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Sleep Study (sleep + study)
Selected AbstractsAssociation Between Sleep and Physical Function in Older Men: The Osteoporotic Fractures in Men Sleep StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2008Thuy-Tien L. Dam MD OBJECTIVES: To determine whether sleep quality is associated with physical function in older men. DESIGN: Cross-sectional. SETTING: Six U.S. centers. PARTICIPANTS: Two thousand eight hundred sixty-two community-dwelling men. MEASUREMENTS: Total hours of nighttime sleep (TST), wake after sleep onset (WASO), sleep latency (SL), and sleep efficiency (SE) measured using actigraphy; sleep stage distribution, respiratory disturbance index (RDI), and hypoxia measured using polysomnography; measures of physical function: grip strength, walking speed, chair stand, and narrow walk. RESULTS: In age-adjusted models, <6 or >8 hours TST, SE less than 80%, WASO of 90 minutes or longer, RDI of 30 or greater, and hypoxia were associated with poorer physical function. (Mean grip strength was 2.9% lower and mean walking speed was 4.3% lower in men with WASO ,90 minutes than men with WASO <90 minutes.) After adjusting for potential covariates, differences in grip strength and walking speed remained significantly associated with WASO of 90 minutes or longer, SE less than 80%, and hypoxia but not with TST or RDI of 30 or greater. CONCLUSION: Greater sleep fragmentation and hypoxia are associated with poorer physical function in older men. [source] Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong KongINTERNAL MEDICINE JOURNAL, Issue 4 2002D. S. C. Hui Abstract Objectives:,To assess the prevalence of sleep-disordered breathing (SDB) and its associated symptoms in a group of commercial bus drivers in Hong Kong. Methods:,Two hundred and sixteen of 410 bus drivers from three different shifts were interviewed with the Sleep & Health Questionnaire (SHQ) and the Epworth sleepiness scale (ESS) at a Hong Kong bus depot. Seventeen subjects from each shift were then randomly selected for at-home sleep study using the Mesam IV device (Madaus Medizin,Elektronik, Freiburg, Germany). Results:,There were 207 men and nine women (mean age 42.4 ± 7.5 years; body mass index (BMI) 25.4 ± 4.5 kg/m2; ESS 5.3 ± 4.2). From the SHQ it was discovered that: (i) daytime sleepiness was reported by 87 subjects (40%), (ii) snoring , 3 times per week was reported by 80 subjects (37%), (iii) witnessed apnoea was reported by 17 subjects (7.9%) and (iv) 29 subjects (13.4%) reported having fallen asleep during driving. Among the 51 subjects who underwent the at-home sleep study: (i) 31 subjects (61%) had respiratory disturbance index (RDI) , 5 per hour of sleep, (ii) 21 subjects (41%) had RDI , 10 per hour of sleep, (iii) 12 subjects (24%) had RDI , 15 per hour of sleep and (iv) 35 subjects (68.6%) snored objectively , 10% of the night. Ten subjects (20%) had RDI , 5 and sleepiness at work, while five subjects (9.8%) had RDI , 5 and ESS > 10. No significant differences were noted in the SHQ responses, ESS, objective snoring or RDI among the three groups. Multiple regression analysis showed that BMI and witnessed apnoea were the only positive independent predictors of RDI. Conclusions:,This study showed a high prevalence of objective snoring and SDB in a group of commercial bus drivers. Neither self-reported sleepiness nor the ESS could identify subjects with SDB. (Intern Med J 2002; 32: 149,157) [source] The Role of Benzodiazepines in the Treatment of InsomniaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001Meta-Analysis of Benzodiazepine Use in the Treatment of Insomnia PURPOSE: To obtain a precise estimate of the efficacy and common adverse effects of benzodiazepines for the treatment of insomnia compared with those of placebo and other treatments. BACKGROUND: Insomnia, also referred to as disorder of initiating or maintaining sleep, is a common problem and its prevalence among older people is estimated to be 23% to 34%.1 The total direct cost in the United States for insomnia in 1995 was estimated to be $13.9 billion.2 The complaint of insomnia in older people is associated with chronic medical conditions; psychiatric problems, mainly depression, chronic pain, and poor perceived general condition;1,3,4 and use of sleep medications.5 Thus in most cases, insomnia is due to some other underlying problem and is not