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1
Imagine Yourself Energy Management for Life. Resiliency for Life, 2007.
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Okun, Michele L. Sleep and pregnancy. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198778240.003.0013.
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Pregnant women experience a greater degree of sleep disturbance than their non-pregnant counterparts. Complaints range from sleep maintenance issues to excessive daytime sleepiness. Emerging evidence suggests that there is variability in sleep patterns and complaints which manifest differently among pregnant women. Moreover, it is well accepted that sleep disturbance can dysregulate normal immune and endocrine processes that are critically important to the health and progression of gestation. A possible consequence of sleep disturbance is an increased risk for adverse pregnancy outcomes. Then again, many endogenous and exogenous factors, including pregnancy-related physiological, hormonal, and anatomic changes, as well as lifestyle changes, can impact the degree and chronicity of sleep disturbance. Alas, there is still much to learn in terms of what women can/should expect with regard to the timing, degree, frequency, and/or severity of a specific pregnancy-related sleep disturbance(s), despite the number of published studies evaluating what sleep during pregnancy encompasses.
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Liu, Lynn. Sleep Disorders and Pregnancy. Edited by Emma Ciafaloni, Cheryl Bushnell, and Loralei L. Thornburg. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190667351.003.0023.
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Pregnant women frequently have sleep concerns. Some concerns are related to the course of the pregnancy, some sleep disorders change during pregnancy, and others develop new onset sleep disorders during pregnancy. Having a sleep medicine professional to assist in the management of a pregnant woman to address the treatment of particular sleep disorders can be helpful in alleviating specific concerns over the course of the pregnancy. Anticipating potential interactions or how the pregnancy and the sleep disorder may affect each other may improve maternal and fetal outcomes. This chapter will review common sleep disorders that can be encountered in pregnant women.
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Chopra, Amit, Piyush Das, and Karl Doghramji, eds. Management of Sleep Disorders in Psychiatry. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190929671.001.0001.
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‘Management of Sleep Disorders in Psychiatry’ provides an in-depth and evidence-based review of sleep-wake disorders included in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) that are associated with a range of psychiatric disorders including mood, anxiety, psychotic, neurocognitive, eating, and substance use disorders. It also includes special sections on sleep-wake disorders associated with pediatric and neurological disorders, and reviews forensic issues encountered in the practice of psychiatry as they relate to sleep disorders. The book is unique in its focus on clinical assessment and management of sleep-wake disorders, and provides in-depth insight into the impact of disturbed sleep and wakefulness on clinical course and treatment outcomes of comorbid psychiatric conditions. Treatments reviewed include both evidence-based pharmacological and behavioral strategies to address sleep-wake disorders in patients with psychiatric disorders. Case vignettes are added to assist in the understanding of key clinical concepts of sleep and psychiatric comorbidity and multiple-choice questions are added for self-assessment. This comprehensive text aims to cater to the needs of the clinicians in a wide range of medical specialties including psychiatrists, sleep medicine physicians, psychologists, primary care physicians, and neurologists who strive to improve the sleep and clinical outcomes of their patients with psychiatric disorders.
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Cohen, Daniel A., and Asim Roy. Sleep and Neurological Disorders. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198778240.003.0010.
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Scientific investigation of the relationships between sleep and neurological disorders is at a relatively early stage. Damage to the nervous system or impaired neural development can cause a wide array of sleep disorders. In turn, sleep disruption may impair neuroplastic processes that are important for functional recovery after nervous system insults. Sleep disorders in patients with neurological disease can negatively affect quality of life for both the patients and the caregivers. Cardiovascular, metabolic, and immune process changes associated with sleep disorders may exacerbate the underlying neuropathological changes in neurological disease. Early intervention for sleep disorders in these patients may substantially improve neurological outcomes. More randomized, controlled treatment trials will ultimately help to determine the optimal timing and treatment modalities for the sleep disorders in these patients and the impact this will have on improving neurological health, enhancing neurological function, and reducing the care burden for this population.
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Harder, Louise, and Atul Malhotra. Pathophysiology and therapeutic strategy for sleep disturbance in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0225.
