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European Respiratory Review : An... Sep 2023Obstructive sleep apnoea is a highly prevalent chronic disorder and has been shown to be associated with disturbed glucose metabolism and type 2 diabetes. However, the... (Meta-Analysis)
Meta-Analysis Review
Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis.
Obstructive sleep apnoea is a highly prevalent chronic disorder and has been shown to be associated with disturbed glucose metabolism and type 2 diabetes. However, the evidence from individual clinical trials on the effect of continuous positive airway pressure (CPAP) treatment on glycaemic control in patients with co-existing obstructive sleep apnoea and type 2 diabetes remains controversial. A systematic review of randomised controlled trials assessing the effect of CPAP on glycaemic control in patients with obstructive sleep apnoea and type 2 diabetes was conducted using the databases MEDLINE, Embase, Cochrane and Scopus up to December 2022. Meta-analysis using a random-effect model was performed for outcomes that were reported in at least two randomised controlled trials. From 3031 records screened, 11 RCTs with a total of 964 patients were included for analysis. CPAP treatment led to a significant reduction in haemoglobin A1c (HbA1c) (mean difference -0.24%, 95% CI -0.43- -0.06%, p=0.001) compared to inactive control groups. Meta-regression showed a significant association between reduction in HbA1c and hours of nightly CPAP usage. CPAP therapy seems to significantly improve HbA1c and thus long-term glycaemic control in patients with type 2 diabetes and obstructive sleep apnoea. The amount of improvement is dependent on the hours of usage of CPAP and thus optimal adherence to CPAP should be a primary goal in these patients.
Topics: Humans; Continuous Positive Airway Pressure; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Sleep Apnea, Obstructive; Glucose
PubMed: 37673425
DOI: 10.1183/16000617.0083-2023 -
Medicina (Kaunas, Lithuania) Mar 2024Insomnia and circadian rhythm disorders are increasingly common in modern society and lead to significant challenges for people's health and well-being. Some studies... (Review)
Review
Insomnia and circadian rhythm disorders are increasingly common in modern society and lead to significant challenges for people's health and well-being. Some studies suggests that men and women differ in neurohormonal secretion, biological processes, and brain morphology. Thus, such differences may affect the etiology, manifestation, and course of sleep disorders, including insomnia and circadian rhythm. This systematic review aims to synthesize the existing literature on sex differences in insomnia and circadian rhythm disorders. PubMed, MEDLINE, Epistemonikos, and Cochrane databases were searched for articles published from inception until 5 September 2023, not older than five years. We performed a systematic search using MESH and non-MESH queries: (sex differences) or (male and female differences) or (men and women differences) or (men and women) AND (insomnia) or (sleep wake disorder*) or (sleep wake rhythm disorder*) or (circadian rhythm disorder*) or (sleep cycle disruption) or (sleep cycle disorder*). Out off 2833 articles screened, 11 studies were included. The prevalence of insomnia is higher among women, and their sleep is more regular and stable compared to men. Studies evaluating the impact of the stressful situation associated with the lockdown on women's and men's insomnia present discordant results concerning sex differences. Women's circadian rhythm was found to be more stable and less fragmented than men's. However, the progression of peak activity time with age was more pronounced in men. The current literature suggests that risk factors for insomnia and circadian rhythm disorders affect men and women differently. These include cerebrovascular and cardiometabolic factors, shift work, and infections. The long-term effects of insomnia seem to be more relevant for the male sex, shortening lifespan more than in women. By summarizing and analyzing existing studies, we highlight the need for further research to improve understanding of the interaction between sex and sleep.
