Pub Date : 2023-11-22eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776869
André Dias Gonçalves, Pedro Pezarat-Correia, Carolina Vila-Chã, Gonçalo Vilhena Mendonça
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.
{"title":"Effects of Acute Sleep Deprivation on the Sequential Rate of Torque Development throughout the Force-Time Curve.","authors":"André Dias Gonçalves, Pedro Pezarat-Correia, Carolina Vila-Chã, Gonçalo Vilhena Mendonça","doi":"10.1055/s-0043-1776869","DOIUrl":"10.1055/s-0043-1776869","url":null,"abstract":"<p><p><b>Objective</b> 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). <b>Materials and Methods</b> 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. <b>Results</b> Sleep deprivation did not affect peak RTD (without sleep deprivation: 283.3 ± 111.6 N.m.s <sup>-1</sup> versus with sleep deprivation: 294.9 ± 99.2 N.m.s <sup>-1</sup> ; <i>p</i> > 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). <b>Discussion</b> 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.</p>","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"16 4","pages":"e454-e461"},"PeriodicalIF":1.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776796
Ann Marie Wagner, Anne Richards, Christine Chiros, Paul Thuras, Elizabeth C Parsons, Angela D Oien, Carlos H Schenck, Muna Irfan
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.
导言:慢性恶梦是创伤后应激障碍(PTSD)的一种常见致残特征,目前仍缺乏广泛有效的治疗方法。虽然意象排演疗法(IRT)对特发性噩梦患者和一些与创伤后应激障碍相关的噩梦患者有一定疗效,但研究表明该疗法对退伍军人的疗效可能较差。叙事疗法(NT)是一种以客户为中心、以价值为重点的心理疗法,已证明对创伤后应激障碍患者有益。将叙事疗法的原则应用于 IRT 可能会为退伍军人的治疗提供一种有价值的治疗方法。目标 对参与第一作者开发的新型简短干预的退伍军人客户进行回顾性病历审查,该干预由采用 NT 原则的 IRT(N-IRT)强化而成,用于治疗噩梦。主要结果是噩梦的频率和强度,次要结果是干预对噩梦困扰和应对、主观睡眠质量以及整体创伤后应激障碍症状的影响。材料与方法 我们对第一作者转诊的八名完成了 N-IRT 治疗的退伍军人进行了回顾性病历审查,包括基线和治疗结束时的测量。治疗方案包括一次60分钟的NT增强型梦境脚本重写疗程和指定的家庭作业以排练修改后的梦境脚本,以及4周后的随访评估。受试者在基线期和干预后的随访评估中分别完成了由第一作者开发的睡眠和噩梦访谈以及创伤后应激障碍核对表。我们进行了配对 t 检验,以检验前后的差异。结果 在统计分析中,我们观察到从治疗前到 1 个月的随访期间,噩梦的频率(p = 0.04)和强度(p = 0.001)均有显著的减少,且具有临床意义。与噩梦相关的情绪困扰、应对噩梦的能力、睡眠时间和睡眠效率以及创伤后应激障碍的总体症状也有了明显改善。结论 这些试验数据提供了令人信服的初步证据,证明用NT(N-IRT)改良的单次IRT干预能有效降低退伍军人的噩梦频率和强度、减少噩梦困扰、改善应对噩梦的行为、改善睡眠质量和整体创伤后应激障碍症状。为了证实该方法的有效性,并更好地了解治疗效果的可能机制,需要采用黄金标准临床试验设计和更大的样本量对该方法进行进一步研究。
{"title":"A Retrospective Pilot Study of Imagery Rehearsal Therapy Enhanced with Narrative Therapy Principles for the Treatment of Nightmares in US Military Veterans.","authors":"Ann Marie Wagner, Anne Richards, Christine Chiros, Paul Thuras, Elizabeth C Parsons, Angela D Oien, Carlos H Schenck, Muna Irfan","doi":"10.1055/s-0043-1776796","DOIUrl":"10.1055/s-0043-1776796","url":null,"abstract":"<p><p><b>Introduction</b> 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. <b>Objective</b> 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. <b>Materials and Methods</b> 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 <i>t</i> -tests were conducted to test for pre-to-post differences. <b>Results</b> In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( <i>p</i> = 0.04) and intensity of nightmares ( <i>p</i> = 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. <b>Conclusion</b> 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.</p>","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"16 4","pages":"e439-e445"},"PeriodicalIF":1.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776770
Jorge Jorquera, Jorge Dreyse, Constanza Salas, Francisca Letelier, Bunio Weissglas, Javiera Del-Río, Mario Henríquez-Beltrán, Gonzalo Labarca, Jorge Jorquera-Díaz
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.
