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Objective Snoring Time And Carotid Intima-Media Thickness In Non-Apneic Female Snorers, Jinyoung Kim, Allan I. Pack, Barbara Riegel, Julio A. Chirinos, Alexandra Hanlon, Seung Ku Lee, Chol Shin 2016 University of Pennsylvania

Objective Snoring Time And Carotid Intima-Media Thickness In Non-Apneic Female Snorers, Jinyoung Kim, Allan I. Pack, Barbara Riegel, Julio A. Chirinos, Alexandra Hanlon, Seung Ku Lee, Chol Shin

School of Nursing Departmental Papers

Controversy persists about whether snoring can affect atherosclerotic changes in adjacent vessels, independently of obstructive sleep apnea and other cardiovascular risk factors. This study examined the independent association between snoring and carotid artery intima-media thickness (IMT) in non-apneic snorers and non-snorers. We studied 180 non-apneic snorers and non-snorers participating in a full-night home-based sleep study. Snoring sound was measured objectively by a microphone. Based on snoring time across the night, participants were classified as non-snorers (snoring time: 0%), mild snorers (1-25%) and moderate to heavy snorers (≥25%). We measured IMT on both common carotid arteries. The three groups were matched ...


Improving The Adherence Of Providers To The American Academy Of Sleep Medicine Guidelines For The Evaluation, Treatment, And Management Of Obstructive Sleep, Heather Miles 2016 University of the Incarnate Word

Improving The Adherence Of Providers To The American Academy Of Sleep Medicine Guidelines For The Evaluation, Treatment, And Management Of Obstructive Sleep, Heather Miles

Doctor of Nursing Practice

The purpose of this project is to increase the adherence of clinic providers to the American Academy of Sleep Medicine’s Clinical Guidelines for the Evaluation, Management, and Longterm Care of Obstructive Sleep Apnea in Adults. OSA is a chronic condition that effects from 2% to 10% of the U.S. adult population. Implications of undiagnosed OSA include excessive daytime sleepiness, fatigue, irritability, difficulty controlling chronic diseases including diabetes and hypertension, heart arrhythmias, gastroesophageal reflux disease, mood disorders, attention deficit disorder, and an increased potential for dementia if left untreated. A protocol was created to align providers with the clinical ...


Is Suvorexant (Belsomra) Effective In Reducing Wakefulness After Sleep Onset In Healthy Patients Diagnosed With Insomnia?, Danielle Hart 2016 Philadelphia College of Osteopathic Medicine

Is Suvorexant (Belsomra) Effective In Reducing Wakefulness After Sleep Onset In Healthy Patients Diagnosed With Insomnia?, Danielle Hart

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine if Suvorexant (Belsomra) is effective in reducing wakefulness after sleep onset in healthy patients diagnosed with insomnia that are 18 years old or older.

STUDY DESIGN: Systematic review of three published, randomized controlled trials (doubleblind, placebo-controlled) between 2012-2014, all English.

DATA SOURCES: Three randomized controlled trials published between 2012-2014 were found using PubMed.

OUTCOMES MEASURED: Polysymnography, psychomotor performance test, PSG measurements of sleep, visual scoring, efficacy assessed with an electronic diary, Sheehan Disability Scale, vitals, EKGs, PE, MVAV questionnaire, QIDS-SR to assess mood, Tyler Withdrawal Symptom Questionnaire

RESULTS: The ...


Age-Related Effect Of Viral-Induced Wheezing In Severe Prematurity, Geovanny F. Perez, Amisha Jain, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Mary C. Rose, Dinesh Pillai, Gustavo Nino 2016 Children’s National Medical Center

Age-Related Effect Of Viral-Induced Wheezing In Severe Prematurity, Geovanny F. Perez, Amisha Jain, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Mary C. Rose, Dinesh Pillai, Gustavo Nino

Pediatrics Faculty Publications

Abstract: Premature children are prone to severe viral respiratory infections in early life, but the age at which susceptibility peaks and disappears for each pathogen is unclear. Methods: A retrospective analysis was performed of the age distribution and clinical features of acute viral respiratory infections in full-term and premature children, aged zero to seven years. Results: The study comprised of a total of 630 hospitalizations (n = 580 children). Sixty-seven percent of these hospitalizations occurred in children born full-term (> 37 weeks), 12% in preterm (32–37 weeks) and 21% in severely premature children (< 32 weeks). The most common viruses identified were rhinovirus (RV; 60%) and respiratory syncytial virus (RSV; 17%). Age-distribution analysis of each virus identified that severely premature children had a higher relative frequency of RV and RSV in their first three years, relative to preterm or full-term children. Additionally, the probability of RV- or RSV-induced wheezing was higher overall in severely premature children less than three years old. Conclusions: Our results indicate that the vulnerability to ...


