Sleep Architecture In Patients Research Articles

Sleep Bruxism and Sleep Structure in Comorbid Insomnia and Obstructive Sleep Apnea (COMISA) Syndrome: A Polysomnographic Study

Introduction: Comorbid insomnia and obstructive sleep apnea (COMISA) is not a well-identified sleep disorder, despite having a significant impact on health. This study investigates the relationship between sleep bruxism (SB) and sleep architecture in patients with COMISA, obstructive sleep apnea (OSA), and in those without any sleep disorders. Methods: 119 patients were included in the study and divided into three groups: OSA, COMISA, and a control group. Polysomnographic (PSG) examination provided parameters related to sleep architecture, OSA, and characteristics of SB. Results: The bruxism episode index (BEI) and other SB parameters were not found to be statistically different between the three groups (p > 0.05). There was no statistical difference in measured sleep architecture between the COMISA and OSA groups (p > 0.05). In comparison to the control group, participants in the COMISA group were found to have an increased apnea–hypopnea index (AHI), oxygen desaturation index (ODI), respiratory disturbance index (RDI), all arousals (AA), and respiratory arousals (RA) (p < 0.05). Among COMISA patients, AA and RA were shown to have a positive linear correlation with the number of bradycardia events per hour (r = 0.49, r = 0.48, p < 0.05). Conclusions: SB does not occur in patients with COMISA more frequently than in patients with OSA or those without any sleep disorders. PSG parameters are not specific for COMISA; therefore, in order to differentiate this disorder from OSA alone, a comprehensive patient assessment has to be performed.

The Effect of Type-2 Diabetes Mellitus on Sleep Architecture and Sleep Apnea Severity in Patients With Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea syndrome (OSAS) is a severe condition that is characterized by recurrent partial or complete breathing interruptions during sleep, leading to insulin resistance, microvascular complications, and cardiovascular complications. It is of great importance to know the impact of type 2 diabetes mellitus (DM), which is prevalent in the world and in our country, Turkey, leads to significant mortality and morbidity, significantly affects the quality of life, and requires continuous follow-up, on sleep in patients with OSAS and to raise awareness on this issue. In this study, we aimed to determine the effects of diabetes on sleep duration and sleep architecture in patients with OSAS and to investigate the relationship between OSAS severity and DM control. Fifty diabeticand 42 non-diabetic patientsdiagnosed with OSAS at the Sleep Disorders Center ofSüreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, between October 2022 and March 2023 were included in the study. Polysomnographic and biochemical parameters of the two groups were compared. The effect of OSAS severity and sleep architecture on diabetes control was investigated. No significant difference was found between diabetic and non-diabetic patients in terms of total sleep duration, sleep efficiency, and sleep latency, whereas REM (rapid eye movement) latency was prolonged and REM sleep duration and percentage were significantly lower in diabetic patients. The severity of OSAS was found to be greater in diabetic patients and they spent significantly more time below 90% saturation during sleep. No correlation was found between the groups in the glycated hemoglobin (HbA1c) parameter, which we examined in terms of diabetes control, sleep architecture, and OSAS severity. The presence of diabetes aggravates the severity of OSAS, prolongs the transition to REM sleep, and leads to a decrease in REM duration. Sleep is essential for both mental and physical well-being. In this regard, it is of utmost importance to examine diabetic patients for OSAS and to perform polysomnography in appropriate patients.

Dopamine agonists in restless leg syndrome treatment and their effects on sleep parameters: A systematic review and meta-analysis

