scholarly journals Can Digital Therapeutics Open a New Era of Sleep Medicine?

2021 ◽  
Vol 3 (4) ◽  
pp. 142-148
Author(s):  
Kyung Mee Park ◽  
Suonaa Lee ◽  
Eun Lee
Keyword(s):  
Sleep Disorders ◽  
Behavioral Therapy ◽  
Low Cost ◽  
Current Status ◽  
Regulatory Agencies ◽  
Effective Treatment Option ◽  
Sleep Related Breathing Disorders ◽  
New Era ◽  
Regulatory Processes ◽  
Breathing Disorders

Digital therapeutics (DTx) are products that provide evidence-based interventions driven by high-quality software programs to prevent, manage, or treat a medical disease. DTx are receiving increasing attention as a new therapeutic approach. Several DTx for insomnia are on the market, some of which have received approval by national regulatory agencies. DTx for insomnia are usually based on cognitive behavioral therapy for insomnia. No DTx for other sleep disorders, such as narcolepsy or sleep-related breathing disorders, have received regulatory authority approval as a medical device. DTx have the substantial benefits of being accessible and relatively low-cost. However, several issues related to DTx have not yet been fully resolved, and discussions regarding DTx are still in the early stages. To use DTx for sleep disorders as an effective treatment option in the future, considering the current status of DTx is necessary. This review discusses definitions and background of DTx; specific DTx for insomnia that have been developed; use of DTx for sleep and related psychiatric comorbid symptoms; global regulatory processes for DTx, including prescribing and medical billing issues; and remaining challenges regarding the use of DTx.

Sleep disorders in dialysis patients

2008 ◽  
Vol 31 (11) ◽  
pp. 919-927 ◽  
Author(s):  
G.C. Kosmadakis ◽  
J.F. Medcalf
Keyword(s):  
Sleep Disorders ◽  
Central Sleep Apnea ◽  
Poor Sleep ◽  
Dialysis Patients ◽  
Periodic Limb Movement Disorder ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Stage Renal Disease ◽  
End Stage

Poor sleep and sleep-related breathing disorders are common in patients with end-stage renal disease (ESRD) but are often unrecognized and undertreated. Sleep disorders are known negative prognostic factors for morbidity and mortality. The most frequent sleep disorders seen in patients with ESRD are conditioned insomnia, excessive daytime sleepiness, obstructive or central sleep apnea (SA), as well as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Several uremic and nonuremic factors are thought to participate in the pathogenesis of sleep disorders in patients with ESRD. The therapy of sleeping disorders includes nonpharmacological and pharmacological measures that can improve the functionality and quality of life in patients with ESRD.

scholarly journals Risk of Mental and Sleep Disorders After the Diagnosis of Adrenal Adenomas: A Population-Based Cohort Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A94-A95
Author(s):  
Sumitabh Singh ◽  
Catherine Zhang ◽  
Elizabeth Atkinson ◽  
Sara Achenbach ◽  
Andreas Ebbehoj ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Sleep Disorders ◽  
Adrenal Adenoma ◽  
Cortisol Secretion ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Increased Risk ◽  
Substance Abuse Disorders

Abstract Background: Adrenal adenomas are incidentally diagnosed in 7% of adults undergoing abdominal imaging. Mild autonomous cortisol secretion is present in 50% of adrenal adenomas, and even “nonfunctioning” adrenal adenomas demonstrate abnormal steroid profile. We aimed to 1) investigate the prevalence of mental and sleep disorders in patients with adrenal adenomas and to 2) determine the risk of mental and sleep disorders after the diagnosis of adrenal adenoma in patients compared to the referent subjects from the same population Methods: Using a medical records linkage system, we identified adult patients living in the Olmsted County, MN diagnosed with an adrenal adenoma during 1995–2017. Patients with overt hormone excess were excluded. Every patient with adenoma was matched by sex and age to a referent subject from the same population. Subjects were followed until death or end of the study. Mental health related comorbidities and sleep disorders were assessed at baseline and during follow up. Results: Our cohort included 1004 patients with adrenal adenomas and 1004 referent subjects (58% women, median age of 63 years). Patients were more likely to smoke (70% vs 54%, p <0.001) and had a higher BMI (30 kg/m2 vs 28 kg/m2, p < 0.001). Within 5 years prior to the index date (diagnosis of adenoma), and after adjusting for BMI and smoking, patients demonstrated a higher prevalence of depression (Odds ratio, OR of 1.3 (CI95% 1.1–1.6), p=0.02), anxiety (OR of 1.4 (CI95% 1.1–1.8, p=0.003), substance abuse disorders (OR of 2.4 (CI 95% 1.7–3.4), p<0.001), but not insomnia (OR of 1.2 (CI95% 0.9–1.7) and sleep related breathing disorders (OR of 1.3 (CI 95% 0.9–1.7). During follow-up, starting 1 year after the diagnosis, patients demonstrated a higher risk of new onset depression (HR of 1.9, CI95%1.5–2.4), anxiety (HR of 1.5,CI95% 1.2–1.9), schizophrenia (HR of 1.7, CI95% 1.2–2.4), and substance abuse disorders (HR of 1.6, CI95% 1.2–2.0). Risk of sleep disorders 1 year after diagnosis was also high for insomnia (HR of 1.4, CI95% 1.1–1.9), sleep-related breathing disorders (HR of 1.8, CI95% 1.4–2.3), hypersomnias of central origin (HR of 2.0, CI95%1.04–3.96), parasomnias (HR of 2.4, CI95%1.2–4.7), and sleep-related movement disorders(HR of 1.9, CI95%1.3–2.6). Conclusion: Patients with adenomas are at increased risk for mental and sleep disorders, possibly explained by the underlying subtle cortisol secretion. Further prospective studies with an in-depth characterization of both hormonal secretion and mental/sleep disorders are needed. Reversibility or improvement of mental health and sleep disorders with adrenalectomy should be investigated.

