Sleep
-
Under simulated shift-work conditions, we investigated the efficacy of a restart break for maintaining neurobehavioral functioning across consecutive duty cycles, as a function of the circadian timing of the duty periods. ⋯ The 34-hour restart break was adequate for maintaining performance in the case of optimal circadian placement of sleep and duty periods (control condition) but was inadequate (and perhaps even detrimental) for maintaining performance in a simulated nighttime duty schedule (experimental condition). Current US transportation hours-of-service regulations mandate time off duty but do not consider the circadian aspects of shift scheduling. Reinforcing a recent trend of applying sleep science to inform policymaking for duty and rest times, our findings indicate that restart provisions in hours-of-service regulations could be improved by taking the circadian timing of the duty schedules into account.
-
Comparative Study
An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea.
Obstructive sleep apnea (OSA) is a common disorder associated with substantially increased cardiovascular risks, reduced quality of life, and increased risk of motor vehicle collisions due to daytime sleepiness. This study evaluates the cost-effectiveness of three commonly used diagnostic strategies (full-night polysomnography, split-night polysomnography, unattended portable home-monitoring) in conjunction with continuous positive airway pressure (CPAP) therapy in patients with moderate-to-severe OSA. ⋯ Full-night polysomnography (PSG) is cost-effective and is the preferred diagnostic strategy for adults suspected to have moderate-to-severe OSA when all diagnostic options are available. Split-night PSG and unattended home monitoring can be considered cost-effective alternatives when full-night PSG is not available.
-
To our knowledge, a systematic study of the effect of air leak on adherence to auto-titrating positive airway pressure (autoPAP) therapy has not been reported. We hypothesized that in patients with obstructive sleep apnea (OSA), greater levels of air leak were associated with poor adherence to autoPAP therapy. ⋯ Air leak was associated with poor adherence to autoPAP therapy. We speculate that air leak could be a potential target for future studies aimed at enhancing adherence to autoPAP therapy.
-
The prevalence of obstructive sleep apnea syndrome (OSAS) in sickle cell disease (SCD) has been reported to be higher than that in the general pediatric population. However, not all subjects with SCD develop OSAS. We hypothesized that SCD patients with OSAS have a blunted neuromuscular response to subatmospheric pressure loads during sleep, making them more likely to develop upper airway collapse. ⋯ This preliminary study has shown that children with SCD but without OSAS have more prominent upper airway reflexes than children with SCD and OSAS.
-
A deficit in arousal process has been implicated as a mechanism of sudden infant death syndrome (SIDS). Compared with control infants, SIDS victims showed significantly more subcortical activations and fewer cortical arousals than matched control infants. Apparent life-threatening event (ALTE) is often considered as an aborted SIDS event. The aim of this study was to study the arousal characteristics of ALTE infants during the first months of life. ⋯ Spontaneous arousals were differently altered in ALTE infants than in SIDS infants, suggesting an entity different from SIDS. ALTE infants with smoking mothers had arousal and respiratory characteristics that were similar to future SIDS victims, suggesting some common abnormalities in brainstem dysfunction.