Introduction:Awareness, assessment and treatment of sleep apnea are disproportionately lower among Blacks, compared to other racial/ethnic groups. To address this health disparity gap, communication strategies that connect Blacks to OSA education, detection and treatment adherence interventions are needed. Strategies that engage individuals through communication technologies, community-level social network support, and medical providers in clinical settings are also needed. We present lessons learned from three studies that offer these solutions using a community-engaged research model: The Metabolic Syndrome Outcome Study (MetSO), Peer-enhanced Education to Reduce Sleep Ethnic Disparities (PEERS-ED), and Tailored Approach to Sleep Health Education (TASHE), to capture program effectiveness and lessons learned from project successes and failures.Methods:The methods of OSA community-based programs included the application of an OSA community-engaged research model. This model served as a strategic guideline for effective interventions to engage communities in research and ensure cultural appropriateness in OSA interventions. Focus groups, in-depth interviews and community steering committee meetings were conducted with various stakeholders. Delphi surveys were used to identify high priority diseases and conditions. Community barriers and needs were identified through iterative combinations of surveys and focus group meetings. Stakeholder groups participated in all aspects of our studies, including the development, dissemination and implementation phases, reflecting a bi-directional decision-making process that ensures the interests of both parties were considered. The MetSO, PEERS-ED and TASHE studies were reviewed to understand the effectiveness of the programs and to evaluate lessons learned.Results:MetSO, PEERS-ED and TASHE interventions revealed that community-engaged strategies are successful in enrolling Black populations into clinical trials. The study teams reached nearly 3,000 Blacks at risk of OSA and screened about 2,000 people in sleep apnea studies in New York City. Sleep brochures were distributed to over 10,000 people. Lessons learned from MetSO, PEERS-ED and TASHE interventions revealed that building relationships, establishing trust, identifying a study champion, learning to adjust and providing participant incentives are key strategic elements for successful recruitment and retention of Blacks participations in clinical trials.Conclusion:Strategic application of community-oriented frameworks ensures active community engagement throughout the research process, allowing for greater enrollment of Blacks in clinical studies as well as increased OSA awareness, diagnosis, and treatment.
As a sleep physician for a military treatment facility our patient population consists of roughly forty thousand soldiers and beneficiaries. Of which we primarily care for an adult population. Part of my experience as a sleep physician has involved the use of group classes and support group sessions for obstructive sleep apnea, insomnia, oral appliance therapy and nightmare therapy groups. I wanted to establish a support group within our clinic for patients with narcolepsy.
Study background: Sleep disturbance may contribute to subjective memory complaints which are frequently encountered in cognitive disorders clinics. Identification of sleep disturbance may contribute to a positive diagnosis of functional cognitive disorders (FCD) compared to dementia or mild cognitive impairment. Methods: Jenkins Sleep Scale (JSS), a validated sleep scale, was administered to consecutive new patients attending a dedicated cognitive disorders clinic based in a regional neuroscience Centre. Results: Sleep disturbance identified using JSS was more frequent in patients with functional cognitive disorders (p 0.8) for FCD when used as a diagnostic test. Conclusion: Identifying sleep disturbance using a simple sleep screening scale may contribute to a positive diagnosis of functional cognitive disorders in a dedicated cognitive disorders clinic. This may have pragmatic implications for the treatment of subjective memory complaints.
Objective: The role of sleep quality in tobacco dependence of young adults, a population in which the prevalence of smoking is highest, is largely unknown. The current study aimed at examining whether the sleep quality of smokers, measured subjectively (the Mini Sleep Questionnaire; MSQ) and objectively (actigraphy) is worse than that of nonsmokers and further deteriorates during one week of abstinence from smoking (i.e., first stage of cessation). Methods: Forty-six young (19–28 years old) volunteers, of them were 26 nonsmokers (73.1% women) and 20 were regular smokers (75% women) smoking at least 10 cigarettes a day. The participants completed the Brief Questionnaire on Smoking Urges, the Fagerström Test for Nicotine Dependence (FTND), and the Mini Sleep Questionnaire (MSQ). Their sleep was then monitored objectively for one week using an actigraph. Subsequently, the participants of the smokers group ceased smoking and their sleep was monitored via actigraphy during the first week of smoking abstinence. At the end of the week they again completed the FTND and the MSQ. Results: Self-reported sleep quality did not differ between the groups. However, actigraphy data pointed to lower sleep continuity in smokers compared to nonsmokers as reflected by increased wake time after sleep onset (WASO) and nighttime awakenings. Total sleep time and sleep onset latency did not differ between the groups. During the week of abstinence sleep continuity further deteriorated as reflected by increases in WASO and in the number of awakenings, and a reduction in sleep efficiency. At the end of the week of abstinence the severity of self-reported symptoms of insomnia predicted urge to smoke. Conclusion: Young adult smokers have lower sleep continuity compared to nonsmokers and their sleep difficulties worsen during smoking cessation. The findings suggest that interventions intended to promote sleep quality could serve as adjunct treatment for smoking cessation.
