Biomedical subjects

G Maislin

Publications and source records attributed to G Maislin.

At least 55 records · Page 3Linked to original sources

PubMed1995

Gonadotropin (LH and FSH) response after submaximal GnRH stimulation in depressed premenopausal women and healthy controls.

Although hormonal response abnormalities in depression have been demonstrated in several hypothalamic-pituitary-target organ axes after a variety of neuroendocrine challenge tests, studies of hypothalamic-pituitary-gonadal (HPG) axis function have been inconsistent in their findings. The use of maximal or supramaximal doses of gonadotropin-releasing hormone (GnRH) in early studies (150-600 micrograms) may have masked the presence of more subtle disturbances in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) responsiveness in depression. We hypothesized that submaximal doses of GnRH might reveal a more subtle dysregulation in gonadotropin responsiveness in depression, and therefore measured LH and FSH responses after GnRH 10 micrograms and 90 micrograms doses in nine premenopausal depressed women and six healthy controls. There were no statistically significant differences between subject groups for mean basal LH, FSH, and estradiol concentrations, nor for any of the LH and FSH response values after either GnRH stimulation dose. The present observations of an intact HPG axis in depression contrast with findings of disturbances in most other hypothalamic-pituitary axes, and suggest that neuroendocrine dysregulation in depression might not represent a generalized limbic system-hypothalamic-pituitary abnormality, but rather a more restricted lesion sparing the medial preoptic and/or arcuate region of the hypothalamus which regulates gonadotropin secretion.

Adult↗

PubMed1995

Acute gastroenteritis in three community-based nursing homes.

BACKGROUND: Acute gastroenteritis is a cause of considerable morbidity and mortality in the elderly population. A prospective assessment of acute diarrhea in three community-based long-stay homes is described. METHODS: A cohort study of acute gastroenteritis was performed in three community-based nursing homes, involving 572 residents over an 8-month period. Diarrhea cases were enrolled on the basis of the acute onset of loose stools of > or = 24 hours, as well as one of the following: a rectal temperature of > or = 100 degrees F, dehydration, positive occult blood, > or = 48 hours duration, or as a part of any outbreak. Stool cultures for Clostridium difficile were performed on all NH 1 patients. RESULTS: Fifty-three gastroenteritis cases were ascertained, consistent with incidence rates of 14.6, 36.4, and 6.7 cases/100 patient years in NH 1, NH 2, and NH 3, respectively. Requiring a Foley catheter (OR = 2.57; 95% CI, 0.93, 7.09) increased diarrhea risk. Six Clostridium difficile enteritis cases and an episode attributable to Aeromonas/Pleisomonas species were diagnosed. One C. difficile diarrhea case was imported from hospital to NH 1. Ten of 12 fecal excretors resided in close geographic clusters in NH 1, where a majority of the latter were mobile and incontinent of stool. CONCLUSIONS: Acute gastroenteritis was a common disease in the study nursing homes, for which specific risk factors were identified. A predominant role for Clostridium difficile in the taxonomy of nursing home diarrhea was suggested.

Acute Disease↗

PubMed1995

Intra-observer and inter-observer variability in scoring laparoscopic diagnosis of pelvic adhesions.

The objective of this study was to investigate intra-observer as well as inter-observer variability in the assessment of laparoscopic scoring of adhesive disease. Patients with suspected pelvic adhesions underwent a laparoscopic examination and surgical correction, using a standardized adhesion scoring system for severity as well as for extent of the adhesive process. An active agent or placebo was placed in the peritoneal cavity to discourage reformation of adhesions on a double-blind basis. A second laparoscopy was performed in 6-10 weeks and patients were re-scored. The videotapes were viewed and re-scored by the operator and four other gynaecological surgeons on two occasions, 3 months apart. Both adhesion severity and extent scores were lower following laparoscopic intervention. Reliability coefficients as defined by intra-class correlations were large indicating good reliability (0.778 and 0.758 for severity and extent respectively). Intra-observer (replication) variability was 12% of the total versus 19% for inter-observer variability of adhesion severity. These values were 15.4 and 22.3% of the total respectively, for adhesion extent. Individual observers tended to up-grade severity and minimize extent of adhesions when comparing the second with the first videotape views. The surgeon recorded greater adhesion score differences between the two procedures than the other observers. Though two physicians consistently had higher scores than two others, the intra-observer and interobserver variabilities were acceptable. Consultant review of high quality videotaped laparoscopic procedures is a valid method of independent assessment of operative findings.

