Pub Date : 2019-04-11DOI: 10.1183/23120541.sleepandbreathing-2019.p41
L. Waldman, S. Parthasarathy, K. Villa, M. Bron, S. Bujanover, M. Brod
Background: Obstructive sleep apnea (OSA) with excessive daytime sleepiness (EDS) can impair quality of life (QOL) and may go undiagnosed. Objectives: To examine the diagnosis experience and impacts of EDS with OSA on QOL in the US. Methods: Focus groups in 3 US cities with 42 patients experiencing EDS with OSA; coded transcripts qualitatively analysed using adapted grounded theory approach. Results: Prior to diagnosis, 40% (n=17) of patients were aware of their EDS and 74% (n=31) were informed of their other OSA symptoms by a spouse/partner, family or friends. About half (n=22, 52%) waited an average of 11.4 (range 1-37) years to seek medical care for OSA; 32% (n=7/22) had thought their symptoms were normal rather than a sign of OSA. Reasons for seeking care were: input from a loved one (n=21, 50%); self-concern about symptoms (n=7, 17%); and impaired driving (n=5, 12%). Twenty-seven patients discussed referral pathways: 15/27 (56%) first saw a primary care physician and 12/27 (44%) a specialist. Although 74% (n=31) were currently on OSA treatment, the majority reported EDS impacts on physical functioning (n=40, 95%); daily life (n=39, 93%); cognition (n=38, 90%); social life (n=37, 88%); and work (n=29, 69%). Conclusions: In the US, OSA diagnosis is often delayed, with many patients unaware of the need to seek medical care. Following OSA diagnosis, EDS may continue to impair QOL. Future research should address diagnostic delays and unmet treatment needs for this population.
{"title":"Diagnosis and illness burden of excessive daytime sleepiness with obstructive sleep apnea in the United States","authors":"L. Waldman, S. Parthasarathy, K. Villa, M. Bron, S. Bujanover, M. Brod","doi":"10.1183/23120541.sleepandbreathing-2019.p41","DOIUrl":"https://doi.org/10.1183/23120541.sleepandbreathing-2019.p41","url":null,"abstract":"Background: Obstructive sleep apnea (OSA) with excessive daytime sleepiness (EDS) can impair quality of life (QOL) and may go undiagnosed. Objectives: To examine the diagnosis experience and impacts of EDS with OSA on QOL in the US. Methods: Focus groups in 3 US cities with 42 patients experiencing EDS with OSA; coded transcripts qualitatively analysed using adapted grounded theory approach. Results: Prior to diagnosis, 40% (n=17) of patients were aware of their EDS and 74% (n=31) were informed of their other OSA symptoms by a spouse/partner, family or friends. About half (n=22, 52%) waited an average of 11.4 (range 1-37) years to seek medical care for OSA; 32% (n=7/22) had thought their symptoms were normal rather than a sign of OSA. Reasons for seeking care were: input from a loved one (n=21, 50%); self-concern about symptoms (n=7, 17%); and impaired driving (n=5, 12%). Twenty-seven patients discussed referral pathways: 15/27 (56%) first saw a primary care physician and 12/27 (44%) a specialist. Although 74% (n=31) were currently on OSA treatment, the majority reported EDS impacts on physical functioning (n=40, 95%); daily life (n=39, 93%); cognition (n=38, 90%); social life (n=37, 88%); and work (n=29, 69%). Conclusions: In the US, OSA diagnosis is often delayed, with many patients unaware of the need to seek medical care. Following OSA diagnosis, EDS may continue to impair QOL. Future research should address diagnostic delays and unmet treatment needs for this population.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130419762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P44
A. Gabryelska, M. Panek, J. Szemraj, P. Białasiewicz
Introduction: Obstructive sleep apnea (OSA) is a chronic condition that is characterised by recurrent pauses in breathing during sleep. Adropin is a short peptide, mainly expressed in liver and brain. It plays a key role in energy homeostasis, lipid and glucose metabolism. Aim: To investigate the relationship between the adropin protein concertation in blood serum and severity of the disorder among OSA patients. Methods: 36 patients (83% male) referred to Sleep Disorders Centre were included in the study. Patients underwent polysomnography (PSG) examination. Peripheral blood was collected in the morning (6:00-7:00 am) after the PSG. Based on PSG results patients were divided into 2 groups: severe OSA (AHI>30) and control group (AHI Results: Higher adropin protein concentration level was observed in group with severe OSA (p=0.022) compared to controls. There has been difference between the groups regarding BMI (p Conclusion: Patients suffering from severe OSA have higher concentration level adropin than controls. There is a need to further investigate adropin, in larger cohort and in context of OSA comorbidities as it could be a relevant factor in their etiopathogenesis.
