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Timothy J Craig - One of the best experts on this subject based on the ideXlab platform.
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the role of pseudoephedrine on Daytime somnolence in patients suffering from perennial allergic rhinitis par
Annals of Allergy Asthma & Immunology, 2011Co-Authors: Amir Sherkat, Erik Lehman, Niti Sardana, Sahar Safaee, Timothy J CraigAbstract:Background Allergic rhinitis is one of several inflammatory diseases affecting the nasal mucosa. Cellular inflammation of nasal mucosa is a hallmark of this disease and is characterized by the accumulation of eosinophils and the release of various chemical messengers such as chemokines, cytokines, and histamine. This inflammation of the nose leads to nasal congestion and a reduction in sleep quality, resulting in Daytime somnolence. Objective Drugs that significantly reduce the symptoms of nasal congestion also may help in alleviating sleep-related symptoms of allergic rhinitis. Pseudoephedrine is a sympathomimetic amine that is indicated for treatment of nasal congestion associated with allergic rhinitis. Despite relieving nasal congestion, we speculated that, because of pseudoephedrine's well-known stimulant profile, sleep would not be improved. Method Fourteen subjects who met the inclusion criteria were enrolled into a double-blind, placebo-controlled, randomized study to either pseudoephedrine or placebo once per day in the morning, using the traditional crossover design. Skin testing test was performed to ensure a positive response to a relevant perennial allergen and a negative response to a seasonal allergen. Several questionnaires were used to evaluate the patients' sleep-related symptoms, allergic rhinitis symptoms, and quality of life. Results Our results showed that pseudoephedrine did not have a positive or negative effect on quality of sleep, Daytime sleepiness, or Daytime Fatigue as compared with placebo. Pseudoephedrine did show a statistical significance in improving stuffy nose ( P = .0172). With respect to quality of life, pseudoephedrine led to a statistically significant decrease in intimate relationships and sexual activity as compared with the placebo group ( P = .0310). Conclusion Our research suggests that sleep quality is not significantly affected by pseudoephedrine. As expected, congestion is reduced, but side effects such as a decline of intimate relationships and sexual activity may interfere with quality of life.
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the role of montelukast on perennial allergic rhinitis and associated sleep disturbances and Daytime somnolence
Allergy and Asthma Proceedings, 2008Co-Authors: Carah B Santos, Christopher Hanks, Jeffrey Mccann, E L Pratt, Erik Lehman, Timothy J CraigAbstract:: Perennial allergic rhinitis (PAR) often causes sleep disturbances and associated Daytime somnolence, thus resulting in a poor quality of life. Various clinical interventions in patients suffering from the disorder seek to improve symptoms and quality of life. Additional studies are needed to establish whether the alleviation of PAR symptoms, particularly the reduction of congestion, will improve sleep quality and reduce Daytime somnolence. This study seeks to determine whether treatment with montelukast is more effective than placebo in reducing nasal congestion and sleep disturbances, resulting in reduced Daytime somnolence and Fatigue in patients with PAR. Thirty-one subjects were enrolled in a double-blinded, placebo-controlled study using Balaam's design. Patients were treated with montelukast or placebo. Collected subjective data included a daily diary recording nasal symptoms, sleep issues, and Daytime Fatigue, the Functional Outcomes of Sleep Questionnaire, the Epworth Sleepiness Scale, Juniper's Rhinoconjunctivitis Quality of Life Questionnaire, the Rhinitis Severity Scale, the Calgary Sleep Apnea Quality of Life Index, and Trail Making tests. Subjects treated with montelukast, compared with placebo, showed a statistically significant improvement in Daytime somnolence (p = 0.0089) and Daytime Fatigue (p = 0.0087), with both factors improving with montelukast and worsening with placebo. In a small cohort of subjects, montelukast, when compared with placebo, improved the symptoms of PAR and reduced the Fatigue and Daytime somnolence associated with the disorder.
