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Thursday, June 14, 2012

Tinnitus Relief: Therapy Mix Helps Ringing in Ears

AppId is over the quota
AppId is over the quota
Ear Infection Slideshow Pictures

Combining Parts of Sound Retraining and Talk Therapy Can Give Relief

By Kathleen Doheny
WebMD Health News

Reviewed by Louise Chang, MD

May 24, 2012 -- Combining parts of two established treatments for tinnitus in a new way can work, according to new research.

Tinnitus is a persistent ringing or buzzing in the ears that can be debilitating.

Researcher Rilana Cima of Maastricht University in the Netherlands and colleagues used parts of sound-based retraining therapy and talk therapy in what they say is a unique way.

This approach worked better than usual care, they found.

"This was very effective in decreasing tinnitus severity, distress, and impact on daily life and general health," Cima tells WebMD.

The study is published in The Lancet.

Two U.S. experts had mixed reaction to the study. One said the new research adds scientific credibility to the two approaches. Another said there is not much new in the study.

About 50 million people in the U.S. experience tinnitus, according to the American Tinnitus Association. About 2% of the population has tinnitus so severe their quality of life is impaired.

Those with tinnitus perceive a sound when no external source of sound exists. They may describe the condition as a ringing, buzzing, hissing, or whooshing in the ears. It can affect one or both ears.

Most often, noise exposure leads to tinnitus, according to the American Tinnitus Association. It can be a single extreme noise or the accumulated result of noise over time.

Another known cause of tinnitus is a head or neck injury.

Typically, many different treatments are offered, but with little evidence of effectiveness.

Often, says Cima, a doctor will tell a patient with tinnitus: "Nothing more can be done; you have to learn to live with it."

In severe cases, patients can become depressed and unable to work or socialize.

Cima assigned 247 patients with tinnitus to usual care and 245 to the specialized care.

Those in the usual care were seen by an audiologist to start. If the audiologist thought they also needed a social worker, the audiologist would refer them.

Those in specialized care got a combination of audiology and psychology treatments. The team included many health care providers, such as psychologists and other therapists.

In typical tinnitus retraining therapy, counseling sessions and exposure to a neutral external sound are used, Cima says.

"A sound generator is prescribed to patients," Cima says. "It generates a sound. The theory is that by listening to this masking sound the patients will [get used] to it, as well as to their tinnitus."

However, what is new, Cima tells WebMD, is that they combined the audiological and psychological treatments within a behavioral framework. In her approach, the behavioral intervention and the sound intervention are carried out at the same time.

"We believe that not the sound itself but the reactions (fear and misinterpretations) to this sound determine whether or not people will develop complaints," she says.

She focuses on modifying the reactions to the sounds. Patients often want to avoid the tinnitus, she says. They do this by not wanting to stay in silent environments, for instance.

"I say often to patients: 'In order to [get used] to your tinnitus, you have to be willing to perceive your tinnitus.'"

After that first step, those with more severe tinnitus went on to a second step, which included group treatment with a variety of therapists.

After 12 months, those in the specialized care group reported better quality of life, less severity of the tinnitus, and decreased impairment compared to the usual-care group.

Many had dropped out of each group. In all, 161 finished all 12 months of the usual care; 171 completed the combined approach.

Ideally, Cima says, the patients can keep using the skills learned in the program. If they have remission, they can return for more treatment, she says.

Information on costs is not yet available, she says.

While the treatments used in the new study have been around for decades, the new research documents that it works in a scientific way, says William Martin, PhD, director of the Tinnitus Clinic and Tinnitus Research at the Oregon Health and Science University in Portland.

"It's not groundbreaking," he says of the combination approach, "but it is an important step in terms of documenting how we should be approaching these poor people."

"The important message here in this study is, there are no shortcuts in managing tinnitus," he tells WebMD. "You have to treat the whole person. It's not just an ear issue."

"In our clinic, we find several things that impede the recovery process," Martin says. "Insomnia, anxiety, and depression. When you bring in a cognitive therapist, you provide an opportunity to address those issues in the context of the tinnitus."

"We have a whole crew we work with," he says. In addition to audiology professionals, they get help from other health professionals, including psychiatrists, as needed.

Martin says only a few U.S. centers offer such a comprehensive approach.

Another expert says the study is well-designed, but he takes a dimmer view of the findings. "There's nothing new in what's happening here," says Richard Tyler, PhD, professor of audiology at the University of Iowa and an expert in the field.

Cima's approach, with input from psychologists, he says, "would be hard to do in the States because there are not that many psychologists who are familiar with tinnitus."

SOURCES: Cima R. The Lancet, May 26, 2012.Langguth, B. The Lancet, May 26, 2012.Richard Tyler, PhD, professor of audiology, University of Iowa, Iowa City.Rilana F.F. Cima, researcher, Maastricht University, Maastricht, Netherlands.William Martin, PhD, director, Tinnitus Clinic and Tinnitus Research, Oregon Health and Science University, Portland.

©2012 WebMD, LLC. All Rights Reserved.



View the original article here

Tinnitus Relief: Therapy Mix Helps Ringing in Ears

AppId is over the quota
AppId is over the quota
Ear Infection Slideshow Pictures

Combining Parts of Sound Retraining and Talk Therapy Can Give Relief

By Kathleen Doheny
WebMD Health News

Reviewed by Louise Chang, MD

May 24, 2012 -- Combining parts of two established treatments for tinnitus in a new way can work, according to new research.

