American Sleep Disorders Association Research Articles

Does OSA Increase Risk for Cancer?: A Large Historical Sleep Clinic Cohort Study

The relationship between OSA and cancer is unclear. What is the association between OSA and cancer prevalence and incidence in a large Western Australian sleep clinic cohort (N= 20,289)? OSA severity was defined by apnea-hypopnea index (AHI) and nocturnal hypoxemia (duration and percentage at oxygen saturation< 90%) measured by in-laboratory polysomnogram. Measures of potential confounding included age, sex, BMI, smoking, socioeconomic status, and BP. Outcomes were determined from the Western Australian cancer and death registries. Analyses were confined within periods using consistent AHI scoring criteria: January 1, 1989, to July 31, 2002 (American Sleep Disorders Association [ASDA] criteria), and August 1, 2002, to June 30, 2013 (Chicago criteria). We examined associations of AHI and nocturnal hypoxemia with cancer prevalence using logistic regression and cancer incidence using Cox regression analyses. Cancer prevalence at baseline was 329 of 10,561 in the ASDA period and 633 of 9,728 in the Chicago period. Nocturnal hypoxemia but not AHI was independently associated with prevalent cancer following adjustment for participant age, sex, BMI, smoking, socioeconomic status, and BP. Of those without prevalent cancer, cancer was diagnosed in 1,950 of 10,232 (ASDA) and 623 of 9,095 (Chicago) participants over a median follow-up of 11.2 years. Compared with the reference category (no OSA, AHI< 5 events per hour), univariable models estimated higher hazard ratios for cancer incidence for mild (AHI 5-15 events per hour), moderate (AHI 15.1-30 events per hour), and severe (AHI > 30 events per hour) OSA. Multivariable analyses consistently revealed associations between age and, in some cases, sex, BMI, and smoking status, with cancer incidence. After adjusting for confounders, multivariable models showed no independent association between OSA severity and increased cancer incidence. Nocturnal hypoxemia is independently associated with prevalent cancer. OSA severity is associated with incident cancer, although this association seems secondary to other risk factors for cancer development. OSA is not an independent risk factor for cancer incidence.

Trastornos circadianos del sueño

The circadian system is synchronized to the light-dark cycle generated by the rotation of the earth, ensuring that wake¬fulness is during the day and sleep occurs at night. However, the sleep-wake rhythm may be out of sync with the light-dark cycle or endogenously out of sync, resulting in insomnia, fatigue, and poor performance in activities of daily living. Sleep disorders are classified by the American Sleep Disorders Association, as intrinsic dyssomnias, extrinsic dyssomnias, parasomnias, or medical/psychiatric sleep disorders. Circa¬dian sleep disorders have been categorized separately to recognize that in most cases the etiology of circadian dis¬turbances is a mix of internal and environmental factors or a temporary mismatch between the two. Symptoms are usually insomnia or hypersomnia, common symptoms in patients with circadian sleep disorders although other causes can be attributed and must be excluded before a diagnosis of a circadian sleep disorder is made. In the patient without other sleep pathology, a daily record of activities, meals, exercise, naps, and bedtime is an essential tool in assessing circadian sleep disorders. These records should be kept for 2 weeks or more, as a disturbance due to job changes or travel across time zones can have effects on sleep and daytime alertness weeks after the event. Keywords: Sleep; biological rhythms; jet-lag; insomnia; light-dark cycle.

Reflections on a journey as sleep researcher and geriatric psychiatrist.

After first recalling the origins of my interest in sleep and dreams at UVa (1969) and my MD thesis at Yale on sleep in mood disorders (1973), I will describe my service to the field of sleep disorders medicine, through various roles in the American Sleep Disorders Association, the Institute of Medicine, the National Institute of Mental Health, and the DSM-5 Task Force of the American Psychiatric Association. I will then present the broad themes of my contributions to psychiatric sleep research, focusing on the neurobiology of sleep as a dimension of the risk and protective architecture for depression in older adults, as a bridge to diagnostic and treatment issues in later-life depression, and to clinical and translational neuroscience addressing the intersections of sleep, aging, and mind/brain health. Throughout this narrative, I highlight many relationships with mentors and mentees. All of my scientific activity has been team-based, providing the social matrix for the physician-scientist I have become. This paper is part of the Living Legends in Sleep Research series, which is sponsored by Idorsia Pharmaceuticals and Jazz Pharmaceuticals.

