Sleep Science最新文献

Objective  To verify if maxillomandibular retrusion, obesity, and increased neck circumference are factors of worse surgical prognosis for lateral pharyngoplasty in apneic patients. Materials and Methods  We evaluated 53 patients with obstructive sleep apnea who underwent lateral pharyngoplasty. Clinical evaluation was performed before the surgical procedure and included the measurement of body mass index (BMI) in kg/m ² , neck circumference in centimeters, and a clinical evaluation of the facial profile obtained through the natural position of the oriented head. The polysomnographic evaluation was performed with at a minimum of 6 months after surgery, and polysomnographic results were correlated with the preoperative clinical data. Results  The mean age of the patients was 38.8 years; the mean BMI was of 29.28kg/m ² , and 84.9% of the sample was composed of men and 15.1% of women. There was a significant reduction in the mean value of the main respiratory parameters verified by polysomnography, such as apnea-hypopnea index (AHI) from 31.60 events per hour to 8.15 ( p  < 0.001); NadirO ₂ went from 81% to 85% ( p  = 0.002) and mean oxyhemoglobin saturation from 94% to 95% ( p  = 0.024). It was also observed that the greater the maxillomandibular retrusion, the lower the mean reduction of the AHI after surgery. The increase in neck circumference proved to be a factor associated with the surgical outcome, and for each 1-cm decrease in the neck circumference, the chance of surgical success increased 1.2-fold. Conclusion  Lateral pharyngoplasty is an efficient surgical obstructive sleep apnea treatment. The lower the neck circumference measurement, the greater the chances of surgical success, and clinically evaluated maxillomandibular retrusion can reduce the magnitude of improvement in respiratory parameters after lateral pharyngoplasty in apneic patients.

Objective  Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia, but half of the patients do not reach remission. This study aimed to explore subjective remission by investigating the characteristics of patients who reported lingering sleep problems after CBT-I. Methods  Secondary analyses of a randomized controlled trial of group CBT-I in 72 primary care patients with insomnia disorder. Sociodemographic characteristics and outcomes (insomnia severity, sleep variables, hypnotics use, fatigue, depressive symptoms, and dysfunctional beliefs/attitudes), including baseline data and symptom change, were investigated in relation to patients' posttreatment response to the yes-or-no question "Would you say that you have sleep problems?" Results  A total of 56.9% of patients reported sleep problems after CBT-I. At baseline, they had worse depressive symptoms (14.9 (SD 7.5) vs. 10.2 (SD 5.9), p  = 0.006) and more awakenings (2.6 (SD 1.5) vs. 1.8 (SD 1.3), p  = 0.034) than those in subjective remission from sleep problems. Patients in the non-remission and remission groups showed similar improvements in sleep, fatigue, and depressive symptoms, but patients in the non-remission group had improved less in insomnia severity, dysfunctional beliefs/attitudes about sleep, and hypnotic use. In patients with more pronounced depressive symptoms before CBT-I, change in depressive symptoms during treatment partially explained subjective remission from sleep problems. Discussion  More severe depressive symptoms prior to CBT-I and less improvements in depressive symptoms during treatment predicted remaining subjective sleep problems after treatment. These findings highlight the importance of assessing depressive symptoms in primary care patients with insomnia, as patients with pronounced depressive symptoms may need tailored treatment.

Objective  To evaluate, through a tomographic analysis, the positional changes of the condyle when using a mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA), and to assess if the condylar positions influence OSA polysomnographic patterns. Materials and Methods  Ten OSA patients underwent treatment with an MAD, and polysomnographic and tomographic examinations were performed before therapy (T0) and after MAD placement (T1). Results  By comparing the T0 and T1 measurements, we observed advancement and extrusion of the condyles in all patients ( p  < 0.001), as well as a decrease in the apnea-hypopnea index (AHI) ( p  < 0.001), increases in the mean ( p  = 0.001) and minimum ( p  < 0.001) oxyhemoglobin saturation, and a significant correlation between the anterior displacement of the right ( p  = 0.003) and left ( p  = 0.015) condyles. Discussion  Condylar advancement was directly correlated with OSA improvement: the greater the advancement, the better the AHI.

