Pub Date : 2024-08-22DOI: 10.1016/j.sleep.2024.07.033
Angelman Syndrome (AS) is a neurodevelopmental disorder with severe symptoms and associated comorbidities. It is caused by the inactivity or lack of the UBE3a gene. Symptoms of the syndrome include intellectual disability and developmental delay.
The current study investigated sleep disturbances (SD) in children and adolescents with AS, associations between SD and possible predictors of SD. Variables examined included age, gender, newborn and infancy history, challenging behavior, type of therapy received, genetic type of AS, and seizures. The sample included data from 109 participants with a mean age of 8.21, accessed via the Global Angelman Syndrome Registry. Chi-square tests were carried out to assess the associations between the variables and a logistical regression was carried out to assess the possible predictors of SD. Associations were found between SD and certain repetitive behaviors: slapping walls, focal hand movements, and agitation at new situations. From these associations, a regression formed a predictive model for sleep disturbances. The findings of this research demonstrated the importance of investigating the relationship between sleep disturbances and challenging behavior in children and adolescents with AS and the need for further research in this area.
{"title":"Association between sleep disturbances and challenging behavior in children and adolescents with Angelman syndrome","authors":"","doi":"10.1016/j.sleep.2024.07.033","DOIUrl":"10.1016/j.sleep.2024.07.033","url":null,"abstract":"<div><p>Angelman Syndrome (AS) is a neurodevelopmental disorder with severe symptoms and associated comorbidities. It is caused by the inactivity or lack of the UBE3a gene. Symptoms of the syndrome include intellectual disability and developmental delay.</p><p>The current study investigated sleep disturbances (SD) in children and adolescents with AS, associations between SD and possible predictors of SD. Variables examined included age, gender, newborn and infancy history, challenging behavior, type of therapy received, genetic type of AS, and seizures. The sample included data from 109 participants with a mean age of 8.21, accessed via the Global Angelman Syndrome Registry. Chi-square tests were carried out to assess the associations between the variables and a logistical regression was carried out to assess the possible predictors of SD. Associations were found between SD and certain repetitive behaviors: slapping walls, focal hand movements, and agitation at new situations. From these associations, a regression formed a predictive model for sleep disturbances. The findings of this research demonstrated the importance of investigating the relationship between sleep disturbances and challenging behavior in children and adolescents with AS and the need for further research in this area.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1016/j.sleep.2024.08.023
Background
Restless legs syndrome (RLS) and periodic leg movements during sleep (PLMS) are prevalent sleep disorders with significant implications for health and well-being. While previous research has highlighted sex-related disparities in RLS and PLMS prevalence, comprehensive understanding of these differences across the lifespan remains limited. This study aims to explore sex differences in RLS and PLMS across diverse age groups, spanning ages 2 to over 80 years, and to investigate the underlying mechanisms influenced by sex hormones.
Methods
A retrospective analysis was conducted on drug-free patients diagnosed with RLS, including 95 females (age range: 2–83.2 years) and 89 males (age range: 2–79.5 years). Polysomnographic recordings were analyzed to assess leg movement activity, including PLMS index and Periodicity index.
Results
A more rapid increase in PLMS index was observed in women starting before age 10, plateauing lower than men until around age 55. An increase in women occurred after 55, lasting over a decade, while in men, PLMS index continued to rise after 75. Conversely, Periodicity index displayed a simpler pattern, increasing progressively from prepuberty to around 35 in males and 45–50 in females. Females maintained a slightly higher Periodicity index than males for over a decade after this age.
Conclusion
These findings underscore the complex interplay between sex hormones, age, and sleep disorders, highlighting the need for tailored approaches to diagnosis and management across diverse demographic cohorts. Further research is warranted to elucidate the underlying mechanisms and develop targeted interventions to optimize sleep health outcomes.
{"title":"Exploring sex differences in periodic leg movements during sleep across the lifespan of patients with restless legs syndrome","authors":"","doi":"10.1016/j.sleep.2024.08.023","DOIUrl":"10.1016/j.sleep.2024.08.023","url":null,"abstract":"<div><h3>Background</h3><p>Restless legs syndrome (RLS) and periodic leg movements during sleep (PLMS) are prevalent sleep disorders with significant implications for health and well-being. While previous research has highlighted sex-related disparities in RLS and PLMS prevalence, comprehensive understanding of these differences across the lifespan remains limited. This study aims to explore sex differences in RLS and PLMS across diverse age groups, spanning ages 2 to over 80 years, and to investigate the underlying mechanisms influenced by sex hormones.</p></div><div><h3>Methods</h3><p>A retrospective analysis was conducted on drug-free patients diagnosed with RLS, including 95 females (age range: 2–83.2 years) and 89 males (age range: 2–79.5 years). Polysomnographic recordings were analyzed to assess leg movement activity, including PLMS index and Periodicity index.</p></div><div><h3>Results</h3><p>A more rapid increase in PLMS index was observed in women starting before age 10, plateauing lower than men until around age 55. An increase in women occurred after 55, lasting over a decade, while in men, PLMS index continued to rise after 75. Conversely, Periodicity index displayed a simpler pattern, increasing progressively from prepuberty to around 35 in males and 45–50 in females. Females maintained a slightly higher Periodicity index than males for over a decade after this age.</p></div><div><h3>Conclusion</h3><p>These findings underscore the complex interplay between sex hormones, age, and sleep disorders, highlighting the need for tailored approaches to diagnosis and management across diverse demographic cohorts. Further research is warranted to elucidate the underlying mechanisms and develop targeted interventions to optimize sleep health outcomes.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1016/j.sleep.2024.08.022
Introduction
Despite disease modifying treatments (DMT), assisted ventilation is commonly required in children with Spinal Muscular Atrophy (SMA). Guidelines suggest screening with oximetry and transcutaneous carbon dioxide (TcCO2) for sleep disordered breathing (SDB).
