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Biomedical subjects

Alon Y Avidan

Publications and source records attributed to Alon Y Avidan.

12 recordsLinked to original sources
PubMed2005

Treatment of sleep disorders in elderly patients.

Sleep disorders are common among the elderly and are associated with diminished quality of life, increased risk for development of psychiatric disorders, inappropriate use of sleep aids, and decreased daytime functioning. The most common and important sleep disorders in the elderly include insomnia, obstructive sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, and the advanced sleep phase syndrome. In this article, we summarize the current treatment strategies for each of these sleep-related disorders. Before contemplating specific treatments, the authors recommend that more conservative and nonpharmacologic therapies be attempted first because the elderly are more likely to have medication side effects or complications related to surgery. Many sleep problems can be treated by simple sleep hygiene modifications that can be implemented and adopted easily. For others, therapies that specifically consider older adults may be required. For each of the sleep disorders we provide an updated discussion of therapies beginning with diet and lifestyle, pharmacologic treatment, interventional procedures, surgery, assistive devices, physical and speech therapy, exercise, and emerging therapies with specific considerations for older adults.

Journal Article↗
PubMed2005

Sleep disorders in the older patient.

Sleep changes dramatically with old age. Subjective and objective measures demonstrate an increase in sleep and wake disturbances with advancing age. The older person has a more fragmented sleep, sleeps less deeply, and tends to experience early morning awakenings. When older patients have sleep disorders, they often present with excessive daytime sleepiness, insomnia, or abnormal motor activity. In making the appropriate diagnosis, the role of the provider is to review the patient's medical history,psychiatric history, medications, underlying medical illnesses, and sleep-wake pattern. The aging process itself does not cause sleep problems and sleep requirements do not decrease with advanced age. The prevalence of insomnia, sleep-related breathing disorder, PLMS, and RLS increases with age and may lead to poor sleep quality. Because many sleep disorders are potentially reversible, it is the responsibility of the primary care provider to screen for these problems. A carefully planned clinical decision-making process when encountering a sleep disturbance in the older patient can greatly enhance quality of life and daytime function.

Age Factors↗
PubMed2005

Sleep in the geriatric patient population.

Older patients often suffer from sleep disturbances caused by age-related physiological changes, polypharmacy, changes in circadian rhythm, retirement, and loss of spouse. Many seniors have readily diagnosed sleep disorders that can be treated to achieve improvement in daytime somnolence or cognitive impairments. After a discussion of normal age-related changes in sleep, specific sleep pathologies common in the elderly will be reviewed, including sleep apnea, restless legs syndrome, advanced sleep phase syndrome, and rapid eye movement sleep behavior disorder.

Aging↗
PubMed2005

Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes.

OBJECTIVES: To examine the relationship between insomnia, hypnotic use, falls, and hip fractures in older people. DESIGN: Secondary analysis of a large, longitudinal, assessment database. SETTING: Four hundred thirty-seven nursing homes in Michigan. PARTICIPANTS: Residents aged 65 and older in 2001 with a baseline Minimum Data Set assessment and a follow-up 150 to 210 days later. MEASUREMENTS: Logistic regression modeled any follow-up report of fall or hip fracture. Predictors were baseline reports of insomnia (previous month) and use of hypnotics (previous week). Potential confounds taken into account included standard measures of functional status, cognitive status, intensity of resource utilization, proximity to death, illness burden, number of medications, emergency room visits, nursing home new admission, age, and sex. RESULTS: In 34,163 nursing home residents (76% women, mean age+/-standard deviation 84+/-8), hypnotic use did not predict falls (adjusted odds ratio (AOR)=1.13, 95% confidence interval (CI)=0.98, 1.30). In contrast, insomnia did predict future falls (AOR=1.52, 95% CI=1.38, 1.66). Untreated insomnia (AOR=1.55, 95% CI=1.41, 1.71) and hypnotic-treated (unresponsive) insomnia (AOR=1.32, 95% CI=1.02, 1.70) predicted more falls than did the absence of insomnia. After adjustment for confounding variables, insomnia and hypnotic use were not associated with subsequent hip fracture. CONCLUSION: In elderly nursing home residents, insomnia, but not hypnotic use, is associated with a greater risk of subsequent falls. Future studies will need to confirm these findings and determine whether appropriate hypnotic use can protect against future falls.

Accidental Falls↗
PubMed2003

Sleep-disordered breathing in Michigan: a practice pattern survey.

