Introduction REM-Behavior-Disorder (RBD) patients are known for parasomnias causing self-injury. ... more Introduction REM-Behavior-Disorder (RBD) patients are known for parasomnias causing self-injury. On literature review, harm to others using a weapon is not well established. Some opinions state REM-parasomnias do not consist of elaborate actions, such firing a gun. This has significant ramifications in forensic medicine when RBD is a consideration. We reviewed our RBD patients to identify instances in which a gun was used during a parasomnic event to characterize clinical features associated with such behaviors. Methods We reviewed over 57 RBD cases from Texas, between 2014-2017 seeking parasomnias in which a gun was used. Results We found two patients in whom a gun was used during a parasomnia, representing < 3.5% of cases. Case-1: 59 y/o F with a 5 year hx of parasomnias of screaming, thrashing, roaming and one instance in which she pointed an unloaded gun at her husband saying she was going to kill him. She had no recollection of the event. NPSG demonstrated REM without atonia...
Introduction If Remote Patient Monitoring (RPM) is to become integrated into sleep medicine pract... more Introduction If Remote Patient Monitoring (RPM) is to become integrated into sleep medicine practices, patient compliance and reliability of data acquisition needs to be determined. We developed the REST Tracker platform to monitor OSA patients nightly, using an oximeter ring with data analyzed by a recognized method (1) to render a sAHI that has been FDA approved (FDA reference number K182618) providing an equivalent to the AHI. The REST Tracker tracks the sAHI along with multiple other parameters, providing the clinician nightly physiologic data to assist in OSA management decisions. Here we present patient compliance and system reliability data. Methods Data obtained from a ring pulse oximeter worn nightly is transmitted by Bluetooth to a cellular device at the bedside. Nightly data from bedtime to final morning awakening is transmitted to the cloud and retrieved by the REST Tracker system which tabulates and displays the data in a format that assists the clinician in OSA managem...
Concussion is a common brain injury. The American Academy of Neurology provides a definition of c... more Concussion is a common brain injury. The American Academy of Neurology provides a definition of concussion: “Concussion is a traumatically, or biomechanically, induced alteration of brain function. Emphasis is placed on a pathophysiological process, or functional disruption, as opposed to anatomic, structural, or tissue injury.”. The incidence of mild traumatic brain injury (mTBI) is estimated at 200 per 100 000. The Centers for Disease Control and Prevention (CDC) estimates 3.8 million sport and recreational mTBIs occurring in the United States each year. A more recent CDC assessment estimates 2.5 million concussion injuries in high school sports alone. The controlled environment and opportunity for direct surveillance and observation has made the sports arena the scientific “wet lab” for the study of mTBI natural history, short- and long-term consequences and opportunities to intervene. Quantitative EEG methods have been utilized in the assessment and management of mTBI and lends ...
Journal of the California Dental Association, 1998
The dilemma frequently encountered by the dentist wishing to offer an appliance for treatment of ... more The dilemma frequently encountered by the dentist wishing to offer an appliance for treatment of snoring or sleep apnea is whether there is a need for extensive testing of patients who present with a complaint of snoring. This article describes diagnostic sleep testing in the evaluation of patients with snoring and sleep apnea.
To test the safety and efficacy of onabotulinum toxin-A (BoNT-A) injections into the masseter and... more To test the safety and efficacy of onabotulinum toxin-A (BoNT-A) injections into the masseter and temporalis muscles in patients with symptomatic sleep bruxism. Participants 18 to 85 years old with clinically diagnosed sleep bruxism confirmed by polysomnography were enrolled in this randomized, placebo-controlled, 1:1, parallel-design trial with open-label extension. Participants were injected with BoNT-A 200 units (60 into each masseter and 40 into each temporalis) or placebo and were evaluated at 4 to 8 weeks after the initial treatment visit. The primary efficacy endpoint was clinical global impression (CGI), and the secondary efficacy endpoint was a visual analog scale (VAS) of change in bruxism and in pain at 4 to 8 weeks after injection. Exploratory endpoints included modified Montreal Bruxism Questionnaire, Headache Impact Test-6, total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Self-Rated Anxiety Scale, and polysomnography data, including EMG recordings of the...
Journal of the California Dental Association, 2012
Conditions that affect sleep can impact overall health. More than 70 million Americans suffer fro... more Conditions that affect sleep can impact overall health. More than 70 million Americans suffer from problems with sleep. The purpose of this article is to provide the basic science of sleep physiology and how it relates to disorders that are pertinent to dentistry. Concepts are presented that explain airway dynamics and how the jaw and tongue influence airway obstruction. Additionally, explanation is given on an association between temporomandibularj aw dysfunction and bruxism during sleep.