Aim
To determine the utility of pulse oximetry and TcCO2 as a screen for SDB and the need for Non-Invasive Ventilation (NIV) in children with SMA type 1–3.
Methods
A prospective cohort study was conducted in Queensland, Australia. Full diagnostic PSG was completed in DMT naïve children with SMA. Pulse oximetry and TcCO2 were extracted from PSG. Apnoea-hypopnoea indices (AHI) criteria were applied to PSG results to define the need for NIV. Abnormal was defined as: ≤3 months of age [mo] AHI≥10 events/hour; >3mo AHI ≥5 events/hour. Receiver operating characteristic curves were calculated for abnormal PSG and pulse oximetry/TcCO2 variables, and diagnostic statistics were calculated.
Results
Forty-seven untreated children with SMA were recruited (type 1 n = 13; 2 n = 21; 3 n = 13) ranging from 0.2 to 18.8 years old (median 4.9 years). Oxygen desaturation index ≥4 % (ODI4) ≥20events/hour had sensitivity 82.6 % (95 % CI 61.2–95.0) and specificity of 58.3 % (95 % CI 36.6–77.9). TcCO2 alone and combinations of oximetry/TcCO2 had low diagnostic ability. The same methodology was applied to 36 children who were treated (type 1 n = 7; type 2 n = 17; type n = 12) and oximetry±TcCO2 had low diagnostic ability.
Conclusion
ODI4 ≥20events/hour can predict the need for NIV in untreated children with SMA. TcCO2 monitoring does not improve the PPV. If normal however, children may still require a diagnostic PSG. Neither oximetry nor TcCO2 monitoring were useful screening tests in the children treated with DMT.
导言尽管采取了疾病调整治疗(DMT),但脊髓性肌肉萎缩症(SMA)患儿通常仍需要辅助通气。方法在澳大利亚昆士兰州进行了一项前瞻性队列研究。在澳大利亚昆士兰州开展了一项前瞻性队列研究,对未接受 DMT 治疗的 SMA 患儿完成了全面的 PSG 诊断。从 PSG 中提取脉搏氧饱和度和 TcCO2。呼吸暂停-低通气指数 (AHI) 标准适用于 PSG 结果,以确定是否需要 NIV。异常定义为:≤3 个月 [mo] AHI≥10 次/小时;>3 个月 AHI≥5 次/小时。结果招募了 47 名未经治疗的 SMA 儿童(1 型 n = 13;2 型 n = 21;3 型 n = 13),年龄从 0.2 岁到 18.8 岁(中位 4.9 岁)不等。氧饱和度指数≥4 % (ODI4) ≥20次/小时的灵敏度为82.6 % (95 % CI 61.2-95.0),特异性为58.3 % (95 % CI 36.6-77.9)。仅 TcCO2 和血氧饱和度/TcCO2 组合的诊断能力较低。同样的方法适用于 36 名接受治疗的儿童(1 型 n = 7;2 型 n = 17;类型 n = 12),血氧饱和度±TcCO2 的诊断能力较低。TcCO2 监测并不能提高 PPV。如果正常,患儿可能仍需要进行诊断性 PSG。在接受 DMT 治疗的儿童中,血氧饱和度和 TcCO2 监测都不是有用的筛查测试。
{"title":"Oximetry and carbon dioxide screening for ventilatory requirements in children with spinal muscular atrophy type 1-3","authors":"","doi":"10.1016/j.sleep.2024.08.022","DOIUrl":"10.1016/j.sleep.2024.08.022","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite disease modifying treatments (DMT), assisted ventilation is commonly required in children with Spinal Muscular Atrophy (SMA). Guidelines suggest screening with oximetry and transcutaneous carbon dioxide (TcCO<sub>2</sub>) for sleep disordered breathing (SDB).</p></div><div><h3>Aim</h3><p>To determine the utility of pulse oximetry and TcCO<sub>2</sub> as a screen for SDB and the need for Non-Invasive Ventilation (NIV) in children with SMA type 1–3.</p></div><div><h3>Methods</h3><p>A prospective cohort study was conducted in Queensland, Australia. Full diagnostic PSG was completed in DMT naïve children with SMA. Pulse oximetry and TcCO<sub>2</sub> were extracted from PSG. Apnoea-hypopnoea indices (AHI) criteria were applied to PSG results to define the need for NIV. Abnormal was defined as: ≤3 months of age [mo] AHI≥10 events/hour; >3mo AHI ≥5 events/hour. Receiver operating characteristic curves were calculated for abnormal PSG and pulse oximetry/TcCO<sub>2</sub> variables, and diagnostic statistics were calculated.</p></div><div><h3>Results</h3><p>Forty-seven untreated children with SMA were recruited (type 1 n = 13; 2 n = 21; 3 n = 13) ranging from 0.2 to 18.8 years old (median 4.9 years). Oxygen desaturation index ≥4 % (ODI4) ≥20events/hour had sensitivity 82.6 % (95 % CI 61.2–95.0) and specificity of 58.3 % (95 % CI 36.6–77.9). TcCO<sub>2</sub> alone and combinations of oximetry/TcCO<sub>2</sub> had low diagnostic ability. The same methodology was applied to 36 children who were treated (type 1 n = 7; type 2 n = 17; type n = 12) and oximetry±TcCO2 had low diagnostic ability.</p></div><div><h3>Conclusion</h3><p>ODI4 ≥20events/hour can predict the need for NIV in untreated children with SMA. TcCO2 monitoring does not improve the PPV. If normal however, children may still require a diagnostic PSG. Neither oximetry nor TcCO<sub>2</sub> monitoring were useful screening tests in the children treated with DMT.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1016/j.sleep.2024.08.021
Objectives
