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Otolaryngologic Clinics of North America Jun 2024Obstructive sleep apnea (OSA) is associated with long-term cardiovascular and respiratory comorbidities and increased burden on the health-care system. Early and... (Review)
Review
Obstructive sleep apnea (OSA) is associated with long-term cardiovascular and respiratory comorbidities and increased burden on the health-care system. Early and accurate diagnosis is essential to reduce physical and financial implications of the disease. Polysomnography uses neurophysiologic channels as well as basic respiratory and sleep parameters to best estimate the presence and/or severity of OSA. Although home sleep testing may have the potential for more variable results, it is a viable alternative to increase access to diagnosis of OSA and facilitate initiation of positive airway pressure.
Topics: Humans; Polysomnography; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure
PubMed: 38042667
DOI: 10.1016/j.otc.2023.11.003 -
Journal of Medical Internet Research Jul 2023Digital clinical tools are a new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA), notwithstanding the crucial role of... (Review)
Review
BACKGROUND
Digital clinical tools are a new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA), notwithstanding the crucial role of polysomnography, the gold standard.
OBJECTIVE
This study aimed to identify, gather, and analyze the most accurate digital tools and smartphone-based health platforms used for OSA screening or diagnosis in the adult population.
METHODS
We performed a comprehensive literature search of PubMed, Scopus, and Web of Science databases for studies evaluating the validity of digital tools in OSA screening or diagnosis until November 2022. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies. The sensitivity, specificity, and area under the curve (AUC) were used as discrimination measures.
RESULTS
We retrieved 1714 articles, 41 (2.39%) of which were included in the study. From these 41 articles, we found 7 (17%) smartphone-based tools, 10 (24%) wearables, 11 (27%) bed or mattress sensors, 5 (12%) nasal airflow devices, and 8 (20%) other sensors that did not fit the previous categories. Only 8 (20%) of the 41 studies performed external validation of the developed tool. Of these, the highest reported values for AUC, sensitivity, and specificity were 0.99, 96%, and 92%, respectively, for a clinical cutoff of apnea-hypopnea index (AHI)≥30. These values correspond to a noncontact audio recorder that records sleep sounds, which are then analyzed by a deep learning technique that automatically detects sleep apnea events, calculates the AHI, and identifies OSA. Looking at the studies that only internally validated their models, the work that reported the highest accuracy measures showed AUC, sensitivity, and specificity values of 1.00, 100%, and 96%, respectively, for a clinical cutoff AHI≥30. It uses the Sonomat-a foam mattress that, aside from recording breath sounds, has pressure sensors that generate voltage when deformed, thus detecting respiratory movements, and uses it to classify OSA events.
CONCLUSIONS
These clinical tools presented promising results with high discrimination measures (best results reached AUC>0.99). However, there is still a need for quality studies comparing the developed tools with the gold standard and validating them in external populations and other environments before they can be used in clinical settings.
TRIAL REGISTRATION
PROSPERO CRD42023387748; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387748.
Topics: Adult; Humans; Surveys and Questionnaires; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Sleep; Polysomnography
PubMed: 37494079
DOI: 10.2196/47735 -
Sleep Health Aug 2023Sleep is often severely disturbed in hospitalized patients due to multiple factors such as noise, pain, and an unfamiliar environment. Since sleep is important for... (Meta-Analysis)
Meta-Analysis Review
Sleep is often severely disturbed in hospitalized patients due to multiple factors such as noise, pain, and an unfamiliar environment. Since sleep is important for patient recovery, safe strategies to improve sleep in hospitalized patients are warranted. Music interventions have been found to improve sleep in general, and the aim of this systematic review is to assess the effect of music on sleep among hospitalized patients. We searched 5 databases to identify randomized controlled trials evaluating the effect of music interventions on sleep in hospitalized patients. Ten studies including a total of 726 patients matched the inclusion criteria. The sample sizes ranged from 28 to 222 participants per study. The music interventions varied in how the music was chosen as well as duration and time of day. However, in most studies, participants in the intervention group listened to soft music for 30 minutes in the evening. Our meta-analysis showed that music improved sleep quality compared to standard treatment (standardized mean difference 1.55 [95% CI 0.29-2.81], z = 2.41; p = 0.0159). Few studies reported other sleep parameters, and only one study used polysomnography for objective sleep measurement. No adverse events were reported in any of the trials. Hence, music may constitute a safe and low-cost adjunctive intervention to improve sleep in hospitalized patients. Prospero registration number: CRD42021278654.
