Sleep Center Research Articles

0808 Comparison of Maxillary Transverse Dimension with Pediatric Obstructive Sleep Apnea Presence and Severity

Abstract Introduction Obstructive Sleep Apnea (OSA) in children and adolescents is commonly discussed amongst dental specialists. Physical attributes such as a high and narrow palate, dolichofacial appearance, and retrognathic mandible are reported to increase pediatric risk for OSA. Previous research states rapid maxillary expansion decreases AHI in children with OSA and may be an effective treatment option. Current literature does not report a consistent method of measuring a maxillary transverse deficiency nor does it report a numerical maxillary threshold deficiency that requires expansion in pediatric patients with OSA. Our aims are to compare two different orthodontic diagnostic methods for measuring the maxillary transverse dimension and to assess whether patients diagnosed with mild, moderate, or severe OSA have a numerical threshold for maxillary deficiency. Methods Participants were ages 7-17 years old (average 11.7 years) with no history of orthodontic treatment, craniofacial syndromes, craniosynostosis forms, or nasal abnormalities. Those with and without adenoids and tonsils were included. Participants presented to the Mayo Clinic Sleep Center for their polysomnogram. Their dentition was scanned, and a digital model was rendered. The maxillary transverse dimension was measured via two different methods: McNamara’s Analysis and Andrew’s Six Elements of Orofacial Harmony. Results There were 65 participants: 31 diagnosed with OSA (13 Mild, 4 Moderate, 5 Severe, and 9 Other) and 34 without (controls). Patients in the Other category were diagnosed based on clinical findings. No statistical difference was found between the maxillary transverse measurements of patients with versus without OSA or between the OSA categories. Patients with OSA were more likely to have permanent teeth (61.3% vs 32.4%, p=0.019), tonsils removed (54.8% vs 26.5%, p=0.020), and to have snored during the PSG (83.9% vs 55.9%, p=0.048). Conclusion Conclusions based on this pilot study should be interpreted carefully due to limited sample sizes. No statistically significant differences of the maxillary transverse dimension were found between those with and without OSA using either diagnostic method. No numerical maxillary deficiency threshold was found. Maxillary expansion should not be recommended based on OSA diagnosis alone. Referral to a dental specialist is recommended based on dental needs. Support (if any) Support was provided by Mayo Clinic CTSA grant UL1TR002377.

Association of Low Arousal Threshold Obstructive Sleep Apnea Manifestations with Body Fat and Water Distribution.

Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E-I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E-I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA.

Anthropometric Determinants of Autonomic Control in Obstructive Sleep Apnea: A Large-Scale Study.

Autonomic dysfunction is an independent risk factor for cardiovascular disease (CVD). Both obesity and obstructive sleep apnea (OSA) are associated with heart rate variability (HRV) (a hall marker of sympathetic arousal) and increased risk of CVD. This study aims to investigate whether anthropometric parameters could predict reduced HRV in adult OSA during wakefulness. Cross-sectional study. Sleep center of Shanghai Jiao Tong University Affiliated Sixth Hospital from 2012 to 2017. Total of 2134 subjects (503 non-OSA and 1631 OSA) were included. Anthropometric parameters were recorded. HRV was recorded during a 5-minute wakefulness period and analyzed by using time-domain method and frequency-domain method. Multiple step-wise linear regressions were performed to determine significant predictors of HRV with and without adjustments. Multiplicative interactions between gender, OSA, and obesity on HRV were also determined and evaluated. Waist circumference (WC) was significant negative determinant of root mean square of successive NN intervals(β = -.116, p < .001) and high-frequency power (β = -.155, p < .001). Age was the strongest determining factor of HRV. Significant multiplicative interactions between obesity and OSA on HRV, gender, and obesity on cardiovascular parameters were observed. Anthropometric parameters could predict reduced HRV during wakefulness in patients with OSA, especially WC was the strongest influenceable factor. Obesity and OSA had significant multiplicative interaction on HRV. Gender and obesity had significant multiplicative interaction on cardiovascular parameters. Early intervention for obesity, especially centripetal obesity, may improve reduction of autonomic function and risk of CVD.