Prolonged sitting is associated with an increased risk of musculoskeletal pain, especially in nightshift workers. However, research investigating effects of breaking up sitting on musculoskeletal pain during nightshifts is lacking. This study evaluated effects of prolonged sitting or breaking up sitting with short bouts of light-intensity physical activity on pain in healthy adults during simulated nightshifts.
Methods
An in-laboratory randomised controlled trial was undertaken with 52 healthy adults completing five simulated nightshifts. Participants were randomised to prolonged sitting (Sit9; n = 26) or breaking up prolonged sitting (Break9; n = 26). Break9 group completed 3-min walking every 30 min during nightshifts, while Sit9 group remained seated. Musculoskeletal pain intensity and sensory/affective pain experiences were assessed. Linear mixed models examined pain within nights (pre-to post-shift) and across nights (pre-shift-night-1 to pre-shift-night-5).
Results
Musculoskeletal pain intensity increased within nights for both Sit9 (mean change [95%CI] points: 0.14 [0.05, 0.24]) and Break9 (0.09 [0.001, 0.19], but not across nights (Sit9: −0.13 [-0.33, 0.08]; Break9: 0.07 [-0.14, 0.29]). Sensory-pain experience improved across nights for Sit9 (−3.08 [-4.72, −1.45]), but not within nights (0.77 [-0.004, 1.55]). There was no change in affective-pain experience in either group. Between-group difference was observed favouring Sit9 for improving sensory-pain across nights (β: 3.71 [1.42, 5.99]). No other between-group difference was observed.
Conclusion
Both prolonged sitting and breaking up sitting were associated with a within-night increase in musculoskeletal pain intensity. Compared to prolonged sitting, breaking up sitting did not induce benefits on pain in healthy adults working simulated nightshifts.
{"title":"The impact of breaking up sitting during simulated nightshifts on musculoskeletal pain: A randomised controlled trial","authors":"","doi":"10.1016/j.sleep.2024.08.021","DOIUrl":"10.1016/j.sleep.2024.08.021","url":null,"abstract":"<div><h3>Objectives</h3><p>Prolonged sitting is associated with an increased risk of musculoskeletal pain, especially in nightshift workers. However, research investigating effects of breaking up sitting on musculoskeletal pain during nightshifts is lacking. This study evaluated effects of prolonged sitting or breaking up sitting with short bouts of light-intensity physical activity on pain in healthy adults during simulated nightshifts.</p></div><div><h3>Methods</h3><p>An in-laboratory randomised controlled trial was undertaken with 52 healthy adults completing five simulated nightshifts. Participants were randomised to prolonged sitting (Sit9; n = 26) or breaking up prolonged sitting (Break9; n = 26). Break9 group completed 3-min walking every 30 min during nightshifts, while Sit9 group remained seated. Musculoskeletal pain intensity and sensory/affective pain experiences were assessed. Linear mixed models examined pain within nights (pre-to post-shift) and across nights (pre-shift-night-1 to pre-shift-night-5).</p></div><div><h3>Results</h3><p>Musculoskeletal pain intensity increased within nights for both Sit9 (mean change [95%CI] points: 0.14 [0.05, 0.24]) and Break9 (0.09 [0.001, 0.19], but not across nights (Sit9: −0.13 [-0.33, 0.08]; Break9: 0.07 [-0.14, 0.29]). Sensory-pain experience improved across nights for Sit9 (−3.08 [-4.72, −1.45]), but not within nights (0.77 [-0.004, 1.55]). There was no change in affective-pain experience in either group. Between-group difference was observed favouring Sit9 for improving sensory-pain across nights (β: 3.71 [1.42, 5.99]). No other between-group difference was observed.</p></div><div><h3>Conclusion</h3><p>Both prolonged sitting and breaking up sitting were associated with a within-night increase in musculoskeletal pain intensity. Compared to prolonged sitting, breaking up sitting did not induce benefits on pain in healthy adults working simulated nightshifts.</p></div><div><h3>Trial registration</h3><p>ACTRN12619001516178.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1389945724003927/pdfft?md5=3d4cb74962eef964aa32d6ce8b518c95&pid=1-s2.0-S1389945724003927-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142058261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1016/j.sleep.2024.08.018
Objective
Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). Unsatisfactory adherence to CPAP is an important clinical issue to resolve. Cluster analysis is a powerful tool to distinguish subgroups in a multidimensional fashion. This study aimed to investigate the use of cluster analysis for predicting CPAP adherence using clinical polysomnographic (PSG) parameters and patient characteristics.
