Pub Date : 2024-09-24DOI: 10.1016/j.sleep.2024.09.025
Megha Agarwal , Amit Singhal
Cyclic alternating patterns (CAP) occur in electroencephalogram (EEG) signals during non-rapid eye movement sleep. The analysis of CAP can offer insights into various sleep disorders. The first step is the identification of phases A and B for the CAP cycles. In this work, we develop an easy-to-implement accurate system to differentiate between CAP A and CAP B. Small segments of the EEG signal are processed using Gaussian filters to obtain sub-band components. Features are extracted using some statistical characteristics of these signal components. Minimum redundancy maximum relevance test is employed to identify the more significant features. Three different machine learning classifiers are considered and their performance is compared. The results are analyzed for both the balanced and unbalanced datasets. The k-nearest neighbour (kNN) classifier achieves 79.14 % accuracy and F-1 score of 79.24 % for the balanced dataset. The proposed method outperforms the existing methods for CAP classification. It is easy-to-implement and can be considered as a candidate for real-time deployment.
在非快速眼动睡眠期间，脑电图（EEG）信号中会出现循环交替模式（CAP）。对 CAP 的分析可以帮助人们了解各种睡眠障碍。第一步是确定 CAP 周期的 A 相和 B 相。在这项工作中，我们开发了一种易于实施的精确系统来区分 CAP A 和 CAP B。利用这些信号分量的一些统计特征提取特征。采用最小冗余最大相关性测试来识别更重要的特征。考虑了三种不同的机器学习分类器，并对其性能进行了比较。对平衡和不平衡数据集的结果进行了分析。在平衡数据集上，k-近邻（kNN）分类器的准确率达到 79.14%，F-1 得分为 79.24%。在 CAP 分类方面，所提出的方法优于现有方法。该方法易于实施，可作为实时部署的候选方法。
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Pub Date : 2024-09-21DOI: 10.1016/j.sleep.2024.09.031
Yulia V. Ukraintseva, Konstantin A. Saltykov, Olga N. Tkachenko
Establishing well-defined relationships between sleep features and memory consolidation is essential in comprehending the pathophysiology of cognitive decline commonly seen in patients with insomnia, depression, and other sleep-disrupting conditions.
Twenty-eight volunteers participated in two experimental sessions: a session with selective SWS suppression during one night and a session with undisturbed night sleep (as a control condition). Fifteen of them also participated in a third session with REM suppression. Suppression was achieved by presenting an acoustic tone. In the evening and the morning, the participants completed procedural and declarative memory tasks and the Psychomotor vigilance task (PVT). Heart rate variability analysis and salivary cortisol were used to control possible stress reactions to sleep interference.
SWS and REM suppression led to more than 50 percent reduction in the amount of these stages. Neither vigilance nor memory consolidation was impaired after SWS or REM suppression. Unexpectedly, a beneficial effect of selective SWS suppression on PVT performance was found. Similarly, after a night with SWS suppression, the overnight improvement in procedural skills was higher than after a night with REM suppression and after a night with undisturbed sleep.
Our data brings into question the extent to which SWS and REM are truly necessary for effective memory consolidation to proceed. Moreover, SWS suppression may even improve the performance of some tasks, possibly by reducing sleep inertia associated with undisturbed sleep.
{"title":"Neither fifty percent slow-wave sleep suppression nor fifty percent rapid eye movement sleep suppression does impair memory consolidation","authors":"Yulia V. Ukraintseva, Konstantin A. Saltykov, Olga N. Tkachenko","doi":"10.1016/j.sleep.2024.09.031","DOIUrl":"10.1016/j.sleep.2024.09.031","url":null,"abstract":"<div><div>Establishing well-defined relationships between sleep features and memory consolidation is essential in comprehending the pathophysiology of cognitive decline commonly seen in patients with insomnia, depression, and other sleep-disrupting conditions.</div><div>Twenty-eight volunteers participated in two experimental sessions: a session with selective SWS suppression during one night and a session with undisturbed night sleep (as a control condition). Fifteen of them also participated in a third session with REM suppression. Suppression was achieved by presenting an acoustic tone. In the evening and the morning, the participants completed procedural and declarative memory tasks and the Psychomotor vigilance task (PVT). Heart rate variability analysis and salivary cortisol were used to control possible stress reactions to sleep interference.</div><div>SWS and REM suppression led to more than 50 percent reduction in the amount of these stages. Neither vigilance nor memory consolidation was impaired after SWS or REM suppression. Unexpectedly, a beneficial effect of selective SWS suppression on PVT performance was found. Similarly, after a night with SWS suppression, the overnight improvement in procedural skills was higher than after a night with REM suppression and after a night with undisturbed sleep.</div><div>Our data brings into question the extent to which SWS and REM are truly necessary for effective memory consolidation to proceed. Moreover, SWS suppression may even improve the performance of some tasks, possibly by reducing sleep inertia associated with undisturbed sleep.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 223-235"},"PeriodicalIF":3.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319877","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 : 2024-09-19DOI: 10.1016/j.sleep.2024.09.030
Na Li , Xu Hong , Yonghua Cui , Ying Li
Background
Sleep conditions are important in children and adolescents with tic disorders. Psychiatric symptoms and tic symptoms themselves can detrimentally affect the quality of life (QOL) in individuals with tic disorders. However, there is currently a lack of explicit research evidence elucidating the relationship between sleep and the QOL in individuals with tic disorders.
