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Giora Pillar

Publications and source records attributed to Giora Pillar.

At least 19 recordsLinked to original sources
PubMed2006

Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea.

OBJECTIVES: To examine whether treatment with continuous positive airway pressure (CPAP) reduces nocturia in patients with obstructive sleep apnea (OSA). METHODS: This prospective clinical study recruited patients referred to the Rambam Sleep Laboratory with suspected OSA. After polysomnography, those found to have no OSA were excluded from the study, and the remainder were treated with CPAP. Nocturia was assessed at four time points: baseline (average number of awakenings to urinate per night during 1 week at home before polysomnography); diagnostic night in the laboratory; CPAP titration in the laboratory; and after 1 to 3 months of stable CPAP treatment at home (average number of awakenings to urinate per night for 1 week). RESULTS: Ninety-seven patients (75 men and 22 women) completed the study. The mean +/- SD age was 55 +/- 12 years, body mass index was 33 +/- 7 kg/m2, and respiratory disturbance index was 34 +/- 24/hr. The mean number of awakenings to void at home before CPAP was 2.5 +/- 2.4 times/night; during CPAP, it was 0.7 +/- 0.6 time/night (P < 0.001). A total of 73 patients reported improvement in nocturia. The mean number of awakenings to void in the laboratory was 1.1 +/- 0.9 before CPAP, with a decrease to 0.5 +/- 0.6 during CPAP (P < 0.001). Weak, but significant, correlations were found in the number of awakenings to void before treatment with the respiratory disturbance index (r = 0.25, P = 0.01) and with minimal oxygen saturation (r = -0.23, P = 0.02). CONCLUSIONS: CPAP appears to be an effective treatment for nocturia associated with OSA.

Adult↗
PubMed2006

Follow-up assessment of CPAP efficacy in patients with obstructive sleep apnea using an ambulatory device based on peripheral arterial tonometry.

This study aimed to assess the accuracy of a wrist-worn device based on peripheral arterial tonometry (Watch_PAT 100) to detect residual episodes of respiratory disturbance during continuous positive airway pressure (CPAP) therapy. Concurrent polysomnography was used as the reference standard to identify sleep disordered breathing (SDB) events. The study was conducted in three sleep laboratories affiliated with tertiary care academic medical centers. Seventy patients using CPAP to treat obstructive sleep apnea for at least 3 months, following an in-laboratory titration to determine the optimal therapeutic positive airway pressure, participated in this study. Symptoms indicating suboptimal therapy were not required for participation, but self-reported adherence to CPAP therapy was necessary for inclusion. Interventions are not applicable in this study. The accuracy of the PAT-derived respiratory disturbance index (PAT RDI scored by automated algorithm) to detect residual SDB on CPAP was assessed against polysomnography (PSG) using Bland-Altman analysis, receiver-operator characteristic (ROC) curves, and likelihood ratios for increasing (LR+) and decreasing (LR-) the probability of moderate-severe SDB in the study population. Respiratory events on the PSG were quantified using standard criteria for research investigations ("Chicago criteria") to yield a PSG RDI.C. Based on the PSG results, 19% of the participants had moderate-severe SDB (PSG RDI.C>15 events per hour) on their prescribed pressure. For PAT RDI >15 events per hour, the area under the ROC curve was 0.95 (SE 0.03, p < 0.0001, 95% CI 0.89 to 1.00), the LR+ was 8.04 (95% CI 3.64-17.7), and the LR- was 0.17 (95% CI 0.05-0.62). The mean difference between the PAT RDI and PSG RDI.C was three (2SD 14.5) events per hour. Therefore, residual moderate-severe SDB on CPAP was not uncommon in a multicenter population self-reporting adherence to CPAP therapy to treat obstructive sleep apnea. The Watch_PAT device accurately identified participants with moderate-severe SDB while using CPAP in the attended setting of a sleep laboratory.

