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Introduction
Skills and Expertise
Publications
Publications (58)
Background:
Evaluation and interpretation of the literature on obstructive sleep apnea is needed to consolidate and summarize key factors important for clinical management of the OSA adult patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International C...
Study objectives:
Clinical benefits of PAP therapy for OSA are assumed to require adherent PAP usage, as defined by CMS as ≥ 4 hours of use ≥ 70% of nights. However, this is based on early data and does not necessarily capture improvements at subthreshold adherence. We explored dose-response relationships between PAP adherence measures and EDS fro...
Study objectives:
Data have demonstrated adverse health effects of sleep deprivation. We postulate that oxidative stress and systemic inflammation biomarkers will be elevated in relation to short-term and long-term sleep duration reduction.
Methods:
We analyzed data from the baseline examination of a randomized controlled trial involving partici...
Background:
Although existing research highlights the relationship of obstructive sleep apnea (OSA) and cardiovascular disease, the effect of OSA treatment on cardiovascular biomarkers remains unclear. We evaluated the effect of OSA treatment on oxidative stress/inflammation measures.
Methods:
We conducted a parallel, randomized controlled trial...
Obstructive sleep apnea (OSA) is common in patients undergoing surgery. OSA, known or suspected, has been associated with significant perioperative adverse events, including severe neurologic injury and death. This study was undertaken to assess the legal consequences associated with poor outcomes related to OSA in the perioperative setting.
A retr...
The physiological effect of sleep on the body’s organ systems is modulated by closed feedback loops. Due to this feedback system, a major disturbance in sleep is highly likely to affect the function and homeostasis of the body as a whole. Similarly, pathological changes in any individual organs may lead to a significant change in sleep structure an...
Study objectives:
Measures of health-related quality of life (HRQL) specific for sleep disorders have had limited psychometric evaluation in the context of randomized controlled trials (RCTs). We investigated the psychometric properties of the Functional Outcomes of Sleep Questionnaire (FOSQ) and Sleep Apnea Quality of Life Instrument (SAQLI). We...
SESSION TITLE: Sleep Posters II
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: In hospitalized patients, sleep deprivation potentially leads to negative outcomes. Sleep deprivation results from multiple factors related to the inpatient setting. We sought to objectively study sle...
Unlabelled:
Obstructive sleep apnea (OSA) is a risk factor for significant perioperative complications. This national survey study sought to determine the attitudes of physicians involved in the perioperative care of OSA patients.
Methods:
We modified the perioperative survey used by Turner et al. among Canadian anesthesiologists. We mailed the...
We hypothesized that restless legs syndrome (RLS) would be common and associated with impaired quality of life (QOL) among palliative care outpatients.
76 palliative care clinic patients completed the National Institutes of Health restless legs syndrome (NIH-RLS) screening questionnaire. Questionnaire data was also gathered on RLS severity and RLS-...
As a field that has emerged in recent years, from multidisciplinary roots within long-standing, traditional academic infrastructures, sleep medicine has assumed highly disparate organizational structures at each institution. Access to the creativity, talent, trainees, administration, and financial investment of one or more departments at each medic...
An associated white paper, previous to this one, describes the current institutional infrastructure for academic sleep medicine, its multidisciplinary roots, and related challenges that the field faces in patient care, education, and research. Here we discuss existing approaches to these challenges at some centers, and ideas to maximize the potenti...
Study objectives:
Black race has been associated with decreased continuous positive airway pressure (CPAP) adherence. Short sleep duration, long sleep latency, and insomnia complaints may affect CPAP adherence as they affect sleep and opportunity to use CPAP. We assessed whether self-reported sleep measures were associated with CPAP adherence and...
Objective:
To investigate the associations between obstructive sleep apnea (OSA) and maternal and neonatal morbidities in a cohort of obese gravid women.
Methods:
Participants were enrolled in a prospective observational study designed to screen for OSA and describe the possible risk factors for and outcomes of OSA among obese (body mass index [...
Emerging data are raising concerns that patients with known or suspected obstructive sleep apnea (OSA) are at increased risk for a myriad of perioperative complications. Strategies to identify patients preoperatively with OSA, or at risk for OSA, are being advocated. In addition, approaches to identify patients most at risk for OSA-related postoper...
To test the utility of an integrated clinical pathway for obstructive sleep apnea (OSA) diagnosis and continuous positive airway pressure (CPAP) treatment using portable monitoring devices.
Randomized, open-label, parallel group, unblinded, multicenter clinical trial comparing home-based, unattended portable monitoring for diagnosis and autotitrati...
There are few established predictors of CPAP adherence; poor adherence limits its effectiveness. We investigated whether race, education level, and residential economic status predict CPAP adherence in participants enrolled in a trial with standard access to treatment.
A multi-center randomized trial of home vs. lab-based evaluation and treatment o...
The objective of this study was to determine if primary care providers (PCPs) screen for sleep disorders during clinical evaluation of new patients, and to compare this to likely sleep diagnoses as assessed by validated questionnaires.
Adult patients evaluated as new patients in a primary care clinic at a tertiary care center were included in a pro...
The mortality attributed to obstructive sleep apnea (OSA) is comparable to that of breast cancer and colon cancer. We sought to determine if patients at high risk for OSA were less likely to be referred by their primary care physician for polysomnograms (PSG) than mammograms or endoscopies.
Prospective cohort study; patients were recruited between...
The objective of the study was to estimate the maternal and neonatal morbidities associated with obstructive sleep apnea (OSA) in pregnancy.