Adnexal Diseases↗

PubMed1995

A survey screen for prediction of apnea.

Questionnaire data from patients presenting at three sleep disorders centers were used to develop and assess a screening tool for sleep apnea based on the reporting of the frequency of various symptoms of sleep apnea and other sleep disorders plus age, body mass index (BMI) and gender. Patients were not specifically referred for suspicion of sleep apnea. Separate factor analyses of survey responses from 658, 193 and 77 respondents from the first, second and third sites, respectively, each yielded four orthogonal factors, one of which accounted for all the questions concerned with the frequency of disordered breathing during sleep. The survey was shown to be reliable in a subset of patients from one of the sites (test-retest correlation = 0.92). Survey data were then compared to a clinical measure of sleep apnea (respiratory disturbance index) obtained from polysomnography. A multivariable apnea risk index including survey responses, age, gender and BMI was estimated using multiple logistic regression in a total sample of 427 respondents from two of the sites. Predictive ability was assessed using receiver operating characteristic (ROC) curves. The area under the ROC curve was 0.79 (p < 0.0001). For BMI alone, it was 0.73, and for an index measuring the self-report of the frequency of apnea symptoms, it was 0.70. The multivariable apnea risk index has potential utility in clinical settings.

Adult↗

PubMed1994

Development of complications during rehabilitation.

BACKGROUND AND METHODS: Although studies have demonstrated that medical rehabilitation patients have many complications that warrant attention, none has attempted to categorize complications by severity. This retrospective cohort study examined the incidence, types, and severity of problems that interrupt rehabilitation and the major risk factors for these events. RESULTS: Of 1075 patients, 359 (33.4%) had acute medical complications on rehabilitation considered severe enough to interrupt treatment. Of the 359 patients, 158 (44%) required an unexpected transfer off rehabilitation. The most common reasons for unexpected transfer were surgical causes (22.8%), followed by infection or fever (17.1%) and by thromboembolic events (16.5%). Logistic regression revealed that major risk factors for complications requiring transfer were a primary diagnosis of deconditioning or nontraumatic spinal cord injury (adjusted odds ratio, 2.7; confidence interval, 1.8 to 4.2), severity of initial disability (adjusted odds ratio, 1.2; confidence interval, 1.1 to 1.3 for every 10-point drop in a Modified Barthel Index), and number of comorbid conditions (adjusted odds ratio, 1.1; confidence interval, 1.0 to 1.2). Risk factors for any complication were similar, but there was an interaction between comorbidity and the degree of functional impairment; in patients who were severely functionally impaired, the number of comorbidities was not as strongly associated with the risk of complications as it was in patients who were less functionally impaired. CONCLUSION: There is a complex relationship among the type of underlying medical impairment, severity of functional limitation, comorbidity, and unanticipated medical or surgical complications that interrupt rehabilitation. The interruptions vary both in type and in severity.

Activities of Daily Living↗

PubMed1994

Risk factors for hip fracture in black women. The Northeast Hip Fracture Study Group.

BACKGROUND: Although more than 1 percent of black women 80 years of age or older have hip fractures each year, little is known about risk factors for hip fracture in these women. METHODS: We carried out a case-control study involving 144 black women admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. The control were 218 black women living in the community who were matched to the case patients according to age and ZIP Code or telephone exchange and 181 hospitalized black women matched according to age and hospital. Information was obtained through personal interviews and was studied by multivariable logistic-regression analysis. RESULTS: When the case patients were compared with the control subjects from the community, the women in the lowest quintile for body-mass index had a markedly increased risk of hip fracture as compared with the women in the highest quintile (odds ratio, 13.5; 95 percent confidence interval, 4.2 to 43.3). Postmenopausal estrogen therapy for one year or more was protective for women under 75 years of age (odds ratio, 0.1; 95 percent confidence interval, < 0.1 to 0.5). Factors associated with an increased risk of hip fracture included a history of stroke (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.1), use of aids in walking (odds ratio, 5.6; 95 percent confidence interval, 2.7 to 11.5), and consumption of seven or more alcoholic drinks per week (odds ratio, 4.6; 95 percent confidence interval, 1.5 to 14.1). The results were similar when the case patients were compared with the hospitalized control subjects. CONCLUSIONS: Among black women thinness, previous stroke, use of aids in walking, and alcohol consumption are associated with an increased risk of hip fracture. Postmenopausal estrogen therapy protects against hip fracture in women under 75 years of age.

Aged↗

PubMed1994

Fluoxetine efficacy in treatment resistant depression.

