Sleep and Breathing最新文献

Background: Obstructive sleep apnoea (OSA) may lead to heart rhythm abnormalities including bradycardia. Our aim was to ascertain clinical and echocardiographic parameters in patients with OSA in whom severe bradycardia was detected in an outpatient setting, as well as to evaluate the efficacy of CPAP therapy on heart rate normalization at the early stages of treatment.

Methods: Fifteen patients mild, moderate or severe OSA and concomitant bradycardia were enrolled. A standard non-invasive diagnostic assessment protocol was followed, including blood tests and echocardiography. The 24-hour Holter ECG was performed to confirm the presence of bradycardia and determine its subtype. Then CPAP therapy was commenced. Throughout the hospitalisation, continued cardiac monitoring was used in all patients, and 3-4 days following CPAP therapy commencement, a follow-up 24-hour Holter ECG was performed.

Results: Out of 15 patients observed, 3 patients did not consent to CPAP therapy, and one patient had to undergo emergency pacemaker implantation before he was started on CPAP. A complete resolution of bradycardia and cardiac conduction abnormalities was achieved in the remaining 11 patients by day 4. of treatment. The mean lowest recorded HR was 52.7 bpm as compared to 33.9 bpm before CPAP therapy commencement (p < 0.0002). Sinus pauses exceeding 2.5s were not detected in any of those patients.

Conclusion: OSA may be comorbid with and precipitate severe bradycardia. CPAP therapy enabled rapid resolution of bradycardia in more than 80% of our cohort, which may potentially prevent pacemaker implantation provided they remain compliant.

Purpose: Obstructive sleep apnea (OSA) affects up to 936 million adults globally and is linked to significant health risks, including neurocognitive impairment, cardiovascular diseases, and metabolic conditions. Despite its prevalence, OSA remains largely underdiagnosed. This study aimed to enhance OSA awareness and risk assessment using the STOP-Bang questionnaire in a telemedicine format.

Methods: During a six-week campaign on a popular Latin American news portal, 5,966 adults completed the STOP-Bang questionnaire. Participants reporting moderate or severe OSA risk were advised to seek clinical evaluation.

Results: Among respondents, 44.7% were identified as having a moderate-to-high risk for OSA. Key risk factors included snoring, witnessed apneas, hypertension, male gender, older age, high BMI, and larger neck circumference. Statistical analyses showed significant associations between these variables and OSA risk.

Conclusions: This study highlights the importance of increasing OSA visibility and early detection in the general population. Despite limitations such as selection bias and potential false negatives/positives with the STOP-Bang tool, the findings demonstrate the potential of media campaigns to raise awareness and prompt early medical consultation. Future efforts should include follow-up assessments to evaluate healthcare-seeking behavior and confirm OSA diagnoses, contributing to improved public health outcomes.

Purpose: Children with achondroplasia (ACH) are at risk for sudden death in infancy due to sleep disordered breathing (SDB) and foramen magnum stenosis (FMS). Sleep studies and neuroimaging are performed in infants with ACH, but interpretation of infant studies is challenging. We sought to describe baseline data on polysomnography (PSG) indices in infants with achondroplasia as well as effects of age and surgery on these parameters.

Methods: Retrospective data were abstracted from the multisite CLARITY ACH database from years 2008-2017. Both obstructive apnea hypopnea index (OAHI) and central apnea index (CAI) were extracted, and effects of age and surgical intervention (adenoidectomy [AD] or cervicomedullary decompression [CMD]) were analyzed.

Results: 172 PSGs from 86 infants were analyzed. In surgically naive children, OAHI decreased over the first year but then increased in the second year, while CAI was mostly stagnant over the first two years. There were no significant differences between age at first PSG or PSG indices for surgically naive infants versus those who underwent AD or CMD. OAHI decreased after AD and CAI decreased after CMD.

Conclusion: Similar to average stature infants, our results demonstrate the need to interpret sleep study findings of children with ACH in the context of age, particularly for obstructive indices. Neither OAHI nor CAI differentiated those infants who subsequently underwent surgery, suggesting that there were other important clinical factors in the surgical decision-making process. Independent of age, AD resulted in improvement in OSA and CMD with improvement in central sleep apnea.

Purpose: The expression of the respiratory events in OSA is influenced by different mechanisms. In particular, REM sleep can highly increase the occurrence of events in a subset of OSA patients, a condition dubbed REM-OSA (often defined as an AHI 2 times higher in REM than NREM sleep). However, a proper characterization of REM-OSA and its pathological sequelae is still inadequate, partly because of limitations in the current definitions.

Methods: We propose a new interpretation of the REM-OSA definition, extending it from a AHI-ratio to a two-dimensional space, considering both time and events ratios in REM over NREM separately. Within this space, we analyzed current definitions of REM-OSA in three large clinical dataset and identified the underlying sources of heterogeneity.

Results: We observed that REM-OSA and REM-independent-OSA subgroups exist. Some subgroups exhibited abnormal REM characteristics (e.g., REM-OSA with reduced time in REM). Others had OSA features that are intermediate between REM-independent-OSA participants and those with a clear disproportion of REM events.

