Bed Partner Research Articles

0563 The Evaluation of a Revolutionary Custom-Made Oral Appliance Design on Effectiveness, Efficacy, and Compliance

Abstract Introduction Evaluate the clinical effectiveness of the SomnoDent Avant with Bflex technology, a custom-made oral appliance therapy (OAT) device in the treatment of mild/moderate Obstructive Sleep Apnea (OSA) for naïve and PAP non-compliant patients. Hypothesis for the study was that the unique strap mechanism design of the appliance encouraged mouth closure and nasal breathing, would have high levels of effectiveness, particularly for supine sleepers. The evaluation of the initial fit of the device as well as patient’s and bed partner’s acceptance were also investigated Methods Prospective 90 day trial, participants age ≥ 18 with AHI of ≥10 to ≤30 events/hr. confirmed by using a WatchPAT, Home Sleep Apnea Testing (HSAT) device at baseline. Initial advancement of the lower jaw was 60%. Treatment effectiveness is derived from two endpoints: efficacy and compliance. The efficacy of the OAT is defined as the change from baseline in AHI, based on one and three-month HSAT. Efficacy was measured in supine, lateral and prone positions. Compliance data was obtained from the Dentitrac (BRAEBON Medical Corporation) chip embedded in the SomnoDent Avant device looking at usage for at least 4 hours per night for at least 5 out of 7 nights a week. Results Preliminary data from 50 participants (66% male, 35% female), age: 52.3 ± 11.8 yrs., BMI: 31.1. A statistically significant 3-month trend change from baseline AHI -11.0 ± 7 (37/37), Average usage:7.0hrs/night, ESS: 3 month change from baseline -3.3 ± 4.0 (80.0% improvement), FOSQ 10: 1.7 ± 2.2 (76.7% improvement). Adequate (first-time) fit of the device upon initial insertion 89.3%, bed partner sleep improvement 83.3%, and 88.9% would recommend the use of the Avant OAT device. Conclusion • SomnoDent Avant demonstrated high effectiveness in the treatment of OSA, particularly with supine dependent OSA participants. The unique design of the Avant strap likely acts to close the patient’s mouth, encouraging nasal breathing • Statistical improvement in the quality of life • Optimum first-time fit • Improvement in bed partner quality of sleep Support (if any) SomnoMed

0716 Quality of Life in Idiopathic REM Sleep Behavior Disorder and Isolated REM Sleep Without Atonia

Abstract Introduction Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) can affect quality of life (QOL) for both patient and bed partner; isolated REM sleep without atonia (iRSWA) has been less well-studied. We aimed to investigate whether QOL changes over time in those with either iRBD or iRSWA, as well as compare these changes to one another. Additionally, we attempted to demonstrate whether certain QOL changes were associated with phenoconversion to neurodegenerative illness. Methods We prospectively analyzed data from the “REM Sleep Behavior Disorder Associations with Parkinson’s Disease Study (RAPiDS)” cohort both at baseline and then at follow-up evaluations. We utilized the Neuro-QOL self-reported questionnaire to ascertain subjects’ level of QOL. Results There were 6 with iRSWA and 33 with iRBD, with an average age of 61.9 ± 13.0 years, with 13 women and 26 men. Significant QOL changes were found in both iRSWA and iRBD group. Among those who phenoconverted, fatigue and social functioning were the main QOL issues that that worsened over time. Conclusion This is the first time the Neuro-QOL has been studied in iRBD and iRSWA. QOL can be affected in both conditions; fatigue and social functioning seem to be of particular importance as they may be associated with phenoconversion. Support (if any) Grant from a private individual

Teaching Neuro Images : Obstructive sleep apnea triggered by vagus nerve stimulation

A 47-year-old man with drug-resistant cryptogenic epilepsy, treated with vagus nerve stimulation (VNS), underwent polysomnography (PSG) for suspected obstructive sleep apnea (OSA). A previous PSG study, performed 1 year before VNS, had showed an apnea-hypopnea index (AHI) = 4 events/hour, but the patient reported that the activation of the VNS was associated with increase of apneas witnessed by his bed partner. PSG was consistent with mild OSA; the AHI was 14.0 events/hour. During PSG, the stimulator was active for periods of 30 seconds, generating a peculiar artifact (figure, black arrows), separated by a 3-minute interval. In 67% of the obstructive events (9.5 events/hour), the onset of the event was simultaneous or immediately followed the start of VNS activation, suggesting that VNS might trigger obstructive apneas/hypopneas1,2 (figure, white arrows).

