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Computer Methods and Programs in... Nov 2022Apnea of prematurity is one of the most common diagnosis in neonatal intensive care units. Apneas can be classified as central, obstructive or mixed. According to the...
BACKGROUND AND OBJECTIVE
Apnea of prematurity is one of the most common diagnosis in neonatal intensive care units. Apneas can be classified as central, obstructive or mixed. According to the current international standards, minimal fluctuations or absence of fluctuations in the chest impedance (CI) suggest a central apnea (CA). However, automatic detection of reduced CI fluctuations leads to a high number of central apnea-suspected events (CASEs), the majority being false alarms. We aim to improve automatic detection of CAs by using machine learning to optimize detection of CAs among CASEs.
METHODS
Using an optimized algorithm for automated detection, all CASEs were detected in a population of 10 premature infants developing late-onset sepsis and 10 age-matched control patients. CASEs were inspected by two clinical experts and annotated as CAs or rejections in two rounds of annotations. A total of 47 features were extracted from the ECG, CI and oxygen saturation signals considering four 30 s-long moving windows, from 30 s before to 15 s after the onset of each CASE, using a moving step size of 5 s. Consecutively, new CA detection models were developed based on logistic regression with elastic net penalty, random forest and support vector machines. Performance was evaluated using both leave-one-patient-out and 10-fold cross-validation considering the mean area under the receiver-operating-characteristic curve (AUROC).
RESULTS
The CA detection model based on logistic regression with elastic net penalty returned the highest mean AUROC when features extracted from all four time windows were included, both using leave-one-patient-out and 10-fold cross-validation (mean AUROC of 0.88 and 0.90, respectively). Feature relevance was found to be the highest for features derived from the CI. A threshold for the false positive rate in the mean receiver-operating-characteristic curve equal to 0.3 led to a high percentage of correct detections for all CAs (78.2%) and even higher for CAs followed by a bradycardia (93.4%) and CAs followed by both a bradycardia and a desaturation (95.2%), which are more critical for the well-being of premature infants.
CONCLUSIONS
Models based on machine learning can lead to improved CA detection with fewer false alarms.
Topics: Infant, Newborn; Infant; Humans; Apnea; Sleep Apnea, Central; Bradycardia; Infant, Premature; Machine Learning
PubMed: 36215858
DOI: 10.1016/j.cmpb.2022.107155 -
Alzheimer's Research & Therapy Jul 2023Previous studies challenge the impact of obstructive sleep apnea (OSA) once patients are diagnosed with Alzheimer's disease (AD). Nevertheless, OSA recognizably disrupts... (Observational Study)
Observational Study
BACKGROUND
Previous studies challenge the impact of obstructive sleep apnea (OSA) once patients are diagnosed with Alzheimer's disease (AD). Nevertheless, OSA recognizably disrupts sleep, and relevant associations between sleep, AD pathological markers, and cognition have been demonstrated. We aimed to further explore this, evaluating the associations between each breathing cessation event that compose the apnea-hypopnea index (AHI) and the sleep structure to finally investigate whether this was related to increased levels of AD markers and higher cognitive decline.
METHODS
Observational, prospective study, including consecutive patients diagnosed with mild-moderate AD. The participants were submitted to overnight polysomnography followed by a cerebrospinal fluid collection for AD pathological markers levels determination. Neuropsychological assessment was performed at baseline and after 12 months of follow-up.
RESULTS
The cohort was composed of 116 patients (55.2% females) with a median [p25;p75] age of 76.0 [72.0;80.0] years and an AHI of 25.9 [15.1;48.5], which was mainly defined by the presence of hypopneas and obstructive apneas. These were distinctively associated with the sleep structure, with obstructive apneas being related to arousals and sleep lightening and hypopneas being related to an increased number of arousals only. Despite having a lower frequency, mixed and central apneas also presented associations with the sleep structure, particularly increasing the time spent in the lighter sleep stages. In relation to AD pathological markers, obstructive and mixed apneas were related to an augment in neurofilament light levels while hypopneas were associated with a higher phosphorylated-tau/amyloid-beta protein ratio. Hypopneas were the most important event for an increased cognitive decline at the 12-month follow-up.
CONCLUSIONS
Our findings highlight the importance of a patient-centered approach, with a comprehensive and detailed analysis of the AHI to effectively predict the different outcomes and tailor the appropriate therapeutic strategies.
