Sleep_Disorders RSS : Gourt

Asleep at the Wheel?

Truck drivers who routinely get too little sleep or suffer from sleep apnea show signs of fatigue and impaired performance that can make them a hazard on the road, according to a major new study by Penn Sleep Centers researchers. The study results, entitled “Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration,” were published in the August 15th issue of the American Journal of Respiratory and Critical Care Medicine.

Sleep Apnea and Heart Disease

Along with the epidemic of obesity, the incidence of sleep apnea has risen at an alarming rate. The most common form, known as obstructive sleep apnea (OSA), is caused by extra tissue in the upper airway that collapses and literally blocks the airflow to the lungs. The risk factors for OSA include male sex (women’s risk increases after menopause), obesity, and neck size greater than 17 inches. The symptoms of sleep apnea include fatigue, early morning headaches, snoring, falling asleep during the daytime, depression and witnessed episodes of irregular breathing while sleeping.

Cognitive-Behavioral Treatment of Insomnia

Insomnia is the most prevalent sleep disorder, representing one of the most common complaints reported to doctors by their patients. In an effort to provide non-pharmacologic treatment options for insomnia, research and clinical practice have focused on developing cognitive- behavior treatments as an alternative.

Do Flies and Worms Sleep?

Can you tell if a fly is asleep? This is precisely the question asked seven years ago by Dr. Joan Hendricks, who is now the Dean of the School of Veterinary Medicine at the University of Pennsylvania. In collaboration with Dr. Amita Sehgal and Dr. Allan Pack of the Penn Center for Sleep and Respiratory Neurobiology (CSRN), Dr. Hendricks wanted to determine if the fruit fly Drosophila melanogaster, an animal used since the early 1900s for genetic studies in biology, has a sleeplike state much as we do. But unlike human studies, where one can measure brain electrical activity to distinguish sleep from the waking state, one cannot easily measure fly brain waves. Instead, Dr. Hendricks used behavioral measures.

Advice for Sleepy Students

Each fall, Grace Pien, MD in the University of Pennsylvania Division of Sleep Medicine sees teenagers being brought into her office by parents. The teens complain about difficulty falling asleep at night. After several follow-up questions, Pien often determines that these patients suffer from a sleep disorder called delayed sleep phase syndrome (DSPS) - when the body's circadian rhythm delays the urge to sleep until much later than what is considered to be a normal bedtime.

New Headquarters for Penn Sleep

In April of this year, the practices and sleep laboratory facilities of the Penn Sleep Centers at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center were merged into a single new site at 3624 Market St. which serves as headquarters for the Penn Sleep Centers. This newly renovated facility provides pleasant and spacious areas for both patients and staff.

Rebound Hypersomnolence, Stimulant Abuse, and DAT-Mediated Dopamine Release

Commentary on Gruner et al. The roles of dopamine transport inhibition and dopamine release facilitation in wake enhancement and rebound hypersomnolence induced by dopaminergic agents. SLEEP 2009;32(11):1425-1438.

Retire for Better Sleep?

Commentary on Vahtera et al. Effect of retirement on sleep disturbances: the GAZEL prospective cohort study. Sleep 2009;32:1459-1466.

Impact of Sleeping Angle on the Upper Airway and Pathogenesis of Cheyne Stokes Respiration

Commentary on Soll et al. The Effect of Posture on Cheyne-Stokes Respirations and Hemodynamics in Patients with Heart Failure, SLEEP 2009;32(11):1499-1506.

The Search for Apnea Genes

Commentary on Thakre et al. Lack of Association of the APOE ε4 Allele with the Risk of Obstructive Sleep Apnea: Meta-Analysis and Meta-Regression. Sleep 2009;32:1507-1511.

Sleep Deprivation Specifically Impairs Short-term Olfactory Memory in Drosophila

Study Objectives: Sleep is crucial to memory consolidation in humans and other animals; however, the effect of insufficient sleep on subsequent learning and memory remains largely elusive. Design: Learning and memory after 1-day sleep deprivation (slpD) was evaluated using Pavlovian olfactory conditioning in Drosophila, and locomotor activity was measured using the Drosophila Activity Monitoring System in a 12:12 light-dark cycle. Results: We found that slpD specifically impaired 1-h memory in wild type Canton-S flies, and this effect could persist for at least 2 h. However, alternative stresses (heat stress, oxidative stress, starvation, and rotation stress) did not result in a similar effect and left the flies’ memory intact. Mechanistic studies demonstrated that flies with either silenced transmission of the mushroom body (MB) during slpD or down-regulated cAMP levels in the MB demonstrated no slpD-induced 1-h memory impairment. Conclusion: We found that slpD specifically impaired 1-h memory in Drosophila, and either silencing of MB transmission during slpD or down-regulation of the cAMP level in the MB protected the flies from slpD-induced impairment. Keywords: Drosophila, sleep, learning and memory, cAMP, slpD, mushroom body

The Roles of Dopamine Transport Inhibition and Dopamine Release Facilitation in Wake Enhancement and Rebound Hypersomnolence Induced by Dopaminergic Agents

Study Objective: Rebound hypersomnolence (RHS: increased sleep following increased wake) is a limiting side-effect of many wake-promoting agents. In particular, RHS in the first few hours following wake appears to be associated with dopamine (DA)-releasing agents, e.g., amphetamine, but whether it can also be produced by DA transporter (DAT) inhibition alone is unknown. In these studies, DA-releasing and DAT-inhibiting agents and their interaction were systematically examined for their ability to increase wake and induce RHS. Design: Chronically implanted rats were evaluated in a blinded, pseudo-randomized design. Participants: 237 rats were used in these studies with 1 week between repeat tests. Interventions: Animals were habituated overnight and dosed the next day, 5 h after lights on, with test agents. Measurements and Results: Sleep/wake activity and RHS were evaluated using EEG/EMG recording up to 22 h post dosing. In vitro dopamine release was evaluated in rat synaptosomes. At doses that produced equal increases in wake, DA-releasing (amphetamine, methamphetamine, phentermine) and several DAT-inhibiting agents (cocaine, bupropion, and methylphenidate) produced RHS during the first few hours after the onset of sleep recovery. However, other DAT-inhibiting agents (mazindol, nomifensine, GBR-12909, and GBR-12935) did not produce RHS. Combination treatment with amphetamine and nomifensine produced waking activity greater than the sum of their individual activities alone while ameliorating the amphetamine-like RHS. In rat synaptosomes, nomifensine reduced the potency of amphetamine to induce DA release ~270-fold, potentially explaining its action in ameliorating amphetamine-induced RHS. Conclusions: All DA releasing agents tested, and some DAT-inhibiting agents, produced RHS at equal wake-promoting doses. Thus amphetamine-like DA release appears sufficient for inducing RHS, but additional properties (pharmacologic and/or pharmacokinetic) evidently underlie RHS of other DAT inhibitors. Enhancing wake while mitigating RHS can be achieved by combining DAT-inhibiting and DA-releasing agents. Keywords: Sleep/wake, dopamine transporter, amphetamine, hypersomnolence, pharmacokinetic, rat

