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, Godden D J Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Two methods for the annual review of patients diagnosed with obstructivesleepapnoea/hypopnoeasyndrome (SAHS), who were being treated with constant positive airway (...) Annual review of patients with sleepapnea/hypopneasyndrome: a pragmatic randomised trial of nurse home visit versus consultant clinic review Annual review of patients with sleepapnea/hypopneasyndrome: a pragmatic randomised trial of nurse home visit versus consultant clinic review Annual review of patients with sleepapnea/hypopneasyndrome: a pragmatic randomised trial of nurse home visit versus consultant clinic review Palmer S, Selvaraj S, Dunn C, Osman L M, Cairns J, Franklin D, Hulks G
Psychological treatment for insomnia in the regulation of long-term hypnotic drug use Psychological treatment for insomnia in the regulation of long-term hypnotic drug use Journals Library An error has occurred in processing the XML document An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation or try a website search above to find the information
Insomnia. Effective management of insomnia begins with recognition and adequate assessment. Family doctors and other health care providers such as practice nurses and psychologists should routinely enquire about sleep habits as a component of overall health assessment. Identification and treatment of primary psychiatric disorders, medical conditions, circadian disorders, or specific physiological sleepdisorders--eg, sleepapnoea and periodic limb movement disorder--are essential steps (...) in management of insomnia. Conditioned aspects of insomnia can be primary (psychophysiological insomnia) or may complicate sleep disturbance owing to other causes. Approved hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in various short-term situations. Despite widespread use of standard hypnotics and sedating antidepressants for chronic insomnia, their role for this indication still remains to be further defined by research evidence. Non-pharmacological treatments
, stroke, sympathetic activity, endothelium, inflammation, and continuous positive airway pressure (CPAP) to identify peer-reviewed studies of OSA. Priority was given to large prospective cohort studies and to randomized controlled trials.We identified 154 original investigations and reviews of sleep-related breathingdisorders. Data from these studies were examined for relevance and extracted by one of the authors.Approximately 1 in 5 adults has at least mild OSA (apnea-hypopnea index [ie, the number (...) Obstructivesleepapnea: implications for cardiac and vascular disease. Obstructivesleepapnea (OSA) has been increasingly implicated in the initiation and progression of cardiovascular diseases.To systematically review the interactions of OSA with cardiovascular pathophysiology and diseases.The MEDLINE database from January 1966 to March 2003 was searched using the Medical Subject Headings sleep, sleepapnea, obesity, hypertension, heart failure, cardiac arrhythmia, coronary artery disease
and hypopneas per hour of sleep. Sleep-disorderedbreathing was defined by an AHI of at least 10 (mild to moderate) or of at least 15 (moderate).Forty-seven (16%) of 286 eligible participants, (95% confidence interval [CI], 13%-21%) had a second-study AHI of at least 10 and 29 (10%) participants (95% CI, 7%-14%) had a second-study AHI result of at least 15. For the AHI results of at least 15, we estimate that about 2.5% may represent test variability. By ordinal logistic regression analysis, AHI (...) Incidence of sleep-disorderedbreathing in an urban adult population: the relative importance of risk factors in the development of sleep-disorderedbreathing. Sleep-disorderedbreathing (SDB) is both prevalent and associated with serious chronic illness. The incidence of SDB and the effect of risk factors on this incidence are unknown.To determine the 5-year incidence of SDB overall and as influenced by risk factors.Of the 1149 participants in the Cleveland Family Study, those aged 18 years
Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructivesleepapnea. Obstructivesleepapnea subjects the failing heart to adverse hemodynamic and adrenergic loads and may thereby contribute to the progression of heart failure. We hypothesized that treatment of obstructivesleepapnea by continuous positive airway pressure in patients with heart failure would improve left ventricular systolic function.Twenty-four patients with a depressed (...) left ventricular ejection fraction (45 percent or less) and obstructivesleepapnea who were receiving optimal medical treatment for heart failure underwent polysomnography. On the following morning, their blood pressure and heart rate were measured by digital photoplethysmography, and left ventricular dimensions and left ventricular ejection fraction were assessed by echocardiography. The subjects were then randomly assigned to receive medical therapy either alone (12 patients
Auto-titrating nasal continuous positive airway pressure systems in the management of obstructivesleepapnea Auto-titrating nasal continuous positive airway pressure systems in the management of obstructivesleepapnea Auto-titrating nasal continuous positive airway pressure systems in the management of obstructivesleepapnea Hailey D, Jacobs P, Mayers I, Mensinkai S 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 Hailey D, Jacobs P, Mayers I, Mensinkai S. Auto-titrating nasal continuous positive airway pressure systems in the management of obstructivesleepapnea. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2003 Authors' objectives To review the evidence for the efficacy, effectiveness, and costs of auto-titrating nasal continuous positive airway pressure (APAP) devices in their use for: - diagnosis
stays and shorter waiting periods. Since there is no medical legitimation for discriminating against the diagnosis and treatment of sleepapnea in an ambulatory setting, the current preference of in-patient care does not appear to be justified. Project page URL Indexing Status Subject indexing assigned by CRD MeSH Costs and Cost Analysis; Polysomnography; Positive-Pressure Respiration; SleepApneaSyndromes /therapy /diagnosis Language Published German Country of organisation Germany English Summary (...) Diagnosis and treatment of sleepapnea - systematic review of diagnostics, therapy, and cost-effectiveness Diagnosis and treatment of sleepapnea - systematic review of diagnostics, therapy, and cost-effectiveness Diagnosis and treatment of sleepapnea - systematic review of diagnostics, therapy, and cost-effectiveness Perleth M, Leyen U von der, Schmitt H, Dintsios CM, Felder S, Schwartz FW, Teske S Record Status This is a bibliographic record of a published health technology assessment from
Science and Engineering Foundation. Bibliographic details Sok S R, Erlen J A, Kim K B. Effects of acupuncture therapy on insomnia. Journal of Advanced Nursing 2003; 44(4): 375-384 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Acupuncture Therapy /methods; Female; Humans; Male; Medicine, Chinese Traditional /methods; Sleep Initiation and Maintenance Disorders /therapy; Treatment Outcome AccessionNumber 12004003216 Date bibliographic record published 31/05/2006 Date abstract record (...) Effects of acupuncture therapy on insomnia Effects of acupuncture therapy on insomnia Effects of acupuncture therapy on insomnia Sok S R, Erlen J A, Kim K B CRD summary This review assessed the effects of acupuncture therapy on insomnia. The authors concluded that acupuncture may be an effective intervention for insomnia. A number of methodological problems, both in the included studies and in the review, mean that this conclusion may not be reliable. Authors' objectives To assess the trends
The influence of CPAP on the neurobehavioral performance of patients with obstructivesleepapneahypopneasyndrome: a systematic review The influence of CPAP on the neurobehavioral performance of patients with obstructivesleepapneahypopneasyndrome: a systematic review The influence of CPAP on the neurobehavioral performance of patients with obstructivesleepapneahypopneasyndrome: a systematic review McMahon J P, Foresman B H, Chisholm R C CRD summary This review assessed continuous (...) the bulk of the evidence came from poor-quality studies, the evidence is weak and the authors' conclusions should be regarded with caution. Implications of the review for practice and research The authors did not state any implications for practice or further research. Bibliographic details McMahon J P, Foresman B H, Chisholm R C. The influence of CPAP on the neurobehavioral performance of patients with obstructivesleepapneahypopneasyndrome: a systematic review. Wisconsin Medical Journal 2003; 102
