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Showing papers on "Polysomnography published in 2007"



Journal ArticleDOI
TL;DR: Recent experiments reveal that following days of chronic restriction of sleep duration below 7 hours per night, significant daytime cognitive dysfunction accumulates to levels comparable to that found after severe acute total sleep deprivation.
Abstract: Adequate sleep is essential for general healthy functioning. This paper reviews recent research on the effects of chronic sleep restriction on neurobehavioral and physiological functioning and discusses implications for health and lifestyle. Restricting sleep below an individual's optimal time in bed (TIB) can cause a range of neurobehavioral deficits, including lapses of attention, slowed working memory, reduced cognitive throughput, depressed mood, and perseveration of thought. Neurobehavioral deficits accumulate across days of partial sleep loss to levels equivalent to those found after 1 to 3 nights of total sleep loss. Recent experiments reveal that following days of chronic restriction of sleep duration below 7 hours per night, significant daytime cognitive dysfunction accumulates to levels comparable to that found after severe acute total sleep deprivation. Additionally, individual variability in neurobehavioral responses to sleep restriction appears to be stable, suggesting a traitlike (possibly genetic) differential vulnerability or compensatory changes in the neurobiological systems involved in cognition. A causal role for reduced sleep duration in adverse health outcomes remains unclear, but laboratory studies of healthy adults subjected to sleep restriction have found adverse effects on endocrine functions, metabolic and inflammatory responses, suggesting that sleep restriction produces physiological consequences that may be unhealthy. Citation: Banks S; Dinges DF. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med 2007;3(5):519-528.

1,271 citations


Journal Article
TL;DR: PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures and must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist.
Abstract: Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea. At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM. The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards. Under the conditions specified above, PM may be used for unattended studies in the patient's home. A follow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography. Citation: Collop NA; Anderson WM; Boehlecke B; Claman D; Goldberg R; Gottlieb DJ; Hudgel D; Sateia M; Schwab R. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med 2007;3(7):737–747.

1,257 citations


Journal ArticleDOI
01 Apr 2007-Sleep
TL;DR: Actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and inpatients suspected of certain sleep disorders, and recent research utilizing actigraphy in the assessment and management of sleep disorders has allowed the development of evidence-based recommendations.
Abstract: Background: Actigraphy is increasingly used in sleep research and the clinical care of patients with sleep and circadian rhythm abnormalities. The following practice parameters update the previous practice parameters published in 2003 for the use of actigraphy in the study of sleep and circadian rhythms. Methods: Based upon a systematic grading of evidence, members of the Standards of Practice Committee, including those with expertise in the use of actigraphy, developed these practice parameters as a guide to the appropriate use of actigraphy, both as a diagnostic tool in the evaluation of sleep disorders and as an outcome measure of treatment efficacy in clinical settings with appropriate patient populations. Recommendations: Actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and inpatients suspected of certain sleep disorders. More specifically, actigraphy is indicated to assist in the evaluation of patients with advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and shift work disorder. Additionally, there is some evidence to support the use of actigraphy in the evaluation of patients suspected of jet lag disorder and non-24hr sleep/wake syndrome (including that associated with blindness). When polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea. In patients with insomnia and hypersomnia, there is evidence to support the use of actigraphy in the characterization of circadian rhythms and sleep patterns/ disturbances. In assessing response to therapy, actigraphy has proven useful as an outcome measure in patients with circadian rhythm disorders and insomnia. In older adults (including older nursing home residents), in whom traditional sleep monitoring can be difficult, actigraphy is indicated for characterizing sleep and circadian patterns and to document treatment responses. Similarly, in normal infants and children, as well as special pediatric populations, actigraphy has proven useful for delineating sleep patterns and documenting treatment responses. Conclusions: Recent research utilizing actigraphy in the assessment and management of sleep disorders has allowed the development of evidence-based recommendations for the use of actigraphy in the clinical setting. Additional research is warranted to further refine and broaden its

