Physician Decision Making and Clinical Outcomes With Laboratory Polysomnography or Limited-Channel Sleep Studies for Obstructive Sleep Apnea: A Randomized Trial. The clinical utility of limited-channel sleep studies (which are increasingly conducted at home) versus laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) is unclear.To compare patient outcomes after PSG versus limited-channel studies.Multicenter, randomized, noninferiority study. (Australian New Zealand (...) Questionnaire (FOSQ) score at 4 months. Secondary outcomes included the Epworth Sleepiness Scale (ESS), the Sleep Apnea Symptoms Questionnaire (SASQ), continuous positive airway pressure (CPAP) compliance, and physician decision making.Change in FOSQ score was not inferior for L3 (mean difference [MD], 0.01 [95% CI, -0.47 to 0.49; P = 0.96]) or L4 (MD, -0.46 [CI, -0.94 to 0.02; P = 0.058]) versus L1 (noninferiority margin [NIM], -1.0). Compared with L1, change in ESS score was not inferior for L3 (MD, 0.08

HL NHLBI NIH HHS United States T32 HL007287 HL NHLBI NIH HHS United States Journal Article Comment 2017 01 10 United States Ann Intern Med 0372351 0003-4819 AIM IM Ann Intern Med. 2017 Mar 7;166(5):332-340 28114683 Decision Making Humans Medicine Polysomnography Sleep Apnea Syndromes Sleep Apnea, Obstructive 2017 1 24 6 0 2019 3 13 6 0 2017 1 24 6 0 ppublish 28114686 2599137 10.7326/M16-2902 PMC5459380 NIHMS860395 J Clin Sleep Med. 2007 Dec 15;3(7):737-47 18198809 Chest. 2010 Aug;138(2):257-63 (...) Making the Most of Simplified Sleep Apnea Testing 28114686 2019 03 12 2019 03 12 1539-3704 166 5 2017 03 07 Annals of internal medicine Ann. Intern. Med. Making the Most of Simplified Sleep Apnea Testing. 366-367 10.7326/M16-2902 Donovan Lucas M LM From University of Washington, Seattle, Washington, and University of Pittsburgh, Pittsburgh, Pennsylvania. Patel Sanjay R SR From University of Washington, Seattle, Washington, and University of Pittsburgh, Pittsburgh, Pennsylvania. eng K24 HL127307

: Gastro-oesophageal reflux disease — for more information, see the CKS topics on and . Nocturnal asthma — for more information, see the CKS topic on . Heart failure — for more information, see the CKS topic on . Panic attacks and night terrors. Basis for recommendation The information on differential diagnoses is largely based on the Scottish Intercollegiate Guidelines Network (SIGN) guideline Management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) in adults [ ] and expert opinion (...) Obstructive sleep apnoea syndrome: What else might it be? Differential diagnosis | Diagnosis | Obstructive sleep apnoea syndrome | CKS | NICE Search CKS… Menu Differential diagnosis Obstructive sleep apnoea syndrome: What else might it be? Last revised in April 2015 What else might it be? Other causes of daytime sleepiness include: Sleep disturbance — for example due to pain or anxiety. Sleep deprivation or inadequate sleep opportunity — for example due to employment with shift work

Intercollegiate Guidelines Network (SIGN) guideline Management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) in adults [ ] and expert opinion in review articles [ ; ; ; ]. Seeking information from a bed partner is useful, as a person with obstructive sleep apnoea syndrome (OSAS) may fail to recognize or downplay symptoms. Daytime sleepiness helps differentiate OSAS from primary snoring. An Epworth sleepiness questionnaire, which measures the person's perception of sleepiness, is helpful (...) Obstructive sleep apnoea syndrome: How should I assess a person with suspected obstructive sleep apnoea syndrome? Assessment | Diagnosis | Obstructive sleep apnoea syndrome | CKS | NICE Search CKS… Menu Assessment Obstructive sleep apnoea syndrome: How should I assess a person with suspected obstructive sleep apnoea syndrome? Last revised in April 2015 How should I assess a person with suspected obstructive sleep apnoea syndrome? Consider if there are features of an . Ask about associated

