Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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Randomized Controlled Trial Multicenter Study
A polysomnographic placebo-controlled evaluation of the efficacy and safety of eszopiclone relative to placebo and zolpidem in the treatment of primary insomnia.
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. ⋯ 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.
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Although obstructive sleep apnea and cardiovascular disease have common risk factors, epidemiologic studies show that sleep apnea increases risks for cardiovascular disease independently of individuals' demographic characteristics (i.e., age, sex, and race) or risk markers (i.e., smoking, alcohol, obesity, diabetes, dyslipidemia, atrial fibrillation, and hypertension). Individuals with severe sleep apnea are at increased risk for coronary artery disease, congestive heart failure, and stroke. The underlying mechanisms explaining associations between obstructive sleep apnea and cardiovascular disease are not entirely delineated. ⋯ Linkage between obstructive sleep apnea and cardiovascular disease is corroborated by evidence that treatment of sleep apnea with continuous positive airway pressure reduces systolic blood pressure, improves left ventricular systolic function, and diminishes platelet activation. Several systematic studies are necessary to explicate complex associations between sleep apnea and cardiovascular disease, which may be compounded by the involvement of diseases comprising the metabolic syndrome (i.e., central obesity, hypertension, diabetes, and dyslipidemia). Large-scale, population-based studies testing causal models linking among sleep apnea, cardiovascular morbidity, and metabolic syndrome are needed.
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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. ⋯ 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.
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There is a relatively small body of literature looking at sleep disordered breathing (SDB) in acutely ill inpatients. The aim of this study was to assess the frequency of SDB in acutely ill patients admitted to tertiary care centers referred for an inpatient polysomnogram and to identify associations between SDB and patient characteristics. ⋯ There is a high frequency of SDB in hospitalized patients referred for polysomnography, especially in patients with underlying cardiopulmonary disease. Further investigation of the impact of SDB on acute exacerbations of cardiopulmonary disease is needed, given the high frequency of SDB in hospitalized patients.