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Current Opinion in Cardiology May 2024This review addresses the evolving intersection of sleep-disordered breathing (SDB) and heart failure, a topic of increasing clinical significance due to the high... (Review)
Review
PURPOSE OF REVIEW
This review addresses the evolving intersection of sleep-disordered breathing (SDB) and heart failure, a topic of increasing clinical significance due to the high prevalence of SDB in heart failure patients and its impact on morbidity and mortality. It reflects recent advancements in diagnostic methodologies and therapeutic strategies. It emphasizes the need for heightened awareness among healthcare providers about the complex relationship between SDB and various forms of heart failure.
RECENT FINDINGS
Recent studies underscore the high incidence of SDB in heart failure patients, varying with the cause of heart failure. Emerging diagnostic tools, including home sleep tests and advanced inpatient screening methods, have improved the early detection and accurate diagnosis of SDB. Novel treatment modalities, like hypoglossal and phrenic nerve stimulation, are promising, especially where conventional therapies are inadequate. The review also discusses the complexities of managing SDB in the context of different heart failure subtypes.
SUMMARY
Findings from recent literature suggest that improved screening, diagnosis, and innovative treatment of SDB in heart failure patients can reduce morbidity, mortality, and healthcare costs. This review emphasizes the need for personalized treatment approaches tailored to individual patient profiles, highlighting the potential of new technologies and multidisciplinary strategies in clinical practice.
Topics: Humans; Sleep Apnea Syndromes; Heart Failure
PubMed: 38375816
DOI: 10.1097/HCO.0000000000001125 -
Dental Clinics of North America Jul 2024The term "comorbid insomnia and sleep apnea" (COMISA) has been used to categorize the co-occurrence of the most prevalent and impacting sleep disorders. Meanwhile, both... (Review)
Review
The term "comorbid insomnia and sleep apnea" (COMISA) has been used to categorize the co-occurrence of the most prevalent and impacting sleep disorders. Meanwhile, both insomnia and sleep apnea have been shown to be associated with increased stress levels and cardiometabolic risk, a major cause of mortality. The better knowledge about such convergence would be critical for better understanding pathophysiological pathways and mechanisms. This article provides an overview of epidemiologic aspects, clinical findings, and mechanisms subsiding COMISA. Odontostomatological approach with mandibular advancement devices are discussed as an effective therapeutic approach in these patients.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Sleep Apnea Syndromes; Mandibular Advancement; Comorbidity; Sleep Apnea, Obstructive
PubMed: 38879279
DOI: 10.1016/j.cden.2024.03.002 -
Revista de Neurologia Jul 2023Narcolepsy type 1 is a focal degenerative disease of the hypothalamus that selectively affects orexin (hypocretin)-producing neurons. It presents multiple clinical...
INTRODUCTION
Narcolepsy type 1 is a focal degenerative disease of the hypothalamus that selectively affects orexin (hypocretin)-producing neurons. It presents multiple clinical manifestations, both in wakefulness and in sleep. The symptoms are often so disruptive that they cause enormous suffering and impair patients' quality of life. Although a non-pharmacological approach is sometimes sufficient, the vast majority of patients need medication for adequate clinical management.
CASE REPORT
A male who, at 43 years of age, began to present acutely with excessive daytime sleepiness and episodes of cataplexy. After a thorough examination, he was diagnosed with narcolepsy type 1. Throughout the course of the disease, he was prescribed antidepressants, neurostimulants and sodium oxybate, in monotherapy or in combination. The response to pharmacological treatment was insufficient and accompanied by numerous side effects. Following the introduction of pitolisant, there was a marked improvement in his symptoms and a reduction in the dose of the other drugs and their adverse effects was achieved.
CONCLUSION
A number of measures are now available to address the cardinal symptoms of the disease, although there are still cases that are resistant to anti-narcoleptic treatment. Drugs with mechanisms of action that act upon receptors in the histaminergic system can be very useful in these cases.
Topics: Humans; Male; Antidepressive Agents; Cataplexy; Central Nervous System Stimulants; Narcolepsy; Quality of Life; Sodium Oxybate; Adult; Drug Resistance, Multiple; Sleepiness
PubMed: 37477029
DOI: 10.33588/rn.77s01.2023198 -
British Dental Journal Jun 2024
Topics: Humans; Sleep Apnea, Obstructive
PubMed: 38877232
DOI: 10.1038/s41415-024-7515-4 -
The Journal of Neuroscience : the... Jul 2023Many sleep less than recommended without experiencing daytime sleepiness. According to prevailing views, short sleep increases risk of lower brain health and cognitive...
