Breathing Disorders Research Articles

Arrhythmia in sleep apnea

Sleep apnea is awidespread and yet still underdiagnosed condition. Various studies from the past have provided evidence that there is alink between sleep apnea and various cardiovascular diseases, including arrhythmias. The aim of this article is to provide an overview of the current study situation and to point out possible consequences relevant to everyday life. Asystematic search was carried out in various databases using the keywords sleep apnea (OSAS/SA) and arrhythmias/dysrhythmias. There are several pathophysiological links between sleep-related breathing disorders and cardiac arrhythmias, the most important of which appear to be intrathoracic pressure, increased adrenergic tone as well as recurrent hypoxia and hypercapnia. This results in an increased occurrence of clinically relevant arrhythmias, such as atrial fibrillation, symptomatic bradycardia, high-grade atrioventricular (AV) blocks as well as ventricular arrhythmias in patients with untreated sleep apnea. These pathologies also appear to be positively influenced by the treatment of sleep apnea. Aclose correlation between sleep apnea and cardiac arrhythmias is undisputed. Large randomized studies in this respect are so far rare but it is undisputed that a thorough search should be carried out for sleep apnea and consistently treated in patients with ahistory of cardiac disease as this can have arelevant influence on the treatment and ultimately the prognosis of the patient.

The pulse of sleep: novel interventions in understanding the sleep-cardiovascular connection: a literature review.

Sleep disorders represent common complaints in different medical illnesses. They encompass a risk for diverse inflammatory, metabolic, and cardiovascular diseases. Sleep disorders include disorders of hypersomnolence, insomnia, parasomnias, sleep-related movement disorders, circadian rhythm sleep-wake-disorders, and sleep-related breathing disorders, each one of which was associated with increased cardiovascular disease risk in a different mechanism. In this review, the authors address the most recent research on the correlation between sleep and CVD. The literature on sleep disorders and their potential links to various cardiovascular diseases was reviewed in narrative form. For the published papers up to June 2023, the authors searched the databases of PubMed and Google Scholar. Literature demonstrating the relationship between these illnesses, pathophysiological mechanisms, diagnosis, and various therapeutic approaches was included. Sleep disorders were significantly linked to heart rate variability, hypertension, and obesity, which can eventually result in cardiovascular consequences and affect mortality and morbidity. The disruption in sleep cycles, which can be noticed in different sleep disorders, can obviously result in blood pressure, heart rate, and other cardiac functions. The clinical assessment acts as the cornerstone in the diagnosis of different spectrums of sleep disorders. The management of sleep disorders ranges from cognitive-behavioral therapy to continuous positive airway pressure (CPAP). Additional research on the topic is needed to pinpoint any potential links and pathological processes. To improve clinical treatment and preventive measures, further observational studies should emphasize the reliability of early diagnostic signs.

A Deep Transfer Learning Approach for Sleep Stage Classification and Sleep Apnea Detection Using Wrist-Worn Consumer Sleep Technologies.

Obstructive sleep apnea (OSA) is a common, underdiagnosed sleep-related breathing disorder with serious health implications Objective - We propose a deep transfer learning approach for sleep stage classification and sleep apnea (SA) detection using wrist-worn consumer sleep technologies (CST). Methods - Our model is based on a deep convolutional neural network (DNN) utilizing accelerometers and photo-plethysmography signals from nocturnal recordings. The DNN was trained and tested on internal datasets that include raw data from clinical and wrist-worn devices; external validation was performed on a hold-out test dataset containing raw data from a wrist-worn CST. Results - Training on clinical data improves performance significantly, and feature enrichment through a sleep stage stream gives only minor improvements. Raw data input outperforms feature-based input in CST datasets. The system generalizes well but performs slightly worse on wearable device data compared to clinical data. However, it excels in detecting events during REM sleep and is associated with arousal and oxygen desaturation. We found; cases that were significantly underestimated were characterized by fewer of such event associations. Conclusion - This study showcases the potential of using CSTs as alternate screening solution for undiagnosed cases of OSA. Significance - This work is significant for its development of a deep transfer learning approach using wrist-worn consumer sleep technologies, offering comprehensive validation for data utilization, and learning techniques, ultimately improving sleep apnea detection across diverse devices.

