screened, 32 were downloaded for full review. No study included a preoperative checklist. No study provided guidance for specific medical disorders to evaluate or screen for prior to sleep surgery. Therefore, we reviewed articles in adults that provided recommendations such as: (1) labs to review, (2) non-operative disorders to evaluate and treat, and (3) comorbidities to optimize prior to performing sleep surgery. These articles were utilized in conjunction with expert opinion to develop a preoperative checklist for surgical guidance. CONCLUSION There are several items to review prior to performing sleep surgery on obstructive sleep apnea patients. This systematic review and expert opinion-based checklist provides over twenty items for reviewing prior to performing sleep surgery to reduce the chance of operating prematurely.
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Affiliation(s)
- Macario Camacho
- Tripler Army Medical Center, Department of Surgery, Division of Otolaryngology, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA; Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA.
| | - Robert W Riley
- Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford Hospital and Clinics, Redwood City, CA 94063, USA
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford Hospital and Clinics, Redwood City, CA 94063, USA
| | - Peter O'Connor
- Department of Otolaryngology, Division of Sleep Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
| | - Edward T Chang
- Tripler Army Medical Center, Department of Surgery, Division of Otolaryngology, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA
| | - Lauren K Reckley
- Tripler Army Medical Center, Department of Surgery, Division of Otolaryngology, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA
| | - Christian Guilleminault
- Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA
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Abstract
OBJECTIVE Pediatric asthma and overweight/obesity (OV/OB) frequently co-occur and youth with both conditions exhibit poor sleep/bedtime habits. This study assessed differences in week-to-weekend bedtime/wake time variability among OV/OB youth with/without comorbid asthma, and tested whether variability predicted weekday sleep. METHODS OV/OB youth (n = 142; 28% comorbid asthma; 7-12 years) wore an Accelerometer for 5 days (2 weekend days), providing estimates of week-to-weekend bedtime/wake-time variability, weekday Total Sleep Time (TST), weekday time in bed (TIB), and weekday wake after sleep onset (WASO). RESULTS There were no demographic differences between groups beyond lower family income for the OV/OB+asthma group. The OV/OB+asthma group exhibited later weekday (mean OV/OB+asthma = 10:39 pm, mean OV/OB only = 10:30pm) and weekend (mean OV/OB+asthma = 11:41 pm, mean OV/OB only = 11:17pm) bedtimes, earlier weekday waketimes (mean OV/OB+asthma = 6:40 am, mean OV/OB only = 6:51 am), and similar weekend waketimes (mean OV/OB+asthma = 7:54 pm, mean OV/OB only = 7:52 pm. Univariate MANOVA follow-ups indicated a main effect of asthma group for week-to-weekend bedtime and waketime variability, with the OV/OB+asthma group evidencing approximately 30 minutes greater bedtime (OV/OB+asthma mean = 90 minutes) and waketime (OV/OB+asthma mean = 108 minutes) variability. Within the OV/OB+asthma group, greater waketime variability predicted fewer minutes of weekday TIB and WASO. Within the OV/OB only group, wake time variability predicted fewer minutes of weekday TIB. CONCLUSION Findings suggest that asthma status confers risk for more week-to-weekend variability among currently OV/OB youth, and that greater variability shortens the weekday sleep period. Further research on reasons for greater week-to-weekend sleep variability in asthma is needed.
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Affiliation(s)
- Kendra N Krietsch
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Casey Lawless
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - David A Fedele
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Christina S McCrae
- b Department of Health Psychology , University of Missouri , Columbia , MO , USA
| | - David M Janicke
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
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Abstract
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-related articles. The Asian institutions that ranked the first two in the number of OSA-related articles were Technion-Israel Institute of Technology and Tel Aviv University in Israel. In Taiwan, Chang Gung Memorial Hospital and Chang Gung University ranked fourth and fifth. Both institutes reported 63 articles. In Asia, Japan leads in the quantity of publication and the Japanese research institutes performed evenly. China had rapid growth in the number of articles since 2011. Although sleep medicine developed smoothly in the past decades in Taiwan, there were problems that the sleep society and specialists had to encounter. Insurance limits the expansion of sleep labs and the reimbursement is very low for sleep medicine to survive. The affiliations of sleep specialist and the sleep education are also important issue that the sleep specialists in the society have to discuss.The previous achievements do not guarantee future success. We have to face these problems seriously and take action for the following years to maintain the development of sleep medicine in Taiwan.