Low Specificity of Rapid Eye Movement Sleep Behavior Disorder Questionnaires: Need for Better Screening Methods.

Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is critical due to its link to α-synucleinopathies and risk of injuries and requires video-polysomnography (V-PSG). Usefulness of screening questionnaires outside the context of validation studies is limited. The aim was to assess the performance of three validated RBD screening questionnaires compared with gold-standard V-PSG. In this bicentric prospective study, 400 consecutive subjects referred to a sleep center for the first time filled three RBD questionnaires (RBD Screening Questionnaire, RBD Single Question, and Innsbruck RBD Inventory) in random order before sleep experts' interview. Subjects positive for at least one questionnaire were invited to undergo V-PSG. Data from patients negative for all questionnaires undergoing V-PSG for other reasons were also evaluated. Questionnaire performances were compared to gold-standard V-PSG RBD diagnosis. Three hundred ninety-nine patients (median age: 51 [interquartile range: 37-64] years, 54.9% men) participated. Two hundred thirty-eight (59.6%) were positive for at least one questionnaire, and RBD was diagnosed using V-PSG in 30 patients (7.5%). Questionnaire specificity was 48.1% to 67.4%, sensitivity 80% to 92%, accuracy 51% to 68.3%, negative predictive value 94.2% to 98%, and positive predictive value 14.1% to 20.7%, with no relevant differences in performances among the evaluated questionnaires. RBD questionnaires have low specificity and low positive predictive value and should not be used as a standalone tool for the diagnosis of RBD. Further development of RBD screening methods is needed, particularly for upcoming neuroprotective trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Reasons and predictors for early termination of pediatric polysomnography: one children's hospital's experience.

We sought to identify reasons for early polysomnography termination in pediatric patients. We retrospectively reviewed all studies conducted at the Pediatric Sleep Center at UT Southwestern Medical Center from January 1, 2017, through December 31, 2019, that were terminated before study completion. We investigated reasons for early termination and gathered characteristics such as age, sex, presence of neurocognitive impairment, payor status, seasonal variability, and testing site location. There were 137 patients who terminated their studies before completion, comprising 1.05% of all patients who arrived for their scheduled polysomnographies during that time frame. The 3 main categories of reasons were equipment intolerance (47%), acute illness (33%), and parental refusal (20%). Parental refusal reasons included the patient's becoming combative, a lack of specialized equipment, patient's inability to fall asleep, forgetting the patient's nighttime medications, and the parent's inability to stay the night. Males represented a greater proportion of those who terminated due to intolerance of equipment (75%). Patients who terminated early due to equipment intolerance consisted of more neurologically impaired patients compared with those who terminated due to acute illness (56% vs 24%). Termination due to acute illness occurred more during the wintertime (44%) than in the summer (7%). In those who terminated due to parental refusal, there was a greater proportion of children under 6 years of age (75%). Determining factors that are associated with early polysomnography termination is an important step to help identify at-risk groups and implement strategies to improve study completion. Luong S, Culp M, McCreary M, Wani A, Caraballo M. Reasons and predictors for early termination of pediatric polysomnography: one children's hospital's experience. J Clin Sleep Med. 2023;19(10):1711-1716.

