Visual short-term memory deficits in REM sleep behaviour disorder mirror those in Parkinson's disease.

Individuals with REM sleep behaviour disorder are at significantly higher risk of developing Parkinson's disease. Here we examined visual short-term memory deficits--long associated with Parkinson's disease--in patients with REM sleep behaviour disorder without Parkinson's disease using a novel task that measures recall precision. Visual short-term memory for sequentially presented coloured bars of different orientation was assessed in 21 patients with polysomnography-proven idiopathic REM sleep behaviour disorder, 26 cases with early Parkinson's disease and 26 healthy controls.

Sleep deficits but no metabolic deficits in premanifest Huntington's disease.

Objective: Huntington disease (HD) is a fatal autosomal dominant, neurodegenerative condition characterized by progressively worsening motor and nonmotor problems including cognitive and neuropsychiatric disturbances, along with sleep abnormalities and weight loss. However, it is not known whether sleep disturbances and metabolic abnormalities underlying the weight loss are present at a premanifest stage.

Methods: We performed a comprehensive sleep and metabolic study in 38 premanifest gene carrier individuals and 36 age- and sex-matched controls.

Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnoea.

Background: Obstructive sleep apnoea (OSA) is a common sleep disorder characterised by partial or complete upper airway occlusion during sleep, leading to intermittent cessation (apnoea) or reduction (hypopnoea) of airflow and dips in arterial oxygen saturation during sleep. Many patients with recognised and unrecognised OSA receive hypnotics, sedatives and opiates/opioids to treat conditions including pain, anxiety and difficulty sleeping. Concerns have been expressed that administration of these drugs to people with co-existing OSA may worsen OSA.

Unmet needs of patients with narcolepsy: perspectives on emerging treatment options.

The treatment options currently available for narcolepsy are often unsatisfactory due to suboptimal efficacy, troublesome side effects, development of drug tolerance, and inconvenience. Our understanding of the neurobiology of narcolepsy has greatly improved over the last decade. This knowledge has not yet translated into additional therapeutic options for patients, but progress is being made.

The impact of changing people with sleep apnea using CPAP less than 4 h per night to a Bi-level device.

Pressure intolerance is a reason for poor acceptance and subsequent compliance in some patients starting treatment with continuous positive airway pressure (CPAP). In unselected populations initiating CPAP; different types of pressure generating device have not been found to improve compliance. We hypothesized that using Bi-level PAP for patients who reported pressure related discomfort as a cause for poor compliance with CPAP might increase their hours of treatment use.

Alternatives to continuous positive airway pressure 2: mandibular advancement devices compared.

Purpose Of Review: Although mandibular advancement devices (MADs) provide an alternative to continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea (OSA), their effectiveness and role remain unclear. Several recent studies and an updated meta-analysis have attempted to address these uncertainties. This review examines their contribution to the existing evidence and discusses the future priorities for MAD research.

A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO).

Rationale: Mandibular advancement devices (MADs) are used to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS) but evidence is lacking regarding their clinical and cost-effectiveness in less severe disease.

Objectives: To compare clinical- and cost-effectiveness of a range of MADs against no treatment in mild to moderate OSAHS.

Measurements And Methods: This open-label, randomised, controlled, crossover trial was undertaken at a UK sleep centre.

Narcolepsy Associated with Duane's Syndrome.

The best characterised disorder of REM sleep, narcolepsy has never previously been associated with Duane's syndrome, in which there is developmental failure of the abducens nerve and its nucleus. The major brain stem nuclei responsible for REM sleep generation are situated in the pons in close proximity to the abducens nerve nucleus. We report the novel combination of Duane's syndrome and narcolepsy, providing new insight into the pathogenesis of narcolepsy.

Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.

Background: Although effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) is not universally accepted by users. Educational, supportive and behavioural interventions may help people with OSA recognise the need for regular and continued use of CPAP.

Objectives: To assess the effectiveness of strategies that are educational, supportive or behavioural in encouraging people who have been prescribed CPAP to use their machines.

Drug therapy for obstructive sleep apnoea in adults.

Background: The treatment of choice for moderate to severe obstructive sleep apnoea (OSA) is continuous positive airways pressure (CPAP) applied via a mask during sleep. However, this is not tolerated by all individuals and its role in mild OSA is not proven. Drug therapy has been proposed as an alternative to CPAP in some patients with mild to moderate sleep apnoea and could be of value in patients intolerant of CPAP.

Hypoxic challenge assessment in individuals with obstructive sleep apnea.

Background: The degree of arterial hypoxemia during air travel in individuals with obstructive sleep apnea (OSA) is not known. The Aerospace Medical Association considers a ground level arterial oxygen tension (PaO₂) above 9.3 kPa as safe before air travel.