BackgroundDopamine agonists (DAs) constitute the standard therapeutic scheme for restless leg syndrome (RLS) because they have been proven to be effective. However, DAs may change sleep parameters, thus having adverse effects on patient condition. This meta-analysis clarified the effects of DAs used in RLS treatment on the sleep architecture. MethodsPubMed, Embase, and Cochrane Central databases were searched for randomized control trials (RCT) (up to October 2023) that discussed the effects of DAs on sleep architecture in patients with RLS. A meta-analysis employing a random-effects model was conducted. The patients were divided into subgroups according to individual DAs and treatment duration (1 day or ≥4 weeks). ResultsThirteen eligible randomized placebo-controlled trials were included in the assessment. The effects of three DAs (i.e., pramipexole, ropinirole, and rotigotine) on rapid eye movement (REM) sleep, slow-wave sleep (SWS), and sleep efficiency (SE) were analyzed. Overall, pramipexole significantly improved SE but decreased the percentage of REM sleep among treated patients. Ropinirole also enhanced SE compared with the placebo group. Rotigotine did not affect SE and REM sleep. Subgroup analysis found that pramipexole used for 1 day and ≥4 weeks significantly diminished the percentage of REM sleep. Ropinirole used for 1 day showed similar REM sleep patterns. Finally, none of the three DAs affected SWS. ConclusionsThis meta-analysis demonstrated that DAs significantly affect sleep parameters.

Effect of daridorexant on sleep architecture in patients with chronic insomnia disorder - A pooled post hoc analysis of two randomized Phase 3 clinical studies.

Post-hoc analysis to evaluate the effect of daridorexant on sleep architecture in people with insomnia, focusing on features associated with hyperarousal. We studied sleep architecture in adults with chronic insomnia disorder from two randomized Phase 3 clinical studies (Clinicaltrials.gov: NCT03545191 and NCT03575104) investigating 3 months of daridorexant treatment (placebo, daridorexant 25mg, daridorexant 50mg). We analyzed sleep-wake transition probabilities, EEG spectra and sleep spindle properties including density, dispersion, and slow oscillation phase coupling. The Wake EEG Similarity Index (WESI) was determined using a machine learning algorithm analyzing the spectral profile of the EEG. At Month 3, daridorexant 50mg decreased Wake-to-Wake transition probabilities (P<0.05) and increased the probability of transitions from Wake-to-N1 (P<0.05), N2 (P<0.05), and REM sleep (P<0.05), as well as from N1-to-N2 (P<0.05) compared to baseline and placebo. Daridorexant 50mg decreased relative beta power during Wake (P=0.011) and N1 (P<0.001) compared to baseline and placebo. During Wake, relative alpha power decreased (P<0.001) and relative delta power increased (P<0.001) compared to placebo. Daridorexant did not alter EEG spectra bands in N2, N3, and REM stages or in sleep spindle activity. Daridorexant decreased the WESI score during Wake compared to baseline (P=0.004). Effects with 50mg were consistent between Month 1 and Month 3 and less pronounced with 25mg. Daridorexant reduced EEG features associated with hyperarousal as indicated by reduced Wake-to-Wake transition probabilities and enhanced spectral features associated with drowsiness and sleep during Wake and N1.

Efficacy and Safety of Cannabidiol Oil on Chronic Insomnia: The First Randomized, Double-Blind, Placebo-Controlled, Crossover, Pilot Study in Thailand

Objective: Cannabidiol (CBD) is a non-intoxicating extract from Cannabis sativa. The advantages of CBD on sleep-wake cycle and insomnia remain sparse. The present study investigated the impact of a continuous four-week sublingual CBD intake on sleep indicators. Materials and Methods: The present study was a randomized, double-blind, placebo-controlled, crossover pilot study involving 45 chronic insomnia patients. The participants were administered medium-chain triglycerides oil soluble cannabidiol (MCT-CBD) using 1 mg/kg/dose, sublingually for four weeks, then two weeks of washout period, and a subsequent four-week placebo phase. Sleep architecture with N1, N2, N3, and rapid eye movement (REM), sleep quality (PSQI), daytime sleepiness (ESS), and quality of life were investigated. Results: Polysomnography (PSG) revealed that the total sleep time (TST), sleep onset latency (SOL), wake time after sleep onset (WASO), and arousal index were significantly improved compared to the patients who were taking placebo, while sleep structure remained unaltered. Additionally, actigraphy showed a substantial improvement in TST, sleep efficiency (SE), and SOL. The results of PSQI, ESS, and EQ-5D-5L were statistically significant and better than placebo (p&lt;0.05). Conclusion: Continuously sublingual CBD treatment could improve sleep duration, sleep maintenance, sleep induction, quality of life, and daytime sleepiness without altering the sleep architecture in patients with chronic insomnia. No evidence of serious side-effects was found. Keywords: Hemp; CBD; Cannabidiol; Cannabis; Insomnia; Sleep

Sleep architecture and vitamin D in hypertensives with obstructive sleep apnea: A polysomnographic study.