1,062 citations


Journal ArticleDOI
01 Jun 2007-Sleep
TL;DR: It is suggested that a greater percentage of patients will achieve normal functioning with longer nightly CPAP durations, but what constitutes adequate use varies between different outcomes.
Abstract: CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) CURRENTLY IS CONSIDERED THE MOST EFFECTIVE TREATMENT FOR OBSTRUCTIVE SLEEP APNEA (OSA) THIS device provides a pneumatic splint to prevent nocturnal airway collapse In randomized clinical trials that included use of sham CPAP as a placebo, treatment with this device has been shown to produce improvements in symptoms, quality of life, sleepiness, neuropsychological performance, and hypertension1 It has also been established that optimal effectiveness depends on consistent use Skipping even 1 night of treatment reverses improvements in daytime sleepiness, response performance, and the physiologic measure of disease severity, the apnea-hypopnea index (AHI)2–4 Although these benefits have been shown in randomized clinical trials, there is considerable variation in use of CPAP by patients in routine clinical practice,5–8 with approximately half using it consistently every night on average 6 hours per night and the other half skipping from 1 to 7 nights per week using it on average 35 hours per night5 It is not known, however, what the impact of differential use of CPAP is on effectiveness of therapy in routine clinical practice It may be that individuals with shorter hours of use are, in general, less well treated with respect to improvements in outcomes such as sleepiness, than are those with longer durations of use Alternatively, there might be individual variation in need for CPAP so that, even though some individuals have shorter hours of CPAP use, they are effectively treated with respect to sleepiness This individual variation might be mediated by biologic mechanisms similar to those of the recently described individual variation in response to sleep deprivation9 To address this question, we conducted a multisite effectiveness study in which we evaluated clinical status outcomes before and after 3 months of routine clinical care that included measurement of CPAP adherence during the entire follow-up period This multisite international study capitalized on patient heterogeneity with regard to average nightly use of CPAP, in order to estimate relationships between the likelihood of achieving a “normal” value on salient clinical measures of sleepiness and functional status and the “dose” of CPAP treatment received (ie, hours of CPAP use per night) Because there is no consensus regarding which outcomes are primary with regard to the assessment of CPAP treatment response, we chose those deemed most applicable to the clinical management of OSA—subjective sleepiness (Epworth Sleepiness Scale [ESS]10), physiologic sleepiness (Multiple Sleep Latency Test [MSLT]11), and disease-specific functional status (Functional Outcomes of Sleep Questionnaire [FOSQ]12) By evaluating the nightly duration of CPAP relative to obtaining normal values in those impaired on each of these measures, we provide data that the clinician can employ in determining optimal treatment response within the context of treatment goals, eg, to reduce daytime sleepiness, improve daily functioning, or both

848 citations


Journal ArticleDOI
TL;DR: In this paper, the authors validated a 10-item patient self-rating questionnaire (maximum total score 13 points) covering the clinical features of idiopathic REM sleep behavior disorder (RBD) and found that the questionnaire poorly discriminated patients with the most challenging differential diagnoses such as sleepwalking or epilepsy.
Abstract: Many patients with assumed idiopathic REM sleep behavior disorder (RBD) may actually represent an early clinical manifestation of an evolving neurodegenerative disorder, such as the alpha-synucleinopathies, Parkinson's disease or multiple system atrophy. Early detection of these patients is clinically relevant for long-term prospective as well as future neuroprotective studies. For this purpose, we validated a 10-item patient self-rating questionnaire (maximum total score 13 points) covering the clinical features of RBD. The RBD screening questionnaire (RBDSQ) was applied to 54 patients with polysomnographically confirmed RBD (29 men; mean age 53.7 +/- 15.8 years), 160 control subjects (81 men; mean age 50.8 +/- 15.5 years) in whom RBD was excluded by history and polysomnography (PSG, control group 1) and 133 unselected healthy subjects (58 men; mean age 46.9 +/- 12.3 years; no PSG, control group 2). In most subjects (n = 153) of control group 1, other sleep-wake disturbances were present. The mean RBDSQ score in the RBD group was 9.5 +/- 2.8 points compared with 4.6 +/- 3.0 points in control group 1 (P < 0.0001). Considering an RBDSQ score of five points as a positive test result, we found a sensitivity of 0.96 and a specificity of 0.56. The RBDSQ poorly discriminated patients with the most challenging differential diagnoses such as sleepwalking or epilepsy. In control group 2, the mean RBDSQ score (2.02 +/- 1.78) was significantly lower than in the RBD group (P < 0.0005), revealing a specificity of 0.92. Due to its high sensitivity, the RBDSQ appears to be particularly useful as a screening tool.

709 citations


Journal ArticleDOI
TL;DR: The results suggest that in heart failure patients, CPAP might improve both left ventricular ejection fraction and heart transplant–free survival if CSA is suppressed soon after its initiation.
Abstract: Background— In the main analysis of the Canadian Continuous Positive Airway Pressure (CPAP) for Patients with Central Sleep Apnea (CSA) and Heart Failure Trial (CANPAP), CPAP had no effect on heart transplant–free survival; however, CPAP only reduced the mean apnea-hypopnea index to 19 events per hour of sleep, which remained above the trial inclusion threshold of 15. This stratified analysis of CANPAP tested the hypothesis that suppression of CSA below this threshold by CPAP would improve left ventricular ejection fraction and heart transplant–free survival. Methods and Results— Of the 258 heart failure patients with CSA in CANPAP, 110 of the 130 randomized to the control group and 100 of the 128 randomized to CPAP had sleep studies 3 months later. CPAP patients were divided post hoc into those whose apnea-hypopnea index was or was not reduced below 15 at this time (CPAP-CSA suppressed, n=57, and CPAP-CSA unsuppressed, n=43, respectively). Their changes in left ventricular ejection fraction and heart tra...

