Polysomnography Testing Research Articles

Morbidity and mortality reduction associated with polysomnography testing in idiopathic pulmonary fibrosis: a population-based cohort study

BackgroundIt is not well-known if diagnosing and treating sleep breathing disorders among individuals with idiopathic pulmonary fibrosis (IPF) improves health outcomes. We evaluated the association between receipt of laboratory-based polysomnography (which is the first step in the diagnosis and treatment of sleep breathing disorders in Ontario, Canada) and respiratory-related hospitalization and all-cause mortality among individuals with IPF.MethodsWe used a retrospective, population-based, cohort study design, analyzing health administrative data from Ontario, Canada, from 2007 to 2019. Individuals with IPF were identified using an algorithm based on health administrative codes previously developed by IPF experts. Propensity score matching was used to account for potential differences in 41 relevant covariates between individuals that underwent polysomnography (exposed) and individuals that did not undergo polysomnography (controls), in order minimize potential confounding. Respiratory-related hospitalization and all-cause mortality were evaluated up to 12 months after the index date.ResultsOut of 5044 individuals with IPF identified, 201 (4.0%) received polysomnography, and 189 (94.0%) were matched to an equal number of controls. Compared to controls, exposed individuals had significantly reduced rates of respiratory-related hospitalization (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.24–0.75), p = 0.003) and all-cause mortality (HR 0.49, 95% CI 0.30–0.80), p = 0.004). Significantly reduced rate of respiratory-related hospitalization (but not all-cause mortality) was also observed among those with > = 1 respiratory-related hospitalization (HR 0.38, 95% CI 0.15–0.99) and systemic corticosteroid receipt (HR 0.37, 95% CI 0.19–0.94) in the year prior to the index date, which reflect sicker subgroups of persons.ConclusionsUndergoing polysomnography was associated with significantly improved clinically-important health outcomes among individuals with IPF, highlighting the potential importance of incorporating this testing in IPF disease management.

438 Rapid Eye Movement Rebound After Continuous Positive Airway Pressure in Co-Morbid Obstructive Sleep Apnea and Fibromyalgia

Abstract Introduction Fibromyalgia (FM) is a chronic pain condition that is associated with poor sleep quality and may present with obstructive sleep apnea (OSA). In OSA patients without FM, previous research has demonstrated a 57% relative increase in rapid eye movement (REM) sleep duration following treatment with continuous positive airway pressure (CPAP). However, there is limited data on REM rebound in patients with co-morbid FM and OSA. Patients with FM are often prescribed medication, like opioid analgesics, that decrease REM sleep. Additionally, pain perception may be altered by decreased REM duration. In the context of a national opioid crisis, it is imperative to explore how nonpharmacological options for treatment of co-morbid FM and OSA may improve REM sleep duration. Methods Following IRB approval at a university-affiliated teaching hospital, an electronic medical chart review was completed on patients diagnosed with FM and OSA who received polysomnography testing (PSG) and subsequent CPAP titration treatment. REM duration and REM total sleep time (TST) percentages were reviewed at baseline PSG and after CPAP titration. Results FM with OSA (n = 30). Mean age: 50.87, female: 28 (93%), male: 2 (7%). Baseline PSG: mean REM duration 34.47 minutes, mean REM TST 11.03%. After CPAP titration: mean REM duration 56.78 minutes, mean REM TST 18.84%. Pre- and post-CPAP titration REM TST percentage increased from 11.0% to 18.8%, indicating a mean difference of 7.8% (p < 0.001) and a 71% relative increase in REM TST percentage duration. Conclusion These findings suggest delivery of CPAP to patients with FM and OSA improved REM sleep duration. The role of sleep in FM and pain severity is underexplored. Given the potential of chronic opioid use in patients with FM, treatment of OSA with CPAP may be a nonpharmacological alternative to pain management. Future studies are needed to see if REM rebound is associated with wellbeing, including perceived sleep quality and decreased pain perception. Support (if any):

467 Positive Airway Pressure Tracking Systems: Outcomes of Polysomnographic Testing Prompted by the Residual Apnea Hyponea Index

