[Potential for the differential correction of night sleep structure by acupuncture therapy].
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Acupuncture Therapy↗
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Results for “SLEEP THERAPY”
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[The diagnostic significance of sleep after sleep deprivation under antiepileptic therapy (author's transl].
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Adolescent↗
A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults.
This study compared Sleep Restriction Therapy (SRT) and Relaxation Therapy (RLT) as treatments for insomnia in a sample of community-residing elderly (mean age, 69.7 years). SRT subjects (n = 10) and RLT subjects (n = 12) reported information about their sleep twice daily to a telephone recording machine for 2 weeks of baseline, 4 weeks of treatment, and 2 weeks at 3-month follow-up. Results showed sleep latency and waking after sleep onset were significantly reduced for both treatment groups under active treatment. Predictable reductions in time in bed and improved sleep efficiency reported during active treatment by SRT subjects were still apparent at 3-month follow-up; no corresponding changes were found for RLT. In both groups, increased total sleep time was reported at follow-up; the improvement for SRT subjects was approximately twice that seen in RLT. These findings, at this early stage in the development of behavioral treatments for insomnia in older adults, encourage further study.
Aged↗
[Effect of the central nervous system on chemotherapy. I. Effect of drug-induced sleep on evolution and therapy of experimental trypanosomiasis in rats].
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Animals↗
[A case of primary alveolar hypoventilation syndrome with a good response to nocturnal low-flow oxygen inhalation and negative pressure ventilation].
A 34-year-old female was admitted on June 25, 1990, for the evaluation of alveolar hypoventilation which worsened after her second delivery. She showed impairment of both hypercapnic and hypoxic ventilatory responses, and marked desaturation due to hypopnea and apnea during sleep. Although administration of methylxanthine and medroxyprogesterone was not very effective, after treatment with low flow oxygen, there was a marked decrease in the frequency and duration of desaturation during sleep and improvement of arterial daytime blood gases, which suggested the existence of hypoxic ventilatory depression in the pathophysiology of her nocturnal desaturation. Furthermore, the use of a negative pressure ventilator for 3 hours in the daytime for 10 days resulted in marked improvement of symptoms, arterial blood gases, respiratory muscle strength, and the frequency and duration of sleep desaturation. These findings suggest that both low flow oxygen therapy during sleep, and daytime negative pressure ventilation may be beneficial in patients with primary alveolar hypoventilation and central sleep apnea syndrome.
Adult↗
[Modification of cardiopulmonary performance parameters in patients with obstructive sleep apnea treated with nCPAP therapy].
nCPAP influences cardiopulmonary hemodynamic function in patients with obstructive sleep apnea (OSA). It is known that systolic function of the right and left ventricle, systemic and pulmonary hypertension, arterial blood gases and lung function during the day may improve under this treatment. We prospectively followed 30 patients with severe OSA and determined diastolic left ventricular function (Doppler echocardiography), cardiovascular efficiency (steady state exercise stress testing); and individual assessment of performance (standardized psychometric questionnaire) before, and 2 weeks and 6 months after initiation of nCPAP treatment. The following results could be obtained (first value after 2 weeks, second value after 6 months): Doppler echocardiography: E/A rose by 9.3% (p < 0.05) and another 0.5% (n.s.). E/A integral increased by 13.8% (p < 0.01) and another 3.5% (n.s.). Deceleration period decreased by 22.7% (p < 0.01) and another 3.1% (n.s.). Steady state exercise stress testing: Maximum performance rose by 10% (p < 0.05) and another 17.5% (p < 0.01). Heart rate ratio 100 W/rest dropped by 13.5% (p < 0.001) and another 6.5% (p < 0.01), systolic blood pressure ratio 100 W/rest by 0.8% (n.s.) and another 14.9% (p < 0.001). Diastolic blood pressure ratio 100 W/rest did not change significantly. Questionnaire: Assessment of well-being increased by 44.5% (p < 0.05) and another 16.9% (n.s.). After an initial drop of 0.8% (n.s.), quality of life increased by 14.9% (p < 0.05). Assessment of performance rose by 21.7% (p < 0.05) and another 4.1% (n.s.). nCPAP therapy in patients with OSA improves diastolic function of the left ventricle, cardiovascular performance and individual assessment of performance.
Adult↗
Oral Appliance Therapy for the Management of Sleep Disordered Breathing: An Overview.
A burgeoning new arena in healthcare has opened to dental professionals with the potential to relieve the suffering of millions of people worldwide. Qualified dentists are increasingly being called upon to interface with the medical profession in an effort to manage the unstable upper airway during sleep. What has come to be called "oral appliance therapy" (OAT) involves the coordinated efforts of sleep physicians and the newly recognized sleep disorders dentist.