Patients/methods
Participants of this multicenter observational study were 1133 patients with OSA who were newly diagnosed and implemented CPAP. Ward's method of cluster analysis was applied to in-laboratory diagnostic PSG parameters and patient characteristics. CPAP adherence was assessed during 90- and 365-day periods after CPAP initiation in each cluster. We adopted the Centers for Medicare and Medicaid Services criterion for CPAP adherence, i.e., CPAP use ≥4 h per night for 70 % or more of the observation period. Logistic regression analysis was performed to stratify clusters according to CPAP adherence.
Results
Five clusters were identified through cluster analysis. Clustering was significantly associated with CPAP adherence at 90- and 365-day periods after CPAP initiation. Logistic regression revealed that the cluster with features including apnea predominant sleep-disordered breathing, high apnea-hypopnea index, and relatively older age demonstrated the highest CPAP adherence.
Conclusion
Cluster analysis revealed hidden connections using patient characteristics and PSG parameters to successfully identify patients more likely to adhere to CPAP for 90 days and up to 365 days. When prescribing CPAP, it is possible to identify patients with OSA who are more likely to be non-adherent.
{"title":"Multidimensional prediction of continuous positive airway pressure adherence","authors":"","doi":"10.1016/j.sleep.2024.08.018","DOIUrl":"10.1016/j.sleep.2024.08.018","url":null,"abstract":"<div><h3>Objective</h3><p>Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). Unsatisfactory adherence to CPAP is an important clinical issue to resolve. Cluster analysis is a powerful tool to distinguish subgroups in a multidimensional fashion. This study aimed to investigate the use of cluster analysis for predicting CPAP adherence using clinical polysomnographic (PSG) parameters and patient characteristics.</p></div><div><h3>Patients/methods</h3><p>Participants of this multicenter observational study were 1133 patients with OSA who were newly diagnosed and implemented CPAP. Ward's method of cluster analysis was applied to in-laboratory diagnostic PSG parameters and patient characteristics. CPAP adherence was assessed during 90- and 365-day periods after CPAP initiation in each cluster. We adopted the Centers for Medicare and Medicaid Services criterion for CPAP adherence, i.e., CPAP use ≥4 h per night for 70 % or more of the observation period. Logistic regression analysis was performed to stratify clusters according to CPAP adherence.</p></div><div><h3>Results</h3><p>Five clusters were identified through cluster analysis. Clustering was significantly associated with CPAP adherence at 90- and 365-day periods after CPAP initiation. Logistic regression revealed that the cluster with features including apnea predominant sleep-disordered breathing, high apnea-hypopnea index, and relatively older age demonstrated the highest CPAP adherence.</p></div><div><h3>Conclusion</h3><p>Cluster analysis revealed hidden connections using patient characteristics and PSG parameters to successfully identify patients more likely to adhere to CPAP for 90 days and up to 365 days. When prescribing CPAP, it is possible to identify patients with OSA who are more likely to be non-adherent.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-18DOI: 10.1016/j.sleep.2024.08.017
Objective/background
There is a significant unmet need for safe and effective nonpharmacological therapies for restless legs syndrome (RLS). The objective was to evaluate the efficacy and safety of tonic motor activation (TOMAC) in patients with RLS.
Patients/methods
A multicenter, randomized, participant-blinded, sham-controlled trial enrolled 45 adults with primary moderate-to-severe RLS who were either medication-naïve (n = 20) or medication-refractory (n = 25). Participants were 1:1 randomized to TOMAC (n = 22) or sham (n = 23) for two weeks and instructed to self-administer 30-min TOMAC sessions when they experienced RLS symptoms. The primary outcome was mean change in International RLS Study Group Rating Scale (IRLS) total score. A subsequent meta-analysis included the present trial and a previous randomized clinical trial that enrolled medication-naïve RLS patients.