Adult↗
PubMed2006

The 20-min trial of the maintenance of wakefulness test is profoundly affected by motivation.

Assessment of the ability to maintain wakefulness, although very important both for research and for clinical purposes, is still equivocal. The current gold standard is considered the Maintenance of Wakefulness Test (MWT), although there are two different potential protocols to perform it and the normal reference range has been determined on selected populations. The effect of potential "penalty" on failing the test (i.e., presenting sleepiness) has not been seriously studied. We therefore planned this study to examine the effect of motivation on the MWT results in a potentially sleepy population. We hypothesized that with the knowledge that participants may lose their driving license if they fail the test, the results would indicate significantly less sleepiness than reported for other populations. Fifty-four consecutive subjects at high risk of sleepiness referred to the sleep laboratory for evaluation of their ability to maintain wakefulness were studied. All were referred by the National Council for Driving Safety, knowing that if they failed the test, their driving license would not be renewed. Referral reasons were previously diagnosed: obstructive sleep apnea (OSA; 43%), sleep-related accident (7%), or other causes to suspect sleepiness. All underwent a full-night polysomnography (PSG) followed by MWT, five trials of 20 min each (MWT20). Of the 54 participants, 13 were treated for OSA and 28 had untreated OSA, 21 of them had severe OSA (Respiratory Disturbance Index > 30/h). Seventy-four percent of the participants had a BMI >30 kg/m2. Only 5 of the participants fell asleep in any of the MWT trials (one to five trials), which could not be predicted by severity of OSA, age, BMI, or variables derived from the previous night PSG. Of the 21 patients with severe untreated OSA, only 1 patient fell asleep during the MWT20. We conclude that motivation profoundly affects the MWT results, raising the question what should be considered normal or abnormal when sleepy results may cause penalty or other practical implications. In addition, we believe that these results suggest that for renewal of driving license purposes, the MWT20 is insufficient. We speculate that MWT40, with tighter cutoff threshold, would be a more effective tool.

Accidents, Traffic↗
PubMed2006

Evening-morning differences in blood pressure in sleep apnea syndrome: effect of gender.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with hypertension. In the current study we sought to determine whether the evening-morning differences in blood pressure (BP) would correlate with the severity of OSA and whether there are gender-related differences. METHODS: A total of 2009 consecutive patients referred to sleep examination because of suspected sleep apnea were retrospectively included. The patients comprised 1566 men, of whom 870 were nonhypertensive (non-HT) and 696 hypertensive (HT) and 443 women, of whom 258 were non-HT and 185 HT. Four BP measurements, two in the evening and two in the morning, were taken. The relationship between evening-morning differences in BP and the number of apneas/hypopneas divided by hours of sleep (AHI) were analyzed separately for HT and non-HT men and women. RESULTS: In men, increase in AHI was associated with increase in morning BP, and the evening-morning difference for both systolic and diastolic BP became negative. These trends were found to be significant by linear regression analyses both for HT (for systolic BP, r = 0.75, P < .05, for diastolic BP r = 0.96, P < .05) and non-HT patients (for systolic BP r = 0.93, P < .05, for diastolic BP r = 0.94, P < .05). In women (unlike in men), increasing AHI was not associated with a linear increase in the evening-morning BP differences. None of the regression lines fitted to the data was significant. CONCLUSIONS: Our results demonstrate that the evening to morning difference in BP in men with OSA is linearly related to the severity of OSA, both in patients with HT and in those with non-HT. These results may have practical relevance in screening for patients with OSA and may have prognostic clinical value in predicting future cardiovascular events.

Adult↗
PubMed2005

Controlled sleep restriction for rhythmic movement disorder.

Rhythmic movement disorder is a parasomnia that is difficult to treat. In our study, 3 weeks of controlled sleep restriction with hypnotic administration in the first week resulted in almost complete resolution of the movements in 6 children. This therapeutic success suggests that rhythmic movement disorder results from a voluntary self-soothing behavior.