Tinnitus is a persistent ringing or buzzing in the ears that can be debilitating.

Researcher Rilana Cima of Maastricht University in the Netherlands and colleagues used parts of sound-based retraining therapy and talk therapy in what they say is a unique way.

This approach worked better than usual care, they found.

"This was very effective in decreasing tinnitus severity, distress, and impact on daily life and general health," Cima tells WebMD.

The study is published in The Lancet.

Two U.S. experts had mixed reaction to the study. One said the new research adds scientific credibility to the two approaches. Another said there is not much new in the study.

About 50 million people in the U.S. experience tinnitus, according to the American Tinnitus Association. About 2% of the population has tinnitus so severe their quality of life is impaired.

Those with tinnitus perceive a sound when no external source of sound exists. They may describe the condition as a ringing, buzzing, hissing, or whooshing in the ears. It can affect one or both ears.

Most often, noise exposure leads to tinnitus, according to the American Tinnitus Association. It can be a single extreme noise or the accumulated result of noise over time.

Another known cause of tinnitus is a head or neck injury.

Typically, many different treatments are offered, but with little evidence of effectiveness.

Often, says Cima, a doctor will tell a patient with tinnitus: "Nothing more can be done; you have to learn to live with it."

In severe cases, patients can become depressed and unable to work or socialize.

Cima assigned 247 patients with tinnitus to usual care and 245 to the specialized care.

Those in the usual care were seen by an audiologist to start. If the audiologist thought they also needed a social worker, the audiologist would refer them.

Those in specialized care got a combination of audiology and psychology treatments. The team included many health care providers, such as psychologists and other therapists.

In typical tinnitus retraining therapy, counseling sessions and exposure to a neutral external sound are used, Cima says.

"A sound generator is prescribed to patients," Cima says. "It generates a sound. The theory is that by listening to this masking sound the patients will [get used] to it, as well as to their tinnitus."

However, what is new, Cima tells WebMD, is that they combined the audiological and psychological treatments within a behavioral framework. In her approach, the behavioral intervention and the sound intervention are carried out at the same time.

"We believe that not the sound itself but the reactions (fear and misinterpretations) to this sound determine whether or not people will develop complaints," she says.

She focuses on modifying the reactions to the sounds. Patients often want to avoid the tinnitus, she says. They do this by not wanting to stay in silent environments, for instance.

"I say often to patients: 'In order to [get used] to your tinnitus, you have to be willing to perceive your tinnitus.'"

After that first step, those with more severe tinnitus went on to a second step, which included group treatment with a variety of therapists.

After 12 months, those in the specialized care group reported better quality of life, less severity of the tinnitus, and decreased impairment compared to the usual-care group.

Many had dropped out of each group. In all, 161 finished all 12 months of the usual care; 171 completed the combined approach.

Ideally, Cima says, the patients can keep using the skills learned in the program. If they have remission, they can return for more treatment, she says.

Information on costs is not yet available, she says.

While the treatments used in the new study have been around for decades, the new research documents that it works in a scientific way, says William Martin, PhD, director of the Tinnitus Clinic and Tinnitus Research at the Oregon Health and Science University in Portland.

"It's not groundbreaking," he says of the combination approach, "but it is an important step in terms of documenting how we should be approaching these poor people."

"The important message here in this study is, there are no shortcuts in managing tinnitus," he tells WebMD. "You have to treat the whole person. It's not just an ear issue."

"In our clinic, we find several things that impede the recovery process," Martin says. "Insomnia, anxiety, and depression. When you bring in a cognitive therapist, you provide an opportunity to address those issues in the context of the tinnitus."

"We have a whole crew we work with," he says. In addition to audiology professionals, they get help from other health professionals, including psychiatrists, as needed.

Martin says only a few U.S. centers offer such a comprehensive approach.

Another expert says the study is well-designed, but he takes a dimmer view of the findings. "There's nothing new in what's happening here," says Richard Tyler, PhD, professor of audiology at the University of Iowa and an expert in the field.

Cima's approach, with input from psychologists, he says, "would be hard to do in the States because there are not that many psychologists who are familiar with tinnitus."

SOURCES: Cima R. The Lancet, May 26, 2012.Langguth, B. The Lancet, May 26, 2012.Richard Tyler, PhD, professor of audiology, University of Iowa, Iowa City.Rilana F.F. Cima, researcher, Maastricht University, Maastricht, Netherlands.William Martin, PhD, director, Tinnitus Clinic and Tinnitus Research, Oregon Health and Science University, Portland.

©2012 WebMD, LLC. All Rights Reserved.



View the original article here

House — Episode 18 (Season 8): “Body and Soul”

AppId is over the quota
AppId is over the quota

House continues the decline started last episode.

Spoiler Alert!!

Lue, an eight year old Hmong boy dreams of being choked and wakes up unable to breathe. He is taken to the ER in acute respiratory distress (but apparently gets better) and ends up admitted to House’s service for evaluation. House tells the team that SUNDS (sudden nocturnal unexpected death syndrome) is more commonly seen in Hmong immigrants, but cautions the team that SUNDS is the easy way out — he wants a real diagnosis. Initial thoughts include ventricular fibrillation due to catecholamine (chemicals like adrenalin) release from a nightmare, obstructive sleep apnea, lung damage from inhaled toxins, or an upper respiratory infection (URI). House starts Lue on antibiotics for pneumonia and has the team search his house for toxins. The search turns up no toxins, but they do find a ritually slaughtered pig in Lue’s bedroom – a Hmong exorcism rite carried out by his grandfather who believes that Lue is possessed by a demon.

