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PubMed2003

Oral appliance therapy for snoring and sleep apnea: preliminary report on 86 patients fitted with an anterior mandibular positioning device, the Silencer.

There has been a great deal of interest recently in snoring and obstructive sleep apnea (OSA) by both dental and medical professions, as well as the media. Oral appliance therapy has been recognized by many sleep disorder specialists as the primary treatment of choice for snoring and mild to moderate OSA. Continuous positive airway pressure (CPAP) is the gold standard treatment for severe OSA, with oral appliance therapy reserved for CPAP failures. CPAP therapy has a compliance rate of 50 to 70%. The author has had experience with anterior mandibular positioning devices, in particular, Dr. Wayne Halstrom's Silencer for approximately 2 years. All patients are thoroughly investigated to include a polysomnogram (PSG) to assess the degree of snoring and OSA. Patients who are suitable candidates for oral appliance therapy are offered a temporary appliance with a follow-up PSG prior to fitting with the permanent appliance or initially with a more comfortable, custom-fitted permanent appliance. In either case, attempts are made to convince the patients of the necessity for a follow-up PSG to evaluate the efficacy of the device. The results, as well as potential harmful side effects and complications, are presented and are compared with the results of other recent studies.

Follow-Up Studies↗
PubMed1998

Obstructive sleep apnea: oral appliance therapy and severity of condition.

OBJECTIVE: The purpose of this study was to determine whether an oral appliance can effectively treat severe obstructive sleep apnea. DESIGN: The study was conducted at a tertiary care military facility with an accredited sleep laboratory. Results of the treatment of the first 25 patients with obstructive sleep apnea referred for oral appliance therapy were retrospectively analyzed. Each patient received a mandibular advancement appliance and underwent polysomnography 2 weeks after delivery of the appliance. Patients were divided into two groups: those with slight-to-mild obstructive sleep apnea who had a respiratory disturbance index less than 21, and those with more severe disease. Treatment was considered to be successful if the posttreatment respiratory disturbance index was less than 5. RESULTS: Nine (90%) of the 10 patients with slight-to-moderate disease were successfully managed with the oral appliance. Of the 15 patients in the moderate-to-severe group, 9 (60%) were successfully managed. CONCLUSION: Oral appliances have commonly been recommended only for mild obstructive sleep apnea. This study indicates that they may also have a role to play in selected cases in which the condition is more severe. There is a paucity of information about long-term success. This short-term (2-week) study should be followed by others evaluating the effect over longer periods.

Adult↗
PubMed1978

The effects of sleep deprivation on the circadian rhythm of plasma cortisol levels in depressive patients.

The circadian rhythm of plasma cortisol levels was studied in 20 endogenous depressive patients who received one-night sleep deprivation therapy and 10 normal controls who were also deprived of sleep together with patients by estimation at four-hourly intervals over 36 hours. The mean values at each sampling time were compared. The result can be summarized as follows: The mean values of depressive patients tended to be higher than those of controls on the day following sleep deprivation. In depressive patients the mean values on the following day were higher compared to those on the preceding day. In the patients who responded well to sleep deprivation therapy, the circadian variation of mean values which was obscure the preceding day showed an evident rhythm the following day. These findings suggest that sleep deprivation may cause a different effect between depressive patients and normal subjects, and that the possible mechanism of the anti-depressive efficacy of sleep deprivation may be to normalize the disturbed rhythm of the physiological function in depressive patients.

Adolescent↗
PubMed1999

[Sleep-phase-related home therapy in congenital central hypoventilation syndrome (CCHS)].

PATIENTS AND METHOD: Eight children with congenital central hypoventilation syndrome (CCHS) (aged 3 to 16 years) underwent repeated polysomnographic recordings (sleep-EEG, induction plethysmography, PtcO2, PtcCO2, PACO2, FO2, SaO2, ECG) during spontaneous breathing and during therapy. The result led to individual therapeutic plans. RESULT: During NREM sleep a close relationship between increasing EEG-delta-activity and increasing PCO2 could be observed (PCO2 max. 107 mm Hg in NREM IV). A similar effect was seen during mechanical ventilation with decreasing spontaneous respiratory activity during increasing sleep depth (PCO2 max. 89 mm Hg in NREM IV). Associated with NREM I/II and REM sleep strong variations in spontaneous breathing with consecutive variations of blood gases were observed. Hyperventilation during REM sleep (PCO2 min. 20 mm Hg) could occur with continuous mechanical ventilation. A continuous blood gas monitoring improved home therapy since blood gas adapted control of mechanical ventilation was possible now. This caused a stabilization of blood gases in sleep. CONCLUSION: Patients with CCHS show a vigilance-dependent, enlarged variability of blood gases which should be considered in the management of home therapy. Continuous monitoring and blood gas adapted mechanical ventilation obtain a stabilization of acid-base balance during sleep. Preliminary data suggest a positive effect on sleep-wake quality and mental performance.

Adolescent↗
PubMed1997

[Changes in the time spent awake in obstructive sleep apnea and snoring--results of a pilot study].

