Higher Arousal Index Research Articles

Sex differences in the risk of excessive daytime sleepiness in mild and moderate ischaemic stroke patients: a retrospective database study

BackgroundExcessive daytime sleepiness (EDS) is a common complication of stroke that has a detrimental effect on patients’ daily life and functional recovery. The clinical characteristics and risk factors for poststroke EDS may differ between males and females.MethodsA retrospective study based on hospital medical records was conducted on patients with a diagnosis of stroke who participated in polysomnographic monitoring at the Affiliated Hospital of Yangzhou University from February 2022 to May 2024. Baseline data, laboratory test data, polysomnographic data, and related scale scores were retrospectively collected. The Epworth Sleepiness Scale (ESS) score was used to assess EDS after stroke. Binary logistic regression was used to determine the risk factors for daytime sleepiness. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Statistical analysis was performed via IBM SPSS 26.0.ResultsESS scores were higher in males than in females, whereas females had higher Pittsburgh Sleep Quality Index (PSQI) scores and Hospital Anxiety and Depression Scale (HADS) scores. Male sex and higher depression scores were risk factors for EDS; among male patients, higher anxiety scores were a risk factor for EDS, whereas smoking was a protective factor. Depression, a higher arousal index and a reduced proportion of N3 sleep periods were risk factors for EDS in females.ConclusionsThe characteristics and influencing factors of EDS differ between the sexes in patients with mild and moderate ischaemic stroke. Our study may provide evidence and guidance for clinical diagnosis and treatment. Interventional studies are needed to assess the impact of treating these risk factors in the future.

The effect of central sleep apnea on sleep architecture in children with obstructive sleep apnea

ObjectiveThis study aimed to investigate how central sleep apnea (CSA) impacts sleep patterns in children with obstructive sleep apnea (OSA). MethodsChildren undergoing polysomnography (PSG) were enrolled and sorted into two groups: those with OSA alone (Group A) and those with both OSA and CSA (CAI <1 nd: children with 10 % CSA or more and less than 50 %, Group B). Statistical analysis was conducted to compare sleep structure and clinical features between Group A and Group B. ResultsGroup B exhibited significantly higher respiratory events, apnea hypoventilation index, apnea index and oxygen desaturation index (ODI) compared to Group A (p < 0.05). Group B also showed higher total sleep time and arousal index than Group A (P < 0.05). The proportion of time spent in stage N3 was lower in Group B than in Group A (P < 0.05). Moreover, mean heart rate and minimum heart rate were higher in Group B compared to Group A (P < 0.05).Minimum oxygenation levels (including non-rapid eye movement (NREM) stages) were lowe in Group B than in Group A (P < 0.05). Additionally, the prevalence of positional obstructive sleep apnea (P-OSA) was greater in Group B than in Group A (P < 0.05). ConclusionIn comparison to those with OSA alone, children with OSA and concurrent CSA exhibited distinct sleep patterns, including reduced N3uration, higher arousal index, longer respiratory events, higher ODI, and lower oxygen saturation, higher heart rate.

Duration of N1 sleep is a factor for excessive daytime sleepiness in epilepsy patients with interictal epileptiform discharges: A polysomnographic study

PurposeThis study aimed to identify the occurrence of excessive daytime sleepiness (EDS) in epilepsy patients with interictal epileptiform discharges and to explore the impact of interictal sleep architecture and sleep-related events on EDS. MethodsThis study included 101 epilepsy patients with interictal epileptiform discharges (IED) and 100 control patients who underwent simultaneous polysomnography and video ambulatory electroencephalography for >7 h throughout a single night. Multiple sleep latency tests were used to assess EDS. Comorbid EDS was present in 25 and 11 patients in the IED epilepsy and control groups, respectively. In addition, univariate and multivariate logistic regression analyses were performed to explore the factors influencing EDS. ResultsThe epilepsy group had a higher prevalence of comorbid EDS and shorter R sleep duration. Univariate logistic regression analysis indicated that an increased risk of EDS may be associated with prolonged N1 sleep duration, higher arousal index, lower mean saturation (mSaO2), higher oxygen desaturation index (ODI), and duration of wake after sleep onset (WASO). Multivariate logistic regression analysis revealed that N1 sleep duration was significantly correlated with EDS. ConclusionIn epilepsy patients with IED, the arousal index, mSaO2, ODI, and duration of WASO were weakly correlated with EDS, and the duration of N1 sleep demonstrated a significant positive correlation with EDS, which requires further research.

