Sleep Arousal Research Articles

The Effect of Gender on Epworth Sleepiness Scale Scoring and Objective Measures of Sleep

We previously demonstrated significant gender and racial differences when self-Epworth Sleepiness Scale (ESS) and spouse-reported ESS were compared. In this study, we investigate whether gender specific self-ESS scores correlate with the objective measures of sleep quality. Seventy-nine patient–spouse pairs completed the ESS questionnaires after which patients underwent polysomnographic testing (PSG). The correlation between ESS results and the PSG-obtained measurements of sleep efficiency (SE), sleep arousal index (AI), and apnea hypopnea index (AHI) were evaluated by calculating Pearson’s and Spearman’s correlation coefficients. Differences within patient–spouse pairs were evaluated using Wilcoxon’s Rank Sum Test. Our results indicated significant difference between patient-reported and spouse-reported scores for all patient age/gender groups except for female patients over 60. Significant correlations were seen between female patient-reported ESS scores, but not their spouse-reported ESS scores, and all three objective measures of sleep. In contrast, there was no significant correlation between male patient, and spouse-reported ESS scores and SE, AI, and AHI. The answers of female patients to individual sleepiness scenarios on ESS strongly correlated with at least one of the PSG-obtained values. In male patients, only one sleepiness scenario correlated with AHI, and their spouse-reported answers to specific ESS questions correlated with patients’ SE. Self-reported ESS is an effective marker of sleep quality only in female patients. For male patients, self-reported and spouse-reported answers to the specific questions of the ESS rather than the total ESS score are better markers of sleep quality.

Application of Wireless Dynamic Sleep Monitor in Acupuncture Treatment of Insomnia after Ischemic Stroke: A Retrospective Study.

Purpose Retrospective analysis of the clinical effect of acupuncture on insomnia after ischemic stroke by using a wireless sleep monitor as an innovative evaluation method. Methods From March 1, 2018, to September 30, 2019, 105 cases of insomnia after ischemic stroke were extracted from the inpatient medical record system of Shenzhen Longhua District Central Hospital. According to differences in the treatment plan, the cases were divided into an acupuncture group (57 cases) and a drug group (48 cases). The acupuncture group was given acupuncture treatment on the basis of usual care, while the drug group was given estazolam oral treatment on the basis of usual care. Under the ICF framework, the related items of sleep function and emotion function were selected for evaluation. As outcome parameters, the alterations of the Pittsburgh sleep quality index (PSQI), the self-rating anxiety scale (SAS), and the self-rating depression scale (SDS) were used before the treatment, after treatment, and in a follow-up; meanwhile, the ActiSleep-BT wireless sleep monitor was used to measure total sleep time (TST), sleep efficiency (SE), and sleep arousal (SA) of the two groups before and after treatment and at follow-up. Results Within-group comparison showed significant differences in the acupuncture group before treatment and after treatment on the ActiSleep-BT wireless dynamic sleep monitor data as well as in PSQI and ICF. Comparing the acupuncture group with the control group also showed significant differences in the ActiSleep-BT wireless dynamic sleep monitor data, PSQI, and ICF. Conclusion By evaluation using ActiSleep-BT wireless sleep monitor, acupuncture treated insomnia after ischemic stroke; the effect is better than usual care.

Impact of obstructive sleep apnea on cardiometabolic health in a random sample of older adults in rural South Africa: building the case for the treatment of sleep disorders in underresourced settings.

The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa. Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis. In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses. In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.

Ambulatory blood pressure monitoring in children undergoing polysomnography.