A randomised crossover trial comparing volume assured and pressure preset noninvasive ventilation in stable hypercapnic COPD.

Recent randomised controlled trials suggest non-invasive ventilation may offer benefit in the long-term management of ventilatory failure in stable COPD. The best mode of ventilation is unknown and newer volume assured modes may offer advantages by optimising ventilation overnight when treatment is delivered. This study compares volume assured with pressure preset non-invasive ventilation.

Is there an alternative to pre-flight hypoxic challenge testing in scoliotic patients?

Introduction: Hypoxic challenge testing (HCT) is not readily available in all hospitals. It has recently been shown that resting oximetry does not reliably predict the results of HCT in patients with extrapulmonary restrictive lung disease. We assessed other clinical tests to see if they might be used as an alternative screen for HCT.

Long-term non-invasive ventilation to manage persistent ventilatory failure after COPD exacerbation.

Background And Objective: Patients with ventilatory failure at discharge from hospital following an exacerbation of COPD (ECOPD) have increased work of breathing and reduced inspiratory muscle strength compared with those with a normal arterial carbon dioxide tension (PaCO(2)). They also have a significantly worse prognosis. Long-term non-invasive positive pressure ventilation (NIPPV) may offer a treatment strategy but benefits have not been established.

The effects of withdrawing long-term nocturnal non-invasive ventilation in COPD patients.

Patients with ventilatory failure due to chronic obstructive pulmonary disease (COPD) are increasingly managed with long-term non-invasive positive pressure ventilation (NIPPV) and this may improve survival. NIPPV can frequently be interrupted but there are few data detailing the short-term effects and none on the longer-term consequences of treatment withdrawal. Ten patients withdrew from NIPPV for 1 week and were randomised to restart NIPPV or to continued withdrawal for up to 6 months.

Weaning from prolonged invasive ventilation in motor neuron disease: analysis of outcomes and survival.

Introduction: Non-invasive ventilation (NIV) improves prognosis in patients with motor neuron disease (MND) in the absence of major bulbar involvement. However, some experience a rapid and unexpected decline in respiratory function and may undergo emergency tracheal intubation. Weaning from invasive ventilation can be difficult, and reported independence from invasive ventilation is uncommon with poor prognosis.

A bench test to confirm the core features of volume-assured non-invasive ventilation.

Unlabelled: Volume-assured non-invasive ventilation (NIV) theoretically guarantees minute ventilation with circuit leak compensation unlike other modes of NIV. Bench testing demonstrated that minute ventilation was maintained with varying lung compliance and resistance with minimal effect from circuit leak, confirming for the first time the core features of volume-assured NIV.

Background And Objective: Volume-assured non-invasive positive pressure ventilation (va-NIPPV) is a novel mode designed to adapt pressure support (PS) to achieve a target minute ventilation (TgV).

Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.

Background: Continuous Positive Airways Pressure (CPAP) is considered to be the cornerstone of therapy for obstructive sleep apnoea (OSA). However, compliance with this treatment is frequently poor, which may lead to ongoing symptoms of sleep disruption, daytime sleepiness and poor waking cognitive function. Mechanical interventions which involve changing the way that positive pressure is delivered, and the addition of humidification, might improve compliance.

Sleep violence.

Violence during sleep is more common than is usually thought and has characteristic clinical features. These reflect the altered cerebral activity during sleep as well as the specific pathophysiology of the underlying sleep disorder. There are often forensic as well as clinical implications of violence during sleep which need careful assessment.

Successful treatment of REM sleep behavior disorder with sodium oxybate.

Objectives: To identify the effectiveness of sodium oxybate in treating the rapid eye movement sleep behavior disorder (RBD).

Methods: Report of effectiveness of sodium oxybate in a patient with severe RBD who was unresponsive to all other standard medication.

Results: The patient's severe symptoms had persisted unchanged for 5 years despite multiple drug treatments.

Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea.

Background: Although effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) does not meet with universal acceptance by users. Educational, supportive and behavioural interventions may help people with obstructive sleep apnoea recognise the need for regular and continued use of continuous positive airway pressure.

Objectives: To critically assess strategies that are educational, or supportive, or behavioural in encouraging people who have been prescribed or offered CPAP to use their machines.

Why does gender influence survival in obstructive sleep apnoea?

The study aim was to compare the mortality risk of men and women diagnosed with obstructive sleep apnoea (OSA) and started on treatment with continuous positive airway pressure (CPAP). From August to December 2003 we reviewed the hospital records of patients who had started on CPAP for OSA between July 1995 and June 1998. Mortality rates were compared between men and women.