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Kushida CA, Roth T, Shapiro CM, Roy A, Rosenberg R, Ajayi AO, Seiden D, Gudeman J. Response to: Once-nightly sodium oxybate (FT218) in the treatment of narcolepsy: a letter to the editor commenting on the recent publication by C. Kushida et al. Sleep 2022; 45:6604255. [PMID: 35695179 PMCID: PMC9265482 DOI: 10.1093/sleep/zsac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Clete A Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center , Palo Alto, CA , USA
| | - Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Health System , Detroit, MI , USA
| | | | - Asim Roy
- Ohio Sleep Medicine and Neuroscience Institute , Dublin, OH , USA
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Kushida CA, Shapiro CM, Roth T, Thorpy MJ, Corser BC, Ajayi AO, Rosenberg R, Roy A, Seiden D, Dubow J, Dauvilliers Y. Once-nightly sodium oxybate (FT218) demonstrated improvement of symptoms in a phase 3 randomized clinical trial in patients with narcolepsy. Sleep 2022; 45:zsab200. [PMID: 34358324 PMCID: PMC9189976 DOI: 10.1093/sleep/zsab200] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/28/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES To assess the efficacy and safety of FT218, a novel once-nightly formulation of sodium oxybate (ON-SXB), in patients with narcolepsy in the phase 3 REST-ON trial. METHODS Narcolepsy patients aged ≥16 years were randomized 1:1 to uptitration of ON-SXB (4.5, 6, 7.5, and 9 g) or placebo. Three coprimary endpoints were change from baseline in mean sleep latency on the Maintenance of Wakefulness Test, Clinical Global Impression-Improvement rating, and weekly cataplexy attacks at 9, 7.5, and 6 g. Secondary endpoints included change from baseline on the Epworth Sleepiness Scale. Safety included adverse drug reactions and clinical laboratory assessments. RESULTS In total, 222 patients were randomized; 212 received ≥1 dose of ON-SXB (n = 107) or placebo (n = 105). For the three coprimary endpoints and Epworth Sleepiness Scale, all three doses of ON-SXB demonstrated clinically meaningful, statistically significant improvement versus placebo (all p < 0.001). For ON-SXB 9 g versus placebo, increase in mean sleep latency was 10.8 versus 4.7 min (Least squares mean difference, LSMD [95% CI], 6.13 [3.52 to 8.75]), 72.0% versus 31.6% were rated much/very much improved on Clinical Global Impression-Improvement (OR [95% CI], 5.56 [2.76 to 11.23]), change in mean weekly number of cataplexy attacks was -11.5 versus -4.9 (LSMD [95% CI], -6.65 [-9.32 to -3.98]), and change in Epworth Sleepiness Scale was -6.5 and -2.7 (LSMD [95% CI], -6.52 [-5.47 to -2.26]). Common adverse reactions included nausea, vomiting, headache, dizziness, and enuresis. CONCLUSIONS ON-SXB significantly improved narcolepsy symptoms; its safety profile was consistent with SXB. ON-SXB conferred efficacy with a clearly beneficial single nighttime dose. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02720744, https://clinicaltrials.gov/ct2/show/NCT02720744.
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Affiliation(s)
- Clete A Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Redwood City, CA, USA
| | | | - Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Thorpy
- Department of Neurology, Montefiore Medical Center, New York, NY, USA
| | | | | | | | - Asim Roy
- Ohio Sleep Medicine and Neuroscience Institute, Dublin, OH, USA
| | | | | | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Univ Montpellier, INM INSERM, Montpellier, France
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Ohayon MM, Krystal AD, Black J, Shapiro CM, Sullivan S, Swick TJ, Wells CC. 0774 Factors Associated With The Continuous Use Of Psychotropic Treatments For Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Narcolepsy is a debilitating disorder characterized by excessive sleepiness and cataplexy episodes. There is no cure for this disease. Current treatments focus on controlling the symptoms with CNS stimulants for sleepiness and antidepressants and/or CNS depressants for cataplexy. This study examines the factors that can contribute to the cessation of narcolepsy treatment.
Methods
The study includes 291 narcoleptic individuals who were interviewed twice, approximately five to seven years apart, in Wave 1 (W1) and Wave 2 (W2). Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy individuals were initially evaluated and diagnosed by a Sleep Specialist.
Results
At W1, 49.2% of narcoleptic individuals were taking a CNS stimulant; at W2, 37% of narcoleptic individuals were taking a CNS stimulant. The use was chronic (i.e., present at W2 and W1) for 52.7% of the W2 subjects. CNS depressants were used by 19.1% at W1 and 17% at W2. Of the W1 subjects, 67.6% still reported using CNS depressants at W2. In terms of antidepressants, 38.6% and 29.6% of subjects reported using these medications at W1 and W2 respectively. Of those taking antidepressants at W2, 58.9% reported chronic use (ie, were also on antidepressants at W1). At least one of the aforementioned medication classes was used by 72% of participants at W1 and 56.1% at W2. Chronicity of nocturnal awakenings (RR: 2.7), the frequency of cataplexy episodes (RR: 2.3) and the chronicity of hypnopompic hallucinations (RR: 2.8) were associated with long-term use of narcolepsy treatment.
Conclusion
Narcolepsy treatments are mostly taken to long term. Some narcoleptics individuals were able to reduce or stop treatment either because the intensity of symptoms decreased or because they developed coping mechanisms to deal with the symptoms.
Support
NIH (R01NS044199), the Arrillaga Foundation and Jazz Pharmaceuticals Inc.
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Affiliation(s)
| | - A D Krystal
- Department of Psychiatry, UCSF School of Medicine, San Francisco, CA
| | - J Black
- Jazz Pharmaceuticals Inc, Jazz Pharmaceuticals inc, CA
| | - C M Shapiro
- Department of Psychiatry, University of Toronto, Toronto, ON, CANADA
| | | | - T J Swick
- Neurology and Sleep Medicine Consultants, Houston, TX
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Felfeli T, Alon R, Al Adel F, Shapiro CM, Mandelcorn ED, Brent MH. Screening for obstructive sleep apnea amongst patients with retinal vein occlusion. Can J Ophthalmol 2020; 55:310-316. [PMID: 32317117 DOI: 10.1016/j.jcjo.2020.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the prevalence and varying severity of obstructive sleep apnea (OSA) amongst those newly diagnosed with retinal vein occlusion (RVO), and screen patients with the use of 2 in-office-administered questionnaires validated against polysomnography. DESIGN Prospective cross-sectional study. PARTICIPANTS Consecutive adult patients (≥18 years of age) with a new diagnosis of RVO confirmed with intravenous fluorescein angiography were enrolled. METHODS The study was conducted at a tertiary academic centre between March 22, 2017, and April 7, 2018. Patients completed the Berlin and STOP-BANG questionnaires screening for OSA at presentation. Diagnostic test properties of the 2 questionnaires compared with polysomnography at a certified sleep laboratory centre as the gold standard for detection of OSA were calculated. RESULTS A total of 27 patients (37% females) with a mean (standard deviation) age of 69.6 (11.5) years completed the study. The diagnosis of OSA based on polysomnography was made in 96% (41% severe OSA) of patients with RVO. The Berlin questionnaire had a sensitivity of 43% (confidence interval [CI]: 22%-66%) and specificity of 67% (CI: 22%-96%). The STOP-BANG questionnaire had a sensitivity of 86% (CI: 64%-97%) and specificity of 50% (CI: 12%-88%). CONCLUSIONS Given the high prevalence of severe OSA amongst those with a new diagnosis of RVO, all patients should be strongly considered for polysomnography. The use of in-office questionnaires may aid in triaging urgency of referrals.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Roy Alon
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
| | - Fadwa Al Adel
- Department of Ophthalmology, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Colin M Shapiro
- Sleep Research Laboratory, Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ont
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ont
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ont..
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Abstract
BACKGROUND Insomnia is a major predictor of adverse outcomes in mild traumatic brain injury (mTBI), including concussion; although insomnia symptoms may be due to various sleep disorders, those related to circadian rhythm sleep-wake disorders (CRSWDs) require specific assessment and treatment. The objective of the current study was to determine the prevalence of CRSWD in a sample of treatment-seeking people with chronic insomnia symptoms after an mTBI. METHODS Participants aged 17-65 years who had experienced an mTBI and reported chronic insomnia were recruited from diverse community clinics in Ontario 3-24 months after their injury to participate in this cross-sectional observational study. Potential participants were screened by both telephone and intake interview. Exclusion criteria were alcohol or substance use disorders, preexisting brain disorder or previous neurosurgery, recent travel across more than 2 time zones or shift work. Assessments included a clinical interview, questionnaires, 2 weeks of actigraphy and a sleep diary, and a dim-light melatonin onset test. The main outcome measure was the proportion of patients with CRSWDs. RESULTS Of the 50 participants (32 [64%] female; median age 39.5 yr), 13 (26% [standard deviation 12%]) had an CRSWD. The most common circadian diagnosis was delayed sleep-wake phase disorder (10 participants [20%]). INTERPRETATION The prevalence of CRSWDs may be exceptionally high among people with chronic insomnia symptoms following mTBI. Proper detection and treatment of CRSWDs in this population is essential to facilitate recovery. The findings emphasize the relevance of a diagnostic circadian assessment in patients with mTBI presenting with chronic insomnia symptoms.
