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Continuous positive airway pressure effect on visual acuity in patients with type 2 diabetes and obstructivesleepapnoea: a multicentre randomised controlled trial We sought to establish whether continuous positive airway pressure (CPAP) for obstructivesleepapnoea (OSA) in people with type 2 diabetes and diabetic macular oedema (DMO) improved visual acuity.We randomly assigned 131 eligible patients aged 30-85 years from 23 UK centres with significant DMO causing visual impairment (LogMAR
Does Armodafinil Improve Driving Task Performance and Weight Loss in SleepApnea? A Randomized Trial Patients with obstructivesleepapnea (OSA) unable to tolerate standard treatments have few alternatives. They may benefit from weight loss, but the major symptom of daytime performance impairment may remain during weight loss programs.We hypothesized that wakefulness-promoter armodafinil would improve driving task performance over placebo in patients undergoing weight loss.This was a placebo (...) -controlled, double-blind, randomized trial of armodafinil versus placebo daily for 6 months in patients who were also randomized to one of two diets for 6 months with follow-up at 1 year in overweight, adult, patients with OSA who had rejected standard treatment and suffered daytime sleepiness.Primary outcome was change in steering deviation in the final 30 minutes of a 90-minute afternoon driving task (AusED) at 6 months. Secondary outcomes were Epworth Sleepiness Scale, Functional Outcomes of Sleep
Improved Survival by Adding Lomustine to Conventional Chemotherapy for Elderly Patients With AML Without Unfavorable Cytogenetics: Results of the LAM-SA 2007 FILO Trial Acute myeloid leukemia (AML) in elderly patients has a poor prognosis. In an attempt to improve outcome for these patients, the prospective open-label phase III LAM-SA 2007 (Adding Lomustine to Chemotherapy in Older Patients With Acute Myelogenous Leukemia (AML), and Allogeneic Transplantation for Patients From 60 to 65 Years
Elevated obstructivesleepapnoea risk score is associated with poor healing of diabetic foot ulcers: a prospective cohort study To assess the prevalence of risk factors for obstructivesleepapnoea in people with diabetic foot ulcers and to determine whether this risk predicts diabetic foot ulcer healing.We studied 94 consecutive people (69% men) with diabetic foot ulcers (Type 2 diabetes, n=66, Type 1 diabetes, n=28) attending a university hospital foot unit. All participants were screened (...) for obstructivesleepapnoea using the STOP-BANG questionnaire, with a score ≥4 identifying high risk of obstructivesleepapnoea. The primary outcome was poor diabetic foot ulcer healing, defined as diabetic foot ulcer recurrence (diabetic foot ulcers which healed and re-ulcerated in same anatomical position) and/or diabetic foot ulcer persistence (no evidence of healing on clinical examination). All participants were evaluated at 12 months.Of the 94 participants, 60 (64%) had a STOP-BANG score ≥4. Over 12
Cross-sectional study of brucellosis and Q fever in Thailand among livestock in two districts at the Thai-Cambodian border, Sa Kaeo province Brucellosis and Q fever impart high morbidity in humans and economic losses among livestock worldwide. However their prevalence is still not fully known in Thailand. We conducted a sero-survey of brucellosis and Q fever in beef, dairy cattle, goat, and sheep herds from Thai communities at the border with Cambodia, a cross-border trading center. Serum
with neurological conditions, such as autism spectrum disorder (ASD) and Smith-Magenis syndrome, who also have insomnia is high and not many treatments are available. Slenyto has been shown to improve sleeping times in these patients, with patients taking Slenyto sleeping for an extra 51 minutes a night compared with an extra 19 minutes with placebo. The side effects seen with the medicine over 2 years appear mild or moderate but more data are needed on longer term safety. The European Medicines Agency decided (...) Melatonin (Slenyto) - insomnia (difficulty sleeping) in children and adolescents (2 to 18 years old) Slenyto | European Medicines Agency Search Search Menu Slenyto melatonin Table of contents Authorised This medicine is authorised for use in the European Union. Overview Slenyto is a medicine for treating insomnia (difficulty sleeping) in children and adolescents (2 to 18 years old) who have: autism spectrum disorder (ASD), a range of conditions that affects the patient’s social interactions
