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Journal of Clinical Sleep Medicine :... Feb 2023This study investigated the diagnostic accuracy of Sleep Profiler, which relies on ambulatory polysomnography (PSG) with electroencephalogram for sleep bruxism (SB) and...
STUDY OBJECTIVES
This study investigated the diagnostic accuracy of Sleep Profiler, which relies on ambulatory polysomnography (PSG) with electroencephalogram for sleep bruxism (SB) and examined its episode-by-episode agreement in comparison to PSG equipped with audiovisual recordings (avPSG).
METHODS
This prospective 2-gate study recruited 10 individuals with probable SB and 10 healthy volunteers. Overnight experimental recordings were performed simultaneously using the ambulatory PSG with masseter electromyography and avPSG with masseter and temporalis electromyography. Sleep staging was performed manually for avPSG and automatically or manually for ambulatory PSG. SB episodes were manually scored based on electromyography signals with reference to sleep stages. The episode-by-episode agreement was analyzed by setting avPSG as the reference standard. The sensitivity, specificity, and accuracy for the diagnosis of SB were calculated after optimizing the cutoff values of the episode index and the burst index.
RESULTS
Regarding the episode-by-episode agreement, median sensitivities were 0.825 and positive predictive values were approximately 0.6, regardless of the sleep staging procedure, indicating that approximately 40% of the overall total SB episodes scored by the ambulatory PSG were false positives. Because of overestimation of SB episodes, the optimal cutoff values for the episode index and the burst index were approximately 1.5 times higher than the avPSG-based cutoff values and dramatically improved the diagnostic precision metrics for the ambulatory PSG.
CONCLUSIONS
Sleep Profiler can eliminate events during wakefulness by electroencephalogram and may provide a definitive diagnosis in patients with possible SB by applying optimized cutoff values. However, the risk of overestimation must be recognized.
CLINICAL TRIAL REGISTRATION
Registry: UMIN Clinical Trials Registry; Name: Accuracy of Portable PSG Device for Detection of Sleep Bruxism-Related Masseter EMG Muscle Activity; URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037380; Identifier: UMIN000032793.
CITATION
Abe Y, Nakazato Y, Takaba M, Kawana F, Baba K, Kato T. Diagnostic accuracy of ambulatory polysomnography with electroencephalogram for detection of sleep bruxism-related masticatory muscle activity. 2023;19(2):379-392.
Topics: Humans; Polysomnography; Sleep Bruxism; Prospective Studies; Masticatory Muscles; Masseter Muscle; Electromyography; Electroencephalography
PubMed: 36305587
DOI: 10.5664/jcsm.10344 -
Journal of Sleep Research Aug 2019Actigraphy is increasingly used in practice and research studies because of its relative low cost and decreased subject burden. How multiple nights of at-home actigraphy...
Actigraphy is increasingly used in practice and research studies because of its relative low cost and decreased subject burden. How multiple nights of at-home actigraphy compare to one independent night of in-laboratory polysomnography (PSG) has not been examined in people with insomnia. Using event markers (MARK) to set time in bed (TIB) compared to automatic program analysis (AUTO) has not been systematically evaluated. Subjects (n = 30) meeting DSM-5 criteria for insomnia and in-laboratory PSG sleep efficiency (SE) of <85% were studied. Subjects were free of psychiatric, sleep or circadian disorders, other chronic conditions and medications that effect sleep. Subjects had an in-laboratory PSG, then were sent home for 7 nights with Philips Actiwatch Spectrum Plus. Data were analysed using Philips Actiware version 6. Using the mean of seven nights, TIB, total sleep time (TST), SE, sleep-onset latency (SOL) and wake after sleep onset (WASO) were examined. Compared to PSG, AUTO showed longer TIB and TST and less WASO. MARK only differed from PSG with decreased WASO. Differences between the PSG night and the following night at home were found, with better sleep on the first night home. Actigraphy in people with insomnia over seven nights is a valid indicator of sleep compared to an independent in-laboratory PSG. Event markers increased the validity of actigraphy, showing no difference in TIB, TST, SE and SOL. AUTO was representative of SE and SOL. Increased SE and TST without increased TIB suggests possible compensatory sleep the first at night home after in-laboratory PSG.
Topics: Actigraphy; Female; Humans; Male; Middle Aged; Polysomnography; Sleep Initiation and Maintenance Disorders
PubMed: 30941838
DOI: 10.1111/jsr.12854 -
Computational and Mathematical Methods... 2022Insomnia is a sleep disorder and the cause of many healthy problems. However, there are few studies on patients with insomnia and dreaminess at present. Therefore, this...
