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UPHS - Penn Sleep Centers Newsletter
Asleep at the Wheel?
Truck drivers who routinely get too little sleep or suffer from sleep apnea show signs of fatigue and impaired performance that can make them a hazard on the road, according to a major new study by Penn Sleep Centers researchers. The study results, entitled “Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration,” were published in the August 15th issue of the American Journal of Respiratory and Critical Care Medicine.
Sleep Apnea and Heart Disease
Along with the epidemic of obesity, the incidence of sleep apnea has risen at an alarming rate. The most common form, known as obstructive sleep apnea (OSA), is caused by extra tissue in the upper airway that collapses and literally blocks the airflow to the lungs. The risk factors for OSA include male sex (women’s risk increases after menopause), obesity, and neck size greater than 17 inches. The symptoms of sleep apnea include fatigue, early morning headaches, snoring, falling asleep during the daytime, depression and witnessed episodes of irregular breathing while sleeping.
Cognitive-Behavioral Treatment of Insomnia
Insomnia is the most prevalent sleep disorder, representing one of the most common complaints reported to doctors by their patients. In an effort to provide non-pharmacologic treatment options for insomnia, research and clinical practice have focused on developing cognitive- behavior treatments as an alternative.
Do Flies and Worms Sleep?
Can you tell if a fly is asleep? This is precisely the question asked seven years ago by Dr. Joan Hendricks, who is now the Dean of the School of Veterinary Medicine at the University of Pennsylvania. In collaboration with Dr. Amita Sehgal and Dr. Allan Pack of the Penn Center for Sleep and Respiratory Neurobiology (CSRN), Dr. Hendricks wanted to determine if the fruit fly Drosophila melanogaster, an animal used since the early 1900s for genetic studies in biology, has a sleeplike state much as we do. But unlike human studies, where one can measure brain electrical activity to distinguish sleep from the waking state, one cannot easily measure fly brain waves. Instead, Dr. Hendricks used behavioral measures.
Advice for Sleepy Students
Each fall, Grace Pien, MD in the University of Pennsylvania Division of Sleep Medicine sees teenagers being brought into her office by parents. The teens complain about difficulty falling asleep at night. After several follow-up questions, Pien often determines that these patients suffer from a sleep disorder called delayed sleep phase syndrome (DSPS) - when the body's circadian rhythm delays the urge to sleep until much later than what is considered to be a normal bedtime.
New Headquarters for Penn Sleep
In April of this year, the practices and sleep laboratory facilities of the Penn Sleep Centers at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center were merged into a single new site at 3624 Market St. which serves as headquarters for the Penn Sleep Centers. This newly renovated facility provides pleasant and spacious areas for both patients and staff.
Journal SLEEP Articles
Heavy Snoring and Carotid Atherosclerosis: Is There More Than an Association?
Commentary on Lee et al. Heavy snoring as a cause of carotid atherosclerosis. Sleep 2008;31:1207-13.
COMMENTARY - Heavy Snoring and Carotid Atherosclerosis: Is There More Than an Association?
Heavy Snoring: Time to Take it More Seriously?
A response to Drager and Lorenzi-Filho. Heavy Snoring and Carotid Atherosclerosis: Is There More Than an
Association? Sleep 2008;31:1335.
COMMENTARY - Heavy Snoring: Time to Take it More Seriously?
Sex Steroid Hormone Profiles are Related to Sleep Measures from Polysomnography and the Pittsburgh Sleep Quality Index
Study Objectives: To relate reproductive hormones (and the preceding 7-year rates of their change) to objectively and subjectively assessed sleep measures, independent of age, vasomotor symptom frequency, depressive symptoms, and body size. Design: A cross-sectional sleep substudy nested in the Study of Women’s Health Across the Nation (SWAN), a longitudinal study of the menopausal transition. Setting: Community-based. Participants: 365 Caucasian, African American, and Chinese women. Measurements and Results: Sleep duration, continuity, and architecture were measured during two nights of in-home polysomnography (PSG) studies. Participants completed the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, sleep diaries for medication, vasomotor symptoms, lifestyle information and questionnaires for depressive symptoms. Blood collected annually in the years prior to sleep study was assayed for follicle stimulating hormone (FSH), estradiol (E2), and total testosterone (T). More rapid rate of FSH change was significantly associated with higher delta sleep percent, longer total sleep time (TST), but less favorable self-reported sleep quality (PSQI). Baseline E2 was modestly and negatively associated with sleep quality. Women in the lowest total testosterone quartile at baseline had more wake time after sleep onset (WASO) than women in the highest quartile. Lower E2/T ratio, an index reflecting the increasing androgenic environment with the menopause transition, was associated with less WASO. Conclusions: More rapid rate of FSH change was associated with longer sleep duration but poor sleep quality. Women with higher T or who were closer to the completion of the transition process (as indexed by a lower E2/T) had less sleep discontinuity (less WASO).