=apnea–hypopnea index; C=control; CI=con?dence interval; CPAP=continuous positive airway pressure; D=drug; ER=extended release; IWQoL-Lite= Impact of Weight on Quality of Life–Lite instrument; OSA=obstructivesleepapnea; QOL=quality of life; SF-36=36-item Short Form Health Survey. AMERICAN THORACIC SOCIETY DOCUMENTS e78 American Journal of Respiratory and Critical Care Medicine Volume 198 Number 6 | September 15 2018 noted among those taking liraglutide. Changes in daytime somnolence did not differ (...) The Role of Weight Management in the Treatment of Adult ObstructiveSleepApnea Guideline AMERICANTHORACICSOCIETY DOCUMENTS TheRoleofWeightManagementintheTreatmentofAdultObstructive SleepApnea An Of?cial American Thoracic Society Clinical Practice Guideline David W. Hudgel, Sanjay R. Patel, Amy M. Ahasic, Susan J. Bartlett, Daniel H. Bessesen, Melisa A. Coaker, P. Michelle Fiander, Ronald R. Grunstein, Indira Gurubhagavatula, Vishesh K. Kapur, Christopher J. Lettieri, Matthew T. Naughton
Management of obstructivesleepapnoea in a primary care vs sleep unit setting: a randomised controlled trial To assess the effectiveness and cost-effectiveness of primary care (PC) and sleep unit (SU) models for the management of subjects with suspected obstructivesleepapnoea (OSA).Multicentre, open-label, two-arm, parallel-group, non-inferiority randomised controlled trial. A total of 302 subjects with suspected OSA and/or resistant hypertension were consecutively enrolled, 149 were treated (...) at 11 PC units and 153 patients at a SU. The primary outcomes were a 6-month change in the Epworth Sleepiness Scale (ESS) score and Health Utilities Index (HUI). The non-inferiority margin for the ESS score was -2.0.A total of 80.2% and 70.6% of the PC and SU patients were diagnosed with OSA, respectively, and 59.3% and 60.4% of those were treated with CPAP in PC and SU units, respectively. The Apnoea-Hypopnoea Index was similar between the groups (PC vs SU (median (IQR); 23.1 (26.8) events/h vs
Effect of 1 month of zopiclone on obstructivesleepapnoea severity and symptoms: a randomised controlled trial Hypnotic use in obstructivesleepapnoea (OSA) is contraindicated due to safety concerns. Recent studies indicate that single-night hypnotic use worsens hypoxaemia in some and reduces OSA severity in others depending on differences in pathophysiology. However, longer clinical trial data are lacking. This study aimed to determine the effects of 1 month of zopiclone on OSA severity (...) , sleepiness and alertness in patients with low-moderate respiratory arousal thresholds without major overnight hypoxaemia.69 participants completed a physiology screening night with an epiglottic catheter to quantify arousal threshold. 30 eligible patients (apnoea-hypopnoea index (AHI) 22±11 events·h-1) then completed standard in-laboratory polysomnography (baseline) and returned for two additional overnight sleep studies (nights 1 and 30) after receiving either nightly zopiclone (7.5 mg) or placebo
Recanalisation therapies for wake-up stroke. About one in five strokes occur during sleep (wake-up stroke). People with wake-up strokes have traditionally been considered ineligible for thrombolytic treatment because the time of stroke onset is unknown. However, some studies suggest that these people may benefit from recanalisation therapies.To assess the effects of intravenous thrombolysis and other recanalisation therapies versus control in people with acute ischaemic stroke presenting (...) and unpublished data.We included one pilot trial with nine participants. The trial was a feasibility trial that included participants with an unknown onset of stroke and signs on perfusion computed tomography of ischaemic tissue at risk of infarction, who were randomised to alteplase (0.9 mg/kg) or placebo. One trial was prematurely terminated due to signs of efficacy of the intervention arm; we did not include this trial because we were not able to obtain data for the portion of the participants with wake-up