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Robust data have shown that sleep disruption and inadequate sleep duration in the general population impact neurocognitive function and produce cardiometabolic sequelae. Despite widespread recognition of the importance of sleep as an essential homeostatic function, there are relatively few data regarding the importance of sleep in critically-ill patients. Obstructive sleep apnoea is a common respiratory condition that is prevalent in the ICU and can be particularly problematic pre-intubation, post-extubation, and in the peri-operative setting. Considerable discussion regarding the impact of sleep versus sedation has occurred, with some insights emerging from improvements in our understanding of basic neurobiology. Sleep disturbance may also have an impact in critically-ill mechanically-ventilated patients by contributing to the development of delirium, which is associated with poor outcomes. However, further data are required to determine the ideal strategy to optimize sleep in the ICU and whether such strategies will in turn improve hard outcomes of critically-ill patients.
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Hoff, Scott, and Nancy A. Collop. Sleep Disorders and Recovery from Critical Illness. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0022.
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Many factors contribute to sleep disruption in critically ill patients. Sleep is a complex process, with broad effects on diverse physiologic systems. Environmental factors, such as light exposure, noise from diverse sources, and sleep interruptions related to patient care, have all received considerable investigational attention. Critical illness can affect elements involved in sleep initiation and maintenance. The various modes of mechanical ventilation may have different effects on sleep fragmentation and on the propensity to cause central apnoeas, thereby potentially prolonging the time on the ventilator. Pharmacologic agents, especially sedatives, can directly affect sleep architecture and may contribute to the incidence of intensive care unit delirium. Additional research is needed on the biological effects of critical illness on sleep, how sleep disruption affects systemic physiology and outcomes, and how these interactions can be modulated for therapeutic purposes.
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Lee, Kathryn Ann. SLEEP PATTERNS, TEMPERATURE RHYTHMS, AND HEALTH OUTCOMES IN HEALTHY WOMEN AT TWO PHASES OF THE MENSTRUAL CYCLE. 1986.
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Moore, Melisa, and Jodi A. Mindell. The Impact of Behavioral Interventions for Sleep Problems on Secondary Outcomes in Young Children and Their Families. Edited by Amy Wolfson and Hawley Montgomery-Downs. Oxford University Press, 2013. http://dx.doi.org/10.1093/oxfordhb/9780199873630.013.0040.
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Horowitz, Sandra L. “I Am Pregnant; Why Can’t I Sleep?”. Edited by Angela O’Neal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190609917.003.0029.
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This chapter reviews the common sleep disorders of pregnancy. During pregnancy and postpartum, 84% of women report poor sleep at least a few nights a week. These problems are common, disruptive to daytime and nighttime activity, and may have multiple causes. This chapter covers aspects of insomnia and restless leg syndrome. It also discusses sleep apnea in pregnancy with related hormonal changes that may increase the incidence. There is an association of sleep apnea and pregnancy-induced hypertension, with increased adverse outcomes of pregnancy, including fetal growth retardation and premature birth. It has been suggested that treating nocturnal airflow limitation may improve gestational hypertension. The recommended therapies in this chapter may also be applied to non-pregnant patients with similar complaints.
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Rosenbluth, Glenn, and Christopher P. Landrigan. Sleep, work hours, and medical performance. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198778240.003.0022.
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Physicians are among the few professionals who are expected to work extended duty shifts of 24 hours or more, often with little opportunity for rest. The physiological factors regulating sleepiness, including circadian rhythms, sleep homeostasis, and sleep inertia, are pushed to their limits when meeting the demands of training programmes and patient care. Sleep-deprived physicians experience reduced clinical performance and vigilance, putting patients at risk. Tired physicians are more likely to make both cognitive errors (e.g. diagnostic reasoning) and technical errors (e.g. surgical complications). Over recent decades, regulations have promulgated that limit physician hours in Europe and the United States. Studies of their impact have generally shown improvements in patient and physician outcomes, though have also revealed concerns about education and training which must also be addressed. As medicine evolves to meet our 24-hour on-demand society, physicians and patients will need to embrace new approaches to high-quality and safe care delivery.
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Pillai, Vivek, and Christopher L. Drake. Shift work sleep disorder and jet lag. Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0021.
