Sleep-related Breathing Disorders Research Articles

Association of edentulism and obstructive sleep apnea: A systematic review.

Sleep apnea is a common and underdiagnosed sleep-related breathing disorder. This systematic review aimed to evaluate the scientific evidence regarding the association between obstructive sleep apnea (OSA) and edentulism. An electronic search was conducted through PubMed (MEDLINE), Scopus, and Cochrane Library, up to January 2024. A systematic approach was followed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement guidelines. The literature search intended to retrieve all relevant clinical studies about any possible association between OSA and edentulism. Only publications in the English language were selected, and animal studies, in vitro studies, case reports, case series, technique presentation articles, and expert opinions were excluded. A total of 23 studies met the inclusion criteria and were included in this systematic review. They were published between 1999 and 2023 and were all clinical studies. These studies examined a possible association between OSA and edentulism and all of them agreed on their positive relation. Tooth loss favors anatomic alterations that deteriorate breathing. The severity of OSA was related to the extent and duration of edentulism. Mean Apnea-Hypopnea Index (AHI) scores in edentulous patients were found to be two to three times higher in comparison to dentate individuals, although the statistical data about it are scarce. No agreement was reached, however, about the use of dentures during sleep time, since the data are controversial. The findings suggest that there is a plausible association between edentulism and OSA. Tooth loss impairs significant anatomic alterations and increases the risk for OSA. However, clinical data are limited and heterogeneous so more clinical studies should be encouraged for more robust conclusions.

Avoid overstepping the bounds of evidence: the role of the orthodontist in managing pediatric Obstructive Sleep Apnea

IntroductionPediatric Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder often linked to distinct craniofacial features and malocclusions. While orthodontic treatments, particularly maxillary expansion and mandibular advancement, have been suggested for managing this condition, the results remain controversial and are based on low-quality evidence. This paper aims to summarize the ongoing debates on this topic by reviewing relevant literature and highlighting the role of the orthodontist in diagnosing and managing OSA in daily clinical practice.Discussion and conclusionsAccording to the present review, there is insufficient evidence to either confirm or deny the effectiveness of oral appliances for treating pediatric OSA due to significant methodological limitations, such as small sample sizes, inadequate control groups, short study durations, and a lack of long-term follow-up. Additionally, this condition cannot be diagnosed solely based on craniofacial morphology, but an interdisciplinary evaluation is strictly required. In addition, orthopedic treatment may be considered only as an adjunct therapy for children with craniofacial anomalies increasing the risk for OSA, and the combination of multiple therapeutic approaches may be necessary to achieve effective treatment outcomes.

A PhD completed. Issues related to indication, surgery, and outcome of maxillomandibular advancement in obstructive sleep apnea

Obstructive sleep apnea is a common sleep-related breathing disorder. Although maxillomandibular advancement is widely recognized for its proven effectiveness, there are still uncertainties surrounding this procedure. This research therefore focused on the indication, surgical techniques, and outcomes of maxillomandibular advancement in patients with obstructive sleep apnea. A systematic review and meta-analysis showed that maxillomandibular advancement is more effective than multilevel surgery for the treatment of obstructive sleep apnea. Both maxillomandibular advancement and hypoglossal nerve stimulation were identified as effective and safe treatment methods for obstructive sleep apnea. Various retrospective studies also indicated that patients with hypopnea-dominant obstructive sleep apnea are better candidates for maxillomandibular advancement, in contrast to patients with cardiovascular diseases or a higher central apnea index. Furthermore, it was demonstrated that maxillomandibular advancement is effective in patients with a high percentage of central and mixed apneas, despite the potential surgical inaccuracies of maxillomandibular advancement, highlighting the broad applicability of this treatment method.