Results
IRLS reduction was significantly greater for TOMAC than sham (TOMAC -6.59 vs. sham −2.17; mean difference (MD) = −4.42; 95 % confidence interval [CI] −1.57 to −7.26; p = 0.0040). Subgroup analysis showed similar IRLS mean difference for medication-refractory (MD = −4.50; p = 0.02) and medication-naïve (MD = −4.40; p = 0.08) cohorts, which was significantly different from sham only for the medication-refractory cohort. Meta-analysis of combined data from 33 medication-naïve RLS patients showed a significant reduction in mean IRLS score after two weeks for TOMAC compared to sham (MD = −4.30; 95 % CI -1.36 to −7.24; p = 0.004).
Conclusions
The present trial confirmed previous reports documenting efficacy and safety of TOMAC in refractory RLS and indicated similar effect sizes in refractory versus naïve subgroups. The meta-analysis demonstrated that TOMAC significantly improves RLS symptoms in naïve participants.
目标/背景对于不宁腿综合征(RLS),安全有效的非药物疗法仍有大量需求未得到满足。患者/方法一项多中心、随机、参试者盲法、假对照试验招募了45名患有原发性中重度RLS的成人患者,他们要么是药物治疗无效者(20人),要么是药物治疗难治者(25人)。参与者按1:1比例随机接受TOMAC治疗(22人)或假治疗(23人),为期两周,并被要求在出现RLS症状时自行接受30分钟的TOMAC治疗。主要结果是国际RLS研究小组评分量表(IRLS)总分的平均变化。随后进行的一项荟萃分析包括了本试验和之前的一项随机临床试验,该试验招募了药物治疗无效的RLS患者。结果TOMAC的IRLS降低幅度明显大于假体(TOMAC -6.59 vs. 假体 -2.17;平均差 (MD) = -4.42;95 % 置信区间 [CI] -1.57 to -7.26;p = 0.0040)。亚组分析显示,药物难治队列(MD = -4.50;p = 0.02)和药物无效队列(MD = -4.40;p = 0.08)的 IRLS 平均差相似,只有药物难治队列的 IRLS 平均差与假体显著不同。对33名药物治疗无效的RLS患者的综合数据进行的荟萃分析表明,与假药相比,TOMAC两周后的平均IRLS评分显著降低(MD = -4.30; 95 % CI -1.36 to -7.24; p = 0.004)。荟萃分析表明,TOMAC能显著改善未接受治疗者的RLS症状。
{"title":"Efficacy and safety of TOMAC for treatment of medication-naïve and medication-refractory restless legs syndrome: A randomized clinical trial and meta-analysis","authors":"","doi":"10.1016/j.sleep.2024.08.017","DOIUrl":"10.1016/j.sleep.2024.08.017","url":null,"abstract":"<div><h3>Objective/background</h3><p>There is a significant unmet need for safe and effective nonpharmacological therapies for restless legs syndrome (RLS). The objective was to evaluate the efficacy and safety of tonic motor activation (TOMAC) in patients with RLS.</p></div><div><h3>Patients/methods</h3><p>A multicenter, randomized, participant-blinded, sham-controlled trial enrolled 45 adults with primary moderate-to-severe RLS who were either medication-naïve (n = 20) or medication-refractory (n = 25). Participants were 1:1 randomized to TOMAC (n = 22) or sham (n = 23) for two weeks and instructed to self-administer 30-min TOMAC sessions when they experienced RLS symptoms. The primary outcome was mean change in International RLS Study Group Rating Scale (IRLS) total score. A subsequent meta-analysis included the present trial and a previous randomized clinical trial that enrolled medication-naïve RLS patients.</p></div><div><h3>Results</h3><p>IRLS reduction was significantly greater for TOMAC than sham (TOMAC -6.59 vs. sham −2.17; mean difference (MD) = −4.42; 95 % confidence interval [CI] −1.57 to −7.26; p = 0.0040). Subgroup analysis showed similar IRLS mean difference for medication-refractory (MD = −4.50; p = 0.02) and medication-naïve (MD = −4.40; p = 0.08) cohorts, which was significantly different from sham only for the medication-refractory cohort. Meta-analysis of combined data from 33 medication-naïve RLS patients showed a significant reduction in mean IRLS score after two weeks for TOMAC compared to sham (MD = −4.30; 95 % CI -1.36 to −7.24; p = 0.004).</p></div><div><h3>Conclusions</h3><p>The present trial confirmed previous reports documenting efficacy and safety of TOMAC in refractory RLS and indicated similar effect sizes in refractory versus naïve subgroups. The meta-analysis demonstrated that TOMAC significantly improves RLS symptoms in naïve participants.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1389945724003885/pdfft?md5=d7a141ff271f73a3af6c61fe067212d2&pid=1-s2.0-S1389945724003885-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1016/j.sleep.2024.08.016
Study objectives
Advanced signal processing of photoplethysmographic data enables novel analyses which may improve the understanding of the pathogenesis of dysglycemia associated with sleep disorders. We aimed to identify sleep-related pulse wave characteristics in diabetic patients compared to normoglycemic individuals, independent of cardiovascular-related comorbidities.
