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Sleep Dec 2021The presence of flow limitation during sleep is associated with adverse health consequences independent of obstructive sleep apnea (OSA) severity (apnea-hypopnea index,... (Observational Study)
Observational Study
STUDY OBJECTIVES
The presence of flow limitation during sleep is associated with adverse health consequences independent of obstructive sleep apnea (OSA) severity (apnea-hypopnea index, AHI), but remains extremely challenging to quantify. Here we present a unique library and an accompanying automated method that we apply to investigate flow limitation during sleep.
METHODS
A library of 117,871 breaths (N = 40 participants) were visually classified (certain flow limitation, possible flow limitation, normal) using airflow shape and physiological signals (ventilatory drive per intra-esophageal diaphragm EMG). An ordinal regression model was developed to quantify flow limitation certainty using flow-shape features (e.g. flattening, scooping); breath-by-breath agreement (Cohen's ƙ); and overnight flow limitation frequency (R2, %breaths in certain or possible categories during sleep) were compared against visual scoring. Subsequent application examined flow limitation frequency during arousals and stable breathing, and associations with ventilatory drive.
RESULTS
The model (23 features) assessed flow limitation with good agreement (breath-by-breath ƙ = 0.572, p < 0.001) and minimal error (overnight flow limitation frequency R2 = 0.86, error = 7.2%). Flow limitation frequency was largely independent of AHI (R2 = 0.16) and varied widely within individuals with OSA (74[32-95]%breaths, mean[range], AHI > 15/h, N = 22). Flow limitation was unexpectedly frequent but variable during arousals (40[5-85]%breaths) and stable breathing (58[12-91]%breaths), and was associated with elevated ventilatory drive (R2 = 0.26-0.29; R2 < 0.01 AHI v. drive).
CONCLUSIONS
Our method enables quantification of flow limitation frequency, a key aspect of obstructive sleep-disordered breathing that is independent of the AHI and often unavailable. Flow limitation frequency varies widely between individuals, is prevalent during arousals and stable breathing, and reveals elevated ventilatory drive. Clinical trial registration: The current observational physiology study does not qualify as a clinical trial.
Topics: Humans; Lung; Polysomnography; Respiration; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34240221
DOI: 10.1093/sleep/zsab170 -
Journal of Clinical Sleep Medicine :... Feb 2014Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA... (Review)
Review
Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Patient Compliance; Polysomnography; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 24533007
DOI: 10.5664/jcsm.3460 -
Sleep Medicine Jan 2024Obstructive sleep apnea (OSA) is a chronic sleep and breathing disorder with significant health complications, including cardiovascular disease and neurocognitive... (Review)
Review
Obstructive sleep apnea (OSA) is a chronic sleep and breathing disorder with significant health complications, including cardiovascular disease and neurocognitive impairments. To ensure timely treatment, there is a need for a portable, accurate and rapid method of diagnosing OSA. This review examines the use of various physiological signals used in the detection of respiratory events and evaluates their effectiveness in portable monitors (PM) relative to gold standard polysomnography. The primary objective is to explore the relationship between these physiological parameters and OSA, their application in calculating the apnea hypopnea index (AHI), the standard metric for OSA diagnosis, and the derivation of non-AHI metrics that offer additional diagnostic value. It is found that increasing the number of parameters in PMs does not necessarily improve OSA detection. Several factors can cause performance variations among different PMs, even if they extract similar signals. The review also highlights the potential of PMs to be used beyond OSA diagnosis. These devices possess parameters that can be utilized to obtain endotypic and other non-AHI metrics, enabling improved characterization of the disorder and personalized treatment strategies. Advancements in PM technology, coupled with thorough evaluation and validation of these devices, have the potential to revolutionize OSA diagnosis, personalized treatment, and ultimately improve health outcomes for patients with OSA. By identifying the key factors influencing performance and exploring the application of PMs beyond OSA diagnosis, this review aims to contribute to the ongoing development and utilization of portable, efficient, and effective diagnostic tools for OSA.