Many sleep less than recommended without experiencing daytime sleepiness. According to prevailing views, short sleep increases risk of lower brain health and cognitive function. Chronic mild sleep deprivation could cause undetected sleep debt, negatively affecting cognitive function and brain health. However, it is possible that some have less sleep need and are more resistant to negative effects of sleep loss. We investigated this using a cross-sectional and longitudinal sample of 47,029 participants of both sexes (20-89 years) from the Lifebrain consortium, Human Connectome project (HCP) and UK Biobank (UKB), with measures of self-reported sleep, including 51,295 MRIs of the brain and cognitive tests. A total of 740 participants who reported to sleep <6 h did not experience daytime sleepiness or sleep problems/disturbances interfering with falling or staying asleep. These short sleepers showed significantly larger regional brain volumes than both short sleepers with daytime sleepiness and sleep problems ( = 1742) and participants sleeping the recommended 7-8 h ( = 3886). However, both groups of short sleepers showed slightly lower general cognitive function (GCA), 0.16 and 0.19 SDs, respectively. Analyses using accelerometer-estimated sleep duration confirmed the findings, and the associations remained after controlling for body mass index, depression symptoms, income, and education. The results suggest that some people can cope with less sleep without obvious negative associations with brain morphometry and that sleepiness and sleep problems may be more related to brain structural differences than duration. However, the slightly lower performance on tests of general cognitive abilities warrants closer examination in natural settings. Short habitual sleep is prevalent, with unknown consequences for brain health and cognitive performance. Here, we show that daytime sleepiness and sleep problems are more strongly related to regional brain volumes than sleep duration. However, participants sleeping ≤6 h had slightly lower scores on tests of general cognitive function (GCA). This indicates that sleep need is individual and that sleep duration per se is very weakly if at all related brain health, while daytime sleepiness and sleep problems may show somewhat stronger associations. The association between habitual short sleep and lower scores on tests of general cognitive abilities must be further scrutinized in natural settings.
Topics: Male; Female; Humans; Cross-Sectional Studies; Brain; Sleep; Sleep Deprivation; Sleep Wake Disorders; Cognition; Disorders of Excessive Somnolence
PubMed: 37365003
DOI: 10.1523/JNEUROSCI.2330-22.2023 -
European Respiratory Review : An... Jan 2024Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have... (Review)
Review
Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have prompted investigations aiming to achieve a more precise differentiation and description of the entities of central sleep apnoea (CSA). There is increasing evidence for the heterogeneity of CSA in terms of underlying aetiology, pathophysiological concepts, treatment response and outcome. Assigning patients to these phenotypes allows for the selection of individualised therapies. Major pathophysiological characteristics include loop gain, apnoeic threshold, breathing regulation and neuromuscular mechanics. Chronic heart failure is the most important underlying disease, leading to nonhypercapnic CSA based on increased loop and controller gain. Although many questions remain, this review tries to describe the current knowledge on the pathophysiology of the clinical entities. The description of prognostic aspects may guide treatment indication and the selection of pharmacotherapy and invasive options. In addition, the paper provides an update on the current understanding of adaptive servo-ventilation and its role in the treatment of CSA.
Topics: Humans; Sleep Apnea, Central; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Respiration; Continuous Positive Airway Pressure; Heart Failure
PubMed: 38537948
DOI: 10.1183/16000617.0141-2023 -
Sleep Medicine Aug 2023Gerstmann-Sträussler-Scheinker (GSS) is a rare prion disease with heterogeneous clinical presentation. Although sleep-related abnormalities are prominent and well-known...
BACKGROUND
Gerstmann-Sträussler-Scheinker (GSS) is a rare prion disease with heterogeneous clinical presentation. Although sleep-related abnormalities are prominent and well-known in other prion diseases such as fatal familial insomnia and Creutzfeldt-Jakob disease, information on sleep is limited in GSS.
METHODS
We evaluated sleep in three genetically confirmed GSS cases using clinical history, sleep scales and video-polysomnography. In addition, patients underwent neurological assessment, neurological scales, neuropsychological testing, lumbar puncture, brain MRI and brain F-FDG-PET.
