Sleep
-
Investigators have postulated that pharyngeal collapse during sleep in patients with obstructive sleep apnea (OSA) may be alleviated by stimulating the genioglossus. The effect of electrical stimulation (ES) of the genioglossus on pharyngeal patency was examined in an isolated feline upper airway preparation and in apneic humans during sleep. ⋯ The evidence suggests that improvements in airflow dynamics with electrical stimulation are due to selective recruitment of the genioglossus, rather than due to nonspecific activation of the pharyngeal musculature or arousal from sleep. The implications of these results for future therapy with ES are discussed.
-
Comparative Study
Central sleep apnea-hypopnea syndrome in heart failure: prevalence, impact, and treatment.
Despite recent advances in its treatment, congestive heart failure associated with depressed left ventricular function continues to be associated with excess morbidity and mortality. Multiple factors may contribute to the progressively declining course of heart failure. Nocturnal arterial oxyhemoglobin desaturation caused by sleep-disordered breathing could be a contributing factor, particularly because it has been associated with excess mortality in patients with chronic obstructive pulmonary disease. ⋯ These episodes were associated with an excess number of arousals and arterial oxyhemoglobin desaturation. Treatment options include nocturnal administration of oxygen, continuous positive airway pressure (CPAP), and medications such as theophylline. Large-scale studies are needed to evaluate the efficacy of these treatment options on quality of life, morbidity, and mortality of patients with heart failure.
-
Randomized Controlled Trial Clinical Trial
Sleeping position, orientation, and proximity in bedsharing infants and mothers.
The impact of mother-infant bedsharing on infant sleeping position, orientation, and proximity to the mother was assessed in 12 breast-feeding Latino mother-infant pairs. Six routinely bedsharing and six routinely solitary-sleeping pairs slept 3 nights in the sleep laboratory. The first night matched the routine home condition, followed by 1 bedsharing night and 1 solitary-sleeping night in random order. ⋯ We conclude that bedsharing minimizes the use of the prone infant sleeping position, probably in part to facilitate breast feeding. By promoting nonprone positions, bedsharing may protect some infants from sudden infant death syndrome (SIDS), since prone sleeping is a known risk factor for SIDS. The large percentage of the night that mothers spent oriented toward their infants suggests that a higher degree of maternal vigilance may also result from bedsharing.
-
Our laboratory previously reported continuously monitored peak sound levels in several areas at Rhode Island Hospital. The number of sound peaks greater than 80 A-weighted decibels (dBA) was found to be high in the intensive and intermediate respiratory care unit (IRCU) areas, even at night. Environmental noise of this magnitude is potentially sleep-disruptive. ⋯ These 61 periods were then classified as quiet, moderately loud, and very loud based on the number of sound peaks (< or = 5, 6-15, and > 15, respectively). Analysis of variance revealed a significant difference between the number of arousals (p = 0.001) in quiet periods and that in very loud periods. We conclude that environmental noise may be an important cause of sleep disruption in the IRCU.
-
Arousal is an important protective response during sleep, and arousal deficit is hypothesized to play a role in the etiology of sudden infant death syndrome (SIDS). Because environmental or caretaking factors have been shown to exert powerful effects on susceptibility to SIDS, manipulations that facilitate arousability might be protective against SIDS. All-night laboratory polysomnographic recordings were performed in 20 routinely bedsharing and 15 routinely solitary sleeping healthy breast-feeding Latino infants within the peak age range for SIDS, in both bedsharing (with mother) and solitary sleeping environments. ⋯ Shorter mean duration episodes of stage 3/4 sleep and longer mean stage 1/2 sleep episodes accounted for these differences. Because the arousal threshold is high in the electroencephalographic delta range, by limiting the amount of stage 3/4 sleep, bedsharing should promote infant arousability and might be protective against SIDS. The results also suggest that accepted normative values for infant sleep established in solitary sleeping infants may not be representative of infants raised in social sleeping environments.