Long-term night-shift work is associated with accelerates brain aging and worsens N3 sleep in female nurses

BackgroundShift work disrupts circadian rhythms and alters sleep patterns, resulting in various health problems. To quantitatively assess the impact of shift work on brain health, we evaluated the brain age index (BAI) derived from sleep electroencephalography (EEG) results in night-shift workers and compared it with that in daytime workers. MethodsWe studied 45 female night shift nurses (mean age: 28.2 ± 3.3 years) and 44 female daytime workers (30.5 ± 4.7 years). Sleep EEG data were analyzed to calculate BAI. The BAI of night shift workers who were asleep during the daytime with those of daytime workers who were asleep at night were statistically compared to explore associations between BAI, duration of shift work, and sleep quality. ResultsNight-shift workers exhibited significantly higher BAI (2.14 ± 6.04 vs. 0 ± 5.35), suggesting accelerated brain aging and altered sleep architecture, including reduced delta and sigma wave frequency activity during non-rapid eye movement sleep than daytime workers. Furthermore, poor deep sleep quality, indicated by a higher percentage of N1, lower percentage of N3, and higher arousal index, was associated with increased BAI among shift workers. Additionally, a longer duration of night-shift work was correlated with increased BAI, particularly in older shift workers. ConclusionNight-shift work, especially over extended periods, may be associated with accelerated brain aging, as indicated by higher BAI and alterations in sleep architecture. Interventions are necessary to mitigate the health impacts of shift work. Further research on the long-term effects and potential strategies for sleep improvement and mitigating brain aging in shift workers is warranted.

Prevalence and Characteristics of Patients with Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease: Overlap Syndrome.

Overlap syndrome (OVS) is a distinct clinical entity that seems to result in potential cardiovascular consequences. We aimed to estimate the prevalence and risk factors for OVS in OSA patients and analyze clinical and PSG characteristics associated with OVS. In this cross-sectional study, 2616 patients evaluated for OSA underwent type-1 polysomnography (PSG). They were grouped as pure OSA (AHI > 15/h) and OVS patients. Demographics, PSG data, pulmonary function tests and arterial blood gases (ABGs) were compared between groups after adjustments for confounders. OSA was diagnosed in 2108 out of 2616 patients. Of those, 398 (19%) had OVS. Independent predictors of OVS were older age [OR: 5.386 (4.153-6.987)], current/former smoking [OR: 11.577 (7.232-18.532)], BMI [OR: 2.901 (2.082-4.044)] and ABG measurements [PaCO2 ≥ 45 OR: 4.648 (3.078-7.019), PO2 [OR: 0.934 (0.920-0.949)], HCO3- [OR: 1.196 (1.133-1.263), all p < 0.001]. OVS was also associated with prevalent hypertension [OR: 1.345 (1.030-1.758), p = 0.03] and cardiovascular disease [OR: 1.617 (1.229-2.126), p < 0.001], depressive symptoms [OR: 1.741 (1.230-2.465), p = 0.002] and nocturia [OR: 1.944 (1.378-2.742), p < 0.001], as well as with indices of OSA severity. Disturbances in sleep architecture were more prominent in OVS expressed by lower %N3 and REM% and higher arousal index. Our data suggest that OVS is prevalent among OSA patients, with distinct clinical and PSG characteristics. These characteristics could be utilized as predictive factors for early identification and further evaluation of these patients towards desirable patient-reported outcomes.

The relationship between obstructive sleep apnea and visual hallucinations in PD patients: a polysomnography study.

Parkinson's disease (PD) patients frequently experience visual hallucinations (VHs) and obstructive sleep apnea (OSA). The aim of this study was to describe the prevalence and clinical correlates of VHs and OSA in the Chinese population with PD. A sample of 489 PD patients was recruited for the present study. Patients were categorized as having formed VHs (FVHs) or minor VHs (MVHs) or as non-hallucinators (NVHs) according to the Unified Parkinson's Disease Rating Scale (UPDRS) and an initial questionnaire. Polysomnography (PSG) was used for objective assessment of sleep. VHs were observed in 143 (29.2%) patients. Among them, 75 of the hallucinators experienced MVHs, and 68 experienced FVHs. The disease duration, UPDRS Part III score, Hoehn and Yahr (H-Y) stage, Pittsburgh Sleep Quality Index (PSQI) score and rapid eye movement (REM) sleep behavior disorder (RBD) score of hallucinators were significantly greater than those of non-hallucinators (P < 0.05). We also observed OSA in 38.7, 54.7, and 63.3% of the NVH, MVH, and FVH groups, respectively. PSG showed that the VH groups had a lower total sleep time, lower sleep efficiency, higher arousal index, lower sleep latency, lower N1%, higher apnea-hypopnea index (AHI), higher average duration of apnea, higher respiratory-related arousal (RRA), and lower values of the lowest O2 and mean O2. The forward binary logistic regression model showed that AHI, N1%, RRA and lowest O2 were independently associated with VHs in PD patients. Our results confirm the high prevalence of VHs and OSA as well as their relationship in patients with PD.

