Sleep and Breathing最新文献

Purpose: Light is a crucial factor influencing sleep arousal patterns. This meta-analysis investigates the efficacy of light therapy (LT) for insomnia treatment.

Methods: Five electronic databases were independently searched by two reviewers until August 2024. The literature screening focused specifically on populations with insomnia complaints treated by LT. Weighted Mean Difference (WMD) and 95% Confidence Interval (CI) were used as statistical tools, while the Cochrane Risk of Bias tool version 2 (RoB 2) was employed to assess the quality of evidence. A total of 10 randomized controlled trials (RCTs) were analyzed.

Results: The results demonstrated that LT showed statistically significant improvements in subjective sleep quality, as evidenced by a reduction in Pittsburgh sleep quality scale (PSQI) scores by -2.89 (95% CI = -4.80 to -0.97) and Insomnia severity index (ISI) scores by -2.16 (95% CI = -4.23 to -0.08) post-intervention. Additionally, actigraphy revealed a statistically significant increase in total sleep time (TST) by 16.78 min (95% CI = 0.67 to 32.89) and a decrease in wake after sleep onset (WASO) by -12.91 min (95% CI = -25.62 to -0.20) by LT.

Conclusion: The preliminary results of the study suggest that LT has some efficacy in improving sleep quality in insomnia. However, it needs to be validated in future clinical trials with larger samples.

Purpose: To evaluate the effect of CPAP and surgical alternatives for OSA on depression and compare the results of surgery to CPAP. ​METHODS: COCHRANE Library, CINAHL, PubMed, and Scopus databases were searched for English-language articles. Meta-analysis of continuous measures (mean), proportions (%), and mean difference (Δ) with 95% confidence interval was conducted for objective and subjective outcomes before and after treatment with CPAP or surgical interventions.

Results: We identified 2018 abstracts, 14 studies (N = 3,488) were included in the meta-analysis. Both treatments witnessed significant improvement in Apnea-hypopnea Index (AHI), with similar improvement with CPAP (Δ-48.8 [-51.2, -46.4]) and surgical interventions (Δ -20.22 [-31.3, -9.17]). An improvement in Epworth Sleepiness Scale (ESS) was noted between groups with (Δ -3.9 [-6.2, -1.6]) for the CPAP group and (Δ -4.3 [-6.0, -2.5]) for surgical interventions. The improvement of BDI II depression scores pre- and post-treatment was comparable between treatments with (Δ -4.1 [-5.8, -2.4]) for the CPAP group and (Δ- 5.6 [-9.2, -2.0]) for surgical interventions.

Conclusion: Our findings suggest a reduction in AHI is seen in both CPAP and surgical interventions for OSA, with no difference in AHI reduction between groups. Both treatments also lead to a similar improvement in depression scores providing strong evidence regards impact of surgery on OSA-associated mood disorders. While percent reduction in depression is higher in the surgical group, the difference did not reach statistical significance when compared to CPAP. When stratified by surgical intervention, most interventions suggest an improvement in depression scores.

Objective: This study investigated the effects of sleep deprivation (SD) on balance after normal sleep, 24 h of SD, and subsequent rest under eyes-open (EO) and eyes-closed (EC) conditions. Our aim was to ascertain whether the reduced efficiency of balance control following SD is generalized or selective.

Method: Nineteen participants (12 females, 7 males) completed the Pittsburgh Sleep Quality Index (PSQI). The mean ages for male participants were 24.14 ± 0.37 years, their height was 180.71 ± 5.46 cm, and weight of male participants were 81.71 ± 13.42 kg. For female participants, the mean ages were 24.41 ± 4.01 years, their height was 163.66 ± 2.64 cm, and their weight was 59.54 ± 9.18 kg. Stance analyses were conducted after normal sleep, 24 h of SD, and subsequent rest of both the EO and EC. Participants performed a normal balance test, a second test while holding cubes and counting backwards from 200 by sevens, and a third test after rest under EO and EC.

Results: Independent samples t-tests showed significant height and weight differences between sexes (p < 0.05), with females generally smaller. No significant differences were found in age, daytime sleep duration, or PSQI score (p > 0.05). Significant differences in parameters such as length of the minor axis (lomna), angle, and area were observed in EO and EC across the three days, revealing the interplay between visual stimuli, cognitive tasks, and parameter stability.

