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Biomedical Engineering Letters Aug 2023Sleep apnea (SLA) is a respiratory-related sleep disorder that affects a major proportion of the population. The gold standard in sleep testing, polysomnography, is... (Review)
Review
UNLABELLED
Sleep apnea (SLA) is a respiratory-related sleep disorder that affects a major proportion of the population. The gold standard in sleep testing, polysomnography, is costly, inconvenient, and unpleasant, and it requires a skilled professional to score. Multiple researchers have suggested and developed automated scoring processes with less detectors and automated classification algorithms to resolve these problems. An automatic detection system will allow for a high diagnosis rate and the analysis of additional patients. Deep learning (DL) is achieving high priority due to the availability of databases and recently developed methods. As the most up-and-coming technique for classification and generative tasks, DL has shown its significant potential in 2-dimensional clinical image processing studies. However, physiological information collected as 1-dimensional data has yet to be effectively extracted from this new approach to achieve the needed medical goals. So, in this study, we review the most recent studies in the field of DL applied to physiological data based on pulse oxygen saturation, electrocardiogram, airflow, and sound signal. A total of 47 articles from different journals and publishing houses that were published between 2012 and 2022 were identified. The primary objective of this work is to perform a comprehensive analysis to analyze, classify, and compare the main characteristics of deep-learning algorithms applied in physiological data processing for SLA detection. Overall, our analysis provides comprehensive and detailed information for researchers looking to add to this field. The data input source, objective, DL network, training framework, and database references are the critical factors of the DL approach examined. These are the most critical variables that influence system performance. We categorized the relevant research studies in physiological sensor data analysis using the DL approach based on (1) Physiological sensor data aspects, like signal types, sampling frequency, and window size; and (2) DL model perspectives, such as learning structure and input data types.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13534-023-00297-5.
PubMed: 37519869
DOI: 10.1007/s13534-023-00297-5 -
Journal of Oral Rehabilitation Dec 2023Bruxism is a parafunctional activity characterised by grinding or clenching of teeth and is a common oral health concern in individuals with down syndrome (DS).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bruxism is a parafunctional activity characterised by grinding or clenching of teeth and is a common oral health concern in individuals with down syndrome (DS). Understanding the prevalence of bruxism in this population is crucial for developing effective management strategies. This systematic review and meta-analysis is aimed to investigate the prevalence of bruxism among individuals with DS and explore its association with other oral health issues.
METHODS
A comprehensive search was conducted across multiple electronic databases to identify relevant studies. Cross-sectional and observational studies were included. Data on bruxism prevalence and associated factors were extracted, and a meta-analysis was performed using both fixed-effects (FE) and random-effects (RE) models of MedCalc software. Heterogeneity among studies was assessed using I statistics. New Castle-Ottawa Scale was used to evaluate methodological quality of the included studies.
RESULTS
Eight studies met the pre-defined inclusion criteria and were included in the analysis. Seven studies used a questionnaire to assess bruxism. The pooled proportion estimate for occurrence of DS across the included studies was found to be 0.33 (95% CI: 0.22-0.45) as per the RE model and 0.35 (95% CI: 0.31-0.450) as per FE model in the quantitative analysis. All studies exhibited good methodological quality.
CONCLUSION
This systematic review and meta-analysis provide evidence of a significant prevalence of bruxism among individuals with DS. The findings highlight the association of bruxism with other oral health issues and specific chromosomal abnormalities. Comprehensive oral health assessments, including diagnostic procedures like Polysomnography, are essential for addressing the unique oral health needs of individuals with DS. Further studies are recommended with a valid tool for the diagnosis. Early interventions and management strategies need to be tailored to this population, considering the multifaceted nature of oral health concerns in individuals with DS.