Methods
We assessed 150 children/adolescents aged 4–14 years old diagnosed with tic disorders. Participants' tic symptoms were evaluated using the Yale Global Tic Severity Scale (YGTSS), while their sleep conditions were assessed using the Children's Sleep Habits Questionnaire (CSHQ), and quality of life was measured using the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), all utilizing standardized measurement instruments. Detailed statistical descriptions, correlation analyses, and mediation analyses of the data were performed.
Results
We observed significant correlations among tic symptoms, sleep, and quality of life. Then, we confirmed the mediating role of sleep in the relationship between tic symptoms and quality of life (β = .591, 95%CI: .252–1.007). We also found that among different sleep variables, particularly bedtime resistance (β = .088, 95 % CI: .003–.260), played a significant mediating role.
Conclusions
Sleep was found to be a significantly mediator between tic symptoms and quality of life across various domains, especially bedtime resistance played an important mediating role. This indicates that assessment and management of sleep conditions in children/adolescents with tic disorders are important. These findings provide potentially valuable insights into the clinical evaluation of children and adolescents with tic disorders and the potential improvement of their quality of life in the future.
{"title":"Clinical tics and quality of life in children and adolescents with tic disorders: The mediating role of sleep","authors":"Na Li , Xu Hong , Yonghua Cui , Ying Li","doi":"10.1016/j.sleep.2024.09.030","DOIUrl":"10.1016/j.sleep.2024.09.030","url":null,"abstract":"<div><h3>Background</h3><div>Sleep conditions are important in children and adolescents with tic disorders. Psychiatric symptoms and tic symptoms themselves can detrimentally affect the quality of life (QOL) in individuals with tic disorders. However, there is currently a lack of explicit research evidence elucidating the relationship between sleep and the QOL in individuals with tic disorders.</div></div><div><h3>Methods</h3><div>We assessed 150 children/adolescents aged 4–14 years old diagnosed with tic disorders. Participants' tic symptoms were evaluated using the Yale Global Tic Severity Scale (YGTSS), while their sleep conditions were assessed using the Children's Sleep Habits Questionnaire (CSHQ), and quality of life was measured using the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), all utilizing standardized measurement instruments. Detailed statistical descriptions, correlation analyses, and mediation analyses of the data were performed.</div></div><div><h3>Results</h3><div>We observed significant correlations among tic symptoms, sleep, and quality of life. Then, we confirmed the mediating role of sleep in the relationship between tic symptoms and quality of life (β = .591, 95%CI: .252–1.007). We also found that among different sleep variables, particularly bedtime resistance (β = .088, 95 % CI: .003–.260), played a significant mediating role.</div></div><div><h3>Conclusions</h3><div>Sleep was found to be a significantly mediator between tic symptoms and quality of life across various domains, especially bedtime resistance played an important mediating role. This indicates that assessment and management of sleep conditions in children/adolescents with tic disorders are important. These findings provide potentially valuable insights into the clinical evaluation of children and adolescents with tic disorders and the potential improvement of their quality of life in the future.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 217-222"},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319991","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 : 2024-09-19DOI: 10.1016/j.sleep.2024.09.032
Chun Ting Au , Nobel Tsz Kin Yuen , Colin Massicotte , Kate Ching Ching Chan , Albert Martin Li , Indra Narang
Background
Elevated sleep apnea-specific hypoxic burden (HB) and pulse rate response (ΔHR) are associated with a higher cardiovascular risk in adults. The clinical significance of HB and ΔHR in children with obstructive sleep apnea (OSA) and their responses to therapy have not yet been investigated. This study aimed to compare the efficacy of high flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) in reducing HB and ΔHR in children.
Methods
This analysis included 17 children (11 males, mean age: 12.6 ± 3.9 years) with obesity and/or medical complexity and moderate-to-severe OSA. Each participant underwent two additional sleep studies: one for HFNC titration and another for CPAP titration. HB and ΔHR were derived from the oximetry and pulse rate signals from overnight sleep studies, respectively.
Results
Both HFNC and CPAP demonstrated significant reductions in HB from baseline, with similar magnitudes [HFNC: −129 (standard error, SE 55) %min/h, p = 0.003; CPAP: −138 (SE 53) %min/h, p = 0.005]. However, for ΔHR, a significant reduction from baseline was observed only in the CPAP group [–2.7 (SE 1.1) beats/min, p = 0.049], not the HFNC group [–1.0 (SE 1.4) beats/min, p = 0.67].
