Eye Movement Latency Research Articles

Association of rapid eye movement sleep latency with multimodal biomarkers of Alzheimer's disease.

Sleep disturbances are associated with Alzheimer's disease (AD)and Alzheimer's disease and related dementias (ADRD), but the relationship between sleep architecture, particularly rapid eye movement (REM) sleep, and AD/ADRD biomarkers remains unclear. We enrolled 128 adults (64 with Alzheimer's disease, 41 with mild cognitive impairment [MCI], and 23 with normal cognition [NC]), mean age 70.8±9.6 years, 56.9% female, from a tertiary hospital in China. Participants underwent overnight polysomnography (PSG), amyloid β (Aβ) positron emission tomography (PET), and plasma biomarker analysis: phosphorylated tau at threonine 181 (p-tau181), neurofilament light (NfL), and brain-derived neurotrophic factor (BDNF). After adjusting for demographics, apolipoprotein E (APOE) ε4 status, cognition, and comorbidities, the highest tertile of REM latency was associated with higher Aβ burden (β=0.08, 95% confidence interval [CI]: 0.03 to 0.13, p=0.002), elevated p-tau181 (β=0.19, 95% CI: 0.02 to 0.13, p=0.002), and reduced BDNF levels (β=-0.47, 95% CI: -0.68 to -0.13, p=0.013), compared to the lowest tertile. Prolonged REM latency may serve as a novel marker or risk factor for AD/ADRD pathogenesis. Rapid eye movement latency (REML) may be a potential marker for Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) pathogenesis. Prolonged REML was associated with higher amyloid beta (Aβ) burden, phosphorylated tau-181 (p-tau181), and lower brain-derived neurotrophic factor (BDNF) levels. Intervention trial is needed to determine if targeting REML can modify AD/ADRD risk. Slow-wave sleep was not associated with AD/ADRD biomarkers.

Objective measures of sleep in adults and older adults with and without depression: A systematic review and meta-analysis

Sleep architecture is poorly defined in people with depression, especially in older adults. We investigated differences in sleep macro- and micro-architecture between adults and older adults (>50 years) with and without depression.A systematic review identified 2135 papers through PubMed, Scopus, Web of Science and Embase databases. Two reviewers excluded articles using PRISMA guidelines. Fifteen articles met inclusion criteria. A random effects model meta-analysis was performed. NICE case-control guidelines were used to assess risk of bias.In the fifteen articles, 838 participants underwent objective sleep measurement (406 depression and 432 control). All adults with depression had less total sleep time, delayed sleep onset latency, higher wake after sleep onset, shorter rapid eye movement latency (ROL) and greater rapid eye movement REM density than controls. Two of these studies examined sleep architecture in 62 older adults (31 depression, 31 control). Older adults with depression had more stage 1 sleep, less stage 2 sleep, shorter ROL than older controls with no between-group difference in sleep efficiency, REM sleep or REM density. Six studies had poor case-control selection, which when removed nullified the effects of REM density and REM latency in all adults. Sleep micro-architecture measures could not be meta-analysed due to the limited studies available.Adults with depression had moderately worse sleep initiation and continuity than controls. Alterations to REM sleep were observed in adults with depression, however these effects were not robust. Sleep macro-architecture differences were not consistent in younger adults and older adults with depression, compared to relative controls.

Functional changes in sleep-related arousal after ketamine administration in individuals with treatment-resistant depression

The glutamatergic modulator ketamine is associated with changes in sleep, depression, and suicidal ideation (SI). This study sought to evaluate differences in arousal-related sleep metrics between 36 individuals with treatment-resistant major depression (TRD) and 25 healthy volunteers (HVs). It also sought to determine whether ketamine normalizes arousal in individuals with TRD and whether ketamine’s effects on arousal mediate its antidepressant and anti-SI effects. This was a secondary analysis of a biomarker-focused, randomized, double-blind, crossover trial of ketamine (0.5 mg/kg) compared to saline placebo. Polysomnography (PSG) studies were conducted one day before and one day after ketamine/placebo infusions. Sleep arousal was measured using spectral power functions over time including alpha (quiet wakefulness), beta (alert wakefulness), and delta (deep sleep) power, as well as macroarchitecture variables, including wakefulness after sleep onset (WASO), total sleep time (TST), rapid eye movement (REM) latency, and Post-Sleep Onset Sleep Efficiency (PSOSE). At baseline, diagnostic differences in sleep macroarchitecture included lower TST (p = 0.006) and shorter REM latency (p = 0.04) in the TRD versus HV group. Ketamine’s temporal dynamic effects (relative to placebo) in TRD included increased delta power earlier in the night and increased alpha and delta power later in the night. However, there were no significant diagnostic differences in temporal patterns of alpha, beta, or delta power, no ketamine effects on sleep macroarchitecture arousal metrics, and no mediation effects of sleep variables on ketamine’s antidepressant or anti-SI effects. These results highlight the role of sleep-related variables as part of the systemic neurobiological changes initiated after ketamine administration. Clinical Trials Identifier: NCT00088699.