Comparison of the clinical and electrophysiological characteristics between type 1 and type 2 narcolepsy: a cross-sectional study

IntroductionNarcolepsy is a chronic brain disease characterized by excessive sleepiness and classified into two types based on the presence of cataplexy or reduced level of cerebrospinal fluid orexin-A (hypocretine-1): narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). These two types differ in symptoms other than cataplexy, as well as in certain examination findings. The present study aimed to investigate the clinical and electrophysiological characteristics of NT1 by comparing its features with those of NT2.MethodsSubjects were 118 first diagnosed and untreated patients with narcolepsy. They underwent both polysomnography (PSG) and multiple sleep latency test (MSLT) as a sleep test. Diagnosis was established in accordance with International Classification of Sleep Disorders, Third Edition, and the type of narcolepsy was determined by the presence or absence of cataplexy, patients with cataplexy were diagnosed with NT1, and without cataplexy were diagnosed with NT2. We investigated characteristics of the patients, PSG and MSLT outcomes, and applied a suite of duly statistical analysis to account for each parameter.ResultsAmong the 118 subjects, 35 patients (29.7%) were NT1, and 83 patients (70.3%) were NT2. Excessive daytime sleepiness which was measured by Japanese version of Epworth sleepiness scale (JESS) was significantly higher in NT1 than NT2. Furthermore, the presence of sleep hallucination (n = 29, 82.9%), sleep paralysis (n = 18, 51.4%), difficult maintaining sleep (n = 22, 62.9%), and sleep related movement and behavior disorders (n = 7, 20.0%) were significantly higher in NT1 than those in NT2. Additionally, parameters indicative of sleep fragmentation, such as the arousal index and wake time after sleep onset measured in PSG, exhibited a statistically significant increase in NT1 when contrasted with NT2.ConclusionsFragmentation of nocturnal sleep which is explained by the high arousal index and the long wake time after sleep onset on PSG was considered a characteristic finding of NT1 compared with NT2, and the patients with NT1 experienced greater difficulty of maintaining sleep. Concomitantly, the prevalence of NT1 in this study may be a representative value of the prevalence of NT1 among the patients with narcolepsy in Japan.

The clinical characteristics of Parkinson's disease patients with concomitant periodic limb movements in sleep

The current study aimed to investigate the clinical characteristics of Parkinson's disease (PD) patients with concomitant periodic limb movements in sleep (PLMS). The clinical data of 36 PD patients who underwent polysomnography (PSG) in Beijing Tiantan Hospital from October 2018 to July 2022 were collected. Unified Parkinson's Disease Rating Scale 3.0 and Hoehn & Yahr (H-Y) stage were used to evaluate the disease severity. Patients were divided into two groups: the PLMS+group periodic limb movements in sleep index [(PLMSI)≥15 times/h] and the PLMS-group (PLMSI<15 times/h), using the PLMSI 15 times/h as the cut-off value. The clinical characteristics between the two groups were compared. There were 15 patients (42%) in the PLMS+group and 21 patients (58%) in the PLMS-group, among which 12 patients (12/15) in the PLMS+group and 9 patients (42.9%) in the PLMS-group had rapid eye movement sleep behavior disorder (RBD). The rate of RBD in PLMS+group was higher than that in PLMS-group (P<0.05). There was statistically significant difference in the blood folate level between the PLMS-group and PLMS+group [6.20 (5.14, 11.70) ng/ml vs 4.41 (3.07, 5.64) ng/ml] (P<0.01). Folate deficiency was more common in the PLMS+group, while no statistically significant differences were found in homocysteine and ferritin levels (both P>0.05). Four patients in the PLMS+group had falling experience, while 14.3% (3/21) patients in the PLMS-group had falling experience. Patients in the PLMS+group were more likely to fall. The PLMS+group had higher arousal index according to PSG [PLMS-group: 11.90 (9.10, 15.80) times/h; PLMS+group: 21.50 (19.35, 29.90) times/h] (P<0.05). No statistically significant differences in other sleep parameters were detected between the two groups (all P>0.05). Meanwhile, the apnea-hypopnea index (AHI) in both groups was higher than normal (<5 times/h), of which the PLMS-group was 9.80 (4.70, 22.20) times/h and the PLMS+group was 8.20 (1.70, 11.15) times/h, indicating that PD patients were more likely to experience sleep apnea and hypopnea. PD patients with PLMS had lower folate level, higher risk for falls, higher sleep arousal index, more sleep fragmentation, and higher prevalence of RBD.

