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PubMed2000

[Interesting cases of ventilatory therapy of sleep apnea in a group of our patients].

UNLABELLED: In the group of patients investigated in our sleep laboratory and successfully treated by positive pressure applied in to the upper airways through nasal mask (nCPAP) some interesting cases appeared. These cases show beneficial effect of nCPAP therapy, unfortunately not widely spread and recognized in our country. These patients were unsuccessfully treated before by conventional methods, which did not improve their situation for a longer time. Only after polysomnography carried out in our sleep laboratory and after home treatment with nCPAP or BiPAP machine, the situation radically improved. FIRST CASE: In a director of important enterprise after unrelated car accident atrial fibrillation caused by dilation was discovered, which did not respond even on Electro cardioversion. After recognition of severe obstructive sleep apnoea syndrome (OSAS) this patient was treated successfully by BiPAP. The second case: a bus driver, who falls asleep on the traffic light with full buss of passengers. A diagnose OSAS with a multiple sleep latency test result below 2.5 minutes. The nCPAP treatment allowed him to continue to work, but transiently on different position. The third: 40-year-old patient with a body mass index (BMI) 38 and with dysrhythmias IIIb-IVb according to Lown. The respiratory disturbance index (RDI) was 40 and oxygen desaturation bellow 77%. There was bigeminia on ECG. During four hour with nCPAP treatment there was only two randomly ventricular extrasystols appeared, confirming the beneficial effect of treatment. These cases demonstrate a wide spectrum of cardiac dysrhythmias, which have only functional character, but are important for the practice. The demonstrated cases highlighted the importance of home nCPAP therapy in OSAS patients.

Adult↗
PubMed1993

[Hemodynamics and sleep structure in attempted weaning after nCPAP ventilation therapy of obstructive sleep apnea syndrome].

nCPAP (continuous positive airway pressure) treatment is presently the standard therapy in marked obstructive sleep apnoea syndrome. Fundamentally, this is a long-term treatment. Various authors have been making different recommendations in respect of the frequency of application, based partly only on the patient's individual pattern of complaints and symptoms. Our study aimed at examining the short-term nocturnal effects of discontinuing the treatment course in 12 patients, using polysomnography as a diagnostic tool. Results showed that directly after discontinuation of therapy the sleep structure, respiration during sleep and the nocturnal blood pressure pattern returned to baseline findings. It is concluded from this that nCPAP treatment should be strictly adhered to every night to minimise the risk of cardiovascular complications in the patients concerned.

Adult↗
PubMed1981

Diagnosis and therapy of sleep apnea.

The presenting symptom complex, diagnostic features, and therapeutic alternatives for obstructive and central sleep apnea are discussed in relation to two illustrative patients. Heavy snoring and restlessness during sleep in an obese individual, usually a male, may indicate obstructive apnea. Daytime hypersomnolence, intellectual deterioration, mental depression, impotence, cardiac arrhythmias, cor pulmonale, systemic hypertension, and erythrocytosis are the most common complications. Tracheostomy, the classic form of therapy, can be replaced by pharmacologic intervention in most patients. The clinical presentation of central apnea is less dramatic, but neurological and cardiac complications can occur. Therapy is less well established for this entity. Knowledge of the increased incidence of these disorders and awareness of more subtle complications indicate that sleep apnea should be placed in the differential diagnosis of pulmonary and systemic hypertension, hypersomnolence states, mental deterioration, psychiatric illness, and even insomnia.

Antidepressive Agents, Tricyclic↗
PubMed1982

[Drug therapy of sleep disorders in shift workers].

The hypnotic action of a soporific may be of limited use in populations who live in contradiction to their "internal biological clock". In order to test the assumption 60 nurses who had a disturbance in their sleep-waking rhythm due to shift work participated in an one-week double blind study. Nurses were randomly assigned to receive either lormetazepam 1 mg (Noctamid) or placebo (n = 30 per group). In the nurses with disturbance of falling asleep, a normalization of the duration of falling asleep occurred in 15 of 17 cases under lormetazepam as compared to ten of 17 under placebo. In the nurses who slept too little the length of the sleeping time normalized in 15 of 16 cases under lormetazepam as compared to the nine of 16 under placebo. With simultaneous consideration of the duration of falling asleep, total duration of sleep and depth of sleep, a distinction was made between "normalization in all three parameters", "normalization in one or two parameters, but no deterioration in any parameter" and "no normalization" for evaluation of the therapy comparison. The action of lormetazepam was shown in higher improvement rates (p less than 0,05). Neurophysiological and social medical implications are being discussed.

Adolescent↗
PubMed1999

Adverse effects of nasal continuous positive airway pressure therapy in sleep apnoea syndrome.