Topics: Humans; Sleep Apnea, Obstructive; Sleep; Polysomnography
PubMed: 38070375
DOI: 10.1016/j.sleep.2023.11.034 -
Journal of Clinical Sleep Medicine :... Mar 2019Polysomnography (PSG) is increasingly used in the assessment of infants. Newborn PSG reference values based on recent standardization are not available. This study...
STUDY OBJECTIVES
Polysomnography (PSG) is increasingly used in the assessment of infants. Newborn PSG reference values based on recent standardization are not available. This study provides reference values for PSG variables in healthy newborn infants.
METHODS
Cross-sectional study of normal term newborn infants using standardized PSG collection and American Academy of Sleep Medicine interpretation criteria.
RESULTS
Thirty infants born between 37 and 42 weeks gestation underwent PSG testing before 30 days of age (mean 19.6 days). The infants had a mean sleep efficiency of 71% with average proportions of transitional, NREM and REM sleep estimated at 16.1%, 43.3% and 40.6% respectively. Mean arousal index was 14.7 events/h with respiratory arousal index of 1.2 events/h. Mean apnea-hypopnea index (AHI) was 14.9 events/h. Central, obstructive, and mixed apnea indices were 5.4, 2.3, and 1.2 events/h respectively. Mean oxygen saturation in sleep was 97.9% with a nadir of 84.4%. Mean end tidal CO was 35.4 mmHg with an average of 6.2% of sleep time spent above end-tidal CO 45 mmHg and 0.6% above 50 mmHg.
CONCLUSIONS
The sleep efficiency was significantly lower and the AHI was significantly higher compared to healthy children older than 1 year. The AHI was also higher than reported in healthy infants older than 1 month. These findings suggest current severity classifications of sleep apnea may not apply to newborn infants.
Topics: Cross-Sectional Studies; Female; Humans; Infant, Newborn; Male; Oxygen Consumption; Polysomnography; Reference Values; Sleep; Sleep Stages; Sleep, REM
PubMed: 30853051
DOI: 10.5664/jcsm.7670 -
Journal of Prosthodontic Research Oct 2022We aimed to clarify the relationship between the number of sleep bruxism (SB) bursts at home and in a laboratory equipped with polysomnography with audio-video recording...
PURPOSE
We aimed to clarify the relationship between the number of sleep bruxism (SB) bursts at home and in a laboratory equipped with polysomnography with audio-video recording (PSG-AV). We applied an identical single-channel wearable electromyography (EMG) device for both types of SB burst scorings.
METHODS
The subjects were 20 healthy student volunteers (12 men and 8 women; mean age, 21.9 years) who were clinically diagnosed with bruxism based on the criteria set forth by the International Classification of Sleep Disorders (ICSD-2). We used a wearable EMG device attached to the masseteric area (the FLA-500-SD [FLA]), for scoring SB bursts at home and in the laboratory. PSG-AV was set within the laboratory environment as well. The mean interval for both sleep studies was 28.8 days. EMG bursts with amplitudes greater than twice the baseline amplitude and with durations of longer than 0.25 s were selected. EMG bursts with amplitudes ≥5% MVC (maximum voluntary contraction), ≥10% MVC, and ≥20% MVC were selected as well. A cluster of bursts was defined as an episode.
RESULTS
In all the conditions for selecting EMG bursts specified above, the number of SB bursts and episodes recorded under laboratory conditions was statistically significantly smaller than that recorded at home. There were no statistically significant differences between the data obtained on the first and second recording days.
CONCLUSION
The results of this study suggest that the unfamiliar environment of a sleep laboratory equipped with PSG-AV affects the emergence of SB as compared with home conditions.
