Sleep Disorders

MDNG Psychiatry, September 2010, Volume 9, Issue 3

Online CMEInsomniaCredits:1.00

Fee:None

Expires:June 25, 2013

Multimedia: None

This Physicians’ Information and Education Resource from the American College of Physicians reviews screening, diagnosis, consultation for diagnosis, hospitalization, non-drug and drug therapy, patient education, consultation for management, and follow-up for insomnia. The fully reference, and incredibly thorough text is expert written and provided in bullet-point format for easy referencing. Enter the link code below in the search window at HCPLive.com, and enter “insomnia” in the search window at the site to which you are directed, and then select “physician” as your profession to access this activity.

Link Code: pn12333

www.cemedicus.com

Restless Legs Syndrome: A Case-based Review

Credits: 1.25

Fee:None

Expires:February 2011

Multimedia:Audio

The prevalence and impact of restless legs syndrome, associated risk factors and conditions, both behavioral and pharmacologic treatments for restless legs syndrome, and the differences in looking at the syndrome from the points of view of a primary care physician, psychiatrist, or neurologist form the foci of this interactive case study-based course from Johns Hopkins University School of Medicine.

Link Code: pn12332

www.sleepuniversitycme.com/case.asp

Evolving Sleep-Wake Research: Implications for Improved Patient Outcomes, Part 3

Credits:1.00

Fee:None

Expires:October 19, 2010

Multimedia:Audio, Slides

With ongoing research in the area of sleep-wake medicine offering insights into the link between sleep disturbances and adverse effects on performance, mood, behavior, and medical illness, an understanding of the implications this data has on clinical practice is necessary. With that in mind, this activity thoroughly reviews the link between the neuronal process of electrical coupling and sleep-wake control. The physiology of electrical coupling and the impact medication may have on electrical coupling and the ability to modulate arousal are also discussed.

Link Code:pn12331

http://hcp.lv/cDpMaW

The Educated PatientTM

Obstructive Sleep Apnea — Sleep Channel

This frequently physician-reviewed site covers all the bases for patients in regards to obstructive sleep apnea (OSA), from causes and risk factors to complications and treatment. Beyond this information, the site provides a lengthy list of questions for patients to ask their physician, the story of another patient with OSA who was able to see the light of the tunnel (site visitors can submit their own stories), a doctor finder, and the chance to participate in any number of related forums that offer guidance and support.

Link Code:pn12321

www.sleepdisorderchannel.com/osa/index.shtml

Sleep Disorders Guide

Quite possibly the most extensive sleep resource online, this site provides patients and caregivers/family members comprehensive reviews on more than 25 conditions, from bed wetting and hypersomnia to night sweats and narcolepsy. Many sleep-related topics are also covered in equal depth, including sleep aids and devices, sleep tests, and sleep-related breathing disorders. Patients who are just beginning their search for online information on sleep are encourage to check out he “Sleep Basics” section, which answers such questions as “What does sleep do for you?”, “What happens when we dream?”, and “What disrupts sleep?”

Link Code: pn12322

www.sleepdisordersguide.com/sleep-center.html

Medical Websites

AASM — Professional Development

Keep with its 30-year tradition of “equipping health care professionals with the tools needed to excel in the field of sleep medicine,” the American Academy of Sleep Medicine provides a collection of links to educational opportunities, professional training, and quality resources through this section of its online home. Through the resources here, physicians can obtain and prepare for board certification in sleep medicine; browse current job openings; take advantage of continuing education opportunities; and review recommendations for quality patient care.

Link Code: pn12311

www.aasmnet.org/ProfDev.aspx

Clinical Trials

Cognitive-Behavioural Therapy (CBT) for Insomnia Via Internet or Telehealth

Study Type:Interventional

Age/Gender Requirement:18-75 years (male/female)

Sponsor:University of Manitoba

Purpose: Though your patients won’t be eligible for this trial—only residents of rural Manitoba, Canada, are eligible—the study is worth keeping an eye on, as the results will certainly have implications on telehealth practices in the US in regards to patients with insomnia. The study will “compare the effectiveness of two brief (6 week) psychological interventions delivered to residents of rural Manitoba using Telehealth or an interactive Internet-based platform” with the hypotheses “that a) participants in the Telehealth condition will report significantly greater improvements in sleep parameters (e.g., sleep efficiency, time awake in bed, sleep-onset latency), insomnia severity, and daytime fatigue than those in the Internet condition, and that b) participants in the Telehealth condition will show better adherence to treatment and greater satisfaction with treatment than those in the Internet condition.”

Link Code: pn123610

www.clinicaltrials.gov/ct2/show/NCT01162655?term=insomnia&recr=Open&rank=4

Cognitive Benefits of Treating Sleep Apnea in Parkinson's Disease (TAP)

Study Type:Interventional

Age/Gender Requirement:50 years (male/female)

Sponsor: University of California, San Diego

Purpose:To “test the effects of treating [sleep disordered breathing (SDB)] among patients with Parkinson's disease and SDB. Specifically, the study will test the effect of [continuous positive airway pressure (CPAP)] treatment on SDB and sleep; the effect of CPAP treatment on daytime sleepiness, cognition, overall quality of life and mood; the effect of CPAP treatment on the frequency of symptoms of REM behavior disorder and restless legs syndrome; the effect of continued CPAP use (beyond the six weeks of the study) on SDB, sleep, cognition, mood and quality of life; whether the study-partner feels that CPAP improves the patient's sleep, mood and overall functioning; [and] whether study-partners feel that their own sleep, mood and overall functioning improve as the patient's sleep improves both during the 6-week protocol and at follow-up for those opting to continue using CPAP.”