Exploring Sleep-Related Breathing Disorders in Pediatric Obesity and Prader-Willi Syndrome

ObjectiveTo analyze the differences of clinical and diagnostic features of sleep related breathing disorders (SRBDs) between children with PWS and obese children, considering obesity as a unifying risk factor for sleep apnea. Study designThis retrospective cohort study included ≥2 years of age children who had obesity and genetically confirmed Prader-Willi syndrome (PWS) or were non-PWS obese children. Out of 267 children, 58 children met inclusion criteria. Clinical data and records of standard overnight polysomnography (PSG) were collected and compared between groups during the study. ResultsObstructive sleep apnea (OSA) was identified in 97.2% non-PWS obese children and 72.7% PWS children (p=0.072). Central sleep apnea (CSA) events were more commonly found in children with PWS (p=0.035, OR 4.35, CI 95% 1.05-18.03) as well as sleep-related hypoventilation (p=0.016, OR 4.66, CI 95% 1.26-17.34). Sleep efficiency was higher in PWS patients (p=0.038). Sleep fragmentation was significantly associated with higher AHI only in non-PWS obese children (p=0.027). In the PWS group patients, a moderate correlation was found between BMI and age (p=0.025, r=0.559, CI 95% 0.087-0.826) as well as AHI and age (p=0.003, r=0.686, CI 95% 0.232-0.895). ConclusionsNon-PWS obese children, similar to those with PWS, exhibit a high risk of SRBDs. Although CSA and sleep-related hypoventilation may occur more frequently in patients with PWS, OSA remains the predominant disorder. Both patient groups are advised to undergo PSG due to the significant risk of SRBDs, particularly during adolescence.

Breathlessness, but not breathing instability, varies with posttraumatic stress symptoms in university students.

Obstructive sleep apnea (OSA) is a chronic sleep-related breathing disorder that is highly prevalent in individuals with posttraumatic stress disorder (PTSD). The reason for this high prevalence remains unclear. We hypothesized that breathing instability, one of the key contributors to OSA, may be altered in PTSD and predispose OSA. Healthy participants (214 females, 98 males) aged 17 to 42 (M = 19.92; SD = 2.85) completed online questionnaires measuring PTSD symptomatology, sleep disturbances, and self-reported breathlessness. A subset of these participants (16 females, 14 males) aged 18 to 42 (M = 23.50; SD = 7.18) completed an in-lab breathing instability assessment, whereby they performed a series of 20-second and maximal duration breath-holds. PTSD severity positively predicted subjective perceptions of breathlessness (P < 0.001) but not objective measures of breathing instability, namely ventilation following 20-s breath-holds (P = 0.93) and maximal breath-hold duration (P = 0.41). These results suggest that breathing instability may not be the driving factor behind the high prevalence of OSA in PTSD. Instead, other factors such as a low arousal threshold, elevated ventilatory responses to arousal, or coexisting insomnia may explain the high rates of OSA in PTSD. One explanation for the discrepancy between subjective breathlessness and breathing stability measures relating to PTSD severity may be that hypervigilance and increased anxiety impacted self-perceptions of breathlessness while not altering breathing instability per se.NEW & NOTEWORTHY Obstructive sleep apnea (OSA) is more common in individuals with posttraumatic stress disorder (PTSD) than the general population for unknown reasons. This study assessed one of the key contributors to OSA, respiratory control instability, in young students with a range of posttraumatic stress symptoms. Although individuals with high PTSD symptoms reported increased subjective breathlessness, objectively measured breathing instability was not altered, suggesting respiratory instability is unlikely to increase the risk of OSA in PTSD.

Anthropometric Indices of Obstructive Sleep Apnea Patients in Mauritius.