Adolescent Insomnia as a Risk Factor for Early Adult Depression and Substance Abuse
Study Objective: To evaluate the association between adolescent insomnia and mental health during adolescence and young adulthood. Design: Cross-sectional and prospective study. Settings: School and in home. Participants: Nationally based population sample of 4494 adolescents, 12 to 18 years old at baseline (mean = 15.83 years), with 3582 young adults, 18 to 25 years old (mean = 21.25 years) at 6- to 7-year follow-up. Measures: Self-report measures of mental health. Results: Insomnia symptoms were reported by 9.4% of the adolescents. Cross-sectionally, adolescent insomnia symptoms were associated with use of alcohol, cannabis, and drugs other than cannabis; depression; suicide ideation; and suicide attempts (all P values < 0.01) after controlling for sex. Prospectively, insomnia symptoms during adolescence were a significant risk factor for depression diagnosis (odds ratio = 2.3) in young adulthood after controlling for sex and baseline depression. Conclusion: This study is the first to longitudinally evaluate insomnia symptoms during adolescence as a risk factor for mental health problems in young adulthood. The findings indicate that insomnia is a prevalent problem for adolescents and argue for future treatment-outcome studies to evaluate the efficacy and effectiveness of various insomnia interventions in this age group.
Effect of Gaboxadol on Sleep in Adult and Elderly Patients with Primary Insomnia: Results From Two Randomized, Placebo-Controlled, 30-Night Polysomnography Studies
Study Objectives: To evaluate the efficacy and tolerability of gaboxadol in the treatment of adult and elderly patients with primary insomnia. Design: Randomized, double-blind, placebo-controlled, multicenter, 30-night, polysomnography studies. Setting: Sleep laboratory. Patients: Primary insomnia, 18-64 y (adult study), or ≥65 y (elderly study). Interventions: Adult study: gaboxadol 15 mg (GBX15; N = 148), 10 mg (GBX10; N = 154), or placebo (N = 156); elderly study: GBX10 (N = 157), gaboxadol 5 mg (GBX5; N = 153), or placebo (N="176). Measurements and Results: Primary endpoints were wake after sleep onset (WASO) and latency to persistent sleep (LPS). Slow wave sleep (SWS) was a secondary endpoint. Analyses were based on the change from baseline for the average of nights 1/2, and nights 29/30, and compared gaboxadol versus placebo. Exploratory endpoints included patient’s subjective assessment of total sleep time (sTST), WASO (sWASO), time to sleep onset (sTSO), and number of awakenings (sNAW); these analyses were based on weekly means. 1) Adult study. GBX15 significantly (P ≤ 0.05) improved WASO through nights 29/30 but had no significant effects on LPS. No significant differences were seen for GBX10 versus placebo on WASO or LPS. GBX15 and GBX10 enhanced SWS. GBX15 significantly improved sTST, sWASO, sTSO, and sNAW at weeks 1 and 4. 2) Elderly study. GBX10 significantly improved WASO through nights 29/30; a significant improvement was also seen for GBX5 at nights 1/2 but this was not maintained through nights 29/30. GBX10 significantly improved LPS at nights 1/2 but the improvement was not maintained through nights 29/30; no significant differences were seen for GBX5 versus placebo on LPS. GBX10 and GBX5 enhanced SWS. GBX10 significantly improved sTST at week 1, and sTST, sWASO, and sNAW at week 4. Gaboxadol was generally well tolerated in both studies. Conclusions: The maximum studied doses of gaboxadol (GBX15 in adult patients and GBX10 in elderly patients) were effective at enhancing objective polysomnography measures of sleep maintenance and SWS, and also some subjective sleep measures, over 30 nights but had little or no effects on sleep onset. The clinical relevance of the enhancement of SWS by gaboxadol is unclear.
Zolpidem Extended-Release 12.5 mg Associated with Improvements in Work Performance in a 6-Month Randomized, Placebo-Controlled Trial
Background: Although most research on pharmacotherapy for chronic insomnia focuses on changes in sleep outcomes, the functional impact of treatment is also of great importance to patients, families, physicians, and employers. Objective: To analyze changes in functioning at work (or work performance) among a subset of employed subjects (N = 752) from a 24-week, randomized, double-blind, placebo-controlled trial of zolpidem extended-release 12.5 mg taken nightly, at least 3 nights per week, by healthy adults with chronic insomnia. Methods: Using 2 scales (Time Management and Work Output) from the Work Limitations Questionnaire (WLQ), subjects’ health-related work limitations were evaluated at baseline, week 4, week 12, and week 24 (end of study) or premature discontinuation. To compare zolpidem extended-release 12.5 mg with placebo, within-group and between group differences were analyzed and effect sizes were computed. The relationship of WLQ scores to scores on the Patient Global Impression, Item 1 (PGI-1), scale, the primary outcome measure for benefit to sleep, was also analyzed. Data were obtained from August 31, 2004 through January 6, 2006. Results: Scores on both WLQ scales were substantially elevated at baseline in this population, reflecting impairment relative to healthy controls. The zolpidem extended-release 12.5 mg group had significantly greater improvement at all time points on the WLQ Time Management (P < 0.0001) and Work Output (P < 0.01) scales. Effect size analysis confirmed the clinical relevance of these improvements. Subjects rating their sleep as improved on the PGI-1 had significantly greater improvement on both WLQ scales at week 12 than did those who reported no benefit or worsening (P < 0.01). Conclusions: Employed adults with chronic insomnia treated with zolpidem extended-release 12.5 mg experienced significantly improved work performance over 24 weeks.
