Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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Randomized Controlled Trial Comparative Study
A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study.
A significant portion of US military personnel are returning from deployment with trauma-related sleep disturbance, and disrupted sleep has been proposed as a mechanism for the development of medical conditions in those with posttraumatic stress disorder (PTSD). Although individuals with PTSD may realize improved sleep with either PTSD treatment or CBT for insomnia, many continue to experience residual sleep difficulties. Newly developed interventions designed to address nightmares are effective to this end, but often do not fully remove all aspects of PTSD-related sleep difficulties when used in isolation. A combined intervention involving both a nightmare-specific intervention and CBT for insomnia may lead to more marked reductions in PTSD-related sleep disturbances. ⋯ Findings demonstrate that an intervention targeting trauma-specific sleep disturbance produces large short-term effects, including substantial reductions in PTSD symptoms and insomnia severity. Future research should focus on the optimal approach to the treatment of comorbid PTSD and sleep disturbance in terms of sequencing, and should assure that sleep-focused interventions are available and acceptable to our younger veterans, who were more likely to drop out of treatment.
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Comparative Study
Emotional content of dreams in obstructive sleep apnea hypopnea syndrome patients and sleepy snorers attending a sleep-disordered breathing clinic.
To assess prospectively the emotional content of dreams in individuals with the obstructive sleep apnea hypopnea syndrome (OSAHS) and sleepy snorers. ⋯ Patients with AHI ≥ 15 had more emotionally negative dreams than patients with AHI < 5. The variation in mean dream emotion decreased with increasing AHI, possibly because sleep fragmentation with increasing AHI results in fewer and shorter dreams, in which emotions are rarer.
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Randomized Controlled Trial Comparative Study
Effectiveness of ramelteon for insomnia symptoms in older adults with obstructive sleep apnea: a randomized placebo-controlled pilot study.
To evaluate the effectiveness of ramelteon, a melatonin receptor agonist, for the treatment of insomnia in older adults starting auto-titrating positive airway pressure (APAP) therapy for sleep apnea. ⋯ Ramelteon was effective in improving objective, but not subjective, sleep onset latency even in older adults who were starting APAP therapy for sleep apnea. Further research is warranted in examining the role of ramelteon in the care of older adults with insomnia symptoms and sleep apnea.
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Comparative Study
Mallampati class is not useful in the clinical assessment of sleep clinic patients.
To assess the utility of Mallampati class, a simple grade of oropharyngeal appearance used to assess difficulty of intubation, to predict severe obstructive sleep apnea and absence of OSA (rule in severe OSA and rule out OSA). ⋯ Mallampati class is associated with AHI but does not significantly modify likelihood of severe OSA or absence of OSA. As such, it is of limited use to "rule in" severe OSA or "rule out OSA" in the sleep clinic population.