0175 Poor Association Between Subjective and Objective Sleepiness in Patients Evaluated in a Clinical Sleep Center

Abstract Introduction Sleepiness is a primary symptom among patients presenting at sleep clinics. Sleepiness is typically subjectively evaluated using the Epworth Sleepiness Scale (ESS), which has been associated with worse cardiovascular outcomes among sleep apnea patients. On the other hand, functional deficits due to sleepiness can be objectively quantified using a Psychomotor Vigilance Test (PVT). To better understand the presentation of “sleepiness”, we examined the relationship between subjective ESS and objective PVT among a clinical sample. We hypothesized that these two different measures of sleepiness would be correlated. Methods A prospective sample of patients being evaluated for sleep disorders in the Sleep Center at the University of Pennsylvania completed the ESS and PVT at the same clinical visit. Demographic data were obtained at the visit or derived from the electronic health record. Pearson’s linear correlations were utilized to examine the association between the ESS and both the transformed lapses (sum of square root of number of lapses and square root of lapses+1) and mean reciprocal response time (RRT) on the PVT. Results In total, 167 patients (98 [58.7%] males) were studied, with a mean (±SD) age of 54.7±16.8 years and BMI of 34.5±9.9 kg/m2. There were a similar number of White (67 [42.1%]) and Black (71 [44.7%]) participants and 129 (77.3%) had diagnosed or suspected obstructive sleep apnea (OSA). Patients had an average ESS of 8.1±5.4, and 10.5±10.6 lapses, 5.9±2.9 transformed lapses, and mean RRT of 3.4±0.7 seconds-1 on PVT. Among all patients, there was no statistically significant correlation between ESS and either transformed lapses (rho = 0.10, p=0.200) or mean RRT (rho = -0.10, p=0.201). Results were similar when comparing the two sleepiness measures restricted to patients with OSA. Conclusion Within patients being evaluated in a clinical sleep center, there was only a weak association between subjective sleepiness on the ESS and objective sleepiness on PVT. Thus, not all patients reporting daytime sleepiness have objective deficits, and vice versa. Results support using both assessments to fully characterize a patient’s sleepiness. Future studies should evaluate the relationship between adverse outcomes and subjective and objective sleepiness, alone and in combination. Support (if any)

0527 Effectiveness of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea at a Major Tertiary Academic Sleep Center

Abstract Introduction The use of hypoglossal nerve stimulation (HGNS) for treatment of obstructive sleep apnea (OSA) has been reported to be efficacious in up to 75% of patients with a 68% improvement in the 3% apnea hypopnea index (AHI). Based on these results, HGNS is an increasingly widespread alternative treatment for OSA patients who are intolerant of Positive Airway Pressure (PAP) treatment. It is unknown if HGNS is equally efficacious outside of the highly controlled setting of a clinical trial. Here, we performed a retrospective cohort study from patients who underwent implantation of a hypoglossal nerve stimulator at our academic institution and report the efficacy based on improvement in AHI. Methods Adult subjects with a diagnosis of OSA, who were intolerant of PAP therapy and underwent implantation of HGNS at Barnes Jewish Hospital in St. Louis, Missouri from 6/4/2019 to 6/28/2022 were included in this retrospective cohort study. Only those who were referred for implantation from Washington University Sleep Medicine Center were included. The efficacy of HGNS was evaluated by comparing the 3% AHI on subjects’ polysomnography before and after the HGNS was implanted and activated. Analysis of the data was done using paired t-tests to determine efficacy of HGNS via a reduction of at least 50% of the 3% AHI and a reduction in 3% AHI to less than 20 events per hour. Results 45 subjects were implanted of which 1 subject did not tolerate HGNS, and 8 subjects were lost to follow-up. Of the remaining 36 subjects, the median 3% AHI decreased 79% from 29.5 to 6.5 events per hour (p&amp;lt; 0.0001). There was a reduction of at least 50% of the 3% AHI in 83% of subjects and a reduction of 3% AHI to less than 20 events per hour in 86% of subjects. Conclusion HGNS achieved significant therapeutic results in the majority of patients with OSA who are intolerant of PAP therapy. These results add to the growing body of evidence reproducing the original clinical trial in a “real-world” setting free of any conflict of interest. Future studies examining predictive factors influencing the effectiveness of HGNS are needed. Support (if any)

Resting-State Cerebral Hemodynamics is Associated With Problem Behaviors in Pediatric Sleep-Disordered Breathing.

