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Biomedical subjects

Charles F P George

Publications and source records attributed to Charles F P George.

13 recordsLinked to original sources
PubMed2006

Impaired performance in commercial drivers: role of sleep apnea and short sleep duration.

Sleepiness plays an important role in major crashes of commercial vehicles. Because determinants are likely to include inadequate sleep and sleep apnea, we evaluated the role of short sleep durations over 1 wk at home and sleep apnea in subjective sleepiness (Epworth Sleepiness Scale), objective sleepiness (reduced sleep latency as determined by the Multiple Sleep Latency Test), and neurobehavioral functioning (lapses in performance, tracking error in Divided Attention Driving Task) in commercial drivers. Studies were conducted in 247 of 551 drivers at higher risk for apnea and in 159 of 778 drivers at lower risk. A multivariate linear association between the sets of outcomes and risk factors was confirmed (p < 0.0001). Increases in subjective sleepiness were associated with shorter sleep durations but not with increases in severity of apnea. Increases in objective sleepiness and performance lapses, as well as poorer lane tracking, were associated with shorter sleep durations. Associations with sleep apnea severity were not as robust and not strictly monotonic. A significant linear association with sleep apnea was demonstrated only for reduced sleep latency. The effects of severe apnea (apnea-hypopnea index, at least 30 episodes/h), which occurred in 4.7%, and of sleep duration less than 5 h/night, which occurred in 13.5%, were similar in terms of their impact on objective sleepiness. Thus, addressing impairment in commercial drivers requires addressing both insufficient sleep and sleep apnea, the former being more common.

Automobile Driving↗
PubMed2006

Sleepiness and relationships in obstructive sleep apnea.

This is a qualitative analysis of data from a multisite study of 156 participants with Obstructive Sleep Apnea (OSA). Participants completed a battery of tests, including the Functional Outcomes of Sleep Questionnaire (FOSQ) that contains an item assessing the impact of OSA on relationships. Approximately one third of participants wrote comments; they were predominately male, mean age 44.7, with severe OSA. Interpersonal themes expressed included work and marital problems and social life restriction. Intrapersonal themes included embarrassment and poor mood. This report adds specific details to previous reports of impaired relationships in OSA, and stresses the importance of assessing this critical area.

Conflict, Psychological↗
PubMed2005

Physiologic pacing in patients with obstructive sleep apnea: a prospective, randomized crossover trial.

OBJECTIVES: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea. BACKGROUND: Apneic episodes during sleep are associated with slowing of the heart rate during apnea and tachycardia with subsequent arousal. Patients with permanent pacemakers may have reduced episodes of sleep apnea when their pacemaker rate is set faster than their spontaneous nocturnal heart rate. METHODS: We conducted a prospective, randomized, single-blind crossover trial of temporary atrial pacing in obstructive sleep apnea to reduce the apnea hypopnea index (AHI). Fifteen patients (age 60 +/- 13 years, 12 men) with moderate to severe obstructive sleep apnea (AHI 34 +/- 14) underwent insertion of an externalized atrial permanent pacing system via the left subclavian vein. Patients underwent overnight respiratory sleep studies in hospital, during atrial pacing at 75 beats/min, and with pacing turned off. The order of pacing mode was randomized, with crossover the subsequent night to the other mode. Patients were blinded to pacing mode, and the analysis of sleep recordings was blind to pacing mode. RESULTS: Pacing was tolerated without complications in all patients. Overnight physiologic pacing did not affect the AHI (pacing 39 +/- 21/h vs. control 42 +/- 21/h, p = 0.23, 95% confidence interval -9.3 to 2.5 for difference), desaturation time (pacing 3.8 +/- 6.0% vs. control 3.5 +/- 4.3%, p = 0.70), or the minimum SaO(2) (pacing 75 +/- 10% vs. control 77 +/- 11%, p = 0.38). There was a borderline significant reduction in circulatory time with pacing (pacing 23.4 +/- 3.2 s vs. control 25.5 +/- 4.4 s, p = 0.09). CONCLUSIONS: Temporary atrial pacing does not appear to improve respiratory manifestations of obstructive sleep apnea. Permanent atrial pacing in this patient population does not appear to be justified.

Aged↗
PubMed2005

Sleep and motor performance in on-call internal medicine residents.

STUDY OBJECTIVES: To compare vigilance and performance among internal medicine residents doing in-house call versus residents not doing in-house call. DESIGN: Prospective study of resident cohorts with repeated testing. SETTING: University Teaching Hospital. PARTICIPANTS: Internal medicine residents doing in-house call and residents not doing in-house call (pathology, endocrinology) (controls). MEASUREMENTS AND RESULTS: Subjective sleepiness scores (daily Stanford Sleepiness Scale and Epworth Sleepiness Scale at start and end of the test period), actigraphy, and daily sleep logs as well as regular psychomotor vigilance testing using a Palm version (Walter Reed Army Institute of Research) of the Psychomotor Vigilance Test (PVT). Subjects were enrolled for a period of 28 to 32 days, which included 4 to 6 on-call nights for the internal medicine residents. Controls took call from home. Participants were compensated for their time. RESULTS: Twenty residents were evaluated, 13 internal medicine and 7 controls. Overall median reaction time was slower in the internal medicine residents (264.7 +/- 102.9 vs 239.2 +/- 26.1 milliseconds; P < .001). Internal medicine residents showed no difference in reaction time postcall versus other periods (269.9 +/- 131.2 vs 263.6 +/- 95.6; P = .65). Actigraphic sleep time was shorter during on-call than noncall nights and in internal medicine residents as compared with controls (287.48 +/- 143.8 vs 453.49 +/- 178.5 and 476.08 +/- 71.9 minutes; P < .001). Internal medicine residents had significantly greater major and minor reaction-time lapses compared with controls (1.26 +/- 3.4 vs 0.53 +/- 1.1 & 2.4 +/- 7.4 vs 0.45 +/- 1.0; P < .001). They reported increased sleepiness on postcall days compared with the start of their call (Stanford Sleepiness Scale: 3.26 +/- 1.2 vs 2.22 +/- 0.8; P < .001) but had scores similar to those of controls by their next call (2.22 +/- 0.8 vs 2.07 +/- 0.8; P = .13). CONCLUSIONS: Internal medicine residents have impaired reaction time and reduced vigilance compared with controls. Despite subjective improvements in sleepiness postcall, there was no change in their objective performance across the study period, suggesting no recovery. Internal medicine residents did not get extra sleep on postcall nights in an attempt to recover their lost sleep time. Implications for residents' well-being and patient care remain unclear.

