Sleep and Breathing最新文献

Study objectives: Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population.

Methods: A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects.

Results: The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57-90% before cancer treatment and 12-94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent.

Conclusions: There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required.

Purpose: Endocan is a biomarker of endothelial dysfunction, which is a precursor to cardiovascular disease. Obstructive sleep apnoea (OSA) is associated with elevated endocan levels but the effects of treatment on endocan levels in OSA are not fully established. We aimed to determine whether endocan levels could be detected by immunoassay and to determine the effect of supplemental oxygen during continuous positive airway pressure (CPAP) withdrawal on circulating endocan levels.

Methods: We conducted an exploratory analysis from a randomised controlled crossover study which included participants with OSA. Participants stopped their CPAP therapy and were randomised to receive either supplemental oxygen or sham for 14 nights before crossing over. Supplemental oxygen blocked the rise in blood pressure seen in the sham group. We analysed plasma endocan levels by immunoassay at baseline and after 14 nights of intervention in both groups.

Results: Twenty-five participants were included, with a total of 100 samples. Endocan levels were detectable at all time points in 22 participants (88%), and in 93 (93%) samples. Supplemental oxygen had no effect on endocan levels compared to sham (+ 0.52 ng/ml, 95%CI -0.21 to + 1.25, p = 0.16), and there was no significant difference in endocan levels from baseline to follow-up in either the sham (-0.30 ng/ml, 95%CI -0.89 to + 0.30, p = 0.31) or supplemental oxygen (+ 0.22 ng/ml, 95%CI 0.00 to + 0.44, p = 0.05) arm.

Conclusions: We have shown that endocan levels are detectable before and after CPAP withdrawal. However, we found no effect of supplemental oxygen following CPAP withdrawal on circulating endocan levels.

Trial registration and date: ISRCTN 17,987,510 19/02/2015.

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated episodes of partial or complete airway obstruction. Continuous Positive Airway Pressure therapy (CPAP) is effective in improving sleep quality and daytime sleepiness. The aim of the study was to evaluate therapeutic adherence in a sample of patients with OSAS from the Pneumology ward of the "Cardinal Massaia" Hospital in Asti.

Materials and methods: A sample of 221 patients with OSAS were collected and retrospectively analyzed from January 2019 to December 2021. Ventilation hours during device titration (T1), possible second titration (T2) and one-year control (T3) were considered. The use of the CPAP device equal to or greater than 4 h/night was considered as therapeutic adherence. Age, gender, severity of OSAS, smoking, interface used and Epworth Sleepiness Scale (ESS) score were considered.

Results: The analysis data showed that the percentage of adhesion during T1 was 84%. Only 9% needed T2, with 84% adherence. At T3 the adherence was 86%. Correlation studies showed that only smoking had a positive correlation with adherence, while OSAS severity, gender, ESS score, interface used and age had no statistically significant correlation.

Conclusion: It was important to understand that OSAS is a disease with prolonged treatment, which affects the life of the person and his family. Therefore, the concept of assistance network was born, which sees the healthcare operators, the person and his family as the main actors involved in a care process.

Purpose: Snoring frequently occurs among pregnant women, particularly in the later stages of pregnancy. It often signals obstructive sleep apnea (OSA), which could potentially affect pregnancy outcomes negatively. Hence, our study aimed to investigate how snoring influences the likelihood of pregnancy complications and fetal outcomes in a cohort of expectant mothers.

Methods: We enrolled pregnant women in their second and third trimesters and had them fill out a questionnaire concerning sleep-related symptoms such as snoring, excessive daytime sleepiness, and frequency of nighttime awakenings, along with anthropometric measurements. Subsequently, the participants were divided into snorers and non-snorers, and the occurrence of pregnancy complications and fetal outcomes was monitored.

Results: The study enrolled a total of 212 pregnant women, among whom 35 were identified as snorers and 177 as non-snorers during mid to late pregnancy. This indicated a snoring prevalence of 16.5% in our sample. Significant differences were noted between the two groups regarding the occurrence of oligohydramnios (11.43% vs. 2.82%, p = 0.044) and fetal distress (28.57% vs. 8.47%, p = 0.003). Logistic regression analyses revealed that snoring was independently associated with fetal distress (odds ratio [OR] = 4.99, 95% confidence interval [CI] 1.88-13.23, p = 0.001).