Obstructive sleep apnea (OSA) and arterial hypertension (AH) are closely linked disorders with common pathophysiological features. The present study aimed to investigate the relationship between AH and OSA by examining sleep architecture, vitamin D concentration and electrolyte levels in patients with these coexisting conditions. A total of 133 patients suspected of having OSA were recruited for examination. The participants were divided into 2 groups: hypertensives (n = 52); and normotensives (n = 81). One full-night polysomnographic examinations were conducted, followed by the statistical analysis of the collected data. Hypertensive individuals displayed increased apnea-hypopnea index (AHI), oxygen desaturation index (ODI), respiratory arousal index (RAI), and periodic limb movement index (PLMI) as compared to non-hypertensive individuals. Moreover, sleep efficiency (SE), the bruxism arousal index (BAI) and oxygen saturation (SpO2)level were decreased in the hypertensive group. In terms of biochemical parameters, hypertensive individuals exhibited a lower magnesium (Mg) level, and higher levels of C-reactive protein (CRP), uric acid (UA) and glucose. Notably, there were no statistical differences in vitamin D concentration between hypertensive and normotensive individuals. The study explored the potential influence of calcium (Ca), Mg, vitamin D, and UA concentrations on the sleep architecture of patients with comorbid AH and OSA. The findings revealed several notable associations. Firstly, sleep fragmentation correlated with Ca level, suggesting a potential role for both Ca and vitamin D in sleep arousals. Secondly, a higher UA concentration was linked to a higher AHI and increased sleep fragmentation. Additionally, alterations in Mg concentration were observed among hypertensive individuals with OSA. However, further research is needed to fully comprehend the potential impact of these factors on the sleep architecture of hypertensive individuals with apnea.

The relations of circulating agouti-related peptide and leptin with altered sleep architecture in patients with active Cushing's disease: a pilot study.

To evaluate sleep architecture of patients with Cushing's disease (CD) and to explore whether agouti-related peptide (AgRP) and/or leptin play a permissive role in sleep alterations in patients with active CD. We performed polysomnography on 26 patients with active CD and age 26 age- and sex-matched control subjects. Blood samples were obtained from all participants for the analyzes of AgRP and leptin. The laboratory and sleep-related parameters were compared. The groups were similar in age, gender, and body mass index. The CD group had reduced sleep efficiency (71.6 ± 12.1% vs. 78.8 ± 12.6%, p = 0.042) and increased wake after sleep onset (WASO%) (24.7 ± 13.1% vs. 17.4 ± 11.6%, p = 0.040) as compared to control group. Seventeen patients with CD (65.4%) and 18 control subjects (69.2%) had obstructive sleep apnea. Serum AgRP (13.2 ± 7.4pg/ml vs. 9 ± 3.1, p = 0.029), leptin (59.5 mcg/l, [IQR] 32.6-94.6 vs. 25.3 mcg/l, [IQR] 12.9-57.5, p = 0.007) were higher in CD group. AgRP and leptin correlated negatively with total sleep time, sleep efficiency, stage N2 sleep (%), and positively with WASO%. In multiple regression analyses, serum cortisol (ß = - 0.359, p = 0.042) and AgRP (ß = - 0.481, p = 0.01) were significant predictor of sleep efficiency. AgRP was also significant predictor of WASO% (ß = 0.452 and p < 0.05). Active CD carries an increased risk of impaired sleep efficiency and continuity which may worsen health-related quality of life. Elevated circulating AgRP and, to a lesser extent, leptin may be associated with decreased sleep efficiency and continuity in patients with CD. Patients with CD who have subjective sleep symptoms should be screened with polysomnography.

Distinct Sleep Alterations in Alcohol Use Disorder Patients with and without Korsakoff's Syndrome: Relationship with Episodic Memory.