The Effects of Sleep Deprivation on Information-Integration Categorization Performance

Background: Sleep deprivation is a serious problem facing individuals in many critical societal roles. One of the most ubiquitous tasks facing individuals is categorization. Sleep deprivation is known to affect rule-based categorization in the classic Wisconsin Card Sorting Task, but, to date, information-integration categorization has not been examined. Study Objectives: To investigate the effects of sleep deprivation on information-integration category learning. Design: Participants performed an information-integration categorization task twice, separated by a 24-hour period, with or without sleep between testing sessions. Participants: Twenty-one West Point cadets participated in the sleep-deprivation group and 28 West Point cadets participated in a control group. Measurements and Results: Sleep deprivation led to an overall performance deficit during the second testing session—that is, whereas participants allowed to sleep showed a significant performance increase during the second testing session, Sleepless participants showed a small (but nonsignificant) performance decline during the second testing session. Model-based analyses indicated that a major contributor to the sleep-deprivation effect was the poor second-session performance of a subgroup of sleep-deprived participants who shifted from optimal information-integration strategies at the end of the first session to less-optimal rule-based strategies at the start of the second session. Sleep-deprived participants who used information-integration strategies in both sessions showed no drop in performance in the second session, mirroring the behavior of control participants. Conclusions: The findings suggest that the neural systems underlying information-integration strategies are not strongly affected by sleep deprivation but, rather, that the use of an information-integration strategy in a task may require active inhibition of rule-based strategies, with this inhibitory process being vulnerable to the effects of sleep deprivation. Keywords: Category learning, procedural learning, striatum, sleep consolidation, sleep deprivation

A Review of the Effects of Sleep During the First Year of Life on Cognitive, Psychomotor, and Temperament Development

During the first year of life, infants spend most of their time in the sleeping state. Assessment of sleep during infancy presents an opportunity to study the impact of sleep on the maturation of the central nervous system (CNS), overall functioning, and future cognitive, psychomotor, and temperament development. To assess what is currently known regarding sleep during infancy and its effects on cognitive, psychomotor, and temperament development, we assessed the relevant literature published over the last several decades.To provide a foundation for a more in-depth understanding of this literature, we preface this with an overview of brain maturation, sleep development, and various assessment tools of both sleep and development during this unique period. At present, we do not have sufficient data to conclude that a causal relationship exists between infant sleep and cognitive, psychomotor, and temperament development. Caution should be used in predicting outcomes, as the timing and subjectivity of evaluations may obviate accurate assessment. Collectively, studies assess a wide array of sleep measures, and findings from one developmental period cannot be generalized readily to other developmental periods. Future studies should follow patients longitudinally. Additionally, refinements of existing assessment tools would be useful. In view of the relatively high reported pediatric prevalence of cognitive and behavioral deficits that carry significant long-term costs to individuals and society, early screening of sleep-related issues may be a useful tool to guide targeted prevention and early intervention. Keywords: Infant sleep, cognitive, psychomotor, and temperament development

Effect of Retirement on Sleep Disturbances: the GAZEL Prospective Cohort Study

Objectives: Changes in health following retirement are poorly understood. We used serial measurements to assess the effect of retirement on sleep disturbances. Design: Prospective cohort study. Setting: The French national gas and electricity company. Participants: Fourteen thousand seven hundred fourteen retired employees (79% men). Measurements and Results: Annual survey measurements of sleep disturbances ranging from 7 years before to 7 years after retirement (a mean of 12 measurements). Before retirement 22.2% to 24.6% of participants reported having disturbed sleep. According to repeated-measures logistic-regression analysis with generalized estimating equations estimation, the odds ratio (OR) for having a sleep disturbance in the postretirement period was 0.74 (95% confidence interval 0.71-0.77), compared with having a sleep disturbance in the preretirement period. The postretirement improvement in sleep was more pronounced in men (OR 0.66 [0.63-0.69]) than in women (OR 0.89 [0.84-0.95]) and in higher-grade workers than lower-grade workers. Postretirement sleep improvement was explained by the combination of preretirement risk factors suggesting removal of work-related exposures as a mechanism. The only exception to the general improvement in sleep after retirement was related to retirement on health grounds. In this group of participants, there was an increase in sleep disturbances following retirement. Conclusions: Repeated measurements provide strong evidence for a substantial and sustained decrease in sleep disturbances following retirement. The possibility that the health and well-being of individuals are significantly worse when in employment than following retirement presents a great challenge to improve the quality of work life in Western societies in which the cost of the aging population can only be met through an increase in average retirement age. Keywords: Retirement, sleep disturbances, trajectory, longitudinal, cohort study

Tolerance of Chronic 90-Minute Time-In-Bed Restriction in Older Long Sleepers

Study Objectives: To examine the influence of chronic time-in-bed (TIB) restriction on selected health-related outcome variables in older long sleepers. Design: Randomized, controlled trial. Setting: Home-based. Participants: Forty-two older adults (aged 50-70 y) who reported sleeping at least 8.5 hours. Following extensive screening, participants were assessed for 10 weeks. Intervention: During a two-week baseline, participants followed their usual sleep-wake habits. Participants were then randomized to one of two eight-week treatments: (1) TIB restriction, in which participants were asked to follow a fixed sleep schedule with a TIB of 90 minutes less than recorded during baseline or (2) a control treatment, which involved following a fixed sleep schedule (consistent with average baseline) but no TIB restriction. Measurements and Results: Continuous wrist actigraphic sleep estimation indicated that TIB restriction elicited significant reductions in TIB and total sleep time compared with the control treatment and significant (albeit modest) improvements in sleep efficiency and sleep latency. However, compared with the control treatment, TIB restriction elicited no significant change in depression, sleepiness, health-related quality of life, or neurobehavioral performance. Moreover, follow-up assessments for one year indicated that, after completing the experiment, the participants assigned to TIB restriction continued to restrict their TIB (at their own initiative) by an average of approximately one hour. Conclusions: The results suggest good tolerance of chronic moderate TIB restriction, without detrimental effects, among older long sleepers. Keywords: Long sleep, time-in-bed restriction, randomized controlled trial

A Compromise Circadian Phase Position for Permanent Night Work Improves Mood, Fatigue, and Performance

Study Objective: To assess night shift improvements in mood, fatigue, and performance when the misalignment between circadian rhythms and a night shift, day sleep schedule is reduced. Design: Blocks of simulated night shifts alternated with days off. Experimental subjects had interventions to delay their circadian clocks to partially align with a night shift schedule. Control subjects had no interventions. Subjects were categorized according to the degree of circadian realignment independent of whether they were in the experimental or control groups. Twelve subjects were categorized as not re-entrained, 21 as partially re-entrained, and 6 as completely re-entrained. Setting: Home sleep and laboratory night shifts. Participants: Young healthy adults. Interventions: Experimental subjects had intermittent bright light pulses during night shifts, wore dark sunglasses outside, and had scheduled sleep episodes in darkness. Measurements and Results: A computerized test battery was administered every 2 hours during day and night shifts. After about one week on the night shift schedule, which included a weekend off, the partially and completely re-entrained groups had markedly improved mood, fatigue, and performance compared to the group that was not re-entrained. The completely and partially re-entrained groups were similar to each other and had levels of mood, fatigue, and performance that were close to daytime levels. Conclusions: Partial re-entrainment to a permanent night shift schedule, which can be produced by feasible, inexpensive interventions, is associated with greatly reduced impairments during night shifts. Keywords: Shift work, performance, alertness, mood, human, circadian rhythms, bright light, melatonin

