Early Intensive Neurorehabilitation of adults with unresponsive wakefulness syndrome or a prolonged minimally conscious state Early Intensive Neurorehabilitation of adults with unresponsive wakefulness syndrome or a prolonged minimally conscious state | Report | National Health Care Institute You are here: Early Intensive Neurorehabilitation of adults with unresponsive wakefulness syndrome or a prolonged minimally conscious state Search within English part of National Health Care Institute (...) Search Early Intensive Neurorehabilitation of adults with unresponsive wakefulness syndrome or a prolonged minimally conscious state Share this page Service About this site

of Nursing, The University of Toronto, Toronto, Ontario, Canada. eng Journal Article Comment 2019 05 30 England Evid Based Nurs 9815947 1367-6539 IM N Int J Nurs Stud. 2018 Sep;85:126-135 29886347 Cognition Cognitive Behavioral Therapy Humans Primary Health Care Sleep Initiation and Maintenance Disorders nursing primary care Competing interests: None declared. 2019 01 29 2019 5 31 6 0 2019 6 27 6 0 2019 6 1 6 0 ppublish 31147344 ebnurs-2018-102975 10.1136/ebnurs-2018-102975 (...) Nurse-led cognitive behavioural group treatment intervention for insomnia successfully reduces daytime symptomatology. 31147344 2019 06 26 2019 06 26 1468-9618 22 3 2019 07 Evidence-based nursing Evid Based Nurs Nurse-led cognitive behavioural group treatment intervention for insomnia successfully reduces daytime symptomatology. 79 10.1136/ebnurs-2018-102975 Scott Lauren L 0000-0001-9526-2385 Faculty of Nursing, The University of Toronto, Toronto, Ontario, Canada. Bawden Jessica J Faculty

-110), a selective dopamine and norepinephrine reuptake inhibitor with robust wake-promoting effects, for the treatment of excessive sleepiness in participants with obstructive sleep apnea with current or prior sleep apnea treatment. Methods: This was a double-blind, randomized, placebo-controlled, parallel-group, 12-week trial comparing solriamfetol, 37.5, 75, 150, and 300 mg, with placebo. Measurements and Main Results: Of 476 randomized participants, 459 were included in the prespecified (...) participants; five participants experienced serious adverse events (two [1.7%] placebo, three [0.8%] solriamfetol); none were deemed related to study drug. The most common adverse events with solriamfetol were headache (10.1%), nausea (7.9%), decreased appetite (7.6%), anxiety (7.0%), and nasopharyngitis (5.1%). Conclusions: Solriamfetol significantly increased wakefulness and reduced sleepiness in participants with obstructive sleep apnea and excessive sleepiness; most adverse events were mild or moderate

process. 3 Insomnia Assessment and Diagnosis Insomnia is a diagnosis of exclusion. Patients who report difficulty initiating sleep, difficulty maintaining sleep, waking too early, or experiencing non-restorative sleep should be assessed to evaluate for: • Comorbid medical conditions (e.g., pulmonary disease, heart failure, chronic pain) • Comorbid psychiatric disorders (e.g., depression, anxiety, post-traumatic stress disorder, substance abuse) • Other sleep disorders (e.g., obstructive sleep apnea (...) , restless legs syndrome, circadian rhythm sleep-wake disorders) It is important to screen the patient for depression, substance use, and alcohol use, as about 1 in 3 patients reporting insomnia have co-occurring psychiatric illness (typically depression or anxiety) and 1 in 6 have alcohol- or drug-induced sleep problems. It is also important to review the patient’s current medications. Table 1 lists medications that may interfere with sleep. • Medication effects on sleep are complex. Medications can

Belsomra (Suvorexant) - for the treatment of insomnia Search Page - Drug and Health Product Register Language selection Search and menus Search Search website Search Topics menu You are here: Summary Basis of Decision - - Health Canada Expand all Summary Basis of Decision (SBD) for Contact: Summary Basis of Decision (SBD) documents provide information related to the original authorization of a product. The for is located below. Recent Activity for SBDs written for approved after September 1

The Combination of Atomoxetine and Oxybutynin Greatly Reduces Obstructive Sleep Apnea Severity. A Randomized, Placebo-controlled, Double-Blind Crossover Trial Rationale: There is currently no effective pharmacological treatment for obstructive sleep apnea (OSA). Recent investigations indicate that drugs with noradrenergic and antimuscarinic effects improve genioglossus muscle activity and upper airway patency during sleep. Objectives: We aimed to determine the effects of the combination (...) of a norepinephrine reuptake inhibitor (atomoxetine) and an antimuscarinic (oxybutynin) on OSA severity (apnea-hypopnea index [AHI]; primary outcome) and genioglossus responsiveness (secondary outcome) in people with OSA. Methods: A total of 20 people completed a randomized, placebo-controlled, double-blind, crossover trial comparing 1 night of 80 mg atomoxetine plus 5 mg oxybutynin (ato-oxy) to placebo administered before sleep. The AHI and genioglossus muscle responsiveness to negative esophageal pressure