Topics: Humans; Music; Music Therapy; Sleep; Polysomnography; Pain
PubMed: 37380591
DOI: 10.1016/j.sleh.2023.03.004 -
Journal of Clinical Sleep Medicine :... Apr 2024In February of 2023, the American Academy of Sleep Medicine issued a "recommended" way to score hypopneas using 1A criteria (scoring of hypopneas using a ≥ 3% oxygen...
STUDY OBJECTIVES
In February of 2023, the American Academy of Sleep Medicine issued a "recommended" way to score hypopneas using 1A criteria (scoring of hypopneas using a ≥ 3% oxygen desaturation from pre-event baseline) that is at odds with the Centers for Medicare & Medicaid Services mandate of scoring hypopneas using a ≥ 4% oxygen desaturation from pre-event baseline. This dichotomy will present an ethical dilemma for sleep medicine providers.
METHODS
We use the principles of medical ethics to discuss the challenges this discrepancy poses for sleep medicine providers.
RESULTS
Disparate hypopnea scoring undermines beneficent patient care and impairs providers' duty to deliver just, equitable care, hence violating the principles of justice and beneficence. This primarily affects older adults, the disabled, the "medically needy," and those living at the federal poverty line dependent on public insurance.
CONCLUSIONS
This discrepancy creates a situation that falls below acceptable levels of health care justice. It is recommended that the American Academy of Sleep Medicine work with the Centers for Medicare & Medicaid Services to develop a scoring policy that consistently promotes individual sleep health regardless of payor.
CITATION
Skolnik C, Attarian H. The ethics of hypopnea scoring. . 2024;20(4):615-617.
Topics: Humans; Aged; United States; Polysomnography; Medicare; Sleep Apnea Syndromes; Sleep; Oxygen
PubMed: 38063188
DOI: 10.5664/jcsm.10944 -
Journal of Clinical Sleep Medicine :... Dec 2023To determine the differences in sleep patterns between preterm infants who received caffeine and those who did not and to evaluate the effects of caffeine therapy on... (Clinical Trial)
Clinical Trial
STUDY OBJECTIVES
To determine the differences in sleep patterns between preterm infants who received caffeine and those who did not and to evaluate the effects of caffeine therapy on early neurodevelopment. Secondarily, actigraphy and polysomnography were compared to evaluate the sleep of preterm infants.
METHODS
Twenty-eight preterm infants ages 28-34 weeks admitted to a single-center Level III neonatal intensive care unit between May 2020 and May 2021 were included. Sleep was assessed by actigraphy for 72 hours with Respironics Mini-Mitter® Actiwatch-2 and Brief Infant Sleep Questionnaire at 6 months corrected age. On the first day of actigraphy, infants underwent polysomnography between 10:00 am and 3:00 pm. Neurodevelopment was evaluated by the Bayley Scales of Infant and Toddler Development-III, the Ages & Stages Questionnaire, and the Hammersmith Infant Neurological Examination.
RESULTS
There were no significant differences in sleep parameters measured by actigraphy, the Brief Infant Sleep Questionnaire, and polysomnography between infants in the caffeine group (n = 12) and no-caffeine group (n = 16). Sensitivity (91.07%) and agreement rate (77.21%) for the actigraphy against polysomnography were highest at the automatic threshold. No significant differences were observed in the neurodevelopment of infants in the caffeine group compared to the no-caffeine group.
CONCLUSIONS
Sleep parameters and neurodevelopmental outcomes were not different in infants at 6 months of corrected age with regard to caffeine therapy. Actigraphy at the automatic threshold can be used in infants for sleep pattern assessment.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Influence of Caffeine Therapy in Preterm Infants; URL: https://www.clinicaltrials.gov/ct2/show/NCT04376749; Identifier: NCT04376749.