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Some of the most devastating catastrophes in the modern world, such as the Chernobyl and Three Mile Island nuclear accidents, the Bhopal gas tragedy, and the Exxon Valdez oil spill, occurred during the night shift. These incidents serve as a painful reminder of the high individual and societal costs associated with sleep–wake schedules that oppose the endogenous physiological regulation of sleep and wakefulness across the 24-hour day. Insomnia-like symptoms during the sleep period and excessive sleepiness during the wake period are among the most common consequences of such circadian misalignment, and form the basis of shift work sleep disorder (SWD). Rapid jet travel across multiple time zones can similarly disrupt circadian synchrony, and trigger a variety of adverse health outcomes, including sleep disturbance, impaired wakefulness, and gastrointestinal complications. This chapter reviews the state of the science on SWD and jet lag, with a special emphasis on clinical evaluation and management.
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Doghramji, Karl, Maurits S. Boon, Colin Huntley, and Kingman Strohl, eds. Upper Airway Stimulation Therapy for Obstructive Sleep Apnea. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197521625.001.0001.
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Upper Airway Stimulation Therapy for Obstructive Sleep Apnea provides the current state of knowledge regarding this novel therapy. It reviews the pathophysiologic basis of sleep apnea and the specific mechanism by which upper airway stimulation provides airway support in this disorder. It also provides practical insights into this therapy related to patient selection, clinical outcomes, surgical technique, long-term follow-up, and adverse events and offers recommendations for those aspiring to develop an upper airway stimulation program. It provides an overview of unique populations and circumstances that may extend the utility of the procedure, and that may provide challenges in management, as well as thoughts on the future of this technology. This textbook is intended for all practitioners who have interest or care for sleep disordered breathing, including sleep medicine physicians, pulmonologists, otolaryngologists, primary care practitioners, as well as physician extenders.
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Silveira, Larissa de Carvalho, and Renata Meira Véras. Associated factors and more frequent sleep disorders in university students: Integrative review. Ludomedia, 2022. http://dx.doi.org/10.36367/ntqr.13.2022.e695.
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Introduction: Sleep disorders affect quality of life on three levels, short, medium and long term. University students are groups prone to changes in sleep quality, as they live with sleep deprivation, among other factors such as anxiety, stress, excessive use of social networks, cell phones and television. The importance of sleep for undergraduates becomes evident in the face of the consequences that poor sleep quality can cause, in addition to allowing professionals in the areas of education and health to create programs that promote and encourage routines with beneficial consequences for students. Objectives: To review the literature on the most frequent sleep disorders in university students and the factors associated with sleep. Methods: This study is a systematic review. The search was performed in December 2021, in the electronic journals PubMed and CAPES journals. The time frame comprised the period from 2017 to 2021. In the end, 20 articles were selected to compose this review. Results: Regarding the main sleep disorders of undergraduates, the main outcomes found in the studies were insufficient sleep, long latency, nocturnal awakenings, excessive daytime sleepiness, insomnia and delayed sleep-wake phase disorder. Factors that are modifiable and non-modifiable for the occurrence of sleep disorders, as well as protective factors that can mitigate the occurrence of sleep disorders. Conclusions: The number of articles included in the review showed that over the five years the interest in researching the subject has been increasing. Even so, there is still a need for more effort from researchers to understand which factors are associated with reduced hours of sleep and how society and universities contribute to this practice of increasing waking hours and reducing sleep hours.
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Troxel, Wendy, Stephanie Holliday, Regina Shih, and Patricia Ebener. Getting To Outcomes® Operations Guide for U.S. Air Force Community Action Teams: Content Area Module for Air Force Sleep Health Promotion. RAND Corporation, 2020. http://dx.doi.org/10.7249/tl311.4.
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Government, U. S., National Aeronautics and Space Administration (NASA), and World Spaceflight News (WSN). NASA Report : Sleep on Earth and in Space: Risk Factors, Health and Performance Outcomes, and Countermeasures - Workshop on Lessons Learned from ISS Space Station and Shuttle Human Flights. Independently Published, 2017.
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Hafner, Marco, Jack Pollard, Wendy Troxel, Erez Yerushalmi, Clement Fays, Michael Whitmore, and Christian Van Stolk. How frequent night-time bathroom visits can negatively impact sleep, well-being and productivity: Examining the associations between nocturia, well-being and economic outcomes in a working-age population. RAND Corporation, 2019. http://dx.doi.org/10.7249/rr3043.
