Sleep-related Respiratory Disturbances Research Articles

A Comprehensive Study on a Deep-Learning-Based Electrocardiography Analysis for Estimating the Apnea-Hypopnea Index.

This study introduces a deep-learning-based automatic sleep scoring system to detect sleep apnea using a single-lead electrocardiography (ECG) signal, focusing on accurately estimating the apnea-hypopnea index (AHI). Unlike other research, this work emphasizes AHI estimation, crucial for the diagnosis and severity evaluation of sleep apnea. The suggested model, trained on 1465 ECG recordings, combines the deep-shallow fusion network for sleep apnea detection network (DSF-SANet) and gated recurrent units (GRUs) to analyze ECG signals at 1-min intervals, capturing sleep-related respiratory disturbances. Achieving a 0.87 correlation coefficient with actual AHI values, an accuracy of 0.82, an F1 score of 0.71, and an area under the receiver operating characteristic curve of 0.88 for per-segment classification, our model was effective in identifying sleep-breathing events and estimating the AHI, offering a promising tool for medical professionals.

Impact of bariatric surgery on obstructive sleep apnea severity and continuous positive airway pressure therapy compliance\u2014prospective observational study

To evaluate association between bariatric surgery and changes in obstructive sleep apnea (OSA) severity and sleep architecture was as well as to asses continuous positive airway pressure (CPAP) effectiveness and compliance. We enrolled patients undergoing bariatric surgery. Polysomnography was performed in each patient preoperatively and 12 months after the procedure in a subgroup of patients diagnosed with OSA. STOP-BANG, Epworth Sleepiness Scale (ESS) and Berlin questionnaire scores were obtained pre- and postoperatively. CPAP compliance data was recorded during follow-up hospitalization. Among 44 patients with median age of 49.5 years, predominantly women (68.2%) pre- and postoperative polysomnography was performed. We observed significant improvement in STOP-BANG (6.0 vs. 3.0, p < 0.001) and ESS (12.0 vs. 5.0, p < 0.001) scores, apnea–hypopnea index (44.9 vs. 29.2, p < 0.001), oxygen desaturation index (43.6 vs. 18.3, p < 0.001) and sleep architecture parameters. CPAP compliance was poor with a median percentage of days with CPAP use accounting to 49.3%. Bariatric surgery is associated with a significant decrease in the number of sleep-related respiratory disturbances, as well as improvement of sleep efficiency. Postoperative CPAP therapy compliance was poor despite low rate of OSA resolution. This study suggests that patients with OSA undergoing bariatric surgery require postoperative reassessment.

Selective serotonin reuptake inhibitor use is associated with worse sleep-related breathing disturbances in individuals with depressive disorders and sleep complaints: a retrospective study.

The effects of serotonergic agents on respiration neuromodulation may vary according to differences in the serotonin system, such as those linked to depression. This study investigated how sleep-related respiratory disturbances relate to depression and the use of medications commonly prescribed for depression. Retrospective polysomnography was collated for all 363 individuals who met selection criteria out of 2,528 consecutive individuals referred to a specialized sleep clinic (Ottawa, Canada) between 2006 and 2016. The apnea-hypopnea index (AHI), oxygen saturation nadir, and oxygen desaturation index during REM and NREM sleep were analyzed using mixed analyses of covariance comparing 3 main groups: (1) medicated individuals with depressive disorders (antidepressant group; subdivided into the selective serotonin reuptake inhibitor and norepinephrine-dopamine reuptake inhibitor subgroups), (2) non-medicated individuals with depressive disorders (non-medicated group), and (3) mentally healthy control patients (control group). Individuals with depressive disorders (on antidepressants or not) had significantly higher AHIs compared to control patients (both P ≤ .007). The antidepressant group had a lower NREM sleep oxygen saturation nadir and a higher NREM sleep oxygen desaturation index than the control and non-medicated groups (all P ≤ .009). Within individuals with depressive disorders, independent of depression severity, the selective serotonin reuptake inhibitor group had a lower oxygen saturation nadir and a higher oxygen desaturation index during NREM sleep than the norepinephrine-dopamine reuptake inhibitor (both P ≤ .045) and non-medicated groups (both P < .001) and a higher NREM sleep AHI than the non-medicated group (P = .014). These findings suggest that the use of selective serotonin reuptake inhibitors may be associated with impaired breathing and worse nocturnal oxygen saturation in individuals with depressive disorders and sleep complaints, but this needs to be confirmed by prospective studies.