Untreated sleep-disordered breathing (SDB) is associated with problem behaviors in children. The neurological basis for this relationship is unknown. We used functional near-infrared spectroscopy (fNIRS) to assess the relationship between cerebral hemodynamics of the frontal lobe of the brain and problem behaviors in children with SDB. Cross-sectional. Urban tertiary care academic children's hospital and affiliated sleep center. We enrolled children with SDB aged 5 to 16 years old referred for polysomnography. We measured fNIRS-derived cerebral hemodynamics within the frontal lobe during polysomnography. We assessed parent-reported problem behaviors using the Behavioral Response Inventory of Executive Function Second Edition (BRIEF-2). We compared the relationships between (i) the instability in cerebral perfusion in the frontal lobe measured fNIRS, (ii) SDB severity using apnea-hypopnea index (AHI), and (iii) BRIEF-2 clinical scales using Pearson correlation (r). A p < .05 was considered significant. A total of 54 children were included. The average age was 7.8 (95% confidence interval, 7.0-8.7) years; 26 (48%) were boys and 25 (46%) were Black. The mean AHI was 9.9 (5.7-14.1). There is a statistically significant inverse relationship between the coefficient of variation of perfusion in the frontal lobe and BRIEF-2 clinical scales (range of r = 0.24-0.49, range of p = .076 to <.001). The correlations between AHI and BRIEF-2 scales were not statistically significant. These results provide preliminary evidence for fNIRS as a child-friendly biomarker for the assessment of adverse outcomes of SDB.

Developmental changes in obstructive sleep apnea and sleep architecture in Down syndrome.

Down syndrome (DS, also known as Trisomy 21) is a condition associated with abnormal neurodevelopment and a higher risk for sleep apnea. Our study sought to better understand and characterize the age-related developmental differences in sleep architecture and obstructive sleep apnea (OSA) severity in children with DS compared to euploid individuals. Retrospective review of polysomnograms in over 4151 infants, children, and adolescents in the pediatric sleep center at Children's National Hospital in Washington D.C. (0-18 years) including 218 individuals with DS. The primary findings of our study are that: (1) severe OSA (obstructive apnea-hypopnea index ≥ 10/h) was more prevalent in the DS group (euploid 18% vs. DS 34%, p < 0.001) with the highest OSA severity being present in young children (<3 years old) and adolescents (>10 years old), (2) abnormalities in sleep architecture in children with DS were characterized by a prolonged rapid-eye movement (REM) sleep onset latency (SOL) (euploid 119 min vs. DS 144 min, p < 0.001) and greater arousal indexes (euploid 10.7/h vs. DS 12.2/h, p < 0.001), (3) developmental changes in the amount of REM sleep or slow wave sleep were not different in DS individuals relative to euploid children, (4) multivariate analyses showed that OSA and REM sleep latency differences between DS and euploid individuals were still present after adjusting by age, biological sex, and body mass index. Severe OSA is highly prevalent in children with DS and follows an age-dependent "U" distribution with peaks in newborns/infants and children >10 years of age. Children with DS also have disturbances in sleep architecture characterized by a longer REM SOL and elevated arousal indexes. As sleep cycle generation and continuity play crucial roles in neuroplasticity and cognitive development, these findings offer clinically relevant insights to guide anticipatory guidance for infants, children, and adolescents with DS.

The promotion of sleep wellness: Resilience as a protective factor.

To evaluate the association between resilience, sleep quality, and health. This cross-sectional study included 190 patients (Mean age = 51, SD = 15.57) recruited from the Johns Hopkins Center for Sleep and Wellness. Patients completed a modified version of the brief resilience scale (BRS) to assess characteristics of resilience and questions to assess aspects of mental health, physical health, sleep quality, and daytime functioning. Participants' average score on the BRS was 4.67 (SD = 1.32, range = 1.17-7), reflecting a high level of resilience. There was a significant gender difference in resilience levels for men (Mean = 5.04, SD = 1.14) and women (Mean = 4.30, SD = 1.38), such that men reported significantly higher levels of resilience compared to women (t (188) = 4.02, p < 0.001) [lower levels of resilience were significantly associated with higher levels of (current) fatigue and tiredness after adjusting for demographic, physical, and mental covariates. In those reporting between one and three mental health symptoms, high levels of resilience minimized the negative influence that these symptoms had on sleep quality. This minimizing effect was no longer evident in those experiencing >3 mental health symptoms, who also reported significantly higher symptoms of fatigue despite their high resilience scores. This study emphasizes how resilience may affect the relationship between mental health and sleep quality in sleep patients. Resilience may further our understanding of the inter-relationships between sleep and the manifestation of physical health symptoms, a relationship that will likely heighten in relevance during personal and global crisis. An awareness of this interaction could be used as a proactive prevention and treatment strategy. In other words, incorporating methods to evaluate resilience in patients with mental illnesses regularly can be useful for predicting the potential manifestation and severity of sleep disturbance. Therefore, strategies that focus on promoting resilience could improve health and wellness.

