"More N.C. Infants Dying Accidentally During Sleep"

Raleigh The number of infants who have died by accidental suffocation and strangulation in bed has increased nearly sixfold since 2000 and child advocates are strengthening their push to teach people how to safely put babies to bed.

Between 2000 and 2005, the number of babies who died in bed grew from four to 23, according to the state Office of the Chief Medical Examiner. The numbers for 2006 aren't expected to be available until spring 2007.

Read via Star News Online

"You need Sleep to Battle your Bulge"

If your New Year’s resolution is to lose weight, don’t be too aggressive and make sure you get enough sleep, experts advise.

“You’re more likely to quit if you do too much too quick,” said Karen McWilliams, dietitian at the Fremont Hy-Vee Food Store. “A 5-10 percent weight loss goal for six months is not only realistic, but more healthy.”

Before starting any type of dieting, she said, it’s important to really know what you eat now.

Read via Fremontneb

"Lack of sleep can Result in Bridezilla"

"Sleep loss causes changes in one's mood," said Esther. "If you are sleep deprived, you are more likely to feel overwhelmed by the tasks you have to accomplish -- tasks that would not ordinarily feel too demanding."

Even a single good night's sleep will lead to recovery of concentration and decreased irritability," said Esther. "So as part of planning the wedding, remember to schedule in relaxation time and plenty of time for sleep.Read via UPI

Sleep Problems Common in School Kids

Parents Often Unaware of Sleep Issues, Study Shows

Nov. 14, 2006 -- Sleep problems are common among elementary-school-aged children, but they are often not recognized by parents, new research shows.
When 8-year-old twins and their parents were surveyed, almost half of the children reported experiencing difficulty falling asleep while fewer than one in five parents said their kids had sleep problems.
Based on their findings, researchers concluded that both genetic and environmental factors influence sleep problems among school-aged children.
Researchers Alice M. Gregory, PhD, of King's College London tells WebMD that the frequency of self-reported sleep problems among the children in the study should not escape the notice of pediatricians.

By Salynn BoylesWebMD Medical News

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ACCREDIATION – PROCESS & BENEFITS

Accrediation is defined as:
The process whereby the organizational and administrative aspects of a board of health/public health agency, including program planning, implementation, monitoring and evaluation, are measured against peer-set principles and standards.
A principle is a simple and fundamental statement of truth upon which are established more specific standards. A standard is a statement of excellence, developed by peers, against which conformity of the agency is evaluated. The principles, standards, components and definitions are presented in 2 sections; Section I - Leadership and Agency Management, and Section II - Program/Service Planning, Implementation, Monitoring and Evaluation.

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For a complete listing of the OCCHA standards, please refer to the Accreditation Documents.

Study Shows How Sleep Improves Memory

Sleep and Memory

A good night's sleep triggers changes in the brain that help to improve memory, according to a new study led by researchers at Beth Israel Deaconess Medical Center (BIDMC).
These findings, reported in the June 30 issue of the journal Neuroscience and currently published on-line, might help to explain why children, infants, in particular, require much more sleep than adults, and also suggest a role for sleep in the rehabilitation of stroke patients and other individuals who have suffered brain injuries.
www.bidmc.harvard.edu - BOSTON

Functional Neuroimaging Evidence for Hyperarousal in Insomnia

Eric A. Nofzinger, M.D., Daniel J. Buysse, M.D., Anne Germain, Ph.D., Julie C. Price, Ph.D., Jean M. Miewald, B.A. and David J. Kupfer, M.D.