Conclusions
HFNC is as effective as CPAP in treating hypoxia in children with OSA, but HFNC might be less effective than CPAP in mitigating cardiovascular stress from autonomic disturbances during obstructive events.
{"title":"Sleep apnea-specific hypoxic burden and pulse rate response in children using high flow nasal cannula therapy compared with continuous positive airway pressure","authors":"Chun Ting Au , Nobel Tsz Kin Yuen , Colin Massicotte , Kate Ching Ching Chan , Albert Martin Li , Indra Narang","doi":"10.1016/j.sleep.2024.09.032","DOIUrl":"10.1016/j.sleep.2024.09.032","url":null,"abstract":"<div><h3>Background</h3><div>Elevated sleep apnea-specific hypoxic burden (HB) and pulse rate response (ΔHR) are associated with a higher cardiovascular risk in adults. The clinical significance of HB and ΔHR in children with obstructive sleep apnea (OSA) and their responses to therapy have not yet been investigated. This study aimed to compare the efficacy of high flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) in reducing HB and ΔHR in children.</div></div><div><h3>Methods</h3><div>This analysis included 17 children (11 males, mean age: 12.6 ± 3.9 years) with obesity and/or medical complexity and moderate-to-severe OSA. Each participant underwent two additional sleep studies: one for HFNC titration and another for CPAP titration. HB and ΔHR were derived from the oximetry and pulse rate signals from overnight sleep studies, respectively.</div></div><div><h3>Results</h3><div>Both HFNC and CPAP demonstrated significant reductions in HB from baseline, with similar magnitudes <strong>[</strong>HFNC: −129 (standard error, SE 55) %min/h, p = 0.003; CPAP: −138 (SE 53) %min/h, p = 0.005]. However, for ΔHR, a significant reduction from baseline was observed only in the CPAP group [–2.7 (SE 1.1) beats/min, p = 0.049], not the HFNC group [–1.0 (SE 1.4) beats/min, p = 0.67].</div></div><div><h3>Conclusions</h3><div>HFNC is as effective as CPAP in treating hypoxia in children with OSA, but HFNC might be less effective than CPAP in mitigating cardiovascular stress from autonomic disturbances during obstructive events.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 187-190"},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311948","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 : 2024-09-19DOI: 10.1016/j.sleep.2024.09.021
Qinghua Wen , Juan Li , Simin Li , Xiaoyue Wang , Huanhuan Zhu , Fengyin Zhang
Background
To investigate the association between sleep disorder and depression in stroke population using data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2005 and 2014.
Methods
Participants included stroke population who reported on sleep disorder and completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptom. Sleep disorder was self-reported and categorized dichotomously. Multivariate logistic regression, subgroup analysis, receiver operating characteristic curve (ROC) and restricted cubic spline (RCS) were used to explore the association between sleep disorder and depression.
Results
The final sample included 566 stroke survivors (weighted n = 3,326,625). Multivariate logistic regression analysis confirmed that sleep disorder was independently associated with an increased risk of depression even after adjusting for potential confounders (OR = 2.616, 95 % CI: 2.561 to 2.599, P < 0.0001). Subgroup analysis indicated that this association was particularly strong among female stroke population (OR = 5.515). Sleep disorder as a significant predictor of depression, while the relationship between sleep time and depression is characterized by non-linearity.
Conclusions
Sleep disorder is significantly associated with an increased risk of depression in stroke. This relationship remains robust across various sociodemographic and lifestyle factors, highlighting the need for integrated interventions targeting both sleep and mood disturbances in stroke care.
{"title":"Association between sleep disorder and depression in stroke in the National Health and Nutrition Examination Surveys (NHANES) 2005 to 2014","authors":"Qinghua Wen , Juan Li , Simin Li , Xiaoyue Wang , Huanhuan Zhu , Fengyin Zhang","doi":"10.1016/j.sleep.2024.09.021","DOIUrl":"10.1016/j.sleep.2024.09.021","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the association between sleep disorder and depression in stroke population using data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2005 and 2014.</div></div><div><h3>Methods</h3><div>Participants included stroke population who reported on sleep disorder and completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptom. Sleep disorder was self-reported and categorized dichotomously. Multivariate logistic regression, subgroup analysis, receiver operating characteristic curve (ROC) and restricted cubic spline (RCS) were used to explore the association between sleep disorder and depression.</div></div><div><h3>Results</h3><div>The final sample included 566 stroke survivors (weighted n = 3,326,625). Multivariate logistic regression analysis confirmed that sleep disorder was independently associated with an increased risk of depression even after adjusting for potential confounders (OR = 2.616, 95 % CI: 2.561 to 2.599, P < 0.0001). Subgroup analysis indicated that this association was particularly strong among female stroke population (OR = 5.515). Sleep disorder as a significant predictor of depression, while the relationship between sleep time and depression is characterized by non-linearity.</div></div><div><h3>Conclusions</h3><div>Sleep disorder is significantly associated with an increased risk of depression in stroke. This relationship remains robust across various sociodemographic and lifestyle factors, highlighting the need for integrated interventions targeting both sleep and mood disturbances in stroke care.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 201-208"},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315629","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 : 2024-09-18DOI: 10.1016/j.sleep.2024.09.029
Shreni Patel , Mark Speechley , Kathryn Nicholson , Osvaldo Espin-Garcia , Graham J. Reid , Saverio Stranges
Objective
Middle-aged to older adults often exhibit the co-existence of poor sleep health and multimorbidity. We examined cross-sectional and prospective associations of pooled index of sleep health with prevalent and incident multimorbidity in the framework of an ongoing cohort study in Canada.