Body Mass Index-Independent Metabolic Alterations in Narcolepsy with Cataplexy

Study Objectives: To contribute to the anthropometric and metabolic phenotyping of orexin-A–deficient narcoleptic patients, and to explore a possible risk of their developing a metabolic syndrome. Design: We performed across-sectional study comparing metabolic alterations in patients with narcolepsy with cataplexy (NC) and patients with idiopathic hypersomnia without long sleep time. Setting: University hospital. Patients: Fourteen patients with narcolepsy with cataplexy and 14 sex and age-matched patients with idiopathic hypersomnia without long sleep time. Interventions: N/A. Measurements and results: Metabolic parameters were evaluated by measuring body mass index (BMI), waist circumference (also with abdominal computed tomography), blood pressure, and daily calorie intake (3-day diary). Chronotypes were assessed through the morningness-eveningness questionnaire. Lumbar puncture for cerebrospinal fluid orexin-A determination and HLA typing were performed. Patients with narcolepsy with cataplexy (all HLA DQB1*0602 positive and with cerebrospinal fluid orexin-A levels < 110 pg/mL) had a higher BMI and BMI-independent metabolic alterations, namely waist circumference, high-density lipoprotein cholesterol, and glucose/insulin ratio (an insulin resistance index), with respect to patients with idiopathic hypersomnia without long sleep time (cerebrospinal fluid orexin-A levels > 300 pg/mL). Despite lower daily food intake, patients with narcolepsy with cataplexy displayed significant alterations in metabolic parameters resulting in a diagnosis of metabolic syndrome in more than half the cases. Conclusions: BMI-independent metabolic alterations and the relative hypophagia of patients with narcolepsy with cataplexy, as compared with patients with idiopathic hypersomnia without long sleep time, suggest that orexin-A influences the etiology of this phenotype. Moreover, considering that these dysmetabolic alterations are present from a young age, a careful metabolic follow-up of patients diagnosed with narcolepsy with cataplexy is mandatory. Keywords: narcolepsy with cataplexy, orexin-A, metabolism, idiopathic hypersomnia, metabolic syndrome

The Effect of Posture on Cheyne-Stokes Respirations and Hemodynamics in Patients with Heart Failure

Study Objectives:Cheyne-Stokes respirations occur in 40% of patients with heart failure. Orthopnea is a cardinal symptom of heart failure and may affect the patient’s sleeping angle. The objective of this study was to assess the respiratory and hemodynamic response to sleeping angle in a group of subjects with stable heart failure. Design: Twenty-five patients underwent overnight polysomnography with simultaneous and continuous impedance cardiographic monitoring. Sleeping polysomnographic and impedance cardiographic data were recorded. Setting: The study was conducted in a sleep center. Patients: All 25 patients had clinically stable heart failure and left ventricular ejection fractions < 40%. Interventions: The patients slept at 0°, 15°, 30°, and 45° in random order. Measurements and Results: Seventeen patients had Cheyne-Stokes apneas (index > 5/h) and 23 patients had hypopneas (index > 5/h). The hypopnea index showed no response to sleeping angle. The Cheyne-Stokes apnea index decreased with increasing sleeping angle (P < 0.001). This effect was seen only during supine sleep and non-rapid eye movement sleep and was absent in non-supine sleep, rapid eye movement sleep, and during periods of wakefulness. Thoracic fluid content index and left ventricular hemodynamics measured by impedance cardiography showed no response to sleeping angle. Conclusions: Changing the heart failure patient’s sleeping angle from 0° to 45° results in a significant decrease in Cheyne-Stokes apneas. This decrease occurs on a constant base of hypopneas. The changes in Cheyne-Stokes apneas are not related to changes in lung congestion and left ventricular hemodynamics. Keywords: Body position, polysomnography, impedance cardiography, Cheyne-Stokes respirations, heart failure

Lack of Association of the Apoe ε4 Allele with the Risk of Obstructive Sleep Apnea: Meta-Analysis and Meta-Regression

Study Objectives: Reports on the association of polymorphisms in the gene encoding apolipoprotein E (APOE)—a vital macromolecule in cholesterol metabolism—with obstructive sleep apnea (OSA) have provided conflicting results. Our objective was to meta-analytically synthesize the existing evidence for the association of the APOE ε4 allele with the risk of OSA. Design: Random effects meta-analysis and meta-regression Setting: Genetic epidemiological studies reporting the association of APOE ε4 allele with OSA susceptibility. Patients or Participants: Synthesis of APOE ε4 allele data from 6,508 subjects including 1,901 cases of OSA and 4,607 controls. Interventions: None Measurements and Results: Eight studies were included in the random effects meta-analysis; the summary effect size measured as odds ratio (OR) for association of the APOE ε4 allele with the risk of OSA was found to be 1.13 (95% confidence interval 0.86–1.47). There was a statistically significant heterogeneity (I2 = 72%, P = 0.001) across study results that was not explained by the mean age, proportion of males, or the proportion possessing the APOE ε4 allele or when grouped based on the geographic location of the study. Conclusions: The hypothesis that the APOE ε4 allele may be causally associated with OSA cannot be supported on the basis of published literature. Keywords: Obstructive sleep apnea; epidemiology; apolipoprotein E; APOE; genetic

Effects of Acute 3, 4-Methylenedioxymethamphetamine on Sleep and Daytime Sleepiness in MDMA Users: A Preliminary Study

Study Objective: 3, 4-Methylenedioxymethamphetamine (MDMA) affects monoamine neurotransmitters that play a critical role in sleep and daytime alertness. However, the acute effects of MDMA on sleep and daytime sleepiness have not been studied under placebo-controlled conditions. This study was designed to establish the effects of acute MDMA or placebo administration and sleep restriction on sleep and daytime sleepiness. Design: Participants with a history of MDMA use were studied on 3 sessions of 3 nights (baseline, treatment, and recovery) and 2 days (following night 2 and 3) per session. On treatment nights (night 2), participants received placebo or 2 mg/kg of MDMA or underwent a restricted bed schedule with placebo. Sleep restriction was a positive control to compare sleep loss and consequent sleepiness associated with MDMA use. The scheduled sleep period was 8 hours long on nonrestricted nights, and standard sleep recordings and daytime sleepiness tests were conducted. Age-matched controls received 1 night and day of standard sleep and daytime sleepiness testing. Setting: Sleep laboratory Participants: Seven recreational MDMA-users and 13 matched control subjects. Measurements and Results: Acute MDMA shortened sleep primarily by increasing sleep latency, and it reduced stage 3/4 sleep and suppressed rapid eye movement (REM) sleep. The MDMA-reduced sleep time was not associated with increased daytime sleepiness the following day, as was seen in the sleep-restriction condition. Compared with control subjects, the MDMA users on the first night in the laboratory had shorter total sleep times and less stage 3/4 sleep. Average daily sleep latency on daytime sleepiness tests the day after nighttime placebo administration was increased in MDMA users compared with the control subjects, and MDMA users had an elevated number of sleep-onset REM periods on these tests, compared with control subjects. Conclusions: Acute MDMA administration disrupts sleep and REM sleep, specifically, without producing daytime sleepiness such as sleep restriction does. Compared with control subjects, recreational MDMA users showed evidence of hyperarousal and impaired REM function. The mechanism behind these effects is likely due to the deleterious effects of MDMA on catecholamines.1-3 Keywords MDMA, disturbed sleep, REM sleep, daytime sleepiness

