Sleep disorder prevalence in at-risk adolescents and potential effects of nightmare triad syndrome.
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Sleep disorder prevalence in at-risk adolescents and potential effects of nightmare triad syndrome.

Int J Adolesc Med Health. 2018 Feb 17;:

Authors: McIver ND, Krakow B, Krakow J, Nadorff MR, Ulibarri VA, Baade R

Abstract
Objective At-risk high school students, those considered to have a higher probability for academic failure or dropping out, were assessed for various sleep disorders. Effects were compared between students with and without the nightmare triad syndrome (NTS+), the sleep disorders' cluster of frequent nightmares, insomnia disorder and suspected sleep-disordered breathing (SDB). Methods Data were gathered at a charter school for at-risk youth using: computer based surveys, physical airway exams, and mental health interviews by school social worker. Ninety-two students were enrolled, and 70 completed all study components. Results Students were teenaged [17.10 (1.50) years], male (52.2%) slightly overweight [BMI 25.50 (6.41)] Hispanics (87.0%); two-thirds (65 of 92) subjectively reported a sleep problem. Frequent nightmares (39.1%), insomnia (ISI ≥ 12, 41.3%), and SDB risk (79.3%) were common. Several presumptive sleep disorders (insomnia, SDB risk, parasomnia, or nightmares) were associated with worse sleep quality and lower quality of life. Nineteen students met criteria for NTS. Compared to NTS-, NTS+ showed significantly lower quality of life (p < 0.003, g = 0.84). Regression analyses revealed higher levels of depression and anxiety symptoms in NTS+ students. NTS was associated with reduced quality of life independent of anxiety symptoms. Conclusion Prevalence of presumptive sleep disorders was high with a tendency for clusters of sleep disorders in the same individual. Students with NTS+ showed worse outcomes and reduced quality of life, mediated partially by depression and anxiety. To examine relationships between sleep disorders and mental health in at-risk adolescents, research investigations must include both subjective and objective measurements of sleep.

PMID: 29453926 [PubMed - as supplied by publisher]



Sleep apnea and type 2 diabetes.
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Sleep apnea and type 2 diabetes.

J Diabetes Investig. 2018 Feb 17;:

Authors: Muraki I, Wada H, Tanigawa T

Abstract
The aim of this review is to clarify the association between obstructive sleep apnea (OSA) and type 2 diabetes, and discuss the therapeutic role of continuous positive airway pressure (CPAP) in type 2 diabetes. OSA patients are more likely than non-OSA populations to develop type 2 diabetes while more than half of patients with type 2 diabetes suffer from OSA. Similarly to the Western countries, in the East Asian population, the association between these two disorders has also been reported. CPAP is the primary treatment for OSA, but the effect of CPAP on comorbid diabetes has not been established. CPAP improved glucose metabolism determined by the oral glucose tolerance test in OSA patients, and several studies have shown that CPAP improves insulin resistance, particularly in obese populations undergoing long-term CPAP. Diabetes is associated with other sleep-related manifestations as well, such as snoring and excessive daytime sleepiness. Snoring is associated with the development of diabetes, and excessive daytime sleepiness appears to modify insulin resistance. Well-designed studies are needed to clarify the therapeutic effect of CPAP on diabetes. Since both diabetes and OSA lead to cardiovascular disease, clinicians and healthcare professionals should be aware of the association between diabetes and OSA, and should take CPAP and health-related behaviors into consideration when treating patients with diabetes and/or OSA. This article is protected by copyright. All rights reserved.

PMID: 29453905 [PubMed - as supplied by publisher]



Incidence and Drug Resistance of Zoonotic Mycobacterium bovis Infection in Peshawar, Pakistan.
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Incidence and Drug Resistance of Zoonotic Mycobacterium bovis Infection in Peshawar, Pakistan.

Adv Exp Med Biol. 2018 Feb 17;:

Authors: Khattak I, Mushtaq MH, Ayaz S, Ali S, Sheed A, Muhammad J, Sohail ML, Amanullah H, Ahmad I, Ur Rahman S

