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PubMed1993

[Regularly employed inpatient group sleep deprivation therapy assessed by nursing staff and patients].

The antidepressive efficacy of sleep-deprivation therapy has been well known for more than 20 years and has repeatedly been demonstrated in clinical trials. In spite of its proven merits, the method is rarely used as an established element of antidepressant therapy in Swiss psychiatric hospitals. This study includes 56 depressive patients having had a total of 341 partial sleep-deprivation treatments at the psychiatric hospital of Königsfelden (CH). The results suggest that sleep-deprivation therapy could be incorporated on an large scale in the clinical treatment of depression.

Adult↗
PubMed1999

Sleep deprivation therapy in depressive illness and Parkinson's disease.

1. Sleep deprivation is commonly associated with feelings of fatigue and cognitive impairment. 2. Patients with depressive illness, however, often experience mood improvements under these same conditions. 3. Other studies now show that tremor and rigidity, in patients with Parkinson's disease, are also improved by sleep depression therapy. 4. The neural substrates which underlie these effects are unclear. Some recent evidence, however, suggests that sleep deprivation may activate mechanisms which are otherwise typical of conditions of metabolic stress. 5. A common feature of these mechanisms is the suppression of cholinergic activity which is thought to be excessive, in relation to monoamine transmission, in both depression and Parkinson's disease.

Animals↗
PubMed1999

Effect of short-term transdermal estrogen replacement therapy on sleep: a randomized, double-blind crossover trial in postmenopausal women.

OBJECTIVE: To evaluate the effect of estrogen replacement therapy on sleep architecture, arousals, and body movements. DESIGN: A 7-month, prospective, randomized, double-blind, placebo-controlled crossover trial. SETTING: Departments of obstetrics and gynecology and a university sleep center in Turku, Finland. PATIENT(S): Seventy-one postmenopausal women, 4 of whom were excluded and 5 of whom withdrew from the study; the final study group consisted of 62 women. INTERVENTION(S): Two periods of treatment with either estrogen or placebo. MAIN OUTCOME MEASURE(S): Polysomnography for measurement of sleep and arousals and a static charge-sensitive bed for monitoring of movements and breathing. Self-reports of climacteric symptoms for 14 days. RESULT(S): Estrogen effectively alleviated hot flashes, sweating, sleep complaints, and headaches. Estrogen decreased the total frequency of movement arousals but increased alpha-arousals, especially during light non-rapid eye movement sleep (stage 1). Sleep latency, distribution of sleep stages, sleep efficiency, and total sleep time were similar during treatment with estrogen and placebo. Changes in serum E2 concentrations correlated with neither subjective nor objective sleep quality. CONCLUSION(S): Estrogen replacement therapy improves objective sleep quality by alleviating the frequency of nocturnal movement arousals. It also reduces climacteric symptoms, especially vasomotor symptoms. Estrogen replacement therapy does not seem to have any effect on sleep architecture.

Aged↗
PubMed1978

Analysis of mood change during and following sleep deprivation therapy.

Recent work suggests that depriving endogenous depressives of sleep for 1 night may be followed by an alleviation of their illness. In order to facilitate further study of the mechanisms underlying this effect, hourly self-rated measurements of mood were obtained throughout the sleepless night and the time of onset of any response noted. Of the patients who improved, some did so during the day following sleep deprivation; in others the response did not occur until after the next night's sleep. The two groups of responders differed in terms of self-reported emotional arousal during the course of the sleepless night. The implications of these findings are discussed in relation to further studies of sleep deprivation therapy.

Adult↗
PubMed2004

Obstructive sleep apnea: therapies other than CPAP.

Nasal application of continuous positive airway pressure (CPAP) is the standard form of therapy for treating obstructive sleep apnea (OSA). Common difficulties associated with CPAP therapy include sense of dryness in the mouth, rhinorrhea, nasal congestion and dryness, mask discomfort, claustrophobia, irritation from device noise, aerophagy, chest discomfort and partner's intolerance. Therefore, many patients are unable to or unwilling to comply with the use of CPAP. This article discusses the various non-CPAP approaches that have been investigated in the management of OSA, which include behavioral therapy (weight loss and positional therapy), pharmacological treatment, mandibular advancement techniques and surgery. However, none of these has been shown to be superior to CPAP. In clinical practice, only selected patients will benefit from therapies other than CPAP.