Thermal Infrared Imaging: A Novel Method to Monitor Airflow During Polysomnography

Study Objectives: This is a feasibility study designed to evaluate the accuracy of thermal infrared imaging (TIRI) as a noncontact method to monitor airflow during polysomnography and to ascertain the chance-corrected agreement (κ) between TIRI and conventional airflow channels (nasal pressure [Pn], oronasal thermistor and expired co2 [PECO2]) in the detection of apnea and hypopnea. Design: Subjects were recruited to undergo polysomnography for 1 to 2 hours, during which simultaneous recordings from electroencephalography, electrooculography, electromyography, respiratory impedance plethysmography, conventional airflow channels, and TIRI were obtained. Setting: University-affiliated, American Academy of Sleep Medicine-accredited sleep disorders center. Patients or Participants: Fourteen volunteers without a history of sleep disordered breathing and 13 patients with a history of obstructive sleep apnea were recruited. Measurements and Results: In the detection of apnea and hypopnea, excellent agreement was noted between TIRI and thermistor (κ = 0.92, Bayesian Credible Interval [BCI] 0.86, 0.96; pκ = 0.99). Good agreement was noted between TIRI and Pn (κ = 0.83, BCI 0.70, 0.90; pκ = 0.98) and between TIRI and PECO2 (κ = 0.80, BCI 0.66, 0.89; pκ = 0.94). Conclusions: TIRI is a feasible noncontact technology to monitor airflow during polysomnography. In its current methodologic incarnation, it demonstrates a high degree of chance-corrected agreement with the oronasal thermistor in the detection of apnea and hypopneas but demonstrates a lesser degree of chance-corrected agreement with Pn. Further overnight validation studies must be performed to evaluate its potential in clinical sleep medicine. Keywords: Sleep apnea syndromes, sleep disordered breathing, sleep apnea, sleep hypopnea, thermography, polysomnography, sleep monitoring

In memoriam of Dr. Yutaka Honda (1929-2009), A Pioneer in Sleep Medicine and Narcolepsy Research

Nocturia and snoring: predictive symptoms for obstructive sleep apnea

Abstract Purpose Current screening for obstructive sleep apnea (OSA) emphasizes self-reported snoring and other breathing symptoms. Nocturia, a symptom with a precise pathophysiological link to sleep apnea, has not been assessed as a screening tool for this common disorder of sleep respiration. In a large sample of adults presenting to area sleep centers, we aimed to determine the predictive power of nocturia for OSA and compare findings with other markers of OSA commonly used to screen for this disease. Methods This was a retrospective chart review. A consecutive sample of 1,007 adult patients seeking treatment at two sleep centers in New Mexico completed detailed medical and sleep history questionnaires and completed diagnostic polysomnography testing. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of nocturia, snoring, high body mass index, sex, and age for OSA were determined. Hierarchical linear regression determined unique variance contribution to the apnea–hypopnea index, the objective measure of sleep apnea severity. Results The results are as follows: sensitivities—snoring, 82.6% and nocturia, 84.8%; specificities—snoring, 43.0% and nocturia, 22.4%; PPVs—snoring, 84.7% and nocturia, 80.6%; and NPVs—snoring, 39.6% and nocturia, 27.9%. With hierarchical linear regression, patient-reported nocturia frequency predicted apnea–hypopnea index (OSA severity) above and beyond body mass index, sex, age, and self-reported snoring (P < 0.0001). Conclusions Nocturia appears comparable to snoring as a screening tool for OSA in patients presenting to a sleep medical center. Research in urology and primary care clinics is needed to definitively clarify the use of nocturia as a screening instrument for obstructive sleep apnea. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0310-2Authors Edward Romero, Sleep and Human Health Institute 6739 Academy NE, Suite 380 Albuquerque NM 87109 USABarry Krakow, Sleep and Human Health Institute 6739 Academy NE, Suite 380 Albuquerque NM 87109 USAPatricia Haynes, Southern Arizona VA Healthcare System 3601 S 6th Ave. Tucson AZ 85723 USAVictor Ulibarri, Sleep and Human Health Institute 6739 Academy NE, Suite 380 Albuquerque NM 87109 USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Obstructive sleep apnea in a patient with the Melkersson–Rosenthal syndrome

Abstract Introduction Melkersson–Rosenthal syndrome (MRS) is a rare disorder of unknown etiology. It is characterized by the triad of macrocheilitis, peripheral facial palsy, and lingua plicata. Case report A 48-year-old nonobese man with a diagnosis of MRS and marked macroglossia was evaluated because of clinically suspected obstructive sleep apnea (OSA). Established causes of OSA such as anatomic abnormalities of the upper airways or the facial skeleton were not present in this patient. Furthermore, hypothyroidism and acromegaly were excluded as underlying diseases. Polysomnography revealed moderate-to-severe OSA. As the swelling of the tongue had been unresponsive to immunosuppressive pharmacotherapy and surgery did not seem to be a reasonable therapeutic option, the patient was finally treated by continuous positive airway pressure therapy. Discussion To the best of our knowledge, this is the first report of OSA occurring in a patient with MRS. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11325-009-0309-8Authors Hans-Joachim Eisele, University of Giessen Lung Center Giessen GermanyFrank Reichenberger, University of Giessen Lung Center Giessen GermanyKonstantin Mayer, University of Giessen Lung Center Giessen GermanyNorbert Weissmann, University of Giessen Lung Center Giessen GermanyWerner Seeger, University of Giessen Lung Center Giessen GermanyRichard Schulz, University of Giessen Lung Center Giessen Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Preacclimatization in hypoxic chambers for high altitude sojourns

Abstract Introduction Since hypoxic chambers are more and more available, they are used for preacclimatization to prepare for sojourns at high altitude. Since there are different protocols and the data differ, there is no general consensus about the standard how to perform preacclimatization by simulated altitude. The paper reviews the different types of exposure and focuses on the target groups which may benefit from preacclimatization. Discussion Since data about intermittent hypoxia for some hours per day to reduce the incidence of acute mountain sickness differ, it is suggested to perform preacclimatization by sleeping some nights at a simulated altitude which follows the altitude profile of the “gold standard” for high altitude acclimatization. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0307-xAuthors Thomas E. A. H. Küpper, RWTH Aachen University Institute for Occupational and Social Medicine Aachen GermanyVolker Schöffl, Medical Commission of the Union Internationale des Associations d’Alpinisme (UIAA MedCom) Pauwelsstr. 30 52074 Aachen Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Intermittent simulated hypoxia for pre-acclimatization