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Affiliation(s)
- Dora M Zalai
- Department of Psychology (Zalai, Girard), Ryerson University, Toronto, Ont.; Oakville Centre for Cognitive Therapy (Zalai), Oakville, Ont.; Division of Neurosurgery and Injury Prevention (Cusimano), St. Michael's Hospital, University of Toronto; Department of Psychiatry (Shapiro), University of Toronto; Youthdale Child and Adolescent Sleep Centre (Shapiro), Toronto, Ont.
| | - Todd A Girard
- Department of Psychology (Zalai, Girard), Ryerson University, Toronto, Ont.; Oakville Centre for Cognitive Therapy (Zalai), Oakville, Ont.; Division of Neurosurgery and Injury Prevention (Cusimano), St. Michael's Hospital, University of Toronto; Department of Psychiatry (Shapiro), University of Toronto; Youthdale Child and Adolescent Sleep Centre (Shapiro), Toronto, Ont
| | - Michael D Cusimano
- Department of Psychology (Zalai, Girard), Ryerson University, Toronto, Ont.; Oakville Centre for Cognitive Therapy (Zalai), Oakville, Ont.; Division of Neurosurgery and Injury Prevention (Cusimano), St. Michael's Hospital, University of Toronto; Department of Psychiatry (Shapiro), University of Toronto; Youthdale Child and Adolescent Sleep Centre (Shapiro), Toronto, Ont
| | - Colin M Shapiro
- Department of Psychology (Zalai, Girard), Ryerson University, Toronto, Ont.; Oakville Centre for Cognitive Therapy (Zalai), Oakville, Ont.; Division of Neurosurgery and Injury Prevention (Cusimano), St. Michael's Hospital, University of Toronto; Department of Psychiatry (Shapiro), University of Toronto; Youthdale Child and Adolescent Sleep Centre (Shapiro), Toronto, Ont
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Abstract
OBJECTIVE Parasomnias are common in childhood but there is no established treatment for parasomnias. The aim of this study was to (1) report on the outcome of using L-tryptophan to manage parasomnias in children and (2) examine sleep architecture and subjective psychological/sleep symptoms in children with parasomnia. METHOD A retrospective analysis was conducted of charts of children (3-18 years old) who underwent polysomnographic testing and were diagnosed with primary parasomnia. Study patients were either prescribed L-tryptophan (daily dose range: 500-4500 mg, mean dose of 2400 mg) to manage their parasomnias or administered no treatment whereby parents/guardians declined treatment. Questionnaires assessing sleep and psychosocial symptoms were administered at the initial clinical consultation and a follow-up parasomnia outcome questionnaire was administered over the phone to parents/guardians. RESULTS One hundred and sixty-five children (106 boys, 59 girls) received a sleep diagnosis of primary parasomnia. A significantly (p < 0.001) higher proportion (84%) of children taking L-tryptophan experienced improvements in their parasomnia symptoms compared with those (47%) who chose not to use L-tryptophan. Polysomnography revealed that children with parasomnias had an altered sleep architecture based on age-related normative values. Children with a diagnosis of parasomnia were also subjectively more fatigued and endorsed more depressive symptoms. CONCLUSIONS This study finds that parasomnias in children are not benign and that treatment with L-tryptophan provides a favorable outcome. Children diagnosed with parasomnia had altered sleep architecture, were more fatigued, and endorsed depressive symptoms. This study supports the need to diagnose and treat parasomnias in children.
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Affiliation(s)
- Louis T van Zyl
- 1 Youthdale Child and Adolescent Sleep Centre , Toronto, Canada
| | | | - Azmeh Shahid
- 1 Youthdale Child and Adolescent Sleep Centre , Toronto, Canada .,2 Youthdale Treatment Centres , Toronto, Canada .,3 Department of Psychiatry, University of Toronto , Toronto, Canada
| | - Colin M Shapiro
- 1 Youthdale Child and Adolescent Sleep Centre , Toronto, Canada .,2 Youthdale Treatment Centres , Toronto, Canada .,3 Department of Psychiatry, University of Toronto , Toronto, Canada
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Gladanac B, Jonkman J, Shapiro CM, Brown TJ, Ralph MR, Casper RF, Rahman SA. Removing Short Wavelengths From Polychromatic White Light Attenuates Circadian Phase Resetting in Rats. Front Neurosci 2019; 13:954. [PMID: 31551702 PMCID: PMC6746919 DOI: 10.3389/fnins.2019.00954] [Citation(s) in RCA: 5] [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: 06/25/2019] [Accepted: 08/23/2019] [Indexed: 11/13/2022] Open
Abstract
Visible light is the principal stimulus for resetting the mammalian central circadian pacemaker. Circadian phase resetting is most sensitive to short-wavelength (blue) visible light. We examined the effects of removing short-wavelengths < 500 nm from polychromatic white light using optical filters on circadian phase resetting in rats. Under high irradiance conditions, both long- (7 h) and short- (1 h) duration short-wavelength filtered (< 500 nm) light exposure attenuated phase-delay shifts in locomotor activity rhythms by (∼40-50%) as compared to unfiltered light exposure. However, there was no attenuation in phase resetting under low irradiance conditions. Additionally, the reduction in phase-delay shifts corresponded to regionally specific attenuation in molecular markers of pacemaker activation in response to light exposure, including c-FOS, Per1 and Per2. These results demonstrate that removing short-wavelengths from polychromatic white light can attenuate circadian phase resetting in an irradiance dependent manner. These results have important implications for designing and optimizing lighting interventions to enhance circadian adaptation.
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Affiliation(s)
- Bojana Gladanac
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - James Jonkman
- Advanced Optical Microscopy Facility, University Health Network, Toronto, ON, Canada
| | - Colin M Shapiro
- Department of Psychiatry and Ophthalmology, University of Toronto, Toronto, ON, Canada.,Youthdale Child and Adolescent Sleep Centre, Toronto, ON, Canada
| | - Theodore J Brown
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Division of Reproductive Endocrinology and Infertility, University of Toronto, Toronto, ON, Canada
| | - Martin R Ralph
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Robert F Casper
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Division of Reproductive Endocrinology and Infertility, University of Toronto, Toronto, ON, Canada
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
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Cunningham JEA, Stamp JA, Shapiro CM. Sleep and major depressive disorder: a review of non-pharmacological chronotherapeutic treatments for unipolar depression. Sleep Med 2019; 61:6-18. [PMID: 31262550 DOI: 10.1016/j.sleep.2019.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/11/2018] [Revised: 03/18/2019] [Accepted: 04/25/2019] [Indexed: 11/25/2022]
Abstract
Depression is a significant public health issue, made worse by the absence of response to antidepressant medications by many patients. Given the high degree of overlap between sleep and circadian complaints and depression, chronotherapies are a promising avenue for novel, effective, and fast-acting treatments for depression. A critical literature review was conducted of bright light therapy (BLT) as a treatment for unipolar depression. Additionally, a separate critical literature review was also conducted of several promising, non-pharmacological, combination chronotherapeutic treatments, including BLT, sleep deprivation/wake therapy, and sleep phase advance. Results of BLT as a treatment for depression are encouraging, especially when used as an adjunct to antidepressant medications. It may also be desirable in special populations, such as geriatric and perinatal patients. Overall, results from combination chronotherapies are encouraging, though none has strong empirical support. Combining chronotherapies is an avenue of treatment which should be further explored.
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Affiliation(s)
| | - Jennifer A Stamp
- Department of Psychology & Neuroscience, Dalhousie University, Canada
| | - Colin M Shapiro
- Departments of Psychiatry and Ophthalmology, University of Toronto, Canada; Youthdale Child and Adolescent Sleep Centre, Canada
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Abstract
Craniofacial abnormalities are a known obstructive sleep apnea (OSA) risk factor, but still need to be better characterized. This study investigates the relationship between mandibular width and the risk of developing OSA.We retrospectively analyzed 3D reconstructions of head and neck computed tomography (CT) scans at our institution for mandibular width, neck circumference, neck fat volume (NFV), airway volume (AWV), and NFV:AWV ratio. Age, gender, and BMI were also documented. Patients were contacted to complete a STOP-BANG survey to assess OSA risk. Only patients with reconstructable scans and completed STOP-BANG questionnaires were included in the study. Survey results were analyzed to assess the correlation between mandible width and STOP-BANG. Mandible association was also compared to the associations of the other known risk factors.The final analysis included 427 patients with a mean age of 58.98 years (standard deviation = 16.77), 56% of whom were male. Mandibular width was found to positively correlate with STOP-BANG score (r = .416, P < .001). Statistically significant differences between mandible size for each risk group was seen (P < .001). After controlling for age and sex, mandible size was significantly different only for the low risk vs. high risk groups (odds ratio = 1.11; 95% confidence interval = 1.03-1.20; P = .007). Furthermore, when stratified according to mandible size, the small mandible group (<77.50 mm) predominantly consisted of low risk patients; the medium size mandible group (77.50-84.40 mm) was predominated by intermediate risk patients, and large mandible (>84.40 mm) was predominantly seen in high risk patients. Mandible width expressed a stronger association than NFV:AWV ratio, but neck circumference and NFV had stronger associations than did mandible width.In addition to previously documented OSA risk factors, mandibular width is positively correlated with OSA as an independent risk factor. Observation of a wide mandible (jaw) should raise awareness of OSA risk and increase screening methods when appropriate.