Some studies have indicated a relationship between the development of Alzheimers Disease (AD) and having obstructive sleep apnea (OSA), while others argue that AD itself leads to sleep disturbances and sleep disordered breathing. Whether peripheral due to the direct effects of abnormal protein aggregation or central due to the systemic effects of Beta - A aggregation in functionally important areas of the central nervous system, there seems to be an association between misfolded protein and sleep disordered breathing. These findings from studies into another proteopathy lends further credence to the revelations reported from the prion related research and brings us closer to understanding the disease mechanism behind both OSA and protein misfolding. The conglomeration of findings from studies into proteopathies clearly provides significant impetus into continuing research in proteopathies to improve our understanding of not only sleep disordered breathing but the enigma that is proteopathy.
IntroductionThis study was deigned to assess the effect of weight and severity of obstructive sleep apnea (OSA) on polysomnography (PSG) outcomes following adeno-tonsillectomy (AT) in children with Trisomy 21. Children with Trisomy 21 have an increased likelihood of persistent OSA following AT due in part to underlying hypotonia and macroglossia. In addition, weight status is known to influence the results of AT in non-Trisomy 21 patients.
OBJECTIVES:To conducted a meta-analysis assessing the relationship between Obstructive Sleep Apnea (OSA) and the risk of Atrial Fibrillation (AF).METHODS:We searched PUBMED, Medline, and Cochrane Library using the keywords "atrial fibrillation", "obstructive sleep apnea" and "sleep disordered breathing (SDB)". All subjects included had established diagnosis of OSA/SDB. We then compared the occurrence of AF versus no AF. Analysis done with Comprehensive Meta-Analysis package V3 (Biostat, USA).RESULTS:A total of 579 results were generated. Duplicates were removed and 372 records were excluded based on irrelevant abstracts, titles, study design not consistent with the stated outcome, or full-text unavailable. Twelve studies meeting the inclusion criteria were reviewed in full-text; 2 of these articles were eventually removed due to unconfirmed OSA diagnostic modality, and one was also removed based on a control group inconsistent with the other studies. Therefore, a total of 9 studies were included (n=19,837). Sample sizes ranged from n=160 patients to n=6841 patients. The risk of AF was found to be higher among OSA/SDB versus control group (OR; 2.120, C.I: 1.845-2.436, Z; 10.598 p: <0.001). The heterogeneity observed for the pooled analysis was Q-value; 22.487 df (Q); 8 P-value; 0.004, I-squared; 64.424 Tau2; 0.098, suggesting appropriate study selection and moderate heterogeneity.CONCLUSION:OSA/SDB is strongly associated with AFib confirming the notion that OSA/SDB populations are high risk for development of AF. Prospective studies are needed to ascertain the effect of the treatment of OSA/SDB for the prevention of AF, a growing health burden with serious consequences.
Treatment Emergent Central Sleep Apnea (TECSA) is a polysomnographic phenomenon whereby there is emergence of new central respiratory events (central apneas and hypopneas) after preexisting obstructive events have mostly resolved while patient is being titrated with positive airway pressure (PAP) therapy [1]. The acronym TECSA was first used by Nigam et al. in 2016 while describing the prevalence and risk factors related to central sleep apnea developing instantaneously with PAP use [2]. They found that the aggregate point prevalence of TECSA is around 8% while the estimated range varies from 5% to 20% in patients with untreated OSA [2]. This phenomenon can occur at any CPAP setting including very low pressure settings [3]. Few years later, Nigam et al. in a sentinel paper demonstrated that TECSA may not always be transient after all. While most cases of newly identified TECSA resolve in few weeks to few months of PAP use, this is not true for all cases. In a rigorous systematic review, they found that about a third of patients with TECSA may continue to exhibit persistence of PAP related central apneas on re-evaluation [4]. A small proportion may experience what they call delayed-TECSA (DTECSA), referring to patients that do not show TECSA on first titration but go on to develop TECSA few weeks to several months after initial exposure to PAP therapy [4,5].
Polysomnography is the gold standard for the diagnosis of obstructive sleep apnea (OSA), evaluation of its severity, and assessment of treatment response. Sleep apnea syndrome has been defined as an apnea hypopnea index (AHI) greater than 5 with the presence of associated symptoms such as excessive daytime sleepiness. Because the correlation between AHI and morbidity and mortality is well established, it is frequently used as the primary parameter to describe surgical treatment outcomes. However, recent reports suggest that polysomnographic indices such as AHI may be discordant with quality of life measures [1-4].
