Sleep Medicine Commons^™

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 …

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 …

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 …

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 …

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, 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, 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

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 …

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 …

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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 …

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

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, 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 …

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 and …

Later School Start Times In Adolescence: Time For A Change, Paul Kelley, Clark Lee

Homeland Security Publications

This briefing paper summarizes the latest research on the subject of chronic sleep deprivation on education and health in adolescents, explores policy options to address this education and public health issue, and sets forth the recommendation that education start times be adjusted appropriately for U.S adolescents.

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 …

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 …

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 organ-dependent. Lungs …

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.

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 …