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Sleep Medicine Clinics

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https://www.readbyqxmd.com/read/27542884/diagnosis-cause-and-treatment-approaches-for-delayed-sleep-wake-phase-disorder
#1
REVIEW
Michelle Magee, Emily M Marbas, Kenneth P Wright, Shantha M W Rajaratnam, Josiane L Broussard
Delayed sleep-wake phase disorder (DSWPD) is commonly defined as an inability to fall asleep and wake at societal times resulting in excessive daytime sleepiness. Although the cause is multifaceted, delays in sleep time are largely driven by misalignment between the circadian pacemaker and the desired sleep-wake timing schedule. Current treatment approaches focus on correcting the circadian delay; however, there is a lack of data investigating combined therapies for treatment of DSWPD.
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542883/diagnosis-and-treatment-of-insomnia-comorbid-with-obstructive-sleep-apnea
#2
REVIEW
Leon Lack, Alexander Sweetman
Insomnia is often comorbid with obstructive sleep apnea. It reduces positive airway pressure (PAP) therapy acceptance and adherence. Comorbid patients show greater daytime impairments and poorer health outcomes. The insomnia often goes undiagnosed, undertreated, or untreated. Pharmacotherapy is not recommended for long-term treatment. Although care should be taken administering behavioral therapies to patients with elevated sleepiness, cognitive behavior therapy for insomnia (CBTi) is an effective and durable nondrug therapy that reduces symptoms and may increase the effectiveness of PAP therapy...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542882/disorders-of-excessive-daytime-sleepiness-including-narcolepsy-and-idiopathic-hypersomnia
#3
REVIEW
Joseph Andrew Berkowski, Anita Valanju Shelgikar
Central disorders of hypersomnolence are rare conditions with a poorly understood pathophysiology, making the identification and management challenging for sleep clinicians. Clinical history is essential for ruling out secondary causes of hypersomnolence and distinguishing among diagnoses. Current diagnostic criteria rely heavily on the polysomnogram and multiple sleep latency test. The current focus of treatment of hypersomnolence is on drugs that promote alertness. Additionally, in the case of narcolepsy type 1, medication management addresses control of cataplexy, the hallmark symptom of this disorder...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542881/residual-daytime-sleepiness-in-obstructive-sleep-apnea-after-continuous-positive-airway-pressure-optimization-causes-and-management
#4
REVIEW
Julia L Chapman, Yasmina Serinel, Nathaniel S Marshall, Ronald R Grunstein
Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), but it is also common in the general population. When sleepiness remains after continuous positive airway pressure (CPAP) treatment of OSA, comorbid conditions or permanent brain injury before CPAP therapy may be the cause of the residual sleepiness. There is currently no broad approach to treating residual EDS in patients with OSA. Individual assessment must be made of comorbid conditions and medications, and of lifestyle factors that may be contributing to the sleepiness...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542880/mandibular-advancement-splints
#5
REVIEW
Ahmad A Bamagoos, Kate Sutherland, Peter A Cistulli
Although mandibular advancement splints (MAS) are not as efficacious as continuous positive airway pressure (CPAP) in reducing obstructive respiratory events, patient adherence and preference are greater than CPAP. Additionally, the effectiveness of both treatments on general health outcomes, cognitive function, and quality of life appears to be equivalent. The main barrier for the implementation of MAS treatment in clinical practice is the interindividual variability in response to MAS treatment. Several prediction tools have been proposed to enhance patient selection for MAS treatment...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542879/surgical-approaches-to-obstructive-sleep-apnea
#6
REVIEW
Stuart G MacKay, Lyndon Chan
Surgery in adult obstructive sleep apnea (OSA) has undergone significant advancement in recent years and continues to evolve. It is a modality of treatment used in the context of failed device use, specifically, failed continuous positive airway pressure or mandibular advancement splint. In this context, the role of surgery is either as salvage therapy or to facilitate better tolerance of device use. Other treatments such as weight loss, adjuvant nasal therapy (medical ± prephase nasal surgery) and positional devices may be combined with airway surgery...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542878/continuous-positive-airway-pressure-therapy-for-obstructive-sleep-apnea-maximizing-adherence-including-using-novel-information-technology-based-systems
#7
REVIEW
Bretton Hevener, William Hevener
