Sleep and Breathing最新文献

Purpose: Comorbid insomnia and sleep apnea (COMISA) is a prevalent clinical syndrome. We characterized differences in characteristics and medication use patterns between participants with COMISA and those with sleep apnea alone.

Methods: Data used came from 2018 Health and Retirement Study, a nationally representative cohort study of U.S. middle-aged and older adults. Participants were asked if "a doctor had ever told them they have a sleep disorder" and which disorder. They also reported frequency of insomnia symptoms (i.e., "falling asleep," "waking during the night," "waking too early,") and how often they "felt rested in the morning." We tested differences in demographic and clinical characteristics as well as medication use between participants with COMISA vs. those with sleep apnea alone by using logistic regression.

Results: Out of N = 1,776 with sleep apnea, 47% had COMISA. Compared to those with sleep apnea alone, participants with COMISA were more likely to be female (p = 0.032), have lower education (p < 0.001), and report lung disease, stroke, psychiatric problems, and dementia/cognitive impairment (all p's < 0.001). They reported difficulty in functioning (i.e., activities of daily living), and greater depressive symptomatology (all p's < 0.001). Finally, they were more likely to report the use of opioids (p = 0.037), stomach (p = 0.028), and sleep medications (p < 0.001).

Conclusions: Compared to those with sleep apnea alone, COMISA participants had a more medically complex health profile and medication use that may exacerbate sleep apnea (e.g., opioids and sleep medications). Future research should focus on managing COMISA in medically complex patients for improved health outcomes.

Introduction: Sleep architectural disruption is associated with atrial fibrillation (AF); however, associated autonomic influences remain unclear and it is unknown if this detriment persists during wakefulness. We hypothesize sleep disruption and autonomic dysfunction have diurnal patterning in patients with paroxysmal AF.

Methods: We analyzed data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study designed to examine paroxysmal AF and sleep apnea, including simultaneous collection of continuous electrocardiogram monitoring (Heartrak Telemetry^®) and actigraphy (Actiwatch GTX) for 7-21 days. Heart rate variability (HRV) measures in time-domain (standard deviation of normal-to-normal (NN) intervals (SDNN), coefficient of variation (CV)) and frequency-domain (low frequency power (LFP), high frequency power (HFP)) were used as surrogates of autonomic function and averaged per sleep/wake per day. A linear mixed-effects model assuming compound symmetry correlation structure was used to assess the relationship of HRV with actigraphy-derived sleep data.

Results: The analytic sample (age 60.1 ± 12.0 years, body mass index 32.6 ± 6.7 kg/m2, 36% female, 75% White) included 100 participants with paroxysmal AF. Longer sleep latency was associated with lower HFP during wakefulness (coefficient - 0.0501, p = 0.031). Higher sleep efficiency was associated with increased SDNN (coefficient 0.0007, p = 0.014) and CV (coefficient 0.0167, p = 0.047). Higher arousal index was associated with increased CV (coefficient 0.0166, p = 0.007) and LFP (coefficient 0.0232, p = 0.003). During sleep, longer average awakenings duration was associated with increased LFP/HFP ratio (coefficient 0.1977, p < 0.001) and reduced HFP (coefficient - 0.1338, p < 0.001). Significant sleep-wake interactions were observed for sleep latency with HFP (p = 0.024), sleep efficiency with SDNN and CV (both p < 0.01), WASO with SDNN, CV, and LFP (all p < 0.05), and frequency of awakenings with CV and LFP (both p < 0.05).

Conclusions: Actigraphy-based measures of sleep disruption were associated with autonomic function alterations exhibiting diurnal variability in paroxysmal AF. Greater overall HRV and parasympathetic modulation were related to better sleep quality. Increased sympathetic activation was associated with sleep fragmentation. Results provide insights into differential autonomic dysfunction related to sleep disruption that may contribute to atrial arrhythmogenesis.

Purpose: Decreased delta and increased alpha wave activity during sleep may be specific pathophysiological features of major depressive disorder; however, their usefulness as biomarkers remains unclear. We examined the use of mean alpha and delta wave power value indices during sleep to identify major depressive disorder using a portable electroencephalography device.