Protective Effect of DHQ-11 against Hypoxia-induced Vasorelaxation

Hypoxia, or the lack of oxygen, has multiple impacts on the vascular system. The major molecular sensors for hypoxia at the cellular level are hypoxia inducible factor and heme oxygenase. Hypoxia also acts on the vasculature directly conveying its damaging effects through disruption of the control of vascular tone, particularly in the coronary circulation, enhancement of inflammatory responses and activation of coagulation pathways. These effects could be particularly detrimental under pathological conditions such as obstructive sleep apnea and other breathing disorders. Introduction: The effect of conjugate 2-(3,4-Dihydroxyphenyl)-6-{[1-(2’-bromo-3’,4’-dimethoxyphenyl)-6,7-dimethoxy-3,4-dihydroisoquinolin-2(1H )-yl]methyl}-3,5,7-trihydroxychroman-4-one (DHQ-11) on hypoxia-induced vasorelaxation was investigated in rat aortic rings using standard organ bath techniques. Materials and methods: Hypoxia was stimulated by a superfusion of aortic rings with a glucose-free Krebs solution bubbled with 95 % N2/5 % CO2. The effect of conjugate DHQ-11 was assessed after a 60- min period of hypoxia on aortic rings precontracted with 50 mm KCl or 1µM phenylephrine (PE). The conjugate DHQ-11 significantly attenuated hypoxia-induced vasorelaxation in the endothelium-intact aortic rings precontracted with KCl or PE in a concentration-dependent manner. Results and discussion: This effect of conjugate DHQ-11 was more potent in aortic rings precontracted with PE than those with KCl where it maximally reduced hypoxia-induced vasorelaxation from 44.7 ± 3.7 to 5.4 ± 3.7 and 33.9 ± 3.4 to 10.8 ± 4.2 %, respectively. The removal of the endothelium attenuated the effect of conjugate DHQ-11 on hypoxia-induced vasorelaxation. Similarly, pretreatment of endothelium-intact aortic rings with L-NAME and methylene blue also attenuated the effect of conjugate DHQ-11 on hypoxia-induced vasorelaxation. Furthermore, the blockade of the ATP-sensitive KATP channel with glibenclamide and the calcium-activated large conductance BKCa channel with TEA also significantly attenuated the effect of conjugate DHQ-11 on hypoxia-induced vasorelaxation. Collectively, these results indicated that conjugate DHQ-11 attenuated the hypoxia-induced vasorelaxation suggesting that it alleviated the oxidative damage of vasculature. Conclusions: This effect of conjugate DHQ-11 possible is mediated through several mechanisms including the blockage of the extracellular Ca2+ entry via the voltage-dependent and receptor-operative Ca2+ channels, as well as inhibition of sarcoplasmic reticulum Ca2+ release via the inositol triphosphate pathway. In addition, endothelium and NO/sGC/cGMP/PKG pathway, as well as KATP and BKCa channels most likely participate in protection by conjugate DHQ-11 against hypoxia-induced vasorelaxation.

Proportion of sleep-related breathing disorders and their association with echocardiographic parameters in stable patients with chronic obstructive pulmonary disease: a cross-sectional observational exploratory study

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. The coexistence of COPD and obstructive sleep apnea (OSA) (i.e., overlap syndrome) has been reported in several studies. Both disorders independently increase the risk of cardiovascular complications. Hence, there is a theoretical possibility that cardiovascular parameters may be worse in patients with overlap syndrome compared to those with only COPD. However, this has been sparsely assessed in the literature. This study aimed to compare the clinical characteristics, echocardiography, and sleep parameters amongst COPD patients with and without sleep-related breathing disorders (SRBD). This observational, cross-sectional study included 30 patients with stable COPD. All participants underwent a detailed clinical evaluation, followed by level 1 polysomnography (PSG). Each participant underwent echocardiographic evaluation to estimate mean pulmonary artery pressure from right ventricular systolic pressure (RVSP). Based on their PSG findings, participants were classified into non-SRBD and SRBD groups. Both groups were further compared with respect to clinical characteristics, echocardiographic, and PSG parameters. We found that most of the participants (93.3%) were male, and the mean age of the study population was 56±8.2 years. The only SRBD identified in this study was OSA, which was observed in 80% of participants. In this group, OSA was not associated with obesity. Systemic hypertension (50%) was the most common comorbidity, followed by diabetes mellitus (26.67%), but both were not significantly different between the groups. The mean RVSP was significantly higher amongst OSA patients than non-OSA patients (41.25±14.98 versus 30.83±5.84, respectively; p=0.01). OSA was seen in 80% of participants with stable COPD, even in the absence of obesity. The presence of OSA was associated with a higher RVSP in this patient group.