Topics: Female; Male; Humans; Sleep Initiation and Maintenance Disorders; Sleep Disorders, Circadian Rhythm; Sex Characteristics; Sleep; Chronobiology Disorders; Sleep Wake Disorders
PubMed: 38541200
DOI: 10.3390/medicina60030474 -
Journal of Sleep Research Feb 2022The outbreak of the novel coronavirus disease 2019 (COVID-19) changed lifestyles worldwide and subsequently induced individuals' sleep problems. Sleep problems have been... (Meta-Analysis)
Meta-Analysis Review
The outbreak of the novel coronavirus disease 2019 (COVID-19) changed lifestyles worldwide and subsequently induced individuals' sleep problems. Sleep problems have been demonstrated by scattered evidence among the current literature on COVID-19; however, little is known regarding the synthesised prevalence of sleep problems (i.e. insomnia symptoms and poor sleep quality) for males and females separately. The present systematic review and meta-analysis aimed to answer the important question regarding prevalence of sleep problems during the COVID-19 outbreak period between genders. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Newcastle-Ottawa Scale checklist, relevant studies with satisfactory methodological quality searched for in five academic databases (Scopus, PubMed Central, ProQuest, Web of Science , and EMBASE) were included and analysed. The protocol of the project was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identification code CRD42020181644). A total of 54 papers (N = 67,722) in the female subgroup and 45 papers (N = 45,718) in the male subgroup were pooled in the meta-analysis. The corrected pooled estimated prevalence of sleep problems was 24% (95% confidence interval [CI] 19%-29%) for female participants and 27% (95% CI 24%-30%) for male participants. Although in both gender subgroups, patients with COVID-19, health professionals and general population showed the highest prevalence of sleep problems, it did not reach statistical significance. Based on multivariable meta-regression, both gender groups had higher prevalence of sleep problems during the lockdown period. Therefore, healthcare providers should pay attention to the sleep problems and take appropriate preventive action.
Topics: COVID-19; Communicable Disease Control; Female; Humans; Male; Pandemics; SARS-CoV-2; Sleep Initiation and Maintenance Disorders; Sleep Quality
PubMed: 34245055
DOI: 10.1111/jsr.13432 -
Sleep Medicine Reviews Feb 2022Sleep is commonly disrupted following mild traumatic brain injury (mTBI), however there is a lack of consensus in the existing literature regarding the prevalence of... (Meta-Analysis)
Meta-Analysis Review
Sleep is commonly disrupted following mild traumatic brain injury (mTBI), however there is a lack of consensus in the existing literature regarding the prevalence of insomnia/insomnia symptoms after injury. The aim of this review was to conduct a systematic review and meta-analysis of insomnia and insomnia symptoms' prevalence following mTBI. Full-text articles published in English in peer-reviewed journals, including adults with a clinical or self-reported mild traumatic brain injury diagnosis, were eligible for inclusion. Studies that assessed insomnia/insomnia symptoms after injury were included. Of the 2091 records identified, 20 studies were included in the review. 19 of these were meta-analysed (n = 95,195), indicating high heterogeneity among studies. Subgroup analyses indicated pooled prevalence estimates of post-mTBI insomnia disorder of 27.0% (95% CI 6.49-54.68) and insomnia symptoms of 71.7% (95% CI 60.31-81.85). The prevalence of insomnia is significantly higher in individuals who have sustained mild traumatic brain injury compared to prevalence estimates reported in the general population but high heterogeneity and methodological differences among studies make it difficult to provide reliable prevalence estimates. Future research should continue to advance our understanding of the onset, progression and impact of post-mild traumatic brain injury insomnia to promote the recovery and wellbeing of affected individuals. PROSPERO registration CRD42020168563.
Topics: Adult; Brain Concussion; Humans; Prevalence; Sleep Initiation and Maintenance Disorders
PubMed: 35033968
DOI: 10.1016/j.smrv.2021.101563 -
Sleep Medicine Reviews Aug 2022Obstructive Sleep Apnea (OSA) has been recognized as a major health concern worldwide, given its increasing prevalence, difficulties in diagnosis and treatment, and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obstructive Sleep Apnea (OSA) has been recognized as a major health concern worldwide, given its increasing prevalence, difficulties in diagnosis and treatment, and impact on health, economy, and society. Clinical guidelines highlight the need of biomarkers to guide OSA clinical decision-making, but so far, without success. In this systematic review and meta-analysis, registered on the International Prospective Register of Systematic Reviews database (ID CRD42020132556), we proposed to gather and further explore candidates identified in the literature as potential OSA biomarkers.
METHODS
Search strategies for eight different databases (PubMed/Medline, Cochrane Library, Biblioteca Virtual da Saúde, Web of Science, EMBASE, World Intellectual Property Organization database, and bioRxiV and medRxiV Preprint Servers) were developed. We identified studies exploring potential biomarkers of OSA, in peripheral samples of adults, with and without OSA, with no comorbidities defined in study inclusion criteria, published after the last systematic review and meta-analysis conducted on OSA biomarkers, until May 31st, 2020. Risk of bias was assessed through the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies. Demographic, clinical, and candidate biomarkers' data were collected and analyzed via random effects meta-analyses.