Background Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder, affecting a significant number of individuals globally.It is associated with poor quality of life and an increased risk of all-cause mortality. It is estimated that most of the patients suffering from OSA are obese. Anthropometric indices can help guide doctors towardthe diagnosis. Objectives This study aimed to establish specific anthropometric thresholds associated with OSA risk, allowing clinicians to identify individuals more likely to have OSA and who may need further evaluation, such as polysomnography. This targeted screening approach would enable better resource allocation to those at higher risk, potentially enhancing the efficiency of OSA diagnosis and management. Methods We conducted a descriptive study using data from the sole private sleep clinic in Mauritius. We analyzed case files of consecutive patients diagnosed with OSA over a 3.5-year period from January 2015 to June 2018. Results The study population comprised 170 patients (79.4% males) diagnosed with OSA by a polygraphy test.The mean age of OSA diagnosis in men and women was 51.7 ± 14.0 years and 53.8 ± 12.5 years, respectively.The mean neck circumference (NC) for males and females was 41.9 ± 3.9 cm and 38.2 ± 3.9 cm, while the mean waist circumference (WC) was 105.6 ± 12.2 cm for men and 103.4 ± 14.5 cm for women. The body mass index (BMI) was 29.1± 5.0 kg/m2 and 31.4± 6.8 kg/m2 for males and females, respectively. The apnea-hypopnea index (AHI) averaged to 42.1 ± 19.7 events/hour for men and 33.3 ± 16.4 events/hour for women.In male patients, we found a positive significant correlation (p<0.001) between AHI and the following parameters: BMI (r=0.443), WC(r=0.337), WC-to-height ratio (WHr) (r=0.378), NC(r =0.274), and neck-to-height ratio (NHr) (r =0.321).In women, we observed a positive significant correlation between apnea severity and the following: BMI (r=0.396, p=0.029), WC (r=0.462, p=0.005), and WHr (r=0.494, p=0.003).No significant relationships were observed between AHI and the following parameters in women: NC (r=0.317, p=0.064) and NHr (r=0.311, p=0.069). A total of 83.5% of patients had a Mallampati score of 3-4. Conclusion This study represents a pioneering effort on the island. While further research is necessary to establish exact anthropometric cutoff values, the findings offer crucial insights for physicians to identify high-risk individuals. With just a scale, measuring tape, and calculator, healthcare professionals can detect important health markers that extend beyond diagnosing OSA. These simple measurements not only help in predicting OSA but also provide a broader view of an individual's overall health, identifying risks that go beyond sleep issues. This research sets an important foundation for future OSA studies within the Mauritian population.

Characteristics of clinical descriptive variables and polysomnographic findings of catathrenia.

Catathrenia has been classified as a sleep-related breathing disorder variant in the third edition of the International Classification of Sleep Disorders, but its validity remains unverified. We analyzed the clinical descriptive variables and polysomnographic findings of catathrenia and discussed the similarities and differences to those of obstructive sleep apnea (OSA), non-REM parasomnias, and sleep bruxism (SB). A retrospective analysis was conducted on 47 patients diagnosed with nocturnal groaning through polysomnography. We examined sex, body mass index, age at symptom onset, weekly symptom frequency, and presence/absence of comorbidities, including OSA, periodic limb movement disorder, non-REM parasomnia, and SB. The groaning event (GE) index was calculated according to sleep position and sleep stage. The distribution of patients with catathrenia did not show sex difference (male/female = 20:27), body mass index was 20.6 ± 3.0 kg/m2, and age of onset was 18.2 ± 7.4 years. The GE index was higher in stages N1 and R than in stage N3 and in the supine position than in the lateral position. There were no cases complicated with non-REM parasomnia, but the complication of SB was observed in 30% of the participants, and SB events appeared immediately before or during the interictal period of the GE episodes in these cases. Given the clinical background, posture- and sleep stage-dependent appearance of GEs, and the relatively high complication rate of SB, catathrenia pathogenesis may be heterogeneous or comprise elements of different sleep disorders.

Impact of asthma and allergic rhinitis control on sleep disordered breathing in pediatrics

AimThe aim of our study is to assess the quality of sleep in children with asthma and/or allergic rhinitis, as well as the impact of the control of allergic respiratory diseases on sleep disturbances. Materials and methodsIt is an observational cross-sectional study on children attending pediatric allergy appointments at a portuguese tertiary hospital (G1), and compared to a control population (G2). The asthma and rhinitis control was determined using the Control of Allergic Rhinitis and Asthma Test (CARAT/CARATKids) questionnaires. Sleep was evaluated using the Pediatric Sleep Questionnaire (PSQ). G1 included 61 patients and G2 included 100 children. ResultsAbout a third of the children in the study group had sleep-related breathing disorders (SDB), compared to 9 % on the control group (p-value <0.05). There was a significant positive correlation between uncontrolled asthma and allergic rhinitis, and SDB (p-value <0.05). ConclusionSDB is more prevalent among children with asthma and/or allergic rhinitis. The absence of control of the allergic respiratory diseases has a negative impact on sleep. We recommend large cross-sectional studies to better comprehend the exact relationship between the two conditions, as well as the use of objective diagnostic tools. We believe it is essential to implement early screening for sleep disorders in children with allergic respiratory diseases, through validated questionnaires.