621 citations


Journal ArticleDOI
01 Nov 2007-Sleep
TL;DR: This abbreviated version of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), a 16-item self-report measure designed to evaluate a subset of sleep related cognitions, should prove a useful instrument to evaluate the role ofSleep related beliefs and attitudes in insomnia and to monitor change on this cognitive variable as a potential moderator of treatment outcome.
Abstract: Study Objective: Sleep related cognitions (e.g., faulty beliefs and appraisals, unrealistic expectations, perceptual and attention bias) play an important role in perpetuating insomnia. This paper presents new psychometric data on an abbreviated version of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), a 16-item self-report measure designed to evaluate a subset of those sleep related cognitions.

587 citations


Journal ArticleDOI
TL;DR: In patients with HF, untreated OSA is associated with an increased risk of death independently of confounding factors, and this study was the first to report this effect.

572 citations


Journal ArticleDOI
TL;DR: In this paper, a meta-analysis of randomized CPAP was conducted to treat OSA in patients with hypertension and showed that continuous positive airway pressure (CPAP) is a very common risk factor for hypertension.
Abstract: Obstructive sleep apnea (OSA) is a very common risk factor for hypertension, and continuous positive airway pressure (CPAP) has been widely used to treat OSA. We conducted a meta-analysis of random...

533 citations


Journal ArticleDOI
01 Nov 2007-Sleep
TL;DR: In this paper, the first part of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine, are presented.
Abstract: Objective: This the first of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. In this first part of this paper, the general principles of circadian biology that underlie clinical evaluation and treatment are reviewed. We then report on the accumulated evidence regarding the evaluation and treatment of shift work disorder (SWD) and jet lag disorder (JLD).

Journal ArticleDOI
01 Nov 2007-Sleep
TL;DR: Circadian rhythm science has also pointed the way to rational interventions for CRSDs and these treatments have been introduced into the practice of sleep medicine with varying degrees of success.
Abstract: Objective This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Disorder (DSPD), Free-Running Disorder (FRD) and Irregular Sleep-Wake Rhythm ISWR). Methods A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. Results A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of CRSDs. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications. Conclusion Circadian rhythm science has also pointed the way to rational interventions for CRSDs and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.

Journal ArticleDOI
01 Apr 2007-Sleep
TL;DR: The data suggest that sleep continuity disturbance, but not simple sleep restriction, impairs endogenous pain-inhibitory function and increases spontaneous pain, supporting a possible pathophysiologic role of sleep disturbance in chronic pain.
Abstract: Impaired central pain modulation is implicated in the pathophysiology of chronic pain In this controlled experiment, we evaluated whether partial sleep loss altered endogenous pain inhibition and reports of spontaneous pain Thirty-two healthy females were studied polysomnographically for 7 nights On Nights 1-2 (Baseline), subjects slept undisturbed for 8 hours After Night 2, subjects were randomized to Control (N = 12), Forced Awakening (FA, N = 10), or Restricted Sleep Opportunity (RSO, N = 10) conditions Controls continued to sleep undisturbed FA underwent 8 forced awakenings (one per hour) on Nights 3-5 RSO subjects were yoked to FA on total sleep time (TST), receiving partial sleep deprivation by delayed bedtime On Night 6, both FA & RSO underwent 36 hours total sleep deprivation (TSD), followed by 11-hour recovery sleep (Night 7) Subjects completed twice-daily psychophysical assessments of mechanical pain thresholds and pain inhibition (Diffuse Noxious Inhibitory Controls), via use of a conditioning stimulus (ie, cold pressor) paradigm FA and RSO demonstrated 50% reductions in total sleep time and increases in nonpainful somatic symptoms during partial sleep deprivation While sleep deprivation had no effect on pain thresholds, during partial sleep deprivation the FA group demonstrated a significant loss of pain inhibition and an increase in spontaneous pain; neither of the other 2 groups showed changes in pain inhibition or spontaneous pain during partial sleep deprivation These data suggest that sleep continuity disturbance, but not simple sleep restriction, impairs endogenous pain-inhibitory function and increases spontaneous pain, supporting a possible pathophysiologic role of sleep disturbance in chronic pain

Journal ArticleDOI
01 Jul 2007-Chest
TL;DR: Knowing of common patterns of OSA may help to identify patients and guide therapy, and nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches.