Sleep and Breathing
Validation of the WristOx 3100™ oximeter for the diagnosis of sleep apnea/hypopnea syndrome
Thu, 02 Oct 2008 09:27:43 -0000
Abstract Objective To evaluate the diagnostic accuracy of the Nonin WristOx 3100™ and its software (nVision 5.0) in patients with suspicion of sleep apnea/hypopnea syndrome (SAHS). Methods All participants (168) had the oximetry and polysomnography simultaneously. The two recordings were interpreted blindly. The software calculated: adjusted O2 desaturation index [ADI]-mean number of O2 desaturation per hour of total recording analyzed time of ≥ 2%, 3%, 4%, 5%, and 6% (ADI2, 3, 4, 5, and 6) and AT90-accumulated time at SO2 < 90%. The ADI2, 3, 4, 5, and 6 and the AT90 cutoff points that better discriminated between subjects with or without SAHS arose from the receiver operating characteristic curve analysis. The sensitivity (S), specificity (E), and positive and negative likelihood ratio (LR+, LR−) for the different thresholds for ADI were calculated. Results One hundred and fifty-four patients were included (119 men, mean age 51, median apnea/hypopnea index [AHI] 14, median body mass index [BMI] 28.3 kg/m2). The best cutoff points of ADI were: SAHS = AHI ≥ 5: ADI2 > 19.3 (S 89%, E 94%, LR+ 15.5 LR− 0.11); SAHS =AHI ≥ 10: ADI3 > 10.5 (S 88%, E 94%, LR+ 15 LR− 0.12); SAHS = AHI ≥ 15: ADI3 > 13.4 (S 88%, E 90%, LR+ 8.9, LR− 0.14). AT90 had the lowest diagnosis accuracy. An ADI2 ≤ 12.2 excluded SAHS (AHI ≥ 5 and 10; S 100%, LR− 0) and ADI3 > 4.3 (AHI ≥ 5 and 10) or 32 (AHI ≥ 15) confirmed SAHS (E 100%). Conclusions A negative oximetry defined as ADI2 ≤ 12.2 excluded SAHS defined as AHI ≥ 5 or 10 with a sensitivity and negative likelihood ratio of 100% and 0%, respectively. Furthermore, a positive oximetry defined as an ADI3 > 32 (SAHS = AHI ≥ 15) had a specificity of 100% to confirm the pathology. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-008-0217-3Authors Carlos Alberto Nigro, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires ArgentinaSilvia Aimaretti, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires ArgentinaSergio Gonzalez, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires ArgentinaEdgardo Rhodius, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires Argentina Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
American Academy of Dental Sleep Medicine Continuing Education Offerings
Tue, 30 Sep 2008 09:04:57 -0000
American Academy of Dental Sleep Medicine Continuing Education Offerings Content Type Journal ArticleCategory CMEDOI 10.1007/s11325-008-0222-6 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 12 Journal Issue Volume 12, Number 4 / November, 2008
17th Annual Meeting of the American Academy of Dental Sleep Medicine, Baltimore, Maryland, USA, 6 – 8 June 2008
Tue, 30 Sep 2008 09:04:57 -0000
17th Annual Meeting of the American Academy of Dental Sleep Medicine, Baltimore, Maryland, USA, 6 – 8 June 2008 Content Type Journal ArticleCategory AbstractsDOI 10.1007/s11325-008-0223-5 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 12 Journal Issue Volume 12, Number 4 / November, 2008
PubMed: 1389-9457
The behavioural features of fatal familial insomnia: A new Italian case with pathological verification.
Raggi A, Perani D, Giaccone G, Iannaccone S, Manconi M, Zucconi M, Garibotto V, Marcone A, Zamboni M, Limido L, Tagliavini F, Ferini-Strambi L, Cappa SF Related Articles The behavioural features of fatal familial insomnia: A new Italian case with pathological verification. Sleep Med. 2008 Sep 26; Authors: Raggi A, Perani D, Giaccone G, Iannaccone S, Manconi M, Zucconi M, Garibotto V, Marcone A, Zamboni M, Limido L, Tagliavini F, Ferini-Strambi L, Cappa SF We report a new, pathologically verified Italian case of fatal familial insomnia, whose clinical presentation was characterised by complex behavioural disturbances, suggesting wakefulness/NREM/REM combinations. PMID: 18824410 [PubMed - as supplied by publisher]
Chronobiology, excessive daytime sleepiness and depression: Is there a link?
Chellappa SL, Schröder C, Cajochen C Related Articles Chronobiology, excessive daytime sleepiness and depression: Is there a link? Sleep Med. 2008 Sep 26; Authors: Chellappa SL, Schröder C, Cajochen C The complaint of excessive daytime sleepiness (EDS), commonly encountered in clinical practice, may arise from a variety of psychiatric disorders, most importantly depression. Even though EDS frequently leads depressed patients to seek medical assistance, it is commonly under-evaluated and under-diagnosed. Therefore, a comprehensive understanding and management of EDS is essential in the clinical assessment of depression. Within a theoretical framework, a chronobiological approach may shed new light on the complex interaction of EDS and depression. In this review, studies on EDS and depression are summarized and discussed within the context of circadian and sleep regulatory mechanisms. Furthermore, potential chronobiological therapeutic strategies are proposed to address some of the unmet needs in the treatment of EDS and depression. PMID: 18824409 [PubMed - as supplied by publisher]
Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on Item Response Theory.
