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Journal of Clinical Sleep Medicine :... Jun 2024We report a case of severe central sleep apnea incidentally diagnosed during polysomnography for suspected obstructive sleep apnea. Characteristic clinical features...
We report a case of severe central sleep apnea incidentally diagnosed during polysomnography for suspected obstructive sleep apnea. Characteristic clinical features included episodic hyperventilation followed by apnea from hypocapnia, which did not follow a Cheyne-Stokes pattern. Combined with the identification of cerebellar and brainstem malformations known as the "molar tooth sign" on a brain MRI, developmental delay, and motor coordination problems, Joubert syndrome (a congenital disease) was first diagnosed at the age of 50 years. Central apneas were also observed during wakefulness, although not continuously. During sleep, continuous positive airway pressure and adaptive servo-ventilation were ineffective at the referring clinic and at our hospital. Supplemental oxygen decreased the frequency of central apneas and significantly shortened the duration of each central sleep apnea compared with room air. In contrast, the opposite response was observed with acetazolamide administration.
PubMed: 38916285
DOI: 10.5664/jcsm.11224 -
Nature and Science of Sleep 2024To explore the role of the mean apnea-hypopnea duration (MAD) and apnea-hypopnea duration per hour (HAD) in hypoxemia and evaluate whether they can effectively predict...
PURPOSE
To explore the role of the mean apnea-hypopnea duration (MAD) and apnea-hypopnea duration per hour (HAD) in hypoxemia and evaluate whether they can effectively predict the occurrence of hypoxemia among adults with OSA.
PATIENTS AND METHODS
A total of 144 participants underwent basic information gathering and polysomnography (PSG). Logistic regression models were conducted to evaluate the best index in terms of hypoxemia. To construct the prediction model for hypoxemia, we randomly divided the participants into the training set (70%) and the validation set (30%).
RESULTS
The participants with hypoxemia tend to have higher levels of obesity, diabetes, AHI, MAD, and HAD compared with non-hypoxemia. The most relevant indicator of blood oxygen concentration is HAD (r = 0.73) among HAD, MAD, and apnea-hypopnea index (AHI). The fitness of HAD on hypoxemia showed the best. In the stage of establishing the prediction model, the area under the curve (AUC) values of both the training set and the validation set are 0.95. The increased HAD would elevate the risk of hypoxemia [odds ratio (OR): 1.30, 95% confidence interval (CI): 1.13-1.49].
CONCLUSION
The potential role of HAD in predicting hypoxemia underscores the significance of leveraging comprehensive measures of respiratory disturbances during sleep to enhance the clinical management and prognostication of individuals with sleep-related breathing disorders.
PubMed: 38915877
DOI: 10.2147/NSS.S452118 -
JAMA Network Open Jun 2024Obstructive sleep apnea (OSA) is a common condition in older adult (aged >65 years) populations, but more mechanistic research is needed to individualize treatments....
IMPORTANCE
Obstructive sleep apnea (OSA) is a common condition in older adult (aged >65 years) populations, but more mechanistic research is needed to individualize treatments. Previous evidence has suggested an association between OSA and posttraumatic stress disorder (PTSD) but is limited by possible selection bias. High-quality research on this association with a careful evaluation of possible confounders may yield important mechanistic insight into both conditions and improve treatment efforts.
OBJECTIVE
To investigate the association of current PTSD symptoms and PTSD diagnosis with OSA.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study of twin pairs discordant for PTSD, which allows for adjustment for familial factors, was conducted using in-laboratory polysomnography from March 20, 2017, to June 3, 2019. The study sample comprised male veteran twins recruited from the Vietnam Era Twin Registry. The data analysis was performed between June 11, 2022, and January 30, 2023.
EXPOSURE
Symptoms of PTSD in twins who served in the Vietnam War. Diagnosis of PTSD was a secondary exposure.
MAIN OUTCOMES AND MEASURES
Obstructive sleep apnea was assessed using the apnea-hypopnea index (AHI) (≥4% oxygen saturation criterion as measured by events per hour) with overnight polysomnography. Symptoms of PTSD were assessed using the PTSD Checklist (PCL) and structured clinical interview for PTSD diagnosis.