Methods
This cross-sectional evaluation of the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) included overnight oximetry-derived pulse wave data from 3997 subjects (45 % males, age 50–64 years). Metabolic status was classified as normoglycemic (n = 3220), pre-diabetic (n = 544), or diabetic (n = 233). Nine validated pulse wave features proposed to influence cardiovascular risk were derived and compared between metabolic status groups. Logistic prediction models and genetic matching were applied to capture diabetes-related pulse wave characteristics during sleep. The model was controlled for anthropometrics, lifestyle, sleep apnea, and in the final adjustment even for cardiometabolic factors like dyslipidaemia, hypertension, and coronary artery calcification.
Results
Pulse wave-derived parameters differed between normoglycemic and diabetic individuals in eight dimensions in unadjusted as well as in the partially adjusted model (anthropometric factors and sleep apnea, p ≤ 0.001). All covariates confirmed significant differences between normoglycemic and diabetic subjects (all p ≤ 0.001). Reduced cardio-respiratory coupling (respiratory-related pulse oscillations) (β = −0.010, p = 0.012), as well as increased vascular stiffness (shortened pulse propagation time (β = −0.015, p = 0.001), were independently associated with diabetes even when controlled for cardiometabolic factors. These results were confirmed through a matched cohort comparative analysis.
Conclusions
Photoplethysmographic pulse wave analysis during sleep can be utilized to capture multiple features of modified autonomic regulation and cardiovascular consequences in diabetic subjects. Dampened heart rate variability and increased vascular stiffness during sleep showed the strongest associations with diabetes.
{"title":"The influence of diabetes on sleep-derived cardiorespiratory features of the finger pulse wave signal – The population-based SCAPIS study","authors":"","doi":"10.1016/j.sleep.2024.08.016","DOIUrl":"10.1016/j.sleep.2024.08.016","url":null,"abstract":"<div><h3>Study objectives</h3><p>Advanced signal processing of photoplethysmographic data enables novel analyses which may improve the understanding of the pathogenesis of dysglycemia associated with sleep disorders. We aimed to identify sleep-related pulse wave characteristics in diabetic patients compared to normoglycemic individuals, independent of cardiovascular-related comorbidities.</p></div><div><h3>Methods</h3><p>This cross-sectional evaluation of the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) included overnight oximetry-derived pulse wave data from 3997 subjects (45 % males, age 50–64 years). Metabolic status was classified as normoglycemic (n = 3220), pre-diabetic (n = 544), or diabetic (n = 233). Nine validated pulse wave features proposed to influence cardiovascular risk were derived and compared between metabolic status groups. Logistic prediction models and genetic matching were applied to capture diabetes-related pulse wave characteristics during sleep. The model was controlled for anthropometrics, lifestyle, sleep apnea, and in the final adjustment even for cardiometabolic factors like dyslipidaemia, hypertension, and coronary artery calcification.</p></div><div><h3>Results</h3><p>Pulse wave-derived parameters differed between normoglycemic and diabetic individuals in eight dimensions in unadjusted as well as in the partially adjusted model (anthropometric factors and sleep apnea, p ≤ 0.001). All covariates confirmed significant differences between normoglycemic and diabetic subjects (all p ≤ 0.001). Reduced cardio-respiratory coupling (respiratory-related pulse oscillations) (β = −0.010, p = 0.012), as well as increased vascular stiffness (shortened pulse propagation time (β = −0.015, p = 0.001), were independently associated with diabetes even when controlled for cardiometabolic factors. These results were confirmed through a matched cohort comparative analysis.</p></div><div><h3>Conclusions</h3><p>Photoplethysmographic pulse wave analysis during sleep can be utilized to capture multiple features of modified autonomic regulation and cardiovascular consequences in diabetic subjects. Dampened heart rate variability and increased vascular stiffness during sleep showed the strongest associations with diabetes.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1389945724003873/pdfft?md5=fc36b6c2ef08e7bda4ddc15cf37abb2d&pid=1-s2.0-S1389945724003873-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.sleep.2024.08.015
Study objectives
This study aimed to investigate the relationship between sleep-aiding music and sleep-related attentional bias based on electroencephalography (EEG) functional connectivity (FC) in patients with insomnia disorder (ID), to evaluate the effectiveness of music in aiding sleep.
Method
This study included 30 participants, comprising 15 patients with ID and 15 healthy controls (HCs). Six types of music were selected for sleep aid, and a dot-probe task based on sleep-related attentional bias was utilized to collect behavioral and EEG data. Vigilance bias and disengagement bias were measured using reaction time and EEG FC. Differences in sleep-related attentional bias before and after the intervention of music were explored to evaluate the sleep-aiding effects and identify EEG biomarkers.