Child↗
PubMed2005

Endothelial dysfunction in obstructive sleep apnea measured by peripheral arterial tone response in the finger to reactive hyperemia.

STUDY OBJECTIVE: The aim of this study was to investigate endothelial functioning in sleep apnea patients using a novel plethysmographic device that monitors peripheral arterial tone response in the finger to reactive hyperemia induced by forearm ischemia. PARTICIPANTS: Forty-six sleep apnea patients, 74.0% men, mean age 46.8 +/- 9.3 years, and 17 control subjects without sleep apnea, 64.7% men, mean age 47.1 +/- 6.7 years. SETTING: Eight-bed Technion Sleep Medicine Center in Haifa, Israel. DESIGN: Endothelial functioning assessed by the reactive hyperemia peripheral arterial tone index was measured twice, before sleep and after waking from sleep monitored by polysomnography in the laboratory. The reactive hyperemia peripheral arterial tone index was calculated as the average amplitude of the peripheral arterial tone signal after the cuff deflation divided by the average amplitude before the cuff inflation. RESULTS: Morning index of endothelial functioning was significantly lower in patients with moderate to severe sleep apnea (apnea-hypopnea index > or = 30) than in patients with mild sleep apnea (30 < apnea-hypopnea index < or = 10) and in the control group without sleep apnea (apnea-hypopnea index < 10). The morning index was significantly inversely correlated with apnea-hypopnea index. Patients with a history of hypertension or cardiovascular disease had significantly lower morning and evening indexes of endothelial functioning than patients without such a history. Multivariate analysis revealed that apnea-hypopnea index and sleep efficiency were significant predictors of the morning index. CONCLUSION: Measurements of the response of the peripheral arterial tone in the finger to reactive hyperemia can be used as a substitute for the brachial artery ultrasound technique to measure endothelial functioning in patients with sleep apnea.

Adult↗
PubMed2004

A novel adaptive wrist actigraphy algorithm for sleep-wake assessment in sleep apnea patients.

STUDY OBJECTIVES: Current actigraphic algorithms are relatively less accurate in detecting sleep and wake in sleep apnea patients than in people without sleep apnea. In the current study, we attempted to validate a novel automatic algorithm, which was developed for actigraphic studies in normal subjects and patients with obstructive sleep apnea by comparing it on an epoch-by-epoch basis to standard polysomnography. DESIGN: Prospective cohort study. SETTING: Multicenter, university hospital, sleep laboratories. PARTICIPANTS: A total of 228 subjects from 3 different sleep centers (Skara, Boston, Haifa) participated. INTERVENTION AND MEASUREMENTS: Simultaneous recording of polysomnography and Watch_PAT100, an ambulatory device that contains a built-in actigraph. The automatic sleep/wake algorithm is based on both the quantification of motion (magnitude and duration) and the various periodic movement patterns, such as those occurring in patients with moderate to severe obstructive sleep apnea. RESULTS: The overall sensitivity and specificity to identify sleep was 89% and 69%, respectively. The agreement ranged from 86% in the normal subjects to 86%, 84%, and 80% in the patients with mild, moderate, and severe obstructive sleep apnea, respectively. There was a tight agreement between actigraphy and polysomnography in determining sleep efficiency (78.4 +/- 9.9 vs 78.8 +/- 13.4%), total sleep time (690 +/- 152 vs 690 +/- 154 epochs), and sleep latency (56.8 +/- 31.4 vs 43.3 +/- 45.4 epochs). While for most individuals the difference between the polysomnography and actigraphy was relatively small, for some there was a substantial disagreement. CONCLUSIONS: We conclude that this actigraphy algorithm provides a reasonably accurate estimation of sleep and wakefulness in normal subjects and patients with obstructive sleep apnea on an epoch-by-epoch basis. This simple method for assessment of total sleep time may provide a useful tool for the accurate quantification of obstructive sleep apnea in the home environment.

