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Surgery For Obesity and Related... Dec 2023Obstructive sleep apnea (OSA) is highly prevalent in patients with morbid obesity. There is a growing interest in the role of bariatric surgery in OSA management. This... (Meta-Analysis)
Meta-Analysis Review
The efficacy of bariatric surgery on pulmonary function and sleep architecture of patients with obstructive sleep apnea and co-morbid obesity: a systematic review and meta-analysis.
Obstructive sleep apnea (OSA) is highly prevalent in patients with morbid obesity. There is a growing interest in the role of bariatric surgery in OSA management. This study aims to evaluate the therapeutic efficacy of bariatric surgery on changes in pulmonary function and sleep architecture. Studies of patients with OSA that underwent bariatric surgery were searched in 4 different databases (PubMed, Cochrane, Web of Science, and Embase) until October 31, 2022. We identified studies evaluating the efficacy of surgical intervention on primary outcomes (body mass index [BMI] and apnea-hypopnea index [AHI]) and secondary outcomes such as forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, oxygen desaturation index (ODI), T90, mean oxygen saturation (SpO), nadirSpO, sleep efficiency (SE), N1%, N2%, N3%, rapid eye movement (REM%), arousal index, Epworth sleepiness scale (ESS), neck circumference, waist circumference, and weight. A total of 24 eligible studies were finally chosen. Risk of bias assessed through funnel plots was collected and analyzed via random effects meta-analyses. There were significant reductions in BMI and AHI after bariatric surgery induced weight loss. Accordingly, improvement in FVC, meanSpO, nadirSpO, SE, N3%, REM%, and ESS were observed compared with baseline. Patients with OSA also exhibit lower ODI, T90, arousal index, neck circumference, waist circumference, and weight after treatment. Bariatric surgery has beneficial effects on patients with OSA and obesity, particularly with morbid obesity. Surgical weight loss significantly eliminates apnea-hypopnea events, reduces weight, increases oxygen saturation, N3 and REM sleep stage, reduces sleep fragmentation, and improves pulmonary functions with augmented FVC.
Topics: Humans; Obesity, Morbid; Polysomnography; Sleep; Sleep Apnea, Obstructive; Bariatric Surgery; Weight Loss
PubMed: 37673709
DOI: 10.1016/j.soard.2023.07.007 -
Sleep Medicine Apr 2024Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of... (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking.
OBJECTIVE
This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population.
DATA SOURCES
PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA.
STUDY SELECTION
Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children.
DATA EXTRACTION AND SYNTHESIS
Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839).
MAIN OUTCOME(S) AND MEASURE(S)
The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2).
RESULTS
17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %).
CONCLUSIONS AND RELEVANCE
The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.
Topics: Child; Humans; Network Meta-Analysis; Acetates; Sleep Apnea, Obstructive; Mometasone Furoate; Cyclopropanes; Quinolines; Sulfides
PubMed: 38460418
DOI: 10.1016/j.sleep.2024.01.030 -
PeerJ 2023Insomnia and depression often co-occur. Cognitive behavioral therapy for insomnia (CBT-I) seems to be effective and safe for mitigating insomnia and depression. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Insomnia and depression often co-occur. Cognitive behavioral therapy for insomnia (CBT-I) seems to be effective and safe for mitigating insomnia and depression. However, the efficacy of digitally-delivered CBT-I (dCBT-I) remains unclear. Therefore, this meta-analysis of randomized controlled trials (RCTs) was to systematically review and evaluate the efficacy of dCBT-I in adults with insomnia and depression.
METHODS
A systematic search in PubMed, Cochrane, Embase, and Web of Science databases (as of June 5, 2022) was conducted for RCTs on dCBT-I. Statistical analyses were performed using Revan Manager. The effects of dCBT-I on insomnia and depression were expressed as standardized mean difference (SMD) with 95% confidence intervals (CIs).
RESULTS
Seven studies involving 3,597 participants were included. This meta-analysis showed that dCBT-I reduced the severity of insomnia (SMD = -0.85, 95% CI [-1.00 to -0.69], < 0.001) and depression (SMD = -0.47, 95% CI [-0.55 to -0.38], < 0.001) in short terms, and also mitigated the severity of insomnia (SMD = -0.71, 95% CI [-1.00 to -0.44], < 0.001) and depression (SMD = -0.42, 95% CI [-0.68 to -0.15], = 0.002) in long terms. The effect of dCBT-I was comparable to that of traditional face-to-face CBT-I, and was generally maintained at follow-ups of 6 weeks to 6 months.