Associations Of Subjective Sleep Quality And Daytime Sleepiness With Cognitive Impairment In Adults And Elders With Heart Failure, Eeeseung Byun, Jinyoung Kim, Barbara Riegel 2016 University of Pennsylvania

Associations Of Subjective Sleep Quality And Daytime Sleepiness With Cognitive Impairment In Adults And Elders With Heart Failure, Eeeseung Byun, Jinyoung Kim, Barbara Riegel

School of Nursing Departmental Papers

This study examined the association of subjective nighttime sleep quality and daytime sleepiness with cognitive impairment in 105 adults (< 60 years old) and 167 elders (≥ 60 years old) with heart failure. Nighttime sleep quality and daytime sleepiness were measured by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Cognitive impairment was assessed using a neuropsychological battery measuring attention, memory, and processing speed. Multivariate logistic regression was used. In adults, daytime sleepiness was associated with cognitive impairment, whereas poor nighttime sleep quality was associated with cognitive impairment in elders. Age may play an important role in how sleep impacts cognition in persons with heart failure. Improving nighttime sleep quality and daytime sleepiness in this population may improve cognition.


Healthy Living An In-Depth Look, Nina Radcliff, MD, Kristin Detterline 2016 Thomas Jefferson University

Healthy Living An In-Depth Look, Nina Radcliff, Md, Kristin Detterline

Jefferson Sleep Disorders Center in the News

Features Dr. Ritu Grewal, pulmonologist and attending physician at Jefferson Sleep Disorder Center Women's Program.


Pharmacotherapy For Chronic Insomnia: A Brief Survey Of Pcp Attitudes And Preferences, Adam J. Sorscher, Ali A. Siddiqui, Ardis Olson, Deborah J. Johnson 2016 Dartmouth College

Pharmacotherapy For Chronic Insomnia: A Brief Survey Of Pcp Attitudes And Preferences, Adam J. Sorscher, Ali A. Siddiqui, Ardis Olson, Deborah J. Johnson

Open Dartmouth: Faculty Open Access Articles

Purpose: To examine primary care professionals (PCP) attitudes and prescribing preferences toward hypnotic medications to treat chronic insomnia. Methods: An online survey was sent to members of the Dartmouth CO-OP, a practice-based primary care research network in Maine, Vermont, and New Hampshire. The survey begins with a case vignette of a 64-year old woman suffering from chronic insomnia. Clinicians were then presented with eight questions about management of the patient and their attitudes toward prescribing medications, focusing on benzodiazepines/benzodiazepine receptor agonists (BDZ/BZRAs). Results: 103 of 198 clinicians (52%) responded. Regarding choice of medication for the case vignette, 80 ...


Does A Short, Thick Neck Predict Obstructive Sleep Apnea?: The Role Of Physical Examination In Osa Screening, Ramya Punati, MD, Shivan Saxena, MD, Constantine Daskalakis, Sc.D., Salvatore Mangione, MD, Ritu G. Grewal, MD 2016 Thomas Jefferson University

Does A Short, Thick Neck Predict Obstructive Sleep Apnea?: The Role Of Physical Examination In Osa Screening, Ramya Punati, Md, Shivan Saxena, Md, Constantine Daskalakis, Sc.D., Salvatore Mangione, Md, Ritu G. Grewal, Md

Department of Sleep Medicine Faculty Papers

Purpose:

The purpose of this study was to determine whether a short neck, alone or together with a thick neck, can predict obstructive sleep apnea (OSA).

Methods:

The laryngeal heights of 169 new adult patients presenting to a sleep medicine physician were measured over a period of 5 months. Neck circumference, Mallampati score, and body-mass index (BMI) were also determined, together with medical history, smoking status, and serum bicarbonate. Lastly, patients’ polysomnograms were obtained in order to ascertain the presence or absence of OSA as indicated by the apnea-hypopnea index, as well as other sleep study parameters.

Results:

No association ...


