Sleep and Breathing最新文献

Introduction: Positive airway pressure (PAP) is the mainstay of treatment for obstructive sleep apnea (OSA). However, suboptimal adherence significantly limits its effectiveness. This study examined the impact of a Sleep Apnea Management (SAM) clinic-an innovative, interactive group intervention providing interpersonal support, education, and resources-on PAP adherence and patient-reported outcomes (PROs) compared to usual care.

Methods: Participants with OSA who were newly prescribed PAP therapy and demonstrated suboptimal adherence (defined using CMS criteria during the first two weeks) were randomized to the SAM clinic (n = 26) or usual care (n = 30) from April 2019 to November 2022 (NCT-03835702). The primary outcome was the change in average daily PAP usage. Secondary outcomes included changes in the Epworth Sleepiness Scale (ESS), Patient Health Questionnaire-9 (PHQ-9), and PROMIS scales from baseline to 1 and 3 months. Baseline-adjusted mixed-effects linear and logistic models estimated differences between and within groups.

Results: Fifty-six participants were enrolled with a mean age of 55 years, 57% female, 63% Caucasian, median AHI of 22.8 (IQR: 9.3,39.6), and median baseline PAP usage of 172 min. After 3 months, the mean (95% CI) SAM clinic daily PAP use was 193 (139, 247) minutes vs usual care at 148 (110, 185) minutes with a mean difference of 46(-8, 99) minutes per day (p = 0.093). Within each group, a mean daily difference of 11(-36,57) minutes (p = 0.65) in SAM clinic and -32(-75,12) (p = 0.15) in the usual care was observed. No significant differences were observed in PROs between SAM and usual care. Within each group, ESS change was -0.7(-2.5,1.2) (p = 0.48) in SAM clinic and -2.5(-4.2, -0.83) (p = .004) in usual care. Significant decrease was noted in PHQ-9 within both SAM clinic at-2.2(-3.9, -0.4) (p = 0.019) and in usual care at -2.3(-4.0, -0.7) (p = 0.006). Improvement in PROMIS sleep-related impairment was noted within both groups: SAM clinic at -3.0(-6.2,0.1) (p = 0.059) and usual care group at -3.5(-6.4, -0.60) (p = 0.019). Similar changes in PAP adherence and PROS were seen at the 1-month follow-up.

Conclusion: The SAM clinic demonstrated trends toward improved PAP adherence and PROs compared to usual care, though differences were not statistically significant, likely reflecting the study's small sample size and other methodological constraints, larger, adequately powered studies are needed to confirm these findings and further explore the impact of SAM clinics on PAP adherence and patient outcomes.

Purpose: Continuous positive airway pressure (CPAP) is the gold standard for managing moderate-to-severe obstructive sleep apnea (OSA). However, adherence to CPAP usage remains problematic with many patients either intermittently or permanently discontinuing CPAP use. However, the impact of CPAP therapy discontinuation remains unclear. This study aimed to evaluate the effects of complete and intermittent CPAP withdrawal on clinical and objective relapse of OSA.

Patients and methods: This randomized study involved patients with moderate-to-severe OSA who were compliant with CPAP therapy. All subjects underwent a CPAP efficacy assessment (CPAP check), followed by 1 month of closely monitored CPAP usage. Subjects were then randomized into two groups: (1) complete CPAP withdrawal (NO-CPAP); (2) intermittent CPAP use (INT-CPAP) (using the device every other day). Clinical relapse was assessed daily and defined as reemergence of any of the OSA symptoms. Weekly home sleep testing was performed to assess OSA relapse objectively, defined as an apnea-hypopnea index (AHI) of > 5.

Results: A total of 22 patients were included, with 12 subjects assigned to NO-CPAP group and 10 to the INT-CPAP group. Both groups exhibited a rapid recurrence of OSA within 1 week of CPAP discontinuation, with significant increases in AHI, oxygen desaturation index, and time spent with O₂ saturation < 90% compared to baseline CPAP-check parameters (p < 0.05). In addition, clinical relapse occurred earlier in ⁓70% of the INT-CPAP group (Median 2.9 days) and 33% in the NO-CPAP group (Median, 3.5 days) (p < 0.05). Age and neck circumference were identified as significant predictors of OSA relapse (p < 0.05).