This study aims to compare the effectiveness of acupuncture and medication therapy on improving sleep disorders in women suffering from Generalized Anxiety Disorder. This study is a quasi-experimental with pretestposttest, control group, and follow-up period. The study population included all women suffering from generalized anxiety disorder and sleep disorder. Purposive sampling was used to select the sample. Using this method, 45 participants were selected and randomly assigned to three groups: acupuncture, medication therapy, and control groups. Acupuncture group received 12 to 15 treatment sessions (2-3 times a week) in DU20, HT7, PC6, Kid6, Ren12, UB62, Sp6, Anmian and Ear-shen men. Medication therapy group were taken drugs under the supervision of a psychiatric while the control group received no intervention over this period. In order to analyze the data, repeated measures were used in the statistical SPSS software version 21. The results showed that both acupuncture and medication therapy programs improve sleep disorder in women with generalized anxiety disorder; however, the acupuncture was more effective than medication therapy.
Sleep is a period of relaxation and repair. During sleep, waste products of brain metabolism are removed. It plays central role in maintenance of physiological homeostasis and psychological balance. Sufficient sleep helps us think more clearly, complete complex tasks better and more consistently. One of the important function of sleep is to promote synaptic plasticity and neuronal recovery for proper brain functioning. Memory consolidation, brain growth and repair are other functions proposed for sleep. Problems related to sleep deprivation are being increased in today's modern society. Every day there seems to be twice as much work and half as much time to complete it, this results in a decrease in sleep or extended periods of wakefulness. Sleep deprived individuals may not have difficulty of verbal disturbances but research studies have shown that individuals have more difficulty in reacting well, to taking biological discussion and implementing the task with efficiency of action. Although day time performance due to sleep loss is experienced universally but in professionals such as paramilitary forces, army personals, who work under stressful conditions are more vulnerable to the sleep deprivation. These conditions become more stressful during emergencies and war because, after periods of extended wakefulness neurons may begin to malfunction, visibly affecting person's behavior. Rapid eye movement (REM) sleep plays a role in learning due to an activation of the hippocampus involved in encoding new memories. Many experiments have shown that the day after a good night's sleep, one may retain newly acquired knowledge or a newly learned skill more effectively. An enriched environment (EE) which is a complex combination of social, cognitive, and physical stimulation, improves learning and memory. Many changes such as increased brain weight, synaptic plasticity, gliogenesis, growth of dendritic spine as well as change in neurotransmitter content, up regulation of neuronal signaling molecules, neurotrophin levels and adult hippocampal neurogenesis have been reported.
Suicide rates are estimated to be 30,000 deaths per year in the United States. Recent news stations and periodicals have been covering reporting of increased deaths by suicides of first responders in a 2016 Center for Disease Control report [1]. The first responder group of firefighters, paramedics and police officers now represents a high risk group. Within this population of suicide deaths, features of more males and use of firearms comprises the highest levels of suicides. The identified risk factors associated with first responders are marital discord, trauma, increased stress and role diffusion with the sudden fame associated with event they responded to. Additional triggers to first responders have, to date, been described as stress and loss of health. Sleep deprivation has been identified as a significant trigger factor linked to depression and suicide [2]. However, the specifics of the extent and history of the sleep deprivation as well as other factors such as mood levels are not provided in the news reporting’s.
The study examined the influence of prenatal stress and sleep quality on pregnant women psychological capital before birth. A cross-sectional survey was used in the study. Convenience sampling technique was used to select 238 antenatal women attending Mother/Child clinic in Ondo State. The result showed significant relationship between prenatal stress and psychological capital among antenatal women. Also sleep quality had a significant influence on psychological capital among antenatal women. It was concluded that inadequate sleep and prenatal stress affect psychological capital. Based on the study findings, it was recommended that health practitioners and maternal health policy makers and nongovernmental agencies should provide adequate prenatal stress management training for antenatal women and maternal health care providers should also provide important information about good sleep quality in relations to their conditions to enhance their psychological capital.
In order to understand the current status of sleep quality of students in Chengdu University of Traditional Chinese Medicine, and to propose countermeasures. A simple random sampling method was used to select 255 university students as the survey subjects, and Pittsburgh Sleep Quality Index (PSQI) scale was used as a tool to evaluate the quality of college students' sleep. The survey found that the average score of PSQI was about 7.6 points. There were 128 people above 7 points, which accounted for 50.2% of the total number of students. This indicated that the overall quality of sleep of the undergraduates was poorer; the quality of sleep for boys was better than that of girls, and the quality of sleep among rural college students was better than that of girls. Urban college students, seniors and undergraduates have worse sleep than sophomores and juniors. The sleep quality of students in Chengdu University of Traditional Chinese Medicine is generally poor, and it is necessary to implement measures that target different populations for different demographic differences to achieve proper treatment and improve sleep quality.