Methods
Data were from approximately 24,000 individuals from the Canadian Longitudinal Study on Aging (CLSA), an ongoing national study of community-dwelling adults aged 45–85 years at baseline. Multimorbidity was defined as two or more chronic conditions out of five major condition categories. Sleep variables included sleep duration, quality, initiation, maintenance, and excessive daytime sleepiness, which were combined into an index using pooled approaches. Weighted logistic regression models were computed for each index with additional age- and sex-stratified analyses.
Results
Higher sleep index scores, indicating poorer sleep health, were observed in females and younger age groups (ages 45–54 and 55–64). In cross-sectional analysis, the fully adjusted model showed that a 1-unit increase in pooled scores was significantly associated with 1.48 higher odds (95 % CI = 1.38, 1.58; p < 0.001) of prevalent multimorbidity at baseline. Similarly, the prospective analysis indicated significant changes in incident multimorbidity with pooled index scores in the fully adjusted model (OR = 1.33; 95 % CI = 1.20, 1.48; p < 0.001).
Conclusion
The pooled sleep index introduced in this study may offer a novel, concise, and comprehensive approach to assessing sleep health among middle-aged and older adults. Those in these age groups experiencing poorer sleep health are at a greater risk of prevalent multimorbidity, as well as of developing multimorbidity over time.
目的 中老年人往往同时存在睡眠质量差和多病症的问题。我们在加拿大一项正在进行的队列研究框架内，研究了睡眠健康综合指数与流行性和偶发性多病症之间的横断面和前瞻性关联。方法数据来自加拿大老龄化纵向研究（CLSA）中的约 24,000 人，该研究是一项正在进行的全国性研究，研究对象为基线年龄在 45-85 岁之间、居住在社区的成年人。多病症的定义是在五种主要疾病类别中患有两种或两种以上慢性疾病。睡眠变量包括睡眠时间、睡眠质量、睡眠开始时间、睡眠维持时间和白天过度嗜睡，这些变量采用集合方法合并成一个指数。结果 女性和年轻年龄组（45-54 岁和 55-64 岁）的睡眠指数得分较高，表明睡眠健康状况较差。在横断面分析中，完全调整模型显示，集合得分每增加 1 个单位，基线多病流行几率就会增加 1.48（95 % CI = 1.38, 1.58; p <0.001）。同样，前瞻性分析表明，在完全调整模型中，随着集合指数得分的增加，多发病的发生率也会发生显著变化（OR = 1.33; 95 % CI = 1.20, 1.48; p <0.001）。在这些年龄组中，睡眠健康状况较差的人患多种疾病的风险更大，随着时间的推移，患多种疾病的风险也更大。
{"title":"Cross-sectional and prospective associations between sleep health and multimorbidity in middle to older-aged adults: Results from the Canadian Longitudinal Study on Aging (CLSA)","authors":"Shreni Patel , Mark Speechley , Kathryn Nicholson , Osvaldo Espin-Garcia , Graham J. Reid , Saverio Stranges","doi":"10.1016/j.sleep.2024.09.029","DOIUrl":"10.1016/j.sleep.2024.09.029","url":null,"abstract":"<div><h3>Objective</h3><div>Middle-aged to older adults often exhibit the co-existence of poor sleep health and multimorbidity. We examined cross-sectional and prospective associations of pooled index of sleep health with prevalent and incident multimorbidity in the framework of an ongoing cohort study in Canada.</div></div><div><h3>Methods</h3><div>Data were from approximately 24,000 individuals from the Canadian Longitudinal Study on Aging (CLSA), an ongoing national study of community-dwelling adults aged 45–85 years at baseline. Multimorbidity was defined as two or more chronic conditions out of five major condition categories. Sleep variables included sleep duration, quality, initiation, maintenance, and excessive daytime sleepiness, which were combined into an index using pooled approaches. Weighted logistic regression models were computed for each index with additional age- and sex-stratified analyses.</div></div><div><h3>Results</h3><div>Higher sleep index scores, indicating poorer sleep health, were observed in females and younger age groups (ages 45–54 and 55–64). In cross-sectional analysis, the fully adjusted model showed that a 1-unit increase in pooled scores was significantly associated with 1.48 higher odds (95 % CI = 1.38, 1.58; p < 0.001) of prevalent multimorbidity at baseline. Similarly, the prospective analysis indicated significant changes in incident multimorbidity with pooled index scores in the fully adjusted model (OR = 1.33; 95 % CI = 1.20, 1.48; p < 0.001).</div></div><div><h3>Conclusion</h3><div>The pooled sleep index introduced in this study may offer a novel, concise, and comprehensive approach to assessing sleep health among middle-aged and older adults. Those in these age groups experiencing poorer sleep health are at a greater risk of prevalent multimorbidity, as well as of developing multimorbidity over time.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 236-243"},"PeriodicalIF":3.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319879","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 : 2024-09-18DOI: 10.1016/j.sleep.2024.09.027
Liping Pan , Hui Li , Jiawei Guo , Chao Ma , Liming Li , Wenfeng Zhan , Huiyu Chen , Yuting Wu , Guihua Jiang , Shumei Li
Objective