简介阻塞性睡眠呼吸暂停（OSA）是一种慢性疾病，其特征是睡眠中反复出现呼吸暂停。Adropin 是一种短肽，主要在肝脏和大脑中表达。它在能量平衡、脂质和葡萄糖代谢中发挥关键作用。目的：研究 OSA 患者血清中阿托品蛋白协同作用与疾病严重程度之间的关系。方法：研究纳入了 36 名转诊至睡眠障碍中心的患者（83% 为男性）。患者接受了多导睡眠图（PSG）检查。在 PSG 结束后的早晨（6:00-7:00）采集外周血。根据 PSG 结果，患者被分为两组：严重 OSA 组（AHI>30）和对照组（AHI 结果为 30）：与对照组相比，严重 OSA 组的阿拖品蛋白浓度水平更高（P=0.022）。各组间的体重指数存在差异（P 结论：严重 OSA 患者的体重指数高于对照组（P=0.022）：严重 OSA 患者的阿拖品蛋白浓度水平高于对照组。有必要在更大的群体中并结合 OSA 合并症进一步研究阿托品，因为它可能是这些合并症发病机制中的一个相关因素。
{"title":"Adropin protein concentration level among obstructive sleep apnea patients – pilot study","authors":"A. Gabryelska, M. Panek, J. Szemraj, P. Białasiewicz","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P44","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P44","url":null,"abstract":"Introduction: Obstructive sleep apnea (OSA) is a chronic condition that is characterised by recurrent pauses in breathing during sleep. Adropin is a short peptide, mainly expressed in liver and brain. It plays a key role in energy homeostasis, lipid and glucose metabolism. Aim: To investigate the relationship between the adropin protein concertation in blood serum and severity of the disorder among OSA patients. Methods: 36 patients (83% male) referred to Sleep Disorders Centre were included in the study. Patients underwent polysomnography (PSG) examination. Peripheral blood was collected in the morning (6:00-7:00 am) after the PSG. Based on PSG results patients were divided into 2 groups: severe OSA (AHI>30) and control group (AHI Results: Higher adropin protein concentration level was observed in group with severe OSA (p=0.022) compared to controls. There has been difference between the groups regarding BMI (p Conclusion: Patients suffering from severe OSA have higher concentration level adropin than controls. There is a need to further investigate adropin, in larger cohort and in context of OSA comorbidities as it could be a relevant factor in their etiopathogenesis.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128127965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P45
M. Ljunggren, J. Theorell-Haglöw, E. Freyhult, A. Malinovschi, C. Janson, E. Lindberg
Background: Proteomic-based technologies offer new possibilities to identify altered levels of cardiac and inflammatory proteins that might reflect the cardiometabolic stress caused by different measures of OSA. Aim: To investigate the effects of OSA on the cardiovascular system by analysing a broad panel of cardiac and inflammatory proteins in relationship to different measures of OSA in a population based cohort of women. Method: In the “Sleep and Health in Women” (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements and blood sampling. Two proteomic assays (Olink Proseek® Inflammation panel and Cardiovascular II panel), each measuring 92 proteins, were analysed in a subsample of 253 women. Results: In unadjusted models, with false discovery rate set to 10%, 57 proteins were associated with AHI, 56 proteins with ODI and 64 proteins with REM AHI. After adjustment for age, BMI and plate there were no significant associations between AHI or ODI and any of the proteins. REM AHI>30 was associated with decreased levels of two proteins involved in anti-inflammatory processes; Sirt2 (q-value 0.016) and LAP-TGFs1 (q-value 0.016). There was further a negative association between REM AHI>30 and Axin1 (q-value 0.095), a protein known to facilitate TGFs signalling. Conclusion: Severe OSA during REM sleep affected the plasma levels of Sirt2, LAP-TGFs1 and Axin1. For overall AHI and ODI the associations with cardiac and inflammatory proteins were weaker and to a large extent explained by age and BMI.