RESULTS
A total of 181 male twins (mean [SD] age, 68.4 [2.0] years) including 66 pairs discordant for PTSD symptoms and 15 pairs discordant for a current PTSD diagnosis were evaluated. In models examining the PCL and OSA within pairs and adjusted for body mass index (BMI) and other sociodemographic, cardiovascular, and psychiatric risk factors (including depression), each 15-point increase in PCL was associated with a 4.6 (95% CI, 0.1-9.1) events-per-hour higher AHI. Current PTSD diagnosis was associated with an adjusted 10.5 (95% CI, 5.7-15.3) events-per-hour higher AHI per sleep-hour. Comparable standardized estimates of the association of PTSD symptoms and BMI with AHI per SD increase (1.9 events per hour; 95% CI, 0.5-3.3 events per hour) were found.
CONCLUSIONS AND RELEVANCE
This cross-sectional study found an association between PTSD and sleep-disordered breathing. The findings have important public health implications and may also enhance understanding of the many factors that potentially affect OSA pathophysiology.
Topics: Humans; Stress Disorders, Post-Traumatic; Male; Sleep Apnea, Obstructive; Cross-Sectional Studies; Aged; Veterans; Middle Aged; Vietnam Conflict; Polysomnography; Diseases in Twins; Twins
PubMed: 38913378
DOI: 10.1001/jamanetworkopen.2024.16352 -
Journal of Clinical Sleep Medicine :... Jun 2024There is limited information about sleep in agenesis of the corpus callosum (ACC). We aim to describe the sleep architecture and respiratory parameters of children with...
STUDY OBJECTIVES
There is limited information about sleep in agenesis of the corpus callosum (ACC). We aim to describe the sleep architecture and respiratory parameters of children with ACC.
METHODS
We performed a retrospective study of 20 patients with ACC who had polysomnography (PSG) between 2000-2023. Demographic data, BMI or weight for length, associated conditions, and PSG findings were collected. National Sleep Foundation (NSF) sleep quality indicators as well as increased PSG arousal index ≥10/h were used in the analysis. Fisher's exact test or unpaired t-test was used to compare groups.
RESULTS
Average age was 5.9 ± 5.4 years old; 12/20 patients were male. 6/20 were overweight/obese. 14/20 had complete ACC, and 6/20 had partial ACC. 8/20 had seizures. 15/20 had ≥1 NSF poor sleep quality indicator (decreased SE (45%), decreased REM (53%)) and 9/20 had increased arousals. Between complete and partial ACC, there was no difference in presence of ≥1 poor sleep quality indicator (p= 0.61), SE (p=0.34), REM (p=0.28), and arousals (p=1.0). 11/18 had obstructive sleep apnea (OSA); 5/11 had associated central sleep apnea. There was no difference in OSA between those with complete and partial ACC (p=1.0). OSA was associated with children <3 years old (p=0.01).
CONCLUSIONS
Children with ACC have poor sleep quality, and many have OSA. There was no difference in sleep quality or presence of OSA between those with complete and partial ACC. OSA was seen more in younger children. Our study supports the need for screening of sleep-related disorders in patients with ACC.
PubMed: 38913362
DOI: 10.5664/jcsm.11234 -
Journal of Clinical Sleep Medicine :... Jun 2024Pediatric obstructive sleep apnea (OSA) is common, however, inclusion of adolescents and especially those of ethnic/racial minorities in research is scarce. We...
STUDY OBJECTIVES
Pediatric obstructive sleep apnea (OSA) is common, however, inclusion of adolescents and especially those of ethnic/racial minorities in research is scarce. We hypothesized that ethnic/racial minority adolescents undergoing polysomnography (PSG) have higher prevalence and more severe OSA compared to those who are non-Hispanic (NH) White.
