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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is increasing evidence that mandibular advancement devices (MADs) can be an effective treatment for some patients with obstructive sleep apnea, a highly prevalent chronic disease. In this study, the objectives were to objectively assess the effectiveness of MAD therapy using a limited channel recorder, and to develop a model for identifying patients who may be appropriate for MAD therapy as the initial treatment option. Thirty patients were prospectively recruited and studied at two independent dentist offices and the participants' homes. Subjects wore the ARES Unicorder for two nights before insertion of the MAD, and again when the dentist determined that the patient had reached the titration endpoint. Self-reported measures of depression, sleepiness, and quality of life were obtained pre- and posttreatment. The reviewer was blinded to the study status while the physiological signals were being visually inspected. Significant reductions in the apnea/hypopnea index (AHI), hypoxemia measures, and snoring level were observed posttreatment. Twenty-seven of the 30 (90%) patients had a posttreatment AHI (using a 4% desaturation for hypopneas) below a clinical cut-off of 10. All but one patient (97%) exhibited at least a 50% decrease in AHI or had a posttreatment AHI < or = 10. Significant differences in body mass index, weight, and neck circumference in patients with posttreatment AHIs above and below a clinical cut-off of five were identified. The linear regression used to predict the posttreatment AHI using pretreatment data resulted in an R(2) of 0.68. The model correctly predicted two patients who were unable to obtain a posttreatment AHI of 10 or less. This study was designed to demonstrate two models of collaboration between a dental sleep medicine specialist and a sleep medicine physician in the monitoring of a patient treated with a MAD. The outcome data suggest that the limited channel recording system can be used as an alternative to laboratory polysomnography to reduce the cost of MAD treatment, and to improve the quality and consistency of posttreatment patient care.
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PMID:In-home evaluation of efficacy and titration of a mandibular advancement device for obstructive sleep apnea. 1723 80

Obstructive sleep apnea syndrome (OSAS) causes numerous pathophysiological changes and influences neuropsychological system. Nasal continuous positive airway pressure (CPAP) is the gold standard treatment of OSAS. We aimed to evaluate the compliance of patients with severe OSAS to CPAP treatment and to compare the anxiety and depression scores before and at the 6th month of the treatment. Seventeen patients receiving CPAP treatment for OSAS that continued regular follow-up were accepted to the study. A questionnaire containing questions about demographic features, OSAS symptoms and Epworth sleepiness scale, Beck anxiety scale and depression scale was filled by the patients before and after CPAP treatment. Additionally, information concerning adverse effects of and compliance to CPAP treatment was obtained after CPAP treatment. Mean age of the patients was 48.4 +/- 8.4 (32-63); 14 (82.4%) of them were male and 3 (17.6%) of them were female. Snoring, witnessed apnea and excessive daytime sleepiness symptoms, and Epworth sleepiness scale scores were significantly decreased after CPAP treatment compared with those before treatment. Mean duration of CPAP device use at night was 5.6 +/- 2.1 (2-8) hours. Nine (52.9%) of the patients were using the device regularly every night and 8 (47.1%) of the patients were using it irregularly. The most frequent adverse effect of CPAP treatment was sore mouth, followed by mask discomfort and erythema on the nose. Anxiety and depression scores of the patients were significantly decreased after CPAP treatment compared with those before the treatment. As a conclusion, OSAS patients with high anxiety and depression scores benefit from CPAP treatment.
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PMID:[Compliance to CPAP treatment and effects of treatment on anxiety and depression in patients with obstructive sleep apnea syndrome]. 1797 25

Epidemiological studies have suggested that excessive daytime sleepiness (EDS) is associated with depression, but the association between EDS and other psychiatric disorders has not been investigated. The aim of this study was to investigate the association of EDS with a wide range of psychiatric disorders and health-related conditions in the elderly population. Two thousand two hundred and fifty-nine non-institutionalised persons aged 65-years and over randomly recruited from the Montpellier district, France, completed the Epworth Sleepiness Scale (ESS). Psychiatric status was assessed by the Mini International Neuropsychiatric Interview and demographic and other health information was obtained. This cross-sectional study was conducted from March 1999 to February 2001. Men were significantly more likely to report EDS (ESS score>10) compared with women (12.0% versus 6.0% respectively). EDS was significantly associated in univariate analyses with chronic diseases, early awakening, snoring, severity of depression and lifetime prevalence of manic and hypomanic episodes. A multivariate analysis revealed that the lifetime prevalence of manic and hypomanic episodes, snoring and gender (male) were independently associated with EDS. No independent association with other psychiatric disorders was found.
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PMID:Determinants of excessive daytime sleepiness in a French community-dwelling elderly population. 1803 81