Results
Compared with HCs, patients with ID showed decreased sleep-related attentional bias of EEG FC between occipital-central and temporal-frontal lobes. Among the six types of music, International Standard Sleep Aid and Lullaby had a greater impact on decreasing vigilance bias in the ID group. Additionally, the International Standard Sleep Aid and Nature Sound were more effective in decreasing disengagement bias in the ID group. This study also examined the resting-state EEG FC of patients with ID before and after the intervention of music. The results showed that the FC in the temporal, frontal, and occipital lobes significantly differed before and after the intervention of music, especially with the use of International Standard Sleep Aid, Lullaby, and Alpha Sound Wave. However, it is worth noting that these three types of music showed no similarities in EEG FC, in contrast to the result of sleep-related attentional bias of EEG FC.
Conclusion
This study found that the sleep-related attentional bias of EEG FC has more distinct characteristics when compared to resting-state EEG FC. The results suggest that the sleep-related attentional bias of EEG FC could be a potential biomarker for assessing the sleep-aiding effect of music interventions. International Standard Sleep Aid was the most effective for patients with ID among six types of sleep-aiding music. These findings could facilitate the development of personalized therapies for patients with ID.
Clinical trials registration
Chinese Clinical Trial Register, http://www.chictr.org.cn, ID: ChiCTR2400081608.
研究目的本研究旨在根据脑电图(EEG)功能连接(FC)研究失眠症(ID)患者的助眠音乐与睡眠相关注意偏差之间的关系,以评估音乐助眠的效果:这项研究包括 30 名参与者,其中包括 15 名失眠症患者和 15 名健康对照组(HCs)。研究选择了六种助眠音乐,并利用基于睡眠相关注意偏差的点探测任务收集行为和脑电图数据。通过反应时间和脑电图FC测量警觉偏差和脱离偏差。探讨了音乐干预前后睡眠相关注意偏差的差异,以评估助眠效果并确定脑电图生物标志物:结果:与普通人相比,ID患者枕叶-中央叶和颞叶-额叶之间的脑电图FC与睡眠相关的注意偏差有所下降。在六种类型的音乐中,国际标准助眠曲和摇篮曲对减少ID组患者的警觉偏差影响更大。此外,国际标准助眠音乐和大自然之音对减少智障组的脱离偏差更有效。这项研究还检查了音乐干预前后智障患者的静息态脑电图功能。结果显示,在音乐干预前后,颞叶、额叶和枕叶的 FC 有明显差异,尤其是在使用国际标准助眠曲、摇篮曲和阿尔法声波时。但值得注意的是,这三种类型的音乐在脑电功能上并无相似之处,这与脑电功能的睡眠相关注意偏差结果形成了鲜明对比:本研究发现,与静息状态脑电功能相比,与睡眠相关的脑电功能注意偏差具有更明显的特征。结果表明,脑电图功能与睡眠相关的注意偏差可能是评估音乐干预对睡眠帮助效果的潜在生物标志物。在六种助眠音乐中,国际标准助眠音乐对智障患者最有效。这些发现有助于开发针对ID患者的个性化疗法:中国临床试验注册中心,http://www.chictr.org.cn,ID:ChiCTR2400081608。
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Pub Date : 2024-08-14DOI: 10.1016/j.sleep.2024.08.014
Background
Sleep is a fundamental and complex physiological process whose duration decreases and characteristics change with age. Around 50 % of children will experience sleep disturbances at some point in their early life. Sleep disturbances can result in a number of deleterious consequences, including alterations in the levels of cellular senescence (CS) markers. CS is a complex process essential for homeostasis characterized by the irreversible loss of cell proliferation capacity; however, the accumulation of senescent cells can lead to age-related diseases.
Objective
In this review, our objective was to gather information about the relationship between sleep duration, sleep-disordered breathing (SDB) and cellular senescence markers, namely: oxidative stress, inflammation, insulin-like growth factor 1 (IGF-1), and growth hormone (GH) in newborns, children, and teenagers.
Methods
To achieve this, we searched six databases: MEDLINE, Scopus, LILACS, Web of Science, Embase, and SciELO, and identified 20 articles that met our inclusion criteria.
Results
Our results show that better sleep quality and duration and, both the surgical and non-surgical treatment of sleep disorders are associated with a reduction in oxidative stress, inflammation, and telomeric attrition levels. Furthermore, our results also show that surgical treatment for SDB significantly reduced the levels of cellular senescence markers. Further studies need to be conducted in this area, particularly longitudinal studies, for a greater understanding of the mechanisms involved in the relationship between sleep and senescence.
Conclusion
Better sleep quality and duration were associated with less oxidative stress, inflammation, and telomeric attrition and a higher level of IGF-1 in children and teenagers.
