Journal of Clinical Sleep Medicine最新文献

Study objectives: U-Sleep is a publicly available automated sleep stager, but has not been independently validated using pediatric data. We aimed to a) test the hypothesis that U-Sleep performance is equivalent to trained humans, using a concordance dataset of 50 pediatric polysomnogram excerpts scored by multiple trained scorers, and b) identify clinical and demographic characteristics that impact U-Sleep accuracy, using a clinical dataset of 3114 polysomnograms from a tertiary center.

Methods: Agreement between U-Sleep and 'gold' 30-second epoch sleep staging was determined across both datasets. Utilizing the concordance dataset, the hypothesis of equivalence between human scorers and U-Sleep was tested using a Wilcoxon two one-sided test (TOST). Multivariable regression and generalized additive modelling were used on the clinical dataset to estimate the effects of age, comorbidities and polysomnographic findings on U-Sleep performance.

Results: The median (interquartile range) Cohen's kappa agreement of U-Sleep and individual trained humans relative to "gold" scoring for 5-stage sleep staging in the concordance dataset were similar, kappa=0.79 (0.19) vs 0.78 (0.13) respectively, and satisfied statistical equivalence (TOST p < 0.01). Median (interquartile range) kappa agreement between U-Sleep 2.0 and clinical sleep-staging was kappa=0.69 (0.22). Modelling indicated lower performance for children < 2 years, those with medical comorbidities possibly altering sleep electroencephalography (kappa reduction=0.07-0.15) and those with decreased sleep efficiency or sleep-disordered breathing (kappa reduction=0.1).

Conclusions: While U-Sleep algorithms showed statistically equivalent performance to trained scorers, accuracy was lower in children < 2 years and those with sleep-disordered breathing or comorbidities affecting electroencephalography. U-Sleep is suitable for pediatric clinical utilization provided automated staging is followed by expert clinician review.

Introduction: This systematic review provides supporting evidence for the accompanying clinical practice guideline on the treatment of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD).

Methods: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of pharmacological or nonpharmacological treatment to no treatment to improve patient-important outcomes. Statistical analyses were performed to determine the clinical significance of using various interventions to treat RLS and PLMD in adults and children. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations.

Results: The literature search resulted in 3631 studies out of which 148 studies provided data suitable for statistical analyses. The task force provided a detailed summary of the evidence along with the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.

Study objectives: Insomnia, poor sleep quality and extremes of sleep duration are associated with COVID-19 infection. This study assessed whether these factors are related to Post-Acute Sequelae of SARS-CoV-2 infection (PASC).

Methods: Cross-sectional survey of a general population of 24,803 U.S. adults to determine the association of insomnia, poor sleep quality and sleep duration with PASC. Three definitions of PASC were used based on post COVID-19 clinical features: COPE (≥3), NICE (≥1), and RECOVER (scoring algorithm).

Results: Prevalence rates of PASC were 21.9%, 38.9%, 15.5% for COPE, NICE and RECOVER PASC definitions, respectively. PASC was associated with insomnia in all 3 models after full adjustment with odds ratios (aORs) and 95% confidence intervals (CI) ranging from 1.30 (95% CI: 1.11-1.52, p≤0.05, PASC Score) to 1.52 (95% CI: 1.34-1.71, p≤0.001, (NICE). Poor sleep quality was related to PASC in all models with aORs ranging from 1.77 (95% CI: 1.60-1.97, p≤0.001, NICE) to 2.00 (95% CI: 1.77-2.26, p≤0.001, COPE). Sleep <6 hours was associated with PASC with aORs between 1.59 (95% CI: 1.40-1.80, p≤0.001, PASC Score) to 1.70 (95% CI: 1.53-1.89, p≤0.001, COPE). Sleep ≥ 9 hours was not associated with PASC in any model. Although vaccination with COVID-19 booster decreased the likelihood of developing PASC, it did not attenuate associations between insomnia, poor sleep quality and short sleep duration with PASC in any of the models.

Conclusions: Insomnia, poor sleep quality and short sleep duration are cross-sectionally associated with PASC and may be potential risk factors. Further longitudinal studies should be conducted.

Study objectives: Examine sleep patterns in children with sleep-disordered breathing (SDB) who habitually bedshare.

Methods: We evaluated associations of bedsharing with parent-reported (n=457) and actigraphy-based (n=258) sleep patterns in a diverse child sample (mean age 6.6±2.3 years, range 3.0-12.9) with mild SDB using baseline data from the Pediatric Adenotonsillectomy Trial for Snoring. Multivariable linear regressions examined associations between sleep patterns and bedsharing, adjusting for sociodemographic, child, and parent/environmental factors. Moderation effects were investigated using interaction terms. Analyses were stratified by age, categorizing children as younger (<6) and older (≥6) years.