Ambulatory blood pressure monitoring (ABPM) is recommended for the diagnosis of hypertension in children at high risk, such as children with obesity or obstructive sleep apnea (OSA). Nocturnal hypertension is highly predictive of cardiovascular outcomes. ABPM allows for early detection of nocturnal hypertension in children. Although OSA is the most common sleep disorder associated with hypertension, studies have also shown an increase in cardiovascular risk in adult patients with other sleep disorders; therefore, there is an imperative need to provide early diagnosis in children at high risk. In the present study, we evaluated the feasibility of using ABPM during polysomnography (PSG) in children referred for sleep disordered breathing to the Seattle Children's Hospital Sleep Disorders Center. A total of 41 children aged 7-18years were included in this study. The ABPM monitor was worn for a mean (SD) of 10.2(1.5)hr. No significant changes were seen in PSG parameters when ABPM was co-performed with PSG, including sleep efficiency and arousals. In total, 12 of the 41 patients were identified as having nocturnal hypertension. Our study is important in that it shows that concomitant use of ABPM during PSG can aid in the early identification of nocturnal hypertension in this population.

Molecular resolution of a behavioral paradox: sleep and arousal are regulated by distinct acetylcholine receptors in different neuronal types in Drosophila.

Sleep and arousal are both important for animals. The neurotransmitter acetylcholine (ACh) has long been found to promote both sleep and arousal in mammals, an apparent paradox which has also been found to exist in flies, causing much confusion in understanding sleep and arousal. Here, we have systematically studied all 13 ACh receptors (AChRs) in Drosophila to understand mechanisms underlying ACh function in sleep and arousal. We found that exogenous stimuli-induced arousal was decreased in nAChRα3 mutants, whereas sleep was decreased in nAChRα2 and nAChRβ2 mutants. nAChRα3 functions in dopaminergic neurons to promote exogenous stimuli-induced arousal, whereas nAChRα2 and β2 function in octopaminergic neurons to promote sleep. Our studies have revealed that a single transmitter can promote endogenous sleep and exogenous stimuli-induced arousal through distinct receptors in different types of downstream neurons.

Automatic detection of non-apneic sleep arousal regions from polysomnographic recordings

A signal processing/machine learning (ML), data-driven approach for classifying targeted sleep arousal regions of polysomnography (PSG) signals is presented focusing on feature subset selection and consensus methods, deploying ensemble techniques. The targeted regions are the regions where RERA and Non-RERA-Non-Apnea events are present. The sensor independent and sensor-based features in time and frequency domain were derived from the PSG signals. To reduce the feature space dimension, a combination of feature selection strategies and a method of rank aggregation was applied to rank the features. Aiming to find a feature set, which conveys the most discriminative information of detection in designated learning models, the Non-Dominated Sorting Genetic Algorithm was used as the optimization algorithm. In order to capture the relation between feature vectors across time, a composition of feature vectors was formed. To tackle the unbalanced data problem, several techniques were used and a data fusion strategy stood out. Also, considering a more robust classifier, a metaclassifier was generated using different features, datasets, and classifiers. Finally, the predictions of models generated by bagging techniques and boosting methods were compared. The presented method was developed, validated and tested on the PhysioNet Challenge 2018 training dataset consisting of 994 subjects. The highest performance on 192 test subjects based on the area under precision-recall curve (AUPRC) and the area under receiver operating characteristic (AUROC) curve were 0.465 and 0.927, respectively. This study suggests that automatic detection of RERA and Non-RERA-Non-Apnea sleep arousal regions from biosignals is possible and can be a suitable substitution for PSG.

Presleep physiological stress is associated with a higher cortical arousal in sleep and more consolidated REM sleep

How sleep regulates physiological stress in healthy individuals is not well understood. We explored the associations between naturally occurring pre-sleep physiological arousal and EEG power spectral density together with rapid eye movement sleep (REMS) continuity. One hundred and fifty-four individuals (mean age 16.9, SD 0.1 years) collected five samples of saliva between the evening (mean time 18:20) and bedtime (mean 23:00) by using swabs, and underwent an overnight in-home polysomnography. We calculated spectral density for REMS and non-rapid eye movement sleep (non-REMS), and the number and duration of REMS arousals (<15 s) during sleep. An observational design allowed for measurement of natural variation in physiological and sleep arousal. Increasing cortisol levels toward bedtime were associated with higher EEG power spectral density at all frequency ranges in frontal locations, the highest association being for the beta1 frequency band. In central locations, the associations were pronounced for beta1 and beta2 bands. Higher overall cortisol levels in the evening were associated with less fragmented REMS. Presleep arousal was not associated with sleep staging. Physiological arousal toward bedtime was associated with EEG power spectral density values during sleep specifically at high EEG frequencies. This may represent a compensatory mechanism that serves as an adaptation to stress, since the REMS was more continuous along a higher physiological arousal level in the evening. Although causality cannot be inferred, a design with nonmanipulated physiological stress followed by naturally timed sleep at home provides new insights into stress regulation homeostasis.