Severe Obesity Hypoventilation Syndrome Treated With Auto-Cpap, Zhanna Fast, MD, Ritu G. Grewal, MD 2016 Thomas Jefferson University

Severe Obesity Hypoventilation Syndrome Treated With Auto-Cpap, Zhanna Fast, Md, Ritu G. Grewal, Md

Department of Sleep Medicine Faculty Papers

Summary

Obesity hypoventilation syndrome (OHS) is a serious medical condition that remains undiagnosed in seriously ill hospitalized patients. Significant improvement of daytime hypercapnia can be achieved with positive airway pressure (PAP) therapy. Bi-level PAP is generally employed with the goal of improving ventilation. A 50-year-old woman with OHS and severe hypercapnia was successfully treated with an auto titrating continuous PAP (Auto-CPAP) device. The major role in the pathogenesis of daytime hypercapnia in patients with OHS, is the progressive accumulation of carbon dioxide (CO2) caused by repetitive obstructive events at night, which can be eliminated with the low cost approach of ...


Do Pressure Requirements Change Over Time With Auto Titrating Positive Airway Pressure Therapy For Obstructive Sleep Apnea?, Anupama Tiwari, MD, Karl Doghramji, MD, Ritu Grewal, MD 2016 East Carolina University

Do Pressure Requirements Change Over Time With Auto Titrating Positive Airway Pressure Therapy For Obstructive Sleep Apnea?, Anupama Tiwari, Md, Karl Doghramji, Md, Ritu Grewal, Md

Department of Sleep Medicine Faculty Papers

Study Objective:

Prior studies have demonstrated reduced inflammation after chronic use of CPAP therapy. This may lead to reduced pressures over time as the upper airway becomes more compliant. We sought to determine if there was a reduction in 90th percentile pressure requirements in patients on Auto PAP for OSA.

Methods:

A retrospective chart review of 988 patients who underwent a sleep study at our sleep center was performed. Those with moderate to severe sleep apnea who were prescribed and compliant with Respironics Auto PAP were included, yielding a total of 46 patients for analysis. All statistical analysis analyses were ...


Open-Loop Neurofeedback Audiovisual Stimulation: A Pilot Study Of Its Potential For Sleep Induction In Older Adults, Hsin-Yi Jean Tang, Michael V Vitiello, Michael Perlis, Barbara Riegel 2015 University of Pennsylvania

Open-Loop Neurofeedback Audiovisual Stimulation: A Pilot Study Of Its Potential For Sleep Induction In Older Adults, Hsin-Yi Jean Tang, Michael V Vitiello, Michael Perlis, Barbara Riegel

School of Nursing Departmental Papers

This pilot study tested the efficacy of a 30-min audio-visual stimulation (AVS) program for the treatment of chronic insomnia in older adults. Chronic insomnia has been conceptualized as entailing increased cortical high frequency EEG activity at sleep onset and during NREM sleep. We hypothesized that an AVS program gradually descending from 8 to 1 Hz would potentially reduce the excessive cortical activation that is thought to contribute to difficulties with initiating and maintaining sleep. Accordingly, we conducted an intervention study of AVS using a pre-post design. Eight older adults (88 ± 8.7 years) complaining of chronic insomnia self-administered a 30-min ...


A Pilot Study Of Audio-Visual Stimulation As A Self-Care Treatment For Insomnia In Adults With Insomnia And Chronic Pain, Hsin-Yi Tang, Michael V. Vitiello, Michael Perlis, Jun James Mao, Barbara Riegel 2014 University of Pennsylvania

A Pilot Study Of Audio-Visual Stimulation As A Self-Care Treatment For Insomnia In Adults With Insomnia And Chronic Pain, Hsin-Yi Tang, Michael V. Vitiello, Michael Perlis, Jun James Mao, Barbara Riegel

School of Nursing Departmental Papers

This pilot study tested the efficacy of an audio-visual stimulation (AVS) program for the promotion of sleep in individuals with chronic pain. Insomnia and chronic pain are common comorbid conditions and their relationship has been viewed as bidirectional. Recent studies suggest a relatively dominant role of sleep in this dyad. The premise of this pilot study was that AVS enhances low frequency while reducing high frequency brain activity resulting in decreased hyperarousal and improved sleep with potential consequent reduction in pain. We conducted a pilot intervention study of AVS using a pre-post design. Participants self-administered a 30-min AVS program nightly ...