Obstructive sleep apnoea syndrome Obstructive sleep apnoea syndrome | Topics A to Z | CKS | NICE Search CKS… Menu Obstructive sleep apnoea syndrome Obstructive sleep apnoea syndrome Last revised in April 2015 Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is the coexistence of excessive daytime sleepiness with irregular breathing at night. Diagnosis Management Background information Obstructive sleep apnoea syndrome: Summary Obstructive sleep apnoea/hypopnoea syndrome (OSAHS (...) ) is the coexistence of excessive daytime sleepiness with irregular breathing at night. The British Thoracic Society (BTS) uses the term 'obstructive sleep apnoea syndrome' (OSAS) for people with repetitive apnoeas and symptoms of sleep fragmentation with excessive daytime sleepiness. This CKS topic will use the BTS term of obstructive sleep apnoea syndrome (OSAS) when referring to OSAHS. OSAS affects all age groups, with the highest incidence between 30 and 60 years of age. OSAS should be suspected in a person

clinical features of adenotonsillar hypertrophy, symptoms of persistent snoring, and features of OSAS. Sleep studies Polysomnography (PSG) or a limited sleep study is used to measure apnoea/hypopnoea episodes and thereby confirm the diagnosis of obstructive sleep apnoea syndrome (OSAS) in adults and children. PSG records sleep and breathing patterns simultaneously. It is routinely carried out in a sleep centre. A limited sleep study is often used to diagnose OSAS and can be carried out in the person's (...) . Basis for recommendation Urgent (2-week wait) ear, nose and throat (ENT) referral to exclude head and neck cancer This recommendation is based on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline Referral guidelines for suspected cancer [ ] and the Scottish Intercollegiate Guidelines Network (SIGN) guideline Management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) in adults [ ]. Urgent referral of adults to a sleep centre This recommendation is based

. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA . 2000;284(23):3015-21. Jonas DE, Amick HR, Feltner C, et al. Primary care screening for and treatment of obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA . 2017;317(4):415-33. Mold JW, Quattlebaum C, Schinnere E, Boeckman L, Orr W, Hollabaugh K. Identification by primary care clinicians of patients with obstructive sleep apnea: a Practice-Based Research (...) Network (PBRN) study. J Am Board Fam Med . 2011;24(2):138-45. Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med. 2005;142(3):187-97. Myers KA, Mrkobrada M, Simel DL. Does this patient have obstructive sleep apnea? The Rational Clinical Examination systematic review. JAMA . 2013;310(7):731-41. Young T, Shahar E, Nieto FJ, et al; Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern

Cognitive behavioural therapy for chronic insomnia RACGP - Handbook of Non-Drug Interventions (HANDI) Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship

alcohol consumption or pain). In patients reporting excessive daytime sleepiness, consider obstructive sleep apnoea. Do not use sleep restriction strategies with patients who have bipolar disorder as this can precipitate manic episodes. Sleep restriction may be contraindicated in people with unstable or untreated medical or psychiatric conditions, seizure disorders or excessive daytime sleepiness, or those who already demonstrate sleep restriction (<6 hours in bed). Advise those who drive vehicles (...) waking behaviours, the physiological systems that regulate sleep (homeostatic and circadian drives) can be modified. Indication Chronic primary insomnia in adults Primary insomnia is defined as repeated difficulty with sleep initiation, duration, consolidation or quality despite adequate time and opportunity for sleep, lasting for at least a month. Precautions Ensure the diagnosis is most likely to be primary insomnia (there are no other conditions or causes such as anxiety, depression, excessive