目的 评估阻塞性睡眠呼吸暂停(OSA)患者临床队列随访五年后,巴韦诺分类法在预测心血管疾病死亡率方面的临床实用性。材料与方法 我们利用圣地亚哥阻塞性睡眠呼吸暂停(SantOSA)研究的数据评估了巴韦诺分类法的可重复性。各组分别标记为巴韦诺 A 组(轻微症状和合并症)、B 组(严重症状和轻微合并症)、C 组(轻微症状和严重合并症)和 D 组(严重症状和合并症)。组内比较采用方差分析(ANOVA)和事后检验。各组与心血管疾病死亡率之间的关系通过经协变量调整的 Mantel-Cox 和 Cox 比例危险比 (HRs) 来确定。结果 共纳入 1300 名 OSA 患者(Baveno A:27.7%;B:28%;C:16.8%;D:27.5%)。随访时间为 5.4 年。与贝文诺 A 相比,贝文诺 B 的完全调整后心血管死亡风险 HR 为 1.38(95% 置信区间 [95%CI]:0.14-13.5;p = 0.78);贝文诺 C 为 1.71(95%CI:0.18-16.2;p = 0.63);贝文诺 D 为 1.04(95%CI:0.12-9.2;p = 0.98)。我们没有发现贝文诺组别、性别和 OSA 严重程度之间存在相互作用。讨论 在 OSA 患者中,巴韦诺分类可以描述不同的亚组。然而,其在确定心血管疾病死亡率方面的作用尚不明确。长期随访研究以及在分类中加入人口统计学变量可提高其检测与心血管死亡相关的高风险表型的能力。结论 巴韦诺分类法是对不同OSA患者群体进行分类的重要方法。然而,它在识别心血管死亡发生方面的准确性仍不明确。
{"title":"Clinical Application of the Multicomponent Grading System for Sleep Apnea Classification and Incident Cardiovascular Mortality.","authors":"Jorge Jorquera, Jorge Dreyse, Constanza Salas, Francisca Letelier, Bunio Weissglas, Javiera Del-Río, Mario Henríquez-Beltrán, Gonzalo Labarca, Jorge Jorquera-Díaz","doi":"10.1055/s-0043-1776770","DOIUrl":"10.1055/s-0043-1776770","url":null,"abstract":"<p><p><b>Objective</b> 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). <b>Materials and Methods</b> 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. <b>Results</b> 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; <i>p</i> = 0.78); with Baveno C, it was of 1.71 (95%CI: 0.18-16.2; <i>p</i> = 0.63); and, with Baveno D, of 1.04 (95%CI: 0.12-9.2; <i>p</i> = 0.98). We found no interactions involving Baveno group, sex and OSA severity. <b>Discussion</b> 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. <b>Conclusion</b> 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.</p>","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"16 4","pages":"e446-e453"},"PeriodicalIF":1.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776749
Michael Raduga, Andrey Shashkov
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.
{"title":"Detecting Lucid Dreams by Electroencephalography and Eyebrow Movements.","authors":"Michael Raduga, Andrey Shashkov","doi":"10.1055/s-0043-1776749","DOIUrl":"10.1055/s-0043-1776749","url":null,"abstract":"<p><p><b>Objective</b> 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. <b>Method</b> 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. <b>Results</b> 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. <b>Discussion</b> 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.</p>","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"16 4","pages":"e408-e416"},"PeriodicalIF":1.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776747
Carolina Cozzi-Machado, Fátima Rosana Albertini, Silvana Silveira, Almiro José Machado-Júnior
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.