Conclusion: Discontinuation of CPAP therapy, whether completely or intermittently, leads to rapid OSA relapse, with age and neck circumference being key predictors of OSA relapse. These findings underscore the impact of CPAP withdrawal and the need for continuous CPAP adherence to effectively manage OSA.

Clinical trial registration: A full trial protocol can be accessed through: https://clinicaltrials.gov/study/NCT05471765 .

Purpose: Experiments on sleep regulation under the condition of self-selected light-dark and wake-sleep cycle revealed a larger sleep fraction in women than men. In questionnaire studies, women usually report a greater need for sleep than men. They also sleep more than men in overall and at most life course stages. However, much of the gap was explained by work/family responsibilities and gendered time tradeoffs. We tested whether females from childhood to late adulthood spend longer time in bed than males on weekends, and whether on weekdays, their time in bed fails to become longer due to the socially rather than biologically governed earlier weekday wake ups.

Methods: A set of 340 paired subsamples of male and female sleep times was analyzed. The averaged sleep times were calculated and simulated.

Results: Female-male difference in weekend time in bed attained the value of 0.26 h (the 0.16-h earlier bedtime was combined with the 0.10-h later risetime). The gender gap in weekday risetime was non-significant and the direction of gender difference in weekday time in bed was inconsistent across the lifespan. Model-based simulations provided support for the prediction that the male-female gap in sleep desire can reflect a higher level of sleep slow-wave activity (SWA) in females found in the vast majority of published studies.

Conclusion: Since SWA is strongly indicative of age and age-associated change in neuronal networks, the persistency of female's greater desire for sleep can be explained by the underlying sex difference in age-associated structural changes in these networks.

Purpose: The purpose of this study was to examine the effects of short-term resistance training on sleep quantity and quality in young women, according to their body fat.

Methods: Thirty-five young women were randomly assigned based on their body fat levels, using the 90th percentile of fat mass as a criterion, with a threshold set at ≥ 21 kg of fat mass for the obese group (n = 16) and < 21 kg of fat mass for the non-obese group (n = 19). Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at pre and post a progressive six-week full-body resistance training (RT).

Results: Post-intervention analysis showed a reduction in the overall sleep score (p = 0.006, η2 = 0.21), improvement in subjective sleep quality (p < 0.001; η2 = 0.357) and a decrease in sleep disturbances (p = 0.034; η2 = 0.129). However, no interaction between group x training for sleep parameters and body composition was observed (p > 0.05). There were no significant correlations between sleep quality, fat mass and fat-free mass in both groups investigated (p > 0.05).

Conclusion: Six-weeks of RT improved subjective sleep quality and reduced sleep disturbances in young women, regardless of the amount of fat mass. Sleep variables were not associated with changes in body composition.

A literary account of an obese individual manifesting excessive daytime sleepiness, Joe the Fat Boy, appeared in Charles Dickens's work The Posthumous Papers of the Pickwick Club published in 1837. Adoption of the terms "Pickwickian" and "Pickwickian syndrome" in the medical literature did not occur until much later, for example by William Osler in 1918. We present a report published in 1889 by the English physician Richard Caton in which he described an obese patient with clinical evidence of excessive daytime sleepiness, nocturnal sleep apnoeas with persistent thoraco-abdominal movements, and cyanosis indicative of oxygen desaturation. Caton's carefully observed case adds to the history of obesity hypoventilation syndrome and obstructive sleep apnoea.

Purpose: Obstructive sleep apnea (OSA) is characterized by collapse of various portions of the pharynx. Epiglottic collapse is difficult to diagnose and may affect treatment tolerance. Previous research shows a distinct nasal airflow pattern during epiglottic obstruction characterized by signal discontinuities. It was hypothesized that primary epiglottic collapse characterized during drug-induced sleep endoscopy (DISE) correlates with nasal airflow discontinuity signals seen on home sleep studies.

