Background: The persistent loss of consciousness caused by general anesthesia without the existence of repeated 90-minute cycles of non-REM and REM sleep might significantly disturb and suppress the cycle of normal physiological sleep in postoperative periods after general anesthesia. Patients with autism spectrum disorders (ASD) with existing circadian rhythm disorder are reported to rapidly deteriorate due to acute sleep disorder during the perioperative period after general anesthesia. A melatonin receptor agonist, ramelteon (Rozerem), which is a sleep cycle regulator, is used as a therapeutic drug for patients with sleep disorders, but there are no studies on the prevention of postoperative sleep disorder after general anesthesia. In this study, we investigate whether prophylactic administration of a sleep-inducing substance, a melatonin receptor agonist, is effective against sleep disorder after general anesthesia in patients with ASD. Methods/design: This study is intended for patients with ASD aged 12 years and above who undergo treatment at Nagasaki University Hospital, Isahaya General Hospital Dentistry, and Sasebo City General Medical Center Dentistry and undergo dental treatment under general anesthesia. A melatonin receptor agonist (Rozerem) will be taken 7 days prior and 7 days postsurgery in patients diagnosed with insomnia. A randomized comparison will be made between 2 groups: an experimental group that is additionally administered Rozerem and a control group. The primary endpoint is the incidence of NREM-REM sleep disorders that occur within 3 to 5 days after general anesthesia. The secondary endpoint is the incidence of circadian rhythm sleep disorders (rate of occurrence of sleep-retardation syndrome with drowsiness and strong fatigue). Discussion: Postoperative sleep disorders after general anesthesia has been reported in patients with ASD; however, effective preventive pharmacological treatments have not been established. A sleep cycle regulator, ramelteon (Rozerem), is used as a therapeutic drug for patients with sleep disorders by decreasing the difficulty of falling asleep in insomnia. If sleep disorder can be prevented after the administration of general anesthesia in patients with ASD, we can support social participation while maintaining their quality of life. Trial registration: The study was registered with the jRCT1071200030.
Background Body position might affect the coordination between respiration and swallowing. This study was carried out to test the hypothesis that during swallowing, coordinated movements of muscle groups such as the diaphragm and rectus abdominis muscles are important to control normal swallowing apnea. Objective To investigate this hypothesis, respiratory parameters, swallowing apnea and muscle activity were measured in each of four body positions: sitting position with feet on the floor, 30° reclining position, lateral position, and standing position. Methods All measurements were performed in nine healthy subjects. Nasal airflow was measured using a pneumotachometer and muscle activity was measured using an electromyograph. All lung volume fraction parameters were measured using spirometer and swallowing apnea time was calculated. Results The maximum inspiratory volume was 2.76 ± 0.83 L in the 30° reclining position, which was significantly larger than that in the other positions (p = .0001). The preliminary expiratory volume was 1.05 ± 0.42 L in the 30° reclining position, which was significantly smaller than that in the other positions (p < .0001). The swallowing apnea time during water swallowing was 1.17 ± 0.35 sec in the lateral position and 0.87 ± 0.28 sec in the 30° reclining position, which tended to be longer than the 0.78 sec in the sitting position. Conclusion We conclude that both lateral and reclining positions require a longer period of swallowing apnea compared to the sitting and standing positions. Differences in body position may significantly influence the coordination between respiration and swallowing.
ObjectivesThe aim of this study was to investigate the factors that influence the decayed, missing due to caries, and filled teeth (DMFT) index of patients with dental anxiety during dental treatment discontinuation.Materials and MethodsA total of 110 patients who complained of fear and anxiety toward dental treatments and who re-visited following treatment discontinuation were enrolled in the study. Patient and dental data considered to be related to caries were digitally collected from medical and dental records. The decayed (D), missing (M), and filled (F) scores, and the DMFT index before and after discontinuation were compared using Wilcoxon signed-rank tests, and the influential factors were evaluated using the Poisson and multiple regression analyses.ResultsThe D score and DMFT index increased significantly during the discontinuation period, and the F score decreased. There was no significant change in the M score. The change in the D score was influenced by the pre-discontinuation D score and the number of experiences of intravenous sedation, and the change in the F score was affected by the duration of treatment discontinuation, the DMFT index before discontinuation, and the number of experiences of intravenous sedation. The increase in the DMFT index was affected by the experience of intravenous sedation, the D and M scores, and the DMFT index before discontinuation.ConclusionDiscontinuation of dental treatment was proven to increase the incidence of caries in patients with dental anxiety.Clinical Relevance: Avoiding treatment discontinuation is crucial, particularly in patients treated using intravenous sedation.
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