Adaptation, Physiological↗
PubMed2004

Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder.

STUDY OBJECTIVES: Children with attention-deficit/hyperactive disorder (ADHD), in spite of being hyperactive, still benefit from treatment with stimulant medications. We hypothesized that children with ADHD are in fact sleepy during the day, and we sought to test it objectively. DESIGN: Single blind comparative study SETTING: University medical center PARTICIPANTS: Thirty-four children with a previous diagnosis of ADHD (mean age +/- SD, 12.4 +/- 4.6 years) and 32 matched controls (mean age, 12.0 +/- 3.6 years). INTERVENTIONS: N/A. MEASUREMENTS: All participants underwent a full-night polysomnographic study followed by a multiple sleep latency test (MSLT). RESULTS: Sleep latency, total sleep time, and sleep efficiency were comparable between the groups, yet children with ADHD were significantly sleepier during the day than those in the control group (mean MSLT score of 21.9 +/- 5.5 minutes versus 27.9 +/- 2.0 minutes, P < .005). Of the children with ADHD, 17 (50%) had signs of sleep-disordered breathing, compared with 7 of the control group (22%, P < .05). Five of the ADHD group had periodic limb movements during sleep (15%) versus none in the control group. Children without sleep-disordered breathing or periodic limb movements during sleep had the lowest nocturnal sleep efficiency and total sleep time. CONCLUSIONS: We conclude that children with ADHD demonstrate objective daytime somnolence, which may explain the beneficial effects of treatment with stimulant medications. Primary sleep disorders, especially sleep-disordered breathing and periodic limb movement disorder, should be looked for in children with ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction.

OBJECTIVES: To assess the association between obstructive sleep apnea syndrome (OSAS) and erectile dysfunction (ED). OSAS is associated with fatigue and daily dysfunction. We hypothesized that OSA severity will correlate with ED. We also sought to determine the specific features with predictive value for ED in patients with OSAS. METHODS: A total of 209 patients evaluated for potential OSAS were given a sleep questionnaire, a revised International Index of Erectile Function questionnaire (composed of three main topics: sexual satisfaction, erection during intercourse, and morning erection), and then underwent a full-night in-laboratory polysomnography examination. The data were scored blindly. RESULTS: A decrease in erectile function was found in all OSAS groups compared with those without OSAS. However, the only group for whom this reduction was statistically significant (P <0.05) in all ED dimensions was the severe OSAS group (respiratory disturbance index [RDI] greater than 40). Furthermore, the patients complaining of severe ED had the greatest RDI. Stepwise multiple logistic regression analyses revealed that the predicting factors for ED in OSAS patients were age, morning tiredness, and RDI. CONCLUSIONS: Severe OSAS is clearly associated with ED. However, the relationship is very weak in patients with mild or moderate OSAS. The predictive factors for ED in patients with OSAS include age, morning tiredness, and RDI.

Adult↗
PubMed2004

[The relationship between attention deficit hyperactivity disorder and sleep-alertness problems].

Several studies have reported a relationship between Attention Deficit Hyperactivity Disorder (ADHD) and sleep problems. Parents of children with ADHD report on decreased nocturnal sleep efficiency and sleep fragmentation compared to controls. On the other hand, objective measurements often show that these children sleep longer, and there is even a theory that suggests that daytime somnolence is the primary cause of the inattention problems seen in the disorder. Experimental sleep restriction, which leads to daytime somnolence, has been shown to be associated with ADHD-like behavior and poor cognitive achievements. In a study that we have recently performed, we found that children with ADHD had high prevalence of primary sleep disorders and objective daytime somnolence. This finding can explain why Ritalin, which is a stimulant medication, improves symptoms in these children. Sleep problems, primarily treatable such as Obstructive Sleep Apnea (OSA) or Periodic Limb Movements Disorder in Sleep (PLMD), should be investigated in the assessment of these children.

