The Experts below are selected from a list of 102 Experts worldwide ranked by ideXlab platform
Jodianne C Coffee - One of the best experts on this subject based on the ideXlab platform.
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is chronic hyperventilation syndrome a risk factor for Sleep apnea part 1
Journal of Bodywork and Movement Therapies, 2006Co-Authors: Jodianne C CoffeeAbstract:Summary There are many pathologies that are proven risk factors for disordered breathing during Sleep, including obstructive pulmonary diseases, neuromuscular diseases, poliomyelitis, obesity, heart failure, and cranio-facial anomalies. When these risk factors are coupled with the normal Physiology of Sleep, REM Sleep in particular, Sleep apnea-hypopnea occurs, thereby resulting in nocturnal hypoxia, disrupted Sleep, and Sleep deprivation. This author proposes that chronic hyperventilation syndrome (HVS) and other upper-chest breathing pattern disorders (BPD) are also risk factors for Sleep apnea–hypopnea because of persistent hypocapnia (in chronic HVS) and poor respiratory muscle mechanics, leading to diaphragmatic weakness. Research in this area is seriously lacking considering the enormous impact that both chronic HVS/BPD and Sleep apnea–hypopnea syndrome have on human health and public safety.
Michael R Gendreau - One of the best experts on this subject based on the ideXlab platform.
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two randomized placebo controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive Sleep apnea
Sleep, 2008Co-Authors: Nathaniel S Marshall, Brendon J Yee, Anup V Desai, Peter R Buchanan, Keith Wong, Renee Crompton, Kerri L Melehan, Nadene Zack, Srinivas G Rao, Michael R GendreauAbstract:OBSTRUCTIVE Sleep APNEA (OSA) IS A COMMON Sleep DISORDER1 THAT HAS BEEN PROSPECTIVELY ASSOCIATED WITH HYPERTENSION AND DEPRESSION in community-based cohorts2,3 and with mortality in patient cohorts and case-control studies.4–6 Continuous positive airway pressure is the most efficacious treatment for severe OSA.7,8 However, effectiveness is limited in the mild to moderate end of the OSA spectrum9 and by poor compliance generally. Moreover, other nonpharmacologic treatment methods (e.g., mandibular advancement splints and upper airway surgery) can be unacceptable to patients or have limited or questionable efficacy.10,11 As a result, there is strong interest in the development of pharmacotherapy for OSA, which might better balance efficacy and tolerability, particularly for certain patient subsets. Despite many attempts, there has been a general lack of success with pharmacotherapy.12,13 Strategies have included drugs that putatively alter the Physiology of Sleep apnea by increasing upper airway muscle tone during Sleep, increasing respiratory drive, or altering Sleep architecture (either increasing slow-wave Sleep or decreasing REM Sleep). Most trials of these medications have shown no benefit or limited benefits of questionable clinical importance.11 However, some medications have shown clinically relevant effects in placebo-controlled studies. For example, in 1 study, acetazolamide, a weak diuretic with carbonic anhydrase inhibitory activity, reduced the apnea-hypopnea index (AHI) from about 50 to 25 events per hour in 10 patients.14 However, as a result of related side effects, its posttrial use was reported in only 1 patient. There also remains the potential for pharmacotherapy for Sleep apnea via drugs that result in weight reduction.15 Recently it was reported that daily administration of the antidepressant mirtazapine, (Remeron in the US and Avanza in Australia) at doses of 4.5 or 15 mg for 1 week, reduced AHI from a mean 22 events per hour to 11 events per hour in a placebo-controlled, 3-way, crossover trial.16 This report stated that “this represents the largest and most consistent drug-treatment effect demonstrated to date in a controlled trial.” Such data, if confirmed, would hold great promise for providing a new treatment alternative for some patients with OSA. This easily available drug might offer a particularly attractive treatment option for patients with mild to moderate OSA, the largest group of patients and the group in which other established treatment options are of questionable effectiveness. Therefore, 2 proof-of-concept trials were designed to assess if different and higher doses of mirtazapine are associated with a superior risk-benefit profile than has been previously observed.16 For the purposes of comparison, 15 mg, the highest dose tested in the previous study, is a typical starting dose for the antidepressant indication. The goal of the present studies was to confirm and extend the results of the previous trial.16 Study 1 was a triple-arm, randomized, crossover, dose-finding study (mirtazapine doses 0, 7.5, 15, 30, and 45mg/day) for 2 weeks per dose. Study 2 was a 3-arm parallel-group, 2:2:1, randomized, controlled trial that compared mirtazapine 15 mg versus mirtazapine + another compound (CD0012, a dopaminergic and serotinergic agent undergoing evaluation for efficacy in Sleep apnea), versus placebo for 4 weeks. The 2 studies were run simultaneously.
Stefania Maccari - One of the best experts on this subject based on the ideXlab platform.
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Physiology of Sleep review interactions between stress and Sleep from basic research to clinical situations
Sleep Medicine Reviews, 2000Co-Authors: O Van Reeth, L Weibel, Karine Spiegel, Rachel Leproult, Christine Dugovic, Stefania MaccariAbstract:Abstract Acute stress is a fundamental adaptive response which enables an organism to cope with daily threatening environmental stimuli. If prolonged and uncontrollable, the stress response may become inadequate and ultimately result in health damage. Animal models of stress in rodents indicate that both acute and chronic stressors have pronounced effects on Sleep architecture and circadian rhythms. One major physiological response elicited by stress is activation of the hypothalamo-pituitary-adrenal axis. In both animals and humans, the hypothalamo-pituitary-adrenal axis plays an important role in Sleep–wake regulation and in alterations of the Sleep–wake cycle secondary to exposure to acute or chronic stressors. In humans, dysfunction of the neuroendocrine regulation of Sleep can lead to severe Sleep disturbances. The progressive decay of the hypothalamo-pituitary-adrenal axis in elderly people, which mimics chronic exposure to stress, may contribute to fragmented and unstable Sleep in ageing. Shift workers, chronic insomniacs or patients suffering from mental disorders show abnormal hypothalamo-pituitary-adrenal secretory activity and concomitant Sleep disturbances. Those Sleep disorders and possible underlying mechanisms are briefly reviewed.