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Vanderveken, Olivier. Sleep nasendoscopy. Edited by John Phillips and Sally Erskine. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834281.003.0066.
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Golier, Julia A., Andreas C. Michaelides, Maya Genovesi, Emily Chapman, and Rachel Yehuda. Pharmacological Treatment of Posttraumatic Stress Disorder. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0019.
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Although psychotherapy is considered first-line treatment for posttraumatic stress disorder (PTSD), advances have been made in pharmacological treatment. Based on controlled clinical trials, antidepressants remain the first-line pharmacological treatment. Studies suggest that selective serotonin reuptake inhibitors reduce PTSD-specific symptoms and improve global outcome. Emerging evidence suggests efficacy for venlafaxine. Other individual agents found to be efficacious include imipramine and phenelzine. Prazosin is emerging as a beneficial adjunct for PTSD-related sleep disturbances and nightmares. Some evidence suggests that atypical antipsychotics may be efficacious against a broad range of symptoms, although the risk of metabolic side effects may limit widespread use. Trials are needed to assess whether anticonvulsants, cortisol-based treatments, sympatholytics, or other novel approaches are efficacious, and how pharmacotherapy can enhance psychotherapy outcomes. These studies should consider the goals of pharmacotherapy in PTSD and the subgroups of patients or clinical presentations most likely to benefit from pharmacological interventions.
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Cetin, Derrick. Medical Evaluation of the Bariatric Surgery Patient. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0002.
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Evaluation of the obese patient requires identification of all comorbidities and health conditions, including underlying cardiac and pulmonary conditions that could have a negative outcome on noncardiac surgery. Once comorbidities have been recognized, aggressive optimization of these medical conditions can provide improved outcomes after bariatric surgery. Estimating medical risk can be performed by several validated classification systems. The preoperative checklist and clinical practice guidelines (CPG) were updated in 2013. The CPG recommendations for preoperative evaluation of the bariatric surgery patient include lab testing, nutritional screening, endocrine assessment, and cardiopulmonary assessment, including sleep apnea screening. The CPG suggest an extensive multidisciplinary team approach to the preoperative bariatric surgery patient. Finally, the medical evaluation includes an algorithm for a seven-step approach to the preoperative visit. Also recommended for evaluation of the morbidly obese patient is an algorithm that uses a five-step approach after a comprehensive history and physical exam and lab testing.
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Hagerman, Nancy S., and Anna M. Varughese. Preoperative Anxiety Management. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0001.
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Up to 65% of pediatric patients experience anxiety and fear in the preoperative period, especially during anesthesia induction. Reasons for this anxiety include the child's perception of the threat of pain, being separated from parents, a strange environment, and losing control. Anxiety and poor behavioral compliance associated with inhalation inductions have been related to adverse outcomes including emergence delirium and maladaptive postoperative behaviors such as general and separation anxiety, eating difficulties, and sleep disturbances. Fortunately, there are behavioral and pharmacological interventions that anesthesiologists can use to improve compliance during induction.
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Liponis, Mark, and Bettina Martin. An Integrative Approach to the Assessment and Treatment of Inflammatory Conditions. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190241254.003.0017.
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The past two decades have seen great progress in recognizing the importance of inflammation in medicine. Increased focus on inflammation in both prevention and treatment has improved outcomes and quality of life in chronic diseases. Science has improved our understanding of inflammation’s many causes and effects on health, and many advances have been made in the availability of targeted therapeutic options for treating inflammation. This chapter gives an overview of recognizing the many causes of inflammation, its many targeted treatments strategies, and the questions that still surround it. It discusses several integrative approaches to reducing inflammation, including exercise, diet, and different strategies for managing sleep, mood, and stress, such as meditation and massage.
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Gullón, Pedro, and Gina S. Lovasi. Designing Healthier Built Environments. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190843496.003.0008.
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The “built environment” is comprised of human-made structures and systems, and aspects include access to and attractiveness of walkable destinations (e.g., retail stores, parks) and community design features (e.g., street connectivity, sidewalk access). A variety of built environment characteristics can influence health outcomes and behaviors, including physical activity, obesity, type 2 diabetes, hypertension, and mental health, as well as sleep and use of tobacco and alcohol. This chapter discusses the large and complex accumulated research on the built environment as well as the methods used to study it, research challenges, policy implication, and how to bring together partnerships for policy change. This chapter also discusses the research conducted across populations (e.g., children, low-income individuals) and geographies (e.g., urban and rural geographies).