The impact of daylight-saving time (DST) on patients with delayed sleep-wake phase disorder (DSWPD).

Due to time zones, sun time and local time rarely match. The difference between local and sun time, which we designate by Solar Jet Lag (SoJL), depends on location within a time zone and can range from zero to several hours. Daylight saving time (DST) simply adds 1 h to SoJL, independently of the location. We hypothesised that the impact of DST is particularly problematic in patients with delayed sleep-wake phase disorder (DSWPD), worsening their sleep debt. DSWPD is characterised by a chronic misalignment between the internal and social timing, reflected by an inability to fall asleep and wake-up at conventional or socially acceptable times. We analysed the clinical records of 162 DSWPD patients from a sleep medicine centre in Lisbon, Portugal (GMTzone), and separated them into two groups: the ones diagnosed across DST or across Standard Time (ST). We included 82 patients (54.9% male; age: median [Q1 , Q3 ] 34.5 [25.0, 45.3]; range 16-92; 54 in DST and 28 in ST) who had Dim Light Melatonin Onset (DLMO) measured as a marker for the circadian phase and sleep timing (onset, SO, mid-point, MS and end, SE) self-reported separately for work- and work-free days. Differences between ST and DST were compared using Mann-Whitney or Student's t-tests. On a weekly average, patients in DST slept less (difference between medians of 37 min. p < .01), mainly due to sleep on workdays (SDw, p < .01), which also correlated with SoJL (rsp = .38, p < .01). While the time from DLMO to SO was similar in those in ST or those in DST, the time from DLMO to SE was significantly shorter for those in DST. The average duration between DLMO and sleep end was close to 10.5 h in ST, the biological night length described in the literature. Our results favour perennial ST and suggest assigning time-zones close to sun time to prevent social jetlag and sleep deprivation.

Investigation of spatial pattern of apnea disorder using geographic information system (GIS)-case study of Kermanshah metropolis.

Apnea disorder is influenced by social and environmental factors. By assessing its hot spots and geography, the foci of this disorder and its at-risk groups can be identified for health interventions. This study was conducted to investigate the spatial pattern of apnea disorder using GIS in the Kermanshah metropolis. In cross-sectional study was conducted in kermanshah, the statistical population were 119 people (73.95% male and 26.05% female) of Kermanshah residents, which referred to the sleep center from 2012 to 2018 due to apnea disorder. Information was collected from the records of patients referred to the Sleep Disorder Center of Farabi Hospital, which is the only service center in the west part of Iran. The statistical tests were the mean center, standard distance, Getis-Ord Gi * index, nearest neighbor index, and kernel density estimation test in GIS software. The spatial pattern of patients with apnea disorder has cluster formation in the Kermanshah metropolis. The age group of 50-54 had more apnea disorder than other age groups. In this age group, women were more prone to apnea than men. In terms of education, people with high education are more affected by this disorder; So that with the increase in education level, apnea disorder had also increased. Also, the findings showed that the disorder was more common in unemployed, married, overweight people with BMI (25-30), and obese people (30-40). The spatial pattern of patients with apnea disorder was clustered and does not correspond to the high population density centers located in the marginal and slum areas of the city. These can be used by stakeholders, including governmental organizations and health authorities at the national-regional level.

