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Sleep-Disordered Breathing and Excessive Daytime Sleepiness in Chronic Kidney Disease and Hemodialysis
Article Sleep-Disordered Breathing and Excessive Daytime Sleepiness in Chronic Kidney Disease and Hemodialysis Maria-Eleni Roumelioti,* Daniel J. Buysse,† Mark H. Sanders,‡ Patrick Strollo,‡ Anne B. Newman,§ and Mark L. Unruh* *Renal-Electrolyte Summary Division, University of Background and objectives Sleep-disordered breathing (SDB) and excessive daytime sleepiness (EDS) are Pittsburgh Medical highly prevalent among hemodialysis (HD) patients. It is unclear to what extent SDB is associated with ad- Center, Pittsburgh, Pennsylvania; and vanced chronic kidney disease (CKD; stages 4 to 5). This paper describes and compares the prevalence, se- †Department of verity, and patterns of SDB and EDS among patients with advanced CKD, HD-dependent patients, and Psychiatry, ‡Division of community individuals without known renal disease. Pulmonary, Allergy, and Critical Care Medicine, Department Design, setting, participants, & measurements Eighty-nine CKD and 75 HD patients were compared with of Medicine, and 224 participants from the Sleep-Strategies Concentrating on Risk Evaluation Sleep-SCORE study of sleep §Department of and cardiovascular risk. Participants had in-home unattended polysomnography for quantifying SDB. EDS Epidemiology and was defined by a score Ն10 on the Epworth Sleepiness Scale. Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Results The sample had a median age 58.1 years, was predominantly male (57.4%) and white (62.5%), and Pennsylvania had a median body mass index of 28.1 kg/m2. Controls and Sleep-SCORE Study CKD patients had signifi- cantly higher median total sleep time and sleep efficiency compared with HD patients. The adjusted odds Correspondence: Dr. of severe SDB were higher for CKD and HD groups compared with the controls. -
Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Medical Policy Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 130 BCBSA Reference Number: 7.01.101 Related Policies None Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Uvulopalatopharyngoplasty (UPPP) may be MEDICALLY NECESSARY for the treatment of clinically significant obstructive sleep apnea syndrome (OSAS) in appropriately selected adult patients who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: Apnea/hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. Hyoid suspension, surgical modification of the tongue, and/or maxillofacial surgery, including mandibular- maxillary advancement (MMA), may be MEDICALLY NECESSARY in appropriately selected adult patients with clinically significant OSA and objective documentation of hypopharyngeal obstruction who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: AHI or RDI 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. -
Fact Sheet Number 14
FACT SHEET No. #4 DEEP TIME AND DRAGON DREAMING: THE SUSTAINABLE ABORIGINAL SPIRITUALITY OF THE SONG LINES, FROM CELEBRATION TO DREAMING John Croft update 28th March 2014 This Factsheet by John Croft is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. Permissions beyond the scope of this license may be available at [email protected]. ABSTRACT: It is suggested that in a culture that is suicidal, to get a better understanding of what authentic sustainability is about requires us to see through the spectrum of a different culture. Australian Aboriginal cultures, sustainable for arguably 70,000 years, provide one such useful lens. TABLE OF CONTENTS INTRODUCTION .............................................................................................................................2 AN INTRODUCTION TO ABORIGINAL CULTURE ............................................................................... 4 THE UNSUSTAINABILITY OF CIVILISED CULTURES ........................................................................... 6 DREAMING: AN ALTERNATIVE VIEW OF TIME? ............................................................................. 10 ABORIGINAL DREAMING, DEEP ECOLOGY AND THE ECOLOGICAL SELF ....................................... 17 DREAMING AND SUSTAINABILITY ................................................................................................. 21 DISCOVERING YOUR OWN PERSONAL SONGLINE ......................................................................... 24 _____________________________________________________________________________________D -
1 Assessment and Treatment of Sleep Disturbances Associated With