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Randerath, Winfried J., and Shahrokh Javaheri. Sleep and the heart. Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0040.
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Heart function and sleep are closely associated. While NREM sleep reduces cardiac workload, phasic REM sleep increases sympathetic activity and cardiac vulnerability. Heart failure (HF) patients suffer from disturbed sleep due to frequent awakenings, periodic limb movements, sleep apnea, and depression. Insomnia seems to be associated with incident HF, and, when comorbid, results in a vicious circle. There is much evidence of a relationship between breathing disturbances during sleep and heart diseases. At least 50% of HF patients suffer from obstructive (OSA) or central (CSA) sleep apnea, both associated with impaired prognosis. OSA is a risk factor for arterial hypertension, atrial fibrillation, and HF. Continuous positive airway pressure devices reduce adverse cardiac events and improve outcome in severe OSA in compliant subjects. Adaptive servoventilation (ASV) is superior to other therapeutic options for CSA. However, the use of ASV is contraindicated in severe HF with reduced, but not preserved, ejection fraction.
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Duncan, Dustin T., Ichiro Kawachi, and Susan Redline, eds. The Social Epidemiology of Sleep. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780190930448.001.0001.
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Sleep, along with the sleep-related behaviors that impact sleep quality, have emerged as one of the major determinants of health and well-being (alongside good diet, regular exercise, and not smoking). In turn research is beginning to identify that sleep is strongly socially patterned—by socioeconomic status, race/ethnicity, immigrant status, stage of the life course, work experiences, stress, and neighborhood contexts. Yet no textbook currently exists that brings together the accumulated evidence on the social epidemiology of sleep. This book is targeted toward (a) social epidemiologists who wish to study sleep as a health outcome, (b) sleep epidemiologists who want to learn about the social determinants of sleep, and (c) other scholars working in the intersection between sleep health, social epidemiology, and health disparities. The textbook begins with an introduction of social epidemiology and sleep epidemiology, that is, a brief overview of the social epidemiology of sleep as well as the methods of assessment in sleep epidemiology and their validity, the descriptive epidemiology of sleep, and some basic biology of sleep. Part II focuses on what is known about the basic descriptive epidemiology of sleep, including consideration of sleep across the life span and among special populations. Each chapter of the remaining sections of the book (Part III) covers the major social determinants of sleep (socioeconomic status, immigration status, neighborhood contexts, etc.) from the accumulated research as well as research needs/opportunities as they relate to that social dimension of health.
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McAnally, Heath B., Lynda Welton Freeman, and Beth Darnall. Preoperative Optimization of the Chronic Pain Patient. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190920142.001.0001.
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Elective surgery on poorly prepared patients suffering with chronic pain and comorbid substance dependence is increasingly shown to confer suboptimal outcomes—both clinical and economic. Achieving biopsychosocial “fitness for surgery” for these patients often requires a process similar to preoperative optimization of cardiac and other chronic diseases, with modification/elimination of risk factors (in many cases shared with those diseases). These risk factors are not so much genetic or uncontrollable, but rather behavioral, and comprise toxic thoughts and toxic habits. The preoperative optimization program for chronic pain patients presented in this book focuses on high-yield modifiable targets that are supported by the literature and the authors’ clinical experience. These comprise tobacco cessation, preoperative opioid reduction or elimination, slow-wave sleep enhancement, nutritional and exercise “prehabilitation,” and reduction of anxiety and pain catastrophization.
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Cheatle, Martin D., and Lara Dhingra. Biopsychosocial Approach to Improving Treatment Adherence in Chronic Pain. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190600075.003.0006.
