Predictive factors for sleep apnoea in patients on opioids for chronic pain.

Background: The risk of death is elevated in patients taking opioids for chronic non-cancer pain. Respiratory depression is the main cause of death due to opioids and sleep apnoea is an important associated risk factor.

Methods: In chronic pain clinics, we assessed the STOP-Bang questionnaire (a screening tool for sleep apnoea; noring, iredness, bserved apnoea, high blood ressure, ody mass index, age, neck circumference and male gender), Epworth Sleepiness Scale, thyromental distance, Mallampati classification, daytime oxyhaemoglobin saturation (SpO) and calculated daily morphine milligram equivalent (MME) approximations for each participant, and performed an inlaboratory polysomnogram.

Profile of CPAP treated patients in Ontario, Canada, 2006-2013: a population-based cohort study.

Rationale: Many studies have demonstrated the benefits of treating obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). However, both recognition of OSA and acceptance of treatment are suboptimal. Current data on CPAP initiation at a population level is lacking.

Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial.

Rationale: Twenty-eight percent of people with mild to moderate obstructive sleep apnea experience daytime sleepiness, which interferes with daily functioning. It remains unclear whether treatment with continuous positive airway pressure improves daytime function in these patients.

Objectives: To evaluate the efficacy of continuous positive airway pressure treatment to improve functional status in sleepy patients with mild and moderate obstructive sleep apnea.

Sleep apnea, daytime somnolence, and idiopathic dizziness--a novel association.

Objectives/hypothesis: To determine if an association exists between sleep apnea, daytime somnolence, and chronic idiopathic dizziness.

Study Design: Case-control study of new patients presenting to a tertiary neuro-otologic practice. A total of 46 subjects with idiopathic dizziness (ID), 20 positive controls with dizziness (benign paroxysmal positional vertigo [BPV]), and 69 negative controls with hearing loss (HL) but no dizziness were enrolled.

Evaluation of sham-CPAP as a placebo in CPAP intervention studies.

Study Objectives: To evaluate the use of sham-continuous positive airway pressure (CPAP) treatment as a placebo intervention.

Design And Setting: Analysis of polysomnograms performed in fixed order without sham-CPAP and on the first night of the sham-CPAP intervention in participants in the CPAP Apnea Trial North American Program (CATNAP), a randomized, placebo controlled trial evaluating the effects of CPAP treatment on daytime function in adults with newly diagnosed mild to moderate obstructive sleep apnea (apnea hypopnea index (AHI) 5-30).

Participants: The first 104 CATNAP participants randomized to the sham-CPAP intervention arm.

A 2-week, polysomnographic, safety study of sodium oxybate in obstructive sleep apnea syndrome.

Purpose: Sodium oxybate (SXB) is approved for cataplexy and excessive daytime sleepiness in narcolepsy. Obstructive sleep apnea syndrome (OSAS) affects ∼9-50% of narcoleptics. Effects of 2-week SXB administration on apnea-hypopnea index (AHI), oxygen saturation (SaO(2)), and sleep architecture were investigated in OSAS patients.

A safety trial of sodium oxybate in patients with obstructive sleep apnea: Acute effects on sleep-disordered breathing.

Objective: Sodium oxybate (SXB) is an approved drug for the treatment of excessive daytime sleepiness (EDS) and cataplexy in narcolepsy. Obstructive sleep apnea syndrome (OSAS) is a condition that frequently co-occurs with narcolepsy. Given the known central nervous system (CNS) depressant effects of SXB, this study aimed to examine its effects on sleep-disordered breathing (SDB) and sleep architecture in patients with OSAS.

Sleep apnea, alertness, and motor vehicle crashes.

Sleep apnea causes impairment in performance and is associated with an increased risk of motor vehicle crashes compared with the general population of drivers. Despite this increased risk, the actual number of accidents is still quite low, although the implications are significant in commercial vehicle drivers. It is difficult for physicians to assess risk and ability to drive in many patients with sleep apnea, yet physicians are often mandated to make these assessments with obvious implications for patients.

Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning.

Study Objectives: Evidence suggests that, to maintain treatment effects, nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) needs to be used every night. What remains unknown is the nightly duration of use required to normalize functioning. This study, employing probit analyses and piecewise regression to estimate dose-response functions, estimated likelihoods of return to normal levels of sleepiness and daily functioning relative to nightly duration of CPAP.

Impaired performance in commercial drivers: role of sleep apnea and short sleep duration.

Sleepiness plays an important role in major crashes of commercial vehicles. Because determinants are likely to include inadequate sleep and sleep apnea, we evaluated the role of short sleep durations over 1 wk at home and sleep apnea in subjective sleepiness (Epworth Sleepiness Scale), objective sleepiness (reduced sleep latency as determined by the Multiple Sleep Latency Test), and neurobehavioral functioning (lapses in performance, tracking error in Divided Attention Driving Task) in commercial drivers. Studies were conducted in 247 of 551 drivers at higher risk for apnea and in 159 of 778 drivers at lower risk.

Sleepiness and relationships in obstructive sleep apnea.

This is a qualitative analysis of data from a multisite study of 156 participants with Obstructive Sleep Apnea (OSA). Participants completed a battery of tests, including the Functional Outcomes of Sleep Questionnaire (FOSQ) that contains an item assessing the impact of OSA on relationships. Approximately one third of participants wrote comments; they were predominately male, mean age 44.

Physiologic pacing in patients with obstructive sleep apnea: a prospective, randomized crossover trial.

Objectives: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea.

Background: Apneic episodes during sleep are associated with slowing of the heart rate during apnea and tachycardia with subsequent arousal. Patients with permanent pacemakers may have reduced episodes of sleep apnea when their pacemaker rate is set faster than their spontaneous nocturnal heart rate.

Sleep and motor performance in on-call internal medicine residents.

Study Objectives: To compare vigilance and performance among internal medicine residents doing in-house call versus residents not doing in-house call.

Design: Prospective study of resident cohorts with repeated testing.

Setting: University Teaching Hospital.

Sleep and breathing in professional football players.

Objectives: To evaluate sleep in professional football players and describe clinical features of players at risk for sleep for sleep-disordered breathing (SDB).

Methods: The Multivariable Apnea Prediction (MAP) index was used to stratify players into high (MAP> or =0.5) and low (MAP<0.

Driving simulators in clinical practice.

Operating a motor vehicle is a complex psychomotor task that requires sustained vigilance. When sleepy, subjects have difficulty maintaining vigilance. As a result, inattention increases the risk of a motor vehicle collision.

Management of insomnia in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common medical disorder, which causes considerable morbidity and mortality. Given the chronic and symptomatic nature of the disease, the patient is often seen in the physician's office with complaints of dyspnea. However, more than 50% of COPD patients also have sleep complaints characterised by longer latency to falling asleep, more frequent arousals and awakenings, and/or generalised insomnia.