Oana Claudia Deleanu

European guideline for the diagnosis and treatment of insomnia

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta‐analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co‐morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate‐ to high‐quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders), in treatment‐resistant insomnia, for professional at‐risk populations and when substantial sleep state misperception is suspected (strong recommendation, high‐quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (strong recommendation, high‐quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short‐term treatment of insomnia (≤4 weeks; weak recommendation, moderate‐quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low‐ to very‐low‐quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low‐quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very‐low‐quality evidence).

The effect of CPAP on blood pressure in patients with OSAS and resistant hypertension followed 1 year

Objective: Few studies analyzed OSAS and resistant hypertension (RH) patients showing a reduction in blood pressure (BP) of 4-5mmHg for systolic (SBP) and 2-3mmHg for diastolic (DBP). We studied patients with moderate-severe OSAS (polysomograph recording, manual titration), compliant to CPAP therapy, monitored 48 hours ambulatory BP baseline, 3, 6 and 12 months. Methods: 35-65years old patients; exclusion criteria: insomnia, restless leg syndrome, parasomnias, secondary hypertension(HT), cardiovascular, respiratory, metabolic or acute uncontrolled pathologies, non-adherent to/changing antihypertensive medication. Results: 265 patients evaluated; 14 of 33 enrolled evaluated at 12 months: 9 men(64.3%), mean values: age 58.1±6.2 years, BMI 34.7±6.7kg/m 2 (similar at 1 year), Epworth 10.2±4.7/h, index of quality of life-SAQLI 4.8±1.6, diagnosis AHI 66.4±5.3/h, ODI 61.9±11.3/h, AHI post-titration 9.2 ±1.9, SBP baseline 161.7±22.1 mmHg, DBP 88.5±14.1 mmHg, diagnosed with HT for 12.8±11.3 years, CPAP compliance 87.9±14.1%, 5.9±1.1 h/night. After 1 year significant changes were recorded in almost all monitored parameters (except 48h average minimum BP both day and night), the decrease of BP: 23.9 mmHg for average/48h SBP and 12.0 mmHg for DBP. Conclusion: This study, included patients with uncontrolled severe RHT diagnosed for long time, is the first study that excluded other sleep associated pathologies with HT and followed patients for 1 year. We obtained significant reduction of BP superior to those previously reported in short term studies, highlighting the importance in terms of cardiovascular risk of proper CPAP therapy for a long period of time in these patients.