1. As many as 30% of depressed patients fail to respond to antidepressant drug therapy, and at least 60%-75% will not achieve complete recovery. Recently, several studies have suggested that newer, "second generation" antidepressants might be beneficial in treatment resistant depression (TRD). In the present study the authors examined the potential utility of fluoxetine in TRD by comparing its efficacy in patients with and without a prior history of antidepressant response. 2. 149 patients with MDD received fluoxetine 20mg daily for a minimum of 5 weeks: 43 (29%) had never responded to drug therapy (TRD patients), 41 (28%) did have a prior drug response (non-TRD patients) and 65 (44%) had never received any antidepressant treatment. Clinical response was defined as a > or = 50% reduction in baseline Hamilton Depression Rating score plus a final score < 7. 3. Compared to non-TRD patients, the TRD patients were more likely to have unipolar depression (p = 0.002), a chronic episode of > 2 years duration (p < 0.0001), a later age of illness onset (p < 0.0001), fewer prior episodes (p < 0.0001) and fewer prior drug treatments (p = 0.04). Overall, the response rate to fluoxetine was slightly greater in the non-TRD patients (76%) compared to the TRD patients (56%); however, this difference did not achieve statistical significance. 4. The present observations suggest that fluoxetine treatment of adequate duration may be beneficial for some patients with a prior history of refractory depression.

Adult↗

PubMed1994

Intraobserver and Interobserver Variability in Scoring Laparoscopic Diagnosis of Pelvic Adhesions

Videotapes of laparoscopic procedures are used for patient and physician education, independent consultation, and even in the courtroom as evidence. Validation of the interpretation of the videotape with respect to intraobserver and interobserver difference has been scarcely studied. As part of the protocol of a prospective, double-blind, placebo study a standardized adhesion scoring system was developed by the investigators. After laparoscopic adhesiolysis and instillation of either an active or placebo agent designed to prevent reformation of adhesions, a second look laparoscopy was performed between 6 and 10 weeks later to allow for a second adhesion score. Five reproductive surgeons evaluated via videotape pre and post adhesion scores in which 11 patients (22 procedures) were operated by one member of the group. Three months after the initial scoring of the videotapes each tape was reevaluated in order to measure intraobserver variability. Intraobserver and interobserver variability was assessed for adhesion extent as well as adhesion severity scores and also included consideration of the differences between the first and second procedures using sophisticated statistical methods. Intraobserver variability for adhesion severity was 12% versus 19% for interobserver variability. The replicate (intraobserver) variability for adhesion extent was 15.4% and interobserver variability was 21.2%. Two of the five observers consistently scored pathology as more severe than two others. The surgeon scored differences between the two procedures as greater than the other observers. Nevertheless, the variability was not so great as to preclude videotape evaluation of pathology in multicentric trials, or to allow for independent consultation of laparoscopic procedures via videotape.

Journal Article↗

PubMed1994

Seasonal and latitudinal occurrence of cerebral vasospasm and subarachnoid hemorrhage in the northern hemisphere.

Using patient data obtained from the International Cooperative Aneurysm Study that evaluated clinical records from 68 neurosurgical centers in 14 countries, we evaluated the data as to the monthly occurrence of cerebral vasospasm and subarachnoid hemorrhage relative to the latitude of the medical center where the data were gathered. Using the Edwards analysis for cyclic patterns, we examined peak to trough ratios and months of peak to assess the strength and nature of the cyclic variations between December 1980 and July 1983. Of the 3,521 subarachnoid hemorrhage patient records examined, 685 developed some grade of vasospasm as defined symptomatically, angiographically, and by the Fisher Grading Scale. Cyclic analysis demonstrated a strong seasonal occurrence for the incidence of subarachnoid hemorrhage, with a peak in February, in the northern hemisphere. Cerebral vasospasm incidence, after controlling for subarachnoid hemorrhage occurrence, exhibited only a small peak to trough ratio (1.15) relative to the larger ratio (1.74) seen with unadjusted vasospasm data. Age was related to both incidence and location. In populations at high risk for cerebrovascular diseases, climatic conditions may act as synchronizers of pathologic vascular events.

Adolescent↗

PubMed1994

Efficacy of alprazolam in reducing fluoxetine-induced jitteriness in patients with major depression.

