PSG shows increased sleep latency, numerous arousals during sleep, and early awakening, as well as sleep efficiency below 85%.4,7 A twofold approach to shift work problems involves treatment directed individually toward the patient, in addition to

attempts to encourage the workplace (through occupational medicine and workers compensation programs) to adapt to the worker’s needs and reduce the overall incidence of shift work-related sleep disorders.55-60 Treatment recommendations include the following: maintain a regular sleep and meal schedule; take naps to limit sleep loss; and practice good sleep hygiene. If sleep is necessary during daylight hours, optimize sleep by darkening the room and Inhibitors,research,lifescience,medical screening for noise and interruptions. Light environment is important – exposure to bright light during the first portion of the shift and protection from bright light after work (sunglasses) and before sleep may be beneficial. Short-halflife hypnotics can be used by those who only occasionally

work shifts to help initiate sleep; chronic hypnotic use by long-term Inhibitors,research,lifescience,medical shift workers is not encouraged.7,55 Disorders of excessive somnolence Sleep apnea, hypopnea, and upper airway resistance syndrome Apnea is defined as cessation Inhibitors,research,lifescience,medical in airflow for longer than 10 s. Hypopnea refers to an abnormal respiratory event lasting longer than 10 s associated with at least a 30% reduction in thoracoabdominal movement or airflow compared to baseline, associated with ≥4% oxygen desaturation.61 Figure 1 demonstrates hypopneas seen during PSG monitoring of a patient with sleep apnea. Apneas and hypopneas are combined to form the AHI (ratio of total Inhibitors,research,lifescience,medical apneas and hypopneas to the total sleep time in hours), also known as respiratory disturbance index (RDI). An AH1>5 in an adult is abnormal. Apneas and hypopneas can result from upper airway obstruction (obstructive), loss of ventilatory effort

(central), or a mixture of both (mixed). OSAS is characterized by repetitive episodes of upper airway obstruction that occur during sleep, PKA inhibitor usually associated with oxygen desaturation.4 The clinical features of OSAS are listed in Table IV. Some patients have increased Inhibitors,research,lifescience,medical upper airway resistance without observed apneas or hypopneas and exhibit increased respiratory effort with Pes (esophageal pressure) crescendos and Pes reversals. Guilleminault secondly et al described the upper airway resistance syndrome (UARS) in patients who had Pes-documented increased respiratory effort associated with increased arousals and daytime sleepiness.62-64 Table IV Clinical features of obstructive sleep apnea syndrome. Figure 1. Hypopnea in a patient with obstructive sleep apnea syndrome. Note the low amplitude signals seen in the nasal cannula and airflow channels with increasing effort demonstrated on the chest and abdominal (Abd) channels. The Pes (esophageal pressure [PES]) … Sleep-disordered breathing (OSAS and UARS) in children peaks between ages 2 to 5 with a second peak in middle to late adolescence.