Functional impact of bilateral vestibular loss and the unexplained complaint of oscillopsia.

The vestibulo-ocular reflex (VOR) stabilizes vision during head movements. VOR disorders lead to symptoms such as imbalance, dizziness, and oscillopsia. Despite similar VOR dysfunction, patients display diverse complaints. This study analyses saccades, balance, and spatial orientation in chronic peripheral and central VOR disorders, specifically examining the impact of oscillopsia. Participants involved 15 patients with peripheral bilateral vestibular loss (pBVL), 21 patients with clinically and genetically confirmed Machado-Joseph disease (MJD) who also have bilateral vestibular deficit, and 22 healthy controls. All pBVL and MJD participants were tested at least 9 months after the onset of symptoms and underwent a detailed clinical neuro-otological evaluation at the Dizziness and Eye Movements Clinic of the Meir Medical Center. Among the 15 patients with pBVL and 21 patients with MJD, only 5 patients with pBVL complained of chronic oscillopsia while none of the patients with MJD reported this complaint. Comparison between groups exhibited significant differences in vestibular, eye movements, balance, and spatial orientation. When comparing oscillopsia with no-oscillopsia subjects, significant differences were found in the dynamic visual acuity test, the saccade latency of eye movements, and the triangle completion test. Even though there is a significant VOR gain impairment in MJD with some subjects having less VOR gain than pBVL with reported oscillopsia, no individuals with MJD reported experiencing oscillopsia. This study further supports that subjects experiencing oscillopsia present a real impairment to stabilize the image on the retina, whereas those without oscillopsia may utilize saccade strategies to cope with it and may also rely on visual information for spatial orientation. Finding objective differences will help to understand the causes of the oscillopsia experience and develop coping strategies to overcome it.

Variations of Sleep Patterns and Their Relations with Positive and Negative Domains of Schizophrenia in Eastern Indian Population

Abstract Objectives: Schizophrenia is a persistent and incapacitating psychiatric condition characterized by symptoms with positive, negative, affective, and cognitive domains. Sleep disturbances represent an important facet of this disorder, impacting both the quality of life and influencing its overall outcome. In the cross-sectional study, we intended to investigate the polysomnographic findings of patients with schizophrenia showing predominantly positive symptoms as opposed to those presenting with predominantly negative symptoms and also as compared to normal population. Methods: This study had a cross-sectional design, involving the recruitment of 60 medication-naive patients diagnosed with schizophrenia according to the ICD-10 criteria and 30 study participants representing normal population. The cases were subdivided into two groups: one characterized by predominantly positive symptoms and the other characterized by predominantly negative symptoms. Both the groups received overnight polysomnography, and study variables were recorded. Results: All the sleep parameters were deranged in patients with schizophrenia as compared to normal controls in the general population, with significantly more pronounced differences found in those with predominant positive symptoms for most variables (p < 0.001). The only exception was the duration of N3 (slow-wave sleep) which was significantly decreased in patients with negative symptoms compared to those with positive symptoms (p < 0.001). But no significant differences were found between the negative and positive symptom domain groups in mean rapid eye movement (REM) latency, duration of N1 and N2 sleep, and total percentage of REM sleep. Conclusion: This study highlights substantial variations in sleep patterns between the negative and positive symptom domains of schizophrenia and also as compared to the general population. Further study is imperative to explore the link between circadian integrity and symptoms of the various domains of schizophrenia.

Sleep physiology in patients with epilepsy: Influence of seizures on rapid eye movement (REM) latency and REM duration.

