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Medical Science Monitor : International... Sep 2023Sleep research has garnered substantial interest among scientists owing to its correlation with various diseases, particularly elevated blood pressure observed in...
Sleep research has garnered substantial interest among scientists owing to its correlation with various diseases, particularly elevated blood pressure observed in patients with obstructive sleep apnea. This systematic review aims to identify and analyze publications exploring the associations between sleep architecture and arterial hypertension. A comprehensive search of PubMed (MEDLINE), Scopus, and Embase databases yielded 111 reports, of which 7 manuscripts were included in the review. Four of the studies reported a significant reduction in the duration of the N3 phase of sleep in hypertensive patients, while 2 studies found a statistically significant reduction in the duration of the N2 and rapid eye movement (REM) stages of sleep. Three studies indicated increased sleep fragmentation in hypertensive patients. They showed a longer duration of the N1 stage of sleep, shorter duration of overall sleep time, and an increased apnea-hypopnea index in hypertensive patients. These findings underscore the association between the duration of non-REM/REM sleep stages and elevated BP, providing substantial evidence. Moreover, a notable increase in sleep fragmentation was observed among patients with hypertension. However, further research is warranted to expand and deepen our understanding of this intricate relationship. This systematic review serves as a valuable resource, guiding future investigations and contributing to advancements in the field of sleep and arterial hypertension.
Topics: Humans; Sleep Deprivation; Sleep; Hypertension; Sleep Apnea, Obstructive; Databases, Factual
PubMed: 37665688
DOI: 10.12659/MSM.941066 -
Evidence-based Dentistry Sep 2023PubMed, Scopus and Cochrane Library were systematically searched for studies published up to October 2021.
DATA SOURCES
PubMed, Scopus and Cochrane Library were systematically searched for studies published up to October 2021.
STUDY SELECTION
Two separate search strategies were employed: (1) In adults with periodontitis, what is the prevalence or incidence of respiratory diseases compared to healthy or gingivitis adults in cross-sectional, cohort or case -control studies. (2) In adults with periodontitis and respiratory disease, what are the effects of periodontal therapy compared to no or minimal therapy in clinical trials (randomised and non-randomised)? Respiratory diseases were defined as chronic obstructive pulmonary disease (COPD), obstructive sleep apnoea (OSA), asthma, COVID-19, and community acquire pneumonia (CAP). Exclusion criteria included non-English studies, individuals with severe systemic comorbidities, less than 12 months follow up, and a sample size less than 10 individuals.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently screened the titles, abstracts, and selected manuscripts against the inclusion criteria. Disagreement was solved by consulting a third reviewer. Studies were classified according to the respiratory diseases investigated. Quality assessment was performed using various tools. Qualitative assessment was performed. Studies with sufficient data were included in meta-analyses. Heterogeneity was assessed using the Q test and I index. Fixed and random effects models were used. Effect sizes were presented as odds-ratios, relative risks, and hazard ratios.
RESULTS
75 studies were included. Meta-analyses revealed statistically significant positive associations of periodontitis with COPD and OSA (p < 0.001) however no association for asthma. Four studies showed positive effects of periodontal treatment on COPD, asthma, and CAP.
Topics: Adult; Humans; Cross-Sectional Studies; COVID-19; Periodontitis; Asthma; Pulmonary Disease, Chronic Obstructive; Sleep Apnea, Obstructive
PubMed: 37188924
DOI: 10.1038/s41432-023-00899-z -
Arquivos de Neuro-psiquiatria May 2023Several randomized clinical trials (RCTs) have shown that dual orexin receptor antagonists (DORAs) are effective in the treatment of chronic insomnia. However, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several randomized clinical trials (RCTs) have shown that dual orexin receptor antagonists (DORAs) are effective in the treatment of chronic insomnia. However, the superiority of one particular DORA over the others remains unclear.
OBJECTIVE
To perform a network meta-analysis to evaluate the efficacy of different DORAs in patients with chronic insomnia.
METHODS
The Medline, Embase, and Cochrane Central databases were searched for RCTs that compared DORA with placebo in patients ≥ 18 years of age with a diagnosis of insomnia disorder. We pooled outcomes for wake time after sleep onset (WASO), latency to persistent sleep (LPS), total sleep time (TST), and adverse events (AEs).
RESULTS
We included 10 RCTs with 7,806 patients, 4,849 of whom received DORAs as the intervention. Overall, we found that DORAs were associated with the improvement of all analyzed efficacy outcomes. Concerning TST, an apparent dose-dependent pattern was noticed, with higher doses relating to a longer TST. Lemborexant 10mg provided the largest reduction in WASO (at month 1) in minutes (standardized mean difference [SMD] = -25.40; 95% confidence interval [95%CI] = -40.02--10.78), followed by suvorexant 20/15mg (SMD = -25.29; 95%CI = -36.42--14.15), which also appeared to provide the largest decrease in long-term WASO (SMD = -23.70; 95%CI = -35.89--11.51). The most frequent AEs were somnolence, nasopharyngitis, and headache, with rates of up to 14.8%.