Intermittent simulated hypoxia for pre-acclimatization Content Type Journal ArticleCategory EditorialDOI 10.1007/s11325-009-0308-9Authors Markus Tannheimer, Armed Forces Hospital Ulm Department of Visceral and Thoracic Surgery Oberer Eselsberg 40 Ulm 89075 Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Continuous positive airway pressure device-based automated detection of obstructive sleep apnea compared to standard laboratory polysomnography

Abstract Purpose Obstructive sleep apnea (OSA) is a common health problem that affects more than 2–4% of the US population. Polysomnography (PSG) is the gold standard for diagnosing OSA. PSG is, however, expensive, time-consuming, and not always readily accessible. Hence, alternative diagnostic methods such as home-based testing have been evaluated. We studied the ability of the REMstar Pro (RSP2, a brand of continuous positive airway pressure (CPAP) device) to identify abnormal breathing events in subjects with OSA and compared this with breathing events simultaneously determined by laboratory-based PSG. Methods We evaluated 10 subjects previously diagnosed with OSA (apnea hypopnea index (AHI) > 15, known therapeutic level of CPAP). Subjects underwent attended PSG using the REMstar Pro M series machine and their prescribed interface/mask type. The first 3 h of the study were conducted using a subtherapeutic CPAP (4 cm H2O). The last 3 h or remaining portion of the PSG was completed using the previously determined therapeutic CPAP. Comparison of respiratory events detected by PSG vs the RSP2 was performed. Results Subjects included four men and six women, aged 32 to 57 years and with a body mass index ranging from 29.5–66.4. The baseline AHI ranged from 18.3–93.1, with the AHI at therapeutic CPAP ranging from 0–3. Apnea counts at baseline and at therapeutic CPAP by manually scored PSG and REMstar were not significantly different (mean at subtherapeutic 11.7 vs 12.5, p = 0.76; median at therapeutic CPAP 2.0 vs 4.5, p = 0.15). Hypopnea counts at baseline and at effective CPAP by PSG and REMstar were not significantly different (mean at subtherapeutic 38.1 vs. 40.9, p = 0.72; median at therapeutic CPAP 5.0 vs. 2.5, p = 0.34). The correlation coefficient of REMstar and PSG for apnea and hypopnea was significant in subtherapeutic phase only (apnea r = 0.78, p = 0.007; hypopnea r = 0.76, p = 0.01). Agreement between the two methods declined for hypopnea detection at therapeutic CPAP. Conclusions The monitoring of residual sleep-disordered breathing on treatment, in addition to adherence, is an important objective therapeutic target in OSA. The REMstar Pro detects sleep-disordered breathing events similar to that of a manually scored PSG—for apnea but not for hypopnea—and merits further investigation as a device to determine disease severity and treatment efficacy. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0285-zAuthors Bharati Prasad, University of Illinois at Chicago Sleep Science Center Chicago IL USADavid W. Carley, University of Illinois at Chicago Center for Narcolepsy, Sleep and Health Research Chicago IL USAJames J. Herdegen, University of Illinois at Chicago Sleep Science Center Chicago IL USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Side effects of boil and bite type oral appliance therapy in sleep apnea patients

Abstract Introduction Based on a mail-out questionnaire, this study analyzed compliance and side effects of one commonly used (TheraSnore) boil and bite oral appliance (OA) in patients with obstructive sleep apnea. Methods The questionnaire was sent to 84 patients 6 months after the delivery of the OA. Results Fifty-eight percent (n = 47) of the patients returned the questionnaire. There was no significant difference in baseline data [age, body mass index (BMI), apnea–hypopnea index or the Epworth Sleepiness Scale (ESS)] between the returned and nonreturned questionnaires. Of the responding patients, 74.5% (n = 35) continued to use the appliance. Nonusers had a higher BMI and higher baseline ESS when compared with users. The majority (74.3%) of the users and 50.0% of the nonusers previously used a nasal continuous positive airway pressure machine. Some 82.9% of the users wore their OA more than 3 days a week. Of the nonusers, 77.8% stopped using the OA in the first 3 months, and the most frequent reason given was “uncomfortable.” Many users complained about a dry mouth and/or excessive salivation and nonusers significantly complained more about ill-fitting appliances. Over 80% of the users experienced improvement in their snoring, daytime sleepiness, and apnea. More than 60% of the users were satisfied with OA therapy. Conclusion While this study demonstrated similar self-reported compliance as previous reports, there were different side effects from those reported for custom-made appliances. Difficulty in optimal fit is considered to be the main cause of the subsequent stopping of the use of the boil and bite appliance. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0304-0Authors Hiroko Tsuda, The University of British Columbia Department of Oral Health Sciences 2199 Wesbrook Mall Vancouver V6T 1Z3 BC CanadaFernanda R. Almeida, The University of British Columbia Department of Oral Health Sciences 2199 Wesbrook Mall Vancouver V6T 1Z3 BC CanadaShin-ichi Masumi, Kyushu Dental College Division of Occlusion & Maxillofacial Reconstruction Kitakyushu JapanAlan A. Lowe, The University of British Columbia Department of Oral Health Sciences 2199 Wesbrook Mall Vancouver V6T 1Z3 BC Canada Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Validation of ECG-derived sleep architecture and ventilation in sleep apnea and chronic fatigue syndrome

Abstract Purpose Newly developed algorithms putatively derive measures of sleep, wakefulness, and respiratory disturbance index (RDI) through detailed analysis of heart rate variability (HRV). Here, we establish levels of agreement for one such algorithm through comparative analysis of HRV-derived values of sleep–wake architecture and RDI with those calculated from manually scored polysomnographic (PSG) recordings. Methods Archived PSG data collected from 234 subjects who participated in a 3-day, 2-night study characterizing polysomnographic traits of chronic fatigue syndrome were scored manually. The electrocardiogram and pulse oximetry channels were scored separately with a novel scoring algorithm to derive values for wakefulness, sleep architecture, and RDI. Results Four hundred fifty-four whole-night PSG recordings were acquired, of which, 410 were technically acceptable. Comparative analyses demonstrated no difference for total minutes of sleep, wake, NREM, REM, nor sleep efficiency generated through manual scoring with those derived through HRV analyses. When NREM sleep was further partitioned into slow-wave sleep (stages 3–4) and light sleep (stages 1–2), values calculated through manual scoring differed significantly from those derived through HRV analyses. Levels of agreement between RDIs derived through the two methods revealed an R = 0.89. The Bland–Altman approach for determining levels of agreement between RDIs generated through manual scoring with those derived through HRV analysis revealed a mean difference of −0.7 ± 8.8 (mean ± two standard deviations). Conclusion We found no difference between values of wakefulness, sleep, NREM, REM sleep, and RDI calculated from manually scored PSG recordings with those derived through analyses of HRV. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0305-zAuthors Michael J. Decker, Centers for Disease Control and Prevention Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-borne Enteric Diseases 1600 Clifton Road, Mail Stop A-15 Atlanta GA 30333 USAShulamit Eyal, HypnoCore Yehud IsraelZvika Shinar, HypnoCore Yehud IsraelYair Fuxman, HypnoCore Yehud IsraelClement Cahan, Share Zedek Medical Center Jerusalem IsraelWilliam C. Reeves, Centers for Disease Control and Prevention Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-borne Enteric Diseases 1600 Clifton Road, Mail Stop A-15 Atlanta GA 30333 USAAnda Baharav, HypnoCore Yehud Israel Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Impact of CPAP treatment on cardiac biomarkers and pro-BNP in obstructive sleep apnea syndrome

