use. These include nonbenzodiazepine hypnotics (zaleplon, zolpidem, eszopiclone), an orexin receptor antagonist (suvorexant), a melatonin agonist (ramelteon), some benzodiazepines (e.g., triazolam, temazepam), and an antidepressant (doxepin). The systematic review assessed the efficacy , comparative effectiveness, and adverse effects of a broad range of management strategies for insomnia disorder in adults. 1. American Psychiatric Association. Sleep-wake disorders. In: Diagnostic and Statistical (...) through January 2015. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/insomnia/. This summary is provided to assist in informed clinical decisionmaking. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. Background Insomnia involves dissatisfaction with sleep quantity or quality and is associated with difficulty initiating sleep, maintaining sleep, returning to sleep after early morning waking

). Parkinson's disease patients who had undergone a baseline and at least one follow-up CBTi session were identified. Electronic medical records and pre-treatment and post-treatment patient sleep diaries were reviewed. Sleep measures of interest included wake time after sleep onset, sleep efficiency, sleep onset latency, and total sleep time. Pre-treatment and post-treatment values were compared within subjects using paired t-test. Five patients were included. Patients attended an average of eight sessions (...) of CBTi (range 5-12). Significant increases in sleep efficiency (p = 0.02) and decreases in number of awakenings per night (p = 0.02) were found. Our data provide preliminary evidence that cognitive behavioral therapy is an effective treatment for insomnia in Parkinson's disease, and is well tolerated and well received by patients. Given the limited data supporting use of medications to treat chronic insomnia in Parkinson's disease, combined with their risks, randomized trials to demonstrate

Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis. Sleep apnea (obstructive and central) is associated with adverse cardiovascular risk factors and increased risks of cardiovascular disease. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV), but the associations with cardiovascular outcomes and death are unclear.To (...) outcomes were a composite of acute coronary syndrome (ACS) events, stroke, or vascular death (major adverse cardiovascular events); cause-specific vascular events; and death.The analyses included data from 10 trials (9 CPAP; 1 ASV) of patients with sleep apnea (N = 7266; mean age, 60.9 [range, 51.5 to 71.1] years; 5847 [80.5%] men; mean [SD] body mass index, 30.0 [5.2]. Among 356 major adverse cardiovascular events and 613 deaths recorded, there was no significant association of PAP with major adverse

trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response-that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index-at 15 months. Secondary (...) outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression. Results Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests

study were identified regarding the use of medical cannabis or cannabinoids in the treatment of insomnia disorder in adults. Tags cannabidiol, cannabinoids, cannabis, insomnia, marihuana, marijuana, mental health, sleep disorders, sleep initiation and maintenance disorders, sleeplessness, Cannabinoid, insomniac, insomniacs, sleep dysfunction Files Rapid Response Summary of Abstracts Published : June 26, 2017 Related Content Follow us: © 2019 Canadian Agency for Drugs and Technologies in Health Get (...) Medical Cannabis or Cannabinoids for the Treatment of Insomnia Disorder in Adults: Clinical Effectiveness and Guidelines Medical Cannabis or Cannabinoids for the Treatment of Insomnia Disorder in Adults: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Medical Cannabis or Cannabinoids for the Treatment of Insomnia Disorder in Adults: Clinical Effectiveness and Guidelines Medical Cannabis or Cannabinoids for the Treatment of Insomnia Disorder in Adults: Clinical

sleep hygiene, sleep consolidation, stimulus control, and relaxation therapies. Cognitive techniques include cognitive behavioural therapy for insomnia (CBT-I). 1,7 Psychotherapies may be used in combination with pharmacotherapy for enhanced effectiveness. 8 Objective The objective of this study was to explore current trends across Canada in the use of interventions for the treatment of insomnia disorder. We surveyed primary care providers for their opinions and prescribing preferences when treating (...) for patients with insomnia disorder (Table 8). All FPs surveyed (100%) indicated that they would prescribe behavioural therapies for their patients. Of these behavioural therapies, sleep hygiene (98%) and relaxation training (73%) were the most popular choices. Mindfulness (43%), CBT-I (29%), and sleep restriction were also cited. Drug therapies were the second most popular intervention overall for patients with insomnia among 99% of FPs surveyed. FPs indicated that they had experience prescribing

sleep hygiene, sleep consolidation, stimulus control, and relaxation therapies. Cognitive techniques include cognitive behavioural therapy for insomnia (CBT-I). 1,7 Psychotherapies may be used in combination with pharmacotherapy for enhanced effectiveness. 8 Objective The objective of this study was to explore current trends across Canada in the use of interventions for the treatment of insomnia disorder. We surveyed primary care providers for their opinions and prescribing preferences when treating (...) for patients with insomnia disorder (Table 8). All FPs surveyed (100%) indicated that they would prescribe behavioural therapies for their patients. Of these behavioural therapies, sleep hygiene (98%) and relaxation training (73%) were the most popular choices. Mindfulness (43%), CBT-I (29%), and sleep restriction were also cited. Drug therapies were the second most popular intervention overall for patients with insomnia among 99% of FPs surveyed. FPs indicated that they had experience prescribing