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the effect of intranasal steroid budesonide on the congestion related sleep disturbance and Daytime somnolence in patients with perennial allergic rhinitis
Allergy and Asthma Proceedings, 2005Co-Authors: F Gurevich, Casey Glass, Jeffery Mccann, L H Fisher, Salman Chegini, Cathy Mende, Michael J. Davies, Timothy J CraigAbstract:Abstract Patients with perennial allergic rhinitis (PAR) often present with nasal congestion, poor sleep, Daytime Fatigue, and Daytime somnolence. Pharmacologic therapy that reduces nasal congestion should improve the PAR patients' sleep quality and reduce Daytime somnolence and Fatigue. Our hypothesis is that intranasal steroid budesonide (BUD), an effective topical anti-inflammatory agent, will reduce nasal congestion and improve the patients' quality of life. The objective of this study was to determine whether topical steroid BUD improves sleep, Daytime somnolence, and Fatigue in patients with PAR. Twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray BUD or placebo. The Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, Daytime somnolence, and Fatigue. The results were summarized and compared by PROC MIXED in SAS. The daily diary data showed significant improvement in self-reported nasal congestion (p = 0.04) and Daytime sleepiness (p = 0.01) and a trend in reduction of Daytime Fatigue (p = 0.08) in the BUD group compared with the placebo group. The sleep measures showed statistically significant improvement in total sleep measures score (p = 0.04), "sleep compared with absolute" (p = 0.01), and "refreshing and restorative" sleep (p = 0.04) in the active group. Nasal corticosteroid BUD is effective in reducing nasal congestion, Daytime somnolence, and Daytime Fatigue, and improving sleep quality in PAR.
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the effect of intranasal steroid budesonide on sleep disturbance and Daytime somnolence in patients with perennial allergic rhinitis
The Journal of Allergy and Clinical Immunology, 2004Co-Authors: Timothy J Craig, F Gurevich, Casey Glass, W Wei, Erik LehmanAbstract:Abstract Rationale The objective of this study was to determine whether intranasal corticosteroid budesonide reduced complaints of nasal congestion, poor sleep, Daytime Fatigue, and somnolence in patients with perennial allergic rhinitis (PAR). Methods Following IRB approval, twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray budesonide or placebo. Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, Daytime somnolence, and Fatigue. The results were summarized and compared by PROC MIXED in SAS. Results The daily diary data showed significant improvement in nasal congestion (p=0.04) and Daytime sleepiness (p=0.01), and marginally significant reduction in Daytime Fatigue (p=0.08) in the budesonide group compared to the placebo group. The sleep measures demonstrated statistically significant improvement in total sleep measures score (p=0.04), "sleep compared with absolute" (p=0.01), and "refreshing and restorative" sleep (p=0.04) in the active group. Conclusions Nasal corticosteroid budesonide is effective in reducing nasal congestion, Daytime somnolence, and Daytime Fatigue, and improving sleep quality and the PAR patients' quality of life.
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efficacy of the topical nasal steroid budesonide on improving sleep and Daytime somnolence in patients with perennial allergic rhinitis
Allergy, 2003Co-Authors: Kathleen Hughes, F Gurevich, Casey Glass, L H Fisher, Michael Ripchinski, T E Weaver, Erik Lehman, Timothy J CraigAbstract:Background: Improving quality of life is considered to be a major endpoint and motivation for clinical intervention in patients with perennial allergic rhinitis (PAR). In addition to classical symptoms of congestion, pruritus, and rhinorrhea, patients will often complain of not being able to sleep well at night and of feeling Fatigued during the day. Like sleep apnea, PAR has also been shown to cause sleep disturbance and consequently worsen Daytime Fatigue and somnolence. Hypothesis: It is proposed that by decreasing nasal obstruction due to allergic rhinitis by treating with the topical steroid budesonide, symptoms of Daytime Fatigue and somnolence can be improved. Methods: Twenty-two subjects were enrolled in a double-blind, placebo-controlled, crossover study using Baalam's design. Patients were treated with either budesonide 128 μg/day or placebo. Subjective data include the Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Rhino-conjunctivitis Quality of Life Questionnaire, and a daily diary recording nasal symptoms, sleep problems, and Daytime Fatigue. Results: The results illustrated that the topical nasal corticosteroid significantly improved Daytime Fatigue (P = 0.03), somnolence (P = 0.02), and quality of sleep (P = 0.05) compared to placebo in patients suffering from PAR. Summary: Budesonide is able to improve congestion, sleep, and Daytime somnolence.
