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  1. Article ; Online: Comorbid insomnia and sleep apnea: characterization of the syndrome and understanding its associations with comorbid sleep conditions.

    Subramanian, Shyam / Hesselbacher, Sean E / Nye, Phillip / Aiyer, Akshar A / Surani, Salim R

    Sleep & breathing = Schlaf & Atmung

    2021  Volume 25, Issue 4, Page(s) 1995–2000

    Abstract: Purpose: Obstructive sleep apnea (OSA) is traditionally associated with excessive daytime sleepiness. Insomnia is characterized by hyperarousal, and is seen as a predominant feature in a subgroup of patients with OSA. The aim of this study was to ... ...

    Abstract Purpose: Obstructive sleep apnea (OSA) is traditionally associated with excessive daytime sleepiness. Insomnia is characterized by hyperarousal, and is seen as a predominant feature in a subgroup of patients with OSA. The aim of this study was to describe the prevalence of comorbid insomnia and sleep apnea (COMISA) in a sleep apnea population and to characterize its features.
    Methods: This was a chart review of patients who underwent overnight polysomnography (PSG). All patients completed questionnaires with the Epworth Sleepiness Scale (ESS), and symptoms of insomnia and other sleep-related comorbidities. Patients with OSA on the PSG were included.
    Results: A total of 296 patients with OSA were included, of which 80% reported at least 1 major symptom of insomnia: 57% reported sleep onset insomnia, 68% sleep maintenance insomnia, and 48% had early morning awakenings. COMISA (OSA plus 2 or more major symptoms of insomnia) was seen in 63%. These patients were more likely to report an abnormal ESS score, gastroesophageal reflux (GER), and restless legs (RL) than those without; no difference was seen in self-reported sleep bruxism. Among the patients with COMISA, 85% reported at least 1 representative symptom of psychophysiological insomnia (PPI); each of the 5 PPI symptoms was present in at least 40% of patients with COMISA.
    Conclusions: Insomnia is extremely prevalent in our population of patients with OSA, accompanied by daytime sleepiness and symptoms of PPI, GER, and RL. Further study is needed to determine the interactions between symptoms and OSA treatments in these patients.
    MeSH term(s) Adult ; Comorbidity ; Disorders of Excessive Somnolence/epidemiology ; Female ; Gastroesophageal Reflux/epidemiology ; Humans ; Male ; Middle Aged ; Polysomnography ; Prevalence ; Restless Legs Syndrome/epidemiology ; Sleep Apnea Syndromes/epidemiology ; Sleep Initiation and Maintenance Disorders/epidemiology
    Language English
    Publishing date 2021-03-04
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1500381-4
    ISSN 1522-1709 ; 1520-9512
    ISSN (online) 1522-1709
    ISSN 1520-9512
    DOI 10.1007/s11325-021-02331-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: COVID-19 ANXIETY AND STRESS SURVEY (CASS) IN HEALTHCARE WORKERS DUE TO CORONAVIRUS DISEASE 2019

    Aiyer, Akshar / Surani, Salim / Varon, Joseph / Ali, Mohammed / Sunesara, Shaleen

    Chest

    2020  Volume 158, Issue 4, Page(s) A313

    Keywords Critical Care and Intensive Care Medicine ; Pulmonary and Respiratory Medicine ; Cardiology and Cardiovascular Medicine ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2020.08.311
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: COVID-19 ANXIETY AND STRESS SURVEY (CASS) IN HIGH SCHOOL AND COLLEGE STUDENTS DUE TO CORONAVIRUS DISEASE 2019

    Aiyer, Akshar / Surani, Salim / Gill, Yashdeep / Ratnani, Iqbal / Sunesara, Shaleen

    Chest

    2020  Volume 158, Issue 4, Page(s) A314

    Keywords Critical Care and Intensive Care Medicine ; Pulmonary and Respiratory Medicine ; Cardiology and Cardiovascular Medicine ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2020.08.312
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article: Ethnic Variance in Prevalence of COPD among Smokers in a Real World Setting.

    Aiyer, Akshar / Surani, Salim / Aguillar, Raymond / Sharma, Munish / Ali, Mohammed / Varon, Joseph

    The open respiratory medicine journal

    2020  Volume 14, Page(s) 93–98

    Abstract: Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent and progressive airflow limitation generally caused by prolonged cigarette smoking. Ethnic differences have been reported regarding COPD risk from smoking. The ... ...