Alcohol Use Disorder (AUD) results in sleep disturbances that may have deleterious impacts on cognition, especially on memory. However, little is known about the sleep architecture in patients with Korsakoff's syndrome (KS). This study aims at characterizing sleep disturbances in KS compared to AUD without KS and at specifying the relationships with cognitive impairments. Twenty-nine AUD patients (22 without KS and 7 with KS) and 15 healthy controls underwent a neuropsychological assessment and a polysomnography. The severity of sleep-disordered breathing and sleep fragmentation was similar in AUD and KS patients compared to controls. Sleep architecture differed between both patient groups: the proportion of slow-wave sleep was reduced in AUD patients only, while a lower proportion of rapid-eye movement (REM) sleep was specifically observed in KS patients. The proportion of REM sleep correlated with the severity of episodic memory deficits when AUD and KS were examined together. These data provide evidence for both similarities and specificities regarding sleep alterations in AUD patients with and without KS. They also indicate that altered sleep architecture may contribute to the pathophysiology of alcohol-related memory disorders.

Whoop there it is: decoding sleep, cirrhosis, and HE.

Sleep abnormalities in cirrhosis and HE have long been an area of interest.1 Sleep disturbances are highly prevalent in patients with cirrhosis, and HE is often characterized as a reversal of the sleep-wake cycle.2 As assessed by validated questionnaires, such as the Pittsburgh Sleep Quality Index, studies have reported over 80% of patients with cirrhosis suffer from poor sleep and associated low quality of life scores.3 Patients with cirrhosis have impaired hepatic clearance of melatonin, a major regulator of the sleep-wake cycle. Higher daytime serum melatonin and peak levels later in the day contribute to daytime sleepiness, and nighttime arousal observed in many patients with HE.4 Not only do patients with cirrhosis suffer from disrupted sleep timing, but conventional methods of monitoring sleep, that is, polysomnography (PSG), have also demonstrated disrupted sleep architecture resulting in less restorative sleep.5,6 Patients with cirrhosis have been found to have decreased sleep efficiency, decreased rapid eye movement (REM) sleep, and increased sleep latency compared with healthy controls.7 These disturbances appear to increase in severity along with more advanced cirrhosis.7 Abnormal sleep architecture, including decreased REM and slow wave sleep on PSG, has also been observed in patients with covert HE (CHE) compared with controls.8 In this issue of Hepatology Communications, Buckholz and colleagues remotely monitored sleep in 25 patients with cirrhosis for almost 3000 nights of data, using the Whoop fitness tracker. They found that patients with CHE were more likely to experience decreased restorative sleep, especially lowered REM sleep. The team provided insight into sleep characteristics and cycle changes over almost 6 months. Furthermore, the authors discovered that these disturbances, such as the percent of time spent in REM sleep, vary from night to night. These are clear advantages of using this technique over traditional PSG, and this unique study furthers the trend of extending the patient-clinician relationship beyond the clinic into their homes.9 Although the study excluded patients with current treatment of overt HE, there remains a major overlap in patients with obstructive sleep apnea (OSA), HE, and those with disordered sleep due to altered melatonin metabolism secondary to cirrhosis (Fig. 1).10 As obesity rates rise, NAFLD represents an increasing proportion of the population with cirrhosis, and OSA as an etiology of sleep disturbances is likely concordantly increasing in prevalence.7 Symptoms such as daytime sleepiness, fatigue, and nighttime arousal are nonspecific, making diagnosis challenging based on the interview alone.10 Adding to the challenge of making the appropriate diagnosis, sleep architecture is disrupted in both OSA and cirrhosis. When using PSG to compare patients with OSA alone to patients with both OSA and cirrhosis, patients had similar sleep architecture with no significant differences in time spent in restorative sleep, such as REM sleep or slow wave sleep.8 In addition, patients with OSA without cirrhosis may have abnormal results on common tests for CHE, including inhibitory control, number connection, and digit symbol tests.11FIGURE 1: Sleep apnea and disordered sleep secondary to melatonin dysregulation share greater symptom overlap than with covert HE (CHE). Not all daytime sleepiness, fatigue, nighttime arousal, and disrupted sleep architecture in patients with cirrhosis can be attributed to CHE alone.Although appropriate identification of the cause of daytime sleepiness in patients with cirrhosis is challenging, it is critical in determining the next steps in management. Patients with OSA and cirrhosis treated with continuous positive airway pressure have demonstrated improvement in PSQI and improvement in executive function on inhibitory control testing.11 In patients with overt and CHE, there is mixed evidence that traditional HE therapies affect sleep parameters or architecture.5,12 Given the relative overlap in symptoms among OSA, disordered sleep secondary to melatonin dysregulation, and CHE, as well as the lack of specificity of current tests for CHE, clinicians should consider testing at-risk patients for sleep apnea and employing multiple modalities for appropriate CHE diagnosis. Although more work is needed, encouraging monitoring of sleep architecture remotely to gauge response to therapy, as outlined in by Buckholz and colleagues, may be an important first step.

