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CMAJ : Canadian Medical Association... Jun 2024
Topics: Humans; Sleep Apnea, Obstructive; Child; Continuous Positive Airway Pressure; Polysomnography; Child, Preschool
PubMed: 38857936
DOI: 10.1503/cmaj.230897-f -
Neurophysiologie Clinique = Clinical... Apr 2024Excessive daytime sleepiness (EDS) is multifactorial. It combines, among other things, an excessive propensity to fall asleep ("physiological sleepiness") and a... (Review)
Review
Excessive daytime sleepiness (EDS) is multifactorial. It combines, among other things, an excessive propensity to fall asleep ("physiological sleepiness") and a continuous non-imperative sleepiness (or drowsiness/hypo-arousal) leading to difficulties remaining awake and maintaining sustained attention and vigilance over the long term ("manifest sleepiness"). There is no stand-alone biological measure of EDS. EDS measures can either capture the severity of physiological sleepiness, which corresponds to the propensity to fall asleep, or the severity of manifest sleepiness, which corresponds to behavioral consequences of sleepiness and reduced vigilance. Neuropsychological tests (The psychomotor vigilance task (PVT), Oxford Sleep Resistance Test (OSLeR), Sustained Attention to Response Task (SART)) explore manifest sleepiness through several sustained attention tests but the lack of normative values and standardized protocols make the results difficult to interpret and use in clinical practice. Neurophysiological tests explore the two main aspects of EDS, i.e. the propensity to fall asleep (Multiple sleep latency test, MSLT) and the capacity to remain awake (Maintenance of wakefulness test, MWT). The MSLT and the MWT are widely used in clinical practice. The MSLT is recognized as the "gold standard" test for measuring the severity of the propensity to fall asleep and it is a diagnostic criterion for narcolepsy. The MWT measures the ability to stay awake. The MWT is not a diagnostic test as it is recommended only to evaluate the evolution of EDS and efficacy of EDS treatment. Even if some efforts to standardize the protocols for administration of these tests have been ongoing, MSLT and MWT have numerous limitations: age effect, floor or ceiling effects, binding protocol, no normal or cutoff value (or determined in small samples), and no or low test-retest values in some pathologies. Moreover, the recommended electrophysiological set-up and the determination of sleep onset using the 30‑sec epochs scoring rule show some limitations. New, more precise neurophysiological techniques should aim to detect very brief periods of physiological sleepiness and, in the future, the brain local phenomenon of sleepiness likely to underpin drowsiness, which could be called "physiological drowsiness".
Topics: Humans; Sleepiness; Disorders of Excessive Somnolence; Sleep; Wakefulness; Polysomnography
PubMed: 38401239
DOI: 10.1016/j.neucli.2023.102938 -
Sleep Medicine Clinics Sep 2023Automatic polysomnography analysis can be leveraged to shorten scoring times, reduce associated costs, and ultimately improve the overall diagnosis of sleep disorders.... (Review)
Review
Automatic polysomnography analysis can be leveraged to shorten scoring times, reduce associated costs, and ultimately improve the overall diagnosis of sleep disorders. Multiple and diverse strategies have been attempted for implementation of this technology at scale in the routine workflow of sleep centers. The field, however, is complex and presents unsolved challenges in a number of areas. Recent developments in computer science and artificial intelligence are nevertheless closing the gap. Technological advances are also opening new pathways for expanding our current understanding of the domain and its analysis.
Topics: Humans; Polysomnography; Artificial Intelligence; Sleep; Sleep Wake Disorders; Sleep Stages
PubMed: 37532369
DOI: 10.1016/j.jsmc.2023.05.002 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Sep 2023At present, the etiology and pathogenesis of most neurodegenerative diseases are still not fully understood, which poses challenges for the prevention, diagnosis, and... (Review)
Review
At present, the etiology and pathogenesis of most neurodegenerative diseases are still not fully understood, which poses challenges for the prevention, diagnosis, and treatment of these diseases. Sleep disorders are one of the common chief complaints of neurodegenerative diseases. When patients suffer from comorbid sleep disorder and neurodegenerative diseases, the severity of their condition increases, the quality of their life drops further, and the difficulty of treatment increases. A large number of studies have been conducted to monitor the sleep of patients with neurodegenerative diseases, and it has been found that there are significant changes in their polysomnography (PSG) results compared to those of healthy control populations. In addition, there are also significant differences between the PSG findings of patients with different neurodegenerative diseases and the differences are closely associated with the pathogenesis and development of the disease. Herein, we discussed the characteristics of the sleep structure of patients with Parkinson's disease, Alzheimer's disease, Huntington's disease, and dementia with Lewy bodies and provided a brief review of the sleep disorders and the PSG characteristics of these patients. The paper will help improve the understanding of the pathogenesis and pathological changes of neurodegenerative diseases, clarify the relationship between sleep disorders and these diseases, improve clinicians' further understanding of these diseases, and provide a basis for future research.
