1,721,424 research outputs found
Reply to Comments on ‘Sleep Disordered Breathing and Periodic Limb Movements in Patients with Narcolepsy with Cataplexy'
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Organisation of sleep medicine centres
No full textSleep medicine centres (SMCs) provide integrative multidisciplinary care to patients with diverse sleep complaints. To be fully operational, it is necessary that the SMC is an independent entity within the healthcare organization to which it belongs. A multidisciplinary team of medical specialists and other practitioners is in charge of the regular healthcare for patients from different age groups.
The SMC is led by a medical director who is a medical specialist and certified somnologist. The SMC elaborates dedicated diagnostic and therapeutic services in which sleep nurses, technologists and secretaries are involved. Structural facilities of the SMC include recording equipment and adequate housing for the performance of in-laboratory sleep testing. To this end, suitable bedrooms and a monitoring room are employed. In addition, the SMC provides facilities for outpatient consultations and for portable testing. The SMC warrants high quality services with a focus on patients’ convenience. In this light, necessary amenities for efficient contacts with the healthcare team and for relevant information exchange are provided on a routine basis. The SMC is responsible for the development and maintenance of standardized procedures related to regular patient care. Such protocols must be made available for all the care programmes that are implemented in the SMC. Furthermore, the SMC must designate protocols for safety, emergency procedures and quality assurance.
Accreditation of SMCs is important to assure that quality criteria for optimal patient care are met. Currently, accreditation procedures are operational in several European countries. Accreditation of sleep training centres is a particular challenge for the future, as structured education and practical training are vital for the further development of sleep medicine in Europe.
Facilities for continuous internal and external education should be offered to the team of the SMC. In addition, SMCs (especially those that operate as training centres) should provide formal programmes for trainees (fellows in sleep medicine) and postgraduate education for referring physicians. Academic activities pertaining to education and research define the highest organizational level of an SMC
Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery.
Full text linkBACKGROUND
Sleep-disordered breathing (SDB) and sleep-wake disturbances (SWD) are highly prevalent in stroke patients. Recent studies suggest that they represent both a risk factor and a consequence of stroke and affect stroke recovery, outcome, and recurrence.
METHODS
Review of literature.
RESULTS
Several studies have proven SDB to represent an independent risk factor for stroke. Sleep studies in TIA and stroke patients are recommended in view of the very high prevalence (>50%) of SDB (Class IIb, level of evidence B). Treatment of obstructive SDB with continuous positive airway pressure is recommended given the strength of the increasing evidence in support of a positive effect on outcome (Class IIb, level of evidence B). Oxygen, biphasic positive airway pressure, and adaptive servoventilation may be considered in patients with central SDB. Recently, both reduced and increased sleep duration, as well as hypersomnia, insomnia, and restless legs syndrome (RLS), were also suggested to increase stroke risk. Mainly experimental studies found that SWD may in addition impair neuroplasticity processes and functional stroke recovery. Treatment of SWD with hypnotics and sedative antidepressants (insomnia), activating antidepressants or stimulants (hypersomnia), dopaminergic drugs (RLS), and clonazepam (parasomnias) are based on single case observations and should be used with caution.
CONCLUSIONS
SDB and SWD increase the risk of stroke in the general population and affect short- and long-term stroke recovery and outcome. Current knowledge supports the systematic implementation of clinical procedures for the diagnosis and treatment of poststroke SDB and SWD on stroke units
Prediction of Sleep disordered breathing in acute stroke patients: questionnaires cannot replace Sleep studies
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