Sleep
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Randomized Controlled Trial Multicenter Study
Efficacy and Safety of Doxepin 1 mg and 3 mg in a 12-week Sleep Laboratory and Outpatient Trial of Elderly Subjects with Chronic Primary Insomnia.
to evaluate the efficacy and safety of doxepin 1 mg and 3 mg in elderly subjects with chronic primary insomnia. ⋯ DXP 1 mg and 3 mg administered nightly to elderly chronic insomnia patients for 12 weeks resulted in significant and sustained improvements in most endpoints. These improvements were not accompanied by evidence of next-day residual sedation or other significant adverse effects. DXP also demonstrated improvements in both patient- and physician-based ratings of global insomnia outcome. The efficacy of DXP at the doses used in this study is noteworthy with respect to sleep maintenance and early morning awakenings given that these are the primary sleep complaints of the elderly. This study, the longest placebo-controlled, double-blind, polysomnographic trial of nightly pharmacotherapy for insomnia in the elderly, provides the best evidence to date of the sustained efficacy and safety of an insomnia medication in older adults.
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to report on symptoms and therapies used in childhood narcolepsy-cataplexy. ⋯ this study reports on the clinical features of childhood narcolepsy and documents the safe use of treatments commonly used in adults in young children.
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to determine the short-term positive airway pressure (PAP) adherence rates and to identify non-mask-related risk factors associated with 30-day nonadherence to PAP in a population of veterans with obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD). ⋯ PAP usage and adherence were lower in PTSD veterans with OSA than veterans without PTSD. Excessive sleepiness predicted PAP adherence while frequent nightmares were correlated with poor adherence to PAP therapy.
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Review Meta Analysis
Surgical modifications of the upper airway for obstructive sleep apnea in adults: a systematic review and meta-analysis.
A substantial portion of patients with obstructive sleep apnea (OSA) seek alternatives to positive airway pressure (PAP), the usual first-line treatment for the disorder. One option is upper airway surgery. As an adjunct to the American Academy of Sleep Medicine (AASM) Standards of Practice paper, we conducted a systematic review and meta-analysis of literature reporting outcomes following various upper airway surgeries for the treatment of OSA in adults, including maxillomandibular advancement (MMA), pharyngeal surgeries such as uvulopharyngopalatoplasty (UPPP), laser assisted uvulopalatoplasty (LAUP), and radiofrequency ablation (RFA), as well as multi-level and multi-phased procedures. ⋯ Outcomes following pharyngeal surgeries were less consistent; adverse events were reported more commonly. Papers describing positive outcomes associated with newer pharyngeal techniques and multi-level procedures performed in small samples of patients appear promising. Further research is needed to better clarify patient selection, as well as efficacy and safety of upper airway surgery in those with OSA.