Journal of Clinical Sleep Medicine最新文献

Study objectives: Cannabis is a common sleep aid; however, the effects of its use prior to sleep are poorly understood. This study aims to determine the impact of nonmedical whole plant cannabis use 3 hours prior to sleep and measured cannabis metabolites on polysomnogram measures.

Methods: This is a cross-sectional study of 177 healthy adults who provided detailed cannabis use history, underwent a 1-night home sleep test and had measurement of 11 plasma and urinary cannabinoids, quantified using mass spectroscopy, the morning after the home sleep test. Multivariable models were used to assess the relationship between cannabis use proximal to sleep, which was defined as use 3 hours before sleep, and individual home sleep test measurements. Correlation between metabolite concentrations and polysomnogram measures were assessed.

Results: In adjusted models, cannabis use proximal to sleep was associated with increased wake after sleep onset (median 60.5 vs 45.8 minutes), rate ratio 1.59 (1.22, 2.05), and increased proportion of stage 1 sleep (median 15.2% vs 12.3%), effect estimate 0.16 (0.06, 0.25). Compared to nonusers, frequent cannabis users (> 20 days per month) also had increased wake after sleep onset and stage 1 sleep, in addition to increased rapid eye movement latency and decreased percent sleep efficiency. Δ9-tetrahydrocannabinol metabolites correlated with these home sleep test measures.

Conclusions: Cannabis use proximal to sleep was associated with minimal changes in sleep architecture. Its use was not associated with measures of improved sleep including increased sleep time or efficiency and may be associated with poor quality sleep through increased wake onset and stage 1 sleep.

Citation: Althoff MD, Kinney GL, Aloia MS, Sempio C, Klawitter J, Bowler RP. The impact of cannabis use proximal to sleep and cannabinoid metabolites on sleep architecture. J Clin Sleep Med. 2024;20(10):1615-1625.

Study objectives: We evaluated the risk of traumatic injury in patients with narcolepsy compared to the general population.

Methods: We conducted a population-based matched cohort study using a Japanese health insurance claims database. For each patient with narcolepsy, up to 5 individuals from the general population without narcolepsy were matched by variables such as sex, age, and cohort entry month. The primary outcome was traumatic injury, and the secondary outcome was fracture. The study population was followed for up to 5 years from the cohort entry date. We estimated crude incidence rates, adjusted incidence rate differences, adjusted hazard ratios, and their 95% confidence intervals (CIs) for study outcomes using crude and multivariable Poisson and Cox regression models.

Results: We included 2,451 patients with narcolepsy (mean age, 30.3 years; male, 58.0%) and 10,591 matched individuals (mean age, 30.6 years; male, 58.4%). Crude incidence rate of traumatic injury was 11.4 per 100 person-years for patients with narcolepsy compared with 6.2 per 100 person-years for matched individuals (adjusted incidence rate difference, 6.2 excess events per 100 person-years [95% CI, 4.9-7.4]; adjusted hazard ratio, 1.8 [95% CI, 1.5-2.2]). Crude incidence rate of fracture was 2.3 per 100 person-years for patients with narcolepsy compared with 1.3 per 100 person-years for matched individuals (adjusted incidence rate difference, 1.2 excess events per 100 person-years [95% CI, 0.7-1.7]; adjusted hazard ratio, 1.7 [95% CI, 1.4-2.1]).

Conclusions: Narcolepsy was associated with increased risk of traumatic injury. For patients with narcolepsy, optimized approaches to injury prevention should be considered.

Citation: Zheng Y, Fukasawa T, Masuda S, Takeuchi M, Kawakami K. Narcolepsy and risk of traumatic injury: a population-based matched cohort study. J Clin Sleep Med. 2024;20(10):1657-1662.

Study objectives: Considering the increased prevalence and more severe manifestations of insomnia among females along with established sex differences in ischemic stroke (IS) occurrence, this research aimed to examine the potential effects of the interaction between insomnia and sex on the incidence and outcome of IS.

