Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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Case Reports
Night-time bradyarrhythmia in a patient with mild obstructive sleep apnea syndrome is reversed with CPAP treatment.
Nocturnal cardiac arrhythmia is a common clinical feature of obstructive sleep apnea syndrome. Pathologically relevant rhythm disturbances such as atrioventricular block or ventricular tachycardia are known to occur mainly in patients with a high apnea-hypopnea index and marked oxygen desaturation. ⋯ Cardiac arrhythmia was reversed with the initiation of nasal continuous positive airway pressure treatment. Based on this case report and taking into account known facts from the literature, the finding of intermittent second-degree atrioventricular block in our patient with mild obstructive sleep apnea syndrome supports careful evaluation of electrocardiogram recording acquired during polysomnography in all patients with suspected obstructive sleep apnea syndrome.
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Randomized Controlled Trial
Sleep and residual sedation after administration of zaleplon, zolpidem, and placebo during experimental middle-of-the-night awakening.
To assess the efficacy of zaleplon 10 mg and zolpidem 10 mg administered during experimental middle-of-the-night awakenings in patients with sleep-maintenance insomnia using objective polysomnographic measures and to assess daytime residual sedation 4 to 7 hours after dosing using sleep-latency testing. ⋯ Zaleplon 10 mg and zolpidem 10 mg effectively shorten sleep latency and lengthen sleep duration after dosing, when administered during experimental nocturnal awakening. Residual sedation was not detected as little as 4 hours after zaleplon 10 mg, whereas residual sedation was detected with zolpidem 10 mg up to 7 hours after treatment. These findings suggest that zaleplon may be an appropriate treatment for use when patients awaken during the night and have difficulty reinitiating sleep.
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Obstructive sleep apnea (OSA) case finding in hospitalized patients occurs commonly. In some institutions, the wait time to polysomnography (PSG) may be long. We investigated the impact of a protocol utilizing autoadjusting continuous positive airway pressure (CPAP) for early initiation of therapy in hospitalized patients suspected of having OSA. ⋯ Compared with oxygen support or no therapy, an autoadjusting CPAP-titration protocol did not improve short-term outcomes in hospitalized patients with symptoms suggestive of OSA. Autoadjusting CPAP may underestimate optimal treatment settings.