BACKGROUND: Serotonin selective reuptake inhibitors (SSRIs) have become the most widely prescribed antidepressants in the United States. The selective influence of SSRIs on serotonin neurotransmission has resulted in a specific constellation of adverse effects termed "jitteriness" syndrome, which occurs in at least 30% of patients taking SSRIs. Because there have been no systematic studies examining treatment of SSRI-induced jitteriness, we conducted a prospective study of the efficacy of adjunctive alprazolam therapy for fluoxetine-induced jitteriness symptoms. METHOD: Fifty-four subjects with major depression were treated with fluoxetine 20 mg/day. Subjects experiencing an increase in jitteriness symptoms within 2 weeks of starting fluoxetine were given adjunctive alprazolam 0.5 mg to 4.0 mg daily for 2 weeks followed by a 2-week taper period. RESULTS: Eighteen (33.3%) of 54 patients experienced jitteriness symptoms during fluoxetine treatment. We observed a statistically significant reduction in the severity and number of jitteriness symptoms with adjunctive alprazolam. Moreover, in most cases jitteriness symptoms did not reappear during the alprazolam taper period or after alprazolam was discontinued. CONCLUSION: These observations suggest that a brief course of adjunctive alprazolam treatment may be efficacious in reducing the duration and severity of jitteriness symptoms resulting from antidepressants that are selective for serotonin.

Adult↗

PubMed1994

Direct vesicoureteral scintigraphy: quantifying early outcome predictors in children with primary reflux.

UNLABELLED: This study quantifies some of the outcome predictors in a group of children with primary vesicoureteral reflux who were initially managed medically. METHODS: We studied 133 patients with primary reflux for 7.1 +/- 2.2 yr. Direct vesicoureteral scintigraphy (DVS) was used to prospectively measure the absolute bladder volume at which reflux began and the maximum volume of urine refluxed into the ureters during the filling and voiding phases of their first two DVS studies. Findings were related to outcome as defined by spontaneous resolution or the eventual need for reconstructive surgery. RESULTS: Medical management eventually failed in 35% of this sample. Patients who did not begin to reflux until their bladders had been filled to more than 60% total bladder capacity had a substantially smaller risk of surgery than those who began to reflux at smaller bladder volumes. Patients who refluxed a volume of urine back into their ureters that was less than about 2% of their total bladder capacity had a substantially smaller risk of surgery than those who refluxed more than 2%. The difference between groups was significant for both DVS variables (p < 0.001). CONCLUSION: Quantitative DVS contributes to the assessment of prognosis in children with vesicoureteral reflux who are managed medically.

Child↗

PubMed1994

Risk factors for delayed healing of duodenal ulcers treated with famotidine and ranitidine.

OBJECTIVES: 1) To validate risk factors for delayed healing of duodenal ulcers identified previously in a pilot study, and 2) To evaluate whether famotidine improves the rate of duodenal ulcer healing and pain relief, compared with ranitidine. METHODS DESIGN: prospective, multicenter, double-observer-blinded, randomized trial. SETTING: 594 patients with active duodenal ulcers seen in private practice offices, university based medical practices and Veterans Affairs hospital clinics. INTERVENTIONS: Patients were randomly assigned to receive famotidine 40 mg or ranitidine 300 mg qhs. MEASUREMENTS: Endoscopy was performed at entry and at 2, 4, and 8 wk after therapy or until complete ulcer healing. Seventeen patient variables, including demographic, past historical, presenting historical and endoscopic characteristics, were assessed for their relationship to healing. RESULTS: After 4 wk of treatment, by a "per protocol" analysis, three risk factors for nonhealing were statistically significant: prior ulcer history [63.0% healed, compared to 77.9% with no history, p = 0.001, odds ratio for not healing (OR) = 2.1, 95% CI = 1.4-3.1]; ulcer size (61.6% of ulcers > or = 10 mm healed at 4 wk compared to 75.5% of smaller ulcers, p = 0.001, OR = 1.9, 95% CI = 1.3-2.8); and smoking (62% of smokers healed vs. 77.7% of nonsmokers, OR = 2.1, 95% CI = 1.4-3.1). The presence of multiple risk factors resulted in additive risk: for patients with no risk factors, 86.8% healed at 4 wk, with any one risk factor 76.8% healed, with two factors 63.0%, and with all three risk factors only 46.9% healed. Multiple risk factors also affected healing rates at 8 wk. Bleeding, alcohol use, and prior NSAID use did not influence ulcer healing. Although famotidine resulted in statistically significant faster ulcer healing when examined on an "intention-to-treat" basis, there were no differences between the drugs when examined on a "per protocol" basis. Patients treated with famotidine achieved more rapid pain relief than those treated with ranitidine. CONCLUSIONS: 1) Smoking, prior ulcer history, and ulcer size > or = 10 mm exert independent risks for nonhealing of duodenal ulcers; 2) These risks are similar for both famotidine and ranitidine; 3) Patients with multiple risk factors for nonhealing may require more prolonged acid suppression therapy than patients who have no risks.

