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Chronotherapy With Nifedipine GITS in Hypertensive Patients: Improved Efficacy and Safety With Bedtime Dosing.

Am J Hypertens. 2008 Jul 3;

Authors: Hermida RC, Ayala DE, Mojón A, Fernández JR

BackgroundPrevious studies have shown that the circadian pattern of blood pressure (BP) remains unchanged after either morning or evening dosing of several calcium-channel blockers (CCBs), including amlodipine, isradipine, verapamil, nitrendipine, and cilnidipine. This trial investigated the administration-time dependent antihypertensive efficacy of the slow-release, once-a-day nifedipine gastrointestinal-therapeutic-system (GITS) formulation.MethodsWe studied 180 untreated hypertensives (86 men and 94 women), 52.5 +/- 10.7 years of age, randomly assigned to receive nifedipine (30 mg/day) as a monotherapy either upon awakening or at bedtime. BP was measured for 48 h before and after 8 weeks of treatment.ResultsThe BP reduction after treatment was significantly larger with bedtime dosing mainly during night time sleep (P < 0.012). The number of patients with controlled ambulatory BP after treatment was greater with bedtime than morning treatment (P = 0.016). The baseline prevalence of nondipping was unaltered after ingestion of nifedipine on awakening, but reduced from 51 to 35% after bedtime dosing (P = 0.025). The morning surge of BP, a risk factor for stroke, was significantly reduced (P < 0.001) only after bedtime administration of nifedipine. Bedtime in comparison to awakening-time ingestion of nifedipine was also associated with a reduction in the incidence of edema from 13 to 1% (P < 0.001).ConclusionsThe increased efficacy on ambulatory BP as well as the significantly reduced prevalence of edema after bedtime as compared to morning ingestion of nifedipine should be taken into account when prescribing this medication to patients with essential hypertension.American Journal of Hypertension (2008). doi 10.1038/ajh.2008.216American Journal of Hypertension (2008). doi 10.1038/ajh.2008.216.

PMID: 18600215 [PubMed - as supplied by publisher]

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Sex steroidal hormones and respiratory control.

Respir Physiol Neurobiol. 2008 Jun 12;

Authors: Behan M, Wenninger JM

There is a growing public awareness that sex hormones can have an impact on a variety of physiological processes. Yet, despite almost a century of research, we still do not have a clear picture as to the effects of sex hormones on the regulation of breathing. Considerable data has accumulated showing that estrogen, progesterone and testosterone can influence respiratory function in animals and humans. Several disorders of breathing such as obstructive sleep apnea (OSA) and sudden infant death syndrome (SIDS) show clear sex differences in their prevalence, lending weight to the importance of sex hormones in respiratory control. This review focuses on questions such as: how early do sex hormones influence breathing? Which is the most effective? Where do sex hormones exert their effects? What mechanisms are involved? Are there age-associated changes? A clearer understanding of how sex hormones influence the control of breathing could enable sex- and age-specific therapeutic interventions for diseases of the respiratory control system.

PMID: 18599386 [PubMed - as supplied by publisher]

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Functional connectivity of the sensorimotor area in naturally sleeping infants.

Brain Res. 2008 May 28;

Authors: Liu WC, Flax JF, Guise KG, Sukul V, Benasich AA

Patterns of cortical functional connectivity in normal infants were examined during natural sleep by observing the time course of very low frequency oscillations. Such oscillations represent fluctuations in blood oxygenation level and cortical blood flow thus allowing computation of neurophysiologic connectivity. Structural and resting-state information were acquired for 11 infants, with a mean age of 12.8 months, using a GE 1.5 T MR scanner. Resting-state data were processed and significant functional connectivity within the sensorimotor area was identified using independent component analysis. Unilateral functional connectivity in the developing sensory-motor cortices was observed. Power spectral analysis showed that slow frequency oscillations dominated the hemodynamic signal at this age, with, on average, a peak frequency for all subjects of 0.02 Hz. Our data suggest that there is more intrahemispheric than interhemispheric connectivity in the sensorimotor area of naturally sleeping infants. This non-invasive imaging technique, developed to allow reliable scanning of normal infants without sedation, enabled computation of neurophysiologic connectivity for the first time in naturally sleeping infants. Such techniques permit elucidation of the role of slow cortical oscillations during early brain development and may reveal critical information regarding the normative development and lateralization of brain networks across time.