Behavior Therapy↗
PubMed1992

An evaluation of long-term nasal CPAP therapy for sleep apnea.

Nasal continuous positive airway pressure (CPAP) is an effective therapy for sleep apnea. Little is known about long-term patient compliance and side effects with this therapeutic modality in the Chinese. In order to evaluate this, we collected 8 obstructive sleep apnea patients who received home nasal CPAP therapy between January 1990 and July 1991. Each received two sets of nap polysomnographic studies. The initial set was performed to diagnose and evaluate patient response to CPAP as well as defining the CPAP pressure the patient would be using at home. The second set of studies were conducted for follow up and re-evaluation. Seven of these patients reported using nasal CPAP during sleep at night, and one did not use it all. Nasal CPAP improved clinical symptoms, particularly daytime sleepiness, and 7 patients were generally satisfied with nasal CPAP. Initially the side effects were a dry throat and nose. After 5 to 15 months of CPAP treatment, the follow-up nap sleep studies showed no significant change in the apnea/hypopnea index, duration of apnea, or oxygen desaturation between the diagnostic and follow-up (without CPAP) studies. However the amount of nasal CPAP pressure setting declined in 4 of 7 patients. Our own experience indicates that long-term nasal CPAP is an important new means of treatment for sleep apnea and allows a normal daytime life. It was well-tolerated by most sleep apnea patients. However, it is necessary to further evaluate of morbidity and the amount of pressure setting relative to long-term home nasal CPAP.

Adult↗
PubMed2003

Continuous positive airway pressure therapy in sleep apnoea.

Sleep apnoea is associated with increased mortality and morbidity. The treatment goal is to reduce the neurocognitive and cardiovascular sequelae. CPAP therapy in sleep apnoea is discussed in two parts in the article. The first part will consider CPAP therapy in the more common form of sleep apnoea (i.e. obstructive or mixed sleep apnoea) and the second part will consider CPAP therapy in central sleep apnoea. Alternative positive airway pressure modalities are discussed. CPAP therapy has been extensively studied and it remains the mainstay of treatment in obstructive sleep apnoea, as it is still the most consistently efficacious and safe option. However, its major disadvantage is that it does not confer a cure to this disorder and hence therapy is generally life long with its usual treatment compliance problems. As such, there are continuous improvement strategies. The role of CPAP therapy in central sleep apnoea is more limited. There has been increasing data on the beneficial effect of CPAP on central sleep apnoea/Cheyne-Stokes respiration in congestive heart failure. Evidence for CPAP therapy in sleep apnoea has evolved significantly over the last decade. However, more research and publication of large-scale long-term randomized trials of treatment in sleep apnoea to assess patient-orientated outcomes and preferences are necessary.

Continuous Positive Airway Pressure↗
PubMed1998

[Auto CPAP Set system for diagnosis and therapy of sleep breathing disorders].

OBJECTIVE: To compare the Auto CPAP Set system with standard polysomnography (PSG) in diagnosis and therapy of sleep breathing disorders. METHOD: Two studies were completed. The Auto CPAP Set system was compared with a simultaneously obtained PSG in eleven patients with sleep breathing disorders. Twenty-three additional patients with obstructive sleep apnea syndrome (OSAS) were treated by Auto CPAP Set. Student's t test was employed to evaluate statistical significance. RESULT: No differences were found between these two systems in AHI, SaO2 and the longest apnea duration (P > 0.05), and the Auto CPAP Set system had a sensitivity of 70% and a specificity 100% for diagnosis of OSAS. AHI decreased and SaO2 increased significantly in OSAS patients after treatment. CONCLUSION: The Auto CPAP Set system provides an accurate and simple method for diagnosis and therapy of sleep breathing disorders, and the time required for analysis of test results was shorter as compared with PSG.

