Bedtime Fading With Response Cost For Treatment Of Sleep Disturbances In Children With Autism Spectrum Disorder, 2017 University of Nebraska Medical Center
Bedtime Fading With Response Cost For Treatment Of Sleep Disturbances In Children With Autism Spectrum Disorder, Sela Ann Sanberg
Theses & Dissertations
As many as 82% of children with Autism Spectrum Disorders (ASD) experience numerous chronic sleep-related problems and at a much higher frequency and severity than their typically developing peers. Behavioral treatments are considered best practice and first-line treatment to address sleep problems. These treatments tend to address one specific sleep-related behavior at a time. Bedtime Fading with Response Cost (BFRC) is a promising intervention that targets a multitude of sleep problems concurrently and has yet to be replicated by more than one investigative team in the home setting with children on the autism spectrum. This study evaluated the effectiveness of …
A Quality Improvement Project To Reduce The Wait Time For Initial Appointment In An Urban Outpatient Sleep Center, 2017 Jefferson Sleep Disorder Center, Thomas Jefferson University
A Quality Improvement Project To Reduce The Wait Time For Initial Appointment In An Urban Outpatient Sleep Center, Anasua Chakraborty, Md, Ritu G. Grewal, Md
House Staff Quality Improvement and Patient Safety Conference (2016-2019)
Project aim:
In this study we aimed to see if replacing one face to face follow up visit after sleep study with a phone call by a trained office staff will
- decrease the total number of follow up office visits, thus decreasing health care cost
- increase the number of new patients seen during the 6 month follow up period
- Did not decrease patient compliance
Poster presented at annual Thomas Jefferson University Hospital House Staff Quality Improvement and Patient Safety conference.
The Acquisition And Analysis Of Electroencephalogram Data For The Classification Of Benign Partial Epilepsy Of Childhood With Centrotemporal Spikes, 2017 University of San Francisco
The Acquisition And Analysis Of Electroencephalogram Data For The Classification Of Benign Partial Epilepsy Of Childhood With Centrotemporal Spikes, Jessica A. Scarborough
Master's Theses
In this thesis, I will expand upon each step in the process of acquiring and analyzing electroencephalogram (EEG) for the classification of benign childhood epilepsy with centrotemporal spikes. Despite huge advancements in the field of health informatics—natural language processing, machine learning, predictive modeling—there are significant barriers to the access of clinical data. These barriers include information blocking, privacy policy concerns, and a lack of stakeholder support. We will see that these roadblocks are all responsible for stunting biomedical research in some way, including my own experiences in acquiring the data for the second chapter of this thesis.
This second chapter …
Research Brief: "The National Veteran Sleep Disorder Study: Descriptive Epidemiology And Secular Trends, 2000–2010", 2017 Syracuse University
Research Brief: "The National Veteran Sleep Disorder Study: Descriptive Epidemiology And Secular Trends, 2000–2010", Institute For Veterans And Military Families At Syracuse University
Institute for Veterans and Military Families
This brief is about the relation between sleep disorder diagnosis and cardiovascular disease, cancer, and mental health disorders among veterans. In policy and practice, physicians should familiarize themselves with signs of and screenings for sleep disorders and should discuss factors that affect sleep with their veteran patients; the VHA should continue recommending policies that help veterans receive a prompt diagnosis and treatment of their sleep disorders, policymakers should fund early intervention programs to help veterans learn how to cope with reintegration, and the VHA should create a database on sleep disorders in veterans. Suggestions for future research include studying veterans …
Commentary: How To Make The Ghosts In My Bedroom Disappear? Focused-Attention Meditation Combined With Muscle Relaxation (Mr Therapy)-A Direct Treatment Intervention For Sleep Paralysis., 2017 Argosy University
Commentary: How To Make The Ghosts In My Bedroom Disappear? Focused-Attention Meditation Combined With Muscle Relaxation (Mr Therapy)-A Direct Treatment Intervention For Sleep Paralysis., Brian A. Sharpless, Karl Doghramji
Department of Sleep Medicine Faculty Papers
No abstract provided.
Longitudinal Cardiovascular Outcomes Of Sleep Disordered Breathing In Children: A Meta-Analysis And Systematic Review., 2017 Children's Mercy Hospital
Longitudinal Cardiovascular Outcomes Of Sleep Disordered Breathing In Children: A Meta-Analysis And Systematic Review., Zarmina Ehsan, Stacey L. Ishman, Thomas R. Kimball, Nanhua Zhang, Yuanshu Zou, Raouf S. Amin
Manuscripts, Articles, Book Chapters and Other Papers
Objectives: The presence of sleep disordered breathing (SDB) is known to impact long-term cardiovascular morbidity in adults; however, the long-term effects in children are poorly understood. We aimed to systematically review and synthesize studies published to date on the long-term effects of SDB in children.
Study Design: Meta-analysis and systematic review using PubMed, CINAHL, Embase, and Scopus (all indexed years).