    Abstract Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent and progressive airflow limitation generally caused by prolonged cigarette smoking. Ethnic differences have been reported regarding COPD risk from smoking. The purpose of this study was to compare COPD prevalence in Hispanic and Caucasian smokers in a real-world setting. We studied consecutive patients referred to the community-based pulmonary practice. Hispanic and Caucasian smokers were included in the study.
    Methods: The clinical diagnosis of COPD was recorded from the chart. COPD was defined by PFT using GOLD criteria. Exclusion criteria were other ethnicities, non-smokers, and patients with a history of asthma /other pulmonary conditions. We reviewed a total of 1,313 consecutive PFTs of which 797 patients met our inclusion criteria.
    Results and discussion: The prevalence of COPD among Hispanics was found to be lower by both clinical diagnosis as well as by spirometry compared to Caucasians (41.6% vs 54.2%). In Hispanics, clinical diagnosis was 91% higher by PFT, whereas for Caucasians, it was 6% lower. The odds of developing COPD (diagnosed based on FEV
    Conclusion: The genetic basis of lower COPD risk and prevalence in Hispanics needs to be better understood. Spirometry threshold criteria for confirming a diagnosis of COPD may need to be modified based on ethnicity in clinical practice.
    Language English
    Publishing date 2020-12-31
    Publishing country United Arab Emirates
    Document type Journal Article
    ZDB-ID 2395996-4
    ISSN 1874-3064
    ISSN 1874-3064
    DOI 10.2174/1874306402014010093
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: A Study to Assess the Relationship between Attention Deficit Hyperactivity Disorder and Obstructive Sleep Apnea in Adults.

    Hesselbacher, Sean / Aiyer, Akshar A / Surani, Salim R / Suleman, Alishah A / Varon, Joseph

    Cureus

    2019  Volume 11, Issue 10, Page(s) e5979

    Abstract: The association between obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD) is well-established in children. However, there is a paucity of literature regarding this association in adults. The aim of this study was to ... ...

    Abstract The association between obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD) is well-established in children. However, there is a paucity of literature regarding this association in adults. The aim of this study was to determine if ADHD is more common in adult patients with OSA. All patients referred to a sleep center for sleep evaluation were administered the Adult ADHD Self-Report Scale and diagnostic polysomnogram. The ADHD screen is considered positive if 4 of 6 questions in part A of the screening questionnaire were answered abnormally. The study population consisted of 194 participants, predominantly male (62%), Caucasian (54%), and Hispanic (44%). OSA was identified in 160 (83%) of participants, with 116 (60%) having moderate to severe OSA. The ADHD screen was positive in 37 (19%) of participants. There was no significant association between the severity of OSA and presence of ADHD symptoms. Patients with OSA who screened positive for ADHD had higher Epworth Sleepiness Scale scores than those that did not. These data suggest that ADHD is more prevalent in patients with OSA, but do not demonstrate a relationship between OSA severity and ADHD symptoms. Interestingly, sleepiness is more prominent in patients with ADHD.
    Language English
    Publishing date 2019-10-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.5979
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Adoption and adherence to chronic obstructive pulmonary disease GOLD guidelines in a primary care setting.

    Surani, Salim / Aiyer, Akshar / Eikermann, Stephen / Murphy, Timothy / Anand, Pranav / Varon, Joseph / Vanderheiden, David / Khan, Alamgir / Guzman, Antonio

    SAGE open medicine

    2019  Volume 7, Page(s) 2050312119842221

    Abstract: Objectives: Over 380 million people in the world live with chronic obstructive pulmonary disease, and it is the third leading cause of death in the United States. Despite updated guidelines, there may be significant variations in diagnosis and ... ...

    Abstract Objectives: Over 380 million people in the world live with chronic obstructive pulmonary disease, and it is the third leading cause of death in the United States. Despite updated guidelines, there may be significant variations in diagnosis and management of chronic obstructive pulmonary disease at a primary care level. The aim of the study was to examine primary care physician management of chronic obstructive pulmonary disease in two community clinics.
    Methods: After approval from the Institutional Review Board, a retrospective chart review was done among all patients with the diagnosis of chronic obstructive pulmonary disease in two community clinics. Baseline demographics, utilization of spirometry, exacerbation history and home oxygen use were also obtained.
    Results: Chart reviews of 101 patients were completed (52 male and 49 female) in two outpatient primary care provider offices (Office A: 66 patients and Office B: 35 patients). None of the patients had validated measures of dyspnoea such as CAT or mMRC scores. Only 21% (22/101) of the patients had formal pulmonary function test testing done, and of those who had pulmonary function tests, 31.5% of patients were incorrectly diagnosed and mislabelled as chronic obstructive pulmonary disease. Pharmacotherapy for chronic obstructive pulmonary disease was not in alignment with GOLD guidelines, with only 42% of patients on an inhaler regimen that included a long-acting muscarinic antagonist.
    Conclusion: There is suboptimal use of pulmonary function test in a primary care setting for diagnosis of chronic obstructive pulmonary disease and substantial errors in diagnosis. There is virtually no use routinely of validated symptom scales for diagnosis of chronic obstructive pulmonary disease. There is substantial variance in pharmacotherapy, and regimens routinely do not follow GOLD guidelines.
    Language English
    Publishing date 2019-04-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 2735399-0
    ISSN 2050-3121
    ISSN 2050-3121
    DOI 10.1177/2050312119842221
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Adoption and adherence to chronic obstructive pulmonary disease GOLD guidelines in a primary care setting