{"title":"Cellular senescence and sleep in childhood and adolescence: A scoping review focusing on sleep-disordered breathing","authors":"","doi":"10.1016/j.sleep.2024.08.014","DOIUrl":"10.1016/j.sleep.2024.08.014","url":null,"abstract":"<div><h3>Background</h3><p>Sleep is a fundamental and complex physiological process whose duration decreases and characteristics change with age. Around 50 % of children will experience sleep disturbances at some point in their early life. Sleep disturbances can result in a number of deleterious consequences, including alterations in the levels of cellular senescence (CS) markers. CS is a complex process essential for homeostasis characterized by the irreversible loss of cell proliferation capacity; however, the accumulation of senescent cells can lead to age-related diseases.</p></div><div><h3>Objective</h3><p>In this review, our objective was to gather information about the relationship between sleep duration, sleep-disordered breathing (SDB) and cellular senescence markers, namely: oxidative stress, inflammation, insulin-like growth factor 1 (IGF-1), and growth hormone (GH) in newborns, children, and teenagers.</p></div><div><h3>Methods</h3><p>To achieve this, we searched six databases: MEDLINE, Scopus, LILACS, Web of Science, Embase, and SciELO, and identified 20 articles that met our inclusion criteria.</p></div><div><h3>Results</h3><p>Our results show that better sleep quality and duration and, both the surgical and non-surgical treatment of sleep disorders are associated with a reduction in oxidative stress, inflammation, and telomeric attrition levels. Furthermore, our results also show that surgical treatment for SDB significantly reduced the levels of cellular senescence markers. Further studies need to be conducted in this area, particularly longitudinal studies, for a greater understanding of the mechanisms involved in the relationship between sleep and senescence.</p></div><div><h3>Conclusion</h3><p>Better sleep quality and duration were associated with less oxidative stress, inflammation, and telomeric attrition and a higher level of IGF-1 in children and teenagers.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.sleep.2024.08.008
Background
The beneficial effects of physical activity on sleep quality in older adults are well-established. However, determining the optimal dose of physical activity remains unclear. This study aimed to investigate the dose-response relationship between physical activity and sleep quality in older adults.
Methods
A comprehensive search was conducted across six electronic databases from inception to May 2024. Included were randomized controlled trials assessing the impact of physical activity on sleep quality in older adults. Changes in sleep quality scores were analyzed using a normal-likelihood model with an identity link function.
Results
Fifty-one studies involving 5890 participants met the inclusion criteria. The dose-response relationship was best described by a “J" shaped curve. The minimum significant dose was 195 metabolic equivalents of tasks (METs)-min/week (Hedges'g = −0.39, SE: 0.27, 95%CrI: −0.82 to 0), with the optimum dose identified as 440 METs-min/week (Hedges'g = −0.85, SE: 0.26, 95%CrI: −1.24 to −0.37). The tolerated dose was also 820 METs-min/week (Hedges'g = −0.85, SE: 0.26, 95%CrI: −1.24 to −0.37). The optimal dose of 440 METs/min/week consistently improved sleep quality across various physical activities. Additionally, participant characteristics such as age, sex, and exercise intensity may moderate the effects of different physical activities.
Conclusion
This study identified the optimal weekly dose of physical activity to enhance sleep quality in older adults, highlighting the effectiveness of various physical activities. It also explored moderating factors affecting intervention outcomes. These findings provide valuable insights for tailoring personalized physical activity programs in clinical settings.
{"title":"The best modality and dose of physical activity to improve sleep quality in older adults: A Bayesian dose-response meta-analysis","authors":"","doi":"10.1016/j.sleep.2024.08.008","DOIUrl":"10.1016/j.sleep.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><p>The beneficial effects of physical activity on sleep quality in older adults are well-established. However, determining the optimal dose of physical activity remains unclear. This study aimed to investigate the dose-response relationship between physical activity and sleep quality in older adults.</p></div><div><h3>Methods</h3><p>A comprehensive search was conducted across six electronic databases from inception to May 2024. Included were randomized controlled trials assessing the impact of physical activity on sleep quality in older adults. Changes in sleep quality scores were analyzed using a normal-likelihood model with an identity link function.</p></div><div><h3>Results</h3><p>Fifty-one studies involving 5890 participants met the inclusion criteria. The dose-response relationship was best described by a “J\" shaped curve. The minimum significant dose was 195 metabolic equivalents of tasks (METs)-min/week (Hedges'g = −0.39, SE: 0.27, 95%CrI: −0.82 to 0), with the optimum dose identified as 440 METs-min/week (Hedges'g = −0.85, SE: 0.26, 95%CrI: −1.24 to −0.37). The tolerated dose was also 820 METs-min/week (Hedges'g = −0.85, SE: 0.26, 95%CrI: −1.24 to −0.37). The optimal dose of 440 METs/min/week consistently improved sleep quality across various physical activities. Additionally, participant characteristics such as age, sex, and exercise intensity may moderate the effects of different physical activities.</p></div><div><h3>Conclusion</h3><p>This study identified the optimal weekly dose of physical activity to enhance sleep quality in older adults, highlighting the effectiveness of various physical activities. It also explored moderating factors affecting intervention outcomes. These findings provide valuable insights for tailoring personalized physical activity programs in clinical settings.</p></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}