performance and safety implications [ ], and associated risks of tolerance and dependence [ ]. Considering sleep clinic advice or referral The recommendation to consider specialist advice or referral to a sleep clinic is extrapolated from the AASM publication, as shift workers with excessive sleepiness may have another co-morbid primary sleep disorder, such as obstructive sleep apnoea syndrome, causing sleep disturbance. Sleep studies may be helpful to assess the person and provide appropriate specialist (...) a person who does shift work has difficulty adjusting to different sleep/wake schedules and experiences sleep disturbance before or after the shift, and/or excessive sleepiness and fatigue during shifts. There may be associated insomnia in addition [ ; ; ]. Shift work describes work time arrangements outside of conventional daytime hours, which includes fixed early morning, evening, and night work, and rotating shift work (alternating day, evening, and night shift) [ ; ; ]. Jet lag disorder (JLD

Long-term efficacy of an education programme in improving adherence with continuous positive airway pressure treatment for obstructive sleep apnoea. 29938667 2018 12 11 2018 12 11 1024-2708 23 Suppl 2 3 2017 06 Hong Kong medical journal = Xianggang yi xue za zhi Hong Kong Med J Long-term efficacy of an education programme in improving adherence with continuous positive airway pressure treatment for obstructive sleep apnoea. 24-27 Lai A A Department of Medicine, Queen Mary Hospital (...) of Life Sleep Apnea, Obstructive therapy 2018 6 26 6 0 2018 6 26 6 0 2018 12 12 6 0 ppublish 29938667

Continuous positive airway pressure effect on visual acuity in patients with type 2 diabetes and obstructive sleep apnoea: a multicentre randomised controlled trial We sought to establish whether continuous positive airway pressure (CPAP) for obstructive sleep apnoea (OSA) in people with type 2 diabetes and diabetic macular oedema (DMO) improved visual acuity.We randomly assigned 131 eligible patients aged 30-85 years from 23 UK centres with significant DMO causing visual impairment (LogMAR

Does Armodafinil Improve Driving Task Performance and Weight Loss in Sleep Apnea? A Randomized Trial Patients with obstructive sleep apnea (OSA) unable to tolerate standard treatments have few alternatives. They may benefit from weight loss, but the major symptom of daytime performance impairment may remain during weight loss programs.We hypothesized that wakefulness-promoter armodafinil would improve driving task performance over placebo in patients undergoing weight loss.This was a placebo (...) -controlled, double-blind, randomized trial of armodafinil versus placebo daily for 6 months in patients who were also randomized to one of two diets for 6 months with follow-up at 1 year in overweight, adult, patients with OSA who had rejected standard treatment and suffered daytime sleepiness.Primary outcome was change in steering deviation in the final 30 minutes of a 90-minute afternoon driving task (AusED) at 6 months. Secondary outcomes were Epworth Sleepiness Scale, Functional Outcomes of Sleep

Improved Survival by Adding Lomustine to Conventional Chemotherapy for Elderly Patients With AML Without Unfavorable Cytogenetics: Results of the LAM-SA 2007 FILO Trial Acute myeloid leukemia (AML) in elderly patients has a poor prognosis. In an attempt to improve outcome for these patients, the prospective open-label phase III LAM-SA 2007 (Adding Lomustine to Chemotherapy in Older Patients With Acute Myelogenous Leukemia (AML), and Allogeneic Transplantation for Patients From 60 to 65 Years

Elevated obstructive sleep apnoea risk score is associated with poor healing of diabetic foot ulcers: a prospective cohort study To assess the prevalence of risk factors for obstructive sleep apnoea in people with diabetic foot ulcers and to determine whether this risk predicts diabetic foot ulcer healing.We studied 94 consecutive people (69% men) with diabetic foot ulcers (Type 2 diabetes, n=66, Type 1 diabetes, n=28) attending a university hospital foot unit. All participants were screened (...) for obstructive sleep apnoea using the STOP-BANG questionnaire, with a score ≥4 identifying high risk of obstructive sleep apnoea. The primary outcome was poor diabetic foot ulcer healing, defined as diabetic foot ulcer recurrence (diabetic foot ulcers which healed and re-ulcerated in same anatomical position) and/or diabetic foot ulcer persistence (no evidence of healing on clinical examination). All participants were evaluated at 12 months.Of the 94 participants, 60 (64%) had a STOP-BANG score ≥4. Over 12

