Sleep and Breathing最新文献

Aim: To analyze sex differences in age trajectories of supine positional obstructive sleep apnea (POSA).

Methods: We conducted retrospective analysis of polysomnography studies from 13,144 individuals aged from 2 to 103 years with at least 30 min of both supine and lateral sleep. We used generalized linear mixed-effects models to estimate position-specific mean apnea-hypopnea index (AHI) values and logistic regression to estimate the proportion with POSA or with exclusive POSA among individuals with obstructive sleep apnea (OSA). Predictors included sex, 5-y age group, sleep position, and their interactions.

Results: Supine AHI was higher than lateral AHI regardless of age or sex except under age 5 y. The ratio of supine AHI to lateral AHI reliably exceeded 2 after age 30-35 in males and age 50-55 in females. For both sexes, the proportion with POSA among individuals with OSA increased rapidly with age until 30-35 and then stabilized. The proportion with POSA among individuals with OSA was significantly higher in males than females for each age group between 40 and 75 (p < 0.03). Among individuals with OSA in those 20 and older, the proportion with POSA was 64.6% (95% CI: 62.7%, 66.5%) in males and 55.8% (95% CI: 53.6%, 57.8%) in females. The proportion of individuals showing exclusive POSA also increased with age and peaked near 41% at age 15-20 in males and at age 20-25 in females.

Conclusion: POSA becomes more common with age in both sexes; in women, its prevalence is generally lower but continues to increase after age 65.

Purpose: To describe the clinical characteristics and outcomes of children with Robin sequence (RS) using non-invasive ventilation (NIV), including continuous and bilevel positive airway pressure, and to compare these parameters to other children using this technology.

Methods: This study is a sub-study of a multicenter retrospective 10-year cohort of children using long-term NIV. Children with RS were identified from medical chart review and matched by age, sex, and year of initiation to other children in the cohort. Clinical characteristics, NIV technology, and treatment effect and outcomes were extracted from the medical chart.

Results: From 622 children in the NIV cohort, 13 had RS and were matched to 39 comparators. Age at NIV initiation and comorbidities did not differ between groups. Use of gastrostomy/nasogastric tubes was higher in children with RS (OR 3.0, 95% CI 1.17-7.69). Neither the proportion of children with obstructive sleep apnea or obstructive apnea-hypopnea index ≥ 10 events/h differed between groups. Improvements in respiratory, oxygen, and carbon dioxide parameters between the diagnostic and treatment polysomnography were similar for children with RS and the comparison group. NIV start location was predominantly at home and for used during sleep in both groups. Children with RS used NIV for a median of 1.45 (IQR 1.85) years. The most common reason for stopping NIV in both groups was an improvement in the underlying condition.

Conclusions: Children with RS have similar characteristics and outcomes to other children using NIV. A high proportion of children with RS cease NIV use because of improvements in the underlying primary condition leading to NIV.

Purpose: Obstructive sleep apnea (OSA) is associated with increased risk of chronic kidney disease (CKD). OSA is highly prevalent among patients with CKD, suggesting a bidirectional link between the two conditions. Recent studies reported that continuous positive airway pressure (CPAP) may benefit renal function in OSA patients; however, uncertainties regarding their effects persist. Therefore, we examined the effects of CPAP treatment on renal function in adults with OSA.

Methods: We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov for relevant studies from their inception until January 2024. Pooled estimates for all outcomes were calculated using a random-effects model. Primary outcome measures were the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR).

Results: Four randomized controlled trials (RCTs) and seven non-RCTs (NRCTs) (n = 2,660) were included. Compared with the control group, the CPAP group exhibited a significantly minimal alleviation in eGFR decline in NRCT (mean difference [MD] = 1.95, 95% confidence interval [CI] = 0.80 to 3.11, p < 0.001), but not in RCT (MD = 1.42, 95% CI = - 0.99 to 3.82, p = 0.25). No significant associations were found between CPAP therapy and UACR (MD = - 0.05, 95% CI = - 0.41 to 0.30, p = 0.77).

Conclusion: Current research provides a low to moderate certainty of evidence, suggesting that CPAP therapy has little to no effect on alleviating the decline in renal function. However, further RCTs with larger sample sizes and extended follow-up periods are required.

