-
Dental Clinics of North America Jan 2024This chapter discusses controversies in diagnosis and management of obstructive sleep apnea (OSA), with particular focus on surgical management to improve quality of... (Review)
Review
This chapter discusses controversies in diagnosis and management of obstructive sleep apnea (OSA), with particular focus on surgical management to improve quality of life. Though OSA is a complex disorder that affects millions of people worldwide, its management remains controversial among clinicians. Gaps in understanding its pathophysiology, long-term health consequences, diagnostic methods, and treatment strategies exist. While continuous positive airway pressure (CPAP) therapy is considered the gold standard for moderate to severe obstructive sleep apnea (OSA), its adherence rate is often low, and its efficacy in improving outcomes beyond symptom reduction and quality of life improvement is uncertain. As such, surgical intervention may be an alternative for specific patient populations. Additionally, the type of surgical intervention may depend on individual patient needs, anatomic features, as well as preferences.
Topics: Humans; Quality of Life; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure
PubMed: 37951627
DOI: 10.1016/j.cden.2023.08.003 -
Seminars in Pediatric Neurology Dec 2023Sleep disordered breathing (SDB) is prevalent among children with neuromuscular disorders (NMD). The combination of respiratory muscle weakness, altered drive, and chest... (Review)
Review
Sleep disordered breathing (SDB) is prevalent among children with neuromuscular disorders (NMD). The combination of respiratory muscle weakness, altered drive, and chest wall distortion due to scoliosis make sleep a stressful state in this population. Symptomatology can range from absent to snoring, nocturnal awakenings, morning headaches, and excessive daytime sleepiness. Sequelae of untreated SDB includes cardiovascular effects, metabolic derangements, and neurocognitive concerns which can be compounded by those innate to the NMD. The clinician should have a low threshold for obtaining polysomnography and recognize the nuances of individual disorders due to disproportionately impacted muscle groups such as hypoventilation in ambulating patients from diaphragm weakness. Non-invasive or invasive ventilation are the mainstay of treatment. In this review we explore the diagnosis and treatment of SDB in children with various NMD.
Topics: Humans; Child; Sleep; Sleep Apnea Syndromes; Neuromuscular Diseases; Hypoventilation; Polysomnography
PubMed: 38065635
DOI: 10.1016/j.spen.2023.101092 -
Journal of Diabetes Nov 2023
Topics: Humans; Sleep Apnea, Obstructive; Diabetes Mellitus, Type 2
PubMed: 37926432
DOI: 10.1111/1753-0407.13494 -
Journal of Sleep Research Aug 2023
Topics: Humans; Sleep Initiation and Maintenance Disorders; Sleep Apnea Syndromes; Polysomnography
PubMed: 37309690
DOI: 10.1111/jsr.13962 -
Revue Neurologique Oct 2023Restless legs syndrome (RLS) is a common neurological sensorimotor disorder that impairs sleep, mood and quality of life. RLS is defined by an urge to move the legs at... (Review)
Review
Restless legs syndrome (RLS) is a common neurological sensorimotor disorder that impairs sleep, mood and quality of life. RLS is defined by an urge to move the legs at rest that increases in the evening and at night, and is frequently associated with metabolic and cardiovascular diseases. Symptoms frequency, age at RLS onset, severity, familial history and consequences of RLS vary widely between patients. A genetic susceptibility, iron deficiency, dopamine deregulation, and possible hypo-adenosinergic state may play a role in the pathophysiology of RLS. Polysomnographic recordings found often periodic leg movements during sleep and wakefulness in patients with RLS. RLS can be classified as primary or comorbid with major diseases: iron deficiency, renal, neurological, rheumatological and lung diseases. First-line treatments are low-dose dopamine agonists, and alpha-2-delta ligands depending on the clinical context, and second/third line opiates for pharmacoresistant forms of RLS. Augmentation syndrome is a serious complication of dopamine agonists and should be prevented by using the recommended low dose. Despite an increase in knowledge, RLS is still underdiagnosed, poorly recognized, resulting in substantial individual health burden and socioeconomic coast, and education is urgently needed to increase awareness of this disabling disorder.
Topics: Humans; Restless Legs Syndrome; Precision Medicine; Dopamine Agonists; Quality of Life; Iron Deficiencies
PubMed: 37689536
DOI: 10.1016/j.neurol.2023.08.009 -
Journal of Sleep Research Dec 2023Insomnia disorder (chronic sleep continuity disturbance) is a debilitating condition affecting 5%-10% of the adult population worldwide. To date, researchers have... (Review)
Review
Insomnia disorder (chronic sleep continuity disturbance) is a debilitating condition affecting 5%-10% of the adult population worldwide. To date, researchers have attempted to model insomnia in animals through breeding strategies that create pathologically short-sleeping individuals or with drugs and environmental contexts that directly impose sleeplessness. While these approaches have been invaluable for identifying insomnia susceptibility genes and mapping the neural networks that underpin sleep-wake regulation, they fail to capture concurrently several of the core clinical diagnostic features of insomnia disorder in humans, where sleep continuity disturbance is self-perpetuating, occurs despite adequate sleep opportunity, and is often not accompanied by significant changes in sleep duration or architecture. In the present review, we discuss these issues and then outline ways animal models can be used to develop approaches that are more ecologically valid in their recapitulation of chronic insomnia's natural aetiology and pathophysiology. Conditioning of self-generated sleep loss with these methods promises to create a better understanding of the neuroadaptations that maintain insomnia, including potentially within the infralimbic cortex, a substrate at the crossroads of threat habituation and sleep.
