Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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Randomized Controlled Trial
The Effects of Milnacipran on Sleep Disturbance in Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled, Two-Way Crossover Study.
This study examined the effects of milnacipran on polysomnographic (PSG) measures of sleep and subjective complaints in patients with fibromyalgia and disturbed sleep. ⋯ ClinicalTrials.gov, identifier: NCT01234675.
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One of the goals of the American Academy of Sleep Medicine (AASM) is to provide clear, evidence-based recommendations in our clinical practice guidelines. Periodically, the AASM will assess and update the process by which these guidelines are developed so that it is in line with the standards currently being used for guideline development. The AASM is now taking the next step forward by fully adopting GRADE (Grading of Recommendation Assessment, Development and Evaluation) as the methodology used for evaluating evidence and forming clinical practice guidelines recommendations. ⋯ In an effort to provide clarity and transparency, all AASM recommendations will be actionable statements that include the specific patient population for which the patient-care strategy is recommended, and clearly define the comparator against which the patient-care strategy was evaluated. In some recommendations, the comparator will be an alternative patient-care strategy (e.g., a "gold standard" or previously available alternative), while in other recommendations the comparator will be a placebo or no treatment; this is determined by the availability of evidence, and analyses decisions made by the AASM task force. Implementation of the complete GRADE criteria by the AASM allows us the best path forward towards continuing to provide high quality clinical practice guidelines.
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Obstructive sleep apnea (OSA) is a risk factor for stroke, which is modulated by accompanying nocturnal hypoxemia. White matter hyperintensities (WMH) share many of the same risk factors as stroke. The purpose of this study was to investigate whether OSA and nocturnal hypoxemia are associated with white matter disease in patients with minor stroke and transient ischemic attack. ⋯ We conclude that nocturnal hypoxemia, predominantly related to OSA, is independently associated with WMH in patients who present with minor ischemic stroke and TIA and may contribute to its pathogenesis.
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Many youth struggle with adherence to bilevel noninvasive ventilation (NIV), often shortly after initiation of treatment. Anecdotal evidence suggests youths with comorbid obesity struggle with adherence while youths with comorbid neuromuscular disease demonstrate better adherence rates. The objective of this study was to explore factors relating to bilevel NIV adherence, and to compare these between youths with underlying obesity or neuromuscular disease. ⋯ A commentary on this article appears in this issue on page 1355.
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To review sleep related consumer technologies, including mobile electronic device "apps," wearable devices, and other technologies. Validation and methodological transparency, the effect on clinical sleep medicine, and various social, legal, and ethical issues are discussed. ⋯ Consumer sleep technologies are changing the landscape of sleep health and clinical sleep medicine. These technologies have the potential to both improve and impair collective and individual sleep health depending on method of implementation.