PubMed Health⌕ Search

Biomedical subjects

Neil J Douglas

Publications and source records attributed to Neil J Douglas.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of CPAP titration at home or the sleep laboratory in the sleep apnea hypopnea syndrome.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) is conventionally started after in-laboratory overnight titration. This use of sleep laboratory space is both costly and limits access for diagnostic studies. This study aimed to evaluate whether automated CPAP titration in the home produced patient outcomes equal to those following laboratory-based automated CPAP titration. The main outcomes were Epworth Sleepiness Scale score, objective daytime sleepiness (Oxford SLEep Resistance test or OSLER test), and CPAP use; we also performed quality-of-life questionnaires: Functional Outcomes of Sleep Questionnaire and SF-36. DESIGN: Prospective, randomized, single-blind, parallel-group, controlled trial SETTING: Regional sleep center and patients' homes. PATIENTS: Two hundred CPAP-naïve patients with OSAHS requiring CPAP treatment. INTERVENTIONS: One hundred patients were randomly assigned to a standard 1-night in-hospital CPAP titration and 100 to 3 nights' home CPAP titration and then issued with fixed pressure CPAP. Data were analyzed on an intention-to-treat basis. MEASUREMENTS AND RESULTS: The patient groups did not differ at baseline. The CPAP pressures defined at titration (mean+/- SEM: 10.6+/-0.2, 10.4+/-0.2 cm H20, p = .19), number of mask leaks, and initial acceptance rates were similar in the sleep-laboratory and home-titrated groups. At 3-month follow-up, there was no significant difference in CPAP use (mean+/-SEM: 4.39+/-0.25, 4.38+/-0.25 h/night; p > .9), Epworth Sleepiness Scale score (9.5+/-0.5, 8.5+/-0.5, p = .14), OSLER, Functional Outcomes of Sleep Questionnaire, or SF-36 between the sleep-laboratory and home-titrated groups. CONCLUSIONS: Home-based automated CPAP titration is as effective as automatic in-laboratory titrations in initiating treatment for OSAHS.

Calibration↗
PubMed2006

Effects of sleep fragmentation on the arousability to resistive loading in NREM and REM sleep in normal men.

STUDY OBJECTIVE: In healthy subjects, arousability to inspiratory resistive loading is greater during rapid eye movement (REM) sleep compared with non-REM (NREM) sleep but is poorest in REM sleep in patients with sleep apnea. We therefore examined the hypothesis that sleep fragmentation impairs arousability, especially from REM sleep. DESIGN: Two blocks of 3 polysomnographies (separated by at least 1 week) were performed randomly. An inspiratory-loaded night followed either 2 undisturbed control nights (LN(C)) or 2 acoustically fragmented nights (LN(F)) SETTING: Sleep laboratory. PARTICIPANTS: Sixteen healthy men aged 20 to 29 years. INTERVENTIONS: In both loaded nights, an inspiratory resistive load was added via a valved facemask every 2 minutes during sleep and turned off either when arousal occurred or after 2 minutes. MEASUREMENTS AND RESULTS: During LN(F), arousability remained significantly greater in REM sleep (71% aroused within 2 minutes) compared with stage 2 (29%) or stage 3/4 (16%) sleep. After sleep fragmentation, arousability was decreased in stage 2 sleep (LN(F): 29%; LN(C): 38%; p < .05) and low in early REM sleep, increasing across the night (p < .01). In stage 3/4 sleep, neither an attenuation nor a change across the night was seen after sleep fragmentation. CONCLUSIONS: Mild sleep fragmentation is already sufficient to attenuate arousability in stage 2 sleep and to decrease arousability in early, compared with late, REM sleep. This means that sleep fragmentation affects the arousal response to increasing resistance and that the effects are different in stage 2 and REM sleep. The biologic reason for this increase in the arousal response in REM sleep across the night is not clear.

Adult↗
PubMed2005

Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint.

