-
Clinics in Chest Medicine Jun 2022Sleep deficiency in patients with obstructive sleep apnea includes abnormal quality, timing, and duration of sleep, and the presence of other comorbid conditions. These... (Review)
Review
Sleep deficiency in patients with obstructive sleep apnea includes abnormal quality, timing, and duration of sleep, and the presence of other comorbid conditions. These include insomnia, circadian misalignment disorders, and periodic limb movements of sleep. The co-occurrence of these conditions with obstructive sleep apnea likely plays a role in the pathogenesis, clinical presentation, and management of obstructive sleep apnea. Considering these conditions and their treatment in evaluating sleep deficiency in obstructive sleep apnea may help to improve patient outcomes. However, future research is needed to understand the intersection between obstructive sleep apnea and these disorders.
Topics: Humans; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders
PubMed: 35659030
DOI: 10.1016/j.ccm.2022.02.013 -
The European Respiratory Journal Apr 2022
Topics: Aged; Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 35483717
DOI: 10.1183/13993003.01627-2021 -
European Respiratory Review : An... Mar 2016Sleep apnoea is a disorder characterised by repetitive pauses in breathing during sleep caused by airway occlusion (obstructive sleep apnoea) or altered control of... (Review)
Review
Sleep apnoea is a disorder characterised by repetitive pauses in breathing during sleep caused by airway occlusion (obstructive sleep apnoea) or altered control of breathing (central sleep apnoea). In this Clinical Year in Review, we summarise high-impact research from the past year pertaining to management, diagnosis and cardio-metabolic consequences of sleep apnoea.
Topics: Animals; Comorbidity; Humans; Prognosis; Risk Factors; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 26929416
DOI: 10.1183/16000617.0077-2015 -
British Journal of Hospital Medicine... Feb 2024Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is... (Review)
Review
Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.
Topics: Child; Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Adenoidectomy; Tonsillectomy
PubMed: 38416524
DOI: 10.12968/hmed.2023.0275 -
Tidsskrift For Den Norske Laegeforening... Sep 2009Insomnia is the most prevalent sleep disorder. Chronic insomnia affects about 10% of the adult population. (Review)
Review
BACKGROUND
Insomnia is the most prevalent sleep disorder. Chronic insomnia affects about 10% of the adult population.
MATERIAL AND METHOD
This review is based on the authors' experience, as well as articles identified through non-systematic searches in Pubmed.
RESULTS
Insomnia is characterized by problems with falling asleep, difficulty maintaining sleep, waking up to early and/or poor sleep quality. The diagnosis implies that the problem causes some type of daytime impairment. Insomnia is divided into several different subtypes. Recent studies indicate that insomnia is an independent risk factor for sick leave and disability pension. Non-pharmacological treatment, i.e. stimulus control and sleep restriction yields better outcome than hypnotics, particularly on a long-term basis.
INTERPRETATION
Insomnia is highly prevalent, and non-pharmacological therapy is the best documented treatment.
Topics: Adult; Humans; Mental Disorders; Quality of Life; Risk Factors; Sick Leave; Sleep Initiation and Maintenance Disorders
PubMed: 19756061
DOI: 10.4045/tidsskr.08.0379 -
Sleep Medicine Clinics Sep 2020Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform;... (Review)
Review
Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform; there was lack of consistent reimbursement; and many clinicians were busy with their in-office practices. This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine.
