Biomedical subjects

J Catesby Ware

Publications and source records attributed to J Catesby Ware.

9 recordsLinked to original sources

PubMed2006

Medical resident driving simulator performance following a night on call.

This study compared driving simulation performance after night call and after being off call in 22 medical residents and 1 medical student in a prospective within-subjects counterbalanced design. The results demonstrated an unexpected interaction between call and sex wherein men performed more poorly after night call than women as measured by lane variance and crash frequency. Secondary measures, including caffeine, actigraphy, and subjective total sleep time, did not differ between men and women. Collectively, results of this study and others suggest that medical residents are at risk when driving after a night on call and support the need for resident education to address sleep needs, consequences of sleep disruption, postcall recovery sleep, and countermeasures that may reduce residents' driving risks.

Accidents, Traffic↗

PubMed2005

Symptoms of gastro-oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients.

BACKGROUND: Studies suggest obstructive sleep apnea syndrome (OSAS) frequently manifests in patients with gastroesophageal reflux disease (GERD) and that there may be a causal relationship. AIM: To determine the relationship between OSAS and symptoms of GERD. METHODS: Consecutive patients referred to the Sleep Disorders Center (SDC) 18 years and older with polysomnographically defined OSAS were evaluated prospectively for GERD using a validated symptoms questionnaire. The GERD and OSAS relationship was assessed by 1) determining frequency of GERD in patients with and without OSAS; 2) ascertaining the relationship between OSAS severity categories and presence of GERD; 3) examining GERD score in relation to those factors that might affect both GERD and OSAS, e.g. obesity. RESULTS: One thousand and twenty-three SDC patients met entry criteria. Amongst participants, GERD was common (29% of women and 17% of males) and OSAS extremely common (58% of women and 80% of males). GERD score did not correlate with OSAS variables. The severity of OSAS did not influence the prevalence of GERD. CONCLUSION: In a large group of patients referred to a sleep disorders center, there was no relationship between OSAS and GERD symptoms. Also, there was no relationship between the severity of OSAS and the likelihood of GERD symptoms.

Adult↗

PubMed2005

Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index.

BACKGROUND: Insufficient sleep and obesity are common in the United States. Restricted sleep causes important neurocognitive changes, including excessive daytime sleepiness and altered mood. This may result in work-related injuries and automotive crashes. Evidence links sleep loss to hormonal changes that could result in obesity. This article examines the association between restricted sleep and obesity in a heterogeneous adult primary care population. METHODS: A total of 1001 patients from 4 primary care practices participated in this prospective study. Patients completed a questionnaire administered by a nurse or study coordinator concerning demographics, medical problems, sleep habits, and sleep disorders. Professional staff measured height and weight in the office. The relationship between body mass index (BMI) and reported total sleep time per 24 hours was analyzed after categorizing patients according to their BMI (calculated as weight in kilograms divided by the square of height in meters) as being of normal weight (<25), overweight (25-29.9), obese (30-39.9), or extremely obese (> or =40). RESULTS: Analyzable forms from 924 patients aged between 18 and 91 years indicated that (1) the mean BMI was 30; (2) women slept more than men; (3) overweight and obese patients slept less than patients with a normal BMI (patients reported less sleep in a nearly linear relationship from the normal through the obese group); and (4) this trend of decreasing sleep time was reversed in the extremely obese patients. CONCLUSIONS: This study found that reduced amounts of sleep are associated with overweight and obese status. Interventions manipulating total sleep time could elucidate a cause-and-effect relationship between insufficient sleep and obesity.

Adolescent↗

PubMed2005

Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial.

CONTEXT: Insomnia is a prevalent health complaint associated with daytime impairments, reduced quality of life, and increased health-care costs. Although it is often self-treated with herbal and dietary supplements or with over-the-counter sleep aids, there is still little evidence on the efficacy and safety of those products. OBJECTIVE: To evaluate the efficacy and safety of a valerian-hops combination and diphenhydramine for the treatment of mild insomnia. DESIGN AND SETTING: Multicenter, randomized, placebo-controlled, parallel-group study conducted in 9 sleep disorders centers throughout the United States. PATIENTS: A total of 184 adults (110 women, 74 men; mean age of 44.3 years) with mild insomnia. INTERVENTIONS: (1) Two nightly tablets of standardized extracts of a valerian (187-mg native extracts; 5-8:1, methanol 45% m/m) and hops (41.9-mg native extracts; 7-10:1, methanol 45% m/m) combination for 28 days (n = 59), (2) placebo for 28 days (n = 65), or (3) 2 tablets of diphenhydramine (25 mg) for 14 days followed by placebo for 14 days (n = 60). OUTCOME MEASURES: Sleep parameters measured by daily diaries and polysomnography, clinical outcome ratings from patients and physicians, and quality of life measures. RESULTS: Modest improvements of subjective sleep parameters were obtained with both the valerian-hops combination and diphenhydramine, but few group comparisons with placebo reached statistical significance. Valerian produced slightly greater, though nonsignificant, reductions of sleep latency relative to placebo and diphenhydramine at the end of 14 days of treatment and greater reductions than placebo at the end of 28 days of treatment. Diphenhydramine produced significantly greater increases in sleep efficiency and a trend for increased total sleep time relative to placebo during the first 14 days of treatment. There was no significant group difference on any of the sleep continuity variables measured by polysomnography. In addition, there was no alteration of sleep stages 3-4 and rapid eye movement sleep with any of the treatments. Patients in the valerian and diphenhydramine groups rated their insomnia severity lower relative to placebo at the end of 14 days of treatment. Quality of life (Physical component) was significantly more improved in the valerian-hops group relative to the placebo group at the end of 28 days. There were no significant residual effects and no serious adverse events with either valerian or diphenhydramine and no rebound insomnia following their discontinuation. CONCLUSIONS: The findings show a modest hypnotic effect for a valerian-hops combination and diphenhydramine relative to placebo. Sleep improvements with a valerian-hops combination are associated with improved quality of life. Both treatments appear safe and did not produce rebound insomnia upon discontinuation during this study. Overall, these findings indicate that a valerian-hops combination and diphenhydramine might be useful adjuncts in the treatment of mild insomnia.