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Affiliation(s)
- Ning-Hung Chen
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan Shang, Taoyuan, 333 Taiwan ; Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Wen Hang
- Sleep Medicine Center, Department of Internal Medicine, China Medical University Hospital, Taichung, 40402 Taiwan ; Department of Respiratory Therapy, College of Health Care, China Medical University, Taichung, Taiwan
| | - Chia-Mo Lin
- Sleep Center, Pulmonary and Critical Care Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan ; Medical College, Fu Jen Catholic University, Taipei, Taiwan
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Keamy DG, Chhabra KR, Hartnick CJ. Predictors of complications following adenotonsillectomy in children with severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2015; 79:1838-41. [PMID: 26315929 DOI: 10.1016/j.ijporl.2015.08.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/26/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify pre-operative risk factors predicting complications following adenotonsillectomy in children with severe OSA. METHODS Retrospective chart review in an academic tertiary care center. Children with symptoms of OSA with overnight polysomnography (PSG) revealing apnea-hypopnea index (AHI) >10, who underwent adenotonsillectomy with overnight postoperative observation between 2008 and 2012. Univariate logistic regression was used to assess odds ratio (OR) of individual risk factors versus postoperative complications such as overnight desaturations <90%, length of stay (LOS)>24 h, supplemental oxygen requirement, and transfer to a higher level of care. RESULTS All patients (n=157) with severe OSA were observed overnight. Mean age was 5.3±3.7 years. Twenty-five (15.9%) patients had LOS>24 h. Forty-two (26.8%) had overnight desaturations <90%. AHI ≥15 and O2 saturation nadir <80% on preop polysomnography (PSG) were independent predictors of post-op O2 saturation <90% and LOS>24 h. (p<0.05). PSG minimum saturation <80% was the strongest predictor of all variables examined with an OR of 6.98 (3.15-15.48, 95% CI) for desaturation <90% and 5.19 (2.11-12.75, 95% CI) for LOS>24 h. Preop PSG O2 saturation<90% predicted overnight post op oxygen requirement with an OR of 3.38 (1.39-8.25, 95%CI). CONCLUSIONS Preoperative polysomnography yields significant independent predictors of post-op complications in children with OSA. While AHI is a significant independent predictor, minimum O2 saturation on preop PSG appeared the strongest predictor when <80%. Patients with these risk factors, especially low O2 on PSG, warrant overnight observation with continuous pulse oximetry.
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Affiliation(s)
- Donald G Keamy
- Massachusetts Eye and Ear Infirmary, Pediatric Otolaryngology, Boston, MA, USA
| | - Karan R Chhabra
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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75
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Kothari S, Kruse D, Karimi R, Silbernagel S, Gursoy N, Jaber R, Roppelt H, Awan R, Gold A, Meliker JR. High mercury seafood consumption associated with fatigue at specialty medical clinics on Long Island, NY. Prev Med Rep 2015; 2:798-802. [PMID: 26844152 PMCID: PMC4721310 DOI: 10.1016/j.pmedr.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated the association between seafood consumption and symptoms related to potential mercury toxicity in patients presenting to specialty medical clinics at Stony Brook Medical Center on Long Island, New York. We surveyed 118 patients from April-August 2012 about their seafood consumption patterns, specifically how frequently they were eating each type of fish, to assess mercury exposure. We also asked about symptoms associated with mercury toxicity including depression, fatigue, balance difficulties, or tingling around the mouth. Of the 118 adults surveyed, 14 consumed high mercury seafood (tuna steak, marlin, swordfish, or shark) at least weekly. This group was more likely to suffer from fatigue than other patients (p = 0.02). Logistic regression confirmed this association of fatigue with frequent high mercury fish consumption in both unadjusted analysis (OR = 5.53; 95% CI: 1.40-21.90) and analysis adjusted for age, race, sex, income, and clinic type (OR = 7.89; 95% CI: 1.63-38.15). No associations were observed between fish intake and depression, balance difficulties, or tingling around the mouth. Findings suggest that fatigue may be associated with eating high mercury fish but sample size is small. Larger studies are needed to determine whether fish intake patterns or blood mercury tests warrant consideration as part of the clinical work-up in coastal regions.