Takegami M, Suzukamo Y, Wakita T, Noguchi H, Chin K, Kadotani H, Inoue Y, Oka Y, Nakamura T, Green J, Johns MW, Fukuhara S Related Articles Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on Item Response Theory. Sleep Med. 2008 Sep 26; Authors: Takegami M, Suzukamo Y, Wakita T, Noguchi H, Chin K, Kadotani H, Inoue Y, Oka Y, Nakamura T, Green J, Johns MW, Fukuhara S Background Various Japanese versions of the Epworth Sleepiness Scale (ESS) have been used, but none was developed via standard procedures. Here we report on the construction and testing of the developer-authorized Japanese version of the ESS (JESS). Methods Developing the JESS involved translations, back translations, a pilot study, and psychometric testing. We identified questions in the ESS that were difficult to answer or were inappropriate in Japan, proposed possible replacements for those questions, and tested them with analyses based on item response theory (IRT) and classical test theory. The subjects were healthy people and patients with narcolepsy, idiopathic hypersomnia, or obstructive sleep apnea syndrome. Results We identified two of our proposed questions as appropriate replacements for two problematic questions in the ESS. The JESS had very few missing data. Internal consistency reliability and test-retest reliability were high. The patients had significantly higher JESS scores than did the healthy people, and higher JESS scores were associated with worse daytime function, as measured with the Pittsburgh Sleep Quality Index. Conclusions In Japan, the JESS provides reliable and valid information on daytime sleepiness. Researchers who use the ESS with other populations should combine their knowledge of local conditions with the results of psychometric tests. PMID: 18824408 [PubMed - as supplied by publisher]
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Asleep at the Wheel?
Truck drivers who routinely get too little sleep or suffer from sleep apnea show signs of fatigue and impaired performance that can make them a hazard on the road, according to a major new study by Penn Sleep Centers researchers. The study results, entitled “Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration,” were published in the August 15th issue of the American Journal of Respiratory and Critical Care Medicine.
Sleep Apnea and Heart Disease
Along with the epidemic of obesity, the incidence of sleep apnea has risen at an alarming rate. The most common form, known as obstructive sleep apnea (OSA), is caused by extra tissue in the upper airway that collapses and literally blocks the airflow to the lungs. The risk factors for OSA include male sex (women’s risk increases after menopause), obesity, and neck size greater than 17 inches. The symptoms of sleep apnea include fatigue, early morning headaches, snoring, falling asleep during the daytime, depression and witnessed episodes of irregular breathing while sleeping.
Cognitive-Behavioral Treatment of Insomnia
Insomnia is the most prevalent sleep disorder, representing one of the most common complaints reported to doctors by their patients. In an effort to provide non-pharmacologic treatment options for insomnia, research and clinical practice have focused on developing cognitive- behavior treatments as an alternative.
Do Flies and Worms Sleep?
Can you tell if a fly is asleep? This is precisely the question asked seven years ago by Dr. Joan Hendricks, who is now the Dean of the School of Veterinary Medicine at the University of Pennsylvania. In collaboration with Dr. Amita Sehgal and Dr. Allan Pack of the Penn Center for Sleep and Respiratory Neurobiology (CSRN), Dr. Hendricks wanted to determine if the fruit fly Drosophila melanogaster, an animal used since the early 1900s for genetic studies in biology, has a sleeplike state much as we do. But unlike human studies, where one can measure brain electrical activity to distinguish sleep from the waking state, one cannot easily measure fly brain waves. Instead, Dr. Hendricks used behavioral measures.
Advice for Sleepy Students
Each fall, Grace Pien, MD in the University of Pennsylvania Division of Sleep Medicine sees teenagers being brought into her office by parents. The teens complain about difficulty falling asleep at night. After several follow-up questions, Pien often determines that these patients suffer from a sleep disorder called delayed sleep phase syndrome (DSPS) - when the body's circadian rhythm delays the urge to sleep until much later than what is considered to be a normal bedtime.
New Headquarters for Penn Sleep
In April of this year, the practices and sleep laboratory facilities of the Penn Sleep Centers at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center were merged into a single new site at 3624 Market St. which serves as headquarters for the Penn Sleep Centers. This newly renovated facility provides pleasant and spacious areas for both patients and staff.
Journal SLEEP Articles
Heavy Snoring and Carotid Atherosclerosis: Is There More Than an Association?
Commentary on Lee et al. Heavy snoring as a cause of carotid atherosclerosis. Sleep 2008;31:1207-13.
COMMENTARY - Heavy Snoring and Carotid Atherosclerosis: Is There More Than an Association?
Heavy Snoring: Time to Take it More Seriously?
A response to Drager and Lorenzi-Filho. Heavy Snoring and Carotid Atherosclerosis: Is There More Than an
Association? Sleep 2008;31:1335.
COMMENTARY - Heavy Snoring: Time to Take it More Seriously?