just a consequence of aging.6 Accordingly, the management of insomnia should focus on addressing the primary problem and not just short-term treatment of the insomnia. Benzodiazepines belong to the drug class of choice for the symptomatic treatment of primary insomnia.7 This abstract will appraise a meta-analysis that compared the effect of benzodiazepines for short-term treatment of primary insomnia with placebo or other treatment. DATA SOURCES: Data sources included articles listed in Medline from 1966 to December 1998 and the Cochrane Controlled Trials Registry. The medical subject heading (MeSH) search terms used were "benzodiazepine" (exploded) or "benzodiazepine tranquillizers" (exploded) or "clonazepam,""drug therapy,""randomized controlled trial" or "random allocation" or "all random,""human," and "English language." In addition, bibliographies of retrieved articles were scanned for additional articles and manufacturers of brand-name benzodiazepines were asked for reports of early trials not published in the literature. STUDY SELECTION CRITERIA: Reports of randomized controlled trials of benzodiazepine therapy for primary insomnia were considered for the meta-analysis if they compared a benzodiazepine with a placebo or an alternative active drug. DATA EXTRACTION: Data were abstracted from 45 randomized controlled trials representing 2,672 patients, 47% of whom were women. Fifteen studies included patients age 65 and older and four studies involved exclusively older patients. Twenty-five studies were based in the community and nine involved inpatients. The duration of the studies ranged from 1 day to 6 weeks, with a mean of 12.2 days and median of 7.5 days. The primary outcome measures analyzed were sleep latency and total sleep duration after a sleep study, subjects' estimates of sleep latency and sleep duration, and subjects' report of adverse effects. Interrater reliability was checked through duplicate, independent abstraction of the first 21 articles. Overall agreement was between 95% and 98% (kappa value of 0.90 and 0.95 accordingly) for classification of the studies and validity of therapy, and 76% (kappa value of 0.51) for study of harmful effects. A scale of 0 to 5 was used to rate the individual reports, taking into account the quality of randomization, blinding, follow-up, and control for baseline differences between groups. Tests for homogeneity were applied across the individual studies and, when studies were found to be heterogeneous, subgroup analysis according to a predefined group was performed. MAIN RESULTS: The drugs used in the meta-analysis included triazolam in 16 studies; flurazepam in 14 studies; temazepam in 13 studies; midazolam in five studies; nitrazepam in four studies; and estazolam, lorazepam, and diazepam in two studies each. Alternative drug therapies included zopiclone in 13 studies and diphenhydramine, glutethimide, and promethazine in one study each. Only one article reported on a nonpharmacological treatment (behavioral therapy). The mean age of patients was reported in 33 of the 45 studies and ranged between 29 and 82. SLEEP LATENCY: In four studies involving 159 subjects, there was sleep-record latency (time to fall asleep) data for analysis. The pooled difference indicated that the latency to sleep for patients receiving a benzodiazepine was 4.2 minutes (95% CI = (,0.7) (,9.2)) shorter than for those receiving placebo. Patient's estimates of sleep latency examined in eight studies showed a difference of 14.3 minutes (95% CI = 10.6,18.0) in favor of benzodiazepines over placebo. TOTAL SLEEP DURATION: Analysis of two studies involving 35 patients in which total sleep duration using sleep-record results was compared indicated that patients in the benzodiazepine groups slept for an average of 61.8 minutes (95% CI = 37.4,86.2) longer than those in the placebo groups. Patient's estimates of sleep duration from eight studies (566 points) showed total sleep duration to be 48.4 minutes (95% CI = 39.6,57.1) longer for patients taking benzodiazepines than for those on placebo. ADVERSE EFFECTS: Analysis of eight studies (889 subjects) showed that those in the benzodiazepine groups were more likely than those in the placebo groups to complain of daytime drowsiness (odds ratio (OR) 2.4, 95% confidence interval (CI) = 1.8,3.4). Analysis of four studies (326 subjects) also showed that subjects in the benzodiazepine