Sleep disorders

2013 ◽  
pp. 413-460
Keyword(s):  
Circadian Rhythm ◽  
Sleep Disorders ◽  
Management Strategies ◽  
Sleep Stages ◽  
Sleep Related Breathing Disorders ◽  
General Management ◽  
Breathing Disorders ◽  
Circadian Rhythm Sleep Disorders ◽  
Normal Sleep

Introduction Normal sleep: stages and cycles Assessment of sleep disorders Insomnia 1: overview Insomnia 2: general management strategies Sleep-related breathing disorders Hypersomnia 1: overview Hypersomnia 2: narcolepsy Hypersomnia 3: other causes Circadian rhythm sleep disorders 1: overview Circadian rhythm sleep disorders 2: management Parasomnias 1: overview...

Polysomnography and other investigations for sleep disorders

2016 ◽  
Author(s):  
Zenobia Zaiwalla ◽  
Roo Killick
Keyword(s):  
Sleep Disorders ◽  
Sleep Latency ◽  
Clinical Information ◽  
Sleep Wake Disorders ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Study Protocols ◽  
Maintenance Of Wakefulness Test ◽  
Wrist Actigraphy ◽  
Multiple Sleep Latency

This chapter describes the key investigations used in the diagnosis of sleep disorders. The recording and value of polysomnography (PSG), with and without electroencephalography is discussed, including the specific parameters essential for the various sleep related breathing disorders. The technical aspects of the multiple sleep latency test and maintenance of wakefulness test are followed by interpretation of findings, recognizing their limitations, especially in adults with co-morbid disorders, and the effect of medication and also shift work. Finally, the value of wrist actigraphy as a diagnostic tool in circadian rhythm sleep–wake disorders is discussed. The chapter emphasizes the importance of selecting appropriate tests based on clinical information and the importance of units providing diagnostic studies for sleep disorders, constantly reviewing their study protocols and auditing inter-rater reliability of PSG sleep staging in children and adults of various ages and sleep disorders.

Excessive sleepiness

2012 ◽  
pp. 938-943
Author(s):  
Michel Billiard
Keyword(s):  
Circadian Rhythm ◽  
Sleep Disorders ◽  
Clinical Work ◽  
Sleep Related Breathing Disorders ◽  
Excessive Sleepiness ◽  
Breathing Disorders ◽  
Delayed Sleep Phase Syndrome ◽  
Central Origin ◽  
Delayed Sleep ◽  
Waking Up

Excessive sleepiness is not an homogeneous concept. It can manifest itself as bouts of sleepiness, irresistible and refreshing sleep episodes, abnormal lengthening of night sleep with a major difficulty waking up in the morning or at the end of a nap or even periods of a week or so of almost continuous sleep recurring at several months’ intervals. According to the recent second edition of the International Classification of Sleep Disorders (ICSD-2), disorders of excessive sleepiness are distributed within three chapters: sleep-related breathing disorders, hypersomnias of central origin not due to a circadian rhythm sleep disorder, sleep-related breathing disorders, or other cause of disturbed nocturnal sleep, and circadian rhythm sleep disorders. However in this volume aimed at psychiatrists, the presentation of disorders of excessive sleepiness will obey another logic. Following “Generalities” including epidemiology, morbidity, clinical work-up, and laboratory tests, the various aetiologies will be presented according to the following six subchapters: ♦ Hypersomnia not due to substance or known physiological condition (non-organic hypersomnia or psychiatric hypersomnia) ♦ Hypersomnia due to drug or substance ♦ Behaviourally induced insufficient sleep syndrome ♦ Hypersomnia in the context of sleep-related breathing disorders ♦ Hypersomnias of central origin ♦ And the special case of delayed sleep phase syndrome.