CONCLUSION
Our results suggest that DORAs are associated with greater efficacy when compared with placebo in the treatment of insomnia, a complex 24-hour sleep disorder. Additionally, dosing might play an important role in the management of chronic insomnia.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Orexin Receptor Antagonists; Network Meta-Analysis; Sleep; Wakefulness
PubMed: 37257468
DOI: 10.1055/s-0043-1768667 -
Sleep Medicine Jan 2021Several observational studies have shown that patients with irritable bowel syndrome (IBS) may have a high risk of restless legs syndrome (RLS). This systematic review... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several observational studies have shown that patients with irritable bowel syndrome (IBS) may have a high risk of restless legs syndrome (RLS). This systematic review and meta-analysis aimed to comprehensively investigate the bidirectional association between IBS and RLS.
METHODS
All conservational studies on IBS and RLS were searched in MEDLINE (assessed by PubMed), Embase, Web of Science, CINAHL, the Cochrane Library database and Google Scholar from inception to June 14, 2020. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality were used to assess the methodological quality of the cohort and cross-sectional studies, respectively. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using Reviewer Manager 5.3.
RESULT
A total of five cross-sectional studies of moderate methodological quality and one cohort study of high methodological quality were included in our review. Four cross-sectional studies and one cohort study involving 86 438 individuals met the criteria of IBS predicating the onset of RLS. Patients with IBS had a nearly three-fold increased odds of RLS compared with controls (OR = 2.60, 95%CI: 2.17-3.12, P < 0.00001; I = 48%, P = 0.11). Three sensitivity analyses confirmed the robustness of the pooled result. Two cross-sectional studies involving 3581 individuals met the criteria of RLS predicating the onset of IBS. RLS patients had a nearly four-fold increased odds of IBS compared with controls without RLS (OR = 3.87, 95%CI: 1.73-8.66, P = 0.0010; I = 77%, P = 0.04).
CONCLUSION
In this systematic review and meta-analysis, we found a substantial bidirectional association between IBS and RLS. More prospective, high-quality, population-based studies are warranted in the future.
Topics: Cohort Studies; Cross-Sectional Studies; Humans; Irritable Bowel Syndrome; Prospective Studies; Restless Legs Syndrome
PubMed: 33348297
DOI: 10.1016/j.sleep.2020.12.002 -
International Journal of Chronic... 2022Physical activity (PA), sedentary behaviour (SB) and sleep are important lifestyle behaviours associated with chronic respiratory disease (CRD) morbidity and mortality.... (Review)
Review
ABSTRACT
Physical activity (PA), sedentary behaviour (SB) and sleep are important lifestyle behaviours associated with chronic respiratory disease (CRD) morbidity and mortality. These behaviours need to be understood in low- and middle-income countries (LMIC) to develop appropriate interventions.
PURPOSE
Where and how have free-living PA, SB and sleep data been collected for adults living with CRD in LMIC? What are the free-living PA, SB and sleep levels of adults living with CRD?
PATIENTS AND METHODS
The literature on free-living PA, SB and sleep of people living with CRD in LMIC was systematically reviewed in five relevant scientific databases. The review included empirical studies conducted in LMIC, reported in any language. Reviewers screened the articles and extracted data on prevalence, levels and measurement approach of PA, SB and sleep using a standardised form. Quality of reporting was assessed using bespoke criteria.
RESULTS
Of 89 articles, most were conducted in Brazil (n=43). PA was the commonest behaviour measured (n=66). Questionnaires (n=52) were more commonly used to measure physical behaviours than device-based (n=37) methods. International Physical Activity Questionnaire was the commonest for measuring PA/SB (n=11). For sleep, most studies used Pittsburgh Sleep Quality Index (n=18). The most common ways of reporting were steps per day (n=21), energy expenditure (n=21), sedentary time (n=16), standing time (n=13), sitting time (n=11), lying time (n=10) and overall sleep quality (n=32). Studies revealed low PA levels [steps per day (range 2669-7490steps/day)], sedentary lifestyles [sitting time (range 283-418min/day); standing time (range 139-270min/day); lying time (range 76-119min/day)] and poor sleep quality (range 33-100%) among adults with CRD in LMIC.
CONCLUSION
Data support low PA levels, sedentary lifestyles and poor sleep among people in LMIC living with CRDs. More studies are needed in more diverse populations and would benefit from a harmonised approach to data collection for international comparisons.