Abstract Introduction To assess positive airway pressure (PAP) adherence and efficacy, tracking systems have been developed to monitor hours of CPAP use, mask leak, and residual apnea-hypopnea index (AHI) while patients are on treatment. No formal guidelines however have been developed on how to interpret and utilize this information. We looked at treatment outcomes after an in-laboratory sleep study reevaluation was made based on clinical symptoms and the residual AHI. Methods We performed a retrospective chart review of adult patients evaluated with an in-laboratory polysomnogram (PSG) based on a clinical concern for inadequately treated obstructive sleep apnea (OSA) and the residual AHI obtained from the PAP tracking system. We documented the outcomes of the repeat study and follow-up AHI after the new intervention (if recommended). We excluded patients non-adherent to PAP. Results Nine patients were identified between January 2015 and 2020 at the McGovern Medical School Outpatient Sleep Clinic. All nine patients were male with an average age of 69.2 years (range 44–84). The average AHI on the diagnostic study (CMS criteria) was 37.1 events/hour (range 17.4–67.1). The average residual AHI prompting reevaluation was 9 events/hour (median 15.9). All patients had a change in treatment based on recommendations made after their sleep study. The clinical suspicion for central events on the tracking system was confirmed on PSG on three patients who were subsequently switched to adaptive servo-ventilation. Two patients were found to have central events without a previous suspicion for central events. Four were prescribed a higher pressure or BPAP for suspected untreated OSA confirmed on the repeat PSG. All of the patients had a decreased residual AHI (average 6.3 events/hour) after treatment changes were made. Conclusion Reevaluation with a PSG after concerns of the residual AHI led to a change in diagnosis (complex sleep apnea) or the need for higher treatment pressures in our cohort. This lead to the optimization of therapy and a decrease in AHI on the tracking system post-intervention, hence justifying the repeat PSG. Exact guidelines however need to be set to standardize the recommendations with a potential cut-off residual AHI after which a repeat PSG is the standard. Support (if any):

Association Between Short Sleep Duration and Increased Cardiovascular Reactivity to Nocturnal Arousal

Reduced habitual total sleep time (TST) is associated with an increased prevalence of hypertension, coronary heart disease, and other cardiovascular complications. Nocturnal arousal intensity, assessed by overnight polysomnography (PSG), and its subsequent impact on nocturnal heart rate (HR) reactivity have been implicated as a potential link between arousal strength and heightened cardiovascular strain. Despite evidence of a positive relationship between nocturnal arousal intensity and heart rate reactivity, little research has established if habitual sleep parameters are associated with these associations. The purpose of the present study was to examine the relationship between objectively measured TST and HR responsiveness to nocturnal arousal in stage 2 (N2) and stage 3 (N3) sleep. We hypothesized that short objective TST would be associated with an augmented HR reactivity to arousals in both N2 and N3 sleep. Habitual TST was measured in 17 adults (10 men, 7 women; 33±4 years; 26±1 kg/m2) using actigraphy monitoring over a duration of 7-14 days (mean, 13±1 days). On a separate occasion, participants underwent a full night of PSG testing, in addition to continuous HR recording (electrocardiogram) throughout the sleep period. Arousals were scored by a certified PSG technician, and verified by a board-certified sleep physician following American Academy of Sleep Medicine guidelines. Peak HR response to arousal was determined as the highest HR measured within 20 seconds following an arousal onset, while the peak change was identified as the post-arousal peak HR minus the average HR taken from 10 cardiac cycles prior to the arousal. Bivariate correlations were utilized to compare associations between the two parameters. The number of arousals varied from 4 - 47 (mean, 19±3 arousals) during N2 sleep, and 0 – 9 (mean, 4±1 arousals) during N3 sleep. There were no associations between habitual, actigraphy-based TST and number of arousals in either sleep stage (P > 0.05). Similarly, there were no significant correlations between pre-arousal HR and TST in either N2 or N3 sleep (P > 0.05). However, our results demonstrated a significant negative correlation between TST and both peak HR reactivity (R = -0.490, P < 0.05) and absolute change in peak HR (R = -0.487, P < 0.05) following arousals during N2 sleep. Similarly, peak HR (R = -0.542, P < 0.05) and change in peak HR (R = -0.577, P < 0.05) after arousals were significantly associated with habitual TST during N3 sleep. Our results indicate a relationship between poor sleep duration and heightened cardiovascular reactivity to nocturnal arousal during both N2 and N3 sleep. These findings suggest that short sleep duration and dysregulated HR reactivity may be underlying mechanisms propagating impaired cardiovascular functioning in chronically sleep restricted individuals. Further research is necessary to fully elucidate the direction of this relationship.

