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European Journal of Medical Research Jul 2023Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a...
BACKGROUND
Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a recommended diagnostic alternative for patients with an increased risk for OSA. In a large clinical cohort, we investigated concordance and predictors for discordance in diagnosing OSA using PAT and PSG, and three-year cardiovascular risk in patients with discordant OSA diagnosis.
METHODS
Retrospective monocentric cohort study. Patients with a PAT AHI ≥ 5/h followed by an in-hospital PSG within three months were included. All patients with a PAT AHI ≥ 5/h but a PSG AHI < 5/h were classified as discordant. Patients with PAT and PSG AHI ≥ 5/h were classified as concordant. To ascertain cardiovascular risk, major adverse cardiovascular events (MACE) were analyzed in discordant patients and sex, age, body mass index (BMI) and cardiovascular disease-matched concordant patients over a follow-up time of 3.1 ± 0.06 years.
RESULTS
A total of 940 patients, 66% male with an average age of 55 ± 0.4 years and BMI of 31 ± 0.2 kg/m were included. Agreement in OSA diagnosis was observed in 80% of patients (55% in mild and 86% in moderate and severe OSA). Factors significantly associated with a discordant diagnosis were female sex, younger age and lower BMI, but not comorbidities. There was no significant difference in MACE (p = 0.920) between discordant patients (n = 155) and matched concordant patients (n = 274) with or without therapy.
CONCLUSIONS
Concordance between PAT and PSG diagnosis of sleep apnoea is good, particularly in moderate and severe OSA. Predictors for discordant results between PAT and PSG were age, sex and BMI. MACE risk is similar in those with OSA diagnosed by PAT or PSG.
Topics: Humans; Female; Male; Middle Aged; Polysomnography; Cohort Studies; Retrospective Studies; Sleep Apnea, Obstructive; Sleep Apnea Syndromes
PubMed: 37481575
DOI: 10.1186/s40001-023-01164-w -
Journal of Clinical Medicine Nov 2023Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and... (Review)
Review
Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/- montelukast, and to compare the impact of standardized approaches for weight loss.
PubMed: 38002704
DOI: 10.3390/jcm12227092 -
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 -
Sleep Sep 2023Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes....
STUDY OBJECTIVES
Multiple sleep characteristics are informative of health, sleep characteristics cluster, and sleep health can be described as a composite of positive sleep attributes. We assessed the association between a sleep score reflecting multiple sleep dimensions, and mortality. We tested the hypothesis that more favorable sleep (higher sleep scores) is associated with lower mortality.
METHODS
The Multi-Ethnic Study of Atherosclerosis (MESA) is a racially and ethnically-diverse multi-site, prospective cohort study of US adults. Sleep was measured using unattended polysomnography, 7-day wrist actigraphy, and validated questionnaires (2010-2013). 1726 participants were followed for a median of 6.9 years (Q1-Q3, 6.4-7.4 years) until death (171 deaths) or last contact. Survival models were used to estimate the association between the exposure of sleep scores and the outcome of all-cause mortality, adjusting for socio-demographics, lifestyle, and medical comorbidities; follow-up analyses examined associations between individual metrics and mortality. The exposure, a sleep score, was constructed by an empirically-based Principal Components Analysis on 13 sleep metrics, selected a priori.
RESULTS
After adjusting for multiple confounders, a 1 standard deviation (sd) higher sleep score was associated with 25% lower hazard of mortality (Hazard Ratio [HR]: 0.75; 95% Confidence interval: [0.65, 0.87]). The largest drivers of this association were: night-to-night sleep regularity, total sleep time, and the Apnea-Hypopnea Index.
CONCLUSION
More favorable sleep across multiple characteristics, operationalized by a sleep score, is associated with lower risk of death in a diverse US cohort of adults. Results suggest that interventions that address multiple dimensions may provide novel approaches for improving health.