Erik Lehman - One of the best experts on this subject based on the ideXlab platform.
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the role of pseudoephedrine on Daytime somnolence in patients suffering from perennial allergic rhinitis par
Annals of Allergy Asthma & Immunology, 2011Co-Authors: Amir Sherkat, Erik Lehman, Niti Sardana, Sahar Safaee, Timothy J CraigAbstract:Background Allergic rhinitis is one of several inflammatory diseases affecting the nasal mucosa. Cellular inflammation of nasal mucosa is a hallmark of this disease and is characterized by the accumulation of eosinophils and the release of various chemical messengers such as chemokines, cytokines, and histamine. This inflammation of the nose leads to nasal congestion and a reduction in sleep quality, resulting in Daytime somnolence. Objective Drugs that significantly reduce the symptoms of nasal congestion also may help in alleviating sleep-related symptoms of allergic rhinitis. Pseudoephedrine is a sympathomimetic amine that is indicated for treatment of nasal congestion associated with allergic rhinitis. Despite relieving nasal congestion, we speculated that, because of pseudoephedrine's well-known stimulant profile, sleep would not be improved. Method Fourteen subjects who met the inclusion criteria were enrolled into a double-blind, placebo-controlled, randomized study to either pseudoephedrine or placebo once per day in the morning, using the traditional crossover design. Skin testing test was performed to ensure a positive response to a relevant perennial allergen and a negative response to a seasonal allergen. Several questionnaires were used to evaluate the patients' sleep-related symptoms, allergic rhinitis symptoms, and quality of life. Results Our results showed that pseudoephedrine did not have a positive or negative effect on quality of sleep, Daytime sleepiness, or Daytime Fatigue as compared with placebo. Pseudoephedrine did show a statistical significance in improving stuffy nose ( P = .0172). With respect to quality of life, pseudoephedrine led to a statistically significant decrease in intimate relationships and sexual activity as compared with the placebo group ( P = .0310). Conclusion Our research suggests that sleep quality is not significantly affected by pseudoephedrine. As expected, congestion is reduced, but side effects such as a decline of intimate relationships and sexual activity may interfere with quality of life.
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the role of montelukast on perennial allergic rhinitis and associated sleep disturbances and Daytime somnolence
Allergy and Asthma Proceedings, 2008Co-Authors: Carah B Santos, Christopher Hanks, Jeffrey Mccann, E L Pratt, Erik Lehman, Timothy J CraigAbstract:: Perennial allergic rhinitis (PAR) often causes sleep disturbances and associated Daytime somnolence, thus resulting in a poor quality of life. Various clinical interventions in patients suffering from the disorder seek to improve symptoms and quality of life. Additional studies are needed to establish whether the alleviation of PAR symptoms, particularly the reduction of congestion, will improve sleep quality and reduce Daytime somnolence. This study seeks to determine whether treatment with montelukast is more effective than placebo in reducing nasal congestion and sleep disturbances, resulting in reduced Daytime somnolence and Fatigue in patients with PAR. Thirty-one subjects were enrolled in a double-blinded, placebo-controlled study using Balaam's design. Patients were treated with montelukast or placebo. Collected subjective data included a daily diary recording nasal symptoms, sleep issues, and Daytime Fatigue, the Functional Outcomes of Sleep Questionnaire, the Epworth Sleepiness Scale, Juniper's Rhinoconjunctivitis Quality of Life Questionnaire, the Rhinitis Severity Scale, the Calgary Sleep Apnea Quality of Life Index, and Trail Making tests. Subjects treated with montelukast, compared with placebo, showed a statistically significant improvement in Daytime somnolence (p = 0.0089) and Daytime Fatigue (p = 0.0087), with both factors improving with montelukast and worsening with placebo. In a small cohort of subjects, montelukast, when compared with placebo, improved the symptoms of PAR and reduced the Fatigue and Daytime somnolence associated with the disorder.