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Affiliation(s)
- Hillel S. Maresky
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, Ontaria, Canada
| | - Miriam M. Klar
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Jaron Tepper
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Haim Gavriel
- Department of Otolaryngology, Assaf Harofeh Medical Center, Affiliated with Sackler Faculty of Medicine
| | - Tomer Ziv Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Colin M. Shapiro
- Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sigal Tal
- Department of Radiology, Assaf Harofeh Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Ohayon MM, Black J, Krystal AD, Shapiro CM, Swick TJ, Bogan R, Wells CC. Longitudinal study of narcolepsy symptoms in first, second, and third-degree relatives of simplex and multiplex narcolepsy families. Sleep Med 2018; 53:88-93. [PMID: 30496948 DOI: 10.1016/j.sleep.2018.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the evolution of narcolepsy symptoms in first-, second, and third-degree relatives and to compare multiplex and simplex families. METHODS A total of 4045 family members and 362 narcoleptic individuals were entered in the study; with 3255 family members interviewed twice, five to seven years apart. A control group (n = 178) composed of spouses or housemates was also interviewed twice. Family members were divided according to their blood relationship with the probands and further divided into multiplex (ie, more than one narcolepsy cases) and simplex (only one narcolepsy case) families. Telephone interviews were conducted with the help of the Sleep-EVAL system; narcolepsy probands were evaluated and diagnosed by a Sleep Specialist in a Sleep Clinic Center. RESULTS A total of 1123 family members from 72 families were identified as members of multiplex families while the rest of the sample were a part of simplex families (n = 2132). Multiplex families had higher incidence and chronicity of hypersomnolence than the simplex family members and the control group. For cataplexy-like symptoms, only prevalence at the time of the first assessment distinguished multiplex (5.5%) and simplex (2.9%) families. Prevalence of sleep paralysis was higher among the first- and second-degree relatives coming from multiplex families, while incidence was the highest among second- and third-degree relatives. Hypnagogic hallucinations had similar prevalence between multiplex and simplex families but the incidence and chronicity were significantly higher among multiplex families. For each symptom, predictive factors were also determined in simplex and multiplex families. CONCLUSIONS Our results show that individuals coming from multiplex families are at greater risks of a broad range of narcolepsy symptoms compared to simplex families.
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Affiliation(s)
- Maurice M Ohayon
- Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, USA.
| | - Jed Black
- Stanford Sleep Medicine Center, Redwood City, CA, USA; Jazz Pharmaceuticals, Inc, Palo Alto, CA, USA
| | | | | | - Todd J Swick
- Neurology and Sleep Medicine Consultants, Houston, TX, USA
| | - Richard Bogan
- University of South Carolina School of Medicine, Columbia, SC, USA; SleepMed, Incorporated, Columbia, SC, USA
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Abumuamar AM, Dorian P, Newman D, Shapiro CM. The prevalence of obstructive sleep apnea in patients with atrial fibrillation. Clin Cardiol 2018; 41:601-607. [PMID: 29745973 DOI: 10.1002/clc.22933] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 01/02/2018] [Revised: 02/13/2018] [Accepted: 02/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a systemic disorder associated with significant cardiovascular complications. OSA may play a role in the initiation and worsening of atrial fibrillation (AF). This study aimed to determine the prevalence and clinical predictors of OSA in patients with AF. HYPOTHESIS OSA is underdiagnosed in a large number of patients with AF and may not be predicted by conventional clinical indices. METHODS Consecutive nonselected patients with AF were recruited from different arrhythmia clinics in Toronto, Ontario, Canada. Patients with previous diagnosis and/or treatment of OSA were excluded. Patients underwent 2 consecutive nights of ambulatory sleep testing with full electroencephalogram recording. OSA was defined as an Apnea-Hypopnea Index (AHI) score ≥ 5 per hour of sleep. RESULTS 123 patients with AF were recruited, with 100 patients included in the final analysis. OSA was detected in 85% of these patients. 27% of patients with normal overall AHI had an increased AHI during rapid eye movement sleep. Only age and male sex were independent predictors of the presence of OSA in these patients. CONCLUSIONS OSA is common and often undetected in patients with AF, especially in nonobese and/or female patients. Patients may have a normal overall AHI but an abnormal AHI during rapid eye movement sleep. The clinical relevance and therapeutic implications in this subgroup should be further investigated. The clinical features of OSA are not reliable predictors of OSA in patients with AF. A low threshold for detection of OSA, with sleep studies, in these patients may be merited.
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Affiliation(s)
- Asmaa M Abumuamar
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Paul Dorian
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario
| | - David Newman
- Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Colin M Shapiro
- Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario
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Abumuamar AM, Dorian P, Newman D, Shapiro CM. The STOP-BANG questionnaire shows an insufficient specificity for detecting obstructive sleep apnea in patients with atrial fibrillation. J Sleep Res 2018; 27:e12702. [DOI: 10.1111/jsr.12702] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 03/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Asmaa M. Abumuamar
- Institute of Medical Science; Faculty of Medicine; University of Toronto; Toronto ON Canada
- Department of Psychiatry; Toronto Western Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Paul Dorian
- Department of Cardiology; St. Michael's Hospital; University of Toronto; Toronto ON Canada
| | - David Newman
- Department of Cardiology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
| | - Colin M. Shapiro
- Department of Psychiatry; Toronto Western Hospital; University Health Network; University of Toronto; Toronto ON Canada
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Cabrera M, Benavides AM, Hallaji NAE, Chung SA, Shapiro CM, Trope GE, Buys YM. Risk of obstructive sleep apnea in open-angle glaucoma versus controls using the STOP-Bang questionnaire. Can J Ophthalmol 2018; 53:76-80. [PMID: 29426446 DOI: 10.1016/j.jcjo.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/27/2017] [Accepted: 07/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the percentage of patients at risk for obstructive sleep apnea (OSA) in open-angle glaucoma (OAG) versus controls using the STOP-Bang questionnaire. METHODS This study used a cross-sectional survey. Patients with OAG and controls completed the STOP-Bang questionnaire-a validated tool to identify patients at high risk for OSA. Patients were considered at risk if they scored 3 or more points or at high risk for moderate/severe OSA if they scored 5 or more out of the maximum 8 points. Demographic information, medical history, and previous diagnosis of OSA were recorded. Details regarding the patients' glaucoma were obtained from their medical records. RESULTS A total of 437 patients with OAG and 441 controls were included. The mean STOP-Bang score was 3.01 ± 1.3 for the glaucoma group and 3.03 ± 1.4 for the control group (p = 0.92). There was no significant difference between the percentage of subjects considered at risk for OSA (62.7% OAG vs 59.4% controls, p = 0.37) or at high risk for moderate/severe OSA (12.6% OAG vs 16.5% controls, p = 0.1). Significantly more patients in the control group had a previous diagnosis of OSA (p = 0.01). More patients with OAG reported feeling tired compared with controls (p = 0.003). A risk/high risk for OSA was not associated with glaucoma severity, progression, intraocular pressure control, or glaucoma type. CONCLUSIONS Our results indicate that a risk or high risk for moderate/severe OSA as measured by the STOP-Bang questionnaire is not correlated with the presence or absence of glaucoma (regardless of the type), glaucoma severity, glaucoma progression, or IOP control.
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Affiliation(s)
- Mariana Cabrera
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - Ana María Benavides
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - Numan A E Hallaji
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - Sharon A Chung
- Sleep Research Laboratory, Department of Psychiatry, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - Colin M Shapiro
- Sleep Research Laboratory, Department of Psychiatry, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - Graham E Trope
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, Ont
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto, Toronto, Ont.
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Abumuamar AM, Dorian P, Newman D, Shapiro CM. Assessment of Sleep and Mood Symptoms in Patients with Undetected Obstructive Sleep Apnea and Atrial Fibrillation. ACTA ACUST UNITED AC 2018. [DOI: 10.4172/2155-9880.1000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Carney CE, Edinger JD, Kuchibhatla M, Lachowski AM, Bogouslavsky O, Krystal AD, Shapiro CM. Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression: A Randomized Controlled Clinical Trial. Sleep 2017; 40:2990154. [PMID: 28199710 DOI: 10.1093/sleep/zsx019] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Study Objective To compare cognitive behavioral therapy for insomnia (CBT-I) + antidepressant medication (AD) against treatments that target solely depression or solely insomnia. Design A blinded, randomized split-plot experimental study. Setting Two urban academic clinical centers. Participants 107 participants (68% female, mean age 42 ± 11) with major depressive disorder and insomnia. Interventions Randomization was to one of three groups: antidepressant (AD; escitalopram) + CBT-I (4 sessions), CBT-I + placebo pill, or AD + 4-session sleep hygiene control (SH). Measurements and Results Subjective sleep was assessed via 2 weeks of daily sleep diaries (use of medication was covaried in all analyses); although there were no statistically significant group differences detected, all groups improved from baseline to posttreatment on subjective sleep efficiency (SE) and total wake time (TWT) and the effect sizes were large. Objective sleep was assessed via overnight polysomnographic monitoring at baseline and posttreatment; analyses revealed both CBT groups improved on TWT (p = .03), but the AD + SH group worsened. There was no statistically significant effect for PSG SE (p = .07). There was a between groups medium effect observed for the AD + SH and CBT + placebo group differences on diary TWT and both PSG variables. All groups improved significantly from baseline to posttreatment on the Hamilton Rating Scale for Depression (HAMD-17); the groups did not differ. Conclusions Although all groups self-reported sleeping better after treatment, only the CBT-I groups improved on objective sleep, and AD + SH's sleep worsened. This suggests that we should be treating sleep in those with depression with an effective insomnia treatment and relying on self-report obscures sleep worsening effects. All groups improved on depression, even a group with absolutely no depression-focused treatment component (CBT-I + placebo). The depression effect in CBT-I only group has been reported in other studies, suggesting that we should further investigate the antidepressant properties of CBT-I.