Methods: We compared the mean alpha and delta wave power value indices of six unmedicated patients with major depressive disorder and seven age- and sex-matched healthy controls using a portable electroencephalography device in this case-controlled study.

Results: The ratio of the mean alpha power values for the non-rapid and rapid eye movement periods was significantly lower in the major depressive disorder group (1.3 ± 0.2) than in the healthy group (2.3 ± 0.6; P = 0.004). The ratio of the mean delta power values for the non-rapid eye movement and rapid eye movement periods did not differ between groups but negatively correlated significantly with the Hamilton Rating Scale for Depression score (r = -0.784, P = 0.002). The area under the receiver operating characteristic curve (95% confidence interval) of the mean alpha power ratio for non-rapid eye movement and rapid eye movement periods for distinguishing the two groups was 0.93 (0.78-1.00), and both sensitivity and specificity exceeded 85% at a cut-off value ≤ 1.71.

Conclusion: The alpha- and delta-related power value indices may capture different aspects of major depressive disorder pathology.

Purpose: It has been suggested that obstructive sleep apnea syndrome (OSAS) is associated with an imbalance in autonomic nervous system (ANS) tone. Pupil size is regarded as a reliable indicator of ANS function. Pupillometry, a straightforward and non-invasive technique, is used to measure both the size and dynamics of the pupil. This study aimed to investigate, through pupillometry, the hypothesis that individuals with OSAS exhibit dysregulation of the autonomic nervous system.

Methods: In this study, OSAS patients and a control group of healthy individuals were included. OSAS patients were divided into mild, moderate, and severe groups according to their apnea-hypopnea index (AHI) scores. In the study, mild sleep apnea is defined as an AHI between 5 and 14, moderate sleep apnea as an AHI between 15 and 29, and severe sleep apnea as an AHI of 30 or higher. Static and dynamic pupillometric measurements were performed in both groups under scotopic, mesopic, and photopic conditions using a digital infrared pupillometer to evaluate autonomic dysfunction.

Results: The mean age of the study participants was 52.1 ± 10.4 years. A significant difference was observed between the groups in terms of mean AHI value (p < 0.001). There was no significant difference between the groups for static scotopic, mesopic, photopic pupil measurements (p > 0.05). However, significant differences were found for dynamic pupillary measurements (D1) (p = 0.023) and post-hoc analysis showed a significant difference between the control group and the severe OSAS group (p < 0.001). Correlation analysis revealed a significant correlation between age and AHI (r = 0.269, p = 0.003) and Moreover, a significant negative correlation was observed between AHI and D1 (r = -0.323, p < 0.001).

Conclusion: In this study on pupillary measurements in OSAS patients, no significant difference was found in static pupillary responses in OSAS patients, whereas dynamic pupillary responses were found to be significantly impaired in severe OSAS. The significant impairment in severe OSAS suggests autonomic dysfunction due to hypoxia-induced neuronal damage. In conclusion, pupillometry may be a simple, noninvasive approach to detect ANS dysfunction in OSAS patients.

Background: Obstructive sleep apnea (OSA) is a common sleep disorder associated with significant health risks. Positive airway pressure (PAP) therapy is the primary treatment for OSA but often presents challenges for patients due to varying patient phenotypes and adherence difficulties. Orofacial myofunctional therapy (OMT) is a potential adjunctive treatment that enhances muscle tone and coordination, which may reduce PAP pressure requirements and improve adherence. This study aimed to investigate the effects of a 3-month OMT intervention on auto-adjusting positive airway pressure (APAP) parameters (maximum, 95th percentile, and mean) and compliance in OSA patients.

Methods: A prospective cohort intervention study was conducted at Naresuan University Hospital involving 70 OSA patients aged 18-80 years on APAP therapy. Participants underwent a 3-month OMT program, performing twice-daily exercises targeting the palate, tongue, and facial muscles. APAP pressure data and compliance were collected before and after the intervention. Statistical analysis was performed using a multivariate multilevel Gaussian regression model to assess changes in pressure over time. APAP compliance was analyzed using student's t-test and the signed-rank test, with statistical significance set at P < 0.05.