A Systematic Review on Machine Learning / Deep Learning Model-based Detection of Sleep Apnea Using Bio-Signals

Backgrounds: Sleep Apnea (SA) is a sleep-related breathing disorder diagnosed in clinical laboratories. The gold standard is Polysomnography (PSG), a multi-parameter evaluation of a sleep monitoring system that records the biological signals during overnight sleep. Apart from PSG recording, apnea events are recorded by various other bio-signals called Electrocardiogram (ECG), Electroencephalogram (EEG), Oxygen Saturation level (SpO2), etc. Further evaluation of the recorded bio-signals is tedious and time-consuming as experts perform it manually. Aiming to overcome the disadvantage without compromising accuracy, scientists focus on developing robust measurements of SA by using Machine Learning (ML) and Deep Learning (DL) models. Method: This study aimed to analyze the recent research findings in the field of sleep apnea classification and various machine learning and deep learning methods implemented in detecting SA. This study revealed the best-performing technique considering different types of bio-signals used for analysis and the respective ML or DL models used for automatic detection Result: The studies and patents included in this review underwent a precise screening process using PRISMA guidelines. The literature study is comprised of three different analysis tools to showcase the review process and provide evidence for the research findings obtained in the respective publications. The publications considered were limited to the last decade. Conclusion: This review delivers the key finding that ECG signals-based detection of sleep apnea using deep learning model-based deep neural network classifiers will provide more accurate and robust classification, which will pave the way for possible future research directions.

Deep learning-based snore sound analysis for the detection of night-time breathing disorders

Snoring, a prevalent symptom of obstructive sleep apnea, is believed to impact 57% of men and 40% of women in the United States. Night-time breathing disorders present significant challenges to both diagnosis and treatment, impacting millions of individuals worldwide. Traditional methods like CPAP machines and lifestyle changes face barriers such as discomfort, low adherence, and high costs, prompting the need for innovative solutions. This paper presents a novel approach using artificial intelligence, specifically deep learning, to create a snore sound analysis-based alerting system. This system aims to detect sleep disorders by analyzing snore patterns, providing a non-intrusive, cost-effective, and user-friendly alternative to traditional methods. By training models on snore sound characteristics, we've achieved promising results in identifying sleep apnea, showcasing the potential of this system in transforming the detection and management of night-time breathing disorders.

Two-dimensional facial photography for assessment of craniofacial morphology in sleep breathing disorders: a systematic review.

Craniofacial morphology is integral to Sleep Breathing Disorders (SBD), particularly Obstructive Sleep Apnea (OSA), informing treatment strategies. This review assesses the utility of two-dimensional (2D) photogrammetry in evaluating these metrics among OSA patients. Following PRISMA guidelines, a systematic review was conducted. PubMed, Embase, and Lilacs databases were systematically searched for studies utilizing 2D photography in SBD. Findings were narratively synthesized. Thirteen studies involving 2,328 patients were included. Significant correlations were found between craniofacial measurements-specifically neck parameters and facial width-and OSA severity, even after BMI adjustment. Ethnic disparities in craniofacial morphology were observed, with photogrammetry effective in predicting OSA in Caucasians and Asians, though data for other ethnicities were limited. Pediatric studies suggest the potential of craniofacial measurements as predictors of childhood OSA, with certain caveats. 2D photogrammetry emerges as a practical and non-invasive tool correlating with OSA severity across diverse populations. However, further validation in various ethnic cohorts is essential to enhance the generalizability of these findings.

Profile of Patients With Obstructive Sleep Apnea: An Initial Experience in a Tertiary Health Facility.