BACKGROUND
Insomnia is a sleep disorder and the cause of many healthy problems. However, there are few studies on patients with insomnia and dreaminess at present. Therefore, this study is aimed at exploring the pathological molecular mechanisms and potential diagnostic and therapeutic targets related to insomnia patients with more dreams.
METHODS
Sleep characteristics of 36 primary insomnia patients with more dreams and 36 well sleeping participants were assessed using polysomnography (PSG) and Pittsburgh Sleep Quality Index (PSQI). Serum samples from 9 insomnia patients and 9 controls were randomly selected for proteomic detection. Differentially expressed proteins (DEPs) between the two groups were identified; enrichment analysis and PPI network were performed. The top 10 most connected proteins in the PPI network were subjected to targeted drug prediction and screened key proteins. Proteins with targeted drugs were recognized as key proteins and subjected to ELISA detection.
RESULTS
Insomnia patients had a distinct REM behavior disorder signature compared with controls. Proteomic sequencing identified 76 DEPs. Enrichment analysis found that DEPs were significantly enriched in the complement and coagulation cascades. Metabolic responses were also activated in insomnia patients. Among the hub proteins screened in the PPI network, APOA1, APOB, F2, and SPARC may be targeted by many herbal medicines and considered as key proteins. ELISA assays validated their differential expression between insomnia and controls.
CONCLUSION
In this study, we identified the potential key proteins of insomnia patients with more dreams. The pathological process may associate with inflammation and metabolic response. These results provide molecular targets for diagnostic and therapeutic targets. The results of our analysis suggest that the expression changes of key proteins have a good predictive diagnostic role for the occurrence of insomnia with more dreams in patients.
Topics: Humans; Polysomnography; Proteomics; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 35432581
DOI: 10.1155/2022/6181943 -
Sleep Jul 2022The mouse-deer or chevrotains are the smallest of the ungulates and ruminants. They are characterized by a number of traits which are considered plesiomorphic for the...
The mouse-deer or chevrotains are the smallest of the ungulates and ruminants. They are characterized by a number of traits which are considered plesiomorphic for the Artiodactyla order. The objective of this study was to examine sleep in the lesser mouse-deer (Tragulus kanchil), which is the smallest in this group (body mass < 2.2 kg). Electroencephalogram, nuchal electromyogram, electrooculogram, and body acceleration were recorded in four adult mouse-deer females using a telemetry system in Bu Gia Map National Park in Vietnam. The mouse-deer spent on average 49.7 ± 3.0% of 24 h in non-rapid eye movement (NREM) sleep. REM sleep occupied 1.7 ± 0.3% of 24 h or 3.2 ± 0.5% of total sleep time. The average duration of REM sleep episodes was 2.0 ± 0.2 min, the average maximum was 5.1 ± 1.1 min, and the longest episodes lasted 8 min. NREM sleep occurred in sternal recumbency with the head held above the ground while 64.7 ± 6.4% of REM sleep occurred with the head resting on the ground. The eyes were open throughout most of the NREM sleep period. The mouse-deer displayed polyphasic sleep and crepuscular peaks in activity (04:00-06:00 and 18:00-19:00). The largest amounts of NREM occurred in the morning (06:00-09:00) and the smallest before dusk (at 04:00-06:00). REM sleep occurred throughout most of the daylight hours (08:00-16:00) and in the first half of the night (19:00-02:00). We suggest that the pattern and timing of sleep in the lesser mouse-deer is adapted to the survival of a small herbivorous animal, subject to predation, living in high environmental temperatures in the tropical forest undergrowth.
Topics: Animals; Artiodactyla; Female; Polysomnography; Sleep; Sleep, REM
PubMed: 34370021
DOI: 10.1093/sleep/zsab199 -
Sleep Oct 2022
Topics: Electroencephalography; Polysomnography; Reproducibility of Results; Sleep; Sleep Stages
PubMed: 35951083
DOI: 10.1093/sleep/zsac190 -
Sleep Dec 2021The presence of flow limitation during sleep is associated with adverse health consequences independent of obstructive sleep apnea (OSA) severity (apnea-hypopnea index,... (Observational Study)
Observational Study
STUDY OBJECTIVES
The presence of flow limitation during sleep is associated with adverse health consequences independent of obstructive sleep apnea (OSA) severity (apnea-hypopnea index, AHI), but remains extremely challenging to quantify. Here we present a unique library and an accompanying automated method that we apply to investigate flow limitation during sleep.