Methods: We searched for English-language articles containing original human data from prospective studies, with ≥7 participants, in children ≤18 years of age. Data regarding study design, demographics, clinical characteristics, outcomes, level of evidence, and risk of bias were obtained. Articles …
Consequences Of Untreated Obstructive Sleep Apnea, 2017 Touro College
Consequences Of Untreated Obstructive Sleep Apnea, Binyamin S. Kanter
The Science Journal of the Lander College of Arts and Sciences
Over the past few years, awareness of the prevalence of obstructive sleep apnea has significantly increased. Indeed, sleep apnea may be more common now with the increasing incidence of obesity and the growing number of elderly individuals in our population. How serious is this condition, and what are the potential long-term effects and consequences of obstructive sleep apnea if left untreated? An overlap of many serious conditions with obstructive sleep apnea has been noticed. These conditions include hypertension, heart disease and failure, stroke, diabetes, neurological diseases, depression, and a number of other serious health concerns. The purpose of this paper …
Is Suvorexant (Belsomra) Effective In Reducing Wakefulness After Sleep Onset In Healthy Patients Diagnosed With Insomnia?, 2017 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 …
Law-Based Arguments And Messages To Advocate For Later School Start Time Policies In The United States, 2017 University of Maryland Center for Health & Homeland Security
Law-Based Arguments And Messages To Advocate For Later School Start Time Policies In The United States, Clark J. Lee, Dennis M. Nolan, Steven W. Lockley, Brent Pattison
Homeland Security Publications
The increasing scientific evidence that early school start times are harmful to the health and safety of teenagers has generated much recent debate about changing school start times policies for adolescent students. Although efforts to promote and implement such changes have proliferated in the United States in recent years, they have rarely been supported by law-based arguments and messages that leverage the existing legal infrastructure regulating public education and child welfare in the United States. Furthermore, the legal bases to support or resist such changes have not been explored in detail to date. This article provides an overview of how …
Effects Of Screen Light Filtering Software On Sleep And Morning Alertness, 2017 Central Washington University
Effects Of Screen Light Filtering Software On Sleep And Morning Alertness, Hengyu Chi
All Master's Theses
Research has shown that blue light can impact the circadian rhythm. Research has also suggested that use of electronic devices, such as computers and televisions that emit blue light before sleep, can negatively impact sleep quality. This research has led to the creation of computer software which lowers the levels of blue light in the evening to help with sleep. This study looked at the impact of wavelength filtering software on sleep onset, sleep duration and subjective alertness after morning waking of four college students. The college students were randomized into two groups and had the wavelength filtering software f.lux …
Improving The Adherence Of Providers To The American Academy Of Sleep Medicine Guidelines For The Evaluation, Treatment, And Management Of Obstructive Sleep, 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 guidelines. Provider …
Age-Related Effect Of Viral-Induced Wheezing In Severe Prematurity, 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 …
Healthy Living An In-Depth Look, 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, 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
Dartmouth Scholarship
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% of respondents …
Does A Short, Thick Neck Predict Obstructive Sleep Apnea?: The Role Of Physical Examination In Osa Screening, 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 …
Sleep: A Human Rights Issue, 2016 University of Maryland Center for Health & Homeland Security
Sleep: A Human Rights Issue, Clark J. Lee
Homeland Security Publications
Recognition of sleep as a human rights issue by governmental and legal entities (as illustrated by recent legal cases in the United States and India) raises the profile of sleep health as a societal concern. Although this recognition may not lead to immediate public policy changes, it infuses the public discourse about the importance of sleep health with loftier ideals about what it means to be human. Such recognition also elevates the work of sleep researchers and practitioners from serving the altruistic purpose of improving human health at the individual and population levels to serving the higher altruistic purpose of …
Do Pressure Requirements Change Over Time With Auto Titrating Positive Airway Pressure Therapy For Obstructive Sleep Apnea?, 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 …
Severe Obesity Hypoventilation Syndrome Treated With Auto-Cpap, 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 …
Hypoglossal Nerve Stimulation Therapy In Obstructive Sleep Apnea, 2015 University of North Dakota
Hypoglossal Nerve Stimulation Therapy In Obstructive Sleep Apnea, Taylor Fontaine
Physician Assistant Scholarly Project Posters
• Obstructive sleep apnea (OSA) is a disorder that results in loud snoring, gasping respirations, and excessive daytime sleepiness.
• OSA also has the potential to progress to other significant diseases such as hypertension, diabetes mellitus, stroke, and pulmonary hypertension.
• Continuous positive airway pressure (CPAP) has been the first line treatment for OSA since the early 1980’s. Unfortunately, despite the ability of CPAP to significantly improve symptoms of OSA, a large amount of patients struggle to comply with this treatment.
• A new alternative treatment for OSA is hypoglossal nerve stimulation therapy (HGNS), resulting in an increase in muscle …
Implementing A Screening Pathway For Identifying Patients At Risk For Obstructive Sleep Apnea In Primary Care, 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 …