How and Why People Use Mobile Phones Near Bedtime and in Bed: Israelis’ Narratives of Digitally Enabled Sleepful Sociality

Although prior studies have examined the impact of smartphone use on sleep and there is a growing interest in the interface between mobile phones and society, researchers know little about how and why people use mobile phones before bedtime and in bed. The current research explores this question by drawing on data from sleep diaries and in-depth interviews with 66 Israelis. The results show that the human–mobile phone sleep assemblage generates agentic capacities that allow individuals to engage in a digitally enabled form of what I call sleepful sociality – a sociality marked by sleep. Through the use of mobile phones, individuals create, maintain and/or detach from social relations and fulfil social obligations near bedtime and during sleep, while also trying to facilitate and protect their own and their bed partner’s sleep. These findings enhance the understanding of how technology is enmeshed with sociality and creates new ways of being social.

Abstract 51: Better Sleep Health is Associated With Greater Adherence to Lifestyle Modification During a 12-month Behavioral Weight Loss Intervention

Introduction: Consistent evidence suggests that poor sleep may impede weight loss efforts; however, the impact of poor sleep on lifestyle modification during attempted weight loss is unclear. Purpose: To examine the relationship between sleep health and measures of lifestyle modification in a sample of adults who participated in a 12-month behavioral weight loss intervention. Methods: Adults (N=125) with overweight or obesity (50.3±10.6 years, 91% female, 81% White) participated in a 12-month behavioral weight loss intervention. Assessments occurred at baseline, 6 months, and 12 months. Six dimensions of sleep were included in our operationalization of sleep health: regularity, satisfaction, alertness, timing, efficiency, and duration. Sleep dimensions were assessed using validated questionnaires and actigraphy, with values dichotomized into ‘good’ and ‘poor’ sleep. A composite sleep health score was calculated based upon the count of the ‘good’ individual dimensions (range: 0-6), with higher scores indicating better sleep health. Measures of lifestyle modification included attendance at group intervention sessions, daily adherence to caloric intake goals (% of days), and change in average daily moderate-vigorous physical activity (MVPA). Linear mixed modeling was used to examine the relationship between baseline and 6-month sleep health and lifestyle modification during the subsequent 6-month interval with adjustment for age, gender, bed partner, and race. The composite sleep health score and individual sleep health dimensions were evaluated in separate models. Results: Mean sleep health was 4.5±1.1 (mean±standard deviation) at baseline and 4.5±1.2 at 6 months; from 0-6 months and 6-12 months, participants attended 79.4±15.0% and 62.3±32.3% of the group intervention sessions, adhered to caloric intake goals on 35.6±23.3% and 21.1±23.3% of the days, and changed MVPA by 8.7±13.6 min/day and -3.7±13.6 min/day. Better sleep health was associated with higher rates of attendance at group intervention sessions (b=2.71, SE=1.29; P=.038), greater adherence to caloric intake goals (b=4.60, SE=1.34; P<.001), and a trend for greater change in MVPA (b=1.41, SE=0.82; P=.088). Associations with lifestyle modification outcomes were observed with the following individual sleep dimensions (each P<.05): regularity with attendance and caloric intake, satisfaction with caloric intake, and duration with MVPA. Conclusions: Better sleep health was associated with greater adherence to lifestyle modification during a 12-month behavioral weight loss intervention. Whether improving sleep health prior to or during a weight loss intervention facilitates better lifestyle modification outcomes merits examination. Support: NIH R01HL107370.

Dependable algorithm for visualizing snoring duration through acoustic analysis: A pilot study

Snoring is a nuisance for the bed partners of people who snore and is also associated with chronic diseases. Estimating the snoring duration from a whole-night sleep period is challenging. The authors present a dependable algorithm for visualizing snoring durations through acoustic analysis. Both instruments (Sony digital recorder and smartphone's SnoreClock app) were placed within 30 cm from the examinee's head during the sleep period. Subsequently, spectrograms were plotted based on audio files recorded from Sony recorders. The authors thereby developed an algorithm to validate snoring durations through visualization of typical snoring segments. In total, 37 snoring recordings obtained from 6 individuals were analyzed. The mean age of the participants was 44.6 ± 9.9 years. Every recorded file was tailored to a regular 600-second segment and plotted. Visualization revealed that the typical features of the clustered snores in the amplitude domains were near-isometric spikes (most had an ascending-descending trend). The recorded snores exhibited 1 or more visibly fixed frequency bands. Intervals were noted between the snoring clusters and were incorporated into the whole-night snoring calculation. The correlative coefficients of snoring rates from digitally recorded files examined between Examiners A and B were higher (0.865, P < .001) than those with SnoreClock app and Examiners (0.757, P < .001; 0.787, P < .001, respectively). A dependable algorithm with high reproducibility was developed for visualizing snoring durations.