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the effect of intranasal steroid budesonide on sleep disturbance and Daytime somnolence in patients with perennial allergic rhinitis
The Journal of Allergy and Clinical Immunology, 2004Co-Authors: Timothy J Craig, F Gurevich, Casey Glass, W Wei, Erik LehmanAbstract:Abstract Rationale The objective of this study was to determine whether intranasal corticosteroid budesonide reduced complaints of nasal congestion, poor sleep, Daytime Fatigue, and somnolence in patients with perennial allergic rhinitis (PAR). Methods Following IRB approval, twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray budesonide or placebo. Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, Daytime somnolence, and Fatigue. The results were summarized and compared by PROC MIXED in SAS. Results The daily diary data showed significant improvement in nasal congestion (p=0.04) and Daytime sleepiness (p=0.01), and marginally significant reduction in Daytime Fatigue (p=0.08) in the budesonide group compared to the placebo group. The sleep measures demonstrated statistically significant improvement in total sleep measures score (p=0.04), "sleep compared with absolute" (p=0.01), and "refreshing and restorative" sleep (p=0.04) in the active group. Conclusions Nasal corticosteroid budesonide is effective in reducing nasal congestion, Daytime somnolence, and Daytime Fatigue, and improving sleep quality and the PAR patients' quality of life.
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efficacy of the topical nasal steroid budesonide on improving sleep and Daytime somnolence in patients with perennial allergic rhinitis
Allergy, 2003Co-Authors: Kathleen Hughes, F Gurevich, Casey Glass, L H Fisher, Michael Ripchinski, T E Weaver, Erik Lehman, Timothy J CraigAbstract:Background: Improving quality of life is considered to be a major endpoint and motivation for clinical intervention in patients with perennial allergic rhinitis (PAR). In addition to classical symptoms of congestion, pruritus, and rhinorrhea, patients will often complain of not being able to sleep well at night and of feeling Fatigued during the day. Like sleep apnea, PAR has also been shown to cause sleep disturbance and consequently worsen Daytime Fatigue and somnolence. Hypothesis: It is proposed that by decreasing nasal obstruction due to allergic rhinitis by treating with the topical steroid budesonide, symptoms of Daytime Fatigue and somnolence can be improved. Methods: Twenty-two subjects were enrolled in a double-blind, placebo-controlled, crossover study using Baalam's design. Patients were treated with either budesonide 128 μg/day or placebo. Subjective data include the Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Rhino-conjunctivitis Quality of Life Questionnaire, and a daily diary recording nasal symptoms, sleep problems, and Daytime Fatigue. Results: The results illustrated that the topical nasal corticosteroid significantly improved Daytime Fatigue (P = 0.03), somnolence (P = 0.02), and quality of sleep (P = 0.05) compared to placebo in patients suffering from PAR. Summary: Budesonide is able to improve congestion, sleep, and Daytime somnolence.
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nasal congestion secondary to allergic rhinitis as a cause of sleep disturbance and Daytime Fatigue and the response to topical nasal corticosteroids
The Journal of Allergy and Clinical Immunology, 1998Co-Authors: Timothy J Craig, Erik Lehman, S Teets, Vernon M Chinchilli, Clifford ZwillichAbstract:Abstract Background: Allergic rhinitis (AR) is a frequent disease affecting up to 20% of the population. AR causes a hypersensitivity reaction, which results in inflamed nasal mucosa and nasal congestion. Negative pressure generated during inspiration in the nasal airway secondary to nasal congestion may lead to nasal collapse, airway obstruction, and an increased number of sleep microarousals. Sleep disturbances and microarousals can detrimentally affect Daytime energy levels, mood, and Daytime function. It is unknown whether treatment directed to reduce congestion may reduce these microarousals, sleep problems, and, consequently, associated Daytime Fatigue. Objective: We sought to determine whether reducing nasal congestion with nasal steroids will reduce sleep complaints and Daytime sleepiness. Method: We enrolled 20 subjects in a double-blind, placebo-controlled study using Balaam's Design. Patients were treated with topical nasal corticosteroids or placebo. Subjective data were collected by use of a daily diary, which focused on nasal symptoms, sleep, and Daytime sleepiness. Results: The results demonstrated that nasal congestion and subjective sleep improved significantly in the topical corticosteroid–treated subjects but not in the placebo group. Sleepiness improved, but not significantly ( p = 0.08). Conclusion: Often, people with perennial allergies may attribute their Daytime Fatigue to causes such as the side effects of medications, when in fact, the Fatigue may be a result of nasal congestion and associated sleep fragmentation. Decreasing nasal congestion with nasal steroids may improve sleep, Daytime Fatigue, and the quality of life of patients with AR. (J Allergy Clin Immunol 1998;101:633-7.)