The changing profile of obstructive sleep apnea: long term trends in characteristics of patients presenting for diagnostic polysomnography.

IntroductionWe aimed to analyze long-term trends in characteristics of patients undergoing diagnostic polysomnography (PSG) and subsequently diagnosed with obstructive sleep apnea (OSA) to inform delivery of sleep services.Material and MethodsWe studied 24,510 consecutive patients undergoing PSG at a tertiary-care sleep service between 1989 and 2013. OSA was defined by an apnea hypopnea index (AHI)≥ 5 events/hour. Changes to hypopnea definition and flow sensing techniques in 2002 created two distinct AHI scoring periods: American Sleep Disorders Association (ASDA) 1989 - July 2002 and American Academy of Sleep Medicine (Chicago) from August 2002.ResultsOver 23.5 years there was a steady increase in proportion of females (15% to 45%), small increases in average age and BMI, and a small decline in socioeconomic status in the overall group. AHI varied between scoring periods both overall [ASDA 10.8/h (3.2-29.6), Chicago 24.3/h (11.8-48.1)] and in the large subgroup (80.7%) diagnosed with OSA [ASDA 20.7/h (10.6-44.1), Chicago 27.4/h (14.8-51.5)]. OSA diagnosis rates increased in the Chicago period (ASDA 66%, Chicago 91%). Increases in AHI and proportion diagnosed appeared better explained by changes in scoring methods than key OSA risk factors.ConclusionTemporal increases in proportion of females and decreases in socioeconomic status of people undergoing PSG may reflect greater community awareness of sleep disorders. Temporal increases in age and obesity are consistent with secular trends. Changes in scoring methods have major impacts on OSA diagnosis and judgement of disease severity, with important implications for contemporary resourcing of sleep services and interpretation of historical OSA data.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Kent D, Stanley J, Aurora RN, etal. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.

A STUDY TO ASSESS THE EFFECTIVENESS OF SLEEP HYGIENE ON QUALITY OF SLEEP AMONG INSOMNIAC PATIENT ADMITTED IN SMVMC AND HOSPITAL AT PUDUCHERRY

Insomnia is highly prevalent, has associated daytime consequences which impair job performance and quality of life, and is associated with increased risk of comorbidities including depression. These practice parameters provide recommendations regarding behavioural and psychological treatment approaches, which are often effective in primary and secondary insomnia. These recommendations replace or modify those published in the 1999 practice parameter paper produced by the American Sleep Disorders Association. Methods: A quantitative research approach was considered as appropriate for present study. The study was conducted in Sri Manakula Vinayagar Medical College and Hospital at Puducherry with 6 week of time duration. Totally 50 sample were selected through Purposive sampling technique, self-Structured Questionnaire used to gathered data. Descriptive and Inferential analytical methods like three dependent Paired t-test and Chi-square were used to find the effectiveness of Sleep hygiene. Result: Study finding shows that Pre-test mean value is 10.53 (32 %) and the standard deviation value is 6.42, where as in post-test mean value is 30.18( 73 %) and Standard deviation value is 10. Mean value increased from 10.53 to 30.18, “t” value is 13.9 and p-value is 0.0005 which is statistically highly significant at the level of p &lt; 0.001. It shows that Quality of Sleep was increased among Insomniac patients after administering the Sleep Hygiene. Conclusion: The study revealed that there was increased quality of Sleep among Insomniac Patients after the administration of Sleep Hygiene especially in Patient with absent of Psychiatric Disorder and Symptoms than Physical Disorder and Patient who were in age group of 26 - 45 years than other age group. Moreover educated patients were shows more effectiveness than other groups. The study findings were statistically significant at P&lt; 0.001; this level of significance revealed that H1, H2, was supported in this present

Association of masticatory muscle activity with sleep arousal and other concomitant movements during sleep.

