Alon Avidan | UCLA David Geffen School of Medicine (original) (raw)
Papers by Alon Avidan
Alzheimer disease and associated disorders, Jan 17, 2015
Advances in Cell Aging and Gerontology, 2005
Sleep disordered breathing (SDB) is a spectrum of nocturnal breathing events. It consists of obst... more Sleep disordered breathing (SDB) is a spectrum of nocturnal breathing events. It consists of obstructive, central, and mixed sleep apnea as well as upper airway resistance syndrome and snoring. Obstructive sleep apnea is characterized by repetitive upper airway obstructive events. The primary symptoms include excessive daytime sleepiness, snoring, and impairment of cognition. In some cases, it can be associated with increased risk of motor vehicle accidents. Obstructive sleep apnea (OSA) varies considerably in its distribution in age and its severity. The exact mechanism of OSA is not yet fully delineated but multiple factors are generally associated with the development of the sleep apnea (SA) syndrome. These factors include upper airway anatomic obstruction, as well as mechanical, neurological, and possibly inflammatory changes in the pharyngeal airspace. The prevalence of the OSA increases with aging. Most studies report a prevalence rate ranging between 11 and 62%. It is further associated with increased mortality in the older patient population. Central sleep apnea (CSA) occurs in higher frequency among patients with cerebral vascular accidents, central nervous system (CNS) tumors, CNS infections, encephalopathies, and congestive heart failure. Patients with cerebral vascular accidents have a markedly elevated prevalence of sleep apnea mainly in the form of OSA and also have a poorer prognosis after an acute infarct. Patients with Alzheimer’s disease also have more frequent SDcB. This SDB should certainly be considered in the differential diagnosis of reversible dementia as treatment of the underlying SDB improves cognitive dysfunction. Medical management of SA relies on treatment with positive pressure therapy and rarely with use of medications, or with surgery. The role of oral appliances has not been clearly determined in elderly cohorts. The aim of this chapter is to help shed light on the epidemiology, pathophysiology, diagnosis, and management of SDB in the geriatric patient population.
The Journal of Community and Supportive Oncology, 2015
Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be ... more Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be present at any stage during treatment for cancer and in some patients, sleep disturbance may be the presenting symptoms that lead to the diagnosis of some types of cancer. Poor sleep impairs quality of life In people with cancer, but most do not specifically complain of sleep problems unless they are explicitly asked. Insomnia and fatigue are most common sleep disorders in this cohort, although primary sleep disorders, including obstructive sleep apnea and restless legs syndrome, which are common in the general population, have not been carefully studied in the oncology setting despite significant impairment to their quality of life.
Reviews in neurological diseases, 2007
Complaints of insomnia are prevalent in neurodegenerative and neurological disorders. Neurologist... more Complaints of insomnia are prevalent in neurodegenerative and neurological disorders. Neurologists therefore must be aware of the underlying causes, pathophysiologic mechanisms, and potential interventions when encountering a patient with underlying neurological disorders who is also complaining of poor sleep and insomnia. This article describes the underlying pathophysiology, diagnostic approaches, and potential interventions for insomnia in the neurological patient. Clinicians need to recognize that insomnia in older patients with underlying neurological disorders is not only unique, but also complex, demanding comprehensive and careful evaluation and management. Treatment of insomnia should start by addressing nonpharmacologic options, including improvements in sleep hygiene, improving sunlight exposure during the day, and searching for underlying reversible causes, such as sleep apnea, restless legs syndrome, periodic leg movements, and circadian rhythm disturbances, all of whic...