Sleep Problems in Adults With ADHD: Prevalences and Their Relationship With Psychiatric Comorbidity

Background: Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient clinic. Methods: We included data of 3,691 adult patients diagnosed with ADHD, who had filled out a screener for sleep disorders (Holland Sleep Disorders Questionnaire (HSDQ)) as part of routine diagnostic assessment. The HSDQ screens for the sleep disorders insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorders (CRSD), restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), and sleep-related breathing disorders (SBD). As delayed sleep phase syndrome (DSPS) is very frequent in ADHD, we additionally screened for DSPS. Psychiatric comorbidities were diagnosed through clinical assessment and the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus, which assesses 26 psychiatric disorders following the classification of the DSM-5. All data were retrieved from the electronic patient files. Results: Mean age was 35.4 and 49.4% of the patients were female. About 60% of the adults with ADHD screened positive for any sleep disorder. Highest prevalences were found for symptoms of DSPS (36%), insomnia (30%), and RLS/PLMD (29%). Sleep problems in adults with ADHD were associated with comorbid depression, anxiety, substance use disorder, personality disorder, and post-traumatic stress disorder. Conclusion: Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems.

The Impact of Adenotonsillectomy on the Quality of Life of Children with Obstructive Sleep Apnea.

Introduction In children, obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is caused by adenotonsillar hypertrophy and is characterized by upper airway obstruction disturbing sleep. Objective We conducted this study to evaluate health-related quality of life (QoL) in children with OSA before and after adenotonsillectomy. Methods A descriptive, observational study was conducted among 43 children in the 4-to-12 years old age group who had symptoms of OSA due to adenotonsillar hypertrophy and who underwent adenotonsillectomy at a tertiary care center during the period from February 2020 to February 2021. The QoL was assessed using the OSA-18 questionnaire preoperatively and at 2 and 6 months postoperatively. Results Among the study population, males (72)%) were more affected with OSA, with a male-to-female ratio of 2.6:1. Based on the OSA-18 questionnaire assessment, the most severe and frequently observed symptoms were in the domains of sleep disturbance and physical symptoms, in which the mean score was 77 preoperatively. After adenotonsillectomy, the mean OSA-18 score decreased to 28.605 and 22.465 at 2 and 6 months, respectively. At 2 months postsurgery, more significant improvement was noticed in sleep disturbances, physical symptoms, and parent's concern while at 6 months postsurgery, all domains showed equal improvement. Therefore, following adenotonsillectomy, the QoL improved significantly. Conclusion Obstructive sleep apnea can adversely affect sleep quality as well as neurocognitive and cardiovascular functions. Adenotonsillectomy resulted in significant improvement in the QoL.

Relationship between sleep-related breathing-disorders and dental factors in children

Relationship between sleep-related breathing-disorders and dental factors in children

Remote monitoring to improve low adherence in non-invasive ventilation: a protocol for a randomised controlled clinical trial (READ-NIV trial).

Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder. Non-invasive ventilation (NIV) is essential for managing hypercapnic respiratory failure in patients with obesity hypoventilation syndrome (OHS) and those with co-existing OSA, where continuous positive airway pressure (CPAP) alone is insufficient. However, adherence to NIV can be challenging, with substantial non-compliance occurring due to factors such as discomfort and phobia. The objective of this protocol is to assess the improvement of adherence to NIV remotely monitored, as well as to record symptom control and long-term clinical outcomes, and to optimise healthcare resource usage. This is a prospective, randomised, and controlled (usual care) trial with a two-arm parallel group design, testing remote monitoring of home NIV (T4P device, SRETT, Paris, France) for 3 months in patients with OSA/OHS who have previously had low NIV adherence (<4 hours/night). This project has been approved by the research ethics committee/Health Research Authority (HRA) [Integrated Research Application System (IRAS) ID: 270108], as well as by Guy's & St Thomas' NHS Foundation Trust R&D Department. Outcomes will be compared between the intervention and the control group (NIV with vs. without remote monitoring). The trial will also assess suitability of the outcome parameters, and test whether the data collection, symptom questionnaires, and used healthcare resources are suitable to describe the impact on patient-related outcomes. This study is registered at ClinicalTrials.gov (NCT04884165).