Michael Kluge - One of the best experts on this subject based on the ideXlab platform.
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emil kraepelin s concepts of the phenomenology and Physiology of Sleep the first systematic description of chronotypes
Sleep Medicine Reviews, 2016Co-Authors: Katrin Becker, Holger Steinberg, Michael KlugeAbstract:Emil Kraepelin is considered one of the most influential psychiatrists ever. His research on Sleep, however, has received little attention to date. Therefore, Kraepelin's published work was reviewed, statements on the topic "Sleep" identified, historically contextualized and compared with current knowledge. His assumptions on the "Physiology of Sleep" are rather speculative and not substantiated by own research. The opposite is true for his findings on the "phenomenology of Sleep". For example, his results on Sleep depth and Sleep stages are not only in overall good agreement with current concepts, but also based on Sleep studies. of special relevance are his findings on chronotypes: Based on empirical clinical studies, neuropsychological experiments and Sleep studies, Kraepelin systematically described a morning and evening disposition and intermediate types on the basis of the maximum physical capacity, cognitive ability and alertness/Sleepiness during the day as well as Sleeping habits. In fact, this concept is basically still valid and these aspects are being captured in morningness-eveningness scales. Our findings challenge the common notion that Nathaniel Kleitman was the first to systematically describe the morningness-eveningness dimension. Overall, we deem Kraepelin's contributions to Sleep research, compiled here for the first time, well worth being acknowledged by modern Sleep research.
Nathaniel S Marshall - One of the best experts on this subject based on the ideXlab platform.
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two randomized placebo controlled trials to evaluate the efficacy and tolerability of mirtazapine for the treatment of obstructive Sleep apnea
Sleep, 2008Co-Authors: Nathaniel S Marshall, Brendon J Yee, Anup V Desai, Peter R Buchanan, Keith Wong, Renee Crompton, Kerri L Melehan, Nadene Zack, Srinivas G Rao, Michael R GendreauAbstract:OBSTRUCTIVE Sleep APNEA (OSA) IS A COMMON Sleep DISORDER1 THAT HAS BEEN PROSPECTIVELY ASSOCIATED WITH HYPERTENSION AND DEPRESSION in community-based cohorts2,3 and with mortality in patient cohorts and case-control studies.4–6 Continuous positive airway pressure is the most efficacious treatment for severe OSA.7,8 However, effectiveness is limited in the mild to moderate end of the OSA spectrum9 and by poor compliance generally. Moreover, other nonpharmacologic treatment methods (e.g., mandibular advancement splints and upper airway surgery) can be unacceptable to patients or have limited or questionable efficacy.10,11 As a result, there is strong interest in the development of pharmacotherapy for OSA, which might better balance efficacy and tolerability, particularly for certain patient subsets. Despite many attempts, there has been a general lack of success with pharmacotherapy.12,13 Strategies have included drugs that putatively alter the Physiology of Sleep apnea by increasing upper airway muscle tone during Sleep, increasing respiratory drive, or altering Sleep architecture (either increasing slow-wave Sleep or decreasing REM Sleep). Most trials of these medications have shown no benefit or limited benefits of questionable clinical importance.11 However, some medications have shown clinically relevant effects in placebo-controlled studies. For example, in 1 study, acetazolamide, a weak diuretic with carbonic anhydrase inhibitory activity, reduced the apnea-hypopnea index (AHI) from about 50 to 25 events per hour in 10 patients.14 However, as a result of related side effects, its posttrial use was reported in only 1 patient. There also remains the potential for pharmacotherapy for Sleep apnea via drugs that result in weight reduction.15 Recently it was reported that daily administration of the antidepressant mirtazapine, (Remeron in the US and Avanza in Australia) at doses of 4.5 or 15 mg for 1 week, reduced AHI from a mean 22 events per hour to 11 events per hour in a placebo-controlled, 3-way, crossover trial.16 This report stated that “this represents the largest and most consistent drug-treatment effect demonstrated to date in a controlled trial.” Such data, if confirmed, would hold great promise for providing a new treatment alternative for some patients with OSA. This easily available drug might offer a particularly attractive treatment option for patients with mild to moderate OSA, the largest group of patients and the group in which other established treatment options are of questionable effectiveness. Therefore, 2 proof-of-concept trials were designed to assess if different and higher doses of mirtazapine are associated with a superior risk-benefit profile than has been previously observed.16 For the purposes of comparison, 15 mg, the highest dose tested in the previous study, is a typical starting dose for the antidepressant indication. The goal of the present studies was to confirm and extend the results of the previous trial.16 Study 1 was a triple-arm, randomized, crossover, dose-finding study (mirtazapine doses 0, 7.5, 15, 30, and 45mg/day) for 2 weeks per dose. Study 2 was a 3-arm parallel-group, 2:2:1, randomized, controlled trial that compared mirtazapine 15 mg versus mirtazapine + another compound (CD0012, a dopaminergic and serotinergic agent undergoing evaluation for efficacy in Sleep apnea), versus placebo for 4 weeks. The 2 studies were run simultaneously.