Journal ArticleDOI
TL;DR: A meta-analytic review of polysomnographic studies comparing sleep in people with and without PTSD suggested that sleep abnormalities exist in PTSD, and that some of the inconsistencies in prior findings may be explained by moderating variables.
Abstract: Although sleep complaints are common among patients with Posttraumatic stress disorder (PTSD), polysomnographic studies examining sleep abnormalities in PTSD have produced inconsistent results. To clarify discrepant findings, we conducted a meta-analytic review of 20 polysomnographic studies comparing sleep in people with and without PTSD. Results showed that PTSD patients had more stage 1 sleep, less slow wave sleep, and greater rapid-eye-movement density compared to people without PTSD. We also conducted exploratory analyses aimed at examining potential moderating variables (age, sex, and comorbid depression and substance use disorders). Overall, studies with a greater proportion of male participants or a low rate of comorbid depression tended to find more PTSD-related sleep disturbances. These findings suggest that sleep abnormalities exist in PTSD, and that some of the inconsistencies in prior findings may be explained by moderating variables.

Journal ArticleDOI
TL;DR: There is a dose-dependent relationship between chronic opioid use and the development of a peculiar pattern of respiration consisting of central sleep apneas and ataxic breathing in patients who chronically used opioids.
Abstract: Background:Chronic opioid therapy for pain management has increased dramatically without adequate study of potential deleterious effects on breathing during sleep.Methods:A retrospective cohort stu...

Journal ArticleDOI
TL;DR: In this paper, a computer algorithm based on analysis of oxygen saturation measured by pulse oximetry was used to determine the probability of obstructive sleep apnea in patients with high probability.
Abstract: Results: The PSG and ambulatory groups had similar median BMI (38 kg/m 2 ), age (55 years), ESS score (14 points), and respiratory disturbance index (31 episodes of respiratory disturbance/h). Each episode is determined by a computer algorithm based on analysis of oxygen saturation measured by pulse oximetry. After 3 months, there were no differences in the primary outcome, AHI on CPAP (median, 3.2 vs. 2.5; difference, 0.8/h [95% CI, 0.9 to 2.3]) (P 0.31), between the PSG and ambulatory groups, or in the secondary outcomes, ESS score, Sleep Apnea Quality of Life Index, and CPAP. Adherence to CPAP therapy was better in the ambulatory group than in the PSG group (median, 5.4 vs. 6.0; difference, 1.12 h/night [CI, 2.0 to 0.2]) (P 0.021). Conclusions: In the initial management of patients with a high probability of obstructive sleep apnea, PSG confers no advantage over the ambulatory approach in terms of diagnosis and CPAP titration. The ambulatory approach may improve adherence to treatment. When access to PSG is inadequate, the ambulatory approach can be used to expedite management of patients most in need of treatment.

Journal ArticleDOI
01 Oct 2007-Sleep
TL;DR: The very low ability of actigraphy to detect wakefulness casts doubt on its validity to measure sleep quality in clinical populations with fragmented sleep or in situations where the sleep-wake cycle is challenged, such as jet lag and shift work.
Abstract: Study Objectives: To evaluate the ability of actigraphy compared to polysomnography (PSG) to detect wakefulness in subjects submitted to 3 sleep conditions with different amounts of wakefulness: a nocturnal sleep episode and 2 daytime recovery sleep episodes, one with placebo and one with caffeine. A second objective was to compare the ability of 4 different scoring algorithms (2 threshold algorithms and 2 regression analysis algorithms) to detect wake in the 3 sleep conditions.

Journal ArticleDOI
01 Jul 2007-Brain
TL;DR: It is suggested that sleep-wake disturbances, particularly EDS, fatigue and hypersomnia are common after TBI, and significantly impair quality of life, particularly in patients with post-traumatic EDS.
Abstract: Sleep-wake disturbances (SWD) are common after traumatic brain injury (TBI). In acute TBI, we recently found decreased CSF levels of hypocretin-1, a wake-promoting neurotransmitter. In the present study, we aimed to delineate the frequency and clinical characteristics of post-traumatic SWD, to assess CSF hypocretin-1 levels 6 months after TBI, and to identify risk factors for posttraumatic SWD. A total of 96 consecutive patients were enrolled within the first 4 days after TBI. Six months later, out of 76 TBI patients, who did not die and who did not move to foreign countries, we included 65 patients (86%, 53 males, mean age 39 years) in our study. Patients were examined using interviews, questionnaires, clinical examinations, computed tomography of the brain, laboratory tests (including CSF hypocretin-1 levels, and HLA typing), conventional polysomnography, maintenance of wakefulness and multiple sleep latency tests (MSLT) and actigraphy. Potential causes of post-traumatic SWD were assessed according to international criteria. New-onset sleep-wake disturbances following TBI were found in 47 patients (72%): subjective excessive daytime sleepiness (EDS; defined by the Epworth Sleepiness Scale > or = 10) was found in 18 (28%), objective EDS (as defined by mean sleep latency or = 2 h per 24 h compared to pre-TBI) in 14 (22%) patients and insomnia in 3 patients (5%). In 28 patients (43% of the study population), we could not identify a specific cause of the post-traumatic SWD other than TBI. Low CSF hypocretin-1 levels were found in 4 of 21 patients 6 months after TBI, as compared to 25 of 27 patients in the first days after TBI. Hypocretin levels 6 months after TBI were significantly lower in patients with post-traumatic EDS. There were no associations between post-traumatic SWD and severity or localization of TBI, general clinical outcome, gender, pathological neurological findings and HLA typing. However, post-traumatic SWD correlated with impaired quality of life. These results suggest that sleep-wake disturbances, particularly EDS, fatigue and hypersomnia are common after TBI, and significantly impair quality of life. In almost one out of two patients, post-traumatic SWD appear to be directly related to the TBI. An involvement of the hypocretin system in the pathophysiology of post-traumatic SWD appears possible. Other risk factors predisposing towards the development of post-traumatic SWD were not identified.