F Gurevich - One of the best experts on this subject based on the ideXlab platform.
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the effect of intranasal steroid budesonide on the congestion related sleep disturbance and Daytime somnolence in patients with perennial allergic rhinitis
Allergy and Asthma Proceedings, 2005Co-Authors: F Gurevich, Casey Glass, Jeffery Mccann, L H Fisher, Salman Chegini, Cathy Mende, Michael J. Davies, Timothy J CraigAbstract:Abstract Patients with perennial allergic rhinitis (PAR) often present with nasal congestion, poor sleep, Daytime Fatigue, and Daytime somnolence. Pharmacologic therapy that reduces nasal congestion should improve the PAR patients' sleep quality and reduce Daytime somnolence and Fatigue. Our hypothesis is that intranasal steroid budesonide (BUD), an effective topical anti-inflammatory agent, will reduce nasal congestion and improve the patients' quality of life. The objective of this study was to determine whether topical steroid BUD improves sleep, Daytime somnolence, and Fatigue in patients with PAR. Twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray BUD or placebo. The Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, Daytime somnolence, and Fatigue. The results were summarized and compared by PROC MIXED in SAS. The daily diary data showed significant improvement in self-reported nasal congestion (p = 0.04) and Daytime sleepiness (p = 0.01) and a trend in reduction of Daytime Fatigue (p = 0.08) in the BUD group compared with the placebo group. The sleep measures showed statistically significant improvement in total sleep measures score (p = 0.04), "sleep compared with absolute" (p = 0.01), and "refreshing and restorative" sleep (p = 0.04) in the active group. Nasal corticosteroid BUD is effective in reducing nasal congestion, Daytime somnolence, and Daytime Fatigue, and improving sleep quality in PAR.
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the effect of intranasal steroid budesonide on sleep disturbance and Daytime somnolence in patients with perennial allergic rhinitis
The Journal of Allergy and Clinical Immunology, 2004Co-Authors: Timothy J Craig, F Gurevich, Casey Glass, W Wei, Erik LehmanAbstract:Abstract Rationale The objective of this study was to determine whether intranasal corticosteroid budesonide reduced complaints of nasal congestion, poor sleep, Daytime Fatigue, and somnolence in patients with perennial allergic rhinitis (PAR). Methods Following IRB approval, twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray budesonide or placebo. Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, Daytime somnolence, and Fatigue. The results were summarized and compared by PROC MIXED in SAS. Results The daily diary data showed significant improvement in nasal congestion (p=0.04) and Daytime sleepiness (p=0.01), and marginally significant reduction in Daytime Fatigue (p=0.08) in the budesonide group compared to the placebo group. The sleep measures demonstrated statistically significant improvement in total sleep measures score (p=0.04), "sleep compared with absolute" (p=0.01), and "refreshing and restorative" sleep (p=0.04) in the active group. Conclusions Nasal corticosteroid budesonide is effective in reducing nasal congestion, Daytime somnolence, and Daytime Fatigue, and improving sleep quality and the PAR patients' quality of life.
