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Biomedical subjects

Michael J Sateia

Publications and source records attributed to Michael J Sateia.

7 recordsLinked to original sources
PubMed2004

The Dartmouth sleep knowledge and attitude survey: development and validation.

OBJECTIVES: To construct and validate an instrument for the purpose of assessing effectiveness of curriculum development and educational interventions in sleep medicine. BACKGROUND: Medical school and graduate medical curricula have historically contained quite limited instruction in sleep physiology and sleep medicine. Recent initiatives, particularly the Sleep Academic Award program, have attempted to address this issue through support of programs designed to develop educational resources and implement curriculum change. Effective measures for assessment of educational outcome are an essential component of these interventions. METHODS: A panel of sleep experts, other medical professionals, and education consultants developed a knowledge and attitude survey, designed to address a broad range of topics in sleep physiology and medicine. The instrument was modified in response to pilot testing, and a final 24-item survey has been administered to two cohorts of college undergraduates before and immediately following a ten-week course of instruction and to a single cohort of first-year medical students. A group of sleep medicine experts served as the comparison population. Results were analyzed for item difficulty, item discrimination, and instructional sensitivity. RESULTS: Analyses of item difficulty, item discrimination, and instructional sensitivity were in line with acceptable norms for criterion-referenced tests. There was evidence of discriminative validity, as shown by scores on the measure and acknowledged expertise. CONCLUSION: This instrument demonstrates both logical and empirical evidence of validity and may serve as a useful tool in assessing outcome of educational interventions in sleep medicine.

Adult↗
PubMed2003

Distinguishing between excessive daytime sleepiness and fatigue: toward improved detection and treatment.

INTRODUCTION: Excessive daytime sleepiness (EDS) and fatigue occur in high percentages in the general population. They are common complaints in primary care and in specialty medicine. Although they may represent distinct or overlapping phenomena, the general medical literature does not normally distinguish between EDS and fatigue. Despite their prevalence, both EDS and fatigue are identified and treated in a relatively small proportion of those affected. The similarity of EDS and fatigue may create diagnostic ambiguity and thereby contribute to under-identification and under-treatment. Fatigue, in particular, is thought to be difficult to manage when it is identified. METHODS: The literature was searched for reviews, meta-analysis and similar levels of papers focused on EDS or fatigue. RESULTS: EDS and fatigue are operationalized in ways that contribute to blurring rather than to distinguishing between them. Existing measures of both EDS and fatigue may also contribute to their misidentification. Effective treatments for both symptoms have been established. Behavioral interventions are effective and underutilized. DISCUSSION: We suggest more precise operationalization of EDS and fatigue, leading to a refinement of existing measures or development of new tools, a structured interview with fatigue and EDS sections in the clinical setting, and more consideration for behavioral interventions.

Behavior Therapy↗
PubMed2003

Neuropsychological impairment and quality of life in obstructive sleep apnea.

Although clinical experience has suggested for more than two decades that OSA is associated with impairment of cognition, emotional state, and quality of life and that treatment with nasal CPAP produces significant improvements in these areas, sound empirical evidence to support this view, especially regarding treatment outcome, has been lacking. More recent investigations have begun to provide this support from randomized, adequately controlled studies. These assessments suggest that some degree of cognitive dysfunction is associated with OSA. The effects are most apparent in the severe cases, whereas results in mild cases are more equivocal. Reported impairments include global intellectual dysfunction and deficits in vigilance, alertness, concentration, short- and long-term memory, and executive and motor function. Considerable discrepancy exists across studies with respect to type and degree of dysfunction, however. Disturbances in general intellectual function and executive function show strongest correlations with measures of hypoxemia. Not unexpectedly, alterations in vigilance, alertness, and, to some extent, memory seem to correlate more with measures of sleep disruption. Although many inadequately controlled investigations have demonstrated reversibility of most or all of these deficits with effective treatment, more recent placebo-controlled studies have raised doubts regarding whether the observed changes are truly a function of treatment. This issue requires further systematic exploration with adequate controls and step-wise analysis of treatment duration effects. A similar set of considerations exists with respect to the relationship between psychological disturbance, primarily depression, and OSA. Although several studies suggest significant depression in these patients, the results are mixed. Placebo-controlled treatment trials fail to demonstrate consistently a difference in mood improvement between active treatment groups and controls, although several methodologic considerations suggest that these results should be interpreted with caution. Numerous investigations leave little doubt about the issue of quality of life impairment among persons with OSA. Further characterization of impairment, particularly in areas specific to this population, will provide clearer understanding of the problem. Preliminary investigations of treatment response in controlled studies indicate significantly greater improvement of quality of life in response to CPAP. Although patients with OSA commonly report disturbances in cognitive and psychological function and general quality of life, the increased rates of obesity, hypertension, diabetes, cardiovascular disease, medication use, and related psychosocial complications present a host of potential etiologies that might explain the impairments noted. There can be little doubt that these covariants do, in some cases, contribute to neuropsychological dysfunctions. It is essential that future studies continue to define those disturbances that are specific to OSA, the relationship between levels of severity and impairment, the role of treatment in reversing these dysfunctions, and the correlation between test results and significant day-to-day social and occupational functional impairment.