About this time, Lue slips into ventricular tachycardia (v-tach, a potentially fatal arrhythmia), but is brought back to a normal heart rhythm by defibrillation and medication. Bearing in mind the new cardiac symptoms — plus the team has learned Lue’s father is in prison for murder — the differential diagnosis now includes PTSD (post traumatic stress disorder), a malignant arrhythmia (a term for a potentially fatal arrhythmia), or acute pericarditis (inflammation of the membranous sac surrounding the heart). House favors the latter and has the team check an echocardiogram, which is normal. Lue starts to complain of abdominal pain, so the team quickly ultrasounds his belly and finds no evidence of obstruction, but does find constipation. Chase now suspects Hashimoto’s thyroiditis so wants a thyroid biopsy. Lue refuses and shouts in Hmong, a language he doesn’t know, before suffering a seizure. These neurological symptoms have the team again changing their differential diagnosis, which now contains scleroderma and Rasmussen’s encephalitis (an inflammatory disease of the brain in children). An MRI is checked, but is normal. Lue again suffers a bad dream of someone choking him, but this time he awakens with bruises on his neck. The team now considers the diagnoses of a coagulopathy (easy bleeding because of problems clotting blood), anemia, vitamin C deficiency, or leukemia. House suggests liver failure, which the team takes to mean hepatic fibrosis. A liver biopsy is checked, but is negative.

Adams and Taub walk in to check on Lue, and find him levitating in bed, briefly, his grandfather beside him. They insist to House and the rest of the team that the levitation was real, but the others suggests muscle spasm, tetanus, or hypocalcemia (low blood calcium) as possibilities. House favors the hypocalcemia suggestion and wants the team to “pump up” Lue’s electrolytes and start him on a beta-blocker. Meanwhile, Lue’s mother is coming around to his grandfather’s way of thinking. She wants to perform another Hmong exorcism. Foreman convinces her to wait twenty-four hours, but when Lue becomes unresponsive, she and the grandfather proceed with the ceremony. While the ceremony proceeds in Lue’s room, the team goes through other possible diagnoses. Brugada and Long QT syndrome (inherited heart rhythm disorder) tests are all negative. Carotid aneurysms are suggested, but dismissed. Kawasaki’s disease is suggested and Adams immediately wants to proceed with cardiopulmonary bypass. House mentions that he thinks Lue has a PDA (patent ductus arteriosis). The ductus is a bypass in the heart important for the fetal circulation, but it should close shortly after birth.) that was infected and is causing the symptoms. After a heated discussion with the team, he allows them only to treat their suspicion – Kawasaki’s – but after Lue starts crashing, Adams slips him ibuprofen, the treatment for PDA. Lue recovers, but his mother and grandfather credit the religious ceremony, not any medical treatment.

House #818

This week demonstrated some of the most inept and nonsensical medicine I have seen yet on House. For pretty much every diagnosis, just ask: “Do the symptoms fit, at all?” The likely answer is NO. Rather than waste your bandwidth and mine by repeating that over and over, I’ll just hit the highlights (lowlights). As always, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

A previously normal eight-year child suddenly begins to have PDA symptoms. His mother never noticed difficulty breathing before – it just started now, eight years after developing the PDA? Maybe that was the mysterious “PSA infection” House was referring to which was supposedly treated by the antibiotics – yet the patient’s symptoms worsened after the antibiotics.
defibA PDA severe enough to cause symptoms at rest and no murmurs on exam, or abnormal echocardiogram? (admittedly, a standard echocardiogram is not the best way to diagnose a PDA, but there should have been signs in one that severe, particularly one that’s “infected”).
defibI’ll agree that a PDA can cause some shortness of breath or respiratory distress, but that’s different than a sensation of being choked. Furthermore, how does the PDA explain the seizure, speaking in tongues, or bruising.
defibAs a side note, another repeat final diagnosis. Seen previously in episode #513, “Big Baby“

Right after Adams suggests URI, House has her start IV antibiotics for pneumonia – which is a lower respiratory disease.

Exactly what evidence for Kawaski’s is there? Where was the fever, rash, conjunctivitis, induration of the skin on the extremities, mucosal erythema, and cervical lymphadenopathy?

See if you can spot the theme:
defibHow about some actual evidence for liver failure before poking a hole in the liver.
defibHow about some actual evidence for Hashimotos before poking a hole in the thyroid.
defibHow about some actual evidence for Kawasaki’s before poking a hole in the heart. (Stopped before they got this far, but they did suggest it and start the paperwork)

How about checking for low calcium before treating it?

I can find no evidence that beta-blockers are indicated for hypocalcemia.

House #818

The medical mystery was interesting, and maintained interest throughout the episode. I give it an A-. The final solution wasn’t great. The final diagnosis didn’t fit well at all from both a time course and a symptom point of view, plus — for the second week in a row — it was a retread. I give it a D-. I realize they were playing a faith versus medicine angle this week, which is a shame, because the medicine was horrible. The team leapt from diagnosis to diagnosis, without logic, and abandoning previous attempts at the drop of a hat. It earns a weak D-. They rushed to risky procedures with no good reasons or proof. The soap opera was fair. The House and Dominika scenes were good, but the House-tells-the-team-what-they’re-secretly-thinking has been overplayed this season. I give it a C+.