Rapid eye movement sleep and slow wave sleep rebounded and related factors during positive airway pressure therapy

This study aimed to investigate the clinical characteristics and predictors of increased rapid eye movement (REM) sleep or slow wave sleep (SWS) in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy. The study retrospectively analyzed data from patients with OSA who underwent both diagnostic polysomnography (PSG) and pressure titration PSG at the Tangdu Hospital Sleep Medicine Center from 2011–2016. Paired diagnostic PSG and pressure titration studies from 501 patients were included. REM rebound was predicted by a higher oxygen desaturation index, lower REM proportion, higher arousal index, lower mean pulse oxygen saturation (SpO2), higher Epworth sleepiness score and younger age (adjusted R2 = 0.482). The SWS rebound was predicted by a longer total duration of apneas and hypopneas, lower N3 duration, lower SpO2 nadir, lower REM proportion in diagnostic PSG and younger age (adjusted R2 = 0.286). Patients without REM rebound or SWS rebound had a high probability of comorbidities with insomnia and mood complaints. Some parameters (subjective and objective insomnia, excessive daytime sleepiness, age and OSA severity) indicate changes in REM sleep and SWS between diagnostic and titration PSG tests. Treatment of insomnia and mood disorders in patients with OSA may helpful to improve the use PAP.

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

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

Use and Performance of the STOP-Bang Questionnaire for Obstructive Sleep Apnea Screening Across Geographic Regions

Obstructive sleep apnea (OSA) is a highly prevalent global health concern and is associated with many adverse outcomes for patients. To evaluate the utility of the STOP-Bang (snoring, tiredness, observed apnea, blood pressure, body mass index, age, neck size, gender) questionnaire in the sleep clinic setting to screen for and stratify the risk of OSA among populations from different geographical regions. MEDLINE, MEDLINE In-process, Embase, EmCare Nursing, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals@Ovid, Web of Science, Scopus, and CINAHL electronic databases were systematically searched from January 2008 to March 2020. This was done to identify studies that used the STOP-Bang questionnaire and polysomnography testing in adults referred to sleep clinics. Clinical and demographic data were extracted from each article independently by 2 reviewers. The combined test characteristics were calculated using 2 × 2 contingency tables. Random-effects meta-analyses and metaregression with sensitivity analyses were performed. The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline was followed. The combined test characteristics and area under summary receiver operating characteristic curves (AUCs) were used to compare STOP-Bang questionnaire accuracy with polysomnography testing. A total of 47 studies with 26 547 participants (mean [SD] age, 50 [5] years; mean [SD] body mass index, 32 [3]; 16 780 [65%] men) met the criteria for the systematic review. Studies were organized in different geographic regional groups: North America, South America, Europe, Middle East, East Asia, and South or Southeast Asia. The prevalence rates for all OSA, moderate to severe OSA, and severe OSA were 80% (95% CI, 80%-81%), 58% (95% CI, 58%-59%), and 39% (95% CI, 38%-39%), respectively. A STOP-Bang score of at least 3 had excellent sensitivity (>90%) and high discriminative power to exclude moderate to severe and severe OSA, with negative predictive values of 77% (95% CI, 75%-78%) and 91% (95% CI, 90%-92%), respectively. The diagnostic accuracy of a STOP-Bang score of at least 3 to detect moderate to severe OSA was high (>0.80) in all regions except East Asia (0.52; 95% CI, 0.48-0.56). The results of this meta-analysis suggest that the STOP-Bang questionnaire can be used as a screening tool to assist in triaging patients with suspected OSA referred to sleep clinics in different global regions.

