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European Archives of... Oct 2023Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated substantial changes in OSA with this therapy by reducing respiratory events and improving symptoms such as daytime sleepiness and quality of life. The objective of this review was to conduct a systematic review and meta-analysis to evaluate patient-reported outcomes and experience with HNS therapy.
METHODS
A systematic literature search of MEDLINE, Cochrane, and Web of Science was performed to identify randomized controlled and observational studies reporting subjective outcomes with different HNS systems in patients with OSA. Abstracts of 406 articles were screened and a subset of 55 articles were reviewed for eligibility. Risk of bias was assessed using the ROBINS-I tool. Meta-analysis using RevMan was performed when > 2 studies were identified that reported data on a specific outcome.
RESULTS
Thirty-four publications reporting data on 3785 patients with a mean follow-up of 11.8 ± 12.2 months were identified and included in the meta-analysis. The analysis revealed a pooled effect of 4.59 points improvement in daytime sleepiness as measured by the ESS questionnaire (Z = 42.82, p < .001), 2.84 points improvement in daytime functioning as measured by the FOSQ score (Z = 28.38, p < .001), and 1.77 points improvement in sleep quality as measured by the PSQI questionnaire (Z = 2.53, p = .010). Patient-reported experience was consistently positive and revealed additional relevant aspects from this perspective.
CONCLUSION
HNS therapy significantly improves quality of life in patients with OSA and reliably produces clinically meaningful effects on daytime sleepiness, daytime functioning, and sleep quality. Treatment regularly meets or exceeds the minimum clinically important differences defined for the respective instruments. Additional research is needed to further investigate effects on quality of life beyond improvements in daytime sleepiness and daytime functioning.
Topics: Humans; Hypoglossal Nerve; Sleep Apnea, Obstructive; Patient Reported Outcome Measures; Quality of Life; Electric Stimulation Therapy
PubMed: 37354340
DOI: 10.1007/s00405-023-08062-1 -
Thorax Nov 2023Vibrotactile positional therapy (PT) devices are a new treatment modality for positional obstructive sleep apnoea (POSA). This review aimed to determine the effect of... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Vibrotactile positional therapy (PT) devices are a new treatment modality for positional obstructive sleep apnoea (POSA). This review aimed to determine the effect of vibrotactile PT on the Apnoea Hypopnoea Index (AHI) and the percentage of time spent in the supine position (%Tsupine) in patients with POSA, compared with baseline. Secondary aims were to investigate the effect on daytime sleepiness, quality of life and sleep quality.
METHODS
A systematic review and meta-analysis was performed of randomised controlled trials (RCTs) and cohort studies that investigated the effect of vibrotactile PT in POSA patients. Searches were performed via MEDLINE, CENTRAL and Embase up to 29 October 2022.
RESULTS
1119 studies were identified, 18 studies met the inclusion criteria (10 RCTs, 8 cohort studies). The use of vibrotactile PT significantly reduced the AHI at follow-up compared with baseline (mean difference (95% CI) -9.19 events/hour (-11.68 to -6.70); p<0.00001). The mean %Tsupine was also significantly reduced (mean difference (95% CI) -32.79% (-38.75% to -26.83%); p<0.00001). The percentage changes in the AHI and %Tsupine were 43% and 70%, respectively. Secondary outcomes were daytime sleepiness, quality of life and sleep indices. These showed minimal change, although follow-up was short.
CONCLUSION
Vibrotactile PT devices are effective in treating POSA; reducing both AHI and %Tsupine. The effect on sleep quality, daytime sleepiness and disease-specific quality of life was minimal. However, there were limited data and follow-up was often brief, meaning that further research is needed to determine the effect of vibrotactile PT on patient-centred outcomes.
PROSPERO REGISTRATION NUMBER
CRD42020188617.