Clinical Trials as Topic↗
PubMed2003

Cardiovascular abnormalities in sleep-disordered breathing.

The role of sleep-disordered breathing (SDB) in the development of persistent daytime pulmonary hypertension (PH) and cor pulmonale is controversial and has not been extensively studied. In this review we discuss the physiological changes that occur during SDB in the cardiovascular system, as well as review the most recent literature examining the relationship between SDB and PH/cor pulmonale. The literature suggests that much of the PH and right heart dysfunction seen in SDB is related to concurrent obesity and underlying lung disease, although it does appear that isolated SDB (in the form of obstructive sleep apnea) may be responsible for a small but significant degree of PH. The clinical consequences of this, however, remain unclear.

Journal Article↗
PubMed2002

Headache complaints in relation to nocturnal oxygen saturation among patients with sleep apnea syndrome.

BACKGROUND: Morning headaches are often ascribed to patients with sleep apnea syndrome (SAS) but the etiology of headaches in SAS is unclear. Given the relationship between oxygen and other headache syndromes, nocturnal hypoxia might be one factor contributing to headaches in SAS. METHODS: All subjects 18-80 years of age who were determined to have SAS and who underwent a continuous positive airway pressure trial in our sleep laboratory between March 1, 1997 and March 18, 1998 were considered for inclusion. Subjects were grouped according to whether they endorsed that waking with headaches is a problem for them. Polysomnography and standardized questionnaires were used to test the main hypothesis that patients with SAS and headaches would spend more time at lower oxyhemoglobin levels than those SAS patients without headache. RESULTS: Headache and non-headache patients did not differ in the percentage of time spent with an oxygen saturation less than 90%, either in total sleep time or in rapid eye movement sleep (REM). The headache patients were more likely to be female and spend a lower percentage of time in REM sleep. The REM sleep difference was not accounted for by the use of REM suppressing medications or by depression (as measured by the Zung scale). CONCLUSIONS: These data do not support the hypothesis that the duration of nocturnal hypoxemia relates to headache complaints in patients with SAS. The lower REM sleep percentage and higher variability in REM apnea index among the headache patients warrants further investigation.

Journal Article↗
PubMedDate not supplied

Insomnia.

Effective management of insomnia begins with recognition and adequate assessment. Family doctors and other health care providers such as practice nurses and psychologists should routinely enquire about sleep habits as a component of overall health assessment. Identification and treatment of primary psychiatric disorders, medical conditions, circadian disorders, or specific physiological sleep disorders--eg, sleep apnoea and periodic limb movement disorder--are essential steps in management of insomnia. Conditioned aspects of insomnia can be primary (psychophysiological insomnia) or may complicate sleep disturbance owing to other causes. Approved hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in various short-term situations. Despite widespread use of standard hypnotics and sedating antidepressants for chronic insomnia, their role for this indication still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with durable long-term improvement in sleep.

Humans↗