Sex Steroid Hormone Profiles are Related to Sleep Measures from Polysomnography and the Pittsburgh Sleep Quality Index
Study Objectives: To relate reproductive hormones (and the preceding 7-year rates of their change) to objectively and subjectively assessed sleep measures, independent of age, vasomotor symptom frequency, depressive symptoms, and body size. Design: A cross-sectional sleep substudy nested in the Study of Women’s Health Across the Nation (SWAN), a longitudinal study of the menopausal transition. Setting: Community-based. Participants: 365 Caucasian, African American, and Chinese women. Measurements and Results: Sleep duration, continuity, and architecture were measured during two nights of in-home polysomnography (PSG) studies. Participants completed the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, sleep diaries for medication, vasomotor symptoms, lifestyle information and questionnaires for depressive symptoms. Blood collected annually in the years prior to sleep study was assayed for follicle stimulating hormone (FSH), estradiol (E2), and total testosterone (T). More rapid rate of FSH change was significantly associated with higher delta sleep percent, longer total sleep time (TST), but less favorable self-reported sleep quality (PSQI). Baseline E2 was modestly and negatively associated with sleep quality. Women in the lowest total testosterone quartile at baseline had more wake time after sleep onset (WASO) than women in the highest quartile. Lower E2/T ratio, an index reflecting the increasing androgenic environment with the menopause transition, was associated with less WASO. Conclusions: More rapid rate of FSH change was associated with longer sleep duration but poor sleep quality. Women with higher T or who were closer to the completion of the transition process (as indexed by a lower E2/T) had less sleep discontinuity (less WASO).
Adolescent Insomnia as a Risk Factor for Early Adult Depression and Substance Abuse
Study Objective: To evaluate the association between adolescent insomnia and mental health during adolescence and young adulthood. Design: Cross-sectional and prospective study. Settings: School and in home. Participants: Nationally based population sample of 4494 adolescents, 12 to 18 years old at baseline (mean = 15.83 years), with 3582 young adults, 18 to 25 years old (mean = 21.25 years) at 6- to 7-year follow-up. Measures: Self-report measures of mental health. Results: Insomnia symptoms were reported by 9.4% of the adolescents. Cross-sectionally, adolescent insomnia symptoms were associated with use of alcohol, cannabis, and drugs other than cannabis; depression; suicide ideation; and suicide attempts (all P values < 0.01) after controlling for sex. Prospectively, insomnia symptoms during adolescence were a significant risk factor for depression diagnosis (odds ratio = 2.3) in young adulthood after controlling for sex and baseline depression. Conclusion: This study is the first to longitudinally evaluate insomnia symptoms during adolescence as a risk factor for mental health problems in young adulthood. The findings indicate that insomnia is a prevalent problem for adolescents and argue for future treatment-outcome studies to evaluate the efficacy and effectiveness of various insomnia interventions in this age group.
Effect of Gaboxadol on Sleep in Adult and Elderly Patients with Primary Insomnia: Results From Two Randomized, Placebo-Controlled, 30-Night Polysomnography Studies
Study Objectives: To evaluate the efficacy and tolerability of gaboxadol in the treatment of adult and elderly patients with primary insomnia. Design: Randomized, double-blind, placebo-controlled, multicenter, 30-night, polysomnography studies. Setting: Sleep laboratory. Patients: Primary insomnia, 18-64 y (adult study), or ≥65 y (elderly study). Interventions: Adult study: gaboxadol 15 mg (GBX15; N = 148), 10 mg (GBX10; N = 154), or placebo (N = 156); elderly study: GBX10 (N = 157), gaboxadol 5 mg (GBX5; N = 153), or placebo (N="176). Measurements and Results: Primary endpoints were wake after sleep onset (WASO) and latency to persistent sleep (LPS). Slow wave sleep (SWS) was a secondary endpoint. Analyses were based on the change from baseline for the average of nights 1/2, and nights 29/30, and compared gaboxadol versus placebo. Exploratory endpoints included patient’s subjective assessment of total sleep time (sTST), WASO (sWASO), time to sleep onset (sTSO), and number of awakenings (sNAW); these analyses were based on weekly means. 1) Adult study. GBX15 significantly (P ≤ 0.05) improved WASO through nights 29/30 but had no significant effects on LPS. No significant differences were seen for GBX10 versus placebo on WASO or LPS. GBX15 and GBX10 enhanced SWS. GBX15 significantly improved sTST, sWASO, sTSO, and sNAW at weeks 1 and 4. 2) Elderly study. GBX10 significantly improved WASO through nights 29/30; a significant improvement was also seen for GBX5 at nights 1/2 but this was not maintained through nights 29/30. GBX10 significantly improved LPS at nights 1/2 but the improvement was not maintained through nights 29/30; no significant differences were seen for GBX5 versus placebo on LPS. GBX10 and GBX5 enhanced SWS. GBX10 significantly improved sTST at week 1, and sTST, sWASO, and sNAW at week 4. Gaboxadol was generally well tolerated in both studies. Conclusions: The maximum studied doses of gaboxadol (GBX15 in adult patients and GBX10 in elderly patients) were effective at enhancing objective polysomnography measures of sleep maintenance and SWS, and also some subjective sleep measures, over 30 nights but had little or no effects on sleep onset. The clinical relevance of the enhancement of SWS by gaboxadol is unclear.