Topics: Humans; Outcome Assessment, Health Care; Cohort Studies; Continuous Positive Airway Pressure; Sleep Apnea, Obstructive; Disorders of Excessive Somnolence
PubMed: 37344178
DOI: 10.1136/thorax-2021-218402 -
Complementary Therapies in Medicine Aug 2023To assess whether mind-body therapies (MBTs) are effective for relieving sleep disturbance among patients with cancer. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess whether mind-body therapies (MBTs) are effective for relieving sleep disturbance among patients with cancer.
DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
METHODS
Seven English electronic databases were searched from the date of inception to September 2022. All RCTs that included adults (≥18 years) who were treated with mindfulness, yoga, qigong, relaxation, and hypnosis were screened. The outcome was subjective and/or objective sleep disturbance.The revised Cochrane tool (RoB 2.0) was applied to evaluate the risk of bias. The RevMan software was applied to assessed each outcome according different control groups and assessment time points. Subgroup analyses were performed according to different categories of MBTs.
RESULTS
Sixty-eight RCTs (6339 participants) were identified. After requesting for missing data from corresponding authors of included RCTs, 56 studies (5051 participants) were included in the meta-analysis. The meta-analysis showed a significant immediate effect of mindfulness, yoga, relaxation, and hypnosis on subjective sleep disturbance, compared with usual care or wait list control, and the effect of mindfulness lasted at least 6 months. For objective sleep outcomes, we observed significant immediate effects of yoga on wake after sleep onset and of mindfulness on sleep onset latency and total sleep time. Compared with active control interventions, MBTs had no significant effect on sleep disturbance.
CONCLUSIONS
Mindfulness, yoga, relaxation, and hypnosis were effective in sleep disturbance severity reduction among patients with cancer at post-intervention, and the effect of mindfulness lasted at least 6 months. Future MBTs studies should apply both objective and subjective sleep measurement tools.
Topics: Adult; Humans; Mind-Body Therapies; Yoga; Meditation; Sleep; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Neoplasms
PubMed: 37244384
DOI: 10.1016/j.ctim.2023.102954 -
Graefe's Archive For Clinical and... Jan 2024The association of obstructive sleep apnea (OSA) with development of eye diseases is unclear. This current systematic review and meta-analysis attempts to summarize and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The association of obstructive sleep apnea (OSA) with development of eye diseases is unclear. This current systematic review and meta-analysis attempts to summarize and analyze associations between OSA and ocular disorders in the literature.
METHODS
PubMed, EMBASE, Google Scholar, Web Of Science, and Scopus databases were searched from 1901 to July 2022 in accordance with the Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA). Our primary outcome assessed the association between OSA and the odds of developing floppy eyelid syndrome (FES), glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), keratoconus (KC), idiopathic intracranial hypertension (IIH), age-related macular degeneration (AMD), and central serous chorioretinopathy (CSR) through odds ratio calculated at the 95% confidence interval.
RESULTS
Forty-nine studies were included for systematic review and meta-analysis. The pooled OR estimate was highest for NAION [3.98 (95% CI 2.38, 6.66)], followed by FES [3.68 (95% CI 2.18, 6.20)], RVO [2.71(95% CI 1.83, 4.00)], CSR [2.28 (95% CI 0.65, 7.97)], KC [1.87 (95% CI 1.16, 2.99)], glaucoma [1.49 (95% CI 1.16, 1.91)], IIH [1.29 (95% CI 0.33, 5.01)], and AMD [0.92 [95% CI 0.24, 3.58] All observed associations were significant (p < 0.001) aside from IIH and AMD.
CONCLUSION
OSA is significantly associated with NAION, FES, RVO, CSR, KC, and glaucoma. Clinicians should be informed of these associations so early recognition, diagnosis, and treatment of eye disorders can be addressed in at-risk groups, and early referral to ophthalmic services is made to prevent vision disturbances. Similarly, ophthalmologists seeing patients with any of these conditions should consider screening and referring patients for assessment of possible OSA.