FINDINGS
Among the 1512 unique studies screened, 120 met the inclusion criteria and 16 studies with low risk of bias were selected for meta-analyses. The selected 16 studies enrolled a total of 2156 participants, from which 1369 were diagnosed with OSA and 787 were disease-free controls. The assessed variables showed high heterogeneity. From the 38 biomarker candidates evaluated, only two were evaluated in more than one study. Most studies pinpointed candidates with more potential for OSA prognosis. ADAM29, FLRT2 and SLC18A3 mRNA levels in PBMCs, Endocan and YKL-40 levels in serum, and IL-6 and Vimentin levels in plasma revealed the most promising candidates for OSA diagnosis.
INTERPRETATION
Although the current systematic review and meta-analysis allowed us to identify candidates to further explore as potential biomarkers in future studies, it is evident that OSA biomarkers research is still at an early stage. Most findings derive from small-size single-center study cohorts and single-candidate studies. We point several gaps in current OSA biomarker research that may guide into new directions and approaches towards the identification of OSA biomarkers.
Topics: Adult; Biomarkers; Humans; Polysomnography; Prevalence; Prognosis; Sleep Apnea, Obstructive
PubMed: 35753150
DOI: 10.1016/j.smrv.2022.101659 -
Sleep Medicine Reviews Aug 2016Many schools have instituted later morning start times to improve sleep, academic, and other outcomes in response to the mismatch between youth circadian rhythms and... (Meta-Analysis)
Meta-Analysis Review
Many schools have instituted later morning start times to improve sleep, academic, and other outcomes in response to the mismatch between youth circadian rhythms and early morning start times. However, there has been no systematic synthesis of the evidence on the effects of this practice. To examine the impact of delayed school start time on students' sleep, health, and academic outcomes, electronic databases were systematically searched and data were extracted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Six studies satisfied selection criteria and used pre-post, no control (n = 3), randomized controlled trial (n = 2), and quasi-experimental (n = 1) designs. School start times were delayed 25-60 min, and correspondingly, total sleep time increased from 25 to 77 min per weeknight. Some studies revealed reduced daytime sleepiness, depression, caffeine use, tardiness to class, and trouble staying awake. Overall, the evidence supports recent non-experimental study findings and calls for policy that advocates for delayed school start time to improve sleep. This presents a potential long-term solution to chronic sleep restriction during adolescence. However, there is a need for rigorous randomized study designs and reporting of consistent outcomes, including objective sleep measures and consistent measures of health and academic performance.
Topics: Adolescent; Circadian Rhythm; Humans; Schools; Sleep; Sleep Deprivation; Students; Time Factors
PubMed: 26545246
DOI: 10.1016/j.smrv.2015.06.002 -
Brazilian Journal of Otorhinolaryngology 2022Sleep is fundamental for both health and wellness. The advent of "on a chip" and "smartphone" technologies have created an explosion of inexpensive, at-home applications... (Review)
Review
OBJECTIVE
Sleep is fundamental for both health and wellness. The advent of "on a chip" and "smartphone" technologies have created an explosion of inexpensive, at-home applications and devices specifically addressing sleep health and sleep disordered breathing. Sleep-related smartphone Applications and devices are offering diagnosis, management, and treatment of a variety of sleep disorders, mainly obstructive sleep apnea. New technology requires both a learning curve and a review of reliability. Our objective was to evaluate which app have scientific publications as well as their potential to help in the diagnosis, management, and follow-up of sleep disordered breathing.
METHODS
We search for relevant sleep apnea related apps on both the Google Play Store and the Apple App Store. In addition, an exhaustive literature search was carried out in MEDLINE, EMBase, web of science and Scopus for works of apps or devices that have published in the scientific literature and have been used in a clinical setting for diagnosis or treatment of sleep disordered breathing performing a systematic review.
RESULTS
We found 10 smartphone apps that met the inclusion criteria.
CONCLUSIONS
The development of these apps and devices has a great future, but today are not as accurate as other traditional options. This new technology offers accessible, inexpensive, and continuous at home data monitoring of obstructive sleep apnea, but still does not count with proper testing and their validation may be unreliable.