导言 阻塞性睡眠呼吸暂停(OSA)是指睡眠时上气道间歇性部分或完全塌陷。它是儿童时期的一种常见病,发病率从1.2%到5.7%不等,可损害儿童生活的多个方面,如认知、新陈代谢和心血管功能等。目前有多种治疗方法,如腺扁桃体切除术、肌功能疗法、下颌前突矫治器(MAAs)、上颌快速扩张术和气道正压装置,但哪种方法更适合治疗儿童 OSA 仍存在疑问。目的 分析上下颌前突矫治器治疗儿童 OSA 的效果。材料与方法 2021 年 8 月在不同的电子数据库中进行了检索,如 PubMed、EBSCO(Dentistry & Oral Sciences Source)、LILACS、Ovid、SciELO、Web of Science、EMBASE BIREME、BBO BIREME 和 Cochrane Library。结果 本研究只纳入了三篇系统综述和两篇荟萃分析。所有研究均显示,使用 MAAs 治疗小儿 OSA 后,呼吸暂停-低通气指数得分有所改善。结论 虽然还需要更多的随机研究,但根据本综述,必须将 MAAs 视为小儿 OSA 多学科治疗的一部分。
{"title":"Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review.","authors":"Carolina Cozzi-Machado, Fátima Rosana Albertini, Silvana Silveira, Almiro José Machado-Júnior","doi":"10.1055/s-0043-1776747","DOIUrl":"10.1055/s-0043-1776747","url":null,"abstract":"<p><p><b>Introduction</b> 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. <b>Objective</b> To analyze the effectiveness of MAAs in the treatment of pediatric OSA. <b>Materials and Methods</b> 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. <b>Results</b> 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. <b>Conclusion</b> Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.</p>","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"16 4","pages":"e468-e475"},"PeriodicalIF":1.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Many patients abandon CPAP treatment because they find the mask uncomfortable. Therefore, specialists may benefit from the predictive value of airway assessment tools. Objective To identify nasal ventilation failure through the Nasal Obstruction Symptom Evaluation (NOSE) scale in patients with obstructive sleep apnea (OSA) who undergo home-based auto-adjusting CPAP titration and to determine whether there is a correlation between NOSE score and the type of mask selected. Materials and Methods In this prospective correlational study, the NOSE scale was used in terms of mask selection and titration indicators. Patients were classified based on their NOSE score: > or < 50. Results We included 303 patients; 226 men (74.5%), BMI: 33.2 ± 6.1 kg/m 2 , neck circumference (cm): 42.8 ± 3.6 and Epworth (ESS) score: 9.2 ± 5.6, mild OSA: 12 (3.9%), moderate OSA: 127 (41.9%), and severe OSA: 164 (54.1%). The mean NOSE score was 24.3 ± 22.8 and 42 patients (13.8%) had NOSE scores > 50. Indicators for both groups were: compliance (5.9 ± 1.3 vs. 5.8 ± 1.4 hours) p: 0.41, therapeutic pressure (9.1 ± 2.0 vs. 8.8 ± 1.6 cm of H 2 O) p: 0.23, residual AHI (2.3 ± 1.8 vs. 2.8 ± 2.6 events/hour) p: 0.25, and leaks (20.5 ± 10.6 vs. 21.3 ± 10.7 liters/minute) p: 0.64. According to adjusted multiple regression, a NOSE of > 50 was not a predictor of mask selection. Conclusions A > 50 NOSE score was not a predictor of mask selection, and it was not correlated to titration performance.