Zolpidem Extended-Release 12.5 mg Associated with Improvements in Work Performance in a 6-Month Randomized, Placebo-Controlled Trial
Background: Although most research on pharmacotherapy for chronic insomnia focuses on changes in sleep outcomes, the functional impact of treatment is also of great importance to patients, families, physicians, and employers. Objective: To analyze changes in functioning at work (or work performance) among a subset of employed subjects (N = 752) from a 24-week, randomized, double-blind, placebo-controlled trial of zolpidem extended-release 12.5 mg taken nightly, at least 3 nights per week, by healthy adults with chronic insomnia. Methods: Using 2 scales (Time Management and Work Output) from the Work Limitations Questionnaire (WLQ), subjects’ health-related work limitations were evaluated at baseline, week 4, week 12, and week 24 (end of study) or premature discontinuation. To compare zolpidem extended-release 12.5 mg with placebo, within-group and between group differences were analyzed and effect sizes were computed. The relationship of WLQ scores to scores on the Patient Global Impression, Item 1 (PGI-1), scale, the primary outcome measure for benefit to sleep, was also analyzed. Data were obtained from August 31, 2004 through January 6, 2006. Results: Scores on both WLQ scales were substantially elevated at baseline in this population, reflecting impairment relative to healthy controls. The zolpidem extended-release 12.5 mg group had significantly greater improvement at all time points on the WLQ Time Management (P < 0.0001) and Work Output (P < 0.01) scales. Effect size analysis confirmed the clinical relevance of these improvements. Subjects rating their sleep as improved on the PGI-1 had significantly greater improvement on both WLQ scales at week 12 than did those who reported no benefit or worsening (P < 0.01). Conclusions: Employed adults with chronic insomnia treated with zolpidem extended-release 12.5 mg experienced significantly improved work performance over 24 weeks.
Sleep and Breathing
Validation of the WristOx 3100™ oximeter for the diagnosis of sleep apnea/hypopnea syndrome
Thu, 02 Oct 2008 09:27:43 -0000
Abstract Objective To evaluate the diagnostic accuracy of the Nonin WristOx 3100™ and its software (nVision 5.0) in patients with suspicion of sleep apnea/hypopnea syndrome (SAHS). Methods All participants (168) had the oximetry and polysomnography simultaneously. The two recordings were interpreted blindly. The software calculated: adjusted O2 desaturation index [ADI]-mean number of O2 desaturation per hour of total recording analyzed time of ≥ 2%, 3%, 4%, 5%, and 6% (ADI2, 3, 4, 5, and 6) and AT90-accumulated time at SO2 < 90%. The ADI2, 3, 4, 5, and 6 and the AT90 cutoff points that better discriminated between subjects with or without SAHS arose from the receiver operating characteristic curve analysis. The sensitivity (S), specificity (E), and positive and negative likelihood ratio (LR+, LR−) for the different thresholds for ADI were calculated. Results One hundred and fifty-four patients were included (119 men, mean age 51, median apnea/hypopnea index [AHI] 14, median body mass index [BMI] 28.3 kg/m2). The best cutoff points of ADI were: SAHS = AHI ≥ 5: ADI2 > 19.3 (S 89%, E 94%, LR+ 15.5 LR− 0.11); SAHS =AHI ≥ 10: ADI3 > 10.5 (S 88%, E 94%, LR+ 15 LR− 0.12); SAHS = AHI ≥ 15: ADI3 > 13.4 (S 88%, E 90%, LR+ 8.9, LR− 0.14). AT90 had the lowest diagnosis accuracy. An ADI2 ≤ 12.2 excluded SAHS (AHI ≥ 5 and 10; S 100%, LR− 0) and ADI3 > 4.3 (AHI ≥ 5 and 10) or 32 (AHI ≥ 15) confirmed SAHS (E 100%). Conclusions A negative oximetry defined as ADI2 ≤ 12.2 excluded SAHS defined as AHI ≥ 5 or 10 with a sensitivity and negative likelihood ratio of 100% and 0%, respectively. Furthermore, a positive oximetry defined as an ADI3 > 32 (SAHS = AHI ≥ 15) had a specificity of 100% to confirm the pathology. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11325-008-0217-3Authors Carlos Alberto Nigro, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires ArgentinaSilvia Aimaretti, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires ArgentinaSergio Gonzalez, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires ArgentinaEdgardo Rhodius, Hospital Alemán Staff Pulmonary Physician and Coordinator of Sleep Laboratory Buenos Aires Argentina Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512
American Academy of Dental Sleep Medicine Continuing Education Offerings
Tue, 30 Sep 2008 09:04:57 -0000
American Academy of Dental Sleep Medicine Continuing Education Offerings Content Type Journal ArticleCategory CMEDOI 10.1007/s11325-008-0222-6 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 12 Journal Issue Volume 12, Number 4 / November, 2008
17th Annual Meeting of the American Academy of Dental Sleep Medicine, Baltimore, Maryland, USA, 6 – 8 June 2008
Tue, 30 Sep 2008 09:04:57 -0000
17th Annual Meeting of the American Academy of Dental Sleep Medicine, Baltimore, Maryland, USA, 6 – 8 June 2008 Content Type Journal ArticleCategory AbstractsDOI 10.1007/s11325-008-0223-5 Journal Sleep and BreathingOnline ISSN 1522-1709Print ISSN 1520-9512 Journal Volume Volume 12 Journal Issue Volume 12, Number 4 / November, 2008
PubMed: 1389-9457
The behavioural features of fatal familial insomnia: A new Italian case with pathological verification.