Topics: Humans; Bruxism; Prevalence; Down Syndrome; Cross-Sectional Studies; Surveys and Questionnaires; Sleep Bruxism
PubMed: 37507203
DOI: 10.1111/joor.13563 -
Journal of Medical Internet Research Jul 2023Digital clinical tools are a new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA), notwithstanding the crucial role of... (Review)
Review
BACKGROUND
Digital clinical tools are a new technology that can be used in the screening or diagnosis of obstructive sleep apnea (OSA), notwithstanding the crucial role of polysomnography, the gold standard.
OBJECTIVE
This study aimed to identify, gather, and analyze the most accurate digital tools and smartphone-based health platforms used for OSA screening or diagnosis in the adult population.
METHODS
We performed a comprehensive literature search of PubMed, Scopus, and Web of Science databases for studies evaluating the validity of digital tools in OSA screening or diagnosis until November 2022. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for diagnostic test accuracy studies. The sensitivity, specificity, and area under the curve (AUC) were used as discrimination measures.
RESULTS
We retrieved 1714 articles, 41 (2.39%) of which were included in the study. From these 41 articles, we found 7 (17%) smartphone-based tools, 10 (24%) wearables, 11 (27%) bed or mattress sensors, 5 (12%) nasal airflow devices, and 8 (20%) other sensors that did not fit the previous categories. Only 8 (20%) of the 41 studies performed external validation of the developed tool. Of these, the highest reported values for AUC, sensitivity, and specificity were 0.99, 96%, and 92%, respectively, for a clinical cutoff of apnea-hypopnea index (AHI)≥30. These values correspond to a noncontact audio recorder that records sleep sounds, which are then analyzed by a deep learning technique that automatically detects sleep apnea events, calculates the AHI, and identifies OSA. Looking at the studies that only internally validated their models, the work that reported the highest accuracy measures showed AUC, sensitivity, and specificity values of 1.00, 100%, and 96%, respectively, for a clinical cutoff AHI≥30. It uses the Sonomat-a foam mattress that, aside from recording breath sounds, has pressure sensors that generate voltage when deformed, thus detecting respiratory movements, and uses it to classify OSA events.
CONCLUSIONS
These clinical tools presented promising results with high discrimination measures (best results reached AUC>0.99). However, there is still a need for quality studies comparing the developed tools with the gold standard and validating them in external populations and other environments before they can be used in clinical settings.
TRIAL REGISTRATION
PROSPERO CRD42023387748; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387748.
Topics: Adult; Humans; Surveys and Questionnaires; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Sleep; Polysomnography
PubMed: 37494079
DOI: 10.2196/47735 -
American Journal of Otolaryngology 2023A systematic review of the evidence on the success of Drug-Induced Sleep Endoscopy (DISE) directed surgery in children with obstructive sleep apnea (OSA) defined as cure...
OBJECTIVE
A systematic review of the evidence on the success of Drug-Induced Sleep Endoscopy (DISE) directed surgery in children with obstructive sleep apnea (OSA) defined as cure rate.
DATA SOURCES
The PRISMA guidelines were followed and three databases (PubMed, Embase and Cochrane Library) were searched for studies on DISE directed surgery in children.
ENDPOINTS
Pre- and post-surgical change in polysomnography (PSG); change in surgical target; side effects.
REVIEW METHODS
Study quality was assessed using the modified Delphi technique quality appraisal tool for case series. Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias.
RESULTS
A total of 1805 studies were found. The most important reasons for exclusion were as follows: none-DISE studies, reports on adults, conflation of results on syndromic and healthy patients, no relevant outcome measurements. Five studies with a total of 376 patients (range: 26-126) were included. The surgeons changed the planned strategy in 50.4 % of patients according to the DISE findings. Comparison of pre- and post-surgical sleep monitoring revealed an average decrease in apnea-hypopnea index (AHI) of 11.1 and a treatment success (AHI < 5) and cure (AHI < 2) of 78 % and 53 %, respectively. The quality of the included studies was moderate especially due to small populations, designs without randomization or control groups, lack of analysis of drop outs, short follow-up, and considerable level of bias.