groups were more likely to complain of dizziness or lightheadedness than the placebo groups. (OR 2.6, 95% CI = 0.7,10.3). Despite the increased reported side effects in the benzodiazepine groups, drop-out rates were similar in the benzodiazepine and placebo groups. For patient reported outcome, there was no strong correlation found for sleep latency data, (r = 0.4, 95% CI = (,0.3) (,0.9)) or for sleep duration (r = 0.2, 95% CI = ,0.8,0.4) between benzodiazepine dose and outcome. COMPARISON WITH OTHER DRUGS AND TREATMENTS: In three trials with 96 subjects, meta-analysis of the results comparing benzodiazepines with zopiclone, did not show significant difference in sleep latency in the benzodiazepine and placebo groups, but the benzodiazepine groups had increased total sleep duration (23.1 min. 95% CI = 5.6,40.6). In four trials with 252 subjects, the side effect profile did not show a statistically significant difference (OR 1.5, CI 0.8,2.9). There was only one study comparing the effect of behavioral therapy with triazolam. The result showed that triazolam was more effective than behavioral therapy in decreasing sleep latency, but its efficacy declined by the second week of treatment. Behavioral therapy remained effective throughout the 9-week follow-up period. There were four small trials that involved older patients exclusively, with three of the studies having less than 2 weeks of follow-up. The results were mixed regarding benefits and adverse effects were poorly reported. CONCLUSION: The result of the meta-analysis shows that the use of benzodiazepines results in a decrease in sleep latency and a significant increase in total sleep time as compared with placebo. There was also a report of significantly increased side effects, but this did not result in increased discontinuation rate. There was no dose-response relationship for beneficial effect seen with the use of benzodiazepines, although the data are scant. Zopiclone was the only alternative pharmacological therapy that could be studied with any precision. There was no significant difference in the outcome when benzodiazepines were compared with zopiclone. There was only one study that compared the effect of benzodiazepines with nonpharmacological therapy; thus available data are insufficient to comment. [source] Review of upper airway resistance syndrome: nursing and clinical managementJOURNAL OF CLINICAL NURSING, Issue 17 2009Tara B Giblin Aims., This study aims to help nurses and nurse practitioners identify and manage paediatric patients with upper airway resistance syndrome. A review of upper airway resistance syndrome is provided, including the signs and symptoms of upper airway resistance syndrome, criteria for diagnosis, recommendations for treatment and implications for nursing in paediatric primary care. Background., Nurses often encounter sleep-related problems in the paediatric primary care setting. Commonly, these problems are well known and include snoring and obstructive sleep apnoea. Upper airway resistance syndrome is a relatively new diagnosis among sleep-related breathing disorders with which nurses and nurse practitioners should be familiar. Upper airway resistance syndrome is characterised by incomplete obstruction of the airway during sleep, leading to increased respiratory efforts and frequent arousals despite normal oxygen saturations. Design., Systematic review. Method. A review of the sleep literature identified articles regarding sleep and/or sleep-related breathing disorders and paediatrics, and upper airway resistance syndrome. Articles published since 2002 were prioritised; however, all articles describing upper airway resistance syndrome since 1993 were considered. Conclusion., Timely recognition of sleep-disordered breathing is crucial to ensuring that patients receive effective and appropriate treatment. Upper airway resistance syndrome should be a part of the differential diagnosis when assessing a child with a sleep-related breathing disorder. Relevance to clinician practice., Nurses and nurse practitioners should become comfortable and skilled in performing a thorough sleep history and physical examination to help identify when a child should receive a sleep study or referral to a specialist. [source] Investigation of sleep disordersJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2005MJ Davey Abstract: Polysomnography or sleep study is the main