Topics: Adult; Electromyography; Female; Healthy Volunteers; Humans; Male; Masseter Muscle; Polysomnography; Sleep; Sleep Bruxism; Wearable Electronic Devices; Young Adult
PubMed: 35095085
DOI: 10.2186/jpr.JPR_D_21_00219 -
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 -
PloS One 2016Research on sleep after stroke has focused mainly on sleep disordered breathing. However, the extend to which sleep physiology is altered in stroke survivors, how these... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Research on sleep after stroke has focused mainly on sleep disordered breathing. However, the extend to which sleep physiology is altered in stroke survivors, how these alterations compare to healthy volunteers, and how sleep changes might affect recovery as well as physical and mental health has yet to be fully researched. Motivated by the view that a deeper understanding of sleep in stroke is needed to account for its role in health and well-being as well as its relevance for recovery and rehabilitation, we conducted a systematic review and meta-analysis of polysomnographic studies comparing stroke to control populations.
METHOD
Medline and PsycInfo databases were searched using "stroke" and words capturing polysomnographic parameters as search terms. This yielded 1692 abstracts for screening, with 15 meeting the criteria for systematic review and 9 for meta-analysis. Prisma best practice guidelines were followed for the systematic review; the Comprehensive Meta-Analysis software was used for random effects modelling.
RESULTS
The meta-analysis revealed that patients with stroke have poorer sleep than controls. Patients had lower sleep efficiency (mean 75% vs 84%), shorter total-sleep-time (309.4 vs 340.3 min) and more wake-after-sleep-onset (97.2 vs 53.8 min). Patients also spend more time in stage 1 (13% vs 10%) and less time in stage 2 sleep (36% vs 45%) and slow-wave-sleep (10% vs 12%). No group differences were identified for REM sleep. The systematic review revealed a strong bias towards studies in the early recovery phase of stroke, with no study reporting specifically on patients in the chronic state. Moreover, participants in the control groups included community samples as well as other patients groups.
CONCLUSIONS
These results indicate poorer sleep in patients with stroke than controls. While strongly suggestive in nature, the evidence base is limited and methodologically diverse, and hands a clear mandate for further research. A particular need regards polysomnographic studies in chronic community-dwelling patients compared to age-matched individuals.
Topics: Humans; Polysomnography; Sleep; Stroke
PubMed: 26949966
DOI: 10.1371/journal.pone.0148496 -
Journal of Oral Rehabilitation Feb 2016
Topics: Electromyography; Female; Humans; Male; Monitoring, Ambulatory; Polysomnography; Sleep Bruxism
PubMed: 26432658
DOI: 10.1111/joor.12353 -
Pediatrics in Review Jan 2019
Topics: Child; Endoscopy; Humans; Polysomnography; Sleep Apnea Syndromes
PubMed: 30600274
DOI: 10.1542/pir.2018-0142 -
Sleep & Breathing = Schlaf & Atmung Mar 2021Little is known regarding the influence of in-laboratory polysomnography (PSG) equipment on sleep position, especially on the prevalence of supine positioning, which in...
PURPOSE
Little is known regarding the influence of in-laboratory polysomnography (PSG) equipment on sleep position, especially on the prevalence of supine positioning, which in many cases may lead to a more severe sleep apnea diagnosis. The aim of this study was to assess the percentage of supine sleep during an in-laboratory PSG compared to that seen during a home sleep apnea test (HSAT).
METHODS
This was a retrospective cohort study comparing in-laboratory PSG and HSAT using a peripheral arterial tone (PAT) technology device.
RESULTS
Of 445 PSG and 416 HSAT studies analyzed, there was no significant difference in the proportion of supine sleep time between PSG (44%) and HSAT (45%, p = 0.53). Analysis of the differences in sleep position (supine versus non-supine), analyzed by sex, BMI (≥ 30 kg/m2 versus < 30 kg/m2), and age (≥ 60 years versus < 60 years), was significant only for women, who had more supine sleep during HSAT at 61 ± 24% than during PSG at 45 ± 26% (p < 0.001).
CONCLUSION
Overall there was no difference in the percentage of supine sleep when comparing in-laboratory PSG to HSAT. However, women had more supine sleep with HSAT than with PSG.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Monitoring, Ambulatory; Polysomnography; Retrospective Studies; Sex Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Supine Position; Time Factors
PubMed: 32418018
DOI: 10.1007/s11325-020-02099-w