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At least 613 records · Page 34Linked to original sources
PubMed2002

Impaired vasodilator responses in obstructive sleep apnea are improved with continuous positive airway pressure therapy.

Obstructive sleep apnea causes cardiovascular morbidity and premature death. Potential links between sleep apnea and cardiovascular complications are chronically elevated activity of the sympathetic nervous system and abnormal vascular function. To explore vascular function, we determined the reactive hyperemic blood flow (RHBF) responses to 10 minutes of forearm arterial occlusion (plethysmography), blood pressure, and muscle sympathetic nerve activity (MSNA, microneurography) in eight patients with sleep apnea and in nine nonapneic control subjects. Peak RHBF and vascular conductance were markedly attenuated in sleep apnea compared with control subjects (p < 0.05). Seven sleep apnea patients were retested after at least two weeks of continuous positive airway pressure (CPAP) therapy. MSNA decreased after CPAP therapy (p < 0.05, n = 6), whereas blood pressure did not change. After CPAP therapy, peak RHBF and vascular conductance were increased compared with before treatment (p < 0.05; n = 7). Thus, vascular function is abnormal in sleep apnea and is improved by CPAP therapy. Furthermore, effective CPAP therapy decreases sympathetic activity in sleep apnea. Thus, sympathoexcitation and abnormal vascular function in patients with sleep apnea appear to be linked to the repetitive nocturnal apneic events.

Adult↗
PubMed2004

Linking race and well-being within a biopsychosocial framework: variation in subjective sleep quality in two racially diverse older adult samples.

Differential life experiences associated with race may critically affect the balance between physical and psychological well-being. This study investigated an age-related and disease-related symptom, restless sleep, among older African American and white members of two sociodemographically matched cohorts, community-dwelling older adults and older adults with chronic renal failure undergoing maintenance dialysis therapy. Sleep behaviors reflect age-dependent and disease-dependent homeostatic and circadian state regulation but are also socioculturally patterned. As hypothesized, restless sleep was significantly more characteristic of the older adults in the chronic disease cohort. With non-renal health conditions, depressed mood, perceived health, medication use, and sociodemographic variables controlled, however, African Americans were significantly less likely than whites in the chronic disease cohort to report restless sleep. African American and white patients differed in their expression of public and private religiousness, which in turn were associated, respectively, with depressed mood and restless sleep complaint. In addition, we suggest that differences for African American and white patients in the environmental exposure of chronic dialysis therapy, including African Americans' greater social integration within the dialysis treatment setting, contributed to their being less at risk than their white peers for subjective perception of sleep decay, a marker of overall well-being.

Black or African American↗
PubMed1984

[Sleep disorders. 2: Specific recommendations for ambulatory drug therapy].

Most sleep disturbances (burring those occurring in the scope of acute psychoses) can be treated ambulatory. In chronic and syndromatic sleep disturbances it is recommended to carry out an intensive (cure type) therapy with i.v. infusions. After 10-20 infusions (antidepressants, neuroleptics, tranquilizers), slowly a transfer is made to peroral treatment where the preparations are incrementally lowered and withdrawn (to prevent rebound phenomena). An acceptable hypnoticum finalizers treatment. Numerous alternative therapy plans are explained.

Ambulatory Care↗
PubMed1998

[Therapeutic outline of sleep disorders].

The more sleep disorders become chronic, the more they become resistible for the treatments. Therefore, it is most important that physicians establish the good relationship with patients and correctly diagnose and treat patients who have acute or transient sleep complaints. Physicians can improve patients' quality of life by evaluation of disease, supportive psychotherapy which include Morita therapy and behavior therapy, sleep hygine advice, and appropriate medications. In all patients, it is necessary for physicians to be aware of the physical, psychological and pharmacological factors, social aspects, and environmental factors of patients, because all these factors play an important role in appearance of sleep disorders.

Anti-Anxiety Agents↗
PubMed2006

Oropharyngeal collapse predicts treatment response with oral appliance therapy in obstructive sleep apnea.

