1,194 research outputs found
Characterisation of cyclic alternating pattern during sleep in older men and women using large population studies
No full textTo assess the microstructural architecture of non-rapid eye movement (NREM) sleep known as cyclic alternating pattern (CAP) in relation to the age, gender, subjective sleep quality and the degree of sleep disruption in large community-based cohort studies of older people
Cyclic alternating pattern in children with obstructive sleep apnea and its relationship with adenotonsillectomy, behavior, cognition, and quality of life
No full textStudy Objectives: To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy (AT) on the cyclic alternating pattern (CAP) and the relationship between CAP and behavioral, cognitive, and quality-of-life measures.
Methods: CAP parameters were analyzed in 365 overnight polysomnographic recordings of children with mild-to-moderate OSA enrolled in the Childhood Adenotonsillectomy Trial (CHAT), randomized to either early AT (eAT) or watchful waiting with supportive care (WWSC). We also analyzed CAP in a subgroup of 72 children with moderate OSA (apnea–hypopnea index > 10) that were part of the CHAT sample. Causal mediation analysis was performed to determine the independent effect of changes in CAP on selected outcome measures.
Results: At baseline, a higher number of A1 phases per hour of sleep was significantly associated with worse behavioral functioning (caregiver Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC): ρ = 0.24, p = 0.042; caregiver Conners’ Rating Scale Global Index: ρ = 0.25, p = 0.036) and lower quality of life (OSA-18: ρ = 0.27, p = 0.022; PedsQL: ρ = −0.29, p = 0.015) in the subgroup of children with moderate OSA, but not across the entire sample. At 7-months follow-up, changes in CAP parameters were comparable between the eAT and WWSC arms. CAP changes did not account for significant proportions of variations in behavioral, cognitive, and quality-of-life performance measures at follow-up.
Conclusions: We show a significant association between the frequency of slow, high-amplitude waves with behavioral functioning, as well as the quality of life in children with moderate OSA. Early AT in children with mild-to-moderate OSA does not alter the microstructure of nonrapid eye movement sleep compared with watchful waiting after an approximately 7-month period of follow-up
Association between psychotropic medication and sleep microstructure: evidence from large population studies
No full textStudy objectives: To assess the association between psychotropic medications and sleep microstructure in large community-based cohorts of older people. Methods: We analyzed overnight polysomnograms of 381 women from the Study of Osteoporotic Fractures (SOF) and 2,657 men from the Osteoporotic Fractures in Men Sleep Study (MrOS), who either used no psychotropic medication (n=2,819), only benzodiazepines (n=112), or only selective serotonin reuptake inhibitors (SSRI) (n=107). Sleep microstructure (cyclic alternating pattern, CAP) was compared between the no medication group and psychotropic medication groups using the Mann-Whitney U-test. Significant differences were investigated using multivariable linear regression adjusted for confounders. Results: CAP rate, arousal index, apnea-hypopnea index, and the frequency of slow, low-amplitude electroencephalography activation phases were significantly lower in MrOS participants using benzodiazepines than participants not taking psychotropic medication. SSRI users in MrOS experienced no altered sleep microstructure compared to those with no psychotropic use. SOF participants using benzodiazepines did not show similar associations with sleep microstructure. However, SSRI users from SOF had a significantly higher frequency of rapid, high-amplitude electroencephalography activation phases (A2 + 3) and periodic limb-movement index than participants not taking psychotropic medication. Multivariable linear regression adjusted for demographic, lifestyle, mood disorders, and health variables indicated additional significant associations between CAP rate and A2 + 3 index, respectively, and benzodiazepine usage in older men, and between CAP rate and SSRI usage in older women. Conclusions: We identified significant associations between sleep microstructure and psychotropic drugs in MrOS and SOF highlighting the importance of comprehensive sleep analysis, including CAP. Our results may help to better understand the differences in sleep-wake mechanisms based on psychotropic usage. Clinical trial registration: Registry: ClinicalTrials.gov; Title: Outcomes of Sleep Disorders in Older Men; Identifier: NCT00070681; URL: https://clinicaltrials.gov/ct2/show/record/NCT00070681
Rigorous performance evaluation (previously, “validation”) for informed use of new technologies for sleep health measurement
