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Sleep Medicine Reviews Aug 2023Sleep initiation and maintenance problems are common in the pediatric population and while behavioral interventions are recommended, their efficacy remains to be... (Meta-Analysis)
Meta-Analysis Review
Sleep initiation and maintenance problems are common in the pediatric population and while behavioral interventions are recommended, their efficacy remains to be evaluated in clinical trials. We conducted a systematic review and network meta-analysis to assess the efficacy of non-pharmacological treatments and melatonin for sleep initiation and maintenance problems in healthy pediatric populations. We included 30 studies in the systematic review and 15 in the meta-analysis. Three network meta-analyses were conducted for sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). For SOL variable, the results support greater effectiveness of light therapy and melatonin than evidence-based psychological interventions, whether implemented in combination with light therapy or not. Regarding WASO variable, evidence-based psychological interventions and a combination of those techniques plus light treatment were the most efficacious. Finally, for TST variable, a larger effect was shown for the combined treatment of evidence-based psychological intervention with light therapy in comparison to other interventions. In conclusion, we found a high variability between study protocols likely impacting the results of the meta-analysis. Future randomized control trials studies, stratified by pediatric age classes, are needed in order to provide clear suggestions in clinical settings.
Topics: Humans; Child; Melatonin; Network Meta-Analysis; Sleep; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy
PubMed: 37406497
DOI: 10.1016/j.smrv.2023.101806 -
Eye (London, England) Oct 2023Obstructive sleep apnoea (OSA) has been thought to be associated with glaucoma, however there are many conflicting studies on this topic. With many new studies having... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Obstructive sleep apnoea (OSA) has been thought to be associated with glaucoma, however there are many conflicting studies on this topic. With many new studies having been published since the previous meta-analysis, we believe it is important to clarify this association. Hence, in this study we meta-analyse the recent literature regarding the association between OSA and glaucoma.
METHODS
Pubmed, Embase, Scopus and Cochrane Library were searched from inception till the 28th February 2022 for observational as well as cross-sectional studies examining the association between OSA and glaucoma. Two reviewers selected studies, extracted data, graded the quality of included non-randomized studies using the Newcastle-Ottawa scale. The overall quality of evidence was assessed using GRADE. Random-effects models were used to meta-analyse the maximally covariate- adjusted associations.
RESULTS
48 studies were included in our systematic review, with 46 suitable for meta-analysis. Total study population was 4,566,984 patients. OSA was associated with a higher risk of glaucoma (OR 3.66, 95% CI 1.70 to 7.90, I = 98%, p < 0.01). After adjustment for various important confounders including age, gender and patient comorbidities such as hyperlipidaemia, hypertension, cardiovascular diseases and diabetes, patients with OSA had up to 40% higher odds of glaucoma. Substantial heterogeneity was eliminated through subgroup and sensitivity analyses after consideration of glaucoma subtype, OSA severity and adjustment for confounders.
CONCLUSIONS
In this meta-analysis, OSA was associated with higher risk of glaucoma, as well as more severe ocular findings characteristic of the glaucomatous disease process. We suggest more clinical studies looking into the effects of OSA treatment on the progression of glaucoma to help clinical decision making for patients.
Topics: Humans; Cross-Sectional Studies; Sleep Apnea, Obstructive; Glaucoma; Cardiovascular Diseases; Data Collection
PubMed: 36977937
DOI: 10.1038/s41433-023-02471-6 -
Hormones (Athens, Greece) Dec 2023PURPOSE : Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder which leads to increased cardiovascular risks. Vitamin D deficiency is... (Meta-Analysis)
Meta-Analysis
UNLABELLED
PURPOSE : Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder which leads to increased cardiovascular risks. Vitamin D deficiency is associated with various cardiometabolic complications, including increased cardiovascular morbidity and mortality. We aimed to analyze the difference in serum 25-hydroxyvitamin D (25-OHD) level, prevalence of vitamin D insufficiency and deficiency, and the effect of CPAP treatment on serum 25-OHD levels among adult patients with OSA.
