Sleep and Breathing最新文献

Purpose: To assess the prevalence of Restless Leg Syndrome (RLS) and associated comorbidities among adults in rural and urban areas of Benin, a Sub-Saharan country, where limited data exists on its burden and clinical relevance.

Methods: A cross-sectional population-based study was conducted in Benin. RLS was identified using the standardized International Restless Legs Questionnaire. Demographic data and lifestyle data (alcohol consumption, smoking) were self-reported by participants, while precise anthropometric measurements (height, weight, BMI) and clinical parameters (blood pressure, blood glucose) were obtained using standardized protocols to assess nutritional status and detect hypertension and diabetes. Sleep quality was evaluated using three validated instruments: the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the Insomnia Severity Index. Data were collected through face-to-face interviews conducted by trained personnel using KoBoToolbox software on digital tablets. Logistic regression models were used to determine the relationship between RLS and associated comorbidities.

Results: Among 2,909 participants (58.7% urban, mean age 44.7 years, 61.2% female), RLS prevalence was 5.0% [95% CI: 4.3-5.9], with higher rates in rural (9.4%) versus urban areas (1.9%). Prevalence increased with age (1.7% in 25-34 years to 12.5% in ≥ 65 years) and was higher in females (5.9%) than males (3.5%). RLS showed significant associations with hypertension (adjusted odds ratio [aOR] = 1.56, 95% CI: 1.04-2.35, p = 0.03) and poor sleep quality (aOR = 3.07, 95% CI: 2.07-4.57, p < 0.001).

Conclusion: RLS shows notable prevalence in Benin with rural-urban disparities and significant associations with hypertension and poor sleep quality, highlighting the need for further research in sub-Saharan populations.

Purpose: Our study aimed to analyze the use of the biopsychosocial model of functioning in the physiotherapeutic evaluation of patients with obstructive sleep apnea in Brazil.

Methods: Physiotherapists working with sleep-related breathing disorders were included. They completed an electronic questionnaire with items related to physiotherapeutic evaluations and sociodemographic characteristics. Data were reported in descriptive statistics, and the Wilcoxon test compared the codes of the International Classification of Functioning, Disability, and Health (ICF) included in the evaluation and therapeutic objectives.

Results: The sample (n = 72) had a mean age of 41.4 ± 8.3 years, and most (n = 40) worked in the Southeast region. About 43.1% of the physiotherapists held sleep therapy certifications, 87.5% worked in clinical care, and most (62.5%) only with sleep disorders. Regarding the evaluation of sleep functions, 98.6% of the physiotherapists evaluated excessive sleepiness, and sleep quality was investigated using subjective questioning (80.3%). The components considered very relevant for evaluation were activity (73.6%), followed by body functions (72.2%), environmental factors (70.8%), body structure (65.3%), and participation (63.9%). Some components were evaluated but were not often included among the therapeutic objectives, such as recreational activity (p = 0.016) and intimate relationships (p = 0.035).

Conclusions: Physiotherapists reported collecting information on all functioning components; most were activity and body function components. However, standardized evaluation tools for investigating functioning are not often applied.

Purpose: Short sleep duration (SSD), defined as less than 7 h of sleep per day, can lead to various health problems. This study aims to assess whether psychosocial wellbeing is associated with short sleep duration in a nationally representative sample of adults in the United States.

Methods: Data (N = 272,472) were from the 2022 Behavioral Risk Factor Surveillance System Survey. We estimated multivariable -binomial and -multinomial logistic regressions to examine the differential odds of SSD among individuals across three instruments of psychosocial wellbeing- life satisfaction, feeling of social isolation, and receipt of needed emotional support.

Results: Prevalence of SSD in the study population was 35.5%. Compared to adults who were very satisfied with their lives, those who were dissatisfied were 1.63 (95% CI: 1.48-1.79) times more likely to have SSD. Adults who rarely/never received emotional support were 1.60 (95% CI: 1.48-1.73) times more likely to have SSD compared to those who always received support. The odds of having SSD were 1.38 (95% CI: 1.28-1.48) times higher among adults who usually/always felt socially isolated than that of adults who never felt isolated. These results were robust across sub-groups of generations and income.