A, Stanchina M L, Ayas N T. Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructivesleepapnea: results of a meta-analysis. Archives of Internal Medicine 2003; 163(5): 565-571 PubMedID Original Paper URL Other publications of related interest This additional published commentary may also be of interest. Rees PJ. Review: continuous positive airway pressure therapy improves subjective and objective sleepiness in obstructivesleepapnoea. Evid Based Med (...) Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructivesleepapnea: results of a meta-analysis Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructivesleepapnea: results of a meta-analysis Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructivesleepapnea: results of a meta-analysis Patel S R, White D P, Malhotra A, Stanchina M L
chronic insomnia. Journal of Psychosomatic Research 2003;54:21-9. Indexing Status Subject indexing assigned by NLM MeSH Adult; Aged; Aged, 80 and over; Chronic Disease; Cognitive Therapy; Drug Administration Schedule; Female; Follow-Up Studies; Health Care Costs; Humans; Hypnotics and Sedatives /administration & Male; Middle Aged; Sleep Initiation and Maintenance Disorders /drug therapy /therapy; dosage AccessionNumber 22004008017 Date bibliographic record published 31/07/2004 Date abstract record (...) that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Patients with chronic sleep problems, who had been using hypnotic drugs for at least 1 month, were given a course of cognitive-behaviour therapy (CBT) to help with their insomnia. The CBT consisted of 6 sessions with a practice counsellor specially trained
Oral appliances for obstructivesleepapnoea. Obstructivesleepapnoea-hypopnoea is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal. Nasal continuous positive airway pressure is the primary treatment for obstructivesleepapnoea-hypopnoea, but many patients are unable or unwilling to comply with this treatment. Oral appliances are an alternative treatment for sleep apnoea.The objective (...) disorderedbreathing compared with a control. Nasal continuous positive airways pressure appears to be more effective in improving sleepdisorderedbreathing than oral appliance. Until there is more definitive evidence on the effectiveness of oral appliances, it would appear to be appropriate to restrict oral appliance therapy to patients with sleepapnoea who are unwilling or unable to comply with continuous positive airways pressure therapy.
Adenotonsillectomy for obstructivesleepapnoea in children. Current treatment of sleepapnoea in children consists of largely surgical based treatments. Adenotonsillectomy is the most commonly used intervention to treat sleepapnoea in children.To determine the efficacy of adenotonsillectomy in the treatment of obstructivesleepapnoea in children.The Cochrane Airways group specialised register was searched with pre-specified terms.Randomised trials recruiting children with a diagnosis (...) of obstructivesleep apnoea.A total of 196 references were identified from electronic searching. Twenty studies were retrieved and none met the inclusion criteria of the review.Due to the absence of randomised trial data, no results could be ascertained.At present there is still debate as to the polysomnographic criteria required to diagnose significant obstructivesleepapnoea in children. Also the natural history of the condition has not been fully delineated. There is an absence of randomised controlled
(increased neck circumference), but overnight polysomnography is needed to confirm presence of the disorder. Repetitive pharyngeal collapse causes recurrent arousals from sleep, leading to sleepiness and increased risk of motor vehicle and occupational accidents. The surges in hypoxaemia, hypercapnia, and catecholamine associated with this disorder have now been implicated in development of hypertension, but the association between obstructivesleepapnoea and myocardial infarction, stroke (...) Obstructivesleepapnoea. Obstructivesleepapnoea is a disease of increasing importance because of its neurocognitive and cardiovascular sequelae. Abnormalities in the anatomy of the pharynx, the physiology of the upper airway muscle dilator, and the stability of ventilatory control are important causes of repetitive pharyngeal collapse during sleep. Obstructivesleepapnoea can be diagnosed on the basis of characteristic history (snoring, daytime sleepiness) and physical examination