STUDY OBJECTIVES: To examine whether primary oropharyngeal collapse of the upper airway during sleep predicts treatment success with oral appliance therapy in patients with obstructive sleep apnea. DESIGN: Prospective physiologic study. SETTING: Multidisciplinary sleep disorders clinic in a university teaching hospital. PATIENTS: Twelve treatment-naïve adult patients with obstructive sleep apnea (apnea-hypopnea index > or = 10/h and at least 2 of the following symptoms: snoring, fragmented sleep, witnessed apneas, or daytime sleepiness). INTERVENTION: Custom-made mandibular advancement splint (MAS). MEASUREMENTS AND RESULTS: A baseline diagnostic polysomnogram confirmed AHI > or = 10 per hour. During the following acclimatization period, a custom-made adjustable MAS was incrementally advanced until maximum comfortable mandibular protrusion was reached. A second polysomnogram with MAS in situ determined efficacy. Following a 1-week washout period, a final sleep study was performed using multisensor catheters (with and without MAS, in random order during the same night) to determine upper-airway closing pressures and the site or sites of upper-airway collapse. MAS resulted in significant improvements, mean +/- SEM, in AHI (22.0 +/- 2.6 vs 9.2 +/- 1.9/h, p < .01) and upper-airway closing pressures during stage 2 non-rapid eye movement sleep (-1.1 +/- 0.3 vs -2.8 +/- 0.5 cm H2O, p < .01). All 4 patients with primary oropharyngeal collapse achieved an AHI < 5 per hour. Only 1 of the 8 patients with primary velopharyngeal collapse achieved an AHI < 5 per hour. Oropharyngeal collapse, compared with velopharyngeal collapse, predicted treatment success with MAS (p < .02). CONCLUSIONS: These preliminary data suggest that primary oropharyngeal collapse of the upper airway during sleep is an important predictor of treatment outcome with MAS therapy.

Adult↗
PubMed2006

Pharmacotherapy for disordered sleep in post-traumatic stress disorder: a systematic review.

Sleep disorders, such as insomnia and nightmares, are common problems in post-traumatic stress disorder (PTSD), exert a strong negative influence on the quality of life and are a great challenge for clinical psychiatry. Several studies have reported on the efficacy of drugs for the treatment of PTSD-related sleep disorders. These studies have not been systematically reviewed. This is the first review on the effectiveness of sleep medication in PTSD. We performed a Medline, EMBASE and Cochrane Library Indexed search, using the keywords: PTSD, pharmacotherapy, therapy, sleep, nightmares, insomnia and review. From this database, English-language, human subject, data driven papers published after 1980 were selected. Forty eight articles are discussed. Open-label and case studies suggest efficacy for some antidepressants, anticonvulsants and atypical antipsychotics. Only a few placebo-controlled studies have been published. They show promising results for the atypical antipsychotic olanzapine, and the alpha1-adrenoceptor antagonist prazosin. In comparison to the incidence and impact of sleep complaints in PTSD, the pharmacotherapeutic armamentarium for PTSD-related sleep complaints remains poorly investigated. Some recent studies show promising results, especially for alpha1-adrenoceptor and 5-HT2 receptor antagonists. However, randomized controlled trials with larger populations need to be conducted.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1997

Bed partners' assessment of nasal continuous positive airway pressure therapy in obstructive sleep apnea.

STUDY OBJECTIVE: This study aimed to evaluate the effects of nasal continuous positive airway pressure (nCPAP) therapy on sleep and daytime symptoms of bed partners and patients with obstructive sleep apnea (OSA). DESIGN: A cross-sectional questionnaire survey. SETTING: The sleep laboratory of a university teaching hospital. PATIENTS: Ninety-one consecutive OSA patients within 2 to 12 months of being prescribed nCPAP. RESULTS: Eighty-five replies (93% of sample population) were received. Twelve patients (14% of replies) had discontinued nCPAP therapy; two patients had not yet been supplied with an nCPAP device. Seventy-one patients continued nightly nCPAP therapy. Bed partners of these patients (n = 55) answered a separate questionnaire assessing improvements in their own sleep quality, daytime alertness, mood and quality of life (questions 1 to 4), and evaluated the same parameters for the patients (questions 5 to 8). Possible scores ranged from -1 (worse) to +3 (marked improvement). Questions 1 to 4 yielded median scores of 2, 1, 1, and 2, respectively, and scores of 3, 3, 2, and 3 for questions 5 to 8. A ninth question addressing perceived changes in the quality of their relationship resulted in a median score of 2. Mean (SD) Epworth sleepiness scores improved from 14.3 (5.8) to 5.2 (4.3) in patients receiving therapy (p < 0.005). CONCLUSIONS: These data indicate that bed partners of OSA patients treated with nCPAP experience important improvements in symptoms and personal relationships. The findings are of practical clinical use when counseling patients with OSA and their partners on the likely impact of nCPAP therapy on their quality of life.

