Sleep medicine最新文献

Study objectives: We previously demonstrated that 80% of patients with chronic thromboembolic pulmonary hypertension (CTEPH) exhibit sleep-related breathing disorders (SBDs), primarily obstructive sleep apnea (OSA), followed by isolated sleep-related hypoxemia (ISRH). In this follow-up study, we aimed to assess the distribution of SBDs and predictors of echocardiography-based residual pulmonary hypertension (PH) risk after pulmonary endarterectomy (PEA) in the same cohort.

Methods: Overnight polysomnography and echocardiography were performed in 24 CTEPH patients approximately 112 ± 65 days after PEA. Residual PH risk was defined as peak tricuspid regurgitation velocity (TRV) > 2.8 m/s and systolic pulmonary artery pressure (SPAP) ≥ 30 mmHg.

Results: In the overall cohort, PEA significantly reduced TRV (from 3.7 ± 0.9 to 2.5 ± 0.9 m/s, p < 0.001) and SPAP (58.3 ± 26.9 to 29.8 ± 17.7 mmHg, p < 0.001). Among six patients with preoperative ISRH, two improved, while four developed OSA postoperatively. Of the 16 patients with preoperative OSA, 14 remained in the same category after surgery. Residual PH risk was observed in 13 patients (54.2%), all of whom had OSA, while no residual PH risk was detected in patients without SBDs (p = 0.003). In multivariate logistic regression, postoperative apnea-hypopnea index was independently associated with echo-based residual PH risk (odds ratio 1.19; 95% CI 1.02-1.38; p = 0.025), after adjustment for age, sex, body mass index, and baseline mean pulmonary arterial pressure.

Conclusions: PEA improves pulmonary hemodynamics and resolves ISRH in some patients with CTEPH. However, residual PH risk remains frequent and is independently associated with OSA severity. These findings emphasize the importance of systematic screening, early diagnosis, and management of OSA to potentially mitigate residual PH risk and improve postoperative outcomes in CTEPH.

Circadian rhythms significantly influence the onset, development, and outcome of ischemic stroke, with the biological clock likely playing a key role in its pathophysiology. In this review, we provide a systematic summary of the influence of circadian rhythms on stroke risk factors, including blood pressure, glucose metabolism, lipid homeostasis, and atrial fibrillation, and further explore their impact across different stages of recovery post-stroke. These encompass metabolic alterations in the ischemic penumbra during the hyperacute phase, excitotoxicity, oxidative stress, and neuroinflammation in the acute phase, as well as glial scar formation and neural remodeling during the subacute and chronic recovery phases. Building on this mechanistic foundation, we assess the role of chronobiology in stroke interventions, including thrombolysis, thrombectomy, neuroprotective strategies, and rehabilitation training. We also discuss key challenges in the field, such as barriers to translating preclinical findings to clinical applications, limitations in circadian rhythm assessment, and practical challenges in implementing circadian-based interventions. Ultimately, this review aims to evaluate the potential of chronotherapy in ischemic stroke and to advance the development of personalized, precision medicine approaches.

Purpose: Obstructive Sleep Apnoea (OSA) is a highly prevalent disease often treated with CPAP therapy, but long-term adherence remains a challenge. This study aimed to explore which phenotypes of OSA patients are more or less likely to achieve high adherence to CPAP therapy, based on pre-treatment characteristics.

Methods: We analysed demographic, socioeconomic, and clinical characteristics across predefined CPAP adherence groups (high, low, and no adherence) in a multicentre cohort of newly diagnosed OSA patients. Multivariate logistic regression was used to assess predictive accuracy, and observed patterns were synthesised into rule-based clinical phenotypes.

Results: Among 2845 patients, 41% were highly adherent, 20% had low adherence, and 39% were non-adherent after one year. High adherence was associated with cohabitation, higher education, employment, and greater disease severity. Low or no adherence was linked to comorbidity burden and social vulnerability. The predictive model yielded an accuracy of 60%. Based on group-level differences and model outputs, three clinically reasoned phenotypes were identified: (1) Symptomatic severe OSA with social support, (2) Multimorbidity-dominated, and (3) Non-employed working-age adults.

Conclusion: Distinct demographic, socioeconomic, and clinical profiles were associated with CPAP adherence. The identified phenotypes offer a practical framework for understanding adherence variation and may support more individualised approaches to treatment and follow-up.

Background: It is well-known patients with atrial fibrillation (AF) have significant fatigue and impaired quality of life (QoL). Because central sleep apnea (CSA) could be associated with AF, CSA could be a contributory but treatable comorbidity.

Objectives: Retrospective assessment of the impact of CSA treatment with transvenous phrenic nerve stimulation (TPNS) on sleep and QoL in a subgroup of patients with CSA and AF from the remedē® System pivotal trial.