Topics: Humans; Mobile Applications; Reproducibility of Results; Sleep Apnea, Obstructive; Smartphone; Sleep Apnea Syndromes
PubMed: 35210182
DOI: 10.1016/j.bjorl.2022.01.004 -
Sleep Medicine Reviews Aug 2017Obesity and obstructive sleep apnea (OSA) have a reciprocal relationship. Sleep disruptions characteristic of OSA may promote behavioral, metabolic, and/or hormonal... (Review)
Review
UNLABELLED
Obesity and obstructive sleep apnea (OSA) have a reciprocal relationship. Sleep disruptions characteristic of OSA may promote behavioral, metabolic, and/or hormonal changes favoring weight gain and/or difficulty losing weight. The regulation of energy balance (EB), i.e., the relationship between energy intake (EI) and energy expenditure (EE), is complex and multi-factorial, involving food intake, hormonal regulation of hunger/satiety/appetite, and EE via metabolism and physical activity (PA). The current systematic review describes the literature on how OSA affects EB-related parameters. OSA is associated with a hormonal profile characterized by abnormally high leptin and ghrelin levels, which may encourage excess EI. Data on actual measures of food intake are lacking, and not sufficient to make conclusions. Resting metabolic rate appears elevated in OSA vs.
CONTROLS
Findings on PA are inconsistent, but may indicate a negative relationship with OSA severity that is modulated by daytime sleepiness and body weight. A speculative explanation for the positive EB in OSA is that the increased EE via metabolism induces an overcompensation in the drive for hunger/food intake, which is larger in magnitude than the rise in EI required to re-establish EB. Understanding how OSA affects EB-related parameters can help improve weight loss efforts in these patients.
Topics: Eating; Energy Metabolism; Exercise; Humans; Leptin; Obesity; Polysomnography; Sleep Apnea, Obstructive
PubMed: 27818084
DOI: 10.1016/j.smrv.2016.07.001 -
Respirology (Carlton, Vic.) Nov 2017Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and... (Review)
Review
Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and non-CPAP therapies are frequently explored. Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA. The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence. Upper airway stimulation augments neural drive by unilaterally stimulating the hypoglossal nerve. The Stimulation Therapy for Apnea Reduction (STAR) study enrolled 126 patients and demonstrated a 68% reduction in OSA severity. A high upfront cost and variable response are the main limitations. Oropharyngeal exercises consist of a set of isometric and isotonic exercises involving the tongue, soft palate and lateral pharyngeal wall. The collective reported trials (n = 120) showed that oropharyngeal exercises can ameliorate OSA and snoring (~30-40%). Nasal EPAP devices consist of disposable one-way resister valve. A systematic review (n = 345) showed that nasal EPAP reduced OSA severity by 53%. The Winx device consists of a mouthpiece placed inside the oral cavity that is connected by tubing to a console that generates negative pressure. Winx may provide successful therapy for ~30-40% of OSA patients. In conclusion, several non-CPAP therapies to treat OSA are currently available.
Topics: Continuous Positive Airway Pressure; Exercise Therapy; Humans; Sleep Apnea, Obstructive
PubMed: 28901030
DOI: 10.1111/resp.13144 -
International Archives of Occupational... Nov 2021Shift work is a workschedule, since industrial era and some employees work in shift. It causes a desynchronization of the biological clock with consequences on sleep... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Shift work is a workschedule, since industrial era and some employees work in shift. It causes a desynchronization of the biological clock with consequences on sleep amount and quality, such as insomnia and easy fatigue. Obstructive sleep apnea (OSA) is one of the sleep problems that are getting more and more attention, but studies on the association between shift work and OSA were rare. Herein, we aimed to conduct a systematic review and meta-analysis to investigate the association between shift work and possible OSA.
METHODS
This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed, Embase, and Web of Science databases using a related set of keywords. The inclusion criteria were as follows: (1) participants were adult employees hired by a company or organization; (2) exposure was shift work; and (3) outcome was possible OSA according to examination or assessment.
RESULTS
We included six studies in the systematic review and five studies were selected for further meta-analysis. A random-effects model showed an association of shift work with a small, non-significant increase in possible OSA cases (pooled prevalence relative risk = 1.05; 95% CI 0.85-1.30; p = 0.65). This association occurred in both healthcare and non-healthcare workers group.
CONCLUSION
The association between shift work and possible OSA remains inconclusive and could be small if not negligible. Future studies should assess the association between specific work schedules and specific OSA definitions.
TRIAL REGISTRATION NUMBER
PROSPERO ID: CRD42020156837.
Topics: Humans; Shift Work Schedule; Sleep Apnea, Obstructive
PubMed: 33677677
DOI: 10.1007/s00420-021-01675-1