Journal of Clinical Sleep Medicine最新文献

Central sleep apnea due to Cheyne-Stokes respiration (CSA-CSR) is frequently described in adults with cardiac failure, but few (<20) cases are reported in children. We report the case of a 10-year old boy with dilated cardiomyopathy and cardiac failure (left ventricular ejection fraction 36%), in whom recurrent, prolonged pauses in breathing during sleep were noted. A cardiorespiratory polygraphy (CRpoly) sleep study was performed, which demonstrated the presence of CSA-CSR. 373 central events were scored and central apnea-hypopnea index (cAHI) was 47.4. Overnight continuous positive airways pressure (CPAP) was commenced via a nasal mask. Both child and mother reported improved well-being on CPAP, and a repeat CRpoly on CPAP noted a fall in cAHI to 1.2. We believe this to be the first case describing successful treatment of CSA-CSR in a child using CPAP. The improvement in patient well-being highlights the importance of a sleep history and/or sleep studies in children with cardiac failure.

Study objectives: Obstructive sleep apnea (OSA) poses significant health risks, warranting effective treatment strategies. While Continuous Positive Airway Pressure (CPAP) therapy is widely utilized, assessing treatment effectiveness remains complex. This study aimed to establish reference values for mean disease alleviation (MDA) in a large CPAP-treated cohort.

Methods: Data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES) were analyzed. A total of 352 participants underwent 6 months of CPAP therapy, with adherence and efficacy monitored objectively. MDA, calculated as the product of treatment efficacy and percentage adherence, was assessed. Age and sex differences in MDA and its association with sleepiness (Epworth Sleepiness Scale scores >10) were evaluated using logistic regression and linear regression models.

Results: The mean MDA in the 352 participants at 6 months was 61.1% (±34.2%), with a significant positive correlation between MDA and adherence (R=0.81, P<0.001). Older participants demonstrated higher adherence and MDA compared to younger participants (58.2% ± 27.8% vs. 51.1% ± 27.4%, P=0.047). Despite higher efficacy, females demonstrated lower adherence, yielding comparable MDA levels to males. Participants achieving MDA ≥40% had significantly lower odds of sleepiness (OR=0.40, 95% CI: 0.23-0.70, P=0.001).

Conclusions: MDA serves as a valuable metric for evaluating OSA therapy outcomes, integrating both adherence and treatment efficacy. MDA ≥40% was associated with clinically meaningful improvements in sleepiness. Embracing MDA as a benchmark for OSA therapy evaluation holds promise for optimizing personalized and effective OSA management and improving patient outcomes. Future research should focus on optimizing MDA and exploring its impact on long-term outcomes.

Study objectives: The prevalence of positional obstructive sleep apnea (POSA) in community populations warrants further investigation. Further, more research is needed into the clinical characteristics of its subtypes such as supine predominant OSA (spOSA) and supine isolated OSA (siOSA).

Methods: A cross-sectional analysis was performed on 1870 Sleep Heart Health Study participants. OSA was defined by an apnea-hypopnea index (AHI) of five events or more per hour of sleep. Participants with OSA were classified as POSA if the supine AHI was ≥2 times the non-supine AHI. Participants with OSA who did not meet this threshold were classified as non-positional OSA participants (non-POSA). Demographics, polysomnographic data, comorbidities, and medications were all considered. The POSA subtypes spOSA and siOSA were also investigated.

Results: POSA participants were slightly older, less obese, and had higher systolic blood pressure than non-POSA subjects, in addition to being more prevalent (62% and 38%, respectively). POSA exhibited higher supine and total AHI. The prevalence of comorbidities or prescription drugs did not differ. In the POSA cohort, spOSA was more prevalent than siOSA (56% vs. 44%). When compared to siOSA, spOSA was associated with more fragmented sleep and higher AHI. Furthermore, when compared to the siOSA group, the spOSA group had a higher prevalence of hypertension and diabetes, as well as more frequently prescribed medications for these comorbidities.

Conclusions: In the SHHS population the prevalence of POSA is greater than non-POSA. The spOSA subtype is more prevalent and appears to have worse health consequences than siOSA.

Study objectives: To elucidate hypotheses for the pathophysiology of idiopathic hypersomnia and discuss the mechanisms by which low-sodium oxybate (LXB) improves idiopathic hypersomnia symptoms.

Methods: Published literature on idiopathic hypersomnia sleep abnormalities, symptoms, treatments, and underlying pathophysiology was reviewed.

Results: Patients with idiopathic hypersomnia often show sleep architecture alterations, such as increased sleep efficiency and reduced slow-wave sleep, although the literature lacks consensus. The current understanding of pathophysiologic changes in idiopathic hypersomnia is sparse, but several hypotheses have been posited to explain specific symptoms. Long biological sleep clock, hypofunction of default mode network, dysregulated gamma-aminobutyric acid (GABA) signaling, inflammation, reduced physical activity, and immunologic abnormalities have been linked, to varying degrees, with the hallmark symptoms of idiopathic hypersomnia (excessive daytime sleepiness, sleep inertia, brain fog, dysautonomia). Treatment mechanisms may help elucidate pathophysiologic mechanisms. LXB effectively addresses idiopathic hypersomnia symptoms and is the only US-approved therapy for this indication. Oxybate, the active moiety in LXB, acts dose-dependently on GABA and gamma-hydroxybutyrate receptors, inhibits dopamine and noradrenaline signaling, and improves sleep architecture in people with narcolepsy. The effectiveness of LXB, a sleep-inducing treatment, on idiopathic hypersomnia symptoms suggests altered sleep architecture may contribute to this disorder.

Conclusions: Idiopathic hypersomnia, a sleep disorder with potentially debilitating symptoms, remains understudied. The underlying pathophysiology of idiopathic hypersomnia needs defining; insights can be gleaned from contextualizing current knowledge about mechanisms of effective treatments, such as LXB.

Study objectives: The objective was to compare demographics between children with achondroplasia and OSA with the general pediatric population with OSA, as well as present treatment outcomes for children with achondroplasia.

Methods: Retrospective chart review of 22 children with achondroplasia and OSA and 141 children with OSA without achondroplasia. Parameters from polysomnography were analyzed. Values before and after surgery were compared for the achondroplasia group, while baseline values were compared between the control group and achondroplasia group.

Results: Pre-intervention in the T&A achondroplasia group, 0 children had mild OSA, 1 had moderate OSA, and 10 had severe OSA. In the comparative group 16 had mild OSA, 11 had moderate OSA, and 114 had severe OSA. The achondroplasia population had a much younger age at T&A compared to the control population - 3.1 versus 6.8 years. When comparing baseline data in the achondroplasia population with respective T&A outcomes, oAHI and SpO₂ were improved. For the adenoidectomy group, there were no significant changes in OSA after surgery. For the Cervicomedullary decompression (CMD) group, there was a decrease in oAHI after surgery.

Conclusions: Patients with achondroplasia and OSA have an earlier age of onset compared to children without achondroplasia. For these patients with moderate to severe OSA, treatment with adenotonsillectomy leads to significant improvement. Treatment with adenoidectomy showed no significant change in OSA. CMD also led to an improvement in oAHI.