Affect↗
PubMed2004

[A trial of titration in oral appliance therapy for obstructive sleep apnea syndrome].

This study evaluated the effect of titration in oral appliance therapy for obstructive sleep apnea syndrome (OSAS), and examined problems with this test. However, the method of predicting the appropriate mandible position has not yet been established. In this study, titration was attempted in order to predict appropriate mandible position prior to wearing an oral appliance. Twenty-three male patients diagnosed as OSAS by a physician participated in this study. The mandible was protruded by a titratable splint (TS) until apneic and hypopneic signs had disappeared. Moreover, polisomnography (PSG) was used to monitor brain wave patterns, eye movement, muscle tone, body movement and breathing. Sleep study was performed by a portable sleep monitoring device before and after examination wearing titrated oral appliance (OA), and the effect of therapy was evaluated. The results obtained were as follows. 1. In the Apnea Hypopnea Index (AHI), Apnea Hypopnea density (AH density), lowest SpO2, Oxygen Desaturation Index (ODI), there was a statistically significant improvement. The mean AHI reduced from 13.8 to 4.7 (p<0.001). The mean AH density reduced from 12.0 to 3.5 (p<0.001). The mean lowest SpO2 increased from 78.7 to 84.7 (p<0.0001). The mean ODI reduced from 15.7 to 6.1 (p<0.001). 2.. The average proportion of protrusive distance for movable distance was 71.7%. 3. Only one patient complained of discomfort in the maxillofacial region, however, this discomfort disappeared after adjustment of OA. Therefore, it is suggested that titration for OA is a very useful examination for OSAS therapy.

Adult↗
PubMed2000

An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults.

We compared the efficacy of sleep restriction therapy combined with sleep hygiene, nap modification of sleep restriction therapy combined with sleep hygiene, and sleep hygiene alone as treatments for insomnia in 39 community-dwelling men and women 55 years and older. We used the wrist actigraph as an objective outcome measure for all subjects at baseline, end of treatment, and 3-month follow-up; polysomnography (PSG) was conducted in a subgroup of subjects. Although subjects appeared to follow restriction instructions through follow-up, we found few between-group differences in treatment efficacy. Lack of treatment effect might be explained by the efficacy of HYG as a treatment in itself and the relatively low symptom level in these healthy older poor sleepers. At baseline, actigraphic results were found to correlate more highly than sleep log data with PSG in our sample. Actigraphic total sleep time, in particular, was highly correlated with PSG.

Adult↗
PubMed2006

Sleep and aggression in substance-abusing adolescents: results from an integrative behavioral sleep-treatment pilot program.

STUDY OBJECTIVE: To examine whether change in total sleep time during an integrative, behavioral sleep intervention is associated with aggression. Specifically, we tested whether adolescents who reported experiencing aggressive thoughts or actions after treatment had worse treatment trajectories (e.g., less total sleep time across treatment) than adolescents with no aggressive thoughts or actions after treatment. DESIGN: Nonpharmacologic open trial with 9 weeks of weekly assessment. SETTING: University of Arizona Sleep Research Laboratory PATIENTS OR PARTICIPANTS: Twenty-three adolescents recently treated for substance abuse in outpatient community centers. INTERVENTIONS: Six-week integrative, behavioral sleep intervention. MEASUREMENTS AND RESULTS: Weekly sleep-summary indexes were calculated from daily sleep diaries and entered as dependent variables in a series of growth-curve analyses. Statistically significant Session x Post-treatment Aggressive Ideation interactions emerged when predicting changes in total sleep time, gamma13 = 9.76 (SE = 4.12), p < .05, and time spent in bed, gamma13 = 10.08, (SE = 4.33), p < .05, even after controlling for aggressive ideation and the frequency of substance use, as assessed at baseline. A similar pattern of results was seen for self-reported aggressive actions occurring during conflicts. CONCLUSIONS: These pilot data suggest that inadequate sleep in substance-abusing adolescents may contribute to the experiencing of aggressive thoughts and actions. Limitations include a small sample size and a restricted assessment of aggression. Nonetheless, these findings lend preliminary support to the breadth of therapeutic effectiveness of an integrative, behavioral sleep-therapy program for adolescents with a history of substance abuse and related behaviors.