Polysomnography as an indicator for cervicomedullary decompression to treat foramen magnum stenosis in achondroplasia.

Management of cervicomedullary compression due to foramen magnum stenosis in achondroplasia remains controversial, especially for patients with no symptoms or mild symptoms. We examined the effectiveness of polysomnography (PSG) as an indicator for cervicomedullary decompression treatment. We retrospectively reviewed nine achondroplasia cases (mean age 1year and 9months) treated from 2008 to 2015. All patients were examined by PSG, magnetic resonance imaging (MRI), and otolaryngeal fibroscopy. We analyzed demographic data, clinical presentation, degree and type of respiratory impairment, severity of foramen magnum stenosis and concomitant cervicomedullary compression, treatment (conservative or surgical), and clinical outcome. Eight of nine patients presented with no severe symptoms in the daytime. However, MRI revealed four severe, four moderate, and one mild case of cervicomedullary compression, and PSG demonstrated severe sleep apnea in four cases and moderate sleep apnea in five cases. All sleep apnea cases were obstructive or obstructive-dominant. Fibroscopy revealed no upper airway stenosis in six cases and mild stenosis in three cases. Four patients who had severe sleep-related respiratory disturbance on PSG and severe or moderate cervicomedullary compression were treated by cervicomedullary decompression. Three of these patients demonstrated improved sleep respiration soon after surgery, while one required temporary tracheostomy due to bilateral vocal cord paralysis caused by compression during intratracheal intubation. Polysomnography can be a useful indicator for cervicomedullary decompression surgery, especially in cases of seemingly asymptomatic achondroplasia with severe foramen magnum stenosis.

The critical influence of nocturnal breathing complaints on the quality of sleep after stroke: the Pittsburgh Sleep Quality Index and STOP-BANG.

In stroke patients particularly, many factors, such as sleep-related respiratory disturbances, can impair sleep. Cheap and easy-to-use tools have been created to identify sleep quality and sleep disturbances in patients after stroke. This study described the scores of the sleep apnea screening questionnaire - STOP-BANG - in patients after a stroke, and correlated the findings with sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). The scores of the STOP-BANG and PSQI were 4.3 ± 1.8 and 76 ± 3.9, respectively. The STOP-BANG scores were higher in poor sleepers (4.5 ± 1.6 versus 3.5 ± 1.9; p = 0.032). Logistic regression analysis was used to identify predictors of subjective sleep quality (PSQI) and the STOP-BANG as a predictor of poor quality sleep, with a relative risk of 1.6, controlled for age and sex. This study indicated that sleep quality was largely influenced by sleep breathing problems, which were well identified by the STOP-BANG, especially in younger stroke patients.

Obstructive sleep apnea

Attempts to understand the causes of cognitive impairment in obstructive sleep apnea (OSA) are complicated by the overlap among clinical and demographic factors that may impact cognition. The goal of the current study was to isolate the contribution of hypoxemia to cognitive impairment in OSA. Two groups of 20 patients with newly diagnosed OSA were compared. The groups differed on severity of hypoxemia but not other demographic (e.g., age, gender, education, estimated premorbid IQ) or clinical (e.g., sleep related respiratory disturbances, daytime sleepiness, depressive symptoms) variables. Participants completed polysonmography and cognitive assessment. We compared patients with high and low hypoxemia on measures of memory, attention, executive functioning, and motor coordination using independent sample t-tests. The high hypoxemia group performed significantly better on immediate recall (Hopkins Verbal Learning Test - Revised; t = -2.50, p < 0.02) than the low hypoxemia group. No group differences were observed on other neuropsychological measures. This study is one of the first to compare the cognitive performance of patients with high and low hypoxemia after controlling for demographic factors and aspects of OSA severity that could confound the relationship. In our carefully matched sample, we observed an unexpected advantage of higher hypoxemia on memory. These preliminary findings are discussed in the context of basic science literature on the protective effects of adaptation to intermittent hypoxemia. Our data suggest that the association between hypoxemia and cognition may not straightforward. Future research targeting the effects of hypoxemia on cognition controlling for other clinical factors in large groups of patients with OSA will be important.