Journal Article↗
Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia.
OBJECTIVE: Although four meta-analytic reviews support the efficacy of pharmacotherapy and behavior therapy for the treatment of insomnia, no meta-analysis has evaluated whether these treatment modalities yield comparable outcomes during acute treatment. The authors conducted a quantitative review of the literature on the outcome of the two treatments to compare the short-term efficacy of pharmacotherapy and behavioral therapy in primary insomnia. METHOD: They identified studies from 1966 through 2000 using MEDLINE, psycINFO, and bibliographies. Investigations were limited to studies using prospective measures and within-subject designs to assess the efficacy of benzodiazepines or benzodiazepine receptor agonists or behavioral treatments for primary insomnia. Benzodiazepine receptor agonists included zolpidem, zopiclone, and zaleplon. Behavioral treatments included stimulus control and sleep restriction therapies. Twenty-one studies summarizing outcomes for 470 subjects met inclusion criteria. RESULTS: Weighted effect sizes for subjective measures of sleep latency, number of awakenings, wake time after sleep onset, total sleep time, and sleep quality before and after treatment were moderate to large. There were no differences in magnitude between pharmacological and behavioral treatments in any measures except latency to sleep onset. Behavior therapy resulted in a greater reduction in sleep latency than pharmacotherapy. CONCLUSIONS: Overall, behavior therapy and pharmacotherapy produce similar short-term treatment outcomes in primary insomnia.
Anti-Anxiety Agents↗
Sleeping Beauty-based gene therapy with indoleamine 2,3-dioxygenase inhibits lung allograft fibrosis.
Sleeping Beauty (SB) transposon is a natural nonviral gene transfer system that can mediate long-term transgene expression. Its potential utility in treating organ transplantation-associated long-term complications has not yet been explored. In the present study we generated an improved SB transposon encoding the human gene indoleamine-2,3-dioxygenase (hIDO), an enzyme that possesses both T cell-suppressive and antioxidant properties and selectively delivered the SB transposon in combination with a hyperactive transposase plasmid to donor lung using the cationic polymer polyethylenimine (PEI) as transfection reagent. This nonviral gene therapeutic approach led to persistent and uniform transgene expression in the rat lung tissue without noticeable toxicity and inflammation. Importantly, IDO activity produced by hIDO transgene showed a remarkable therapeutic response, as evident by near normal pulmonary function (peak airway pressure and oxygenation), histological appearance, and reduced collagen content in lung allografts. In addition, we established a hIDO-overexpressing type II cell line using the SB-based gene transfer system and found that hIDO-overexpressing lung cells effectively inhibited transforming growth factor-beta-stimulated fibroblast proliferation in vitro. In summary, the SB-based gene therapy with hIDO represents a new strategy for treating lung transplantation-associated chronic complications, e.g., obliterative bronchiolitis.
Animals↗
Case series utilizing exposure, relaxation, and rescripting therapy: impact on nightmares, sleep quality, and psychological distress.
Experiencing a traumatic event may initiate or exacerbate the occurrence of nightmares. Nightmares may impact sleep quality and quantity, posttraumatic stress symptoms, and depression. Recently, imagery rehearsal has gained attention in the treatment of trauma-related nightmares and is reported to be promising in the reduction of nightmares. On the basis of the vast literature describing the therapeutic benefits of exposure techniques for anxiety-related problems, the treatment was modified to enhance the exposure component. This article presents a case series using this modified version of imagery rehearsal, Exposure, Relaxation, and Rescripting Therapy, with 1 male and 3 female participants. Overall, the participants treated reported a reduction in nightmare frequency and severity; 3 out of 4 participants also reported a reduction in posttraumatic stress and depression symptomotology and an increase in sleep quality and quantity. Clinical implications and future research directions are discussed.
Adaptation, Psychological↗
[The antidepressant viloxazin. A multicenter study under practice conditions].
As part of an open multicentre study involving 22 psychiatric clinics 212 patients with depressive symptoms (predominantly endogenous depression) were treated over one month with viloxazine. The drug was administered either alone or- if it seemed clinically necessary--in combination with minor or major tranquilizers. Overall, the depressive symptoms improved in 77% of the cases (10-20% total remissions) of both endogenous and reactive depression. Depressive mood, anxiety and reduced activity were the symptoms which responded best to therapy. In sleep disturbances, psychomotor and internal unrest combination therapy with minor or major tranquilizers was superior to viloxazine given alone.