Adult↗
PubMed1989

Progesterone therapy for sleep apnea syndrome evaluated by occlusion pressure responses to exogenous loading.

We investigated the mechanisms of the beneficial effect derived from progesterone therapy for sleep apnea syndrome (SAS). Nine patients with SAS were treated for 7 days with chlormadinone acetate (CMA), a respiratory stimulant known to increase not only CO2 and hypoxic chemosensitivity but also respiratory drive response for ventilatory loading. They were examined as to sleep events and ventilatory control during wakefulness before and during CMA treatment. Apnea-hypopnea index was significantly reduced from 51.1 +/- 5.7 to 43.6 +/- 8.1 episodes/h (p less than 0.05). The ratio of desaturation time with more than 4% SaO2 fall to total sleep time was diminished in seven of nine patients, and its mean value decreased from 44.9 +/- 8.6 to 28.7 +/- 8.1% (p less than 0.05). Both hypercapnic ventilatory response (HCVR) and load response during wakefulness were significantly increased, although isocapnic hypoxic ventilatory response (HVR) was not significantly enhanced by CMA. The degree of augmentation in awake load response as well as in HCVR was positively correlated with that of improvement in sleep-disordered breathing. Moreover, patients who did not show amelioration in oxygen desaturation were found to be incapable of increasing load response despite increased HCVR. We conclude that CMA therapy for sleep apnea syndrome is effective in the patients whose load response as well as respiratory control activity are augmented during wakefulness.

Chlormadinone Acetate↗
PubMed1991

[Long-term follow-up of sleep apnea therapy with sustained-release theophylline administered every evening].

Sleep apnoea increases mortality and morbidity. The physiological sleep profile is disturbed and functional capacity is decreased. At present nasal CPAP breathing (continuous positive airway pressure) seems to be the best treatment method in obstructive sleep apnoea. However, this therapy is expensive, imposing a strain on the patient, and hence some patients will not tolerate it. Medical treatment of sleep apnoea with theophylline has proved effective. In 40 patients suffering from sleep apnoea, long-term treatment with sustained-release theophylline was investigated. Responders show a significant reduction of apnoeic phases and of apnoea index at the beginning and after long-term treatment. Using an individual theophylline dosage with morning theophylline concentration between 5 and 8 micrograms/ml, only few side-effects occurred. Positive effects on cardiopulmonary capacity could be detected. The Broca index does not change significantly. Sustained-release theophylline applied in the evening showed a positive effect on sleep apnoea in responders.

Adult↗
PubMed2002

Bright light therapy for sleep problems in adults aged 60+.

BACKGROUND: The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatment for sleep disorders (particularly insomnia) is pharmacological. The efficacy of non-drug interventions has been suggested to be slower than pharmacological methods, but with no risk of drug-related tolerance or dependency. Bright light treatment involves participants sitting in front of a "light box" which emits very high (typically 10,000 lux) fluorescent light for periods of around two hours daily. The timing of this light treatment will depend on the irregular timing of the participant's sleep pattern. OBJECTIVES: To assess the efficacy of bright light therapy in improving sleep quality (sleep timing in particular) amongst adults aged 60 and above. SEARCH STRATEGY: The following databases were searched: MEDLINE (1966 - January 2001); EMBASE (1980 - January 2001), CINAHL ( 1982 - January 2001; PsychINFO 1970 to 2001; The Cochrane Library (Issue 1, 2001); National Research Register (NRR [2001]). Bibliographies of existing reviews in the area, as well as of all trial reports obtained, were searched. Experts in the field were consulted. SELECTION CRITERIA: Randomised controlled trials of bright light therapy for primary sleep problems where 80% or more of participants were over 60. Participants must have been screened to exclude those with dementia and/or depression. DATA COLLECTION AND ANALYSIS: Abstracts of studies identified in searches of electronic databases were read and assessed to determine whether they might meet the inclusion criteria. MAIN RESULTS: Reviewers found no trials on which to base conclusions for the effectiveness of this treatment. REVIEWER'S CONCLUSIONS: When the possible side-effects of standard treatment (hypnotics) are considered, there is a reasonable argument to be made for clinical use of non-pharmacological treatments. In view of the promising results of bright light therapy in other populations with problems of sleep timing, further research into their effectiveness with older adults would seem justifiable.