Topics: Adult; Humans; Ethnicity; Prospective Studies; Sleep; Polysomnography; Atherosclerosis
PubMed: 37523657
DOI: 10.1093/sleep/zsad048 -
Parkinsonism & Related Disorders Oct 2023Parkinson's disease (PD) is a chronic neurodegenerative disease characterized by motor and non-motor symptoms, including obstructive sleep apnea (OSA), a common comorbid... (Review)
Review
Parkinson's disease (PD) is a chronic neurodegenerative disease characterized by motor and non-motor symptoms, including obstructive sleep apnea (OSA), a common comorbid sleep disorder. The prevalence of OSA in PD is high, and its impact on quality of life, accident risk, and limited treatment options underscores the need for vigilant monitoring and effective interventions. OSA is observed in 20-70% of PD patients, whereas the general population exhibits a lower prevalence ranging from 2 to 14%. These discrepancies in prevalence may be attributed to differences in demographic characteristics, sample sizes with selection bias, and variations in scoring systems for apnea and hypopnea events used across different studies. This review highlights the potential pathogenesis of comorbid OSA in PD and provides an overview of ongoing clinical trials investigating interventions for this condition. Several mechanisms have been implicated in the development of OSA in PD, including intermittent hypoxemia, sleep fragmentation, alterations in the glymphatic system homeostasis, upper airway obstruction, and inflammation. Given the adverse effects of PD comorbid OSA, early intervention measures are crucial. It is imperative to conduct longitudinal studies and clinical trials to elucidate the pathogenesis and develop novel and effective interventions for OSA in PD patients. These efforts aim to delay the progression of PD, enhance patients' quality of life, and alleviate the burden on society and families.
Topics: Humans; Parkinson Disease; Quality of Life; Neurodegenerative Diseases; Polysomnography; Sleep Apnea, Obstructive
PubMed: 37541789
DOI: 10.1016/j.parkreldis.2023.105790 -
NeuroImage Oct 2023Human cognitive performance is a key function whose biological foundations have been partially revealed by genetic and brain imaging studies. The sleep...
Human cognitive performance is a key function whose biological foundations have been partially revealed by genetic and brain imaging studies. The sleep electroencephalogram (EEG) is tightly linked to structural and functional features of the central nervous system and serves as another promising biomarker. We used data from MrOS, a large cohort of older men and cross-validated regularized regression to link sleep EEG features to cognitive performance in cross-sectional analyses. In independent validation samples 2.5-10% of variance in cognitive performance can be accounted for by sleep EEG features, depending on the covariates used. Demographic characteristics account for more covariance between sleep EEG and cognition than health variables, and consequently reduce this association by a greater degree, but even with the strictest covariate sets a statistically significant association is present. Sigma power in NREM and beta power in REM sleep were associated with better cognitive performance, while theta power in REM sleep was associated with worse performance, with no substantial effect of coherence and other sleep EEG metrics. Our findings show that cognitive performance is associated with the sleep EEG (r = 0.283), with the strongest effect ascribed to spindle-frequency activity. This association becomes weaker after adjusting for demographic (r = 0.186) and health variables (r = 0.155), but its resilience to covariate inclusion suggest that it also partially reflects trait-like differences in cognitive ability.
Topics: Male; Humans; Aged; Cross-Sectional Studies; Polysomnography; Sleep; Electroencephalography; Cognition
PubMed: 37574121
DOI: 10.1016/j.neuroimage.2023.120319 -
Sleep Medicine Sep 2023The current evidence of a relationship between periodic leg movements during sleep (PLMS) and cognitive functioning is limited and inconsistent. This cross-sectional...
OBJECTIVE
The current evidence of a relationship between periodic leg movements during sleep (PLMS) and cognitive functioning is limited and inconsistent. This cross-sectional study assessed associations between PLMS and cognitive functioning among community-dwelling older adults.
METHODS
We included community-dwelling older adults who underwent a polysomnography and a cognitive assessment. The PLMS index (PLMI) and PLMS arousal index (PLMAI) were categorized into tertiles: PLMI <5/h (reference), 5-29.9/h, ≥30/h; and PLMAI <1/h (reference), 1-4.9/h, ≥5/h. The cognitive assessment consisted of ten scores covering the main cognitive domains: global cognition, processing speed, executive function, language, episodic verbal memory, and visuospatial function. Associations between PLMI, PLMAI, and cognitive scores were assessed using regression unadjusted and adjusted models.
RESULTS
A total of 579 individuals without dementia were included (mean age: 71.5 ± 4.4 years; men 45.4%). The number of participants in the high-PLMI categories, 5-29.9/h and ≥30/h, was 185 (32.0%) and 171 (29.5%), respectively. Participants in the high-PLMI categories showed no significant difference compared to the reference group regarding their cognitive performance according to the unadjusted and adjusted models. Similarly, we found no association between PLMAI severity and cognitive functioning.
