Sleep medicine
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Randomized Controlled Trial Multicenter Study
Evaluation of subjective efficacy and safety of ramelteon in Japanese subjects with chronic insomnia.
To assess patient-reported efficacy and safety of ramelteon in Japanese patients with chronic insomnia. ⋯ In Japanese adults with chronic insomnia, ramelteon 8 mg significantly reduced patient-reported sleep latency, increased total sleep time and improved sleep quality after 1 week of treatment. Ramelteon was generally well tolerated with no rebound insomnia.
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Obstructive sleep apnea (OSA) and behavioral sleep disturbances (BSD) are known to have a negative health impact on children. OSA and BSD may coexist; however, such comorbidity is not fully appreciated in clinical settings. ⋯ Children referred for evaluation of OSA have a high likelihood of experiencing clinically significant BSD irrespective of OSA diagnosis. Sleep medicine clinicians should be careful not to overlook the potential impact of BSD even after a child has been formally diagnosed with OSA. Physician knowledge of empirically supported behavioral sleep treatments or access to behavioral sleep medicine services is an essential component of comprehensive care for children clinically referred for OSA evaluation.
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While continuous positive airway pressure (CPAP) effectively treats obstructive sleep apnea (OSA), adherence to CPAP is suboptimal. The short-term efficacy of and adherence with a convenient expiratory positive airway pressure (EPAP) nasal device was evaluated in OSA patients non-adherent with CPAP. ⋯ The improvements in AHI and ESS, combined with the high degree of treatment adherence observed, suggest that the convenient EPAP device tested may become a useful therapeutic option for OSA.
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In the elderly, obstructive sleep apnea (OSA) is frequently under diagnosed. This study was undertaken to assess the accuracy of the Berlin questionnaire to diagnose OSA in a large healthy elderly population. ⋯ The Berlin questionnaire did not provide a high level of diagnostic specificity to discriminate OSA in an elderly population. Although not sufficiently accurate, this questionnaire can be used to identify subjects for sleep study assessment.
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In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services. ⋯ Management of OSA in different European countries is similar except for reimbursement rules, qualification of sleep specialists and procedures for titration of the CPAP treatment. A European network (such as the one accomplished by the European Cooperation in Science and Technology [COST] B26 Action) could be helpful for implementing these findings into health-service research in order to standardize management in a cost effective perspective.