Sleep and Breathing最新文献

Background: The Epworth Sleepiness Scale (ESS) is a brief instrument to identify sleep propensity. However, little is known about the psychometric performance of the Spanish version in university students. The study aimed to study the validity and reliability of the ESS in Colombian university students.

Methods: A psychometric study was designed with 465 students of health-related careers between 18 and 29 years old (M = 20.48, SD = 2.27); 66.67% of the students were women. A confirmatory factor analysis was conducted, comparisons of scores between men and women, correlations with insomnia (Athens Insomnia Scale, AIS), anxiety (GAD-7), depression (PHQ-9), and sleep hygiene (SHI-10) and sex differential item functioning as indicators of validity and Cronbach's alpha and McDonald's omega were calculated as estimators of internal consistency.

Results: The ESS showed a unidimensional structure, similar scores in men and women, statistically significant correlations with AIS, GAD-7, PHQ-9, and SHI-10, without sex differential item functioning, and high internal consistency (Cronabch's alpha and McDonald's omega of 0.82).

Conclusion: The Spanish version of the ESS presents acceptable validity and reliability indicators in Colombian university students. However, these findings must be corroborated in other samples of Spanish-speaking participants.

Purpose: Both obstructive sleep apnea (OSA)and patent foramen ovale (PFO) can lead to changes in blood oxygen. However, it is unclear whether PFO exacerbates the blood oxygen indicators of OSA.

Methods: This case series study included patients who underwent contrast-enhanced transcranial Doppler (c-TCD) and polysomnography (PSG examination) between January 2017 to December 2023 at the Third Affiliated Hospital of Yan'an University. Based on c-TCD and PSG results, patients were categorized into two groups: OSA and PFO double-positive group (OSA + PFO), OSA single-positive group (OSA). Furthermore, both the OSA + PFO and OSA groups were further subdivided into mild (5 times/hour ≤ AHI < 15 times/hour), moderate (15 times/hour ≤ AHI < 30 times/hour) and severe (AHI ≥ 30 times/hour) groups according to their apnea-hypopnea index (AHI). This study compared the minimum oxygen saturation, oxygen desaturation index (ODI), the percentage of cumulative time with oxygen saturation < 90% in total sleep time (T90) among all groups.

Results: A total of 509 patients were included (386 males,75.83%; 123females,24.17%), with an average age of 56.76 ± 10.23 years. The study cohort included 97 OSA + PFO cases (55.67% moderate to severe) and 412 OSA cases (63.35% moderate to severe). No significant differences were observed in minimum oxygen saturation (75.97 ± 12.70% vs. 76.34 ± 12.67%, respectively, P =0.607) and ODI (32.99 ± 24.16% vs. 34.31 ± 23.59%, respectively, P =0.173) between the OSA group and the OSA + PFO group. Similarly, no significant differences were found in T90 (14.20 ± 20.50% vs. 16.69 ± 21.62%, respectively, P =0.075) between the OSA group and the OSA + PFO group. However, the T90 values were significantly higher in the moderate-severe OSA + PFO group compared to the moderate-severe OSA group (26.21 ± 22.97% vs.18.68 ± 22.02%, respectively, P < 0.05).

Conclusions: Although PFO has no significant effect on minimum oxygen saturation and ODI, PFO further aggravates intermittent hypoxia in patients with moderate to severe OSA.

Purpose: This study investigates the association between weekend catch-up sleep (CUS) and overweight/obesity in Korean adolescents, focusing on weekday sleep sufficiency.

Methods: A nationwide cross-sectional study was conducted among 12,434 high school students in South Korea. Sleep patterns including total sleep duration and weekend CUS were assessed using self-reported questionnaires. Body mass index (BMI) was calculated and categorized into overweight/obese and normal weight groups based on age- and sex-adjusted Z-scores. Logistic and linear regression models were used to assess the associations between sleep variables and overweight/obesity.

