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and clinical features of insomnia are based on the clinical guidelines Management of Chronic InsomniaDisorder in Adults: A Clinical Practice Guideline [ ], European guideline for the diagnosis and treatment of insomnia [ ] and Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline [ ], the American Thoracic Society Statement The importance of healthy sleep. Recommendations and future priorities (...) Insomnia: What are the diagnostic criteria for insomnia? Clinical features | Diagnosis | Insomnia | CKS | NICE Search CKS… Menu Clinical features Insomnia: What are the diagnostic criteria for insomnia? Last revised in January 2020 What are the diagnostic criteria for insomnia? Suspect insomnia if (despite adequate time and opportunity to sleep) the person has: Difficulty in getting to sleep, difficulty maintaining sleep, early wakening, or non-restorative sleep which results in impaired
and cognition are thought to be involved in development of chronic insomnia. Other sleepdisorders (such as obstructivesleepapnoea and parasomnias) should be considered in the assessment of a person with suspected insomnia. A sleep diary can be helpful identifying sleeping patterns and lifestyle factors that may exacerbate or maintain insomnia. The diary should be kept for at least two weeks. Good sleep hygiene should be established in all people with insomnia. This aims to make people more aware (...) daytime functioning. Daytime symptoms typically include poor concentration, mood disturbance, and fatigue. Sleep disturbance in the absence of daytime impairment is not considered to be insomniadisorder. There is no standard definition of what constitutes normal sleep — the amount of sleep needed to ensure good health varies from person to person and with ageing. It usually takes less than 30 minutes for a person to fall asleep. Insomnia can be categorized according to duration or likely duration
(less than 3 months duration)? Consider the need for to a sleep clinic or neurology if symptoms of are present. Address any circumstances/stressors associated with onset of insomnia . Ensure comorbidities (for example anxiety or depression) are optimally managed. Offer advice on . Advise the person not to drive if they feel sleepy. The DVLA must be informed if excessive sleepiness is having, or is likely to have, an adverse effect on driving such as: Obstructivesleepapnoeasyndrome (any severity (...) ). Primary/central hypersomnias (such as narcolepsy). Any other conditions or medication that may cause excessive sleepiness. For more detailed guidance, see the DVLA ' ' guide. If sleep hygiene measures fail, daytime impairment is severe causing significant distress, and insomnia is likely to resolve soon (for example due to a short term stressor): Consider a short course (3-7 days) of a non-benzodiazepine hypnotic medication (z-drug). Do not prescribe hypnotics routinely — use only for short courses
. For more information see the CKS topics on and . Past medical history including: Previous sleep problems and treatment. Comorbidities such as chronic pain, medical disorders (such as chronic obstructive pulmonary disease, heart failure or gastro-oesophageal reflux disease) and psychological disorders (such as stress, anxiety, or depression). Impact of insomnia on quality of life, ability to drive, employment, relationships, and mood. Medications and substance use including caffeine, alcohol, nicotine (...) for Psychopharmacology consensus statement Evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update [ ], and expert opinion in review articles [ ; ; ; ]. Insomnia symptoms To fulfil the diagnostic criteria for insomnia, sleep difficulties must have a significant impact on daytime functioning [ ; ; ]. Consider other sleepdisordersSleep disturbance and daytime fatigue can be caused by several sleepdisorders including sleepapnoea and parasomnias — referral to secondary care
disorder (such as a parasomnia, narcolepsy, or obstructivesleepapnoea) is suspected — for more information, see the CKS topics on and . There is doubt regarding the diagnosis. Seek specialist advice/consider referral to secondary care if : Treatment in primary care has failed. Insomnia occurs in a person from an occupational at-risk group, for example professional drivers. Do not routinely refer adults with insomnia, jerks on falling asleep or isolated brief episodes of sleep paralysis . Basis (...) sleepapnoeasyndrome (any severity). Primary/central hypersomnias (such as narcolepsy). Any other conditions or medication that may cause excessive sleepiness. For more detailed guidance, see the DVLA ' ' guide. Offer cognitive behavioural therapy for insomnia (CBT-I) as the first-line treatment for chronic insomnia in adults of any age. CBT-I typically includes behavioural interventions (such as stimulus control and sleep restriction), cognitive therapy and relaxation training. It can be provided