Decreased serum betatrophin may correlate with the improvement of obstructive sleep apnea after Roux-en-Y Gastric Bypass surgery

Obesity is strongly correlated with obstructive sleep apnea (OSA), and bariatric surgery can effectively treat obesity and alleviate OSA. However, the contributing factors are still unclear. We aimed to explore the relationship between betatrophin and OSA in patients undergoing Roux-en-Y gastric bypass (RYGB) surgery. Our study consisted of thirty-seven individuals with OSA and type 2 diabetes (16 males, 21 females) undergoing RYGB surgery. The polysomnography test, anthropometric results, serum betatrophin, and abdominal magnetic resonance images were evaluated both before and 1 year after RYGB surgery. Factors that may correlate with the alleviation of OSA were investigated. In our study, RYGB surgery significantly decreased apnea hypopnea index (AHI) and serum betatrophin concentration (p < 0.001). The abdominal visceral fat area, subcutaneous fat area and HOMA-IR were also significantly decreased (p < 0.001). The preoperative AHI, postoperative AHI and the change in AHI were significantly correlated with the preoperative betatrophin, postoperative betatrophin and the change in betatrophin, respectively (p < 0.05). These correlations were still significant after adjustment for other risk factors. The change in betatrophin was also independently associated with the change in minimum oxygen saturation (p < 0.001). Our data might indicate that serum betatrophin was significantly independently correlated with the improvement of OSA after bariatric surgery.

Automatic Sleep Scoring Stages using Real-Time EMG Signals

Sleep is completely regarded as obligatory component for an individual’s prosperity and is an extremely important element for the overall mental and physical well-being of an individual. It is a condition in which physical and mental health of an individual are in condition of halt. The conception of sleep is considered extremely peculiar and is a topic of discussion and it has attracted the researchers all over the world. Proper analysis of sleep scoring system and its different stages gives clinical information when diagnosing on patients having sleep disorders. Since, manual sleep stage classification is a hectic process as it takes sufficient time for sleep experts to perform data analysis. Besides, mistakes and irregularities in between classification of same data can be recurrent. Therefore, there is a great use of automatic scoring system to support reliable classification. The proposed work provides an insight to use the automatic scheme which is based on real time EMG signals. EMG is an electro neurological diagnostic tool which evaluates and records the electrical activity generated by muscle cells. The sleep scoring analysis can be applied by recording Electroencephalogram (EEG), Electromyogram (EMG), and Electrooculogram (EOG) based on epoch which is defined as a period of 30 second length segments, and this method of sleep scoring system is also called polysomnography test or PSG test. The standard database of EMG signals was collected from different hospitals in sleep laboratory which gives the different stages of sleep. These are Waking, Non-REM1 (stage-1), Non-REM2 (stage-2), Non-REM3 (stage-3), REM. The main motive of the proposed work is the synchronization of EEG, EMG, EOG in order to understand different stages of sleep when they are simultaneously recorded. The procedure can be useful in clinics, particularly for scientists in studying the wakefulness and sleep stage correlation and thus helps in diagnosing some sleep disorders.

Lipid accumulation product (LAP) was independently associated with obstructive sleep apnea in patients with type 2 diabetes mellitus

BackgroundLipid accumulation product (LAP) is a new index based on a combination of waist circumference (WC) and serum triglycerides (TG) reflecting lipid accumulation. In this cross-sectional study, we aimed to explore whether LAP was independently associated with obstructive sleep apnea (OSA) in Type 2 diabetes mellitus (T2DM) patients.MethodsA cross-sectional study of 317 T2DM patients who underwent overnight polysomnography (PSG) tests was conducted. The clinical data between non-OSA group and OSA group were compared. Multivariable linear regression and multivariable logistic regression analyses were performed to determine associations of LAP, with apnea-hypopnea index (AHI) and OSA.ResultsAmong 317 patients, 219 (69.1%) were men, and the mean ages (±SD) were 51.4 (±13.5) years for men and 54.6 (±15.1) years for women (p = 0.067). The prevalence rates of OSA were 63.0% for men and 68.4% for women (p = 0.357). LAP (log-transformed) was significantly correlated with AHI (log-transformed), with the Pearson’s correlation coefficient of 0.170 (p = 0.002). With adjustment for potential confounding factors, multivariate linear regression analyses showed the association of LAP with AHI was not statistically significant, with the adjusted linear regression coefficients (95% CI) of per SD increase of LAP for AHI (log-transformed) was 0.092 (− 0.011–0.194, p = 0.080). Multivariate logistic regression analyses showed LAP was significantly associated with increased risk of OSA, with the adjusted OR (95%CI) of per SD increase of LAP of 1.639 (1.032–2.604, p = 0.036). However, as constituents of LAP, neither TG nor WC was significantly associated with AHI and OSA.ConclusionLAP was independently associated with OSA and might be used as a potential OSA risk marker in T2DM patients, beyond the general index of obesity.