Sleep Medicine Clinics, 2006
Diabetes, 1991
The effects of oral vanadyl sulfate administration for 9-12 days on carbohydrate and lipid metabo... more The effects of oral vanadyl sulfate administration for 9-12 days on carbohydrate and lipid metabolism in the basal state and on glucose dynamics during submaximal hyperinsulinemic clamps were investigated in nondiabetic and streptozocin-induced diabetic rats. Decreases in growth rate and water and food consumption were the only significant alterations noted in control animals receiving vanadyl. Administration of vanadyl to diabetic rats resulted in weight loss; a significant decrease in plasma glucose, triglyceride, and cholesterol levels; and decreases in food and water intake, without a concomitant change in plasma insulin concentrations. Vanadyl treatment did not modify either peripheral glucose utilization or hepatic glucose production in control rats during submaximal insulin clamps. In contrast, vanadyl therapy increased insulin-induced glucose utilization significantly and had a small but nonsignificant effect on insulin-mediated suppression of glucose production in diabetic rats. The tyrosine kinase activity of liver- and muscle-derived insulin receptors from diabetic rats that underwent clamp study, which reflected the in vivo phosphorylation state of insulin receptor, was not altered by vanadyl treatment. In conclusion, these results show that augmentation of peripheral glucose utilization is the major determinant of the antidiabetic action of vanadyl and support the notion that the action of vanadyl is independent of insulin-receptor kinase activity.
Critical Care Clinics, 2015
Sleep is disrupted in most patients hospitalized in the intensive care unit and the disturbances ... more Sleep is disrupted in most patients hospitalized in the intensive care unit and the disturbances are even more profound in patients impacted by epilepsy. Nocturnal seizures must be differentiated from other common nocturnal events, such as delirium, parasomnias, and sedation. Many antiepileptic drugs produce undesirable side effects on sleep architecture that may further predispose patients to insomnia during the night and excessive sedation and hypersomnolence during the day. Failure to recognize, correctly diagnose, and adequately manage these disturbances may lead to more prolonged hospitalization, increased risk for nosocomial infections, poorer health-related qualify of life, and greater health care financial burden.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 2, 2015
We report a case of a 53-year-old man presenting with depressed alertness and severe excessive sl... more We report a case of a 53-year-old man presenting with depressed alertness and severe excessive sleepiness in the setting of neurosarcoidosis. Neuroimaging demonstrated hypothalamic destruction due to sarcoidosis with a CSF hypocretin level of 0 pg/mL. The patient also experienced respiratory depression that presumably resulted from hypocretin-mediated hypothalamic dysfunction as a result of extensive diencephalic injury. This is a novel case, demonstrating both hypocretin deficiency syndrome, as well as respiratory dysfunction from destruction of hypocretin neurons and extensive destruction of key diencephalic structures secondary to the underlying neurosarcoidosis.
Annals of the American Thoracic Society, 2014
British Journal of Anaesthesia, 2004
fluorocarbons (CFC) as a medical aerosol propellant in an attempt to reduce damage to the ozone l... more fluorocarbons (CFC) as a medical aerosol propellant in an attempt to reduce damage to the ozone layer. This study compared the effects of HFA- and CFC-based inhalers on four anaes- thetic gas monitoring systems. Methods. The HFA- and CFC-based inhalers were activated in close proximity to the sample line of two Datex Ohmeda, an Agilent and a Siemens infrared anaesthetic
Journal of Clinical Sleep Medicine, 2000
Seminars in Neurology, 2005
... during apneic spells.[26] Another study demonstrated normal fetal heart rate reactivity on ..... more ... during apneic spells.[26] Another study demonstrated normal fetal heart rate reactivity on ... Other considerations include oral appliances, uvulopalatopharyngoplasty, tracheostomy, or oxygen supplementation, the latter of ... in women than in men.[35] The reported rate declines with ...
Journal of Neuropsychiatry, 2013
The authors examined associations of various sleep-disturbance symptoms with health-related quali... more The authors examined associations of various sleep-disturbance symptoms with health-related quality of life (HRQOL) in 153 adults with Parkinson's disease (PD). PD patients reported more snoring, sleep inadequacy, daytime somnolence, and sleep-maintenance problems than the general population. Symptoms having the broadest and strongest unique associations with generic HRQOL (eight scales; two composites of SF-36) were daytime somnolence (five scales; one composite), sleep initiation (eight scales; two composites), and awakening short of breath or with headache (six scales; two composites). Associations of selected sleep-disturbance symptoms--some unanticipated--suggest that assessing specific symptoms is worthwhile in clinical care.