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Abumuamar AM, Mollayeva T, Sandor P, Newman D, Nanthakumar K, Shapiro CM. Efficacy of Continuous Positive Airway Pressure Treatment in Patients with Cardiac Arrhythmia and Obstructive Sleep Apnea: What is the Evidence? ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1179559x17734227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Asmaa M Abumuamar
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Tatyana Mollayeva
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Sandor
- Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - David Newman
- Department of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Kumaraswamy Nanthakumar
- Department of Cardiology, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| | - Colin M Shapiro
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Abumuamar AM, Chung SA, Kadmon G, Shapiro CM. A comparison of two screening tools for paediatric obstructive sleep apnea. J Sleep Res 2017; 27:e12610. [DOI: 10.1111/jsr.12610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Asmaa M. Abumuamar
- Institute of Medical Science; Faculty of Medicine; University of Toronto; Toronto ON Canada
- Department of Psychiatry; Toronto Western Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Sharon A. Chung
- Department of Psychiatry; Toronto Western Research Institute; University Health Network; Toronto ON Canada
| | - Gili Kadmon
- Pediatric Intensive Care Unit; Sackler Faculty of Medicine; Schneider Children's Medical Center; Tel-Aviv University; Tel-Aviv Israel
| | - Colin M. Shapiro
- Department of Psychiatry; Toronto Western Hospital; University Health Network; University of Toronto; Toronto ON Canada
- Youthdale Child and Adolescent Sleep Centre; Toronto ON Canada
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Mollayeva T, Colantonio A, Cassidy JD, Vernich L, Moineddin R, Shapiro CM. Sleep stage distribution in persons with mild traumatic brain injury: a polysomnographic study according to American Academy of Sleep Medicine standards. Sleep Med 2017; 34:179-192. [PMID: 28522089 DOI: 10.1016/j.sleep.2017.02.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 01/20/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE AND BACKGROUND Sleep stage disruption in persons with mild traumatic brain injury (mTBI) has received little research attention. We examined deviations in sleep stage distribution in persons with mTBI relative to population age- and sex-specific normative data and the relationships between such deviations and brain injury-related, medical/psychiatric, and extrinsic factors. PATIENTS AND METHODS We conducted a cross-sectional polysomnographic investigation in 40 participants diagnosed with mTBI (mean age 47.54 ± 11.30 years; 56% males). MEASUREMENTS At the time of investigation, participants underwent comprehensive clinical and neuroimaging examinations and one full-night polysomnographic study. We used the 2012 American Academy of Sleep Medicine recommendations for recording, scoring, and summarizing sleep stages. We compared participants' sleep stage data with normative data stratified by age and sex to yield z-scores for deviations from available population norms and then employed stepwise multiple regression analyses to determine the factors associated with the identified significant deviations. RESULTS In patients with mTBI, the mean duration of nocturnal wakefulness was higher and consolidated sleep stage N2 and REM were lower than normal (p < 0.0001, p = 0.018, and p = 0.010, respectively). In multivariate regression analysis, several covariates accounted for the variance in the relative changes in sleep stage duration. No sex differences were observed in the mean proportion of non-REM or REM sleep. CONCLUSIONS We observed longer relative nocturnal wakefulness and shorter relative N2 and REM sleep in patients with mTBI, and these outcomes were associated with potentially modifiable variables. Addressing disruptions in sleep architecture in patients with mTBI could improve their health status.
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Affiliation(s)
- Tatyana Mollayeva
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada; Collaborative Program in Neuroscience, University of Toronto, Canada; Toronto Rehab-University Health Network, Ontario, Canada.
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada; Acquired Brain Injury Research Lab, University of Toronto, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Ontario, Canada
| | - J David Cassidy
- Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Canada; Division of Epidemiology, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Lee Vernich
- Division of Epidemiology, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Rahim Moineddin
- Division of Epidemiology, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Colin M Shapiro
- Faculty of Arts and Science, University of Toronto, Canada; Toronto Western Hospital, University Health Network, Ontario, Canada; Youthdale Child & Adolescent Sleep Clinic, Ontario, Canada
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Beltran-Agulló L, Buys YM, Jahan F, Shapiro CM, Flanagan JG, Cheng J, Trope GE. Twenty-four hour intraocular pressure monitoring with the SENSIMED Triggerfish contact lens: effect of body posture during sleep. Br J Ophthalmol 2017; 101:1323-1328. [PMID: 28270491 DOI: 10.1136/bjophthalmol-2016-308710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/30/2016] [Revised: 10/28/2016] [Accepted: 02/08/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine the difference in relative intraocular pressure (IOP) measured by the SENSIMED Triggerfish (TF) contact lens in flat compared with 30° head-up sleeping positions in patients with progressive primary open-angle glaucoma or normotensive glaucoma, based on recent or recurrent disc haemorrhage. DESIGN Prospective, randomised, cross-over, open-label comparative study. METHODS IOP was monitored for 24 hours using TF on two separate sessions. Patients were randomly assigned to sleep flat one night and 30° head-up the other. Outputs in arbitrary units were obtained. Sleep and wake periods were defined as 22:00-6:00 and 8:00-22:00, respectively. Mean TF values during sleep and wake periods and wake-sleep and sleep-wake slopes were calculated for each session. TF output signals were compared between positions. RESULTS Twelve subjects completed the study. Significant mean positive slopes were noted during the sleep period for both positions (p<0.01). No significant differences in the TF mean values were observed between positions (p=0.51). Six (54%) subjects had mean TF values significantly higher during the flat supine session, while four (36%) subjects had higher values during the head-up session. A significant increase in Goldmann IOP (p=0.001) and TF (p=0.02) measurements were observed after 24 hours of TF wear ('drift phenomenon'). CONCLUSIONS Sleep position affects IOP as measured by TF in some patients with progressive glaucoma. The upward drift in TF output detected in >50% of the subjects requires further investigation to establish whether the increased output values over time are an artefact induced by the TF or a real change in IOP. TRIAL REGISTRATION NUMBER NCT01351779.
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Affiliation(s)
- Laura Beltran-Agulló
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada.,Institut Català de la Retina, Barcelona, Spain
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Farzana Jahan
- Sleep Research Unit, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Colin M Shapiro
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada
| | - John G Flanagan
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Jason Cheng
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Graham E Trope
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ontario, Canada
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Liao P, Wong J, Singh M, Wong DT, Islam S, Andrawes M, Shapiro CM, White DP, Chung F. Postoperative Oxygen Therapy in Patients With OSA. Chest 2017; 151:597-611. [DOI: 10.1016/j.chest.2016.12.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/27/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022] Open
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Abstract
Pain is an unpleasant, complex, and perceived experience that places a significant burden on patients and clinicians. Its severity may be mediated by emotion, attitude, and environmental influences, and pain may be expressed differently in males and females. Traumatic brain injury (TBI) is frequently associated with chronic pain. This diagnostic modeling study examined sex differences in the construct of chronic pain in patients with delayed recovery from concussion/mild traumatic brain injury (mTBI).Data were collected from standardized questionnaires, neuroimaging records, and comprehensive clinical assessments. Bivariate associations were calculated using the Spearman correlation coefficient or analysis of variance. We established sex-specific stepwise multivariate linear regression models of factors associated with pain.Of the 94 participants diagnosed with mTBI (the mean age was 45.20 ± 9.94 years; 61.2% were males; the median time since injury was 197 days [interquartile range 139-416]), head/neck, and bodily pain were reported by 93% and 64%, respectively. No sex differences were identified in pain frequencies or severity. Pain was significantly associated with certain socio-demographic, injury-related, behavioral, and clinical variables. In the multivariable regression analysis, several determinants explained 60% of the pain variance in males and 46% in females.Pain is common in patients with delayed recovery from mTBI and is significantly associated with potentially modifiable clinical and nonclinical variables. Examining the multidimensional construct of pain in concussion/mTBI through a sex lens garners new directions for future longitudinal research on the pain mechanisms involved in postconcussion syndrome.