RESULTS
Two patients reported sleep maintenance insomnia attributed to leg stiffness and back pain while the remaining patient did not report sleep problems. Video-polysomnography showed normal sleep staging in all of them. Findings such as reduced sleep efficiency in two patients, a confusional arousal in one patient, obstructive apneas in one patient, and periodic legs movements in sleep in two patients were observed.
CONCLUSIONS
In contrast to fatal familial insomnia, the normal sleep staging in GSS may suggest dissimilar involvement of the neuronal structures that regulate sleep. We found non-specific sleep alterations in GSS such as obstructive apneas and periodic leg movements in sleep which are of unknown origin and of uncertain clinical relevance. Studies including a larger number of patients, serial sleep evaluations and incorporating neuropathological assessment will further help to understand sleep in GSS.
Topics: Humans; Gerstmann-Straussler-Scheinker Disease; Insomnia, Fatal Familial; Sleep; Brain; Sleep Apnea, Obstructive; Sleep Apnea Syndromes
PubMed: 37302168
DOI: 10.1016/j.sleep.2023.05.010 -
Current Opinion in Otolaryngology &... Feb 2024Obstructive sleep apnea (OSA) is a ubiquitous disease defined by repetitive partial or complete cessation of airflow during sleep caused by upper airway collapse.... (Review)
Review
PURPOSE
Obstructive sleep apnea (OSA) is a ubiquitous disease defined by repetitive partial or complete cessation of airflow during sleep caused by upper airway collapse. Otolaryngologists play a crucial role in the management of OSA, which is rapidly evolving with the advent of new surgical techniques and medical devices. Here we review the medical and surgical treatment options for OSA with a focus on unique considerations for patients with OSA who undergo nasal, sinus, and skull base surgery.
RECENT FINDINGS
Treatment of OSA includes both nonsurgical and surgical options. Positive airway pressure (PAP) therapy remains the first-line medical treatment for OSA, but alternatives such as oral appliance and positional therapy are viable alternatives. Surgical treatments include pharyngeal and tongue base surgery, hypoglossal nerve stimulation therapy, and skeletal surgery. Nasal surgery has been shown to improve sleep quality and continuous positive airway pressure (CPAP) tolerance and usage. Sinus and skull base patients with comorbid OSA have special perioperative considerations for the rhinologist to consider such as the need for overnight observation and timing of CPAP therapy resumption.
SUMMARY
OSA patients present with special considerations for the rhinologist. Patients with moderate to severe OSA may benefit from overnight observation after ambulatory surgery, especially those with an elevated BMI, cardiopulmonary comorbidities, and those who are not using CPAP regularly at home. Though CPAP may be safely resumed in the perioperative setting of nasal, sinus, and skull base surgery, the exact timing depends on patient, surgeon, and systemic factors such as severity of OSA, CPAP pressures required, extent of surgery, and the postoperative monitoring setting. Lastly, nasal and sinus surgery can improve sleep quality and CPAP tolerance and compliance in patients with OSA.
Topics: Humans; Sleep Apnea, Obstructive; Nose; Continuous Positive Airway Pressure; Comorbidity; Patient Compliance
PubMed: 37997886
DOI: 10.1097/MOO.0000000000000941 -
Sleep Medicine Clinics Sep 2023Sleep apnea is heterogeneous in multiple dimensions. There are different physiological risk factors that may have clinical relevance. However, assessing them is... (Review)
Review
Sleep apnea is heterogeneous in multiple dimensions. There are different physiological risk factors that may have clinical relevance. However, assessing them is challenging. An approach to ascertain them using a simple model of ventilatory control has been proposed. It is based, however, on untenable assumptions. There are limited validation data and reproducibility is not stellar. There are also different symptom subtypes. They have been found in multiple population-based and clinical cohorts worldwide. Symptomatic benefit from therapy is most marked in the excessively sleepy subtype. This group may also be the group at increased CV risk from obstructive sleep apnea.
Topics: Humans; Reproducibility of Results; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Wakefulness; Risk Factors
PubMed: 37532370
DOI: 10.1016/j.jsmc.2023.05.003 -
Sleep May 2024
Topics: Humans; Narcolepsy; Phenotype
PubMed: 38452192
DOI: 10.1093/sleep/zsae047