Introduction REM-Behavior-Disorder (RBD) patients are known for parasomnias causing self-injury. ... more Introduction REM-Behavior-Disorder (RBD) patients are known for parasomnias causing self-injury. On literature review, harm to others using a weapon is not well established. Some opinions state REM-parasomnias do not consist of elaborate actions, such firing a gun. This has significant ramifications in forensic medicine when RBD is a consideration. We reviewed our RBD patients to identify instances in which a gun was used during a parasomnic event to characterize clinical features associated with such behaviors. Methods We reviewed over 57 RBD cases from Texas, between 2014-2017 seeking parasomnias in which a gun was used. Results We found two patients in whom a gun was used during a parasomnia, representing < 3.5% of cases. Case-1: 59 y/o F with a 5 year hx of parasomnias of screaming, thrashing, roaming and one instance in which she pointed an unloaded gun at her husband saying she was going to kill him. She had no recollection of the event. NPSG demonstrated REM without atonia...
Introduction If Remote Patient Monitoring (RPM) is to become integrated into sleep medicine pract... more Introduction If Remote Patient Monitoring (RPM) is to become integrated into sleep medicine practices, patient compliance and reliability of data acquisition needs to be determined. We developed the REST Tracker platform to monitor OSA patients nightly, using an oximeter ring with data analyzed by a recognized method (1) to render a sAHI that has been FDA approved (FDA reference number K182618) providing an equivalent to the AHI. The REST Tracker tracks the sAHI along with multiple other parameters, providing the clinician nightly physiologic data to assist in OSA management decisions. Here we present patient compliance and system reliability data. Methods Data obtained from a ring pulse oximeter worn nightly is transmitted by Bluetooth to a cellular device at the bedside. Nightly data from bedtime to final morning awakening is transmitted to the cloud and retrieved by the REST Tracker system which tabulates and displays the data in a format that assists the clinician in OSA managem...
Concussion is a common brain injury. The American Academy of Neurology provides a definition of c... more Concussion is a common brain injury. The American Academy of Neurology provides a definition of concussion: “Concussion is a traumatically, or biomechanically, induced alteration of brain function. Emphasis is placed on a pathophysiological process, or functional disruption, as opposed to anatomic, structural, or tissue injury.”. The incidence of mild traumatic brain injury (mTBI) is estimated at 200 per 100 000. The Centers for Disease Control and Prevention (CDC) estimates 3.8 million sport and recreational mTBIs occurring in the United States each year. A more recent CDC assessment estimates 2.5 million concussion injuries in high school sports alone. The controlled environment and opportunity for direct surveillance and observation has made the sports arena the scientific “wet lab” for the study of mTBI natural history, short- and long-term consequences and opportunities to intervene. Quantitative EEG methods have been utilized in the assessment and management of mTBI and lends ...
Journal of the California Dental Association, 1998
The dilemma frequently encountered by the dentist wishing to offer an appliance for treatment of ... more The dilemma frequently encountered by the dentist wishing to offer an appliance for treatment of snoring or sleep apnea is whether there is a need for extensive testing of patients who present with a complaint of snoring. This article describes diagnostic sleep testing in the evaluation of patients with snoring and sleep apnea.
To test the safety and efficacy of onabotulinum toxin-A (BoNT-A) injections into the masseter and... more To test the safety and efficacy of onabotulinum toxin-A (BoNT-A) injections into the masseter and temporalis muscles in patients with symptomatic sleep bruxism. Participants 18 to 85 years old with clinically diagnosed sleep bruxism confirmed by polysomnography were enrolled in this randomized, placebo-controlled, 1:1, parallel-design trial with open-label extension. Participants were injected with BoNT-A 200 units (60 into each masseter and 40 into each temporalis) or placebo and were evaluated at 4 to 8 weeks after the initial treatment visit. The primary efficacy endpoint was clinical global impression (CGI), and the secondary efficacy endpoint was a visual analog scale (VAS) of change in bruxism and in pain at 4 to 8 weeks after injection. Exploratory endpoints included modified Montreal Bruxism Questionnaire, Headache Impact Test-6, total Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Self-Rated Anxiety Scale, and polysomnography data, including EMG recordings of the...
Journal of the California Dental Association, 2012
Conditions that affect sleep can impact overall health. More than 70 million Americans suffer fro... more Conditions that affect sleep can impact overall health. More than 70 million Americans suffer from problems with sleep. The purpose of this article is to provide the basic science of sleep physiology and how it relates to disorders that are pertinent to dentistry. Concepts are presented that explain airway dynamics and how the jaw and tongue influence airway obstruction. Additionally, explanation is given on an association between temporomandibularj aw dysfunction and bruxism during sleep.
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