Topics: Adult; Developing Countries; Exercise; Humans; Pulmonary Disease, Chronic Obstructive; Sedentary Behavior; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 35469273
DOI: 10.2147/COPD.S345034 -
Journal of Sleep Research Dec 2023Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an... (Meta-Analysis)
Meta-Analysis Review
Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an appropriate treatment for COMISA; however, no previous study has systematically reviewed and meta-analysed literature reporting on the effect of CBTi in people with COMISA. A systematic literature search was conducted across PsychINFO and PubMed (n = 295). In all, 27 full-text records were independently reviewed by at least two authors. Forward- and backward-chain referencing, and hand-searches were used to identify additional studies. Authors of potentially eligible studies were contacted to provide COMISA subgroup data. In total, 21 studies, including 14 independent samples of 1040 participants with COMISA were included. Downs and Black quality assessments were performed. A meta-analysis including nine primary studies measuring the Insomnia Severity Index indicated that CBTi is associated with a large improvement in insomnia severity (Hedges' g = -0.89, 95% confidence interval [CI] -1.35, -0.43). Subgroup meta-analyses indicated that CBTi is effective in samples with untreated obstructive sleep apnoea (OSA) (five studies, Hedges' g = -1.19, 95% CI -1.77, -0.61) and treated OSA (four studies, Hedges' g = -0.55, 95% CI -0.75, -0.35). Publication bias was evaluated by examining the Funnel plot (Egger's regression p = 0.78). Implementation programmes are required to embed COMISA management pathways in sleep clinics worldwide that currently specialise in the management of OSA alone. Future research should investigate and refine CBTi interventions in people with COMISA, including identifying the most effective CBTi components, adaptations, and developing personalised management approaches for this highly prevalent and debilitating condition.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy; Sleep; Sleep Apnea, Obstructive; Comorbidity
PubMed: 36872072
DOI: 10.1111/jsr.13847 -
Sensors (Basel, Switzerland) Nov 2019Sleep apnea is a sleep related disorder that significantly affects the population. Polysomnography, the gold standard, is expensive, inaccessible, uncomfortable and an... (Review)
Review
Sleep apnea is a sleep related disorder that significantly affects the population. Polysomnography, the gold standard, is expensive, inaccessible, uncomfortable and an expert technician is needed to score. Numerous researchers have proposed and implemented automatic scoring processes to address these issues, based on fewer sensors and automatic classification algorithms. Deep learning is gaining higher interest due to database availability, newly developed techniques, the possibility of producing machine created features and higher computing power that allows the algorithms to achieve better performance than the shallow classifiers. Therefore, the sleep apnea research has currently gained significant interest in deep learning. The goal of this work is to analyze the published research in the last decade, providing an answer to the research questions such as how to implement the different deep networks, what kind of pre-processing or feature extraction is needed, and the advantages and disadvantages of different kinds of networks. The employed signals, sensors, databases and implementation challenges were also considered. A systematic search was conducted on five indexing services from 2008-2018. A total of 255 papers were found and 21 were selected by considering the inclusion and exclusion criteria, using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach.
Topics: Deep Learning; Humans; Neural Networks, Computer; Sleep Apnea Syndromes
PubMed: 31726771
DOI: 10.3390/s19224934 -
Sleep Medicine Feb 2018A systematic review and meta-analysis of the association between alcohol consumption and risk of sleep apnoea in adults. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A systematic review and meta-analysis of the association between alcohol consumption and risk of sleep apnoea in adults.
METHODS
We searched Medline, EMBASE and Web of Science databases from 1985 to 2015 for comparative epidemiological studies assessing the relation between alcohol consumption and sleep apnoea. Two authors independently screened and extracted data. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was quantified using I and explored using subgroup analyses based on study exposure and outcome measures, quality, design, adjustment for confounders and geographical location. Publication bias was assessed using a funnel plot and Egger's test.
RESULTS
We identified 21 studies from which estimates of relative risk could be obtained. Meta-analysis of these estimates demonstrated that higher levels of alcohol consumption increased the risk of sleep apnoea by 25% (RR 1.25, 95%CI 1.13-1.38, I = 82%, p < 0.0001). This estimate's differences were robust in alcohol consumption and sleep apnoea definitions, study design, and quality but was greater in Low and Middle Income Country locations. We detected evidence of publication bias (p = 0.001). A further eight included studies reported average alcohol consumption in people with and without sleep apnoea. Meta-analysis revealed that mean alcohol intake was two units/week higher in those with sleep apnoea, but this difference was not statistically significant (p = 0.41).