Adolescent↗
PubMed2006

[The effect of the combined therapy on obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To study the effect of the combined therapy on obstructive sleep apnea hypopnea syndrome (OSAHS) with radiofrequency ablation (RFA) and oral appliance (OA), and to evaluate the side effect of oral appliances. METHOD: Twenty one cases with OSAHS were selected to receive radiofrequency ablation or/and to wear oral appliance according to obstructive site. Polysomnography (PSG) was used before and after 3 months of treatment to evaluate the therapeutic effect. We analyzed the lateral cephalogram and dental casts before initiating treatment and after 14 - 24 months of treatment. RESULT: PSG studies confirmed improved breathing parameters with the combined therapy. No skeletal changes in the position of the mandible were noted, a alteration in the occlusion was found for lifelong OSAHS treatment with an OA. CONCLUSION: This combined therapy is effective for OSAHS, regular dental follow up visits are necessary when lifelong OSAHS treatment with an OA is being considered for patients with OSAHS.

Adult↗
PubMedDate not supplied

Sleep apnoea. Laser therapy for OSAS.

The standard treatments for obstructive sleep apnoea syndrome (OSAS) to date have been postural treatment, which involves the patient sleeping on the stomach; continuous positive airway pressure, using a nasal mask during the night to maintain a positive pressure to prevent collapse of the airway; and surgical uvolopalatopharyngoplasty (UPPP). This is a radical surgical procedure where the soft palate and uvula are excised. There are drawbacks to all of these procedures, either because patients may regard as unacceptable the position they must maintain in bed or the equipment required to be worn or because of surgical complications. This paper describes an alternative method of treatment that has shown good results and is less disturbing to the patient: laser resection of the palatopharynx. This procedure is relatively new to the UK and not as yet widely accepted by many doctors, although it has been performed on the continent for a number of years with documented results.

Humans↗
PubMed1999

Cancer-related fatigue: guidelines for evaluation and management.

Fatigue is a highly prevalent condition among cancer patients. Although most cancer patients report that fatigue is a major obstacle to maintaining normal daily activities and quality of life, it is seldom assessed and treated in clinical practice. Few studies have explored its epidemiology, possible etiologies, or management. Cancer-related fatigue, which recently was accepted as a diagnosis in the International Classification of Diseases 10th Revision-Clinical Modification, reduces physical, psychological, and social functioning and results in significant distress for patients and caregivers. Adequate evaluation of fatigue must do more than simply assess severity. The assessment should clarify other characteristics, determine the degree to which fatigue interferes with the activities of daily living, and identify potential causes, including the underlying disease, disease treatments, intercurrent systemic disorders, psychological disorders, and other conditions. Possible primary therapies include modification of the patient's drug regimen, correction of metabolic abnormalities, and pharmacologic treatments for anemia (e.g., epoetin alfa), depression, or insomnia. Other symptomatic interventions include specific drug treatments, exercise, modification of activity and rest patterns, cognitive therapies, sleep hygiene approaches, and nutritional support. Pharmacologic approaches, which are supported by limited studies and growing clinical experience, include psychostimulant drugs, corticosteroids, and possibly other therapies. Although additional research is needed to further identify the causes and corresponding treatment of fatigue, practitioners should routinely assess and treat patients who may benefit from currently identified interventions, because fatigue can profoundly undermine the quality of life of patients with cancer.

Depression↗
PubMed1983

The diagnostic value of the sleep EEG with and without sleep deprivation in patients with atypical absences.

Hitherto it has not been known whether or not the sleep EEG after sleep deprivation is more effective than the simple or drug-induced sleep EEG. To investigate this, we recorded for 32 patients both sleep EEGs without sleep deprivation and, on the following day, sleep EEGs after 24 h of sleep deprivation. All the patients had atypical absences which were almost exclusively combined with generalized seizures or some other seizure types. All patients were receiving antiepileptic therapy. Sleep without sleep deprivation was induced by oral administration of 2 mg/kg body weight Protactyl (promazine hydrochloride). In patients showing no epileptic activity in the routine EEG, epileptic discharges could be provoked in 78% without sleep deprivation and in 72% after sleep deprivation. Epileptic activity was already seen in 28.1% of the cases in the awake EEG without sleep deprivation, recorded immediately before the sleep EEG, and in 50% of the cases in the awake EEG after sleep deprivation. It is unlikely that promazine hydrochloride in the dose used here has an additional inherent provocative effect. Generalized spike-and-wave complexes or sharp slow wave complexes which were combined twice with foci and runs of rapid spikes were recorded. In the sleep EEG without sleep deprivation, epileptic discharges were seen in the somewhat shallower stages (C leads to A leads to B leads to D) and, in the sleep EEG after sleep deprivation, in the somewhat deeper stages (D leads to C leads to B leads to A). Fewer epileptic discharges were elicited in patients who were older at the time of their first seizure. The illness was mild in patients whose sleep EEGs showed no epileptic activity. It is concluded that, as a rule, it is not necessary to record an EEG after sleep deprivation in patients with atypical absences whose routine EEGs show no epileptic activity; the drug-induced sleep EEG shows the same provocative effect.