Abstract Objective To evaluate the effect of continuous positive airway pressure (CPAP) therapy on pro-brain natriuretic peptide (BNP) and cardiac markers in patients with obstructive sleep apnea syndrome and normal cardiac function. Methods Thirty-three consecutive patients with sleep apnea syndrome were analysed for serum pro-BNP and cardiac markers prior to and after 6 months of CPAP therapy. Results Twenty five patients had normal (83.3%) while remaining five (16.7%) revealed high pro-BNP values. We did not detect any significant difference between severity of obstructive sleep apnea syndrome and serum pro-BNP levels (p = 0.534). A statistically significant difference was not observed between basal and sixth-month creatine kinase (CK), creatine kinase-MB (CK-MB), troponin I, pro-BNP, aspartate transaminase (AST), and CK levels in patients with sleep apnea syndrome (p > 0.05). Conclusion Obstructive sleep apnea syndrome does not induce myocardial damage enough to increase serum pro-BNP, CK, CK-MB, troponin I, and AST levels. Markers sensitive to ischemia could be preferred to evaluate effect of obstructive sleep apnea syndrome. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0306-yAuthors Nilüfer Çifçi, University of Gaziantep Department of Pulmonary Diseases, Faculty of Medicine Gaziantep 27035 TurkeyMeral Uyar, University of Gaziantep Department of Pulmonary Diseases, Faculty of Medicine Gaziantep 27035 TurkeyOsman Elbek, University of Gaziantep Department of Pulmonary Diseases, Faculty of Medicine Gaziantep 27035 TurkeyHüseyin Süyür, University of Gaziantep Department of Pulmonary Diseases, Faculty of Medicine Gaziantep 27035 TurkeyErhan Ekinci, University of Gaziantep Department of Pulmonary Diseases, Faculty of Medicine Gaziantep 27035 Turkey Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Changes of hematocrit and hemoglobin concentration in the cold Himalayan environment in dependence on total body fluid

Abstract Introduction The organism is exposed to a considerable hypoxic stress at high altitude, and the well-known polyglobulia is an effective strategy to sustain oxygen delivery to the tissue at reduced saturation of hemoglobin. In general, an increasing erythropoiesis is thought to be the reason, although this increase of red blood count can be observed after a short time of altitude exposure and the parameters are expressed as water-depending concentrations. Therefore, the influence of water distribution on hemoglobin (Hb) and hematocrit (Hct) values during a long-term exposure at high altitude was investigated. Materials and methods Measurements were performed in 12 mountaineers before, during, and either 7/8 or 11/12 days after a Himalaya expedition (26–29 days at 4,850 to 7,600 m altitude). Arriving at 4,850 m an initial increase of Hb and Hct was followed by a short decrease during the first week and a continuous increase during the further stay. Results In maximum, 131.3% (Hb) and 117.4% (Hct) of the starting point were reached during the fourth week at altitude after the attempt to reach the summit of Broad Peak (8,047 m). Parallel the dehydration in the beginning turned to a hyperhydration at the end of the stay (D2O method). Discussion Erythropoietin rose only temporarily at altitude (max. +11 +1 mU/ml serum). Upon return, Hb and Hct normalized within a few days whereas hemoglobin mass (initially 881+ 44 g, CO-Hb method) was still increased by 13% (p < 0.01). Conclusion In conclusion, a hemoconcentration effect (dehydration) is the reason of the initial peak of Hb and Hct. The further increase can only partially be explained by an absolute increase of Hb and Hct caused by stimulated erythropoiesis. A shift of intravasal fluid to the interstitial space is the other main reason of the observed changes in red blood count. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0284-0Authors Markus Tannheimer, Armed Forces Hospital Ulm Department of Visceral and Thoracic Surgery Oberer Eselsberg 40 89081 Ulm GermanyChristian Fusch, Ernst-Moritz-Arndt-Universität Greifswald Institut für Kinder- und Jungendmedizin Greifswald GermanyDieter Böning, Freie Universität Berlin Institut für Sportmedizin Berlin GermanyAlfred Thomas, Armed Forces Hospital Department of Anesthesiology Koblenz GermanyMichael Engelhardt, Armed Forces Hospital Ulm Department of Visceral and Thoracic Surgery Oberer Eselsberg 40 89081 Ulm GermanyRoland Schmidt, Armed Forces Hospital Ulm Department of Visceral and Thoracic Surgery Oberer Eselsberg 40 89081 Ulm Germany Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Submaximal exercise in patients with severe obstructive sleep apnea

Abstract Purpose Several studies have used the cardiopulmonary exercise test to assess patients with obstructive sleep apnea (OSA). However, no report has investigated the use of the 6-min walk test (6MWT) in this group of patients. Methods We studied consecutive, newly diagnosed, OSA patients (aged >18 years). The control group was composed of matched healthy subjects with no clinical history indicative of sleep breathing disorders. The study population was divided into three groups: an OSA group, a control obese group, and a control lean group. The obese controls were gender-, age- (±2 years), height- (±5 cm), and weight- (±2 kg) matched to the OSA patients, while the lean controls were matched in gender, age, and height, but not weight. All patients underwent sleep study at our Sleep Disorders Center. Each subject underwent a single 6MWT within 1 week of the sleep study. Results A total of 55 patients were recruited to the OSA group (age 36.7 ± 7.9 years, body mass index 38.7 ± 8.6 kg/m2, and apnea hypopnea index 66.6 ± 34.8/h), 32 subjects to the control obese group, and 30 to the control lean group. There was no difference in distance walked (6-min walk distance (6MWD)) between the OSA group (389 ± 70 m) and the obese group (408 ± 66 m). In the OSA group, the 6MWD results did not correlate with patient age, apnea hypopnea index, or other polysomnographic variables. At the end of the test, heart rate, systolic and diastolic blood pressure, and dyspnea perception were significantly increased in the OSA group compared with healthy subjects. Conclusions The 6MWT is easy to perform and well tolerated by patients with OSA. There were no correlations between the 6MWD and the severity of OSA or other polysomnographic parameters. However, patients with OSA exhibited abnormal hemodynamic responses to submaximal exercise. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0300-4Authors Hatem Alameri, College of Medicine, King Saud University Pulmonary Division and Pulmonary Physiology Laboratory Riyadh Saudi ArabiaYusra Al-Kabab, College of Medicine, King Saud University Pulmonary Division and Pulmonary Physiology Laboratory Riyadh Saudi ArabiaAhmed BaHammam, College of Medicine, King Saud University Pulmonary Division and Pulmonary Physiology Laboratory Riyadh Saudi Arabia Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death