OBJECTIVE: The authors investigated the neurobiological basis of poor sleep and daytime fatigue in insomnia. METHOD: [18F]Fluorodeoxyglucose positron emission tomography was used to assess regional cerebral glucose metabolism of seven patients with insomnia and 20 healthy subjects. RESULTS: Compared with healthy subjects, patients with insomnia showed greater global cerebral glucose metabolism during sleep and while awake, a smaller decline in relative metabolism from waking to sleep states in wake-promoting regions, and reduced relative metabolism in the prefrontal cortex while awake. CONCLUSIONS: Subjectively disturbed sleep in patients with insomnia is associated with greater brain metabolism. The inability to fall asleep may be related to a failure of arousal mechanisms to decline in activity from waking to sleep states. Further, daytime fatigue may reflect decreased activity in the prefrontal cortex resulting from inefficient sleep.

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Am J Psychiatry 161:2126-2128, November 2004© 2004 American Psychiatric Association

Functional Neuroimaging of Sleep

From Seminars in Neurology

Eric A. Nofzinger, M.D.
Abstract: Sleep and sleep disorders have traditionally been viewed from a polysomnographic perspective. Although these methods provide information on the timing of various stages of sleep and wakefulness, they do not provide information regarding function in brain structures that have been implicated in the generation of sleep and that may be abnormal in different sleep disorders. Functional neuroimaging methods provide information regarding changes in brain function across the sleep-wake cycle that provides information for models of sleep dysregulation in a variety of sleep disorders. Early studies show reliable increases in function in limbic and anterior paralimbic cortex in rapid eye movement (REM) sleep and decreases in function in higher-order cortical regions in known thalamocortical networks during non-REM sleep. Although most of the early work in this area has been devoted to the study of normal sleep mechanisms, a collection of studies in diverse sleep disorders such as sleep deprivation, depression, insomnia, dyssomnias, narcolepsy, and sleep apnea suggest that functional neuroimaging methods have the potential to clarify the pathophysiology of sleep disorders and to guide treatment strategies.

Eric A. Nofzinger, M.D. , Sleep Neuroimaging Research Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes

Karine Spiegel,1 Kristen Knutson,2 Rachel Leproult,2 Esra Tasali,2 and Eve Van Cauter2

Chronic sleep loss as a consequence of voluntary bedtime restriction is an endemic condition in modern society. Although sleep exerts marked modulatory effects on glucose metabolism, and molecular mechanisms for the interaction between sleeping and feeding have been documented, the potential impact of recurrent sleep curtailment on the risk for diabetes and obesity has only recently been investigated. In laboratory studies of healthy young adults submitted to recurrent partial sleep restriction, marked alterations in glucose metabolism including decreased glucose tolerance and insulin sensitivity have been demonstrated. The neuroendocrine regulation of appetite was also affected as the levels of the anorexigenic hormone leptin were decreased, whereas the levels of the orexigenic factor ghrelin were increased. Importantly, these neuroendocrine abnormalities were correlated with increased hunger and appetite, which may lead to overeating and weight gain. Consistent with these laboratory findings, a growing body of epidemiological evidence supports an association between short sleep duration and the risk for obesity and diabetes. Chronic sleep loss may also be the consequence of pathological conditions such as sleep-disordered breathing. In this increasingly prevalent syndrome, a feedforward cascade of negative events generated by sleep loss, sleep fragmentation, and hypoxia are likely to exacerbate the severity of metabolic disturbances. In conclusion, chronic sleep loss, behavioral or sleep disorder related, may represent a novel risk factor for weight gain, insulin resistance, and Type 2 diabetes.

Sleep Lab Partner Services

Whether you're seeking a "low-risk" option for a new sleep lab in your hospital or practice - or interested in improving or expanding your sleep service with an outstanding approach, SleepMed offers many flexible and customizable options to meet your needs.
In our most popular business model, the hospital or medical group provides the furnished and maintained space, as well as the marketing for the sleep lab and billing for the sleep study. A qualified member of the medical staff provides and bills for the sleep study interpretation.
SleepMed provides:
Medical director training and orientation
"State of the art" sleep system
Morpheus™ sleep database offering web-based data review, report access and interpretation functions for interpreting physicians and lab managers
Patient scheduling services

The advantages of a hospital-based program (operated by Sleep Ave.) include

Service Features:

Permanent laboratories with fully attended studies and state-of-the-art equipment.
All scoring services provided through centralized scoring centers. Scored studies are returned to the client lab via overnight mail.
Comprehensive technician training at a Sleep Ave. freestanding facility, followed by onsite training.
Start-up marketing program for initiation of services, including brochures, mailings, advertising support and marketing training and support for hospital staff.