Topics: Humans; Neurodegenerative Diseases; Polysomnography; Parkinson Disease; Sleep; Sleep Wake Disorders
PubMed: 37866969
DOI: 10.12182/20230960304 -
Cerebral Cortex (New York, N.Y. : 1991) Sep 2023Pediatric overweight/obesity can lead to sleep-disordered breathing (SDB), abnormal neurological and cognitive development, and psychiatric problems, but the...
Pediatric overweight/obesity can lead to sleep-disordered breathing (SDB), abnormal neurological and cognitive development, and psychiatric problems, but the associations and interactions between these factors have not been fully explored. Therefore, we investigated the associations between body mass index (BMI), SDB, psychiatric and cognitive measures, and brain morphometry in 8484 children 9-11 years old using the Adolescent Brain Cognitive Development dataset. BMI was positively associated with SDB, and both were negatively correlated with cortical thickness in lingual gyrus and lateral orbitofrontal cortex, and cortical volumes in postcentral gyrus, precentral gyrus, precuneus, superior parietal lobule, and insula. Mediation analysis showed that SDB partially mediated the effect of overweight/obesity on these brain regions. Dimensional psychopathology (including aggressive behavior and externalizing problem) and cognitive function were correlated with BMI and SDB. SDB and cortical volumes in precentral gyrus and insula mediated the correlations between BMI and externalizing problem and matrix reasoning ability. Comparisons by sex showed that obesity and SDB had a greater impact on brain measures, cognitive function, and mental health in girls than in boys. These findings suggest that preventing childhood obesity will help decrease SDB symptom burden, abnormal neurological and cognitive development, and psychiatric problems.
Topics: Male; Female; Adolescent; Humans; Child; Body Mass Index; Overweight; Polysomnography; Pediatric Obesity; Sleep Apnea Syndromes; Brain
PubMed: 37522299
DOI: 10.1093/cercor/bhad267 -
Revue Neurologique Oct 2023Hypersomnolence is a major public health issue given its high frequency, its impact on academic/occupational functioning and on accidentology, as well as its heavy... (Review)
Review
Hypersomnolence is a major public health issue given its high frequency, its impact on academic/occupational functioning and on accidentology, as well as its heavy socio-economic burden. The positive and aetiological diagnosis is crucial, as it determines the therapeutic strategy. It must consider the following aspects: i) hypersomnolence is a complex concept referring to symptoms as varied as excessive daytime sleepiness, excessive need for sleep, sleep inertia, or drowsiness, all of which warrant specific dedicated investigations; ii) the boundary between physiological and abnormal hypersomnolence is blurred, since most symptoms can be encountered in the general population to varying degrees without being considered as pathological, meaning that their severity, frequency, context of occurrence and related impairment need to be carefully assessed; iii) investigation of hypersomnolence relies on scales/questionnaires as well as behavioural and neurophysiological tests, which measure one or more dimensions, keeping in mind the possible discrepancy between objective and subjective assessment; iv) aetiological reasoning is driven by knowledge of the main sleep regulation mechanisms, epidemiology, and associated symptoms. The need to assess hypersomnolence is growing, both for its management, and for assessing the efficacy of treatments. The landscape of tools available for investigating hypersomnolence is constantly evolving, in parallel with research into sleep physiology and technical advances. These investigations face the challenges of reconciling subjective perception and objective data, making tools accessible to as many people as possible and predicting the risk of accidents.
Topics: Humans; Polysomnography; Disorders of Excessive Somnolence; Sleep; Surveys and Questionnaires; Apathy
PubMed: 37563022
DOI: 10.1016/j.neurol.2023.07.004 -
Sleep Medicine Reviews Aug 2023Patients with central sleep apnea (CSA) have a lower quality of life and higher morbidity and mortality. Phrenic nerve stimulation (PNS) is a novel treatment for CSA... (Meta-Analysis)
Meta-Analysis Review
Patients with central sleep apnea (CSA) have a lower quality of life and higher morbidity and mortality. Phrenic nerve stimulation (PNS) is a novel treatment for CSA that has been shown to be safe. However, the effects of PNS on sleep changes are still under debate. This meta-analysis was performed to evaluate the efficacy of PNS in patients with CSA. PubMed, Scopus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science databases were searched for relevant studies published. We performed random-effects meta-analyses of the changes in apnea-hypopnea index (AHI), central apnea index (CAI), Arousal Index, percent of sleep with O2 saturation <90% (T90), Epworth Sleepiness Scale (ESS) and sleep efficiency. Ten studies with a total of 580 subjects were analyzed. Overall meta-analysis showed AHI [SMD: -2.24, 95% confidence interval (CI): was -3.11 to -1.36(p<0.00001)], CAI [SMD: -2.32, 95% CI: -3.17 to -1.47 (p<0.00001)] and Arousal Index (p = 0.0002, SMD (95% CI) -1.79 (-2.74 to -0.85)) significantly reduced after PNS. No significant changes were observed in T90, ESS and sleep efficiency (p > 0.05). Meta-analysis of observational studies demonstrated AHI, CAI and Arousal Index had a decreasing trend between before and after PNS (all, p<0.05). However, ESS and T90 did not change significantly after PNS (p > 0.05). Meta-analysis of RCTs showed that CSA patients had trends of a lower AHI (I = 0%), CAI (I = 74%), Arousal Index (I = 0%), T90 (I = 0%) and ESS (I = 0%) after PNS (all, p<0.05). The use of PNS appears to be safe and feasible in patients with CSA. However, larger, independent RCTs are required to investigate the efficacy and long-term effect of PNS and more attention should be paid to T90 and ESS.
