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Current Pediatric Reviews 2024Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. (Review)
Review
BACKGROUND
Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children.
OBJECTIVE
To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents.
METHODS
A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled.
RESULTS
Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized.
CONCLUSION
Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.
Topics: Adolescent; Child; Humans; Sleep; Sleep Apnea, Obstructive; Polysomnography; Sleep Wake Disorders
PubMed: 36043722
DOI: 10.2174/1573396318666220827102018 -
Sleep Medicine Oct 2023The diagnosis of narcolepsy is based on clinical information, combined with polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). PSG and the MSLT are...
BACKGROUND
The diagnosis of narcolepsy is based on clinical information, combined with polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT). PSG and the MSLT are moderately reliable at diagnosing narcolepsy type 1 (NT1) but unreliable for diagnosing narcolepsy type 2 (NT2). This is a problem, especially given the increased risk of a false-positive MSLT in the context of circadian misalignment or sleep deprivation, both of which commonly occur in the general population.
AIM
We aimed to clarify the accuracy of PSG/MSLT testing in diagnosing NT1 versus controls without sleep disorders. Repeatability and reliability of PSG/MSLT testing and temporal changes in clinical findings of patients with NT1 versus patients with hypersomnolence with normal hypocretin-1 were compared.
METHOD
84 patients with NT1 and 100 patients with non-NT1-hypersomnolence disorders, all with congruent cerebrospinal fluid hypocretin-1 (CSF-hcrt-1) levels, were included. Twenty-five of the 84 NT1 patients and all the hypersomnolence disorder patients underwent a follow-up evaluation consisting of clinical assessment, PSG, and a modified MSLT. An additional 68 controls with no sleep disorders were assessed at baseline.
CONCLUSION
Confirming results from previous studies, we found that PSG and our modified MSLT accurately and reliably diagnosed hypocretin-deficient NT1 (accuracy = 0.88, reliability = 0.80). Patients with NT1 had stable clinical and electrophysiological presentations over time that suggested a stable phenotype. In contrast, the PSG/MSLT results of patients with hypersomnolence, and normal CSF-hcrt-1 had poor reliability (0.32) and low repeatability.
Topics: Humans; Polysomnography; Orexins; Sleep Latency; Reproducibility of Results; Narcolepsy; Disorders of Excessive Somnolence
PubMed: 37544279
DOI: 10.1016/j.sleep.2023.07.029 -
Journal of the American Dental... Apr 2024The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition,... (Review)
Review
BACKGROUND
The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition, pathophysiology, and management of SB, from the early 1960s through the present. The role of peripheral factors, such as dental occlusion, in the pathogenesis of SB has been discarded.
TYPES OF STUDIES REVIEWED
The authors searched several electronic databases (ie, PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE) for studies on bruxism. The search was conducted from January 1961 through May 2023 and yielded 4,612 articles, of which 312 were selected for comprehensive review after eliminating duplicates and nonfocused articles.
RESULTS
There has been an evident progressive shift from the role of peripheral factors, such as dental occlusion, to more central factors, such as the involvement of a central pattern generator as well as the autonomic nervous system, in the genesis of bruxing movements. There is continued robust interest in the dental community to elucidate the contributing factors involved in SB.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
The neurophysiology of SB appears to be leaning more toward central rather than peripheral factors. There is increasing evidence of the role of the autonomic nervous system, genetics, and comorbidities in the genesis of SB. The scientific literature seems to refute the role of dental occlusion in the causation of bruxing movements. As per the literature, there has been a paradigm shift in the definition and genesis of SB and its possible dental implications and management, which also highlights the need for succinct scientific studies in this regard.
Topics: Humans; Sleep Bruxism; Polysomnography
PubMed: 38363252
DOI: 10.1016/j.adaj.2023.12.004 -
Epilepsia Open Sep 2023This study evaluated sleep and respiratory abnormalities, and their relationship with seizures, in adults with developmental and epileptic encephalopathies (DEEs). We...
This study evaluated sleep and respiratory abnormalities, and their relationship with seizures, in adults with developmental and epileptic encephalopathies (DEEs). We studied consecutive adults with DEEs undergoing inpatient video-EEG monitoring and concurrent polysomnography between December 2011 and July 2022. Thirteen patients with DEEs were included (median age: 31 years, range: 20-50; 69.2% female): Lennox-Gastaut syndrome (n = 6), Lennox-Gastaut syndrome-like phenotype (n = 2), Landau-Kleffner syndrome (n = 1), epilepsy with myoclonic-atonic seizures (n = 1), and unclassified DEEs (n = 3). Sleep architecture was often fragmented by epileptiform discharges and seizures resulting in arousals (median arousal index: 29.0 per h, range: 5.1-65.3). Moderate-to-severe obstructive sleep apnea (OSA) was observed in seven patients (53.8%). Three patients (23.1%) had tonic seizures that frequently occurred with central apnea; one met criteria for mild central sleep apnea. Of the patients with tonic seizures, two had other identifiable seizure manifestations, but in one patient, central apnea was commonly the only discernable seizure manifestation. Polysomnography during video-EEG is an effective diagnostic tool in detecting sleep and seizure-related respiratory abnormalities. Clinically significant OSA may increase the risk of comorbid cardiovascular disease and premature mortality. Treatment of epilepsy may improve sleep quality, and conversely, improved sleep, may decrease seizure burden.