Benefits:
Rapid response to this emerging market with minimal financial risk.
Lab can be set up within 60 days of administrative approval.
Continuous Quality Improvement (CQI) audits are performed on all tests scored, and the results are summarized in monthly reports.
All labs are provided with policy and procedure manuals including CQI standards.
Facilities are designed to meet AASM or JCAHO standards for accreditation.
Emergency Room services available.

Investigation and treatment of upper-airway obstruction: childhood sleep disorders I

J Declan Kennedy and Karen A Waters
Obstructive sleep apnoea syndrome is common and is associated with significant childhood morbidities
Always take a history of snoring and sleep disturbance when reviewing children in primary care, as there is evidence that episodes of hypoxia and arousal during sleep may result in deficits in memory, attention and behaviour, in addition to the well known sequelae of growth failure, developmental delay and cor pulmonale. Check for changes in behaviour affecting school progress.
To investigate for possible obstructive sleep apnoea syndrome (OSAS), clinical examination, lateral neck x-ray (adenoidal hypertrophy) and overnight oximetry (desaturation episodes) are useful screening tests, but oximetry is best used in conjunction with polysomnography. A negative oximetry test does not exclude OSAS.

Epidemiology of Obstructive Sleep Apnea

Terry Young, Paul E. Peppard and Daniel J. Gottlieb

Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority.

Undiagnosed Obstructive Sleep Apnea Syndrome in Children With Syndromal Craniofacial Synostosis.

Children with syndromal craniofacial synostosis have a high risk for obstructive sleep apnea syndrome. Early diagnosis and treatment can relieve symptoms and morbidity. Little is known about the development and natural history of obstructive sleep apnea syndrome through life. The aim of this study was to investigate our experience of clinical history and treatment modalities concerning obstructive sleep apnea syndrome from birth until the current age in children with syndromal craniofacial synostosis. Children with one of the three syndromal craniofacial synostoses (Apert, Crouzon, or Pfeiffer) born between 1984 and 2001 were evaluated. The medical history and symptoms of obstructive sleep apnea syndrome were assessed by retrospective analysis of the medical records. The present and past complaints were explored by means of a questionnaire. Retrospective analysis of the medical records showed a suspicion for obstructive sleep apnea syndrome in 26% of the children compared with 53% in the questionnaire. The severity and presentation of obstructive sleep apnea syndrome were not related to the age of the child. Obstructive sleep apnea syndrome symptoms occurred in almost half of the children during colds. Several symptoms were significantly more common in children with a high suspicion for obstructive sleep apnea syndrome. Treatment modalities consisted of adenotonsillectomies, continuous positive airway pressure, and Le Fort III surgery. Use of a standard questionnaire showed that the suspicion for obstructive sleep apnea syndrome in children with syndromal craniofacial synostosis is much higher than reported in the medical records. Regular screening for obstructive sleep apnea syndrome with a standard questionnaire could be of additional value for the detection of obstructive sleep apnea syndrome in children with syndromal craniofacial synostosis.
(C)2004Muntaz B. Habal, MD

Impact of heart failure on quality of sleep

Dr A Rao Department of Cardiology, Queens Medical Centre, Nottingham NG7 2UH, UK

Chronic heart failure is an important health problem associated with a high mortality and morbidity. Appropriate treatment reduces mortality and leads to improved exercise tolerance but many patients report poor quality of sleep. Sleep studies of patients with heart failure suggest that sleep disordered breathing is experienced in 50% of patients and is a powerful predictor of poor prognosis. Sleep disordered breathing broadly comprises obstructive sleep apnoea, when upper airway instability causes mechanical obstruction to breathing; and central sleep apnoea, characterised by an absence of ventilatory effort. Sleep disordered breathing occurring in patients with heart failure is in most part attributable to central sleep apnoea and reflects uncompensated instability of the ventilatory feedback mechanism.