Results: Statistically significant reductions in all APAP parameters were observed subsequent to OMT: mean pressure (-0.50 cmH2O, 95% CI: -0.66, -0.32), 95th percentile pressure (-0.68 cmH2O, 95% CI: -0.89, -0.47), and maximum pressure (-1.14 cmH2O, 95% CI: -1.47, -0.80). Additionally, APAP adherence significantly improved, with average nightly usage increasing from 5.86 ± 1.27 h to 6.42 ± 1.23 h.

Conclusion: A 3-month OMT program effectively reduced APAP pressure requirements and improved adherence in OSA patients. While pre-OMT data suggested a gradual increase in APAP pressure needs over time, OMT counteracted this trend by addressing both anatomical and non-anatomical factors. These findings support OMT as a valuable adjunctive therapy for enhancing PAP therapy outcomes.

Purpose: Vitamin D (Vit D) deficiency has been associated with both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) as well as with their combination, known as overlap syndrome (OS). There is evidence that continuous positive airway pressure (CPAP) may lead to an increase of Vit D levels in OSA patients. However, the effect of CPAP treatment on Vit D levels in OS patients has yet to be determined. The aim of the present study was to investigate the effect of one year of CPAP therapy on Vit D levels in patients with OS.

Methods: Vit D serum levels were measured in consecutive OS patients at baseline and after one year of CPAP therapy. Compliance with CPAP therapy was assessed by the data retrieved from the CPAP device.

Results: Vit D serum levels were measured in 46 OS patients (43 males). Among participants, 27 had good and 19 poor compliance with CPAP therapy. Results showed that serum Vit D levels increased after 12 months of CPAP therapy from 21.3 ± 8.4 to 23.8 ± 8.7 ng/ml (p = 0.001). Moreover, patients with good CPAP compliance demonstrated higher serum 25(OH)D levels compared to those with poor compliance (25.8 ± 7.6 versus 20.4 ± 9.6 ng/ml, respectively; p = 0.038).

Conclusions: In conclusion, 12 months of CPAP therapy improved Vit D serum levels in OS patients, more so in compliant patients.

Purpose: Several clinically available variables have been identified as predictors of non-response to oral appliance (OA) treatment, including endotypical traits such as severe upper airway collapsibility, unstable ventilatory control, and low arousal threshold. This study aimed to identify potential predictors of non-response to OA treatment in patients with OSA non-adherent to treatment with positive airway pressure.

Methods: Patients in this study were initially treated with OAs with and without elastic bands in a crossover design. Subsequently, each patient selected their preferred treatment modality for continued therapy based on subjective preferences. The chosen OA treatment. The chosen OA treatment modality was titrated optimally based on reduction of REI. Patients not reaching > 50% reduction of REI from baseline were classified as non-responders. Statistical analyses were conducted using Student's t-test and Pearson's chi-squared test to assess differences in baseline variables between responders and non-responders, and logistic regression analyses were performed to investigate variables associated with not responding to OA treatment.

Results: Overall, 63.2% (n = 36) of the patients were responders to OA treatment following titration. Smaller distance from habitual bite position to maximal retruded position (Odds ratio: 0.28, p = 0.016), positional OSA (Odds ratio: 0.94, p = 0.024) and a higher number of the endotypical OSA traits severe collapsibility, high loop gain and low arousal threshold (Odds ratio: 7.41, p = 0.038), were found to predict non-response to OA treatment.

Conclusion: These novel findings suggest that severe upper airway collapsibility, high loop gain and low arousal threshold, identified through clinically available variables, appear to be important predictors of non-response to OA treatment, along with short distance from habitual bite position to maximal retruded position and positional OSA.

Trial registration number: NCT05987618 (clinicaltrials.gov).

Objective: To evaluate the reliability of the GeneActiv actigraphy device in measuring sleep parameters and compare its performance with polysomnography (PSG) in older adults with self-reported sleep disturbances.

Methods: This sub-study was part of a pilot double-blinded randomized controlled crossover trial (CleverLights Study, ANZCTR ID 12619000138189). Participants (n = 12, mean age 67.7 years) underwent two nights of sleep studies with simultaneous GeneActiv actigraphy and PSG, separated by a 2-week interval. Sleep parameters including time in bed (TIB), total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency (SE), and number of awakenings were assessed. Intraclass Correlation Coefficients (ICCs) and Bland-Altman plots were used to determine reliability and agreement between methods.