This study aims to verify the associations among sleep bruxism (SB), sleep arousal (SA) and concurrent body movements. Subjects underwent a standard overnight polysomnography test and audio-video recordings. Sleep quality was evaluated according to the Rechtschaffen and Kales criteria, while SA was determined as per the American Sleep Disorders Association criteria. Analyses were performed by an external institution after masking of the subjects' information. SB was assessed based on the presence/absence of rhythmic masticatory muscle activity (RMMA) episodes, which were identified by using electromyography of the masseter muscle. The observed simultaneous movements included lower leg movement (LLM), swallowing, face scratching, head movement, body movement, eye blinking, coughing, licking, sighing, body scratching, lip sucking, somniloquy and yawning. The LLM was determined visually, as well as through an increase in the tibialis electromyogram signal. Other movements were visually assessed using audio-video recordings. The incidences of all the simultaneous movements were compared between RMMA with intercurrent SA (SAwRMMA; RMMA episode derived from a masseter electromyogram showing more than 10% of maximum voluntary contraction) and SA without RMMA (SAw/oRMMA). Fourteen subjects were included in this study (females/males: 4/10, mean age: 31.5±5.7years). Among these, LLM, swallowing, body movement, licking, body scratching and lip sucking were frequently observed in SAwRMMA episodes than in SAw/oRMMA episodes, significantly. However, the non-specific simultaneous movements were higher observed in SAw/oRMMA episodes than that in SAwRMMA. Our results suggest that SB is concurrently activated with LLM in relation to arousal.

Freely available or over-the-counter occlusal splints obtainable in commercial outlets: a reality dentists should know

Aim and objective: Bruxism is defined by The American Sleep Disorders association as “tooth grinding during sleep plus tooth wear, sounds or jaw muscle discomfort in absence of medical disorder. People are obtaining over the counter splints (OTC) as a possible alternative to manage bruxism without the need for dental assessment. The aim of this study is survey OTC bruxism splints available in Chile through the internet or other commercial outlets, categorize their characteristics, claims, safety warnings and contrast it with scientific evidence. Materials and Methods: An internet search was made for OTC bruxism splints available in Chile. Only Chilean domains were evaluated. Information recorded was manufacture, name of the device, splint design, material, adjustability, price, claims and safety warnings. Results: five devices were found in our search. Only one is from a Chilean laboratory, being the most accessible. All devices have a full coverage splint design. the material made of is only described in one and their prices in the market are very dissimilar. The most usual advertising was “Eliminate Bruxism. Stop Night-Time Grinding &amp; Clenching”. Two manufactures suggest that the device will help to sleep better. No manufacture provided a guide for how long each day the splint must be worn. Conclusion: Dentists should be aware to keep this market in mind when reviewing patients if there have been unexplained occlusal changes or other problems. Bruxism is often a long-term problem and with any type of bruxism appliance the importance of regular review by a professional is critical.

Effect of valproate on the sleep microstructure of juvenile myoclonic epilepsy patients – a cross-sectional CAP based study

ObjectiveStudies looking at the effect of anti-epileptic medications on sleep microstructure of patients with epilepsy are almost non-existent. The aim of this study was to compare sleep microstructural characteristics of drug-naïve juvenile myoclonic epilepsy (JME) patients with those on valproate (VPA) monotherapy. MethodsThree age- (p = 0.287) and gender- (p = 0.766) matched groups (N = 20 in each group): (1) drug-naïve JME (mean age: 21.2 ± 4.06 years; M : F = 9:11); (2) JME on VPA (mean age: 21.85 ± 4.28 years; M : F = 11:9); (3) healthy controls (mean age: 23.2 ± 3.82 years; M : F = 9:11) underwent overnight polysomnography. Scoring and analysis of arousals American Sleep Disorders Association (ASDA, 2002), cyclic alternating pattern (CAP) (Terzano et al., 2002) parameters were performed. Comparison of arousal and CAP parameters was performed using one-way ANOVA, followed by pairwise comparisons using Fisher's LSD test (p ≤ 0.05). ResultsRapid eye movement (REM) arousal indices were higher in JME patients (Group 1 [p = 0.002] and Group 2 [p < 0.001]), whereas the overall and NREM arousal indices were comparable between the three groups. CAP rate was higher in JME patients as compared to controls (p < 0.001). Duration of phase A and its subtypes (p < 0.001) was reduced in drug-naïve patients as compared to VPA group and controls. Finally, percentage of phase A1 (p = 0.003) was decreased and A3 (p = 0.045) was increased in drug-naïve patients as compared to VPA group and controls. ConclusionsWe found significant alterations in REM arousal indices and several CAP parameters in JME patients. However, many of these alterations were not seen in the valproate group. This might indicate that anti-epileptic medications such as valproate may beneficially modulate arousal instability in JME patients, and hence promote sleep quality and continuity.