{"title":"Performance of the NOSE Questionnaire in Mask Selection for Home CPAP Titration.","authors":"Magalí Blanco, Glenda Ernst, Alberto Rabino, Alejandro Salvado, Eduardo Enrique Borsini","doi":"10.1055/s-0043-1776769","DOIUrl":"10.1055/s-0043-1776769","url":null,"abstract":"<p><p><b>Introduction</b> Many patients abandon CPAP treatment because they find the mask uncomfortable. Therefore, specialists may benefit from the predictive value of airway assessment tools. <b>Objective</b> To identify nasal ventilation failure through the Nasal Obstruction Symptom Evaluation (NOSE) scale in patients with obstructive sleep apnea (OSA) who undergo home-based auto-adjusting CPAP titration and to determine whether there is a correlation between NOSE score and the type of mask selected. <b>Materials and Methods</b> In this prospective correlational study, the NOSE scale was used in terms of mask selection and titration indicators. Patients were classified based on their NOSE score: > or < 50. <b>Results</b> We included 303 patients; 226 men (74.5%), BMI: 33.2 ± 6.1 kg/m <sup>2</sup> , neck circumference (cm): 42.8 ± 3.6 and Epworth (ESS) score: 9.2 ± 5.6, mild OSA: 12 (3.9%), moderate OSA: 127 (41.9%), and severe OSA: 164 (54.1%). The mean NOSE score was 24.3 ± 22.8 and 42 patients (13.8%) had NOSE scores > 50. Indicators for both groups were: compliance (5.9 ± 1.3 vs. 5.8 ± 1.4 hours) p: 0.41, therapeutic pressure (9.1 ± 2.0 vs. 8.8 ± 1.6 cm of H <sub>2</sub> O) p: 0.23, residual AHI (2.3 ± 1.8 vs. 2.8 ± 2.6 events/hour) p: 0.25, and leaks (20.5 ± 10.6 vs. 21.3 ± 10.7 liters/minute) p: 0.64. According to adjusted multiple regression, a NOSE of > 50 was not a predictor of mask selection. <b>Conclusions</b> A > 50 NOSE score was not a predictor of mask selection, and it was not correlated to titration performance.</p>","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"16 4","pages":"e425-e429"},"PeriodicalIF":1.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776750
Ozeas de Lima Lins-Filho, Aluisio Andrade-Lima, Auguste Daniel Torres, Luciano Machado Oliveira, Wagner Luiz do-Prado, Raphael Ritti-Dias, Diego Giulliano Destro Christofaro, Breno Quintella Farah
Objective To analyze the impact of sleep quality/duration on cardiac autonomic modulation on physically active adolescents with obesity. Materials and Methods The present cross-sectional study included 1,150 boys with a mean age of 16.6 ± 1.2 years. The assessment of cardiac functions included the frequency domain of heart rate variability (HRV; low frequency - LF; high frequency - HF; and the ratio between these bands -LF/HF -, defined as the sympathovagal balance), and each parameter was categorized as low / high . Physical activity levels and sleep quality/duration were obtained by questionnaires. Abdominal obesity was assessed and defined as waist circumference > 80 th percentile. Results Poor sleep quality resulted in lower HF (odds ratio [OR]: 1.8; 95% confidence interval [95%CI]: 1.01-3.21]) regardless of physical activity and abdominal obesity. Moreover, the study found no association between sleep duration and HRV parameters in adolescents. Conclusion Sleep quality, not sleep duration, reduces parasympathetic cardiac modulation apart from other factors such as physical activity and abdominal obesity in adolescents.