Sleep apnea is a form of sleep-disordered breathing that is associated with an increase in disease comorbidities, mortality risks, health care costs, and traffic accidents. Sleep apnea is most commonly treated with positive airway pressure (PAP). PAP can be difficult for patients to tolerate. This leads to initial and long-term noncompliance. Most insurance companies require compliance with PAP treatment to cover ongoing reimbursements for the device and related disposable supplies. Therefore, there are both clinical and financial incentives to a sleep apneic patient's compliance with PAP therapy...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542877/managing-comorbid-illness-in-obstructive-sleep-apnea-what-can-we-learn-from-other-diseases
#8
REVIEW
Walter D Conwell, Sheila C Tsai
Obstructive sleep apnea (OSA) is associated with numerous comorbid medical conditions. Symptoms of OSA may mimic those of comorbid conditions. The presence of OSA may worsen outcomes from the primary condition. Conversely, OSA treatment may benefit both sleep symptomatology and comorbid illness. Because of potential significant benefit, it is important to screen for sleep apnea symptoms, to have a low threshold to perform diagnostic testing, to treat OSA if present, and to closely monitor symptoms. OSA management does not necessarily replace, but rather, should be performed in conjunction with primary therapy for comorbid conditions...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542876/personalized-medicine-for-obstructive-sleep-apnea-therapies-are-we-there-yet
#9
REVIEW
Bradley A Edwards, Shane Landry, Simon A Joosten, Garun S Hamilton
Currently there is no method to predict which treatments for obstructive sleep apnea will have the best outcomes in individual patients. Given that there is increasing interest in a personalized medicine approach to the treatment of a variety of disorders, this review describes the personalized approaches that are currently available for the treatment of obstructive sleep apnea as well as future directions for individualized obstructive sleep apnea treatment.
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542875/impact-of-obstructive-sleep-apnea-on-neurocognitive-function-and-impact-of-continuous-positive-air-pressure
#10
REVIEW
Charles R Davies, John J Harrington
There is evidence that obstructive sleep apnea (OSA) can negatively impact attention, memory, learning, executive function, and overall intellectual function in adults and children. Imaging techniques, including MRI, MR diffusion tensor imaging, MR spectroscopy, and fMRI, have provided additional insight into the anatomic and functional underpinnings of OSA-related cognitive impairment. Both animal and human studies have looked to elucidate the separate effects of oxygen desaturation and sleep fragmentation on independent aspects of cognition...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542874/consequences-of-obstructive-sleep-apnea-cardiovascular-risk-of-obstructive-sleep-apnea-and-whether-continuous-positive-airway-pressure-reduces-that-risk
#11
REVIEW
Rami Khayat, Adam Pleister
Obstructive sleep apnea (OSA) is present in up to 25% of otherwise healthy individuals. OSA is associated with intermittent hypoxia, oxidative stress, sympathetic activation, and an inflammatory response. These perturbations mediate the role of OSA as an independent and modifiable risk factor for cardiovascular disease (CVD). OSA can induce CVD or accelerate the progression of CVD into an end-stage disorder, including heart failure and stroke. Current clinical recommendations are based on existing clinical trial data and the clinical experience of our program; current and future clinical trials will help to optimize management of OSA in the setting of CVD...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27542873/ambulatory-diagnosis-and-management-of-obstructive-sleep-apnea-screening-questionnaires-diagnostic-tests-and-the-care-team
#12
REVIEW
R Doug McEvoy, Ching Li Chai-Coetzer, Nick A Antic
Obstructive sleep apnea has increased in prevalence in recent years and despite the expansion in sleep medicine services there is a significant unmet burden of disease. This burden presents a challenge to specialists and requires a reappraisal of service delivery, including a move toward lower-cost, simplified methods of diagnosis and treatment, an expansion of the sleep apnea workforce to include suitably trained and equipped primary care physicians and nurses, and the incorporation of chronic disease management principles that link patients to relevant community resources and empower them through new technologies to engage more fully in their own care...
September 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236062/novel-approaches-to-the-management-of-sleep-disordered-breathing-reviewing-the-past-and-looking-into-the-future
#13
EDITORIAL
Neil Freedman
No abstract text is available yet for this article.
June 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236061/advances-and-new-approaches-to-managing-sleep-disordered-breathing-related-to-chronic-pulmonary-disease
#14
REVIEW
Ronaldo A Sevilla Berrios, Peter C Gay
Chronic obstructive pulmonary disease (COPD) is a common disease affecting about 20 million US adults. Sleep-disordered breathing (SDB) problems are frequent and poorly characterized for patients with COPD. Both the well-known success of noninvasive ventilation (NIV) in the acute COPD exacerbation in the hospital setting and that NIV is the cornerstone of chronic therapy for SDBs have urged the attention of the medical community to determine the impact of NIV on chronic COPD management with and without coexisting SDBs...