METHODS
We pooled data from 18 observational studies involving 5592 individuals. Baseline parameters that might have contributed to the significant differences observed were also analyzed.
RESULTS
Patients with OSA had significantly lower serum 25-OHD levels (pooled d + - 0.74 [95% CI: - 1.19 to - 0.28], p < 0.01) and higher prevalence of vitamin D deficiency (pooled log (odds ratio) 0.98 [95% CI: 0.30 to 1.67], p < 0.01) compared to those without OSA. Subgroup analysis demonstrated that these differences were significant only in moderate OSA and severe OSA. Neither age nor BMI nor geographical latitude contributed significantly to the differences observed in serum 25-OHD levels. The use of CPAP did not lead to significant changes in serum 25-OHD levels.
CONCLUSION
Patients with OSA have lower serum 25-OHD levels with a higher prevalence of vitamin D deficiency, regardless of age or BMI, pointing to an independent association between vitamin D and OSA.
Topics: Adult; Humans; Vitamin D; Vitamin D Deficiency; Sleep Apnea, Obstructive; Vitamins
PubMed: 37704922
DOI: 10.1007/s42000-023-00481-3 -
Sleep Medicine Reviews Aug 2023Continuous positive airway pressure is the first-line and gold-standard treatment for obstructive sleep apnea (OSA). Pharmacotherapy is not commonly used in treating OSA... (Meta-Analysis)
Meta-Analysis Review
Continuous positive airway pressure is the first-line and gold-standard treatment for obstructive sleep apnea (OSA). Pharmacotherapy is not commonly used in treating OSA until recently. Combined noradrenergic and antimuscarinic agents have been clinically applied for OSA patients with variable results. This meta-analysis study aimed to investigate the efficacy of the combined regimen on OSA. A systematic literature search was performed up to November 2022 for the effects of the combined regimen on OSA. Eight randomized controlled trials were identified and systematically reviewed for meta-analysis. There were significant mean differences between OSA patients taking a combined regimen and placebo in apnea-hypopnea index (AHI) [mean difference (MD) -9.03 events/h, 95%CI (-16.22, -1.83 events/h; P = 0.01] and lowest oxygen saturation [MD 5.61%, 95% CI % (3.43, 7.80); P < 0.01]. Meta-regression showed that a higher proportion of male participants was associated with a greater reduction of AHI (p = 0.04). This study showed a positive but modest effect of pharmacotherapy in the reduction of OSA severity. The combination drugs are most applicable to male OSA patients based on their efficacy and pharmacological susceptibility. Pharmacotherapy may be applied as an alternative, adjunctive or synergistic treatment under careful consideration of its side effects.
Topics: Humans; Male; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Norepinephrine
PubMed: 37423095
DOI: 10.1016/j.smrv.2023.101809 -
Obesity Reviews : An Official Journal... Mar 2024Social jetlag, the weekly variation in sleep timing, is proposed to contribute to increased obesity risk, potentially because of the misalignment of behavioral cycles... (Meta-Analysis)
Meta-Analysis Review
Social jetlag, the weekly variation in sleep timing, is proposed to contribute to increased obesity risk, potentially because of the misalignment of behavioral cycles relative to the endogenous circadian timing system. This systematic review and meta-analysis aim to determine the association between social jetlag and adiposity-related measures using observational studies. We reviewed 477 references, of which 43 studies met inclusion criteria with a total sample size of 231,648. There was a positive association between social jetlag and body mass index (correlation coefficient [r]: 0.12; 95%CI, 0.07, 0.17; P < 0.001; I = 94.99%), fat mass (r: 0.10; 95%CI, 0.05, 0.15; P < 0.001; I = 0.00%), fat mass index (fat mass divided by height in meter squared, β: 0.14 kg/m ; 95%CI, 0.05, 0.23; P < 0.001; I = 56.50%), percent of body fat (r: 0.37; 95%CI, 0.33, 0.41; P < 0.001; I = 96.17%), waist circumference (r: 0.15; 95%CI, 0.06, 0.24; P = 0.001; I = 90.83%), and the risk of having overweight/obesity (odds ratio: 1.20; 95%CI, 1.02, 1.140; P = 0.039; I = 98.25%). Social jetlag is positively and consistently associated with multiple obesity-related anthropometric measures. Further studies are needed to test causality, underlying mechanisms, and whether obesity interventions based on increasing regularity of the sleep/wake cycle can aid in the battle against the obesity pandemic.
