Journal of Clinical Sleep Medicine最新文献

Study objectives: A non-intrusive sleep monitoring technology based on the data from a commercially available depth sensing camera has been utilized for respiratory monitoring and shown to have good performance in assessing respiratory rates across a range of rates. This non-contact, or touchless, technology allows continuous respiratory monitoring without attaching probes to the patient. We have noticed a strikingly similar morphology between the touchless flow signal (NCM_flow) and the flow signal derived using the chest and abdomen respiratory inductance plethysmography (RIP_flow) bands. Here we report on a quantitative assessment of the morphological similarity between the two signals for a cohort of patients undergoing polysomnography (PSG).

Methods: We collected depth data from 25 sleep patients undergoing attended PSG. Correlation and mutual trending were assessed between the NCM_flow and RIP_flow signals in subjects undergoing diagnostic and split night PSG using Pearson correlation and concordance between the NCM_flow and RIP _flow signals.

Results: Strong correlation was observed across all patients between the NCM_flow and RIP_flow signals (range: 0.78 - 0.98, mean: 0.89±0.06). Similarly, high values of concordance were achieved between the NCM_flow and RIP_flow signals (range: 0.85 - 1.0, mean: 0.96±0.04).

Conclusions: The high values of correlation and concordances confirm that the NCM_flow signal can potentially be used as a surrogate for RIP_flow signal during sleep. Our findings strongly support the potential for non-contact, continuous monitoring of respiratory disturbances during sleep.

Study objectives: To evaluate the concordance between visual scoring and automated detection of REM sleep without atonia (RSWA) and the validity and reliability of in-home automated-RSWA detection in REM sleep behavior disorder (RBD) patients and a control group (CG).

Methods: Sleep Profiler signals were acquired during simultaneous in-laboratory polysomnography in 24 isolated RBD patients. Chin and arm RSWA measures visually scored by an expert sleep technologist were compared to algorithms designed to automate RSWA detection. In a second cohort, the accuracy of automated-RSWA detection for discriminating between RBD and CG (n = 21 and 42, respectively) was assessed in multi-night in-home recordings.

Results: For the in-laboratory studies, agreement between visual and auto-scored RSWA from the chin and arm were excellent, with intra-class correlations of 0.89 and 0.95, respectively, and substantial, based on Kappa scores of 0.68 and 0.74, respectively. For classification of iRBD patients versus controls, specificities derived from auto-detected RSWA densities obtained from in-home recordings were 0.88 for the chin, 0.93 for the arm, and 0.90 for the chin or arm, while the sensitivities were 0.81, 0.81 and 0.86, respectively. The night-to-night consistencies of the respective auto-detected RSWA densities were good based on intra-class correlations of 0.81, 0.79 and 0.84, however some night-to-night disagreements in abnormal RSWA detection were observed.

Conclusions: When compared to expert visual RSWA scoring, automated RSWA detection demonstrates promise for detection of RBD. The night-to-night reliability of chin- and arm-RSWA densities acquired in-home were equivalent.

Obesity hypoventilation syndrome (OHS) is caused by complex interactions between multiple pathological processes, including diminished respiratory drive and sleep-related breathing alterations, leading to structural and functional respiratory impairment and ultimately, pulmonary hypertension (PH). Because PH is closely associated with OHS, thoroughly evaluating its etiology is essential, and individualized treatments must be considered. We describe two patients with OHS exhibiting severe PH with pulmonary vascular resistance exceeding 5 Wood units; both were classified as Group 1 PH, i.e., pulmonary arterial hypertension (PAH). Initially admitted to our hospital complaining of dyspnea, both patients commenced PAH therapies in addition to positive airway pressure therapy and diuretics, improving their hemodynamic status, dyspnea, and exercise capacity, and finally enabling their discharge. These findings suggest that PAH can coexist with OHS, and PAH therapies, introduced with careful consideration, may provide substantial benefits for select patients.

Study objectives: Mitigating gender inequality in the diagnosis and management of sleep-disordered breathing (SDB) is of paramount importance. Historically, the diagnostic criteria for SDB were based on male physiology and did not account for variations in disease manifestation based on sex. Some payors use a definition of hypopnea that requires a 4% oxygen desaturation (AHI-4) to determine coverage for treatment, while the criteria recommended by the American Academy of Sleep Medicine requires either a 3% oxygen desaturation or an arousal (AHI-3A). This study examined the diagnostic implications of these two definitions for men and women in a clinical setting.

Methods: We reviewed polysomnography (PSG) reports for all patients who completed a diagnostic PSG study at one sleep disorders center in 2019. Every PSG was scored using both sets of criteria to determine AHI-4 and AHI-3A.

Results: Data from 279 women (64.7%), and 152 men (34.3%) were analyzed. Overall, the mean AHI-4 was 21.9±27.3, and the mean AHI-3A was 34.7±32.3 per hour of sleep. AHI-3A resulted in a diagnostic increase of 30.4% (p=0.001) for women and 21.7% (p=0.006) for men. Women saw a greater increase in diagnosis of mild and moderate SDB, while men saw a greater increase in severe SDB with the AHI-3A compared to the AHI-4 definition.