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Up to 53% of patients with chronic nonmalignant pain demonstrate medication nonadherence, and many are nonadherent with behavior-change interventions for pain, presenting a significant challenge to providers managing this population and compromising patient-reported outcomes related to treatment efficacy, symptom control, and quality of life. Patients with chronic pain are often highly complex and present with numerous medical and psychological comorbidities. Many of these comorbidities, including mood, sleep, and substance use disorders, in addition to maladaptive coping with pain and varied clinician, health system, and family-related factors, can influence adherence to pain interventions. This chapter applies a biopsychosocial framework to guide the clinical assessment of nonadherence behaviors in chronic pain, including the identification of risk factors, mechanisms, and underlying processes of nonadherence, and presents strategies providers can potentially implement to enhance patient adherence to pharmacologic and behavioral therapies for pain management.
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Balzafiore, Danielle, Thalia Robakis, Sarah Borish, Vena Budhan, and Natalie Rasgon. The treatment of bipolar disorder in women. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0020.
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Sex-specific effects in the clinical presentation and course of bipolar disorder in women have important treatment implications for the management of symptoms across the menstrual cycle and reproductive lifespan. Women with bipolar disorder are particularly vulnerable to premenstrual mood symptoms, menstrual abnormalities, and polycystic ovary syndrome. Special considerations include understanding the interactions between these reproductive issues, oral contraceptives, and mood-stabilizing agents. Additionally, the management of bipolar disorder during the perinatal period requires a careful approach to psychotropic medication to optimize the maintenance of mood stability while minimizing the potential for adverse risk of fetal and neonatal outcomes. Non-pharmaceutical approaches, including electroconvulsive therapy, transcranial magnetic stimulation, selected psychotherapies, and social and behavioural interventions may represent efficacious treatment options to reduce medication burden. Lastly, women with bipolar disorder may be at particular risk for worsening of affective symptoms during the menopausal transition, and strategies to reduce sleep disruption are imperative.
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Giuseffi, Jennifer, John McPherson, Chad Wagner, and E. Wesley Ely. Acute cognitive disorders: recognition and management of delirium in the cardiovascular intensive care unit. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0074.
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Delirium is the most common acute cognitive disorder seen in critically ill patients in the cardiovascular intensive care unit. It is defined as a disturbance of consciousness and cognition that develops suddenly and fluctuates over time. Delirious patients can become hyperactive, hypoactive, or both. The occurrence of delirium during hospitalization is associated with increased in-hospital and long-term morbidity and mortality. The cause of delirium is multifactorial and may include imbalances in neurotransmitters, inflammatory mediators, metabolic disturbances, impaired sleep, and the use of sedatives and analgesics. Patients with advanced age, dementia, chronic illness, extensive vascular disease, and low cardiac output are at particular risk of developing delirium. Specialized bedside assessment tools are now available to rapidly diagnose delirium, even in mechanically ventilated patients. Increased awareness of delirium risk factors, in addition to non-pharmacological and pharmacological treatments for delirium, can be effective in reducing the incidence of delirium in cardiac patients and in minimizing adverse outcomes, once delirium occurs.
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McPherson, John, Jennifer Giuseffi, Chad Wagner, and E. Wesley Ely. Acute cognitive disorders: recognition and management of delirium in the cardiovascular intensive care unit. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0074_update_001.
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Delirium is the most common acute cognitive disorder seen in critically ill patients in the cardiovascular intensive care unit. It is defined as a disturbance of consciousness and cognition that develops suddenly and fluctuates over time. Delirious patients can become hyperactive, hypoactive, or both. The occurrence of delirium during hospitalization is associated with increased in-hospital and long-term morbidity and mortality. The cause of delirium is multifactorial and may include imbalances in neurotransmitters, inflammatory mediators, metabolic disturbances, impaired sleep, and the use of sedatives and analgesics. Patients with advanced age, dementia, chronic illness, extensive vascular disease, and low cardiac output are at particular risk of developing delirium. Specialized bedside assessment tools are now available to rapidly diagnose delirium, even in mechanically ventilated patients. Increased awareness of delirium risk factors, in addition to non-pharmacological and pharmacological treatments for delirium, can be effective in reducing the incidence of delirium in cardiac patients and in minimizing adverse outcomes, once delirium occurs.
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Stan, Dylan, and Kalina Christoff. Potential Clinical Benefits and Risks of Spontaneous Thought. Edited by Kalina Christoff and Kieran C. R. Fox. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780190464745.013.45.