Journal ArticleDOI
TL;DR: It is concluded that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring andSleep apnea.
Abstract: Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance. These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized. This review focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index or respiratory disturbance index), ability of oral appliances to reduce snoring, effect of oral appliances on daytime function, comparison of oral appliances with other treatments (continuous positive airway pressure and surgery), side effects, dental changes (overbite and overjet), and long-term compliance. We found that the success rate, defined as the ability of the oral appliances to reduce apnea/hypopnea index to less than 10, is 54%. The response rate, defined as at least 50% reduction in the initial apnea/hypopnea index (although it still remained above 10), is 21%. When only the results of randomized, crossover, placebo-controlled studies are considered, the success and response rates are 50% and 14%, respectively. Snoring was reduced by 45%. In the studies comparing oral appliances to continuous positive airway pressure (CPAP) or to uvulopalatopharyngoplasty (UPPP), an appliance reduced initial AHI by 42%, CPAP reduced it by 75%, and UPPP by 30%. The majority of patients prefer using oral appliance than CPAP. Use of oral appliances improves daytime function somewhat; the Epworth sleepiness score (ESS) dropped from 11.2 to 7.8 in 854 patients. A summary of the follow-up compliance data shows that at 30 months, 56–68% of patients continue to use oral appliance. Side effects are relatively minor but frequent. The most common ones are excessive salivation and teeth discomfort. Efficacy and side effects depend on the type of appliance, degree of protrusion, vertical opening, and other settings. We conclude that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring and sleep apnea.

Journal ArticleDOI
TL;DR: The results suggest that television and computer game exposure affect children's sleep and deteriorate verbal cognitive performance, which supports the hypothesis of the negative influence of media consumption on children'sSleep, learning, and memory.
Abstract: OBJECTIVE.Television and computer game consumption are a powerful influence in the lives of most children. Previous evidence has supported the notion that media exposure could impair a variety of behavioral characteristics. Excessive television viewing and computer game playing have been associated with many psychiatric symptoms, especially emotional and behavioral symptoms, somatic complaints, attention problems such as hyperactivity, and family interaction problems. Nevertheless, there is insufficient knowledge about the relationship between singular excessive media consumption on sleep patterns and linked implications on children. The aim of this study was to investigate the effects of singular excessive television and computer game consumption on sleep patterns and memory performance of children. METHODS.Eleven school-aged children were recruited for this polysomnographic study. Children were exposed to voluntary excessive television and computer game consumption. In the subsequent night, polysomnographic measurements were conducted to measure sleep-architecture and sleep-continuity parameters. In addition, a visual and verbal memory test was conducted before media stimulation and after the subsequent sleeping period to determine visuospatial and verbal memory performance. RESULTS.Only computer game playing resulted in significant reduced amounts of slow-wave sleep as well as significant declines in verbal memory performance. Prolonged sleep-onset latency and more stage 2 sleep were also detected after previous computer game consumption. No effects on rapid eye movement sleep were observed. Television viewing reduced sleep efficiency significantly but did not affect sleep patterns. CONCLUSIONS.The results suggest that television and computer game exposure affect children’s sleep and deteriorate verbal cognitive performance, which supports the hypothesis of the negative influence of media consumption on children’s sleep, learning, and memory.

Journal ArticleDOI
01 Feb 2007-Chest
TL;DR: The data suggest that aldosterone excess may contribute to OSA severity in subjects with resistant hypertension and in those with equally severe OSA but without resistant hypertension serving as control subjects.