    Salim Surani / Akshar Aiyer / Stephen Eikermann / Timothy Murphy / Pranav Anand / Joseph Varon / David Vanderheiden / Alamgir Khan / Antonio Guzman

    SAGE Open Medicine, Vol

    2019  Volume 7

    Abstract: Objectives: Over 380 million people in the world live with chronic obstructive pulmonary disease, and it is the third leading cause of death in the United States. Despite updated guidelines, there may be significant variations in diagnosis and management ...

    Abstract Objectives: Over 380 million people in the world live with chronic obstructive pulmonary disease, and it is the third leading cause of death in the United States. Despite updated guidelines, there may be significant variations in diagnosis and management of chronic obstructive pulmonary disease at a primary care level. The aim of the study was to examine primary care physician management of chronic obstructive pulmonary disease in two community clinics. Methods: After approval from the Institutional Review Board, a retrospective chart review was done among all patients with the diagnosis of chronic obstructive pulmonary disease in two community clinics. Baseline demographics, utilization of spirometry, exacerbation history and home oxygen use were also obtained. Results: Chart reviews of 101 patients were completed (52 male and 49 female) in two outpatient primary care provider offices (Office A: 66 patients and Office B: 35 patients). None of the patients had validated measures of dyspnoea such as CAT or mMRC scores. Only 21% (22/101) of the patients had formal pulmonary function test testing done, and of those who had pulmonary function tests, 31.5% of patients were incorrectly diagnosed and mislabelled as chronic obstructive pulmonary disease. Pharmacotherapy for chronic obstructive pulmonary disease was not in alignment with GOLD guidelines, with only 42% of patients on an inhaler regimen that included a long-acting muscarinic antagonist. Conclusion: There is suboptimal use of pulmonary function test in a primary care setting for diagnosis of chronic obstructive pulmonary disease and substantial errors in diagnosis. There is virtually no use routinely of validated symptom scales for diagnosis of chronic obstructive pulmonary disease. There is substantial variance in pharmacotherapy, and regimens routinely do not follow GOLD guidelines.
    Keywords Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2019-04-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article: Covid-19 Anxiety and Stress Survey (cass) in High School and College Students Due to Coronavirus Disease 2019

    Aiyer, A. / Surani, S. / Gill, Y. / Ratnani, I. / Sunesara, S.

    Chest

    Abstract: ... relationships by Akshar Aiyer, source=Web Response No relevant relationships by Yashdeep Gill, source=Web ...