bent backwards), and bedwetting. Daytime symptoms such as changes in behaviour (for example irritability), poor concentration, decreased performance at school, tiredness and sleepiness, failure to gain weight or grow, and mouth breathing. Basis for recommendation The recommendations on when to suspect obstructivesleepapnoea (OSAS) in adults are largely based on the Scottish Intercollegiate Guidelines Network guideline Management of obstructivesleepapnoea/hypopnoeasyndrome (OSAHS) in adults (...) Obstructivesleepapnoeasyndrome: When should I suspect obstructivesleepapnoeasyndrome? When to suspect OSAS | Diagnosis | Obstructivesleepapnoeasyndrome | CKS | NICE Search CKS… Menu When to suspect OSAS Obstructivesleepapnoeasyndrome: When should I suspect obstructivesleepapnoeasyndrome? Last revised in April 2015 When should I suspect obstructivesleepapnoeasyndrome? Suspect obstructivesleepapnoeasyndrome (OSAS) in a person with any of the following symptoms: Excessive
. Preview - Sie müssen einen PDF-Viewer auf Ihrem PC installiert haben wie z. B. , oder 500kB Abstract Obstructivesleepapnea is a sleep-related breathingdisorder that is caused by a collapse of the upper airway. Current standard therapy is the continuous positive airway pressure therapy (CPAP), which is limited in its effectiveness due to poor compliance. A new functional therapy approach is the stimulation of the hypoglossal nerve (HNS) by an implantable device to restore the tone of the upper (...) airway dilator muscles. The update search for this first update did not identify any additional RCTs for assessing effectiveness. For safety assessment, we included five single-arm prospective studies and one registry study. The inclusion in the Austrian catalogue of benefits is currently not recommended based on the available evidence. A new evaluation is proposed for the year 2021. Item Type: Decision Support Document Keywords: Obstructivesleepapnea, hypoglossal nerve, electric stimulation
Long-term efficacy of an education programme in improving adherence with continuous positive airway pressure treatment for obstructivesleepapnoea. 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 obstructivesleepapnoea. 24-27 Lai A A Department of Medicine, Queen Mary Hospital (...) of Life SleepApnea, 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 obstructivesleepapnoea: a multicentre randomised controlled trial We sought to establish whether continuous positive airway pressure (CPAP) for obstructivesleepapnoea (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
Elevated obstructivesleepapnoea risk score is associated with poor healing of diabetic foot ulcers: a prospective cohort study To assess the prevalence of risk factors for obstructivesleepapnoea 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 obstructivesleepapnoea using the STOP-BANG questionnaire, with a score ≥4 identifying high risk of obstructivesleepapnoea. 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
Does Armodafinil Improve Driving Task Performance and Weight Loss in SleepApnea? A Randomized Trial Patients with obstructivesleepapnea (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
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=obstructivesleepapnea; 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 ObstructiveSleepApnea Guideline AMERICANTHORACICSOCIETY DOCUMENTS TheRoleofWeightManagementintheTreatmentofAdultObstructive SleepApnea 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
Effect of 1 month of zopiclone on obstructivesleepapnoea severity and symptoms: a randomised controlled trial Hypnotic use in obstructivesleepapnoea (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
Management of obstructivesleepapnoea 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 obstructivesleepapnoea (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
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
suspected of sleep-disorderedbreathing. (Conditional) Remarks: This recommendation only applies to patients who are appropriate candidates for a home sleepapnea test (HSAT). It has been well established that testing with an HSAT, in comparison to PSG, typically underestimates the severity of sleep-disorderedbreathing (SDB). A component of this underestimation arises from the event-per-hour indices used for the diagnosis and severity determination of obstructivesleepapnea (OSA). Specifically (...) disorder. (Conditional) We suggest that clinicians use actigraphy in the assessment of adult patients with circadian rhythm sleep-wakedisorder. (Conditional) We suggest that clinicians use actigraphy in the assessment of pediatric patients with circadian rhythm sleep-wakedisorder. (Conditional) We suggest that clinicians use actigraphy integrated with home sleepapnea test devices to estimate total sleep time during recording (in the absence of alternative objective measurements of total sleep time