To investigate gray matter volume (GMV) changes in patients with comorbid insomnia and sleep apnea (COMISA) of differing severity and relationships between GMV alterations and clinical measures.
Methods
Thirty-four COMISA patients and 24 healthy controls (HC) were recruited. All patients underwent structural MRI and completed measures related to respiration, sleep, mood, and cognition. COMISA patients were further divided into a mild and moderate COMISA (MC) and a severe COMISA (SC) group. Changes in GMV of COMISA patients were investigated via VBM. The voxel-wise differences in GMV were compared between HC group and COMISA group. Analysis of covariance (ANCOVA) was performed on individual GMV maps in MC, SC, and HC groups to further investigate effects of different stages of COMISA severity on GMV. Partial correlation analysis was then performed to analyze relationships between altered GMV and clinical measures.
Results
GMV atrophy was mainly located in the temporal lobes and fusiform gyrus in COMISA group. The post-hoc analysis of the ANCOVA revealed temporal lobes and fusiform gyrus atrophy in MC and SC groups compared to HC and the temporal lobe atrophy was expanded in SC group based on cluster size. Moreover, the SC group showed GMV atrophy of the right amygdala compared to both MC and HC groups. Partial correlation analysis revealed positive relationships between the GMV and mood-and cognitive-related measures and negative correlation between GMV and respiration measure.
Conclusions
Our findings showed GMV atrophy expansion from temporal lobe to limbic system (right amygdala) as severity stages increase in COMISA patients. These findings contribute to our understanding of neurobiological mechanisms underlying different stages of severity in COMISA patients.
方法招募 34 名 COMISA 患者和 24 名健康对照组（HC）。所有患者均接受了结构性核磁共振成像检查，并完成了与呼吸、睡眠、情绪和认知相关的测量。COMISA患者被进一步分为轻度和中度COMISA（MC）组以及重度COMISA（SC）组。通过 VBM 研究了 COMISA 患者 GMV 的变化。比较了 HC 组和 COMISA 组 GMV 的体素差异。对 MC 组、SC 组和 HC 组的单个 GMV 图进行协方差分析（ANCOVA），以进一步研究 COMISA 严重程度的不同阶段对 GMV 的影响。结果GMV萎缩主要位于COMISA组的颞叶和纺锤形回。方差分析的事后分析表明，与 HC 相比，MC 组和 SC 组的颞叶和纺锤形回萎缩，且根据聚类大小，SC 组的颞叶萎缩范围扩大。此外，与 MC 组和 HC 组相比，SC 组显示右侧杏仁核 GMV 萎缩。我们的研究结果表明，随着 COMISA 患者病情严重程度的增加，GMV 萎缩范围从颞叶扩展到边缘系统（右侧杏仁核）。这些发现有助于我们了解COMISA患者不同严重阶段的神经生物学机制。
{"title":"Expanded gray matter atrophy with severity stages of adult comorbid insomnia and sleep apnea","authors":"Liping Pan , Hui Li , Jiawei Guo , Chao Ma , Liming Li , Wenfeng Zhan , Huiyu Chen , Yuting Wu , Guihua Jiang , Shumei Li","doi":"10.1016/j.sleep.2024.09.027","DOIUrl":"10.1016/j.sleep.2024.09.027","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate gray matter volume (GMV) changes in patients with comorbid insomnia and sleep apnea (COMISA) of differing severity and relationships between GMV alterations and clinical measures.</div></div><div><h3>Methods</h3><div>Thirty-four COMISA patients and 24 healthy controls (HC) were recruited. All patients underwent structural MRI and completed measures related to respiration, sleep, mood, and cognition. COMISA patients were further divided into a mild and moderate COMISA (MC) and a severe COMISA (SC) group. Changes in GMV of COMISA patients were investigated via VBM. The voxel-wise differences in GMV were compared between HC group and COMISA group. Analysis of covariance (ANCOVA) was performed on individual GMV maps in MC, SC, and HC groups to further investigate effects of different stages of COMISA severity on GMV. Partial correlation analysis was then performed to analyze relationships between altered GMV and clinical measures.</div></div><div><h3>Results</h3><div>GMV atrophy was mainly located in the temporal lobes and fusiform gyrus in COMISA group. The post-hoc analysis of the ANCOVA revealed temporal lobes and fusiform gyrus atrophy in MC and SC groups compared to HC and the temporal lobe atrophy was expanded in SC group based on cluster size. Moreover, the SC group showed GMV atrophy of the right amygdala compared to both MC and HC groups. Partial correlation analysis revealed positive relationships between the GMV and mood-and cognitive-related measures and negative correlation between GMV and respiration measure.</div></div><div><h3>Conclusions</h3><div>Our findings showed GMV atrophy expansion from temporal lobe to limbic system (right amygdala) as severity stages increase in COMISA patients. These findings contribute to our understanding of neurobiological mechanisms underlying different stages of severity in COMISA patients.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 191-200"},"PeriodicalIF":3.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315628","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 : 2024-09-18DOI: 10.1016/j.sleep.2024.09.028