Results: Bedsharing rates were 38%, with higher rates in younger (48%) vs. older (30%) children (p<0.001). In adjusted models, bedsharing was associated with about 30 minutes shorter actigraphy-derived nocturnal sleep duration (p=0.005) and parent-reported later sleep midpoint (p< 0.005) in younger children. In older children, associations of bedsharing with shorter parent-reported sleep duration were more pronounced in children with greater SDB symptom burden (p=0.02), and in children with higher ratings of anxiety (p=0.048) and depressive symptoms (p=0.02).

Conclusions: In children with mild SDB, bedsharing is associated with shorter sleep duration and later sleep timing in younger children. In older children, these relationships were modified by child factors, including SDB symptom burden and internalizing symptoms. These findings suggest that whereas age and parenting factors may play a greater role in the younger group, SDB and internalizing symptoms may play more of a role in older children who bedshare, suggesting the need to address co-occurring medical and emotional problems in children with SDB.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Pediatric Adenotonsillectomy for Snoring (PATS); Identifier: NCT02562040.

Study objectives: While previous research has primarily focused on the immediate effects of concussion within the first year post-injury, this study examines the persistent effects of concussion on subsequent sleep quality in adolescent soccer players.

Methods: This study utilized a cross-sectional design, recruiting a convenience sample of adolescent athletes from US Youth Soccer camps. Participants completed a self-reported questionnaire including the Pittsburgh Sleep Quality Index (PSQI) to assess their sleep quality. Athletes were also asked to report sport participation information, any past occurrence of concussion or knee injury, and any sport-related injury in the past 12 months. Independent Samples t-tests were performed to identify significant differences in PSQI scores between injured and non-injured participants.

Results: A total of 177 participants (103 male, 14.61±1.88 years) were included in the analysis. The concussion injury group exhibited later bedtimes (difference: 0.32±0.05 hours; p=0.047), fewer hours of sleep (difference: 0.56±0.11 hours, p=0.015), and more frequent sleep disturbances (p=0.012). Furthermore, these athletes reported lengthened sleep latency (difference: 2.55±3.36 minutes, p=0.016) and higher levels of daytime dysfunction (p=0.041) following their concussion injuries. Moreover, athletes in the concussion injury group displayed worse sleep quality scores (difference: 0.42±0.06, p<0.001) and higher total PSQI scores (difference: 1.91±0.41, p<0.001). No significant differences were found based on past knee injury or sport-related injury in the past 12 months.

Conclusions: These findings suggest the need for targeted interventions aimed at improving sleep quality in adolescent athletes with a history of concussion.

Sleep-disordered breathing (SDB), with both central and obstructive sleep apneas, has been reported in association with Chiari malformation type 1 (CM1). CM1 is a congenital or acquired herniation of the cerebellar tonsils through the foramen magnum. In this case, a five-year-old girl with a history of CM1 and syringomyelia experienced worsening intracranial pressure (ICP) secondary to SDB. This case highlights the importance of early recognition of sleep related respiratory disorders in patients with Chiari malformation and its association with increased intracranial pressure.

Study objectives: Optimal cutoff values of oximetry indices that differentiate obstructive sleep apnea (OSA) from primary snoring (PS) is not well established. Our study aimed to assess the utility of overnight oximetry indices in differentiating PS from OSA and assessing OSA severity, compared to polysomnography (PSG), in children with suspected OSA.

Methods: This was a retrospective study of children (1-18 years) with snoring who underwent PSG. Patients with Down syndrome, craniofacial anomalies, known genetic syndromes, neuromuscular conditions and central apnea index ≥ 5 were excluded. Demographic data, PSG variables and oximetry indices (e.g. oxygen desaturation index [ODI_3, defined as number of ≥ 3% desaturation episodes/hour of artifact free recording time and SpO₂ nadir]) were collected.

Results: Of 1,203 children (mean age 9.1±3.9 years, 67.7% males), 91.8% (847/923) ≤ 12 years and 84.3% (236/280) > 12 years had OSA. Optimal cutoff of ODI₃ for differentiating PS from OSA was 2.4 [Se: 78.8% (75.9%-81.6%), Sp: 80.5% (69.9%-88.7%)] in ≤ 12 years and 3.6 [Se: 71.1% (64.8%-76.8%), Sp: 91.1% (78.8%-97.5%)] in > 12 years. The optimal cutoff of ODI₃ for differentiating PS from mild, moderate and severe OSA categories were 2.0 [Se: 70.1% (65.3%-74.5%), Sp: 70.1% (58.6%-80.0%)]; 3.7 [Se: 82.3% (76.6%-87.1%), Sp: 94.8% (87.2%-98.6%)] and 4.3 [Se: 99.1% (96.8%-99.9%), Sp: 98.7% (93.0%-100.0%)] in ≤ 12 years; and 1.9 [Se: 78.8% (75.9%-81.6%), Sp: 80.5% (69.9%-88.7%)]; 4.1 [Se: 85.4% (72.2%-93.9%), Sp: 91.1% (78.8%-97.5%)] and 6.9 [Se: 98.4% (91.2%-100.0%), Sp: 97.8% (88.2%-99.9%)] in > 12 years, respectively.

