Stop Breathing Research Articles

Sleep Disturbances and Glucose Metabolism in Older Adults: The Cardiovascular Health Study.

OBJECTIVEWe examined the associations of symptoms of sleep-disordered breathing (SDB), which was defined as loud snoring, stopping breathing for a while during sleep, and daytime sleepiness, and insomnia with glucose metabolism and incident type 2 diabetes in older adults.RESEARCH DESIGN AND METHODSBetween 1989 and 1993, the Cardiovascular Health Study recruited 5,888 participants ≥65 years of age from four U.S. communities. Participants reported SDB and insomnia symptoms yearly through 1989–1994. In 1989–1990, participants underwent an oral glucose tolerance test, from which insulin secretion and insulin sensitivity were estimated. Fasting glucose levels were measured in 1989–1990 and again in 1992–1993, 1994–1995, 1996–1997, and 1998–1999, and medication use was ascertained yearly. We determined the cross-sectional associations of sleep symptoms with fasting glucose levels, 2-h glucose levels, insulin sensitivity, and insulin secretion using generalized estimated equations and linear regression models. We determined the associations of updated and averaged sleep symptoms with incident diabetes in Cox proportional hazards models. We adjusted for sociodemographics, lifestyle factors, and medical history.RESULTSObserved apnea, snoring, and daytime sleepiness were associated with higher fasting glucose levels, higher 2-h glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of the development of type 2 diabetes was positively associated with observed apnea (hazard ratio [HR] 1.84 [95% CI 1.19–2.86]), snoring (HR 1.27 [95% CI 0.95–1.71]), and daytime sleepiness (HR 1.54 [95% CI 1.13–2.12]). In contrast, we did not find consistent associations between insomnia symptoms and glucose metabolism or incident type 2 diabetes.CONCLUSIONSEasily collected symptoms of SDB are strongly associated with insulin resistance and the incidence of type 2 diabetes in older adults. Monitoring glucose metabolism in such patients may prove useful in identifying candidates for lifestyle or pharmacological therapy. Further studies are needed to determine whether insomnia symptoms affect the risk of diabetes in younger adults.

Out at Sea

Out at Sea Pamela Schmid (bio) On May 5, 1929, my great-uncle Howard plunged into the choppy surf of Hermosa Beach in southern California. It was a Sunday afternoon, and the shore was littered with towels and umbrellas, families and picnic baskets. Seagulls wheeled and cried over bone-white sand, over coins of light that danced on the water. A wide concrete pier with tiled pavilions stretched one thousand feet into the ocean. It must have felt like heaven to a boy of sixteen, churning through that salty-cool water, feeling the waves’ silky spray pulse through his fingers and tickle the downy-soft hairs of his chest. The push and pull, the weightlessness. Fishy and rank and pure. Losing himself in it, not noticing the tug of the tide, his growing distance from shore. He is sepia-bathed inside a gilded oval frame, and I cannot take my eyes off him. He is four, maybe five, and he is lovely—a golden child. Consider the double-breasted jumpsuit (is it blue? red?) and the silky bow tied beneath his chin. Consider the upturned nose, the eyes’ impish gleam. His palms are relaxed, open, resting on knees, shockingly [End Page 91] white against dark, sumptuous velvet. An unruly lock of hair curls like a fishhook above his right eye. It indicates mischief uncorked, irrepressible boyness. His beauty sears me. He is the future’s gleaming promise. Howard, the boy, sits on the lap of his mother—Mamie, my great grandmother, whose index finger rests lightly on his hand. Perhaps she caresses it inadvertently, the primal need for skin to find skin. Her deep-set eyes are framed by plain wire glasses. She sits beside my great grandfather, George, who sports a blunt mustache and the bushy eyebrows of my father. He is a Methodist minister and looks the part. I can hear his stentorian voice blasting down the pews. Completing the set is Lowell, my grandfather, who is nine years older than Howard and looms behind the other three. His hair is parted down the middle, shorn high and close, bangs curlicued like the horns of a ram, a look that accentuates his long face and jug ears (also like my father’s). Shadows cover the left half of his face. His thin lips betray the merest hint of a smile. His three-piece suit appears to strangle him. Photographs trick us. They capture the leaf before it falls: the smooth, unfurrowed forehead, the thick and lustrous hair. They prop up the dead, pull their skin taut, dust their cheeks with rouge. They make us yearn to touch the untouchable, to say: If only you knew. The stiff formality and fancy clothes and quaintly curled mustaches—all just a ruse. We see past that, and see ourselves. I learn about Howard during a weeklong visit with my father’s sister. “You know that picture in the guest room, the one of Grandpa as a teenager?” I ask. “Who’s that cute little boy in the front?” I’m sitting on the couch, between my aunt and my father, while my eighteen-month-old son naps nearby. Sunlight bounces off the cathedral ceilings. A pair of giant sandhill cranes trot past the back window. My aunt feeds her elderly poodle a treat and shoots me a look of [End Page 92] surprise. “Oh,” she says. “That’s your great-uncle Howard. He’s the one who drowned.” For a second, I stop breathing. Then I turn to my father. “Grandpa had a brother who drowned?” I ask. Dad considers the question for a moment or two. “That’s true,” he finally says before turning back to his newspaper. I have been surrounded by ancestors for the past four nights, here in my aunt’s guestroom, amid the palm trees and impeccable, spongy lawns of southwestern Florida. Black and white strangers—all related to me—plaster nearly every inch of wall space. Their eyes follow me around the room. When I lie in bed at night, I imagine them humming secrets like grasshoppers. Among this jumble of forbearers, Howard fascinates me most. Those apple cheeks, those plump and immaculate hands—they...