Introduction Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with increasing prevalence worldwide. The disease is, however, underdiagnosed in many resource-limited countries, especially in sub-Saharan Africa with unknown prevalence. Study aim The aim of this study was to determine the demographic and clinical characteristics, as well as measured sleep study parameters of suspected OSA patients. Methods The study was a retrospective review of the clinical characteristics and home sleep study reports of patients seen at the respiratory and sleep clinic from January 2020 to June 2022. Descriptive statistics such as means, medians, and percentages were employed to summarize the data using tables and graphs. Spearman correlation coefficient and Fisher's exact test were used to determine associations between the variables. Findings The study participants were predominantly male, and 64.7% were ≥50 years of age. Approximately 76% of the cases had moderate-to-severe OSA based on the apnea-hypopnea index (AHI) scores with a mean BMI of 38.4kg/m2 and 43.1kg/m2, respectively (p=0.013), and a mean STOP-BANG score of 5.2 and 6.2, respectively (p <0.001). There was a positive correlation between AHI scores and BMI of the patients (r=0.252, p=0.003), as well as with their STOP-BANG scores (r=0.436, p< 0.001). Oxygen desaturation index (ODI) parameters of participants also positively correlated with the AHI scores (r=0.872, p<0.001). Conclusion The proportion of patients with moderate-to-severe OSA was high. Obesity was significantly associated with AHI scores, which also positively correlated with the STOP-BANG and ODI scores. These results suggest that the burden of OSA, which is closely linked with obesity, could be underestimated in Ghana and requires epidemiological studies in the very near future to clearly define and anticipate its impact on the health economy of Ghana.

Modification of a parent-report sleep scale for individuals with CDKL5 deficiency disorder: a psychometric study.

Sleep difficulties are common in CDKL5 deficiency disorder (CDD), a developmental and epileptic encephalopathy (DEE). This study evaluated the factor structure of the Disorders of Initiating and Maintaining Sleep (DIMS), Disorders of Excessive Daytime Somnolence (DOES) and Sleep Breathing Disorders (SBD) domains of the Sleep Disturbance Scale for Children (SDSC) for CDD. A cross-sectional psychometric study design was used. Data were collected for 125 individuals aged 3 years or older who attended a US Centers of Excellence clinic or registered with the International CDKL5 Disorder Database. The median age was 10.3 years (range 3.2 - 40.7 years) and 105 (84%) were female. Two of the three SBD items related were not observed by most respondents and analysis was restricted to the DIMS and DOES domains. Using all items in the initial confirmatory factor analysis, two items in the DIMS domain and one item in the DOES domain loaded poorly. After deleting these items and repeating the analysis, item loading (0.524-0.814) and internal consistency (DIMS: 0.78, DOES: 0.76) statistics were good. The square of the inter-domain correlation coefficient was 0.17, less than Average Variance Extracted values for both domains and indicating good discriminant validity. The Tucker-Lewis and Comparative Fit indices were slightly lower than the threshold of >0.9 for establishing goodness of fit. The modified DIMS and DOES domains from the SDSC could be suitable clinical outcome assessments of insomnia and related impairments in CDD and potentially other DEE conditions.

Mind reading dysfunctions in patients with obstructive sleep apnoea: A neuropsychological approach.

Obstructive sleep apnoea syndrome (OSAS) is a prevalent sleep-related breathing disorder that has been extensively studied for its effects on cognitive functions. However, little attention has been given to investigating Mind Reading (MR) skills in patients with OSAS. In this study, we employed a neuropsychological approach to thoroughly assess various facets of MR skills in patients with OSAS. Forty-two patients with untreated moderate or severe OSAS (AHI ≥15; 30 men, 12 women) and 16 healthy controls (7 men and 9 women), matched by age, were enrolled. To assess MR skills, we used: (i) The Story-based Empathy Task (SET), which includes three experimental conditions: identifying intentions (SET-IA), emotional states (SET-EA), and a control condition for inferring causality reactions (SET-CI); (ii) the Ekman 60 Faces Test (Ek60), which measures emotion recognition from facial expressions. Our findings revealed that patients with OSAS exhibit deficits in emotion-related MR skills, while their ability to make inferences about the cognitive states of social partners remains largely preserved. This finding corroborates previous evidence indicating that social cognition, particularly MR skills, may be one of the cognitive domains affected by OSAS. It emphasizes the significance of investigating social cognition and the relationship between MR skills and social functioning as a new and intriguing area of research in patients with OSAS.

Pulmonary hypertension in patients affected by sleep-related breathing disorders: up to date from the literature.