Topics: Humans; Eyelid Diseases; Glaucoma; Keratoconus; Optic Neuropathy, Ischemic; Retinal Vein Occlusion; Sleep Apnea, Obstructive
PubMed: 37227479
DOI: 10.1007/s00417-023-06103-3 -
Journal of Sleep Research Dec 2023Despite the success of cognitive behavioural therapy for insomnia and recent advances in pharmacotherapy, many patients with insomnia do not sufficiently respond to... (Review)
Review
Despite the success of cognitive behavioural therapy for insomnia and recent advances in pharmacotherapy, many patients with insomnia do not sufficiently respond to available treatments. This systematic review aims to present the state of science regarding the use of brain stimulation approaches in treating insomnia. To this end, we searched MEDLINE, Embase and PsycINFO from inception to 24 March 2023. We evaluated studies that compared conditions of active stimulation with a control condition or group. Outcome measures included standardized insomnia questionnaires and/or polysomnography in adults with a clinical diagnosis of insomnia. Our search identified 17 controlled trials that met inclusion criteria, and assessed a total of 967 participants using repetitive transcranial magnetic stimulation, transcranial electric stimulation, transcutaneous auricular vagus nerve stimulation or forehead cooling. No trials using other techniques such as deep brain stimulation, vestibular stimulation or auditory stimulation met the inclusion criteria. While several studies report improvements of subjective and objective sleep parameters for different repetitive transcranial magnetic stimulation and transcranial electric stimulation protocols, important methodological limitations and risk of bias limit their interpretability. A forehead cooling study found no significant group differences in the primary endpoints, but better sleep initiation in the active condition. Two transcutaneous auricular vagus nerve stimulation trials found no superiority of active stimulation for most outcome measures. Although modulating sleep through brain stimulation appears feasible, gaps in the prevailing models of sleep physiology and insomnia pathophysiology remain to be filled. Optimized stimulation protocols and proof of superiority over reliable sham conditions are indispensable before brain stimulation becomes a viable treatment option for insomnia.
Topics: Adult; Humans; Sleep Initiation and Maintenance Disorders; Transcranial Magnetic Stimulation; Sleep; Polysomnography; Brain; Treatment Outcome
PubMed: 37202368
DOI: 10.1111/jsr.13927 -
The Journal of Maternal-fetal &... Dec 2023The majority of expectant mothers report sleep alterations during pregnancy and almost 40% report poor sleep quality. There is growing evidence that sleep quality (SQ)... (Review)
Review
BACKGROUND
The majority of expectant mothers report sleep alterations during pregnancy and almost 40% report poor sleep quality. There is growing evidence that sleep quality (SQ) during pregnancy influences maternal health. This review focuses on how SQ during pregnancy relates to maternal health-related quality of life (HRQoL). The review also aims to identify whether this relation varies between pregnancy trimesters, and for different subdomains of HRQoL.
METHODS
A systematic review was performed according to PRISMA guidelines and registered on Prospero in August 2021 with ID no: CRD42021264707. Pubmed, Psychinfo, Embase, Cochrane, and trial registries were searched up to June 2021. Studies with any design that investigated the relation between SQ and quality of life/HRQoL in pregnant women, published in English, and peer-reviewed, were included. Two independent reviewers screened titles, abstracts, and full texts, and extracted data from the included papers. The quality of the studies was evaluated using the Newcastle-Ottawa Scale.
RESULTS
Three hundred and thirteen papers were identified in the initial search, of which 10 met the inclusion criteria. Data included 7330 participants from six different countries. The studies had longitudinal ( = 1) or cross-sectional designs ( = 9). In nine studies SQ was reported subjectively by self-report questionnaires. Actigraphic data was available from two studies. HRQoL was assessed by validated questionnaires in all studies. Due to high levels of clinical and methodological heterogeneity in included studies, a narrative synthesis was employed. Nine studies found that poor sleep quality was related to a lower overall HRQoL during pregnancy. Effect sizes were low to medium. This relation was reported most during the third trimester. Especially sleep disturbances and subjective low SQ seemed to be related consistently to lower HRQoL. Furthermore, an indication was found that SQ might have a relation with the mental and physical domain of HRQoL. The social and environmental domain may also be associated with overall SQ.