Methods: Patients with clinical records of undergoing both DISE and home portable sleep studies with raw data available from December 2016 to August 2021 were screened for epiglottic collapse or no epiglottic collapse using the VOTE scoring system. Any patient with tongue base collapse was excluded. Characterization of nasal airflow signals as discontinuities was based on previously published data. Acute flow discontinuities were scored by two blinded observers (AS, JN) from home cardiorespiratory studies using nasal pressure cannulas (Apnea Link Plus). Breath statistics (total number of breaths and flow limited breaths) for each patient were captured by the home cardiorespiratory device. DISE was performed under propofol anesthesia to a Ramsay level 5. Epiglottic collapse was described by shape, direction (AP or lateral), and timing (prolonged or intermittent).

Results: The home sleep studies and DISE of 18 patients being considered for surgical therapies were retrospectively analyzed. Patients included had either complete (n=11) or no epiglottic collapse (n=7). The mean AHI was 21.3 and 19.7, respectively. There was a significant difference between nonepiglottic and epiglottic collapse groups in the total discontinuity breaths (median 7 vs 29, p=0.002), discontinuity breaths/hour (median 0.91 vs 5.3, p=0.001), and fraction of discontinuity breaths over total flow limited breaths (0.5% vs 1.9%, p=0.001). Morphological changes in epiglottic collapse did not affect discontinuities.

Conclusion: The data from this study demonstrates nasal airflow signals from home sleep studies correlate with DISE epiglottic collapse.

Purpose: Sleep and psychological disorders are critical global health issues, and medical personnel are not immune to their effects. This cross-sectional study explores the relationship between Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and mental health among medical staff, with a focus on the mediating role of sleep quality.

Methods: A web-based questionnaire was distributed to participants between April and May 2023.The research employed several assessment tools, including a General Information Questionnaire, the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder Scale (GAD-7).

Results: The study included 263 medical staff and 270 non-medical staff. Medical personnel reported significantly higher DBAS scores and poorer sleep quality than non-medical staff (p < 0.01). There were significant correlations between DBAS, sleep quality (r = -0.232, p < 0.01), and symptoms of depression (r = -0.242, p < 0.01) and anxiety (r = -0.274, p < 0.01) among medical staff. Further analysis of the intermediary effect revealed that sleep quality partially mediated the relationship between DBAS and symptoms of depression and anxiety.

Conclusion: The findings suggest that depression and anxiety can adversely impact beliefs and attitudes about sleep, potentially leading to poorer sleep quality. Conversely, cultivating positive beliefs and attitudes about sleep may act as cognitive protective factors, promoting better sleep quality and mental health, particularly among medical professionals.

Background: It remains unclear whether patients diagnosed as having obstructive sleep apnea (OSA) incidentally while undergoing gastrointestinal endoscopy under conscious sedation (GE-CS) have predominantly mild disease.

Materials and methods: We evaluated differences in the disease characteristics, severity and treatments received between patients who were suspected as having OSA during GE-CS (GE group, n = 56) and patients who visited our hospital with a history of OSA-related symptoms (SY group, n = 123).

Results: The median age of patients, percentage of men and percentage of patients with obesity were 54 years, 68%, and 21% in the GE group and 51 years, 78%, and 31% in the SY group, respectively. The percentages of patients with mild, moderate, and severe OSA were 18%, 36%, and 43% in the GE group and 30%, 17%, and 39% in the SY group, respectively. The percentages of patients with subjective symptoms (e.g., daytime sleepiness/tiredness, 61% vs. 75%, p = 0.056) and scores on the Epworth sleepiness scale of ≥ 11 (18% vs. 37%, p = 0.009) were lower in the GE group, whereas there was no difference in the proportion of patients with objective symptoms (e.g., loud snoring or apnea, 70% vs. 70%) between the two groups. Patients with moderate-to-severe OSA who received continuous positive airway pressure (CPAP) therapy were fewer in the GE group (34% vs. 65%, p = 0.001).