Postoperative monitoring of children with obstructive sleep apnea syndrome

Treatment of pediatric obstructive sleep apnea syndrome is surgical. The incidence of postoperative respiratory complications in this population is 5-25%. The aim of the authors was to present the preoperative evaluation and monitoring procedure elaborated in Heim Pál Children Hospital, Budapest. 142 patients were involved in the study. Patient history was obtained and physical examination was performed in all cases. Thereafter, polysomnography was carried out, the severity of the obstructive sleep apnea syndrome was determined, and the patients underwent tonsilloadenotomy. 45 patients with mild, 50 patients with moderate and 47 patients with severe obstructive sleep apnea syndrome were diagnosed. There was no complication in patients with mild disease, while complications were observed in 6 patients in the moderate group and 24 patients in the severe group (desaturation, apnea, stridor, stop breathing) (p<0.000). In patients with severe obstructive sleep apnea syndrome, no significant difference was noted in preoperative apnoea-hypapnea index (p = 0.23) and in nadir oxygen saturation values (p = 0.73) between patients with and without complication. Patients with severe obstructive sleep apnea syndrome should be treated in hospital where pediatric intensive care unit is available.

Associations between self‐reported sleep duration and sleeping disorder with concentrations of fasting and 2‐h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes (在未诊断糖尿病的成年人中自我报告的睡眠时间、睡眠障碍与空腹及餐后2小时血糖、胰岛素以及糖化血红蛋白浓度之间的关系)

There is limited information from population-based investigations of the associations between sleep duration and sleep disorders and parameters of glucose homeostasis. The objective of the present study was to examine cross-sectional associations between sleep duration and sleep disordered breathing with concentrations of insulin, fasting and 2-h glucose, and HbA1c. Data from 11 815 adults aged ≥20 years without diagnosed diabetes (5002 with an oral glucose tolerance test) from the National Health and Nutrition Examination Survey 2005-2010 were used. Information about sleep duration (2005-2010) and sleep apnea and sleep-disordered breathing (2005-2008) was obtained via questionnaire. An estimated 36.0% of participants reported sleeping ≤6 h/night, 62.0% reported sleeping 7-9 h/night, and 2.0% reported sleeping ≥10 h/night. In 2005-2008, 33.0% reported snoring ≥5 nights per week, 5.9% reported they snorted, gasped, or stopped breathing ≥5 nights/week, and 4.2% reported sleep apnea. Sleep duration was significantly associated with fasting concentrations of insulin and concentrations of HbA1c only in models that did not adjust for body mass index (BMI). Concentrations of fasting and 2-h glucose were significantly associated with sleep duration in models that adjusted only for age. Snoring frequency was positively associated with concentrations of insulin and HbA1c. Frequency of snorting or stopping breathing and sleep apnea status were associated with concentrations of insulin and of HbA1c only when BMI was not accounted for. In a representative sample of US adults, concentrations of insulin and HbA1c were significantly associated with short sleep duration, possibly mediated by BMI.