Purpose: Spinosin, a key flavonoids component found in Semen Zizhiphi spinosae, is known to enhance pentobarbital-induced sleep, which is primarily assessed with the loss-of-righting reflex (LORR). This research focused on investigating the impact of spinosin on sleep regulation in typical murine models.

Methods: We used electroencephalogram (EEG) and electromyogram (EMG) recordings to evaluate the effects of spinosin (10, 20, 40 mg/kg, i.p.) on sleep-wake state. Immunohistochemical techniques were employed to investigate the c-Fos expression in various sleep-wake brain regions following the injection of spinosin.

Results: In the initial three-hour period following administration, spinosin administered at a dose of 40 mg/kg exhibited a notable augmentation in the duration of non-rapid eye movement (NREM) sleep, with a 2.04-fold increase (P < 0.0001), accompanied by a reduction in wakefulness by approximately 42.84% (P < 0.0001) compared to the vehicle group. Immunohistochemical analysis revealed an enhancement in c-Fos expression within the accumbens nucleus (Acb) when treated with spinosin at 40 mg/kg. In contrast, a notable reduction in c-Fos expression was detected across various brain regions, including the paraventricular thalamic nucleus (PV), lateral hypothalamic area (LHA), ventrolateral periaqueductal gray (VLPAG), dorsal raphe nucleus (DR), and lateral parabrachial nucleus (LPB) (P < 0.05). In addition, the treatment resulted in an increase in c-Fos expression within gamma-aminobutyric acid (GABAergic) neurons in the Acb, while simultaneously decreasing c-Fos expression in orexin neurons within the LHA.

Conclusions: The results indicate that spinosin (40 mg/kg, i.p.) enhances NREM sleep in mice. Moreover, heightened activity of GABAergic neurons in the Acb and reduced activity of orexin neurons in the LHA may be the pathway through which spinosin promotes sleep.

Background: There is limited investigation on the longitudinal association between common electrocardiogram (ECG) features and the incidence of obstructive sleep apnea (OSA). This study aimed to examine the association of common ECG features with the incidence of OSA in a prospective cohort.

Methods: 2,563 participants aged 60 years or more were selected from the baseline survey of the Guangzhou Heart Study. OSA was evaluated by the Berlin Questionnaire. Eight electrocardiogram features including PR interval, QRS duration, QT interval, QTc interval, heart rate, P-wave, R-wave, and T-wave were extracted from 24-hour single-lead Holter. Relative risk (RR) with 95% confidence interval (CI) was estimated using the multivariate logistic regression model. A receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of ECG features.

Results: 397 (15.5%) participants were divided into the OSA group and 2,166 (84.5%) into the OSA non-group. When comparing the highest with the lowest quartiles, heart rate was related to a 30% reduced risk of OSA (RR: 0.70, 95%CI: 0.51-0.97) after adjustment for possible confounders. Participants with prolonged PR interval were more likely to be at risk of OSA (RR: 2.68, 95%CI: 1.02-6.55). No significant association was found between the other six ECG features and OSA risk. Area under ROC curve was 0.676 (95% CI: 0.648-0.704), 0.676 (95%CI: 0.648-0.704), and 0.678 (95%CI: 0.651-0.706) for heart rate, PR interval, and their combination, respectively.

Conclusions: The results suggest that heart rate and PR interval are related to OSA incidence. Future studies should be carried out in different populations, and consider the use of portable monitors together with scales to comprehensively determine OSA, and comprehensively elucidate the relationship of various ECG features and their changes with OSA occurrence.

Purpose: We aimed to evaluate the characteristics of sleep disordered breathing (SDB) in a cohort of pediatric patients with achondroplasia and to describe magnetic resonance imaging (MRI) findings and management strategies.

Methods: A single center retrospective study that included a cohort of pediatric achondroplasia patients and age, gender, and AHI-matched normally developed controls. Medical records and PSGs were reviewed for both cohorts and additionally MRI findings and SDB management strategies were evaluated in the achondroplasia cohort.