METHODS
Retrospective review of 1,745 adolescents undergoing diagnostic PSG. Demographic characteristics, age, body mass index percentile (BMIp), and PSG parameters were obtained. Descriptive statistics comparing race/ethnicity were analyzed. Linear regression of log-transformed obstructive apnea-hypopnea index (OAHI), and logistic regression of moderate-severe OSA (OAHI ≥ 5 events/h) adjusting for covariates were analyzed.
RESULTS
58.2% adolescents were Hispanic, 24.1% NH-White, 4.3% NH-Asian/Pacific Islander (PI), 4.2% NH-Black/African American (AA), and 6.6% NH-other. Compared to the NH-White group, the Hispanic group had higher OAHI and any level of OSA severity; the Black/AA group had higher moderate-severe and severe OSA, and the NH-Asian group had higher moderate-severe OSA. Multiple linear regression of log-OAHI identified an association with Hispanic ethnicity (β: 0.25, -value < .05). Compared to the NH-White group, the Hispanic and the Asian/PI groups were 1.45 (95% CI: 1.10, 1.93) and 1.81 (95% CI: 1.05, 3.10) times more likely to have moderate-severe OSA, respectively, after adjusting for relevant covariates. Stratified analysis by sex identified an association only among males between Hispanic ethnicity (OR: 1.85, 95% CI: 1.27, 2.70) and Asian/PI ethnicity (OR: 2.62, 95% CI: 1.35, 5.11) and moderate-severe OSA, compared to the NH-White group.
CONCLUSIONS
Among adolescents undergoing PSG evaluation, we identified OSA racial/ethnic and sex disparities in Hispanic and NH-Asian adolescents. Community level studies with adequate representation of these minority groups are needed to identify factors associated with the reported increased susceptibility.
PubMed: 38913342
DOI: 10.5664/jcsm.11238 -
Neurological Sciences : Official... Jun 2024Sleep disturbances are being increasingly recognized in association with autoimmune encephalitis (AIE). We investigated the prevalence of sleep-related symptoms and...
INTRODUCTION
Sleep disturbances are being increasingly recognized in association with autoimmune encephalitis (AIE). We investigated the prevalence of sleep-related symptoms and polysomnographic features of patients with AIE and the long-term outcomes in these patients in a multi-center, prospective study from Turkey.
METHODS
We prospectively evaluated patients with definite AIE in a common database including demographics, AIE-related and sleep-related symptomatology. Maximum and latest modified Rankin scores (mRS) and Liverpool Outcome Score (LOS) were noted.
RESULTS
Of 142 patients, 87 patients (61.3%) fulfilled the criteria for definite AIE (mean age, 46.8+18.8 years; 51.7% women; mean disease duration, 21.0+38.4 months). 78.9% of patients had at least one or more new onset or worsened sleep-related symptomatology: insomnia (55.3%), excessive daytime sleepiness (EDS, 28.0%), sleep apnea (18.7%), REM sleep behavior disorder (RBD, 17.3%), restless legs syndrome (10.7%) and oneiric stupor (9.3%). Sleep efficiency, N3 and REM sleep were decreased and N1 sleep was increased in patients with Ab[+] AIE. LOS points were highest in those with insomnia and sleep apnea, and lowest in those with EDS, RBD and oneiric stupor. RBD and sleep apnea were more common in anti-LG1 Ab[+] group than anti-NMDAR Ab[+] group. Index of periodic leg movements was highest in anti-LG1 Ab[+] group. Patients with EDS and oneiric stupor had more common memory problems. Maximum and latest mRS scores were positively correlated with EDS and oneiric stupor. EDS, RBD and oneiric stupor were negatively correlated with LOS points.
CONCLUSION
Our study emphasizes the presence and importance of early diagnosis of sleep disturbances in AIE in regard to their deteriorative influences on disease prognosis.
PubMed: 38913197
DOI: 10.1007/s10072-024-07652-z -
Journal of Applied Biomedicine Jun 2024The current obstructive sleep apnea (OSA) diagnostic uses polysomnography or limited polygraphy and requires specialized personnel and technical equipment. Glycoprotein...