To Breathe or Not to Breathe: Negative Data on Ozone and Vascular Function in an Established Research Model

To Breathe or Not to Breathe: Negative Data on Ozone and Vascular Function in an Established Research Model

The association between obstructive sleep apnea and hypertension by race/ethnicity in a nationally representative sample.

The association between obstructive sleep apnea (OSA) and hypertension by race/ethnicity has not been well characterized in a national sample. Adult participants in the 2007-2008 National Health and Nutrition Examination Survey were reviewed by self-report of sleep apnea diagnosis, snorting, gasping or stopping breathing during sleep, and snoring to derive whether OSA was probable (pOSA). Multivariable logistic regression determined whether pOSA predicted hypertension in the overall cohort, and by body mass index (BMI) group and ethno-racial strata. pOSA predicted hypertension in several groups: (1) Within BMI strata, there was a significant association among overweight individuals [odds ratio [OR], 1.82; 95% confidence interval [CI], 1.26-2.62); (2) In race/ethnicity subgroups, the association was significant among Hispanic/Latinos (OR, 1.69; 95% CI, 1.13-2.53) and whites (OR, 1.40; 95% CI, 1.07-1.84); (3) In models stratified by both race/ethnicity and BMI, pOSA predicted hypertension among overweight black/African Americans (OR, 4.74; 95% CI, 1.86-12.03), overweight whites (OR, 1.65; 95% CI, 1.06-2.57), and obese Hispanic/Latino participants (OR, 2.01; 95% CI, 1.16-3.49). A simple, self-report tool for OSA was strongly associated with hypertension, and may serve as a potential future opportunity for OSA diagnosis.

Parents of preterm evaluation of stress and nursing support

This study aims to examine differences relating to the gender of parents of preterm infants on their experiences of parental stress and nursing support while their infant was in NICU. This study has a descriptive comparative survey design. Mothers (N = 41) and fathers (N = 41) answered two self-reporting questionnaires, the Nurse Parent Support Tool (NPST) and the Parental Stressor Scale (PSS: NICU). Both mothers and fathers in general experienced high stress levels in relation to the infant's appearance. Some experienced stress relating to the parental role and alteration of that role. Fewer experienced stress relating to the dimension of sight and sound. However mothers' experiences of stress decreased but fathers reported increased stress at discharge compared to their responses at baseline for a number of variables; i.e. on the appearance of sudden noise from monitor alarms (p = 0.035), seeing the baby stop breathing (p = 0.012) and not having time alone with the baby (p = 0.008). Although borderline statistically significant (p = 0.07), fathers also reported higher levels of stress at discharge regarding fear of being separated from the baby. There is no reported gender differences regarding the support received from nurses. The result has drawn attention to the importance of stress preventing initiatives towards fathers before discharge. The results also highlights that nurses' communication skills are essential in the care of premature infants and their parents.

Escala de sonolência de Epworth detecta sintomas da apneia do sono em docentes de Odontologia

The aim of this article was to correlate the Epworth sleepiness scale with symptoms of sleep apnea in the course of Odontology of a public University in the state of Paraiba. It was conducted a cross sectional study using two questionnaires to practicing professors. The sample was composed of 45 professors. We evaluated the following variables: sex, snoring, excessive tiredness, stop breathing and restless sleep. Despite the Epworth Sleepiness Scale did not provide a statistically significant relationship with the variables of the research, there is a considerable percentage of professors with excessive sleepiness, probably resulting from overloading professional. Therefore, we propose new studies to prove the results.