CONCLUSION
These findings suggest that alcohol consumption is associated with a higher risk of sleep apnoea, further supporting evidence that reducing alcohol intake is of potential therapeutic and preventive value in this condition.
Topics: Alcohol Drinking; Humans; Risk; Sleep Apnea Syndromes
PubMed: 29458744
DOI: 10.1016/j.sleep.2017.12.005 -
Medicina (Kaunas, Lithuania) Aug 2023: Obstructive sleep apnea (OSA) in children is a debilitating disease, difficult to treat. Dental appliances have been proposed as a valid therapy for improving... (Meta-Analysis)
Meta-Analysis Review
: Obstructive sleep apnea (OSA) in children is a debilitating disease, difficult to treat. Dental appliances have been proposed as a valid therapy for improving functional outcomes with good compliance rates. Herein, we aimed to perform a meta-analysis comparing clinical outcomes between OSA children treated with dental appliances versus controls. : The study was registered with PROSPERO. A systematic search was performed for all comparative studies examining outcomes in pediatric patients who underwent treatment of OSA with oral appliances versus controls. Data was extracted and analyzed using a random effects model via Rev Man 5.3. : Six studies including 180 patients were analyzed split into two groups: patients treated with dental appliances (n = 123) and the controls (n = 119). Therapy with dental appliances was shown to significantly improve the apnea-hypopnea index ( = 0.009) and enlarge the superior posterior airway space ( = 0.02). Maxilla-to-mandible measurements were not significantly different between the two groups, nor was the mean SO ( = 0.80). : This is the most updated meta-analysis assessing the role of dental appliances for OSA in children; it shows that such devices can improve functional outcomes by decreasing the apnea-hypopnea index.
Topics: Humans; Child; Patient Compliance; Sleep Apnea, Obstructive
PubMed: 37629737
DOI: 10.3390/medicina59081447 -
Neuroepidemiology 2022Narcolepsy is a chronic neurological disorder. The diagnostic criteria of narcolepsy evolve from clinical symptoms to molecular biomarkers, along with the understanding...
INTRODUCTION
Narcolepsy is a chronic neurological disorder. The diagnostic criteria of narcolepsy evolve from clinical symptoms to molecular biomarkers, along with the understanding of its clinical nature and pathogenesis. Estimates of incidence and prevalence of narcolepsy vary between studies, while the contribution of changing diagnostic criteria to the variation remains unclear. We aimed to explore sources of heterogeneity in estimates of incidence and prevalence, with a particular focus on diagnostic criteria.
METHODS
We searched 5 databases for observational studies on the incidence or prevalence of narcolepsy published before October 14, 2021. Subgroup analyses and meta-regression were used to assess the impact of diagnostic criteria on incidence/prevalence of narcolepsy after adjusting for age-group, region, study period, vaccination status, index date, and type of narcolepsy.
RESULTS
Thirty-five studies were selected from 2,833 articles. The estimates of incidence and prevalence were wide-ranging with high heterogeneity (incidence I2 = 99.8%; prevalence I2 = 99.7%), from 0.06 to 6.56 per 100,000 person-years for incidence and from 1.05 to 79.40 per 100,000 population for prevalence, respectively. Totally 10 diagnostic criteria were used, including the 1st revised edition of International Classification of Diseases (ICSD-1), ICSD-2, ICSD-3, the 8th revision of International Classification of Diseases (ICD-8), ICD-9, ICD-10, Brighton collaboration case definition (Brighton), Mayo classification, the Ullanlinna Narcolepsy Scale, and clinical symptoms with the multiple sleep latency test. ICD tended to provide higher estimates of incidence/prevalence than Brighton (incidence odds ratio [OR] 1.38, [95% CI: 1.02, 1.86]; prevalence OR 1.50, [95% CI: 1.04, 2.39]). No significant difference was found in estimates of two rates between ICSD and Brighton. The incidence was higher for children than adults (OR 1.61, [95% CI: 1.25, 2.07]) and for individuals vaccinated with Pandemrix than those unvaccinated (OR 6.49, [95% CI: 3.86, 10.91]).
CONCLUSIONS
Estimates of incidence/prevalence of narcolepsy could not be pooled reliably with substantial heterogeneity. Incidence/prevalence studies using ICSD and Brighton provided lower estimates than studies using ICD and other criteria. Diagnostic criteria should be standardized when comparing or pooling the incidence/prevalence to understand the epidemiology of narcolepsy. Future studies are needed to focus on the at-risk population for the etiology investigation of narcolepsy.
Topics: Adult; Child; Humans; Incidence; Prevalence; Narcolepsy; International Classification of Diseases; Regression Analysis
PubMed: 35820399
DOI: 10.1159/000525282