Nasal continuous positive airway pressure (nCPAP) is now the treatment of choice for patients with sleep apnoea syndrome. Side-effects and adverse reactions have been described in isolated reports with this device. We have, therefore, systematically studied the side-effects of nCPAP therapy in 300 consecutive patients referred to the London Chest Hospital Ventilatory Support Unit. Ninety-six per cent of patients complained of at least one side-effect resulting from the therapy, with 45 per cent complaining of a side-effect specific to the nasal mask. There was no correlation between the side-effects and level of pressure used during nCPAP. The rate of compliance remained high in spite of the side-effects, with a daily use of 7.8 hours (SD 8.05) and with 83 per cent of the patients using the device every night. Although nCPAP treatment remains acceptable to most patients there exists a high incidence of adverse effects.

Adult↗
PubMed2004

Light therapy for non-seasonal depression.

BACKGROUND: Efficacy of light therapy for non-seasonal depression has been studied without any consensus on its efficacy. OBJECTIVES: To evaluate clinical effects of bright light therapy in comparison to the inactive placebo treatment for non-seasonal depression. SEARCH STRATEGY: We searched the Depression Anxiety & Neurosis Controlled Trials register (CCDANCTR January 2003), comprising the results of searches of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 -), EMBASE (1980 -), CINAHL (1982 -), LILACS (1982 -), National Research Register, PsycINFO/PsycLIT (1974 -), PSYNDEX (1977 -), and SIGLE (1982 - ) using the group search strategy and the following terms: #30 = phototherapy or ("light therapy" or light-therapy). We also sought trials from conference proceedings and references of included papers, and contacted the first author of each study as well as leading researchers in the field. SELECTION CRITERIA: Randomized controlled trials comparing bright light with inactive placebo treatments for non-seasonal depression. DATA COLLECTION AND ANALYSIS: Data were extracted and quality assessment was made independently by two reviewers. The authors were contacted to obtain additional information. MAIN RESULTS: Twenty studies (49 reports) were included in the review. Most of the studies applied bright light as adjunctive treatment to drug therapy, sleep deprivation, or both. In general, the quality of reporting was poor, and many reviews did not report adverse effects systematically. The treatment response in the bright light group was better than in the control treatment group, but did not reach statistical significance. The result was mainly based on studies of less than 8 days of treatment. The response to bright light was significantly better than to control treatment in high-quality studies (standardized mean difference (SMD) -0.90, 95% confidence interval (CI) -1.50 to -0.31), in studies applying morning light treatment (SMD -0.38, CI -0.62 to -0.14), and in sleep deprivation responders (SMD -1.02, CI -1.60 to -0.45). Hypomania was more common in the bright light group compared to the control treatment group (risk ratio 4.91, CI 1.66 to 14.46, number needed to harm 8, CI 5 to 20). Twenty studies (49 reports) were included in the review. Most of the studies applied bright light as adjunctive treatment to drug therapy, sleep deprivation, or both. Treatment REVIEWERS' CONCLUSIONS: For patients suffering from non-seasonal depression, bright light therapy offers modest though promising antidepressive efficacy, especially when administered during the first week of treatment, in the morning, and as an adjunctive treatment to sleep deprivation responders. Hypomania as a potential adverse effect needs to be considered. Due to limited data and heterogeneity of studies these results need to be interpreted with caution.

Depression↗
PubMed2002

[Diagnosis and therapy of sleep disorders. Early assessment--prompt treatment].

Effective medications, as well as other effective options, are available for the treatment of insomnia. Since many patients do not inform their family doctors that they have sleep-related problems, the physician should himself question his patients on this point, with the aim of initiating specific treatment early enough to prevent such a condition becoming chronic.

Combined Modality Therapy↗
PubMed2004

Comorbidities in chronic neuropathic pain.

Neuropathic pain arises from a lesion or dysfunction within the nervous system; the specific mechanisms that elicit neuropathic pain symptoms are the subject of ongoing research. It is generally acknowledged that neuropathic pain is extremely difficult to treat, and a major factor impacting outcomes is the presence of comorbidities such as poor sleep, depressed mood, and anxiety. Patients who suffer from chronic pain experience difficulties in initiating and maintaining sleep. Sleep deprivation has been associated with a decreased pain threshold, muscle aches, and stiffness in normal volunteers. The interrelationship of these factors is complex: Many chronic pain patients are depressed and anxious; sleep deprivation can lead to anxiety; and depression can be both the cause and the result of sleep disturbances. Thus, physicians must evaluate all aspects of pain, sleep, and mood in chronic pain patients. Several instruments have been developed to aid physicians in gathering qualitative and quantitative information from chronic pain patients. This triad of chronic pain, sleep disturbances, and depression/anxiety must be fully addressed if the patient is to be restored to optimal functionality. A multidisciplinary team approach allows for treatment of the whole patient. Nonpharmacologic interventions include relaxation therapy, sleep restriction therapy, and cognitive therapy. Strategies for pharmacologic interventions should attempt to maximize outcomes by employing, where possible, agents that address both the pain and the comorbidities. In this way, functionality may be restored and the patient's quality of life improved.