Sleep Disordered Breathing and Depression among U.S. Adults: National Health and Nutrition Examination Survey, 2005-2008

To determine if symptoms of sleep disordered breathing (SDB) are associated with depression symptomology in a national sample. National Health and Nutrition Examination Survey. U.S., 2005-2008. 9,714 adults (≥ 18 years). Respondents were asked about frequency of snoring and snorting, gasping, or stopping breathing while asleep and completed the PHQ-9 (a 9-item depression screener). Odds ratios (OR) and 95% confidence intervals (CI) for SDB symptom-associated probable major depression (defined as a PHQ-9 score ≥ 10) were obtained from sex-specific logistic regression analyses adjusted for body mass index, age, race/ethnicity, and education. Among men, 6.0% reported physician-diagnosed sleep apnea, 37.2% snored ≥ 5 nights/week, 7.1% snorted/stopped breathing ≥ 5 nights/week, and 5.0% had PHQ-9 scores ≥ 10. Among women, 3.1% reported sleep apnea, 22.4% snored ≥ 5 nights/week, 4.3% snorted/stopped breathing ≥ 5 nights/week, and 8.4% had PHQ-9 scores ≥ 10. Sleep apnea was associated with probable major depression (OR = 2.4; 95% CI: 1.5, 3.6 among men; OR = 5.2; 95% CI: 2.7, 9.9 among women). Snoring was not associated with depression symptoms in men or women. Snorting/stopping breathing ≥ 5 nights/week compared to never was strongly associated with probable major depression in men (OR = 3.1; 95% CI: 1.8, 5.2) and women (OR = 3.0; 95% CI: 1.6, 5.4). Frequent snorting/stopping breathing was associated with probable major depression by the PHQ-9 in a national sample of adults. Additional research may be needed to determine whether regular screening for these conditions by mental health professionals and sleep specialists should be recommended.

Breathe In… Breathe Out… Stop Breathing: Does Phase of Respiration Affect the Haller Index in Patients with Pectus Excavatum?

Breathe In… Breathe Out… Stop Breathing: Does Phase of Respiration Affect the Haller Index in Patients with Pectus Excavatum?

P24 Prevalence of obstructive sleep apnoea in patients scheduled for bariatric surgery and validation of the STOP-BANG questionnaire as a screening tool

BackgroundObstructive Sleep Apnoea (OSA) is common in morbidly obese patients scheduled for bariatric surgery, and many sleep centres perform routine preoperative sleep studies for all. However a significant proportion will...

Breathe In... Breathe Out... Stop Breathing: Does Phase of Respiration Affect the Haller Index in Patients With Pectus Excavatum?

The purpose of this article is to determine whether the phase of respiration at the time of imaging affects chest wall measurements and compression of internal structures in patients with pectus excavatum. Forty-seven patients (median age, 14 years) imaged for preoperative pectus excavatum underwent limited axial balanced steady-state free precession MRI of the chest at inspiration, expiration, and stop quiet breathing. Two radiologists, who were blinded to prior measurements, independently calculated the Haller index, asymmetry index, and sternal tilt in each phase of respiration. Compression of internal structures was recorded. Statistical comparison was performed. The Haller index was significantly lower at inspiration, compared with stop quiet breathing and expiration, with medians (interquartile ranges) of 3.96 (3.27-4.61), 5.16 (4.02-6.48), and 5.09 (4.14-6.63), respectively (p < 0.0001 for both). No significant difference in Haller indexes was observed between expiration and stop quiet breathing (p = 0.1171). Of 11 patients with a Haller index less than 3.25 at inspiration, eight (72.7%) had an index greater than 3.25 on expiration and stop quiet breathing, which accounted for 17% (8/47) of all patients imaged. Compression of the liver or vascular structures was present in 24 (51%) patients. There was no significant difference in the asymmetry index, sternal tilt, or right heart compression between phases of respiration. Obtaining the Haller Index at inspiration may result in a value significantly lower than that at expiration, potentially affecting surgical and financial decision making. Compression of the liver and vascular structures was observed in 51% of patients, but additional research is needed to determine the clinical significance of this finding.