Methods: We used data from the Korean Genome and Epidemiology Study. The main exposure variables were insomnia history and sex. The main outcome was the occurrence of IS observed in biennial follow-up surveys. Cox proportional regression analysis was performed to estimate the effects of insomnia and sex on IS incidence. We also conducted interaction analysis to investigate the interaction effects between insomnia and sex on IS incidence.

Results: During 19 years of follow-up involving 8,933 individuals, we documented 370 cases of new-onset stroke (2.88 cases per 1,000 person-years). Cox proportional regression analysis showed that insomnia and female sex did not increase the risk of IS (hazard ratio: 1.13 [95% confidence interval: 0.86-1.51] and hazard ratio: 0.86 [95% confidence interval: 0.63-1.17], respectively). Interaction analysis demonstrated that stroke risk was increased only among females with insomnia (hazard ratio: 1.34 [95% confidence interval: 1.05-1.80]) compared with those without insomnia.

Conclusions: Our study highlights the significance of considering sex-specific factors when evaluating the relationship between insomnia and IS risk, particularly emphasizing the unique role of insomnia in IS risk among females.

Citation: Jung E, Kim DK, Lee SY, Ryu HH. Sex disparity in stroke risk among patients with insomnia: a 19-year prospective cohort study. J Clin Sleep Med. 2024;20(10):1669-1674.

Study objectives: Advances in prenatal repair of myelomeningocele have improved outcomes involving different organ systems. There are limited data on respiratory outcomes following prenatal surgical repair. We hypothesize there is no difference in respiratory outcomes between patients with spina bifida who have undergone prenatal vs postnatal repair.

Methods: We performed a retrospective study of 46 infants < 1 year with spina bifida seen at Children's Hospital Los Angeles from 2004-2022. Demographic data, timing of closure, neonatal course, Chiari II malformation, ventriculoperitoneal shunt, polysomnography results, and need for supplemental oxygen were collected. Unpaired t test and χ² test were used to analyze results.

Results: A total of 31/46 had prenatal repair of myelomeningocele; average age at repair was 27 weeks postconception. Average age at postnatal repair was 37 weeks postconception. There was no difference in age at polysomnography. There was no difference in Chiari II malformation presence (P = .61). Sixty pecent of patients with postnatal repair and 23% in the prenatal group underwent ventriculoperitoneal shunt placement (P = .01). There was no difference in polysomnography findings between the 2 groups: central apnea index (P = .11), obstructive apnea-hypopnea index (P = .64), average oxygen saturation baseline (P = .91), average oxygen saturation nadir (P = .17), average end-tidal carbon dioxide baseline (P = .87), and average end-tidal carbon dioxide maximum (P = .54). There were no significant differences in the proportion of patients on supplemental oxygen (P = .25), central sleep apnea or obstructive sleep apnea between groups.

Conclusions: Patients with spina bifida who have undergone closure of neural tube defect have persistent central apneas, obstructive apneas, and significant hypoxemia. There were no differences in the frequency or severity of sleep-disordered breathing in those with prenatal repair vs postnatal repair.

Citation: Stark KG, Wang RY, Smith KA. Sleep-related breathing disorders in infants with spina bifida repaired prenatally and postnatally. J Clin Sleep Med. 2024;20(10):1579-1583.

Study objectives: We undertook a study to describe and compare sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with childhood systemic lupus erythematosus (cSLE) to a healthy comparison group of youth and test the associations between sleep and symptoms of pain, fatigue, and depressed mood in youth with cSLE.

Methods: Forty-three youth (23 youth with cSLE; 20 age- and sex-matched healthy youth) wore actigraphs and completed sleep diaries for 10 days and completed self-report questionnaires on sleep quality, pain, fatigue, and depressed mood.

Results: On average, both groups had a total sleep time of less than 7 hours. Youth with cSLE had worse sleep efficiency (73.3%) and sleep regularity index scores (55.4) compared to the healthy comparison group of youth (79.2% and 60.1, respectively). Youth with cSLE had worse pain (P = .03) and fatigue (P = .004) compared to the healthy comparison group. Negative associations were found among self-reported sleep quality, sleep satisfaction, and symptoms of pain, fatigue, and depressed mood in youth with cSLE and wake after sleep onset was positively associated with fatigue.