investigation for paediatric sleep disorders. It involves the continuous and simultaneous recording of multiple physiological parameters evaluating sleep and respiration. It is most commonly used to diagnose obstructive sleep apnoea and to monitor nocturnal non-invasive ventilation requirements of children. Its role in other sleep related breathing disorders, narcolepsy and parasomnias is discussed. [source] Overnight Hospital Stay Is Not Always Necessary after Uvulopalatopharyngoplasty,THE LARYNGOSCOPE, Issue 1 2005FACS, Jeffrey H. Spiegel MD Abstract Objectives: To determine whether patients with obstructive sleep apnea who undergo uvulopalatopharyngoplasty (UPPP) have a significant incidence of postoperative complications that would justify overnight postoperative observation in the hospital. Study Design: Part 1: review of published medical literature to determine incidence of postoperative complications. Part 2: retrospective review of 117 patients undergoing UPPP with or without additional procedures. Methods: A literature search for existing studies describing the postoperative complications after UPPP for obstructive sleep apnea was conducted. After this, the records of 117 patients who had undergone UPPP at a university-based medical center during a 5-year span were reviewed. Results: Respiratory events occur in 2% to 11% of cases. These include airway obstruction (e.g., laryngospasm), postobstructive pulmonary edema (POPE), and desaturation. Airway obstruction occurred in the immediate postoperative setting. POPE was rare and usually occurred within minutes after the conclusion of the surgical procedure. Desaturation could occur at any time, but the severity was usually equivalent to that found on preoperative sleep study. Hemorrhage occurred in 2% to 14% of cases and had a biphasic incidence, occurring either immediately postoperatively or several days after surgery. Depending on definition, hypertension was observed in between 2% and 70% of patients postoperatively. This was most commonly diagnosed and treated in the immediate postoperative setting. In most reports, arrhythmia and angina occurred in less than 1% of cases. Conclusions: The majority of complications after UPPP with or without additional procedures occur within 1 to 2 hours after surgery. Postoperative oxygen desaturation is usually no worse than that that was observed on preoperative polysomnography findings. A 2 to 3 hour observation period may be suitable for patients after UPPP; if a patient experiences no complications and is maintaining adequate oxygenation and analgesia, same-day discharge from recovery room may be considered. [source] A Pilot Study of Quantitative Aspiration in Patients with Symptoms of Obstructive Sleep Apnea: Comparison to a Historic Control Group,THE LARYNGOSCOPE, Issue 6 2004Michael Beal MD Abstract Objective: It has been shown that many healthy people aspirate secretions at night. Patients with obstructive sleep apnea (OSA) have frequent episodes of gasping at night that may predispose them to aspiration. The purpose of this study was to determine whether patients with symptoms of OSA are predisposed to pharyngeal aspiration. Study Design: A prospective study in which patients with symptoms of OSA were compared with a historic group of normal controls by using the same methodology. Methods: The study was offered to patients with symptoms of OSA undergoing a sleep study. The radiotracer Technicium99 was infused through a plastic tube placed in the nasopharynx after the patient achieved stage II sleep. A chest radionuclide scan determined the amount of material aspirated. The Wilcoxon-rank sum test was used to compare the mean amount aspirated between the experimental and historic control groups. Results: Fourteen patients successfully completed the study. One normal volunteer in our study aspirated a quantity similar to the historic normal control group. The amount of aspirated material in the study group ranged from 0.152 to 3.648 mL, with a mean of 1.24 mL ± 0.905 (SD). When compared with the historic normal control group, the patients with symptoms of OSA aspirated significantly more radio-tracer (P <.01). There was a lack of association between respiratory disturbance index and amount aspirated. Conclusions: The results suggest there is an apparent risk of increased pharyngeal aspiration in patients with symptoms of OSA. [source] | ||||||||||