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Affiliation(s)
- Tatyana Mollayeva
- Rehabilitation Sciences Institute, Faculty of Medicine
- Department of Occupational Science and Occupational Therapy, University of Toronto
- Toronto Rehabilitation Institute
| | - J. David Cassidy
- Division of Health Care and Outcomes Research, University Health Network
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
| | - Colin M. Shapiro
- Toronto Western Hospital, University Health Network
- Youthdale Child & Adolescent Sleep Clinic
| | - Shirin Mollayeva
- Department of Biology, University of Toronto, Mississauga, Ontario, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine
- Department of Occupational Science and Occupational Therapy, University of Toronto
- Toronto Rehabilitation Institute
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Mollayeva T, Mollayeva S, Shapiro CM, Cassidy DJ. Complex Perceived States in Work-Related Chronic Concussion. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mollayeva T, Colantonio A, Vernich L, Mollayeva S, Cassidy DJ, Shapiro CM. Polysomnographic Assessment of Sleep Function and Structure in Adults With Mild Traumatic Brain Injury/Concussion. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.09.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Goril S, Zalai D, Scott L, Shapiro CM. Sleep and melatonin secretion abnormalities in children and adolescents with fetal alcohol spectrum disorders. Sleep Med 2016; 23:59-64. [PMID: 27692277 DOI: 10.1016/j.sleep.2016.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 11/11/2015] [Revised: 05/02/2016] [Accepted: 06/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Caregivers describe significant sleep disturbances in the vast majority of children and adolescents, which is diagnosed as fetal alcohol spectrum disorders (FASD), but objective data on sleep disorders in this population are almost completely lacking. Animal models suggest that intrauterine alcohol exposure may disrupt sleep wake patterns, cause sleep fragmentation, and specifically affect the suprachiasmatic nucleus, thus disrupting melatonin secretion. The objective of this pioneering study was to evaluate sleep and melatonin abnormalities in children with FASD using objective, gold-standard measures. METHODS Children and adolescents (N = 36, 6-18 years) with FASD participated in clinical assessments by sleep specialists, overnight polysomnography (PSG), and a dim light melatonin onset (DLMO) test in a pediatric sleep laboratory. PSG was analyzed according to standardized scoring guidelines and sleep architecture was compared with normative data. DLMOs were determined and melatonin secretion curves were evaluated qualitatively to classify melatonin profiles. Sleep disorders were evaluated according to international diagnostic criteria. RESULTS There was a high prevalence (58%) of sleep disorders. The most common sleep problems were parasomnias (27.9%) and insomnia (16.8%). The sleep studies showed lower than normal sleep efficiency and high rates of sleep fragmentation. Most participants (79%) had an abnormal melatonin profile. CONCLUSIONS This study led to the recognition that both sleep and melatonin secretion abnormalities are present in children with FASD. Therefore, to be effective in managing the sleep problems in children with FASD, one needs to consider both the sleep per se and a possible malfunction of the circadian regulation.
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Affiliation(s)
- Shery Goril
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada; Collaborative Program in Neurosciences, University of Toronto, Toronto, Ontario, Canada
| | - Dora Zalai
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
| | | | - Colin M Shapiro
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada; Department of Psychiatry and Ophthalmology, University Health Network, Toronto, Ontario, Canada
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Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Med Rev 2016; 25:52-73. [PMID: 26163057 DOI: 10.1016/j.smrv.2015.01.009] [Citation(s) in RCA: 896] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 01/16/2015] [Accepted: 01/26/2015] [Indexed: 12/17/2022]
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Shahid A, Chung SA, Maresky L, Danish A, Bingeliene A, Shen J, Shapiro CM. The Toronto Hospital Alertness Test scale: relationship to daytime sleepiness, fatigue, and symptoms of depression and anxiety. Nat Sci Sleep 2016; 8:41-5. [PMID: 26855603 PMCID: PMC4725691 DOI: 10.2147/nss.s91928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The Toronto Hospital Alertness Test (THAT) scale was designed to measure alertness, defined as the capacity of the mind to respond appropriately to external and internal stimuli. The present study's aim is to determine normative values of alertness on the THAT and to explore the relationship among excessive daytime sleepiness, fatigue, depressive symptoms, and alertness. METHODS Normative data were collected from 60 healthy males and females. To explore the relationship among alertness, daytime sleepiness, fatigue, depression, and anxiety, data were collected from charts of sleep clinic patients. All study subjects completed measures for fatigue, sleepiness, depressive symptoms, and anxiety. RESULTS The average score on the THAT was 34.9±7.2 (range 22-50) for the control group. The cutoff score for the THAT, indicative of clinically significant reduced alertness, was determined to be ≤20.5 (mean -2 SD). THAT alertness scores were found to be modestly, significantly, and negatively correlated with fatigue levels (r=-0.39, P<0.001), depressive symptoms (r=-0.53, P<0.001), and anxiety symptoms (r=-0.41, P<0.001). No correlations were found between alertness levels and daytime sleepiness. Regression analyses revealed a significant model (F=19.9, P<0.001, adjusted R (2)=0.35) with depressive symptoms (P<0.001) and fatigue (P=0.006) emerging as the only significant predictors of scores on the THAT. CONCLUSION The findings of this study support that sleepiness is not the same as poor alertness. Depressive symptoms and fatigue, but not sleepiness, were found to have a strong and significant impact on levels of alertness. This is the first study to link poor alertness to depressive symptoms.
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Affiliation(s)
- Azmeh Shahid
- Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Youthdale Treatment Centres, University of Toronto, Toronto, ON, Canada; Youthdale Child and Adolescent Sleep Centre, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Sharon A Chung
- Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Youthdale Treatment Centres, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Lance Maresky
- Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Affan Danish
- Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Arina Bingeliene
- Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Jianhua Shen
- Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Colin M Shapiro
- Sleep Research Laboratory, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada; Youthdale Treatment Centres, University of Toronto, Toronto, ON, Canada; Youthdale Child and Adolescent Sleep Centre, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Mollayeva T, Mollayeva S, Shapiro CM, Cassidy JD, Colantonio A. Insomnia in Workers with Delayed Recovery from Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mollayeva T, Pratt B, Mollayeva S, Shapiro CM, Cassidy JD, Colantonio A. The relationship between insomnia and disability in workers with mild traumatic brain injury/concussion: Insomnia and disability in chronic mild traumatic brain injury. Sleep Med 2015; 20:157-66. [PMID: 26790723 DOI: 10.1016/j.sleep.2015.09.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 05/31/2015] [Revised: 09/20/2015] [Accepted: 09/22/2015] [Indexed: 01/24/2023]
Abstract
AIM/BACKGROUND The principal aim of this study was to, for the first time, examine the relationship between insomnia and perceived disability among workers with mild traumatic brain injury (mTBI)/concussion. PATIENTS/METHODS A cross-sectional study was conducted at the Workplace Safety and Insurance Board Clinic of the largest rehabilitation teaching hospital in Canada. Data from questionnaires, insurer records and clinical investigations were analysed. The Insomnia Severity Index measured the primary independent variable, and the Sheehan Disability Scale measured disability outcomes, classified as 'mild/moderate' or 'marked/extreme'. Two-sided t-tests and Chi-squared tests were used for bivariate associations. A binomial logistic regression model was fit using previously identified variables. RESULTS The sample comprised 92 workers (45.1 ± 9.9 years old, 61% male) with mTBI/concussion at median time 196 days after injury. When compared with workers reporting lower disability, workers with higher disability were found with more severe insomnia, depression, anxiety and pain. In the multivariable analysis, the odds of reporting higher global disability increased with increasing insomnia and pain [adjusted odds ratio (OR) 1.16 (95% CI 1.03-1.31) and 1.117 (95% CI 1.01-1.24), respectively]. Insomnia was the only significant covariate in a fully adjusted work disability model. None of the variables studied were statistically significant in the social and family life disability models. CONCLUSIONS Greater attention should be given to the diagnosis and management of insomnia in persons with mTBI/concussion.
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Affiliation(s)
- Tatyana Mollayeva
- Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Collaborative Program in Neuroscience, University of Toronto, Toronto, ON, Canada; Toronto Rehab-University Health Network, Toronto, ON, Canada.
| | - Brandy Pratt
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shirin Mollayeva
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada; Aquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Colin M Shapiro
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Youthdale Child & Adolescent Sleep Clinic, Ontario, Canada
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, ON, Canada
| | - Angela Colantonio
- Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Rehab-University Health Network, Toronto, ON, Canada; Aquired Brain Injury Research Lab, University of Toronto, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Mollayeva T, Shapiro CM, Mollayeva S, Cassidy JD, Colantonio A. Modeling community integration in workers with delayed recovery from mild traumatic brain injury. BMC Neurol 2015; 15:194. [PMID: 26452471 PMCID: PMC4600293 DOI: 10.1186/s12883-015-0432-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/16/2015] [Indexed: 12/28/2022] Open
Abstract
Background Delayed recovery in persons after mild traumatic brain injury (mTBI) is poorly understood. Community integration (CI) is endorsed by persons with neurological disorders as an important outcome. We aimed to describe CI and its associated factors in insured Ontario workers with delayed recovery following mTBI. Methods A cross-sectional study of insured workers in the chronic phase following mTBI was performed at a rehabilitation hospital in Ontario, Canada. Sociodemographic, occupational, injury-related, clinical, and claim-related data were collected from self-reports, medical assessments, and insurers’ referral files. Community Integration Questionnaire (CIQ) scores were compared using analysis of variance or Spearman’s correlation tests. Stepwise multivariable linear regression models were used to evaluate the associations with CI. Results Ninety-four workers with mTBI (45.2 ± 9.9 years old, 61.2 % male) at 197 days post-injury (interquartile range, 139–416 days) were included. The CIQ total and subscale scores were similar to those reported in more severe TBI samples. The CIQ scores were moderately to strongly correlated with various sociodemographic, claim-related, and clinical variables. In the multivariable regression analysis, several covariates accounted for 36.4 % of the CIQ variance in the final fully adjusted model. Discussion This study evaluated CI in workers with mTBI, and analyzed its associated variables. Analysis revealed insomnia, head or neck pain, being married or in a relationship, time since injury, and a diagnosis of possible/probable malingering were independently associated with limited CI. Conclusions Workers with delayed recovery from mTBI experience difficulty with CI. Insomnia is a particularly relevant covariate, explaining the greater part of its variance. To enhance participation, care should focus on clinical and non-clinical covariates. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0432-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tatyana Mollayeva
- Graduate Department of Rehabilitation Science, Collaborative Program in Neuroscience, University of Toronto, Toronto, Canada. .,Toronto Rehab-University Health Network, Ontario, Canada.
| | - Colin M Shapiro
- Toronto Western Hospital, University Health Network, Ontario, Canada. .,Youthdale Child & Adolescent Sleep Clinic, Ontario, Canada.
| | - Shirin Mollayeva
- Faculty of Arts and Science, University of Toronto, Toronto, Canada. .,Aquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Sport Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.
| | - Angela Colantonio
- Toronto Rehab-University Health Network, Ontario, Canada. .,Department of Occupational Science and Occupational Therapy, University of Toronto Ontario, Ontario, Canada.