Conclusion: We found that a time and events' ratio of REM and NREM allow a more precise characterization of REM-OSA subgroups. Our new interpretation can be used to bolster new research into REM-OSA pathophysiological mechanisms.

Background: This study aimed to investigate the association between Obstructive Sleep Apnea (OSA) and Tinnitus using NHANES data from 2005 to 2020.

Methods: This study analyzed data from NHANES (National Health and Nutrition Examination Surveys) conducted between 2005 and 2020, and included 4871 participants aged 16 or older. OSA was assessed using the Multivariate Apnea Prediction Index and the variables from the National Health and Nutrition Examination Survey. Tinnitus was defined as participants who reported being bothered by a ringing, roaring, or buzzing sound in the ears or head lasting 5 min or more during the past 12 months. Logistic regression models were employed to examine the association between OSA and Tinnitus.

Results: The study cohort had an overall prevalence of Tinnitus of 16.5%, with 53.51% for males and 46.49% for females. After controlling for potential confounders, there was a significant association between Tinnitus and OSA (odds ratio = 1.43, 95% confidence interval = 1.05-1.94, P = 0.03).

Conclusion: These findings indicate that OSA is a risk factor for the development of Tinnitus.

Background: Our previous study have demonstrated chronic intermittent hypoxia (CIH) induced cardiomyocyte apoptosis and cardiac dysfunction. However, the molecular mechanisms are complicated and varied. In this study, we first investigated the CaMKIIγ expression and signaling pathway in the pathogenesis of cardiomyocyte apoptosis after CIH.

Methods: Rats were separated into CIH and Normoxia groups, and H9c2 cells were divided into Control and CIH + 8 h groups. Rat body weight (BW) was markedly gained from two to six weeks. Furthermore, CIH decreased cardiac dysfunction, damaged cellular structure, induced myocardial fibrosis, and promoted cardiomyocyte apoptosis by HE, masson, sirius-red, and TUNEL staining. Western blot, immunohistochemical, immunofluorescence, double immunofluorescence staining were performed to investigate CaMKIIγ, Bcl-2, Bax, Caspase 3, HIF-1 protein expression.

Results: Heart weight (HW) and HW/BW ratio in CIH group was markedly gained compared with the Normoxia group. CaMKIIγ expression was notably increased after CIH, and mainly expressed in the cytoplasm in vivo and vitro. The results of HIF-1 expression have the same trend of CaMKIIγ expression and cardiomyocyte apoptosis. In addition, the co-localizations of CaMKIIγ with Caspase 3, and CaMKIIγ with HIF-1 were observed by double immunofluorescence staining.

Conclusions: These results indicated increased CaMKIIγ expression advances CIH-induced cardiomyocyte apoptosis via HIF-1 signaling pathway, which afford a new insight and provide a potential therapy for OSA patients.

Background: The repeated airway obstructions in the common disorder Obstructive Sleep Apnea (OSA) cause health risks. Continuous Positive Airway Pressure (CPAP), the standard treatment, faces adherence challenges. Mandibular Advancement Devices (MADs) have been used successfully for mild to moderate OSA, as a good alternative for these patients.

Objective: to evaluate the effectiveness of MADs in reducing the Apnea-Hypopnea Index (AHI) and improving symptoms in patients with very severe OSA unable to tolerate CPAP.

Methods: This retrospective study included 22 patients with very severe OSA (AHI ≥ 50) treated with MADs. Baseline characteristics, including: age, sex, BMI, and AHI, were recorded, and changes in AHI following treatment were assessed. Adherence was monitored using patient-reported data. Unlike previous studies, this research focuses exclusively on the efficacy of MADs in treating patients with very severe OSA, a population often excluded from similar inspections.

Results: median AHI significantly decreased from 60.0 (IQR: 57.0-65.0) to 15.0 (IQR: 10.0-24.0) after treatment (P < 0.001), with a mean reduction of 72.5% (± 14.3). Notably, 95.5% of patients achieved at least a 50% reduction in AHI. Symptom improvements, including reduced snoring and daytime tiredness, were reported by 72.7% of patients. BMI positively correlated with baseline AHI, and significant AHI reductions were observed across overweight and obese categories, although some patients remained in the severe AHI range post-treatment. Adherence varied, with 63.6% continuing to use the device.

Conclusions: MADs are effective in managing very severe OSA, providing significant reductions in AHI and symptom improvements. MADs may be a viable alternative for patients unable to tolerate CPAP. Further investigations into the long-term efficacy and impact on quality of life are needed.

Purpose: This study aimed to validate the new DormoTech Vlab device's performance, usability, and validity as a sleep test and physiological data recorder. The novel device has been designed for patient comfort, ease of use, and home-based assessment of sleep disordered breathing and other sleep-related measurements.

Methods: Forty-seven adults (mean age = 52 years, 42% female, body mass index 29.4 kg/m²) underwent simultaneous testing with the DormoTech Vlab device and routine full polysomnography (PSG) using the Nox A1 system (K192469, Nox Medical). The sleep studies were manually and independently scored according to recommended guidelines. The primary outcome measure was the apnea-hypopnea index (AHI) and its corresponding conventional severity level (i.e., normal, mild, moderate, severe). Secondary endpoints included other standard PSG parameters.