Continuous positive airway pressure (CPAP) therapy reduces sleeping time per day and daytime sleepiness in obstructive sleep apnoea (OSA) and heavy snoring. Due to sleep fragmentation the OSA and heavy snoring are associated with a daytime sleepiness and increased necessity of sleep. In this pilot study the effect of CPAP-therapy on daytime sleepiness and sleep time during 24 hours were assessed in patients with OSA or heavy snoring (daytime sleepiness, none or slight apnoea with AHI < 10/h and benefit of CPAP). We studies 42 patients with OSA (AHI: 34.5 +/- 23.6) and 15 patients with heavy snoring: inclusion criteria: Patients with OSA (AHI > 10/h, ESS-Score > 8) and heavy snoring (AHI < 10/h, ESS-Score > 8) who were treated with nCPAP. Before and 2 months after initiation the CPAP-therapy all patients completed diary cards recording the sleeping time/day for 1 month; additionally they scored sleepiness using the Epworth sleepiness scale (ESS-score ranged from 0 to 24, the higher the score the worse the sleepiness) before and 2 months after initiation the CPAP-therapy. In the whole study population nCPAP-therapy reduced the sleeping time significantly by a mean period of 46 minutes per 24 hours (from 8.3 +/- 1.3 to 7.5 +/- 1.2 hours, p < 0.001) and improved the ESS score from 13.7 +/- 4.6 to 6.1 +/- 3.6 (p < 0.0001). In respect of the change of sleeping time/day and of the sleepiness score there was no significant difference between the OSA and heavy snoring group. With CPAP the AHI in OSA patients was reduced from 34.5 +/- 23.6/h to 3.2 +/- 3.2/h. Due to the improvement of sleep-related breathing disorders CPAP therapy reduced the mean sleeping time/day by approximately 10% and the daytime sleepiness score both in patients with OSA and heavy snoring compared to the pretreatment period.

Airway Obstruction↗
PubMed2004

Effect of cognitive behavioural therapy for insomnia on sleep architecture and sleep EEG power spectra in psychophysiological insomnia.

There is now an overwhelming preponderance of evidence that cognitive behavioural therapy for insomnia (CBT-I) is effective, as effective as sedative hypnotics during acute treatment (4-8 weeks), and is more effective in long term (following treatment). Although the efficacy of CBT-I in the treatment of chronic insomnia is well known, however there is little objective data on the effects of CBT-I on sleep architecture and sleep EEG power densities. The present study evaluated, first, subjective change in sleep quality and quantity, and secondly the modifications occurring in polysomnography and EEG power densities during sleep after 8 weeks of CBT-I. Nine free drug patients with psychophysiological insomnia, aged 33-62 years (mean age 47 +/- 9.7 years), seven female and two male participated in the study. Self-report questionnaires were administered 1 week before and 1 week after CBT-I, a sleep diary was completed each day 1 week before CBT-I, during CBT-I and 1 week after CBT-I. Subjects underwent two consecutive polysomnographic nights before and after CBT-I. Spectral analysis was performed the second night following 16 h of controlled wakefulness. After CBT-I, only scales assessing insomnia were significantly decreased, stages 2, REM sleep and SWS durations were significantly increased. Slow wave activity (SWA) was increased and the SWA decay shortened, beta and sigma activity were reduced. In conclusion CBT-I improves both subjective and objective sleep quality of sleep. CBT-I may enhance sleep pressure and improve homeostatic sleep regulation.

Adult↗
PubMed1993

Adequacy of prescribing positive airway pressure therapy by mask for sleep apnea on the basis of a partial-night trial.

We tested the hypothesis that a prescription for positive-pressure therapy (including pressure level, patient-device interface, and positive-pressure modality, e.g., CPAP or BiPAP) for obstructive sleep apnea (OSA) can be developed on the same night as the polysomnographic (PSG) diagnosis is made. Fifty consecutive patients with OSA in whom a partial-night PSG diagnosis was made (PSGD) underwent a therapeutic trial of positive-pressure therapy during the remainder of the night (PSG-PPP). The average apnea index during PSGD was 54.96 +/- 36.3 (mean +/- SD). On a subsequent full-night PSG (PSG-PPF), the prescription was tested. Thirty-one of the 50 patients were satisfactorily treated with CPAP, without variation of the interface during both PSG-PPP and PSG-PPF. In these patients the average pressure prescription while receiving PSG-PPF was statistically higher than during PSG-PPP (11.77 +/- 3.6 versus 10.56 +/- 3.6 cm H2O, respectively, p = 0.002). In 14 of these 31 patients (45%) some alteration in pressure requirement was necessary during PSG-PPF. Eleven patients required 2.5 cm H2O higher pressure and three patients required 5 cm H2O higher pressure during PSG-PPF than during PSG-PPP. There was a change of interface across the two therapeutic trials in 15 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed2005

Combined total sleep deprivation and light therapy in the treatment of drug-resistant bipolar depression: acute response and long-term remission rates.