CITATION
Atalah YEY, Barış HE, Akdere SK, et al. Effects of caffeine therapy for apnea of prematurity on sleep and neurodevelopment of preterm infants at 6 months of corrected age. . 2023;19(12):2075-2085.
Topics: Humans; Infant; Infant, Newborn; Apnea; Caffeine; Infant, Premature; Polysomnography; Sleep
PubMed: 37559530
DOI: 10.5664/jcsm.10760 -
Journal of Clinical Sleep Medicine :... Oct 2023Although wrist-worn consumer wearables are widely used for home sleep monitoring, few have been validated. It is unclear whether consumer wearables could be an...
STUDY OBJECTIVES
Although wrist-worn consumer wearables are widely used for home sleep monitoring, few have been validated. It is unclear whether consumer wearables could be an alternative to Actiwatch. This study aimed to establish and validate an automatic sleep staging system (ASSS) utilizing photoplethysmography and acceleration data collected from a wrist-worn wearable device.
METHODS
Seventy-five participants from a community population underwent overnight polysomnography (PSG) while wearing a smartwatch (MT2511) and Actiwatch Spectrum Plus (Philips Respironics, Inc; Murrysville, PA, USA). Photoplethysmography and acceleration data collected from the smartwatches were utilized to build a 4-stage (wake, light sleep, deep sleep, and rapid eye movement [REM] sleep) classifier, which was validated against PSG. The performance of the sleep/wake classifier was compared with Actiwatch. All analyses were conducted separately for participants with PSG sleep efficiency (SE) ≥ 80% and SE < 80%.
RESULTS
The 4-stage classifier and PSG showed fair overall epoch-by-epoch agreement (kappa, 0.55; 95% confidence interval, 0.52 to 0.57). The deep sleep and REM times were comparable between ASSS and PSG, while ASSS underestimated the wake time and overestimated the light sleep time among participants with SE < 80%. Moreover, ASSS underestimated sleep-onset latency and wake after sleep onset and overestimated total sleep time and SE among participants with SE < 80%, while all were comparable among participants with SE ≥ 80%. The biases were smaller for ASSS than for Actiwatch.
CONCLUSIONS
Our photoplethysmography- and acceleration-based ASSS was reliable for participants with SE ≥ 80% and had a smaller bias than Actiwatch among those with SE < 80%. Thus, ASSS may be a promising alternative to Actiwatch.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: Validation of Sleep Healthcare System; URL: https://clinicaltrials.gov/study/NCT04252482; Identifier: NCT04252482.
CITATION
Liu P-K, Ting N, Chiu H-C, et al. Validation of photoplethysmography- and acceleration-based sleep staging in a community sample: comparison with polysomnography and Actiwatch. . 2023;19(10):1797-1810.
Topics: Humans; Polysomnography; Actigraphy; Photoplethysmography; Reproducibility of Results; Sleep
PubMed: 37338335
DOI: 10.5664/jcsm.10690 -
Chest Aug 2023Many cellular processes are controlled by sleep. Therefore, alterations in sleep might be expected to stress biological systems that could influence malignancy risk.
BACKGROUND
Many cellular processes are controlled by sleep. Therefore, alterations in sleep might be expected to stress biological systems that could influence malignancy risk.
RESEARCH QUESTION
What is the association between polysomnographic measures of sleep disturbances and incident cancer, and what is the validity of cluster analysis in identifying polysomnography phenotypes?
STUDY DESIGN AND METHODS
We conducted a retrospective multicenter cohort study using linked clinical and provincial health administrative data on consecutive adults free of cancer at baseline with polysomnography data collected between 1994 and 2017 in four academic hospitals in Ontario, Canada. Cancer status was derived from registry records. Polysomnography phenotypes were identified by k-means cluster analysis. A combination of validation statistics and distinguishing polysomnographic features was used to select clusters. Cox cause-specific regressions were used to assess the relationship between identified clusters and incident cancer.