A well-established bidirectional relationship exists between sleep and epilepsy. Patients with epilepsy tend to have less efficient sleep and shorter rapid eye movement (REM) sleep. Seizures are far more likely to arise from sleep transitions and non-REM sleep compared to REM sleep. Delay in REM onset or reduction in REM duration may have reciprocal interactions with seizure occurrence. Greater insight into the relationship between REM sleep and seizure occurrence is essential to our understanding of circadian patterns and predictability of seizure activity. We assessed a cohort of adults undergoing evaluation of drug-resistant epilepsy to examine whether REM sleep prior to or following seizures is delayed in latency or reduced in quantity. We used a spectrogram-guided approach to review the video-electroencephalograms of patients' epilepsy monitoring unit admissions for sleep scoring to determine sleep variables. In our cohort of patients, we found group- and individual-level delay of REM latency and reduced REM duration when patients experienced a seizure before the primary sleep period (PSP) of interest or during the PSP of interest. A significant increase in REM latency and decrease in REM quantity were observed on nights where a seizure occurred within 4 h of sleep onset. No change in REM variables was found when investigating seizures that occurred the day after the PSP of interest. Our study is the first to provide insight about a perisleep period, which we defined as 4-h periods before and after the PSP. Our results demonstrate a significant relationship between seizures occurring prior to the PSP, during the PSP, and in the 4-h perisleep period and a delay in REM latency. These findings have implications for developing a biomarker of seizure detection as well as longer term seizure risk monitoring.

Polysomnographic characteristics of sleep in adults with and without physician-diagnosed atopic dermatitis: results from the Study of Health in Pomerania

PurposeTo analyze sleep characteristics as measured with polysomnography (PSG) in adults from the general population with and without physician-diagnosed atopic dermatitis (AD).MethodsWe analyzed data from participants from the German population-based Study of Health in Pomerania (SHIP) TREND-0. AD was diagnosed in a standardized skin examination. The following polysomnographic parameters were measured: total sleep duration (min), sleep latency (min), wake after sleep onset (WASO; min), rapid eye movement (REM) latency (min), sleep efficiency (%), total number of wakefulness and movement episodes, stages of sleep (%), and apnea-hypopnea index (AHI). Additionally, the subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). We compared sleep characteristics of participants with and without AD.ResultsAmong 1187 participants, 47 (4.0%) had AD. We found no differences between participants with and without AD in any of the analyzed PSG parameters except for the total number of wakefulness and movement episodes and the percentage of REM sleep. Participants with AD had a higher number of wakefulness and movement episodes, and a lower proportion of REM sleep compared to those without AD. Regarding subjective sleep parameters, no significant differences were found between participants with and without AD.ConclusionOur data do not provide evidence for poor sleep quality in individuals with AD. Major limitations of the study include the unavailability of data on AD severity and the small number of participants with AD. Larger-scaled longitudinal studies considering disease severity and specific AD symptoms with an effect on sleep are required.

The Effect of Stimulus Contrast and Spatial Position on Saccadic Eye Movement Parameters.

(1) Background: Saccadic eye movements are rapid eye movements aimed to position the object image on the central retina, ensuring high-resolution data sampling across the visual field. Although saccadic eye movements are studied extensively, different experimental settings applied across different studies have left an open question of whether and how stimulus parameters can affect the saccadic performance. The current study aims to explore the effect of stimulus contrast and spatial position on saccadic eye movement latency, peak velocity and accuracy measurements. (2) Methods: Saccadic eye movement targets of different contrast levels were presented at four different spatial positions. The eye movements were recorded with a Tobii Pro Fusion video-oculograph (250 Hz). (3) Results: The results demonstrate a significant effect of stimulus spatial position on the latency and peak velocity measurements at a medium grey background, 30 cd/m2 (negative and positive stimulus polarity), light grey background, 90 cd/m2 (negative polarity), and black background, 3 cd/m2 (positive polarity). A significant effect of the stimulus spatial position was observed on the accuracy measurements when the saccadic eye movement stimuli were presented on a medium grey background (negative polarity) and on a black background. No significant effect of stimulus contrast was observed on the peak velocity measurements under all conditions. A significant stimulus contrast effect on latency and accuracy was observed only on a light grey background. (4) Conclusions: The best saccadic eye movement performance (lowest latency, highest peak velocity and accuracy measurements) can be observed when the saccades are oriented to the right and left from the central fixation point. Furthermore, when presenting the stimulus on a light grey background, a very low contrast stimuli should be considered carefully.