Conclusions: This study provides optimal cutoff values for ODI₃ in differentiating PS from OSA and assessing OSA severity in children. As oximetry is cheaper and widely available, ODI₃ has the potential to be incorporated into cost-effective clinical decision-making algorithms, especially in resource limited settings.

Study objectives: Patients with obstructive sleep apnea (OSA) often require the use of a continuous positive airway pressure (CPAP) machine. However, some patients experience issues using CPAP after receiving a dacryocystorhinostomy (DCR) for epiphora. This review aims to assess these complications and the potential interventions.

Methods: A systematic literature search was conducted in March 2023 with the PubMed, EMBASE, Web of Science, and Scopus databases. Since most of the studies were case reports and lacked quantitative results, a narrative review was done.

Results: Fourteen studies were included for review, representing 49 patients. During nightly CPAP use, 77.6% (38/49) of patients experienced air regurgitation onto the ocular surface via the tear drainage passage constructed by DCR. The interventions attempted could be categorized into (a) CPAP changes or (b) ophthalmic management. CPAP changes included changing the CPAP mask (successful in 5/6 patients), modifying the pressure or incorporating heated humidifier tubing (2/8 successes), changing the ventilation mode (1/3 successes), and switching to a CPAP alternative (1/2 successes). Ophthalmic management included eye plugs (3/3 successes), eye lubricants (2/6 successes), an eye patch (1/2 successes), and removal of the Lester Jones tube placed during DCR (1/1 successes). After trying these interventions, 36.7% (18/49) of patients continued to experience symptoms and opted to discontinue CPAP therapy.

Conclusions: CPAP related issues after DCR are common and can be difficult to treat. There are a variety of techniques to improve CPAP use and adherence after DCR.

Study objectives: Narcolepsy type 1 (NT1) is an autoimmune disease caused by the selective attack of orexin-producing neurons. However, the pathophysiology of narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) remains controversial. The neutrophil-to-lymphocyte ratio (NLR) is an easily calculated parameter from the white blood cell (WBC) count, which has already been extensively used as an inflammatory marker in immunological disorders. In this study, by examining the WBC counts of patients with NT1, NT2, and IH compared to controls, and evaluated the NLR to test the possibility of identifying an easy biofluid marker for detecting inflammation and distinguishing patients from healthy controls (HC).

Methods: WBC counts and NLR were compared in 28 NT1, 17 NT2, and 11 IH patients, in addition to 21 sex/age-matched HC. These parameters were correlated with cerebrospinal fluid (CSF) levels of orexin-A, the CSF/serum albumin ratio (as a marker of blood-brain barrier integrity), and polysomnographic parameters.

Results: NT1 (2.01±0.44) patients showed higher NLR than NT2 (1.59±0.53), IH (1.48±0.37), and HC (1.48±0.43), with no significant difference between NT2 and IH patients. The ROC curve analysis detected an optimal cut-off value to discriminate patients with NT1 from NT2, IH, and HC for values of NLR≥1.60, 1.62, 1.59, respectively.

Conclusions: Patients with NT1 showed a higher NLR than those with NT2, IH, and HC, possibly reflecting lymphocyte migration within the CNS, supporting the hypothesis of a neuroinflammatory attack of lymphocytes on orexin-producing neurons. Considering its sensitivity, this easily obtainable biofluid marker could help to screen NT1 patients.

Study objectives: Obstructive sleep apnea (OSA) is a common chronic medical condition that results in impaired daytime functioning. While the link between OSA and cardiovascular disease is important, there has been increasing recognition of the impact of OSA on daytime functioning and experience. Better insight into illness perceptions can help better understand how to initiate and maintain treatment.

Methods: Data from two OSA clinical trials were examined. The baseline Respiratory Event Index (REI) was obtained from diagnostic sleep testing. The Brief Illness Perception Questionnaire (BIPQ) assesses the cognitive and emotional representation of illness and was administered at baseline along with the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI).

Results: 523 patients diagnosed with OSA were studied. The sample had a mean age of 51.1 ± 16.6, mean REI of 28.6 ± 17.9/h, and mean body mass index of 32.8 ± 15.5 kg/m^2. The mean BIPQ total score at baseline was 43.3 ± 11.3. BIPQ scores were significantly correlated with sleepiness and sleep quality but not with REI. Relative to other common chronic conditions with major comorbidities, BIPQ scores for patients with OSA were higher on consequences, identity, concern, and emotional representation dimensions.

Conclusions: The study shows that Veterans with OSA report elevated illness perceptions across several dimensions at levels as high, or higher, than other common chronic conditions. Implications for clinical practice are that it is important to ask patients about their understanding of illness across several dimensions to appreciate better patient needs and preferences.