Evidence from clinical observation and population studies suggests that migraine sometimes transforms into chronic migraine. Risk factors for progression include headache frequency, obesity, snoring, stressful life events, and head injury. Other candidate risk factors include depression, anxiety, and lifestyle factors. Progression in a subgroup only raises the possibility that risk factor management or other forms of treatment may prevent migraine progression. Herein, we consider the design of clinical trials for interventions which could prevent the transformation of migraine to chronic migraine. We recommend enrolling individuals at high risk for progression based on baseline high headache frequency, delivering intervention in the context of a double-blind randomized trial and assessing either the onset of chronic migraine or major change in headache frequency as outcomes.
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PMID:Looking to the future: research designs for study of headache disease progression. 1818 87

There are multiple risk factors for chronic daily headache (CDH), but they are usually assessed in an isolated form without an adequate control for confounders. CDH is considered a variant of episodic headache, but studies have not gathered enough evidence to evaluate simultaneously CDH and episodic in the same population. We set out to establish simultaneously the factors associated with chronic daily or episodic headache in a population setting, using a cross-sectional survey in a random sample of 1505 adult urban inhabitants (Bucaramanga, Colombia). The survey asked questions about headache, family and personal history of disease, and consumption or abuse of caffeine, alcohol, hypnotics and analgesics. The association among independent variables and CDH or episodic headache was made with multinomial logistic regression. Female gender, arterial hypertension or cranial trauma history, and a high score in the depression scale are associated with episodic headache and CDH. Parents with CDH, the complaint of multiple arousals during sleep and use of hypnotics are associated with CDH, but not with episodic headache. Age <36 years, alcoholism and snoring are factors associated only with episodic headache. Chronic daily headache and episodic headache have several common risk factors, but there are other factors not shared by both conditions.
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PMID:Prevalence and associated factors for episodic and chronic daily headache in the Colombian population. 1917 Jul

The objective of this study was to assess whether parameters of the negative expiratory pressure (NEP) technique are able to detect obstructive sleep apnea syndrome (OSAS) in snoring patients. A cross-sectional study included 42 OSAS patients diagnosed by polysomnography (PSG), 34 simple snorers, and 32 healthy subjects. Lung function was measured by using a plethysmograph and the NEP technique was performed with the patient in the seated and supine positions in a random order. The depression was fixed to 5 cmH(2)O. All patients had normal forced expiratory flow/volume loops. Apneic patients had lower Dflow in both positions with a number of oscillations on the expiratory curve obtained with NEP and an expiratory flow limitation (EFL) in the supine position higher than that of other groups (p < 0.05). Changing from the sitting to the supine position raised the EFL of the three groups, with a significant decrease in Dflow and an increase in the number of oscillations in snoring and OSAS patients (p < 0.05). The analysis of variance showed that only the number of oscillations was significantly different between apneic and snoring patients. NEP constitutes a simple and useful tool for the screening OSAS by EFL, especially the number of oscillations obtained with NEP.
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PMID:Negative expiratory pressure (NEP) parameters can predict obstructive sleep apnea syndrome in snoring patients. 1892 68

A total of 37 primary snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) patients were treated with two sessions of radiofrequency tissue ablation (RFTA) to assess the relationship among RFTA and sleepiness, anxiety and depression in patients with OSAHS. Patients' sleepiness was rated according to the Epworth sleepiness scale (ESS), anxiety--on Spielberg's trait-state anxiety inventory scale and depression degree--with Beck depression inventory-second edition scale and the patients' major complaints were evaluated using visual analog scales before and after the treatment. A remarkable decrease in patients' complaints, sleepiness and depression after RFTA was observed. The ESS mean score decreased from 9.3 +/- 3.4 to 7.14 +/- 3.2 points (P < 0.05) and Beck depression index mean value decreased from 14.2 +/- 10.8 to 8.7 +/- 7.6 points (P < 0.05), respectively. RFTA is a treatment of choice for snoring and mild to moderate OSAHS. Reduction of sleepiness and depression was statistically significant after RFTA.
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PMID:Changes in emotional state of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation. 1902 83