<0.001). For both apnea and hypopnea, the value for the index was 28 +/- 22 in spontaneous rhythm, as compared with 11 +/- 14 with atrial overdrive pacing (P<0.001).In patients with sleepapneasyndrome, atrial overdrive pacing significantly reduces the number of episodes of central or obstructivesleepapnea without reducing the total sleep time. (...) Benefit of atrial pacing in sleepapneasyndrome. Many patients with sleepapneasyndrome have nocturnal bradycardia, paroxysmal tachyarrhythmias, or both, which can be prevented by permanent atrial pacing. We evaluated the effect of using cardiac pacing to increase the heart rate during sleep in patients with sleepapnea syndrome.We studied 15 patients (11 men and 4 women; mean [+/-SD] age, 69+/-9 years) with central or obstructivesleepapnea who had received permanent atrial-synchronous
Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructivesleepapnoea: a randomised parallel trial. Obstructivesleepapnoea is associated with raised blood pressure. If blood pressure can be reduced by nasal continuous positive airway pressure (nCPAP), such treatment could reduce risk of cardiovascular disease in patients with obstructivesleepapnoea. Our aim was to see whether nCPAP for sleepapnoea reduces blood pressure (...) compared with the most robust control intervention subtherapeutic nCPAP.We did a randomised parallel trial to compare change in blood pressure in 118 men with obstructivesleepapnoea (Epworth score > 9, and a > 4% oxygen desaturation index of > 10 per h) who were assigned to either therapeutic (n=59) or subtherapeutic (59) nCPAP (about 1 cm H(2)O pressure) for 1 month. The primary outcome was the change in 24-h mean blood pressure. Secondary outcomes were changes in systolic, diastolic, sleep
2002LancetControlled trial quality: predicted high
patients with obstructivesleepapnoeasyndrome. Sleep 2002;25:143-7. Indexing Status Subject indexing assigned by NLM MeSH Adult; Disorders of Excessive Somnolence /diagnosis; Equipment Design; Equipment Failure; Humans; Positive-Pressure Respiration /instrumentation; SleepApnea, Obstructive /complications /therapy; Time; Treatment Outcome AccessionNumber 12002000690 Date bibliographic record published 31/03/2003 Date abstract record published 31/03/2003 Record Status This is a critical abstract (...) The use of auto-titrating continuous positive airway pressure for treatment of adult obstructivesleepapnea The use of auto-titrating continuous positive airway pressure for treatment of adult obstructivesleepapnea The use of auto-titrating continuous positive airway pressure for treatment of adult obstructivesleepapnea Berry R B, Parish J M, Hartse K M Authors' objectives The review was conducted by a Task Force appointed by the American Academy of Sleep Medicine to inform practice
Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease: a survey by the Canadian Movement Disorders Group. Somnolence is a recognized adverse effect of dopamine agonists. Two new dopamine agonists, pramipexole and ropinirole, have been reported to cause sudden-onset sleep spells in patients with Parkinson disease (PD) while they were driving. The frequency of these spells and whether driving should be restricted has yet to be established.To determine the frequency (...) of and predictors for sudden-onset sleep and, particularly, episodes of falling asleep while driving among patients with PD.Prospective survey conducted between January and April 2000 in 18 clinics directed by members of the Canadian Movement Disorders Group; 638 consecutive highly functional PD patients without dementia were enrolled, of whom 420 were currently drivers.Excessive daytime sleepiness and sudden-onset sleep as assessed by the Epworth Sleepiness Scale and the Inappropriate Sleep Composite Score
Drug treatments for obstructivesleepapnoea. The treatment of choice for moderate to severe obstructivesleepapnoea (OSA) is continuous positive airway pressure (CPAP) via a mask during sleep. However this is not tolerated by all patients and its role in mild OSA is not proven. Drug therapy has been proposed as an alternative to CPAP in some patients with mild to moderate sleepapnoea. The mechanisms by which drugs might reduce OSA include; a reduction in the proportion of rapid eye movement (...) (REM) sleep (during which apnoeas tend to be more frequent), an increase in ventilatory drive or an increase in upper airway muscle tone during sleep.To determine the efficacy of drug therapies in the treatment of sleep apnoea.Searches were carried out on the Cochrane Airways Group RCT Register. Additional hand searching was performed as relevant.Double blind, randomised placebo controlled trials were included, involving patients with confirmed obstructivesleepapnoea. Trials were excluded