Development and Validation of a clinical scale for defining RBD severity in participants of the North American Prodromal Synucleinopathy (NAPS) consortium

AbstractBackgroundREM Sleep Behavior Disorder (RBD) is a prodromal marker of α‐synucleinopathies with no standardized tool for assessing severity in clinical or research practice. RBD severity may have implications in measuring risk of phenoconversion, monitoring response to treatment and clinical trial design. This study assessed the validity of the RBD symptom severity scale (RBDSSS) and its correlation to the clinical global impression of severity (CGI‐S) in a cohort of participants enrolled in the North American Prodromal Synucleinopathy (NAPS) Consortium.MethodParticipants and their bedpartners enrolled in the NAPS cohort filled out an 8‐item questionnaire, developed by the International RBD Study Group, assessing frequency and severity of dreams, vocalizations, movements, and injuries associated with RBD, with higher scores indicating more severe symptoms. The CGI‐S is a 7‐point scale ranging from normal (1) to most severely ill (7) and was completed by a clinician based on an independent interview with the participant ± their bedpartners. Total scores for participant (RBDSSS‐PT) and bed partner (RBDSSS‐BP) questionnaires were derived by multiplying frequency and severity scores for each feature, then summing the products for possible maximum scores of 54 and 38 respectively.ResultThis cohort (n = 212) was predominantly male (82.5%) with a mean ± SE age of 65.16 ± 1.46 years. The median (interquartile range) for RBDSSS‐PT, RBDSSS‐BP and CGI‐S was 11 (4‐17), 8 (4‐14.3) and 3 (3‐4), respectively. Spearman’s rank correlation coefficients (rs) were as follows: RBDSSS‐PT vs. RBDSSS‐BP, rs = 0.579; RBDSSS‐PT vs. CGI‐S, rs = 0.642; RBDSSS‐BP vs. CGI‐S, rs = 0.487 (all P&lt;0.0001). RBDSSS‐BP scores were significantly lower in women (6 vs. 9, Chi‐Square p = 0.009) while there were no differences in RBDSSS‐PT scores by sex. (9 vs. 11, p = 0.473).ConclusionA moderate correlation was observed between RBDSSS‐PT and RBDSSS‐BP suggesting good construct validity for the scale. CGI‐S correlated most with RBDSSS‐PT and had a weaker association with RBDSSS‐BP. Women had lower severity scores as reported by bed partners unlike their self‐reported scores, indicating possible sex differences in perceived RBD severity.

Sudden Unexpected Death in Epilepsy: Pathogenesis, Risk Factors, and Prevention.

Sudden unexpected death in epilepsy (SUDEP) is a tragic and unexpected cause of death in patients with a known diagnosis of epilepsy. It occurs in up to 6.3 to 9.3/1,000 patients with drug-resistant epilepsy. The main three risk factors associated with SUDEP are the presence of generalized tonic-clonic seizures, the presence of a seizure in the past year, and an intellectual disability. There are several mechanisms that can result in SUDEP. The most likely sequence of events appears to be a convulsive seizure, overactivation of the autonomic nervous system, cardiorespiratory dysfunction, and death. While the risk of SUDEP is relatively high in patients with drug-resistant epilepsy, studies indicate that more than 50% of patients and caregivers are unaware of the diagnosis. Counseling about the diagnosis and preventative measures at the time of diagnosis is important. There are numerous interventions that may reduce the risk of SUDEP, including conservative measures such as nocturnal surveillance with a bed partner (where applicable) and automated devices. Optimizing seizure control with antiseizure medications and surgical interventions can result in a reduced risk of SUDEP.

Pharmacotherapy for Obstructive Sleep Apnoea and Coupled Life: A Descriptive Phenomenological Study of a Complex Interaction.