PMID: 18599026 [PubMed - as supplied by publisher]

Thermal welding technology vs ligasure tonsillectomy: a comparative study.

Am J Otolaryngol. 2008 Jul-Aug;29(4):238-41

Authors: Karatzanis A, Bourolias C, Prokopakis E, Panagiotaki I, Velegrakis G

OBJECTIVE: The objective of the study was to compare and assess parameters related to thermal welding tonsillectomy (TWT) vs ligasure tonsillectomy (LT). STUDY DESIGN: This was a prospective randomized study. METHOD: A prospective study was conducted on 143 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy or any procedure together with tonsillectomy and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the TWT or LT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS: There was no measurable intraoperative bleeding in any group. No significant difference regarding mean operative time was noted. Mean postoperative pain score was significantly lower in the TWT group. Late postoperative hemorrhage was noted in 1 subject of the TWT and 2 subjects of the LT group. Mild uvula edema was significantly lower in the TWT group. CONCLUSION: Both TWT and LT procedures provide sufficient hemostasis and reduced operative time, although lower postoperative pain and mild uvula edema were noted in TWT procedures. Furthermore, since both methods use single-use instruments, they provide safety against diseases such as Creutzfeld-Jakob disease.

PMID: 18598834 [PubMed - in process]

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Probiotics in the intensive care unit: why controversies and confusion abound.

Crit Care. 2008 Jun 24;12(3):160

Authors: Morrow LE, Kollef MH

ABSTRACT: Probiotics are living microorganisms that, when administered in adequate amounts, confer health benefits on the host. Because probiotics are not marketed as pharmaceuticals, they are commercially available without rigorous scientific documentation of their efficacy for many health-related claims. Results from existing clinical trials are both confusing and controversial. The evidence base is relatively limited, includes studies with varied designs, assesses multiple probiotic preparations across discrepant disease states, and provides conflicting results. Recent advances in the delineation of probiotics' mechanisms of action offer the opportunity to construct a more logical framework within which future trials are designed.

PMID: 18598379 [PubMed - as supplied by publisher]

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Predictors of health-related quality of life in patients with obstructive sleep apnoea.

J Adv Nurs. 2008 Jul;63(1):54-63

Authors: Ye L, Liang ZA, Weaver TE

Aim. This paper is a report of a study to identify the common symptoms and demographic and physiological factors of obstructive sleep apnoea that are predictive of health-related quality of life in a Chinese population. Background. Health-related quality of life impairment in obstructive sleep apnoea is an increasingly important consideration, but little is known about the factors that influence quality of life in this population. Method. A total of 108 Chinese patients with newly diagnosed obstructive sleep apnoea were recruited in 2003 and assessed for health-related quality of life, daytime sleepiness, depression and anxiety. Associations between symptoms, demographic and physiological factors and quality of life were examined by Pearson linear correlation. Hierarchical multiple regression were used to determine predictors of overall quality of life and its dimensions. Results. Forty-six patients (42.6%) had depressed mood and 21 (19.4%) were anxious. Fifty-nine (54.6%) were hypersomnolent. The severity of symptoms of sleepiness, depression, and anxiety was statistically significantly inversely correlated with each domain and the total score for health-related quality of life. No statistically significant correlation was observed between disease severity and quality of life. Controlling for age and gender, anxiety and sleepiness predicted 45.2% of the variance of overall quality of life (R(2) = 0.452, P < 0.001). Anxiety was the strongest predictor of overall and each domain of health-related quality of life. Conclusion. Assessment of mood in patients with obstructive sleep apnoea should be an essential part of nursing practice. Comprehensive evaluation of symptoms, especially mood disturbance, is important for improving quality of life for these patients.