{"title":"Impact of severe OSA during REM sleep on cardiac and inflammatory protein levels","authors":"M. Ljunggren, J. Theorell-Haglöw, E. Freyhult, A. Malinovschi, C. Janson, E. Lindberg","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P45","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P45","url":null,"abstract":"Background: Proteomic-based technologies offer new possibilities to identify altered levels of cardiac and inflammatory proteins that might reflect the cardiometabolic stress caused by different measures of OSA. Aim: To investigate the effects of OSA on the cardiovascular system by analysing a broad panel of cardiac and inflammatory proteins in relationship to different measures of OSA in a population based cohort of women. Method: In the “Sleep and Health in Women” (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements and blood sampling. Two proteomic assays (Olink Proseek® Inflammation panel and Cardiovascular II panel), each measuring 92 proteins, were analysed in a subsample of 253 women. Results: In unadjusted models, with false discovery rate set to 10%, 57 proteins were associated with AHI, 56 proteins with ODI and 64 proteins with REM AHI. After adjustment for age, BMI and plate there were no significant associations between AHI or ODI and any of the proteins. REM AHI>30 was associated with decreased levels of two proteins involved in anti-inflammatory processes; Sirt2 (q-value 0.016) and LAP-TGFs1 (q-value 0.016). There was further a negative association between REM AHI>30 and Axin1 (q-value 0.095), a protein known to facilitate TGFs signalling. Conclusion: Severe OSA during REM sleep affected the plasma levels of Sirt2, LAP-TGFs1 and Axin1. For overall AHI and ODI the associations with cardiac and inflammatory proteins were weaker and to a large extent explained by age and BMI.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132039836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.sleepandbreathing-2019.p46
M. Mészáros, P. Horváth, Z. Lázár, L. Kunos, A. Bikov
Background: Obstructive sleep apnoea (OSA) is characterised by chronic intermittent hypoxia (CIH), which can induce expression of adhesion molecules, such as P-selectin. P-selectin interacts with its major ligand, the P-selectin glycoprotein ligand-1 (PSGL-1). PSGL-1 expressed on leukocytes and its interaction with P-selectin plays important role in rolling and migration of leukocytes trough the endothelium. The aim of this study to evaluate circulating P-selectin and PSGL-1 concentrations and to understand their role in the pathogenesis of OSA. Methods: 51 patients with OSA and 42 healthy volunteers were recruited. Blood samples were taken before and after a diagnostic polysomnography (PSG). The concentration of plasma PSGL-1 and P-selectin was measured using ELISA. Results: There was no difference between circulating PSGL-1 levels of OSA patients and control subjects, either in the evening or in the morning (478.06 ± 170.43 U/ml vs. 497.95 ± 236.09 U/ml p = 0.67 in the morning and 476.20 ± 217.24 U/ml vs. 495.72 ± 230.81 U/ml p = 0.70 in the evening). P-selectin levels were significantly higher in OSA patients compared to the control group (18.43 ± 7.40 vs. 22.85 ± 11.90 ng/ml in controls and OSAS respectively, p = 0.03). There was no correlation between OSA severity and circulating PSGL-1, but P-selectin correlated significantly with AHI (r = 0.45, p Conclusion: Our results suggest that endothelial activation plays a role in OSA without altering adhesion molecules on leukocytes.
