Sleep medicine
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Randomized Controlled Trial
Managing sleep problems in school aged children with ADHD: a pilot randomised controlled trial.
To evaluate the feasibility and helpfulness of a behavioral sleep program for children with ADHD, and explore the impact of different program dosages on child and family outcomes. ⋯ A behavioral sleep intervention in children with ADHD is feasible to deliver and improves child sleep by parent report. The extended program resulted in greater improvements in child and caregiver outcomes.
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Clinical Trial
Screening for obstructive sleep apnea in early outpatient cardiac rehabilitation: feasibility and results.
Obstructive sleep apnea (OSA) has been recognized as a risk factor for cardiovascular disease and mortality. The aim of this study was to determine the feasibility and efficacy of implementing a screening program for OSA in early outpatient cardiac rehabilitation (CR) and to estimate the risk for OSA in this population. ⋯ Implementation of a simple screening program for OSA in early outpatient CR is feasible with minimal incremental resources. A significant percentage of patients at high-risk decline further evaluation, suggesting that their perceived risk for OSA and its consequences may be low.
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Sleep-disordered breathing in children is most prevalent in the pre-school years and has been associated with sleep fragmentation and hypoxia. We aimed to compare the sleep and spontaneous arousal characteristics of 3-5-year-old children with obstructive sleep apnoea (OSA) with that of non-snoring control children, and to further characterise the arousal responses to obstructive respiratory events. ⋯ These findings suggest that in pre-school children OSA has a profound effect on sleep and arousal patterns. Given that these children are at a critical period for brain development, the impact of OSA may have more severe consequences than in older children.
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The clinical significance of rapid eye-movement (REM)-related obstructive sleep apnea (OSA) is unknown. Moreover, it is unclear what the determinants of sleepiness and quality of life (QoL) are among these patients. Our aim was to identify whether the apnea-hypopnea index during REM sleep (AHI(REM)), AHI during NREM sleep (AHI(NREM)), depressive symptoms, or obesity are independent predictors of excessive daytime sleepiness and reduced QoL in patients with REM-related OSA. We also assessed if these characteristics were predictors of sleepiness and QoL in all patients with OSA (AHI ≥ 5) as well as in non-stage specific OSA. ⋯ Higher depression scores and obesity, rather than the severity of OSA (as measured by AHI(NREM) and AHI(REM)), were predictive of sleepiness and QoL scores in patients with REM-related OSA.
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Randomized Controlled Trial
Effectiveness of evening phototherapy for insomnia is reduced by bright daytime light exposure.
To examine the effect of ambulatory daytime light exposure on phase delays and on the advances produced by timed exposure to bright evening or morning light. ⋯ Greater light exposure during the daytime may decrease the ability of evening light, but not morning light, exposure to engender meaningful changes of circadian phase.