American Journal of Psychiatry, 2004
The aim is to review sleep disturbances in different movement disorders, mainly Parkinson&... more The aim is to review sleep disturbances in different movement disorders, mainly Parkinson's disease, and highlight current concepts on merging the boundaries between movement disorders and dissociative states of being. Since the observation that rapid eye movement sleep behavior disorder (RBD) may be an early marker of neurodegeneration, many studies focused on this disorder for the opportunity to explore the pathogenetic mechanisms underlying movement disorder and future neuroprotective therapies. It is also increasingly evident that this disorder is a possible marker for incoming dementia and for a general worst prognosis. Mechanisms of excessive daytime sleepiness in Parkinson's disease are still to be clarified and, if the role of hypocretin neuron loss is still doubtful, attention is moving to the role of monoaminergic system disruption. The role of dopamine in circadian rhythm regulation is opening new scenarios, namely the disruption of clock genes expression. Finally, the close relationship between sleep and movement disorder is emerging also in primarly sleep disorders. Recent studies provided new insights into the links between sleep and movement disorder that may simplify the diagnostic process and shed light on the underlying pathophysiological mechanisms.
Sleep medicine, 2002
The Internet is a rich but unregulated source of information, and no studies have evaluated sleep... more The Internet is a rich but unregulated source of information, and no studies have evaluated sleep medicine content designed for patient or public use. To examine how the Epworth Sleepiness Scale is presented on the World Wide Web. We searched the web with eight search engines, in November 2000, for the terms 'ESS' or 'Epworth Sleepiness Scale' and examined every site that listed the full ESS. The 91 sites were sponsored by academic institutions (n=11), private medical groups (34), corporations (21), and web information services (25). No information on interpretation of ESS results was given by 24 (26%) of the sites; 37 (41%) of the sites stated that a score greater than 8, 9, 10, 11, or 12 merits consultation with a clinician. Few sites mentioned that insufficient sleep and depression are among the most common causes of excessive sleepiness, or that the meaning and value of the ESS are somewhat controversial. The ESS is widely available on web sites designed for publ...
Alzheimer disease and associated disorders, Jan 17, 2015
Advances in Cell Aging and Gerontology, 2005
Sleep disordered breathing (SDB) is a spectrum of nocturnal breathing events. It consists of obst... more Sleep disordered breathing (SDB) is a spectrum of nocturnal breathing events. It consists of obstructive, central, and mixed sleep apnea as well as upper airway resistance syndrome and snoring. Obstructive sleep apnea is characterized by repetitive upper airway obstructive events. The primary symptoms include excessive daytime sleepiness, snoring, and impairment of cognition. In some cases, it can be associated with increased risk of motor vehicle accidents. Obstructive sleep apnea (OSA) varies considerably in its distribution in age and its severity. The exact mechanism of OSA is not yet fully delineated but multiple factors are generally associated with the development of the sleep apnea (SA) syndrome. These factors include upper airway anatomic obstruction, as well as mechanical, neurological, and possibly inflammatory changes in the pharyngeal airspace. The prevalence of the OSA increases with aging. Most studies report a prevalence rate ranging between 11 and 62%. It is further associated with increased mortality in the older patient population. Central sleep apnea (CSA) occurs in higher frequency among patients with cerebral vascular accidents, central nervous system (CNS) tumors, CNS infections, encephalopathies, and congestive heart failure. Patients with cerebral vascular accidents have a markedly elevated prevalence of sleep apnea mainly in the form of OSA and also have a poorer prognosis after an acute infarct. Patients with Alzheimer’s disease also have more frequent SDcB. This SDB should certainly be considered in the differential diagnosis of reversible dementia as treatment of the underlying SDB improves cognitive dysfunction. Medical management of SA relies on treatment with positive pressure therapy and rarely with use of medications, or with surgery. The role of oral appliances has not been clearly determined in elderly cohorts. The aim of this chapter is to help shed light on the epidemiology, pathophysiology, diagnosis, and management of SDB in the geriatric patient population.