Women delivering between 2000-2008 with confirmed OSA in an academic center were included. Normal-weight and obese controls were randomly selected at a 2:1 ratio. Maternal and neonatal morbidities were compare...
Obstructive sleep apnea (OSA) is associated with postoperative airway obstruction, hypoxemia, cardiac arrhythmias, cardiorespiratory arrest, hypoxic encephalopathy, and death. Three cases highlighting important issues in patients with OSA are presented that occurred prior to and after implementation of an OSA protocol.
To study the role of adjunctive upper airway surgery in obese patients with obstructive sleep apnea (OSA) who were poorly compliant with continuous positive airway pressure (CPAP) therapy.
Retrospective study of obese patients with OSA and documented poor CPAP compliance who underwent noncurative upper airway surgery for anatomical obstruction. Dat...
Obstructive sleep apnea (OSA) and asthma are common and share similar nocturnal symptoms. We hypothesized that the prevalence of OSA symptoms would be greater in asthmatics compared to a general internal medicine population.
Patients in the Asthma Clinics (n=177) and Internal Medicine Clinics (n=328) at MetroHealth Medical Center, an urban academic...
Obstructive sleep apnea (OSA) is associated with cardiovascular diseases, yet available data suggests cardiologists underreport OSA. This study assessed whether cardiologists' knowledge and attitudes about OSA contribute to this finding. A previously validated questionnaire, the "Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire" (OSAKA...
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary out...
This the first of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. In this first part of this paper, the general principles of circadian biology that underlie clinical evaluation and treatment are reviewed. We then repo...
This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Disord...
Patients with obstructive sleep apnea (OSA) are at increased risk to sustain adverse events during the perioperative period including difficulty with airway control, hypoxemia, airway obstruction requiring reintubation, arrhythmias, myocardial ischemia, and death. Numerous factors appear to be responsible for these consequences, including the effec...
Objective: This the first of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. In this first part of this paper, the general principles of circadian biology that underlie clinical evaluation and treatment are reviewed. W...
Objective: This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep P...
PURPOSE: Obstructive sleep apnea (OSA) is a risk factor for perioperative cardiopulmonary complications. Available data suggests that postoperative use of positive airway pressure (PAP = CPAP or bilevel pressure support) may reduce complication rates. This study was performed to determine if OSA patients on PAP had significant hypoxemic episodes fo...
PURPOSE: National Sleep Foundation data suggests that poor sleep hygiene practices are common. However, details of these poor practices and their relationship to sleep disorders have not been well-studied. We hypothesized that poor sleep hygiene behaviors would be more common in patients with Obstructive Sleep Apnea (OSA) as compared to those witho...
Autoimmune adrenalitis is the most common cause of primary adrenal insufficiency in western countries. The remaining causes are infectious diseases, metastatic cancer, adrenal hemorrhage, sarcoidosis, amyloidosis, and medication induced. Tuberculosis is still one of the most common causes worldwide because of its high prevalence; however, it result...
A growing body of literature is suggesting that there is a link between head and neck cancer treated with radiation therapy and the development of obstructive sleep apnea/ hypopnea syndrome (OSAHS). We describe the case of a 54-year-old man with a history of head and neck cancer whose OSAHS had gone undiagnosed for 3 years. After the diagnosis was...
PURPOSE: The use of polysomnography (PSG) has increased dramatically. In 2004, a multicenter study found the incidence of adverse events (AE) during PSG to be only 0.35%, though only 1 of 17 sites studied was at a major hospital (> 500 beds). We hypothesized that the incidence of AE will depend upon the nature of patient population studied and thus...
PURPOSE: Obesity is a rapidly growing epidemic worldwide. Increasingly, studies have suggested an association between obesity and insufficient sleep. Most studies, however, have involved non-obese populations without known sleep disorders. We hypothesized that in patients referred for polysomnography (PSG), we would find a relationship between body...
Obstructive sleep apnea (OSA) case finding in hospitalized patients occurs commonly. In some institutions, the wait time to polysomnography (PSG) may be long. We investigated the impact of a protocol utilizing autoadjusting continuous positive airway pressure (CPAP) for early initiation of therapy in hospitalized patients suspected of having OSA.
A...
Unlabelled:
Anesthesia and surgery both affect the architecture of sleep. Aside from the postoperative effects of anesthesia and surgery, sleep deprivation and fragmentation have been shown to produce apneas or desaturations even in patients without presumed sleep apnea. Recent epidemiologic data have placed the prevalence of obstructive sleep apn...
Obstructive sleep apnea syndrome (OSAS) has been associated with motor vehicle accidents and work-related injuries. Proposed mechanisms for this association have included excessive sleepiness, decreased vigilance, inattentiveness, and psychological impairment, all related to the abnormal sleep and nocturnal hypoxia seen in OSAS. This report describ...
Reduced DNA repair capacity of carcinogen-induced DNA damage is now thought to significantly influence inherent susceptibility to lung cancer. DNA-dependent protein kinase (DNA-PK) is a serine-threonine kinase activated by the presence of double-strand breaks in DNA that appears to play a major role in non-homologous recombination and transcription...
Identification of individuals at greatest risk of developing lung cancer could enhance the efficacy of intervention modalities, thereby greatly reducing mortality from this disease. One strategy for identifying these people is to establish molecular markers which reflect the severity of their cancerization field. Thus, investigations were initiated...
Early identification and subsequent intervention are needed to decrease the high mortality rate associated with lung cancer. The examination of bronchial epithelium for genetic changes could be a valuable approach to identify individuals at greatest risk. The purpose of this investigation was to assay cells recovered from nonmalignant bronchial epi...