Michel Cramer-Bornemann

Mindfulness-Based Stress Reduction Versus Pharmacotherapy for Chronic Primary Insomnia: A Randomized Controlled Clinical Trial

OBJECTIVE The aim of this study was to investigate the potential of mindfulness-based stress reduction (MBSR) as a treatment for chronic primary insomnia. DESIGN A randomized controlled trial was conducted. SETTING The study was conducted at a university health center. PATIENTS Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision, 4th Edition were randomized 2:1 to MBSR or pharmacotherapy (PCT). INTERVENTIONS Mindfulness-based stress reduction, a program of mindfulness meditation training consisting of eight weekly 2.5 hour classes and a daylong retreat, was provided, with ongoing home meditation practice expectations during three-month follow-up; PCT, consisting of three milligrams of eszopiclone (LUNESTA) nightly for eight weeks, followed by three months of use as needed. A 10-minute sleep hygiene presentation was included in both interventions. MAIN OUTCOMES The Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diaries, and wrist actigraphy were collected pretreatment, posttreatment (eight weeks), and at five months (self-reports only). RESULTS Between baseline and eight weeks, sleep onset latency (SOL) measured by actigraphy decreased 8.9 minutes in the MBSR arm (P < .05). Large, significant improvements were found on the ISI, PSQI, and diary-measured total sleep time, SOL, and sleep efficiency (P < .01, all) from baseline to five-month follow-up in the MBSR arm. Changes of comparable magnitude were found in the PCT arm. Twenty-seven of 30 patients completed their assigned treatment. This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary, actigraphy, well-validated sleep scales, and measures of remission and clinical recovery.

Nocturnal Cardio-Respiratory Indices - A Novel Screening Tool for Pediatric Obstructive Sleep Disordered Breathing

Obstructive sleep apnea (OSA) is a common breathing disorder among children with a prevalence estimated at 2-4%. Electrocardiography (ECG) based signal processing, especially heart rate analysis, demonstrated its promising future as both an alternative to other expensive portable sleep study methods and additional approach to sleep cardio-respiratory autonomic interactions which the current clinical standard polysomnography (PSG) lacks. A novel strategy was applied on pediatric OSA detection using RR intervals. A sensitivity of 89%, specificity of 96%, positive predictive value of 89%, and negative predictive value of 96% was achieved in case-to-case detection using 37 clinical pediatric full PSG data

Did this father's sleep apnea contribute to the inadvertent death of his infant son?

Sleepiness impairs memory and concentration. We report a case of a patient who inadvertently left his infant son in a car, having forgotten to drop him off at day care. The infant died of heat exposure. There is credible evidence that sleepiness from a combination of sleep deprivation and previously undiagnosed severe obstructive sleep apnea contributed to this tragedy.