Adherence to prescribed overnight sleep study in patients suspected of sleep apnea: problem size and influential factors.

Despite the serious consequences of sleep apnea, some patients do not follow their physicians' advice to undergo a sleep study. The present study aimed to determine the rate of adherence and influencing factors in conducting a polysomnography test in patients suspected of obstructivesleep apnea. This qualitative and quantitative analysis was conducted between July 2017 and November 2019 on patients suspected of sleep apnea. The quantitative analysis aimed at determining the rate of adherence through a retrospective cross-sectional study. The qualitative content analysis was conducted on purposefully selected subgroup ofpatients suspected of obstructive sleep apnea who were referred for polysomnography. The required data were collected through the semi-structured in-depth interviews and then recorded, transcribed, and analyzed using SPSS.22 and MAXQDA10. Quantitative part: Of 311 patients (mean age: 47.6 ± 13.1 years) referred for polysomnography, 283 patients (91%)were at a high risk of developing obstructive sleep apnea. Among those referred for polysomnography, 31% (n = 95) adhered to recommendations for a sleep study. Qualitative part: Factors affecting adherence to polysomnography were categorized as "barriers" and "triggers." Barriers included inadequate knowledge, psychological factors, cost, and the service system. Triggers included adequate knowledge and tangible experience of consequencesof the illness. The majority of patients at risk of developing obstructive sleep apnea did not follow the recommendation for polysomnography, indicating a need for systematic interventions. Among the identified barriers, knowledge and psychological factors are modifiable ones that can be addressed with the patient. We theorize that raising awareness among patients by providing additional information and eliminating concerns may help to increase the rate of adherence. Insurance coverage or subsidy to reduce the sleep study costs may also be an effective strategy to increase adherence to recommendations for polysomnography.

The Effects of Circadian Rhythm Disruption on Mental Health and Physiological Responses among Shift Workers and General Population.

Background: The effect of circadian disruption on the bio-psychological clock system has been widely studied. However, the mechanism and the association of circadian rhythm disruption with mental health and physiological responses are still unclear. Therefore, this study was conducted to investigate the effects of circadian rhythm disruption on mental health and physiological responses among shift workers and the general population. Methods: A total of 42 subjects participated in this quasi-experimental study. Participants were divided into a group of shift workers (n = 20) and a general population group (n = 22). Polysomnography tests, blood tests (cortisol, triglycerides and glucose), and psychological tests (Abbreviated Profile of Mood States, General Health Questionnaire-28, Working Memory and Processing Speed Indexes of the Wechsler Adult Intelligent Scale (WAIS-IV) were used to examine the effects of circadian rhythm disruption. Results: The results showed a significant relationship between circadian rhythm disruption and mood (r = 0.305, p < 0.05). The findings of this study also indicated that there was a significant effect of circadian rhythm disruption on mood (F(2,40) = 8.89, p < 0.001, η2 =0.182), processing speed (F(2,40) = 9.17, p < 0.001, η2 = 0.186) and working memory (F(2,40) = 4.963, p < 0.01, η2 = 0.11) in shift workers and the general population. Conclusions: Our findings showed that circadian rhythm disruption affects mood and cognitive performance, but it does not significantly affect psychological wellbeing and physiological responses. Future studies are warranted to examine moderator and mediator variables that could influence the circadian rhythm disruption.

Plethysmographic data and profile of North-African patients with severe obstructive sleep apnea treated with continuous positive airway pressure