Background: Obstructive Sleep Apnoea (OSA) is a common chronic sleep-related breathing disorder. Drug therapy is a recent approach to treating OSA, and no data is available regarding its effects on a couple’s life. The aim of this study was to investigate the impact on couples’ lives of a novel drug treatment for OSA. Methods: Participants of a trial on new drug therapy (reboxetine plus oxybutynin) for OSA were interviewed. The study was conducted using a descriptive phenomenological approach by Sundler et al. Results: Ten patients and six of their partners were recruited through a purposive sampling between February and April 2021. The results indicate that drug treatment of OSA had a favourable impact on the couples’ lives. Pharmacotherapy improved self-reported sleep quality, as the absence of CPAP allows people to sleep closer to the bed partner and because the patient does not have to sleep in a forced position. Moreover, the couples developed teamwork from the beginning which appeared to be crucial during the trial, especially when some difficulties and adverse events occurred. Conclusions: This study presents the presence of a positive closed loop that could be considered a predictor of adherence to drug therapy.

Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers.

Bed partners play a critical role in the treatment of obstructive sleep apnea and are affected by the treatment (or lack thereof) of their partner's obstructive sleep apnea, but few studies have included partners formally in treatment. In this qualitative study, we examine key stakeholder perspectives (patient, bedpartner, and sleep medicine provider) to inform the development of a novel, couples-based intervention to promote adherence to positive airway pressure (PAP) and sleep health among older adult couples. We conducted 3 focus group discussions with patients with obstructive sleep apnea/using PAP and their partners and 3 focus group discussions with sleep medicine providers. A standard interview guide was used to gather stakeholder input: (1) to understand interdependence of sleep among couples with sleep apnea; (2) to understand collaborative strategies that couples are currently using to address their sleep health challenges, including their perceptions of what is helpful vs not helpful; and (3) feasibility of the intervention design and delivery. Interviews were transcribed and thematically analyzed. Participants (n = 25) included 9 patients, 7 partners, and 9 providers. Analysis of the discussion identified themes within the 3 topics addressed in the focus group discussions: (1) interdependence of sleep health among couples, (2) collaboration and other dyadic strategies for increasing PAP use, and (3) facilitators and barriers to a couples-based PAP adherence intervention. Results of the focus group discussions provided new insights into collaborative strategies that could be used to enhance the sleep health of both patients and partners. Patient/partners reported that a couples-based treatment could reduce common frustrations experienced by new PAP users, thereby benefiting their relationship. However, barriers to couples-based treatment included patients and partners feeling overwhelmed and reluctance to discuss intimacy. Providers recognized the benefits of involving partners but reported concern about exacerbating conflict in the couple. Results indicate that couples and providers are enthusiastic about couples-based treatment that addresses their individual and dyadic sleep health challenges and identified important barriers that will need to be addressed to enhance uptake by clinicians and participation/retention of couples. Baron KG, Troxel WM, Galway S, etal. Couples-based interventions to promote PAP adherence among older adults: a qualitative study of patients, partners, and providers. J Clin Sleep Med. 2022;18(11):2627-2634.

Treatment of snoring using a non-invasive Er:YAG laser with SMOOTH mode (NightLase): a randomized controlled trial

ObjectivesThe aim of this study was to assess safety and efficacy of a non-invasive 2940 nm Er:YAG treatment with SMOOTH mode in reducing snoring in adult patients and to compare its efficacy and safety to sham treatment in a randomized controlled trial setting. Methods40 primary snoring patients (≥ 18 year, AHI < 15e/h, BMI ≤ 30) were randomized to receive either 3 sessions NightLase or sham laser treatment. The main outcome measures were Snore Outcomes Survey (SOS), the Spouse/Bed Partner Survey (SBPS), a visual analogue snoring scale (bed partner) and a visual analogue pain scale.ResultsNightLase was well tolerated, no local anaesthesia was required (mean VAS pain score in NightLase group = 3.0 ± 1.7). No complications occurred. SOS, SBPS and VAS snoring scores improved in the NightLase group (33.7 ± 14.1 to 56.2 ± 16.1) (35.0 ± 17.1 to 61.5 ± 16.4) and (7.9 ± 2.0 to 4.7 ± 2.8) while no changing in the sham group (32.2 ± 14.5 vs 32.1 ± 13.0) (36.7 ± 12.1 vs 34.7 ± 12.7) (8.1 ± 1.7 vs 8.0 ± 1.6), respectively.ConclusionsNightLase is a safe, minimal invasive treatment that significantly reduced snoring compared to sham treatment.