METHODS
A library of 117,871 breaths (N = 40 participants) were visually classified (certain flow limitation, possible flow limitation, normal) using airflow shape and physiological signals (ventilatory drive per intra-esophageal diaphragm EMG). An ordinal regression model was developed to quantify flow limitation certainty using flow-shape features (e.g. flattening, scooping); breath-by-breath agreement (Cohen's ƙ); and overnight flow limitation frequency (R2, %breaths in certain or possible categories during sleep) were compared against visual scoring. Subsequent application examined flow limitation frequency during arousals and stable breathing, and associations with ventilatory drive.
RESULTS
The model (23 features) assessed flow limitation with good agreement (breath-by-breath ƙ = 0.572, p < 0.001) and minimal error (overnight flow limitation frequency R2 = 0.86, error = 7.2%). Flow limitation frequency was largely independent of AHI (R2 = 0.16) and varied widely within individuals with OSA (74[32-95]%breaths, mean[range], AHI > 15/h, N = 22). Flow limitation was unexpectedly frequent but variable during arousals (40[5-85]%breaths) and stable breathing (58[12-91]%breaths), and was associated with elevated ventilatory drive (R2 = 0.26-0.29; R2 < 0.01 AHI v. drive).
CONCLUSIONS
Our method enables quantification of flow limitation frequency, a key aspect of obstructive sleep-disordered breathing that is independent of the AHI and often unavailable. Flow limitation frequency varies widely between individuals, is prevalent during arousals and stable breathing, and reveals elevated ventilatory drive. Clinical trial registration: The current observational physiology study does not qualify as a clinical trial.
Topics: Humans; Lung; Polysomnography; Respiration; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34240221
DOI: 10.1093/sleep/zsab170 -
Sleep Medicine Reviews Jun 2022Sleep is characterized by an intricate variation of brain activity over time. Measuring these temporal sleep dynamics is relevant for elucidating healthy and... (Review)
Review
Sleep is characterized by an intricate variation of brain activity over time. Measuring these temporal sleep dynamics is relevant for elucidating healthy and pathological sleep mechanisms. The rapidly increasing possibilities for obtaining and processing sleep registrations have led to an abundance of data, which can be challenging to analyze and interpret. This review provides a structured overview of approaches to represent temporal sleep dynamics, categorized based on the way the source data is compressed. For each category of representations, we describe advantages and disadvantages. Standard human-defined 30-s sleep stages have the advantages of standardization and interpretability. Alternative human-defined representations are less standardized but offer a higher temporal resolution (in case of microstructural events such as sleep spindles), or reflect non-categorical information (for example spectral power analysis). Machine-learned representations offer additional possibilities: automated sleep stages are useful for handling large quantities of data, while alternative sleep stages obtained from clustering data-driven features could aid finding new patterns and new possible clinical interpretations. While newly developed sleep representations may offer relevant insights, they can be difficult to interpret in for example a clinical context. Therefore, there should always be a balance between developing these sophisticated sleep analysis techniques and maintaining clinical explainability.
Topics: Electroencephalography; Humans; Learning; Polysomnography; Sleep; Sleep Stages
PubMed: 35278893
DOI: 10.1016/j.smrv.2022.101611 -
Croatian Medical Journal Dec 2022To establish patterns or themes of dreams and dreamlike mentation content reported in all forms of non-rapid eye movement (NREM) parasomnias and to identify gaps in the... (Review)
Review
AIM
To establish patterns or themes of dreams and dreamlike mentation content reported in all forms of non-rapid eye movement (NREM) parasomnias and to identify gaps in the current understanding of this topic.
METHODS
A scoping review of available evidence on dreams and dreamlike mentation in NREM parasomnias was conducted in accordance with the PRISMA-ScR guidelines. We searched peer-reviewed literature using Google Scholar, PubMed, Ovid (Embase), Ovid Medline®, Global Health, and APA Psych Info. The Mixed Method Appraisal Tool (MMAT) was used to appraise the quality of selected articles.
RESULTS
The final analysis included 16 studies. All of the studies were from high-income countries. The studies reported on dreams and dreamlike mentation in NREM parasomnias, but there was scarcity of literature for sexsomnia, sleep-related eating disorder, and confusional arousal. All of the studies had the highest quality as shown by the MMAT (76%-100%). Emotions such as apprehension and misfortune were associated with sleepwalking and sleep terrors.
CONCLUSION
Sleep studies involving collection of dream content immediately following NREM parasomnia could significantly minimize reporting bias and improve dream data quality.
