Clinical Management of Insomnia

Throughout the book, we are guided by our main goal of providing practitioners with clinically relevant, evidence-based, and state-of-the-art information in the evaluation and management of insomnia. We have made a concerted attempt to ensure that our reviews are consistent with professional guidelines to the extent that current knowledge permits

Preface to the Psychiatric Clinics of North American, 2006

Introducton to the special issue on the sleep-psychiatry interface

Meningitis Presenting as Depression: A Case Report

The relationship between psychiatric and medical illness has long been recognized by clinicians. Of special importance to psychiatrists are the diagnostic dilemmas posed by medical illnesses presenting as psychiatric disorders. In a review of recent studies, LaBruzza found that at least one out of every twenty patients receiving an initial psychiatric evaluation may have an underlying medical illness which accounts for the psychiatric symptoms. This was especially true with inpatients, where between 5% and 30% of patients, with a weighted average of 12%, had medical illnesses accounting for their psychiatric complaints 11). One medical illness which can resemble psychiatric illness is aseptic meningoencephalitis, a subject about which there is a paucity of literature. We present here a case of aseptic meningoencephalitis which, because of the history and presenting symptoms, bore a strong resemblance to a major depressive episode

Diagnostic Accuracy of Home Sleep Apnea Testing (HSAT) Based on Recording Duration

Introduction: Obstructive Sleep Apnea (OSA) is a chronic sleeping disorder with serious health consequences. Currently, standard diagnosis is through in-lab polysomnography; however, there has been a shift to greater use of Home Sleep Apnea Testing (HSAT) for patients with a high pre-test probability of having OSA. Objective: To investigate the minimum recording time needed during HSAT to accurately diagnose the presence and severity of OSA. Methods: A retrospective review was conducted of HSATs done from January-October 2017. Each study was divided into 1-, 2-,3-,4-,5-, 6-, and 7 hour intervals beginning at the recording start time. The respiratory event index (REI) was determined for each of these time intervals and then compared to the initial REI derived from the total monitoring time (REITMT) by a Fleiss’ κ test, a paired samples t-test, and concordance correlation coefficients (CCC). Results: Significant differences were found between the REITRT and the REI at 60 min (P \u3c 0.0001), 120 min (0.0002), 180 min (\u3c 0.0001) and 240 min (0.0002) with a lack of concordance, signifying these intervals are poor diagnostic correlates for the REITRT. REIs determined at 300, 360, and 420 min were not significantly different from the REITRT and had very significant CCCs, 0.979, 0.990, and 0.996, respectively. The Fleiss’ κ test showed almost perfect agreement between the REITRT and and the REI for 360 and 420 min. Discussion: The results suggest that at least 6 hours of monitoring time during HSAT is needed to accurrately diagnose and determine the severity of OSA

Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature.

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management

Disposable Equipment for Efficient Home Sleep Apnea Testing and Minimizing Human Handling at the Sleep Laboratory

As part of the disease mitigation strategy at the time of the pandemic, the Jefferson sleep laboratory has completely shifted towards utilization of the third-party vendor for HSATs. The vendor specializes in handling, shipping and disinfecting the HSAT equipment. They send the data electronically to the Jefferson sleep laboratory for interpretation. We propose a single-use, fully disposable HSAT kit (WatchPAT One) to further minimize potential virus exposures and spread. The single-use design allows no return shipment, no charging or downloading, no cleaning and no infection transmission risk. Since the equipment utilizes a different mechanism - peripheral arterial tone (PAT) signal instead of airflow, the Sleep Disorders Center will require scorer and provider staff training

Medical Student Knowledge of Narcolepsy

Background: Narcolepsy is a sleep disorder, whose main symptoms include daytime sleepiness, cataplexy, sleep paralysis, disturbed sleep, and hypnagogic hallucinations. The disorder is poorly identified in medical settings. We hypothesized that lack of knowledge of narcolepsy and its hallmark symptoms are a cause for the low levels of identification of this disorder. This was a pilot study into medical student knowledge of narcolepsy at Sidney Kimmel Medical College of Thomas Jefferson University (SKMC). Methods: Two groups of SKMC students, years 1 and 2 (before sleep medicine education) and years 3 and 4 (after sleep medicine education) were the subjects of this study. All students were sent a survey regarding their knowledge of narcolepsy. Results from these surveys were analyzed, and compared using a proportions test. Results: 24.42% of first and second year students correctly chose the pathognomonic symptom of narcolepsy compared to 62.63% of that of the third and fourth year classes (p\u3c0.0001). 5.43% of first and second year students correctly chose the pentad of narcolepsy symptoms compared to 20.19% of that of the third and fourth year classes (p\u3c0.0001). Conclusions: There is a significant difference in knowledge of narcolepsy between students who received education regarding narcolepsy at SKMC and those who have not. This suggests that the educational curriculum in sleep medicine at SKMC is effective in enhancing knowledge regarding narcolepsy. Future studies should assess other medical schools and their student’s knowledge of narcolepsy to evaluate the effectiveness of medical school education regarding sleep disorders on a national basis

Urine Drug Screening at the Sleep Disorder Center

Aim Introduce UDS for all patients undergoing MSLT or MWT Eliminate false positive and negative results Optimize management of disorder Goal To have 100% of patients undergoing an MSLT or MWT to have a UD

MCI: CPAP Treatment of OSA

Introduction: An estimated 30 percent of adults (20% of men and 10% of women) in the US have sleep apnea. Approximately 60% of patients with Mild Cognitive Impairment (MCI) are also diagnosed with Obstructive Sleep Apnea (OSA). The suggested mechanism of this is damage to the brain due to hypoxia during sleep. Few studies have investigated the effect of Continuous Positive Airway Pressure (CPAP) treatment for OSA, on mild cognitive impairment. Methods: Patients are screened for eligibility based on specific inclusion and exclusion criteria. Potentially eligible patients who screen positive for MCI using the Telephone Interview for Cognitive Status (TICS) survey are enrolled. CPAP adherent (n=200), CPAP non-adherent (n=160), and no apnea control (n=100) groups are followed for 1 year total with study visits at zero and six months that include cognitive testing and brain MRI. Results: At Jefferson, 272 charts have been reviewed, with 2 patients enrolled in the study. Across all study sites, approximately 5000 charts have been reviewed, and 157 patients enrolled. We hypothesize that adherence with CPAP treatment of OSA will delay the progression of cognitive impairment. Discussion: MCI is a precursor to Alzheimers, for which there is currently no effective treatment. If CPAP proves to be effective in delaying the progression of cognitive impairment in patients with OSA and MCI, CPAP may have a clinically significant impact on patient morbidity, mortality, and quality of life