The association between mattress size and objectively measured sleep in 8,214 users with bed partners

The association between mattress size and objectively measured sleep in 8,214 users with bed partners

Adherence to Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea.

Adherence to either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) therapy in patients with obstructive sleep apnea syndrome (OSAS) represents a real challenge to sleep medicine physicians. Many risk factors/predictors for nonadherence exist, and usually, it is multifactorial. Long-term nonadherence with CPAP therapy has been associated with the use of CPAP for <4 hours/night during early treatment, moderate to severe obstructive sleep apnea (OSA), poor self-efficacy, and unsupportive bed partner. The American Academy of Sleep Medicine (AASM) recommends follow-up of patients with OSA within the first two weeks of CPAP use to optimize adherence. Measures to improve adherence to positive airway pressure (PAP) therapy go through an integrated approach that involves behavioral therapy and prompt management of side effects. Pharmacologic therapy in the form of a sedative-hypnotic sleep aid has a minor role in managing nonadherence to CPAP based on the greater risk of side effects. This article will briefly discuss the risk factors and management of nonadherence to PAP therapy in patients with OSAS.

A Quality Improvement Project (QI) on Screening for Rapid Eye Movement Sleep Behaviour Disorder (RBD) in Patients Referred to Trafford Memory Assessment and Treatment Service (MATS), Part of Greater Manchester Mental Health Trust (GMMH)

AimsLewy Body Dementia (LBD) is predicted to be under-diagnosed in the general population. RBD is one of the four core clinical criteria for the diagnosis of LBD. Longitudinal studies of RBD show strong association with LBD, so there is potential for early identification of LBD and subsequent management. We aimed to screen 100% of patients referred to Trafford MATS for RBD.MethodsWe performed three Plan-Do-Study-Act (PDSA) cycles; in the first cycle we introduced a validated RBD screening question, from the DIAMOND-Lewy study, to the initial memory assessment proforma. This asked ‘Have you ever been told that you “act out your dreams” while sleeping (punched or flailed arms in the air, shouted or screamed)?’In the second PDSA cycle, we delivered a RBD and LBD educational package to the specialist memory nurses who undertake the initial assessments. In the third PDSA cycle reminders were sent to the team to use the new assessment proforma.We collated data from patients who had undergone an initial memory assessment between 06/04/21- 22/06/21 from the trusts electronic database.ResultsInitial baseline data showed that 0% of initial assessments screened for RBD; at the end of PDSA one this was 100% and 75% at the end of PDSA two. This increased to 100% at the end of the last PDSA cycle. The main reason for non-completion of the screening question was use of the old proforma.4/152 patients screened positive; patients were diagnosed with Alzheimer's disease, delirium, vascular dementia and mixed Alzheimer‘s disease and vascular dementia, respectively.ConclusionThe introduction of a RBD screening question into the MATS initial assessment proforma improved screening for RBD. We think the variation in screening compliance rates was likely due to practitioners using old assessment proformas, hence sending reminders of the new proforma.A limitation of the project was that some patients did not have a bed partner, which makes identification of the disorder more difficult.Since the completion of the project, we have circulated a news bulletin through the Dementia United charity to raise awareness of our QI project nationally and also discussed the project with the Lewy Body society. Whilst our project has not yet identified a patient with LBD, we feel that introducing this screening question is a very easy and reproducible change to implement and RBD should be screened for in all memory patients.