Results: Students with 3 or more h of CUS had lower odds of being overweight/obesity (odds ratio = 0.67, 95% confidence interval: 0.57-0.80) compared to those with non-CUS. This protective effect remained significant in the subgroup with perceived insufficient weekday sleep. Furthermore, students with 3 or more h of CUS had significantly lower BMI z-scores (β = -0.18, p < 0.001), an association that was also observed in those with perceived insufficient sleep (β = -0.16, p = 0.003). The analysis showed a dose-dependent pattern, with greater weekend CUS being associated with a stepwise reduction in BMI z-scores.

Conclusions: Weekend CUS may serve as an important compensatory mechanism for adolescents to reduce the risk of being overweight or obese. However, no additional benefits of CUS were observed in adolescents with sufficient sleep quality.

Purpose: Telemedicine is useful for home management of sleep disordered breathing (SDB). However, the number of patients with SDB is high and public resources are low. The aim of this pilot study, conducted by the Universities of Pisa and Palermo, was to assess whether an external Medical Center, based on telemonitoring, could help in the management of patients on home positive airway pressure (PAP) treatment.

Methods: The management model included the following professional figures: the sleep physician, the local home care provider performing diagnostic studies and home PAP titration, and the external Medical Center monitoring PAP therapy alerts. A dedicated App allowed patients to answer questionnaires, receive alerts and contact the external Medical Center. Data on mask leakage, hours of use and efficacy were available on a web platform. Patients were evaluated with videocalls at 1, 2 and 4 months and as needed.

Results: We enrolled 30 subjects, 27 patients received Continuous PAP and 3 patients received Bilevel devices. Five patients withdrew during titration and 1 during follow-up. The number of interventions for technical problems requested by patients to the external Medical Center was highly variable. During the titration phase the interventions required were 2.1 ± 2.0 (range 0-11), while during the 4-month follow-up they were 6.0 ± 4.5 (range 0-18). At the end of follow-up, 93% of patients were satisfied by the telemedicine protocol.

Conclusion: A model of telemedicine using an external Medical Center can help in the home management of patients with SDB during both home titration and long-term treatment. FISR2020IP_02014 Project (MUR). May 2021.

Background: Obstructive sleep apnea syndrome (OSAS) is a condition defined by recurrent episodes of airflow cessation or significant reduction during sleep, resulting in fragmented sleep patterns and intermittent hypoxemia. These physiological disturbances are known to contribute to cognitive deficits, including impairments in attention, memory, and overall cognitive function. In parallel, amyloid beta (β-Amyloid, Aβ) has gained prominence as a crucial biomarker in Alzheimer's disease pathogenesis, raising interest in its potential role in the early detection of neurocognitive dysfunction. This study aims to explore the association between plasma Aβ levels, neurocognitive performance, and polysomnographic parameters in middle-aged patients diagnosed with OSAS.

Methods: This prospective, cross-sectional study was conducted over a four-month period in a sleep disorders clinic. Patients who diagnosed as OSA in polysomnographic evaluation with no pre-existing neurocognitive conditions and possessed at least a primary school education were included. The study participants were evaluated using Montreal Cognitive Assessment (MoCA) test and Epworth Sleepiness Scale (ESS). Morning fasting blood samples were collected to measure plasma total Aβ levels.

Results: A total of 126 individuals (mean age: 54.7 ± 7.5 years; 53 females, 42%) participated in the study. Based on their apnea-hypopnea index (AHI), patients were categorized into two groups: Group 1 (AHI < 15, 23.8% mild OSA) and Group 2 (AHI ≥ 15, moderate-severe OSA, 76.2%). The mean MoCA scores were 25 ± 7 in Group 1 and 24 ± 6 in Group 2. Following multivariable adjustment, reduced sleep duration, lower mean nocturnal oxygen saturation, and prolonged time with SpO2 below 90% (T90%) were significantly correlated with lower MoCA scores. Serum Aβ concentrations were notably elevated in patients with severe OSAS, exhibiting a negative correlation with MoCA scores and slow wave sleep stage. Additionally, serum Aβ levels showed a direct correlation with both AHI and oxygen desaturation index (ODI), while an inverse correlation was found with minimum oxygen saturation.

Conclusion: Neurocognitive impairment was common in OSAS patients. Elevated serum Aβ levels were found to be directly associated with OSA severity, and OSA-related hypoxemia was linked to diminished cognitive function.