Man on Wire, Woman on Couch, Screaming

Man on Wire, Woman on Couch, Screaming Alison Luterman (bio) Watching a film about Philippe Petit wire-walking between Watching a film about Philippe Petit wire-walking between the twin towers of the World Trade Center Above flapping green awnings and cars idling at stoplights,yellow lines and white lines painted on the asphalt,and the man hawking coffee and donuts from his little metal cart,above cruel, jagged cornices of buildings,above clouds, above gulls and their squawking, higher than that,a hundred and ten stories up, one slippered foot glides onto a strung cable, then the other,and he's dancing, holding nothingbut a long pole, balanced against air currents,against laws, against common sense,dancing in God's empty palm! Slender wisp of a man. Black-clad crazy clown. And you, watching the video on your couch,why are you screaming and writhinglike a woman in orgasm or childbirth, like someone being dangledhead down from a great height by one straining ankle? You're safe as a hamster in your own safe house,watching this man walk on a wire between what used to betwin towers—there used to be a world to step off from;elevators, fax machines, water coolers. [End Page 61] Who'd ever dream the dreamer would outlast steel? There are moments you pray to be ready forbut seldom are. He steps off the edge into air, great sliding whooshes of sheer freedom, sliding glass of pure oxygen the magnetic dread and pull of it. Now he kneels. You stop breathing. Now he salutesthe towers, the city, all space and time. Now he lies down,face to the sky, perfectly relaxed,and you want to faint,you who do not trust even the groundto hold you, who think you'll falloff the face of the earth for one misspoken word— But this.It's like being inside a cathedralof pure terror,skewered by the sound of bells. And even after he climbs downand is received into the blue-coated armsof a disgruntled New York cop;even after the whole city exhalesand goes back to its ordinary pleasures and ills— it still goes on, somewhere, forever in the mind, in the living cells. [End Page 62] To step out of the possibleinto sheer wonder. How the dream floatsover the citywhere steel melted and buildings dissolved; how in the end only the ephemeralendures. [End Page 63] Alison Luterman Alison Luterman's two books of poems are The Largest Possible Life (Cleveland State U P) and See How We Almost Fly (Pearl Editions). Her work has been published in the Sun, Poetry East, Kalliope, and Oberon; in the anthology Poetry 180; and on subway trains and buses in San Francisco and Portland. Copyright © 2011 University of Nebraska Press

Ubiquitous Health Monitoring System for Diagnosis of Sleep Apnea With Zigbee Network and Wireless LAN

The Greek word “apnea” literally means “without breath.” The three types of apnea are obstructive, central, and mixed. Obstructive is the most common type. Despite the difference in the root cause of the three types of apnea, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for 1 min or longer. Sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotency, and headaches. Sleep apnea may be responsible for job impairment and motor vehicle accidents. Apart from the physical health risks, sleep apnea can lead to social problems when left undiagnosed or untreated such as a high amount of unnecessary health care cost. Sleep disorder is diagnosed with polysomnography, an overnight sleep study, by monitoring electrical activity of brain, heart, eye movement, muscle activity, breathing pattern, and other physiological signals. Because polysomnography requires overnight monitoring by a sleep technologist with full sleep staging, polysomnography is expensive, inconvenient, time consuming, and labor intensive. Although some systems provide home based diagnosis, most systems record the sleep data in a memory card. The patient must send the memory card to a medical center through the mail or internet. The real-time monitoring is not performed and a patient can experience life threatening episodes by not receiving proper feedback from a medical center or a physician. We propose a wireless health monitoring system to diagnose sleep apnea, which enables the global monitoring of biomedical signals. A patient does not need hospitalization and can be diagnosed and receive feedback at home. The system supports monitoring five different biomedical signals to diagnose sleep apnea: electrocardiogram with dry electrodes (no gel), body position, nasal airflow, abdomen/chest efforts and oxygen saturation. The system consists of three units: a wireless transmitter, a wireless receiver, and a monitoring unit. A wireless transmitter unit sends the measured signals from sensors to a receiver unit with Zigbee communication. The receiver unit, which has two wireless modules, Zigbee and Wi-Fi, receives signals from the transmitter unit and retransmits signals to the remote monitoring system with Zigbee and Wi-Fi communication, respectively. By using both the Zigbee network and wireless LAN, the system can achieve low power consumption in a local monitoring area with the feature of the Zigbee standard. The system also provides wide data coverage and easily extends its sensor network to the Internet with the Wi-Fi standard. The features of the system and the results of the continuous monitoring of vital signals are presented.