The review of the previous episode of House
A list of all prior House reviews

This week’s House Challenge scores have been posted.

View the original article here

House — Episode 18 (Season 8): “Body and Soul”

AppId is over the quota
AppId is over the quota

House continues the decline started last episode.

Spoiler Alert!!

Lue, an eight year old Hmong boy dreams of being choked and wakes up unable to breathe. He is taken to the ER in acute respiratory distress (but apparently gets better) and ends up admitted to House’s service for evaluation. House tells the team that SUNDS (sudden nocturnal unexpected death syndrome) is more commonly seen in Hmong immigrants, but cautions the team that SUNDS is the easy way out — he wants a real diagnosis. Initial thoughts include ventricular fibrillation due to catecholamine (chemicals like adrenalin) release from a nightmare, obstructive sleep apnea, lung damage from inhaled toxins, or an upper respiratory infection (URI). House starts Lue on antibiotics for pneumonia and has the team search his house for toxins. The search turns up no toxins, but they do find a ritually slaughtered pig in Lue’s bedroom – a Hmong exorcism rite carried out by his grandfather who believes that Lue is possessed by a demon.

About this time, Lue slips into ventricular tachycardia (v-tach, a potentially fatal arrhythmia), but is brought back to a normal heart rhythm by defibrillation and medication. Bearing in mind the new cardiac symptoms — plus the team has learned Lue’s father is in prison for murder — the differential diagnosis now includes PTSD (post traumatic stress disorder), a malignant arrhythmia (a term for a potentially fatal arrhythmia), or acute pericarditis (inflammation of the membranous sac surrounding the heart). House favors the latter and has the team check an echocardiogram, which is normal. Lue starts to complain of abdominal pain, so the team quickly ultrasounds his belly and finds no evidence of obstruction, but does find constipation. Chase now suspects Hashimoto’s thyroiditis so wants a thyroid biopsy. Lue refuses and shouts in Hmong, a language he doesn’t know, before suffering a seizure. These neurological symptoms have the team again changing their differential diagnosis, which now contains scleroderma and Rasmussen’s encephalitis (an inflammatory disease of the brain in children). An MRI is checked, but is normal. Lue again suffers a bad dream of someone choking him, but this time he awakens with bruises on his neck. The team now considers the diagnoses of a coagulopathy (easy bleeding because of problems clotting blood), anemia, vitamin C deficiency, or leukemia. House suggests liver failure, which the team takes to mean hepatic fibrosis. A liver biopsy is checked, but is negative.

Adams and Taub walk in to check on Lue, and find him levitating in bed, briefly, his grandfather beside him. They insist to House and the rest of the team that the levitation was real, but the others suggests muscle spasm, tetanus, or hypocalcemia (low blood calcium) as possibilities. House favors the hypocalcemia suggestion and wants the team to “pump up” Lue’s electrolytes and start him on a beta-blocker. Meanwhile, Lue’s mother is coming around to his grandfather’s way of thinking. She wants to perform another Hmong exorcism. Foreman convinces her to wait twenty-four hours, but when Lue becomes unresponsive, she and the grandfather proceed with the ceremony. While the ceremony proceeds in Lue’s room, the team goes through other possible diagnoses. Brugada and Long QT syndrome (inherited heart rhythm disorder) tests are all negative. Carotid aneurysms are suggested, but dismissed. Kawasaki’s disease is suggested and Adams immediately wants to proceed with cardiopulmonary bypass. House mentions that he thinks Lue has a PDA (patent ductus arteriosis). The ductus is a bypass in the heart important for the fetal circulation, but it should close shortly after birth.) that was infected and is causing the symptoms. After a heated discussion with the team, he allows them only to treat their suspicion – Kawasaki’s – but after Lue starts crashing, Adams slips him ibuprofen, the treatment for PDA. Lue recovers, but his mother and grandfather credit the religious ceremony, not any medical treatment.

House #818

This week demonstrated some of the most inept and nonsensical medicine I have seen yet on House. For pretty much every diagnosis, just ask: “Do the symptoms fit, at all?” The likely answer is NO. Rather than waste your bandwidth and mine by repeating that over and over, I’ll just hit the highlights (lowlights). As always, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

A previously normal eight-year child suddenly begins to have PDA symptoms. His mother never noticed difficulty breathing before – it just started now, eight years after developing the PDA? Maybe that was the mysterious “PSA infection” House was referring to which was supposedly treated by the antibiotics – yet the patient’s symptoms worsened after the antibiotics.
defibA PDA severe enough to cause symptoms at rest and no murmurs on exam, or abnormal echocardiogram? (admittedly, a standard echocardiogram is not the best way to diagnose a PDA, but there should have been signs in one that severe, particularly one that’s “infected”).
defibI’ll agree that a PDA can cause some shortness of breath or respiratory distress, but that’s different than a sensation of being choked. Furthermore, how does the PDA explain the seizure, speaking in tongues, or bruising.
defibAs a side note, another repeat final diagnosis. Seen previously in episode #513, “Big Baby“

Right after Adams suggests URI, House has her start IV antibiotics for pneumonia – which is a lower respiratory disease.

Exactly what evidence for Kawaski’s is there? Where was the fever, rash, conjunctivitis, induration of the skin on the extremities, mucosal erythema, and cervical lymphadenopathy?