Aged↗
PubMed1999

A preliminary study of the effects of correction of anemia with recombinant human erythropoietin therapy on sleep, sleep disorders, and daytime sleepiness in hemodialysis patients (The SLEEPO study).

End-stage renal disease (ESRD) is commonly associated with complaints of disturbed sleep and sleep disorders, frequently related to periodic limb movements in sleep (PLMS) or sleep apnea that may result in daytime sleepiness and other sequelae. Improvements in quality of life, including subjective sleep quality, have been reported in ESRD patients treated with recombinant human erythropoietin (rHuEPO). We investigated the objective effects of normalizing hematocrit on sleep disorders, sleep patterns, and daytime ability to remain awake in ESRD patients. Ten hemodialysis patients with sleep complaints while on rHuEPO therapy were studied by polysomnography while moderately anemic (mean hematocrit, 32.3%) and again when hematocrit was normalized (mean hematocrit, 42.3%) by increased rHuEPO dosing. Sleep patterns and associated parameters were monitored. Delivered dialysis dose and iron storage factors were monitored. Maintenance of Wakefulness Testing (MWT) was performed to assess daytime alertness/sleepiness. All 10 subjects experienced highly statistically significant reductions in the total number of arousing PLMS (P = 0.002). Nine of 10 subjects showed reductions in both the Arousing PLMS Index (P < 0.01) and the PLMS Index (P = 0.03) when hematocrit was normalized. Measures of sleep quality showed trends to improved quality of sleep. MWT demonstrated significant improvement in the length of time patients were able to remain awake (9.7 versus 17.1 minutes; P = 0.04). RHuEPO therapy with full correction of anemia reduces PLMS, arousals from sleep, and sleep fragmentation while allowing for more restorative sleep and improved daytime alertness. These findings may explain one mechanism for the improved quality-of-life parameters reported in ESRD patients treated with rHuEPO.

Adult↗
PubMed2006

Massage therapy and sleep behaviour in infants born with low birth weight.

This study attempts to evaluate the impact of massage therapy on sleep behaviour in infants born with low birth weight (LBW) in St. Petersburg, Russia. Fifty infants (22 boys, 28 girls) who were born in St. Petersburg between 2000 and 2002 and defined as LBW babies (<2500g at birth) were enrolled onto the study at the age of 2 months. Of these, 41 (19 boys, 22 girls) were light and pre-term infants (gestational age < or =36 weeks), and 9 (3 boys, 6 girls) born light at term. The control group consisted of 50 healthy infants born with LBW who were cross-matched with an experimental group of babies and controlled for gender, gestational age, weight and date of birth. The groups were also matched for proximal geographical distribution in the city. Babies in the experimental group were assigned massage intervention therapy that include gentle rubbing, stroking, passive movements of the limbs and other means of kinaesthetic stimulation performed by professionals until the infant is 8 months old. The findings suggest that 8-month-old LBW infants who received massage intervention were less likely to snore during sleep, required less feeding on waking-up at night, and appeared more alert during the day. These apparent correlations remained significant after adjustment was made for major potential confounders. No statistically significant difference was found in sleep behaviour between LBW infants exposed to massage therapy who were either born pre-term or at term. It is suggested that massage may be a valuable approach to improve quality of sleep and reduce sleep-disordered breathing in infants born with LBW. It is acknowledged that whilst this study does not represent a large sample, it is felt that the findings suggest further investigation and offer an insight into an area previously relatively unexplored.

Analysis of Variance↗
PubMedDate not supplied

Effects of light therapy on sleep, mood, and temperature in women with nonseasonal major depression.