ABSTRACT Objectives In obstructive sleep apnea (OSA) patients, the frequencies of the different ventilatory defects are unknown and the studies examining their plethysmographic profiles and/or pulmonary function test data have contradictory results. The main aim of this prospective study was to establish the plethysmographic profile of severe OSA patients treated with continuous positive airway pressure (CPAP). Methods 100 (33 females) clinically consecutive stable patients with severe OSA treated with CPAP were included. Anthropometric, polysomnographic, and pulmonary function test data were collected. The following definitions were applied: large airways obstructive ventilatory defect (LAOVD): (FEV1/SVC or FEV1/FVC < lower limit of normal (LLN), small airways obstructive ventilatory defect (SAOVD): (FEV1/FVC and FVC) > LLN and maximal mid-expiratory flow (MMEF) < LLN, restrictive ventilatory defect (RVD): total lung capacity (TLC) < LLN, lung-hyperinflation: residual volume > upper limit of-normal, and nonspecific ventilatory defect (NSVD): (FVC and FEV1) < LLN and TLC > LLN and (FEV1/SVC or FEV1/FVC) > LLN. Results The plethysmographic profile of OSA patients included RVD (73%), SAOVD (50%), LAOVD (16%), mixed-VD (11%), lung-hyperinflation (11%), and NSVD (2%). Conclusion The plethysmographic profile of OSA patients was dominated by the presence of an RVD.

The coexistence of obstructive sleep apnea in patients with slow coronary flow: a cross-sectional study

BACKGROUND: Interestingly, obstructive sleep apnea (OSA) and coronary slow-flow (CSF) have similar pathogenic mechanisms, including increased sympathetic activity and endothelial dysfunction. However, the association between OSA and CSF is not known well. If undiagnosed, OSA is a cause of increased cardiovascular morbidity and mortality. We investigated the presence of OSA in the patients diagnosed CSF after coronary angiography. METHODS: The prospective cross-sectional study included 4515 patients admitted angiography laboratory from February 2018 to March December 2019. After coronary angiography of 4515 patients, 336 patients were diagnosed as slow coronary flow. These patients were examined by pulmonology and sleep specialist. Of the 336 patients, 276 patients were found high risk in terms of OSA by using Berlin questionnaire (BQ). Only 75 of 276 patients underwent polysomnography (PSG) testing. Control group patients (n=40) had normal coronary artery and no OSA. RESULTS: Of 4515 patients, 336 (7.4%) met the criteria for CSF. After BQ, 276 of 336 patients had high-score BQ (82.1%). The study group consisted of 276 patients (188 males, 88 females). The mean ages of the study group were 48.48 ±7.61 years. Body mass index (BMI) according to WHO criteria was 33.02±2.18 kg/m2. When 75 patients underwent PSG were divided on two groups as mild OSA and moderate/severe OSA according to respiratory disturbance index (RDI). We found a significant positive correlation between mean corrected TIMI Frame Count (CTFC) and RDI. While CTFC-Lad in mild OSA group was 32.73, CTFC-Lad in moderate/severe OSA group was 35.04 (p=0.022). While CTFC-Cx in mild OSA group was 31.67, CTFC-Cx in moderate/severe OSA group was 35.26 (p=0.001). While CTFC-Rca in mild OSA group was 32.57, CTFC-Rca in moderate/severe OSA group was 36.33 (p<0.001). CONCLUSION: This study revealed the coexistence between CSF and OSA. Moreover, we demonstrated a significant relationship between mean CTFC and RDI. To determine the clinical association of OSA and CSF may be help to understand pathophysiology of CSF.

The influence of opioids and nonopioid central nervous system active medications on central sleep apnea: a case-control study.

Opioids are known to contribute to central sleep apnea (CSA), but the influence of nonopioid central nervous system active medications (CNSAMs) on CSA remains unclear. In light of the hypothesized impact of nonopioid CNSAMs on respiration, we examined the relationships between the use of opioids only, nonopioid CNSAMs alone, and their combination with CSA. Among all adults who underwent polysomnography testing at the University of Michigan's sleep laboratory between 2013 and 2018 (n = 10,606), we identified 212 CSA cases and randomly selected 300 controls. Participants were classified into four groups based on their medication use: opioids alone, nonopioid CNSAMs only, their combination, and a reference group, including those who did not use any of these medications. We defined CSA as a binary outcome and as a continuous variable using central apnea index data. Logistic and linear regression were used to examine associations between medication use, CSA diagnosis, and central apnea index. Study participants included 58% men, and mean age was 50 (± 14 standard deviation years. Nearly half of the study participants did not use opioids or nonopioid CNSAMs, 6% used opioids alone, 27% nonopioid CNSAMs alone, and 16% used a combination of these medications. In adjusted analyses, opioids-only users had a nearly twofold increase in CSA odds, whereas those who used a combination of opioids and nonopioid CNSAMs had fivefold higher odds of CSA relative to the reference group. In contrast, the use of nonopioid CNSAMs alone had protective associations with CSA. This report showed increased odds of CSA, particularly among patients with sleep complaints who were prescribed opioids in combination with nonopioid CNSAMs compared with those who did not use any of these medications.