The Oxygen Desaturation Index for Severity Assessment of Obstructive Sleep Apnea Associated With Cigarette Smoking

Objectives: Nicotine stimulates release of neurotransmitters that regulate the sleep-wake cycle and thereby leads to insomnia. Smoking is associated with upper airway distress; however, its role in severe sleep-related breathing disorders remains controversial. In this study, we investigated the effects of smoking on obstructive sleep apnea (OSA).Methods: We investigated 1,163 patients diagnosed with OSA who underwent polysomnography between March 2020 and July 2022. We recorded details including smoking status (current, former, and non-smoker), demographics, questionnaire-related data, and polysomnography findings and performed univariate analysis to compare these variables between smokers and non-smokers. We also analyzed the correlation between smoking status and OSA severity. The risk of smoking on the severity of OSA was determined using logistic regression analysis.Results: Current and former smokers included 461 male (49.1%) and 10 female (4.4%) (&lt;i&gt;p&lt;/i&gt;=0.001). Smokers had a high apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) (&lt;i&gt;p&lt;/i&gt;&lt;0.001), high arousal index (&lt;i&gt;p&lt;/i&gt;=0.001), and severe daytime sleepiness (indicated by the Epworth Sleepiness Scale, &lt;i&gt;p&lt;/i&gt;&lt;0.001). We observed no correlation between the AHI and the number of cigarettes smoked per day and the duration of smoking. Logistic regression analysis after adjustment for age, sex, body mass index, and alcohol consumption showed that smoking was a risk factor for ODI (ODI &gt;15, odds ratio 1.33, &lt;i&gt;p&lt;/i&gt;=0.04), and AHI was independent of smoking.Conclusions: Controversy regarding the severity of OSA with smoking has currently not been definitively determined. However, our results provide new evidence to support the association between smoking and the ODI, which few studies have investigated to date.

Association between Arousals during Sleep and Subclinical Coronary Atherosclerosis in Patients with Obstructive Sleep Apnea.

(1) Aim: We aim to evaluate the association between arousals during sleep and subclinical coronary atherosclerosis detected by coronary computed tomography angiography (CTA) in patients with obstructive sleep apnea (OSA). (2) Methods: This was a cross-sectional study. Consecutive newly diagnosed OSA patients, who underwent coronary CTA examinations within 3 months of the sleep study, were eligible. We used the arousal index (ArI) derived from polysomnography to assess arousals during sleep and a semi-automated plaque quantification software to characterize and quantify the subclinical coronary atherosclerosis. Multiple regression models were used to evaluate the associations of the ArI with the coronary atherosclerotic plaque presence, volume, and composition. (3) Results: A total of 99 patients with OSA were included in the study. In the multivariable models, patients with a high ArI (ArI > 32.2 events/h) were more likely to have coronary plaques compared to those with a low ArI (ArI ≤ 32.2 events/h) (OR: 3.29 [95% CI: 1.284 to 8.427], p = 0.013). Furthermore, the ArI exhibited significant associations with total (β = 0.015), noncalcified (β = 0.015), and low-attenuation (β = 0.012) coronary plaque volume after accounting for established risk factors (p = 0.008, 0.004, and 0.002, respectively). However, no association between the ArI and calcified plaque volume was found. (4) Conclusion: Repetitive arousals during sleep are associated with an increased coronary plaque burden in patients with OSA, which remained robust after adjusting for multiple established cardiovascular risk factors.

Discordant Subjective Perception of Sleep in Patients with Obstructive Sleep Apnea and Insomnia: A Retrospective Study.