{"title":"Association between Sleep Quality and Cardiac Autonomic Modulation in Adolescents: A Cross Sectional Study.","authors":"Ozeas de Lima Lins-Filho, Aluisio Andrade-Lima, Auguste Daniel Torres, Luciano Machado Oliveira, Wagner Luiz do-Prado, Raphael Ritti-Dias, Diego Giulliano Destro Christofaro, Breno Quintella Farah","doi":"10.1055/s-0043-1776750","DOIUrl":"10.1055/s-0043-1776750","url":null,"abstract":"<p><p><b>Objective</b> To analyze the impact of sleep quality/duration on cardiac autonomic modulation on physically active adolescents with obesity. <b>Materials and Methods</b> The present cross-sectional study included 1,150 boys with a mean age of 16.6 ± 1.2 years. The assessment of cardiac functions included the frequency domain of heart rate variability (HRV; low frequency - LF; high frequency - HF; and the ratio between these bands -LF/HF -, defined as the sympathovagal balance), and each parameter was categorized as <i>low</i> / <i>high</i> . Physical activity levels and sleep quality/duration were obtained by questionnaires. Abdominal obesity was assessed and defined as waist circumference > 80 <sup>th</sup> percentile. <b>Results</b> Poor sleep quality resulted in lower HF (odds ratio [OR]: 1.8; 95% confidence interval [95%CI]: 1.01-3.21]) regardless of physical activity and abdominal obesity. Moreover, the study found no association between sleep duration and HRV parameters in adolescents. <b>Conclusion</b> Sleep quality, not sleep duration, reduces parasympathetic cardiac modulation apart from other factors such as physical activity and abdominal obesity in adolescents.</p>","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"16 4","pages":"e462-e467"},"PeriodicalIF":1.6,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. F. Drager, Maria Assis, Andrea Frota Rego Bacelar, D. Poyares, Silvia Gonçalves Conway, G. Pires, Alexandre Pinto de Azevedo, Alicia Carissimi, A. Eckeli, Álvaro Pentagna, Carlos Maurício Oliveira Almeida, C. Franco, E. Sobreira, F. Stelzer, Giuliana Macedo Mendes, G. Minhoto, Ila Marques Porto Linares, Ksdy Maiara Moura Sousa, L. Gitaí, Lucia Sukys-Claudino, M. Sobreira-Neto, Marcio Andrei Zanini, Regina Margis, Sandra Cristina Gonçalves Martinez
Abstract Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P – Patient, problem, or population; I – Intervention; C – Comparison, control, or comparator; O – Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.
{"title":"2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults – Brazilian Sleep Association","authors":"L. F. Drager, Maria Assis, Andrea Frota Rego Bacelar, D. Poyares, Silvia Gonçalves Conway, G. Pires, Alexandre Pinto de Azevedo, Alicia Carissimi, A. Eckeli, Álvaro Pentagna, Carlos Maurício Oliveira Almeida, C. Franco, E. Sobreira, F. Stelzer, Giuliana Macedo Mendes, G. Minhoto, Ila Marques Porto Linares, Ksdy Maiara Moura Sousa, L. Gitaí, Lucia Sukys-Claudino, M. Sobreira-Neto, Marcio Andrei Zanini, Regina Margis, Sandra Cristina Gonçalves Martinez","doi":"10.1055/s-0043-1776281","DOIUrl":"https://doi.org/10.1055/s-0043-1776281","url":null,"abstract":"Abstract Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P – Patient, problem, or population; I – Intervention; C – Comparison, control, or comparator; O – Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"45 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139328515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luciana Moraes Studart-Pereira, Esther Mandelbaum Gonçalves Bianchini, Márcia Assis, Marieli Timpani Bussi, Camila de Castro Corrêa, Thays Crosara Abrahão Cunha, Luciano Ferreira Drager, Vanessa Ieto, Geraldo Lorenzi-Filho, Gabriele Ramos de Luccas, Evelyn Lucien Brasil, Silmara Regina Pavani Sovinski, Edilson Zancanella, Gabriel Natan Pires
Abstract Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either “agree” or “disagree”). Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.