See if you can spot the theme:
defibHow about some actual evidence for liver failure before poking a hole in the liver.
defibHow about some actual evidence for Hashimotos before poking a hole in the thyroid.
defibHow about some actual evidence for Kawasaki’s before poking a hole in the heart. (Stopped before they got this far, but they did suggest it and start the paperwork)

How about checking for low calcium before treating it?

I can find no evidence that beta-blockers are indicated for hypocalcemia.

House #818

The medical mystery was interesting, and maintained interest throughout the episode. I give it an A-. The final solution wasn’t great. The final diagnosis didn’t fit well at all from both a time course and a symptom point of view, plus — for the second week in a row — it was a retread. I give it a D-. I realize they were playing a faith versus medicine angle this week, which is a shame, because the medicine was horrible. The team leapt from diagnosis to diagnosis, without logic, and abandoning previous attempts at the drop of a hat. It earns a weak D-. They rushed to risky procedures with no good reasons or proof. The soap opera was fair. The House and Dominika scenes were good, but the House-tells-the-team-what-they’re-secretly-thinking has been overplayed this season. I give it a C+.

The review of the previous episode of House
A list of all prior House reviews

This week’s House Challenge scores have been posted.

View the original article here

Shift work and the assessment and management of shift work disorder (SWD)

Available online 2 May 2012

In Press, Corrected Proof — Note to users

a Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, 1725 Pleasant Street, Boulder, CO 80309, USAb SleepMed Incorporated, SleepMed of South Carolina, 700 Gervais Street, Suite #200, Columbia, SC 29201, USAc School of Medicine, University of South Carolina, USAd Sleep Disorders Service and Research Center, Rush University Medical Center, Johnston R. Bowman Health Center, 710 S. Paulina Street, 6 South JRB, Chicago, IL 60612, USAReceived 5 July 2011. Revised 10 February 2012. Accepted 13 February 2012. Available online 2 May 2012.View full text Nearly 20% of the labor force worldwide, work shifts that include work hours outside 07:00 h to 18:00 h. Shift work is common in many occupations that directly affect the health and safety of others (e.g., protective services, transportation, healthcare), whereas quality of life, health, and safety during shift work and the commute home can affect workers in any field.

Increasing evidence indicates that shift-work schedules negatively influence worker physiology, health, and safety. Shift work disrupts circadian sleep and alerting cycles, resulting in disturbed daytime sleep and excessive sleepiness during the work shift. Moreover, shift workers are at risk for shift work disorder (SWD). This review focuses on shift work and the assessment and management of sleepiness and sleep disruption associated with shift work schedules and SWD. Management strategies include approaches to promote sleep, wakefulness, and adaptation of the circadian clock to the imposed work schedule. Additional studies are needed to further our understanding of the mechanisms underlying the health risks of shift work, understanding which shift workers are at most risk of SWD, to investigate treatment options that address the health and safety burdens associated with shift work and SWD, and to further develop and assess the comparative effectiveness of countermeasures and treatment options.

prs.rt("abs_end");Shift work; Shift work disorder; Circadian rhythm; Circadian adaptation; Circadian misalignment; Homeostatic sleep drive; Good sleep behavior; Sleep duration; Caffeine; Naps; Melatonin; Hypnotics; Armodafinil; Modafinil

Figures and tables from this article:

Fig. 1. Occupations with a large proportion of shift workers (>20%).8

View Within ArticleFig. 2. Characterization of brain arousal across the 24-h day in a typical day worker and a night shift worker. Wakefulness and sleep are dependent upon the interplay between the circadian alerting signal and the homeostatic sleep drive in day- and night-shift workers. In a typical day worker (A), the sleep and circadian systems interact in such a way that alert wakefulness is promoted during the day and sleep is promoted at night. A circadian arousal signal increases across the day to counteract the buildup of sleep pressure that occurs with time awake. In a non-adapted night-shift worker (B), the circadian arousal signal increases across the day when the shift worker is attempting to sleep, resulting in short sleep duration. During the night shift, the circadian system and sleep pressure promote sleep, leading to excessive sleepiness during the work shift. Modified from Drake, 2010.128

View Within ArticleFig. 3. Baseline untreated. In the modafinil study (n = 182) (data on file)69 and armodafinil study (n = 216) (data on file, Cephalon),70 mean nighttime sleep latencies at baseline in untreated patients with shift work disorder (SWD) decreased over the course of a laboratory night shift. Sleep latency data from healthy control groups in three relatively small (n = 15–30), simulated, night-shift studies are also depicted (Study 1: Walsh et al., 1988; Study 2: Walsh et al., 1991; Study 3: Muehlbach and Walsh, 1995 [74], [75] and [76]) showing that healthy controls are more alert than patients with shift work disorder (A). A worsening of subjective sleepiness, as measured by the Karolinska sleepiness scale (KSS), also was seen in the modafinil and armodafinil studies in patients with SWD (B). Modafinil study: At the final visit of the modafinil study (n = 182), multiple sleep latency test (MSLT) scores for the modafinil group had significantly improved from baseline, compared with MSLT scores for the placebo group, at 02:00 h and 04:00 h but not at 06:00 h or 08:00 h (C). KSS scores in the modafinil group were also significantly improved at each time point from midnight to 05:00 h and also at 07:00 h, compared with scores in the placebo group (D).69 Panel C adapted with permission from Czeisler et al., 2005.69 Armodafinil study: At the final visit of the armodafinil study (n = 216), MSLT scores for the armodafinil group were significantly improved, compared with MSLT scores for the placebo group, at all time points measured (E). KSS scores also were significantly improved at each time point from 23:55 h to 05:55 h in the armodafinil group (F).70 Panels E and F reprinted with permission from Czeisler et al., 2009.70*p < 0.001; †p < 0.05, change from baseline vs. placebo. Higher KSS scores indicate greater sleepiness.