Research has supported the applicability and efficacy of light therapy in the treatment of nonseasonal depression. The investigators examined the effects of light therapy on sleep, core temperature, depressed mood, and perception of fatigue and energy in a sample of pre-menopausal and post-menopausal women diagnosed with nonseasonal, nonbipolar depression. Women were randomly assigned to either light therapy (n = 16) or placebo (n = 13) for a 28-day period. Pre and post measures of sleep and core temperature were collected. In addition, measures of depressed mood, fatigue, and energy were collected throughout the study period. Significant changes in depression and energy were found in the treatment group, but not in the placebo group. There was a significant reduction in the temperature mesor and less wake time during the first third of the sleep period in the treatment group but not in the placebo group. Light therapy yielded significant improvement in depression when compared with placebo intervention and core temperature mesor returned to normal. There was no significant phase shift, perhaps due in part to the absence of any baseline circadian phase disturbances. Relationships between temperature, sleep, depressed mood, fatigue, and energy variables offer potential directions for future research and clinical intervention.

Adult↗
PubMed2001

[Modified hyoid suspension for therapy of sleep related breathing disorders. operative technique and complications].

BACKGROUND: : Concerning the therapy of obstructive sleep apnea (OSA) the discrimination between either retropalatal or retrolingual site of obstruction seems to be an oversimplification. Thus modern surgical concepts address both anatomical areas. Minimal invasive surgical techniques treating the soft palate have recently been developed while there is still an ongoing development concerning the base of tongue. METHODS: A less invasive modification of the hyoid suspension to the thyroid cartilage, originally described by Riley, is presented as treatment modality for sleep related breathing disorders. Between October 2000 and March 2001, 14 patients underwent modified hyoid suspension within a multi-level surgery concept. The operative technique manages with only one wire-suture and does not include myotomies and intersection of the ligamenta stylohyoidea. RESULTS: All together 10 male and 4 female subjects with a mean age of 50.9 years were included in the analysis. Preoperatively the mean apnea hypopnea index (AHI) was 18.4. The procedure was well tolerated. Neither increased postoperative pain nor increased requirement of analgetics was observed. Substantial side-effects were one case of seroma and 9 cases of transitory dysphagia. The retrolingual airway space increased significantly after surgery. CONCLUSIONS: These preliminary results are promising. The presented modified hyoid suspension is time-effective and shows less postoperative morbidity. Therefore it might become a suitable treatment modality within the multi-level surgery concept for sleep related breathing disorders.

Adult↗
PubMed1999

Efficiency of continuous positive airway pressure versus theophylline therapy in sleep apnea: comparative sleep laboratory studies on objective and subjective sleep and awakening quality.

Sleep apnea is the most common sleep-related breathing disorder characterized by repetitive episodes of hypoxemia. Therapies include behavioral, surgical, orthodontic, pneumological, and pharmacological interventions. The aim of the present study was to compare the efficiency of pneumological therapy by nasal continuous positive airway pressure (CPAP) versus a pharmacological approach with theophylline (Respicur retard(R) 400 mg) on respiratory variables as well as objective and subjective sleep and awakening quality in patients with moderate sleep apnea measured by polysomnography and psychometry. Under CPAP therapy all respiratory variables improved and normalized, while under theophylline only the apnea-hypopnea index and the desaturation index improved but still did not return to normal values. Regarding sleep initiation and maintenance, CPAP therapy prolonged sleep latency and reduced movement time, while patients treated with theophylline showed reduced total sleep period, total sleep time and sleep efficiency. Sleep architecture demonstrated an increase in deep sleep and REM stages under CPAP therapy, and remained unchanged under theophylline. Concerning subjective sleep and awakening quality, both treatments improved well-being in the morning. Regarding objective awakening quality, reaction time performance was improved in both groups. In conclusion, CPAP treatment is more effective than theophylline regarding respiratory variables as well as the normalization of sleep maintenance and sleep architecture in sleep apnea patients.

Bronchodilator Agents↗