Double-Blind Method↗

PubMed1993

Bilateral and unilateral gamete intrafallopian transfer (GIFT) are not equivalent therapies if unilateral GIFT is chosen to avoid one abnormal tube.

PURPOSE: The relative effectiveness of bilateral and unilateral gamete intrafallopian transfer (GIFT) was compared. Bilateral GIFT, where possible, was the preferred method of transfer and occurred in 328 patients. One hundred sixty-seven patients undergoing unilateral GIFT were placed into one of seven categories based on the indication for unilateral GIFT. Three categories included patients with either historical or laparoscopic evidence of unilateral tubal abnormalities, two categories included patients without tubal disease, and two categories contained patients in whom the physician could not choose between unilateral or bilateral GIFT. RESULTS: Results demonstrate that unilateral GIFT in patients with either historical or laparoscopic evidence of unilateral tubal disease had significantly lower pregnancy and implantation rates than patients undergoing bilateral GIFT or those undergoing unilateral GIFT without evidence of tubal disease (P < 0.01). CONCLUSION: The presence of unilateral tubal abnormalities predicts a lower likelihood of pregnancy in patients undergoing unilateral GIFT through the tube presumed to be normal.

Adult↗

PubMed1993

Differences in antigen expression between neoplastic and nonneoplastic gallbladder epithelium. An immunohistochemical study.

Immunoreactivity for a panel of 15 monoclonal antibodies (MAbs), which are known to react with different gastrointestinal tumor antigens, was assessed in formalin-fixed paraffin-embedded sections that were prepared from cholecystectomy specimens obtained from Mexican patients. Each case was classified histologically into one of the following groups: (1) invasive adenocarcinoma (N = 21), (2) high-grade dysplasia (carcinoma in situ) (N = 2), (3) low-grade dysplasia (N = 4), hyperplasia (4) (N = 15), and (5) chronic cholecystitis (N = 10). Significant differences (P < 0.05) were identified among the five histopathologic groups in the proportion of epithelial cells demonstrating immunoreactivity with MAbs to Lewisb; Lewis(a); sialylated Lewis(a); sialylated Lewis(a) and Lewis(a); Y antigen; H antigen; X antigen; X-like antigen; 200-kDa protein of CEA; 180-, 160-, 50-, 40-kDa proteins of CEA; 30- to 37-kDa protein; and an undefined antigen identified by MAb 99-57, with invasive carcinoma more frequently being positive as compared to nonneoplastic (hyperplasia, chronic cholecystitis) epithelium. Significant differences were also observed among the five histopathologic groups (P < or = 0.0005) in the proportion of epithelial cells demonstrating immunoreactivity with MAbs to Y antigen and the 20- to 50-kDa glycoprotein. However, with these two antibodies immunoreactivity was more frequently found in nonneoplastic epithelium rather than in invasive carcinomas. No significant differences in immunoreactivity were detected among the different histologic groups with MAb to blood group B antigen, types 1 and 2. This study demonstrates that cellular antigens are both developed and lost during the process of neoplastic transformation in the gallbladder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1993

Acute hemodynamic effects induced by chorionic villus sampling: a preliminary investigation.

OBJECTIVE: Our purpose was to evaluate the effects of chorionic villus sampling on the fetal heart rate, the fetal umbilical artery pulsatility index, and the maternal arcuate artery resistance index. STUDY DESIGN: M-mode fetal heart rate, pulsed Doppler fetal umbilical artery pulsatility index, and maternal arcuate artery resistance index measurements were obtained before and immediately after chorionic villus sampling in 50 patients and were compared with 50 procedure-free, gestational age--matched controls. Comparisons within groups were performed with paired T tests and mean changes between groups with two-sample T tests, and variance comparisons between groups were performed with F tests. RESULTS: The mean changes (SD) in fetal heart rate, umbilical artery pulsatility index, and arcuate artery resistance index in patients undergoing chorionic villus sampling and in controls were not statistically different from zero or from each other. However, the variance around the mean fetal heart rate change was 17.1 times larger in the chorionic villus sampling group than the control group (F 17.1, degrees of freedom 49,49, p < 0.0001), and the variance around the mean pulsatility index change was 2.7 times larger in the chorionic villus sampling group than in the control group (F 2.7, degrees of freedom 49,49, p = 0.0007). There was no significant difference in mean resistance index change or variance around the mean resistance index change between groups. CONCLUSION: Chorionic villus sampling induces significant but unpredictable fluctuations in fetal heart rate and umbilical artery pulsatility index but does not affect maternal arcuate artery resistance index.