CONCLUSION
dCBT-I seems to be effective in alleviating insomnia and depression and might be considered as a viable treatment option for depression.
Topics: Adult; Humans; Sleep Initiation and Maintenance Disorders; Depression; Randomized Controlled Trials as Topic; Cognitive Behavioral Therapy
PubMed: 37927792
DOI: 10.7717/peerj.16137 -
Sleep Medicine Reviews Oct 2023Our systematic review and meta-analysis estimated the prevalence of post-COVID sleep disturbances in adult population. We systematically searched relevant studies from... (Meta-Analysis)
Meta-Analysis Review
Our systematic review and meta-analysis estimated the prevalence of post-COVID sleep disturbances in adult population. We systematically searched relevant studies from four databases that reported post-COVID sleep disturbances prevalence with a mean or median follow-up duration of ≥28 days. We identified 153 eligible papers, with a total COVID-19 population of 252437. Employing multilevel mixed-effects meta-analyses, we estimated the overall pooled prevalence of post-COVID sleep disturbances being 28.98% (25.73-32.34), with the highest prevalence reported in Europe and the lowest in Southeast Asia. Poor sleep quality was the most prevalent definition of sleep disturbances, followed by excessive daytime sleepiness, insomnia, sleep apnea. Prevalence estimates were notably higher when measured with Epworth sleepiness scale, or Pittsburgh sleep quality index compared to symptom questionnaires, self-reports, or personal interviews. Female sex (Odds ratio, OR = 1.59, 1.38-1.83) and severe/critical acute COVID-19 (OR = 1.36, 1.09-1.69) emerged as substantial risk factors. Our review underscore the persistent prevalence of sleep disturbances among COVID-19 survivors, and the importance of factors such as geography, definition, measures of sleep disorders, sex, and severity of acute COVID-19 infection. These findings highlight the urgent need for further investigation into the underlying molecular mechanisms driving these sleep disturbances to develop effective therapeutic strategies.
Topics: Humans; Adult; Female; Follow-Up Studies; Prevalence; COVID-19; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Sleep Quality
PubMed: 37597302
DOI: 10.1016/j.smrv.2023.101833 -
Journal of Oral Rehabilitation Dec 2023Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This... (Review)
Review
Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions.
BACKGROUND
Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users.
METHODS
A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies.
RESULTS
A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs.
CONCLUSION
The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.
Topics: Humans; Occlusal Splints; Sleep Apnea, Obstructive; Temporomandibular Joint Disorders; Pain; Mandibular Advancement; Treatment Outcome
PubMed: 37644889
DOI: 10.1111/joor.13574 -
Sleep Feb 2024Dual orexin receptor antagonists (DORAs) are emerging treatments for insomnia. This meta-analysis study aimed to assess the safety of FDA-approved DORAs (suvorexant,... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVES
Dual orexin receptor antagonists (DORAs) are emerging treatments for insomnia. This meta-analysis study aimed to assess the safety of FDA-approved DORAs (suvorexant, lemborexant, and daridorexant), focusing on narcolepsy-like symptoms associated with these drugs.
METHODS
Five prominent databases were searched to identify randomized controlled trials (RCTs) on this topic. Primary safety outcomes included treatment-emergent adverse events (TEAEs), treatment-related TEAEs, TEAEs leading to discontinuation, and serious TEAEs. Excessive daytime sleepiness (EDS), sleep paralysis, and hallucinations were categorized as adverse events (AEs)-related narcolepsy-like symptoms.
RESULTS
Eleven RCTs with 7703 patients were included. DORAs were associated with a higher risk of TEAEs (risk ratio [RR], 1.09; 95% confidence interval [CI], 1.03 to 1.15) and treatment-related TEAEs (RR, 1.69; 95% CI: 1.49 to 1.92) when compared to placebo. The DORA group exhibited a significantly higher risk of EDS (RR, 2.15; 95% CI: 1.02 to 4.52) and sleep paralysis (RR, 3.40; 95% CI: 1.18 to 9.80) compared to the placebo group.