Langzeitergebnisse nach Tonsillotomie im Kindesalter

Tonsillotomy is accepted as a safe and effective method for treatment of obstructive sleep-related respiratory disturbances in children. However, the question of inflammatory complications in the remaining tonsillar tissue is still present for long-term progression. Investigations performed with multiple-year observations should contribute to a clarification of the indicative conditions. A total of 181 patients were observed following a tonsillotomy performed with CO(2) laser (age: 4.6 years;+/-1.9 years). Using a standardized questionnaire, 145 patients were evaluated over an observation period of up to 6 years (average 3.0 years) with respect to post-operative complications, as well as subsequent inflammatory illnesses. Of these, 131 patients were evaluated with regard to long-term development of obstructive symptoms. Within the subsequent observation period no abscess formation occurred, a re-occurrence of tonsillitis was observed in fewer than 3% of the patients. Subsequent bleeding requiring treatment did not occur during the post-operative progress for any of the 145 patients. Obstructive symptoms in the form of snoring, respiratory interruptions, daytime symptoms, or dysphagy could also be significantly reduced (p<0.001) in the long-term. The overall success of the operation was evaluated by 95% of parents as "good" or "very good". A CO(2) laser tonsillotomy using for treatment of obstructive tonsil hyperplasy in small children (with consideration of an inflammation-free anamnesis) represents a safe, effective, and low-complication method, also for long-term continued development.

Pharmacology of vagal afferent influences on disordered breathing during sleep

Sleep-related breathing disorders (SRBD) are a significant public health concern, with a prevalence in the US general population of approximately 2% of women and approximately 4% of men. Although significant strides have been made in our understanding of these disorders with respect to epidemiology, risk factors, pathogenesis and consequences, work to understand these factors in terms of the underlying cellular, molecular and neuromodulatory processes remains in its infancy. Current primary treatments are surgical or mechanical, with no drug treatments available. Basic investigations into the neurochemistry and neuropharmacology of sleep-related changes in respiratory pattern generation and modulation will be essential to clarify the pathogenic processes underlying SRBD and to identify rational and specific pharmacotherapeutic opportunities. Here we summarize emerging work suggesting the importance of vagal afferent feedback systems in sleep-related respiratory pattern disturbances and pointing toward a rich but complex array of neurochemical and neuromodulatory processes that may be involved.

Treatment of obstructive sleep-disordered breathing with positive airway pressure systems

Positive airway pressure systems are widely used to treat patients with moderate-to-severe obstructive sleep-disordered breathing. The application of stable continuous positive airway pressure (CPAP) <i>via</i> the nose (nasal CPAP) has been the mainstay of treatment since the early 1980s. For treatment to be effective, the pressure level must be fine-tuned to restore patency of the individual patient9s upper airway. Currently, there is ongoing controversy concerning which outcomes to observe when adapting the pressure level, and which methods to use for pressure adaptation. Adjusting the pressure level to control apnoeas and hypopnoeas is one major objective, but may not be sufficient to restore normal sleep. Evidence is available that elimination of inspiratory flow limitation leads to better results. In recent years, it has become evident that the use of empirically set CPAP or automatic CPAP devices parallel the clinical results obtained with the classical approach of manual CPAP titration. A striking and still unexplained paradox lies in the fact that automatic CPAP devices perform very differently on the bench, but still yield satisfactory results on several clinical outcomes, <i>e.g.</i> control of sleep-related respiratory disturbances, restoration of good sleep quality and daytime alertness. Understanding the functioning of automatic CPAP devices can prove difficult, as the mode of operation is usually not disclosed by the manufacturers. At present, it is impossible to make any scientifically sound statement on the appropriateness of using automatic continuous positive airway pressure devices for the routine treatment of patients with obstructive sleep-disordered breathing. For this purpose, convincing results of phase I–III clinical trials are needed.

Effects of bedding systems selected by manual muscle testing on sleep and sleep-related respiratory disturbances

In this study, we investigated the feasibility of applying manual muscle testing (MMT) for bedding selection and examined the bedding effect on sleep. Four lay testers with limited training in MMT performed muscle tests for the selection of the bedding systems from five different mattresses and eight different pillows for 14 participants with mild sleep-related respiratory disturbances. For each participant individually, two bedding systems—one inducing stronger muscle forces and the other inducing weaker forces—were selected. The tester-participant pairs showed 85% and 100% agreement, respectively, for the selection of mattresses and pillows that induced the strongest muscle forces. The firmness of the mattress and the height of the pillow were significantly correlated with the body weight and body mass index of the participants for the selected strong bedding system but not for the weak bedding system. Finally, differences were observed between the strong and the weak bedding systems with regard to sleep-related respiratory disturbances and the percentage of slow-wave sleep. It was concluded that MMT can be performed by inexperienced testers for the selection of bedding systems.