Topics: Female; Male; Humans; Polysomnography; Lennox Gastaut Syndrome; Sleep Apnea, Central; Sleep; Seizures; Electroencephalography; Sleep Apnea, Obstructive
PubMed: 37277988
DOI: 10.1002/epi4.12772 -
Sleep Medicine Reviews Oct 2023Although rapid eye movement (REM) sleep behavior disorder (RBD) has been widely considered as a male-predominant parasomnia, the existing evidence for the sex difference... (Meta-Analysis)
Meta-Analysis Review
Although rapid eye movement (REM) sleep behavior disorder (RBD) has been widely considered as a male-predominant parasomnia, the existing evidence for the sex difference in the risk of RBD in the general population was conflicting. The present study conducted a systematic review to explore the sex differences in the prevalence, comorbidities, clinical characteristics, and phenoconversion of RBD. One hundred thirty-five eligible studies were identified for the systematic review, and 133 were finally included in the meta-analysis. Males in the general population showed a trend for a higher risk of probable/possible RBD (pRBD), especially among the male older adults (aged ≥60). In the clinical populations, males showed a significantly higher risk of confirmed RBD, but not of pRBD. Among idiopathic RBD (iRBD) patients, males had a significantly earlier age onset of RBD compared with females. Male patients with Parkinson's disease (PD) had a higher risk of comorbid RBD. There was no significant sex difference in the risk of developing neurodegenerative diseases in iRBD patients. Large scale and prospective studies utilizing stringent diagnostic criteria for RBD are recommended to further verify the sex differences in RBD and to investigate the mechanism underlying the sex difference.
Topics: Humans; Male; Female; Aged; Sex Characteristics; Prospective Studies; REM Sleep Behavior Disorder; Polysomnography; Parkinson Disease
PubMed: 37422999
DOI: 10.1016/j.smrv.2023.101810 -
Sleep Dec 2023
Topics: Polysomnography; Deep Learning; Sleep; Sleep Stages
PubMed: 37843473
DOI: 10.1093/sleep/zsad268 -
Journal of Medical Internet Research Dec 2023Sleep disturbances are core symptoms of psychiatric disorders. Although various sleep measures have been developed to assess sleep patterns and quality of sleep, the...
BACKGROUND
Sleep disturbances are core symptoms of psychiatric disorders. Although various sleep measures have been developed to assess sleep patterns and quality of sleep, the concordance of these measures in patients with psychiatric disorders remains relatively elusive.
OBJECTIVE
This study aims to examine the degree of agreement among 3 sleep recording methods and the consistency between subjective and objective sleep measures, with a specific focus on recently developed devices in a population of individuals with psychiatric disorders.
METHODS
We analyzed 62 participants for this cross-sectional study, all having data for polysomnography (PSG), Zmachine, Fitbit, and sleep logs. Participants completed questionnaires on their symptoms and estimated sleep duration the morning after the overnight sleep assessment. The interclass correlation coefficients (ICCs) were calculated to evaluate the consistency between sleep parameters obtained from each instrument. Additionally, Bland-Altman plots were used to visually show differences and limits of agreement for sleep parameters measured by PSG, Zmachine, Fitbit, and sleep logs.
RESULTS
The findings indicated a moderate agreement between PSG and Zmachine data for total sleep time (ICC=0.46; P<.001), wake after sleep onset (ICC=0.39; P=.002), and sleep efficiency (ICC=0.40; P=.006). In contrast, Fitbit demonstrated notable disagreement with PSG (total sleep time: ICC=0.08; wake after sleep onset: ICC=0.18; sleep efficiency: ICC=0.10) and exhibited particularly large discrepancies from the sleep logs (total sleep time: ICC=-0.01; wake after sleep onset: ICC=0.05; sleep efficiency: ICC=-0.02). Furthermore, subjective and objective concordance among PSG, Zmachine, and sleep logs appeared to be influenced by the severity of the depressive symptoms and obstructive sleep apnea, while these associations were not observed between the Fitbit and other sleep instruments.
CONCLUSIONS
Our study results suggest that Fitbit accuracy is reduced in the presence of comorbid clinical symptoms. Although user-friendly, Fitbit has limitations that should be considered when assessing sleep in patients with psychiatric disorders.