Hole in Heart Worsens Sleep Apnea: Study

Dec 21 (Reuters Health) - Sleep apnea -- frequent, short periods during sleep when breathing stops -- may be much worse in people with a relatively common heart defect called patent foramen ovale or PFO, a study by Swedish researchers has found.
In PFO, an opening between the heart's two upper chambers that normally closes during fetal development remains open. PFO is present in 25 percent of the adult population, and the defect may allow deoxygenated blood to pass through the hole in the heart.

SOURCE: European Heart Journal, January 2007.
Publish Date: December 21, 2006

Sleepy with Apnea Could Signal Heart Trouble

Dec. 22 (Reuters Health) - Daytime sleepiness brought on by obstructive sleep apnea (OSA), a condition in which airways become blocked during sleep and breathing frequently stops for brief periods, may go hand in hand with heart problems, a report shows.
In a study of 86 adults with OSA but no other medical conditions aside from high blood pressure, a higher score on a standardized daytime sleepiness scale was independently associated with decreases in cardiac function, the researchers found.

Sleep Disordered Breathing in Children With Single Ventricle Physiology

This is an exploratory study designed to evaluate the incidence of, and to quantify sleep disordered breathing following stage I Norwood reconstructive surgery. Sleep disordered breathing will be correlated with:
Elevations in pulmonary vasculature resistance at the time of Stage II surgery.
Risks of death
Children with single ventricle physiology are exquisitely sensitive to alterations in pulmonary vascular resistance. Following their first operative repair (stage I Norwood), performed in their first week of life, pulmonary and systemic circulations are in parallel rather than series. As such, elevations in pulmonary vascular resistance can result in severe arterial desaturation. Additionally, elevated pre-operative pulmonary artery pressure is directly correlated with poor survival following the third and final operative repair (stage III Norwood, or Fontan).
Periodic breathing is a normal breathing pattern in sleeping infants. At the other end of the spectrum is sleep apnea. In between lies a continuum of sleep disordered breathing. Obstructive sleep apnea has an incidence of approximately 2% in children, and is associated with pulmonary and systemic hypertension. Specific studies of the incidence and effects of sleep disordered breathing in congenital heart disease are lacking. Otherwise normal children have baseline oxygen saturation in the high 90’s, thereby placing them on the flat part of the oxyhemoglobin curve. But children with cyanotic congenital heart disease live with baseline oxygen saturations in the mid 70’s, so that they exist on the steep part of the oxyhemoglobin dissociation curve. We hypothesize therefore that these patients are at increased risk for the hemodynamic variations occurring during apneas/hypopneas even when they are more subtle, namely during sleep disordered breathing.

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, affecting 5-15% of the population. It is characterized by intermittent episodes of partial or complete obstruction of the upper airway during sleep that disrupts normal ventilation and sleep architecture, and is typically associated with excessive daytime sleepiness, snoring, and witnessed apneas. Patients with obstructive sleep apnea present risk to the general public safety by causing 8-fold increase in vehicle accidents, and they may themselves also suffer from the physiologic consequences of OSA; these include hypertension, coronary artery disease, stroke, congestive heart failure, pulmonary hypertension, and cardiac arrhythmias. Of these possible cardiovascular consequences, the association between OSA and hypertension has been found to be the most convincing. Although the exact mechanism has not been understood, there is some evidence that OSA is associated with frequent apneas causing mechanical effects on intrathoracic pressure, cardiac function, and intermittent hypoxemia, which may in turn cause endothelial dysfunction and increase in sympathetic drive. Therapy with continuous positive airway pressure has been demonstrated to improve cardiopulmonary hemodynamics in patients with OSA and may reverse the endothelial cell dysfunction. Despite the availability of diagnostic measures and effective treatment, many patients with sleep-disordered breathing remain undiagnosed. Therefore, OSA continues to be a significant health risk both for affected individuals and for thegeneral public. Awareness and timely initiation of an effective treatment may prevent potential deleterious cardiovascular effects of OSA.
Copyright © 2006 S. Karger AG, Basel