CONCLUSION
Despite the scarcity of studies available, this systematic review found evidence that low SQ is related to low HRQoL during pregnancy. An indication was found that the relationship between SQ and HRQoL during the second trimester might be less prominent.
Topics: Humans; Female; Pregnancy; Quality of Life; Sleep Quality; Cross-Sectional Studies; Pregnant Women; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 37197986
DOI: 10.1080/14767058.2023.2212829 -
Evidence-based Dentistry Sep 2023PubMed, Scopus and Cochrane Library were systematically searched for studies published up to October 2021.
DATA SOURCES
PubMed, Scopus and Cochrane Library were systematically searched for studies published up to October 2021.
STUDY SELECTION
Two separate search strategies were employed: (1) In adults with periodontitis, what is the prevalence or incidence of respiratory diseases compared to healthy or gingivitis adults in cross-sectional, cohort or case -control studies. (2) In adults with periodontitis and respiratory disease, what are the effects of periodontal therapy compared to no or minimal therapy in clinical trials (randomised and non-randomised)? Respiratory diseases were defined as chronic obstructive pulmonary disease (COPD), obstructive sleep apnoea (OSA), asthma, COVID-19, and community acquire pneumonia (CAP). Exclusion criteria included non-English studies, individuals with severe systemic comorbidities, less than 12 months follow up, and a sample size less than 10 individuals.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently screened the titles, abstracts, and selected manuscripts against the inclusion criteria. Disagreement was solved by consulting a third reviewer. Studies were classified according to the respiratory diseases investigated. Quality assessment was performed using various tools. Qualitative assessment was performed. Studies with sufficient data were included in meta-analyses. Heterogeneity was assessed using the Q test and I index. Fixed and random effects models were used. Effect sizes were presented as odds-ratios, relative risks, and hazard ratios.
RESULTS
75 studies were included. Meta-analyses revealed statistically significant positive associations of periodontitis with COPD and OSA (p < 0.001) however no association for asthma. Four studies showed positive effects of periodontal treatment on COPD, asthma, and CAP.
Topics: Adult; Humans; Cross-Sectional Studies; COVID-19; Periodontitis; Asthma; Pulmonary Disease, Chronic Obstructive; Sleep Apnea, Obstructive
PubMed: 37188924
DOI: 10.1038/s41432-023-00899-z -
Journal of Sleep Research Oct 2023Optimal sleep, both in terms of duration and quality, is important for adolescent health. However, young people's sleeping habits have worsened over recent years. Access... (Review)
Review
Optimal sleep, both in terms of duration and quality, is important for adolescent health. However, young people's sleeping habits have worsened over recent years. Access to and use of interactive electronic devices (e.g., smartphones, tablets, portable gaming devices) and social media have become deep-rooted elements of adolescents' lives and are associated with poor sleep. Additionally, there is evidence of increases in poor mental health and well-being disorders in adolescents; further linked to poor sleep. This review aimed to summarise the longitudinal and experimental evidence of the impact of device use on adolescents' sleep and subsequent mental health. Nine electronic bibliographical databases were searched for this narrative systematic review in October 2022. Of 5779 identified unique records, 28 studies were selected for inclusion. A total of 26 studies examined the direct link between device use and sleep outcomes, and four reported the indirect link between device use and mental health, with sleep as a mediator. The methodological quality of the studies was generally poor. Results demonstrated that adverse implications of device use (i.e., overuse, problematic use, telepressure, and cyber-victimisation) impacted sleep quality and duration; however, relationships with other types of device use were unclear. A small but consistent body of evidence showed sleep mediates the relationship between device use and mental health and well-being in adolescents. Increasing our understanding of the complexities of device use, sleep, and mental health in adolescents are important contributions to the development of future interventions and guidelines to prevent or increase resilience to cyber-bullying and ensure adequate sleep.