Conclusions: The definition of hypopnea used in the AHI-3A criteria is more consistent with the pathophysiology of SDB in women and results in higher rates of diagnosis. Use of the AHI-4 criteria may create a sex-based disparity in diagnosis, leading to symptomatic women remaining undiagnosed and untreated.

Study objectives: Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by autonomic dysfunction associated with a combination of cerebellar, parkinsonian, or pyramidal signs. Sleep-disordered breathing (SDB) such as stridor, obstructive sleep apnea (OSA) and central sleep apnea (CSA) are common in MSA and can impact survival. Several studies have evaluated treatment modalities. However, the optimal strategy often remains unclear in these patients. This review aims to provide an overview of the current evidence on treatment of SDB in MSA.

Methods: Systematic review of the current literature through combined keyword search in PubMed, Embase, the Cochrane Library and cited references: multiple system atrophy, stridor, sleep apnea syndrome, sleep-disordered breathing, Shy Drager syndrome.

Results: Twenty-nine papers were included, with a total of 681 MSA patients with SDB. Treatment modalities are: continuous positive airway pressure (CPAP); tracheostomy; tracheostomy invasive ventilation (TIV); non-invasive positive pressure ventilation (NPPV); adaptive servoventilation (ASV); vocal cord surgery; botulinum toxin injections; oral appliance therapy; cervical spinal cord stimulation; selective serotonin reuptake inhibitors (SSRIs).

Conclusions: Conflicting results on survival are found for CPAP therapy. Tracheostomy has a proven survival benefit. Most beneficial outcomes are seen with TIV. CPAP, other types of PAP and tracheostomy can adequately control symptoms of OSA. However, CPAP may exacerbate central sleep apnea. There was a lack of sufficient data regarding ASV or NPPV. Some patients exhibit a floppy epiglottis and require a different approach. In conclusion, due to the complex characteristics of SDB in MSA, an individualized and multidisciplinary approach is mandatory.

Study objectives: To examine the feasibility, acceptability, and impact of a Sleep Promotion Program (SPP).

Methods: This pilot trial randomized adolescents (13-15y) with insufficient sleep duration and irregular sleep timing to SPP-continuation (n=24; SPP in month 1, continuation treatment in month 2) or monitoring-SPP (n=20; monitoring in month 1, SPP in month 2). SPP included one clinician session and at-home delivery of web-based reports of each youth's sleep diary data with accompanying intervention questions that prompt youth to engage in sleep behavior change. Attrition rate primarily measured feasibility. Program satisfaction measured acceptability. Total sleep time (TST), sleep timing, and sleep timing regularity were measured via sleep diary at baseline, follow-up 1, and follow-up 2 (each ∼1 month apart). Linear mixed effects models compared treatment arms on changes in sleep from baseline to follow-up 1 (month 1). We also compared changes in sleep during month 1 to changes in sleep during month 2 among SPP-continuation participants.

Results: Attrition rate was 8.5%. 96.5% participants rated the quality of care received as good or excellent. In month 1, SPP-continuation youth showed a significantly greater increase in mean TST than monitoring-SPP youth (0.57 vs. -0.38 hours; contrast=0.95; CI=0.14, 1.76, p=0.024). SPP-continuation participants showed an increase in TST during month 1 (0.51h) but a decrease during month 2 (-0.74 h; contrast=-1.24, CI=-2.06, -0.42, p=0.005). No other significant effects were observed.

Conclusions: SPP is highly feasible, acceptable, and associated with a significant increase in TST early in treatment.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Targeted Intervention for Insufficient Sleep among Typically-Developing Adolescents; Identifier: NCT04163003; URL: https://clinicaltrials.gov/ct2/show/NCT04163003.

Study objectives: The primary objective is to determine if pulsating airflow can achieve therapeutic pharyngeal pressure levels without requiring a tight-sealing mask.

Methods: A pilot study included 12 nasal-breathing adults who are currently using positive airway pressure (PAP) for therapy. Patients were awake, and pharyngeal pressures were measured using a miniature pressure probe inserted through their nares. Pulsating airflow was applied via a nasal cannula with a customized valve. The inspiratory flow rate was increased until the pharyngeal pressure matched or exceeded the participant's prescribed PAP level. The expiratory flow rate was maintained at a constant low level of continuous airflow.

Results: The study demonstrated that pulsating airflow could generate pharyngeal pressures equivalent to or higher than those achieved with PAP therapy in all participants. The peak inspiratory pressures with pulsating airflow followed an oscillatory pattern matching the pulsation frequency. The mean peak pressure increased linearly with the pulsating flow rate. Compared to a high-flow nasal cannula, pulsating airflow produced significantly higher inspiratory pharyngeal pressures, reaching nearly 20 cmH2O.

Conclusions: Pulsating airflow could be a viable method for delivering PAP therapy to patients with respiratory or sleep disorders without needing a tight-sealing mask. Further research is required to establish whether this method can improve patient compliance with PAP therapy, assess long-term safety and efficacy, and explore the impact of varying pulsation parameters on treatment outcomes.