David P. White , Ludovico Messineo , Evelyn Thompson , Bryan Hughes , Wilson D. Lannom , Bernard Hete , Abinash Joshi , William H. Noah
Study objectives
A recent study challenged the prevailing clinical view that maintaining inspiratory positive airway pressure (IPAP) is necessary for upper airway patency, demonstrating no differences in apnea hypopnea index (AHI) between continuous PAP (CPAP) with and without a resistor to reduce IPAP. In this study, we assessed the effect of Kairos PAP (KPAP), a new algorithm which features multiple drops in IPAP, only returning to therapeutic pressure near the end expiration, on sleep apnea severity and subjective comfort.
Methods
Two randomized clinical trials were conducted. In the Efficacy trial, the effect of KPAP vs. CPAP on AHI in PAP-treated OSA patients was examined using a split-night design, adjusting for period, sequence and fraction of supine sleep (mixed models). Unintentional leak differences between treatments were also examined. Exploratory analyses assessed the effect of KPAP vs. CPAP on key polysomnography outcomes. In the Comfort trial, we tested subjective preference for KPAP vs. CPAP at 9 and 13 cmH2O in PAP-naïve OSA patients.
Results
In the Efficacy trial (N = 48), KPAP reduced AHI more than CPAP (mean difference [95%CI]: −0.5 [−0.8, −0.2] events/h, P = 0.007). Unintentional leak was also reduced by over 50 % (−2.5 [−3.2, −1.7] L/min, P < 0.001). No significant change was observed in the exploratory variables assessed. In the Comfort trial (N = 150), 69 [61, 77] % and 84 [77, 89] % of participants preferred KPAP over CPAP at 9 and 13 cmH2O, respectively (P < 0.001).
Conclusions
KPAP is as effective as CPAP in reducing respiratory events, but is more comfortable and potentially better tolerated.
{"title":"Kairos positive airway pressure (KPAP) equals continuous PAP in effectiveness, and offers superior comfort for obstructive sleep apnea treatment","authors":"David P. White , Ludovico Messineo , Evelyn Thompson , Bryan Hughes , Wilson D. Lannom , Bernard Hete , Abinash Joshi , William H. Noah","doi":"10.1016/j.sleep.2024.09.028","DOIUrl":"10.1016/j.sleep.2024.09.028","url":null,"abstract":"<div><h3>Study objectives</h3><div>A recent study challenged the prevailing clinical view that maintaining inspiratory positive airway pressure (IPAP) is necessary for upper airway patency, demonstrating no differences in apnea hypopnea index (AHI) between continuous PAP (CPAP) with and without a resistor to reduce IPAP. In this study, we assessed the effect of Kairos PAP (KPAP), a new algorithm which features multiple drops in IPAP, only returning to therapeutic pressure near the end expiration, on sleep apnea severity and subjective comfort.</div></div><div><h3>Methods</h3><div>Two randomized clinical trials were conducted. In the <em>Efficacy</em> trial, the effect of KPAP vs. CPAP on AHI in PAP-treated OSA patients was examined using a split-night design, adjusting for period, sequence and fraction of supine sleep (mixed models). Unintentional leak differences between treatments were also examined. Exploratory analyses assessed the effect of KPAP vs. CPAP on key polysomnography outcomes. In the <em>Comfort</em> trial, we tested subjective preference for KPAP vs. CPAP at 9 and 13 cmH<sub>2</sub>O in PAP-naïve OSA patients.</div></div><div><h3>Results</h3><div>In the <em>Efficacy</em> trial (N = 48), KPAP reduced AHI more than CPAP (mean difference [95%CI]: −0.5 [−0.8, −0.2] events/h, P = 0.007). Unintentional leak was also reduced by over 50 % (−2.5 [−3.2, −1.7] L/min, P < 0.001). No significant change was observed in the exploratory variables assessed. In the <em>Comfort</em> trial (N = 150), 69 [61, 77] % and 84 [77, 89] % of participants preferred KPAP over CPAP at 9 and 13 cmH<sub>2</sub>O, respectively (P < 0.001).</div></div><div><h3>Conclusions</h3><div>KPAP is as effective as CPAP in reducing respiratory events, but is more comfortable and potentially better tolerated.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 268-275"},"PeriodicalIF":3.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327861","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}
Recent research indicates that intravenous ferric carboxymaltose (IV FCM) presents a promising solution for Restless Legs Syndrome (RLS), distinguishing itself from other iron sources with minimal to no adverse effects. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety profile of administering IV FCM in patients with RLS, assuming that RLS and Iron deficiency anemia (IDA) are correlated.