Transoral robotic surgery vs. endoscopic partial midline glossectomy for obstructive sleep apnea To compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy.This was a retrospective study. A total of 114 robotic and 37 endoscopic midline glossectomy surgeries were performed between July 2010 and April 2015 as part of single or multilevel surgery. Patients were excluded (...) for indications other than sleep apnea or if complete sleep studies were not obtained. Thus, 45 robotic and 16 endoscopic surgeries were included in the analysis.In the robotic surgery group there were statistically significant improvements in AHI [(44.4 ± 22.6) events/h-(14.0 ± 3.0) events/h, P < 0.001] Epworth Sleepiness Scale (12.3 ± 4.6 to 4.5 ± 2.9, P < 0.001), and O2 nadir (82.0% ± 6.1% to 85.0% ± 5.4%, P < 0.001). In the endoscopic group there were also improvements in AHI (48.7 ± 30.2 to 27.4 ± 31.9

Anatomic measures of upper airway structures in obstructive sleep apnea Determine if anatomic dimensions of airway structures are associated with airway obstruction in obstructive sleep apnea (OSA) patients.Twenty-eight subjects with (n = 14) and without (n = 14) OSA as determined by clinical symptoms and sleep studies; volunteer sample. Skeletal and soft tissue dimensions were measured from radiocephalometry and magnetic resonance imaging. The soft palate thickness, mandibular plane-hyoid (MP

Hyoid myotomy and suspension without simultaneous palate or tongue base surgery for obstructive sleep apnea Determine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA).Patients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic. Those who underwent concurrent palatal or tongue base sleep surgery were excluded. Outcomes included simultaneous (...) procedures, apnea-hypopnea index (AHI), lowest oxyhemoglobin saturation (LSAT), and Epworth Sleepiness Scale (ESS).Nineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery. The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71%). Concurrent procedures included the following: torus mandibularis excision (n = 1), endoscopic sinus surgery (n = 4), septoplasty (n = 10), inferior turbinate reduction (n = 12), and nasal valve repair (n = 2

Publication trends in obstructive sleep apnea: Evidence of need for more evidence Published research in obstructive sleep apnea (OSA) appears limited despite OSA being a highly prevalent adult and pediatric disease leading to many adverse outcomes if left untreated. We aimed to quantify the deficit in OSA scientific literature in order to provide a novel way of identifying gaps in knowledge and a need for further research inquiry.This was a Bibliometric analysis study. Using Ovid Medline

Impact of Mandibular Advancement Therapy on Endothelial Function in Severe Obstructive Sleep Apnea Endothelial dysfunction, a major predictor of late cardiovascular events, is linked to the severity of obstructive sleep apnea (OSA).To determine whether treatment with mandibular advancement device, the main alternative to continuous positive airway pressure, improves endothelial function in patients with severe OSA.In this trial, we randomized patients with severe OSA and no overt cardiovascular (...) disease to receive 2 months of treatment with either effective mandibular advancement device or a sham device. The primary outcome, change in reactive hyperemia index, a validated measurement of endothelial function, was assessed on an intention-to-treat basis. An embedded microsensor objectively measured treatment compliance.A total of 150 patients (86% males; mean [SD] age, 54 [10] yr; median [interquartile range] apnea-hypopnea index, 41 [35-53]; mean [SD] Epworth sleepiness scale, 9.3 [4.2]) were

Tonsillectomy for obstructive sleep-disordered breathing or recurrent throat infection in children Tonsillectomy for obstructive sleep-disordered breathing or recurrent throat infection in children Tonsillectomy for obstructive sleep-disordered breathing or recurrent throat infection in children Francis DO, Chinnadurai S, Sathe NA, Morad A, Jordan AK, Krishnaswami S, Fonnesbeck C, McPheeters ML Record Status This is a bibliographic record of a published health technology assessment (...) . No evaluation of the quality of this assessment has been made for the HTA database. Citation Francis DO, Chinnadurai S, Sathe NA, Morad A, Jordan AK, Krishnaswami S, Fonnesbeck C, McPheeters ML. Tonsillectomy for obstructive sleep-disordered breathing or recurrent throat infection in children. Rockville: Agency for Healthcare Research and Quality (AHRQ). Comparative Effectiveness Review No. 183. 2017 Authors' objectives To systematically review evidence addressing tonsillectomy in children with obstructive

filtration rate <60 ml/min/1.73m2 or urine albumin-to-creatinine ratio ≥30 mg/g. Sleep duration, sleep symptoms (difficulty falling asleep, difficulty staying asleep, daytime sleepiness and non-restorative sleep), and sleep disorders (restless legs syndrome and sleep apnea) were self-reported. Vital status was determined using NHANES mortality linkage through December 2011.Mean age was 61 years, 58% were women, and 75% non-Hispanic white. During 4.4 years of median follow-up, we observed 234 deaths (...) Association of Sleep Duration, Symptoms, and Disorders With Mortality in Adults With Chronic Kidney Disease In general populations, short and long sleep duration, poor sleep quality and sleep disorders have been associated with increased risk of death. We evaluated these associations in individuals with chronic kidney disease (CKD).Prospective cohort study of 1,452 National Health and Nutrition Examination Survey (NHANES) 2005-2008 participants with CKD. CKD was defined by estimated glomerular

