Biomedical subjects

D N Neubauer

Publications and source records attributed to D N Neubauer.

3 recordsLinked to original sources

PubMed1999

Sleep problems in the elderly.

Refreshing sleep requires both sufficient total sleep time as well as sleep that is in synchrony with the individual's circadian rhythm. Problems with sleep organization in elderly patients typically include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening and less total sleep time. Poor sleep habits such as irregular sleep-wake times and daytime napping may contribute to insomnia. Caffeine, alcohol and some medications can also interfere with sleep. Primary sleep disorders are more common in the elderly than in younger persons. Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs. Sleep apnea can lead to excessive daytime sleepiness. Evaluation of sleep problems in the elderly includes careful screening for poor sleep habits and other factors that may be contributing to the sleep problem. Formal sleep studies may be needed when a primary sleep disorder is suspected or marked daytime dysfunction is noted. Therapy with a benzodiazepine receptor agonist may be indicated after careful evaluation.

Aged↗

PubMed1999

Modeling hypersomnolence in sleep-disordered breathing. A novel approach using survival analysis.

The etiology of excessive daytime sleepiness in patients with sleep-disordered breathing (SDB) is not well defined. In this study, we examined the relationships between several clinical and polysomnographic parameters and the degree of hypersomnolence in 741 patients with SDB (apnea-hypopnea index [AHI] >/= 10 events/h). The study sample was obese (body mass index [BMI]: 35.3 +/- 8.5 kg/m2) and had evidence of moderate SDB (AHI: 47.6 +/- 29.3 events/h). Hypersomnolence was quantified with the multiple sleep latency test (MSLT) and survival analysis was used to assess the risk factors for hypersomnolence. In a multivariate proportional hazards model, AHI and nocturnal hypoxemia were independent predictors of hypersomnolence (MSLT < 10 min). The adjusted relative risks (RR) of hypersomnolence were 1.00, 1.30, and 1.65 for patients with an AHI of 10 to 29.9, 30 to 59.9, and >/= 60 events/h, respectively. A positive association between hypersomnolence and oxyhemoglobin desaturation (DeltaSaO2) was observed with RR of 1.00, 1.18, 1.43, and 1.94 for a DeltaSaO2 of </= 5%, 5.1 to 10%, 10.1 to 15%, and > 15%, respectively. Sleep fragmentation, as assessed by the distribution of sleep stages, was also an independent predictor of hypersomnolence. Using stage 1 sleep as a reference, an increase in stage 2 and slow wave sleep (SWS) were protective from hypersomnolence. For a 10% increase in stage 2 or SWS the adjusted RR for hypersomnolence were 0.93 and 0.79, respectively. REM sleep showed no significant association with the degree of hypersomnolence. These results suggest that AHI, nocturnal hypoxemia, and sleep fragmentation are independent determinants of hypersomnolence in SDB.

Adult↗

PubMed1988

Psychiatrists' accuracy in predicting violent behavior on an inpatient unit.

Courts and legislators continue to assume psychiatrists are able to predict dangerousness, but research has shown they have no special ability to do so. In this study, two psychiatrists examined 47 new inpatient admissions to a short-term psychiatric treatment unit and predicted whether they would commit battery or demonstrate threatening or suicidal behavior within seven days. The psychiatrists were not accurate in predicting battery or suicidal behavior but had some efficacy in predicting threatening behaviors. The presence of assaultive or threatening behavior on admission, hallucinations on mental status examination, and a discharge diagnosis of mania were useful for predicting battery. A discharge diagnosis of mania was useful for predicting threatening behavior. The use of likelihood ratios to conceptualize predictive data is described.

Adjustment Disorders↗