Sleep disorders

2018 ◽  
Author(s):  
Lawrence J. Epstein
Keyword(s):  
Sleep Disorders ◽  
Sleep Apnoea ◽  
Behaviour Disorder ◽  
Sleep Wake Disorders ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Sleep Behaviour ◽  
Obstructive Sleep ◽  
Broad Array ◽  
The Individual

Over 70 described sleep disorders disrupt the sleep of an estimated 50–70 million Americans. The disorders present with a broad array of symptoms but result in the individual not getting the health, cognitive, and restorative benefits of a good night’s sleep. The disorders have been categorized into the following categories: insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders. This chapter reviews each category and provides details on the symptoms, pathophysiology, and treatment of the most common disorder in each category, including insomnia, obstructive sleep apnoea, narcolepsy, restless legs syndrome, and REM sleep behaviour disorder. The presenting complaint is the key to diagnosis, directing subsequent evaluation.

scholarly journals 0998 Health Care Utilization of Pediatric Sleep Disorders in Cerner Health Facts Database

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A379-A379
Author(s):  
B Al-Shawwa ◽  
E Glynn ◽  
M Hoffman ◽  
Z Ehsan ◽  
D Ingram
Keyword(s):  
Health Care ◽  
Circadian Rhythm ◽  
Health Care Utilization ◽  
Sleep Disorders ◽  
Movement Disorders ◽  
Access To Health Care ◽  
Care Utilization ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Circadian Rhythm Disorders

Abstract Introduction This study was aimed to identify health care utilization of sleep disorders in pediatrics and adults by using Cerner health facts database. Methods Health facts database has unidentified health records from all the participating facilities that have Cerner as their electronic medical records software. There are 68.7 million patients in the data warehouse with about 506.9 million encounters in about 100 healthcare systems. Sleep disorders are mostly seen in outpatient settings and therefore this study included outpatient records between the years 2010 to 2017. Results There were 20.5 million patients with total of 127.4 million outpatient encounters. In pediatric patients (ages 0-18 years), healthcare utilization of major sleep diagnoses per 100,000 encounters showed sleep related breathing disorders are the most commonly seen followed by parasomnia, insomnia, sleep movement disorders, hypersomnolence then circadian rhythm disorders (820.1, 258.1, 181.6, 68.3, 48.1 and 16.2 per 100,000 encounters). However, for adult patients the ranking was: sleep related breathing disorders, insomnia, sleep related movement disorders, hypersomnolence, parasomnia then circadian rhythm disorders (1352.6, 511.6, 166.3, 79.1, 25.7 and 4.2 per 100,000 encounters). Further analysis for the age groups showed bimodal pattern for sleep related breathing disorders and sleep movement disorders with the highest utilization were between the ages of 2-11 year and 40-60 years. Adolescents (age 12-18 years) showed increase utilization in the areas of circadian rhythm disorders. Conclusion Patients with sleep disorders have relatively low health care utilization despite high prevalence of these sleep disorders in the general population. This may highlight underrecognized sleep problem or decreased access to health care. In addition, this study highlights the effect of age on different sleep disorders which may have an impact on allocating resources. Support None

Sleep disorders in Amyotrophic Lateral Sclerosis

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Sireesha Murala ◽  
Nakul Katyal ◽  
Naureen Narula ◽  
Raghav Govindarajan ◽  
Pradeep Sahota
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Sleep Disorders ◽  
Neurodegenerative Disorder ◽  
Wide Spectrum ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Behavioral Abnormalities ◽  
Obstructive Sleep ◽  
Als Patients ◽  
Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder affecting both the central and peripheral nervous system. The median survival rate for ALS patients after symptom onset is 2.5 to 3.5 years and after diagnosis of ALS is about 1.5 to 2.5 years. Patients with ALS can have a wide spectrum of sleep disorders including but not limited to insomnia, sleep related breathing disorders, parasomnias, obstructive sleep apnea (OSA) and nocturnal hypoventilation (NH). Sleep-related breathing disorders substantially increase both morbidity and mortality in ALS patients. In this review, we have discussed the ALS motor symptoms, sleep-related breathing disorders, behavioral abnormalities and sleep disturbing factors which impair the health-related quality of life.

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