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Scientific Reports Jan 2021Accurate and low-cost sleep measurement tools are needed in both clinical and epidemiological research. To this end, wearable accelerometers are widely used as they are...
Accurate and low-cost sleep measurement tools are needed in both clinical and epidemiological research. To this end, wearable accelerometers are widely used as they are both low in price and provide reasonably accurate estimates of movement. Techniques to classify sleep from the high-resolution accelerometer data primarily rely on heuristic algorithms. In this paper, we explore the potential of detecting sleep using Random forests. Models were trained using data from three different studies where 134 adult participants (70 with sleep disorder and 64 good healthy sleepers) wore an accelerometer on their wrist during a one-night polysomnography recording in the clinic. The Random forests were able to distinguish sleep-wake states with an F1 score of 73.93% on a previously unseen test set of 24 participants. Detecting when the accelerometer is not worn was also successful using machine learning ([Formula: see text]), and when combined with our sleep detection models on day-time data provide a sleep estimate that is correlated with self-reported habitual nap behaviour ([Formula: see text]). These Random forest models have been made open-source to aid further research. In line with literature, sleep stage classification turned out to be difficult using only accelerometer data.
Topics: Accelerometry; Adolescent; Adult; Aged; Algorithms; Deep Learning; Female; Humans; Machine Learning; Male; Middle Aged; Polysomnography; Sleep; Sleep Stages; Sleep Wake Disorders; Wearable Electronic Devices; Young Adult
PubMed: 33420133
DOI: 10.1038/s41598-020-79217-x -
Sleep Aug 2023
Topics: Humans; Aged; Polysomnography; Reproducibility of Results; Sleep Apnea, Obstructive
PubMed: 37074871
DOI: 10.1093/sleep/zsad116 -
Critical Care (London, England) Jan 2021Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is... (Observational Study)
Observational Study
BACKGROUND
Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring.
METHODS
Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time.
RESULTS
We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland-Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated.
CONCLUSIONS
Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).
Topics: Actigraphy; Adult; Aged; Feasibility Studies; Female; Humans; Intensive Care Units; Male; Middle Aged; Polysomnography; Prospective Studies; Reproducibility of Results
PubMed: 33514414
DOI: 10.1186/s13054-020-03447-8 -
Journal of Clinical Sleep Medicine :... Feb 2022To compare type 2 polysomnography (T2PSG) to the gold standard type 1 in-laboratory polysomnography (T1PSG) for diagnosing obstructive sleep apnea (OSA) in children;...
Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children.
STUDY OBJECTIVES
To compare type 2 polysomnography (T2PSG) to the gold standard type 1 in-laboratory polysomnography (T1PSG) for diagnosing obstructive sleep apnea (OSA) in children; validate home T2PSG in children with suspected OSA.
METHODS
Eighty-one participants (ages 6-18) with suspected OSA had simultaneous T1PSG and T2PSG in the sleep laboratory, 47 participants (ages 5-16) had T1PSG in the sleep laboratory and T2PSG performed at home. Sleep scientists staged and scored polysomnography data, and pediatric sleep physicians assigned a diagnosis of normal or OSA. Participant demographics, polysomnography variables, and diagnoses were compared using chi-square and Fisher's exact tests for nominal variables, test for continuous variables and Cohen's kappa to assess concordance.
RESULTS
Acceptable recordings were obtained for every home T2PSG. When T1PSG and T2PSG were simultaneous, correlation between the number of arousals, respiratory disturbance index, and sleep stages was excellent. T2PSG at home demonstrated less stage 2 sleep, more rapid eye movement sleep, and higher sleep efficiency. Comparison of home T2PSG to T1PSG for diagnosing OSA showed a false-positive rate of 6.6% and false-negative rate of 3% for those performed at home.
CONCLUSIONS
T2PSG in the home is feasible with excellent concordance with T1PSG for the purposes of diagnosing OSA in children aged 5-18 years. Home T2PSG may be more representative of a "normal" night for children and could benefit those suspected of having OSA by reducing waiting times for laboratory PSG, improving access to PSG and possibly reducing costs of investigating and treating OSA.
CITATION
Withers A, Maul J, Rosenheim E, O'Donnell A, Wilson A, Stick S. Comparison of home ambulatory type 2 polysomnography with a portable monitoring device and in-laboratory type 1 polysomnography for the diagnosis of obstructive sleep apnea in children. . 2022;18(2):393-402.