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.

A study of Cardiorespiratory Parameters and Sleep Architecture in Patients with Pediatric Obstructive Sleep Apnea undergoing Adenotonsillectomy

A study of Cardiorespiratory Parameters and Sleep Architecture in Patients with Pediatric Obstructive Sleep Apnea undergoing Adenotonsillectomy

The effect of lacosamide monotherapy on sleep architecture in patients with epilepsy: a preliminary evidence.

Lacosamide (LCM) is a third-generation antiseizure medication (ASM), and its effect on sleep architecture was supported by a few studies in patients with drug-resistant epilepsy in which LCM was used as an add-on treatment. To gather knowledge on ASMs effects on sleep, this study aimed at evaluating the effects of LCM monotherapy on sleep in patients with focal epilepsy. Ten patients diagnosed with epilepsy (mean age 58.00 ± 14.77, 60.0% female, mean monthly seizure frequency 1.20 ± 2.48) starting LCM as monotherapy were included. Sleep architecture was assessed through polysomnography at baseline and at the 6-month follow-up visit. A significant decrease was observed in seizure frequency (p = 0.004), being all patients seizure-free at follow-up. At baseline, eight patients had poor sleep efficiency (< 85%). Sleep efficiency increased at follow-up, with onlythree patients having an index < 85% (p = 0.022). From baseline to follow-up, a significant decrease was observed in sleep latency (p = 0.022) and wakefulness after sleep onset (p = 0.047). Moreover, a significant decrease was observed in the percentage of stage 1 (Md = 6.70 vs Md = 3.85, p = 0.005) and stage 3 (Md = 27.70 vs Md = 22.35, p = 0.01) of Non-REM sleep. This study suggests that LCM monotherapy may positively impact sleep architecture in patients with epilepsy. The sleep efficiency improvement and the decrease of sleep latency and wakefulness after sleep onset observed at follow-up highlight better sleep stability and continuity in patients treated with LCM. Notably, all patients were seizure-free at follow-up, and seizure freedom may also concur to sleep structure improvement.

Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis

Trazodone has been widely prescribed for off-label use as a sleep aid. Identifying how trazodone impacts the performance of polysomnographic sleep architecture in insomnia disorder will provide additional data that can be used to guide clinical application. To assess the efficacy of trazodone in altering the polysomnographic sleep architecture in insomnia disorder so that sleep can be facilitated. PubMed, EMBASE, Web of Science, PsycINFO, Cochrane Library, Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure, Wanfang Database, and the China Science and Technology Journal Database were searched for articles published between inception and June 2022. RCTs in patients with insomnia disorder applying trazodone in one arm of interventions at least 1 week, and reporting PSG parameters in the outcomes were eligible. RoB 2 was used to evaluate the risk of bias. The results of quality of evidence assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. When I2 < 50%, the fixed effects model was used. When I2 ≥ 50%, the random effects model was used. The mean differences (MD) or standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals (CIs) were estimated. Eleven randomized controlled trials were selected and participants were 466. Risk of bias was low in 5 trials (45.5%), and was moderate in 6 (54.5%). Compared with the control group, trazodone significantly increased total sleep time (TST, min) (MD = 39.88, 95% CI 14.44–65.32, P = 0.002) and non-rapid eye movement stage 3 (N3, mixed min and %) (SMD = 1.61, 95% CI 0.69–2.53, P = 0.0006); trazodone significantly decreased latency to onset of persistent sleep (LPS, min) (MD = − 19.30, 95% CI − 37.28 to − 1.32, P = 0.04), non-rapid eye movement stage 1 (N1, mixed min and %) (SMD = − 0.62, 95% CI − 1.13 to − 0.12, P = 0.02), the number of awakenings (NAs, including both arousal times and arousal index) (SMD = − 0.67, 95% CI − 0.91 to − 0.42, P < 0.00001), and waking time after persistent sleep onset (WASO, mixed min and %) (SMD = − 0.42, 95% CI − 0.81, − 0.03, P = 0.04), with no obvious effect on non-rapid eye movement stage 2 (N2, mixed min and %) (SMD = − 0.15, 95% CI − 0.41 to 0.11, P = 0.25), rapid eye movement (REM, mixed min and %) (SMD = 0.22, 95% CI − 0.26 to 0.70, P = 0.37), rapid eye movement latency (REML, min) (MD = 2.33, 95% CI − 27.56 to 32.22, P = 0.88), or apnea–hypopnea index (AHI) (MD = − 4.21, 95% CI − 14.02 to 5.59, P = 0.40). Daytime drowsiness (OR = 2.53, 95% CI 1.14–5.64, P = 0.02) and decreased appetite (OR = 2.81, 95% CI 1.14–6.92, P = 0.02) occurred with greater frequency in the trazodone group as compared to the control group, and the differences were significant. The results of quality of evidence were very low in TST, N3 and AHI, were low in LPS, WASO and REM, and were moderate in N1 and NAs. The sources of heterogeneity in TST and N3 were not found out from sensitive and subgroup analysis and there was no high quality of evidence in outcomes by GRADE Assessment. Trials with combination of other therapy could be a problem in this meta-analysis as the possibility of interactions were found from sungroup analysis. Trazodone could improve sleep by changing the sleep architecture in insomnia disorder, but it should be used with caution due to the adverse events that may occur.PROSPERO registration register name: The effect of trazodone on polysomnography sleep architecture in patients with insomnia: a systematic review and meta-analysis protocol; Registration Number CRD42020215332.

0667 The effect of tinnitus on sleep architecture in patients with depression

Abstract Introduction There is an established link between tinnitus (an auditory symptom affecting sound in the ear or head, in the absence of auditory stimulus) and depression in adults. However, there is a lack of research into the effect of tinnitus on sleep architecture in this depression. Methods Female participants (n=149) with sleep disturbance and temporomandibular joint (TMJD) pain were recruited as part of a treatment trial. Data were used to identify a cohort of participants with clinically significant depressive symptoms (CES-D &amp;gt;16), with and without tinnitus. We examined the pre-randomization polysomnography (PSG) dataset, and calculated sleep architecture, and relative spectral power (Alpha, beta, theta, delta). We compared cohorts using independent t-tests, testing for differences in architectural and spectral sleep parameters, controlling for anxiety symptoms. Results 14 females (mean age = 41.76) reporting current tinnitus were age and depression severity matched with 14 females reporting no tinnitus (mean age = 41.27). Groups did not differ significantly in age (p = 0.91), BMI (p = 0.868), race (p = 0.328) or severity of depressive symptoms (CES-D: 23.93 No tinnitus vs 25.07 Tinnitus, p = 0.540), but the tinnitus group reported significantly higher anxiety (GAD-7: 9.43 no tinnitus vs 13.36 Tinnitus, p = 0.016). Data indicated TMJD patients with tinnitus had greater N2 sleep percentage (24.243% no tinnitus vs 57.200% Tinnitus, p = 0.033) compared with controls. There were no significant differences in N1% (4.2% No tinnitus vs 3.7% Tinnitus, p = 0.874), SWS% (23.164% No tinnitus vs 17.236% Tinnitus, p = 0.217) or REM% (26.386% No Tinnitus vs 21.88% Tinnitus, p = 0.238) between groups. Analysis of spectral data showed no significant differences in relative alpha (0.129 No tinnitus, 0.143 Tinnitus, p = 0.099), beta (0.186 No tinnitus vs 0.188 Tinnitus, p = 0.814), theta (0.123 No Tinnitus vs 0.125 Tinnitus, p = 0.069), or delta power (0.360 Tinnitus vs 0.346 Tinnitus, p = 0.399). Conclusion Our results indicate an association between tinnitus and increased N2% in TMJD participants reporting sleep disturbance and depressive symptoms. The effect of tinnitus on objective sleep parameters, in the context of depressive symptoms warrants further study. Support (If Any) This research study was supported financially by the NIH Grant R01 DE019731 (Haythornthwaite, JA and Smith, MT).[MR1] [MR1]Don’t include this in the main body, it’ll use too many words. If there’s a section on the submission portal to include this, add it. If not can just put the grant reference (as one word) in brackets after “treatment trial”