Differences between hemispheres and in saccade latency regarding volleyball athletes and non-athletes during saccadic eye movements: an analysis using EEG.

The saccadic eye movement is responsible for providing focus to a visual object of interest to the retina. In sports like volleyball, identifying relevant targets quickly is essential to a masterful performance. The training improves cortical regions underlying saccadic action, enabling more automated processing in athletes. We investigated changes in the latency during the saccadic eye movement and the absolute theta power on the frontal and prefrontal cortices during the execution of the saccadic eye movement task in volleyball athletes and non-athletes. We hypothesized that the saccade latency and theta power would be lower due to training and perceptual-cognitive enhancement in volleyball players. We recruited 30 healthy volunteers: 15 volleyball athletes (11 men and 4 women; mean age: 15.08 ± 1.06 years) and 15 non-athletes (5 men and 10 women; mean age: 18.00 ± 1.46 years). All tasks were performed simultaneously with electroencephalography signal recording. The latency of the saccadic eye movement presented a significant difference between the groups; a shorter time was observed among the athletes, associated with the players' superiority in terms of attention level. During the experiment, the athletes observed a decrease in absolute theta power compared to non-athletes on the electrodes of each frontal and prefrontal area. In the present study, we observed the behavior of reaction time and absolute theta power in athletes and non-athletes during a saccadic movement task. Our findings corroborate the premise of cognitive improvement, mainly due to the reduction of saccadic latency and lower beta power, validating the neural efficiency hypothesis.

The insensitivity of sleep to an unfamiliar sleeping environment in patients with insomnia disorder.

Sleeping in an unfamiliar environment, such as a sleep laboratory, is thought to disturb sleep in healthy individuals and could express a hyperarousal state called the first night effect. Insomnia disorder (ID) is a highly prevalent health problem characterized by increased arousal during the night and daytime. Whether or nota similar phenomenon occurs in patients with ID is unclear. This study aimed to investigate the effect of an unfamiliar environment on the sleep of patients with ID. In an unfamiliar sleep laboratory, polysomnographic recording testing was performed for two consecutive nights in patients with ID and age- and sex-matched healthy controlsubjects (HC). We collected sleep diaries and questionnaires regarding sleep, medical conditions, psychological status, and health history. Sleep continuity and architecture in both groups were compared and analyzed for two consecutive nights. Participants with ID(n = 39) and HC(n = 35) demonstrated differentially poor sleep on laboratory adaptation after exposure to the sleep laboratory. Patients with ID had longer rapid eye movement (REM) latency on the first night than on the second sleep night. HC showed increased duration and percentage of N1, decreased duration and percentage of N3, and decreased REM percentage during initial nights compared to subsequent nights. The other sleep variables showed no differences between the first and second sleep nights in patients with ID and HC. An unfamiliar sleep environment does not aggravate the disruption of sleep continuity and sleep architecture but only affects the REM latency in patients with ID compared with HC.

Eye Movement Latency Coefficient of Variation as a Predictor of Cognitive Impairment: An Eye Tracking Study of Cognitive Impairment.

Studies demonstrated impairment in the control of saccadic eye movements in Alzheimer's disease (AD) and people with mild cognitive impairment (MCI) when conducting the pro-saccade and antisaccade tasks. Research showed that changes in the pro and antisaccade latencies may be particularly sensitive to dementia and general executive functioning. These tasks show potential for diagnostic use, as they provide a rich set of potential eye tracking markers. One such marker, the coefficient of variation (CV), is so far overlooked. For biological markers to be reliable, they must be able to detect abnormalities in preclinical stages. MCI is often viewed as a predecessor to AD, with certain classifications of MCI more likely than others to progress to AD. The current study examined the potential of CV scores on pro and antisaccade tasks to distinguish participants with AD, amnestic MCI (aMCI), non-amnesiac MCI (naMCI), and older controls. The analyses revealed no significant differences in CV scores across the groups using the pro or antisaccade task. Antisaccade mean latencies were able to distinguish participants with AD and the MCI subgroups. Future research is needed on CV measures and attentional fluctuations in AD and MCI individuals to fully assess this measure's potential to robustly distinguish clinical groups with high sensitivity and specificity.