Dental Considerations in Obstructive Sleep Apnea Patients: A review

Upper airway sleep disorders are becoming recognized common medical concerns. The management and treatment of obstructive sleep apnea patients have long since been addressed by medical personals. Recently, dental participation in management of the patients through oral devices has been accepted as a recommended treatment modality by the American Sleep Disorders Association. As dental professionals, we have significant role to play in the early diagnosis, management and care of patients suffering from sleep apnea. This article reviews the etiology, clinical features, management and dental perspective of obstructive sleep apnea.

An overlooked cause of resistant hypertension: upper airway resistance syndrome - preliminary results

OBJECTIVE:Upper airway resistance syndrome is a sleep-disordered breathing syndrome that is characterized by repetitive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome was associated with poorly controlled hypertension.METHODS:A total of 40 patients with resistant hypertension were enrolled in the study. All of the patients underwent polysomnographic examinations and 24-hour ambulatory blood pressure monitoring to exclude white coat syndrome and to monitor treatment efficiency. Among 14 upper airway resistance syndrome patients, 2 patients had surgically correctable upper airway pathologies, while 12 patients were given positive airway pressure therapy.RESULTS:All patients underwent polysomnographic examinations; 22 patients (55%) were diagnosed with obstructive sleep apnea and 14 patients (35%) were diagnosed with upper airway resistance syndrome, according to American Sleep Disorders Association criteria. The patients with upper airway resistance syndrome were younger and had a lower body mass index compared with other patients, while there were no difference between the blood pressure levels and the number of antihypertensive drugs. The arousal index was positively correlated with systolic blood pressure level (p = 0.034; rs = 0.746), while the Epworth score and AHI were independent of disease severity (p = 0.435, rs = 0.323 and p = 0.819, rs = -0.097, respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all of them, whereas no pressure reduction was observed in four untreated patients.CONCLUSIONS:We conclude that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and that its proper treatment could result in dramatic blood pressure control.

OP-346 An Overlooked Cause of Resistant Hypertension; Upper Airway Resistance Syndrome