Sleep architecture in patients with interstitial lung disease with and without pulmonary hypertension

Sleep disturbance is common in patients with advanced interstitial lung disease (ILD) often complicated by pulmonary hypertension (PH) and may contribute to poor quality of life. The etiology of sleep disturbance and the relationship between PH and sleep architecture in patients with ILD remains unknown. We performed a retrospective cohort study comparing sleep architecture on polysomnography in patients with ILD with and without PH, defined as mean pulmonary artery pressure on right heart catheterization ≥ 20mmHg. We tested the hypothesis that patients with ILD and PH would have increased wake time after sleep onset (WASO) compared to patients with ILD without PH using univariate analysis and multivariable linear regression. In our cohort of patients with ILD who underwent polysomnography (N = 49), patients with PH had lower total diffusion capacity for carbon monoxide (DLCO) (9.28 vs. 12.87ml/min/mmHg, P = 0.04) and percent DLCO (39% vs. 53%, P = 0.03). On polysomnography, patients with PH had increased percentage of total sleep time with saturation < 90% (T90) (17% vs. 6%, P = 0.03), decreased N2 sleep (181 vs. 233min, P = 0.03), decreased %N2 sleep (59% vs. 66%, P = 0.04), increased %N1 sleep (22% vs. 14%, P = 0.02), decreased sleep efficiency (62% vs. 72%, P = 0.03), and increased WASO (133 vs. 84min, P = 0.01). In multivariable analysis, PH was associated with a 43-min increase in WASO (95% CI 6.2-80.2, P = 0.02). Patients with ILD and PH have decreased total and %N2 sleep, increased %N1 sleep, decreased sleep efficiency, and increased WASO, likely indicating increased sleep fragmentation.

Sleep Architecture in Progressive Supranuclear Palsy: A Video-Polysomnography Study.

Sleep disturbances have been reported to occur in progressive supranuclear palsy (PSP). The anatomical regions affected in PSP and those regulating sleep and wake cycle like dorsal raphe nucleus, locus coeruleus (LC), and pedunculopontine nucleus (PPN) overlap. There is a paucity of polysomnographic studies in PSP and they have shown altered sleep architecture. To study the sleep architecture in patients with PSP using video-polysomnography (vPSG) and correlate it with the disease severity and duration. This was a prospective, cross-sectional, case-control, single-center study. A total of 22 patients with PSP and 15 age and gender-matched controls were recruited. The cases and controls underwent clinical assessment, face-to-face interviews with sleep questionnaires, anxiety and depression scales, and one overnight vPSG. The sleep architecture was analyzed in detail. The sleep architecture was altered as compared to the controls. The total sleep time, stage N2 duration, stage N3 duration, rapid-eye-movement (REM) sleep duration, sleep efficiency %, and N2%, N3%, and REM% were significantly lesser in PSP patients. The wake duration, wake after sleep onset (WASO) duration, wake%, WASO%, stage N1 duration was significantly greater in PSP patients. The stage N2 and N3 latencies were significantly prolonged in patients. REM sleep without atonia was noted in four patients and no patients had vPSG proven REM sleep behavior disorder. Sleep architecture is altered in PSP even during the early stages of the disease. There is reduced total sleep including both non-REM and REM sleep, sleep efficiency, prolonged sleep latencies, and increased wake duration. This correlates with the neurodegenerative processes affecting the anatomical region regulating the sleep/wake cycle like dorsal raphe nucleus, locus coeruleus (LC), pedunculopontine nucleus (PPN).