Sleep-related breathing disorders (SBD) are conditions of abnormal and difficult respiration during sleep, including chronic snoring, obstructive sleep apnea (OSA), central sleep apnea (CSA), sleep-related hypoventilation disorders and sleep-related hypoxemia. Some of them have a limited impact on health, but others (e.g., OSA) can have serious consequences, because of their dangerous effects on sleep and the hematic balance of oxygen and carbon dioxide. According to several population-based studies, prevalence of OSA is relatively high, approximately 3-7% for adult males and 2-5% for adult females in the general population. However, methodological differences and difficulties in characterizing this syndrome yielded to variability in estimates. Moreover, it is estimated that only about 40% of patients with OSA are diagnosed, which can lead to underestimation of disease prevalence. OSA is directly correlated with age and male sex and to risk factors such as obesity. Several studies found that OSA is associated with an increased risk of diabetes, some cancer types, cardiovascular and cerebrovascular diseases, such as hypertension, coronary artery disease and stroke. Pulmonary hypertension (PH), a noted cardiovascular disease, is significantly associated with sleep-related breathing disorders and lot of scientific studies published in the literature demonstrated a strong link between these conditions and the development of pulmonary hypertension PH. PH is relatively less common than sleep-related breathing disorders. The purpose of this systematic review is to analyze both the current knowledge around the consequences that SBD may have on pulmonary hemodynamics and the effects resulting from pharmacological and non-pharmacological treatments of SDB on PH.

The diagnostic accuracy of the Arabic version of the Pediatric Sleep Questionnaire for screening for pediatric sleep-related breathing disorders in Saudi children.

Pediatric Sleep Questionnaire (PSQ) is a valid, reliable tool for screening for sleep-related breathing disorders (SRBDs) translated into several languages since 2000. The diagnostic accuracy of an Arabic version of the PSQ has never been tested. Our aim was to translate the original version of PSQ into Arabic (Arabic-PSQ), validate it as a reliable screening tool, and compare it to the gold standard diagnostic method for SRBDs. This was a prospective longitudinal study of 54 children (2-14 years) who were to undergo polysomnography (PSG). SRBD was assessed by administering the Arabic version of PSQ to the parents of these children. The validity and reliability of the Arabic-PSQ were assessed. Data were analyzed using Stata 16. Correlation between with polysomnographic indices and PSQ scores, as well as measurement of the diagnostic accuracy were determined. Receiver operating characteristic analysis between the mean PSQ scores and binary PSG results was done and the area under curve (AUC) value was calculated. Thirty-four (63%) children were diagnosed with obstructive sleep apnea by PSG (Apnea-Hypopnea Index [AHI] ≥1), 26 of whom were accurately identified with the Arabic-PSQ (76.5%). Arabic-PSQ showed comparable validity and reliability. Using a cutoff of 0.33, the score showed a significant correlation with AHI: Rs: 0.30 (P = 0.029). The sensitivity was 76.5%, the specificity was 50%, the positive predictive was 72.2%, the negative predictive value was 55.6%, the positive likelihood ratio was 1.63, and the negative likelihood ratio was 0.37. The Arabic-PSQ is a valid tool for the screening of Arabic-speaking populations for SRBD. It is valuable for directing the diagnostic approach in a timely and cost-effective manner.

Sleep quality in patients with Parkinson’s disease in the Republic of Moldova – preliminary results

Background and objectives. The rising prevalence of sleep issues are a consequent societal problem, notably impacting individuals with Parkinson’s disease (PD). This study aims to examine the differences in sleep quality between diagnosed patients and their counterparts, while also highlighting its effects on their symptoms and quality of life. Materials and methods. This study enrolled 37 PD subjects. Sleep quality, established via the Pittsburgh Sleep Quality Index (PSQI), was compared through a case control approach against 49 control subjects. PD symptomatology assessment was ensured via: Hoehn &amp; Yahr (H&amp;Y); Movement Disorder Society-Unified Parkinson’s disease rating scale (MDS-UPDRS I-IV); Non-motor Symptom Scale (NMSS); Beck Depression Inventory (BDI); Montreal Cognitive Assessment (MoCA); Scale for Outcomes in Parkinson’s disease – Psychosocial Functioning (SCOPA-PS); 39-Item Parkinson’s Disease Questionnaire (PDQ-39). Results. Compared to their homologues, PD subjects were prone to worse subjective sleep quality (18.9% vs. 8.2%), sleep efficiency (13.5% vs. 4.1%), diurnal functionality (27% vs. 12.2%), sleep related breathing disorders (62.2% vs. 46.9%). The global PSQI positively correlates to H&amp;Y staging (rp= 0.443, p=0.008), UPDRS-III (rp= 0.369, p=0.029), UPDRS-IV (rp=0.412, p=0.011). PD subjects with PSQI &gt;5 registered higher UPDRS-III (p=0.091), BDI (p=0.928), SCOPA-PS (p=0.051). PSQI5 correlates to PDQ-39 (rp=0.423, p=0.010) and SCOPA-PS (rp= 0.462, p=0.004). Conclusions. The study proved a clear correlation between altered sleep patterns and the clinical presentation of PD delineating the worsening of motor along to non-motor symptoms. In addition, the quality of life along to the psychosocial functioning of PD subjects is at risk in those manifesting sleep disturbances. Correspondingly, a greater interest should be applied in the establishment of prophylactic measures.

