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Continuum (Minneapolis, Minn.) Aug 2017Sleep-disordered breathing encompasses a broad spectrum of sleep-related breathing disorders, including obstructive sleep apnea (OSA), central sleep apnea, as well as... (Review)
Review
PURPOSE OF REVIEW
Sleep-disordered breathing encompasses a broad spectrum of sleep-related breathing disorders, including obstructive sleep apnea (OSA), central sleep apnea, as well as sleep-related hypoventilation and hypoxemia. Diagnostic criteria have been updated in the International Classification of Sleep Disorders, Third Edition and the American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events. Neurologic providers should have basic knowledge and skills to identify at-risk patients, as these disorders are associated with substantial morbidity, the treatment of which is largely reversible.
RECENT FINDINGS
OSA is the most common form of sleep-disordered breathing and is highly prevalent and grossly underdiagnosed. Recent studies suggest that prevalence rates in patients with neurologic disorders including epilepsy and stroke exceed general population estimates. The physiologic changes that occur in OSA are vast and involve complex mechanisms that play a role in the pathogenesis of cardiovascular and metabolic disorders and, although largely unproven, likely impact brain health and disease progression in neurologic patients. A tailored sleep history and examination as well as validated screening instruments are effective in identifying patients with sleep-disordered breathing, although sleep testing is necessary for diagnostic confirmation. While continuous positive airway pressure therapy and other forms of noninvasive positive pressure ventilation remain gold standard treatments, newer therapies, including mandibular advancement, oral appliance devices, and hypoglossal nerve stimulation, have become available. Emerging evidence of the beneficial effects of treatment of sleep-disordered breathing on neurologic outcomes underscores the importance of sleep education and awareness for neurologic providers.
SUMMARY
Sleep-disordered breathing is highly prevalent and grossly underrecognized. The adverse medical and psychosocial consequences of OSA and other sleep-related breathing disorders are considerable. The impact of sleep therapies on highly prevalent neurologic disorders associated with substantial morbidity and health care costs is becoming increasingly recognized.
Topics: Apnea; Humans; Polysomnography; Risk Factors; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 28777178
DOI: 10.1212/01.CON.0000522245.13784.f6 -
Journal of Clinical Sleep Medicine :... Mar 2017This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with...
INTRODUCTION
This guideline establishes clinical practice recommendations for the diagnosis of obstructive sleep apnea (OSA) in adults and is intended for use in conjunction with other American Academy of Sleep Medicine (AASM) guidelines on the evaluation and treatment of sleep-disordered breathing in adults.
METHODS
The AASM commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use. In addition, the task force adopted foundational recommendations from prior guidelines as "good practice statements", that establish the basis for appropriate and effective diagnosis of OSA. The AASM Board of Directors approved the final recommendations.
RECOMMENDATIONS
The following recommendations are intended as a guide for clinicians diagnosing OSA in adults. Under GRADE, a STRONG recommendation is one that clinicians should follow under most circumstances. A WEAK recommendation reflects a lower degree of certainty regarding the outcome and appropriateness of the patient-care strategy for all patients. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources. Good Practice Statements: Diagnostic testing for OSA should be performed in conjunction with a comprehensive sleep evaluation and adequate follow-up. Polysomnography is the standard diagnostic test for the diagnosis of OSA in adult patients in whom there is a concern for OSA based on a comprehensive sleep evaluation.Recommendations: We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing. (STRONG). We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA. (STRONG). We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA. (STRONG). We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia. (STRONG). We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (WEAK). We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA. (WEAK).
Topics: Academies and Institutes; Adult; Humans; Polysomnography; Sleep Apnea, Obstructive; Sleep Medicine Specialty; Surveys and Questionnaires
PubMed: 28162150
DOI: 10.5664/jcsm.6506 -
Journal of Clinical Sleep Medicine :... May 2017
Topics: Humans; Polysomnography; Sleep Apnea, Obstructive; Sleep Medicine Specialty; Societies, Medical; United States; Practice Guidelines as Topic
PubMed: 28416048
DOI: 10.5664/jcsm.6576 -
The Lancet. Respiratory Medicine Jun 2019Existing normal polysomnography values are not truly normative as they are based on small sample sizes due to the fact that polysomnography is expensive and burdensome... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Existing normal polysomnography values are not truly normative as they are based on small sample sizes due to the fact that polysomnography is expensive and burdensome to obtain. There is a clear need for a large sample of truly normative data for clinical management and research. This study is a comprehensive meta-analysis of adult polysomnography parameters scored using recent criteria and establishes normative values adjusted for age and sex.