Results: GeneActiv actigraphy demonstrated strong correlations with PSG for TST (ICC = 0.79, p = 0.001) and SE (ICC = 0.85, p < 0.001), but tended to overestimate these parameters. Actigraphy also significantly underestimated the number of awakenings (ICC = 0.45, p = 0.021). Correlations with observed TIB (ICC = 0.30, p = 0.433), WASO (ICC = 0.33, p = 0.386), and SOL (ICC = 0.32, p = 0.056) were non-significant. Bland-Altman plots revealed proportional bias, especially in SOL and the number of awakenings.

Conclusion: Compared to PSG, the GeneActiv actigraphy device provides reliable measurements for total sleep time and sleep efficiency, but agreement was weaker for wake after sleep onset, sleep onset latency, and the number of awakenings. The device showed consistent performance across multiple nights, suggesting good reproducibility. However, it systematically overestimated total sleep time and underestimates wake-related parameters, hence it may not fully replace PSG for detailed sleep assessments.

Purpose: To determine the prevalence of high-risk OSA among people diagnosed with psoriasis and to investigate relationships between the risk of OSA and the characteristics of psoriasis.

Methods: This cross-sectional study was conducted after the approval of the review board during February 2023 and February 2024. Inclusion criteria were psoriasis patients aged ≥ 18 years who visited the dermatologic clinic, Siriraj Hospital, Thailand. Demographic data, anthropometric measurements, underlying conditions, types of psoriasis, Psoriasis Area and Severity Index scores, disease duration, percentage of body surface area involvement, Epworth Sleepiness Scale (ESS), and STOP-Bang questionnaire were collected. Patients who were unable to answer these questionnaires were excluded.

Results: Of the 200 participants (106 men, 94 women), 108 patients (54%) were identified as high-risk for OSA; of them, 70 were men (64.8%) and 38 were women (35.2%). Within this group, statistically significant differences were observed in male (p < 0.001), age (p = 0.02), and the presence of hypertension, diabetes, and dyslipidemia. Both BMI and an ESS score > 10 were also significantly elevated in the high-risk group (p < 0.05). However, no significant correlations were detected between various characteristics of psoriasis and the risk of OSA. Only male sex [adjusted odd ratios (OR) = 3.51], HT (OR = 2.87), and an ESS score > 10 (OR = 4.13), showed statistically significant associations with an increased risk of OSA (p < 0.05).

Conclusion: Psoriasis patients had a higher prevalence of high-risk OSA compared to the general Thai population. This underscores the importance of screening individuals with psoriasis, particularly those exhibiting concurrent HT, male sex, and EDS, for OSA.

Introduction: Most pharmacologic treatments with clinical data for insomnia symptoms are controlled substances. An exception is doxepin, an antihistamine that has shown efficacy for the treatment of difficulties with sleep maintenance. This analysis assessed the utility of doxepin 3 mg in the treatment of difficulties with sleep onset.

Patients and methods: A pooled analysis of two phase 3, randomized, controlled trials was conducted. Patients with primary insomnia received doxepin 3 mg or placebo 30 min before bedtime. Latency to persistent sleep (LPS) was assessed by polysomnography at screening (baseline), night 1 following a single dose (the main outcome of interest), and nights 15 and 29. Patient-reported latency to sleep onset (LSO) was recorded in a diary the following morning.

Results: A total of 310 patients, 153 randomized to placebo and 157 randomized to doxepin 3 mg, were included. Doxepin 3 mg resulted in a small but statistically significant 22% improvement in LPS compared with placebo on night 1 following a single dose (risk ratio: 0.78; 95% CI: 0.64, 0.94). A similar improvement was seen in a subgroup of patients with baseline LPS > 35 min. This subgroup had an 11-min reduction in LPS, compared with a 6.4-min reduction for the overall population. There was a nonsignificant 12% reduction in LSO in the overall population (risk ratio: 0.88; 95% CI: 0.73, 1.05).

Conclusions: Doxepin 3 mg has a statistically significant effect on sleep latency on the first night of treatment in adults with insomnia that did not reach the clinical significance threshold.