Conclusion: These results showed a strong link between sleep deprivation and psychosocial wellbeing, after accounting for various demographic, socioeconomic, and health related attributes. Future research, therefore, may explore the role of psychosocial wellbeing as a potential avenue for improving sleep health at the population level.

Purpose: We aimed to investigate the associations between serum matrix metalloproteinase (MMP)-2 and MMP-9 levels and obstructive sleep apnea (OSA) severity with a focus on nocturnal hypoxemia.

Methods: The OSA patients (n = 105) were recruited from a prospective sleep apnea cohort after polysomnography, with 27 healthy volunteers as the controls. OSA severity was assessed via the apnea-hypopnea index (AHI) and percent night time with SpO₂ < 90% (T90).

Results: The serum MMP-9 levels were significantly higher in the OSA patients (AHI ≥ 5/h, 68.8 ± 44.9 ng/mL) than the controls (49.0 ± 18.6 ng/mL, p < 0.001). The MMP-2 levels showed no significant differences. When grouped into T90 quartiles, the MMP-9 levels were higher in the OSA patients in the highest quartile compared to those in the lowest quartile or the controls (90.6 ± 56.3 ng/mL vs. 56.9 ± 31.9 ng/mL, p = 0.022; 90.6 ± 56.3 ng/mL vs. 49.0 ± 18.6 ng/mL, p = 0.002, respectively). The MMP-9 levels correlated with T90 and the AHI (r = 0.36, p < 0.001; r = 0.35, p < 0.001, respectively). Multiple linear regression confirmed a significant association between MMP-9 and T90 after adjusting for body mass index, smoking status, and comorbidities (β = 0.53, p = 0.013). A similar association was observed for the AHI (β = 0.48, p = 0.019).

Conclusion: We concluded that serum MMP-9 levels are independently associated with OSA severity, particularly with T90 and the AHI, which suggests that MMP-9 could be a biomarker for OSA severity.

Background: Cancer-related insomnia demonstrates twice the prevalence observed in the general population, with significant implications for disease progression. This network meta-analysis systematically compares the therapeutic efficacy of diverse interventions for managing insomnia in oncological populations.

Methods: We systematically queried four biomedical databases (PubMed, Embase, Medbase, and Web of Science) for eligible studies assessing insomnia interventions in cancer patients. Primary outcomes encompassed standardized metrics: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). A frequentist approach with random-effects model was employed for comparative effectiveness analysis.

Results: The analysis incorporated 21 studies with sample sizes ranging from 16 to 255 participants. Comparative evaluation against standard care revealed that both cognitive behavioral therapy for insomnia (CBT-I) (MD = - 3.04, 95%CI[- 4.49,-1.59]) and electroacupuncture (MD = - 3.80, 95%CI[- 6.50,-1.09]) produced clinically meaningful reductions in ISI scores, while CBT-I (MD = 2.71%, 95%CI[0.89,4.53]) and Tai Chi (MD = 5.26%, 95%CI[0.41,10.11]) exhibited statistically significant improvements in sleep efficiency metrics.

Conclusions: CBT-I emerges as an evidence-based intervention for ameliorating insomnia severity and optimizing sleep efficiency in cancer patients. Complementary modalities including electroacupuncture and Tai Chi present viable alternatives. Methodological limitations necessitate future rigorously designed trials to strengthen clinical recommendations.

Purpose: To evaluate the correlation and relationship between iron parameters including serum iron level, iron-binding capacity, ferritin, transferrin saturation, and the severity of OSAS in the patients who underwent polysomnography.

Methods: We retrospectively reviewed 209 patients and divided the patients into two groups; AHI ≥ 30 and AHI < 30. The groups were compared using the Mann-Whitney U and the chi-square test. In addition, Spearman's correlation analysis was performed to analyze the correlation between AHI and iron parameters.