Raggi A, Perani D, Giaccone G, Iannaccone S, Manconi M, Zucconi M, Garibotto V, Marcone A, Zamboni M, Limido L, Tagliavini F, Ferini-Strambi L, Cappa SF Related Articles The behavioural features of fatal familial insomnia: A new Italian case with pathological verification. Sleep Med. 2008 Sep 26; Authors: Raggi A, Perani D, Giaccone G, Iannaccone S, Manconi M, Zucconi M, Garibotto V, Marcone A, Zamboni M, Limido L, Tagliavini F, Ferini-Strambi L, Cappa SF We report a new, pathologically verified Italian case of fatal familial insomnia, whose clinical presentation was characterised by complex behavioural disturbances, suggesting wakefulness/NREM/REM combinations. PMID: 18824410 [PubMed - as supplied by publisher]
Chronobiology, excessive daytime sleepiness and depression: Is there a link?
Chellappa SL, Schröder C, Cajochen C Related Articles Chronobiology, excessive daytime sleepiness and depression: Is there a link? Sleep Med. 2008 Sep 26; Authors: Chellappa SL, Schröder C, Cajochen C The complaint of excessive daytime sleepiness (EDS), commonly encountered in clinical practice, may arise from a variety of psychiatric disorders, most importantly depression. Even though EDS frequently leads depressed patients to seek medical assistance, it is commonly under-evaluated and under-diagnosed. Therefore, a comprehensive understanding and management of EDS is essential in the clinical assessment of depression. Within a theoretical framework, a chronobiological approach may shed new light on the complex interaction of EDS and depression. In this review, studies on EDS and depression are summarized and discussed within the context of circadian and sleep regulatory mechanisms. Furthermore, potential chronobiological therapeutic strategies are proposed to address some of the unmet needs in the treatment of EDS and depression. PMID: 18824409 [PubMed - as supplied by publisher]
Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on Item Response Theory.
Takegami M, Suzukamo Y, Wakita T, Noguchi H, Chin K, Kadotani H, Inoue Y, Oka Y, Nakamura T, Green J, Johns MW, Fukuhara S Related Articles Development of a Japanese version of the Epworth Sleepiness Scale (JESS) based on Item Response Theory. Sleep Med. 2008 Sep 26; Authors: Takegami M, Suzukamo Y, Wakita T, Noguchi H, Chin K, Kadotani H, Inoue Y, Oka Y, Nakamura T, Green J, Johns MW, Fukuhara S Background Various Japanese versions of the Epworth Sleepiness Scale (ESS) have been used, but none was developed via standard procedures. Here we report on the construction and testing of the developer-authorized Japanese version of the ESS (JESS). Methods Developing the JESS involved translations, back translations, a pilot study, and psychometric testing. We identified questions in the ESS that were difficult to answer or were inappropriate in Japan, proposed possible replacements for those questions, and tested them with analyses based on item response theory (IRT) and classical test theory. The subjects were healthy people and patients with narcolepsy, idiopathic hypersomnia, or obstructive sleep apnea syndrome. Results We identified two of our proposed questions as appropriate replacements for two problematic questions in the ESS. The JESS had very few missing data. Internal consistency reliability and test-retest reliability were high. The patients had significantly higher JESS scores than did the healthy people, and higher JESS scores were associated with worse daytime function, as measured with the Pittsburgh Sleep Quality Index. Conclusions In Japan, the JESS provides reliable and valid information on daytime sleepiness. Researchers who use the ESS with other populations should combine their knowledge of local conditions with the results of psychometric tests. PMID: 18824408 [PubMed - as supplied by publisher]
Sites:
1-2-Sleep.com - Want To Sleep: Looking for sleep related information? 1-2-Sleep.com has a collection of useful links and articles in this aspect.About Sleep Disorders: Discusses the types of sleep disorders, and how anxiety and diet may influence rest. Suggests keeping a daily record and taking a polysomnography test (sleep study).
Better Homes and Gardens - Sleep Basics: Sleep Basics from Ladies' Home Journal
Brain Basics: Understanding Sleep: The National Institute of Neurological Disorders and Stroke (NINDS) is the leading supporter of biomedical research on disorders of the brain and nervous system.
CME on Sleep: CME on Sleep provides online CME courses, conferences, medical journal articles, study cases, medical news, and medical resources.