CONCLUSION
This meta-analysis achieved a comparative evaluation of the clinical safety and tolerability of FDA-approved DORAs for primary insomnia, specifically focusing on AEs-related narcolepsy-like symptoms. This study contributes to understanding the safety profile of FDA-approved DORAs for treating insomnia.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Orexin Receptor Antagonists; Sleep Paralysis; Narcolepsy
PubMed: 37950346
DOI: 10.1093/sleep/zsad293 -
The Journal of Maternal-fetal &... Dec 2023The majority of expectant mothers report sleep alterations during pregnancy and almost 40% report poor sleep quality. There is growing evidence that sleep quality (SQ)... (Review)
Review
BACKGROUND
The majority of expectant mothers report sleep alterations during pregnancy and almost 40% report poor sleep quality. There is growing evidence that sleep quality (SQ) during pregnancy influences maternal health. This review focuses on how SQ during pregnancy relates to maternal health-related quality of life (HRQoL). The review also aims to identify whether this relation varies between pregnancy trimesters, and for different subdomains of HRQoL.
METHODS
A systematic review was performed according to PRISMA guidelines and registered on Prospero in August 2021 with ID no: CRD42021264707. Pubmed, Psychinfo, Embase, Cochrane, and trial registries were searched up to June 2021. Studies with any design that investigated the relation between SQ and quality of life/HRQoL in pregnant women, published in English, and peer-reviewed, were included. Two independent reviewers screened titles, abstracts, and full texts, and extracted data from the included papers. The quality of the studies was evaluated using the Newcastle-Ottawa Scale.
RESULTS
Three hundred and thirteen papers were identified in the initial search, of which 10 met the inclusion criteria. Data included 7330 participants from six different countries. The studies had longitudinal ( = 1) or cross-sectional designs ( = 9). In nine studies SQ was reported subjectively by self-report questionnaires. Actigraphic data was available from two studies. HRQoL was assessed by validated questionnaires in all studies. Due to high levels of clinical and methodological heterogeneity in included studies, a narrative synthesis was employed. Nine studies found that poor sleep quality was related to a lower overall HRQoL during pregnancy. Effect sizes were low to medium. This relation was reported most during the third trimester. Especially sleep disturbances and subjective low SQ seemed to be related consistently to lower HRQoL. Furthermore, an indication was found that SQ might have a relation with the mental and physical domain of HRQoL. The social and environmental domain may also be associated with overall SQ.
CONCLUSION
Despite the scarcity of studies available, this systematic review found evidence that low SQ is related to low HRQoL during pregnancy. An indication was found that the relationship between SQ and HRQoL during the second trimester might be less prominent.
Topics: Humans; Female; Pregnancy; Quality of Life; Sleep Quality; Cross-Sectional Studies; Pregnant Women; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 37197986
DOI: 10.1080/14767058.2023.2212829 -
Nutrients Jan 2024The prevalence of sleep disorders, characterized by issues with quality, timing, and sleep duration is increasing globally. Among modifiable risk factors, diet quality... (Review)
Review
The prevalence of sleep disorders, characterized by issues with quality, timing, and sleep duration is increasing globally. Among modifiable risk factors, diet quality has been suggested to influence sleep features. The Mediterranean diet is considered a landmark dietary pattern in terms of quality and effects on human health. However, dietary habits characterized by this cultural heritage should also be considered in the context of overall lifestyle behaviors, including sleep habits. This study aimed to systematically revise the literature relating to adherence to the Mediterranean diet and sleep features in observational studies. The systematic review comprised 23 reports describing the relation between adherence to the Mediterranean diet and different sleep features, including sleep quality, sleep duration, daytime sleepiness, and insomnia symptoms. The majority of the included studies were conducted in the Mediterranean basin and reported a significant association between a higher adherence to the Mediterranean diet and a lower likelihood of having poor sleep quality, inadequate sleep duration, excessive daytime sleepiness or symptoms of insomnia. Interestingly, additional studies conducted outside the Mediterranean basin showed a relationship between the adoption of a Mediterranean-type diet and sleep quality, suggesting that biological mechanisms sustaining such an association may exist. In conclusion, current evidence suggests a relationship between adhering to the Mediterranean diet and overall sleep quality and different sleep parameters. The plausible bidirectional association should be further investigated to understand whether the promotion of a healthy diet could be used as a tool to improve sleep quality.
