Sleep
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Randomized Controlled Trial
Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial.
Complaints of fatigue are frequent in patients with obstructive sleep apnea (OSA); however, the impact of continuous positive airway pressure (CPAP) on fatigue remains unclear. ⋯ Results suggest that 3 weeks of therapeutic CPAP significantly reduced fatigue and increased energy in patients with OSA. Therapeutic CPAP significantly reduced daytime sleepiness in patients who reported excessive sleepiness at the onset of treatment.
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Traffic noise disturbs sleep and may impair recuperation. There is limited information on single and combined effects of air, road, and rail traffic noise on sleep and recuperation. ⋯ Road, rail, and air traffic noise differentially affect objective and subjective assessments of sleep. Differences in the degree of noise-induced sleep fragmentation between traffic modes were explained by the specific spectral and temporal composition of noise events, indicating potential targets for active and passive noise control. Field studies are needed to validate our findings in a setting with higher ecologic validity.
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Various treatment methods exist to treat obstructive sleep apnea (OSA); continuous positive airway pressure (CPAP) is considered the gold standard. It is however a clinical reality that the use of CPAP is often cumbersome. CPAP treatment is considered compliant when used ≥ 4 h per night as an average over all nights observed. Surgery, on the other hand, is regarded as successful when the apnea hypopnea index (AHI) drops at least 50% and is reduced below 20/h postoperatively in patients whose preoperative AHI was > 20/h. The effectiveness of CPAP compliance criteria can be questioned, just as the effectiveness of surgical success criteria has often been questioned. ⋯ Using a mean AHI in CPAP therapy is more realistic than using arbitrary compliance rates, which, in fact, hide insufficient reductions in AHI.
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Randomized Controlled Trial
Clonidine has a paradoxical effect on cyclic arousal and sleep bruxism during NREM sleep.
Clonidine disrupts the NREM/REM sleep cycle and reduces the incidence of rhythmic masticatory muscle activity (RMMA) characteristic of sleep bruxism (SB). RMMA/SB is associated with brief and transient sleep arousals. This study investigates the effect of clonidine on the cyclic alternating pattern (CAP) in order to explore the role of cyclic arousal fluctuation in RMMA/SB. ⋯ CAP phase A3 frequency increased under clonidine, but paradoxically, RMMA/SB decreased. RMMA/SB was associated with and facilitated in CAP phase A2 and A3 rhythms. However, SB generation could be influenced by other factors besides sleep arousal pressure. NREM/REM ultradian cyclic arousal fluctuations may be required for RMMA/SB onset.
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Slow wave activity (SWA) during NREM sleep is the best characterized marker of sleep homeostasis, and the occurrence of sleep slow waves is necessary to reduce sleep need. Recent evidence suggests that sleep slow waves may mediate several beneficial effects of sleep on performance, from the prevention of cognitive impairments to memory consolidation. However, slow waves are also triggered by low doses of many anesthetics, but very few reports have examined whether anesthesia-mediated slow waves affect the homeostatic regulation of sleep. Moreover, no study has examined how sleep is affected by higher doses of anesthetics, which lead to a predominantly "isoelectric" EEG tracing without slow waves. ⋯ The blunted SWA rebound after ISO-sw and DES-sw suggests that anesthesia slow waves may substitute for sleep slow waves. The reduced SWA rebound after DES-iso may reflect a pathological condition that results in a chronic decrease in SWA, or may suggest that anesthesia slow waves are not an absolute requirement to discharge sleep pressure.