Results: A total of 15 subjects were included in the achondroplasia cohort and they were matched to 15 normally developed subjects included in the control group. 60% were found to have an AHI in the moderate-to-severe range, and 86.7% subjects were found to have apnea that was predominately obstructive in nature. There were no significant differences found in sleep efficiency, wake after sleep onset, arousal index, time spent in each sleep stage, or oxygen desaturation nadir between the two groups. In the achondroplasia group, MRI findings demonstrated foramen magnum stenosis in 33.3% (5 patients), 2 of whom had subsequent decompression surgery. Within this cohort, 3 patients underwent adenotonsillectomy and 4 patients received positive airway pressure therapy.

Conclusion: There were no significant differences found between sleep architecture and arousal index between children with achondroplasia and normally developed control subjects. This supports the belief that general management strategies for pediatric SDB, including adenotonsillectomy and continuous positive airway pressure, may be beneficial in this population. However, due to the increased risk of foramen magnum stenosis in this population, evaluation of SDB should also include neuroimaging when clinically warranted.

Purpose: The assessment of scientific articles is essential for making informed decisions regarding promotion, tenure, and funding, as well as for identifying influential research within a specific field. Traditional metrics like citation count have been the standard for evaluating the reach and influence of publications, but they have limitations. A new web-based metric-the Altmetric Attention Score (AAS)-offers a dynamic analysis of online engagement through social media platforms, including X (Formerly Twitter), Facebook, and YouTube. This study primarily examines the role of X activity in shaping AAS and explores its correlation with traditional citation counts in sleep medicine journals.

Methods: The study included articles from the top 10 sleep journals ranked by impact factor, focusing on articles published in 2020 and 2021. Data on citation counts were extracted from Journal Citation Reports (JCR), while AAS data were retrieved from the Altmetrics website. The analysis primarily focused on X activity as a proxy for online engagement. Pearson's and Spearman's correlations were used to evaluate the relationship between AAS, citation counts, and X activity. Statistical analysis was conducted using R software.

Results: A total of 3,944 articles were analyzed. The average AAS was 20, with a median of 2. A weak but statistically significant positive correlation (r = 0.22, P < 0.001) was observed between AAS and citation counts. X activity showed a strong correlation with AAS (r = 0.65, P < 0.001), but only a weak correlation with citation counts (r = 0.16, P < 0.001).

Conclusion: This study highlights the strong relationship between X activity and AAS, emphasizing X's role in influencing Altmetric scores. However, the weaker correlation between AAS and citation counts implies that while AAS may measure immediate online attention, it is not always a reliable predictor of long-term academic impact.

Purpose: Sleep dysfunction is often reported post-stroke, but its impact on short-term outcomes and caregiver burden remains less studied. Here, we studied the prevalence of sleep dysfunction and its relationship with self-reported depression, caregiver burden, and functional outcome after stroke.

Methods: Prospective observational study where consecutive patients with acute ischemic stroke were recruited at 3 months follow-up visit from stroke outpatient clinic from January 2022-March 2023. After informed consent, all the recruited patients were administered 5 questionnaires[Epworth Sleepiness Scale, Insomnia Severity Index, and Pittsburgh Sleep Quality Index for sleep, Patient Health Quality 9 for depression, and Zarit's Caregiver Burden Scale]. 20% of patients underwent overnight ambulatory level 3 polysomnography. Clinical and sleep characteristics were correlated with functional outcome and caregiver burden scores at 3 and 6 months follow-up.

Results: Of 100 patients, with a mean age of 62.2 ± 11.2 years, 67% had moderate to severe strokes at admission with mean National Institute of Health Stroke Scale [NIHSS] 8.3 ± 6.24.63% reporting one or more sleep disturbances post-stroke. 20% had hypersomnolence,35% had insomnia and 40% had poor sleep quality at 3 months after stroke.45% reported depression and 22% caregivers reported significant burden. Caregiver burden had a strong correlation with patient-reported hypersomnolence and poor sleep quality. Sleep dysfunction showed a significant association with poor functional outcomes at 6 months after stroke.

Conclusion: Sleep dysfunction is present in a significant number of ischemic stroke survivors 3 months after stroke and can contribute to poor functional outcomes and caregiver stress. The impact of early recognition and timely treatment of sleep dysfunction post-stroke needs to be studied in larger populations.