PMID: 18598251 [PubMed - as supplied by publisher]

Thioctic Acid and acetyl-L-carnitine in the treatment of sciatic pain caused by a herniated disc : a randomized, double-blind, comparative study.

Clin Drug Investig. 2008;28(8):495-500

Authors: Memeo A, Loiero M

BACKGROUND and objective: Sciatica is a painful condition characterized by radiating leg pain that most commonly originates from a herniated disc in the lumbar or sacral spine. Although sciatic pain is typically self-limiting, pharmacological analgesic therapy forms the mainstay of treatment. Acetyl-L-carnitine (levacecarnine; ALC) is a naturally occurring substance that promotes peripheral nerve regeneration and has been shown to have analgesic effects in patients with peripheral neuropathies of diabetic, HIV-related or chemotherapeutic origin. Thioctic acid, a key compound in oxidative metabolism, has antioxidant properties that may help the recovery of nerve functionality and decrease neuropathic pain. This study aimed to compare, for the first time, the efficacy of oral treatment with ALC or thioctic acid in patients with peripheral neuropathic (sciatic) pain associated with a herniated disc. M ethods: This was a randomized, double-blind trial conducted in a hospital setting. A total of 64 consecutive patients (mean age 61 years; range 29-85) with acute backache and moderate sciatica were recruited. Patients in group 1 (n = 33) received ALC 1180 mg/day; patients in group 2 (n = 31) received thioctic acid 600 mg/day. The study period was 60 days. The primary efficacy endpoint was change in clinical signs and symptoms of sciatica, as measured on the Neuropathy Impairment Score in the Lower Limbs (NIS-LL) questionnaire, the Neuropathy Symptoms and Change in the Lower Limbs (NSC-LL) questionnaire, and the Total Symptom Score (TSS) questionnaire. The secondary efficacy endpoint was improvement in neurological deficit (as measured by electromyography) compared with baseline. RESULTS: Both treatments produced significant improvements from baseline in neuropathy on electromyography at day 60, and greater mean improvements were observed with thioctic acid (-0.19 +/- 0.29 vs baseline) than with ALC (-0.09 +/- 0.40 vs baseline), although the between-group difference was not statistically significant. Thioctic acid produced significantly greater mean improvements than ALC from baseline for NIS-LL (-2.52 +/- 1.50 vs -1.48 +/- 1.37, respectively), NSC-LL (-2.16 +/- 1.37 vs 1.42 +/- 1.37, respectively) and TSS (-1.90 +/- 1.08 vs 1.18 +/- 1.01, respectively) scores (p < 0.05 for all comparisons). More patients receiving thioctic acid than ALC reported a decreased need for analgesia (71.0% vs 45.5%, respectively; p < 0.05) and neither treatment impacted significantly on sleep quality. CONCLUSIONS: Thioctic acid 600 mg/day appears to be at least as effective as ALC in the treatment of sciatic pain caused by a herniated disc and may be associated with an improvement in symptom scores and reduced need for analgesia. However, because of the limited number of patients evaluated and the lack of a placebo control in this trial, further studies are warranted in order to provide more definitive results.

PMID: 18598095 [PubMed - in process]

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Armodafinil for excessive daytime sleepiness.

