Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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To study the effect of American Academy of Sleep Medicine accreditation of sleep centers and sleep-medicine certification of physicians on the management of patients with obstructive sleep apnea (OSA). ⋯ In this web-based survey, accreditation or certification status of sleep centers and physicians was associated with better indexes of clinical management in patients with OSA. Better patient education that fostered risk perception may have been partly responsible for such an association. Prospective studies designed to collect objective data regarding the effect of accreditation or certification status on outcomes in patients with OSA are still needed.
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The gamma-aminobutyric acid subtype A (GABAA) receptor is widely considered to be an important target for most clinically effective sedative-hypnotic compounds, including general anesthetics, benzodiazepines, barbiturates, and gaboxadol or THIP (4,5,6,7-tetrahydroisoxazolo (5,4-c)pyridin-3-ol). GABAA receptors are highly expressed in anatomical regions that are implicated in sleep processes, notably the thalamus. Furthermore, concentrations of these drugs that modify behavior in vivo also increase GABA-induced inhibitory conductances in vitro. ⋯ Particular emphasis is placed on subpopulations of GABAA receptors that are expressed in extrasynaptic regions of neurons, as these receptors are exquisitely sensitive to several classes of sedative-hypnotic compounds. Evidence to date suggests that extrasynaptic GABAA receptors can be broadly classified into two groups; those containing the delta subunit and the non-delta subunit-containing GABAA receptors. Finally, the probable contribution of extrasynaptic GABAA receptors in the modulation of sleep will be considered.
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Cheyne Stokes Breathing (CSB), a form of central sleep apnea is often found in medical illnesses such as heart failure, stroke or renal failure. Adaptive servo-ventilation (ASV) has been reported to be an effective treatment of CSB in heart failure. However, there are no reports about using ASV for idiopathic CSB, which is not associated with heart failure or other serious medical problems. ⋯ A trial of ASV for patients with idiopathic CSB is recommended if they do not have improvement in sleep respiration or daytime performance on CPAP and/or oxygen.
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To assess, in individuals referred for evaluation of obstructive sleep apnea, the potential clinical significance of brief versus longer arousals from sleep. ⋯ Individuals with obstructive sleep apnea experience frequent respiratory event associated cortical arousals, many of which are greater than 15 seconds in duration. These longer arousals, which, in this study, constituted 18.4% of all arousals and accounted for 37.5% of the total arousal time, correlate more closely with the ESS than does the frequency or time attributable to the more numerous brief arousals. This suggests that these more-prolonged arousal events may have a greater impact on the restorative aspect of sleep, or on the perception thereof.