Topics: Humans; Circadian Rhythm; Obesity; Sleep; Jet Lag Syndrome; Body Mass Index; Observational Studies as Topic
PubMed: 38072635
DOI: 10.1111/obr.13664 -
Journal of Sleep Research Dec 2023Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy... (Review)
Review
Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy for insomnia, cognitive constructs are termed and conceptualised differently in different theories of insomnia proposed over the past decades. In search of consensus in thinking, the current systematic review identified cognitive factors and processes featured in theoretical models of insomnia and mapped any commonality between models. We systematically searched PsycINFO and PubMed for published theoretical articles on the development, maintenance and remission of insomnia, from inception of databases to February, 2023. A total of 2458 records were identified for title and abstract screening. Of these, 34 were selected for full-text assessment and 12 included for analysis and data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified nine distinguishable models of insomnia published between 1982 and 2023 and extracted 20 cognitive factors and processes featured in these models; 39 if sub-factors were counted. After assigning similarity ratings, we observed a high degree of overlap between constructs despite apparent differences in terminologies and measurement methods. As a result, we highlight shifts in thinking around cognitions associated with insomnia and discuss future directions.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy
PubMed: 37364869
DOI: 10.1111/jsr.13923 -
Sleep & Breathing = Schlaf & Atmung Dec 2023Several studies evaluated the effect of bariatric surgery on obstructive sleep apnea (OSA) but findings have been inconsistent. The aim of this study was to conduct an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies evaluated the effect of bariatric surgery on obstructive sleep apnea (OSA) but findings have been inconsistent. The aim of this study was to conduct an updated systematic review and meta-analysis to investigate the effect of bariatric surgery on OSA.
METHODS
The databases for PubMed, CENTRAL, and Scopus were searched up to the 1st of December, 2021. Studies were included if they were cohort or case-control in design, included patients with diagnosis of OSA, the patients underwent any bariatric surgery, and the study performed postoperative polysomnography.
RESULTS
The total number of the included patients was 2310 patients with OSA from 32 studies. Our analysis showed that bariatric surgery was associated with significant reduction in BMI (WMD = - 11.9, 95%CI: - 13.4, - 10.4), apnea-hypopnea index (AHI) (WMD = - 19.3, 95%CI: - 23.9, - 14.6), and respiratory disturbance index (RDI) (WMD = - 33.9, 95%CI: - 42.1, - 25.7). The rate of OSA remission after the surgery was 65% (95%CI: 0.54, 0.76).
CONCLUSION
Our results suggest that bariatric surgeries are effective in reducing obesity among patients with OSA in addition to OSA severity measures. However, the low rate of OSA remission suggests that the main etiology of OSA is not only obesity but also includes other important variables such as the anatomy of the jaw.
Topics: Humans; Bariatric Surgery; Obesity; Sleep Apnea, Obstructive; Polysomnography; Weight Loss; Obesity, Morbid
PubMed: 37145243
DOI: 10.1007/s11325-023-02840-1 -
Journal of Clinical Anesthesia Nov 2023This meta-analysis aimed at identifying the risk factors for and their strengths in predicting difficult mask ventilation (MV) through a systematic approach. (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
This meta-analysis aimed at identifying the risk factors for and their strengths in predicting difficult mask ventilation (MV) through a systematic approach.
DESIGN
Meta-analysis of observational studies.
SETTING
Operating room.