背景:阻塞性睡眠呼吸暂停(OSA)以慢性间歇性缺氧(CIH)为特征，可诱导p -选择素等粘附分子的表达。p -选择素与其主要配体p -选择素糖蛋白配体-1 (PSGL-1)相互作用。PSGL-1在白细胞上的表达及其与p -选择素的相互作用在白细胞通过内皮的滚动和迁移中起重要作用。本研究的目的是评估循环p -选择素和PSGL-1浓度，并了解它们在OSA发病机制中的作用。方法:招募51例OSA患者和42名健康志愿者。在诊断性多导睡眠图(PSG)前后采集血样。ELISA法测定血浆PSGL-1和p -选择素浓度。结果:OSA患者与对照组夜间和清晨循环PSGL-1水平无差异(清晨478.06±170.43 U/ml比497.95±236.09 U/ml p = 0.67，晚间476.20±217.24 U/ml比495.72±230.81 U/ml p = 0.70)。OSA患者p -选择素水平显著高于对照组(对照组为18.43±7.40 ng/ml, OSA组为22.85±11.90 ng/ml, p = 0.03)。OSA严重程度与循环PSGL-1无相关性，但p -选择素与AHI有显著相关性(r = 0.45, p)。结论:内皮活化在OSA中起作用，但不改变白细胞粘附分子。
{"title":"The role of PSGL-1 and P-selectin in OSA","authors":"M. Mészáros, P. Horváth, Z. Lázár, L. Kunos, A. Bikov","doi":"10.1183/23120541.sleepandbreathing-2019.p46","DOIUrl":"https://doi.org/10.1183/23120541.sleepandbreathing-2019.p46","url":null,"abstract":"Background: Obstructive sleep apnoea (OSA) is characterised by chronic intermittent hypoxia (CIH), which can induce expression of adhesion molecules, such as P-selectin. P-selectin interacts with its major ligand, the P-selectin glycoprotein ligand-1 (PSGL-1). PSGL-1 expressed on leukocytes and its interaction with P-selectin plays important role in rolling and migration of leukocytes trough the endothelium. The aim of this study to evaluate circulating P-selectin and PSGL-1 concentrations and to understand their role in the pathogenesis of OSA. Methods: 51 patients with OSA and 42 healthy volunteers were recruited. Blood samples were taken before and after a diagnostic polysomnography (PSG). The concentration of plasma PSGL-1 and P-selectin was measured using ELISA. Results: There was no difference between circulating PSGL-1 levels of OSA patients and control subjects, either in the evening or in the morning (478.06 ± 170.43 U/ml vs. 497.95 ± 236.09 U/ml p = 0.67 in the morning and 476.20 ± 217.24 U/ml vs. 495.72 ± 230.81 U/ml p = 0.70 in the evening). P-selectin levels were significantly higher in OSA patients compared to the control group (18.43 ± 7.40 vs. 22.85 ± 11.90 ng/ml in controls and OSAS respectively, p = 0.03). There was no correlation between OSA severity and circulating PSGL-1, but P-selectin correlated significantly with AHI (r = 0.45, p Conclusion: Our results suggest that endothelial activation plays a role in OSA without altering adhesion molecules on leukocytes.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114157624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P42
W. Trzepizur, J. Boursier, A. Berréhare, M. Vaillant, P. Ducluzeau, S. Dubois, S. Henni, P. Abraham, P. Calès, C. Aubé, F. Gagnadoux
Background and Aims: Obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD) are frequently encountered in overweight and obese patients. Whether OSA is associated with liver steatosis investigated by magnetic resonance imagery (MRI), a robust and non-invasive physical marker of liver steatosis in a large cohort of patients suspected for OSA is unknown. Methods: 167 nondrinking patients with nocturnal polysomnographic recording for clinical suspicion of OSA were included in the study. Liver steatosis evaluation was performed by measuring the proton density fat fraction (PDFF) which is the fraction of MRI visible protons bound to fat divided by all protons in the liver. Significant liver steatosis was defined as a PDFF ?6.5%. Results: 11(6.5%) patients had no OSA, 31 (18.6%) had mild OSA, 56 (33.5%) had moderate OSA and 69 (41.3%) had severe OSA. 79 (47.3%) patients had a PDFF values ?6.5%. On univariate analysis, severe OSA (AHI ?30 events/h) was associated with a significantly increased risk of a PDFF ?6.5% (OR 2.04, 95% CI 1.09–3.80) but the association was not maintained after adjusting for confounders including age, gender, triglycerides level and body mass index (OR 1.27, 95%CI 0.63–2.56). Conclusions: Severe OSA is associated with increased liver steatosis but the association is not maintained after adjusting for confounders including BMI.
