Sleep
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Two separate groups consisting of both long-haul (N=184) and short-haul (N=133) truck drivers were surveyed to examine the frequency of driver sleepiness-related problems at work during the previous three months and to assess the incidence of sleep apnea syndrome symptoms. We also aimed to identify factors likely to predict self-reported difficulties in staying alert in work driving, dozing off (sometimes referred to as microsleeps) at the wheel and near misses. The responses suggest that for approximately 13% of the long-haul drivers the mean driving time per shift exceeded the EEC regulation. ⋯ Work and individual related factors as well as factors indicating sleep apnea syndrome contributed only slightly to predicting driver sleepiness-related problems. This suggests that driver sleepiness-related problems tend to be shared by many of the professional drivers, rather than being a "specific" and permanent problem for a smaller portion of drivers. However, difficulties in sleep patterns, such as having difficulty falling asleep, were infrequent.
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Comparative Study
Effects of nasal O2 on sleep-related disordered breathing in ambulatory patients with stable heart failure.
The purpose of this study was 1) to determine the effects of nasal O2 on periodic breathing, arterial oxyhemoglobin desaturation and nocturnal ventricular arrhythmias in patients with heart failure and 2) determine the characteristics of patients whose periodic breathing will be reversed by O2 administration; our hypothesis was that patients with more severe periodic breathing and desaturation, will respond more favorably to oxygen. ⋯ In patients with stable heart failure, administration of nasal O2 significantly improves periodic breathing and virtually eliminates clinically significant arterial oxyhemoglobin desaturation. The beneficial effects of O2, however, may be modulated by the level of arterial PCO2. Acute O2 therapy has important benefits on sleep apnea and nocturnal arterial oxyhemoglobin desaturation in heart failure patients. Long term benefits of O2 therapy in heart failure and sleep apnea need to be determined.
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Practice Guideline Guideline
Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine.
Insomnia is the most common sleep complaint reported to physicians. Treatment has traditionally involved medication. Behavioral approaches have been available for decades, but lack of physician awareness and training, difficulty in obtaining reimbursements, and questions about efficacy have limited their use. ⋯ Improved experimental design has significantly advanced the process of evaluation of nonpharmacologic treatments for insomnia using guidelines outlined by the American Psychological Association (APA). Recommendations for individual therapies using the American Academy of Sleep Medicine recommendation levels for each are: Stimulus Control (Standard); Progressive Muscle Relaxation, Paradoxical Intention, and Biofeedback (Guidelines); Sleep Restriction, and Multicomponent Cognitive Behavioral Therapy (Options); Sleep Hygiene Education, Imagery Training, and Cognitive Therapy had insufficient evidence to be recommended as a single therapy. Optimal duration of therapy, who should perform the treatments, long term outcomes and safety concerns, and the effect of treatment on quality of life are questions in need of future research.
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Sleep is controlled by both circadian and homeostatic mechanisms. As the light-dark cycle is the most important time cue in humans, blind individuals may have circadian rhythm disorders including sleep. The aim of the study was to assess sleep with simultaneous measurement of an endogenous marker of the circadian clock, namely 6-sulphatoxymelatonin (aMT6s). ⋯ Changes in sleep and activity rhythms reflect changes in circadian phase.
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Periodic leg movements of sleep are currently subdivided based upon whether or not they are associated with EEG arousal. "Autonomic" arousals, characterized by elevations in heart rate and blood pressure without AASM-defined EEG changes, have been associated with daytime somnolence in experimental protocols. In this study, we will describe the heart rate response to periodic leg movements of sleep, both with and without associated arousals. ⋯ Periodic leg movements of sleep are associated with cardiac acceleration, even in the absence of AASM-defined arousal. It appears premature to conclude that periodic leg movements of sleep not associated with visible EEG arousal are clinically insignificant.