Conclusions: Our findings suggest that habitual snoring was the independent risk factor fetal distress after adjusting for potential confounders, indicating that habitual snoring may have a detrimental effect during mid to late pregnancy.

Purpose: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway narrowing or collapse during sleep. Continuous positive airway pressure (CPAP) remains the preferred treatment in selected patients and masks' choice plays an important role for subsequent respiratory events' reduction. It is known that oronasal masks are not as effective at opening the upper airway compared to nasal ones. Thus, the objective of this study was to investigate differences in US-assessed diaphragmatic excursion (DE) using oronasal vs. nasal CPAP masks.

Methods: This observational study included 50 OSA patients presenting a moderate to severe apnea-hypopnea index and requiring CPAP treatment. All participants received US evaluations on diaphragm motion during their oronasal and nasal CPAP trial at equal positive end-expiratory pressure level.

Results: The difference of DE switching mask during CPAP was assessed by using the non-parametric Wilcoxon signed-rank test. A statistically significant increase in US- assessed DE was found when shifting from oronasal to nasal mask (p-value < 0.01). Linear regression models revealed that increased neck circumference and more severe AHI were associated with decreased DE when shifting to an oronasal mask.

Conclusion: This study evaluated the acute impact on US-assessed DE after changing CPAP route from oronasal to nasal mask. Our results suggest that the nasal type should be the more suitable option for most patients with OSA, especially those with higher nasal circumference. Diaphragmatic motion throughout US may become a practical tool to help in the choice of the fittest mask in patients undergoing CPAP.

Background: Sleep apnea (SA) and insomnia (INS) are prevalent sleep disorders among referrals to sleep clinics. People with comorbid insomnia and sleep apnea (COMISA) suffer both disorders simultaneously. The epidemiology of COMISA is not well known in the Middle East including Iran. We hypothesized that COMISA is prevalent in metropolitan sleep clinic cohorts in Iran.

Method: The records of patients aged < 95 years referred to sleep disorders centers in four large metropolitan areas including Kermanshah, Tabriz, Shiraz, and Ahvaz were examined. Polysomnography (PSG) was performed in all these patients in specialized centers and the results were scored by a trained technician and interpreted by a sleep specialist. SA was defined as an Apnea-Hypopnea Index (AHI ≥ 5), INS was defined by psychiatrists according to self-report and clinical interviews, and COMISA was defined if both disorders were present. Participants with neither condition were included in as comparator group. One-way ANOVAs, correlation, and linear/logistic regression analyses were used.

Results: This study included 1807 patients (Mean age 49.3, SE ± 13.7; 38.8% Female). Comparator, INS, SA and COMISA made up 7.2%, 16%, 50.2% and 26.6% of the sample, respectively. Logistic regression analyses showed that male gender, older age, and increasing neck circumference, but not BMI, were associated with COMISA. Epworth Sleepiness Scale scores were lower in INS (5.39 ± 5.78) compared to the other three groups.

Conclusion: COMISA is a prevalent condition in metropolitan sleep centers in Iran among participants referred to sleep centers. The data showed that male gender and age were associated significantly with COMISA.

Purpose: The increasing incidence of sleep apnea has led to an increased workload for healthcare professionals. Continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnea. To reduce the CPAP waiting list in public healthcare, we proposed a CPAP voucher for use in private clinics for CPAP initiation. This study evaluated the success rate of CPAP initiation via this voucher.

Methods: We selected patients from our sleep apnea clinic referred to CPAP initiation aged 18-80 years with no significant physical or psychological comorbidity. Three private clinics (A, B, C) accepted the CPAP voucher.

Results: A total of 1922 patients fulfilled CPAP voucher criteria. Of these, we included 1604 patients (38% women). Mean BMI was 32 kg/m², mean age was 55 years, and mean apnea-hypopnea index was 34/h. Data were missing for 113 patients at the 1-year follow-up visit. Of the remaining 1491 patients, 1398 continued CPAP therapy beyond 1 year, indicating a CPAP therapy success rate of 94%. There were no significant differences between clinics in the number of patients staying on CPAP at 1 year after initiation.

Conclusion: A CPAP voucher may reduce the CPAP initiation waiting list in public healthcare with a good success rate.

Purpose: Poor sleep quality is a global health problem for adolescent. The aim of this study was to examine how sleep education, with or without social media reminders, affects sleep quality in adolescents aged 14 to 18.