No full textNew sleep technologies have become pervasive in the consumer space, and are becoming highly common in research and clinical sleep settings. The rapid, widespread use of largely unregulated and unstandardized technology has enabled the quantification of many different facets of sleep health, driving scientific discovery. As sleep scientists, it is our responsibility to inform principles and practices for proper evaluation of any new technology used in the clinical and research settings, and by consumers. A current lack of standardized methods for evaluating technology performance challenges the rigor of our scientific methods for accurate representation of the sleep health facets of interest. This special article describes the rationale and priorities of an interdisciplinary effort for rigorous, standardized, and rapid performance evaluation (previously, “validation”) of new sleep and sleep disorders related technologies of all kinds (eg, devices or algorithms), including an associated article template for a new initiative for publication in Sleep Health of empirical studies systematically evaluating the performance of new sleep technologies. A structured article type should streamline manuscript development and enable more rapid writing, review, and publication. The goal is to promote rapid and rigorous evaluation and dissemination of new sleep technology, to enhance sleep research integrity, and to standardize terminology used in Rigorous Performance Evaluation papers to prevent misinterpretation while facilitating comparisons across technologies
Sleep apnea cardiovascular clinical trials-current status and steps forward: the International Collaboration of Sleep Apnea Cardiovascular Trialists
No full textSleep apnea is a common chronic disease that is associated with coronary heart disease, stroke, heart failure and mortality, although the ability of sleep apnea treatment to reduce cardiovascular morbidity and mortality has not been demonstrated. In contrast to patients seeking treatment in sleep disorders centers, as many as half of individuals with moderate to severe sleep apnea in the general population do not report excessive sleepiness; however, if treatment of sleep apnea were shown to reduce cardiovascular disease risk, this would provide a strong rationale for treatment of sleep apnea even in the absence of daytime sleepiness. This article summarizes the status of clinical trials evaluating the potential cardiovascular benefits of sleep apnea treatment and discusses the challenges of conducting such trials, and introduces the International Collaboration of Sleep Apnea Cardiovascular Trialists (INCOSACT), a clinical research collaboration formed to foster cardiovascular sleep research.Daniel J. Gottlieb, Sonya E. Craig, Geraldo Lorenzi-Filho, Emma Heeley, Susan Redline, R. Doug McEvoy and Joaquín Durán-Cantoll
Age is the only predictor of small decrease in lung function in children with sickle cell anemia
No full textThe longitudinal pattern of lung function in children with sickle cell anemia (SCA) has shown a decrease in FEV1 % predicted, a risk factor for death in adults with SCA, but predictors for this decline are poorly characterized. In a prospective longitudinal multi-center cohort of children with SCA, we tested the hypotheses that: 1) FEV1 % predicted declines over time; and 2) SCA-specific characteristics and therapy predict this decline. At three clinical centers, children with SCA (HbSS or HbSβ0 thalassemia), unselected for respiratory disease, were enrolled in the Sleep and Asthma Cohort (SAC) study. Study-certified pulmonary function technicians performed spirometry and lung volumes. Each assessment was reviewed centrally. Predicted values were determined for TLC, FEV1 , FVC, and FEV1 /FVC ratio. A total of 197 participants, mean age 11.0 years at first testing (range 4-19.3 years), had a minimum of three spirometry measurements an average of 4.4 years (range 1.08-6.5 years) from baseline to endpoint. In a multivariable model, FEV1 % predicted declines by 0.3% for every additional year of age (95% CI -0.56 - -0.05, p=0.020). Sex, asthma history, hemoglobin, reticulocyte count, white blood cell count, incidence rate of severe acute pain and acute chest syndrome episodes, and hydroxyurea therapy were not associated with a decline in FEV1 % predicted. In a large rigorously evaluated, prospective cohort of an unselected group of children with SCA, FEV1 % predicted declines minimally over an average of 4 years, and none of the examined disease features predict the decline
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Sleep Duration, Diet Quality and Type 2 Diabetes