RESULTS
Among 29,907 individuals, 2,514 (8.4%) received a diagnosis of cancer over a median of 8.0 years (interquartile range, 4.2-13.5 years). Five clusters were identified: mild (mildly abnormal polysomnography findings), poor sleep, severe OSA or sleep fragmentation, severe desaturations, and periodic limb movements of sleep (PLMS). The associations between cancer and all clusters compared with the mild cluster were significant while controlling for clinic and year of polysomnography. When additionally controlling for age and sex, the effect remained significant only for PLMS (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.06-1.50) and severe desaturations (aHR, 1.32; 95% CI, 1.04-1.66). Further controlling for confounders, the effect remained significant for PLMS, but was attenuated for severe desaturations.
INTERPRETATION
In a large cohort, we confirmed the importance of polysomnographic phenotypes and highlighted the role that PLMS and oxygenation desaturation may play in cancer. Using this study's findings, we also developed an Excel (Microsoft) spreadsheet (polysomnography cluster classifier) that can be used to validate the identified clusters on new data or to identify which cluster a patient belongs to.
TRIAL REGISTRY
ClinicalTrials.gov; Nos.: NCT03383354 and NCT03834792; URL: www.
CLINICALTRIALS
gov.
Topics: Humans; Cohort Studies; Sleep; Polysomnography; Sleep Wake Disorders; Neoplasms; Ontario
PubMed: 36907376
DOI: 10.1016/j.chest.2023.03.006 -
Sleep Health Aug 2023Compare the accuracy and reliability of sleep/wake classification between the Fitbit Charge 3 and the Micro Motionlogger actigraph when applying either the...
GOAL AND AIMS
Compare the accuracy and reliability of sleep/wake classification between the Fitbit Charge 3 and the Micro Motionlogger actigraph when applying either the Cole-Kripke or Sadeh scoring algorithms. Accuracy was established relative to simultaneous Polysomnography recording. Focus technology: Fitbit Charge 3 and actigraphy. Reference technology: Polysomnography.
SAMPLE
Twenty-one university students (10 females).
DESIGN
Simultaneous Fitbit Charge 3, actigraphy, and polysomnography were recorded over 3 nights at the participants' homes.
CORE ANALYTICS
Total sleep time, wake after sleep onset, sensitivity, specificity, positive predictive value, and negative predictive value.
ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES
Variability of specificity and negative predictive value across subjects and across nights.
CORE OUTCOMES
Fitbit Charge 3 and actigraphy using the Cole-Kripke or Sadeh algorithms exhibited similar sensitivity in classifying sleep segments relative to polysomnography (sensitivity of 0.95, 0.96, and 0.95, respectively). Fitbit Charge 3 was significantly more accurate in classifying wake segments (specificity of 0.69, 0.33, and 0.29, respectively). Fitbit Charge 3 also exhibited significantly higher positive predictive value than actigraphy (0.99 vs. 0.97 and 0.97, respectively) and a negative predictive value that was significantly higher only relative to the Sadeh algorithm (0.41 vs. 0.25, respectively).
IMPORTANT ADDITIONAL OUTCOMES
Fitbit Charge 3 exhibited significantly lower standard deviation in specificity values across subjects and negative predictive value across nights.
CORE CONCLUSION
This study demonstrates that Fitbit Charge 3 is more accurate and reliable in identifying wake segments than the examined FDA-approved Micro Motionlogger actigraphy device. The results also highlight the need to create devices that record and save raw multi-sensor data, which are necessary for developing open-source sleep or wake classification algorithms.
Topics: Female; Humans; Polysomnography; Actigraphy; Reproducibility of Results; Sleep; Fitness Trackers
PubMed: 37270397
DOI: 10.1016/j.sleh.2023.04.001 -
Annals of the American Thoracic Society Sep 2023Obstructive sleep apnea (OSA) is a heterogeneous syndrome with various endotypic traits and symptoms. A link among symptoms, endotypes, and disease prognosis has been...