. ( Strong ) Recommendation 3 : The TF recommends that if a single home sleep apnea test is negative, inconclusive or technically inadequate, polysomnography be performed for the diagnosis of OSA. ( Strong ) Remarks : The following remarks are based on specifications used by studies that support these recommendation statements: An uncomplicated patient is defined by the absence of: Conditions that place the patient at increased risk of non-obstructive sleep-disordered breathing (e.g., central sleep apnea (...) or suspicion of sleep-related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. ( Strong ) Diagnosis of Obstructive Sleep Apnea in Adults Using a Split-Night versus a Full-Night Polysomnography Protocol Recommendation 5 : The TF suggests that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used in the diagnosis of OSA. ( Weak ) Remarks : Clinically appropriate is defined as the absence

for single agents. Finally, there was insufficient evidence found to determine the balance of benefits versus harms. BACKGROUND Insomnia disorder is defined in the International Classification of Sleep Disorders, Third Edition as a complaint of trouble initiating or maintaining sleep which is associated with daytime consequences and is not attributable to environmental circumstances or inadequate opportunity to sleep. The disorder is identified as chronic when it has persisted for at least three months (...) for treatment of chronic insomnia in the adult populations regardless of comorbidities. In summary, the analysis indicates moderate and significant improvement in major sleep parameters with both BZDs and BzRAs in both objective (PSG) and subjective (sleep diary) assessments, with the exception of PSG results for wake after sleep onset (WASO) and TST, which yielded results just below the range of significance. Far fewer studies were available for antidepressants. These showed significant reduction in sleep

or cerebrovascular disease and moderate to severe obstructive sleep apnoea Article Text Therapeutics/Prevention Randomised controlled trial CPAP did not reduce cardiovascular events in patients with coronary or cerebrovascular disease and moderate to severe obstructive sleep apnoea Yüksel Peker 1 , 2 , Patrick J Strollo Jr 3 , 4 Statistics from Altmetric.com Commentary on : McEvoy RD , Antic NA , Heeley E , et al . CPAP for prevention of cardiovascular events in obstructive sleep apnea . Context Cardiovascular (...) Randomised controlled trial: CPAP did not reduce cardiovascular events in patients with coronary or cerebrovascular disease and moderate to severe obstructive sleep apnoea CPAP did not reduce cardiovascular events in patients with coronary or cerebrovascular disease and moderate to severe obstructive sleep apnoea | BMJ Evidence-Based Medicine 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

Otolaryngol Head Neck Surg . 2015;141(11):990–996. [ ] 25 Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med . 2013;368(25):2366–2376. [ ][ ] 26 Kasapkara CS, Tumer L, Aslan AT, et al. Home sleep study characteristics in patients with mucopolysaccharidosis. Sleep Breath . 2014;18(1):143–149. [ ] 27 Jheeta S, McGowan M, Hadjikoumi I. Is oximetry an effective screening tool for obstructive sleep apnoea in children with Down syndrome? Arch (...) , Rosen C, Larkin E, Tishler P, Aylor J, Redline S. Predictors of sleep-disordered breathing in children with a history of tonsillectomy and/or adenoidectomy. Sleep . 2001;24(7):823–829. [ ] 8 Gozal D, Capdevila OS, Kheirandish-Gozal L. Metabolic alterations and systemic inflammation in obstructive sleep apnea among nonobese and obese prepubertal children. Am J Respir Crit Care Med . 2008;177(10):1142–1149. [ ][ ] 9 Gozal D, Kheirandish-Gozal L. Cardiovascular morbidity in obstructive sleep apnea

Mayo Clinic, Rochester, MN; 7 American Academy of Sleep Medicine, Darien, IL ABSTRACT Introduction: This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults. Methods: The AASM commissioned a task force of experts in sleep medicine. A systematic review (...) -determined obstructive respiratory disturbance index (RDI) ≥ 5 events/h associated with the typical symptoms of OSA (e.g., unrefreshing sleep, daytime sleepiness, fatigue or insomnia, awakening with a gasping or choking sensation, loud snoring, or witnessed apneas), or an obstructive RDI ≥ 15 events/h (even in the absence of symptoms). In addition to apneas and hypopneas that are included in the AHI, the RDI includes respiratory effort-related arousals (RERAs). The scoring of respiratory events