Conclusions: Poor sleep efficiency and sleep irregularity accompanied by symptoms of pain, fatigue, and depressed mood was prevalent in youth with cSLE. Youth with lupus should be encouraged to maintain a regular sleep schedule. Because this is the first study to incorporate objective sleep and sleep regularity measures in youth with cSLE, additional studies with objective and self-reported sleep measures are needed to replicate our findings.

Citation: Wi D, Palermo TM, Stevens A, Ward TM. Sleep deficiency and symptoms of pain, fatigue, and depressed mood in youth with and without childhood systemic lupus erythematosus. J Clin Sleep Med. 2024;20(10):1607-1614.

Study objectives: Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea is poorly explained by standard clinical sleep architecture metrics. We hypothesized that reduced sleep stage continuity mediates this connection independently from standard sleep architecture metrics.

Methods: A total of 1,907 patients with suspected obstructive sleep apnea with daytime sleepiness complaints underwent in-lab diagnostic polysomnography and next-day Multiple Sleep Latency Test. Sleep architecture was evaluated with novel sleep-stage continuity quantifications (mean sleep stage duration and probability of remaining in each sleep stage), and conventional metrics (total non-rapid eye movement stages 1, 2, 3 (N1, N2, N3) and rapid eye movement times; and sleep onset latency). Multivariate analyses were utilized to identify variables associated with moderate EDS (5 ≤ mean daytime sleep latency ≤ 10 minutes) and severe EDS (mean daytime sleep latency < 5 minutes).

Results: Compared to those without EDS, participants with severe EDS had lower N3 sleep continuity (mean N3 period duration 10.4 vs 13.7 minutes, P < .05), less N3 time (53.8 vs 76.5 minutes, P < .05), greater total sleep time (374.0 vs 352.5 minutes, P < .05), and greater N2 time (227.5 vs 186.8 minutes, P < .05). After adjusting for standard sleep architecture metrics using multivariate logistic regression, decreased mean wake and N3 period duration, and the decreased probability of remaining in N2 and N3 sleep remained significantly associated with severe EDS, while the decreased probability of remaining in wake and N2 sleep were associated with moderate EDS.

Conclusions: Patients with obstructive sleep apnea and EDS experience lower sleep continuity, noticeable especially during N3 sleep and wake. Sleep-stage continuity quantifications assist in characterizing the sleep architecture and are associated with objective daytime sleepiness highlighting the need for more detailed evaluations of sleep quality.

Citation: Chen X, Leppänen T, Kainulainen S, et al. Sleep stage continuity is associated with objective daytime sleepiness in patients with suspected obstructive sleep apnea. J Clin Sleep Med. 2024;20(10):1595-1606.

Study objectives: This study assessed the current state of sleep medicine accreditation and training in Asia by conducting a comprehensive survey across 29 Asian countries and regions facilitated by the Asian Society of Sleep Medicine to identify existing gaps and provide recommendations for future enhancements.

Methods: The Asian Society of Sleep Medicine Education Task Force Committee designed a survey to gather data on accreditation, education, and training standards in sleep medicine, including information on challenges in enhancing education in the field.

Results: With an 86% (25 countries/regions) response rate, the survey showed that sleep medicine is recognized as an independent specialty in just 9 countries/regions (36% of the countries/regions surveyed). Ten countries/regions have established sleep medicine training programs, with Japan and Saudi Arabia offering it as a distinct specialty. Significant disparities in training and accreditation standards were identified, with many countries/regions lacking formalized training and practice guidelines. The survey also revealed that most local sleep societies across Asia support the development of an Asian Sleep Medicine Training Curriculum led by the Asian Society of Sleep Medicine. However, several barriers significantly impede the establishment and development of sleep medicine training programs, including the scarcity of trained specialists and technologists and the absence of national accreditation for sleep medicine.