Effective? Engaging? Secure? Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder Effective? Engaging? Secure? Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder | Evidence-Based Mental Health We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log in using your username and password (...) For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Effective? Engaging? Secure? Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder Article Text Original article Effective? Engaging? Secure? Applying

Cross-sectional study of brucellosis and Q fever in Thailand among livestock in two districts at the Thai-Cambodian border, Sa Kaeo province Brucellosis and Q fever impart high morbidity in humans and economic losses among livestock worldwide. However their prevalence is still not fully known in Thailand. We conducted a sero-survey of brucellosis and Q fever in beef, dairy cattle, goat, and sheep herds from Thai communities at the border with Cambodia, a cross-border trading center. Serum

with neurological conditions, such as autism spectrum disorder (ASD) and Smith-Magenis syndrome, who also have insomnia is high and not many treatments are available. Slenyto has been shown to improve sleeping times in these patients, with patients taking Slenyto sleeping for an extra 51 minutes a night compared with an extra 19 minutes with placebo. The side effects seen with the medicine over 2 years appear mild or moderate but more data are needed on longer term safety. The European Medicines Agency decided (...) Melatonin (Slenyto) - insomnia (difficulty sleeping) in children and adolescents (2 to 18 years old) Slenyto | European Medicines Agency Search Search Menu Slenyto melatonin Table of contents Authorised This medicine is authorised for use in the European Union. Overview Slenyto is a medicine for treating insomnia (difficulty sleeping) in children and adolescents (2 to 18 years old) who have: autism spectrum disorder (ASD), a range of conditions that affects the patient’s social interactions

=apnea–hypopnea index; C=control; CI=con?dence interval; CPAP=continuous positive airway pressure; D=drug; ER=extended release; IWQoL-Lite= Impact of Weight on Quality of Life–Lite instrument; OSA=obstructive sleep apnea; QOL=quality of life; SF-36=36-item Short Form Health Survey. AMERICAN THORACIC SOCIETY DOCUMENTS e78 American Journal of Respiratory and Critical Care Medicine Volume 198 Number 6 | September 15 2018 noted among those taking liraglutide. Changes in daytime somnolence did not differ (...) The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea Guideline AMERICANTHORACICSOCIETY DOCUMENTS TheRoleofWeightManagementintheTreatmentofAdultObstructive Sleep Apnea An Of?cial American Thoracic Society Clinical Practice Guideline David W. Hudgel, Sanjay R. Patel, Amy M. Ahasic, Susan J. Bartlett, Daniel H. Bessesen, Melisa A. Coaker, P. Michelle Fiander, Ronald R. Grunstein, Indira Gurubhagavatula, Vishesh K. Kapur, Christopher J. Lettieri, Matthew T. Naughton

Management of obstructive sleep apnoea in a primary care vs sleep unit setting: a randomised controlled trial To assess the effectiveness and cost-effectiveness of primary care (PC) and sleep unit (SU) models for the management of subjects with suspected obstructive sleep apnoea (OSA).Multicentre, open-label, two-arm, parallel-group, non-inferiority randomised controlled trial. A total of 302 subjects with suspected OSA and/or resistant hypertension were consecutively enrolled, 149 were treated (...) at 11 PC units and 153 patients at a SU. The primary outcomes were a 6-month change in the Epworth Sleepiness Scale (ESS) score and Health Utilities Index (HUI). The non-inferiority margin for the ESS score was -2.0.A total of 80.2% and 70.6% of the PC and SU patients were diagnosed with OSA, respectively, and 59.3% and 60.4% of those were treated with CPAP in PC and SU units, respectively. The Apnoea-Hypopnoea Index was similar between the groups (PC vs SU (median (IQR); 23.1 (26.8) events/h vs