Snoring and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are often treated with mandibular repositioning splints (MRS), but the efficacy and satisfaction of them has not been comprehensively addressed. A survey on the use of and satisfaction with MRS was posted to 177 patients referred by a hospital orthodontic department for custom-fitting of a MRS. Data were analysed using non-parametric techniques. The response rate was 81% (n=144). Responders (30F, 114M) had mean (SD) age of 51 (11) years, apnoea+hypopnoea index (AHI) of 24 (21) per hr and Epworth Score of 10 (5) at diagnosis, and had been supplied with their MRS a median 7 (IQR 5-11) months previously. Fifty of the 144 patients (35%) had been offered continuous positive airway pressure (CPAP) treatment but had declined or abandoned this. Self-reported MRS use was 5 (2) h/night, with 74 of the 144 patients (51%) continuing to use MRS at least occasionally at a median 7 months after fitting. Survival analysis showed 12% still using MRS at 12 months. Epworth score fell slightly with MRS therapy [-2.4 (3.5); P=0.005] and 7 daytime and 2 nocturnal symptoms improved in MRS users (all P<0.05). Marital satisfaction did not change with MRS. Problems preventing MRS use in 70 non-users included: non-retention (n=12), sore mouth (n=13) or jaw (n=7), difficulties falling asleep (n=10) or breathing (n=7), excessive salivation (n=4), dental damage (n=4) and other problems (n=3). Continued use of MRS therapy was associated with a higher number of teeth, low marital satisfaction perceived by partners and greater improvement in symptoms reported by patients and partners. Continuance with MRS may be low and linked to tolerance problems.

Continuous Positive Airway Pressure↗
PubMed2005

Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women.

BACKGROUND AND PURPOSE: To examine whether snoring and sleepiness are linked in pregnancy and pre-eclampsia. PATIENTS AND METHODS: We recruited 167 healthy and 82 pre-eclamptic women in the third trimester of pregnancy and 160 non-pregnant women. Subjects and their partners completed a sleep questionnaire. Height, weight, neck circumferences and blood pressure were recorded for all. RESULTS: Pregnant and pre-eclamptic women were (mean +/-SD) 36+/-3.6 and 36+/-3 weeks pregnant, respectively. Age and height did not differ significantly between groups (P>0.2), but pre-eclamptic women were heavier than pregnant and non-pregnant women and had higher BMI than pregnant women before pregnancy (all P<0.05). Thirty-two percent of control, 55% of pregnant and 85% of pre-eclamptic women snored (P<0.001), but pre-pregnancy snoring rates (pre-eclamptic=36%, healthy pregnant women=27%) were similar to those in non-pregnant women (32%) (P>0.7). Sleepiness was reported by 12% of non-pregnant, 23% of pregnant and 15% of pre-eclamptic women (P<0.04), but non-pregnant women had lower mean Epworth Sleepiness scores than both pregnant and pre-eclamptic groups (P<0.001). Snoring was correlated with (P=0.002), but explained only <2%, of the variance in sleepiness. CONCLUSION: Snoring and sleepiness increased in the third trimester of pregnancy, particularly in patients with pre-eclampsia. However, the study suggests that sleepiness in pregnancy is largely due to factors other than snoring or breathing pauses.

Adult↗
PubMed2005

Acoustic reflection for nasal airway measurement in patients with obstructive sleep apnea-hypopnea syndrome.