Abstract
Prevalence of zoonotic Mycobacterium bovis (bTB) disease in human population is underreported from the North of Pakistan. Here, we report on the proportion of human bTB disease among the overall TB patients, drug resistance pattern of bTB isolates, and knowledge, attitude, and practices (KAP)-based analysis of bTB disease. For this purpose, sputum samples from a total of 300 clinically diagnosed TB patients and 100 randomly selected school children suspected of pulmonary TB were processed by culture as well as polymerase chain reaction (PCR) for isolation, identification, and confirmation of Mycobacterium tuberculosis (mTB) and bTB species. Isolates of bTB were processed for drug susceptibility tests. Data on KAP regarding TB were obtained on a pretested questionnaire. Sputum-based PCR results indicated that 288/300 (96%) were confirmed as mTB, while 12/300 (4%) were found as bTB diseases. Interestingly, none of the school child was declared positive for either mTB or bTB. Notably, 274/300 (91.3%) positively cultured samples were identified as mTB, 13/300 (4.3%) as bTB, while 5/300 (1.7%) as mixed containing both. Importantly, except one, all of the bTB isolates were found resistant to pyrazinamide. Surprisingly, most of the bTB isolates (~70%) were found resistant to a broad range of first- and second-line anti-TB drugs. SplitsTree and recombination analysis indicated no evidence of intergenic recombination. Finally, residence, occupation, presence of animals at home, and sleeping alongside animals were found significantly associated with occurrence of bTB disease. To the best of our knowledge, we report for the first time on the high (4%) burden of bTB disease in human TB patients in Peshawar, Pakistan.

PMID: 29453670 [PubMed - as supplied by publisher]



Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study.
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Effect of semi-rapid maxillary expansion in children with obstructive sleep apnea syndrome: 5-month follow-up study.

Sleep Breath. 2018 Feb 17;:

Authors: Hoxha S, Kaya-Sezginer E, Bakar-Ates F, Köktürk O, Toygar-Memikoğlu U

Abstract
BACKGROUND: The purpose of this study was to investigate the effect of semi-rapid maxillary expansion (SRME) orthodontic treatment on biomarkers and respiratory parameters in children with obstructive sleep apnea syndrome (OSAS) and maxillary transverse deficiency.
METHODS: Thirty children with OSAS were included in this study. Fifteen children were enrolled as control, and 15 children were subjected to SRME orthodontic treatment method for 5 months. Beside respiratory parameters, pharyngeal area, dental arch, and postero-anterior widths and the levels of OSAS biomarkers in serum and urine were measured.
RESULTS: Pharyngeal airway space, dental arch, and postero-anterior widths were increased after SRME treatment. Sleep tests showed a decrease in the apnea-hypopnea index (AHI) after 5-month control/treatment duration. Serum kallikrein (KLK)1 levels decreased significantly in the treatment group. There was a significant increase in serum orosomucoid (ORM)2 levels and a decrease in urine perlecan levels in the control group after a 5-month follow-up. A significant negative correlation between serum ORM2, perlecan, gelsolin, and KLK1 levels and intercanin width, as well as between serum ORM2 and KLK1 levels and intermolar width, was observed.
CONCLUSIONS: SRME treatment can be considered as a useful approach in children with OSAS. A further investigation of OSAS-related biomarkers and their relationship with sleep and orthodontic parameters is needed for providing easier and reliable modulatory strategies in the treatment of OSAS.

PMID: 29453640 [PubMed - as supplied by publisher]



Upper airway obstruction induced by non-invasive ventilation using an oronasal interface.
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Upper airway obstruction induced by non-invasive ventilation using an oronasal interface.

Sleep Breath. 2018 Feb 17;:

Authors: Schellhas V, Glatz C, Beecken I, Okegwo A, Heidbreder A, Young P, Boentert M

Abstract
BACKGROUND: On initiation of long-term non-invasive ventilation (NIV), intermittent upper airway obstruction has rarely been described as possibly treatment-induced. Inspiratory pressure effects and the use of an oronasal interface may promote obstructive events in some patients with neuromuscular disease (NMD) and amyotrophic lateral sclerosis (ALS) in particular.
METHODS: We evaluated clinical data from 212 patients in whom NIV was initiated using an oronasal mask. Treatment-induced upper airway obstruction (TAO) was defined as an AHI > 5/h along with a relative increase of the AHI in the first treatment night compared to diagnostic sleep studies.
RESULTS: Prevalence of TAO was 14.2% in the entire cohort, 17.0% in patients with NMD (n = 165), 20.4% in the ALS subgroup (n = 93), and 4.3% in non-NMD patients (n = 47). Fixed expiratory positive airway pressure (EPAP, n = 192) was significantly correlated with AHI reduction (r = 0.50; p < 0.001). The inspiratory-expiratory pressure interval (∆PAP, n = 191) showed inverse correlation with the AHI change achieved in the first treatment night (r = - 0.28; p < 0.001). However, ∆PAP and the effective pressure range between EPAP and the highest inspiratory PAP achieved were not predictive of TAO. In patients with ALS, TAO was associated with better bulbar function. Study results were limited by initial EPAP being significantly lower in NMD patients reflecting that sleep apnea was less frequent and severe in this subgroup.
CONCLUSIONS: Initiation of NIV using an oronasal interface may be associated with TAO in a subset of patients. Since both EPAP and ∆PAP appear to play a causative role, careful titration of ventilator settings is recommended.

PMID: 29453639 [PubMed - as supplied by publisher]



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