Impact of microarousal associated with increased negative esophageal pressure in sleep-disordered breathing.

PURPOSE: "Microarousals" during sleep have not been analyzed systematically. We investigated the importance of "microarousals" (lasting 1.5-3 s). METHODS: Standard polysomnography including esophageal pressure (Pes) assessment was performed on ten patients (aged 54.0 +/- 5.0 years) with respiratory effort-related arousal > or =5/h. We measured the number of arousals per hour (American Sleep Disorders Association (ASDA) arousal index) and the number of microarousals lasting 1.5-3 s per hour (mASDA arousal index). On the night after the baseline sleep study, we performed overnight continuous positive airway pressure (CPAP) titration. RESULTS: mASDA arousals, characterized by lower Pes values, were observed more frequently in patients with sleep-disordered breathing. The Pes results did not differ significantly between ASDA and mASDA arousals (-15.6 +/- -5.0 vs -15.0 +/- -4.4 cmH(2)O). mASDA arousals were significantly improved by CPAP treatment (mASDA arousals, 82.6 +/- 60.1 vs 6.0 +/- 1.4/h). CONCLUSIONS: mASDA arousals were characterized by an increase in Pes. mASDA arousals are thus key to our understanding of clinical manifestations in patients with sleep-disordered breathing.

Follow-up for patients with obstructive sleep apnea syndrome using a portable recording device.

A home screening device, LT-200, can record data on both breathing conditions and body positions during sleep for up to 3 consecutive days in patients with obstructive sleep apnea (OSAS). We investigated the usefulness of the LT-200 device for follow-up of OSAS. Eighteen patients (age 51.0 +/- 10.8 years, mean +/- SD) were enrolled in this study. Standard polysomnography (PSG) was performed on all patients. The number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI), the total time that nocturnal oxygen saturation was < 90% (oxygen desaturation time: ODT), and the minimum oxygen saturation during sleep (lowest Spo2) were calculated. We used the LT-200 and PSG to evaluate any improvement in the data obtained after auto-continuous positive airway pressure (auto-CPAP) therapy. AHI was also measured using the LT-200 in three sleep positions to evaluate the efficacy of the lateral position. AHI, ODT, and lowest Spo2 values did not differ significantly between the PSG and LT-200 recordings on the control and therapy nights. The LT-200 recordings showed that AHI, ODT, and lowest Spo2 tended to be better on the second night of auto-CPAP therapy than on the first. AHI was significantly lower in the right and left lateral sleep positions than that in the supine position. Our findings suggest that since the LT-200 device provides important information about the severity of OSAS, the efficacy of auto-CPAP therapy, and body position under unattended conditions in the home. It may prove to be a useful tool for following up patients.

Thirteen-week repeated dose oral toxicity study of coenzyme Q10 in rats.

As part of a safety evaluation of Coenzyme Q10, a subchronic toxicology study was conducted. Coenzyme Q10 was repeatedly administered orally to male and female Crl:CD(SD) rats at daily dose levels of 300, 600 and 1200 mg/kg for 13 weeks. Neither death nor any toxicological signs were observed in any group during the administration period. No change related to the test substance administered was observed in any group with regard to body weight, food consumption, ophthalmoscopy, hematology, blood biochemistry, necropsy, organ weights or histopathology. Based on these results, the non-observed-adverse-effect level (NOAEL) of Coenzyme Q10 was considered to be 1200 mg/kg/day for male and female rats under these study conditions.

[Educational effectiveness of a group health education program in the workplace and an examination of educational methods to promote behavior modification].

BACKGROUND: It is well-known that health education programs carried out in the work place are useful for employees' health promotion. However, the effectiveness of group health education programs for workers as a population approach is unclear. OBJECTIVE: The purpose of this study was to examine the effectiveness of a group health education program in the workplace, and to investigate educational methods which support workers modifying their health behaviors. METHODS: A total of 289 workers who received a group health education program in the manufacturing industry (mean age, 42.1 ± 11.3 years old; 175 males and 114 females) were enrolled in this study. The group health education program was carried out to educate the subjects about periodontitis, oral health actions and lifestyle behaviors to prevent oral diseases. Participants were required to fill out a self-administered questionnaire which included information about oral health knowledge, oral health actions, lifestyle behaviors and symptoms of periodontitis before, immediately after and one month after the education. We used McNemar's test for the paired comparison of questionnaire responses. The relation between acquiring knowledge about periodontitis and subjects' modification of oral health action, behavior modification and symptoms of periodontitis were examined using the chi-squared test. The relationships of knowledge retention about periodontitis, the modification of the oral health actions and lifestyle behaviors (i.e., cigarette smoking, alcohol drinking and eating between meals), were examined with participants' characteristics (i.e., age, gender and occupational category) using Fisher's exact test. RESULTS: Knowledge about periodontitis significantly improved immediately after receiving the health education, and this effect of education was evident one month later. However, not all of the knowledge was sufficiently retained one month after the education session. The proportion of participants undertaking desirable oral health actions significantly increased one month after the education, whereas lifestyle behaviors did not alter. The modification of oral health actions improved periodontitis-related symptoms, however, no relationship was found between knowledge acquisition and behavior modification. The characteristics of the participants did not influence knowledge retention about periodontitis or modification of oral health actions. CONCLUSIONS: Our group health education program was appropriate and effective at providing knowledge about periodontitis and at modifying oral health actions. We should identify factors that obstruct workers behavior modification, and eliminate them to improve health behaviors.