STUDY OBJECTIVE: To measure nasal dimensions and explore relationships between these and patients' use of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). DESIGN: Prospective single-blind study. SETTING: A tertiary-care, sleep disorders referral center. PATIENTS: Sixty OSAHS patients (52 men, mean age 51 years, body mass index (BMI) 36.1 +/- 9.4 kg/m2). MEASUREMENTS: After in-vitro validation, acoustic reflection was used to measure the nasal minimal cross-sectional area (MCSA), mean area, and volume in OSAHS patients receiving CPAP treatment. Variables from sleep studies included the apnea-hypopnea index (AHI), titration pressure, and CPAP use (hours per night) after 3 months. Median MCSA was used to categorize subjects into small and large MCSA groups. Correlation and regression analyses were conducted to investigate the relationship between results of polysomnography and nasal acoustic reflection. RESULTS: At baseline the small and large MCSA groups were not different (P > .05) in BMI, age, mask type, or previous nasal stuffiness, but there were more women in the smaller MCSA group (P = .02). CPAP use was significantly lower in the small MCSA group (P = .007), but apnea-hypopnea index and titration pressure were indistinguishable between the 2 groups. Furthermore, CPAP use correlated significantly and positively with MCSA (r = 0.34, P = .008), mean area (r = 0.27, P = .04), and volume (r = 0.28, P = .03). Step-wise multiple regression models revealed that MCSA was a predictor of the CPAP compliance (R2 = 0.16, P = .002), and MCSA (P = .001) and age (P = .04) were predictive factors of CPAP compliance (R2= 0.22). Nasal dimensions were not related to subjective nasal stuffiness. CONCLUSIONS: CPAP use in patients with smaller nasal passages was lower than in those with larger passages. Objective measurement of nasal dimension may be more reliable than subjective self-report of nasal symptoms in identifying patients with OSAHS who might struggle with CPAP therapy.

Acoustics↗
PubMed2005

A cephalometric comparison of patients with the sleep apnea/hypopnea syndrome and their siblings.

STUDY OBJECTIVES: To define differences in the skeletal components of facial structure predisposing to the obstructive sleep apnea/hypopnea syndrome (OSAHS) by a comparison of the craniofacial complex between people with OSAHS and their siblings without OSAHS. DESIGN: Case-control study using sibling pairs. SETTING: Scottish Sleep Centre. PARTICIPANTS: 104 patients with OSAHS living in Scotland and 107 of their siblings. INTERVENTIONS: All subjects had sleep studies, clinical review, and cephalometry performed. All measurements were scored blind to index or control status. MEASUREMENTS AND RESULTS: 207 cephalograms were available for analysis, of which 145 were for dentate subjects (90 with definite OSAHS; 55 without). In the dentate subjects, regression analysis (correcting for body mass index and age) showed OSAHS was associated with a significantly longer distance from the hyoid bone to the mandibular plane in men (P = .02) and in women (P = .036). Regression analysis in 22 pairs of dentate brothers, discordant for the diagnosis of OSAHS (controlling for age and body mass index), showed a shorter mandibular corpus (P = .013) and lower hyoid in relation to the mandibular plane (P = .006) to be significantly associated with a diagnosis of OSAHS. CONCLUSIONS: Men and women with OSAHS have a lower-set hyoid bone than do those without OSAHS. This occurs independently of obesity and remains even when intersubject variance is minimized by performing pairwise comparison of the craniofacial complex between siblings with and without OSAHS.

Adult↗
PubMed2004

Functional status in patients with narcolepsy.

OBJECTIVE: To describe health and functional status in treated narcolepsy patients and to compare it with normative data and with patients with another cause of sleepiness, the obstructive sleep apnea/hypopnea syndrome (OSAHS) patients. METHODS: A functional status survey in narcolepsy patients and in symptomatic untreated and CPAP treated OSAHS patients with an apnea-hypopnea index (AHI) >5 was assessed using the UK Short Form 36 (SF-36) questionnaire, the Functional Outcomes of Sleep Questionnaire (FOSQ) and the Epworth Sleepiness Scale (ESS). SF-36 scores in narcoleptics were compared to age and sex matched controls. Narcolepsy patients also replied to a psychosocial aspects questionnaire. Health history and demographic data were obtained via a review of medical records and postal survey. RESULTS: Forty-nine treated narcolepsy patients, 56 untreated OSAHS and 48 CPAP treated OSAHS patients attending the sleep disorders clinic were recruited for this study. Narcoleptics presented significantly lower scores in all SF-36 domains compared to normative data. No difference in SF-36 scores was found between narcoleptics and untreated OSAHS patients but narcoleptics were sleepier and had lower FOSQ scores. These treated narcolepsy patients had lower scores in two dimensions of the SF-36 and in all FOSQ domains compared to CPAP-treated OSAHS patients. CONCLUSIONS: Functional status in treated narcoleptics is poor.