Adolescent↗
PubMed1990

Testosterone replacement therapy and sleep-related erections in hypogonadal men.

Hypogonadal men usually have diminished libido and erectile dysfunction, and testosterone replacement therapy in these men increases sexual activity, erotic thoughts, and self-reported nocturnal erections. The polygraphic assessment of nocturnal penile tumescence (NPT) provides an objective index of erectile capability and is useful for differentiating psychogenic from organic erectile dysfunction. In this study we evaluated NPT in six hypogonadal adult men during and after termination of androgen therapy. Multinight sleep studies were conducted within 1 week and 7-8 weeks after each man received 20 mg testosterone cypionate, im. The mean serum testosterone level 4-7 days after testosterone injection was 35.9 +/- 3.4 (+/- SE) nmol/L, and it fell to 2.3 +/- 0.9 nmol/L after 7-8 weeks. Significant declines (P less than 0.05) in the number of NPT episodes (3.7 to 2.0), maximum penile circumference increase (24 to 13 mm), and total tumescence time (107 to 55 min) accompanied the fall in the serum testosterone level. No androgen-related changes in the amount or integrity of rapid eye movement sleep were found. Finally, the mean penile rigidity (buckling pressure) decreased from 770 +/- 98 to 590 +/- 81 g (P less than 0.05). Comparison of these results to those in normal men revealed that none of these men met all diagnostic criteria for organic impotence, even 7-8 weeks after discontinuation of testosterone administration. While men with androgen deficiency may have normal NPT, sleep-related erections increase in response to testosterone administration.

Adult↗
PubMed2005

Effectiveness of short-term treatment with nocturnal oxygen therapy for central sleep apnea in patients with congestive heart failure.

OBJECTIVES: To evaluate the short term effects of inhalation of oxygen at night in 51 patients with congestive heart failure (CHF) and sleep apnea syndrome (SAS). METHODS: Fifty-one patients with stable CHF (31 males, 20 females, mean age 79.0 +/- 11.9 years; brain natriuretic peptide level of > 100 pg/ml) were evaluated between September 2003 and August 2004, using a Morpheus monitor. The complication rate of SAS in patients with CHF was assessed and apnea hypopnea index, oxygen desaturation index 3%, heart rate, and autonomic nerve activity under room air compared to supplemental O2 (2 l/min) over two consecutive nights. RESULTS: Thirty-eight (75%)of the CHF patients had SAS. Of these SAS patients, 49% suffered from central SAS and 51% had obstructive SAS. Apnea hypopnea index and oxygen desaturation index 3% improved remarkably with supplemental oxygen (p < 0.001), in particular, the central SAS group demonstrated prominent improvement (p < 0.001). Obstructive SAS patients exhibited no significant changes (p = 0.3356), but tended to exacerbate the episodes of sleep apnea. Total heart rate was decreased (p = 0.0079). Nevertheless, heart rate variability analysis showed little effect of nocturnal oxygen therapy on the autonomic nervous system during sleeping. CONCLUSIONS: Nocturnal oxygen therapy improved the number of sleep apnea episodes and decreased total heart rate during sleep time for the CHF patients with central SAS, despite little influence on the autonomic nervous system, based upon assessment of heart rate variability. Obstructive SAS might exacerbate the episodes of sleep apnea.

Aged↗
PubMed2005

Dental therapy for obstructive sleep apnea.

This article reviews the history of dental therapy as it has led up to currently available options for the treatment of sleep-related breathing disorders with an emphasis on oral appliance therapy. Over the last 20 years and in particular the last 5 to 7 years the contribution as well as the effectiveness of oral appliances has impacted the treatment of sleep apnea and at the same time provides an alternative for many patients. The focus here is to examine oral appliances and the role they have as it may be delivered by the dentist with an interest as well as the expertise in dental sleep medicine.

Contraindications↗