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Spontaneous thought has recently been defined as a state of reduced constraints on the mind, and it encompasses a range of experiences such as mind-wandering, day and night dreaming, creative idea generation, and others. While its day-to-day benefits have been explored for some time, its clinical implications have been understudied, and for the most part have been limited to potential detrimental effects on mood. We propose that spontaneous thought has a wider variety of clinical effects, as well as a number of potential therapeutic benefits—affording the opportunity to address suppressed or repressed material, facilitating therapeutic insights, and promoting general relaxation. Its unconstrained mode may not be without clinical risks, however. Within literature discussing meditation, sleep, relaxation, and sensory deprivation—activities that promote unconstrained attention—evidence suggests that some individuals may become destabilized, or face a worsening of symptoms in some circumstances. More research needs to be done to clarify the mediating factors that could result in these divergent outcomes.
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Innominato, Pasquale F., and David Spiegel. Circadian rhythms, sleep, and anti-cancer treatments. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198778240.003.0016.
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The circadian timing system temporally regulates biological functions relevant for psycho-physical wellbeing, spanning all the systems related to health. Hence, disruption of circadian rhythms, along with sleep cycles, is associated with the development of several diseases, including cancer. Moreover, altered circadian and sleep functions negatively impact on cancer patients’ quality of life and survival, above and beyond known determinants of outcome. This alteration can occur as a consequence of cancer, but also of anti-cancer treatments. Indeed, circadian rhythms govern also the ability of detoxifying chemotherapy agents across the 24 hours. Hence, adapting chemotherapy delivery to the molecular oscillations in relevant drug pathways can decrease toxicity to healthy cells, while increasing the number of cancer cells killing. This chronomodulated chemotherapy approach, together with the maintenance of proper circadian function throughtout the whole disease challenge, would finally result in safer and more active anticancer treatments, and in patients experiencing better quality and quantity of life.
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Allen, Mike, Lars Benjaminsen, Eoin O'Sullivan, and Nicholas Pleace. Ending Homelessness? Policy Press, 2020. http://dx.doi.org/10.1332/policypress/9781447347170.001.0001.
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In recent years, across Europe, North America and the Antipodes, a significant number of countries, states and regions have devised strategies that aim to end long-term homelessness and the need to sleep rough. Long considered an intractable or ‘wicked’ social problem, the notion that homelessness could be ended represents a significant sea change in conceptualising and responding to homelessness. A key driver for states, regions and municipalities to devise plans to end homelessness, and an optimism that this policy objective can be achieved, is that there is an increasing research evidence base on what works to end homelessness. This increasingly sophisticated research evidence covers both the prevention of homelessness in the first instance and the support mechanisms that can ensure sustainable exits and stable, secure accommodation for people who have experienced homelessness. This book explores these issues through a detailed comparison of the experiences of Denmark, Finland and Ireland over the past decade. From 2008 to the end of 2018, the numbers living rough and in temporary and emergency accommodation showed a decline of 72 per cent in Finland, while the number of households in emergency accommodation increased by 300 per cent in Ireland; in Denmark, the number of adults in emergency accommodation increased by 12 per cent over the shorter time period of 2009–17. The purpose of this book is to offer explanations for stark variations in these outcomes despite similar starting points.
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Forsyth, Rob, and Richard Newton. Specific conditions. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198784449.003.0004.
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This chapter adopts a systematic approach to common diagnoses in paediatric neurology, aetiologies, management to include investigation and treatment, and outcome. For each condition current knowledge on cause and underlying biology is summarized. A rational approach to investigation and treatment is summarized for each topic. These include: acquired brain injury; autoimmune and autoinflammatory disease of the CNS; cerebral palsy and neurodisability which covers feeding, communication, special senses, and respiratory disease; demyelinating disease; epilepsy including its impact on daily life; non-epileptic paroxysmal phenomena; functional illness, illness behaviour; headache; hydrocephalus; spina bifida and related disorders; idiopathic intracranial hypertension; infection of the CNS; congenital infection; mitochondrial disease; movement disorders; neuromuscular disease which covers neuropathy, anterior horn cell disease, and myasthenic syndromes; neurocutaneous syndromes; neurodegenerative conditions; late presentations of metabolic disease; neurotransmitter disorders; sleep disorders; stroke and intracerebral haemorrhage; tumours of the CNS; and vitamin-responsive disorders.