Sleep medicine practices in pediatric patients during the COVID-19 pandemic

Objectives: The COVID-19 pandemic required precautions for infection control in sleep centers. Our aim was to assess the impact of the COVID-19 pandemic on sleep medicine practices. Methods: Data of patients undergoing polysomnography and positive airway pressure titration studies prior to (2019) and during the pandemic (2020) were analyzed. In addition, the effect of taking appropriate precautions and performing SARS-CoV-2 polymerase chain reaction testing on the safety of sleep medicine practices was investigated. Results: The median age of the patients who underwent sleep studies (polysomnography + positive airway pressure titration studies) in 2019 was 7 (2.5-11.5) years (164 male, 147 female), whilst it was 9 (4-12) years (127 male, 84 female) in 2020. During the outbreak, the frequency of sleep studies increased from 3% (311 tests/10068 total number of outpatient visits in 2019) to 3.7% (211 tests/5666 in 2020). In contrast, the frequency of positive airway pressure titration studies declined from 31.8% (99 positive airway pressure titration studies/311 sleep studies) to 21.8% (46 positive airway pressure titration studies/211 sleep studies) in 2020 compared to 2019. Down syndrome was found to be the most common indication both in 2019 (20.9% of all tests) and 2020 (13.7%). Conclusions: Polysomnographies were performed at a high rate despite the pandemic. However, positive airway pressure titration studies were avoided except for urgent indications because of the potential for aerosolization. In this study, it was shown that sleep studies can be performed safely when necessary precautions are taken.

Effects of different accompanying symptoms of obstructive sleep apnea on the risk of cardiovascular and cerebrovascular and diabetes events

Objective: To investigate the effects of different accompanying symptoms on the risk of cardiovascular and cerebrovascular and diabetes events in patients with obstructive sleep apnea (OSA). Methods: Patients diagnosed with OSA in the sleep center of Tangdu Hospital from January 4, 2011 to December 28, 2016 were retrospectively collected and divided into four groups according to accompanying symptoms: group A included OSA patients without insomnia and excessive daytime sleepiness (EDS), group B included OSA patients with insomnia, group C included OSA patients with EDS and group D included OSA patients with insomnia and EDS. Patients were followed up by telephone for 6 to 11 years. Outcome measures were composite cardiovascular and cerebrovascular and diabetes events (including new onset or recurrent heart disease, cerebral infarction, cerebral hemorrhage, newly diagnosed hypertension and diabetes). Kaplan-Meier method was used to draw survival curves, log-rank test was performed to compare the prognosis of OSA patients with insomnia and/or EDS symptoms, and multivariate Cox proportional hazards model was constructed to analyze the influencing factors of adverse outcome events in OSA patients. Results: Five hundred and four patients with OSA were included, and 307 patients [274 males and 33 females, aged (49±11) years] completed the follow-up, including 27 patients in group A, 143 patients in group B, 27 patients in group C, and 110 patients in group D. After a median follow-up of 7.7 years, 78 patients developed cardiovascular and cerebrovascular and diabetes events. Outcome events occurred in 1 patient (3.70%) in group A, 30 (20.98%) in group B, 10 (37.04%) in group C, and 37 (33.64%) in group D. Compared with patients in group A, there was a statistically significant difference in the incidence of outcome events in groups B (P=0.034), C (P=0.004), and D (P=0.003). After adjusting for age, sex, body mass index, apnea-hypopnea index, baseline cardiovascular and cerebrovascular risk factors and subsequent continuous positive airway pressure therapy, patients in group C (HR=9.67, 95%CI: 1.23-76.37, P=0.031) and group D (HR=11.35, 95%CI: 1.55-83.43, P=0.017) had an increased risk of cardiovascular and cerebrovascular and diabetes events when compared with group A. Conclusions: In OSA patients with successful long-term follow-up, insomnia and EDS symptoms are risk factors for the development of cardiovascular and cerebrovascular and diabetes events. Insomnia and EDS symptoms should be evaluated in patients with OSA during clinical practice to find the cause and carry out the targeted intervention.

