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weeks Fatigue (FSS, other scales), HRQL, AE AE=adverse events; DB=double blind; CPAP=continuous positive airway pressure; ESS=Epworth Sleepiness Scale; FSS=Fatigue Severity Score; HRQL=health related quality of life; MWT=Maintenance of wakefulness test; OSAS=obstructivesleepapneasyndrome; RCT=randomized controlled trial; SWSD=shift work sleepdisorder Modafinil for SleepDisorders and MS Fatigue 11 Appendix 3: Validity Assessment of Included Studies First Author, Publication Year, Study Design (...) system stimulant approved in Canada for the symptomatic treatment of excessive sleepiness in adult patients with narcolepsy, obstructivesleepapnea, and shift work sleepdisorder. 1 Its efficacy has also tested in a number of off-label conditions such as fatigue related to multiple sclerosis (MS) or Parkinson’s disease, cocaine addiction, attention deficit disorder, and depression. 2,3 Modafinil’s mechanism of action of promoting wakefulness is not known, but it has a different pharmacologic profile
Association between treated and untreated obstructivesleepapnea and risk of hypertension. Systemic hypertension is prevalent among patients with obstructivesleepapnea (OSA). Short-term studies indicate that continuous positive airway pressure (CPAP) therapy reduces blood pressure in patients with hypertension and OSA.To determine whether CPAP therapy is associated with a lower risk of incident hypertension.A prospective cohort study of 1889 participants without hypertension who were (...) referred to a sleep center in Zaragoza, Spain, for nocturnal polysomnography between January 1, 1994, and December 31, 2000. Incident hypertension was documented at annual follow-up visits up to January 1, 2011. Multivariable models adjusted for confounding factors, including change in body mass index from baseline to censored time, were used to calculate hazard ratios (HRs) of incident hypertension in participants without OSA (controls), with untreated OSA, and in those treated with CPAP therapy
and hypopnea per hour of sleep, was 9.1 (2.8 to 21.4) [median (interquartile range)] and 64% patients had AHI >5. There was a significant correlation between oxygen desaturation index (ODI, hourly average number of desaturation episodes) and cumulative time percentage with SpO(2) <90% (CT90) from nocturnal oximetry, with the parameters measuring sleepbreathingdisorders from PSG. Compared to CT90, ODI had a stronger correlation and was a better predictor for AHI. The area under receiver operator (...) Oxygen Desaturation Index from Nocturnal Oximetry: A Sensitive and Specific Tool to Detect Sleep-DisorderedBreathing in Surgical Patients It is impractical to perform polysomnography (PSG) in all surgical patients suspected of having sleepdisorderedbreathing (SDB). We investigated the role of nocturnal oximetry in diagnosing SDB in surgical patients.All patients 18 years and older who visited the preoperative clinics for scheduled inpatient surgery were approached for study participation
Relation of natriuretic peptide concentrations to central sleepapnea in patients with heart failure Central sleepapnea (CSA) is frequent among patients with heart failure (HF) and associated with increased morbidity and mortality. Elevated cardiac filling pressures promote CSA and atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) secretion. We hypothesized that circulating natriuretic peptide concentrations predict CSA.Consecutive patients with HF (n = 44) with left (...) ventricular ejection fraction (LVEF) ≤ 35% underwent polysomnography for detection of CSA. CSA was defined as an apnea-hypopnea index ≥ 15 with ≥ 50% central apneic events. The relation of natriuretic peptide concentrations to CSA was evaluated by estimation of ORs and receiver operator characteristics (ROCs).Twenty-seven subjects (61%) had CSA, with men more frequently affected than women (73% vs 27%; OR, 7.1; P = .01); given that only three women had CSA, further analysis was restricted to men. Subjects
An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructivesleepapnea An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructivesleepapnea An integrated health-economic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructivesleepapnea Pietzsch JB, Garner A, Cipriano LE, Linehan JH Record Status (...) ) titration and treatment, for patients who might have had moderate-to-severe obstructivesleepapnoea. The authors concluded that full-night polysomnography, with CPAP treatment, was cost-effective and the preferred diagnostic strategy for these patients. The methods were valid and various areas of uncertainty were considered, showing that the authors’ conclusions are robust. Type of economic evaluation Cost-utility analysis Study objective This study assessed the cost-effectiveness of three common
Effects of home-based exercise training for patients with chronic heart failure and sleepapnoea: a randomized comparison of two different programmes To evaluate the effects of home-based exercise for patients with chronic heart failure and sleepapnoea and to compare two different training programmes.A randomized, prospective controlled trial.Department of Cardiology, University Hospital, Brazil.Fifty chronic heart failure patients with sleepapnoea were randomized in three groups: Group 1 (...) = 0.743). Untrained Group 3 demonstrated significant decrease or no change on measurements after three months without training.Home-based exercise training is an important therapeutic strategy in chronic heart failure patients with sleepapnoea, and strength training resulted in a higher increase in muscle strength and endurance.
Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Diagnostic accuracy of the Berlin Questionnaire in detecting sleep-disorderedbreathing in patients with a recent myocardial infarction The Berlin Questionnaire (BQ) has been used to identify patients at high risk for sleep-disorderedbreathing (SDB) in a variety of populations. However, there are no data regarding the validity of the BQ in detecting the presence of SDB in patients after myocardial infarction (MI). The aim of this study was to determine the performance of the BQ in patients (...) after MI.We conducted a cross-sectional study of 99 patients who had an MI 1 to 3 months previously. The BQ was administered, scored using the published methods, and followed by completed overnight polysomnography as the "gold standard." SDB was defined as an apnea-hypopnea index of ≥ 5 events/h. The sensitivity, specificity, and positive and negative predictive values of the BQ were calculated.Of the 99 patients, the BQ identified 64 (65%) as being at high-risk for having SDB. Overnight
study.2 sleep clinics in Spain.All women consecutively referred for suspected OSA between 1998 and 2007.Every woman had a diagnostic sleep study. Women with an apnea-hypopnea index (AHI) less than 10 were the control group. Obstructivesleepapnea was diagnosed when the AHI was 10 or higher (classified as mild to moderate [AHI of 10 to 29] or severe [AHI ≥30]). Patients with OSA were classified as CPAP-treated (adherence ≥4 hours per day) or untreated (adherence <4 hours per day or not prescribed (...) Cardiovascular mortality in women with obstructivesleepapnea with or without continuous positive airway pressure treatment: a cohort study. Obstructivesleepapnea (OSA) is a risk factor for cardiovascular death in men, but whether it is also a risk factor in women is unknown.To investigate whether OSA is a risk factor for cardiovascular death in women and assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk.Prospective, observational cohort
Home sleep studies for diagnosis of obstructivesleepapneasyndrome in patients younger than 18 years of age Home sleep studies for diagnosis of obstructivesleepapneasyndrome in patients younger than 18 years of age Home sleep studies for diagnosis of obstructivesleepapneasyndrome in patients younger than 18 years of age Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA (...) database. Citation Home sleep studies for diagnosis of obstructivesleepapneasyndrome in patients younger than 18 years of age. Lansdale: HAYES, Inc.. Directory Publication. 2012 Authors' conclusions The goal of obstructivesleepapnea diagnosis is to identify patients with obstructivesleepapneasyndrome (OSAS), to establish the precise factors responsible for the apnea, and to determine the most appropriate strategy for treatment. Home sleep studies are used to diagnose OSAS without the need
[Polysomnography in the diagnosis of sleep-related breathingdisorders] [Polysomnography in the diagnosis of sleep-related breathingdisorders] [Polysomnography in the diagnosis of sleep-related breathingdisorders] Shin S, Lee HJ, Kim JH, Lee DH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Shin S, Lee HJ, Kim JH, Lee DH (...) . [Polysomnography in the diagnosis of sleep-related breathingdisorders] Seoul: National Evidence-based Healthcare Collaborating Agency (NECA). NECA-C-12-006. 2012 Authors' conclusions The objective of this study is to verify the clinical evidence for the use of Polysomnography (PSG) in the diagnosis of sleep-related breathingdisorders (SRBD). This systematic review was performed to investigate scientific evidence for the diagnostic accuracy of PSG in SRBD. The clinical textbooks and guidelines were also
The impact of effective continuous positive airway pressure on homeostasis model assessment insulin resistance in non-diabetic patients with moderate to severe obstructivesleepapnea Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
(OSA) is a breathingdisorder that is defined by either a decrease or complete cessation of airflow during sleep. Airflow obstruction arises when the muscles in the back of the throat fail to keep the airway open. OSA is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. These pauses in breathing, called apneas, typically last 20 to 40 seconds. Hypopnea involves episodes of overly (...) shallow breathing or an abnormally low respiratory rate. Hypopnea differs from apnea in that there remains some flow of air. Untreated OSA is associated with symptoms of sleep deprivation and excessive sleepiness, cognitive dysfunction, diminished quality of life and productivity, sexual dysfunction, mood changes, increased accident risk, and cardiovascular disease and stroke. OSA has an estimated prevalence of 9% in women and 24% in men. Treatment of OSA includes behavioral therapy (e.g., weight loss
Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructivesleepapnea: a randomized controlled trial. Continuous positive airway pressure (CPAP) is the first-line treatment for patients with symptomatic obstructivesleepapnea (OSA). However, its indication for all patients with sleep-disorderedbreathing, regardless of daytime symptoms, is unclear.To evaluate the effect of CPAP treatment on the incidence (...) of hypertension or cardiovascular events in a cohort of nonsleepy patients with OSA.Multicenter, parallel-group, randomized controlled trial in 14 teaching hospitals in Spain. Between May 2004 and May 2006, 725 consecutive patients were enrolled who had an apnea-hypopnea index of 20 h(-1) or greater and an Epworth Sleepiness Scale score of 10 or less (scores range from 0-24, with values <10 suggesting no daytime sleepiness). Exclusion criteria were previous cardiovascular event, physical or psychological