Sleep Disturbance, Symptoms, Psychological Distress, And Health-Related Quality Of Life In Pulmonary Arterial Hypertension, Lea Ann Matura, Annette McDonough, Alexandra L. Hanlon, Diane L. Carroll, Barbara Riegel 2014 University of Pennsylvania

Sleep Disturbance, Symptoms, Psychological Distress, And Health-Related Quality Of Life In Pulmonary Arterial Hypertension, Lea Ann Matura, Annette Mcdonough, Alexandra L. Hanlon, Diane L. Carroll, Barbara Riegel

School of Nursing Departmental Papers

Background:

Pulmonary arterial hypertension (PAH) is a devastating disease characterized by elevated pulmonary pressures that lead to right heart failure and premature mortality. Patients experience multiple symptoms including dyspnea, fatigue and chest pain, but little is known about sleep disturbance, PAH symptoms, psychological distress and health-related quality of life (HRQOL) in PAH.

Aim:

The purpose of this study was to describe the occurrence of sleep disturbance and compare PAH symptoms, psychological distress, and HRQOL across severity of sleep disturbance.

Methods:

One hundred and ninety-one participants completed a socio-demographic and clinical data form, PAH Symptom Severity Scale, Profile of Mood States ...


Implementing A Screening Pathway For Identifying Patients At Risk For Obstructive Sleep Apnea In Primary Care, Emily Fett 2014 South Dakota State University

Implementing A Screening Pathway For Identifying Patients At Risk For Obstructive Sleep Apnea In Primary Care, Emily Fett

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Obstructive sleep apnea (OSA) is emerging as a significant health problem largely underrecognized by health care providers in the primary care setting (Pagel, 2008). The intent of this practice innovation project was to change and reduce the variation in practice for OSA screening that did not follow what is known about best practices. In this study, a preexperimental one-group pretest-posttest design was carried out to evaluate the outcomes associated with implementing an evidence-based screening pathway into practice for OSA based on the recommendations set forth in a clinical practice guideline recently published by the American Academy of Sleep Medicine (Epstein ...


Resolution Of Severe Obstructive Sleep Apnea After Treatment Of Anti-Muscle Kinase Receptor-Positive Myasthenia Gravis Despite 60-Pound Weight Gain, M. Morgenstern, E. Singas, B. Zleik, H. Greenberg 2014 Northwell Health

Resolution Of Severe Obstructive Sleep Apnea After Treatment Of Anti-Muscle Kinase Receptor-Positive Myasthenia Gravis Despite 60-Pound Weight Gain, M. Morgenstern, E. Singas, B. Zleik, H. Greenberg

Journal Articles

Obstructive sleep apnea (OSA) in patients with myasthenia gravis (MG) may be caused by reduced pharyngeal dilator muscle activity. We report a patient with anti-muscle kinase receptor MG with severe OSA and hypoventilation that resolved upon successful treatment of MG despite a 60-lb weight gain.


An Obligatory Role Of Nf-Kappa B In Mediating Bone Marrow Derived Endothelial Progenitor Cell Recruitment And Proliferation Following Endotoxemic Multiple Organ Injury In Mice, S. Z. Mao, X. B. Ye, G. Liu, D. M. Song, S. F. Liu 2014 Northwell Health

An Obligatory Role Of Nf-Kappa B In Mediating Bone Marrow Derived Endothelial Progenitor Cell Recruitment And Proliferation Following Endotoxemic Multiple Organ Injury In Mice, S. Z. Mao, X. B. Ye, G. Liu, D. M. Song, S. F. Liu

Journal Articles

Background: Recruitment of bone marrow derived endothelial progenitor cells (BMDEPCs) alleviates multiple organ injury (MOI) and improves outcomes. However, mechanisms mediating BMDEPC recruitment following septic MOI remain largely unknown. This study characterized the kinetics of BMDEPC recruitment and proliferation and defined the role of NF-kappa B in regulating BMDEPC recruitment and proliferation. Methods and Main Findings: Chimeric mice with an intact or disrupted NF-kappa B p50 gene and BMDEPC-restricted expression of green fluorescent protein were created and injected with LPS (2 mg/kg, i.p.). BMDEPC recruitment and proliferation in multiple organs were quantified. BMDEPC recruitment and proliferation are highly ...


