Try a new search

Format these results:

Searched for:

person:walslj01

Total Results:

55


Response to CPAP Withdrawal in Patients with Mild Versus Severe Obstructive Sleep Apnea/Hypopnea Syndrome

Young, Laura R; Taxin, Zachary H; Norman, Robert G; Walsleben, Joyce A; Rapoport, David M; Ayappa, Indu
BACKGROUND: Patients with obstructive sleep apnea/hypopnea syndrome (OSAHS), even those generally compliant with CPAP therapy, often intermittently discontinue CPAP. STUDY OBJECTIVE: Examine the impact of CPAP withdrawal on sleep, sleep disordered breathing (SDB), and daytime function in subjects with varying severity of OSAHS. PATIENTS AND INTERVENTIONS: Forty-two subjects (26M/16 F) with OSAHS (AHI4% = 45.2 +/- 35.5/h pretreatment) on CPAP for 4 months were evaluated on the second night of CPAP withdrawal. Sleep architecture, SDB indices, and subjective/objective daytime function were assessed pretreatment, on CPAP therapy, and after CPAP withdrawal. Comparisons were made between pretreatment and CPAP withdrawal for the entire group, and for subgroups of mild/moderate (AHI4% < 30/h, n = 22) and severe (AHI4% > 30/h, n = 20) SDB. RESULTS: Overall, and for mild/moderate subjects, SDB indices returned to pretreatment values on CPAP withdrawal but with fewer apneas and more hypopneas/RERAs. For severe SDB, the event frequency (AI, AHI4%, and RDI) was lower and O desaturation was improved on CPAP withdrawal. Across SDB severity, sleep architecture showed lower %REM (15.6% vs 12.9%, P = 0.009) on the CPAP withdrawal compared to pretreatment. Stanford Sleepiness Score, MSLT, and PVT measures were not significantly different between pretreatment and CPAP withdrawal. CONCLUSIONS: Over a wide range of SDB severity CPAP withdrawal results in recurrence of SDB, albeit with less severe O desaturation. Subjective/objective daytime function returned to pretreatment levels. Sleep architecture changes on CPAP withdrawal (acute SDB) may reflect reduced sleep pressure compared to pretreatment chronic SDB. Our data suggest detrimental effects of even brief withdrawal of CPAP in subjects with both mild and severe OSAHS. CITATION: Young LR; Taxin ZH; Norman RG; Walsleben JA; Rapoport DM; Ayappa I. Response to CPAP withdrawal in patients with mild versus severe obstructive sleep apnea/hypopnea syndrome. 2013;36(3):405-412.
PMCID:3571747
PMID: 23449493
ISSN: 0161-8105
CID: 231272

Continuous Positive Airway Pressure Treatment of Sleepy Patients with Milder Obstructive Sleep Apnea: Results of the CPAP Apnea Trial North American Program (CATNAP) Randomized Clinical Trial

Weaver, Terri E; Mancini, Cristina; Maislin, Greg; Cater, Jacqueline; Staley, Bethany; Landis, J Richard; Ferguson, Kathleen A; George, Charles F P; Schulman, David A; Greenberg, Harly; Rapoport, David M; Walsleben, Joyce A; Lee-Chiong, Teofilo; Gurubhagavatula, Indira; Kuna, Samuel T
Rationale: Twenty-eight percent of people with mild to moderate obstructive sleep apnea experience daytime sleepiness, which interferes with daily functioning. It remains unclear whether treatment with continuous positive airway pressure improves daytime function in these patients. Objectives: To evaluate the efficacy of continuous positive airway pressure treatment to improve functional status in sleepy patients with mild and moderate obstructive sleep apnea. Methods: Patients with self-reported daytime sleepiness (Epworth Sleepiness Scale score >10) and an apnea-hypopnea index with 3% desaturation and from 5 to 30 events per hour were randomized to 8 weeks of active or sham continuous positive airway pressure treatment. After the 8-week intervention, participants in the sham arm received 8 weeks of active continuous positive airway pressure treatment. Measurements and Main Results: The Total score on the Functional Outcomes of Sleep Questionnaire was the primary outcome measure. The adjusted mean change in the Total score after the first 8-week intervention was 0.89 for the active group (n = 113) and -0.06 for the placebo group (n = 110) (P = 0.006). The group difference in mean change corresponded to an effect size of 0.41 (95% confidence interval, 0.14-0.67). The mean (SD) improvement in Functional Outcomes of Sleep Questionnaire Total score from the beginning to the end of the crossover phase (n = 91) was 1.73 +/- 2.50 (t[90] = 6.59; P < 0.00001) with an effect size of 0.69. Conclusions: Continuous positive airway pressure treatment improves the functional outcome of sleepy patients with mild and moderate obstructive sleep apnea. Clinical trial registered with www.clinicaltrials.gov (NCT 00127348).
PMCID:3480519
PMID: 22837377
ISSN: 1073-449x
CID: 181852