Review of respiratory sleep disorders in children with genetic and metabolic diseases

Sleep is an important physiological process for the optimal functioning of the human body. Respiratory sleep disorders in children can be found in any age group with a prevalence of 2-5%. Genetic and metabolic syndromes in children associate a higher prevalence of sleep pathology. Polysomnography represents the gold standard investigation for evaluation and monitoring of breathing disorders associated with sleep. Early detection of sleep pathology in children and periodic monitoring plays an important role in improving quality of life of these patients.

Sleep Disordered Breathing in Professional Drivers in Damietta Governorate

Background: The overarching term sleep-related breathing disorders is utilized to collect the various conditions in which a person experiences an aberration of respiration entirely or in part, during sleep. Aim of the work: The aim of this work was to estimate the prevalence of sleep disordered breathing among professional drivers in Damietta Governorate. Methods: This research included two parts: First part was descriptive longitudinal study contained two phases: Phase- I: diagnosis of the symptomatized patients as SDB patients and Phase-II: treatment and follow up of the diagnosed patients. Second part: cross sectional study. Phase-I: 110 male commercial drivers with license belong to Damietta Governorate Traffic Unit who were self-referred or referred by a physician to SDB Unit Clinic with symptoms suggesting sleep disordered breathing. Phase-II: The diagnosed drivers with SDB 100 from 110 drivers were offered treatment options according to clinical practice guidelines. This second part of the study included 510 male commercial drivers. Results: Multivarivate analysis of statistically significant predictors of OHS in bivariate analysis and we found three independent predictors (with percentage for accuracy of this model= 99%): AHI (OR=2.3), sleep efficiency (OR=0.98) and arousal index (OR= 1.89). where each unit increase in both AHI, sleep efficiency results in increase in the risk of OHS by 2.3 and 0.98 respectively. Each unit increase in arousal index decrease the risk of OHS (1.89). there was a higher percentage of accidents in the group of OHS in comparison to OSA group and this difference was statistically significant (p≤0.001). Conclusions: High prevalence of SDB among commercial drivers in Dameitta governorate. Neck circumference (≥ 38.5) is the most useful independent predictor for SDB and cut of point of AHI and arousal index are the most useful independent predictors of OHS. Higher prevalence of accidents and near accidents in those with SDB versus those without SDB and more prevalent in OHS vs OSA.

Sleep Disorders and Dementia Risk in Older Patients with Kidney Failure: A Retrospective Cohort Study.

Community-dwelling older adults with sleep disorders are at higher risk of developing dementia. Greater than 50% of older patients with kidney failure experience sleep disorders, which may explain their high burden of dementia. Among 216,158 patients (age ≥66 years) with kidney failure (United States Renal Data System; 2008-2019), we estimated the risk of dementia (including subtypes) associated with sleep disorders using Cox proportional-hazard models with propensity score weighting. We tested whether positive airway pressure (PAP) therapy was associated with reduced dementia risk among patients with obstructive sleep apnea (OSA). 26.3% of patients were diagnosed with sleep disorders; these patients had a higher five-year unadjusted cumulative incidence for any type of dementia (36.2% vs. 32.3%; P<0.001), vascular dementia (4.4% vs. 3.7%; P<0.001), and other/mixed dementia (29.3% vs. 25.8%; P<0.001). Higher risk of any type of dementia was identified in patients with insomnia (aHR=1.42; 95%CI: 1.34-1.51), sleep-related breathing disorders (SRBDs) (aHR=1.20; 95%CI: 1.17-1.23), and other sleep disorders (aHR=1.24; 95%CI: 1.11-1.39). Higher vascular dementia risk was observed in patients with insomnia (aHR=1.43; 95%CI: 1.19-1.73), SRBDs (aHR=1.15; 95%CI: 1.07-1.24). Patients with SRBDs (aHR=1.07; 95%CI: 1.00-1.15) were at higher risk of Alzheimer's disease. Among patients with OSA, PAP therapy was associated with lower risk for any type of dementia (aHR=0.82; 95%CI: 0.76-0.90), and vascular dementia (aHR=0.65; 95%CI: 0.50-0.85). Older patients with kidney failure and sleep disorders are at a higher risk of dementia. Sleep is an important modifiable factor that should be considered for targeted interventions to mitigate dementia risk in patients with kidney failure. For patients with OSA, PAP therapy is associated with lower dementia risk.