Results: The mean age of the patients was 47.9 ± 13.7 (19-89) years. Of the 209 patients, 40.7% (n = 85) were female and 59.3% (n = 124) were male. Iron and transferrin saturation was significantly lower in the patients with AHI ≥ 30 compared to the patients with AHI < 30. In female patients, there wasn't any correlation between AHI and iron, ferritin, transferrin saturation, and iron-binding capacity. But, there was a significant negative correlation between the AHI and iron (r = -0.292, p = 0.001) and transferrin saturation (r = -0.349, p < 0.001) in male patients. Also, the AHI was significantly positively correlated with iron binding capacity (r = 0.307, p = 0.001) in male patients.

Conclusion: Our results showed that iron levels were lower in severe OSAS. Suggesting that iron levels decrease as a result of oxidative stress and inflammation seen in OSAS, iron parameters may be a good biomarker in OSAS patients.

Objective: To examine the effects of diaphragm breathing relaxation training and cognitive-behavioral therapy on sleep quality in the elderly.

Methods: In this three-arm randomized clinical trial, 99 older patients with a primary diagnosis of insomnia were randomly divided into two intervention groups (n = 33) and a control group (n = 33). The study design was a parallel group trial with an allocation ratio of 1:1. The CBT-I intervention was done in a group format for four weeks, consisting of two 60-min sessions per week. The diaphragmatic breathing intervention was trained in a group setting session and practiced individually for 30 min every night before sleep. The control group received no information about sleep or relaxation. Participants completed the Pittsburgh Sleep Quality Questionnaire before, four weeks, and eight weeks after the intervention.

Results: A total of 99 patients were randomized to the CBT-I intervention (n = 33), diaphragmatic breathing intervention (n = 33), or control arm (n = 33), with 74 patients providing final analysis data. Repeated measures ANOVA revealed a significant decrease in sleep quality score (p < 0.001) from pre-test to post-test and one-month follow-ups. The greatest effect of both interventions in reducing the sleep quality score was during the first period of the study (four weeks after the intervention), and there was no significant reduction eight weeks after the intervention.

Conclusion: Diaphragmatic breathing and CBT-I interventions improved sleep quality indicators among older adults.

Background: Obstructive sleep apnea (OSA) is a neglected global health issue and when left untreated could lead to cognitive impairment (CI), one of the most burdensome outcomes of OSA. Enlarged perivascular spaces (EPVS), an imaging feature as well as a subtype of cerebral small vessel disease and integral part of CSVD, are associated with cognitive function, but the relationship between EPVS and CI is not well understood and by extension the correlation between OSA and EPVS, how CI develops under the joint impact of OSA and EPVS remains unclear. It is the goal of This study to explore the associations among OSA, EPVS, and CI.

Methods: This cross-sectional study included 175 older adults with imaging features of EPVS with or without other CSVD subtype features by cranial magnetic resonance imaging between January 2021 and June 2023 at the Shanghai Fifth People's Hospital. We assessed OSA using polysomnography. Blood samples were collected to determine vascular risk factor indices. Cognitive scoring modalities included the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA). To explore the relationship among OSA, EPVS, and CI, we used single-factor analysis, multifactorial analysis, and receiver operating characteristic (ROC) curves.

Results: A total of 136 participants were analyzed. In our statistical process, MMSE showed a more distinguished performance than MoCA. Participants with OSA had greater EPVS burdens in the midbrain (p < 0.001) and hippocampus (p < 0.001) and more serious CI (p = 0.001). OSA positively influenced EPVS in the midbrain (β = 0.052; 95% confidence interval [CI]: 0.006, 0.097; p = 0.026) and hippocampus (β = 0.190, 95% CI: 0.104, 0.275, p < 0.001). Moreover, the apnea-hypopnea index (AHI; β = -0.514; 95% CI: -0.077, -0.031; p < 0.001) negatively affected cognitive e function. With each increase in the AHI by 1 unit, the risk of CI increased by 12.0% (odds ratio = 1.120; 95%CI: 1.062, 1.181; p < 0.001). The AHI (sensitivity, 67.20%; specificity, 92.20%; area under the ROC curve, 0.828; p < 0.001) had a certain degree of accuracy in ruling out CI in the EPVS population, as calculated using the ROC curve.