Adult↗
PubMed2003

Sleep and breathing in professional football players.

OBJECTIVES: To evaluate sleep in professional football players and describe clinical features of players at risk for sleep for sleep-disordered breathing (SDB). METHODS: The Multivariable Apnea Prediction (MAP) index was used to stratify players into high (MAP> or =0.5) and low (MAP<0.5) risk for SDB. Players from both risk groups were randomly selected for overnight polysomnography, with over-sampling from the High-risk group. Of 302 players from eight professional football teams; 52 underwent attended polysomnography. Anthropometrics including neck circumference, airway size (Mallampati score, maxillary overjet) and sleepiness measured by Epworth scores (ESS) were recorded. The primary outcome measures were ESS and an apnea-hypopnea index (AHI) > or =10. RESULTS: Ninety-two percent of players were <30 years old (mean (SD) age: 25.5+/-2.7 years) with large necks (45.2+/-3.6 cm) and elevated BMI (31.5+/-4.6). More than 20% of players had an ESS>10 with ESS highest in habitual snorers. An AHI of > or =10 was found in 13 (34%, 95% confidence interval (CI) 21-50%) high-risk players but only one (7%, 95% CI 1-31%) of 14 low-risk players. Offensive (9) or defensive (3) linemen accounted for the majority of the positive cases. Based on our sample, we estimate the prevalence of SDB to be 14% (2-25%). CONCLUSIONS: Excessive daytime sleepiness (EDS) is present in a large fraction of professional football players. Some but not all of this may be due to an increased prevalence of SDB. Further study is required to understand all of the factors responsible for EDS and to determine which of the biggest players will have SDB, which may impact not only performance and productivity but also future health.

Adult↗
PubMed2003

Driving simulators in clinical practice.

Operating a motor vehicle is a complex psychomotor task that requires sustained vigilance. When sleepy, subjects have difficulty maintaining vigilance. As a result, inattention increases the risk of a motor vehicle collision. There is extensive literature that demonstrates that sleepy patients have poor performance and increased motor vehicle crashes. Determining an individual's risk of crash has not been possible solely on clinical grounds and as a result, a number of driving simulators have been developed/employed to aid in this process. While the data shows a consistent effect of sleepiness on driving and simulated driving performance, the role of these simulators in day to day clinical practice is still evolving.

Arousal↗
PubMed2003

Management of insomnia in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common medical disorder, which causes considerable morbidity and mortality. Given the chronic and symptomatic nature of the disease, the patient is often seen in the physician's office with complaints of dyspnea. However, more than 50% of COPD patients also have sleep complaints characterised by longer latency to falling asleep, more frequent arousals and awakenings, and/or generalised insomnia. Sleep disturbance tends to be more severe with advancing disease and substantially reduces the COPD patients' quality of life. In approaching the COPD patient who complains of insomnia it is important to take a complete sleep history. Having characterised the degree and duration of the problem, medical management of the underlying COPD must first optimise oxygen saturation while minimising the effects of many of the medications used for COPD. While aerosol therapies may be systemically absorbed and contribute to sleep disruption, anticholinergics, such as ipratropium bromide, are the least likely to do so and indeed have been shown to improve sleep quality in this population. Many of the traditional sedatives and hypnotics have been used in the COPD population including benzodiazepines, imidazopyridines, pyrazolopyrimidines and, less commonly, antidepressants and phenothiazines. Clinical trials support the role of numerous agents in treating insomnia in this population but do not always provide reassurance that these therapies can be used safely, particularly in the patient with severe COPD with hypercarbia. Benzodiazepines are among the most commonly employed agents, but case reports and series continue to describe adverse pulmonary events. Although the newer pyridine derivatives also have the potential to worsen pulmonary function, they appear less likely to do so. Data to date are limited with the tricyclic antidepressants and phenothiazines, although they appear to be very well tolerated from a respiratory point of view. Since sleep disturbances are often long-standing and associated with maladaptive behaviours towards sleep, cognitive/behavioural approaches are often useful and are more effective in the long-term than are hypnotics. When prescription of a sedative is to be made, extra caution is required for those patients at increased risk of adverse respiratory effects, such as those with advanced disease and hypercarbia in whom pharmacological therapy is often best avoided. Selection of the various options will depend upon the degree of underlying disease and the patient's specific complaints of insomnia. Finally, it is important to remember that while most hypnotics work in an acute setting, the long-term management will require an integrated approach.

Clinical Trials as Topic↗