Association of Unrecognized Obstructive Sleep Apnea With Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery. Unrecognized obstructive sleep apnea increases cardiovascular risks in the general population, but whether obstructive sleep apnea poses a similar risk in the perioperative period remains uncertain.To determine the association between obstructive sleep apnea and 30-day risk of cardiovascular complications after major noncardiac surgery.Prospective cohort (...) sleep monitoring.The primary outcome was a composite of myocardial injury, cardiac death, heart failure, thromboembolism, atrial fibrillation, and stroke within 30 days of surgery. Proportional-hazards analysis was used to determine the association between obstructive sleep apnea and postoperative cardiovascular complications.Among a total of 1364 patients recruited for the study, 1218 patients (mean age, 67 [SD, 9] years; 40.2% women) were included in the analyses. At 30 days after surgery, rates

Indigenous Food Safety and Security: Community Adaptations in the Wake of Climate Pressures INDIGENOUS FOOD SAFETY AND SECURITY: COMMUNITY ADAPTATIONS IN THE WAKE OF CLIMATE PRESSURES FEBRUARY 2019 Prepared by: Leela Steiner, National Collaborating Centre for Environmental Health Casey Neathway, First Nations Health AuthorityNational Collaborating Centre for Environmental Health 1 INTRODUCTION Indigenous people have long relied on traditional foods, as they are nutritionally, culturally (...) public health risks while at the same time supporting community efforts to improve food safety in the wake of their adaptation efforts to address climatic pressures. This review presents evidence on six unique food safety issues, based on adaptation measures taken or planned to be taken to help ensure food security: 1) smokehouse construction considerations; 2) gardening and the use of tires as planters; 3) greywater use in crop irrigation; 4) traditional preservation techniques (specifically sun

Solriamfetol (Sunosi) - To treat excessive sleepiness in adult patients with narcolepsy or obstructive sleep apnea Drug Approval Package: Sunosi U.S. Department of Health and Human Services Search FDA Submit search Drug Approval Package: Sunosi Company: Jazz Pharmaceuticals Ireland Limited Application Number: 211230 Approval Date: 03/20/2019 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. FDA Approval Letter and Labeling (PDF) (PDF

Positional therapy for obstructive sleep apnoea. The modalities of therapy for obstructive sleep apnoea (OSA) include behavioural and lifestyle modifications, positional therapy, oral appliances, surgery and continuous positive airway pressure therapy (CPAP). Though CPAP has proven efficacy in treating OSA, adherence with CPAP therapy is suboptimal. Positional therapy (to keep people sleeping on their side) is less invasive and therefore expected to have better adherence. This review considered (...) therapy. Two studies showed that CPAP produced a greater reduction in Apnoea-Hypopnoea Index (AHI) with a mean difference (MD) of 6.4 events per hour (95% CI 3.00 to 9.79; low-certainty evidence) compared to positional therapy. Subjective adherence, evaluated in one study, was found to be significantly greater with positional therapy (MD 2.5 hours per night, 95% CI 1.41 to 3.59; moderate-certainty evidence).In terms of secondary outcomes, one study each reported quality-of-life indices and quality

Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure.A semiautomated algorithm assessed risk of treatment (...) failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment).A total of 102 patients were classified as at risk and randomly assigned

to treat adult patients with sleep-related breathing disorders. Sleep . 2006;29(3):375–380. [ ] 2 Kushida CA, Chediak A, Berry RB, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep (...) , Minnesota; 4 McGill University Health Centre, Montreal, Quebec, Canada; 5 University of Pittsburgh, Pittsburgh, Pennsylvania; 6 American Academy of Sleep Medicine, Darien, Illinois ABSTRACT Introduction: This guideline establishes clinical practice recommendations for positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines in the evaluation and treatment of sleep-disordered

(CPAP) withdrawal on CVR.41 OSA patients (88% male, mean age 57±10 years) were randomised to either subtherapeutic or continuation of therapeutic CPAP. At baseline and after 2 weeks, patients underwent a sleep study and magnetic resonance imaging (MRI). CVR was estimated by quantifying the blood oxygen level-dependent (BOLD) MRI response to breathing stimuli.OSA did recur in the subtherapeutic CPAP group (mean treatment effect apnoea-hypopnoea index +38.0 events·h-1, 95% CI 24.2-52.0; p<0.001 (...) Effects of short-term continuous positive airway pressure withdrawal on cerebral vascular reactivity measured by blood oxygen level-dependent magnetic resonance imaging in obstructive sleep apnoea: a randomised controlled trial Impaired cerebral vascular reactivity (CVR) increases long-term stroke risk. Obstructive sleep apnoea (OSA) is associated with peripheral vascular dysfunction and vascular events. The aim of this trial was to evaluate the effect of continuous positive airway pressure