{"title":"Association between obstructive sleep apnea and liver steatosis investigated by magnetic resonance imaging","authors":"W. Trzepizur, J. Boursier, A. Berréhare, M. Vaillant, P. Ducluzeau, S. Dubois, S. Henni, P. Abraham, P. Calès, C. Aubé, F. Gagnadoux","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P42","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P42","url":null,"abstract":"Background and Aims: Obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease (NAFLD) are frequently encountered in overweight and obese patients. Whether OSA is associated with liver steatosis investigated by magnetic resonance imagery (MRI), a robust and non-invasive physical marker of liver steatosis in a large cohort of patients suspected for OSA is unknown. Methods: 167 nondrinking patients with nocturnal polysomnographic recording for clinical suspicion of OSA were included in the study. Liver steatosis evaluation was performed by measuring the proton density fat fraction (PDFF) which is the fraction of MRI visible protons bound to fat divided by all protons in the liver. Significant liver steatosis was defined as a PDFF ?6.5%. Results: 11(6.5%) patients had no OSA, 31 (18.6%) had mild OSA, 56 (33.5%) had moderate OSA and 69 (41.3%) had severe OSA. 79 (47.3%) patients had a PDFF values ?6.5%. On univariate analysis, severe OSA (AHI ?30 events/h) was associated with a significantly increased risk of a PDFF ?6.5% (OR 2.04, 95% CI 1.09–3.80) but the association was not maintained after adjusting for confounders including age, gender, triglycerides level and body mass index (OR 1.27, 95%CI 0.63–2.56). Conclusions: Severe OSA is associated with increased liver steatosis but the association is not maintained after adjusting for confounders including BMI.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124472226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.sleepandbreathing-2019.p40
M. Zimmermann, M. Maathuis, Sunil Kumar
EEG based sleep staging is commonly conducted at clinical setting, which may disturb patients’ sleep habits and thus impair study results. A non-invasive method of sleep staging through cardiorespiratory signals and body movement allow us to classify the stages awake, light, deep and REM sleep using random forest (RF) with good clinical accuracy. The aim is to improve the latter by tuning the RF hyperparameters. Statistical features of size p=63 extracted from vital signals from 13 nights of healthy subjects were used as inputs to the classifiers and classified using 30s epochs. The hyperparameters were tuned over the splitting criteria Gini and entropy, maximal tree depth (up to fully grown), number of trees (up to 1000) and maximal number of features considered at each split (p, vp or log p). Classification accuracies when employing a 10-fold cross-validation were highest with the hyperparameters Gini, vp used features, tree depth of 30 and 1000 trees, yielding an accuracy of (72.8±1.3)%. The feature importance ranking was consistent between the different classifiers, where respiration variability standard deviation always came first with (5.3±2.3)%, ahead of the second by (1.9±1.1)%. Selecting only the most important features may allow to increase the accuracy further by reducing noisy inputs while decreasing computation time. Cardiorespiratory features came out as much more relevant than movement, which indicates that the latter may be omitted without risking a meaningful decrease in scoring accuracy.