Drugs Today (Barc). 2008 Jun;44(6):395-414

Authors: Nishino S, Okuro M

Armodafinil is the (R)-enantiomer of the wakepromoting compound modafinil (racemic), with a considerably longer half-life of 10-15 hours. Armodafinil (developed by Cephalon, Frazer, PA, USA) was approved in June 2007 for the treatment of excessive sleepiness associated with narcolepsy, obstructive sleep apnea syndrome and shift work disorder, and the indications are the same as those for modafinil. Like modafinil, the mechanisms of action of armodafinil are not fully characterized and are under debate. Clinical trials in these sleep disorders demonstrated an enhanced efficacy for wake promotion (wake sustained for a longer time period using doses lower than those of modafinil). The safety profile is consistent with that of modafinil, and armodafinil is well tolerated by the patients. Like modafinil, armodafinil is classified as a non-narcotic Schedule IV compound. Many patients with excessive sleepiness may prefer the longer duration of effect and may have better compliance (with low doses) with armodafinil. The commercial challenge to armodafinil may come from generic modafinil, which may become available in 2012, as well as from classical amphetamine and amphetamine-like compounds (for the treatment of narcolepsy).

PMID: 18596995 [PubMed - in process]

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Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: A first evaluation.

Crit Care Med. 2008 Jul 1;

Authors: Ista E, van Dijk M, Gamel C, Tibboel D, de Hoog M

OBJECTIVE:: To establish frequencies of benzodiazepines and opioids withdrawal symptoms, and correlations with total doses and duration of administration. DESIGN:: A prospective, repeated-measures design. SETTING:: Two pediatric intensive care units in a university children's hospital. PATIENTS:: Seventy-nine children, aged 0 days-16 yrs, who received intravenous midazolam and/or opioids for >5 days. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Pediatric intensive care unit nurses assessed withdrawal symptoms using the Sophia Benzodiazepine and Opioid Withdrawal Checklist, which includes all withdrawal symptoms (n = 24) described in the pediatric literature. Over 6 months, 2188 observations in 79 children were recorded. Forty-two percent of observations were performed within 24 hrs after tapering off or discontinuation of medication. Symptoms representing overstimulation of the central nervous system, such as anxiety, agitation, grimacing, sleep disturbance, increased muscle tension, and movement disorder, were observed in >10% of observations. Of symptoms reflecting gastrointestinal dysfunction, diarrhea and gastric retention were most frequently observed. Tachypnea, fever, sweating, and hypertension as manifestations of autonomic dysfunction were observed in >13% of observations. The Spearman's rank-correlation coefficient between total doses of midazolam and maximum sum score (of the Sophia Benzodiazepine and Opioid Withdrawal Checklist) was .51 (p < 0.001). The correlation between total doses of opioids and the maximum sum score was .39 (p < 0.01). A significant correlation (.52; p < 0.001) was also found between duration of use and maximum sum score. CONCLUSIONS:: This is the first study to report frequencies of all 24 withdrawal symptoms observed in children after decrease or discontinuation of benzodiazepines and/or opioids. Agitation, anxiety, muscle tension, sleeping <1 hr, diarrhea, fever, sweating, and tachypnea were observed most frequently. Longer duration of use and high dosing are risk factors for development of withdrawal symptoms in children.

PMID: 18596622 [PubMed - as supplied by publisher]

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Sleep Patterns in Preschool-Age Children With Autism, Developmental Delay, and Typical Development.

J Am Acad Child Adolesc Psychiatry. 2008 Jun 26;

Authors: Goodlin-Jones BL, Tang K, Liu J, Anders TF

OBJECTIVE:: A prominent noncore symptom of autistic disorder is disturbed sleep, but relatively few studies have investigated this symptom. METHOD:: A multimethod approach assessed the quantity and quality of sleep in 194 children (68 with autism [AUT], 57 with developmental delay without autism [DD], 69 with typical development) recorded over 1 week. Parent perceptions, structured questionnaires, and actigraphy were compared. In addition, problem sleep as defined by parents was compared with research diagnostic criteria for behavioral insomnia obtained from actigraph recordings. RESULTS:: On actigraphy, children in the DD group, after sleep onset, exhibited more and longer awakenings than the other two groups. In contrast, children in the AUT group exhibited less total sleep time in 24 hours than the other two groups. Parent reports of sleep problems were higher in the AUT and DD groups than the typical development group, but parent reports did not concur with more objective RDC for behavioral insomnia. Parent reports of sleep problems in all of the groups were significantly associated with increased self-reports of stress. Total 24-hour sleep durations for all of the groups were shorter than recommended for preschool-age children. CONCLUSIONS:: Our study provides objective evidence that sleep patterns are different in preschool children across the categories of AUT, DD, or typical development. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(8):932-940.