BACKGROUND
The current obstructive sleep apnea (OSA) diagnostic uses polysomnography or limited polygraphy and requires specialized personnel and technical equipment. Glycoprotein biomarkers and microRNAs are being explored as a possible new method for screening. We aimed to evaluate whether certain biomarkers and microRNA, previously identified as related to OSA, could be influenced by factors such as gender, age, and obesity level in patients with OSA.
METHODS
In this retrospective analytical study, patients with moderate to severe OSA (n = 130) were compared with the control group. Serum levels of selected biomarkers and microRNA were taken from both groups. The group of OSA patients was then stratified by gender, obesity level, and age to see the possible influence of those variables on biomarker levels.
RESULTS
Levels of all studied biomarkers - C-reactive protein (CRP), high-sensitivity troponin I (hsTnI), pentraxin-3 (PTX-3), and microRNA-499 were significantly higher in patients with OSA compared to the control group. In the OSA group only hsTnI showed a statistically significant relationship with gender. Levels of CRP and hsTnI showed a significant dependence on the level of obesity. Dependency on age was proven for hsTnI. CRP, PTX-3, and microRNA-499 did not have any statistically significant relationship with age.
CONCLUSION
We found that serum levels of pentraxin-3 and microRNA-499 in patients with moderate to severe obstructive sleep apnoea are independent of gender, obesity, and age. CRP was affected by the level of obesity and hsTnI was influenced by all 3 variables. We consider these findings important for further research of OSA biomarkers.
Topics: Humans; Sleep Apnea, Obstructive; Male; Female; Middle Aged; Biomarkers; MicroRNAs; Obesity; C-Reactive Protein; Adult; Age Factors; Sex Factors; Retrospective Studies; Glycoproteins; Aged; Serum Amyloid P-Component; Troponin I
PubMed: 38912863
DOI: 10.32725/jab.2024.011 -
Sleep Jun 2024to define sleep-related movements in healthy adults according to sex and age.
Physiological movements during sleep in healthy adults across all ages: a video-polysomnographic analysis of non-codified movements reveals sex differences and distinct motor patterns.
STUDY OBJECTIVES
to define sleep-related movements in healthy adults according to sex and age.
METHODS
sleep-related movements from 50 video-polysomnography (vPSG) recordings of 27 men and 23 women, from 20 to 70 years old, were classified according to ICDS-3-TR and AASM criteria (codified movements); the remaining movements (non-codified movements) were described according to type (elementary movements-EMs or complex movements-CMs), topography (focal, segmental, multifocal or generalized) and, if present, were assigned to motor patterns (MPs).
RESULTS
of 4057 movements analyzed, 54.6% (2216/4057) were non-codified (1861 CMs, 355 EMs) and 1841 were codified. CMs were mainly generalized (70%) while EMs were multifocal (40%) or focal (30%). The median movement index (MI; movement/hour) was 11 and the median duration was 4 s. MI decreased from stages N1/REM>N2>N3; men showed a higher MI. An MP was assigned to 2204 codified and non-codified movements, mainly stretching (50%) and scratching (30%). Stretching increased in REM sleep while food-carrying behaviors increased in N2. Men showed more food-carrying behaviors, changes of body positions and comfort movements while stretching was more common in women. Younger subjects exhibited more food-carrying behaviors, while scratching and stretching were more prevalent in the middle-aged group. Older subjects showed more changes in body positions and comfort movements.
CONCLUSIONS
54.6% of sleep-related movements in healthy subjects were non-codified and characterized by motor sequences that can configure MPs. Our comprehensive classification method allows a detailed description of the physiological movements underlying differential motor control during sleep stages influenced by age and sex.
PubMed: 38912822
DOI: 10.1093/sleep/zsae138 -
Nature and Science of Sleep 2024The COVID-19 pandemic has influenced clinical sleep protocols with stricter hospital disinfection requirements. Facing these new rules, we tested if a new artificial...
