Sleep
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Randomized Controlled Trial Comparative Study
Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome.
Continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) is conventionally started after in-laboratory overnight titration. This use of sleep laboratory space is both costly and limits access for diagnostic studies. This study aimed to evaluate whether automated CPAP titration in the home produced patient outcomes equal to those following laboratory-based automated CPAP titration. The main outcomes were Epworth Sleepiness Scale score, objective daytime sleepiness (Oxford SLEep Resistance test or OSLER test), and CPAP use; we also performed quality-of-life questionnaires: Functional Outcomes of Sleep Questionnaire and SF-36. ⋯ Home-based automated CPAP titration is as effective as automatic in-laboratory titrations in initiating treatment for OSAHS.
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Taking an afternoon nap (siesta) is a common habit. A number of studies have shown an increased cardiovascular mortality in habitual nappers. Afternoon nappers have anthropometric characteristics similar to those of patients with sleep apnea. Nappers appear to suffer from more sleep apnea, which could contribute to cardiovascular disorders. Our aim was therefore to determine the association between sleep apnea and napping, as well as to analyze the relationship of sleep apnea and napping with hypertension. ⋯ Our findings suggest that napping could be regarded as a marker of sleep apnea, which could account for the cardiovascular diseases observed in nappers. Given that napping is common and that sleep apnea is treatable, more attention should be focused on this population.
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We hypothesized that alterations in cardiac hemodynamics associated with obstructive sleep apnea-hypopnea (OSAH) would be reflected in higher natriuretic peptide levels. We examined the association of OSAH with natriuretic peptides in a community-based sample. ⋯ Lack of association of natriuretic peptides with OSAH indices suggests that undiagnosed OSAH may not be associated with major alterations in left ventricular function, as reflected in morning natriuretic peptide levels.
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Randomized Controlled Trial
A randomized trial evaluating the effectiveness of sodium oxybate therapy on quality of life in narcolepsy.
To evaluate the efficacy of sodium oxybate versus placebo to improve quality of life in patients with narcolepsy. ⋯ The nocturnal administration of sodium oxybate in patients with narcolepsy was associated with statistically significant and clinically relevant improvements in functional status, an important component of quality of life.
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A significant number of patients with obstructive sleep apnea neither tolerate positive airway pressure (PAP) therapy nor achieve successful outcomes from either upper airway surgeries or use of an oral appliance. The purpose of this paper, therefore, was to systematically evaluate available peer-reviewed data on the effectiveness of adjunctive medical therapies and summarize findings from these studies. A review from 1985 to 2005 of the English literature reveals several practical findings. ⋯ PAP therapy has set the bar high for successful treatment of sleep apnea and its associated morbidities. Nonetheless, we should strive towards the development of universally effective pharmacotherapies for sleep apnea. To accomplish this, we require a greater knowledge of the neurochemical mechanisms underlying sleep apnea, and we must use this infrastructure of knowledge to design well-controlled, adequately powered studies that examine, not only effects on the apnea/hypopnea index, but also the effects of pharmacotherapies on all health related outcomes shown beneficial with PAP therapy.