Abstract Purpose This study aims to determine whether obstructive sleep apnea independently increases the risk of coronary events, including death from cardiovascular causes. Methods We conducted an observational cohort study among consecutive patients ≥50 years of age who were referred during 1997–2001 to the Yale Center for Sleep Medicine for suspected sleep-disordered breathing and were followed longitudinally for subsequent coronary events or cardiovascular death. Each study participant underwent an overnight polysomnography; obstructive sleep apnea was defined as an apnea–hypopnea index ≥5/h. The composite outcome during a mean duration of follow-up of 2.9 years was myocardial infarction, coronary artery revascularization procedures (angioplasty, stent placement, or coronary artery bypass graft surgery), or death from cardiovascular causes. Results Among 1,436 enrolled patients, 1,024 (71%) had an apnea–hypopnea index ≥5/h. In an unadjusted analysis, obstructive sleep apnea was associated with an increased risk of coronary events or cardiovascular death (hazard ration (HR) 2.57, 95% confidence interval (CI) 1.39–4.72, P = 0.003). After adjustment for traditional cardiovascular risk factors (including body mass index and hypertension), obstructive sleep apnea retained a statistically significant association with this composite outcome (HR 2.06, 95% CI 1.10–3.86, P = 0.024). Conclusion Obstructive sleep apnea increases the risk of coronary events or death from cardiovascular causes. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-009-0298-7Authors Neomi A. Shah, Yale Center for Sleep Medicine New Haven CT USAHenry Klar Yaggi, Yale Center for Sleep Medicine New Haven CT USAJohn Concato, Yale University School of Medicine General Internal Medicine New Haven CT USAVahid Mohsenin, Yale Center for Sleep Medicine New Haven CT USA Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Circadian preference in bipolar disorder

Abstract Purpose A role for circadian rhythm abnormalities in the pathogenesis of bipolar disorder (BD) has been suggested. The present study assessed circadian preference, a subjective preference for activities in the morning or evening related to chronotype. Methods The sample was comprised of 81 outpatients with BD in remission and 79 control subjects. Circadian preference was derived from an interview evaluating biological rhythms and sleep pattern from the Pittsburgh Sleep Quality Index. Results Patients were significantly more likely to have an evening preference than control subjects. Circadian preference was also associated with sleep latency. Conclusions The association of evening preference and longer sleep latency may be related to the frequent clinical observation of a sleep/wake cycle reversal in bipolar disorder. Content Type Journal ArticleCategory Short CommunicationDOI 10.1007/s11325-009-0301-3Authors Larriany Maria Falsin Giglio, Universidade Federal do Rio Grande do Sul Molecular Psychiatry Laboratory and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre Porto Alegre BrazilPedro V. S. Magalhães, Universidade Federal do Rio Grande do Sul Molecular Psychiatry Laboratory and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre Porto Alegre BrazilMônica Levy Andersen, Universidade Federal de São Paulo Department of Psychobiology, Department of Pharmacology São Paulo BrazilJulio Cesar Walz, Universidade Federal do Rio Grande do Sul Molecular Psychiatry Laboratory and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre Porto Alegre BrazilLourenço Jakobson, Universidade Federal do Rio Grande do Sul Molecular Psychiatry Laboratory and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre Porto Alegre BrazilFlávio Kapczinski, Universidade Federal do Rio Grande do Sul Molecular Psychiatry Laboratory and INCT Translational Medicine, Hospital de Clínicas de Porto Alegre Porto Alegre Brazil Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Special considerations for obstructive sleep apnea in women

Special considerations for obstructive sleep apnea in women Content Type Journal ArticleCategory Letter to the EditorsDOI 10.1007/s11325-009-0303-1Authors Ahmed Salem BaHammam, King Saud University Sleep Disorders Center P.O. Box 225503 Riyadh 11324 Saudi Arabia Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Orthoimplants: an alternative treatment for SAHS?

Abstract Abstract Numerous sleep studies have been published recently regarding the use of intraoral devices (ODs) for the treatment of sleep apnea–hypopnea syndrome (SAHS). The effectiveness of these devices varies, however, according to the series studied (patient characteristics, parameters assessed, type of device, etc.). Two factors should always be assessed: the presence of an appropriate dental support and a possible temporomandibular joint pathology which can, on occasions, contraindicate the use of these devices. Objectives To use orthoimplants as orthodontic anchorages for intermaxillary elastic bands which allow a mandibular advancement to be performed as an alternative treatment to ODs in SAHS patients without appropriate dental support. Materials and methods Four orthoimplants were placed in an edentulous SAHS patient who did not tolerate continuous positive airway pressure (CPAP). The mandible is pushed forward using orthodontic elastic bands anchored to the orthoimplants. Results and conclusions Although more studies are still required, orthoimplants could be an alternative treatment for reducing snoring and the apnea–hypopnea index and increasing SaO2, which should be considered for patients who do not tolerate CPAP and lack appropriate dental support for attaching intraoral devices. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11325-009-0302-2Authors Felix de Carlos, Universidad de Oviedo, Clinica Universitaria de Odontologia Department of Surgery and Medical-Surgical Specialities, Area of Orthodontics, Faculty of Medicine C/Catedrático José Serrano s/n 33006 Oviedo SpainJuan Cobo, Universidad de Oviedo, Clinica Universitaria de Odontologia Department of Surgery and Medical-Surgical Specialities, Area of Orthodontics, Faculty of Medicine C/Catedrático José Serrano s/n 33006 Oviedo SpainMaria Pilar Fernandez Mondragon, EHU-UPV Patologia y terapeutica dental Leioa, Vizcaya SpainAlberto Alvarez Suarez, University of Oviedo Escuela Politécnica Superior de Ingeniería Asturias SpainJuan Calvo Blanco, Hospital Universitario central de Asturias Oviedo Spain Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Improvement in quality of life after adenotonsillectomy in a child with Prader Willi syndrome

Abstract Introduction We report a child with Prader Willi syndrome who developed obstructive sleep apnea (OSA). This patient underwent surgical treatment for OSA. There was improvement not only on her OSA but in her quality of life score as well. This report highlights the need for a comprehensive assessment in the management of patients with Prader Willi syndrome. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11325-009-0297-8Authors Chin-pang Wong, Kwong Wah Hospital Department of Paediatrics Kowloon Hong Kong SAR ChinaDaniel K. Ng, Kwong Wah Hospital Department of Paediatrics Kowloon Hong Kong SAR ChinaTracy M. Ma, Kwong Wah Hospital Clinical Psychology Unit Kowloon Hong Kong SAR ChinaChristy Chau, Queen Mary Hospital Department of Paediatrics and Adolescent Medicine Hong Kong Hong Kong Island ChinaPok-yu Chow, Kwong Wah Hospital Department of Paediatrics Kowloon Hong Kong SAR ChinaKa-li Kwok, Kwong Wah Hospital Department of Paediatrics Kowloon Hong Kong SAR China Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512

