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Biomedical subjects

Max Hirshkowitz

Publications and source records attributed to Max Hirshkowitz.

24 records · Page 2Linked to original sources
PubMed2003

Effect of the new Medicare guideline on patient qualification for positive airway pressure therapy.

BACKGROUND: New Medicare criteria for prescribing continuous positive airway pressure (CPAP) recognize hypopnea as a sleep disordered breathing event. In so doing, hypopnea was redefined as requiring a 4% oxygen desaturation. The criteria omit electroencephalogram (EEG) arousals from the definition. This study was designed to assess how the new Medicare guideline changes CPAP eligibility. METHODS: Polysomnograms from 113 consecutive patients with obstructive sleep apnea were scored using both a definition for hypopnea that considered EEG arousals and the new Medicare definition that does not consider EEG arousal. CPAP eligibility was evaluated and compared. RESULTS: Sixteen percent of all patients and 41% of patients apnea+hypopnea index </=20 did not qualify for CPAP under the new Medicare guidelines. CONCLUSIONS: The new Medicare guidelines may underestimate OSA event occurrence and thereby deny CPAP therapy to many patients.

Adult↗
PubMed2003

Contextual factors and perceived self-reported sleepiness: a preliminary report.

OBJECTIVES: The purpose of the present study was to determine whether contextual factors affect self-reported sleepiness. Specifically, when a reference situation is held constant (e.g. watching television), does the respondent's position, location, or interest in the activity alter sleepiness rating. We also evaluated interactions between an individual's level of sleepiness and the effect of these contextual factors. METHOD: This is a prospective survey conducted at a teaching hospital. Samples were drawn from four populations: a general non-patient population (n=53), a geriatric population (n=22), a medical resident population (n=18), and patients referred for sleep evaluation (n=53). We developed and administered a questionnaire that included a list of activities varied according to respondent's position, location, or interest in the activity. This questionnaire, along with the Epworth Sleepiness Scale (ESS), was administered to 146 individuals. RESULTS: Overall, we found significant differences (P<0.01) in self-reported sleepiness when contextual factors were varied. However, the influence of contextual factors declined as a function of increasing sleepiness (estimated using ESS scores). CONCLUSIONS: The results of this preliminary study indicate that contextual factors can influence self-reported sleepiness rating; however, this influence diminishes as sleepiness increases. Thus, clarifying context may improve test sensitivity in more alert individuals but does not appear to add incremental value to self-reported sleepiness in sleepy patients.

Adult↗
PubMed2003

Practice parameters for using polysomnography to evaluate insomnia: an update.

Insomnia is a common and clinically important problem. It may arise directly from a sleep-wake regulatory dysfunction and/or indirectly result from comorbid psychiatric, behavioral, medical, or neurological conditions. As an important public-health problem, insomnia requires accurate diagnosis and effective treatment. Insomnia is primarily diagnosed clinically with a detailed medical, psychiatric, and sleep history. Polysomnography is indicated when a sleep-related breathing disorder or periodic limb movement disorder is suspected, initial diagnosis is uncertain, treatment fails, or precipitous arousals occur with violent or injurious behavior. However, polysomnography is not indicated for the routine evaluation of transient insomnia, chronic insomnia, or insomnia associated with psychiatric disorders.

Chronic Disease↗
PubMed2003

Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea: a 12-week, open-label study.

STUDY OBJECTIVES: The purpose of this 12-week study was to evaluate the efficacy and safety of adjunct modafinil to treat excessive sleepiness in patients with obstructive sleep apnea (OSA) who experience residual sleepiness despite regular nasal continuous positive airway pressure (nCPAP) use. DESIGN: Twelve-week, open-label trial. SETTING: Twenty-two centers in the United States. PATIENTS: We studied 125 patients with moderate-to-severe OSA (ie, respiratory disturbance index > or =15) before nCPAP therapy and residual daytime sleepiness (Epworth sleepiness scale [ESS] score > or =10) despite effective and regular nCPAP therapy. Patients were studied after completing a 4-week, double-blind, placebo-controlled trial of nCPAP plus modafinil for the treatment of residual daytime sleepiness. INTERVENTIONS AND MEASUREMENTS: Patients received individually titrated doses of modafinil (200 to 400 mg qd). Sleepiness was assessed using the ESS, quality of life was evaluated using the Functional Outcomes of Sleep Questionnaire (FOSQ), and the overall clinical effect was indexed using the clinical global impression of change scale. Adverse events, nCPAP use, and vital sign measurements were also recorded. RESULTS: The significant improvements in daytime wakefulness and sleep-related functional status observed with modafinil treatment during the 4-week, double-blind study were maintained throughout 12 weeks of open-label treatment: week 12 ESS, 7.8 (4.7) vs 14.4 (3.1) at double-blind baseline; week 12 FOSQ, 3.3 (0.6) vs 14.4 (2.7) at double-blind baseline (mean [SD]). The percentage of patients rated as clinically improved increased from 83% after 1 week to > or =93% after 2 to 12 weeks of open-label treatment. Mean (SD) nCPAP use decreased from 6.3 (1.3) h/night at baseline to 5.9 (1.4) h/night (p = 0.004) during open-label treatment. The most common adverse events were headache (28%), anxiety (16%), and nervousness (14%). CONCLUSIONS: Modafinil remained effective and well tolerated as an adjunct therapy for residual daytime sleepiness even after 12 weeks of daily dosing in patients with OSA receiving nCPAP therapy.

Adult↗