Sleep and Breathing最新文献

Purpose: Long-term management of sleep apnea patients treated with CPAP raises questions about the cost-effectiveness of certain resources. With the growing use of remote CPAP monitoring and patient questionnaires, the importance of direct patient supervision by technicians is being challenged. To date, no real-life study has investigated the long-term additional value of a technician in evaluating common CPAP side effects compared to patient-reported side effects.

Methods: InterfaceVent-CPAP is a prospective real-life cross-sectional study conducted in a cohort of apneic adults treated with CPAP for at least 3 months. Three common CPAP side effects (pain, erythema, and leaks) were independently assessed by the patient and the technician on visual analogue scales and diagrams, respectively. CPAP-reported leaks were also collected. Gwet's concordance coefficient was used to analyze concordance between patient and technician assessments of CPAP side effects.

Results: 1484 patients (median age 67 years (IQ_25-75: 60-74)) were evaluated by 32 technicians. Correlation between CPAP-reported leaks and technician-reported leaks was weak. For pain and erythema, moderate to high concordance was observed between technician and patient responses, while no concordance was found for leaks. Univariate linear regression analyses examining the effect of technician-reported areas of pain, erythema and leaks on the Epworth-Sleepiness-Scale revealed statistically significant associations between sleepiness in women and certain technician-reported areas of mask leaks and mask pain.

Conclusion: Direct supervision of chronic apneic patients by technicians adds value in managing mask-related issues. Long-term care should include a combination of remote CPAP monitoring, patient-reported outcomes, and technician direct supervision.

Trial registration: InterfaceVent is registered with ClinicalTrials.gov (NCT03013283). First registration date is 2016-12-23.

Study objectives: Intra-oral negative pressure therapy (OPT) for obstructive apnea delivers a negative pressure into the oral cavity to increase the upper airway patency and has been shown as an effective CPAP alternative treatment. Rather than one-size-fits-all pressure, it is believed that individualized titration of the negative pressure is needed to achieve the optimal treatment effectiveness. This study aims to evaluate the outcome of OPT after the pressure titration process.

Methods: A total of 30 people with OSA (3 females, with baseline AHI 39.59 ± 20.05 events/h) completed the OPT titration PSG study. In the OPT titration study, the pressure of the OPT device (iNAP^® Lite, Somnics inc.) started at -40 mmHg. The negative pressure increases at least - 10 mmHg if one or more of the following conditions were met (1) ≧ Two obstruction apnea, (2) ≧ 3 hypopneas, (3) ≧ 5 RERAs, (4) ≧ 3 min of loud snoring. The effect of each pressure adjustment is observed for at least 15 min before the next adjustment. The titration process is stopped if the treatment pressure reaches - 250 mmHg.

Results: The result indicates that 83% of subjects achieve the successful treatment criteria (AHI < 5) under individuals' optimal treatment pressure. The mean AHI reduced by 80% with iNAP treatment compared to baseline (8.17 ± 8.123 vs. 9.59 ± 20.05 events/hr). In addition, the percentage of NREM stage 3 (14.89 ± 10.69 vs. 23.23 ± 12.10) and arousal index (48.47 ± 23.78 vs. 26.23 ± 11.43) were significantly improved after treatment compared to baseline. The effectiveness of the OPT significantly increased after the pressure lower than - 100 mmHg compared to the baseline pressure (66.67% vs. 26.67%; p = 0.0042).

Conclusions: In this study, the number of apnea and hypopnea decrease in the OSA patients as increases in the given negative pressure. That result shows that increasing intraoral negative pressure would further improve the treatment effectiveness and efficacy of OPT for sleep apnea.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Real-World Experiences of the iNAP^® Lite in OSA Adults in Taiwan; Identifier: NCT03559322.

Background: Obstructive sleep apnea (OSA) may induce chronic systemic inflammation, which may serve as a potential mechanism contributing to multiple complications. The timely identification of high inflammatory status (HIS) in pediatric OSA is crucial for effective clinical diagnosis and management. This study aimed to evaluate influencing factors in hsCRP levels, and further investigated the risk factors associated with HIS in pediatric OSA patients.

Methods: Children aged 3 to 15 years who presented with snoring symptoms and underwent polysomnography (PSG) at the sleep center were included in this study. All participants completed a comprehensive questionnaire, a physical examination, nasopharyngeal X-ray imaging and a blood test. The physical examination included measurements of height, weight, and visual evaluation of tonsillar hypertrophy.

Results: A total of 1,171 children were enrolled, with 562 cases diagnosed with OSA. Utilizing threshold for hsCRP generated via ROC curve, 299 and 872 children exhibited HIS and Low Inflammatory Status, respectively. Compared to the control group, the hsCRP levels in the OSA group were significantly elevated. Pediatric OSA with HIS had higher BMI and a greater proportion of both overweight and obese. Logistic regression analysis demonstrated that HIS was independently positively correlated with BMI and mean time of obstructive apnea, and negatively associated with minimum SpO₂.