Conclusion: SD has multifaceted impacts on motor and cognitive performance, even when attentional and sensory resources are not strained. Our findings elucidate the nuanced impact of SD on cognitive performance, and suggest the efficacy of external factors in mitigating its effects on postural control.

Purpose: Noradrenergics and antimuscarinics have been proposed as future pharmacotherapy for obstructive sleep apnea (OSA). However, the available randomized controlled trials (RCTs) showed heterogeneous results regarding the safety and efficacy of the combined regimen in OSA. Therefore, we performed this meta-analysis from the published RCTs to clarify this conflicting evidence.

Methods: A systematic search of four electronic databases was done till December 2023.

Results: Thirteen RCTs (n = 345) were systematically reviewed and meta-analyzed. The combined regimen significantly reduced apnea-hypopnea index (AHI): AHI 3% [events/h; Mean difference (MD): - 6.30; 95% Confidence interval (CI) (- 9.74, - 2.87); P = 0.0003], AHI 4% [events/h; MD: - 6.50; 95% CI (- 8.74, - 4.26 events/h); P < 0.00001]. All gasometric measures significantly improved in the combined regimen group except mean SpO2. No difference was found in total sleep time between the treatment and placebo. However, compared to placebo, the combined regimen altered sleep architecture and decreased sleep efficiency. Regarding OSA endotypes, the combined regimen significantly improved loop gain, pharyngeal muscle compensation, pharyngeal muscle recruitment, and respiratory arousal threshold.

Conclusion: The combined regimen effectively reduces AHI and OSA severity with improvement in almost all OSA endotypes. However, this regimen decreased sleep efficiency and altered sleep architecture. Short-term side effects can be confined to increased heart rate, dry mouth and urinary hesitancy. Therefore, noradrenergics and anti-muscarinics is a promising regimen for treating OSA, yet this optimism must be titrated by the lack of long-term effects of the regimen. Future RCTs with focus on the long-term efficacy of the regimen and cardiovascular outcomes is recommended.

Background: Epworth Sleepiness Scale(ESS) is widely used in the assessment of excessive daytime sleepiness (EDS) despite certain deficiencies. It was aimed to evaluate the factors associated with low ESS scores in subjects investigated for OSA.

Methods: In this cross sectional study, we recorded the ESS and Pittsburg sleep quality index (PSQI) scores of patients undergoing polysomnography in our sleep center between November 2022-January 2023. Additional questions regarding literacy, vehicle use, driver licence and travelling habits were asked. Sleep indices of patients with AHI ≥ 5 were recorded following PSG.

Results: 96 patients with mean age 51 ± 12, 68% male, median AHI 34.6 (7-105), ESS 7 (0-22), PSQI 9 (2-15) were included. Among moderate-severe OSA patients without EDS; 10% were illiterate, 67% performed reading only from cellular phone, 88% did not attend the social settings, 53% did not travel frequently and 40% did not use any vehicle. The listed factors were also associated with low ESS (p < 0.001). The sleep indices and PSQI scores of patient groups with and without EDS were similar. There was a correlation between ESS and total PSQI score (β = 0.31, p = 0.002) and subjective sleep quality (β = 0.21, p = 0.04), sleep disturbances (β = 0.29, p = 0.004) and daytime dysfunction (β = 0.49, p < 0.001) domains.

Conclusion: ESS may be inadequate in the assessment of the demographical features and daily habits of patients from different sociocultural settings. Clinicians should be aware that the patients may have severe OSA and poor sleep quality despite low ESS scores and should evaluate each patient individually.

Background: Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder usually diagnosed through polysomnography (PSG). Moderate to severe OSA can significantly increase morbidity and mortality. Existing screening tools have limited accuracy. This study aimed to evaluate the Wellue O₂ ring, a commercial pulse oximeter ring, for screening moderate to severe OSA.

Methods: A cross-sectional study included adults aged 18 and older suspected of having OSA who underwent PSG while wearing the Wellue O2 ring on their thumb. The oxygen desaturation index (ODI) from both the O2 ring and PSG was recorded. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated to determine the optimal ODI cutoff value for predicting moderate to severe OSA.

Results: The study included 190 participants (53.2% male) with an average age of 43 years and an average apnea-hypopnea index (AHI) of 50.4 events per hour. Among the participants, 84.7% had moderate to severe OSA. The optimal cutoff value for 11% ODI was 1.25 events per hour lasting 20 s, with a sensitivity of 87.30% and a specificity of 78.70%. The area under the ROC curve for identifying moderate to severe OSA was 0.91.