Toxicity studies of Asahi Kasei PI, purified phosphatidylinositol from soy lecithin.

Although phosphatidylinositol (PI) is an important component in all plants and animals, there is no toxicity report when purified PI is orally administrated to animals. As a safety evaluation of PI, acute, subchronic and genotoxicity studies were conducted with purified PI from soy lecithin (Asahi Kasei PI). Up to 2,000 mg/kg of Asahi Kasei PI was administrated once orally to male and female rats. There were no deaths or any clinical sign in any group throughout the observation period. Then, Asahi Kasei PI was repeatedly administered orally to male and female rats at daily doses of 100, 300 and 1,000 mg/kg for 13 weeks. Neither death nor any toxicological signs during the administration period and no changes related to the test substance administered were observed in any group with regard to body weight, food consumption, ophthalmoscopy, hematology, blood biochemistry, necropsy, organ weights or histopathology. Based on these results, the no-observed-adverse effect level (NOAEL) of Asahi Kasei PI was considered to be 1,000 mg/kg/day for male and female rats. Genotoxicity evaluation of Asahi Kasei PI was also carried out by the bacterial reverse mutation test (Ames test) and in vitro chromosome aberration test in compliance with the Japanese guidelines on genotoxicity testing of pharmaceuticals, the OECD guidelines for testing chemicals and guidelines for designation of food additives and for revision of standards for use of food additives. The results indicate neither increases of revertant colonies nor chromosome aberration, suggesting that Asahi Kasei PI has high safety in genotoxicity.

Daytime polysomnography for early diagnosis and treatment of patients with suspected sleep-disordered breathing.

Excessive daytime sleepiness (EDS) is a common complaint among patients with sleep-disordered breathing (SDB). Population-based studies on traffic and industrial accidents suggest a relationship between EDS and life-threatening events, and adults with EDS have cognitive and memory problems. Nocturnal polysomnography (nPSG) is essential for diagnosing SDB but it is time and energy consuming. We examined the usefulness of daytime polysomnography (dPSG) for the early diagnosis and treatment of patients with suspected SDB. We studied 108 consecutive patients aged 51.9 +/- 13.5 years (mean+/-SD). All patients underwent dPSG and nPSG. The number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI) and the number of 3% desaturation episodes per hour (desaturation index: DSI) were calculated. All patients were classified into two groups. The REM group consisted of subjects who had an AHI < or = 25/h, AHI(REM)/AHI(NREM) > 2, and AHI(NREM) < 15/h. Those who did not satisfy these criteria were placed in the NREM group. Continuous positive airway pressure (CPAP) titration was performed for patients whose AHI was > or =20/h on dPSG. Using the international classification of sleep disorders, 96 patients were diagnosed as obstructive sleep apnea [including five upper airway resistance syndrome (UARS) patients], six patients were snoring, four had idiopathic hypersomnia due to a medical condition, and two had circadian rhythm sleep disorders. The sensitivity of dPSG for AHI was 81.0%, specificity was 100%, and accuracy was 83.5%. The sensitivity and accuracy of dPSG for AHI in the REM group were considerably lower than in the NREM group. There was no significant difference for optimal CPAP between dPSG and nPSG. In the five patients with UARS, their AHI, DSI, and arousal index on dPSG were 0.92 +/- 1.2/h, 2.9 +/- 3.4/h, and 29.3 +/- 3.5/h, respectively, and their AHI and DSI on nPSG were 3.2 +/- 2.5/h and 2.8 +/- 2.4/h, respectively. However, their respiratory effort-related arousals were 37.9 +/- 7.4/h, and their arousal index was 33.2 +/- 6.3/h. The five patients with UARS were also treated with CPAP, and their daytime sleepiness was improved. Although dPSG has limitations, these results indicate that dPSG recording is clinically useful for the diagnosis of and determination of types of treatment in patients with suspected SDB.