Topics: Betacoronavirus; COVID-19; Child; Continuous Positive Airway Pressure; Coronavirus Infections; Humans; Otolaryngology; Pandemics; Pediatrics; Pneumonia, Viral; Polysomnography; Referral and Consultation; Restless Legs Syndrome; SARS-CoV-2; Sleep; Sleep Apnea, Obstructive; Sleep Disorders, Circadian Rhythm; Sleep Initiation and Maintenance Disorders; Sleep Medicine Specialty; Sleep Wake Disorders; Telemedicine
PubMed: 33008491
DOI: 10.1016/j.jsmc.2020.07.003 -
Anales Del Sistema Sanitario de Navarra 2007Insomnia is a common pathology in the general population. It is estimated that 10 to 15 percent of the adult population has chronic insomnia and 25 to 35 percent have... (Review)
Review
Insomnia is a common pathology in the general population. It is estimated that 10 to 15 percent of the adult population has chronic insomnia and 25 to 35 percent have suffered occasional or transient insomnia due to stressful situations. The aim of this article is to provide a review of insomnia: causes, differential diagnosis, and different options of treatment. To that end we have made a search in Pubmed with the keywords "insomnia", "sleeplessness", "sleep disorders" and "pharmacological therapy". Insomnia evaluation includes a careful sleep history, personal and family history of mental and organic illness, and a registration of drug and medication intake. Authors agree that treatment should be based primarily on etiology, and secondarily on symptomatology.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders
PubMed: 17486153
DOI: No ID Found -
European Respiratory Review : An... Jan 2024Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have... (Review)
Review
Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have prompted investigations aiming to achieve a more precise differentiation and description of the entities of central sleep apnoea (CSA). There is increasing evidence for the heterogeneity of CSA in terms of underlying aetiology, pathophysiological concepts, treatment response and outcome. Assigning patients to these phenotypes allows for the selection of individualised therapies. Major pathophysiological characteristics include loop gain, apnoeic threshold, breathing regulation and neuromuscular mechanics. Chronic heart failure is the most important underlying disease, leading to nonhypercapnic CSA based on increased loop and controller gain. Although many questions remain, this review tries to describe the current knowledge on the pathophysiology of the clinical entities. The description of prognostic aspects may guide treatment indication and the selection of pharmacotherapy and invasive options. In addition, the paper provides an update on the current understanding of adaptive servo-ventilation and its role in the treatment of CSA.
Topics: Humans; Sleep Apnea, Central; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Respiration; Continuous Positive Airway Pressure; Heart Failure
PubMed: 38537948
DOI: 10.1183/16000617.0141-2023 -
Handbook of Clinical Neurology 2011Restless legs syndrome (RLS) is characterized by a compelling, often insatiable, need to move the legs, accompanied by unpleasant sensations located mainly in the ankles... (Review)
Review
Restless legs syndrome (RLS) is characterized by a compelling, often insatiable, need to move the legs, accompanied by unpleasant sensations located mainly in the ankles and calves. Because symptoms are brought on by inactivity, distress intrudes upon everyday, sedentary activities such as plane travel, car rides, and attending school, meetings, or the theatre. Symptoms show a diurnal preference for the evening and night, so disruption of sleep onset or maintenance is particularly common. RLS is associated with both lower ratings of quality of life and higher rates of cardiovascular disease. Four common genetic loci associating to RLS have recently been identified, but the molecular pathways by which they increase risk for RLS have yet to be determined. Both sensory (RLS) and motor (periodic limb movements of sleep) symptoms are responsive to dopaminergic medications, yet clear delineation of dopaminergic pathology has not emerged. Brain iron is reduced in many, but not all, patients with RLS. First-line treatment for RLS includes agents acting at D(2) and D(3) dopamine receptors.
Topics: Humans; Nervous System; Restless Legs Syndrome
PubMed: 21496614
DOI: 10.1016/B978-0-444-52014-2.00047-1 -
The Cochrane Database of Systematic... Oct 2022Central sleep apnoea (CSA) is characterised by abnormal patterns of ventilation during sleep due to a dysfunctional drive to breathe. Consequently, people with CSA may... (Review)
Review
BACKGROUND
Central sleep apnoea (CSA) is characterised by abnormal patterns of ventilation during sleep due to a dysfunctional drive to breathe. Consequently, people with CSA may present poor sleep quality, sleep fragmentation, inattention, fatigue, daytime sleepiness, and reduced quality of life.
OBJECTIVES
To assess the effectiveness and safety of non-invasive positive pressure ventilation (NIPV) for the treatment of adults with CSA.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Scopus on 6 September 2021. We applied no restrictions on language of publication. We also searched clinical trials registries for ongoing and unpublished studies, and scanned the reference lists of included studies to identify additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) reported in full text, those published as abstract only, and unpublished data.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias of the included studies using the Cochrane risk of bias tool version 1.0, and the certainty of the evidence using the GRADE approach. In the case of disagreement, a third review author was consulted.