Sleep Syndrome Takes Days, Months From Sufferers' Lives

Dec 5, 2006 10:08 pm US/Central
(CBS 42) There is a sleep syndrome that could strike at any moment, robbing both children and adults of days, even months of their lives. After a long, hard day, most of us look forward to a good night's sleep. But Spencer Spearin, 20, is sometimes afraid to shut his eyes.

Profiting from a good night's sleep

Snoring. Thrashing around. All night.
So Ortega saw his doctor, who referred him to a sleep disorder clinic in Colonial Heights. Ortega slept over one night, and specialists at the lab studied his nighttime behavior.
Periodically, Ortega would stop breathing for several seconds. Then his body would flog around, and he'd begin breathing again. It happened again and again throughout his night.
Ortega was diagnosed with a condition known as sleep apnea.

Affecting 1 in 5 Americans, sleep apnea can prove fatal to sufferers

November 27,2006 Miriam Ramirez Monitor Staff Writer
Alicia Hernandez thought waking up on the wrong side of the bed for many years was normal.
She thought dozing off in the middle of the day was a result of a bad night’s sleep. She also thought feeling just a tad bit too cranky all of the time was just her way.
Most of all, she thought her incessant snoring was just a bad habit.
"I always felt like I didn’t get enough sleep," said the San Juan resident. "I was always so tired and grumpy."

All In A Good Day's Sleep

By Carole Moore
Garbage bags on the windows, white noise running in the background and over-the-counter sleep aids: Worn-out officers have tried just about everything in their quest to grab a few Z's.
Rotating shifts — working days one week and midnights the next — can lead to a jumbled body clock and an even worse disposition. Short of drinking on the job, there's little more debilitating to an officer's performance than sheer exhaustion.
Sure, it's a given cops won't always have enough sleep. But putting in long hours on a drug round-up, homicide or even a natural disaster are the kinds of details fueled by equal jolts of enthusiasm and adrenaline. Shift work — especially rotating shifts — go beyond the occasional and become a lifestyle. But one that's very dark and draining and can lead to health problems, bad judgment and short tempers.

Sleep Apnea Diagnosis at Home

Tuesday, 19 December 2006Some suspected cases of Sleep Apnea can now be confirmed at home, instead of at the sleep lab.

The Lung Association of Saskatchewan and the Saskatoon Health Region are sponsoring a one year pilot project that will allow some people to be tested at home.
Ten patients a week will be tested.
It is estimated about 5 percent of Saskatchewan adults have severe sleep apnea which, if left untreated, can lead to hypertension, heart disease and stroke. (sv)

Nature is teeming with healing power

By Lisa Roberts
The Orlando Sentinel
(MCT)
ORLANDO, Fla. - There's something about the outdoors - something essential - that Lynn Van Horne and her husband, Kurth Chin Fatt, must have.
The couple hike most Saturdays and often shape their vacations around backpacking and camping. "My husband and I have backpacked to the bottom of the Grand Canyon six times," said Van Horne, who teaches at McCoy Elementary School in Orlando, Fla. "It is the most amazing thing. We come home rejuvenated and completely relaxed. You are so in the moment that your brain is completely rested from anything stressful."
Call it nature's cure.
Though the present-day "built environment" - the infrastructure of cities and suburbs and their accouterments - has greatly insulated us from this nature of ancient mankind, our bond is not easily relinquished. In fact, research into humanity's relationship with nature - or lack of it - is finding that it can be a salve for mind, body and spirit.

Invitation

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Pavan K. Sahu