Journal ArticleDOI
TL;DR: The SRBD scale may predict OSA-related neurobehavioral morbidity and its response to adenotonsillectomy as well or better than does polysomnography.
Abstract: Objectives To further validate a questionnaire about symptoms of childhood obstructive sleep apnea (OSA) and to compare the questionnaire with polysomnography in their ability to predict outcomes of adenotonsillectomy. Design Retrospective analysis of data from a longitudinal study. Setting University-based sleep disorders laboratory. Participants The Washtenaw County Adenotonsillectomy Cohort, comprising 105 children aged 5.0 to 12.9 years at entry. Intervention Parents completed the 22-item Sleep-Related Breathing Disorder (SRBD) scale of the Pediatric Sleep Questionnaire, and children underwent polysomnography before and 1 year after clinically indicated adenotonsillectomy (n = 78, usually for suspected OSA) or unrelated surgical care (n = 27). Main Outcome Measures Findings from commonly used hyperactivity ratings, attention tests, and sleepiness tests. Results At baseline, a high SRBD scale score (1 SD above the mean) predicted an approximately 3-fold increased risk of OSA on polysomnography (odds ratio, 2.80; 95% confidence interval, 1.68-4.68). One year later, OSA and symptoms had largely resolved, but a high SRBD score still predicted an approximately 2-fold increased risk of residual OSA on polysomnography (odds ratio, 1.89; 95% confidence interval, 1.13-3.18). Compared with several standard polysomnographic measures of OSA, the baseline SRBD scale better predicted initial hyperactivity ratings and 1-year improvement, similarly predicted sleepiness and its improvement, and similarly failed to predict attention deficit or its improvement. Conclusions The SRBD scale predicts polysomnographic results to an extent useful for research but not reliable enough for most individual patients. However, the SRBD scale may predict OSA-related neurobehavioral morbidity and its response to adenotonsillectomy as well or better than does polysomnography.

Journal ArticleDOI
TL;DR: Evaluated the outcome of adenotonsillectomy for obstructive sleep apnea in children using objective data from polysomnography supplemented by subjective proxy reports from the OSA‐18 quality of life instrument.
Abstract: Objective:To evaluate the outcome of adenotonsillectomy for obstructive sleep apnea (OSA) in children using objective data from polysomnography supplemented by subjective proxy reports from the OSA-18 quality of life instrument.Study Design:Prospective cohort study.Methods:Children 3 to 14 years of

Journal ArticleDOI
TL;DR: The Pediatric Task Force provides an evidence-based review of the age-related development of the polysomnographic features of sleep in neonates, infants, and children, assessing the reliability and validity of these features, and assessing alternative methods of measurement.
Abstract: Age is probably the single most crucial factor determining how humans sleep Age and level of vigilance significantly influence the electroencephalogram (EEG) and the polysomnogram (PSG) The Pediatric Task Force provide an evidence-based review of the age-related development of the polysomnographic features of sleep in neonates, infants, and children, assessing the reliability and validity of these features, and assessing alternative methods of measurement We used this annotated supporting text to develop rules for scoring sleep and arousals in infants and children A pediatric EEG or PSG can only be determined to be normal by assessing whether the EEG patterns are appropriate for maturational age Sleep in infants at term can be scored as NREM and REM sleep because all the polysomnographic and EEG features of REM sleep are present and quiet sleep, if not NREM sleep, is at least "not REM sleep" The dominant posterior rhythm (DPR) of relaxed wakefulness increases in frequency with age: (1) 35-45 Hz in 75% of normal infants by 3-4 months post-term; (2) 5-6 Hz in most infants 5-6 months post-term; 3) 6 Hz in 70% of normal children by 2 months of age; and 3) 8 Hz (range 75-95 Hz) in 82% of normal children age 3 years, 9 Hz in 65% of 9-year-olds, and 10 Hz in 65% of 15-year-old controls Sleep spindles in children occur independently at two different frequencies and two different scalp locations: 110-1275 Hz over the frontal and 130-1475 Hz over the centroparietal electrodes; these findings are most prominent in children younger than 13 years Centroparietal spikes are often maximal over the vertex (Cz), less often maximal over the left central (C3) or right central (C4) EEG derivation About 50% of sleep spindles within a particular infant's PSG are asynchronous before 6 months of age, 30% at 1 year Based on this, we recommend that: (1) sleep spindles be scored as a polysomnographic signature of NREM stage 2 sleep (N2) at whatever age they are first seen in a PSG, typically present by 2 to 3 months post-term; (2) identify and score sleep spindles from the frontal and centroparietal EEG derivations, especially in infants and children younger than 13 years NREM sleep in an infant or child can be scored if the dominant posterior rhythm occupies 20% of the 30-second epoch contain 05 to 2 Hz >75 microV (usually 100-400 microV) activity as N3 The DPR should be scored in the EEG channel that is best observed, (typically occipital), but DPR reactive to eye opening can be seen in central electrodes Because sleep spindles occur independently over the frontal and central regions in children, they should be scored whether they occur in the frontal or central regions Because sleep spindles are asynchronous before age 2 years, simultaneous recording of left and right frontal and central activity may be warranted in children 1-2 years of age Simultaneous recording of left, right, and midline central electrodes may be appropriate because of the asynchronous nature of sleep spindles before age 2 years, but reliability testing is needed Evidence has shown that the PSG cannot reliably be used to identify neurological deficits or to predict behavior or outcome in infants because of significant diversity of results, even in normal infants Normal sleep EEG patterns and architecture are present in the first year of life, even in infants with severe neurological compromise Increasing evidence suggests that sleep and its disorders play critical roles in the development of healthy children and healthy adults thereafter Reliability studies comparing head-to-head different scoring criteria, recording techniques, and derivations are needed so that future scoring recommendations can be based on evidence rather than consensus opinion We need research comparing clinical outcomes with PSG measures to better inform clinicians and families exactly what meaning a PSG has in evaluating a child's suspected sleep disorder