Topics: Aged, 80 and over; Female; Humans; Male; Alzheimer Disease; Polysomnography; Prospective Studies; Sleep; Sleep Apnea, Obstructive; Aged
PubMed: 37452339
DOI: 10.1186/s13195-023-01266-x -
Respirology (Carlton, Vic.) Oct 2017Obstructive sleep apnoea (OSA) is a disorder of breathing during sleep resulting in temporary reduction in cerebral oxygenation and sleep disruption. A growing body of... (Review)
Review
Obstructive sleep apnoea (OSA) is a disorder of breathing during sleep resulting in temporary reduction in cerebral oxygenation and sleep disruption. A growing body of research reveals a relatively consistent pattern of deficits in cognition, particularly in attention, episodic memory, and executive function, which are partially remediated by treatment. This is where the consensus ends. Despite a number of competing explanations regarding how OSA affects cognition, reliable evidence is hard to find, which may relate to the many, common conditions co-morbid with OSA or to the methodological challenges in this field. This paper reviews the evidence for cognitive impairment in OSA, the proposed models of cognitive harm, the impact of co-morbidities and the many methodological and theoretical challenges of exploring the effect of OSA on cognition. To overcome some of these challenges, we end by proposing a number of future directions for the field, including suggesting some core design elements for future studies.
Topics: Cognition; Cognition Disorders; Executive Function; Humans; Sleep Apnea, Obstructive
PubMed: 28779504
DOI: 10.1111/resp.13140 -
Scientific Reports Mar 2020While full-night polysomnography is the gold standard for the diagnosis of obstructive sleep apnea, its limitations include a high cost and first-night effects. This... (Clinical Trial)
Clinical Trial Comparative Study
While full-night polysomnography is the gold standard for the diagnosis of obstructive sleep apnea, its limitations include a high cost and first-night effects. This study developed an algorithm for the detection of respiratory events based on impulse-radio ultra-wideband radar and verified its feasibility for the diagnosis of obstructive sleep apnea. A total of 94 subjects were enrolled in this study (23 controls and 24, 14, and 33 with mild, moderate, and severe obstructive sleep apnea, respectively). Abnormal breathing detected by impulse-radio ultra-wideband radar was defined as a drop in the peak radar signal by ≥30% from that in the pre-event baseline. We compared the abnormal breathing index obtained from impulse-radio ultra-wideband radar and apnea-hypopnea index (AHI) measured from polysomnography. There was an excellent agreement between the Abnormal Breathing Index and AHI (intraclass correlation coefficient = 0.927). The overall agreements of the impulse-radio ultra-wideband radar were 0.93 for Model 1 (AHI ≥ 5), 0.91 for Model 2 (AHI ≥ 15), and 1 for Model 3 (AHI ≥ 30). Impulse-radio ultra-wideband radar accurately detected respiratory events (apneas and hypopneas) during sleep without subject contact. Therefore, impulse-radio ultra-wideband radar may be used as a screening tool for obstructive sleep apnea.
Topics: Adolescent; Adult; Body Mass Index; Equipment Design; Feasibility Studies; Female; Humans; Male; Middle Aged; Neck; Pilot Projects; Polysomnography; Predictive Value of Tests; Pulmonary Ventilation; ROC Curve; Radar; Respiration; Sensitivity and Specificity; Severity of Illness Index; Sleep Apnea, Central; Sleep Apnea, Obstructive; Symptom Assessment
PubMed: 32210266
DOI: 10.1038/s41598-020-62061-4 -
International Dental Journal Jun 2022Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder. Dentists should play an essential role in OSA screening, referral, and management....
BACKGROUND
Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder. Dentists should play an essential role in OSA screening, referral, and management. However, few studies have investigated dentists' knowledge and attitude towards OSA.
OBJECTIVE
This cross-sectional survey aimed to assess the level of knowledge and attitude regarding OSA amongst dentists and evaluate whether the level of knowledge affects their attitude towards OSA.
METHODS
Using the Google Forms platform, an online questionnaire was distributed via e-mail to all Ministry of Health dentists (N = 352). The questionnaire included 3 sections: demographics, knowledge, and attitude. Participant responses were stratified by professional title (general dentists, specialists, or consultants) and practice sector (primary health care centres or hospitals). Descriptive statistics, independent t tests, one-way analyses of variance, and Pearson's correlation were used to analyse the data.
RESULTS
Of the 352 dentists, 191 responded to the questionnaire (54.55%). Although 80.6% of the respondents reported having previous OSA knowledge in the self-assessment question, 65.58% scored below 12 in the total knowledge scores, and 63.35% scored below 3 in the total attitude scores based on Bloom's cutoff. The mean total knowledge score was 9.86, while the mean total attitude score was 2.08. No significant differences between the mean total knowledge and attitude scores were found based on sex, professional title, or practice sector. A positive and statistically significant correlation was found between total knowledge and attitude scores (P value = .001).