Link Code: pn123611

www.clinicaltrials.gov/ct2/show/NCT00492115?term=restless leg syndrome&recr=Open&rank=19

Transoral Robotic Surgery for Sleep Apnea

Study Type:Interventional

Age/Gender Requirement:18 years (male/female)

Sponsor:University of Pennsylvania

Purpose:To determine if the da Vinci Robotic Surgical system “allows for ‘adequate exposure’ for transoral resection of hypertrophic lingual tonsils in patients with obstructive sleep apnea.”

Link Code: pn123612

www.clinicaltrials.gov/ct2/show/NCT01187160?term=sleep&recr=Open&rank=43

eAbstracts

Development of the Pediatric Restless Legs Syndrome Severity Scale (P-RLS-SS)©: A Patient-reported Outcome Measure of Pediatric RLS Symptoms and Impact

Journal:Sleep Medicine (August 30, 2010)

Authors:Arbuckle R, Abetz L, Durmer J, et al.

Purpose: “To develop a questionnaire to measure Pediatric Restless Legs Syndrome (P-RLS) symptoms and impact for use in clinical research.”

Results:Although it is recommended that the scale be recommended, detailed input from both children and adolescents suffering from RLS, their parents, and clinical experts was used to create the P-RLS-SS. Therefore, the scale has “strong content validity that is intended to be comprehensive, clinically relevant, and important to patients.”

Link Code: pn123577

http://dx.doi.org/10.1016/j.sleep.2010.03.016

Relationship Between Insomnia and Pain in Major Depressive Disorder: A Sleep Diary and Actigraphy Study

Journal:Sleep Medicine (September 2010)

Authors:Chung K, Tso K

Purpose: To analyze “the association between insomnia and pain symptoms using subjective and objective sleep measures.”

Results: The authors concluded that their “study supports specific role of subjective sleep disturbances and actigraphic measures in predicting pain symptoms in major depressive disorder. Further studies using a micro-longitudinal design are necessary to find out the causal relationship between sleep and pain in depressed patients.”

Link Code: pn123578

www.sleep-journal.com/article/S1389-9457%2810%2900008-0/abstract

PDA Resources

AASM-endorsed Insomnia GUIDELINES Pocketcard

Cost:$9.95

Memory Requirement:1.9MB (Android)/0.5MB (BlackBerry, Symbian s60)/2.5MB (iPhone, iPod Touch, iPad)/2.2MB (Palm OS)/2.9MB (Pocket PC, Windows Mobile Smartphone)

Demo Available:Yes

Use this practical, quick-reference tool to obtain all you need to make accurate decisions at the point of care in regards to insomnia, through algorithms on diagnosis and treatment and information that covers screening, drug therapy, dosing, patient monitoring, and counseling.

Link Code:

http://www.skyscape.com/estore/ProductDetail.aspx?ProductId=2708

Pharma Focus

Silenor (doxepin)

Clinical Trials

Treatment of Insomnia in Patients with HIV DiseaseStudy Type:Interventional

Age/Gender Requirement: 18-69 years (male/female)

Sponsor:Duke University

Purpose:This randomized, double-blind, placebo controlled study will assess the safety and efficacy of both doxepin and temazepam in patients who are HIV seropositive and suffer from insomnia.

Link Code: pn123670

http://www.clinicaltrials.gov/ct2/show/NCT00465972?term=doxepin&rank=3

eAbstracts

Low-dose Doxepin: In the Treatment of Insomnia

Journal:CNS Drugs(August 2010)

Authors:Weber J, Siddiqui M, Wagstaff A, McCormack P

Purpose:To review the results of treatment with doexpin 3mg or 6mg once daily in “three large, well-designed, phase III trials in adult or elderly patients with chronic primary insomnia.”

Results:In the three studies, the agent was well tolerated and improved “wake time after sleep onset, total sleep time and sleep efficiency to a significantly greater extent than placebo.” Low-dose doxepin was able to maintain symptom control for up to 12 weeks, with no physical dependence or worsening insomnia seen after withdrawal of the drug.

Link Code: pn123570

http://adisonline.com/cnsdrugs/Abstract/2010/24080/Low_Dose_Doxepin__In_the_Treatment_of_Insomnia.6.aspx

New Guidelines for Diagnosis and Treatment of Insomnia

Journal: Arquivos de Neuro-Psiquiatria(August 2010)

Authors:Pinto L, Alves R, Caixeta E, et al.

Purpose:To develop new guidelines on the diagnosis and treatment of insomnias, taking into consideration “concepts, clinical and psychosocial evaluations, recommendations for polysomnography, pharmacological treatment, behavioral and cognitive therapy, comorbidities and insomnia in children.”

Results:Psychosocial and polysomnography investigation are recommended for diagnosis, cognitive behavioral treatment should be the standard for non-pharmacologic treatment, and zolpideam should be the standard drug for pharmacologic treatment because of its hypnotic profile. Doxepin, zopiclone, and trazodone are recommended for pharmacologic treatment.

Link Code: pn123571

http://dx.doi.org/10.1590/S0004-282X2010000400038

From the HCPLive Network

Brain Injuries Can Disrupt Sleep

People with brain injuries may produce low amounts of melatonin, which affects their sleep, according to findings from a recent study.

http://hcp.lv/9MYyCf

Bedwetting Management

Dr. Pullen reviews the most effective treatments for nocturnal enuresis.

http://hcp.lv/cQA95V

Insomnia Risks and Costs: Health, Safety, and Quality of LifeThis review article discusses the issues surrounding the risks and costs of sleep disturbance as they relate to society and the individual.

http://hcp.lv/asmRjf