Journal ArticleDOI
TL;DR: This study demonstrates that the ApneaLink device provides reliable information, is a simple, easy-to-use device, and is highly sensitive and specific in calculating AHI, when compared with the AHI obtained from full polysomnography.
Abstract: Sleep apnea is a common disorder that affects more than 20 million adult Americans.1 It is associated with poor sleep quality, excessive daytime sleepiness,2 and decreased quality of life.3 Sleep apnea has been shown to have an increased prevalence in, or association with, morbid conditions such as heart failure,4,5 hypertension,6,7 cardiovascular disease,8,9 cerebrovascular disease,10 and insulin resistance.11,12 Studies have also demonstrated that sleep apnea is associated with increased rates of traffic accidents13 and has been identified as a major public health concern.14 Although effective treatment for sleep apnea is available, referral for diagnosis and treatment of sleep apnea may be difficult in some settings due to limited access to or availability of sleep specialists and sleep laboratories for diagnostic evaluation.15 In areas in which access is not an issue, some patients may be unwilling to undergo a sleep-laboratory study, even when recommended by their physician. Current estimates reveal that 93% of women and 82% of men with moderate to severe sleep apnea remain undiagnosed.16 Given the prevalence of the disorder in the general population, and the increased prevalence in populations with certain comorbid conditions, screening studies for sleep apnea may play an important role. Although full polysomnography (PSG) is the standard diagnostic test for sleep apnea,17 the use of a screening device may allow physicians to screen for sleep apnea in a variety of settings, such as patients' homes, hospitals, or extended-care facilities, allowing more effective triaging for sleep center diagnostic testing. A number of devices are now commercially available to screen patients for sleep apnea outside the traditional sleep-laboratory setting. These devices include single-channel and multi-channel recorders; however, there are limited data available regarding their efficacy as screening or diagnostic tools for sleep apnea, compared with PSG.18, 19 The aim of this study was to examine the accuracy of the apnea-hypopnea index (AHI) provided by the ApneaLink™ (ResMed Corporation, Poway, Calif), a single-channel recording device, against that obtained during simultaneous PSG, and to validate the ApneaLink device as a screening tool for sleep apnea in clinical practice.

Journal ArticleDOI
TL;DR: There is a high prevalence of sleep disorders and of excessive daytime sleepiness in subjects with TBI and there is a clinical indication for NPSG and MSLT.
Abstract: STUDY OBJECTIVES: Determine prevalence and consequences of sleepiness and sleep disorders after traumatic brain injury (TBI). METHODS: Prospective evaluation with polysomnography (PSG), multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS) and neuropsychological testing including Psychomotor Vigilance Test (PVT), Profile of Mood States (POMS), and Functional Outcome of Sleep Questionnaire (FOSQ). SETTING: Three academic medical centers with level I trauma centers, accredited sleep disorders centers, and rehabilitative medicine programs. Participants; Eighty-seven (87) adults at least 3 months post TBI. Measurements And Results: Abnormal sleep studies were found in 40 subjects (46%), including 20 (23%) with obstructive sleep apnea (OSA), 10 (11%) with posttraumatic hypersomnia (PTH), 5 (6%) with narcolepsy, and 6 (7%) with periodic limb movements in sleep (PLMS). Among all subjects, 22 (25%) were found to have objective excessive daytime sleepiness with MSLT score or =30, p Language: en