Methodology
This study was conducted according to the PRISMA guideline, with search conducted on PubMed, Google Scholar, and the Medline library. Data was extracted from each study regarding RLS and the effect of IV FCM on it, while analysis was conducted on Review Manager Software.
Results
This meta-analysis comprises of 7 randomized controlled trials (RCTs). All 7 studies reported international RLS severity scale (IRLS) and the pooled analysis revealed a significant reduction in IRLS score favoring IV FCM [WMD: −6.03, 95 % CI (−10.11, −1.96), p = 0.004]. 3 out of 7 studies reported short form-36 health survey (SF-36) and the pooled analysis revealed that the total score of SF-36 significantly favors the group taking IV FCM [WMD: 7.44, 95%CI (1.67, 13.20) p = 0.01]. 4 out of 7 studies reported visual analogue scale (VAS) for RLS severity and pooled analysis revealed that IV FCM significantly decreased VAS) of RLS severity score as compared to the control [MD -19.21, 95%CI (−31.90, −6.52) p0.003].
Conclusion
The study findings support the efficacy of IVFCM in reducing the severity of RLS symptoms. Significant improvements in the IRLS scores were observed, alongside enhancements in overall quality of life measured by SF-36 scores.
{"title":"Clinical efficacy and safety of IV ferric carboxymaltose in restless legs syndrome: A meta-analysis of 537 patients","authors":"Syeda Nimra Qadri , Saifullah Jamil , Subhan Zahid , Tehreem Asghar , Syeda Muzna Gillani , Soban Ali Qasim , Tilyan Kambar , Zain Ul Abideen , Usama Brohi , Sammon Khan Tareen , Palay Khan Tareen , Sandhya Kumari , Satesh Kumar , Mahima Khatri","doi":"10.1016/j.sleep.2024.09.017","DOIUrl":"10.1016/j.sleep.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Recent research indicates that intravenous ferric carboxymaltose (IV FCM) presents a promising solution for Restless Legs Syndrome (RLS), distinguishing itself from other iron sources with minimal to no adverse effects. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety profile of administering IV FCM in patients with RLS, assuming that RLS and Iron deficiency anemia (IDA) are correlated.</div></div><div><h3>Methodology</h3><div>This study was conducted according to the PRISMA guideline, with search conducted on PubMed, Google Scholar, and the Medline library. Data was extracted from each study regarding RLS and the effect of IV FCM on it, while analysis was conducted on Review Manager Software.</div></div><div><h3>Results</h3><div>This meta-analysis comprises of 7 randomized controlled trials (RCTs). All 7 studies reported international RLS severity scale (IRLS) and the pooled analysis revealed a significant reduction in IRLS score favoring IV FCM [WMD: −6.03, 95 % CI (−10.11, −1.96), p = 0.004]. 3 out of 7 studies reported short form-36 health survey (SF-36) and the pooled analysis revealed that the total score of SF-36 significantly favors the group taking IV FCM [WMD: 7.44, 95%CI (1.67, 13.20) p = 0.01]. 4 out of 7 studies reported visual analogue scale (VAS) for RLS severity and pooled analysis revealed that IV FCM significantly decreased VAS) of RLS severity score as compared to the control [MD -19.21, 95%CI (−31.90, −6.52) p0.003].</div></div><div><h3>Conclusion</h3><div>The study findings support the efficacy of <span>IV</span> <span>FCM</span> in reducing the severity of <span>RLS</span> symptoms. Significant improvements in the IRLS scores were observed, alongside enhancements in overall quality of life measured by SF-36 scores.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 244-253"},"PeriodicalIF":3.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319990","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 : 2024-09-17DOI: 10.1016/j.sleep.2024.09.024
Yves Dauvilliers , Thomas Roth , Richard Bogan , Michael J. Thorpy , Anne Marie Morse , Asim Roy , Jennifer Gudeman
Objective/Background
Extended-release, once-nightly sodium oxybate (ON-SXB) significantly improved narcolepsy symptoms in participants in the phase 3, randomized, double-blind, placebo-controlled REST-ON trial. This post hoc analysis of REST-ON data evaluated ON-SXB efficacy in participants with or without concomitant alerting agent use.