Obstructive Sleep Apnea Indicators and Injury in Older Farmers

ABSTRACT The purpose of this study was to explore the relationship between sleep apnea indicators and injury in older farmers from Kentucky and South Carolina. Participants reported at least 1 day of farm work during the preceding year (n = 756) and received income from farming. The primary outcome variable was occurrence of injuries because of farm work in the past year. Main explanatory variables of interest included snoring, gasping, snorting, or cessation of breathing while asleep; trouble sleeping; consumption of sleep medications; trouble staying awake during daytime; and sleep quality. Simple logistic regressions established bivariate associations between explanatory and outcome variables. Explanatory variables significantly associated with the outcome in the bivariate analyses were used to fit a multivariable logistic regression model. The results show that just over 10% of participants experienced a farm injury in the past year. Significant bivariate associations were detected between the occurrence of injuries and number of days of farm work (odds ratio [OR] = 1.003, p = .0002); number of hours of farm work during the last week (OR = 1.017, p = .0047); male gender (OR = 2.48, p = .0007); arthritis or rheumatism conditions (OR = 1.981, p = .004); stopped breathing while sleeping (OR = 2.338, p = .0027); and problems staying awake during the past month (OR = 2.561, p = .001). In the final multivariable model, “stopping breathing while asleep” (p ≤ .05) and “problems staying awake last month” (p ≤ .01) were retained. These results show that sleep problems were associated with injury in this sample of older farmers. Future studies are necessary to screen and diagnose older farmers with obstructive sleep apnea (OSA) to empirically determine the effect of this sleep disorder on injury.

High Baseline Insulin Levels Associated With 6-Year Incident Observed Sleep Apnea

OBJECTIVEObstructive sleep apnea is common in patients with type 2 diabetes, and its association with insulin and insulin resistance has been examined in cross-sectional studies. We evaluate risk factors for incident observed sleep apnea in a general population not selected for sleep disturbances.RESEARCH DESIGN AND METHODSA total of 1,780 men and 1,785 women, aged 33 to 68 years, from the cohort Data from an Epidemiologic Study on the Insulin Resistance Syndrome (D.E.S.I.R.) responded to the question, “Has someone said to you that you stop breathing during your sleep?” at baseline and 6 years. Anthropometric, clinical, and biological factors were recorded at both time points.RESULTSAt baseline, 14% of men and 7% of women reported having observed sleep apnea (positive response to question); 6-year incidences were 14 and 6%, respectively. Age, anthropometric parameters, blood pressure, and sleep characteristics were all associated with prevalent, observed apnea episodes, in both sexes. Baseline waist circumference was the strongest predictor of incident apnea: standardized odds ratio (OR), adjusted for age and sex, 1.34 (95% CI 1.19–1.52). After adjustment for age, sex, and waist circumference, the standardized ORs for incident observed apnea were identical for fasting insulin and the homeostasis model assessment of insulin resistance: 1.31 (1.13–1.51) and 1.24 (1.09–1.41) for triglycerides and 1.52 (1.12–2.05) for smoking. Observed apnea at baseline was not associated with changes in anthropometric or biological parameters over the 6-year follow-up.CONCLUSIONSThe most important baseline risk factor for incident apnea was adiposity. After accounting for adiposity, other risk factors were high insulin, insulin resistance, high triglycerides, and smoking, factors amenable to lifestyle intervention.