Heart rate variability and obstructive sleep apnea: Current perspectives and novel technologies.

Obstructive sleep apnea (OSA) is a highly prevalent condition, resulting in recurrent hypoxic events, sleep arousal, and daytime sleepiness. Patients with OSA are at an increased risk of cardiovascular morbidity and mortality. The mechanisms underlying the development of cardiovascular disease in OSA are multifactorial and cause a cascade of events. The primary contributing factor is sympathetic overactivity. Heart rate variability (HRV) can be used to evaluate shifts in the autonomic nervous system, during sleep and in response to treatment in patients with OSA. Newer technologies are aimed at improving HRV analysis to accelerate processing time, improve the diagnosis of OSA, and detection of cardiovascular risk. The present review will present contemporary understandings and uses for HRV, specifically in the realms of physiology, technology, and clinical management.

Abnormal Brain Network Topology During Non-rapid Eye Movement Sleep and Its Correlation With Cognitive Behavioral Abnormalities in Narcolepsy Type 1.

Objective: Simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) were applied to investigate the abnormalities in the topological characteristics of functional brain networks during non-rapid eye movement(NREM)sleep. And we investigated its relationship with cognitive abnormalities in patients with narcolepsy type 1 (NT1) disorder in the current study.Methods: The Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) and EEG-fMRI were applied in 25 patients with NT1 and 25 age-matched healthy controls. All subjects participated in a nocturnal video polysomnography(PSG)study, and total sleep time (TST), percentage of TST (%TST) for each sleep stage and arousal index were calculated. The Epworth Sleepiness Score (ESS) was used to measure the degree of daytime sleepiness. The EEG-fMRI study was performed simultaneously using a 3T MRI system and a 32-channel MRI-compatible EEG system during sleep. Visual scoring of EEG data was used for sleep staging. Cognitive function was assessed for all subjects using the MoCA-BJ. The fMRI data were applied to establish a whole-brain functional connectivity network for all subjects, and the topological characteristics of the whole-brain functional network were analyzed using a graph-theoretic approach. The topological parameters were compared between groups. Lastly, the correlation between topological parameters and the assessment scale using Montreal Cognition was analyzed.Results: The MoCA-BJ scores were lower in patients with NT1 than in normal controls. Whole-brain global efficiency during stage N2 sleep in patients with NT1 displayed significantly lower small-world properties than in normal controls. Whole-brain functional network global efficiency in patients with NT1 was significantly correlated with MoCA-BJ scores.Conclusion: The global efficiency of the functional brain network during stage N2 sleep in patients with NT1 and the correspondingly reduced small-world attributes were associated with cognitive impairment.

DeepSleep convolutional neural network allows accurate and fast detection of sleep arousal

Sleep arousals are transient periods of wakefulness punctuated into sleep. Excessive sleep arousals are associated with symptoms such as sympathetic activation, non-restorative sleep, and daytime sleepiness. Currently, sleep arousals are mainly annotated by human experts through looking at 30-second epochs (recorded pages) manually, which requires considerable time and effort. Here we present a deep learning approach for automatically segmenting sleep arousal regions based on polysomnographic recordings. Leveraging a specific architecture that ‘translates’ input polysomnographic signals to sleep arousal labels, this algorithm ranked first in the “You Snooze, You Win” PhysioNet Challenge. We created an augmentation strategy by randomly swapping similar physiological channels, which notably improved the prediction accuracy. Our algorithm enables fast and accurate delineation of sleep arousal events at the speed of 10 seconds per sleep recording. This computational tool would greatly empower the scoring process in clinical settings and accelerate studies on the impact of arousals.