Twistable and Stretchable Nasal Patch for Monitoring Sleep-Related Breathing Disorders Based on a Stacking Ensemble Learning Model.

Obstructive sleep apnea syndrome disrupts sleep, destroys the homeostasis of biological systems such as metabolism and the immune system, and reduces learning ability and memory. The existing polysomnography used to measure sleep disorders is executed in an unfamiliar environment, which may result in sleep patterns that are different from usual, reducing accuracy. This study reports a machine learning-based personalized twistable patch system that can simply measure obstructive sleep apnea syndrome in daily life. The stretchable patch attaches directly to the nose in an integrated form factor, detecting sleep-disordered breathing by simultaneously sensing microscopic vibrations and airflow in the nasal cavity and paranasal sinuses. The highly sensitive multichannel patch, which can detect airflow at the level of 0.1 m/s, has flexibility via a unique slit pattern and fabric layer. It has linearity with an R2 of 0.992 in the case of the amount of change according to its curvature. The stacking ensemble learning model predicted the degree of sleep-disordered breathing with an accuracy of 92.9%. The approach demonstrates high sleep disorder detection capacity and proactive visual notification. It is expected to help as a diagnostic platform for the early detection of chronic diseases such as cerebrovascular disease and diabetes.

High altitude polycythemia and its maladaptive mechanisms: an updated review.

High altitude polycythemia is a maladaptation of highlanders exposed to hypoxic environment, leading to high blood viscosity and severe cardiorespiratory dysfunction. Prolonged hypoxia causes respiratory depression and severe hypoxemia, and further mediates changes in genetic and molecular mechanisms that regulate erythropoiesis and apoptosis, ultimately resulting in excessive erythrocytosis (EE). This updated review investigated the maladaptive mechanisms of EE, including respiratory chemoreceptor passivation, sleep-related breathing disorders, sex hormones, iron metabolism, and hypoxia-related factors and pathways.

Coherent Feature Extraction with Swarm Intelligence Based Hybrid Adaboost Weighted ELM Classification for Snoring Sound Classification.

For patients suffering from obstructive sleep apnea and sleep-related breathing disorders, snoring is quite common, and it greatly interferes with the quality of life for them and for the people surrounding them. For diagnosing obstructive sleep apnea, snoring is used as a screening parameter, so the exact detection and classification of snoring sounds are quite important. Therefore, automated and very high precision snoring analysis and classification algorithms are required. In this work, initially the features are extracted from six different domains, such as time domain, frequency domain, Discrete Wavelet Transform (DWT) domain, sparse domain, eigen value domain, and cepstral domain. The extracted features are then selected using three efficient feature selection techniques, such as Golden Eagle Optimization (GEO), Salp Swarm Algorithm (SSA), and Refined SSA. The selected features are finally classified with the help of eight traditional machine learning classifiers and two proposed classifiers, such as the Firefly Algorithm-Weighted Extreme Learning Machine hybrid with Adaboost model (FA-WELM-Adaboost) and the Capuchin Search Algorithm-Weighted Extreme Learning Machine hybrid with Adaboost model (CSA-WELM-Adaboost). The analysis is performed on the MPSSC Interspeech dataset, and the best results are obtained when the DWT features with the refined SSA feature selection technique and FA-WELM-Adaboost hybrid classifier are utilized, reporting an Unweighted Average Recall (UAR) of 74.23%. The second-best results are obtained when DWT features are selected with the GEO feature selection technique and a CSA-WELM-Adaboost hybrid classifier is utilized, reporting an UAR of 73.86%.

Prevalence and impact of sleep-related breathing disorder in multiple system atrophy patients: a cross-sectional study and meta-analysis.