Adjustment Disorders↗
[Compliance with continuous positive airway pressure therapy in patients with sleep apnea/hypopnea syndrome].
Predictive factors and compliance level were evaluated in a group of patients with sleep apnea syndrome under CPAP treatment, assessing side effects and equipment condition: silicone interface (SI), mask-conectors (M-C), air tube (AT) and head strap (HS). Patients with >3mo treatment were included, clock counter reading was registered at the beginning, 2 and 4 mo. Patients were considered compliant (C+) when usage was >4h/day and >5day/week. Of 46 patients (male 34; age 62 +/- 9years; BMI 33 +/- 7kg/m2; AHI 38 +/- 18/h; time of therapy 2.1 +/- 1.7years; CPAP 9 +/- 1.4 cmH2O), 34 had a clock counter and 24 (71%) were C+. Initial symptoms included: somnolence (65%), snoring (39%), bed-partner witnessed apneas (28%). Comparing C+ and C- we didn't find significant difference in age, BMI, CPAP pressure, length of therapy, AHI and pre-treatment Epworth classification. Referred vs. measured time of use in C+ and C- were 6.6 +/- 1 vs. 6.1 +/- 1 h/d (p=0.02) and 5.6 +/- 1 vs. 2.4 +/- 1 h/d (p<0.005). Compliant patients reported more resolution of somnolence (p<0.005) and nocturia (p<0.05), lower post CPAP Epworth (p<0.05), more frequent somnolence as initial symptom (p<0.05) and a higher education level (p=0.01). Side effects (SE) (n=45): dry mouth 36%, nasal congestion 27%, sleep disruption 11%, CPAP noisy 9%, dry nose, rhinorrhea and skin irritation 7%. Twenty seven percent of patients reduced the CPAP use because of the SE. Correction strategies included: humidifier, nasal steroid, surgery or infiltration of turbinates. Comparing the condition of SI, M-C, AT and HS between < or =1 vs. >1year of use, we observed a lower percentage of fine elements (87 to 44%, 74 to 44%, 83 to 44%, 91 to 78%, respectively). Most common defects included stiffness of SI, cracks in SI, M-C and AT, loose conexions. The study confirms the importance of objective monitoring in patients with CPAP. Side effects and equipment condition require special attention because this could affect an effective treatment.
Aged↗
[Intra-oral therapy of borderline sleep-related respiratory disorders with a modified protrusion-fixation of the mandible].
BACKGROUND: Aim of this study was the investigation of the efficacy and acceptance by mechanic-prosthetic mandibular protrusion for patients with mild to moderate OSAS. METHODS AND PATIENTS: During interdisciplinary teamwork between pneumology (sleep medicine) and dentistry we studied the change in the apnoea-index (AI) of 21 unselected patients treated with a modified oral appliance according to Lyon using less protrusion of the mandible and individual occlusion of the jaws. All patients were asked to rate their complaint-score using the oral appliance. RESULTS: 21 patients--aged 55.03 +/- 9.71 years; body mass index (BMI) 28.6 +/- 2.4 kg/m2 (mean value +/- SD)--had an improvement of apnoea-index (1/h) high significant (p < 0.0005). (Al before therapy 15.25 +/- 6.6; Al with therapy 6.07 +/- 3.7). Using a validated ambulatory respiratory evaluation device we saw an improvement in the Al of 57% +/- 19% during the estimated sleeptime of 6 h 12 min +/- 30 min. After a wearing-time of about 6 months the low complaint-score of the patients verified the high acceptance and efficacy of the modified oral appliance. CONCLUSION: The modified oral appliance of Lyon can improve disease severity, life- and sleep-quality of patients with mild to moderate OSAS. Engaged teamwork of sleep medicine and dentistry is necessary to take care of a very individual and carefully fixation and occlusion of the mandible, resulting a continuing compliance and efficacy for the patients.
Adult↗
A brief behavioral sleep intervention for family caregivers of persons with cancer.