Conclusions: HsCRP in pediatric OSA patients were notably elevated, whilst identifying BMI, mean time of obstructive apnea, and minimum SpO₂ as independent factors leading to HIS. HsCRP may function as an effective blood index capable of identifying individuals exhibiting HIS linked to OSA.

Background: The rising rates of obstructive sleep apnea (OSA) and frailty among older adults are linked to higher mortality rates. Depression merges as a critical determinant associated with both OSA and frailty. This study investigates the impact of depression on the risk of developing frailty in older adults diagnosed with OSA.

Method: Data from 1,021 older adults diagnosed with OSA were analyzed. Participants were stratified into two groups based on their scores on the 12-item Geriatric Depression Scale (GDS-12) to evaluate differences in frailty incidence over time.

Result: Depression was identified in 113 patients (11.0%). Frailty developed in 276 patients during the median 52-month follow-up. The multivariate analysis indicated a significant link between depression and increased frailty risk (aHR = 2.65; 95% CI: 2.01-3.05; P < 0.001). Further subgroup analyses indicated that patients with moderate-to-severe OSA (aHR = 3.01; 95% CI: 2.20-4.10; P < 0.001) who also experienced depression faced a particularly heightened risk of frailty.

Conclusion: Depression is prevalent among older adults with OSA and constitutes an independent risk factor for frailty development. These findings underscore the need for targeted interventions addressing depression in this population to mitigate frailty risk.

Objective: Nocturnal blood pressure (BP) surge is a characteristic phenomenon in patients with obstructive sleep apnea (OSA) associated with sympathetic nerve overactivity. This study aimed to explore the relationship between the sleep-breathing events induced nocturnal BP surge and sympathetic nerve activity.

Methods: A total of 85 patients with moderate-to-serve OSA and 44 controls were included in the study between April 2022 and October 2023 based on the inclusion and exclusion criteria. Full-night BP and heart rate variability (HRV) were monitored continuously and synchronized with polysomnography (PSG). The average of nocturnal BPs was taken as the asleep BP and the average of the highest BPs induced by all sleep-breathing events as the asleep peak BP. Nocturnal short-term BP variability (BPV) was calculated as follows: event-related systolic BP elevation (ΔSBP) as the gap between the peak and the lowest value of post-apneic SBP, BP index as the number of ΔSBP ≥ 12 mm Hg within 30 s/h, and the percentage of BP fluctuation induced by sleep-breathing events (PBPF) as the ratio of BP index and apnea-hypopnea index. Patients with OSA were divided into two subgroups (high- and low-BP surge groups) according to the median PBPF. The sympathetic nerve activity was reflected by plasma norepinephrine (NE) level and HRV. The PSG and BP parameters were compared among three groups, and the correlation between nocturnal short-term BPV and sympathetic nerve activity was analyzed.

Results: Patients with OSA were fatter and suffered from dyslipidemia and sympathetic nerve overactivity compared to controls. The high-BP surge group displayed higher sympathetic nerve activity and more severe hypoxia compared with the low-BP surge group. The Pearson correlation analysis showed a positive correlation of the higher nocturnal short-term BPV with increased sympathetic nerve activity (all P < 0.05). After excluding confounding factors, such as age, body mass index, and smoking history, the multiple linear regression revealed a positive correlation of the LF/HF (ratio of low-frequency to high-frequency power, indicating the activity of sympathetic nerve activity) with the BP index (β = 7.337, P < 0.001), ΔSBP (β = 2.797, P < 0.001), and PBPF (β = 9.036, P < 0.001). The plasma NE level also had a positive correlation with the BP index (β = 3.939, P = 0.022) and PBPF (β = 8.752, P < 0.001).

Conclusion: The sleep-breathing events induced nocturnal BP surge was positively correlated with sympathetic nerve activity in patients with moderate-to-serve OSA.

Purpose: Solriamfetol is approved for use in the European Union to treat excessive daytime sleepiness (EDS) associated with obstructive sleep apnea (OSA). SURWEY characterized real-world evidence regarding physician initiation and titration strategies and patient experiences with solriamfetol. We report SURWEY data for patients with OSA and EDS in Germany (N = 83).

Methods: SURWEY was a retrospective chart review conducted among physicians in Germany. Eligible patients were age ≥ 18 years who reached a stable solriamfetol dose and completed ≥ 6 weeks of treatment. Patients were grouped by solriamfetol initiation strategy: changeover, add-on, new-to-therapy.