0353 Estimated Sleep-Wake Patterns Obtained from a Large U.S. Sample by Home-Based Under-Mattress Monitoring Devices

Abstract Introduction Sharing the bed with a partner is common among adults and is likely to impact sleep in multiple ways. However, polysomnograms are performed without a bed partner and objective data on co-sleeping couples are extremely rare. This study aimed to investigate the effects of a bed partner's presence on objective sleep parameters. Methods Sleep data from 5190 users (43% female, 14% unspecified gender, mean age 47) and their bed partners were collected through a commercially-available home sleep monitoring device (Sleeptracker-AI Monitor, Fullpower Technologies, California, USA). The device passively monitors sleep using piezo-electric sensors that register the forces exerted through the mattress. Subjects with at least 10 weekday sleep recordings with a bed partner present for at least an hour, and at least 10 weekday sleep recordings without a bed partner present at all during the period from 08/2021 to 11/2021 were included. Estimated total sleep time (TST), wake after sleep onset (WASO), sleep efficiency (SE), and light, deep, and REM sleep were analyzed comparing between the nights with and without a bed partner. Results The mean (standard deviation) across subject averages of estimated TST (min), WASO (min), SE (%), and light, deep and REM sleep (min) with a bed partner were: TST 417.2(44.5), WASO 47.2(24.9), SE 89.5(6.4), light sleep 255.4(34.2), deep sleep 56.7(11.9) and REM sleep 105.2(17.5) and without a bed partner were: TST 414.7(49.2)-*, WASO 40.7(20.5)-*, SE 90.7(5.8)+*, light sleep 243.6(38.0)-*, deep sleep 62.9(12.9)+* and REM sleep 108.2(19.0)+*; a (+) indicates an increase and (-) a decrease in the sleep parameter between nights with and without a bed partner, and (*) signifies p &amp;lt; 0.05 by paired t-test. Conclusion When the bed partner is absent, an individual’s sleep architecture shows on average a higher sleep efficiency, with less awake time but also less total sleep; more minutes spent in deep and REM sleep, and less in light sleep. This suggests a less interrupted night, perhaps due to fewer disruptions from the partner, where the individual has enough continuity in his/her sleep to transition to deeper stages. Further work will add the effect of a bedpartner in AHI and snoring. Support (If Any)

0323 Gender-Specific Differences in Self-Reported Factors Attributed to Sleep Disruption

Abstract Introduction Women are more likely to report sleep difficulties. There are many ways for sleep to be disrupted (social influences, external sensory stimuli, somatic cues) but limited data exists on the relative burden of these disruptors. The purpose of the present analysis was to compare the occurrence of disruptors between males and females of equal ages. Methods We used self-reported data from the PSG-validated SleepScore mobile app to analyze the relative occurrence of a variety of sleep disruptors in an age- and gender-balanced sample of users (39,560 male and 39,560 female, median age=41, SD=15). Fisher's exact test was used to examine whether gender was a significant factor in the likelihood of reporting each disruptor. Disruptors were categorized as follows: somatic cues included hot flashes/thermal discomfort, chronic pain, bathroom visits, and heartburn; external sensory stimuli included temperature, light, and noise; social influences included: bed partner, pet, and children. All p &amp;lt; 0.00001 results are reported. Results Women were significantly more likely than males to report at least one sleep disruptor (Odds ratio (OR): 2.29, prevalence: 90% vs 80%) and were more likely to report sleep disruption attributed to external stimuli (OR: 1.61, prevalence: 54% vs 42%), somatic cues (OR: 1.66, prevalence: 68% vs 56%), and social influences (OR: 1.95, prevalence: 50% vs 34%). Among somatic cues, women were more likely than males to report hot flashes/thermal discomfort (OR: 3.42), chronic pain (OR: 2.32), bathroom visits (OR: 1.24), and heartburn (OR: 1.14). Among external sensory stimuli, women were more likely than males to report sleep disruption attributed to sound (OR: 1.58), light (OR: 1.54), and temperature (OR: 1.54). Among social influences related disruptive factors, women were more likely than males to report sleep disruption attributed to pets (OR: 2.31), bed partners (OR: 1.65), and children (OR: 1.62). Conclusion The present analysis found that women reported higher rates of regular disruption for every cause. These findings highlight the role of gender in sleep-health reporting behavior and mirror other findings showing lower symptom reporting and healthcare utilization among males. Support (If Any)

Experiences with Continuous Positive Airway Pressure Among African American Patients and their Bed Partners

ABSTRACT Rationale Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking. Objectives To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play. Methods We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis. Results 15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP. Conclusions African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners.

Patient Related Outcome and Therapy Effects in Stimulation Treatment of Sleep-Related Breathing Disorders.