a general introduc- tion to circadian biology, addresses “exogenous” circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the “endogenous” circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), de- layed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non–24-hour sleep-wake syndrome (nonentrained type) or free- running disorder (FRD). These practice parameters were developed (...) for sleep related complaints. For example, shift workers with hypersomnia may have both suspected obstructive sleep apnea and clinical characteristics consistent with shift work dis- order. In this event, PSG is indicated to evaluate and establish appropriate therapy for OSA. 3.2 Recommendations for Evaluation and Treatments of Circadian Rhythm Sleep Disorders 3.2.1 Shift Work Disorder Shift work refers to non-standard work schedules, including permanent or intermittent night work, early morning work

. 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

of deployment of CBT-I to provide effective first-line treatment of insomnia into general medical and healthcare practice. Similar studies should be conducted to replicate and extend this finding and explore its likely generalisability beyond the older veteran population. Such research should explore which patients with insomnia respond best to non-clinical sleep coaches and which might require referral to practitioners with greater clinical expertise. Context Insomnia is the most common sleep disorder (...) is effective, safe and highly deployable Michael V Vitiello Statistics from Altmetric.com Commentary on: Alessi C , Martin JL , Fiorentino L , et al . Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: randomized controlled trial . Implications for practice and research The ability of non-clinician sleep coaches to deliver efficacious cognitive–behavioural therapy for insomnia (CBT-I) was demonstrated, suggesting such coaches can increase the rate and range

of the following three criteria: habitual loud snoring, witnessed apnea or gasping or choking, or diagnosed hypertension. The developer defines an uncomplicated patient as the absence of the following: conditions that place the patient at increased risk of non-obstructive sleep-disordered breathing; concern for significant non-respiratory sleep disorder(s) that require evaluation; and environmental or personal factors that preclude the adequate acquisition and interpretation of data from HSAT. Diagnostic (...) apnea test is negative, inconclusive or technically inadequate, polysomnography be performed for the diagnosis of OSA. ( Strong ) Remarks : The following remarks are based on specifications used by studies that support these recommendation statements: An uncomplicated patient is defined by the absence of: Conditions that place the patient at increased risk of non-obstructive sleep-disordered breathing (e.g., central sleep apnea, hypoventilation and sleep related hypoxemia). Examples

Hypoglossal nerve stimulation for obstructive sleep apnea: A review of the literature To review the indications and clinical evidence supporting hypoglossal nerve stimulation (HNS) therapy for the treatment of moderate-to-severe obstructive sleep apnea (OSA).Peer reviewed literature on hypoglossal nerve stimulation therapy for obstructive sleep apnea from 2001 to 2016.The only currently FDA-approved HNS device for the treatment of moderate-to-severe OSA is produced by Inspire Medical Systems (...) , which recently published its 36-month outcomes data from its Stimulation Therapy for Apnea Reduction (STAR) trial. HNS therapy is currently indicated for moderate-to-severe OSA patients who are CPAP-intolerant, have a body mass index <32, apnea-hypopnea index <50, and without a concentric pattern of upper airway collapse on sleep endoscopy.Data from the STAR trial suggests that a subset of OSA patients can achieve a significant therapeutic response from hypoglossal nerve stimulation. However

Sleep apnoea and stroke Sleep disorders have been known to physicians for a long time. In his famous aphorisms, Hippocrates said "Sleep or watchfulness exceeding that which is customary, augurs unfavorably". Modern medicine has been able to disentangle some of the phenomena that disturb sleep. Among the most notable offenders is sleep apnoea that has gained prominence in the past few decades. It is being proposed as one of the potentially modifiable risk factors for vascular diseases including (...) stroke. The pathological mechanisms linking sleep apnoea to vascular risk factors include hypoxia, cardiac arrhythmias, dysautonomia, impaired glucose tolerance, hypertension, dyslipidaemia and inflammation. In this article, we review literature linking sleep apnoea and stroke, including sleep apnoea as a risk factor for primary prevention with the potential to improve outcome after acute stroke and as a secondary risk factor, amenable to modification and hence vascular risk reduction.