Analysis of Variance↗

PubMed1993

Applying quantitative methods to the prediction of full functional recovery in adult rehabilitation patients.

The purpose of this project was to construct a pilot prognostic index for use in research and clinical practice that would predict functional recovery in adult rehabilitation patients at discharge using clinical characteristics at admission to rehabilitation (independent performance of seven activities of daily living and three basic mobility tasks). We constructed the index from retrospectively collected data on 1,020 adult rehabilitation patients who underwent rehabilitation between 1980 and 1986. Adjusting for patient characteristics, the odds of recovering independent function doubled for each ten-point increase in the 100-point functional status score measured at admission to rehabilitation (odds ratio = 2.1, 95% confidence interval [CI] = 1.9 to 2.4). The odds increased by a factor of 1.9 (95% CI = 1.1 to 3.2) in patients with an impairment considered more functionally reversible and by a factor of 2.1 (95% CI = 1.3 to 3.4) in patients transferred from an acute hospital. The odds of functional recovery decreased in those over 79 years of age, in those who were unemployed before hospitalization, and as the number of comorbid conditions increased. Our findings demonstrate the feasibility of developing quantitative estimates of functional prognosis. Prior to use, the index should be externally validated in different rehabilitation facilities.

Activities of Daily Living↗

PubMed1993

The luteal phase after ovulation induction with human menopausal gonadotropin and one versus two doses of a gonadotropin-releasing hormone agonist.

OBJECTIVE: To use a GnRH agonist (GnRH-a) to induce ovulation after priming with exogenous hMG. DESIGN: Prospective, randomized double-blind protocol using one or two doses of intranasal nafarelin. SETTING: Office-based ovulation induction program. PATIENTS, INTERVENTIONS: Infertile women not conceiving after use of clomiphene citrate for at least 6 months who were given hMG and nafarelin. No luteal support was given. MAIN OUTCOME MEASURES: Serum concentrations of FSH, LH, E2, and P acutely and at 6 days after GnRH-a administration. Duration of the luteal phase was assessed. RESULTS: Ovulation with elevation of both FSH and LH was achieved. The two-dose regimen was more effective than one dose for sustained LH release. Luteal phase P values and luteal phase duration were both less than usually seen with gonadotropin hCG therapy in the absence of luteal phase support. CONCLUSIONS: Ovulation induction with GnRH-a after hMG priming produces unacceptable luteal phase cycles in the absence of hormonal support.

Adult↗

PubMed1993

Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea.

Nasal continuous positive airway pressure (CPAP) has become the nonsurgical treatment of choice for obstructive sleep apnea syndrome (OSAS). Recent evidence suggests that intermittent use of CPAP by patients is more common than nightly compliance. To determine the consequences of intermittent CPAP use, in terms of a return of sleep-disordered breathing and daytime hypersomnolence, 15 OSAS subjects were evaluated at three times: (1) before CPAP treatment (pretreatment), (2) after 30 to 237 days posttreatment during a night of CPAP use (on CPAP), and (3) during a night without CPAP (off CPAP). Evaluations of sleep-disordered breathing and three domains of hypersomnolence, physiologic sleep tendency, subjective sleepiness, and performance, were accomplished with the respiratory disturbance index (RDI), multiple sleep latency test (MSLT), Stanford sleepiness scale (SSS), and psychomotor vigilance task (PVT), respectively. CPAP use was encouraged and monitored from pretreatment to post-treatment by daily diaries for most subjects and an electronic device for a subset of subjects. As expected, CPAP eliminated apneas and hypopneas, and following the on CPAP night, there were statistically significant improvements in objective measures of sleepiness (MSLT and PVT). Subjective measures of sleepiness and fatigue also showed improvement. Sleeping without CPAP for one night reversed virtually all of the sleep and daytime alertness gains derived from sleeping with CPAP. This occurred despite a statistically significant reduction in the RDI on the night off CPAP (M = 36.8, SD = 28.0 events/h) relative to the pretreatment night (M = 56.6, SD = 24.8 events/h), which may be due to a lessening of the edema of the upper airway following CPAP use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