Adult↗

PubMed2003

Multiple sleep latency test by polysomnography: a case report.

Obstructive sleep apnea syndrome may disguise the presence of other less common but equally important etiologies of sleepiness in patients presenting to sleep disorder specialists. In this case report the authors detail how multiple polysomnograms performed over 6 years eventually suggested that a patient had both obstructive sleep apnea and narcolepsy.

Adult↗

PubMed2003

The long-term results of gastric bypass on indexes of sleep apnea.

STUDY OBJECTIVES: Weight loss improves obstructive sleep apnea (OSA), and clinicians regularly recommend dieting to their patients with OSA; however, many morbidly obese patients may be unable to lose weight without medical or surgical intervention. Gastric bypass surgery (GB) facilitates weight loss for morbidly obese patients. Studies show GB will improve symptoms associated with OSA, but little is known regarding the long-term effects of GB on this population. DESIGN: Historical, retrospective, cohort study. SETTING: Sleep Disorders Center, Sentara Norfolk General Hospital, Norfolk, VA. PARTICIPANTS: A list of subjects who underwent vertical Roux-en-Y GB was cross-referenced with the Sleep Disorders Center at Sentara Norfolk General Hospital to identify patients with a diagnosis of OSA during the preoperative evaluation prior to undergoing GB. INTERVENTIONS: GB. MEASUREMENTS: Our primary end point was the respiratory disturbance index (RDI). Secondary variables were body mass index (BMI), mean oxygen saturation, low oxygen saturation, a standardized depression scale, and the continuous positive airway pressure (CPAP) requirement. RESULTS: Thirty-four subjects with a diagnosis of OSA prior to GB were identified. Of these, 28 subjects were located and offered follow-up polysomnography after GB. Eight subjects returned for repeat polysomnography. The subjects were re-evaluated an average of 28 months after GB. Seven subjects had a lower BMI after GB. Mean BMI was reduced by 31% (p = 0.001). The mean decrease in RDI was 75% (p = 0.01), and five of the eight subjects no longer required nasal CPAP. Mean nocturnal oxygen saturation improved from 95 to 97% (p = 0.04). CONCLUSIONS: Weight reduction following GB is associated with significant improvements in sleep apnea indexes an average of 28 months after GB. Re-evaluation after GB is necessary to identify and treat those patients who, despite subjective improvement, may continue to require CPAP for residual OSA.

Adult↗

PubMed2002

Marital satisfaction of wives of untreated sleep apneic men.

OBJECTIVES: The purpose of this study was to assess marital satisfaction of the wives of untreated sleep apnea patients. DESIGN AND METHODS: A prospective study was carried out that compared the marital satisfaction of wives of men with sleep apnea to the marital satisfaction of wives of men presenting to a primary care physician's office. The study examined three patient groups: 26 wives of men with severe sleep apnea, 19 wives of men with mild sleep apnea, and 19 controls from a primary care physician's office. Those with other significant medical disorders were excluded. Marital satisfaction using the Dyadic Adjustment Scale and a sleep behaviors questionnaire was compared between the patient groups. RESULTS: Wives of severe and mild apneic men were similar to controls on marital satisfaction but differed significantly in satisfaction with husbands' sleep behaviors. CONCLUSIONS: Although the presence of sleep apnea in married men has little effect on their wives' overall marital satisfaction, it did affect whether they slept together or apart. For these patients, the choice to sleep apart may have benefited rather than impaired marital satisfaction.

Journal Article↗

PubMed2002

Exacerbation of REM sleep behavior disorder by chocolate ingestion: a case report.

REM sleep behavior disorder (RBD) is manifest by loss of normal rapid eye movement sleep atonia and the acting out of dreams of often violent content. Both idiopathic and secondary forms of RBD exist. We report on chocolate as a possible new precipitating agent for RBD and comment on a possible mechanism of action in this disorder.

Journal Article↗

PubMed2002

Sleep disordered breathing and driving risk.

Obstructive sleep apnea syndrome leads to an increased risk of motor vehicle accidents through multiple pathways. Sleep apnea and motor vehicle crashes are common, and motor vehicle collisions are the leading causes of death amongst accidents. Therefore, the clinician charged with the care of apneic patients must address the issue of safe driving. Some recent evidence reveals that driving simulator technology may discriminate apneic drivers from control drivers as well as those apneics at a lesser risk for automobile crashes. This same tool demonstrates an improvement in driving capabilities to baseline when patients with sleep apnea are treated with nasal continuous positive airway pressure and that this improvement may occur rapidly. The prevention of driving accidents in patients with sleep apnea appears cost effective. Educating the patient with sleep apnea about sleepy driving and objective documentation of treatment efficacy are important in reducing the likelihood of accidents.

Accidents, Traffic↗