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Patil S.P.,Johns Hopkins Sleep Disorders Center
Sleep Medicine Clinics | Year: 2013

Obstructive sleep apnea (OSA), a highly prevalent condition affecting 24% of men and 9% of women, is associated with many comorbidities. Patients with OSA are at increased risk for postoperative respiratory and cardiovascular complications, resulting in the need for increased levels of monitoring and longer hospitalizations. Most patients at risk for OSA, however, remain undiagnosed or untreated, placing the surgical patient with OSA at risk for postoperative complications. Diagnostic testing for OSA can be performed using in-laboratory polysomnography (PSG) or limited-channel portable monitoring (PM). This article addresses the use of PM and in-laboratory PSG in the assessment of OSA. © 2013 Elsevier Inc. Source

Krishnan V.,Case Western Reserve University | Patil S.P.,Johns Hopkins Sleep Disorders Center
Sleep Medicine Clinics | Year: 2013

Obstructive sleep apnea (OSA) is associated with an increased risk of accidents related to driving or mass transportation. In this article, the mechanisms for neurocognitive deficits and common subjective and objective testing for determining alertness-related impairments are reviewed. The basis of legal culpability for sleep-related accidents and the role of the clinician or sleep physician are discussed. Education of the patient and public on the risk of OSA on driving ability is a critical role of the clinician. General laws and regulations regarding OSA and driving are reviewed. Physicians are responsible for familiarizing themselves with policies that govern their jurisdiction.© 2013 Published by Elsevier Inc. All rights reserved. Source

Dorsey E.R.,University of Rochester | De Roulet J.,University Hospitals Case Medical Center | Reminick J.I.,University of Rochester | Thai A.,Johns Hopkins Sleep Disorders Center | And 5 more authors.
JAMA - Journal of the American Medical Association | Year: 2010

Context: With the exception of the American Recovery and Reinvestment Act, funding support for biomedical research in the United States has slowed after a decade of doubling. However, the extent and scope of slowing are largely unknown. Objective: To quantify funding of biomedical research in the United States from 2003 to 2008. Design: Publicly available data were used to quantify funding from government (federal, state, and local), private, and industry sources. Regression models were used to compare financial trends between 1994-2003 and 2003-2007. The numbers of new drug and device approvals by the US Food and Drug Administration over the same period were also evaluated. Main Outcome Measures: Funding and growth rates by source; numbers of US Food and Drug Administration approvals. Results: Biomedical research funding increased from $75.5 billion in 2003 to $101.1 billion in 2007. In 2008, funding from the National Institutes of Health and industry totaled $88.8 billion. In 2007, funding from these sources, adjusted for inflation, was $90.2 billion. Adjusted for inflation, funding from 2003 to 2007 increased by 14%, for a compound annual growth rate of 3.4%. By comparison, funding from 1994 to 2003 increased at an annual rate of 7.8% (P<.001). In 2007, industry (58%) was the largest funder, followed by the federal government (33%). Modest increase in funding was not accompanied by an increase in approvals for drugs or devices. In 2007, the United States spent an estimated 4.5% of its total health expenditures on biomedical research and 0.1% on health services research. Conclusion After a decade of doubling, the rate of increase in biomedical research funding slowed from 2003 to 2007, and after adjustment for inflation, the absolute level of funding from the National Institutes of Health and industry appears to have decreased by 2% in 2008. ©2010 American Medical Association. All rights reserved. Source

Gamaldo C.E.,Johns Hopkins Sleep Disorders Center | Shaikh A.K.,Emory University | McArthur J.C.,Johns Hopkins Hospital
Neurologic Clinics | Year: 2012

Research models show a strong interrelationship between sleep quality and immune function. The proinflammatory cytokines, interleukin-1, interleukin-6, and tumor necrosis factor α are classified as official sleep-regulatory substances. However, sleep-promoting properties are also possessed by several other immune and proinflammatory cellular classes. This article reviews the current physiologic evidence for the prominent somnogenic and sleep-regulatory properties inherent to these immune substances. Clinical examples of this relationship are discussed from the perspective of infectious and primarily immune-related conditions associated with significant sleep disruption and from the perspective of immune dysregulation associated with several primary sleep disorders. © 2012 Elsevier Inc. Source

Kezirian E.J.,University of California at San Francisco | Boudewyns A.,University of Antwerp | Eisele D.W.,University of California at San Francisco | Schwartz A.R.,Johns Hopkins Sleep Disorders Center | And 3 more authors.
Sleep Medicine Reviews | Year: 2010

Upper airway occlusion in obstructive sleep apnea has been attributed to a decline in pharyngeal neuromuscular activity occurring in a structurally narrowed airway. Surgical treatment focuses on the correction of anatomic abnormalities, but there is a potential role for activation of the upper airway musculature, especially with stimulation of the hypoglossal nerve and genioglossus muscle. We present evidence from research on upper airway neuromuscular electrical stimulation in animals and humans. We also present results from eight obstructive sleep apnea patients with a fully implanted system for hypoglossal nerve stimulation, demonstrating an improvement in upper airway collapsibility and obstructive sleep apnea severity. Future research, including optimization of device features and stimulation parameters as well as patient selection, is necessary to make hypoglossal nerve stimulation a viable alternative to positive airway pressure therapy and upper airway surgical procedures. © 2009 Elsevier Ltd. Source

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