Early signs of neurobehavioral improvement after short-termcontinuous positive airway pressure in obstructive sleep apnea

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Commentary on: Ivana Rosenzweig, Martin Glasser, William R. Crum, Matthew J. Kempton, Milan Milosevic, Alison McMillan, Guy D. Leschziner, Veena Kumari, Peter Goadsby, Anita K. Simonds, Steve C.R. Williams, Mary J. Morrell. (2016) Changes in Neurocognitive Architecture in Patients with Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure EBioMedicine, Volume 7, May 2016, Pages 221-22

Obstructive Sleep Apnoea: Therapeutic Options and Challenges

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).Obstructive sleep apnoea (OSA) is a common sleep disorder that is associated with significant negative health outcomes including cardiovascular disease, daytime sleepiness, neurocognitive deficits, and increased motor vehicle and workplace accidents. There is wide variation in OSA symptoms and other downstream effects between patients highlighting the need to individualise therapy. Continuous positive airway pressure delivered by a face mask is the gold standard treatment, but adherence to this therapy is poor and improvements in outcomes are often incomplete. A range of alternative treatments are available and may suit different patients. These include behavioural treatments such as weight loss, mandibular advancement using an oral device, sleep posture modification, upper airway surgery, and upper airway muscle stimulation. Towards individualised OSA therapy, novel phenotyping approaches are being developed to identify the specific pathophysiological causes of OSA applying to individual patients. Furthermore, research is underway to help identify patients with OSA at higher risk of daytime sleepiness and adverse cardiovascular and neurocognitive consequences and predict how individuals might respond to treatment. In this article, we review the prevalence, risk factors, and main consequences of OSA; the main treatment modalities available at present; and some new methods for phenotyping patients with OSA that hold promise for a more personalised and effective approach to screening, diagnosis, and treatment

European Union directive 2014/85/EU on driver licensing in obstructive sleep apnoea:early experiences with its application in the UK

OSA patients’ risk of RTA should be assessed using detailed driving history with specific focus on “red flags” http://ow.ly/mxPi305isn

Post-stroke sleep-disordered breathing - pathophysiology and therapy options

Note: This article was submitted to Otorhinolaryngology - Head and Neck Surgery, a section of the journal Frontiers in Surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Sleep-disordered breathing (SDB), encompassing both obstructive and central sleep apnea, is prevalent in at least 50% of stroke patients. Small studies have shown vast improvements in post-stroke functional recovery outcomes after the treatment of SDB by continuous positive airway pressure. However, compliance to this therapy is very poor in this complex patient group. There are alternative therapy options for SDB that may be more amenable for use in at least some post-stroke patients, including mandibular advancement, supine avoidance, and oxygen therapy. There are few studies, however, that demonstrate efficacy and compliance with these alternative therapies currently. Furthermore, novel SDB-phenotyping approaches may help to provide important clinical information to direct therapy selection in individual patients. Prior to realizing individualized therapy, we need a better understanding of the pathophysiology of SDB in post-stroke patients, including the role of inherent phenotypic traits, as well as the contribution of stroke size and location. This review summarizes the available literature on SDB pathophysiology and treatment in post-stroke patients, identifies gaps in the literature, and sets out areas for further research

Economic evaluation of cognitive behavioural therapy for insomnia (CBT-I) for improving health outcomes in adult population: A systematic review protocol

INTRODUCTION:Insomnia is associated with a number of adverse consequences that place a substantial economic burden on individuals and society. Cognitive behavioural therapy for insomnia (CBT-I) is a promising intervention that can improve outcomes in people who suffer from insomnia. However, evidence of its cost-effectiveness remains unclear. In this study, we will systematically review studies that report on economic evaluations of CBT-I and investigate the potential economic benefit of CBT-I as a treatment for insomnia. METHODS AND ANALYSIS:The search will include studies that use full economic evaluation methods (ie, cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) and those that apply partial economic evaluation approaches (ie, cost description, cost-outcome description and cost analysis). We will conduct a preliminary search in MEDLINE, Google Scholar, MedNar and ProQuest dissertation and theses to build the searching terms. A full search strategy using all identified keywords and index terms will then be undertaken in several databases including MEDLINE, Psychinfo, Proquest, Cochrane, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science and EMBASE. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for protocol guidelines in this review. Only articles in the English language and those reporting on adult populations will be included. We will use standardised data extraction tools for economic evaluations to retrieve and synthesise information from selected studies into themes and summarised in a Joanna Briggs Institute dominance ranking matrix. ETHICS AND DISSEMINATION:No formal ethics approval will be required as we will not be collecting primary data. Review findings will be disseminated through a peer-reviewed publication, workshops, conference presentations and a media release. PROSPERO REGISTRATION NUMBER:CRD42019133554.Andrea Natalie Natsky, Andrew Vakulin, Ching Li Chai-Coetzer, Leon Lack, R. Doug McEvoy, Billingsley Kaambw

Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners

BACKGROUND: Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. METHODS: A descriptive, pragmatic qualitative study. Purposive sampling was used to recruit practising Australian general practitioners, varying in age, years of experience and geographic location. Semi-structured interviews were conducted, and data analysed using thematic analysis.  RESULTS: Twenty-eight general practitioners participated in the study. Three major themes were identified: 1) Responsibility for insomnia care; 2) Complexities in managing insomnia; and 3) Navigating treatment pathways. Whilst general practitioners readily accepted responsibility for the management of insomnia, provision of care was often demanding and difficult within the funding and time constraints of general practice. Patients presenting with comorbid mental health conditions and insomnia, and decision-making regarding long-term use of benzodiazepines presented challenges for general practitioners. Whilst general practitioners confidently provided sleep hygiene education to patients, their knowledge and experience of CBTi, and access and understanding of specialised referral pathways for insomnia was limited.  CONCLUSIONS: General practitioners report that whilst assessing and managing insomnia can be demanding, it is an integral part of general practice. Insomnia presents complexities for general practitioners. Greater clarity about funding options, targeted education about effective insomnia treatments, and referral pathways to specialist services, such as benzodiazepine withdrawal support and psychologists, would benefit insomnia management within general practice

How the chance of missing the alarm during an on-call shift affects pre-bed anxiety, sleep and next day cognitive performance

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (September 2018) in accordance with the publisher’s archiving policy.This study investigated how the likelihood of missing an alarm affects pre-bed anxiety, sleep and next day cognitive performance during on-call shifts. Participants (n=24) completed one adaptation night, one control night and two on-call nights in a time-isolated sleep laboratory. On one of the on-call nights, participants were informed that they would be woken by a loud alarm that they would definitely not be able to sleep through (low likelihood of missing the alarm). On the other on-call night, participants were informed that they would be woken by a quiet alarm that they may sleep through (high likelihood of missing the alarm). The two on-call nights were counterbalanced. Pre-bed anxiety was measured using the State Trait Anxiety Inventory x-1, while sleep macro- and micro-architecture was examined via routine polysomnography and power spectral analyses respectively. Following each sleep, cognitive performance was assessed four times (0930, 1200, 1430, 1700) using the 10-min psychomotor vigilance task (PVT). Results indicated that while pre-bed anxiety was similarly increased during both high and low likelihood of missing the on-call alarm conditions compared with control, only in the high likelihood condition was total sleep time shorter and sleep efficiency lower compared with the control condition. However, more wake after sleep onset was found in the low likelihood condition compared with control. PVT data indicate that response times (mean reciprocal and mean fastest 10% of reaction time) were fastest in the low likelihood condition, indicating better performance when compared with both other conditions. However, there were significantly more lapses in the low likelihood condition compared with control. No significant EEG power spectral differences were observed. As such, it appears that there are detrimental effects of both on-call conditions on anxiety, sleep and performance, with sleep poorest when the likelihood of missing the alarm is high. The adverse impacts on sleep and performance outcomes while on-call may be mitigated by the implementation of workplace systems to reduce the likelihood of missing alarms (e.g., having two available options for contacting on-call workers).This study was funded by an Australian Research Council Discovery grant (DP 150104497). Funding for Madeline Sprajcer’s PhD scholarship was provided by this grant. Dr Grace Vincent is supported by an Early Career Fellowship at Central Queensland University

Multi-night measurement for diagnosis and simplified monitoring of obstructive sleep apnoea