BackgroundFactors affecting subjective perception of sleep are unclear but clinically important. We investigated the differences in subjective sleep perception of patients with obstructive sleep apnea (OSA) and insomnia disorder (ID).Material/MethodsFrom our Sleep Medicine Center database, 33 patients with OSA and 69 with ID were selected and assessed with the Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder screen, Patient Health Questionnaire-9, Epworth Sleepiness Scale, Pre-sleep Arousal Scale (PSAS), and polysomnography.ResultsIn subjective sleep tests, PSQI total score, sleep quality, sleep onset latency (SOL), total sleep time, and sleep efficiency (SE) were higher in patients with ID. In objective sleep tests, patients with OSA had longer total sleep time, shorter SOL, lower percentage of stage N3, less SE, higher percentage of stage N1, more arousals, and higher arousal index. Hyperarousal state evaluation showed cognitive hyperarousal significantly higher with ID. Subjective sleep perception with OSA correlated positively with PSAS total score, cognitive hyperarousal, and percentage of stage N2 and negatively with percentage of REM, apnea-hypopnea index, and desaturation index. Subjective sleep perception of patients with ID correlated positively with PSAS total score, cognitive hyperarousal, SOL, N3 sleep latency, and REM sleep latency and negatively with SE.ConclusionsSubjective sleep perception of OSA patients was mainly related to sleep structure and respiratory events, and that of ID patients, to sleep latency. Individual cognitive hyperarousal levels may be involved in negative subjective sleep perception. Clinicians should be aware that OSA patients may not actually experience adequate sleep.

0524 Polysomnographic Characteristics of Adolescent Patients with Class III Obesity and Severe OSA (AHI ≥30)

Abstract Introduction Adolescents with obesity are at increased risk for obstructive sleep apnea (OSA). Polysomnographic characteristics of pediatric patients with severe OSA (defined as AHI ≥30 events/hour) have not been frequently described. This study aims to describe clinical characteristics and polysomnographic data from a cohort of adolescents with both severe (class III, BMI ≥40 kg/m2) obesity and severe OSA. Methods This IRB-approved, retrospective review examines clinical and polysomnographic data from pediatric patients (ages 8-18) at Nemours Children’s Hospital, Wilmington, Delaware, who had initial baseline diagnostic polysomnogram performed from December 2012-September 2021. Subgroup analysis and descriptive statistics were performed in patients with severe OSA (AHI ≥30 events/hour). Results 259 (mean age 15.2 years, range 8 – 18 years, 64.4% female, 40.2% white, 46.7% black, mean BMI 50.3 kg/m2) pediatric patients with severe obesity completed initial baseline diagnostic polysomnogram in the study period. Of these patients, 41/259 (15.8%) met criteria for severe OSA (mean age mean age 15.4 years, range 12 – 18 years, 43.9% female, 46.3% white, 43.9% black, mean BMI 53.7 kg/m2). Of these studies, the mean total AHI was 65.2 (range 31.4-159.4) events/hr, obstructive apnea index (OAI) of 11.4 (range 0 – 69.4) events/hr and hypopnea index of 47.8 (range 12.9 – 108.8) events/hour. Mean SpO2 nadir was 78.9 (range 52 – 98)% with peak ETCO2 of 53.2 (range 39 – 69) mmHg. 12/41 (29.2%) of patients met polysomnographic criteria for hypoventilation (EtCO2 &amp;gt;50 mmHg for &amp;gt;25% of TST). Sleep architecture was notable for decreased mean sleep efficiency at 62.8% and elevated arousal index (mean 62.4 arousals/hour). Conclusion Adolescents with both severe OSA and obesity demonstrated a high frequency of hypopneas compared to apneic events and disrupted sleep architecture with high arousal index and decreased sleep efficiency. Interestingly, even among those with severe OSA, ventilation was acceptable in a majority of the patients. Further analysis will be completed to correlate patient clinical characteristics, including co-morbidities and lung function measurements, to help identify which patients with severe obesity are at risk for the most severe OSA. Support (If Any) None