Conclusion: A large percentage of patients with OSA diagnosed incidentally while undergoing GE-CS had moderate-to-severe disease but refused CPAP as they often had few subjective symptoms.

Purpose: The aim of the study is to explore the extent to which daytime sleepiness in patients with suspected Obstructive Sleep Apnea (OSA) was correlated with OSA itself and OSA-related comorbidities and symptoms.

Methods: 1,305 consecutive patients undergoing OSA workup were included. They underwent standard respiratory polygraphy during sleep and completed a 19-item questionnaire about sleep-related symptoms and signs, as well as the Epworth Sleepiness Scale (ESS). Analyses were based on questionnaire responses and the Apnea-Hypopnea Index (AHI) results and were conducted using stepwise regression analysis.

Results: Using the ESS as the dependent variable, the strongest associations were found with self-reported orthopnea (7%) and restless legs (2%). For daytime sleepiness, self-reported restless legs accounted for 7,6% of the variance, followed by reported orthopnea (3.8%). Regarding daytime irritability, self-reported restless legs accounted for 7.7%, followed by age (4.4%), reported orthopnea (3%), and nocturia (1%) as significant factors. Reported likelihood of falling asleep while driving was best associated with the severity of self-reported restless legs (1,3%), orthopnea (0.6%), and patient age (0.4%). For work performance, restless legs were the strongest predictor (5.9%), followed by age (3.6%) and orthopnea (3%). AHI emerged as a significant explanatory factor regarding ESS score (1.7%) and falling asleep as driver (0.4%) when analyzing the above-mentioned variables.

Conclusion: Daytime sleepiness-associated symptoms were more strongly correlated with reported levels of restless legs, nocturia, and orthopnea than with the AHI score. If restless legs, orthopnea, or nocturia are present, they should be evaluated during the clinical workup for suspected OSA.

Purpose: Sleep disturbances arising during ICU stay among ARDS (acute-respiratory-distress-syndrome) patients may continue long after discharge. This study is aimed at evaluating the sleep quality in severe-pulmonary-ARDS survivors.

Methods: This was a prospective-observational study recruiting all eligible patients, who survived after invasive-ventilation for ARDS diagnosis. Subjects were evaluated just before discharge and at 6-weeks after discharge with Epworth Sleepiness Scale(ESS), Richards-Campbell Sleep Questionnaire(RCSQ), Insomnia severity index(ISI), Pittsburgh Sleep Quality Index (PSQI) and overnight level 1 polysomnography(PSG).

Results: Out of 54 non-COVID19 severe ARDS survivors, 23 were included and Scrub Typhus was the most common etiology. The mean PaO₂/FiO₂ ratio and APACHE-II scores were 110.90 ± 21.6 and 19.04 ± 5.1, respectively. The mean duration of stay in the ICU was 14.22 ± 10.5 days. The change in mean ESS and RCSQ scores at discharge and 6-weeks were statistically significant (p < 0.001). During the early evaluation, sleep efficiency was low (mean 61.6 ± 7.2% and predominantly N1 and N2 stage) which improved at 6-weeks evaluation (mean 68.52 ± 7.8%, p < 0.001). At 6 -weeks REM component increased from 10.96 ± 2.83 to 15.31 ± 9.96 (p < 0.001). Out of the total 23 patients, 7 had AHI > 5 in early and 4 in late evaluation. Oxygen desaturation index also decreased significantly at 6-weeks follow up. PSQI > 5 was present in 13 patients at 6 weeks after discharge. PaO₂/FiO₂ ratio had positive correlation with RCSQ score and duration of mechanical ventilation had positive correlation with PSQI and ISI score at 6-weeks (p < 0.001 for all 3).

Conclusion: Sleep disturbances are common in ARDS survivors in both early and late period after discharge from ICU.