June 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236060/the-role-of-big-data-in-the-management-of-sleep-disordered-breathing
#15
REVIEW
Rohit Budhiraja, Robert Thomas, Matthew Kim, Susan Redline
Analysis of large-volume data holds promise for improving the application of precision medicine to sleep, including improving identification of patient subgroups who may benefit from alternative therapies. Big data used within the health care system also promises to facilitate end-to-end screening, diagnosis, and management of sleep disorders; improve the recognition of differences in presentation and susceptibility to sleep apnea; and lead to improved management and outcomes. To meet the vision of personalized, precision therapeutics and diagnostics and improving the efficiency and quality of sleep medicine will require ongoing efforts, investments, and change in our current medical and research cultures...
June 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236059/novel-therapies-for-the-treatment-of-central-sleep-apnea
#16
REVIEW
Shahrokh Javaheri, Robin Germany, John J Greer
Neurophysiologically, central apnea is due to a temporary cessation of respiratory rhythmogenesis in medullary respiratory networks. Central apneas occur in several disorders and result in pathophysiological consequences, including arousals and desaturation. The 2 most common causes in adults are congestive heart failure and chronic use of opioids to treat pain. Under such circumstances, diagnosis and treatment of central sleep apnea may improve quality of life, morbidity, and mortality. This article discusses recent developments in the treatment of central sleep apnea in heart failure and opioids use...
June 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236058/the-challenges-of-precision-medicine-in-obstructive-sleep-apnea
#17
REVIEW
Abdelnaby Khalyfa, Alex Gileles-Hillel, David Gozal
Obstructive sleep apnea (OSA) is a highly prevalent condition that remains underdiagnosed and undertreated. The onerous and labor-intensive nature of polysomnography or similar diagnostic multichannel-based approaches paves the way for exploration of biomarkers aimed at diagnosis, morbidity detection, and monitoring of therapy and its outcomes. To this effect, "Omics" technologies coupled with appropriate bioinformatic approaches should enable discovery of unique biomarker-based signatures, enabling simplified and highly precise algorithms for the evaluation and treatment of symptomatic individuals...
June 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236057/pharmacologic-approaches-to-the-treatment-of-obstructive-sleep-apnea
#18
REVIEW
David P White
The concept of pharmacologic therapy for obstructive sleep apnea (OSA) treatment has always been considered but no agent has had a large enough effect size to drive substantial adoption. A new construct of the pathophysiology of OSA is that there are 4 primary physiologic traits that dictate who develops OSA. These traits vary substantially between patients, meaning OSA may develop for quite different reasons. This encourages new thinking regarding pharmacologic therapy and continued attempts to find the ideal or acceptable drug...
June 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236056/novel-surgical-approaches-for-the-treatment-of-obstructive-sleep-apnea
#19
REVIEW
Ryan J Soose
Novel approaches to upper airway anatomic phenotyping, more reconstructive upper airway surgical techniques, and new implantable hypoglossal neurostimulation technology have very favorable potential to improve symptoms and quality-of-life measures, to reduce obstructive sleep apnea (OSA) disease severity and associated cardiovascular risk, and to serve as an adjunct to continuous positive airway pressure, oral appliances, and other forms of OSA medical therapy. Successful surgical therapy depends critically on accurate diagnosis, skillful knowledge and examination of the upper airway anatomy, proper procedure selection, and proficient technical application...
June 2016: Sleep Medicine Clinics
https://www.readbyqxmd.com/read/27236055/novel-approaches-to-the-management-of-sleep-disordered-breathing
#20
REVIEW
Todd D Morgan
In the last several years, a variety of novel approaches to the treatment of sleep-disordered breathing have emerged. This new technology holds promise in serving to re-engage with patients who have previously been lost to follow-up due to continuous positive airway pressure intolerance. With more tools at our disposal, in turn more options can be offered to patients' growing demand for alternatives that are tailored to their individual needs. The key to proper deployment of alternative therapies will often depend on identification of certain phenotypic traits that trend toward a reasonable response to a given therapy...
June 2016: Sleep Medicine Clinics
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