Study Objectives: To assess the benefit and tolerance of autotitrating positive airway pressure (APAP) versus continuous positive airway pressure (CPAP) in subjects who experience aerophagia. Methods: This is the report of a prospective, two-week, double-blinded, randomized crossover trial set in an Australian clinical sleep laboratory in a tertiary hospital. Fifty-six subjects who reported symptoms of aerophagia that they attributed to CPAP were recruited. Full face masks were used by 39 of the 56 subjects recruited. Subjects were randomly and blindly allocated to either CPAP at their treatment recommended pressure or APAP 6-20 cm H2O, in random order. Subjects spent two weeks on each therapy mode. Therapy usage hours, 95th centile pressure, maximum pressure, 95th centile leak, and residual apnea-hypopnea index (AHI) were reported at the end of each two-week treatment period. Functional Outcome of Sleepiness Questionnaire, Epworth Sleepiness Scale, and visual analog scale to measure symptoms of aerophagia were also completed at the end of each 2-week treatment arm. Results: The median pressure (P < .001) and 95th centile pressure (P < .001) were reduced with APAP but no differences in compliance (P = .120) and residual AHI were observed. APAP reduced the symptoms of bloating (P = .011), worst episode of bloating (P = .040), flatulence (P = .010), and belching (P = .001) compared to CPAP. There were no differences in Epworth Sleepiness Scale or Functional Outcome of Sleepiness Questionnaire outcomes between CPAP and APAP.

In treating obstructive sleep apnea (OSA), the use of oronasal masks with continuous positive airway pressure (CPAP) has been reported to increase pressure levels and reduce compliance. These reports come mostly from large observational studies. In this study, we examined the impact that oronasal masks have on 95th centile pressures, the residual apnea-hypopnea index (AHI) and compliance compared with nasal masks. A randomised crossover design was implemented. Participants already established on CPAP were randomly allocated to a nasal mask or oronasal mask with auto-titrating positive airway pressure (APAP) for 2 weeks. Participants then crossed over to use the alternate mask for another 2 weeks. Seventy-one participants were recruited but only 60 completed the trial. There were no differences in median 95th centile pressure (nasal, 11.5 cm H O; oronasal, 11.7 cm H O; p = 0.115), median residual AHI (nasal, 4.9 events/hr; oronasal, 5.3 events/hr; p = 0.234) or median compliance (nasal, 7.3 hr/night; oronasal, 7.3 hr/night; p = 0.961). Only four patients had 95th centile pressures that were at least 1.5 cm H O greater with oronasal masks. Oronasal masks do not systematically increase therapeutic CPAP requirements. Rather, a small subset of patients display significant differences in CPAP levels.

No abstract

The last decade has seen a dramatic increase in our understanding of sleep-dependent memory consolidation, moving it from a generally discredited (or at best ignored) concept to a largely accepted tenet among both memory and sleep researchers, even found in undergraduate psychology textbooks. This work has established a firm connection between sleep and memory function. But given the complexity of both sleep and memory, each of which comprise multiple stages and subtypes, even the most basic characterizations of this phenomenon remain unclear. To date, most studies have sought to assign consolidation of particular classes of memory to discrete sleep stages, for example consolidation of procedural memories to REM sleep or declarative memories to slow wave sleep (SWS). But exceptions to this simple dichotomy come close to outnumbering supporting studies.Several new studies, presented here, lead us to now propose a unified sleep-dependent memory consolidation hypothesis, to describe how sleep stages contribute to memory consolidation. We propose that sleep plays a more nuanced role in memory processing than previously considered, with sleep stages being selectively involved not with specific memory types, but with specific components of the memory consolidation process. Specifically, we propose that SWS stabilizes recently acquired declarative and procedural memories, while REM and Stage 2 nonREM sleep subsequently enhance them, selectively reinforcing their most valuable components and integrating them into pre-existing networks of stored information.This new hypothesis is consistent with the growing literature of sleep-dependent consolidation across a range of memory functions, and is strongly supported by new results presented in this talk. These new results, in concert with the unified memory consolidation hypothesis, move the study of sleep and memory beyond a discussion of classical memory consolidation (i.e., stabilization), into the realm of more powerful and valuable forms of sleep-dependent memory processing that (i) enlarge the neural networks in which memories are stored, (ii) extract patterns and rules from large bodies of encoded information (iii) integrate them with other, older memories into rich semantic networks, and, perhaps as a consequence of these other processes, (iv) selectively enhance those aspects of memories of greatest value to the organism.Background: There are few data on the sleep patterns of Australian children, or the associations between sleep and sociodemographic factors [age, sex, socio-economic status (SES)], temporal context (type of day, season), type of day (school day, weekend, holiday), and individual characteristics (weight status). Methods: Between 2001 and 2007, 4,033 9-18 year old Australians reported the time of falling asleep and waking up on 9,053 individual nights. Using a computerised use-of-time recall, the adolescents also reported all activities performed on that day, choosing from 250 different activities and reporting in time slices as fine as 5 minutes. Resul...