{"title":"Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association","authors":"Luciana Moraes Studart-Pereira, Esther Mandelbaum Gonçalves Bianchini, Márcia Assis, Marieli Timpani Bussi, Camila de Castro Corrêa, Thays Crosara Abrahão Cunha, Luciano Ferreira Drager, Vanessa Ieto, Geraldo Lorenzi-Filho, Gabriele Ramos de Luccas, Evelyn Lucien Brasil, Silmara Regina Pavani Sovinski, Edilson Zancanella, Gabriel Natan Pires","doi":"10.1055/s-0043-1776109","DOIUrl":"https://doi.org/10.1055/s-0043-1776109","url":null,"abstract":"Abstract Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either “agree” or “disagree”). Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136011147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Objectives The aim of the present study was to investigate the improvements of gas exchange and excessive daytime sleepiness in patients with obesity hypoventilation syndrome (OHS) in daytime and night-time split polysomnography (DSPSG and NSPSG). Materials and Methods In the present randomized controlled trial, patients with OHS were enrolled in two DSPSG (51 patients) and NSPSG (50 patients) groups in the Bamdad respiratory and sleep research center in Isfahan, Iran. In both groups, the diagnostic polysomnography (PSG) and titration were conducted in one session according to the guidelines of NSPSG. SpO2, PaCO2, and the Epworth Sleepiness Scale (ESS), were measured initially and 12 weeks after treatment. Furthermore, the PSG parameters and the type of treatments for the two groups were recorded and analyzed. Results A total of 101 OHS patients (age: 62.02 ± 12.4 year old; 61 females [60.4%]) were evaluated. There were no significant differences regarding BMI, gender, and AHI between groups (p > 0.05). Primary SpO2, PaCO2, and ESS were not significantly different between the two groups. After 12 weeks of treatment by continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP), there were significant improvement of SpO2, PaCO2, and ESS score (p < 0.001). The amount of change of these variables was not different between groups. Among all variables, only the lower SpO2 and higher PaCO2 were associated with response to BiPAP. Discussion There were no significant differences in the number of changes of SpO2, PaCO2, and ESS by treatment in the DSPSG and NSPSG groups. Therefore, DSPSG may be considered as a valuable alternative method for the diagnosis and titration in OHS patients. Clinical Trials IRCT20170512033930N2
{"title":"Positive Pressure Ventilation Treatment Based on Daytime and Night-time Titration in Patients with Obesity Hypoventilation Syndrome: A Randomized Controlled Trial","authors":"Babak Amra, Marzieh Ghasemi, Forogh Soltaninejad, Mehrzad Salmasi","doi":"10.1055/s-0043-1773790","DOIUrl":"https://doi.org/10.1055/s-0043-1773790","url":null,"abstract":"Abstract Objectives The aim of the present study was to investigate the improvements of gas exchange and excessive daytime sleepiness in patients with obesity hypoventilation syndrome (OHS) in daytime and night-time split polysomnography (DSPSG and NSPSG). Materials and Methods In the present randomized controlled trial, patients with OHS were enrolled in two DSPSG (51 patients) and NSPSG (50 patients) groups in the Bamdad respiratory and sleep research center in Isfahan, Iran. In both groups, the diagnostic polysomnography (PSG) and titration were conducted in one session according to the guidelines of NSPSG. SpO2, PaCO2, and the Epworth Sleepiness Scale (ESS), were measured initially and 12 weeks after treatment. Furthermore, the PSG parameters and the type of treatments for the two groups were recorded and analyzed. Results A total of 101 OHS patients (age: 62.02 ± 12.4 year old; 61 females [60.4%]) were evaluated. There were no significant differences regarding BMI, gender, and AHI between groups (p > 0.05). Primary SpO2, PaCO2, and ESS were not significantly different between the two groups. After 12 weeks of treatment by continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP), there were significant improvement of SpO2, PaCO2, and ESS score (p < 0.001). The amount of change of these variables was not different between groups. Among all variables, only the lower SpO2 and higher PaCO2 were associated with response to BiPAP. Discussion There were no significant differences in the number of changes of SpO2, PaCO2, and ESS by treatment in the DSPSG and NSPSG groups. Therefore, DSPSG may be considered as a valuable alternative method for the diagnosis and titration in OHS patients. Clinical Trials IRCT20170512033930N2","PeriodicalId":21848,"journal":{"name":"Sleep Science","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}