Conclusions: The survey highlights the need for standardized sleep medicine training and accreditation across Asia. Developing an Asian Sleep Medicine Training Curriculum and promoting Asian Society of Sleep Medicine accreditation guidelines are key recommendations. Implementing these strategies is essential for advancing sleep medicine as a widely recognized discipline throughout Asia.

Citation: BaHammam AS, Al-Abri MA, Abd Rashid R, et al. Mapping the landscape of sleep medicine training across Asia. J Clin Sleep Med. 2024;20(10):1647-1656.

Study objectives: Pediatric obstructive sleep apnea (OSA) is common; however, inclusion of adolescents and especially those of ethnic/racial minorities in research is scarce. We hypothesized that ethnic/racial minority adolescents undergoing polysomnography have higher prevalence and more severe OSA compared to those who are non-Hispanic (NH) White.

Methods: Retrospective review of 1,745 adolescents undergoing diagnostic polysomnography. Demographic characteristics, age, body mass index percentile, and polysomnography parameters were obtained. Descriptive statistics comparing race/ethnicity were analyzed. Linear regression of log-transformed obstructive apnea-hypopnea index, and logistic regression of moderate-severe OSA (obstructive apnea-hypopnea index ≥ 5 events/h) adjusting for covariates were analyzed.

Results: A total of 58.2% adolescents were Hispanic, 24.1% NH-White, 4.3% NH-Asian/Pacific Islander, 4.2% NH-Black/African American, and 6.6% NH-other. Compared to the NH-White group, the Hispanic group had higher obstructive apnea-hypopnea index and any level of OSA severity, the Black/African American group had higher any level of OSA, and the NH-Asian group had higher moderate-severe OSA. Multiple linear regression of log-obstructive apnea-hypopnea index identified a positive association with Hispanic ethnicity (β: 0.25, P value < .05). Compared to the NH-White group, the Hispanic and the Asian/Pacific Islander groups were 1.45 (95% confidence interval: 1.10, 1.93) and 1.81 (95% confidence interval: 1.05, 3.10) times more likely to have moderate-severe OSA, respectively, after adjusting for relevant covariates. Stratified analysis by sex identified an association only among males between Hispanic ethnicity (odds ratio: 1.85, 95% confidence interval: 1.27, 2.70) and Asian/Pacific Islander ethnicity (odds ratio: 2.62, 95% confidence interval: 1.35, 5.11) and moderate-severe OSA, compared to the NH-White group.

Conclusions: Among adolescents undergoing polysomnography evaluation, we identified OSA racial/ethnic and sex disparities in Hispanic and NH-Asian adolescents. Community level studies with adequate representation of these minority groups are needed to identify factors associated with the reported increased susceptibility.

Citation: Landeo-Gutierrez J, Ryu J, Tantisira K, Bhattacharjee R. Ethnic/racial and sex disparities in obstructive sleep apnea among adolescents in southern California. J Clin Sleep Med. 2024;20(10):1637-1645.

We report a case of severe central sleep apnea incidentally diagnosed during polysomnography for suspected obstructive sleep apnea. Characteristic clinical features included episodic hyperventilation followed by apnea from hypocapnia, which did not follow a Cheyne-Stokes pattern. Combined with the identification of cerebellar and brainstem malformations known as the "molar tooth sign" on a brain magnetic resonance imaging, developmental delay, and motor coordination problems, Joubert syndrome (a congenital disease) was first diagnosed at the age of 50 years. Central apneas were also observed during wakefulness, although not continuously. During sleep, continuous positive airway pressure and adaptive servo-ventilation were ineffective at the referring clinic and at our hospital. Supplemental oxygen decreased the frequency of central apneas and significantly shortened the duration of each central sleep apnea compared with room air. In contrast, the opposite response was observed with acetazolamide administration.

Citation: Murashima R, Shiota S, Sugiyama A, et al. A case of middle-aged central sleep apnea due to Joubert syndrome with different treatment effects of oxygen and acetazolamide. J Clin Sleep Med. 2024;20(10):1705-1710.