METHODS
For this meta-analysis of adult polysomnography parameters, we searched Scopus for studies of any design published between Jan 1, 2007, and July 31, 2016, that reported polysomnographic parameters scored using recent American Academy of Sleep Medicine criteria (2007 or 2012) collected during an overnight level 1 in-laboratory sleep study in healthy controls. We excluded studies of patients with conditions or subjected to treatments that might affect sleep and studies not available in English. Study endpoints were the pooled estimates of 14 reported polysomnographic parameters. Estimates for each parameter were pooled using a random-effects meta-analysis. The influence of age and sex was ascertained using multivariate mixed-effects meta-regressions. This study is registered with PROSPERO, number CRD42017074319.
FINDINGS
Of 3712 articles, 169 studies, comprising 5273 participants, were eligible for inclusion. We report normative data stratified by age and sex. For each decade of age, total sleep time decreased by 10·1 min (95% CI 7·5 to 12·8), sleep efficiency decreased by 2·1% (1·5 to 2·6), wake after sleep onset increased by 9·7 min (6·9 to 12·4), sleep onset latency increased by 1·1 min (0·3 to 1·9), arousal index increased by 2·1 events per h (1·5 to 2·6), percentage of N1 sleep increased by 0·5% (0·1 to 0·8), apnea-hypopnea index increased by 1·2 events per h (0·9 to 1·4), mean oxygen saturation decreased by 0·6% (0·5 to 0·7), minimum oxygen saturation decreased by 1·8% (1·3 to 2·3), and periodic limb movement index increased by 1·2 events per h (0·8 to 1·6). Changes with age in the percentage of N2 sleep (0·0%, 95% CI -0·1 to 0·1), N3 sleep (-0·1%, -0·1 to 0·0), and rapid eye movement (REM) sleep (0·0%, -0·1 to 0·0) were not significant. Every 10% increase in the percentage of male participants was associated with reduced REM latency (0·9 min decrease, 95% CI 0·1 to 1·6) and mean oxygen saturation (0·1% decrease, 0·0 to 0·1), and greater arousal index (0·3 events per h, 0·0 to 0·5) and apnea-hypopnea index (0·2 events per h, 0·1 to 0·3).
INTERPRETATION
These normative values serve as a useful control reference for clinicians and for future research where it might be difficult to obtain polysomnographic controls. The resulting normative trends by age and sex might also be hypothesis-generating for a broad range of investigations.
FUNDING
None.
Topics: Adult; Aged; Aged, 80 and over; Female; Healthy Volunteers; Humans; Male; Middle Aged; Polysomnography; Reference Values; Sleep; Young Adult
PubMed: 31006560
DOI: 10.1016/S2213-2600(19)30057-8 -
Advances in Experimental Medicine and... 2022Cardiopulmonary coupling (CPC) is a technique that generates sleep spectrogram by calculating the cross-spectral power and coherence of heart rate variability and...
Cardiopulmonary coupling (CPC) is a technique that generates sleep spectrogram by calculating the cross-spectral power and coherence of heart rate variability and respiratory tidal volume fluctuations. There are several forms of CPC in the sleep spectrogram, which may provide information about normal sleep physiology and pathological sleep states. Since CPC can be calculated from any signal recording containing heart rate and respiration information, such as photoplethysmography (PPG) or blood pressure, it can be widely used in various applications, including wearables and non-contact devices. When derived from PPG, an automatic apnea-hypopnea index can be calculated from CPC-oximetry as PPG can be obtained from oximetry alone. CPC-based sleep profiling reveals the effects of stable and unstable sleep on sleep apnea, insomnia, cardiovascular regulation, and metabolic disorders. Here, we introduce, with examples, the current knowledge and understanding of the CPC technique, especially the physiological basis, analytical methods, and its clinical applications.
Topics: Heart; Heart Rate; Humans; Polysomnography; Respiration; Sleep; Sleep Apnea Syndromes
PubMed: 36217085
DOI: 10.1007/978-3-031-06413-5_11 -
Behavioral Sleep Medicine 2019: To evaluate the performance of a multisensor sleep-tracker (ŌURA ring) against polysomnography (PSG) in measuring sleep and sleep stages. : Forty-one healthy...