Sleep-related breathing disorder (SRBD) is a prevalent non-motor symptom in multiple system atrophy (MSA). However, the reported prevalence of SRBD in MSA from different studies has shown inconsistency. Additionally, only one study has examined the impact of SRBD on both motor and non-motor symptoms in MSA. Cross-sectional study of 66 patients with probable MSA from China. SRBD was ascertained with polysomnography (PSG). All the MSA individuals were assessed using the Epworth Sleepiness Scale (ESS), Unified Multiple-System Atrophy Rating Scale (UMSARS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), the Mini-mental State Examination (MMSE), Non-Motor Symptoms Scale (NMSS), and Pittsburgh Sleep Quality Index (PSQI). Moreover, a meta-analysis was conducted by searching studies related to MSA and SRBD in PubMed, Web of Science, Embase, and Cochrane databases. Data were pooled as necessary to calculate prevalence of SBRD with 95% confidence intervals (CI). Our study included 66 patients with MSA, 52 of whom had a diagnosis of SRBD (78.8%). There were no significant differences between the MSA with SRBD and without SRBD groups on the age, sex, disease onset, disease duration, UMSARS I, II, and IV, the NMSS, the HAMA, HAMD, the ESS the FSS, the MMSE, and the PSQI scales. However, MSA patients with SRBD having a significant higher obstructive apnea index and percentage of snoring during sleep than MSA patients without SRBD [10.0 (4.1-10.6) vs. 0.1 (0-0.3), and 8.3 (5.1-12.2) vs. 4.2 (0-7.5)]. Also, between the two groups, the mean and minimum oxygen concentrations during sleep were lower in MSA patients with SRBD than in those without SRBD [93.7 (93-95) vs. 95.5 (95.8-97), p = 0.001] and [83.9 (81.2-89.0) vs. 90.3 (89.8-93.3), p = 0.000]. The primary search strategy identified 701 articles, with 10 meeting the inclusion criteria. The overall prevalence of SRBD in a combined sample of 295 MSA patients was found to be 60.5% (95% CI, 43.2-76.5%). Further analysis revealed that the prevalence of SRBD in MSA patients in Asia was 79.2% (95% CI, 54.7-96.3%), which was higher than that in Europe (41.6, 95% CI, 32-51.5%). The study found a prevalence of 78.8% of SRBD in MSA patients, with a notably higher prevalence in Asia compared to Europe. The majority of SRBD cases in MSA were attributed to obstructive apnea. Furthermore, the presence of SRBD did not show a significant impact on the motor and non-motor symptoms of MSA patients.

Arrhythmia in sleep apnea

Sleep apnea is awidespread and yet still underdiagnosed condition. Various studies from the past have provided evidence that there is alink between sleep apnea and various cardiovascular diseases, including arrhythmias. The aim of this article is to provide an overview of the current study situation and to point out possible consequences relevant to everyday life. Asystematic search was carried out in various databases using the keywords sleep apnea (OSAS/SA) and arrhythmias/dysrhythmias. There are several pathophysiological links between sleep-related breathing disorders and cardiac arrhythmias, the most important of which appear to be intrathoracic pressure, increased adrenergic tone as well as recurrent hypoxia and hypercapnia. This results in an increased occurrence of clinically relevant arrhythmias, such as atrial fibrillation, symptomatic bradycardia, high-grade atrioventricular (AV) blocks as well as ventricular arrhythmias in patients with untreated sleep apnea. These pathologies also appear to be positively influenced by the treatment of sleep apnea. Aclose correlation between sleep apnea and cardiac arrhythmias is undisputed. Large randomized studies in this respect are so far rare but it is undisputed that a thorough search should be carried out for sleep apnea and consistently treated in patients with ahistory of cardiac disease as this can have arelevant influence on the treatment and ultimately the prognosis of the patient.

The pulse of sleep: novel interventions in understanding the sleep-cardiovascular connection: a literature review.