Effects of endobronchial coils for endoscopic lung volume reduction on sleep in COPD patients with advanced pulmonary emphysema.

Treatment of advanced pulmonary emphysema with endobronchial coils can improve clinical outcomes like quality of life (QOL). Yet, patients with chronic obstructive pulmonary disease (COPD) are also known to suffer from reduced sleep quality. The effect of coil therapy on sleep has not yet been investigated. The primary aim of this study was to investigate sleep efficiency before and after coil treatment. Secondly, we investigated the effects on nocturnal breathing pattern, QOL, and physical activity. Polysomnography (PSG) testing was performed before (T0), 6 month after (T3), and 12 months after (T4) treatment with endobronchial coils. Further examinations included QOL by St George's Respiratory Questionnaire (SGRQ) and COPD assessment test (CAT), and physical activity using an accelerometer for 1 week after each visit. Of 21 patients, 14 completed the study: 6 women; meanage 58.0 ± 4.9years; BMI 22.6 ± 4.6 kg/m2; FEV1 28.6 ± 7.1% predicted; residual volume (RV) 278.2 ± 49.4% predicted. Sleep efficiency did not vary between baseline and follow-up examinations (T0 69.0 ± 15.8%; T3 70.9 ± 16.0%; T4 66.8 ± 18.9%). Non-REM respiratory rate decreased compared to baseline (T0 19.4 ± 3.9/min; T3 17.8 ± 3.5/min; T4 17.1 ± 3.1/min (p = 0.041; p = 0.030) and QOL improved meeting the minimal clinically important difference (MCID) (SGRQ, T3 -12.8 units; T4 -7.1 units; CAT: T3 -5.6 units; T4 -3.4 units). No increase in physical activity was recorded (light activity T0 31.9 ± 9.9; T3 30.8 ± 16.9; T4 26.3 ± 10.6 h/week). Treatment with endobronchial coils did not influence objectively measured sleep quality or physical activity, but reduced nocturnal breathing frequency and improved QOL in severe emphysema patients. ClinicalTrials.gov Identifier: NCT02399514, First Posted: March 26, 2015.

House Dust Mite Related Allergic Rhinitis and REM Sleep Disturbances.

Sleep disturbances are common in patients with allergic rhinitis (AR). Perennial allergens like house dust mites (HDM) are difficult to avoid and have nocturnal impacts on the respiratory system and Quality of Life (QOL). The Rapid Eye Movement (REM) sleep stage is associated with memory, cognition, dreams, and overall restfulness, which can be impaired in AR patients with Sleep Disordered Breathing (SDB) even when normal all-night apnea-hypopnea (AHI) or respiratory disturbance (RDI) indices are noted on polysomnography (PSG). We hypothesized that AR HDM allergen positive patients would show REM-specific SDB reflected in their objectively elevated REM-RDI values. This retrospective analysis of 100 patients included 47 with HDM positive allergy testing. All patients underwent PSG testing calculating the RDI during REM. Multivariate logistic regression models evaluated relationships between allergic statuses and sleep parameters while controlling for potential confounders. Compared with allergy negative patients, HDM allergen positive patients were significantly more likely (OR 4.29, 95%CI 1.26-14.62) to have a REM-RDI in the moderate/severe range (≥15events/h). Our study highlighted the significance of respiratory allergies to HDM in patients with SDB. We revealed a significant relationship between HDM allergen positivity and SDB characterized by elevated REM-RDI regardless of all-night AHI, RDI, or REM-AHI values. Clinical implications of knowing about disturbed REM and/or HDM allergenicity include better preparation, treatment, outcomes, and QOL for allergic, SDB, and upper airway surgery patients.