Obstructive sleep apnea is the most frequent sleep disorder. The prevalence of sleep apnea in the general population is 2-4% and the main characteristic of the disease is the intermittent cessation or substantial reduction of airflow during sleep, caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. The clinical presentation of the disorder is complex. Loud snoring with breathing pauses and daytime sleepiness should raise the suspicion of sleep apnea, but we have to consider this disease if the patient has therapy resistant hypertension, heart failure, arrhythmias, stroke, depression or memory problems. Family physicians have an important role in recognizing sleep apnea. High risk patients can easily be identified by the main symptoms and using the Berlin sleep apnea questionnaire. These patients should be referred to a sleep laboratory for polysomnographic assessment and, if necessary, for further treatment.
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PMID:[The role of family physicians in the recognition and screening of obstructive sleep apnea]. 1902 51

Migraine attacks sometimes increase in frequency over time. Headache experts conceptualize this process with a model that envisions transition into and out of four distinct states: no migraine, low-frequency episodic migraine (<10 headaches per month), high-frequency episodic migraine (10-14 headaches per month), and chronic migraine (CM, >or=15 headaches per month). Transitions may be in the direction of increasing or decreasing headache frequency and are influenced by specific risk factors. Overall, population studies estimate that patients who have low-frequency episodic migraine or high-frequency episodic migraine will transition to CM at the rate of about 2.5% per year. Two longitudinal population studies, the Frequent Headache Epidemiology study and the ongoing American Migraine Prevalence and Prevention (AMPP) study provide longitudinal population data that has defined the rates of and risk factors for transition. Launched in 2004, the AMPP study has followed a sample of >10,000 migraine sufferers annually for 4 years. Cross-sectional data from the Frequent Headache Epidemiology study and the AMPP study show that patients with chronic daily headaches have lower levels of education and household income. In addition, epidemiologic profiles show that CM sufferers tend to be older and have higher body mass indexes. These studies have also assessed a number of potential risk factors associated with the transition to CM. These include baseline high attack frequency, obesity, stressful life events, snoring, and overuse of certain classes of medication. In particular, opiate and barbiturate combination products contribute to migraine progression, and nonsteroidal anti-inflammatory agents are protective in patients with <10 headache days per month. The influence of medication is modified by both headache attack frequency and frequency of medication use. Although depression and anxiety are associated with an increased risk of new-onset CM, the influence of depression is accounted for by migraine disability assessment scale score, whereas the effect of anxiety may be independent of migraine disability assessment scale score. Emerging data on the longitudinal risk of CM suggest that, in a population at risk, CM may be a preventable disorder.
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PMID:Tracing transformation: chronic migraine classification, progression, and epidemiology. 2560 59

In OSA, the patient suffers repeated episodes of apnoea caused by narrowing or closure of the pharyngeal airway during sleep. The degree of closure of the airway leads to periods of either apnoea (complete) or hypopnoea (partial) obstruction. Population-based surveys estimate that 2-4% of the middle-aged population have OSA, which is similar to the prevalence of diabetes and asthma. Although understanding of the condition has improved considerably, it is estimated that 85-90% of sufferers still remain undiagnosed. OSA is not only a cause of excessive daytime somnolence leading to an increased risk of accidents on the road and poor work performance, but also a major cause of social dysfunction, reduced quality of life related to poor health, and mood disorders. Untreated OSA predicts a substantially increased risk of hypertension, cardiovascular disease, cerebrovascular disease, depression, and mortality. Wherever OSA is considered, the following questions should be asked: Is this patient falling asleep regularly against their will? Is this patient often sleepy while driving? Is this patient experiencing difficulty at work because of excessive sleepiness? Is sleep refreshing? Is surgery for snoring being considered (OSA should be excluded first)? The gold standard for investigation of OSA is polysomnography. It is possible to diagnose almost 90% of OSA patients from limited sleep studies often conducted on a domiciliary basis with portable diagnostic equipment.
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PMID:Obstructive sleep apnoea increases risk of CVD. 2004 5


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