Polysomnographic survey of sleep architecture in patients with methamphetamine dependence during remission

IntroductionMethamphetamine dependence is common in the world. Methamphetamine affects sleep architecture through changes in the monoaminergic activity of the brain. Limited studies investigated the sleep architecture in patients with methamphetamine dependence during prolonged abstinence. Therefore, this study investigated the sleep architecture of methamphetamine ex-users in the remission phase by polysomnography.Material and MethodsThis was a cross-sectional study conducted during 2015-2017 in Mashhad, Iran. 12 methamphetamine ex-users in early full remission phase were selected from residential treatment centers through the convenient sampling method. The clinical interview was made to confirm the diagnosis and assess the inclusion and exclusion criteria. We performed urine dipstick tests to detect any relapses. Participants underwent a one-night polysomnographic evaluation, voluntarily. The collected data were analyzed by independent sample t-test and chi-square test, using SPSS-16. The level of significance was less than .05.ResultsThe mean total sleep time of participants was significantly lower than the total sleep period (333.6±79.1 vs. 403.0±52.9 minutes, respectively; p=0.001), leading to a significant low sleep efficiency (75.7±14.4%, p=0.047). Evaluation of rapid eye movement (REM) sleep showed a significant increase in the REM latency compared to the healthy population (p<0.001). Stages 1 and 3 of non-REM sleep were increased compared to the healthy population, too (p<0.001 and p=0.002, respectively).ConclusionFormer methamphetamine users continue to experience some long-term abnormalities in sleep architecture a few months after drug cessation

Sleep architecture in patients with frontal brain tumor

IntroductionThe aim of the study was to characterize sleep architecture and self-reported sleep questionnaires in patients with frontal brain tumor. MethodsEight patients with frontal brain tumor underwent polysomnographic testing and completed self-report questionnaires on sleep quality, insomnia, drowsiness and risk of obstructive sleep apnea, in addition to depression and anxiety inventories. ResultsPatients with frontal brain tumor exhibited a disruption of the sleep architecture, characterized by changes in the pattern and in the time they spend asleep. It was found that objective values (polysomnographic variables) do not necessarily correspond to the perception of alteration through subjective methods (self-reported questionnaires). ConclusionsChanges in the architecture of sleep in patients with frontal tumors allow us to understand the organization of the brain during this state in the presence of this type of pathology, which causes structural and functional changes.

Opioids and obstructive sleep apnea.

Freire C, Sennes LU, Polotsky VY. Opioids and obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):647-652.

Characteristics of Cancer-Related Fatigue and Concomitant Sleep Disturbance in Cancer Patients

ContextCancer patients often experience cancer-related fatigue (CRF) and sleep disturbances due to cancer and cancer treatment, and symptoms can persist long after treatment. Despite these common occurrences, few studies simultaneously characterize CRF and sleep architecture among cancer patients. ObjectivesThe objective was to characterize CRF and the sleep architecture of patients seen in a CRF clinic and sleep clinic at the University of Texas MD Anderson Cancer Center. MethodsCRF Clinic medical records were retrospectively reviewed from September 1, 2006, to September 30, 2010, for self-reported performance status, fatigue, pain, sleep disturbance, depression, anxiety, and sleepiness (n = 219). Polysomnography results were recorded for those referred for additional sleep consultation (n = 39). ResultsNotably, patients often reported fatigue, sleep disturbance, excessive daytime sleepiness, and a majority of patients referred for a sleep consultation were diagnosed with obstructive sleep apnea (n = 33). ConclusionThe results highlight the promise of an interdisciplinary collaboration between dedicated a CRF clinic and sleep clinic to conduct effective assessments to identify treatable CRF and sleep disorders.