CONCLUSION
DISE directed surgery has been shown to change the surgical approach when treating children with OSA. If this can be transferred into a better outcome compared to standard surgical treatment is unknown, due to the current poor level of evidence. To decide whether or not DISE should be included in the treatment of children with OSA, we suggest further data, preferably an RCT, to increase the level of evidence.
Topics: Adult; Humans; Child; Sleep Apnea, Obstructive; Sleep; Endoscopy; Polysomnography; Tonsillectomy
PubMed: 37480683
DOI: 10.1016/j.amjoto.2023.103992 -
Epidemiology and Psychiatric Sciences Jul 2023This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD). (Meta-Analysis)
Meta-Analysis
AIMS
This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD).
METHODS
We systematically searched PubMed/Medline, Embase and Web of Science databases from inception through March 22, 2021. This study was registered with PROSPERO (CRD42021243881). Any observational study was included that enrolled medication-naïve children and adolescents with ASD and compared objective (actigraphy and polysomnography) or subjective sleep parameters with typically developing (TD) counterparts. We extracted relevant data such as the study design and outcome measures. The methodological quality was assessed through the Newcastle-Ottawa Scale (NOS). A meta-analysis was carried out using the random-effects model by pooling effect sizes as Hedges' . To assess publication bias, Egger's test and -curve analysis were done. A priori planned meta-regression and subgroup analysis were also performed to identify potential moderators.
RESULTS
Out of 4277 retrieved references, 16 studies were eligible with 981 ASD patients and 1220 TD individuals. The analysis of objective measures showed that medication-naïve ASD patients had significantly longer sleep latency (Hedges' 0.59; 95% confidence interval [95% CI] 0.26 to 0.92), reduced sleep efficiency (Hedges' -0.58; 95% CI -0.87 to -0.28), time in bed (Hedges' -0.64; 95% CI -1.02 to -0.26) and total sleep time (Hedges' -0.64; 95% CI -1.01 to -0.27). The analysis of subjective measures showed that they had more problems in daytime sleepiness (Hedges' 0.48; 95% CI 0.26 to 0.71), sleep latency (Hedges' 1.15; 95% CI 0.72 to 1.58), initiating and maintaining sleep (Hedges' 0.86; 95% CI 0.39 to 1.33) and sleep hyperhidrosis (Hedges' 0.48; 95% CI 0.29 to 0.66). Potential publication bias was detected for sleep latency, sleep period time and total sleep time measured by polysomnography. Some sleep alterations were moderated by age, sex and concurrent intellectual disability. The median NOS score was 8 (interquartile range 7.25-8.75).
CONCLUSION
We found that medication-naïve children and adolescents with ASD presented significantly more subjective and objective sleep alterations compared to TD and identified possible moderators of these differences. Future research requires an analysis of how these sleep alterations are linked to core symptom severity and comorbid behavioural problems, which would provide an integrated therapeutic intervention for ASD. However, our results should be interpreted in light of the potential publication bias.
Topics: Humans; Child; Adolescent; Autism Spectrum Disorder; Sleep; Comorbidity; Outcome Assessment, Health Care; Observational Studies as Topic
PubMed: 37469173
DOI: 10.1017/S2045796023000574 -
Sleep Medicine Sep 2023Sleep latency is a measure of time it takes to enter sleep. Very short sleep latencies are indicative of excessive daytime sleepiness and pathological sleep conditions... (Meta-Analysis)
Meta-Analysis
Sleep latency is a measure of time it takes to enter sleep. Very short sleep latencies are indicative of excessive daytime sleepiness and pathological sleep conditions such as narcolepsy. The normal range of mean sleep latency calculated from the multiple sleep latency test in healthy adults is not well-established. We provide a review of normative mean sleep latency values on the multiple sleep latency test by synthesizing data from 110 healthy adult cohorts. We also examine the impact of demographic variables such as age, sex, body mass index, sleep architecture and sleep-disordered breathing as well as methodological variables such as sleep onset definitions and multiple sleep latency test protocols. The average mean sleep latency was 11.7 min (95% CI: 10.8-12.6; 95% PI: 5.2-18.2) for cohorts evaluated using the earlier definition of sleep onset and 11.8 min (95% CI: 10.7-12.8; 95% PI: 7.2-16.3) for those evaluated using the later definition. There were no significant associations between mean sleep latency and demographic or methodological variables. A negative association of -0.29 per one unit increase (95% CI: -0.55 to -0.04) was found between mean sleep latency and apnea-hypopnea index on prior night polysomnography. Establishing updated ranges for mean sleep latency among healthy adults may guide clinical decision-making surrounding sleep pathologies and inform future research into the associations between patient variables, daytime sleepiness, and sleep pathologies.