Conclusions: We identified significant relations among OSA, EPVS, and CI. The AHI is a potential marker for estimating cognitive function in patients with EPVS.

Purpose: Although cognitive behavioral therapy for insomnia (CBT-I) is considered the preferred treatment for insomnia in patients with comorbid insomnia and obstructive sleep apnea (COMISA), the remission rate with CBT-I is generally considered lower than in insomnia-only populations. There is also a sizable variability in individual treatment responses. Due to the limited availability of CBT-I, we sought to identify specific clinical attributes that predict benefit from Brief Behavioral Therapy for Insomnia (BBTI)-an adaptation of CBT-I-in patients with COMISA.

Methods: We conducted a retrospective analysis of the National Veterans Health Administration (VHA) electronic medical records covering veterans diagnosed with COMISA between January 2021 and December 2023. Insomnia Severity Index (ISI) scores were recorded at baseline and after 12±1 weeks after BBTI. A positive response to BBTI was defined as a reduction in ISI score of ≥ 8 from baseline. A multivariate generalized linear model analysis was performed to delineate predictive factors of BBTI responsiveness.

Results: 131 eligible cases received BBTI over 6 weeks, 56 (43%) of whom did not respond. Non-whites (OR 3.5, 95% CI [1.4, 8.8]) and shorter sleep time (OR 0.98, 95% CI [0.98, 0.99] were independent predictors of blunted response to BBTI. These findings remained true even when depression and AHI were forced into the regression model. Patients with a total sleep duration of < 4.1 h were at greatest risk of being nonresponsive to BBTI.

Conclusion: These findings indicate that identifying insomnia phenotypes in patients with COMISA would help deliver personalized care while maximizing BBTI treatment resources.

Introduction: Obstructive Sleep Apnea (OSA) is a prevalent condition affecting millions worldwide and is associated with an increased risk of cardiovascular complications, including ST-Elevation Myocardial Infarction (STEMI). The relationship between OSA and STEMI is complex, with OSA potentially exacerbating the severity of coronary artery disease and influencing outcomes following acute coronary events.

Methods: We retrospectively analyzed data from the National Inpatient Sample database from 2016 to 2021. Hospitalized patients aged 18 and older diagnosed with STEMI were included. Key outcomes, such as in-hospital mortality, cardiac interventions and inpatient complications, were compared between those with and without OSA. Propensity score matching was utilized to account for potential confounders and risk of complications was compared.

Results: Among 1,203,915 STEMI hospitalizations, 75,035 (6.2%) had OSA. After PSM, OSA was associated with lower in-hospital mortality (aOR: 0.82, 95% CI: 0.76-0.89, p < 0.001) but higher risks of atrial fibrillation (aOR: 1.28, 95% CI: 1.21-1.36, p < 0.001), venous thromboembolism (aOR: 1.23, 95% CI: 1.06-1.44, p = 0.009), acute kidney injury (aOR: 1.10, 95% CI: 1.04-1.16, p = 0.001), and second-degree atrioventricular block (aOR: 1.69, 95% CI: 1.33-2.15, p < 0.001). OSA patients were more likely to require non-invasive ventilation (aOR: 2.78, 95% CI: 2.48-3.11, p < 0.001) but less likely to need invasive ventilation (aOR: 0.91, 95% CI: 0.84-0.96, p < 0.001) or vasopressors (aOR: 0.77, 95% CI: 0.68-0.87, p = 0.001). Female STEMI patients with OSA had higher mortality than males (aOR: 1.17, 95% CI: 1.14-1.20, p < 0.001) and underwent fewer invasive interventions.

Conclusion: OSA in STEMI patients was associated with lower in-hospital mortality but a higher burden of complications, emphasizing the need for proactive risk stratification. The increased reliance on non-invasive ventilation highlights distinct management patterns. Additionally, the significant sex disparity, with higher mortality and fewer interventions in women, underscores the need for tailored, evidence-based strategies.