Topics: Adolescent; Child; Child, Preschool; Humans; Laboratories; Monitoring, Ambulatory; Polysomnography; Sleep; Sleep Apnea, Obstructive
PubMed: 34323688
DOI: 10.5664/jcsm.9576 -
Annals of Medicine Dec 2022Obstructive sleep apnoea (OSA) is characterized by nocturnal repetitive upper airway (UA) collapse. For sleep physicians, the recognition of UA collapse characteristics... (Review)
Review
Obstructive sleep apnoea (OSA) is characterized by nocturnal repetitive upper airway (UA) collapse. For sleep physicians, the recognition of UA collapse characteristics is critical for understanding OSA mechanisms and developing individualized treatment plans. Drug-induced sleep endoscopy (DISE) is an exam during simulated sleep that allows the dynamic assessment of the UA of individuals with OSA. The initial recognition of DISE was to locate the sites of UA obstruction and direct the surgical selection of OSA since it was introduced in the 1990s. After approximately 30 years of studies, based on advances in endoscopic operative techniques and innovative treatments of OSA, DISE had been performed to explore mechanisms and comprehensive treatments related to UA collapse. This article reviewed contemporary DISE advances, including indications and contraindications, technique of induced sleep, endoscopic operation, UA characteristics classification. Precise selection based on the association between collapse patterns and treatment modalities, such as continuous positive airway pressure, oral appliance, positional therapy, robotic surgery and neurostimulator implanting, is the future research prospect based on DISE.Key messagesDISE provides sleep physicians with valuable information about the upper airway collapse characteristics and dynamic changes during sleep.The studies based on DISE findings improve the selectivity and efficiency of treatment modalities, including classical therapies such as continuous positive airway pressure, oral appliance, positional therapy, and innovative therapies such as neurostimulator implanting and robotic surgery, promote the advancement of OSA precision medicine.
Topics: Humans; Polysomnography; Sleep Apnea, Obstructive; Endoscopy; Sleep; Airway Obstruction
PubMed: 36269026
DOI: 10.1080/07853890.2022.2134586 -
Journal of Sleep Research Jun 2021Because of unspecific diagnostic criteria, there is much controversy around narcolepsy type 2, its existence and its frequency. With this retrospective and purely...
Because of unspecific diagnostic criteria, there is much controversy around narcolepsy type 2, its existence and its frequency. With this retrospective and purely descriptive study, we aimed to compare the frequency of narcolepsy type 2 compared to the well-described narcolepsy type 1, in a large (n = 3,782) retrospective sample from a single tertiary sleep centre. After 2 weeks washout of sleep-wake active medication, all patients with excessive daytime sleepiness (n = 1,392) underwent 2 weeks actigraphy, polysomnography and multiple sleep latency test, and all diagnoses were made along current diagnostic criteria. Narcolepsy type 1 was diagnosed in 91 patients, and 191 patients without cataplexy had multiple sleep latency test (MSLT) results indicating narcolepsy. After exclusion of shift work syndrome (n = 19), suspected insufficient sleep syndrome (n = 128), delayed sleep phase syndrome (n = 4) and obstructive sleep apnea (n = 34), six patients were diagnosed with narcolepsy type 2, of whom two patients later developed narcolepsy type 1. Altogether, our observations suggest that narcolepsy type 2 exists, but its frequency may be much lower compared to narcolepsy type 1. In addition, they emphasize the importance of scrupulously excluding other potential causes of sleepiness, if possible, with 2-week actigraphy and polysomnography.
Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Humans; Male; Narcolepsy; Polysomnography; Retrospective Studies
PubMed: 32989797
DOI: 10.1111/jsr.13203 -
Journal of Clinical Sleep Medicine :... Mar 2022To compare the efficiency of a TCM scoring system that includes 3 independent predictors obtained by physical examination, computed tomography, and polysomnography with...
STUDY OBJECTIVES
To compare the efficiency of a TCM scoring system that includes 3 independent predictors obtained by physical examination, computed tomography, and polysomnography with the standard Friedman staging system that includes only physical examination variables for predicting surgical outcomes in patients with obstructive sleep apnea syndrome who undergo velopharyngeal surgery.
METHODS
This prospective study was carried out in 265 patients with obstructive sleep apnea syndrome who underwent velopharyngeal surgery. All these patients were re-examined with polysomnography for evaluation of surgical outcomes at least 3 months after surgery. The efficacies in the surgical outcome prediction of 2 systems were calculated and compared.
RESULTS
The overall response rate and cure rate was 63.8% (169/265) and 22.3% (59/265), respectively. There were 32 patients with Friedman stage I, with a response rate and cure rate of 81.3% (26/32) and 28.1% (9/32), respectively, and 70 patients with TCM scores of < 14 with a response rate and cure rate of 91.4% (64/70) and 42.9% (30/70), respectively. Friedman stage and TCM grade were the only 2 factors independently predictive of surgical response ( < .05, odds ratio value = 0.642 and 0.382). The receiver operating characteristic curve analysis for surgical response showed that the area under the curve value was 0.600 for Friedman stage, which was significantly lower than that for TCM grade, 0.718 ( = .005). Apnea-hypopnea index and TCM grade were the only 2 factors independently predictive of surgical cure ( < .05, odds ratio value = 0.981 and 0.465).
CONCLUSIONS
Compared with the Friedman staging system, the TCM scoring system was more efficient in selecting proper candidates for velopharyngeal surgery. The main reason may be its better utilization of patients' preoperative information, especially the inclusion of physiological factors.