Methods: Patients were implanted with a TPNS device and randomized to treatment or control. Therapy was activated in the treatment arm and remained off in control for 6 months, when TPNS was also activated. Patients were followed through 12 months.

Results: Sixty-four of 151 implanted participants had AF, including 32 per arm. The apnea hypopnea index and central apnea index decreased significantly from medians of 49 and 20 events/hour of sleep at baseline to 21 and 1/hour after 6 months of TPNS therapy (p < 0.001 for each), respectively. In parallel, changes in arousal index (48 at baseline vs. 25/hour of sleep at 6 months, p < 0.001) and percent of sleep time with oxygen saturation less than 90% (8% vs. 4%, p = 0.071) improved. Compared to the control group, Patient Global Assessment and Epworth Sleepiness Scale improved significantly with treatment. Improvements were sustained for 12 months and results were similar in the control group after therapy activation.

Conclusions: AF was highly prevalent in patients with CSA. TPNS therapy may significantly improve sleep metrics, QoL, and daytime sleepiness in patients with CSA and AF.

Registration: ClinicalTrials.gov identifier NCT01816776.

Sexsomnia is a NREM parasomnia characterized by involuntary sexual behavior during confusional arousal. Video examples are rare. Here we present the case of a man who was accused of sexually assaulting his girlfriend during the night but had no memory of doing so. During a video polysomnography, he masturbated in his sleep with his left hand during the N2 and N3 sleep stages, confirming sexsomnia. However, he always masturbated with his right hand when awake. Treatment with gabapentin did not alleviate sexsomnia and triggered obstructive sleep apnea, which improved when the treatment was replaced with paroxetine. The effect of paroxetine on sexsomnia was unknown. This case supports the concept of automatic behavior in sexsomnia.

Introduction: Access to cognitive behavioral therapy for insomnia (CBT-I) in children and adolescents is limited. Mobile health applications (MHAs) available in app stores may provide an accessible and scalable option for delivering CBT-I. This study systematically evaluated the quality of MHAs targeting insomnia in children and adolescents and examined their evidence base and treatment components.

Methods: In November 2024, a systematic search of the Google Play and Apple App Stores was conducted to identify MHAs targeting insomnia in children and adolescents. MHAs were screened for eligibility in a two-level process: first based on app store descriptions, then after downloading the MHA. Eligible MHAs were independently evaluated using the German Mobile Application Rating Scale (MARS-G), which rates MHAs from 1 (inadequate) to 5 (excellent) across the subscales engagement, functionality, aesthetics, and information. Additionally, the featured treatment components and supporting scientific evidence were assessed.

Results: Of 2341 MHAs initially identified, eight MHA products met the inclusion criteria. The overall quality was moderate (mean = 3.5, SD = 0.4). Among the subscales, functionality was rated highest (mean = 3.8, SD = 0.6), followed by aesthetics (mean = 3.6, SD = 0.6), engagement (mean = 3.3, SD = 0.4), and information (mean = 3.1, SD = 0.8). Sleep hygiene was the most commonly featured treatment component (seven MHA products). While scientific evidence was identified for five MHA products, none specifically evaluated insomnia in the target population.

Conclusion: Although many MHAs claim to target sleep in children and adolescents, few incorporate CBT-I components beyond sleep hygiene. The moderate quality and limited evidence base underscore the need for theory-driven, rigorously evaluated MHAs tailored to this age group.

Introduction: Melatonin plays a key role in sleep regulation. Combining melatonin with its precursors, L-tryptophan (LT) and 5-Hydroxytryptophan (5HTP), may influence sleep-related outcomes, but evidence in children with neurodevelopmental disorders (NDDs) is limited. This exploratory study compares the effects of melatonin combined with 5HTP (M-5HTP) and melatonin combined with LT (M-LT) on sleep disorders in children with NDDs.

Methods: This single-center, randomized pilot comparative trial involved children under five years of age with NDDs free of sleep-inducing drugs. Baseline evaluations and actigraphy monitoring were performed. Children were randomly assigned to either M-5HTP (1 mg Melatonin +10 mg 5HTP) or M-LT (1 mg Melatonin +20 mg LT) treatment at 8 p.m. for at least four weeks. Post-treatment actigraphy monitoring assessed sleep parameters.

Results: Of 51 screened children, 26 were enrolled and 13 completed the study (M-5HTP: 9, M-LT: 4). No statistically significant between-group differences in change scores were observed. Within-group analyses showed a significant reduction in the Sleep Movement Index (SMI) from baseline to follow-up in the M-5HTP group (T0: 6.55; T1: 1.25; p=0.006), whereas no significant changes were observed in the M-LT group.

Discussion: In this exploratory pilot study, a within-group reduction in nocturnal motor activity was observed among M-5HTP completers. Given the small sample size, high attrition rate, and limited statistical power, these findings should be interpreted cautiously and considered hypothesis-generating.