) with recently diagnosed (<6 months) OSA and an apnea-hypopnea index (AHI) of 20 events/hour or more. These patients had been prescribed continuous positive airway pressure (CPAP) therapy to manage OSA and were identified via accredited community sleep clinics. The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical researchers in Melbourne, Australia. Patients with obesity hypoventilation syndrome, previous bariatric surgery, contraindications (...) Surgical vs conventional therapy for weight loss treatment of obstructivesleepapnea: a randomized controlled trial. Obstructivesleepapnea (OSA) is strongly related to obesity. Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA.To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA.A randomized controlled trial of 60 obese patients (body mass index: >35 and <55
Effect of acetazolamide and autoCPAP therapy on breathing disturbances among patients with obstructivesleepapneasyndrome who travel to altitude: a randomized controlled trial. Many patients with obstructivesleepapneasyndrome (OSA) living near sea level travel to altitude, but this may expose them to hypoxemia and exacerbation of sleepapnea. The treatment in this setting is not established.To evaluate whether acetazolamide and autoadjusted continuous positive airway pressure (autoCPAP (...) 800 m. At altitude, patients either took acetazolamide (750 mg/d) or placebo in addition to autoCPAP.Primary outcomes were nocturnal oxygen saturation and the apnea/hypopnea index; secondary outcomes were sleep structure, vigilance, symptoms, adverse effects, and exercise performance.Acetazolamide and autoCPAP treatment was associated with higher nocturnal oxygen saturation at 1630 m and 2590 m than placebo and autoCPAP: medians, 94% (interquartile range [IQR], 93%-95%) and 91% (IQR, 90%-92%) vs
Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial. To assess the effectiveness and safety of melatonin in treating severe sleep problems in children with neurodevelopmental disorders.12 week double masked randomised placebo controlled phase III trial.19 hospitals across England and Wales.146 children aged 3 years to 15 years 8 months were randomised. They had a range of neurological and developmental disorders (...) ) measured by actigraphy (n=59). Melatonin reduced sleep onset latency measured by sleep diaries (-37.5 minutes, -55.3 to -19.7 minutes) and actigraphy (-45.3 minutes, -68.8 to -21.9 minutes) and was most effective for children with the longest sleep latency (P=0.009). Melatonin was associated with earlier waking times than placebo (29.9 minutes, 13.6 to 46.3 minutes). Child behaviour and family functioning outcomes showed some improvement and favoured use of melatonin. Adverse events were mild
Melatonin for the management of sleepdisorders in children and adolescents Problems of sleep initiation and maintenance occur in 15% to 25% of children and adolescents. Studies of the benefits of melatonin for sleepdisorders have been published for healthy populations, for children and adolescents with attention-deficit hyperactivity disorder, for children and youth with autism, and for several other special populations. These studies demonstrate benefit with minimal side effects in both (...) short- and long-term use. However, all studies have involved small numbers of subjects and few have studied long-term use. Further studies are needed to confirm the usefulness and safety of melatonin for sleepdisorders in children and adolescents. Key Words: Attention-deficit hyperactivity disorder; Autism; Developmental disabilities; Melatonin; Sleepdisorders
[Upper respiratory tract surgical techniques for the treatment of patients with obstructivesleepapneasyndrome] Técnicas quirúrgicas de la vía aérea superior para pacientes con apnea obstructiva del sueño [Upper respiratory tract surgical techniques for the treatment of patients with obstructivesleepapneasyndrome] Técnicas quirúrgicas de la vía aérea superior para pacientes con apnea obstructiva del sueño [Upper respiratory tract surgical techniques for the treatment of patients (...) with obstructivesleepapneasyndrome] Pichon Riviere A, Augustovski F, Garcia Marti S, Glujovsky D, Alcaraz A, Lopez A, Bardach A, Ciapponi A, Romano M Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Pichon Riviere A, Augustovski F, Garcia Marti S, Glujovsky D, Alcaraz A, Lopez A, Bardach A, Ciapponi A, Romano M. Técnicas quirúrgicas de la vía aérea
. Authors' conclusions The content of these two procedures was first of all defined and a distinction was made between the medical part and the technical part. The main indications and non-indications for polysomnography and respiratory polygraphy were listed for the following categories of sleepdisorder: respiratory sleepdisorders (including obstructivesleepapnoea/hypopnoeasyndrome), insomnia, central hypersomnia, parasomnia, circadian rhythm disorders and sleep-related motor disorders (...) polygraphy, or indeed much simpler examinations consisting of just one or two measurements. The detailed conclusions of this assessment report can be consulted in the short text published on the HAS website. Final publication URL INAHTA brief and checklist Indexing Status Subject indexing assigned by CRD MeSH Humans; Polysomnography; Psychological Tests; SleepApneaSyndromes; SleepWakeDisorders Language Published French Country of organisation France English summary An English language summary