Sleep disorders represent common complaints in different medical illnesses. They encompass a risk for diverse inflammatory, metabolic, and cardiovascular diseases. Sleep disorders include disorders of hypersomnolence, insomnia, parasomnias, sleep-related movement disorders, circadian rhythm sleep-wake-disorders, and sleep-related breathing disorders, each one of which was associated with increased cardiovascular disease risk in a different mechanism. In this review, the authors address the most recent research on the correlation between sleep and CVD. The literature on sleep disorders and their potential links to various cardiovascular diseases was reviewed in narrative form. For the published papers up to June 2023, the authors searched the databases of PubMed and Google Scholar. Literature demonstrating the relationship between these illnesses, pathophysiological mechanisms, diagnosis, and various therapeutic approaches was included. Sleep disorders were significantly linked to heart rate variability, hypertension, and obesity, which can eventually result in cardiovascular consequences and affect mortality and morbidity. The disruption in sleep cycles, which can be noticed in different sleep disorders, can obviously result in blood pressure, heart rate, and other cardiac functions. The clinical assessment acts as the cornerstone in the diagnosis of different spectrums of sleep disorders. The management of sleep disorders ranges from cognitive-behavioral therapy to continuous positive airway pressure (CPAP). Additional research on the topic is needed to pinpoint any potential links and pathological processes. To improve clinical treatment and preventive measures, further observational studies should emphasize the reliability of early diagnostic signs.

A Deep Transfer Learning Approach for Sleep Stage Classification and Sleep Apnea Detection Using Wrist-Worn Consumer Sleep Technologies.

Obstructive sleep apnea (OSA) is a common, underdiagnosed sleep-related breathing disorder with serious health implications Objective - We propose a deep transfer learning approach for sleep stage classification and sleep apnea (SA) detection using wrist-worn consumer sleep technologies (CST). Methods - Our model is based on a deep convolutional neural network (DNN) utilizing accelerometers and photo-plethysmography signals from nocturnal recordings. The DNN was trained and tested on internal datasets that include raw data from clinical and wrist-worn devices; external validation was performed on a hold-out test dataset containing raw data from a wrist-worn CST. Results - Training on clinical data improves performance significantly, and feature enrichment through a sleep stage stream gives only minor improvements. Raw data input outperforms feature-based input in CST datasets. The system generalizes well but performs slightly worse on wearable device data compared to clinical data. However, it excels in detecting events during REM sleep and is associated with arousal and oxygen desaturation. We found; cases that were significantly underestimated were characterized by fewer of such event associations. Conclusion - This study showcases the potential of using CSTs as alternate screening solution for undiagnosed cases of OSA. Significance - This work is significant for its development of a deep transfer learning approach using wrist-worn consumer sleep technologies, offering comprehensive validation for data utilization, and learning techniques, ultimately improving sleep apnea detection across diverse devices.

Proportion of sleep-related breathing disorders and their association with echocardiographic parameters in stable patients with chronic obstructive pulmonary disease: a cross-sectional observational exploratory study

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. The coexistence of COPD and obstructive sleep apnea (OSA) (i.e., overlap syndrome) has been reported in several studies. Both disorders independently increase the risk of cardiovascular complications. Hence, there is a theoretical possibility that cardiovascular parameters may be worse in patients with overlap syndrome compared to those with only COPD. However, this has been sparsely assessed in the literature. This study aimed to compare the clinical characteristics, echocardiography, and sleep parameters amongst COPD patients with and without sleep-related breathing disorders (SRBD). This observational, cross-sectional study included 30 patients with stable COPD. All participants underwent a detailed clinical evaluation, followed by level 1 polysomnography (PSG). Each participant underwent echocardiographic evaluation to estimate mean pulmonary artery pressure from right ventricular systolic pressure (RVSP). Based on their PSG findings, participants were classified into non-SRBD and SRBD groups. Both groups were further compared with respect to clinical characteristics, echocardiographic, and PSG parameters. We found that most of the participants (93.3%) were male, and the mean age of the study population was 56±8.2 years. The only SRBD identified in this study was OSA, which was observed in 80% of participants. In this group, OSA was not associated with obesity. Systemic hypertension (50%) was the most common comorbidity, followed by diabetes mellitus (26.67%), but both were not significantly different between the groups. The mean RVSP was significantly higher amongst OSA patients than non-OSA patients (41.25±14.98 versus 30.83±5.84, respectively; p=0.01). OSA was seen in 80% of participants with stable COPD, even in the absence of obesity. The presence of OSA was associated with a higher RVSP in this patient group.