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Sleep Medicine Mar 2022This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and...
This chapter summarizes the known associations between COVID-19 and sleep dysfunction, including insomnia, excessive daytime sleepiness, restless legs syndrome and nightmares, and touches upon pandemic-related considerations for obstructive sleep apnea and continuous positive airway pressure treatment. Treatment strategies and management approaches are also briefly discussed.
Topics: COVID-19; Continuous Positive Airway Pressure; Disorders of Excessive Somnolence; Humans; Sleep Apnea, Obstructive; Sleep Wake Disorders
PubMed: 34391672
DOI: 10.1016/j.sleep.2021.07.021 -
Deutsches Arzteblatt International Aug 2021Fatigue is a main or secondary reason for 10-20% of all consultations with a primary care physician. (Review)
Review
BACKGROUND
Fatigue is a main or secondary reason for 10-20% of all consultations with a primary care physician.
METHODS
This review is based on pertinent publications retrieved by a comprehensive, selective literature search on the epidemiology, etiology, and diagnostic evaluation of fatigue as a leading symptom of disease, as well as on the treatment of its common causes. Information was also included from the literature search we conducted for the German clinical practice guideline on fatigue that was issued by the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM).
RESULTS
Fatigue can be due to any of a broad spectrum of diseases, including decompensation of already known conditions. Sleep disorders and sleep-related disorders of breathing, depression (18.5%), and excessive psychosocial stress are the most common causes of persistent fatigue. Previously undiagnosed cancer is a rare cause, accounting for only 0.6% of cases (95% confidence interval [0.3; 1.3]). Anemia and other organic causes are rare as well (4.3% [2.7; 6.7]). Investigations beyond the history, physical examination, and simple laboratory tests are needed only in the presence of additional symptoms or findings. If the diagnosis remains unclear, watchful waiting and regularly scheduled follow-up help prevent an excessive focus on somatic causes, leading to overdiagnosis. Irrespective of specific causes, psychoeducative and psychotherapeutic approaches should be discussed with the patient, as well as an individually adapted exercise program.
CONCLUSION
The work-up of fatigue as a chief complaint should be guided by investigating common and/or potentially dangerous disorders. Since the latter are rare, an exclusively somatic focus should be avoided in order to prevent overdiagnosis.
Topics: Exercise; Fatigue; General Practitioners; Humans; Physical Examination; Sleep Wake Disorders
PubMed: 34196270
DOI: 10.3238/arztebl.m2021.0192 -
Clinical Interventions in Aging 2023Exogenous melatonin is commonly used for sleep disorders in older adults, and its use is increasing over time. It appears to have modest efficacy in treating insomnia... (Review)
Review
Exogenous melatonin is commonly used for sleep disorders in older adults, and its use is increasing over time. It appears to have modest efficacy in treating insomnia and circadian rhythm sleep-wake disorders. Melatonin is commonly perceived to be a safe alternative to other hypnotics and is available without prescription in some jurisdictions. New evidence suggests that endogenous melatonin has pleomorphic effects on multiple organ systems, many of which are poorly understood. This narrative review summarizes the current evidence regarding the safety of melatonin in older adults (defined by age over 65 years). Melatonin appears to have a favorable safety profile in this population, however there is a dearth of evidence regarding the safety of prolonged use. There are several factors which increase the risk of adverse effects of melatonin in older adults, and these should be taken into consideration when prescribing to this population.
Topics: Humans; Aged; Sleep; Melatonin; Sleep Initiation and Maintenance Disorders; Hypnotics and Sedatives; Sleep Wake Disorders; Circadian Rhythm; Sleep Disorders, Circadian Rhythm
PubMed: 36660543
DOI: 10.2147/CIA.S361519 -
Preventing Chronic Disease Aug 2023
Topics: Humans; Sleep Deprivation; Sleep Wake Disorders; Chronic Disease
PubMed: 37651644
DOI: 10.5888/pcd20.230197 -
Missouri Medicine 2017Neurocognitive and sleep problems are common, underdiagnosed, and frequently co-morbid. Sleep disruption, and fatigue, predict cognitive impairment. Cognitive... (Review)
Review
Neurocognitive and sleep problems are common, underdiagnosed, and frequently co-morbid. Sleep disruption, and fatigue, predict cognitive impairment. Cognitive impairment, in turn, can worsen sleep hygiene. In dementia patients, sleep disorders are common, and dementia medications affect sleep. Emerging insights on the brain's glymphatic system suggests that sleep may drive clearance of Aβ peptide to affect Alzheimer pathophysiology. Parkinsonian dementias are linked with REM behavior disorder, a highly treatable problem that predicts future conversion into dementia.
Topics: Amyloid beta-Peptides; Cognitive Dysfunction; Dementia; Humans; Neuropsychological Tests; Parkinsonian Disorders; Peptide Fragments; REM Sleep Behavior Disorder; Sleep Wake Disorders
PubMed: 30228618
DOI: No ID Found -
Acta Dermato-venereologica Apr 2022Psoriasis alters patients' quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most... (Review)
Review
Psoriasis alters patients' quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;' physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.