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Mollayeva T, Shapiro CM, Mollayeva S, Cassidy JD, Colantonio A. Insomnia as a Covariate of Community Integration in Workers with Delayed Recovery from Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mollayeva T, Thurairajah P, Mollayeva S, Shapiro CM. Systematic Review and Meta-Analysis of the Pittsburgh Sleep Quality Index as a Screening Tool for Sleep Dysfunction. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zalai D, Carney CE, Sherman M, Shapiro CM, McShane K. Fatigue in chronic hepatitis C infection: Understanding patients' experience from a cognitive-behavioural perspective. Br J Health Psychol 2015; 21:157-72. [PMID: 26250404 DOI: 10.1111/bjhp.12155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 12/29/2014] [Revised: 07/11/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Fatigue is a leading concern of patients with chronic hepatitis C virus (HCV) infection. Despite its clinical significance, fatigue in HCV is poorly understood and therefore invariably under-treated. A cognitive-behavioural approach offers a framework to understand and treat fatigue, but the characteristics of fatigue in chronic HCV infection have not been documented from a cognitive-behavioural perspective. This study captured the common and unique aspects of fatigue from a cognitive-behavioural perspective in individuals with HCV infection and clinically significant fatigue. DESIGN Cross-sectional, qualitative using a critical realism approach. METHODS Fourteen individuals (64% women; age >18 years) participated in semi-structured interviews. The interviews documented the features, course, and perceived antecedents of fatigue; fatigue-specific cognitions; fatigue management behaviours; and the functional impact of fatigue. RESULTS Participants' descriptions included the aspects of fatigue that have been targets of cognitive-behavioural therapy in other medical conditions, including attributing fatigue to the illness; expectation of chronicity; low control; and fatigue-driven coping. There were also components of fatigue experience that appear to be unique characteristics of fatigue related to HCV, including predominantly physical fatigue; high acceptance of fatigue; and liver-protective diet as a fatigue management behaviour. CONCLUSIONS This was the first study to document the experience of fatigue in chronic HCV infection in a cognitive-behavioural framework. The findings suggest that the cognitive-behavioural approach can be applied to fatigue in chronic HCV infection. This would open an avenue to alleviate fatigue and thus improve the primary patient-reported outcome of the disease. STATEMENT OF CONTRIBUTION What is already known on this subject? Fatigue is a key patient-reported outcome measure of chronic hepatitis C virus (HCV) infection. Fatigue management is not part of the standard care, because fatigue is poorly characterized in this population. What does this study add? A cognitive-behavioural approach can be applied to understand fatigue in HCV infection. Identified aspects of fatigue (antecedents, consequences, cognitions, behaviours) that can be treatment targets. Cognitive-behavioural therapy would open a new treatment avenue to alleviate fatigue in HCV infection.
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Affiliation(s)
- Dora Zalai
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Colleen E Carney
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Morris Sherman
- Department of Gastroenterology, University Health Network, University of Toronto, Canada
| | - Colin M Shapiro
- Department of Psychiatry, University Health Network, University of Toronto, Canada.,Department of Ophthalmology, University Health Network, University of Toronto, Canada
| | - Kelly McShane
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Chung F, Liao P, Yang Y, Andrawes M, Kang W, Mokhlesi B, Shapiro CM. Postoperative Sleep-Disordered Breathing in Patients Without Preoperative Sleep Apnea. Anesth Analg 2015; 120:1214-24. [DOI: 10.1213/ane.0000000000000774] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Shapiro CM, Chung SA, Wylie PE, Hossain NK, Holle RHO, Rosenberg RP, Muehlbach MJ, Doekel RC, Pegram GV, Jasko JG. Home-use servo-ventilation therapy in chronic pain patients with central sleep apnea: initial and 3-month follow-up. Sleep Breath 2015; 19:1285-92. [PMID: 25813356 PMCID: PMC4662950 DOI: 10.1007/s11325-015-1161-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/19/2015] [Accepted: 03/10/2015] [Indexed: 01/24/2023]
Abstract
PURPOSE Opioid treatment of non-malignant chronic pain can result in hypoxemia, hypercarbia, and central sleep apnea. The aim of this study was to determine the initial efficacy of auto servo-ventilation (ASV) and after 3 months of home use. METHODS This prospective multicenter interventional study recruited chronic pain patients prescribed ≥100 morphine equivalents for at least 4 months. PARTICIPANTS Following full-night polysomnography (PSG) to confirm the presence of sleep-disordered breathing, patients were randomized to three additional full-night-attended PSGs with continuous positive airway pressure (CPAP), ASV, and servo-ventilation with an initial mandatory pressure support of 6 cm H2O (ASV manual PSmin 6). Following the PSGs, patients were sent home with EncoreAnywhere and ASV with or without mandatory pressure support. RESULTS Based on the initial PSG studies, CPAP improved but did not normalize the apnea-hypopnea index (AHI), central apnea index (CAI), or hypopnea index (HI), as all remained elevated. Clinically significant reductions were noted after just one night of ASV and ASV manual (PSmin 6). After 3 months of ASV home use, the AHI, CAI, and obstructive apnea index (OAI) were significantly reduced when compared to baseline diagnostic levels and even when compared to respiratory disturbance indices with CPAP treatment. CONCLUSIONS Initial and home use of ASV for 3 months resulted in significantly lower AHI, CAI, and OAI. This reduction attests to the efficacy of ASV treatment in chronic pain patients on high doses of opioids.
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Affiliation(s)
- Colin M Shapiro
- Department of Psychiatry, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 7 Main - 429, Toronto, Ontario, M5T 2S8, Canada.,Youthdale Treatment Centres, Toronto, Canada
| | - Sharon A Chung
- Department of Psychiatry, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 7 Main - 429, Toronto, Ontario, M5T 2S8, Canada. .,Youthdale Treatment Centres, Toronto, Canada.
| | - Paul E Wylie
- Arkansas Center of Sleep Medicine, Little Rock, AR, USA
| | - Naheed K Hossain
- Department of Psychiatry, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 7 Main - 429, Toronto, Ontario, M5T 2S8, Canada
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Zalai D, Sherman M, McShane K, Shapiro CM, Carney CE. The importance of fatigue cognitions in chronic hepatitis C infection. J Psychosom Res 2015; 78:193-8. [PMID: 25433976 DOI: 10.1016/j.jpsychores.2014.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/25/2014] [Revised: 11/09/2014] [Accepted: 11/12/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chronic Hepatitis C virus (HCV) infection is a source of significant public health burden worldwide. Fatigue is a cardinal patient reported consequence of the disease. HCV infection associated fatigue leads to significant impairment in the quality of life and day-to-day functioning. Despite its clinical significance, the factors that contribute to adverse impact of fatigue in HCV infection are largely unknown. OBJECTIVES This study evaluated the contributions of insomnia, depression symptoms, and fatigue-specific cognitions to fatigue-related functional impairment. METHODS Fatigue, insomnia, depression symptoms, as well as fatigue cognitions were assessed in participants (36% females; age>18 years, N=115) with chronic HCV infection at a tertiary hepatitis clinic. RESULTS Sixty percent of participants reported clinically significant fatigue (Fatigue Severity Index FSS ≥ 4). Comorbidities and fatigue perceptions accounted for 61% of the variation of fatigue. Fatigue perceptions were the main predictors of adverse fatigue outcomes (B=.114, 95% CI=.054-.154). Patients with clinically significant fatigue were four-times more likely than less fatigued patients to believe that the main cause of their fatigue was the infection. CONCLUSION Patients' beliefs about their fatigue were the main predictors of adverse fatigue outcomes. These results suggest that fatigue associated with chronic hepatitis C infection can be conceptualized using a cognitive behavioral approach. This was the first study to evaluate the role of both comorbid mood/sleep and cognitive predictors of fatigue in a single model. Integrating the findings into existing treatment strategies could improve patient reported outcomes in chronic hepatitis C infection.