Introduction  Systematic reviews and metanalyses have shown that mindfulness-based interventions can have positive effects on health, such as reducing anxiety, depression, and chronic pain. However, their effect on sleep-related outcomes is not yet well established. Sleep can be assessed subjectively (questionnaires, sleep logs, self-reporting) and/or objectively (actigraphy, polysomnography, biological markers), and outcomes may differ depending on which type of assessment is used. Objective  In this study, we present a literature overview on mindfulness and sleep, innovatively presenting and discussing studies that address sleep subjectively and objectively. Methods  The search was undertaken using four databases (Pubmed Medline, Scopus, Web of Science, Psychinfo) in September 2019, and repeated in May 2021. Studies were analyzed through a two-step process: (1) reading titles and abstracts, and (2) full text analysis that met the review's eligibility criteria, with the final sample comprising 193 articles. We observed a growth in the number of studies published, particularly since 2005. However, this was mostly due to an increase in studies based on subjective research. There is a moderate to nonexistent agreement between objective and subjective sleep measures, with results of subjective measures having higher variability and uncertainty.We identified 151 articles (78%) using an exclusively subjective sleep evaluation, which can cause a misperception about mindfulness effects on sleep. Conclusion  Future studies should place greater emphasis on objective measurements to accurately investigate the effects of mindfulness practices on sleep, although subjective measures also have a role to play in respect of some aspects of this relationship.

Objective  The objective of the present study was to find biomechanical correlates of single-task gait and self-reported sleep quality in a healthy, young population by replicating a recently published study. Materials and Methods  Young adults ( n  = 123) were recruited and were asked to complete the Pittsburgh Sleep Quality Inventory to assess sleep quality. Gait variables ( n  = 53) were recorded using a wearable inertial measurement sensor system on an indoor track. The data were split into training and test sets and then different machine learning models were applied. A post-hoc analysis of covariance (ANCOVA) was used to find statistically significant differences in gait variables between good and poor sleepers. Results  AdaBoost models reported the highest correlation coefficient (0.77), with Support-Vector classifiers reporting the highest accuracy (62%). The most important features associated with poor sleep quality related to pelvic tilt and gait initiation. This indicates that overall poor sleepers have decreased pelvic tilt angle changes, specifically when initiating gait coming out of turns (first step pelvic tilt angle) and demonstrate difficulty maintaining gait speed. Discussion  The results of the present study indicate that when using traditional gait variables, single-task gait has poor accuracy prediction for subjective sleep quality in young adults. Although the associations in the study are not as strong as those previously reported, they do provide insight into how gait varies in individuals who report poor sleep hygiene. Future studies should use larger samples to determine whether single task-gait may help predict objective measures of sleep quality especially in a repeated measures or longitudinal or intervention framework.

Objective  The impact of sleep deprivation on the physiological determinants of explosive torque production remains poorly understood. We aimed at determining the acute effects of 24 hours of sleep deprivation on the sequential rate of torque development (RTD) obtained during plantar flexion through maximum voluntary isometric contraction (MVIC). Materials and Methods  The study included 14 healthy-young adults (8 men and 6 women). The participants visited the laboratory on 2 different occasions: without and with 24 hours of sleep deprivation. In each session, the subjects were tested for RTD of the plantar flexors with concomitant recordings of the electromyographic (EMG) amplitude of the soleus over the following time intervals: 0 to 30, 30 to 50, 50 to 100, and 100 to 150 ms. Results  Sleep deprivation did not affect peak RTD (without sleep deprivation: 283.3 ± 111.6 N.m.s ^-1 versus with sleep deprivation: 294.9 ± 99.2 N.m.s ^-1 ; p  > 0.05) of plantar flexion. The sequential values of RTD, as well as the normalized amplitude of the soleus EMG, remained similar between both conditions (p > 0.05). Discussion  In conclusion, we found that 24 hours of sleep deprivation do not affect muscle activation, nor explosive torque production throughout the torque-time curve. Thus, exercise performance and daily functionality in tasks involving rapid torque development might remain well preserved after 24 hours of acute sleep deprivation.

Introduction  Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans. Objective  To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms. Materials and Methods  We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t -tests were conducted to test for pre-to-post differences. Results  In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( p  = 0.04) and intensity of nightmares ( p  = 0.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements. Conclusion  These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.