Adrenergic Uptake Inhibitors↗
PubMed2003

Awake negative pressure reflex response of the genioglossus in OSA patients and normal subjects.

We hypothesized that the response of the genioglossus to negative pressure during wakefulness should be intact in obstructive sleep apnea (OSA) patients despite published evidence showing impairment of the response of palatal muscles (Mortimore IL and Douglas NJ. Am J Respir Crit Care Med 156: 867-873, 1997). Thus the response of the genioglossus to brief nasal negative pressure applications (NPAs) in early inspiration was compared between OSA patients and an age-matched group of normal subjects at two study sites (n = 11 per group in Long Beach, n = 14 per group in Boston). Subjects were studied in the sitting (Long Beach) or supine (Boston) posture, and the genioglossus electromyogram (EMGgg) was measured with an intraoral surface electrode (Long Beach) or intramuscular electrode (Boston). The response of the EMGgg was expressed as the percent change from baseline where the baseline EMGgg was the value at the onset of the NPA. In Long Beach, the EMGgg response was significantly higher in the OSA patients at a lower suction pressure of approximately 10 cmH(2)O (75.2 +/- 8.4 vs. 37.4 +/- 4.0% increase; P < 0.001) but not at a higher suction pressure of approximately 20 cmH(2)O. In Boston, the response in the OSA patients was also greater (107.2 +/- 25.9 vs. 46.3 +/- 8.3%; P < 0.05) at a suction pressure of approximately 13 cmH(2)O. We conclude that the response of the genioglossus to NPA during wakefulness is not impaired in OSA patients compared with normal subjects and is greater at low suction pressures.

Adult↗
PubMed2003

Prevalence and risk of sleep disturbances in adolescents after minor head injury.

Sleep disturbances were reported in patients during the acute stage after minor head injury, and for some of these patients, the disturbances may become chronic. The purpose of the present study was to assess the prevalence and risk factors of the long-term sleep disturbances in adolescents after minor head injury. Unselected adolescents (98) who had experienced a minor head injury 0.5-6 years before the institution of the study and 80 matched control subjects were interviewed and completed a detailed questionnaire. The prevalence of sleep disturbances was significantly larger among adolescents who experienced minor head injury compared with the control subjects (28% versus 11%, P < 0.05). Within the study group, those who developed long-term sleep disturbances manifested a greater body mass index (20.8 +/- 4.0 vs 18.4 +/- 2.8 kg/m(2), P = 0.005) and poorer parental education (fathers 11.0 +/- 4.0 vs 13.4 +/- 3.0 years, mothers 11.8 +/- 3.3 vs 13.2 +/- 2.9 years, P < 0.05 for both), compared with those who did not develop sleep disturbances. Our data indicate that subjective sleep disturbances may be evident in a fairly high percentage of adolescents after minor head injury, up to 28%, suggesting that minor head injury may not be as benign as previously estimated. Risk factors include heavier body mass and poorer parental education.

Adolescent↗
PubMed2003

An automatic ambulatory device for detection of AASM defined arousals from sleep: the WP100.

OBJECTIVES AND BACKGROUND: Arousals from sleep are associated with increased sympathetic activation and therefore with peripheral vasoconstriction. Sleep fragmentation in the form of multiple arousals is associated with daytime somnolence and cognitive impairment; however, manual scoring of arousal is time consuming and problematic due to relatively high inter-scorer variability. We have recently shown that automated analysis of in-lab recorded peripheral arterial tone (PAT) signal and the pulse rate derived from it can accurately assess arousals from sleep as defined by the American Academy of Sleep Medicine (AASM). In the current study we sought to extend these findings to the Watch_PAT100 (WP100), an ambulatory device measuring PAT, oximetry and actigraphy. METHODS: Sixty-eight subjects (61 patients referred to the sleep lab with suspected obstructive sleep apnea and seven healthy volunteers, mean age 46.3+/-14.2 years) underwent a whole night polysomnography (PSG) with simultaneous recording of PAT signal by the ambulatory WP100 device. The PSG recordings were blindly manually analyzed for arousals based on AASM criteria, while PAT was scored automatically based on the algorithm developed previously. RESULTS: There was a significant correlation between AASM arousals derived from the PSG and PAT autonomic arousals derived from the WP100 (R=0.87, P<0.001), with a good agreement across a wide range of values. The sensitivity and specificity of PAT in detecting patients with at least 20 arousals per hour of sleep were 0.80 and 0.79, respectively, with a receiver operating characteristic curve having an area under the curve of 0.87. CONCLUSIONS: We conclude that automatic analysis of peripheral arterial tonometry signal derived from the ambulatory device Watch_PAT100 can accurately identify arousals from sleep in a simple and time saving fashion.