Heart rate change and clinical characteristics in patients with neck myoclonus: An observational study

ObjectiveThis study was conducted to evaluate heart rate (HR) change and clinical characteristics in patients with neck myoclonus (NM), a physiological motor phenomenon occurring during sleep. MethodsFor 18 consecutive patients in whom NM was confirmed from video-polysomnography, we analyzed 576 NMs. Change rate of HR at each 1 sec point towards the averaged HR in prior 5 sec period was calculated before and after all NM events. ResultsFindings show NM events as more prevalent during REM sleep than during NREM sleep (83.9% vs. 16.1%). For NM without cortical arousal in REM and NREM sleep, the respective HR increased 20 s before NM (p < 0.05); the change rate was up to 13%. For NM with cortical arousal in REM sleep, the HR increased 50 s before NM (p < 0.05); the change rate reached 18%. Three NM subjects showed abnormal vocalization or shouting during REM. Six NM subjects had excessive daytime sleepiness without sleep disorder. ConclusionHR increased before NM events, which may be associated with pathophysiology of NM. NM may possibly be associated with excessive daytime sleepiness or abnormal behaviors during REM sleep. SignificanceHR increase is associated with pathophysiology of NM and clinical symptoms.

Enhanced Vigilance Stability during Daytime in Insomnia Disorder.

Central nervous hyperarousal is as a key component of current pathophysiological concepts of chronic insomnia disorder. However, there are still open questions regarding its exact nature and the mechanisms linking hyperarousal to sleep disturbance. Here, we aimed at studying waking state hyperarousal in insomnia by the perspective of resting-state vigilance dynamics. The VIGALL (Vigilance Algorithm Leipzig) algorithm has been developed to investigate resting-state vigilance dynamics, and it revealed, for example, enhanced vigilance stability in depressive patients. We hypothesized that patients with insomnia also show a more stable vigilance regulation. Thirty-four unmedicated patients with chronic insomnia and 25 healthy controls participated in a twenty-minute resting-state electroencephalography (EEG) measurement following a night of polysomnography. Insomnia patients showed enhanced EEG vigilance stability as compared to controls. The pattern of vigilance hyperstability differed from that reported previously in depressive patients. Vigilance hyperstability was also present in insomnia patients showing only mildly reduced sleep efficiency. In this subgroup, vigilance hyperstability correlated with measures of disturbed sleep continuity and arousal. Our data indicate that insomnia disorder is characterized by hyperarousal at night as well as during daytime.

CONTINUOUS NOCTURNAL BP MONITORING DURING POLYSOMNOGRAPHY: PROOF OF CONCEPT STUDY

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Obstructive sleep apnea (OSA) is associated with cardiovascular disease, but recent randomized trials showed that current diagnostic and therapeutic algorithms for treating OSA do not lead to ideal improvements in cardiovascular outcomes. Nocturnal blood pressure (BP) is a strong predictor of adverse cardiac events, yet nocturnal BP is an under-explored modality in assessing cardiovascular impacts of OSA in part because previous BP technologies were interruptive to sleep and difficult to integrate with multi-channel PSG. METHODS: We set to develop an expanded PSG set-up which would: 1) enable a continuous BP recording without interrupting sleep, 2) allow integration of the BP channel into the existing multi-lead PSG, and 3) record accurate BP measurements as compared with traditional brachial cuff-based nocturnal BP measurements. To achieve these aims, we modified a non-invasive finger-based continuous hemodynamic monitor (plethysmograph and finger-based BP cuff system) to complement an existing attended in-laboratory PSG. This novel expanded PSG set-up was tested on a healthy sleeping subject. RESULTS: In this proof-of-concept study performed during sleep we showed that our novel expanded PSG set-up: 1) continuously recorded BP without interrupting sleep; 2) modifications to the existing non-invasive hemodynamic monitor allowed for integration into existing PSG recording system with direct display of continuous BP on the PSG monitor screens (Figure); 3) the accuracy of the continuous finger-based BP measurement was similar to the traditional BP obtained from brachial cuff [mean BP difference = 1.8 +/- 4.9 mmHg]. CONCLUSIONS: Continuous nocturnal non-invasive BP recording is feasible and could be cost-effectively added to presently used PSG laboratory set-up. Finger based BP recording accurately corresponds to brachial BP, and it does not interrupt sleep or cause excessive arousals. CLINICAL IMPLICATIONS: Our methodology of continuous nocturnal BP recording can be effectively used in subsequent clinical studies. This novel set-up would allow for routine assessment of OSA-induced nocturnal BP changes, and it would allow for BP directed titration of OSA therapies. DISCLOSURES: No relevant relationships by Richard Castriotta, source=Web Response No relevant relationships by Alexander Gong, source=Web Response Speaker/Speaker's Bureau relationship with Respicardia Please note: $1001 - $5000 Added 06/22/2020 by Vincent Grbach, source=Web Response, value=Honoraria No relevant relationships by Howard Hodis, source=Web Response No relevant relationships by Michael Khoo, source=Web Response No relevant relationships by Tomas Konecny, source=Web Response No relevant relationships by Andrew Lee, source=Web Response No relevant relationships by Arash Motamed, source=Web Response No relevant relationships by Winston Tran, source=Web Response no disclosure on file for Edwin Valladares