Estudio vídeo-polisomnográfico en prematuros menores de 1.800 g

Neonatal video-polysomnography (VPSG) in preterm infants is indicated to rule out sleep-related respiratory disturbances before discharge from neonatal units and to study neonatal sleep patterns and associated pathologic conditions. To study the presence of apnea, hypopnea, and periodic breathing in preterm infants with low birth weight (< 1,800 g) and to describe their cardio-respiratory variability, electroencephalogram (EEG) abnormalities, and brain maturity in connection with sleep stages. We performed a cross-sectional, descriptive study through review of the clinical histories of preterm infants with a birth weight < 1,800 g who had undergone VPSG (2001-2003). The most common indication for VPSG was the presence of sleep apneas and oxygen desaturation. The data obtained were used for descriptive statistical analysis. Thirty-one infants were studied, with a mean gestational age of 27.8 weeks and a mean birth weight of 1,158 g. The most frequently associated condition was hyalin membrane disease (68 %). Cardiorespiratory impairment was detected in 65 %, altered sleep pattern in 6 %, immature EEG recording in 32 %, abnormal pattern in 13 %, and immature plus abnormal pattern in 3 %. Sixty-nine percent of the infants required home monitoring and 23 % needed oxygen at home. Four infants were readmitted on several occasions due to apnea. We wish to stress the importance of carrying out VPSG with suitable methodology in preterm infants with cardiorespiratory or neurological impairment in order to detect abnormalities on EEG and to assess brain maturity and sleep-related abnormal respiratory events.

A case of achondroplasia with severe pulmonary hypertension due to obstructive sleep apnea

Achondroplasia is the most common skeletal dysplasia in children. Achondroplasic patients have a short cranial face and midface hypoplasia. They often have sleep-related respiratory disturbances that lead to hypoxemia caused by midfacial hypoplasia, a small upper airway, hypotonia of airway muscles, or brain stem compression. It has been well described that obstructive sleep apnea can cause pulmonary hypertension (PH) through the mechanism of chronic hypoxemia. However, severe PH due to obstructive-type sleep disorder is rare in patients with achondroplasia. In this report, we describe a 5-year-old girl with achondroplasia whose severe PH was caused by upper-airway obstruction and was resolved gradually after adenotonsillectomy.

Plasma orexin-A-like immunoreactivity in patients with sleep related respiratory disturbance

Plasma orexin-A-like immunoreactivity in patients with sleep related respiratory disturbance

Sex differences in the polysomnographic sleep of young adults: a community-based study

Background and purpose In small, clinical samples, men have reduced slow wave sleep compared to women. Given the higher prevalence of sleep-related breathing disturbance in men, this study assessed sex differences in sleep in a large, non-clinical sample of adults and controlled for primary sleep disorders. Patients and methods Men and women, 31–40 years old, drawn from a longitudinal sample representative of southeast Michigan served as subjects. Each underwent a sleep study consisting of two consecutive 8-h nights of standard polysomnography (NPSG) and a multiple sleep latency test (MSLT) the intervening day. Results Of the 439 eligible participants, 292 (66.5%) agreed to spend two consecutive nights and the intervening day in the sleep laboratory. Standard polysomnograms that monitored respiration and leg movements were collected each night, and on the intervening day the MSLT was performed. Men had more sleep-related breathing disturbance than women. After adjusting for this higher prevalence of respiratory disturbance, men still had a lower mean sleep efficiency (i.e. increased wake time) and a higher percentage of stage 1 sleep. Men and women did not differ in most other sleep parameters and did not differ in level of daytime sleepiness on the MSLT. Conclusions Sleep-related respiratory disturbance accounted for some of the sex differences in sleep. After correcting for respiratory disturbance, men still had lighter and less efficient sleep, but this was not associated with greater daytime sleepiness. Whether this reflects a sex difference in the functioning of the sleep homeostat will require further study.