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Affiliation(s)
- Dora Zalai
- Dept. of Psychology, Ryerson University, Toronto, Canada.
| | - Morris Sherman
- Dept. of Gastroenterology, University Health Network, University of Toronto, Toronto, Canada
| | - Kelly McShane
- Dept. of Psychology, Ryerson University, Toronto, Canada
| | - Colin M Shapiro
- Dept. of Psychiatry, University Health Network, University of Toronto, Toronto, Canada; Dept. of Ophthalmology, University Health Network, University of Toronto, Toronto, Canada
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Abstract
Purpose:To describe an association of Tourette's syndrome with rapid eye movement sleep behaviour disorder (RBD) in a prepubescent boy.Methods:A four year longitudinal single-case study.Results:The co-existence of Tourette's syndrome and RBD was confirmed after polysomnographic studies using the standard criteria. The authors propose possible overlap in the pathophysiological mechanisms underlying the two disorders.
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Abstract
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.
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Affiliation(s)
- Miqdad H Bohra
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Daniel Temple
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon A Chung
- Sleep Research Laboratory, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Colin M Shapiro
- Department of Psychiatry, University Health Network, Toronto, ON, Canada ; Sleep and Alertness Clinic Youthdale Child & Adolescent Sleep Centre, Toronto, ON, Canada
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Fisher BC, Garges DM, Yoon SYR, Maguire K, Zipay D, Gambino M, Shapiro CM. Sex differences and the interaction of age and sleep issues in neuropsychological testing performance across the lifespan in an ADD/ADHD sample from the years 1989 to 2009. Psychol Rep 2014; 114:404-38. [PMID: 24897898 DOI: 10.2466/15.10.pr0.114k23w0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Chart review of population (9 to 80 years) neuropsychological test battery for ADHD diagnosis, questionnaires with multiple responders were evaluated in outpatient setting from 1989-2009. The focus was gender differences across age, diagnostic group (ADHD-Inattentive/ADHD plus), neuropsychological test performance, and reported sleep symptoms over the lifespan. Individuals were assigned to ADHD-I group or ADHD plus group (based upon secondary diagnosis of sleep, behavioral, emotional disturbance); ADHD not primary was excluded (brain insult, psychosis). Among these were 1,828 children (ages 9 to 14), adolescents (ages 15 to 17), and adults (ages 18 and above); 446 children (312 diagnosed ADHD-I), 218 adolescents (163 diagnosed ADHD-I), and 1,163 adults (877 ADHD-I). Sleep was problematic regardless of age, ADHD subtype, and gender. The type and number of sleep problems and fatigue were age dependent. ADHD subtype, gender, fatigue, age, and sleep (sleep onset, unrefreshing sleep, sleep maintenance) were significant variables affecting neuropsychological test performance (sequencing, cognitive flexibility, slow- and fast-paced input, divided attention, whole brain functioning). Findings suggest that ADHD involves numerous factors and symptoms beyond attention, such as sleep which interacts differently dependent upon age.
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Mollayeva T, Colantonio A, Mollayeva S, Shapiro CM. Screening for sleep dysfunction after traumatic brain injury. Sleep Med 2013; 14:1235-46. [PMID: 24211035 DOI: 10.1016/j.sleep.2013.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 02/12/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Numerous studies on the high prevalence of sleep disorders in individuals with traumatic brain injury (TBI) have been conducted in the past few decades. These disorders can accentuate other consequences of TBI, negatively impacting mood, exacerbating pain, heightening irritability, and diminishing cognitive abilities and the potential for recovery. Nevertheless, sleep is not routinely assessed in this population. In our review, we examined the selective screening criteria and the scientific evidence regarding screening for post-TBI sleep disorders to identify gaps in our knowledge that are in need of resolution. We retrieved papers written in the English-language literature before June 2012 pertinent to the discussion on sleep after TBI found through a PubMed search. Within our research, we found that sleep dysfunction is highly burdensome after TBI, treatment interventions for some sleep disorders result in favorable outcomes, sensitive and specific tests to detect sleep disorders are available, and the cost-effectiveness and sustainability of screening have been determined from other populations. The evidence we reviewed supports screening for post-TBI sleep dysfunction. This approach could improve the outcomes and reduce the risks for post-TBI adverse health and nonhealth effects (e.g., secondary injuries). A joint sleep and brain injury collaboration focusing on outcomes is needed to improve our knowledge.
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Affiliation(s)
- Tatyana Mollayeva
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario M5G 2A2, Canada; University of Toronto, Toronto, Ontario M5G 1V7, Canada.
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Kadmon G, Shapiro CM, Chung SA, Gozal D. Validation of a pediatric obstructive sleep apnea screening tool. Int J Pediatr Otorhinolaryngol 2013; 77:1461-4. [PMID: 23838544 DOI: 10.1016/j.ijporl.2013.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 01/26/2013] [Revised: 06/08/2013] [Accepted: 06/10/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Pediatric obstructive sleep apnea (OSA) is a prevalent but under-diagnosed disease. The importance of screening for OSA in every child has been recently re-emphasized by the American Academy of Pediatrics Guidelines. Although several screening questionnaires are available for pediatric OSA, they are either complicated to use or not sensitive enough, and therefore OSA is seldom screened in primary care settings. Here, we validated a previously developed short (6-item) hierarchically-based screening questionnaire tool for pediatric OSA. METHODS Parents of 85 children referred for a sleep study at a pediatric community-based sleep clinic completed the questionnaire and their children underwent an overnight PSG. Receiver operator curve analyses and other predictive scales were assessed. RESULTS The 6-item questionnaire exhibited favorable sensitivity and fair specificity for diagnosis of OSA, which varied depending on the apnea-hypopnea index used for OSA definition. CONCLUSIONS A 6-item questionnaire is a sensitive and easy-to-use screening tool for pediatric OSA in a pediatric sleep clinic setting.
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Affiliation(s)
- Gili Kadmon
- Pediatric Intensive Care Unit, Schneider Children's Medical Center (Affiliated with Sackler Faculty of Medicine, Tel-Aviv University), Israel.
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Mollayeva T, Kendzerska T, Mollayeva S, Shapiro CM, Colantonio A, Cassidy JD. Fatigue in adults with traumatic brain injury: predictors and consequences. A systematic review of longitudinal study protocols. Syst Rev 2013; 2:57. [PMID: 23842583 PMCID: PMC3717139 DOI: 10.1186/2046-4053-2-57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite strong indications that fatigue is the most common and debilitating symptom after traumatic brain injury, little is known about its frequency, natural history, or relation to other factors. The current protocol outlines a strategy for a systematic review that will identify, assess, and critically appraise studies that assessed predictors for fatigue and the consequences of fatigue on at least two separate time points following traumatic brain injury. METHODS/DESIGN MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO will be systematically searched for relevant peer-reviewed studies. Reference lists of eligible papers will also be searched. All English language studies with a longitudinal design that focus on fatigue in adults with primary-impact traumatic brain injury will be included. Studies on fatigue following brain injury due to secondary pathological processes (intracranial complications, edema, ischemia/infarction, and systemic intracranial conditions) will be excluded. Excluded studies, along with the reasons for exclusion will be reported. Two independent reviewers will conduct all levels of screening, data abstraction, and quality appraisal. Randomized control trial data will be treated as a cohort. The quality will be assessed using the criteria defined by Hayden and colleagues. The review will be conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CONCLUSIONS The review will summarize the current knowledge in the field with the aim of increasing understanding and guiding future research on the associations between fatigue and clinically important factors, as well as the consequences of fatigue in traumatic brain injury. PROSPERO registry number: CRD42013004262.
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Affiliation(s)
- Tatyana Mollayeva
- Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Toronto, Canada
- Collaborative Program in Neuroscience, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University of Toronto, 550 University Avenue, Rm 11207, Toronto, Ontario M5G 2A2, Canada
| | - Tetyana Kendzerska
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Shirin Mollayeva
- Faculty of Arts and Science, University of Toronto, Toronto, Canada
- Acquired Brain Injury Research Lab, University of Toronto, 160-500 University Ave, Toronto, Ontario M5G 1V7, Canada
| | - Colin M Shapiro
- Toronto Western Hospital, University Health Network, 399 Bathurst Street, Rm 7MP421, Toronto, Ontario M5T 2S8, Canada
- Youthdale Child & Adolescent Sleep Clinic, Toronto, Ontario, Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University of Toronto, 550 University Avenue, Rm 11207, Toronto, Ontario M5G 2A2, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Saunderson Family Chair in Acquired Brain Injury Research, Toronto Rehabilitation Institute, University of Toronto, 160-500 University Ave, Toronto, Ontario M5G 1V7, Canada
| | - J David Cassidy
- Institute of Sport Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
- Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada
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Rahman SA, Shapiro CM, Wang F, Ainlay H, Kazmi S, Brown TJ, Casper RF. Effects of filtering visual short wavelengths during nocturnal shiftwork on sleep and performance. Chronobiol Int 2013; 30:951-62. [PMID: 23834705 PMCID: PMC3786545 DOI: 10.3109/07420528.2013.789894] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Circadian phase resetting is sensitive to visual short wavelengths (450-480 nm). Selectively filtering this range of wavelengths may reduce circadian misalignment and sleep impairment during irregular light-dark schedules associated with shiftwork. We examined the effects of filtering short wavelengths (<480 nm) during night shifts on sleep and performance in nine nurses (five females and four males; mean age ± SD: 31.3 ± 4.6 yrs). Participants were randomized to receive filtered light (intervention) or standard indoor light (baseline) on night shifts. Nighttime sleep after two night shifts and daytime sleep in between two night shifts was assessed by polysomnography (PSG). In addition, salivary melatonin levels and alertness were assessed every 2 h on the first night shift of each study period and on the middle night of a run of three night shifts in each study period. Sleep and performance under baseline and intervention conditions were compared with daytime performance on the seventh day shift, and nighttime sleep following the seventh daytime shift (comparator). On the baseline night PSG, total sleep time (TST) (p < 0.01) and sleep efficiency (p = 0.01) were significantly decreased and intervening wake times (wake after sleep onset [WASO]) (p = 0.04) were significantly increased in relation to the comparator night sleep. In contrast, under intervention, TST was increased by a mean of 40 min compared with baseline, WASO was reduced and sleep efficiency was increased to levels similar to the comparator night. Daytime sleep was significantly impaired under both baseline and intervention conditions. Salivary melatonin levels were significantly higher on the first (p < 0.05) and middle (p < 0.01) night shifts under intervention compared with baseline. Subjective sleepiness increased throughout the night under both conditions (p < 0.01). However, reaction time and throughput on vigilance tests were similar to daytime performance under intervention but impaired under baseline on the first night shift. By the middle night shift, the difference in performance was no longer significant between day shift and either of the two night shift conditions, suggesting some adaptation to the night shift had occurred under baseline conditions. These results suggest that both daytime and nighttime sleep are adversely affected in rotating-shift workers and that filtering short wavelengths may be an approach to reduce sleep disruption and improve performance in rotating-shift workers.