Objective: Assess differences between hematocrit levels in a population with and without obstructive sleep apnea (OSA) and determine if these differences correlate with disease severity and/or with levels of hypoxemia.

Material and methods: Data was collected from patients who underwent level I polysomnography (PSG) in the sleep laboratory at Hospital Rainha Santa Isabel, Torres Novas, Portugal, between January 2018 and December 2022. The patients' medical data was analyzed and sociodemographic (gender, body mass index (BMI) and age), polysomnographic (Apnea and Hypopnea Index (AHI), mean SpO2, minimum SpO2, Oxygen Desaturation Index (ODI), T90 and T85) and laboratory data (hematocrit (HCT), hemoglobin (HGB) and erythrocyte count) were collected. Statistical analysis included one-way ANOVA with Tukey's HSD for pairwise comparisons, Pearson's correlation for associations between polysomnographic and hematological parameters, and multivariate regression to identify independent factors.

Results: HCT levels were found to be higher in the moderate OSA group, particularly compared to the no OSA group (42.34 ± 4.09% vs 40.28 ± 2.75%), with significant differences between groups (p = 0.032). Although HCT levels were shown to be higher in the OSA group, the mean values remained within normal range, so no patient manifested erythrocytosis.

Conclusion: Our results suggest that moderate OSA is associated with increased HCT levels but does not seem to cause secondary erythrocytosis. Future research should further evaluate the hypoxic burden of OSA, as increased HCT may raise the risk of cardiovascular complications.

Objective: In this meta-analysis, we provide the findings of randomized controlled trials on the levels of inflammatory markers in patients with obstructive sleep apnea (OSA) receiving continuous positive airway pressure (CPAP).

Methods: Literature published in the PubMed, Web of Science, Embase and Cochrane databases up to May 21, 2024, was comprehensively searched, and inclusion and exclusion criteria were developed. Pooled estimates of CPAP therapy were analyzed via the standardized mean difference (SMD). This meta-analysis follows the PRISMA 2020 guidelines and is registered with PROSPERO (ID CRD42024548588).

Results: A total of 15 studies were included, each reporting data on one or more inflammatory markers, as follows: 10 studies on C-reactive protein (CRP), 12 studies on interleukin-6 (IL-6), 3 studies on interleukin-8 (IL-8), and 9 studies on tumor necrosis factor-α (TNF-α). The results revealed that the SMDs (95% confidence intervals [CIs]) for CRP, IL-6, IL-8 and TNF-α levels before and after CPAP treatment were 0.88 (95% CI 0.28-1.48), 0.58 (95% CI 0.12-1.05), 0.20 (95% CI 0.39-0.80) and 0.17 (95% CI 0.05-0.29), separately.

Conclusion: CPAP therapy used for a certain duration can lower CRP, IL-6 and TNF-α levels in OSA patients, and there are substantial differences observed in the various inflammatory indicators. To confirm the usefulness of these biomarkers in evaluating CPAP therapy for cardiovascular risk reduction among OSA patients, more randomized controlled trials (RCTs) have to be carried out in the future.

Background: High-quality sleep is essential for both physical well-being and mental health, particularly in promoting the health and longevity of older adults. However, limited evidence exists regarding the relationship between chronic diseases and sleep quality in this population.

Methods: The study investigated 35 common chronic diseases among 1186 older individuals aged 60 and above from six rural communities in northwest China. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multiple logistic regression and interaction analyses were employed to explore the relationship between multiple chronic diseases and sleep quality.

Results: Compared with the first quartile (≤ 1) of the number of chronic diseases, the second (2), third (3-4), and fourth (≥ 5) quartile ORs were 1.771 (95% CI: 1.191-2.631, p = 0.005), 2.434 (95% CI: 1.660-3.567, p < 0.001), and 3.180 (95% CI: 2.039-4.959, p < 0.001), respectively. For the duration of chronic diseases, compared with the first quartile (≤ 4.32 years) of duration of chronic diseases, the second (4.33-7.49 years), third (7.50-11.32 years) and fourth (≥ 11.33 years) quartile ORs were 1.350 (95% CI: 0.931-1.957, p = 0.113), 1.381 (95% CI: 0.953-2.000, p = 0.088), and 1.629 (95% CI: 1.122-2.365, p = 0.010), respectively. Older adults with multimorbidity and a longer duration of chronic diseases (≥ 7.5 years) had poorer sleep quality than those without multimorbidity and shorter duration of chronic diseases.