Ictal blinking triggered by isolated spikes as the only manifestation of seizures.

To describe blinking as the only manifestation of seizures from isolated focal and generalized cortical spikes and investigate the relationship between blinks and epileptic discharges. We measured the latency from the onset of spikes to the onset of blinks in two patients using electroencephalogram (EEG) and an electrooculogram (EOG), and calculated the median latency in both cases. We analyzed the latency from spike onset to the onset of additional specific eye movements, seen only in the second case. To determine the frequency of spontaneous blinks (not triggered by spikes), we defined a "control point" at 45 s following a random spike for the first case. We tested for statistically significant associations between latencies of blinks (Case 1) as well as between latencies of blinks and specific eye movements (Case 2). A total of 174 generalized spike-waves followed by a blink were analyzed in the first patient. Approximately 61% of the blinks occurred within 150-450 ms after the onset of the spike. Median latency for blinks following a spike was 294 ms compared to 541 ms for control blinks (p=.02). For the second patient, a total of 160 eye movements following a right occipito-parietal spike were analyzed. The median spike-blink latency in the second case was 497 milliseconds. Median latencies of spike onset to contralateral oblique eye movements with blink and left lateral eye movements were 648 and 655 milliseconds, respectively. Our study shows that isolated cortical spikes can induce epileptic seizures consisting exclusively of blinks. These findings emphasize the importance of careful EEG and EOG analysis to determine blinking as the only ictal phenomenon. We additionally describe a new technique to prove the temporal relationship between cortical discharges and a specific movement when, in addition to the movements triggered by a spike, the same movement is also spontaneously performed by the patient (in this case, blinking).

Analysis of the effect of brexpiprazole on sleep architecture in patients with schizophrenia: A preliminary study.

Brexpiprazole is an atypical antipsychotic drug widely used in Japan for the treatment of schizophrenia. Previous studies have investigated the therapeutic effects of some antipsychotics on sleep variables; however, to our knowledge, the effects of brexpiprazole on sleep architecture have not been examined in patients with schizophrenia. Therefore, we aimed to exploratorily investigate the effect of brexpiprazole on sleep variables measured by polysomnography in patients with schizophrenia. This study included 10 patients with schizophrenia who were originally treated with haloperidol alone. Sleep variables of the participants were measured using polysomnography. After excluding those who did not meet the study criteria, seven patients (five men and two women; mean age [SD], 59.0 [10.0] years) were eligible for further analysis. Polysomnography was repeated at 4 weeks after the participants were prescribed brexpiprazole in addition to haloperidol. We compared the sleep architecture of the participants, measured using polysomnography, before and after taking brexpiprazole. Add-on brexpiprazole significantly prolonged rapid eye movement latency, increased the duration and percentage of stage N2 and stage N3 sleep (min, %), and decreased the duration and percentage of stage rapid eye movement sleep (min, %) at a significance level of nominal p < 0.05. Although not significant after correcting for multiple comparisons, the present results showed that add-on brexpiprazole could alter the sleep architecture of patients with schizophrenia. Future studies are warranted to replicate these findings and to further investigate the beneficial influence of brexpiprazole on sleep.

O064 A Portable Ocular Assessment for Predicting Fitness to Drive under Extended-Wakefulness Conditions – Preliminary Analysis

Abstract Introduction In response to the high incidence of fatigue-based vehicle accidents, roadside assessments of sleepiness are in significant demand. For this purpose, we’ve piloted the existing NeuroFlex® Platform, which takes ocular performance measurements of both prosaccade and antisaccade eye-movements using a portable Virtual Reality (VR) headset. We’ve conducted preliminary comparisons between these measures and simulated driving performance. Methods Sixteen young-adults (females= 8; age M= 25.13, SD= 4.30) completed five test batteries starting 1-hour post-wake where repeated testing encapsuled more than 24-hours of extended wakefulness. Each battery consisted of one 60-minute drive on the AusEd driving simulator, in addition to three administrations of 60-second prosaccade and antisaccade assessments using the NeuroFlex® VR platform. Results Steering deviations from the median lane position showed a time main effect, F(4,24.49) = 13.38, p &amp;lt;.001, with the most diminished performance occurring at 19 (M=59.50cm, SD=26.61cm) and 25-hours post-wake (M=72.88cm, SD= 40.09cm) (vs. peak performance @13-hours post-wake M=35.09, SD=12.81; M diff.= 24.41 and 37.79 respectively, p &amp;lt;.001). One moderate association between prosaccade latency and steering deviation was found in the final battery following 25-hours of wakefulness (r=.51, p= 0.04). No significant associations were found for antisaccade latency. Discussion Despite the lack of significant associations with steering deviations, eye-movement latency did demonstrate durational increases over extended wakefulness. In this preliminary investigation we were limited to the existing output generation of the NeuroFlex® platform. Therefore, with refined data analyses of ocular control, we see promise in the NeuroFlex® platforms capability of detecting road users’ fitness to drive.