) for 12-week treatment. Upon completion of treatment, snoring, mouth breathing, and sleep discomfort were re-measured. Before treatment, all children had snoring most times or always. Posttreatment, 80% of children treated with Montelukast only snored sometimes or never. Sleep discomfort and mouth breathing studies showed statistically significant improvement (P #2) Venekamp/2016 Three studies on children with obstructive sleep disorders Meta-Analysis Key results The authors examined three different (...) Adenotonsillectomy Remains the Treatment of Choice for Children with Obstructive Sleep Apnea but Multiple Non-surgical Options Exist for Select Cases UTCAT3217, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Adenotonsillectomy Remains the Treatment of Choice for Children with Obstructive Sleep Apnea but Multiple Non-surgical Options Exist for Select Cases Clinical Question Are nonsurgical treatments

Insomnia and somnolence in idiopathic RBD: a prospective cohort study Although some sleep disorders are markers of prodromal Parkinson's disease and dementia with Lewy bodies, it is unclear whether insomnia and somnolence can predict disease. We assessed a large cohort of patients with idiopathic rapid eye movement sleep behavior disorder and age/sex matched controls, comparing the Epworth sleepiness scale, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, and polysomnographic (...) remaining disease-free (6.7+/-4.4 vs. 7.1+/-4.7, p = 0.70). Pittsburgh Index scores were higher in patients than controls (7.2+/-3.8 vs. 4.9+/-3.4, p = 0.004), mainly driven by the sleep disturbance/medication components (reflecting rapid eye movement sleep behavior disorder symptoms/treatment). Baseline Pittsburgh scores did not predict conversion to neurodegeneration, although sleep duration increased over time in those converting to neurodegenerative disease (+0.88+/-1.32 h, p = 0.014). Insomnia

Appropriate Use of Interventions for Adults With Insomnia Disorder Interventions for Insomnia Disorder | CADTH.ca Find the information you need Interventions for Insomnia Disorder Interventions for Insomnia Disorder Published on: December 10, 2018 Project Number: HT0003-OP0527 Product Line: Result type: Report Insomnia 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 up frequently, experience early awakening, have a limited amount of sleep, or have a poor quality of sleep. Insomnia may be acute, meaning it generally starts suddenly and lasts for less than three months, or it may be chronic, meaning it lasts for a longer duration. Insomnia may affect a person’s ability to work or study, and can negatively affect their relationships with others. People with insomnia may experience a reduced quality of life because of the consequences of poor sleep

[Tasimelteon (non-24-hour sleep-wake disorder in totally blind adults) - assessment according to õ 35a (para. 1, sentence 10) Social Code Book V] Tasimelteon (Non-24 bei völlig blinden erwachsenen): bewertung gemäß § 35a abs. 1 satz 10 SGB V; dossierbewertung; auftrag G16-08 [Tasimelteon (non-24-hour sleep-wake disorder in totally blind adults) - assessment according to § 35a (para. 1, sentence 10) Social Code Book V] Tasimelteon (Non-24 bei völlig blinden erwachsenen): bewertung gemäß § 35a (...) abs. 1 satz 10 SGB V; dossierbewertung; auftrag G16-08 [Tasimelteon (non-24-hour sleep-wake disorder in totally blind adults) - assessment according to § 35a (para. 1, sentence 10) Social Code Book V] Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Institut für Qualität

Ultrasonographic Detection of Airway Obstruction in a Model of Obstructive Sleep Apnea Purpose Obstructive sleep apnea (OSA) is a common clinical disorder characterized by repetitive airway obstruction during sleep. The gold standard for diagnosis of OSA, polysomnogram (PSG), cannot anatomically localize obstruction. Precise identification of obstruction has potential to improve outcomes following surgery. Current diagnostic modalities that provide this information require anesthesia, involve (...) ionizing radiation or disrupt sleep. To mitigate these problems, we conceived that ultrasound (US) technology may be adapted (i) to detect, quantify and localize airway obstruction and (ii) for translational application to home-based testing for OSA. Materials and Methods Segmental airway collapse was induced in 4 fresh cadavers by application of negative pressure. Following visualization of airway obstruction, a rotary US probe was used to acquire transcervical images of the airway before and after

Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement. Based on data from the 1990s, estimated prevalence of obstructive sleep apnea (OSA) in the United States is 10% for mild OSA and 3.8% to 6.5% for moderate to severe OSA; current prevalence may be higher, given the increasing prevalence of obesity. Severe OSA is associated with increased all-cause mortality, cardiovascular disease and cerebrovascular events, diabetes, cognitive impairment