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Sleep Research

The Newcastle Sleep Disorders Centre has been investigating sleep disorders for many years. The titles of the current projects and papers are printed below.

Previous papers from the Newcastle Sleep Disorders Centre are listed in date (by year, most recent first) and alphabetical order.

Current Projects

1. Randomized crossover study of nasal CPAP and mandibular advancement in the treatment of mild obstructive sleep apnoea.

Patients with mild sleep apnoea (defined as apnoea -hypopnoea index between 15 and 30) are randomised to treatment with nasal CPAP or mandibular advancement device (mouthguard) for six weeks. Following two weeks of washout the patients will crossover to the other treatment. Both objective and subjective outcomes are measured.

2. The use of Stimulant Medication in a Special Population of Chronic Fatigue Syndrome Patients: A Randomized Control Trial.

Cole M, Ambrogetti A, Olson LG, Sutherland D

We are currently conducting a randomized, parallel, double blind controlled study into the effects of stimulant medication (dexamphetamine) in persons diagnosed with Chronic Fatigue Syndrome.

Hypothesis: In patients with Chronic Fatigue Syndrome and evidence of increased daytime somnolence and/or REM abnormalities dexamphetamine sulphate improves symptoms and quality of life.

Eligible Patients: Patients who meet the diagnosis for Chronic Fatigue Syndrome and have evidence of daytime sleepiness (mean sleep latency less than 10mins in Multiple Sleep Latency Test [MSLT]) or objective (MSLT) or clinical evidence or REM abnormalities (eg. cataplexy, sleep paralysis, hypnagogic hallucinations).

Assessment: Initial assessment involves a full overnight polysomnographic (PSG) recording followed by a MSLT. Patients will complete the MOS-SF36, SCL-90-R, Fatigue Severity Scale (FSS) and decide on two patient determined outcomes. The first two weeks of the medication regimed will be a titration period followed by four weeks medication. Final assessment involves a repeat PSG and MSLT as well as the MOS-SF36, SCL-90-R, FSS, patient determines outcome assessment and a Medication Questionnaire.

The Use of Stimulant Medication in An Adult Population with Hypersomnolence

Cole M, Ambrogetti A, Gyulay S, and Olson LG, Sutherland D

Introduction

Despite the usefulness of stimulant medications in patients with narcolepsy, both patients and prescribing physicians often have concerns based on the reputation of this class of drug. Some of the most common concerns involve the development of tolerance and/or dependence, side effects and psychosocial consequences.

Tolerance refers to the need for an increased amount of medication to effect the same physiological response.

Dexamphetamine and methylphenidate are classified as addictive, but the frequency of addiction associated with medical use is unknown.

There has been little research on side effects in a group using stimulant medication for the treatment of narcolepsy.

Psychosocial implications of both narcolepsy and its treatment with stimulant medication are most salient in areas such as work performance, driving, planning recreational activities and interpersonal relationships.

Aim

The aim of this survey is to assess the attitudes and beliefs of patients using stimulant medication and to estimate the frequency of tolerance, dependence and side-effects.

Respondants

A total of 115 (77%) questionnaires were completed and returned. Of these respondents 51 were male (44%) and 64 female (56%). The average age of the respondents was 37 years (SD 13, range 15-73years).

The respondents were taking the following stimulant medication at the time of the questionnaire being administered:

61 Dexamphetamine

25 Methylphenidate

29 None

Results

There was an enormous amount of data obtained from the survey, these are some of the more important results. The final article will contain a more in depth discussion of the results.

Positive Outcomes

87% of respondents report that stimulant medication makes them more alert. It is possible that other positive outcomes reported are primarily due to that increase in alertness. The next most common positive outcomes reported were:

Feeling better 85%

Easier to carry out duties 81%

Tolerance

28 patients (24%) reported that the benefit of stimulant medication had reduced over time. This corresponds roughly with the 32 patients (28%) who had to increase the dosage after an initial effective dose had been reached.

Dependance

The stimulant medication group scored lower on the dependence scale than both an illegal amphetamine user group and an insulin dependent group, however, the validity of this scale in a medically treated group is questionable.

Intension

Are the people currently taking medication going to continue?

Likely 74 (86.04%)

Unlikely 9 (10.47%)

Psychosocoal

Most respondents families were not opposed to them taking stimulant medication. The respondents didn't mind their friends and employers knowing that they take stimulant medication and were not embarrassed filling the prescription. Half felt comfortable disclosing this information to a prospective employer while the other half thought that it would lessen their chances of employment.

Side Effects

The following side effects were spontaneously reported by more than 5% of the respondents.

Appetite Loss (15) 13.0%

Migraine/Headache (11) 9.6%

Mood Problems (10) 8.7%

Shakiness/Tremor (9) 7.8%

Weight Loss (8) 7.0%

Palpitations (7) 6.1%

Off Balance (6) 5.2%

Still Sleepy (6) 5.2%

Lack of Concentration (6) 5.2%

Conclusion

The use of stimulant medication in our patients with narcolepsy proved to be both safe and effective, provided the appropriate medical supervision was given. In instances where effectiveness is less than optimal patients were easily able to stop medication.

What now?

This project is just the beginning of a long term assessment of people using stimulant medication for medical purposes. It is our intention to continue to monitor progress both for research and clinical purposes.