Patients/methods
Participants with narcolepsy aged >16 years were randomized 1:1 to ON-SXB (week 1: 4.5 g, weeks 2–3: 6 g, weeks 4–8: 7.5 g, weeks 9–13: 9 g) or placebo. Primary endpoints in this post hoc analysis included change from baseline in mean sleep latency on the Maintenance of Wakefulness Test (MWT), Clinical Global Impression-Improvement (CGI-I) rating, and number of weekly cataplexy episodes. The secondary endpoints were change from baseline in the Epworth Sleepiness Scale (ESS) score and in objective and subjective disrupted nighttime sleep parameters. Post hoc analyses assessed participants with and without alerting agent use across 6-, 7.5-, and 9-g doses.
Results
In the modified intent-to-treat population, 119 (63 %) were (ON-SXB, n = 66; placebo, n = 53) and 71 (37 %) were not (ON-SXB, n = 31; placebo, n = 40) taking alerting agents. Regardless of alerting agent use, treatment with ON-SXB resulted in significant improvements vs placebo (all doses, P < 0.05) for MWT, CGI-I, and number of weekly cataplexy episodes. Significant improvements in ESS (all doses, P < 0.05) with ON-SXB vs placebo were observed in the alerting agent use cohort. Directional improvements in ESS were reported with all doses in the no alerting agent use group.
Conclusions
Regardless of concomitant alerting agent use, ON-SXB improved daytime and nighttime narcolepsy symptoms vs placebo.
{"title":"Efficacy of once-nightly sodium oxybate (FT218) on daytime symptoms in individuals with narcolepsy with or without concomitant alerting agent use: A post hoc analysis from the phase 3 REST-ON trial","authors":"Yves Dauvilliers , Thomas Roth , Richard Bogan , Michael J. Thorpy , Anne Marie Morse , Asim Roy , Jennifer Gudeman","doi":"10.1016/j.sleep.2024.09.024","DOIUrl":"10.1016/j.sleep.2024.09.024","url":null,"abstract":"<div><h3>Objective/Background</h3><div>Extended-release, once-nightly sodium oxybate (ON-SXB) significantly improved narcolepsy symptoms in participants in the phase 3, randomized, double-blind, placebo-controlled REST-ON trial. This post hoc analysis of REST-ON data evaluated ON-SXB efficacy in participants with or without concomitant alerting agent use.</div></div><div><h3>Patients/methods</h3><div>Participants with narcolepsy aged >16 years were randomized 1:1 to ON-SXB (week 1: 4.5 g, weeks 2–3: 6 g, weeks 4–8: 7.5 g, weeks 9–13: 9 g) or placebo. Primary endpoints in this post hoc analysis included change from baseline in mean sleep latency on the Maintenance of Wakefulness Test (MWT), Clinical Global Impression-Improvement (CGI-I) rating, and number of weekly cataplexy episodes. The secondary endpoints were change from baseline in the Epworth Sleepiness Scale (ESS) score and in objective and subjective disrupted nighttime sleep parameters. Post hoc analyses assessed participants with and without alerting agent use across 6-, 7.5-, and 9-g doses.</div></div><div><h3>Results</h3><div>In the modified intent-to-treat population, 119 (63 %) were (ON-SXB, n = 66; placebo, n = 53) and 71 (37 %) were not (ON-SXB, n = 31; placebo, n = 40) taking alerting agents. Regardless of alerting agent use, treatment with ON-SXB resulted in significant improvements vs placebo (all doses, <em>P</em> < 0.05) for MWT, CGI-I, and number of weekly cataplexy episodes. Significant improvements in ESS (all doses, <em>P</em> < 0.05) with ON-SXB vs placebo were observed in the alerting agent use cohort. Directional improvements in ESS were reported with all doses in the no alerting agent use group.</div></div><div><h3>Conclusions</h3><div>Regardless of concomitant alerting agent use, ON-SXB improved daytime and nighttime narcolepsy symptoms vs placebo.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"124 ","pages":"Pages 209-216"},"PeriodicalIF":3.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S138994572400443X/pdfft?md5=e3058ae83bf0692013bee01f466ebe34&pid=1-s2.0-S138994572400443X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315631","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}
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