ObjectiveUpper airway resistance syndrome is a sleep disordered breathing syndrome characterized by repetetive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome is related to resistant hypertension.MethodsFourty patients with resistant hypertension were enrolled in the study. All patients underwent polysomnographic examination. All patients underwent 24 hours ambulatory blood pressure monitoring in order to rule out white coat syndrome and to monitor treatment efficiency.ResultsTwenty-two patients (55%) were diagnosed with obstructive sleep apnoea and 14 patients (35%) were diagnosed with upper airway resistance syndrome according to American Sleep Disorders Association criteria. Upper airway resistance syndrome patients were younger and had a lower BMI when compared to other patients while there were no difference between the blood pressure levels and the number of antihypertensive drugs. Arousal index was determined to be positively correlated with systolic blood pressure level (p=0.034; r=0.746 ) while epword score and apnea-hypopnea index were independent of disease severity (p=0.435, r=0.323 and p=0.819, r= -0.097 respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all whereas no pressure reduction was observed in 4 untreated patients.ConclusionsWe concluded that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and its proper treatment can result in dramatic blood pressure control. ObjectiveUpper airway resistance syndrome is a sleep disordered breathing syndrome characterized by repetetive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome is related to resistant hypertension. Upper airway resistance syndrome is a sleep disordered breathing syndrome characterized by repetetive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome is related to resistant hypertension. MethodsFourty patients with resistant hypertension were enrolled in the study. All patients underwent polysomnographic examination. All patients underwent 24 hours ambulatory blood pressure monitoring in order to rule out white coat syndrome and to monitor treatment efficiency. Fourty patients with resistant hypertension were enrolled in the study. All patients underwent polysomnographic examination. All patients underwent 24 hours ambulatory blood pressure monitoring in order to rule out white coat syndrome and to monitor treatment efficiency. ResultsTwenty-two patients (55%) were diagnosed with obstructive sleep apnoea and 14 patients (35%) were diagnosed with upper airway resistance syndrome according to American Sleep Disorders Association criteria. Upper airway resistance syndrome patients were younger and had a lower BMI when compared to other patients while there were no difference between the blood pressure levels and the number of antihypertensive drugs. Arousal index was determined to be positively correlated with systolic blood pressure level (p=0.034; r=0.746 ) while epword score and apnea-hypopnea index were independent of disease severity (p=0.435, r=0.323 and p=0.819, r= -0.097 respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all whereas no pressure reduction was observed in 4 untreated patients. Twenty-two patients (55%) were diagnosed with obstructive sleep apnoea and 14 patients (35%) were diagnosed with upper airway resistance syndrome according to American Sleep Disorders Association criteria. Upper airway resistance syndrome patients were younger and had a lower BMI when compared to other patients while there were no difference between the blood pressure levels and the number of antihypertensive drugs. Arousal index was determined to be positively correlated with systolic blood pressure level (p=0.034; r=0.746 ) while epword score and apnea-hypopnea index were independent of disease severity (p=0.435, r=0.323 and p=0.819, r= -0.097 respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all whereas no pressure reduction was observed in 4 untreated patients. ConclusionsWe concluded that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and its proper treatment can result in dramatic blood pressure control. We concluded that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and its proper treatment can result in dramatic blood pressure control.

Relation of the Severity of Obstructive Sleep Apnea in Response to Anti-Arrhythmic Drugs in Patients With Atrial Fibrillation or Atrial Flutter

Atrial fibrillation (AF) is more common in those with obstructive sleep apnea (OSA) than in unaffected subjects and recurs more frequently in the presence of severe OSA after electrical cardioversion and AF ablation. However, it is unknown whether the severity of OSA influences the efficacy of antiarrhythmic drug (AAD) therapy in patients with OSA and AF. The aim of this study was to examine the impact of OSA severity on the treatment of patients with symptomatic AF using AADs. Sixty-one patients (mean age 62 ± 15 years, 21 women) treated with AADs for symptomatic AF who underwent overnight polysomnography were studied. Rhythm control was prospectively defined as successful if a patient remained on the same AAD therapy for ≥6 months with ≥75% reduction in symptomatic AF burden. Twenty-four patients (40%) had severe OSA. Thirty patients (49%) were rhythm controlled with AADs. Nonresponders to AADs were more likely to have severe OSA than milder disease (52% vs 23%, p <0.05); those with severe OSA were less likely to respond to AADs than participants with nonsevere OSA (39% vs 70%, p = 0.02). Nonresponders had higher apnea-hypopnea indexes than responders (34 ± 25 vs 22 ± 18 events/hour, p = 0.05), but there were no differences between these groups in minimum oxygen saturation or percentage of time spent in rapid eye movement sleep. In conclusion, patients with severe OSA are less likely to respond to AAD therapy for AF than those with milder forms of OSA.

