Sleep medicine
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Obstructive sleep apnea syndrome (OSAS) is associated with stress system activation involving the hypothalamic-pituitary-adrenocortical (HPA) axis. The relationships among salivary cortisol, a measure of the HPA axis, and objective parameters of polysomnography (PSG) and subjective sleep symptoms were examined. ⋯ Among the four salivary cortisol parameters, r-sCor was negatively associated with OSAS severity, ODI, and QOL (KOSA-18), which may indicate a chronically stressed HPA axis. These results demonstrate that salivary cortisol may be a useful biomarker of OSAS.
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Restless legs syndrome (RLS) is a common sensorimotor condition characterized by an urge to move the legs, worsening of symptoms at rest and during the evening/night, and improvement of symptoms with movement. Our review explores the role and impact of sensory symptoms in RLS. The phenomenology of RLS is discussed, highlighting the difficulty patients have in describing their sensations and in differentiating between sensory and motor symptoms. ⋯ Peripheral neuropathies may account for some of the sensory disturbances in secondary RLS, while alterations in central somatosensory processing may be a more viable explanation for the sensory disturbances in primary RLS. The effectiveness of analgesics in treating RLS supports the concept of abnormal sensory modulation in RLS and suggests an overlap between pain modulatory pathways and sensory disturbances. Future studies are needed to better understand the experiential and biologic aspects of altered sensory experiences in RLS.
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Randomized Controlled Trial
Alertness and psychomotor performance effects of the histamine-3 inverse agonist MK-0249 in obstructive sleep apnea patients on continuous positive airway pressure therapy with excessive daytime sleepiness: a randomized adaptive crossover study.
We aimed to evaluate the efficacy of the selective H3 receptor inverse agonist MK-0249 to treat excessive daytime sleepiness (EDS). ⋯ MK-0249 did not significantly affect MWT sleep latency. However, the pattern of improvement on subjective ratings and psychomotor performance end points suggested that MK-0249 was associated with changes in aspects of cognition and performance not captured by the MWT.
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Comparative Study Clinical Trial
The influence of timing of polysomnography on diagnosis of obstructive sleep apnea in patients presenting with acute myocardial infarction and stable coronary artery disease.
We aimed to determine if timing of polysomnography (PSG) influences the diagnosis of obstructive sleep apnea (OSA) in acute myocardial infarction (AMI) or stable coronary artery disease (CAD). ⋯ The timing of PSG influenced the diagnosis of OSA in patients who presented with AMI but not in those who presented with stable CAD.
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We aimed to evaluate Latin American primary care physicians' knowledge and attitudes about obstructive sleep apnea (OSA) using a Spanish-language version of the OSA Knowledge and Attitudes (OSAKA) questionnaire and to evaluate its psychometric properties. ⋯ This Spanish-language version of the OSAKA yielded considerable variance in Spanish-speaking physicians' knowledge about OSA and confidence in identifying and managing patients with OSA. Focused OSA education for Latin American general physicians is needed.