CLINICAL TRIAL REGISTRATION
Registry: Chinese Clinical Trials Register; Name: Clinical Phenotypes and Precise Treatment of Adult OSA (Obstructive Sleep Apnea): A Multicenter Study; URL: http://www.ChiCTR.org.cn/showproj.aspx?proj=21189; Identifier: ChiCTR-ONC-17013132.
CITATION
Zhang J, Cao X, Yin G, et al. The significance of better utilization of patients' preoperative information in predicting outcomes of velopharyngeal surgery: a prospective cohort study. . 2022;18(3):843-850.
Topics: Humans; Odds Ratio; Polysomnography; Prospective Studies; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 34710037
DOI: 10.5664/jcsm.9734 -
Journal of Clinical Sleep Medicine :... Mar 2022Sleep is one of the most common factors related to health, yet a standard definition of sleep quality has not been identified. Polysomnography provides important... (Review)
Review
STUDY OBJECTIVES
Sleep is one of the most common factors related to health, yet a standard definition of sleep quality has not been identified. Polysomnography provides important information about objective sleep variables. However, the relationship between objective sleep variables and perception of sleep quality remains unclear. The purpose of this review was to (1) summarize the current methods of measuring objective sleep macrostructure and microstructure, including electroencephalography arousals, spectral frequency, cyclic alternating pattern, and self-report sleep quality, and (2) investigate the relationship between objective measures of sleep physiology and self-report sleep quality in healthy adults.
METHODS
A literature search was conducted using Medline, PubMed, and PsycInfo databases and cited reference searches. Eligible studies included a comparison between self-report sleep quality and polysomnography sleep measures in healthy adults.
RESULTS
Thirteen studies were identified. Measurement of self-report sleep quality varied widely across studies. Total sleep time and sleep efficiency were most consistently related to sleep quality, while other objective sleep variables, including electroencephalography spectral analysis, were not reliably predictive of self-report sleep quality in healthy adults. There is preliminary support that microstructural sleep analysis with cyclic alternating pattern may be related to self-reported sleep quality.
CONCLUSIONS
Further research is needed to define and standardize self-report measures of sleep quality and investigate the microstructure of sleep. Objective measures of sleep and experiences of "quality" sleep are not as closely related as one may expect in healthy individuals, and understanding this relationship further is necessary to improve the clinical utility of sleep physiology.
CITATION
Cudney LE, Frey BN, McCabe RE, Green SM. Investigating the relationship between objective measures of sleep and self-report sleep quality in healthy adults: a review. . 2022;18(3):927-936.
Topics: Adult; Electroencephalography; Humans; Polysomnography; Self Report; Sleep; Sleep Quality
PubMed: 34609276
DOI: 10.5664/jcsm.9708 -
Journal of Internal Medicine Jan 2022
Topics: Humans; Polysomnography; Sleep; Sleep Quality
PubMed: 34549466
DOI: 10.1111/joim.13373 -
Journal of Clinical Sleep Medicine :... Oct 2020Obstructive sleep apnea (OSA) is a chronic condition that is characterized by recurrent pauses in breathing during sleep causing intermittent hypoxia. The main factor...
STUDY OBJECTIVES
Obstructive sleep apnea (OSA) is a chronic condition that is characterized by recurrent pauses in breathing during sleep causing intermittent hypoxia. The main factor responsible for oxygen metabolism homeostasis is hypoxia-inducible factor 1 (HIF-1), comprised of 2 subunits: α (oxygen sensitive) and β. The aim of the study was to investigate the HIF-1α serum protein level and mRNA HIF-1α expression in patients with OSA and a healthy control group and determine their evening-morning variation and association with polysomnography parameters.
METHODS
Eighty-four individuals were enrolled in the study. All patients underwent polysomnography examination and based on the results were divided into 2 groups: OSA group (n = 60) and control group (n = 24). Peripheral blood was collected in the evening before and in the morning after the polysomnography. HIF-1α expression was evaluated on protein in blood serum and mRNA level in peripheral blood leukocytes.
RESULTS
HIF-1α serum protein concentration was higher in patients with OSA compared with control patients in both the evening (1,490.1 vs. 727.0 pg/mL; P < .001) and the morning (1,368.9 vs. 702.1 pg/mL; P < .001) samples. There was no difference between evening and morning HIF-1α serum protein level in either group. No differences were observed in HIF-1α mRNA expression between the OSA and control group. Additionally, evening and morning HIF-1α serum protein level correlated with number of desaturations during sleep (r = .384, P < .001 and r = .433, P < .001, respectively).
CONCLUSIONS
Observed differences in HIF-1α serum protein level between the OSA and the control groups without difference between evening and morning measurements suggest chronic increase in this protein concentration by intermittent nocturnal hypoxia in OSA.
Topics: Blood Proteins; Humans; Hypoxia; Polysomnography; Sleep Apnea, Obstructive; Up-Regulation
PubMed: 32663129
DOI: 10.5664/jcsm.8682