is a sleepdisorder affecting approximately 13% of the Canadian population. People with insomnia often have difficulty falling asleep or difficulty remaining asleep. They may also wake 2017 11. Treatments for Insomnia : A Review of Patient and Experiences and Perspectives Treatments for Insomnia : A Review of Patient and Experiences and Perspectives | CADTH.ca Find the information you need Treatments for Insomnia : A Review of Patient and Experiences and Perspectives Treatments for Insomnia : A Review (...) of what constitutes normal sleep. It usually takes less than 30 minutes for a person to fall asleep. Average (...) total nocturnal sleep time decreases with age from about 8 hours at 15 years of age to less than 6 hours at 80 years of age. Insomnia can be categorized according to duration or likely duration: Short-term insomnia lasts less than 4 weeks. Long-term (or persistent) insomnia lasts for 4 weeks or longer. Sleepdisorders that need to be excluded when making a diagnosis of insomnia are: Sleep
American Thoracic Society Documents 289 Overview The overlap syndrome (OVS) is the co-occurrence of chronic obstructive pulmonarydisease (COPD)and obstructivesleepapnea (OSA). This statement summarizestheexistingliterature,identi?es knowledge gaps, and provides guidance regarding future priorities in research for sleep-disorderedbreathing (SDB) in patientswithCOPDandotherlungdiseases. Key Conclusions d OVS is common because COPD and OSA are common. There is no de?nitive evidence that patients (...) without comorbid insomnia. Although the detection of apnea is reasonably straightforward, hypopneas, as de?ned by Decreased I/E Airflow ?PaO2 ?PaCO2 Chemoreceptor Stimulation Arousal Expiratory UA Narrowing Diaphragm Dysfunction Dynamic Hyperinflation Alveolar Hypoventilation Inspiratory UA Narrowing Ventilatory Overshoot Increased work of Breathing Decreased Ventilatory Motor Output Worsening Airflow Obstruction Upper Airway Muscle Activity ? Caudal Traction Sleep + Circadian Factors + Supine
syndrome? Introduction Methods Committee Composition Workshop Structure and Literature Review Document Development Perioperative Outcomes of Patients with Sleep- disorderedBreathing Screening for ObstructiveSleepApnea in Surgical Patients ObstructiveSleepApnea Endotypes and Potential Relevance in the Perioperative Period Role of Algorithms in the Perioperative Management of ObstructiveSleepApnea and Obesity Hypoventilation Syndrome Perioperative Use of Positive Airway Pressure Obesity (...) Hypoventilation Syndrome in the Perioperative Period OpioidsandtheSurgicalPatient with ObstructiveSleepApnea The Use of Administrative Databases and Patient Registries Patient Safety and Healthcare Management Considerations Conclusions American Thoracic Society Documents 117 Overview Perioperative management of sleep- disorderedbreathing, such as obstructivesleepapnea (OSA) and obesity hypoventilationsyndrome(OHS),isanarea of patient care that requires improvement due to the risk of morbidity
suspected of sleep-disorderedbreathing. (Conditional) Remarks: This recommendation only applies to patients who are appropriate candidates for a home sleepapnea test (HSAT). It has been well established that testing with an HSAT, in comparison to PSG, typically underestimates the severity of sleep-disorderedbreathing (SDB). A component of this underestimation arises from the event-per-hour indices used for the diagnosis and severity determination of obstructivesleepapnea (OSA). Specifically (...) disorder. (Conditional) We suggest that clinicians use actigraphy in the assessment of adult patients with circadian rhythm sleep-wakedisorder. (Conditional) We suggest that clinicians use actigraphy in the assessment of pediatric patients with circadian rhythm sleep-wakedisorder. (Conditional) We suggest that clinicians use actigraphy integrated with home sleepapnea test devices to estimate total sleep time during recording (in the absence of alternative objective measurements of total sleep time
Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial Delayed Sleep-Wake Phase Disorder (DSWPD) is characterised by sleep initiation insomnia when attempting sleep at conventional times and difficulty waking at the required time for daytime commitments. Although there are published therapeutic guidelines for the administration of melatonin for DSWPD, to our knowledge, randomised controlled trials are lacking (...) . This trial tested the efficacy of 0.5 mg melatonin, combined with behavioural sleep-wake scheduling, for improving sleep initiation in clinically diagnosed DSWPD patients with a delayed endogenous melatonin rhythm relative to patient-desired (or -required) bedtime (DBT).This randomised, placebo-controlled, double-blind clinical trial was conducted in an Australian outpatient DSWPD population. Following 1-wk baseline, clinically diagnosed DSWPD patients with delayed melatonin rhythm relative to DBT