Nocturia, sleep and daytime function in stable heart failure

Redeker, Nancy S; Adams, Laura; Berkowitz, Robert; Blank, Lenore; Freudenberger, Ronald; Gilbert, Michele; Walsleben, Joyce; Zucker, Mark J; Rapoport, David
BACKGROUND: The aim of this study was to evaluate nocturia severity and nocturia-related differences in sleep, daytime symptoms and functional performance among patients with stable heart failure (HF). METHODS AND RESULTS: In this cross-sectional observational study, we recruited 173 patients [mean age 60.3 +/- 16.8 years; female n = 60 (35%); mean left ventricular ejection fraction 32 +/- 14.6%] with stable chronic HF from HF disease management programs in the northeastern United States. Participants reported nocturia and completed a 6-minute walk test (6MWT), 1 night of ambulatory polysomnography, and the SF-36 Medical Outcomes Study, Epworth Sleepiness, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Fatigue, and Centers for the Epidemiological Studies of Depression scales. Participants reported 0 (n = 30; 17.3%), 1-2 (n = 87; 50.2%), and >/=3 (n = 56; 32.4%) nightly episodes of nocturia. There were decreases in sleep duration and efficiency, REM and stage 3-4 sleep, physical function, and 6MWT distance and increases in the percentage of wake time after sleep onset, insomnia symptoms, fatigue, and sleepiness across levels of nocturia severity. CONCLUSIONS: Nocturia is common, severe, and closely associated with decrements in sleep and functional performance and increases in fatigue and sleepiness in patients with stable HF.
PMCID:3389347
PMID: 22748491
ISSN: 1071-9164
CID: 171573

An experimental human model of sleep disordered breathing [Meeting Abstract]

Ayappa, I A; Keating, J; Norman, R G; Mooney, A M; Walsleben, J A; Rapoport, D M
Experimental models of human sleep disordered breathing (S
EMBASE:70850282
ISSN: 1073-449x
CID: 177187

Greater risk of Alzheimer's disease in older adults with insomnia [Letter]

Osorio, Ricardo S; Pirraglia, Elizabeth; Aguera-Ortiz, Luis F; During, Emmanuel H; Sacks, Hayley; Ayappa, Indu; Walsleben, Joyce; Mooney, Anne; Hussain, Asad; Glodzik, Lidia; Frangione, Blas; Martinez-Martin, Pablo; de Leon, Mony J
PMCID:3378676
PMID: 21391952
ISSN: 1532-5415
CID: 134223

Women and sleep

Walsleben, Joyce A
PMID: 21056215
ISSN: 0072-9752
CID: 128876

Insomnia symptoms and daytime function in stable heart failure

Redeker, Nancy S; Jeon, Sangchoon; Muench, Ulrike; Campbell, Della; Walsleben, Joyce; Rapoport, David M
OBJECTIVES: To evaluate insomnia symptoms and the extent to which they are associated with clinical and demographic patient characteristics, daytime symptoms, and functional performance in patients with stable heart failure (HF). DESIGN: Cross-sectional, observational. SETTING: Five structured HF disease management programs in the Northeastern U.S. PARTICIPANTS: 173 stable chronic HF patients INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: Full polysomnography was obtained for one night in participants' homes. Participants completed the six-minute walk test, Medical Outcomes Study SF-36, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Multi-Dimensional Assessment of Fatigue Scale, Centers for the Epidemiological Studies of Depression Scale, and questionnaire items eliciting insomnia symptoms (self-reported difficulty initiating and maintaining sleep and waking too early in the morning). Over half of HF patients reported insomnia symptoms. These were associated with increased daytime symptoms (depression, fatigue), excessive daytime sleepiness, and functional performance in models that statistically controlled for clinical and demographic covariates. These relationships were not explained by sleep disordered breathing. CONCLUSIONS: Insomnia symptoms are common in patients with stable heart failure and are associated with daytime symptoms and decrements in functional performance
PMCID:2938862
PMID: 20857868
ISSN: 0161-8105
CID: 113938

Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study

Baldwin, Carol M; Ervin, Ann-Margret; Mays, Mary Z; Robbins, John; Shafazand, Shirin; Walsleben, Joyce; Weaver, Terri
STUDY OBJECTIVES: To compare health-related quality of life (HR-QOL) across subgroups defined by sleep disturbances and ethnicity. METHODS: Men (47%) and women (53%) Sleep Heart Health Study participants age 40 and older (N = 5237) underwent overnight polysomnography and completed self-report questionnaires on symptoms of sleep disturbances. The physical and mental composite scales (PCS and MCS) of the Medical Outcomes Study 36-item short form survey assessed HR-QOL and were compared to sleep data. RESULTS: Participants self-identified as Caucasian/White (n = 4482, 86%), African American/Black (n = 490, 9%), or Hispanic/Mexican American (n = 265, 5%). The prevalence of obstructive sleep apnea (OSA) was 17%, frequent snoring was 34%, difficulty initiating or maintaining sleep (DIMS; insomnia symptoms) was 30%, and excessive daytime sleepiness (EDS) was 25%. African American participants with frequent snoring, insomnia symptoms, or EDS had significantly poorer physical health compared to Caucasians (p < 0.001). Hispanics with frequent snoring, insomnia symptoms, or EDS had significantly poorer mental health than Caucasian participants (p <0.001). Neither PCS nor MCS scores differed significantly across ethnic subgroups for participants with moderate to severe OSA (respiratory disturbance index > 15, 4% desaturation). CONCLUSIONS: Across ethnic/racial subgroups, sleep disturbances are associated with worse physical and better mental HR-QOL than the U.S. norm, but this relationship may be moderated by comorbid health conditions. This study replicates and extends prior research indicating differences among minority and non-minority participants and highlights the need for future studies of sleep disturbances with larger samples of minorities that control for comorbid health conditions.
PMCID:2854706
PMID: 20411696
ISSN: 1550-9389
CID: 162557