Continuous positive airway pressure for sleep-related breathing disorders in multiple system atrophy: long-term acceptance

Background and purpose To assess the long-term acceptance of non-invasive nasal continuous positive air pressure (CPAP) in multiple system atrophy (MSA) patients with polysomnographic (PSG)-confirmed sleep apneas and/or nocturnal stridor. Patients and methods Sleep-related breathing disorders were investigated by PSG in 22 MSA patients in whom stridor and sleep-related respiratory disturbances were clinically suspected. Patients in whom the first PSG disclosed either a sleep apnea/hypopnea index (AHI)≥10 or stridor with or without apneas underwent a second PSG for CPAP titration. Results Three patients presented with an obstructive sleep apnea syndrome without stridor, whereas 15 patients presented stridor occurring alone or accompanied by apneas. Twelve patients pursued CPAP. Two severely disabled patients died a few days after CPAP initiation, and five discontinued CPAP because of discomfort. One patient died after 17 months of follow-up. Since the onset of CPAP, the four remaining patients reported more efficacious sleep and improved daytime alertness. These patients had significantly less severe disease at the time of CPAP initiation. Age, disease duration, the presence of sleep complaints, excessive daytime somnolence (EDS) and AHI did not account for CPAP compliance. Conclusion The severity of motor impairment at the initiation of treatment appears to be the most significant limiting factor for CPAP long-term acceptance.

Plasma orexin-A-like immunoreactivity in patients with sleep apnea hypopnea syndrome

Orexin-A (hypocretin-1), a neuropeptide produced in hypothalamus, stimulates arousal. We studied plasma concentrations of orexin-A-like immunoreactivity (orexin-A-LI) in 156 patients with sleep apnea hypopnea syndrome (SAHS) and 22 control subjects. Plasma orexin-A-LI levels were significantly decreased in 156 patients with SAHS (4.4±0.15 pmol/l, mean±S.E.) as compared with controls (5.3±0.45 pmol/l). The levels were decreased in parallel with the severity of sleep-related respiratory disturbance and magnitude of sleep fragmentation. These findings raise the possibility that a low plasma level of orexin-A-LI may be a marker to show the severity of the disease in patients with SAHS.

Overnight Pulse Oximetry in Nursing Home Residents with Behavior Problems: Case Reports

Sleep-related hypoxia is common in nursing home residents and may present as delirium, anxiety, agitation, or behavior problems as well as polycythemia, or it may exacerbate hypertension and/or congestive heart failure. 1 Strollo Jr, PJ Rogers RM Obstructive sleep apnea. N Engl J Med. 1996; 334: 99-104 Crossref PubMed Scopus (553) Google Scholar , 2 Drinka PJ Jochen AL Cuisinier M et al. Polycythemia as a complication of testosterone replacement therapy in nursing home men with low testosterone levels. J Am Geriatr Soc. 1995; 43: 899-901 Crossref PubMed Scopus (83) Google Scholar Its mechanisms include chronic cardiopulmonary disease, sleep hypopnea or apnea syndromes (obstructive and central), pulmonary edema with nocturnal resorption of peripheral edema, and dependency-related small airway closure with continued perfusion of nonventilated alveoli. Sleep-related respiratory disorders are more common in individuals with dementia and may be exacerbated by sedatives such as benzodiazepines or metabolic abnormalities such as end-stage renal disease. 3 Ancoli-Israel S Epidemiology of sleep disorders. Clin Geriatr Med. 1989; 5: 347-362 PubMed Google Scholar , 4 Ancoli-Israel S Klauber MR Butters N et al. Dementia in institutionalized elderly: Relation to sleep apnea. J Am Geriatr Soc. 1991; 39: 258-263 PubMed Google Scholar , 5 Mant A Saunders NA Eyland AE et al. Sleep-related respiratory disturbance and dementia in elderly females. J Gerontol. 1988; 43: M140-M144 Crossref PubMed Scopus (28) Google Scholar , 6 Guilleminault C Silvestri R Mondini S Coburn S Aging and sleep apnea: Action of benzodiazepine, acetazolamide, alcohol, and sleep deprivation in a healthy elderly group. J Gerontol. 1984; 39: 655-661 Crossref PubMed Scopus (76) Google Scholar , 7 Hanly PJ Pierratos A Improvement of sleep apnea in patients with chronic renal failure who undergo nocturnal hemodialysis. N Engl J Med. 2001; 344: 102-107 Crossref PubMed Scopus (473) Google Scholar

Interaction of sleep disturbances and gastroesophageal reflux in chronic laryngitis

