Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
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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.
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To determine the prevalence, risk factors, and impact on daytime sleepiness and hypertension of periodic leg movements of sleep (PLMS) with associated arousals in patients with obstructive sleep apnea (OSA). ⋯ One in 2 patients investigated for OSA has PLMS. Risk factors for PLMS include preexisting medical conditions-particularly depression, fibromyalgia, and diabetes mellitus-increasing age, predisposing medications, obesity, and OSA. The combination of OSA and PLMS results in no greater subjective daytime sleepiness or prevalence of hypertension than OSA alone.
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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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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.