GÜNCEL LİTERATÜR - 2008

 

Chest. 2008 Sep; 134(3): 653-60.

Sleep loss and sleepiness: current issues.

Balkin TJ, Rupp T, Picchioni D, Wesensten NJ.

Department of Behavioral Biology, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA. thomas.balkin@us.army.mil

Awareness of the consequences of sleep loss and its implications for public health and safety is increasing. Sleep loss has been shown to generally impair the entire spectrum of mental abilities, ranging from simple psychomotor performance to executive mental functions. Sleep loss may also impact metabolism in a manner that contributes to obesity and its attendant health consequences. Although objective measures of alertness and performance remain degraded, individuals subjectively habituate to chronic partial sleep loss (eg, sleep restriction), and recovery from this type of sleep loss is slow, factors that may help to explain the observation that many individuals in the general population are chronically sleep restricted. Individual differences in habitual sleep duration appear to be a trait-like characteristic that is determined by several factors, including genetic polymorphisms.


 

 

J Am Coll Cardiol. 2008 Aug 19; 52(8): 686-717.

Sleep apnea and cardiovascular disease: an American Heart Association/ American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing.

Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T.


 

 

J Neuroendocrinol. 2008 Jun; 20(6): 812-9.                                                                                     

Two decades of circadian time.

Hastings MH, Maywood ES, Reddy AB.

Division of Neurobiology, MRC Laboratory of Molecular Biology, Cambridge, UK. jacques.epelbaum@broca.inserm.fr

Circadian rhythms coordinate our physiology at a fundamental level. Over the last 20 years, we have witnessed a paradigm shift in our perception of what the clocks driving such rhythms actually are, moving from 'black boxes' to talking about autoregulatory transcriptional/post-translational feedback loops with identified molecular components. We also now know that the pacemaker of the suprachiasmatic nuclei (SCN) is not our only clock but quite the opposite because circadian clocks abound in our bodies, driving local rhythms of cellular metabolism, and synchronised to each other and to solar time, by cues from the SCN. This discovery of dispersed local clocks has far-reaching implications for understanding our physiology and the pathological consequences of clock dysfunction, revealing that clocks are critical in a variety of metabolic and neurological conditions, all of which have long-term morbidity attributable to them. Without the currently available molecular framework, these insights would have not have been possible. In the circadian future, a growing appreciation of the systems-level functioning of these clocks and their various cerebral and visceral outputs, will likely stimulate the development of novel therapies for major illnesses.


 

 

Chest. 2008 Jun;133(6):1495-504.

Central sleep apnea: implications for congestive heart failure.

Garcia-Touchard A, Somers VK, Olson LJ, Caples SM.

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.

Congestive heart failure (HF), an exceedingly common and costly disease, is frequently seen in association with central sleep apnea (CSA), which often manifests as a periodic breathing rhythm referred to as Cheyne-Stokes respiration. CSA has historically been considered to be a marker of heart disease, since improvement in cardiac status is often associated with the attenuation of CSA. However, this mirroring of HF and CSA may suggest bidirectional importance to their relationship. In fact, observational data suggest that CSA, associated with repetitive oxyhemoglobin desaturations and surges in sympathetic neural activity, may be of pathophysiologic significance in HF outcomes. In light of the disappointing results from the first large trial assessing therapy with continuous positive airway pressure in patients with CSA and HF, further large-scale interventional trials will be needed to assess the role, if any, of CSA treatment on the outcomes of patients with HF. This review will discuss epidemiologic, pathophysiologic, diagnostic, and therapeutic considerations of CSA in the setting of HF.


 

 

Expert Opin Pharmacother. 2008 Jul; 9(10): 1721-33.

Management of narcolepsy.

Bhat A, El Solh AA.

Hospital Hill, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Truman Medical Center, Kansas City, MO, USA.

BACKGROUND: Narcolepsy is a rare chronic sleep disorder classically characterized by excessive daytime sleepiness. Other symptoms of the disease, including cataplexy, sleep paralysis, hypnagogic hallucinations and disturbed nocturnal sleep, may follow later. The disease can be incapacitating and frequently results in impaired psychosocial interaction. In the absence of a cure for narcolepsy, medical therapy is directed at symptom control. OBJECTIVES: The aim of this study was to review the current approach to the treatment of narcolepsy. METHODS: A search of three bibliographic databases (MEDLINE/PubMed, EMBASE and the Cochrane Library Database) was conducted from 1966 to January 2008 using the National Library of Medicine MeSH search terms narcolepsy and cataplexy. Relevant studies, case reports, review articles, editorials, short communications and chapters from selected textbooks were then extracted and manually cross-referenced. RESULTS/CONCLUSIONS: Traditionally, stimulants have been used to improve the symptoms of excessive daytime sleepiness. However, the treatment of narcolepsy has evolved recently with the widespread use of newer drugs, including modafinil for daytime sleepiness, newer antidepressants for cataplexy and gamma-hydroxybutyrate (sodium oxybate) for both excessive daytime sleepiness and cataplexy.


 

 

Dent Update. 2008 May; 35(4): 230-2, 234-5.

A review of the use of mandibular advancement appliances in sleep-disordered breathing.

Johal A.

Department of Oral Growth and Development, Bart's and The London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary's College, London, UK.

This paper sets out to provide a review of the provision of mandibular advancement appliances for patients with sleep-disordered breathing. A contemporary overview is provided in relation to: the rationale for their use; guidelines on patient selection; design features; clinical evidence of success; advantages; disadvantages; treatment objectives and follow-up and practical aspects to their provision. Clinical relevance: Mandibular advancement appliances are now increasingly being recognized by sleep specialists as playing a valuable role in the management of sleep-disordered breathing. The dentist is ideally positioned and, with the appropriate training, could provide this relatively simple form of treatment for patients who suffer what can be a socially-embarrassing condition, with high levels of morbidity.


 

 

Semin Pediatr Neurol. 2008 Jun; 15(2): 100-6.

Obstructive sleep apnea in children: implications for the developing central nervous system.

Gozal D.

Kosair Children's Hospital Research Institute and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY 40202, USA. david.gozal@louisville.edu

Recent increases in our awareness to the high prevalence of sleep disorders in general and of sleep-disordered breathing among children, in particular, has led to concentrated efforts aiming to understand the pathophysiological mechanisms, clinical manifestations, and potential consequences of such conditions. In this review, I will briefly elaborate on some of the pathogenetic elements leading to the occurrence of obstructive sleep apnea (OSA) in children, focus on the psychobehavioral consequences of pediatric OSA, and review the evidence on the potential mechanisms underlying the close association between central nervous system morbidity and the episodic hypoxia and sleep fragmentation that characterize OSA.