Methods: The study was a three-center, parallel-arm, randomized controlled study, recruiting participants from September 9, 2019, to January 6, 2020. Adolescents with poor sleep quality and sleepiness, using smartphones apps and internet browser, without chronic diseases, and obesity, and without mental problems were included in the study. Primary outcomes were sleep quality, sleepiness, sleep hygiene, and sleep parameters at week 5 as measured by subjective report scales and actigraphy. Sleep quality was measured by the Pittsburgh Sleep Quality Index (Poor sleep quality = PSQI > 5), sleepiness by the Cleveland Adolescent Sleepiness Questionnaire (CASQ > 16), and sleep hygiene developed by the researchers in the literature of Adolescent Sleep Habits Form.

Results: A total of 55 participants (mean [SD] age, 15.64 [1.22] years) participated. PSQI and CASQ scores of adolescents in sleep education that were not supported by social media reminders decreased compared to the baseline (p = 0.01, p = 0.02). Adolescent PSQI score in sleep education supported by social media reminders decreased from baseline, their sleep hygiene score increased (p = 0.02). There were no significant differences between the groups in terms of sleep parameters (total sleep duration, deep and light sleep levels, nighttime sleeping, and morning wake-up times) (p > 0.05).

Conclusion: This study suggests that sleep education, supported by reminders via social media, can be used to improve the quality of sleep of adolescents.

Trial registration: ClinicalTrials.gov Identifier: NCT05071989.

Purpose: This study aimed to clarify the relationship between the oral environment and psychological factors as predictor variables of sleep quality, in addition to inferring the relevant mechanisms of sleep and temporomandibular disorders (TMDs) by analyzing the relationship between TMDs and stress.

Methods: This cross-sectional study analyzed data from 1,032 participants, comprising 420 men and 612 women, from the 2017 Iwaki Health Promotion Project using multiple regression analysis. The primary endpoints were the scores of each item in the Pittsburgh Sleep Quality Index (PSQI) and its sum. Predictor variables included the number of teeth; TMDs; stress, assessed using the World Health Organization-5 (WHO-5); sleep bruxism; and oral health-related quality of life, assessed using the oral health impact profile-14 (OHIP14). The confounding factors included age, body mass index, and alcohol intake.

Results: Multiple regression analysis revealed that TMDs (β value = 0.293, p = 0.034) and stress (β value = 1.3, p < 0.001) were significantly correlated with the PSQI total score. In addition, TMDs were significantly correlated with stress (β value = 0.076, p = 0.007).

Conclusion: The significant relationship between sleep and TMDs suggests that mental stress contributes to the development sleep disorders and consequently is associated with the development of TMD symptoms.

Backgrounds: Obstructive sleep apnea syndrome (OSA) is increasingly encountered by anesthesiologists in clinical practice. However, research on managing these patients among anesthesiologists in China is scarce. This study aims to investigate the knowledge, attitudes, and perioperative management strategies for OSA patients among Chinese anesthesiologists.

Methods: In this cross-sectional study, anesthesiologists from various hospitals across China were invited to complete a thirty-eight-item online questionnaire survey between October 1 and November 1, 2022. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) scale was utilized to measure their knowledge and attitudes.

Results: A total of 470 valid participants were recruited for this research, resulting in a valid response rate of 73.3%. (1) While the majority of participants acknowledged the importance of identifying OSA during perioperative management, only 58.3% felt confident in managing OSA patients; (2) Anesthesiologists with higher professional titles and longer work experience exhibited greater confidence in managing OSA patients; (3) Just under half of the participants were familiar with the STOP-Bang and Berlin questionnaires. Anesthesiologists with over 20 years of work experience were more likely to use the STOP-Bang and Berlin questionnaires compared to those with less than 10 years of work experience (OR = 3.166, P < 0.001); (4) 71.1% of participants expressed approval regarding the preparation of sugammadex for muscle relaxation reversal, while only 32.8% approved the safety of opioid use for postoperative analgesia in OSA patients.

Conclusion: The study displayed that Chinese anesthesiologists have inadequate knowledge and perioperative management of OSA than expected. However, they have positive attitudes towards the assessment and management of OSA. The study highlights the need for high-quality training to identify and manage OSA among Chinese anesthesiologists.