Anxiety Disorders↗
PubMed2006

A preliminary study of psychological factors affecting patients' acceptance of CPAP therapy for sleep apnoea syndrome.

BACKGROUND: Many patients abandon continuous positive airway pressure (CPAP) treatment after initial acceptance. This may be for physical or psychological reasons. METHODS: We have carried out semi-structured interviews, constructed from the Health Belief Model (HBM) with a convenience sample of patients who had recently abandoned CPAP treatment after at least 6 months of use. We explored their understanding and experiences of their OSA and of the CPAP therapy and their reasons for stopping treatment. RESULTS: Nine patients were interviewed (age 32-70 years; 8 males). Four patients were not clear about the nature, severity, or consequences of sleep apnoea syndrome (SAS) and did not consider themselves to be ill. Three expected to be cured by the machine. Only one patient spoke of life-threatening risk. Eight of the nine patients had other health disorders. Seven stopped CPAP because of negative experiences, including problems with the mask and noise from the machine. Two patients felt 'liberated' on stopping treatment. CONCLUSIONS: Studies at the initiation stage of CPAP treatment are needed in order to identify factors impeding acceptance, which can be addressed early. The Health Belief Model, which emphasises subjective health experience and patients' beliefs about treatment, may be a useful tool for such investigations.

Adult↗
PubMed1998

Comparison of nose and face mask CPAP therapy for sleep apnoea.

BACKGROUND: Many patients with sleep apnoea/hypopnoea syndrome (SAHS) find nasal continuous positive airway pressure (CPAP) treatment unsatisfactory due to side effects related to mouth air leakage. A study was performed to compare side effects with face mask and nose mask CPAP therapy in patients with SAHS, with and without uvulopalatopharyngoplasty (U3P). METHODS: Twenty newly diagnosed patients with SAHS took part in a randomised double limb trial of face or nose mask CPAP therapy (four weeks per limb) in which CPAP compliance in terms of machine run time was measured and patients answered a symptom questionnaire on side effects resulting from the mask. Ten patients with SAHS with U3P (SAHS/U3P) who were already regular users of nasal CPAP were also given a four week trial of face mask CPAP to compare compliance and symptoms. Ten patients with SAHS were matched with the 10 SAHS/U3P patients for body mass index, age, apnoea/hypopnoea index, and CPAP pressure. Long term compliance was estimated one year after the mask comparison studies. RESULTS: For patients with SAHS nightly compliance was higher with a nose mask (mean (SE) 5.3 (0.4) hours/night CPAP) than with a face mask (4.3 (0.5) hours/night CPAP), p = 0.01 (mean difference 1.0 hour/night, 95% CI 1.8 to 0.3). Nose masks were rated more comfortable by 19 of 20 patients (p < 0.001) despite more mouth leak related symptoms. For SAHS/U3P patients compliance was marginally higher with nose masks (5.1 (0.7) hours/night CPAP) than with face masks (4.0 (0.8) hours/night CPAP), p = 0.07 (mean difference 1.1 hour/night, 95% CI 2.1 to 0.1). Nose masks were rated more comfortable by seven of 10 patients. There were no significant differences in side effect scores with face and nose masks. At one year nine of 10 SAHS patients and nine of 10 SAHS/U3P patients were still using CPAP. Compliance was 5.4 (0.6) hours/night for the SAHS patients and 3.5 (0.4) hours/night for the SAHS/U3P patients, p = 0.02 (mean difference 1.9 hour/night, 95% CI 3.6 to 0.3). CONCLUSIONS: Compliance is greater with nose mask CPAP than with face mask CPAP because the overall comfort is better and compensates for increased symptoms associated with mouth leakage. Improved face mask design is needed.

Double-Blind Method↗
PubMed1991

Acceptance of CPAP therapy for sleep apnea.

Although NCPAP is the most efficient nonsurgical treatment for patients with OSA, many patients do not accept sleeping with a nose mask. To determine the factors influencing acceptance, treatment with NCPAP was offered to 95 patients with an AHI greater than 15. After the first night on NCPAP, 47 of 65 patients decided to have NCPAP as a home therapy. Excessive daytime sleepiness was more frequently reported by acceptors than refusers. The frequency of complaints about psychomental symptoms such as poor mental performance and bad memory, was not different between the two groups. There was a close correlation between the rate of acceptance and the AHI as well as the number of positive answers to questions about symptoms of daytime sleepiness in a questionnaire, which correlated with the number and length of apneas. Acceptance of NCPAP was found to be dependent on the subjective feeling of impairment by hypersomnolence due to OSA.

Attitude to Health↗