Dr. William Brim, Deputy Director, Center for Deployment Psychology Assessment and Treatment of Sleep Sleep and Insomnia Basics Disturbances Associated with Deployment Dr. William Brim “I’ll sleep when I’m dead Deputy DIrector ‐Warren Zevon 1 2 Why do we sleep? How is sleep regulated? Inactivity Theory • Also called an adaptive or evolutionary theory • Early scientists believed that gases rising • Sleep serves a survival function and has developed through natural selection • Animals that were able to stay out of harm’s way by being still and quiet during times of vulnerability, from the stomach during digestion brought usually at night…survived Energy Conservation on the transition to sleep. • Related to inactivity theory • Suggests primary function of sleep is to reduce energy demand and expenditure • Research has shown that energy metabolism is significantly reduced during sleep Restorative Aristotle (c350 B.C.) “We awaken when the • Sleep provides an opportunity for the body to repair and rejuvenate • Major restorative functions such as muscle growth, tissue repair, protein synthesis and growth hormone digestive process is complete” release occur mostly or exclusively during sleep Brain Plasticity • One of the most recent theories is based on findings that sleep is correlated to changes in the structure and organization of the brain. • Sleep plays a critical role in brain development with infants and children spending 12‐14 hours a day sleep and a link to adult brain plasticity is becoming clear as well 3 4 14-15 October 2014 1 How is sleep regulated? • Homeostatic sleep drive (Process S) – During wakefulness a drive for sleep builds up that is discharged primarily during sleep “Sleep is a dynamic behavior. -
Move Your Wheelchair with Your Eyes
International Journal of Applied Mathematics, Advanced Technology and Science Electronics and Computers ISSN:2147-82282147-6799 www.atscience.org/IJAMEC Original Research Paper Move Your Wheelchair with Your Eyes Gökçen ÇETİNEL*1, Sevda GÜL2, Zafer TİRYAKİ3, Enes KUZU4, Meltem MİLLİGÜNEY5 Accepted : 12/05/2017 Published: 21/08/2017 DOI: 10.18100/ijamec.2017Special Issue30462 Abstract: In the proposed study, our goal is to move paralyzed people with their eyes. Otherwise, use this document as an instruction set. Paper titles should be written in uppercase and lowercase letters, not all uppercase. For this purpose, we use their Electrooculogram (EOG) signals obtained from EOG goggles completely designed by the authors. Through designed EOG goggles, vertical-horizontal eye movements and voluntary blink detection are verified by using 5 Ag-AgCl electrodes located around the eyes. EOG signals utilized to control wheelchair motion by applying signal processing techniques. The main steps of signal processing phase are pre-processing, maximum-minimum value detection and classification, respectively. At first, pre-processing step is used to amplify and smooth EOG signals. In maximum-minimum value detection we obtain maximum and minimum voltage levels of the eye movements. Furthermore, we determine the peak time of blink to distinguish voluntary blinks from involuntary blinks. Finally, at classification step k-Nearest Neighbouring (k-NN) technique is applied to separate eye movement signals from each other. Several computer simulations are performed to show the effectiveness of the proposed EOG based wheelchair control system. According to the results, proposed system can communicate paralyzed people with their wheelchair and by this way they will be able to move by their selves. -
Electroretinography 1 Electroretinography
Electroretinography 1 Electroretinography Electroretinography measures the electrical responses of various cell types in the retina, including the photoreceptors (rods and cones), inner retinal cells (bipolar and amacrine cells), and the ganglion cells. Electrodes are usually placed on the cornea and the skin near the eye, although it is possible to record the ERG from skin electrodes. During a recording, the patient's eyes are exposed to standardized stimuli and the resulting signal is displayed showing the time course of the signal's Maximal response ERG waveform from a dark adapted eye. amplitude (voltage). Signals are very small, and typically are measured in microvolts or nanovolts. The ERG is composed of electrical potentials contributed by different cell types within the retina, and the stimulus conditions (flash or pattern stimulus, whether a background light is present, and the colors of the stimulus and background) can elicit stronger response from certain components. If a flash ERG is performed on a dark-adapted eye, the response is primarily from the rod system and flash ERGs performed on a light adapted eye will reflect the activity of the cone system. To sufficiently bright flashes, the ERG will contain an A patient undergoing an electroretinogram a-wave (initial negative deflection) followed by a b-wave (positive deflection). The leading edge of the a-wave is produced by the photoreceptors, while the remainder of the wave is produced by a mixture of cells including photoreceptors, bipolar, amacrine, and Muller cells or Muller glia.[1] The pattern ERG, evoked by an alternating checkerboard stimulus, primarily reflects activity of retinal ganglion cells. -
Procedure Manual for Polysomnography