View Within ArticleTable 1. Diagnostic and supportive criteria for shift work disorder.13

View table in articleView Within ArticleTable 2. Clinical guidelines for assessment and management of shift work disorder (SWD).73

View table in articleESS, Epworth sleepiness scale; SWD, shift work disorder; KSS, Karolinska sleepiness scale. Modified with permission from Drake and Wright.73

View Within ArticleCopyright © 2012 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Shift work and the assessment and management of shift work disorder (SWD)

Available online 2 May 2012

In Press, Corrected Proof — Note to users

a Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, 1725 Pleasant Street, Boulder, CO 80309, USAb SleepMed Incorporated, SleepMed of South Carolina, 700 Gervais Street, Suite #200, Columbia, SC 29201, USAc School of Medicine, University of South Carolina, USAd Sleep Disorders Service and Research Center, Rush University Medical Center, Johnston R. Bowman Health Center, 710 S. Paulina Street, 6 South JRB, Chicago, IL 60612, USAReceived 5 July 2011. Revised 10 February 2012. Accepted 13 February 2012. Available online 2 May 2012.View full text Nearly 20% of the labor force worldwide, work shifts that include work hours outside 07:00 h to 18:00 h. Shift work is common in many occupations that directly affect the health and safety of others (e.g., protective services, transportation, healthcare), whereas quality of life, health, and safety during shift work and the commute home can affect workers in any field.

Increasing evidence indicates that shift-work schedules negatively influence worker physiology, health, and safety. Shift work disrupts circadian sleep and alerting cycles, resulting in disturbed daytime sleep and excessive sleepiness during the work shift. Moreover, shift workers are at risk for shift work disorder (SWD). This review focuses on shift work and the assessment and management of sleepiness and sleep disruption associated with shift work schedules and SWD. Management strategies include approaches to promote sleep, wakefulness, and adaptation of the circadian clock to the imposed work schedule. Additional studies are needed to further our understanding of the mechanisms underlying the health risks of shift work, understanding which shift workers are at most risk of SWD, to investigate treatment options that address the health and safety burdens associated with shift work and SWD, and to further develop and assess the comparative effectiveness of countermeasures and treatment options.

prs.rt("abs_end");Shift work; Shift work disorder; Circadian rhythm; Circadian adaptation; Circadian misalignment; Homeostatic sleep drive; Good sleep behavior; Sleep duration; Caffeine; Naps; Melatonin; Hypnotics; Armodafinil; Modafinil

Figures and tables from this article:

Fig. 1. Occupations with a large proportion of shift workers (>20%).8

View Within ArticleFig. 2. Characterization of brain arousal across the 24-h day in a typical day worker and a night shift worker. Wakefulness and sleep are dependent upon the interplay between the circadian alerting signal and the homeostatic sleep drive in day- and night-shift workers. In a typical day worker (A), the sleep and circadian systems interact in such a way that alert wakefulness is promoted during the day and sleep is promoted at night. A circadian arousal signal increases across the day to counteract the buildup of sleep pressure that occurs with time awake. In a non-adapted night-shift worker (B), the circadian arousal signal increases across the day when the shift worker is attempting to sleep, resulting in short sleep duration. During the night shift, the circadian system and sleep pressure promote sleep, leading to excessive sleepiness during the work shift. Modified from Drake, 2010.128

View Within ArticleFig. 3. Baseline untreated. In the modafinil study (n = 182) (data on file)69 and armodafinil study (n = 216) (data on file, Cephalon),70 mean nighttime sleep latencies at baseline in untreated patients with shift work disorder (SWD) decreased over the course of a laboratory night shift. Sleep latency data from healthy control groups in three relatively small (n = 15–30), simulated, night-shift studies are also depicted (Study 1: Walsh et al., 1988; Study 2: Walsh et al., 1991; Study 3: Muehlbach and Walsh, 1995 [74], [75] and [76]) showing that healthy controls are more alert than patients with shift work disorder (A). A worsening of subjective sleepiness, as measured by the Karolinska sleepiness scale (KSS), also was seen in the modafinil and armodafinil studies in patients with SWD (B). Modafinil study: At the final visit of the modafinil study (n = 182), multiple sleep latency test (MSLT) scores for the modafinil group had significantly improved from baseline, compared with MSLT scores for the placebo group, at 02:00 h and 04:00 h but not at 06:00 h or 08:00 h (C). KSS scores in the modafinil group were also significantly improved at each time point from midnight to 05:00 h and also at 07:00 h, compared with scores in the placebo group (D).69 Panel C adapted with permission from Czeisler et al., 2005.69 Armodafinil study: At the final visit of the armodafinil study (n = 216), MSLT scores for the armodafinil group were significantly improved, compared with MSLT scores for the placebo group, at all time points measured (E). KSS scores also were significantly improved at each time point from 23:55 h to 05:55 h in the armodafinil group (F).70 Panels E and F reprinted with permission from Czeisler et al., 2009.70*p < 0.001; †p < 0.05, change from baseline vs. placebo. Higher KSS scores indicate greater sleepiness.