CONCLUSIONS
This study showed that dentists had a low OSA-related knowledge and a negative attitude towards OSA, and a positive association was seen between knowledge level and attitude. Dental practitioners with high knowledge scores tended to have a positive attitude towards OSA. These findings suggest that dentists in Jeddah require more education and clinical training in sleep medicine to maximise patient benefits and minimise adverse outcomes.
Topics: Attitude of Health Personnel; Cross-Sectional Studies; Dentists; Health Knowledge, Attitudes, Practice; Humans; Professional Role; Sleep Apnea, Obstructive; Surveys and Questionnaires
PubMed: 34193341
DOI: 10.1016/j.identj.2021.05.004 -
Neurologia I Neurochirurgia Polska 2022This study aimed to assess the association between nocturnal hypoxemia and early acute ischaemic stroke (AIS) outcomes in patients without oxygen supplementation.
CLINICAL RATIONALE FOR THE STUDY
This study aimed to assess the association between nocturnal hypoxemia and early acute ischaemic stroke (AIS) outcomes in patients without oxygen supplementation.
MATERIAL AND METHODS
One hundred and six AIS patients consecutively admitted to the stroke unit were included in this study. Baseline demographic and medical data and arterial blood saturation (SpO2) measurements during night-sleep (from 10pm to 6am) were examined for their association with stroke outcomes, including the National Institutes of Health Stroke Scale (NIHSS) score on the 7th day or differences between the NIHSS score on the 1st day and the 7th day after stroke onset. Measurements of SpO2 were made using a pulse oximeter of the Spacelabs Medical Inc. (USA) monitoring system, and the number of apnoea episodes and their duration were recorded by ECG Holter with respiration monitoring (CardioMem®, Getamed, GE).
RESULTS
The study showed that age (Spearman's r = 0.207, p = 0.033) and parameters attributable to anaemia (RBC r = -0.205, p = 0.035, Hb r = -0.225, p = 0.02 and HCT r = -0.196, p = 0.044), atrial fibrillation and ischaemic changes in both brain hemispheres (p = 0.023 and 0.01, respectively) were correlated with the study outcomes. In terms of saturation parameters, we demonstrated that the 'total desaturation burden' (i.e. [100% minus actual measured SpO2%] x apnoea duration) and multiple apnoeas of longer than 20 seconds were correlated with worse functional outcomes. Measures of shorter desaturation episodes (i.e. SpO2 oxygen desaturation index (ODI) at 3% and 4%, and time-weighted desaturations below the determined thresholds (SpO2 from 95% to 85%) demonstrated non-significant associations with the study outcomes.
CONCLUSIONS AND CLINICAL IMPLICATIONS
This study demonstrated that long-lasting desaturation episodes during the night, depicted by the 'total desaturation burden', were correlated with worse functional outcomes in AIS, while measures of shorter desaturation episodes were not correlated. In future clinical trials, indications for oxygen supplementation should include the methodology of personalised medicine and introduce individual approaches based on specially formulated, novel multifactorial algorithms.
Topics: Apnea; Brain Ischemia; Humans; Ischemic Stroke; Oxygen; Stroke; United States
PubMed: 35607842
DOI: 10.5603/PJNNS.a2022.0033 -
Journal of Clinical Sleep Medicine :... Jul 2020Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for...
STUDY OBJECTIVES
Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for the detection and characterization of apneas and hypopneas; however, these sensors are not well tolerated by patients and have poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds (TSs) and RIP signals.
METHODS
Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in random order using the AASM standard signals and the combination TS and RIP signals, without respiratory sensors placed on the patient's face. The TS-RIP scoring used the TS and RIP-flow signals for detection of apneas and hypopneas, respectively, and the suprasternal pressure and RIP belt signals for the characterization of apneas.
RESULTS
Sensitivity and specificity of the TS-RIP combination were 96.21% and 91.34% for apnea detection and 89.94% and 93.25% for detecting hypopneas, respectively, with a kappa coefficient of 0.87. For the characterization of apneas, sensitivity and specificity were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea into severity classes (none, mild, moderate, and severe obstructive sleep apnea) with a Cohen's kappa coefficient of 0.96.
CONCLUSIONS
Compared with the AASM reference sensors, the TS-RIP combination allows reliable noninvasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for diagnosis of obstructive sleep apnea in adults, either as an alternative to the AASM sensors or in combination with the recommended AASM sensors.