Examining Sleep and Mood in Parents of Children with Sleep Disturbances.

ObjectiveThe current study examined sleep and mood associations in parents of children with sleep disturbances across a sample of typically developing children and children with neurodevelopmental disorders. The mediating effect of children’s sleep on the relationship between parents’ sleep and mood was also assessed. The study explored differences in parents’ sleep based on whether 1) the child had a sleep disturbance, and 2) the child was typically developing or had a neurodevelopmental disorder.MethodsA total of 293 parents of children aged 2–12 years completed an online questionnaire. Parental sleep was examined using the Pittsburgh Sleep Quality Index, the Glasgow Sleep Effort Scale and the Pre-sleep Arousal Scale, and mood was assessed using the Profile of Mood States-short form. Measures for children included the Child’s Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire.ResultsAcross the overall sample, children’s sleep disturbances were associated with parents’ sleep disturbances, accounting for 22% of the change in parental sleep quality. Children’s sleep partially mediated parents’ sleep and mood. Significant differences were observed for sleep and mood outcomes in parents of children with sleep disturbances (CSHQ scores ≥41). However, no significant differences were reported for children’s sleep disturbances and parents’ sleep quality based on whether the child was typically developing or had a neurodevelopmental disorder.ConclusionParents of children with sleep disturbances experience poor sleep and high pre-sleep arousal, indicative of insomnia. Given that these parents experience cognitive arousal and insomnia, it is recommended that parents’ sleep problems are addressed and treated in clinical settings.

Glasgow Sleep Effort Scale: Translation, Test, and Evaluation of Psychometric Properties of the Persian Version.

PurposeThe purpose of the current study is to translate, test and evaluate the psychometric properties of the Glasgow Sleep Effort Scale (GSES) in Persian language.MethodsParticipants consisted of two samples: a clinical sample of 120 patients (58%) with insomnia disorder meeting DSM-5 criteria for insomnia and a non-clinical sample of 110 participants (42%) with normal sleep. Both samples completed the following measures: GSES, Pittsburg Sleep Quality Index, Insomnia Severity Index, Dysfunctional Beliefs and Attitudes about Sleep Scale-10, Pre Sleep Arousal Scale-cognitive subscale, Depression-Anxiety-Stress Scale-21 and sleep diary.ResultsSignificant correlations were found between GSES and related measures in both groups. Principal component analysis indicated a single component accounted for 64.77% of total variance in the clinical group. Results of the fit estimates for the one-factor model were consistent with the previously specified fit criteria and adequately fitted the data in the non-clinical group. Statistical analyses showed that the GSES has acceptable internal consistency in terms of Cronbach’s Alpha in the clinical (0.75) and non-clinical (0.77) samples. Test–retest reliability for a 4-week interval was significant (r = 0.70). The cut-off point, sensitivity, and specificity of the scale were 6, 85% and 94.5%, respectively.ConclusionThe Persian translated and validated version of the GSES obtained adequate values in psychometric properties in both clinical and non-clinical samples and it can be used for research and clinical purposes in Iran.