Obstructive sleep apnea (OSA) is a heterogeneous syndrome with various endotypic traits and symptoms. A link among symptoms, endotypes, and disease prognosis has been proposed but remains unsupported by empirical data. To link symptom profiles and endotypes by clustering endotypic traits estimated using polysomnographic signals. We recruited 509 patients with moderate to severe OSA from a single sleep center. Polysomnographic data were collected between May 2020 and January 2022. Endotypic traits, namely arousal threshold, upper airway collapsibility, loop gain, and upper airway muscle compensation, were retrieved using polysomnographic signals during non-rapid eye movement periods. We used latent class analysis to group participants into endotype clusters. Demographic and polysomnographic parameter differences were compared between clusters, and associations between endotype clusters and symptom profiles were examined using logistic regression analyses. Three endotype clusters were identified, characterized by high collapsibility/loop gain, low arousal threshold, and low compensation, respectively. Patients in each cluster exhibited similar demographic characteristics, but those in the high collapsibility/loop gain cluster had the highest proportion of obesity and severe oxygen desaturation observed in polysomnographic studies. The low compensation cluster was characterized by fewer sleepy symptoms and exhibited a lower rate of diabetes mellitus. Compared with the excessively sleepy group, disturbed sleep symptoms were associated with the low arousal threshold cluster (odds ratio, 1.89; 95% confidence interval, 1.16-3.10). Excessively sleepy symptoms were associated with the high collapsibility/loop gain cluster (odds ratio, 2.16; 95% confidence interval, 1.39-3.37) compared with the minimally symptomatic group. Three pathological endotype clusters were identified among patients with moderate to severe OSA, each exhibiting distinct polysomnographic characteristics and clinical symptom profiles.
Topics: Humans; Latent Class Analysis; Polysomnography; Sleep Apnea, Obstructive; Sleep; Cluster Analysis
PubMed: 37321164
DOI: 10.1513/AnnalsATS.202212-1054OC -
International Journal of Pediatric... Aug 2023To develop consensus statements for the scoring of pediatric drug induced sleep endoscopy in the diagnosis and management of pediatric obstructive sleep apnea.
OBJECTIVES
To develop consensus statements for the scoring of pediatric drug induced sleep endoscopy in the diagnosis and management of pediatric obstructive sleep apnea.
METHODS
The leadership group identified experts based on defined criteria and invited 18 panelists to participate in the consensus statement development group. A modified Delphi process was used to formally quantify consensus from opinion. A modified Delphi priori process was established, which included a literature review, submission of statements by panelists, and an iterative process of voting to determine consensus. Voting was based on a 9-point Likert scale. Statements achieving a mean score greater than 7 with one or fewer outliers were defined as reaching consensus. Statements achieving a mean score greater than 6.5 with two or fewer outliers were defined as near consensus. Statements with lower scores or more outliers were defined as no consensus.
RESULTS
A total of 78 consensus statements were evaluated by the panelists at the first survey - 49 achieved consensus, 18 achieved near consensus, and 11 did not achieve consensus. In the second survey, 16 statements reached consensus and 5 reached near consensus. Regarding scoring, consensus was achieved on the utilization of a 3-point Likert scale for each anatomic site for maximal observed obstructions of <50% (Score 0, no-obstruction), ≥ 50% but <90% (Score 2, partial obstruction), and ≥ 90% (Score 3, complete obstruction). Anatomic sites to be scored during DISE that reached consensus or near-consensus were the nasal passages, adenoid pad, velum, lateral pharyngeal walls, tonsils (if present), tongue base, epiglottis, and arytenoids.
CONCLUSION
This study developed consensus statements on the scoring of DISE in pediatric otolaryngology using a modified Delphi process. The use of a priori process, literature review, and iterative voting method allowed for the formal quantification of consensus from expert opinion. The results of this study may provide guidance for standardizing scoring of DISE in pediatric patients.
Topics: Child; Humans; Endoscopy; Pharynx; Polysomnography; Sleep; Sleep Apnea, Obstructive
PubMed: 37441992
DOI: 10.1016/j.ijporl.2023.111627