    Abstract SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The covid19 crisis has rapidly become the most significant public health crisis of our times It has particularly impacted students due to cancellation of school and having to adjust to online learning and anxiety about their future, as well as prolonged social isolation All these factors has likely led to significant stress and anxiety The purpose of this study was to study the prevalence and severity of covid19 associated anxiety and stress in high school (HS) students and undergraduate (UG) college students in the US during the period of the Covid19 pandemic METHODS: We created a covid19 anxiety and stress survey (CASS) by combining 2 abbreviated instruments – the Perceived Stress Scale (PSS-4) and the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) We distributed the CASS survery in electronic format during the month of March/April at the peak of the covid19 pandemic, both directly, as well as through use of social media to students in HS and UG We also collected limited information about grade level, age, gender, ethnicity and location RESULTS: A total of 116 (72Male;44 Female) students completed the questionnaire - Grade distribution was15 HS (Gr 9,10), 41 HS (Gr 11,12), 41 UG (Yr 1,2), & 19 UG (Yr 3,4) 56 (48 2%) had an elevated perceived stress level (PSS-4 of >8) 66 of students (56 9%) screened positive for a mood disorder depression/anxiety based on PSQ4 of >4 When we examined the subscales we found 43(37%) had anxiety (PSQ-2 for anxiety of >3) and 36 (31%) had depression (PSQ-2 for depression >3) Both HS and UG had similar levels of stress, but both overall PSQ4 as well as subscales for anxiety and depression was significantly more prevalent in college than in high school students (Mean total PSQ4 scores was 5 4 +/- 4 for UG vs 3 9 +/- 3 3 HS respectively) Strong gender influence in both PSS and PSQ was seen – mean PSS for girls and boys was 8 7 +/- 2 6 vs 7 2 +/- 2 8;p <0 05 and PSQ4 was 6 1 +/- 3 2 vs 4 2 +/- 3 8 respectively) There was a strong correlation between PSS and PSQ scores (r = 0 68) CONCLUSIONS: The Covid19 pandemic has resulted in an extremely high level of stress and mental health morbidity in both high school and especially college students There is a high prevalence of depression and anxiety in students, and this is more pronounced in girls CLINICAL IMPLICATIONS: Specific screening measures and interventions to improve mental health of students especially in college is urgently warranted with a particular focus on women, due to the covid19 pandemic DISCLOSURES: No relevant relationships by Akshar Aiyer, source=Web Response No relevant relationships by Yashdeep Gill, source=Web Response No relevant relationships by Iqbal Ratnani, source=Web Response No relevant relationships by Shaleen Sunesara, source=Web Response No relevant relationships by Salim Surani, source=Web Response
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #866523
    Database COVID19

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  9. Article: Covid-19 Anxiety and Stress Survey (cass) in Healthcare Workers Due to Coronavirus Disease 2019

    Aiyer, A. / Surani, S. / Varon, J. / Ali, M. / Sunesara, S.

    Chest

    Abstract: ... DISCLOSURES: No relevant relationships by Akshar Aiyer, source=Web Response No relevant relationships ...

    Abstract SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The covid19 crisis has rapidly become the most significant public health crisis of our times It has particularly impacted healthcare workers (HCW) due to overwhelming of healthcare resources, as well as a critical absence of protective equipment and risk to their own health as well as risk of exposure to their family All these factors have likely resulted in significant levels of stress and anxiety The purpose of this study was to study the prevalence and severity of covid19 associated anxiety and stress in healthcare workers in the US during the period of the Covid19 pandemic METHODS: We created a covid19 anxiety and stress survey (CASS) by combining 2 abbreviated instruments – the Perceived Stress Scale (PSS-4) and the Patient Health Questionnaire for Depression and Anxiety PHQ-4 We distributed the CASS survery in electronic format during the month of March/April at the peak of the covid19 pandemic, both directly, as well as through use of social media We invited all HCW including nurses (RN) physicians (MD) medical and nursing assistants (MA, CNA) and respiratory therapists (RT) We also collected limited information about age, gender, ethnicity and location RESULTS: A total of 313 (53Male;260 Female) HCW completed the questionnaire - 166 RNs, 95 MDs, 15 CNA/MA, & 16 RTs Age distribution – 130 between 20-40, & 166 41-60 151 (48 2%) had an elevated stress level (PSS-4 of >8) Both MD and RN had similar levels of high stress 175 HCW (55 9%) screened positive for a mood disorder depression/anxiety based on PSQ4 of >4 When we examined the subscales we found 133(42 4%) had anxiety (PSQ-2 for anxiety of >3) whereas only 89 (28 4%) had depression (PSQ-2 for depression >3) Both MD and RN had similar levels of high stress Age did not have a influence but a significance gender influence in both PSS and PSQ was seen – male gender representation was 10% of HCW for high stress vs 24% in normal stress and 9% for anxiety/depression vs 20 8% respectively (p <0 05) There was a strong correlation between PSS and PSQ scores (r = 0 70) There was no significant differences between MD and RN in stress or anxiety scales CONCLUSIONS: The Covid19 pandemic has resulted in an extremely high level of stress and mental health morbidity Over half of healthcare workers had significant anxiety and depression and nearly 50% had high levels of perception of stress, regardless of age This was especially more pronounced in female gender for both stress as well as anxiety CLINICAL IMPLICATIONS: Specific screening measures and interventions to improve mental health of HCW is urgently warranted with a particular focus on womens health due to the covid19 pandemic DISCLOSURES: No relevant relationships by Akshar Aiyer, source=Web Response No relevant relationships by Mohammed Ali, source=Web Response No relevant relationships by Shaleen Sunesara, source=Web Response No relevant relationships by Salim Surani, source=Web Response No relevant relationships by Joseph Varon, source=Web Response
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #866522
    Database COVID19

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