PMID: 18596550 [PubMed - as supplied by publisher]

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Endogenous glutamatergic control of rhythmically active mammalian respiratory motoneurons in vivo.

J Neurosci. 2008 Jul 2;28(27):6826-35

Authors: Steenland HW, Liu H, Horner RL

The transmission of rhythmic drive to respiratory motoneurons in vitro is critically dependent on glutamate acting primarily on non-NMDA receptors. We determined whether both non-NMDA and NMDA receptors contribute to respiratory drive transmission at respiratory motoneurons in the intact organism, both in the state of anesthesia and in the same animals during natural behaviors. Twenty-seven rats were implanted with electroencephalogram and neck electrodes to record sleep-wake states and genioglossus and diaphragm electrodes for respiratory muscle recordings. Microdialysis probes were inserted into the hypoglossal motor nucleus (HMN). Under anesthesia, non-NMDA or NMDA receptor antagonism significantly decreased respiratory-related genioglossus activity, indicating a contribution of each receptor to respiratory drive transmission at the HMN. However, despite the presence of respiratory-related genioglossus activity in the same rats across sleep-wake states, neither non-NMDA receptor antagonism at the HMN nor glutamate uptake inhibition had any effect on respiratory-related genioglossus activity. These results showed that, compared with anesthesia, respiratory drive transmission through the non-NMDA receptor is low in the behaving organism. In contrast, glutamate uptake inhibition increased tonic genioglossus activity in wakefulness and non-rapid-eye-movement sleep, indicating a functional endogenous glutamatergic modulation of tonic, but not respiratory, motor tone. Such an effect on tonic drive may contribute to the suppression of both tonic and respiratory-related genioglossus activity in wakefulness and sleep with NMDA receptor antagonism at the HMN. These data do not refute previous identification of a glutamatergic (mostly non-NMDA receptor activating) respiratory drive to hypoglossal motoneurons, but this mechanism is more prominent in anesthetized or in vitro preparations.

PMID: 18596158 [PubMed - in process]

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Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy.

Pediatrics. 2008 Jul;122(1):75-82

Authors: Hogan AM, Hill CM, Harrison D, Kirkham FJ

OBJECTIVE: The goal was to determine whether amelioration of sleep-disordered breathing through adenotonsillectomy would reduce middle cerebral artery velocity in parallel with improvements in cognition and behavior. METHODS: For 19 children (mean age: 6 years) with mild sleep-disordered breathing, and 14 healthy, ethnically similar and age-similar, control subjects, parents repeated the Pediatric Sleep Questionnaire an average of 12 months after adenotonsillectomy. Children with sleep-disordered breathing underwent repeated overnight measurement of mean oxyhemoglobin saturation. Neurobehavioral tests that yielded significant group differences preoperatively were readministered. Middle cerebral artery velocity measurements were repeated with blinding to sleep study and neuropsychological results, and mixed-design analyses of variance were performed. RESULTS: The median Pediatric Sleep Questionnaire score significantly improved postoperatively, and there was a significant increase in mean overnight oxyhemoglobin saturation. The middle cerebral artery velocity decreased in the sleep-disordered breathing group postoperatively, whereas control subjects showed a slight increase. A preoperative group difference was reduced by the postoperative assessment, which suggests normalization of middle cerebral artery velocity in those with sleep-disordered breathing. The increase in mean overnight oxyhemoglobin saturation postoperatively was associated with a reduction in middle cerebral artery velocity in a subgroup of children. A preoperative group difference in processing speed was reduced postoperatively. Similarly, a trend for a preoperative group difference in visual attention was reduced postoperatively. Executive function remained significantly worse for the children with sleep-disordered breathing, compared with control subjects, although mean postoperative scores were lower than preoperative scores. CONCLUSIONS: Otherwise-healthy young children with apparently mild sleep-disordered breathing have potentially reversible cerebral hemodynamic and neurobehavioral changes.