Topics: Humans; Psoriasis; Quality of Life; Restless Legs Syndrome; Sleep; Sleep Wake Disorders
PubMed: 35191513
DOI: 10.2340/actadv.v102.1991 -
Current Biology : CB Sep 2020Interview with John Peever, who studies the brain mechanisms that control REM sleep and how their dysfunction underlies sleep disorders at the University of Toronto.
Interview with John Peever, who studies the brain mechanisms that control REM sleep and how their dysfunction underlies sleep disorders at the University of Toronto.
Topics: Brain; History, 21st Century; Humans; Interviews as Topic; Sleep Wake Disorders; Sleep, REM
PubMed: 33242001
DOI: 10.1016/j.cub.2020.08.057 -
Neurologia Sep 2022Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesisable and can be administered orally, which has led to interest in... (Review)
Review
Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesisable and can be administered orally, which has led to interest in its use as a treatment for insomnia. Moreover, as production of the hormone decreases with age, in inverse correlation with the frequency of poor sleep quality, it has been suggested that melatonin deficit is at least partly responsible for sleep disorders. Treating this age-related deficit would therefore appear to be a natural way of restoring sleep quality, which is lost as patients age. However, despite the undeniable theoretical appeal of this approach to insomnia, little scientific evidence is available that supports any benefit of this substitutive therapy. Furthermore, the most suitable dose ranges and pharmaceutical preparations for melatonin administration are yet to be clearly defined. This review addresses the physiology of melatonin, the different pharmaceutical preparations, and data on its clinical usefulness.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Circadian Rhythm; Melatonin; Sleep Wake Disorders; Pharmaceutical Preparations
PubMed: 30466801
DOI: 10.1016/j.nrl.2018.08.002 -
Journal of Clinical Sleep Medicine :... Jul 2018The purpose of this guideline is to establish clinical practice recommendations for the use of actigraphy in adult and pediatric patients with suspected or diagnosed...
INTRODUCTION
The purpose of this guideline is to establish clinical practice recommendations for the use of actigraphy in adult and pediatric patients with suspected or diagnosed sleep disorders or circadian rhythm sleep-wake disorders.
METHODS
The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assigned strengths based on a systematic review of the literature and an assessment of the evidence using the GRADE process. The task force provided a summary of the relevant literature and the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations. The AASM Board of Directors approved the final recommendations.
RECOMMENDATIONS
The following recommendations are intended as a guide for clinicians using actigraphy in evaluating patients with sleep disorders and circadian rhythm sleep-wake disorders, and only apply to the use of FDA-approved devices. Each recommendation statement is assigned a strength ("Strong" or "Conditional"). A "Strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "Conditional" recommendation (ie, "We suggest…") reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding any specific care must be made by the treating clinician and the patient, taking into consideration the individual circumstances of the patient, available treatment options, and resources. We suggest that clinicians use actigraphy to estimate sleep parameters in adult patients with insomnia disorder. (Conditional). We suggest that clinicians use actigraphy in the assessment of pediatric patients with insomnia disorder. (Conditional). We suggest that clinicians use actigraphy in the assessment of adult patients with circadian rhythm sleep-wake disorder. (Conditional). We suggest that clinicians use actigraphy in the assessment of pediatric patients with circadian rhythm sleep-wake disorder. (Conditional). We suggest that clinicians use actigraphy integrated with home sleep apnea test devices to estimate total sleep time during recording (in the absence of alternative objective measurements of total sleep time) in adult patients suspected of sleep-disordered breathing. (Conditional). We suggest that clinicians use actigraphy to monitor total sleep time prior to testing with the Multiple Sleep Latency Test in adult and pediatric patients with suspected central disorders of hypersomnolence. (Conditional). We suggest that clinicians use actigraphy to estimate total sleep time in adult patients with suspected insufficient sleep syndrome. (Conditional). We recommend that clinicians use actigraphy in place of electromyography for the diagnosis of periodic limb movement disorder in adult and pediatric patients. (Strong).
Topics: Academies and Institutes; Actigraphy; Humans; Sleep Disorders, Circadian Rhythm; Sleep Medicine Specialty; Sleep Wake Disorders; United States
PubMed: 29991437
DOI: 10.5664/jcsm.7230 -
Journal of Clinical Sleep Medicine :... Oct 2015A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep...
Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for...
A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep Medicine Practice Parameters on the treatment of intrinsic circadian rhythm sleep-wake disorders. Available data allowed for positive endorsement (at a second-tier degree of confidence) of strategically timed melatonin (for the treatment of DSWPD, blind adults with N24SWD, and children/ adolescents with ISWRD and comorbid neurological disorders), and light therapy with or without accompanying behavioral interventions (adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia). Recommendations against the use of melatonin and discrete sleep-promoting medications are provided for demented elderly patients, at a second- and first-tier degree of confidence, respectively. No recommendations were provided for remaining treatments/ populations, due to either insufficient or absent data. Areas where further research is needed are discussed.
Topics: Academies and Institutes; Adolescent; Adult; Child; Humans; Sleep Disorders, Circadian Rhythm; Sleep Medicine Specialty; Sleep Wake Disorders; United States
PubMed: 26414986
DOI: 10.5664/jcsm.5100