Procedure Manual for Polysomnography The PSG Reading Center Case Western Reserve University Triangle Building 11400 Euclid Avenue Suite 260 Cleveland, Ohio 44106 January 7-9, 2002 (Rev. 8/20/02) Table of Contents 1.0 INTRODUCTION 1.1 Definition of Sleep Apnea 1.2 Polysomnography 1.2.1 Signal Types 1.2.2 Sleep Stages 1.2.3 Respiratory Monitoring - Measurement Tools 1.3 Home Polysomnography - Sleep System 1.4 Glossary of Sleep Terms 2.0 HOME POLYSOMNOGRAPHY (PSG) 2.1 Supply List 2.1.1 Understanding the Electrode 2.1.1.1 Gold disks - Cleaning, Disinfecting, Conditioning 2.1.2 Cleaning and Disinfecting Other Sensors and Equipment 2.2 Preparation Pre-Visit Hook-up 2.3 Detailed Hookup Procedures 2.3.1 Setting Up in the Home 2.3.2 Sensor Placement Step 1: ECG Electrodes Step 2: Respiratory Bands Step 3: EEG Scalp Electrodes Preparation of Electrode Sites Attaching Gold Electrodes Step 4: Position Sensor Step 5: Oximier Step 6: Nasal Cannula Step 7: Thermistor Step 8 Leg Sensors 2.4 Checking Impedances and Signal Quality 2.4.1 Verify Connections and Auto Start On 2.4.2 Impedance Checks (Signal Verification Form - SV) 2.4.3 View Signals 2.5 Final Instructions to Participant and Morning After Procedures 2.6 Troubleshooting Equipment and Signal Quality 3.0 PSG DATA COLLECTION PROCEDURES 3.1 Compumedics Programs Used for Data Collection 3.1.1 Data Card Manager (Setting up Flashcard) 3.1.2 Net Beacon (PSG on Line) 3.1.3 Profusion Study Manager 3.1.4 Profusion PSG 3.2 PSG Sleep Data Retrieval Procedures 3.3 Backup Studies to Zip Cartridges 3.4 Review -
Assessment and Management of Infantile Nystagmus Syndrome
perim Ex en l & ta a l ic O p in l h t C h f Journal of Clinical & Experimental a o l m l a o n l r o Atilla, J Clin Exp Ophthalmol 2016, 7:2 g u y o J Ophthalmology 10.4172/2155-9570.1000550 ISSN: 2155-9570 DOI: Review Article Open Access Assessment and Management of Infantile Nystagmus Syndrome Huban Atilla* Department of Ophthalmology, Faculty of Medicine, Ankara University, Turkey *Corresponding author: Huban Atilla, Department of Ophthalmology, Faculty of Medicine, Ankara University, Turkey, Tel: +90 312 4462345; E-mail: [email protected] Received date: March 08, 2016; Accepted date: April 26, 2016; Published date: April 29, 2016 Copyright: © 2016 Atilla H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract This article is a review of infantile nystagmus syndrome, presenting with an overview of the physiological nystagmus and the etiology, symptoms, clinical evaluation and treatment options. Keywords: Nystagmus syndrome; Physiologic nystagmus phases; active following of the stimulus results in poor correspondence between eye position and stimulus position. At higher velocity targets Introduction (greater than 100 deg/sec) optokinetic nystagmus can no longer be evoked. Unlike simple foveal smooth pursuit, OKN appears to have Nystagmus is a rhythmic, involuntary oscillation of one or both both foveal and peripheral retinal components [3]. Slow phase of the eyes. There are various classifications of nystagmus according to the nystagmus is for following the target and the fast phase is for re- age of onset, etiology, waveform and other characteristics. -
Pitt+Me Online Study Advertisement
PITT+ME ONLINE STUDY ADVERTISEMENT Pitt+Me Title SIESTA: Solving Insomnia Electronically: Sleep Treatment for AGE: 18-75 Asthma GENDER: M/F VISITS: 3 Study Basics (400 character limit) DURATION: 8 months Do you have asthma and insomnia? Are you 18-75 years old? If so, you may be able to take part in a research study to find out if LOCATION: insomnia treatment can reduce both sleep problems and asthma University of Pittsburgh symptoms. Compensation provided. Asthma Institute at UPMC Montefiore Hospital Study Purpose (Oakland) Asthma is a chronic condition that causes swelling and inflammation of the airways, making it difficult to breathe. Many people who have asthma also have insomnia (trouble sleeping). Research has shown that insomnia can worsen a person’s asthma and increase the risk of having an asthma attack. The purpose of this study is to help researchers find out if an online behavioral treatment for insomnia can help improve sleep and asthma control in adults with asthma and sleep problems. Could This Study Be Right for You? • Ages 18-75 • Have asthma and are using an inhaled asthma medication COMPENSATION: such as Qvar, Flovent, Asmanex, Advair, Symbicort, or Up to $250 Dulera • Have insomnia (trouble sleeping) • Have an email address with reliable internet access • Are a non-smoker or quit smoking at least one year ago What Participants Can Expect (1500 character limit) Participation involves 3 in-person visits lasting about 2 hours each. STUDY LOGO: At the first visit, you will complete questionnaires, lung function testing, an exhaled nitric oxide test, and a blood draw. -
Surgical Treatments for Obstructive Sleep Apnea (OSA) Policy Number: PG0056 ADVANTAGE | ELITE | HMO Last Review: 06/01/2021