P021 Associations between Virtual Reality (VR) Ocular Assessments and Vigilance during Extended Wakefulness – Preliminary Analysis

Abstract Introduction Sustained vigilance is essential for safety in high-risk workplaces, making rapid and accessible alertness failure vulnerability assessments extremely desirable. We are piloting existing technology, the NeuroFlex® Platform, which takes ocular performance measurements of both prosaccade and antisaccade eye-movements using a portable Virtual Reality (VR) headset. We’ve conducted preliminary comparisons between these measures and Psychomotor Vigilance during extended wakefulness. Methods Sixteen young-adults (females= 8; age M= 25.13, SD= 4.30) completed five test batteries starting 1-hour post-wake where repeated testing encapsuled more than 24-hours of extended wakefulness. Each battery consisted of two 10-minute visual Psychomotor Vigilance Tasks, in addition to three administrations of 60-second prosaccade and antisaccade assessments using the NeuroFlex® VR platform. Results Time main effects occurred for reciprocal reaction time, F(3.83,57.37) = 20.54, p &amp;lt;.001, and proportions of lapses/trials, F(3.55,48.33) = 7.36, p &amp;lt;.001. Vigilance troughs occurred around the circadian nadir (19-hours post-wake) with some recovery at final administrations (25-hours post-wake). No associations were found between prosaccade latency and vigilance metrics. Moderate negative (r=-.63, p=.01 &amp; r=-.54, p=.03) associations were found between antisaccade latency and reciprocal reaction time near the nadir, but not the number of lapses per trial. Discussion This preliminary analysis has demonstrated potential sensitivity of the NeuroFlex® platforms ocular measurements to vigilance. Though we have not detected associations between lapses and eye-movement latency, we were limited to the existing output generation of the NeuroFlex® platform in this preliminary investigation. With refined data analyses, we see promise in the NeuroFlex® platforms capability of predicting alertness failure.

P096 Objective Measures of Sleep Architecture in Adults and Older Adults with Depression: A Systematic Review and Meta-Analysis

Abstract Depression is intrinsically linked to sleep, however, the exact nature of sleep disturbances has been poorly defined, especially for older adults over 50 years with depression. We examined published articles with overnight EEG recordings in adults with and without depression to determine if objective measures of sleep macro and micro architecture differ. We also examined differences in these outcomes in older adults. 2135 papers were identified through four databases. Two reviewers, using the PICO structure, removed 2062 papers at abstract review and 58 at full text review. Fifteen articles met inclusion criteria and reported macroarchitecture. Three reported microarchitectural outcomes but were not meta-analysed. RevMan 5.4 software was used to perform a random effects model meta-analysis. NICE case-control guidelines were used for risk of bias. Fifteen studies were assessed (406 depressed and 432 control). Two papers examined older adults (31 depression and 31 controls). Within the total population, adults with depression had less total sleep time, lower sleep efficiency(SE), delayed sleep onset latency, higher wake after sleep onset, shorter rapid eye movement latency(ROL) and greater REM density than controls. No differences in stage 1(N1), stage 2(N2), stage 3(N3) or REM sleep were observed. In older adults, the depressed group had greater N1, less N2, shorter ROL, greater REM density and no difference in SE or in REM sleep duration. REM latency and REM density outcomes were consistent across older and younger depressed groups, whereas younger adults with depression had worse sleep continuity. Differences in sleep phenotype may relate to underlying neuropathology.