The Journal of Community and Supportive Oncology, 2015
Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be ... more Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be present at any stage during treatment for cancer and in some patients, sleep disturbance may be the presenting symptoms that lead to the diagnosis of some types of cancer. Poor sleep impairs quality of life In people with cancer, but most do not specifically complain of sleep problems unless they are explicitly asked. Insomnia and fatigue are most common sleep disorders in this cohort, although primary sleep disorders, including obstructive sleep apnea and restless legs syndrome, which are common in the general population, have not been carefully studied in the oncology setting despite significant impairment to their quality of life.
Reviews in neurological diseases, 2007
Complaints of insomnia are prevalent in neurodegenerative and neurological disorders. Neurologist... more Complaints of insomnia are prevalent in neurodegenerative and neurological disorders. Neurologists therefore must be aware of the underlying causes, pathophysiologic mechanisms, and potential interventions when encountering a patient with underlying neurological disorders who is also complaining of poor sleep and insomnia. This article describes the underlying pathophysiology, diagnostic approaches, and potential interventions for insomnia in the neurological patient. Clinicians need to recognize that insomnia in older patients with underlying neurological disorders is not only unique, but also complex, demanding comprehensive and careful evaluation and management. Treatment of insomnia should start by addressing nonpharmacologic options, including improvements in sleep hygiene, improving sunlight exposure during the day, and searching for underlying reversible causes, such as sleep apnea, restless legs syndrome, periodic leg movements, and circadian rhythm disturbances, all of whic...
Sleep Medicine Clinics, 2006
Diabetes, 1991
The effects of oral vanadyl sulfate administration for 9-12 days on carbohydrate and lipid metabo... more The effects of oral vanadyl sulfate administration for 9-12 days on carbohydrate and lipid metabolism in the basal state and on glucose dynamics during submaximal hyperinsulinemic clamps were investigated in nondiabetic and streptozocin-induced diabetic rats. Decreases in growth rate and water and food consumption were the only significant alterations noted in control animals receiving vanadyl. Administration of vanadyl to diabetic rats resulted in weight loss; a significant decrease in plasma glucose, triglyceride, and cholesterol levels; and decreases in food and water intake, without a concomitant change in plasma insulin concentrations. Vanadyl treatment did not modify either peripheral glucose utilization or hepatic glucose production in control rats during submaximal insulin clamps. In contrast, vanadyl therapy increased insulin-induced glucose utilization significantly and had a small but nonsignificant effect on insulin-mediated suppression of glucose production in diabetic rats. The tyrosine kinase activity of liver- and muscle-derived insulin receptors from diabetic rats that underwent clamp study, which reflected the in vivo phosphorylation state of insulin receptor, was not altered by vanadyl treatment. In conclusion, these results show that augmentation of peripheral glucose utilization is the major determinant of the antidiabetic action of vanadyl and support the notion that the action of vanadyl is independent of insulin-receptor kinase activity.
Critical Care Clinics, 2015
Sleep is disrupted in most patients hospitalized in the intensive care unit and the disturbances ... more Sleep is disrupted in most patients hospitalized in the intensive care unit and the disturbances are even more profound in patients impacted by epilepsy. Nocturnal seizures must be differentiated from other common nocturnal events, such as delirium, parasomnias, and sedation. Many antiepileptic drugs produce undesirable side effects on sleep architecture that may further predispose patients to insomnia during the night and excessive sedation and hypersomnolence during the day. Failure to recognize, correctly diagnose, and adequately manage these disturbances may lead to more prolonged hospitalization, increased risk for nosocomial infections, poorer health-related qualify of life, and greater health care financial burden.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 2, 2015
We report a case of a 53-year-old man presenting with depressed alertness and severe excessive sl... more We report a case of a 53-year-old man presenting with depressed alertness and severe excessive sleepiness in the setting of neurosarcoidosis. Neuroimaging demonstrated hypothalamic destruction due to sarcoidosis with a CSF hypocretin level of 0 pg/mL. The patient also experienced respiratory depression that presumably resulted from hypocretin-mediated hypothalamic dysfunction as a result of extensive diencephalic injury. This is a novel case, demonstrating both hypocretin deficiency syndrome, as well as respiratory dysfunction from destruction of hypocretin neurons and extensive destruction of key diencephalic structures secondary to the underlying neurosarcoidosis.