Topics: Humans; Adult; Polysomnography; Sleep Latency; Reference Values; Sleep; Disorders of Excessive Somnolence
PubMed: 37442016
DOI: 10.1016/j.sleep.2023.06.019 -
Frontiers in Neurology 2023Stroke is the second leading cause of death worldwide, and improving sleep quality in post-stroke insomnia is beneficial to the recovery of stroke. Acupuncture is widely...
BACKGROUND
Stroke is the second leading cause of death worldwide, and improving sleep quality in post-stroke insomnia is beneficial to the recovery of stroke. Acupuncture is widely used for the treatment of post-stroke insomnia in China. Therefore, this systematic review and meta-analysis were performed to explore the efficacy and safety of acupuncture for post-stroke insomnia.
METHODS
Eight databases were searched from their inception to 12 September 2022. Two reviewers independently performed the study screening and data extraction. The outcomes include Pittsburgh Sleep Quality Index (PSQI), objective sleep data measured by polysomnography (PSG), long-term efficacy and adverse events. The quality of the trials was assessed by the Cochrane risk of bias tool 2.0. The RevMan 5.4 and Stata 15.1 were used for data synthesis.
RESULTS
Among 3,233 participants from 41 studies were included. Pooled results indicated that acupuncture was superior to control group (CG) in improving PSQI total score (standardized mean difference () = -1.03, 95% confidence interval (CI): -1.32, -0.74, < 0.00001), increasing sleep efficiency ( = 0.65, 95% CI: 0.37 to 0.92) and total sleep time ( = 0.54, 95% CI: 0.22 to 0.86). The favorable results in improving PSQI total score ( = 0.65, 95% CI: 0.37 to 0.92), reduced sleep latency ( = 1.84, 95% CI: 0.31 to 3.38) and increased total sleep time ( = -0.73, 95% CI: -1.15 to -0.31) were also observed in comparisons of acupuncture plus CG vs. CG. As of long-term efficacy and safety, the effects of acupuncture were long-term and robustness, however, due to limited safety information, reliable safety conclusions cannot be drawn. Subgroup analysis showed that acupuncture plus CG was superior to CG for post-infarction patients, but the efficacy of acupuncture alone compared to non-BZDs or other hypnotics needs further research. The GRADE assessment demonstrated that the level of evidence was mostly low or very low given the flaws in the study design and considerable heterogeneity among the included studies.
CONCLUSION
Acupuncture could improve sleep quality, has long-term efficacy and without serious adverse events. However, the findings should be treated with caution owing to the existence of methodological quality issues. More studies with rigorous designs are warranted for validation and explored the safety of acupuncture.
PubMed: 37441610
DOI: 10.3389/fneur.2023.1164604 -
Sensors (Basel, Switzerland) May 2023Compared with the gold standard, polysomnography (PSG), and silver standard, actigraphy, contactless consumer sleep-tracking devices (CCSTDs) are more advantageous for... (Meta-Analysis)
Meta-Analysis Review
Compared with the gold standard, polysomnography (PSG), and silver standard, actigraphy, contactless consumer sleep-tracking devices (CCSTDs) are more advantageous for implementing large-sample and long-period experiments in the field and out of the laboratory due to their low price, convenience, and unobtrusiveness. This review aimed to examine the effectiveness of CCSTDs application in human experiments. A systematic review and meta-analysis (PRISMA) of their performance in monitoring sleep parameters were conducted (PROSPERO: CRD42022342378). PubMed, EMBASE, Cochrane CENTRALE, and Web of Science were searched, and 26 articles were qualified for systematic review, of which 22 provided quantitative data for meta-analysis. The findings show that CCSTDs had a better accuracy in the experimental group of healthy participants who wore mattress-based devices with piezoelectric sensors. CCSTDs' performance in distinguishing waking from sleeping epochs is as good as that of actigraphy. Moreover, CCSTDs provide data on sleep stages that are not available when actigraphy is used. Therefore, CCSTDs could be an effective alternative tool to PSG and actigraphy in human experiments.