. Marcus CL, Brooks LJ, Draper KA, et al.; American Academy of Pediatrics. Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome. Pediatrics. 2012;130(3):576-584. 9. Roland PS, Rosenfeld RM, Brooks LJ, et al; American Academy of Otolaryngology—Head and Neck Surgery Foundation. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011 Jul;145(1 Suppl):S1-15. Other Literature 1. Berry RB, Hill G (...) and/or cognitive impairment are not suitable candidates for home sleep studies. Patients with sleep disorders other than OSA are not suitable candidates for home sleep testing. Regardless of the site of testing, sleep studies objectively measure the degree of respiratory disturbance during sleep. Episodes of apnea (cessation of breathing lasting at least 10 seconds and hypopnea (reduction, but not a cessation of air exchange, with an associated fall in oxygen saturation [at least 3% to 4%] or arousal

with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173:910. Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 2010; 122:352. Yumino D, Tsurumi Y, Takagi A, et al. Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome. Am J (...) , Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001;163:608-613. Basner RC. Continuous positive airway pressure for obstructive sleep apnea. N Engl J Med . 2007;356:1751–8. doi: 10.1056/NEJMct066953. White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med 2005;172:1363-1370. Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA. Indications for positive airway pressure treatment of adult

Combined electroacupuncture and auricular acupuncture for primary insomnia: a randomised controlled trial of dose-response effect. 30674705 2019 01 24 1024-2708 25 Suppl 2 2019 Feb Hong Kong medical journal = Xianggang yi xue za zhi Hong Kong Med J Combined electroacupuncture and auricular acupuncture for primary insomnia: a randomised controlled trial of dose-response effect. 28-33 Chung K F KF Department of Psychiatry, The University of Hong Kong. Yeung W F WF School of Chinese Medicine

randomized to the HT002 (n = 20) or waitlist (n = 20) groups. The HT002 group consumed HT002 twice daily for 4 weeks. Outcomes were assessed using the Insomnia Severity Scale (ISI), Pittsburgh Sleep Quality Index (PSQI), and 12-item Short Form Health Survey (SF-12) at baseline and after 4 and 8 weeks.The ISI score differences from baseline at weeks 4 and 8 were significantly greater in the HT002 than that in the waitlist group (week 4: -4.0 ± 0.8 vs. -0.4 ± 0.8, p < 0.05; week 8: -4.8 ± 0.7 vs. -0.9 (...) Effect of Traditional East Asian Medicinal herbal tea (HT002) on insomnia: a randomized controlled pilot study. Complementary and alternative medicine treatment for insomnia has been sought due to the possible adverse effects of conventional pharmacotherapies. We performed a preliminary evaluation of the feasibility of using, and of the effect of a herbal tea (HT002), based on Traditional East Asian Medicine, in mild-to-moderate insomnia.Patients (n = 40) with mild-to-moderate insomnia were

Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation.To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute (...) of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea

Insomnia: What issues should I be aware of when prescribing modified released melatonin? Melatonin | Prescribing information | Insomnia | CKS | NICE Search CKS… Menu Melatonin Insomnia: What issues should I be aware of when prescribing modified released melatonin? Last revised in January 2020 What issues should I be aware of when prescribing modified released melatonin? Be aware that recent data suggest similar safety concerns with melatonin to those associated with other hypnotic drugs (falls (...) , accidents, cognitive impairment, dependence and withdrawal symptoms, and an increased risk of dementia) [ ; ]. Indications and dose The recommended oral dose of modified-release melatonin for insomnia (short-term use only) for an adult aged 55 years and over is 2 mg once daily (1–2 hours before bedtime and after food) for up to 13 weeks. The recommended initial duration of treatment is 3 weeks continued if there is a response to treatment for a further 10 weeks only. Contraindications and cautions

Insomnia: What else might it be? Differential diagnosis | Diagnosis | Insomnia | CKS | NICE Search CKS… Menu Differential diagnosis Insomnia: What else might it be? Last revised in January 2020 What else might it be? Consider other sleep disorders such as: Obstructive sleep apnoea — for more information, see the CKS topic on . Circadian rhythm disorders — for more information see the CKS topic on . Restless legs syndrome — for more information, see the CKS topic on . Narcolepsy — may present (...) with falling asleep in the daytime without warning and collapse or muscle weakness triggered by emotion. Parasomnias — may present with unusual or unpleasant experiences or behaviours associated with sleep that are troublesome or dangerous. [ ; ; ] © .