Topics: Humans; Diet, Mediterranean; Sleep Initiation and Maintenance Disorders; Sleep; Sleep Quality; Risk Factors; Observational Studies as Topic
PubMed: 38257175
DOI: 10.3390/nu16020282 -
PloS One 2024Stroke is a serious threat to human life and health, and post-stroke insomnia is one of the common complications severely impairing patients' quality of life and... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIM
Stroke is a serious threat to human life and health, and post-stroke insomnia is one of the common complications severely impairing patients' quality of life and delaying recovery. Early understanding of the relationship between stroke and post-stroke insomnia can provide clinical evidence for preventing and treating post-stroke insomnia. This study was to investigate the prevalence of insomnia in patients with stroke.
METHODS
The Web of Science, PubMed, Embase, and Cochrane Library databases were used to obtain the eligible studies until June 2023. The quality assessment was performed to extract valid data for meta-analysis. The prevalence rates were used a random-efect. I2 statistics were used to assess the heterogeneity of the studies.
RESULTS
Twenty-six studies met the inclusion criteria for meta-analysis, with 1,193,659 participants, of which 497,124 were patients with stroke.The meta-analysis indicated that 150,181 patients with stroke developed insomnia during follow-up [46.98%, 95% confidence interval (CI): 36.91-57.18] and 1806 patients with ischemic stroke (IS) or transient ischemic attack (TIA) developed insomnia (47.21%, 95% CI: 34.26-60.36). Notably, 41.51% of patients with the prevalence of nonclassified stroke developed insomnia (95% CI: 28.86-54.75). The incidence of insomnia was significantly higher in patients with acute strokes than in patients with nonacute strokes (59.16% vs 44.07%, P < 0.0001).Similarly, the incidence of insomnia was significantly higher in the patients with stroke at a mean age of ≥65 than patients with stroke at a mean age of <65 years (47.18% vs 40.50%, P < 0.05). Fifteen studies reported the follow-up time. The incidence of insomnia was significantly higher in the follow-up for ≥3 years than follow-up for <3 years (58.06% vs 43.83%, P < 0.05). Twenty-one studies used the Insomnia Assessment Diagnostic Tool, and the rate of insomnia in patients with stroke was 49.31% (95% CI: 38.59-60.06). Five studies used self-reporting, that the rate of insomnia in patients with stroke was 37.58% (95% CI: 13.44-65.63).
CONCLUSIONS
Stroke may be a predisposing factor for insomnia. Insomnia is more likely to occur in acute-phase stroke, and the prevalence of insomnia increases with patient age and follow-up time. Further, the rate of insomnia is higher in patients with stroke who use the Insomnia Assessment Diagnostic Tool.
Topics: Humans; Aged; Sleep Initiation and Maintenance Disorders; Quality of Life; Stroke; Ischemic Attack, Transient; Ischemic Stroke
PubMed: 38598535
DOI: 10.1371/journal.pone.0297941 -
Journal of Sleep Research Dec 2023So-called 'sleep misperception' refers to a phenomenon in which individuals have the impression of sleeping little or not at all despite normal objective measures of... (Review)
Review
So-called 'sleep misperception' refers to a phenomenon in which individuals have the impression of sleeping little or not at all despite normal objective measures of sleep. It is unknown whether this subjective-objective mismatch truly reflects an abnormal perception of sleep, or whether it results from the inability of standard sleep recording techniques to capture 'wake-like' brain activity patterns that could account for feeling awake during sleep. Here, we systematically reviewed studies reporting sleep macro- and microstructural, metabolic, and mental correlates of sleep (mis)perception. Our findings suggest that most individuals tend to accurately estimate their sleep duration measured with polysomnography (PSG). In good sleepers, feeling awake during sleep is the rule at sleep onset, remains frequent in the first non-rapid eye movement sleep cycle and almost never occurs in rapid eye movement (REM) sleep. In contrast, there are patients with insomnia who consistently underestimate their sleep duration, regardless of how long they sleep. Unlike good sleepers, they continue to feel awake after the first sleep cycle and importantly, during REM sleep. Their mental activity during sleep is also more thought-like. Initial studies based on standard PSG parameters largely failed to show consistent differences in sleep macrostructure between these patients and controls. However, recent studies assessing sleep with more refined techniques have revealed that these patients show metabolic and microstructural electroencephalography changes that likely reflect a shift towards greater cortical activation during sleep and correlate with feeling awake. We discuss the significance of these correlates and conclude with open questions and possible ways to address them.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Sleep; Wakefulness; Sleep, REM; Perception
PubMed: 37678561
DOI: 10.1111/jsr.14028