Topics: Adult; Humans; Plethysmography; Polysomnography; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 32267226
DOI: 10.5664/jcsm.8460 -
Clinics (Sao Paulo, Brazil) Nov 2016Obstructive sleep apnoea syndrome is a type of sleep-disordered breathing that affects 1 to 5% of all children. Pharyngeal and palatine tonsil hypertrophy is the main... (Review)
Review
Obstructive sleep apnoea syndrome is a type of sleep-disordered breathing that affects 1 to 5% of all children. Pharyngeal and palatine tonsil hypertrophy is the main predisposing factor. Various abnormalities are predisposing factors for obstructive sleep apnoea, such as decreased mandibular and maxillary lengths, skeletal retrusion, increased lower facial height and, consequently, increased total anterior facial height, a larger cranio-cervical angle, small posterior airway space and an inferiorly positioned hyoid bone. The diagnosis is based on the clinical history, a physical examination and tests confirming the presence and severity of upper airway obstruction. The gold standard test for diagnosis is overnight polysomnography. Attention must be paid to identify the craniofacial characteristics. When necessary, children should be referred to orthodontists and/or sleep medicine specialists for adequate treatment in addition to undergoing an adenotonsillectomy.
Topics: Adenoids; Child; Child, Preschool; Craniofacial Abnormalities; Humans; Hypertrophy; Palatine Tonsil; Polysomnography; Sleep Apnea, Obstructive
PubMed: 27982168
DOI: 10.6061/clinics/2016(11)08 -
The Role of Myofunctional Therapy in Treating Sleep-Disordered Breathing: A State-of-the-Art Review.International Journal of Environmental... Jul 2021Myofunctional therapy (MFT) may have a role in improving muscle tone and alleviating upper airway collapse in sleep-disordered breathing. The purposes of this... (Review)
Review
Myofunctional therapy (MFT) may have a role in improving muscle tone and alleviating upper airway collapse in sleep-disordered breathing. The purposes of this state-of-the-art review are to first review systematically the current literature on the effectiveness of MFT in treating sleep-disordered breathing and then to provide an overview of the current understanding of patient selection, side effects, type and duration of exercises, guidance of exercise performance, evaluation of results, and how best to promote adherence. PubMed (Medline), the Cochrane Library, and the EMBASE, Scopus and SciELO databases were checked for relevant studies by three authors, and a total of 23 studies were included. This review focuses only on adults with sleep-disordered breathing. The available evidence shows a positive effect of MFT in reducing sleep apnoea, as measured using polysomnography and clinical variables (including snoring). There is no evidence of the utility of MFT for treating upper airway resistance syndrome, the duration of the effects of MFT, or regarding which MFT protocol is best. Despite these knowledge gaps, the available evidence suggests that MFT is a safe treatment modality.
Topics: Adult; Humans; Myofunctional Therapy; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring
PubMed: 34299742
DOI: 10.3390/ijerph18147291 -
European Journal of Applied Physiology Jun 2021Breath-hold diving is an activity that humans have engaged in since antiquity to forage for resources, provide sustenance and to support military campaigns. In modern... (Review)
Review
Breath-hold diving is an activity that humans have engaged in since antiquity to forage for resources, provide sustenance and to support military campaigns. In modern times, breath-hold diving continues to gain popularity and recognition as both a competitive and recreational sport. The continued progression of world records is somewhat remarkable, particularly given the extreme hypoxaemic and hypercapnic conditions, and hydrostatic pressures these athletes endure. However, there is abundant literature to suggest a large inter-individual variation in the apnoeic capabilities that is thus far not fully understood. In this review, we explore developments in apnoea physiology and delineate the traits and mechanisms that potentially underpin this variation. In addition, we sought to highlight the physiological (mal)adaptations associated with consistent breath-hold training. Breath-hold divers (BHDs) are evidenced to exhibit a more pronounced diving-response than non-divers, while elite BHDs (EBHDs) also display beneficial adaptations in both blood and skeletal muscle. Importantly, these physiological characteristics are documented to be primarily influenced by training-induced stimuli. BHDs are exposed to unique physiological and environmental stressors, and as such possess an ability to withstand acute cerebrovascular and neuronal strains. Whether these characteristics are also a result of training-induced adaptations or genetic predisposition is less certain. Although the long-term effects of regular breath-hold diving activity are yet to be holistically established, preliminary evidence has posed considerations for cognitive, neurological, renal and bone health in BHDs. These areas should be explored further in longitudinal studies to more confidently ascertain the long-term health implications of extreme breath-holding activity.
Topics: Adaptation, Physiological; Apnea; Breath Holding; Cardiovascular Physiological Phenomena; Diving; Humans; Physical Education and Training; Respiratory Physiological Phenomena
PubMed: 33791844
DOI: 10.1007/s00421-021-04664-x