Activities of Daily Living↗
PubMed2003

Sleep-disordered breathing as a risk factor for cerebrovascular disease: a case-control study in patients with transient ischemic attacks.

BACKGROUND AND PURPOSE: The evidence that obstructive sleep apnea/hypopnea (OSAH) is a risk factor for ischemic cerebrovascular disease is inconclusive. We explored this relationship in transient ischemic attack (TIA) patients because they are less likely than stroke patients to have OSAH as a consequence of cerebrovascular disease. METHODS: We performed a case-control study among 86 patients with TIA from a hospital neurovascular clinic, matched for age (+/-5 years) and sex with controls from the referring local family practice registers. RESULTS: Forty-nine of the 86 matched pairs were male and the body mass index was similar among cases and controls. The primary outcome measure, the apnea/hypopnea index [AHI=number of (apneas+hypopneas)/h slept, measured during overnight polysomnography and scored blind to case-control status], was the same for cases and controls (21/hour). However, the median number of 4% desaturations during sleep was slightly greater in the cases (12/hour) than controls (6/hour, P=0.04). There were the expected associations between TIA and higher fibrinogen levels (TIA 3.3, control 3.0 g/L, P=0.01), previous myocardial infarction (TIA 22, control 6%, P=0.007), a history of ever smoking (TIA 71, control 54%, P=0.01), hypertension (TIA 51, control 21%, P=0.001), and raised cholesterol (TIA 27, control 10%, P=0.01), with a weak trend for diabetes mellitus (TIA 10, control 6%, P=0.4). CONCLUSIONS: OSAH does not appear to be strongly associated with TIAs.

Aged↗
PubMed2003

Acquired narcolepsy in an acromegalic patient who underwent pituitary irradiation.

The authors report the case of a 60-year-old man with acromegaly, who developed narcolepsy 2 weeks after completing radiotherapy for a pituitary adenoma. Cataplexy and sleepiness were predominant symptoms. Onset of narcolepsy is unusual at this age and the temporal relationship following radiotherapy suggests this treatment was implicated. His CSF hypocretin levels were normal, indicating other factors may be important in his narcolepsy.

Acromegaly↗
PubMed2003

Home diagnosis of the obstructive sleep apnoea/hypopnoea syndrome.

Polysomnography has been accepted by many as a "gold standard" for the diagnosis of the Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS). Although polysomnography is a good method for diagnosing OSAHS, there is no evidence that the results of polysomnography more accurately identify patients with the syndrome than more simple investigations which may be done at lower cost in the patient's home. This article examines the evidence for and against home sleep studies and concludes that home sleep studies have a role. Precisely what that role is will depend on financial and organisational aspects for each sleep centre.

Home Care Services↗
PubMed2002

The upper airway in pregnancy and pre-eclampsia.