A deep learning model developed for sleep apnea detection: A multi-center study

Objective. Manual detection of obstructive sleep apnea (OSA) is a challenging task for many reasons such as time-consuming and subjective. This study aimed to develop a deep learning model for automatically detecting abnormal sleep respiratory episodes in patients with OSA and to explore the performance differences between different sleep centers and different kind of sleep monitoring devices. Methods. The proposed model which comprised branch convolution, separable convolution, and self-attention mechanisms, took minute-to-minute raw electroencephalography (EEG) and oral-nasal airflow signals as its input. Results. The results of five-fold cross-validation in 50 clinical polysomnography recordings evidenced that the average accuracy was 0.877, with a sensitivity and specificity of 0.837, and 0.873, respectively. The proposed method achieved almost perfect agreement with manual scoring method according to the apnea-hypopnea index. In addition, experiments revealed that the combination of EEG and oral-nasal airflow signals could improve the accuracy of approximately 10% relative to oral-nasal airflow signals. Furthermore, a significant difference (P < 0.05) in performance between different sleep centers and different sleep-monitoring devices was also observed. Conclusion and significance. The proposed model achieved a comparably high performance in three different sleep centers, indicating its feasibility and robustness. This study suggested the reliable and simple alternative to clinical OSA screening. The model and data can be found at https://github.com/Lifanfan-dlut/OSA-detection.

Safety and efficacy of pitolisant in children aged 6 years or older with narcolepsy with or without cataplexy: a double-blind, randomised, placebo-controlled trial

Narcolepsy is a life-long disorder characterised by excessive daytime sleepiness and cataplexy, often arising in childhood or adolescence. Pitolisant, a selective histamine H3 receptor inverse agonist, has been approved in Europe and USA for adults with narcolepsy with or without cataplexy, with a favourable safety profile. This phase 3 study aimed to assess the safety and efficacy of pitolisant in children with narcolepsy with or without cataplexy. For this double-blind, randomised, placebo-controlled, multisite study, we recruited patients aged 6-17 years with narcolepsy with or without cataplexy in 11 sleep centres in five countries (Italy, France, Netherlands, Russia, and Finland). Participants were required to have a Pediatric Daytime Sleepiness Scale score of 15 or greater and to have not received psychostimulants for at least 14 days before enrolment; participants who needed anticataplectics (including sodium oxybate) were required to have been on a stable dose for at least 1 month. Participants were randomly assigned to treatment with pitolisant or placebo in a 2:1 ratio at the end of screening. Randomisation was stratified by study centre and treatment was allocated using an interactive web response system. After a 4-week screening period including a 2-week baseline period, patients entered in a 4-week individual up-titration scheme from 5 mg a day to a maximum of 40 mg a day of pitolisant or placebo; treatment was administered at a stable dose for 4 weeks, followed by a 1-week placebo period. For the primary analysis, we assessed pitolisant versus placebo using change in the Ullanlinna Narcolepsy Scale (UNS) total score from baseline to the end of double-blind period in the full analysis set, defined as all randomly allocated patients who received at least one dose of treatment and who had at least one baseline UNS value. A decrease in the UNS total score reflects a reduction in both excessive daytime sleepiness and cataplexy. All adverse events were assessed in the safety population, defined as all participants who took at least one dose of study medication. An open-label follow-up is ongoing. This study is registered at ClinicalTrials.gov, NCT02611687. Between June 6, 2016, and April 3, 2021, we screened 115 participants and 110 were randomly assigned (mean age 12·9 [SD 3·0] years, 61 [55%] male, and 90 [82%] with cataplexy; 72 assigned to pitolisant and 38 to placebo); 107 (70 receiving pitolisant and 37 receiving placebo) completed the double-blind period. The mean adjusted difference in UNS total score from baseline to the end of the double-blind period was -6·3 (SE 1·1) in the pitolisant group and -2·6 (1·4) in the placebo group (least squares mean difference -3·7; 95% CI -6·4 to -1·0, p=0·007). Treatment-emergent adverse events were reported in 22 (31%) of 72 patients in the pitolisant group and 13 (34%) of 38 patients in the placebo group. The most frequently reported adverse events (affecting ≥5% of patients) in either group were headache (14 [19%] in the pitolisant group and three [8%] in the placebo group) and insomnia (five [7%] in the pitolisant group and one [3%] in the placebo group). Pitolisant treatment resulted in an improvement in narcolepsy symptoms in children, although the UNS was not validated for use in children with narcolepsy when our study began. The safety profile was similar to that reported in adults but further studies are needed to confirm long-term safety. Bioprojet.