Topics: Humans; Polysomnography; Cross-Sectional Studies; Reproducibility of Results; Sleep; Sleep Wake Disorders; Electroencephalography; Actigraphy
PubMed: 38090797
DOI: 10.2196/51336 -
Neurology Sep 2023
Topics: Humans; Polysomnography; Sleep
PubMed: 37336769
DOI: 10.1212/WNL.0000000000207461 -
BMJ Open Aug 2023Insomnia is the most prevalent sleep disorder, with few effective pharmacotherapies. Anecdotal reports and recent preclinical research suggest that cannabinol (CBN), a...
Cannabinol (CBN; 30 and 300 mg) effects on sleep and next-day function in insomnia disorder ('CUPID' study): protocol for a randomised, double-blind, placebo-controlled, cross-over, three-arm, proof-of-concept trial.
OBJECTIVE
Insomnia is the most prevalent sleep disorder, with few effective pharmacotherapies. Anecdotal reports and recent preclinical research suggest that cannabinol (CBN), a constituent of derived from delta-9-tetrahydrocannabinol, could be an effective treatment. Despite this, the isolated effects of CBN on sleep have yet to be systematically studied in humans.
METHODS
The present protocol paper describes a randomised, double-blind, placebo-controlled, single-dose, three-arm, cross-over, proof-of-concept study which investigates the effects of CBN on sleep and next-day function in 20 participants with clinician-diagnosed insomnia disorder and an Insomnia Severity Index Score ≥15. Participants receive a single fixed oral liquid dose of 30 mg CBN, 300 mg CBN and matched placebo, in random order on three treatment nights; each separated by a 2-week wash-out period. Participants undergo overnight sleep assessment using in-laboratory polysomnography and next-day neurobehavioural function tests. The primary outcome is wake after sleep onset minutes. Secondary outcomes include changes to traditional sleep staging, sleep-onset latency and absolute spectral power during non-rapid eye movement (NREM) sleep. Tertiary outcomes include changes to sleep spindles during NREM sleep, arousal indices, absolute spectral power during REM sleep and subjective sleep quality. Safety-related and exploratory outcomes include changes to next-day simulated driving performance, subjective mood and drug effects, postural sway, alertness and reaction time, overnight memory consolidation, pre and post-sleep subjective and objective sleepiness; and plasma, urinary, and salivary cannabinoid concentrations. The study will provide novel preliminary data on CBN efficacy and safety in insomnia disorder, which will inform larger clinical trials.
ETHICS AND DISSEMINATION
Human Research Ethics Committee approval has been granted by Bellberry (2021-08-907). Study findings will be disseminated in a peer-reviewed journal and at academic conferences.
TRIAL REGISTRATION NUMBER
NCT05344170.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cannabinol; Sleep; Polysomnography; Sleep Latency; Randomized Controlled Trials as Topic
PubMed: 37612115
DOI: 10.1136/bmjopen-2022-071148 -
Annals of Biomedical Engineering Jun 2024In recent years, research on automated sleep analysis has witnessed significant growth, reflecting advancements in understanding sleep patterns and their impact on... (Review)
Review
In recent years, research on automated sleep analysis has witnessed significant growth, reflecting advancements in understanding sleep patterns and their impact on overall health. This review synthesizes findings from an exhaustive analysis of 87 papers, systematically retrieved from prominent databases such as Google Scholar, PubMed, IEEE Xplore, and ScienceDirect. The selection criteria prioritized studies focusing on methods employed, signal modalities utilized, and machine learning algorithms applied in automated sleep analysis. The overarching goal was to critically evaluate the strengths and weaknesses of the proposed methods, shedding light on the current landscape and future directions in sleep research. An in-depth exploration of the reviewed literature revealed a diverse range of methodologies and machine learning approaches employed in automated sleep studies. Notably, K-Nearest Neighbors (KNN), Ensemble Learning Methods, and Support Vector Machine (SVM) emerged as versatile and potent classifiers, exhibiting high accuracies in various applications. However, challenges such as performance variability and computational demands were observed, necessitating judicious classifier selection based on dataset intricacies. In addition, the integration of traditional feature extraction methods with deep structures and the combination of different deep neural networks were identified as promising strategies to enhance diagnostic accuracy in sleep-related studies. The reviewed literature emphasized the need for adaptive classifiers, cross-modality integration, and collaborative efforts to drive the field toward more accurate, robust, and accessible sleep-related diagnostic solutions. This comprehensive review serves as a solid foundation for researchers and practitioners, providing an organized synthesis of the current state of knowledge in automated sleep analysis. By highlighting the strengths and challenges of various methodologies, this review aims to guide future research toward more effective and nuanced approaches to sleep diagnostics.
Topics: Humans; Sleep; Machine Learning; Polysomnography; Electroencephalography; Signal Processing, Computer-Assisted; Support Vector Machine
PubMed: 38493234
DOI: 10.1007/s10439-024-03486-0