CONCLUSIONS
This study shows no cross-sectional association between PLMS severity and cognitive functioning among community-dwelling older adults. However, given the paucity of data in this field, further studies are needed to clarify the relationship between PLMS and cognitive functioning.
Topics: Male; Humans; Aged; Nocturnal Myoclonus Syndrome; Leg; Cross-Sectional Studies; Sleep; Cognition
PubMed: 37473717
DOI: 10.1016/j.sleep.2023.07.011 -
ArXiv Jul 2023Efficient and accurate evaluation of long-term photoplethysmography (PPG) recordings is essential for both clinical assessments and consumer products. In 2021, the top...
Efficient and accurate evaluation of long-term photoplethysmography (PPG) recordings is essential for both clinical assessments and consumer products. In 2021, the top opensource peak detectors were benchmarked on the Multi-Ethnic Study of Atherosclerosis (MESA) database consisting of polysomnography (PSG) recordings and continuous sleep PPG data, where the Automatic Beat Detector (Aboy) had the best accuracy. This work presents Aboy++, an improved version of the original Aboy beat detector. The algorithm was evaluated on 100 adult PPG recordings from the MESA database, which contains more than 4.25 million reference beats. Aboy++ achieved an F1-score of 85.5%, compared to 80.99% for the original Aboy peak detector. On average, Aboy++ processed a 1 hour-long recording in less than 2 seconds. This is compared to 115 seconds (i.e., over 57-times longer) for the open-source implementation of the original Aboy peak detector. This study demonstrated the importance of developing robust algorithms like Aboy++ to improve PPG data analysis and clinical outcomes. Overall, Aboy++ is a reliable tool for evaluating long-term wearable PPG measurements in clinical and consumer contexts. The open-source algorithm is available on the physiozoo.com website (on publication of this proceeding).
PubMed: 37502630
DOI: No ID Found -
Journal of Sleep Research Dec 2023The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the... (Review)
Review
The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the science regarding PSG indications and findings in ID, and the indications to conduct PSG in ID as stated by relevant guidelines. It then highlights the most relevant questions regarding the topic, including the relevance of ID subtyping, to allow an individualised pharmacological or psychotherapeutic treatment approach.
Topics: Humans; Polysomnography; Sleep Initiation and Maintenance Disorders
PubMed: 37680011
DOI: 10.1111/jsr.14036 -
Chest May 2024Stroke is the second-leading cause of death worldwide. Obstructive sleep apnea (OSA) is an independent risk factor for stroke and is associated with multiple vascular... (Review)
Review
TOPIC IMPORTANCE
Stroke is the second-leading cause of death worldwide. Obstructive sleep apnea (OSA) is an independent risk factor for stroke and is associated with multiple vascular risk factors. Post-stroke OSA is prevalent and closely linked with various stroke subtypes including cardioembolic stroke and cerebral small vessel disease. Observational studies have demonstrated that untreated post-stroke OSA is associated with an increased risk of recurrent stroke, mortality, poorer functional recovery and longer hospitalizations.
REVIEW FINDINGS
Post-stroke OSA tends to be underdiagnosed and under-treated, possibly because stroke patients with OSA present atypically compared to the general population with OSA. Objective testing, such as the use of ambulatory sleep testing or in-laboratory polysomnography, is recommended for diagnosing OSA. The gold standard for treating OSA is continuous positive airway pressure (CPAP) therapy. Randomized controlled trials (RCTs) have shown that treatment of post-stroke OSA using CPAP improves non-vascular outcomes such as cognition and neurological recovery. However, RCTs that have evaluated the effect of CPAP on recurrent stroke risk and mortality have been largely negative.
SUMMARY
There is a need for high quality RCTs in post-stroke OSA that may provide evidence to support the utility of CPAP (and/or other treatment modalities) in reducing recurrent vascular events and mortality. This may be achieved by examining treatment strategies that have yet to be trialed in post-stroke OSA, tailoring interventions according to post-stroke OSA endotypes and phenotypes, selecting high risk populations, and using metrics that reflect the physiological abnormalities that underlie the harmful effects of OSA on cardiovascular outcomes.
PubMed: 38815623
DOI: 10.1016/j.chest.2024.04.028