Guideline for the Standardized Construction of Sleep Medicine Centers in China: Undertaking the Mission of Medicine of the Era and Caring for People's Sleep Health

Humans spend one third of their life sleeping. Sleep, a vital life process, is an essential part of human health. In response to people's growing needs concerning sleep health, sleep medicine was born and is growing rapidly, and there is also an upsurge in the construction of sleep medicine centers in China and other countries. Unfortunately, there are no Chinese standards available for the construction of sleep medicine centers and the sleep medicine centers already constructed are of varied quality. In view of this academic problem, Professor Lu Lin, an academician of Chinese Academy of Sciences and the president of Peking University Sixth Hospital, organized Chinese experts with outstanding achievements in the field of sleep medicine to draft "Guideline for the Standardized Construction of Sleep Medicine Centers in China". This guideline mainly introduces the overall status of standardized construction of sleep medicine centers and the status of the construction of specialized sleep medicine centers in China, aiming to guide the construction of high-quality and high-standard sleep medicine centers in China, to promote the development of sleep medicine, and to safeguard people's sleep health.

Association between obstructive sleep apnoea and cancer: a cross-sectional, population-based study of the DISCOVERY cohort

ObjectivesNocturnal hypoxia in obstructive sleep apnoea (OSA) is a potential risk factor for cancer. We aimed to investigate the association between OSA measures and cancer prevalence in a large national...

Establishment and Application Evaluation of an Improved Obstructive Sleep Apnea Screening Questionnaire for Chinese Community: The CNCQ-OSA.

Obstructive sleep apnea (OSA) is a common sleep-disordered breathing disease. We aimed to establish an improved screening questionnaire without physical examinations for OSA named the CNCQ-OSA (Chinese community questionnaire for OSA). A total of 2585 participants who visited sleep medicine center and underwent overnight polysomnography were grouped into two independent cohorts: derivation (n = 2180) and validation (n = 405). The CNCQ-OSA was designed according to the baseline of patients in derivation cohort. We comprehensively analyzed the data to evaluate the predictive value of the CNCQ-OSA, compared to the GOAL questionnaire, STOP-Bang questionnaire (SBQ) and NoSAS questionnaire. The CNCQ-OSA included seven variables: loud snoring, BMI ≥ 25 kg/m2, male gender, apnea, sleepiness, hypertension and age ≥30, with a total score ranging from 7 to 16.7 points (≥13.5 points indicating high risk of OSA, ≥14.5 points indicating extremely high risk). In the derivation and validation cohorts, the areas under the curve of the CNCQ-OSA were 0.761 and 0.767, respectively. In the validation cohort, the sensitivity and specificity of a CNCQ-OSA score ≥13.5 points for the apnea-hypopnea index (AHI) ≥5/h were 0.821 and 0.559, respectively (Youden index, 0.380), and the score ≥14.5 points were 0.494 and 0.887, respectively (Youden index, 0.375). The CNCQ-OSA had a better predictive value for AHI ≥ 5/h, AHI > 15/h and AHI > 30/h, with the highest Youden index, compared to the other questionnaires. The CNCQ-OSA can effectively identify the risk of OSA, which is appropriate for self-screening at home without physical examinations.

Prostaglandin D2 Controls Local Blood Flow and Sleep-Promoting Neurons in the VLPO via Astrocyte-Derived Adenosine.

Prostaglandin D2 (PGD2) is one of the most potent endogenous sleep-promoting molecules. However, the cellular and molecular mechanisms of the PGD2-induced activation of sleep-promoting neurons in the ventrolateral preoptic nucleus (VLPO), the major nonrapid eye movement (NREM)-sleep center, still remains unclear. We here show that PGD2 receptors (DP1) are not only expressed in the leptomeninges but also in astrocytes from the VLPO. We further demonstrate, by performing real-time measurements of extracellular adenosine using purine enzymatic biosensors in the VLPO, that PGD2 application causes a 40% increase in adenosine level, via an astroglial release. Measurements of vasodilatory responses and electrophysiological recordings finally reveal that, in response to PGD2 application, adenosine release induces an A2AR-mediated dilatation of blood vessels and activation of VLPO sleep-promoting neurons. Altogether, our results unravel the PGD2 signaling pathway in the VLPO, controlling local blood flow and sleep-promoting neurons, via astrocyte-derived adenosine.