Topics: Humans; Parasomnias; Polysomnography; Emotions
PubMed: 36597564
DOI: 10.3325/cmj.2022.63.525 -
Journal of Clinical Sleep Medicine :... Jul 2020Pediatric polysomnography can result in suboptimal patient and provider (physician and advanced practice provider) experiences. We embarked on a project aimed at...
STUDY OBJECTIVES
Pediatric polysomnography can result in suboptimal patient and provider (physician and advanced practice provider) experiences. We embarked on a project aimed at increasing the proportion of maximal satisfaction survey scores by a minimum of 10% in 1 year without adding personnel or major expenses.
METHODS
We used a Six Sigma framework, define, measure, analyze, improve, and control (DMAIC), to conduct our analysis. For measurement, we designed a project-specific survey that was given to caregivers of children who underwent PSG in February 2018 and repeated the survey after interventions in February 2019. Lean and Six Sigma quality improvement tools were used to define important processes that influence patient satisfaction, including: supplier, input, process, output, customer, and requirements (SIPOC-R); journey mapping; 1-2-4-All brainstorming; and views solicited from our center's Patient and Family Advisory Council. We analyzed the relationships between identified processes and outcomes using usual descriptive statistics. We prioritized interventions using a Kano model and a quality function deployment (QFD) technique to rank priorities for interventions. Multiple opportunities to improve patient and family satisfaction before, during, and after a pediatric polysomnography were identified. Many were simple, one-step interventions and were implemented simultaneously. For those that required substantial training and/or scheduling changes, pilots were performed and plan, do, study, act (PDSA) cycles were used to check effectiveness.
RESULTS
After implementation, top box scores rose 20%, from 51% (n = 47) in 2018 to 71% (n = 50) in 2019.
CONCLUSIONS
Various quality improvement techniques employed in business, engineering, and manufacturing were used to identify and address areas of improvement in the pediatric polysomnography experience.
Topics: Child; Humans; Nigeria; Patient Satisfaction; Polysomnography; Quality Improvement; Sleep
PubMed: 32065112
DOI: 10.5664/jcsm.8386 -
Journal of Clinical Sleep Medicine :... Aug 2021(1) To determine the characteristics of term and preterm infants for whom polysomnography (PSG) was used as a primary diagnostic tool in infants with recurrent...
STUDY OBJECTIVES
(1) To determine the characteristics of term and preterm infants for whom polysomnography (PSG) was used as a primary diagnostic tool in infants with recurrent desaturation episodes, suspected obstructive apnea, or both, and the prevalence of abnormal studies. (2) To identify the interventions following PSGs. (3) To assess the added value of airway and swallow evaluations.
METHODS
Retrospective cohort study of infants evaluated by PSG in the Neonatal Intensive Care Unit at New York-Presbyterian Hospital-Weill Cornell from January 2012 to April 2018.
RESULTS
PSGs were performed on 31 infants; 15 (48%) term and 16 (52%) preterm infants. Indications for PSG were persistent desaturations (n = 24), suspected obstructive apnea (n = 15), and stridor (n = 2). Primary comorbid conditions were respiratory (n = 11), craniofacial (n = 9), airway anomalies (n = 6), and neurologic (n = 5). The apnea-hypopnea index was abnormal in 30 (97%) infants. Of those, 23 (74%) were severe, 7 (23%) were moderate, and 1 was normal (3%). Apneic events were predominantly obstructive in 23 infants and predominantly central in 6. The apnea-hypopnea index improved in all but 1 follow-up PSG. The PSG findings resulted in interventions in 24 (77%) infants, in addition to concomitant otolaryngology evaluations (abnormal in 20/25) and swallow studies (abnormal in 9/14). Clinical signs completely resolved in 22 (71%) infants.
CONCLUSIONS
This is one of the first reports on the diagnostic value of inpatient PSGs in the neonatal intensive care unit in infants with recurrent desaturation episodes, suspected obstructive apnea, or both. Our findings indicate that PSG is an important tool in evaluating and targeting therapies in complex term and preterm infants with a wide variety of comorbidities.
CITATION
Kim J, Gueye-Ndiaye S, Mauer E, Modi VK, Perlman J, Veler H. Polysomnography use in complex term and preterm infants to facilitate evaluation and management in the neonatal intensive care unit. . 2021;17(8):1653-1663.
Topics: Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; New York; Polysomnography; Retrospective Studies
PubMed: 33755011
DOI: 10.5664/jcsm.9264