PMID: 18595989 [PubMed - in process]

A patient with obstructive sleep apnea undergoing bariatric surgery.

J Clin Sleep Med. 2008 Jun 15;4(3):279-80

Authors: Kuzniar TJ, Morgenthaler TI

PMID: 18595442 [PubMed - in process]

Atrioventricular block during the phasic events of REM sleep in a patient with severe obstructive sleep apnea syndrome.

J Clin Sleep Med. 2008 Jun 15;4(3):257-9

Authors: Kawana F, Kasai T, Maeno K, Momomura S, Narui K

Patients with obstructive sleep apnea syndrome (OSAS) sometimes have atrioventricular (AV) block during sleep. However, significant resolution of such AV block with treatment for OSAS has been reported. On the other hand, during rapid eye movement (REM) sleep, conduction disturbances not associated with the apnea event can be observed, particularly in young healthy subjects. We report the case of a 67-year-old man with severe OSAS and 2:1 AV block that occurred only during the phasic events of REM sleep; continuous positive airway pressure (CPAP) treatment did not result in resolution of the AV block. No specific abnormalities were found on cardiac evaluation. Based on the analysis of overnight heart rate variability, CPAP treatment resulted in a markedly reduced ratio of low-frequency to high-frequency power and an increased high-frequency power, though high-frequency power was not increased during REM sleep on CPAP.

PMID: 18595440 [PubMed - in process]

Correlation between severity of obstructive sleep apnea and prevalence of silent cerebrovascular lesions.

J Clin Sleep Med. 2008 Jun 15;4(3):242-7

Authors: Nishibayashi M, Miyamoto M, Miyamoto T, Suzuki K, Hirata K

STUDY OBJECTIVES: We investigated the prevalence of silent cerebrovascular lesions in patients with obstructive sleep apnea (OSA) and the correlation between OSA severity and prevalence of silent cerebrovascular lesions in Japanese patients. METHODS: Study subjects were 192 polysomnography (PSG)-confirmed patients who visited the sleep disorders clinic in our university hospital. None had a history of cerebrovascular disease (CVD). We performed a cross-sectional study on OSA severity and the prevalence of silent cerebrovascular lesions detected by brain MRI analysis. RESULTS: The control (AHI < 5/h) group included 19 subjects with a mean AHI of 1.7 +/- 1.6/h, the mild OSAS (AHI 5 to < 15/h) group included 25 patients with a mean AHI of 9.5 +/- 3.7/h, the moderate OSAS (AHI 15 to < 30/h) group included 35 patients with a mean AHI of 22.0 +/- 7.0/h while the severe OSAS (AHI > or = 30/h) group included 113 patients with a mean AHI of 59.9 +/- 20.5/h. A larger percentage of patients with severe OSAS had a higher BMI and hyperglycemia than those with mild or moderate OSAS and control subjects (p < 0.05). Silent lacunar infarction was identified in 4 (21.1%) control subjects, 3 (12.0%) patients with mild OSA, 17 (48.6%) with moderate OSA and 61 (54.0%) with severe OSA. Among control subjects and the mild, moderate, and severe OSA groups, 4 (21.1%), 5 (20.0%), 19 (54.3%) and 61(54.0%), respectively, had periventricular hyperintensity (PVH); most PVH was mild to moderate. CONCLUSION: Results indicate that patients with moderate to severe (AHI > or = 15/h) OSA have a higher prevalence of silent cerebrovascular lesion than those with less severe OSA.

PMID: 18595437 [PubMed - in process]

A polysomnographic placebo-controlled evaluation of the efficacy and safety of eszopiclone relative to placebo and zolpidem in the treatment of primary insomnia.