Therapeutic Effect of Extended Uvulopalatal Flap Surgery in Patients With Obstructive Sleep Apnea

Background and Objective Although numerous studies have reported surgical results of uvulopalatopharyngoplasty, efficacies of extended uvulopalatal flap (EUPF) surgery have only been reported in a few studies. Thus, the aim of this study was to evaluate the success rate of EUPF and investigate the advantage and practicality of this surgery.Methods Medical records of patients who underwent EUPF surgery were retrospectively analyzed. Through medical record analysis, demographic information was confirmed. Postoperative polysomnography (PSG) results were divided into a surgical ‘success’ group and a ‘failure’ group. Patients’ PSG results, questionnaires, and cephalometry were comparatively analyzed.Results All sleep parameters of PSG except rapid eye movement latency and hypopnea index were significantly improved after surgery. Ten patients were in the success group (success rate, 33.3%) and 20 patients were in the failure group. Among preoperative PSG parameters, apnea-hypopnea index, apnea index, and number of awakenings showed significant differences between the two groups. However, there were no significant differences in results of cephalometry or Friedman stage between the two groups.Conclusions The EUPF surgery can change sleep factors and improve subjective symptoms in obstructive sleep apnea patients. It could be considered as one of the treatment options for patients with surgical indications, although its success rate was only 33.3%.

Effects of exercise training and exercise plus acupuncture on chronic insomnia: a feasibility study.

ObjectiveThe aim of this study was to investigate the effects of exercise and exercise plus acupuncture on chronic insomnia.Material and Methodssuggest replacing with “effects of” no feasibility things are reported chronic insomnia were randomized to a 12-week treatment with exercise or exercise plus acupuncture. Exercise treatment included 50 minutes of moderate-intensity aerobic exercise (50% of reserve heart rate), on a treadmill, 3 times/wk. Exercise plus acupuncture treatment included the exercise protocol plus acupuncture once per week. Pre- and post-treatments measures included insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), polysomnography (PSG), 10 days-sleep diary, state-trait anxiety inventory, Beck depression inventory, quality of life (SF-36), and morning cortisol level.ResultsNo group by time interaction was found for insomnia severity, sleep, mood or quality of life. Significant time differences (p<0.05) were observed for ISI, PSQI, and some variables of sleep diary. Polysomnography data showed a decrease in rapid eye movement (REM) latency after the interventions. Significant time improvements were also observed for mood, anxiety, depression, and quality of life. A significant moderate correlation was found between changes in the ISI and morning cortisol level.ConclusionThere were no significant differences between treatments on insomnia severity, sleep, mood or quality of life. Exercise and exercise plus acupuncture were efficacious for decreasing insomnia severity to subthreshold insomnia. Greater reduction in morning cortisol was associated with a greater reduction on insomnia severity across both treatments.

Relationship between gastroesophageal reflux disease and objective sleep quality.

To objectively characterize (1) the relationship between gastroesophageal reflux disease (GERD) and sleep quality, and (2) the influence of sleep position on this relationship, using in-laboratory polysomnography. We retrospectively analyzed first-night diagnostic in-laboratory polysomnography data for 3411 patients (median age 55 years; 48% male). Medication use and medical condition data were obtained through self-reported questionnaires. Associations between sleep quality and the presence of GERD, and the influence of sleep position on these associations, were analyzed using multivariable linear regression models. After adjusting for age, sex, body mass index, and relevant comorbidities, GERD was associated with a 3.0% decrease in sleep efficiency, 8.8-minute increase in wake after sleep onset, 24.4-minute increase in rapid eye movement (REM) latency, 13.4-minute decrease in total sleep time, 1.4% decrease in %REM sleep, and 1.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the right side was associated with an 8.6% decrease in sleep efficiency, 27.5-minute increase in wake after sleep onset, 35.6-minute decrease in total sleep time, 2.1% decrease in %REM sleep, and 3.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the left side was associated with an 8.7-minute increase in sleep onset latency. GERD is associated with an impairment in objective sleep quality. These associations were more pronounced in right-sided sleep and mostly ameliorated in left-sided sleep. Physicians should recognize the potential for poor sleep quality in patients with GERD and the effect of body position on this relationship. Gurges P, Murray BJ, Boulos MI. Relationship between gastroesophageal reflux disease and objective sleep quality. J Clin Sleep Med. 2022;18(12):2731-2738.

Effects of State of Eye Movements before Saccade on Eye Movement Latency and Velocity

Effects of State of Eye Movements before Saccade on Eye Movement Latency and Velocity