Sleep disordered breathing (SDB) is an umbrella term for several chronic conditions in which partial or complete cessation of breathing occurs many times throughout the; one SDB condition in particular, obstructive sleep apnea syndrome (OSAS), has been globally recognized as a growing public health issue. OSAS is a chronic disease involving repetitive pauses in breathing during sleep that can cause numerous health issues if left untreated such as increased risk for hypertension, coronary heart disease, type-2 diabetes, stroke and depression. Daytime sleepiness, which can occur secondary to OSAS, impacts one’s ability to operate a motor vehicle properly and is likened to driving under the influence of alcohol. Early screening has the potential to identify OSAS and initiate subsequent treatment, which can improve breathing during sleep and decrease daytime sleepiness. The significance of early detection cannot be overlooked, as the far-reaching effects of OSAS have large public health implications.
Sleep is an important resting period, especially for the cardiovascular system, which has to work persistently. Therefore, qualitative and quantitative sleep disturbances can lead to cardiovascular disease (CVD). An inappropriate sleep duration, which leads to quantitative sleep impairments, and insomnia and sleep-disordered breathing (SDB), which result in quantitative/qualitative sleep impairments, are widely recognized to affect the incidence of CVD. Patients with CVD generally sleep less than the general population and frequently have sleep disorders, such as insomnia or SDB, which have adverse prognostic effects. Thus, sleep plays an important role in the development and progression of CVD. In this manuscript, we discuss the physiological changes in hemodynamics seen during sleep and the relationship between sleep and CVD from the point of view of primary and secondary prevention.
The sleep disordered breathing (SDB) in children is associated with both cardiovascular diseases and cognitive impairment. A representative case with SDB is witnessed to have frequent snoring, interrupted breathing, and arousal during sleep by caregivers, some of whom may also find paradoxical breathing at apneic phase during sleep, probably leading to funnel chest in severe SDB case. In addition, the affected children may suffer from adeno-tonsillar hypertrophy, or nasal congestion, which may play a pathogenic role. Because of consequent cognitive impairment, school children may not be able to concentrate well in school, leading to poor school performance and/or injury, sometimes resulting in a mis-diagnosis of attention deficient hyperactive disorders (ADHD). Since these will affect future life in those children, the appropriate diagnosis and treatment are essential. The therapeutic approach to children with SDB includes adenotonsilectomy, and anti-allergic drug against nasal congestion, in addition to continuous positive airway pressure (CPAP).
As SDB in children is not well recognized, we described the epidemiologic aspect of SDB in children, after developing a Japanese version of Gozal’s questionnaire. We administered the questionnaire to all the 26,000 primary school children in Matsuyama. This elucidated the prevalence of SDB-related symptoms, as well as those related to hyperactivity and anxiety. Around 10% of children snored 3 nights or more a week, 40% snored 1 to 2 nights per week, across all the grade. They slept 8 to 9 hours a day, but children of higher grade slept less. This epidemiologic data makes us aware of the sleep problems in children, and encourages us to provide them with appropriate diagnosis and treatment.
Background: Influence of dopamine (DA) on working memory (WM) performance follows an inverted U-shaped function, with excessive levels of neurotransmitters impairing WM performance. Antipsychotics have an ameliorating effect on this impairment according to studies on monkeys and rats. DA release increases during illness exacerbation in schizophrenia. Therefore, WM performance may improve by increased DA release in patients with schizophrenia being treated with high-dose antipsychotics. If improvement in WM performance was an indicator for increased DA release, it could serve as a predictor for relapse.
Method: We included 130 patients with schizophrenia taking ≥1,000 mg chlorpromazine equivalent/day. The antipsychotic dose was reduced to ≤1,000 mg/day. The Digit Span, Vocabulary, and Block Design tests were used before the dose reduction and in comparing relapse and non-relapse cases.
Results: 51 subjects relapsed. In comparison with the no relapse group, the relapse group scored significantly higher in the Digit Span test but significantly lower in the Vocabulary and Block Design tests. The logistic regression analysis indicated a correlation between relapse and cognitive function.
Conclusion: Our study revealed a correlation between relapse and cognitive function. Our findings are consistent with the idea that relapse and changes in cognitive function are caused by increased DA release.
Attenuation properties of the iBEAM evo carbon fiber couch were modeled with a commercial Monte Carlo treatment planning system, Monaco (Elekta AB, Stockholm, Sweden), and we evaluated the dosimetric effect due to the couch displacement on the prostate volumetric modulated arc therapy (VMAT) treatment plans. The couch shape and dimensions were set according to the vendor specifications and a cone-beam computed tomography scan. The accuracy of the couch model was validated by comparison with ionization chambers and treatment planning system calculated dose. In order to evaluate the couch displacement effects on prostate VMAT plans, phantom position on the couch was shifted from the original position by a simulation in Monaco and measurements with the ionization chamber and films were obtained. For a 5 cm shift, the deviation in dose at the isocenter was less than 1.0% and the dose distribution showed a good agreement with the original (no-shifted) plan. Our findings for the phantom lateral displacement suggest that the positioning accuracy will have no clinical significance on prostate VMAT plans when the iBEAM evo couch is adopted. The insensitivity of the couch displacement indicated that the couch dimension can be simplified in the couch modeling calculation in the Monaco treatment planning system.
Juni Amira Dasril Syah is a medical graduate from The University of Auckland. At the time of writing, she was a final year medical student who had attended 8 weeks of clinical observership at Juntendo University Hospital, Hongo, Tokyo. This article is written based on her observation at Juntendo University Hospital Emergency Department, Hongo, Tokyo.