Sleep Disruption in Epilepsy: Ictal and Interictal Epileptic Activity Matter.

Disturbed sleep is common in epilepsy. The direct influence of nocturnal epileptic activity on sleep fragmentation remains poorly understood. Stereo-electroencephalography paired with polysomnography is the ideal tool to study this relationship. We investigated whether sleep-related epileptic activity is associated with sleep disruption. We visually marked sleep stages, arousals, seizures, and epileptic bursts in 36 patients with focal drug-resistant epilepsy who underwent combined stereo-electroencephalography/polysomnography during presurgical evaluation. Epileptic spikes were detected automatically. Spike and burst indices (n/sec/channel) were computed across four 3-second time windows (baseline sleep, pre-arousal, arousal, and post-arousal). Sleep stage and anatomic localization were tested as modulating factors. We assessed the intra-arousal dynamics of spikes and their relationship with the slow wave component of non-rapid eye-movement sleep (NR) arousals. The vast majority of sleep-related seizures (82.4%; 76.5% asymptomatic) were followed by awakenings or arousals. The epileptic burst index increased significantly before arousals as compared to baseline and postarousal, irrespective of sleep stage or brain area. A similar pre-arousal increase was observed for the spike index in NR stage 2 and rapid eye-movement sleep. In addition, the spike index increased during the arousal itself in neocortical channels, and was strongly correlated with the slow wave component of NR arousals (r = 0.99, p < 0.0001). Sleep fragmentation in focal drug-resistant epilepsy is associated with ictal and interictal epileptic activity. The increase in interictal epileptic activity before arousals suggests its participation in sleep disruption. An additional increase in the spike rate during arousals may result from a sleep-wake boundary instability, suggesting a bidirectional relationship. ANN NEUROL 2020;88:907-920.

High flow nasal cannula treatment for obstructive sleep apnea in infants and young children.

Continuous positive airway pressure (CPAP) is the nonsurgical treatment of choice for children with obstructive sleep apnea (OSA). However, CPAP limitations include difficulty with adherence and midface hypoplasia risk. We, therefore, sought to assess the effect of warm humidified air delivered via open nasal cannula (HFNC) on OSA in children in the sleep laboratory and at home. A retrospective review was performed among children recommended treatment of OSA with HFNC. Reasons for HFNC recommendation included poor surgical candidacy, residual OSA following surgery, and CPAP intolerance. Children underwent both diagnostic and HFNC titration sleep studies and were prescribed HFNC for home use. Standard sleep architecture, arousals, and apnea-hypopnea indices (AHI) were assessed with the evaluation of reported adherence and complications over 12 months of treatment. Twenty-two children (average 12.8 months, 95% confidence interval [95% CI: 7.0, 18.6]) with OSA (obstructive AHI [OAHI] range: 4.8-89.2 events/h) underwent HFNC titration with significant reduction in OAHI (28.9 events/h [17.6, 40.2] vs 2.6 [1.1, 4.0]; P < .001) (mean [95% CI]). Nineteen patients received home HFNC treatment. By 12 months, four patients were lost to follow-up and OSA resolved in three patients (16%). Of 12 remaining patients, 7 (58%) continued therapy while 5 (42%) discontinued due to intolerance. The most common treatment complication was cannula dislodgement. Additional complications included skin irritation, dry mucus membranes, restlessness, oxygen desaturation, and increased central apneas. HFNC offers a treatment alternative to CPAP in infants and young children with OSA and was well tolerated at home in our study.

Automatic Detection of Respiratory Effort Related Arousals With Deep Neural Networks From Polysomnographic Recordings.