OBJECTIVES: This survey sought to determine whether self-professed sleep specialists in the State of Michigan show practice variations in the diagnosis and management of sleep-disordered breathing (SDB), and whether such variations occur between pulmonologists and neurologists. METHODS: Questionnaires on practice volume and patterns during the prior 12 months were mailed to physician members of the Michigan Sleep Disorders Association ( n = 119); 67 were completed and returned. RESULTS: Respondents reported that they personally saw a median of 8 new patients each week for suspected SDB; estimates were that 86% of these patients were eventually confirmed to have SDB. Most patients (82%) had laboratory-based polysomnography after an initial clinic evaluation, and most (69%) of those treated for SDB received continuous positive airway pressure. However, practice patterns differed substantially among respondents, even when the analysis was limited to the 42 who reported board certification by the American Board of Sleep Medicine. For example, among all surveyed practices the likelihood that suspected SDB would be evaluated with a split-night diagnostic and treatment polysomnogram varied from 0 to 90%. The likelihood of SDB treatment with bilevel positive airway pressure varied from 0 to 50%, with automatically titrating devices from 0 to 100%, with surgery from 0 to 100% (0 to 50% among certified practitioners), and with oral appliances from 0 to 20%. The practice patterns of pulmonologists and neurologists did not differ significantly. CONCLUSION: Approaches to SDB vary widely in Michigan, though not according to clinician background in pulmonary medicine or neurology. A patient's experience, in both assessment and treatment, could differ substantially based on which clinician is consulted.

Humans↗
PubMed2003

Insomnia in the geriatric patient.

Insomnia in the geriatric patient is unique and complex, requiring a comprehensive and careful evaluation. Insomnia is the most common sleep complaint reported by persons > 60 years. It is defined as the inability to initiate or maintain sleep, and the etiology can be multifactorial. Insomnia in the geriatric patient may be due to a primary sleep disorder, such as obstructive sleep apnea, periodic limb movements in sleep, circadian rhythm disorders, or restless legs syndrome, or it may be secondary to underlying medical or psychiatric conditions, medication effects, or psychosocial factors. When insomnia becomes chronic, it may exacerbate medical and psychiatric illnesses. Insomnia can lead to excessive daytime sleepiness, which may result in disturbed intellect, impaired cognition, confusion, psychomotor retardation, or increased risk of injury, any of which can compromise the patient's quality of life and create social and economic burdens for caregivers. This article discusses the recommended diagnostic and treatment approaches that may be used by the clinician in treating the geriatric patient. Case studies are presented to illustrate diagnoses of insomnia and therapeutic interventions.

Age Factors↗
PubMed2002

Sleep changes and disorders in the elderly patient.

Sleep disorders are very common among older patients. Our population as a whole is experiencing substantial growth in the geriatric population. Thus, it is all the more prudent that healthcare professionals become familiar with the major sleep disorders that affect the older patient, as well as the diagnosis and treatment of these disorders. This paper deals with the various sleep changes that take place in the course of the aging process and with the assessment of sleep disorders in the older patient. Special attention is paid to sleep-disordered breathing, periodic limb-movement disorder of sleep, insomnia, and circadian rhythm anthology, as well as parasomnias that are unique to the older patient. The final section of the paper deals with specific neurologic disorders and their impact on sleep patterns.

Aged↗
PubMed2002

ESS dot com.

BACKGROUND: The Internet is a rich but unregulated source of information, and no studies have evaluated sleep medicine content designed for patient or public use. OBJECTIVE: To examine how the Epworth Sleepiness Scale is presented on the World Wide Web. METHODS: We searched the web with eight search engines, in November 2000, for the terms 'ESS' or 'Epworth Sleepiness Scale' and examined every site that listed the full ESS. RESULTS: The 91 sites were sponsored by academic institutions (n=11), private medical groups (34), corporations (21), and web information services (25). No information on interpretation of ESS results was given by 24 (26%) of the sites; 37 (41%) of the sites stated that a score greater than 8, 9, 10, 11, or 12 merits consultation with a clinician. Few sites mentioned that insufficient sleep and depression are among the most common causes of excessive sleepiness, or that the meaning and value of the ESS are somewhat controversial. CONCLUSION: The ESS is widely available on web sites designed for public use, but information that would allow appropriate interpretation of results is often lacking, misleading, or incomplete.

Journal Article↗