Topics: Humans; Sleep; Polysomnography; Sleep Stages; Actigraphy; Beds
PubMed: 37430756
DOI: 10.3390/s23104842 -
Sleep Medicine Reviews Oct 2023Although rapid eye movement (REM) sleep behavior disorder (RBD) has been widely considered as a male-predominant parasomnia, the existing evidence for the sex difference... (Meta-Analysis)
Meta-Analysis Review
Although rapid eye movement (REM) sleep behavior disorder (RBD) has been widely considered as a male-predominant parasomnia, the existing evidence for the sex difference in the risk of RBD in the general population was conflicting. The present study conducted a systematic review to explore the sex differences in the prevalence, comorbidities, clinical characteristics, and phenoconversion of RBD. One hundred thirty-five eligible studies were identified for the systematic review, and 133 were finally included in the meta-analysis. Males in the general population showed a trend for a higher risk of probable/possible RBD (pRBD), especially among the male older adults (aged ≥60). In the clinical populations, males showed a significantly higher risk of confirmed RBD, but not of pRBD. Among idiopathic RBD (iRBD) patients, males had a significantly earlier age onset of RBD compared with females. Male patients with Parkinson's disease (PD) had a higher risk of comorbid RBD. There was no significant sex difference in the risk of developing neurodegenerative diseases in iRBD patients. Large scale and prospective studies utilizing stringent diagnostic criteria for RBD are recommended to further verify the sex differences in RBD and to investigate the mechanism underlying the sex difference.
Topics: Humans; Male; Female; Aged; Sex Characteristics; Prospective Studies; REM Sleep Behavior Disorder; Polysomnography; Parkinson Disease
PubMed: 37422999
DOI: 10.1016/j.smrv.2023.101810 -
Sleep Medicine Reviews Oct 2023The purpose of this systematic review and meta-analysis is to delineate the concordance of objective and subjective measures of sleep in children with neurodevelopmental... (Review)
Review
The purpose of this systematic review and meta-analysis is to delineate the concordance of objective and subjective measures of sleep in children with neurodevelopmental conditions (NDCs). A systematic literature search identified 31 studies that compare objective and subjective estimates of sleep parameters in autism, ADHD or rare genetic syndromes associated with intellectual disability. The meta-analyses revealed smaller mean differences and larger correlations indicative of greater concordance for parameters associated with sleep scheduling compared to parameters associated with sleep duration and night awakenings. Relative to objective measures, subjective measures produced: 1) greater estimates of total sleep time, sleep efficiency and time in bed; and 2) lower estimates of wake after sleep onset and number of night awakenings. Subgroup analyses also revealed differences in concordance between measurement comparison types (e.g., stronger correlations between actigraphy and sleep diaries, compared to actigraphy and questionnaires) and NDC diagnostic groups. The results predominantly replicate concordance trends observed in typically-developing samples, although some NDC-specific patterns of concordance were identified. This indicates that objective and subjective sleep measures retain broadly similar properties across populations, although researchers and clinicians should be cautious of the impact of NDC-related characteristics on sleep parameter estimates. These findings should inform sleep assessment design and the interpretation of sleep parameter estimates in NDCs, increasing the rigour of sleep parameter description across research and clinical settings.
PubMed: 37422998
DOI: 10.1016/j.smrv.2023.101814