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Thiruchelvam, Nikesh. Benign prostatic hyperplasia. Edited by Christopher R. Chapple. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0057.
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Male lower urinary tract symptoms (LUTS) has a multifactorial aetiology and is not simply solely due to bladder outflow obstruction (BOO) from benign prostatic hyperplasia (BPH). Other causes of LUTS include bladder dysfunction, malignant prostatic disease, urethral disease, and medical conditions such as polyuria and sleep disorders. In an ageing population, LUTS and BPH will become more common. BOO can only be diagnosed by urodynamic evaluation, although treatment can be started before requiring this invasive investigation. Once considered the only treatment option for BOO, open prostatectomy has been surpassed by TURP and over the past few decades by medical therapy for BPH. α-blockers and 5-α reductase inhibitors improve LUTS and in combination, can reduce the progression of BPH. There are now many competing surgical options for TURP including a variety of laser ablating and enucleating techniques. To date, no one endourological option shows superiority on outcome and complication rates.
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Servin, Frédérique S., and Valérie Billard. Anaesthesia for the obese patient. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0087.
Full textAbstract:
Obesity is becoming an epidemic health problem, and the number of surgical patients with a body mass index of more than 50 kg m−2 requiring anaesthesia is increasing. Obesity is associated with physiopathological changes such as metabolic syndrome, cardiovascular disorders, or sleep apnoea syndrome, most of which improve with weight loss. Regarding pharmacokinetics, volumes of distribution are increased for both lipophilic and hydrophilic drugs. Consequently, doses should be adjusted to total body weight (propofol for maintenance, succinylcholine, vancomycin), or lean body mass (remifentanil, non-depolarizing neuromuscular blocking agent). For all drugs, titration based on monitoring of effects is recommended. To minimize recovery delays, drugs with a rapid offset of action such as remifentanil and desflurane are preferable. Poor tolerance to apnoea with early hypoxaemia and atelectasis warrant rapid sequence induction and protective ventilation. Careful positioning will prevent pressure injuries and minimize rhabdomyolysis which are frequent. Because of an increased risk of pulmonary embolism, multimodal prevention is mandatory. Regional anaesthesia, albeit technically difficult, is beneficial in obese patients to treat postoperative pain and improve rehabilitation. Maximizing the safety of anaesthesia for morbidly obese patients requires a good knowledge of the physiopathology of obesity and great attention to detail in planning and executing anaesthetic management. Even in elective surgery, many cases can be technical challenges and only a step-by-step approach to the avoidance of potential adverse events will result in the optimal outcome.
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Mills, Gary H. Pulmonary disease and anaesthesia. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0082.
Full textAbstract:
Respiratory adverse events are the commonest complications after anaesthesia and have profound implications for the recovery of the patient and their subsequent health. Outcome prediction related to respiratory disease and complications is vital when determining the risk:benefit balance of surgery and providing informed consent. Surgery produces an inflammatory response and pain, which affects the respiratory system. Anaesthesia produces atelectasis, decreases the drive to breathe, and causes muscle weakness. As the respiratory system ages, closing capacity increases and airway closure becomes an increasing issue, resulting in atelectasis. Increasing comorbidity and polypharmacy reduces the patient’s ability to eliminate drugs. The proportion of major operations on older frailer patients is rising and postoperative recovery becomes more complicated and the demand for critical care rises. At the same time, the population is becoming more obese, producing rapid decreases in end-expiratory lung volume on induction, together with a high incidence of sleep-disordered breathing. Despite this, many high-risk patients are not accurately identified preoperatively, and of those that are admitted to critical care, some are discharged and then readmitted to the intensive care unit with complications. Respiratory diseases may lead to increases in pulmonary vascular resistance and increased load on the right heart. Some lung diseases are primarily fibrotic or obstructive. Some are inflammatory, autoimmune, or vasculitic. Other diseases relate to the drive to breathe, the nerve supply to, or the respiratory muscles themselves. The range of types of respiratory disease is wide and the physiological consequences of respiratory support are complex. Research continues into the best modes of respiratory support in theatre and in the postoperative period and how best to protect the normal lung. It is therefore essential to understand the effects of surgery and anaesthesia and how this impacts existing respiratory disease, and the way this affects the balance between load on the respiratory system and its capacity to cope.