trial including baseline and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group.Seven primary health care centers (Stockholm, Sweden).One hundred and sixty-five primary care patients who meet the criteria for insomniadisorder (mean age 54 years, SD 16). Most were women (73%).severe untreated illness, bipolar disorder, current stressful life event, night shift work, and untreated sleepdisorder other than insomnia.Data came from a randomized controlled trial (...) ), improved daytime symptomatology in primary care patients with insomnia.Fatigue (Fatigue Severity Scale [FSS]; main outcome), mood (General Health Questionnaire and Montgomery-Asberg Depression Rating Scale), health-related quality of life (Short-Form Health Survey), general daytime functioning, specific daytime symptoms (individual items from the Insomnia Severity Index and Uppsala Sleep Inventory), and dysfunctional beliefs (Dysfunctional Beliefs and Attitudes about Sleep).A randomized controlled
data from participants in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a population-based study that enrolled 16,415 adults in 4 US communities. Sleep-disorderedbreathing was assessed using a home sleepapnea monitor for overnight recording and was defined using 3 thresholds of the apnea-hypopnea index (AHI; 3% desaturation): ≥5, ≥15, and ≥30. Albuminuria was defined as a urine albumin-to-creatinine ratio of ≥30 mg/g.There were 12,572 participants with complete data available (...) Sleep-DisorderedBreathing and Prevalent Albuminuria in Hispanics/Latinos Although sleep-disorderedbreathing has been found to be associated with higher urine albumin excretion, this association has not been evaluated in Hispanic/Latino populations, which experience a high burden of end-stage renal disease compared with non-Hispanics. We evaluated the association of sleep-disorderedbreathing with prevalent albuminuria among US Hispanics/Latinos.This was a cross-sectional study of baseline
Intermittent Hypoxia and Hypercapnia, a Hallmark of ObstructiveSleepApnea, Alters the Gut Microbiome and Metabolome Obstructivesleepapnea (OSA) is a common disorder characterized by episodic obstruction to breathing due to upper airway collapse during sleep. Because of the episodic airway obstruction, intermittently low O2 (hypoxia) and high CO2 (hypercapnia) ensue. OSA has been associated with adverse cardiovascular and metabolic outcomes, although data regarding potential causal pathways (...) are still evolving. As changes in inspired O2 and CO2 can affect the ecology of the gut microbiota and the microbiota has been shown to contribute to various cardiometabolic disorders, we hypothesized that OSA alters the gut ecosystem, which, in turn, exacerbates the downstream physiological consequences. Here, we model human OSA and its cardiovascular consequence using Ldlr-/- mice fed a high-fat diet and exposed to intermittent hypoxia and hypercapnia (IHH). The gut microbiome and metabolome were
Diagnostic accuracy of a two-stage model for detecting obstructivesleepapnoea in chronic tetraplegia Obstructivesleepapnoea (OSA) is highly prevalent in people with spinal cord injury (SCI). Polysomnography (PSG) is the gold-standard diagnostic test for OSA, however PSG is expensive and frequently inaccessible, especially in SCI. A two-stage model, incorporating a questionnaire followed by oximetry, has been found to accurately detect moderate to severe OSA (MS-OSA) in a non-disabled (...) thresholds for diagnosing MS-OSA. The accuracy of both models in diagnosing MS-OSA was prospectively evaluated in 100 participants with chronic tetraplegia across four international SCI units.Injury completeness, sleepiness, self-reported snoring and apnoeas were included in the modified questionnaire, which was highly predictive of MS-OSA (ROC area under the curve 0.87 (95% CI 0.79 to 0.95)). The 3% oxygen desaturation index was also highly predictive (0.93 (0.87-0.98)). The two-stage model