{"title":"Feature selection for sleep staging using cardiorespiratory and movement signals","authors":"M. Zimmermann, M. Maathuis, Sunil Kumar","doi":"10.1183/23120541.sleepandbreathing-2019.p40","DOIUrl":"https://doi.org/10.1183/23120541.sleepandbreathing-2019.p40","url":null,"abstract":"EEG based sleep staging is commonly conducted at clinical setting, which may disturb patients’ sleep habits and thus impair study results. A non-invasive method of sleep staging through cardiorespiratory signals and body movement allow us to classify the stages awake, light, deep and REM sleep using random forest (RF) with good clinical accuracy. The aim is to improve the latter by tuning the RF hyperparameters. Statistical features of size p=63 extracted from vital signals from 13 nights of healthy subjects were used as inputs to the classifiers and classified using 30s epochs. The hyperparameters were tuned over the splitting criteria Gini and entropy, maximal tree depth (up to fully grown), number of trees (up to 1000) and maximal number of features considered at each split (p, vp or log p). Classification accuracies when employing a 10-fold cross-validation were highest with the hyperparameters Gini, vp used features, tree depth of 30 and 1000 trees, yielding an accuracy of (72.8±1.3)%. The feature importance ranking was consistent between the different classifiers, where respiration variability standard deviation always came first with (5.3±2.3)%, ahead of the second by (1.9±1.1)%. Selecting only the most important features may allow to increase the accuracy further by reducing noisy inputs while decreasing computation time. Cardiorespiratory features came out as much more relevant than movement, which indicates that the latter may be omitted without risking a meaningful decrease in scoring accuracy.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115324804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.sleepandbreathing-2019.p48
I. Prediletto, F. Tavalazzi, A. Fabiani, S. Nava
LAM is a rare and progressive pulmonary disease characterized by cystic radiological pattern and by the possible presence of angiomyolipomas in other organs. Functionally LAM consists in airway obstruction and progressive hypoxemia leading to respiratory failure. No studies, so far, investigated whether during sleep LAM patients show changes in the sleep profile. Aim of our study was to evaluate if, during sleep, the physiological modification of respiration is associated with polysomnographic (PSG) alterations. 8 patients affected by LAM underwent a whole-night polysomnography. Either respiratory failure or use of long-term oxygen therapy were exclusion criteria. All patients were female and had a normal BMI. 3 out of 8 patients (37.5%) had alterations to the PSG pattern: 1 patient showed obstructive sleep apnea (AHI 8.6), 1 patient had nocturnal desaturation (SatO2 time below 90% "T90" equal to 17.2%), while 1 patient had nocturnal desaturation (T90 = 27%) and obstructive sleep apnea (AHI 7.5). No arrhythmias were reported. Median sleep efficiency was 91% and median REM latency was 49 minutes. The two patients (25%) with nocturnal desaturation were treated with nocturnal oxygen therapy solving sleep desaturations, showing clinical improvement. This pilot study underlines the importance of assessing respiration during sleep in patients affected by LAM: these patients have a fragile respiratory balance and the normal physiological sleep modifications could translate in pathological desaturations, worsening the damage.