Substantial night-to-night variability in obstructive sleep apnoea (OSA) severity has raised misdiagnosis and misdirected treatment concerns with the current prevailing single-night diagnostic approach. In-home, multinight sleep monitoring technology may provide a feasible complimentary diagnostic pathway to improve both the speed and accuracy of OSA diagnosis and monitor treatment efficacy. This review describes the latest evidence on night-to-night variability in OSA severity, and its impact on OSA diagnostic misclassification. Emerging evidence for the potential impact of night-to-night variability in OSA severity to influence important health risk outcomes associated with OSA is considered. This review also characterises emerging diagnostic applications of wearable and non-wearable technologies that may provide an alternative, or complimentary, approach to traditional OSA diagnostic pathways. The required evidence to translate these devices into clinical care is also discussed. Appropriately sized randomised controlled trials are needed to determine the most appropriate and effective technologies for OSA diagnosis, as well as the optimal number of nights needed for accurate diagnosis and management. Potential risks versus benefits, patient perspectives, and cost-effectiveness of these novel approaches should be carefully considered in future trials.Bastien Lechat, Hannah Scott, Jack Manners, Robert Adams, Simon Proctor, Sutapa Mukherjee, Peter Catcheside, Danny J. Eckert, Andrew Vakulin, Amy C. Reynold

Структурно-функциональные модификации лимфоидных органов при вибрационных воздействиях и их коррекция с использованием эссенциальных фосфолипидов

The research of lymphoid organs of male rats of Vistar line wich were subjected to vibration with freguency of 32 Hz during 30 days has been conducted. Cytological shifts of the basic structural components of the investigated organs during the vibration period, postcontact rehabilitation period (30, 60 days) and under essencial phospholipides correction were estimated by the methods of light and electron microscopy and morphometry. The analysis of the obtained data demonstrated that the important infringement of lymphoid organs structures takes place. The dynamic study of morphofunctional and ultrastructural changes, cytoarchitectony of parenchymatous stromal compartment gives evidence of the development of degenerate-distrophic processes with mainly involutional character. Pharmacological correction resulted in positive dynamic of cytological shifs and helped to rehabilitation the natural cell phenotype.Проведено экспериментальное исследование лимфоидных органов (тимус) у крыс-самцов линии Вистар, подвергавшихся воздействию вибрации частотой 32 Гц в течение 30 дней. Методами световой и электронной микроскопии, морфометрии оценивались цитологические сдвиги основных структурных компонентов изучаемых органов в период вибрационной нагрузки, восстановительный постконтактный период (30, 60 сут) и на фоне коррекции эссенциальными фосфолипидами. Анализ полученных данных показал, что в процессе вибрационного влияния происходит существенное нарушение структуры лимфоидных органов. Изучение динамики морфофункциональных и ультраструктурных изменений, цитоархитектоники паренхиматозно-стромального компонента свидетельствует о развитии дегенеративно-дистрофических процессов преимущественно инволютивного характера. Фармакологическая коррекция способствует восстановлению естественного фенотипа клеток

Effect of high-risk sleep apnea on treatment-response to a tailored digital cognitive behavioral therapy for insomnia program : a quasi-experimental trial

Introduction: Therapist-delivered Cognitive Behavioral Therapy for Insomnia (CBTi) is an effective but largely inaccessible treatment for people with Co-Morbid Insomnia and Sleep Apnea (COMISA). To increase CBTi access for COMISA, we aimed to develop a self-guided interactive 5-session digital CBTi program that is appropriate for people with insomnia-alone and COMISA, and compare its effectiveness between people with insomnia-alone, vs. comorbid insomnia and high-risk sleep apnea. Methods: Data from 62 adults with insomnia symptoms were used. High-risk sleep apnea was defined as a score of ≥5 on the OSA50. Participants self-reported symptoms of insomnia (ISI), depression, anxiety, sleepiness (ESS), fatigue, and maladaptive sleep-related beliefs (DBAS-16) at baseline, 8-week, and 16-week follow-up. ESS scores were additionally assessed during each CBTi session. Intent-to-treat mixed models and complete-case chi2 analyses were used. Results: There were more participants with insomnia-alone [n = 43, age M (sd) = 51.8 (17.0), 86.1% female] than suspected COMISA [n = 19, age = 54.0 (14.8), 73.7% female]. There were no between-group differences in baseline questionnaire data, or rates of missing follow-up data. There were no significant group by time interactions on any outcomes. Main effects of time indicated moderate-to-large and sustained improvements in insomnia (d = 3.3), depression (d = 1.2), anxiety (d = 0.6), ESS (d = 0.5), fatigue (d = 1.2), and DBAS-16 symptoms (d = 1.2) at 16-weeks. ESS scores did not increase significantly during any CBTi session. Conclusion: This interactive digital CBTi program is effective in people with insomnia-alone, and people with co-morbid insomnia and high-risk sleep apnea. Further research is required to determine the effectiveness, safety and acceptability of digital CBTi in people with insomnia and confirmed sleep apnea. Clinical Trial Registration: This trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, ACTRN12621001395820)