PURPOSE
The COVID-19 pandemic has influenced clinical sleep protocols with stricter hospital disinfection requirements. Facing these new rules, we tested if a new artificial intelligence (AI) algorithm: The Nox BodySleep™ (NBS) developed without airflow signals for the analysis of sleep might assess pertinently sleep in patients with Obstructive Sleep Apnea (OSA) and chronic insomnia (CI) as a control group, compared to polysomnography (PSG) manual scoring.
PATIENTS-METHODS
NBS is a recurrent neural network model that estimates Wake, NREM, and REM states, given features extracted from activity and respiratory inductance plethysmography (RIP) belt signals (Nox A1 PSG). Sleep states from 139 PSG studies (CI N = 72; OSA N = 67) were analyzed by NBS and compared to manually scored PSG using positive percentage agreement, negative percentage agreement, and overall agreement metrics. Similarly, we compared common sleep parameters and OSA severity using sleep states estimated by NBS for each recording and compared to manual scoring using Bland-Altman analysis and intra-class correlation coefficient.
RESULTS
For 127,170 sleep epochs, an overall agreement of 83% was reached for Wake, NREM and REM states (92% for REM states in CI patients) between NBS and manually scored PSG. Overall agreement for estimating OSA severity was 100% for moderate-severe OSA and 91% for minimal OSA. The absolute errors of the apnea-hypopnea index (AHI) and total sleep time (TST) were significantly lower for the NBS compared to no scoring of sleep. The intra-class correlation was higher for AHI and significantly higher for TST using the NBS compared to no scoring of sleep.
CONCLUSION
NBS gives sleep states, parameters and AHI with a good positive and negative percentage agreement, compared with manually scored PSG.
PubMed: 38911319
DOI: 10.2147/NSS.S431650 -
Nature and Science of Sleep 2024The coexistence of insomnia and obstructive sleep apnea (OSA) is very prevalent. Hypoglossal nerve stimulation (HGNS) is an established second-line therapy for patients...
PURPOSE
The coexistence of insomnia and obstructive sleep apnea (OSA) is very prevalent. Hypoglossal nerve stimulation (HGNS) is an established second-line therapy for patients suffering OSA. Studies investigating the effect of the different aspects of insomnia on the therapeutic outcome are largely missing. Therefore, this study aimed to understand the impact of the different aspects of insomnia on the therapeutic outcome under HGNS therapy in clinical routine.
PATIENTS AND METHODS
This is a retrospective study including 30 consecutive patients aged 55.40 ± 8.83 years (8 female; 22 male) undergoing an HGNS implantation in our tertiary medical center between 2020 and 2023. All patients underwent preoperative polysomnography (PSG) according to AASM. First follow-up PSG was performed 95.40 ± 39.44 days after activation (30 patients) and second follow-up PSG was performed 409.89 ± 122.52 days after activation (18 patients). Among others, the following PSG-related parameters were evaluated: apnea-hypopnea index (n/h) (AHI) and oxygen desaturation index (n/h) (ODI). Insomnia was assessed by the insomnia severity index (ISI) questionnaire. Preoperatively, all patients included filled out each ISI item. Spearman's-rho correlation coefficient was calculated for correlations.
RESULTS
Preoperative score of ISI item 1 (difficulty falling asleep) was 1.93 ± 1.34 and preoperative cumulative ISI score (item1-7) was 18.67 ± 5.32. Preoperative AHI was 40.61 ± 12.02 (n/h) and preoperative ODI was 38.72 ± 14.28 (n/h). In the second follow-up, the mean difference in AHI was ∆ 10.47 ± 15.38 (n/h) and the mean difference in ODI was ∆ 8.17 ± 15.67 (n/h). Strong significant correlations were observed between ISI item 1 (difficulty falling asleep) and both ∆ AHI (r: -0.65, =0.004) and ∆ ODI (r: -0.7; =0.001) in the second follow-up.
CONCLUSION
Difficulty falling asleep may hence negatively influence HGNS therapeutic outcome. Insomnia-related symptoms should be considered in the preoperative patient evaluation for HGNS.
PubMed: 38911316
DOI: 10.2147/NSS.S459690