{"title":"Sleep disorders in patients affected by Lymphangioleiomiomatosis (LAM)","authors":"I. Prediletto, F. Tavalazzi, A. Fabiani, S. Nava","doi":"10.1183/23120541.sleepandbreathing-2019.p48","DOIUrl":"https://doi.org/10.1183/23120541.sleepandbreathing-2019.p48","url":null,"abstract":"LAM is a rare and progressive pulmonary disease characterized by cystic radiological pattern and by the possible presence of angiomyolipomas in other organs. Functionally LAM consists in airway obstruction and progressive hypoxemia leading to respiratory failure. No studies, so far, investigated whether during sleep LAM patients show changes in the sleep profile. Aim of our study was to evaluate if, during sleep, the physiological modification of respiration is associated with polysomnographic (PSG) alterations. 8 patients affected by LAM underwent a whole-night polysomnography. Either respiratory failure or use of long-term oxygen therapy were exclusion criteria. All patients were female and had a normal BMI. 3 out of 8 patients (37.5%) had alterations to the PSG pattern: 1 patient showed obstructive sleep apnea (AHI 8.6), 1 patient had nocturnal desaturation (SatO2 time below 90% \"T90\" equal to 17.2%), while 1 patient had nocturnal desaturation (T90 = 27%) and obstructive sleep apnea (AHI 7.5). No arrhythmias were reported. Median sleep efficiency was 91% and median REM latency was 49 minutes. The two patients (25%) with nocturnal desaturation were treated with nocturnal oxygen therapy solving sleep desaturations, showing clinical improvement. This pilot study underlines the importance of assessing respiration during sleep in patients affected by LAM: these patients have a fragile respiratory balance and the normal physiological sleep modifications could translate in pathological desaturations, worsening the damage.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"227 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120840305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-11DOI: 10.1183/23120541.SLEEPANDBREATHING-2019.P39
Sejoong Kim, Y. Lee, Jong-Sun Park, Y. Cho, H. Yoon, C. Lee, Jae Ho Lee
Background: Delirium is common in the intensive care unit (ICU). Many critically ill patients treated in the ICU experience sleep disruption. Disrupted sleep in the ICU has been proposed as a potential risk factor for delirium, but the evidence is sparse. This study was undertaken to identify the sleep status for the development of delirium in non-sedated critically ill patients Methods: This prospective study was conducted in medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hour to assess the quantity and quality of sleep. Delirium was measured daily using the Confusion Assessment Method for the ICU. Results: Total 20 patients were enrolled. Median total sleep time was 03:43 (hh:mm, IQR: 00:49 - 06:10). The majority of sleep was stage 1 (median 03:02 [00:47 - 04:34]) with scant stage 2 (median 00:00 [00:00 - 00:46]), REM (median 00:00 [00:00 - 00:15]) and absent stage 3. Delirium was developed in 4 patients (20%). In multivariable analysis, the duration of ICU stay more than 5 days was independently associated with delirium incidence (P=0.042). We also found that patients who stayed more than 5 days in ICU showed significant reduction in night sleep time compared to patients who stayed less than 5 days (00:42 ± 0:46 vs 2:04 ± 1:25, P=0.012), despite of similar total sleep time. Conclusions: The long duration of ICU stay disrupted night sleep which might contribute to the development of delirium in critically ill patients.
{"title":"Night sleep disruption related to delirium incidence in critically ill patients","authors":"Sejoong Kim, Y. Lee, Jong-Sun Park, Y. Cho, H. Yoon, C. Lee, Jae Ho Lee","doi":"10.1183/23120541.SLEEPANDBREATHING-2019.P39","DOIUrl":"https://doi.org/10.1183/23120541.SLEEPANDBREATHING-2019.P39","url":null,"abstract":"Background: Delirium is common in the intensive care unit (ICU). Many critically ill patients treated in the ICU experience sleep disruption. Disrupted sleep in the ICU has been proposed as a potential risk factor for delirium, but the evidence is sparse. This study was undertaken to identify the sleep status for the development of delirium in non-sedated critically ill patients Methods: This prospective study was conducted in medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hour to assess the quantity and quality of sleep. Delirium was measured daily using the Confusion Assessment Method for the ICU. Results: Total 20 patients were enrolled. Median total sleep time was 03:43 (hh:mm, IQR: 00:49 - 06:10). The majority of sleep was stage 1 (median 03:02 [00:47 - 04:34]) with scant stage 2 (median 00:00 [00:00 - 00:46]), REM (median 00:00 [00:00 - 00:15]) and absent stage 3. Delirium was developed in 4 patients (20%). In multivariable analysis, the duration of ICU stay more than 5 days was independently associated with delirium incidence (P=0.042). We also found that patients who stayed more than 5 days in ICU showed significant reduction in night sleep time compared to patients who stayed less than 5 days (00:42 ± 0:46 vs 2:04 ± 1:25, P=0.012), despite of similar total sleep time. Conclusions: The long duration of ICU stay disrupted night sleep which might contribute to the development of delirium in critically ill patients.","PeriodicalId":250960,"journal":{"name":"Clinical Assessment and Comorbidities of Sleep Disorders","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129446825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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