Results: The AHI was 21.7 ± 24.2 events/h (mean ± standard deviation) using the Vlab device versus 21.5 ± 23.9 events/h for gold standard PSG Nox A1 (p = 0.7). When AHI was grouped by severity, inter-test agreement was high (Cohen's kappa = 0.97). Results between the two systems were largely similar in the secondary endpoints, with high correlation between the two systems, and statistically significant (p < 0.05) differences only in REM latency measurements. The Vlab device provides similar sleep study data to conventional gold standard PSG and clinically near-identical test interpretation in almost all cases.

Conclusion: Based on these results, the Vlab device can be considered substantially equivalent to the reference Nox A1 system in terms of usability, efficacy, and validity.

Clinical trial registration: Trial name: Evaluation of the Usability and Performance Assessment of the DormoTech VLAB Device as a Home Sleep Test Identification number: NCT06224972. Date of Registration: 2023-12-06.

Purpose: To investigate the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) severity and fat, bone, and muscle indices.

Methods: This study included 102 patients with OSAHS and retrospectively reviewed their physical examination data. All patients underwent polysomnography, body composition analysis, dual-energy X-ray absorptiometry, computed tomography (CT) and blood test. Correlation and multiple linear regression analyses were performed using SPSS 22.0.

Results: Among the fat indices, fat mass (FM) (r = 0.27-0.43), body fat percentage (BFP) (r = 0. 25-0.35), visceral fat area (VFA) (r = 0.28-0.40) and trunk fat mass (TFM) (r = 0.26-0.34) were positively correlated with hypopnea index (HI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and percent of time spent with oxygen saturation below 90% (T90%), respectively, and negatively correlated with mean pulse oxygen saturation (SpO₂) (r= -0.28--0.41). For bone indexes, T8, T9, T11, L1-CT value, mean vertebral CT value and 25-Hydroxyvitamin D3 were positively correlated with mean SpO₂ (r = 0.23-0.32), respectively. For muscle indexes, pectoralis muscle density (PMD) was negatively correlated with HI, AHI, and ODI (r= -0.20--0.36) and positively correlated with mean SpO₂ (r = 0.26). In separate models predicting sleep measures, AHI increased by 0.36, 0.29, 0.34 and 0.25 events/h per unit increase in FM, BFP, VFA, and triglyceride (TG), respectively. AHI decreased by 0.27 per unit increase in PMD. T90% increased with FM, BFP, VFA, WHR, TG and total cholesterol (TC), but decreased with appendicular skeletal muscle mass (ASM) and PMD respectively.

Conclusion: Higher fat levels and lower vertebral CT values, muscle mass and density correlated with a higher degree of OSAHS severity. Intermittent hypoxia may affect fat, bone, and muscle metabolism in patients with OSAHS.

Objectives: Sleep is often compromised in adolescents, affecting their health and quality of life. This pilot-study was conducted to evaluate if implementing brief-behavioral and sleep-hygiene education with mindfulness intervention may positively affect sleep-health in adolescents.

Method: Participants in this community-based non-randomized cohort-study volunteered for intervention (IG)- or control-group (CG). Sleep was recorded during regular school-schedule for 3-school-nights and 2-non-school-nights with an FDA-cleared/EU-Medical Device Regulation (CE-2862) compliant home sleep test, and Questionnaires were utilized to evaluate chronotype, sleepiness, insomnia-, anxiety- and depression-symptoms. The four-week intervention included sleep-hygiene education, mindfulness- and breathing-practices for one-hour, twice weekly. Data was collected during the last-week of February and first two-weeks of March 2023 and repeated after intervention.

Results: Fifty-five participants completed the study, IG (86%) and CG (77%). Average age was 17.3-years and prevalence of severe social-jetlag (SJL) 72%. Participants who quit participation (n = 10) after baseline data-collection all females (3-IG/7-CG) in comparison to participants who completed the study were sleepier than the IG and CG (+ 2.6-p = 0.04; + 3.8-p = 0.001), with more symptoms of insomnia- (+ 3.8-p = 0.002; + 4.7-p < 0.0001), and depression (+ 16.7-p < 0.0001; + 19.6-p < 0.0001), and report being later-chronotypes, (-18.2, p < 0.0001;-13.1, p < 0.0001). On average the IG advanced sleep-onset (32-min; p = 0.030), decreased SJL (37-min; p = 0.011) and increased total sleep time (TST, 29-min; p = 0.088) compared to the CG. Average sleep duration did not differ significantly comparing IG and CG after intervention. Stratifying participants with severe SJL (> 2-h) at baseline; 1) responders (61%) advanced sleep-onset on non-school-nights (96-min) and decreased SJL (103-min; p < 0.001) 2) non-responders (39%) increased sleep-duration on school-nights (36-min) and non-school-nights (63-min) but maintained severe-SJL.

Conclusion: Teacher-lead sleep-education and mindfulness program can improve TST and SJL in adolescence.