J Clin Sleep Med. 2008 Jun 15;4(3):229-34

Authors: Erman MK, Zammit G, Rubens R, Schaefer K, Wessel T, Amato D, Caron J, Walsh JK

STUDY OBJECTIVES: To evaluate the polysomnographic efficacy and the safety of a range of doses of eszopiclone relative to placebo in patients with primary insomnia. Zolpidem 10 mg was included as an active control. METHODS: This multicenter, randomized, crossover study enrolled patients aged 21-64 years meeting the DSM-IV criteria for primary insomnia (n = 65). Patients received 2 nights treatment each with placebo, eszopiclone 1 mg, 2 mg, 2.5 mg, or 3 mg, and zolpidem 10 mg after randomization to one of 6 treatment sequences. Visits were separated by a 3-7 day washout. Objective efficacy was assessed by polysomnography (PSG). The primary endpoint was latency to persistent sleep (LPS); key secondary endpoints were sleep efficiency (SE) and wake time after sleep onset (WASO); other endpoints included wake time during sleep (WTDS) and number of awakenings (NAW), as well as patient-reported variables. RESULTS: LPS and SE were significantly different than placebo for all active treatments (p < 0.05 for all). Significant differences from placebo were noted in the 3 objective sleep maintenance measures (WASO, WTDS, and NAW) for eszopiclone 3 mg (p < 0.05), which was not the case for zolpidem 10 mg or the other eszopiclone doses. The incidence of central nervous system adverse events was 23.4% for zolpidem 10 mg, 6.2% to 12.5% for the eszopiclone doses, and 7.9% for placebo. CONCLUSIONS: Relative to placebo, all active treatments were effective in reducing LPS and increasing SE. Eszopiclone 3 mg was significantly different from placebo on the 3 PSG measures of sleep maintenance (WASO, WTDS, and NAW). Significant differences between zolpidem 10 mg and eszopiclone (2 mg or 3 mg) were not observed for PSG-measured outcomes, although the study was not powered to detect differences between the active drug conditions.

PMID: 18595435 [PubMed - in process]

A daytime, abbreviated cardio-respiratory sleep study (CPT 95807-52) to acclimate insomnia patients with sleep disordered breathing to positive airway pressure (PAP-NAP).

J Clin Sleep Med. 2008 Jun 15;4(3):212-22

Authors: Krakow B, Ulibarri V, Melendrez D, Kikta S, Togami L, Haynes P

STUDY OBJECTIVES: To assess the impact of a daytime sleep medical procedure--the PAP-NAP--on adherence to positive airway pressure (PAP) therapy among insomnia patients with sleep disordered breathing (SDB) METHODS: The PAP-NAP is based on Current Procedural Terminology (CPT) codes and combines psychological and physiological treatments into one procedure, which increases contact time between SDB patients and polysomnography technologists to enhance PAP therapy adherence. Using a Sleep Dynamic Therapy framework, explicating SDB as a mind-body disorder, the PAP-NAP includes mask and pressure desensitization, emotion-focused therapy to overcome aversive emotional reactions, mental imagery to divert patient attention from mask or pressure sensations, and physiological exposure to PAP therapy during a 100-minute nap period. Patients treated with the PAP-NAP test (n = 39) were compared to an historical control group (n = 60) of insomnia patients with SDB who did not receive the test. RESULTS: All 99 insomnia patients were diagnosed with SDB (mean AHI 26.5 +/- 26.3, mean RDI 49.0 +/- 24.9), and all reported a history of psychiatric disorders or symptoms as well as resistance to PAP therapy. Among 39 patients completing the PAP-NAP, 90% completed overnight titrations, compared with 63% in the historical control group; 85% of the nap-tested group filled PAP therapy prescriptions for home use compared with 35% of controls; and 67% of the nap-tested group maintained regular use of PAP therapy compared with 23% of the control group. Using standards from the field of sleep medicine, the nap-tested group demonstrated objective adherence of 49% to 56% compared to 12% to 17% among controls. All studies were reimbursed using CPT 95807-52. CONCLUSION: In this pilot study, the PAP-NAP functioned as a brief, useful, reimbursable procedure to encourage adherence in insomnia patients with SDB in comparison to an historical control group that did not undergo the procedure.