View Within ArticleTable 1. Diagnostic and supportive criteria for shift work disorder.13

View table in articleView Within ArticleTable 2. Clinical guidelines for assessment and management of shift work disorder (SWD).73

View table in articleESS, Epworth sleepiness scale; SWD, shift work disorder; KSS, Karolinska sleepiness scale. Modified with permission from Drake and Wright.73

View Within ArticleCopyright © 2012 Elsevier Ltd. All rights reserved.

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Secular trends in adult sleep duration: A systematic review

Little evidence exists to support the common assertion that adult sleep duration has declined. We investigated secular trends in sleep duration over the past 40 years through a systematic review.

Systematic search of 5 electronic databases was conducted to identify repeat cross-sectional studies of sleep duration in community-dwelling adults using comparable sampling frames and measures over time. We also attempted to access unpublished or semi-published data sources in the form of government reports, theses and conference proceedings. No studies were excluded based on language or publication date. The search identified 278 potential reports, from which twelve relevant studies were identified for review.

The 12 studies described data from 15 countries from the 1960s until the 2000s. Self-reported average sleep duration of adults had increased in 7 countries: Bulgaria, Poland, Canada, France, Britain, Korea and the Netherlands (range: 0.1–1.7 min per night each year) and had decreased in 6 countries: Japan, Russia, Finland, Germany, Belgium and Austria (range: 0.1–0.6 min per night each year). Inconsistent results were found for the United States and Sweden.

There has not been a consistent decrease in the self-reported sleep duration of adults from the 1960s to 2000s. However, it is unclear whether the proportions of very short and very long sleepers have increased over the same period, which may be of greater relevance for public health.

Table 1. Literature search strategy and number of results for each database.

View table in articleView Within ArticleTable 2. Summary of included results by country (some studies have multiple results).

View table in articleView Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.


View the original article here

Secular trends in adult sleep duration: A systematic review

Little evidence exists to support the common assertion that adult sleep duration has declined. We investigated secular trends in sleep duration over the past 40 years through a systematic review.

Systematic search of 5 electronic databases was conducted to identify repeat cross-sectional studies of sleep duration in community-dwelling adults using comparable sampling frames and measures over time. We also attempted to access unpublished or semi-published data sources in the form of government reports, theses and conference proceedings. No studies were excluded based on language or publication date. The search identified 278 potential reports, from which twelve relevant studies were identified for review.

The 12 studies described data from 15 countries from the 1960s until the 2000s. Self-reported average sleep duration of adults had increased in 7 countries: Bulgaria, Poland, Canada, France, Britain, Korea and the Netherlands (range: 0.1–1.7 min per night each year) and had decreased in 6 countries: Japan, Russia, Finland, Germany, Belgium and Austria (range: 0.1–0.6 min per night each year). Inconsistent results were found for the United States and Sweden.

There has not been a consistent decrease in the self-reported sleep duration of adults from the 1960s to 2000s. However, it is unclear whether the proportions of very short and very long sleepers have increased over the same period, which may be of greater relevance for public health.

Table 1. Literature search strategy and number of results for each database.

View table in articleView Within ArticleTable 2. Summary of included results by country (some studies have multiple results).

View table in articleView Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.


View the original article here

Sleep scoring using artificial neural networks

Marina Ronzhinaa, Corresponding author contact information, E-mail the corresponding author, Oto Janoušeka, d, E-mail the corresponding author, Jana Kolárováa, e, E-mail the corresponding author, Marie Novákováb, g, E-mail the corresponding author, Petr Honzíkc, h, E-mail the corresponding author, Ivo Provazníka, f, E-mail the corresponding authora Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Kolejní 4, Brno 61200, Czech Republicb Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 753/5, Brno 62500, Czech Republicc Department of Control and Instrumentation, Faculty of Electrical Engineering and Communication, Brno University of Technology, Kolejní 4, Brno 61200, Czech RepublicReceived 18 March 2011. Revised 30 June 2011. Accepted 30 June 2011. Available online 24 October 2011.View full text Rapid development of computer technologies leads to the intensive automation of many different processes traditionally performed by human experts. One of the spheres characterized by the introduction of new high intelligence technologies substituting analysis performed by humans is sleep scoring. This refers to the classification task and can be solved – next to other classification methods – by use of artificial neural networks (ANN). ANNs are parallel adaptive systems suitable for solving of non-linear problems. Using ANN for automatic sleep scoring is especially promising because of new ANN learning algorithms allowing faster classification without decreasing the performance. Both appropriate preparation of training data as well as selection of the ANN model make it possible to perform effective and correct recognizing of relevant sleep stages. Such an approach is highly topical, taking into consideration the fact that there is no automatic scorer utilizing ANN technology available at present.

prs.rt("abs_end");Polysomnographic data; Sleep scoring; Features extraction; Artificial neural networks

Figures and tables from this article:

Fig. 1. Schematic representation. (a) Single neuron with vector input. (b) One-layer network with m neurons.

View Within ArticleFig. 2. Transfer functions. (a) Log-sigmoid. (b) Tan-sigmoid. (c) Hard limit. (d) Linear.

View Within ArticleFig. 3. Extraction of the 4-elements features vector from EEG epoch. PSD – power spectral density, d, ?, a, ß – delta, theta, alpha and beta bands, respectively, drel, ?rel, arel, ßrel – relative power values for delta, theta, alpha and beta bands, respectively.