Objective  To evaluate the clinical utility of the Baveno classification in predicting incident cardiovascular mortality after five years of follow-up in a clinic-based cohort of patients with obstructive sleep apnea (OSA). Materials and Methods  We evaluated the reproducibility of the Baveno classification using data from the Santiago Obstructive Sleep Apnea (SantOSA) study. The groups were labeled Baveno A (minor symptoms and comorbidities), B (severe symptoms and minor comorbidities), C (minor symptoms and severe comorbidities), and D (severe symptoms and comorbidities). Within-group comparisons were performed using analysis of variance (ANOVA) and post hoc tests. The associations between groups and incident cardiovascular mortality were determined through the Mantel-Cox and Cox proportional hazard ratios (HRs) adjusted by covariables. Results  A total of 1,300 OSA patients were included (Baveno A: 27.7%; B: 28%; C: 16.8%; and D: 27.5%). The follow-up was of 5.4 years. Compared to Baveno A, the fully-adjusted risk of cardiovascular mortality with Baveno B presented an HR of 1.38 (95% confidence interval [95%CI]: 0.14-13.5; p  = 0.78); with Baveno C, it was of 1.71 (95%CI: 0.18-16.2; p  = 0.63); and, with Baveno D, of 1.04 (95%CI: 0.12-9.2; p  = 0.98). We found no interactions involving Baveno group, sex and OSA severity. Discussion  Among OSA patients, the Baveno classification can describe different subgroups. However, its utility in identifying incident cardiovascular mortality is unclear. Long-term follow-up studies and the inclusion of demographic variables in the classification could improve its ability to detect a high-risk phenotype associated with cardiovascular mortality. Conclusion  The Baveno classification serves as a valuable method for categorizing varying groups of patients afflicted with OSA. Nevertheless, its precision in identifying occurrence of cardiovascular mortality is still unclear.

Objective  When metacognition arises during rapid eye movement (REM) sleep, people experience lucid dreaming (LD). Studies on this phenomenon face different obstacles. For example, its standard verification protocol requires at least three types of sensors. We hypothesized that preagreed frontalis movements (PAFMs), as a sign of lucidity, could be seen on electroencephalography (EEG) during REM sleep. In this case, only one EEG sensor would be needed to verify LD. Method  Under laboratory observation, five volunteers were instructed to induce LD, during which they needed to use the standard verification protocol with pre-agreed eye movements (PAEMs) and then immediately raise their eyebrows three times as a PAFM. Results  All participants were able to send signals from a total of eight LDs using one or both methods. Preagreed frontalis movements and PAEMs were equally distinctive on most EEGs, but PAFM quality was strongly dependent on the accuracy of the method. Preagreed frontalis movements exhibited two types of EEG patterns and led to immediate awakening when LD was not stable. Discussion  Though the outcomes show that PAFMs can be used to verify LD, this method was less consistent and apparent than PAEMs. Furthermore, accurate instructions are needed before using PAFMs. When polysomnography is unavailable, PAFMs can be applied, as it requires only one EEG sensor to detect REM sleep and consciousness simultaneously.

Introduction  Obstructive sleep apnea (OSA) is defined as intermittent partial or complete collapse of the upper airway during sleep. It is a common condition in childhood, with an incidence ranging from 1.2% to 5.7%, and it can harm several aspects of children's life, such as cognitive, metabolic and cardiovascular functions, among others. There are treatment options, such as adenotonsillectomy, myofunctional therapy, mandibular advancement appliances (MAAs), rapid maxillary expansion, and positive airway pressure devices, but there is still doubt about which method is more suitable for the treatment of OSA in children. Objective  To analyze the effectiveness of MAAs in the treatment of pediatric OSA. Materials and Methods  The search was conducted in August 2021 in different electronic databases, such as PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS, Ovid, SciELO, Web of Science, EMBASE BIREME, BBO BIREME, and the Cochrane Library. Results  Only three systematic reviews and two meta-analyses were included in the present study. All studies showed improvement in the score on the apnea-hypopnea index after using MAAs in the treatment of pediatric OSA. Conclusion  Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.