Surgical Treatments for Obstructive Sleep Apnea (OSA) Policy Number: PG0056 ADVANTAGE | ELITE | HMO Last Review: 06/01/2021 INDIVIDUAL MARKETPLACE | PROMEDICA MEDICARE PLAN | PPO GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder terms, conditions, exclusions and limitations contract. It does not constitute a contract or guarantee regarding coverage or reimbursement/payment. Self-Insured group specific policy will supersede this general policy when group supplementary plan document or individual plan decision directs otherwise. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to assist in making coverage decisions and administering benefits. SCOPE X Professional _ Facility DESCRIPTION Sleep apnea is a disorder where breathing nearly or completely stops for periods of time during sleep. In obstructive sleep apnea (OSA), the brain sends the message to breathe, but there is a blockage to air flowing into the chest. It is a condition in which repetitive episodes of upper airway obstruction occur during sleep. The obstruction may be localized to one or two areas, or may encompass the entire upper airway passages to include the nasal cavity (nose), oropharynx (palate, tonsils, tonsillar pillars) and hypopharynx (tongue base). The hallmark symptom of OSA is excessive daytime sleepiness, and the typical clinical sign of OSA is snoring, which can abruptly cease and be followed by gasping associated with a brief arousal from sleep. The snoring resumes when the patient falls back to sleep, and the cycle of snoring/apnea/arousal may be repeated as frequently as every minute throughout the night. -
32 Surgical Treatment of Sleep-Related Breathing Disorders Donald M
32 Surgical Treatment of Sleep-Related Breathing Disorders Donald M. Sesso Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A. Nelson B. Powell and Robert W. Riley Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center and Department of Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, California, U.S.A. INTRODUCTION Snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obstructive sleep apnea-hypopnea syndrome (OSAHS) are collectively referred to as sleep- related breathing disorders (SRBD). These terms describe a partial or complete obstruction of the upper airway during sleep. Patency of the pharyngeal airway is maintained by two opposing forces: negative intraluminal pressure and the activity of the upper airway musculature. Anatomical or central neural abnormalities can disrupt this delicate balance and result in compromise of the upper airway. This reduction of airway caliber may cause sleep fragmentation and subsequent behavioral derangements, such as excessive daytime sleepiness (EDS) (1–3). The goal of medical and surgical therapy is to alleviate this obstruction and increase airway patency. The first therapeutic modality employed to treat SRBD was surgery. Kuhlo described placement of a tracheotomy tube in an attempt to bypass upper airway obstruction in Pickwickian patients (4). Although effective, tracheotomy does not address the specific sites of pharyngeal collapse and is not readily accepted by most patients. These sites include the nasal cavity/nasopharynx, oropharynx, and hypopharynx. Often, multilevel obstruction is present. Consequently, the surgical armamentarium has evolved to create techniques that correct the specific anatomical sites of obstruction. -
Parasomnias: a Comprehensive Review
Open Access Review Article DOI: 10.7759/cureus.3807 Parasomnias: A Comprehensive Review Shantanu Singh 1 , Harleen Kaur 2 , Shivank Singh 3 , Imran Khawaja 1 1. Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA 2. Neurology, Univeristy of Missouri, Columbia, USA 3. Internal Medicine, Maoming People's Hospital, Maoming, CHN Corresponding author: Harleen Kaur, [email protected] Abstract Parasomnias are a group of sleep disorders characterized by abnormal, unpleasant motor verbal or behavioral events that occur during sleep or wake to sleep transitions. Parasomnias can occur during non- rapid eye movement (NREM) and rapid eye movement (REM) stages of sleep and are more commonly seen in children than the adult population. Parasomnias can be distressful for the patient and their bed partners and most of the time, these complaints are brought up by their bed partners because of the possible disruption in their quality of sleep. As clinicians, it is crucial to understand the characteristics of various parasomnias and address them with detailed sleep history and essential diagnostic approach for proper evaluation. The review aims to highlight the epidemiology, pathophysiology and clinical features of various types of parasomnias along with the appropriate diagnostic and pharmacological approach. Categories: Internal Medicine, Neurology, Psychiatry Keywords: parasomnia, sleep walking, confusional arousals, sleep terror, nightmares, rem behavior disorder, sleep paralysis, rem parasomnias, nrem parasomnias Introduction And Background Parasomnias are a group of sleep disorders that are characterized by abnormal, unpleasant motor, verbal or behavioral events that occur during sleep or wake to sleep transitions [1]. The term ‘parasomnia’ was first coined by a French researcher Henri Roger in 1932 [2].