Conclusions: The Wellue O2 ring demonstrated high accuracy in detecting moderate to severe OSA and could be a viable alternative for screening in clinical settings due to its accessibility and ease of use. However, larger studies are required to validate its clinical utility for diagnosing and managing moderate to severe OSA.

Objectives: This study aims to evaluate the quantity, types, and trends of surgical procedures used to treat obstructive sleep apnea (OSA) within a diverse national population, utilizing a comprehensive proprietary healthcare database.

Methods: This descriptive observational study analyzed longitudinal data from the Optum Clinformatics® Data Mart databases, covering the period from January 2004 to December 2020. The study included patients aged 18 to 89 years, both male and female, with a confirmed diagnosis of OSA. These patients were either treated with continuous positive airway pressure (CPAP) or underwent surgical interventions.

Results: Throughout the study period, 1,250,273 individuals were diagnosed with OSA. The average age at diagnosis was 62 years (SD = 16), with a male predominance of 62.3%, and 75% of the patients were identified as Caucasian. The most frequently performed surgical procedure for OSA was Uvulopalatopharyngoplasty (UPPP). However, the implantable hypoglossal nerve stimulator was more commonly utilized among older patients.

Conclusions: This study provides essential insights into the prevalence and characteristics of surgical procedures used in OSA treatment across a diverse national population. The findings underscore the significance of understanding surgical intervention patterns and trends to enhance patient care and outcomes.

Purpose: This study aimed to examine the association between obstructive sleep apnea (OSA) and cognitive function in patients with severe chronic obstructive pulmonary disease (COPD).

Methods: Patients with severe COPD, who had not previously been diagnosed with OSA, were recruited between January 2021 and January 2023. To evaluate cognitive function, the Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT) and a driving simulator were used. OSA was identified using a CardioRespiratory Monitor (CRM). Cognitive tests were repeated for patients who were identified with and received treatment for OSA, to determine whether treatment improved cognitive function.

Results: In total, 80 patients participated in the study and 50 patients (63%) were diagnosed with OSA, with or without nocturnal desaturation (ND), and six patients (8%) with ND only. Thirty-two patients (40%) had mild OSA and 18 (23%) had moderate/severe OSA. We found no statistically significant difference in the prevalence of cognitive impairment (CI) between patients with and without OSA and/or ND. However, a multiple regression analysis showed that patients with moderate/severe OSA had a significant lower CRT-index, indicating a decrease in attention and reaction time, compared to patients with mild OSA.

Conclusion: In patients with COPD and OSA, the degree of CI may depend on the severity of OSA. The 23% prevalence of moderate/severe OSA emphasizes the importance of OSA screening in severe COPD. The study was registered at www.

Clinicaltrials: gov in March 2020, with the identification number NCT04458038.

Purpose: Chinese Herbal Medicine (CHM) may have a place in the treatment of obstructive sleep apnoea (OSA), but the evidence has not been systematically assessed. The objective of this study is to evaluate the evidence for the effectiveness of CHM for OSA.

Methods: CENTRAL, EMBase, PubMed, CINAHL, CNKI, Wanfang and Chongqing VIP were searched from database inception to the 13th of August 2023. Randomised-controlled trials in which the effect of CHM on sleep variables was tested in the treatment of OSA were selected. The primary outcomes of this review and meta-analysis were the apnoea hypopnoea index (AHI) measured with polysomnography.

Results: A total of 58 studies, involving 4,590 participants, were included. The meta-analysis showed that CHM reduced AHI more significantly than placebo (mean difference = -7.10 events/hour, 95% CI = -11.95, -2.25, P < 0.01, 7 studies, 583 participants) and the combination of CHM and Continuous Positive Airway Pressure (CPAP) more effective than CPAP alone (mean difference = -4.71 events/hour, 95% CI = -5.62, -3.80, P < 0.001, 28 studies, 2,267 participants). CHM improved sleepiness, quality of life, body weight, oxidative biomarkers, inflammatory biomarkers, cognitive function, blood pressure and respiratory function.

Conclusion: Our results suggest that CHM, alone and as an adjunct treatment, can improve various aspects of OSA and its comorbidities and is therefore a viable therapeutic option for OSA.