Adult↗
PubMed2003

Interactions between hypoglycemia and sleep architecture in children with type 1 diabetes mellitus.

OBJECTIVES: To assess the interactions between nocturnal hypoglycemia and sleep in children with type 1 diabetes mellitus (DM). STUDY DESIGN: Children with DM (n = 15) and 15 matched control children underwent full night polysomnographic recordings. Blood glucose levels were measured in the diabetic children by means of the MiniMed Continuous Glucose Monitoring System. Six of the diabetic children were also studied by peripheral arterial tonometry (an indirect indicator of sympathetic responses). RESULTS: Five children with DM (33%) had profound nocturnal hypoglycemia, which was associated with increased sleep efficiency, increased slow wave sleep, and increased Delta power in spectral analysis of the electroencephalogram. Hypoglycemic episodes were not associated with sympathetic activation. Rapid decline in glucose levels (>25 mg/dL/hour) but not the absolute degree of hypoglycemia were associated with awakenings from sleep. CONCLUSIONS: We conclude that sleep may inhibit sympathetic and arousal response to hypoglycemia. Rapid changes in glucose levels, independent of absolute glucose levels, may result in awakening from sleep. Continuous measurement of glucose levels during sleep may add important features in the treatment of children with DM.

Adolescent↗
PubMed2003

Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies.

BACKGROUND: Diagnosis of obstructive sleep apnea syndrome (OSAS) by ambulatory systems is a growing practice in view of the large number of patients awaiting correct diagnosis. The Watch PAT100 (WP100) [Itamar Medical; Caesarea, Israel] is a portable device based on the peripheral arterial tone (PAT) signal, and is designed for unattended home sleep studies. OBJECTIVES: To evaluate the efficacy, reliability, and reproducibility of the WP100 device for the diagnosis of OSAS as compared to in-laboratory, standard polysomnographic-based manual scoring. DESIGN AND METHODS: One hundred two subjects (78 men; 69 patients with OSAS and 33 normal volunteers; mean +/- SD age, 41.4 +/- 15.2 years; body mass index, 26.8 +/- 5.5) underwent in-laboratory full polysomnography simultaneously with WP100 recording. Fourteen subjects also underwent two additional unattended home sleep studies with the WP100 alone. The polysomnography recordings were blindly scored for apnea/hypopnea according to the American Academy of Sleep Medicine criteria (1999), and the polysomnography respiratory disturbance index (RDI) [PSG-RDI] was calculated. The WP100 data were analyzed automatically for the PAT RDI (PRDI) by a proprietary algorithm that was previously developed on an independent group of subjects. RESULTS: Across a wide range of RDI levels, the PRDI was highly correlated with the PSG-RDI (r = 0.88, p < 0.0001), with an area under the receiver operating characteristic curve of 0.82 and 0.87 for thresholds of 10 events per hour and 20 events per hour, respectively. The PRDI scores were also highly reproducible, showing high correlation between home and in-laboratory sleep studies (r = 0.89, p < 0.001). CONCLUSION: The WP100 may offer an accurate, robust, and reliable ambulatory method for the detection of OSAS, with minimal patient discomfort.

Adult↗