An Angry Bed Partner

A 59-year-old man presented with the concern that his wife had witnessed him stopping breathing while asleep. Review of his sleep history also revealed agitated behaviors occurring during sleep. He reported almost nightly episodes of flailing his arms and legs about, often accompanied by angry yelling. When awoken from these episodes by his wife, he had clear dream recall, usually involving being in an argument or a fight with someone. His wife had resorted to sleeping in another bed so as not to be harmed. He had to date not suffered serious injury from one of these episodes. These behaviors were first noticed at 30 years of age. His past medical history included depression, hypertension, coronary artery disease and hypercholesterolemia, for which he took fluoxetine, clopidogrel, atenolol, ezetimibe/simvastatin, lisinopril, aspirin, and a multivitamin. Neurologic and systemic examinations were normal. There was no family history of neurodegenerative disease. Polysomnography with time-synchronized audiovisual monitoring and an expanded EEG montage showed mild OSA, with an AHI of 5. REM sleep was notable for persistent muscle tone recorded using 3 chin EMG leads. Overt yelling (“you want trouble, then keep it shut”) and swinging of the arms in a punching motion were recorded on video during REM sleep as well. An example of his REM sleep is shown in Figure 1. Figure 1 30-second epoch tracing of polysomnography recorded during REM sleep reveals persistent chin EMG tone during REM sleep, with overt whole-body movements at the end of the epoch. LEOG = Left electrooculogram, REOG = Right electrooculogram, FP1A2 – ... How would you treat this patient? Withdrawal of fluoxetine with careful psychiatric monitoring. REM sleep behavior disorder (RBD) is a REM-sleep parasomnia characterized by a lack of generalized atonia during REM sleep. Clinically, this usually presents as pronounced activity during sleep accompanied by vivid dream recall when awoken. Most often, the dream content is violent or anxious in nature.1 RBD may be idiopathic or secondary, being associated with neurodegenerative diseases, narcolepsy, cerebrovascular disease, intracranial tumors, central nervous system infection, and medication use. In particular, selective serotonin reuptake inhibitors, including fluoxetine, have been shown to cause secondary RBD.2 After a careful review of the patient's medication history, it was found that the RBD symptoms began around the time he had started taking fluoxetine 40 mg daily for severe depression symptoms. Therefore, secondary RBD (to fluoxetine) was suspected due to the start of symptoms with the start of fluoxetine therapy. Fluoxetine had fully controlled his depression symptoms during 19 years of continuous therapy. Two options were considered to treat the patient's RBD: addition of clonazepam, or withdrawal of fluoxetine with careful monitoring. The patient chose the latter option, and weaning was performed with close outpatient monitoring of his depressive symptoms. His RBD symptoms resolved around 6 weeks after discontinuation of fluoxetine, and a repeat polysomnogram was performed 3 months later. A representative REM sleep epoch is shown in Figure 2, showing a restoration of appropriate atonia in REM. The patient's clinical course demonstrates a more rapid response to withdrawal of fluoxetine compared to the original case report of this association, a major difference between the cases being patient age.2 There was a recurrence of depressive symptoms four months after discontinuing fluoxetine, and the patient was treated with bupropion, a dopaminergic/noradrenergic antidepressant without any reported tendency to induce or aggravate RBD.3 Bupropion therapy did not result in recurrence of RBD symptoms. Figure 2 0-second epoch tracing of polysomnography recorded during REM sleep shows normal reduction of EMG tone during REM sleep 3 months after fluoxetine discontinuation. LEOG = Left electrooculogram, REOG = Right electrooculogram, FP1A2 – O2A2 = Electroencephalogram ... The possibility of obstructive sleep apnea (OSA) triggering the RBD symptoms was entertained.4 Given the mild nature of the OSA, the polysomnographic findings, and the clinical response to fluoxetine withdrawal, this was not considered a major factor in this case. The patient's OSA was treated with positional therapy, and he and his wife were able to return to sleeping in the same bed with improvement in both his OSA and RBD symptoms.