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Affiliation(s)
- Shadab A Rahman
- Fran and Lawrence Bloomberg Department of Obstetrics and Gynecology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res 2013; 37:539-49. [PMID: 23347102 DOI: 10.1111/acer.12006] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 08/09/2012] [Indexed: 11/29/2022]
Abstract
This review provides a qualitative assessment of all known scientific studies on the impact of alcohol ingestion on nocturnal sleep in healthy volunteers. At all dosages, alcohol causes a reduction in sleep onset latency, a more consolidated first half sleep and an increase in sleep disruption in the second half of sleep. The effects on rapid eye movement (REM) sleep in the first half of sleep appear to be dose related with low and moderate doses showing no clear trend on REM sleep in the first half of the night whereas at high doses, REM sleep reduction in the first part of sleep is significant. Total night REM sleep percentage is decreased in the majority of studies at moderate and high doses with no clear trend apparent at low doses. The onset of the first REM sleep period is significantly delayed at all doses and appears to be the most recognizable effect of alcohol on REM sleep followed by the reduction in total night REM sleep. The majority of studies, across dose, age and gender, confirm an increase in slow wave sleep (SWS) in the first half of the night relative to baseline values. The impact of alcohol on SWS in the first half of night appears to be more robust than the effect on REM sleep and does not appear to be an epiphenomenon REM sleep reduction. Total night SWS is increased at high alcohol doses across gender and age groups.
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Mehta V, Subramanyam R, Shapiro CM, Chung F. Health effects of identifying patients with undiagnosed obstructive sleep apnea in the preoperative clinic: a follow-up study. Can J Anaesth 2012; 59:544-55. [PMID: 22461134 PMCID: PMC3345111 DOI: 10.1007/s12630-012-9694-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/13/2012] [Indexed: 12/03/2022] Open
Abstract
Background Undiagnosed obstructive sleep apnea (OSA) is a highly prevalent breathing disorder. The purpose of this study was to determine the effects of preoperative screening and subsequent treatment for OSA on the health of patients. Methods We conducted a two-year follow-up study of patients previously enrolled in a large prospective study in which patients were given the STOP questionnaire for OSA screening (n = 2,467). All patients who underwent a polysomnography were considered eligible (n = 211) and were asked to complete a paper-based mailed questionnaire. The severity of OSA, comorbidities, and treatment modalities and their effects were evaluated from the returned questionnaire. Research ethics board approval was obtained and returning the questionnaire implied informed patient consent. Results The response rate was 67%. One hundred twenty-eight (82%) of the 156 patients who responded had OSA established by polysomnography. Among these 128 patients with OSA, 88 (69%) were prescribed continuous positive airway pressure (CPAP) therapy and 40 (31%) were prescribed other (non-CPAP) treatment. Among those 88 patients receiving CPAP, 40 (45%) were compliant and 48 (55%) were non-compliant. The CPAP compliant patients had a greater reduction in medication for comorbidities than the CPAP non-compliant or the other treatment group (38% vs 3% vs 0%, respectively; P < 0.001). A significant improvement in snoring, sleep quality, and daytime sleepiness was reported by CPAP compliant users compared with CPAP non-compliant or other treatment groups (P < 0.001). Conclusion The preoperative patients who were identified to have OSA and were compliant with CPAP use may have health benefits in terms of improved snoring, sleep quality, and daytime sleepiness. Timely diagnosis and treatment compliance may reduce symptoms of OSA and severity of associated comorbidities along with a reduction in medications.
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Affiliation(s)
- Vanita Mehta
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
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Abstract
Insomnia is a common, often chronic medical disorder with significant medical and socioeconomic repercussions. However, unlike other medical conditions, there is intense debate as to whether the long-term treatment of insomnia is clinically appropriate. The perceived deleterious side effect of sedative-hypnotic medications may result in patients remaining untreated or undertreated. This review proposes that a more subtle approach needs to be taken in the management of patients with chronic insomnia and that long-term use of the newer sedative-hypnotics may be a feasible and effective treatment option when used in conjunction with thorough medical assessment and regular patient follow-up. This review discusses these issues and discusses the pros and cons of long-term sedative-hypnotic use.
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Affiliation(s)
- Azmeh Shahid
- Department of Psychiatry, University of Toronto and Toronto Western Hospital, University Health Network, Toronto, Canada
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Lee YJ, Marcu S, Berall G, Shapiro CM. Tryptophan for the treatment of excessive daytime sleepiness in Prader-Willi Syndrome. Indian Pediatr 2011; 48:319-21. [DOI: 10.1007/s13312-011-0053-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rahman SA, Marcu S, Shapiro CM, Brown TJ, Casper RF. Spectral modulation attenuates molecular, endocrine, and neurobehavioral disruption induced by nocturnal light exposure. Am J Physiol Endocrinol Metab 2011; 300:E518-27. [PMID: 21177289 DOI: 10.1152/ajpendo.00597.2010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The human eye serves distinctly dual roles in image forming (IF) and non-image-forming (NIF) responses when exposed to light. Whereas IF responses mediate vision, the NIF responses affect various molecular, neuroendocrine, and neurobehavioral variables. NIF responses can have acute and circadian phase-shifting effects on physiological variables. Both the acute and phase-shifting effects induced by photic stimuli demonstrate short-wavelength sensitivity peaking ≈450-480 nm. In the current study, we examined the molecular, neuroendocrine, and neurobehavioral effects of completely filtering (0% transmission) all short wavelengths <480 nm and all short wavelengths <460 nm or partially filtering (~30% transmission) <480 nm from polychromatic white light exposure between 2000 and 0800 in healthy individuals. Filtering short wavelengths <480 nm prevented nocturnal light-induced suppression of melatonin secretion, increased cortisol secretion, and disrupted peripheral clock gene expression. Furthermore, subjective alertness, mood, and errors on an objective vigilance task were significantly less impaired at 0800 by filtering wavelengths <480 nm compared with unfiltered nocturnal light exposure. These changes were not associated with significantly increased sleepiness or fatigue compared with unfiltered light exposure. The changes in molecular, endocrine, and neurobehavioral processes were not significantly improved by completely filtering <460 nm or partially filtering <480 nm compared with unfiltered nocturnal light exposure. Repeated light-dark cycle alterations as in rotating nightshifts can disrupt circadian rhythms and induce health disorders. The current data suggest that spectral modulation may provide an effective method of regulating the effects of light on physiological processes.
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Affiliation(s)
- Shadab A Rahman
- Samuel Lunenfeld Research Institute, 25 Orde St., Mount Sinai Hospital, Toronto, Ontario, Canada
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Buys Y, Flanagan JG, Trope GE, Jin YP, Smith M, Gouws P, Geffen N, Shapiro CM. Author reply. Ophthalmology 2010. [DOI: 10.1016/j.ophtha.2010.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea syndrome (OSAS). Consistent adherence to CPAP improves the patient's longevity and quality of life as well as public safety. However, nonadherence is a significant contributor to the growing burden of untreated OSAS, and is associated with negative consequences for the patient, public safety, and the healthcare system. OBJECTIVE The use of CPAP is a classic example of an effective treatment for which adherence is extremely variable. This paper examines a multiplicity of factors that influence CPAP adherence. FACTORS These factors are traditionally thought of in terms of patient and equipment variables, but in addition physician, family, healthcare facility, and governmental issues all contribute to CPAP adherence. DISCUSSION These factors are reviewed and pragmatic recommendations are made for improving clinical practice.
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Affiliation(s)
- Gilla K Shapiro
- Youthdale Child and Adolescent Sleep, 227 Victoria St., Lower Level 2, Toronto, ON, M5B 1T8, Canada.
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