Neurophysiological Two-Channel Polysomnographic Device in the Diagnosis of Sleep Apnea

Our objective was to evaluate a portable device (Somté, Compumedics, Australia), which incorporates 2 neurophysiological channels (electroencephalography and electrooculography) with cardiorespiratory monitoring for the diagnosis of obstructive sleep apnea (OSA). Full polysomnography (PSG) and Somté recordings were simultaneously performed in 68 patients with suspected OSA. Data were analyzed blindly by 2 scorers. A good agreement between methods in sleep efficiency was observed (68.8% [18.4] with PSG vs 68% [19.1] with Somté [p: n.s.] for scorer 1, and 67.5% [19.1] vs 68.4% [18.5; p: n.s.] for scorer 2). The apnea-hypopnea index (AHI) obtained with Somté was lower than with PSG: 19 (17.8) vs 21.7 (19) (p < 0.001) for scorer 1, and 16.6 (16.7) vs 20 (18.8) (p < 0.001) for scorer 2. The sensitivity of Somté for a PSG-AHI > 5 was 91% for scorer 1 and 90% for scorer 2, while specificity was 77% and 90%, respectively. The areas under the receiver operating curve for different PSG-AHI cutoff points (≥ 5, ≥ 15, and ≥ 30) were 0.81, 0.90, and 0.86, respectively, for scorer 1, and 0.90, 0.88, and 0.83 for scorer 2. These data suggest that Somté is an effective device to identify sleep and respiratory variables in patients with suspected OSA.

Assessment of sleep-related breathing disorders in patients with duchenne muscular dystrophy.

BackgroundRespiratory failure is a significant cause of morbidity and mortality in neuromuscular diseases. Although clinical findings and respiratory function tests aid in diagnosing sleep-related breathing disorders, polysomnography is the gold standard for the diagnosis of these disorders. We aimed to investigate the role of sleep-wake symptoms and clinical findings of patients with Duchenne muscular dystrophy (DMD) in predicting sleep-related breathing disorders through the comparison of polysomnography findings. In addition, we evaluated the sleep architecture of our patients.MethodsA total of 35 children (12 patients with DMD and 23 controls) were included in this cross-sectional study. Activity status and clinical severity of the patients were determined by history and clinical findings such as scoliosis, obesity. All subjects were hospitalized for one night in the Sleep Unit and their polysomnography examinations were performed. Sleep, breathing, arousals and limb movements were scored manually according to the American Sleep Disorders Association criteria.ResultsNocturnal and daytime symptoms were present in 50% of patients with DMD, 40.8% were wheelchair-bound and 58% had scoliosis. Obstructive sleep apnea was noted in 16.6% of patients with DMD. The apnea-hypopnea index, leg movement index were significantly higher in the DMD group as compared to the control group (P < 0.05). The number of desaturations, total arousal index and the percentage of total superficial sleep were significantly higher in patients with wheelchair, scoliosis, sleep-wake symptoms.ConclusionsBeing wheelchair-bound or having scoliosis do not predict sleep-related breathing disorders, so patients with DMD should be followed-up via polysomnography. Sleep-wake symptoms should be carefully questioned in these patients and symptomatic patients should be referred to pediatric respiratory units.

Termination of Respiratory Events with and without Cortical Arousal in Obstructive Sleep Apnea

A total of 20-30% of respiratory events in obstructive sleep apnea are terminated without clear arousal. Arousals are thought to predispose to further events by promoting hyperventilation, hypocapnia, and upper-airway dilator muscle hypotonia. Therefore, events terminated without arousal may promote stable breathing. To compare physiologic changes at respiratory event termination with American Sleep Disorders Association (ASDA) Arousal to No Arousal, and determine whether secondary respiratory events are less common and have higher dilator muscle activity after No Arousal compared with ASDA Arousal. Patients with obstructive sleep apnea wore sleep staging, genioglossus (EMG(GG)), and tensor palatini (EMG(TP)) electrodes plus a nasal mask and pneumotachograph. During stable sleep, continuous positive airway pressure (CPAP) was lowered for 3-minute periods to induce respiratory events. Physiologic variables were compared between events terminated with (1) ASDA Arousal, (2) No Arousal, or (3) sudden CPAP increase (CPAPinc, control). Sixteen subjects had adequate data. EMG(GG), EMG(TP), and heart rate increased after ASDA Arousal (340 ± 57%, 215 ± 28%, and 110.7 ± 2.3%) and No Arousal (185 ± 32%, 167 ± 15%, and 108.5 ± 1.6%) but not CPAPinc (90 ± 10%, 94 ± 11%, and 102.1 ± 1%). Ventilation increased more after ASDA Arousal than No Arousal and CPAPinc, but not after accounting for the severity of respiratory event. Fewer No Arousals were followed by secondary events than ASDA Arousals. However, low dilator muscle activity did not occur after ASDA Arousal or No Arousal (EMG(GG) rose from 75 ± 5 to 125 ± 7%) and secondary events were less severe than initial events (ventilation rose 4 ± 0.4 to 5.5 ± 0.51 L/min). Respiratory events that were terminated with ASDA Arousal were more severely flow-limited, had enhanced hyperventilation after event termination, and were more often followed by secondary events than No arousal. However, secondary events were not associated with low dilator muscle activity and airflow was improved after both No Arousal and ASDA Arousal.