Sleep disorders have become more common due to the modern lifestyle and stress. The most severe case of sleep disorders called apnea is characterized by a complete breaking block, leading to awakening and subsequent sleep disturbances. The automatic detection of sleep arousals is still challenging. In this paper, a novel method is presented to detect non-apnea sources of arousals during sleep using Polysomnography(PSG) recordings. After the preprocessing, a sequence-to-sequence deep neural network (DNNs) consisting of a series of Bidirectional long short-term memory (Bi-LSTM) layer, and fully connected layers were trained to classify samples in the segments. Initially, three different models were prepared for different datasets. Finally, obtaining the classification result through an ensemble model consisting of the three trained models. The result shows that the area under the receiver precision-recall curve (AUPRC) is 0.59 for the test dataset exceeding the performance of the classifiers in the existing literature.Clinical relevance- Analyzing Polysomnographic recordings is a time consuming a critical process yet to identify sleep disorders. These recordings span several hours and contain different data streams that include EEG, EMG, etc. This paper proposes a system that can automatically detect respiratory effort-related arousals using a deep neural network from Polysomnographic Recordings. By automating this process with a machine learning-based solution that can eliminate the manual process while facilitating further improvements of the system with future data.

Exploring Baseline Concussion-Assessment Performance in Adapted Wheelchair Sport Athletes.

With growing awareness of and advocacy for including individuals with disabilities in sport, implementation of concussion-assessment and -management strategies is warranted. Limited research is available on concussion assessment in adapted wheelchair sport athletes. To examine baseline symptom reporting, computerized neurocognitive testing, and a modified balance scoring system in adapted athletes. A secondary objective was to provide preliminary normative data for this population. Cross-sectional study. University athletic training room and computer laboratory. Twenty-one athletes (age = 22.1 ± 3.0 years) from 1 institution's collegiate adapted athletics program. Athletes completed baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the Wheelchair Error Scoring System (WESS) before the start of their respective seasons. Symptom reporting variables consisted of total symptoms, symptom severity scores, and baseline symptom factors (eg, vestibular-somatic, sleep arousal, cognitive-sensory, and affective). We analyzed ImPACT composite scores of verbal memory, visual memory, visual motor processing speed, and reaction time and impulse control to determine neurocognitive function. Balance performance was quantified using the WESS condition and overall errors. Compared with normative reference values, 17 (81%) of adapted athletes reported greater symptoms and 20 (95%) performed at or below average on at least 1 neurocognitive composite score. Mean errors on the WESS were 3.14 ± 2.9, with 81% committing ≥1 error. Sex differences were not present for symptoms, neurocognitive testing, or balance measures. Our findings provide context for baseline performance in adapted athletes and help to further develop the WESS as an assessment of balance in these athletes.

Sleep-related leg movements in obstructive sleep apnea: definitions, determinants, and clinical consequences

Study objectivesTo investigate (1) the effect of different scoring rules on leg movement (LM) classification in patients with obstructive sleep apnea (OSA); (2) determinants of respiratory event related leg movements (rLM); and (3) to relate LM parameters to clinical outcomes. Methods(1) LM classification was compared between the World Association of Sleep Medicine (WASM) 2006 and the WASM 2016 rules in 336 participants with apnea hypopnea index (AHI) ≥ 5; (2) determinants and features of rLM were investigated with logistic mixed regression in 172 participants with AHI ≥ 10 and respiratory disturbance index (RDI) ≥ 15, and (3) LM parameters were compared for patients with and without cardiovascular events and related to continuous positive airway pressure (CPAP) adherence. ResultsWASM-2016 scoring significantly reduced periodic limb movements of sleep (PLMS) frequency in OSA participants even when only considering the new periodicity criteria. Probability of rLM was strongly increased when respiratory events ended with an arousal, but rLM probability was lower for hypopneas and respiratory effort-related sleep arousal (RERAs) than for obstructive apneas. In participants with frequent non-respiratory PLMS, rLM were more frequent and behaved more PLMS-like. In participants without PLMS, rLM probability mostly depended on respiratory event features. LM parameters were neither related to cardiovascular event risk nor to CPAP-adherence. ConclusionsIt is likely that the PLMS frequency in OSA populations has been previously overestimated. Our results suggest that there are two types of rLM, true periodic ones that happen to synchronize with the respiratory events, and periodic appearing but respiratory driven LM, and that the presence of non-respiratory PLMS is instrumental in distinguishing between the two.