BACKGROUND: Drug resistance remains a persistent source of morbidity and mortality for patients with bipolar depression. A growing number of clinical studies support the usefulness of chronotherapeutic interventions, such as total sleep deprivation (TSD) and light therapy (LT), in the treatment of nonresistant bipolar depression. METHOD: To investigate the clinical usefulness of TSD plus LT in the treatment of drug-resistant bipolar depression, we treated 60 inpatients for 1 week with repeated TSD and LT combined with ongoing antidepressants and lithium salts. All patients had a DSM-IV diagnosis of bipolar I disorder. Drug resistance was rated according to Thase and Rush criteria. The pattern of relapses and recurrences was assessed during a prospective 9-month follow-up. Data were gathered from September 2002 to July 2004. RESULTS: A 2-way repeated-measures analysis of variance with changes in self-rated perceived mood scores as dependent variable and with time and group (history of drug resistance) as independent factors confirmed significant time-by-group interaction (p = .0339). A logistic regression on rates of achievement of response (50% reduction in Hamilton Rating Scale for Depression ratings) confirmed the significance of observed differences: overall, 70% (23/33) of nonresistant versus 44% (12/27) of drug-resistant patients achieved response (p = .045). A survival time analysis (Cox proportional hazards model) showed that history of drug resistance significantly influenced the pattern of relapses and recurrences, with 57% (13/23) of nonresistant responders and 17% (2/12) of drug-resistant responders being euthymic after 9 months (p = .0212). DISCUSSION: The combination of repeated TSD and LT in drug-resistant patients was useful in triggering an acute response. Further clinical research is needed to optimize this treatment option for drug-resistant patients in the long term.

Adult↗
PubMed2005

Sleeping beauty transposon-mediated gene therapy for prolonged expression.

The Sleeping Beauty (SB) transposon system represents a new vector for non-viral gene transfer that melds advantages of viruses and other forms of naked DNA transfer. The transposon itself is comprised of two inverted terminal repeats of about 340 base pairs each. The SB system directs precise transfer of specific constructs from a donor plasmid into a mammalian chromosome. The excision of the transposon from a donor plasmid and integration into a chromosomal site is mediated by Sleeping Beauty transposase, which can be delivered to cells vita its gene or its mRNA. As a result of its integration in chromosomes, and its lack of viral sequences that are often detected by poorly understood cellular defense mechanisms, a gene in a chromosomally integrated transposon can be expressed over the lifetime of a cell. SB transposons integrate nearly randomly into chromosomes at TA-dinucleotide base pairs although the sequences flanking the TAs can influence the probability of integration at a given site. Although random integration of vectors into human genomes is often thought to raise significant safety issues, evidence to date does not indicate that random insertions of SB transposons represent risks that are equal to those of viral vectors. Here we review the activities of the SB system in mice used as a model for human gene therapy, methods of delivery of the SB system, and its efficacy in ameliorating disorders that model human disease.

Animals↗
PubMed1989

Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure.

Nasal continuous positive airway pressure (CPAP) is an effective therapy for sleep apnea. We treated 144 patients with nasal CPAP and observed them for periods of as long as 25 months. No pneumothoraces occurred in any patient. Compliance rates were between 65% (90/139) and 83% (90/108), depending on the patient population considered. Demographic factors unrelated to discontinuing using CPAP included age, sex, and the presence of a housemate. Better-educated patients were less able to tolerate the equipment. Dry throat and nose and sore eyes were the most common side effects, but only sore eyes related to the amount of pressure. Side effects were unrelated to the number of months on the treatment, and obesity was related to higher pressures. Our study provides optimistic intermediate-term follow-up observations of patients on nasal CPAP therapy for sleep apnea. Whether adverse consequences occur over longer periods of time remains to be seen.

Adult↗
PubMed1989

[Long-term acceptance of nasal continuous positive airway pressure therapy in 70 patients with sleep apnea over a 6-month treatment period].

NCPAP therapy is considered to be an effective method of treatment in cases of obstructive and mixed sleep apnea (SA). We investigated its effectiveness during initiation of therapy, and the acceptance of the ambulatory long-term treatment. Here we present the first 70 patients (68 m, 2f) treated with nCPAP for at least six to a maximum of 20 months (on average: eleven months). Sixty-seven of the 70 patients were effectively treated with a nCPAP pressure of 5-15 mbar. The apnea index was reduced from 49 apnea episodes per hour (range 12-125) to 2 episodes per hour (range 0-8) on average. Therapy failed in one case (anatomical defect of the nasopharynx) and had to be abandoned in two cases (claustrophobia, acute rhinitis). Sixty-three patients, decided in favour of ambulatory long-term therapy. These patients were asked to complete a questionnaire about their experience with nCPAP. Four patients abandoned therapy (all within the first four weeks because of intolerance towards the apparatus), and one patient died 10 days after terminating treatment of an infection of the upper airway. Fifty-eight patients (82% of all) are still undergoing treatment. Eighty-eight per cent of these are using nCPAP for 5-7 nights a week throughout the entire sleep period, or at least for five hours. All patients report a marked reduction in or elimination of subjective symptoms. Mild local side effects occur quite frequently, but can be greatly reduced or eliminated in most cases. In individual cases they lead to a shortening of the nocturnal duration of application.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