Topics: Humans; Adolescent; Prospective Studies; Mental Health; Sleep; Sleep Initiation and Maintenance Disorders; Smartphone
PubMed: 37029099
DOI: 10.1111/jsr.13899 -
Journal of Sleep Research Dec 2023Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an... (Meta-Analysis)
Meta-Analysis Review
Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an appropriate treatment for COMISA; however, no previous study has systematically reviewed and meta-analysed literature reporting on the effect of CBTi in people with COMISA. A systematic literature search was conducted across PsychINFO and PubMed (n = 295). In all, 27 full-text records were independently reviewed by at least two authors. Forward- and backward-chain referencing, and hand-searches were used to identify additional studies. Authors of potentially eligible studies were contacted to provide COMISA subgroup data. In total, 21 studies, including 14 independent samples of 1040 participants with COMISA were included. Downs and Black quality assessments were performed. A meta-analysis including nine primary studies measuring the Insomnia Severity Index indicated that CBTi is associated with a large improvement in insomnia severity (Hedges' g = -0.89, 95% confidence interval [CI] -1.35, -0.43). Subgroup meta-analyses indicated that CBTi is effective in samples with untreated obstructive sleep apnoea (OSA) (five studies, Hedges' g = -1.19, 95% CI -1.77, -0.61) and treated OSA (four studies, Hedges' g = -0.55, 95% CI -0.75, -0.35). Publication bias was evaluated by examining the Funnel plot (Egger's regression p = 0.78). Implementation programmes are required to embed COMISA management pathways in sleep clinics worldwide that currently specialise in the management of OSA alone. Future research should investigate and refine CBTi interventions in people with COMISA, including identifying the most effective CBTi components, adaptations, and developing personalised management approaches for this highly prevalent and debilitating condition.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy; Sleep; Sleep Apnea, Obstructive; Comorbidity
PubMed: 36872072
DOI: 10.1111/jsr.13847 -
Journal of Sleep Research Aug 2023Insomnia is more prevalent in older adults (> 60 years) than in the general population. Cognitive behavioural therapy for insomnia is the gold-standard treatment;... (Review)
Review
Insomnia is more prevalent in older adults (> 60 years) than in the general population. Cognitive behavioural therapy for insomnia is the gold-standard treatment; however, it may prove too cognitively taxing for some. This systematic review aimed to critically examine the literature exploring the effectiveness of explicitly behavioural interventions for insomnia in older adults, with secondary aims of investigating their effect on mood and daytime functioning. Four electronic databases (MEDLINE - Ovid, Embase - Ovid, CINAHL, and PsycINFO) were searched. All experimental, quasi-experimental and pre-experimental studies were included, provided they: (a) were published in English; (b) recruited older adults with insomnia; (c) used sleep restriction and/or stimulus control; (d) reported outcomes pre-and-post intervention. Database searches returned 1689 articles; 15 studies, summarising the results of 498 older adults, were included - three focused on stimulus control, four on sleep restriction, and eight adopted multicomponent treatments comprised of both interventions. All interventions brought about significant improvements in one or more subjectively measured facets of sleep although, overall, multicomponent therapies demonstrated larger effects (median Hedge's g = 0.55). Actigraphic or polysomnographic outcomes demonstrated smaller or no effects. Improvements in measures of depression were seen in multicomponent interventions, but no intervention demonstrated any statistically significant improvement in measures of anxiety. This corroborates with the existing consensus that multicomponent approaches confer the most benefit, and adds to the literature by demonstrating this to be the case in brief, explicitly behavioural interventions. This review guides future study of treatments for insomnia in populations where cognitive behavioural therapy for insomnia is not appropriate.
Topics: Humans; Aged; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Cognitive Behavioral Therapy; Behavior Therapy; Sleep
PubMed: 36802110
DOI: 10.1111/jsr.13843