No full textType 2 diabetes has reached epidemic proportions globally, and accumulating evidence suggests extremes of sleep duration increase risk. Diet may be an important mechanism, yet few studies examine prospective relationships of sleep duration and diet quality or whether diet explains associations of sleep duration with childhood obesity or diabetes in adults. In Chapter One, we report a moderate correlation between self-reported sleep duration and actigraphy in Sueño, the sleep ancillary study to the Hispanic Community Health Study/Study of Latinos. Chapter Two identifies associations of chronic insufficient sleep duration since infancy with lower diet quality in mid-childhood in Project Viva: children with the least favorable diet and sleep have the highest body mass index z-scores in mid-childhood, but diet does not explain associations with adiposity. In Chapter Three, adherence to healthful dietary patterns reduces risk of diabetes in the Women’s Health Initiative; high quality diets are protective in all groups, but race/ethnicity modifies associations. In Chapter Four, we find that changes in sleep duration, increases in particular , are associated with diabetes and concomitant changes in diet quality, physical activity and weight in the Nurses’ Health Study. Each of these studies contributes new knowledge: Sueño represents the largest sleep validation to date, the only validation among Hispanic/Latinos and allows researchers to better understand the information contained in (and the limitations of) self-reported measures of sleep duration within subgroups. In the Women’s Health Initiative, we address limitations of the current literature on dietary patterns by calculating four dietary indices within the same cohort, standardizing the scores for comparison and examining associations across racial/ethnic groups. Project Viva is the first study to examine the influence of chronic insufficient sleep on diet quality in childhood when health behaviors and dietary preferences are being formed. Finally, examining changes in sleep duration and changes in diet quality, physical activity and weight in the Nurses’ Health Study represents a novel way to leverage repeated assessments. Results of this dissertation may help build the case for policy and intervention efforts to prevent and treat obesity and diabetes, particularly those that seek to improve both sleep and diet.Nutritionsleep duration; obesity; childhood obesity; Diet; diabetes; dietary patterns; change in sleep; Mediterranean diet; Alternate Healthy Eating Index; Dietary Approaches to Stop Hypertensio
Stability of polysomnography for one year and longer in children with sickle cell disease
No full textStudy Objectives: Serious morbidity may be linked to sleep disordered breathing (SDB) among children with sickle cell disease (SCD). We investigated the stability of polysomnography (PSG) results among children not having acute complications of SCD. Methods: Two PSGs were performed on a subsample of 63 children 4 to 18 years of age from the Sleep and Asthma Cohort Study. All had Hb SS or HbSβ0 disease. Two PSGs were compared for 45 subjects. Excluded from comparison were 18 children who had begun transfusions or hydroxyurea, had an adenotonsillectomy between the PSGs, or had a pain crisis or the acute chest syndrome within 3 months of the second PSG. Sleep disordered breathing was identifi ed using 2 thresholds for the apnea hypopnea index (AHI): ≥ 2 or ≥ 5 respiratory events per hour. Results: Ages were 12.3 yrs ± 4.0, BMI, 18.2 ± 3.2. Interval between PSGs was 581 ± 119 days (19.1 ± 3.9 months). Ten of 45 changed from ≥ 2 events per hour to < 2; 3 of 45 from < 2 to ≥ 2; 7 of 45 had ≥ 2 on both nights. Six of 45 changed from ≥ 5 to < 5, 2 of 45 from < 5 to ≥ 5, and 1 had ≥ 5 on both nights (McNemar χ2, p = 0.09, and p = 0.29). Conclusions: In the absence of acute SCD complications, overnight PSG usually remains stable or improves over a 12- to 30-month period. Only 6.7% subjects, or fewer, had AHI on a subsequent PSG that would re-classify the child as having SDB not identifi ed in the earlier PSG.</p
The Long Run E�������ects of De Jure Discrimination in the Credit Market: How Redlining Increased Crime
No full textPublicFinance|Retirement_SavingsToday in the United States, the welfare costs of crime are disproportionately borne by individuals living in predominately African-American or Hispanic neighborhoods. This paper by author John Anders shows that redlining practices established in the wake of the Great De-pression make present-day contributions to this inequity. In particular, an unannounced population cuto������� is used that determined which cities were redline-mapped to show that redline-mapping increased present-day city-level crime. Channels though which redline-mapping in�������uenced crime include increasing racial segregation, decreasing educational attainment and harming housing markets
Blonde Indian: Manuscript, Author's Notes, and Correspondence
No full textItem 1. Author's notes on structure --
Item 2. Draft versions of Acknowledgements, Book Summary and About the Author sections -- Item 3. Draft version of portion of "The Bog" section -- Item 4. Completed manuscript appraisal forms from reviewers -- Item 5. Letter from Ernestine Hayes to University of Arizona Press -- Item 6. Letter from editor at University of Arizona Press to Hayes -- Item 7. Copyedited "redline" manuscript sent to Ernestine Hayes in September 2005, with publisher's suggested edits shown in-line and comments from author's proofreader in margins: part 1, pages 1-58 -- Item 8. Copyedited "redline" manuscript: part 2, pages 59-92 -- Item 9. Copyedited "redline" manuscript: part 3, pages 93-156 -- Item 10. Copyedited "redline" manuscript: part 4, pages 157-217 -- Item 11. Letter from Hayes to editor, University of Arizona Press
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