INTERVENTION
Airway- or patient-related risk factors for difficult MV reported in over 20% of eligible studies identified through literature review.
PATIENTS
Adults receiving anesthetic induction with requirement of MV.
MEASUREMENTS
Databases including EMBASE, MEDLINE, Google Scholar, and Cochrane Library were searched from inception to July 2022. The primary outcomes were the identification of commonly reported risk factors for MV and a comparison of their strengths in difficult MV prediction, while the secondary outcomes were the prevalence of difficult MV in the general population and those with obesity.
MAIN RESULTS
Meta-analysis of 20 observational studies involving 335,846 patients identified 13 risk factors with predictive strengths (all p < 0.05): neck radiation (OR = 5.0, five studies, n = 277,843), increased neck circumference (OR = 4.04, 11 studies, n = 247,871), obstructive sleep apnea (OSA) (OR = 3.61, 12 studies, n = 331,255), presence of beard (OR = 3.35, 12 studies, n = 295,443), snoring (OR = 3.06, 14 studies, n = 296,105), obesity (OR = 2.99, 11 studies, n = 278,297), male gender (OR = 2.76, 16 studies, n = 320,512), Mallampati score III-IV (OR = 2.36, 17 studies, n = 335,016), limited mouth opening (OR = 2.18, six studies, n = 291,795), edentulous (OR = 2.12, 11 studies, n = 249,821), short thyroid-mental distance (OR = 2.12, six studies, n = 328,311), old age (OR = 2, 11 studies, n = 278,750), and limited neck movement (OR = 1.98, nine studies, n = 155,101). The prevalence of difficult MV was 6.1% (16 studies, n = 334,694) and 14.4% (four studies, n = 1152) in the general population and those with obesity, respectively.
CONCLUSIONS
Our results demonstrated the strengths of 13 most common risk factors for predicting difficult MV, which may serve as an evidence-based reference for clinicians to incorporate into their daily practice.
Topics: Adult; Humans; Male; Prevalence; Laryngeal Masks; Risk Factors; Obesity; Sleep Apnea, Obstructive
PubMed: 37413763
DOI: 10.1016/j.jclinane.2023.111197 -
Journal of Sleep Research Dec 2023Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior... (Review)
Review
Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.
Topics: Humans; International Classification of Diseases; Phenotype; Reproducibility of Results; Self Report; Sleep Initiation and Maintenance Disorders
PubMed: 37122153
DOI: 10.1111/jsr.13910 -
Sleep Medicine Reviews Aug 2023Parental relationship dissolution is considered one of the most common adverse childhood experiences. Although sleep is crucial for healthy development of children and... (Review)
Review
Parental relationship dissolution is considered one of the most common adverse childhood experiences. Although sleep is crucial for healthy development of children and very sensitive to environmental changes, it is poorly studied in the context of parental relationship dissolution. The aim of the current study was to systematically review and critically assess the existing literature on the associations between parental relationship dissolution and child sleep (0-18 years old; registered on PROSPERO (CRD42021272720)). PsycInfo, MEDLINE, Scopus, ProQuest Dissertations and Theses Global, Social Work abstracts, and Web of Science Core Collection were searched. Published empirical quantitative studies were included if they reported statistics regarding the association between parental relationship dissolution and any child sleep variable. Out of the 358 articles screened, 14 articles met inclusion criteria and reported on several sleep dimensions: sleep quality, dreams and nightmares, and sleep disorders (enuresis, night terrors, and bruxism). Out of the 14 articles, six were longitudinal studies and eight were cross-sectional studies. While most studies found that parental relationship dissolution was associated with some indices of poorer child sleep, studies were generally of low to moderate quality. Health professionals should assess child sleep in the context of a parental relationship dissolution.
Topics: Child; Humans; Infant, Newborn; Infant; Child, Preschool; Adolescent; Solubility; Sleep; Parents; Dreams; Sleep Initiation and Maintenance Disorders
PubMed: 37390636
DOI: 10.1016/j.smrv.2023.101804