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efficacy of the topical nasal steroid budesonide on improving sleep and Daytime somnolence in patients with perennial allergic rhinitis
Allergy, 2003Co-Authors: Kathleen Hughes, F Gurevich, Casey Glass, L H Fisher, Michael Ripchinski, T E Weaver, Erik Lehman, Timothy J CraigAbstract:Background: Improving quality of life is considered to be a major endpoint and motivation for clinical intervention in patients with perennial allergic rhinitis (PAR). In addition to classical symptoms of congestion, pruritus, and rhinorrhea, patients will often complain of not being able to sleep well at night and of feeling Fatigued during the day. Like sleep apnea, PAR has also been shown to cause sleep disturbance and consequently worsen Daytime Fatigue and somnolence. Hypothesis: It is proposed that by decreasing nasal obstruction due to allergic rhinitis by treating with the topical steroid budesonide, symptoms of Daytime Fatigue and somnolence can be improved. Methods: Twenty-two subjects were enrolled in a double-blind, placebo-controlled, crossover study using Baalam's design. Patients were treated with either budesonide 128 μg/day or placebo. Subjective data include the Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Rhino-conjunctivitis Quality of Life Questionnaire, and a daily diary recording nasal symptoms, sleep problems, and Daytime Fatigue. Results: The results illustrated that the topical nasal corticosteroid significantly improved Daytime Fatigue (P = 0.03), somnolence (P = 0.02), and quality of sleep (P = 0.05) compared to placebo in patients suffering from PAR. Summary: Budesonide is able to improve congestion, sleep, and Daytime somnolence.
Casey Glass - One of the best experts on this subject based on the ideXlab platform.
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the effect of intranasal steroid budesonide on the congestion related sleep disturbance and Daytime somnolence in patients with perennial allergic rhinitis
Allergy and Asthma Proceedings, 2005Co-Authors: F Gurevich, Casey Glass, Jeffery Mccann, L H Fisher, Salman Chegini, Cathy Mende, Michael J. Davies, Timothy J CraigAbstract:Abstract Patients with perennial allergic rhinitis (PAR) often present with nasal congestion, poor sleep, Daytime Fatigue, and Daytime somnolence. Pharmacologic therapy that reduces nasal congestion should improve the PAR patients' sleep quality and reduce Daytime somnolence and Fatigue. Our hypothesis is that intranasal steroid budesonide (BUD), an effective topical anti-inflammatory agent, will reduce nasal congestion and improve the patients' quality of life. The objective of this study was to determine whether topical steroid BUD improves sleep, Daytime somnolence, and Fatigue in patients with PAR. Twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray BUD or placebo. The Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, Daytime somnolence, and Fatigue. The results were summarized and compared by PROC MIXED in SAS. The daily diary data showed significant improvement in self-reported nasal congestion (p = 0.04) and Daytime sleepiness (p = 0.01) and a trend in reduction of Daytime Fatigue (p = 0.08) in the BUD group compared with the placebo group. The sleep measures showed statistically significant improvement in total sleep measures score (p = 0.04), "sleep compared with absolute" (p = 0.01), and "refreshing and restorative" sleep (p = 0.04) in the active group. Nasal corticosteroid BUD is effective in reducing nasal congestion, Daytime somnolence, and Daytime Fatigue, and improving sleep quality in PAR.
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the effect of intranasal steroid budesonide on sleep disturbance and Daytime somnolence in patients with perennial allergic rhinitis
The Journal of Allergy and Clinical Immunology, 2004Co-Authors: Timothy J Craig, F Gurevich, Casey Glass, W Wei, Erik LehmanAbstract:Abstract Rationale The objective of this study was to determine whether intranasal corticosteroid budesonide reduced complaints of nasal congestion, poor sleep, Daytime Fatigue, and somnolence in patients with perennial allergic rhinitis (PAR). Methods Following IRB approval, twenty-six subjects were enrolled in a double-blind, placebo-controlled, crossover study using Balaam's design. Patients were treated with intranasal steroid spray budesonide or placebo. Epworth Sleepiness Scale, daily diary, and questionnaires were used as tools for subjective data analysis, which focused on nasal symptoms, sleep quality, Daytime somnolence, and Fatigue. The results were summarized and compared by PROC MIXED in SAS. Results The daily diary data showed significant improvement in nasal congestion (p=0.04) and Daytime sleepiness (p=0.01), and marginally significant reduction in Daytime Fatigue (p=0.08) in the budesonide group compared to the placebo group. The sleep measures demonstrated statistically significant improvement in total sleep measures score (p=0.04), "sleep compared with absolute" (p=0.01), and "refreshing and restorative" sleep (p=0.04) in the active group. Conclusions Nasal corticosteroid budesonide is effective in reducing nasal congestion, Daytime somnolence, and Daytime Fatigue, and improving sleep quality and the PAR patients' quality of life.