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Affiliation(s)
- Shivam Kothari
- Program in Public Health, Stony Brook University, NY 11794, United States
| | - Danielle Kruse
- Stony Brook University School of Medicine, NY 11794, United States
- Corresponding author at: Stony Brook University School of Medicine, MS-II, Health Sciences Center, Level 3, Room 071, Stony Brook University, Stony Brook, NY 11794-8338, United States.Stony Brook University School of MedicineMS-IIHealth Sciences CenterStony Brook UniversityLevel 3Room 071Stony BrookNY11794-8338United States
| | - Roxanne Karimi
- School of Marine and Atmospheric Sciences, Stony Brook University, NY 11794, United States
- Consortium for Inter-Disciplinary Environmental Research, United States
| | - Susan Silbernagel
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195, United States
| | - Nurcan Gursoy
- Department of Neurology, Stony Brook University School of Medicine, NY 11794, United States
| | - Raja Jaber
- Department of Preventive Medicine, Stony Brook University School of Medicine, NY 11794, United States
| | - Heidi Roppelt
- Department of Rheumatology, Stony Brook University School of Medicine, NY 11794, United States
| | - Rina Awan
- Sleep Disorders Center, Department of Medicine, Stony Brook University, NY 11794, United States
| | - Avram Gold
- Sleep Disorders Center, Department of Medicine, Stony Brook University, NY 11794, United States
| | - Jaymie R. Meliker
- Program in Public Health, Stony Brook University, NY 11794, United States
- Department of Preventive Medicine, Stony Brook University School of Medicine, NY 11794, United States
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76
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Tekiner H, Kosar M. The opium poppy as a symbol of sleep in Bertel Thorvaldsen's relief of 1815. Sleep Med 2016; 19:123-5. [PMID: 26210393 DOI: 10.1016/j.sleep.2015.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Danish sculptor Bertel Thorvaldsen (1770-1844) is one of the most remarkable representatives of Neoclassicist sculptural art in Europe, which was largely inspired by the classical art and culture of Greek and Roman antiquity. A pair of marble reliefs, Night and Day, exhibited in the Thorvaldsen Museum (Copenhagen), marks the culmination of Thorvaldsen's relief art and is of particular interest to the history of sleep medicine. In the first relief, Night, an angel with her neck bent and eyes closed has two babies in her embrace and seems to be floating down in grief, with an owl hovering behind her. Her hair is also twined with opium poppies, the symbol of sleep and death in antiquity. Our findings suggest that this relief not only indicates a mythological association between the opium poppy and sleep but also has a strong connotation with the poppy's medicinal use for inducing sleep throughout the centuries.
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77
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Abstract
While Emil Kraepelin's comprehensive psychiatric oeuvre has attracted researchers' attention, his studies on sleep disorders and their treatment as well as on the interconnections between sleep and mental disorders so far seem to have been neglected.This article identifies and analyzes Kraepelin's sporadic contributions on the pathology of sleep, the comorbidities and treatment made between 1883 and 1924 in textbooks and isolated papers as well as in a presentation that was also published and compares them with current opinions in sleep research.Kraepelin never published a dedicated work on sleep, apart from a summary of the different narcotics; however, his occasional statements reveal astonishing insights and in particular his clear etiologically oriented classification of sleep disorders is captivating. Similar to the current classification, Kraepelin conceptualized sleep disorders as symptoms or rather a complex of symptoms and also identified associated diseases which once again are very near to current opinion. Apart from this his recommendations on sleep hygiene and, in a second step, pharmacological treatment of pathological sleep patterns are still clinically relevant. As early as the end of the nineteenth century Kraepelin laid down an algorithm of treatment which is very similar to the current clinical guidelines. At Kraepelin's time it seemed impossible to reach an agreement on classification and treatment issues of sleep disturbances and even though there has been an ongoing discussion until the present day, an agreement at least about guidelines could be reached. Against this background Kraepelin's contributions can still be regarded as a proposal for best practice.
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Affiliation(s)
- K Becker
- Archiv für Leipziger Psychiatriegeschichte, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - M Kluge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Leipzig, Deutschland
| | - H Steinberg
- Archiv für Leipziger Psychiatriegeschichte, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
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78
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Hirata Y, Nabekura T, Maruyama H, Aonuma K, Satoh M. Elevation of plasma basic fibroblast growth factor after nocturnal hypoxic events in patients with obstructive sleep apnea syndrome. Springerplus 2013; 2:260. [PMID: 23805411 PMCID: PMC3689910 DOI: 10.1186/2193-1801-2-260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/31/2013] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is associated with recurrent nocturnal hypoxia during sleep; this hypoxia has been implicated in the pathogenesis of cardiovascular complication. However, a useful soluble factor that is sensitively correlated with OSAS severity for the diagnosis remains unidentified. We hypothesized that systemic levels of basic fibroblast growth factor (bFGF), a hypoxia-induced cytokine, were affected by nocturnal hypoxemia in OSAS patients, and we assessed whether the degree of change in the plasma bFGF concentrations before and after nocturnal hypoxia is correlated with the severity of OSAS. Thirty subjects who had suspected OSAS and had been investigated by nocturnal polysomnography (PSG) were enrolled. Plasma bFGF and vascular endothelial growth factor (VEGF) concentrations the night before PSG and the next morning were measured by sandwich enzyme-linked immunosorbent assay. Correlations between the changes in these factors and hypoxia-associated parameters for OSAS severity were analyzed. Patients with OSAS had significantly elevated levels of plasma bFGF but not VEGF and hemoglobin after rising. The degree of change in bFGF concentrations after nocturnal apnea episodes was significantly correlated with diagnostic parameters for OSAS severity. The change in plasma bFGF levels is associated with the degree of hypoxic state in OSAS patients, implying that bFGF might be a useful soluble factor for evaluating OSAS severity.
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Affiliation(s)
- Yumi Hirata
- Division of Sleep Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575 Japan
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