Snoring is common in pregnancy, and snoring pregnant women have increased rates of pre-eclampsia. Patients with pre-eclampsia show upper airway narrowing during sleep. The present study aimed to compare upper airway dimensions in pregnant and nonpregnant women and in patients with pre-eclampsia. A total of 50 women in the third trimester of pregnancy and 37 women with pre-eclampsia were recruited consecutively from the antenatal service and matched with 50 nonpregnant women. Upper airway dimensions were measured using acoustic reflection. Comparisons were made by analysis of variance and Student-Newman-Keuls tests. Snoring was reported by 14% of nonpregnant women, 28% of pregnant women, and 75% of pre-eclamptic women (p < 0.001). When seated, pregnant women had wider upper airways than nonpregnant women (p < 0.02), but there was no difference when supine. Oropharyngeal junction area in the seated position was less (p < 0.01) in the women with pre-eclampsia (mean +/- SD: 0.9 +/- 0.1 cm2) than either nonpregnant (1.1 +/- 0.1 cm2) or pregnant women (1.3 +/- 0.1 cm2). Supine oropharyngeal junction area was less in the women with pre-eclampsia than in the nonpregnant women (0.8 +/- 0.1 versus 1.0 +/- 0.1 cm2; p = 0.01) but similar in women with pre-eclampsia and pregnant women (0.9 +/- 0.1 cm2; p > 0.3). The study showed that women with pre-eclampsia have upper airway narrowing in both upright and supine postures. These changes could contribute to the upper airway resistance episodes during sleep in patients with pre-eclampsia, which may further increase their blood pressure.

Adolescent↗
PubMed2002

Comparison between automatic and fixed positive airway pressure therapy in the home.

We tested the hypothesis that continuous positive airway pressure (CPAP) use and outcomes can be improved by an autotitrating CPAP device in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) who require higher CPAP (10 cm H2O or more). In this multisite randomized single-blind cross-over study, 44 patients (mean age, 49 +/- 10 years) were randomized to 6 weeks at laboratory-determined fixed pressure and 6 weeks on autotitrating CPAP. Average nightly use was greater in automatic mode (306 versus 271 minutes, p = 0.005); median and 95th centile pressures in automatic mode were lower (p < 0.002). Automatic CPAP resulted in better SF-36 Vitality scores (65 +/- 20 versus 58 +/- 23, p < 0.05) and mental health scores (80 +/- 14 versus 75 +/- 18, p < 0.05), but no significant difference in Epworth score (p = 0.065). During automatic therapy, patients reported more restful sleep, better quality sleep, less discomfort from pressure, and less trouble getting to sleep for both the first week of therapy and for the averaged scores for Weeks 2-6 (all p values < 0.006). Patients who require higher fixed CPAP use autotitrating CPAP more and report greater benefit from this therapy.

Adolescent↗
PubMed2002

Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint.

Mandibular repositioning splints (MRSs) and continuous positive airway pressure (CPAP) are used to treat the sleep apnea/hypopnea syndrome (SAHS). There are some data suggesting that patients with milder symptoms prefer MRS, but there are few comparative data on outcomes. Therefore, we performed a randomized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new outpatients diagnosed with SAHS (apnea/hypopnea index [AHI] >or= 5/hour, and >or= 2 symptoms including sleepiness). Assessments at the end of both limbs comprised home sleep study, subjective ratings of treatment value, sleepiness, symptoms, and well-being, and objective tests of sleepiness and cognition. Forty-eight of 51 recruited patients completed the trial (12 women; age [mean +/- SD], 46 +/- 9 years; Epworth 14 +/- 4; median AHI, 22/hour; interquartile ratio [IQR], 11-43/hour). Significant (p <or= 0.01) differences between MRS and CPAP were observed for 7 of 21 variables (effect sizes, 0.3-0.6 SDs), all favoring CPAP, including AHI (15 +/- 16 and 8 +/- 6/hour, respectively), effectiveness rating, symptoms, Epworth (12 +/- 5 and 8 +/- 5, respectively), functional outcomes of sleepiness questionnaire, short-form 36 health survey mental component, and health transition scores. Objective sleepiness, cognitive performance, and preference for treatments were not different. In patients experiencing a mild form of the syndrome (AHI < 15, n = 18), symptoms, treatment efficacy and satisfaction, and subjective sleepiness were also better with CPAP than with MRS (effect sizes, 0.7-1.1 SDs). These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS.

Adolescent↗