Sleep medicine reviews
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Epidemiologic and mechanistic evidence is increasingly supporting the notion that obstructive sleep apnea is a risk factor for dementia. Hence, the identification of patients at risk of cognitive decline due to obstructive sleep apnea may significantly improve preventive strategies and treatment decision-making. Cerebrospinal fluid and blood biomarkers obtained through genomic, proteomic and metabolomic approaches are improving the ability to predict incident dementia. ⋯ Markers of these processes include amyloid-β, tau proteins, inflammatory cytokines, acute-phase proteins, antioxydants and oxidized products, homocysteine and clusterin (apolipoprotein J). Thus, these biomarkers may have the ability to identify adults with obstructive sleep apnea at high risk of dementia and provide an opportunity for therapeutic intervention. Large cohort studies are necessary to establish a specific fluid biomarker panel linking obstructive sleep apnea to dementia risk.
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Sleep medicine reviews · Dec 2018
ReviewDetermining the likelihood that fatigue was present in a road accident: A theoretical review and suggested accident taxonomy.
Estimates in developed countries of the extent to which fatigue contributes to road accidents range from as low as 5% to as high as 50% of all accidents. Compared with other causes of road accidents (e.g., speeding, drink-driving), the variability in these estimates is exceptionally high and may be indicative of the difficulty in determining the likelihood of fatigue as a cause of road accidents. ⋯ A putative accident 'taxonomy' is proposed using two dimensions: (1) estimating the likelihood that a driver was fatigued at the time of the accident, and (2) estimating the degree to which accident phenomenology is consistent with fatigue-related error. This 'taxonomy' could assist accident investigators and road safety regulators to more reliably quantify the contribution of fatigue to road accidents, and may also assist researchers and regulators in the post-hoc interrogation of existing accident databases to better determine the relative incidence of fatigue-related road accidents.
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Sleep medicine reviews · Dec 2018
ReviewTargeting volume overload and overnight rostral fluid shift: A new perspective to treat sleep apnea.
Sleep apnea is a common condition associated with increased morbidity and mortality. Continuous positive airway pressure and oral appliances are efficient for treating sleep apnea; however, they are often poorly tolerated. Therefore, alternative therapies are needed. ⋯ As a result of this observation, it has been suggested that the prevention of overnight fluid shift may reduce sleep apnea severity. It has recently been shown that interventions targeting fluid overload and daytime fluid accumulation in the legs consistently attenuate nocturnal fluid shift and sleep apnea, as greater reductions in fluid shift are correlated with greater reductions in sleep apnea severity. This review will focus on interventions that counteract fluid shift, such as diuretics, ultrafiltration/dialysis, physical activity, compression stockings and salt/fluid restriction, which have been shown to have efficacy in reducing sleep apnea severity.