Background: A considerable percentage of patients with reflux laryngitis do not respond to conventional treatment with proton pump inhibitors or prokinetics. At the present time, the reasons for this are not well known. Purpose: To investigate whether nocturnal reflux associated with sleep-related respiratory disorders is the cause of refractory laryngitis. Method: The data from 227 patients (133 women, ages 18 to 75 years, body mass index 17.4 to 38.3, mean 32.1 kg/m2) with LG were analyzed retrospectively. All received laryngoscopy and gastroscopy. All patients initially received 40- to 80 mg omeprazole and underwent a follow-up laryngoscopy after 6 weeks. Of the patients, 202 showed a clear improvement, whereas 25 (11.1%) did not. All underwent 24-hour pH monitoring and cardiorespiratory polysomnography. Results: All of the patients showed laryngoscopic signs of LG. Of the patients, 102 (45%) had a hiatal hernia and 53 (28%) suffered from reflux esophagitis. Forty-two patients (19%) were found to have Helicobacter pylori in the stomach. Among the 25 patients who failed to respond to omeprazole, pH monitoring showed nocturnal acid reflux in 15 (60%). Twenty-four patients (96%) showed a sleep-related respiratory disturbance manifesting as pathologic snoring (16 patients) or obstructive sleep apnea (8 patients, respiratory disturbance index [RDI] 11 to 33, mean 16.3/h). All received nasal continuous positive airway pressure (nCPAP) treatment, 16 with constant mask pressure (4 to 12, mean, 5.6 mbar) and 8 with autoadjusting pressure. One patient abandoned treatment; the other 23 showed clear subjective and objective improvement after 3 months of treatment. Conclusions: Even without pH monitoring evidence of nocturnal reflux, refractory LG is very often associated with sleep-related respiratory disorders and responds well to nCPAP treatment. Prospective studies are needed to clarify the details of this association. (Am J Otolaryngol 2002;23:20-26. Copyright © 2002 by W.B. Saunders Company)

Compliance with continuous positive airway pressure therapy: assessing and improving treatment outcomes.

Although nasal continuous positive airway pressure (CPAP) is generally effective in correcting sleep-related respiratory disturbance and associated daytime sequelae in obstructive sleep apnea syndrome (OSAS), resistance to and intolerance of CPAP poses a serious limitation to its use. Failure to comply with treatment has been reported to be as high as 25 to 50%, with patients typically abandoning therapy during the first 2 to 4 weeks of treatment. Reasons for discontinuing CPAP therapy have been primarily related to issues of mask discomfort, nasal dryness and congestion, and difficulty adapting to the pressure. Although there has been great variability in the reported rates of CPAP compliance, there have been few systematic studies to evaluate barriers to CPAP compliance or ways to improve compliance. Early identification of CPAP-related tolerance problems or barriers, psychological factors, and the predictive value of pretreatment background variables ( ie, age and gender) may enhance compliance with therapy. An important goal for OSAS management is the development of intervention strategies and educational approaches that minimize side effects and maximize patient compliance. A new classification is presented, along with suggestions and ideas for intervention.

Occupational status and sleep-disordered breathing in a sample of French males.

Sleep-disordered breathing (SDB) and lower socio-professional status have in common a series of risk factors for ill health such as sedentary lifestyle, weight excess, heavy alcohol and tobacco consumption. We hypothesised that SDB will be more prevalent in lower socio-professional groups. A total of 496 male middle aged subjects (23-66 years) were tested with a protocol including a self-completed structured sleep questionnaire (translation of the Madison sleep cohort study form), anthropometry (including neck, waist and hip girth) and a simple, non-invasive nose-throat examination by a specialist physician. The subjects were classified according to the 10 major groups of the ISCO-88 classification (International Labour Office). Our sampling base did not contain subjects in the major groups 1 (senior officials, legislators), 6 (fishery and agricultural workers), and zero (armed forces), thus these groups were not represented in the analysis. To improve the power of the statistical analysis, groups 3 and 4, 5 and 7, 8 and 9 were merged, the analysis thus including four categories. The differences in demographic data were negligible; as expected, smoking was more prevalent in low socio-occupational groups (difference non-significant). A history of chronic bronchitis was more frequent in low socio-occupational groups, while a low physical job labour was more frequent in higher occupational groups. We did not find any differences in the prevalence of sleep-related respiratory disturbances (snoring, sleep apnoeas). This first study of the possible association between socio-occupational factors and sleep disordered breathing was negative, but we believe further studies, on larger samples, with a more homogeneous distribution of social groups are warranted.