Effect of 1 month of zopiclone on obstructive sleep apnoea severity and symptoms: a randomised controlled trial Hypnotic use in obstructive sleep apnoea (OSA) is contraindicated due to safety concerns. Recent studies indicate that single-night hypnotic use worsens hypoxaemia in some and reduces OSA severity in others depending on differences in pathophysiology. However, longer clinical trial data are lacking. This study aimed to determine the effects of 1 month of zopiclone on OSA severity (...) , sleepiness and alertness in patients with low-moderate respiratory arousal thresholds without major overnight hypoxaemia.69 participants completed a physiology screening night with an epiglottic catheter to quantify arousal threshold. 30 eligible patients (apnoea-hypopnoea index (AHI) 22±11 events·h-1) then completed standard in-laboratory polysomnography (baseline) and returned for two additional overnight sleep studies (nights 1 and 30) after receiving either nightly zopiclone (7.5 mg) or placebo

Recanalisation therapies for wake-up stroke. About one in five strokes occur during sleep (wake-up stroke). People with wake-up strokes have traditionally been considered ineligible for thrombolytic treatment because the time of stroke onset is unknown. However, some studies suggest that these people may benefit from recanalisation therapies.To assess the effects of intravenous thrombolysis and other recanalisation therapies versus control in people with acute ischaemic stroke presenting (...) and unpublished data.We included one pilot trial with nine participants. The trial was a feasibility trial that included participants with an unknown onset of stroke and signs on perfusion computed tomography of ischaemic tissue at risk of infarction, who were randomised to alteplase (0.9 mg/kg) or placebo. One trial was prematurely terminated due to signs of efficacy of the intervention arm; we did not include this trial because we were not able to obtain data for the portion of the participants with wake-up

is a sleep disorder affecting approximately 13% of the Canadian population. People with insomnia often have difficulty falling asleep or difficulty remaining asleep. They may also wake 2017 11. Treatments for Insomnia : A Review of Patient and Experiences and Perspectives Treatments for Insomnia : A Review of Patient and Experiences and Perspectives | CADTH.ca Find the information you need Treatments for Insomnia : A Review of Patient and Experiences and Perspectives Treatments for Insomnia : A Review (...) of what constitutes normal sleep. It usually takes less than 30 minutes for a person to fall asleep. Average (...) total nocturnal sleep time decreases with age from about 8 hours at 15 years of age to less than 6 hours at 80 years of age. Insomnia can be categorized according to duration or likely duration: Short-term insomnia lasts less than 4 weeks. Long-term (or persistent) insomnia lasts for 4 weeks or longer. Sleep disorders that need to be excluded when making a diagnosis of insomnia are: Sleep

American Thoracic Society Documents 289 Overview The overlap syndrome (OVS) is the co-occurrence of chronic obstructive pulmonarydisease (COPD)and obstructive sleep apnea (OSA). This statement summarizestheexistingliterature,identi?es knowledge gaps, and provides guidance regarding future priorities in research for sleep-disordered breathing (SDB) in patientswithCOPDandotherlungdiseases. Key Conclusions d OVS is common because COPD and OSA are common. There is no de?nitive evidence that patients (...) without comorbid insomnia. Although the detection of apnea is reasonably straightforward, hypopneas, as de?ned by Decreased I/E Airflow ?PaO2 ?PaCO2 Chemoreceptor Stimulation Arousal Expiratory UA Narrowing Diaphragm Dysfunction Dynamic Hyperinflation Alveolar Hypoventilation Inspiratory UA Narrowing Ventilatory Overshoot Increased work of Breathing Decreased Ventilatory Motor Output Worsening Airflow Obstruction Upper Airway Muscle Activity ? Caudal Traction Sleep + Circadian Factors + Supine