MAIN RESULTS
We included 15 RCTs with a total of 1936 participants, ranging from 10 to 1325 participants. All studies had important methodological limitations. We assessed most studies (11 studies) as at high risk of bias for at least one domain, and all studies as at unclear risk of bias for at least two domains. The trials included participants aged > 18 years old, of which 70% to 100% were men, who were followed from one week to 60 months. The included studies assessed the effects of different modes of NIPV and CSA. Most participants had CSA associated with chronic heart failure. Because CSA encompasses a variety of causes and underlying clinical conditions, data were carefully analysed, and different conditions and populations were not pooled. The findings for the primary outcomes for the seven evaluated comparisons are presented below. Continuous positive airway pressure (CPAP) plus best supportive care versus best supportive care in CSA associated with chronic heart failure In the short term, CPAP plus best supportive care may reduce central apnoea hypopnoea index (AHI) (mean difference (MD) -14.60, 95% confidence interval (CI) -20.11 to -9.09; 1 study; 205 participants). However, CPAP plus best supportive care may result in little to no difference in cardiovascular mortality compared to best supportive care alone. The evidence for the effect of CPAP plus best supportive care on all-cause mortality is very uncertain. No adverse effects were observed with CPAP, and the results for adverse events in the best supportive care group were not reported. Adaptive servo ventilation (ASV) versus CPAP in CSA associated with chronic heart failure The evidence is very uncertain about the effect of ASV versus CPAP on quality of life evaluated in both the short and medium term. Data on adverse events were not reported, and it is not clear whether data were sought but not found. ASV versus bilevel ventilation in CSA associated with chronic heart failure In the short term, ASV may result in little to no difference in central AHI. No adverse events were detected with ASV, and the results for adverse events in the bilevel ventilation group were not reported. ASV plus best supportive care versus best supportive care in CSA associated with chronic heart failure In the medium term, ASV plus best supportive care may reduce AHI compared to best supportive care alone (MD -20.30, 95% CI -28.75 to -11.85; 1 study; 30 participants). In the long term, ASV plus best supportive care likely increases cardiovascular mortality compared to best supportive care (risk ratio (RR) 1.25, 95% CI 1.04, 1.49; 1 study; 1325 participants). The evidence suggests that ASV plus best supportive care may result in little to no difference in quality of life in the short, medium, and long term, and in all-cause mortality in the medium and long term. Data on adverse events were evaluated but not reported. ASV plus best supportive care versus best supportive care in CSA with acute heart failure with preserved ejection fraction Only adverse events were reported for this comparison, and no adverse events were recorded in either group. ASV versus CPAP maintenance in CPAP-induced CSA In the short term, ASV may slightly reduce central AHI (MD -4.10, 95% CI -6.67 to -1.53; 1 study; 60 participants), but may result in little to no difference in quality of life. Data on adverse events were not reported, and it is not clear whether data were sought but not found. ASV versus bilevel ventilation in CPAP-induced CSA In the short term, ASV may slightly reduce central AHI (MD -8.70, 95% CI -11.42 to -5.98; 1 study; 30 participants) compared to bilevel ventilation. Data on adverse events were not reported, and it is not clear whether data were sought but not found.
AUTHORS' CONCLUSIONS
CPAP plus best supportive care may reduce central AHI in people with CSA associated with chronic heart failure compared to best supportive care alone. Although ASV plus best supportive care may reduce AHI in people with CSA associated with chronic heart failure, it likely increases cardiovascular mortality in these individuals. In people with CPAP-induced CSA, ASV may slightly reduce central AHI compared to bilevel ventilation and to CPAP. In the absence of data showing a favourable impact on meaningful patient-centred outcomes and defining clinically important differences in outcomes in CSA patients, these findings need to be interpreted with caution. Considering the level of certainty of the available evidence and the heterogeneity of participants with CSA, we could draw no definitive conclusions, and further high-quality trials focusing on patient-centred outcomes, such as quality of life, quality of sleep, and longer-term survival, are needed to determine whether one mode of NIPV is better than another or than best supportive care for any particular CSA patient group.
Topics: Adult; Male; Humans; Adolescent; Female; Sleep Apnea, Central; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Disorders of Excessive Somnolence; Heart Failure
PubMed: 36278514
DOI: 10.1002/14651858.CD012889.pub2