Sleep disordered breathing, daytime symptoms, and functional performance in stable heart failure

Redeker, Nancy S; Muench, Ulrike; Zucker, Mark J; Walsleben, Joyce; Gilbert, Michelle; Freudenberger, Ronald; Chen, Ming; Campbell, Della; Blank, Lenore; Berkowitz, Robert; Adams, Laura; Rapoport, David M
STUDY OBJECTIVES: To evaluate characteristics of sleep disordered breathing (SDB); clinical and demographic correlates of SDB; and the extent to which SDB explains functional performance and symptoms in stable heart failure patients receiving care in structured HF disease management programs. DESIGN: Cross-sectional, observational study. SETTING: Structured heart failure disease management programs. PARTICIPANTS: 170 stable chronic heart failure patients (mean age = 60.3 +/- 16.8 years; n = 60 [35%] female; n = 50 [29%] African American; left ventricular ejection fraction mean = 32 +/- 14.6). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Full polysomnography was obtained for one night on participants in their homes. Participants completed the 6-minute walk, 3 days of actigraphy, MOS-SF 36, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Multi-Dimensional Assessment of Fatigue Scale, and the Centers for the Epidemiological Studies of Depression Scale. Fifty-one percent had significant SDB; Sixteen (9%) of the total sample had central sleep apnea. Severe SDB was associated with a 4-fold increase in the likelihood of poor self-reported physical function (OR = 4.15, 95%CI = 1.19-14.57) and CSA was associated with low levels of daytime mobility (OR = 4.09, 95%CI = 1.23-13.62) after controlling for clinical and demographic variables. There were no statistically significant relationships between SDB and daytime symptoms or self-reported sleep, despite poorer objective sleep quality in patients with SDB. CONCLUSIONS: Severe SDB is associated with poor physical function in patients with stable HF but not with daytime symptoms or self-reported sleep, despite poorer objective sleep quality in patients with SDB.
PMCID:2849795
PMID: 20394325
ISSN: 0161-8105
CID: 162558

Evaluation of sham-CPAP as a placebo in CPAP intervention studies

Rodway, George W; Weaver, Terri E; Mancini, Cristina; Cater, Jacqueline; Maislin, Greg; Staley, Bethany; Ferguson, Kathleen A; George, Charles F P; Schulman, David A; Greenberg, Harly; Rapoport, David M; Walsleben, Joyce A; Lee-Chiong, Teofilo; Kuna, Samuel T
STUDY OBJECTIVES: To evaluate the use of sham-continuous positive airway pressure (CPAP) treatment as a placebo intervention. DESIGN AND SETTING: Analysis of polysomnograms performed in fixed order without sham-CPAP and on the first night of the sham-CPAP intervention in participants in the CPAP Apnea Trial North American Program (CATNAP), a randomized, placebo controlled trial evaluating the effects of CPAP treatment on daytime function in adults with newly diagnosed mild to moderate obstructive sleep apnea (apnea hypopnea index (AHI) 5-30). PARTICIPANTS: The first 104 CATNAP participants randomized to the sham-CPAP intervention arm. MEASUREMENTS AND RESULTS: Compared to the polysomnographic measures without sham-CPAP, the study on the first night with sham-CPAP had statistically significant differences that suggested a decrease in sleep quality: decreased sleep efficiency, increased arousal index, increased time in stage 1 NREM sleep, and prolonged latency to REM sleep. However, all of these differences had a relatively small effect size. Compared to the polysomnogram without sham-CPAP, the number of hypopneas on the sham-CPAP polysomnogram was significantly increased and the number of apneas significantly decreased. Relatively minor differences in AHI with and without sham-CPAP were present and were dependent on the criteria used to score hypopneas. CONCLUSION: Comparison of polysomnograms with and without sham-CPAP revealed differences that, although statistically significant, were small in magnitude and had relatively low effect sizes suggesting minimal clinical significance. The results support the use of sham-CPAP as a placebo intervention in trials evaluating the effects of CPAP treatment in patients with obstructive sleep apnea. CLINICAL TRIAL INFORMATION: This paper was a secondary analysis of clinical trial data. CATNAP: CPAP Apnea Trial North American Program, the trial from which the data were obtained, is registered with clinicaltrial.gov. Registration #NCT00089752
PMCID:2817913
PMID: 20175410
ISSN: 0161-8105
CID: 134983