0629 Metabolic syndrome in narcoleptic children

Abstract Introduction Narcolepsy is a disabling neurological disorder characterized primarily by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis, rapid eye movement (REM) behavior disorder (RBD) and disturbed nocturnal sleep. Over 50% of children with narcolepsy are obese. Metabolic syndrome (MetS), a constellation of disturbances associated with obesity, is increasingly seen in narcolepsy. A higher prevalence of MetS was revealed both in adults and children with narcolepsy. The objective of the present study was to compare clinical and sleep characteristics in children with narcolepsy with different components of MetS to clarify the mechanisms in MetS in these children. Methods This retrospective study included 58 children with narcolepsy. Data on blood pressure, High density lipoprotein (HDL) cholesterol, triglyceride, glucose, insulin and anthropometry (height and weight) were collected. MetS was defined when ≥3 of the following criteria were met: (1) Body mass index (BMI) ≥IOTF-30, (2) Blood pressure ≥90th percentile, (3) HDL-C ≤0.4 g/L, (4) Triglycerides ≥1.3 g/L, (5) homeostasis model assessment of insulin resistance (HOMA-IR) ≥75th percentile. Then, clinical and sleep characteristics were compared in groups with different MetS components. Results A total of 17 % of children with narcolepsy had MetS including 79% with high HOMA, 26% with high BMI, 24% with low HDL cholesterol and 12% with high triglycerides, but no patient with high blood pressure. 58% of the patients without obesity had at least 1, 2 or ≥3 MetS risk factors (78%, 15% and 6%, respectively). 55% of them were overweight. In children with narcolepsy with at least two MetS risk factors, there was a higher proportion of night eating, a lower percentage of N3 sleep, a higher arousal index, a shorter mean sleep latency and more sleep onset REM periods (SOREMPs) compared to patients with fewer MetS risk factors. Conclusion Altered sleep architecture and eating behavior are closely associated with risk factors of MetS in children with narcolepsy, even without obesity. We recommend to evaluate MetS risk in all children with narcolepsy to prevent complications such as type 2 diabetes and cardiovascular outcomes. Support (If Any)

Associations of the Severity of Obstructive Sleep Apnea With Age-Related Comorbidities: A Population-Based Study.

Aging is accompanied by changes in the quantity and quality of sleep. Obstructive sleep apnea (OSA) is also more prevalent in the older population. Although severe OSA has been linked to a higher risk of cardiovascular disease regardless of adult age, clinical consequences of mild-to-moderate OSA in the older adults are still uncertain.ObjectivesTo investigate the relationships between severity and metabolic, cognitive, and functional characteristics in community-dwelling older adults from a representative sample of the city of São Paulo.MethodsIn total, 199 participants of the first follow-up of the São Paulo Epidemiologic Sleep Study (EPISONO, São Paulo, Brazil) >60 years were cross-sectionally assessed through questionnaires, physical evaluations, laboratory tests, and full in-lab polysomnography (PSG). Three groups according to the OSA severity were compared according to sociodemographic characteristics, anthropometric measures, PSG parameters, the frequency of comorbidities, and the use of medications.ResultsParticipants' age ranged from 60 to 87 years with a mean of 70.02 ± 7.31, 59.8% female. In the univariate analysis, body mass index (BMI, kg/m2) (p = 0.049) and waist circumference (p = 0.005) were significantly higher in the participants with moderate OSA, but not among those with severe OSA. Participants with severe OSA had a higher arousal index (p = 0.007). Multivariate analysis showed that severe OSA was significantly associated with hypertension (p = 0.005), heart diseases (p = 0.025), and the use of two or more medications (p = 0.035).ConclusionIn a population-based study, severe, but not mild-to-moderate, OSA in older adults was associated with hypertension and the use of more medications. As age advances, anthropometric indicators of obesity may not increase the risk of severe OSA.

Early signs of sleep-disordered breathing in healthy women predict carotid intima-media thickening after 10 years

BackgroundCardiovascular disease (CVD) is the leading cause of death in women. The risk of CVD increases in women after menopause. The aim was to study how sleep parameters and cardiovascular risk factors in 46-year-old women predict future carotid intima-media thickness (IMT) 10 years after. MethodsProspective study of 92 healthy women, aged 46 years, were studied at baseline and at 10-year follow-up. Polysomnography for sleep and breathing; blood samples for cholesterol, glucose and follicle stimulating hormone; blood pressure (BP), weight and height measurements; questionnaires for background variables and vasomotor symptoms were carried out at both time points. Carotid ultrasound was scanned for IMT at 10-year follow-up. ResultsAfter adjusting for conventional risk factors, apnea-hypopnea index (AHI) during rapid-eye-movement (REM) sleep was the only parameter at baseline that predicted IMT 10 years after (IMT mean: β 81.4 [95% CI, 14.0–148.8]; IMT max: β 104.7 [95% CI, 15.4–194.1]). At 10-year follow-up, higher arousal index (IMT mean: β 55.6 [95% CI, 19.5–91.8]; IMT max β 59.9 [95% CI, 11.4–108.4]) and lower vasomotor symptoms (IMT max: β −60.5 [95% CI, −119.0 to −2.0]) were associated with concurrent higher IMT. The conventional risk factors at baseline did not associate with future IMT but 10 years after higher concurrent HbA1c (IMT mean: β 11.0 [95% CI, 3.4–18.5]; IMT max β 14.0 [95% CI, 4.1–23.8]) and systolic BP (IMT mean: β 2.4 [95% CI, 1.1–3.7]; IMT max: β 2.7 [95% CI, 1.03 to 4.53]) were associated with higher IMT. ConclusionsIn healthy 46-year-old women, AHI during REM sleep predicted IMT 10 years after. The conventional risk factors (HbA1c and BP) only associated with the concurrent IMT at 10-year follow-up.