Conclusion: The higher number and longer duration of chronic diseases are associated with poorer sleep quality among older adults, with a stronger correlation observed in females compared to males.

Background: Epidemiological studies indicate a strong association between OSA and type 2 diabetes. Currently, the insulin signal transduction pathway and its associated effector proteins have emerged as a focal point in type 2 diabetes research. However, the underlying mechanisms in OSA remain elusive. We have established an experimental model of chronic intermittent hypoxia in SD rats and conducted measurements of their fasting blood glucose, fasting plasma insulin levels, as well as the insulin signaling pathway effector proteins IRS-2, P-Akt, and GSK-3.

Method: In the experiment, the gas path control system connected to a sealed glass container regulated the delivery of oxygen and nitrogen, ensuring a minimum oxygen concentration of 6%-12% within the cabin. Forty male Sprague-Dawley rats were divided into five groups (n = 8) and exposed to chronic intermittent hypoxia or normal air environment for 2, 4, 6, and 8 weeks, respectively. Upon completion of the experiment, the rats were anesthetized and euthanized. Immediately thereafter, their fasting blood glucose was measured, and their fasting insulin levels were determined using radioimmunoassay. Finally, the insulin resistance index (HOMA-IR) was calculated based on the steady-state model evaluation method. HE staining was employed to observe the morpho- logical changes of liver cells in each group of rats. Immunohistochemistry was utilized to detect the expression of insulin signaling pathway-related effector proteins, namely IRS-2, p-Akt, and GSK-3, in the liver, with their expression levels expressed as average grayscale values.

Result: With the extension of intermittent hypoxia exposure duration, compared to the normal control group, the fasting blood glucose, fasting insulin, and insulin resistance index of rats in each experimental group increased (n = 8, P < 0.05). Additionally, the liver cells of rats exhibited damage and morphological changes. The expression of liver pathway proteins IRS-2 and P-Akt decreased (n = 8, P < 0.05), whereas the expression of GSK-3 protein increased (n = 8, P < 0.05).

Conclusion: Chronic intermittent hypoxia activates the proteins IRS-2, P-Akt, and GSK-3 in the hepatic insulin signaling pathway, leading to liver cell damage, insulin resistance, and glucose metabolism disorders.

Purpose: Obstructive sleep apnea (OSA) and asthma are connected through similar epidemiology, clinical symptoms, pathophysiological features, and risk factors. However, the shared genetic basis of these conditions remains poorly understood. This study sought to identify risk genes that contribute to both OSA and asthma and to explore their associated biological pathways.

Methods: This study was conducted using an in silico approach based on publicly available Genome-Wide Association Studies (GWAS) data. Gene sets associated with OSA (2,159 genes) and asthma (786 genes) were manually curated from GWAS results. These lists were subsequently compared to identify intersecting genes, and their statistical significance was assessed using Fisher's Exact Test. Pathway enrichment analysis was conducted utilizing the Benjamini-Hochberg test with a significance threshold set at an adjusted p-value < 0.05.

Results: A total of 187 genes overlapped between OSA and asthma, indicating a significantly higher occurrence than expected by chance. The pathway overrepresentation analysis of these intersecting genes identified processes associated with immune system functions, encompassing human leucocyte antigen (HLA), antigen presentation, cell differentiation, cell signaling, and positive regulation of inflammatory mediators.

Conclusion: This study unveils shared genetic mechanisms associated with OSA and asthma risks, highlighting intricate interactions within pathways governing immune response and inflammation. These findings provide a preliminary step toward understanding the genetic basis of this association; however, their clinical significance remains to be established. Further functional studies and validation in independent cohorts are needed to determine their potential relevance for biomarker development and immune-targeted therapeutic strategies.