The differences of carotid atherosclerosis among non-OSAHS and OSAHS patients of different severities: a cross-sectional study.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a widely prevalent problem with many complications, such as hypertension and cerebral vascular diseases. Atherosclerosis, whose most severe outcome is ischemic stroke, is reported being affected by OSAHS. The objective of this article is to investigate the differences of carotid atherosclerosis patients with or without OSAHS by a cross-sectional research. Patients diagnosed with carotid atherosclerosis by ultrasonography were recruited. They were requested to fill the primary screening OSAHS questionnaire. Patients with high tendency ofOSAHS underwent polysomnography (PSG) tests into OSAHS group, and patients without OSAHS were into non-OSAHS group. Blood tests and medical history were collected. Carotid atherosclerosis severity was analyzed by carotid artery intima-media thickness (IMT), carotid plaque, blood flow velocity, etc. Differences between the two groups and subgroups were analyzed. A total of 242 carotid atherosclerosis patients were enrolled including 118 non-OSAHS patients (38 males and 80 females) and 124 OSAHS patients (40 mild, 32 moderate, and 52 severe). Significant differences were found in PSV-ICA and EDV-ICA on both sides (p < 0.05) but no significant differences on IMT and velocity of CCV. CA patients with OSAHS were younger than ones without OSAHS. With the severity of OSAHS increasing, the age of CA patients decreased. The more severity of OSAHS, the younger the patients were. There were no significant differences in comparing cholesterol, triglyceride, HDL, LDL, and glucose. As far as CIMT, carotid plaque, blood flow velocity, and blood lipid are concerned, the severity of CA is not affected by the severity of OSAHS accordantly. The relationship between OSAHS and CA may not be dose dependent. This study has been registered on clinical trials (No. NCT03665818).

The relationship between attachment, treatment compliance and treatment outcomes in patients with obstructive sleep apnea

ObjectiveObstructive sleep apnea (OSA) is a common condition with numerous health and psychological consequences. While treatment with Continuous Positive Airway Pressure (CPAP) is highly effective, it seems to be impacted by interpersonal aspects of the patient. The current study explores the role of two major interpersonal descriptors (attachment and relationship satisfaction) on treatment initiation and compliance with CPAP. The benefit of CPAP treatment on sleep measures and psychological functioning is also examined. MethodsParticipants in stable relationships, diagnosed with OSA following an inpatient polysomnography test (N = 83), were recruited. Participants were appraised on their decision to initiate treatment and completed interpersonal measures (couples' satisfaction, attachment dimensions) as well as sleep measures and mental health measures. Participants were invited to repeat the measures after 3 months (N = 31 agreed). Associations between interpersonal measures and CPAP initiation and compliance as well as the impact of CPAP on sleep and all psychological measures was assessed. ResultsIndividuals with high attachment anxiety pursued OSA treatment based on a mutual decision with the partner, while individuals with lower attachment anxiety made the decision themselves. Couples' satisfaction was positively associated with CPAP compliance over 3 months. CPAP compliance significantly improved sleep measures, mood and anxiety symptoms. ConclusionThe study brings evidence for a positive role of interpersonal factors in the initiation and compliance with OSA treatment as well as longitudinal benefits on sleep, mood and anxiety levels. The results can inform clinical approaches meant to increase treatment engagement and adherence in OSA patients through psychoeducation.

A wireless, real-time respiratory effort and body position monitoring system for sleep

The number of people suffering from a sleep disorder is growing considerably, with obstructive sleep apnea syndrome (OSAS) being the most common one. Unfortunately, it is estimated that at least 75% of OSAS cases are currently undiagnosed and without treatment, mainly due to the lack of availability and high costs of the polysomnography (PSG) test required. OSAS is known to increase the risk for many severe health complications such as hypertension and neurodegenerative conditions, to mention a few, making early diagnosis important. The monitoring of respiratory effort (RE) and body position (BP) during sleep is essential for OSAS detection. Compared to existing commercial systems for respiratory effort monitoring using piezoelectric sensors wired to a central processing system, we present an embedded system solution that is wireless, runs standalone for up to 12 h, and implements on board an extended Kalman filter (EKF) for performing data fusion. An inertial measurement unit (3D acceleration, angular rate, and orientation sensors) is used for real-time measurement of both the respiratory effort and the body position. The experimental tests, when we compare the collected data with a reference signal, acquired by a commercial belt, indicate a general average Pearson correlation coefficient of ρ=0.963 with results ranging from 0.928 to 0.981, improving over previous works. Low-cost technologies, such as the one presented here, can help to reduce the number of undiagnosed cases of OSAS, and sleep disorders in general, and improve the health of those patients.