syndrome? Introduction Methods Committee Composition Workshop Structure and Literature Review Document Development Perioperative Outcomes of Patients with Sleep- disordered Breathing Screening for Obstructive Sleep Apnea in Surgical Patients Obstructive Sleep Apnea Endotypes and Potential Relevance in the Perioperative Period Role of Algorithms in the Perioperative Management of Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome Perioperative Use of Positive Airway Pressure Obesity (...) Hypoventilation Syndrome in the Perioperative Period OpioidsandtheSurgicalPatient with Obstructive Sleep Apnea The Use of Administrative Databases and Patient Registries Patient Safety and Healthcare Management Considerations Conclusions American Thoracic Society Documents 117 Overview Perioperative management of sleep- disordered breathing, such as obstructive sleep apnea (OSA) and obesity hypoventilationsyndrome(OHS),isanarea of patient care that requires improvement due to the risk of morbidity

suspected of sleep-disordered breathing. (Conditional) Remarks: This recommendation only applies to patients who are appropriate candidates for a home sleep apnea test (HSAT). It has been well established that testing with an HSAT, in comparison to PSG, typically underestimates the severity of sleep-disordered breathing (SDB). A component of this underestimation arises from the event-per-hour indices used for the diagnosis and severity determination of obstructive sleep apnea (OSA). Specifically (...) 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

Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial Delayed Sleep-Wake Phase Disorder (DSWPD) is characterised by sleep initiation insomnia when attempting sleep at conventional times and difficulty waking at the required time for daytime commitments. Although there are published therapeutic guidelines for the administration of melatonin for DSWPD, to our knowledge, randomised controlled trials are lacking (...) . This trial tested the efficacy of 0.5 mg melatonin, combined with behavioural sleep-wake scheduling, for improving sleep initiation in clinically diagnosed DSWPD patients with a delayed endogenous melatonin rhythm relative to patient-desired (or -required) bedtime (DBT).This randomised, placebo-controlled, double-blind clinical trial was conducted in an Australian outpatient DSWPD population. Following 1-wk baseline, clinically diagnosed DSWPD patients with delayed melatonin rhythm relative to DBT

trial including baseline and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group.Seven primary health care centers (Stockholm, Sweden).One hundred and sixty-five primary care patients who meet the criteria for insomnia disorder (mean age 54 years, SD 16). Most were women (73%).severe untreated illness, bipolar disorder, current stressful life event, night shift work, and untreated sleep disorder other than insomnia.Data came from a randomized controlled trial (...) ), improved daytime symptomatology in primary care patients with insomnia.Fatigue (Fatigue Severity Scale [FSS]; main outcome), mood (General Health Questionnaire and Montgomery-Asberg Depression Rating Scale), health-related quality of life (Short-Form Health Survey), general daytime functioning, specific daytime symptoms (individual items from the Insomnia Severity Index and Uppsala Sleep Inventory), and dysfunctional beliefs (Dysfunctional Beliefs and Attitudes about Sleep).A randomized controlled

data from participants in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a population-based study that enrolled 16,415 adults in 4 US communities. Sleep-disordered breathing was assessed using a home sleep apnea monitor for overnight recording and was defined using 3 thresholds of the apnea-hypopnea index (AHI; 3% desaturation): ≥5, ≥15, and ≥30. Albuminuria was defined as a urine albumin-to-creatinine ratio of ≥30 mg/g.There were 12,572 participants with complete data available (...) Sleep-Disordered Breathing and Prevalent Albuminuria in Hispanics/Latinos Although sleep-disordered breathing has been found to be associated with higher urine albumin excretion, this association has not been evaluated in Hispanic/Latino populations, which experience a high burden of end-stage renal disease compared with non-Hispanics. We evaluated the association of sleep-disordered breathing with prevalent albuminuria among US Hispanics/Latinos.This was a cross-sectional study of baseline