Depression In Pulmonary Arterial Hypertension And Interstitial Lung Diseases, S. Verma, J. Cardenas-Garcia, P. R. Mohapatra, A. Talwar 2014 Northwell Health

Depression In Pulmonary Arterial Hypertension And Interstitial Lung Diseases, S. Verma, J. Cardenas-Garcia, P. R. Mohapatra, A. Talwar

Journal Articles

Advanced lung diseases such as pulmonary arterial hypertension (PAH) and interstitial lung diseases (ILD) are chronic diseases that cause significantly high morbidity and mortality. As a result, patients can undergo some psychological changes leading to a poor quality of life and depression. Diagnosis of depression is often obscured because fatigue and apathy, two common symptoms of depression, frequently overlap with PAH and ILD. Healthcare providers are sometimes reluctant to ask or mistakenly believe that these symptoms are part of the ongoing disease process, rather than a serious condition like depression. Screening tools are available for physicians to be well positioned ...


Ulinastatin Activates Haem Oxygenase 1 Antioxidant Pathway And Attenuates Allergic Inflammation, D. M. Song, G. Song, Y. H. Niu, W. Song, J. T. Wang, L. Yu, J. W. Yang, H. Steinberg, S. F. Liu, B. S. Wang, +1 additional author 2014 Zucker School of Medicine at Hofstra/Northwell

Ulinastatin Activates Haem Oxygenase 1 Antioxidant Pathway And Attenuates Allergic Inflammation, D. M. Song, G. Song, Y. H. Niu, W. Song, J. T. Wang, L. Yu, J. W. Yang, H. Steinberg, S. F. Liu, B. S. Wang, +1 Additional Author

Journal Articles

Background and PurposeUlinastatin (UTI), a serine protease inhibitor, was recently found to have an anti-inflammatory action. However, the mechanisms mediating this anti-inflammatory effect are not well understood. This study tested the hypothesis that UTI suppresses allergic inflammation by inducing the expression of haem oxygenase 1 (HO1). Experimental ApproachControl mice and mice sensitized (on days 1, 9 and 14) and challenged (on days 21 to 27) with ovalbumin (OVA) were treated with UTI. The effects of UTI on basal expression of HO1 and that induced by OVA challenge were examined. The involvement of UTI-induced HO1 expression in anti-inflammatory and antioxidant effects ...


What Happens To Patients With Copd With Long-Term Oxygen Treatment Who Receive Mechanical Ventilation For Copd Exacerbation? A 1-Year Retrospective Follow-Up Study, N. Hajizadeh, K. Goldfeld, K. Crothers 2014 Zucker School of Medicine at Hofstra/Northwell

What Happens To Patients With Copd With Long-Term Oxygen Treatment Who Receive Mechanical Ventilation For Copd Exacerbation? A 1-Year Retrospective Follow-Up Study, N. Hajizadeh, K. Goldfeld, K. Crothers

Journal Articles

We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791 patients, 23% died in the hospital, and 45% died in the subsequent 12 months. 67% of patients were readmitted at least once in the subsequent 12 months, and 26.8% were discharged to a nursing home or skilled nursing facility within 30 days. We conclude that these patients have high mortality rates, both in-hospital and in the 12 months postdischarge. If patients survive, many will be readmitted to the hospital ...


Effects Of Pulmonary Rehabilitation On Fatigue Severity Scale In Patients With Lung Disease, A. Talwar, S. Sahni, S. John, S. Verma, J. Cardenas-Garcia, N. Kohn 2014 Zucker School of Medicine at Hofstra/Northwell

Effects Of Pulmonary Rehabilitation On Fatigue Severity Scale In Patients With Lung Disease, A. Talwar, S. Sahni, S. John, S. Verma, J. Cardenas-Garcia, N. Kohn

Journal Articles

INTRODUCTION: Fatigue is a known symptom of advanced lung disease and impacts quality of life and psychological health. Many of these patients undergo pulmonary rehabilitation as part of their therapy. Understanding the effect of pulmonary rehabilitation on fatigue in these patients is important, as one may be able to design more focused rehabilitation programs. The aim of this study is to evaluate the effect of pulmonary rehabilitation on fatigue as measured by the Fatigue Severity Scale (FSS) in patients with advanced lung disease. MATERIAL AND METHODS: Patients were enrolled in a standardized 6 week pulmonary rehabilitation program. They were asked ...


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