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efficacy of the topical nasal steroid budesonide on improving sleep and Daytime somnolence in patients with perennial allergic rhinitis
Allergy, 2003Co-Authors: Kathleen Hughes, F Gurevich, Casey Glass, L H Fisher, Michael Ripchinski, T E Weaver, Erik Lehman, Timothy J CraigAbstract:Background: Improving quality of life is considered to be a major endpoint and motivation for clinical intervention in patients with perennial allergic rhinitis (PAR). In addition to classical symptoms of congestion, pruritus, and rhinorrhea, patients will often complain of not being able to sleep well at night and of feeling Fatigued during the day. Like sleep apnea, PAR has also been shown to cause sleep disturbance and consequently worsen Daytime Fatigue and somnolence. Hypothesis: It is proposed that by decreasing nasal obstruction due to allergic rhinitis by treating with the topical steroid budesonide, symptoms of Daytime Fatigue and somnolence can be improved. Methods: Twenty-two subjects were enrolled in a double-blind, placebo-controlled, crossover study using Baalam's design. Patients were treated with either budesonide 128 μg/day or placebo. Subjective data include the Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Rhino-conjunctivitis Quality of Life Questionnaire, and a daily diary recording nasal symptoms, sleep problems, and Daytime Fatigue. Results: The results illustrated that the topical nasal corticosteroid significantly improved Daytime Fatigue (P = 0.03), somnolence (P = 0.02), and quality of sleep (P = 0.05) compared to placebo in patients suffering from PAR. Summary: Budesonide is able to improve congestion, sleep, and Daytime somnolence.
Christian Guilleminault - One of the best experts on this subject based on the ideXlab platform.
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Sleep-Disordered Breathing in Ehlers-Danlos Syndrome: A Genetic Model of OSA
Chest, 2013Co-Authors: Christian Guilleminault, Michelle Primeau, Hsiao Yean Chiu, Kin Yuen, Damien Leger, A. MetlaineAbstract:Objectives The objective of this study was to investigate the presence of sleep-disordered breathing (SDB) in patients with Ehlers-Danlos syndrome. Ehlers-Danlos syndrome is a genetic disorder characterized by cartilaginous defects, including nasal-maxillary cartilages. Methods A retrospective series of 34 patients with Ehlers-Danlos syndrome and complaints of Fatigue and poor sleep were evaluated by clinical history, physical examination, polysomnography (PSG), and, in some cases, anterior rhinomanometry. Additionally, a prospective clinical investigation of nine patients with Ehlers-Danlos syndrome was performed in a specialized Ehlers-Danlos syndrome clinic. Results All patients with Ehlers-Danlos syndrome evaluated had SDB on PSG. In addition to apneas and hypopneas, SDB included flow limitation. With increasing age, flow limitation decreased in favor of apnea and hypopnea events, but clinical complaints were similar independent of the type of PSG finding. In the subgroup of patients who underwent nasal rhinomanometry, increased nasal resistance was increased relative to normative values. Nasal CPAP improved symptoms. Patients with Ehlers-Danlos syndrome presenting to the medical clinic had symptoms and clinical signs of SDB, but they were never referred for evaluation of SDB. Conclusions In patients with Ehlers-Danlos syndrome, abnormal breathing during sleep is commonly unrecognized and is responsible for Daytime Fatigue and poor sleep. These patients are at particular risk for SDB because of genetically related cartilage defects that lead to the development of facial structures known to cause SDB. Ehlers-Danlos syndrome may be a genetic model for OSA because of abnormalities in oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation.