Arousal characteristics in different OSAHS populations

Objective:This study sought to explore the effect of age on arousal index in patients with OSAHS, and the significance of arousal index among different phenotypes identified through cluster analysis according to clinical symptoms and complications. Methods:A total of 607 adult patients with OSAHS who received polysomnography in the Second Affiliated Hospital of Xi'an Jiaotong University from July 2020 to July 2021 were selected. All patients registered basic human data, symptoms, complaints and complications, completed the Epworth Sleepiness Scale. We explored the distribution of several PSG parameters in different age groups, and included typical symptoms and complications into cluster analysis to explore the parameter differences in patients with different phenotypes. Results:Young patients had the lowest arousal index and arousal frequency in NREM stage, in middle-aged patients, the arousal index was relatively higher, the arousal times during NREM with oxygen desaturation were the highest. Among elderly patients, the wakefulness after sleep onset（WASO） was the longest, the arousal times in REM sleep was the lowest, and the spontaneous arousal times in NREM sleep were the highest（P<0.05）. Among the 3 types according to the cluster analysis, phenotype Ⅰwas characterised by maximally complications, excessive daytime sleepiness and obesity, while memory and attention impairment were obvious in phenotype Ⅱ. Phenotype Ⅲhad minimal complications, relatively better mental state with shorter time-course of snoring and apnea. Phenotype I differed significantly by higher severity, more severe hypoxemia, higher arousal index and longer WASO time（P<0.05）. Conclusion:the arousal index distribution varies among OSAHS patients with different age, and cluster analysis shows that patients with severe symptoms and more complications tend to have higher arousal index.

Sleep-related hypoventilation and hypercapnia in multiple system atrophy detected by polysomnography with transcutaneous carbon dioxide monitoring.

PurposeWe aimed to evaluate sleep-related hypoventilation in multiple system atrophy (MSA) using polysomnography (PSG) with transcutaneous partial pressure of carbon dioxide (PtcCO2) monitoring.MethodsThis prospective study included 34 patients with MSA. Motor and autonomic function, neuropsychological tests, PSG with PtcCO2 monitoring, and pulmonary function tests were performed. Sleep-related hypoventilation disorder (SRHD) was defined according to the International Classification of Sleep Disorders, third edition.ResultsNine (27%) of the 34 patients met the diagnostic criteria of SRHD. Twenty-nine (85%) patients had sleep-related breathing disorders based on an Apnea–Hypopnea Index of ≥ 5/h. The patients with MSA and SRHD had a higher arousal index (p = 0.017) and obstructive apnea index (p = 0.041) than those without SRHD. There was no difference in the daytime partial pressure of carbon dioxide in arterial blood or respiratory function between MSA patients with and without SRHD.ConclusionSleep-related hypoventilation may occur in patients with MSA even with a normal daytime partial pressure of carbon dioxide. This can be noninvasively detected by PSG with PtcCO2 monitoring. SRBD and sleep-related hypoventilation are common among patients with MSA, and clinicians should take this into consideration while evaluating and treating this population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11325-022-02568-4.

Sleep in Children With Pallister Killian Syndrome: A Prospective Clinical and Videopolysomnographic Study.