Topics: Adult; Animals; Humans; Sleep Initiation and Maintenance Disorders; Sleep; Models, Animal; Sleep Wake Disorders; Dyssomnias
PubMed: 36748845
DOI: 10.1111/jsr.13845 -
Missouri Medicine 2024Insomnia is a prevalent sleep disorder with pervasive effects on quality of life. The deleterious effects of insomnia are largely preventable with appropriate... (Review)
Review
Insomnia is a prevalent sleep disorder with pervasive effects on quality of life. The deleterious effects of insomnia are largely preventable with appropriate therapeutic interventions. Pharmacotherapy should be initiated in patients with inadequate response to CBT-I and tailored to comorbidities. Referral to a sleep medicine specialist should be considered in patients with a suboptimal response.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Quality of Life; Treatment Outcome; Cognitive Behavioral Therapy; Comorbidity
PubMed: 38404423
DOI: No ID Found -
Peptides Nov 2023Loss of orexin/hypocretin causes serious sleep disorder; narcolepsy. Cataplexy is the most striking symptom of narcolepsy, characterized by abrupt muscle paralysis... (Review)
Review
Loss of orexin/hypocretin causes serious sleep disorder; narcolepsy. Cataplexy is the most striking symptom of narcolepsy, characterized by abrupt muscle paralysis induced by emotional stimuli, and has been considered pathological activation of REM sleep atonia system. Clinical treatments for cataplexy/narcolepsy and early pharmacological studies in narcoleptic dogs tell us about the involvement of monoaminergic and cholinergic systems in the control of cataplexy/narcolepsy. Muscle atonia may be induced by activation of REM sleep-atonia generating system in the brainstem. Emotional stimuli may be processed in the limbic systems including the amygdala, nucleus accumbens, and medial prefrontal cortex. It is now considered that orexin/hypocretin prevents cataplexy by modulating the activity of different points of cataplexy-inducing circuit, including monoaminergic/cholinergic systems, muscle atonia-generating systems, and emotion-related systems. This review will describe the recent advances in understanding the neural mechanisms controlling cataplexy, with a focus on the involvement of orexin/hypocretin system, and will discuss future experimental strategies that will lead to further understanding and treatment of this disease.
Topics: Animals; Dogs; Cataplexy; Orexins; Narcolepsy; Sleep, REM; Cholinergic Agents
PubMed: 37598758
DOI: 10.1016/j.peptides.2023.171080 -
Current Opinion in Pulmonary Medicine Nov 2023Insomnia and obstructive sleep apnea have previously been viewed as completely independent conditions. However, there is now increasing recognition that insomnia and... (Review)
Review
PURPOSE OF REVIEW
Insomnia and obstructive sleep apnea have previously been viewed as completely independent conditions. However, there is now increasing recognition that insomnia and sleep apnea frequently co-occur. Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent condition that is associated with impairment of sleep, daytime function, mental health and physical health outcomes, and mortality risk. This review aims to provide an update on COMISA prevalence, consequences, treatment approaches, and future research directions.
RECENT FINDINGS
People with COMISA experience worse sleep, mental health, physical health, quality of life and longevity compared to people with neither condition, and often compared to those with insomnia alone and sleep apnea alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is an effective treatment in the presence of treated and untreated sleep apnea, that may also improve manifestations and subsequent management of sleep apnea. Future research is required to understand the etiology of COMISA, and to develop and implement tailored treatment approaches.
SUMMARY
It is important for sleep and respiratory technicians, researchers and clinicians to be aware of the high co-morbidity rates, consequences, and treatment requirements of patients with co-morbid insomnia and sleep apnea.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Quality of Life; Sleep Apnea Syndromes; Comorbidity; Sleep Apnea, Obstructive
PubMed: 37642477
DOI: 10.1097/MCP.0000000000001007 -
Sleep Medicine Clinics Dec 2023Women of advancing age can suffer from an array of sleep disorders. We review the changes in sleep architecture, the impact of hormonal changes on sleep, and the various... (Review)
Review
Women of advancing age can suffer from an array of sleep disorders. We review the changes in sleep architecture, the impact of hormonal changes on sleep, and the various sleep disorders in women of advancing age. A focused history in this population should include the temporal relation to menopause and comorbid conditions. Treatment options should involve patient preference and review of current medications and comorbid conditions to optimize sleep in this population.
Topics: Female; Humans; Sleep Apnea Syndromes; Aging; Menopause; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 38501526
DOI: 10.1016/j.jsmc.2023.06.017