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upper airway resistance syndrome a long term outcome study
Journal of Psychiatric Research, 2006Co-Authors: Christian Guilleminault, Damien Leger, Ceyda Kirisoglu, Dalva Poyares, Luciana Palombini, Mehran Faridmoayer, Maurice M OhayonAbstract:UNLABELLED: This prospective study aimed to assess symptomatic evolution of patients diagnosed with Upper Airway Resistance Syndrome (UARS) four and half years after the initial UARS diagnosis. For this purpose, 138 UARS patients were contacted by mail between 43 and 69 months after the initial evaluation; 105 responded to the letter and 94 patients accepted to undergo new clinical and polysomnographic evaluations. Initial and follow-up polysomnographic recordings were scored using the same criteria. RESULTS: Of the 94 patients who completed the follow-up examination, none of them were using nasal CPAP. It was related to refusal by insurance providers to provide equipment based on initial apnea-hypopnea index (AHI) in 90/94 subjects. Percentage of patients with sleep related-complaints significantly increased over the four and half year period: Daytime Fatigue, insomnia and depressive mood increased by 12 to 20 times. Reports of sleep maintenance sleep onset insomnia and depressive mood was significantly increased. Hypnotic, antidepressant and stimulant prescription increased from initial to follow-up visit (from 11.7% to 61.7%; from 3.2% to 25.5% and from 0% to 9.6%, respectively) with antidepressant given as much for sleep disturbance as mood disorder. The polysomnography results at follow-up showed that 5 subjects had AHI compatible with Obstructive Sleep Apnea Syndrome (OSAS) but overall, respiratory disturbance index had no significant change. Total sleep time was significantly reduced compared to initial visit. CONCLUSIONS: Many UARS patients remained untreated following initial evaluation. Worsening of symptoms of insomnia, Fatigue and depressive mood were seen with absence of treatment of UARS.
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upper airway resistance syndrome nocturnal blood pressure monitoring and borderline hypertension
Chest, 1996Co-Authors: Christian Guilleminault, Toshiaki Shiomi, Riccardo Stoohs, Clete A Kushida, Ingela SchnittgerAbstract:Upper airway resistance syndrome (UARS) is a sleep-disordered breathing syndrome characterized by complaints of Daytime Fatigue and/or sleepiness, increased upper airway resistance during sleep, frequent transient arousals, and no significant hypoxemia. Of a population of 110 subjects (58 men) diagnosed as having UARS, we investigated acute systolic and diastolic BP changes seen during sleep in two different samples. First, six patients from the original subject pool were found to have untreated chronic borderline high BP, and were subjected to 48 h of continuous ambulatory BP monitoring before treatment and another 48 h of BP monitoring 1 month after the start of nasal-continuous positive airway pressure (N-CPAP) treatment. Five of six subjects used their equipment on a regular basis and had their chronic borderline high BP completely controlled. No change in BP values was seen in the last subject, who discontinued N-CPAP after 3 days. A second protocol investigated seven normotensive subjects drawn from the initial subject pool. Continuous radial artery BP recording was performed during nocturnal sleep with simultaneous polygraphic recording of sleep/wake variables and respiration. BP changes were studied during periods of increased respiratory efforts and at the time of alpha EEG arousals. Increases in systolic and diastolic BP were noted during the breaths with the greatest inspiratory efforts without significant hypoxemia. A further increase in BP was noted in association with arousals. Three of these subjects also underwent echocardiography during sleep, which demonstrated a leftward shift of the interventricular septum with pulsus paradoxus in association with peak end-inspiratory esophageal pressure more negative than −35 cm H 2 O. Our study indicates that, in the absence of classic apneas, hypopneas, and repetitive significant drops in oxygen saturation (below 90%), repetitive increases in BP can occur as a result of increased airway resistance during sleep. It also shows that, in some patients with both UARS and borderline high BP, high BP can be controlled with treatment of UARS. We conclude that abnormal upper airway resistance during sleep, often associated with snoring, can play a role in the development of hypertension.