Objectives: Pallister-Killian syndrome (PKS) is a rare genetic disorder with multi-organ involvement caused by mosaic tetrasomy of chromosome 12p. Although many caregivers report the presence of impaired sleep in their children, there are no clear data in the literature on this issue and no systematic study has ever been performed. With this study, we aimed to characterize the features of sleep in Pallister-Killian syndrome and identify the possible influence of clinical and demographic features. Moreover, our aim was to verify the effectiveness of conventional screening questionnaires in this particular group of patients.Methods: We prospectively enrolled 14 patients aged 1–17 years in collaboration with PKS Kids Italia ONLUS. The Sleep Disturbance Scale for Children (SDSC) questionnaire was administered to caregivers. Then, video polysomnography (VPSG) of at least 24 h was performed and results were compared with a same-aged control group.Results: A total of 92% of patients had abnormal SDSC scores, extremely high in the “disorder of initiating and maintaining sleep” (DIMS) and “sleep breathing disorders” (SBD) subscales. VPSG showed a significantly impaired macrostructure in PKS patients, with a higher Arousal Index (p < 0.00001) and percentage of time spent in N3 (p < 0.00001), and reduced Sleep Efficiency (p = 0.0006). After dividing both PKS and controls into two groups based on median age, some peculiarities emerged: the younger group had higher Awakenings Index (p = 0.0207) and percentage of time spent in N1 (p = 0.015) while the older group showed higher time in bed (TIB) (p = 0.0485), compared with controls. Due to poor compliance, the Apnea-Hypopnea Index (AHI) was evaluated only for 10 PKS children, being significantly increased (p = 0.0427) compared with controls. SBD subscale scores in SDSC were significantly related to AHI values in VPSG (p = 0.0099).Conclusions: This study constitutes the first attempt to describe the sleep pattern in PKS. Despite small numbers due to the rarity of the syndrome, our VPSG results confirm the high prevalence of sleep disorders (SDs) in these patients. It is therefore essential to investigate and treat them. The SDSC scale is a good screening tool for early detection also in these patients, with particular sensitivity in detecting breathing disorders.

The association between obstructive sleep apnea and sleep spindles in middle-aged and older men: a community-based cohort study.

Sleep spindles show morphological changes in obstructive sleep apnea (OSA). However, previous small studies have limited generalizability, leaving associations between OSA severity measures and spindle metrics uncertain. This study examined cross-sectional associations between OSA severity measures and spindle metrics among a large population-based sample of men. Community-dwelling men with no previous OSA diagnosis underwent home-based polysomnography. All-night EEG (F4-M1) recordings were processed for artifacts and spindle events identified using previously validated algorithms. Spindle metrics of interest included frequency (Hz), amplitude (µV2), overall density (11-16 Hz), slow density (11-13 Hz), and fast density (13-16 Hz) (number/minute). Multivariable linear regression models controlling for demographic, biomedical, and behavioral confounders were used to examine cross-sectional associations between OSA severity measures and spindle metrics. In adjusted analyses, higher apnea-hypopnea index (AHI/h, as a continuous variable) and percentage total sleep time with oxygen saturation <90% (TST90) were associated with decreased slow spindle density (AHI, B = -0.003, p = 0.032; TST90, B = -0.004, p = 0.047) but increased frequency (AHI, B = 0.002, p = 0.009; TST90, B = 0.002, p = 0.043). Higher TST90 was also associated with greater spindle amplitude (N2 sleep, B = 0.04, p = 0.011; N3 sleep, B = 0.11, p < 0.001). Furthermore, higher arousal index was associated with greater spindle amplitude during N2 sleep (B = 0.31, p < 0.001) but decreased overall density (B = -1.27, p = 0.030) and fast density (B = -4.36, p = 0.028) during N3 sleep. Among this large population-based sample of men, OSA severity measures were independently associated with spindle abnormalities. Further population studies are needed to determine associations between spindle metrics and functional outcomes.

The relationship between body composition and sleep architecture in athletes

Sleep is essential for athletes to recover physical fitness. It has been suggested that sleep is affected by muscle volume. Compared to female athletes, male athletes with greater muscle volume may have inferior objective sleep quality. This study aimed to assess the relationship between body composition and objective sleep parameters in male and female athletes. The body composition of 17 male and 19 female collegiate athletes were measured, and they underwent overnight home sleep monitoring. Compared with female athletes, male athletes had more muscle mass and less fat mass. Moreover, male athletes had lower sleep efficiency, longer sleep onset latency, higher arousal index, less rapid eye movement (REM) sleep, and lower percentage of slow-wave (N3) sleep in the initial non-REM sleep. Furthermore, the percentage of muscle mass was inversely related, whereas fat mass or percentage of fat mass was directly related to the percentage of N3 sleep in the initial non-REM sleep. Overall, there were no significant association between sex and sleep parameters. However, a significant correlation was found within both subgroups. Objective sleep quality was suggested to be worse in male athletes than in female athletes, implying that sleep architecture may be related to the muscle volume.