View Within ArticleTable 1. Summary of artificial neural network (ANN) based systems for sleep scoring. BP: backpropagation, EEG: electroencephalogram, EMG: electromyogram, EOG: electrooculogram (LEOG, REOG: left, right EOG, respectively), FC: fully connected, FT: Fourier transform, MLNN: multilayer neural network, MLP: multilayer perceptron, MT: movement time, RatP: ratio power, REM, rapid eye movement, RMS: root mean square, RP: relative power, RUM, LM: Rumelhart (gradient descent without momentum) and Levenberge-Marquardt learning algorithm, respectively, S1, S2, S3 and S4: see section “Polygraphic data and visual sleep scoring” for definitions, SD: standard deviation, SOM: self-organizing map, SWS: slow wave sleep, TP: total power, W: wakefulness, WT: wavelet transform. Description of sleep stages is according to R&K and AASM.

View table in articleView Within ArticleTable 2. Output neurons of proposed artificial neural network models. REM: rapid eye movement, S*: stage involving four stages of non-REM sleep (other sleep stages are according to R&K), S1, S2, S3 and S4: see section “Polygraphic data and visual sleep scoring” for definitions, W: wakefulness.

View table in articleView Within ArticleTable 3. Results of sleep scoring obtained by proposed artificial neural network (ANN) models. EEG: electroencephalogram, REM: rapid eye movement, RP, relative power, S: stage involving the four stages of non-REM and REM sleep, S*: stage involving the four stages of non-REM sleep (other sleep stages are according to R&K), S1, S2, S3 and S4: see section “Polygraphic data and visual sleep scoring” for definitions, W: wakefulness.

View table in articleView Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

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Sleep scoring using artificial neural networks

Marina Ronzhinaa, Corresponding author contact information, E-mail the corresponding author, Oto Janoušeka, d, E-mail the corresponding author, Jana Kolárováa, e, E-mail the corresponding author, Marie Novákováb, g, E-mail the corresponding author, Petr Honzíkc, h, E-mail the corresponding author, Ivo Provazníka, f, E-mail the corresponding authora Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Kolejní 4, Brno 61200, Czech Republicb Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 753/5, Brno 62500, Czech Republicc Department of Control and Instrumentation, Faculty of Electrical Engineering and Communication, Brno University of Technology, Kolejní 4, Brno 61200, Czech RepublicReceived 18 March 2011. Revised 30 June 2011. Accepted 30 June 2011. Available online 24 October 2011.View full text Rapid development of computer technologies leads to the intensive automation of many different processes traditionally performed by human experts. One of the spheres characterized by the introduction of new high intelligence technologies substituting analysis performed by humans is sleep scoring. This refers to the classification task and can be solved – next to other classification methods – by use of artificial neural networks (ANN). ANNs are parallel adaptive systems suitable for solving of non-linear problems. Using ANN for automatic sleep scoring is especially promising because of new ANN learning algorithms allowing faster classification without decreasing the performance. Both appropriate preparation of training data as well as selection of the ANN model make it possible to perform effective and correct recognizing of relevant sleep stages. Such an approach is highly topical, taking into consideration the fact that there is no automatic scorer utilizing ANN technology available at present.

prs.rt("abs_end");Polysomnographic data; Sleep scoring; Features extraction; Artificial neural networks

Figures and tables from this article:

Fig. 1. Schematic representation. (a) Single neuron with vector input. (b) One-layer network with m neurons.

View Within ArticleFig. 2. Transfer functions. (a) Log-sigmoid. (b) Tan-sigmoid. (c) Hard limit. (d) Linear.

View Within ArticleFig. 3. Extraction of the 4-elements features vector from EEG epoch. PSD – power spectral density, d, ?, a, ß – delta, theta, alpha and beta bands, respectively, drel, ?rel, arel, ßrel – relative power values for delta, theta, alpha and beta bands, respectively.

View Within ArticleTable 1. Summary of artificial neural network (ANN) based systems for sleep scoring. BP: backpropagation, EEG: electroencephalogram, EMG: electromyogram, EOG: electrooculogram (LEOG, REOG: left, right EOG, respectively), FC: fully connected, FT: Fourier transform, MLNN: multilayer neural network, MLP: multilayer perceptron, MT: movement time, RatP: ratio power, REM, rapid eye movement, RMS: root mean square, RP: relative power, RUM, LM: Rumelhart (gradient descent without momentum) and Levenberge-Marquardt learning algorithm, respectively, S1, S2, S3 and S4: see section “Polygraphic data and visual sleep scoring” for definitions, SD: standard deviation, SOM: self-organizing map, SWS: slow wave sleep, TP: total power, W: wakefulness, WT: wavelet transform. Description of sleep stages is according to R&K and AASM.

View table in articleView Within ArticleTable 2. Output neurons of proposed artificial neural network models. REM: rapid eye movement, S*: stage involving four stages of non-REM sleep (other sleep stages are according to R&K), S1, S2, S3 and S4: see section “Polygraphic data and visual sleep scoring” for definitions, W: wakefulness.

View table in articleView Within ArticleTable 3. Results of sleep scoring obtained by proposed artificial neural network (ANN) models. EEG: electroencephalogram, REM: rapid eye movement, RP, relative power, S: stage involving the four stages of non-REM and REM sleep, S*: stage involving the four stages of non-REM sleep (other sleep stages are according to R&K), S1, S2, S3 and S4: see section “Polygraphic data and visual sleep scoring” for definitions, W: wakefulness.

View table in articleView Within ArticleCopyright © 2011 Elsevier Ltd. All rights reserved.

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