Journal of sleep research
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Journal of sleep research · Jun 2011
Randomized Controlled Trial Comparative StudyNasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy.
Side-effects directly due to the nasal mask are common in patients with obstructive sleep apnoea syndrome (OSAS) commencing continuous positive airway pressure (CPAP). Recently, nasal pillows have been designed to overcome these issues. Limited evidence exists of the benefits and effectiveness of these devices. ⋯ The applied CPAP pressure did not correlate with compliance, AHI and ESS. Furthermore, no differences in outcome parameters were noted comparing groups with CPAP pressure <10 and ≥10cm H(2) O. Nasal pillows are equally effective in CPAP therapy, but do not generally lead to improved compliance.
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Journal of sleep research · Mar 2011
Randomized Controlled TrialRandomised controlled trial of auto-adjusting positive airway pressure in morbidly obese patients requiring high therapeutic pressure delivery.
Auto-adjusting positive airway pressure (APAP) devices are being increasingly used to treat obstructive sleep apnoea (OSA). Anecdotal encounters of obese patients requiring high therapeutic pressure whose OSA was inadequately controlled by APAP led to this study aiming to compare the effectiveness of continuous positive airway pressure (CPAP) and APAP (S8 Autoset II(®) , ResMed, NSW, Australia) in a randomised, single-blinded crossover trial. Twelve morbidly obese patients with severe OSA [mean±SD apnoea-hypopnoea index (AHI) 75.8±32.7, body mass index 49.9±5.2 kg m(-2) , mean pressure 16.4 cmH(2)O] were consecutively recruited, and received CPAP or APAP in random order for six nights at home, separated by a four-night washout. ⋯ The machine-scored AHI significantly overestimated the level of residual disease compared with the laboratory-scored AHI (using Chicago criteria); however, when the machine-scored AHI was ≤5 and ≤10 this was always confirmed by the PSG data. In morbidly obese OSA patients without significant co-morbid disease requiring high therapeutic pressure, our data provide support for the use of either APAP or manually titrated CPAP. We recommend objective assessment by sleep study if the S8 Autoset II indicates a high level of residual disease.
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Journal of sleep research · Dec 2010
Randomized Controlled TrialA two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behaviour disorder.
Rapid eye movement (REM) sleep behaviour disorder (RBD) has been suggested to predict the development of neurodegenerative disorders. Patients with RBD are acting out dream behaviour associated with loss of normal muscle atonia of REM sleep. The aim of the present study was to confirm that exogenous melatonin improves RBD. ⋯ Interestingly, the number of REM sleep epochs without muscle atonia remained lower in patients who took placebo during Part II after having received melatonin in Part I (-16% compared to baseline; P = 0.043). In contrast, patients who took placebo during Part I showed improvements in REM sleep muscle atonia only during Part II (i.e. during melatonin treatment). The data suggest that melatonin might be a second useful agent besides clonazepam in the treatment of RBD.
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Journal of sleep research · Sep 2009
Randomized Controlled Trial Comparative StudyCNS arousal and neurobehavioral performance in a short-term sleep restriction paradigm.
Few studies have investigated waking electrophysiological measures of arousal during sleep restriction. This study examined electroencephalogram (EEG) activity and performance during a 96-hour laboratory protocol where participants slept a baseline night (8 h), were randomly assigned to 3-, 5-, or 8-hour sleep groups for the next two nights sleep restriction (SR1, SR2), and then slept a recovery night (8 h). There were dose-dependent deficits on measures of mood, sleepiness, and reaction time that were apparent during this short-term bout of sleep restriction. ⋯ The 5-hour group had increased beta EEG at central-parietal sites following both nights of restriction, whereas the 3-hour group had increased beta and gamma EEG at occipital regions following the first night only. Short-term sleep restriction leads to deficits in performance as well as EEG slowing that correspond to the amount and duration of sleep loss. High-frequency EEG may be a marker of effort or compensation.
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Journal of sleep research · Sep 2009
Randomized Controlled TrialContinuous positive airway pressure treatment for obstructive sleep apnoea reduces resting heart rate but does not affect dysrhythmias: a randomised controlled trial.
Obstructive sleep apnoea (OSA) is associated with cardiovascular morbidity and may precipitate cardiac dysrhythmias. Uncontrolled reports suggest that continuous positive airway pressure (CPAP) may reduce dysrhythmia frequency and resting heart rate. We undertook a randomised controlled trial of therapeutic CPAP and compared with a subtherapeutic control which included an exploration of changes in dysrhythmia frequency and heart rate. ⋯ Compared with subtherapeutic control, CPAP reduced mean 24-h heart rate from 83.0 (11.5) to 79.7 (9.8) (P < 0.002) in the CPAP group compared with a non-significant rise (P = 0.18) from 79.0 (10.4) to 79.9 (10.4) in the subtherapeutic group; this was also the case for the day period analysed separately. There was no significant change in the frequencies of dysrhythmias after CPAP. Four weeks of CPAP therapy reduces mean 24-h heart rate possibly due to reduced sympathetic activation but did not result in a significant decrease in dysrhythmia frequency.