Annals of the American Thoracic Society, 2014
British Journal of Anaesthesia, 2004
fluorocarbons (CFC) as a medical aerosol propellant in an attempt to reduce damage to the ozone l... more fluorocarbons (CFC) as a medical aerosol propellant in an attempt to reduce damage to the ozone layer. This study compared the effects of HFA- and CFC-based inhalers on four anaes- thetic gas monitoring systems. Methods. The HFA- and CFC-based inhalers were activated in close proximity to the sample line of two Datex Ohmeda, an Agilent and a Siemens infrared anaesthetic
Journal of Clinical Sleep Medicine, 2000
Seminars in Neurology, 2005
... during apneic spells.[26] Another study demonstrated normal fetal heart rate reactivity on ..... more ... during apneic spells.[26] Another study demonstrated normal fetal heart rate reactivity on ... Other considerations include oral appliances, uvulopalatopharyngoplasty, tracheostomy, or oxygen supplementation, the latter of ... in women than in men.[35] The reported rate declines with ...
Journal of Neuropsychiatry, 2013
The authors examined associations of various sleep-disturbance symptoms with health-related quali... more The authors examined associations of various sleep-disturbance symptoms with health-related quality of life (HRQOL) in 153 adults with Parkinson's disease (PD). PD patients reported more snoring, sleep inadequacy, daytime somnolence, and sleep-maintenance problems than the general population. Symptoms having the broadest and strongest unique associations with generic HRQOL (eight scales; two composites of SF-36) were daytime somnolence (five scales; one composite), sleep initiation (eight scales; two composites), and awakening short of breath or with headache (six scales; two composites). Associations of selected sleep-disturbance symptoms--some unanticipated--suggest that assessing specific symptoms is worthwhile in clinical care.
American Journal of Psychiatry, 2004
The aim is to review sleep disturbances in different movement disorders, mainly Parkinson&... more The aim is to review sleep disturbances in different movement disorders, mainly Parkinson's disease, and highlight current concepts on merging the boundaries between movement disorders and dissociative states of being. Since the observation that rapid eye movement sleep behavior disorder (RBD) may be an early marker of neurodegeneration, many studies focused on this disorder for the opportunity to explore the pathogenetic mechanisms underlying movement disorder and future neuroprotective therapies. It is also increasingly evident that this disorder is a possible marker for incoming dementia and for a general worst prognosis. Mechanisms of excessive daytime sleepiness in Parkinson's disease are still to be clarified and, if the role of hypocretin neuron loss is still doubtful, attention is moving to the role of monoaminergic system disruption. The role of dopamine in circadian rhythm regulation is opening new scenarios, namely the disruption of clock genes expression. Finally, the close relationship between sleep and movement disorder is emerging also in primarly sleep disorders. Recent studies provided new insights into the links between sleep and movement disorder that may simplify the diagnostic process and shed light on the underlying pathophysiological mechanisms.
Sleep medicine, 2002
The Internet is a rich but unregulated source of information, and no studies have evaluated sleep... more The Internet is a rich but unregulated source of information, and no studies have evaluated sleep medicine content designed for patient or public use. To examine how the Epworth Sleepiness Scale is presented on the World Wide Web. We searched the web with eight search engines, in November 2000, for the terms 'ESS' or 'Epworth Sleepiness Scale' and examined every site that listed the full ESS. The 91 sites were sponsored by academic institutions (n=11), private medical groups (34), corporations (21), and web information services (25). No information on interpretation of ESS results was given by 24 (26%) of the sites; 37 (41%) of the sites stated that a score greater than 8, 9, 10, 11, or 12 merits consultation with a clinician. Few sites mentioned that insufficient sleep and depression are among the most common causes of excessive sleepiness, or that the meaning and value of the ESS are somewhat controversial. The ESS is widely available on web sites designed for publ...