PMID: 18595433 [PubMed - in process]

Does CPAP lead to change in BMI?

J Clin Sleep Med. 2008 Jun 15;4(3):205-9

Authors: Redenius R, Murphy C, O'Neill E, Al-Hamwi M, Zallek SN

STUDY OBJECTIVES: Obesity is an important risk factor for obstructive sleep apnea syndrome (OSAS), and weight loss can reduce apnea severity or even lead to resolution in some patients. Effective CPAP therapy may lead to weight loss by any of several proposed mechanisms, including, but not limited to, increased physical activity and increased responsiveness to leptin. This retrospective study sought to determine whether subjects who adhered to prescribed CPAP treatment for OSAS would lose weight, or gain less weight than control subjects who were either untreated or did not adhere to prescribed CPAP treatment. METHODS: BMI was determined at the time of diagnosis and at followup approximately 1 year (10-14 months) later. Subjects who used CPAP > or = 4 h per night and > or = 70% of nights were considered treatment subjects. Control subjects used no treatment for OSAS or used CPAP < 4 hours per night or < 70% of nights for 1 year. RESULTS: BMI of treatment and control subjects did not significantly differ (p = 0.3157). BMI increased with 1 year of CPAP use in women but not men (p = 0.0228) and in non-obese subjects (p = 0.0443). BMI did not significantly decrease in any group treated with CPAP. CONCLUSIONS: CPAP was associated with weight gain in some; none lost weight. CPAP may affect weight in ways not measured here. Physicians should stress an active weight loss plan and not assume CPAP alone will lead to weight loss. A larger, prospective study may help clarify these findings.

PMID: 18595431 [PubMed - in process]

[Development of sleep medicine in Croatia]

Lijec Vjesn. 2008 Mar-Apr;130(3-4):106-7

Authors: Hodoba D

PMID: 18595181 [PubMed - in process]

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Minimal hepatic encephalopathy matters in daily life.

World J Gastroenterol. 2008 Jun 21;14(23):3609-15

Authors: Bajaj JS

Minimal hepatic encephalopathy is a neuro-cognitive dysfunction which occurs in an epidemic proportion of cirrhotic patients, estimated as high as 80% of the population tested. It is characterized by a specific, complex cognitive dysfunction which is independent of sleep dysfunction or problems with overall intelligence. Although named "minimal", minimal hepatic encephalopathy (MHE) can have a far-reaching impact on quality of life, ability to function in daily life and progression to overt hepatic encephalopathy. Importantly, MHE has a profound negative impact on the ability to drive a car and may be a significant factor behind motor vehicle accidents. A crucial aspect of the clinical care of MHE patients is their driving history, which is often ignored in routine care and can add a vital dimension to the overall disease assessment. Driving history should be an integral part of care in patients with MHE. The lack of specific signs and symptoms, the preserved communication skills and lack of insight make MHE a difficult condition to diagnose. Diagnostic strategies for MHE abound, but are usually limited by financial, normative or time constraints. Recent studies into the inhibitory control and critical flicker frequency tests are encouraging since these tests can increase the rates of MHE diagnosis without requiring a psychologist. Although testing for MHE and subsequent therapy is not standard of care at this time, it is important to consider this in cirrhotics in order to improve their ability to live their life to the fullest.

PMID: 18595126 [PubMed - in process]

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Association between the development of the body axis and the craniofacial skeleton studied by immunohistochemical analyses using collagen II, Pax9, Pax1, and Noggin antibodies.

Spine. 2008 Jul 1;33(15):1622-6

Authors: Sonnesen L, Nolting D, Kjaer KW, Kjaer I

STUDY DESIGN: Immunohistochemical analyses on the axial skeleton from wild type mice. OBJECTIVE: In the clinic, we have previously observed