Prevalence of Sleep Apnea in a Population of Adults with Type 2 Diabetes Mellitus

To assess the prevalence of sleep apnea (SA) in adults with type 2 diabetes mellitus (T2DM) and examine whether demographics and comorbid factors were associated with SA in this population. This study enrolled 330 consecutive adults with T2DM referred to a diabetes clinic, 279 of whom completed the study. Evaluation of the presence of SA was performed with use of a single-channel recording device that measures disordered breathing events from a nasal cannula airflow signal. The device was worn by the study participants in their home, after instruction in appropriate use by clinical staff at the diabetes center. The presence and severity of SA were determined by use of an apnea-hypopnea index (AHI), reflecting periods of diminished and absent breathing. Demographic and medical information data were collected to detect factors associated with SA in this study population. In addition, a time and cost analysis was conducted regarding the screening process for SA by clinical staff at the diabetes center. The results show a high prevalence of SA in adults with T2DM, ranging from 48% (AHI level of >or=10 events/h) to 29% (AHI level of >or=20 events/h). At an AHI cutoff value of >or=15 events/h, the overall prevalence rate was 36% (49% in male and 21% in female participants). The following variables were associated with SA: age >or=62 years, male sex, body mass index >or=30 kg/m2, snoring, and reports of stopping breathing during sleep. The time and cost analysis showed that the screening device involved minimal setup time, was simple to use, and was a cost-effective method to screen for SA. SA is a common disorder associated with major morbid conditions, including hypertension, obesity, cardiovascular disease, and insulin resistance. Predisposing factors for SA and T2DM are similar. This study showed that SA has a high prevalence in adults with T2DM and identified factors that may be associated with its presence in this population. Assessment for SA can be easily performed in an outpatient setting with a portable recording device such as the one used in this study. Screening for SA should be considered in the T2DM population.

Continuous measurement of acute toxicity in water using a solid state microrespirometer

This work presents the first true solid-state microrespirometer. It consists on a naturally developed biofilm of Pseudomonas aeruginosa over a Nafion modified array of gold microdisc electrodes. Such a device can be used to monitor acute toxicity in water streams based on the oxygen reduction current recorded at the microelectrode array. When a healthy biofilm is exposed to a toxic stream the bacteria conforming stop breathing which results in an immediate increase of the oxygen supply reaching the microelectrode array. The fabrication and use of such a microrespirometer is described, and a possible operation mode for a real application is presented. Given that different waters may contain toxic compounds of diverse nature, the respirometer presented here provides qualitative information only.

中高齢期における運動・スポーツ活動に関する研究(4) : ストレッチングの実施方法に関する記述に着目して

In this research, it aimed to inquire from the comparative study of the concrete content that had been described to the enlightenment book, material, etc. that related to about the execution method guessed to be in the situation of that was the main, effective movement not understood still enough more in detail.first of all, the description concerning how to extend it, hold time, the frequency and the breath method was basically included. was a description concerning the breath method that seemed for the interpretation to be performed variously.Next, it was possible to divide it roughly into the description Nature without stopping breathing and breath is slowly vomited. And a lot of descriptions that used the method of abdominal breathing, It inhaled slowly, it crowded, time was spent from the nose in a full chest for about slowly 30 seconds, and the breath from the mouth, were seen.finally, ‘the of the whole body' assumed to be first doing was good of all stretching and It is very good to do best in the beds in mornings was mainly considered from among a lot of posture. The part that perceived the stretch, duration, and the frequency were different, there was different descriptions about the concreteness of the execution method.