Topics: Humans; Sleep Apnea, Central; Phrenic Nerve; Quality of Life; Polysomnography; Sleep
PubMed: 37467524
DOI: 10.1016/j.smrv.2023.101819 -
Psychiatry Research Oct 2023Sleep disturbances are often linked to attention-deficit/hyperactivity disorder (ADHD). Consistent findings document that children and adolescents with ADHD report more... (Meta-Analysis)
Meta-Analysis Review
Sleep disturbances are often linked to attention-deficit/hyperactivity disorder (ADHD). Consistent findings document that children and adolescents with ADHD report more sleep problems than their typically developing (TD) peers across subjective sleep domains. However, few differences between these groups were observed in objectively measured sleep parameters, such as polysomnography (PSG) and actigraphy. This study synthesized empirical studies to identify objectively measured sleep continuity differences between children and adolescents with ADHD and TD. We included observational research and baseline data from intervention studies between 5- to 18-year-old individuals with ADHD and their TD peers at five databases from inception and September 2022. This systematic review and meta-analysis of 45 articles, including 1622 children and adolescents with ADHD and 2013 TD, found that compared with TD, children and adolescents with ADHD have higher sleep latency and moderately decreased sleep efficiency measured by actigraphy. Polysomnography-measured differences between ADHD and TD were not significant. Medication status and comorbid psychiatric status significantly moderated the group differences in sleep efficiency between ADHD and TD. Also, the group differences in sleep latency between ADHD and TD were moderated by actigraphy recorded nights. These findings highlight the importance of reducing disparities in sleep parameters among children and adolescents with and without ADHD.
Topics: Humans; Child; Adolescent; Child, Preschool; Attention Deficit Disorder with Hyperactivity; Sleep; Polysomnography; Actigraphy; Sleep Latency; Sleep Wake Disorders
PubMed: 37657199
DOI: 10.1016/j.psychres.2023.115447 -
International Journal of Pediatric... Aug 2023To evaluate adherence to polysomnography in pediatric patients and determine if demographics, socioeconomic status, polysomnography indication, or prior otolaryngology...
OBJECTIVE
To evaluate adherence to polysomnography in pediatric patients and determine if demographics, socioeconomic status, polysomnography indication, or prior otolaryngology intervention are associated with polysomnography adherence and time to definitive surgery.
STUDY DESIGN
Retrospective review study.
SETTING
Tertiary-care children's hospital.
METHODS
Electronic medical record was queried to identify patients ordered for a sleep study between January and May 2019. Demographic information, time to sleep study, and time to surgery were collected and calculated.
RESULTS
304 patients were recommended to obtain polysomnography, with adherence rate of 65.4%. There was no significant difference in adherence or loss to follow-up rates based on patient sex, age, language, socioeconomic status, state of residence, single-parent status, or polysomnography indication. There was no difference between time to surgery for patients who did or did not obtain polysomnography (181 vs. 161 days, P = .51). Patients with prior otolaryngology intervention were more likely to obtain polysomnography and less likely to be lost to follow-up (P < .05). Median household income demonstrated a significant inverse relationship with time to polysomnography (P < .05) as well as time to surgery (P < .05). Medically complex patients tended to experience longer time to surgery compared with non-complex patients.
CONCLUSION
Families with lower socioeconomic status or medically complex children may require assistance to obtain polysomnography and pursue surgery for sleep-disordered breathing. Patients without prior otolaryngology intervention may be less likely to follow up and may need assistance with navigating the polysomnography process.
Topics: Child; Humans; Polysomnography; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Retrospective Studies; Otolaryngology
PubMed: 37348250
DOI: 10.1016/j.ijporl.2023.111637 -
Otolaryngologic Clinics of North America Jun 2024Positional sleep apnea (POSA), a distinctive subtype of obstructive sleep apnea, underscores the critical influence of a patient's sleeping position on the severity of... (Review)
Review
Positional sleep apnea (POSA), a distinctive subtype of obstructive sleep apnea, underscores the critical influence of a patient's sleeping position on the severity of their condition. In the management of POSA, compliance with positional therapy (PT) is paramount, as it wields a profound impact on the treatment's efficacy and the overall alleviation of the disease. The advent of new-generation PT devices offers a promising alternative to conventional methods like the tennis ball technique, boasting higher compliance rates and substantial disease alleviation.
Topics: Humans; Sleep Apnea, Obstructive; Posture; Patient Compliance; Patient Positioning; Treatment Outcome; Polysomnography
PubMed: 38311472
DOI: 10.1016/j.otc.2024.01.002