: To evaluate the performance of a multisensor sleep-tracker (ŌURA ring) against polysomnography (PSG) in measuring sleep and sleep stages. : Forty-one healthy adolescents and young adults (13 females; Age: 17.2 ± 2.4 years). : Sleep data were recorded using the ŌURA ring and standard PSG on a single laboratory overnight. Metrics were compared using Bland-Altman plots and epoch-by-epoch (EBE) analysis. : Summary variables for sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO) were not different between ŌURA ring and PSG. PSG-ŌURA discrepancies for WASO were greater in participants with more PSG-defined WASO ( < .001). Compared with PSG, ŌURA ring underestimated PSG N3 (~20 min) and overestimated PSG REM (~17 min; < .05). PSG-ŌURA differences for TST and WASO lay within the ≤ 30 min a-priori-set clinically satisfactory ranges for 87.8% and 85.4% of the sample, respectively. From EBE analysis, ŌURA ring had a 96% sensitivity to detect sleep, and agreement of 65%, 51%, and 61%, in detecting "light sleep" (N1), "deep sleep" (N2 + N3), and REM sleep, respectively. Specificity in detecting wake was 48%. Similarly to PSG-N3 ( < .001), "deep sleep" detected with the ŌURA ring was negatively correlated with advancing age ( = .001). ŌURA ring correctly categorized 90.9%, 81.3%, and 92.9% into PSG-defined TST ranges of < 6 hr, 6-7 hr, > 7 hr, respectively. : Multisensor sleep trackers, such as the ŌURA ring have the potential for detecting outcomes beyond binary sleep-wake using sources of information in addition to motion. While these first results could be viewed as promising, future development and validation are needed.
Topics: Actigraphy; Adolescent; Adult; Female; Humans; Male; Polysomnography; Reproducibility of Results; Sleep; Young Adult
PubMed: 28323455
DOI: 10.1080/15402002.2017.1300587 -
Sleep Medicine Clinics Dec 2016Polysomnography provided a means to objectively study sleep. Initial challenges were technical; the next challenge was overcoming communication difficulties and lack of... (Review)
Review
Polysomnography provided a means to objectively study sleep. Initial challenges were technical; the next challenge was overcoming communication difficulties and lack of standardization. The new specialty, sleep medicine, created a huge demand for laboratory polysomnography. By the early 2000s, home sleep testing and treatment devices made inroads into clinical sleep practice. The economic consequence was shrinking demand for clinical laboratory polysomnography. Therefore, polysomnography must now find new directions, approaches, and purpose. Engineering challenges remain, and the "new" polysomnography needs to revisit some of the original questions about sleep, including what constitutes optimal sleep quantity, timing, and quality.
Topics: Humans; Polysomnography; Sleep Wake Disorders
PubMed: 28118865
DOI: 10.1016/j.jsmc.2016.07.002 -
Revue de L'infirmiere Mar 2016
Topics: Humans; Polysomnography; Quality of Life; Sleep; Smartphone; Telemedicine
PubMed: 26944637
DOI: 10.1016/j.revinf.2016.01.004 -
Archives of Disease in Childhood.... Jun 2020A 5-year-old child presents to a paediatric clinic with their parents because of concerns about snoring, which is loud, every night and associated with respiratory... (Review)
Review
A 5-year-old child presents to a paediatric clinic with their parents because of concerns about snoring, which is loud, every night and associated with respiratory pauses. This has been present for 6 months. Can clinical evaluation diagnose sleep-disordered breathing in children or are further investigations required? Should further investigations include oximetry or polysomnography? If a polysomnogram is performed, how are the results interpreted? In this paper we describe the indications for polysomnography, outline the parameters measured and decode a clinical polysomnography report.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Male; Oximetry; Pediatrics; Polysomnography; Practice Guidelines as Topic; Sleep Apnea Syndromes; Snoring; Surveys and Questionnaires
PubMed: 31615846
DOI: 10.1136/archdischild-2018-316031 -
Sleep Medicine Clinics Mar 2017This article provides the current state of evidence on the socioeconomic impact of portable testing (PT) for sleep apnea. It seems the traditional in-laboratory... (Review)
Review
This article provides the current state of evidence on the socioeconomic impact of portable testing (PT) for sleep apnea. It seems the traditional in-laboratory polysomnography and the newer home-based PT model for sleep apnea diagnosis both have places in sleep medicine diagnostic algorithm. PT would be cost-effective in a selected group of patients as long as certain criteria, discussed in this article, are carefully considered.
Topics: Humans; Monitoring, Ambulatory; Point-of-Care Testing; Polysomnography; Practice Guidelines as Topic; Sleep Apnea, Obstructive
PubMed: 28159092
DOI: 10.1016/j.jsmc.2016.10.006