Several neurostimulation devices exist for the treatment of various sleep-related breathing diseases. The most data for hypoglossal nerve stimulation (HNS) in the therapy of obstructive sleep apnea (OSA) derive the HNS with respiratory sensing. Herewith, daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) was improved in several publications by 5 points with a stability shown for up to several years. Sleep related quality of life, documented with the Functional Outcomes of Sleep Questionnaire, increased by 2 points. In many cohorts showed a mean usage of 5 to 6 hours per night. Under the consideration of shorter follow-ups and smaller group sizes, the ESS improved by 4 under unilateral continuous HNS and by 3 under bilateral HNS. Transvenous stimulation of the phrenic nerve is approved for the treatment in central sleep apnea. In a pivotal trial with 5 year follow-up data, an ESS reduction is documented by 3 points. There is one publication describing a usage of more than 5 hours. The daytime enoral neuromuscular electrical therapy improved ESS (2 points) and sleep-related quality of life of the snoring patients and the bed partner. The daytime training for the effects during the night adherence is given with 83%. For all described devices, there are running or announced studies and/or registry trials that consider patient related outcome.

Sleep disorders among Aboriginal Australians with Machado-Joseph Disease: Quantitative results from a multiple methods study to assess the experience of people living with the disease and their caregivers

BackgroundMachado-Joseph Disease (MJD), or Spinocerebellar Ataxia Type 3 (SCA3), is a genetic disorder that causes progressive muscle weakness, loss of motor control, ataxia and permanent physical disability. Sleep disturbances are associated with MJD but remain poorly understood. ObjectiveTo investigate frequency and characteristics of sleep disorders and their association with health-related quality of life and psychosocial wellbeing for Aboriginal Australians living with MJD. MethodsA convenience sample of MJD participants n = 24 participated in a semi-attended, ambulatory diagnostic sleep study to capture polysomnography, actigraphy and sleep diary data. Self-report measures collected were the Pittsburgh Sleep Quality Index (PSQI), STOP-BANG Questionnaire for Obstructive Sleep Apnoea (OSA), International Restless Legs Syndrome Study Group rating scale (IRLS), Kessler-5 (K5) and EuroQoL-5 Dimension (EQ5D). Caregivers (n = 22) reported EQ-5D, K5 and bed partners’ sleep behaviour (Mayo Sleep Questionnaire-Informant). Environmental factors were measured. ResultsWe observed Nocturia, Sleep Related Leg Cramps, OSA, REM Behaviour Disorder, and RLS, respectively in 100%, 71%, 47%, 43%, and 33% of participants with a significant positive correlation between Body mass index (BMI) and Apnoea hypopnea index (AHI). The majority of sleep was spent in non-rapid eye movement sleep (NREM)-N2 stage (77.8% (67.7, 81.6)). Overcrowding (92%) and overnight care needs (42%) interrupted sleep. MJD participants and caregivers reported high psychological distress (K5 median 12.5 IQR 7, 16.5 & 8 IQR 6, 12 respectively). ConclusionPoor sleep quality and sleep disturbances are prevalent among this cohort. Disease manifestations and environmental factors are driving factors. Larger sample sizes are required to predict risk factors and confirm observed associations.

Influence of Pair-housing on Sleep Parameters Evaluated with Actigraphy in Female Rhesus Monkeys.

Rhesus monkeys are naturally social animals, and behavioral management strategies have focused on promoting pairhousing in laboratory settings as an alternative to individual or group housing. In humans, co-sleeping can have a major impact on bed partners' sleep, raising the possibility that pair-housing also may influence sleep parameters in monkeys. In the present study, we investigated if pair-housing would impact home-cage partner's sleep in female rhesus monkeys, and if nighttime separation using socialization panels would alter this pattern. Sleep parameters of 10 experimentally naïve adult female rhesus monkeys (5 pairs) were evaluated for 7 consecutive days using actigraphy monitors attached to primate collars. Paired animals then were separated by socialization panels during the night, and sleep-associated measures were evaluated for 7 consecutive days. The data showed that sleep efficiency was significantly lower when monkeys were pairhoused as compared with when they were separated. On the nights when subjects were pair-housed, a positive correlation was detected for sleep measures (both sleep latency and efficiency) of both members of a pair (R2's = 0.16-0.5), suggesting that pair-housing influences sleep quality. On nights when subjects were separated, no correlations were observed for sleep measures between members of the pairs (R2's = 0.004-0.01), suggesting that when separated, the home-cage partner's sleep no longer influenced the partner's sleep. Our results indicate that pair-housing has a strong impact on the home-cage partner's sleep, and that this pattern can be prevented by nighttime separation using socialization panels. Studies evaluating sleep in pair-housed monkeys should consider the effects that the partner's sleep may have on the subject's sleep. Sleep is a biologic phenomenon and experimental outcome that affects physical and behavioral health and altered sleep due to pair-housing may affect a range of research outcomes.