Drowsy Driving and Automobile Crashes: NHLBI report dealing with combatting drowsy driving.
eMedicine Health - Disorders That Disrupt Sleep (Parasomnias): Parasomnias are disruptive sleep-related disorders. They are characterized by undesirable physical or verbal behaviors or experiences. Parasomnias occur in association with sleep, specific stages of sleep (see Sleep: Understanding the ...
eMedicine Health - REM Sleep Behavior Disorder: Normal sleep has 2 distinct states: non-rapid eye movement (NREM) and rapid eye movement (REM) sleep (see Sleep: Understanding the Basics for details of various stages of sleep). NREM sleep ...
eMedicine Health - Sleep: Understanding the Basics: Sleep is defined as a state of unconsciousness from which a person can be aroused. In this state, the brain is relatively more responsive to internal stimuli than external stimuli. ...
Glossary of Terms: List of commonly used sleep terms.
GoodSleep: Site provides users with individualized, sleep information and advice.
Helpguide: Sleep Disorders: Learn about sleep disorder types, risk factors, diagnosis, and prevention. Contains information on common sleep disorders including insomnia, restless legs syndrome, snoring, sleep apnea, narcolepsy, and parasomnias.
Horlicks: Horlicks is a delicious and nourishing malted food drink, which can make you sleep better at night. People have drunk Horlicks as their bed-time ritual for many years.
Kleine-Levin Syndrome: Provides a description KLS and of ongoing research into its cause. From Stanford University Center for Narcolepsy.
MedicineNet.com - Focus on Sleep Disorders: Medical information about sleep Disorders including, insomnia, snoring and nightmares
National Heart, Lung, and Blood Institute: Covers sleepiness,insomnia, sleep apnea, and narcolepsy.
Pediatric Sleep Disorders: The mission of KIDZZZSLEEP is to provide current and accurate information on sleep, sleep disorders, and the impact of sleep on health and behavior in infants, children, and adolescents to parents, pediatric health care and mental health practitioners, pediatric sleep researchers, and educators i...
Put an End to Snoring: We list hundreds of snoring cures and remedies. Take our interactive questionnaire to help determine which snoring remedy is most likely to work for you.
Sleep (From Neuroscience for Kids): Basic information about sleep
Sleep and Alcohol Survey: Created for a research project conducted at the Johns Hopkins University for the course 200.368 - Sleep, Dreams and Altered States of Consciousness.
Sleep and Health: A resource for information on sleep disorders, alertness, mood and performance designed to educate, inform and help.
Sleep and Sleep Disorders News from Medical News Today: Press releases, research reports, and headlines in feed form.
Sleep Desk: Sleepdesk with online Epworth sleep test and message board. Details of CPAP and masks, Sleep Study, Tracheostomy, Night Terrors, Insomnia, Narcolepsy and Restless Legs Syndrome are included
Sleep Disorder Channel: Information on diagnosis and treatment for Insomnia, Bruxism, Restless Leg Syndrome, Narcolepsy, Jet Lag, Sleep Apnea and other sleep health info. Physician developed and monitored.
Sleep Disorders: Sleep Disorders
Sleep Disorders: Articles and links to information on sleep and sleep disorders, everything from sleep apnea to night sweats to sleep deprivation and insomnia.
Sleep Disorders: Old (1987) but useful article written by a science writer on contract with the U.S. National Institute of Mental Health.
Sleep Disorders - MSNBC: Sleep disorders descriptions including gastroesophageal reflux.
Sleep Disorders Australia - Queensland Branch: Provides information and awareness, with an introduction, workshops, links and contact details. Also fact sheet about all the different types of disorders.
Sleep Disorders Symptoms: The sleep cycle.
Sleep From A to Zzz: A study by ThinkQuest the complexity and importance of your daily biological ritual from apnea, insomnia, and sleep disorders to sociological and zoological facts.
Sleep Home Pages: Comprehensive sleep information site which includes directories and contact information for all major sleep organisations. Useful for researchers, doctors and patients.
Sleep Information: Every animal does it, some more than others, and to this day the reasons are a mystery. Why do we sleep? What happens if we dont sleep? How much sleep do we really need? Find out about sleep.
Sleep Medicine: A comprehensive links and resources one-pager for both professionals and sufferers.
Sleep Neurobiology: Series of scientific abstracts concerning sleep produced by Cambridge Scientific Abstracts in 1997.
Sleep Tips: Get tips about improving your sleep with memory foam mattresses and memory foam mattress toppers at Sleep.Lifetips.com. Get tips about latex mattresses and latex foam pillows.
Sleepdex: About sleep. Advice for getting better sleep.
SleepNet: Everything you wanted to know about sleep disorders but were too tired to ask. Open Sleep Forum. SleepNet links to over 200 sites. Come on in and check it out.
Stop Snoring Tips: Tips to help people to stop snoring as well as information on how to deal with a snorer and other snoring information.
Talk About Sleep: Sleep disorder community providing information and resources on Sleep Disorders
The Sleep Connection: A network of home healthcare providers who specialize in sleep therapy products and services supports this site. These dealer/providers partner in the communities they serve, with Primary care Physicians and technicians in sleep labs, which perform diagnostic tests for sleep disorders. These sl...
The Sleep Well: Information on sleep, disorders, activism and related events.
Yahoo! Health - Sleep Disorders Health Center: Find information on the types, causes, symptoms, diagnosis, testing, and treatment of various sleep disorders.
This directory is based on the Open Directory and may have been modified