Snoring and the role of the dental practitioner

Snoring and the role of the dental practitioner Content Type Journal ArticleCategory Society NewsDOI 10.1007/s11325-009-0296-9 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 13 Journal Issue Volume 13, Number 4 / November, 2009

Collaborative care

Collaborative care Content Type Journal ArticleCategory EditorialDOI 10.1007/BF03045023Authors Laurence I. BarshWolfgang Schmidt-Nowara Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 4 Journal Issue Volume 4, Number 2 / June, 2000

Supine cephalometric analyses of an adjustable oral appliance used in the treatment of obstructive sleep apnea

Abstract Objective: To investigate the effects of the KlearwayTM appliance on the upper airway in patients with obstructive sleep apnea (OSA) in the supine position.Methods: Sixteen subjects (12 males and 4 females) were recruited cruited on the basis of baseline polysomnography with a documented Apnea and Hypopnea Index (AHI)>15 per hour. A second overnight sleep study was performed for each subject with the appliance in place. Baseline supine cephalometry was performed for each subject before the initial insertion of the appliance, and follow-up supine cephalometry was undertaken with the appliance in place.Results: The polysomnographic variables improved significantly, and the mean changes in overbite and overjet were 5.15 mm and 6.26 mm after insertion of the KlearwayTM appliance. The supine sagittal cross-sectional areas of the pharynx and the tongue significantly increased, while the linear distance from the hyoid position to the mandibular plane or the RGN-C3 line significantly decreased after insertion of the appliance. The ratio of the vertical pharyngeal length to the sagittal cross-sectional area of nassopharynx or tongue decreased significantly. When the subjects were evaluated on the basis of the after-insertion AHI, the group with good response (n=11) was found to be significantly younger than the group with the poor response (n=5). Similarly, the good responders revealed less prominent chins, larger tongue heights, and an increase in hypopharyngeal sagittal cross-sectional area after insertion of the appliance. There was a significant correlation between the improvement in AHI (%) and the supine middle airway space (r=−0.52, p<0.05).Conclusion: The mechanical effect of the KlearwayTM appliance on the upper airway and the stabilization of jaw posture may be important determinants of the efficacy of the appliance. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/BF03045025Authors Yuehua Liu, The University of British Columbia Department of Oral Health Sciences, Faculty of Dentistry 2199 Wesbrook Mall V6T 1Z3 Vancouver B.C. CanadaYoung-Chel Park, Yonsei University Department of Orthodontics, Dental College Seoul KoreaAlan A. Lowe, The University of British Columbia Department of Oral Health Sciences, Faculty of Dentistry 2199 Wesbrook Mall V6T 1Z3 Vancouver B.C. CanadaJohn A. Fleetham, The University of British Columbia Department of Medicine, Vancouver Hospital and Health Sciences Centre Vancouver Canada Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 4 Journal Issue Volume 4, Number 2 / June, 2000

Recently published abstracts and reviews

Recently published abstracts and reviews Content Type Journal ArticleDOI 10.1007/BF03045030Authors Kingman P. Strohl Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 4 Journal Issue Volume 4, Number 2 / June, 2000

Mandibular advancement modulates respiratory-related genioglossus electromyographic activity

Abstract The purpose of this study was to determine if mandibular advancement had any effects on the respiratory-related electromyographic (EMG) activity of the genioglossus (GG) muscle in normal adults for both the upright and supine positions. Spontaneous GG EMG activity during quiet nasal breathing was recorded in 5 mandibular positions: centric occlusion (CO), maximal protrusion (MAX), 25% (MAX25), 50%(MAX50), and 75%(MAX75) of MAX. The maximal GG EMG activities during inspiration (GGinsp) and minimal GG EMG activities during expiration (GGexp) were compared. The GGinsp and GGexp significantly increased with mandibular advancement in both body positions. Furthermore, there were significant differences in both GGinsp and GGexp between CO and more protruded mandibular positions. However, no significant differences were found in the GGinsp at MAX compared to that at MAX75’ and in the GGexp at MAX compared to those at MAX75 and MAX50. These results suggest that augmentation of the respiratory-related GG EMG activity with mandibular advancement diminishes the propensity of the upper airway to collapse. Moreover, the lack of any remarkable difference between the GGinsp at MAX75 and that at MAX may be relevant to the effectiveness of oral appliances in the treatment of obstructive sleep apnea. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/BF03045024Authors Satoru Tsuiki, Tokyo Medical and Dental University Maxillofacial Orthognathics, Maxillofacial Reconstruction, Division of Maxillofacial/Neck Reconstruction, Graduate School 5-45, Yushima I-chome, Bunkyo-ku 113-8549 Tokyo JapanTakashi Ono, Tokyo Medical and Dental University Maxillofacial Orthognathics, Maxillofacial Reconstruction, Division of Maxillofacial/Neck Reconstruction, Graduate School 5-45, Yushima I-chome, Bunkyo-ku 113-8549 Tokyo JapanTakayuki Kuroda, Tokyo Medical and Dental University Maxillofacial Orthognathics, Maxillofacial Reconstruction, Division of Maxillofacial/Neck Reconstruction, Graduate School 5-45, Yushima I-chome, Bunkyo-ku 113-8549 Tokyo Japan Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 4 Journal Issue Volume 4, Number 2 / June, 2000

Pressure stability with CPAP devices: A bench evaluation.

Related Articles Pressure stability with CPAP devices: A bench evaluation. Sleep Med. 2009 Nov 3; Authors: Louis B, Leroux K, Boucherie M, Isabey D, Grillier-Lanoir V, Fauroux B, Lofaso F BACKGROUND: Continuous positive airway pressure (CPAP) maintains a constant pressure to reduce the patient's work of breathing (WOB). The aim of this study was to measure the additional WOB imposed by four current CPAP devices during simulation of a difficult but commonly encountered clinical situation. METHOD: Flow contour, respiratory system compliance and total lung-airway resistance of a patient under CPAP were simulated. The devices were tested at a CPAP of 15cm H(2)O with a heated humidifier and a nasal pillow, which increased circuitry resistance and with and without a simulated unintentional leak. RESULTS: With no leak, positive end-expiratory pressure (PEEP) at the interface varied across devices from 14.0 to 15.3cm H(2)O. With a leak of 1L/s, PEEP varied from 11.5 to 17.1cm H(2)O. Imposed inspiratory WOB ranged from less than 0.1J/min to 0.45J/min with no leak, and the range broadened with leaking. Findings were similar for the imposed expiratory WOB. CONCLUSION: The performances of CPAP devices are variable. The device that calibrated for the pressure loss in the circuitry under dynamic conditions and made appropriate pressure adjustments outperformed the other devices. PMID: 19892594 [PubMed - as supplied by publisher]