In Memoriam: A Tribute to an Unsung Hero

In Memoriam: A Tribute to an Unsung Hero

Influence of Experimental Esophageal Acidification on Sleep Bruxism

The aim of this cross-over, randomized, single-blinded trial was to examine whether intra-esophageal acidification induces sleep bruxism (SB). Polysomnography with electromyogram (EMG) of masseter muscle, audio-video recording, and esophageal pH monitoring were performed in a sleep laboratory. Twelve healthy adult males without SB participated. Intra-esophageal infusions of 5-mL acidic solution (0.1 N HCl) or saline were administered. The frequencies of EMG bursts, rhythmic masticatory muscle activity (RMMA) episodes, grinding noise, and the RMMA/microarousal ratio were significantly higher in the 20-minute period after acidic infusion than after saline infusion. RMMA episodes including SB were induced by esophageal acidification. This trial is registered with the UMIN Clinical Trials Registry, UMIN000002923. Abbreviations: ASDA, American Sleep Disorders Association; EMG, electromyogram; GER, gastroesophageal reflux; LES, lower esophageal sphincter; NREM, non-rapid eye movement; REM, rapid eye movement; RMMA, rhythmic masticatory muscle activity; SB, sleep bruxism; SD, standard deviation; UES, upper esophageal sphincter.

S1-2 The clinical and polysomnographic features relevance of idiopathic REM sleep behavior disorders

For a long time has Rechtschaffen and Kales (R&K) manual been considered as the sleep community’s bible for sleep scoring. This manual was published in 1968, intending to achieve the consensus among a small number of sleep researchers. However, it survived following 40 years as the essential manual for clinicians and sleep technologists due to its powerful utility. One of the characteristics of R&K scoring criteria is that it is based on epoch-by-epoch sleep staging. Later in 1970s when the concept of sleep apnea syndrome (SAS) was introduced, scoring respiratory events became essential. With the recognition of SAS, sleep gained the status as a clinical subject, which involved treating patients for having a good sleep. As a result, scoring criteria of EEG arousals and periodic leg movements were developed by the American Sleep Disorders Association in early 1990s for more extensive evaluation of sleep quality and sleep-related phenomena. These criteria basically formulated the rules to count defined events, and were incorporated in sleep staging of the R&K manual, which made it difficult for beginners to master them without proper on-the-job training. In 2007, American Academy of Sleep Medicine (AASM) completed a new manual for the scoring of sleep and associated events including cardiac, movement, and respiratory events. Although there has been a controversy on the use of this manual, it should be valued as the first attempt to unite all the measurements necessary for sleep scoring through reviewing numerous articles in pursuit of validity or reliability of measures. However, one thing we should bear in mind is that the AASM manual was developed with the purpose to provide a guideline for AASM accredited sleep disorders centers. Therefore, we should not be bound by it for scientific purpose, and make every effort to introduce more refined methods in the future.

Cardiovascular Disease and Sleep Disordered Breathing: Are Children Vulnerable?

Cardiovascular Disease and Sleep Disordered Breathing: Are Children Vulnerable?