Periodic limb movements during sleep in children with neuromuscular disease or cerebral palsy – An important potential contributor to sleep-related morbidity

ObjectivesPoor sleep is frequently reported in children with neuromuscular diseases (NMD) and cerebral palsy (CP) however breathing disorders during sleep are often the clinical focus. Periodic limb movements (PLMs) have an increased prevalence in adults with NMD and may contribute to sleep disturbance in this population. We assessed the prevalence of PLMs in children with NMD or CP. MethodsRetrospective review of polysomnography (PSG) with leg electromyography in children age 1–18 years with NMD (including Duchenne muscular dystrophy, myotonic dystrophy, spinal muscular atrophy) or CP performed at a paediatric sleep centre 2004–2022. ResultsLeg electromyography was available in at least 1 PSG in 239 children (125 NMD, 114 CP), and in 2 PSGs in 105 children (73 NMD, 32 CP). At initial PSG, 72 (30 %) were female with a median age 9y and respiratory disturbance index 3.5/h (interquartile range 1.3–9.9/h). Elevated PLM index (PLMI; >5/h) occurred in 9.6 % of each of the CP and NMD groups, quantified by initial PSG. Overall, PLMI increased from baseline (median 0, maximum 33/h) to follow-up (median 0, maximum 55.8/h; p < 0.05). In those with an elevated PLMI, arousal percentage attributable to PLMs was up to 25 % (median 7.5 %). ConclusionsElevated PLMI occurred at a higher prevalence in children with NMD and CP than reported in other clinic-referred paediatric populations. It is important that PLMs are not overlooked as identification and treatment may help improve sleep outcomes. Further research is required to understand the pathophysiology and consequences of PLMs specifically in this population.

Role of the oral health professional in obstructive sleep apnea

American Academy of Sleep Medicine (AASM) describes obstructive sleep apnea (OSA) as a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. This causes multiple episodes of hyperarousal or wakefulness from sleep, which leads to a decrease in the quality of sleep, leading to daytime sleepiness, increased affinity to accidents, and cardiovascular diseases such as myocardial infarction, congestive heart failure, and stroke. It is measured using the apnea-hypopnea index, that is, the number of sleep arousals in a given night. Possible risk factors for the disease include obesity (body mass index of ≥30), older age, Down’s syndrome, family history of OSA, and abnormal craniofacial features. Treatment options include continuous positive airway pressure, weight loss, oral devices, surgeries of the soft palate and/or genioglossus muscle, and maxilla-mandibular advancements. This review aims to address the oral diagnosis and dental treatment of OSA.

Evaluation of Sleep Quality in Asthmatic Children with the Paediatric Sleep Questionnaire (PSQ).

Considering the high prevalence of sleep-related breathing disorders (SRBD) in asthmatic patients, we aimed to compare asthmatic children and healthy children in terms of SRBD according to Paediatric Sleep Questionnaire (PSQ) scores. A questionnaire covering sociodemographic characteristics of the patients and the PSQ, which evaluates sleep quality and consists of 22 questions, was administered. During the data collection process, 180 patients in the patient group and 170 patients in the control group were included. The patient group showed statistically significantly higher total scores and subscale scores for snoring, sleepiness, and inattention compared to the control group. Statistically significant correlations were found between the sleepiness subscale and body mass index z score in a negative direction and between age at presentation and duration of asthma in a positive direction. Our findings endorse employing the PSQ as a screening instrument in the outpatient environment to ensure timely referral of asthma patients to a sleep specialist for SRBD evaluation. Considering the widespread occurrence of snoring and asthma, this tool could aid in identifying patients with an elevated risk of SRBD and expedite the scheduling of nocturnal polysomnography for these children.