Behavioral interventions that support caregivers' restful sleep may delay the onset or decrease the severity of debilitating depressive symptoms. This, in turn, may increase caregivers' physical and psychological health and wellbeing. A repeated-measures experimental design was used to test the feasibility and effectiveness of a brief behavioral sleep intervention for family caregivers of persons with advanced stage cancer. The CAregiver Sleep Intervention (CASI) includes stimulus control, relaxation, cognitive therapy, and sleep hygiene elements. CASI is individualized and delivered to accommodate caregiver burden. Thirty adult caregivers participated. The Pittsburgh Sleep Quality Index (PSQI), Center for Epidemiological Studies-Depression scale (CES-D), and Caregiver Quality of Life-Cancer scale (CQOLC) were used to measure self-reported sleep quality, depressive symptoms, and quality of life. Actigraphs measured latency, duration, efficiency, and wake after sleep onset (WASO) scores. Data were collected at baseline, 3 and 5 weeks, 2, 3, and 4 months post baseline. Improvement was seen across groups; however, intervention caregivers showed more improvement in PSQI and CES-D scores than control caregivers. The CASI appears to be effective in improving sleep quality and depressive symptoms in caregivers of persons with cancer. Improvements in quality of life scores were similar across groups. Sample size and homogeneity limit generalizability.
Adult↗
Sleep in late-life recurrent depression. Changes during early continuation therapy with nortriptyline.
The sleep of thirty elderly patients with recurrent unipolar depression was examined at baseline (before acute treatment of the index episode) and again in a state of symptomatic remission with nortriptyline (mean steady-state level: 82.1 ng/ml). Continuation therapy with nortriptyline was associated with improvement of polysomnographic sleep maintenance (mainly in the third and fourth sleep cycles, to a level similar to that of controls), prolongation of rapid-eye-movement (REM) sleep latency (exceeding that of controls), and potentiation of slow-wave activity during the first non-REM (NREM) sleep period. Clinical improvement, as measured by the Hamilton Depression Rating Scale, was significantly associated with shift of delta activity toward sleep onset (p less than 0.002), prolongation of REM sleep latency (p less than 0.0001), and improvement in sleep maintenance (p less than 0.0002). Multiple regression analysis showed that the single best correlate of clinical change was prolongation of REM sleep latency (i.e., prolongation of first NREM period). Perceived sleep quality improved significantly during early continuation therapy with nortriptyline, but not to the level reported by a group of 30 age- and sex-matched healthy controls. The findings are consistent with the concept that anti-depressant drug efficacy may depend upon strengthening of the homeostatic regulation of sleep and upon changes in the REM-sleep regulation.
Aged↗
Insomnia. Use of a 'decision tree' to assess and treat.
Insomnia, a remarkably common disturbance in a basic biologic function, arises from multiple psychological, physiologic, and environmental factors. Transient insomnia usually resolves spontaneously. Short-term insomnia is usually normalized by coping with acute changes in a medical condition or a relationship. In patients with insomnia caused by stressful life events, a short (ie, 10 days or less) course of a short- or intermediate-acting benzodiazepine hypnotic may be indicated. Long-term insomnia deserves comprehensive evaluation. Psychiatric disorders are common in patients with long-term insomnia. In patients over age 50, intrinsic sleep disorders are more prevalent. Behavioral therapy, including improved sleep hygiene, stimulus-control techniques, and sleep-restriction therapy, is preferred in the management of long-term insomnia. Pharmacotherapy (eg, low-dose antidepressant or benzodiazepine) is best used as an adjunct.
Decision Trees↗
[Improvement of health-related quality of life in patients with obstructive sleep apnea syndrome under CPAP therapy].
BACKGROUND: Only poor data regarding changes in quality of life in patients with obstructive sleep apnea syndrome (OSAS) under continuous positive airway pressure (CPAP) therapy concerning long-term effects are available. PATIENTS AND METHODS: In this study, 85 patients were evaluated before and under CPAP therapy using the Visual Analog Scale (VAS) Quality of Life, the Nottingham Health Profile (NHP), and the Quality of Life Index (QL-Index). The results of patients with continuous usage of CPAP (n = 66) were compared with a control group of patients who discontinued CPAP therapy (n = 19). RESULTS: VAS (before CPAP 56.9 +/- 27.0, under CPAP 67.2 +/- 21.8 mm; p = 0.027) as well as the NHP dimensions "Energy" (before CPAP 44.2 +/- 39.5, under CPAP 25.0 +/- 34.2 points; p < 0.001), "Emotional reactions" (before CPAP 24.7 +/- 22.5, under CPAP 11.8 +/- 18.8 points; p < 0,001), and "Sleep problems" (before CPAP 32.0 + 30.0, under CPAP 21.5 + 27.2 points; p = 0.005) showed a significant improvement after 16 +/- 9-month follow-up. In the control group, none of the instruments displayed a significant change. A correlation between CPAP compliance (mask hours) and changes in quality of life was not detected. CONCLUSION: Thus, even suboptimal CPAP usage might bring benefit regarding quality of life. As not all health-related instruments or dimensions were able to display the effects on quality of life, there is a need to translate and validate disease-specific instruments into the German language.
Adult↗