Journal ArticleDOI
TL;DR: Self‐reported sleep disturbances are present in over 80% of patients with depression, however, sleep electroencephalography findings, based on overnight polysomnography have not always differentiated depressed patients from healthy individuals.
Abstract: Objective: Self-reported sleep disturbances are present in over 80% of patients with depression. However, sleep electroencephalography (EEG) findings, based on overnight polysomnography have not always differentiated depressed patients from healthy individuals. Method: The present paper will review the findings on sleep EEG studies in depression highlighting how recent technological and methodological advances have impacted on study outcomes. Results: The majority of studies, including our own work, do indicate that sleep homeostasis and sleep EEG rhythms are abnormal in depression, but the sleep disturbances were strongly moderated by gender and age. Melancholic features of depression correlated significantly with low slow-wave activity in depressed men, but not in depressed women. Women with depression showed low temporal coherence of sleep EEG rhythms but the presence or absence of melancholic features did not influence correlations. Conclusion: Diagnostic classification schemas and clinical features of depression may influence sleep EEG findings, but gender may be a more important consideration.

Journal ArticleDOI
01 Feb 2007-Brain
TL;DR: The restored motor control during REM sleep suggests a transient 'levodopa-like' reestablishment of the basal ganglia loop and parkinsonism may disappear by REM sleep-related disjunction between pyramidal and extrapyramidal systems.
Abstract: Although normal subjects do not move during REM sleep, patients with Parkinson's disease may experience REM sleep behaviour disorder (RBD). The characteristics of the abnormal REM sleep movements in RBD have, however, not been studied. We interviewed one hundred consecutive non-demented patients with Parkinson's disease and their bed partners using a structured questionnaire assessing the presence of RBD. They rated the quality of movements, voice and facial expression during RBD as being better, equal or worse than in awake ON levodopa condition. Night-time sleep and movements were video-monitored during polysomnography in 51 patients to evaluate the presence of bradykinesia, tremor and hypophonia during REM sleep. Fifty-nine patients had clinical RBD with 53/59 bed partners able to evaluate them. All 53 (100%) reported an improvement of at least one component of motor control during RBD. By history, movements were improved in 87% patients (faster, 87%; stronger, 87%; smoother, 51%), speech was better in 77% patients (more intelligible, 77%; louder, 38%; better articulated, 57%) and facial expression was normalized in 47% patients. Thirty-eight per cent of bed partners reported that movements were 'much better', even in the most disabled patients. The video-monitored purposeful movements in REM sleep were also surprisingly fast, ample, coordinated and symmetrical, without obvious sign of parkinsonism. The movements were, however, jerky, violent and often repetitive. While all patients had asymmetrical parkinsonism when awake, most of the time they used the more disabled arm, hand and leg during the RBD (P = 0.04). Movements involved six times as often the upper limbs and the face as the lower limbs (OR: 5.9, P = 0.004). The percentage of time containing tremor EMG activity decreased with sleep stages from 34.9 +/- 15.5% during wakefulness, to 3.6 +/- 5.7% during non-REM sleep stages 1-2, 1.4 +/- 3.0% during non-REM sleep stages 3-4, and 0.06 +/- 0.2% during REM sleep (in this last case, it was subclinical tremor). The restored motor control during REM sleep suggests a transient 'levodopa-like' reestablishment of the basal ganglia loop. Alternatively, parkinsonism may disappear by REM sleep-related disjunction between pyramidal and extrapyramidal systems. We suggest the following model: the movements during the RBD would be generated by the motor cortex and would follow the pyramidal tract bypassing the extrapyramidal system. These movements would eventually be transmitted to lower motor neurons because of brainstem lesions interrupting the pontomedullary pathways which mediate the REM sleep atonia.

Journal Article
TL;DR: Single doses of oral opioid medications can significantly affect sleep architecture in healthy adults, and observed reductions in slow-wave sleep following opioid administration may have important implications for the pathogenesis of opioid-use related fatigue.
Abstract: STUDY OBJECTIVES The effect of opioid medications on sleep architecture has been demonstrated in patients with comorbid pain or opioid addiction. This study examined whether commonly used opioid medications have an adverse effect on sleep architecture in healthy adults. METHODS Forty-two healthy subjects were examined with polysomnography after a bedtime dose of placebo, sustained-release morphine sulfate (15 mg), or methadone (5 mg) on each of 3 different nights in a double-blind multiple crossover study in a sleep laboratory in the General Clinical Research Center at an academic medical center. RESULTS Both opioid drugs significantly reduced deep sleep and increased stage 2 sleep (both p < .01); neither had an effect on sleep efficiency, wake after sleep onset, or total sleep time. CONCLUSIONS Single doses of oral opioid medications can significantly affect sleep architecture in healthy adults, and observed reductions in slow-wave sleep following opioid administration may have important implications for the pathogenesis of opioid-use related fatigue.