Results: Patients' mean (SD) age was 49 (14) years. New-to-therapy was the most common initiation strategy. Solriamfetol was initiated at 37.5 mg/day in most patients (n = 57, 69%) and titrated in 53 patients (64%); 30 (57%) completed titration within 2 weeks. In a post-hoc analysis, mean (SD) Epworth Sleepiness Scale (ESS) score was 16.0 (3.2) at baseline and decreased by 5.4 (3.6) at final follow-up (~ 16 weeks; p <.001). Improvement in patient- and physician-rated EDS was reported by ~ 90% of patients. Most patients (55%) reported effects of solriamfetol lasting ≥ 8 h; 91% of patients reported no change in nighttime sleep quality. The most frequent adverse events were headache (8%), decreased appetite (7%), and insomnia (6%).

Conclusion: Most patients in this study were new to therapy. Solriamfetol was typically initiated at 37.5 mg/day; titration was common. ESS scores improved with solriamfetol treatment, and most patients self-reported improvement in EDS symptoms. Common adverse events were consistent with those reported in previous clinical trials.

Purpose: This study aimed to evaluate the reliability and validity of the ESS Bangla version (ESS-B) for Bangla speaking population of Bangladesh.

Methods: This cross-sectional study was conducted over a period of 12 months. A total of 148 Bangla-speaking individuals aged 12-65 years were participated in this study. The original ESS was translated into a Bangla ESS version through several stages including translation, backtranslation, expert review and pretesting. All participants were tested with this questionnaire and retested after two weeks of test. Psychometric properties of ESS-B including internal consistency, test-retest reliability, and validity, were assessed along with exploratory factor analysis.

Results: The ESS-B demonstrated satisfactory internal consistency with a Cronbach's alpha of 0.73. The test-retest reliability of all items including the overall total scores were also satisfactory (τb ranged from 0.496 to 0.662). Convergent validity was supported by a moderately positive correlation with 'daytime dysfunction' of PSQI-B tool (τb = 0.309, p < 0.05), while divergent validity was indicated by a weak positive correlation with 'trouble to relax' component of GAD 7-B tool (τb = 0.175, p < 0.05). Exploratory factor analysis revealed two distinct factor structures corresponding to sedentary activity and active engagement.

Conclusion: The ESS-B exhibited satisfactory reliability and validity among the Bangla-speaking population of Bangladesh.

Purpose: Sleep disturbance is one of the most prevalent health issues among community-dwelling older adults. This systematic review aims to assess the prevalence of sleep disturbances among these adults living in the community and identify associated risk factors.

Methods: A comprehensive literature search was performed using PubMed, Web of Science, Embase, and the Cochrane Library databases. We screened studies focusing on the prevalence of sleep disturbances in community-dwelling older adults (≥ 60 years). A random-effects model was used to calculate the pooled prevalence of sleep disturbances. Sensitivity and subgroup analyses were conducted to investigate sources of heterogeneity, and funnel plots were used to assess publication bias.

Results: Our systematic review included 41 articles, encompassing a total sample of 71,607 participants from 13 countries. The pooled prevalence of sleep disturbances, measured by PSQI, was found to be 45% (95% CI: 40-50%). Notably, the prevalence of sleep disturbances was significantly higher among individuals aged 70 years and older (48%) compared to those aged 60 years and older (41%). Common risk factors for sleep disturbances included depression, advanced age, females, chronic diseases (hypertension, coronary heart disease, chronic obstructive pulmonary disease) and poor external support (poor social support and poor family relationships).

Conclusion: The findings highlight the necessity for comprehensive assessments and management strategies targeting this population with depression, advanced age, females, hypertension, coronary heart disease, chronic obstructive pulmonary disease, and poor external support while also underscoring the significance of healthcare planners and policymakers in enhancing sleep quality for older adults.

Purpose: The effect of mandibular advancement device therapy on daytime sleepiness remains unclear. Here, we evaluate the effect of a mandibular advancement device on daytime sleepiness using the Karolinska Sleepiness Scale.

Methods: We randomized 88 snoring patients with an apnea-hypopnea index < 30 and daytime sleepiness to a mandibular advancement device or a sham device for four months. The Karolinska Sleepiness Scale, which measures grades of sleepiness from 1 (very alert) to 9 (very sleepy), was used for seven consecutive days, four times each day. The results were analyzed with quantile regression at quartiles controlling for baseline, age, body mass index (kg/m²), sex, apnea-hypopnea index, and full-time work.

Results: The Karolinska Sleepiness Scale score was lower with the mandibular advancement device than with the sham device at specific time intervals. The positive effect of mandibular advancement device therapy occurred at wake up and before lunch during the whole week and before lunch on weekdays at the middle quartile. The adjusted differences between the interventions favored mandibular advancement device therapy by almost one unit and normalized the Karolinska Sleepiness Scale scores at wake up and before lunch. In addition, there were positive effects of mandibular advancement device therapy before dinner at the highest quartile during the whole week, on weekdays, and on the weekend.

Conclusion: Mandibular advancement devices used for snoring and sleep apnea reduce daytime sleepiness, particularly at wake up and before lunch, but provide some benefit before dinner.