Sleep
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Randomized Controlled Trial Multicenter Study Comparative Study
Effect of gaboxadol on sleep in adult and elderly patients with primary insomnia: results from two randomized, placebo-controlled, 30-night polysomnography studies.
To evaluate the efficacy and tolerability of gaboxadol in the treatment of adult and elderly patients with primary insomnia. ⋯ The maximum studied doses of gaboxadol (GBX15 in adult patients and GBX10 in elderly patients) were effective at enhancing objective polysomnography measures of sleep maintenance and SWS, and also some subjective sleep measures, over 30 nights but had little or no effects on sleep onset. The clinical relevance of the enhancement of SWS by gaboxadol is unclear.
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Randomized Controlled Trial Comparative Study
Portable monitoring and autotitration versus polysomnography for the diagnosis and treatment of sleep apnea.
To compare a clinical pathway using portable monitoring (PM) for diagnosis and unattended autotitrating positive airway pressure (APAP) for selecting an effective continuous positive airway pressure (CPAP) with another pathway using polysomnography (PSG) for diagnosis and treatment of obstructive sleep apnea (OSA). ⋯ A clinical pathway utilizing PM and APAP titration resulted in CPAP adherence and clinical outcomes similar to one using PSG.
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To determine the effect of head posture on upper airway collapsibility and site of collapse of the passive human upper airway. ⋯ Head posture has a marked effect on the collapsibility and site of collapse of the passive upper airway (measured by EMGgg) indicating that controlling head posture during sleep or recovery from anesthesia may alter the propensity for airway obstruction. Further, manipulating head posture during propofol sedation may assist with identification of pharyngeal regions vulnerable to collapse during sleep and may be useful for guiding surgical intervention.
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Sleep-disordered breathing (SDB) is a treatable but markedly under-diagnosed condition of frequent breathing pauses during sleep. SDB is linked to incident cardiovascular disease, stroke, and other morbidity. However, the risk of mortality with untreated SDB, determined by polysomnography screening, in the general population has not been established. ⋯ Our findings of a significant, high mortality risk with untreated SDB, independent of age, sex, and BMI underscore the need for heightened clinical recognition and treatment of SDB, indicated by frequent episodes of apnea and hypopnea, irrespective of symptoms of sleepiness.
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Previously published cohort studies in clinical populations have suggested that obstructive sleep apnea (OSA) is a risk factor for mortality associated with cardiovascular disease. However, it is unknown whether sleep apnea is an independent risk factor for all-cause mortality in a community-based sample free from clinical referral bias. ⋯ Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality in this community-based sample.